Self Care duriing Family Medical Crisis: Part 2 Elements of Self-Care

This is the second part in a series in which I am focusing on the personal lessons of self-care during family medical crisis.

 

Self-Care Buddy. My primary self-care buddy – my husband – was at home when I received the call.  He held me when I was shaking.  He helped me find things that I could not see but were right in front of me.  He helped me stay calm and grounded in facts.  He did everything I needed at the time and then some.  

No Major Decisions.  My husband/self-care buddy reminded me of something I teach in Field Traumatology about crises: this is not the time to make any major decisions.  I agreed to defer major decisions whenever I can, and to discuss with him and those directly involved any major decisions that could not be deferred. 

Social Media. I am a regular Facebook user.  One of the first things I did was to put out the word to my closest network of family and friends and ask for prayers.  At first I felt weird about putting such a personal matter into the larger social media context.  That feeling gave way quickly as I started receiving messages of support.  Those messages over the next few days were beacons of light nourishing me at the deepest levels.  I have a deep sense of gratitude to those who rallied around me and my family.  Thank you!

Technology. I cannot underscore enough the value of technology and social media during times of crisis.  My husband loves technology and stays current with trends.  Both daughter and husband had been encouraging me for a long time to give up my flip phone for more advanced technology.  Last year I started with the iPod Touch.  Having mastered that, I went this year for the iPhone.  This communications tool kept me in touch with my family and social support network from the moment the crisis began.

Unexpected Support. My flight north had a very tight connection through Charlotte NC.  I feared missing the second leg of my travel.  I talked with the flight attendant, asking if someone towards the front of the plane might be willing to change seats with me. I tried to manage my anxiety as we began our initial descent and I was still at the back of the plane.  Minutes before landing, the flight attendant told me there was a volunteer.  An elderly gentleman traded seats with me. 

The woman seated beside me was his wife, a hospice volunteer in the Jacksonville area who works with caregivers.  She touched my arm as she talked, and underscored the importance of touch when one is in crisis. Her gentleness and kindness touched me but also reminded me of what I needed to do for DCR: be fully present.  As we talked I noticed a piece of paper near my foot.  It was her husband’s boarding pass.  I now had  the name of the man who traded places with me.  As soon as I can I will thank them in writing for helping me.

We’re All Doing the Best We Can.  During times of extreme stress it’s common for people to become crabby or short in tone or forgetful or make errors in details.  My first challenge came at my destination airport, when I discovered someone else’s luggage in the back seat of my rental car.  I had to walk back to the airport terminal in the cold at 11:30 p.m., dragging my bags behind me, fearful that the car rental agent may have left already since it was so late.  The agent was on the phone as I approached her desk, talking to the person who had placed his luggage in the car next to the one he rented.  Gee, he must have been really tired or stressed to not notice.  The agent accompanied me back to the car, and I drove her back to the terminal  I was not happy about the delay but was able to stay civil and grateful for her help.

I went to the hospital address given to me by a family member.  DCR was not there.  After a few minutes of confusion, reception kindly located DCR at another local hospital which was not far away.  The correct address and GPS in hand led me to DCR’s location.

I told these stories to several folks, partly because were it not for the circumstances they were amusing.  It was when an apology was offered about the wrong address that I said “We’re all doing the best we can.” At times like these we need each other.  Mistakes happen.  And good self-care requires that we let them go.

Next: The Hospital Emergency Room

Self Care During Family Member Medical Crisis: Part 1 Reactionss

My blogging plan for the New Year has been derailed, and a new one defined.  A family medical emergency changed my focus.  My blog – at least for now – is very personal though my intent is for it to be educational. I will focus on the successes and challenges of attending to my self-care during this difficult time. This ties in to the original blog focus on self-care. The original blog plan will be back on track in due time. Now that I have written the first 3300 words, I know it is therapeutic.

The Crisis

On Thursday, January 3 at 4 p.m. I received the phone call none of us want to get: one of my dearest close relatives (DCR) was admitted to the hospital with life threatening double pneumonia.  The distressed voice on the phone let me know the severity of the situation within seconds. My voice and body started shaking. My normal work day turned into a focused quest to travel north immediately.  My blog, drafted and planned for Friday, was the last thing on my mind.  

