Category Archives: Praying

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

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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.

End of a Month of Celebration

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Almost everyone knows that I love Thanksgiving. I like the fact that while it’s a civil holiday, most people think of it in at least partly religious terms. I like that it doesn’t cause the problems of specifically religious holidays (e.g. Christmas). I also like the idea of taking a time to specifically look at those people and things we are grateful for.

Thanksgiving was fun, but the real celebration was the wedding of my nephew Nathan to Makayla Nadeau. I can safely say that if it weren’t for their wedding there would be no way we’d go to Newport, Rhode Island in November. It goes without saying but it was a magical weekend. I’m Nathan’s godfather and as a priest I gave him his 1st Communion; I was also touched to be asked to participate in part of the wedding ceremony. Rev. Dan Hopkins presided and did all the legal stuff, but I treasure my part in it.

Nancy and I flew into New York City and we were able to spend time with our niece Katie and her boyfriend David. I’ll confess that I like NYC better and Nancy does, but it was great.

We took the train from Penn Station to Providence, RI. It came a month after peak foliage but it was a beautiful ride nonetheless. I love San Diego and will never move but I do miss the East Coast from time to time and it was nice to experience it from sea level.

Nathan and Makayla, Nancy and I wish you as happy a marriage as ours.

Another Health Care Post

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The current Health Care Debate answers one of the critical needs in this country: how to provide protection to everyone (or nearly everyone). But there is another need: how to contain costs and make health care more efficient. We’re hearing more about how to provide health care to some of the 47 million people in this country without health insurance, but very little about how to make the system more efficient. Let me tackle these two separate issues one at a time.

The figure of 47 million without insurance comes from the census department and is from 2008. That translates to 20% of the US population under 65. There is nearly universal coverage for the population over 65 because of Medicare. Most Americans get health insurance from their work, or the work of someone in their household. Unfortunately that excludes people who are under 65 and not working, people who own their own business, and people who are not eligible to receive health insurance from their employers. These people daily live with the awareness that an accident or serious illness can have catastrophic effects. It’s true that if you are uninsured and are injured, the emergency room of any hospital is required to treat you regardless of ability to pay, but that’s a long way away from being cured. According to the Emergency Medical Treatment and Active Labor Act (EMTALA) the hospital is required to treat a life threatening emergency until you are stable or can be transported somewhere else you can be treated. They are not required to treat a serious, but not life threatening, emergency and can “release” you once you are stable even if you life was in danger when you came in.

Now, whenever we liberals talk about expanding health coverage conservatives scream that government run health care would be a disaster. But the funny thing is that since 1966 we’ve had virtually universal, government run health care for those 65 or older. It’s called Medicare. I work with the elderly and to a person they like how Medicare is run. When you turn 65 you are eligible to enroll in Medicare, but not required. You are free to not enroll and find health insurance on your own. Funny that I don’t know anybody who has done that. It’s also funny that we have universal health care for the elderly (who vote in high numbers) but not children (who can’t vote).

But this misses my main point. We are not dealing with is the outrageous cost of health care and how poorly we ration it. Do not be fooled: we currently ration health care but we do it by coverage. If two 40 year old men are diagnosed with Type 2 Diabetes (formally called “Adult Onset Diabetes”) and only one of them has health insurance, their lives will become dramatically different. The one with health insurance almost certainly has access to medication (either oral or injectable), counseling to change your lifestyle, and methods to monitor your blood sugar level. The one without has none of this. The one without health insurance is looking at a dramatically shorter lifespan with the added benefits of possible blindness and gangrene in your feet.

The hard, cold reality is this: no matter what we do, we won’t ever be able to have everything we want as we want it as soon as we want it. We as a nation have to decide who will not receive all they want. Currently we ration by ability to pay (either privately or through insurance). I don’t believe this is the best way.

The further hard, cold reality is that no matter what we do, the death rate is still the same: one per person. We are all going to die one day and all the health care in the world isn’t going to stop that. The purpose of health care is not to allow us to live forever, but to allow us to live a good quality of life for as long as is practical. That said, there really does come a point where additional health care dollars are not doing that. For example, if a 95 year old man with terminal prostate cancer wishes to have aggressive chemotherapy treatment it probably doesn’t make sense. The chemo is likely to be unsuccessful, and even if it does stop the cancer, he is likely to be much sicker from the chemo. Even if the chemo is successful and doesn’t lead to additional bad side effects, he is still a 95 year old man who will likely die of something else within the next few years.

