No Birthright Citizenship? EEEeeek!

This birthright-citizenship-ending business is getting personal. Surely Mr. Trump has nothing against me exactly – although one can never be sure. I don’t follow his tweets (until they are reported on real news,) but he may have access to my emails. Still, how does he feel about us birthright outliers? And where will we wind up? Stateless?

Birth Certificate - Portugese

They don’t write ’em like this any more. I mean, who even learns cursive?

Here’s the whole story. When I arrived on the planet my mother (along with my father and three older sisters) happened to be in Porto Alegre, Brazil. They’d actually been there for a little more than a decade, my dad helping start a school and my mother teaching music to preschoolers. A dozen or so of the latter were her bridesmaids in tiny matching dresses she made and oh, how I wish I could put my hands on that photo. But back to the birthright.

Since my mother (a legal, if temporary, immigrant) happened to be in Porto Alegre, I was born in the German hospital there. Brazil, being a friendly sort of country, immediately granted me citizenship.

Birth Certificate - US Parents

Will this do, if we axe the birthright citizenship?

 

Not to be outdone, the USA simultaneously granted me citizenship, under the “American Parents Abroad” act. And that, for a number of years, was that. (But is the APA still OK? Should we trust those babies born in shit-hole countries not to be inherently terrorist?)  My family came back to the States when I was too young to have started learning Portugese – more’s the pity; it is a beautiful language. I grew up hardly even noticing my dual citizenship.

Then I reached voting age. When I registered to vote there appeared a mildly ominous-seeming document stating I must renounce my Brazilian citizenship (no dual citizenship allowed in the scary 1950s.) So with hardly a passing thought to my birthright country I renounced it. This might make me okay with President Trump, I guess, though in hindsight it makes me a little sad. And conflicted. Dual citizenship is now possible, and I might want to relocate if things keep going south (or alt-right) in my chosen country.

Fast forward about a half-century. My irreplaceable Final Husband, learning I had never revisited the country of my birth, suggested we should go back. Five minutes later I was on the phone (this was the 1990s, but pre-email) making arrangements and reservations. My favorite exchange was with a hotel reservations clerk in Rio who said, “Oh, you cannot stay one night in Rio. You must stay two, three nights in Rio.” (Which we did.) The primary plan, though, was to visit Porto Alegre, and the Instituto Porto Alegre where my father had famously served.

Passports

My two 1990s passports

 

Initial plans made, we set out for the Brazilian Consulate to obtain visas. “Oh, you cannot travel on a visa,” the nice lady said to me – after granting my husband a visa. “You were born in Brazil; you will need a Brazilian passport.” Which was a little startling, but as it turns out the passport is cheaper than the visa. Small victories. In time, my new passport arrived – in my birthright name, which is not exactly the name on my US passport or airline tickets, but who’s worrying about details?

Me, actually. I figured I might get into Brazil and never get out. But all was well. We visited Iguacu Falls, surely one of the most beautiful spots on the planet (after spending the requisite few nights in Rio and taking photos ostensibly of me but really of the gorgeous girl(s) from Ipanema in the background.) Mostly, I went around smiling at everyone, displaying my passport to sales clerks and waiters and saying muito obrigada – essentially the full extent of my Portugese. Nobody didn’t smile back.

Brazil - Ipanema

Girl from CA; girls from Ipanema

Safely home, things rested for another decade or two. But now our president is saying – constitution be damned – that he might just delete that birthright citizenship. Does he mean just all those murderers and rapists storming the border, or since every immigrant except Melania is a potential terrorist, is he going for retroactive non-birthers? I.e., yours truly?

A quick call to the Brazilian consulate yesterday informed me I am welcome to reinstate my Brazilian citizenship, even if my passport has expired. But now with Mr. Bolsonaro down there wanting to chop down the rain forest – not to mention his political opponents – my alt-birthright country isn’t looking so great either. Still, hedging my bets, I’m hanging onto all these documents. And praying a lot for the whole planet.

Can Love & Prayer Save 2 Small Boys?

