We Reap What We Sow

We reap what we sow

At my workplace, there is a framework for projects and initiatives.  The framework is RADAR, which stands for “Rationale – Approach – Deployment – Action - Review”.

Having been trained in RADAR, I used the framework to help me organise my care of my father.  I turned one of the bedrooms in the house into a mini-ward and the rest of the facilities at home to support it.  This personal project did not depress me.  In fact it brought up the abilities and skills I have picked up through the years.

Someone at my workplace suggested - Just send your father to the nursing home.  Why bring yourself through so much trouble?  I was not angry with my colleague because he meant well.  Caring for a patient at the hospital saps energy; having one at home 24/7 is burdensome. 

In March 2013, the Straits Times reported an interview with a head of a palliative hospital. The good doctor said that there was an indicator which predicted the amount of homecare.  Whether the family was willing to look after their parents in the latter’s autumn years was based on the saying “we reap what we sow”.  When the parents / parent had previously established good relations with the children, the more likely the children were willing to take up responsibility.  He knew of families who had many sons and daughters but they were unwilling to look after the patient.  On the other hand, there were families he knew of, whose children gave up all to look after their parents.

My father is the only father I have.  It is my duty to look after him till the end.

 

Rationale

I have a purpose.  My purpose statement is “The best nursing care at home for Father till his last day”

Unpacking of terms in the purpose statement: 

·       I defined the term “best” as the best level of care that the family can afford such that my father is able to live for as long as he can, comfortably at home. The term “nursing care” comes from the availability of care givers, facilities and resources, including medical supplies and medical advice. 

·       My performance indicator – the deliverables in the physical setup for nursing care; the expertise and the performance of the caregivers.

·       The key performance indicator – how long will my father live with good management of his chronic medical conditions.

As I reflect on the arduous journey, I met many angels.  Most of them are nurses and doctors.  A few are fellow colleagues at my workplace.  They paved the way more smooth, and made things possible for me to bring father from the rehabilitative community hospital back home. 

All in all, my father was at the following places:

2 months from November 2010 to December 2011 at the Changi General Hospital for heart tests and recuperation,

2 months at the Singapore General Hospital for the heart by-pass surgery from January to February 2011,

4 days at the St Andrews Community Hospital before suffering a stroke in early February 2011,

3 months at the Singapore General Hospital – Intensive Care Unit and step down care from early February to April 2011,

4 months at the Ang Mo Kio Thye Kwan Moral Hospital from May to July 2011 before going

Home from July 2011 till now, in 2013.

Although my father is stationed at home, he has a number of hospital admissions ranging from 4 days (skin infection) to 14 days (fluid overload and lung infection).  I became familiar faces to private ambulance medics and ward nurses.

 

Approach

I tried to be focused in my handling of the matters concerning my father’s care.  The period of time (about 11 months) when my father was at the hospital, I spent a lot of time thinking through the things to do and the order of things to be done.  Time was a necessity when only one individual is there to handle the matters. It was a long task preparing for Father’s return but it was achievable with the help if luck and resourcefulness.  Yes, with a lot more resourcefulness.    

One guideline is: No crying until the required task / work is done.  If there are people who are not willing to help me out, I would rather leave them out as I felt that there is no need for time and energy wasted on persuasion.  If one does not have the heart initiative for the task, there is no need for further persuasion.  In other words, I was seeking for a common vision among the stakeholders.  My fierce independent and stubborn “lembu” (workhorse) spirit prop me up.

The next guideline is: Be ultra-organised.  No detail is too small is to be left out.  Check and double-check until I am very sure of it myself.  I was trained in keeping records and setting up a registry.  I took a personal interest in knowing how the machine works or how the room arrangement will look like. I also had to anticipate problems would come up.  When it came to machines – it was maintenance and how to use it.  When it came to teaching my foreign domestic workers, I chose to set a personal hands-on example.

The third guideline is: Be honest in my relationships to others. Lip service is cheap; prove what is said with action.  Appreciate others who helped me.

The fourth guideline I followed and this is the most important to me: Pray to God for His Grace and Strength.

Changes

Changes

There would be a lot of changes to our lives at home. Mine and my mother’s. 

When my father was well, he is an independent person who does not like to be at home except morning when he read newspapers.  When he was well, he loved to visit bookshops, arts and crafts shops, pharmacies, Chinatown and catch movies at the Bugis Junction Cinema. I was used to seeing my parents only at around 7 pm when they brought home dinner.  Both of them would watch television till 11 pm and then listen to the radio till midnight.  On the following day, they repeated the same routine.  My parents did not mind the same routine. I did not mind as their habit left me alone to do my office work or pursue my leisure.

