Friday, December 21, 2007

A house should be an expression of your soul, an extension of your personality

This article give an interesting idea.. that our home is to reflect our soul -- who we are -- is to be a place where we LIVE, versus show off.

Does your home reflect the way you live?

A house should be an expression of your soul, an extension of your personality

FRIDAY dec 21, 2007 -- Kelly Deck


I have a recurring dream: The world stops moving and everything freezes in time. Everyone but me disappears and, miraculously, I'm free to roam, home to home, revelling in the exploration of people and the spaces they create.

Now, ask yourself this: If I stole into your home, what would I learn about you? How would your home describe the way you live, the things you love? Is it a unique expression of you and your family? Dare I ask: Does it have soul?

Many homes do not. These days, the average interior is unfortunately (and unnecessarily) suburban -- that is, homogenous, bland and conservative.

So, at the risk of offending, let me describe to you what you probably think when you walk into one of these homes.

Hmmm, this is pretty good: glossy hardwood floors, warm neutral finishes and ivory crown mouldings. In the living room a beige sofa, chocolate leather chairs, a faux Persian rug, an ottoman, dark wood side tables, glass lamps and a silver fireplace mirror. Pale blue and green cushions.

"Hmm," you say to yourself. "Nice house."

Nice?

Nice is, at best, a middling virtue. But it's not wow! It's not ahhhhh or yummm, or anything else you'd say in a moment of ineffable appreciation. Nice is how you describe your best friend's plain boyfriend. Your home has more potential.

A house becomes a home when it's filled with authenticity, history and personality -- all of which are unique to you. Don't rush -- these qualities develop over time. The defining aspect of a home is that it's a work in progress. It's an entity that breathes and lives.

Remember also what a home is not: a showroom, a formula or a storehouse for items that signify status.

Let's start with the idea of authenticity. Ask yourself: How do I spend my time here? What hours of the day am I at home? What do I do in this time? What do I need to enjoy these tasks and experiences fully?

Me, I'm at home evenings and weekends. My days pulse with the lives and needs of clients and staff, and so, in my downtime, I require a quiet, restful retreat. I read, listen to music, and watch TV, so lots of comfortable seating is important. Most weekends, I have a friend or two over for dinner, and we never sit at a table.

For me, home means relaxation and ease. Nothing is precious: feet can rest anywhere, and no surface is inhospitable to a glass of wine. The informality of my home reflects one basic assumption: that my friends and our time together are more important than the items that occupy my space.

In contrast, I have many clients who love to formally entertain. These are people who have glamorous and sometimes extravagant tastes. They favour lacquered finishes, crystal chandeliers, and dramatic accessories. I revel in the play of designing for the privileged and their well-heeled needs, but their experience is distinct from my own.

Next, let's talk history. It's difficult for people to properly revere the historic in a country where few buildings are more than a hundred years old. I find our Western indifference to history disheartening. Culturally, we constantly pursue newness. Our homes are filled with the trendy, the poorly manufactured, and the designed-to-be-obsolete. As a result, our spaces often feel contrived and impersonal.

Don't get me wrong: We don't need to be neo-classicists. I love modern interiors. But people, places, and things have their own unique and intimate history, and a home should reflect that.

Incorporate family heirlooms or antiques into your furnishing plan. Paired with contemporary or mid-century modern furnishings, aged pieces can make a dynamic addition to the home. Consider painting or lacquering the pieces if their original finish lacks lustre.

The patina of weathered or distressed surfaces creates a reference to age and history, without the actual presence of them. Oxidized metal, chiselled stone, and earthenware ceramics are materials that bring sensuousness to any space.

Most importantly, look to your own history--to the objects you've saved, to the items you cherish and pack away. Is there a way to celebrate them in your home? Such items create a connection between you and your home. They're wonderful pieces upon which to build collections or create decorative vignettes.

This brings me to my final point: personality.

What is your favourite item of clothing? What colour do you like best? What is your favourite food, wine, or dessert? Where have you travelled? Why did you go? What is your most cherished memory? At what time of year do you feel most alive?

In creating a space that's an authentic expression of you, these are not arbitrary questions. They are your inspiration.

Here's what I mean: My favourite shirt is linen, my favourite colour white. My comfort food is Indian and I prefer to eat it at the beach. I like spicy, earthy wines, and I'll always take a mango over a fancy dessert. In addition to Canada, I've lived in England, New Zealand and Australia, and I've travelled in Europe, the United States, Mexico and Costa Rica. New York is my favourite city and summer is the season in which I feel most alive.

Could a beige sofa, chocolate leather chairs, and the rest of the standard kit ever be an expression of me?

And you?

So, here's my appeal: Forgo safety and predictability, unless, of course, those are the adjectives you'd use to describe yourself. Create a home infused with your personality and inspired by your needs. Do this by identifying what you love and then celebrating the colours, textures, and experiences that move you. By your labours, you'll impress yourself and all those you welcome into your home.

TIPS:

Assess your needs: Think how you need your home to function to support your lifestyle. Shape it accordingly.

Don't forget history: Incorporate furnishings, finishes and objects that have history and texture. They'll add visual tension, sensuousness and warmth to your contemporary home.

Celebrate you: Make a list of your favourite ideas, memories and experiences. Then collect a series of your favourite objects. Collectively, these ideas and objects make up a "pallet" that will inspire a unique look for your home.

Experiment: Don't be afraid to try different groupings and furniture configurations -- move furnishings from one room to the next, try colours and textures together that you're uncertain about. The only way to learn is by trying.

Don't aim for perfection: The imperfect, the weathered, the delightfully mismatched and the tarnished can all add character to any home.

