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August 24, 2015

Jury Duty: the Good Citizen job

The dreaded envelope arrived. Superior Court of California, County of San Francisco:

You are summoned for JURY SERVICE (capitalization theirs) during the week, and at the place indicated below. Please read the entire summons entirely…

Who has not received – usually with a little dread – that windowed envelope? Because it means a day, or a week, or a month or more of your life has just been appropriated for Citizenship Duty. That is, after all, what Jury Duty is all about: being the Good Citizen. Doing what you can for the greater good of your fellow citizens.

Actually, I have always loved jury duty. Over the years, my jury duty experiences have ranged from the sublime to the ridiculous.

There was the sweet young thing who scammed a few dozen friends and relations out of a few thousand dollars each, and wanted us to believe she really meant just to make everyone rich and didn’t understand why anybody was mad at her. The unanimous vote to convict came by about the time we got seated and organized.

There were times we deliberated to the point of exhaustion, and times I wondered if a better lawyer would have had us voting differently. There were plenty of times I spent a day or two and wasn’t chosen for duty; usually with a great sense of relief.

There was the time, in a jury pool for a domestic violence case, when the defense attorney introduced his spiffed-up client, and addressed the pool: “There could be implications about Mr. Smith… that he had a few glasses of wine…” The attorney smiled knowingly at us, wanting to be sure we’re all grown-ups and what’s a few glasses of wine after all? I was tempted to say, “Man, don’t give me that bull. You don’t want me on this jury, I will so fry your client.” But I asked to be excused, saying I felt personal bias would make it difficult for me to remain open-minded.

The only other time I asked to be excused was when the case involved two corporate entities and some sort of asbestos issue. The judge told us at the beginning that it could run six months. Six months? A couple of corporations wanted 12 citizens (plus alternates) to give up six months of their lives to settle something they should lock their lawyers into a small room to work out? I was beyond irate. The judge invited anyone who felt jury service would be a hardship to come to an adjacent room; virtually the entire pool rose. Uncertain what exactly I would say I began, “My brother-in-law is a chest physician…” and that was as far as I got. “Excused,” said the judge, without looking up. I wasn’t actually very sure where I was going with that explanation, but apparently the judge just wanted to get it over with. I felt sorry for him.

But that’s the way the system works. Good people go to law school, get to be judges and have to sit through all this. More good people give up their time to try to find justice for other good people and perhaps a little justice for the bad guys while they’re at it.

For now, though, I’m opting out. This presents a problem, since apparently you never age out of jury duty and there is no excuse box for Overwhelmed.

One can opt out if under 18, not a citizen, or if one has been convicted of a felony or malfeasance in office. Or if one has a physical or mental disability. None of the above quite worked for me.

At the bottom of the opting-out section, though, I discovered one can be excused if one has a full-time, non-professional obligation to provide care for a related disabled person and alternative arrangements are not possible during court hours. (California Rules of Court, rule 2.1008.)

At last. A reward for the caregiving business. Does caregiving equate to good citizenship? One hopes.

California/Death and Dying/End-of-Life/General interest/geriatrics/Health/Healthcare/Lifestyle/Medicine/San Francisco/seniors

August 1, 2015October 7, 2021

Fighting off dementia

by Fran Johns

Alzheimer’s – already afflicting well over 5 million Americans – is expected to claim more than 16 million of us by 2050 if a cure isn’t found. Today it is at the top of the Bad News list of potential diagnoses for almost anyone over 50. Justifiably so, since the Centers for Disease Control and Prevention reports than one in three seniors now die with Alzheimer’s or other dementia.

That’s the bad news.

The good news, explained recently by Patricia Spilman, M.S. at a sold-out Commonwealth Club event in San Francisco, is that there are things one can to do lower the risk, and perhaps slow the progress of the disease. Spilman, who is Staff Scientist at the Buck Institute’s Bredesen Lab, should know. She has spent more than two decades researching neurodegenerative disease, and has written and spoken extensively on Alzheimer’s and related diseases.

“Forgetting,” Spilman says, by way of reassurance, “is normal. You don’t need to remember where you put the car keys last week, or a doctor’s appointment last month.” And studies – including one by Buck Institute founding President and CEO Dale Bredesen M.D. that is fascinating even for a lay reader – suggest that cognitive decline can be slowed, or in some cases reversed.

