A Night in the Emergency Room

“The very first requirement in a hospital is that it should do the sick no harm.” ~ Florence Nightingale

“A hospital bed is a parked taxi with the meter running.” ~ Groucho Marks

“I joke, but only half joke, that if you show up in an American hospital missing a finger, no one will believe you until they get a CAT scan, MRI and orthopedic consult.”  ~ Abraham Verghese

As firsts go it wasn’t exactly my idea of a memorable milestone.  But there I was strapped to a gurney, taking a ride in an ambulance.  And this one came complete with a paramedic in training.  “Do you mind if our trainee treats you today?” one of the paramedics asked?  “No it’s alright; go for it.”

It all started when I came home from the gym and sat down to watch sports.  I felt a crappiness that I'd never felt before.  The wife and I debated what to do and I decided that maybe we just ought to drive down to emergency.  We’d just about got out of town when feeling crappy turned to feeling like ten pounds of shit in a five pound sack.  “You know I’m not feeling at all good.  Let’s just swing around and go back to the fire station.”  

Three firefighters greeted us and led us into the garage where they hooked me up to a cardiogram.  My racing pulse had slowed down and the irregular heartbeat was back to normal.  I was actually feeling a bit better than when we pulled in.  That’s the way it always works isn’t it?  That toothache that felt like a cattle prod in your mouth all day long turns benign the minute the dentist walks in and you end up feeling like a dumb ass.  I tried to beg off of the ambulance ride but I was talked out of it by all three firefighters and the wife. 

Dinner at Mom's: 2nd Course - Fried Meat, Mushrooms, Politics and a Side Order of Fear

Don't you understand, what I'm trying to say?

Can't you see the fear that I'm feeling today?

If the button is pushed, there's no running away,

There'll be no one to save with the world in a grave,

take a look around you, boy, it's bound to scare you, boy,

but you tell me over and over and over again my friend,

ah, you don't believe we're on the eve of destruction. 

~ Eve of Destruction written by P. F. Sloan, recorded by Barry McGuire.

October 1964; probably 3 or 4 times in a month mom put fried pork chops on the menu.  Chops carried more fat back then and so it followed that they carried a hell of a lot more flavor.  Mom would put the pan drippings to good use and make a batch of cream gravy.  Nothing quite like pork chops and mashed potatoes in a bath of cream gravy.  It was the meat and potatoes diet that was starting to undergo scrutiny.  The medicos waved a bony finger at America and warned that fatty red meat, cream, butter and all that frying was going to clog the arteries and bring about a national cardiac crisis.  We were faced with the fear that our diet was killing us.

As so as we cemented our arteries, we watched the dour TV newsmen report on the upcoming presidential election. The GOP had nominated the conservative Barry Goldwater to unseat Lyndon B. Johnson who took office after JFK was assassinated.  It was the dual of initials; LBJ versus AuH2O (the chemical symbols for Gold and Water).  Johnson teetered on the Vietnamese fence by positioning himself as a pillar of war restraint who could still be tough on Communism. It might have been a hard sell against anyone but Goldwater.  The Arizona Senator's tough posture on the Commies translated to acute "hoof in mouth" disease with some propositions that scared the shit out of the electorate. His notion on dealing with Chinese supply lines in Vietnam was to clear them out with "low yield nuclear weapons."  I still recall the GOP campaign slogan touting Goldwater's conservatism, "In your heart you know he's right," being turned by the Democrats to, "In your heart you know he might" (launch a nuke) and "In your guts you know he's nuts." And so as we sat at the dinner table that forkful of dessert hung suspended as we watched with unease and then gasped at Johnson’s campaign ad; a little girl, a daisy and a nuclear mushroom cloud.

Oh yeah, we knew all about mushroom clouds.  Hiroshima and Nagasaki were within my parents’ recent memories and as a kid I remember news footage of those boiling explosions. My grade school friends and I may have been too young to be concerned but we knew all about mega tonnage and we were in awe along with the rest of the world of the Soviet's gargantuan tests. I was 10 years old when Kennedy, Khrushchev and Castro had their atomic pissing contest. It was the Eve of Destruction that Barry McGuire would sing about two years later.

As kids we carried A-bombs in the backs of our minds.  We wondered if the destructive force of a nuke dropped on downtown San Francisco would carry as far south as San Mateo.  My friends and I would ride our bikes around the nearby College of San Mateo, often passing by the stairs that led down to the fallout shelter.  I seem to recall some sense of relief that we had a shelter so close, although in retrospect had the bomb been dropped when class was in session the shelter would have filled up with college students leaving the rest of us to go through the radioactive baking cycle. We knew all about the Strategic Air Command B-52s that hovered round the clock on the outskirts of Soviet air space to deliver retaliation in the event of of a Soviet launch.  We knew that fighter pilots on alert slept in the cockpits of their jets on the tarmacs.  When the sixties began we went through the bomb drills not really knowing what we were doing as we got into a tuck position under our desks.  We giggled and made faces at each other.  By the mid-sixties we probably started to question what the hell good a student desk would do in the midst of a nuclear attack.  Finally, by the end of the sixties as we entered high school we darkly joked that the tuck position was invented to be able to conveniently and easily "kiss your ass goodbye."  And yet there was this perverse fascination, an attraction to the images of nuclear blasts.  The vivid colors and the seeming grace in which the big cloud formed carried a strange and awful beauty. And then of course there was the awesome, hard to imagine power. We were transfixed, but really, who would admit to it?

Practicing to kiss your ass goodbye?

