What do YOU want?

No one wants to think about getting sick or making end of life decisions for themselves or someone they love, but getting sick happens and death will eventually happen too. Questions about how you want to live your life, what kind of care you would like to receive, and the extent of what measures are to be taken on your behalf should be addressed while you are healthy and alert, not in a moment of desperation or left to family to determine what YOU would want. Now I know you are probably thinking, "Wow, Kristen is being really morbid and depressing", but I have always been a strong believer that we should be the ones in control of our health care. I remember when I worked on the Health Plan side of KP and I would go present at health fairs and employer events. I would talk to employees about why they should choose Kaiser Permanente and how to navigate this big system of ours. I would always tell them that if they have a bad experience, they need to let us know about it by contacting member services. If they don't feel like they connect with the provider they were assigned, they can ask to switch to someone else. This is THEIR health plan and they must have a voice in the care they receive. I've also wondered why we haven't made Advance Directives part of our enrollment packet. Some may argue that it sets a tone of "you might die with us", but I think it can be approached it a way that says, "We want YOU to help us make these very important decisions. Tells us how you want us to care for you."

So now you are probably thinking, "No one just randomly starts thinking about POLST and Advance Directives, this must be because Kristen's daughter just died." My answer is yes and no. Yes... this has been on my mind a lot since my daughters passing and I'll explain why in a moment, but no... it isn't random, this is something I've thought about for years. When my late grandmother was in her 80's, she and I became pen pals. Writing letters back and forth became a weekly thing. As her health slowly deteriorated, her letters included words to me about how she wanted the end of her life to be handled. She did not want drastic measures taken on her behalf. She was quite clear that she did not want to be put on life support or have her life prolonged if the quality of life was poor. She had already arranged for a plot next to my cousin where she wanted her cremated ashes to be buried and reminded me of that in almost every letter. My grandmother lived until she was almost 98 years old. She had a high quality life and wanted to leave this world with grace and dignity. When my aunt wanted to hold on to her even longer by requesting extreme efforts by her medical team, I was able to provide the advance directive that my grandmother had given me and my nana's wishes were respected and upheld. Those letters and that advance directive gave me and my sisters the peace of mind we needed to make the right decisions for my grandmother in a time when the heart begs you to do something completely different.

So how does this relate to Amanda's passing? When Amanda was 12 years old she was very ill and spent six months of her 7th grade year in and out of the hospital. She was so sick that there were times when her father and I weren't sure she was going to survive her illness. One day I came home from work and her older sisters, who had taken a semester off from college to help take care of her, came to me in a panic because Amanda had written a Will. My heart skipped a beat to think my 12 year old daughter thought she was going to die. I went to talk to her about it and she looked at me with surprise and laughed and said, "Mom... don't you know that you are supposed to write your Will when you are healthy? The people on TV said it's called a Living Will and you should have one so people know what to do with you and your stuff." With a deep sigh, I realized my daughter, who had become a tv  infomercial addict during her illness, had the clarity and insight that most adults don't think to have. She understood the concept of "letting people know your wishes". When she passed away in July, her sisters and I sat together and pulled from our memories all that we could from her will.

• Her clothes were to go to her friends - if we could find someone who could fit in to her 00 pants - she added with a smiley face.
• She wanted her dog to go to her sister Breanna (who politely said we could keep him)
• Her make-up and nail polish collection to her sister Lauren
• Her music to her cousins
• And along with all the other things on her list... in a final note to her dad and I she wrote "Dear mom and dad... Enjoy the memories and my stuffed bunny".

This took a huge weight off my shoulders, because I knew what my daughter would want us to do. We called over a couple of her 'tiny' friends and had them do their back to school shopping in Amanda's closet. Amanda, being an extreme fashionista, had an amazing wardrobe and she was able to bless her friends who weren't financially able to go back to school shopping on their own. I was able to release her belongings with the assurance that I have truly been left with the most beautiful memories and that those are more important than any material goods.

Amanda also taught me another lesson about the importance of making your wishes known. She was sixteen years old and had one month left to go before she could get her drivers license. Her 23 year old sister took a little bit longer to get her license and didn't make that move until a couple months before Amanda's passing. Amanda went with her sister and her dad when Breanna took her drivers test. Amanda saw Breanna filling out an Organ Donor card and asked what that meant. Breanna and her dad explained that it means when you die, you are offering to give some of your organs to others so they can live or improve the quality of their life. Amanda, without any hesitation, asked if she could sign up. Once again, she made her wishes clear. So, after learning of her death and knowing there was a small window of time for organ donation, I asked my friend, Dr. Mark Eastman, who had come to our house immediately after hearing the news, if he would ask the coroner if organ donation was a possibility. He looked at me and said "Are you sure?" and I, remembering the conversation with my daughter not too long ago said, "Yes... It's what she wanted."

We received this letter a few weeks ago from One Donation who handled her organ donation.

I realize that Advanced Directives are not the same as writing a will or becoming an organ donor, but the concept is the same. It is about making your wishes clear and letting others know what YOU want to happen to YOU. I believe, it is one of the kindest things you can do for your loved ones because you take away the guilt of having to make those tough decisions. It provides peace of mind for those who may be left to act on your behalf because they know you and what you want. 

So I leave you with this thought... Are you prepared? Have you made your wishes known? What do YOU want?