Spilman’s prepared remarks consisted largely of useful, realistic advice about how to delay the cognitive decline most of us will experience at some point. The audience, ranging from 20-somethings to more than a few senior citizens, was furiously note-taking throughout (or furiously jotting down questions for the Q&A session to follow.)

Exercise – particularly activities that combine movement and navigation such as tennis or golf – is at the top of the list. “It’s easier if you have a partner,” Spilman suggests, “because this adds the important element of socialization. Walking, plus climbing, is particularly good if you try new routes.” More than a few audience members nodded knowingly when Spilman noted the increasing, widespread dependence on mindless GPS. “Take the opportunity to look at a map,” she said.

Cognitive decline can also be offset by paying attention to the critical need for plenty of sleep. To help with a good night’s sleep, Spilman advises allowing at least several hours between eating and going to bed, and having a dark room. Chronic stress is relieved by a combination of exercise and sleep, along with those other preservatives of gray matter, yoga and mindfulness meditation.

Also good for the brain: almost any sensory stimulation. Music, smells, touch. Spilman cites Oliver Sacks’ Musicophilia: Tales of Music and the Brain, and Norman Cousins’ Anatomy of an Illness, in which Cousins treated himself with comedy as useful reading.

“Do something new every week,” Spilman suggests; “every day. Have goals in later life. Take classes, volunteer, build intergenerational relationships, pursue spirituality, encourage others to change and to grow.”

Computer games can improve cognition also. Spilman did not mention any specific sites, but this writer has enjoyed BrainHQ, and other brainy items from Posit Science’s Karen Merzenich, as well as introductory games on the Lumosity site. Most fascinating of all is the University of California San Francisco (UCSF)’s Brain Health Registry, in which anyone can participate; it’s free, and your brain might wind up helping someone else’s brain one day.

The Q&A segment following Spilman’s talk was fast and full of both personal stories and pertinent questions: “What’s normal decline?” (The difference between not remembering the movie star’s name and not being able to do a job well. You might keep a diary of cognitive function.) “What about genetics – the father-daughter-son factors?” (Yet unproven.) “How about overexposure to electromagnetic fields? (Don’t have unnecessary radiation.) And enough other issues raised for two or three more hours.

No one’s brain, in any event, was idle. Which indicates that everyone in Spilman’s audience was lowering his or her risk of Alzheimer’s.

California/General interest/Lifestyle/Politics & Causes/Religion/USA

June 29, 2015

On Being Instruments of Peace

by Fran Johns

Watching the families of people killed at Charleston’s Emanuel A.M.E. Church repeatedly declare their forgiveness of shooter Dylann Roof was, for many including this writer, somewhat surreal. Seriously? Set aside the rage, grief, unbelief, and go straight to forgiveness?

For some faith traditions, that is indeed possible.

Also possible is the response for good coming out of Roof’s act for evil: removal of an emblem – the Confederate flag I recall seeing on some of my ancestors’ gravestones – from public spaces, and serious confrontation of the racism firmly embedded in U.S. culture. Not just the south, not just in police forces, not just in politics; in the U.S. culture.

One small part of the attempt to confront, and hopefully address, those issues in one small piece of the culture began recently when John Weems, pastor of mainline (if hardly traditional) Calvary Presbyterian Church in San Francisco, got to talking with Bishop Ernest Jackson, pastor of Grace Tabernacle Community Church across town in San Francisco’s largely African American Bayview-Hunter’s Point neighborhood. This conversation led to a group of mostly white Calvary members leaving their 10 AM Sunday service early to join the 11 AM worshippers at Grace Tabernacle. (We were saved from embarrassing Caucasian-ness by one tall African American and one third-generation Chinese American.)

Calvary’s Minister of Spiritual Care Victor Floyd was preaching before the group set out – on a day the long openly gay Floyd said he never thought he’d live to see – and admonished the group that worshipping with Pentecostals would mean staid Presbyterians (the Frozen Chosen, we are commonly called) would have to raise their arms above the level of their waists.

Well, who knew?

The incredibly gracious Pentecostals greeted the chosen-frozen Presbyterians with exuberance. And a forgiveness for our frozen-ness that would probably be understood only by people like the survivors of the Charleston massacre.

“Forgiving is not forgetting,” Bishop Jackson said. “We have little control over what we remember or what we forget.” But he reminded the uniquely mixed group that it is wise to remember “the wrong that harbors no malice.”

