This Christmas, cherish your greatest gift

holding-handsA slim, fake Christmas tree stands close against a set of chairs in front of the nurses’ station at Missouri Baptist Hospital’s Cancer and Infusion Center outside St. Louis. Oversized gold and silver ornaments and tinsel cling to the tree’s nylon branches, which sway as the nurses, treatment counselors, and orderlies hurry to serve their patients.

A few feet away, a string of red and green letters spelling “Merry Christmas” dangles in a low curve from the ceiling. Air blowing from the heating vents causes the letters to dance and twinkle in the fluorescent light.

Beneath the string of letters, I listened to Martha, mother of four and grandmother of nine. She was in a treatment lounge chair near mine. We were not introduced. However, I turned my head when a woman sitting next to her commented on Martha’s wig.

“This one is much better,” the woman said to Martha. “Almost looks lifelike.”

Martha smiled and reached up to touch her new hair. “Yes, it does. I think it’s a real improvement, don’t you?”

Small things matter now, such as how Martha’s bangs frame her forehead and curl over her ears. These are the elements of her life she can control. Everything else depends on how her body responds to the pint bag of clear fluid hanging from a metal rod by her head. As she touched her wig, the fluid trickled down a tube toward a pump sewn into her shoulder.

Martha was worried. Thanksgiving was in two days, and she was expecting 30 house guests – family and friends from across the country. She wanted to feel well enough to see them, enjoy them. The last time she was here for treatment, three days of nausea followed. She vomited so hard a blood vessel burst in her eye.

“I can’t be sick this time,” she told her friend. “Every moment this week has to count, you know?”

The Infusion Center is a broad, open room subdivided into small, curtained cubicles. This is where cancer patients receive chemotherapy treatments. Each cubicle contains a reclining chair, a pump to dispense intravenous fluids, and a small flat-screen TV.

Treatments can last hours depending on the dosages and immediate side-effects. The nurses do what they can to make patients comfortable: warm blankets, cool drinks, conversation. One walks around with a guitar and offers to sing the patients’ favorite songs.

On the day Martha and I were there, all 35 cubicles were occupied.

Three weeks later, a young woman named Karen was in the recliner nearest mine. The curtain was drawn between us; she requested privacy. A nurse pulled up a rolling chair next to Karen, and they began chatting.

In August, Karen received her master’s of Business Administration. She already had two job interviews scheduled in New York when she walked onstage at Washington University to accept her diploma. Karen blamed the summer-long exhaustion that came with her across the stage on too much studying. Her parents insisted she get a checkup to be sure.

The nurse listened as she prepared Karen’s first chemotherapy treatment.

“I wish I could plan. I wish I knew what was next,” Karen said, “I feel I was just getting started. Now, I don’t know.”

The nurse’s voice was calm, reassuring.

“You should go ahead and plan. It sounds like you’ve got a lot going on. And it’s always good to be optimistic. Helps with the recovery more than you know.”

Karen said she was trying to keep an open mind, but it was difficult. “Nobody hires someone with cancer.”

The pair turned quiet as the metallic clicking and snapping sounds of chemo treatment preparation continued. Then:

“Is there someone here waiting for you?” the nurse asked.

“No,” Karen mumbled. “I don’t want anyone seeing me this way.”

On my third visit, I was sitting near the Christmas tree awaiting an open cubicle. Across from me, also waiting, were two women with Kyle, 8, a slight pale boy in flannel pajamas, SpongeBob slippers, a blue knit cap and a big smile. Kyle squirmed in his seat. The women – his mother and aunt – were tickling him. He giggled. He charmed the nurses, the orderly pushing a mop bucket, the woman with the guitar.

“Looking good, Kyle. Like the hat,” said Amy, the social services counselor, whose white smock fluttered against Kyle’s ears as she breezed past.

“My sister made it for me,” he said happily. “She’s 13, you know.”

Kyle’s initial leukemia diagnosis had come before he turned 5, which means his lifetime of memories is framed by the disease. He knows everyone’s names at the Infusion Center, including the volunteers who work without name tags. He sparkled like the Christmas ornaments. They bounced and clanked as his chair nudged the tree.

It occurred to me at that moment: the ornaments were oversized because everything else here is, too – the love and the loss, the plans and dreams, the joy and pain, and the laugh of a little boy awaiting his next dose of hope.

Each of us carries around a gift too great for the space in our hearts. Yet we take that gift for granted because it fits neatly within the container of our lives. This holiday season, pay special attention to those great gifts. For millions like Martha, Karen, and Kyle, they are the most precious any of us ever possess.

Smoking clouds your financial judgment, researchers find

Smoking was once a major part of my life even though I never lit up.

My parents did, however, and often. So often that I remember clearly how long, brown nicotine streaks stretched down our bathroom walls after each steamy shower; how the burn marks on our furniture multiplied until my mother figured how to hide them with throws and pillows – until those were burned through, too; how the school dean once told me to change clothes because they smelled strong of second-hand smoke.

You’d think all that exposure would carve a similar habit into my behavior; after all, we tend to pick up many of the same habits our parents do. Instead, the constant exposure to cigarettes and their noxious or ashy effluent did just the opposite; I grew up repelled by cigarette smoke and tended to steer clear of its sources.