Sleepless Dreamer: Measuring Your Absence

Sleepless Dreamer: Measuring Your Absence: How do we measure your absence my love In breaths, moments, months, weeks, days, or hours Shall we number the tears that have burned our c...

Sleepless Dreamer - Night Thoughts & Daydreams: I Miss...

Sleepless Dreamer - Night Thoughts & Daydreams: I Miss...: What I miss about you...  I miss your chocolate brown eyeballs and your beautiful lips.   How your smile could make my heart skip a beat. ...

Hugs Heal - Part II

A couple weeks ago I wrote a blogpost called "Hugs Heal - So Hug Like You Mean It". In that post I shared the hugs that have impacted me most in my life. At the time, there were only around 16 hugs that had etched their memory deep into my soul. 


On July 11th, 2012, my world changed forever when my beautiful 16 year old daughter Amanda took her own life and, with that devastating event, the number of significant hugs that I have received and have given has become uncountable.  Hugs came to us immediately from coworkers, neighbors, relatives, church members, friends of our family, and friends of our daughters. Prayers and hugs were sent out across Twitter with a #HugsHeal hashtag and Facebook wall notifications. Friends of Friends, who didn't even know us sent out their hugs and prayers and I felt strengthened by them all. Strangers who understood our grief from having endure the same dire circumstances and strangers who had never experienced the loss of a child, but knew it would feel almost unsurvivable without love from others; strangers or not. 


In our LDS faith, as in many others, when someone passes the congregation pulls together to provide love, support, and meals. Lots and lots of meals. With each meal that is dropped off, I could almost see the remnants of tears that spilled onto their aprons as they prepared nourishment for our family using ingredients of love, friendship, hope, and pain. One of my co-workers came by the day after Amanda's passing, knowing that our home would be filled with teenagers coming to grieve, pay respects, and heal each other, she brought tons of snacks and drinks. When Amanda's friends came, we were prepared and I was extremely grateful. Friends and family came from near and far to hold us. My friend Lara, who I mention in my Hugs Heal blog, even organized my kitchen while our family friend Mandy J. cleaned up. Others stopped by to volunteer their services, even if it meant walking our three dogs. Church members who served their mission in our area and who had become a part of our family came too. We had visitors from North Carolina, Texas, Utah, BC, and both Northern and Southern California... all to wrap their arms around us to tell us we are not alone. Donations also poured in to help with the funeral expenses, taking a huge burden off our shoulders so we could focus on the healing process with our two older daughters. 


I don't think I could have made it through without all of you. No one should ever have to experience a loss of any kind alone. Whether it be the loss of a loved one, a family pet, or friend, we should all learn to reach out to one another and give what we can of ourselves. My daughter Amanda was a very happy girl who had a brief moment of despair.  Let this be a reminder to all of us to love deeply. My daughter was very loved and she loved deeply. We know she did not intend for the outcome to be this final, but it can not be changed. We must Carry On and live worthily so we can all be reunited again. Think about your decisions before you act. Choose the Right (CTR). 


I feel like I have so much writing to do, but my heart will only let me get it out in pieces. Bare with me. Love Me. Hug Me. #hugsheal

Carry On, Carry On

I can’t tell you how much I miss your laughter 
And those teasing names that said you loved me too 
You bugged me so much about cutting my hair 
So it is short again just for you 
I know I yelled because you would take my clothes, 
But if you were here now they would all be yours 
I would give up anything... Do anything 
To have you here with me once more 


Don’t cry Lauren, 
I am not gone
Carry on sister, 
Carry on, carry on 

When you were little I carried you every where 
Until it drove you nuts and you'd push me away 
The older we got the closer we became 
I loved it when you would ask me to come stay 
Remember how we wrote funny poems back and forth 
And you said I smelled like moldy afghan goat cheese? 
You always had the best sense of humor 
Won't you come back to me please? 


Don’t cry Breanna, 
I am not gone 
Carry on sister, 
Carry on, carry on 


Your friends and other family have been here sharing their memories with us 
Eating smiley face fries on the roof in the sun 
Jamming to your favorite "gangster" music each day 
Going to the trail for a walk or run 
Sleepovers and pillow fights, make-up, clothes, and boys 
They share treasured secrets that bring us comfort and joy 
Teachers and friends you haven't seen for awhile 
Have all sent the most beautiful comments about you 
You touched so many, many lives for good 
We know you will live on in them in everything they do 


Don’t cry loved ones, 
I am not gone 
Carry on friends, 
Carry on, carry on 


I've been so blessed to be your father
To have the Lord trust me with your care
I'll always cherish our road trips with the Judd's and Dean
Your cuddle chambers, chili fries requests, and bedtime prayers
Now when I think of you, I smile 
Though my heart is aching from the pain 
I go on because I know you would want me to 
But living without you just isn’t the same 
Desperately clinging to every memory of you 
I think of how you touched our lives in so many ways 
You visit me in my dreams at night 
But I can never make you stay 


Don’t cry daddy,  
I am not gone 
Carry on daddy, 
Carry on, carry on 

I sit in your empty room at night 

Dreaming dreams that will never be. 

Surrounded by all the things you loved, 

For they bring you nearer to me. 

I hug your pillow close to my heart, 

Just a hint of perfume lingers from your shampoo. 

I remember all the time we spent cuddling together. 

