On Being Instruments of Peace

dove of peaceWatching the families of people killed at Charleston’s Emanuel A.M.E. Church repeatedly declare their forgiveness of shooter Dylann Roof was, for many including this writer, somewhat surreal. Seriously? Set aside the rage, grief, unbelief, and go straight to forgiveness?

For some faith traditions, that is indeed possible.

Also possible is the response for good coming out of Roof’s act for evil: removal of an emblem – the Confederate flag I recall seeing on some of my ancestors’ gravestones – from public spaces, and serious confrontation of the racism firmly embedded in U.S. culture. Not just the south, not just in police forces, not just in politics; in the U.S. culture.

One small part of the attempt to confront, and hopefully address, those issues in one small piece of the culture began recently when John Weems, pastor of mainline (if hardly traditional) Calvary Presbyterian Church in San Francisco, got to talking with Bishop Ernest Jackson, pastor of Grace Tabernacle Community Church across town in San Francisco’s largely African American Bayview-Hunter’s Point neighborhood. This conversation led to a group of mostly white Calvary members leaving their 10 AM Sunday service early to join the 11 AM worshippers at Grace Tabernacle. (We were saved from embarrassing Caucasian-ness by one tall African American and one third-generation Chinese American.)

Calvary’s Minister of Spiritual Care Victor Floyd was preaching before the group set out – on a day the long openly gay Floyd said he never thought he’d live to see – and admonished the group that worshipping with Pentecostals would mean staid Presbyterians (the Frozen Chosen, we are commonly called) would have to raise their arms above the level of their waists.

Well, who knew?

Grace Tabernacle dancer

Grace Tabernacle dancers

The incredibly gracious Pentecostals greeted the chosen-frozen Presbyterians with exuberance. And a forgiveness for our frozen-ness that would probably be understood only by people like the survivors of the Charleston massacre.

“Forgiving is not forgetting,” Bishop Jackson said. “We have little control over what we remember or what we forget.” But he reminded the uniquely mixed group that it is wise to remember “the wrong that harbors no malice.”

There was a great deal of praise music – hands waving, or for the more frozen, clapping, higher than the level of one’s waist. There was some extraordinary dancing by three costumed young Grace Tabernacle women. There was talk about the burden of unforgiveness. And there were parting words of the sort that will bring exactly the change and reconciliation Dylann Roof (for whose immortal soul a lot of great Americans are praying) sought to prevent.

“Thank you,” said John Weems, “for helping us thaw out.”

“We must disconnect,” said Ernest Jackson, “from hatred and racism.

“We are instruments of peace.”

One can only hope.

 

It was — 1933 — a very good year

Ruth Bader Ginsberg

Ruth Bader Ginsberg

Ruth Bader Ginsberg is too old? Perhaps she should consider stepping down from the Supreme Court?

These suggestions were floated more than once in the Q&A session after a recent Commonwealth Club talk by University of California Hastings Professor of Law Scott Dodson. Dodson is the editor of a newly released collection of essays, The Legacy of Ruth Bader Ginsberg, whose writers suggest nothing of the kind. Contributors to the book, and Dodson himself, focus instead on the significant contributions made thus far by the 82-year-old justice, and the impact she continues to have on jurisprudence and on life in the U.S.

Dodson was drawn to write about Ginsberg because he “kept encountering her clear and consistent opinions” and wanted to create an objective view of her legacy – notably including gender discrimination, as in the case that ended Virginia Military Institute’s male-only admission policy, and racial discrimination, as in the voting rights case Shelby County v Holder. In the latter case, Ginsberg famously wrote that throwing out an anti-discriminatory measure as no longer needed “is like throwing away your umbrella in a rainstorm because you are not getting wet.”

As New York Times columnist Gail Collins wrote several months ago: Ruth Bader Ginsberg has no interest in retiring.

Carol_Burnett_1958

Carol Burnett in 1958

Several days before the Dodson talk, David McCullough, 82, spoke at another San Francisco event in conjunction with his most recent book, The Wright Brothers. McCullough did not go into detail about his next project, but gives every indication that he is a writer with no interest in retiring.

Meanwhile in Texas, Willie Nelson, 82, has another concert coming up, and the next show planned by Carol Burnett, 82, is almost sold out.

