Loss and Love

A friend wrote recently about preparing to plunge into a rooftop pool with a spectacular view of the south Asian capital she was visiting.  She’s a recent widow, her husband having died about a year ago.  A lovely guy, he was relatively young, not yet eligible for Medicare.  Before my friend dove into the pool, she saw a young pair of honeymooners gazing soulfully into each other’s eyes.  Suddenly she was overwhelmed by grief.  “Life’s a bitch,” she wanted to tell them.  “Loss is the price of love.”

That’s true, but the honeymooners would have been unlikely to absorb her message.  If they are like my wife and me at their age, their own death is not yet real to them.  It takes a long time for that to happen, but for me, at least, it happened twenty years ago, when I experienced my first bout with cancer.  It was at about that time that I began to file material that would be useful to my wife if I preceded her.  It included data on our bank accounts, various clerical procedures, people and institutions that should be notified about my death, and so on. 

I’m five and a half years older than my wife, and since men don’t live as long as women in any event, the probability of my predeceasing her is high.  Now that I’m eighty, with an arm’s length of medical problems, the probability is even higher.  I wonder how she will manage without me, but that’s giving her too little credit and me too much.  She’ll manage perfectly well, although I’m sure it will be hard for her at first.  

How do I know it will be hard?  Because I put myself in her place and imagine how I would feel if she checked out before me.  Still, I’d say that the profound pain of loss is a price worth paying for the great happiness that our marriage has brought me.

2010-2012 Anchises-An Old Man’s Journal All Rights Reserved

The Inadequacy of Living Wills

My indefatigable daughter, a palliative care social worker, alerted me to a recent article in The Wall Street Journal that points out the inadequacy of living wills.  In a living will, you specify how you want to be treated if you become seriously ill.   Once your wishes are known, your health care proxy can make decisions for you when you become too ill to make them yourself.  The living will removes the health care proxy’s guess work.  Or so it was thought.

The WSJ article gave an example of a man whose living will called for withdrawing life support “if there was no reasonable expectation of regaining a ‘meaningful quality of life’ but didn’t describe what that means.”  In an earlier post I wrote about a man who told his daughter that for him a meaningful quality of life meant being able to watch football games on television and to eat chocolate ice cream.  That would not be enough for me, but the point is that one should let one’s health care proxy know what one considers a quality of life worth living.  For the record, I’d want to be reasonably pain free and able to recognize and understand people, either visually or aurally.  The ability to eat vanilla ice cream with caramel sauce, while greatly appreciated, would not be a necessary condition.

Another problem with living wills is the uncertainty attached to medical diagnoses.  The article’s author wrote that her father, in a coma, was hooked up to a ventilator.  His living will stated that “he didn’t want to be kept alive if he was terminally ill, or in an irreversible vegetative state.”  When he woke up, said his neurologist, there was a good chance he would have suffered severe brain damage.  What were the odds?  The doctors didn’t know.  The family postponed a decision, and fortunately her father woke up able to make decisions for himself.

The article quotes Lee H. Schwamm, vice chairman of neurology at Mass General, who says that “even when he thinks he can predict a patient’s outcome after a stroke, he is wrong 15% to 20% of the time on major outcome measures, such as whether a patient will be able to walk again.”

In my living will, I state that I do not want life-support treatment if my doctor and another health care professional both decide that (a) I am close to death or (b) I’m in a coma and not expected to wake up or (c) I’ve suffered severe and irreversible brain damage and that life support treatment in any of those cases would only delay the moment of my death.  There’s still room for incorrect prediction here, I suppose, but it seems to me to be pretty slim.  But we worry about the wrong things.  I’ll probably be run over while crossing the street, looking at a pretty girl instead of at the traffic.

2010-2012 Anchises – An Old Man’s Journal All Rights Reserved

Allan and Ina

When I looked out our window on Friday morning, I saw steep, snow-capped, fir-clad hills, from 3,000 to 4,000 feet high, which ran down to the street below.  No, I wasn’t dreaming.  I was in Juneau, Alaska.   We had come for a double celebration, the birthday of our dear friend Ina Gartenberg and the 60^th wedding anniversary of Ina and her husband Allan.

