Showing posts with label hospice. Show all posts
Showing posts with label hospice. Show all posts

Monday, January 16, 2017

What Dying People Want You To Know / Kerry Egan, "On Living"

OPRAH.com:



5 Things That People Who Are Dying Want You to Know

The hospice chaplain and author of On Living reveals what she's learned about supporting loved ones as they prepare to embark on their last journey.
Photo: Malte Mueller/Getty Images












1. They are starved for touch.

"No one ever touches me anymore," my patient Betty said. "You can't imagine what that's like." She looked very small on her nursing home bed.

Didn't the aides touch her, I asked, when they took care of her, bathed her and helped her move?

Yes, she said, but it was different. They touched her because they had to, not because they loved her. It wasn't the same.

"I long to be held," she said, and her voice cracked and broke.

What could I do with such a deep, heartbreaking need right in front of me? What would you do? I lay next to Betty, wrapped my arms around her and kissed the top of her head, the way I do with my children when they go to sleep.

Many people who are dying are starved for touch. So ask your friend or family member whether she wants to be hugged. Put your arms around her. Hold her cheeks in your hands. If she wants you to, climb into bed.

2. They don't need to be told what to do.

There's a well-intentioned but odd piece of advice floating around out there that friends and neighbors of the dying should show up without calling first and do the laundry or clean out the refrigerator. Without asking.

People who are dying often feel like they've lost so much control over their lives already. Someone taking over your home without permission can feel like yet another loss to bear.

Yes, offer to help with chores, but don't decide you know what needs to be done. Call first to see if your friend is feeling up to having visitors that day. Set up a time so he can be ready. Ask how you can be helpful.

Dying is exhausting. If the person says he's tired, go home. And if he cancels at the last minute, know that it might be that he feels absolutely awful that day. Don't take it personally. If he says he's overwhelmed by phone calls, believe him, and send a card instead.

3. They know you are scared, but they still need you there.

People who are dying are still living. They laugh, and reminisce, and love to see the people they love. They're still who they always have been, even as they go through this new experience.

But they're often crushingly lonely. Too many times, I've heard about the children, the friends, the churches, the clubs who have stopped visiting. "She doesn't need prayers! She needs her friends!" a husband whose wife hadn't had visitors in years once cried.

I get it. I really do. I've had education and training to be a hospice chaplain, and have probably visited over a thousand people who are dying, and sometimes it's still hard for me. Sometimes, the sights and smells overwhelm me. Some people die quickly and easily, but most, at least in hospice, do not. The body struggles to hold on, and it can be really hard to witness.

Someone who's dying often looks different, sounds different, smells different and can't do the things she might have once done. Too often, these changes, and perhaps their own fears of death or saying or doing the wrong thing, make a dying person's friends and family afraid of her.

Can you imagine knowing you're leaving this world soon, needing the people you love more than you ever have in your entire life, and all of a sudden, seeing that they're afraid of you? So try. Try really hard to overcome your fear, and call or visit.

4. They might not tell you the truth about their feelings.

"Do you know why you're my favorite?" a hospice patient named Stan asked. "Because you're the only one who will pray that I die this afternoon."

Stan closed his eyes and started again on his favorite pastime: imagining his own death. The scenarios were always different, but what he imagined heaven would be like always remained the same: He'd be walking down a path in a park, and his wife would jump out from behind a tree and yell, "Boo!"

Just as she had 70 years before, on the day they met.

One of the most common things patients ask me to pray for is that they die soon. It can be a huge relief to talk openly about and pray for a quick death, because often their family and friends shush them when they try to.

On the other end of the spectrum, I've had plenty of patients whose families have assured me that their loved ones aren't afraid at all because of family beliefs. And many of those patients, as soon as the family leaves the room, break down in tears, terrified and grateful for the chance to finally talk about their soul-shaking fear.

Never assume you know anything about their spiritual life or feelings. If you want to pray with someone, ask him if he wants to first. Then, ask what he really wants to pray for. There's a good chance you'll be surprised.

5. They're willing to learn with you.

Kate, my new friend at the swimming pool, welled up when I told her I was a hospice chaplain. That didn't surprise me; it's a common reaction if someone's used hospice for their family before.

"The nurse gave us this booklet that explained what would happen as Mom died, and it all happened exactly the way the pamphlet said it would!" Kate said as tears slipped from her eyes. "It was totally accurate!" Her voice caught in her throat.

