Finding Hope in the Queue

Posted by RJ Thesman

While printing off documents, my printer suddenly decided to morph into la-la land. Electronic devices are wonderful — until they don’t work.

Frustrated, I tried to print the last document, not realizing what was happening on the other end of cyberspace. After rebooting, unplugging and still not printing, I turned everything off and quit for the day.

The next morning, the printer decided to resuscitate itself. It spewed out page after page of documents hidden in the queue. Eventually, it stopped — but not before adding several inches to my pile of recyclable scrap paper.

Sometimes, the electronic world imitates life.

How many times do we pray for something, wait and wait longer while heaven lives in introverted silence? Nothing happens for weeks, months, even years.

Our prayers are stuck in the queue of God’s waiting room.

Then suddenly — an avalanche of answered prayers, all bunched up at the same time. We gasp at the range of unexpected blessings, certain once again that God does indeed love us.

What can we learn from our moments stuck in the queue?

Persistence is a worthwhile virtue.

The best writing, the purest answers to prayer, the most productive days evolve as a result of self-discipline. When we give it our best and keep at it — over and over — we eventually see the results.

We may not currently see the finish line, but it WILL appear. Persistence produces results — one of the key principles of life.

Nothing worthwhile happens easily. When we have to work for it, we fully appreciate the results. We are then energized to persist with more fervor.

Effective Results Require Patience.

Patience and persistence are twins. They sometimes look alike and often require the same disciplines to feed them.

But the persistence twin is a process while the patience twin reveals a quality of life.

Patience reminds us to wait, then wait more. And when we can no longer stand the wait, we dig deep. We learn how much strength authentic waiting requires.

Patience is the months-or-years-long battle, waiting for the chemo to take effect and save a life.

Patience allows the preschooler to tie his own shoes even while the school bus honks.

Patience sits beside the Alzheimer’s resident and responds to the same question again and again.

Patience learns the passage of time, because the process cannot be rushed. If we want the best results, we must not deny the waiting.

Patience turns off the printer, instead of continuing the process of frustration, adding more documents to the queue which then wastes paper. Lesson learned.

Sometimes the Best Action is No Action. For planners like me, it feels better to do something — anything — to help the process along.

But sometimes, the cyberspace universe has to arrange its pixels and find its missing megabytes. I don’t even understand its language. How then, can I make it do something?

When we’ve prayed and prayed, waited and persisted, yet nothing happens, we can use the prayer of relinquishment. I don’t always understand God’s language. I cannot make him do something, so I relinquish the problem to him.

“Oh God, I can’t stand this. I have absolutely no clue what to do. Please take over and do whatever is needed to mend this problem. I give up.”

This prayer seems counterintuitive to what we have been taught about productivity, but the Psalmist declared the same advice, “Be still and rest in the Lord; wait for him and patiently lean yourself on him” (Psalm 37:7 AMP).

Be still. Unplug. Stop trying to figure it out. Don’t worry. Let go and let God salve your weary soul.

If we won’t learn how to be still, then we end up with a heap of nothing: wasted words, frustrated prayers and sometimes — piles of worthless paper.

But if we let go and let God figure it out, then we return to the task refreshed, ready for whatever he will give us and grateful for lessons learned.

Waiting in the queue is rarely easy. We may tire of the time required before something happens.

But God knows what he is doing. Maybe he’s waiting for us to trust him so he can finish the job.

Pastor Tanner struggles with what to do. He can’t make himself well, even by praying about it. And his cat thinks he’s a bit weird. Check out The Year of my Redemption.

Hope Within a Stalled Memory

Posted by RJ Thesman

Our family has suffered a tragedy, and we are all trying to process it.

Last week, a favorite cousin suddenly had a cardiac arrest. No warning. Nothing wrong with her heart.

Madeleine (a pseudonym to protect her privacy) was only 54 and in good health. She was bright, beautiful, a wonderful person with everything to live for.

The paramedics worked tirelessly for 40 minutes and shocked her heart multiple times. Finally, Madeleine began to breath again. But the damage to her brain was extensive. She was basically gone.

As the news traveled via text throughout family around the nation, we prayed. Grieved. Believed for a miracle. Tried to make sense of it.

The double tragedy was that Madeleine’s mother, Clare (also a pseudonym) is a favorite auntie. Across the miles, we all felt the emotional slam.

