Saturday, September 23, 2017

My past is in my future...

My past is in my future - and it’s a good thing.

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September 21st marked, what would have been, my Dad’s 88th birthday. My Dad was many things: a bootstrap kind of guy who rose from abject hunger and poverty to homeownership and sending his kids to college. He was quiet and steady and full of practical know-how. He taught me to balance a checkbook, to “always save 10%” and to live within my means. 
Dad loved the outdoors; in describing him I sometimes called him “Mr. Sierra Club”. I learned to hike with my Dad - day hikes in Hawaii then overnights in the mountains which graduated into multi-day trips in Haleakala and such. My love for the wilds is my Dad’s greatest gift to me, his legacy in me, manifest in the world.
It is fitting that on the day of his birth, I would buy BAM = Baconz Adventure-Mobile. The purchase of this van is the first step in my plans to tour the USA, every National Park, and Europe in my post-retirement era. With 3.5 years to retirement, I will have time to pay for the van and the conversion to BAM.
These plans are the culmination of a lifetime yearning that has taken shape and form in the last few years. The numbers of people who have tried to dissuade me is… stunning - so I no longer talk about it with certain people. My friends who backpack and camp - totally get it.
During my last three summer forays into our National Parks, I accosted nearly every camper-van owner. They tend to be an older group with a willingness to give tours, sharing their stories and tips. I did meet a young family who had converted a short, tangerine school bus - fascinating. A big mahalo to all for the inspiration they provide.
Unbeknownst to me, the military owns private campground peppered across the US. I hear they are wonderful and I have access to them - thanks to the US Army Nurse Corps. Woo-hoo!

In the immediate future, I will complete the conversion from cargo van to BAM; then plan weekend forays to work out the kinks. Then I’ll try longer trips in the US. I have friends in Nashville, Louisiana, and an Aunt in Florida. I’d like to see the fall colors of New England and then ship BAM to Europe for travel the following year. We’ll see how far I get. Stay tuned - Adventure Girl is on the move. Thanks Dad!

Saturday, July 15, 2017

Civics 101 - CliffsNotes

Civics 101 - CliffsNotes

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So it is written: When in the Course of human events, it becomes necessary for one people to dissolve the political bands which have connected them with another, and to assume among the powers of the earth, the separate and equal station to which the Laws of Nature and of Nature's God entitle them, a decent respect to the opinions of mankind requires that they should declare the causes which impel them to the separation.
We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness. 

So it shall be: On July 4, 1776, with 56 signatures and the stroke of many quills, these British colonies declared themselves the independent United States of America, separate and equal to the Crown of England. (1)
Talk about the Resistance and an act of civil disobedience - Five signers were captured by the British and brutally tortured as traitors. Nine fought in the War for Independence and died from wounds or from hardships they suffered. Two lost their sons in the Continental Army. Another two had sons captured. At least a dozen of the fifty-six had their homes pillaged and burned. Originally men of means, many died in poverty.

Why am I writing about these foundational documents? Because they are in the news and I find myself puzzling; which document declares that we are all created equal? What specifically are states rights? It's all right here boys and girls. Civics 101 - CliffsNotes.

The United States Constitution was written by the provisional government and second Constitutional Congress, in 1787 and ratified in 1788. These are the laws of the land, greatly limiting the powers of the government and ensuring freedom for its peoples. It begins, “We the people”, declaring at the outset, that it is a government “of the people, by the people and for the people” though those specific words were codified later in the Gettysburg Address of 1863.
The second Constitutional Congress had two parties and each proffered a constitutional plan. The nationalist majority, soon to be called Federalists, put forth the Virginia Plan, proposing a bicameral Congress based on proportional representation by population, thusly favoring more populace states. The "old patriots," later called Anti-Federalists, advocated the New Jersey Plan, a unicameral Congress providing each state with one vote, thusly favoring less populace states. 
Our government is a combination of both: a bicameral Congress with the House having representation by population, and the Senate allotted two representatives per state.