There was a great deal of praise music – hands waving, or for the more frozen, clapping, higher than the level of one’s waist. There was some extraordinary dancing by three costumed young Grace Tabernacle women. There was talk about the burden of unforgiveness. And there were parting words of the sort that will bring exactly the change and reconciliation Dylann Roof (for whose immortal soul a lot of great Americans are praying) sought to prevent.

“Thank you,” said John Weems, “for helping us thaw out.”

“We must disconnect,” said Ernest Jackson, “from hatred and racism.

“We are instruments of peace.”

One can only hope.

California/caregiving/Death and Dying/End-of-Life/General interest/Health/Healthcare/Medicine/physicians

June 12, 2015October 7, 2021

When Cure Is Not An Option

by Fran Johns

“Has anybody asked the patient?”

Jessica Nutik Zitter raised her hand to pose that question some years ago, at a “Morbidity and Mortality” conference wherein a room full of physicians were discussing treatment options for a dying patient. The doctors continued to talk about surgery A or drastic measure B. Zitter raised her hand again to say, “Has anybody asked the patient?”

Zitter is now a highly regarded critical care/palliative care physician who speaks and writes often on end-of-life issues. A solitary voice at that “M&M” conference, today she is one of the leading voices for medical care that asks the patient first. It is the care most of us would choose.

Zitter spoke recently at San Francisco’s Commonwealth Club, an event titled “Avoiding the End-of-Life Medical Conveyor Belt.” Her horror stories explain the conveyor belt metaphor, and confirm the immensity of the end-of-life care problem facing us all. The problem is not just with our cultural inclination to ignore death altogether, as has often been written about in this space, or with physicians’ inclination to continue treatment as if death were not an option. It’s both.

Fran & Jessica Zitter 6.9.15 — Jessica Nutik Zitter with Fran Johns

Jessica Nutik Zitter’s stories (a book is forthcoming from Penguin Random House) starkly highlight the death-is-not-an-option attitude unfortunately still common in the medical profession – and the pain and anguish endured by patients who wind up on the conveyor belt as a result.

People will often say, “Take a chance! Maybe God will work a miracle…” Zitter comments, but “the odds are high for (that person’s) being committed to a great deal of suffering and a grisly death.”

Thus the conveyor belt: a patient who is dying and could use a little peace instead winds up undergoing a cruel series of events – resuscitations that mean broken ribs, restored breathing that means a tube thrust down the throat, futile interventions that add to – and prolong – pain and suffering.

Zitter tells of a patient who was essentially “a body,” shrunken and yellowed, being given emergency resuscitation that one nurse likened to torture; and of a man repeatedly taken from the nursing home to the ICU, because he had hand-written a note saying he wanted his life prolonged ‘at all costs.’ “We don’t give people graphic visuals of what those costs may be,” she says.

Asked why doctors don’t practice patient-centered care, Zitter cites two factors – in addition to the imbedded tradition of always providing treatment, and more treatment. One is the need for physicians to get paid for time spent on end-of-life discussion, something that seems perfectly rational but tends to get shouted down in the politicized healthcare arena. The second is equally simple: “If you don’t offer care, someone else will.”

Asked by an audience member about what constitutes good care when cure is not an option, Zitter recommended that decision making in such cases should be made early on. “The possibility to cure gets me up in the morning,” she said, “but helping a dying person achieve a good death is equally satisfying.” While advance directives are useful, she points out, they are not enough. It’s important to talk extensively with friends and loved ones, and to create documents with the help of legal and/or healthcare professionals if possible. (A growing number of individuals and organizations are offering such services.) “But decisions have to start with the patient,” Zitter says. “The patient saying ‘do this’ or ‘don’t do that.'”

Otherwise, it’s onto the conveyor belt.

Authors/California/Education/Family and Friends/General interest/journalism/Lifestyle/Literature/Media/San Francisco/seniors

May 19, 2015

Figuring Out Who You Are

by Fran Johns

“Please don’t call me Doctor Jones,” said an extremely distinguished PhD speaker I met recently; “I’m just a teacher named Joe. I’ve been Joe all my life.” His name is changed to protect the innocent.

Having one name all your life is almost as interesting to some of us… of a certain age… as meeting a prominent multiple-degree lecturer who calls himself “just a teacher.”

Not someone of many degrees, I am nevertheless someone of many names. Maiden name, married name, resumption of maiden name after divorce, brief and ill-fated second marriage (yep, changed my name again,) eventual marriage to my Final Husband, whose name I took on moving across the U.S. nearly a quarter of a century ago. Because I’ve been writing since college (Fran Moreland) I often joke – though this is not a source of pride, only comic relief – that my literary resume reads like an anthology. Each name still bears its own notoriety, as well as its own burdens.