Madeleine and Clare were a team: business partners, besties, always there for each other. We connected them together. “Clare and Madeleine will be at the wedding.”

“Clare and Madeleine made it to the top honors of their corporation – again. They continue to be Number One in all categories.”

“Clare and Madeleine have started a side business. They are so much fun.”

And they were. Both believers in staying positive and sharing a laugh each day. Both settled in the arid Southwest to avoid the humidity and colder temps of the Midwest. Both tall and graceful, expansive huggers and accepting of all our flaws.

Always together.

Yet now … Clare was left to wait in the ICU as her daughter struggled to breathe. Organ donors waited in line. Doctors shook their heads.

The “Why” question bobbed near the surface.

How could we pray? “God, save her life. But not as a vegetable. She wouldn’t want that. Oh, God oh God oh God.”

How could we let Madeleine go and how could Clare survive without her?

Across the miles and without the benefit of a cell phone or any direct communication, my mother sat in the nursing home. Her brain cells not connecting at the age of 93, muddled by the plaque of Alzheimer’s.

Yet when my sister visited her during this tragic week, Mom held a greeting card from Clare. Spoke no words. Just held it.

Did she sense her sister and niece were tangled in a traumatic battle? Did the Alzheimer’s plaque somehow lift so the emotions of Mom’s heart clearly sailed through?

Was my mother on some higher plane, breathing her own prayers for some sort of miracle?

And the miracle did come. Not the one we wanted, but the miracle of a soul released from the confines of this earth to find its forever home.

At the age of 54, Madeleine stopped breathing and joined her dad, her grandparents, my dad in that glorious place where spiritual hearts beat together. Where love reigns. Where death never enters.

And we are left with a bittersweet answer to our prayers. Grateful Madeleine is free yet shattered for the grief Clare suffers.

The veil between earth and heaven, between earthly life and forever life, is thin. We sometimes glimpse a taste of it as faith and hope merge.

Even when it hurts. Especially when it hurts.

Yet hope continues somehow in the stalled memory of my mother’s brain. She holds a greeting card. She cherishes her family somewhere in her deprived days. She whispers prayers only God can hear.

And we all look forward to the day when Alzheimer’s will be defeated, death will be conquered and good-bye will no longer be spoken.

Hope in the Darkness

Posted by RJ Thesman

It is difficult to stay in hope while we are living within darkness.

Consider the faith of Mary Magdalene. Scripture tells us, “While it was still dark, she went to the tomb” (John 20:1).

While it was still dark, her faith was strong enough to visit the grave of her Lord. She wanted to be with Jesus one more time, to hold his body in her arms and thank him for rescuing her from the demons.

I imagine she had not slept since the horror of standing near the cross and watching him die. Because of her devotion, God granted her the desire of her heart — to see Jesus again.

But this time, he was gloriously — almost unbelievably alive.

Then he gave her the privilege of telling the fearful brothers how she had seen him. He spoke to her, called her by name. Gave her a job to do.

While it was still dark.

When we dwell in dark places, it is so difficult to imagine life at the end of the tunnel. We see only our pain, the challenge of each day. Another twenty-four hours required of us: giving care to a loved one, enduring chronic pain, watching our personal world crumble.

We feel only the raw depth of the struggle.

Our faith tends to fester, encased in a crust of growing bitterness. We inwardly scream questions:

“Why did this happen?”

“When will it end?”

“Where is the answer to my prayer?”

Yet the answer is silence.

At the end of the darkness stands the only One who conquered it. The One who laughed at the eternal outcome of death. The One who understood that sometimes life is much harder than death.

And he conquered the gloom while it was still dark. He had already stepped out of that tomb before Mary came to look for him.

Maybe you live in the depths of a grief that never seems to ease. Every day is a reminder of the emptiness, the place where that loved one used to live.

Maybe you struggle with illness. Every day is a reminder of the health you have lost.

Maybe you trudge through emotional pain, the reminder of what others did to you. Those who did not care enough about your heart.

While you are in the darkness, Love steps out of the tomb, ready to embrace you and give you a reason to live. An abundance of a better life waits for you. The risen Jesus longs to empower you with his hope-filled strength.

Stay in hope. The darkness will gradually fade, and you will breathe life again.

Finding Hope When Life Unravels is an e-book with action points for stepping out of the darkness.