This writer may not have anything else in common with Ruth, David, Carol and Willie, but we take what we can get. 1933 wasn’t a bad year to be born.

 

David McCullough on Books & Life

David McCullough

David McCullough

Master storyteller David McCullough, touring with his new book, entertained an unabashedly admiring San Francisco audience recently with stories historical, literary and political. Including more than a few stories about the Wright brothers, Wilbur and Orville, subjects of his latest literary achievement.

McCullough was interviewed – to the extent that anyone needs to provide a launch for a McCullough commentary – by Roy Eisenhardt for a City Arts & Lectures event. To McCullough’s story about The Little Engine That Could being the most important book he’s read – “I kept saying ‘I think I can, I think I can’’’ – Eisenhardt remarked, “I think you did.”

So far in his career – and he gives no indication of retiring any time soon – McCullough has won two Pulitzer prizes (for Truman and John Adams), two National Book Awards and the Presidential Medal of Freedom. But it is his down-home, one-of-us persona that wins over audiences (and readers) and provides the unshakable foundation for his comments and stories. Following are a few from the City Arts & Lectures event:

Another favorite childhood book was Robert Lawson’s Ben and Me, “the true story of Benjamin Franklin as told by his friend, Amos the mouse.” Though Amos lived in Ben Franklin’s house, McCullough explained, he left 25 siblings back home in Christ Church. “I wondered if their relatives weren’t still there. And every time I go to Christ Church I wonder if they’re not somewhere behind those walls.”

Johnstown Flood

Aftermath of the Johnstown Flood

The motivation for his first book, The Johnstown Flood published in 1968, came from happening upon an extensive collection of photos of the event. He was struck by the fact that “it was an entirely preventable tragedy, caused by human actions,” and by what he could discover through looking deeply into the photos. McCullough said he had been fortunate to know many great writers when he was at Yale, including Thornton Wilder. “If you want to write a book,” Wilder had told him, “write a book you’d want to read.” Looking closely at the Johnstown flood photos, McCullough said, “I thought there had been a lot of bad books about it, and I wanted to write a good book – a book I’d want to read.” Judging by its thousands of enthusiastic reviews, and the fact that it is still selling nearly 50 years after publication, a lot of others seem to have found McCullough’s Johnstown Flood a book they want to read.

A few McCullough observations on literature and life:

How does one become a writer? “Start writing. And thinking. John Adams sometimes in his diaries would simply make a one-line entry: ‘At home, thinking.’ Imagine anybody doing that today?”

Wright Brothers plane

Orville Wright aloft, 1908

About Wilbur and Orville Wright’s achievements despite having only three (Orville) and four (Wilbur) years high school education? “They grew up in a home which encouraged and stimulated intellectual curiosity.” Reading the classics that filled the home amounted to what McCullough terms a liberal arts education. “There are over 1,000 letters (written among the Wright brothers and family members) and it is humbling to read those letters. Not only were the brothers brilliant, they were superbly educated.”

Is there anything about American law and politics you would change? “The role of big money has become a disgrace. It is rank corruption. I think of Harry Truman. After he left office, he would never accept a fee for making a speech or serving on a board because it would be a disgrace to the office of president. When the Kennedy campaign announced they were having a dinner to raise money, Truman said, ‘There goes democracy.’”

After lamenting the fact of political fundraising dinners with $50,000 price tags, McCullough closed the San Francisco event by leaning forward in his chair and addressing the audience with a mix of righteous indignation and urgency: “We need someone who will lift the American spirit,” he said; “don’t you agree?”

He got a responsive standing ovation.

When Cure Is Not An Option

“Has anybody asked the patient?”

Jessica Nutik Zitter raised her hand to pose that question some years ago, at a “Morbidity and Mortality” conference wherein a room full of physicians were discussing treatment options for a dying patient. The doctors continued to talk about surgery A or drastic measure B. Zitter raised her hand again to say, “Has anybody asked the patient?”

Zitter is now a highly regarded critical care/palliative care physician who speaks and writes often on end-of-life issues. A solitary voice at that “M&M” conference, today she is one of the leading voices for medical care that asks the patient first. It is the care most of us would choose.

