Thursday, March 26, 2009

The Lessons of Natasha

The tragic death of Natasha Richardson last week gave us all much to think about. In sitting down to write this installment of Prairie Pondering (again), I am (again) hit with a stream of consciousness of subject matter: the fragility of life, bad things happening to good people, privacy rights of celebrities, cherishing the time we have with friends and loved ones, sweating the small stuff, "if only ____", karma, taking advice, refusing advice, health care, the irrelevance of social status in matters of fate, etc., etc., etc.

No doubt I will revisit the event from time to time to make a point or two, but today I intend to focus on just a couple of the things I have been pondering.

My first reaction to hearing the news was that I would need no further urging from my bride to wear a helmet when bike riding. A few years ago, I spent one summer as an avid cyclist and, supported by a client in the business, loaded up with fancy riding equipment, including a tear-drop shaped helmet that I was instructed never to ride without. Once we moved to the country one farm over from a bike trail I used to drive a half hour to get to, I decided that it was more important to look "cool" than ride safe. I believed that since I was limiting my cycling to carefree jaunts down car-free gravel paths, I could leave the helmet behind and rely only on a baseball cap to shield my balding head from the sun. Deb protested; I chose vanity over safety.

That will not be the case in the future. The fluke of Ms. Richardson's death made me realize that it was stupid to unnecessarily risk my life on the hope that my baseball cap and enclosed head would not suddenly hit the gravel roadway (less forgiving than snow) as a result of a blown bike tire, unleashed dog, unnoticed rear-approaching cyclist or inability to timely remove my feet from toe clips.

Undoubtedly, many cyclists, skiers, snowboarders and other outdoor enthusiasts will similarly take the lesson of Ms. Richardson's death to heart and head. Her senseless sacrifice will save lives. That is not much of a silver lining, but it satisfies our collective desire to find something positive come from a shared horrific experience.

The second item I keep returning to is the lesson to be taken from Ms. Richardson's death with respect to the allocation of health care. Allow me the assumption that an identical fall and resulting injury sustained by any other visitor to that ski resort last week would not have made front page news all over the world.

After the event, I suggested to my wife, an R.N. with 30+ years of experience, that the public's awareness of the dangers of subdural hematomas publicized by Ms. Richardson's death would result in more accident victims obtaining treatment, as Ms. Richardson had been encouraged to to, and, correspondingly, many lives being saved.

Deb's response illustrated the stark realities of health care today. She explained, accurately, that medical facilities lack the hardware and staff resources, and insurance companies lack the funds, to allow everyone who takes a tumble on a ski hill to obtain an M.R.I. or a CAT Scan. For the most part, the wounded will be advised to watch for symptoms of head trauma and seek medical attention only in the event symptoms develop.*

I can imagine some contentious debates over course of treatment while the Richardson tragedy is fresh in our minds. The forthcoming demands for expensive procedures to rule out undetected, potentially fatal trauma, are consistent with the level of care we have come to expect and which have resulted in health care costs that have created the current health care crisis. In reality, entitlement to basic health care, including access to preventive medicine, must be distinguished from universal entitlement to the best possible health care that science can deliver.

This reality constitutes the flash point in any discussion about what kind of universal health care system we can and should adopt. Accepting it means that we acknowledge that some people will suffer health consequences medically avoidable. On the other hand, accepting it means we also acknowledge that the greater good, i.e., the ability to deliver affordable basic health care services to the largest number of recipients, trumps the alternative of spending the same finite amount of funds on premium levels of care for far fewer recipients.

Whoever is funding universal health care, be it insurance companies or the government, absent an increase in premiums or taxes, there will always be a limited amount of money to spend on all the medical services that will be delivered to all the beneficiaries of the funding entity. Therefore, as a matter of fundamental fairness, the pool of shared available funds should not be depleted by the purchase of extraordinary services by the most demanding. Rather, it must be left to individuals to purchase extraordinary services, like an immediate M.R.I. in response to a seemingly innocuous bump on the head, either directly, or with supplemental insurance coverage priced accordingly.

Again, this approach means that patients with better financial resources will receive "better" health care. There is no viable alternative. The hope, of course, is that by bringing costs down through the implementation of universal coverage, everyone's basic health needs will be met and higher levels of care will become more affordable and therefore available to more and more patients. In the mean time, we have to accept the fact that we are not, and will likely never be, a prosperous enough society to offer unlimited, on demand, state of the art, high technology medical services to everyone regardless of their ability to pay.

The Natasha Richardsons of the world will, of course, always have the offer of such services available to them. Hopefully, when needed, they will take advantage of the privileges they enjoy, continue to thrive and, use their privileged status to support philanthropic endeavors, as did Ms. Richardson, that care for the rest of us. I'll be thinking about that while riding down the neighborhood bike path wearing my geeky helmet.

*P.S. The morning after I posted this blog, there was a related story on ABC's Good Morning America. Here's a link to the news coverage of the story. May God bless you, Natasha.

Saturday, March 21, 2009

The Mom Song. [Lyrics on Screen+Download]

While I'm pondering my blog on Natasha Richardson and the lives she saved, I offer you this video which sums up the relationship between all mothers and their children. Enjoy!

