Sunday, November 3, 2013

Death With Dignity

         My mother matter-of-factly told me yesterday that she was no longer going to get mammograms. This proclamation stunned me, coming from my breast cancer survivor mother. My mother has always been proactive when it came to her health. A life-long advocate of vitamins and supplements, she never missed an annual appointment, dental cleaning, or vision exam. She was fastidious about her colonoscopies and Procrit shots. So when she informed me of her new position, I was caught completely off guard. She went on to clarify her perspective: “I am 87 years old. If they find something, I am not going to have an operation to take care of it. And I’m not going to have any long drawn out treatment that will only prolong my illness, that won’t cure me. I will take measures to be comfortable, but I am not being cut into at my age.” That’s my mother. Determined and in control. Always.
         This new declaration came after one she had told me six months previous: That when the time came and she decided she didn’t want to live anymore, she was going to stop eating. “And don’t you try to make me eat. I wont. I’ve read all about it. I’m going to stop eating and I will gently fade away. On my terms.” And that is the way it will be.
         This new realization that she shared with me gave me pause. Not about my mother, because I knew she was right, absolutely. I completely agree with her position. But it made me think about our elderly citizens and questioning if their rights are being met. Are they being allowed to die when they want to die? Do they get to choose how they die if they are suffering from a terminal illness? Do they have to suffer? Should euthanasia or physician-assisted suicide be legalized? This is an unpleasant topic to discuss, to be sure. It’s difficult enough to make arrangements with your parents or spouse for a Durable Power of Attorney, determining what measures should be taken if you are considered brain dead and should be put on a ventilator. Under what circumstances should heroic measures stop? No one likes to think like that. But people who think ahead, people who don’t want family members to be burdened or fraught with the angst of making a life and death decision, plan for exactly that. I know for my mother it gives her great comfort knowing that there is a plan of action that she helped develop. We will do it her way, not what we think she wants, because she told us precisely what she wants. She is in control of her life and her death. And isn’t that the way it should be?
         When Vermont announced last spring that they were joining the ranks of Washington State, Oregon, and Montana, all of which have legalized Physician Assisted Death (PAD) my mother and most of her neighbors in her 50 and above retirement community were very pleased. But there were a few who thought it was wrong. Their religion didn’t allow for that. They were “good Catholics” and the Catholic Church holds “sacred both the dignity of each individual person and the gift of life.”  
         The Church has three binding tenets. It states it is considered an evil action if anyone attempts to kill an innocent person.  “Second, each person is bound to lead his life in accord with God's plan and with an openness to His will, looking to life's fulfillment in heaven. Finally, intentionally committing suicide is a murder of oneself and considered a rejection of God's plan.”  It would be considered murder on the part of the physician. How can a “good Catholic” possibly agree to PAD or euthanasia?
         In the sixteenth century, Thomas More, better known as the Catholic’s Saint Thomas, in describing a utopian community, “envisaged such a community as one that would facilitate the death of those whose lives had become burdensome as a result of ‘torturing and lingering pain’.”  St. Thomas not only supported it, he worked to pursue it.   
         Jack Kevorkian, better known as Dr. Death, made it his mission to help terminally ill patients end their lives. As an advocate for the terminally ill, he challenged the social taboos of disease and dying, and believed that he was helping to end the unnecessary suffering of people. It is believed that he helped 130 people end their lives, and although he was arrested, tried, and found guilty of second degree murder of his last patient, Dr. Kevorkian helped promote the growth of hospice care in the United States and made the medical community more sympathetic to those in unbearable pain. The Detroit Times reported that “Jack Kevorkian, faults and all, was a major force for good in this society. He forced us to pay attention to one of the biggest elephants in society’s living room: the fact that today vast numbers of people are alive who would rather be dead, who have lives not worth living.”
         The American public remains deeply divided on the question of whether to legalize physician-assisted death. Those who oppose it feel that it is categorically wrong to purposefully help someone die. Instead the physicians should offer excellent palliative care to the patient. Palliative care is a team approach that focuses on improving the quality of life for the seriously ill patient and his family. Not only is the patient getting management of their pain and other symptoms by experts, because of their close communication as a team they are able to better navigate an often confusing healthcare system. They are given guidance through difficult and complex treatment options, as well as emotional and spiritual support for the patient and the family. The American Medical Association and American Geriatrics Society are against assisted death. They are apprehensive to link PAD to the practice of medicine for fear of damaging the integrity and image of the profession. The Hippocratic oath states, I will "be of benefit, or at least do no harm." Thus  they believe “Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer.”
         Being labeled as “terminally ill” is a judgment call. Physicians have to weigh all the quantitative and qualitative data and then come to a medical decision about the status of that illness. What if their decision proves inaccurate? What if they haven’t examined all the variables? What if they discount the qualitative data and focus solely on the quantitative data? Will they not arrive at a different decision if the physician downplays what the patient and families have said and instead focuses on blood pressure and urine output? Another physician who focuses equally on both will certainly make a different decision. Take for example a patient with Parkinson’s disease. Parkinson’s Disease is unquestionably a terminal disease. Unless they die from another unrelated cause, they will die as a result of Parkinson’s disease. That’s why the states that allow P.A.D. have stringent guidelines that mandate that an entire team including the patient and family members make those kinds of decisions together.
         Those same questions need to be talked about regardless of your or your loved one’s perspective. For instance you have to consider if you are the patient, when you think it will be the right time to let go. Likewise, religious beliefs are deeply personal. So you and your loved one must consider those deeply held spiritual beliefs in whatever decision is finally made. You have to have that conversation before hand. Because if you don’t know what your loved one’s true desires are, too many things can get in the way; conservatorships, powers of attorney, wishes of other family members who didn’t have that conversation. All of those things can interfere with the patient’s true wishes. Finally, we must reshape our views to acknowledge death as a natural last step in the progression of aging and of disease.