Zitter spoke recently at San Francisco’s Commonwealth Club, an event titled “Avoiding the End-of-Life Medical Conveyor Belt.” Her horror stories explain the conveyor belt metaphor, and confirm the immensity of the end-of-life care problem facing us all. The problem is not just with our cultural inclination to ignore death altogether, as has often been written about in this space, or with physicians’ inclination to continue treatment as if death were not an option. It’s both.

Fran & Jessica Zitter 6.9.15

Jessica Nutik Zitter with Fran Johns

Jessica Nutik Zitter’s stories (a book is forthcoming from Penguin Random House) starkly highlight the death-is-not-an-option attitude unfortunately still common in the medical profession – and the pain and anguish endured by patients who wind up on the conveyor belt as a result.

People will often say, “Take a chance! Maybe God will work a miracle…” Zitter comments, but “the odds are high for (that person’s) being committed to a great deal of suffering and a grisly death.”

Thus the conveyor belt: a patient who is dying and could use a little peace instead winds up undergoing a cruel series of events – resuscitations that mean broken ribs, restored breathing that means a tube thrust down the throat, futile interventions that add to – and prolong – pain and suffering.

Zitter tells of a patient who was essentially “a body,” shrunken and yellowed, being given emergency resuscitation that one nurse likened to torture; and of a man repeatedly taken from the nursing home to the ICU, because he had hand-written a note saying he wanted his life prolonged ‘at all costs.’ “We don’t give people graphic visuals of what those costs may be,” she says.

Asked why doctors don’t practice patient-centered care, Zitter cites two factors – in addition to the imbedded tradition of always providing treatment, and more treatment. One is the need for physicians to get paid for time spent on end-of-life discussion, something that seems perfectly rational but tends to get shouted down in the politicized healthcare arena. The second is equally simple: “If you don’t offer care, someone else will.”medical symbol

Asked by an audience member about what constitutes good care when cure is not an option, Zitter recommended that decision making in such cases should be made early on. “The possibility to cure gets me up in the morning,” she said, “but helping a dying person achieve a good death is equally satisfying.” While advance directives are useful, she points out, they are not enough. It’s important to talk extensively with friends and loved ones, and to create documents with the help of legal and/or healthcare professionals if possible. (A growing number of individuals and organizations are offering such services.) “But decisions have to start with the patient,” Zitter says. “The patient saying ‘do this’ or ‘don’t do that.'”

Otherwise, it’s onto the conveyor belt.

 

John Paul Stevens: 95 & Going Strong

John Paul Stevens

Retired Justice John Paul Stevens, a man of many accomplishments, comes across as a man of few regrets. The latter might be summed up in two words: Citizens United. His regrets over that controversial 5-4 decision, handed down just months before he left the Supreme Court, are strong, and many.

Stevens, who turned 95 in April, appeared recently at an event in Washington DC co-sponsored by the Alliance for Justice and George Washington University Law School. Introduced by AFJ President Nan Aron, Stevens was interviewed by Slate senior editor Dahlia Lithwick and Washington Post opinion writer Jonathan Capehart.

Stevens demurred on several issues such as the benefits or evils of social media and citizen journalists: “I’m not a good person to ask about that.” But on most points he was crystal clear.

Re political candidates having “a litmus test” for potential Supreme Court nominees? Even as to Citizens United, “it’s a bad idea. But the (Citizens United) case should be overruled.” Throughout the interview Stevens referred to the case as bad for the country and the future, and damaging to the basic principles of democracy, “which should be ‘one person, one vote’ and not (decisions hinging) on a bunch of money.”

Asked by Capehart why he had changed from the conservative he was considered when first named to the bench to his later identification as a liberal, Stevens said, “I didn’t change, the Court changed.” Every member appointed from 1981-91, he pointed out, was more conservative than his predecessor.Scales of justice

On electoral reform, another issue Stevens sees as imperative, he said “some things can be done at the state level. The right to contribute (to campaigns, etc) should have some geographical boundaries. Excessive photo IDs have never made sense.”

Stevens, in response to a question from Lithwick about “bombast and aggressive, ideological arguments” in the Court, said that “ideology is not good. That’s one reason I am against televising arguments, which would have an adverse impact on the deliberating process. I believe firmly in people knowing the institution, but not if it has an adverse effect on the institution itself.” Possibly because some member might be a camera hog, Lithwick interposed? “Any one of the nine. And I would include myself.”

