On being grateful – for rain & waterfronts

bridge in rain

“It’s not happiness that makes you grateful,” goes one of my favorite recent quotes (thanks, Joann Lee;) “it’s being grateful that makes you happy.”

Here’s to gratitude.

For one thing, it has been raining in San Francisco. That strange wet stuff that falls occasionally from the sky – but we haven’t seen in a very long time. A planned Commonwealth Club Waterfront Walk tour, which I had earlier volunteered to help host, was advertised “Rain or Shine;” and as it happened there was both. The rain dampened all streets but no spirits, and the beauty of the waterfront literally shone.

There is something mystic about a waterfront on a dark day: an ethereal quiet hanging just below the clouds, the call of a gull who could be from another world, the scent of newness.

FullSizeRender (7)

The waterfront in sunshine is brilliant and exciting; in rain it invites your imagination – and appreciation.

As with waterfronts everywhere, San Francisco’s is steeped in history: sailors and conquerors, longshoremen and adventurers. There is public art, and private beauty. Waterfront Walk guide extraordinaire Rick Evans covers a remarkable range of them in two hours:

FullSizeRender (5)

The rise and – literal – fall of Rincon Hill, once one of San Francisco’s famous seven, which overlooked the Bay until the city unwisely bulldozed a street through it in the 19th century and the sandy hill collapsed upon itself. (Earthquake and fire finished the job.) Today Rincon Hill is rising again, as gleaming steel towers. The buildings that survived earthquake and fire are other centerpieces of the walk, plus the monumental artwork on the waterfront that was a trade-off for Gap tycoon Don Fisher’s corporate headquarters building when it went up – insurance of unobstructed, breathtaking views.

Some of the beauty of many waterfronts, physical and informational, is manmade, as is true of this piece of San Francisco Bay. But every waterfront has its story, and its soul.

Rain or shine. A cause for exquisite gratitude.

FullSizeRender (4)

Danger Zone in End-of-Life Talk

carved ice dove

A suicide pill for everyone over 85? Not the wisest plan to suggest right now. But it is, in fact, a possibility put forth by Joyce Appleby, Professor Emerita of History at the University of California, Los Angeles.

In a letter published in the New York Times on November 13, Appleby notes a recent anti-longevity article by Ezekiel Emmanuel and a new book on end-of-life care by Atul Gawande (both physicians,) and says,

“Perhaps the moment is right for broaching the idea of what we might call prophylactic suicide: the decision of an elderly person to pre-empt the grim reaper and avoid the disabilities of extended life.”

Appleby goes on to note that organizations such as Compassion & Choices, with which this writer has worked closely for well over a decade, “are campaigning for dignified terminations of life for those with incurable diseases” but writes, “What I propose goes a step further, extending the right to people before they face terminal or debilitating illnesses.”

Not surprisingly, Appleby’s letter – one of The Times’ regular “Invitations to Dialog” – drew more than 300 responses. Nine were selected to appear either in print or online; this writer’s is among those online and is as follows:

“I strongly support the right of a terminally ill, mentally competent adult to choose aid-in-dying, now legal in five states, but Ms. Appleby does a disservice to the cause by suggesting “a step further” — prophylactic suicide. The latter bears no relation to the former.

“We would be far better served to fight unwanted medical treatment, so often futile and excruciatingly painful at the end of life, and to enforce individual advance directives. My own directives (I’m 81) stipulate that no medication other than pain relief be given should I become unable to speak for myself, and stress that I do not wish to be fed if unable to feed myself. More important, all of my children and close friends understand these wishes because we’ve had the conversation.

“Let’s work toward those sane measures, and leave “suicide” out of it.”