When I look back on the cold war I pause for a moment at 9/11; I recall the general fear that gripped our nation in the hours, days and weeks that followed. It makes me wonder how much fear our parents felt when they knew that destruction and death from above were just a few minutes away.  A nuclear storm could strike Oklahoma City with more destruction than a tornado and about as little warning; or a bomb could topple San Francisco as suddenly as a 7.0 earthquake.  If we kids could sense the danger of nuclear holocaust how much fear dogged our parents?  In some cases it was enough for them to build bomb shelters under the house and then be prepared to lock out the desperate folks who used to be friends and neighbors before the sky started to fall.

The images that left us in awe

In October 1963, just weeks before the election, my parents brought me with them to Washington Square in San Francisco to listen to Johnson preach peace in a stump speech.  LBJ concluded his speech by saying, “For 11 months I have tried to help us have peace in the world, and if I can have your help, if I can have your hand, if I can have your heart, if I can have your prayers, if the good Lord is willing, I will continue to try to lead this Nation and this world to peace." Johnson won the election handily but in the end it didn't work out so well; for LBJ or for America - at least not on the foreign policy front.

America sat at the dinner table that election year and was fed a diet of fear. By Goldwater, the fear of the Red Menace; by Johnson the fear of Goldwater. Not much has really changed has it? Candidates still serve up the fear diet; just in a different flavor.  Soft on Communism has become naive about terrorism. I feel fortunate that as a boy I had a connection to a different time, as my dad would relate to me the calm that FDR tried to deliver to an anxious nation; "The only thing we have to fear is fear itself." Fear is now a permanent ingredient in the campaign recipe. We'll never go back will we? Sad.  

Stump speeches.  I look back at LBJ in Washington Square as irretrievable nostalgia.  Presidential candidates don’t make stump speeches anymore.  They rarely come to California anymore but when they do it's with a purpose irrelevant to the election itself; Republicans know they can’t win here and Democrats know it’s in the bag.  So why would you come to the most populous state in the Union? To meet the people you hope to lead?  To deliver to the electorate your vision of hope for the nation?  Hell no. It’s to appear at a gazillion dollar a plate fundraising dinner.  They go out of their way to appear in front of friendly crowds because protest signs make bad photo ops and heckling a poor sound bite.  Politicians have lied through their teeth for ages.  In the old days you got to see them do it in person - for free, in a big city park.  Now you have to whip out the AMEX, or mortgage the homestead so you can listen to a fellow mortgage his morals at a private dinner in a rich guy's mansion.

And ironically, some fifty years after we were being told that our diet was about as healthy as a glass of hemlock, the stigma has been removed from red meat, starches and heavy cream.  Meat and potatoes have been repackaged as the healthy, salutary paleo-diet.  I suppose that if the diet experts ever tire of analyzing what we eat they can turn to politics.  They seem to be pretty good at flip-flopping and scaring the shit out of the public.
"Wife, we need to get off those damned grains and legumes.  They're killing us.  Whip me up a chicken fried steak with a an order of cream gravy and do it on the double quick"

A Terrorism of Indifference

"I would invite anyone in Washington to come look my patients in the eye and tell them that waiting for a flight is a bigger problem than traveling farther and waiting longer for chemotherapy."  ~  Dr. William Nibley, of United Cancer Specialists in Utah.

It came home to roost this past week.  The IT is sequestration.  You remember sequestration don’t you?  It’s only been about 8 weeks since President Obama and Congress foisted the sequester on the folks they’re paid to serve, and for the most part it’s been almost forgotten; by the public, by the media and most of all by the men and women who are responsible for it.  Perfectly content and comfortable with sequestration conveniently out of the news, they were no doubt equally disappointed when it came back to the headlines with something of a vengeance.

When Things Fall Apart

I’ve achieved a new personal record as we runners like to say.  I now have a small collection of little amber pill jars; 3 actually.  That’s the most I’ve ever had at one time.  My previous personal best in pill jar collecting was two and it usually came after oral surgery; antibiotics and the ever popular Vicodin. 

Lance and Fair Play

“I’m deeply sorry for what I did.” ~ Lance Armstrong.

“He that is without sin among you, let him first cast a stone..”  ~ Book of John; Chapter 8.

Let’s make one thing clear from the start; I loathe drug cheats in sports.  And that’s both ironic and understandable because three of my favorite sports, baseball, cycling and track and field, have made as many headlines about doping as they have about competition. 

Dis-HEART-ened

It’s Tuesday the 8^th and I’m in bed by 7:30.  On a normal evening I would be relaxing after dinner and feeling good about the day’s run.  It’s not a normal evening.  My heart is doing its version of the Macarena or the Rhumba.  It’s pretty much a middle-aged white guy version of one of those dances; or any dance for that matter.  You see, middle aged white guys are supposed to be notorious for not having rhythm; I’m a prime example.  And so that about describes what my heart is doing; it’s beating to no particular beat; out of rhythm.  It’s a condition known as atrial fibrillation.  Those of us with a more intimate knowledge of the disease refer to it contemptuously as a-fib.

Life is Not Fair

The game of life is hard to play
I'm gonna lose it anyway
The losing card I'll someday lay
So this is all I have to say

~  Suicide is Painless (M*A*S*H Theme).  Music by Johnny Mandel, Lyrics by Mike Altman

"Life is not fair; get used to it."
~  Bill Gates

"The world is not fair and often fools, cowards, and the selfish hide in high places."
~  Bryant H. McGill; Author and poet.

Within the short space of a week I was reminded more than once that life is not fair. They came of course by way of that universally respected organ of philosophic discussion; Facebook.  

One was a debate about 49er quarterbacks.  I’d expressed displeasure over Alex Smith, the starting quarterback apparently losing his job because his understudy had performed well the week before while Smith sat out with a concussion.  My contention was that Smith had been playing well over the course of the season and done nothing to lose his status as the starting player.  There was an exchange of opinions over the merits of one player over the other with one poster punctuating his comment with, “Life’s not fair.”

