Khalil Bourgoub

Without women, there is no god (or healthcare)

By: Craig Dresang, CEO, YoloCares

Maude LaMontagne-Fellner, an early 20^th century activist with the Women’s Suffrage Movement, became the first licensed female insurance agent in the country.  I wish I could have known her because she was also my great grandmother.

Not long after she received a license to sell insurance, her home state of Wisconsin led the country in ratifying the Nineteenth Amendment, granting women the right to vote.

The circle of women on my mom’s side of the family were widely known for their quick wit, silver tongue, and their ability to get stuff done.  They were intelligent, clever, and had minds that could access and process information rapidly . . .   characteristics that made them charming, wise, and often hilarious.

They were also a persuasive bunch.  Family members often joked that any one of them could sell water to a drowning man or a lighter to the devil.  I remember one conversation around our dining room table when my mom, her sisters, and their mom (who were all raised Catholic) were debating the legitimacy and value of religion.   During a brief pause in the conversation, my mom leaned in toward the center of the table, took a long, long drag off of her L&M cigarette and with a slow sip of wine said, “Just remember, it was a woman who gave birth to God. If it wasn’t for women, the son of God wouldn’t exist.”

Everyone laughed, but I never knew if the comment was said in jest or if there was something more behind her words.  I so often wish she was here so that I could ask her.

From my earliest days, I witnessed how much more balanced, thoughtful, and interesting life could be by having women at the center of it.  Decades of studies have now shown that women leaders help increase productivity, enhance collaboration, inspire organizational dedication, and improve fairness.  When more women are empowered to lead, everyone benefits.  Nowhere has this been more true than in healthcare.

It was a woman by the name of Dame Cicely Saunders who founded the modern hospice movement in the mid-1900s.  At the start of her career, she cared for terminally ill patients in England.  It was there that she came to believe patients who were near the end of their lives needed a different type of health care.  As a result, she dedicated her life to becoming a nurse, social worker and then a physician so that she could design a model of care that was patient-centered instead of illness- or disease-centered.  That meant reimagining traditional healthcare and creating an approach that was respectful of and responsive to the individual’s preferences, needs, and values.

In 1963, Saunders gave a guest lecture at Yale University, discussing specialized care for the dying. Not long after, hospice care slowly began taking root in the United States.  Then, another woman by the name of Dr. Elisabeth Kubler-Ross released her book titled “On Death and Dying” in 1969.  It became a bestseller and made Kubler-Ross an internationally renowned author. Her work highlighted the “five psychological stages of dying” and Saunders’ new revolutionary way of dealing with dying patients. This work caught the interest of a young Madalon Amenta who is now a resident of University Retirement Community in Davis and member of the YoloCares Board of Directors.

Amenta’s life — past, present and future — represents purpose, accomplishment and an eagerness to shape the world around her. Not everyone can at once stake a claim as poet, nurse, researcher, author, lobbyist, mother, academician, national leader, pioneering entrepreneur and YoloCares board member. But Amenta, a lover of life, is all of these things and more.

Not too many decades ago, quality standards for hospice care did not exist. Clinicians had no national standards and no official guidelines to follow. Frustrated by this reality, Virginia Shubert who was a nurse and executive of Yolo Hospice, along with three other California women/nurses, locked arms to work on what would become the country’s first set of quality assurance manuals.

When they were finished cobbling together guides that could be used by hospice nurses everywhere, they handed their work over to Amenta, the first president of the Hospice & Palliative Care Nurses Association, which certifies nurses in the field.  Amenta took the work of these four nurses and spread it out on her dining room table where she spent the next six weeks pulling together “Quality Assurance for Hospice Patient Care.” First published in 1988, the manual served as the go-to standard for hospice nurses. Each page represented a framework that is still used by hospice professionals today.

Chuckling, Amenta says, “We sold it for $25 a copy. As an organization, we had no money in the early days. Our only source of income came from charging $35 for membership fees and there were fewer than 100 members.”  Now, nearly 12,000 members belong to the association.

“From my first nursing student days I felt that the American health-care system, for all its wonders of technology, failed patients as people,” according to Amenta. “It didn’t deal with the meaning of illness or the consequences of treatment. It needed to be reformed.  Caring as well as curing needed to become institutionalized.”

