Sunday, March 28, 2010

Better than Halloween

On Halloween one can play at assuming an identity of choice. When hanging out with people who are delirious or confused, the element of choice can be lacking.Ob a recent night there were several confused patients on the unit. At some point the team members conpared notes. The charge nurse had been mistakeb for a priest. One of the nursing assistnts was mistaken for a physician.I, the chaplain, was thought to be qa physical therapist. And one patient, trying to reconcile the information that Mike was his nurse with an old belief that nurses are female, asked me if Mike was a bearded lady...

Monday, March 22, 2010

Major mortuary bad fun

There were a couple of questions about my mention of marketing collateral on my last post. I wasn't exactly thinking about marketing collateral for mortuaries themselves, although I know some businesses market by presenting seminars on funeral planning, bereavement, and the like, and they offer brochures and other small items. I've seen nice pens and notepads, and coffee cups are within the realm of imagination. The products I've seen are well-designed and tasteful.

Where marketing gets interesting, though, is in marketing products sold through mortuaries to customers. I learned this when my Mom and later my Dad died. When Mom died, my older brother and I went to the funeral home with Dad to Make the Arrangements. We were assisted by a funeral director who was both very kind and very earnest. He took us to a couple of cemeteries so Dad could pick gravesites for himself and Mom to be buried together. (By the way, if you Make Arrangements for a burial, you'll encounter fees labeled "grave opening" and "grave closing." These fees are for digging a hole, and filling it in later.) After that, we visited what I remember as Giant Roomful O Caskets and we chimed in our support as Dad picked one he thought was right for Mom. (Believe me, you DO NOT want to think much about the plethora of options in caskets. Spring counts for the mattress on which the deceased will lie? Hello--the deceased is DEAD, right?)

Afterwards, we went to the director's office, where we were fortified by styrofoam cups of coffee as we faced the final tasks on the huge list of Arrangements to be Made. It turned out that we needed to select a burial vault, which is sort of a concrete box with a top that fits in the grave and contains the casket. The funeral director offered us three choices--basically a Good, Better, and Best of burial vaults. This would not have been really funny, I suppose, except for the fact that as a family we had often joked about the old Sears Catalogue, which offered a Good, Better, and Best option for about anything you might care to buy, from cloth diapers to tractors. We started feeling a bit giggly as we viewed the brochure the director produced. They looked a lot the same, the vaults, and to my non-technical eye it seemed the major difference (besides price) was the length of the guarantee. Each of these choices offered a guarantee to protect the remains of the Loved One from various, erm, degrading influences encountered in the Burial Situation, so to speak. This struck me as rather bizarre and also rather mercenary; after all, who would mark a date on the calendar fifty years hence to go dig up Aunt Ruby and make sure she looked as good as the day you buried her? Odd. I can't remember which vault Dad selected; it wasn't any of my business actually. But we did have quite a laugh when we got out of the place, about the Good, Better, and Best vaults.

Some years later my Dad died. The same brother and I repaired to the same funeral home to make the same Arrangements. We may even have met with the same director, though I can't recall. The year was 1976, the Bicentennial. Anyone alive then must surely recall the patriotically-themed products that flooded every market. We learned that the funeral business had gone with the flow when we entered the Giant Roomful O Caskets. Striped linings and star-studded pillows and linings with the Declaration of Independence printed so as to show above the deceased's head were available in abundance. There were metal caskets subtly and not-so-subtly tinted in shades of red, white, and blue. Coffin kitsch, who would have thought? My Dad loved laughing at kitsch, but would probably have haunted us forever had we buried him in it, so we picked a casket that closely matched Mom's, which we knew he would like. (We were slightly taken aback by the price tag, which showed evidence of significant inflation, but pressed boldly on.) We might, had Dad lived until 1977, been able to get a good discount on a bicentennial casket, but the fear of haunting is not one I take lightly.

When we went to the director's office to finish the Arrangements, we were presented with the same styrofoam cups of coffee. I wasn't startled when the director mentioned burial vaults, but I must say the marketing collateral for same had been greatly enhanced. Instead of glossy brochures, the director brought out three small scale models, cutaway, each model being 1/2 of a vault, for the Good, Better, and Best options. The models fit in a man's hand. Each included the lid, and if you lifted the lid, a tiny light bulb went on so you could view the interior. Each model had a Good Housekeeping Seal of Approval sticker affixed to the outside. (I don't know whether the Approval had been granted to the models or to the products they represented, come to think of it.) OMG!!!!! Dad would have died laughing if he had not already died of a heart attack. My brother and I could NOT, absolutely COULD NOT, look at each other. The director was terribly earnest as he showed us the models, which made the moment even funnier, not that it needed any help. I'm sure he thought our choked voices as we ordered "the same as Mom's" were evidence of our deep grief. I found myself wondering if I could abscond with one of the little vaults, so I could keep it on a shelf as a lifelong conversation starter.

