Developing An Effective ER Strategy

Posted June 30, 2009 by Joseph Kornowski
Categories: Best Practices, Caregiver Awareness, Doctor Interactions, Empowerment, Patient Advocacy
Tags: , ,

A recently-released Emergency Department Pulse Report by Press Ganey Associates provides some very helpful insights on the state of EDs nationally, as well as in various regions of the country. It is a report based on survey results from patients who have been treated and released from EDs and were given the opportunity to provide feedback about their stay. It is used by EDs nationally to monitor and improve the quality of their service and the care they deliver.

Among other findings, the report shows that: (1) patient satisfaction rose in 2008, following a five-year trend of improvement; (2) average wait time decreased over the previous year, but only by a few minutes; and (3) patients spent an average of just over four hours in the ED in 2008. Frankly, this is quite impressive, especially given that the period for the 2009 report included the first three quarters of the current recession, which only has added to the demands of EDs as more people lacking health insurance may turn to the ED as their only source for various kinds of medical care.

While the report offers some suggestions to hospitals for how to improve overall patient satisfaction, my own observation and experience after dozens of trips to the ED in three states over the last six years or so, suggests that patients, themselves, and/or their family members and caregivers can do more to improve significantly their overall ED experience than they realize. The key is to understand how the ED works, where it fits in the scheme of your loved one’s medical care options, and how to optimize those things over which you do have considerable control. At that point, you can empower yourself with a strategy for ED visits that will maximize the likelihood that your loved one will get the best of what your local ED can provide.

Here is the way that I break down the issues and decisions into chronological steps (please note: this is an illustration of what works for me based on years of ED visits, and is not intended as a specific recommendation or advice for anyone else):

Step 1: When to go to the ED
This can be easy or difficult to answer depending on the circumstances. Assume that an ED visit IS going to wipe out a good four hours, expose you and/or your loved one to others who may have contagious illnesses, and recognize that there is always some wear and tear in just the ordeal of it. And even if the visit is covered by insurance, there may be a co-pay or deductible. So, assume there will be some cost involved.

What you need to do is apply some basic home assessment based on your own knowledge (e.g., known symptoms, patterns, treatments, etc.), prior conversations with doctors (if it’s a known illness and you are told what signs/symptoms to watch for), and your own comfort level.

  • The simple answer: when you have run out of other options for a medical situation that is urgent and requires immediate assistance — for example, it’s late in the evening, the doctor’s office or pharmacy is closed (but find out where the closest 24-hour pharmacy is located), you don’t have the necessary medicine/knowledge/skill to get through the night until the doctor’s office is open. This should be a no-brainer. You shouldn’t be spending more than a couple of minutes getting to the decision.
  • The more difficult answer: The factors above just aren’t that obvious. Maybe you don’t really know how serious/urgent the situation is, or the symptoms aren’t familiar to you. You actually may have the “tools” — medications at home, necessary knowledge and skill about how to administer — but you’re not sure if they will help in this situation, or how to use them (specific medications, dosages, etc.). Get a quick expert opinion: if you think you have the time, try to call the patient’s doctor or the doctor on-call for the regular doctor to advise you. But remember that what that person tells you is only advice. YOU are there at the scene perceiving what the doctor can’t except through your description or explanation. I’ve had doctors tell me that they thought I probably could wait until morning, and I knew pretty quickly afterwards that I couldn’t. Other times, a doctor (or a neighbor who is a critical care nurse) has confirmed my suspicion that I had better get my loved one to the ED. If it’s still not clear, then go. That’s what the ED is there for; they are the experts with the knowledge, skill, and tools.

Step 2: How to get there
Some people still seem to have a cultural stigma about calling 911 and having rescue vehicles show up at their house. But this isn’t a time to worry about anything other than a person’s life and the need for medical attention.

  • When to drive yourself — if someone can comfortably get into the car and withstand the trip, then maybe it’s okay to drive them. Factor in the possibility of getting stuck in traffic or otherwise delayed in a way that vehicles with red lights and siren usually aren’t in terms of additional delay in getting them medical assistance.
  • When to call 911 — Just about any other time. Remember that most ambulances today are like mini-EDs, with highly trained EMTs/paramedics who have a LOT of training, knowledge and skill. Bringing that training, knowledge and skill, and “tools” — oxygen, breathing treatments, IVs, and various drugs that they can administer — to where the person needing assistance is, rather than wasting valuable time driving the ill or injured person to a hospital, can make a big difference in the outcome.
  • TIP #1: The ED staff usually triages patients arriving by professional first-responders more highly than someone who drives in themselves (or by family or friends). This means usually by-passing the waiting room and exposure to others there who may be contagiously ill.
  • TIP #2: The rescue squad knows whether any hospitals in your area may be “closed” — a situation where a hospital is at full-capacity and accepting no new patients. You would never know that if you decided to drive yourself, and so could be further delayed in getting your loved one medical attention quickly.