Oh sweet girl, I will always love you. 

I long for those precious moments again, 

Yes, I know I’ll have them back in time 

Until then I have my beautiful memories of you 

And your skinny hugging arms wrapped around mine. 

Don’t cry momma, 

I am not gone 

Carry on momma, 

Carry on, carry on 

I sit here by Heavenly Father’s side 
Rubbing my hands through Walnuts soft fur 
Jesus said He will watch over you now 
And send you the spirit as a comforter 
The angels sing me "Come, Come Ye Saints" 
When I want to feel you near 
And when you say your prayers at night 
They always let me hear 

Amanda Kellie Andrews
Beloved daughter, sister, cousin, and friend
Rest in Heaven my love
12-19-95 to 7-11-2012

So don’t cry family, 
I am not gone 
Carry on family, 
Carry on, Carry on

A Father's Kiss

In loving memory of my baby girl Amanda. 16 years were not enough. 
You are ours for eternity and we will see you on the other side. 

Amanda Kellie Andrews 12/19/1995-7/11/2012

Her Father holds her in His loving arms, 
And with a kiss He lets her go. 
He sends his beloved daughter down, 
To her family waiting below. 


He knows that they will love her, 
With every fiber of their hearts. 
The temple bond He sealed them in, 
Promises they will never truly part. 


His Father’s intuition reminds Him 
How faith can be shaken when in rough seas, 
So He blows kisses from the heavens 
To etch her smile forever in their memories. 


A family kneels in prayer together. 
Hearts breaking as they try to comprehend. 
How the love and joy they shared with her, 
Could come so abruptly to an end. 


He tries His best to comfort them, 
Somehow hoping to lighten their load. 
The bonds of eternity begin to strengthen, 
As she prepares their castle at the end of their road. 


She sits, perfected, by His side, 
As He watches the scene below. 


Her father holds her in his loving arms, 

And with a kiss he lets her go.

Mommy

"We'll love you forever. We like you for always. As long as we are living, our baby you'll be."

Hugs Heal - So Hug Like You Mean It

I've been thinking a lot about hugs lately. Strange right? Let me explain...


A few weeks ago, my friend Ted Eytan (@tedeytan for you twitter followers) introduced me to a special lady named Lauree Ostrofsky (@simplyleap) through a tweet which was on the subject of hugs.  Lauree is the founder of Simply Leap and has been going around the country on what she calls a "Hug Tour". The message is simple... Hug like you mean it. 

"My hug tour is a personal journey with a larger purpose. I want the people in my life to know they are important. To feel that they are loved, because they are. I also hope that my actions encourage others to share love. As adults we can be apprehensive, or just preoccupied, to show how we really feel. In answer to that, I say: It’s time to hug like you really mean it."  - Lauree

How can one tweet make you rethink how you hug? Rethink your life? I guess that's really the power of Twitter. The messages, though sometimes life-changing, are short and sweet - the reader must decide what and how to interpret and/or apply. When I read about Lauree's #hugtour, my first thought was... she really is brave. You see, I didn't come from a big family of huggers, at least not growing up. I don't recall my mom being overly affectionate, though I know she loved me. My dad was on the road a lot for work, so I do remember him hugging us as he would come and go. I DO remember a couple of family friends who were like uncles to us that always gave hugs. My uncle Dan, who was the stand in father figure when my dad was away and David who liked to hug a little too much (He turned out to be a child molester - so his creepy hugs don't count).  My step-dad is a big hugger, but I think I felt like it would be betraying my dad if I accepted them as freely as they were given. Other than that, I didn't really have a lot of huggers in my life who hugged "like they meant it". You know the kind of hug that says, "I care about you and I'm not going to let you go". 


It's such a strange and almost uncomfortable feeling for me when I encounter someone who hugs like they mean it. It is cathartic and terrifying at the same time. Sometimes I feel like I have so much of my past built up inside me that I fear if someone were to hug me with their heart and soul too long I would quite possibly crumble in tears. 


Is it a sad statement when you can list the hugs that you remember that changed you a little bit inside? Here are the hugs that I etched their memory in to my heart.


Hugging my dad when he and my mom separated and he was leaving for his new appt. Hugging him when he left for Saudi Arabia to work for a few years. Running to hug him every time he came to see us. 


Hugging my sister Kellie who was going to live with my grandmother when she was 13. 


Hugging my sister Kim after helping her pack a bag so she could run away. Having her tell me to look out for my younger sister.


Hugging my boss, who was more like a fatherly figure to me than a boss, who could just tell that something was wrong when I showed up for work without a smile on my face. He made me go sit down with him. Told me I didn't need to talk if I didn't want to. I couldn't find the words, but the tears I had been holding back for the last hour started to fall. He got up and hugged me. He hugged me through all of my sobbing and heart ache. He hugged me until I could whisper the words; Right before I left for work my younger sister told me that one of my best friends, Robbie, was killed in a car accident the night before. 

Hugging my best friend Lara right before I drove away to start a new life in Southern California... without her. She was my family and a huge piece of my heart. Leaving her behind left a piece of me too.


Hugging my two year old after she saved me from her father who had me pinned down to ground and was strangling me. My brave little hero came to my rescue, climbing on his back as she cried "No papi No!" Her plea broke him from his wicked spell. He climbed off me, kicked me in the ribs and walked away. Leaving her to hold my head while I caught my breath.


