Anchises' Law

As all the world knows, Anchises’ Law states that you never know where it’s coming from.  The latest example of this imperishable truth occurred recently when my left foot began to hurt.  We were in Alaska then and I thought I’d give it a few days to see if the pain subsided.  But once in New York, when the pain became even worse, I suspected that I had fractured a bone, which I had done twice before.  In fact my foot doctor told me that this time I had broken not one, not two, but three bones.  Would you believe that the breakage resulted from my participation in a kick-boxing contest?  I didn't think so.  In fact I have no memory of bumping or spraining my foot, so the breakage, according to my doctor, is the consequence of osteoporosis.

Limping is an appropriate problem for me, since my namesake, the first Anchises, was lame.  This was a result not of osteoporosis but of speaking out of turn.  He was so beautiful a young man that Aphrodite fell for him big time: she came to earth and seduced him.  It’s not written whether she had to work at this, but I suspect she did not.  Anchises, in a drunken moment, bragged to his friends about his affair with her, which so incensed Zeus that the king of the gods hurled a thunderbolt at him, which lamed him for life.  The fruit of his affair with Aphrodite was Aeneas, the legendary founder of Rome, who carried him on his back out of the burning city of Troy.  I know I've told you this story before but it's such a good story it deserves to be told at least once a year and besides, as an old man, I  have the license to repeat myself.

I’m thankful that New York isn’t burning and that even if it were I wouldn’t have to depend upon my son to carry me out.  I’m thankful that the laming is not permanent.  Most of all, I’m grateful that for the last 49 years, Aphrodite has seen fit to stay with me.  If this is bragging, I hope Zeus won’t throw a thunderbolt in my direction.  Three broken bones are enough for now.

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

Dying Well

Recently I heard an interview with Ira Byock on the occasion of his new book, The Best Care Possible.    Dr. Byock, a professor at the Dartmouth Medical School and the director of the Palliative Care Service at the Dartmouth-Hitchcock Medical Center, spoke of the distressing state of end-of-life care in America, where advances in medical technology often prolong life at the expense of its quality.

When our loved ones are terminally ill, we want the best care possible for them.  But the best care must take into account patients’ preferences and their quality of life.  Hospice care, stated Dr. Byock, helps people live longer and more comfortably than aggressive treatment at the end of life.

There’s something worse than death, he said, and that’s dying badly.   But alas, patients often do die badly, hooked up to machines or subjected to operations and procedures that offer no hope of recovery but only prolong suffering.  Although most people prefer to die at home, in New York City 20% die in an intensive care unit and half die in a hospital.  Dying badly results from our unwillingness to acknowledge our mortality, which leads to our not telling our loved ones our preferences for end of life care, and from the medical profession’s fixation on the disease rather than the patient.  We need a revolution in attitudes so that fewer people will die badly and more will die gently.

Unlike Dylan Thomas, I hope to go gentle into that good night and not to burn and rave at close of day.

Spending Time with People We Love

Fireworks bracketed our last day in Juneau.  We saw them at midnight, when the Fourth of July began, viewing them from the home of our hosts, on Douglas Island, high above the Gastenau Channel, and from the air we saw the annual Macy’s display on the East River a few minutes before we landed at ten that night.  Had there been fanfares along with the fireworks, it would have been entirely appropriate, for our two-week visit to Juneau was a spectacular success.

My wife and I tried to analyze the reasons for our enjoyment.   First of all, our hosts, the son and daughter-in-law of the couple celebrating their 60^th anniversary, were meticulous in their planning of the celebration, no mean feat considering that it took place over a two-week period for 21 people ranging in age from 14 to 82 in two successive venues, a rustic lodge on the mainland and a luxurious villa on the heights of Douglas Island. 

There was plenty to do: whale watching, where we saw several whales breaching, zip lining, a visit to a botanic garden, a visit to a nearby glacier, an all day sail down a fjord, where we saw the glacier at the head of the fjord calve several times, deep-sea fishing, and so forth.  And if we tired of these activities, we could simply gaze at the magnificent scenery right outside our windows.  And of course there was plenty of time for old-fashioned schmoozing, the best part of all, for it was the participants in the celebration as well as the couple, Ina and Allan Gartenberg, who were its object, that provided the greatest pleasure. 