Under the current system, if he (or his family) demands aggressive treatment he will likely get it. His primary doctor can refuse to allow the chemotherapy but most doctors will go along with the patient or family if they are insistent enough. Also, if his heart stops beating (for any reason) the local paramedics will try through CPR to get it going again. Essentially there is little in the current system that will tell him it’s time to go. These are resources that are not being used to help people who will. The chemotherapy the 95 year old man receives takes away from the ability to provide preventative medicine for children and the poor. Unfortunately at this time there is nobody who is able to say no to the 95 year old man.

This isn’t about death panels. It is about recognizing that limited health care resources need to be allocated where they will do the most good for the most people. My father in law is 90 years old and is in good health. Recently I overhead a conversation he was having with a few friends. He was explaining that if there was a procedure that he needed and a 30 year old man needed the same procedure, the younger man should get it even if the younger man cannot pay for it. His friends were astonished and basically said that the 90 year old is entitled to whatever he can afford, and if the younger man can’t afford it, well that’s life. Frankly, I hope when I’m 90 I’ll have the same insight as my father in law.

At some point this discussion has to be part of our health care debate.

Memorial Day: Remembering Those Who Have Fallen

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It’s become an annual tradition for me to post on Memorial Day. Since shortly after the Civil War families of those who were killed in war have felt the need to commemorate their sacrifices. Since 1868 it has been a national holiday, now celebrated on the 4th Monday of May. Last year I noted that 4083 of our young men and women have died in Iraq since 2003. The number is now 4300.

That is, in a sense, good news in that only 217 have died in the last year, but that’s of little consolation to their families. The major focus of the war is moving to Afghanistan and I’m having a hard time finding a web page that tracks casualties there.

Regardless, it’s a good day to thank a veteran.

Shock and Outrage Reaches a New High

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This is a story I read in my local paper, the San Diego Union Tribune, and still can’t believe it’s true. In Luzerne County, Pennsylvania two federal judges, Mark A. Ciavarella Jr. and Michael T. Conahan, have plead guilty to accepting money to send juveniles to a privately owned (for profit) juvenile detention center.

You can read the timeline here and you should. Basically they were paid by the operators of the facility to sentence juvenile offenders to long sentences, disproportionate to their offenses.

Perhaps the best synopsis is an editorial from the local newspaper, the Citizen’s Voice:

Luzerne County’s top judges have hurt, betrayed and shamed all of Luzerne County.
For the last six years, Michael T. Conahan and then Mark A. Ciavarella Jr. served as president judges, at the very top of the Luzerne County judiciary.
Instead of assuring the justice we expect when we appear in county court, the two men, through a variety of complex schemes, severely violated the public trust as they secretly raked in $2.6 million for themselves, according to federal prosecutors.
Federal officials say the two defrauded taxpayers, in part by arranging for county money to build a juvenile center from which they would secretly profit. They assured the center would have plenty of paying customers by tearing juveniles from their families and sending them to the facility, at times against the advice of probation officers.
The judges covered up their schemes, filing false documents and lying about their income to the state and to the Internal Revenue Service, federal officials say.
Conahan and Ciavarella entered a plea agreement Friday to two counts each of fraud and agreed to 87-month federal prison terms, disbarment and restitution.
County residents, although angered and disgusted with the news, were not all that surprised. The indictments Monday confirmed the very worst of their fears.
Rumors and speculation about corruption within the county courthouse have been circulating for more than a year, and many area residents say these charges of fraud, even against judges, are not so surprising for Luzerne County.
Still, Judge Chester Muroski, in comments Monday morning, offered hope for an immediate new beginning to the county’s judicial system.
The remaining county judges will “do everything we need to restore pubic confidence in the court,” said Muroski. Fairness and justice without outside influences would be top priorities, he promised.
The courthouse probe will continue and federal officials ask the public for help with information that may aid their investigation.
We urge the remaining county judges and all who will take the bench in the future to remember Conahan’s and Ciavarella’s shameful examples.
Remember, too, they must earn the trust we so badly need from our judges.

The next question, of course, is how we do restitution to those children who were improperly incarcerated. I pray for their healing.

