Monday, July 20, 2015

How to meet the inevitable?

Reflections  (and  feelings)  on the Realization that I, too, must die!    

I was sitting with my dermatologist discussing  the inanity of the typical sixteen year old   know  it all   who sits upon a hot beach  getting terribly blistered and   insists the whole  thing  is “really cool  and hip.”  The gangly adenoidal youth imagines he is   truly “with it.” I am embarrassed   to admit  that  this ridiculous and uninformed posture was similar to my own at sixteen . It was somewhat akin to the nutty craze of my adolescence   that the height of  “class” was wearing saddle brown shoes while pretending to smoke a pipe.

Now bald and pale skinned ,  about  seven decades later, at 93 , I share with my doctor   my great insight  that since I consider such beach behavior  incredibly stupid   “I must be  getting   old “.  She shocked me by  responding:  “ Correction, Father, You are old.”   But how could this be? Being  old happens to other people . I am young  Jimmy Lloyd. I am not really old— right now I am only 93  and –well- you know—years are just a statistic, anyway!

But the nagging indices  of stiff, aching legs, the omnipresent  urge to fall asleep as soon as I sit down, anywhere, and the need I have of  saying  “eh?” to every conversation are cutting  through this commonplace denial. I am getting a message!  I am close to the end of my sojourn on this planet. Andy Rooney, the crusty old battle axe of “ Sixty Minutes”, was asked when he was 92, did he ever think about his own death” He replied “ yes and I hate it!”  It is a rare being, I think, who looks eagerly  ahead  to his personal dissolution with a “ hot diggity—hotdog “ attitude. The great saints perhaps. And their like, but for the most part, we mortals dread  the day of our death.  Most of us need to put our houses “in order.”  Most of us need to have some kind of even half resolution on this matter, even though denial and dodging honest  focusing is a badge of  our human tribe.

 Those of us who believe in an after life—an eternity with a loving  Lord have a leg up on this  human challenge.  The idea of a life  without end  while intellectually mind boggling is nevertheless appealing. There is, in the average person, some kind of powerful wish to live forever. Is that wish implanted by God?  Is  there some kind of “connect” between the wish and the reality?  Human analogies abound from an eternal land of milk and honey festooned with gorgeous virgins  all the way to the bliss of gazing  upon the Face of the  God of us all.

It is said that old men dream dreams and young men have visions. While I am keenly aware of the delightful electronics of this modern age, the speed and ease of today’s   travel, the access to art and literature, the cornucopia of  apparently endless  supply of   any kind of  data, the glorious,  contemporary  food, and my own strong wish  to “do it all”,  I am  flooded now with more pressing needs.  Various commentators on authentically living one’s life often have a final level of maturity focusing on “integration” as a way of finding  meaning in what one has experienced. This is my present “obsession”.   Youth is obsessed with the doing of things -- with the tasting of the delicacies of Life. This may explain some reluctance of  dying—that there are so many things and experiences I would still  like to have but  which are now  impossible! Yet, in old age, it is the seeking real, personal answers which absorbs one’s soul.  So I retrospect.  I assess where I have been, where I am and where I am going.

Although coming  from a densely populated area in a very large  American city, my character formation was provincial. We were highly influenced, almost saturated with an Irish Catholic ethos. For me and my sister we were somewhat diluted by having a Jewish father. We were, apparently, poor. I was the  prototypic  “dirty necked kid from the West side”. Nonetheless, our values, our spirituality, our humor, our fears were thoroughly colored by this total community value system. Our school, our church, our park were all within a 1/4 of a mile of each other. It was possible to remain within those parameters for days, even weeks and feel no need to go elsewhere. The unspoken goals were largely centered on survival, physical, social, spiritual.  Paramount, however was the notion of “saving my soul.”

As far back as I can remember, that notion clearly implied survival after death. This survival, though largely undefined, carried a profound sense of unending beauty and joy, so delightful and glorious that one would be willing to forego one’s own life in this world rather than lose  “one’s soul.” So endless stories of brave men and women were told us as children, wherein terrible tortures and afflictions were loaded on these people who at their Martyr‘s death went straight to God for “eternal happiness.”  This happiness is obliquely described by the apostle Paul as “The eye hath not seen nor the ear heard what things God has prepared for those who love Him.” This eschatological view had enormous impact on my adult and professional life. It gave a transcendental meaning to everything I did, saw, heard and encountered. It could all be lost should one die in what was called “mortal sin”, mortal meaning   deadly. 

