Archive for the ‘Health’ Category

Delayed new year’s post…

February 10, 2017

In this time of New Year’s resolutions and personal industry, I am taking advantage of the first snowstorm of 2017 to take things down a notch.

A perfectly timed storm, leaving space on the Saturday morning for exercise and last minute grocery shopping before the bulk of the light snow came drifting down, and we were able to move our dinner plans to next Saturday. This opened space for an afternoon of projects (the kind that take four years and a half hour to complete) and the leisure and joy of preparing food for our friends’ annual Epiphany party.

People are asking about intentions for the New Year, what changes and shifts have risen to the surface to establish priority on the grand To Do list of the year. I support this notion, despite Mark Twain’s declaration that this week’s New Year’s Resolutions will be used next week to pave the path to hell. It is important to live with intention; without a sense and description of what that means to someone personally, it is easy for life to ooze by without ticking off even the top items on the bucket list.

However, in order to establish even a preliminary idea of what is most important to achieve in life, there has to be some quiet time, some space to allow in the scope of possibility, let alone which of those possibilities are fitting for a particular person at a specific time in the continuum of the lifespan. And the ideal time for reflection is now, in this time when light is shortest, and it takes the most effort to be out in the elements. So have we set ourselves up by choosing the most inwardly spacious time to set immediate outward goals?

I’ve realized how much courage it takes to be still. I enjoy being busy, as many people do. I’m fairly organized, so generally feel like I can make good use of my time, but it is more challenging to let time drift. It is only in the leaning into the mystery that true answers emerge. They are there within, but we must open the window to beckon them forth. They cannot be forced, but slip out when we are looking the other way, and take shape only when we return our gaze upon them.

Our current rescue dogs are also a lesson in patience combined with diligent and intentional setting of messages. There is no rushing them. When they are fearful, we cannot demand that they stop being afraid and simply come and be scratched behind the ears.The rapport must come as we make the time to spend together, and keep the promise of walking regularly, and keeping their food bowls filled.

So, too, our psyches are willing to part with what often lies dormant while we work, watch TV or check our Facebook feed. I know this to be true, and yet I still find it challenging to ensure that my day involves time for the avenue to be swept clean so that my deepest utterances may make an appearance.

What am I afraid of? Surely there is nothing there that cannot be spoken. It is alway my choice to act upon what I see or believe.

In this year of 2017, I am asking myself to do less, so that when the important and surprising newness comes a calling, I am ready to let it in and act upon it should I so desire.

Yoga on my mind…

December 13, 2016

Although I have practiced mindfulness for over thirty years, I have not instituted an active yoga practice until the last couple of months. For years I have been asserting that yoga would be a great addition to my winter Zumba and dog walking regiment but it took my daughter’s discovery of New England Yoga to get me to the studio.

I was immediately comfortable in the open space with high ceilings and skylights, and even on the occasions when there have been twenty people there I have not felt claustrophobic.

I seem just a tad competitive with myself about being able to do the positions. However, there is no rushing this. One cannot (mercifully) force a split. I cannot even pronounce most of the postures yet, but I know that I will eventually be able to discern a Chattanooga from a chaturanga. I mostly don’t even mind being a beginner. Everyone has aspects that are easier and those that are more challenging. Some can make spectacular pretzels out of their arms, but their legs will not succumb to such a mold. Others can stand on their head quite handily but cannot easily balance on one leg.

It is a relief to have someone else leading the session, making it a place I am responsible for no one but myself. I have caught not a single person smirking, snickering, or most likely even noticing let alone caring whether my palms are flat on the floor. I am certainly too preoccupied with my own efforts to give a hoot about what anyone else is up to.

Each of the instructors is professional and encouraging. He or she might correct a hand or foot position (for which I am grateful) or help me stretch to the next level. I love that some of it is out of reach. It gives me more to look forward and aspire to, even when I am frustrated that I am not there NOW.

On Sundays, Sue Pendleton, the owner, brings Singing Bowls and at the end of the 75 minute session, she induces magical harmonics by running the baton around their edges. Their sounds shimmer and glow, deepening our collective state of rest and meditation, particularly after sweating through the contortions the class requires. Sometimes she will strike the three large gongs at the very end, whose resonance continue to reverberate, fostering the peace that falls over the class. There is a discernible shift that happens as we all settle and let the rest of our lives drift on their own for a little while.