Tuesday, December 11, 2007

Commentary on Newspaper articles

Hands off Christmas, say British religious leaders
By Paul Majendie
LONDON (Reuters) - Hindus, Sikhs and Muslims joined Britain's equality watchdog on Monday in urging Britons to enjoy Christmas without worrying about offending non-Christians.
"It's time to stop being daft about Christmas. It's fine to celebrate and it's fine for Christ to be star of the show," said Trevor Phillips, chairman of the Equality and Human Rights Commission.
"Let's stop being silly about a Christian Christmas," he said, referring to a tendency to play down the traditional celebrations of the birth of Christ for fear of offending minorities in multicultural Britain.
Suicide bombings by British Islamists in July 2005 which killed 52 people in London have prompted much soul-searching about religion and integration in Britain, a debate that has been echoed across Europe.
The threat of radical Islam, highlighted by the London attacks, prompted reflection about Britain's attitude to ethnic minorities and debate about whether closer integration was more important than promoting multiculturalism.
Phillips, reflecting on media reports of schools scrapping nativity plays and local councils celebrating "Winterval" instead of Christmas, feared there might an underlying agenda -- using "this great holiday to fuel community tension."
So he joined forces with leaders of minority faiths to put out a blunt message to the politically correct -- Leave Christmas alone.
"Hindus celebrate Christmas too. It's a great holiday for everyone living in Britain," said Anil Bhanot, general secretary of the UK Hindu Council.
Sikh spokesman Indarjit Singh said: "Every year I am asked 'Do I object to the celebration of Christmas?' It's an absurd question. As ever, my family and I will send out our Christmas cards to our Christian friends and others."
Their sentiments were echoed by British Muslim leaders, who were also forthright last week in condemning Sudan for jailing a British teacher for letting her pupils name a teddy bear Mohammad.
Muslim Council of Britain spokesman Shayk Ibrahim Mogra said "To suggest celebrating Christmas and having decorations offends Muslims is absurd. Why can't we have more nativity scenes in Britain?"
Lately in the paper, I have been seeing things about Christmas echoing the sentiments as seen above. There was an incident with a Santa in Austrailia who was supposed fired because he refused to say "ha ha ha" instead of "ho ho ho". The Ho Ho Ho was considered offensive as "ho" is derogatory towards women. "Merry Christmas" is considered offensive to those who are not Christians or who do not celebrate this tradition. I remember when the expression was changed. or rather people were banned/advised against using the term "Merry Christmas" but were encouraged to attend "Holiday concerts" instead of "Christmas concerts", to have "holiday trees", etc.
I am a Christian minister working in a multifaith context. Part of our work is to have dialogue with our patients/clients, etc. We are not here to "preach at them" but rather we are to engage people in dialogue about their faith, their spiritual life and what it is that brings them hope, meaning and to encourage them to use these as resources in times of crisis. Spiritual care is about dialogue not about evangelism. Unfortunately, a lot of people have had bad experiences or bad education and hence my role is often misunderstood. A key aspect to dialogue is respect. Respect for the other person's views in light of their personal experience and their view of the world. So this is my goal to maintain respect and encourage growth of their spiritual life. This should be the goal of everyone in society -- Respect -- however not everyone understands this term in the same way. And so we get incidents and comments like the newspaper articles.

Wednesday, December 05, 2007

More Files from my computer

Did you know that when you envy someone, it's because you really like that person?

Did you know that those who appear to be very strong in heart are real weak and most susceptible?

Did you know that those who spend their time protecting others are the ones that really need some one to protect them?

Did you know that the three most difficult things to say are:
I love you, Sorry and help me

The people who say these are actually in need of them or really feel them, and are the ones you really need to treasure, because they have said them.


Did you know that people who occupy themselves by keeping others company or helping others are the ones that actually need your company and help?

Did you know that those who dress in red are more confident in themselves?

Did you know that those who dress in yellow are those that enjoy their beauty?

Did you know that those who dress in black are those who want to be unnoticed and need your help and understanding?

Did you know that when you help someone, the help is returned in two folds?

Did you know that those who need more of you are those that don’t mention it to you?

Did you know that it's easier to say what you feel in writing than saying it to someone in the face? But did you know that it has more value when you say it to their face?

Did you know that what is most difficult for you to say or do is much more valuable than anything that is valuable that you can buy with money?

Did you know that if you ask for something in faith, your wishes are granted?

Did you know that you can make your dreams come true, like falling in love, becoming rich, staying healthy, if you ask for it by faith, and if you really knew, you'd be surprised by what you could do.


^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^

Sitting With A Shattered Soul

So how do you sit with a shattered soul?
Gently, with gracious and deep respect.
Patiently, for time stands still for the shattered, and
the momentum of healing will be slow at first.
With the tender strength that comes from an openness
To your own deepest wounding,
and to your own deepest healing.
Firmly, never wavering in the utmost conviction that
evil is powerful, but there is a good
that is more powerful still.
Stay connected to that goodness with all your being,
however it manifests itself to you.
Give freely. Take in abundantly.
Find your safety, your refuge, and go there as you need.
Words won't always come;
sometime there are no words
in the face of such tragic evil.
But in your own willingness to be with them,
they will hear you;
from soul to soul
they will hear that for which there are no words.
When you can, in your own time,
turn and face that deep chasm within.
Let go. Grieve, rage, shed.

*****************************************

Butt Prints in the Sand

One night I had a wondrous dream,

One set of footprints there was seen,

The footprints of my precious Lord,

But mine were not along the shore.


But then some stranger prints appeared,
And I asked the Lord, "What have we here?"
Those prints are large and round and neat,
"But Lord they are too big for feet."


"My child," He said in somber tones,
"For miles I carried you alone.
I challenged you to walk in faith,
But you refused and made me wait."

"You disobeyed, you would not grow,
The walk of faith, you would not know.
So I got tired, I got fed up,
and there I dropped you on your butt."

"Because in life, there comes a time,
when one must fight, and one must climb.
When one must rise and take a stand,
or leave their butt prints in the sand."

author unknown


Friday, November 23, 2007

It is an interesting thing .. this position of "doctor to the soul" (term coined from being mistaken by staff as being a doctor.. originally because I used to wear heels and business suits, skirts, but now I have had to adopt a more causal attire due to the need for orthopedics, caused by excessive wear of heels) is a neverending job.

Yesterday I was at my church for a group when I noticed an elderly gentleman walking slowly, and a little unsteady I might add, down the hall towards the room that our group was using. I commented to him that I didn't see him here much outside of Sunday services. He explained that he thought there was a concert this evening. I decided that I'd better get him to sit somewhere, so I asked him into the next room and got him a chair that was close to the door. Then I went to room where my group was to check if there was some concert or function that I was not aware of. I then had to ask that the leader go call this man's son to come pick him up. Either way, the gentleman was showing signs of dementia and I thought the son needed to be aware of this incident. I didn't want to embarrass the man so I explained that it was not December but in fact November, and that no concerts were yet. He kept saying it was December and said he felt awful. But then he seemed to laugh as he said he was 91 ...
In the end, I called the son and explained the situation and asked if I should put his father in a cab, or would he like to pick him up. I think that the son was embarrassed as well but I tried to handle this as sensitively as possible. So I got to know this nice gentleman while we waited for his son to come. It was a surprising opportunity in a way, as I would never have been able to exchange more than pleasantries at service if this hadn't occurred.