I was confused. Hospice nurses give out these booklets to comfort families, to assure them that what they are seeing and experiencing is normal. Why did it have the opposite effect? Why was Kate so upset?

"How did I not know this?" Kate continued. "How did I get to be 45 years old and not know that this is how people die? That it's so well known they can predict it? It just seems like something I should've known!"

We don't see death up close very often in our culture anymore, and most people have little or no experience navigating it, so it's normal not to know how it usually happens, and that there are steps and stages to it. Add in the fact that you might already be grieving for your loved one even before he or she is gone, and it's a recipe for confusion and regret.

It's okay that you're not an expert in dying. The person who is dying has never died before either. You can muddle through this process together.

Hospice patients are surrounded by aides, nurses, social workers and chaplains who do know what they're doing. Ask them for advice and information. Don't be ashamed of being nervous or overwhelmed. Not knowing what you're doing is not a reason to stay away.

What people who are dying really need is to be surrounded by the people who love them, even if those people have no idea what's happening. Your loving presence is the greatest thing you can offer someone. You don't need to know anything to do that.

On Living Kerry Egan is a hospice chaplain and the author of On Living.
Cherish Every Day
More Inspiration

Monday, April 18, 2016

Death in a Hospice Room Captured by an Artist and a Poet

For T’s ongoing series, the Rome prize-winning artist Nari Wardresponded to a poem by Carol Muske-Dukes, the former poet laureate of California. 
Photo
“Off the hook” by Nari Ward, 2016.CreditCourtesy of the artist and Lehmann Maupin, New York and Hong Kong 
LIVE, DIE: A GHAZAL
The door of the hospice room in which you die
stays open. Dreaming, you drift there, dying
in that floating bed of fierce arguments that live
on, until the moment when you no longer live.
Cheered on by a chorus of voices as you die,
“Go now! Go to the light!” Still, Don’t die!
Cries a dissenting voice within: a flickering live
Wire behind the nightlight’s angel face. Live
News at 7 AM, after the great orange moon dies.
Sunlight fingers a blue bowl of shaved ice. Die?
No. Not now. A tiny version of you pops out alive
From a burning wood, swims upstream, panting. Live
as Nurse Good’s softshoe entrance to applause, dying.
She smiles, squints at her syringe, held up, lit, like dye
bubbles lengthening in a radiant corridor: see lives
unborn (half-souls blindly pushing toward life)
gather outside time, inside your mind. Move! Die!
they cry. You won’t acquiesce. Mother, I cannot die
For you, I don’t know how. You brought me here alive.
You taught me everything but how to let you die.
— CAROL MUSKE-DUKES

Carol Muske-Dukes reads “Live, Die: A Ghazal” 

Audio

Wednesday, November 18, 2015

Birth=Beginning, Death=Destination EULOGY by Alvin I. Fine



Birth is a Beginning

Birth is a beginning.  And death a destination.  And life is a journey:  From childhood to maturity and youth to age; from innocence to awareness And ignorance to knowing; from foolishness to discretion.  And then perhaps to wisdom; from weakness to strength or strength to weakness-and, often back again; from health to sickness and back, we pray, to health again; from offense to forgiveness, From loneliness to love, and joy to gratitude, from pain to compassion, And grief to understanding-From fear to faith; From defeat to defeat to defeat-Until, looking backward or ahead, We see that victory lies, Not at some high place along the way, But in having made the journey, stage by stage, A sacred pilgrimage.  Birth is a beginning and death a destination.  But life is a journey, a sacred pilgrimage-
                                                             To life everlasting.

~ Alvin I. Fine

Saturday, August 1, 2015

DEATHWATCH:A Day in the Life of My Dying Mother-in-Law PART IV

Continued from yesterday - Part IV - more parts to follow:


Everyone is looking for you” (Mark 1:37).Just another add on thought FYI:  Geri has been mostly very difficult through all this, very mean and demanding something often, close to all of the time.  She has not been thankful or appreciative.   And she has often been very mean to Amy, insulting and belittling Amy.