A few days later a friend posted a commencement address made (allegedly) by Bill Gates in which he listed 11 things that they don’t teach you in high school.  Rule number one on the list of Gatesian sagacity was; “Life is not fair – get used to it.”  Ouch. 

Let me make it clear, these weren’t the first times I’ve come across that pearl, “Life’s not fair.”   You hear it all the time.  At times its glib bullshit – something to say when you’ve really nothing more of any substance to add to the conversation.  Other times it’s used as Gates intended; a sort of hardnosed, Darwinian, tough love approach to survival in this veil of tears.

An Open Letter From a Breaking Heart

This is a post written by Calvin Peña.  I met Calvin, who is one of my daughter's friends, through social media.  This post by Calvin started out as a message that he sent me in response to my last post; America Heal Thyself IV.  His words resonated so I asked him permission to publish it as a post.

An Open Letter From a Breaking Heart

Calvin Peña

Even when I was a regular church-goer I never thought I would break down and cry at a Bible verse.  Think again.  I came across a verse in Matthew 25 recently that brought me to uncontrollable tears: "He will reply, 'Truly I tell you, that whatever you did not do for the least of these, you did not do for me." 

America Heal Thyself IV

Final Part

People over Money 

This is the last post of four dealing with healthcare in America.  Before commencing I should point out some important facts about myself to provide perspective.  I’ve always had health insurance through an employer and still do.  I’ve never complained about the premiums or copays.  I would not flinch if my rates or taxes were increased to provide healthcare for each and every citizen.  There are always personal sacrifices that we can make for the good of all.

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.

From The Declaration of Independence.

Of the thirty-three developed nations, thirty two have universal healthcare.  The lone exception is the United States.  How could that be?  In 1776, when America was just a concept a group of patriots signed a document that established as unalienable rights, life, liberty and the pursuit of happiness.  Integral to two of those rights, life and the pursuit of happiness is good health; or at the very least the opportunity for good health. And yet we find ourselves mired in a cantankerous debate over whether we should have universal health care anchored by a robust government system.  If we were a truly civilized society, we would have long ago figured out how to accomplish this. 

Nearly 50 years ago America experienced a similar debate about healthcare.  It was a time when the elderly were tied to their children for survival.  There was no healthcare system in place for the elderly to turn to.  In 1959, George Reedy, the man who 5 years later would become Lyndon Johnson’s press secretary summed up the status of America’s elderly; “Somehow the problem must be dramatized in some way so that Americans will know that the problem of the aging amounts to a collective responsibility.  America is no longer a nation in which grandmother and grandfather can spend their declining years in a log cabin doing odd jobs and taking care of the grandchildren.” Johnson took on the challenge and in 1965, Medicare became a reality.  Oh there was a hue and cry and the alarm of creeping socialism.  Said Ronald Reagan; “If you don’t [stop Medicare] and I don’t do it, one of these days you and I are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.”  Well I’m closing in on the sunset years and I still don’t have a portrait of Joe Stalin on the wall and contrary to Reagan’s dire warning Medicare was actually liberating.  America isn’t bound by the shackles of despotic Socialism but the elderly are no longer tied to their children.  They live longer more productive lives on their own, assured that their medical needs are taken care of. Young families no longer have to wonder what to do with the grandparents when planning the family vacation.  They no longer have to choose between saving for their children’s college education and keeping granny healthy.

Once again we’re in a healthcare debate; this time over universal coverage.  We’re told by conservative pundits that if it’s a government program, it’s bound to fail.  Nothing that the government does ever turns out right.  These are words that come from the self-same individuals who will regale us with the greatness of America; a nation that can accomplish whatever it sets its collective mind to. The nation that sponsored the exploration and opening of the West in the 19^th century, facilitated the carving of a canal in Panama, spearheaded the downfall of Axis tyranny, built the Federal Highway System, funded science research that is second to none, possesses the most powerful military ever known, landed a man on the moon and for decades operated a successful space shuttle.  We did all of these things yet we can’t find a way to make healthcare for everyone a reality? When it’s convenient to make their case, the Palin’s and Limbuagh’s will always decry the incompetence of American government.

At the heart of the debate is money; the rising costs of healthcare; an aging population putting pressure on funding and medical resources; the impact on the deficit.  We’ve been told that to have government sponsored healthcare is not sustainable; that it’s impossible.  I have to believe that finding the means to fund universal healthcare is possible.  This country spends mountains of money on programs that nobody bats an eyelash over.  Consider a military budget that dwarfs the rest of the world.  Our two “potential military opponents” Russia and China have combined military budgets of 142.5 billion dollars a figure that is dwarfed by our budget of 739.3 billion dollars.  And while Mitt Romney is ready to add another two trillion dollars to the defense budget he finds that we can’t afford medical care for the citizenry. 

Investing in the health of Americans is a positive investment but if you're looking for investments to fume over there are plenty out there.  How about Pakistan?  Why did we never have a contentious national argument over doling out some 20 billion dollars to Pakistan? Over the last 10 years we poured money into a nation that not only gave aid and comfort to insurgents fighting against us in the Afghan war, it pretended not to notice a tall Arab terrorist hooked to a dialysis machine living next door to their military academy; and then they were outraged when we killed the man.  But Pakistan was Bin Laden’s friend years before he was on our radar.  That was a time when the Soviets had left Afghanistan and we poured countless millions and more millions into Pakistan while it supported Bin Laden and the precursors to the Taliban. Where was the outrage over giving money to a nation playing us for fools?  We can support a rogue nation that works against our own interests but we’re pennywise and pound foolish with healthcare for our own.    

