Our aging crisis: the need for a dignified death - September 14, 2013 : 6:14pm In his final published work, “Mortality,” written while succumbing to esophageal cancer, Christopher Hitchens captures in one sentence the unavoidable truth of the dying process: “I don’t have a body, I am a body.” No one understands this truism quite as well as journalist Katy Butler, who witnessed the prolonged process of dying that her once-formidable, war-veteran father underwent after suffering a stroke in 2001, devolving into dementia and then finally dying from pneumonia seven years later. As doctors pushed life-support surgeries, new medications and cutting-edge interventions, Butler and her mother didn’t pray for a cure. Instead, they wished for his death, all of which is chronicled in her troubling investigative memoir “Knocking on Heaven’s Door.” The “end-of-life crisis,” or as Butler calls it “the caregiver crisis,” has hit epidemic levels as the number of Americans over 85 doubled to 6 million since 1990. Baby boomers, like Butler, must now wrangle with what to do with sick elderly parents, asking questions of themselves they probably thought would never be fathomable: What can be done when a person lives too long? And has science gone too far in its mission to ward off death? Through her experiences with her father, Butler is unwavering in her answers. “Our optimistic science-worshiping culture wants to medicalize aging and make it nothing more than a collection of specific diseases that medicine can prevent or fix,” she writes. “But no matter what deal we make with the devil, nature outwits us. Dying can be postponed, but aging cannot be cured.” These are bitter pills to swallow and many might fall in the trap of citing Dr. Kevorkian, death panels, and agism in health care as reasons why these end-of-life conversations should never start. But Butler argues that this very fear, our culture’s unwillingness “to engage with death until it is in our faces,” is what has gotten us so deep in trouble in the first place. For example, 75 percent of elderly patients would rather die in their homes, yet 44 percent of them will die in hospitals, she writes. Last-ditch defibrillators, surgeries for incurable cancers and chemotherapy that only buys a few days continue to be the norm; while what she calls “Slow Medicine” �" home and palliative care �" remains on the fringes and is rarely covered by Medicare. Meanwhile, about a third of Medicare patients will have surgery in the last year of their life and a tenth will have a surgery done in the last month of life, she writes �" costing us an estimated $158 billion to $226 billion in medical overtreatment costs. But what is perhaps worse is the emotional and traumatic toll continual care for a dying relative takes on the survivors, which is the true core of her book. When Jeffrey, Butler’s hyper-intelligent Wesleyan history-professor dad, who lost his left arm while fighting in Italy during World War II, suffered a stroke at the age of 79, he was reduced to something much, much less: “With the memories, mind and reading comprehension of a highly educated 80-year-old; the spoken speech of a 4-or 5-year-old; and the physical dependence of a boy of 6.” He could comprehend his shortcomings, and it made him “miserable,” she writes. At one point, he even commented that he had “lived too long.” The stroke devastated not one, but two lives. “The day before [the stroke], my mother was a talented amateur artist and photographer, a woman of intimidating energy, and a spectacular housewife . . . After the stroke, she cared for my father the way she cared for my brothers and me when we were 3 or 4.” At 77, her mother had become one of the 29 million “unpaid, politically powerless, and culturally invisible family caregivers,” while Butler herself joined the 24 million baby boomers now tending to sick parents. When it became necessary for Jeffrey to undergo hernia surgery, his cardiologist suggested that they implant a pacemaker. The family agreed, unaware of the downsides of what was such an (they would only later find) unnecessary preventative treatment. Now, Jeffrey’s heart would tick on, long past his time should have been up. “Not having a pacemaker would not have guaranteed my father a quick or easy death,” she writes. “But having a pacemaker deprived him of his best chance for one.” Despite the surgery �" or perhaps because of it �" Jeffrey quickly got worse. Like about one third of those over 80, he suffered from dementia. His eyesight went, then his mobility. He began misspelling words. Then he began to see things that weren’t there. He became bladder and bowel incontinent. “I woke up some morning in a fury. Why had his doctors not let nature take its course? If the pacemaker had never been implanted, I thought, my father might well have been out of his misery, and so would my mother and me,” Butler writes. The family begged his cardiologist to turn off the pacemaker, but he refused. Other cardiologists refused, as well. In 2008, Butler’s father contracted pneumonia. Knowing that sending him to the hospital would only prolong his suffering with “life-saving” procedures, they avoided calling 911. He eventually became sick enough to be accepted into hospice care, where he finally died. Here is a link that might be useful: Our aging crisis: the need for a dignified death

I live near SF. The place we go for brunch on really special occasions is the top of the Mark Hopkins Hotel at the top of Nob Hill (across the street from the Fairmont Hotel). It has a great view and a wonderfully amazing brunch -- the best I've ever seen and I have travelled a lot. For drinks, lunch or dinner, I would also recommend the revolving restaurant at the top of the Hyatt Embarcadero. I have taken out of town guests there several times. I don't remember much about the food but the view is wonderful. Walking across the Golden Gate Bridge is also fun (and still free, I think) (you will need a car or cab to get there, though, and getting a cab for the ride back could be tricky). If you decide to get a car (and San Francisco is not THAT hard to drive in) I would also recommend Guaymas restaurant in Tiberon or a stroll in Sausalito (across the Golden Gate Bridge from SF). Both have great views of San Francisco and are only a short drive from SF (assuming traffic is OK across the Golden Gate).

