Quarantined in the Geezer House

Clouds 3.21.20
West view from 7th floor

“Six die, 53 ill at nursing home,” reads the San Francisco Chronicle headline. It follows a similar, recent headline, “Coronavirus: 27 test positive at Orinda nursing home,” and seemingly endless others: “New cases in Alameda County facility,” “Another death at Gateway Manor”. . .  These are the sorts of headlines that the management of my particular senior housing community most fears, and that strike a little dread in the aging hearts of my neighbors and myself. I live in a 12-story assisted living building near downtown San Francisco. It includes some 90 apartments housing singles and a few couples with a median age of, say, 87. That is a random number, chosen only because it puts me in the younger half. I generally refer to our place as the Geezer House, but the marketing materials use slightly more refined wordage. Those materials do not lie: this is not the ritziest senior living place in town, but it would fall in the “upscale” category.

There are hundreds of senior living facilities in the San Francisco Bay Area, ranging from minimum-care to rehab to lifecare to nursing home; all of us are, to one degree or another, the scariest target populations for COVID-19’s quiver of poison arrows. At the center are the nursing homes, source of the horror stories that seem to increase daily; my community is somewhere around the second ring out from the bullseye. Though we are somewhat less vulnerable than nursing homes, if one COVID-19 virus particle managed to sneak into our building it would be Katie-bar-the-door. We’ve had practice runs, with flu or norovirus, but those moved in slowly, two or three new cases per day until the mini-epidemic retreated. With COVID-19 we’re staring down a mystery virus that, in neighboring senior facilities at least, seems to move in and take over in a blinding flash.Covid cluster

Extreme measures are underway to prevent that from happening in my building. Think San Quentin, but with better food. We began with Mayor London Breed’s shelter-in-place decree on March 16; this being San Francisco, Mayor Breed got a three-day jump on Governor Gavin Newsom’s March 19 statewide order. Life in geezer houses took a sharp turn toward confinement at that point. I encountered the new reality head-on when innocently heading out to drop some mail in the box across the street. “If you step out that door,” my friend the concierge remarked, “you must first sign this document.” He handed me a paper declaring that I “understand that by departing (the facility) I am violating Public Health Order No. C19-09, enforced by the San Francisco Police Department” and that I “may be excluded from (the facility) and not re-admitted.” I thought better of mailing my letters.

Birds in treesThere is a stillness here. Sometimes it’s eerily pleasant, the silence broken by birdsong in nearby trees. But often it is ominous. Having worked as a hospice volunteer and with other end-of-life organizations, I know the sudden stillness that is death, and others here have experienced it when losing a loved one. So here we are, in a place where most of us have come planning to stay until we die – and we’d just prefer not to be thinking about it in the middle of a pandemic. Listening to the stillness, watching the quiet streets no longer bustling with cars and people – manages to equate with death and become just a tiny bit stressful.

Life in confinement turns out to be something for which many of us were remarkably ill prepared, and there’s little comfort in knowing we share that woeful lack with millions of fellow citizens and certainly the Trump administration. Comfort is in short supply under social distance guidelines. Most of us here were children during World War II, memories of which have a certain nostalgia: there was shared sacrifice then too, but it felt noble rather than resentful. And there were Mr. Roosevelt’s fireside chats.

FDR 1936
FDR in 1936

I don’t remember the first of these, which was given a few months before I was born, but I well remember some of the last, during the war, when we’d gather around the big Philco radio to hear that deep, cultured voice. Grammatically perfect, unfailingly calm and reassuring. It’s hard not to yearn for such a voice when listening to our current president’s egotistical bombast and vulgar, vicious divisiveness. I think the memories of very different times accentuate the vague feeling among residents of senior living facilities that we are imprisoned against our will.

On the upside for my fellow inmates here and me, our fortress is pretty posh. Three good meals delivered daily in compostable containers, creature comforts like views of the San Bruno mountains to the south, or the San Francisco sunsets from our west windows. On the downside, it is possible to spend days at a time without seeing another human being, other than the masked person who shows up every day to take your temperature. For those of us still mobile there are decidedly other upsides: a small exercise room with treadmill, weights etc, and an outdoor terrace on the second floor (barred gate at the bottom of its stairs.) Walking from one end of the terrace to the other requires 180 steps. The exercise room being too small to accommodate more than one socially-distanced person, I get my best exercise walking from the 7th floor to the 3rd to see if anyone is on the treadmill. Eight or ten of us are also known to go walking at the same time, appropriately distanced, and thereafter to hang out for also distanced but at least human-to-human, conversation – though it does include frequent remarks in the “Did you see who that gurney came for?” category.Treadmill Some of us are more obsessive than others about checking the case/death numbers posted every morning at 9 by the San Francisco Department of Public Health; everyone talks less and less about when the country may “open up.” Or about politics at all, for that matter. Political discussions pretty much begin and end with “What about Trump saying . . .” This place is not a bastion of conservatism.

