Paul's Heart

Life As A Dad, And A Survivor

The Power Of The Living Directive


There are two things that make us squirm to talk about, death, and how to prepare should something go wrong during an illness or injury.  We go through life assuming, or perhaps just wanting to ignore the realities, because, “that kind of talk is for old people.”  I know that is the way that I thought, even having gone through cancer.  I was immortal, or at least for as long as I could tell, for decades to come.

That thinking changed obviously in 2008 with my heart surgery, and the realization that it was likely I would face many other challenges to my health.  I could no longer make it about my age for my reason to put off the discussion of preparations.  I got lucky the doctors saved my life while I was in the grips of a silent killer, a “widow maker” cardiac event.

For the sakes of my children, I needed to not only have a will for if I died, but a living directive if something would go wrong with any procedure or any kind of event.  Time was not going to wait for me to get old.  For me, it was fairly simple.  I made it very clear, no artificial means to keep me alive, and not to let me be in pain.  I have had to make some changes in both will and living directive following my divorce, but I have kept everything pretty much the same.  I am not a complicated individual.

For others, this may not be the case.  When my father was in the process of being diagnosed with lung cancer, he made the decision to make me his medical proxy.  He did it for two reasons.  One, my extensive history and experience with medicine (in spite of not being a doctor), he knew I would be able to explain things to him clearly, as well as help him to express what he needed to have explained.  The other, having watched both of his parents suffer in their ends, he believed in me, that I would not let the same thing happen to him.

This came at a personal cost for me, because, being in that position, I could not allow myself to feel any emotions that might jeopardize anything my father wanted to happen, or not happen.  This loss of emotion admittedly makes me realize I can have quite a cold personality in situations like this, almost robotic.  But when my father was in his best mind, he made it clear to me, what he wanted, and what he did not want to happen.

If you are hospitalized, or having to go through any medical challenge like cancer, you are likely to face these life and quality of life decisions.  As I said, I have things in place.  But recently, I came across some information, once provided to me years ago, called “Five Wishes.”

This pamphlet is a very well thought out document, to help plan out the “what if” so that there is no mistaking what a person’s wishes are.  I know my personal physician has disagreed with my directive in that I have made it too simple, too black and white.  But it is how I feel.  Don’t get me wrong, I do not plan to be in that situation anytime soon.

Five Wishes is a form of living will that talks about your personal, emotional, spiritual, and medical needs.  The one thing that this form makes the author aware of, is that there are still some states that will not recognize the document or your wishes.  That is a big deal.

The first thing necessary to do, is like my father chose, someone to make decisions in the event he was not able to do.  This is a big deal because that representative has to put all personal biases and beliefs aside to respect the wishes of the patient, no matter who it is.  And that is a big deal, it does not have to be a family member either, as family members, not me in my dad’s case, can be too emotional when it comes to decisions.

I will tell you, the hardest part for me to get family and others to understand, was when the time came, to stop giving him access to certain maintenance medications (like for cholesterol, etc.).  Because legal decisions had to be made in his care, handled by my stepbrother, insurance changes to allow my father and stepmother to be in the same care facility, and the fact that he was going to die, made these medications unnecessary.  But other challenges would come if a serious illness like pneumonia were to develop or some other issue.  It was difficult for others to understand, there would be no treatment, to prolong his inevitable passing.  A simple concept, not to allow him to recover from one illness, to eventually suffer as the cancer spread causing more pain than what could have spared him.

There are a lot of other responsibilities that this advocate must take on.  Keeping the emotions in check is not only necessary, but unavoidable because of all of the responsibilities.

You should decide what efforts or treatments are done to keep you alive.  This is where my doctor and I sort of disagree.  The two most common terms you quickly become familiar with are DNR (do not resuscitate) or being put on life support.

With Covid19, this becomes a very difficult reality for me.  I have made it clear, I do not want to be kept alive on life support mechanisms.  But if I were to contract this virus, because of my frailties, there is more than a good chance I would end up on just that because of what the virus does to the lungs, which mine are compromised.  It then becomes a choice if the life support is used to save my life, versus sustain it.  But my directive says what it does.  Therefore, I need to avoid this virus at all costs.  Needless to say, a fatal end caused by this virus, your five wishes mean nothing.

Two other aspects or wishes pertain to the humane aspects of this directive, comfort or quality of life, and what is expected from others, especially loved ones.  From medicines to control pain, to location of where the passing might occur, and the overall atmosphere of those around the ill person.

The final wish deals with the patient themself, and what they want their loved ones, family, friends, and in most cases, their caregivers to know.  These can be kind words, actual gifts, perhaps asking for personal differences to be resolved before passing, and of course, post end of life plans.