Our favorite mortuary owners have said they might be able to score me a miniature vault. I may have to take them up on it. They also told me that (1) the REAL purpose of the vault is to keep the ground from settling, which helps with appearance and maintenance of a cemetery; (2) all of the vaults do about the same job; and (3) all of them eventually get water in them, so you should bury your Loved One with a snorkel and fins. No need to thank me; when I receive information that valuable, I feel some obligation to pass it along.

There are conventions and expos where manufacturers of caskets, vaults, and the like present their products to the mortuary-owning public. I almost wish, maybe I DO wish, that I could go to one of these, although I might die laughing.

Wednesday, March 17, 2010

Odd bits and pieces

I have not written in some time, largely because things at work have been busy and I have been tired, and so a lot of bits and pieces of stories are stuck in the bits and pieces of my mind. I've lost a bunch of weight due to modifying my diet for blood pressure reasons, and I like that! My foot is just about totally better--I can walk my big dogs in regular shoes with just a little soreness and no pain, and I really like that!!!

We have had rough times at work with very, very sick patients accompanied by very, very stressed families. Some time ago we had a run of patients with liver failure, often involving alcohol consumption. We've also had some patients with cancers that kind of putter along for awhile and then flare up like wildfires overnight. Patients of both types can seem to be doing pretty well for some time and then crash, and families often are just so shocked they can't keep up. "She was fine two weeks ago," they will say, looking at us in disbelief as we begin the process of what is charted as "teaching re: dying process." Sometimes family members become angry and accusative because they cannot, really cannot believe their relative's position is going so very far south so very rapidly. They insist that the staff is overmedicating or underfeeding or any number of other things. They believe that there HAS to be a way to make their relative comfortable but still awake, alert, oriented, and able to relate. The bad stuff is just too bad and coming too fast for them to cope. Thank heavens for our wonderful physicians who are excellent at talking to families and explaining what is going on. Sometimes the families don't believe anyone except the doctor. Sometimes they don't believe the doctor either...

One thing that anyone doing hospice work learns fast is that old communication patterns, old relational patterns do not change just because someone in a family is dying. It's not like TV, where suddenly every member of a family is called to be their very best, and to behave in ways they have never behaved before, so that Complete Healing happens. Rather, people and families can be profoundly stressed by a terminal illness and impending death, and react in the ways that are most familiar to them. If a family has never "done" direct communication, that's in most cases not going to start now. If a family has been a welter of conflict since its inception, through multiple generations, that's in most cases going to continue. If a family has reacted to stress by manufacturing chaos, then an impending death is likely going to result in chaos. And, if a family system's preferred reaction is to create chaos, then that system will fairly predictably blow up when supporting institutions are least prepared to respond--that is, nights and weekends. Thus, the job of on-call chaplain for nights and weekends can be very interesting indeed.

To be sure, some families make some astounding changes when a member is dying. I have been tremendously moved--for instance, by a son long in conflict with his ill father who said, matter-of-factly, that they had decided they didn't have time anymore for quarreling and it was time to lay everything out on the table and get it over with. And so they did. And I've been similarly moved by other family members who have been inspired to take responsibility for their own participation in estrangements, seek to make amends, and offer words of love and appreciation. That's grace in motion, but to expect it of all families leads only to frustration and judgment. We only get a snapshot of dynamics, and we don't see the future. It is not true that everything has to be tied up with a bow before death--it's not true that that is "the last chance." What is, is. Even if it makes my hair stand on end.

So, our favorite mortuary driver showed up last Sunday when it was snowing outside. (The weather forecast, by the way, had mentioned "a chance of rain.") He was in his usual dark suit and long dark overcoat. He was smiling as he said, "It's snowing." I responded, "Yes, but it's not sticking to the roads yet." "Ah," he answered, "But it will be later on. And there will be NO traffic by then, and THE ROADS WILL BE MINE." He had a very sinister gleam in his eye, so I imagine some Very Quiet Passengers got the rides of their lives, or perhaps I should say the rides they never had in their lives.

We have a favorite mortuary too, now. The owners bring us donuts. LOTS of donuts. The owners are thin. This seems a little unfair. They are trying to build relationships in the community--hence the donuts--and I like them because they respect hospice work and are (we hear) very nice to families who select their mortuary. We cannot explicitly recommend or disparage any mortuary, especially one that feeds us donuts, but I do like these folks. Especially because one of them told me they could get me all manner of horrible marketing collateral for funeral products, which is another whole post in itself. I may take them up on the offer...