Fact: We all die.

Optimistic Opportunity #5: Americans deserve to embrace death; discuss their end of life wishes, plan their final moments, and share their wishes with their family.

I was 22 when I witnessed my first death. I was an RN, and I arrived at work as I did any other day; I had limited nursing experience, maybe six months? I received report from the night nurse about my patient, she stated: “he had a rough night, he was screaming in pain all night, and I couldn’t convince the family or the doctor to change him to comfort measures until the screaming continued for seven hours.” I thought … comfort care? Hmmm….how long would he live on comfort care? Would today be the day that I witnessed my first death?? Oh please, oh please, please live until my shift is over.

Death, I was scared of it. I didn’t want to face it, and I certainly did not want my patient to die. Around 12:07 p.m., my pager buzzed: “Kelley, room 22’s heart stopped….” And my heart stopped. I approached the room, and I don’t have the words to describe my experience, the best I have is surreal. The patient’s wife charged out of the room as soon as she saw me, with tears rolling down her face she embraced me in the middle of the hallway just outside her late husband’s room. She wanted me to be strong; after all…I was his nurse? I couldn’t hold myself together, when she asked: “what do I do now?” I answered, “I don’t know….” And I cried in her arms.

Thirty minutes later, my patient’s family was escorted out of the room so that I could complete the necessary paperwork. Here I was, 22, scared, emotional.... body bag…toe tag…is this really how it ends??

The man who lay before me was a contributing member of society; he had a legacy, a family, a story. Unfortunately, I knew him as kidney failure, morphine, and morgue.

                          Death is not the greatest loss in life.
               The greatest loss is what dies inside us while we live.”
                                      Norman Cousins

From that moment forward, I did not handle death well. Every time a patient died, I was sick inside, and I wouldn't sleep for multiple days following any death. Some patients died on morphine drips, some patients died after a failed emergent resuscitation….either way, their final story neglected dignity.

                       Love is stronger than death even though it can’t
                  stop death from happening, but no matter how hard death
               tries it can’t separate people from love. It can’t take away our
                 memories either. In the end, life is stronger than death.”
                                            ~Unknown

Death, in my experiences, was not a celebration of life until I became part of the most amazing, loving, and devoted family. My husband’s grandmother received a life changing diagnosis less, she was 87. She could have undergone the necessary testing, procedures, surgeries, but she didn’t. She planned her final days far before they planned her.

She wished to avoid the traditional medical setting and spend her final days reflecting and embracing her story, wearing her own clothes, surrounded by her own intimate family. She shared her wishes with her family long before her medical diagnosis; her family knew what she wanted, and they prepared to respect her wishes, even though it was hard.

              “I believe that imagination is stronger than knowledge-
  myth is more potent than history- dreams are more powerful than facts-
     hope always triumphs over experience- laughter is the cure for grief-
                      love is stronger than death.” ~Robert Fulghum

After experiencing death in a hospital setting, I would never describe one's final days as peaceful, serene, and magnificent. While sitting in a small community at the tip of Maine, in a warm living room with 16+ family members listening to stories reflecting a lifetime of memories, my vision of death changed. Grammy rested in the center of the family circle, peacefully in a hospital bed, and I saw that beautiful death is possible.

She took her final breath on September 7, 2007. I wasn't there, but I heard that she smiled just before she died. Surrounded by her four beautiful children, and her husband of 70 years, she died.

The family took their time mourning with her body and they mourned with one another in their own private, intimate setting. No chaos, no nurses rushing them, no buzzers, no machines.....just peace.

Grammy went to heaven, and we know that she is smiling down on us every day.

Death is certain, we will die. Sometimes we can't plan our death; sometimes death in a hospital is inevitable. Nonetheless, no medication, surgery, research, doctor, nurse...nothing...will stop death. So why not plan for the final days? Why not design our final moments and share our wishes with our family? Why not embrace death and plan to smile before our last breath here on earth?


Plan your wishes: Living Will Document Planning

The cost of dying: CNN News Story
So, does American’s Healthcare system offer optimistic opportunities? Yes, if we embrace that our healthcare belongs to us. We can contribute to HealthCare reform in our own homes, with our own bodies. What can we do to create optimism in healthcare?

Opportunity #1: Ask questions about available, effective, and cost effective treatment options

Opportunity #2: Choose to feed and exercise your body.

Opportunity #3: Role model healthy nutrition and exercise to our children.

Opportunity #4: Take advantage of your health insurance! Obtain your preventative care tests and screenings.

Opportunity #5: Accept that death is certain and plan accordingly.