This incident is not uncommon as seniors age and show signs of dementia. (Dementia refers to decrease of memory or brain function. As the cells age, or die, the brain ceases to function at optimal level. Dementia was erroneously but commonly referred to as Alzheimer's.) When I started in chaplaincy, I began my training in long term care (or nursing home). This type of story was a common factor for admission to long term care. The previous posts from the local paper about aging posit that it is often a fall that precipitates going to a care home or facility. But I think it needs to be clear that it is not that the individual falls and then are admitted to facility. This is not the goal for geriatric medicine. Often an admission to long term care is precipitated by numerous events such as the one I described. I have heard stories from my relatives and neighbors, persons in various parts of the country (Canada) telling me that they met or found a person wondering the streets who didn't know their name, were wearing proper attire for the weather, "then the lady started to strip off all of her clothes in the church" (luckily that incident was a weekday and not during the service), a woman that I met in the lobby of my previous building claiming she was waiting for her sister to come visit, and telling me that we were in New York, not in Canada ... There are numerous examples since I have begun health care chaplaincy. I am not saying this a problem and needs to be fixed. I'm merely saying this is how it is, a fact of living in this day and age. It makes for interesting times.

Thursday, November 22, 2007

comment about "living our faith"

I ran across this article in a local rag and I get a kick out of a comment in it.

"Some people go to church, but black people have church. It's a different thing. It's a full-contact sport with us."

This is an interesting comment about the attitude or self-expression of worshippers of the Christian traditions in North America. The speaker goes on to say that Canadian congregants tend to reserved in their expression of their belief/praise in comparison with African -Canadian persuasions. Why is this? Why do we (Canadians typically not black, as per the speaker) not loosen up and shout praise? Why do we look with disdain upon those who do when they are within our walls, with a "thatisnothowwedothingshere" attitude. Is this something we learn? or or is this something that we do because it is this way, but don't really wish to ponder why we do what we do? I went through religious studies courses as part of my training and there was one course that the professor told us had a "smoker's warning", it was hazardous to our spiritual health. The course was called the "Psychology of Religion" and it basically was an opportunity to examine why I believe what I do. Is it because it was what I was raised with (because my parents made me) or because it was what I wanted. In my roundabout way, what I'm getting at is that "having church" versus "going to church" connotes an expression of how deeply one's spiritual life is manifested. Do we just get a weekly dose or put in our time, or do we express what is our lives everyday not just on the day of worship? Something to think about. And now the article, that goes on about a different tangent...

Although St. James Hall has long been deconsecrated, Marcus Mosley is happy that the site of the Sojourners' upcoming CD-release party was once holy ground. It's not that he minds performing in secular environments–the Sojourners see a lot of blues clubs when they're on the road with their friend and occasional employer, singer Jim Byrnes. Still, the sanctified aura that permeates the former chapel is going to make it easier for Mosley and his fellow vocalists Ron Small and Will Sanders to achieve their goal: having church.

"Some people go to church, but black people have church," says Mosley, calling the Straight from his Vancouver home. "It's a different thing. It's a full-contact sport with us."

The affable singer and former missionary is laughing, but he's serious, too. For people who have been brought up in the African-American tradition, one of the most puzzling aspects of Canadian life is the grave solemnity that attends religious functions north of the border. "I'm not criticizing Cana­dian church and worship," the Texas-born Mosley notes dryly, "but it's a little bit different than African-American Baptist or Pentecostal church services."

One difference, I posit, is that in Canada the church has generally been an instrument of social control, whereas African-American pastors preached a kind of liberation theology long before that term came into vogue. Mosley counters that it's not quite so cut and dried: in some southern areas of the U.S., the church encouraged obedience to obviously unjust laws. Still, Sunday services were one of the few opportunities slaves and sharecroppers had to join together as a community.

"The church was a source of survival, not just physical survival but spiritual survival," he says. "If you want to go back to the slave period, it was that one hour or so on a Sunday when blacks were allowed to gather together and form a circle and start singing their songs. It was that one moment where they were able to be totally open, and self-empowered, and in touch with their higher selves–and then, of course, it would be back to the whip and the slave-owner mistreating them. So it was an hour of personal expression and freedom–an hour of grace."

The conditions of exile that apply to Vancouver's small African-American community are not so harsh, but for many U.S. transplants the church retains its social purpose. "Many of us miss the kind of church that we have back home," Mosley says, and as the leader of the Christ Church Cathedral–based Good Noise Vancouver Gospel Choir, he's in a position to do something about it. The 85-voice ensemble is also home to Sanders, who leads the men's chorus, and Small, its de facto patriarch. But the Sojourners didn't come together until 2006, when Byrnes was putting together his own gospel-inspired House of Refuge.

"Jim called me and said, 'Marcus, I'm working on a CD project, so can you get a couple of guys together and do some background vocals?'" Mosley explains. "So we did, and that became House of Refuge, which has been really successful. I mean, he's gotten like at least five different awards for it, Junos and all that stuff. And then [guitarist and producer] Steve Dawson came to us and said, 'You know, you guys are probably going to go on tour with Jim, so I'd like to produce a CD for you so you'll have some product.' So we got our heads together and came up with some songs and some arrangements, and then went into the studio. We spent about three days and put it all down on disc. Very down-and-dirty, and not over-produced; we just kept it very simple. But I liked the way it turned out."

Hold On, the Sojourners' debut, justifies Mosley's pride. With Dawson's expressive slide lines and Roebuck "Pops" Staples–approved rhythm work fleshing out the sound, the disc is already finding favour with roots-music enthusiasts as well as gospel zealots. It's Small, however, who just might be the record's biggest fan.

"Ron's having his 70th birthday on the seventh of December," Mosley notes. "And when we've been performing, he's started telling the audience, 'I've been singing all my life, but since I've been with this trio, it's like I'm having a whole new career. So if I die, I'm going to get up to those pearly gates and say: "I'm ready to go back! I'm not finished!"'"

Does this mean that the Sojourners are going to be more than just a one-album experiment?