Happy Birthday President Lincoln

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I pray no American isn’t aware of this, but 200 years ago today Abraham Lincoln (1809-1865) was born in Hardin County, Kentucky. He was a great man at a time when our nation needed a great man and it’s hard to imagine what our nation would look like if he hadn’t been there.

He is also a man of great paradoxes. If you haven’t read Team of Rivals I suggest that you do. Doris Kearns Goodwin is an superb writer and she gives an excellent portrait of Lincoln. The point of her book is that when newly elected President Lincoln was choosing his cabinet he chose the men who ran against him for the Republican nomination. They were more than simple rivals: they disliked him and never took him seriously as an opponent. The fact that Lincoln selected them and eventually won them over shows how secure a man he was.

On the other hand, he had deep periods of depression earlier in life. The love of his life, Ann Rutledge died at 22. Lincoln was sent into a depression so deep that his friends put him on what we would call a suicide watch. In 1841 he wrote this to his first law partner John Stuart: “I am now the most miserable man living. If what I feel were equally distributed to the whole human family, there would not be one cheerful face on the earth. Whether I shall ever be better I can not tell; I awfully forebode I shall not. To remain as I am is impossible; I must die or be better, it appears to me.”

After Ann’s death he married Mary Todd Lincoln and they had four sons; only one survived into adulthood and there are no living descendants of Lincoln. More is the pity as this was a gene pool that would have benefitted the world.

Take some time to read his Second Inaugural Address and The Gettysburg Address.

Rest in Peace Aunt Freda

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When Nancy and I were on our way home from Yosemite we got a call from my father that his older sister Alfreda Theresa Allain Ladroga died. I had to ask him if I had heard it right because she was not the person I expected to be the one to die. My father is the youngest of seven children: Jeanne, Ed, Joe, Freda, Norman, Andre, and Donald (my father). Andre was always known as “Tonto” and I always heard him referred to as “Uncle Tonto.” He died in a drowning accident in 1964 and I’m too young to remember him. My father is 77 and his siblings are all in their 80s. I’ve known for a while that in the next few years I’ll be getting some calls with this news, but this call was a surprise. At 83 she was one of the younger ones and appeared to be in good health. On the other hand I found that the last time she had seen a doctor was when my cousin Rick was born in 1960.

As I understand it she was talking about abdominal pain and my cousin John noticed that she appeared weak. Last week he finally convinced her to go to the hospital. When she got there they noticed her liver enzymes were off and further tests showed she had advanced colon cancer that had spread to her kidneys and liver. In a few days she was gone. My theory is that she had known for a while she was sick and chose not to have it treated. I respect that as she was in her 80s and probably didn’t look forward to facing chemotherapy and/or radiation for the rest of her life.

In any case I will miss her. Earlier in my life Gardner, Massachusetts was an important part of my life as were my father’s siblings. A few times I visited Gardner in college I stayed with her since she had the room and she was very kind to me. She had also been important to my father as she could give him information on what was going on with his siblings (this may not make much sense unless you’re French and understand that communication is not our strong suit).

Here is her obit in the Gardner News:

GARDNER — Alfreda Therese “Freda” (Allain) Ladroga, 83, of 61 Lake Street, Gardner, died Friday, January 23rd in UMASS-Memorial Medical Center, 55 Lake Ave N., Worcester, surrounded by her family, following a brief illness.

Born in Gardner on March 18, 1925, she was the daughter of the late Calixte and Emma (LeBlanc) Allain.

Alfreda graduated from Gardner High School with the Class of 1943.

She was a Personal Care Attendant, employed by Worcester State Hospital, Worcester for several years, retiring in 1985. She was previously employed by Rutland State Hospital, Rutland and Gardner State Hospital, Gardner.

Alfreda was a member of Our Lady of the Holy Rosary Church, Gardner.

She enjoyed playing scrabble, crocheting and doing crossword puzzles “in ink”. Alfreda loved to cook and was generous with her special recipes. She most enjoyed her family, friends and church.

Alfreda was predeceased by her husband of 53 years, Zigmond Ladroga, who died in 2001.

