Goals, objectives, strategies, outputs, and outcomes

~~ ONLY ONE GOAL ~~

The other night at dinner one of my children was talking about his goals. My daughter-in-law asked, “Are you talking about goals, objectives, strategies, outputs, or outcomes? They’re all different, you know.”

I messaged her this morning to ask her to list them again and then I started looking up the differences.

Most of the websites that define the terms are about grant-writing — which makes sense because Emily writes grants for her job.

I read through several websites. As best I can figure out,

  • a Goal is broad and general. It defines purpose.
  • Objectives are specific and concrete. They move you toward your goal.
  • your Strategy is the approach you take
  • your Output is the actual result of your work
  • your Outcome are the changes that were wrought as a result of whatever it is you’re doing

I smiled and nodded as I read. I understood, but the hard part is application.

So I decided to tackle just one goal à la Emily the grant writer.


GOAL — to keep my father home.

The top story in today’s newspaper cemented that: 

This happened in the nursing home where my mother had been. I get a pit in my stomach when I read these stories.

I know that not everyone can care for their family member at home for a number of reasons. To those of you who cannot, I give this advice: Be present. On a regular basis, be there. Talk to the staff. Talk to the other residents. Look through your family member’s closet and dresser to make sure things are there, clean, and belong to your family member.

My goal, though, is to keep my father home.

OBJECTIVE — Live in the same house with him.

STRATEGY — Move to Cooperstown. I know many people move their parent(s) in with them, but, for a number of reasons, this wasn’t the best option for us. I moved here in 2015 with my two youngest daughters and we hoped that my husband would soon join us.

This house had become the repository for many family members. In order for us to live here, we had to clear stuff out.

And we did.

But there’s still a long way to go.

OUTPUT —We’re here and my father is here.

We’ve reclaimed rooms in the house so the kids have space that is theirs. I’ve slowly whittled away at stuff that has accumulated here. Two loveseats went to the curb a few weeks ago and were quickly taken. I’m making headway with the boxes of papers. We still have more to go, but we’re moving in the right direction.

After being a frequent flyer at the Emergency Room for chest pain, my father’s doctor and I came up with a strategy. She told me to 1) Sit him in his recliner with his feet up. 2) Check his blood pressure. 3)DON’T take him to the ER for at least 2 hours unless his numbers look bad. The first few times were rough — he was very insistent that he needed to go, but with his BP, pulse, and O2 all normal, I told him that we needed to wait. Each time whatever it was passed and he went back to bed. We’re making progress.

OUTCOME —My father is still home. It’s not so much a change as standing our ground.

I think that’s an accomplishment. It’s not easy. It’s hard on everyone, but as the doctor we saw today said, “I would do anything for this man.”

My father is that kind of person. Having lived a generous life, he should be able to reap some of what he has sown.


A Privilege

Yesterday I ran into someone at the pool that I hadn’t seen in years — Bridget‘s father.

Bridget was on the first team that I coached and I still think back on her fondly. In fact, I had just been telling Laurel about Bridget the other day.

Bridget held all her team records with open hands. When Helen was quite young, Bridget told her to go break all those records. It was such a gift, so encouraging. Helen went on to break quite a few of them.

Anyway, Bridget’s father, Mike, asked about my father. I told him that I was staying with my father to take care of him.

“It’s such a privilege, don’t you think?” he asked.

I nodded in agreement.

Those were words I needed to hear.

Sometimes caregiving doesn’t feel like a privilege. It feels more like a chore. When I was home with small children, there were days when I would  look out the window and long for the freedom to go do something, anything besides laundry and cooking and changing diapers and wiping noses.

I used to bring my kids to the gym for a playtime we called “Kiddie-gym.”  The pre-schoolers would climb around on the mats and throw balls and scoot on scooters. The moms would sit and talk.

