Reckonings: a journal of justice, hope and history

An appreciation of Charles Addams on Halloween

One of my treasured and almost lifelong gifts from my family has been an appreciation of and (coming a little later) subscription to The New Yorker. In my childhood - and truthfully, well after - I turned primarily to the cartoons, and came to look forward particularly to those drawn by the inimitable Charles Addams. Robert Mankoff, who came to The New Yorker as a cartoonist in Addams's later years, spoke recently with an interviewer about the influence of Addam's work:

 

What influence has Charles Addams’s work had on cartooning and American humor?

I think his influence is, like the man, largish. He tapped into that vein of American gothic that has a touch of paranoia about it, seeing behind every comforting façade the uncomfortable truth about the duality of human nature. But where Gothic literature usually combined these themes with romance, Addams made the horror hilarious: disturbing, but at the same time friendly, identifiable, and acceptable. In cartooning, you can see the direct influence of his work in someone like Gahan Wilson, and in many other cartoonists. Horror films that combine humor with horror, such as “A Nightmare on Elm Street,” with its wise-cracking Freddy Krueger, are also in his debt. And, of course, Addams’s humor was “black” and “sick” before those terms applied.

But I think his influence extends beyond the horror genre, to humor not as a comforting “laughter is the best medicine” anodyne but as something deeply skeptical of the purported values of middle-class American life. By making us laugh at, and with, his fiendish protagonists, he makes us temporarily share their values, and doubt our own.

 

 Those with an interest in the private and professional life of the man Charles Addams should turn to Linda H. Davis's biography, Charles Addams: A Cartoonist's Life (Unabridged), published by Random House in 2006, now also available as an audio book wonderfully read by Don Hagen. Addams's widow gave the biography her blessing, and it's said to pull out all the stops.

 

 Charles Addams

 

But for this particular Halloween occasion, I want simply to offer to readers of Reckonings a small selection; one of Addams's many covers for The New Yorker, and two of his cartoons.

The first is a cover for the issue of July 8, 1961, depicting ghosts from an upland cemetery watching an outdoor drive-in movie - a Western with a particularly appropriate scene - in the valley below:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The second cartoon below is a Halloween occasion, the lady of the house kindly apologizing to a small alien creature (see space ships and companions in background) she plausibly assumes is a boy in costume.

 

"I'm sorry, sonny. We've run out of candy."

 

The Liberation of Isabel Allende: An Interview

Note by JRB: I greatly enjoy the novels of Isabel Allende. So it's a pleasure to learn that she is now a Marin County neighbor. I'm delighted that she has a new book, The Japanese Lover, due out next week. But the best reason for including the following short and absorbing text in Reckonings is that her responses to every single question asked in the interview are so full of life renewed and enlarged, after, as she says, "a very bad year, a year of losses and sorrow." Such redemption is not "magical realism" of the kind she and Gabriel Garcia Marquez are known for, but in another sense the term is a snug expression of all she says here. And the kind of transformation of which she speaks, known at whatever age, is always cause for learning and celebration.

 

The Liberation of Isabel Allende: An Interview

The Chilean-American author’s novel ‘The Japanese Lover’ comes out in English next week

by Jennifer Maloney

The Wall Street Journal

Oct. 30, 2015

 

How did you come up with the idea for this novel?

The idea came from a conversation with a friend walking in the streets of New York. She told me that her mother, who was in her 80s, had had a Japanese gardener that had been her best friend for more than 40 years. And I said, “OK, maybe they were lovers.” She said, “No, why would you think that?” Of course I thought that! But the truth is that that was just an excuse to start exploring themes that have been in my mind recently. I see people around me my age and they are dealing with very old or dying parents. The theme of aging, of death, of letting go, of memory, is very present right now in my life. Plus the theme of romantic and passionate love. Is that possible at any age? Or is it a privilege of the young?

There is a hint of magic and ghosts in this book, but just a hint. Where has the magic gone in your work?

It depends on the book. There are stories that are magical per se, and other stories that simply don’t fit in the mold of magic realism. Magic realism is not like salt and pepper that you can sprinkle everywhere.

What has surprised you about getting older?

I have had a very bad year, a year of losses and sorrow. But I feel liberated, I feel free, I feel full of energy. And I know myself so much better. I have more self-confidence. I can write in a very relaxed mood because I know that I can do it. I’ve written 22 books. And only recently I have the feeling that I don’t need to make a big effort. Let it flow. Just relax. Smile. Drink tea. And it will happen. And so that’s wonderful.