Allan and Ina don’t live in Juneau.  They live in Culver City, California, but in December of 2010, at their son’s wedding in San Diego, Ina announced that she wanted to hold these celebrations in Juneau, because her son and his bride were moving there.  And what a celebration has been planned!  Among the activities are whale watching, deep-sea fishing, zip lining over a forest, kayaking, and a visit to a salmon cannery.  It’s as close as we’ll ever come to attending an affair as elaborate as the Queen’s diamond jubilee.

But the main attraction, of course, is not these activities or even the gorgeous scenery in which Juneau is set but Allan and Ina themselves.  For they display a zest for life, a sense of humor, and a warmth and concern for their friends that is both endearing and inspiring, a model that few of us can match but all can try to emulate.

It is an honor and privilege to have been invited and we would have gone to Timbuktu had that been the venue.  But thoughtful as always, the Gartenbergs have chosen a setting incomparably beautiful, where every prospect pleases and not even man is vile as long as Allan and Ina are around.  

Crème Anglaise

There’s a little restaurant around the corner from where we live.  Its ambiance is pleasant, the food good, and the prices reasonable.  Besides, it’s the only restaurant within the radius of a fifteen-minute walk from our home.  So every other Tuesday, when our cleaning lady comes to us, we go there for lunch.  Last week at the restaurant, while my wife was finishing her salad, I thought about dessert.  I had reached the stage at which I was no longer hungry.  In fact I was pleasantly full.  Still, I wasn’t satisfied.  I wanted something more.  To be precise, I wanted a rich dessert, bathed in calories, preferably with vanilla ice cream.  If your moral character has kept you from entertaining such thoughts let alone succumbing to them, read no further. I have no intention of insulting your virtue or leading you astray.

The dessert menu contains six or seven items, all suitably fattening and artery clogging, all likely to make a dietician faint.  It was hard to choose which path to hell to take – all were alluring, all invited a depraved plunge into indulgence – but after much difficulty I chose warm brioche bread pudding with crème anglaise, mixed berries, and vanilla ice cream.   Please understand that it was mainly scientific curiosity that motivated my choice.  What, I wondered, was crème anglaise?  This was a question that had long been unanswered.  At last I was to find out. 

Finally, our waitress brought a large plate on which four slices of brioche pudding were arrayed in a circle surrounding a large scoop of vanilla ice cream.  Sprinkled over the pudding and the ice cream were blueberries and raspberries.  The ice cream had slightly melted into the fruit, resulting in a pretty purple coulis. Or was that the crème anglaise?  Where was the crème anglaise?

We summoned the waitress. "Where is the crème anglaise?"  She consulted the kitchen and returned.  “I’m so sorry. There is no more crème anglaise.”    No more crème anglaise!  I felt absurdly disappointed, not at all mollified by the waitress’s assurance that she would reduce our bill by two dollars.

So it shouldn’t be a total loss, as my father would say, we asked her what crème anglaise is.  It’s a thick, slightly sweet custard sauce made with vanilla, egg yolks, and sugar.   I’m sorry we asked, for now that I know what it is, I'll have no excuse for ordering, at some point in the future, warm brioche bread pudding with crème anglaise, mixed berries, and vanilla ice cream.   For of course I’m going to order it again, after first checking that there is still some crème anglaise left.  After all, you have to die of something.

2010-2012 Anchises-An Old Man's Journal All Rights Reserved

High Points

The other day we spoke to an acquaintance, the oldest active person we know.  He’s 92 years old, was married for 56 years, and now lives by himself in his house in Brooklyn.  Slim and quick moving, he appears to be in excellent health.  He still drives, although he confesses that when he has to park downhill from his destination, he sometimes finds the walk uphill trying. 

During the Second World War he served in the Navy, at one point the radio operator for an admiral.  He served on seven ships, two of which were sunk from under him.  He participated in four invasions: Sicily, Italy, Normandy, and as for the fourth one I’ll have to ask him to remind me.  Clearly it’s something he’ll never forget.  The stories he tells about his time in the navy are colorful and arresting.  It’s fun to hear them even when we’ve heard them several times before.  The Second World War was, I believe, the highpoint of his life.   He continues to relive it, not only in the stories he tells his younger listeners but also in his volunteer service with the American Legion and the Intrepid Sea, Air, and Space Museum.