Her earliest inclinations were artistic. In her youth, she fancied herself an actor, poet and writer. However, “My forays into those fields never even began to pay the bills, so I decided to become a nurse,” she says.  Years later, out of a deep engagement of working on the book, “Nursing Care for the Terminally Ill,” she concluded that the essence of hospice care is found in a spiritual dimension, the source of love and caring.

“According to St. John, ‘work is love,’ and according to Khalil Gibran, ‘work is love made visible,’ and according to me, hospice work is love made operational,” Amenta says.  As an early American voice in the hospice movement, Amenta served as a founder of both the national Hospice & Palliative Nurses Association and the Pennsylvania Hospice Network. She also was the director of education and research at Forbes Hospice, and later co-authored “Nursing Care of the Terminally Ill,” the first American textbook on hospice care.

Today, women health care workers are the backbone and heartbeat of strong health systems. Women represent 75 percent of the workforce in hospitals and 77 percent of total employment in health services, but only 25 percent of leadership roles in healthcare.

By contrast, YoloCares has a five-decade history of supporting women at the most senior levels of leadership.  Six, out of nine, members of the YoloCares senior leadership team, including the chief financial officer (CFO), are women.  Ten out of 12 members of the board of directors are also women.  During Women’s History Month, YoloCares celebrates the contributions women have made in the lives of those who are suffering or in need.  The agency also reaffirms its commitment to advancing rights and opportunities for women who have courageously fought for equality, justice, and opportunity.  It is the organization’s hope that the trailblazer spirit that has guided the course of American history will continue to shape its future.

Leading MD and star poet to headline at Care Summit

By Gia Martucci, Marketing and Communication Specialist

Mark Doty, recognized as one of the most accomplished poets in America – and frequently compared to James Merrill and Walt Whitman — will be one of two keynote speakers at the next national Quintessential Care Summit hosted by YoloCares, Sacramento State University Department of Gerontology, and the California Hospice Network on March 15, 2024. 

The Quintessential Care Summit, the region’s premier hospice and palliative care conference, attracts community members, healthcare professionals seeking continuing education credits, caregivers, and clinicians from nearly every discipline.  Last year’s event featured internationally celebrated clinicians Dr. BJ Miller and Teepa Snow, drawing 350 participants to Sacramento State University’s campus.  “The summit offers something for everyone,” according to Louise Joyce, director of community programs at YoloCares.  “Professionals, students, and the community-at-large have all felt that attending the summit is time well spent.  Everyone will walk away with something valuable.”

Mark Doty, who will be traveling from New York, is a noted memoirist praised by the New York Times for his “dazzling, tactile grasp of the world.”  He offers a compelling perspective on how ordinary human experiences can be interpreted.   Known as a maker of big, risky, fearless poems in which ordinary human experience becomes music, he has received two National Endowment for the Arts fellowships, a Guggenheim Fellowship, Rockefeller Fellowship, a Whiting Writers Award, a Lila Wallace/Readers Digest Award, and the National Book Award.  In 2011, he was elected a Chancellor of the Academy of American Poets.  Mary Oliver, another American poet, says, “One of the things that has been constant about Mark Doty’s work, poetry and prose, is his intense search for the exact word or phrase, of whatever issue, which lead him (and us) into the very furnace of meaning within the human story.”

The author of nine books of poetry and four memoirs, Doty’s first memoir, Heaven’s Coast, brings to life the impotence and rage with which we greet death at what should be life’s richest and most vital moment.  The book chronicles the journey of losing his partner to AIDS, and lays bare the love, hardship, and innumerable gifts that can come from loss and letting go.  He is currently a distinguished professor at Rutgers University, and also teaches in NYU’s low-residency MFA program in Paris.

The Quintessential Care Summit’s other keynote speaker, Cameron Muir, MD, is a nationally recognized leader in hospice and palliative medicine and advanced illness care. Arriving to Sacramento from Washington DC, Muir serves as the chief innovation officer at Capital Caring Health as well as chief innovation officer for the National Partnership for Healthcare & Hospice Innovation (NPHI).  YoloCares is one of just two Sacramento-area hospice organizations to be accepted into NPHI’s membership.

