I have been urging everyone to write an advanced directive, but recently, I realized that it is hard to have it with you when you need it. Whenever you are admitted to a hospital, even for outpatient surgery, they ask if you have an advanced directive. How many of us can remember to bring it with us? And of course if you have an accident, you certainly don't have it with you. Thus far I have found two ways to store it on the internet. One website, My Directives, will guide you through writing one that is compatible with state guidelines. Then you can print out a card and carry it with you, so any hospital could access that record of your advanced directive.

There is also a Virginia Registry that will store your advanced directive. You can download a form, fill it out, and then save it in the Virginia Registry. Many people think you need an attorney for an advanced directive, but Virginia has made it easy to use a form and register it. If you know what you want, fill in the form, sign and date it and have two witnesses sign it. You do not need a notary or an attorney. If you are not sure about what you want, call me. I can explain what therms mean, and help you look at your own values, so you can verbalize your desires.

"Can't we have lunch instead?" is the response one daughter gave, when her mother brought up the conversation about end-of-life care. Recently, I brought up the topic at my relatives' house. Fortunately, I plunged ahead with the topic for at least 5 minutes, before someone said, "Can we talk about something more pleasant now?" It might be easier to talk about sex!!
Ellen Goodman, a writer for the Washington Post, co-founded The Conversation Project which provides a starter kit to help people get going on this conversation. They commissioned a survey, and found that 9 in 10 Americans think it is important to discuss end-of-life care wishes, but less than 3 in 10 have actually done so. Many people say it is too soon to talk about it, but it is "too soon until it is too late."

Aging gracefully

Here's to growing older! A friend in his eighties says, "Growing old is not for the faint-hearted." I just read a piece in the New Yorker by Roger Angell, now in his eighties. Since growing older is inevitable, let's embrace it.

Transitions

"I am so stressed out!" is a phrase I have used many times, and I have heard everyone I know say it. What does that mean? There is actually a scale to measure how many life-changing events we have, and a measure of how much it could affect our health. For example, divorce has 73 life change units, marriage has 50, retirement has 45, and even Christmas has 12. The problem for our health status is when we have multiple stressors. Many people have stress of some sort, but as long as the life change units total up to less than 150, it will not affect our health. If it is over 300, it will definitely affect our health.So if my spouse dies and I move, I retire, lose my sister, have a car accident and injury, and my daughter gets ill, all in one year, then I have a score over 300, and I am at great risk for illness.

Fortunately, I usually have one or two stressors at a time. This past year I changed my line of work, and refinanced my home. Everything else in my life remained fairly constant, and I did not feel stressed. I think we feel less stressed when we identify these points in our life as transitions. There are many transitions that are generally considered positive, such as getting married, having a baby, buying a new house, or retiring. Sometimes those transitions are not smooth and not easy. That is why they are also listed on the stress scale.

Realizing that we are going through a transition is the most important part of doing it graciously. Hopefully, we will come out on the other side as a better person. In my work as a midwife, I helped many women through that transition to being a mother. Many of them prepared for the event with reading books and the Internet, but they also needed some reassurance and a helping hand. The transition that we all go through as adults when we lose our parents is hard, but we will survive it, and become stronger.

Relationships also go through transitions, and it is important to the health of the relationship to give it some attention. It is not always easy to move from a courtship to a committed dating couple, and then to living together or getting married. Sometimes we need help, and it is crucial to get that help before that relationship falls apart. That help can come from a quiet cup of coffee with a friend or a sister, or sometimes from a counselor. The point is, if you are stressed, can you do something about it? Or do you just need a helpinghand to come through that necessary transition graciously?