Dr. Diana Barnard; Excellence in End of Life Care

Local Physician Earns Award for Excellence in End-of-Life Care

Middlebury--Dr. Diana Barnard, a palliative care physician and long-time member of the Addison County medical community who works at both Porter Medical Center and the UVM Medical Center, has been awarded the UVM Health Network Home Health & Hospice Madison-Deane Award for Excellence in End-of-Life Care. This annual award is given by the Madison-Deane Education Fund, formerly the Madison-Deane Initiative (MDI), which is the educational arm of the UVM Health Network Home Health & Hospice’s Hospice and Palliative Care Program.

According to the MDI website, this award is given annually by the Madison-Deane Initiative to a Vermont individual, group or organization who “exemplifies the original mission and vision of MDI, thereby continuing the legacy of Drs. Madison and Deane and their original intent. Dr. Madison wanted to see physicians educated about pain assessment and control, and Dr. Deane wanted to see education about advance directives and hospice and palliative care, so as to prevent unnecessary suffering for patients at the end of life.”

“We are so pleased to learn of this well-deserved award, and deeply grateful to Dr. Barnard for the specialized and invaluable work she does here at Porter to provide palliative and end-of-life services to the people of our community,” said UVMHN Porter Medical Center President Seleem Choudhury. “Diana exemplifies our mission of caring for our community, one person at a time.”

The mission of the Madison-Deane Education Fund (MDEF) is to improve end-of-life care through inspiration, education and collaboration in the following ways: “Be a catalyst for the acceptance of death as a natural part of life. Be a leader for education, information and resources relevant to end-of-life issues. Support those who create and encourage dialogue about how individuals and families face life-threatening illness.”

Spinning Together; A Volunteer Story

Spinning Together; A Volunteer Story

Last Thursday, I took her to the Twist of Wool Spinning Guild for the last time. Then this week I informed them that she was at the Respite House, every person was surprised and said how well she seemed at Guild. Not one person realized how sick she was.

That is so like "B". She forged ahead, didn't spend time complaining about how she felt, and did the things she loved that she could. And then when she had no more "push" in her, she let go.

I will really miss our Tuesday visits. We would set up our spinning wheels in her living room and spin for a solid hour. "B" would suck down those Diet Cokes and we would talk and laugh. (Okay, I admit, I had one or two DC's in my year there and I enjoyed them)!

Every first Thursday of the month, we would load the spinning wheels and her O2 tanks, sometimes a wheel chair, into the car and drive to Middlebury for Twist of Wool Guild meetings. We were quite a sight coming through the door!

She loved going to Guild, and she was, I think, very pleased with herself that it was she who got me re-involved with them. You see, I was a member of the Guild when my husband was alive in the early 2000's. But after he died, in 2006, I stopped spinning and knitting altogether. It just made me too sad.
So when I met "B", and she told me that she loved to spin and go to Guild, I knew that I had to make that step and reconnect.

It seems perfect that it was my hospice patient who brought me back into that world. I will probably set aside time every Tuesday now to spin, and I am definitely re-joining the Guild.

Thanks for taking the time to hear my little story.
CW

Singing Over; A Wellspring Poem

SINGING OVER

a Wellspring poem by Jack Mayer

He nears the end of this journey,

preparing for the next,

breathing coarse, intermittent,

body tranquil but for fitful breath.

We stand in a semi-circle and sing a hymn,

cocoon a man we know because he is one of us,

and do not know because he approaches the boundary.

Small voices in four-part harmony

fill the dying room, majestic as a choir

suffusing renaissance heights.

I know my part well enough

to be present to the mystery,

to see myself in his place,

to give comfort and receive comfort at the same time.

To attend at the time of dying,

and sing,

is grace made visible,

audible,

palpable.

Reading Recommendations and Top Picks

EOL Committee Picks

We are entering a time of year when curling up under a cozy blanket with a cup of tea and a good book or snuggling on the couch with popcorn for a good movie is just what the doctor ordered. We hope you enjoy these recommendations from members of our partnership.