In the initial stage of preparation, I consulted my mother.  Both of us were under a lot of pressure.  I did not know that she could not bear the stress until there was a time when she cried and said aloud that she could not manage.  At that time, both of us had to learn how to perform peritoneal dialysis (PD) for my father at the PD Centre, Singapore General Hospital.  My mother claimed that she could not remember.  I insisted that she must, and we spent several week nights revising the PD process.  Mother needed to understand and do the PD as she had to supervise the maid later at home when I was at work. 

After my mother’s cry, I did most of the things on my own. In my opinion, my mother has been dependent on my father for too long a time.  They were childhood friends, grew up and fell in love and got married in October 1963.  Mother and I have diverse different working styles.  I prefer to do things immediately but she likes to wait for action to happen.  She is haphazard with her things and is forgetful (not withstanding her age) but I am detailed and neat. 

Many times in the preparation phase, we had arguments.  I tried my utmost to explain my intention behind the action again and again until my mother agreed to some of the actions to be taken (while all the time, I would be seething inside with impatience).  At times, I would be so tired and just simply wrote on a piece of paper as clearly as I could. Visual representation or a picture was the best way for my mother to understand the flow of how things went.  I did a number of flow charts of the different steps to be taken, complete with consequences.

My mother could not walk for long periods as her legs are arthritic.  She has back pains and could not sit for long periods.  The preparation required a lot of physical work.  Thus, my mother relegated the care of my father to me.  She took upon this attitude – I am not the boss.  I do not decide.  I did not do anything wrong.

Sigh. 

But I was free to decide on what’s the best action using my brains and gut feelings.

 

Preparation work

The following are some areas of work:

·       Clear two rooms – one for my father and one for the maids.  That meant clearing cupboards and shelves, putting the things into bags.  And throwing a lot of junk to make space. Mopping the floor again and again, and cleaning the windows and shelves.  Moving tables and sofa set.  I have learnt my lesson – keep everything neat and tidy – don’t hoard and don’t buy things unnecessarily without checking stock at home.

 

·       Buy beds and toilet accessories for my maids.  I got my maids to help me clear the living room, the kitchen and the store room.  In short, what we could do to make as much space as possible for father’s things.  At the same time, to help me clear rubbish of what we had accumulated.  This was also to occupy my maid before my father returns from hospital.

 

·       Make ramps for the main door and the bathroom.

 

·       Buy a hospital bed and ripple mattress.

 

·       Buy a commode and a wheelchair.  Buy replacements parts such as the bucket and the seat cushion. 

 

·       Buy a steel trolley and medical equipment such as an ivy stand, stethoscope, ear-scan thermometer, blood pressure monitor, suction machine, weighing scale and sugar level monitor. 

 

·       Buy medical supplies include syringes, litmus papers, needles for checking sugar level, syringe needles for injection of insulin, disposable alcohol swaps, potassium permanganate crystals, Dettol disinfectants, Mikoyan anti-fungal cream, TCP, Thyme mouthwash, tooth sponges, Secura moisturiser, Sanyrene for backside, cotton wool, cotton buds, adult diapers, tissue paper, suction catheters, powder for prickly heat, teatree gel, mosquito repellent

 

 

·       Buy Novasource Renal milk and Myotein milk powder

 

·       Buy health supplements such as Manuka Honey (UMF at least 15+ and above), Lactofort, Chicken essence with ginseng / cordiceps

 

·       Order from the Baxter Company who will deliver 20 cartons of PD solutions a month. I am thankful that they are generous with the supplies of iodine swaps, minicaps, gauze, surgical tapes and alcohol wipes, alcohol hand wash and soap hand wash.

 

·       Change of father’s NGT tube; arrange appointment with the homecare nurse.

 

·       Shop for groceries- food for the meals, detergents for keeping the house clean

 

·       During the preparation period, my refrigerator broke down, my stove too and my sinks leaked.  I decided that I would be more proactive.  I asked a plumber, an electrician and a gasman to do the necessary. 

My friend said that I was very “jialat”.  In the Hokkien dialect, it meant that I had a hard time. 

