Being Mortal

Being Mortal:  Medicine and What Matters in the End by Atul Gawande

http://www.goodreads.com/book/show/20696006-being-mortal

The information below has been taken from reviews of this book:

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Bestselling author Atul Gawande tackles the hardest challenge of his profession: how medicine can not only improve life but also the process of its ending.  Gawande, a practicing surgeon, addresses his profession’s ultimate limitation, arguing that quality of life is the desired goal for patients and families.

Oldsters who face neglect of institutionalization may feel they must put their life decisions in the hands of their children.  The other choice might be a controlled and unsupervised institutional existence, giving them a life designed to be safe but empty of anything they care about.  They are left bored, lonely and helpless.

Gawande offers examples of freer, more socially fulfilling models for assisting the infirm and dependent elderly, and he explores the varieties of hospice care to demonstrate that a person’s last weeks or months may be rich and dignified.

Gawande tells us how it is possible in some cases to choose less treatment rather than more when faced with life-threatening illness and to experience a better quality of life in our final days.

This is pretty grim stuff but Gawande is graceful, as graceful as he can be when the choices are so limited and so frankly horrible. Our hierarchy of needs changes when we face a life threatening situation. When a loved one (or we ourselves) must make choices, it is wise, he counsels, to ask ourselves a few questions:

What do we fear most?

What do we want most to be able to do?

What can/can’t we live without?

What will we sacrifice so that we can accomplish what it is we want?

Gawande addresses some of the most difficult questions we have to decide in a lifetime. It is not easy to read. But it helps, I think, to know what choices we can make when the time comes for someone we love or for ourselves.

 

Follow Your Bliss

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If you follow your bliss,

you put yourself on a kind of track

that has been there all the while waiting for you,

and the life you ought to be living

is the one you are living.

Joseph Campbell ca1980

I have simply grown to know

that I must fill the lead

stay in the flow as best I can

and rest in the reasoning

Balance is a fine line

Lillian Rumfeld Bryson 1995

Vigil

Moments, give me pause to stay,

for I have grown to walk the walk..

to recognize that should I veer

there will be balance..and to know

not to stretch the oh so fine line

beyond its measure

And on this day, this very day,

wakened to the path long followed;

its light seeping into my morning

brought a moment of bliss

Lillian Rumfeld Bryson  2016

Susan Sontag

images-2.jpegimages-1.jpegGrowing older, Susan Sontag wrote, in a 1972 essay called “The Double Standard of Aging,” is “much more a social judgment than a biological eventuality”–an “ordeal of the imagination”that “afflicts women much more than men.”

This is precisely what “stamina” pokes at:  an American subconscious that stereotypes older women as sick, weak, unattractive and useless.

Going Back to School Chap 1———-Stranger in a Strange Land Chap 2—

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CHAPTER 1.                 (Chapter 2 has been added following Chapter 1)

My sixteen year old granddaughter and I sat talking in the back seat of her parent’s car. She was taking a college prep course at Barnard College. A vague impulse came to my mind as my thoughts drifted to my lifelong wish to take a course at a prestigious university.

I wondered if my age, now 75, would hamper the ability to return to school.  Would I be able to do coursework? Should this wish remain a fantasy of repeating an experience that I had enjoyed at age nineteen?  When I asked my granddaughter how she would feel if I took a course there, she exclaimed, “Well, I guess so,  grandma, but you can’t be in my class.”

I asked an advisor, age 90, about it. He said confidently, “Do it! Aging is terrible. It will open doors for you.” So I did.

After doing some investigation, I found that I could audit a course in the Lifelong Learner’s Program at the same school.

Registration was the first hurdle. It had to be done online, and the directions were intricate. Online navigation of security intricacies and multiple passwords reminded me of the difficulty I had in learning French in high school.  It was a foreign language to me.

After many attempts, I finally gained access to student libraries for course requirements and academic papers. Setting up an email account for correspondence with teachers and other students within the university system was finally completed. Even though I hadn’t yet met a single professor or fellow student, a sketched skeleton path toward student status appeared.

