About a month ago, I found out that a place I used to work at, one that I left at the end of January which caused my schedule to change significantly (for good), and which I have talked about many times in this blog, is closing.

The girl who took my place there, L,  called me the day she found out, and the following week I paid a visit to the residents there to whom I promised I’d come back, and simultaneously participated in their music therapy session.

Before I went back though, I had several thoughts.  I thought about L – how she had just taken that position at the end of January and how now she’s losing her job.  Subsequently, I had a selfish thought about how lucky I was that I left when I did, and now don’t have to deal with some of the issues she is currently dealing with.  Of course I thought about the staff and how they may have a hard time finding another job, but most of all, I thought about the residents.  Where are they going to go?  How are they feeling about all of this?  Are they going to be able to keep in touch with the friends they’ve made there?

So…during the group I visited, the new MT asked if anyone wanted to talk about the news they had received.  The residents started out by saying cooly, “What are you gonna do?” “There’s nothing to say,” and “It is what it is,” among other very vague and apathetic-sounding answers, but as the hour wore on, more information came out.  Some became tearful and talked about how “I thought I’d live out my days here,” “we are losing our home,” and “we have nowhere else to go,” and talked about how their families (or lack thereof) can’t care for them at home, so they’ll have to go somewhere else, and how scary it is not knowing where or when that will be.

How terrible it must be, having literally no control in the matter. When a natural disaster occurs – a fire, an earthquake, a flood – I wonder the same thing.  There’s something about the lack of control in all of this that must take a lot out of a person.

The group ended up being a good forum for people to discuss their feelings and I can only hope that they didn’t stop there.  I hope they found solace outside of the group in talking to others about it and commiserating on their uncertain futures.  I hope they were able to keep in touch.  I just hope that it doesn’t kill them in their such fragile conditions.  Or maybe (for those who are emotionally ready to die) I hope the change does something to make whatever end someone might be experiencing more quick and less physically painful.  I’m sure it won’t take away the tasking emotional pain – in fact, it may make it worse, though I hope not.  I have probably too much hope, because I can’t bear to think about one hundred miserable elderly people who have to move AGAIN in the last years of their lives into a new place with strangers and an unfamiliar set of norms.

When I talked to the MT who took my position the other day, she told me there were 34 residents left in the 120+ bed facility.  I can’t even imagine what it must be like to go there right now.  It must feel like a ghost town.

I wonder…when someone’s home is gone, what do they do?

I discuss the idea of  “home” a lot in my sessions and what it means to individuals.  It can mean a country, it can mean a city or state, it can mean a specific house one once lived in, it can be where someone currently lives, and it can be a feeling you get when love and comfort is surrounding you.  The residents at this facility that is closing will have a new home, but I wonder how long it will take for it to feel like home.  It doesn’t happen overnight, and these elders don’t have a lot of time.

I’m going back to visit this coming week, one last time.  I wonder if the reality of it all will be palpable.  I’m sure I’ll get a lot of answers that I didn’t have the last time, and I’m sure there will be more questions.  Here are two more:

In a society that depends on elder housing and relies on space in skilled nursing facilities, how can we avoid this kind of thing from happening all over?

Building codes change and inspection criteria gets more nitpicky, but people still need a home.  Without a home, who are we?

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Keep Talking

May 8, 2012

This will be a short one for those of you who know that I am usually quite wordy…

Yesterday I had a session at a nursing home I work at.  There is a resident there who has been in my groups since I began working there – a sweet woman from California who had a stroke a few years back and lost most of her verbal skills.  She is still able to process information, but can’t respond coherently, and when she says words, they are accompanied by a jumbled salad of sounds and other parts of words.  It’s no surprise to me that she is able to sing entire songs without exhibiting even a hint of the turmoil hidden within her brain.

Yesterday, after about a half hour of group drumming, shaking, singing and conversing, I asked her to choose between two songs, knowing that it may be more of a guessing game for me, depending on how unclear her speech was.  I said, “D, should we sing Side by Side or I Left My Heart in San Francisco?”  What came out of her mouth shocked me and made my day simultaneously.  She said, in slow motion, but clearly…”I would like to sing…I Left…San Francisco.”  The activity director and I enthusiastically validated her success, and after the concerted effort and intention she put into her words, she seemed so happy with herself, I wanted to cry.

