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

Newport

Judy's view when she lived in Newport

     Our time in Newport was a vacation rather than a trip. For five days I didn't make a list or refer to a list.  I had left the charger for my computer at home, so I couldn't clean up photos or study mattress reviews or check the finances.  Since I couldn't do those tasks, they had no place in my mind.

Honoring whales

   I would wake up, have coffee overlooking the ocean, and then walk Mutt Leigh.  Newport has created a great series of walkways curving gently down to the beach,with plenty of benches built in.  People of all ages and abilities can enjoy the view without clambering down and up.  The most agile young boys climb on the whale bones that the Siletz tribes have installed as a tribute to the resident leviathans.
   The hotel provided a substantial breakfast, so I would eat heartily and then bring a tray down for Judy.  For the first few

Mutt Leigh on the beach path

days we made short excursions onto the bay front.  We found a place where Judy could drink her latte overlooking the working of this  active fishing village.  We missed the loud barking of the sea lions who pile onto the docks.  They are gone until August, seeking harems. The combined weight of these bachelors had made the dock collapse, and the merchants got together to replace it.  They want to keep the sea lions as a tourist attraction, while the fishermen want the big scavengers gone. Newport's one bayfront street has limited space.  A working fishing harbor and fish processing center crammed in with  a tourist town creates friction.
   Judy lived in Newport in the 1990s.We ate dinner at the lounge where she had studied for her national Occupational Health nursing boards, competing with the fishermen for the happy hour appetizers. The men cheered and bought her a drink when she passed.  This time it was a  bittersweet farewell visit to the marina where she had docked her boat, and a last long gaze at the harbor and bridge that had been her view when I first met her.

Judy at the marina

Judy keeps an eye on the ocean

   Most of the time Judy rested and looked at the ocean right beyond our balcony. Some afternoons the heat in the Willamette Valley pulled a thick fog bank inland at the coast, so Judy listened to the ocean she couldn't see. She could hear the fog horn; I could not.
    In the afternoons Mutt Leigh and I would walk again, and then I would hunt and gather for our lunch and dinner.  I often walked to nearby restaurants for takeout; sometime I drove a mile or so to the grocery store or the farmer's market.  I did not drive much. The highlight of the evenings came at eight o'clock when I went down to the lobby and brought fresh-baked chocolate chip cookies back for Judy and me. I read and did jigsaw puzzles while Judy slept.
  At night Mutt Leigh and I walked again around the curve of the city park overlooking the beach. The road curves almost 90 degrees there.  One night after dark a big pickup truck drove around the bend facing us, and its lights

Place of courteous drivers

Backyard blooms

shone right into my eyes.  The driver turned off his lights and rounded the bend with only his parking lights, then turned the headlights on again when he had passed me.  "Must be a local," said Judy.
    We are back home now, and all of our plants have survived the heat.  The hydrangeas are in bloom.

Down the coast

Judy and Mutt Leigh at Cape Lookout

   Judy and I set off drive down the Oregon coast, from Astoria in the north to Brookings in the south.  The weather in the Willamette Valley where we live was predicted to reach 100 degrees, so we soaked the garden for days before we left.
   We spent a night in Astoria, catching glimpses of the big ships on the river. I liked seeing the way the light hits the buildings there. The light is different  at the mouth of the Columbia River from the way it looks in our river valley, 45 miles inland. On the second day we meandered south past fabulous overlooks to Pacific City, where we immersed ourselves in an older version of the  Oregon coast. As we drove in, Judy kept saying, "This doesn't look like the Pacific City I remember."  There were tall modern condos with balconies overlooking the ocean, a large tourist market open 24 hours a day, and a crowded brewpub next to the beach where the surf-launched fishing dories put in.

Our room with extension cord at Pacific City

     When we crossed the Nestucca River, we got to the original commercial district and found our AAA- guaranteed motel.  What was that electrical wire so carefully snaked beneath our door?  It provided power to the trailers next door.  The room was probably clean, but looked like it hadn't  had anything done to it that costs money since 1960. I had forgotten what bad printing of Impressionist reproductions looks like; the pictures on the wall reminded me of college decor. The  wrought iron  chairs were too uncomfortable to sit on, so I sat on the small patio next to the painted coffee can with empty Marlboro packages in it.  In the morning Mutt Leigh was awakened by the resident Husky dog

Bad art

sniffing at our sliding glass door.  Judy kept saying, "I thought it would have an ocean view." But the manager was kindly concerned about Judy's health, and the neighbors in the trailer were considerate.  I spent peaceful hours on the patio while Judy rested.
    We looked for breakfast in the older part of town.  We passed the public library with its adjacent community gardens, and I shopped at the large high-end thrift shop that helps support the library.