Sunday, March 15, 2009

The Ides of March (Plus One)

Spoiler Alert: I admit to fallibility in this edition of Prairie Pondering. Stop reading now if that is a problem.

Tomorrow is my 57th birthday. I've been joking that these are the last of my pre-Heinz days. I started celebrating a couple of days ago when I hit two downtown bars during happy hour with friends from work. I continued on Saturday at a wonderful dinner with Dana and Greg (b. March 15) Kellenberger. This morning, I was joined by three dozen friends and family members at Jun Bo, the town's best dim sum restuarant, for brunch. The owners' presented me with the frozen whipped cream cake pictured here in appreciation for my business generation on their behalf.

I am always grateful to reach another birthday. I never feel as old as the calendar makes me out to be. 57 used to seem ancient. Now it must be the new 37. I certainly do not feel close to retirement age, either chronologically or financially. I have survived on Earth nearly twice as long without my mother as I was blessed to live on it with her. But, as usual, my father contrasts her early passing with his youthful exuberance at 80. It was fun to watch him hold court at brunch this morning as long time friends discussed
their parents settling into the local Jewish assisted living facility. He reminded me, again, that he was never going to "end up" there, too.

There are a few indications that the new 37 is not exactly the same as the old 37. Last year, my dentist fitted me with a mouth guard so I would not grind my teeth at night. When she asked me if I was self conscious about how I looked wearing it, I just laughed. As I told her, I'm 30 pounds overweight, I'm balding, I sleep with a CPAP so I look like a scuba diver in bed, and when my sciatica acts up, I walk with a cane. No, I assured her, I was okay with a mouth guard.

My memory is probably not what it was when I hit 37 for the first time. I'm not worried about it, yet, but there are times when I'm an idiot. Last Wednesday I left the office in Minneapolis at about 4 p.m. to drive 120 miles to Brainerd. I had a meeting Thursday morning as a member of an advisory group to the Minnesota Department of Natural Resources and didn't want to have to drive up at 6:30 a.m. to make it on time. I made plans to have an early evening dinner with some clients to prepare for Thursday's meeting.

After driving for about 45 minutes and 40 miles, it occurred to me that I did not remember putting my overnight bag in the car when I left the house Wednesday morning. I pulled over on the freeway, looked in the back of the car, and spoke sailor. Taking the next exit, I returned to the farm on snowy, icy back roads, trusting my GPS rather than my memory, picked up my bag and headed out towards a planned shortcut to get me to my destination in a reasonable time. I forgot about the detour around the road construction on U.S. 12.

By the time I arrived in Brainerd with an extra 50 miles on the odometer, I was 80 minutes late. The clients were waiting for me in the hotel bar and we had a nice dinner. But it was not an early evening. It would have been nice to relax in the hotel's indoor pool as I did before last month's meeting, except I forgot to bring a bathing suit or shorts. Anxious to get a decent night's sleep, I plugged in the CPAP and grabbed my iPod, which I fall asleep to each night. Except that I had forgotten a component of the CPAP that I had removed to dry out, rendering it useless, and I had forgotten my headphones to use with the iPod. Without my mechanical aids, I did not get much sleep.

In the morning, I dragged myself out of bed to get ready for my meeting. I wanted to look my best, but I had forgotten my razor. I went out to the car, which, of course, had been parked outside all night. It had warmed up to -12 F by 9 a.m. The windshield was covered in frost. I needed to scrape it because I was running out of time waiting for the vehicle to heat up. I had my scraper but I had forgotten my gloves in the office.

The good news is that I have acquired wisdom from aging and don't sweat the small stuff. The world did not end by being 80 minutes late or by having to spend an extra $5 on gasoline. My hands warmed up once inside for my meeting. I slept well the
next night. I'll be more careful when leaving home next time. Until I drop some weight, it's probably best that I don't go out in public in a swimsuit. My stubble while meeting with the D.N.R. was notable only in its inadequacy. And not having headphones for the iPod Wednesday night just meant I had more podcasts to listen to on the drive home.

March 16th. A birthday I've shared for 57 years with James Madison, our similarly short 4th President, and with Jerry Lewis, our similarly bloated cultural ambassador to France. Tomorrow I turn 57 and, as I've often noted to others fretting about their age, it beats the alternative. "Thank you" to all my well-wishers. I do love celebrating birthdays, whether mine or yours, in large part because it reunites me annually with so many great friends.

From memory (mostly):

Fairy tales can come true,
It can happen to you, if you're young at heart;
For it's hard, you will find
To be narrow of mind, if you're young at heart;

You can go to extremes with impossible schemes,
You can laugh when your dreams fall apart at the seams;
And life gets more exciting with each passing day;
And love is either in your heart or on the way;

Don't you know that it's worth
Every treasure on earth to be young at heart;
For as rich as you are,
It's much better by far to be young at heart

And if you should survive to a hundred and five,
Look at all you'll derive out of being alive;
And here is the best part, you have a head start,
If you are among the very young at heart!

Wednesday, March 4, 2009

Georgia's Mind on my Mind

Last weekend was rough. I know I have to write about it, but it has taken some time to compose my thoughts and start writing.