Finding Hope When Life Unravels

Posted by RJ Thesman

As I entered one of the big box stores, I knew time was fleeting. The local government officials had just closed all the restaurants. All major events canceled. How much longer would it be possible to buy food and necessary items?

The Coronavirus jack-knifed us into what felt like a pre-apocalyptic world. Empty shelves. Shoppers avoiding each other, keeping their social distance. Hygienic wipes in my pocket to kill the germs on my cart, my hands, the number pad.

What in the world happened to our comfortable norm? The virus and its effects showed us how fragile life can be.

So how do we find hope when life unravels?

Focus on God instead of the Problem. During other emotional apocalypses in my life, problems have seemed insurmountable.

A period of 14 months with no job and no unemployment insurance. Cancer scares for my son and me. The medical tests alone were enough to saturate our emotions with fear. A father dying slowly from dementia, a mother locked in the shadows of Alzheimer’s. Miscarriages. A toxic job environment. Multiple abuses over a lifetime.

When I was training to become a Stephen Minister, we were assigned the task of writing about the losses in our lives. I filled my 3×5 card front and back.

Another minister saw it and said, “You win.”

“I don’t think so,” I responded.

During each of those problems, every time I felt overwhelmed, I tried to focus on God rather than the situation. I filled my journal with all the attributes of God that I had personally experienced. My Bible was colored with highlighted verses about God’s love and care.

Sometimes I spoke out loud to the problem itself. “Go away. Leave me alone. I will trust in God.”

So that’s what I’m doing now, during this Covid-19 outbreak. I’m filling my journal with all the ways God is protecting us. My Bible reflects the colors of new highlighters and more verses talking about God’s loving care.

And sometimes I shout, “Go away, you filthy virus. Leave me alone fear. I am determined to trust in God.”

Focus on the Lesson rather than the Pain. It is so easy to complain about self-quarantine, to frown about the fact that I am in the “risky” demographic, to worry about the numbers of people dying.

But what can we learn from this situation? How can we turn it into a lesson?

We can pull out the old recipes Grandma used during the Great Depression. The creativity of those depression-era cooks came from a deep survival mode. When food was rationed and winter threatened, they learned how to add more water to the soup, how to make beans the main protein source.

We can do the same.

We are learning how to stay at home and be families once again. The kids are out of school. Teach them how to cook, how to clean a bathroom properly, how to make a bed with hospital corners, how to change a flat tire.

Gather around the dinner table and learn more about each other. Sing a song. Dust off the board games and play together. Find out how beautiful family bonding can be.

I believe we will also learn how much we took for granted — before the Coronavirus shouted from every internet site.

How easy was it to just pull into a restaurant and order a meal? How many of us fell to the impulse of buying because the shelves were full of wondrous things?

Perhaps now we will be more grateful for the little we DO have. We will learn how it feels to truly be thankful.

Focus on the Future instead of the Present. Hope looks beyond the current problem toward an optimistic tomorrow.

One day, hopefully soon, this virus will wear itself out. We will dig out from our isolation bunkers and find freedom again.

We grieve the loss of so many dear souls today, but in the future — babies will be born, another generation will arise. Healthcare services will normalize, and we won’t be afraid to join groups.

Keep focused on what the new tomorrow will bring. Perhaps our “normal” will be completely changed for the better. Re-energized. More of a dominance on mercy, justice and how to walk humbly with our God.

When all this is over, we may save more for the next crisis and treat small business owners with more respect. Our leaders will keep in place the disaster plans other administrations toiled over. Nobody will hoard toilet paper, because it will no longer be the domineering purchase.

We will be glad to see each other, hug more, appreciate church leaders and healthcare workers who continued to meet the needs.

And the news cycles will underscore baseball games, fashions of the new season and the pride we take in our people. He-roes and She-roes will emerge from this crisis, and we will make more commitments to keep family together, to help one another each day.

One of the verses in my Bible is highlighted, then colored over with another hue, then framed in black ink. I have returned to it multiple times. It has become my mantra when life unravels.

“Hope in God, for I will yet praise him, my Savior and my God” (Psalm 43:5).

Stay in hope. Live in the yet.

The Lenten Season is a time to focus on the Future – on the promise of Resurrection. Who were the women during that period of history? Check out The Women of Passion Week and discover new stories of courage.