Over time, however, I wasn’t the one who modified my behavior to meet social demands; the marketplace did. Smoking’s cachet fell away, driven largely by repeated health warnings, to be replaced with a stigma that attached to it like barnacles and pushed persistent smokers outside and away from workplace centers of decision-making.

Now, add a new discouragement to smoking: Research led by the University of Wisconsin-Milwaukee says habitual smokers tend to make worse decisions regarding their personal finances than people who smoke infrequently or not at all.

The research, buttressed by other economic analysis of smokers and led by Scott Adams, a professor of economics at UWM, surveyed more than 1,000 smokers over a two-year period and found that people who retreat into a cigarette break seeking instant gratification are likely to bridle when their attempts at fiscal gratification do not similarly yield immediate benefits.

The outcomes are reflected in credit scores, Adams says. Among the economic analyses, 41 percent of smokers were denied credit, 30 percent routinely missed credit card payments, and 27 percent had filed at least once for bankruptcy. Across the board, these percentages were twice as high as those for non-smokers. (These experiences were common among the survey group.)

In general, smokers accept the risk of poor health to pursue their habit, Adams stipulated. That risk-taking can be considered reflective of an overall willingness to take chances – an appealing quality in business.

But risking a smoke is met with the immediate gratification nicotine provides. Rewards gleaned from taking financial risks are neither readily apparent nor readily available, and hurrying toward those perceived rewards tends toward recklessness, Adams said.

“(A) smoking habit has an important and independent ability to predict behavior even after we control for variables that might be considered the true source of the poor performance in personal finances,” he wrote. “… We find that there is residual information in smoking status that can help predict credit score, and the size of this residual information is substantial.”

Adams acknowledges that other factors not measured by this study may clarify the relationship between smoking and personal finance but gave no indication that his research group would investigate them.

The best birthday gift for my mother

Hospice careMy mother just had her 78th birthday. She doesn’t know it though.

If I or anyone told her, she still wouldn’t know it. She’s past the point of understanding or caring.

Earlier this year, Sandra Kay Sheets, ravaged by an untold number of strokes, entered hospice. Now, three nice nurses monitor her all day. They bathe her, change her bedding, administer pain medication and feed her three squares daily. Or try to; Mom loses interest in food after one spoonful.

In the evenings, she picks gingerly at the edges of her bed sheet and mumbles about distant memories, though from what I can interpret, those memories involve times when she was young and vibrant and happy.

She is among the estimated 1.7 million people nationwide who receive hospice care, according to the National Hospice and Palliative Care Organization. However large that number sounds, it’s double from a decade ago as palliative care expanded beyond its original intent of serving terminal cancer sufferers to include patients diminished by other diseases.

My mother entered those statistics because she was in and out of hospitals and rehabilitation centers after her initial attacks, with varying success. Her health trended up and down, but never improved enough for her to regain a clear perception of the world around her. My uncle and I, who share legal responsibility for her care, began measuring her status by the number of moments we thought she knew who we were.

That number is down to the low single digits.

“Hospice care is designed to address the needs of the entire family,” writes Sheryl M. Ness, a nurse educator specializing in end-of-life care, in a blog for the Mayo Clinic in Rochester, Minn. “The focus of hospice care isn’t to treat or cure the underlying disease, but to provide the highest quality of life for whatever time remains.”

Because of that, more dementia sufferers continue entering hospice. By 2011, cancer diagnoses constituted just 33.7 percent of all hospice admissions, with dementia topping the list of non-cancer diagnoses at almost 13 percent of the whole, according to NHPCO findings.

“As the average life span in the United States has increased, so has the number of individuals who die of chronic progressive diseases that require longer and more sustained care,” the NHPCO says in its 2012 analysis of hospice care nationwide.

At first, I resisted putting my mother in hospice, her health decline notwithstanding. For one thing, “hospice” is synonymous with “terminal” in our culture, and I wasn’t ready to ascribe that term to her condition.

For another, I, like most everyone, was inculcated to believe that “cure” and “care” were synonymous, too, and that both extended across the breadth and depth of modern medicine.

But then I witnessed the exhaustion among overworked doctors and nurses at hospitals and the relentless workload at understaffed rehabilitation facilities along each step of my mother’s treatment. I realized then that “cure” and “care” can be exclusive of one another where cost, time and patience force a choice.

So, my mother reposes in a place devoted to her needs, such as they are. She can’t move, so the nurses move her to prevent bedsores. The nurses change the TV channels for her, brush her hair, talk to her, tuck in the stuffed gray kitten I bought because it resembled her own cat.

Her express respite care instructions, dictated by her when she was clear-minded and accepting of the likely course her condition would take, discourage much else.

When I visited her last, my mother looked through me to the reality she selected. At various times, I was her son, her brother, her uncle. One afternoon, she worried about the state of her wedding dress. Another afternoon, she worried about the cleanliness of an outfit I was supposed to wear in a parade.

It took me awhile to realize she was talking about a parade I was in at age 5.

I indulged her and said not to worry; the outfit was clean and ready. She said “OK,” then settled into sleep.

For this birthday, peace of mind was the best gift I could give.

__________

Update: Sandra Kay Sheets died Aug. 20 of complications from a series of strokes.