One day one of the moms talked about trying to find childcare for her twin two-year-olds so she could go back to college for a graduate degree. The mom next to me leaned close and whispered, “After all she went through to have those children, she’s abdicating her responsibility.”

It’s true that the woman with the twins had used in vitro fertilization. It’s true her husband had a good job so she didn’t need to work. But abdication? It seemed like a strong term to describe a mother furthering her education. Abdication was what a king did when he gave up his throne.

My take-away from that conversation, though, was that motherhood was on par with royalty. It was an honor and a privilege to be a mom. On my looking-out-the-window days, longing for something else, I would remind myself of that. I would lean in and embrace the wearisome work because not everyone has that privilege.

This morning a woman complained to me about the child-care hours at the gym.

“They don’t open until like 8:15 AM and they aren’t even open every day,” she said. “What if someone wants to work out before they go to work?”

“Maybe their spouse or significant other can watch the children,” I suggested.

“That discriminates against single moms,” she replied.

“Being a parent involves a lot of sacrifice,” I said, but I could see that she didn’t appreciate my answer.

I was glad for my conversation the previous day about care-giving being a privilege. It reminded me to stop thinking about the things I can’t do, but to appreciate the things that I can.

I can find the Jumble in the newspaper.

I can change the channel to Jeopardy.

I can fix over-easy eggs.

I can help with crossword puzzle clues.

I can drive him to the doctor or to get a haircut.

I can rescue photographs from the garbage.

I can remind him of people’s names.

I can tell him at 3 AM that it’s time to go back to sleep.

I can keep him in the home where he has lived for over 50 years.

Yes, it’s a privilege.

 

Shouting

Laurel said the other day, “We should all learn another language. As a family, you know?”

“Why?” I asked.

“Well, then if we’re someplace all together and we want to say to something to someone in the family but we don’t really want everyone else to know, we can just say it in that other language,” she said.

I think she was thinking along the lines of a let’s-get-out-of-here signal.

“Like Swedish,” she said. “We could all learn Swedish and nobody would know what we’re saying.”

“Ummm… you’d be surprised,” I told her. “I’m pretty sure Amy knows Swedish.”

Amy — former pastor, dear friend.

“Oh, well…” Laurel said. “You know what I mean.”

Personally, I think we should all learn sign language. Not as a secret language — because there are a lot of people in the world who know sign — but as a quieter way of communicating.

I can always tell when my father’s hearing aids aren’t working.

“What?” he’ll ask.

Frequently.

“I’m having trouble hearing you,” he’ll say.

I’ll check to see if his hearing aids are in, and, if they are, if he has turned them on. Often these days he forgets the latter.

The other day Mary had a dentist appointment. As she and I headed out the door, I stopped to check my father’s hearing aids — and turned them both on. He was on his way to sit in the living room with the Daily Jumble.

An hour later when we got home, he was standing at the kitchen table.

“What’s going on, Dad?” I asked.

“I need to put this in my…” and his voice trailed off as he searched for the word. He was holding a hearing battery in his hand.

“You need to put a new battery in your hearing aid?” I asked.

“Yes,” he said, and he pointed to his right ear — where there was no hearing aid.

“Okay, I can help with that,”I said. “Where’s the hearing aid?”

“That’s the problem,” he said.

“Did you set it on the table here?” I asked, and began moving papers and looking.

“I don’t know,” he replied — and that became his reply to every question.

“Where were you when you took it out?”

“I don’t know.”

“Were you sitting in your chair in the living room?”

“I don’t know.”

“Did you go in your bedroom?”

“I don’t know.”

I began looking everywhere — the bedroom, the bathroom, the living room, the dining room, the kitchen, the sun porch. I crawled around on the floor, looking under furniture, putting my cheek to the floor because that made it easier to see the incongruity of the hearing aid.

“Is it in your pocket?” I asked.

“I don’t think so,” he replied, but he dutifully emptied his pockets for me.

All this conversation was taking place at a high volume — because of the missing hearing aid. That, alone, is exhausting.