Do you have health insurance? Use it!!

Optimistic Opportunity #4: Americans blessed with health insurance deserve to take advantage of preventative care opportunities.

Americans hear about the millions of uninsured every minute, never the millions of insured. Our country holds a tremendous opportunity to improve the health and lives of millions of insured Americans.

If you have health insurance, use it! Go to the doctor when you are well! Simple preventative exams, tests, and procedures can save billions of dollars for individuals and the nation. Furthermore, simple preventative exams can obviate catastrophic life changing events that disrupt quality of life, financial security, and families.

3 Simple Preventative Tests everyone should have:

1. Blood pressure: my husband discovered his elevated blood pressure when he was only 22! Over the years, he was able to make modifications and today his blood pressure is within a healthy range! Imagine the physical and financial implications that would exist had he waited until he was 50 to discover he had lived with elevated blood pressure for 28 years?

2. Cholesterol panel: one of my good friends has elevated cholesterol thanks to genetic inheritance! Fortunately, she can adjust her nutrition and develop a plan for future medication management because she obtained her cholesterol numbers early in her life! 

3. Annual physical exam: Why wait until your heart stops, you can’t breathe, you can’t move to talk to your doctor? Why wait until your pain is so severe that you cannot enjoy your friends and family to talk to your doctor? Why wait until you need 14 prescriptions, 4 surgeries, and 6 pieces of medical equipment to talk to your doctor?

Yesterday, my friend received her application for COBRA insurance; she called me astounded! Do you want to know the cost of the COBRA plan AFTER the American Investment Recovery Act reduction?? $700+ per month; almost the cost of some people’s mortgage payments! The crazy reality is that she is a healthy, young, and educated woman. The probably of her spending $700 in health care per month is highly unlikely.

So we ask ourselves….why do we have to pay so much for our health care? One answer (multiple factors play into cost): people who can choose to obtain their preventative care do not. They wait until their conditions are acute, costly, and unmanageable, and they end up spending four times more money and losing five times the quality of life along the way. Insurance companies and the health care system cover the cost of sick individuals through premiums well individuals.

Unfortunately, as a nation, we cannot continue to accept the rising costs of healthcare. Young people cannot afford to pay $700 per month in healthcare, our seniors cannot afford $700 per month in healthcare, my parents cannot afford $700 per month in healthcare. We are all in this together. Healthcare is a cycle that affects everyone. If you have health insurance, use it! Go to the doctor, obtain your recommended screenings. If you don’t want to do it for yourself, do it for your neighbor, do it for your children, your grandchildren….heck, do it for me and my friends!

Delicious Turkey Soup!

1 tablespoon olive oil


½ cup minced onion

3 cloves garlic, minced

2 teaspoons chili powder

½ teaspoon cumin

½ teaspoon oregano

4 cups water

1 (10.75 ounce) can tomato soup (less than 200mg sodium)

1 (28 ounce) can diced tomatoes (less than 50mg sodium)

1 cup salsa (use home made salsa recipie)

4 cups shredded cooked turkey

1 tablespoon dried parsley

3 chicken bouillon cubes

1 (14 ounce) can black beans, rinsed, drained

2 cups frozen corn

Directions:

Heat olive oil in a large saucepan over medium heat. Add minced onions and cook until onions begin to soften, about 4 minutes. Add garlic, chili powder, cumin and oregano and cook, stirring for about 1 minute.

Stir in water, tomato soup, diced tomatoes, salsa, shredded turkey, parsley and bouillon cubes. Bring to a boil, then reduce heat, and simmer 5 minutes or until bouillon cubes dissolve. Add black beans, corn, and cilantro. Simmer for 20-30 minutes.

The Children are the Future

Optimistic Opportunity #3: American children deserve to eat nutritious meals and engage in fun physical activity every day.

“The Children are the Future” is a beautiful catch phrase that most Americans believe. Parents want the best for their children; they want them to grow into productive, successful American citizens with strong values and integrity.

In America, we fight to give our children the “best.” We strive to offer all children healthcare, but do we forget about the basic fundamental healthcare that we can choose to give our children every day?

In my work, I meet with individuals one-on-one and together we work to develop wellness plans designed to generate their personal best. The most common plans involve two basic wellness components: nutrition and exercise. Throughout hundreds of meetings, I recognized two common themes:
1. Behavior practiced for 20+ years is incredibly difficult to change.

2. Parents believe that nutrition and exercise is important; yet they do not involve their children in these healthy behaviors.