I blanched upon receiving a health directive to list my vaccination history. They laughed out loud when I told them it had occurred seventy years ago.

I emailed the professor of the course, History of American Women in the 20th Century, to see if there was room for an additional auditing student.

“Dear Prof. Thompson:   My name is Wendy Wilson.  I have just received confirmation of my acceptance as an auditor into the School of Professional Studies.  I saw the course that you are giving in the Fall, 2016 semester bulletin.

It has been my wish for years to take a course relevant to women’s studies at  Barnard/ Columbia.  To my happy surprise, you are giving such a course.  I am  a feminist personally   and in my work as a psychoanalyst and author. I would hopefully request inclusion in your class.”

“Dear Wendy,  Thanks for your inquiry.  The course is already pretty full. I would suggest you come to class.  After the first few sessions I will know if there are enough seats for auditors.  As I am sure you understand, priority will be given to students taking the course for credit.   Professor Thompson”

Well, maybe I’d have to bring my own chair! I was half in and half out.

I stood in line to get my student ID photo card. With a wide smile, I took a selfie for my card. The expiration date on the card read 10/01/2021. I wondered who would expire first, my student card or me.

In preparation, I asked my granddaughter how I should dress for class. She pointed to my jeans and t-shirt explaining, “Just like that, a college student”.

I thought about it and decided that I had to find attire appropriate for my age, so I bought a pair of slim slacks and a woolen jacket. I didn’t want to dress as a young adult, yet my usual professional clothes were ancient for school. That was the start of redefining myself even though I had little idea of what would come next.

When I was younger, the custom was to buy your “school clothes” in late August in preparation for the real thing.  I decided that I would wear my new school jacket the first day of school.

I wanted to match the elite status of the college so I chose a jacket which was on sale that was described as ‘high end’. It had a shabby chic distressed look about the seams.

I got off the subway on the first day of the course. A young woman whispered to me, “You have your jacket on inside out.” I looked down at the front of my jacket and checked it.

I went swanning around the school grounds in my jacket.  As I stood at a café drinking coffee another woman whispered, “Your jacket is inside out.”  I told her in a superior way, “ This is a high end jacket. It’s supposed to look this way”. She retorted, “No, the price tags are hanging down your back”!

We had a good laugh at my  predicament as I turned my jacket around and marched confidently toward my class.

I found myself as one of two older people in a class of fifty young women. The course was held in one of the old unpretentious classrooms crowded into an historic building. The room was filled with small desk and chair seats, and a video screen hung from the blackboard.

When a teacher arrived I asked the student next to me the teacher’s name. It was then that I realized that I was in the wrong room. She handed me a map to another building as I skittered out and around the campus, up elevators and down stairs. I feared there would not be room for me in my appropriate classroom.

I was told that I should have read my internal email where the change of class was noted. Why would I look for an internal email if I hadn’t met anyone yet? Navigating these changes challenged my resolve.

I remember starting first grade at age six, excited and scared. My mother had given me a shiny penny for good luck to hold in my hand as I went in. This time I entered empty handed, not having any idea of what to expect.

Eventually, I got into the right class and found a seat among fifty 18 year old girls who were assembled.  They looked serious, studious and worried and seemed nerdy and passive, not vibrant and expansive. Both seats on either side of me remained vacant.  I felt like a reserved sign had appeared over my head.   Reserved for whom?

Uh oh, this wasn’t going to be an “all in together girls’ moment. ” It was an “ew…What are you doing here?” moment.

As my granddaughter had predicted the millennials were wearing flip flops, shorts and  t-shirts. They were makeup free and wore tank tops looking  as if they had just returned from the beach. They looked as uneasy as I felt. I tried to adjust knowing I was standing out like a sore thumb.

The professor spoke clearly in an interesting and well prepared manner about women’s historic struggle for gender equality and political justice.  We learned about our  responsibilities  in terms of class readings and tests.

The generational difference between the students, the professor and me floated through my mind in dream-like confusion. I wondered about her age when it came to me  that she was younger than I was. It disoriented me to realize that we would be hearing her  lectures about events that occurred when I was in my twenties and before she was born.  How could she be lecturing me about being a woman in the 20th Century?  I lived the history.  Shouldn’t I be lecturing the students and her about the subject?

