of Christian Medicine & Dentistry Vol. 25 No. 3 November 2020 ISSN 2209-9441
Ageing Gracefully
1 • CMDFA LUKE’S JOURNAL • November 2020 www.cmdfa.org.au will take you... Deeper SMBC’s academic curriculum is founded on, and saturated in, the Bible – the inspired word of God. Study at SMBC will give you a deep and systematic understanding of the Bible, its theology and its application to all aspects of life. We offer academic rigour with flexibility – from undergraduate diplomas through to postgraduate research degrees – full-time and part-time. Further Cross-cultural mission is the very DNA of SMBC. With three missiologists on staff, weekly visiting missionaries, a missionary mentoring program, the SMBC Missions Conference, plus a broad range of missions units, SMBC excels in preparing its students for ministry across all kinds of cultural boundaries. Wider SMBC is interdenominational – lecturers, staff and students represent various denominational allegiances. There is mutual respect and understanding for differing viewpoints whilst holding to the heart of the gospel message. This, along with our international ‘flavour’ provides a diverse and healthy environment to study in. Closer It is a priority of SMBC that in addition to gaining a deep knowledge of the Bible, our students continue to grow in holiness with lives marked by prayer, love, humility and obedience to God. Time spent in the College community and being mentored by lecturers will help strengthen your Christian character and draw you closer into relationship with Jesus and his people.
“As a medical student, I was challenged to see theological education as akin to secular education. Prior to this I had felt it was only for those considering full-time vocational ministry. We study and train for years to work as a doctor, but we are called to be followers of Jesus 24/7. I had intended to do a short stint of theological study after completing medicine but, with work, family and continued lay ministry, this decision was delayed until this year. As I became a father and more involved in church, I realised that studying the Bible in depth has value for every facet of life. As a doctor it will shape and mould the way I approach my work, but more importantly it will equip me to understand and teach the Bible better. Ultimately, it will allow me to serve God effectively wherever he places me. After proclaiming I'd had enough of study forever, this year has been the LEARN MORE @ SMBC.EDU.AU most rewarding, enjoyable and life-changing study I have done. It's never too late!” SMBC student, Julian /SMBCOLLEGE 2 • CMDFA LUKE’S JOURNAL • April 2020 2 • CMDFA LUKE’S JOURNAL • November 2020
LJ 420 letter.indd 2 21-Apr-20 8:54:18 AM CONTENTS
3 EDITORIAL – Dr Eleasa Sieh 30 Positive Ageing and Meaningful Life – Dr Chris Poulos 5 Remembering (and being remembered) – 4 Dr Paul Mercer 33 VALE: Dr Bill Ramsay 30 8 Letter to the Editor 34 Everyday Joy! – Georgia Strimaitis
9 Finding Meaning in Ageing 35 Make a bequest to CMDFA – Rev Prof Elizabeth MacKinlay 36 Enhancing Dignity for Those Nearing the 9 12 COVID Lament – Georgina Hoddle, RN End of Their Life – Steve Calder 34
13 Is a Residential Aged Care Facility 38 DEVOTION: Ageing Unhindered merely a Waiting Room for Death? – Dr Kristen Dang – Viv Allanson, RN 36 40 Age: More Than A Number 13 14 Luke’s Journal Contact Details – Dr Monique Peris
15 In God’s Waiting Room: Questions and 41 VALE: Dr Maree Farley Reflections on Memory, Death, and Aged 15 Care in COVID-19 times – Dr Lauren Chong 42 Anne and I: A Journey with Alzheimer’s Dementia – Dr Michael Nicholson 17 About Luke’s Journal 38 44 BOOK REVIEW: Second Forgetting by 18 Depression in Ageing Dr Benjamin Mast – Dr Eleasa Sieh – A/Prof Kuruvilla George 45 BOOK REVIEW: Ageing, Disability and 21 Combating Frailty In Ageing – Dr John Best Spirituality – Georgina Hoddle, RN
46 Pastoral Care in Aged Care Facilities 21 24 A Christian GP Reflects on Residential 42 – Rev Jonathan (Jon) Phua Aged Care – Dr Richard Chittleborough
47 Hope and longer lives for Aboriginal and 26 Conducting Christmas Outreach Services Torres Strait Islander people: Vaccines for at Aged Care Facilities as a visiting GP 24 a time such as this – Georgina Hoddle, RN 47 – Dr Richard Wong
49 Sense of Safety During Covid – Dr Johanna 27 Ode to a Farmer’s Wife – Ian Johnston Lynch
28 Ageing Gracefully and Living Well 51 Discussion Paper on Moral Injury – Dr Kenneth Ibe – CMDFA Ethics Management Team (EMT) 28 29 Luke’s Journal Instructions for contributors 51
Themes for Fire in the Belly Until the Very End: Next Editions: copy due 15 Dec 2020 Dying and Palliative Care copy due 30 Mar 2021
3 • CMDFA LUKE’S JOURNAL • November 2020 Dr Eleasa Sieh Eleasa is a Canadian-born Chinese permanent resident of Australia, and works as a general practitioner on the Sunshine Coast, Queensland. This book was one she had on her always too-long to-read list but when it showed up on a list of book recommendations as part of a Biblical counselling course, she jumped at the chance to read it and write this for Luke’s Journal. EDITORIAL
Ageing Gracefully
“I would like everything to be Closer to home, poor systems of care In this issue, you will read reflections on immemorial – to have the same old have been exposed with the recent Royal ageing and living with disabilities that arise horizons, the same garden, the same Commission into Aged Care Quality and from ageing, from medical professionals smells and sounds, always there, Safety. The needs of the vulnerable and and aged-care pastoral care workers, as changeless. Autumn is really the best the frail continue to lie at the mercies of well as a registered nurse and priest and of the seasons: and I’m not sure that systems and institutions. These needs will associate professor in theology. You will old age isn’t the best part of life. But of exponentially increase, as the Australian find a poem dedicated to the singular course, like autumn, it doesn’t last.” Bureau of Statistics documents a rise uniqueness of a farmer’s wife, learn about – C.S. Lewis over the last 20 years that is projected Dignity Therapy, and enter into the realities to exponentially continue over the next of journeying with a spouse living with This issue of Luke’s Journal comes at the decade.4 dementia as a medical professional. end of a year that has shaken and sifted us all, with the SARS-CoV-2 virus and There is a clear need for leadership, My hope is that this issue would cause you the COVID-19 pandemic having swept guidance, research, and thinking into the to find meaning and purpose, or joy and across the globe, crossing international care of this growing populace. Deeper peace, and even hope, for the autumn of boundaries, and affecting all cultures and than the statistics, there is the existential ageing that we must all face, and discover ages, including the loss of nearly 1.2 million question of whether there is truth to what that there is a practical and tangible reality lives at the time of writing this editorial.1 C.S. Lewis calls the “best part of life” – to Ageing Gracefully. Among those who have lost their lives this is autumn truly the best of the seasons year, the majority have, unsurprisingly, before winter’s inevitable arrival? In the grace of Christ, been those aged 70 and above.2 It is this cohort in our societies who have been the The Christian doctrine of the Imago Dei – Eleasa Sieh focus of global public health guidelines that each human being is born imprinted On behalf of the Luke’s Journal on lockdowns of nursing home facilities. with the image of God – provides the editorial team. Facing strict no-visitor policies even at unique undergirding exemplified in this the end of life, and feeling the extent of issue’s collection of articles and reflections. References: suffering is aptly captured by the Italian This issue is dedicated to this cohort of 1. https://www.worldometers.info/coronavirus/ word “straziante”, defined as “a very acute individuals who are part of us, whether 2. https://www.worldometers.info/coronavirus/ physical or moral pain, beyond any capacity ourselves, or those we daily interact with coronavirus-age-sex-demographics/ 3 3. https://www.economist.com/europe/2020/03/26/in- for tolerance”. in our work, our spouses, our parents, italy-the-coronavirus-steals-even-the-last-farewell our extended family members, our fellow 4. https://www.abs.gov.au/statistics/people/population/ church members, and our neighbours. national-state-and-territory-population/latest-release
4 • CMDFA LUKE’S JOURNAL • November 2020 Dr Paul Mercer Dr Paul Mercer is an active General Practitioner in Brisbane. He is the former editor of Luke’s Journal and enjoys his work in Aged Care Facilities.
Remembering (and being remembered)
Old Testament theologian, Walter grow numb; my whole being refuses to be “cry out”, to complain to God no-holds- Brueggemann, describes Psalm 77 as a comforted. I remember God and I moan. barred. Such cries don’t have to be the end “speech pilgrimage”. While Protestants I complain, and my spirit grows tired.” of life or at the bottom of despair either. are modest about the concept of pilgrimage, walking the Camino in Spain As our bodies and minds fail at the tail end As medical doctors and healthcare has an enduring attraction. Christians have of life, we can imagine that even the final professionals, we have the special honour always been interested in visiting Israel. moments themselves will be frustrating. to share the witness of crumpled faith at What about Bunyan’s Pilgrim’s Progress? “You’ve kept my eyelids from closing. I’m this unravelling and inelastic time in life’s Or hymns like Guide Me O Thou Great so upset I can’t even speak” (v5). It is hard pilgrimage. Like Ezekiel, sometimes all I Jehovah? As health professionals, we share to imagine this pilgrimage is likely to bring can do is sit with individuals; to be present a privileged apprenticeship in life’s journey us close to God. as a sort of “cheer squad”, when flickering with our patients. We have “walked a mile” memories of God’s loving kindness re- on good, bad, and even ugly pathways. emerge. “The witness of God’s This psalm is a pilgrimage that starts in In verse 5 the psalm takes a turn, though despair, “I cry out loud to God”. Here is the story to us in the without much confidence, away from feel of the despair of an ageing body, the Scriptures is that we have moaning. Memory is the vehicle for change loss of social meaning and a threatening in this speech pilgrimage. Memory is an sense of loss of the memory of God. It is a permission to ‘cry out’, important part of faith. The liturgical call psalm which captures echoes that could be to complain to God of the Christian life is to both share in and generated from an aged care facility. There remember, with all the saints, the life, is a pathos even with and for the love of no-holds-barred.” death, and resurrection of Jesus for us. In God. This worship leader speaks for anyone this faith-generated practice of communion who will listen, from the place that senses we repeatedly recognise that God always God has forgotten us, that the strong right- Our speech pilgrimage then starts its remembers who we are. His love never hand of God has lost its grip on us (v10). journey as a classic lament. It is a challenge ends. to be so honest with ourselves and God in The psalm gathers all the groans of this way. Have you ever been to such a dry Asaph, who has created the speech someone who senses they are spent. “I well? That rock-bottom dungeon where pilgrimage of Psalm 77, remembers in v5-9: cry out loud to God – out loud to God so even words fail you? “I think about days long past; I remember that he can hear me! During the day when years that seem an eternity in the past. I I’m in trouble I look for my Lord. At night The witness of God’s story to us in the meditate with my heart at night; I complain, my hands are still outstretched and don’t Scriptures is that we have permission to and my spirit keeps searching: ‘Will my
5 • CMDFA LUKE’S JOURNAL • November 2020 Lord reject me forever? Will he never be pleased again? Has his faithful love come to a complete end? Is his promise over for future generations? Has God forgotten how to be gracious? Has he angrily stopped up his compassion?’ ”
In this remembering, Asaph recognises for us that life can seem to stretch out. During this stage of his speech pilgrimage, he meditates, he questions, he searches his heart. All of these are robust components of the faith pilgrimage. They require patience, critical reasoning and honesty.
While this psalm has captured a speech pilgrimage, it has also given us a glimpse of the apophatic components of the journey of Yu Art by Tracy life – the “be still and know I am God” stages of the path, times when words fail us, when • Procedural memory covers how we do recognised as vital to episodic memory. speaking no longer cuts through. “My spirit things and develop skills. For instance, Our left frontal cortex is vital to critical keeps on searching”, the psalmist says. a person with no reliable short-term reasoning or how we make sense of the memory could play the piano. world and our memories. One of the many benefits of a long life is to accept a slowing down and a recovery of • Episodic memory or the subjective In addition to long-term memory, we stillness, of patience before God. Stillness experience of explicitly remembering also have a short-term or working and a seeking heart are genuine components past incidents is the type of memory memory system. This memory helps us of a normal spiritual life. that is deeply personal and is where orientate, choose the next step, be socially dementia impacts memory most appropriate, etc. Our working memory is At the same time, empty uncluttered spaces profoundly. in the order of 1-5 minutes. If distracted in life can be misinterpreted. In our driven at the wrong moment, working memory world, we may be tempted to interpret them will rapidly fade. Our working memory as a waste of time. As Asaph takes us there, “Honest pilgrims bear can almost instantaneously access stored he becomes aware of painful questions: witness to grace in good memory capacity to make sense of the Has God’s faithful love come to an end? Has present. God forgotten how to be gracious? Has God times and bad – grace, angrily stopped up his compassion? Memory even in times of pandemic Returning to our speech pilgrimage in can be wrapped in intense emotion. Psalm 77, verses 5-10 draw on Asaph’s lockdown and fear.” episodic memory as he increasingly senses What about you? Have you ever asked these God’s absence in the failing circumstance pilgrimage questions? It takes courage, a he finds himself in. He can exercise his Job-like defiance toward despair and the Science gives us a range of other insights: memory to identify other times of his life failures of ageing. when God’s love was close, almost tenderly • Apparently, we remember interesting palpable, and yet so far away from where Let us consider memory for a few moments. information that we process deeply, that the pilgrimage has brought him in the Can we trust our memory? What does it we reflect on or mull over and so on. present. mean if we reach a point when we forget the love of God is for us? Is despondent ageing, • We remember visuospatial information We often read the Bible and live the ageing with memory white-out, a strange better than verbal instructions. Christian life as if everything is stable, as prank that God plays on our lives? if our lives are destined to remain happy • We remember information that is and healthy, for our sanity and memory to Human beings exercise three different types connected to things we already know. remain intact. But are we aware that the life of memory, as we live with the elusivity of God calls each of us to never comes with time. • We remember information that we test such a guarantee? Prosperity gospels are a ourselves on. cruel hoax which simply ignore a psalm like • Semantic memory relates to how we this. Honest pilgrims bear witness to grace remember concepts and facts, such as Science also can locate the brain structures in good times and bad – grace, even in names, places, formulas, and so on. involved in memory. The hippocampus is times of pandemic lockdown and fear.
6 • CMDFA LUKE’S JOURNAL • November 2020 Psalm 77 now takes a semantic twist. As possibilities of God’s action. “The waters John Swinton. This author says, “It makes Christians, we can remember the fact of the saw you, God – the waters saw you and a world of difference to suggest that the Cross, of Jesus’ grace-scarred hands. As we reeled! Even the deep depths shook! The memory loss we encounter in dementia do, we know our sins are forgiven. We know clouds poured water; the skies cracked happens to people who are loved by God, the shame and guilt of sin can be replaced thunder; your arrows were flying all around! who are made in God’s image and who by the hope of resurrection life. Our speech The crash of your thunder was in the swirling reside within God’s creation”. The speech pilgrimage chooses these words in verses storm; lightning lit up the whole world; the pilgrimage of Psalm 77 has orientated us to 11-15, “But I will remember the Lord’s deeds; earth shook and quaked. Your way went recognise this truth. yes, I will remember your wondrous acts straight through the sea; your pathways from times long past. I will meditate on went right through the mighty waters. But There are many types of dementia but all your works; I will ponder your deeds. your footprints left no trace!” (v77:16-19) the most common and well known is God, your way is holiness! Who is as great Alzheimer’s type dementia. Swinton a god as you, God? You are the God who Self-preoccupation hanging on for grim observes in his book that dementia is works wonders; you have demonstrated death has now transposed to delight, in the diagnosed by exclusion language. This is an your strength among all peoples. With your possibilities of any future moment. We have illness of deficit in memory and, to some mighty arm you redeemed your people; reached the “then sings my soul” moment in extent, thinking. Much of the description redeemed the children of Jacob and our pilgrimage here. of dementia assumes a loss of the sense of Joseph.” self. Swinton argues that theology needs to work with science to defend the self in By choosing to refocus and also actively “If God can bring His dementia. Our self is a reflection of being meditate on the facts about God in Scripture people out of slavery into created in God’s image. Here Swinton – in the history of God’s people, in the tells the story of a person wandering the stories of miracles during the great Exodus the freedom of a land corridors of a care facility repeating the event – the redemption of the children flowing in milk and honey, word “God”. Eventually, a nurse asked the of Jacob and Joseph – the mood of this question, “Are you afraid you will forget pilgrimage changes. A new type of question isn’t there hope for new God?” The immediate response was, “Yes”. emerges, “Who is as great a god as you?” joy even in an aged care Pastoral care at this point helped all the In the place of failing weakness that age agitation to settle. may bring us, memory of God and for God’s facility?” action from “time long past” are a source of The “image of God” identifies not only rebalancing grace. the importance of vertical relationships, Our psalm started quite acceptably in but also of horizontal. Our communities, We Christians live with a double blessing self preoccupied despair. Remembering our friendships, our human relationships of the memory of God’s acts and qualities by the risk of faith has allowed a healing, all contribute to the sense of who we are. which are then consummated in the a renewal, to take place. At the start of We are most clearly ourselves when we incarnation, in God becoming one of us the pilgrimage, God seemed distressingly tell, or reflect on, the story of our lives in through Jesus the Son. We also live with the absent. Now through memory, we can speak relationships. blessing of God’s presence in our own life imaginatively of God as a playful, active pilgrimage as God’s story intersects with our creator. It’s chalk and cheese. It’s moving Swinton has a word for the view of story. from “I” to “you”. “It is no longer I who live, dementia which strips the self from a but Christ [who] lives in me” (Gal 2:20)! The human being – “dementogenic cultures”. And there is more. This speech pilgrimage testimony of this psalm is that the smallest Such cultures give permission to society to invites us to ask all sorts of new questions. faith, the most tentative of faith as we look consider euthanasia rather than maximising Questions like, “If God can bring His people away from despair and diminishing capacity relationships of care. Unsurprisingly, death out of slavery into the freedom of a land back toward God in whose image we are anxiety is on the rise in our contemporary flowing in milk and honey, isn’t there hope created, is a critical pastoral challenge in the world. for new joy even in an aged care facility?” pilgrimage of life. There is scope to dream, to imagine, to Community surveys confirm that dementia grasp new visions, to find the mind of Christ At the start of this psalm, our pilgrim or loss of memory is one of our greatest on any pilgrimage. Why? Because we can senses the absence of God. This breeds fears. The truth that God chooses not to remember Jesus’ promise to never leave further despair. Now through the exercise forget any of us is of great comfort. Any or forsake us, we remember his promise to of memory there is a revived sense of the honest speech pilgrimage will discover send the Spirit as a Comforter at any point of vital presence of God. Ironically, there are sooner or later that whether or not we our life’s calling. still “no footprints” but memory has re- remember, we can trust God remembers established a relationship. us. Isaiah 49:15-16 says, “I will not forget In Asaph’s speech pilgrimage, his words you! See I have engraved you on the start to run wild with excitement. A Spirit- I recently have been reading a book titled palm of my hands”. God’s memory is of fired imagination gets him recreating the Dementia: Living in the Memories of God, by “yesterday, today and forevermore”
7 • CMDFA LUKE’S JOURNAL • November 2020 (Heb 13:8)! And yet, God can choose to which is our true memory and our only we can all, in God’s power, minister to and forget – to forget our sins because of his real source of identity and hope. support each other. great love for us. Now we can say of our lives, “we are not what we remember, we Swinton continues on with other profound As we come to the finishing line in our are remembered”. Nothing can separate reflections, but I think this picture is speech pilgrimage, you may be unsure us from this truth, generated through the enough to carry us to the end of our speech about God’s love. Is it because our bodies great love of God. God’s memory informs pilgrimage. are failing, and we sense our memories the actions of God the Father, Son and are fading? The darkness of our doubts Spirit. Asaph has guided us from the despair of have a menacing quality, yet as we weakness, back to the playful presence of remember God’s story, as we “eat the Swinton’s reflections about God’s memory God. So how will his pilgrimage end? Verse bread and drink the wine”, the Spirit are rich. He says these things: 20 ends this psalm with the image of a ministers God’s memory of us, back to faithful, open journey assisted by guides. us. This is a wonderful blessing. We may • God’s memory is for the purpose of Listen, “You lead your people like sheep have consigned God to “imaginary friend” remembering; to bring together that under the care of Moses and Aaron”. This status, only to discover the playful return of which is fragmented. verse reminds me of Israel’s favourite the most loyal of lovers. psalm, number 23, “The Lord is my • God remembers because God promises. shepherd; I shall not want”. Jesus speaks of Our speech pilgrimage has guided worship Promises like, “I will be with you until sheep knowing his voice and following as from the grip of despair to bring us to this the end of this age” (Matt 28:20). he leads to “green pastures”. Any memory place of enduring rest. Do you hear the we have of God’s grace is a preparation voice of Jesus today, that most tender • God’s memory is not a recreation of the for discovering new, fresh expressions of voice that knows you and your journey? Our past, but a continuation of the self-same grace now and of God remembering us in life pilgrimage is naturally coming home, purpose. the future. to rest. As we approach this day, let us confess that we are remembered. • God’s memory encompasses his entire Our calling at this point of the pilgrimage is relationship with his people (as this trust, it is sweet surrender, again and again. This reflection is adapted from a sermon psalm acknowledges). His memory While God doesn’t leave footprints, he delivered at a Christian Aged Care facility in includes both great deeds of the past gives us leaders like Moses and Aaron who September 2019. as well as his continued concern for his can support God’s people in wilderness Resources: people in the future. times, support when we are in the presence • Bible – CEB • Swinton, John. 2012. Dementia: Living in the Memories of enemies or even in the valley of the of God. Grand Rapids: Eerdmans Publishing Group. • Human memory is nothing more shadow of death. Indeed, Moses saw • Brueggemann, Walter, 1995. The Psalms and the Life (and nothing less) than one mode of the day when the Spirit of God would be of Faith. Minneapolis: Fortress Press. • Polk, Thad A. 2016. The Aging Brain: Course participation in the memory of God, poured out on all the people, the day when Guidebook. Virginia: The Great Courses.