Hugging my soon to be second husband as he broke down in tears. His ex-wife had taken their daughter (HIS heart and soul) and hid her away. 


Hugging a lady named Sherri Green who I met when I joined the Church of Jesus Christ of Latter Day Saints. Her hugs were so full of love and strength... they scared me. I wasn't used to someone hugging me like that... like a mother would do. 


Hugging my sister Kim who moved away to Texas to start her new life when she was just 19 years old. I hadn't seen her for a couple years and I was in Texas for a conference that I was speaking at. She drove from Lubbock to San Antonio after working all day to spend a day and half with me. When she got to my hotel, she gave me one of her bear hugs. Tight and secure... full of sisterly love.


Hugging my nephew Matt when I stepped off the plane in Alabama to go to his college graduation. He and I have become quite close over the years and it was like hugging one of my own children. I wish he lived closer to us, but since he doesn't, our hugs have to last until the next time we'll see each other.


Hugging Lara again after not seeing her for several years. She will always be my best friend and soul sister.


Hugging my boss, Gail Lindsay(@nurseqm) and co-worker, Ruthie Goldberg, after having a bit of a nervous breakdown at work.


Hugging a lady at a grocery store who stopped me tell me I was beautiful. I broke down in tears and, without any hesitation, she hugged me whole again. Earlier that day my mother-in-law had told me I was fat and should consider gastric bypass. I spent the rest of the day telling myself I was ugly and unworthy, until I met this random woman who said I was beautiful. 


Hugging two friends I had met through Twitter at DC HealthCamp and The Walking Gallery Event. The first was a hug from Regina Holliday(@reginalholliday). Her hug said, "I get you and I love you for being who you are." Then, meeting Lisa Fields(@practicalwisdom) who I had made an instant connection with through Twitter. When we met, she hugged me until I almost cried. Had nothing else in DC gone right, the trip would have all been worth it because of that hug.


Hugging my daughters every day, who won't let me walk by them without a REAL hug. I love the way they make me feel.


Hugging my chiropractors massage therapist who confided in me that he was feeling numb from the loss of a best friend. We talked about his pain and my own numbness when my best friend had died. When he finished massaging my neck, I reached out and gave him a hug. Only this hug was different from what I was used to giving. All I could hear in the back of my mind was Lauree saying "Hug him like you mean it. Show him that you care." So I hugged him tight and didn't let go. After about a minute he started to cry, and I cried with him. All I could think was... Hugs really do heal. 


I will be 45 this Saturday, July 7th and I find it a little disturbing that I'm figuring this out so late in life, but there is no better time to start like the present. From now on, I'm going to hug like I mean it. If you are a sideways, one-arm-around-the-back hugger, please know that I will not let you get away without giving you a full on, two-armed hug. (If you only have one arm, I will still accept a one-armed hug, but you had better damn well mean it!)


I realize now, as I write this blog, that the hugs that really impacted me the most throughout my childhood are the hugs where someone was telling me goodbye. I don't want to think of hugs like that anymore. I want my hugs to be healing and full of love...for me and the recipient. To those who have hugged me with their whole heart... thank you. Whether you knew it or not, you have helped me heal a little bit with each embrace.  


Huh... it seems that Twitter really can help change the world. One 140 character Tweet and hug at a time.


p.s.
Need some hug inspiration? Check out Lauree's HugWall. You can even send her pictures and she'll post them.

Well Taken Care Of

It started as just another day for me
Nothing special, significant, or grand
One more visit to the doctors office
For these lungs that can't meet their demand


Greeted with a smile and a warm heart
Tina's kindness was comforting and genuine
As she performed the test on my lungs
She reminds me it's time for a mammogram... again


I told her I really hate that painful squeezing
and I didn't have the time anyway
What if I made it easy for you 
and could get you in right away?


I said I would give it some thought
Her persistence was gentle but persuading
She walked me over to mammography
Leaving absolutely no chance of me evading


A suspicious area is what they said
A biopsy would soon follow
I found my way back to Tina 
Tears made it so hard to swallow


Another visit to the oncologist 
We caught it just in time
A lumpectomy and no need for chemo
I was going to be just fine


The excitement filled my heart with joy
Someone special I needed to find
She was the one who saved my life
Who gave me this peace of mind


No "What If's" for me to worry about
All because of Tina's gentle shove
Everyone was kind and caring
I felt so well taken care of


Thank you to all my partners in health
I know these words will never do
But my gratitude is deep and overflowing
I will live because of you


Written by me for a patient of ours who needed help expressing how she felt.

Inspiration Point

Inspiration Point - Courtesy of 

Postivityworks.wordpress.com

There will always be times when you feel discouraged. 
I too have felt despair many times in my life, 
but I do not keep a chair for it;
I will not entertain it. It is not allowed to eat from my plate.
The reason is this: In my uttermost bones I know something,
as you do. It is that there can be no despair when you remember
why you came to Earth, who you serve, and who sent you here.
The good words we say and the good deeds we do are not ours:
they are the words and deeds of the One who brought us here. 
In that spirit, I hope you will write this on your wall:
When a great ship is in harbor and moored, it is safe, 
there can be no doubt. But that is not what great ships are built for. 
This comes with much love and prayer that you remember 
who you came from, and why you came to this beautiful, needful earth.