My daughter is surprised that I am hooked. I guess I am too, but I cannot get around the fact that much as I like to bicycle or Zumba my booty through an hour, my body is benefitting from the strength and flexibility that is slowly building from yoga. I have not yet completely coordinated my breath to all the movements, but I can see where this will also serve to sharpen the focus and my practice.

It is all humbling. We support one another by showing up, by doing what we can on any given day and by following the instruction of the teacher whose experience and tone set the course for class. This is an addiction I am happy to pursue. Turns out all those folks across the millennia had some remarkable notions about the body/mind/spirit connection. If only I can follow them.

A new way to view Pinktober

October 7, 2016

I recently commented on an online status of an artist friend who stated that she had been accepted to participate on Top Chef. I was startled and surprised, but given her immense talent as an artist thought it completely plausible that she might have hidden talents as well, and commented this.

Hours later she sent me a private message that since I remarked on her status, she was obliged to tell me that she was not, in fact, accepted to Top Chef, nor did she have a squirrel in her car (something I missed in my excitement about Top Chef participation). Her posting was part of a Breast Cancer Awareness “game.” Anyone who comments is invited/encouraged to continue the hoax and post one of ten untruths including the above two, plus others as provocative as #6 “I’ve decided to stop wearing underwear,” or #10 “I’m getting a pet monkey.” They are all unlikely but to varying degrees in the realm of possibility.

I was puzzled and a little miffed at what I perceived to be a lack of connection to breast cancer. The ten semi-outrageous declarations range from delightful to mildly jolting and none carry the weight or depth of a cancer diagnosis. Certainly it would be cruel and in very poor taste to post untruthfully that someone was diagnosed with any disease, so I suppose this game was one way to evoke the element of surprise. It catches our attention, and we are willing to engage in discourse with someone who asks “#3 How do you get rid of foot fungus?” What then are we willing to discuss when we learn that someone we hold dear has been diagnosed with a serious disease?

Having been on the receiving end of the real thing, I know that there is no complete preparation for such news. No matter the process with ultrasounds or biopsies, there is not a way to stop the stomach dropping news to hear the word cancer in connection with your health. Although life goes into a surreal time warp, protracting and distorting the experience while waiting for next steps, it does in fact march on resolutely, leaving a bevy of feelings in its wake.

Now also learning about people’s responses to breast cancer through my psychotherapy practice, I know that people work through the shock and make decisions about treatment which are often not straight forward or simple. There can be similarities in diagnosis, but not in personal circumstances, or people can be of similar age and proximity to health care, but have radically different severity or type of disease. In addition, when someone has a lumpectomy and radiation, typically the least amount of treatment, she is still dealing with the psychological impact of working through an otherwise deadly disease and a near miss can provoke thoughts about one’s mortality, wishes for life, order of priorities.

A potential gain of the game is the community that Facebook can generate. In the face of upsetting news, the power of the group cannot be underestimated, but one must be ready, and in a position to receive the focus and attention.

If the Facebook “game” helps people to have more compassion for receiving unanticipated news, then the net result is positive, offsetting the confusion and clarification that inevitably ensue.Without knowledge of where the game was initiated or by whom, it is impossible to completely understand the intent. I will assume the head scratching that results is meant to help us all to expect the unexpected. At least they are not doing it in the omnipresent pink that also characterizes this month.

A nod to the nap

August 31, 2016

Summer is THE time to hone one’s skill in the Department of Nap. I have never been prone to this practical and invaluable skill, and I am trying to make some headway into this seemingly unbreachable fortress.

There is no doubt about the restorative properties of the Nap. It can mean the difference between a struggle through the evening and being able to greet it cheerfully. My husband has the capacity to snooze on demand, and while this may come with its own downsides, I wish to be able to call it up when the situation warrants, without fear of incoherence and disorientation upon awakening. Even in college when I would regularly play ping pong until 2 a.m., and then trundle out of bed for an 8 a.m. class, I could not dally in Dozeland during the day.