He’s not alone in regarding wartime experience as a high point in his life.  This is said to be true for the survivors of the Blitz, for example.   Perhaps it’s the combination of involvement in a great undertaking supported by the whole population, the adrenalin rush from danger, and the camaraderie forged in battle, siege, or bombardment that was responsible for the feeling that every fiber of their being was wholly alive.

What must it be like to reach the high point of your life when you are so very young?  Is your life a long anti-climax?  I can’t answer that question from personal experience, for my own high points have been spread out over my lifetime.   Between the projects that have so enlivened me, among them the Language Survey of Ethiopia and Mark Twain’s world lecture tour, I feel a sense of anticlimax as  I search for a new project that will recapture the thrill of total involvement.  I’m in one of those troughs between projects today.  Like Helen Trent, who refused to believe that romance was over at 35, I refuse to believe that engagement in a great project is over at 80.   So I continue to look.  In the meantime, I'm grateful for the peaks of engagement I've experienced.  Even if I never find another, life won't have owed me a thing.

2010-2012 Anchises-An Old Man's Journal All Rights Reserved

Last Words

In Inside Out, my friend Judith Flesch Rose’s new memoir, I read and was deeply moved by her parents’ last words to her.   Mother: “Why are you crying, darling?”  Father: “I love you.”

My mother died towards the end of my sophomore year in college, so after I returned to college for the second semester, I never spoke to her again.  During that semester, however, she wrote me one letter, assuring me that she would recover from her illness.  I’ve kept it all these years, but in our last move I misplaced it.  I suppose I will find it some day, but in the meantime, I can’t tell you what her last words to me were, if indeed a letter can be considered last words.

“I’m dying,” were my father’s last words to me.   He was sitting up in bed in the ICU of a hospital in Albany.   I didn’t know what to say, so I said nothing.  I could at least have repeated what he said., something like, “You feel you are dying.”  But I didn’t even say that and I’ve felt bad about it ever since.

“I love you,” the last words Judith Rose’s father spoke to her, were the perfect last words, the words I would have wanted to hear from each of my parents.  I can’t recall either of them ever telling me that they loved me.  And even though I knew they did, I would have liked to hear it.  When I last saw my mother she was in a coma, unable of course to tell me anything.  When I last saw my father, he was consumed with his own agony, unable to say more than “I’m dying.”

Just about every day I tell my wife I love her.  I will try to tell my children I love them more often than I do.  And I hope I will have the strength and the luck to tell them that at the very end.

2010-2012 Anchises-An Old Man's Journal All Rights Reserved

Lashon Hara

Every now and then I have the somewhat scary privilege of presenting, to our minyan, a short commentary on the Torah portion that has just been read.  It’s scary because I know so little.  Still, preparing these commentaries is a great way to learn, and our minyan is extraordinarily encouraging to and tolerant of beginners.  What follows is not the commentary I gave last week but rather reflections based on it.

In my commentary on last week’s portion, B’haalot’cha, I focused on the notion of lashon hara, literally evil speech.  The term is found nowhere in the Torah.  It’s a rabbinic construction, whose chief example is the conversation between Miriam and Aaron which takes place in this portion.  They are bad-mouthing their brother Moses for having married a Cushite woman.  The underlying reason for their negative speech is their dissatisfaction with Moses’s status as the Israelites’ chief prophet.  Their speech enrages the Almighty who comes down in a pillar of smoke, castigates the pair, and strikes Miriam down with leprosy.   Moses intervenes, begging the Eternal to modify her punishment.   This the Almighty consents to do.  After one week her leprosy will vanish but in the meantime she has to leave the camp.

