Jennifer O’Brien: “Mind the happiness spectrum”

Mind the happiness spectrum: Happiness ranges from contentment and peace to elation and exuberance. In turbulent times, shift your focus to the peace and contentment end of the happiness spectrum rather than looking for elation. Happiness is ephemeral and elusive. Recognize and savor the moments of contentment. They are to be relished as much, perhaps […]

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Mind the happiness spectrum: Happiness ranges from contentment and peace to elation and exuberance. In turbulent times, shift your focus to the peace and contentment end of the happiness spectrum rather than looking for elation. Happiness is ephemeral and elusive. Recognize and savor the moments of contentment. They are to be relished as much, perhaps more than the glee. For me, this was never more true than when I was caring for my late husband. There were countless moments of tenderness and intimacy as we prepared for his death and my survivorship. The memories of them continue to bring me contentment and peace.

It sometimes feels like it is so hard to avoid feeling down or depressed these days. Between the sad news coming from world headlines, the impact of the ongoing raging pandemic, and the constant negative messages popping up on social and traditional media, it sometimes feels like the entire world is pulling you down. What do you do to feel happiness and joy during these troubled and turbulent times? In this interview series called “Finding Happiness and Joy During Turbulent Times” we are talking to experts, authors, and mental health professionals who share lessons from their research or experience about “How To Find Happiness and Joy During Troubled & Turbulent Times”.

As a part of this series, I had the pleasure of interviewing Jennifer O’Brien

Jennifer A. O’Brien, MSOD, has been in healthcare leadership and consulting for 34 years. The personal art journal she created, as a method of selfcare during her late husband’s illness and just after his death, was published as The Hospice Doctor’s Widow: A Journal in February 2020 and has won a Nautilus silver award in the Death & Dying/Grief & Loss category, a Next Gen Indie Book gold for Relationships, an Independent Publishers (IPPY) bronze for Gift and an International Impact gold for the interior design of the book.

Thank you so much for joining us in this interview series! Before we dive into the main focus of our interview, our readers would love to “get to know you” a bit better. Can you tell us a bit about your childhood backstory?

Thank you for having me. Perhaps the most significant aspect of my backstory for this interview is that my only sibling, David, died when he was 13 and I was 18. This is important because we are shaped as much by those we have loved and lost as those who are still with us. Moreover, because of this loss, I have 38 years of experience finding joy during some of the most difficult and turbulent times.

What or who inspired you to pursue your career? We’d love to hear the story.

While not an inspiration per se, losing my brother three weeks into my freshman year certainly shaped my life. I did not fight for my right to party like most college students. I studied and had a just handful of close friends. Immediately after college, I went to work with a boutique consulting firm that specialized in practice management education and consulting for physicians. I taught my first educational program when I was 22. Working with physicians, mostly surgeons, meant being held to extremely high-performance standards and expectations from a young age. I am inspired by physicians because they combine high level intellect with simply helping people every day.

None of us can achieve success without some help along the way. Was there a particular person who you feel gave you the most help or encouragement to be who you are today? Can you share a story about that?

Definitely, (she says with a smile) my late husband, Bob Lehmberg, MD. Bob was the consummate physician. For 30+ years he did comprehensive plastic and reconstructive surgery ranging from trauma, and hand surgery to body contouring and breast augmentation. When he was unable to operate anymore because of a neck injury, instead of retiring, he retrained and board certified in palliative care and hospice. He and I met about two years into his second career. By then, having lost my brother, my mother, and several other members of my extended family, I knew how important palliative care and hospice were to patients and their families. What I knew personally, he knew professionally. Besides, he was smart, cute, and had a wonderful sense of humor. We fell in love almost instantly.

We had a beautiful life together. Bob was on faculty at our university medical center and I continued to help physicians understand the business and leadership side of their organizations. One day Bob found two small lumps on the left side of his neck, which were diagnosed as a stage IV, metastatic cancer. And so, we were faced with turning all of his professional expertise and my personal experience with family caregiving and end-of-life preparation on ourselves.

He lived for 22 months following his diagnosis. Being my beloved Bob’s only family caregiver while he was ill and then actively dying, was some of the most turbulent and troubled time imaginable. And while I cannot say we found “happiness” per se, we experienced joy, peace, love, courage, patience and intimacy of a depth and type I did not know possible as we leaned into the love and care and made preparations for his death and my survivorship.

Can you share the funniest or most interesting mistake that occurred to you in the course of your career? What lesson or take away did you learn from that?