I am at this particular location every other week and I don’t have a lot of background or treatment plan information, so she may be seeing a speech therapist or going through some other treatment I’m not aware of, but that kind of result is similar to what happens when someone goes through Melodic Intonation Therapy.  I have never used those techniques, but is it possible that the consistent singing has helped her to find her voice again?  It may just be a fluke, but whatever the reason, D’s surprising verbal breakthrough made me so glad to be a music therapist, and to be making a difference in people’s lives in a visible and meaningful way.

Do you have any success stories on this subject?

Wake Me Up Inside

April 23, 2012

Last night I finally watched the video of Henry, a man who suffers from frequent seizures and doesn’t respond fluently to questions, but for whom music is an extremely therapeutic tool.  The activity leader at his nursing home found that having him listening to music from his era with headphones was effective in improving his posture, affect, energy, his ability to connect with others, and when the headphones are taken away, is still able to engage with others and answer questions enthusiastically for a bit afterwards.  Oliver Sacks participates in this video, which is actually a clip from a new documentary.

For those of us (music therapists) who see this kind of response every day, the clip is nothing new.  OF COURSE music has the ability to wake us up – to reach places within our brains that we weren’t able to get at with other therapeutic methods.  I’m so glad that people continue to publicize the power of music, and I’m glad that influential scientists like Dr. Sacks are continuing to write books and compile research supporting what I do.

That being said… (you knew this was coming, didn’t you?) the documentary, “Alive Inside” seem to focus on the power of recorded music.  There is nothing wrong with recorded music.  Let me say that again – There is nothing wrong with recorded music.  We have favorite recordings of songs, and favorite singers.  There is nothing wrong with making playlists of our favorite tunes and being able to listen to them immediately.  There’s also nothing wrong with playing recorded music for patients or residents, or them having their own iPod to listen to on a regular basis. Nothing wrong at all.  Except when you call it music therapy.

For those of you reading this who are not music therapists, you may not fully understand the pains we go through on an all-too-regular basis to inform people of what it is that we do.  What is music therapy?  My version is this: Music therapy is the scientifically-based use of music as a therapeutic tool between a clinically trained music therapist and a client in order for the client to reach non-musical goals.  Therapeutic music activities are something that can be provided by anyone, and enjoyed by many.  I have nothing against other people using music therapeutically in their jobs.  I do however, have a viscerally negative response when I hear people talk about music therapy as something that happens when you listen to music in your car.  Or when a care assistant sings with a patient while walking them down the hall.  Music has been around since the dawn of humanity, and many different cultures have found it therapeutic and spiritually enlivening among many other things.  Music therapy, as we know it today, has been around since the first accredited college degree program opened in the 1940s.  It is an official profession.  It is something you must have a degree in to practice.  It is scientifically based.  There is research supporting benefits of music therapy, and I could really go on all day being defensive about what it is that I do every day, but instead, I’ll move on.

After I watched the 6+ minute clip of Henry, I listened to an NPR segment two people sent me the link to about the power of music with people who have dementia.  It mentioned the “Alive Inside” clip for several minutes, which to me seemed coincidental, considering I didn’t know the two were connected. The guest speaker, a social worker, Dan Cohen who runs a non-profit called Music and Memory and who the documentary follows, talked about how his organization got funding to buy hundreds of iPods for a nursing home, so that the residents could have musical experiences (that obviously benefit them) on a regular basis.  A question was posed about isolation and how people already lost in a solitary world can sometimes withdraw when alone for extended periods of time, and he answered by talking about how people who listened to music alone were stil able to connect with their peers following individual music listening sessions, and talked about artists, songs and other information regarding what they had just heard.  That’s so wonderful, right?  The power of music is going viral!?!?! I thought there must be some mention of music therapists in the documentary, or in the clip. It turns out that the woman who hosts the program “All Things Considered,” asked the social worker the following question: “I think the responses that you’re describing are something that music therapists have talked about for years, not just with dementia, but also with say, traumatic brain injury.  What does science say about music and the effects on the brain?”  His response was, “Well…I’m not a neuroscientist. I come in as a social worker and I have sort of a working knowledge of applying this and watching the results.  My goal is to make this a standard of care…” and goes on to say that caregivers could use this program with good results.  I was glad that she gave a shout out to music therapists in her question, but he didn’t mention us at all in his answer.