We have a hospice nurse coming roughly every other day to the house.  She is really quite helpful, to us and to Geri.  Yesterday she pulled us aside and asked if we had a funeral home in mind that we want to use for Geri.  And we answered no we do not have a particular funeral home in mind.  She offered that now is the time to pick out a funeral home and that we should keep their phone # handy.  She feels that Geri's at time labored breathing among other issues indicates that Geri could have an episode at any time, and that she could die.
It's funny because the nurse being so direct makes you focus on and really think about death pretty clearly, as clearly as is possible.  It's still hard to fully grasp, especially for Amy who has not lost a parent yet.  And Jack doesn't want to think about it and the details at all.  When we've brought up death with Geri briefly and only 2 or 3 times in the last few months, when she was able to think better and to understand things, she always said, "do whatever you want."  To me that is very selfish, irresponsible and actually kind of mean. The Geri I know has been great at times but often she's been very selfish, and jealous, living her life.  The right thing to do is to figure it out FOR us and tell us what to do in detail so that we don't have to figure out what to do, to "do whatever we want."  Death is hard for most people.  Even right now Amy is struggling with what to do.  We're not thinking clearly NOW.  It's hard to focus on.  And when death
does occur thinking clearly will be hard; emotion, grieving and sadness kick in.  It can be easy to talk about death away from death, way before death has occurred (even though most Americans, only about 28%, preplan), but most Americans still do not like to talk about death, and do not do so easily.
Amy is thinking that when Geri dies she does not want to see people.  While grieving she just wants to grieve she doesn't want to talk to people.  So she does not want a funeral.  She's wondering though if our friends and her family would think that that's a terrible thing.  Probably we will cremate Geri and scatter most of her ashes privately in different places nearby.  Thinking about "doing whatever we want" burial-wise and funeral-wise for Geri has been hard and usually Amy starts crying.
Amy advised Jack to tell Geri he loves her.  He offered that he had not said that to Geri in a long time.  Amy thinks she will start calling some family and friends today and suggest that they come by the house to say goodbye to Geri.  Even though Jack thinks we should tell no one.  Watch, Geri will live 6 more months, or years.?!
Hospice asked Geri a # of times if she would like to see a chaplain and Geri has said no, loudly, each and every time.  As difficult as Geri has been at times, we still love her very much.
It's such a cliche unfortunately, and we all get so caught up in our lives, but love the one you're with, and enjoy each and every day.

To Be Continued 

Thursday, July 30, 2015

A Day in the Life of My Dying Mother-in-Law PART II

Continued from Part I yesterday   -   Part II:


Everyone is looking for you” (Mark 1:37).

As of this week Geri cannot leave her bed.  Prior to her most recent hospital visit I was able to lift her out of her bed and place her in a wheelchair so she could eat, watch TV, etc.  Now we cannot do that.!  Plus in the hospital she developed a severe bedsore!! which smells mightily of rotting flesh, and cleaning it and changing the dressing are difficult and actually disgusting. 
A few weeks ago it was suggested that she start hospice.  Medicare will pay for hospice care here at home.  Geri agreed to it verbally but when it came time to sign literally on the dotted line she refused.  She said she felt hospice care meant death and she wanted to try rehab yet again only here at home.  Well once again she really didn't try to rehab very hard.  So the other day in the hospital she finally agreed to hospice care here at home and she signed the documents required.  So we'll see.  She's a bit delusional at times but the boys (grandsons, aged 5 and 2) have been great to her and very loving.  I think it's tough on them too.  Her husband Jack has been obscenely mean to Geri.  We think it's horrible of him.  But Amy has been very tough with him and is insisting that he get more involved, and that he be nicer to his wife, and to us.  We understand it's probably difficult for him to cope with not having a healthy spouse for some years now, but . . .


To be continued  -  Part III next

Tuesday, July 1, 2014

Arthur Nazaryan's Hospice Nurse & Patients Photographs-Death's Absence




New York Times, Sunday, June 29, 2014, METROPOLITAN section, Page 8:






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SLIDE SHOW|11 Photos

There at the End

There at the End

CreditImage by Arthur Nazaryan

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Death typically appears in photographs as an intruder: an unbidden force that sweeps down on a battlefield or leaves survivors pained and bereft. We see the images and know that just hours or moments earlier, the subjects’ lives were intact, the world complete and in order. In Arthur Nazaryan’s photographs of a hospice nurse and her patients, death plays a different role, shaping the scene by its absence, not its presence. It is the reason the characters are assembled, the order toward which the chaos of life is resolving itself; not just their lives, but ours as well.
Last summer, Mr. Nazaryan accompanied Kathleen Fanelli, a registered nurse at Calvary Hospital in the Bronx, on home visits for five patients and their families. Two patients died in the course of his project. “It made me think about death in a different way,” he said. “It’s not something that just happens to you. It involves the whole family” — sometimes bringing relatives together, other times exacerbating family fissures.
Ms. Fanelli, 51, said the work gave her a certain comfort with death. Patients often began hospice afraid of dying, their families unwilling to accept the inevitable. “You see the patients holding, holding, holding,” she said. “And when they’re finally able to let go, you can see they’re at peace. They’re not grimacing. There’s no more tightness, no more tension in their facial expressions. It is amazing to be part of it. It’s such a reward that I can walk out and say, when I first walked in there they couldn’t breathe, their families were crying, and when I left their families were sitting, smiling.”
She added: “Like the birth of a baby, death is a process. The birth is nine months. With death, you don’t know how long the process will take. There will be different symptoms each day. But like birth, it’s a part of life.”

Monday, June 30, 2014

Caring for Ailing Elderly Parent-Life Lessons From DAD-Dementia




Wall Street Journal, Saturday/Sunday, June 28-29, 2014, REVIEW section, Front Page, Page C1:



THE SATURDAY ESSAY

Life Lessons From Dad: Caring for an Elderly Parent

Caring for an ailing parent can teach us a lot about toughness, perseverance and, especially, love.