Because the Death With Dignity movement is so important, and informed dialog about it so critical, it is both tragic and dangerous to have misinformation and misperception spread. There’s been enough of both over the decade+ in which the movement has slowly gained strength. To set the record straight:

Death With Dignity – the right of a terminally ill, mentally competent adult to ask a physician for aid in dying – is now legal in five states (Appleby left out New Mexico) and the movement is fast gaining ground in half a dozen others. This is partly because people increasingly understand that Death With Dignity is not suicide – and is certainly no kin to “euthanasia,” as Emmanuel would have us believe. Under Death With Dignity laws, death comes because of a disease. Every death certificate for those who have considered or used DWD laws lists the cause of death as the disease; it is not caused by suicide. Euthanasia would never be allowed under DWD laws.

But the movement is also gaining strength because it has been carefully thought out and tested. Because it is rational and safe. DWD laws are designed to promote individual autonomy, and incorporate safeguards against abuse.

Much of the opposition (as evidenced in several of the letters in The Times) comes from misunderstandings which are advanced by Emmanuel’s and others’ misuse of the word “suicide” and by fears that the elderly will be encouraged to get out of the way as Appleby’s notion suggests. Both writers muddy the waters and undermine an important cause.

Death With Dignity is a safety zone. Irresponsible words throw it into a danger zone.

 

Sign a Contract, Lose Your Rights

scales of injusticeDeep within the contract I signed for a recent $699 purchase were these words:

Arbitration Agreement: Should any dispute arise in regards to this product, I/we agree to settlement by arbitration.

Well, great, I thought, after glancing through the multiple-page document and noticing the clause. I am not a litigious sort of person, and arbitration seems far preferable to courts and lawyers and outrageous legal expenditures. A reasonable solution.

Wrong. That agreement means I signed away all rights in any future dispute involving the product, committing to a decision that will be made by the person or firm hired by the company who wrote the contract. If I complain, and the company is paying the arbitrator, guess who’s going to win? A recent study showed that 94% of the time, in cases like these, the judgment goes in the company’s favor. Appeal? There is none. The decision is binding, and I have signed away my right to appeal – that’s also in the fine print.

Lost in the Fine Print”, an eye-opening film just released by the Alliance for Justice, explains how these forced arbitration clauses affect millions of people every day, people like you and me who assume we enjoy such constitutional rights as equal protection, the right to appeal – a voice. I could be out $699. But what if the forced arbitration clause in the small print meant you were done in by a for-profit college that took your money, gave you a worthless “diploma” and prevented you from ever getting a job because they’d already flooded the market with others far less qualified? Or suppose it meant you had no power over the credit card company that was ruining your small business with ever-increasing “swipe” fees. Or it meant that though you had been unjustly fired from your job, you were denied even a hearing? These are three of the stories told in “Lost in the Small Print.”

“It’s a rigged system that helps companies evade responsibility for violating anti-discrimination, consumer protection, and public health laws,” says film narrator Robert Reich.

Reich, a noted political economist, author and speaker who served as U.S. Secretary of Labor under President Bill Clinton, explains how forced arbitration clauses usually go unnoticed in the pages of boiler-plate accompanying today’s contracts. But even if they do catch the eye of the signer – as happened with my recent purchase – their potential impact cannot be foreseen.

And that impact can be huge: a job lost, a business struggling, a life wrecked.

“Lost in the Fine Print” runs for just under 20 minutes. You can watch it online, or order the DVD. It’s free. Those could be the most important 20 minutes you’ll spend in a very long time.

 

 

Bold Hope for the World’s Poor

Map_of_the_world_1998

A Solution to Poverty?

If governments can’t solve world poverty, and nonprofits can’t make serious dents in it… can the private sector be the answer? With the help of you and me and major investors?

Mal Warwick thinks so. Warwick, co-author, with Paul Polak, of The Business Solution to Poverty, spoke recently at the Commonwealth Club in San Francisco about their conviction that the long-term solution to the ongoing tragedy of global poverty lies in coming up with answers that will pay off. Not just to suffering individuals, by helping lift them out of poverty, but to investors by turning a profit.

