Sir Edward's Choice

It is ironic that while some of us were offering mostly light-hearted comments about how we might choose to die, news circulated  that  Great Britain’s reknowned conductor Sir Edward Downes and his wife had just made that very real decision for themselves.

Sir Edward and his wife Joan, a ballerina before she gave up her own career in support of his and of their family, flew to a Swiss clinic sponsored by the Dignitas organization with their two grown children to end their lives together. He was 85, almost blind and losing his hearing; she was in the final stages of terminal cancer.

I strongly support the right of terminally ill, mentally comptetent adults to hasten their own death. While there is a very distinct line between hastened dying for the terminally ill and “suicide,” it would seem almost cruel to criticize Sir Edward’s choice. And the key word is choice.

What most of us would choose is precisely what Sir Edward and his wife did indeed have: a swift, peaceful end with loved ones at the bedside. Few of us would choose what actually happens too often in the U.S.: prolonged pain and indignity, often a death that follows extended, expensive, frequently futile treatment, in circumstances we would never have chosen for ourselves.

Physician aid in dying, now legal in Oregon and Washington, is one good way to put rational choice back in the hands of mentally competent adults.  The Oregon law has been in effect for over a decade and has proven that such legislation works. It offers comfort and compassion and has not been abused. Efforts to extend this humane law into other states have been vigorously fought by religious groups, but end-of-life choice is just as much a right as is reproductive choice; like other individual rights, it will eventually come.

Given the enormous financial cost of the universal healthcare system most of us want, and the enormous human cost of futile end-of-life treatments and denial of physician aid to terminally ill adults, the time has come for serious dialogue about the right to die.

Sir Edward Downes left a remarkable legacy in his music. A very private man throughout his long life, he nonetheless left another admirable legacy in his poignant death. Maybe those of us over here in the colonies can learn something. Maybe we could at least honor him with a little civilized discourse.

A Novel Idea for Healthcare Reform

Not long ago I attended an event at San Francisco’s Commonwealth Club, featuring a speech by the President’s Council of Economic Advisors Chair Christina Romer. Dr. Romer’s talk, “The Great Credit Freeze and the U.S. Economy,” was all about improving healthcare while slowing down the growth of its cost. We know we can’t reduce costs, she said; what we hope to do is reduce the rate of increase. And one way to contain healthcare costs might be to find out what the patient wants. Imagine.

This observation was not in direct response to a question, but could well have been. Dr. Romer was asked, by more than one audience member, about how to address excessive expenditures at the beginning and end of life. A grossly disproportionate share of costs, she conceded, “are spent on the last six months of life. And one thing we’re not doing enough of is letting patients express what they want.”

If the issue were not so grim and sorrowful it would call for a “Well, duh.”

It would be hard to find many people saying they’d like their last few days on this planet to be spent semi-conscious or in pain and distress, hooked up to a tangle of wires and tubes in a blue-lit hospital room (see Scott Bowen’s post 7/14.) But this is in fact the system we have created: we focus on prolongation of life without regard to quality, we aid and abet doctors who equate death with failure, we never talk about our own mortality as if in silence we can become immortal. Most of us would choose to die at home, properly medicated for pain and surrounded by our loved ones; most of us will die in an institution

Audience members had a wide assortment of questions, and Dr. Romer had plenty more to say. But finding out what the patient wants, and acting accordingly, is surely one excellent path towards better care – and even contained cost growth — and everyone in America could begin that process today.

It is an easy solution, even if only a small, partial solution, to this piece of the muddled medi-puzzle of our healthcare system: talk. Tell your doctors, caregivers, loved ones what you do or don’t want. Write it down. Use the forms universally available (Advance Directives, POLST, others.) You might even wind up with what you actually want in your final days. Christina Romer is on your side.

On Getting Started, and Re-started…

Front pages of the two east coast newspapers that arrive on our west coast doorstep every morning featured references to a few of the primary issues this column proposes to address: staying active and upbeat while confronting one’s mortality; the multiplicity of housing shifts in late generations; and whether one’s life experiences lead to rigidity or understanding.

 

Even the front page of today’s True/Slant, in Scott Bowen’s innovative take on Boston Globe books and publishing writer David Mehegan’s Over and Out, takes up the end-of-life choices question which has consumed much of my time and energies over the past decade and which I tackled (albeit anecdotally) in a 1999 book, Dying Unafraid.

 

Now. If life experience can be applied to mastery of T/S’s technological tools – which are not, after all, quite so daunting as the above – it will be great joy for Boomers &Beyond to explore these through headline grabs, riffs and commentaries and perhaps some lively reader responses. Stay tuned.

 

 

The Joys of Oxalis

Pulling oxalis is one of life’s little abundances. Not because of anything to do with gardening, or weeding, or environmental enhancement. If one looks closely at the issue, oxalis-pulling is an exercise in existential self-care.

I know this because I pull oxalis on a continuing basis. As therapy, you understand, not as enterprise. Weeding, trimming, yard-care all smack of work. An hour or so yanking grass from between pavings and what have you got? Neatness and bursitis. Gardening, if your thumb is the color of mine, inevitably spells sudden death. Pull oxalis, though, and you are in tune with Nature, awash in golden blooms and the smell of childhood. Oxalis hardly even pulls back. It just piles up in luminous green and yellow piles, yankable by the handful, occasionally adding snaky white roots to the spidery threads that connect it to itself (and to every other living plant and flower in your garden.)

Furthermore, no matter how assiduously you apply yourself to oxalis-removal, there will always be more oxalis available when next you need relief.
I know this because I am, you could say, at one with oxalis. Partly because we live next door to the mother lode of oxalis, our neighbors not having ventured into their back yard in recent years and the lode being well enough established that it will be the next millennium before anything else grows there, and partly because oxalis and I understand each other. I understand the benefits of battle, it knows it will always win.