Step 3: What to bring

  • Essentials: Patient’s insurance card, photo ID and medication list. Everything else is optional.
  • Leave at home: anything of value (jewelry, purses, expensive shoes/jackets), food, extra people — bringing the whole family or friends is going to be more hindrance than help in most cases.
  • TIP: Get the medication list immediately after you call 911; the EMTs/paramedics will need it once they arrive.

Step 4: What to say/ask
Either the patient or the caregiver needs to be able to describe to first responders and/or ED staff, if possible:

  • symptoms — time of onset, what led up to them, how they manifested
  • circumstances — anything the patient said or any behavior that seemed unusual OR similar to some known pattern associated with some health condition, even if not directly related to what you think are their symptoms
  • recent medical history/issues
  • known allergies (especially to medications)
  • whatever else the EMT, triage nurse or treating doctor asks — note: this may include the patient’s wishes in the event that resuscitation might be needed and to do whatever is necessary (”full code”) versus do not resuscitate (”DNR”), as may be specified by the patient in an advance directive.

A caregiver needs to stay actively engaged with the ED staff by asking:

  • for whatever the patient seems to need, especially if the patient can’t ask themselves or needs assistance
  • about any needed tests, when they will happen, in what order, and next steps
  • about any medications (pills, IV, injections) to be administered to the patient — what they’re for, any side effects to watch for, etc.
  • whether the patient will be admitted as an in-patient, what the criteria are for that, and when a bed might be ready
  • depending on the patient’s state of consciousness/awareness, to be allowed to accompany the patient wherever he/she might be taken — for tests, to another floor, etc.

Step 5: What you can do to help
EDs can be very busy places, and you are an extra pair of hands, eyes, ears, and legs that might actually be able to help move things along or monitor your loved one’s status; first, you get points with ED staff for asking how you can help rather than demanding their immediate attention for every little thing; second, you make yourself part of the extended ED team, which helps you feel useful rather than helpless and also lets your loved one know that you personally are assisting in their care. It also puts you in the mindset of learning what IS helpful, building your own knowledge. Of course, you also have to be prepared to hear the response, “Just please stay out of our way,” and not take it personally, knowing that is helping your loved one, too.

Step 6: What kind of care to expect
It’s important to understand the purpose of the ED in terms of its strategy for delivering care in order to set your expectations appropriately. One of my favorite ED physicians explains it this way:

[Y]ou will be evaluated for any number of EMERGENT conditions and after that, diagnostic interventions and procedures are limited. You may not receive a diagnosis or specific treatment because we operate in a world of “ruling out the worst case scenario.” For instance, if you have chest pain, we will do every test necessary in order to establish that your pain is not being caused by any number of life-threatening conditions (heart attack, pneumothorax, pneumonia, etc). If these tests are negative, we may let you leave without a final diagnosis (only “chest pain”). That does not mean there is nothing wrong. It only means we cannot find a cause that needs immediate attention or admission. It does help us to know if there is an agenda that the patient or family has (”just want to get an xray to make sure I didn’t break my back” or “worried I have breast cancer”). Sometimes, these concerns can be addressed directly rather than confounding the picture with a bunch of useless and expensive studies.

So, the ED is part of a continuum of care. Patients with serious problems that cannot be quickly resolved may be admitted to the hospital.  Those who are discharged from the ED without a clear or final diagnosis typically will be advised to seek specific follow-up care (e.g., with their primary care physician) as soon as reasonably possible for further diagnosis and treatment.