So, I Googled, “Alive Inside and music therapy” “Alive Inside and music therapists” and a few other variations.  What I found actually made me cry a little.  There were articles, reviews and commentaries about the viral clip of “Alive Inside” that all talked about how powerful music therapy is for these patients.  Remember how music therapy is the process by which a music therapist and a client are working together to meet non-musical goals?  The articles meant well, but the idea behind “Alive Inside” is not music therapy, and there were no music therapists.

You may be thinking, “Hey, you’re missing the point!  This is further evidence now on the benefits of music on folks with dementia and seizure disorders!”  I know, I know… For once, though, I wish that we didn’t always have to fight for our validity.

Music awakens us all in one way or another, so why are most Americans just finding out about it now?

Ease on Down the Road

January 18, 2012

In two weeks I’m leaving a job I’ve been at for four and a half years.  It’s at a nursing home in the Boston area and while I love the residents I work with there and have become very attached to some, it’s become a twice-weekly reminder that we do not care for the elders in our country with the right priorities.

There are other reasons why I need a change, but that’s all I’ll say for now, because this post is actually about the transition I am helping to create with the music therapist who is taking over my position.

I gave almost three months notice, and while I’m no Mother Teresa, I admit I feel some responsibility, not only to the residents I work with but also to the person replacing me, to ease everybody into my absence smoothly.

So…for the past few weeks, my lovely replacement has been attending my groups, meeting my clients, learning their favorite songs and asking priceless questions about technique and interventions, as well as exhibiting a wonderful personality that fits into the group dynamics well (If you’re reading this, L., I really mean it).  What’s interesting about all of this is that she wants feedback, which I am comfortable giving because of my love for supervision and, I feel like I’m training someone, which wasn’t my original plan but seems to be working out quite well for everyone involved.

Today she and a Master’s level expressive therapy student (who has been observing my group for several months) led the entire session and my residents really seemed to enjoy it. They have always loved it when I’ve had students in my groups and I think the fact that a familiar face (ET student) will still be there after I leave, and that my replacement is able to spend so much time with them before I leave, is hugely helpful for them.  Some of them have known me for nearly five years and have voiced their sadness that I’m leaving, but seeing them so enthusiastic and open to the new MT makes me feel like a giant load has been lifted off my shoulders, and makes me feel less like I’m abandoning them.

When it’s time to ease out of a job, thinking about everyone involved may be inconvenient for us, but it’s worth it for them.

My advice is this: When quitting a job, if it’s possible for you to prepare your clients, co-workers or supervisors for your absence with good feelings, peace of mind and a smooth transition, do it.  It makes all the difference in the world.

 

You wanna know what’s unfortunate?  That someone who has lived for almost a century isn’t allowed to have what they want later in life, because a nutritionist or a doctor said so.

In this post, I briefly discussed my grandfather’s love for ice cream and the nursing home’s refusal to let him have some.  The fear was that he would aspirate.  At 93.  I don’t know about other 93 year-olds, but my grandfather wanted his ice cream. He may not have actively wanted to aspirate, but he knew he cared less about that and more about his quality of life.  It was one of the only pleasures he was still able to enjoy that wouldn’t make him pass out (Cut to the one and only time he came to my parents’ house after his admission to the SNF – he wanted a Budweiser, drank it, and promptly slept for the next four hours in the shade of a tree outside while 15 members of his family played, talked, ate and drank around him).  Anyway, he wanted his ice cream, and my mother – a tough cookie – fought for his right to ice cream.  And won (after weeks of arguments with the dietary staff).  Should it have been this hard?  Shouldn’t a 93 year old be able to have some ice cream?  Shouldn’t an 86 year old woman be able to have some candy when she wants it, without having to focus on her “Diabetus?”

Looks great, huh? Imagine this every day.

In most elder care facilities, the food is less than ideal.  In “dietary’s” defense, there are some people who don’t have teeth.  There are some people who keep Kosher.  There are some people who have been discouraged from having sodium.  There are some people who don’t eat pork, and there are some people with food allergies.  This all makes a SNF chef’s job a bit more difficult, and because of the volume of food that all has to come out at the same time, it’s probably not easy to make a variety of meals, or food that tastes the way most of us would prefer.  BUT, it should be better.  When I get complaints (yes, I, the music therapist who has literally no control over this) from residents who complain that they have had scrambled eggs with no salt and dry toast every day for a month, it makes me want to bring them a waffle or an omelet or something.  When I find out that the kitchen has produced a chicken and rice dinner every night for a week, I want to go down and talk to the food department. Would you want the exact same meals every day?  I sure wouldn’t.  Would you want to be told you can’t have cheese because you’re lactose intolerant?  Lactaid, people!!  What’s the problem here?????