Have you ever thought about writing in English?

No. I can write a speech or an article for a magazine, but I cannot write fiction. Fiction happens in the womb. It’s like counting, like praying, like cursing, like making love. You do it in your own language.

Alma has purged her life of most possessions and social obligations. Have you felt a similar impulse?

Yes, absolutely. I used to be surrounded by piles of books that I knew I was never going to read again. And then one day I decided that that was stupid. So I started this habit of giving them away once a year. I also give away my clothes, my shoes. I used to live in a large house with my husband and then when we separated I bought a little house where everything is very contained. The idea of throwing overboard everything that you don’t need is wonderful.

What don’t you have time for anymore?

I don’t have time for cocktail parties. I’m very short. So in a cocktail party I only see nostrils. The shrimp that other people are eating fall on my clothes. I don’t have time for small talk.

What’s left on your bucket list?

Ooh! A Japanese lover. [Laughs] Or maybe not Japanese. I don’t mind what ethnicity he might have.

What is your most cherished possession?

I’ve been corresponding with my mother all my life. We were separated when I was 15 and we have corresponded, writing to each other every single day. Now we email each other but I print the letters. I have a closet with years and years of letters. I know that my mother will probably die before I do but I will be able to open a letter from her every day for the rest of my life.

This novel feels spare, pared down. Were you trying to evoke the idea of minimalism?

I think it just came naturally because of the process I have been going through. I had to let go of many things last year and this year. I had to let go of my beloved dog that I had had for 15 years. Then my agent, who was like a mother to me. And then moving to a small house, letting go of the material stuff. And that process has been painful and necessary.

What does it mean to you to be a storyteller?

It means that I’m a good listener. I was born with a good ear for stories. And because I have been always a foreigner all my life, I have to ask things that other people take for granted because I don’t understand what’s going on. In asking those questions, I get the good stories.

You’ve done a crime novel, magical realism, realism, memoir. Is there another genre you would like to try?

I used to say I wanted to write an erotic novel but I have to wait until my mother dies. And my mother is immortal, she doesn’t die. By the time she dies, I don’t think I will have the energy to write anything erotic.

Maybe she would forgive you.

I know she wouldn’t. She would not.

 

 

Grace Dammann: Recovery to reinvention

Grace Dammann: Recovery to reinvention 

(from The Pacific Sun, October 21-27, 2015)

The Dalai Lama honors Dr. Grace Dammann at the Unsung Heroes of Compassion award ceremony in 2009. Photo by Michael Yamashita.

 

by Joanne Williams

It takes 40 minutes to travel from Mill Valley to Sausalito by battery-operated wheelchair. Last September, Grace Dammann piloted her power chair on the bike path and took the ferry to the city for lunch. It was her first such foray, but she’s planning more independent ventures. This is her story since an accident in 2008 confined her body but not her mind.

Dr. Grace Dammann maneuvers her wheelchair next to the man seated across the room, takes both hands and gently massages his knuckles and joints. He smiles; his shoulders retreat from his ears. “I think you should get more exercise,” she says. “Do you swim in the pool? I know I need more exercise. I got this shiner under my right eye when I tried a new exercise and fell off the treadmill,” Dammann says. He chuckles at the attention as she continues to ask him how he’s doing.

Grace Dammann, MD, a 68-year-old, pixie-sized physician with short dark hair laced with silver, is director, founder (in 2006) and a team member of the first San Francisco in-patient unit for patients with chronic pain, located in a skilled nursing facility at San Francisco’s Laguna Honda Hospital and Rehabilitation Center. Dammann landed there after the near-death head-on collision on the Golden Gate Bridge in 2008 that put her in a wheelchair for life and resulted in a lawsuit against the Bridge District and the eventual installation of a moveable median barrier last year.

Every Thursday in a bright airy room in the new wing of the hospital at the foot of Twin Peaks, she and eight other professionals—acupuncturists, massage therapists, occupational therapists, advanced care nurses, substance abuse workers, pharmacists, physicians and a psychiatrist—attend to disabled residents, one at a time, to tame their pain.