The rabbis define lashon hara as negative speech about a person or group that is true, not widely known, and not uttered for a constructive purpose.  If A tells B that C is stingy, and it’s true but not publicly known, and if A is not warning B about C in order to prevent a negative outcome, that’s lashon hara.  Some authorities forbid speech of any kind about a third party, even if it’s complimentary, on the grounds that it might lead to lashon hara..  If A tells B that D is generous, B might be lead to say yes, but D’s brother C is stingy.  Other authorities permit negative speech about a third party to a group of at least three persons, on the grounds that it will soon become common knowledge, since everyone has a friend.  But the rules that surround speaking to a group of three about a third person are so complicated that it’s safer not to speak negatively about anyone at all.  Consider what you need to know before you can criticize someone.  You have to be sure that what you’re saying is true and that it’s generally known.  But how can you be sure of either?

It’s curious that the classic example of lashon hara, Miriam and Aaron’s speech about Moses, does not fit the rabbis’ definition of lashon hara.   What Moses’s siblings said about his marrying a Cushite was both negative at that time and true, but the truth of what they were saying was widely known, which disqualifies it from being lashon hara.  And their complaints about Moses’s being the chief prophet did not rise to lashon hara either, for they made no claims as to his fitness for the role.

If everyone refrained from lashon hara, what would happen to conversation?  Would dinner parties be largely silent, arid affairs, the spice confined to the dishes consumed?   Yet according to the rabbis, lashon hara is a grievous sin, as bad as murder, adultery, and idolatry combined, any one of which will bar the sinner from the world to come.  If this is true, and if most of us are like me, few of us will enter the world to come.

I find it hard to avoid speaking lashon hara and even harder to avoid hearing it.  Our daughter taught us the following doggerel when she was studying at the Pardes Yeshiva in Jerusalem:  Lashon hara/lamed heh/go to hell the easy way/tell it to me anyway!  Which reminds me of the embroidered pillow which Alice Longworth Roosevelt is said to have placed on her drawing room sofa.  “If you don’t have anything nice to say about anyone, sit right next to me.”

2010-2012 Anchises–An Old Man’s Journal All Rights Reserved,

My Wife is Seventy-five Today

My wife is 75 today.

Born on Sunday, bonny and blithe,

She’s good and gay.

Sound the trumpets without delay

and play the drums with great delight.

My wife is 75 today.

The crowds will roar "hooray! hooray!"

as she waves to them in golden light.  

She’s good and gay.

Is she still bonny and blithe?  I say

yes. And what's more, she's still lithe.

My wife is 75 today.

She’s let her hair turn silver gray,

a lovely color in any light.

She’s good and gay.

I look at her and see each day

the bonny girl on our wedding night.

My wife is 75 today.

She’s good and gay.





2010-2012 Anchises-an Old Man's Journal All Rights Reserved

A Regular Person Like Everybody Else

NPR’s Morning Edition presented a program last week about differences between the brains of people with autism and those of ordinary people.   (http://www.npr.org/blogs/health/2012/06/04/154175007/whats-different-about-the-brains-of-people-with-autism).  

With the help of MRI and PET scans, which make images of the brain when a subject is reading, viewing, or thinking about something, an intriguing hypothesis has recently emerged.  It’s now suspected that the fiber tracks that connect different parts of the brain are less robust in people with autism, so that there’s a lack of synchrony between the front and rear areas of the brain.  In the ordinary brain, there’s “this sort of beautiful rhythmic dance together” between the activity in the front of the brain with that in the back, said Marcel Just, a researcher at Carnegie Mellon University, but in autistic brains, the “beautiful rhythm wasn’t always there.”

To arrive at this conclusion, researchers needed lots of volunteers, both autistic and ordinary, to submit to scans while performing various mental operations.  One of these volunteers is Jeff Hudale, a 40-year-old with autism.  Like many people with autism, he has an exceptional ability, an unusual aptitude for computations, which, for example, enables him to do triple-digit multiplication in his head.   He graduated from the University of Pittsburgh with a degree in engineering.  “I like working with things that are rather concrete and structured,” he says.  “Yeah, I like things with some logic and some rules to it.”  This enables him to do well in his job at a bank.  But he doesn’t do so well in social interactions, where whatever rules apply are not so obvious.  “Most people my age are nowadays married,” he says.  “But me, not only am I totally single, I’ve never even had a date.”