Warwick’s audience included a variety of interested individuals familiar with much of the work already being doing by nonprofits whose funders tend to seek reward through humanitarian success rather than financial return. But major infusions of capital, Warwick maintains, will be needed to continue building the ladders people everywhere will need to climb out of poverty’s depths, and that will require – business solutions.

As a shining example, Warwick cited the treadle pump. It is a human-powered device, inexpensive to manufacture and simple to use, which enables farmers to multiply the yield of their land and thus, in many cases, raise themselves and their families out of poverty. It works as a business solution on a number of levels. Factories needed to manufacture the pump were set up in villages, providing employment for people there, village shops distributed them, workers were employed to drill the wells and financial institutions made loans for purchases.

The problem, Warwick says, was with marketing – radio, TV, newspapers and traditional advertising methods weren’t available. The solution? Roaming troubadors and a Bollywood movie.

Among the facts Warwick brought to light were: One billion people lack access to electricity. One billion people lack access to safe water. One billion farms are without irrigation. The 20 million people lifted out of poverty between 1981 and 2006 by international aid programs, Warwick says, are only a drop in the bucket to the numbers who continue to suffer.

“It’s possible,” Warwick says, “to create brave new companies” with the lure of “reaching at least 100 million $2/day customers.” Some of those companies already at work include Australia’s SunWater which is developing a variety of safe-water solutions, several businesses working toward turning organic waste into affordable charcoal briquettes, and SpringHealth, which is addressing the problem of contaminated drinking water.

If governments and nonprofits can’t solve global poverty, can businesses? It might take all of the above – plus you and me, ordinary citizens.

Thanks, Brittany

clouds

Brittany Maynard, 1984-2014

No one was surprised by the news of Brittany Maynard’s death on November 1, as she had planned. The news arrived in my Inbox late Sunday night, November 2, in an email from Compassion & Choices, an organization I have supported — as a volunteer, Northern California board chair and in all other ways — for well over 15 years,

What Brittany did for Compassion & Choices, and for you and me, though, far exceeds what any one person might ordinarily have done. Hers was an extraordinary demonstration of how to live, and die.

More of how she lived will continue to be in the news. But it’s how she died, with generosity and grace, that is worth noticing right now. Just to touch on a few things:

Brittany, in making her own choice, showed us how to make our own choices. Demand the right to control your destiny, she was saying. Fight for legalized aid in dying. Complete your own advance directives and make sure EVERYONE in your family and circle of friends knows what your own wishes are. Death with dignity was Brittany’s choice, and she wanted it to be yours — if you choose.

“The freedom is in the choice,” Brittany said.  “If the option of Death With Dignity is unappealing to anyone for any reason, they can simply choose not to avail themselves of it.”

Brittany was irate over insinuations that she had been “manipulated” by anyone. She was a strong, educated, independent, intelligent woman who led a joy-filled life and confronted its abbreviated end with remarkable courage. The reality was simply that she took control of her own final months, weeks, days, by moving to Oregon where aid in dying is legal. The reality is that she wanted her life — and death — to have meaning for all of us. She hoped that by sharing her story all of us might benefit.

It’s about freedom. Brittany, thankfully, is now free of the terrible pain her illness was bringing, a pain that was certain only to increase. Her family will mourn for a long time, but they are free of the pain and anguish that comes from watching someone you love suffer.

You and I are free to choose. We can continue to let those who hold differing views deprive us of our right to control our final weeks and days. Or we can fight to legalize our right to choose a compassionate death. Eventually, that right will prevail.

Thanks, Brittany.

WHI: Strengthening Women’s Health

WHICould the health and wellbeing of a few million women be improved, and a few billion dollars saved in the process? A very big dream.

When the Women’s Health Initiative was established more than 20 years ago, no one was talking in grandiose terms and few would have anticipated the wide-ranging health benefits (and huge cost savings) that would result in the decades ahead. Many of us were simply saying, “Imagine this. At last we’re studying women to find answers about women’s health issues.”

