The Right Paperwork for Your End-of-Life Wishes

Joshua Bright for The New York Times

Joshua Bright for The New York Times

By Jessica Nutik Zitter
April 29, 2015—The New York Times

The patient’s heart was barely contracting under my ultrasound probe, like a limp handshake. He was in shock, his ineffective heartbeat unable to maintain the pressure necessary to keep his organs alive.

And now he was on full life support on my service in the intensive care unit.

What had just felt like a satisfying process may in fact have been assault and battery with a dose of hostage taking. 

Our ultrasound completed, the resident resumed her presentation of the case. The troops had already been called in, she assured me. The cardiologists were considering taking him for a heart catheterization to determine if there was a blockage that could be reversed. The respiratory therapists were fiddling with the knobs on the breathing machine. It hissed as it rhythmically inflated and deflated his lungs. The I.C.U. nurse was connecting a dobutamine drip to the large plastic catheter that had been inserted deep into a neck vein by the emergency room physician. This medication is like a shot of adrenaline to a dying heart, conjuring any remaining fumes of life to keep it beating until an intervention might solve or improve the problem. Unfortunately, and far too commonly, dobutamine simply serves to prolong the inevitable, and the patient’s heart, which would have tired and stopped long before, sputters along on this high-octane fuel. Our patient was tucked in as we awaited next steps.

“But,” my resident went on, looking at the floor, “the daughters are on their way in. Apparently the patient had told them no machines. They’re very upset.”

Suddenly, this case was turned on its head. What had just felt like a satisfying process may in fact have been assault and battery with a dose of hostage taking. None of it intentional. But the effect was the same.

Read the full article in the NYT
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Free Online Courses Keep Retirees in the Know

By Walecia Konrad
MARCH 19, 2015—The New York Times

Mary Lou Russell has a passion for learning. Since retiring 10 years ago, the 79-year-old former grant maker has taken more than a dozen classes on subjects including classical music and appreciating Andy Warhol. She has attended most of her classes from her Manhattan living room.

“I used to go up to Columbia, down to N.Y.U. and over to New School. I was all over the place with my MetroCard,” Ms. Russell said. “Then I learned about online courses and that has been so freeing for me. I call it the anti-aging vitamin for those of us over 60 who want to stay relevant.”

Taking courses online is well suited for retirees, according to John Blair, 85, a retired engineer in Wayland, Mass. He especially likes the accessibility to top professors at elite universities. He adds that online courses have given him a way to dive into subjects unrelated to engineering, like economics. “By jumping from Yale to Harvard to Stanford to M.I.T., I was able to sample economics courses in a broad way,” Mr. Blair said.

Colleges have been catering to online adult learners for years, often offering video lectures and courses on their websites and posting popular lecture series on YouTube and iTunes. Starting around 2011, the latest iteration of virtual education, massive open online courses or MOOCs, hit the scene. Often free, many of these classes take online learning a step further and provide interactive video features like mini quizzes and student discussion forums.

Read the full article here

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Finding Success, Well Past the Age of Wunderkind

Lucille Shulklapper started writing in retirement and has published poetry and a children’s book called “Stuck in Bed Fred.” (Ryan Stone for The New York Times)

Lucille Shulklapper started writing in retirement and has published poetry and a children’s book called “Stuck in Bed Fred.” (Ryan Stone for The New York Times)

By Abby Ellin
March 20, 2015—The New York Times

As a girl growing up in Jamaica, Queens, Lucille Gang Shulklapper dreamed of being a writer and “having a househusband like Edna St. Vincent Millay.”

Life didn’t unfold quite that way. Instead of having a literary career, she married, took a teaching job and raised three children. She wrote off and on, mostly for herself. But when she retired in her late 50s, “words came tumbling out of closets and drawers, leaking from rusty faucets and reappearing as character actors,” said Ms. Shulklapper, now 80. She began sending out poems and short stories, and published her first book of poetry in 1996, when she was 60.

Since then, she has published four chapbooks, which are typically small editions of 40 pages or so, and a fifth is in progress. And in January, Guardian Angel Publishing released Ms. Shulklapper’s first children’s book, “Stuck in Bed Fred.”

“We absolutely have to revamp this idea of a linear pattern of accomplishment that ends when you’re 50 or 60”

“I am living beyond my dreams,” said Ms. Shulklapper, a widowed grandmother of six who lives in Boca Raton, Fla. “I feel as though it’s my baby. A long pregnancy and now its delivery, all 10 toes and fingers.”

Conventional wisdom holds that if you do not write your “Farewell to Arms,” paint your “Starry Night,” start the next Twitter or climb Mount Everest by young adulthood, or at least middle age, then chances are you will never do it.

But that idea is becoming increasingly outdated as people are not only having successes later in life, but blooming in areas they never expected. Maybe they are not making millions, or wielding a brush like Rembrandt. Still, many people are discovering that the latter part of their lives can be just as (or even more) rewarding creatively, emotionally and spiritually.

Read the rest of this article here.