To fully understand the situation one must know that DCR is multiply handicapped.  Her rare condition leaves her susceptible to a cascade of additional life threatening medical issues. Resolving double pneumonia is only the first step in her recovery.  While I may mention DCR’s condition generally to create a context, details about my family and the medical issues will be omitted out of respect for their privacy. 

Reactions

Anyone who has received shocking news will understand my reactions.  It took about 15 minutes for my body to stop shaking.  My thinking was both focused (I must get there as soon as I can) and disorganized (I felt like I was going in circles trying to get things done). 

Focus prevailed when it came to scheduling a flight.  I went to the Delta website and saw immediately that their schedule did not accommodate my needs.  Using a website like Travelocity seemed too overwhelming.  Our family has a AAA  membership so I called AAA Travel Services.  The kind woman on the other end of the line was able to get me to my destination at 11:15 p.m.  My 6:20 flight gave me little time to pack and drive to the airport.  There was no time to think about what was going on, though every cell of my body was reacting to the news.

Packing was a different issue.  Decisions about what to take were difficult to make.  Thank goodness the laundry was done and I had plenty of clean clothes.  I packed my favorite new sweaters and the jeans our daughter  suggested I try.  At least I would feel good about how I looked while the rest of me was a jumble.

Next: Elements of Self-Care

Zimmerman, Bales and Mother Nature: The common thread

Zimmerman, Bales, and Mother Nature

The first three months of this year wrapped up with news which has an international focus.  Media images provide us with almost daily updates in the cases of Zimmerman  and Bales, and the details of the notable weather pattern change which caused early spring-like weather that generated destructive tornadoes.  I’ve been thinking about these three events for several days now, looking for the common thread that unites the three. 

The most obvious thread is the emotional pain of those most affected by these traumas.  Each event meets the first criteria when screening for PTSD: an event occurred which threatened bodily harm to self and/or others, and the response to which includes intense fear, helplessness, or horror.  As bystanders observing media images, or listening to various broadcasts, we slowly learn the impact via unfolding event details.  We, too, must come to terms with the reality.

When being interviewed about trauma, Charles Figley routinely underscores the importance of answering “Five Victim Questions”:

 -What happened?

-Why did it happen?

-Why did I behave the way I did then?

-Why am I behaving the way I am now?

-What will I do if something like this happens again? 

Most people can answer these questions sufficiently to acquire peace of mind and become survivors. The process requires deep trust in the practitioner (psychological or spiritual), and/or deep faith in one’s capacity to overcome the trauma.  Answering these questions when one is ready is both powerful and transformative.  

One tool to help victims become survivors and create a healing theory is the Spiritual Intelligence Self-Report Inventory.  The inventory measures four constructs, quoted here from King’s website:

I. Critical Existential Thinking: the capacity to critically contemplate meaning, purpose, and other existential/metaphysical issues (e.g., existence, reality, death, the universe); to come to original existential conclusions or philosophies; and to contemplate non-existential issues in relation to one’s existence (i.e., from an existential perspective).

II. Personal Meaning Production: the ability to derive personal meaning and purpose from all physical & mental experiences, including the capacity to create and master (i.e., live according to) a life purpose.

III. Transcendental Awareness: the capacity to identify transcendent dimensions/patterns of the self (i.e., a transpersonal or transcendent self), of others, and of the physical world (e.g., holism, nonmaterialism) during normal states of consciousness, accompanied by the capacity to identify their relationship to one’s self and to the physical world.

IV. Conscious State Expansion: the ability to enter and exit higher/spiritual states of consciousness (e.g. pure consciousness, cosmic consciousness, unity, oneness) at one’s own discretion (as in deep contemplation or reflection, meditation, prayer, etc.).

The scores may be used to identify areas in which an individual remains strong after a traumatic event, or to monitor growth post-trauma. 

My hope in sharing this tool is that you will find it useful when working with someone who is traumatized.  I am very interested in hearing your feedback about its application.

Combat Stress Injury & TBI: Figley Institute's Picks of the Week (2012-6)

When I heard the news that a soldier had killed 16 civilians in Afghanistan, my first reaction was deep sadness.  I felt sad for those who suffered and died. I felt sad for those who loved those who were killed, and all those in Afghanistan who mourned and were angry.  I felt sad for the military personnel who were in the war zone.  I felt sad for our country. I felt sad for the soldier who committed this horrible act.

