A city dweller is alarmed by the terrible sounds drifting into her window. Dark, guttural cries. No words, just frightened, frightening cries. They seem to be coming from below ground, probably the stairs that go from the sidewalk to an entry into the garage of the building across the street, below her seventh-floor balcony.
Finally, the watcher calls 311. 311 is unquestionably the best thing the City of San Francisco has going for it. An actual, real person answers your call, and sends it to the appropriate other real person. “Someone’s in distress,” says the caller, watching (and holding the phone out) from the balcony window. “It’s been going on for some time and I’m worried about him.” Within minutes a red van and a white car quietly approach.
Four men get out of the van. They begin talking in soft voices to the stranger in distress. The watcher only picks up occasional words, but it’s clear they are trying to talk him into coming up. He’s no longer shouting.
Eventually, a forlorn figure emerges from below. The would-be rescuers gather around him, keeping far enough away that he won’t be frightened further. For 10 or 15 minutes they plead with him to let them take him somewhere for shelter, perhaps medical attention. He is having none of it.
Finally the figure shuffles off into the darkness, into the streets of the city which are, the watcher suspects, his only familiar. The red van and the white car drive away. The watcher goes back inside her warm apartment, feeling grateful for her city’s resources, but sorrowful for humankind.
Anita Hannig’s “The Day I Die” and Amy Bloom’s “In Love”
(The following appeared first as a blog for End of Life Choices California, an excellent nonprofit on whose board I’m proud to serve. It’s reprinted with pleasure, especially after Hannig told me that our blog resulted in more visits to her website than did her interview with Diane Rehm; I love being mentioned in the same sentence with Diane Rehm.)
Anita Hannig’s The Day I Die: The untold story of assisted dying in America has taken a well-deserved place as the definitive book on Medical Aid in Dying. Want information on how it works? On the history of the assisted dying movement? On the future of legal death with dignity laws? Hannig covers it all, in a book that reads like a personal, informal conversation with the author.
Hannig spoke recently with this reporter about The Day I Die – which is filled with stories of her own experience as a hospice volunteer, and accompanying other volunteers and professionals – and about the work we do at End of Life Choices CA.
“Volunteers are the lifeblood of assisted dying,” Hannig says. “They provide firstline support for families and patients, and it’s hard to overestimate the role they play. In my research, I witnessed how much families and their loved ones leaned on volunteers for their technical expertise but also – and equally importantly – for their human touch and care. In a time of great vulnerability and uncertainty, volunteers help patients navigate the ins and outs of qualifying for the law and accompanying them each step of the way afterward. The emotional labor volunteers put into their work is nothing short of admirable. I have profound respect for their work.”
Hannig, an associate professor of anthropology at Brandeis University, invested five years of study and hands-on involvement in writing The Day I Die. Along the way she accumulated a wealth of stories – poignant, humorous, heart-tugging, enlightening – that she shares in the book.
Looking ahead, Hannig says she wants to be optimistic about the future of the law, “but in the current political (or perhaps judicial) climate I am not sure such optimism is warranted. In the long term, however, I do think that we as a society will gradually move into a direction of granting more rights and freedoms to the dying. My hope is that assisted dying will eventually become legal in all fifty states.”
For now, Hannig says “there are still some misunderstandings about all the different steps someone needs to complete to qualify for assisted dying. Most people think it’s more straightforward than it actually is. Or they wait too long to start the process. Many are still under the impression that there’s a “magic pill,” when in reality the protocol of the medications is quite nuanced and complex. My book talks about the fascinating pharmacology of dying in more detail.”
The Day I Die, in fact, talks about the fascinating work of assisted dying in all its important, often difficult, always rewarding details. It’s a book to read, to keep and to give to those you love.
Amy Bloom’s In Love is a book for anyone facing Alzheimer’s, anyone who knows someone with Alzheimer’s – or anyone who’s ever been in love.
It is, despite the somber underlying theme, a love story.
Bloom writes unblinkingly of her husband’s decision to end his life before Alzheimer’s can pull him into years of oblivion, and her own decision to support him in this quest.