End of Life Services in the MarbleWorks, Middlebury (directly across from the Addison Independent) has an extensive lending library of books and films. All “Favorite Picks” mentioned below are currently available for sign out.

Dorothea Langevin: The Hummingbird, by Stephen P. Kieran, is a Hospice Nurse’s journey with a patient through his end of life; a testament of the work that goes far beyond routine and transforms all - including the reader. A magnetic novel of interwoven life-stories, rich in insightful cultural context, and masterfully conducting two separate timelines into one powerful experience. “My copy of the book is littered notations of AHA moments - a true gift.”

Margaret Olson: Coco, a film by Pixar Animation Studios, uses the yearly Mexican celebration of The Day of The Dead to speak to cultural differences around grief and loss, death and dying. The deeper focus is about family and legacy as expressed through storytelling and song. “What I love most about this film is how the story depicts the many facets of grief and loss, as well as the life changing transformative opportunities that can happen when we feel supported and validated.”

Laurie Borden: Modoc, a biography written by Ralph Helfer, tells the story of a boy and an elephant and their fight to stay together across three continents. “This book demonstrated the breadth and depth of love and loss, and how they are woven together in our lives across cultures, beings and time.”

Brian's Song is a movie aired in 1971 that tells the true story of Brian Piccolo - a football player stricken with terminal cancer after turning pro - and his unlikely friendship with teammate Gale Sayers. “This film taught me that anyone can die and it is okay to cry till you’re dry.”

Diana Barnard: “The Fault in Our Stars, written by John Green (2012) and then made into a movie in 2014, is a beautiful story about two teenagers navigating life and love in the setting of cancer. The story explores the challenges of living with a life limiting illness - there is a healthy dose of humor as well as tears.”

“Tear Soup: A Recipe for Healing after Loss” (1999), is a lovely illustrated book that addresses the universal and deeply personal experience of grief. In words and pictures, it normalizes the process, explores hope, and shows us how to transform our sadness into healing. I've purchased and given this book to friends and patients of all ages and highly recommend it for your coffee table!”

Priscilla Baker: Julia Alvarez and Sabra Field’s poem/picture book, Where Do They Go? captures the mystery of what happens after death. Although found in the Children’s section of libraries and book stores, it is a reassuring book for all ages.

Kate Braestrup’s memoir, Here If You Need Me, is filled with stories, reflections and wisdom by a woman who became the first chaplain for the Maine Game Warden Service. She is “here” for families, wardens, and her own children as they face challenges and all the curve balls life throws our way.

Matt Wollam-Berens: “Here if You Need Me” gives a good description of end of life situations from a chaplain’s point of view, as well as that of first responders. While my experiences in a hospital, rehab, and nursing home situation are not as dramatic, the spiritual, emotional, and physical aspects to it are very similar. It’s the best book I’ve read about how chaplains deal with death and dying.”

Maureen Conrad: Confessions of a Funeral Director, is a sometimes humorous and always thoughtful description of the life of a funeral director whose family has operated a funeral home for generations. Caleb Wilde writes honestly and openly about the good, the bad and things you never even thought to ask.”

Shirley Ryan: One Wave at a Time; A Story About Grief and Healing by Holly Thompson is a favorite. I first purchased this book for my 9-year-old grandson to help process his emotions after the death of his uncle; sadness, anger, fear, guilt or just flatness. This lyrical story and extraordinary illustrations are tools for anyone at any age to cope and heal from loss.

Permission to Mourn; A New Way to Do Grief by Tom Zuba is a comforting book. It is a poetic read, an easy read with a profound message of embracing the death, telling the stories, learning to live on and giving oneself permission to mourn.