Over the course of three posts, I’ve not discussed the debate over money.  I’ve not delved into the minutiae over the funding of universal healthcare and I certainly won’t begin here.  That’s because at its very core it is not a money issue, it is a moral issue.  And yet the two, money and morality, have become tragically intertwined.  We’ve come to a hell of a situation in which people cannot afford to get sick. Consider that:

     Crushing hospital and medical bills are the cause of most personal bankruptcies. The results of a 2007 study by the American Medical Association states: Using a conservative definition, 62.1% of all bankruptcies in 2007 were medical; 92% of these medical debtors had medical debts over $5000, or 10% of pretax family income. The rest met criteria for medical bankruptcy because they had lost significant income due to illness or mortgaged a home to pay medical bills. Most medical debtors were well educated, owned homes, and had middle-class occupations. Three quarters had health insurance. Using identical definitions in 2001 and 2007, the share of bankruptcies attributable to medical problems rose by 49.6%. In logistic regression analysis controlling for demographic factors, the odds that a bankruptcy had a medical cause was 2.38-fold higher in 2007 than in 2001. The study also found that; The share of bankruptcies attributable to medical problems rose by 50% between 2001 and 2007.

      People put off medical care until such time that they can afford it. US News reported that a woman in New Jersey had a 51 pound tumor removed.  The tumor was not only malignant; it was putting pressure on her interior vena cava which returns blood to the heart.  The tumor grew to its appalling size not because the woman was obese and didn’t know it was there or because she was chronically stupid.  No she was forced to wait until Medicare kicked in before she could have the required surgery. What would have happened to her if she were not on the cusp of Medicare?

     
And then there are those not as lucky as the New Jersey woman; the ones that simply die; something that Mitt Romney assures us doesn’t happen; “We don’t have people that become ill, who die in their apartment because they don’t have insurance.”  Well according to a Harvard Medical School study, some 45000 people a year die due to lack of medical insurance.  The study also found that uninsured, working-age Americans have a 40 percent higher risk of death than their privately insured counterparts, up from a 25 percent excess death rate found in 1993.

     I imagine that someone could try to make the argument that the study is flawed; the numbers inflated.  Okay let’s grant that the numbers are inflated. From what? 35,000?  20,000?  10,000?  Is there a point where the figure becomes acceptable? If there is then please go to the comments section and fill in the blank.
 

Beware the sanctimonious hypocrites; the so called God fearing folks, Huckabee, Santorum and their apostles, the Tea Party.  Phony Christians and blustering humbugs; they claim a franchise on the defense of life and bloviate about the moral decay of America while their actions and policies expose their meanness and cruelty caring not one fig for a family on the edge of poverty that suffers a parent with untreated high blood pressure or a child with autism and no recourse but to simply soldier on.  It doesn’t touch the souls of these "Christian soldiers" that over 35% of uninsured children go a year or more without seeing a doctor. Carrying a Bible in one hand and a bludgeon in the other their twisted creed distorts Christian charity as creeping Socialism.  An inbreeding of right wing ideology, tub thumping evangelical Protestantism and unbridled paranoia seeks to marginalize “the least of these” as Christ called them.

“Then he will say to those on his left, ‘Depart from me, you who are cursed, into the eternal fire prepared for the devil and his angels. For I was hungry and you gave me nothing to eat, I was thirsty and you gave me nothing to drink, I was a stranger and you did not invite me in, I needed clothes and you did not clothe me, I was sick and in prison and you did not look after me.’

“They also will answer, ‘Lord, when did we see you hungry or thirsty or a stranger or needing clothes or sick or in prison, and did not help you?’

“He will reply, ‘Truly I tell you, whatever you did not do for one of the least of these, you did not do for me.’

The Book of Matthew; Chapter 25; 41 – 45.

In my first post on healthcare I quoted a man’s response to an article on healthcare. He said; “if u want insurance buy it, if not pay Cash..if not, go Die..”  As loathsome as I find that sentiment I have to say that I’ve more respect for this fellow than those that choose to remain behind a veil. 

I’ve long ago grown weary of the whiners on social media bitching about Obamacare and how its going to raise their insurance rates and lighten their bank accounts.  Tough shit. I have someone close to me with type 1 diabetes.  She did nothing wrong except sit by while her pancreas decided to short circuit.  I’ve a wife who’s gone toe to toe with cancer three times, won each time and shown more courage and character than some pudknocker sniveling over having to cut back on his Coors ration because my wife deserves coverage as much as he does.  I’ve a friend with a child who has a heart condition.  I’ve another friend with a quirky thyroid that requires medication.  One with a history of spinal surgeries.  These people are all a job loss away from possibly losing health coverage and losing a chance to thrive, to be productive members of society to love and be loved by their families and of losing those unalienable rights of life and the pursuit of happiness.

And so to those whiners I have a challenge and a parting sentiment.

Your challenge is to become courageous and honest and stand up for your view to the people who would be most affected. Your challenge is to go to a friend with some affliction; you must know somebody; we all do.  Look that person in the eye and say these words; "You know if you ever lose your health insurance I guess it sucks for you.”

And my parting sentiment?  I don’t give a good goddamn about your fucking bank account.   

America; Heal Thyself III

 Third Part in a Series

"Just go to an emergency room"

“People have access to health care in America.  After all just go to an emergency room.”  George W. Bush

Mitt Romney recently echoed Mr. Bush in a 60 Minutes interview. If you have a heart attack “you go to the hospital, you get treated, you get care, and it’s paid for, either by charity, the government or by the hospital.”