No, this part of life is not easy to talk about, let alone go through.  And there is no minimum age that is required.  Though definitely as you get longer in the tooth, it definitely becomes a priority.

Adopt! Don’t Shop!


It is perhaps the best slogan/advertisement.  Easy enough to remember.  Just three words, “adopt, don’t shop.”

I got triggered this morning, because of all ads to appear on my news feed, is the advertisement for a new pet store that is opening today.  In general, I am not opposed to pet stores, just those that sell dogs and cats.  And this is one that does sell those cute and cuddly kittens and puppies.  It is also a chain of stores.

I am not sharing a snapshot of the advertisement because I do not want to draw attention to their disgusting business.  But I noticed something when I responded to the ad, with an angry emoji, and an explanation of why pet stores that sell pets really should not be in business, a sentiment echoed by others on that same ad.  Later in the day, the comments and ability to “like” or dislike the ad were turned off and the negative comments were removed.  And then, more ads for the same store came across my feed, and before I could respond on those, as any advocate would do, the ability to comment was also turned off.  So far I count at least six attempts for them to try and get some positive exposure.  But as I mentioned, this is a chain store, and that means that people who had negative experiences will share those negative experiences in any perspective new locations.

Instead of just facing on the criticism, the most frequent complaint, selling puppy mill puppies, their first line of defense is “deny, deny, deny.”

Semantics is defined by Websters as the “language used to have a desired effect.”  In other words, pet stores deny that they buy from puppy mills.  And technically they would be correct.  Except they have a middle man called a broker.  This broker goes from puppy mill to puppy mill, then sells those cute and cuddly puppies to the pet stores.  Semantics.

How can I prove this?  Simple, I went through the experience.

This was Pollo, an eight week old Golden Retriever.  OMG he was so cute and cuddly.  I really had no business going into the pet store in the first place.  I was leaving on a week long trip in two weeks.  Really bad timing.  But he was sooooo cute.  I had to have him.

Pet stores know what they are doing.  They know we cannot resist puppies.  Why do you think people avoid walking into animal shelters, because they know there is a good chance they will walk out with a rescue, because we have hearts and empathy.  But to be able to get a puppy and start from the beginning?  They are just so cute!

And then, if you are unfortunate, you find out there is an ugly truth behind where he came from.

Pollo loved the water.  At around the age of six months, he experienced an episode that I ended up carrying his limp body into the vet hospital.  I never did find out what happened to him, but he did recover.  To help the vet, I figured it would be helpful if I got the health history of his parents and I approached the pet store for his vet records.  That is when I ran into an unbelievable roadblock and in the end, discovered that Pollo came from a puppy mill in the Lancaster, Pennsylvania area.

This is not a photo of the exact Amish farm that Pollo came from, but it is very similar to the image of where he came from.  I know this, because of my efforts of involving the USDA, the Pennsylvania Department Of Agriculture and Dog Warden, journalists and more.  As we got close to the truth, circumstances got bizarre in that evidence of any puppy activity had been relocated, we would later discover to another family member, a common tactic to avoid regulation and discovery of these awful conditions.  All because the pet store fought me on some simple and basic information.  The pet store, Pollo, and I all ended up on People’s Court over this very issue.  Needless to say, they lost.

Other than that one fateful day, I enjoyed nearly fifteen years with my best friend, known affectionately as “the Happy Golden,” a nickname because of his non-stop wagging tail and always giving the appearance of him smiling.  My fur family member went to the Rainbow Bridge nearly seven years ago, breaking my heart, but not my resolve.  I am unable to have another dog yet, emotionally.  But I will still advocate for awareness of the need to adopt the many pets that are abandoned, lost, or even rescued.

It has been a long time since I got involved in this effort, the last time happened when that same pet store opened a new location where I was living previously.  But as this new pet store is opening today, with lots of fun and excitement, and get this, $500 off the price of a new puppy.  THIS IS DISGUSTING!!!!

The puppy mill industry is a billion dollar industry for the Amish and other groups.  And the more puppies you buy, the longer they are all just too willing to meet the demand.  Remember the picture above.  I have seen situations way worse, and it is only because of pet stores selling their merchandise.  Stop buying puppies from pet stores, and the demand stops.  It is that simple.

There are all kinds of ways to adopt pets, even puppies if that is a requirement.  There are animal shelters, humane societies, and even breed specific organizations.  There are so many ways to adopt a wonderful fur friend who has been abandoned or lost, unable to be found by its owner.

But the demand needs to end for puppies from puppy mills, and that starts with stop buying dogs and cats from pet stores.