LETTER TO THE EDITOR
Dear Editor, In this regards I would like to share a meetings 3-4 times a year with couple of developments that might discussion of interesting topics to All of us working in the healthcare sector be of some interest to Christian health Christian mental health professionals. are well aware of the increasing issues professionals who are involved in the Following the pandemic this year, with the mental health of our patients. area of mental health; our meetings have been in the virtual There is more awareness and focus space and we welcome anyone about mental health in the public arena. 1. The Centre for Theology and interested to join us from anywhere The current pandemic is only making Psychology (CTP) is a new initiative at in Australia. It is a loose fellowship matters worse with an increase in the the Melbourne School of Theology. to support and encourage one incidence of anxiety and depression. For more information about the another. Anyone interested please The Church is also beginning to accept Centre and the activities, please let me know and I will add you to our that Christians are not immune to visit the website of CTP at mailing list so that you can be kept mental illness and there is an awakening ctp.mst.edu.au CTP is organising informed of future meetings. My of interest in the role that Christians webinars, workshops, a graduate email id is [email protected] can play in the healing ministry. This diploma course and research in is a welcome change but Christians the interface of Theology and I trust that this information will be of involved with mental health have faced Psychology. some assistance to some of your readers theological conflicts and challenges involved in the metal health sector. 2. There has been a Christian Mental over the years when it comes to mental Health Fellowship functioning May God bless you illness. in Victoria for a few years with Kuruvilla George (KG)
8 • CMDFA LUKE’S JOURNAL • November 2020 Rev Prof Elizabeth MacKinlay AM, FACN, PhD Elizabeth is both a registered nurse and a priest in the Anglican Church of Australia. She was the inaugural Director of the Centre for Ageing and Pastoral Studies at St Mark’s National Theological Centre, Canberra 2001 to 2012. She is an Adjunct Research Professor, Public and Contextual Theology Research Centre, Charles Sturt University and Director, CAPS (Colloquium for Aging Perspectives and Spirituality) Australian Centre for Christianity and Culture, CSU.
Finding Meaning in Ageing
Ageing: what is longer life for? connect with the wondrous story of which be personal; ‘it’s something out there.’ Still Those of us living in twenty-first century we are a part. others search for meaning and find life to Western countries for the most part, be meaningless. At least some of those even in the time of COVID-19 pandemic, who take their own lives do so because experience the gift of longer life. Yet, if “The gift of added years of they struggle to find meaning and fail. we search the biblical record, we find that life raises questions of its The very narrative that they have used generally over the centuries, average life as a framework for life has failed them, expectancy was much lower than it is now own; what are these added yet personal narrative or story remains (MacKinlay & Cameron 2019). In terms of years for?” important for the life journey. The Christian longevity, we have more years for living; Scriptures tell God’s story through the but are these added years to be blessing millennia, and it is His story that is the or burden? The gift of added years of life This relationship with God and our vehicle carrying meaning for each of us. raises questions of its own; what are these understanding of it goes to the depth Each of us has a unique story that we may added years for? How are we to live these of our being; it is tied with our identity become more conscious of at particular added years? Can we still find meaning in Christ and lies at the very essence of times of our lives. In fact, it could be said in older age, in the midst of increasing meaning. Paul wrote: “So if anyone is in that we do not just have a story, we are disabilities, frailty, and/or dementia? Christ, there is a new creation: everything story (Kenyon, Clark & De Vries 2001). From old has passed away; everything has the beginning, the Abrahamic faiths have The answers to our questions depend at become new” (2 Corinthians 5:17). However affirmed story as the basis of faith and least to some extent on how we view life in a cautionary note, Paul wrote in his life, thus linking God’s story with human – do we see older age as burden? Do we first letter to the Corinthians, “I fed you story. Lash (1986, p120) wrote of the story expect to live our later years in the same on milk, not solid food, for you were not of our own faiths, linked through the ways our parents and grandparents did? ready for solid food. Even now you are still autobiographical nature of Christian and Or, do we see these years as God’s gift to not ready” (1 Corinthians 3:2). Our growth Jewish faith narrative. us and perhaps as a bonus, where we may in faith as Christians needs to come to continue to grow spiritually, walking in maturity and this growth towards maturity Our story becomes the vehicle for knowing God’s love, having reason to live life to the may take a lifetime; coming to see meaning our identity in Christ. Our story, if it is full? As we were promised in Romans 8:19, in our lives is a crucial component of this authentic, is the conveyor of meaning and we are co-creators with God; there must be developing maturity. is deeply connected to meaning in our lives. meaning to be found in this revelation from However, meaning is not only personal. For God. However, it is only as we come to The search for meaning Christians our stories are also connected more deeply know our place in the whole How do we find meaning in life? Some to our families, our faith community, and of God’s creation that we can begin to people would argue that meaning cannot ultimately to God. Meaning lies at the
9 • CMDFA LUKE’S JOURNAL • November 2020 very core of our being, and as Christians, meaning is encapsulated in our growing into Christ, as we increasingly come to see with God’s eyes, rather than solely through human eyes.
There is a tendency to become more deeply concerned with life meaning as we grow older. In fact, Robert Butler (1995) wrote of the importance of reminiscence and review in later life:
As one’s life nears an end, the opportunity to confront lifetime conflicts and acts of omission and commission, which warrant guilt as well as opportunities for atonement, resolution, and reconciliation, is precious because this is the last opportunity one had.’ (p.xxi) spiritual reminiscence (MacKinlay 2018; transformation and the joy of living in God’s Our story and God’s story MacKinlay & Trevitt 2015, 2010), may bring love. Life is not just about material things, When we search the Bible, we find that us, for the first time, to intentionally search as Paul clearly articulated in 2 Corinthians: God has spread out so much of what for and realise the meaning of our lives. “So we do not lose heart. Even though our He wants us to know in story. However, Viktor Frankl (2006) wrote that during outer nature is wasting away, our inner too often in recent years, story has been our lives, we assign provisional meaning nature is being renewed day by day” trivialised; it has become a popular activity to situations as we experience them, but (2 Corinthians 4:16). In all situations we in residential aged care to record each it is only as we become more aware of may search for and pray to find meaning person’s story. Once that is done, the our mortality that we may become aware and God’s purpose in our lives. task has been completed, set in stone. of a call from within to search for final But what is important about story is not life meaning. So, understood in this way, A model of spiritual tasks and just the facts, dates, and places that are there is a distinct difference from what process of ageing remembered, but the meaning of these to is sometimes called ‘meaning-making’ to As we live longer it is relevant to ask the person; this has often been neglected. merely searching for meaning. whether there are changes in spirituality It is through meaning that the Holy Spirit in these later years. Does ageing stimulate connects with each of us, and how we are changes in meaning or the way it is drawn into God’s story. But how do we “How do we learn to see perceived, or is simply more of the same? learn to connect with that story, the story Often, we graduate young people out of that is both yours and mine, the story that and respond to God’s story the churches, with the expectation that informs our identity as living human beings and our stories as God as children, they have learnt all there is to and children of God? being a Christian, and adults simply need would want?” to continue to live their lives with what How do we learn to see and respond to they learned as children. But there are two God’s story and our stories as God would possibilities that make this belief difficult. want? In a very real sense, story is closely Searching for meaning is not an activity or One is that often these days, children tied to our identity; it goes to the very pastime, it is a deeply personal life journey. have not had the benefit of learning and core of who we are as human beings. All For Christians, this is our answer to the committing to a faith; at least some of of us are conscious of having a story, in question of ‘why am I here?’ and ‘what has these, as adults in later life, come to search some way or another, even when we are been and is God’s purpose for me in life?’ for faith, but lack the deposit of learning children. However, it is in later life that Various situations can raise the importance of faith that would provide the basis for the significance of who we are becomes of this final search for meaning. Perhaps spiritual growth. more important to us, as we begin to it is the diagnosis of a terminal condition, seek answers to the important questions or the loss through death of a loved life The second possibility is that even growing of life. As we grow older, we are able to partner; perhaps it is increasing disability, up in a Christian community, we still have revisit events of our earlier life, to review or admission to residential aged care. Yet it not learnt all we need to learn about living and sometimes to revise the way that we is only as we acknowledge our vulnerability and being as Christians by the time we saw these events at the time they were and our need of interdependence, rather reach adulthood. More recent (secular) experienced (MacKinlay 2017). This review than autonomy and independence, scholarship sees learning as a life-long of life, perhaps through the process of that we may at last discover our own pursuit. And shouldn’t this be the same
10 • CMDFA LUKE’S JOURNAL • November 2020 for adult and ageing Christians? In fact, it the spiritual tasks and process of ageing meaning and final or ultimate meaning. seems that there are possibilities through and was followed by the construction of decremental experiences of the ageing a model of spiritual tasks and process of Meaning is found through relationship, human body that may stimulate the person ageing for those with a Christian faith. with others and/or God; through creation/ to ask the very questions that God wants us (See Figure 1) creativity, natural and human made; to ask, whether we have a faith or not. through the arts, including art, music, This study sought to find whether there poetry, drama and dance; and religion There are fundamental questions that were specific developmental changes in through liturgy, religious services, symbols come to most people, in mid- or later a spirituality of later life. It was a mixed and rituals that carry meaning for the life, or earlier, if confronted by life crises. methods study using a survey of spiritual people and sacred texts (MacKinlay 2017). Importantly, ‘Why am I here?’ and ‘Where wellbeing in later life, and in-depth do I find meaning in my life?’ Clements interviews of independent living older These ways of connecting and conveying (1990) wrote that potential crises of people. Factor analysis compared the meaning remain important for frail meaning may occur for young and old survey and in-depth interview findings older people. A recent study of the lived people which may result in some cases (MacKinlay 1998, 2017). experience of frailty (MacKinlay, Mordike in conversion. Neugarten (1968) noted & Burns 2020) was valuable in finding how the change in perception of time in older The interviews produced rich data on the frail participants were able to negotiate people – a change from time since birth to where participants found meaning. physical decrements and find meaning at
Figure 1 – A model of spiritual tasks of ageing for Christians. Figure 2 – Ways of mediating spirituality Reprinted with permission from MacKinlay (2017 p. 121) Modified from MacKinlay (2017) time left to live. It was with these questions This data corresponded with Frankl’s this time in their lives. It was at this point that I began a journey of discovery in the perspective which found a progression that their very frailty brought opportunities 1990s, to explore with older people where from provisional meanings as people for some, in terms of their self-awareness they found meaning in life. This exploration encounter situations through life, assigning of increasing vulnerability, to be able to culminated in doctoral studies and the meaning, but only later in life being able self-transcend their difficulties. Finding development of a model of spiritual tasks to see final meaning in their lives. Meaning meaning and inner strength are ways and process of ageing (MacKinlay 1998). was seen in two ways: provisional meaning, towards self-transcendence. A number of which in a sense was associated with their these frail older people spoke of their inner It is this model that I wish to write about life process at the time of the event, and strength, based on their certainty of God now. final or ultimate meaning being assigned, being present through the Holy Spirit in if at all, near the end of life. The model their lives. In my initial studies, being aware of the developed in this study (MacKinlay 1998) proportions of the Australian population identified six main themes from the data – Conclusion holding a religious faith and those with no the first four are four continuums between At no time in life does meaning cease faith affiliation, I chose to include people self-sufficiency to vulnerability; provisional to exist, although it may be hard to find of faith and with no religious faith in meaning and process of moving toward meaning in some situations. Finding this study. This approach resulted in the final meaning; relationship to isolation; meaning in life remains crucial for many construction of an initial generic model of hope to despair or fear; then response to in later life and is often accentuated as
11 • CMDFA LUKE’S JOURNAL • November 2020 people become more acutely aware of the an important factor for many people in ageing. Doctoral Thesis, La Trobe University, Melbourne. nearness of end of life. (MacKinlay 2006, 2017), for meaning is • MacKinlay, E. (2017) The Spiritual Dimension of closely connected with hope, peace and joy. Ageing, second edition. London: Jessica Kingsley But, returning to a question I asked at Publishers. the beginning of this article, can one still • MacKinlay, E. (2018) Spiritual Reminiscence in Later References Life. In F. Gibson (ed) International Perspectives find meaning in dementia, when memory • Butler, R. N. (1995) Forward. In B. Haight and J. on Reminiscence, Life Review and Life Story Work. is failing, or recall dysfunction may exist? Webster. (eds) The art and science of reminiscing. London: Jessica Kingsley Publishers, 143-159. Helping people who have dementia to Washington: Taylor & Francis. • MacKinlay, E. & Trevitt, C. (2010) Living in aged care: • Clements, W. M. (1990) ‘Spiritual Development in the using spiritual reminiscence to enhance meaning in connect with meaning is one of the most Fourth Quarter of Life.’ In J.J. Seeber (ed) Spiritual life for those with dementia. International Journal of important things we can do in support of Maturity in the Later Years. New York: The Haworth Mental Health Nursing. 19, 394-401. these people, even as cognitive function Press. • MacKinlay, E. and Cameron, A. (2019). Biblical perspectives on aging. In D. Gu and M. E. Dupre declines. While cognitive abilities may • Frankl, V. E. (1984) Man’s Search for Meaning. New York: Washington Square Press. (Eds), Encyclopedia of Gerontology and Population Aging. Heidelberg, Germany: Springer-Verlag GmbH. continue to be lost, the search for meaning • Frankl, V.E. (2006 with foreword Kushner) Man’s and sense of meaning at the very core of our search for meaning. Boston: Beacon Press. • MacKinlay, Mordike & Burns 2020 Finding meaning in the lived experience of frailty. Unpublished research being remains, and it is through the spiritual • Kenyon, G.M. Clark, P. and de Vries, B. (2001) (eds) report, The Public and Contextual Theology Research Narrative Gerontology: Theory, research, and practice. Centre, Charles Sturt University. level of connecting with meaning that life New York: Springer. can remain worth living for these people. • New Revised Standard Version Bible (1989) Nashville: • Lash, N. (1986) Ideology, metaphor, and analogy. In Thomas Nelson Inc. This deep level of connection beyond S. Hauerwas, & L.G. Jones, (Eds) (1997) Readings in • Neugarten, B. L. (1968) ‘Adult Personality: Toward a language is profound and connects with the narrative theology: why narrative? Eugene OR: Wipf & Stock Publishers. 113-137. Psychology of the Life Cycle.’ In B. L. Neugarten (ed) spiritual and ultimately, with God. Finding Middle Age and Aging: A Reader in Social Psychology. • MacKinlay, E. (1998) The spiritual dimension of ageing: Chicago: The University of Chicago Press. meaning in the final life career remains Meaning in life, response to meaning, and wellbeing
COVID Lament Cry out to the Creator implore our living God for He alone can save us from this viral pestilence.
We sinners all on our knees beg for man alone with COVID cannot see ahead.
We aged are closer to You living at risk but not in fear for surely our lament is heard preparing for eternity.
Bereft of paths to wellness pain surpasses understanding mortality is high and pregnant women die.
People suffer mental ill health acquire disability and despair who is there for them if not the One who Loves.
Lord hear our pleas our laments rise high to Heaven we turn for there many lie awaiting your judgement Poem by Georgina Hoddle, RN Registered Nurse, NCFA Vice-President • July 2020 and merciful eye. Photo: Melissa Markenstein
12 • CMDFA LUKE’S JOURNAL • November 2020 Viv Allanson Viv is a Registered Nurse and has held the position of CEO of Maroba for over two decades. Viv has devoted herself to caring for people in need her entire career and has extensive experience in the Aged Care and the Business Sector. www.maroba.com.au
Is a Residential Aged Care Facility merely a Waiting Room for Death?
In my experience this is a question, a Yes, they removed ‘Responsibilities’ from description, not mine) Rural Aged Care statement, and an entrenched belief for the charter. What modern democracy has service in Kwazulu Natal and had no prior individuals and society as a whole. ever removed the basic human right for healthcare experience whatsoever. I made an individual to have both social rights a commitment to bring her to Australia to My personal view is that the Aged Care and social responsibilities? I continue to experience Aged Care in another nation service I lead is more like God’s Living be outraged by this demeaning gesture on and to personally support her journey. As Room rather than God’s waiting room. the part of our political leaders, however I soon as I said it I thought: “How on earth In fact, I frequently find myself gently never miss the opportunity to step up and will I raise the funds to bring her to Oz?” challenging the many people who have remind our residents that they continue Upon my return, one of my staff asked formed the view that Aged Care is merely a to make a difference to our society, and me to give the Christmas message to our waiting room for death, and that nothing of indeed, humanity. I encourage each one residents, so I began with: “Is there room value happens there. that they have not finished the good works in our inn for Jesus this Christmas?” then that they were created to do until their last began to tell Sr Lucia’s story and the life You see, when we even repeat that belief breath. of older people in St Antonines Nursing (some people say it as if it is funny) we are Home in Kwazulu Natal – the poorest of reinforcing the general societal view that the poor. I then asked: “Was there room in older people have little value or have no “Older people are our inn for Sr Lucia this Christmas?” To my contribution to make to their families, their spectacular human beings dismay, people started leaving the room. community, and even to humanity. My I immediately thought: “This isn’t going expectation for older people is that they and long to make a down well… Was it that Sr Lucia is dark have the right to live out the full number of difference to others … skinned? Is it that she is a nun? Is it that their days – long and strong! she is a foreigner, what could it be?” But and they do!” wait, those same high care residents began Entry into an Aged Care service should not to return waving $5, $10 and $20 notes at be the opportunity to give up on our life me. Noel, who was a retired missionary, goals and aspirations or our contribution After 28 years working in the Aged Care came forward with his $2 coin that he had to society, or have others give up for us sector, I can say that Older people are planned to spend on a cappuccino. They all when we can no longer exercise our voice. spectacular human beings and long to had tears in their eyes as they just wanted Sadly, the federal government recently make a difference to others … and they do! to make room for Sr Lucia and her residents formalised the devaluing of older people from St Antonines. by removing the Charter of Residents In November 2013, I met a nun from South Rights and Responsibilities and replacing Africa at a conference in China. She was It didn’t stop there. One lady who has been it with the ‘Charter of Residents Rights’. sent to work in a very poor Black (Sr Lucia’s confined to a water chair for two decades
13 • CMDFA LUKE’S JOURNAL • November 2020 and can’t even scratch her nose, sent for deceased for burial at the back of the we share stories with families and other me and asked how much it would cost nursing home. Upon my return, everyone residents about each one. I always love to to bring Sr Lucia to Australia. I suggested couldn’t wait to learn of all that took place remind families that their Mum or Dad or about $5000 by the time we covered visas, and what life was like. We connected our both at times were wonderful role models transport, and bribes. She smiled and residents and theirs on Skype many times to us younger ones of what a faithful bond whispered: “I can afford that, let’s make it to learn more of each other’s way of life. of marriage looks like in a world where happen.” Over the following months, all the Yes, older people are interested in the marriage is disposable. I love to reflect on residents and staff continued to raise funds plight of those across the globe. the way they taught us to be good friends so that when Sr Lucia arrived in May 2014 on to each other and how they led the way in Maroba’s red carpet we gave her a further Maroba residents continue to support sustainability in a wasteful world. Yes, they $2000 so that she could purchase items many causes and continue to be generous contributed to humanity until their last needed for her nursing home upon her with their time, their resources and their breath. return. Sr Lucia and her understudy Sr Busi words – a great example to us all of being returned to Australia a couple of years ago an effective global citizen. They continue It is important for our residents that we and some residents continue to contribute to sign up for gym memberships, beauty demonstrate to them while they are well from their pensions to support her. I love to therapy, and everything that is on offer, so and active what the end will look like, so remind our residents of their compassion, don’t believe for a minute that Aged Care is that when it gets close for them they too generosity and ongoing contribution to the beginning of the end. know they will be honored, talked about society and the difference they have made and remembered in positive ways. to humanity. They have truly touched the When residents pass away, we honour nations with the love of God. them in death and remember their So next time you think or even say that contribution to each of us that have shared Aged Care facilities are God’s Waiting Our residents were excited to send me our lives with theirs. As they leave the Room … think again, change your thought, off to St Antonines in 2015, where 2 of us building we form a Guard of Honour at the change your talk and raise the profile and spent 3 weeks working and living with front door so that they leave through the value of older people by believing that the team there, nursing, painting, doing same door as they entered. The whole team being a contributor to the common good policies, food preparation, washing up, participates: carers, admin, maintenance, and engaging in humanitarian efforts maintenance, training, doing activities and housekeeping, laundry, catering, should never depend on where you live or participating in their faith-filled services volunteers, and residents. We hold several the means of mobility required, but more and even the privilege of preparing the memorial services throughout the year and on the attitude of the people around you!
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14 • CMDFA LUKE’S JOURNAL • November 2020 Dr Lauren Chong Lauren is a geriatrician in Sydney, working in a public hospital and aged care outreach service to RACFs – known as InReach and other names elsewhere, with different models of specialised nursing and geriatrician support provided to RACF residents, staff and GPs. She is also the current secretary of the NSW committee of CMDFA.