Talking briefly about interactions among the justices, Stevens – known to have had a close relationship with conservative Justice Antonin Scalia – gave the impression that the Court does indeed function as intended. “I think John Roberts is a very good Chief Justice,” he said. “He executes the duties of Chief Justice well, although I disagree with some of his decisions.”

Stevens recalled stumbling over a few words while giving his dissent in Citizens United. “I said to myself, ‘You’re not as articulate as you were.’ And that’s when I stepped down.”

Fielding questions five years later, the renowned Justice showed no problem articulating his thoughts. Including the need for electoral reform – and the need to overturn Citizens United.

Wit, Wisdom and Joe Biden at USNA

Covers awayHe may not be known for his oratorical/linguistic skills, but as commencement speakers go Joe Biden did himself proud at the U.S. Naval Academy’s recent graduation and commissioning ceremonies: a few pearls of wisdom, a handful of jokes (some better than others), a smattering of policy comments and it was all over in a matter of moments.

For the serious heart of his talk, Vice President Biden spoke of the significance of the planet’s waters, from the Arctic Ocean to the Baltic Sea to – most specifically – the Pacific. He recounted a conversation with Chinese president Xi Jinping during which he was asked why he referred to the U.S. as a Pacific power, and he responded, “Because we are.” Biden added that he told the Chinese leader further, “Mr. President, you owe your stability over the last 30 years to the United States Navy and military.”

Pacific oceanThe midshipmen were congratulated on having “spent summers on real ships instead of internships,” and for having a job immediately upon graduation. “You chose to join the real 1%,” Biden told them, “to protect the rest of us 99%.”

But it was Admiral Jonathan W. Greenert, USN, Chief of Naval Operations, who got in the best words in the briefest amount of time, offering four lines of advice before administering the oath of office to the Navy-bound members of the Class of 2015.

“Guard your integrity,” the Admiral said. “Learn unconditional trust.”

His third piece of advice probably hasn’t been given to graduating seniors over very many years: “Keep your social media private.”

And lastly, “Call your mother once a week.”

If any of those 1,070 men and women commissioned by Adm Greenert (and General Joseph Dunford, USMC, Commandant of the Marine Corps), were listening, someone from the USNA Class of 2015 could certainly wind up Chief of Naval Operations – or Vice President of the US.

Figuring Out Who You Are

Hand with book“Please don’t call me Doctor Jones,” said an extremely distinguished PhD speaker I met recently; “I’m just a teacher named Joe. I’ve been Joe all my life.” His name is changed to protect the innocent.

Having one name all your life is almost as interesting to some of us… of a certain age… as meeting a prominent multiple-degree lecturer who calls himself “just a teacher.”

Not someone of many degrees, I am nevertheless someone of many names. Maiden name, married name, resumption of maiden name after divorce, brief and ill-fated second marriage (yep, changed my name again,) eventual marriage to my Final Husband, whose name I took on moving across the U.S. nearly a quarter of a century ago. Because I’ve been writing since college (Fran Moreland) I often joke – though this is not a source of pride, only comic relief – that my literary resume reads like an anthology. Each name still bears its own notoriety, as well as its own burdens.

A fascinating look at what names and name changes have meant to women over the centuries is offered by my talented writer/scientist friend Jo Anne Simson in a recent article published in Persimmon Tree magazine titled “What’s in a Name.”

Names, Simson writes, have been used against women in subtle – and sometimes not so subtle – ways to subjugate, control and deny their sense of personhood. Probably the most damning of these practices for women in America was the assigning to slaves the surname of their masters, which “ruptured a connection to a past culture from which they had been torn most unwillingly. Moreover, the name change signified an identity conversion from personhood to property… ‘Leave your past behind. You are now property, not a person.’”

This writer’s post graduate experience ended with an MFA in short fiction, University of San Francisco Class of 2000, which conferred a degree but no title. I have, however, managed to keep my final literary name since 1992.

At about the same time I took on the final marital/literary name above, my first grandchild was born, bringing the other defining ID: Gran. The favorites survive.

 

 

Choosing a better death

Could dying be better?