"Well, I'm sure hoping so," Mosley confides. "From your lips to God's ears, as they say!"

The Sojourners play St. James Hall on Saturday (November 24).

Poems and other sundries

I have been hunting for inspiration for a sermon I'm working on and went through my files...



On Chronic Bed of Pain You Lie


Deep rooted torment,
Soul slipping to lie dormant,
Racks your body these demonic years
Sanity sliced open with surgical shears.

Rage, rage at the cruel joke
Heaven rain down fire and smoke
Stupid accident, helpless instance
Terrible nerve - searing existence.

Change the pump, correct the leads
Dilaudid, morphine drip like sweats beads
One more time put me under
Before life is drained of all its wonder.


On chronic bed of pain you lie
Suffering soldiers give your hero’s cry
I AM

I was regretting the past
And fearing the future.
Suddenly my LORD was speaking,
“My name is I AM”.

He paused.
I waited. He continued.

“When you live in the past
with its mistakes and regrets, it is hard. I am not there.
My name is not I WAS.

When you live in the future,
With its problems and fears,
it is hard. I am not there.
My name is not I WILL BE.

When you live in this moment,
it is not hard. I am here.
My name is I AM.

Helen Mallancott.
IF I KNEW

If I knew it would be the last time that I'd see you fall asleep,
I would tuck you in more tightly and pray the Lord, your soul to keep.
If I knew it would be the last time that I see you walk out the door,
I would give you a hug and kiss and call you back for one more.
If I knew it would be the last time I'd hear your voice lifted up in praise,
I would video tape each action and word, so I could play them back day after day.
If I knew it would be the last time, I could spare an extra minute to stop and say "I love you,"
instead of assuming you would KNOW I do.

If I knew it would be the last time I would be there to share your day,
Well I'm sure you'll have so many more, so I can let just this one slip away.
For surely there's always tomorrow to make up for an oversight,
and we always get a second chance to make everything just right.

There will always be another day to say, "I love you,"
And certainly there's another chance to say our "Anything I can do?"
But just in case I might be wrong and today is all I get,
I'd like to say how much I love you and I hope we never forget.
Tomorrow is not promised to anyone, young or old alike,
And today may be the last chance you get to hold your loved one tight.

So if you're waiting for tomorrow, why not do it today?
For if tomorrow never comes, you'll surely regret the day,
That you didn't take that extra time for a smile, a hug, or a kiss
and you were too busy to grant someone, what turned out to be his or her one last wish.
So hold your loved ones close today, and whisper in their ear,
Tell them how much you love them and that you'll always hold them dear
Take time to say "I'm sorry," "Please forgive me," "Thank you," or "It's okay."
And if tomorrow never comes, you’ll have no regrets about today.


Life's Survival Kit


TOOTHPICK...To remind you to pick the good qualities in everyone, including yourself.

RUBBERBAND...To remind you to be flexible. Things might not always go the way you want, but it can be worked out.

BAND-AID...To remind you to heal hurt feelings, either yours or someone else's.

ERASER...To remind you everyone makes mistakes. That's okay, we learn by our errors.

CANDY KISSES...To remind you everyone needs a hug or a compliment every day.

MINT...To remind you that you are worth a mint to your family.

BUBBLE GUM...To remind you to stick with it and you can accomplish anything.

PENCIL...To remind you to list your blessings every day.

TEA BAG...To remind you to take time to relax daily and go over that list of blessings.


Sunday, November 18, 2007

One perspective on prayer

I've been reading this book for my book club. There is an interesting statement by a character about his view of prayer. I realize that some of it is contextual for the story, but I thought it was an interesting way of looking at things. Especially the second paragraph.

I got to thinking about how easy my life is compared to Papa’s. Then I started thinking what a strange notion it is that Jesus supposedly got strung up on a cross to save zillions of other people – as if his one life, in exchange for zillions, was some kind of trade. It didn’t make much sense to me really, but what I thought was: What the hell. If that’s how things actually work, why not propose a similar swap—on a much smaller scale of course – to help Papa out. Why not ask God, if He exists, to let me do that for Papa what Jesus supposedly did for everybody on earth. Why not ask to trade some of my good luck for some of Papa’s bad, just to get his life back on track. …

Maybe the reason prayers never get answered is that everybody prays the wrong way, and for the wrong things. People ask God for good things all the time, and never offer anything in return. But if God exists, if He really made the world, and is all –powerful and all-wise and all that, then I figure He made all of the world, including the bad stuff. So if He ‘saw that it was good’, He meant just that. From His point of view, bad stuff must somehow be ‘good’, or at least must serve some of divine purpose. I was trying to give God the benefit of the doubt, don’t you see? …. If God is God, the only sort of prayer that seems to make any sense to me might go something like:

“Hello there, God. I know Thy Will is being done today, as usual, and I think that’s terrific as usual. Of course to me Your Will looks like a crazy mess that getting the rich richer and the poor poorer and the innocent killed and babies stomped and starved and the whole world in danger of being blown up any minute by atom bombs and all. But You know all about me thinking that, since ou made me. So, uh, sorry. And please, go right ahead and do Your Will no matter what I think, even if it kills us. Talk to you tomorrow, Lord! Love, Everett.

Sunday, November 04, 2007

Article about Seniors/ Healthcare


llness can accelerate trip to residential care

Gillian Shaw, Vancouver Sun

Published: Saturday, November 03, 2007


Dr. Janet McElhaney wants to see B.C. seniors age well.

The head of geriatric medicine at the University of B.C., holder of the Allan M. McGavin chair in geriatric research at UBC and head of geriatric medicine for Providence Health Care, sees prevention as key to keeping seniors independent and active.

McElhaney is also behind VITALiTY, a research orientation to support healthy aging which stands for the Vancouver Initiative To Add Life to Years.

The point, she said, "is that we need to be looking at transitions in the health of older individuals and really understand how we manage risk to get preventable loss of independence.

"We can do that through vaccines, we can do that through a more comprehensive approach . . . a more goal-centred approach to the care of seniors, for instance, in the emergency department."

Going into emergency could be one transition point of risk.

"One in every three persons over the age of 70 admitted to hospital is discharged at a higher level of disability than before they got sick," said McElhaney, citing a U.S. study, but one she said probably translates into the Canadian experience as well.

"There has got to be something preventable there."