I know a lot of the moms(and maybe their daughters)are interested in how things are going in this situation with the gym class difficulties(which almost became a phobia of avoidance for Kimmy). A lot of the girls on the gURL website(her own peers)told her to SUCK IT UP and get on with life BUT many have offered her EXCELLENT suggestions for solving these issues and showing improvement. She was upset at the SUCK IT UP Comments but she realized the girls had all passed PE Class and she has not. Kimmy and I do have good communication(now that she is living with me and the Gossip Girls type social clique from her past is a thing of the past with me). She and I read her own entries on the gURL website about this issue and they were WHINEY and immature for a 9th Grader.Kimmy is making progress toward solving this. Again many of the comments on the websiteto her from girls who have taken an interest have been supportive and several offered excellent strategies to improve her physical fitness. Here we go with the progress as the First Nine Week Grading Period ended at the school on Friday. Her two PE Teachers met with me and Kimmy will get a C (passing grade) 70 (lowest possible passing grade at that school)for Physical Education. With the P(Passing) Grade brought with her from that class at the public high school in North Carolina for five of the nine weeks(PE/Health was taught in a computer lab with interactive software...casual clothes,flipflops,snacks,you get the image. Actual physical activity -free choice-was 30 minutes on Fridays there... I know many of you,like me,don't see the logic of Physical Education taught by computer,but very few public schools even require specific physical fitness classes with vigorous fitness requirements even as the state of youth health in the U>S> declines. Health Education could certainly be taught with software but Physical Education....GIVE ME A BREAK as they say on the television program with John Stoessel.With the emphasis in the public schools on basic ACADEMIC SKILLS testing many public schools have or are eliminating physical education requirements,health/safety ed.,the arts,home economics/consumer living,vocational ed.,continuing on and on.I know it my heart it was the right decision to transfer my daughter to an all girls private school here in Virginia. I really think there is an opportunity for Kimmy to experience support but demands,high standards,and leadership development/community service. The comments many of you made to my original entry(OP) about a week ago have been both helpful and thoughtful,most recently from plumbly 22. Because Kimmy's PE grade was passing from the transfer school,she got an excellent(28 out of 30 points)on the written Field Hockey Skills Test for the first unit this year,30 of 50 points on the performance skills testing(fitness,field hockey,beginner ballet,beginning swimming class-Red Cross Level I completed---one step forward) and 12 points participation(including a very generous 10 points from the transfer class since it was ungraded at that school...S/U or P/F symbols;2 points were granted for Kimmy completing 2 hours of the PE Detention last week as the grading period ended)resulting in a score of 70. The ladies told Kimmy that the non-participation/dressing out/not showering after PE Class/ballet/swimming was at an end. The transfer points from her previous school was at only for the first grading period. Kimmy told them that she was going to get the remaining 4 hours of PE Detention served next week and NEVER AGAIN. Those sessions are very hard on her (think two PE Teachers,several girls as gym assistants,and constant activities...military boot camp style...you get the image.. Kimmy was proud of herself for getting through two afternoons of that and not passing out but yes,you guessed it,she did throw up both sessions but the other girls did not laugh at her the second day. They offered her some of their bottled water and helped her keep going until it was finished.) The ladies told Kimmy that the girls serving as student gym assistants were there to help them but Kimmy doesn't buy that part. It's a peer thing and that new kid at school situation. When you see some girls able to do the activities so well and yes,look so good in their work out clothes which of course,the assistants get to CHOOSE,its easy for a younger student to see the "glass half empty" instead of half-full. The PE teachers explained to Kimmy the solution for the wet hair(except the chlorine remains on swim class day) was a shower cap since PE/ballet/swim class for 9th Graders is first class bell(90 minutes) each day. Except for the swim class day,no wet hair for her the other days at school. Hair that air dries sticks out on her..she says she looks like a porcupine. The TEMPORARY SOLUTION to the gymsuit issue is the combination blue shorts/blue leotard with white knee type athletic socks/athletic shoes...you get the visual image..I am still trying to find some remote source for the blue onepiece gymsuit Kimmy threw away(not "lost"). The reason the school does not have any larger size (XL) gymsuits remaining this year is that they repurchase them from Senior Girls at the end of each school year to use for the upcoming school year as needed. The school has massive amounts of the gymsuits in smaller sizes from years in the past(think 1950's,1960's) but they don't fit Kimmy due to the one-piece style. I'm still trying to locate a source and feel perhaps there may be some girls private school somewhere they may have an XL size. 5'6",150 lbs.