         Providing care for a dying patient is challenging and, when done well, a meaningful and gratifying experience for the physician. To help someone die in comfort, in peace, and with dignity is to give one final gift of life.  No matter what camp you are in, whether it is my mother’s camp ending your life by not eating, or letting nature take its course without intervention, or persuing physican assisted death, you need to have that conversation with your loved one.  You need to have that conversation now.

Tuesday, August 20, 2013

Growing Memories

Growing Memories

Yes, that was me who gleefully shouted last summer, “I have worms!” The land was previously hard clay and I had been working it, digging, adding, preparing it to become a fruitful and productive garden. So worms were a glorious sight.

I love to garden. Not fanatically so, but there is something I get when I’m out digging in the dirt. I get excited about the quality of the earth, its texture, its pungent aroma. The worms!

I look forward to the pile of gardening catalogs that arrive in the mail in the dead of winter. Determining what to plant, where to plant, how many of each to plant, creating my mosaic of nature; it thrills me. I have copious sketches of gardens; maps that I draw with the intention that my gardens will be beautiful and colorful, as well as fruitful. Drawing and planning and perusing those catalogs gives me hope that spring is just around the corner, even though it is months away.

Dad used to have a stack of seed magazines beside his bed. The pile was strewn all over the floor. At hand level next to his can of peanuts, intermingled with Playboys and Down East magazines, he had his favorite, Burpee’s, with dog-eared pages. He too, was a planner.

I reach down for my trowel; holding it in my hand, I give it a jostle to feel the heft of it before I actually start to pummel, loosening up the earth, readying it for planting. The tool looks war-torn-- the varnish is flaking off the handle, and the tines are rusted from being left out in the rain too many times. I recall Dad’s gardening tools. His tools in general were weathered, rusted, dirty, used.

“I don’t give a good God-damn what they look like. They work just fine.”

I believe my gardening gene is from my dad. The desire to garden has become stronger as I’ve grown older. It wasn’t always that way. I hated doing it as a kid; it was a dreaded chore, weeding.  I loathed that on a gloriously hot day my mother would decree that we were going to help Daddy work in the garden. What? I thought. We aren’t going swimming? We aren’t going shopping? We aren’t…pretty much doing anything rather than gardening? My day was ruined.

One time it was so hot as we were working in the garden, I began to feel dizzy. I was parched, dehydrated even. So we all headed into the kitchen for some water. I was standing by Dad’s chair, about to take a sip, when suddenly I found myself in a heap on the floor, and Dad covered in water.

“GODDAMN-JESUS-CHRIST-RED-ROSY-SON-OF-A…” Dad could get fired up, and when he did, the litany of profane language was impressive.