Years ago, having found the perfect pair of work pumps, I bought them in black and in navy. I kept both pair under my desk and wore walking shoes on my commute. One day, I came into work, removed my walking shoes and did not slip on my pumps until it was time to head to my first meeting. I think it was 1pm before someone pointed out to me that I was wearing one navy shoe and one black shoe. While we had a good laugh, I was embarrassed. I did not make that mistake again. Now, many years later, looking back on it, I think another mistake was being embarrassed about it and ruminating about it for too long. It simply wasn’t that big a deal. As we say in medicine, “Nobody died.”

What are some of the most interesting or exciting projects you are working on now? How do you think that might help people?

I have two exciting creative endeavors in the works right now. One is a proposal for an exhibition called At Peace: The Art of End of Life. You may be familiar with memento mori, which is an is an artistic or symbolic reminder of the inevitability of death and has been an art concept dating back to medieval times. Well, this exhibition is a contemporary exploration of memento mori. Through art and interactivity, it engages the participant in reflection, conversation, and preparation for end of life.

The other is called Widow Wisdom: The Cancer Edition. I have designed a short set of questions that engage those who have lost a partner to cancer to share feedback with healthcare providers and current family caregivers specific to discussing and preparing for the end of their person’s life and how it helped or hindered their transition from caregiver to griever.

You are a successful leader. Which three character traits do you think were most instrumental to your success? Can you please share a story or example for each?

Authenticity — As CEO of large physician organizations and now author, I contend with a wide range of stakeholders from demanding (sometimes egotistical) specialists to patients who are ill/injured, and a whole lot of folks in between. I need to be my real self in every situation, using both my head and my heart whether it is helping an organization to realize a strategic goal or hearing out a patient who needs help.

Empathy — When my husband was ill, I accompanied him to nearly every healthcare visit from diagnostic scans to doctor appointments, to infusion treatments. As difficult as some of those days were, whether it was getting him ready and out the door, suffering the “scanxiety” that comes before each periodic imaging service to reveal if the cancer has grown, or just waiting in reception areas with loud, obnoxious televisions, they were our time together. Now in a leadership position as I walk through the seating areas of a facility or listen to someone sharing their story after reading my book, I have an informed empathy that makes me more effective in my work.

Accountability — Administrative leader for a physician organization is an odd, lonely spot; neither physician nor employee. For the organization to be successful, I must give credit whenever and wherever I can so the employees are valued by the physicians, and I must be accountable and take the blame when things don’t go well.

For the benefit of our readers, can you briefly let us know why you are an authority about the topic of finding joy?

Sure. As I mentioned earlier, I lost my only sibling at 18. The death of a sibling in childhood really sets a family up for a lifetime of emotional turbulence and difficulty. Managing to find joy during the last 38 years has given me the authority of experience. My mother died some years later. Most recently, I was my late husband’s sole family caregiver during his 22-month cancer illness. I allowed my very personal art journal about the most difficult time in my life to be published as a book, to help those currently caregiving for loved ones with life-limiting conditions.

Just prior to the pandemic the National Alliance for Caregiving and AARP tallied 53 million people in the US providing uncompensated (family) caregiving for a loved one. These are people caring for adults. Three out of five are women, the average caregiver age is 49.4. If living with the care recipient, the caregiver averages 37.4 hrs. per week caregiving — a full time job. The average duration of caregiving is 4.5 yrs. For most, the caregiving ends with the death of the care recipient.

In other words, this huge portion of the population was, is and will be in turbulent times regardless of the pandemic, news, and negativity on social media so the need for this interview series is timeless and ubiquitous.

Ok, thank you for all of that. Let’s now shift to the main focus of our interview about finding joy. Even before the pandemic hit, the United States was ranked at #19 in the World Happiness Report. Can you share a few reasons why you think the ranking is so low, despite all of the privileges and opportunities that we have in the US?

Our national history of manifest destiny has not served our inner contentment well as it has us looking outside ourselves and to material acquisition as a source of happiness. Also, the well- known phrase from the Declaration of Independence that provides three specific unalienable rights, “life, liberty and the pursuit of happiness;” I think most Americans, especially today, don’t recognize the importance of the term, pursuit in that list. Perhaps because of the rhythm of the sentence or the list of three, the word “happiness,” is often emphasized, when in practice our fulfillment is found in the “pursuit.”

What are the main myths or misconceptions you’d like to dispel about finding joy and happiness? Can you please share some stories or examples?

One myth is that “happiness” means nothing short of exuberance. The word happiness has been over-used thus diluted to the point of simply conjuring happy face emojis, rainbows, puppies and ponies. In reality, “happiness” represents a spectrum that ranges from feeling contented and sated to exuberance and exhilaration. I prefer the peace, courage, intimacy, and fulfillment end of the “happiness” range. There is greater depth and authenticity there.