It was a privilege to spend time with people who were so fond of each other.  The couple’s sons and their spouses clearly enjoyed being in each other’s company, and it’s no exaggeration to say that those friends of the couple who attended the celebration loved them – no surprise in view of the couple’s warmth, humor, and compassion for others. Those of their friends who attended the celebration have supported them in days of grief as well as joy and in the process have become attached to each other. They've become part of the Gartenbergs' extended family.

In a recent article in the Times, Tim Krieder wrote about the obsession of so many of us with being madly busy, with scarcely any free time.  “My own resolute idleness has mostly been a luxury rather than a virtue,” he writes, “but I did make a conscious decision, a long time ago, to choose time over money, since I’ve always understood that the best investment of my limited time on earth was to spend it with people I love. “  His essay, which I read while flying back to New York, resonated with me, for we had just spent two weeks in the company of people we love.  Like Mr. Krieder, I can’t think of a better way to have spent my time, which for the young as well as for the old, is all the time that's left.

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

Zip Lining

Zip lining was among the optional activities planned for the guests at our friends’ birthday and 60^th anniversary party in Juneau, Alaska.  A dozen of us signed up, including the birthday girl.  Had she not done so, it’s doubtful that most of the rest of us would have agreed to go.  And had I known what was involved, I would probably not have had the nerve to participate.

Harnessed into a complicated set of straps and buckles, you ascend to a very tall platform that surrounds an even taller tree.  You are then buckled into a hook on the tree, and then – in our case -  a very pretty college student attaches your harness to two overhead wires, one above the other, which run from the platform on which you are standing to the next platform about several hundred yards away.   She then detaches you from the tree, asks you to sit down so that your harness supports your weight, and tells you to lift your feet, which propels you into space, over the trees in the forest below, over the streams and the waterfalls.  Your weight then carries you over the wires to the next platform, where a second college student catches you to prevent your colliding into the tree that stands in the middle of the platform.  You do this five times.

It’s perfectly safe, safer than crossing the street on a crosswalk when the light is in your favor.  The wires that support your weight can carry a load of thousands of pounds and you are hooked up to two overhead wires although one would be sufficient.  I knew it was safe.  Still, to lift up my feet, which I knew would propel me into the void, took more courage than I expected to have to summon.  I told myself that this was not a parachute jump nor was it a bungee jump.   Even so, I was far enough off the ground to be killed should I fall.  Yet I knew I wouldn’t fall, so my fear was entirely irrational.  But if Ina Gartenberg, the birthday girl, married for 60 years, could do it, and if my wife, only five years younger than I, could do it, so could I.  And so I did.  Five times.

It never became any easier.  I would have been glad to stop after the first one but once you’ve embarked on the circuit, there’s no way to confine yourself to one zip. Besides, chickening out would have required even more courage than lifting up my feet.  Zip lining is a bit like swimming in the Dead Sea, something that everyone should do once, but only once.  Just as I would not choose to swim again in the Dead Sea, I would not voluntarily go zip lining again.  Still, I’m glad I did it, glad for the spectacular views below of tree tops and waterfalls, and glad for the fact that at 80 I’m still able to dare.

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

The Last Frontier

In my last post I wrote about the singularity of Alaska, or at least of that part of it that Juneau represents.  It’s a land apart, I wrote, and concluded my essay with the observation that it reminded me of old age.  You may view this as strange, since Alaska is a young state and prides itself on being “the last frontier,” the motto that appears on its license plates. 

This is not to say that old age approaches utopia to the extent that Alaska does, but like Alaska, old age is both familiar and strange, a land apart.  My emotions haven’t changed with age, but as an old man I feel outside the social system, unranked, powerless, much as I was viewed in Ethiopia, where doormen at the university would bow deeply to low-level clerks but would remain erect in my presence.   Like a baby, whom strangers feel free to address, I am the recipient of comments from strangers that they would keep to themselves were I twenty years younger, such as “you look great!”  Not that I mind the compliment, but it’s a reminder that I’m old, just as are the frequent offers of a seat on the subway.

Then of course are the physical betrayals.  What could be more familiar to me than by own body?  But it’s become strange, no longer obeying my commands, and protesting when asked to carry out familiar tasks, such as walking up a few flights of stairs.   Wrinkles and sagging flesh have made my body almost unrecognizable to me.  The mirror on the wall has become malign.  