She leaves two sons, John A. Ladroga and his companion Renee Haley of Phillipston and Richard K. Ladroga and his wife Tracy of Athol; one daughter, Kathleen A. Gallant and her husband Laurie of Gardner; four brothers, Edward Allain and his wife Eva of Gardner, Norman Allain and his wife Lempi of Gardner, Joseph Allain of Gardner and Donald Allain and his wife Claire of Woodbridge, VA; one sister, Jeanne Hetnik of Otter River; ten grandchildren; six great-grandchildren; several nieces, nephews and cousins.

She was predeceased by a son, John Henry Ladroga and by one brother, Andre Allain.

Funeral services will be held Wednesday, January 28th from the Boucher Funeral Home, Inc., 110 Nichols Street, Gardner with a Mass at 10:00 a.m. in Our Lady of the Holy Rosary Church, 135 Nichols Street, Gardner. Burial will be in Notre Dame Cemetery, Gardner, at a later date.

Calling hours in the funeral home are Tuesday, January 27th from 6:00 p.m. to 8:00 p.m. and Wednesday, January 28th from 8:30 a.m. to 9:30 a.m.

Memorial contributions may be made to Our Lady of the Holy Rosary School, 135 Nichols Street, Gardner, MA 01440.

Rest in peace, Aunt Freda. I’m sorry I’ll miss your sendoff.

The Day Has Arrived

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No doubt about it: yesterday was a historic day. I hope that years from now all of us will remember where we were when President Obama was inaugurated as our nation’s 44th President. Nancy and I, alas, couldn’t watch it as we were traveling to Yosemite National Park for our annual Chef’s Holidays trip. We were able to listen to it compliments of National Public Radio and we’re grateful for that.

Yesterday’s events held meaning for so many people on so many levels it’s hard, even a day later, to encapsulate all the emotions. As I said in a previous post, I always believed we would have a President of African descent in my lifetime and in that sense this isn’t much of a surprise. I was raised to always believe racism to be a sin and I believed that our nation wouldn’t keep excluding the gifts and talents of all our men and women of color. That said, perhaps the most moving part of yesterday was hearing from the aging generation who still vividly remembers segregation, and how grateful they are to live long enough to see this.

For me the inauguration of President Obama has less to do with race and more to do with hope. His inaugural address struck several chords with me. Here are a few excerpts:

  • On this day, we gather because we have chosen hope over fear, unity of purpose over conflict and discord.
  • In reaffirming the greatness of our nation, we understand that greatness is never a given. It must be earned. Our journey has never been one of shortcuts or settling for less. It has not been the path for the fainthearted — for those who prefer leisure over work, or seek only the pleasures of riches and fame. Rather, it has been the risk-takers, the doers, the makers of things — some celebrated, but more often men and women obscure in their labor — who have carried us up the long, rugged path toward prosperity and freedom. For us, they packed up their few worldly possessions and traveled across oceans in search of a new life.
  • The state of the economy calls for action, bold and swift, and we will act — not only to create new jobs, but to lay a new foundation for growth. We will build the roads and bridges, the electric grids and digital lines that feed our commerce and bind us together. We will restore science to its rightful place, and wield technology’s wonders to raise health care’s quality and lower its cost. We will harness the sun and the winds and the soil to fuel our cars and run our factories. And we will transform our schools and colleges and universities to meet the demands of a new age. All this we can do. And all this we will do. (emphasis mine)
  • Nor is the question before us whether the market is a force for good or ill. Its power to generate wealth and expand freedom is unmatched, but this crisis has reminded us that without a watchful eye, the market can spin out of control — and that a nation cannot prosper long when it favors only the prosperous. The success of our economy has always depended not just on the size of our gross domestic product, but on the reach of our prosperity; on our ability to extend opportunity to every willing heart — not out of charity, but because it is the surest route to our common good.
  • As for our common defense, we reject as false the choice between our safety and our ideals. Our Founding Fathers, faced with perils we can scarcely imagine, drafted a charter to assure the rule of law and the rights of man, a charter expanded by the blood of generations. Those ideals still light the world, and we will not give them up for expedience’s sake.

OK, maybe I should have included the whole address.

Finally, you can see some changes in this page. I did take down the countdown clock of the last President’s administration, but for the time being I’ve edited it to be the days since this inauguration. I may leave it up indefinitely or I may take it down after the first 100 days; I haven’t decided yet. I’ve also added the new White House blog under “political blogs.” I found it this morning; it seems that Macon Phillips, the Director of New Media, will be keeping a blog. I’ll be interested to read his stuff.