Lately, I have found that Nap comes looking for me the day after I have been up in the middle of the night for some time. I have tried to infer some correlation between what I have poured down my gullet and any subsequent wakefulness, and have eliminated caffeine, meat and most dairy from my feed. Add in a couple hours biking and swimming and this typically ensures a pleasant forty winks, as long as it is also cool in the bedroom. My primary care physician describes sleep as becoming more fragile as we move through the life cycle. I like this description, as it suits so well. If I have set the stage properly, I generally enjoy my six-seven hours of z’s even with brief forays to pee if I surface. I have also learned not to sweat the times when I’m wakeful from 1-3 a.m., but instead try to enjoy the quiet, and get in some needed reading that I have missed from the day.

I’m not taking this lying down. I realized that this occasional night wakefulness has actually paved the way for my budding expertise in the area of the Nap. Interrupted night’s slumber, plus full workday or workout and voilà! We’re talking droopy, unplugged and battery reset kind of siesta. No lightweight catnap. Nothing to snort (or snore) about.

Philip Roth advises napping to be embraced so completely that one changes to pajamas and snuggles beneath the blankets to more fully take advantage of this delicious passage. I worry that this extreme measure will catapult me into a full on two hour bout of unconsciousness which will then TOTALLY wreck any hope of shut eye at night.

So I’m starting small. During my week on Cape Cod, after a walk through the dunes and a late lunch, I managed not once, not twice, but three times to have a tėte à tėte with the sandman while parked on a sun saturated lawn chair overlooking the ocean. Each time thirty lovely minutes elapsed before I could utter chocolate fro-yo and I found myself only slightly discombobulated and full of energy for voicing my opinion about dinner options. How soon, what to make, what kind of music to accompany.

Ah, Nap. You’re within my grasp. Soon it will not be just during movies that you ask me to visit. Soon it will be my choice to ask for your elixir, your rejuvenating brain massage. If logs really do sleep well, I’m all for emulating them. Rest easy, Nap. I’m coming for you.

Death is not convenient

January 29, 2016

Death is not convenient. It does not wait, tarry, ask permission, or discriminate against age, race or gender. The place and time are a secret agreement with every person and are revealed in its own time, in ways dramatic and quiet, public and private, violent and peaceful.

When I learned of the death of my childhood friend’s father, I was saddened for him and his brothers and their families. I was coming off a long week’s work with meetings after work on Monday and Tuesday, a day long out of town conference on Wednesday and a ten hour workday on Thursday. So when I learned Friday morning about Herb’s passing, and the service on Sunday, I did not immediately assume I was going. It was over three hours away, and I couldn’t imagine it. Even though Herb was 91, it was a surprise for them, as he had been in fine health, exercising regularly, and still living at home.

By Saturday morning, however, with a more typical day on Friday, I couldn’t imagine missing it. This was the husband of my mother’s partner with whom she ran a school for 25 years. Their son, Seth and I were founding (and dominating) students at age three, and I had spent countless hours at their house growing up. We laid out under the stars, filmed movies riding their St. Bernard, or in pretend cars on their long, steep, winding driveway. We played the board game Shenanigans by the hour and wolfed down lunches Shirley cooked up before running outside again. This was my second home and it has become a museum for the family, displaying photographs by my friend who became an internationally renown photographer, paintings by his older brother and family photos of the past fifty years.

It was the end of an era for me, but mostly for the three sons who stood together as each spoke about the dedication and steady influence of their father who I didn’t know as well. Their arms on each other’s shoulders, they were a living representation of that steadiness and of the respect and love that infused their relationships.

The link to the future was evidenced in their children, ranging in age from 25 to 3, and as I watched them host a meal afterward in that historic home built in 1881, I thought about the joining links from parent to child, parent to child. Herb’s death marks a passage for them and others, but they will navigate this wave with the connection to each other, and perhaps the next time they collect from the corners of the United States will be a celebration: a graduation, a wedding or a birthday.

What will become of the seventeen room house that I remember as the most intimidating place to play hide and seek I could imagine? None of them live near there now. They are all ensconced in their lives in California or Florida.

As time warps, creating the topsy turvy disorientation following the death of a close and beloved family member I wish them time to sit with their thoughts, with the fullness of their feelings, and allow the length and breadth of their memories to float forward. May the waves of joy of a long life well lived waft in, smoothing the tearful bumps that will inevitably surface as well. Their straightforward relationships mean a deep wound that will heal cleanly with time. May this first holiday time bring some welcome distraction, if not quite yet the start of new traditions as they move forward in this next stage of life.