In just the first few pages it’s easy for the reader also to fall in love with Brian Ameche. Bloom writes with warmth and honesty about their love affair, begun while each was committed to someone else and eventually legitimized into a more or less conventional marriage. The handsome Italian architect/ex-Yale football player from a sprawling Catholic family and the celebrated Jewish writer/ teacher/ psychotherapist who share, at least, a dedicated atheism, create a life together bursting with joy. Until his diagnosis.
Brian, who has probably had Alzheimer’s for a few years, finally exhibits enough symptoms – confusion, forgetfulness, erratic behavior – that it can’t be ignored. And he is immediately, defiantly certain that he wants to end his life while he has the wits to do so.
In the U.S., there’s no legal, nonviolent way to accomplish this goal. Even in the 11 states or jurisdictions where Medical Aid in Dying is legal, one has to have a terminal diagnosis and be mentally competent; Alzheimer’s is a disqualifier.
Ameche and Bloom finally settle on Dignitas, a Swiss nonprofit that helps people with terminal illness – including Alzheimer’s – end their lives peacefully. But Dignitas, in addition to the costs of getting to Zurich, has its own strict regulations: certifications of Ameche’s diagnosis, medical information and proof that he’s not just depressed, time-consuming hoops that must be jumped through. The couple set about making it happen, while keeping their plans from all but a necessary few. Toward the end they accomplish the final details – notes to friends and relatives that will be delivered after Ameche’s death, discussions about his wishes, plans for a few celebratory days in Zurich – which do include a celebratory moment or two – and for a friend to be there to fly home afterward with Bloom.
Bloom skillfully weaves glimpses of their romance and marriage, the good and the bad, into the story of their struggle to meet Dignitas qualifications and complete the journey. It’s a remarkable journey, remarkably well told.
(For anyone addicted to audio books, as this writer increasingly is, this one is a special treat: Bloom reads her own words. It’s as if she were telling the reader the tale.)
Though still, I honestly believe, a very good driver, I cannot escape a tiny, nagging question: Could I live with myself if I were involved in an accident in which someone is injured or killed? Even if it were clearly not my fault, could I avoid suspecting some failure of eyesight or reflexive response or yet unknown factor had played a part in an accident that might not have happened if I weren’t driving?
So I have begun this conversation with myself.
It starts with the memory of former conversations, one in particular. For years my three sisters and I discussed who would get our widowed father from behind the wheel of his car (none of us wanted to volunteer.) “Never had an accident in fifty years!” our father would declare. None of us wanted to point out the chaos in his wake. We were saved by a family friend who undertook to explain to our father how much money he could save on gas, insurance, repairs, etc.; he threw in a list of small town neighbors happy to be on-call chauffeurs. My father died 12 years later, at 90, never having injured a fellow creature.
This background conversation relates to the personal relationship I have with my 2001 Volvo S40 The Bud. Less intimate than my relationship with its predecessor LilyPad, a forest green 2000 Volvo S40 that was demolished by a 14-wheeler in 2020. The LilyPad and I were turning right from the right-turn lane; the 14-wheeler was turning right from the center lane blithely unaware of the legal maneuvers of that little car below. I consider it a testament to good reflexes that I was able to get out of his way after he demolished the front of the LilyPad and before he demolished the rear; the driver’s side and I survived unscathed.
But two more years have ensued. The conversation continues:
How certain are you that your reflexes are really as good as safety requires? Suppose someone’s beloved dog darts into the street and you don’t hit the brakes quickly enough. Could you live with that loss — knowing that a better driver might have avoided it?
And how about eyesight? I have, like much of the over-70 population, macular degeneration. Cataract surgery several years ago greatly helped my vision, but still. I have AMD and my eyesight is only going to get worse. At what point do I decide it’s worsened enough?
I think there is no magic moment when one can say, Today I should quit driving. Occasionally a driver receives a signal. My sister Helen, for example, was in her early 70s when she went to get the family car from its parking space in a Boston street lot. Instead of backing up a few feet as she had done countless times before she went forward, rolling to a stop against a sidewalk sign.