Related story? While I would not dismiss recent White-House-speak of abandoning Census-2020, the Census IS protected because it measures our population. And we have a Constitution that provides for representation apportioned by population. That's why you may hear hubbub about the Census. Budget cuts may render less information and scientists are loathe to lose the opportunity to fully engage with every household each decade. But presently, draining the swamp will seemingly include flushing some monies for our Census. 
The LGTBQ crowd is currently lobbying for questions regarding their community to remain in the proposed Census-2020. Why? They say, “If you’re not counted, you don’t exist.” Meaning, there is no awareness and no federal acknowledgment. 
The issue of forcing boys who identify and dress as girls into the boy's bathrooms (the gender designated on their birth certificates) or vice versa, may be more prevalent than we know. Pretending it does not exist is not a powerful way to engage with the truth. Census-2020 could put a finger on that pulse… er… probably not. But I digress.

The Federalist Papers provided background and justification for the Constitution. Some states agreed to ratify the Constitution only if the amendments that were to become the Bill of Rights would be taken up immediately by the new government.
As an aside, The Federalist (later known as The Federalist Papers) is a collection of 85 articles and essays written (under the pseudonym Publius) by Alexander Hamilton, James Madison, and John Jay promoting the ratification of the Constitution. They were serially published in the Independent Journal and the New York Packet during a ten-month span in 1787-1788. They pre-date Constitutional ratification and are comprised of philosophical debates “…whether societies of men are really capable or not, of establishing good government from reflection and choice, or whether they are forever destined to depend, for their political constitutions, on accident and force.” The arguments for a republic versus a democracy and the protections from the tyranny of the majority are contained within The Federalist Papers.
Our newest Supreme Court Justice, Justice Neil Gorsuch describes himself as a Federalist and indeed holds membership in the Federalist Society - for they whom adhere closely to the written word of The Constitution. 

The Constitution of the United States Preamble (2)
We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defense, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.
ARTICLES:
Article I -  establishes the Legislative Branch of government, House & Senate, their responsibilities, and duties. 
Article II - establishes the Executive Branch of government, The President & Vice President, their responsibilities, and duties. 
Article III - establishes the Judicial Branch of government and its power.
Article IV - The States; establishes the rights of states. (When you hear “states rights,” think Article IV.)
Article V - how Amendments are made to The Constitution.
Article VI - Debts, Supremacy, Oaths.
Article VII - Ratification.

AMENDMENTS:
Amendment 1 - Freedom of Religion, Press, Expression. (12/15/1791).
Amendment 2 - Right to Bear Arms. (12/15/1791).
Amendment 3 - Quartering of Soldiers. (12/15/1791).
Amendment 4 - Search and Seizure. (12/15/1791).
Amendment 5 - Trial and Punishment, Compensation for Takings. (12/15/1791).
Amendment 6 - Right to Speedy Trial, Confrontation of Witnesses. Ratified 12/15/1791.
Amendment 7 - Trial by Jury in Civil Cases. (12/15/1791).
Amendment 8- Cruel and Unusual Punishment. (12/15/1791).
Amendment 9 - Construction of Constitution. (12/15/1791).
Amendment 10 - Powers of the States and People. (12/15/1791).
Amendment 11 - Judicial Limits. (2/7/1795).
Amendment 12- Choosing the President, Vice-President. (6/15/1804).
Amendment 13 - Slavery Abolished. “Emancipation Proclamation.” (12/6/1865).
Amendment 14 - Citizenship Rights. (7/9/1868).  
Amendment 15 - Race No Bar to Vote. (2/3/1870).
Amendment 16 - Status of Income Tax Clarified. (2/3/1913).
Amendment 17 - Senators Elected by Popular Vote. (4/8/1913)
Amendment 18 - Liquor Abolished. (1/16/1919). Repealed by Amendment 21, (12/5/1933).
Amendment 19 - Women's Suffrage. (8/18/1920).
Amendment 20 - Presidential, Congressional Terms. (1/23/1933).
Amendment 21 - Amendment 18 Repealed. (12/5/1933).
Amendment 22 - Presidential Term Limits. (2/27/1951).
Amendment 23 - Presidential Vote for District of Columbia. (3/29/1961).
Amendment 24 - Poll Tax Barred. (1/23/1964).
Amendment 25 - Presidential Disability and Succession. (2/10/1967).
Amendment 26 - Voting Age Set to 18 Years. (7/1/1971).