“Just go to the emergency room” is a great plan if you have a heart attack, break a limb, have a stroke or get shot. That’s what every rational person does because the emergency room is there for critical conditions that require immediate attention. 

America; Heal Thyself II

 Second Part in a Series 
We Don't Insure a Burning House

I clearly recall the interview that I heard on NPR prior to the 2008 presidential election.  A woman described her efforts to find insurance when she was pregnant.  The charming response from one agent was, "We don't insure a burning house."  By good fortune or the grace of God, her job transferred her to Germany where she immediately was accepted into the health care system and received prenatal and postnatal care.

America; Heal Thy Self I

 First Part in a Series
The Rhetoric

“We are the only industrialized country in the world that does not have national health insurance. We are the richest in wealth and the poorest in health of all the industrial nations.”  ~ Studs Terkel

“If they would rather die they had better do it, and decrease the surplus population.”  ~ Ebenezer Scrooge speaking of the poor. 

Countries with universal healthcare: Norway, New Zealand, Japan, Germany, Belgium, United Kingdom, Kuwait, Sweden, Bahrain, Brunei, Canada, Netherlands, Austria, UAE, Finland, Slovenia, Denmark, Luxembourg, France, Australia, Ireland, Italy, Portugal, Cyprus, Greece, Spain, South Korea, Iceland, Hong Kong, Singapore, Switzerland, Israel. 

 

Richie Batra’s comment was chilling, “if u want insurance buy it, if not pay Cash..if not, go Die..im not worried about anyone but myself and nobody should worry about me either(sic)."  Mr. Batra’s remark was a comment in a thread responding to an article last December in Think Progress covering then presidential candidate Rick Santorum’s Q & A with a group of high school students.

Albert, Carrie and Carl

On this publication date, it’s Albert’s birthday.  He would be 66 today. Coincidentally I’m participating in the Relay for Life in Pinole, California to benefit the American Cancer Association. 

Don't wait to make your son a great man - make him a great boy. 

  

This is a positive story.  But like so many good stories this one has its own gloomy side.  I would completely leave out the tragedy in this story but for the fact that it’s necessary to the telling of the whole; and so we’ll dispense with it at the start. 

Turning the Century

Every now and again we do something that attracts the admiration of some and makes us the laughingstock of others.  There’s skydiving, buying a motorcycle (or if you’re over 50 buying a Corvette convertible), scaling the face of El Capitan and most recently in my case, riding a bike 100 miles; in one day.  A few months back I signed up to do the Livestrong Challenge bike ride in Davis CA.  My co-worker across the hall expressed a fair amount of admiration.  My boss in the office next door thought I was nuts.  And that was more or less the mix; some thought admirable and others certifiable.    

Why We Ride: John

It was hard to hold a conversation.  He would speak a few words and then be interrupted by a cough; a wet, relentless cough, releasing a malicious fluid that gurgled up from deep within his failing lungs; a cough that convulsed his entire, now frail, body for what seemed minutes at a time.  The coughing seizures seemed to last for minutes and left him spent beyond the exhaustion brought on by the illness itself.  I was visiting John at Kaiser Hospital in Oakland.  John was dying.  I knew it, his friends knew it, his family knew it and John knew it.  By this point John was philosophical about it all.  John was dying of lung cancer.

Riding for a Cause

"The most moral act is one which is actuated by disinterested motives...from the viewpoint of the author of an action, unselfishness must remain the criterion of the highest morality."
Reinhold Neibuhr

“If children have the ability to ignore all odds and percentages, then maybe we can all learn from them.  When you think about it, what other choice is there but to hope?  We have two options, medically and emotionally:  give up, or fight like hell.”
Lance Armstrong

"Cancer changes your life, often for the better. You learn what's important, you learn to prioritize, and you learn not to waste your time. You tell people you love them. My friend Gilda Radner (who died of ovarian cancer in 1989 at age 42) used to say, 'If it wasn't for the downside, having cancer would be the best thing and everyone would want it.' That's true. If it wasn't for the downside."

Joel Siegel

Gym Dandy

I just recently joined my sixth, or so, gym.  No, not concurrently; I’m all for fitness but there are limits.  My first gym was Gold’s.  Joined it in the early 80s.  As I’ve gone from gym to gym I’ve noticed that they’ve both changed and remained the same. For one the name has changed.  What used to be a gym is now a fitness center.  I guess the name gym conjures up visions of  boxers and weightlifters in a Spartan testosterone filled room, smelling of sweat and punctuated with the sounds of grunts and clanking weights; intimidating.  They’re now called fitness centers; much more egalitarian.  Gyms, pardon me, fitness centers have modernized, offer more amenities and options and cater to a wider demographic, but one aspect of the gymnasium or fitness center that has never changed is that it is a great place to observe human behavior, sometimes in its most ill-mannered or make you shake your head in disbelief, bizarre forms.

Gyms have always had their own set of theoretical protocols usually associated with taking care of the equipment and also with being courteous to your fellow members.  The real protocol however is to often ignore the theoretical protocols and destroy equipment and disgust your fellows.

Let’s take sweat.  When I joined Gold’s, sweat seemed to be a good thing.  It showed that you are actually exerting yourself.  There was one small form of etiquette that sweat required and that was to put a towel down on that bench you were laying on.  Over the years the level of toxicity in sweat has apparently been on the rise.  That’s because when I joined 24 Hour Fitness in nearby Richmond some years later members were admonished to use a towel to thoroughly wipe down the equipment.  Later I joined Hercules Fitness in the town in which I live and it has dispensers posted around the gym with sanitized wipes to wipe off the equipment.  Most recently I joined my current gym and it has various stations with spray bottles of disinfectant and towels.  I never knew that someone else’s sweat could be so horribly offensive.  Not that I want to bathe in it (well maybe Diane Lane’s but we’ll save that for another post) but c’mon; really?  Sanitizer?  I’ve seen folks, who apparently distrusting the honor of their fellow members, take the sanitizer and wipe down nearly every square inch of a piece of equipment before using it.  Do they ever sit at a park bench that over the years has been shat on by a legion of squirrels and pigeons?  Do they ever hold hands with someone or as my Uncle Al used to call it, swap spit?