I lost 9 kg in 6 months.  For once in my life, I was slimmer. J



I love Monet

At a Christian Conference for Women, I first heard that the Lotus plant or the Nelumbo nucifera stands tall above the waters.  Its rhizome is in  the soil, rooted below.  However the leaves and the flowers of the Lotus rise above the waters in order to survive.  The title of the Conference was "Rise Above the Ordinary".

 

That was my inspiration from my teenage years. 

The Theory of the Dipper and the Bucket

Extracted from “How full is your bucket?” by Tom Rath and Donald Clifton (2004) Gallup Press, New York.

 Page 59

We are all certain to face major challenges as we progress through our lives.  Often we feel that if we were dealt a bad hand, and that life is unfair.  But we don’t have to allow ourselves to be defined by our hardships.  Our responses to difficult events and our emotional state are much more important.  Continual reinforcement about our strengths can buffer us against getting overwhelmed with the negative.  And understanding what we do best allows us not only to survive, but grow and thrive in the face of diversity.

 

Page 5 - The Theory of the Dipper and the Bucket

Each of us has an invisible bucket.  It is constantly emptied or filled, depending on what others say or do to us.  When our bucket is filled, we feel great.  When it is empty, we feel awful.

Each of us has an invisible dipper.  When we use that dipper to fill other people’s buckets – by saying or doing things to increase their positive emotions – we also fill our own bucket.  But when we use that dipper to dip from other’s buckets – by saying or doing things that decrease their positive emotions – we diminish ourselves.

Like the cup that runneth over, a full bucket gives us a positive outlook and renewed energy.  Every drop in that bucket makes us stronger and more optimistic.

But an empty bucket poisons our outlook, saps our energy and undermines our wills.  That’s why every time, someone dips from our bucket, it hurts us.

So we face a choice every moment of every day.

We can fill one other’s buckets or we can dip from them.  It’s an important choice – one that profoundly influences our relationships, productivity, health and happiness.

Three Strands

I am 49 years old.   I am a collector.

My hobby probably stems from my compulsive habit to organise things.  Internally, I was driven by a need to build up a reference.  Probably I see the collection as an extension of my need to find evidence to support my decisions in life.    

What do I collect?    

I collect newspaper cuttings. The newsprints are taken mainly from local newsprint and magazines. I think thoughts expressed on paper are precious.  When the thoughts resonate with mine, the writing becomes more valuable.  Writing takes effort.  The authors of the articles have taken time and energy to express their thoughts.  It is worth and a privilege to read and enjoy them.

I want to keep the thoughts with me, for as long as I can. 

Does a collection reflect the thinking and character of the collector?  I hope so.

Recently I tidied my collection from 2010 to February 2013. Usually, I “throw” the newspaper cuttings into a paper bag and then go through them in June and in December.  The reviews of thoughts are my favourite holiday past times.  This time, I did my review in March.  (Reasons why I am taking a holiday in March will be in my other posts.)      

I sorted my collection.  Interestingly, the newspaper cuttings were roughly grouped into the following groups:

·         The meaning of work and self-worth

·         The causes of health issues in particular depression versus positive thinking

·         The process of dying and dealing with grief

These three strands have occupied my thoughts for almost 2.5 years.  And it’s because I am facing a crisis in my life.

More stories of that crisis and my decisions in other posts.  Keep on reading. J 

Life Made Possible Without Limits

I took my cue for the title of the journal entries from the book “Life Without Limits” by Nick V.  In the last chapter in the book, Nick V encouraged all to be happy.  He suggested that we should be ridiculously happy in whatever we do, because we have a life made possible, without limits.

Never Say Die

More aware

Two years ago, I had burnout followed by depression.  My depression still occurs with occasional outbursts of negative feelings.

However, I am more aware of when the depression will start and how my body would respond.  My mind would seem to go numb and I don’t exactly remember things.  I am not joking.  When I am depressed, I would not be able to remember even a moment or half an hour ago.  I could not recall where I was and what I was doing then.  I would be “cloudy” in my mind. 

Of course, when I am asked to do tasks that require concentration and facts, I really don’t remember how to do them.  I made silly mistakes that a person as senior as I am in the office, should not do.  When I am depressed, my sense of judgment is impaired. 

In addition, the nasty feeling of being incompetent adds to the vicious cycle.