Underneath the dense tangles of oxalis that present themselves everywhere in our yard it is possible to find things like verbena and geraniums and pretty ground cover of yore. When this happens, it is like establishing a tiny bit of order in the world, and Lord knows we need a little order. It is also a temporary victory, something else rare and lovely. In the meantime, the green-and-gold pile grows, everything smells warm and earthy, the compost-collection people are kept busy and the upper body is exercised. Also in the meantime, one can meditate on the meaning of the universe. At the end of the day, one can sit back and admire one’s progress, secure in the knowledge that tomorrow the oxalis will be back.

The relationship between issues most often addressed in this space and the pulling of oxalis may not be immediately evident but I think it all fits. I offer these thoughts into cyberspace because the stock market and our IRAs are tanking, world peace seems unlikely and the globe is warming. With so many uncertainties surrounding us, it is a comfort to know there will always be oxalis.

Singing with Sisters

My sister Mimi and I used to belt out a two-part harmony tune on our way to work in downtown Richmond, VA a few decades back. “Strolling aLONnng… singing a sonnng… side by side.” Nobody threw shoes at us, although some may have considered it. We actually kept the volume down. But the world at any decibel level was our oyster and the sidewalks of a dozen or so blocks between our apartment and jobs – at the Richmond Times-Dispatch and radio station WRNL – our kingdom . That little pop song and a few other seize-the-day tunes got us through dark mornings and small hangovers for an exuberant season or two – and to work on time. I think it was less about the words and music, though, than the two-part harmony and the sheer joy of singing.

Harmony, particularly among women, might be the secret to world peace. Threshold Choirs (three- and four-parts and more) bring peace and comfort to the bedsides of dying folks, a movement that started not long ago with a group of 15 women and has expanded into many states and several countries. Founder Kate Munger dates her inspiration for Threshold Choir to the time, gathered around a Girl Scout campfire, when “we were all singing and everything about the world was wonderful, connected and sweet.” This may not be globally possible any time soon. But the metaphorical image of everyone hunkered around a giant campfire to sing away our problems surely warms the heart, at least for most of us girls. My friend Susan McMane recently returned from Washington with the elite Chorissima group of the San Francisco Girls Chorus , where they helped sing the new president into office; maybe that campfire spirit will catch on.

And back to the strolling-along spirit – “Side by Side” continues thus: “We don’t know what’s coming tomorrow, maybe it’s trouble and sorrow, but we’ll travel the road, sharing our load, side by side.”

Mimi departed this world recently, leaving me seriously bereft but with the two-part harmony permanently in my head. The world is welcome to join in.

Conversations With Cars


Some of us talk to ourselves, some of us talk to cars.

As in a recent parking episode, at the intersection of 9th Street and Bryant in downtown San Francisco. It happened at the precise spot where traffic from the Hwy 101 off-ramp muscles its impatient way into the mainstream maelstrom of 9th Street. I was late for a lunch meeting on Bryant.

“I don’t think I want to go into reverse,” said The Volvo.

I was, at the time, pretty much parallel to the far-right curb in a metered space on one-way 9th. But I was interested in getting a little closer so as to reduce chance encounters with cars making reckless right turns. This required only the slightest maneuvering back and forth, but The Volvo, as I mentioned, was interested only in forth. I eyeballed the off-ramp traffic on the left, and the rather aggressive Bryant traffic dead ahead.

“Oh, please,” I said, inching ever farther into Bryant every time I tried the reverse gear and The Volvo chose not to reverse.

It should be noted that The Volvo, which went only by that uninspired name from the time my husband purchased it, new, was a 1977 two-door stick shift. We had had similar conversations before. “I am, after all, Scandanavian…” it would murmur on days when, left alone in hot sunshine, it would refuse to restart until the cool of evening. Or, “Do you realize you are confirming my image as an old geezer lady,” I would say, gently – well, sometimes not – when it choked up in front of two Yuppies driving BMWs.

Eventually, at 9th & Bryant, I put the thing in neutral, got out, pushed it more or less into a parking place and went to my meeting. Thence I drove it, in forward gears, a few blocks to the Popular Mechanix Volvo place, with which we have a long and intimate relationship.

“I can get home on foot or on the Muni bus,” I said to Jon the P.M. guy and the assorted Volvos hanging around, “but if you by any chance have a loaner it would simplify my day.” Jon understands both Volvos and Volvo owners in distress. Out came a lovely little ’98 number named True Blue. Wayyy fancier than Popular Mechanix’ regular loaners Goldfinger and Black Beauty, True Blue boasted all manner of things I had long coveted: right-side mirror, four doors, automatic everything, functional radio… the works. I sensed right away that we might communicate well.

En route home, while True Blue was beginning a sort of sexual identity epiphany which would lead to knowing herself as The Blue Iris (my favorite flower), we became ardently conversational.

“I could be yours,” she said. And lo, there, affixed to her dashboard was a small card proclaiming, “This Car Is For Sale.” Jon is no dummy.

The next day I signed the adoption papers, and two days later we delivered the ’77 – now fully repaired and running like a Rolls Royce – to the auto dismantlers, where the State of California paid us $650 to get it off the road. I felt a little like I was leaving Great Uncle Philemon at the county home for the indigent. But The Volvo said, “Don’t you work all the time with end-of-life issues? Didn’t you provide palliative care? Doesn’t the time come for many of us when physician-hastened dying is the best choice?”

And Iris said, liltingly, “Hmmmmmm….”

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