I can’t imagine that these sanitized individuals ever go in the locker rooms because I’ve seen some behavior there that’s made me want to crawl into a hazmat suit.

One of the more memorable was at 24 Hour Fitness where some fellow was at the sink shaving his head.  No not a little touch up with a blade but actual locks of hair falling in clumps on the floor around him.  To this day I wonder if he at least had the decency to take a towel and mop up that mess.  I tend to doubt it.

There’s a lot of nudity in the locker room.  A female Facebook friend commented about how disgusting it is to see all of those women walking around naked.  Really?  I don’t know what to say about that.  Maybe I can see her point though.  This happens in the men’s locker room as well.  And it’s not just walking from locker to shower and back to locker.  It’s more like strutting around, brushing teeth, strolling to the bathroom stall, brushing teeth or standing in front of the TV to watch an inning of baseball.  And it’s so often the 300 pound guy with boobs an enormous gut, and a back with so much hair it would make a grizzly bear envious.

Hey buddy can you wrap up in a towel or put on a pair of drawers before shaving in front of the mirror?  Did you know your winky is dangling in that sink that your fellow members might want to use?

And just when I thought that the new gym, uh, fitness cent...screw it you know what I mean, that I just joined has a more mature and well-mannered crowd along came the guy shaving his nether regions in the shower.  But that wasn’t the extent of it because you know how those little hairs can cling so stubbornly to the blade?  He found it necessary to give the razor an occasional vigorous shake to dislodge the little buggers.  Oh look, it’s raining pubes in here.

  

And then a day later; Say sport, is it really necessary to dry your bean with the community dryer?  Really?   I know the device is called a BLOW dryer but I don’t think that’s the job the inventor had in mind. 

When you go to a gym you often see and sometimes get to know a core group of regulars.  That’s except for that one particular time of the year.  For anyone who regularly visits the gym the worst time of the year is that two month period from January through February.  This is time of the resolutionaries; those folks who think that they added a few extra pounds over the holidays but actually have been sedentary, gluttonous sloths for years.  And so as they’re packing in that fifth plate of food at the New Year’s Day all you can eat buffet they announce to the fam that they’ve resolved to join a gym and get back that lithe body that they had 15 or 20 or 40 years ago.  They crowd into the gym, take up equipment time, walk around in a daze, join a class, hire a trainer and wheeze through a month or so of halfhearted workouts until they realize that getting in shape requires work, sweat, some discomfort and yes, real honest to goodness resolve (that’s where the word resolution comes from).  By President's Day they've become discouraged the crowds have thinned and the only folks you see are the regulars you’ve seen every day for months.  

Every gym that I’ve ever belonged to has offered some sort of nutritional option.  When I belonged to a racquetball club back when I was in my early twenties we would sit in the spa and sip beers that the club sold.  Gold’s offered a number of powdered supplements, proteins and carbohydrates and mega-doses of vitamins that, as my dad used to say, you might as well just toss straight into the toilet and cut out the middleman.  Given the times and the number of beefy bodies at Gold’s I would imagine that some independent entrepreneurs offered some injectable options that years later would help to fuck up the baseball record books. 24 Hour offered some energy bars and operated a juice bar.  But it's Hercules Fitness that has taken nutritional options to a whole new level.

The club partners with a young lady who teaches classes in something called cleanse and detox (No, not that kind of detox) that is supposed to remove toxins, parasites and colon build up from your body; sort of an intestinal Drano I guess.  A major component of this program is something called PaleoGreens, a powdered drink mix that is supposed to clean out your guts and cure what ails you.  The website claims that, among other things, it will give you a strong liver, heal the intestines, keep you regular, take care of skin problems, give you stronger hair and nails and accelerate wound healing.  I’ve heard people in the gym talk about PaleoGreens and from what I could gather it tastes like pure shit.  But don’t take my word for it.  I checked a five star review on the website that proclaims, in a classic case of damning with faint praise, “the taste is acceptable.”  Another five star review offers, “If you don't mind the dark green taste, it will be great.”  I’m not sure what exactly a “dark green taste” is but I feel safe in saying that it isn’t something that Bobby Flay is aiming for when he dons an apron.  Maybe part of the problem is that the name PaleoGreens doesn’t exactly stimulate the appetite.  When I hear PaleoGreens the first thing that comes to mind is that picture you see in kid’s dinosaur books of a Brontosaurus with green slime hanging from its mouth.  It amazes me that highly paid, supposedly smart people can get together in a conference room and decide that PaleoGreens would be a great name for a product that they want people to spend their hard earned rubles on and then actually ingest.  I think they should come up with a more appetizing name for the product.  I suggest calling it “bacon.” In fact I would go so far as to suggest tossing the greens and just eating bacon but I don’t suppose that would fly because my toxic, un-cleansed and parasitic gut tells me bacon is a paleo no-no.  I’ll wager that burgers, baloney, bread, booze, steak, chicken, churros, cheese, chocolate, coffee, candy, meat, potatoes, pastries, pasta, pizza, sausage, hot dogs, cookies, cakes, ice cream, an apple, a pear, a plum, a cherry and any good thing to make us all merry and anything else that might be enjoyable to eat are all paleo no-nos’s.  My guess is that the regimen calls for PaleoGreens a couple times a day and a bland tofu, grains and egg white concoction for your “regular” meal.  Call me a know nothing cynical bastard but when I hear PaleoGreens two words come quickly to mind; snake oil.  The website says that PaleoGreens contains grass juices, algae, enzymes, fruits, vegetables and berries.  I’ve an alternate idea; eat your vegetables.  I don’t know what to tell you about grass juices.  I suppose you could just go out to a field and graze.  It isn't really a testimonial but my dog does that now and again and then she vomits; is that the cleanse part?  As for the algae I just happen to have some in my pool at the moment; feel free, I need to get rid of that shit before summer rolls around.  Have you noticed that I’m poking fun at this?  Hey, maybe the stuff works.  You have your daily paleo and a couple of meals that taste like nothing at best and the newspaper at worst and then what? Do men and women grow inches in those places where it’s supposed to count?  Do you leap out of bed every morning ready to take on the world? Can you run faster than a speeding bullet?  Do you notice that your liver is stronger?  I always thought it was a strong son of a bitch to begin with.  Does it add a year or two to your life?  I picture the two octogenarians at the senior center.  One says to the other, “I got to be this old by eating PaleoGreens, grilled chicken, egg whites, chickpea paste and tofu all without seasoning.”  The second one says, “Really?  I ‘ve been eating sausage and biscuits and gravy every morning and having two martinis every afternoon at five.”  And then the first guy says, “Balls.”  The gym, I’m sorry, fitness center that I just joined has energy bars, energy drinks and vitamins.  It also has microwave popcorn and snacks.  If you’re old enough to pay ninety five bucks a month you’re old enough to name your own poison. I think I digressed a bit.  Sorry about that.