By now most people acknowledge that there are “good” deaths: peaceful, with minimal pain, at home surrounded by loved ones – and “bad”: pain-filled and prolonged, often for months or years and more often than not in a hospital or other institutional setting. The movement toward “good” death – legalized medical aid in dying – has been growing for decades in the U.S., but has been gaining momentum and attention in recent months.

Liner.2Robert Liner MD, a retired obstetrician/gynecologist, gave an informative update on the movement at a recent University of California San Francisco grand rounds. Liner is one of four patient plaintiffs in a California lawsuit which would make that state the sixth to legalize physician aid in dying, and a longtime supporter of leading end-of-life organization Compassion & Choices. The suit is also joined by three physician plaintiffs.

Liner, whose cancer is in remission, said he would personally prefer to avoid death altogether. “But along with birth, dying is a universal experience. It’s what we all do.” And equally universal, he noted, is the wish to make that experience a little more compassionate, a little closer to what most of us would choose.

Liner outlined the current status of California SB-128, the End of Life Options Act, now working its way through the senate. While granting terminally ill, mentally competent adults the right to ask their physicians for life-ending medication, the bill would also establish safeguards such as requiring assessments by multiple physicians and repeat requests for the medication made at least 15 days apart. A similar law in Oregon has proven valuable in many aspects over the 18 years in which it has now been in place, Liner said. Death W Dignity newspaper

He cited a study published in the New England Journal of Medicine at the end of the Oregon law’s first decade which found that since passage of the law Oregon has seen improved training for physicians in end-of-life care, an increase in individuals’ completing advance directives, improved pain management and rates of referral to hospice and an increase in number of people dying at home.

Putting the better-death movement in historical context, Liner referenced a significant case several decades ago that sometimes goes unnoticed. In 1991, he explained, New York physician Timothy Quill published an article in the New England Journal of Medicine describing how he had prescribed barbiturates to a dying patient when her leukemia reached a point at which she no longer wanted to live. A grand jury subsequently declined to prosecute. Quill later became one of the plaintiffs in a case that wound up reaching the U.S. Supreme Court. And in 1997 the Court let stand a New York law prohibiting what was then called physician-assisted suicide, ruling that there is no federal constitutional right to die – effectively turning the issue back to the states.

Five states – Oregon, Washington, Vermont, Montana and New Mexico now allow physician aid in dying, Liner explained. California’s efforts to become the sixth include a campaign launched last year by Compassion & Choices and the lawsuit filed early this year.

Scales of justiceLiner distributed copies of the April edition of San Francisco Medicine, the journal of the San Francisco Medical Society, in which he and two of the other physicians involved in the lawsuit explain their support for legalized aid in dying. “Collectively, we represent almost a century of medical practice, teaching and research…(and) probably most relevant is our extensive experience caring for dying patients,” write lawsuit plaintiffs Liner, Donald Abrams, MD and Marcus Conant, MD in San Francisco Medicine.

The lawsuit is backed by national disability rights advocacy group Disability Rights Legal Center, Liner explained, and cites a number of reasons why aid in dying should now be legalized. While some arguments – such as privacy and liberty interests – are complex, one seems fairly straightforward: California penal code section #401, which makes it a crime to aid or encourage someone to commit suicide (a very different situation from a dying person’s wish to shorten his suffering), was written more than a century ago. Before dying shifted from being commonly a home event overseen by the familiar family physician to hospitals or other institutions where the large majority of Americans now spend their final days and weeks. Before medical technology made it possible to prolong life, often far past any “life” many would choose.

Liner, and millions of other Americans, believe choice in dying should rest with those who are dying themselves.

 

 

Want to put your brain to good use?

child Head

(Part Two of Data Today – Better Tomorrow)

Could this be you? Creating a better tomorrow through brain research??

It turns out one does not have to be a pro football linebacker to have a brain worth studying. One does not even need to have a brain like Albert Einstein’s, Steven Hawking’s or any of those scientists/exceptionalists/geniuses whose brains would seem worth figuring out.

One only needs to be 18 or over and willing to be studied, and then to go sign up on the Brain Health Registry. This entitles you to sit back and wait for your brain to help discover a cure for Alzheimer’s or ADHD or depression, or perhaps help find better ways to treat traumatic brain injury. Not bad, for just having a brain and investing a little time (no money.)