Philadelphia
Separate but Equal. Articles I-III establish our three, equal branches of government: the Legislative Branch (the bicameral Congress), the Executive Branch = the President of the US (POTUS), and the Judicial Branch comprised of the Supreme Court of the US (SCOTUS) and other lower courts. This brilliant separate but equal form of government was a reaction to the tyranny of the Crown and protects us from tyranny from within. They are the means to check any branch of government from lawlessness (i.e. clandestine meetings with foreign governments or profit and gifts from foreign governments) and tyranny (i.e. Executive Orders that might be unconstitutional or the overstepping of the Courts). 
You may have heard it said that we are facing a Constitutional Crisis. When one branch of government (legislative, judicial or executive) tries to usurp power from the others, that constitutes a Constitutional Crisis. No “nothing burger” here, I am demonstrating the basis for why it matters and is newsworthy.

Articles lV-Vl entrench concepts of federalism, describing the rights and responsibilities of state governments and of the states in relation to the federal government. 
The dissenting voices of the healthcare debate fall out along the lines drawn by state’s rights. My over-simplification will demonstrate. The Tea Party and ultra-Conservative Right want each state to have ultimate authority and autonomy in healthcare distribution. The Far Left wants Obamacare bolstered and improved for all citizens = bigger federal government = the antithesis of states rights.
I see healthcare not through a state’s rights lens but from a “promote the general welfare” (Constitutional) and a social justice view. Here’s my take: 100% of us will use healthcare in our lifetime so 100% of us should have healthcare insurance. It’s like car insurance - required. There are a number of ways to do this and thus far, the US has chosen the most expensive and least accountable methods. There are many functioning models throughout the world. None is perfect but many are better than what we currently employ. Both Medicare and Medicaid are also very viable models.
I am vehemently opposed to high-risk pools and exclusion by pre-existing conditions. We will all, sooner or later, have a pre-existing condition and the older you get - it's guaranteed. We’ve been down that road - it left the sickest amongst us uninsured and seeking care in the Emergency Department at the highest price-point possible. 
Fiscal Conservatives argue the federal government can’t pay for healthcare because if they lower taxes (disproportionately on individuals who earn greater than $200K per year), the money to pay for healthcare disappears. That’s why you hear the Bernie Sanders’ camp calling Trumpcare the biggest transfer of wealth in years. The current tax levied on individuals earning above $200K has partially paid for Obamacare subsidies and the expansion of Medicaid.
The last military budget request was $639 BILLION - with a B. Each Presidential weekend at Mar-a-Lago or another Trump Resort costs the tax payer $3 million. Do you think we could figure out how to get our citizens covered with comprehensive healthcare?
And WHY are we trimming women’s health and birth control from plans to make them cheaper? OVER half the population is FEMALE! I notice we’re not trimming men’s health, prostate care, Cialis and Viagra from any plans. …just sayin’. 
This is obviously what happens when you cloister 13, mostly rich, mostly elderly, mostly white with one Hispanic, men (and no women), in a room and charge to them compose a healthcare bill. A New York Times headline says it all: 13 Men and No Women Are Writing New G.O.P. Health Bill in Senate. 
God help us - GIRL you lis’nin? 

The Bill of Rights is composed of the first ten Amendments to the Constitution. Written by James Madison in response to calls from several states for greater constitutional protection of individual liberties, it was a condition of Constitutional ratification for some. The Bill of Rights was ratified in 1791 and lists specific prohibitions and limitations on governmental power.
The first twelve Amendments were crafted by our Founding Fathers excepting the few who predeceased their composition. There is no denying the brilliance of these men; indeed history holds them in esteem.