My friends Susan and Andy Nelson threw over successful careers (his in law, hers in corporate America) some time ago to join the foreign service. They spent two years in Managua, Nicaragua, two years in Hanoi, and are now representing our country — the very best of our country — in Delhi, India. Susan posted the following on her Facebook page recently. It’s been tugging at my heart every day since; I hope it will tug at yours:

 

Image may contain: 2 people, people smiling, people sitting and food

Chandan and Nandan

Last Friday we received the devastating news that the High Courts of India decided to reunite these two beautiful boys with their physically abusive parents, for a one month trial. Our family sponsors Chandan and we do monthly play dates at the children’s home where they live. The father is out on parole after serving a shorter than expected sentence for murder. And the mom is violent, threatening, and unrelenting in her struggle for power. The boys were forced by their parents to beg as street dancers, like trained monkeys, which is what led to their rescue and move to the children’s home two years ago. The parents will be back in court on Nov 14, fighting for permanent custody. If they win, these kids will slip through our fingers – likely forever. Between now and Nov 14, Andy and I are trying to do anything we can to influence the Court’s decision that day. We’ve reached out to lawyers, reporters, clergy, friends, child welfare advocates, even a Nobel Peace Prize winner – and now I’m reaching out to you. I believe in the power of prayer. And even if you don’t, hopefully we all believe in the power of LOVE. Please shine your love and light into the world for Chandan and Nandan – every day, several times a day, when you lay your head down on your pillow each night, when you wake up and have your morning coffee….PLEASE!

Image may contain: 3 people, including Susan Johnson Nelson, people smiling, people sitting, people eating, table, child, food and indoor

The Nelsons with one Nelson son & his playmates

Please keep these boys in your heart for the next 3 weeks – and send love to them, to their parents, to the courts, to the children’s home where they are loved and where they were safe, to the child welfare watchdogs….to everyone involved! Our love can influence this decision on Nov 14. I believe that. Andy and I are working every angle, chasing every lead or creative idea we can think of, here in Delhi. If you could do the loving part – HARD – we would be forever grateful! Please don’t stop!

 

Seems like prayer, if you’re into praying, and hard loving wherever you stand on prayer,  are easy things to do.

Weird Times and Guardian Angels

“I don’t know where I am,” I said. “I don’t recognize this place.”

“Well, you did get here. Where’s your car? Did you drive?”

“I don’t know how I got here.” And since I also didn’t know where I came from or where I lived, it was not going to be easy to get home.050910-F-MS415-009

My short-term memory had totally, inexplicably vanished

I had just told the story of my long-ago (1956, to be precise) back-alley abortion at a fundraising event for nonprofit TEACH (Teaching Early Abortion for Comprehensive Healthcare) in a San Francisco theater. One five-minute speaker followed me, and the program ended. When we got up to leave – I was on the second row next to my young friend Alexa and her visiting aunt and uncle – I didn’t know how to get to the lobby. Since I had met with other speakers onstage before the event and had led my guests to our seats, something was obviously weird. We finally did get to the lobby, where we had met and visited before the event, and the above exchange took place. At that point something weird turned into something frighteningly wrong.

Alexa left her aunt and uncle to find their own way back to their hotel, summoned a cab and gave the driver my address. Later I would have a dim fragment of memory about being in the cab, and another fleeting memory of entering our building, going up to our condo and then seeing my husband.

“Something’s wrong,” I said. “I need to go to the hospital.” He and Alexa had long since come to that conclusion. She had been texting with one of my children on the east coast and on the phone with my husband since the exchange in the theater lobby. Finding my car safely in its garage space, she had already called a cab to get to the emergency room.  But after that moment of seeing my husband, the next four or five hours are lost to me forever.

Its official name is Transient Global Amnesia. If you have it, it’s a good idea to be among friends.

