There is a new controversy on the Internet:
- People are dying and may be in hospice;
- We as family and friends of dying people are very busy;
- We may be angry at the dying person for past transgressions;
- We can’t be expected to Telephone the dying person if only to say I am thinking of you and love you;
- We cant be expected to visit the dying person if only to smile, play gentle music, be present;
- We can’t be expected to use an old-fashioned pen and paper to scribe a handwritten note to say that the dying person matters in people’s lives.
The Internet controversy is whether it is appropriate to delegate the “end of life” and hospice sentiments to corporate America. Enter Hallmark Greeting Cards. By the way, I am a rabid conservative and I believe the market driven capitalist system solves most every problem in our country. This, however, is one instance that Hallmark and corporate America is not the answer. The answer is found in the hearts and souls of human beings.
The case for and against Hallmark greeting cards for people who are dying or in hospice (“Hallmark End of Life or Hospice Greeting Cards”) is a heated issue. The emotion driven hostility of patient advocates perplexes me. Advocates for the Hallmark End of Life or Hospice Greeting Cards are collecting names and petitioning Hallmark to include an aisle for end of life issues. Organizers of the petition are actually “blocking” tweeps who disagree. These tweeps are all patient advocates. The one emotion all patients agree must be that dying is personal and demands respect.
I hope Hallmark to listen to all the voices – even ones not on the Internet who can’t sign a petition – that risk being traumatized by preprinted “end of life” greeting cards. Remember that there are many elderly and very sick patients that have no access to the Internet and cannot complete an Internet questionnaire regarding Hallmark End of Life or Hospice Greeting Cards. It is ironic because these elderly and very sick patients will be the ones that become lonely, isolated and among the medical bills they receive a Hallmark End of Life or Hospice Greeting Card in the mail.
For the record, I am against Hallmark End of Life or Hospice Greeting Cards. Preprinted greeting cards for those at the end of life and/or in hospice care are a curious concept to me. My reasoning is that the process of dying is intimate, heart wrenching, personal, emotional. I also believe that it is the caregivers, family members and friends of the terminally ill that need support so that they can wake up tomorrow and do it again.
I believe that as a person is in the sometimes lengthy process of dying, G*d is present and holds the dying person in the palms of His hands. It is the survivors, caregivers, family members and friends who are worn out and cry into their pillow every night. It is the survivors, caregivers, family members and friends who wonder how they will make it through another day. And it is the caregivers, family members and friends who often wish that they could take away the suffering from the ill and carry the burden themselves. Of course G*d is also with the caregivers. But, we on Earth are morally obligated to be additional angels to help the overwhelmed, stressed caregivers.
The elderly couple that received no visitors
One hospice case I would like to share involves an elderly husband and wife. I watched the once strong, healthy couple become victims of their own bodies. They are a husband and wife and I knew them for many years.
The wife is in hospice care at home. Other than a very rare visit from one of their sons, the couple’s only companionship is the home health care assistants. I often dropped by to say hello and visit.
The husband was a victim of multiple serious strokes. But his mind was completely in tact. His wife, on the other hand, struggled with Alzheimer’s disease. She had no clue who I was but she welcomed a human presence. The husband and I would chat about the past, the future.
This husband would never have allowed his wife to be placed in traditional hospice care or nursing home care. This was his wife and he intended to move through every stage of life w life and each of its stages with her.
One day, the husband and I were talking and I saw tears in his eyes. His wife was hospitalized at the time and he was waiting for her to return home. I looked at him straight in the eyes and said, “[y]ou are an amazing husband.” I told him that he was a rock for his wife and he was making a difference in her life. I told him that G*d was proud of him. He looked at me and said, “[d]o you really think so?” I assured him “yes.” I reached out and gave the frail man a gentle hug. He was visibly thankful for my presence and our conversation.
Through a simple personal visit and gesture, I helped a caregiver pull up his inner the strength to make it through another day.
No preprinted Hallmark End of Life or Hospice Greeting Card directed to the Alzheimer’s inflicted wife could have helped. She couldn’t understand. Rather, the husband only needed what most people need at the time when a life is ending. He needed what caregivers and family need – strength from human contact.
Sending a Hallmark End of Life or Hospice Greeting Card to a patient with advanced Alzheimer’s would be cruel to the living, caregiving fragile elderly spouse. The Alzheimer victim could not read the card. The husband would feel additional, unnecessary sadness to read the card to her.
The husband’s wife passed last July 2012. The widower has not returned to the marital home. The home is empty – just like the chairs where the couple sat together and looked toward the street.
The 40-something year old with a weak heart and history of multiple strokes
Another hospice case involves a younger man in his forties who has about 20-30% heart capacity and suffered multiple strokes. He goes through periods of strength and periods of weakness when he is placed in hospice.
This man doesn’t want anyone to know when he is sick and going through weak times. He doesn’t want flowers, cards or sympathy (which he perceives as pity). He wants to have the inner strength to pull himself through illness and back to well-being.