In God’s Waiting Room Questions and Reflections on Memory, Death, and Aged Care in COVID-19 times
I try to remember all their names and There are so many families who are BPSD* management, and increasing carer faces, but there are so many. unable to see their loved ones, our stress. patients, for months – even as they • The retired pharmacist with dementia might be approaching the end of life. This pandemic has served to further whose mild word-finding difficulties in Death seems so much more lonely and highlight the cracks (chasms) in the aged English (unusually) disappeared when scary during COVID-19 times.1-4 I helped care system that were already being he spoke in the 6-7 other languages he to draft a local guidance sheet on the brought to light by the Royal Commission. knew. He was nevertheless declining palliative management of COVID patients Chronic understaffing and underfunding, cognitively after losing the mental approaching end of life in RACFs, noting lack of adequate training, overuse of stimulation from his wife’s daily visits to that the drug doses and up-titration rates chemical and physical restraint, and the play cards and backgammon. She only were significantly higher than those we list goes on.6,9 Yet Australia still has one lived down the road - so near yet so far. normally used in the frail elderly, because of the highest proportions of elderly She would come to stand in the garden of how severe and distressing symptoms in living in RACFs compared to other OECD* below his “balcony” (window) for a a COVID death can be.5 I spent hours with nations7 – why is this the case? Alternative chat – “We’re like Romeo and Juliet, options are limited when care needs but in reverse!” he said. exceed the practicalities of what can “Death seems so much be managed outside of institutionalised • The frail 36kg Indonesian lady, bed and more lonely and scary aged care. I spend a large portion of my chair-bound, whose family could only time counselling families through the wave at her through the glass doors of her during COVID-19 times.” guilt, loss and anxiety surrounding this RACF*. Could she still recognise who they difficult decision with no good answers.8 were anymore? They wondered if she was It is not our place to judge another’s eating, without them visiting to patiently my public health and outreach colleagues circumstances, only to allow them the spoon in her pureed diet. She told me her in Zoom meetings, poking holes through dignity of risk, and support them through favourite food was fried chicken. RACF outbreak management plans one by whatever choice they make. And true, one. We watched events unfold south of there are some RACF residents who call • The nth episode of recurrent aspiration the border, fearing the worst if our turn their facilities ‘home’ and would rather stay pneumonia in as many months for the came, with 4500-odd residents across 60 there than be transferred to hospital, or to gentleman with advanced dementia. RACFs in our district. And the cost of trying avoid feeling like a burden to their families. Back in hospital yet again (thankfully, to keep them ‘safe’? A deterioration in Not to mention the many RACF staff who COVID-negative) because his family relationships, quality of life, oral intake, genuinely care, but are restricted by the would be unable to visit him at all if he the early detection of subtle delirium and limitations of bureaucracy, funding and remained in his RACF for treatment... myriad other problems, person-centred their own human strength.
15 • CMDFA LUKE’S JOURNAL • November 2020 So, how can we improve the parlous state the value of one’s life does not depend of aged care in Australia? Where the frail on health, function, dependency, choice elderly are hidden away in institutions and or the views of others, but on something where their individuality becomes just more intrinsic and difficult to define: the another number? Perhaps it may help to worth of individuals as made in God’s view the older person (no matter their image, whose times are in His hands. And cognition, function, or social background) yet they are flawed by sin, their bodies not as troublesome, irrelevant, a disease/ subject to the disease of death (which an problem to be solved or a burden on earthly physician can never cure), with the society, but as a person made in the image only certainty being the eternal life in Jesus of God – beloved and deserving of dignity, which follows. How can we as clinicians respect and the best available evidence- better enable those who are at the ends based, person-centred care we can of their earthly lives to face death with provide. They are someone’s friend, parent, dignity, peace, and freedom from fear? grandparent - but even if they weren’t (I have met many “orphaned” elderly in I don’t claim to have the answers to any RACFs) it shouldn’t matter.9 of the questions I’ve asked, and I’m not sure where they might exist. But just as the Somewhere in the middle of the pandemic, achieve? Most people don’t wish to die Lord does not forsake the elderly (Psalm my grandfather died at home in his sleep, alone, or surrounded by strangers, unable 71), so should we not. The important aged 94. I remember the feeling of shock to communicate their needs and utterly thing is to keep asking the questions, as I scrolled through the messages while dependent.2-4 But most people also don’t fighting for better solutions, constantly walking down from the COVID ward after begin to talk about their goals of care until reevaluating the individual’s needs as a post-take round (all turned out COVID it’s too late, and then the overlay of fear, their circumstances evolve – in spite of negative, thankfully). My grandfather, the denial and unrealistic expectation plays the uncertainty without a one-size-fits-all staunch Methodist whose last months in. I’ve had countless discussions about approach. were blunted by a progressive decline from advance care planning (even more in the vascular dementia, was finally released era of COVID-19), with so many met by I often get asked why I chose to become from the indignities of a crumbling body surprise at the mere notion. Age and multi- a geriatrician – you might say we have a on the frailty trajectory into a wondrous morbidity are key risk factors for increased bit of a chip on our shoulders that many eternity in the loving arms of Jesus. I had do not entirely understand what exactly the strange thought that I’d probably been it is that we do, as perhaps one of the awake as he was taking his last breaths, “How can we as clinicians less “desirable” and more “generalist” having been woken at 2:30am by yet better enable those who specialties. It is because of the people: another call from ED. The rest of the day’s routine unfolded numbly with its usual are at the ends of their • the opportunity to spend time with meetings, teaching and administrative earthly lives to face death and get to know my patients (and duties. Perhaps it was the cumulative write 4-page CGAs* on them) and their exhaustion from months of pandemic with dignity, peace, and families, tension without a sign of reprieve on the freedom from fear?” horizon (or the pressure release of annual • taking a holistic and individualised leave), but one of the last things one feels approach to caring for a vulnerable like doing is looking after other people’s mortality from COVID-19,10 though there population, grandparents when one’s own has just is still a proportion of the elderly who died. But I turned up to work the next day will have a minor illness and survive it, • and finding out what matters most to anyway (as you do too, so often). Focusing receiving supportive treatment that does them as they reach the pointy end of on other people’s problems is such a great not require hospitalisation. But inevitably, life. mental distraction. Besides, the team death is a reality that faces us all with rising was understaffed due to sick leave (all probability as age increases. I have seen But it’s also the people I get to work with turned out COVID negative, thankfully). such vastly disparate perspectives on the – amazing multidisciplinary teams, the It helps when you can hide half of your appropriate management of frail, severely people in the sector who are all striving to grieving face behind a surgical mask. And impaired older persons (ranging from doing provide the best possible care of the aged. so, we soldier on – as my ever-pragmatic “everything” including CPR and invasive No-one ever said it would be easy, and like grandmother said, “That’s just life.” life support, to considering euthanasia) all geriatric medicine, it’s a team effort – a that I begin to question the underlying society effort, even. Many told me it was a blessing to be able views on the meaning or purpose of an to die at home in his sleep – yet why is individual’s life and death that drive this. And so to the aged and all those care for this much-envied outcome so difficult to The Christian perspective suggests that them, whether personally or professionally,
16 • CMDFA LUKE’S JOURNAL • November 2020 Ageing Agenda, 27 May 2020. https://www. I would encourage you with this verse – *Abbreviations: australianageingagenda.com.au/contributors/ which provided great comfort as I mourned RACF = residential aged care facility (i.e. nursing home) opinion/covid-19-places-spotlight-on-dying-alone/ my grandfather whom I will not see again BPSD = behavioural and psychological symptoms 5. ANZSPM (2020). Further Symptom Management in this life. I used it in the printouts for his of dementia (e.g. wandering, aggression, agitation, in COVID-19 patients: Treatment Approaches and funeral, only belatedly realising it was my apathy, depression, sleep-wake cycle disturbance) Alternative Routes http://www.anzspm.org.au/c/anzs pm?a=sendfile&ft=p&fid=1591173787&sid= Powerchart password at the time (this is OECD = Organisation for Economic Co-operation and Development 6. Commonwealth of Australia (2019). Royal my way of providing new reminders from Commission into Aged Care Quality and Safety: God’s word every 6 months or so – don’t CGA = comprehensive geriatric assessment, the Interim Report - Neglect (Volume 1). https:// “black-box” core business of geriatricians, comprised worry, I’ve changed it since then!). It speaks agedcare.royalcommission.gov.au/sites/default/ of a multidimensional, usually interdisciplinary process files/2020-02/interim-report-volume-1.pdf to the hope of eternity and the source of of assessing an older person’s medical, psychosocial, 7. Dyer, S.M., Valeri, M., Arora, N., Tilden, D. & Crotty, inner renewal that enables us to persevere: functional and cognitive status (often within the frameworks of geriatric syndromes), with the aim of M. (2020). Is Australia over‐reliant on residential aged developing patient-based interventions within an overall care to support our older population? Med J Aust; 213 “Therefore we do not lose heart. treatment plan aimed at optimising function (11) (4):156-157.e1. || doi: 10.5694/mja2.50670 Though outwardly we are wasting away, Bibliography: 8. Porter, M. (2020). When Alzheimer’s Disease came for my husband, I was left like a widow who cannot yet inwardly we are being renewed day 1. Wakam, G.K., Montgomery, M.D., Biesterveld, mourn. ABC News 29 August 2020. https://www. by day. M.D. & Brown, C.S. (2020). Not Dying Alone – abc.net.au/news/2020-08-29/aged-care-living-with- Modern Compassionate Care in the COVID-19 unmourned-grief/12570328 For our light and momentary troubles Pandemic. N Engl J Med 2020; 382:e88 || DOI:10.1056/ are achieving for us an eternal glory that NEJMp2007781 9. (recommended further reading) Holland-Batt, S. (2020). Magical thinking and the aged-care crisis far outweighs them all. 2. Burke, D. (2020). Coronavirus preys on what terrifies Utopian fantasies and dystopian realities. Griffith So we fix our eyes not what is seen, but us: dying alone. CNN World 29 March 2020. https:// Review 68. edition.cnn.com/2020/03/29/world/funerals-dying- on what is unseen, alone-coronavirus/index.html 10. Holt, N.R., Neumann, J.T., McNeil, J.J. & Cheng, since what is seen is temporary, but what A.C. (2020). Implications of COVID-19 in an ageing 3. Dow, A. (2020). Cancer patient dies in isolation, population. Med J Aust (preprint) 6 May 2020 https:// is unseen is eternal.” waiting for negative COVID-19 test. The Sydney www.mja.com.au/journal/2020/implications-covid-19- 2 Corinthians 4:16-18 Morning Herald, 15 April 2020. https://www.smh.com. ageing-population au/national/cancer-patient-dies-in-isolation-waiting- for-negative-covid-19-test-20200415-p54jyg.html 11. Kelly, L. & Caplan, G. (2014). Comprehensive geriatric assessment. In Caplan, G. (ed), Geriatric Medicine: An 4. Hamilton, M., Kirby, E. & van Toorn, G. (2020). Introduction (1st ed., pp17-29). IP Communications. COVID-19 places spotlight on dying alone. Australian
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17 • CMDFA LUKE’S JOURNAL • November 2020 A/Prof Kuruvilla George (KG) Kuruvilla is the Clinical Director of the Aged Persons Mental Health Service for Eastern Health, Melbourne. He is also the Director of Medical Services for the Peter James Centre. Prior to coming to Australia, KG was the first full time General Secretary of the Evangelical Medical Fellowship of India.
Depression in Ageing
Depression in the elderly is common and folate deficiency and/or vitamin B-12 on society (including to their family) can potentially disabling. Depression is the deficiency increases the risk of vascular be an important factor. Ageism that is most common mental illness in old age. disease and depression. prevalent in society does not help this Due to the rise in our ageing population, • Cerebrovascular lesions – atheromatous feeling. the significance and impact of depression and ischaemic changes in the white • There is a higher incidence of will also increase as a consequence. matter of the brain. depression in the residential care Depressive disorders in older people are • Neurological disorders (eg. CVA’s, population. often under-diagnosed and inadequately Parkinsonism and Motor Neurone managed even after a diagnosis has been Disease) are particularly important as Main features of depressive made. It is also associated with significant risk factors for depression. disorder morbidity and high mortality rates. As • Disability has been found to be more Core symptoms part of the fallen human race, Christians significant than the acuity of the illness. • Depressed mood sustained for at least and non-Christians are all vulnerable to For example, disability from congestive two weeks depressive illness in ageing. cardiac failure would contribute more • Loss of interest or pleasure in normal to depression than an acute myocardial activities Causative and contributory factors infarction. • Decreased energy, increased fatigue for depression in ageing • Chronic pain is another important • Physical ill health is a major risk factor contributory factor. Additional symptoms for depression in old age. This is the • Loss of independence and the guilt of • Loss of confidence or self esteem single most important factor. The risk being a burden on family and others. • Inappropriate and excessive guilt increases with both an increase in • Alcohol abuse. • Recurrent thoughts of death, suicidal the number of illnesses as well as the • Prescribed medications – Around thoughts or behaviour severity of the illness. two dozen different drugs have been • Diminished evidence of ability to think • Age-related reduction in brain implicated and the elderly who have or concentrate neuroamines (both serotonergic and polypharmacy are more vulnerable. • Change in psychomotor activity dopaminergic). • Psychosocial factors such as the death (agitation or retardation) • Genetic – Older people can have new of a spouse or other recent losses • Sleep disturbance onset depression or they can have a including pets, living alone, loneliness, • Appetite change with corresponding recurrent episode of depression from poor accommodation and financial weight change (mainly weight loss in a pre-existing illness earlier in life. stress. older persons) The genetic component plays a more • The “scrap heap phenomena” where an important role in recurrent depression. individual feels that they have outlived If the patient has at least five symptoms • Elevated homocysteine with associated their usefulness and are now a burden (including two core ones) from the list,
18 • CMDFA LUKE’S JOURNAL • November 2020 then by definition he or she has a “major Under-detection of depression include Parkinsonism, hypothyroidism, depressive” disorder. If the patient has two in older people chronic pain disorders), resulting in low to four symptoms (including at least one The clinical presentation of depression recognition rates of depression in the core symptom) then it would be considered in older people can often be vague and elderly. as “minor depression”. non-specific. The elderly are less likely to complain of sadness or to identify Depression and Dementia Psalm 38 is an excellent description of depressive feelings. They have been There is an interesting but complex someone suffering from depression: brought up to be more “stoic” and are relationship between depression and more likely to complain about physical dementia in the elderly. A Psalm of David, for the memorial offering. problems rather than emotional problems • Depression can be mistaken for O LORD, rebuke me not in your anger, when seeing a doctor. Their presentation dementia – depression may present nor discipline me in your wrath! may minimise depressed mood and focus as new-onset confusion or increased For your narrows have sunk into me, instead on physical complaints, generalised confusion. It can be difficult for and your hand has come down on me. anxiety, nervousness and irritability. non-psychiatrists to distinguish There is no soundness in my flesh Physical co-morbidities and cognitive true dementia from depressive because of your indignation; deficits may also mask depression in older pseudodementia. there is no health in my bones people. Ageism and the thinking that it is • Depression and dementia can co-exist because of my sin. “normal to be old and depressed” could be in the same individual. For my iniquities have gone over my head; a factor for underdetection. Social stigma • Late-onset but recurrent depressive like a heavy burden, they are too heavy for me. about mental illness including depression disorder in the elderly could be the My wounds stink and fester is another factor. Christians are especially precursor to a dementing illness. because of my foolishness, vulnerable due to the view that is wrongly • Some of the pharmacological I am utterly bowed down and prostrate; held by many Christians that depression is interventions for depression, especially all the day I go about mourning. due to lack of faith or due to a weak faith the tricyclic antidepressants, can give For my sides are filled with burning, (Docetism). rise to cognitive deficits. and there is no soundness in my flesh. I am feeble and crushed; Depression and Psychosis I groan because of the tumult of my heart. “The elderly are less likely Sixty percent of women and fifty percent of O Lord, all my longing is before you; to complain of sadness men with late-onset major depression have my sighing is not hidden from you. psychotic symptoms. Psychotic symptoms My heart throbs; my strength fails me, or to identify depressive are more common in late-onset depressive and the light of my eyes – it also has gone from me. feelings.” disorders. Common delusional themes My friends and companions stand aloof from my plague, include persecution, guilt, poverty, nihilism and my nearest kin stand far off. and somatic delusions. Those who seek my life clay their snares; Depression and Physical Illness those who seek my hurt speak of ruin The interaction between physical Suicide in the elderly and meditate treachery all day long. illness and depression is complex and Elderly people who have depression are a But I am like a deaf man; I do not hear, bidirectional. high risk group for suicide. Thirty percent like a mute man who does not open his mouth. • Depression is an independent risk of all suicides in Australia are accounted I have become like a man who does not hear, factor for numerous medical conditions, for by people over the age of 65 years. and in whose mouth are no rebukes. including stroke. Risk factors for suicide include elderly But for you, O LORD, do I wait; • Depressive symptoms add to the men, living alone, social isolation, physical it is you, O Lord my God, who will answer. disability experienced from physical disability, recent bereavement and recent For I said, “Only let them not rejoice over me, illness in older people. These symptoms relocation. Symptoms that should cause who boast against me when my foot slips!” are also associated with physical decline concern include expressed risk of self-harm, For I am ready to fall, and worsen the prognosis for co- anhedonia, guilty ruminations, weight and my pain is ever before me. existing physical disorders. loss, persistent physical complaints and I confess my iniquity; • Elderly people who have a physical alcohol abuse. Any deliberate self-harm I am sorry for my sin. disability are three times more likely in the elderly must be treated seriously as But my foes are vigorous, they are mighty, to develop depression. Disability they are rarely attention-seeking and there and many are those who hate me wrongfully. rather than acuity is the important is a high risk of completed suicide or a Those who render me evil for good contributory factor. subsequent completed suicide. accuse me because I follow after good. • Chronic ill health contributes to a poor Do not forsake me, O LORD! prognosis in depressive disorders. Protective factors O my God, be not far from me! • Sensory impairment (hearing and visual) Good physical health and physical fitness Make haste to help me, is associated with depression. are protective factors. Those who are O Lord, my salvation! • Depressive symptoms are often socially active and have well developed masked by physical illness (examples coping skills in early life are less vulnerable
19 • CMDFA LUKE’S JOURNAL • November 2020 for depression in older age. Marriage and The choice of treatment will be influenced When to refer to a Specialist adequate social supports have also been by the type of depression. Major depression Mental Health Service found to be protective factors. Spirituality (with melancholic and/or psychotic features) • When the diagnosis is in doubt and religiosity are also protective factors. requires pharmacological treatment and • Severe depression with melancholic/ As mentioned in the introduction, being sometimes Electro-Convulsive Treatment psychotic features a Christian does not make one less (ECT) with adjunct psychological therapies • Depression with suicidal risk vulnerable to depression. However, as the patient begins to recover. Minor • Medical comorbidities that warrant research has repeatedly shown that the depression is often best treated with specialist input prognosis and recovery from depression psychological therapies but there may also • Failure to respond to first-line therapies is much better in one who has faith. It is spirituality rather than religiosity that Summary is of significance. Having a faith creates “Research has repeatedly • Depression is the most common mental hope, which aids recovery. As Christians, shown that the prognosis health problem in the elderly. we know what, and more importantly • Depression is often unrecognised and Who, we believe in. The importance of and recovery from untreated in older people. taking a spiritual history is pertinent in depression is much better • The main risk factor is poor physical this regard. In addition, undergoing Saline health. Process Witness training and being able to in one who has faith.” • Losses – of loved ones, independence, sensitively ask about and talk about faith health, retirement are also important. issues would be particularly useful in our be a role for pharmacological interventions. • The elderly, especially elderly men, are clinical work. With pharmacological treatments, the at high risk group for suicide. dictum with the elderly is to “start low • Depression treatments are effective Management and go slow”. There are no significant but require appropriate management Due to the role of multiple factors differences in speed of onset although older strategies to achieve and maintain in late onset depression, the work- people generally have a longer recovery remission. up of depression needs an extensive period. Cognitive Behaviour Therapy (CBT) • Christians are not immune to depression consideration of medical (including and Interpersonal Therapy (IPT) have been in ageing. medication history), psychological and proven to be useful in the elderly with • Having a faith has been shown to social issues. As comorbidities play an mild to moderate depression. Other forms facilitate recovery from depression. important role in the elderly, investigations of therapy such as brief psychotherapy, for a first episode of major depression in problem-solving therapy and life review later life needs to be comprehensive. have also been found to have some benefit.
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20 • CMDFA LUKE’S JOURNAL • November 2020 Dr John Best John is a Specialist Sports and Exercise Medicine Physician and worked with elite sports teams. He was Physician with the Australian Wallabies Rugby Team. He is an SMBC graduate and was a men’s pastor. John co-founded an injury clinic for refugees in Sydney’s West.
