Partnering for Today and Tomorrow

crop diverse colleagues stacking hands together during training in office
Photo by Andrea Piacquadio on Pexels.com

Got a partner? Partnering is alive and well, and might still save us all.

Not just the individual partner (lovely construct though that is, and I miss mine!) but partnering on the local, national and global level. What’s heart-warming to see are the innovative ways being discovered for partnering while apart.

Hopefully we’ll be able to revive this at the international level. While America-First-ing for the past three years we’ve pretty much eliminated every partnership that was helping us fight climate change, slow the threat of nuclear destruction, protect the planet’s air and water, little things like that. But may we please not totally un-partner ourselves from the W.H.O. and everyone around the globe working to find COVID-19 therapies or vaccines?

But on the upside! Other partnerships are thriving, innovating and saving lives. My friends Terry and Rich, for example – she’s an artist/printer, he’s a retired physician – are partnering with nonprofits which, in turn, partner with restaurants and food sources, and together (while apart) they are cooking, serving, delivering and feeding hordes of isolated or homeless souls across San Francisco. All over America kids and young people are partnering with faith communities that partner with other nonprofits to shop, run errands and otherwise help homebound seniors. The abounding stories of generosity in partnership can get you through the darkest times.

And even for us homebound/quarantined seniors – probably the last who will be sprung free as things open up – there are new and interesting ways to partner with those on the outside world. If you’ve not already met my favorite current partner, may I introduce you to End of Life Choices California. EOLCCA has, from its beginning, partnered with individuals facing the end of their own lives and considering using the California End of Life Option Act. I’m privileged to have worked as a volunteer in this field for the past several decades, most recently with EOLCCA. Supporting someone who is dying, easing that transition however you can, is a fairly straightforward (and immensely rewarding) task. But when you can’t be there to hold someone’s hand? A remarkable EOLCCA management team quickly perfected a system using communications technology to connect key personnel, critical data and the individual volunteer in order to walk dying individuals and their loved ones through an intricately difficult time. I’ve not done this yet, but reports on early cases are uniformly optimistic and encouraging.

Here’s the bottom line: We’re better off partnered. Even when six feet apart, and hopefully back with our arms around each other one day.  Not “first” or best, solo macho or going-it-alone. Partnered.

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This essay appeared earlier on Medium.com, a good site for information and ideas that I’ve been writing for in recent months. You might want to check it out. (But my Medium thoughts will also continue to appear on this page. Thanks for visiting!

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/

 

 

Cycles of Living and Dying . . .

Sebastian entered the world eight weeks ahead of schedule, weighing all of two pounds. His lineage is Korean/African American/German, which may offer an insight into how determined, individualistic and utterly beautiful he is. He had emerged from NICU (the neonatal unit at Kaiser) and gotten his fighting weight up to nearly six pounds when he first came to visit my husband Bud.

Bud w Sebastian 1.3.19
Sebastian (unimpressed) meets his honorary grandfather

That was about mid-January. In early February, about the 11th, Bud’s congestive heart failure of many decades took a sudden downward turn, and by Valentine’s Day he was in his last hours of life on this planet. Sebastian came to visit – well, he brought his parents too, but they are not central to this story.

His mom plunked Sebastian onto Bud’s chest, as he lay breathing heavily on his hospital bed, red balloons snagged from the downstairs dining room floating around. The last deliberate movement I can associate with my husband as he died was his left arm making a sort-of patting gesture toward the tiny pajama-clad bundle of new life on his chest.

We should all sign up for this: old life ending as new life begins. Seeing life as a natural continuum might not make much difference as we enter, but it could help us take more control of our exit – simply by confronting the fact that we will indeed exit. I like to think that my husband’s last moments were somehow heartened by the certainty that life does, and will, go on.

Bud was fortunate in other ways. Having reached his 90th year, he had been vocal about his readiness to die and had expressed his wishes clearly in writing. There are many good options now: hospice or palliative care, enforceable documents like DNRs and POLST forms (Do Not Resuscitate, Physicians Order for Life Sustaining Treatment,) etc. POLST formAnd in a growing number of states there is a right to confront mortality by hastening one’s dying. In California where I live there is the End of Life Option Act which gives terminally ill, mentally competent adults the right to ask their physician for life-ending medication. For many, that is a way to meet life’s end with extraordinary peace.

A relatively new organization, End of Life Choices CA, is part of this continuum, this big picture of Birth/Life/Death/Peace. EOLCCA provides information and personal support re  California’s End of Life Option Act and all other legal end of life options. It is among several nonprofits dealing with critical aspects of end-of-life care – and helping us all see more clearly that death, like birth, is a universal experience.

When training, recently, to be an EOLCCA volunteer I met a remarkable fellow volunteer named Lori Goldwyn, who may understand both ends of this continuum as well as anyone around. After earning an M.S. degree in Education and working in women’s health for several years, Lori had a homebirth 30 years ago that led her to become a childbirth educator and labor doula. “I came to believe in the value of supporting the natural process as much as possible,” she says, “for both the mother’s and her baby’s sake. A woman in labor contends not only with the pain of labor,” Lori adds, “but with the intensity of realizing that there’s no way out. She can’t escape, quit or divorce this one. The only way out – as is true with the rest of life – is through.”