Imagine if healthy nutrition and daily exercise were just “life?” Imagine if we didn’t have to dread, resent, and struggle to incorporate exercise…..imagine if we didn’t have to feel deprived, guilty, and hungry just to lose 10 pounds?? The truth is that we can give this gift to our children; children are pliable!

Health Myth #1: “I can’t force my children to eat my ‘diet’ foods”

Fact: When we feed our children nutritious foods we: nourish their brains for a productive day of learning, protect them from disease and infection, and prepare them to enjoy healthy eating throughout the rest of their lives.

How can we raise engaged children when we feed them cereal with 45grams of sugar for breakfast? How can we keep our children healthy if we feed them fruit snacks and pop tarts for lunch? How can we expect children to expand their creative energies when our school lunch programs serve children foods filled with preservatives, fillers, and chemicals?

Our children deserve healthy doses of vitamins, minerals, antioxidants, and nutrients to support their emotional and physical development; they deserve to be supplied the armor against the chronic conditions that plague our nation.

Health Myth #2: “I can’t exercise because I need to spend time with my children.”
Fact: When children watch parents exercise, they view their parents as positive role models who value exercise and health. What’s even better?? When parents find creative ways to include children in their exercise routines!

How can we expect children to release their energy and function at their highest when we eliminate funding for physical education programs? How can we expect our children to prevent illnesses, injuries, depression, and emotional illness when we sit them in front of the television while we run on the treadmill??
Our children deserve to move their bodies, run, play, and have fun!

Health Myth #3: “My kids don’t need to worry exercise and eating; they don’t have a weight ‘problem’”


Fact: Our future deserves to avoid fighting the battle of “diet” and “exercise” later in life. Our future deserves to eat foods that will help them emotionally handle the bully on the play ground, physically participate in a game of basketball, and mentally excel in math. Our children are our future, and healthy eating and exercise is a primary healthcare practice that we can choose to role model and teach to our children.

Obesity & Children Clip: http://www.youtube.com/watch?v=5f5O6LBhOZo

Kid Friendly Delicious Home-Made Super Food Inspired Salsa:

1 can black beans

1 can black eyed peas

1 small onion

1 orange bell pepper

1 cup frozen corn

1-3 jalapeño peppers (depending on how alive you want to feel)

1(19oz) can diced tomatoes- look for a can with less than 40mg of sodium/serving

1 cup of low-sodium Italian dressing- search for a brand with less than 200mg of sodium/serving

Refrigerate for 1 hour and enjoy!

We choose.

Optimistic opportunity #2: Our health belongs to us; every day, we have the option to choose the type of healthcare we provide to our body.

We live in America. Most agree that we live in the best country on earth. Each new day presents us with choices, our choices. We choose how we will treat our bodies. We choose the best healthcare for our body.

God gave us one body and one life. How will we choose to treat the most beautiful gift we were given?

The beauty is that we are free to choose how we will show respect for our body. We are free to choose to feed our body vital nutrients necessary for optimal energy, healing, and vitality. We are free to choose to wake up every morning and walk, run, bike, play sports, or swim. We are free to choose to remove ourselves from unnecessary stressful relationships and environments. We are free, and our choices belong to us.

The healthcare debate will continue. We can watch and agree and disagree with the politicians. We can feel frustrated with the chaos that exists in the system, we can choose to take the victim role, and we can choose to sit back and let politicians, doctors, nurses, and healthcare providers determine our healthcare…or we can choose to take our own health into our own hands.

The fact is that 75% of all disease is preventable: 75% of the costs that currently jeopardize our healthcare economy, burn out our healthcare providers, and steal our quality of life is all preventable based on our choices.

What is your choice today? Will you choose to take an active role in your own healthcare? Will you choose to cultivate your body’s true potential? Will you choose to seek energy, vitality, and healing? We choose.

Does American's Healthcare system promise optimistic opportunites??

Our current healthcare system is dysfunctional; I see dysfunction, feel dysfunction, and hear dysfunction daily. The system has reached a level of dysfunction that has generated fear and uncertainty for most Americans; a level of dysfunction that has created a shortage of nurses, physicians, and pharmacists; a level of dysfunction that is nearly bankrupting our country. Needless to say, healthcare is not on my list of “optimistic reflections!”


However, since healthcare is close to my heart, and I am passionate about my profession as a nurse, and I am proud to live in the United States of America, I want to rephrase my thoughts on healthcare and focus on 5 areas of opportunity that, if executed, would reflect “optimism” for the future of our beloved American HealthCare system.

“Optimistic Opportunity 1:”

Individual choice: We deserve to visit a healthcare provider and receive a list of treatment, medication, or prevention options in rank order of cost and effectiveness and proceed to make an independent, conscious decision based on our personal preference.