The G.R.A.C.E Model

Brian Joshin Byrnes, Sensei, Bread Loaf Mountain Zen Community

The G.R.A.C.E. model of Roshi Joan Halifax has five elements:

1. Gathering attention: focus, grounding, balance

2. Recalling intention: the resource of motivation

3. Attuning to self/other: affective resonance

4. Considering: what will serve

5. Engaging: ethical enactment, then ending

You can use the following detailed description of each element as a script for your own G.R.A.C.E. practice:

1. Gather your attention.

Pause, breathe in, and give yourself time to get grounded. Invite yourself to be present and embodied by sensing into a place of stability in your body. You can focus your attention on the breath, for example, or on a neutral part of the body, like the soles of your feet or your hands as they rest on each other. You can also bring your attention to a phrase or an object. You can use this moment of gathering your attention to interrupt your assumptions and expectations and to allow yourself to relax and be present.

2. Recall your intention.

Remember what your life is really about, that is to act with integrity and respect the integrity in all those whom you encounter. Remember that your intention is to help others and serve others and to open your heart to the world. This "touch-in" can happen in a moment. Your motivation keeps you on track, morally grounded, and connected to your highest values.

3. Attune by first checking in with yourself, then the person you are interacting with.

First notice what's going on in your own mind and body. Then, sense into the experience of the person you are with; sense into what the other person is saying, especially emotional cues: voice tone, body language. Sense without judgment. This is an active process of inquiry, first involving yourself, then the other person. Open a space in which the encounter can unfold, in which you are present for whatever may arise, in yourself and in the other person. How you notice the other person, how you acknowledge the other person, how the other person notices you and acknowledges you... all constitute a kind of mutual exchange. The richer you make this mutual exchange, the more there is the capacity for unfolding.

4. Consider what will really serve the other person by being truly present for this one and letting insights arise.

As the encounter with the other person unfolds, notice what the other person might be offering in this moment. What are you sensing, seeing, and learning? Ask yourself: What will really serve here? Draw on your expertise, knowledge, and experience, and at the same time, be open to seeing things in a fresh way. This is a diagnostic step, and as well, the insights you have may fall outside of a predictable category. Don't jump to conclusions too quickly.

5. Engage, enact, and then end the interaction and allow for emergence of the next step.

From Frank Ostaseski, The Five Invitations.

Welcome Everything. Push Away Nothing. It is our task to trust the moment, to listen, and to pay careful attention to the changing experience. It is a kind of fearless receptivity, always entering new territory – a mystery we need to live into, opening, risking, and forgiving constantly.

Bring Your Whole Self to the Experience. We draw on our strength and our helplessness, our wounds and passion to discover a meeting place with the other. Professional warmth doesn’t allow us to touch into another persons pain, rather it is the exploration of our own humanity that allows us to be of real assistance. This allows us to touch another’s pain with compassion instead of fear or pity. We can’t travel with others in territory that we haven’t explored ourselves.

Don’t Wait. Patience is different than waiting. When we wait, we are full of expectations, and can miss what this moment has to offer. Waiting for the moment of death we miss these moments of living. Strategizing about the future, we miss the opportunities that are right in front of us. Allow the precarious nature of this life to show you what’s most important then enter fully.

Find A Place Of Rest In The Middle Of Things. We imagine that we can only rest when we change the conditions of our lives. But it is possible to discover rest right in the middle of chaos. It is experienced when we bring our full attention, without distraction, to this moment, to this activity. This place of rest is always available. We need only turn toward it. It is an aspect of us that is never sick, is not born, and will never die.

Cultivate Don’t-Know Mind. This describes a mind that is open and receptive, not limited by agendas, roles and expectations. Being in the open place of Don’t-Know Mind is not a place of ignorance; rather it is a characterized by openness. We stay very close to the experience allowing the situation itself to inform our actions. We listen carefully to our inner voice, sensing our urges, trusting our intuition. We learn to look and see with fresh eyes.

We live in a time when science is validating what humans have known throughout the ages: that compassion is not a luxury; it is a necessity for our well-being, resilience, and survival. My hope is that the G.R.A.C.E. model will help you to actualize compassion in your own life and that the impact of this will ripple out to benefit the people with whom you interact each day as well as countless others.