Friday, January 16, 2026
1919 The 18th Amendment to the US Constitution, authorizing the prohibition of alcohol, was ratified by a majority of US stat
1945 Adolf Hitler moved into the Führerbunker, his underground bunker in Berlin, where he lived until his suicide on April 30
In bed at 10,up at 5:40, thinking of Zeke Emanuel's article, 25/12/35/22. Sleet between 6 and 7 a.m., snow showers later.
Meds, etc. Morning meds at ? a.m. Trulicity injection at ? a.m.
Text to Sarah and Andy: Hi, Sweeties. FYI, here’s what I learned at the Cardiac Clinic this afternoon. It seems I have a few heart problems, none of them life-threatening now. First, I’ve got congestive heart failure, which just means my heart muscle isn’t pumping enough oxygenated blood to supply what my old body needs. It manifests mainly in shortness of breath and fatigue, but requires big dietary changes, which I doubt that I’m up to. Time will tell. I also have a couple of heart rhythm problems. One is called Bradycardia, which means my heartbeat slows down when it shouldn’t, low- to mid-30s, about half what it should be. I also have something that sounds like it should be treated by Viagra but is actually another heart problem, called premature ventricular contraction, where my heart follows a repeating 3-beat pattern, 2 normal heartbeats plus an extra one. It happens in my heart’s left ventricle, the primary pumping chamber. I’ve also experienced some thickening and stiffening of the heart muscle, which decreases the heart's ‘loading capacity’ and reduces the volume of blood it pumps out. I understand this is part of the heart failure condition. The specialists have changed some of my medications, and I’ve been referred to a heart rhythm specialist for further whatever. As I said, nothing life-threatening and mainly manifesting in chronic fatigue and shortness of breath with any exertion, occasionally with no exertion. I tell you all this stuff because the first question they ask when taking the medical history is “Is there any history of heart disease in your family?” I had to answer that question, “None that I’m aware of”, and I hope I am not a trendsetter. In any case, you should be aware of it (as well the history of diabetes, polymyalgia rheumatica, etc. from me and colon cancer from my Dad. My medical record at the VA also says I have ‘mild cognitive impairment’ but no suggestion yet of dementia (fingers crossed🙏🤞🏻😱)❤️❤️ If I find out more from the heart rhythm specialist (who’s probably from Freoderdt/MCOW), I’ll pass it on. I suspect I won’t get to see him for at least a few weeks.
The Emanuelian quandary. My meetings with the CHF nurse Michelle and NP Maggie were both faithfully devoted to keeping me alive and comfortable. The regimens they prescribed are at least a little bit demanding, keeping a daily record of my weight and blood pressure, paying close attention to reducing salt to 2,000 mg/day, I very much appreciate their professional, devoted care. NP Maggie especially made a point of studying my medical history for the last few years at the VA. If I follow their advice, I may live for several more years. My heart failure is only at Stage II, meaning it's probably easily "managed" by doing what I'm told. The problem is a don't want to live several more years since those years will only be more difficult than how I am living now, i.e., with chronic back pain, hip problems. weak legs, wearing compression socks and velcro wraps every day, wearing arthritis gloves every night, taking a big handful of pills and capsules every morning, injecting myself every week, avoiding exertion, avoiding steps and stairwells, and so on. With each passing day, I grow closer to a 90th birthday and further away from my 80th, more pain, more disability, more decrepitude and illness, more immobility, more isolation and loneliness, and more risk of dementia and dependency. Am I missing something? Having passed the midpoint of my 9th decade, I'm looking ahead to a slow-motion trainwreck. (And maybe not so slow.)
Here's what Zeke Emanuel said he would do in his Atlantic article:
Seventy-five. That is all I want to live. But if I am not going to engage in euthanasia or suicide, and I won’t, is this all just idle chatter? Don’t I lack the courage of my convictions? No. My view does have important practical implications. One is personal and two involve policy.
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. I take guidance from what Sir William Osler wrote in his classic turn-of-the-century medical textbook, The Principles and Practice of Medicine: “Pneumonia may well be called the friend of the aged. Taken off by it in an acute, short, not often painful illness, the old man escapes those ‘cold gradations of decay’ so distressing to himself and to his friends.”
My Osler-inspired philosophy is this: 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.
This means colonoscopies and other cancer-screening tests are out—and before 75. If I were diagnosed with cancer now, at 57, I would probably be treated, unless the prognosis was very poor. But 65 will be my last colonoscopy. No screening for prostate cancer at any age. . . 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. Certainly, if there were to be a flu pandemic, a younger person who has yet to live a complete life ought to get the vaccine or any antiviral drugs. A big challenge is antibiotics for pneumonia or skin and urinary infections. Antibiotics are cheap and largely effective in curing infections. It is really hard for us to say no. Indeed, even people who are sure they don’t want life-extending treatments find it hard to refuse antibiotics. But, as Osler reminds us, unlike the decays associated with chronic conditions, death from these infections is quick and relatively painless. So, no to antibiotics.
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.
What will happen to me if I don't follow the advice/instructions of the VA professionals? Fluid retention and weight will increase, meaning my shortness of breath will get worse, the disease will progress faster, leading eventually to multiple visits to the Emergency Room, hospitalizations, cardiovascular "events," kidney and liver damage from decreased blood flow, and a protracted death like Kitty's and David Branch's. What does Dr. Zeke say he would do in those circumstances? I believe he would follow the doctor's orders, even though it would probably prolong his life (and, as he reminds us, his dying). I will try to do the same.
Text exchange with Geri:
Geri Clausen:
Geri Clausen:
Hi,
My apologies for this overdue text. I actually just woke from a nap— it’s 5:30.
We went to see Jimmy today and Katherine had briefed me on what to expect. Nonetheless I was so sad to see how frail he was and his mental decline. He didn’t know me although he gave me a very knowing smile when he saw me and we tried to tell him who I was.
I couldn’t fall asleep last night till maybe one or later. Hope to do better tonight. K&J are out walking the dogs and it is very cold here! When they come back we’re getting pizza.
We’re going to see Jim tomorrow sometime.
Your text to “Dear Sweeties” was that to Caela also?
My flight was fine and even very good because the passengers were light and we were asked to spread out in the plane so I had a whole row to myself!
More tomorrow— love you.
Charles Clausen:
The Sweeties text was just to Sarah and Andy. Do you think I should tell Caela? I am so sorry about Jimmy. I feared it would be a sad experience for you to see him even more impaired than he was the last time you saw him. Although I take at face value your statement about him not knowing you, I suspect that the “knowing smile” when he saw you was kind of like “muscle memory.” His brain recognizes you as a good part of his life, though he can’t put together all the memories buried deep in his brain that makes it recognize you. I hope you get a better night’s sleep tonight and for the rest of your stay. I reheated the pot roast this afternoon and had an early bird dinner which was delicious. The only things that would have made it better were maybe some ketchup for the beef and some SALT!😄😟😢 And maybe some grapefruit!😄 I had straight decaf coffee this morning - not very good. I think today is the anniversary of your new knee.🎉 Have I told you lately that I love you? Have I told you lately that I care? Well, darling, I’m telling you now.❤️