One of the problems is that there is usually one person organizing meals, ordering products and designing nutritionally balanced menus for sometimes 300 people with different nutritional needs.  That, my friends, is at least a three man job, and maybe that’s the real problem.  How can these issues be remedied?  I sure don’t know, but I have to imagine it’s a financial problem.  I also imagine its because we are deciding what food people can and can’t have at a time in their lives when it really doesn’t matter to most of them.

Alcohol is a little harder to support.  Sometimes, people have long running problems with alcoholism.  Sometimes, alcohol makes people with dementia and those on certain medications more confused, unbalanced, and sick.  But sometimes, someone who doesn’t have these problems and side effects just wants a Budweiser.  Or a glass of wine.  Or a little Jack Daniels.  What’s the harm here, really?  Some places say that a resident can’t have wine because then other people will want some.  Shouldn’t people be able to have a little locked refrigerator in their “apartments” where they can keep their own stuff?  Should other people be able to dictate what their quality of life is?

The thing is, most elderly people (at least the ones I work with) don’t care about the health risks – they care about their quality of life. In nursing facilites, there are doctors and nurses and care staff who decide what’s best for a resident, from what they’re allowed to eat, what medicines they should take, when they should have to go to the bathroom (don’t even get me started there…) when they should go to sleep, when they should wake up – the list goes on.  What are the things that our grandparents and elderly friends get to decide?  In my experience, not a whole lot.  Usually, they’re bound to wheelchairs, aren’t able to go outside more than twice a year and really aren’t living what’s left of their lives.  It’s very sad, and I wish I knew how to advocate.  ACTUALLY…I guess that’s what I’m trying to do.

I can’t save everyone and I can’t change someone’s current nutritional and dietary orders, but I can encourage anyone reading this to put this information in a living will, so when you’re 97 and have Diabetes, you can say you want to have some chocolate or a cookie with actual sugar in it.  When you’re 88 and have high blood-pressure, you can say that regardless of what a nursing home’s dietary department wants, you want to have salt in your food.  You can say that if you are dying for a beer, there’s no reason why you shouldn’t be able to feel like a person again and throw back a cold one (see roof scene in Shawshank Redemption).  Unfortunately, having a quality of life as an elderly person doesn’t come automatically.

Fight for your right to Wine, Cheese and Chocolate!

The Great Gig In the Sky

October 24, 2011

As someone who works with elderly clients, I experience a lot of loss on a pretty regular basis.  I go into each session hoping all of my clients will still be there, but knowing that may not always be the case.

I’ve made my peace with death.  I really have.

La Jolla - The best place in the world to work ridiculously hard.

When I was in my internship, I was working at Scripps Memorial Hospital in San Diego in the ICU as part of my job.  It was intense, but there were so many people I worked with who were so touched in so many ways by music therapy that it made it all worth it.  There was one experience in particular that sticks with me to this day…

What ended up happening, was this: A 20 year-old had an accident in the ocean on either a surfboard or a jetski (details are foggy) and was in a coma.  After his family conversed with his doctors, they found out that if he were to come out of the coma, he would not be able to live even a small fraction of the life he once experienced and loved.  His family decided that the best thing for him would be for them to take him off of life support and rush him to the Operating Room so his young, healthy organs could be given to someone in need.  I came into this picture five minutes before he was extubated.  I was working in the ICU that afternoon, and his mother approached me, and told me that her son loved the Beatles and asked if I’d play a couple of songs while his family and close friends said goodbye before he was taken to the OR.  I played a slow (Joe Cocker-esque) version of “With a Little Help From My Friends,” and the old MT standard, “Let it Be,” while this was all taking place, and I felt like I was looking at myself and the situation from somewhere outside of my body.  It was so unreal.  I don’t know if I was sad, but I do know that I needed to take the rest of the afternoon off.  And I did.  And then I was fine.