McElhaney said while people usually think about frail individuals when they think of geriatrics, geriatric specialists must also concern themselves with the task of preventing disability in the majority of older people who are out there and active in the community.

"There is a thing called catastrophic disability," she said. "This is, by definition, you lose up to three of your basic self-care activities of daily living -- like bathing, walking and toileting.

"The leading causes of those things are heart attacks, heart failure, influenza and pneumonia and strokes."

McElhaney said older people can lose up to five per cent of their muscle power for every day they spend in bed, typically with their legs most affected. So even a bout of influenza can be catastrophic.

"If you are in hospital 10 days and spend most of the time in bed you have lost 50 per cent of your strength," said McElhaney. "It doesn't take long to figure out how we get to this catastrophic disability.

"It is shocking. I think that every older person needs to understand the risk when they get sick."

Illness can accelerate the path to needing residential care, said McElhaney, who points to diet, exercise and vaccinations as key primary prevention strategies.

She said the job of geriatric health care won't fall only to the geriatricians, but to others in the health care system and the community as well.

Canada has 180 to 200 geriatricians -- probably about one-quarter of what it needs -- but among those, she said, many are not practising full-time but instead divide their time between research, administration and other academic roles.

"We have to get the whole health-care system to understand this requires a different kind of approach than we have in the past," McElhaney said.

There is a shift taking place here to a more collaborative practice among different health care disciplines, she said. "To keep people walking, to rehab them, requires more than a nurse-physician model."

McElhaney said there are initiatives aimed at making it easier to care for the frail elderly, but with the very brief exposure students get to it, the training period is too short.

Instead of tackling the entire issue of geriatric medical care, McElhaney said focusing on the transitions, such as entry to the hospital, is the first step.

The acute-care-of-the-elderly unit at Vancouver General Hospital is based on a successful model of care developed in the U.S., she said.

There is also a focus on seniors in the emergency department to ensure their needs are fully understood.

"It is to try and provide a little more comprehensive assessment in the emergency department to serve the needs of these individuals," said McElhaney. "You can't just hand them a prescription and send them home."

Elderly patients in major centres such as Vancouver may have better access to services, but outside of those centres, access can be sadly lacking.

"The challenge is that they [the elderly patients] usually have quite complicated needs and the treatment is difficult to access locally," said Dr. Chris Frank, president of the Canadian Geriatric Society.

"Multi-disciplinary approaches tend to be easier to access in larger centres and it leaves people having to travel quite far for treatment."

Frank is director of the Care of the Elderly program, clinical director of the Southeastern Regional Geriatric Program in Ontario, and an assistant professor in the medicine department at Queen's University with a cross-appointment in family medicine.

He recalled a recent patient who was in the hospital for "fairly basic physiotherapy and fairly basic occupational therapy," that wasn't available in his community.

"Realistically, if he had lived in Kingston he would have come to our out patient clinic a couple of days a week," he said. "Instead, his wife had to drive 21/2 hours each way twice a week, and at one time she had to sleep in their car because they were financially strapped. They were both in their late 70s."

Frank said when nursing staff learned of the woman's dilemma, they stepped in to help her find sleeping arrangements to get her out of her car.

gshaw@png.canwest.com

Friday, November 02, 2007

Article

I found this article today. Considering that I work with a lot of the "elderly" population, I was intrigued by the headline. It is true that a lot of people come into contact with others who might make them sicker, but some times, the GP isn't trained to see all the possible problems that arise. This article is yet another statement about how the medical profession has changed, how the shortage of physicans in certain areas is affected yet another large cohort of our population.

Key to elder care: Avoiding Hospitals

We need to keep the frail elderly 'happy and comfortable and home,' says Dr. John Sloane, who has one of the last house-call practices

Gillian Shaw, Vancouver Sun

Published: Friday, November 02, 2007

TODAY: A plea for proper medical home care as a far better option than hospital care.

SATURDAY: Home-care options that help keep ailing seniors where they want to be -- in their home.

It's a sunny fall afternoon and 82-year-old Rose Sorrenti turns her attention away from her afternoon television to point to a swollen and gaping wound on her calf the size of a baseball.

"My sister-in-law saw it and she said, 'you'd better get hold of your doctor and let him see that,' but I knew you'd be here," says Sorrenti, gesturing to Dr. John Sloane, who is perched on a nearby stool, his tablet computer open and ready for the scribbled notes that will record his patient's condition.

It's a somewhat complicated condition, as it is with most of the frail, elderly patients who make up Sloane's practice.

It is a practice that has taken him from an office to his Mercedes, appropriately enough a geriatric model itself, in which he tours around Vancouver seeing patients where they live.

In an age where "doc-in-a-box" drop-in clinics have replaced trusted family doctors making house calls, Sloane is from another era. And while a program out of Vancouver Coastal Health promises to continue serving his patients when Sloane retires in the new year, medical students aren't lining up to follow his lead.

Instead, many of them will end up being the doctors who see elderly patients when they land in emergency rooms and hospital beds, an outcome Sloane says is exactly counter to what the frail elderly need.

"As funding for reasonable coordinated home care of house-bound people has fallen, the venue of default has remained the emergency room," he said. "If you are in trouble, you push 911.

"Bang, in comes the ambulance and the person is hustled out and the next thing they know they are a bed-blocker in an emergency room.

"The truth of the matter is, the service of an acute-care hospital can't help the frail elderly, they just don't benefit. We have a frail elderly person occupying these terribly expensive and much-needed acute-care beds, and those people aren't benefiting.

"It all boils down to [the need for] an effective strategy for keeping the frail elderly out of the hospital."

"Frail, elderly" isn't defined by age as much as health.

"Once a person goes through a gate which we call frail, there is a linear deterioration punctuated by dying," said Sloane.

"Once they go into that situation, all of this preventative stuff, everything we do in hospital, most of the investigations are actually counterproductive and useless.

"What we need to be doing for those people is keeping them happy and comfortable and home. Nobody wants to spend a nickel on home care, but boy, is it cheaper than sending Granny through emergency."

People become frail through the irremediable inability to perform the activities of daily living. Many people may suffer that inability at one time or another, either through illness or an accident, but what separates the frail is that they will not get better. There won't come a day when they will be able to fend for themselves again.

If you fix stuff and the person goes right back to being normal like you and me, they are not frail," said Sloane. "Frailty and homebound-ness approximately coexist.