The pain clinic’s mandate of compassionate care is clearing away the underbrush of confusion when it comes to pain management—trying alternative techniques besides medication. Clinic team member Dan Rybold, M.D., an acupuncturist and family practice physician, believes pain is blocked energy. “By releasing blockage the energy can flow again,” he says. The pain clinic uses various techniques, from foot and neck massage, talk therapy and meditation to yoga, Qigong, acupuncture and a vibration acupuncture called acutonics, a method using tuning forks that vibrate and are believed to release blocked energy. Medication, including medical marijuana, can be part of the recommendation, particularly with AIDS patients.

The morning begins at 9am with a staff meeting to discuss patient progress and a new patient, who requires a translator. “There is a family member who wants to direct treatment,” Dr. Dan says. (It’s hard to use their formal title in this relaxed setting). “The patient has multiple system failure. How do we handle this?” The ensuing conversation is off-limits to this reporter. Before the team breaks—they will see 30 patients today—they take time for 10 minutes of meditation together.

At around 10 o’clock, patients arrive, some walking, some in wheelchairs, one lively woman in bed who likes to chat about anything. Dr. Rybold speaks in Spanish to a man from Vera Cruz with a colostomy bag hanging from his waist and places acupuncture needles in his ear and on the top of his head. He makes no sound and accepts the needles while he and Dan converse in Spanish like old friends. “How are you feeling today?” Dan asks. “Where are you hurting?”

On the other side of the room, Alice Wong, an activity specialist, wields the acutonic tuning forks, different colors for various vibrations, smacking them against a small disc strapped to her thigh with the verve of a Taiko drummer, and as the wood and metal forks begin to vibrate she passes them over the painful areas on the patient. “It helps with diabetic pain, arthritis, AIDS inflammation and similar discomfort,” she says. (Alice and Dan met at the pain clinic and were married by Grace at the Zen Center at Green Gulch Farm in Marin.)

Pain is the fifth vital sign, after pulse-rate, respiration, body temperature and blood pressure, and physicians are beginning to pay more attention to it. The pain clinic at Laguna Honda has developed various alternative methods of treatment that have been noticed nationally. “They try to use alternative treatments long enough on a patient to see what works for each patient,” Dammann says. Among them: Mid-morning, the clinic lights are dimmed and the team and the entire group of patients close their eyes for a 10-minute meditation.

If these procedures seem too far out they appear to work. “My own experience after the near-fatal accident on the Golden Gate Bridge that resulted in 15 surgeries and 58 units of blood led me to research pain and palliative care. I was bored being a patient myself,” Dammann says. “When I was cleared to work again and I was offered the pain clinic at Laguna Honda I didn’t want to do it, but as I thought about it, physicians need pain education, and who better to teach it than a disabled physician. I believe in patient-centered care. Pain is under-treated and the medical community realized it needed to be addressed. It is very complicated and has very little to do with physical symptoms but everything to do with how a person experiences it.”

Grace Meigs Dammann grew up in a small town near Winnetka, Illinois, from a long line of physicians—she’s seventh in the chronology, and the oldest of four siblings. Her grandmother was a pediatric physician, a contemporary of Jane Addams who started Hull House, the first Settlement House in Chicago that started the social welfare movement. Grace received her B.A. from Smith College, went on to Yale Divinity School where she graduated as an agnostic but was impressed with the idea of belief.

From there Dammann moved to Wisconsin, where she received her MSW, gravitated further west and asked for guidance from her then deceased grandmother, who advised her in a dream to go to medical school. Dammann enrolled at Mills College for pre-med, and then “all the doors opened,” she says. At 35 she continued her studies, received her M.D. from UCSF in 1986 and in 1990 established the first AIDS inpatient unit in a skilled nursing facility at Laguna Honda.

Before the horrific head-on collision that put her in a wheelchair for life, Dammann had lived for 27 years at the Zen Center at Green Gulch Farm above Muir Beach in Marin with her partner, Nancy “Fu,” Schroeder and their adopted daughter Sabrina. She also maintained an AIDS and family practice in Mill Valley and was directing the first AIDS clinic for poor people at Laguna Honda Hospital.

Both Sabrina and their beloved dog, Mack, survived the accident (Fu was not in the car), but Dammann had so many internal injuries and broken bones she was not expected to survive. But after nearly two months in a coma she woke up. “I was glad to be alive,” she says, even with multiple injuries. Colleagues at Laguna

Honda gave up a year of sick days to maintain her salary during rehab. Her arduous rehabilitation is captured in the 2014 documentary States of Grace by her longtime friends, filmmakers Helen S. Cohen and Mark Lipman.