Step 7: Who to know and acknowledge
Get to know the names of treating nurses and doctors, at least. First, you’ll then know who to ask for when that person disappears and you don’t see them around for a long period.  Second, it begins to build rapport and personalize your interactions; after a couple of hours of seeing the same faces, you want to be able to walk up to the busy nurse working on a chart (but only if you need to) and say, “Jennifer, I know you’re awfully busy, but did the doctor okay my wife having some water? If so, I’ll get it if you show me where it is.” You’ve thereby done several things: made it personal (which it sure is for you and your loved one!), acknowledged your awareness that the place is busy and getting water for a patient isn’t all that high on their priority list compared to other things going on, shown you understand that allowing beverage or food is a matter of a doctor’s order in the ED, not the nurse’s discretion, and offered to be the nurse’s surrogate or proxy (part of the team) by getting it yourself. Chances are you’ll get a very positive reaction.

Depending on what happens during that ED visit, you may feel compelled to write a letter later to a staff member or supervisor — hopefully of praise for extraordinary patient care rather than complaint for neglect or error. Remember, you may need to come back to that ED in the future. So, don’t burn any bridges, unless you really have to — hasn’t happened to me yet.

Overall, the more time I spend in EDs, the more impressed, amazed and in-awe I am of the work those nurses and doctors do under some of the most challenging circumstances when people often are at their worst. And, anytime I do need to be in the ED, I am honored when I am treated like part of their extended team.

Copyright © 2009 Joseph Kornowski

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Support the Declaration of Health Data Rights!

Posted June 24, 2009 by Joseph Kornowski
Categories: Empowerment, Patient Advocacy, Public Policy, Technology
Tags: , ,

Family caregivers know all too well that the challenge of creating, maintaining and appropriately sharing accurate and reliable health and medical information about the person needing care can be a daunting task. Fortunately, a group of concerned doctors, researchers, software developers, writers, entrepreneurs, health economists, and many others who share a common goal of greater health data availability have recently formed HealthDataRights.org to give people a voice in preserving their right to take responsibility for their own information and care. It is intended to serve as the portal for those who wish to endorse and support a new Declaration of Health Data Rights, an articulation of people’s inalienable right to have and share their own health data. The Declaration reads:

In an era when technology allows personal health information to be more easily stored, updated, accessed and exchanged, the following rights should be self-evident and inalienable. We the people:

  1. Have the right to our own health data
  2. Have the right to know the source of each health data element
  3. Have the right to take possession of a complete copy of our individual health data, without delay, at minimal or no cost; if data exist in computable form, they must be made available in that form
  4. Have the right to share our health data with others as we see fit

These principles express basic human rights as well as essential elements of health care that is participatory, appropriate and in the interests of each patient. No law or policy should abridge these rights.

In explaining the need for such a declaration now, the organizers of HealthDataRights.org state: “We believe, largely because people’s right to their own health data in computable form isn’t acknowledged, we are facing a crisis in the healthcare system right now which only the easy flow of computable data and true patient engagement in their own health can avert. We further believe that we are now at an inflection point where the country is acknowledging this issue and pondering what is to be done to avert a worse crisis.”

They go on to say that by creating the declaration of these obvious and inalienable rights, and seeking endorsement of these rights by anyone and everyone who is concerned and interested, they “hope that policy makers, legislators, health care professionals, and health care administrators will listen to this message, and change their attitudes about how health data are managed, respecting the rights of people to immediate access to their own health data.”

Integral Caregiver has endorsed the Declaration of Health Data Rights and asks you to do the same by either completing the short form at HealthDataRights.org or by using the hash #myhealthdata on Twitter — your name and Twitter account will automatically be listed on the HealthDataRights.org Endorsements page.

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Support Cancer Research by Simply Rating a Video Clip!

Posted June 18, 2009 by Joseph Kornowski
Categories: Uncategorized
Tags: , , ,

The good folks at WordPress and SocialVibe have just teamed up to allow blogs like Integral Caregiver to help raise funds for good causes and specific charities through corporate sponsorship donations in an innovative way that doesn’t cost readers a dime. Now, Integral Caregiver readers can help support Stand Up to Cancer, which funds cancer research, simply by watching and then rating (with a single click) a short video clip from PowerBar. You rate a short clip, and Power Bar donates to cancer research through Stand Up to Cancer — it’s that simple! You can read more about how this works here.

In just over a year, SocialVibe has enabled people to raise close to half a million dollars for charities. I chose Stand Up to Cancer as Integral Caregiver’s cause, and PowerBar as the corporate sponsor, because they seemed best aligned with the purposes and spirit of Integral Caregiver.

Please help support cancer research by clicking on the SocialVibe “badge” in the right column, and viewing/rating a short video clip.