"My practice is homebound. All of my patients are frail and all of my patients are homebound and it is about the same group."

But when it comes to medical care, often the frail 85-year-old is treated as if he or she was 39 and all that is needed is for that broken hip to repair, or the heart problem to be stabilized and they'll be back up and running almost like new.

That doesn't happen. The 85-year-old stranded in the emergency department may suffer some form of dementia along with the ailment that landed him in hospital. He could already have several diseases from diabetes to Parkinson's to respiratory problems to a range of conditions -- a complexity that can overwhelm a medical system geared to dealing with what is wrong with a patient, not seeing the whole person and all the underlying issues.

"So what do we do with frailty is, you talk to them and get them to understand what is going on in their life," Sloane said. "We treat their illnesses from a medical point of view, we treat their disabilities, and we look after them psychologically.

"We do it at home and we do it on a primary-care level."

That, argues Sloane, is where the money should go and where the care should go.

"That kind of shutting them off from the acute-care system is the opposite of abandonment," he said. "Just ask any old person who has been in emerg in the last six months, or who has ever spent a couple of nights in hospital.

"They don't ever want to go back."

Sorrenti appears to share that sentiment.

"Oh, I hate that hospital," she said, recounting a litany of ailments from broken bones to heart troubles that have landed her in one hospital or the other -- some getting a better report from her than others and one clearly a target of her wrath: "I call it murdering hospital," she said.

Sloane ignores the jibes and, persuading Sorrenti to turn down the volume on the television, carries on his questions and examines the angry-looking wound. He calls in a prescription to the pharmacy from his cell phone and calls to arrange for a public-health-care nurse to come by to change dressings and monitor the infection.

Sorrenti, who looks younger than her 82 years -- "You should see me with my makeup and you'd think I was even younger," she says -- has definite ideas about checking out of this life and it doesn't involve hospitals.

"My mother had the perfect death," she said. "She went to sleep at 99 and didn't wake up."

At 88, Mary Goulah manages with the help of some home care, but she doesn't stir far from her chair in her living room -- certainly not far enough to get to a doctor's office.

"I had trouble with my feet for one thing," she said. "That was when he (Dr. Sloane) first started coming to see me.

"I wore him out, that's why he is retiring," she said with a laugh, her sense of humour clearly not dimmed by a range of ailments. "It's too much for me to go out to a doctor."

Sloane will likely be retiring before one of his patients, Jim Steele, does. The 91-year-old isn't quite ready to calls it quits with the wholesale bakery business he took on as a retirement project after his retail bakery closed.

One of Steele's sons was in school with Sloane in Kerrisdale from kindergarten on, and the elder Steele remembers the doctor as a young lad at class events.

Steele's balance is unsteady and he leans on a walker, but asked how he negotiates steep stairs at his premises, he is indignant.

"I walk up them just like any other human being," he said sharply when asked about the stairs Sloane aptly describes as "breaktakingly steep."

Paul Steele, another son, doesn't think Sloane can be easily replaced.

"It's going to be difficult if not impossible to replace people like John," said the younger Steele. "To find people with that experience in family practice and in gerontology, and who care enough to do this."

Watching Sloane care for his father, Steele is convinced that the health-care system would save money if there were more doctors ready to take on the care of homebound seniors. But it won't happen, he said, unless public policy makes it a worthwhile option for doctors.

"You have to make it attractive," he said.

gshaw@png.canwest.com

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© The Vancouver Sun 2007

What happens to our aging seniors with too few doctors to provide medical care?

The elderly are the fastest-growing segment of the Canadian population

Gillian Shaw, Vancouver Sun

Published: Friday, November 02, 2007

At a time when Canada's aging population means that seniors are Canada's fastest-growing population group and the fastest-growing segment is 85-plus, Canadian medical schools are barely turning out a handful of geriatric specialists every year.

Even young people are having trouble finding a family physician.

Where then does that leave the frail elderly, often with complicated medical issues that require much more time than the fee-mandated few minutes of an office visit?

They often find a visit to the doctor's office virtually impossible, and instead end up rushed by ambulance into overcrowded emergency departments when a health crisis hits.

Once in hospital, the situation can go from bad to worse. During a week in a hospital bed, they can go from being mobile to being unable to stand, let alone get themselves to the bathroom or do any of the things that were so vital to their independence.

The more fortunate elderly will have family to help navigate their way through the medical system.

But that takes its toll, with caregivers burning out. One elderly Ontario woman recently had to sleep in her car overnight while her husband was being treated for the after-affects of a stroke. They simply lived too far from the only centre that could provide the rehabilitation he needed, and she couldn't afford a hotel room.

The stress can bring out old grievances and sibling rivalries as the debate rages over just how to care for mum or dad. As one doctor points out, if your kids didn't get along when they were 16 and 17, they'll still be fighting at 50.

Medical care for the frail elderly doesn't stop with the doctor. Best practices suggests it takes a team, with nurses and social workers involved with doctors and specialists who get to know the patient and their circumstances and liaise with family or other caregivers. But unless you're fortunate enough to live in centre that has the services, plus live long enough to get to the top of the waiting list, you might be out of luck.

Faced with such an urgent demand for geriatric specialists, you'd think students would be lining up to fill the spots. They're not. Geriatrics is a poor cousin to the more lucrative specialties like cardiology or neurology. Students graduating with crippling loans have to maximize their incomes to pay them off -- not see one patient in the same time their cardiology colleague sees six.

Yet while students are steering away from a geriatric specialty, the reality is the average doctor will see more seniors than anyone else.

"Except if you are a pediatrician, the classes graduating now will spend 50 per cent of their time with people over the age of 65," said Dr. Laura Diachun, a geriatrician, associate professor of medicine at the University of Western Ontario and co-author of a study pointing to a shortage of doctors who practice geriatric medicine.

"Although 50 per cent of their time will be spent looking after people who are the age of 65, the amount of training they get in medical school is negligible."

Dr. Janet Gordon, a professor in geriatric medicine at Dalhousie University, did a survey of medical schools across Canada and found that students were exposed to anywhere from seven to 200 hours of geriatrics.

"In medical school, people do close to two years or more of classroom learning and then clerkship, on the floor-clinical learning," Gordon said. "Only half the schools have people do geriatrics even though all have them do pediatrics."

Gordon said in problem cases set for medical students at her university, she found only seven per cent of the cases had patients over the age of 65 and none included patients over 70.