Library with community garden

The Grateful Bread bakery was closed because it was Tuesday, so we crowded into the only other option, Lori's Village Coffee Shoppe.  There was a red-white and blue 4th of July theme everywhere, from the butterflies on the soffits to the hand towels in the rest room. The smart, busy waitresses wore T-shirts that say, "Pacific City, a quaint little drinking village with a fishing problem."
    It only took us two hours to drive south to Newport, but by that time Judy was trembling with fatigue.  She crawled into bed in our fine room, muttering softly, "Could we stay here few more days?"  I had no investment in seeing Bandon or Brookings again, and there was no way I was going to put her in the car for another drive the next morning.  However, hotel rooms up and down the coast were completely booked with  people looking to escape the heat.  The manager at the Elizabeth Street Inn said simply, "I'm aware of the situation," and she juggled.  We stayed in Newport for five nights.

Oregon conversations

    You know you're an aging Oregonian when your conversation features not only your grandchildren but your garden, your dog, and your alternative health practitioners.

The garden

The dog

    This spring I was plagued by bright pain in my neck and shoulder.  My regular doctor, after eliminating the possibility of more dreadful neurological problems, advised me to get a new pillow and a new mattress.  The acupuncturist was so pleased with the composition of needles and cups that she placed on my back that she wanted to take a picture. "I haven't seen this work so well since I was in school," she said.  Her ministrations relaxed the muscles and made the pain leave, at least temporarily.  The osteopathic physician effected the most complete cure. He poked and prodded and subtly moved the position of my head.  How on earth does that help?  But it sure did.
     All three of them talked about my posture.  Lift up your breastbone and let your shoulders drop., they suggested. Here are some exercises.  Here's how to sit in the car.  I think about the words from the Masses of my childhood, Sursum Corda, lift up your hearts.  If I don't lift up my heart, life is a pain in the neck.  Is that  Oregonian woo woo?
     Yesterday I found myself falling into a habit of speech that I used to marvel at when I first came to Oregon. We were trying to settle on a coffee shop midway between our house and our friend Jenny's place in Vancouver.  "You know that Starbucks just off the Banfield  across from where the old Sears building was?" she asked. The Banfield is the local name for Interstate 84. Sears has not occupied that building since 1983.  I knew coffee shop that Jenny was talking about. "Yes, it used to be a Coffee People," I replied.

Hasn't been the Sears building since 1983

   

The lesbian nod

Irish rainbow

   I was walking down a sidewalk in Chicago with my grandsons gamboling about me.  Coming toward us was a woman pushing a stroller with one hand and guiding a toddler with the other.  She gave me a brief, courteous nod. Ah, the lesbian nod, a sign of recognition and encouragement between strangers.  I exchanged that nod with an old woman in the waiting room at the OSHU hospital.  It came again from a younger woman walking down the aisle of a plane, as I sat there with  my mask and stoic air-travel face already on.  The lesbian nod says, "I see  you." It is a grace note, and a comfort.
    Last week the Republic of Ireland voted decisively to recognize gay marriage.  Ireland is the first country in the world to enshrine gay marriage in its constitution by poplar vote. 60% of citizens voted, with many Irishmen flying back home from abroad just for the election.  62.5% voted yes.  The measure passed in all provinces except for one. After the results were announced, in Irish first and then in English, a double rainbow appeared over Dublin.

Double rainbow over Dublin

 
    Meanwhile, back in everyday life, I went to the bank to cancel a credit card that has a fee. The young banker persuaded me to open another credit card, one with no fees and cash back. She was following a script to fill out the application, and asked me about my annual income. "For both Judy  and me?" I asked. Yes. No looking up special Oregon rulesfor domestic partners, no calling a manager for clarification, no bewildered look.  She just filled out the form, and issued a card with more favorable terms than I would have gotten with just my income.

Wedding portrait

    What I didn't say to the banker was, "For me and my wife?"  I have hesitated to describe Judy as my wife.  In my early life I experienced shrinking into a wife, and it was awful.  I also find it awkward, after 20 years of calling her my partner, to say "wife."  But I am going to start doing it.  Our new minister refers matter-of factly to her first wife and her second wife.  The other day I heard a young male sportscaster talking about misogyny in FIFA, the world's governing body of soccer.  The head of the FIFA mistook the wife of one of the best women's soccer players the world for somebody else and he didn't bother to apologize, scolded the sportscaster.  I am getting used to hearing "his husband" or "her wife."  I realize that it is important to use the word "wife" as another way of saying that I claim the privileges of marriage.