Weeding was cancelled for the rest of the afternoon.

But now, 20 years later,  as I sit amid neat rows  of lush, leafy greens, the sun beating down on my shoulders, listening to the radio, gardening is soothing. The mocking birds and I whistle back and forth in conversation and I just enjoy the relaxation and repetition of the pull, pull, pull of weeds.

Daddy had an enormous garden. It started off relatively good- sized, but as he wanted to try new things it would get bigger and bigger. It began with the usual suspects: tomatoes, bell peppers, carrots, beets, parsnips, squash—oh, all kinds of squash!

And then one year he decided to try some herbs. Basil, sorrel, marjoram, pahz-lee. (Dad was from Maine and had a thick Down East accent.)

“What’s the sorrel for, Dad?”

“Goddamned if I know. Just tryin’ it out, seein’ if it’ll grow.”

And each time he added a new vegetable, or herb, or fruit, he rototilled another row or two, or three, …or four. The garden began in the back yard. We had a lot of land. Our house sat on 2 acres, and then we had 7 acres of field.

“Ralph, I’m not going to have a back yard if you keep adding to that huge, too-goddamn-big-garden,” my mother was heard to exclaim. But that didn’t deter the gentleman farmer. He then created a second garden behind the pine trees in the field.

And being the Maine-iac he was, he began planting potatoes, of course. Rows and rows of  potatoes, which are glorious plants. Even the bugs they attract are pretty. Potato bugs.

“Weeze, c’mon out with me. Let’s pick off the potato bugs.”

And of course I’d go, even if it was to  pick potato bugs, because when Dad invited you to do something, you went along! Even when you were a 30-year old!

And out we’d go, Dad lumbering across the yard in his leather work boots, me barefoot, taking one and a half steps for each of his strides. Under the locust tree, around the peach trees, behind the row of pines toward the westward sky.

Together we grabbed the potato bugs and put them into a container. When the container was full, we’d dump it into the beer can that held an inch or so of kerosene, that Dad kept hanging on a branch of a pine.

“Garden looks good, Dad.”

“Oh yes. The Garden of Eden.”

I’d heard him call it that hundreds of times.

“Come on out and take a look at the Garden of Eden, Herman,” I can remember my Dad saying to his best friend, who was a real farmer.

“God, Ralph, that’s a good lookin’ gahden.” Words that would make my father stand even taller than his six-foot-two frame.

After we finished debugging the potatoes, he’d give me a tour of the garden, showing me the plants, and if they were ready, he would pick the vegetables as we walked by.

“Here, Weeze, try this,” and he’d pop a fresh green bean or carrot into my mouth. A gift from Dad. From him to me. “How’s that taste?”

“Good, except for the dirt on it.”

“Agh, a little dirt won’t hurt ya.”

Daddy always gave gifts from his garden to friends and of course family. We’d go to someone’s house for dinner and Dad would head out to the garden to pick some zucchini or peppers or tomatoes to take with us.

And everyone would rave about the lovely produce. “Oh Ralph, I don’t know how you grow such lovely vegetables. They are just beautiful. Really beautiful.”

My grandmother, Mamie, was Dad’s biggest fan. He’d bring her a cucumber, a tomato, and a single perfectly shaped six-inch summer squash.

“Oh, well, there’s dinner! That’s just the way I like my squash, Ralphie.” And sure enough, she’d steam the squash with just a dab of butter, salt and pepper, and slice the tomato and cuke with a little white vinegar and a pinch of sugar for a dressing. And that was her dinner.

He was a giver of gifts, a sharer of nature, an experimenter of vegetables, my quasi-farmer-dad. I wish I could ask his advice about the damn soaker hose that isn’t working right. I wish I could ask him why my tomatoes had black spots on the bottom. I wish he could hand me a green bean to nibble as we walk. And even though he’s not here, it is in my garden as I hold the handle of the worn old trowel, and sing back and forth to the birds, and of course pulling weeds, that I feel closest to him.

Thursday, June 27, 2013

About Paula

The more I think about it, the more I say I had a knee-jerk reaction about Paula Deen. That’s it, we are not going to her restaurant when we go to Savannah this summer! I will not support her!  

