Here's a Health Care Idea: Stop Trying to Live to Be 100

Working for hospice for the past 12 years I’ve had the opportunity to see how we age in this country, and I keep coming back to a disturbing thought: in many ways our health care system is intended to keep people alive forever and in many cases we sacrifice quality of life for quantity of life.

Now, before you start making unkind comparisons between me and Jack Kevorkian let me assure you that I’m not talking about death panels and assisted suicide. I’m also willing to concede that long life sometimes goes hand in hand with good quality of life (my 91 year old father in law who still drives, sits on several boards, and plays bridge every Thursday is a case in point).

I’m also aware that average life expectancy in this country has grown from 46 years in 1900 to 76 years now. Vaccines, clean water, antibiotics and many other avenues of health care have given us this gift.

But we also see improved health care can cause us to live longer, but live sicker and we accept this because we are obsessed with living as long as we can. Look how much we cheer the centenarians that Willard Scott brings us on the Today Show. I love Willard but he shows these people looking good and talks about how everybody loves them. Just once I’d like to see him celebrate someone who has advanced dementia or has been bedridden for the past 5 years. Those centenarians never seem to get on the show.

I’m guessing that this obsession for living to be 100 is rooted in our fear of death. On one level that makes sense and we are often guided by fear more than anything else. But on another level, we need to stop fooling ourselves. The oldest documented person in the world was Jeanne Calment (1875-1997) who lived to be 122. And the death rate for all of us is the same: one per person.

The harsh truth is that no matter what we do, if we eat healthy, eschew alcohol and tobacco, exercise, moderate fat intake, whatever, we’re going to die. We can’t control that. We can, however, control how we live given the finite nature of our lives.

I think we need to rethink our goal. Instead of trying to live forever, or at least as long as we can, we should think about living well for the time we have. That sounds easy, but it’s not what we do. It means we have to acknowledge the point where it’s not working. For my part, here’s what I’ve decided:

  • I’m currently 49. On May 11th I turn 50. I acknowledge that I probably have more yesterdays than tomorrows.
  • If I make it to 80 I will have outlived half of my grandparents. At that point I will have ice cream for breakfast and stop caring what I eat.
  • I hope to retire at an age where we can enjoy our retirement. I don’t know if this is possible but if it is, I will accept the fact that I will have to live on a fixed budget for the rest of my life
  • I hope to travel but will accept that this may not be possible. If I never see Paris or Mongolia before I die, I will live with that fact.
  • I don’t want to spend my last years in a nursing home, but if it happens, I will make the best of it.
  • If the last years of my life are centered on caring for someone at the expense of my fulfillment, I accept that fact with grace and gratitude
  • None of us chooses the disease that takes our life. I pray that it is not ALS (Lou Geherig’s disease) or Alzheimer’s, but I accept that it may be a disease I wouldn’t choose.
  • I accept that at the end of my life I may need someone to do personal care for me. That means when I can no longer bathe or toilet myself, someone else will help me. I pray for the ability to accept this help without shame or embarrassment
  • I don’t want to live to be 100 unless I am reasonably healthy. If I am diagnosed with advanced cancer at age 90 I don’t want to spend the rest of my life in the hospital. If I choose not to undergo chemotherapy or radiation I hope my family can accept this.
  • Finally, I pray for the opportunity to die well: I hope my death will cause those who survive me to to find my death peaceful enough to not fear their own death. I hope my funeral is a joyful one where people can laugh and celebrate my life.

I can only imagine how strange this posts looks for most people, but accept it for what it is.

Yosemite 2010: The Agony and the Ecstasy

Every January Nancy and I make the trek to Yosemite National Park to participate in the Chef’s Holidays. It’s an annual event where the park brings in gourmet chefs to do cooking demonstrations and cook meals that are out of this world. We’ve been going for about 10 years.

Every year we know there is a chance we will hit inclement weather. We rent a minivan from Enterprise Rent-a-Car and get tire chains in the hopes that we don’t need to use them. Even in 2005, the last El NiƱo winter, we didn’t have to drive through snow or ice. This year our luck was up. The time in Yosemite was the ecstasy; the travel too and from was the agony.

We left San Diego on Monday the 18th knowing that a series of fronts were taking aim on most of California. We had been told that the week would be very rainy and we feared our time in Yosemite would be spent looking out the window at the rain. We did hit rain, at times heavy, going through Los Angeles, but nothing we couldn’t handle. As is our tradition we stayed overnight at the Marriott Courtyard in Bakersfield. Once in Bakersfield we found that there was a slow leak in one of the van’s tires. Enterprise directed us to a Firestone in Fresno. As we were sweating the weather we got to sit at the Firestone dealer for the better part of an hour as we found out that both front tires were worn and needed replacing (in fairness, Enterprise paid for the new tires and has given us a 15% discount on our next rental to compensate us for the pain of being in Fresno for nearly an hour).