There may be some hope to rescue my situation.  In the book “ Thinking, Fast and Slow” by Daniel Kahneman (2011), page 28 – “The best we can do is a compromise (between System 1 and System 2 ) : learn to recognize situations in high mistakes are likely and try harder to avoid significant mistakes when the stakes are high. “

 

Situations to avoid

There are some situations which I avoid.  The first is to avoid a situation when I do not have enough time to do the task.  Last minute things add up my internal pressure and then I would usually get cloudy.  I try to prepare for things as early as I could.  A tool to organise my tasks and the priorities is to make a list of things.  I enjoy doing lists.  A laundry list where I can strike off the tasks when I have done them makes me happy and hopeful.  The laundry list boosts my confidence as I believe that I have accomplished my tasks.

The second situation to avoid is to do tasks that are beyond me.  I tried to negotiate the difficulty of the tasks that I should do in the office.  I am aware that my faculties are not as sharp as they use to be.  Tasks that will emphasize my weakness in concentration are a “no” on my list.  This requires me to be humble and admit to my bosses that I could not do such tasks well.  If the bosses wish to give me the tasks, I would need to be supervised. However, such requests implied a lower ranking in work appraisal at year-end.  At my workplace, the annual appraisal of an officer is divided into two areas of assessment – the competence of an individual and the capacity of the individual.  A more senior officer is expected to be more competent and to have higher capacity.  Such expectation seems logical in ordinary circumstances.  However, such a system of appraisal works against me.  I was destined to be a poor performer and indeed since 2010, I was ranked lowest in my grade.

The third situation to avoid is to avoid prolonged stress periods resulting in fewer amounts of sleep and rest.  This was the “biggie” because I could not have enough rest due to the care of my ill-stricken father in late 2010 (the same year that I had burnout and start of depression).  It is a bad, very bad situation in my life.

 

Refocus

How do I stop my spirits from flagging? Through a lot of perseverance, I slowly worked out a way for myself.

The way out is to RE-FOCUS.  I had to decide what was more important to me.  Looking after my father was more important. My work performance took a second place.  The penalties of poor work performance – I had to accept them as humbly as I could.

A very close friend encourages me by sharing his thinking when things went bad in his life.  He says, “Never say die until the Lord tells me so.”  My father has a debilitating stroke and lies moribund in bed.  He doesn’t give up.  My father has shown me that he is a fighter.  Why should I give up now?    

A Good Decision

A good decision

My workplace has granted me 6 months of leave from March till September 2013.  Three weeks ago, at the beginning of my leave, I was unsure of whether I had made a right decision.  Three weeks later, now I feel that I have done something good.  Something good for my own physical and mental well-being.

Regrettably, the decision had to do with the results of my symptoms of burnout and depression. 

I was unable to find out the cause of the two symptoms.  As early as 2010, I began my anguish.

The book “Fried” by Jonis B (2011) is an enlightening read.  I just read it in March 2013.  Better late than never to be made aware.  “Fried” describes the symptoms of burnout and the description fitted my symptoms to a T.

Motivation

I have worked hard all my life.  The strong work ethic is imbued in me by my grandmother and father since I was a child. As far as I could remember, my father worked like a “lembu” (“cattle” in the Malay Language) every day, even on weekends. As a laboratory technician, he was responsible for carrying out tests for set pathogens.  The test results were important for further medical diagnosis.  Even at weekends, he would be at the hospital laboratory to complete the required tests for the patients.  He always told me - why delay the test results when they were needful.  My late grandmother was a task-oriented lady who insisted on adhering to the highest standards for ordinary housekeeping.

Through the two decades of hard work and high motivation, I achieved promotions and recognition.  I was a high achiever at my workplace.  Up till 2010 when I faced a downward change.

A vicious cycle

In early 2010, I changed my workplace and I believed that I had to prove myself.  I was under a lot of pressure to perform in my new job.  Thinking back, the perfectionist streak and the pessimist freak in me did not help to ease the mental burden.  My body told me of the burden but I did not pay attention to the physical symptoms.

I had a persistent cough which lasted almost 3 months then.  My body was unusually weak that time and I wrongly attributed the weakness to the spread of drug-resistant germs (the SARs and the H1N1).  The cough was hackling and it kept me awake at night.  As a result, I was not having enough sleep.  At the same time, my body felt cold all the time.  I had to wear thick jackets whenever I attend meetings in air-conditioned rooms.  My doctor suspected that I had thyroid problems. She did blood tests and did not find any unusual markers.  My stomach felt hard and bloated and I checked myself in for a gastro-endocrinologist appointment. As part of the check up, I had to endure a colon scope.  During the scope, I was drugged under general anaesthesia and a tube explored my stomach.  After a month, the doctor met me and told me reassuringly, I did not have growths in my stomach.  My stomach was well. 

