Sunday, August 25, 2024
1814 British forces destroyed the Library of Congress, containing 3,000 books
1916 US Department of Interior formed the National Park Service
1944 German commander Dietrich von Choltitz surrendered Paris to the Free French forces, disobeying Adolf Hitler's orders to destroy the city
1950 "Rashomon" Japanese film directed by Akira Kurosawa, starring Toshiro Mifune, was released
2017 President Donald Trump pardoned Maricopa County Sheriff Joe Arpaio who had been convicted of contempt of court for racial profiling
In bed at 9, up and about at 4:30, after sleeping through TV programs before 9, exhausted from the prior night's insomnia. Lilly sleeps soundly beside her mattress in the TV room despite my moving about. She got up at 5:10 and walked by me sitting in the recliner to the living room. I'm not sure she was even aware of my presence. I let her out at 6:45 when the sun was just rising above the treetops across the street.
Prednisone, day 105, 10 mg., day 12. I applied diclofenac to my knee at about 5 a.m. and took 10 mg. of prednisone at 5:30. Morning meds and 650 mg. of Tylenol at 8:50. Around noon, I applied more diclofenac and 2 Lidocaine 5% patches to the knee.
I woke up OK but the CPP started early on. Last night's pain was pretty nasty right up to bedtime. Intense pain this morning around 7:45, a 7 or 8, right kidney area, had me moaning and thinking about calling Andy to see if he or Anh or Peter could drive me to the VA emergency room since Geri is quarantined with COVID. It got better after 10 minutes or so. Where did that come from??? It came back @ 8:25. I typed out a text message to Andy but didn't send it; again the pain went away.???? Pain worsened at about 2, sent the text to Andy, who picked me up and took me to the Zablocki ER. Got there at 3, got home at 9. UTI or a flare of my IC.
How well I remember the day, the pain, and the hours in the ER with Dr. Uihlein and the nurses. The pain was diagnosed as a flare of my interstitial cystitis and must have been from the lesions/ulcers in my bladder. I was hoping for a UTI diagnosis, something that could be cured by antibiotics. I had fulguration surgery on March 6th and have had no flares or unusual bladder pain since then. I made a point of abstaining from known bladder irritants since 11/25, hence no coffee, tea, caffeine, soda, carbonated beverages, wine, beer, or liquor for the last 9 months. Every now and then I think about having a cup of coffee, a glass of Zinfandel, or a cognac and I probably will one of these days, but so far, remembering that intense pain on 11/25, I have been getting along on water, an occasional cup of herbal tea, and milk with cereal. I stopped taking 3 tabs of misoprostol after the fulguration surgery. Still, I'm wondering whether I should start taking it again, especially if I move away from complete abstinence from caffeine, carbonated, and alcoholic beverages.
Zeke Emanuel has an essay in today's The Atlantic: "The Worst Advice Parents Can Give First-Year Students" in which he discourages parents from advising their college students to pursue career-enhancing curricula rather than a core curriculum of classic studies. At age 57, Zeke wrote another piece for The Atlantic in the October 2014 issue titled "Why I Hope to Die at 75" and subtitled "An argument that society and families—and you—will be better off if nature takes its course swiftly and promptly." I printed a copy of it which I have read more than once in the ensuing years.
[H]ere is a simple truth that many of us seem to resist: living too long is also a loss. It renders many of us, if not disabled, then faltering and declining, a state that may not be worse than death but is nonetheless deprived. It robs us of our creativity and ability to contribute to work, society, the world. It transforms how people experience us, relate to us, and, most important, remember us. We are no longer remembered as vibrant and engaged but as feeble, ineffectual, even pathetic.
[O]ver recent decades, increases in longevity seem to have been accompanied by increases in disability—not decreases... [B]etween 1998 and 2006, the loss of functional mobility in the elderly increased. In 1998, about 28 percent of American men 80 and older had a functional limitation; by 2006, that figure was nearly 42 percent. And for women the result was even worse: more than half of women 80 and older had a functional limitation. ;C]onclusion: There was an “increase in the life expectancy with disease and a decrease in the years without disease. The same is true for functioning loss, an increase in expected years unable to function.” . . . [O]ver the past 50 years, health care hasn’t slowed the aging process so much as it has slowed the dying process.
Take the example of stroke. The good news is that we have made major strides in reducing mortality from strokes. Between 2000 and 2010, the number of deaths from stroke declined by more than 20 percent. The bad news is that many of the roughly 6.8 million Americans who have survived a stroke suffer from paralysis or an inability to speak. And many of the estimated 13 million more Americans who have survived a “silent” stroke suffer from more-subtle brain dysfunction such as aberrations in thought processes, mood regulation, and cognitive functioning. Worse, it is projected that over the next 15 years there will be a 50 percent increase in the number of Americans suffering from stroke-induced disabilities. Unfortunately, the same phenomenon is repeated with many other diseases.
