You may know someone who has rigid ideas about how Christmas or Hanukah or Kwanza is celebrated. Who's on the gift list and what's an acceptable gift and which parties must be graced with an appearance. Dr Rackner notes, "Caring for sick loved ones offers many gifts. Maybe the most important is the invitation to look at your life in a new way. Almost out of necessity harried caregivers get a flash of insight that there's no holiday rule book or present police!"

In this month's Medical Bridges newsletter, Dr. Rackner identifies several common holiday traps that family caregivers fall into. She also offers suggestions about how to avoid them. "The message is simple. Free yourself from ideas about what should happen; instead give yourself permission to celebrate the holidays in a way that works for you and your family."

Trap #1: Planning for the worst.

Many caregivers think, "This could be Dad's last Christmas, so I want to make it really special." Dr. Rackner argues, "Wouldn't it be great if we came into the world with an owner's manual that included the expiration date! We do not. I have seen patients defy all medical odds and laugh about the doctor who gave them six months to live—20 years ago. Then there are the tragic untimely deaths. We should all celebrate as if this is our last holiday season!"

Trap #2 Creating Norman Rockwell scenes.

The idea of a picture-perfect holiday has an emotional tug that's particularly seductive to family caregivers. It‘s an expression of the longing to return to earlier carefree days of health and vitality.

While there is no perfect holiday celebration, you can create holiday rituals that are perfect for your family. Ideas about what makes the holiday special may be very different among family members. Say, "Our lives are different this year, so we need to think about how our holiday celebration will be different. What are the two or three things that you want to make sure we do? " For most people, it's the little things that make the big difference, like the Russian Tea Cakes or the special hand-embroidered tablecloth or playing board games. You can then create a montage of your family's perfect holiday.

Trap #3 Buying your way out of guilt

For those of the sandwich generation, caring for both children and parents, the guilt that someone is getting short-changed looms large. Who doesn't wish there more hours in the day so that children and friends and even the person in the mirror would get more time and attention. The life of a caregiver leaves big gaps. If you have tried to fill this gap with gifts, you will undoubtedly find that it does not work very well.

All family members, including kids of all ages, need to know that they are loved and treasured. Gifts are one way to say this; what most kids of all ages really want is more of you. Consider a different kind of holiday present, like a coupon for 10 minutes of undivided attention each day, or a trip to the ice cream store or a visit to the zoo. The card can include a list of reasons this person is so special to you. In fact, at a holiday dinner you shine a spotlight on each person at the table, with each guest offering a story that demonstrates why this person is special. You can even write then down on 3X5 cards and give them wrapped in ribbon or mounted on a collage.

Consider inviting your kids into an act of giving rather than receiving by touching the lives of those less fortunate. Serve a meal at a shelter. Invite a lonely neighbor to your house. Look for a chance to give a stranger a $20 bill, or whatever you can afford.

Trap #4 "Smile!"

The instruction given before every photo captures the tone for the entire holiday season. Over and over we're told there's a right way to feel during the holiday, and that's happy. Family caregivers have a spectrum of feelings that rise to the surface during the holidays, like sadness or anger or disappointment. It IS sad to have the first holiday without Mom. Allow yourself to live in your truth. Not expressing this feeling does not make it any less real, and adds to the holiday burden.

Trap #5 Party on!

If you are a healthy extrovert—someone who gets recharged from being in the presence of others—you are in your element in December. Party on!

However, for those introverts who get recharged by spending time alone, or those who have limited pep because of illness, the holiday season can be emotionally depleting. There is still hope for a joyous holiday celebration. It just requires some advanced planning.

Plan a social calendar that's reasonable for you as a caregiver and for your loved one. Be realistic about your energy limits before you make endless commitments. Ask family members to do the same. There's no rule that says that all family members have to go to all events. You partner can go alone. If either you or your loved one is an introvert, it's perfectly reasonable to respond to an invitation with, "Thanks for the lovely offer. Unfortunately, we have other plans. I'm sure you'll have a terrific time, and I'm sorry to miss it" The host does not need to know that your other plans are a nap.

Rackner says , "Your life became different when you became a family caregiver, and it's time to do things differently. Free yourself from the idea that there's a right way to celebrate the holiday. Look to your family and decide how to make it the holiday work for you. Then adjust expectations. That's the recipe for celebrating the blessings in your life and the joy and love you share with others."

Vicki Rackner M.D. president of Medical Bridges, is a surgeon who left the operating room to help patients partner more effectively with their doctors. She's a speaker, author and consultant.

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