But I was not well in another part of my body.  My brain told me that it was tired.

I had not yet recovered my body strength.  The lack of sleep was a big cause for my lack of energy.  I was worried about how I would do well in my new job.  The first part of the year was very important as it sets the tone at work.  I could not set any tone or hum.  At the same time, the clients whom I worked with were unusually difficult and they demanded a lot.  Due to my prolonged absence medically, I received a number of complaints.  Coincidentally, my own boss was undergoing some difficult situation at her home and was not sympathetic.  My father was not feeling well at that time too.  I was worried about him.  It was a vicious cycle.  A downward spiral for me.

Life has its ups and downs.  I was dealt with a down, down time.  I wished that there was a hole that I could jump in to hide from the overwhelming pressures.

I lost my motivation. 

I felt lousy about myself and what I did – what good would it do that I prepare the most wonderful proposal and what does it matter to anyone?  What was I doing?  What a waste of time! I began to hate what I do.  I felt guilty because work took me away from the most important person in my life – my father.  My father’s heart was failing and I thought he would die.  I felt that I did not spend enough time with him given my workaholic nature in the past years. 

In truth, now that I am feeling better, I forgot that I did spend time with my father.  More than anyone else in the family.  Almost every day – at the kitchen table, we would talk about the daily happenings in my office and his thought of the events in our country and around the world.  We had breakfasts together at weekends.  My holidays were spent with him and my mother in tours.  We have done his favourites in England and China.  If he could do it, we would have travelled to America. 

More to come

My downward spiral continued for another 2 years.  My burnout led to my depression. 

Life dealt my father its hardest blow.  In January 2011, my father was brought down by a bleed in his brain resulting in a crippling stroke.  My father was paralysed and his chronic problems set in drastically – diabetes, high blood pressure and kidney failure set in.  His condition had been described by doctors as moribund.  Even the sound of the word is depressing. 

As his main caregiver, I gave my father the best of my job training (another story here) and left not much energy to daily work at office.  My performance in my office dived and my bosses were not that sympathetic. There were some suggestions that I seek psychiatric help; these were half-hearted.  It seemed that my bosses were more interested to get the department work done rather than look after my well-being.  And why should they, I thought?  Bosses look after work, not their employee’s right? 

My assumption is wrong.  Our bosses have a big part in our motivation.  They are responsible for staff motivation.  This area is expounded in the book “How full is your bucket?” by Tom Rath and Donald Clifton.

 

Luckily I had a good set of friends who saw that I was suffering and took time to give counsel.  Without their help, I would be too devastated to pick myself up.

Luckily, I had a spiritual anchor – my Christian belief that my Lord would not leave me alone or give me more than I could bear.

 

My personal aftermath has not ended.  At times the negative feelings reared its ugly head and make me numb.  I find ways to de-“press” the negative thoughts and “press” up the positive feelings. 

I also made another choice. Unthinkable of a workaholic – take a break.  I made a conscious choice – I need a break.

Writing my thoughts helps in my mental recovery.  Hence this blog. 

Hope Quotes

 

Extracted from “Life Without Limits” by Nick Vujicic (2010).  Doubleday Religion International, New York.

Page 34

Even in our worst situations that seem beyond our capacities, God knows how much our hearts can endure. 

I hold onto the belief that our life here is temporary as we are being prepared for eternity.  Whether our lives here are good or bad, the promise of Heaven awaits.  I always have hope in the most difficult times that God will give me the strength to endure the challenges and the heartache and that better days await, if not on this earth, then for certain in heaven. 

 

Page 37

Remember that sadness does serve a purpose.  It is perfectly natural to experience this emotion but you should never let it dominate your thoughts day and night.  You can control your response by turning to more positive thoughts and actions that life your spirits. 

…the power of believing in better days is so indisputable, that to me, it seems more probable that your days will change for the better.  Hope, along with faith and love, is one of the pillars of spirituality.  Whatever your beliefs, you should never be without it, because everything good in life begins with it.

“Those who hope in the Lord will renew their strength.  They will soar on wings like eagles; they will run and not grow weary.  They will walk and not be faint.”

Don’t forget that the Lord never gives up on you.  Keep moving ahead because an action creates momentum, which in turn creates unanticipated opportunities.