Since I come from a long line of stroke victims, that had been the immediate fear. But it only took a few tests in the Kaiser ER to rule out stroke, a few more to rule out other serious afflictions and arrive at the diagnosis of TGA. Sometime around 2 AM my conscious memory swam back to the surface of reality, which was Alexa sitting on the side of my bed. Then, with a little help from some drug they gave me, I fell asleep.Guardian angel

Fewer than one half of one percent of people in the U.S. experience episodes of TGA every year. It is most common in people between ages 56 and 75, with the average age being approximately 62 – unless I’ve now upped that by a decade or so. For the victim, TGA is really no big deal. You don’t remember anything anyway; but there’s no pain, no suffering, no after-effect and no permanent damage. All I do remember is the comforting vision of my lovely friend, who is known as my West Coast Daughter (now additionally Guardian Angel), sitting on the side of my bed. I was visited by numerous concerned physicians and nurses, several of whom said they’d never heard of TGA.

But now we all have! Before sending me home the next day the very cautious Kaiser people did an MRI of my head, and lo, my brain was still there. Actually, it was functioning on remote even while I was malfunctioning. When posing the traditional questions about what year it was (Nope, didn’t know) etc the ER doctors asked if I could say who is the president of the U.S.

“Noooo,” I said, “but I know I don’t like him.”

 

A Global Look at Death & Dying

Three things you and I have in common with the rest of the world: We are born, we live, we die.

Lisbon - Conference brochure

Conference brochure

Dying being so universal, it seems appropriate to talk about it. But the truth is we seldom do that, unless it’s happening to somebody else. An interesting group of people who do talk about it got together recently for a global conference in Lisbon I was lucky enough to attend, The End of Life Experience: Dying, Death and Culture in the 21st Century. It was put on by Progressive ConnexionsInterdisciplinary Life, a not-for-profit network registered in the U.K. (Freeland, Oxfordshire) and a successor to the organization that ran earlier conferences I attended in Prague and Budapest. Full disclosure: Part of my motivation for the hard work of creating papers for these events is the mesmerizing pull of Prague, Budapest and Lisbon. That mea culpa is now out of the way.

As end-of life conferences go, this was the best. Not because any great, existential questions were answered, but simply because it proved so eloquently that we’re all in this life (and death) together. We struggle with the same questions about pain, loss and grief; we face the same dilemmas about aging, illness and dying itself. Whatever corner of the planet, whoever we are.

Lisbon - Castelo view

Lisbon at dusk

In my group in Lisbon were a couple of anthropologists, professors of everything from Philosophy to Nursing to English Literature, an actress/storyteller, some doctors & nurses & clinical psychologists, an interfaith chaplain, a textile artist – just lovely people from corners of the planet like Portugal, the U.S., Canada, Malaysia, U.K., Australia. Ordinary people sharing extraordinary insights shared below (and in subsequent posts on this page.) No attention was paid to titles and degrees – a very good thing for me, since an MFA in short fiction wouldn’t exactly be at the top of the list; attention was paid only to the voices, insights and generously shared thoughts. Here’s the first report:

Pain. Nobody gets out of life without pain, and since it’s often a big factor in end-of-life experiences, pain got its share of attention in Lisbon. Conference chair Nate Hinerman (a professor at Golden Gate University in San Francisco) submitted a paper titled “The Death of Hospice” which was in the first conference segment. Because he was committed to keeping to a strict time schedule – and this was a talkative group not easy to settle down – Hinerman skipped the actual presentation of his own paper. But it was appropriate to the broader issues addressed in the first segment, of which I was a part. There are some big questions here.  Pain

“I argue that as boundaries blur between palliative care, hospice care, and patient-centered curative care,” Hinerman writes, “ultimately, palliative care ought to the goal.” Palliative care means, essentially, do everything to alleviate pain – for patient and family alike. Focus on quality of life rather than life-extending treatments and technologies. “Patients do not benefit,” Hinerman says, “from boundaries like those, say between disease-centered care and palliative care. Or say between palliative care and complex chronic conditions management. Or again, especially between palliative care and hospice.”

In other words, are these fine points (which are eternally argued by professional groups – as well as insurance companies) focused on you and me – patient and patient-advocate – or somewhere else? Boundaries get blurred. “We still need policy changes to support this (palliative care) work, and payment structures to ensure coverage of palliative care.” Hinerman says.