My life as a student, Priest, teacher, media person, psychologist has been extremely fulfilling.  Professionally, socially, interpersonally.  I have known “success”.  I have hit innumerable  pastoral “home runs”.   I have published. I have had friends.  Real friends.  Men and women. From every class  and religion and political persuasion. I have travelled in strata, both physical and social,   which in my childhood days  I would have  considered totally unavailable to me, a mere day dream.  I have traveled the world on freighters and jets and dirty railroads and buses. Europe  over 30  times. The veldt of Africa many  times. The enchantment of Jerusalem. The vastness of Australia. The list would be endless.

There is something thrilling about “being there” after having seen the wonders only in books and movies and  my own fantasies. To experience the Sistine chapel and the sphinx  and Notre Dame and Victoria Falls and Sydney harbor and Madrid’s Plaza de los toros was  breathtaking.. I have enjoyed so many meals with exhilarating  conversation. But even more than travel,. It has been  people.  The joy of interaction with others has been tagged as the real source of human happiness.  The Big Tycoon with the exciting  episodes of  making big money seems utterly fulfilled  in his board room. But he, too, in quiet times, wonders what really matters! Maybe, in the depth of the soul each of us secretly knows that it is Love that matters.

The plaintive question of Tevyev of Fiddler on the Roof to his wife   “Golda, do you love   me?”  sums it up. Without love, there can be  no joy.  So have I been blessed by my early Indoctrination that God in Jesus loves me implacably with a passion beyond my ken. So even  amidst the turbulence of Mel Gibson’s Passion of the Christ  I have been, not  repulsed  by the gory Hollywoodian depiction,  but moved almost to     speechlessness by  the graphic depiction of what He  did for me  even  were I the only human being ever  to  have lived.  So, He tells me that perfect love casts out fear! And as my Church guides me  through this dark valley She teaches me  that   all my sins have been forgiven with one heartfelt expression of love for the Father as  I lament my past with deep, deep resolution for my future atonement as I realize  how much He  loves me!

It is this love which is the real answer to fear of  dying.    Connect this with a Faith in Him which never wavers and a total trust that He means what  He says and one has an approach   to one’s own death which is workable.  But feeling loved is essential for peace in dying.I        one feels unloved and forgotten and lonely.    Augustine in his Confessions (or testimonies) teaches   “Thou has made us for Thyself O God and  our hearts are restless until  they rest in Thee.”  While one can never shed the first law of Human Nature, instinctive reflex for survival,  the question of Tevyev “ Am I  loved”? Am I?      

Why do specialists in Death and Dying often suggest that we whisper into the ear of the dying:  “I love you”?  A life lived without love is a terrible thing. But If one believes that death brings us into the eternal arms of God in unspeakable undefinable love which lasts forever,  it loses some of its sting and  fear. , nor can one live totally free of all negative 

Thursday, May 7, 2015

The Modern American Nursing Home

Should it (or could it)  be more than custodial?  Is it really just babysitting while awaiting death ?