I reflected on what had happened, and decided that it was my job to provide a service for people in the ICU, and that the real loss wasn’t for me, it was for that kid’s family and friends.  I sucked it up, and went back to the ICU the next day.  I have lost many clients over the years since then and have been present during some clients’ passings, and I’m always fine and usually honored to be there at such a significant time in someone’s life.  Maybe it’s because I haven’t had any traumatic losses in my life, or maybe it’s because I compartmentalize well, or maybe I have a disorder where the only losses that affect me emotionally are romantic relationships and when animals die in movies.  I don’t know.  OR…maybe I can let go of my personal issues for the sake of my clients.  Yeah – I like that one the best :/

Loss is hard, and for a lot of people, but…it doesn’t seem like it’s very hard for me.  When a client passes away, I process quite a bit with the people that client was close with, and I process with my students if they knew the person, but I don’t really feel like I need to process with myself that much – until my blogging began that is.

In the spring, a man in one of my groups stopped breathing literally minutes before my music therapy group was supposed to begin.  I asked my student to remove the two residents already in the group room, and I notified the nurses that something was going on.  We waited down the hall for twenty minutes while EMTs tried to revive him, and finally, we learned that he had passed away.  My student needed to process quite a bit, and never quite got over the whole thing.  I can’t say I blame him, but I was fine. I feel that when people are elderly and in poor health, passing away is not only inevitable, but often a blessing, so when I learn of someone’s death, I’m more relieved than anything else.  I’m happy I was able to contribute something to the end of their life, and increase the quality of it to some extent.  Most of my clients are so unhappy in their old age (outside of music groups) that they talk about being “ready,” and who am I to deny them of those feelings?  Who am I to decide that it’s sad?

Jazz funeral in New Orleans

In recent years, I have subscribed to the New Orleans Jazz Funeral perspective on death.  This is “THE” number, as in – “Oh lord, I want to be in that number, when the saints go marching in.”  This is why people march in procession to jazz music instead of sitting sadly in a church basement eating cheese and crackers.  This is why they call it “The Great Beyond,” and why in “Swing Low, Sweet Chariot,” the narrator wants to be carried “home.”

In the spring, five of my clients – regular group members – passed away.  I learned recently that seven residents I used to work with at the dementia-specific AL passed away between April and July, and one last week (A. from Young At Heart) and in the past week, three clients at one of my SNFs died, one of whom I did individual sessions with, and two of whom were regular group attendees.  I also learned today that G., of the last statement in this post, is in the hospital.

I am sad that it may not be too long from now that G. won’t come back to my group, but I’m happy for her, if she’s finally able to be taken from her suffering.  In my work, I find it harder than anything else to watch as my clients become frustrated when their bodies aren’t responding to the end of life the same way their minds are, and are treated medically (!!!) for symptoms and conditions that are actually just a part of the body’s decline, and would allow them to be released with some semblance of dignity remaining.  This is where hospice comes in, which I believe is one of the most valuable systems our society has in caring for aging or terminally ill people.  It’s just not used enough.

This post was a forum for me to express my own thoughts on death and dying, as I learned of two deaths today, and I hope that even if you disagree with what I say, you can understand the place I’m coming from.

“And I am not frightened of dying, any time will do, I don’t mind.  Why should I be frightened of dying?  There’s no reason for it, you’ve gotta go sometime.” –Pink Floyd

Party Rock Anthem

October 24, 2011

Today I had a really great group with one of my students.  Fifteen or twenty minutes into the session, a new resident was brought into the room and my student began talking about “shuffling” the wheelchairs.  I don’t know who it was who started it, but one of us began singing, “every day I’m shuffling…” and before we knew it, we had the entire group of elderly nursing home residents playing instruments and singing along with the refrain to a song that was released six months ago.

The best part, is that in the song there is a section where the singer says, “Shake that!”  All of the residents in the group were playing shakers or tambourines, so when we said (adapted) “Shake it!” all of them not only were shaking their instruments, but they were shaking their shoulders and wiggling in their wheelchairs as well.  People were tapping their feet and seemed to really enjoy the adapted dance anthem we spontaneously brought to the group.  Upon closer examination and adaptation, if you choose to use the song, consider these (very repetitive) lyrics:

__________________________________________________________________

Party rock is in the house tonight, 

Everybody just have a good time!

Party rock is in the house tonight,

Everybody just have a good time!

-Repeat the first three lines, and on the last line, 

We  just want to see you – Shake it!