What’s not heard a lot? Complaints. If we chafe at confinement, we’re grateful to wake up without a fever. Most of us have friends or family in New York, Atlanta, New Orleans or Seattle and we worry about them far more than they need worry about us. All of us have friends or family who are doctors, nurses, first responders and others on the front lines. Somehow, gratitude seems to edge out the fear in our geezerly hearts.

Gratitude - sunrise

This essay also appears on Medium.com, a fine site committed to the exchange of ideas, knowledge and perspectives, on which I’ll be posting in the future. But I’ll still be holding forth right here on franjohns.net. So stick around!

Could We Use a Little Logic in Virus-Fighting?

This space tries hard to avoid overt political issues. But today, with the novel coronavirus sitting in front of our eyeballs on waking and hanging out in our brains throughout the day – whether we happen to be infected or not – it’s almost impossible to avoid how politics impacts the reality of the pandemic. The following is offered just because it seems such a ridiculously obvious way to address the problem.

Recently, this letter of mine appeared in the New York Times:

“At 86, I am absolutely fine with dying — although I’m healthy and active and would not turn down another five or 10 years. So if I wind up with Covid-19, give the ventilator to someone else.

“What bothers me is that if our national leadership had just a fraction of Gov. Andrew Cuomo’s brain, they would follow his very rational advice to send all available ventilators to New York until the curve begins to bend, and then ship them to the next crisis area. Under that system, San Francisco would get an adequate supply in time for my neighbor and me both to survive.”

Covid-19 globeAbout that “give the ventilator to someone else” line. I should say up front that this is not some lofty altruistic declaration. Ventilators are not a lot of fun, and many older patients (one physician friend suggested a scarily high percentage) wind up dead on them anyway. Even for just a few days, lying still with perhaps a hole in my windpipe and for sure a tube down my nose for nutrition approaches torture, in my considered opinion. Lying still would additionally involve being unable to write, communicate or do anything else that makes life meaningful. Thus, compromised with a dangerous virus and probably soon dying alone without loved ones of any sort nearby – no thanks. Shoot me with all the morphine on hand and let me go.

I am a grateful and enthusiastic board member of End of Life Choices California. As such I’m a firm believer in Medical Aid in Dying: the right of terminally ill, mentally competent adults to ask their physicians for life-ending medications. Now legal in nine states and the District of Columbia, MAID will, I hope, eventually be “best practice” for the medical professions. Refusal of a ventilator falls in the category of mechanical aid in dying, of sorts, and why not?

The second, less esoteric issue addressed in my brief letter is simply a plea for national response to the next pandemic – which Dr. Anthony Fauci, may he long survive and prosper, tells us is likely to come with a reappearance of the novel coronavirus in the fall. Assuming it doesn’t start somewhere they’re still convinced it’s a hoax – hello, Mississippi? – maybe we as a nation could adopt a fast and sensible strategy: throw everything we’ve got at the first peep-through, and try to snuff out subsequent peeps-through as fast as supplies can be diverted from the first. My degrees are in Art and Short Fiction, not medicine or policy, and I admit to having only a rudimentary left brain. But how does this not make sense?

I’m just saying.

For more about MAID, and a lot of other good information you can use, I encourage you to visit https://endoflifechoicesca.org/

 

 

On Covid-19, Flexibility and Compassion

Covid-19 globeI don’t know about your neighborhood, but Covid-19 is making life interesting here in the San Francisco Bay Area. Difficult for many, devastating for some, and interesting for the rest of us. As of this writing (I recommend the CDC site for accurate data on other areas, other updates) we have sped past the first hundred confirmed cases in the state, and who knows how many of the 10,000+ Californians in self-quarantine are also my Bay Area neighbors.

This little virus brings with it a large bunch of life lessons. Some of them are shared here, as a public service.

First off (I hate to bring politics ever into this space, but what can you do?) if you ever believed anything said by our commander in chief, this is a good time to mend your ways. Covid-19 is not a Democrat hoax, it is not going to disappear in a short time, you really shouldn’t go to work if you’re sick, a vaccine is at best many months away, and good luck finding those test kits that anybody who wants can get. This is only a life lesson in the sense that, in today’s crazy information-overload reality, Truth is hard to find. So, Life Lesson #1: Seek Truth. Read several newspapers if you still read news. Otherwise, visit the CDC site and scroll through more than one mainstream news source, please; do not believe Facebook will give you Truth. Watch PBS and occasionally Fox News; if one disseminates truth, the other reinforces your neighbor’s version of truth – and we’re all in this together.    Covid-19 greenie

Other life lessons are happier, and equally easy to learn. For instance, at my church we very quickly learned to replace hugs and handshakes with fist bumps and peace signs. Not as much fun, but whatever. The ushers are equipped with bulletins and hand-sanitizer. Choir members last Sunday spaced themselves three feet apart, which looked rather elegant – but they sounded the same, i.e. gorgeous. We also learned translations of the word Covid into Hebrew and Yiddish, which I have already forgotten, and which doesn’t matter anyway since the name was chosen by the World Health Organization thusly: Co and Vi come from coronavirus, D stands for disease and 19 (as in 2019) = the year the first cases were seen. To connect all this: I belong to a Presbyterian church that is heavy into hugs, scientific truth and interfaith understanding.