Hope for the Why Question

Posted by RJ Thesman

why Ever since the patriarch Job lived his troubled life, we have been asking, “Why?”

Actually, the question “Why?” was probably asked since the beginning of time. Perhaps Adam halted in his naming of the animals to ask, “Why, God? Why spend so much time on the colorful details of the bluejay, then throw together this ridiculous version of the dodo bird?”

The first mother, Eve, no doubt asked, “Why did Cain have to take Abel’s life? Why even allow me to birth these boys if you’re just going to take one of them away? Why God? Why?”

Every infertile woman, every family standing beside a coffin, every couple whose marriage ends in divorce will ask, “Why?”

We seek answers because we try to make sense of whatever horrible thing has happened. If we can underscore the event with a logical answer, we can put together a plan for dealing with the loss.

But life doesn’t work that way.

We cannot control the surprise ending nor can we surround the trauma with some sort of reasoning. No earthly logic can explain why my mother lives within the shadows of the Long Goodbye. Why? What is the key to this disease? How can my family deal with it from the viewpoint of a logical answer?

We can’t.

Like faith, we have to accept some things as they are and believe a higher power will absorb the shock. Especially when we don’t understand.

But good old Job provides a possible solution, even when our fists are clenched in angry denial. The answer hides within a verse that whispers to me every time I ask a new, “Why?”

Whether for correction, or for His world, or for lovingkindness — He allows it to happen” (Job 37:13 NASB).

For correction. Sometimes God allows terrible things to happen because we need to be shocked into the reality that we are not gods. Only the real God knows the reason behind everything. We cannot figure it all out.

But perhaps in those moments of horrific happenings, we will reset our course and start over.

Our response might be, “What can I learn from this situation?” Instead of “Why?” rephrase it with “What?”

As gracious and loving as God is, he sometimes allows terrible things to happen. Why? So we can learn from our experiences and grow up. So we will reach out for him and learn more about trust.

For his world. We live in a depraved world. We are deceived into thinking we can fill our minds, our bodies and our souls with junk and not face the consequences. We eat what is not good for us, buy guns and forget to hide the bullets from children, look at someone’s skin color and judge him.

Our world is not a safe place to live, so obviously — bad things are going to happen. Tornadoes, floods, violence, trauma, illness, death. All are part of the definition of living.

Why does God allow the world to turn against us? To remind us that we are human and a better place DOES exist. Tornadoes, violence and Alzheimers will not touch us in heaven.

God has planned for something better.

For lovingkindness. For me, this is the most difficult of the Job answers. Sometimes God allows certain tragedies to happen because he is a loving God, a backward opposite world sort of treatise.

Did God allow the groom to be killed the night before his wedding because he would someday betray his bride and destroy his family?

Does God invite little children into his heavenly arms because he knows their homes will be bombed and it is kinder to take them out of the horror?

Will God prevent a student from finishing a degree because he knows that particular pathway is the wrong direction?

We cannot second guess Almighty God.

I do not pretend to know what God determines about anyone else’s life. But he has sometimes worked his backward lovingkindness for me. Hindsight is wiser than the present experience.

God allowed me to be downsized out of a good job to force me to rest. Then he pointed me toward something better.

I wonder if God took Deb home to prevent her from living a blind life from the effects of macular degeneration. I am glad for her, but sad for me.

Is God protecting Mom by allowing her to move into the world of Alzheimers? She is unaware of racial tensions, ISIS terrorists and a democracy teetering on the edge. She does not care who will become the next president. She just wakes up every morning and shuffles to breakfast, then back to her room to turn up the television and wait for lunch. No worries. No stress.

Life will always present us with quandaries, with questions we cannot answer. We can only move toward hope by embracing the direction of forward, one day, one moment at a time.

My fictional character, Reverend G, often said “The question is ‘Why?’ but the answer is ‘Who.’”

When something happens we cannot understand, the best thing we can do, is stay in hope that something good will replace it. Then run into the loving arms of the God who knows the answers.

The above essay is an excerpt from Sometimes They Forget — Finding Hope in the Alzheimer’s Journey.

When Hope is Sidelined

Posted by RJ Thesman

Although I have become known as the platform writer of hope, life sometimes interferes with the process. When circumstances force me to the sideline, I have to work harder to find hope and encourage myself again.