In 2010 Dammann left the hospital and resumed life at Green Gulch, where she had worked in the garden and in the kitchen while maintaining her public health jobs. It was not an easy adjustment. Fu made a five-year commitment to take care of her partner, yet they had always had differences. “I am an extrovert and Fu is an introvert,” Dammann says. “Being a 24/7 caregiver is an impossible job. Fu wanted a more monastic life, and I wanted to go back to work. I gotta get a job, I told Fu. It was a bad joke. Also I wanted to be ordained as a Buddhist priest. I had missed a year and a half of Sabrina’s life as a teenager. I had arm and leg surgery, foot surgery. When I first woke up I was glad to be alive. Then I became frustrated by my limitations. I wanted to dance, to surf.”

The offer in 2011 to create a pain clinic turned out to be a gift. “I hired Dan Rybold and we quickly pulled a team together who wanted to work with us on this alternative approach to pain management,” she says.

Last month, Dammann was invited by Harvard University Medical School to teach compassionate care to third-year medical students. She also taught the medical staff at Brown University, in both instances using her case history in States of Grace, which has become a valuable teaching tool. The National Institutes of Health and other hospitals nationwide are now studying pain management and compassionate care. Dammann herself is now off of pain medications because she believes in her case that they intensify pain if one becomes dependent on them and then tries to stop.

Today, Dammann has a unique vision of her task. “The role of the healer is to help make patients happier,” she says. “I tell my staff if you are depressed don’t come to the office. I learned from being a patient the importance of relationship-centered care, of compassionate care. To me this is not work.”

During the six-year period that marked the AIDS disease’s deadliest era, Dammann signed more than 1,000 death certificates. The Dalai Lama honored her work with an Unsung Heroes of Compassion Award in 2005.

Perhaps Dammann’s capacity for pain is due to her Buddhist philosophy and her ambition to become ordained. Her left hand is still crippled from the accident, and she struggles to use it, but she managed to finish 15,000 tiny stitches on the garment that she will wear if ordained.  

Now living at The Redwoods retirement community in Mill Valley, Dammann starts her day with meditation at 5:30am. A hummingbird feeder hangs above her apartment door facing the marsh and Tibetan prayer flags greet the breezes. Mack’s water dish sits near a smiling Buddha statue. Dammann tried the treadmill again and with a physical therapist makes a strenuous effort to walk. After her trip to Boston she officiated at a wedding in Santa Barbara, then went to Bellingham, Washington to do more professional consultation.

Dammann has learned to accept change. Her Buddhist philosophy helps.

“You can’t argue with what is, that can create more suffering,” she says. “I remember after my accident what pleasure I experienced for my first shower. It was better than sex. You can’t control what happens but you can control how you behave in response. Now I have learned to say yes to everything, to travel, to everything that presents itself.”

Dammann won’t run the Bay to Breakers again, but she anticipates more journeys on her power chair, like her trip to the Ferry Building. She has occasional twinges when crossing the Golden Gate Bridge because of the memory, but for her weekly commute she takes the Whistlestop bus or has a driver with her personal wheelchair-accessible van. To stay engaged at Green Gulch, she spends two days a week in the office, answering the phone and taking reservations for visitors. She’s also a fan of the Golden State Warriors.

As Dammann writes in "Lessons from an Accident," published online at Awakin.org, “I realize now that my greatest happiness in life has been in my service to people, particularly the joy that comes from being totally present with my own and their suffering. When I woke up from my coma I had new insight, I understood that I hadn’t completely shown up in life. My new emphasis in service is to remind myself of this motto, ‘Do it now, just do it now.’ Whatever life offers, take it.

 

Editor's note: Grace is a remarkable woman, a good and generous friend, a devoted and imaginative physician, a longtime resident member of the Green Gulch Farm Zen Center near Muir Beach, California, a fellow member of The Redwoods community in Mill Valley, California. Her wisdom and long immersion in the spiritual tradition of Buddhist practice nourishes our twice-weekly Meditation Circle at The Redwoods. In all the manifold meanings of the term, I am deeply grateful for her presence.

The Pond, by Mary Oliver (with a comment by JRB)

The Pond

by Mary Oliver

 

August of another summer, and once again

I am drinking the sun

and the lilies again are spread across the water.