Another myth is that happiness can be willed with a directive and a forced smile. Baristas, flight attendants, and receptionists exclaim, “Have a GREAT day!” in lieu of a simple “thank you” or “good-bye.” At the end of any given day, I might well have been told to, “Have a GREAT day!” six or eight times. Besides being a ridiculous amount of pressure (she laughs out loud), it is a shallow, unfounded directive. Greatness has its place in the world, I am just not sure it needs to be forced into my day, multiple times a day.

In a related, but slightly different question, what are the main mistakes you have seen people make when they try to find happiness? Can you please share some stories or examples?

They think they cannot possibly be happy if they are sad. They must be one or the other. I submit that replacing “or” with “and” allows us to find happiness more easily and is infinitely more accurate most of the time. For example:

  • I am happy and struggling.
  • I am tired and energized.
  • I am grieving and healing.
  • I am content and curious.

Most of us have made the mistake of looking outside ourselves and our circle and convincing ourselves that the happiness is out there to be acquired — the I-will-be-happy-when (I lose 10 pounds, I am making more money, I get through this difficult time) syndrome.

This was never clearer than while I was caring for my husband. There is a page in my journal that says:

I will not miss the sleepless nights filled with his relentless moaning, wheezing, and suffering.

I will not miss trying yet failing to comfort him.

I will not miss wrapping his swollen legs.

I will not miss giving him injections.

I will not miss changing the sheets in the middle of the night because of his night sweats.

I will miss loving someone so much that I do all those things.

That is, the I-will-be-happy-when-I-get-through-this-difficult-time simply doesn’t work for family caregivers. No longer having to do all those exhausting, tough things will mean their person has died. So sometimes leaning into our most turbulent and troubled situations with our best selves is the way to happiness and joy.

Fantastic. Here is the main question of our discussion. Can you please share with our readers your “5 things you need to live with more Joie De Vivre, more joy and happiness in life, particularly during turbulent times?” (Please share a story or an example for each.)

  1. Mind the happiness spectrum.

Happiness ranges from contentment and peace to elation and exuberance. In turbulent times, shift your focus to the peace and contentment end of the happiness spectrum rather than looking for elation. Happiness is ephemeral and elusive. Recognize and savor the moments of contentment. They are to be relished as much, perhaps more than the glee. For me, this was never more true than when I was caring for my late husband. There were countless moments of tenderness and intimacy as we prepared for his death and my survivorship. The memories of them continue to bring me contentment and peace.

2. Tend to selfcare and self-awareness.

When my inner voice starts taking a cynical, grumpy, blue or even self-deprecating tone, I first ask myself, “When was the last time I ate and do I need a rest?” Nourishment and rest are essential to maintaining happiness in difficult times. As a family caregiver, sometimes a bite of food and closing my eyes for five minutes was all I could manage, yet it helped. Also know yourself and what you need. Introverts and ambiverts need replenishing, alone time after being in certain social settings. Extroverts need to be with others. Some people need hardcore exercise, some need to veg out on television or games, still others need classical music. Know what you need. Get it when you can, appreciate it in a way that carries you through.

3. Give of yourself, create when you can.

Generosity is really, quite selfish because giving and helping others, makes you feel so good. When I am feeling down, one of my favorite things to do is write cards and letters to my friends reminding them how much I love and appreciate them. It brings me comfort. When I make the cards I send, well, then we’re talking full-on joy.

4. Maintain balance and remember, the only constant is change.

Each morning, while in the bathroom getting ready for work, Bob and I would read Max Ehrmann’s Desiderata to each other. Sometimes in a silly voice, sometimes in a serious one. If you are not familiar with the poem, check it out. We found reciting it to each other in the morning helped center ourselves for the day. I do it by myself now. Happiness and joy require maintenance, tending and balance. There will be sadness, there will be anger. When I regularly center myself, I can handle the lows and know that they will not last, just as the highs won’t.

5. Manage regret proactively.

If memories of intimate, loving moments continue to bring joy, the residual effect of regrets is the opposite to an exponential degree. Regrets make difficult and turbulent times worse. Thus, regret prevention is paramount to happiness and joy. As a hospice physician, my late husband would tell families they were into Precious Time, meaning death was imminent. He would explain, Precious Time is when you say what needs to be said and you don’t say what you will later regret. Because Bob coined this term, I was keenly aware that we were in Precious Time for the entire 22 months he lived following his diagnosis. I knew facing what was ahead and conducting myself in a way that I would be able back on without regret, would be essential to my survivorship and it has. I have been able to feel the love, grief, sadness, and peace rather than consternation and regret.

What can concerned friends, colleagues, and life partners do to effectively help support someone they care about who is feeling down or depressed?