"I think there is a belief geriatrics is too complicated to teach them early on," said Gordon.

Geriatrics is a complex and challenging field. It's not like a 40-year-old landing in emergency with a heart attack or pneumonia. Treat the problem in the younger patient and chances are the patient will be up and on his or her way.

For an 80-year-old, one ailment may be complicated by a range of other conditions. Is the confused patient suffering dementia or is the confusion coming from an infection and dehydration? If he's sent home after days in the hospital, is there someone there to ensure he eats? Takes medication?

In medical school, students spend days and weeks gaining pediatric experience. They spend only hours with the elderly. Yet the reality is that when they graduate, they are much more likely to be caring for old people than for children.

"The bottom line is this is not a sexy place to be," said Lynn McDonald, director of the Institute for Life Course and Aging and a professor in the faculty of social work at the University of Toronto. "It is not glamorous like brain surgery or saving children who are dying from leukemia.

"We live in an ageist society; there is the feeling, 'who cares?' They are going to die anyway. . . . There is no prize, no glory.

"It is hard, hard complicated work and it is work that requires many disciplines. It is an interdisciplinary team approach. Older people don't just have one problem, they have many problems, it is very complicated and there is a special knowledge base."

McDonald said when she first went to work in gerontology in 1970, no one even knew what the word meant. "Society is catching up, but not fast enough in my opinion," she said. "I think it was in 2001, seven doctors went into geriatric medicine in all of Canada -- we need hundreds."

Geriatrics is also lacking in nursing training, McDonald said, but the curriculum is so stretched there is little room for geriatric medicine.

"Maybe we get three or four nurses in the program a year," she said of a multidisciplinary program at U of T in aging, palliative and supportive care.

"That's not very many when you think most old people end up on the medical wards in hospitals and they end up in long-term care.

"Who's looking after them? People off the street -- that's who is looking after them, with a nurse in charge if you are lucky."

McDonald says in the United States, the John A. Hartford Foundation, dedicated to improving health care for older Americans, is putting millions of dollars into training professionals in nursing and social work in geriatric medicine.

"They know they are going to have an age wave," she said. "They are preparing and they are throwing money at the problem big-time, and it works.

"If you start to pay students for doing it, they are a lot happier than if they are doing it because it is noble."

Drawing on the Hartford example, McDonald wrote a proposal for a national centre of excellence in aging focused on the three professions that provide social, psychological and physical care to Canada's older population, the National Initiative for the Care of the Elderly.

We were shocked when we got this letter saying 'congratulations,' " said McDonald of the success of her proposal.

But the dollars are not lavish. While Hartford is pouring $25 million into a single profession -- nursing -- McDonald said that in Canada, by the time overhead is paid, there will be $1.6 million left for four years.

The centre has put together academicians and practitioners working with older people and is focusing on best practices, with the aim of providing community agencies and institutions across Canada the tools they need to work with them.

"That's turning out to be a big winner," she said. "People don't have that information in one spot."

The institute also has a mentorship program for students in gerontology from the three professions, and it pays their way to an annual knowledge exchange.

McDonald said one way to get people involved is to offer scholarships and money for students to do research.

"Once you start to do it you love it," she said. "People who are in gerontology and geriatric medicine love it.

"It really is a challenge; it is really exciting when you can make a difference for an older person and their family."

gshaw@png.canwest.com

GERIATRIC CRUNCH

- Adults 65 years of age and older are Canada's fastest-growing population group.

By 2021, Canada will have 6.7 million seniors; by 2041 it will be 9.2 million and nearly one in four Canadians.

- The fastest-growing numbers among seniors are those aged 85 and older.

- Life expectancy for Canadians is rising, now at 82.5 years for women, and 77.7 years for men.

- The median age of Canadians has been rising steadily since 1966. In 2006, it was 38.8, a record high, up from 37.2 in 2001.

- The proportion of people aged 80 and above increased by 25 per cent between 2001 and 2006 to reach one million, second only to the rate of increase of those aged 55 to 64.

- During the same time, there was a 22-per-cent increase in the proportion of centenarians in this country.

- Kelowna has the oldest population of any Canadian city, with 19 per cent being elderly.

- There are fewer than 200 geriatricians in Canada, but the estimated need is more than 600, a number that is expected to skyrocket as the number of people over age 65 doubles in the next 25 years.

- On average, four to nine residents enter a geriatric medicine specialty training program every year.

© The Vancouver Sun 2007

Tuesday, October 30, 2007

Story that makes you go hmm..

Toddler survives plane crash
Only survivor after craft goes down near Golden, B.C., is three-year-old city girl
By DANIEL MACISAAC AND DAVE DORMER, SUN MEDIA