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Seeking a ‘Beautiful Death’

Ken Orvidas (NYT)

Ken Orvidas for NYT

By Jane E. Brody
The New York Times Well Blog—February 9, 2015

Virgie Divinigracia had the kind of death last month that most Americans say they want: at home, relieved of physical and mental pain, surrounded by those she loved, “a beautiful death” as those present described it. Alas, this is true for too few Americans. Most still die in costly medical facilities tethered to machines, often unable to communicate, in a futile attempt to prolong their lives.

Dr. Angelo E. Volandes, the author of an enlightening new book, “The Conversation,” said that although Americans received some of the best health care money could buy, “they also experience some of the worst deaths in the developed world,” mainly because people failed to articulate what they wished for at the end of life, and doctors failed “to recognize that fixing specific problems may not fix the whole patient.”

Mrs. Divinigracia’s experience is illustrative. At 88 and in need of full-time care after 10 years with Alzheimer’s disease, she developed acute kidney failure. Her doctor suggested dialysis.

But after a clearheaded review of her prospects, her devoted husband and primary caregiver, Paul, and their son and daughter acknowledged that, had she been able to say so, she would not have chosen aggressive medical treatment that would only further diminish the quality of her remaining days.

And so she lived to have an 89th birthday celebration with her family before deteriorating health prompted a call to hospice for help.

Read the full post here.

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The Tyranny of Safety

YOUNG, OLD. NO ONE ESCAPES THE TYRANNY OF SAFETY. Image: Greg Hollobaugh

YOUNG, OLD. NO ONE ESCAPES THE TYRANNY OF SAFETY. Image: Greg Hollobaugh

By Anthony B. Robinson
Crosscut.com — February 3, 2015

In the era of school shootings and terrorism it is understandable that safety has become a priority. But has it also become an obsession?

Are we so focused on “safety” that we overlook the downsides, or at least the other side, of this priority? In her provocative book, A Field Guide to Getting Lost, Rebecca Solnit notes, “A recent article about the return of wildlife to suburbia described the snow-covered yards in which the footprints of animals are abundant and those of children entirely absent.

But it is not only the young that lose out when safety becomes an unquestioned norm. It is also the old.

“As far as the animals are concerned,” Solnit continues, “the suburbs are an abandoned landscape, and so they roam with confidence. Children seldom roam, even in the safest places. Because of their parents’ fear of the monstrous things that might happen (and do happen, but rarely), the wonderful things that happen as a matter of course are stripped away from them . . . I wonder what will come of placing this generation under house arrest.”

Others have also commented on the constrictions of so-called helicopter parenting and the over-scheduled child. A concern for safety is at least part of what has eroded the opportunities for children to roam the neighborhood and have the unstructured time to do so.

But it is not only the young that lose out when safety becomes an unquestioned norm. It is also the old.

In the new book of physician-author Atul Gawande, Being Mortal, Gawande describes what has happened as safety becomes the be-all and end-all as people age and encounter the trials of sickness and mortality. Safety, concludes Gawande, is not the same thing as meaning.

Continue reading here.

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How Americans’ refusal to talk about death hurts the elderly

the conversation about death is really about autonomy (via Vox)

By Sarah Kliff
Vox—January 11, 2015

In my family, we don’t really talk about death. But, every now and then, we joke about it.

For some reason, there is a running joke among my immediate family about how my parents will die. Specifically, my brother and I will come home for Thanksgiving one year and find them decomposing on the couch.

…these conversations could be the starting point for a health-care system that cares just as well for patients who will heal as those who will not

Yes, this is a bizarre thing to crack jokes about. But it’s also, in its own, ghoulish way, a bit of a fantasy — an affront to the way that Americans tend to die in the 21st century, with ticking machines and tubes and round-the-clock care. In this joke, my parents’ death is a simple, quiet, and uncomplicated death at home.

I joke about death because I am as terrified of having serious end-of-life conversations as the next person. Usually I don’t have to think much about dying: my job as a health-care reporter means writing about the massive part of our country devoted to saving lives — how the hospitals, doctors, and drugs that consume 18 percent of our economy all work together, every day, to patch up millions of bodies.

But recently, the most interesting stories in health care have been about death: the situations where all the hospitals, doctors, and drugs in the world cannot halt the inevitable.

Read the full article here

Finding Communities That Connect and Nurture the Like-Minded

Photo Credit Katherine Taylor for The New York Times

Dorothy Adelman, 99, lives at Lasell Village, a retirement community run by Lasell College in Newton, Mass. She takes various courses and teaches a weekly art class. (Photo by Katherine Taylor for The New York Times)

By Abby Ellin
The New York Times— December 26, 2014

Jon Allen lived most of his life very much out of the closet. He didn’t want to go back in when he grew older.

“Baby boomers won’t want to move into typical ‘old folks homes,’ no matter how nice they look.”

“After you live in Key West for 20 years, you’re out comfortably every minute of every day,” said Mr. Allen, 72. “The fear is not that you’re going to move into a place that’s homophobic but that at some point you might become fairly helpless and that you’ll come across some random odd caregiver who makes it his or her purpose in life to make you miserable or to let you know you’re a sinner or whatever.”

So in May, he packed up his belongings and moved into a three-bedroom apartment at Fountaingrove Lodge, a continuing-care retirement community in Santa Rosa, Calif., in the heart of wine country.