That’s all for now.

My Hopes for the Next Four Years

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I’m writing this a few days before the Inauguration. As I’m looking over my web page I’m realizing that I should take down the countdown clock; I could take it down now, but I want to see “0” just once. It will come down soon. I’m also thinking about taking down the Bert and Ernie terror alert level. It’s a spoof of the Department of Homeland Security’s Terror Alert Level. It’s an easy thing to spoof and I hope it’s one of the things that President Obama eliminates.

We’re hearing that the President Elect is planning on closing the prison at Guantanamo. This is nothing but good news; I’m one of the people who have been troubled by the fact that our government, in complete disregard of the 4th Amendment has imprisoned people without due process, representation, or opportunity to have their case heard.

There is much to write here as it has been a long 8 years. The bottom line is that I pray we once again become a country that lives its dreams and not its fears. We are in a bad place economically and I don’t expect we are going to inaugurate a Messiah who will fix things overnight. But I do think we are, at the very least, turning the ship of state back to a good direction. I ask that we all pray for him.

Exit Thoughts on 2008

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It’s been a while since I’ve posted; I keep thinking that someday I’ll have the time to post on a more regular basis.

It’s been quite a year; the most important news is good: George W. Bush leaves office in 20 days and Barack Obama will take the helm. It’s been a long 8 years and I believe the country has suffered greatly under the Bush years. He believes that history will vindicate him and his reputation (like Harry Truman’s) will improve. I, on the other hand, believe in 20 years it will be hard to find anyone who will admit that they voted for him.

Much of the rest of the news is bad. It’s hard to believe what’s happened to the economy in the last year. Wall Street will be open tomorrow and these numbers will change, but not significantly. Stocks in the Dow Jones Industrial Average have declined nearly 35% this year. Unemployment is up and it appears we are in the beginning stages of a long and painful recession. As for Nancy and me, our portfolio has gone down 28% (even with our contributions to our retirement plans). My employer, San Diego Hospice, like many nonprofits, is feeling the twin blows of decreased donations and declining stock portfolios. So far they’ve announced no payraises in 2009 as well as no employer contributions to our 401(k)’s. We’ve also had some layoffs in the bereavement department. It appears my job is safe though.

Speaking of jobs, there has been some good news in that department. In February I’ll celebrate 4 years at San Diego Hospice (and I just passed 11 years as a hospice chaplain). For the past 3 years I’ve been a preceptor: I’ve been one of the chaplains who has mentored new chaplains in the agency. I’ve found that I really love meeting and mentoring new folk. I appear to have some success: of the 7 new chaplains I’ve mentored, all are still with the agency. I’ve been asked if I’m interested in going up the ladder in management, and while that’s flattering I have no desire to do that. Last month ago the agency decided to come up with a new classification: advanced clinician master preceptor. We are developing two teams where everyone (nurse, social worker, home health aide, and chaplain) is a preceptor and will mentor new employees as a team. This sounds complicated as I’m describing this, but let me say this: I applied for one of the positions and was accepted into the program.

This is really the best of both worlds as I will continue to see patients and do more mentoring. I’ll also be working on a team where all of us are advanced clinicians. Since there are two teams, I’ll be working with another chaplain and it’s someone I work well with. The teams will be working closely together to develop curricula, not only for new employees, but for the agency as a whole. I’ll be working on a nursing home team (not a home team) and I haven’t worked in nursing homes since I was with Odyssey over 4 years ago. As I told my new boss, there will be a definite “remembering curve.” I’ll also be working at nursing homes much closer to home which will give my Prius a break.

One of the reasons I haven’t posted in a while is that I was down with a bad case of pertussis, also known as whooping cough. I came down with it the beginning of November, and ironically enough, my worst day with it was election day. As I told Nancy, I never remember being this sick, and the day I’ve been anticipating for 8 years was not even a day I could celebrate well. It was horrible and I can’t imagine what it must be like for infants and children. It’s not hard to imagine how this can be fatal in infants. I missed a week and a half of work and probably came back too soon. Even now I have an occasional coughing fit. It was probably exacerbated by my asthma but even so, my heart goes out to anyone who has this illness. It’s good to be feeling better.

Finally, let us all pray that 2009 is a good year for all.