Updated June 27, 2014 9:49 p.m. ET
Caring for an ailing parent is a life-changing event. Beyond the sadness and suffering, the experience can teach caregiving children a lot about toughness, perseverance and especially love. WSJ contributor Dave Shiflett shares his story on Lunch Break with Tanya Rivero. Photo: Ron Shiflett Jr.
My father was born and died at home. Nearly 91 years separated those two days, as did a lifetime of significant experiences, including one Great Depression, one World War, one wife, three children, and one year at my house, where he, accompanied by my mother, went through hospice during his struggle with dementia.
Our family's experience was hardly unique. Around 5 million Americans suffer from dementia of some type (Alzheimer's disease is the most prominent) and up to half of Americans over the age of 85 are afflicted. As our population ages, tens of millions of Americans will be called on to care for stricken parents. Over 15 million nonprofessionals are estimated to provide Alzheimer's care alone.
What can families expect?
Like all extreme experiences, caring for Dad changed our lives. Dementia is a terrible disease that robs its victims of their memories, their good nature and much of their dignity. Children of suffering parents will see many things they wish they hadn't, and they may learn things about themselves that aren't always flattering.
Ronald C. Shiflett at the James River, outside Richmond, Va., in 2013. Shiflett Family
But that's not the whole story. Even in the sadness of hopeless decline, my parents—members in good standing of the Greatest Generation—had a few things to teach their baby-boomer offspring about toughness, perseverance, quality of life and, especially, love. We were reminded, vividly, that we are often at our best when life is at its worst.
Ronald C. Shiflett—Ron to most everybody—was born June 17, 1923, in a row house in Richmond, Va. He rarely talked about his early years, though as he grew older Dad would recall his World War II experiences as a navigator on a Naval Air Corps troop transport, ferrying soldiers from San Francisco to Hawaii to Guam. "All that water," he'd say of the vast Pacific. He also told stories about seeing fighter ace Pappy Boyington throwing back drinks at the Top of the Mark bar in San Francisco. Those were among the last memories to leave him.
As a father, Dad was definitely old-school. He wore the pants in the family—and the belt. During the hirsute 1960s, he seemed to take special delight in hauling me to the barbershop, where my ambitious locks were shorn with extreme malice. But he also had a good sense of humor, took us hunting and camping and hardly ever missed a day of work (he started his career in a gas station). Along with Mom, a public-school teacher, he sent me, my sister and my brother through college.
Ronald kneels in front of his unit in the U.S. Naval Air Corps. Courtesy of the Shiflett Family
He was remarkably healthy and didn't have a regular doctor until he was 85. Then his life, and ours, began a drastic change. Decline introduced itself in the form of delusions. One day Mom called from their home in Roanoke, Va., to say that she had found Dad standing down by the street, dressed in a suit. When asked what he was doing, he replied that he was waiting for the police to pick him up. Dad had come to believe he was guilty of various transgressions, which were all in his mind.
The dementia diagnosis came in April 2010, with physical ailments soon to follow. In May 2012, a bout of pneumonia kept him hospitalized for a week, and the dementia seemed to take over. The medical staff agreed that hospice—a program designed to provide comfort and support for patients with six months or less to live—was our best option.
After a quick huddle with family members, my wife and I said we would move Dad and Mom into our house, where Dad would receive hospice care. We had plenty of room—just under 3,000 square feet, including spare bedrooms (now that our sons had left) and a spare bathroom.
My wife works at a hospital and is gone much of the day, but I work from home. All of this would require some adjustments. I'd need to be available to help Dad go up and down stairs, but that didn't seem like too much. In any event, this wasn't going to be a long-term situation. We expected him to live another two or three months.
As Dad's flame flickered, ours burned brighter. As his life faded, it brought our lives closer together. The challenge of caring for him also made us stronger.
That was just over two years ago.
Lesson one from this adventure was that old folks, even when they're frail, can be very tough. Dad, though cadaverous and confused, definitely didn't get the memo that his end was near. Instead, he staged something of a comeback, part of which I attribute to "grub therapy"—a steady diet of everything that sends chills down the spine of the Surgeon General: lots of red meat, fried food (a crab cake a day keeps the Reaper away) and enough cookies to build a two-story chimney.
Meanwhile, Dad's mental distress was somewhat ameliorated by various medications. The hospice nurses and workers—who checked his vital signs and helped clean him (and were paid through Medicare)—were impressed by his resurgence.
But life was difficult.
Dad was almost always cold and became deeply sensitive to being touched. He couldn't shave or clean himself at any level. His mobility steadily declined, and his sense of humor faded. He couldn't be left alone for more than a minute before crying out, "What am I supposed to do?"
Dementia also destroyed his short-term memory, so he might ask the same question five times within a minute. If Mom went out for a few hours, he could easily ask 100 times when she would return. It was as if he were being dragged back into a state of infancy. My wife and I sometimes felt our once-spacious house had suddenly become very small.
Mr. Shiflett and his wife during a hospital stay. Shiflett Family
All of which produced mixed feelings—sadness and exasperation, plus guilt for feeling exasperated, especially when considering everything Dad and Mom had done for us. Perhaps we suffered from Gratitude Deficit Disorder, if there is such a thing (if not, let's hope the medical and pharmaceutical industries get cracking on this issue). We kept stiff upper lips, but those lips often concealed grinding teeth, despite help from dedicated and sometimes angelic sitters, who came several times a week and were paid for by Mom. Without them, we might have been overwhelmed by Dad's constant need for attention.
Mom bore the brunt of Dad's decline with almost supernatural grace. During the early months she showered him daily, which from outside the bathroom could sound like a mugging in process. Dressing him wasn't much more peaceful. As Dad became increasingly bewildered, she patiently responded to his questions about the most basic elements of life, such as eating breakfast. Every morning Dad would look at his bowl of cereal and ask, "What am I supposed to do with this?" To which she would calmly reply, "You must eat it to keep up your strength." This was usually followed by an exhortation to drink his prune juice.
