Death panels

 

Judy and Rob 2012

  I have been worried ever since I read Atul Gawande's Being Mortal: Medicine and What Matters in the End and Katy Butler's Knocking on Heaven's Door: the Path to a Better Way of Death.  What if Judy has a breathing crisis and I call 911 and the EMTs or the ER docs do something to her that will increase her suffering without any benefit? Something that would result in a permanent situation that she definitely does not want, such as being put on a ventilator?  Nephew Rob, the Emergency

Medical Technician leader, says that his guys are required to "do everything" unless they can find a POLST do not resuscitate order.  What is "everything?'" And how am I supposed to know if it will do any good?  How does one procedure  lead to another?  How will I know what to say yes or no to, especially when I am frightened and all I want is for Judy to breathe better? Judy says, "If a procedure can reverse a situation, do it.  If the situation cannot be reversed, don't do it."  Not nearly specific enough to guide me through my ignorance.
  Judy meets with a new pulmonology fellow every other August. When this year's  fellow, Dr. Sakata, asked, "Do you mind if I type while we're talking?"  I thought, "Oh, no, he's not going to take his head out of his computer." But he was wonderfully direct. At the end of the visit he scooted his stool closer to Judy and looked her in the eye and said that now we needed to talk about end of life issues.  "Do you have a POLST (Physician Orders for Life Sustaining Treatment)?" Here's the thing about intubation and ventilators."  Judy talked about her wishes. I expressed my worries about my lack of knowledge.
Dr Sakada told me that if I see mask go over Judy's face, that's OK, but if I see a long tube ready to go down her throat, that's when I should say no.  That is the level of detail and simplicity that I need.  
   Les and Betsy have been reading the same books.  Les, ever prepared and thorough, worked and worried over the wording of advanced directives, supplemental letters to the directives, and health

Les and Betsy

authorization releases.  These are legal documents stating a patient's wishes in great detail and authorizing representatives to make health care decisions for her.  We spent a working morning with Betsy and Les drinking coffee, eating fruit and cinnamon rolls, and going over the documents word for word.

Ukulele buddies with Maddie

     Of course, all this fussing helps me avoid my deeper fears.
     Meanwhile, life goes on.  Judy and her ukulele buddies sang "Happy Trails" to their favorite  waitress, who will be leaving the Painted Lady.  Maddie is  beginning community college, the first step in her long-held dream of becoming a registered nurse.

 

Green flash

Jack on skim board:  John's photo

Rob and Jess: Jake's photo

Josh with sand tool

     Four houses full of the family gathered in Manzanita this summer, as we did in 2013.  Paul and

Bridget, Lucy, Vonnie

Tina and the boys had their base camp in a house high in the trees. Rose and John and their family filled 3-story Hallie House. Cole and Bianca rented a sweet place close to town with Vonnie and Ernie, and Judy and I  settled into a beachfront house with a spectacular view. Judy and Mutt Leigh held court from the couch

Hikers

while our loved ones flowed in and out.

John introduces sea creature: Jake's photo

    I asked each of the boys to come by early in the morning to have hot chocolate while I drank my coffee.  They were  sweet
times for me, one-on-one with my grandsons.
     John brought Judy a cinnamon roll from the bakery every morning.  He led the group to the tide pools, which this year had few star fish but many sea anemones.  He organized a hike up Neahkhanie Mountain, and games of petanque.  He and Josh

Ernie and Judy with walkie-talkie

created the most complicated sand drawing yet.  The little girls and Sam built a fairy village on the beach, and Jack learned to ride a skim board.  Judy and Ernie surveyed the action and kept up with breaking events by walkie-talkie with Bridget down by the water.

Lucy and sea anemones: Jake's photo

     Rose and I took short forays into town, congratulating ourselves on getting the family to Manzanita one more time. Gathering in Manzanita one year and Rehoboth the next seems like a great pattern to us.  We also reassured

each other that we were  not trying  to micromanage anything.