Just days before hearing the news, I facilitated a daylong conference at St. Thomas University entitled "Listening with Love: The Coming Home Experience for Veterans and Military Families".  This conference included two panels of personnel from various military branches who had served in the "war on terror".  They shared their experiences, and were open to questions. I felt grateful for their sharing, which educated the audience about the realities of war and reinforced with real life examples my teaching points.  I hoped my presentation was meaningful for them, and those veterans, chaplains, students, faculty, and professionals who attended.

My role at the conference was to educate about the stressors of war, their psychosocial/spiritual impact, and the means by which military personnel could receive assistance post-deployment. I focused on Combat Stress Injury and PTSD, and shared ways in which the marital relationship might be impaired and repaired.

When I heard the news I thought about wear and tear injury such as the sleep deprivation that goes with the war zone (an average of four hours a night), and the unrelenting 145 degree heat. I thought about grief injury, the loss of those whom they cared about who were killed in the war zone.  I thought about the traumatic situations in which trained soldiers might feel terrorized, horrified, or helpless.  I wondered what the conference participants and panelists were thinking when they heard the news of the rampage.  I hoped that my presentation was helpful as they tried to sort out what might have triggered the soldier's killing spree.

My second reaction was "I wonder how many times the accused soldier had been deployed".  I suspected that the wounds of war were a big factor when the soldier opened fire on sleeping Afghans. I had been thinking that repeated deployments and possibly PTSD would explain.  I felt angry when I thought that the lives lost were possibly due to the strains of war that could break the best of us, and the system-wide lack of resources for addressing psychosocial/spiritual wounds that can result.

This morning my sadness deepened when I heard on the news that the alleged killer had suffered a head injury.  I immediately thought "could it be Traumatic Brain Injury (TBI)?  Tears flowed as I imagined multiple deployments complicated by TBI, and possibly a triggering event which pushed this man over the edge of reason.  I decided I must do something. As an educator, my deepest desire is that readers understand the effects of war on our military, and do their part to learn so that those who serve receive the best we as Americans have to offer them in terms of compassion and support.

Recommended reading: Combat Stress Injury; Families Under Fire; Counseling Military Couples;

Dedicated to Lt. Col. (Dr.) David E. Cabrera and all others who serve our country through military service; and to whose who love and care about them.

Figley Institute's Picks of the Week: Lessons from the "Community Resilience" Conference (2012-5)

Tornado Recovery - The Gold Standard

Have you ever heard of Greensburg, Kansas? If you are a disaster worker, it is likely you recall the F5 tornado that destroyed the town in which approximately 1400 people lived in May 2007.  Why do I bring this up now?  It's because I recently had the pleasure of meeting the Greensburg, Kansas mayor, Bob Dixon.

Bob and I both were presenters at the Third Annual Resilience and Disaster Mental Health Response Conference: Community Resilience in Indianapolis last week.  His presentation about rebuilding Greensburg, which had been wiped off the map, is inspirational.  The recovery plan "...is a document that emerged directly from the community and is representative of both the planning team’s recommendations, the City’s operational requirements and input from many stakeholder groups." And, for those who are now in the process of picking up the broken pieces of their homes, schools, and businesses from the recent tornadoes, Greensburg is a shining beacon of hope for the future.

Yesterday I sent a message to Mayor Bob, in which I expressed my concern for Greensburg and the tornadoes of late.  He left a voice message for me, saying that all was well.  Greensburg citizens, he said, had started helping those in other areas who were impacted.  When I see the news about tornadoes (e.g., Harveyville), I wonder if any of the volunteers I see are from Greensburg.

I've invited Mayor Bob to present at Tulane University's Disaster Resilience Leadership Academy for the benefit of my students and others on campus.  I'm certain that they will experience the true meaning of leadership as they listen to Mayor Bob describe Greensburg's triumphant return to life.

Note:  Greensburg KS will mark the 5 year anniversary with a weekend of events:  Tragedy to Triumph...5 Years Later  on  May 4-6, 2012.