Twenty minutes into the search and I was ready to give it a rest. My neck hurt from sleeping in a bad position the night before and this cheek-to-the-floor business wasn’t helping. I sat down.

“We’ve got to find it!” my father said when he saw me sitting. He was looking through some papers that hadn’t been moved in a year. The hearing aid would surely not be among them.

“Criminy,” I muttered under my breath. My neck ache was quickly becoming a headache.

“Keep looking,” he said urgently. “We can’t stop looking!”

I got back to my feet and went back over the same places I had been looking. Finally, in his bedroom, I spotted it poking out from the back edge of a chair cushion.

I could see the relief on his face when I brought it to him.

“Where did you find it?” he asked.

“On the chair in your room,” I replied, while trying to put the new battery in.

“Where?” he asked again.

“On the chair in your room,” I replied, while trying to put the hearing aid in his ear.

“That’s better,” he said, once it was in place. “Where did you find it?”

Something in me snapped. “ON THE CHAIR IN YOUR ROOM,” I shouted — not in a nice way.

I left in search of Advil.

Frederick Buechner, in his new book The Remarkable Ordinary, talks about his mother’s hearing loss and the difficulty of shouting conversations.

from “The Remarkable Ordinary” by Frederick Buechner

I thought about my deaf friends who read lips so well — and appreciated that I don’t have to shout at all with them.

When Laurel said she wanted to learn Swedish, all I could think is that I’d rather learn sign language.

That way maybe I could communicate better with my friends who use it.

And when I’m old and hard-of-hearing, my family can converse with me without shouting.

Surgery

Each member of the surgical team looped through the room.  An introduction. Name and date of birth requested. The why-are-you-here question.

My mother didn’t know the answers when I had sat in the same spot with her some years before. I helped.

My father knew — for the most part.

“Did you have anything to eat this morning?” the anesthesiologist asked.

“Not too much,” he answered.

“He had nothing,” I said.

“Has the surgeon marked on you yet?” a nurse asked.

“No, I don’t think so,” he answered.

“Yes, he did,” I replied.

“Can you tell me about your other surgeries?” the surgeon asked.

“It’s been years and years,” my father answered.

“Last August he had a VP shunt put in, and a few years before that he got a pacemaker,” I answered.

He knew his name. He knew his birthday. He knew what the surgery was.

All in all, I’d say he did pretty well.

A few weeks ago, he had had an episode of chest pain that landed him in the Emergency Room. They ask a different set of questions.

“Are you still a full-code?” the nurse had asked, but then she looked to me for the answer. It’s an uncomfortable question.

“Well, I’m not ready to cash in yet!” my father answered.

“Would you like to be placed on life support?” she asked.

“I’m not going to live forever, you know,” he replied.

His mixed responses were confusing, but he and my mother had both very clearly written out their wishes many years ago. I told his doctor and she asked that I bring in a copy to put in his chart. Just so it’s there.

Last night, I went for a walk. The fields were fifty shades of green. The timothy alone was a full palette of color — spring green, grass green, grey green, a whispery pale green at the very edges of the flower-head.

The fields whispered with the breeze, carrying along its little breaths like a melody passed around an orchestra. The meadow swayed and danced, and the only audience for this performance was the deer, the red-wing blackbirds, and me.

When the Bible talks about grass, it’s usually in reference to transience.

“The grass withers, the flower fades…” (Isaiah 40:8)

The comparison isn’t that man will last forever. We are just as transient.

A surgery day is a time to remember that.

It’s a time to pause. Even if we’re not ready to cash in, it’s okay to remember that we aren’t going to live forever either.

*****

The surgery went well. He’s already home. He’s not ready to cash in yet — and neither am I.

Trapped

In the spirit of “Leaning In,” I offered to help my father write some letters.