(Kimmy and I are both working together on the weight issue too). Showering after PE Class/ballet/swimming is not an option but Kimmy was allowed to wear her bathing suit except on swim class day itself when the suit has to be removed because of the chlorine. This is really a compromise Kimmy understands - 1 day butt naked instead of 5. With PE/swim Class being first class of the day(you can imagine how the 9th Grade Girls react to that when Senior Girls have PE last class period then go home or to activities/dorm rooms,etc.)I explained to Kimmy the hygiene aspects and that swimming pool chlorine can affect the body as well as the hair color. I talked with Kimmy about my getting her doctor(still a pediatrician and you know how she reacts to those office visits with the little kids staring at her and laughing and their moms quieting them but that's another story for another day)to write a note of permanent excuse from Physical Education Requirements or a note requesting the Adapted PE Class but Kimmy almost jumped out of the car. Then I realized the true impact of peer pressure on girls today. Something may be difficult or embarrassing,but they are in together and have to solve it together(with hopefully their moms support and understanding). As she put it,Kimmy said it was tough for her,but she knew she was going to solve it not drop it. Being the ONLY 9th Grader in a study hall(instead of PE) or the only 9th Grade girl without a true medical restriction in the Adapted/individualized PE /swim Class would have certainly resulted in more negative peer pressure and emotional scenes. In no way is the problem solved but there has been progress. The PE Teachers told Kimmy the PE Unit next grading period was Gymnastics/Tumbling (you should have seen her eyes as she was thinking about the balance beam and rope climb requirements),beginner ballet continues(PINK Leotard and everything although we both laugh WITH each other now that she looks like the Energizer Bunny on the television ads....you can only imaginethe image of PINK everything from the hair tie down to the slippers)and she now has to start Red Cross Level II Swim Requirements(she still sinks but I reminded Kimmy the girls serving as pool assistants who are on the swim team get her above the surface again and that her skills and swim endurance will improve with practice). Passing the Skills Level I swim test was a boost to her confidence. The school swim test comes again in January as first semester ends. I continue to show Kimmy all of the entries on this forum as I think many of the moms (and their daughters) are pulling for her success and do understand improvement is difficult but possible(the "glass half full" Concept not half empty).Kimmy understands that. I also have her in Aquatic Fitness Class with me to improve confidence in the water and endurance. She is in the Red Cross Babysitting/CPR Class two evenings where the Red Cross instructors also take the time to review swimming test requirements with her;youth bible study is one evening,and I am starting her activity with a neighbor (she is a Certified PE Teacher and teaches at the elementary school level not at Kimmy's School) to help Kimmy prepare for the Series 10 Physical Fitness Test in mid-November at her school(the Monday-Wednesday of the Thanksgiving Week)(10 fitness tests in 3 days,100 possible points,passing grade of 70 C required,which counts as the first semester exam;testing repeated in June for second semester). Each student has to choose the order of the events they will do(4 events day 1,3 events day 2,3 events day 3 with one retake allowed on day 3 among all the events if a score of 70 had not been earned). Maybe some of the moms(and their daughters) might remember those physical fitness tests since obviously there must be a strategy from a physical standpoint,as to events to group together. In my days of PE(1980's) we simply did them as one group,everyone doing the tests at the same time. At this school,to develop decision-making and self-responsibility skills,the girls rotate to event stations in the order they choose but they are responsible for