Combating Frailty In Ageing
Front-page headlines of the Australian community members in our society are treatment where she lost almost 10% of Newspaper on the 17th of July 2020 read: vulnerable. The experience of losing her lean muscle mass. An avid swimmer “Age not an issue: Hospitals ordered to independence, being taken advantage of all her life, Pam participates in swim treat elderly”. and often disregarded is not uncommon. In meets three times per week before this context, the Bible exhorts us to honour having coffee with her squad. She also In the midst of COVID-19, the fact that our God by caring for the vulnerable and needy. loves gardening. elderly members are still loved and admired has been a refreshing reminder. This “The Bible exhorts us to In her post-cancer treatment Pam fell contrasts with the discrimination of ageism, and tore her rotator cuff tendon in her which I believe has grown in our youth- honour God by caring for shoulder. There was no improvement with obsessed and happiness-chasing culture. the vulnerable and needy.” non-operative treatment. She was advised by some doctors not to have surgery, This article is a reflection on these ideas in as she is “too old”. Her pain, movement the context of combating frailty in ageing. “He who oppresses the poor shows restriction and weakness left her unable It is about helping the elderly live well in contempt for their Maker, but whoever to swim and limited in her gardening. Let’s their season of life. is kind to the needy honours God”. keep her in mind as we look at frailty and (Proverbs 14:31) ageing. The Biblical view on ageing Seniority and old age are viewed very Meanwhile, “I’m getting old!” is a common Defining frailty and ageing positively in the Bible. They are often reflection from individuals whose bodies The term “older” carries different considered to be part of a good life. Indeed, are failing, whether it is osteoarthritis or connotations around the world. In “long life” is a common blessing in the lack of capacity. It highlights the negative developing countries it is associated with Jewish community. Many if not all of us are view our society has on ageing, suggesting the inability to live independently and aware of the commandment to honour our a despondent, defeatist attitude and a obtain gainful employment. The World parents as the commandment that comes sense of worthlessness. Health Organisation (WHO) defines with a promise. “older” as “age > 50 years”, while the “Too old?”: An introduction to United Nations uses “> 60 years”. In “Honour your father and your mother, so Pam’s story Western countries “older” is considered that you may live long in the land that the As we consider this topic, meet Pam, to be “> 65 years”, which comprises 15% Lord your God is giving you”. (Exodus 20:12) aged 76 years. Her parents lived into of the Australian population. Our older their 90’s. She has been widowed 7 years community is then sub-categorised into The Bible additionally regards older people after enjoying a great marriage, Pam “young-old” (65-75 years), “old” (75-85 as wise and to be respected. The ageing has also recovered from breast cancer years) and “very old” (>85 years).1
21 • CMDFA LUKE’S JOURNAL • November 2020 The process of ageing is often associated need for excellent General Practitioners with the syndrome of frailty. According to (GPs) in this setting. A great GP stands out the British Geriatrics Society (BGS), ‘Frailty as gold. describes a condition in which multiple body systems lose their built-in reserves’.2 A holistic approach is required, which is In general, people suffer from three or both highly satisfying and time consuming. more out of five symptoms that co-exist. Within formal geriatric care services there These include: will be multi-disciplinary teams available 1. Unintentional weight loss to the patient. This is ideal but not always 2. Muscle loss and weakness possible. In the setting of a general 3. A feeling of fatigue practice, where the patient may have good 4. Slow walking speed family and social support, gains can be 5. Low levels of physical activity. made to conquer frailty and improve the health and wellbeing of the elderly. These symptoms will be expanded on, as changes, such as short-term memory loss, we consider the physiological changes may affect compliance with exercises and Once any acute illness is excluded such occurring with ageing. also the ability to learn new movements. as infection or metabolic disorder, the foundations of exercise prescription, The prevalence of frailty is 15-26% in those d) Other factors dietary review and social support work over 75 years, increasing with age. Sleep, hormonal changes, fatigue and together. Supervision to enhance adjusting to the changing seasons of compliance is needed more than that The physiological changes and life all have to be taken into account required in younger patients. To combat frailty symptoms in ageing when considering the prescription of frailty the interventions include increased The physiological changes of ageing are exercise. Relationally, many elderly people physical activity, dietary review and support well understood as affecting all systems experience bouts of severe loneliness to aid compliance. of the human body. Understanding following the loss of a loved one, a these changes allows us to tailor our “shrinking friendship circle” and social a) The principles of prescribing exercise in interventions more effectively, in particular isolation from the community. In addition the elderly regarding physical activity. to the existing physical deficiencies, there The health benefits of exercise for the are frequently deep social, emotional and elderly are profound.5,6 The ability to a) Cardio-respiratory changes spiritual needs. improve aerobic performance, strength From the age of 50, there is a 5-10% decline and balance still exists despite the ageing in VO2max (cardio-respiratory capacity) per process. The results are impressive with decade. A VO2max of 15-20ml/kg is required “The health benefits of even the most sedentary individuals. for independent community living. The exercise for the elderly are sedentary (inactive) elderly often reach this Patients should be active and exercise for around age 80-85.3 profound.” at least thirty minutes every day, i.e. > 150 minutes per week. Variety and safety is key b) Musculoskeletal changes with good supervision and support through The process of sarcopenia – loss of Assessing frailty family or health care professionals such as muscle mass, strength and endurance There are many tools available to assess nurses, personal trainers, physiotherapists – commences at age 25. This becomes for frailty. As a minimum the BGS include or exercise physiologists. significant after 65 years when at least 25% gait speed, a timed up and go test and the of peak youth strength is lost. At 80 years, PRISMA 7 questionnaire. As the majority of It should be noted that certain patients there is 50% loss of skeletal muscle due to frail patients have sarcopenia the “SARC-F” are fundamentally lazy and indeed may be muscle atrophy. Degenerative changes questionnaire is a helpful scoring tool. This proud of their inactivity. In a respectful way within most tissues occur, in particular the tool combines capacity (e.g rising from a they need to be led to see that by choosing development of tendinopathy and articular chair) with at-risk events (e.g. falls). It is to be inactive and idle they will become a cartilage degeneration. also a predictor for falls and frailty.4 burden to loved ones and the community. Remember the sluggard in Proverbs c) Neurological changes It is incumbent on all healthcare providers 24:30-34. (Note: I am excluding those Proprioceptive, sensory and cognitive to be on the lookout for frailty in elderly unmotivated due to mental illness.) changes occur. The proprioceptive and people. Do approach this holistically sensory changes increase the risk of falls considering physical, psycho-social and As a guideline, exercise prescription for the and therefore hospital admission for spiritual needs. elderly7 is similar to younger patients with trauma care. The outcome from such the following adjustments: admissions generally leaves older patients How to combat frailty in ageing i) Longer recovery, warm up and cool in a declining health state. Cognitive I must underpin all I say by endorsing the down periods required
22 • CMDFA LUKE’S JOURNAL • November 2020 ii) More variety and less repetition in tough for you at the moment. How do you platform of great care and trust it is an training and activities feel looking ahead?” I frequently offer to opportunity for the Christian healthcare iii) Aerobic training: Moderate intensity for pray for them, noting that this has never worker to share the gospel hope of an 150 minutes a week. Vigorous intensity been rejected and even may lead to gospel eternal future where there is no more pain for 60 minutes a week conversations. These experiences are a and suffering. iv) Resistance training twice weekly reminder of the command in 1 Peter 3:15-16 v) Careful balance (proprioceptive) and to “be ready and speak with gentleness “There will be no more death or mourning flexibility training and respect.” or crying or pain, for the old order of vi) Consider group activities such as aqua- things has passed away”. aerobics, chair based exercises and slow “Old, but not frail”: Pam’s story (Revelation 21:4b) movement classes. continues Remember Pam, the swimmer and References b) Nutritional review gardener? She did not improve with 1. National Ageing Research Institute www.nari.net.au/ Patients’ weight, protein and caloric intake non-operative treatment and underwent 2. Turner, G et al. Best practice guidelines for the all need careful assessment. Supplements arthroscopic rotator cuff repair surgery, management of frailty: a British Geriatrics Society, may be required. In patients who are rehabilitation and reconditioning. She Age UK and Royal college of General Practitioners Report. Age and Ageing 2014; 43:744-747. DOI: motivated and otherwise well, the use of returned to her friends swimming at 80% 10.1093/AGEING/AFU 138 testosterone and other anabolic agents of her pre-injury levels. Gardening is fine 3. Cruz-Jentoft, AJ, et al. Sarcopenia: revised European have been studied. and makes her happy. In her gratitude she Consensus on definition and diagnosis. Age and became an effective swimming instructor Ageing 2018, 0 :1-16. DOI: 10.1093/ageing/afy 169 c) Care in other areas for children with disabilities. 4. Malstrom K.M, eta al. SARC-F: A Simple questionnaire Psychosocial and spiritual care is essential. to rapidly diagnose sarcopenia. JAMDA 14(2013) 531- 532. www.jamda.com I have found that the reality of being frail Summary and needy usually makes older patients 5. Exercise in the Age of Evidence Based Medicine: A Combating frailty in ageing is satisfying, Clinical Update. Dr Stephen Blair et al http://www. consider their life purpose and the important and time consuming. A multi- medscape.org/viewarticle/549398 trajectory of their life journeys. disciplinary approach is best where the 6. Concannon et al. Exercise in the Older Adult: From patient knows that the practitioner is a the Sedentary Elderly to the Masters Athlete. American Academy of Physical Medicine and This is very similar to what I have observed great support and offers hope. Rehabilitation, Vol. 4,833-839, November 2012. caring for elite athletes with career-ending/ 7. https://orthosports.com.au/pdf-download/Exercise- threatening injuries. I frequently take the Heroics are not expected, as most patients Prescription-(Part-2).pdf opportunity to ask: “I know things are understand their season of life. From a
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23 • CMDFA LUKE’S JOURNAL • November 2020 Dr Richard Chittleborough Richard has worked for 17 years in suburban General Practice, 2 years in a rural district hospital in Tanzania, and spent his final 16 years in solo practice. These latter years were devoted to Aged Care and Palliative Care in hospital and domiciliary locations but mainly Residential Aged Care Facilities. He retired in 2014.
A Christian GP Reflects on Residential Aged Care
Ageing people come into Residential decreased exercise, burden of disease visited earlier that day. Or they may Aged Care Facilities (RACF) with – and such as anaemia, hypothyroidism, drug suffer the perception or reality of family, sometimes because of – some established effects doctor, nurse, carer or allied health disabilities. Their admission often adds one • Tremor – Parkinsonian or otherwise, or professional not visiting as promised or or more unintended disabilities. Their new simply a general deterioration in fine or expected. residence is usually foreign, with unfamiliar gross motor function • Malnutrition – caused by dental nurses and doctors providing care now. • Constipation – secondary to diet, fluid problems or poor appetite They are often transferred via an unfamiliar intake, reduced physical activity, drug • Mental health issues - depression and hospital because of a recent acute event, effects anxiety such as a stroke, fracture or worsening of • Loss of independence chronic illness like dementia. “The nursing and care A welcomed or enjoyable priority? Consider the following list of possible staff need access to good Few doctors see nursing home residents disabilities accompanying a new resident records from the GP, and as an interesting or enjoyable priority in into a Residential Aged Care Facility: their clinical practice. A senior geriatrician • Change – whether in location, food, vice versa.” from the UK related his involvement in a neighbours, noises regional team of about 14 geriatricians, • Pain – secondary to arthritis, recent • Polypharmacy – Most of us doctors are of whom only two saw nursing home trauma, angina, constipation relatively capable of and comfortable involvement as an enjoyable or important • Breathing difficulty – due to chronic with starting medications, but we part of their practice. When I withdrew COPD, asthma, recent pneumonia are not good at knowing when we from involvement in wider areas of General • Impaired vision – necessitating the should stop. Hence, with each new Practice to focus on nursing homes, a importance of keeping glasses clean problem detected or a different doctor couple of fellow GPs made comments and in place consulted, patients and nurses are such as, “Does that mean that I can dump • Impaired hearing – managed with the burdened by yet another drug addition all my nursing home patients on you?” GP appropriate use of hearing aids, clearing to their already long list of medications. involvement in caring for nursing home the wax from the ear canal We need to have good reasons for all residents can be more time-consuming and • Deteriorating mobility – impacting our prescribing and need to keep clear less lucrative than seeing only patients who transport for specialist or hospital records of the medications, indications come to the doctor’s rooms. follow-up and directions. • Impaired speech • Social isolation – Many Aged Care Verbal communication is important • Disturbed sleep residents feel forgotten. They may Because of geographic change, the aged • Chronic tiredness – contributed by forget that their daughter had already resident is often new to the GP and vice
24 • CMDFA LUKE’S JOURNAL • November 2020 versa, and likewise for families, nurses My mother-in-law often asked for more fractures requiring insertion of several and carers. Family conferences involving fruit, mainly figs, for her bowels. The rods, plates or screws, who had been doctor, resident, family and nurses can be nursing staff said she always answered increasingly adamant about avoiding and enormously helpful, preferably as soon as in the affirmative when asked if she had refusing any more hospital admissions. possible after the resident’s admission. had her bowels open today. Her records He was already on significant doses of They help to build relationships and indicated that she had “as required” orders regular analgesia. He remained remarkably establish mutually realistic expectations. for laxatives but never accepted or asked coherent in speech and in understanding of for them. his predicament. Written communication is also important When I asked what her bowel actions When the nursing staff contacted me one Sourcing the health history of a resident were like, she said, “Like passing a brick.” afternoon to say he was in agony because is a perennial problem. One doctor may With further questions she admitted that of a newly displaced pathological fracture prepare the hospital discharge summaries she opened her bowels with considerable of mid-femoral shaft, what should we do? (sometimes a day before discharge), discomfort and difficulty, and only about We discussed the options again, and gave but another doctor may make additional once a week! some intravenous diazepam and morphine medication changes without knowledge and waited to see if he would physically of the first. The copy of their hospital drug relax. He did relax but also commenced a chart does not always arrive at the same “Always we can endeavour rather prolonged phase of not breathing time as the resident. Occasionally several during which nurses and I achieved pages of hospital record may arrive on to accompany the patient significant correction of his femoral time, but with some pages lacking dates or on their journey and give displacement. We waited anxiously for him even names of the patient. All potentially to breathe again. He managed about two disastrous if another new resident arrives them hope that we will not more weeks of reasonable comfort with from the same hospital at a similar time! We abandon them despite our the help of excellent nursing care and his all need to take great care to legibly name usual analgesics. and date every page of health records. inability to cure them.” Always we can endeavour to accompany The nursing and care staff need access the patient on their journey and give them to good records from the GP, and vice My father asked me to put new batteries in hope that we will not abandon them versa. Over time it is possible to develop his torch. despite our inability to cure them. excellent mutually helpful relationships between GP and nurses. The GP can build “Why?” I asked. Feelings and Faith a mental record of which staff members It is rather common for nursing home in the nursing home provide the most “So I can read the clock in the night.” residents to feel forgotten (by family, accurate and helpful information. This also He had had 5 timepieces in his room, nurse, carer or doctor), burdensome or facilitates the possibility of good telehealth but sometimes could see none of them beyond their usefulness. A few see their advice after hours. A brief conversation because of low light or because someone nursing home admission as one of the best with the relevant carer can often provide had moved a clock or put another object in things that ever happened to them. Some vital insight into the resident’s needs. Site front of it! are glad for the time to chat to others or to Director, Clinical Nurse, Registered Nurse, pray for others. Others may find everyone hands-on Carer, Domestic and Cleaning Residents’ stories are amazingly varied else a nuisance. Aged Care Chaplains staff all have vital roles to play, as well as and informative and often repetitive, but do a great job, and we can be mutually the GP. None should be discounted. also very interesting. Helpful therapeutic supportive of all the other members of the decisions sometimes arise from listening to team. Occasionally we might pray with and Asking questions that matter, long-winded stories! for the resident or the bereaved. gaining answers through stories The elderly love to talk. Dealing with the acute on chronic New or acute events can still be expected In summary, good care in My own father spent his final years in in those whose life and health are nursing homes includes: a local RACF. If I asked him a general already dominated by chronic illness. For question such as “How are you today?” some diseases we can do very little but • Careful listening he would often launch into a lengthy encourage patient and family acceptance of description of his bowel habits. However, the chronicity. Fairly often we can do useful • Accurate record keeping if I said, “Hi Dad, can you remember more things to relieve symptoms. about the uncle who used to ride his • Clear conversations, and motorcycle from Melbourne to Adelaide?” A more severe example is the man with he would expound all kinds of interesting a long history of advanced prostatic • Lots of time! family details. carcinoma, numerous pathological
25 • CMDFA LUKE’S JOURNAL • November 2020 Dr Richard Wong Richard is a GP with city and rural experience, and does part-time hospital work. He serves as the CMDFA QLD (and formerly NSW) secretary, on the board of Healthserve, as a Saline trainer, and is interested in medical missions, both short and long term.
Conducting Christmas Outreach Services at Aged Care Facilities as a visiting GP
In the months before Christmas 2019, I with him presenting two of them based (ministers tell me it’s a common issue in started thinking about hosting a series of on Mark 1:14-15, and Christin presented her their congregations with not many younger Christmas outreach services at the aged well-received testimonies of her faith in ones playing the piano), but after a few care facilities I regularly visit. I considered Christ and what Christmas means to her. attempts, we were blessed with the service that this would be the one time of the Altogether, these shaped essentially a full of the daughter of a BSF (Bible Study year an evangelistic message would be church service, consisting of me chairing Fellowship) leader as well as a member acceptable. I had previously conducted the services with an opening prayer, from another Presbyterian church who such services in Sydney when I was working singing a few well-known Christmas carols agreed literally the night before in answer there so had a good idea of how to conduct interspersed the testimony, a Bible reading to my prayer request for one. them though here in Brisbane, when followed by the main message, closing approaching the facility management for in prayer, and thanking the staff for their Other difficulties included the “inaccurate” permission, it seemed novel and intriguing permission. The invitation to join in the reporting from some staff who had rather than something they were used to, singing of the carols was extended not only advertised it as a carol service or sing-a- so I realised I was on fertile soil if I ran them to my patients at each facility, but also to long rather than as including a Christmas with discernment and sensitivity. anyone else interested. message, so I had to gently rectify that. Also, given the high care needs of the Thankfully all three facilities I approached residents, there needed to be dedicated enthusiastically granted permission and I “I considered that this staff who worked beyond their usual role would like to think it was because of the would be the one time of duties to bring and supervise the residents rapport and integrity I had developed in the halls we were using (which I scoped with them as a Christian doctor honed by the year an evangelistic weeks beforehand for suitability), so I was lessons learnt from years in CMDFA. The message would be conscious to thank them during this and next step was to find a team that I could after the service. For many of you reading work together with to run these three acceptable.” this as medical professionals, treating the consecutive Thursday afternoon half hour elderly either at facilities or in hospital is likely services. I was blessed to have other church friends part of your everyday practice, but I think for come and participate in the singing of the some of my non-medical church friends who I asked a young couple at the church carols as well as talk to the elderly residents are young and fit, it was an eye-opener to the I attend, Rayk and Christin Platzek, who in the background, which freed me up to despair and morbidities that this section of are studying at Queensland Theological run it from the front. the community live with. This is highlighted College and they were a delight to work even more so now during the current climate with in implementing these services. Rayk Some logistical challenges I faced included in which I write this article, and for this I was and I alternated in delivering the messages, an unexpected difficulty finding a pianist very grateful they offered to serve.
26 • CMDFA LUKE’S JOURNAL • November 2020 As one of the team commented, “We were are to bringing light and hope to those in Across the three aged care facilities, I was indeed out of our comfort zone because we despair.” excited that we could share the Christmas hadn’t expected to see that level of physical message to approximately one hundred decline and mental impairment. It made Feedback that I and my church friends people in north Brisbane, and that God us realise how cut-off we younger people received included that the residents found could give me/us the opportunity to generally are from the sick and dying in our it a different way of serving, and refreshing proclaim His Name! Looking back, it is a community. So, seeing the pain and misery of for some to see parts of the body of Christ reminder to me that as Christian medicos, these men and women was hard and yet, it with our differing ages and personalities we are in a unique position to access areas spurred us on to share the gospel with them working together. For others, it was a of society and people’s lives that many as clearly as possible. Perhaps it was the last break in their daily “boring” routine, as one others are not (and I mean this respectfully time they heard about the love and peace put it. Others were appreciative of having and lovingly). Hopefully, this endeavour of Christ, about God’s offer of pardon and an outside group visit. As for any feedback and reflection may be of encouragement eternal life in His kingdom... So, we thank about the deeper aspect of the Gospel for us to take the initiative in sharing the Richard for this ministry opportunity because message convicting hearers, this will be Gospel. it opened our eyes to the gospel urgency in knowledge in which the Holy Spirit will have such places and how vital Christian workers to lead and for us to find out in eternity.
Ode to a Farmer’s Wife
It was just after “Rest Time”, Then I asked her how she was going – I thought if I sang a few lines with patients still sleeping, what the hospital staff hoped to gain. of this wonderful faith-lifting hymn, the nurses were busy updating She shook her head with much sadness, my suffering patient might remember, their notes. “My body is wracked with great pain!” and start putting her trust in Him. I had “Out-of-Towners”, brought in from the Country, “Perhaps I could pray for that with you,” But nothing like that even got started, and I wanted to see those I said with all the confidence I had. no memories with joy went on show, “Long Distant” ones first. But she buried her face in the pillow, until I launched into, “Jesus loves me”, and told me, “I’m probably too bad.” the Bible, it does tell me so. One of those patients was a little old lady, a Farmer’s wife, from way out “the Back” “When I married, we moved Her face was beginning to soften, She was a widow with no close relations, to the country, the memories brought deep humility. no one to visit and take up the slack. to the Bush and onto a farm. I rejoiced as I heard her saying, Then little by little things took over – “Perhaps you could pray for me!” Almost engulfed in pillows and doonas, the fences, the shearing, the barn. the sides on her bed were raised I reached out my hand and asked her like a cot. It was quite a long trip for groceries, if her hand I could hold for a while, I nearly walked past that small even further for mechanical parts. Just while I prayed to the Father, grey-haired lady, When you factored in Church for this daughter who needed His smile. so frail and alone, like they all had forgot. on a Sunday, it really challenged our hearts. And when we had finished our praying, So I put on my friendliest face and my visit had come to an end, and mustered a heart-warming smile, So I really don’t think that I’m worthy, I offered a tract about Jesus, before announcing my mission, to ask for your prayers for my pain, and the Hymn which says he’s our Friend. to visit all the “Pressies” on file. For I left God and His house off my “Do List”, The lady, unworthy no longer, The Lady responded quite quickly, and didn’t go near Him again.” reached up with her outstretched hands, when she realised I was one of her own, and gladly read of the Saviour, “I used to teach Sunday School children, My heart ached for this suffering lady, who saved her and taught her to dance. when I lived with my parents at home.” who had toiled many years on the land, So I pulled out a tract about Jesus, and the Hymn that says he’s our friend.
Ian Johnston Ian has been the Presbyterian chaplain at the John Hunter Hospital in Newcastle since 2012. He grew up in Coonamble, NSW, working as a computer programmer in Sydney till he was called to the ministry in 1973. He and his wife, Roseanne, served parishes in country NSW and northern Queensland till 2005, after which he lectured at Tahlee Bible College. Art by Emile Chou
27 • CMDFA LUKE’S JOURNAL • November 2020 Dr Kenneth Ibe Kenneth emigrated to Australia from Africa about twenty years ago. He is happily married to Sophia with four children and is a general practitioner in Dubbo, Western NSW. He eagerly looks forward to the soon return of our Lord Jesus Christ.