Prescient as our Founding Fathers were - a few things are self-evident. When they asserted “all men are created equal”, they indeed meant men and only men. The Preamble’s, “secure the Blessings of Liberty to ourselves and our Posterity” applied to rich, white guys - others need not apply. Conspicuously excluded from the blessed were the majority of the young country’s denizens: women, slaves, and indigenous peoples - for they were considered chattel,  er… personal property or worse.

The word suffrage comes from Latin suffragium, meaning "vote", "political support", and the right to vote. Universal suffrage consists of the right to vote without restriction due to sex, race, social status, education level, or wealth though generally, restrictions on age and citizenship exist.

In a government “of the people, by the people and for the people”, there is no OF or BY without the right to vote.
A striking feature of the Constitutional Amendments, listed thusly and hence more apparent, are the number of Amendments that specifically address the right to vote. Consider and review Amendments 14, 15, 19 and 24. (2)
For temporal context, Amendment 13 abolished slavery in 1865. 
In 1868, Congress amended the Constitution with the 14th Amendment, asserting “all persons born or naturalized in the United States … excluding Indians not taxed” … are citizens of the United States and entitled to its privileges. Amendment 14 goes on to grant voting rights to males only, of 21 years or more.
Nineteen months later, Congress addressed the right to vote, yet again in 1870, because former slaves (males over 21) were being denied the right to vote. Amendment 15: The right of citizens of the United States to vote shall not be denied or abridged … on account of race, color, or previous condition of servitude (slavery). 
FIFTY years later, in 1920, women were finally granted the right to vote. (I see a major girl-party and women’s march in the offing.)
Lastly, in 1964, Amendment 24 forbids other barriers to voting including quizzes and additional poll taxes - methods used in the deep South to bar the poor, colored vote.
How many Amendments are required to protect a citizen’s right to vote? Apparently many … but wait -  there’s more!

Public Law 89-110, the Voting Rights Act of 1965 is a landmark piece of federal legislation that prohibits racial discrimination in voting. Signed into law by President Lyndon Johnson during the height of the Civil Rights Movement on August 6, 1965, Congress later amended the Act five times to expand its protections. Designed to enforce the voting rights guaranteed by the fourteenth and fifteenth Amendments, penned100 years prior, the Act secured voting rights for racial minorities throughout the country, especially in the South. According to the U.S. Department of Justice (DOJ), the Act is considered to be the most effective piece of civil rights legislation ever enacted in our country. (3)
The South has consistently found ways to block the black and minority vote and have thusly been strictly monitored since 1965. But in 2013, SCOTUS struck down Section 4 of the Voting Rights Act. In a 5-to-4 vote, it freed nine states, mostly Southern, to change their election laws without advance, federal approval. The court divided itself along ideological lines. At the core of the disagreement was whether racial minorities continued to face barriers to voting in states with a history of discrimination. “Our country has changed,” Chief Justice John G. Roberts Jr. wrote for the majority.
United States Attorney and head of the DOJ, Jeff Sessions hails from Alabama. When the Supreme Court gutted the single most effective provision of the Voting Rights Act - the most important statute in getting African-Americans the right to vote in this country - then Senator Sessions called that “A good day for the South” and Southern states immediately enacted voter ID laws.

The latest versions to disenfranchise black and minority voters - because clearly, discrimination at the ballot box is unlawful - are gerrymandering and voter identification requirements.
What is gerrymandering? A Mother Jones article explains: The Supreme Court struck down a North Carolina congressional map that packed African Americans into two districts and reduced their voting power elsewhere. The ruling was a decisive blow against the use of race in drawing district lines and a victory for voting rights advocates who argued that the map violated the Constitution’s 14th Amendment. But it also shed light on the court’s thinking about an even more politically consequential issue, and one that the court is likely to consider soon in multiple major cases: gerrymandering aimed at boosting a political party. (4) 
You’re going to hear much more about gerrymandering - a means of neutralizing or minimizing the votes cast by specific groups. A means by which some say, Republicans have systematically garnered Congressional seats despite Democrats casting more ballots. Why should you care? Because when freedoms are curtailed for one group, we’re next.