This writer got off to a sluggish start as a Brain Health Registry member. Signed up early on because it sounds like such a great endeavor, but then I ran into a few off-putting instructions like “This will take about 20 minutes. It is best done in a quiet room where there will be no distractions or interruptions.” Twenty minutes, quiet rooms and absence of distractions are three things hard to come by around my house.

Eventually, however, the requisite conditions were found, and I was off to create a better tomorrow – well, in partnership with a few thousand other participants and some very smart neuroscientists – by finding out stuff about the human brain. And this is one fascinating journey. The neuroscientists find it fascinating because they really are going to figure stuff out. But for participants, the fascination is in the process.

Participants enter a little basic, very general data about medical/family history etc. Then the fun begins. We have two sets of ‘Cognition’ tests aimed at assessing our memory, attention and other cognitive characteristics. “These tests give us a sense of how your brain is currently functioning,” the screen says. This participant can only wonder what the Brain Health assessment people think about how her brain is functioning. The ‘Cognition’ tests are computer games on steroids. For a while you try to remember and replicate the pattern of dots, and then you go to the card games. The card games require Yes or No answers about what the cards are doing, press D for Yes and K for No. My brain kept trying to tell me what the cards were doing, while my fingers tried to remember that K was not for Yes.

It is, all in all, a lot more fun that the computer games the rest of the world is playing.

In another three to six months, the BHR people will be reminding me to go back and do it again, or do something else, to see how the brain is getting along. Perhaps they will flag my entry and advise me to check myself into an institution. But more likely they will just combine my data with the data of a zillion more or less anonymous others – and find a cure for Alzheimer’s! Or depression! Or improvements in treatment of traumatic brain injuries! All with the help of my weary, aging brain. Plus, when the survey was completed I got an email from UCSF professor Michael Weiner, MD telling me I am a medical hero. “You’re helping to make brain research faster, better and less expensive – and ultimately that gets us closer to a cure for Alzheimer’s, Parkinson’s, and other brain disorders that strike tens of millions of Americans every year.” Who could resist?

You may want to go straight over to the Brain Health Registry and join the fun.

Data Today, Better Tomorrow, yay!

Women's Health Initiative

Some of us are suckers for studies: clinical trials, focus groups, surveys – whatever promises to shed a little light on the human condition, or possibly make that condition a little better.

This writer is a hopeless volunteer.

I have had my knees examined by MRIs, perhaps studying why I still have the originals despite a long history of abuse. I have had blood drawn for a study of celiac disease by someone who came to the house as part of the deal but unfortunately was not trained to find veins without causing excruciating pain. I have filled out lengthy surveys about addictive behavior – which may include addiction to study-participation (though that was not among the category choices.)

Currently, I am proudest of being an original part of the Women’s Health Initiative, which launched in 1993 with more than 160,000 postmenopausal women including this writer. In 1993 this was a Very Big Deal: studies had been made for all sorts of things with all sorts of participants, but finally there was a study of WOMEN. It sought to discover links between cancer (imagine! Studying women and cancer!) medical protocols, diet and other factors. Being a congenital wimp, and knowing I wouldn’t change my diet or stick to other proscribed regimens, I just signed up for the control group… but still. Even we control groupies are useful.

Over the years, WHI has developed a huge amount of useful data, probably the most beneficial being the finding that (imagine! Studying women!) hormone replacement therapy was not the be-all and end-all we had originally thought, but actually not such a good idea. (Read all about it.)

WHI has published over a thousand articles, approved well over 300 ancillary studies, and twice conducted extension studies. Findings have been about links between age, daily activities, diet etc and things like body fat, omega oils, heart disease, endometrial cancer – there is a list of useful discoveries resulting from this one large and ever-growing study project that boggles the mind.

Some – though surely not all – of this data is collected through regular survey forms received every year by WHI participants in addition to the annual birthday cards that by now this writer accepts as a “Congratulations! Are you’re still alive?” greeting. They seek data about lifestyles and life changes along with the traditional general health issues – and sometimes make one wonder what the next findings may be. My personal favorite question was, “When you enter a room full of people, do you often imagine they are talking about you?”

Paranoia after mastectomy? Who knows.

It is fascinating to be on the questioning end of tomorrow’s answers. Next blog: The Brain Health Registry. Assuming my closely-watched brain is still functioning.

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