Ageing Gracefully and Living Well
Ageing is a universal part of life. We are is never too late to start. Exercising helps and pneumonia. Regular consults and born and pass through the natural stages with weight control, lowers blood pressure, checkups with your general practitioner of life, including old age, and then die. The strengthens muscles and prevents falls. It or specialist may help prevent diseases World Health Organisation considers old decreases the risks of dementia, diabetes through early diagnosis or timely risk age as beginning at 65 years of age, but at and certain types of arthritis. Older adults assessments to mitigate onset. 55 years of age in Africa. need not rigorously work out. Walking, gardening, or anything to keep moving is Optimism Old age is the stage of life characterised by sufficient. In addition, stretching exercises Being happy and having a generally sunny declining regenerative abilities, diseases are essential for maintaining and improving outlook on life is also linked to longer, and sicknesses more than in the younger flexibility. About five minutes of stretching healthier lives. ages. As an individual transitions into old every day is beneficial. age, they undergo changes in physical and Studies indicate that optimistic people mental capacities that may lead to ill health. live longer and are less likely to develop Sadly, Western culture does not esteem “Being happy and having a certain chronic conditions such as heart the aged. Old age is often thought of as generally sunny outlook on disease. Being optimistic and maintaining an evil, an infirmity, and a dreary time of a positive attitude is associated with preparation for death. However, growing life is also linked to longer, longevity and better recovery from old does not have to mean developing healthier lives.” diseases. Being optimistic and lowering disability and disease. Older adults can take one’s stress levels through relaxation action to reduce the risk of developing a techniques such as meditation, breathing chronic disease or minimise the impact Prevention exercises, adequate sleep, and talking of existing chronic diseases, so as to Preventive measures like annual to a friend helps much to prevent the continue to live productive, purposeful vaccinations and screening tests for development of diseases, including mental and enjoyable lives. Ageing gracefully and breast, cervical and colorectal cancers health conditions. Having a pet has been living well is the art of living our best lives are important for growing old gracefully. linked to lower stress and blood pressure, in our old age and having the physical and Healthy diets nourish the body and also reduced loneliness and better mood. mental health to enjoy it. It is about being help to prevent the development of Finding new and meaningful hobbies can healthy and happy. Much can be done to diseases. Quitting smoking and decreasing help with maintaining a sense of purpose age gracefully and live well. alcohol consumption prevent premature and engagement throughout the course ageing and reduce the risk of developing of life. Evidence shows that people who Exercise lifestyle-related diseases. Good oral health engage in hobbies, leisure and social Foremost, exercise. Exercise improves our and regular dental checkups prevent the activities are happier, experience less health and prevents chronic diseases. It risks of gum disease, heart disease, stroke, depression, and live longer.
28 • CMDFA LUKE’S JOURNAL • November 2020 What does the Bible say about when the almond tree blossoms together. ageing gracefully and living well? and the grasshopper drags itself along They say, “God has forsaken him; The Bible has much to say about being and desire no longer is stirred. pursue him and seize him, born, growing old and dying. Ecclesiastes 12 Then people go to their eternal home for no one will rescue him.” talks about the infirmities of old age. and mourners go about the streets. Do not be far from me, my God; Remember him – before the silver cord is come quickly, God, to help me. Ecclesiastes 12 severed, May my accusers perish in shame; Remember your Creator in the days of and the golden bowl is broken; may those who want to harm me your youth, before the pitcher is shattered at the be covered with scorn and disgrace. before the days of trouble come and the spring, As for me, I will always have hope; years approach when you will say, and the wheel broken at the well, I will praise you more and more. “I find no pleasure in them”– and the dust returns to the ground it before the sun and the light came from, By developing a walk with God that and the moon and the stars grow dark, and the spirit returns to God who gave it. involves a deep, personal, and experiential and the clouds return after the rain; “Meaningless! Meaningless!” says the knowledge of God, that includes the habits when the keepers of the house tremble, Teacher. of trust, praise, and hope, and a walk that and the strong men stoop, “Everything is meaningless!” involves a lifestyle and ministry for God, when the grinders cease because they are then as long as we have life, we can show few, By contrast, Psalm 71 is the psalm of God’s and tell and sing of the greatness of our and those looking through the windows way to grow old gracefully: God to the next generation.1 grow dim; when the doors to the street are closed Psalm 71:9-14 What a way to live out our life! and the sound of grinding fades; Do not cast me away when I am old; when people rise up at the sound of birds, do not forsake me when my strength is Reference: but all their songs grow faint; gone. 1. https://bible.org/seriespage/psalm-71-growing-old- when people are afraid of heights For my enemies speak against me; god%E2%80%99s-way and of dangers in the streets; those who wait to kill me conspire
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29 • CMDFA LUKE’S JOURNAL • November 2020 Dr Chris Poulos Chris is a rehabilitation physician and Head of Research and Aged Care Clinical Services for independent Christian charity HammondCare. He is also a conjoint professor in the Medical Faculty at the University of NSW. Chris attends St Phillip’s Anglican Church in Caringbah, Sydney.
Positive Ageing and Meaningful Life
“Even to your old age and grey hairs care, such as those with extreme frailty, or genetics, or the environment in which they I am He, I am He who will sustain you. the more specialised needs of people living were raised, or because they have made I have made you and I will carry you; with dementia or those who are receiving poor decisions in the past that cannot be I will sustain you and I will rescue you.” palliative care. undone. (Isaiah 46:4 NIV) Positive Ageing and Meaningful I prefer the term positive ageing, not To do the subject of ‘Positive ageing Life – a clinical approach necessarily confining its meaning to the and meaningful life’ justice in only a few realm of positive psychology. I use it in pages is an impossible task. We can only What is positive ageing? a more ‘off-label’ sense, such as: there is scratch the surface of this important A number of terms (such as healthy, active, usually something positive a person can do to topic. However, I will attempt to provide productive, successful) have been used to improve their ageing journey. This approach a framework in this article, divided into is more helpful to people who may not have three sections. aged particularly successfully, healthily, “Having meaning and productively or actively. • The first is a clinical approach to positive purpose in life is also ageing, which focuses on functional Functional ability ability as well as having purpose and integral to positive Because I am a rehabilitation physician, meaning in life. ageing.” I tend to view a patient in terms of their ability to function. People seek medical • The second section discusses how attention for many reasons, but declining purpose and meaning is strengthened describe what ‘ideal’ ageing might look function resulting in activity limitations is by a Christian worldview. like. While it’s helpful to describe an ideal certainly one of the main ones. Activity picture of older age, and to study the limitations lead to a reduced ability for • The third draws both together. epidemiological determinants of ageing people to participate in life pursuits that are well (and hopefully raise the bar for all in meaningful to them. The focus of the article is on someone the future) by identifying an ideal picture who may be just entering, or is well into, of older age, it is not particularly helpful for The World Health Organisation, in older age (let’s say late-50s – either fully people who are already there. its 2015 World Report on Ageing and retired, or retirement is on the horizon). Health1, introduced the term intrinsic One caveat – even though many of the The ideal ageing journey usually requires capacity. Intrinsic capacity is defined as principles still apply, I don’t claim to cover a life-course approach, and many of the the “the composite of all the physical some of the more complex needs of older determinants of the ideal are out of a and mental capacities of an individual”. people requiring high levels of supportive person’s control – either because of A person’s intrinsic capacity, along with
30 • CMDFA LUKE’S JOURNAL • November 2020 the environment, is what determines their present. Allied health therapies, especially Within HammondCare we run a program functional ability. exercise in its various forms (aerobic, called Arts on Prescription, in which older strengthening and balance training), can people with unmet health and wellness The environment, in this context, consists also help a person maximise intrinsic needs work with professional artists to of all the extrinsic factors that can influence capacity. Overcoming internal ageist explore their own creativity in small group function, such as the use of assistive attitudes about the benefits of exercise, settings. An evaluation of the program technologies, the physical environment, and promoting self-efficacy is key. In the suggests that this type of pursuit was able social policy, or the formal and informal case of exercise, self-efficacy is a belief by to create meaning and purpose and improve support available to the person. the person that by exercising they can make mental well-being.4 (Note that eudaimonia a difference to their ability to function. can be contrasted with hedonia, which is The life-course view Allied health practitioners are also very happiness from short-term gratification and Over the life-course, the aim is to maximise effective in looking at how the environment pleasure. Hedonistic pursuits are unlikely to a person’s intrinsic capacity, thereby impacts function and they will be able to create purpose and meaning – your football creating a buffer, or reserve, against advise on assistive technologies as well as team may not always win!). functional decline. The WHO Report modifications to the environment. provides a public health framework in Volunteering is another pursuit that has which this can occur. From early in the If functional deficits remain, then further been shown to promote positive ageing.5 life-course, the aim is to promote capacity ‘environmental’ modifications in the form Volunteering and participatory arts both enhancing behaviours. This is done of community services are fortunately help to create purpose, connect people by education, as well as public health readily available in Australia. Providing with others, develop new skills, and and societal strategies (for example, supportive care might not seem to be a build confidence, all of which can lead to minimising tobacco use through taxation way of promoting functional ability, but improved mental well-being. They can also and restrictions on supply, or creating it can do this when it allows someone to be a means by which people increase their environments which help promote physical continue to undertake meaningful activities physical activity. activity). The health system also plays a (for example, assistance with meals and role in helping people to build and maintain cleaning to allow someone to live in their Meaningful life and the Christian intrinsic capacity (for example, through own home, or assistance with transport to worldview identifying and managing risk factors for allow continuation of shopping). Assistance chronic disease). with a task itself in the form of ‘doing Meaning and purpose with’, and not ‘doing for’, can also serve to There are numerous self-help books that An inevitable consequence of ageing is promote the retention of functional ability. aim to help people age positively. Generally, a decline in intrinsic capacity. The aim they contain sensible suggestions that most should be to slow the decline wherever Informal support through family carers is people would agree with. possible, as well as take opportunities to also very important, as is supporting those reverse any declining capacity that occurs people in their caring role. For example, in his book Seven Strategies following illness or injury. Once again, the for Positive Ageing6, psychologist Robert Hill health system plays a large role in disease Ultimately, however, a change in lists: management, secondary prevention, and accommodation, including to supported the provision of rehabilitation (and other accommodation such as nursing home 1. Finding meaning; restorative strategies). However, the care, may be required. However, this too 2. You’re never too old to learn; environment surrounding the individual can positively impact a person’s ability to 3. Using the past to cultivate wisdom; also plays a role and can help people continue to do some of the tasks that are 4. Maintaining and enhancing meaningful maintain or maximise their functional meaningful to them. relationships in older age; ability by compensating for loss of capacity 5. The importance of giving (and receiving (for example, through the use of assistive Meaning and purpose as factors in gratefully); technology and removing environmental positive ageing 6. The power of forgiveness; and, barriers to participation). Having meaning and purpose in life is also 7. Having a grateful attitude. integral to positive ageing. Eudaimonia is a The individual view term for happiness or well-being. According While Hill’s book is secular in nature, it does In a positive ageing approach, the same to academic and psychologist, Carol include a part of one Bible reference at the public health framework can be used at the Ryff3, psychological well-being includes beginning of his chapter on forgiveness: individual patient level. A very truncated the following constructs: self-acceptance; “Be kind and compassionate to one version of this approach follows2: positive relationships with others; autonomy; another, forgiving each other” environmental mastery; purpose in life; and (Ephesians 4:32) The starting point is to explore ways to personal growth. maximise a person’s intrinsic capacity He then goes on to talk about the through optimal disease management, Having purpose includes having goals and a psychological, and some physical, benefits including the management of pain, if belief that life has a purpose. of forgiveness. There are clearly similarities
31 • CMDFA LUKE’S JOURNAL • November 2020 between Hill’s Seven Strategies and the work 7. We are to be grateful and give thanks: books, I find that the former often take of Ryff and others. “Make sure that nobody pays back wrong on a more contemplative approach, with for wrong, but always strive to do what a greater focus on dealing with loss, in its Meaning and purpose are Biblical precepts is good for each other and for everyone many facets: loss of loved ones; loss of We should expect that a secular view of else. Rejoice always, pray continually, status and meaning derived from work; loss positive ageing and the things that create give thanks in all circumstances; for this is of financial means; and loss of function – to meaning and purpose would be similar God’s will for you in Christ Jesus.” name just a few. for both the Christian and non-Christian, (1 Thessalonians 5:15–18) because we all share the same Creator God. While ‘loss’ is a theme that is especially In fact, we can find Biblical precepts behind The added dimension prevalent in older age, given that our earthly Hill’s Seven Strategies: Within a Christian worldview, the things that life is fallen, fragile and fleeting, the Christian create meaning and purpose in this life have should be better placed to deal with loss, 1. Our lives have meaning: an added dimension and greater depth: and able to maintain an eternal perspective. “I praise you because I am fearfully and But I also wonder if some of these Christian wonderfully made;” (Psalm 139:14) We value relationships not only because books are written with these in focus so as strong relationships are inherently good, but to counterbalance the anti-ageing, “Let’s 2. God wants us to grow, especially within because we are in relationship with God, and not talk about death,” mindset that is so the Christian faith: He with us: pervasive in Western society today? “For this very reason, make every effort to add to your faith goodness; and to “But when the set time had fully come, Christians who are ageing goodness, knowledge; and to knowledge, God sent his Son, born of a woman, born can still embrace life self-control; and to self-control, under the law, to redeem those under the There is every reason why the Christian perseverance; and to perseverance, law, that we might receive adoption to should embrace older age to the extent that godliness; and to godliness, mutual sonship. Because you are his sons, God sent they are able. It is good to seek to maintain affection; and to mutual affection, love. the Spirit of his Son into our hearts, the an active, meaningful life into older age, For if you possess these qualities in Spirit who calls out, ‘Abba, Father.’ So, you and it’s good to look for ways to improve increasing measure, they will keep you are no longer a slave, but God’s child; and functional ability when declining function from being ineffective and unproductive in since you are his child, God has made you interferes with the ability to do so. Not to do your knowledge of our Lord Jesus Christ.” also an heir.” (Galatians 4:4-7). this is both ageist and, I believe, not the view (2 Peter 1:5-8) of ageing presented in the Bible. We can use our experiences as we age, 3. We develop wisdom as we age: including through suffering, to grow Older age also presents many opportunities “Is not wisdom found among the aged? spiritually: to strengthen one’s faith and continue to Does not long life bring understanding?” play a role in advancing God’s kingdom and (Job 12:12) “Not only so, but we also glory in our imparting that faith to generations to come sufferings, because we know that suffering – particularly to grandchildren. 4. God intended for us to value produces perseverance; perseverance, relationships: character; and character, hope.” Within Australia there are a range of “A new command I give you: Love one (Romans 5:3-4). government-funded programs, including another. As I have loved you, so you must allied health services, to help people address love one another.” (John 13:34) Ageing, with God’s help, allows us to functional decline.2 There are also many develop wisdom (i.e. a greater ability opportunities for undertaking purposeful 5. We should be generous: to discern, choose and encourage, see activities, such as volunteering. There are “In everything I did, I showed you that by Proverbs 1 through 7). We are generous to resources available now that were not this kind of hard work we must help the others because God is generous to us. We available to previous generations that can weak, remembering the words the Lord are forgiving to others because, through assist older people to maintain an active Jesus himself said: ‘It is more blessed to Jesus, God has forgiven us. We are grateful faith life, despite functional loss. give than to receive.’ ” (Acts 20:35) to God for rescuing us. • Audiobooks, podcasts and online 6. We should be forgiving: And we have a future hope to help us sermons have opened up new “Therefore, as God’s chosen people, holy through times of trouble – because, let’s opportunities for people who are visually and dearly loved, clothe yourselves with face it, ageing isn’t always fun. impaired or otherwise isolated. David compassion, kindness, humility, gentleness Suchet’s complete reading of the Bible and patience. Bear with each other and Positive ageing within a (NIV) is an excellent resource. forgive one another if any of you has a Christian worldview grievance against someone. Forgive as the When I contrast some of the Christian books • The COVID-19 pandemic has fast-tracked Lord forgave you.” (Colossians 3:12-13) written to provide practical advice about the adoption of technology by many ageing, with the ‘self-help’ style secular churches to bring church into the homes
32 • CMDFA LUKE’S JOURNAL • November 2020 of people, including the unchurched and another) and internal (i.e., how someone References
people who are isolated and who may views themselves). Ageism is the enemy of 1. World Health Organization. World report on ageing not have been able to attend in person, positive ageing and living a meaningful life. and health. Geneva; 2015. even before the current pandemic. Churches have an important role to play in 2. Poulos CJ, Poulos RG. A function-focused approach in combatting ageist attitudes (but this is a primary care for older people with functional decline. Making the most of reablement and restorative care. • Videoconferencing apps allow people topic for another day). Aust J General Practice. 2019;48(7):434 - 9. to connect within home groups. Tablet 3. Ryff CD. Happiness is everything, or is it? Explorations devices allow visually impaired people A future hope on the meaning of psychological well‐being. much greater access to the written word. Inevitably there will come a time when Journal of Personality and Social Psychology. 1989;57(6):1069–81. Within Australia, the purchase of these ageing and functional decline does beat us. devices can even be done through home Until that time comes, there is opportunity 4. Poulos RG, Marwood S, Harkin D, Opher S, Clift S, Cole AMD, Rhee J, Beilharz K, Poulos CJ. Arts on care package funds if it is deemed that to extract the most out of life. However, prescription for community-dwelling older people the purchase improves the well-being of when the inevitable comes, the Christian has with a range of health and wellness needs. Health Soc Care Community. 2019;27(2):483-92. the person, and they cannot otherwise the comforting words of Isaiah 46:4 to rest 5. Lum TY, Lightfoot E. The Effects of Volunteering afford them. on: on the Physical and Mental Health of Older People. Research on Aging. 2005;27(1):31-55.
Ageism “Even to your old age and grey hairs 6. Hill RD. Seven Strategies for Positive Ageing. New Finally, a word on ageism. Ageism can I am he, I am he who will sustain you. York: W. W. Norton & Company; 2008. be both external (i.e. how society views I have made you and I will carry you; older people, or how one person views I will sustain you and I will rescue you.”
VALE Dr Bill Ramsay 29 March 2020 (85yrs)
My friend Dr Bill Ramsay FRACS died on New Guinea, then at Vellore CMC in Sunday 29 March aged 85 years after Tamil Nadu, training in further leprosy a long illness, and the effects of a rare techniques under Dr Paul Brand’s brain tumour that affected his balance. successor. Bill was a man one could never forget. Then followed 14 years back in Melbourne from 1973 at Box Hill Hospital; he then My earliest memories date back to the volunteered to work at Taksin in Nepal, early fifties, where at Scotch College, then in Bhutan, then in the Cameroon for Bill was my senior school hero – mainly 12 months, before heading for Northern because we all worshipped the demigods Iraq to serve among the Kurds - always of the first division football and cricket aided and abetted by his best friend, teams; Bill was a champion in both. and wife, Dr Robyn. What an incredible, His dear wife, Robyn, has confirmed that adaptable and resilient couple. Bill came into the Crusader Group at Bill was a big man, with a cheeky glint Qualities like integrity, faithfulness and school through the ministry of the Bryan in his eye; he had a very strong faith in a humble stamina were there in spades Green Echoes. Crusaders was a precursor very big God, which determined how he throughout Bill’s extraordinary life, but of the wider based Inter-School Christian spent his time, his surgical skills, and his deep down it was his personal faith in a Fellowship (ISCF) and Scripture Union. money. I believe his faith was fostered personal God that shone through. Bill was a keen young Christian in the in his gracious family at their home in mid-fifties when lots of school leaders He always felt grateful to the members of Templestowe, which has been preserved found a vigorous Christian discipleship the CMDFA, who were such a network of in the family for his son Peter. quite fashionable. He developed a close support for him, and he was a regular at friendship with junior teacher David Bill was a skilled surgeon of the old most CMDFA Conferences. He is part of Scott, and then with the late Rev Lawrie school, where a General Surgeon was that heritage; on whose shoulders we see Bartlett, who was Commandant at trained to do generally everything. This the future more clearly. Camp Tallawalla at Toolangi. I can still was superb preparation for the life he We are diminished by his loss, but remember Bill as a young leader at one felt called to live after an intentional inspired to serve and love our God Camp there, thumping a footy with his early retirement so that he could work generously, even wastefully, because Bill bare feet right out of the paddock! In in a mission overseas where his skills did it so naturally. fact, the all-purpose Hall at Toolangi site were more needed. He became quite still bears the Ramsay name, but for more peripatetic, and with Robyn, worked than his football prowess! with The Leprosy Mission in Papua by David Price
33 • CMDFA LUKE’S JOURNAL • November 2020 Georgia Strimaitis Georgia is an Occupational Therapist working in residential aged care in Perth. Georgia gave her life to Christ when she was six years old, and is passionate about showing His love and grace to those who are most vulnerable. Georgia grew up in Brisbane, and is currently living in Perth with her husband, who is studying medicine.
Everyday Joy!