(Shaking break)

(Movement/exercise section below- a part I adapted just now after listening to the song)

Put ’em up, Put ’em down, 

Put your hands up to the sound

Put ’em up, Put ’em down

Put your hands up to the sound

Put ’em up, Put ’em down, 

Put your hands up to the sound, Put your hands up to the sound, Put your hands up to the sound, 

Put your hands up, Put your hands up, Put your hands up, (repeat “put your hands up” as many times as you want and then go back to the beginning – we ended with a ritardando and “everybody just have a good time…”)

__________________________________________________________________

I usually don’t bring newer songs into a group unless there is an obvious clinical purpose.  Apparently, Party Rock Anthem can easily be turned into a clinical/movement song.  I wonder if LMFAO had any idea someone like me would someday be using their song like this?

Every day I’m shuff-ff-ffling…

 

 

I have such respect for the elderly. I work with well elders (elders without significant health problems), elders in nursing homes, elders in traditional assisted living facilities, elders in geri-psych units, elders with various forms of dementia…the list goes on. It’s safe to say that in the five years that I have been a Board Certified Music Therapist, I have become somewhat of an expert regarding the aging population. Their diseases, their musical tastes, and their general distaste at being treated as if they were children, are almost second nature to me.

Part of my job is to supervise undergraduate music therapy students during their school year in hands-on, required clinical training. I love the supervisor “hat” and it may be the highlight of my career. I help students learn, improve, and get to really use MT techniques. They come to my sites for 11-13 weeks, and for the last several weeks, they usually are leading entire sessions on their own with my elderly clients, and grow quite attached. They’re not the only ones. Particularly at the nursing homes, the clients (most of whom aren’t suffering from severe dementia) look forward to each student’s visit and when the semester is over, they find it difficult to let go. Those students are literally the high point in my clients’ days.

In my experience, elders like to be around young people because it makes them feel younger, and healthier, and more full of life. They often say things in sessions that would turn their children’s faces bright red, and during discussions, they surprise me by how well they have adapted to today’s societal norms. When we (the young people) aren’t there anymore though, reality often sinks way in.

When one is lucid, can have coherent conversations, and is aware of their declining health, it can be very depressing for them to realize that after our session is over, they must sit with themselves again, often alone, and either dwell on the past, on current aches and pains, or even negative prognoses, and play the waiting game. When a client is emotionally ready to “go,” but their body isn’t finished yet, what can we do, as therapists, to make their time easier AFTER sessions are over, and BEFORE they are able to travel to the great beyond…

I find the Patch Adams school of thought to be very helpful in cases like these. I validate their aggravation, pain, suffering and displeasure at being “old,” and we talk about those things, but then we sometimes go in a different direction. I begin discussions with my elders about the circle of life, about the Earth’s (and our own) natural and perpetual changes, the thousands of generations who experienced the same things, and then we explore the humor in certain unavoidable shared experiences. Ten elderly clients in my groups discuss their various ailments and are always amused and calmed by the fact that everyone is in the same boat. I use a songwriting exercise based on the song “The Old Grey Mare” (she ain’t what she used to be) and encourage the clients to think of things that have changed for them over the years. Through their sometimes hilarious suggestions, they often find companionship and understanding from others, which they might have forgotten existed. They get a reminder that they aren’t alone, and that it’s okay to laugh about a bladder that “aint what it used to be,” or the fact that hair is growing in places it never did before, or even that computers seem to be taking over our brains. It’s a time when humor can be a valuable coping mechanism for folks who have very little in that department, but it’s not always appropriate.

Today, at the end of a session at an SNF, a client’s daughter, who often joins the group with her 96 year-old mother, began talking about how her mother, A., is the “only one left” of all of her friends and family. This is where humor, and my “Old Grey Mare” won’t work, but it was amazing what happened. Every person (who could hear) added a thought or theory about how they deal with loss and loneliness, and we had a meaningful conversation about living “in the now,” as client, L. shared, and not dwelling on things we can’t change. L. is a client who admits to being much nicer and more patient now than she was as a younger person, and presently, she lights up a room with her good attitude (despite hardship and a stroke which left the left side of her body paralyzed) and I believe she copes with her current condition by creating community and friendship whenever she can. Being in the moment is an umbrella that humor is safe underneath, I realize.

We finished the group very differently than how we began it. I’m not a religious person, and “God” isn’t necessarily a part of my life, but here’s what my clients needed at the time:

God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.

Que Sera, Sera.