The Complexities of Healing

January 1, 2016

When I asked my physical therapist what she feels are the most important elements in healing, she responded first that getting the swelling down was key in allowing a person’s body to heal and feel less pain. I had been wrestling with factors like age, level of physical fitness prior to diagnosis or surgery, amount of support, expertise and connection with the person’s medical team, attitude toward healing and experience with and toward pain.

Another physical therapist mentioned nutrition, age and shape of the tissue prior to surgery (how long from time of injury to date of repair). I wonder about sleep, and its healing power as well. And of course though neither of them mentioned it directly, how much a person follows up on the exercises prescribed by her therapist will also make a difference, as will attending the therapy sessions. Neither can replace the other.

My massage therapist answered immediately that it is a person’s mental attitude that most affects outcome. That and how fit someone is prior to surgery. If a person is expecting to do well, she finds that they do. If someone goes into surgery expecting it to be terrible, then they often experience it that way.

It is a complex matrix of all of these factors and I’m fascinated by the interplay and balance of them, as well as how to stack the deck toward greater healing.

I asked my regular PT whether the protocol following the repair of the massive tear in my rotator cuff was based on the injury itself, or some other factor. She confirmed that it is indeed based on the injury itself, so a 20 year old woman would take the same steps as a 70 year old man. The older person might need more time, but the 20 year old would not be allowed to move more quickly than protocol dictates.

I understand the necessity of standards of care and that the team has experience with many many people in treating this injury and how the safest, most efficient recovery can happen. My therapist is not willing to risk further injury or compromise the repair just because I am eager to move ahead and I feel ready. My subjective experience of readiness must be weighed and balanced with my therapist’s knowledge. It is a challenge for someone who is active and impatient. Who wouldn’t want to feel better NOW?

As I gradually use my arm more, I must be mindful of not pushing too far. Because I have no reference point other than my own, I must be content with moving along as I have. What facilitated my positive outcome, and how can people benefit from this?

The way someone experiences pain, and level of fear is also relevant. Fear can get in the way of willingness to try something new or push a threshold. This can be helped with information. The clearer I am about what to expect, the easier it is to try something and push myself. Knowing the difference between discomfort that is in the service of stretching and healing and pain that indicates something one shouldn’t be doing is important to distinguish. Muscles getting used to doing new things can feel good, even if a bit uncomfortable at first.

The more we know, though, the better position we are in to partner with our health care providers in moving through surgery and recovery as quickly as possible. It requires paying attention, being aware of our bodies, and noticing the differences day to day, the incremental gains as well as the warning signs to back off. The dynamic, ever changing miracle that is the human body has never benefitted more from the interventions that medicine and the multiple therapies have to offer.

What’s in a Lash?

October 24, 2015

Eyelashes are not the most important piece of equipment that we carry, but their featherweight carries more import than initially meets the eye. Ask the beauty business who has created ways to enhance, elongate, thicken and now grow them.

I had always been fond of my eyelashes. When I was a kid, people would comment on how long and thick they were. I thought little of it; I had done nothing to make them that way and cared little for make-up of any kind, but liked them none-the-less. I took them for granted, assuming they would always be there, blinking back at me as I brushed my teeth every day.

It was not surprising when they became more scarce as a result of chemotherapy several years ago. My hair had exited; why not eyebrows and lashes? My hair has grown back, and looks much like it did prior to breast cancer treatment, but my eyebrows and eyelashes remain woefully scant. One sound piece of advice took care of the eyebrow problem. A woman whose son had undergone treatment recommended eyebrow color applied with a brush as the most natural looking fix. She was right, and this simple addition to my morning routine has added only the briefest amount of time. Well worth it, as there is something severe about the look without eyebrows; it’s alien, or skinhead, or something which does not feel like me. It calls attention in an uncomfortable way, which is reason enough for me to do something about it. Their absence makes much more of a statement than their customary presence.

I realized that I have been bothered by the lack of eyelashes, too. They make a difference. I used enjoy using mascara to bring back that full lash look. They actually do frame the eyes in a way that enhances them, makes them seem larger, stand out. I have been using eyeliner to help with this and avoid looking washed out, and that, too, adds a little to my morning rush. But recently a friend who had also undergone chemotherapy, and whose parents used to own a beauty supply business, said that she has used a product that is helping her eyelashes to grow back.