Living With Survivor’s Guilt


Have you ever had one of those moments, either walking or driving by someone or something, and your head snaps back because you thought you saw something but were not quite sure?  That is what happened to me yesterday.  I was flipping through television channels, a skill that I have mastered, knowing I only have to spend less than a second to know if it is going to be something that I might be interested in.

The man pictured above had survived the worst that Covid19 could do to him short of dying.  He experienced the Acute Respiratory Syndrome (ARS, the pnuemonia diagnosis normally fatal) as well as sepsis, which by itself is fatal.  At the age of 37, he spent weeks in the hospital.  In his interview, he says, “the hardest part for me is seeing how many people die from Covid19, why did I live?  And everybody else died.”

This emotional issue is called “Survivor’s Guilt.”

There are two myths about “Survivor’s Guilt.”  The first, often this term was used for those who had served in the military, previously called “shell shock”, “battle fatigue,” among others.  But at some point, during the 1980’s, some events in our history resulted in people having survived natural disasters dealing with emotional survival issues especially when there were mass casualties were associated with it.  And then, upon the completion of my cancer treatments, though not diagnosed officially until 2008, I developed what was definitely called “Survivor’s Guilt.”

Myth number two, just because someone experiences “Survivor’s Guilt,” does not mean they wish that they had not survived, want to die, or are ungrateful.  Quite the contrary.

I first can trace my Survivor Guilt issue, to the first cancer patient that I counseled following my cancer treatments.  She was a fourteen year old girl at the time, and she had the exact same cancer that I did.  I have her story, called “Jennifer’s Story” on the page section of my blog.  But in summary, she would not survive her Hodgkin’s Lymphoma.  She would never hear the words remission.  And as I visited with her over the three years, I often sat across from her mother while visiting with Jennifer, wondering what might be going through her mother’s mind as I sat there, cured of the same cancer her child would die from.

Jennifer was the first experience I had with survivor guilt, and I would have many more experiences like this over my thirty years.  And it would not just occur with Hodgkin’s Lymphoma directly, but the first half of my thirty years of survival were issue free, whereas so many I knew were dealing with harsh late developing side effects, but not me.  Some would die as well from those issues.  And then of course, I would join that club of long term survivors with late effects, and deal with at least four issues that were serious enough to cost me my life if not dealt with promptly and correctly.  And yet, here I am, while other survivors did not survive theirs, and of course, still other Hodgkin’s survivors as well not making remission.

“Why do I live, when others die?”

Make no mistake, I am definitely glad to have survived all of these years.  I have been blessed with two wonderful daughters and watch them grow, and I even count on being able to see many of their adult years.  I believe that I have a good team of doctors and specialists, and just as important, a support network of survivors that no one could have imagined back before the 1990’s and the internet.

I just wish that every one  that I crossed paths with, could have had that same opportunity as me.  And I cannot make those feelings stop.

It took a therapist specializing in cancer survivorship to explain “Survivorship Guilt.”  I spent years in therapy for this, to discover that there were other issues associated with my cancer journey that complicated things.  And then there was life as well and the many issues that came up.  Soon, my cancer issues and survivor guilt often found themselves taking a backseat to employer related discrimination issues, other family member medical issues, family deaths, and divorces.  Sure, those not going through cancer, deal with all of those issues on a daily basis, some deal with all, some maybe one or two of the issues.  But when you throw in cancer, survivorship, and it effects, it really complicates things, and that is when peer survivors and professional therapists make a difference.

But wait, “do you mean seeing a shrink?”  Right, that stigma and stereotype, only crazy people need to see a psychiatrist.

I promise you, there is not one survivor I know, or have ever known, who has had the counsel of a therapist that would have matched the stereotype or deserving of the stigma.  Some of my fellow survivors find it sufficient just to relate with another survivor, but some have feelings much stronger, and I encourage anyone who feels that way, needing more than their peers, their friends, even their significant other, to seek out a therapist.  It really makes a difference.

I still have my survivor’s guilt after thirty years.  I have said goodbye to so many.  But I have so many that remind me every day, that there is a reason I am still here.  Because I offer them the same support, and remind them of the same things, that there are so many that depend on our survival.  Until any of us possess the power to make the sun rise and set, form ocean waves, or make snow fall, we just have to accept that things happen the way that they do, just because.

But there is going to be a new large population of people who are going to survive this horrific virus, Covid19, and because of how contagious it is, many are likely to lose loved ones and friends.  And like the gentleman above, left to wonder why them, and not the others.

As a country, we need to do better to offer better emotional help not just to those with the obvious issues, but also those who survive traumas whether it be war, a car accident, a natural disaster, cancer, or a pandemic.  There are too many of us that struggle with this to just be forgotten to deal with on our own.

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