Joy. A lot can be conveyed in only three My job as an OT is a strange one. On the my residents’ faces light up with happiness letters. Joy is an emotion we all aspire too, one hand I am one of the clinical staff, during these moments. yet is not one often associated with ageing tasked with pain management and ensuring and aged care. In an age of the Royal residents have equipment that is both Recently I witnessed a man watching his Commission and COVID-19, the pictures appropriate and safe for them to use. On wife participate in a game with a giant being painted of the aged care industry the other hand, however, I am there to balloon. This lady has advanced dementia, are often quite bleak, and it can be hard to ensure the men and women living in our and is no longer independently mobile. She imagine joy fitting in with the images we facility are able to engage and participate has recently been asleep when he visits, are fed of neglect, abuse and loneliness. in the activities and tasks they most want and watching him watch her face as she As a professional, it can be disheartening to. Whether it is working with our Therapy caught the balloon filled me with a joy that to see your workplaces – and people’s Assistants to plan the best activities was not the “jump up and down” joy most homes – viewed in this way. However, as people think of, but a warm, golden joy an Occupational Therapist (OT) working that sat in my chest. It is this kind of joy that in residential aged care, I am afforded the “I’m not worried about I most want my residents to feel every day. unique opportunity to not only witness, but the future, because to spark joy in the lives of the people I work While I have been creating these moments with, and perhaps to even change their God has a plan.” of “great pleasure and delight” for my perspective on what it means to age. residents, they are the ones who have been teaching me about the joy that Rick Warren Before I go any further, I want to look at program we can, going for a walk with a was talking about. Working in a Christian just what joy is. The dictionary definition lady who is vision impaired, or engaging facility, I have been privileged to have many of the word joy is “to experience great someone with advanced dementia in doll conversations with older Christians, many pleasure or delight,” (Merriam-Webster, therapy, I am able to create pockets of joy of whom have walked with the Lord for 2020). According to Bill High (2017), that others may not ever witness. two or even three times my lifetime. Their Rick Warren defines joy as “the settled quiet faith in their loving Father has been assurance that God is in control of all the If there is one thing that working in aged a stark contrast to my frenzied approach details of my life, the quiet confidence that care has taught me about joy, it is that to each day. On the days where I am at my ultimately everything is going to be alright, something does not have to be a big, flashy most stressed and panicked, God will send and the determined choice to praise God in event to bring you joy. Joy can be found me a conversation that reminds me of what every situation.” in winning a round of bingo, eating the is most important – my faith in Him, and best ANZAC biscuit you’ve ever seen, or the blessings he has given me. Often, God It is both of these definitions that I am making decorations for the common area. sends me these moments coupled with blessed to witness each and every day. As a staff member, I feel joy at watching one of my less-enjoyable roles – assessing
34 • CMDFA LUKE’S JOURNAL • November 2020 Dr Dianne Pacey Di worked at Royal Newcastle Hospital on the clerical staff. She gained a Bachelor of Medicine, specialist qualifications in Rehabilitation Medicine and Pain Medicine. Currently, she and Geoff are co-leaders of the Pastoral Care Team at Northlakes Salvos. She volunteers in aged care and addiction rehabilitation facilities. She also works as a School Chaplain. TESTIMONY
myI had residents always forthought symptoms that Iof was anxiety a lucky and An elderly Salvation Army lady in her blue follower and I began to experience a depression.person. Life seemed to go pretty well serge uniform, showed the grace and God who is all around us and in us. I for me. I was born into a ‘good’ family love of Jesus in an amazing way. That learnt about sin, both conscious and Givenin the themid-20th high prevalence century; a of great mental time ill- for night we happened to run into Ian O’Dea unconscious, and there was a change to healtha woman in the to beelderly, born it in is Australia. to be expected I had with whom we had worked at Rankin the deep posture of my inner being. thataccess many to education, of my residents never – wentregardless hungry of Park Hospital and his wife Pam, part of faithor worried – struggle about with a roofsome over really my difficult head. the senior leadership team at Northlakes I gave up things that do not relate to my emotionssurprisingly, and I thoughts. was admitted It can to be Medical easy Salvation Army. They invited us to that relationship with Jesus and experienced toschool be swept despite up inbeing this, afocusing single parent only church and this began our journey of a decline in anxiety. I developed a onwithout the negatives. an HsC; atMany a time older when people Gough regular church attendance. deep trust in God and peace. I gave up are struggling with the loss of their Whitlam made the single Parent Pension practising medicine and now find myself independence, and medical conditions that available and had removed tertiary working in a school as a Chaplain, and make each day a struggle against pain and education fees. have been greatly challenged by this. illness. Many cannot see any hope, today or “God has a love for us I have had to depend totally on God’s for the future. I loved my job working as a doctor. independent of our Spirit to guide me in this work, as I am I had the good fortune of pursuing completely inexperienced in this area. I However, not all of these assessments circumstances, our Annetta Tsang art – One at a time flowers Rehabilitation and Pain Medicine and have learned much and He continues to are negative. Every so often, I will ask a self-perception or residentlooking afterabout people how they with see chronic their future, day reminds me of God’s sovereignty, and encourageI have made me youto depend and I will not carry on you;my own anddisabilities. receive somethingI was inspired like by the the following: way the joy thatanything can be found else.” in entrusting my resources I will sustain but on you Him. and I will rescue you.” “I’mthey notdealt worried with life about and the their future, ongoing because situation to him. Godchallenges. has a plan. Life I washave good. my family I had and a great AsWhile I reflect I have theon the daily past, privilege I have of the creating friends,job, loving and family, when itmaterial is my time, security, God will call InBy our the current good grace society, of God,ageing Geoff is often followed seen realisationmoments of that joy someonein the lives else of my is and residents, has megood home.” friendships, and good health. I did asnot a farnegative behind experience, me in experiencing something the to lovebe alwaysGod reminds been leadingme that myit is life. He thatBut bringsnow I am struggle with a work/life balance and had feared.of Jesus Many and wepeople accepted whom Him I have as Lordspoken and settrue free. joy, bothI now now ask andmyself, for the rest of my Wow.had one What episode a different of reactive perspective depression on life. toSaviour also view into ageingour lives. as aWe very came lonely to process,know life. I can rest assured knowing that my life Abut perspective I do not remember that only comesfeeling through an absence duringthat there which is athey love watch for us their independent family and of – and“What the lives are the of my invitations residents of – Jesus are held in this ain deep my life; faith the in so-calledthe One who ‘God-shaped holds all of hole’. friendshow we pass might away, feel leaving even about them ourselves,alone. securelyphase in of His my hands, life?” and He will sustain us our lives in His hand. It is in conversations Isaiahthat God 46:3-4 has reminds a love for us usthat independent we are never of until we are one day called home. likesalvation: these that I am reminded of Simeon alone,our circumstances, even in our old our age. self-perception or “What is Jesus trying to do in my life andSix years Anna, ago, who Geoff knew thatsee( his God Testimony had a plan anything else. right now?” and, Bibliography: foron earliernot only page them,) and but I happened all of humanity, to find “Listen to me, you descendants of Jacob, High, Bill. How do You Define Joy. [Internet] 2020. andourselves waited at patiently the Salvation for God Army to fulfil Hamilton that Followingall the remnant Jesus: of the people of Israel, Available“How from: do https://billhigh.com/faith/how-do-you-I say yes?” promise.Corps supporting When I think a family about member. how I react It to I beganyou whom to follow I have Jesus, upheld learning since your his birth, define-joy/ stressorswas to my and great set-backs surprise in thatmy own night life, that the I teachings and have through carried the since Bible you andwere the born. TheMeriam end Webster. goal ofJoy. my [Internet] journey 2020. now Available is to from: live patienthad an experienceendurance of of Simeon, the love Anna of God and so the church.Even toI began your old to practiceage and gray this hairsancient inhttps://www.merriam-webster.com/dictionary/joy God’s presence and love. residentspowerful Ithat am privilegedI could not to deny work it. with each spiritual I am he, discipline I am he ofwho being will sustaina Jesus you.
Make a bequest to CMDFA CMDFA relies so much on the generosity of our members to promote, grow and share the Fellowship of Christ through our profession. After taking care of your family and loved ones, consider what a difference you can make to the future of your profession byleaving a bequest to CMDFA. A bequest is a lasting legacy that links the achievement of one generation to the well-being of the next. It will help CMDFA fulfil its ministry to the healthcare profession. A bequest to CMDFA can be made in a number of ways: • A stated percentage of your estate after your family has been provided for. Help the next • The residue of your estate after debts, charges and other bequests have been deducted. generation • A specific sum of money, or shares, or property. of Doctors • Life insurance, with CMDFA as a beneficiary. and Dentists So please prayerfully consider whether you can help the future work of CMDFA through a bequest. share the love If you would like help or more information, please contact our National Manager: David Brown of Christ... Tel: 02 9680 1233 • Mob: 0414 340 848 • Email: david @cmdfa.org.au
35 • CMDFA LUKE’S JOURNAL • November 2020 43 • CMDFA LUKE’S JOURNAL • April 2020
LJ 420 letter.indd 43 21-Apr-20 8:54:24 AM Steve Calder Steve is the Senior Pastoral Care Coordinator for HammondCare Health, a provider of inpatient and community services (including palliative care) in NSW. Originally working in Anglican ministry in Sydney, he is married to Sandra and has five sons.
Enhancing Dignity for Those Nearing the End of their Life
As I write this, I’m looking at a book on my had been emotionally hurt by many people Introducing Dignity Therapy desk. It’s a book I had a hand in producing, throughout her life. She knew little of the It was then that I realised that Penny and yet I didn’t write it. It was written by worth and value that she had, though she would be an excellent candidate for a Penny. It is Penny’s story. How the book was made in the image of God and deeply specialised intervention to which I had came about is a story in itself. But first let loved by him (Genesis 1:26, Psalm 36:7). been introduced only weeks before: Dignity me introduce you to Penny. Therapy. In short, Dignity Therapy is a way of capturing a person’s story in writing so Introducing Penny that hopes and wishes for loved ones can Penny was a patient in the Palliative Care be expressed, and so “live on” after death, Ward where I work. She was 80 years old, thereby conserving and enhancing dignity. suffering from metastatic endometrial cancer, and bed bound. When I met Penny Dignity Therapy was developed by she was sitting up in bed, her long silver Canadian Palliative Care physician, Harvey hair pulled up into a tight bun. At first she Chochinov.1 His research indicated that eyed me with suspicion; after all, I was the many people with a life-limiting illness have “chaplain”, and by her own admission she dignity-related concerns. In one study, over wasn’t at all religious. Indeed, it became 87% of patients reported that their sense immediately obvious that she was very Penny’s book. of dignity was most likely to be influenced angry about her upbringing in a very by end-of-life worries, such as not being religious household, which had turned her Her son, Adrian, was the light of her life. treated with respect or understanding, and off anything... and anyone... who reminded He was a gifted university academic, and feeling like they didn’t matter anymore.2 her of that past. Penny often spoke of how proud she was of him. Of course, Adrian knew most of his Dignity Therapy dignifies the patient Soon, though, as we began to talk, Penny mother’s stories, and yet it was clear that in through the process of engaging in a softened and slowly told me her story. the retelling of the account of her life, there directed and captured conversation. Penny had grown up in country NSW in a were feelings that Penny had never shared This conversation is built around a set large and strict family, and at a young age with Adrian – her hopes and dreams for of questions called the “Dignity Therapy had been sent away to boarding school. him, her love for him. She was also worried Protocol Questions” (which are presented Tragically, she’d experienced physical about him. He was single, and she longed to the patient for review before the abuse there. Later, as a young woman, for him to have a family of his own. But she therapy begins). Questions include: she’d endured a broken engagement, had found it difficult to talk to him face-to-face, a child out of wedlock, and had suffered and this was distressing to her, especially as • Are there particular things that you biting criticism from family members. She she knew her time was short. would want your family to know about
36 • CMDFA LUKE’S JOURNAL • November 2020 you and are there particular things you saw an opportunity to further enhance the older people, and to listen carefully to their would want them to remember? document I would hand her at the end. I stories. We mediate Christ’s love by slowing sourced some beautiful recent photos of down, attending to, reflecting, and seeking • What do you take most pride in in your her town, and having obtained permission to understand what they say. Their stories life? to use them, included them with her words always contain clues about their spiritual in a book made using an online bookbinder. state. My conversations with Penny were • Are there particular things that you Penny graciously allowed me a make and deeper and more profound after Dignity feel need to be said to your family (and keep a copy of the book myself. Therapy, as we touched on her relationship others) or things that you would like to with God in a way that would have been take the time to say once again? I well remember the day I handed Penny impossible before. Dignity Therapy is not her completed book. Her copious tears of for everyone, but when appropriate it is • What are your hopes and dreams for joy were eloquent testimony that she knew one tool that enhances the message that your loved ones? that she had been dignified by this process. we want to convey as Christians: that each She had been able to express herself in person has God-given worth and value, and The directed conversation is recorded, a way that would have a lasting effect, indeed dignity, right to the last moment of transcribed, and, in an iterative process, especially upon Adrian. Later, when I visited their life. the transcript is edited to form a final her, the book was prominently displayed document which is then handed to the on her over-bed table, and she would beam References: patient. It is this whole process which when she recounted how she would show 1. Chochinov, Harvey Max. Dignity Therapy: Final Words imbues the patient with dignity. it to every visitor. for Final Days. Oxford: OUP, 2006.
2. Chochinov HM, Krisjanson LJ, Hack TF, Hassard T, Penny’s Book Final reflections McClement S, Harlos M. Dignity in the terminally ill: As I went through this process with Penny, As I reflect back on participating in Dignity revisited. J Palliat Med. 2006:9(3):666-672. and she talked fondly about the rolling Therapy with Penny, I am reminded of hills of the town in which she grew up, I what a privilege it is to spend time with
37 • CMDFA LUKE’S JOURNAL • November 2020 Dr Kristen Dang Kristen is a family doctor who loves all things creative. She lives with her husband and daughter in Adelaide, and writes a regular blog (lostnowfoundk) on life with God. Her second blog (lilyofthevalleysk), aims to share her love for Jesus through the creative arts.
DEVOTION Ageing Unhindered
People talk about ageing gracefully, despite having a “thorn in the flesh”, Dropbox” is a documentary that covers embracing the gray hairs, appreciating commonly thought to reference a some of his work and testimony. what helped us grow, and investing in the disease affecting his eyesight. next generation. Yet ageing often brings • Nick Vujicic was born without properly regrets, worries, fears and disability. “Don’t • The prophetess Anna was 84 years old formed arms or legs and shares his get old!”, people say as they smile through at the time she recognised the young testimony through multiple platforms as the weariness of physical decline. The years Jesus as Messiah and began to proclaim an evangelist and motivational speaker. are inevitable, but there is a crown of glory the good news. that we can look forward to. • George Matheson went blind in his • Sarah and Elizabeth were both older youth. His blindness caused his fiancée “Gray hair is a crown of glory; women well past child-bearing years. to leave him and he never married. it is gained in a righteous life.” In their old age, Sarah became the Yet he knew God was faithful and (Proverbs 16:31) mother of Isaac, patriarch of Israel, composed the hymn O Love That Wilt and Elizabeth the mother of John the Not Let Me Go. As I get older, I find I am much more aware Baptist. of life’s stages: childhood play, disciplined • Billy Graham died in 2018, aged 99. He learning, milestones of family life, loss of There are also examples to be seen in more continued to share Christ with people loved ones and the day we ourselves take recent times: right until the end of his earthly life. that final breath. Each stage of life has its His book Nearing Home, was published own challenges and celebrations, and God • Pastor Lee Jong Rak continues to care in 2011, and addresses some of the remains our fortress through it all. for, and speak God’s life over disabled challenges our faith may face in older children and abandoned babies despite years of life. He ends triumphantly, Never too old, never too weak his age and medical issues. “The however, in reminding us that getting What an encouragement it is that God older on earth also means getting closer works through people of every age, nation, to our real home, eternity with Christ. gifting and capacity. Many elderly and “Each stage of life has disabled people were used powerfully by Lessons from Nonnas and Nonnos God: its own challenges and When I “grow up” and grow old, I want celebrations, and God to have the kind of seasoned, matured • Moses was 80 years old when he spoke and steadfast faith I see in the nonnas and to Pharaoh. remains our fortress nonnos of my local church. through it all.” • The apostle Paul ministered to people Age has not wearied their passion for
38 • CMDFA LUKE’S JOURNAL • November 2020 Christ, and it has not lessened their zeal for approaching and are not afraid of it, but sharing the good news with strangers on are confident that they will be with Christ the street. It has brought physical losses that day. with reduced mobility, pain, hospital visits and the loss of spouses, but they have One way to grow old but not weary, is to remained steadfast in praising God. These keep refreshed daily with hope in Christ. nonnas and nonnas are an inspiration to This hope reminds us that there is a better me. They show me what it looks like to day still to come, a day when we will be love God wholeheartedly even when your home with Christ. What a glorious day to physical condition means you need to sit look forward to! down midway through the service. Ageing Unhindered They might not be on stage with a Rather than letting the years hinder our microphone in their hand, but the faith, let us age gloriously, having the genuineness of their faith proclaims Christ eternal perspective of knowing that life on to all they meet. They gladly worship earth is a journey towards our true home Him despite their griefs on earth. They with Christ. lovingly pray for and build up the younger members of the church, giving them Let us celebrate the elderly, persevere opportunities to serve and grow and through times of disability, lean on God learn. They remember the testimonies our strength, and never cease to testify of of God throughout their life and joyfully what He has done for us. Age is no barrier share these powerful moments in “Ageing Unhindered - Gray Hairs a Crown” to being used by God and who knows, everyday conversation. They see death by Kristen Dang perhaps the best is yet to come!
39 • CMDFA LUKE’S JOURNAL • November 2020
58 • CMDFA LUKE’S JOURNAL • April 2020
LJ 420 letter.indd 58 21-Apr-20 8:54:26 AM Dr Monique Peris Monique is a General Paediatric Advanced Trainee working in Melbourne, Victoria. She completed her medical training in NSW, joining the CMDFA community in her first year of medical school in 2007 through Transfusion camp.
Age: More Than A Number
“Hi, I’m the doctor in emergency. Do “You need to prepare yourself that The journey to that point has not been you want us to treat your grandmother this might be it for her. She may never peaceful, but my family and I take comfort aggressively or what? Your family can’t recover.” in the knowledge that she is now at decide so that’s why you’re on the complete peace with her Lord and savior, phone.” I found myself wondering if we were the ultimate physician and healer. talking about the same person as my “What’s wrong with her?” grandma sat bolt upright in bed happily Several days before she passed we were drinking her tea and talking about the ride once again faced with prejudice directed at “I don’t know but she’s 96.” in the ambulance. grandma’s age.
Sadly my grandmother’s case is not “You may want to discuss with the doctor isolated. Working in medicine it becomes “When did we give up on about rationalising things.” apparent that the worth of the generation that lived through wars, drought and the generation that has At the time grandma had been sleeping economic crisis can be boiled down to a given so much to us?” for longer periods of time and eating number. Since when did everyone over the less. Despite this she remained happy and age of 80 automatically earn themselves well, eating and taking her tablets. Once a label of ‘medical futility?’ When did we My grandmother may have been 96, but again we were faced with changing her give up on the generation that has given she loved her life. She was certainly more management while she appeared to be so much to us? When did these legends frail and forgetful, but she still had her coping. Several days later she was reviewed of the past lose the basic right to be mind, for which we were grateful. by the GP having refused her medication informed of their options? The last of the that morning. We ran into the GP in the ‘doctor knows best’ generation, elderly Thankfully my grandmother did live to fight corridor who mentioned they may “change patients can be particularly vulnerable in another day. She returned to the nursing a few things”. My mother didn’t know what healthcare encounters as they are more home excited to see everyone, regaling the that meant but she trusted the medical likely to accept the advice of treating adventure of the ambulance. team. I approached the doctor to clarify the medical professionals without question or plan. It seemed that she had ceased all of complaint. * * * * * Grandma’s medications and commenced her on regular oral morphine. Even though the bedside manner of the It has only been a few weeks since my physicians involved in Grandma’s care grandmother passed. Every breath was on There was no explanation for us as a improved, the attitude towards her her own terms. She died with dignity and in family. No discussion about a change to treatment did not. peace surrounded by family. medications. No reasoning was given,
40 • CMDFA LUKE’S JOURNAL • November 2020 nor was there an explanation of the dying centered care means looking at the person process or what we may expect over the “In my case, the doctor beyond the number. next few days, weeks and months. in ED had seen my Every patient needs our time, attention and While the outcome would have been grandmother ... as a compassion. the same, the process was horrendous, member of the over-90s stemming from an apparent disregard for Every patient should have their medical the value of someone’s life due to their club in whom the discussion management thoughtfully considered in age. As a family we constantly felt we were of medical investigation and light of their physical and mental health. fighting for grandma to die with dignity in her own time. management was futile.” Every patient and their family has the right to hear all medical options in order to make We all have attitudes, experiences and an informed decision. beliefs that influence the way we practice. patient as an individual with their own story It is important to practice self-reflection and and unique needs and has been shown to be I want every one of my patients and their self-awareness as to what influences not is perceived positively by the patients.3 Non- families to have the hope that I have. It only our attitude towards each patient but accommodating communication commonly is my belief that there will be a final day also what influences how we communicate occurs in cases where the recipient is where there will be ‘no more death or with families and make decisions about a unable to communicate for themselves or is mourning or crying or pain, for the old person’s care. perceived to be of a different societal group. order of things has passed away’. (Rev 21:4) These encounters are more likely to occur The concept of Communication when the patient is seen more as a member I’ve heard it said: “Few people will see a Accommodation Theory (CAT) was of a societal group as opposed to an priest, but most will see a doctor. You may first described by Howard Giles.1 CAT individual with their own unique story and be the only Bible someone reads that day.” encompasses the concept that each person needs. Non-accommodating communication We can be a witness, showing our belief brings their own beliefs, experiences includes closed questions and use of through our work, ready to give an account and perceptions to a conversation medical jargon and subsequently leads to to our collegues. We can be the difference which influences how words are spoken the perception of hostility and ‘rudeness’ and ensure every patient is treated with and received.2,3 In our communication by patients and families.3 In my case, the respect and dignity. we can be “accommodating” or “non- doctor in ED had seen my grandmother References: accommodating”. Accommodating not as an individual person who enjoyed a 1. Giles H. Communicative effectiveness as a function of accented speech. Speech Monographs 1973; 40: 330-1. behaviors are when a practitioner good quality of life. Instead they saw her 2. Farzadnia S, Giles H. Patient-Provider Interaction: adjusts their language, speech, tone and as a member of the over-90s club in whom A Communication Accommodation Theory manner to meet the needs of a patient.4 the discussion of medical investigation and Perspective. International Journal of Society, Culture & Language 2015; 3: 17-34. Accommodating communication may management was futile. 3. Baker SC, Watson BM. How Patients Perceive Their involve open-ended questions, listening, Doctors’ Communication: Implications for Patient Willingness to Communicate. Journal of Language explaining, inviting input and expressing Age is more than a number. It does not and Social Psychology 2015; 34: 621-39. understanding which create a friendly, determine a person’s worth. Capacity to 4. Hehl J, McDonald DD. Older Adults’ Pain Communication During Ambulatory Medical Visits: polite and compassionate atmosphere. This make informed decision about one’s own An Exploration of Communication Accommodation approach requires the practitioner to see the health can be influenced at any age. Patient Theory. Pain Management Nursing 2014; 15: 466-73.