There was another woman my age in the class. She filled me in on the specifics of auditing classes as we strolled down to  the West Side market where we sampled her favorite pizza which cost $4.00 a slice and was delicious.  I hoped that we would become friends.

As we talked I began to accommodate myself to the reality involved in the need to meet deadlines, adhere to travel schedules, and find appropriate parking.  I used a backpack to carry books,  pads, laptop, rain gear etc.  All in all it was an invigorating but tedious beginning.

I thought about the young women in the class. They looked  younger than springtime.  I sensed that they had been drawn to Barnard because they wanted a place where they could be serious learners and develop personal and professional expansion. They looked hopeful about being where their goals could be nourished.

I recognized these goals  as my own although I was fifty years older than the class.  Age differences melted as I sat among these interested students. I absorbed their curiosity, felt the warmth of their  youth, and was invigorated by their commitment. Because it was a class about the history of women’s struggles, the age difference evaporated.

As the professor continued her lecture, I felt my earlier anxieties begin to diminish and to be replaced by a feeling of personal courage and triumph.

Following the class, I cheerfully walked to the elevator.  An older woman came toward me gesturing toward the gray hair we shared.  Signaling a thumbs up sign as the students whooshed by,  she laughed, “We have to show them how to do it.”

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STRANGER  IN  A  STRANGE  LAND

Looking back, I remember walking to my class and feeling like I was carrying a stranger on my back, a very heavy big person with  arms around my shoulders weighing me down. I didn’t know this person. I had to bear carrying her. Stranger, stranger, stranger. This new unfamiliar burden required all my energy with no reward in sight.

I felt as if I had become a five year old child.  I had dismissed my adult self.  Nothing was  familiar to me, yet I had taken it on.

I felt scared and angry that I had to pretend to fit into this class. I have trouble with this charade of appearance. I had to disguise myself in artificial clothes trying to be perfect and to match something directed by requirements outside of myself. This costume had to be perfect.   It wasn’t like wearing self-selected clothes that reflected my taste and identity. I couldn’t be myself.

Recently, while departing the train on the way to the course, the zipper in my coat got stuck with material from the coat. It strangled me at the throat. I imagined that I would never be able to get my coat open. Maybe I would have to use scissors to cut off the arms and neckpiece.

Instead I boldIy stopped and asked a policeman to try to undo the snag. With a serious look as if he were solving a crime, he leaned down and fought with the zipper until it loosened. An authority figure had come to the rescue.

I remembered the first day at class when I inadvertently put my jacket on inside out. Again I was acting like a child who had put her clothes on incorrectly. I got help in straightening out this situation by two people who told me the price tag for my jacket was hanging down my back, proving that the wrong side of the coat was exposed.

What was alienating  me about returning to school?   The students were so much younger than what I had expected. The age span of fifty years came into play. If they had been my grandchildren visiting my home, being in the family would have  normalized things.

Attending this university class called for much more accommodation since we were also listening to a professor speaking about a complicated subject and struggling to take in the facts of this detailed academic course. I felt like a character in the Woody Allen film “Midnight in Paris”.

The film was about a hack screenwriter visiting Paris on vacation. At the stroke of midnight he was picked up in a Ford roadster and magically transported to Paris in the 1920’s where he met Fitzgerald, Hemingway, Gertrude Stein and other legends. They invited him to join their party. He became swept along in their wake and found himself plunged into the Jazz Age and all its legends.   After a time he returned to present day Paris renewed by his adventure.  He had internalized the beauty and talent of these legends and could begin to realistically work at actualizing his own dream. Maybe that is what I wish for as well, youth and inspiration.

Perhaps these university students were wishing to discover the beauty and talent of historic and academic legends.  They could use these legends as models of motivation in pursuit of their own dreams.