I know now what they want is to touch each other.

I have not been here for many years

during which time I kept living my life.

Like the heron, who can only croak, who wishes he

    could sing,

I wish I could sing.

A little thanks from every throat would be appropriate.

This is how it has been, and this is how it is:

All my life I have been able to feel happiness,

except whatever was not happiness,

which I also remember.

Each of us wears a shadow.

But just now it is summer again

and I am watching the lilies bow to each other,

then slide on the wind and the tug of desire,

close, close to one another,

Soon now, I'll turn and start for home.

And who knows, maybe I'll be singing.

 

This poem is included  in Mary Oliver's latest collection of poetry, Felicity, published by Penguin Press in October, 2015.

 

JRB’s comment: The herons I come upon in the marsh I walk beside are usually silent, almost still in their slow graceful searching movement. I’ve never heard one croak, but there is a sub-species called whistling heron, and typically the voices of birds are more diverse than we imagine, depending on what experience they’re conveying to one another. Whatever the heron’s wishes (do herons wish?), like the poet I too wish I could sing. This poet knows that she can and does sing, as do even those of us taught when young that we cannot carry a tune. My high school Latin teacher, leading us in Latinate song, bent down beside me to listen for a moment, then said quietly, “John, why don’t you just hum.”

 

This heron, fishing, photographed so beautifully by Chris Harshaw, is a song.

As is Mary Oliver’s poem, a tribute to “living my life,” wholly, in each moment, again and again, light and shadow, season by season, whatever we find and are given, leaving home, turning, returning, singing or humming, or croaking.

 

The Quality of Death

Perspectives On Aging – Muriel Gillick, MD − Harvard Medical School

---

18 Oct 2015   Five years ago, The Economist commissioned a report on the quality of death throughout the world. Now, the magazine has issued an all new report on the same topic, expanding and improving its methodology and increasing the number of countries studied from 40 to 80. Whenever this kind of global study is released, my interest is in how the US performed and in what we can learn from other parts of the world, much as I wrote about in my recent posts on the WHO Report on Ageing. And as usual, the interesting part is not so much the bottom line—the US came in 9th among the 80 countries surveyed—as the specific strengths and weaknesses that determined the bottom line.   The report broke down its assessment into 5 domains: palliative and health care environment; human resources; affordability; quality of care; and level of community involvement. The first 3 areas each contribute 20% of the overall score, quality contributes 30%, and community involvement 10%. If we look at each of these areas, what we find is that the US sub-rankings were 6, 14, 18, 8, and 9, which is to say we were dragged down by a relatively weak supply of palliative care professionals and by high costs. In the areas of national policy towards palliative care, quality of care, and public awareness, we were strong but not superlative. In other words, while we have made enormous strides in training a palliative care workforce, developing fellowship programs for physicians, nurse practitioners, and social workers, we have a long way to go, given the size and aging of our population.   What is particularly noteworthy is the case of Taiwan, which the report regards as a model to watch and to emulate. Taiwan ranks number one in Asia, and #6 overall. It has successfully increased the number of hospices by 50% between 2004 and 2012; and it has markedly changed its culture to encourage discussion of prognosis. In Taiwan, everyone has a health insurance card that includes key medical information, and older individuals now often include their code status on this card. In addition, the country is piloting a program to monitor end of life care in rural areas using smartphones and tablets. It has published resources for caregivers in six languages. And it allows patients and their caregivers to Skype with their doctors.   Taiwan is not the only country that out-performed the US (the other 8 are the UK, Australia, New Zealand, Ireland, Belgium, Taiwan, Germany, and the Netherlands. At least in healthcare, particularly for older people and those near the end of life, American exceptionalism is a myth. We can do better, and we should.

Leaves and blossoms along the way: a new poem by Mary Oliver

Leaves and Blossoms Along the Way: a poem

by Mary Oliver

 

If you're John Muir you want trees to 
live among. If you're Emily, a garden
will do. 
Try to find the right place for yourself. 
If you can't find it, at least dream of it. 

                                             •

When one is alone and lonely, the body
gladly lingers in the wind or the rain, 
or splashes into the cold river, or
pushes through the ice-crusted snow. 

Anything that touches. 

                                             •

God, or the gods, are invisible, quite
understandable. But holiness is visible, 
entirely. 