The situation becomes of even greater concern when we confront the most dreadful of all possibilities: living with dementia and other acquired mental disabilities. . . Instead of predicting a cure in the foreseeable future, many are warning of a tsunami of dementia—a nearly 300 percent increase in the number of older Americans with dementia by 2050. Half of people 80 and older with functional limitations. A third of people 85 and older with Alzheimer’s.
Emanuel goes on to list and defend other reasons to want to die at age 75, including economic, familial, and social reasons in addition to the biological and health reasons already mentioned. Then he writes that he hopes to accomplish his goal by refusing medical tests and treatments:
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. . .
After 75, if I develop cancer, I will refuse treatment. 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. . . What about simple stuff? Flu shots are out. . . [N]o to antibiotics. . .
He puts a lot of disclaimers in the article, statements of what he is not proposing (euthanasia, for example), but one wonders exactly why he did the research and expended the effort to write the article. There is certainly something creepy about it and about the fact that he wrote it 18 years before what would be his 75th birthday. He would deny any connection to the two Japanese movies that come to mind: The Ballad of Narayama 1983) and Plan 75 (2022). In the former, residents of a poor village are expected to leave the village at age 70 when they no longer can contribute to the welfare of the community i.e., when they become "takers" and no longer "makers," and to climb or be taken to a mountain where they will die of starvation. In Plan 75, the Japanese government is portrayed as having adopted a program in which it offers free euthanasia and a cash incentive to persons who are 75 or older. In each of the movies' scenarios, there are great social and psychological pressures on the elderly to go along with the custom (Narayama) or program (Plan 75). Basically, however, it comes down to the uselessness of the elderly and the burden they place on the younger persons who must support them. In other words, it's the Paul Ryan "takers" vs. "makers" argument. The Narayama custom and the Plan 75 program are very rational; they are sensible responses to social and economic problems. The same can be said of Zeke Emanuel's article: rational, sensible, objective. In Peter Freuchen's book Eskimo, he describes the practice of Eskimo families who build an igloo around their elderly who can no longer keep up with the hunt for food and leave them to die. The alternative is for the family, the adults and children, to starve and otherwise suffer because of their inability to follow seals, whales, caribou, or other sources of food. Emanuel's argument is not based on existential necessity, as in the case of the Eskimos and the residents of Narayama, but rather on his judgment of what constitutes a good life, a life well-lived.
"What I am trying to do is delineate my views for a good life and make my friends and others think about how they want to live as they grow older. I want them to think of an alternative to succumbing to that slow constriction of activities and aspirations imperceptibly imposed by aging."
One wonders whether Emanuel favors VSED, or voluntarily stopping eating and drinking as a method of avoiding the 'ravages' of life after age 75, or is that too rational, too directly a form of suicide, unlike mere refusal to allow medical tests, screening, vaccines, antibiotics, or any treatment to prolong life after age 75.
One wonders too about how firm that number 75 is. Why not 74 or 76? Might age 75 be a moving target, depending on how he feels at 73 or 77? Is the article itself just an academic exercise, a "thought experiment", as J. D. Vance described his proposal to give parents more voting power than non-parents?
I am now 8 years past my 75th birthday. During those 8 years, I have lived through the COVID-19 pandemic, often wearing a mask, frequently washing my hands, avoiding crowds, and getting vaccinated 6 times. I have gotten a flu vaccine each of those 8 years plus pneumonia and shingles vaccines I have endured some long-lasting and intense chronic pain experiences and loss of physical functionality. I have also experienced short-term memory loss, mild cognitive decline, and executive function challenges. Am I just prolonging my dying? Should I stop regularly seeing Dr. Chatt at the VA, stop the regular blood and urine tests, eschew the upcoming 7th COVID booster and flu shots, and stop taking my daily aspirin, blood pressure meds, and diabetes meds? I know only too well that the future looks grim. I think about it often, whether I want to or not. god knows I've thought about suicide often enough during periods of severe pain and disabilities, but I've never been able to ignore the effect suicide has on survivors.
Intimations of Mortality. I had some heart palpitations this afternoon which made me think, like Redd Foxx in Sanford and Son, maybe 'This is the big one!' i.e., a heart attack. It wasn't of course, just a normal palpitation, but it reminded me of how one could happen, anytime and anywhere. It happened while I was listening to Emmylou Harris singing "When They Ring Those Golden Bells:"
Anniversaries thoughts: First, it's interesting that the British commander in the War of 1812 ordered the burning of the Library of Congress, hardly a military target, and the German commander in Paris defied Hitler's order to burn Paris when the Germans withdrew. A reminder of individual responsibility in warfare.There’s a land beyond the river,
That we call the sweet forever,
And we only reach that shore by faith’s decree;
One by one we’ll gain the portals,
There to dwell with the immortals,
When they ring the golden bells for you and me.
Chorus:
Don’t you hear the bells now ringing.
Don’t you hear the angels singing?
’Tis the glory hallelujah
Jubilee.
In that far off sweet forever,
Just beyond the shining river,When they ring the golden bells for you and me.
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