A fascinating look at what names and name changes have meant to women over the centuries is offered by my talented writer/scientist friend Jo Anne Simson in a recent article published in Persimmon Tree magazine titled “What’s in a Name.”

Names, Simson writes, have been used against women in subtle – and sometimes not so subtle – ways to subjugate, control and deny their sense of personhood. Probably the most damning of these practices for women in America was the assigning to slaves the surname of their masters, which “ruptured a connection to a past culture from which they had been torn most unwillingly. Moreover, the name change signified an identity conversion from personhood to property… ‘Leave your past behind. You are now property, not a person.’”

This writer’s post graduate experience ended with an MFA in short fiction, University of San Francisco Class of 2000, which conferred a degree but no title. I have, however, managed to keep my final literary name since 1992.

At about the same time I took on the final marital/literary name above, my first grandchild was born, bringing the other defining ID: Gran. The favorites survive.

California/journalism/Media/Politics & Causes/USA/World Affairs

April 24, 2015

ISIS: What’s In A Name?

by Fran Johns

Remember when Isis was just a Greek goddess? The goddess of – among other things – health and wisdom?

Not many people today would know the goddess, but there are few who don’t know ISIS. According to a new CNN/ORC poll, people in the U.S. consider ISIS a greater threat than Iran, Russia, North Korea, China – or probably even the economic woes of the earlier Isis’ native land.

In an effort to increase understanding of the situation, Celia Menczel of San Francisco’s Commonwealth Club Middle Eastern Affairs group recently assembled a panel of experts to discuss the issue in both human and political terms. Moderated by Media Analyst Dina Ibrahim, the program was titled The Islamic State. Panelists included Honorary Consul General of Turkey Bonnie Joy Kaslan; Kurdish human rights activist Karaman Mamand; University of California, Davis Professor Karima Bennoune, author of the irresistibly titled Your Fatwa Does Not Apply Here; and Jordanian academic Maher Kalaj.

Panelists were invited to give a brief overview of their perspectives. This unfortunately was an impossible assignment; though several panelists made valiant attempts, it turns out that expert views and insights on the Islamic State simply cannot be condensed into ten minutes – if, indeed, a day. The issue is too vast, too complex, too fraught and too weighted with centuries of conflict.

But on one issue there was emphatic agreement: ISIS is not a state.

Kaslan led off her summary with that declaration, and concluded by stressing the importance of this distinction: ISIS, ISIL, SIC, IS, Da’ish is many things, but not a state. Among the many things it is? A terrorist organization; an amorphous group of men who commit unspeakable acts of violence and brutality; a sprawling movement that condones and conducts beheadings, kidnappings, mass executions of religious groups, absolute subjugation of women.

A state, most would argue, involves more than territorial control – which ISIS surely has, in constantly shifting areas – and more than the declaration of power. A state exhibits some degree of care and concern for its people – and the rest of humankind.

Many diverse elements of the troubling terrorist movement were illuminated by members of the distinguished panel, but this was perhaps the key:

Whatever ISIS is, it’s not Islamic to the vast majority of believers in Islam…… and hopefully it will never become a state.

California/economics/Money/Politicians/Politics & Causes/USA

April 4, 2015

Bernie Sanders, presidential candidate?

by Fran Johns

Bernie Sanders, the feisty Vermont senator introduced as “Independent in every sense of the word” isn’t likely to change if he runs for President. And if he does run – a suggestion that brought the evening’s loudest applause during a recent appearance at the Commonwealth Club of California – it should not be dull.

Within the first several minutes of his talk Sanders had ticked off a list of reasons he might indeed be tempted to enter the presidential fray: “Income inequality, planetary challenges, growing disillusionment with the establishment, massive greed, reckless and illegal behavior on the part of Wall Street resulting in millions of people losing their jobs and homes, a corporate establishment that cares only about its own interest…

“The American middle class,” Sanders says, “has been disappearing for the last 40 years. Forty-five million Americans live in poverty. Despite the Affordable Care Act, 35 million are still uninsured. The U.S. is the only major country that does not guarantee healthcare as a right.”