—Clarissa Pinkola Estes, Ph.D

http://positivityworks.wordpress.com/2011/03/21/words-to-think-on-dealing-with-despair/

Underneath My Wonder Woman Cape

My sister and I were talking the other day and she confided in me that as her body tiptoes into menopause she is experiencing a seesaw of emotions which makes her feel weak. "One minute I'm up, the next I'm down. You are such a rock" she tells me, "you always have been". We both know that is not true, but I rarely let the outside world know of my internal and private struggles. (Unless of course, you read my blog) Friends, family, and co-workers know the smiling "see the world with all of it's bright colors" Kristen.  


When my sister told me she feels like crying all of the time, how she just wants to sleep, and she has been gaining weight, I told her she should talk to her doctor because it sounded to me like she was experiencing signs of depression. Even as I said those words, feelings of being a hypocrite crept upon me. The voice in my head shouted "What about YOU?!?!" Who me? I can handle my issues on my own... I always have. "Except for the time you took a handful of sleeping pills and your friend had to put his fingers down your throat to make you puke them up" the voice reminds me. "That was a very long time ago" I think, as I bury that memory down deep.  


One of my former employees sent me an email after reading one of my blog posts that said "what makes you a great leader that people respect is that you aren't afraid to share raw emotions to help the meaning of what we do sink in." I guess in my own way, I believe if I put myself out there and share what I have gone through or what I am going through, it will give someone else the strength to share their own stories or get the help they need. The way I find my way through the world is by writing it all out and bearing my soul in the process. So... In the spirit of being a good leader, better sister, and just plain real, here is the side of Kristen that hides under the Wonder Woman cape.


Most days, I am absolutely fine and the person you see is really me and I am happy. But there are days, sometimes weeks, that old memories bubble up to the rim of my already full life. Days that I fight back tears and have absolutely no desire to interact with others, eat, talk, exercise, or just BE. Not that I feel like hurting myself or anyone else, but times when I just want to stop the world and get off for a while. Times when my mind feels so cloudy that I actually avoid trips to my doctor because she knows me well enough to see through my facade, and I don't want anyone, not even her, to think I am not the person they think they know. Sometimes those feelings are brought on by "trigger events" like birthdays of someone I loved who has passed on or the anniversary of their death. Other times it is related to my work. Not the stress of my work, because I manage that pretty well, but the subject of the work itself. For instance, when we started our alcohol screening initiative I was reminded on a daily basis of the day I lost my best friend to an alcohol related car accident. The loss I felt after his death and other circumstances in my life with my family pushed me in to a world of true depression so dark that I thought I would be better off leaving it. Thankfully, a friend intervened. 


Recently we have been working on Domestic Violence screening so I felt inspired to share my personal story as a domestic violence survivor through my blog(s). Because of my DV blog someone reached out to me to help their friend and, while I'm extremely grateful that I could help, it conjured up emotions that I had disassociated myself from for some time and it sent me in to grey days. I was recently asked to join the Domestic Violence committee at work and at the first meeting my friend said wanted me to share my personal story with the group. I literally felt like I was about to have a panic attack because though I have had private conversations about my past, I have never been asked to vocalize my experience in front of a group.  I was so grateful that we ran out of time and that part was skipped, at least for that meeting. I know I want to use that chapter of my life to help educate others  so I will have to find a way to cope with the overwhelming emotions that come from bringing those skeletons out of my closet. Baby steps though.


Now the focus is on Depression Screening and there is a voice inside me screaming "Yes... we need to find THESE people who need our help" and a quieter voice saying,"but, whatever you do, don't screen me because I'm just fine." Right?


From a young age I used writing and music to deal with and share my emotions. If I was upset about something, I would write a poem or a story and slip it under my mom's bedroom door and we would talk about it on the way to school. One of my first poems was called "A Point of View of a Spider" as a plea to get my mom to stop killing spiders, but growing up in a pretty dysfunctional family - my teenage years introduced darker topics like "On the Edge of Suicide". My mom freaked when I slipped that one under her door. I remember the drive to school that morning and this expression on her face that was a mix of irritation, concern, and panic all mixed together. She looked at me and said "Do I need to worry about this?" "Nope... I'm good" was all I said, even though I wasn't. Music has also been a huge part of my life. I grew up around music because my dad's band would use our house to practice. There are times when I can't find the right words to express my thoughts, so I lose myself in music until the words come along. The one that helped carry me through my teenage years and the death of my friend Robbie was "Lord is it Mine?" by Supertramp. I would slip my cassette in to my yellow sony walkman and go down to the park where I would climb a tree and hide from the world.

These past couple years, while as amazing as it is to be in the role I am in at work, have come with many challenges.  There are times when work, family, home, being adult (with bills to pay), and dealing with fibromyalgia can get to be a bit overwhelming.  This song "Swim" by Jack's Mannequin has helped me pull through the difficult times by reminding me of the reasons I do what I do and who I do it for.  Occasionally, you're going to get caught up in turbulent seas and the only thing you can so is just "swim".  