the results and their endurance over the 3 days. Any ideas for a strategy there or maybe your daughters might have some ideas. Kimmy is now interested in being on the Field Hockey team next year and it seems to be a sport that could be started at high school age. She is still trying to come up with a solution to the whacks on the butt and back of the thighs with the hockey sticks during the PE Class hockey activity but I told her on a team,her teammates would look out for each other. She has not yet come up with a solution in PE Class when some of the other girls come up behind her during the game with rough stick play...new kid experience again...and again) and Kimmy does not want to risk more PE Detention Hours. She feels she would be the one punished for fighting/lack of sportsmanship. She is trying to be cooperative with the gym teachers. Those ladies made a believer of her with the PE Detention. I knew I could not show up there but you can only imagine how bad I felt for her getting off the activity bus last Thursday and Friday at 6:00 and simply going to bed. Please keep the ideas and support coming. It's good karma. I show Kimmy all the feedback here(but you guessed it,she only shows me SOME of the girl feedback from the sisterhood of the gURL website,as I think about it,probably very little of the girl chat,it's like a diary in our day). Kimmy's other report card grades first 9weeks were 4 A's,2 B's,C(Latin) and the C(PE) but Kimmy knows the PE Grade could have been much worse and there is an opportunity for success. Now it's own to gymnastics/tumbling(new experience for her as well as me). Fencing and Girls Basketball from the 1980's did not prepare me for all the fitness opportunities girls/women have now. Thanks for your feedback and support.Kim J.

Boy...this was a posting and a half to read but definitely shows some different ideas on what parents and teachers think about discipline in a class. All I can add is that each group of children and for that matter each child will react differently to different ways of handling a situations. I think group punishment is needed as a foregound to control an entire class who is out of control but not as a continual way of controling certain disruptive students. Once a teacher has the feel for who is causing the problem then that individual needs to be dealt with just as a parent when discovering which child broke the house rules or made the mistake. When in doubt everyone gets punished and it has to be explained that this is being done to avoid favorism. The child causing the problem should also be given a chance to come forward and appologize without punishment if they choose to with in a certain time frame after which a punish applies. If you gain the trust of a child and treat them like a real person 9 out of 10 children will respond. They want exactly what we want to be respected and noticed for our good acts. Children who act out have found it the only way to get attention and don't care anymore that it's negative attention just as long as someone is seeing them. I have four children with very different personalities. Each has their own way of getting attention when they feel they are not getting any...multiply that by how ever many and you have aclass full of children all trying to get one adults attention so they feel SEEN. It must be the hardest thing for a teacher to deal with everyday. It is as a parent to four, and because I have grown to know them so well I know what they are doing. When my 9 year old son who is easily bored starts to act like a clown I know he wants mom to spend sometime with him or he needs something to interesting to do while I am busy. When my 11 year old son talks my ear off I know he has had a day and a half and needs to download his feelings, when my 7 year old daughter gets clingy with me I know it's time to do an activity with just her and I, When my 2 year old is pulling at my shirt for something for the upteenth time I know it's her turn. It's not easy to figure out what each child needs individually but as a parent we have only a few children and need to take the time to know as a teacher wouldn't always have that time and has 30 students or more to get to know in under a year. That's when the group discipline needs to come into play and then be broken down to find out the individual needs within a short time frame. My suggestion is discuss it with the class in an open forum explaining the need for rules and the rewards of following them then stick to them and show your students that you respect them and they will respect you. That makes the difference in whether they will learn from you or ignore you.The best teachers I have meet have been strict with class ediquette but reward their students with respect and privelges of being a helper rather than give them material things as a reward.