Recently I visited a self described  “ state of the art”  Nursing home in one of the North eastern states to  greet an old  time friend who has been  placed  there by family   because of indications  of the dreaded plague,  Dementia. This facility lists on Its webpage Gourmet dining for residents,  careful, professional and regular  treatment for the improvement  of the various levels of the disease, stimulation, multiple occasions  for interaction with  games, music concerts and in general  a kind of edenic living.
Situated on a busy avenue loaded with garages, gas stations, hot dog stands and  businesses selling  tires and accessories, the Home is a large attractive building  with a sweeping driveway. When I arrived, there were several elderly people seated on the porch in rocking  chairs sunning  themselves. They looked at me with empty vacuous eyes and instantly dropped their gaze, reminiscent of cows munching on grass  who are distracted momentarily by a passing railroad rain. Those who are residing there for dementia care live in a confined locked area cheerily  called   the Reminiscence area.
When I was ceremoniously admitted through the coded locked doors, my first reaction was of oppressive temperature. No open windows. The air was heavy, perhaps, because older people like warmer room temp. Yet, the general sense was of cleanliness with no trace of urine odor so offensive in poorly kept institutions. However, there was a sense of total enclosure which can be so deadening and crushing  in time. I was told that once a week the residents are taken outside the enclosure for “ice cream”, an event viewed by the residents with greatly anticipated joy. This “lock up” seems quite proper for those whose dendrites have been destroyed. Those patients who are in the Alzheimer  “bubble” must be protected from the  “wandering” possibility which could result  in major damage  to  themselves. Quite clear.
 Staff  try mightily. The  fault is not  theirs. The error in this facility, as in many others, is failing to recognize that all dementia patients are not in the same severe level of the disease. These patients should be treated in terms of where they are medically at the present time .  In spite of the hoopla of “interaction” there are huge chunks of the day which the residents spend alone, a bellringer for depression possibiliies. Confinement, unfortunately, makes for flattened personalities. Prisoners readily attest to this and while all nursing home administrators try, sometimes desperately,  to provide stimulating activities,  the structures make it exceedingly difficult. Placement and diagnosis are sometimes made hurriedly without sufficient over all analysis, Experienced diagnosticians know that mildly depressed residents can experience more rapid deterioration when plunged abruptly into what they experience as a total life change with a concomitant sense of confusion and futility.  The sadness is that what little opportunity for “happiness” one possessed has now been quickly abolished  with confinement in the deadening atmosphere of the severely  afflicted..