The younger man came to visit a group of friends after he outlived hospice for the third time. He was so proud that he was strong and healthy again. He knew that people were worried about his absence from activities. Well meaning friends said, “you should have told us” and “we could have visited you or sent you cards.”
The younger man was put in the bizarre position of comforting healthy friends. That was precisely what the man wanted to avoid when he was sick. That is precisely why the man told no one he was in hospice.
The friends did not know the man was in hospice. And if they had that knowledge, the man would not have benefitted from a preprinted Hallmark End of Life or Hospice Greeting Cards. Rather, he would have been uncomfortable that so many people knew of his illness. The process of facing imminent death (even if you beat it) is tremendously personal. Invading that personal space is risky. Ask yourself why you would want to send such a card. If you, as a healthy person, want to feel better by sending a Hallmark End of Life or Hospice Greeting Cards then you miss the point of caring for another person.
My dad and I Share Cancer
My Dad and I shared many common interests. We loved to run, shared strange senses of humor, loved Atlanta Braves baseball and liked to laugh at Nancy Grace. We also shared the horrific diagnosis of invasive, aggressive cancer.
My cancer was diagnosed a year before Dad. I was diagnosed with stage aggressive breast cancer. I was very sick and in the hospital many times with low white blood count. Of course I was bald and weak. I was also scared.
My well-meaning aunt sent me a breast cancer awareness basket and mug. I hated those gifts. They reminded me of the cancer. The gifts also made me feel that I was supposed to be part of some cool breast cancer club where we would all embrace pretty pink ribbons and arrange breast cancer walks (like children’s play dates) so we could proudly display our bald heads. There is nothing fun, cute, character building about having a crippling form of cancer.
My friend flew from Illinois to North Carolina for a surprise visit to see me. I opened the door when he unexpectedly arrived. I asked him to sit on the porch. I scrambled to place on my wig and dress normally (no sweat pants). We went out to lunch. It was important for my friend to make a human contact with me. A Hallmark End of Life or Hospice Greeting Card would have been meaningless. How could my friend know what a card should even say if he had not seen me, touched me, cared about me face-to-face? Moreover, I was supposed to die. I beat the odds for now. It would be creepy to receive a Hallmark End of Life or Hospice Greeting Card and then live.
Less than a year after my diagnosis, Dad was diagnosed with Stage 3B colon cancer. He was already worn out from caring for me. Now it was my responsibility.
I took Dad to every doctor visit. I sat with him everyday. At nights when he was scared to sleep, Mom and I were there with him. Mom prayed with Dad every night. And then I would ask, “who’s my hero”? Dad would smile and say “me.” Dad was right.
The doctors at Duke University did a horrible job caring for both Dad and me as we journeyed through cancer. We both developed severe, chronic osteomyelitis.
My brother rarely visited Dad. And, when my brother did come to the house, he did not understand Dad. My brother’s frustration level was low.
My brother would have loved to ignore Dad and send a Hallmark End of Life or Hospice Greeting Card to Dad. Seeing an elderly man lose a valiant fight with cancer and osteomyelitis is not pretty. My brother was easily frustrated by my Dad’s weakness. The man he always knew as invincible was dying. Dad had difficulty putting on shoes because of the osteomyelitis. My brother got angry and went to the YMCA to swim laps. But as difficult as the visits were for my brother, my Dad treasured every moment he spent with his son.
My Dad’s sister telephoned and spoke with Dad routinely. She lives in California and cares for her husband with shingles. Dad treasured his sister’s phone calls. He even wrote notes memorializing her calls.
My cousins came for a visit with Dad. They sat on the couch with Dad for a group picture and talked of more visits.
There would never be more visits from the cousins. Dad died of osteomyelitis at home with mom and me. We held him and discussed how it was okay that he let go. Dad reached out his blistered, painful arm and laid his hand on her leg. “I love you,” he told Mom. Through tears, Mom replied “And I love you.”
Dad never used the word cancer. He never used it with respect to him or me. He never wanted to think about being ill or dying. My Dad was a medicinal research scientist who designed medications, chemical compounds for very ill people. He could not envision being so sick and so helpless. Sending a Hallmark End of Life or Hospice Greeting Card would be horrifying for my Dad. But how could a Hallmark Greeting Card purchaser know my Dad’s sensitivities if the card was a substitution for human interaction?
I was glad people reached out to Dad (even my brother in his clumsy way) instead of sending Hallmark End of Life or Hospice Greeting Cards. After Dad’s death, Mom would have received no strength or comfort from the cards. She would have received only immense sadness and those cards would have been promptly thrown away. Unlike sympathy cards directed at my Mom and respecting her need for comfort, the Hallmark End of Life or Hospice Greeting Card would be a constant reminder that some people thought her husband was not as “tough as cancer.”
What’s wrong with Hallmark greeting cards for the dying?