Everyone said, “Oh, that’s a common error. Your foot slipped.” “Nope,” said Helen, as she handed the keys to an attendant. “Someone could’ve been on that sidewalk. I put my foot on the wrong pedal. I am never driving again.” She never did.
There are, of course, good drivers in their 80s — I continue to consider myself among them — or perhaps older. There are plenty of bad drivers in their 20s or 30s. But those of us in the older category should be peculiarly attuned to the questions about when we turn from good to bad. It’s unlikely to be one lightbulb moment.
So we might all do well to have the conversation. What are the pluses? All that money I’ll save on no more insurance, gas, repairs (you might figure from the age of my vehicles that car payments are not an issue.) Parking meters. Garage fees. Fastrak fees and miscellaneous tolls. And even as little as I drive it, The Bud is not helping the environment; its namesake worked hard for the planet.
The minus? It comes in handy. There’s the convenience of being able to zip off to the park or the grocery — almost the only places to which I frequently drive. Freedom? A lot of drivers cite their car as a symbol of freedom; actually, I feel most free when walking a few miles, carrying stuff in my backpack.
I live in a city where public transportation is quite good for the most part; taxis and ride shares are everywhere. For what I’d save on the costs outlined above I could take an awful lot of cabs. My father’s small town had no public transportation — but neighbors beat light rail any day.
You can see the direction this conversation is going. Before my next birthday — still nine months off — when it’ll be time for driver’s license renewal and close to time for new smog check, registration etc, I think I will have taken the leap, gotten the airport-effective Real ID, sold The Bud and adjusted to a new life of being chauffeured when necessary.
My baby daughter likes scooters. That would be okay if this were on the playground in 1967 when she was three. But now she is 58 and scooting around in the whizzing traffic of downtown Washington, DC. This is not easy on a mom.
When they were still quite young my children and I adopted a fine system called “Tell me about it afterward. So by the time I learned someone had spent the night alone in the Gare de Lyon because she didn’t have money for a Paris hotel room — well, at least I knew she had survived. This may not be a parenting style appropriate for everyone, but it worked for me. It’s probably still helpful that my children and I live on separate coasts, so our parental notification system continues to be effective.
Now that they’re older, my children’s risk tolerance has receded somewhat anyway. My son flies airplanes, but he’s a careful, confirmed Type A and you will want him to fly your airplane. The fact that he’s nearing retirement and insists on playing pick-up soccer with his buddies — well, that’s for his wife to worry about. (She does. She’s a mom.)
My older daughter, retired and living the good life, is into calmer, low-risk adventures like snow-shoeing and fly fishing. Plus, what she retired from was running her own spin studio so her fitness and safety are not that much of a thing for anybody to worry about.
The baby girl, Pam, though — she may be 58, but she’s still my baby girl — is in a category apart. I have been known to say I raised two yuppies and a free spirit. I made it through a decade or so of Pam’s rock climbing period by diligently not thinking about it. But one memorable time, on a weekend holiday, I found myself at the foot of a sheer mountainside she had recently scaled. (Long’s Peak, 14,259′) Across my brain suddenly flashed an image of my daughter — who is about 5’ tall and 100 pounds wringing wet — a mere speck in the middle of a wall of sheer granite. Sheer terror. But I did at least know she had quit rock climbing after that.
Currently, Pam, a nurse, is living and working in DC. For a while, she had two floors of covid patients. But she survived, along with most of her patients, and on a recent visit, we had the loveliest of times enjoying gentle pursuits like strolling around historic rose gardens and visiting museums. Walking home from the National Gallery, one day when she was working and I was roaming around on my own, I managed to get caught in a sudden rainstorm. (Living in bone dry California one forgets about rainstorms.) I waited it out in a building overhang — having cleverly left my raincoat in the hotel room — until Pam, just getting off work, rescued me with her ever-present umbrella. By the time we got back to where I was staying the rain had somewhat abated and darkness was quickly falling.