VALE
Dr Maree Farley 21/12/33 - 8/4/20 With great regret I “chosen profession”. Since then she She went onto a career in General would like to inform progressed steadily through Medicine, Practice in Chatswood and also assisted you that Dr Maree without a backward glance. the Church Missionary Society as their Farley died in RNSH Registrar looking after missionaries Maree was an active and enthusiastic on the 8 April 2020 around the world. member of the Evangelical Union, and after a long illness. showed a keen interest in her local She was a member of St Pauls’, Maree completed church activities. Although a regular Chatswood and then St Stephens, her final year at concert-goer, her interest in music was Willoughby after she moved to a nearby Abbotsleigh in the imposing role of a not merely passive, for her relaxation was nursing home. prefect. At the University her first year to dabble in the works of Beethoven and by Louise Holliday was spent in the Faculty of Science, Chopin. In the line of sport, tennis was until she saw the light and took up the her favourite.
41 • CMDFA LUKE’S JOURNAL • November 2020 Dr Michael Nicholson Michael Nicholson has been a rural GP and VMO for most of his career. When Michael and Anne married in 1998, they established an olive grove in the hills above Mudgee in central west NSW. The years that followed produced many rewards as part-time farmers and full-time doctor. A period of reduced practice in the nearby town of Gulgong was followed by Michael’s retirement in 2015. Anne and I A Journey with Alzheimer’s Dementia
Michael and Anne Nicholson (standing on right) at a Newcastle CMDFA event.
Let’s face it. When it comes to our nearest were less now. We could, and did, do more against one another. Forgive as the Lord and dearest, sometimes dedication to together. forgave you”. our professional lives is not in their best interests. How true are the reflections of I wonder if others ponder whether it is The Reality long ago ‘the painter’s house is the one better not to know. This is, of course, A number of physical issues meant trips to in the street that needs painting’ and ‘It is essentially selfish, as having the diagnosis Anne’s GP, a 200 km round trip. It is hard in only the doctor’s children playing in the is essential to making adjustments to the country towns to see the doctor who may gutter in the dirt’? inevitability of life from now. Not knowing live all but next door. A wider delve into the encourages a sea of doubt while the whole picture led to the psycho-geriatric And so, with shame, it took a while before relationship deteriorates and little events diagnosis and suspicions confirmed. I had one of those ‘strike your forehead’ are magnified with recriminations and moments. sometimes anger. The need for lifestyle change was with us. A move to retirement from active practice The Awakening The pressure must be unbearable on became inevitable, to be closer to family It was 2013 and I had recently ceased full someone, to struggle with the awareness and plan stimulating activities where there time practice at Mudgee in country NSW. I of loss of memory and a lack of awareness were good supports. was working 3 days a week at the medical from those around . centre in the nearby old gold heritage The Lake Macquarie, Newcastle area fitted town of Gulgong. We were living there, Col 3:13 comes to mind. “Bear with each perfectly with excellent medical facilities, with an excellent Iraqi doctor whom I had other whatever grievances you may have an active “University of Third Age” (Anne supervised since his arrival in Australia. signed up for almost daily courses!), various church denominations and a wonderful At last there was more time for us both, but “Not knowing encourages CMDFA group, which gave us those things with Anne were changing. I noticed precious three years before deterioration subtle problems: a lack of confidence in a sea of doubt while set in. tasks easily performed, a loss of interest in the relationship affairs generally, a hardening of attitudes Anne had travelled widely prior to our and sometimes a coolness or unusual loss deteriorates and little move and we tended to confine ourselves of consideration towards others. events are magnified to local visits, only occasionally interstate. One cherished break in Norfolk Island Admittedly we are all prone to similar with recriminations and involved flying internationally with NZ issues if over tired, stressed or anxious. And sometimes anger.” Airlines. Losing her within the terminal those factors had been there, but I felt they half an hour before boarding was a near
42 • CMDFA LUKE’S JOURNAL • November 2020 disaster but she had found her way to The Dreaming “We are not what we do. We are not the right gate and queue, leaving me the I ponder and remember. what we are. We are not what others shaken one. think of us. Sometimes you seemed so far from me. I How that slow loss of ability creeps up see it when you sit immobile, eyes closed Coming Home is claiming the Truth: I am a and saps the very essence of an extremely yet not asleep, listening, a Mozart concerto beloved child of the loving Creator. We no capable person. It is then so easy to try to playing perhaps, or during a Mass. It is as longer have to beg permission from the help by taking over, but easy too to start if you are half-way to heaven and the rest world to exist.” to resent the extra time you have to spend, of you longs for that other half. Your face to ignore one’s mounting exhaustion and smooths, you radiate a warmth to a world Can we ever enter that inner sanctum that shorter fuse – how very human we are! that knows it not, nor is it yet for me your can no longer speak our language? At times earthly companion. I feel you speak without words nor need Since then life has become more confining. translation: Car trips are a welcome change of scenery and source of remembrance. However, “ It is as if you are half-way ‘I close my eyes as the world confuses leaving her and the keys in the car one chilly to heaven and the rest of me and I dream dreams that only heaven day, well after her licence had been handed understands. But They ask questions, in, resulted in an escapade involving some you longs for that other sometimes They are out to get me. very understanding police. When neither half. ” she nor the vehicle could not be found Help me – I must resist; and whilst we were all debating the next step at our home, she swept in, innocently Just maybe then we can relate to the No! let them do their worst, it must not unaware of the concerns, and parked the forlorn cry in the Song of Songs 8:13,14 disturb my dream. vehicle perfectly well in the garage. Some ‘You who dwell in the gardens, let me hear activities are better retained than others. your voice’ and still know that you long to Surely though the colours fade, a grey More lessons are learnt. respond ‘Come away my lover and be like a haze surrounds the meaning and the gazelle’. memory is vanishing in the gloom for The illness ever. A million words or more must have been Or these words come to mind as I feel I am written about dementia in all its disparity losing you: Then They are back – do this, do that, we – the academic, seeking to unravel the “Are you a mere picture? must clean you up, here’s your tea, we scientific mystery, words of condolence, You came to me with the first want to help you. comfort, compassion, of hope, sitcom ray of dawn. laughs at benign expense. Those in the I lost you with the last gold of evening. But you cannot help because I need to early stages or recently diagnosed have Ever since I am finding you find my dream again and you cannot written and spoken searingly of the through the dark. enter it – I won’t let you; it is all I have inevitable agony. No, you are no mere picture”. got. (Rabindranath Tagore. Lover’s Gift. XL11) Now that care is beyond our capacity at So please understand, this is me now.’ home, Anne is living in a dementia unit with But you know better and instead extol the Covid-19 visiting restrictions. words of Henri Nouwen:
BOOK REVIEW Second Forgetting by Dr Benjamin Mast – continued from p 44
My grandmother speaks little English, redemptive grace during the physical toil of In our human finiteness we tend to forget thus she hasn’t and will never read this caring for him. God’s grace and mercy, even during the book. Yet I marvel at how God endowed best of times. This book has served as a her with His supernatural patience and I am compelled now to live in light of this touchstone to “number my days” and perseverance in caring for my grandfather, hope, by remembering God’s faithfulness live wisely by taking the time now to who once served as a former general of the together with my grandmother through her remember, both who God is and what He Nationalist army in China reduced to frailty retelling stories of her years caring for my has done for me and my family. by Alzheimer’s dementia in his later years. grandfather. I hope to be able to pass on My grandmother undoubtedly lived with these stories of God’s faithfulness to our providential hope and knowledge of God’s family one day.
43 • CMDFA LUKE’S JOURNAL • November 2020 Dr Eleasa Sieh Eleasa is a Canadian-born Chinese permanent resident of Australia, and works as a general practitioner on the Sunshine Coast, Queensland. This book was one she had on her always too-long to-read list but when it showed up on a list of book recommendations as part of a Biblical counselling course, she jumped at the chance to read it and write this for Luke’s Journal. BOOK REVIEW Second Forgetting by Dr Benjamin Mast
“This is a book about hope.” The redemption of this groaning is seen through the lens of the Gospel, as well The opening sentence of the preface as the practical advice referenced from struck me. I first picked this book up out geriatric and psychiatric studies showing of curiosity at the meaning of its title and that emotional and procedural memory subtitle: “Remembering the power of the remain largely preserved in those living Gospel during Alzheimer’s disease”. with dementia.
As a General Practitioner (GP) and Furthermore, Dr Mast provides pastoral granddaughter who watched her encouragement for caregivers in two grandmother provide more than 10 years specific chapters, as well as writing one of care for my grandfather, who lived chapter exhorting the body of Christ in how and eventually died with Alzheimer’s to more carefully and creatively care for the dementia, the penny had never dropped person living with dementia, their caregiver on how hope played an important role in and family. There is helpful engagement the life of someone living with dementia. with the reader through questions at the Hope certainly wasn’t considered when end of each chapter, addressing those I conducted home visits on spouses and who live with dementia, those who may even couples living with dementia during be caring for and living with someone with my thus far short working experience in dementia as well as a church member or community geriatrics and general practice. pastoral care worker to this person. These personal reasons made this book a pertinent read. And having done so, I The “first forgetting” is the hallmark heartily recommend this to anyone who is of dementia, the predominant loss of as intrigued by its title and content as I was. declarative memory when a person “It is Dr Mast’s hope with develops one of the various types of this book to engage the dementia. The “second forgetting” is that of a spiritual amnesia, a temporary sufferer and the carer with “[For me] the penny had loss of memory of foundational Christian the God who never forgets, never dropped on how truths that is prevalent in people, including redeemed Christ-followers. This forgetting reminding both of them of hope played an important includes (but is not restricted to) that this comforting truth.” role in the life of someone of God’s faithfulness in the past, His presence in the midst of current trials and living with dementia.” His promises for the future. As such, this is not just a book about dementia and It is Dr Mast’s hope with this book to caring for someone with dementia, but engage the sufferer and the carer with Dr Benjamin Mast is a clinical psychologist also “about how we respond to seemingly the God who never forgets, reminding and associate clinical professor in Geriatric overwhelming situations of life and the both of them of this comforting truth. Medicine at the University of Louisville, weight of suffering”. This book is primarily addressed to the Kentucky. He has had extensive experience believer, who has redemptive freedom in clinical work and academic research It is no surprise that the suffering of in their repentance and trust in God, for with both those living with all stages of dementia is largely silent, as functionality whom God’s remembrance is a mercy and dementia, as well as their caregivers. It is and declarative memory ebb away, comfort. (On the other side of the coin also obvious that he has a clear and deep robbed by the unrelenting disease. Dr and outside the scope of this book, God’s grasp of the redemptive story of God and Mast speaks the words of Scripture into remembrance is also the foundation of His His people, applying the Gospel to the book this silence, giving voice to the grief and justice, who because of Christ’s redeeming title’s meaning and its implications for the the groaning dementia causes to both its blood shed on the cross, “remembers sins to sufferer, the carer and the local church. sufferers and their surrounding community. no more” as stated in Isaiah 43:25.) p43
44 • CMDFA LUKE’S JOURNAL • November 2020 Georgina Hoddle, RN Georgie is a Registered Nurse, works as a NSW Health Authorised Nurse Immuniser in Aged Care. In 2010, while studying a master’s degree in applied Linguistics (TESOL) at Macquarie University, Georgie received the Holy Spirit in a water baptism and has begun to age well on the shores of Port Stephens. Georgie is currently Vice-President of Nurses Christian Fellowship Australia. BOOK REVIEW Ageing, Disability and Spirituality
Ageing, Disability and Spirituality, her an important question: “Are you afraid edited by Elizabeth MacKinlay, pp.7-271 you will forget God?”, to which Mary replied Jessica Kingsley Publishers, ©2008 ISBN 978-1-84310-584-8 “Yes, yes!” (p.32). Swinton puts forward arguments for the personhood of people Through a collection of skilfully edited with dementia that are real and ever-present essays, this book illustrates how people “even in the midst of the experience of with disabilities, whether life-long or severe dementia” (p.33). secondary to the ageing process, can lead spiritually meaningful lives. MacKinlay’s In Chapter 8, Hallahan draws our attention introduction to the book is ground- to the fact that people with disability rarely breaking, informative and questions our participate “at the heart of congregational knowledge and understanding of the life”. The perception one has of people with spiritual lives of people with disabilities. disabilities can create a difference in the nature of relationships one has with those For a book filled with so many different who have disabilities. Hallahan introduces us challenges, I struggled to find a good start to the Celtic concept “of thin places” where to this book review. I eventually decided to we are able to converge with deeper and start with the intriguing Chapter 12: Bodhi, more meaningful aspects of life (p.13). This Karunā and Mettā: Buddhist perspectives is where she believes the marginalised live. for theology of pastoral care for the ageing It is a privilege for us to meet them in these and persons with disabilities (Ruwan “thin places” as we care for them physically Palapathwka). This chapter is relevant to my touched my heart. Christine eloquently and spiritually. Relationships and ‘being experience as an aged care and disability describes her journey to her inward spiritual connected’ are the focal points of these nurse. In this chapter, the author addresses self as dementia progressed; she was chapters, and there are many more that will issues that arise from the question “What running out of time. be of interest to not only nurses but other is holistic care for the ageing and persons healthcare workers too. with disabilities?”. Having worked with both After that, I read Chapter 2: Remembering multi-cultural and Australian nurses who the Person: Theological reflections on As the Nursing and Midwifery Board of follow Buddhist philosophies and practices, God, personhood and dementia, by John Australia’s Standard for Practice N.1 focuses I have witnessed first-hand their expression Swinton of the University of Aberdeen, on nursing ethics, I then felt led to embrace of compassion through person-centred care. UK. I came across a contribution from my a very difficult topic: Ethics. This is addressed Christians can establish common ground dear friend and long-serving colleague in Chapters 6 and 7, by both Christopher with Buddhists’ beliefs and worldview by from Nurses Christian Fellowship Australia, Newell of the University of Tasmania and answering this question together. This will Margaret Hutchison. She relayed a story Rosalie Hudson from the University of lead to better outcomes for their patients of a fellow nurse whose patient, Mary, Melbourne. However, such an important and residents in care homes. While Mahatma would repeatedly say “God, God, God”, be topic requires a Luke’s Journal article of its Gandhi said, “The way we treat the ‘last pacing and displaying distressed behaviour. own. person’ is a measure of our humanity” This situation was better understood and (p.91), we can relate to a similar teaching subsequently resolved by the nurse asking I recommend you source this volume and with Jesus’ words: read it for yourself. “I tell you the Truth, when you refused to help the least of these my brothers and Footnote: I bought this book at an international conference on sisters, you were refusing to help me.” Spirituality in Ageing, in Canberra October 2019. I heard (Matt. 25: 45b, NLT) of the work of Elizabeth MacKinlay and several other authors whose essays she edits in this volume, through my previous work as nurse educator in the field of Next I ventured into the world of Christine intellectual and developmental disability. Bryden in Chapter 11. Her experience Ageing and disability often go hand in hand, literally – we, of “dancing with dementia” by living Georgie Hoddle and author as nurses, often ask for permission to take the hand of people who, in their fourth season of life, have acquired optimistically with this progressive disease Elizabeth Mackinlay. disability and cognitive/intellectual impairment.
45 • CMDFA LUKE’S JOURNAL • November 2020 Rev Jonathan (Jon) Phua Jonathan is a Sydney Anglican Minister, currently working as Associate Pastor for the Evangelical Free Church of Australia (EFCA at East Lindfield). From 2016-2019, he was a Pastoral Care Coordinator (Aged Care Chaplain) for HammondCare. He is married with two children.