You’re probably reading this (well maybe you probably aren’t) and thinking, why does he go to these horrible places called gyms, er, fitness centers?  Well let’s face it, we aren’t amused by good behavior so that’s why I’m writing about the, uh, different behavior.  But in all seriousness gyms are great places.  If you put it to good use with a real sense of resolve a gym can do wonders for you.  I’ve been inspired by folks I’ve met and seen at the gym.  There is my all-time favorite spin instructor who was at one time very overweight.  She basically lost a person and is now a personal trainer.  There is the fellow who I regularly saw at Hercules Fitness.  He was grossly overweight and would struggle through a cardio and weight workout, stopping often to catch his breath but seemed to be making progress when I let my membership expire.  There are the very fit who do some incredibly tough workouts and show some amazing determination.  I highly recommend gyms for everyone at every level.  And not just during January but all year long.  Just do me a big favor.  When you’re shaving?  Put on your drawers and keep your lizard out of the sink. 

Life's Awful Curve

My last post, Dad;Reconnecting inspired some responses that merit not just a reply but an entire post.

In my original, I touched on my dad’s final years and his – our, mine and my wife and childrens’ – battle with dementia and my regrets over how badly I handled it.  In conversation with a couple of acquaintances I found that they also felt regrets over the way in which they dealt with parents suffering dementia.  A high school friend of mine, Susan, left a touching, heartfelt comment and our mutual high school friend, Craig left a kind and comforting response of his own. 

Susan wrote:  “My mom, like your dad, began suffering from dementia a very short time after my dad died. She was such a strong person that she lived too many years with it before finally succumbing. I, too, am filled with regret for the way I handled her illness. I, too, am not proud of the way I handled her situation. I don't have a lot of regrets in my life, but I wish I could have a do-over on that one.”

Craig’s response: “Never regret how you dealt with a parent's dementia. I deal with dementia on a daily basis. Some days I will see each stage of dementia - early silly confusion, one's undeniable fear and trepidation as they realize the harpoon is set, the early failings, the argumentative phase, the wandering phase, the incontinence phase, the placement phase. I no longer see the zombie/coma phase, as I do not do nursing homes any longer. There is no instruction booklet for the process. I see families struggling to 'do the right thing' neither knowing what that is or how to do it. That's because there are no rights and wrongs, strong players and inadequate players - we are all just regular folk shlepping though life who get thrown an awful curve-ball. You take your best swing! That's it. Neither of you did a bad job - there is no such thing. Remember too, that as you felt your inadequacies mount, as the disease progressed, the shell that personified your loved-one lack the insight and memory to either know or recall that they were treated badly. In fact they were not. When your fathers hug you at The Pearly Gates, neither will even mention it. If you apologize, "Poppa I'm sorry I let you down there at the end", your going to make him frown and then smile and wink at you and confess, "You did a great job - a hell-of-a-lot better than I did with my old man. So give us another hug." I will brook no more regret over this ugly, diabolical illness which is impossible to 'handle' well. 'Nuf said!”

In her response to Craig, Susan summed up my feelings, again better than I could express:  “Craig, you brought a tear to my eye with your kind comments! When we're young and in a different place in our lives, we make choices we wouldn't necessarily make later on. (I had a similar conversation with my daughter just a few weeks ago on choices made and possible regrets later.) I don't know how much I would have done differently if my parent was facing dementia today. I know there would be some things done differently, but you're right. We do the best we can at the time, with the knowledge and abilities we have at that time. I can't say I won't continue to have some regrets, but it helps to know I'm not alone when it comes to simply being human and making good decisions and not-so-good ones. Thanks Craig, and Paul, for helping me better understand that I'm not alone.”

As I read their comments again in writing this post the emotions welled up again.  I don’t always respond to comments, though I should, but theirs particularly warrant a response and this post is in part my response.  I’d already planned on writing a post on this topic and I even had some version of, “there’s no instruction book that covers this,” all ready to go but Craig beat me to it and said it all so much better than I could.  While he didn’t say as much, I’m certain that Craig’s daily encounters with dementia come through his work as a physician. 