Visits to doctors and testing facilities take increasing amounts of time, changing from an annual physical, when I was in my twenties, to today’s one to three visits per week.  My awareness of mortality is heightened now, pervading my consciousness.  This has the advantage of making me appreciate each day, grateful to see the sun rise, no longer taking it for granted that I when I lie down to sleep, I’ll wake up in the morning.   It has also made me calmer.  I now view with greater serenity the normal contretemps of daily life, problems that used to upset me.  It’s as though I now stand on a mountain top, which give me a wider perspective, reducing the problems of everyday life to relative unimportance.

Alaska prides itself on being the last frontier.   But if ever there was a last frontier, it's old age.

A Place Apart

The longer we stayed in Juneau, the more convinced I became that Alaska, or at least that part of it that Juneau represents, is a place apart.  True, people speak American English there and drive on the right side of the road, but Juneau seemed as strange as does Puerto Rico, American but not quite.  The state’s motto, The Last Frontier, which appears on its license plates, is an emblem of its apartness.

The scenery is unparalleled.  Juneau must be the most beautiful city in North America.  Snow-streaked, fir-clad mountains surround it and some come down to the streets of the city.  The air is pure.  The streets are clean.  Civility is high.  Motorists stop before you even put your foot onto a crosswalk.   When we were there in late June and early July, the sky was not dark until about eleven at night and by three in the morning it began to lighten.  

People smile at you.  From the conversations we’ve had with those who live there, the city’s residents are genuinely glad that Juneau is their home.  Unemployment is so low in Juneau that college students have no difficulty finding summer jobs.  Still, no place is perfect.  Each has its disadvantages.  But for the first-time visitor, Juneau’s disadvantages require a large magnifying glass to discover.

Well, I’m exaggerating, of course.   It would be hard for a scholar to work there without the resources of a first-class library and aside from Native American productions, there is little for aficionados of art.  And I imagine that drama and music enthusiasts might pine for the theaters and concert halls of a metropolitan center.  And then there's the weather.  The rain forest in which Juneau stands wraps it in what seems like a perpetual mist - during our two-week stay, we saw the sun but three times - and in winter the sun sets in mid-afternoon.  Shoveling snow for an hour before you go to work and for another hour when you return soon loses its charm.  Still, Juneau is so beautiful, so close to nature, that staying there restores the soul. 

Yes, Juneau is strange but wonderful.  It reminds me of old age, that stage of development that is similar in some ways to our previous lives, but radically different in others.  Like Juneau, old age is a place apart.  But that’s a topic for another post.

Uncertainty

A recent study by Katrina Hopper at Yale (http://newoldage.blogs.nytimes.com/2012/06/04/among-the-very-ill-confusion-about-lifes-end/?ref=health) suggests that elderly patients with serious diseases are confused about the course of their illness.  She studied 185 people whose average age was 73.  All lived at home.   All had advanced cancer, heart disease, or lung disease and were thought likely to die within six months, although some lived a lot longer.  Interviewers asked them “which of the following best describes what you think the course of your final illness will be?”  The options were “Will die suddenly."  "Will die within a day or two of a serious complication." "Will die after a prolonged illness."  "I don’t know.” 

Interviewers asked the respondents this question every four months for up to two years.  The most frequent response was “I don’t know.”  Only a third expected a long illness, although this was most likely to be the case. (“Very few people die suddenly in their sleep,” noted Dr. Hopper.)  Striking was the respondents’ uncertainty, with almost all of them changing their answer between one interview and another.  Over half changed their minds two or more times.  The only variable related to the patients’ expectations was their disease.  If they had cancer, they were more likely to expect a lingering illness.

Why were the patients in Dr. Hopper's study uncertain?  Each of them had a terminal disease that followed a relatively predictable path.  Did they not ask their doctors?  Had their doctors been reluctant to tell them?  Or had their doctors told them but the patients were unwilling or unable to understand what they heard?

I didn’t ask my medical oncologist to describe the course of my disease – or if I did, I didn’t process his answer.  He was, as I recall, rather vague, beyond telling me that once the hormone treatment stops working, there are other treatments available in his armamentarium and that I should not view myself as suffering from a terminal disease but from a chronic one that can be managed, like hypertension.  He didn't really convince me that stage four cancer is a chronic disease, although at my age, one of my other medical problems might just as likely knock me out.  When next I see him, I will ask him to be more specific.  How much longer is the hormone treatment likely to be effective?  How painful will the next stage of treatment be?  I think it better to be realistically informed than to imagine that I’ll continue to feel so good for the indefinite future.  Or is it?  Perhaps I should continue living in my Fool's Paradise.  It's awfully nice in here.