The staff was warm and cheery, a bit artificial, but generally pleasing. They greet one well and are perfectly pleasant.  I was ushered into a room for “general” purposes. It had a large television  screen which no one was watching but seven or eight dementia residents of various levels of awareness  were present.  It was apparently acceptable that they sit and watch me visit my friend. One gray haired woman who seemed to be at least eighty sat hugging a toy doll and treating it as if it were human and living. A senior man with arms folded and eyes closed sat silent when he suddenly got up and began to pace the floor slowly but repeatedly. He was like the Indian psychotic inmate in “One flew over the cukoo’s nest.” A woman seeing my clerical collar dashed over to say, in a surprisingly deep guttural voice that she owned the place . I felt a bit cowed and reminded myself to behave appropriately.   Three or four senior women almost sprawled in chairs while they “looked out there” at something or nothing. No conversation. No smiles. When eyes would meet it was a momentary connection of no-life. They just “sat” there. The heaviness of mood was powerful.
 I managed to contact a 92 year old woman who had lost her husband 9 months ago  and whose 5 sons agreed that she could not live alone so  they  gathered her up and deposited her in this facility. With tears In her eyes she told me none of them came to visit her in this facility which she described as “ I hate it.”   One of the dominant reasons for her low feelings was not only abandonment, but more, the sense that she had lost all control or decision sharing in her life. Others decided for her. Coming to such a facility  like this actually aggravates this feeling  of being overwhelmed. She is told when to retire and get  up. When to eat.  To take medications when others decide for her. She is allowed very little in the way of personal decision making.   Furthering her depression she got the impression that they confined her for their own convenience. They say they  feel better. They don’t worry about her any more so they  can  go on with their respective lives with relative peace  of mind and enjoyment.  Every one is happier except her, and that realization is painful  and is enormously  hard to carry alone.    Did she tell me truth or was it distorted perception? I don’t know but one factor is indisputable.   The cookie cutter dimension.
As noted, institutions do what they can. There is no perfect solution. That is why cookie cutting resolutions can be very damaging and unfair. Each patient has to be assessed individually. Some of these patients might do well if incorporated into the more “normal” populations.  For example, there are some dementia patients who can, at present, enjoy and benefit from more free living, even if lightly supervised by competent and caring  people. Does it help a partially functioning dementia patient to be totally immersed in a very sick environment or would it be worth a chance to allow that person to move even limitedly in a more normal population? To my psychologist’s mind the question is academic.
Recently, some friends of mine  described their treatment of their  aged mother who was in dementia  and living in a Nursing home. The mother had difficulty speaking   complete sentences and finding words  to express her thoughts. They brought her to  their home  four days over the Christmas holidays. They report that the return to more instant   comprehension and ease of speaking  was  markedly  obvious. She was stimulated by conversation which was more than discussions about showers or  takings pills.  Total immersion in the numbing atmosphere of a confined area will take its inevitable and terrible toll.       
 It is fairly clear that dementia type diseases are irreversible, When dendrites die, they do not regenerate. Surely the Facility knows that elemental point. So when they suggest, relative to my friend, that IF she improves at 86, they will move her into assisted living, are they telling less than the truth?  Don’t all of us unconsciously seek the easy solution? To reduce “memory units” to custodial levels might be fair enough but to pretend that they are rehab designed is really pushing the envelope!!
Relative to my friend.   The reality is that her few times left of enjoyable living are fleeting each day as she stays  in the Memory unit.  Her last happy moments have been stolen on behalf of the peace of mind of others. She has been there six weeks with rapid negative consequences. She has fallen twice, the second with some significant injury to her leg, has had three serious episodes of vomiting twice accompanied by loss of  consciousness. I rode with her in the ambulance to the local hospital where after 8 hours of testing  she was discharged with no findings. CT scan, EKG, BP,  total blood work up and observation. Is this not obvious psychological messaging of rejection and rebellion? Her heart begins to act up after all the excitement but more so her deep unhappiness. She cries herself to sleep. On her third vomiting episode, again with ambulance transport to the local hospital, after heavy  testing, she was sent  to another hospital in another city. She was discharged again to resume living in the Lockup. Will she vomit again? She did not vomit once when living in New York.  What does one make of this?  One legitimate question is obvious. Not all problems are purely and only physical. Patients sometimes communicate nonverbally   through bodily symptoms. It is known as psychosomatic reactions.
In 6 weeks she has not had ONE therapy session in spite of the alleged programs so colorfully described. In six weeks her mentation is worse. Her confusion seems compounded. Her word search has become painful. She says she feels: degraded----demolished---in prison. Her words. In a kind of Stockholm syndrome she fears to tell others what she is feeling.  She fears, probably aggravated by her hours of  being alone or by the garbled conversation of  the dementia population, that the staff will “punish”  her  if  she  speaks up and says what she is really thinking .  She resists taking showers because of the (from her point of view) Nazi like attitudes of handlers who are usually  aides  who are under a nurse overseer.
Dementia is a  terrible disease.  Not much has been found to date which offers substantial hope for cure but all researchers recommend  that caregivers do as much as possible to maintain at least the present level of self esteem which the patient possess. Dementia care is stressful  for caregivers but who for the most part   sincerely wish to safeguard   the limited reservoir of peace these unfortunate patients  cling  to. The spiritual, the emotional, the social factors are at least as important as the physical factors so necessary in the final days of those we have loved who themselves  took care of  others in  the past . Psychological  factors are serious dynamics which ought to be acted on. At least they should be seriously considered.

Wednesday, August 20, 2014

The Mess at Gaza

The wise old Sigmund Freud said among other witticisms that nothing is all that it seems. The Hamas/Israel tragedy, for example, fairly screams  “complication.”

To Israel, it is an obvious “given” that they are  a duly, lawfully constituted nation with an indisputable right to a peaceful existence equal to the United States, England or Pakistan. Consequent to that right is a further one which is not only a right but a duty. That consequent right and duty is the protection of the lives, properties and liberties of its citizens, even, if by severe military force. This is, to them, non-negotiable.
To Hamas, however, Israel has stolen Arab land. Israel is an occupier. The land  must be returned.   Unless this happens there can be no peace. This is, to them, non-negotiable.  
In any event, a necessary point must be noted. All rights have real limitations. The response against an unprovoked attack has to be measured and cannot morally go beyond the minimum damage, collateral or otherwise.           
The defending nation will claim that that such force is necessary for legitimate  protection. This factor similarly operates in the difficult area of the “just war” analysis. What is the criterion whereby one can justly argue that the force used is beyond the restraint of the common moral position?