When I put on my work clothes, it is like I'm putting on a different me. The person with all those fears, doubts, and worries gets pushed aside and the strong, confident Kristen takes her place. The one that always responds "great" when someone asks how I am or cracks a joke to make someone else smile. However, Wonder Woman Kristen knows that there is a different person quietly hiding under that flowing cape waiting to surface and lately I've been thinking that, "Yes... some people can handle most things on their own, but perhaps it takes an even stronger person to ask for help when it's just too much". Feeling sad or down occasionally is normal. Depression isn't and shouldn't have to be. We should all just take off our super capes and let the world see us for who we are and allow others to help us paddle through life together.


Wondering if you or someone you love is suffering from symptoms of depression, use this  Interactive Tool: Are You Depressed?

If you think you have a medical or psychiatric emergency, call 911 or go to the nearest hospital. 

Steps You Can Take To Feel Better

Want to know what songs I use to work through my gray days? Check out my iTunes Playlist - Hold On

I See You

I see you... Sitting on the exam room table
Bare back exposed through an undersized gown
Hands twisting together in nervous anticipation
The person I've come to know through ups and downs
I see you... grey hair speckled through shades of black
Skin pale and freckled... wrinkles slowly staking their claim
You have been my patient for so many years now
I've grown to welcome the sight of your name


I see you with your list in your lap
The latest of ailments to set in
I know these pains are more than just aging
How your heart still aches from loosing him
I saw the brave act you put on for my nurse
But I'm grateful you drop down your guard with me
I ask how you are and see tears swell in your eyes
Though your voice whispers "fine"... You know I can see


I hand you a Kleenex and sit quietly... Waiting
Allowing this moment of release you so desperately need
"Sometimes it's just so hard" you say softly
Wounds so very deep; but they never bleed
I take your hand and ask how I can make things better
You stare at my hand on yours and say "you just did"
A simple gesture they didn't cover in medical school
That I learned from my mom when I was a kid


I see you... Not just a patient but a person
And though at times I admit I've forgotten
I know compassion is the first medicine I must offer
Before any other medical healing can begin
I am grateful that you still confide in me
You are a reminder of why I do what I do
And if you continue to trust in me
I promise... I will always see you

The Theme of the Week is "Collaboration"

Northern California KP visits Southern California to share innovations

In a meeting a couple weeks ago one of our doctors told me she didn't think we should share information with one of our sister regions."I don't like xxx person in that region" she said adamantly, "and I don't think we should partner with her. She will just steal our ideas and take credit for them." So I gently reminded her that we always share our work openly and freely because, in the end, it isn't about who gets credit, it's about improving the lives of our patients and our communities. When you think about it, Kaiser Permanente exists because of a collaboration that began over 60 years ago between Henry Kaiser and Sidney Garfield. That journey continues today because of internal collaboration within our three entities (Hospital, Health Plan, and the Medical Group) who have come together to build a partnership all aimed towards one vision and goal - Providing high-quality affordable care. 

Interestingly enough, the work theme for the past couple weeks for me has been all about collaboration.  Starting with a meeting with our Southern California Complete Care Leaders where we shared ideas for improving care for patients with rare diseases, diabetes, asthma,  etc. The meeting opened with our Southern California Medical Director over Quality and Clinical Analysis and our Foundation Hospital Senior Vice President for Quality and Patient Care Services Patti Harvey who spoke of their appreciation towards this group for coming together to improve outcomes, to improve quality, and improve lives.  The collaboration theme was echoed by our Southern California Permanente Medical Group Business Leader, Judy White, who spoke about replacing the competition that we have with each other across service areas to a culture of collaboration to improve care for all patients.   

Three days later I met with consultants from Community Partners to go over our plans to deploy our Proactive Encounter program in surrounding community clinics throughout Los Angeles area... work sponsored by our Kaiser Permanente Community Benefits grant program. This work aims to improve the quality of care delivered to patients across our communities by teaching clinics quality improvement strategies, implementing standard workflows, and sharing clinical guidelines. When I was approached by our Community Benefits team last year about the idea of sharing and deploying Proactive Office Encounter (POE) across our community clinic partners I didn't need any persuading to get me on board. "Count me in!" was my ecstatic response.

Wednesday we spent almost two hours on a conference call with Northern California KP explaining how we developed and implemented a Proactive Encounter program for our Obstetric patients that provides prompts in our EHR to remind staff to stage orders for providers so based on what each individual patient needs according to gestational age. If depression screening hasn't been completed, labs are missing, or a RH- patient hasn't had Rhogam given by her 28th week a care gap will remind the staff to place the order. Sharing strategies, programming logic, technologies, and thought processes helps us deliver outstanding care to both the mother and child.

My last call today was with a group of physician leaders from our Colorado region who were in the process of rolling their version of Proactive Care out to their specialties and shoring up the work already accomplished in primary care with a Successful Opportunity Report much like what we use in Southern California to monitor the effectiveness of our Proactive Care program by measuring how often patients came in to our health care system with a care gap and whether that gap was closed within 30 days. I shared with them some of our strategies for engaging specialties and how we used the report to identify areas for improvement and celebrate successes. After the call, I had a side conversation with one of their project leads who had more questions of her own. She thanked me for taking the time to talk with her offline. What they don't get is that this is one of my greatest joys... Sharing successful practices to improve the patient care experience. 

I'm grateful every day that I work for an organization that allows open collaboration. Together we save lives... one patient at a time.


