One Perfect Day

My daughter, a palliative care social worker and an indefatigable source of stories for this blog, sent me a link to an article in Cleveland.com, which reports a story that first appeared in the Cleveland Plain Dealer about the efforts of three hospices to give their patients one perfect day.  (http://www.cleveland.com/brett/blog/index.ssf/2012/05/hospice_patients_treated_to_th.htmlabout hospice patients’ )  Two of the hospices, The Hospice of the Western Reserve and The Crossroads Hospice ask their patients, “If you had only one day to live, what would it look like?”  The third hospice, Malachi House, a hospice for the indigent terminally ill , doesn’t ask what their patients would like but observes their wishes as expressed in ordinary conversation.   All three hospices do their best to make their patients’ wishes come true.

None of the patients have asked to travel to exotic locales or to embark on ambitious activities such as sky diving or bungee jumping.  Most of the patients ask to be surrounded by family and food.  Some ask to experience something that they misss, something that once gave them pleasure: a visit from a cat, a fish-fry, a birthday party, playing the slot machines, engaging in an ice cream social, having one’s hair brushed.

One man asked to go for a drive.  A chauffeur arrived in a limosine, which took him, among other places, to the drive-through window at McDonald’s, much to the patient’s delight.

At Malachi House a man asked for Christmas presents.  He had never received any.  The staff bought him gifts, which they carefully wrapped.  He refused to open the packages, preferring instead to gaze at the pretty paper and ribbons, tokens that someone cared for him.

These wishes were for pleasures which to the healthy seem small, even trivial, but to the dying are important, reminders of the lives they used to live, activities that they once took for granted.    Their desires for the pleasures of everyday life tell us to savor them now while we can. 

I return yet again to Emily Webb in Our Town.  Having died in childbirth, she ignores the warnings of the dead to forget her past life.  Instead, she returns to the morning of her twelfth birthday.  She observes her parents, who neither see nor hear her, prepare for the day.  The everyday life she so longs for, taken for granted while she was alive, now seems achingly precious.  When she returns to the graveyard, she asks the Town Manager, Does anyone ever realize life while they live it…every, every minute?   And he replies, No. Saints and poets maybe…they do some.

Few of us are saints or poets, but one aspect of their lives is open to all of us, to realize life while we live it....every, every minute.  Most of the time, each of us is living a perfect day.    What a pity not to realize it now.


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Personal Identity

Since the day, about six weeks ago, when I struggled up the stairs of the subway stop at 86^th and Broadway, I’ve been thinking a lot about identity.  That’s because as I half pulled myself up the stairs by means of the railing, I remembered running up the same stairs almost fifty years ago.  That’s when we lived on 86^th Street between Columbus and Amsterdam.  I was 31 and newly married. 

Could I be the same person now as I was then?  Running up the stairs now would be as likely as my flying up them.  But my physical decline is only one of the differences between that young man and this aged one.  I have changed in so many fundamental ways that I question the extent to which I’m the same person now as I was then.  Is it an illusion to think that that 31- year- old and I are the same?

When I posed this question to my good friend Elaine Yaffe, she referred me to an essay written by her son Gideon Yaffe, a professor of the philosophy of law at USC, “Locke on ideas of identity and diversity.”  This was a big help in furthering my cogitations, although Professor Yaffe should not be blamed for the marked lack of rigor in my own conclusions.    

While I’m a lot different from that newlywed, not yet a father, who thought, for example, that I would stop worrying about my as yet unborn children when they turned eighteen, I’m even more different from the two-year old child who appears in a studio photograph I recently found.  He’s seated on a bench, one leg folded under the knee of the other, holding a ball and smiling.  My parents told me that this picture is of me, which I would otherwise have doubted since the child has light colored hair and I cannot remember a time when my hair was other than dark brown or gone.

In what sense are that child and I the same person?  We share no memories.  The child did not yet speak – I waited until I was three before I spoke, leading my parents to wonder if I was mentally disabled – so, on the assumption that we need language in order to retain memories,  we cannot be linked through a sequence of memories that might connect us through a long chain beginning with him and running through intermediate manifestations of himself until the chain ended with me right now.  

“An Oak, growing from a Plant to a great Tree, and then lopp'd,” Prof. Yaffe quotes Locke as stating, “is still the same Oak.”  So in that sense that child and I are the same organism.  But are we the same person?   