The Edmonton Sun
A three-year-old Edmonton girl has miraculously survived the crash of a small plane near Golden, B.C.- the third tragic air incident in that province in a week.
Two other Edmontonians died in the crash of the Cessna 172 that had left Golden for Edmonton yesterday afternoon: the male pilot, 60, who police say is related to the girl, and a male passenger.
The girl, Kate Williams, miraculously survived the crash on Sunday because she was strapped into a child’s car seat, said Mike Plonka, a member of Golden’s search-and-rescue team.
“What saved her life was being strapped into that car seat,” Plonka said Monday.
“You could see that she was very scared. Her big concern at the time was her little teddy bear. She didn’t want to leave without it.
“She was just pointing at it and calling it ‘Baby.”’
The girl, who suffered head injuries, was reunited with her parents in the southeastern B.C. community of Golden, said hospital officials.
The family arrived at the Alberta Children’s Hospital in Calgary mid-afternoon Monday, accompanied by a team from the Calgary Health Region. The girl was in good condition, and was admitted to hospital overnight “for observation only,” said health region spokesman Don Stewart.
RCMP said the Cessna 172 was on its way to Edmonton on Sunday when it took off from Golden around 1 p.m. into low clouds and snow. Visibility was poor.
An hour later, the Search and Rescue Centre in Victoria picked up the aircraft’s emergency locator transmitter signal from somewhere near the Blaeberry River.
Three search teams, which included military rescue experts, scoured the area by helicopter and on the ground. The chopper had to stay below 200 metres to remain under the clouds as it carefully skimmed above the dense forest.
The crash scene was finally found by a civilian team using a hand-held beacon locator. From the air, all searchers could see was the plane’s tail jutting out from the riverbed.
Searchers, including two military rescue technicians from Comox, B.C., Sgt. Scott Elliston and Master Cpl. Bruno Lapointe, then landed in a civilian helicopter on a logging road. The two men raced through the snow in the gloom of the late afternoon and reached the plane sometime after 5 p.m.
As they checked the wreckage for survivors, they discovered the girl alive but surrounded by debris in the back of the plane. As the two soldiers removed her from the wreckage, she made it clear she didn’t want to leave without her teddy bear.
“I got her out and I handed her to Bruno. She was calling out for her teddy bear. I picked up the teddy bear to give it to her but ... she wasn’t too happy that it was covered in snow so I brushed it off,” Elliston said.
“Everyone is happy that the child survived this.”
The search crew then carried her back to the helicopter for the flight back to hospital in Golden.
RCMP Sgt. Marko Shehovac said the girl probably owes her life to the flying prowess of her grandfather, a veteran pilot.
Williams was CEO and founder of Edmonton-based A.D. Williams Engineering Inc.
“He was very seasoned,” Shehovac said. “If he knew he was going to go down he probably would have done everything in his power to lessen the impact, which may have helped.”
Sutton was chief financial officer of the company.
The two men had been attending a business retreat in Golden.
“Allen has been a visionary and a leader in the consulting engineering industry throughout Alberta and across the country,” said Naseem Bashir in a statement on behalf of the company and families.
“Steve, a trusted adviser to our firm and in our community was an honest man who lived what he believed.
“Both men are treasured husbands, fathers, grandfathers and mentors who will be greatly missed.”
Yesterday's crash follow two other air incidents in B.C.
On Friday, a Piper Malibu flying from Oregon to Alberta crashed about 10 km east of Invermere, B.C., killing all three people aboard, including father and son William and David Wood.
And earlier in the week, another Cessna 172 went missing en route to Qualicum on Vancouver Island.
Pilot Ron Boychuk was flying from Revelstoke on Tuesday but his plane never arrived. His family is pleading for the public to look out for the 61-year-old, who is an experienced outdoorsman.
Chris Boychuk said he and his brothers Jon and Mike have rented a helicopter for the past three days to investigate a number of tips and possible sightings of their father's plane in the steep Fraser Canyon near Lillooet and Spences Bridge.
"As we speak, my brothers are in the bush where there was a flare seen a day or two ago," said Chris, 32, yesterday.
"My dad would never give up on looking for us and we're not going to give up looking for him."
The elder Boychuk was scheduled to fly from Springbank Airport to Qualicum Beach on Vancouver Island en route to his home in Nanaimo.
He was returning from Manitoba, where his son runs a charter flight business.
Boychuk stopped for fuel in Revelstoke at 3:05 p.m., after which his last transmission placed him south of Spences Bridge.
Search and Rescue spokesman Second-Lt. Alexandre Cadieux said crews continue to scour a large area with two Buffalo planes and five of their own helicopters after receiving a number of tips over the last few days.
"They are very useful, especially in a mission that comprises of a very large search area," said Cadieux.

Friday, October 19, 2007

Life is full of mystery and wonder. It never ceases to amaze me what news we will hear from out of the blue. I received an email 2 days ago to tell me that one of my former mentors was in hospital, and then the following day to say that she had died.




Rev. Patricia Shirley "Pat" Gow , 57.

It is with profound sadness that we announce the peaceful passing of Pat Gow at the Halifax Infirmary on Wednesday, October 17th, 2007, after having suffered a massive heart attack. Born on December 24th, 1949 in Bridgewater, N.S., she was the eldest daughter of Frank and Shirley (Fraser) Gow. Over the past year she fought a courageous and successful battle with breast cancer. Pat was a graduate of Acadia University with degrees in Bachelor of Arts, Bachelor of Education, Master of Divinity and Master of Theology (Pastoral Care). She also studied at the Andover Newton Theological School in Newton Center, Massachusetts where she worked toward a Doctor of Ministry Degree. After a brief career as a teacher in the public school system, Pat worked in the family business, Gow’s Home Hardware in Bridgewater, where she made a very valuable contribution. After being called to the Ministry, Pat was ordained a Baptist Minister in 1989. She worked at Acadia University as Adjunct Faculty at the Divinity College teaching Clinical Pastoral Education (CPE), Grief Counseling and Basic and Advanced Pastoral Counseling. Pat was a mentor to many students who loved and respected her. She worked for a time as the Coordinator of Valley Pastoral Counseling at the Eastern Kings Memorial Community Health Center. Pat was also Chaplain for three years at the Cape Breton Psychiatric Hospital in Sydney, N.S. She had been an Associate Teaching Supervisor with the Canadian Association for Pastoral Practice and Education (CAPPE). Pat was Vice Chair of the local committee of the Atlantic Baptist Senior Citizen’s Homes Inc. This committee spearheaded the development of Drumlin Hills Assisted Living for Seniors Complex now under construction in Bridgewater. She also served as Interim Minister at various local churches. The last few years she devoted herself to the care of her parents, while continuing her involvement with the Bridgewater United Baptist Church and her own counseling service. Pat was a very intelligent, capable leader and teacher, a loving daughter, sister, aunt, friend and colleague. We will all miss her deeply. Besides her parents, she is survived by her brother, Peter, wife, Zelda and their children, Jennifer and Denise; sister, Sharon Gow-Knickle, husband, David Knickle, along with many aunts, uncles, and cousins. Visitation will be held Sunday from 6 to 9pm in Sweeny’s Funeral Home, Bridgewater with cremation to follow. A Baptist Memorial Service to celebrate her life will be held 2pm Monday in the Bridgewater United Church, Rev. Sarah Duffy and Rev Eric Campbell officiating. A reception will follow the service in the Christian Education Center at the church. No flowers by request. In lieu of flowers, memorial donations may be made to the Bridgewater Baptist Church, Canadian Cancer Society or the N. S. Heart and Stroke Foundation. Online condolences may be made by visiting www.sweenysfuneralhome.com

Wednesday, October 17, 2007

What do you say..?

Last week, I was called to a bedside for a stillbirth. The baby was full-term so it looked like they were sleeping. It was not the first time that I had been called for such a situation, but it was still not easy. For some reason the words of the following song came to mind.. probably for the chorus.


REBA MCENTIRE lyrics