In my sampling of “end of life” examples, the Hallmark End of Life or Hospice Greeting Cards would be okay for the older husband (widower) or my mom (widow). Why? Because the older husband and my mom performed caregiver duties 24/7 and they needed the support often found in the wise preprinted Hallmark Greeting Cards. Although a simple and beautiful “Thinking of You” card would suffice.
We aren’t talking about St. Valentine’s Day or an anniversary. We aren’t talking about a federal holiday where a Hallmark Greeting Card would be unexpected and welcomed. Answers to very basic and personal questions must be known. Is it the appropriate time to send the Hallmark End of Life or Hospice Greeting Card? The card purchaser should not send a Hallmark End of Life or Hospice Greeting Cards unless and until he or she knows:
- At what point does the Hallmark Greeting Card purchaser know that the sick person is dying or in hospice (as opposed to waiting for the physician’s narrative before insurance okays hospice)?
- At what point does the Hallmark Greeting Card purchaser know that the sick person has beaten the odds and is no longer in hospice?
- Should the Hallmark Greeting Card purchaser call the family and ask at what stage the sick person is in the dying process?
- Should the Hallmark Greeting Card purchaser assume the elderly person with cancer will die and so a Hallmark End of Life or Hospice Greeting Card is definitely appropriate?
- What about the 40 year old? His heart is really bad and he has survived several serious strokes. He’s pretty weak. He can barely breathe on good days. Friends haven’t seen him in awhile.
- Should the Hallmark Greeting Card purchaser call the 40 year old’s mom and ask if he’s dying. Or should we just presume a Hallmark End of Life or Hospice Greeting Card is appropriate because he looked sickly a lot and friends all know he has a bad heart?
Assuming the card purchaser decides sending the Hallmark End of Life or Hospice Greeting Cards is indeed appropriate and timely, he or she must learn even more additional, extraordinarily personal information:
- What if we (the “non dying”) are picking out a Hallmark End of Life or Hospice Greeting Card for the dying person?
- Should we go with funny card?
- What about a religious card?
- How is the dying person feeling?
- Does the dying person know about his impending death?
- Is the dying person scared?
- Is it possible the dying person will survive hospice?
Indeed, picking out the Hallmark greeting card for the dying is certainly different than a birthday greeting card.
It is the living that read and pick out the pre-printed Hallmark Greeting Cards. Buying the Greeting Cards makes us feel good. We rely on Hallmark to “say” the words we didn’t know even could be said. No matter the occasion:
- Hallmark Greeting Card purchaser reads dozens of cards and chooses the perfect Hallmark card;
- Hallmark Greeting Card purchaser makes sure the envelope actually matches and fits the beautiful Hallmark card;
- Hallmark Greeting Card purchaser wonders what the current USPS postage is and whether the oversized card will require additional postage;
- Then Hallmark Greeting Card purchaser makes his or her way to the store’s check out aisle, secure in the knowledge that he or she chose the perfect card with the best-preprinted Hallmark narrative;
- Thank goodness for Hallmark.
Sending a Hallmark Greeting Card make us, the living, feel terrific. We imagine the recipient laughing or crying at the words we would have said if we were as clever as Hallmark.
Despite what advocates of cards for the dying insist, the Hallmark End of Life or Hospice Greeting Cards aren’t really intended for the dying. Unless the end of life case is rare,
- The person facing death may or may not even be able to read;
- He may be unconscious, demented, overly medicated, depressed;
- A nursing assistant or, if the dying person is very fortunate, a family member will probably read the card.
Is there a place for Hallmark End of Life or Hospice Greeting Cards?
What if the Hallmark Greeting Card purchaser thought about the living caregiver, family member, friend of the terminally ill when choosing a card? Would such a card serve a purpose and advance the quality of life during the final stages of someone’s life? Would such a card provide caregivers with strength and a sense that they are not alone in the world? Yes.
If we are setting aside the possibility of a family member or friend (1) personally visiting, (2) telephoning or (3) scribing a handwritten personal note to the very ill person, then the next best alternative may be a greeting card. And, if the preprinted greeting card can be written with respect and dignity then those greeting cards have the potential of providing a powerful sense of community and strength – but only for the caregiver, family member, friend. The message can be powerful and positive.
In that regard, there may be a very limited, specific place for Hallmark End of Life or Hospice Greeting Cards. The cards must, however, only be directed at the caregiver, family member or friend. Hallmark End of Life or Hospice Greeting Cards must not be directed at the person who may or may not actually be dying. The risk of creating additional sadness and trauma through Hallmark End of Life or Hospice Greeting Cards directed at the potentially dying person does not outweigh a possible benefit.
As G*d cuddles the very sick in His hands, we as a community have the moral duty to reach out to the caregivers, family members and friends and give them strength, peace and hope. If Hallmark can accomplish those functions (to caregivers, family members and friends) through End of Life or Hospice Greeting Cards then please do so with my blessing.
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