Mr. Hudale has served as a research subject since the mid-1980s.  At first his motivation was to help solve the problem of his own brain but he now realizes that his participation in these studies will help many more people than himself.  “I don’t want to quit until they finally can get this set right and get this thing eradicated,” he says.  “I’d like to have some semblance of, just be a regular person like everybody else.”

Of course one has to ask if he could have done as much good as “a regular person” as he has done as, so to speak, an irregular one, who without doubt has suffered because of his disability.  His story suggests that each of us has the potential to help others, even if we’re damaged in some way, even if we’re very old.  



2010-2012 Anchises-An Old Man's Journal All Rights Reserved 

Kindness and Old Age

A recent review of the literature by Kenneth Vail and associates found that when people are reminded of their mortality, they are more likely to be good to others and to themselves (http://www.theatlantic.com/health/archive/2012/05/the-secret-to-a-long-life-is-thinking-about-death/257675/).  In one study, for example, people were found to be more helpful to others when they were in the vicinity of a cemetery than when they were not. 

Other studies have found that when people are reminded of death, they are more likely to engage in healthy behaviors such as using sun screen, exercising more, and performing breast self-exams.  They are also more likely to engage in pro-environmental behaviors.

The elderly are not necessarily more aware of their mortality than others, but based on this sample of one, myself, I believe they are.  If I’m right about that, does it follow that the elderly are kinder to others and do they take better care of themselves than is true for the general population?  My wife tells me that I’m a much nicer guy these days, but if true, it is probably one of the effects of my hormone treatment, which has drastically reduced the amount of testosterone in my body, rather than an outcome of age. 

When I think about the old people I have known, including my aunts and uncles, some were generous and kind in old age, while others were crabbed and selfish.  Awareness of death may have intensified their character traits, but not changed them.  They were much the same in old age as they were when they were younger.

I don’t believe that awareness of death has made me kinder to others or to myself.  But it has had other valuable  effects.  First, I’m less upset and more tolerant of the troublesome behavior of others and of the inevitable contretemps one encounters in everyday life than I used to be  – life’s too short to obsess about such things – and second, I’m constantly aware of how good it is to be alive.  I’m thankful for every day. 

Interpreting Bad News

Surrogates for incapacitated patients in intensive care units must evaluate proposed medical interventions in the light of the patient’s values and wishes.  For this reason, it’s important that surrogates, typically a spouse or a child, understand the prognosis for their loved ones.  A recent article in The Annals of Internal Medicine by Lucas S. Zier and colleagues, “Surrogate decision makers’ interpretation of prognostic information,” suggests that decision makers interpret the prognosis differently according to its favorability for the patient's survival (http://www.annals,org/content/156/5/360.abstract).

Over a three-year period, 80 surrogates for critically ill patients in an intensive care unit at a San Francisco hospital were asked to interpret 16 prognostic statements for hypothetical patients, unrelated to their loved ones.  For example, “If a doctor says ‘He will definitely survive,’ what does that mean to you?”  Participants were asked to place a mark on a probability scale corresponding to the patient’s probability of survival from “Will survive (100% chance of survival)” to “Will not survive (0% chance of survival).”  Respondents whose answers varied markedly from the prognosis were individually interviewed.

The researchers found that the respondents interpreted favorable prognoses correctly but that their interpretation of negative prognoses (5% to 50% chance of survival) tended to be more optimistic than warranted by the prognosis.  Interviewees explained these discrepancies in terms of the need to be positive and the reluctance to take at face value doctors’ predictions, since these are sometimes wrong. 

Naturally, I wondered how patients themselves view such prognoses. My guess is that they give a more favorable interpretation to negative predictions of their own survival.  Given a 5% chance of survival, many patients probably figure that they’ll be among that 5%.  Somebody has to be, after all.  A friend of mine, for example, has survived with pancreatic cancer for more than five years, when fewer than 5% live that long with the disease.

As for myself, I hope I’ll greet a negative prognosis, when it comes, realistically.  I know that I harbor a terminal disease.  The only question is whether that or something else will carry me off.  I won’t want aggressive treatments when the likelihood of surviving them is low and when the extra months of life that they provide are likely to be few.  That’s how I feel now.  I hope I’ll still feel that way when the time comes.

2010-2012 Anchises-An Old Man’s Journal All Rights Reserved