ESF-8 Disaster Behavioral Health Plan - Florida and Indiana

When I still lived in Tallahassee, I was privileged to participate as a member of the Florida Crisis Consortium as a member of Green Cross Academy of Traumatology. The mission of the Consortium was to  "...develop Florida’s Disaster Behavioral Health (BDH) Response Plan, as part of the ESF-8 annex to the Florida Comprehensive Emergency Management Plan (CEMP).... The intent of the disaster behavioral health response plan is to mitigate the adverse effects of disaster-related trauma by promoting and restoring psychological well-being and daily life functioning in impacted individuals, responders, and communities."

Florida has been cutting edge in Emergency Management for many years, so of course I felt proud to be a part of this group whose mission made so much sense to me:  remedy the gap between disaster impact and implementation of the FEMA Funded Crisis Counseling Program. The ESF 8 DBH plan addressed that delay and assured funding for the response.  Little did I know that another state had run with the same idea. The State of Indiana has a similar plan.  Check out their Field Guide which includes section on Self-Care.

The Federal Response Plan addresses Disaster Behavioral Health; the Department of Health and Human Services published their HHS Disaster Behavioral Health Concept of Operations in December 2011.

These are great steps forward in taking care of the public in the aftermath of disaster.  I hope more states follow the leads of Florida and Indiana.

Note:  If other states have similar Disaster Behavioral Health Programs, I'd love to hear about them.

Upcoming Courses

Beyond Psychological First Aid: Helping Communities Heal
Military Stress and Trauma: The Healing Process

Figley Institute's Picks of the Week: Compassion Stress (2012-4)

The Importance of Self-Care Buddies

I am a strong advocate of the self-care planning process, which is outlined in the Standards of Self-Care developed by international experts in the topics of traumatic stress and compassion fatigue (Green Cross Academy of Traumatology). Self-Care strategies include regularly monitoring progress; and meeting regularly with your self-care buddy to discuss successes, challenges, and ways to overcome challenges. As a self-care buddy, you may learn about strategies which will help your buddy move past a challenge. A multi-pronged approach to good self-care might include information such as that provided in the section below:  The Importance of Counterbalancing Stress.

Buddy Check - How are You Doing?

It's almost the end of January, the first day of the month in which some of you started your New Year's Resolutions.  In my first blog of the year I offered a link to to Four Things to Strive for in 2012 (do you remember them?); and offered a fifth: Be gentle with yourself! 

In keeping with the concept of self-care buddies, I'm checking in with you. Are you satisfied with your progress? What are your successes and challenges?  Your feedback will inspire future blogs.  I'm serious! Write to me at krf@figleyinstitute.com with your stories.


The Importance of Counterbalancing Stress

Those of you who have followed my work know that I frequently quote Dr. John Wilson from the video "When Helping Hurts: Sustaining Trauma Workers".  Dr. Wilson states: "It's important to counterbalance the intensity of the work you do." At the Gift from Within website you will find this video and others, along with brief (FREE) video excerpts, such as "What is Compassion Fatigue?"  If you are interested in reading more, Gift from Within has posted a dozen FREE articles about Compassion Fatigue by leading experts in the field.

This morning I finished writing "Counterbalancing Stress", the first of my promised six entries for the Encyclopedia of Trauma, due to be published in September. In this entry I highlight four strategies for inducing the relaxation response:  breath work, meditation, progressive relaxation and visualization/guided imagery.  Regardless of whether stress is primary or secondary, these strategies are effective when practiced regularly.  You can read more about them in one of my favorite resources: The Relaxation and Stress Reduction Workbook. One or more of these strategies may fit nicely into your self-care plan or that of your buddy.


A Note of Gratitude

Expressing gratitude is an element of good self-care. Many of you signed up for Figley Institute's Compassion Fatigue Educator course.  I'm delighted about this for two reasons: 1) most important, you understand that compassion stress is a real phenomena and are taking steps to address it at a personal level; and 2) some of you are instituting organizational change which translates to healthier work environments for those who work with people who are suffering. To you I express my deepest gratitude. 

PS  Sign up for the Compassion Fatigue Educator course by January 31 to receive this months' special rate.  Enter promo code govt.  

