An Idea Is Not A Practice

Ideas get us into trouble. Even good ones. From this blog’s subject file, I find several ideas that have caused and continue to cause me trouble once I reach out to realize them.

Consider ideas about love, marriage, physical fitness, or weight reduction. What about meditation, representative democracy, hydrocarbon, or tech dependency? Or consider economic and racial justice! Simply simplifying our lives is such a big idea as to frighten us into going shopping for the latest Marie Kondo life hack.

But this is a hospice blog. Then let’s take hospice as an example of what can go wrong when we confuse ideas with practice. And what can go right.

Hospice is covered under the Medicare benefit, Medicaid, and private insurances. That sounds pretty good: Free medical care, supplies, equipment, related medications. The idea of hospice is sold to the public as home-based medical care, a compassionate alternative to 911, but hospice benefits go beyond the individual and their families. When Medicare funded to those over 65 (who are the vast majority of terminally-ill people), it is a means to decrease medical expenses paid out by private insurance. It’s governmental relief to private insurance companies, which would otherwise be paying out big bucks to cover major medical expenses. When I say, “big bucks”, I refer to long established expense records that show the bulk of medical consumption for most people occurs within the last year, or months, or even weeks before death. Is it wrong, then, to call government-insured hospice benefit an indirect insurance subsidy?

Leaving aside whether the government is guaranteeing insurance company profits or not, nurses come to see you instead of you going to the hospital. Toll free phone numbers connect us to call center nurses who triage our needs immediately, perhaps advise the use of what’s inside the “comfort box.” Lorazepam if anxious, prochlorperazine if nauseous, hyoscyamine if Gramps is gurgling on his pooling saliva. For old-fashioned misery, morphine for everything under that heading; it’s pharma’s mother’s milk, covering a multitude of symptomatic sin. But all these contingencies are still in the realm of idea.

Reality, on the other hand, cannot be otherwise but lived through. Realities of caring for someone at home who has a “sickness unto death” will be unique to ourselves, our settings, our circumstances. This is the Practice. Here, nothing is fully known. The subject in that last sentence is “nothing”. Put yourself as the subject since this idea includes you: You cannot fully prepare for anything. Pain, anxiety, piss and shit, skin damage, hunger, loss of appetite, nausea and vomiting, strong emotions, fatigue, boredom — all these eventualities will come dressed in their unique shapes and in their own time. You are not in control of them. You cannot control their coming.

We are not in control. Get the idea?

The idea of hospice is presented as a choice, the selection of which feels empowering. Neo in The Matrix taking the red pill, an easy choice. Then the reality sickened him, made him puke his maladjusted ‘orientation’, his idea of knowing the matrix. The reality must be lived through, it’s messy, and unsure is the footing. But it gets easier, and no better choices exist than the hard ones. The heart choices. But that’s if you are “all in” about learning how to care for dependent people at home, open to adapting, feeling your way through the dark of ignorance. The places that stamp deep memories. What stands out after our travels and holidays, but sticky uncertainties, initially frightening us?

Some people miss their sleep too much or feel with excessive force the burden of responsibility for medicating their parent, or partner, or child while watching them get weaker and eventually die. Others would never do it again, and the next parent, when they seem to falter, is sentenced without recourse to a nursing facility.

Ideas about caring for family full-time in the home start as ideal imaginings. Ideals are difficult to give up, but we must when they’re tested in the workshop, on the job, anywhere in the real world, but most emphatically while caring for a terminally ill family member. Practice is all about surrendering ideals and letting them go. Keep ideas/ideals in view but also accept how you will be humbled, be changed, and molded like heated clay from the inside-out.

But first you must practice. “Practice, not perfection” and “Let go and let God” the 12-Steppers say. I prefer Warren Zevon’s “Life’ll kill ya”. I have nothing against perfection, it’s just an idea.

After many years I hold onto my own ideas about most things. A good practice teaches flexibility. Practicing and letting go will never become stale. I recommend them. As a practice, not as Ideals.