When non-combatant civilians, including children, women and senior citizens are killed or seriously injured in large numbers, when their lives are totally uprooted, when their homes are devastated, it would appear, even though in war there is often unavoidable collateral damage, that the force used was beyond “measured.” 

However, on the other hand, if the attacking  force, in this instance  classified by many as “terrorist” hides its rockets in  schools, hospitals, mosques, residences as  behind a  “human shield”, Israel is placed in the intolerable position of simply enduring the cascade of rockets  from these protected places with no defense but their own  “dome” system, awesome but not perfect. This means that civilian  Israeli lives are not only endangered but open to widespread death.   Hence, the “other side” morality of the Israelis. Yet, Hamas publicly denies any kind of   human shield activity claiming that the charge is manufactured for American propaganda. What does one do with such a dilemma? Whom does one believe?

Of course,  the placing of armaments in such nonmilitary places is highly unethical and would suggest,  if true,  that the Hamas cares  little for human lives, even of their own people. There has been some grotesque reporting that   civilians are advised NOT to leave a building designated for attack so that the incident can be used as an anti-Israeli propaganda tool. 

While Israelis claim that they notify Palestinian residents before the destruction of a certain building which houses rocketry, by leaflets, radio, internet, the question then arises:  Where do the endangered local Palestinians go? Get out, they are told, to place of safety the existence of which is nebulous.

Some truth is to be found everywhere. But is one side all right and the other all wrong? To listen to the debate, depending on which side speaks, one could believe that there are not two sides to this story. As frustrating as it is, more talking and listening are required. There have been so many “peace” talks in the past that one becomes some what cynical of the whole  situation. We have seen the warm cozy handshakes in the past with “sincere” hopes of a peaceful side by side arrangement. Again and again the agreement is broken and hate, not peace, emerges.

The reality of life teaches that rarely does one get all that one wants. Legitimate compromise does not diminish nations.  Intractability does.   When nations write into their charters that Israel is to be eliminated from the face of the earth, it forces that Nation into a defensive national posture with heavy emphasis on a powerful military, ready to fight in a moment for survival.

When Israel constructs a world for Palestinian Arabs who whereby are (in their view) deprived of a just share in the world’s goods, when they are subjected to what they see as an unfair, harmful and unjustified embargo, when  they suffer perceived disrespect and discrimination, they rise in protest. When, however, that protest is co-opted by fanatics such as Hamas, the legitimacy of the protest is sullied when otherwise the protest might have some credibility. Further, Israel contends that the embargo is necessary to inhibit the flow of arms from hostile nations willing to underwrite the attacks on Israel.

In a world of intractability, hopes for peace are scant if not impossible. The catastrophic possible outcome is that there is no solution except unconditional war. The war will be ever present until one side is totally crushed and eliminated. This is a horrendous possibility. This carries the frightening possibility of an expanded, world wide conflict which would make past wars seem puny by comparison.  This is why efforts for a resolution must be pursued. As useless as it may seem, the talking must continue. And the listening.

And the praying. The Pope must be involved and the President and the Queen and all people of good will. And the essential question must be answered:  Do the two sides really want a resolution of the tension?  How serious is the concrete desire for peace?

Some media say: If Israel lays down its arms, the next day Israel ceases to exist. If  Palestinians lay down their arms, the next day we have peace. Is this so? In spite of what I write, I am sure if I lived in Tel Aviv, I would be with the majority who seek survival. I would be all for  aggressive  but defensive action. The first law of  human nature is probably self survival. The Manhattan liberal may proclaim lofty platitudes but as the old Indian adage goes:  Don’t judge until you walk in the other’s moccasins. Sermonizing is counterproductive. So is “Second guessing.” Israel is a strong ally. Our leaders should refrain from criticism of Israel as they fight for their very existence.  But on the other hand, if I am Muslim and Palestinian,  I see my people diminished and brutalized, I go with the other side since I feel there is no way to justice and peace in the present arrangement.  So I fight and sacrifice and protest!!

It will take the wisdom of Solomon and the patience of Ghandi and the help of God/Allah to craft a fair and lasting agreement.  I wish them well.  I am content that they do not ask me for an answer!