As to flexibility, this viral pandemic is teaching us, wisely, not to be so rigid about stuff. I was dismayed when the San Francisco Symphony cancelled a concert on my regular series that I really wanted to hear; and the political roundtable at the Commonwealth Club, a favorite regular program at which I always volunteer, similarly disappeared. But symphony season will resume in good time, and do we really need to talk politics late into the evening when it invariably produces nightmares? Sleep is better. That long-planned trip to Tucson in a couple of weeks? Probably not the wisest thing for my octogenarian cardiovascular system. Purpose of trip, however, was to join my daughter for a visit with a childhood friend of hers (whose mother, lost to cancer decades ago, was a good friend of mine) – and they can definitely have a ball without me.

So take deep breaths and wash your hands. We and the planet will survive in good time.

Moon & clouds
 

A Reflection – or Two – on Widowhood

solitary_by_chibbitsuki
Solitary by Chibbitsuki

For the record: widowhood is the pits.

I can say this with some authority, having inhabited this strange new realm for roughly two months now. And though I concede probably 90% of the widows of the world – more, if you count Syria, Afghanistan, Mozambique, etc – are way worse off than I, still I can feel pretty pitiful about it with very little effort at all. Because:

No matter how independent you might have been for how long – and in six wearying years as a caregiver I have surely gotten used to flying solo – there is a weird stigma thing one now feels, as if an indelible W had been surreptitiously stamped onto one’s forehead. Accented by a gray veil that is technically invisible, but all-enveloping. The status is distinctly different from being single, or divorced, on both of which I can also speak with authority. Singlehood and divorce imply a chosen freedom, an aura of devil-may-care, if you will. Unless one all but takes out an ad proclaiming I don’t want this! I need a partner! (been there done that too, I’m afraid) the solo by choice can have a pretty good time doing exactly as he or she pleases.

Widowhood, on the other hand, is the Great Unchosen. (Well, unless you do in an unloved spouse with an axe or something, and choose to spend your widowhood in the penitentiary.)

It is like being suddenly halved. The other side of the bed is too vast and cold; the placemat on the left too perpetually vacant. The ability to spread out the New York Times without knocking over the adjacent morning coffee does not compensate for the darkness spoken by that empty space. Half of you reads the paper and sips coffee; the other half of you waits in vain for commentary on today’s breaking news or for the request for another piece of toast. The toaster isn’t even half functional any more; it only grudgingly accepts the new reality. Doors

Widowhood is forever opening doors onto sadness. Occasional doors open to rooms full of people who feel sorry for you. They’re only being kind, but still. Many doors open into areas of couplehood where you no longer belong. And who can predict how many zillion times you open the door on coming home, calling out greeting and overflowing with tales that can no longer be told — because who can tell tales into a void?

The world shifts and resettles. Life goes on. Widowhood – even for the young, who lose husbands to stupid wars or senseless tragedies – is likely forever, since we females have an unnerving habit of outliving the males of the species. One adjusts, explores new avenues of finding joy.

But it’s still the pits.

A new fight for good death

Kathryn Tucker
Kathryn Tucker

Christie White and Dan Swangard are fighting to live – and also fighting for their right to die: peacefully, at home, surrounded by those they love.

Kathryn Tucker and Nico van Aelstyn are now taking that fight to the Superior Court of the State of California; and it will be a fight worth watching.

Tucker, a distinguished attorney now serving as the executive director of the Disability Rights Legal Center, has already led a number of such battles for peace at life’s end, including defense of the Oregon Death With Dignity Act several times in the early years of that now 18-year-long success story. van Aelstyn has a similarly notable record and an award-winning history of pro bono work on end-of-life issues. Many supporters of end-of-life choice, including this writer, are optimistic about the potential outcome.

But court battles aren’t settled overnight, and White and Swangard know they may not have a lot of time left.

Christie White
Christie White

“My mother will tell you,” White remarked during the press conference announcing the lawsuit, “that from the time I took my first steps I wanted to be in control. I want to be in control. I am adamant about not wanting to die in a hospital, but at home, surrounded by my family. I want to be able to gather my loved ones and meet my death with some dignity and peace of mind.”

Since first diagnosed with non-Hodgkin’s lymphoma and then acute myeloid leukemia or AML Leukemia more than five years ago, White has undergone chemotherapies, radiation therapy and a bone marrow transplant. Because of those prior interventions, her medical options would be severely limited should her leukemia recur.

Dan Swangard, MD was diagnosed with tumor of the pancreas, with metastatic disease to the liver, and had major surgery in 2013. “Not to state the obvious,” he told the press, “but dying is something we all do. It can be loud, quiet, filled with anxiety, pain and suffering, at home or on the road. It can also be peaceful, filled with connections to people we love the most – if planned.”

Swangard has practiced medicine for 22 years. He has also served as a volunteer with Zen Hospice and at Laguna Honda Hospital in San Francisco, experiences that add to his own understanding of what a good death can be.

This lawsuit is about the possibility of a good death for everyone in California. Christie White and Dan Swangard are two good Californians who deserve such an option.