                                             •

Some words will never leave God's mouth, 
no matter how hard you listen.  

                                             •

In all the works of Beethoven, you will 
not find a single lie.

                                             •

All important ideas must include the trees,
the mountains, and the rivers. 

                                             •

To understand many things you must reach out 
of your own condition. 

                                             •

For how many years did I wander slowly 
through the forest. What wonder and 
glory I would have missed had I ever been
in a hurry!

                                             •

Beauty can both shout and whisper, and still
it explains nothing. 

                                             •

The point is, you're you, and that's for keeps.

Donald Hall on Jane Kenyon

Editor's note: While Jane Kenyon was a student at the University of Michigan she met poet Donald Hall. The two married in 1972 and three years later moved to Eagle Pond Farm, Hall's ancestral home in Wilmot, New Hampshire. They lived and wrote there until Kenyon's life was cut short by leukemia in 1995 at the age of 47. While readers of Reckonings will be familiar with my admiration of Jane Kenyon and her poetry so steeped in place and depth of feeling, I've been less attentive in these pages to the impact of their marriage and her final illness and death on Donald Hall, which were profound. They were expressed shortly after she died in a volume of his poems he called simply Without; and then in a later, more reflective and wider ranging gathering of poems entitled The Painted Bed. The poem reprinted below, "Her Long Illness," is expressive of the personal effect of their love and suffering, and is drawn from Without. 

 

Her Long Illness

by Donald Hall

 

          Daybreak until nightfall,
he sat by his wife at the hospital
          while chemotherapy dripped
through the catheter into her heart.
          He drank coffee and read
the Globe. He paced; he worked
          on poems; he rubbed her back
and read aloud. Overcome with dread,
          they wept and affirmed
their love for each other, witlessly,
          over and over again.
When it snowed one morning Jane gazed
          at the darkness blurred
with flakes. They pushed the IV pump
          which she called Igor
slowly past the nurses’ pods, as far
          as the outside door
so that she could smell the snowy air.

 

Jerry Brown’s Personal Message on Assisted Suicide

New York Times, Wed., Oct. 7, 2015

by Philip M. Boffey

Gov. Jerry Brown of California gave a deeply personal explanation on Monday for his decision to sign legislation allowing terminally ill patients to obtain a lethal dose of painkillers from a doctor to hasten their death. When the law goes into effect next year, California will become the fifth state, after Oregon, Washington, Montana and Vermont, to enact and retain aid in dying or physician-assisted suicide laws. Many other states are considering similar laws; they ought to follow the example of these pioneers.

The California law has robust protections to protect patients from recklessly taking their own lives. Two different doctors must certify that the patient has six months or less to live before prescribing the drugs, patients must be able to swallow the medication themselves, and they must be of sound mind and not under coercion from their families. Hospitals and doctors can decline to participate.

Governor Brown, a Democrat, said that he had carefully read the opposition materials presented by a number of doctors, religious leaders and champions of disability rights and had considered religious arguments that shortening one’s life is sinful. He also consulted with a Catholic bishop, two of his own doctors, and former classmates and friends, who took a variety of positions.

In the end, he reflected on what he would want in the face of his own death. “I do not know what I would do if I were dying in prolonged and excruciating pain,” he wrote. “I am certain, however, that it would be a comfort to consider the options afforded by this bill. And I wouldn’t deny that right to others.”

 

 

The Fine Art of Failing − Pema Chödrön

The Fine Art of Failing

by Pema Chödrön| October 5, 2015, from Lion's Roar

Photo by Liza Matthews.

In her commencement speech at Naropa University, Pema Chödrön explains that if there’s one thing we all need to practice, it’s how to fail well.

When Naropa asked me for the topic of my talk, I decided not to give it to them because I thought if I did, they wouldn’t let me do it! My talk is inspired by a quote from Samuel Beckett that goes like this: “Fail. Fail again. Fail better.” I thought if there is one skill that is not stressed very much but is really needed, it is knowing how to fail well. The fine art of failing.

There is a lot of emphasis on succeeding. And whether we buy the hype or not, we all want to succeed, especially if you consider success as “it works out the way I want it to.” You know it feels good in the gut and in the heart because it worked out. So failing, by that definition, is that it didn’t work out the way you wanted it to.

And failing is what we don’t usually get a lot of preparation for.