Which brings us to another common theme: money. In both the formal sessions and in casual conversations throughout the conference, the issue of the almighty dollar was often raised. The problem of how to pay for healthcare needs is not confined to the U.S. But more common, and more complicated, is the also-universal question of distribution of finances. Such as: if we spent less on the last few days of life – emergency room and intensive care unit costs are significant especially in the U.S. – could we put those dollars to better use somewhere else?

Lisbon presentation

Doing my presentation

My own paper looked at two different models of Continuing Care Retirement Communities in the U.S. One is a church-related not-for-profit community with independent living, assisted living, nursing and dementia units. Newcomers must be mobile and reasonably healthy, and pay a substantial entry fee, but – as my brother-in-law remarked when he and my sister moved into a similar facility in another state, “the advantage is, they can’t throw us out.” The other is a condominium building in which residents own their apartments but buy into the management company, a national for-profit corporation which furnishes meals, assisted living in owners’ apartments, activities, etc. Both have substantial monthly fees; the condominium community’s are higher, but when a resident dies at least the heirs profit from the unit’s sale. CCRCs now number almost 2,000 across the country – and, while fairly well regulated, none of them are cheap. It is a very big business. One of my questions is: should these populations of aging and dying Americans, among the most vulnerable of groups, be caught up in a multi-billion-dollar enterprise? If something comes up that requires a choice between the aging residents and the bottom line, which direction do giant corporations usually go?

After my presentation, which was mostly a group discussion about such choices, a conference speaker from Malaysia approached me to apologize for not having participated. “In my home,” she explained, “if I were to allow my parent to live in one of those places, no matter how nice it might be, it would bring great shame on my family. Our culture mandates that the family take care of its aging members.” Ah, so. In our U.S. culture, that was also true as recently as two or three generations ago; but we have become so scattered, and so technologically and institutionally advanced, that living with family through dying is a rarity today.

All of the above offers more questions than answers. But they are universal questions and worth pondering: When you’re seriously ill and in pain, what kind of care would you choose? Where would you prefer to die, ICU or at home? Where will you spend the retirement years leading until you die? Pondering – and creating written plans – could avoid a lot of grief for you and loved ones alike.

Lisbon conference group

The 2018 EOL Experience Conference Group

 

Next week: The Lisbon Conference: Appearances from beyond the grave

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

in addition to supplying trained providers, and maintaining ongoing public engagement.We need to increase the consumer demand, and at the same time, continue to pursue palliative care with hospital administrators, so that those services can be bolstered.

Aging, Guilt & When to Complain

One of an occasional series on the advancing years

It’s more than a little ominous: 85. I mean, look at all those good people who missed this mark in just the past few months or so: Oliver Sacks, 84 – just barely. Dead Poets Society founder Walter Skold, 57. Peter Mayle, 78. David Cassidy, 67. Stephen Hawking for heaven’s sake, 76. Approaching 85 is its own little why should I still be around anyway? season of guilt.

Guilt - Lachlan Hardy

(Lachlan Hardy)

So perhaps it’s only right that the impending milestone might involve a teeny negative or two. Guilt will do it every time. For me, it’s a nagging suspicion that this party is about to be crashed. On March 15th of my last turn at being 84, for example, I woke up at 5 AM, even before the alarm rang, to catch a flight beginning an overseas adventure. Everything went right. Bags properly packed. Good breakfast. All devices and power cords cross-checked. Problem-free trip to the airport. Zip through security. Thirty minutes before boarding time, when I heard my name being summoned to Gate 11 it was not even a surprise. Probably left my wallet at home, I figured, or someone just called to say the conference had been cancelled. It was so unexpected, this call, that by the time I reached the gate I was fully reconciled to having had too much good fortune for any one day. They wanted to offer me $500 on a future flight if I’d trade my Business Class upgrade. Such is the emotional hazard of approaching 85.