But after being inundated with Paula updates in the news and seeing her interview with Matt Lauer, I’ve changed my mind. Yes, it was very, very wrong of her to use the N-word. And she knows that, owns that, and has apologized for it. She’s embarrassed by her actions. Frankly, I don’t think she’s that good of an actress—I think she truly meant what she said.

After watching the interview on The Today Show, I said to Andy, They can take away all the endorsements they want—she’s going to be just fine. In fact probably better than fine. ”

He  paused to look at me. We then began to make a mental list of all the famous people who had erred and were forgiven, and basically the mishap was forgotten and they came back better and stronger and more popular than ever:

Bill Clinton
Martha Stewart
Kim Kardashian
Rob Lowe
Robert Downey, Jr.
Brittany Spears
Michael Vic
Eddie Murphy
Hugh Grant
Chris Brown
Paul Ruebens

That’s just the short list. We are fickle people.

So rather than just drop her and dismiss her, I wish she could have a meaningful consequence. She should pay a hefty fine to the NAACP or the United Negro College Fund. Or do a PSA about hurting people with words. She should show her remorse by doing community service—she’s a cook, she should prepare food for her local soup kitchen—and not just once, and not with a TV crew filming it! I just think there is a more productive way for her to be repentant.

She’ll be back in a year with a new line of cookware, or a cookbook (Eating Crow?), or a sauce…and people will be buying it.  Heck, Oprah will probably be endorsing it.

Sunday, April 7, 2013

About Writing

“I hate to write. But I like having written.” My husband told this to me, and I remember thinking how odd. He’s an accomplished author, having written nine books and countless articles for journals and magazines, and blogs about writing for the medical professional community. And that’s his side job, so essentially he does this for fun. So how on Earth is it that he, of all people, hates to write?

I have hated writing my whole life. Writing in school was never fun. College papers? All I can say is thank God I was a music major for my undergrad work—two papers in four years! Writing? Hated it!

Well, there have been moments in time where I enjoyed it.  Songs have been rewritten for birthdays, anniversaries, introductions to honorees, and farewells. Ridiculous poems and limericks were crafted—with the help of wine—for celebrations. Plays have been created for retirement parties. Of course the most meaningful writings were the odes to my mother for her 75th and 80th birthdays. And the most difficult were the eulogies for my dad’s two memorial services.

Last May I was told I would be moving from fifth to sixth grade, and I would be the writing teacher for the entire sixth grade. Gulp!  It was shortly thereafter that I determined I would write a blog. After all, if I expected my students to write every day, I should as well.

Lead by example.

Model good writing.

My plan was to do it every day.  Every. Single. Day.

That didn’t happen. I do have a blog, and I have nine entries on it. I realized there was no possible way I would post a new entry every day for several reasons:  A) I have a life.  B) Sometimes the quality of writing was subpar, and I will publish nothing that is not my best.  C ) I had nothing to write about, and I’m not like Seinfeld—I can’t write about nothing.  D) Creating a publishable piece every day is a ridiculous expectation from someone who is not a writer—even more so from someone who hates to write. My students will be gratified.

I hadn’t realized it before, but most days I am surrounded with good writing. I read every day—online pieces, magazines, newspapers, Facebook, or my current Kindle book. I’m a chronic list maker, so I’m able to not only get my thoughts down, but also organize from them. I peruse product labels, recipes, directions, and advertisements. I read shampoo labels as I shower. I play about 20 games of Words with Friends every day.  I never just sit and do nothing. I am steeped in words.

And I require the same from my students. We read an enormous variety of mentor texts and pick them apart for style, words, parts of speech, ideas, transitions—everything. We talk about writing, back and forth, sharing ideas. Writing class seems organic to me as a natural evolution of the spoken to the written  word. We share, we revise, we talk again, we reflect, we change, we write more. We critique kindly, we praise, we refine, we take risks.  Most of all we try.

I write truthfully and primarily from what I know. I want to learn from people who love to write, who think it’s a wonderful, time-honored craft. I want to peek into their brain and see how they think, plan, work, and rework writing. I want to know how to inspire and challenge. I want to know how to grow writers. I want to know how to help them flourish.

They say there’s a fine line between love and hate. I’m now questioning my feelings about writing. Maybe I don’t hate it. Maybe I don’t love it, but maybe I don’t hate it either.
Or maybe, like my husband’s stolen Dorothy Parker line, I actually do hate writing, but I love having written.

Yes, I think that’s it.