Charlie and Mutt Leigh

     Mutt Leigh spent the week being petted and walked. Charlie cuddled her constantly, and Jake declared that she is "a teddy bear of a dog." Lucy and Jamie would appear at our door and ask to walk Mutt Leigh.  One evening while the sun set, the crab eaters
crowded our picnic table while all the kids were in the hot tub.  When the kids emerged from the tub they streamed down the dunes to the beach, taking Mutt Leigh and Rob's dog Gracie with them.  Then they climbed back up the dunes to gather around the fire pit and roast marshmallows for S'mores.  Jack took great care in toasting a perfect marshmallow for Judy.

Judy enjoying life

Happy with Paul

     That evening while the sun was going down, John alerted us that the absence of any clouds might make it possible to see the green flash.  I have heard about the green flash ever since the first time I stayed in Manzanita, but I never really thought I would catch it.  We all stood looking out the windows.  Sure enough, the moment the sun went down below the horizon, it turned into a bright green orb for about one second. I saw it!  Judy saw it!
        What a fine time of happiness and contentment.
 
   

Sequim and Milwaukie

 

John, Rose, Florrie, Mike

 My sister Florrie and her husband Mike were visiting Sequim, so I drove up to see them.   I figured Judy would be fine at home: she had lunch with her ukulele buddies scheduled, and I left her plenty of easy food.

Totem pole at Sequim City hall

     There is always lots to do in Sequim. Rose and Florrie and I shopped, of course. We strolled through  the woods at  Railroad Bridge Park, where the Dungeness River had changed course and destroyed the trestle over the river. Florrie taught Megan, Jamie, and Josh how to make nonpareil candies. Jess made an upside down cake using blueberries, cherries, and plums from the backyard.  We all walked over to the town museum to see the shell featured inBoys in the Boat, the book about  a Sequim boy on the University of Washington crew team that won gold in the Berlin Olympics of 1936.

Joah cleans up

    Florrie is wonderful at drawing young people out. Josh had just returned from a vigorous wrestling camp.  Megan's soccer team won first place, and Jamie had tales and songs from Girl Scout camp.  I learned more details about the kids' school lives and hopes for the future than I ever have.
     We marveled at the  totem pole that the Jamestown S'Klallam tribe donated to the new City Hall.  The tribe employs a full-time carver, who creates stunning works of art.  Judy donated her carving tools to his program; they will be used by his new apprentice.  Judy also wanted to give her Northwest Coast art books to the Jamestown S'Klallam tribal library. It is a small gem of a library, dedicated to preserving culture but open to all. I had a sent the librarian a list of the books ahead of time.  When I delivered the books, she told me how she planned to use each one.

Judy's carving tools

    When I returned home to Milwaukie after two days, I found that Judy had not gone to her regular Thursday lunch, and had subsisted on Ensure and Popeye's chicken.
   Over the weekend Milwaukie hosted the Moving Wall,  a replica of the Vietnam Memorial in DC. With the help of Judy's friend Suzanne, who was volunteering, I found the names of five boys  from my grade school who had died in the war.  Suzanne was worried about Judy's missing  lunch.  As I left, my friend Katie's American Legion band was playing marches and the Young Marines were

Young Marine shouting names of Vietnam dead

reading (shouting) names from the wall. The streets were blocked off and people were setting up chairs to view the parade. I parked a few blocks away, and found my way to  the Painted Lady coffee shop to buy a latte and oatmeal to bring home to Judy.  Maddie the clerk was concerned because she hadn't seen Judy at lunch on Thursday. Jill, the tattooed painted lady, asked, "Is Judy OK?" The coffee shop was packed, and I waited a long time for my order.

Milwaukie sign

    I got to see the parade as it passed by outside the  window: a brass band, lots of decorated jeeps, the sheriff's horse patrol, the Boys Scout color guard, and many
Vietnam vets. Portland might have its naked bike ride, but out here, where the bumper stickers read "Weird isn't working," they wave small flags and cheer for the Harley riders and the Black Veterans group.
     When the cook's helper emerged from the kitchen with my order, she read the name on the slip and looked for, "Judy's wife?"

Painted Lady