Which brings us to perhaps the most harrowing and widely feared aspect of caring for a stricken parent: poop—the palindrome that sends countless hearts palpitating, at least until you get a little experience under your belt. Everyone I've ever talked to about caring for parents has had a somewhat similar story.
One morning I heard Dad crying from the upstairs bathroom. There is no pleasant way to describe what I discovered: He was standing in his own excrement, which was scattered widely about. Cleaning up was no picnic, especially when attending to his soiled body, which puts one in frightfully close contact with the apparatus instrumental to your existence.
But, as in other sometimes sticky situations we encountered during Dad's stay, this one revealed a previously unrecognized talent for adapting on the spot. As Dad apologized for "the mess" (which he always did in these situations, right up to the end), I said, coolly and out of nowhere, "You're hanging in there." It became my go-to phrase whenever he became frustrated and saddened by his decline.
The Shifletts on their wedding day June 3, 1948.Shiflett Family
Dad had some good moments. He especially liked looking up at the blue sky from my brother's back porch and taking boat rides with my brother, and he warmed up when my sister came to visit. My mother's presence brought him peace. And while there was no mistaking where this was heading, I never heard him express any fear of death. He would, however, deliver stinging commentary on his status, usually as I helped him descend the stairs. As we neared the bottom step, he would often say, "This is no way to live."
To some younger members of the family, that was a self-evident truth. We, of course, are all about "quality of life," whose definition doesn't include living in diapers (which are euphemistically referred to as "briefs"). More than once I told my wife I never wanted to find myself in Dad's condition. "You know what to do," I instructed my youngest son, only partly in jest. "A pillow over the face at dawn."
My parents' perspective was quite different: Life, no matter how hopeless, is to be lived to the final breath. Even when it reached the point where Mom had to feed Dad, she would worry if he didn't eat what she thought was a sufficient amount. Dad, despite his grumbling, would try to exercise every day, even when he had to rely on his hated walker. His life had become a burden, but in their eyes that didn't diminish its value.
Dad had one last surprise up his sleeve—he "graduated" from hospice care. After a year with us, he no longer seemed to be at death's door: His vital signs were good, though climbing the stairs was still a supreme struggle. Mom found a nearby assisted-living facility where, soon after arrival, Dad was taken out of the hospice program after an evaluation determined that he might have more than six months to live.
And the hospice people were right. He held on for almost another full year.
Dad lived mostly in a large recliner during that last year, and eventually the hospice workers returned. His long-term memory deserted him; he could no longer recall, even with prompting, Pappy Boyington and the Top of the Mark in San Francisco. He did recognize family members and could manage a sentence or two about the weather, though after 10 months or so at their new home, his mental age, according to a hospice calculation, was that of a 4-year-old.
By then I think most family members had made the transition from thinking of death as an adversary to thinking of death as a liberator. This too raised some conflicting feelings: You hate to wish death on your father, but you also hate to see him suffer. Death was his only way out.
Mom was probably the last to make this mental transition, but a week or so before the end she said she thought it was time for him to go. He had begun refusing to eat or drink, which the hospice nurses said was a sign his body was shutting down. The last time we trekked to the bathroom, I held Dad by both hands and walked backward toward our target. His stride was about 3 inches. We didn't make it in time.
"I'm sorry," he said.
"You're hanging in there."
Dad died two days later, in his bed, surrounded by family. As the day progressed, he turned waxen and slightly blue. His mouth was constantly agape as he struggled to breathe, and at the end we told Mom that she probably shouldn't look too closely. This was May 5, less than a month before their 66th wedding anniversary.
His service, which we held in my brother's side yard, was a nice antidote to the sting of death. The Rev. Robert Bluford, one of Dad's oldest friends and a bomber pilot during the war, read the standard Psalms to a crowd that was thin on churchgoers but stretched all the way from Richmond to San Francisco, where my oldest son watched the proceedings via Skype.
A friend sang "Over The Rainbow" (Dr. Bluford was in his early 20s when the song came out in 1939) and "My Beautiful Friend," which underscored one of the most important lessons we learned from this experience: Never take friends for granted. Among our most cherished memories are of friends who stood with us, whether by bringing over a meal, letting us use a second home to get away for a few days or simply asking how things were going.
A hospice nurse told me, early on, that lots of children won't move a stricken parent into their homes, opting instead for a facility such as a nursing home. How would I advise others who are facing this situation? For our family, bringing Dad home was the right thing to do. When he came out of the hospital, he was so weak and disoriented that putting him into an unfamiliar setting might have finished him off. I also think that caring for Dad made us better people.
As Dad's flame flickered, ours burned brighter. As his life faded, it brought our lives closer together. The challenge of caring for him also made us stronger. We hung in there. None of this was easy or pretty, and while it was happening, it was easy to wish that we were somewhere else. But if we hadn't done what we did, I know that we would regret that decision today.
Mr. Shiflett Shiflett Family
To be sure, we had the room and the wherewithal to care for Dad. If he had been highly agitated or in acute pain, our decision might have been different. Judge not those who do not opt for home hospice.
Our family walked a hard road. We watched Dad get stripped to the bone by a pitiless disease. Today, our house echoes with memories of his struggle—echoes that are a sad but strangely beautiful part of our song of life.
Mr. Shiflett posts his writing and original music at www.daveshiflett.com.