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A Caregiver’s Moment of Insight (a true story in the Zen Tradition)

Posted June 16, 2009 by Joseph Kornowski
Categories: Caregiver Awareness, Empowerment
Tags: , , , ,

Recently, I’ve found the Big Mind process of zen master Dennis Genpo Merzel Roshi particularly helpful as a tool to increase my awareness. I’ve read his book, Big Mind – Big Heart, and I’ve watched at least a dozen of his videos on YouTube.

On Sunday, he gave his first live web video talk. The subject was exploring the voices of “caring,” “caring deeply,” and “not caring.” As a caregiver, of course, I thought that this was just about perfect. The talk and discussion progressed with those attending live, Genpo Roshi and his students describing what caring and caring deeply meant, what it felt like, what the implications were. Collectively, we could see that deeply caring resulted in forming a strong attachment to the subject of one’s caring; and the strong attachment resulted in a desire to control the person, thing, or situation about which one deeply cared. It also brought into play fear and worry that our caring might not be good enough, that harm might come despite our caring — and then guilt! In fact, it was possible to care so much that there was the real possibility that we could make ourselves sick.

We all could begin to see how caring deeply actually could cause harm to our own well-being!  And, somehow, this dynamic of caring deeply, and the consequences of attachment, fear, worry, and guilt began to feel like shackles or the walls of a prison that we had created inadvertently from our well-intentioned caring.

Then, as Genpo Roshi typically does in these sessions of the Big Mind process, he shifted to exploring that place in us that does not care, that does not “give a s***,” in Genpo Roshi’s words. He explained that we all have that side to us, too. Yet, it is culturally taboo to acknowledge, let alone indulge, our “no heart” side.

But he took the group through it — what it meant, how it felt, to experience “no heart.” And we began to see that it had real benefits. No attachment, for one! If you really don’t care about something, you surely don’t get attached to it. You also don’t worry about controlling anything or about outcomes. For whatever it lacked in emotional connectedness and a sense of compassion, it made up in . . . freedom! No attachment, no fear, no worry, no guilt, nothing to do and nothing left undone. Everything was fine as it was. The world turned, flowers blossomed, rivers ran their course.

Genpo Roshi pointed out that this was one of the chief teachings of the Buddha: the liberation from suffering of all sentient beings — living as truly free beings — can only come about through unattachment. And, by detaching in this way, we liberate not only ourselves but all sentient beings, which then become free from our attachment to them.

Genpo Roshi, of course, then changed gears again. He reminded us that we’re human, and compassion and loving-kindness are an important part of our true nature and the path to enlightenment. So, how do we reconcile these apparently opposing aspects of us?

In his process, he describes a perspective or “voice” called the “apex,” which sits above two apparently-opposing aspects of self, and contains or holds both. What happens when we are at the apex of deeply caring and not caring at all, Roshi asked. One woman in attendance said that it allowed her to truly grieve her dear friend who had just died the day before, and at the same time say, “But it’s okay.” When we can transcend caring and not caring, we can both truly care and then let go, without fear, without worry, without guilt, as truly free and empowered beings.

I realized by this point that what I was witnessing — participating in live, in the moment — was the unfolding of something that seemed truly unimaginable. It was all the more extraordinary for me because it was deeply personal. See, 23 years earlier, a very aware (I’m sure it would be appropriate to say “enlightened”) being came into my life for a time. She had assignments and messages for me, but never spoke with me directly; instead, she contacted me only through my wife and would speak only to her. Needless to say, it was a very interesting time in our lives. And I journaled regularly during this time, not wishing to miss anything.

But I never needed to refer back to any journal entry to recall one of her more cryptic directions for me: “Learn to care, and not to care.” I turned it over in my mind countless times trying to really comprehend what seemed like a riddle. It became a kind of personal koan she had given me, and I had been carrying it around with me for over two decades, coming back to it from time to time to see if new experiences or the passage of time had provided any better understanding about its meaning. And then this past Sunday morning, towards the end of Genpo Roshi’s talk, it hit me. And I got it! In Zen, they call it an enlightened insight or kensho moment.

Of course, I was beside myself with awe and excitement. I had not taken notes because I was so engaged in the talk. Fortunately, however, Genpo Roshi’s video talk was being recorded and made available for download to a computer or on CD within 48 hours. I quickly placed my order, and checked email throughout the day to see when it would be ready for download.