Not to worry, she assured me. “I’ll hop a bus right here.” The bus stop was across the street and directly below my third-floor window. “And if a bus doesn’t come along soon I’ll just grab a scooter.” Nurses in DC get a lot of appreciation and free scooters.
The photo above was taken at dusk in the rain from my window. If you squint you can spot a small person in nursing scrubs (no helmet) scanning a scooter lock, or whatever one does in preparation for scootering. It was taken a moment or two before she hopped on, wove her way across three lanes of moving traffic, and turned left toward home. Throwing her mother briefly into cardiac arrest.
Some things, I explained the next day, seeing her still alive and in the bloom of health, are much better left un-witnessed by moms.
The following appeared on my Medium.com site, result of a conversation/sort-of-contest about Life Lessons in Ten Steps. (New & improved versions welcome.)
1 – Start positive. Finding one hopeful thing to focus on can kick-start anybody’s day, especially when there’s not a lot of hopeful going around. Finders keepers.
2 – Pay attention to Mother Nature. The planet needs help: turn off the water, turn the thermostat down if it’s winter and up if it’s summer, eat local. Meanwhile, fight for policy changes.
3 – Move. As long as you’re up, go for a walk. Running is fine – I did that, neighborhood 5k’s, marathon, the whole endorphin thing, for decades. But walking opens up brand new interactions with humankind and the natural universe. Plus, you can pick up litter (see Step 2.)
4 – Listen to your grandchildren. Or anybody under 30. But ONLY if they’re explaining the viewpoints of their generation, or technology. Do not, under any circumstances, let them try to explain – or worse, invite you to try – Tik Tok. Looking at Tik Tok will lower your anticipated lifespan by at least 5 or 10 years. There are kids out there who may never reach adulthood.
5 – Eat pretty. My mother taught me that a colorful plate equals a healthy meal. You know: something yellow, something green, etc. Plus, your lunch guests will think you’re culinarily clever. Chocolate goes with everything.
6 – Do a good thing. A tiny thing, like smiling at a street person (while looking him or her in the eye!) or a bigger thing like accompanying an immigrant to an asylum hearing. Good things may or may not do much for the recipient, but one or two can make your own whole day.
7 – Dump a bad thing. I for one carry around a long list of Oughts, such as I-really-ought-to- call-Suzie-whom-I-don’t-actually-know-and-it’ll-open-up-a- whole-can-of-worms-but-she’s-driving-me-nuts . . . But most of those Suzies don’t even remember your name. Every such person or chore wiped off your contact list/calendar permanently improves your wellbeing.
8 – Go for another walk. You cannot go for too many walks. Or go to the gym, or do yoga or tai chi or anything else that requires putting away your cellphone. There is life without cellphone.
9 – Think positive. See Step #1. There’s plenty of darkness in the world but light overcomes it (thanks, MLK.) Or, to sort-of quote another great philosopher, Emily Dickinson, hope perches in the soul and asks nothing in return.
10 – Be kind. It doesn’t cost anything. In decades of being with people as they die (volunteering with hospice, End of Life Choices CA etc) I’ve never seen a mean person suddenly change and die kindly. I’ve seen a lot of kind people die peacefully. Along the way, the world just needs kindness. It perches in your soul, and reaches into infinity.
After more than six months of near-total drought in Northern California, one cross-country flight to JFK and a side trip to Ithaca provided a reminder of wet stuff from the skies. It’s been easy to forget: by last May, 2022 was the driest year ever recorded in California. We’ve tried everything but the rain dance; and probably there are rain dances going on somewhere. Can we spell Climate Change? California looks as if someone might drop a match and the whole state will go up in flames.
Setting out from Ithaca to Manhattan one August morning, though, things looked promising. Cloudy skies! And we’re not talking fog here! (No offense, Karl the fog.)
Intermittently the skies brightened – enough for glimpses of leaves just starting to turn. Another east coast specialty. (The orange markers were filling in for full fall colors to come.)
Some of parched California’s favorite things? Raindrops on windshields! Especially, as in this case, when someone else is driving. It was possible to watch the raindrops ahead, and to look toward the west where the cloudy skies could be seen breaking up.