And WHAT is the issue with voter ID requirements; you ask? It's an issue for the elderly. Why? Because many, like my Mom and Dad, were born at home. Record keeping was shoddy and state sanctioned birth certificates were not always available. My own father’s birth date was in question. For some, births were entered into the family Bible, which was subsequently lost. The requirement for a state sanctioned ID disproportionately disadvantages the rural, poor (usually minority) and home-birthed. In this day and age, it is difficult, if not impossible, to get a state sanctioned ID without a birth certificate. This issue may die with the Greatest (WWll) Generation but they’re not gone yet and they deserve the right to vote.
The argument for voter ID requirements is to ensure the security and integrity of our elections. Makes sense; right? But look at the map of states who have enacted voter ID requirements. (5) They are heavily weighted in the South.  
With little evidence of voter fraud, except within a few delusional minds, and in a culture requiring multiple Constitutional Amendments to guarantee voter rights for its citizens, one wonders. As the old adage goes - if it looks like a duck and quacks like a duck… Said another way, racial discrimination by any other name is still discrimination.

Kamehameha lll, no heathen he.
As an interesting aside: King Kamehameha lll and the 1840 Constitution of the Kingdom of Hawai'i granted universal suffrage to all male and female adults. In 1893, when the Kingdom of Hawai'i was overthrown in a coup orchestrated by the rich, white guys of a more “advanced” society, women lost the right to vote. Go figure.

Amendment 1 - protects our freedom of speech, more specifically “Freedom of Religion, Press, Expression.” Pay particular attention to the First Amendment as it is getting lots of air-time. It protects my right to write and express my opinions. It protects your right to attend a place of worship of your choosing. 
Importantly, it protects a free press: from Huffington Post to Breitbart and everyone in-between. Threats to sue and lock-up journalists are threats to the free press. Make no mistake, a free press keeps the powerful in check. You know who murders journalists en masse? Mexican cartels and the Russian government. What do they have to hide? Plenty! Who imprisons and tortures journalists? China and Saudi Arabia. 
Threats directed at our press corps are a threat to our Constitution. Some of our own press has been harassed and beaten following inciting remarks and Tweets by others. When Trump singles out specific members of the press corp in an arena full of sycophants, its a threat and reporters worry for their safety. NO ONE should be threatened - no matter how much we dislike them - because we are not lawless people and this is not a lawless land. We count on our Constitutional laws and freedoms.

Lastly, watch for challenges to Roe v. Wade,. the landmark, 1973 decision by SCOTUS allowing a woman’s right to abortion - and death by back-alley, coat hanger abortions became a thing of the past. The decision was passed by affirming a “right to privacy” - a right that appears nowhere in the Constitutional text. 
Back in the day, Justice Ruth Bader Ginsburg felt the decision for Roe v. Wade was premature and she took a lot of heat from women’s rights groups for her position. She felt that a decision for Roe based on “the right to privacy” was weak and might not withstand vigorous challenge. She preferred a statute based upon individual liberty - which is a Constitutional guarantee.
Enter Justice Neil Gorsuch - a federalist who argues eloquently and adheres closely to the written word of The Constitution - where no “right to privacy” exists. If you can’t take the heat, get out of the kitchen baby - it's gonna be a scorcher. Macadamia-pineapple pancakes anyone? ...it's my specialty...

The injustices creep and crawl, niggle and gnaw, clatter and clang in my cranium, go bump in the night and keep me from sleep. Perhaps now that it's steaming out my ears and streaming from my blog, I can let go, just a bit. …and you can take up the worry beads… or not.

  1. https://en.wikipedia.org/wiki/United_States_Declaration_of_Independence#/media/File:United_States_Declaration_of_Independence.jpg
  2. https://constitutioncenter.org/media/files/constitution.pdf
  3. http://library.clerk.house.gov/reference-files PPL_VotingRightsAct_1965.pdf
  4. http://www.motherjones.com/politics/2017/05/supreme-court-north-carolina-racial-gerrymander-case-voting-rights/
  5. https://ballotpedia.org/Voter_identification_laws_by_state


Monday, May 29, 2017

We Too, Shall Pass

We too, shall pass.