"Every day is Collaboration Day when you have friends on Twitter and other social media platforms" KA

When The Stars, The Moon, and Planet Align

Our church has a Visiting Teaching program where the women (or as we call each other "sisters") are assigned another female in our congregation to visit on a monthly basis with the purpose of watching out for them and their family, befriending them, and helping wherever needed. I recently asked our leaders if I could be assigned to visit a specific sister in our ward. She and I often sit next to each other in Sunday school and, even though there is a 10 year age difference, we have similar interests. She is a Kaiser member who also happens to be a diabetic and, like me, struggles with weight issues. In our last visit, after a discussion about how hard it is to get out and exercise after work, we made a pact to walk together instead of sitting and visiting. Using a Dr. Sallis tone, I reminded her that "Walking, even if in small increments, is the single most important thing she(we) can do to improve her(our) health."  She promised to try and walk whenever possible.

Recently, her PCP left KP and she was sent a letter saying she would have to find another. She asked me if I could recommend someone from the Pasadena clinic. I told her I wasn't sure if Dr. David Morris's panel was open or not, but that was who I would choose. Last Sunday she shared with me that she had gone on to KP.Org to use the Find a Physician feature and found that Dr. Morris' panel was indeed open. She selected him and was VERY surprised when his nurse called within 10 minutes to say "Dr. Morris would like to schedule an appointment to meet you and review your medical history." 

Just a few short days later, she went in for her appointment. "The nurse asked me if I was exercising and I was really happy to say that I was walking for a total of 30 minutes a day 5 days a week!" she said with great satisfaction. She told me that the nurse showed her on the computer screen that she needed to have a mammogram and a diabetic foot exam then she helped her book an appointment for a mammogram and asked her to take off her shoes and socks before leaving a "cute little poker thing" on the keyboard for the doctor.  When Dr. Morris came in the room he went over all of her medications with her. She is still on Actos so Dr. Morris explained that we were trying to move patients off of Actos because of the bladder cancer issues. She told him she was aware of the concerns but felt like she had really good control of her numbers and didn't want to come off yet. She commented to me that she appreciated having a conversation about her medications instead of being told what to do. They talked about how she will eventually need to start insulin and she told him she didn't think that she would EVER be able to do that so she was going to do whatever she could to avoid it. He asked her about exercising and she said "I walk because Kristen Andrews made me promise I would try." It surprised me when she said this because I didn't know I was one of the reasons she was walking which reminds me just how important it is that we speak up to our friends, neighbors, colleagues, and family about importance and simplicity of walking whenever and wherever possible. She also asked him if she should get a shingles immunization (something else I may have gently suggested because of her medical history and age). He told her she was just the right age to get the immunization and ordered it for her. She rolled up her sleeve to show me a little red mark. "See... Proof! That sucker hurt!"

After scheduling our next walking visit for the next day we opened up our hymn book to start our Sunday School session. Right before the conductor raised her right arm to lead the music, my dear friend leaned over and whispered "You didn't tell me Dr. Morris was so darn cute! That was a real plus!" What can I say... we aim to please.

Tim Ho has a phrase that he uses to describe a visit where everything goes right. He says it is like the "Stars, moon, and planets line up and the agenda of the patient, the agenda of the physician/staff, and even the agenda of the organization provide an opportunity for change." Dr. Morris and his staff created a moment like this for their patient... my friend. It's these kind of stories that make my heart beam with pride. This is how we make a difference and help improve the lives of each person that comes through our door. Saving lives... together... one person at a time.

Through the Eyes of a Patient

For years my husband and I have been Saturday morning regulars at a little restaurant nestled in the foothills of Monrovia. The term "regulars" takes on a deeper meaning here. It means you are part of a family connected by the owner who knows you by name, where you like to sit, and who you like to sit next to. One of my favorite people to sit next to is a lovely lady named "Doreen".  She is a pistol of a woman who reminds my of my late grandmother. Doreen is seventy-two years old and has wonderful stories to tell about coming from Scotland be an RN in the states, stories she will share with anyone who will listen. If Doreen comes to our table, my husband has learned to just eat his food instead of waiting for the conversation to finish because there is a chance it will be cold before she leaves. 


One Saturday morning Doreen's story was about her new primary care doctor who was younger and didn't seem to like being personal with her patients. She told me how much she missed her old doctor who took an administrative position. Curiosity got the best of me and I asked Doreen where she went for her health care. When she replied, "Kaiser Permanente" my husband and I both smiled. Twenty years ago I would have kept my employers identity a secret because our reputation wasn't that great, but now, I said with pride in my heart "I work for Kaiser." "Really?"... Doreen perked up with excitement. "Oh dear..." she said with her Scottish accent, "I wish I had my old doctor back. I understand she has a wonderful new role now, but I miss her dearly. She took the time to listen to me. My new doctor is very good, but she likes to look at the computer and type, which, I must say... she is very good at typing." Hearing Doreen find the good in every situation garnered another chuckle from me. I asked which one of our facilities she went to and who her doctor was then and is now.  When I told her that her last doctor is a good friend of mine, she bubbled with joy and said, "Isn't she lovely dear! I used to be able to call her with a question and she or someone from her team would call me back.  Will you please tell her I said Hello? I'd love to talk to her sometime. My new doctor said she prefers to communicate through email so I had to have my son show me how to use the computer so I can talk to her. " As she spoke, I couldn't help but make a mental note "what happened to the patients preferred communication?" I listened to my friend describe a couple things she would change if "she was running things." At one point she said, "Oh dear, I'm talking too much. Tell me what you do for Kaiser?" I said, "I run a proactive care program that is meant to improve your care experience." Doreen's eyes got big and she laughed "Now I've gone and got myself in trouble. Don't get me wrong, my doctor is good, she just is too young to want to listen to an old bird like me." I assured her that no one was going to be in trouble and that her insight was valuable to me. From that day on, Doreen has been my secret shopper. Each Saturday amidst the tables of other regulars, we sit for at least 10-20 minutes as she gives me the scoop. "Employees parking in the Emergency parking lot causing patients who need easy access to park in a remote lot. Why did Kaiser move that department to a different location without telling the patients? Do you know that area has just been empty for months? Isn't that a waste of money?" I don't try and provide excuses, I just listen. On Monday's, when I'm back at the office, I go over all of my mental notes and reach out to the administrators who need to know what their patients see, hear, and say. Sometimes I am able to come back to Doreen with answers to her questions and other times I have resolutions to share.