I’m 58, about the age my dad was when he was starting to forget things and become flustered.  I’ve reached that point at which I ask myself, how will I age?  It’s a question that we baby boomers have to face.  And that question comes with its own myriad subset of questions.  Will we be self-sufficient?  Will we be physically able to take care of ourselves?  What will become of our mental faculties?  Will we be financially able?  One of the acquaintances that I spoke with told me that her husband has a real and tangible fear of the same dementia that plagued the aunt he had to care for.  In a comment to my post, Scott wrote; “I find myself getting a little lump in the throat whenever I do something that is a mental slip, thinking about how it must have been for him and wondering if it is something I'll be dealing with in the not so distant future.” 

And then there is the question that haunts those of us with children, making their way with families of their own; will we be a burden on our children?  After having difficulties with my maternal grandmother, my parents suggested to me that they would never be a burden.  Which of course begs its own question; how can you make that suggestion?  There’s the strong potential that the option will not be one that we can control; which is just the reason that I’ve not made that suggestion to my own children.  I do what I can to avoid that circumstance by keeping both physically and mentally active.  And while my future independence isn’t the motivation it is a hopeful byproduct that I keep in the back of my still able mind.

I have two wonderful children who’ve expressed that they would of course take care of my wife and me when we’re doddering.  They make that statement with the same certainty that they would have in saying the sun will rise in the morning and while I don’t doubt their sincerity and have every faith in their love for us I have to wonder if they realize the full import of the baggage that comes with a dependent parent.  Every generation, every young family potentially has to face the quandaries.  Dealing with everything from deciding whether or not to take the old boy out to dinner with the family, to is he going to be okay at home, to is he going to wander out of the house, to how in the hell do we take our family vacation which all boil down to the question of “how do we just have a normal family life?”   

With the large boomer generation transitioning into late middle and old age this shouldn’t be just a question within the domestic circle.  A big segment of this nation is going to be losing its collective marbles and we, those of us that are aging and our families, should be wondering how this nation is going to deal with it.  From the Alzheimer’s Association website are just a few of the many sobering facts:

·         5.4 million Americans are living with Alzheimer's disease.

·         One in eight older Americans has Alzheimer's disease.

·         Alzheimer's disease is the sixth-leading cause of death in the United States and the only cause of death among the top 10 in the United States that cannot be prevented, cured or even slowed.

·         More than 15 million Americans provide unpaid care valued at $210 billion for persons with Alzheimer's and other dementias. 

·         Payments for care are estimated to be $200 billion in the United States in 2012.

•        Today, 5.4 million Americans are living with Alzheimer’s disease – 5.2 million aged 65 and over, and 200,000 under the age of 65. By 2050, up to 16 million will have the disease.

•     Of Americans aged 65 and over, 1 in 8 has Alzheimer’s, and nearly half of people aged 85 and             

       older have the disease.

•     Another American develops Alzheimer’s disease every 68 seconds. In 2050, an American will develop the disease every 33 seconds.

This country has faced up to major crises in the past with large measures of success and some of these have included finding many cures.  On the other hand, as I’m reminded every time I fill up the tank, we’ve had a history of kicking the can down the road.  I suppose that I could transition this into a commentary about the debate over nationalized health care and the rising costs of health care.  I’ll leave that for another time and just keep hoping that one of the cans that we kick down the national road won’t be full of those lost marbles. 

Just this past week a co-worker’s mother had a heart attack that put her in hospice care.  The mother has been suffering from dementia for ten years now.  In conversation another co-worker commented that he couldn’t imagine what it would be like to have a loved one “not know who I am.”  I told him that I went through that for nearly 10 years myself and he sadly shook his head and allowed that he was sorry.  The woman whose mother is now in hospice said to me that there will be no heroic efforts from here on out; “It’s been 10 years now; its time.”  Of course I felt the same way when my father passed; hell it was past time.  And he would have agreed.  Had he been able to have a half day of lucidity and figured out a way to end it himself he would have.  I know I would; sit in front of the TV, watch the Three Stooges with a nice sedative or ten and a bottle of Maker’s Mark.  Yeah I know it would horrify some of the family and friends and the local Catholic prelate; “my son how can you disrespect God’s gift?”  Look I got an electric pizza cooker as a wedding gift but at a certain point it gave up the ghost and the pizzas came out half-baked and it was about time to toss it.  When my thought processes start coming out half-baked it’s time to realize that the gift is about wore out.  I don’t want to deal with 5 years of putting the can of shaving cream in the oven and a quart of milk in the toolbox; or worse.  

And so thank you to Susan and to Scott and those who I spoke with over the last week or so.  It was somewhat reassuring to know that there are others who went through the same experience of trying to do right and in the end feeling like the job got badly botched at times.  And thank you to Craig who reminded us with some of the most eloquent words that I’ve ever read that “…we are all just regular folk shlepping though life who get thrown an awful curve-ball. You take your best swing! That's it.”

And a final note:  Susan, Scott and Craig are three of my oldest friends.  I went to high school and junior college with Susan and Craig and we were best of friends who went our separate ways.  We reconnected through Facebook but have not yet reunited.  I’d say it’s time.  I met Scott after graduating college.  We spent some years sharing living quarters and some great memories, many that are lost in a fog of varied substances.  He was the best man at my wedding and we still get together at times, although not often enough.  They are three of the finest people that I’m proud to know. 

Comments are greatly appreciated and encouraged and may be left in the comments section below.  While I don’t always respond to them (and I admit to it being bad manners) I do read them.  Unrepentant spam will be deleted and sent to spam hell.