Tuesday, April 21, 2026
1954 The USAF flew a French battalion to Vietnam
1956 Elvis Presley's first hit record, "Heartbreak Hotel," reaches #1
1975 Last South Vietnam President Nguyễn Văn Thiệu resigned after 10 years in power
1989 Thousands of Chinese crowded into Beijing's Tiananmen Square, cheering for students demanding greater political freedom
2025 Cardinal Kevin Farrell, Camerlengo of the Holy Roman Church, announced that Pope Francis had died early on Easter Monday, at the age of 88.
In bed around 9, up at 4. 0445 148/58/32, 0500 131/62/62, 0515 136/65/64 207.8; 45/38/68/43, sunny, partly cloudy.
Morning meds at 8 a.m. Ranolazine at 6:30 a.m. and X p.m. I was told by Dr. Singh this morning that the Ranolazine didn't work and to stop taking it and start taking a half dose of the med that put me in the hospital for 5 days.
Cardiology. I saw the cardiologist this morning at the VA, or more accurately, I saw the electrohysiologist, the arrythmia specialist. He told me that the medication I've been taking isn't working to fix my ventricular tachycardia and that he recommends that I undergo a catheter ablation, for which the first available date is June 1. I told him I needed to think about it. I spent about 10 minutes with him and didn't learn much other than what I reported above, plus the risks of not having the surgery are increasing heart failure and cardiac arrest. My first instinctive response to the recommendation of heart catheterization was to say, "Thanks, but no thanks." I am ever mindful of Ezekiel Emanuel's article in the October 2014 Atlantic, Why I Hope to Die at 75 and the tension between wanting to live forever and not wanting to grow ever older and ever more decrepit. With every passing year, I am physically weaker, with decreased executive function, more frail/feeble, and less mentally focussed than I was the year before. If it weren't for Geri, I would probably be in an assisted living facility now. I can't take care of ordinary maintenance requirements at home, anything that requires climbing a ladder or getting down on the floor (I can get down, but I can't get up unassisted.) Climbing and descending stairs is a challenge for me. So is climbing or stepping down from one step. A one step stoop without a railing, like ours was and Andy's is, is a real impJediment for me. Just a few weeks ago, I fell onto our driveway taking our garbage cart from the garage to the street and my Apple Watch Fall Detector called the North Shore Fire Department to come get me up from the driveway's 20℉ surface. The same watch regularly reminds me of my "very unsteady gait" and "high risk of falling." I'm closer to age 90 now than I am to my 80th birthday and I'm mindful of my brother-in-law and friend Jimmy at age 91 and addled. Researchers opine that Americans have a 42% lifetime risk of dementia with the majority of the risk occurring at age 85 and after. Zeke Emanuel's article reports that one in three Americans 85 and older has Alzheimer's. How many others have disabilities from strokes, on top of the many disabilities resulting simply from age, from body parts breaking down and/or failing, or from late-onset cancer of the bladder, lungs, pancreas, or other organ?
Cardiac catheterization is considered a relatively safe procedure, but it is not risk free. It can lead to bleeding, blood clots, pulmonary embolisms, stroke, injury to heart muscles, blood vessels, or a heart valve, and lesser problems. But it's not surgical risks that give me pause, though I don't minimize or ignore them; it's what I want to do to avoid a 'natural death' from cardiac arrest, or heart failure. I started to write 'to avoid early death' but what is "early" about death in the mid or late 80s? I am going to die from something someday and I've been in the "dying zone" for several years now, where when I die no one would call the death 'tragic' or 'untimely' or think, 'but he was so young, with so much to look forward to." My Health Care Power of Attorney on file with the VA contains a DNR instruction, Do Not Resuscitate in the case of my heart stopping. Before my last outpatient surgery I was asked if I wanted to waive that instruction if my heart stopped during the surgery. When I was hospitalized on March 19th with a serious heart and blood pressure condition, I was asked the same question. In each case, I said NO. I didn't want extraordinary medical means to be employed to keep me alive if I died. Those situations concerned the use of extraordinary means to restore life after tmy heart quit. My current situation concerns an extraordinary measure to prevent a natural death from occurring. The situations are very different. of course. If I were faced with the choice I'm facing at age 65, I daresay I wouldn't hesitate very long before saying 'yes' to the surgery, but doesn't may age and poor health make this and poor prospects make this a difficult choice? Or am I being foolish?
Here's what Zeke wrote.
Once I have lived to 75, my approach to my health care will completely change. I won’t actively end my life. But I won’t try to prolong it, either. Today, when the doctor recommends a test or treatment, especially one that will extend our lives, it becomes incumbent upon us to give a good reason why we don’t want it. The momentum of medicine and family means we will almost invariably get it.
My attitude flips this default on its head.
At 75 and beyond, I will need a good reason to even visit the doctor and take any medical test or treatment, no matter how routine and painless. And that good reason is not “It will prolong your life.” I will stop getting any regular preventive tests, screenings, or interventions. I will accept only palliative—not curative—treatments if I am suffering pain or other disability. . . Similarly, no cardiac stress test. No pacemaker and certainly no implantable defibrillator. No heart-valve replacement or bypass surgery. If I develop emphysema or some similar disease that involves frequent exacerbations that would, normally, land me in the hospital, I will accept treatment to ameliorate the discomfort caused by the feeling of suffocation, but will refuse to be hauled off.
. . . . Obviously, a do-not-resuscitate order and a complete advance directive indicating no ventilators, dialysis, surgery, antibiotics, or any other medication—nothing except palliative care even if I am conscious but not mentally competent—have been written and recorded. In short, no life-sustaining interventions. I will die when whatever comes first takes me.
As I told Dr. Singh this morning, I need to think about this.
As I've written about before, Zeke's thoughts are the thoughts of a single man. He's long divorced and never remarried. Everything is more complicated for those of us who are married and care about our spouses. What does Geri think I should do? Why? How do I - and we - go about analysing the factors that should go into decision-making on these life and death issues? Another factor: would undergoing this catheterization not be primarily extending my life by avoiding a natural death, or be palliative, in the sense for protecting against the many disabilities and burdens of heart failure?
Depleted US stockpiles. Center for Strategic and International Studies: 45% of precision strike missiles, 50% of THAAD missiles, and 50% of Patriot Air Defense Interceptor missiles. This is a major problem. Hegseth and Trump have been lying about the US having no problem in terms of running out of weapons, especially high-tech, high-cost weapons that take years to produce.
The Idiot. I'm 75% through the novel with mixed feelings about it. A good deal of it seems contrived, partly the result of its initial serialization for magazine publication, but much of it reminds me of a soap opera, the way the characters interact and the pivotal roles of two women, Natasia Phillipovna and and Aglya Ivanovna.