Unless you work with the dying or in a hospital, CA Senate Bill 128 (SB-128) likely passed with little notice in June of 2016. With it, California became only the sixth state in the union to enact an aid-in-dying law.
I had keen interest in this law for I have been witness to many deaths both in and outside the hospital. Further, I had a friend dying of breast cancer that had metastasized to her bones - a notoriously painful death - and she was hoping to avail herself of SB-128 and its cocktail. Just in case SB-128 failed to pass or she didn’t live until it did, she was stockpiling pain pills, informing me she had “an exit strategy” if the pain became too great. I applauded her courage, convinced I’d do the same.

You may remember Brittany Maynard, a beautiful, vibrant and young Californian, who at age 29, was diagnosed with glioblastoma, an aggressive brain cancer. She suffered from debilitating headaches and seizures as her cancer grew. She moved to Oregon to take advantage of their Death with Dignity law, all-the-while advocating for California lawmakers to get their act together.
Brittany wrote, ““I considered passing away in hospice care at my San Francisco Bay-area home. But even with palliative medication, I could develop potentially morphine-resistant pain and suffer personality changes and verbal, cognitive and motor loss of virtually any kind.
Because the rest of my body is young and healthy, I am likely to physically hang on for a long time even though cancer is eating my mind. …an end-of-life option for mentally competent, terminally ill patients with a prognosis of six months or less to live. …I could self-ingest to end my dying process if it becomes unbearable.
When my suffering becomes too great, I can say to all those I love, “I love you; come be by my side, and come say goodbye as I pass into whatever's next.” I will die upstairs in my bedroom with my husband, mother, stepfather and best friend by my side and pass peacefully. I can't imagine trying to rob anyone else of that choice.”” 

Brittany died in 2014 and testified for SB-128 before the state legislature in 2015 from beyond the grave, in a message recorded prior to her death. “Every one of us will die. We should not have to suffer excruciating pain, shame or a prolonged dying process. The laws in California, and 45 other states, must change to prevent prolonged, involuntary suffering for all terminally ill Americans,” Maynard said in the video.
Dr. Robert Olvera, a bill supporter, described watching his daughter with leukemia, fight the disease for 17 years. “I watched my daughter decompose,” Olvera testified.
Christy O’Donnell, a 46-year-old Republican lawyer and ex-L.A. Police Department sergeant who was featured in People magazine, said she had terminal lung cancer and expected to die within months. “I do not want to see my daughter watching me gasp for air,” O’Donnell said.
“It gives me a great peace of mind to know that I will not be forced to die slowly and painfully," said Wallner, a 52-year-old single mother from Sacramento with advanced colon cancer and metastasis to liver and lungs. "The agonizingly traumatic image of me suffering will not be my family's last memory of me."

The argument is over the right to die with a doctor’s help at the time and in the manner of your own choosing. To date, only a handful of European countries, Colombia and seven American states allow some form of doctor-assisted dying. But draft bills and ballot initiatives are progressing in 33 states and several other countries. (1)
For some, the argument is moral and absolute. Deliberately ending a human life is wrong - because life is sacred and the endurance of suffering confers its own dignity. For others, doctor-assisted-dying is the first step on a slippery slope where the vulnerable are threatened and where premature death becomes a cheaper alternative to palliative care, nursing homes, long term care, board and care and institutions.
These views are deeply held and deserve to be taken seriously. But liberty and autonomy are also sources of human dignity. “In a secular society, it is odd to buttress the sanctity of life in the abstract by subjecting a lot of particular lives to unbearable pain, misery and suffering.” (2) 

Opponents fear the laws would be used to pressure the sick into killing themselves, “widespread euthanasia” they cried, labeling it physician-assisted-suicide. Right-to-Die has been lawful in Europe for decades and in Oregon since 1994 = decades. Many checks and balances are put in place to prevent patient coercion and suicide. The evidence does not reveal a slippery slope toward cavalier killings. Rather, the evidence leads to the conclusion that most laws for assisted-dying should be bolder and broader.