At Capital Caring Health, Muir led the medical staff from 2002 – 2018 which provided over 260,000 hospice and palliative care visits. Additionally, his work on research and program outcomes has resulted in the publication of over a dozen peer-reviewed articles that define innovations and best practices in advanced illness care. With NPHI, Muir serves as the director of the Innovation Lab, as well as chair of the National COVID-19 Task Force.

As the founding program director of Capital Caring Health’s Accreditation Council for Graduate Medical Education (ACGME), he has trained more than 30 physicians in hospice and palliative medicine. This program has evolved into lasting partnerships with similar fellowship programs at George Washington University and MedStar Health.

In multiple leadership roles, Muir is both a fellow and the past-president of the American Academy of Hospice and Palliative Medicine (AAHPM) and served on the AAHPM board of directors. In addition, he has been a consultant to the National Comprehensive Cancer Network (NCCN) and for two decades has served on the faculty of the Education for Physicians in End-of-Life Care Project (EPEC).

Current academic appointments include associate professor of medicine at University of Virginia School of Medicine, clinical associate professor of Medicine at George Washington University School of Medicine, and clinical assistant professor of oncology at Johns Hopkins University.

Several other care professionals will join Muir and Doty as Quintessential Care speakers including music-thanatologist Margaret Pasquesi, California Correctional Healthcare Services Hospice Medical Director Michele DiTomas, and Frish Brandt who serves as president of the Frankel Gallery in San Francisco.

Pasquesi was founder of the music thanatology program at Journeycare in Chicago. In this subspecialty of palliative care, practitioners use harps to ease a patient’s symptoms during their final hours, countering normal feelings of fear and anxiety that come with dying. Pasquesi says, “We use music to address the physical manifestations of the dying process.  Our main job is to accompany someone through the final stages of life, and we tailor the music to what is going on physically for the patient.”  Her work has been featured in Crain’s Chicago Business, the Chicago Tribune, National Public Radio, NBC and WGN.  As an accomplished vocalist, she serves within the Archdiocese of Chicago as a liturgical cantor.

DiTomas, MD, MS has worked for the California Correctional Healthcare Services since 2007 and is board-certified in both family medicine, hospice and palliative medicine. She is currently the statewide Chief Medical Executive over the Palliative Care Initiative which strives to provide high quality care to those with serious, life-limiting illness. As Hospice Medical Director she works with the hospice team at the California Medical Facility to create an environment where patients can live their final days with dignity, respect and comfort despite their incarceration.

Frish developed a practice of letter writing for others, which she does as a volunteer through various hospice-related organizations. She calls herself a “Letter Midwife” as she helps others nearing the end of their lives to express themselves. She is associated with Stanford Hospital and By the Bay Health.

The summit will also feature notable dementia care educator and advocate, Laura Wayman. Known as the Dementia Whisperer, Wayman wants to help improve the quality of life for those diagnosed with a cognitive impairment and help caregivers and families improve relationships and daily interactions with their loved ones living with brain change.

Rounding out the offerings, the summit will feature presentations from quality and compliance expert Carrie Cooley of Weatherbee Resources, Coalition for Compassionate Care of California CEO Jennifer Moore-Ballentine, and California Hospice and Palliative Care Association (CHAPCA) CEO Sheila Clark.

With four distinct learning tracks for caregivers, clinicians and administrators, The Quintessential Care Summit will be an engaging and exciting experience for healthcare professionals, students, and caregivers. Tickets are available at https://www.eventbrite.com/e/quintessential-care-summit-tickets-718125782547.

Your most important holiday dish

By Craig Dresang

Passing a platter of roast turkey or a bowl of buttery mashed potatoes during a holiday dinner frequently includes the traditional passing of family tales as well. In fact, food can be the least important part of a special meal. Holidays, like Thanksgiving, are a sacred time for friends and family members from different generations to come together and share histories, relive common experiences, learn about and from each other, and connect.

In our family, whenever table talk veered into potentially controversial territory like politics or the 15-year-old cousin who got his girlfriend pregnant, my mom had a strategy for shifting the conversation to something less dangerous and more entertaining. One year, she handed out old photographs of relatives . . . some still living and others who were long gone. She then requested that each dinner guest tell a story about the person in the photograph they were holding.