The last weeks of 2019 were harrowing. Beginning with December 5, the side effects of a medicine gradually sapped my strength and shackled me to the bathroom. What I didn’t know was that my electrolytes were being screwed as my body lurched into dehydration.

Then the flu hit and what was left of my immunities were destroyed. I woke up December 26 with no strength, blacked out and conked my head on the bathroom tile. When I came to, I was sweating and my heart racing. That’s when I called 9-1-1 and crawled downstairs to unlock the door.

As the siren screamed ever closer, I thought how ironic. Whenever I hear sirens, I pray for the first responders and the people involved. Was anyone praying for me?

The paramedics found me on the floor, semiconscious and breathing fast. They immediately started intravenous fluids and helped me to the gurney. Their strength and professional demeanor encouraged me. At least I would not die alone.

The emergency room was another experience, but my son soon arrived and took control. I have no recollection of signing forms, speaking to nurses or agreeing to treatments, but my son was fully conscious and did everything necessary for my care. It was only later that I realized I still wore my colorful Christmas jammies.

Dehydration was the main culprit and an ugly form of the flu, followed by a urinary tract infection. It took several weeks to recuperate with multiple meds and more trips to Urgent Care. I lost twelve pounds, and Gatorade became my new friend.

But the experience taught me how fragile is hope, how we have to work hard to emotionally receive it after we’re sidelined.

Independence Narrows with Age.

Of course, I know about the narrowing of independence from watching my mother fade into Alzheimer’s. She moved from independence in her own home to a hospital visit to assisted living.

But we rarely imagine the same for ourselves.

The truth is that none of us is immune to losing our independence. As we age, illness can take a greater toll. No matter how determined I was to eat nutritious food and take my supplements, one month of severe side effects and a common virus derailed everything.

I was grateful my final decisions for death and burial were already determined and the paperwork complete, because I was not sure I would return home. I have never felt so powerless. It reminded me of Catherine Marshall who was bound to her bed when tuberculosis stole her life. She wrote many of her books with her arms propped up by pillows.

A Support System is Crucial.

Although I raised my son to deal with the unexpected, I was surprised how quickly and efficiently he took control. His wisdom and decision-making brought me comfort. It was easy to return home and let him do everything. The ease of the role shift enabled me to relax, stay in bed and heal.

I was grateful for Caleb’s presence but also for his boss who let him leave work and said, “Family is more important.”

So protect your support system, complete all that important paperwork and make sure your special person is on speed dial.

Living Alone is Becoming Less of a Possibility.

It is scary to go through a health crisis alone.

Although my son currently lives with me, he was at work that day. And the future may change our comfortable living situation.

The beauty of being independent means I can have my own space, set my own hours and live where I want. But reality presents a different scenario. Living alone for the rest of my days no longer seems possible or even smart.

In 2017, my plan for living with someone and taking care of each other died when Deb walked into eternity. It seemed so easy and the best possible solution for the two of us to become the Golden Girls. Sadly, that did not happen.

For years, I have wished for a big house or some sort of solution for all the single women I know — a safe place where we could have community together and help each other. That answer has not appeared.

Most of us cannot afford the senior living townhomes or the luxury apartments shown on TV. Sure, who wouldn’t want those beautiful spaces to live out life, find a community, yet guard your own identity?

But beauty and safety come with a price tag. Hope fades with the reality of finding affordable housing as we age.

The 9-1-1 operator comforted me with his words, “I’ll stay on the line until they get there. I’ll stay with you.” And he did, bless him! His words were my main recollection of that scary day. This stranger on the phone with the soft voice would NOT abandon me.

Now that I am recovering, once again I am going through the house, giving things away. As I feel independence narrowing, I know I must choose what I will need for an even smaller space. And those choices make me sad.

Finding Hope Requires More Intentionality.

To be brutally honest, this illness has challenged this Hope writer. I find myself having to search for the positive outlook and remind myself daily that God has promised to never forsake me.

Each day becomes a more intentional desire to give it everything I can.

To write the words that must be released to the world — while I can.
To express my gratitude for colorful sunsets, faithful friends and anything good that happens — while I still recognize them.
To hug my son, often and wholeheartedly — while I have the strength.
To make each 24-hour period matter for the good — while I can still hang on to hope.

And to enjoy the independence I still have.