hymns, prayers, Bible readings and sermon messages allow people to read and follow the structures with familiar patterns, Pastoral without getting lost. I print out my sermon message in full text, so people can follow on with me, and not lose concentration. Care in Set prayers such as the Lord’s Prayer, the Apostles’ Creed, thanksgivings and confessions are meaningful, allowing people Aged Care to continue or resume faith expressions, even if they have not been in church for years. Holy Communion gives visual, and Facilities experiential participation for believers to share in the benefits of Christ’s sacrifice for It is a privilege to spend time with people into it: not religious, not church attenders. our sins. The bread and cup are held up, are in Aged Care settings, as the interactions For one man in our low level Dementia consumed, and each part of the service is are often so rewarding and meaningful. Cottage who was not religious but a past explained. When I was a Pastoral Care Coordinator Snooker champion, this meant engaging him (Aged Care Chaplain, from 2016-2019) for with Snooker videos giving him enjoyment Similarly, Bible study group has the chosen HammondCare in the residential Aged Care with one of his loves, allowing him to Bible passage, along with discussion setting of Hammondville, there were many express what made it a good part of his life. questions, in large print for each participant. opportunities to serve and help residents Discussion arises from basic comprehension there. Hammondville had multiple sections: Inclusion means including those of other and sharing of personal views, without independent living units (retirement village) faiths. I once cared for a Muslim man in complex exegetical debate, as might happen and residential aged care, which was divided his late forties, receiving palliative care with young adult university Bible studies! into low and high level care, and low and in high level aged care, as there was no One keen Christian lady with dementia high level dementia-specific care. other under-65 facility available for him. He would share her thoughts and though she explained that for his faith he read the Koran was all too aware of her memory loss, she Pastoral Care adopted a broad model of on his mobile phone. When I asked him and was encouraged and affirmed for her faith spirituality: that which gives people meaning his wife if he would like a visit from the local and wisdom, rather than scolded for any and purpose – from where can they can Imam (Muslim priest from the Mosque), deficits. gain some answers to life’s questions? they both declined, as they felt this was Religion is a subset of this as, naturally, faith not his need. Pastoral care involves linking Whole facility group activities are conducive in God gives people meaning and purpose. people with their faith communities if that is for a whole village ethos. It was a great However, people who are not religious can important to them, but may not necessarily pleasure to be part of a Lawn Bowls still have other aspects of their lives that give require this. group that had men and women from them meaning and purpose – relationships, the different Hammondville sections: artistic expression, music, sports, being in Group Activities independent living, aged care and our natural settings, meditation.1 A variety of group activities are vital dementia-specific cottages. Each resident for building friendships, relationships was welcomed and helped to bowl This inclusive approach allows Christians and a sense of belonging. Specifically, regardless of skill and experience without to provide care and support to any and chapel services and Bible study group are competitive expectations! Residents everyone in Aged Care. It involves wanting essential for people’s spiritual growth enjoyed the outdoors, conversation, and to listen, asking interested questions, and and relationships. Singing well-known, company with it. engaging with them wherever they are in uplifting hymns such as Amazing Grace, and their spiritual journey. As most residents Blessed Assurance in a group is a reminder In summary, aged care ministry makes a were of Anglo-Australian background, a of one’s faith, Christian upbringing, and significant difference in people’s lives and is natural question for me to ask was: ‘Are reinforcement of Biblical truth. Singing lifts appreciated by residents, staff, and family. you Catholic or Church of England?’ These mood with cognitive benefits as participants References: two affiliations covered over 90% of people, make effort to stay in time and tune.2 1. This was drawn from the work of Elizabeth giving an opportunity to find out about Hopefully, post-COVID-19 pandemic, singing MacKinlay in her book: Spiritual Growth and Care in attending Sunday School, Mass, Catholic of all sorts will resume in Aged Care Settings! the Fourth Age of Life. Jessica Kingsley Publishers London, 2006. P13,14. School in the past. Sometimes people said 2. https://theconversation.com/why-singing-may-help- that they were raised in church, but are not Large-print chapel service outlines with people-with-dementia-64383
46 • CMDFA LUKE’S JOURNAL • November 2020 Georgina Hoddle Georgina is a Registered Nurse with experience as clinical nurse educator in disability nursing; currently an Aged Care RN and NSW Health Authorised Nurse Immuniser. She studied General Nursing at St.Luke’s Hospital (1971) and retrained at Royal North Shore Hospital (2005); Georgina studied at Macquarie University, gaining a Masters Degree in Applied Linguistics (TESOL,2011). Hope and longer lives for Aboriginal and Torres Strait Islander people Vaccines for a time such as this Artwork by Esther/1721
Aboriginal and Torres Strait Islander (ATSI) of these needs are acknowledged by public for non-Indigenous people may be people have a shorter life expectancy than health departments when considering recommended in a broader age range for the non-Indigenous Australian population.1 why and how to make essential vaccines Aboriginal and Torres Strait Islander people We are living in very particular times. available to ATSI people3-8. (see table over page). COVID-19 has brought about an awareness of the need to prevent illnesses from spreading Vaccination programs Adult vaccine schedules and this year (2020) has seen uptake of the Through vaccination, Australians have One example of a vaccine-preventable influenza vaccine at extraordinary rates. benefited from the elimination or disease that has a disproportionately high Commonwealth Public Health Orders substantial reduction in the rates of many burden of disease in ATSI people compared directed all healthcare and aged care vaccine-preventable diseases in recent with non-Indigenous Australians is invasive workers to have the influenza vaccine before decades. This has also substantially pneumococcal disease. Vaccination has 1st May, 2020 and recommended influenza improved ATSI child mortality rates5. reduced the burden of disease caused vaccination for all “at risk” groups. Successful vaccination programs among by serotypes that are in the vaccines, ATSI people have significantly reduced but not all serotypes are included in the The pneumococcal vaccine schedule was the incidence of diphtheria, poliomyelitis, available vaccines. These other serotypes also revised in 2020, as the incidence of tetanus hepatitis A and B, measles, mumps continue to cause disease among ATSI pneumonia affecting adults between the and rubella. people.6 Environmental factors mentioned ages of 65-70 years does not indicate beforehand may also contribute to that either Prevenar 13 or Pneumomax 23 ATSI people have higher rates of some increased exposure to the disease,6-8 and are required in otherwise healthy people diseases, therefore some extra vaccines are untimely administration of vaccines may be before the age of 70 years. An exception is recommended. Some vaccines indicated another factor.9,10 where a person identifies as ATSI. In such a case, Prevenar 13 remains the first choice Background The ATSI people are a particularly vulnerable population. Since colonisation by the pneumococcal vaccine at the age of 50 British and Europeans, these people have experienced very high morbidity and years. (See Table over page). mortality from infectious disease epidemics with serious effects, such as smallpox (mortality rate >30%)3, tuberculosis, annual influenza, measles (mortality rate >20%)4, It is not just a person’s physical health that and syphilis. Lack of previous exposure4 and high-density living in newly established needs to be considered when introducing settlements caused high rates of disease which, over the decades, have become the topic of longevity2; there are spiritual, associated with a higher burden of chronic disease (eg. diabetes, heart disease and mental health, social and psychological chronic kidney disease). Additional factors include poorer access to water, housing and 5 needs that also need to be addressed when health care. Some social determinants of health, such as poor standards of education, 4 employing immunisation programs within loss of control over life circumstances and lack of cultural safety also contribute to their healthcare burden. the context of person-centred care. Some
47 • CMDFA LUKE’S JOURNAL • November 2020 Extra vaccines recommended disabilities procured by untreated risk 7. Grant, E.K., (2004) Unseen, Unheard, Unspoken: for Aboriginal and Torres Strait factors17. Exploring the Relationship Between Aboriginal Spirituality & Community Development. University of Islander adults South Australia: Adelaide, pp.8-9. These are a few of the vaccines indicated Acknowledgement 8. SNAICC. Healing in Practice: Promising Practices in for ATSI people, which are in addition to The Author acknowledges the Australian Healing Programs for Aboriginal and Torres Strait those recommended for all Australians, Government Immunisation Handbook Islander Children and Families. 2012; Available from: https://www.snaicc.org.au/wp-content/ including those for particular medical, (online, accessed 15 June 2020, as the uploads/2015/12/02926.pdf occupational, behavioural or other risk source of the specific immunisation groups. 9. Menzies, R., Turnour, C., Chiu, C., McIntyre, P. (2008) information contained in this article.) Vaccine preventable diseases and vaccination coverage in Aboriginal and Torres Strait Islander Vaccine Recommendation for people, Australia, 2003 to 2006. Communicable Aboriginal and Torres Strait Islander people Diseases Intelligence 32 Suppl:S2-67. Hepatitis B Non-vaccinated and non-immune adults 10. Naidu, L., Chiu, C., Habig, A., et al. (2013) Vaccine preventable diseases and vaccination coverage in Influenza All people aged ≥6 months – Annual vaccination Aboriginal and Torres Strait Islander people, Australia 2006–2010. Communicable Diseases Intelligence 37 13vPCV (pneumococcal All adults aged ≥50 years (1 dose) Suppl:S1-95. conjugate) 11. Quinn, E.K., Massey, P.D., Speare, R. (2015) 23vPPV (pneumococcal All adults aged ≥50 years – 2 doses (1 dose 12 months after the Communicable diseases in rural and remote Australia: the need for improved understanding and polysaccharide) 13vPCV dose and 2nd dose at least 5 years later) action. Rural and Remote Health 15:3371. References 12. Bailie, R.S., Togni, S.J., Si, D., Robinson, G., & d’Abbs, Vaccination services to ATSI people are P.H. (2003) Preventive medical care in remote 1. Australian Government Department of Health and important to the success of immunisation Aboriginal communities in the Northern Territory: a Ageing. (2013). National Aboriginal and Torres Strait follow-up study of the impact of clinical guidelines, programs, and can be provided by: Islander Health Plan 2013-2023. Canberra: Australian computerised recall and reminder systems, and audit Government Department of Health and Ageing. • General Practitioners and feedback. BMC Health Services Research 3:15. • Aboriginal Community Controlled 2. Gee, G., Dudgeon, P., Schultz, C., Hart, A., Kelly, K.. 13. Usborne, E. & D.M. Taylor (2010), The role of cultural (2014). Aboriginal and Torres Strait Islander social identity clarity for self-concept clarity, self-esteem, Health Services and emotional wellbeing. In Dudgeon, P. Milroy, H. and subjective well-being. Personality and Social • Aboriginal Medical Services Walker, R. (Ed.), Working together: Aboriginal and Psychology Bulletin, 2010. 36(7): p. 883-897. Torres Strait Islander mental health and wellbeing • Community Health Services principles and practice (2nd ed., pp. 55-68). Canberra: 14. Andrews, B., Simmons, P., Long, I., Wilson, R. (2002) • The Royal Flying Doctor Service Department of The Prime Minister and Cabinet. Identifying and overcoming the barriers to Aboriginal access to general practitioner services in rural New • State and Territory Corrective Services 3. Dowling, P.J. (1998) ‘A great deal of sickness’: South Wales. Aust Rural Health 10:196-201. introduced diseases among the Aboriginal people of colonial southeast Australia, 1788–1900 [PhD thesis]. 15. Hayman, N.E., White, N.E., & Spurling, G.K.(2009) It is important to ascertain if people identify Canberra: Australian National University. Improving Indigenous patients’ access to as being of Aboriginal and/or Torres Strait mainstream health services: the Inala experience. 4. Boughton, C.R.(2002) Smallpox and Australia. Med J Aust 190:604-606. Islander background, in particular during Internal Medicine Journal 32:59-61. 16. Couzos, S., & Delaney Thiele, D. (2010) The new presentations to urban mainstream health 5. Australian Institute of Health and Welfare (AIHW) “Indigenous health” incentive payment: issues and services. Patient information systems can (2011). The health and welfare of Australia’s Aboriginal challenges. Med J Aust 192:154-157. and Torres Strait Islander people: an overview. Cat. no. be employed to record ATSI status, and IHW 42. Canberra: AIHW. 17. Weinberger, B (2018) Vaccines for the elderly: preventive health services scheduled to Current use and future challenges. Immun Ageing, 6. Eades, S.J. (2000) Reconciliation, social equity and 15:3 https://www.ncbi.nlm.gov/pmc/articles/ increase opportunistic vaccination and Indigenous health [editorial]. Med J Aust 172:468-469. PMC5778733/ accessed 3 Dec’19 enable patients to receive reminders.11 These measures will help ensure increased quality of life and increase longevity1 for this vulnerable patient group.
Improvements in coverage ensures that people receive their vaccines according to the relevant schedules.12 ATSI status records also play a critical role in conveying changes to vaccine recommendations for these people. Culturally-appropriate service delivery and communication strategies are essential,13 as well as the relevant Medicare items, to bring about improvements and access to health services for ATSI people.14-16
Providing ATSI people with preventive measures through vaccination will enable them to age well, and without the acquired Image: Shutterstock
48 • CMDFA LUKE’S JOURNAL • November 2020 Dr Johanna Lynch PhD MBBS FRACGP Grad Cert (Loss and Grief) FASPM – Johanna is a GP psychotherapist in Brisbane working with adults who have survived childhood trauma and neglect. She teaches medical students, GPs and mental health clinicians and completed a PhD through University of Queensland – recently turned into a book A Whole Person Approach to Wellbeing: Building Sense of Safety.
Sense of Safety During Covid
Abraham Maslow called humans ‘safety Canadian consultant liaison psychiatrists They prompt a direction of travel towards seeking’ organisms.1 He named safety as a note: “Feeling secure in a frightening safety. They can prompt us to search for human meta-need. This echoes the wisdom circumstance is often perceived as a answers, new directions of growth, current literature of my Judeo-Christian faith as more urgent goal than remaining healthy resources, or new sources of help. God repeatedly reminds us not to fear and over a longer time”.3 The realisation of draws attention to Himself as refuge, rock the potential physiological impacts of Perhaps we can emerge from this time and hiding place. His promise to be our not feeling safe and its fundamental of COVID-19 with new-found strengths, covering, a shield, and rampart, to bring importance to healthcare4 underpinned my connections, and meaning: our whole peace in the midst of life’s journey is a doctoral research: Sense of Safety: A whole person grounded in refuge with the One promise that not all people know. person approach to distress.5 The wisdom who offers us both comfort and courage. In culture of Aboriginal understanding, of the a way this time of plague calls us to return I have felt called to translate my personal integrated whole in their concept of Social to some of the deep truths about who we revelation of deep spiritual safety, in and Emotional Wellbeing, was also a lovely are and how we know our God… The One belonging to Jesus, into a wider invitation alignment. Along the way I also discovered who the Psalmist reminds: “He will cover to our community. This has been a long the word safe derives from the Proto-Indo- you with his feathers, and under his wings journey that has been enacted in my own European base word solwos, meaning you will find refuge; his faithfulness will be heart, clinical work, mentoring, and now “whole”. So, I saw my doctoral research as your shield and rampart.” Psalm 91:4 my life as clinician-researcher! a revelation, a sacred entrustment, a way References to enfranchise whole person dignity and 1. Maslow, A.H., Motivation and Personality Third As an Australian GP I shifted my practice to spiritual meaning-making as part of health, Edition, ed. R. Frager, Fadiman, J., McReynolds, C., offer the first principle of trauma-informed a way to describe key goals of healing.1 Cox, R. 1954, New York: Harper Collins Publishers. care: Stabilisation2 and found myself asking 2. Kezelman, C. and P. Stavropoulos, Practice Guidelines for Treatment of Complex Trauma. 2019, Sydney: new questions – such as ‘did you have One night early in March 2020, I woke in Blue Knot Foundation anywhere in your childhood where you the night with a desire to make my PhD 3. Maunder, R.G. and J.J. Hunter, Can patients be felt safe?’ The answers to these questions useful to those who were facing the risks ‘attached’to healthcare providers? An observational study to measure attachment phenomena in patient– led me to new understandings of vague of COVID-19 in their day to day work. I provider relationships. BMJ open, 2016. 6(5): p. and confusing somatic complaints; life integrated two key themes of my PhD e011068. stories that spoke of relational invasion, research – Whole Person Domains (the 4. Lynch, J.M. and A.L. Kirkengen, Biology and Experience intertwined: trauma, neglect and physical disconnection or confusion; the impact circles in the image over page) with Sense health., in Humanising Mental Health Care in Australia: of finances and living conditions; as well of Safety Dynamics – the processes that A Guide to Trauma-informed Approaches, R. Benjamin, J. Haliburn, and S. King, Editors. 2019, CRC Press as complicated patterns of physiological build, protect and reveal a sense of safety, Taylor and Francis Group, Routledge: Sydney. arousal and the addictive and obsessive tailoring questions for this pandemic time. 5. Lynch, J.M., Sense of Safety: a whole person approach ways that people defend against being This image is shared with the consent of to distress, in Primary Care Clinical Unit. 2019, University of Queensland: Brisbane. To be published overwhelmed. Safety became a priority of Routledge my book publisher – feel free by Routledge as a book in January 2021: Lynch, J.M. A my care. to share these questions with others. Whole Person Approach to Wellbeing: Sense of Safety.
49 • CMDFA LUKE’S JOURNAL • November 2020 Sense of Safety During Covid
Do you have anywhere Do you have any online In your closest relationships to rest where you are not community space where you is there fun and safe warm feeling threatened? are free from covid content? connection?
VIRONM EN ENT CL SOCIAL IMATE
TIONSH RELA IPS Calm During Covid Calm During Covid ODY Calm During Covid CalmB During Covid Self-care questis in the time co d Self-care questi s in the time cod R EXPERIEN In your closest relationships NInE your closest relationshipsCE In your closest relationships Can you help your In your closest relationships IN Can you help your Can you help your is there fun and safe Can you help your is there fun and safe is there fun and safe body to feel calm for is there fun and safe LF body to feel calm for body to feel calm for Do you have any online warm connection? body to feel calm for Do you have any online warm Sconnection?E Do you have any online warm connection? mommomentsments in your day? Do you have any online warm connection? mommomentsments in your day? mommomentsments in your day? community space where momomentsments in your day? community space where community space where community space where you are free from you are free from you are free from you are free from covid content? ENVIRONMENT covid content? ENVIRONMENT covid content? ENVIRONMENT Can you find comfort covid content? ENVIRONMENT MEANING Can you find comfort Can you find comfort Can you find comfort SOCIAL CLIMATE to still your mind & SPIRIT SOCIAL CLIMATE to still your mind SOCIAL CLIMATE to still your mind SOCIAL CLIMATE to still your mind and see things in and see things in and see things in and see things in RELATIONSHIPS perspective calmly? RELATIONSHIPS perspective calmly? RELATIONSHIPS perspective calmly? RELATIONSHIPS perspective calmly? BODY BODY BODY BODY Do you have anywhere Do you have anywhere Do you have anywhere Do you have anywhere to rest where you are INNER EXPERIENCE Are you feeling safe to rest where you are INNER EXPERIENCE Are you feeling safe to rest where you are INNER EXPERIENCE Are you feeling safe to rest where you are INNER EXPERIENCE Are you feeling safe not feeling threatened? enough in yourself to not feeling threatened? enough in yourself to not feeling threatened? enough in yourself to SELF not feeling threatened? enough in yourself to SELF SELF face this challenge? SELF face this challenge? face this challenge? face this challenge?
MEANING MEANING MEANING MEANING & SPIRIT Do you have any & SPIRIT Do you have any & SPIRIT Do you have any & SPIRIT Do you have any meaningful way to hold meaningful way to hold meaningful way to hold meaningful way to hold onto hope in the midst of onto hope in the midst of onto hope in the midst of onto hope in the midst of Can you help your Can you find comfort Are you feeling safe Do you have any this change in your world? this change in your world? this change in your world? this change in your world? body to feel calm for to still your mind enough in yourself to meaningful way to moments in your day? and see things in face this challenge? hold onto hope in the perspective calmly? midst of this change in your world?
This model of self-care is the outcome of a transdisciplinary project that integrates TThis model of self-care is the outcome of a transdisciplinary project that integrates attachment, trauma-informed, TThis model of self-care is the outcome of a transdisciplinary project that integrates attachment, trauma-informed, This model of self-care is the outcome of a transdisciplinary project that integrates attachment, trauma-informed, attachment,TThis model oftrauma-informed, self-care is the outcome psychophysiology of a transdisciplinary and stress project research that integrates in the context attachment, trauma-informed, Dr Johanna Lynch ppspsychophysiology and stress research in the context of whole person approaches to distress in primary care. Dr JOhanna Lynch ppspsychophysiology and stress research in the context of whole person approaches to distress in primary care. Dr Johanna Lynch psychophysiology and stress research in the context of whole person approaches to distress in primary care. Dr JohannaJOhanna LynchLynch ofppspsychophysiology whole person approaches and stress research to distress in the in contextprimary of care whole. person approaches to distress in primary care. PhD | MBBS | FRACGP | Grad Cert (Grief & Loss) LLyynch, J.M., Sense of Safety: a whole person approach to distress, in Primary Care Clinical Unit. 2019, University of Queensland: Brisbane. © Copyright 2020 Dr Johanna Lynch. LLyynch, J.M., Sense of Safety: a whole person approach to distress, in Primary Care Clinical Unit. 2019, University of Queensland: Brisbane. © Copyright 2020 Dr Johanna Lynch. PhD | MBBS | FRACGP | Grad Cert (Grief & Loss) Lynch, J.M., Sense of Safety: a whole person approach to distress, in Primary Care Clinical Unit. 2019, University of Queensland: Brisbane. © Copyright 2020 Dr Johanna Lynch. LLyynch, J.M., Sense of Safety: a whole person approach to distress, in Primary Care Clinical Unit. 2019, University of Queensland: Brisbane. © Copyright 2020 Dr Johanna Lynch. More on the sense of safety framework can be found in A Whole Person EMAIL [email protected] EMAIL [email protected] EMAIL [email protected] EMAIL [email protected]@uq.edu.au LINKEDIN linkedin.com/in/johanna-lynch-33852323 LINKEDIN linkedin.com/in/johanna-lynch-33852323 Approach to Wellbeing: Building Sense of Safety (2020 Routledge). LINKEDIN linkedin.com/in/johanna-lynch-33852323 LINKEDIN linkedin.com/in/johanna-lynch-33852323 LINKEDIN linkedin.com/in/johanna-lynch-33852323 Lynch, J.M., Sense of Safety: a whole person approach to distress, in Primary Care Clinical Unit. 2019, WEB drjohannalynch.com University of Queensland: Brisbane. © Copyright 2020 Dr Johanna Lynch.
50 • CMDFA LUKE’S JOURNAL • November 2020 CMDFA Ethics Management Team Any thoughts or comments can be directed to Kuruvilla George (KG) via email [email protected] DISCUSSION PAPER Discussion Paper on Moral Injury – CMDFA Ethics Management Team (EMT)
Moral injury has been defined as the In view of the serious consequences of moral “ethical unease or disquiet resulting from distress on the healthcare professional, it is a situation where a clinician believes they important that it is addressed and support have contributed to avoidable patient or accessed. While it is not always possible community harm through their involvement to eliminate all situations that cause moral in an action, inaction, or decision that conflicts distress, there are ways to mitigate their with their own values.”1 impact. The EMT would like to help CMDFA members to understand moral distress and Moral distress is found to correlate with provide guidance to those who experience it. burnout, consideration or intention to leave a position or workplace and non- Further reading: alignment with workplace ethical climate. Canadian Medical Association COVID-19 Nurses score significantly higher on moral and moral distress distress measures than doctors. The EMT is https://www.cma.ca/sites/default/files/pdf/ aware that the subject is always pertinent Moral-Distress-E.pdf for Christian healthcare professionals, for example in the context of progressive Concerns raised about COVID-19 and legalization of abortion and euthanasia, moral distress but that it has greater significance at the https://www.bioedge.org/bioethics/ moment because of the COVID-19 crisis. This I have done that involves others, even concerns-raised-about-covid-19-and-moral- is particularly the case in places where hard without them ever knowing. It may be distress/13482 decisions are having to be made in a context something that has been done to me or I of overwhelming need and allocation of have witnessed done to others. It may be COVID-19 patients need not die alone finite health resources. something that I have been compelled or https://www.bioedge.org/bioethics/covid- obliged to do by others with the power to 19-patients-need-not-die-alone/13483 The EMT proposes to investigate Moral enforce it, or because they did not support Injury as its initial project. A sub-committee me as they ought. It may at times simply be Members of the Ethics has been appointed with this in view, to the failure or inability to give good bedside undertake the work and provide further care. It is more than “just” a traumatic Management Team reports. We would like to introduce the topic event. It is also something more than “just” Rev Dr Andrew Sloane, NSW, Chair to our members and nurses to facilitate guilt although this may be involved. Even Dr Megan Best, NSW Gabrielle Macaulay, NSW, NCFA Rep discussion and mutual support. Sometimes when the event involves no actual physical Assoc Prof Anna Walsh, NSW, legal member just a simple understanding of the issue describable trauma, it is still a violation and Dr Joseph Thomas, QLD can be helpful for coping. Moral injury it needs to be recognised as such, as part of Dr Lachlan Dunjey, WA has frequently been categorised as post- recovery. Dr Rohit Joshi, SA traumatic stress disorder, and this has not Dr Kuruvilla George, VIC, CMDFA Board Rep been helpful for dealing with it. Recognising/acknowledging the reality/truth Ian Gowlett, retired RN, NCFA Board of what happened, that it was more than Moral injury is an event that violates deeply just a traumatic or tragic event, that it ran in References 1. Sanderson, C., Sheahan, L., Kochovska, S., Luckett, held moral beliefs or values. It can cause opposition to deeply held morals, that it was T., Parker, D., Butow, P., & Agar, M. (2019). Re- a profound psychological distress that the result of a deliberate, non-accidental, defining moral distress: A systematic review and results from actions, or lack of them, which course of action that was in conflict with critical re-appraisal of the argument-based bioethics literature. Clinical Ethics, 14(4), 195–210. https://doi. deeply impacts one’s moral code.2 It may those morals – even if it seemed there was org/10.1177/1477750919886088 be something I have done, deeply personal no other course of action when it might have 2. Williamson, V., Murphy, D., & Greemberg, N. (2020). and not necessarily known to any person been the lesser of two evils – still requires COVID-19 and experiences of moral injury in front- line key workers. Occupational medicine (Oxford, other than myself. It may be something defining for recovery to occur. England), 70(5), 317-319. doi:10.1093/occmed/kqaa052
51 • CMDFA LUKE’S JOURNAL • November 2020 APPLY A CHRISTIAN PERSPECTIVE TO YOUR LIFE AT WORK
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“I have worked in many fields of the health care sector as a Registered Nurse for around 30 years. I have been blessed to use these practical skills in both large city teaching hospitals as well as remote areas that have no running water. Having completed a Masters of Ministry at Morling College I found the tools to apply and teach a Christian perspective for both bedside and colleague spiritual care. I realised that God has not ‘sent’ me to work but in fact delights in co-labouring with me in the privileged path that each nursing shift provides me. I am learning (and teaching) how to infuse my Christian faith into my workplace and can honestly say I am loving the opportunities this has brought to my journey. For me taking my faith to work is now second nature and I am so grateful for how gentle yet powerful is His presence through me.”
- Gabrielle Macaulay
59 • CMDFA LUKE’S JOURNALFind • April out 2020 more | www.morling.edu.au
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