We hit rain most of the rest of the way, and the snow began almost as soon as we got inside the park on Tuesday afternoon. It’s been about 18 years since I’ve driven in the snow, but this wasn’t bad. We felt lucky to get there when we did.

Wednesday, our first full day in the park, found the snow hitting full force. It seems the weather forecasts were right about the precipitation but wrong about the temperature. We did some hiking on the valley floor as we kept brushing snow off our jackets. It was wonderful to see.

Thursday was mostly snow free in the morning but not the afternoon. Since we planned to leave on Friday morning, this was more than a little concerning. The temperature was just around freezing which made the snow wet and heavy. It made for beautiful photographs but strained the trees.

Friday morning we learned that the park was closed. All the snow not only blocked the roads, but weighed down the trees enough to cause multiple road closures by fallen branches and trunks. Nobody was coming in or out of Yosemite by any route. By mid morning we learned that we should learn something by 12:30 PM; later it was moved to 1:30 PM. Shortly before 1:00 PM we learned that there was a window: between 1PM and 3PM escorted caravans could leave the park. That started a frenzy where we (and dozens of other guests of the Ahwahnee) needed to pack, check out, dig out our cars, put on chains, and get to the staging area. We were able to do this only with the cooperation and hard work of the Ahwahnee staff. We got out of the park at about 2:30PM.

We got out, got to Bakersfield that night, and home tonight. It was a wild ride, but we are grateful for all the people who made it possible. We hope next year is boring.

By the way, Nancy took some great pictures. You can see them here.

Twenty Gallons and Counting

I started donating blood in 1979 as a student at George Mason University. I was walking by the student union building and saw a Red Cross bloodmobile. I had a few hours before my next class so I decided to roll up my sleeve and do some good for someone I’ll never meet. I wasn’t afraid of needles, found that giving a pint of blood didn’t make me overly dizzy or tired, and I liked the karma bump.

In the 31 years since I’ve donated blood, or plasma, or platelets, pretty consistently. I’ve had some good experiences and met some fun people.

  • In about 1982 I was at Dulles Airport and my flight was delayed. I saw that there was a bloodmobile at the fire station next door and I decided to fill the time by giving a pint. It went well with one small exception. It was a cold day with the temperature in the low 20s. They had moved the fire trucks out of the station and moved the gurneys in; unfortunately when the fire alarm goes off, it automatically raises the garage doors. We were there, lying on the gurneys, needles in our arms, when the doors opened and the cold air blasted in. Amazing how fast blood stops flowing when it’s that cold; also amazing that nobody there knew how to close the garage doors. It was a frigid 5 minutes or so.
  • When I lived in Boston there was a bloodmobile at the Boston Children’s Museum. In an interesting twist, they had a unique giveaway. If you gave a pint of blood you got a free pass to visit the museum, but you also got a coupon for a free pint of ice cream at any Brigham’s Ice Cream Store. It was called “Give a pint, get a pint.” I did.
  • As a seminarian I gave blood at a bloodmobile at the Washington Theological Union. The Red Cross folk knew we were all studying to be Catholic priests, and the questions they had to ask about our sexual histories were hilarious for us and deeply embarrassing for them the ask. I loved every minute of it.
  • In my brief time at St. Patrick’s Church in Memphis, Tennessee in 1994 I connected with St. Jude’s Children’s Hospital. When they found out I would be a regular donor they suggested that I switch from donating whole blood to donating platelets. It was more invasive in that (at the time) they needed to put needles in both arms. The blood was drawn out of one arm, the platelets were spun out, and the blood was replaced in the other. It took two hours and they would set me up with a movie in the VCR. The technology is much improved now; they can draw and return the blood with the same needle and it takes less than an hour. I donated platelets until 2006 when my veins made it harder for the return cycle. I’m now back to donating whole blood. I guess all the donations have built up so much scar tissue on my veins that they aren’t as sturdy as they used to be.

From 1979 to 1995 I donated blood in several different locations for several different organizations. I have no idea how much blood I gave during that time. In 1995 I moved to San Diego and connected with the San Diego Blood Bank. As of this past Tuesday, I have now given them 20 gallons of blood. That’s almost an entire gas tank for a large SUV. Pretty amazing.

As I look back, I feel very, very blessed. I know many people who would be happy to give, but can’t (Nancy included). I’m grateful that I can. I’ve never known where my blood has gone and that has been a gift in itself. It’s given me the opportunity to imagine that I’ve saved lives.

The medieval Jewish philosopher Moses Maimonmides (1120-1190) wrote about what he calls the “ladder of tzedakah.” Tzedakah is often translated as “charity” but is probably better understood as “justice.” The lowest form of tzedakah is to give unwillingly (e.g. being guilted into it). The 2nd highest form is to give anonymously to an unknown recepient and the highest form is to give to someone before he is in need of it. I like to think of blood donations as the 2nd highest form. Over the years I’ve given to people I’ll never meet who will never be able to repay me. I like that.