If each person represents a unique collection of memories, abilities, attitudes, habits of mind, and so forth, then that child and I are not the same person, nor is that 31-year-old man who ran up the subway stairs the same person as the writer of this post.  But this leads to an uncomfortable conclusion, namely that as persons we keep changing, as we acquire new skills, memories, attitudes or change or lose them, so we’re never exactly the same person from one day to the next.   My late uncle, a doctor, told of the army recruit who, in response to the question, during his initial medical examination,  “when did you stop masturbating?” replied “you’re supposed to stop?”   This is probably apocryphal, but the point is that we never finish growing up.  We continue to grow and to change.

Sixty-three years ago, I barely passed a college course on the introduction to philosophy, a fact that my readers will say contradicts my thesis, inasmuch as I’m as philosophically inept at 80 as I was at 17.    But I ‘m not claiming that everything changes only that some things change and that these changes transform one person into another. Although the net change from one manifestation to the next may be slight, the change from the earliest to the latest version may be great.  In the meantime, when our friends and relations see us, they see the same person as they saw yesterday or last week.   This is too useful an illusion, both for them and for me, to tell them that they’re wrong.  The organism is the same, but the person is not.




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Shavuot and Pentecost

Last Sunday, we left Shavuot services early, just before the Torah reading was to begin, in order to arrive on time at our eldest grandson’s confirmation ceremony at St. Augustine R.C. church in Park Slope.   It was one of those years that Shavuot and Pentecost arrive on the same day, always, of course, a Sunday.  A gothic church, both inside and out, St. Augustine’s interior is beautiful, with numerous large stained glass windows, which filtered the bright noon light.  An organist was playing Bach when we entered, looking for our daughter and our son-in-law, who had preceded us.  We had almost decided they hadn’t yet arrived, when our son-in-law spotted us and guided us to our seats.  Our grandson was seated in a separate section along with his sponsor, a first cousin once removed, the daughter of his father’s aunt.

A screaming child sat directly behind us, which meant there was much I couldn’t hear, including the presiding priest’s explanation of the meaning of the Holy Spirit.  When it was time for parishioners to greet each other, with the expression “Peace be with you, “ I told the unfortunate mother, who was holding the child, quiet for the moment, “Peace be with you” with unusual sincerity.   In spite of my not hearing well, I thought that the ceremony was a beautiful one. 

Much as I would have wished my grandson to have grown up Jewish, I had to admit that there are many routes to spirituality, no matter how strange they might seem to an outsider, and that our grandson seems committed to the faith of his father and his father’s fathers.  I also had to admit to myself that when I only a little older than he is now, I felt an attraction to the Catholic church after having read Thomas Merton’s The Seven Storey Mountain. Of course, that was well before I learned anything at all about my own religious heritage.

An Orthodox Jewish family sits shiva when their child marries a non-Jew, treating their child as dead.  This was furthest from our minds when our daughter chose to marry a devout Catholic and promised, as a condition of being married by the Church, to raise their children as Catholics.  Consider our beloved daughter dead?  What could be more horrible?  Lose her? Lose our wonderful grandson?  Never.  Our son-in-law is a lovely man, a decent man, a good father and a good husband, and it’s not his fault that he’s not Jewish.   Nobody’s perfect, after all. 




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The Saddest Sound

It’s a Jewish practice for mourners to shovel some dirt onto the coffin of the departed, carrying the dirt on the back of the shovel to show reluctance for the task.   The sound of dirt striking a coffin is the saddest sound in the world.  It is also the most final.  It brings home to the mourners the unassailable fact that their loved one is gone.

I heard that sound Wednesday.  It was at the funeral of my first cousin, Malcolm Fritz, a year and a half younger than me.  As children we never lived more than a ten minute walk from each other’s homes and I used to play with him.  I remember our climbing a tree in his back yard.  For the past thirteen years he had been battling prostate cancer until at last he had no more strength to fight and the cancer killed him at last.

