One more heavy post about my Grandma Pauline. I wrote this while at my conference a few weeks ago and never published it.
My shiva candle burned for a week. It's my third shiva candle (this is my last of my three maternal grandparents) and I have learned how symbolic the candle is representing the time we need to mourn and reflect. Hoping to watch the candle burn to the end (or at least be there for the flicker to go out), so I can go on to the next phase of mourning, but instead, in this case, reminded me of sitting on grandma's bedside wondering if it would be with her, her last breath. Would I be present for the last flicker to burnout?
Just, like I had to leave hospice to go back to my kids, I had to leave the candle a night early to get to a conference required by Florida to keep our license. We had signed up for it months before knowing we had to be there. Or else. For me it was hard to leave my personal shiva space that I created in my bedroom and go on while the candle continued to burn.
The previous times, I burned a shiva candle, I felt a sense of responsibility of being present to respect the shiva space and for the memory of my grandparents' soul. It was frustrating for me not to be able to be present for Grandma Pauline's candle to go out.
What made me decide to come back to this post tonight is what Scott said to me.
He said in my absence, he was watching the candle burn. He "told" the candle that he promises to tell his children and grandchildren about Grandma Pauline. Then the candle went out and was done burning. He said it was like grandma was telling him that she understood.
With some rituals we wonder why we do it. We just do it. In the end, we find meaning. Sometimes you never find the meaning, but the symbolism and meaning was clearly there this time. If I couldn't be there, I am glad Scott was. It gave me a feeling of resolution. I can only imagine how Blessed Scott is.
Tuesday, December 28, 2010
One more heavy post about my Grandma Pauline. I wrote this while at my conference a few weeks ago and never published it.
Posted by Denise Punger MD IBCLC at 11:30 PM
Wednesday, December 22, 2010
Scott interviewed me for his fitness class today. Lucky for my readers, You get a blog post today! He has a chance to turn in an interesting assignment!
Job: Family Physician
Date and time of interview: December 23, 2010
What are some major health concerns that you have? Poor nutrition and tobacco abuse.
Are there ways that you know you can prevent these health concerns (or other concerns like obesity)? Obesity can be prevented by avoiding processed food. Babies should be breastfed, avoiding formula ,as much as possible. After weaning and for the rest of your life food should include fresh greens, sprouts, and a wide range and variety of seasonal plant-based food. Animal products including meat, fish, poultry, and dairy should be less than 5 % of the diet. No fast food and no soda, Ever.
If you need to find out more about a specific health issue, what do you do? Please be specific. (Don’t let them say “look on the internet”, because we have already learned that not everything on the Internet is reliable! They should tell you a specific site if they use the Internet as a source.) I listen to my patients to know what the issues are. My favorite nutrition site is greensmoothiegirl.com. I like radicalhealth.com. I like asking Dr. Google and Dr. Youtube too!
What do you think is the biggest health concern facing our country is? The tobacco/ food/meat/dairy/formula lobbyist give money to our government keeping their profitable products in consumers faces. Americans believe the government have their best interests in mind.
What are some things that you do to help monitor your health? Annually check cholesterol, intracellular vitamin levels, food sensitivities, check weight and blood pressure. Monitor and record fitness progress.
How do you monitor your food and water intake now? I drink at least 4 cups of green smoothie daily and two handfuls of green leafy vegetables a day. I add some kind of sprouts and superfood to my daily nutrition. We grow our own greens. I eat something from our own garden daily.
How would you help get the word out about this lifestyle change? I have a preventive medicine family practice. I blog.
How do you think the media influences what concerns we have for our health? The media has a negative influence on what people think they should eat and where to shop. Farmers and grass roots businesses can't compete with the millions of dollars spent trying to fool Americans. Everyone needs to take their own responsibility.
9. How do you stay fit?
I go to the gym and lift weights when the boys are in karate. I am active with the boys kayaking, walking, yard work, and cycling.
10. Why did you start trying to be healthy? I was tired of being fat. I didn't like how processed food tasted anymore. I wanted my kids to be healthier.
Monday, December 20, 2010
Saturday, December 18, 2010
The First Winner of My Give Away is Andrea Santoro. This is the Permission to Mother book review she posted on amazon. She won a copy of my book.
"I found out about this book after being referred to Dr Punger when my newborn was losing a significant amount of weight. It was evident that I was having supply issues. Lost and without other support, I went to see Dr Punger and she assured me that we could work this out and that I didn't have to throw in the towel. Through Dr Punger's guidance, I was able to double my supply and am still breastfeeding my daughter who just turned 6 months old yesterday!