Now this was intriguing. The idea of tattooing liner had crossed my mind briefly, but seems a painful and not very creative way to venture into the world of tattoos. (Maybe not as painful as 20 lashes with a wet noodle, but still…)Fake eyelashes look unnatural. But the possibility of growing them back….now that sounds appealing.

No one is unchanged by breast cancer treatment. The physical alterations are an outer representation of inner shifts. I have been able to return to my former level of energy and activity and made peace with non symmetrical breasts. I embrace life as I always have, appreciate my loved ones and my ability to be present with others. But I have missed my eyelashes. Quirky as it is, irrational perhaps, it is a daily activity to glance in the mirror and know they are missing. If a few applications with a little lotion can be safe and without backlash, I am all for it. I am willing to pay a few hundred dollars for their passage here. Details matter, and if I can reclaim this connection to myself, I am thrilled to try.

A Young Life Lost to Drugs

August 20, 2015

We had last seen Garrett about ten years ago. He was a big, strong boy of 12 with lots of energy. My husband remembers that he swam across Long Lake, our local swimming hole around 2/3 the size of Walden Pond. The four kids in his family were members of the swim team which seemed a good fit for them. I remember thinking how these were the right parents to have four children. Organized, structured and loving, they channeled the kids’ excess zest into positive places. It took a lot of focus, and they were up to the task. Both of them came from big families, and their constellation of four was welcome.

Although we hadn’t seen the whole family recently, Bret, my husband’s close high school buddy, came to visit a few times. He told us that Garrett had had some trouble with drugs. We knew he had done some jail time, and had also taken the fall for a friend. He had been clean for 2 1/2 years when he evidently felt a pull for the drug, and took too much. Which killed him. We are stunned to think about a world without him in it.

We didn’t learn about his death until recently, and I’m not sure, even, exactly when it occurred. Bret had not had the space to make the call, and so we found out when my husband happened to pick up the phone to check in with his buddy. There are no words to adequately express the depth of sadness of a loss of this magnitude. Nothing can bring a child back, or a brother. Nothing can rewind the clock, or create another chance. The pain of losing such a young person runs deep; there is not a way to short cut the process of grief, or move through the dense brush of unreality and surrealism.

The family must rearrange themselves, reorient to a new way of living, of including their absent family member in ways that feel possible, doable, without feeling cloying, distantly unreal or false. They bore witness to his difficulties, and on some level may have known that with the way he behaved in the world, his largeness could lead to dramatic events, including the loss of his life. He was not a person of moderation by nature, so anything done on a big scale could tip events in unintended ways. But the searing truth of his loss must also stop them short, bring them to their knees at unexpected times. I feel the jolt.

Our hearts reach out to them. I know that their large families enfolded them, and held them close. We wish to do the same, sending them the wind to lift their wings as they navigate this unknown and frightening territory, whose landscape is so unfamiliar and without softness. The unpredictability of negotiating grief is always surprising, tipping our stable carts when we least expect it, upending the calmest of days and catapulting us into a whirlpool of transition. It takes time to resettle into a new rhythm, to reach a new equilibrium, and to recognize it when it happens. I wish for them to stay connected with each other, to allow their grief to join and not separate them, which sometimes happens. And I hope that they are not blaming themselves, or each other, as there is no winning from this. If love alone could give them solace, they would be consoled. If support could transform their sadness, they would no longer be sad. They must each make their own journey through the mire and choose what helps them. We can listen for the call, and be there with hearts and arms open.

And in the end…

March 14, 2015

My father in law died a few weeks ago. It was not a surprise, as he had been failing steadily for years, really and acutely for the past months. I was angry, at first, that he steadfastly refused to talk about his state of health. As much as a week before he died, when someone came to visit at the nursing home where he spent his last two months, he would immediately say, “let’s all go out to dinner!” even though he had not eaten more than a few bites a day for weeks, and could barely stand, much less remain upright and free of stomach problems through an entire meal.

I have come to see our close proximity and ability to be with him frequently for short visits as a privilege, and am grateful for his inadvertent teachings. I know beyond a doubt that he lived his life as he believed he should, which meant ignoring the extent of his multiple illnesses and level of needed care. His yearning to be home and doing what he loved best, watching political news on MSNBC with his beloved third wife, and prowling in the night for sweets kept him ever focussed in that direction.