Eventually the link between natural birth and natural death became clear. “While being with my mother in an inpatient hospice in 2010,” Lori says, “I was struck by the similarities between the birthing and dying experiences.” That epiphany led to her working in hospice and palliative care, as an End of Life Doula, and now also as a volunteer with EOLCCA. Her website, Comings and Goings, reasserts the validity of this continuum with this subtitle about Doulas: Caregivers to those on the threshold points of our Earthly existence.Moon & clouds

“When we get that terminal prognosis, or as we lie dying,” Lori says, “there’s no escaping this reality, this ultimate inevitability.” She quotes the Italian director Federico Fellini: “All we can do is try to become aware that we are part of this unfathomable mystery. We are a mystery among mysteries.”

As he grows, I think Sebastian will also understand this mystery, this continuum, as well as anyone. Sebastian started off in a softly-lit incubator watched over by his mother, a nurse. Weeks later, his honorary grandfather was leaving the planet. And they were able to trade greetings on their journeys.

 

 

On Parenting Aging Parents

Caregiving1         “I thought I would have a life,” Sharon said to me. “My youngest is now in college, my husband is nearing retirement and we thought we would have a life. Instead, I am juggling time with my father – who’s in an independent living facility but is certainly not independent – and my mother who lives alone in the house she’s had for 40 years. My mother is, how do I put this?, needy. Suddenly she needs help with all sorts of things and I have been designated The Helper.”

It was one of the saddest mini-conversations I’ve had in a very long time. I had known  Sharon for less than an hour. She is 54. She was visiting a friend of mine, and this report came when 6 of us were having lunch at the retirement condo where I live. Actually, other than one sixty-something I’ll call Joan, I was the only one in the group older than 54. At 86 I happily accumulate younger friends as often as possible, since the rest of us keep dying off. My lunch guests were talking about what a good spot I am in, especially since my children all live in faraway states.Caregiving4 That was when one 40-something said, “I wish my parents would consider moving to a place like this; they don’t want to leave their big, three-story house, and I’m afraid I’m going to be trying to take care of them there by the time I hit my fifties. And that’s when Sharon chimed in with the comment above: “Yeah, I thought I would have a life . . .” And Joan said, with a wry smile, “Welcome to the club.”

I have another friend I’ll call Robert, a business associate with whom I’m not all that close. But because he knew I was writing this piece he told me a similar story. His parents are somewhat younger than this octogenarian writer, but not that much. They had what my friend describes as “a rather loveless marriage” for more than 20 years, but when it ended – with his father leaving to be with an old sweetheart whom “he probably should’ve married in the first place” – that was the last time they spoke. His mother later found a new partner, and both parents, though neither remarried, were contentedly partnered for many years. Not long ago, though, his mother’s partner died, and at about the same time his father’s partner sold their house (which she owned) and moved to another state to be near her daughter. Robert’s father “now rents a room in a home not his own — surviving on Social Security and a small amount of work— surprised he’s still here because he thought he would be dead 10 or more years ago and did not plan to see his 80s.” So much for life plans.Caregiving5 “Both are alone and needy now, in different, complementary ways,” Robert says. “If they could somehow bring themselves to talk to one another, perhaps they could begin to chisel away at the layers of resentment, hostility and blame that destroyed their relationship.” Apparently this won’t begin to happen any time soon, however, as Robert tells me they maintain no interest in communicating. His mother lives alone in a home she owns and craves companionship; his father has little money left and needs a roof over his head, a more secure one than the stranger’s home in which he’s been unhappily existing for more than two years now. Robert laments they are in a unique position to help each other, if they were open to it. As their only child, Robert sees this as the sensible alternative to driving him crazy. But he also admits they might not reflect upon or even begin to realize just how their current lives affect him.

Two messages stand out: Needy parents, and children going crazy as designated helpers.

These two examples may not be universal, but they are surely not uncommon. The upside is that many such parents have children at least able to help. (Many parents also have children who are delighted to be caregivers, resulting in a blessing for all. I’m just not sure this is often the case.) But consider the aging elderly who have no (available) children and even fewer resources; be grateful if you’re aged and have one or the other. The downside, at least across the U.S., is a growing inter-generational tragedy. My unscientific micro-sampling, conducted over a period of several weeks, turned up a half-dozen youngish Boomers caring (with varying degrees of joy & satisfaction) for septuagenarian or octogenarian parents, and a handful of Gen-X’ers caring for Boomer parents.Caregiving3 Two of the latter have serious financial concerns put this way by one: “So I’m spending my retirement savings on my mom, and – considering my choice not to have children myself – wondering what’s going to happen to me.”

The above, should you want to consider it as such, is an open letter to parents of my generation. Here’s the thing: 100% of us are going to die, which will definitely not be the worst thing that ever happens: just look at all the great people who have already done it. Most of us will need some degree of care by someone, in the months or years leading up to our deaths. Some of us have more choices about our final years than others, but there may be ways to get through our geezerhood without upending our children’s lives – if we talk with them about it.