Then there is the limitations business. Pre-80, who worried about acknowledging limits?  Certainly not I. At 72 I signed up to run my first marathon, just because I figured everyone should try to run a marathon before hitting 75.Runner A bout with breast cancer intervened to mess up my training, but I got back on track at least enough to finish the half, feeling absolutely confident I could’ve kept right on going. (Although probably not for another 11 or 12 miles.) And then. One day in Paris, having inched past 80 with no further temptations into distance running, the ominous stairs challenge sneaked up on me. I had only recently moved, at the time, out of a 4-story house in which I was constantly zipping from laundry (ground level) to studio (4th floor) with nary a care. Thinking it would be fun to trip up the circular staircase to the top of Notre Dame right before closing time, I got about 30 steps and decided to let the rest of the group go ahead. More slowly, I climbed another 20 or 30 steps before my little heart said, “I don’t think so.” This would’ve been less embarrassing were not the Notre Dame lookout designed as one way Up, straight across, and one way Down the other side. Luckily for me the concessionaires were just closing up shop and let me follow them down the Up staircase, which is why I did not have to spend the night locked inside the cold stone walls of Notre Dame.Nob_hill_view

Ever since, I have begun to notice limitations on previously-negotiable San Francisco hills. If the heart doesn’t send out alerts, the lungs huff and puff their indignation. This happens a few times to my intense consternation, and I make an appointment with my doctor. I complain a lot. She orders tests that proclaim everything is just fine and dandy. She speaks briefly of the really sick people under her care, mentioning a few of their ages and afflictions. “You’re 84 years old,” she observes; get over it.”

How am I going to complain when I hit 85?

 

 

In Sickness, Health & Clutter

Some weeks ago – I have lost all track of time – I embarked upon an adventure with this year’s Not-the-Flu. Whatever it is. A bug you don’t want to mess with, that much I can tell you. One marker I do have: exactly two weeks and four days ago my good doctor – who assured me it was Not The Flu – estimated I was over the worst of it. Oh, well.Cold

The Not-the-Flu means you skip the chills and aches and fevers of the Real Flu (count your blessings) and you probably won’t die. But you still have the existential horrids and wearies, a little cough, snuffles, sore throat, and mostly you want to pull the covers up over your head and feel very sorry for yourself. This is not easy to do if you’re a fulltime caregiver, as I am, which in my opinion entitles me to feel REALLY sorry for myself. The caregivee, for his part, has spent the past weeks saying – every time I saw a potential opportunity to go back to bed and pull the covers over my head – “Why don’t you do that?”

In between, since the Not-the-Flu saps your energy but leaves your brain functional, you are left with the question of what to do with yourself. Leaving the house is not an option except for utter necessities, because staying away from humankind is #1 on the recovery-plan list. That leaves you to read the newspapers – which can definitely make you sicker – and drink liquids and take vitamins. Boring. OR! You can dig out past, present and future writing projects and finish them all. Then what?Clutter-desk

For me, the obvious answer is to de-clutter. A cleaned-out drawer is far more curative to this writer than a super-size bottle of mega-vitamins. So in an effort to keep myself from going totally stir crazy, I have now plowed through three formerly messy drawers, the box of Christmas cards – – – and my desk. This is not to say that orderliness, a virtue!, is an ongoing trait I can claim. Put stuff in drawers, close the drawer, most of the time I’m fine. But actually going through messes, throwing stuff away and neatening up – as we used to say in the old country – this is balm for my soul. And therefore, cure for whatever ails.Clutter-piles

Not so the caregivee. My excellent spouse thrives on piles. Piles of clippings, notes, magazines, letters, papers, God only knows what is at the bottom of some of his piles. They are everywhere he regularly inhabits, a comfort and balm to his soul. So ever since I undertook to clear out a few piles (and okay, filing cabinets too) in the small formerly-office room into which we plan to install a day bed, it has been acutely painful for him.

The Not-the-Flu presented a tipping point. A few hours sleep, say, between 3 and 7 AM when the caregivee is not always quiet and still as a churchmouse, made the day bed (it’s on order) ever more attractive; confinement to the house increased my neatening-up urges about 300%. Clutter-cornerToday emerged a pristine corner, utterly cabinet/clutter free.

In retaliation, the caregivee did what probably any respectable partner so threatened would do: he came down with the Not-the-Flu. Oh, me.