One of the biggest issues I dealt with was the guilt of not being able to provide all that my daughter needed. I felt that I was neglecting her. After reading Permission to Mother, I realized that I am doing the best that I can and I can bond with her not only by breastfeeding, but in other ways like co-sleeping and co-bathing. I have really enjoyed the special closeness I have with her now that I have given myself permission to mother in the way that feels so right for me/us.
I wish I would've read this book while pregnant because I didn't have the labor I had hoped for. I would've liked to be more in control and have experienced it but instead, I let doctors manipulate me into their convenience and while I am so blessed to have my daughter, I do feel cheated. I'm hoping to have the birthing of my dreams when I have my next child and I know it is possible and I have been encouraged by the experiences in this book.
Thank you Dr Punger!
Get this book if you want to be encouraged to parent the way that you feel works best for your family. You don't have to follow what society says is normal, or what your best friend or even your own parents did. Give yourself permission to mother and be the best mother to your precious baby."
I appreciate this review and the insight and update it provided me about Andrea's situation.
Their was no entries for the second book I had to give away. I may do this again in just a few weeks when we are not all so busy with the holidays. I appreciate any feedback you'd like to give me.
Posted by Denise Punger MD IBCLC at 11:00 PM
This Certificate Officially Declares That William and Scott Coquelet has Successfully completed all requirements in accordance with the curriculum of the United States Karate Federation and has been tested in all aspects of the Martial Arts systems of Shorinj-Kempo and Mas Oyama's Kyo Kushin Kai-Kan attaining the rank of Sho Don 1st Degree Black Belt on Dec 17th 2010.
The Grand Master is 10th degree Hanshi Robert Fabrey. Also shown are 5th degrees Shihon Joe and Shihon Rich.
Thursday, December 16, 2010
For convenience my office stocks these popular items in our little store.
The best sellers are:
1. Permission to Mother, autographed by Denise Punger
2. Motherlove Products to support milk supply and breast pain
3. Chocolate Bliss and other whole food, raw supplements to support
weight loss and blood sugar,
(No artificial ingredients, fillers, dyes)
4. My Breastfriend Nursing Pillow
5. Mustela skin care and sunscreen for babies (and adults with sensitive skin)
6. Medela Double Electric Pumps, tubing, flanges, etc...
7. Cloth Diapers and covers: Bumkin, Bummies, cotton, bamboo, All-in-one, fitted, traditional rectangle
9. MD Forte Replenish Hydrating Cream (staff favorite)
10. Lact-aid and SNS for low milk supply
11. We have a few beautiful Peonies non-padded ring slings
Medela Lactina Breast Pump Rentals and Supplies
These are all products that I would use for myself or family.
Posted by Denise Punger MD IBCLC at 8:18 PM
Tuesday, December 14, 2010
I am going to have a give-away for my readers of my book Permission to Mother. I am going to give away 2 books.
I am giving the first copy to the first new positive review added to my amazon page. I positive review would be 5 stars and share how my book helped you or inspired you.
I am going to give a 2nd copy of my book to a randomly selected person amongst the additional positive reviews added. If you already put a review leave me a comment that you would like to be entered.
Please leave a comment on my blog after you have done this. I will randomly select the 2nd winner after 12 noon on Saturday. Amazon reviews don't always show up right away. I may not be able to announce the winner exactly at 12 noon. Please be patient. Thanks. Good Luck!
Posted by Denise Punger MD IBCLC at 9:45 PM
Sunday, December 5, 2010
This is heavy stuff...
If there was anything about Judaism that ever left the most impression on me was Jewish Death Rituals. Obviously, the death rituals are for the family(survivors) to follow through on. But I do feel like, how we respect the deceased spirits and remains are are of significant spiritual value for survivors and respectful to the parted on getting them to World After.
First all, Grandma bought her plot near her brothers about 20 years ago. Back then I thought what a morbid kind of thing to do. But now:
1. I am glad she made her wishes known (whether by accident or peer pressure or she got a good deal). And now we the survivors didn't have to decide or fight about it.
2. Her plot was $1800 back than rather than $18,000 it would have cost now (or was it 180 and now 1800?).
3. She is in a Jewish cemetery. Her good deal ( I am pretty sure it was a good deal, or a 2 for 1 deal, or she wouldn't have done it.) worked out in her favor so she had a respectful Jewish burial. She is also near her brothers.