In the spring of 2011, after taking a few weeks off from our regular Saturday routine, my husband and I walked in to the Peach to find Doreen on her way out. Was it just me or were there tears in her eyes? I stopped to hug her and she broke down in my arms. We stayed in that embrace until we could both gather our composure. I didn't know why she was crying, but I cried with her. Then she whispered, "I have breast cancer." My heart sunk. I am estranged from my mother and my grandmother passed away two years ago so Doreen is like my mother and grandmother rolled up in one beautiful being. She told me she had gone to Rhuematology and they reminded her to get her mammogram done. (Thank goodness for Proactive Care) When she did, they found the tumor and biopsies confirmed it had spread to 5 of her lymph nodes. My mind raced with questions about stages, but I knew I needed to let her guide the conversation. She would tell me what she was strong enough to tell. Doreen seemed disheartened as she explained to me that she wasn't sure if she would be able to go through with the treatment because she didn't drive and she wouldn't be able to get to her appointments because the location was too far away. "There must be options. Our social workers should know about resources available" I said. She told me she checked with the Social Worker and her Oncologist and both had no solutions to offer. I asked her if she would mind if I helped her handle this one and she gave me permission to ask around. We spoke for a few more minutes before she left to get some rest, still recovering from her biopsies.


A phone call to one of my doctor friends, who also happens to be the Assistant Medical Director for Quality and Clinical Guidelines for KP SCAL and, more importantly, an Oncologist, and I learned that our Los Angeles Medical Center had apartments nearby where patient's could stay while they were undergoing treatment. Why our Social Worker didn't know about this vital program was something I would fix later, my first priority was helping Doreen. She would spend the week at the apartments and the weekends at home. Her dispair turned to hope. She started her own walking club with other patient's who, as she put it, "Seemed so sad - I knew walking would make them feel better." Even on bad days, she carried her sense of humor with her, teasing the nursing staff and other patient's. On Saturday's, she would confide in me about how she was really feeling and in true Doreen fashion, share with me her ideas for improving the care experience. "Everyone is very good on an individual basis, but it doesn't seem like they talk to each other. It would be nice if there was a case manager who could help guide you through the process. The social worker is good, but this doesn't seem to be her expertise", she would say. "I found out they had support groups offered by Kaiser from another patient." 


On another Saturday morning, Doreen was quiet and not as talkative as normal. I asked her what was wrong and she told me her Oncologist had retired and she had a new young doctor. The medication was really making her feel horrible and she just wasn't sure she wanted to continue with the treatment at age 72. She tried to talk to her new doctor about it, but she just seemed to be in "I can save you from this disease" mode. Doreen wanted to have a real conversation with someone that would help her explore ALL options, including doing nothing. In her sweet Doreen way, she said "I'm sure she is a wonderful doctor, but I wish I had someone who could understand that I am old and tired. I've done some research of my own and there are some studies that say treatment at 72 isn't always the best choice." Once again, I asked for her permission to consult my Oncologist friend, Dr. Schottinger, who also happens to be in her late 50's and perhaps more relatable.  I arranged for the two of them to talk.  Dr. S reviewed her chart and assured Doreen she was in very good hands and agreed with the treatment recommendations, but suggested she talk to her doctor about the extreme fatigue she was experiencing and ask to switch to a different medication. She spent 45 minutes on the phone with Doreen... consulting, reassuring, and listening. Doreen called me afterwards and said she felt like a weight had been lifted and that Dr. S allieviated so many of her concerns. Doreen spoke to her doctor at her next visit and together they made changes to her medications which she didn't cause the fatigue she felt before.


Doreen continues to go through treatment and has good and bad days. She is still walking every day and living life full of hope, but ready to stop the treatment if she feels the quality of her life is diminished in any way. She speaks up. Sometimes to her doctor directly and sometimes through me, but she has a voice nonetheless. Doreen continues to be my secret shopper and I know she loves it as much as I love her for doing it. In fact, she is the perfect kind of secret shopper because she knows how to highlight the good while looking for opportunities for improvement. She always apologizes for "carrying on", but I cherish every moment with her. She has taught me so much about improving care just by reminding me to see things through the eyes of a patient. We all have something we can learn from the Doreen's of the world and it's time for the world to listen.


I am grateful to Doreen for allowing me to share her story so others can learn from her too.