Figley Institute's Picks of the Week: Workplace Violence (2012-3)

This past Friday there was a critical incident at Mondo, one of our neighborhood restaurants (see Times-Picayune news report)  One employee shot and killed another.  As it turns out, the two had familial ties: the incident related to family issues.  As was later reported, a New Orleans Police Chaplain was brought in to attend to the needs of the restaurant employees. The question arises: Is there something that could have been done to prevent this tragedy?  While it is not my place to evaluate the Mondo critical incident, I feel a responsibility to promote education about Workplace Violence. The resources listed below are FREE.

 ~~~~~~~~~~~

Workplace Violence Basics

Go to the OSHA website for a Workplace Violence Fact Sheet.

 ~~~~~~~~~~~

In-Depth Information

For more in-depth information, the freely available USDA Handbook on Workplace Violence Prevention and Response includes these chapters: 

1. What is Workplace Violence?
2. Responsibilities
3. Prevention of Workplace Violence
4. Identifying Potentially Violent Situations
5. Responding to Violent Incidents
6. Disclosure of Information
7. Resources

 ~~~~~~~~~~~

OnLine Training - FREE

FEMA offers a one (1) hour online course "Workplace Violence Awareness Training 2011".

~~~~~~~~~~~

Inspired by New Year focus on good self care Figley Institute is offering a  

Special rate of $129 for the month of January 

Compassion Fatigue Educator Certification Online 8 hour Course 

Developed and Delivered by the Drs. Figley.
Start your New Year off with a

 clear plan for personal and professional resilience!

Click here to register now! http://bit.ly/tWZdWh

Enter promotion code: govt

~~~~~~~~~~~


Follow Figley Institute on
Facebook: Figley Institute; Care for the Caregiver
Twitter: http://twitter.com/figleyinstitute
Linked In: http://www.linkedin.com/in/figleyinstitute 

~~~~~~~~~~~

Mission: To alleviate human suffering which results from traumatic life experiences by providing laypersons and professionals with high quality traumatologist training.

Figley Institute's Picks of the Week (2012-2)

If you have seen the news lately, you know that an incident is being investigated in which four marines were videoed when behaving in an uncivilized manner.  Social media discourse I've read ranges from those who want them tarred and feathered through those who have been to war and, while not condoning the behavior, understand that war does things to the human soul that those not in war cannot understand.  So, this week is dedicated to understanding our soldiers, the wounds they carry, and the support they need from us.  Click on the title to view.

PTSD (A Tribute to Our Soldiers)   
(http://bit.ly/xIodAL)


by Phillip Sebulsky

A beautifully created and deeply powerful three minute video which depicts the realities of war.

~~~~~~~~~~~

Back From War, Fear and Danger Fill Driver’s Seat

by James Dao

In this article, James Dao describes the challenges for veterans assimilating into civilian life via something we take for granted: the ability to drive.

~~~~~~~~~~~

Finding Hope after Head Injury and Posttraumatic Stress Disorder   

by Dr. Angie Panos 

Dr. Angie Panos is a psychologist and a board certified expert in traumatic stress with 25 years of experience and the mother of a daughter who is currently serving in the military. In this article she offer an example of a soldier, then describes symptoms associated with mild traumatic brain injury; and finally offers practical guidance, which includes an excellent list of resources on Traumatic Brain Injury and PTSD.

~~~~~~~~~~~

Operation Harmony

via Soldier's Angels (soldiersangels.org)

Operation Harmony is a partnership with Yamaha Music & Wellness Institute to give American troops the ability and opportunity to heal and thrive through music. The Institute strives to improve quality of life through research, education and programs that focus on active music participation.  Through Operation Harmony, this includes providing guitar and keyboard courses to wounded warriors and supplying instruments to service members on military bases throughout the world. (quoted from their website).

~~~~~~~~~~~

Inspired by New Year focus on good self care Figley Institute is offering a Special rate of $129 for the month of January 

Compassion Fatigue Educator Certification Online 8 hour Course 

Developed and Delivered by the Drs. Figley.
Start your New Year off with a

 clear plan for personal and professional resilience!

Click here to register now! http://bit.ly/tWZdWh

Enter promotion code: govt

~~~~~~~~~~~


Follow Figley Institute on
Facebook
Twitter: http://twitter.com/figleyinstitute
Linked In: http://www.linkedin.com/in/figleyinstitute 

~~~~~~~~~~~

Mission: To alleviate human suffering which results from traumatic life experiences by providing laypersons and professionals with high quality traumatologist training.