This writer was proud and happy to enlist in the first WHI study. I joined more than 100,000 other postmenopausal women volunteering to fill out forms, have blood drawn and answer questions over the next 15 years. That initial focus was on tracking the effects of hormone therapy, dietary patterns and/or calcium/vitamin D supplements on prevention of heart disease, cancer and osteoporotic fractures. I had not yet had breast cancer – that would come about 10 years into the study; a family history of osteoporosis added to my personal interest in WHI. Over the years I volunteered to participate in some of the wide-ranging ancillary studies looking at other health-related things like physical activities, lifestyle, tobacco and dozens of peripheral issues. (My personal favorite question appeared on one of the multi-page annual update forms. It read – Yes or No – “When you enter a room full of other people, do you have the feeling they are talking about you?” There may someday be a report on women and paranoia.)

Mysterious questions aside, WHI is serious business. Here, excerpted from the latest Extension Study newsletter are a few facts about what has been learned from the historic initiative, and a little of what is still ahead.

Those hormones millions of postmenopausal women were taking, widely thought to be miracle answers? Studies showed the risks far outweighed the benefits, and millions stopped taking them. Hormones in different combinations had been commonly taken to minimize chances of cardiovascular disease, cancers, fractures, diabetes, gall bladder disease and a variety of quality-of-life measures; quitting the hormones proved a better choice. Health benefits can’t be precisely measured, but the reduction in hormone use has led to a decrease in rates of breast cancer and cardiovascular disease.

And in dollars and cents? Some $37.1 billion, (in 2012 when all costs and quality-adjusted years of life are considered, has been the total economic return of the WHI trial.

By June, 2014, over 1000 papers based on WHI data had been published in scientific journals. What’s ahead? Researchers are looking at pet ownership and risk of cardiovascular disease; physical activity during childhood and risk of Alzheimer’s disease; breast cancer distribution by rural/urban areas and geographic differences in cognitive decline/dementia.

Every year on their birthday, WHI study participants receive a card – some of us call it the “Hooray, you’re still alive” card. For women everywhere, it represents something worth more than gold.

Adventures in Distracted Driving

Car_crash_1

Distracted drivers kill. Not just themselves, unfortunately, but innocent others: conscious drivers, bicyclists, pedestrians, passengers. In 2012, for example, 3,328 people were killed in distracted driving crashes.

So why, some of us wonder, are today’s cars designed to distract? Touch screens for multiple uses, gadgets for audible texting, voice-activated music or phone calls, GPS instructions that can be conflicted or confusing. Aids and upgrades? Or distractions?

Even with two hands on the wheel – tough, when you’re working with a touch screen – it is not possible to have any of the above in use without being distracted from the essential goal of driving: getting from Point A to Point B without endangering yourself or others. That goal once summed up the business of driving.

But cars and driving have changed in recent years. Cars are sold on the strength of how they make you feel – free, macho, superior. Driving, at least in the ads, is not a matter of getting from Point A to Point B, but “an experience.” An enhancement of self, time and energy.

My friend Mac spends a good bit of time and energy on the 1962 Volvo which is the family transportation, not always to the delight of his wife. But a functioning car is a functioning car. My own automotive experience has evolved from a 1977 Volvo stick shift to a 2000 S40, a rather spiffy little vehicle with sun roof and great radio sound – but no computer. It is increasingly difficult to find a car as uncomplicated as a 2000 Volvo S40.

Recently I was a passenger in a new car with one of the now-standard dashboard computer screens. Traveling 75 mph on a well-lit highway we were passing an accident of some sort and a police car with red and blue lights flashing when the computer screen blinked, a beep sounded and a friendly voice from somewhere said, “Hi, I just wanted to check with you about the wine.” Happily, the driver understood the blink, knew the voice, and had earlier set the interior phone to speaker since she wasn’t using ear plugs. She was immediately able to switch from the conversation we’d been having to a conversation about buying wine for the dinner party ahead that evening – while maintaining speed and staying in the same lane. The driver is also a highly skilled multi-tasker who hadn’t had any wine at all yet.