When I checked this evening, I saw the note. The subject line read: “Genpo Roshi’s June 14th Talk – Apology.“  My brow furrowed. I got to this sentence and stopped reading: “Unfortunately we encountered a technical error and couldn’t keep the recording.”  To say that I was disappointed doesn’t begin to describe how it felt not to be able to review something that had opened me to the true meaning of my 23 year old cryptic message.

But I stopped and reflected. I realized that I was missing something important. I composed a reply to the email. After explaining my deep disappointment, I wrote: “I was so looking forward to reviewing the talk carefully to make sure I understood every nuance. And the fact that it is not available for that purpose is . . . fitting somehow — a lesson there, too.”

That’s the thing about true awareness insights — they exist only in the moment, and can no more be held onto for later reference than a snowflake the moment it hits your hand. I can only express my deepest gratitude, let it go, and move on . . . .

Copyright © 2009 Joseph Kornowski

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Discerning Needs Through Compassionate Awareness

Posted May 30, 2009 by Joseph Kornowski
Categories: Best Practices, Caregiver Awareness, Self-Care
Tags: , ,

For me as a family caregiver, understanding the needs of one I’m caring for starts with understanding the whole person whose needs I want to help satisfy. It is a matter of compassionate awareness and discernment of both my own needs and those of the person who needs care. This gets to the core of how caregiving can either empower or dis-empower either or both the caregiver and partner in need of care. A few quick examples from my own experience with my wife may help illustrate:

1. Simply asking – The occasional “Is there anything I can do for you right now?” or “Is there anything you need?” has value in itself, regardless of the answer, because it shows you are engaged, caring, attentive and willing to help.

2. Over-asking – Asking too often has the opposite effect. And I do this sometimes. It means that I’m worried, anxious, distracted, fearful. It’s about me and my needs, not her needs. I can’t be truly engaged and caring in a selfless way if I’m dealing with my own anxiety, fear and discomfort, and then projecting it onto her — the person who doesn’t need to be burdened with “my stuff” while she is dealing with her own pain, fatigue, discomfort, fear, depression, etc. (which I’m supposed to be helping with).

3. Anticipating – Anticipating a need validates a level of connection or closeness that can be reassuring of the underlying bond between the partners in healing, like truly sensing and then asking, in order to validate, “Do you need more pain medication?” or “Do you need something to drink?” If accurate and appropriate, it can be a very powerful way to reaffirm that you are in-sync and “in it together,” which strengthens the bond between the caregiver and partner in need. But don’t guess about someone’s needs. At best, getting it wrong can be off-putting; at worst, it actually can be alienating (e.g., “Wow, he really has no clue what I really want or need”).

4. Just “being with” – When my wife asks me, “Sit with me for five minutes,” I now know that it is an honor, not an imposition, even if I am in the middle of work (fortunately being able to work at home most of the time). She needs my true presence. If I’m not really paying attention and living in the moment with her, I can mistake this for something else and ask, “Why? What do you need?” That means I wasn’t really listening: she expressly told me what she needed, and I missed it.

As a male, I sometimes default more to my human doingthan my human being. If I can recognize and put aside my innate desire and need to “fix it,” to “do something for” her, then I’m more likely to be able to understand and accommodate her need to just have me close by. It doesn’t mean anything more than that — not that she wants some deep conversation or intense sharing. It may just mean sitting with her while she watches what I think is a silly tv show. It doesn’t matter. The point is to really “be” with her. And, when I can do it, I realize that I need that at least as much as she does. It empowers us both.

5. Self-care – This really is the pre-condition for all of the points above. Martyrs can’t be good caregivers. The paradox of care-giving is: if you don’t first take care of yourself, you can’t hope to meaningfully and effectively care for another. This means eating right, getting enough sleep, exercising, staying balanced and grounded, and only then being able and open enough to truly serve another, which will empower and benefit both of you.

Copyright © 2009 Joseph Kornowski

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The Living Matrix – New “Field Work” in Energy Healing and Informational Medicine

Posted May 25, 2009 by Joseph Kornowski
Categories: CAM Research, Energy Medicine, Mind-Body, Spirit
Tags: , , , , , , , ,

Last week, I attended the U.S. premiere of The Living Matrix, a film about some of the innovations that are expanding the boundaries of alternative medicine. While presented in a style and format very reminiscent of What the Bleep Do We Know?, Living Matrix is a much more focused and serious film that takes a thoughtful look at mind-body medicine and energy medicine, including selected older (Neuro-Linguistic Programming, placebo effect) and newer healing approaches (Nutri-Energetic System, Reconnective Healing, Emotional Release Therapy), against the backdrop of leading research in biofields (or body fields) and informational medicine.