Deb and I drove to the South Dakota/Minnesota border to visit her parents. My father-in-law Ken is in a nursing home in Ortonville, Minnesota, where his Parkinson's disease and Myasthenia Gravis can be properly dealt with. Dad still spends most of his days at the family home overlooking Big Stone Lake a few miles north of Big Stone City, South Dakota, where Georgia, his bride of 55 years, still resides. Dad returns to the nursing home each evening; Mom is under the care of various family members, including her son, daughter-in-law and grandson. Mom is only 72 years old. But she has Alzheimer's.

Dad's Parkinson's has been getting gradually worse over the past 20 some years. Dad still insists on doing yard work around the house. The fact that the "yard" encompasses several acres does not slow him, or his Hover-round. Joking about how well he'd be able to jig for fish seemed funny when he was diagnosed. Not so much today. Although his tremors are fairly well under control through medications, it's heartbreaking watching the deterioration of the body of the former high school basketball star and all around athlete who loved recalling his swims across Big Stone Lake. Dad's mind is still sharp, probably exacerbating his frustration with his inability to live independently and certainly exacerbating the helplessness he feels as he watches Mom slip away.

When we arrived home on Saturday morning, I was a bit taken aback to see my nephew Shawn coloring in a children's coloring book. Shawn has taken on the responsibility of caring for his grandmother. I took the coloring to be a form of relaxation on the weekend since he had other family members around to relieve him of the constant obligation. Nonetheless, it struck me that, at 18, he should be spending time reading, not coloring pictures of kittens and bunnies.

Unfortunately, the coloring books were not for Shawn. As if a pointed demonstration of Mom's mental decline just since Christmas, the coloring books serve as a way for her to pass time. Shawn was not coloring for his own account. He was starting a page as a guide for his grandmother. During the 30 hours or so that we shared with Mom and Dad last weekend, I experienced a number of such doses of reality and realized, sadly, that an important era in my life as all but over.

The two parental in-laws presented a stark contrast to one another. Dad is healthy of mind; weak of body. Mom is physically fit but slipping away mentally. Both strive to overcome the lousy cards they've been dealt. Dad insists on staying active beyond the dictates of common sense. Mom repeats snippets of conversation as exchanged in order to appear as if she is fully following and participating in the discussion. She still seems to recognize everyone around her. But she makes allusions to events that never happened and places that don't exist.

Dad, Ken, has an amazing spirit and he will continue to fight against the physical limits his illnesses impose. I expect him to dance at MY funeral. Today, I find myself pondering Georgia's transformation from the doyenne of Big Stone Lake, whose accomplishments are memorialized in granite tributes on the Minnesota/South Dakota border, to the vulnerable and frightened recluse facing a loss of all she has known.

I remember being told 26 years ago that there was no experience like becoming a parent, that no amount of detailed, image evoking description beforehand could prepare you for the emotional tsunami that arrives with the birth of your first child. I believe it is the same way with watching a loved one succumb to Alzheimer's disease. There is simply no way to prepare for having someone with whom you've shared your entire life carry on in front of you as if you had never met and without any memory of everything that went into weaving a family fabric.

Mom is not yet at the point where she cannot relate to her family members. In some ways, living three hours away is a blessing. We are not confronted daily with the face to face evidence that Mom is slipping away. On the other hand, there is a desire to spend as much time as possible before we are strangers to her.

As I hugged her last weekend and, even more sadly, as I watched Deb hug her, I had to wonder if this would be the last time where there would be mutuality in the recognition. Given the progression in just the past two months, I have no assurance that Mom will continue to know us in the months ahead.

The scourge of memory loss disease runs in Mom's family. She conveyed a blessing on my wife some years ago while visiting Mom's ailing sister when she directed Deb not to take anything personally once Mom faced her own challenges with Alzheimer's. Her past thoughtfulness has helped. There have been instances when Deb has had to take charge of financial matters, business matters and health care matters for her parents. Dad understands; Mom pushed back, unsuccessfully, wanting to maintain her independence as a badge of competency.

But now, after a few months have passed, there seems to be an emotional surrender and a willingness to let others care for Mom's needs. She has transitioned from hiding her smoking, to smoking openly (including, very temporarily, in the family fireworks store), to not caring about smoking. Her days of exercising her mind with crossword puzzles are long gone. Now, she struggles to follow Shawn's lead and color in the line drawings of cute little animals.

I know we are not alone in this. I am blessed that my father seems abundantly healthy in mind and body. But I have so many contemporaries going through the same struggles that Deb and I face with Mom. Modern Medicine has bestowed the blessing of long life; Mother Nature taketh away some of that blessing for some of us. Years ago, we would joke about grandma or grandpa "getting senile". Now that our lifespans have increased, we are forced to deal with the progression of senility over an additional ten years or so.

Like the newborn that filled us with wonder, and as with the responsibilities that we gladly accepted when we joined the ranks of parenthood, we now begin to cope with equally dependent loved ones at the other end of the life cycle and, like it or not, must again take on responsibilities of care and nurturing as we would wish to be cared for and nurtured.