There are many who can give blood who don’t. If you are one of those, give some thought to sharing in the joy I have experienced in the last 31 years and (more than) 20 gallons.

Is Air Travel Ever Going To Not Suck?

They tell me that there was a golden age of air travel. There was a time when air passengers were treated like kings and queens and the idea of flying somewhere came with a sense of elegance. It’s hard to imagine what those days were like.

I flew for the first time in the early 1970s, going to visit my grandparents; it was a quick flight from Washington DC to Boston and I remember that people dressed up to fly. It was almost like going to church. The good news back then was that we were treated well; the bad news is that flying was so expensive that it was beyond the reach of most people. That changed in 1978 when the airlines were deregulated. It made air travel cheap, but much more complicated as there were more airlines, more routes, more choices, and more variables.

It all changed for the worse on September 11, 2001. Virtually everything we believed about air travel changed. There was a flurry of hijackings in the early 1970s and we learned to get used to screenings before we boarded a plane. But we also learned that the hijackers expected to survive the incident and we were better off cooperating with the hijackers and allowing the negotiators on the ground to fix the problem. Finding out that hijackers were now suicide bombers told us that we needed to be aware of the people we sit next to.

This new awareness benefited us; in 2002 the shoe bomber was unable to blow up the plane because of the quick thinking of those around him.

It also benefited us on Christmas Day, 2009, when a flight from Amsterdam to Detroit landed safely despite the efforts of Umar Farouk Abdulmutallab. He boarded the plane with the intent to destroy the plane and kill everyone on it. He had, hidden in his underwear, a chemical called PETN; it’s related to TNT and he intended to detonate it by lighting it on fire. It’s a compound that’s easy to get past security but hard to detonate. Passengers around him noticed that he was attempting to light something and stopped him. There’s been no end to the gnashing of teeth about how he was allowed to get this far, and the Obama administration conceded that their security failed.

I disagree. If we’ve learned anything from September 11th, it’s that the last line of defense are the seatmates of the suicide bomber. I agree that it’s scary to think that the bomber got that close to success, but the fact that the plane landed safely and nobody died indicates that the system worked.

Unfortunately this has led to the “we have to do something” syndrome and it’s started in spades. Camera crews in seeming every major city were dispatched to seemingly every airport to see what changes the airlines made and to ask random travelers if they felt safer. This was not the best way to cover the story and it certainly wasn’t the best way to figure out how to make air travel safer.

One suggested (kneejerk) change was that passengers not be allowed to have anything in their laps for the last hour of the flight. This came out of the fact that the bomber waited until the flight was nearly over before attempting the detonation. This appears foolish because a bomber who knows this will simply detonate the bomb before the last hour. This is my best example of a change that makes us feel better but doesn’t make us safer.

There is also a hue and cry to use body scans before passengers are allowed on planes. The only real concern I’ve heard is about privacy. That argument normally appeals to me, but I have different concerns about these scans. My primary concern is the radiation used; from what I can read they use T-Rays instead of X-Rays which are not as dangerous, but I’m not convinced. We already know of a link between overuse of X-Rays and cancer, and we know that there are lots of people who fly lots of miles. Do we know there is not a cumulative, bad outcome to being scanned? I hope I’m wrong.

The other problem is that while it will detect a weapon that is wedged between skin and clothing, it will not detect anything hidden in folds of skin (either body cavities or skin folds in overweight people). Simply put, it’s easy to circumvent.

Clearly we need to do a better job screening people before they get on a plane but that story does not report well. This most recent bomber paid cash for a one way ticket from Lagos, Nigeria to Amsterdam to Detroit. His father warned us that he might be trouble. We need to improve screening so someone like him doesn’t get on the plane to begin with.

The hysteria over this reached a crescendo on Sunday, January 3rd. A man at Newark (N.J.) Airport walked past the TSA screening and made it into a secure area without being screened. The terminal was essentially shut down and no flights were allowed to take off; flights that landed were left on the tarmac and not allowed to get to the gates. This went on for the better part of six hours. The man who breached security apparently left the airport 20 minutes later and has not been identified. We’re approaching the point where a trip to the airport (or connecting flights) needs to include the contingency of finding a place to stay if the airport gets shut down. That’s right: if you’re elderly, if you have health troubles, if you’re an unaccompanied minor, or you’re too poor to afford a hotel room near the airport, you may well spend the night sleeping on the floor with your suitcase as a pillow. I don’t want to travel like that.

We need to be honest about the steps that really will make air travel safer. We need to be better at screening people before they get on the plane. We need to be willing to say that my 78 year old father with an artificial hip is not the same security risk as someone from Yemen who pays cash for a one way ticket to the U.S. the day before the flight. And we need to continue to be as vigilant as the passengers on the flight to Detroit were on Christmas Day.