Anecdotal recreated stories of various healings, animations, and interviews/narrations by some of the pioneers in energy/information medicine research and modern clinical approaches lead the viewer through a thought-provoking, and almost dizzying, tour of some of the latest thinking and available treatments.  For me, it brought a progression of inspiration, frustration and resolution.

First, I was inspired, both by the possibilities presented in the film itself and by the members of the audience who had brought their own hope and enthusiasm to the small downtown theater on that night to form an ad hoc community of kindred spirits.  I could feel the courage and eagerness in the audience during the film, and hear it in the questions asked afterwards of the panel of some of the participants in the film — from those looking for answers to personal or specific medical problems for which conventional medicine had not provided satisfactory answers, from practitioners of various CAM treatments or approaches, from researchers, and from others just curious and interested in learning more. The woman sitting next to me told me that her energy healing teacher had told her about the screening; the woman said she was also a reiki practitioner. I didn’t bother telling her that I was, too (I probably could have tossed a Milk Dud anywhere in the theater and hit another one).

Second, I was frustrated on several levels. The film, itself, seemed to be limited in its focus to just a handful of the newer manifestations or approaches in energy medicine (see NCCAM’s definition here). Also, the various researchers and practitioners who were featured in the film used various terms — body fields, biofields, information, energy, virtual particles, quantum theory — in ways that often were confusing or overlapping. It made me realize that we don’t yet even have an accepted taxonomy for the various phenomena that we’re talking about when we try to discuss this type of CAM (even “CAM,” itself, seems so inadequate and misleading at this point). So, it was a reminder that, despite the new research and approaches being featured in the film, this field has not progressed all that far in key areas since the early days of homeopathy, qi gong and reiki. In that respect, I think my own frustration was rooted in impatience at the slow pace of scientific validation and broader mainstream acceptance of even those more established practices, let alone the new ones.

Finally, I somehow had a renewed sense of resolve as I left the theater, maybe as a result of both the inspiration and frustration I experienced. Participants in the film including Marilyn Schlitz, President of the Institute of Noetic Sciences, and Rollin McCraty, Director of Research at Institute of HeartMath — both of whom were on the live panel that evening to answer questions– are doing cutting edge research on consciousness and healing. There is a palpable excitement in hearing what they’ve learned and knowing that you are involved with something of great potential that is still in its infancy in our culture or — perhaps more accurately, as some argue — part of a new shift in our consciousness, a tipping point in our individual and collective awareness, that will open up new possibilities.

In the week since I saw the film, I have read Dr. Eric Pearl’s “The Reconnection” and spoken to a local practitioner of Reconnective Healing, scheduling a session for my wife. I don’t know what to expect or where my ongoing explorations will lead. I just know that I have a role to play, and I am committed to its continued unfolding and willing to explore its unimagined implications.

Copyright © 2009 Joseph Kornowski

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The Global Impacts of Caregiver’s Heart-Mind

Posted May 15, 2009 by Joseph Kornowski
Categories: Caregiver Awareness, Empowerment, Energy Medicine, Meditation, Mind-Body, Technology
Tags: , , , ,

A national demonstration project in the summer of 1993 showed that a group of up to 4000 Transcendental Meditation practitioners in Washington, DC, successfully lowered the violent crime rate in DC by 48%.

Today, projects like the Global Consciousness Project and the Global Coherence Initiative are seeking scientific validation of the effects of large scale group consciousness on the physical world by examining the subtle correlations that may reflect the presence and activity of consciousness in the world.

These initiatives are based on the hypothesis that: (1) the heart radiates the largest rhythmic electromagnetic field in the body; (2) that field radiates outward from the body; and (3) that field includes encoded emotions. By shifting our emotions to be more appreciative, compassionate, caring, giving and loving — what I think of as “caregiver’s heart-mind” — we create a more positive state of heart-brain “coherence” that is embedded in the heart’s electromagnetic field and that can create positive impacts on those around us and the planet itself. The way this works is explained further by Rollin McCraty of the Institute of HeartMath courtesy of the Institute of Noetic Sciences in the video below.