But after the phone conversation ended (and my heartbeat had gone back to normal) the driver told me she hadn’t noticed the police car.

Suppose the flashing police light had been a warning of hazard ahead? Suppose another driver on another, more troubling, phone call had done something unexpected in another lane? However skilled at both driving and multi-tasking, could my driver have had enough remaining undistracted resources to keep driving safely?

Given my choices, I would take sharing the road with Mac and his ’62 Volvo over all these roads filled with cars equipped with audible texting devices, voice-activated music systems and dashboard computer screens.

Unfortunately, we no longer have that choice.

 

 

Peaceful dying vs Doctor Knows Best

credit acpinternist.org

Barbara Coombs Lee, the sharp and articulate president of Compassion & Choices, spoke to the issue of death with dignity on PBS NewsHour tonight, with opposing views presented by Ira Byock, noted physician, author and advocate for palliative care. Neither really won; the time was too short and the issue is too complex. The Death With Dignity movement though, is not going away, and we the people will only win when the movement wins.

Lee spent 25 years as a nurse and physician’s assistant before becoming an attorney and devoting her life to personal choice and autonomy at life’s end. She believes a terminally ill, mentally competent adult should have the right to end his or her life when and how he or she chooses. Byock, chief medical officer of the Providence Institute for Human Caring, believes that if doctors were properly trained in pain management and end-of-life care – which he readily admits is far from the case – no one would ever want, or choose, to hasten one’s end. Lee appreciates the grace with which Brittany Maynard is facing her own very premature death; Byock says the active, well-educated 29-year-old is “being exploited” by Compassion and Choices.

A few caveats:

Barbara Coombs Lee is a good friend whom I admire and respect. I have worked with Compassion & Choices for well over a decade as a volunteer, Northern CA member and board chair, and now member of the Leadership Council. I strongly support physician aid-in-dying and individual autonomy.

“Hospice and palliative care,” Lee said on the NewsHour segment, “are the gold standard” for end-of-life care. But no amount of hospice care, or palliative care, can alter “the relentless, dehumanizing, unending” progression of a disease such as Maynard has and many of us will also face. For many of us, as for Maynard, there will be loss of every bodily function, one by one, quite likely accompanied by excruciating pain and possibly things like the seizures Maynard would like to minimize for her own sake as well as the sake of her loved ones who would be forced to watch.Stethoscope

Perhaps doctors will eventually all be adequately trained in pain management and palliative care. But even then – and “then” is a very long way off – must the doctor always know best? Why can’t I, the patient, the person facing my own dying, be the one in control?

Byock is dismissive of the pain involved with watching a loved one suffer agonies of prolonged dying. Maynard’s inevitably increasing seizures, for example, would be helped by palliative care, he suggested, so she wouldn’t suffer terribly. If I chose – as Maynard is choosing – to have my loved ones remember me as a woman at peace while holding their hands rather than a disintegrating person gripped with terrible spasms – why is that not an honorable choice?

Byock – who in this NewsHour fan’s humble opinion got the better time and treatment – slipped in words like “suicide” and “slippery slope” and “euthanasia,” and phrases like “euthanized in the Netherlands” too far along in the program for Lee to answer in the brief time given her. Byock ignores the fact that no one choosing to hasten death under the existing laws (four states now have the law, two others allow aid-in-dying) is committing suicide; they are being killed by their disease. No one has been, or will be, “euthanized.” The United States is not the Netherlands. He also ignores the fact that in the long years of Oregon’s successful law – it was first enacted in 1997 – there has been not one report of abuse. Not one.

There is no slippery slope. There is only compassion. Self-determination. Autonomy. Dignity. Grace. Peace. Why should they not be legal?