During December I felt trapped, much the way a mother of a toddler feels. I remember being home with small children and wondering what it would be like to be able to do and go without worrying about other people. Now I sometimes feel that way again, but it’s not because of small children.

I had asked Laurel some of the same questions I asked Mary (see Explanation). Laurel knew how old I was. She also astutely answered the what’s-my-favorite-thing-to-do question. “You like alone-time,” she said — and I felt a little lump in my throat because she understood me so well.

Alone time. I crave it. Like chocolate. Or coffee.

When I was home with toddlers, I would retreat to the bathroom — and they would stand outside the door, talking to me, trying to get in, asking when I was coming out.

In December, my father would sometimes stand at the bottom of the stairs. “Sally? Sally? Are you going anywhere today? I’d like to go out,” he would say. And I would feel so selfish that I just wanted to go out alone. All. By. Myself.

With toddlers, sometimes they would follow me everywhere. “Fred” used to sit on my foot and hold onto my leg. I would hobble around, my steps uneven because I was dragging a little boy with me. He simply wanted to be with me.  If I stopped to read with him or play with him, sometimes that would satisfy his Mom-time need, and, in turn, I would have a little alone time. In the kitchen. Woohoo.

Of course, I couldn't find a picture of Jacob hanging on my leg -- they do exist! -- but this him, the youngest at the time, at about the right age.

Of course, I couldn’t find a picture of “Fred” hanging on my leg — they do exist! — but this is him, the youngest at the time, at about the right age.

So — leaning in. I decided in 2017 that I wouldn’t try to escape, but would rather lean in. Embrace.

Instead of escaping upstairs, I asked my father if I could help him write a letter. He had been saying that he wanted to write to a few people, but, beyond the struggle of gathering thoughts into words, he also struggles with the fine motor coordination of writing.

Yesterday, we sat to “write.”

It took him a long time to formulate his thoughts, but his words revealed how trapped he felt, too. He told his friend why he couldn’t travel to visit her —

 … I feel like I should accept the wisdom of the rest of my family that I should not drive a car.  I agreed to this reluctantly, but there’s no way out.

No way out. What a terrible feeling.

He got frustrated with the writing process and we put the letter aside.

So today, we’ll finish that letter and get it in the mail.

And I’ll take him out with me.

It’s a lot slower running errands with a person with a walker.

Not unlike a child hanging on a leg.

 

Unsung and Under-appreciated

That morning, I had taken my father to a doctor’s appointment.

When we got back to the house, the answering machine was flashing. The message was from the nursing home. “Please call.”

My mother had had an incident. She was being taken to the emergency room.

In retrospect, that day was the beginning of the end.

After my mother passed away, my father wanted to unravel the incident. The information given us was vague. The diagnostician side of my father needed to categorize. The husband side needed to understand.

We walked down the long corridor to the nurses’ station on my mother’s unit. So many people offered their condolences. My mother would be missed.

The head nurse on the unit told us her story, but it was a CNA (Certified Nursing Assistant) who had been with my mother when it happened.

We tracked down the CNA.

CNAs are the unsung heroes of nursing homes. A good CNA is worth a thousand administrators. I was relieved to see that the CNA who had been caring for my mother that morning was one of the best.

I still remember the first time that I met her. I had come down to feed my mother while my father was away.

“Mom, you look really nice today,” I had commented. Her hair was brushed. Her shirt was a pretty one that fit well. Her glasses were around her neck on a chain.

“I got her dressed this morning,” chimed a voice from the other side of the dining room. A petite 50-ish woman was smiling at me, pleased that I had noticed.

“Thank you,” I told her.

Over the next several months, I recognized this CNA, not only when I ran into her in the dining area, but I could often tell when she had been the one to care for my mother. She always paid attention to the details.

This was the CNA who was with my mother when she had her “incident.”

the flowered shirt

the flowered shirt

“I had laid out her clothes for the day,” she told us, “the brown slacks and the flowered shirt.”