Thank you for asking this. I get this question a lot from people who want to know what to do or say to a friend who recently lost a loved one or is caring for someone with a life-limiting condition. Perhaps let’s start with some of the common mistakes people make, aka the Don’ts:

  • Don’t- Opt for avoidance because you don’t know what to say. Don’t turn and walk the opposite direction when you see someone in public (happens all the time after a death). To this I say, showing up imperfectly is far better than not showing up at all.
  • Don’t — Offer platitudes that are void of empathy. “He’s in a better place.” “Everything happens for a reason.” These phrases can make a person feel sadder and more isolated.
  • Don’t — Share the so-called bright side or a comparative statement, “You are still young, you can (have more kids, marry again, etc.). Stay away from anything that begins with “At least,” or “Could be worse.”
  • Trying to “fix” the person or situation or implying they will “get over” the loss. Here, offerings that start with, “You should,” must be avoided.

Those feeling down need a non-judgmental, kind presence. In my journal from when I was caring for my late husband, there is a notation that says, “Our best friends in this are those who check in frequently with no expectation of a response.” That is, don’t leave me to feel alone and isolated and don’t give up on me when I cannot respond in a way that makes you feel you are helping. You are helping just by making your presence and support known.

When I know someone is feeling down or depressed, I try to send relatively frequent texts. Some say, “Sending you love and peace,” “You continue to be in my thoughts,” or sometimes the little bouquet emoji. I also like to send cards and notes, you know, snail mail (she adds a wink and smiles).

A wonderful byproduct of taking the time to learn and listen to what a person or situation needs when they are less than splendid, is it ultimately makes you feel better.

Ok, we are nearly done. You are a person of great influence. If you could inspire a movement that would bring the most amount of good for the greatest number of people, what would that be? You never know what your idea can trigger.

The movement I am working to inspire is Death Literacy. We don’t all have children, go to college, get married, own a home, retire, but we all die. Moreover, we will all likely outlive someone we love.

At the end of life comes death.

There are no do-overs in end of life.

Changed forever, loved ones remain and remember.

This is what I have termed The Triad of Certainty. This happens, without fail, to every single person on the planet. For people of all races, creeds, nationalities, political persuasions, the loss of a loved is the BIGGEST thing that happens in their lives. Death has profound and lasting, physical, emotional, spiritual, financial, legal, and legacy effects, yet we know little about it and don’t discuss it and prepare for it. For many the illness and death of a loved one is the most turbulent, troubled time they experience. Preparing for it openly and mindfully, may not alleviate the sadness itself but it will allow us to focus on the love, grief and mourning rather than questions about what the person would have wanted at end of life, for a memorial and legacy.

If we understood and openly talked about end of life as a society, we would find more intimacy with those we love and more assuredness and peace when the death comes. With death it is when not if. We would likely live and love more fully having faced the fact that we are going to die and having prepared. While they might not bring joy and happiness per se, having care planning and preference discussions and preparing for end of life bring us closer to our loved ones mitigate the trouble and turbulence after the loss. End-of-life planning and preparation with our loved ones is key for the long game when it comes happiness and joy during difficult times.

We are very blessed that some of the biggest names in Business, VC funding, Sports, and Entertainment read this column. Is there a person in the world, or in the US, whom you would love to have a private breakfast or lunch with, and why? He or she might just see this, especially if we both tag them 🙂

Well, my table seats four so, to brainstorm our Death Literacy movement, I would invite:

Atul Gawande, MD, because he has written one of the best books on end of life and he holds position and influence in academic medicine, which is an essential stakeholder in this movement. (We should start by requiring every medical, nursing, and allied health student to document their advance healthcare directives and proxies as part of their registration then move onto residents, fellows, faculty and staff.)

Katie Couric because she has been through family caregiving and the death of her first husband, Jay Monahan. In an interview with the podcast Death, Sex & Money, she described regret about not having openly discussed end of life with her husband. She said, “I really tried not to fall apart on Jay, and looking back on it, there’s probably a lot of dishonesty about the whole thing. I think that sort of cockeyed optimism prevented me from ever really saying good-bye.” So, I know she understands how necessary death preparation and open discussion is among loved ones.

Dolly Parton because she is experienced with under-resourced literacy programs, she is highly credible and universally beloved, and in a recent interview with Rolling Stone, when asked about death preparation she responded: “I would not want to leave that mess to somebody else… If you haven’t made those provisions, do that. You don’t want to leave that mess to your family to have to fight over. You need to take care of that yourself, even if it is a pain in the ass — and it is.”

And I will be serving grilled cheese sandwiches and chocolate chip cookies because I make really good ones, and I can’t think of better foods for bringing joy and happiness in turbulent and troubled times. 😊

How can our readers further follow your work online?

Thank you for these really excellent insights, and we greatly appreciate the time you spent with this. We wish you continued success and good health!

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