As stated by the Global Coherence Initiative, “GCI researchers’ goal is to show that massive amounts of positive coherent energy can influence global consciousness in positive ways.” Ultimately, GCI seeks to unite people “in heart-focused care and intention … shifting global consciousness from instability and discord to balance, cooperation and enduring peace.”

GCI currently is seeking to take the next step toward this goal by acquiring a search-coil magnetometer and amplifier for creating their global coherence monitoring system, at a cost of $8,100. Those wishing to donate toward this effort may do so here.

Copyright © 2009 Joseph Kornowski

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Harmonizing the Voice of Fear

Posted May 8, 2009 by Joseph Kornowski
Categories: Caregiver Awareness, Empowerment, Mind-Body, Self-Care, Technology
Tags: , , , , , , , , ,

As a family caregiver, I’m constantly afraid. My short list of fears includes:

– my loved one’s death;
– my loved one’s suffering;
– the prospect of living in a world without her;
– losing hope for my own future resulting from unfathomable grief, sadness and despair;
– not being able to do my best for her day to day; and
– something bad might happen if I leave her alone for too long.

There are many more. In fact, the list probably is infinite, but not because I’m consumed with fear. Instead, I’ve recently come to recognize that my fear is a natural and normal part of me, of what it means to be human. More than that, I think I’m finally learning to accept and even embrace my fear. I used to think that fear was a source of embarrassment and shame. That notion is subliminally embedded in our minds by our culture as illustrated by bravado movie lines like “What?! Are you afraid???!!!”

But the honest answer to the question should be, “Yes! Most of the time, in fact.” Fear needs to be both appreciated and respected, not denied as a shame or an embarrassment. Fear protects us, steers us out of harm’s way, reminds us of our mortality and fragility when our stupidity and excitement otherwise might send us over a cliff before we are old enough to spell “cliff.”

In his book Big Mind – Big Heart: Finding Your Way, American zen master Dennis Genpo Merzel discusses what he calls the “voice” of fear in us. When we isolate that voice and dialog with it, Genpo Merzel tells us, we learn that its function is simply “to be afraid” because “there’s a lot to be afraid of” when things seem constantly out of control, and everything is constantly changing and can’t be depended upon for any length of time. Fear reminds us that nothing is really as stable, secure or comfortable as other “voices” in us would like us to believe. That is fear’s job — all the time. And that is very healthy and helpful for us.

My own short list of fears above has saved my loved one’s life a few times already because I was vigilant and observed when she didn’t look or sound right, and I knew that I needed to get her to the hospital right away. My fears concerning her also compel me to examine pills whenever she gets a refill; I discovered the wrong medication in a regularly refilled prescription once. Fear makes me diligent about keeping a medication list for her, recording when she takes her meds in a medication log, learning what signs and symptoms should be cause for seeking immediate medical treatment. Fear has been a good motivator and ally.

The point is not to ignore, deny or minimize our fear. Our goal should be, first, to understand it and then to see how we can use it to our best advantage. Like fire or nuclear energy, our own fear is powerful in ways that can either be useful or destructive.  If we don’t accept our fear, understand it, and learn how to handle it properly, then we are more likely to be injured by it.

Where we get into trouble is when we allow the “voice of fear” to run the show, to drown out the other voices that need to be heard in a given situation. We know how easily it happens. The voice of fear sounds more like an ambulance siren then the hushed calm tone of a golf announcer. Again, that’s not a bad thing; fear’s job is to get our attention, to warn, to alert us.

What we need to do is make sure that all of our other “voices” know fear when they hear it and continue to do their jobs rather than running and hiding when they hear fear’s siren wail. That is exactly what Captain Chesley ‘Sully‘ Sullenberger did when he landed his jet in the Hudson River with no loss of life. He had trained to develop that very skill, which pilots call “deliberate calm,” to “ignore their fear when fear isn’t useful and … to make quick, complicated decisions in the most fraught situations.”

It requires self-observation, an awareness of fear, an understanding of when it has done it’s job and when it is time for another aspect of us to take over. I noticed myself doing something similar about the third or fourth time I had to call 911. My voice sounded calm and steady; I knew what information was needed, what to expect, and how to optimize the result of getting my wife the immediate attention she needed.  I had learned to “borrow” the calm of the paramedics arriving on scene as they efficiently went to work to do what needed to be done. Granted it wasn’t their loved one needing emergency medical help. But watching them, paying attention to what they were doing and how they were doing it helped me detach enough from my fear to actually be helpful rather than incapacitated by my own fear.