4. She was buried quickly, within 40 hours, as it should be. No embalming (don't speed or slow down the process of dust to dust). No make-up and fixings. No public viewing. I agree with Jewish explanation that that a viewing does not help the mourning process in anyway. Not for me anyway. But we all do have different needs.
5. My boys and I arrived to the cemetery right on time. The cemetery brought her all pine, all wood, casket out. Before you could blink, they were lowering it into the 6 foot hole. In Observant Judaism the family is responsible for the actual burial. Never in my life had I given it much thought, but my boys all took the shovels and put the dirt back on over Grandma's casket. Talk about reality check. Acceptance. Physically doing the work ourselves until we were tired. When we couldn't do it any more, we read, Lord is my Sheppard, Mourner's Kaddish, my sisters Eulogy, and a few other short blurbs from the The Comfort Book provided to us. We read what worked for us and had meaning for us. Each of my boys read something. We watched until the last piece of sod was in place like there was no hole just an hour before by the team of workers. I recall being at graveside once for this (but don't ask me who, don't remember, I was a kid along for the ride). I also recall being graveside for a non-Jewish burial and after the memorial, the mourners go elsewhere, to eat and console, and the "dirty" work is done the the burial team. I am glad my Grandmother left this last opportunity to my boys.
I am so glad it worked out that I could be there to represent the family especially because it was important to me. Sometimes you do something that feels right and you don't know why it's right, it just is and you get the blessings later and insight later on. Family is far and spread out. Each one of us had our own roles in the arrangements, prayers, Grandma's life or some how getting her to her resting place, or helping getting each other through this.
Modern culture forces us to go on with life. Before the burial is the time of preparation, after the burial is a Shiva period for a week. Shiva is more strict for household immediate family. I feel like Grandma is immediate family, although, some Rabbi's might tell me I am not obligated. It's her health (lack of mobility and poor hearing) that separated us in later years. Although I am not Observant, I do think it's appropriate to follow my heart. And if I don't want to go to a party or parade this week, I don't belong there. It's not like I am crying, "Grandma, why'd you leave, I don't understand, Come back." I totally accept that she lived a peaceful life til 95. Like the hospice nurse said, her last breath was between her and her creator. But there is a lot for me to process for myself, for my boys, for my family who I am not immediate with and listening to them. Giving them some space to process. Mourning does not mean just begging the dead to come back and crying. It is so much more complicated than that. It is so appropriate to reflect on your memories. Reflect on your life and your own goals. I am totally enjoying hearing what other people have to say about her. I want this Shiva time.
A Shiva candle is symbolic of this time I want to allow myself. (Catholics use a similar candle.) Ideally I wouldn't work, go out to party, show vanity. And heck, I don't really want to. Right now. (I do have to work a little.) I totally get where Jewish mourning rituals come from because it feels right to me. It doesn't end after a week, but that's all I want to deal with right now.
Two "angels" came to visit her in the hospital. I had no idea she had friends at skilled nursing. Two ladies who visited their Dad truly missed my Grandma and left the hospital in tears seeing my Grandma. They told me since their Dad couldn't talk my Grandma would give them updates. And she made them laugh. This is so nice to know.
My family wants to have a memorial at a later date for all the out of town relatives. Without asking for it or us knowing anything about it, her skilled nursing facility is planning a memorial for her on Tuesday. I am so impressed they would do this. I am moved that she is being honored this way. I know she was taken good care of.
So Grandma, You can rest peacefully knowing your "deal" way back did not burden us and your immediate memorial was "included." I know that would make you happy. Many people may not understand why the ritual details are important to me, you may not even understand. We all have different needs, and for different reasons, we both have peace with the final arrangements.
Posted by Denise Punger MD IBCLC at 8:59 AM
Friday, December 3, 2010
My Grandmother Pauline took her last breath today.
She lived in Orlando. She is 95. We share the same birthday and she is 50 years older than me. Each birthday I made it a point to go celebrate her birthday with her.
Living 2 hours away and a crazy-hectic schedule, I have often wondered how in the world I would get up there when the time came and if I would even make it.