Caregiving6       It might be a conversation worth having.

 

Life, Death and Rebirth 2019

Note paperThe envelope is lying right here on my left, now looking altogether spooky. It is even stamped and addressed; that’s how close I was to getting a note into the mail.

Then the phone rang. The note was to begin, “So, how are things going? How’s Gerry? How are you holding up?” The envelope is addressed to Gerry’s wife Kathy.

Several months ago our old, dear friend Gerry, age 75, was looking after the horses on their beautiful Southern California ranch when his heart failed. They got him to the hospital, but then came the bad news: his heart could not be revived or repaired. His only option would be a transplant. The good news? Because he was strong and otherwise healthy, he was a good candidate for a new heart. The further bad news? In order to be on the transplant list he would need to remain in the hospital, in intensive care, ready.Heart in circle

Kathy and Gerry are what I would call salt-of-the-earth Good People. They are deeply religious, clean-living and hard-working, and committed to living lives of service and gratitude. Within a few days of Gerry’s diagnosis they found themselves in the unenviable position of waiting for someone, somewhere, to die. Some generous someone who had signed agreements for his organs to be donated. (It would presumably be a ‘he,’ as Gerry is a fairly big guy, and would need a heart coming from someone roughly of equal size and weight.) After talking with Kathy early on in this saga I found myself also having queasy thoughts: How hard should I pray for some good person – do bad people sign organ donor forms? – to die in order for Gerry to live? It is an across-the-board existential dilemma.

The longer he remained in intensive care, the further Gerry’s condition deteriorated. This  presented a scary picture but pushed him higher on the recipient list. In other words, the worse he got, the more urgent his need, the higher his spot on the transplant list. Another existentially fraught situation.

They waited.

New life - typewriterOn August 15 (or perhaps the hours before August 15 dawned,) a 34-year-old man died in another state. A man who was on life support in a hospital because at some earlier point he had taken the generous step of signing organ donor forms. One of Gerry’s doctors flew to that hospital, examined the heart, confirmed it to be a very good match for Gerry, and boarded another jet plane back to Southern California. Gerry was already opened up, his original heart beating – with a lot of help from outside sources – outside his body.

He is already back home. Part of the somehow endearing characteristics of these two old friends of ours is that they do not have email or participate in any social media. So it’s taken Kathy time to get around to calling friends with this lovely update.

Somewhere in the southwest a grieving family is saying goodbye to a 34-year-old they had not expected to lose. “Gerry cries every time he thinks of him,” Kathy says. “There are just no words.”Birthday candles

Other than these: “August 15th is his new birthday.”

 

A Table, and a Day in the Life of Sadness

Table
Table photo 2019

They took the table in the morning. Two hefty moving men who were working in a nearby apartment and agreed to find it a new home. I had had it on Craigslist (for best offer) but got nothing but scammers, so the appearance of these gracious gentle giants was a blessing. The new furniture was scheduled for delivery at 12:30. Carefully they lifted the table around the living room corner and out the door – and only then did I realize I was not ready to say goodbye. Most of life had been lived around that table for the past 26 years. I wanted to run after the moving men and say, “No! Wait!! I changed my mind!!

Who knew grief could come with such a wallop?

And why was I so unprepared? Had I not had the table on Craigslist for a week, and had I not talked with a half-dozen nonprofits who might be able to pick it up next month?

Blue tablecloth
Houseguests 1990s

The table needs to go today, though, because the new furniture is arriving. New furniture chosen in the early weeks of this thing called widowhood. When images of a quarter-century of happiness around a clunky old oak table were an unformed abstract.

As I remarked to countless friends in recent weeks, the only big, clunky thing I ever really loved was Bud. I did not love our big, clunky old furniture. So it had seemed perfectly reasonable to send the aged sofa, chair, giant oblong desk/table etc off to new homes via the San Francisco Recology people and go select some lovely new pieces at Pottery Barn. (“You want to spend a lot of money fast?” I also remarked more than once; “get my daughter Sandy to go with you to Pottery Barn.”)

Bud, Milt, Carol 1993
Old best friends at table (c 1993)

Before the new furniture arrived I had a long-scheduled interview for a newspaper story I was writing. As soon as it was in place there was a San Francisco Contemporary Music Players concert – with the weekend’s concerts dedicated to my good husband. There was very little time to mourn the table. Life goes on, and it is a wonderful life.

Still. At that table for happy decades every morning started with coffee and the New York Times and the San Francisco Chronicle (print editions.)

Pam, Georgia, Caiti 1993
Granddaughter Georgia & friends (c 1993)

Around that table friends gathered for drinks, meals, conversation. Bud posed Tonto, his 1930s childhood doll, for a portrait. Martinis were served. Grandchildren now grown sat in highchairs while the grown-ups had a cold beer. Hands were held as prayers (multi-faith grace at meals for the most part) were said. Goodnights were declared.

Somewhere, for sure, the sturdy oak table is finding a new, happy home for its next half-century or so. May it rest in peace.

bud and tonto1
Purchaser (used, c 1965) of table posing his childhood doll Tonto (c 1930s) on table (c 1995)