Currently, we have little to no choice in the healthcare we receive, or the options available to us. Let’s compare our experience with healthcare to other areas of our lives. For example, let’s say we go out to a restaurant for dinner. We receive a menu of options with clear descriptions of each menu item along with the cost of the item. We have the choice of what we order based on our personal preference and price range. We order what we wish to eat, we eat, and we pay our bill, and we go on our merry way. In any consumer buying scenario, we are in the driver’s seat before we spend money: buying a home, car, tv, clothing, hair supplies…….

Now, let’s look at our experience with healthcare. We visit our provider, we tell him or her our complaint (or if we are good, we are simply attending our yearly ‘tune-up’-no complaints necessary), the provider enters information into a computer and sends us away with lab slips, prescriptions, follow-up tests, referrals, ect. We go to the pharmacy to pick up your prescription and the pharmacist says, “that will be $502” we gasp, we had no idea how much the medication cost, and we debate if the medication is worth the price, or not?

We go to the lab, they draw our blood…we have no idea what they are looking for?? Seven months later, we receive a loooong bill from the laboratory, final bill: “$1012.67.” We had no idea what we were buying when we went to the lab, and we certainly had no idea how much the tests cost!

Did we ever have a choice in the care we received? What if another medication, with equivalent effectiveness, cost $4 rather than $502? What if we didn’t need all of the labs that the provider ordered? What if knowing the results of certain tests won’t change the treatment plan, or the outcome? Would we still want to pay?

I am shocked, almost daily, by the number of tests, labs, medications, treatments that are prescribed or recommended without thorough cost-effective analysis. Why? Because we accept and believe that healthcare happens to us, we are letting the system rob us of our financial future and potentially our emotional and physical future.

Healthcare belongs to the individual receiving the care, but most often the individual has no idea what he or she is buying or receiving? Does this make sense?

We need to take a stand on healthcare. We need to start asking our providers, “is this the absolute best treatment option for my condition? What evidence did you use to support this decision?” What other options are available? Do I need this test? What will happen if the test indicates X? What if the test indicates Y? What lifestyle changes can I make to avoid this medication? How much will this cost? Can I defer treatment until I determine the price?

Opportunities 2-5 to follow..

Ditch the 'diet'

I was raised in a family that loves burgers drenched in mayonnaise and cheese, meat lover’s pizza, and chocolate chip cookies. Throughout my childhood I was overweight; I hated my body, and I felt embarrassed about the way I looked and felt.

I believed that the only way to a “normal” body was restricting foods I loved, starvation, and misery. In high school I started to cut food portions, and I found this approach effective, but I always felt deprived and weak. In college, I moved toward “sugar-free” and “fat-free” processed foods. My roommates would tease me for my obsession with “low-fat cheese-its” “sugar-free” candy and “fat free chips.” (Okay, maybe they didn’t tease me…they just didn’t like the negative side effects caused by my eating habits).

My crazy food interventions did help me lose weight, but the process was complicated. In 2009, James and I moved to Portland and we started a Strout household food revolution: we ate real food. We ditched the fat-free cheese, 100-calorie packs, and spray butter and replaced them with real cheese, whole grain crackers, and real butter. Surprisingly, the new approach was easy, cheap, and effective. We enjoyed more energy; we lost and maintained weight, and felt full and satisfied throughout the day.

For many years, I had no idea healthy eating was so simple, and I am dissapointed that our culture evolved to today’s modern food dilemma. Michael Pollan, a journalist, set out to get to the route of our food crisis, and  his published work is a MUST READ!! My good friend strongly encouraged I read this book: Food Rules, and she is pretty smart and reliable, so I took her advice.

Pollan is not a nutritionalist, scientist, researcher, or medical provider. He has no affiliation with the healthcare system, the food manufacturing companies, or any other biased parties. He is a journalist, but I would like to think of him as a genius!

His book is an eating manual and given the racket in the media, you would think that this “food manual” would be at least 50000000 pages in length. But, this “manual” is much smarter and much simpler, all 140 ½ paragraph pages!

I will share some of the food “rules” from Pollan’s book that make me smile:

· Avoid products containing ingredients a third grader cannot pronounce

· Don’t eat breakfast cereals that change the color of your milk

· Eat all the junk food you want as long as you cook it yourself

· Cook

· If it came from a plant, eat it; if it was made in a plant, don’t

· Avoid foods pretending to be something they are not

I read this simple manuscript in a couple of hours, and laughed out loud through the entire experience! The rules make sense, they are easy to follow, and you don’t have to hold a PhD in food science nutrition to understand the concepts. Eating is fun and easy, and I am relieved!