Wednesday evening she seemed fine to her friends at her dinner table in skilled nursing. Thursday (my first of four days in a row) morning, the nurses called my mother and I, and said she was having trouble breathing and could they transfer her to the ER. The ER doctor called my mother 3 times as we were preparing our Thanksgiving dinner. By the time we sat down to eat, we already knew we would be packing and driving to Orlando. The good food was not really enjoyed and the abundant left-overs was packed straight into coolers. I got a pair of jeans and a few shirts together (and Scott and Max) and we drove. (I left William and David behind.I never leave them overnight, let alone 3 nights.) By the time we got there, Grandma seemed to be better than expected. She seemed to make improvements since the morning. Whew. She was social and enjoyable to converse with. In the morning she still looked good. BUT, doctor started talking PEG tube (feeding her through a permanent line to her stomach) because she was aspirating her stomach contents into her lungs and that is what gave her pneumonia. Doctor said that would keep on happening. This was really emotional seeing her stable, but seeing no potential and each hour bringing different news.
My mom and I researched our options. Hospice care. We knew the PEG wasn't going to happen. She was already confined to a wheel chair for two years since a hip fracture. She had a subtle case of congestive heart failure and probably some renal insufficiency. I couldn't see making her go through heroic and futile tests and procedures. We made some calls and appointments. Ironically by the time we had a plan, Grandma seemed to decline again in just hours. (This was Friday afternoon).
Saturday we took advantage of a coherent period. We put her on the phone with my sister and cousins. She said, I love you Carrie. I love you Jason. I love you Geoff. She named each. I was touched. She mumbled a lot about bingo and cards. She loved bingo and cards, too! She recognized us in the room.
I asked her if she remembered the time she took me on the bus to the beach. Remember the bus driver looked at me and exclaimed. "An Angel! An Angel!" I was only like 21, yeah, I looked good, the only young person the bus driver probably ever saw on public transport in S. Florida (haha), but my Grandmother never forgot his excitement and repeated that story to me many times with a smile. And she smiled this time, too, when I reminded her. She loved to show me off like a proud puppy owner and this bus driver justified her bragging right. When I became a doctor (my grandparents dream), she would take me around and tell her friends, can you believe she is a "doctah" in her strong Brooklyn accent. So embarrassing.
During this coherent period on Saturday morning she talked to us more, but I could see her slipping away and agitated. Sunday was long as we waited for a Hospice bed. I was eager to see her transferred OUT of the hospital and comforted in hospice. Finally she was in hospice at 4:30. She was bathed and we could visit her some more. I didn't think she would talk to me. I thought she was to far away by now and too medicated. But she had one more alert period.
I told her that the time had come for me to go back home. It was so hard to leave. She squeezed my hand and said, "Stay more."
My Mom, and Scott were all sobbing and emotional.
I told her it was to hard for me to leave her and she might have to leave me first.
I told her it was ok to close her eyes and rest and go. You see she was still breathing hard. Although she said she wasn't in pain, I felt pain.
The hospice nurse gave her medicine to relax her and told us they usually sleep a lot after the hospital because they are drained from all the noise and disturbance. It was good to see her respirations relax and facial muscles relax. It was good for me to see the poking and prodding ceased. When I peaked into the hospice rooms of other residents they all looked peaceful. In the hospital did you ever notice that geriatrics sleep with their mouths open, arms restrained, struggling and often unintended, almost ignored (by hospital staff). Grandma was relaxed now. I feel like at some point then her spirit left us, but the heart would take some time to slow. Like when I toss the ball, I must let go, yet it takes some time for the ball to come to a complete stop.
That was Sunday night. And her heart beat until Wednesday as she slumbered comfortable until her time. My mother and the nurses say she didn't stir. Gasped for the last breath.
I do feel like I was there for her need or was it my need? That doesn't make it easy, though.
Grandma was there for me as a little girl when she was able. My sister already did a great job telling that story here. I too eagerly waited for her to get off the train for her weekend stays on Long Island. I loved waking her up long before she was ready. I loved hearing of her travels to Mexico with her sister, Greece and cross country with her husband. She inspired me to travel. When old enough she toured us through New York City. Later she moved to South Florida. She brought me on several day cruises and the infamous bus ride. When she couldn't live independently anymore she was moved to Orlando by my mother. Most of the 13 years she lived in Orlando, I lived with in driving distance and could pop in for short visits as she tolerated. For the first few years she was mobile and we could bring her to mom's house or out to eat. In the past two years it was short visits as she couldn't tolerate her routine being interfered with. She loved seeing me and the boys. Almost every time she saw me she reminded me I was an angel like the bus driver proved to her. She also always told me I was still adorable like I was still her baby, her first grandchild.
She is my last Grandma to go. She will be remembered and miss.
October 8, 1915- December 1, 2010
Rest in peace....
Posted by Denise Punger MD IBCLC at 7:17 PM