I think if there is one thing that prepares you for having some idea of how to work with the rawness of things not working out the way you want them to, it would be contemplative education. You have gotten a lot of instruction and encouragement and support for feeling how things impact you—not just going down the tubes with it but actually taking responsibility for what is happening to you and having some tools about how to work with painful feelings, raw feelings.

So fail, fail again, fail better. It’s how to get good at holding the rawness of vulnerability in your heart.

Life in the End Zone: perspectives on aging

Editor's note: For some time I have been following a weekly blog published each  Sunday. It's called "Life in the End Zone: perspectives on aging," and is written by Muriel Gillick, MD, who describes herself briefly as "a physician who specializes in the care of patients with advanced illness (palliative care) or advanced age (geriatrics), or both. I am also a professor at Harvard Medical School in Boston, Massachusetts and a faculty member in the Department of Population Medicine within the Harvard Pilgrim Health Care Institute." You can explore Dr. Gillick's blog by clicking on this address.

With more and more of my friends−as well as myself−nearing "the end zone," and with a career-long personal and professional interest in the whole human life cycle, I've found Dr. Gillick's short weekly combination of information and reflections of real value, and wanted to bring them to your attention. I do so this week, with her words below, because she is beginning a series of weekly discussions of a new World Health Organization report on aging that she persuasively describes as "a remarkable and inspiring document."

 

Posted: 04 Oct 2015

The World Health Organization released a brand new report. It doesn’t have a very snazzy title—it’s called World Report on Ageing and Health—but it’s a remarkable and inspiring document. 

 

Not surprisingly, none of the major US newspapers breathed a word about its release. Maybe the reporters just haven’t had time to go over it: it is, after all, 260 pages. Or maybe they figure that what’s happening in the rest of the world isn’t terribly germane to the US. Perhaps−and I suspect this is the real reason−the media don't want to think about aging. In fact, the report is brimming with fascinating observations and interesting insights, many of which are relevant to the United States both in terms of our own aging population and in terms of national security. There is so much in here worth commenting on, that I think I will devote more than one blog post to the report. Let me begin by sharing some of the most astonishing things I learned in the first half of the report.

 

The report begins by suggesting that rather than thinking about expenditures on older people as pure costs, they should be seen as investments. It points to a study done in the UK a few years ago which calculated that if you put everything that the government spends on old people in one column (pensions, health care, other social welfare programs) and you put the contributions of older people in another column (taxes, consumer spending, work), you come up with a positive balance. At least in England, the net contribution of older people amounts to 40 billion pounds per year.

 

One of the most startling differences between this new report and its predecessor is that today's version defines healthy aging as the process of developing and maintaining the functional ability that enables well-being in older age. I like that. All health care systems in all countries, the authors argue, should have as their [preeminent] goal fostering the functional ability of older people by supporting and maintaining their intrinsic capacities and by enabling those with diminished functional capacity to do the things most important to them. This is a marked improvement, in my view, from the last major WHO report, Active Ageing, which came out in 2002, that talked about "optimizing opportunities for health." Then, health was the ultimate objective; now, health and healthcare are means to an end and that end has to do with the ability to function in society.

 

The description of what health in older age looks like in different countries is both intriguing and sobering. My attention was drawn to a single chart showing the percent of the population age 65-74 and the percent age 75 and older with limitations in one or more activities of daily living, by country. Only a handful of countries were listed. But the gap between the worst off and the best off was shocking—as was the revelation of who occupied the extremes. In first place is Switzerland, with fewer than 10% of the 65-74 year olds suffering a limitation in function and fewer than 20% of those over 75. In last place is Russia, with 60% of the younger old and 80% (that’s not a typo) of the older old reporting at least one ADL [activities of daily living] deficit. I haven’t quite figured out how this relates to Putin’s policy in Ukraine and Syria, but I suspect there’s a connection. There's something very rotten in the state of Russia.

 

On a more optimistic note, the chapter on “Health Systems” gives some uplifting examples of countries that have introduced novel approaches to improving the well-being of their older populations. Ghana is making an effort to harness its well-established system of community health workers to meet the needs of older people. And Brazil has begun integrating aging into its national family health strategy: it is using multidisciplinary teams comprised of physicians, nurses, and physical therapists, psychologists, nutritionists, occupational therapists, and others to work in community centers and to go into patients’ homes to deliver care.

 

More to follow....