After the gravesite ceremony, I wandered over to my parents’ graves.  The first two American generations of my mother’s family are buried in this beautifully maintained cemetery in Wakefield, Massachusetts, a small town about twelve and half miles from downtown Boston.  There lie my grandparents, my parents, my two uncles, my three aunts, and my aunts’ and uncles’ spouses.  Malcolm was not the first of my maternal grandparents’ sixteen grandchildren to die – his older sister and a younger cousin preceded him, but neither is buried at this cemetery.  Malcolm is the first of the third generation, our generation, to be buried next to his parents.  You can read about it from another point of view, that of my niece, who kindly drove me up and back: lazygal.blogspot.com/2012/05/circle-of-life.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+blogspot%2FNqJH+%28Killin%27+time+being+lazy%29

After the ceremony I wondered if my wife and I were doing the right thing to leave our bodies to a medical school.  I worried that that the death of the other would not seem as real as it would if the thud of dirt on the coffin were heard.  My wife assured me that nothing would make the death of the other seem real.  “Even if you’ve shoveled dirt on my coffin,” she said, “you will still look for me; you will see me walking down the street; you will find me everywhere and nowhere.  Only with time will you realize I’m gone for good, but even that won’t stop you from holding imaginary conversations with me.”  She convinced me that leaving our bodies to a medical school would not cause the other to suffer additional pain.

Once the medical students have learned what there is to be learned from our ancient cadavers, our instructions are that our remains be cremated.  My wife asked me if I’d like my ashes to buried in our family’s plot.  There’s room for several more corpses.  I asked her if it wouldn’t be too much of an imposition for her, our children and grandchildren, my siblings and their children to travel all the way to Wakefield just to deposit  my ashes.  For  most of the people who would come to the burial, Wakefield is relatively inaccessible.  "We won’t visit your grave afterwards, no matter where it is," she said, "so after the burial it won’t matter. We’ll have plenty of time to arrange the funeral.”  She said she wouldn’t mind her ashes being placed there as well.  The idea of my being buried not only near my wife but also near my parents is pleasing to me.  Before we change our instructions I’ll have to check it out with our children and my siblings, but if they don’t object, we’ll probably be buried there. 

In the meantime, I remain the senior cousin, from the point of view of age, a position I hope to maintain for many more years.

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Palliative Care

Among my daughter’s many virtues is her alertness to articles that might stimulate a blogpost.  She’s done it yet again with an article in The Washington Post, by Amy Berman, who received a diagnosis two years ago of stage four breast cancer (http://www.washingtonpost.com/national/health-science/terminal-breast-cancer-leads-woman-to-pick-palliative-care-not-aggressive-therapy/2012/04/30/gIQAY6rBsT_story.html).   Her breast cancer, inflammatory breast cancer, is the most deadly kind, with only a 40% five-year survival rate. 

She decided to forego aggressive therapy – intensive chemotherapy, radiation, a mastectomy, and more chemotherapy – which might extend her life for a few months but would, as she knew from her experience as a registered nurse, make her miserable in the process.  “Because my progressing illness is incurable,” she wrote, “I’ve chosen a solely palliative approach, and my oncologist has embraced my choice.  Together the two of us chose a treatment regimen that would slow tumor growth while protecting what was precious to me, my quality of life.  Instead of waging war with a disease that can’t be cured, my doctors and I are focusing on treatment that optimizes how I function and addresses my symptoms,  This treatment will include, when I need it, comfort care for pain symptoms.”

At the beginning of my current treatment, four years after the initial diagnosis of prostate cancer, which had supposedly been cured by radiation and hormone therapy, my new medical oncologist told me that he would begin with hormone therapy and after that treatment failed, as it eventually does, he would proceed to other measures, including chemotherapy.   For the moment, the hormone treatment has slowed the progress of my illness to the extent that I have no symptoms.  I can carry on my normal activities without pain.  As for the next steps after the present regime fails, I don’t know what to ask for.  I don’t know what is more precious to me, a good quality of life or added months of life.  I’ll need to find out how miserable the next set of treatments will make me and how much time they are likely to buy me.   After reading the article my daughter sent me, I know that I must make that decision sooner rather than later.



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Fear of Driving

In last Monday’s post, I wrote that we struggle not to give unsolicited advice to our children but that they don’t return the favor, giving us more advice the older we become.  “They suspect, I fear, that whatever sense we might once have possessed has declined with age to the point that we’ve become innocents in a depraved world.”  In response, my niece wrote me that it’s not that our children think we’ve become simple-minded but that they see us acting as if we’re a lot younger and that such behavior could get us into trouble.  The example she gave is now faced by a friend of hers, the child of elderly parents who don’t realize that their driving skills have deteriorated. 