I knew the ones.

“I was rubbing lotion on her legs and feet. She always seemed to enjoy that,” she said.

Yes, I could picture the whole thing.

“Suddenly, she gasped and drew her arms up like this,” she said, demonstrating by clenching her fists and bringing them towards her chin.

“I summoned help immediately,” she said, “but your mom was unresponsive.”

“I’m so, so sorry for your loss,” she said multiple times.

And I know she meant it.

So many times I have looked back on that day and whispered a prayer of thanks that she was the one. My mother was in the best earthly hands while on her way into the best heavenly hands

Every time I hear about the proposed wage of $15/hour for fast food workers, I bristle inside.

CNAs don’t get paid that much.

And they don’t have time to lobby about it.

They are too busy taking care of our loved ones.

“I Can Do It”

Darn it, Mary. You weren’t supposed to worm your way into my heart like you did.

I’m not talking about my Mary. Of course my own daughter is firmly entrenched there. I’m talking about nursing home Mary. I-can-do-it Mary. I-love-you Mary.

My father had pointed her out to me a while ago.

“See that woman,” he said, nodding towards her. “She always kisses me.”

Sure enough, she wheeled herself over to my father and took his hand.

“I llllove you,” she had said, carefully pronouncing each word and leaving a space between them.

My father patiently waited while she held his hand and said these words. Then, she started to sing, “I can do it. I can do it.” I think there may have been a few more lyrics, but those were the main ones. On repeat. Accompanied by an elderly fist pump. For emphasis.

Only one hand could fist pump, though. The other was curled in tetany.

“She had a stroke, I think,” my father told me one day after the hand-kissing ritual.

I would see her around when I went to visit my mother.

“I love you,” she always said. I could tell that the letter “L” took special effort on her part.

IMG_6324She hugged and kissed my Mary one day. Over and over. My Mary was gracious and allowed it.

“I can do it,” she always said, too. Sometimes she sang out those words to a tune that only she knew.

Sometimes, though, she would come very near and cradle another person’s face in her hand, her one good hand, look them in the eye, and say, “Say, ‘I can do it.'” She would repeat it until the other person echoed the words. Then she would reward them with “I love you.”

I watched her go through the dining area one day and get every single resident to say “I can do it.” It was remarkable.

IMG_6961Since she sat near my mother, Mary took particular interest in her, especially when my mother didn’t eat well.

“I can do it,” she said. “I love you.”

Last week, I heard Mary say something different. She said, “No.”

The man serving dinner asked if she wanted a meatball sub.

She gave an emphatic no. I didn’t blame her. The food was pathetic.

But she refused all the food she was offered. She indicated that she wanted something in her cup. It was already filled with milk. An aide got out the chocolate syrup.

“NO,” she responded, covering the cup with her hand.

The aide got her a straw and got the same response.

“Ginger ale?”

“NO.”

“Juice?”

“NO.”

Finally, Mary wheeled herself away never getting whatever it was she wanted. It must be so hard to communicate with only the words “I can do it,” “I love you,” and “No.”

And I never heard her say the first two at all that night.

Last night, she sat at the dinner counter looking so sad. Again she refused all food with a much weaker “no” before wheeling herself away. I watched her putter down the hall and wished I could help.

A few minutes later a nurse was calling for help. For Mary. She was in distress. The nurse asked someone to call the ambulance.

“No,” Mary said.

The she spoke progressively louder — “No. NO. NO.

I wanted so badly to hear her say, “I can do it.”

I wanted her to tell somebody, “I love you.”

They got her chart out. “No hospitalization” was noted there. The ambulance was cancelled. Mary was wheeled to her room.

Today I can’t stop thinking about her.

I stood outside her door before we left, but there was too much bustling going on inside, and, really, I don’t know her.

IMG_7089“Happiness dwells in the soul” reads her door. Surely, it dwells in her soul.

You can do it, Mary.

I love you.