Hearts - 2

 

Emergency Medicine Then & Now

cartwheels-sq

The author and sister Mimi, circa 1940

We were, I think, about six and eight. My sister Mimi and I came home from somewhere, hot and tired and thirsty. We leaned our bikes against the side porch and ran up to the French door – which was stuck tight, as often happened on muggy days. I gave the door a mighty wham. But I missed the wood frame I was aiming for and my hand crashed through the glass pane. I stood there saying “Oh my! Oh my!” until Mimi, who was wise beyond her years, reached through the hole, turned the knob and shoved the door open. I think I was still “Oh my!-ing” while Mimi lead me through the living room, hallway and dining room to the kitchen, splattering blood along the way. We grabbed dish towels, tied them around my arm, returned to our bikes and headed for the offices of our friend Dr. Enos Ray.

Like most small-town doctors’ offices in the 1940s, Dr. Ray’s office consisted of several rooms adjacent to his home – about 8 or 10 blocks from our house. He stitched up my wound, after listening to the story and rather cleverly asking if we had left a note of explanation for our mother. Oops, hadn’t thought of that. Mrs. Ray obligingly started calling around to see if she could find our mother before she encountered an unexplained bloody scene on coming home from somewhere Mimi and I didn’t remember. Dr. Ray probably sent our parents a bill for $5.

Scar

The scar survives

My memory of the entire  incident ends with the bike ride home, all beautifully bandaged and hoping we would see a lot of friends on the way. But the scar (now getting pretty dim amidst the blotches and mottles of seven+ decades) is a constant reminder of my days with the World’s Best Big Sister and a current reminder of the changes in healthcare over those decades.

 I was re-reminded recently. I am fond of remarking at the slightest opportunity that I still, in my golden octogenarian years, have all my original parts – give or take a few teeth. Two of those unoriginal teeth are in the form of very expensive crowns attached for the last 15 years to a far more expensive (not to mention painfully acquired) implant. Not long ago, they decided to swing slightly outward, without so much as a by-your-leave. After a moment of horror (and gratitude that this happened at breakfast with no one but a sympathetic husband at the table) I realized I could nudge them back to where they belonged. I took to chewing on the other side. I called my good friend, longtime neighbor and fine dentist Richard Leeds. He said I should make an appointment with his implant friend Dr. Chin. “You’ll really like Dr. Chin,” he said. “It’s kind of like going to see the mad scientist. But he’s the best.” So I waited until Dr.Chin returned from vacation. And indeed, despite the very proper and competent staff who welcomed me, there was something of a mad scientist to the good doctor. “Let me just peeeeeer around here,” he would say, reaching for strange radar-beam lights and x-ray machines, studying my jaw from every conceivable angle.

 Eventually, he said, “There’s good news and bad news. The bad news is that you’ll Grinprobably need an expensive new crown. The good news is that the implant is just fine so you don’t need surgery, so you don’t need me.” Whereupon he shook my hand, said it had been a pleasure, and no, there was no charge.

 Later, summoned back to Dr. Leeds’ office – and anticipating future appointments for expensive new crowns – I thanked him for sending me to the charming mad scientist. He said he had a few not-so-mad-scientist ideas of his own. Whereupon he gave me a crash course in types of crowns and types of implants now in use, and explained that he thought he could screw my errant teeth back to where they belonged. The explanation was accompanied by several rather vehement maneuvers, and followed by extensive fiddlings around, bite-checking, tooth-filing and what have you. And lo, I am back to where I started with the non-original teeth and their original compatriots. Dr. Leeds will send a bill for considerably more than $5, but probably thousands less than a new crown would have cost. I could not help remembering the days of the de riguer family doctor and family dentist.

Sadly, it should be noted here that Dr. Ray has long since gone to his rewards, and Dr. Leeds is no longer accepting new patients. But given the precarious state of healthcare in the U.S., I can only be grateful for the extraordinary emergency care (Kaiser Permanente included) this middle-class American has been blessed to receive.

Would that healthcare were such for everyone.