Caregiving and the fight-flight-freeze response

Judy Long
Judy Long

Fight, flight or freeze. Those are the three traditional options we humans have when confronted with dangerous or overwhelming situations. Judy Long suggests a fourth: challenge. For caregivers whose stress levels often keep them on a high-fight-or-flight alert, this new option can come as good news.

Long spoke recently on Caregiver Resilience and Well-Being: Sustainable Caregiving at a meeting in San Francisco. “The ‘challenge’ response,” she told members of the San Francisco Bay Area Network for End of Life Care, “can actually have biological benefits. When you can look at (your stress) as excitement you can actually perform better.”

Judy Long, who is currently Palliative Care Chaplain in the Department of Neuropathy at the University of California San Francisco, has an extensive list of credentials in things like Mindfulness-Based Stress Reduction and Mindful Self-Compassion – the academics underlying today’s insights into the caregiving business. And for those in the trenches of caregiving, small suggestions can offer big help.

“Sustainable caregiving,” Long says, involves “all of the things we do for ourselves when we’re involved with caregiving. I know how exhausting it can be. But we can all be doing things that have great meaning, that are nurturing and nourishing for ourselves.”

Long tells of completing her chaplaincy training, which included a year of training at the University of California San Francisco. One year later, she says, she was asked to take on a six-month chaplaincy at UCSF – assigned to the neonatal intensive care unit, commonly referred to as NICU. “I wondered how to keep myself centered in all that terrible suffering.” The patients in NICU are mostly premature or very sick hands-with-heartsinfants, lying in “isolettes.” While extraordinary progress has been made, and continues to be made, with successful treatments, having a newborn in NICU is stressful for parents, and many infants die. It falls to the chaplain, much of the time, to tell a parent his or her baby will not survive, or will have permanent damage. “I found out I was okay with that,” Long says, partly for having had some time in between training and actual chaplaincy work in a difficult setting.

“I’m a pragmatist,” Long says; “I always ask what works.” She was determined not to fall into the trap of many caregivers: “overwhelm, shutting myself off from caring by building an armor. Caregiving also points back to ourselves.”

Long credits one of her teachers and mentors, Roshi Joan Halifax of the Upaya Zen Center in Santa Fe, NM, with offering guidelines she uses to guard against the common pitfalls of isolation – “there are a lot of opportunities to be isolated while trying to do good” – and the sense of helplessness. “I call them my three points: purpose, connection and control.”

Long’s audience at the recent meeting included many who have chosen, as Long herself has, a career path in the caregiving field. It also included three older women, among whom is this writer, who are fulltime caregivers for their husbands: one with peripheral neuropathy, one with both cancer and progressive memory loss and one with Parkinson’s disease. For the family caregiver, purpose and connection are clear. But control? An elusive element at best.

Which brings us back to the fight-flight-freeze business. Challenge may still be an option.

 

On Stage with Ann Randolph

Ann Randolph 10.15
Randolph On Stage

Does she know something we all should know?

It’s not your dream career trajectory: Living (and working) in a locked facility for chronically mentally ill to get through college. Sliming fish on an Alaskan production line. Braving Arctic winds and a dozen macho racist shipmates for a year on a fishing skiff. Broke, in New York, solving the problem with an ad that reads: Alaskan Bush Woman seeks room and board in exchange for tutoring in the arts and/or companionship. . .

It worked for Ann Randolph. But she would be the first to say it wasn’t exactly a piece of cake.

Actress/comedienne Randolph is currently on stage at San Francisco’s Marsh Theater with her solo show “Inappropriate In All the Right Ways.” It’s part autobiography (she was told early on, “Ann, that’s inappropriate”) part stand-up hilarity, part therapy and 100% fun.

Randolph is best known recently for her solo show Loveland (“Riotously demented and brilliantly humane,”) but she’s been making headlines for a long time. Her life and career path have featured stunning successes – Best Solo Show awards in San Francisco and Los Angeles, a long list of other awards and citations for acting, writing and directing – and crushing lows. Among the latter would be the incidents cited above, alongside her close friendship with Mel Brooks and his late wife Anne Bancroft, who recognized her genius and were backing the progress of her solo show toward Broadway when Bancroft was diagnosed with the cancer that would soon end her life.

Randolph, though, does know this: it’s not about the highs and lows, it’s about the trajectory. Through her shows, her writing workshops, and her generous pro-bono appearances before groups like the end-of-life nonprofit that caught the attention of this writer, the high-energy Randolph explores that theme.

Randolph with the author
Randolph with the author

And following life trajectories is Adventure Theater at its best. Randolph pulls her audiences into the act with markers of her own ups and downs – Sacrifice! Synchronicity! Visualization! Fake it ‘til you make it! – and then turns the tables. Given pencils and ruled tablets when they entered, audience members are invited to do 5-minute life lists of their own. When time is called there’s a jazzy sing-along moment and then – spoiler alert – they are also invited to take the stage.

Nobody leaves a performance of “Inappropriate” without being moved to laughter; many leave after discovering something about their own life trajectory. It’s a show like no other.

If you’re in San Francisco before “Inappropriate” closes (it’s been extended! Weekends through 12/13) you can catch Ann Randolph in a show. Or find her doing a writing workshop near you.

Dying in the Fix-It Society

Buddhist teacher/lecturer Frank Ostaseski spoke recently to the Bay Area Network of End-of-Life Care on the subject of compassion – something Ostaseski preaches, teaches and practices himself. Co-founder, in 1987, of the Zen Hospice Project, the first Buddhist hospice in the U.S., Ostaseski currently heads the Metta Institute, created to provide education and training on spirituality in dying.Buddha

Buddhism, Ostaseski said, holds that life is supported by two wings, compassion and wisdom, and neither is at its best without the other. His audience, made up of physicians, hospice workers and others involved with end-of-life care, was in interested agreement with the renowned speaker as he expanded on the theme. But this writer, also in agreement, found one side remark particularly pertinent to today’s end-of-life issues.

Ostaseski spoke of a severe heart attack he suffered not long ago, and of the wisdom gained from that experience. It was insight on critical illness “from the other side of the sheets.” During his hospitalization most visitors, even longtime friends with credentials in compassion, said the wrong things. “They were always saying, ‘It’ll be better tomorrow, Frank,’ when I wanted to talk about what was going on that very moment.” Additionally, Ostaseski found that nurses and doctors “interacted with monitors far more than with the patient.” What could well have been an end-of-life situation was, in short, lacking in compassion and wisdom both.

“Hospitals are fix-it places,” Ostaseski remarked.

We may have gotten fixated on being a fix-it society. Whatever the problem, a chemical or technological answer, in the fix-it society, is instantly sought. We fix brain injuries, once-fatal diseases, missing limbs, and more. But can we let someone who is terminally ill quietly die? Seldom. More often than not we keep trying to fix her with extended interventions, futile and expensive treatments or hospital stays that make dying a horror.

Ostaseski and others are working hard to help people find meaning in their final days, focusing on palliative care. Some, including this writer, are working hard to make medical aid in dying a legal option available across the U.S. ALL of us want a peaceful and compassionate death.

The_flame_of_wisdom
The flame of wisdom

 

The personal bottom line, yours and mine, is this: eventually we die. If the focus can be shifted away from constantly trying to extend our days, we can fix the final days that lead, one way or another, to the mysterious, inevitable, unpredictable, un-fixable but quite natural end. All it takes is a little compassion, and a lot of wisdom.