Sanders deplores what he sees as a movement toward oligarchy, with a handful of very rich holding the reins of power. Within that handful are the Koch brothers. Citing their 1980s Libertarian campaign goals, Sanders lists a few expectations of what oligarchic control would bring: abolition of Medicare, Medicaid and the postal service, abandonment of all government welfare, abolition of the minimum wage…

Sanders’ rapid-fire listing of grim possibilities ahead, shared in both his prepared remarks and in the Q&A moderated by San Francisco Supervisor David Campos, had more than an occasional campaign-speech sound. “It would be a very sad state of affairs if Hillary (Rodham Clinton) ran without serious opposition,” he said. Nor does he have much enthusiasm for likely Republican candidate Jeb Bush. “There clearly is something wrong with the political system if we’re not seeing dozens and dozens of vibrant young leaders whose dad wasn’t president or whose husband wasn’t president.”

His own platform would likely have the overturning of Citizens United and movement toward publicly funded election as a primary plank, a change Sanders sees as necessary to restoring democracy to our democratic system. Sharing the top would be fixing income inequality, an injustice he terms obscene and grotesque. “Between 2013 and 2015,” he said, “the 14 wealthiest people – Gates, Kochs, Buffett – saw their wealth increase by $157 billion. Not what they’re worth; increase. That $157 billion is more wealth than is owned by the bottom 40 percent of the American people. One family, the Walton family, owns more wealth than the bottom 40 percent.” Sanders on income inequality is Sanders in a rage against injustice.

The senator also has solutions: make public colleges free, weatherize houses, invest in solar, build a national rail system. Overturn Citizens United.

“The issue is not what happens in Congress,” he says; “it’s what happens in the grassroots. You’re going to have to start listening to the working class, not just billionaire corporations. Mobilize young people to say ‘stop spending billions on the military, spend on education.’

“This stuff is not easy,” the possible-candidate adds. “These guys who have got it all want more.” And Sanders is quick to say that he has few friends on Wall Street, in corporate America or in the military-industrial complex. “But I have seven beautiful grandchildren,” he adds, “and I’ll be damned if they’re not going to live in a country we can be proud of.”

Which sounds a little like he may run for President.

California/caregiving/compassion and choices/Death and Dying/End-of-Life/Healthcare/Lifestyle/Medicine

March 9, 2015October 7, 2021

Dying in the Fix-It Society

by Fran Johns

Buddhist teacher/lecturer Frank Ostaseski spoke recently to the Bay Area Network of End-of-Life Care on the subject of compassion – something Ostaseski preaches, teaches and practices himself. Co-founder, in 1987, of the Zen Hospice Project, the first Buddhist hospice in the U.S., Ostaseski currently heads the Metta Institute, created to provide education and training on spirituality in dying.

Buddhism, Ostaseski said, holds that life is supported by two wings, compassion and wisdom, and neither is at its best without the other. His audience, made up of physicians, hospice workers and others involved with end-of-life care, was in interested agreement with the renowned speaker as he expanded on the theme. But this writer, also in agreement, found one side remark particularly pertinent to today’s end-of-life issues.

Ostaseski spoke of a severe heart attack he suffered not long ago, and of the wisdom gained from that experience. It was insight on critical illness “from the other side of the sheets.” During his hospitalization most visitors, even longtime friends with credentials in compassion, said the wrong things. “They were always saying, ‘It’ll be better tomorrow, Frank,’ when I wanted to talk about what was going on that very moment.” Additionally, Ostaseski found that nurses and doctors “interacted with monitors far more than with the patient.” What could well have been an end-of-life situation was, in short, lacking in compassion and wisdom both.

“Hospitals are fix-it places,” Ostaseski remarked.

We may have gotten fixated on being a fix-it society. Whatever the problem, a chemical or technological answer, in the fix-it society, is instantly sought. We fix brain injuries, once-fatal diseases, missing limbs, and more. But can we let someone who is terminally ill quietly die? Seldom. More often than not we keep trying to fix her with extended interventions, futile and expensive treatments or hospital stays that make dying a horror.

Ostaseski and others are working hard to help people find meaning in their final days, focusing on palliative care. Some, including this writer, are working hard to make medical aid in dying a legal option available across the U.S. ALL of us want a peaceful and compassionate death.

The_flame_of_wisdom — The flame of wisdom

The personal bottom line, yours and mine, is this: eventually we die. If the focus can be shifted away from constantly trying to extend our days, we can fix the final days that lead, one way or another, to the mysterious, inevitable, unpredictable, un-fixable but quite natural end. All it takes is a little compassion, and a lot of wisdom.

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