I respect the medical and literary achievements of Ira Byock. But I’m sorry: the doctor does not always know best.

The Comfort of Cocooning

(This first appeared on Huffington Post)

On arrival at JFK airport in New York I spotted two small children, cherubic blond apparent siblings about 4 and 5, who embodied what might be the gold standard for bliss. They (or their parents) had created a mini-cave on a corner bench of a fast food dining area, kid-sized backpacks serving as pillows, sweaters draped from a utility pipe across chair backs tenting them in. Some strands of Halloween faux-cobwebs were stretched loosely across the foot of the structure to complete the scene. People pulling suitcases were rattling by just a few feet away, talking in varieties of foreign tongues. Loudspeakers were announcing flights, music was blaring from several directions. They were sound asleep with – I swear – smiles on their faces.

What is it about small and cozy spaces?

Safety, perhaps. Or comfort and peace. The most basic of assurances – all is well with the world – that can be in short supply these days.

Who among us didn’t spend at least a part of childhood huddled under a blanket-covered card table with a good friend or a good book? Or snuggled, three or four at a time, into a one-person tent in the rain? The ultimate may still be the sleeping compartment on a speeding, swaying overnight train – as really was the case in the days of the Chattanooga Choo Choo.

These observations come to you from Pod51 – which, as far as is known, gives no discount for free advertising in the blogosphere. Planning a quick trip from San Francisco for a family visit, this writer Googled “mini-hotel” in search of something we’d read about not long ago. And up popped the Pods.

The pods are one step – perhaps two or three steps – above the “capsule” hotels that first appeared in Japan and China in the late 20th century and boil down to just that: an oblong capsule into which one might slot oneself for a good night’s sleep but not much standing up or roaming around, and a few too many similarities with drawers in a morgue for yours truly.

But the pods in the Pod Hotels? Snug. I went for the Full Pod, which includes a teeny tiny bathroom accompanying the teeny tiny desk and sort-of double bed in the teeny tiny room. With just enough floor space for my grown, Outward Bound employed daughter to roll out her sleeping bag – and we both have smiles on our faces.

Death with Dignity: How to crash a website

 

IMG_1580Among a long list of emails piling into my Inbox is one that says “Thanks to a particularly successful story on People.com the increased traffic has crashed our site. Please be patient as we yell and shake our fists at our web hosting company. We’ll be back up and running shortly.”

It’s from Compassion & Choices, an organization I’ve worked with for nearly two decades. Compassion & Choices is an excellent nonprofit, leader in the fight to make Death With Dignity — specifically, physician aid-in-dying for terminally ill, mentally competent adults — a right for all Americans.

This particular story is a People.com type of story: beautiful young woman dying of brain cancer, choosing to die with dignity and courage… and sadly having to move to Oregon to accomplish this. But similar stories, some with happy endings and some not, occur every day: men and women of all ages in the U.S. find themselves with terminal diagnoses and seek to control their final days and hours. It shouldn’t be that hard.

Though I’m no longer active in this capacity, for many years I served as a Compassion & Choices volunteer — trained C&C volunteers will help those who fit the criteria (terminally ill, mentally competent adults) understand their options. In California, which does not have a DWD law but hopefully will within the next few years, the best option is often to stop eating and drinking. Or sometimes just to stop taking the medications that are keeping you alive.  To be candid, some people also hoard life-ending medications and when their numbered days get to be very few — or their suffering becomes more intense than they feel worth the struggle — they stir those pills into applesauce and spend their final moments in peace, surrounded by loved ones and in the quiet of their own homes.

How in the world is this not a good idea? Why in the world is prolonging life to the bitter end, more often than not in a cold & sterile hospital room ever a better idea?

Brittany Maynard, the 29-year-old subject of the People.com story, is choosing to die on her own terms. Wouldn’t we all?

 

Follow

Get every new post delivered to your Inbox.

Join 229 other followers