Modeled after Oregon’s law, let’s first examine what California’s law requires.
To be eligible to request a prescription for the aid-in-dying drugs, an individual must:
Be an adult (18 years old or older).
Be a California resident.
Have a diagnosis from his/her primary physician of an incurable and irreversible disease which will, within reasonable medical judgement, result in death within six months.
Be able to make medical decisions for themselves (be of sound mind) as determined by health professionals.
Voluntarily request a prescription for an aid-in-dying drug without influence from others.
Be able to self-administer (eat, drink, and swallow) the aid-in-dying drug.
The request must be made solely and directly by the patient to the attending physician, and cannot be made on behalf of the patient through a power of attorney, an advance health care directive, a conservator, health care agent, surrogate, or any other legally recognized health care decision maker. (3)

People with neuromuscular diseases tend to be excluded from using SB-128 as many lose the ability to “self-administer” long before their final six-months. Those with dementia are absolutely excluded by the requirement to be of sound mind. This sound mind requirement then, also excludes all with cognitive disabilities: mental retardation, psychiatric illness, traumatic brain injury, autism, etc.

At Kaiser, we created voluntary teams of physicians, nurses, social workers, chaplains, and others to guide patients through Gentle Passing with knowledge, respect and sensitivity. Because these requests are relatively infrequent, it was thought that designated teams could become expert in the process. It was also agreed that this responsibility should not fall solely upon our Hospice and Palliative Care teams.
Based on the Oregon experience, Kaiser’s northern California region anticipated:
207-414 patient inquiries
103-207 requests for End of Life (EOL) cocktail
67-119 cocktail administration
Not yet one-year into Gentle Passing, I am unaware of the actual numbers.

Back to my girlfriend dying of metastatic breast cancer; let’s call her Jill. Jill was beyond her 5-year, cancer window: she had completed breast cancer therapy and close monitoring for 5-years with no recurrence. Some years ago, we attended a weekend workshop in Pacific Grove. Our group made a short walk through Asilomar, to the Pacific. Jill’s back hurt and as we continued, her pain grew, forcing a retreat. She saw her doctor the following week for what seemed like unusually severe back pain. Subsequent tests revealed metastatic lesions on her spine. 
Jill’s ensuing battle with cancer lasted another four years; it gave her lots of time to think and plan. She held a party, more than a year before her death - to celebrate with friends while she could. Unbeknownst to attendees, it was a memorial party, a living wake. Jill emceed her party, asking friends to say the things they might say at her funeral. Her friends rose to acknowledged her and reminisce; the event was filmed.
Jill put her affairs in order and appointed a “death squad”, close friends to help her as her time drew nigh. They helped with bill pay and meal prep and in the end - reading friendly, supportive messages sent via Facebook. Facebook became her means of remaining connected to her community once she could no longer leave home and then - bed. She was very open with her feelings and sensations. “I feel weird today. This dying thing…” Sometimes she had sooo much pain - and nothing helped to ease it.
Jill picked a “kick the bucket day” that was widely publicized. She asked friends to join her in rewatching her memorial party. At the appointed time, she drank her cocktail and slipped into sleep - then death, surrounded by her loving death squad. They posted a message on Facebook when Jill had passed. 
Jill’s death was the most transparent death I’ve ever experienced. I appreciated sharing in her thoughts and emotions. In contrast, I tend to hole-up when things are not well or right. Jill lived out loud. No going quietly into that good night - she went with a bullhorn, sharing her view of the path ahead. That takes courage and a commitment to stay connected.

In their own words: Listen to the reflections of two women who were interviewed before their deaths on Insight with Beth Ruyak of Capitol Public Radio. In the broadcast, retired Hospice Chaplain Ellen Robinson Haynes asserts, “We put a lot of effort into planning births and into planning weddings and all kinds of transitional moments. Planning an assisted-death is an exquisitely intimate and beautiful process. This is not suicide… this is a rational, well-grounded choice to make for somebody who is already dying. (5) Link below.