Hope may change, but if I intentionally look for it and seek to grasp it — it will be revealed. At least, I’m believing that today.

Check out the books I wrote in 2019, listed on my Amazon Author Page.

Image by Peggy und Marco Lachmann-Anke from Pixabay

Holiday Tips for Caregivers

Posted by RJ Thesman

cover-holiday-tips The calendar reminds us how deep we are into the holiday season. Our waistlines expand while the stresses of family dynamics emotionally stretch us.

As much as we enjoy the family time, the abundance of good food and the reminders to be grateful — we also need to remember how stressful this time can be for someone who suffers from Alzheimer’s or dementia.

How can we best help our loved ones survive the holidays? How can caregivers find some joy during this stressful time?

Trim the Food Responsibilities.

One year into her Alzheimer’s diagnosis, Mom tried to figure out a recipe. She wanted to feel part of the festivities but even finding pots and pans proved to be difficult.

As we watched her struggle, worry about the cost of groceries and wonder if she had made her salad — hundreds of times — we realized it was time to stop expecting Mom to cook.

Even if your loved one has a favorite recipe, relieve her of the stress of making it. Give her a simple task and make it together.

Plan Ahead for Shopping.

Be prepared with a list and know the easiest way to get in and out of the stores. Forget about Black Friday shopping — too many people, too much noise and parking places are limited.

Be patient. Take plenty of time and be prepared to answer many questions. If possible, buy everything in one store. Then go home.

Better yet, sit down with a laptop and show your loved one the pictures. Then order everything online.

Include Favorite Foods.

Even though her appetite has changed, Mom still wants pecan pie. One of my holiday duties includes buying a pecan pie for Mom. I recommend the frozen variety. No fuss.

When we walk into the farm kitchen, Mom’s eyes always go to the dessert table. She may not say anything, but I know what she’s looking for. “I brought your pecan pie, Mom, and the first piece goes to you.” Then I dress it with a generous dollop of whipped topping.

Every year, Mom replies, “I DO love pecan pie.” Someday even this sentiment will disappear. Enjoy blessing your loved ones with their favorite foods.

Plan an Activity Together.

Although sending Christmas cards is becoming one of those forgotten traditions, my mother’s demographic still considers it a holiday courtesy. She loves receiving her cards.

Remind your loved one who the senders are or tell a favorite story about the person behind the return address.

Be prepared to look at the cards several times during the holidays and tell the same stories. This repetition is part of the Alzheimer’s process. Someday you’ll be glad you took the time to do this simple task.

Be Careful About Timing.

If you check your loved one out of assisted living for the day, check back in before dark. As the sun sets, Alzheimer’s patients often experience Sundowner’s Syndrome. They may pace, say the same words over and over and exhibit anxiety.

They feel safer in their rooms before dark, so time your meals and activities accordingly.

Travel is NOT for Everyone.

Although we all want to be together during the holidays, travel out of the comfort zones is difficult for the Alzheimer’s patient: several hours cramped in a car or a plane, strangers, noise, unfamiliar surroundings, different types of foods and smells.

It makes more sense to hire a caregiver and let your loved one stay home while you join the rest of the family.

Avoid the false guilt that says you cannot leave for a day or two. Yes, you can. Taking care of yourself is one of the best ways to make it through the marathon of caregiving.

Take a break and be with your family.

Gift-giving.

None of us needs more junk, least of all — the Alzheimer’s patient. Keep the gift-giving simple.

Try these suggestions: a stuffed animal, a baby doll (especially for the women), a pretty picture for the room, a picture of family members with their childhood photos inserted next to the adult photo, a favorite piece of candy, a comfortable sweater.

Be aware that some gifts may disappear. Mom constantly loses things. Last year, I bought her new sheets for her bed. Then I put them on for her. No chance to lose them.

One gift that always works is spending time with your loved one, a hug and a kiss, a “Merry Christmas. I love you.”

Do it while you can.

For a more substantive list of helpful tips, check out Holiday Tips for Caregivers, available on Amazon and Kindle.

RJThesman.net

Author | Coach | Speaker | Editor

Alzheimer’s

Finding Hope in the Queue

Hope Within a Stalled Memory

Hope in the Darkness

Finding Hope When Life Unravels

Hope for the Why Question

When Hope is Sidelined

Holiday Tips for Caregivers