They were housed in dormitories or apartments. It was their place.  Many here were privileged, intelligent, conscientious and self-possessed. They were busy racing around as special people in a prestigious school.  I felt envious  that I never had and never would have what they are enjoying now. They were beginning a excursion toward a long road in life whereas I was beginning future late in my life.

Strolling toward this class I felt confident and intelligent. As I sat down  in a tiny school chair, I felt like a mannequin, a piece of cardboard posing as if I belonged, a 5 year old who couldn’t talk or react or take any chances.

A feeling of spontaneous understanding overcame me. The articulate professor begin her lecture.  She described the way that women of varied race and class had struggled with discrimination. They were disenfranchised economically and  discriminated against  socially.  Hearing about how brave and difficult it was to upgrade the status of  these courageous women brought home to me a deeper perspective of their  enormous struggle.  I had never put that together before. My focus as a feminist was on individual search for independence.  Now I took in the cooperative camaraderie that was necessary for world wide awakening of women’s plight.  I repeated to myself, “Wow, now I see”.

The professor faced us from the front of the room where I sat with the other ‘kids’.  As she spoke, I received her words as gifts.  I squirreled away  these morsels of knowledge in my brain, treasuring the ownership of the prize. I was overcome with gratitude.

My eyelids drooped into a brief spell of relaxed  sleep. I felt so tired. It was so hard to manage this strange lonely experience.

I awoke, feeling five years old again, unable to think at all.  Then my curiosity and imagination began informing me it was aware of what the teacher was saying. I felt exhilarated, excited, addressed, and connected.

I made a comment in class. The professor listened for a brief minute, then signaled with her eyes that I should stop talking. I should say no more.  I retreated, telling myself that I should be teaching the class.

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Does Aging & Decline Affect Our need for Love?

 

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1.—–Does aging lessen or increase your wish for love?

2.—-Do you need more love from other people especially when you feel that you are declining?

3—– What is the reason that you feel you need more or less love? What causes that change to happen?

4—–What form does your wish for love take?

5—– Does the fact that you are weakening influence your wish or need for more love?

6—–Do you want more caring, reassurance and encouragement?

7—–Would that help you to adapt to the realization of aging and decline?

8—— Do you want to to be physically loved; to have more close physical contact, sexual contact, verbal contact?

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How do you handle these wishes and feelings?

Do you feel lonely? Do you withdraw from others?

Does feeling less necessary influence a wish for more love?

Do you seek love and support when you feel this way?

Do you have energy to search for contact from others?

Do you try to gratify yourself by:

(a)   sleeping, watching TV.

(b) eating, crying , reading.

(c ) talking about this with other people.   Whom do you talk to?

(d) getting sick (headaches, falling).

(e) keeping busy, volunteering.

(f) remembering meaningful moments with people and things you have loved.

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Can you tolerate not having these wishes to be loved met?

I hold these truths to be self evident

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The rose of sharon alongside the garage

catches my eye as we see the last of summer,

and there in the driveway, still announcing the arrival of spring,

a robin is doing whatever it is that robins do before they leave.

 

I watch from the doorway recollecting a time

when myrtle carpeted the woods across the street,

and now small patches call me to gratitude….

 

Lily of the valley standing fast where the rock garden was.

The time when Mama’s purple clematis climbed the rain spout.

The dogwood that my father planted,

the mothers day geraniums, pansies on the stoop

and the trumpet vine… proclaiming

 

Continuing to prod my memory with sprouts

generations walk the path with small bouquets

of violets and myrtle for kitchen window sills,

with fragrant fresh cut lilacs… and daisies in June.

 

When dis-ease first worried its way into our lives,

denial came to the rescue, easier not to accept…

but balance is a fine line and there was no net.

 

What about me!! What if I were to fall!!!

 

There is a place between yes and no,

a place where there are no answers.

Acceptance is a process, and doses of reality

doled in starter pieces are bearable

 

But when the full dose came! I was gasping for relief..

a starving piglet flailing for a sows teats

until the reality became acceptable.

 

But there are times when I wonder how it can be real.

And inside the house, the air conditioner,

having hummed its way through summer

is barely heard these waning days…

 

Lillian Rumfield Bryson, August 2016