Below is an innovative recipe that I created for James’ and my superfoods eating plan. The recipe follows Pollan’s rules: cook and eat all the junk food you want as long as you cook it yourself!


Super-Delicious Lasagna!!

½ pound raw spinach

1 tomato

16 oz black beans

1 diced orange pepper

1 8oz can tomato paste

1 jar all natural tomato sauce

½ pound broccoli

1 cup yogurt

1 cup fat-free ricotta

1 egg

1 1/2 cups low-moisture mozzarella

2 garlic cloves

Pepper

Italian seasoning

1 box lasagna noodles- OR 1 mid-sized spaghetti squash

1. In a large mixing bowl add beans, spinach, broccoli, tomato sauce, tomato paste, garlic, and spices

2. In a mid-sized mixing bowl add yogurt, ricotta, 1 cup mozzarella cheese, 1 diced orange pepper, and egg.

3. Grease a 9X11 pan and layer vegetable mix, lasagna noodles or spaghetti squash, and cheese mixture. Top final lasagna with ½ cup mozz cheese.

4. Cover lasagna with tin foil and bake at 350 degrees for 45 minutes, or follow the directions on the lasagna noodles.

5. If you use spaghettie squash: cut the squash in half and bake for 30-45 minutes at 350 degrees. Once the squash noodles cool, gently separate the squash strings

and use as your lasagna noodles.

6. ENJOY!

Why I ditched coffee for tea!

I survived 18 years of life without a single “caffeine-induced” high...unitl I met my two, blonde-coffee-crazed, college roommates: Katie and Kristina. Freshmen year of nursing school the three of us sat though long, boring lectures while I whined 24-7 about my fatigue and lethargy. Every day, they would peer-pressure with words of persuasion, “Kelley, you wouldn’t feel tired if you drink coffee…coffee is the answer to your problem.”

My coffee-addiction started with cappuccino. Katie insisted that I needed to wean my way into the “real deal.” I slowly upgraded to Katie’s nifty invention: coffee mixed with a package of hot chocolate, and before I knew it I was a full-fledged coffee addict.

Seven years later, my coffee addiction was severe: I was chugging at least 4-5 cups of black, bold java daily! I couldn’t function without my daily fix, and I started to have embarrassing side effects: perfuse sweating, sleepless nightly, racing heart, nausea….my husband even forced me to throw away some of my favorite shirts because of…[I am embarrassed to admit this], “pit stains.”

This past October I fell dangerously ill, and I was unable to consume anything for at least five days. Of course, my coffee addition went out the window during this time. When I started to feel better, the thought of coffee made my stomach churn, yet my addition was evident with my nagging headache. I didn’t know where to turn, what had I got myself into?


My Mother-in-law encouraged me to drink a tea resolve my caffeine withdrawal induced headace, so like a wise little daughter-in-law, I took her advice. I started drinking green and black tea for about a week when I realized that I kinda enjoyed tea. I started to feel better, and I wondered if tea was good for me? I stuck with the tea experiment and did a little investigating, and here is what I uncovered:

I was sleeping like a baby!!

Caffeine remains in the body for 12 hours. I was drinking coffee well past 11am each day, so I decided to end my tea consumption before 11am daily. An 8oz cup of coffee contains about 95mg of caffeine whereas an 8oz cup of green or black tea contains between 30-40mg of tea. My switch from 4 cups of coffee to 4 cups of tea saved my body from ingesting about 300mg of caffeine which resulted in:

Falling asleep faster

Staying a sleep longer

Sleeping more soundly

Tea is a superfood!

Green and black teas are superfoods! I learned that the tea helps to prevent certain types of cancers, improve metabolism, reduce stress, improve irritability, and prevent risk factors associated with heart disease!

Drinking tea is relaxing!

Instead of chugging coffee, I sip my tea and enjoy the experience throughout my morning routine. I drink about four cups of tea, and I enjoy every minute!

James and I also started drinking hibiscus [non-caffeinated] tea before bedtime to help us relax and prepare for sleep. I read research stating that hibiscus tea may help to improve blood pressure. Since James had slightly elevated BP, we decided to try to launch our own “Strout- hibiscus tea” research. After three months of drinking the tea nightly, his last blood pressure reading: 118/67!!

I still enjoy a Starbucks, venti, soy mocha [my personal favorite] or a cup of jo- every now and then, but in my day-to-day routine, I am sticking to the tea!