This is a problem for a lot of adult children - how to pry the driver’s keys away from their parents, when those parents’ driving has become dangerous to themselves and to others.   Understandably, many parents resist their children’s efforts to remove them from the driver’s seat because in many cases, giving up driving means loss of independence, especially if they live in a city with inadequate public transportation, such as Los Angeles, or if they live in the country.  But practical considerations are only one of the factors that motivate resistance.  Driving is an icon of adulthood, of mastery.  To remove it symbolizes a return to that earlier state when one was dependent on others, in this case a symbol not of youthfulness but of decay.

About five years ago I let my driver’s license lapse.   We were then living in the center of downtown Jerusalem, which offered splendid public transportation. Mainly I didn’t use it because I could walk to most of my destinations.  I drove so very seldom that I began to feel uneasy when I did get behind the wheel.  One day, I drove too near a bus that had stopped by the side of the road.  I drove so close to the bus that I clipped my right-hand side-view mirror, which flew into the passenger compartment.  This incident so unnerved me that I decided then and there that my driving days were over, even though at that time I was only 75.  A motoring career that had begun at age 16 and had seen me drive on three continents, including countries in which you drive on the wrong side of the road, a career in which I drove across America three times by myself, had come to an inglorious conclusion.   I knew I was right to stop driving, but I felt bad about it just the same.  I felt less of a man, which is absurd, I know, but there it is.

But I also felt relief.  For the fact is I was never a superb driver, not like my wife, who loves to drive.  I remember that the late Paul Reynolds, my college friend who had come home with me during one of our breaks from classes, criticized my driving, telling me I was straddling two lanes.  This happened more than 60 years ago but the memory of it is as clear as if it happened yesterday. The only time I saw my beloved father–in- law lose his temper was when he was a passenger in a car I was driving much too slowly to suit him.  He insisted I change places with him.  This hurt my feelings, and it took me a while to forgive him for it, but no doubt he was right.  My pokiness has a precedent in my mother, who was among the world’s worst drivers.  It was she who taught me to drive.  (“Now stay in the left-hand lane,” she would say, “and don’t pay any attention to the honking behind you,” as we proceeded at a stately 25 miles per hour.)  I felt relief when I stopped driving because for the almost 60 years after I started to drive, I never lost the fear that I would run someone over.  At long last that fear has gone.

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Letting Go and Shutting Up

Our daughter, a palliative care social worker at a Brooklyn hospital, organizes an annual memorial for those patients who have died during the past year.  Held last week, this year’s memorial attracted about 100 mourners.  Among them was a woman in her seventies, who told the following anecdote about her mother, who lived with her and who died in her mid-nineties. 

A few months before her mother died, the two of them went to an evening party.  After awhile the mother went home but the daughter remained at the party for a few more hours.   When she came home, her mother gave her hell for staying out so late.  “I had to wait up for you until you came home, and all the time I was worried!”

If I manage to live to my mid-nineties, I hope I’ll be able to go home by myself from an evening party, but I also hope that I won’t be so far gone as to talk to my children like that.  

As parents we’re responsible for the care and nurturing of our children from infancy to their adulthood, but at some point we have to let go.  We have to let them make their own way along with their own mistakes, even as we grit our teeth to keep ourselves from giving them unsolicited advice.

That old lady was worried about her daughter, even though her daughter was an old lady too.  That’s only natural.  We worry about our children and then, to a lesser extent, about their children, as long as we live.   A mother once told me that she was only as happy as her least unhappy child, and a mother of five told me that she was glad she had so many children.  She figured that at any one time at least one of them was likely to be in good shape.

Before I became a parent, I thought that once my as yet unborn children turned 18, I could forget about them.  How absurd!  Your children are forever uppermost in your mind.

“Sorry is the hardest word,” according to an Elton John lyric, but even harder is to say nothing at all, when tempted to give your adult child unsolicited advice.  When a child marries, I once heard, you should open your wallet and shut your mouth.  I’m not sure about the first, but as for the second, it’s essential, no matter how worried you are about your child.

But your children are not obligated to act the same way towards you.  Both of ours offer unsolicited advice and the older we become the more frequent the advice.  They suspect, I fear, that whatever sense we might once have possessed has declined with age to the point that we’ve become innocents in a depraved world, in need of their protection.  I don’t mind.  Their concern is motivated by love.  Besides, they may be right.






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