My grandmother, holding a yellowed and tattered black and white photograph of someone that only she recognized, said, “Oh my! It’s my Great Uncle Charles.” Charles was born in 1831. Just after his 99th birthday in 1930, relatives gathered together for Thanksgiving at the family farmstead outside of Iron River, a tiny village in the northwoods of Wisconsin just 15 miles south of Lake Superior’s icy shoreline. In Charles’s time, Iron River was a rugged and rowdy boom town that was fueled by the sheer frontier energy of those who came to work in the region’s iron mines and lumber industry. Charles’s nephew worked for a relatively new company called Kellogg’s in Battle Creek, Michigan, and at the time, he was sending his Wisconsin relatives a new product called Corn Flakes. These flakes of corn were originally developed for patients at the Battle Creek Sanitarium, however, they quickly became popular with those who worked both in and outside the walls of that facility.

As a result, my grandmother’s mom felt fortunate to have received a new and interesting ingredient to test out in their kitchen. One of those dishes, being served at Thanksgiving dinner in 1930, included carrots, butter, shredded cheese and corn flakes. It was the first time Charles tasted this new carrot recipe and so with a mouthful of crunchy cheesy goodness he declared, “These carrots are to die for.” Two hours later he was still munching on leftover carrots while playing cards in a smoke-filled parlor with the other men. Outside, the wind was howling, and snow was accumulating rapidly. Holding his cards in one hand and a carrot in the other, he suddenly leaned forward and then dropped his head to the table. The other men thought he was joking around. My grandmother who was eighteen years old, recalls her father saying, “Come on Charles. Your hand can’t be that bad.” But to everyone’s surprise, he had died.

His death was complicated by the fact that there was a blizzard outside and every road out of town was impassable. The closest hospital or funeral home was an hour away during good weather. It was not feasible for the family to reach help on the eve of Thanksgiving in the middle of a northwoods blizzard. One of the cousins was a nurse so she checked his breathing and heartbeat, but felt nothing. His pupils were fixed and his eyelids were half open. Despite all attempts to shake him to life, he was indeed lifeless.
Not knowing what to do, the family nurse suggested they prop up Charles in a snowbank outside until the weather broke and help could arrive. So, my Great, Great, Great Uncle Charles spent his last Thanksgiving night in a snowbank after unintentionally naming the latest family recipe, “Carrots to Die For.” For nearly every Thanksgiving since, some relative has made this recipe with a side of family lore.
For families who are caring for, or recently lost, a loved one, food stories can be a powerful way to help an individual connect with their identity and sense of self. This is especially true for someone who is in their last days of life. Being able to engage with their own memories and convey who they are or what is important to them can foster communication, engagement, and sense of meaning. Sometimes stories can also deliver much needed levity or humor into the life of someone who is struggling.

In hospice, encouraging patients to share their stories is often highly therapeutic. The stories also become a treasured gift that they can pass on to the rest of the family. Holiday meals can serve as a conduit to feed a family the most important dishes of all: connection, meaning, history, and a dash of laughter during your own personal snowstorm.

It is in this spirit that I share a tiny bit of our family history and deliciousness: Carrots to Die For.

Carrots to Die For Recipe
Approximately 8 servings

Ingredients

• 1/2 cup crushed cornflakes
• 4 tablespoons softened butter
• 1/3 cup chopped onion
• 3-4 tablespoons flour
• 1/4 teaspoon salt
• 1/4 teaspoon pepper
• 1 1/2 cups milk
• 1 cup of shredded Swiss cheese
• 4 1/2 cups cooked, sliced carrots (drained)
• 2 tablespoons fresh chopped parsley or 1 tablespoon parsley flakes

Combine cornflake crumbs and 1 tablespoon butter. Set aside. To three tablespoons of butter, add onion and sauté over low heat. Add flour, salt and pepper.Stir in milk. Increase heat to medium; cook until bubbly and thickened, stirring constantly. Add cheese and stir until smooth. Stir in carrots and parsley. Spread in shallow 1 1/2 quart baking dish. Sprinkle top with crumb mixture. Bake at 350 degrees for about 20 minutes or until bubbly and crumbs are golden brown.