But that’s acute or emergent fear. It’s infrequent for most of us, and usually temporary. So, what about the more chronic fears like those I listed above — the ones that can get in the way of eating right and sleeping well over extended periods, and thereby make me a less effective caregiver?  This kind of fear manifests as on-going stress. Again, the key is to make sure other situation-appropriate “voices” are able to do their jobs once the fear or stress gets our attention, is acknowledged but then no longer needed.  Put another way, the voice of fear needs to be harmonized with our other voices.

Fear-driven stress can be harmonized with other aspects of us through training and skill-development, just like the airline pilot’s “deliberate calm” in the face of acute fear.  That stress-reduction training can come from practicing ancient techniques like meditation, reiki or yoga; or, it can come from practicing with new technologies like the Institute of HeartMath’s emWave device – or some combination.

A recent article in Cancer Fighters Thrive Magazine illustrates how a cancer patient’s fears about chemotherapy and radiation treatments were transformed by an integrative approach utilized by the Cancer Treatment Centers of America that included mind-body therapies such as guided imagery and HeartMath’s heart coherence technique.  Once we begin to self-observe, acknowledge our fear, and understand it’s appropriate purpose, we can then train ourselves to develop the skills that will empower other needed aspects of us to tell our fear, “Thanks! We’ll take it from here.”

Copyright © 2009 Joseph Kornowski

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Are Perceptions Changing Our Genes?

Posted April 24, 2009 by Joseph Kornowski
Categories: Empowerment, Mind-Body
Tags: , ,

Epigenetics is providing new insights about the role of the environment, and how we perceive it, in changing the way our genes are expressed.

As Bruce Lipton explains this new understanding of the role of genetics and disease, “Our illnesses are not necessarily programmed in our genes, but they are responses to the way we perceive our environment.”

The potential implications about the importance of positively changing our environment and, perhaps equally important, our perceptions about it would seem to be profound. Perhaps the science is suggesting we have more power to change the likelihood of developing certain kinds of illnesses than we have been led to believe.

© 2009 Joseph Kornowski and Integral Caregiver.

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Twitter Versus the Compassionate Brain

Posted April 14, 2009 by Joseph Kornowski
Categories: Caregiver Awareness, Technology
Tags: , , , ,

New research findings confirm what most of us have long suspected about the phenomenon of “too much information” coming at us too fast.  A new University of Southern California study shows that when information streams to us too fast, such as through television news or online feeds from social networking sites like Twitter, the brain’s “moral compass” cannot process it.  As noted by researcher Mary Helen Immordino-Yang in the CNN story, the findings suggest that, “‘If things are happening too fast, you may not ever fully experience emotions about other people’s psychological states and that would have implications for your morality.’”

The brain scans of study participants showed that the brain very quickly processes and responds to indications of physical pain in others, but showing admiration of compassion took longer. The researcher noted that the study raises questions about the emotional cost of relying heavily on fast-paced information like news snippets and online feeds.

It makes sense. I can remember the days of television news before the now-pervasive “crawl” at the bottom of the screen (text data), while a news reporter provides verbal information (audio data), and a smaller video streams live footage (visual data) — all running simultaneously on the screen — bombarded my senses. Add to that the multi-tasking of mobile phone texting, IM, and online feeds from Twitter, Facebook, and similar social networking tools, and the brain seems to be spending a disproportionate amount of its processing power just dealing with the relentless sensory input.

We seem to be watching more, but seeing less; listening more, but hearing less. Where do we find the space, the room, inside ourselves for reflection, for contemplation, for discernment, for the kind of deep thinking that allows us to really see connections between ourselves and our world, to hear the cries for help, to understand the need and the implications, and heed the call to be of service?  Contemporary zen master Dennis Genpo Merzel’s observation seems more true than ever: “Our eyes and our mind are usually focused outward, on externals. Our blind spot is what’s behind the eyes“ [Big Mind - Big Heart].  And we should be concerned about its implications for the future of caring and caregiving, both individually and as a society.

It’s ironic that Microsoft’s new technology enabling us to manipulate digital content by using natural motions, such as hand gestures, or physical objects is called “Surface.” That’s exactly where our senses are focusing our lives.

© 2009 Joseph Kornowski and Integral Caregiver.

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