Read the full article here

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Confronting the Inevitable, Graphically

A full-page panel from Roz Chast’s new memoir, featuring “cautionary” tales from her childhood. Credit Roz Chast

A full-page panel from Roz Chast’s new memoir, featuring “cautionary” tales from her childhood. (Illustration by Roz Chast)

Review by Michiko Kakutani
May 5, 2014—The New York Times

Can't We Talk About Something More Pleasant?

#1 New York Times Bestseller / 2014 NATIONAL BOOK AWARD FINALIST

Can’t We Talk About Something More Pleasant? A Memoir
By Roz Chast
(Bloomsbury, 2014)

Roz Chast feels — and draws — our pain. Our neurotic worries and genuine fears, our mundane and existential anxieties, our daydreams, nightmares, insecurities and guilty regrets. Or, rather, she does such a funny, fluent job in her New Yorker cartoons of conveying the things that keep her up at night that many readers are convinced that she is somehow mapping their own inner lives.

It hasn’t been hard to discern the autobiographical impulse in Ms. Chast’s work. Though her earliest cartoons tended to be more conceptual, many of the later ones in her “selected, collected, & health-inspected” anthology “Theories of Everything” (2006) are clearly informed by her experiences as a daughter, wife and mother.

Her account is…by turns grim and absurd, deeply poignant and laugh-out-loud funny.

In her latest book, “Can’t We Talk About Something More Pleasant?,” Ms. Chast tackles the subject of her parents, writing with a new depth and amplitude of emotion. Her account of growing up with them in Brooklyn as an only child and her efforts, decades later, to help them navigate the jagged shoals of old age and ill health, is by turns grim and absurd, deeply poignant and laugh-out-loud funny. Her fondness for the exclamatory (expressed in capital letters, underlined words and multiple exclamation points) is cranked up several notches here, and her familiar, scribbly people go from looking merely frazzled and put-upon to looking like the shrieking figure in Munch’s “The Scream” — panicked and terrified as they see the abyss of loss and mortality looming just up the road.

Read the full review

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Find this book!

Seattle Public Library: http://seattle.bibliocommons.com/item/show/2974415030_cant_we_talk_about_something_more_pleasant

IndieBound: http://www.indiebound.org/book/9781608198061

Goodreads: https://www.goodreads.com/book/show/18594409-can-t-we-talk-about-something-more-pleasant?from_search=true

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The Dutch Village Where Everyone Has Dementia

The town of Hogeway, outside Amsterdam, is a Truman Show-style nursing home.

Gabriel Rocha | Flickr

Gabriel Rocha | Flickr

By Josh Planosov
The Atlantic—November 14, 2014

When Yvonne van Amerongen received a phone call from her mother two decades ago, relaying that her father had died of a heart attack—sudden and painless—one of the first things she thought was, Thank God he never had to be in a nursing home.

Van Amerongen was working as a staff member at a traditional Dutch nursing home at the time, getting a front-line view of what she never wanted for her parents. That call from her mother spurred Yvonne into action as she became committed to making nursing homes more livable and less of a departure from reality for their residents. She envisioned a setup as far away as possible from the nondescript buildings and polished floors of her workplace, where everything carried the scent of a dentist’s medical cabinet. Over the next 20 years, she worked to secure the funding she’d need to make the idea a reality.

There are homes resembling the 1950s, 1970s, and 2000s, accurate down to the tablecloths.

Today, the isolated village of Hogewey lies on the outskirts of Amsterdam in the small town of Wheesp. Dubbed “Dementia Village” by CNN, Hogewey is a cutting-edge elderly-care facility—roughly the size of 10 football fields—where residents are given the chance to live seemingly normal lives. With only 152 inhabitants, it’s run like a more benevolent version of The Truman Show, if The Truman Show were about dementia and Alzheimer’s patients. Like most small villages, it has its own town square, theater, garden, and post office. Unlike typical villages, however, this one has cameras monitoring residents every hour of every day, caretakers posing in street clothes, and only one door in and out-of-town, all part of a security system designed to keep the community safe. Friends and family are encouraged to visit. Some come every day. Last year, CNN reported that residents at Hogewey require fewer medications, eat better, live longer, and appear more joyful than those in standard elderly-care facilities.

Read the full article here

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Rx for soaring health costs: Give more Americans a ‘purpose in life’

Are people who have a "sense of purpose" in life more likely to take advantage of cost-saving preventive healthcare services? Researches put the theory to a test.  (Joe Raedle|Getty Images)

Are people who have a “sense of purpose” in life more likely to take advantage of cost-saving preventive healthcare services? Researches put the theory to a test. (Joe Raedle|Getty Images)

By Karen Kaplan
Los Angeles Times—November 3, 2014

Researchers have an unconventional idea for reducing medical costs in the U.S.: Give more Americans a sense of purpose.

You see, people who believe their lives have purpose are motivated to optimize their health. That means they’re more likely than other folks to take advantage of preventive health services, like cancer screenings. And people who take advantage of preventive healthcare save the medical system big bucks.

Read the full article

Read the scientific abstract at PNAS

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