And then— rounding another mountain or two, blue skies again. For someone totally, thoroughly heart-transplanted to San Francisco, sunny skies to glorious rains in a six-hour drive across New York is still a gift worth sharing.
I’m simply in love with the San Francisco Main Library. Yes, THAT library, with the rotating cast of questionable characters on one side and tent encampments on another. But how about the gleaming dome of City Hall lending a little majesty to the third side, just across the street from the proper front door?
It’s more of a crush, this thing I have with the Main. Presidio Branch was my true love for decades. It took some wrenching away when we finally broke up, after I downsized to the Western Addition’s neighborhood. But one should love one’s neighbor, and Western Addition and I have built a respectable relationship. It’s far more multicultural, as this new love offers affection in Chinese characters that Presidio barely knew. Plus, proud little Western Addition stakes its sixties-funk architectural claim to my affection in defiance of the multitude of branches in the classic Carnegie style. (Is there a Carnegie style? Well, Carnegie money built a bunch of those lovely branches. They’re just a few of the 1,689 libraries Andrew Carnegie built with his accumulated millions. Hardly an admirable man, but you’ve got to appreciate all those libraries.)
The Main, though, behind its politely classic exterior, has nothing but shiny, multi-floored open arms waiting for love. I mean. Not only the real people just sitting there ready to answer your questions or check out your books, those smiling faces also featured in my other librarian loves. Free wi-fi, with nobody spilling coffee on you! But at the Main are multi-story stairs descending (or ascending if you really want exercise) into floor after floor of collections and attractions. When this brief story appeared on another site (I get sidetracked onto Medium.com) one reader observed, about elevators at the Main, “You can’t get there from here.” I think the architect just intended for everyone to roam. Talking Books & Braille Center on the 2nd floor. Deaf Services Center on the 1st. Music on the 4th floor, History on the 6th. LGBTQIA on floor 3, Jobs & Careers on 4. What’s not to love about The Main Library of San Francisco?
Altogether, the Main is magic-making. Professor Harold Hill, though he might not find his Marian the Librarian, could stage a Music Man for the ages in the heart of downtown San Francisco. I’d be first in line for auditions.
I seldom agree with the good Pope Francis, although we do share a name. (It’s spelled with an ‘i’ for the Franks of the world; Frances is for the Frans & Frannies. This is an educational essay.)
Our disagreements include:
The pontiff would have just about every pregnant woman in the world carry that fetus to term, without a nod toward what else is going on with that woman, her life, her health or her concern for a fetus that’s not viable — all things that seem worth considering before we just ban abortion, period. He and I do read the same Bible, which, by the way, does not mention abortion.
The other cause with which I am deeply involved, the right to control one’s final days when one is near death, is opposed at every turn by Pope Francis and his otherwise perfectly respectable church. Happy side note: In California we have the End of Life Option Act, which was signed into law in 2015 by deeply religious Catholic Gov. Jerry Brown. Gov. Brown opined that he didn’t know if he’d want to make such a choice — using legal Medical Aid in Dying — himself, but didn’t think he had the right to deny others such a choice. And bless his Jesuit heart.
So I follow the goings-on of the aging pontiff with a degree of fellow-Christian skepticism. But here he is, in a recent New York Times, urging compassion for the aged. I would definitely be in agreement with the Vatican on this one; surely we can all get on board for compassion.
As the story evolved, though, the pontiff kept throwing in phrases like “spending time with the old forces people to slow down, turn off their phones and follow a deeper clock;” or “there is a gift in being elderly, understood as abandoning oneself to the care of others.” Full disclosure: I am older than the pope. This is admittedly VERY old, but such is life. Seeing photos of Francis in a wheelchair when I’ve just finished a three-mile walk around the hills of San Francisco evokes a degree of compassion from yours truly.
I just resist giving The Old a blanket bad rap of total decrepitude. Some of us (not me) are still running corporations or making scientific discoveries. Some of us (not me) are still running marathons. Some of us are agitating for reproductive justice, end-of-life choice and world peace — all of which are compassionate endeavors.