It didn’t matter that when he procured his cookies and milk that he more and more frequently fell, necessitating a visit from the tirelessly cheerful EMTs, and sometimes a swing by the emergency room. It was only when one of these escapades resulted in a broken neck that we intervened and insisted that despite his wishes, he could not return home. This required some finesse on my husband’s part in convincing him of this, because even though most of the time at the ER my father in law was on assignment in some foreign land in 1996, at the time of his formal assessment they deemed him competent to make his own decisions.

We watched the love story unfold between my father in law and his bride of not yet three years, as she struggled to balance how much care he needed with how much he would allow. She would rest easy running out to the store knowing an aide was with him, only to return to find that my father in law had dismissed the unwitting young woman.

Ultimately it was not ever a question of what was right, but what was possible, and what he and we could endure. He had started on dialysis only a year and a half earlier, too late for it to really help a lot, but he did this because although he had previously refused it, he now wanted to squeeze every possible minute with his new love.

When it became obvious to health care workers and to us that dialysis was no longer working, but only driving an increase in hospital visits, discomfort and deep unease, we were able to cease the treatment, thus giving him a week of greater clarity and presence to be with anyone who visited. This gift to all was followed by a week of more agitated time, and finally the day he took a bite of steak, (and a sip of milk), greeted his wife with “I love you,” looked his son square in the eye, and took his leave. His way, his timing, his departure.

I will continue to ponder the choices we are all afforded, but it was clear to me that the most I could do for him was remain a peaceful, loving presence, wishing him the best the world had to offer at that moment, and for all moments going forward. I can only hope it was enough.

The human challenges of health care decisions

People say that physicians can play God. The same might be said of a health care proxy who must make decisions on behalf of someone who is no longer able to do this for him or herself. As I have watched my husband assume the role of health care proxy for his father, I am profoundly struck by just how intensely human a role this is.

We agreed that it made sense for my mother in law, who has been married to my father in law for not yet three years, to switch this job to my husband. She stated that she knows herself well enough to realize that this delicate position would be too difficult to manage when the time came to invoke it.

My father in law, a once dynamic, charismatic man who commanded a room with his booming voice, colorful language and keen intellect, has slowly left us as his kidneys no longer clean his blood effectively, leaving his thinking and memory more foggy. He started dialysis too late for it to really maintain his health, thus it has put a brake on his decline, but at this point the slide is more rapid, gaining ground every day on his once decisive and knife edged clarity. At times he retreats to meetings from his position with the United Nations in various countries, and further back to his stint in the Navy where he made powerful connections with people who remain loyal to him still.

Although he has been time traveling, (and recently added a son to his actual two) he had been able to answer questions about what he wants with greater coherence, and even at the time when he fell and broke his neck was deemed legally competent much to our dismay as he was insisting he was fine to go home. It took a gentle, direct conversation with my husband to convince him that he was too ill, and his love for his wife was too great to put them both at risk at home.

It has been this disconnect between his actual state of health and how he perceives it that has been the most challenging to manage. His physical decline although so sad, would be simpler if he were able to recognize it and plan accordingly. Although very sweet and sometimes touching that he still suggests we go out to dinner when we visit him at his facility, he eats almost nothing and can barely stand. It is painful because he doesn’t understand our quiet, persistent refusal.

After three professionals from three separate facilities suggested we consider ceasing dialysis and setting up hospice, we had to seriously consider it. This would mean a gentle slide into unconsciousness and a pain free death, the type of end that many people would prefer. It has become a matter of interpretation of his former wish to not be kept alive by extraordinary measures and his more recent proclamations that he is not ready to die. He had stated that he did not want his last days to be like that of his father who had suffered strokes and was alive for two years following that. Would there be a point he would articulate a readiness to die? At what point will dialysis feel like an extraordinary measure? Without an an explicit conversation about this, my husband has elected to continue dialysis for now. As my father in law’s pain from various injuries continues to cause him discomfort, his weight loss leaves him more vulnerable, and his connection with reality more tenuous, there may be a point at which dialysis seems like an extra burden, or cruelty.

For now, we struggle with the extraordinarily human challenge of trying to honor the wishes of a man we love, without clear direction from him. We can only hope that we are doing right by him, and trust that he will be able to give us a signal, if nonverbal, of his readiness to say his final farewells. We must remember to have these conversations with each other, and document them, so that we might provide guidance when our time comes to make this most important and inevitable transition.

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