No matter your view of right-to-die laws, patients with terminal illness agree that they want autonomy (like most of us) - over their lives and deaths. People hope to die quietly in their sleep, to drift off. Statistically, only 10% of us do that, so… hope all you want. 30% of us die quickly by catastrophe du jour: accident, suicide, sudden cardiac death, massive stroke, etc. But 60% of us have the dwindles, where we slowly dwindle in our abilities and capacities until we die by some chronic disease. 
A small percentage of people suffer with unrelenting, intractable pain OR shortness of breath so severe that they can’t even lift an arm to feed themselves (patients say this kind of air hunger is terrifying) OR complete paralysis (including breathing) while the brain remains active and aware OR like Brittany Maynard - disabling headaches and seizures OR any number of horrific maladies that we cannot imagine enduring.
SB-128 is for them, for that small cadre for whom living has become an unbearable torture and who want out.

Notice that the demented are excluded by this law - and appropriately so. Many of you know my father died with Alzheimer’s disease - HE was gone years before his body gave up the ghost. Eventually, he no longer recognized those who loved him. He thought he lived amongst strangers and tormentors. Simple requests and bodily functions made no sense to him. In the end, without the ability to understand words or their meanings, he became reactive, defensive and offensive - like a threatened, cornered animal. Those were difficult years in which the kitchen knives were hidden - a consequence of just one of many horrors.
When he stopped swallowing, the deathwatch began. A hospital bed was rolled into the middle of their living/dining room, the only place their small condo could accommodate its bulk. There, he tossed and turned and mumbled and moaned and eventually became still, and breathed, until that too slowed and finally stopped. Ten days… TEN DAYS… Have you ever watched someone die for ten days? Why is this okay? I wouldn’t do that to my dog! In fact, that might be considered cruelty to animals. Honestly for me, his passing was long overdue and a relief. He would have never wanted to live that way and I would never wish it upon anyone. 

Brittany Maynard’s Oregon physician, Dr. Eric Walsh says, "When somebody is facing the end of their life, shouldn't they be in control? Shouldn't I be able to help them when they're suffering and the burden of their suffering becomes intolerable to them?”

It is my hope that future Advance Directives can be even more proactive. That I could direct my medical team to “administer the cocktail” when certain conditions are met. i.e. if my Montreal Cognitive Assessment Tool score is so low that my cat would do better? Time to go bye-bye. A little too Soylent Green for you? I get it, obviously your choices will be different. The important part in all this is that the patient gets to choose; the patient has a say.

Supreme Court Justice Ruth Bader Ginsberg’s husband Marty, himself a lawyer and suffering with metastatic cancer wrote to his wife:
June 17, 2010
My dearest Ruth,
You are the only person I have loved in my life, setting aside a bit, parents and kids and their kids. And I have admired and loved you almost since the day we first met at Cornell some 56 years ago. What a treat it has been to watch your progress to the very top of the legal world. 
I will be in JH Medical Center until Friday, June 25th, I believe. And between then and now, I shall think hard on my remaining health and life. And whether on balance, the time has come for me to tough it out or to take leave of life because the loss of quality now simply overwhelms. I hope you will support where I come out but I understand you may not. I will not love you a jot less. Marty (4)
Marty died on June 27, 2010.

Thank you Marty, for getting to the heart of the matter. I don’t expect to change any minds with this blog. But I do hope to stir your deepest thoughts and bring you to some place of compassion for the dying - to give them voice and honor their choice. For we too, shall pass.

P.S. - please excuse my absence. My bathrooms have been remodeled and/or refurbished. By necessity, I've had many boxes strewn across the house and furniture shoved into corners. I find it impossible to write amongst the chaos. But that all ended approximately 1 month ago.

Footnotes:
3) Coalition for Compassionate Care of California  http://coalitionccc.org/tools-resources/end-of-life-option-act/

4) I Carmon & S Knizhnik, Notorious RBG, Chap 7.

5) Choosing the End of Life Option on Insight w/Beth Ruyak on Cap Radio. http://www.capradio.org/85513

Saturday, January 7, 2017

2016 Recap

Hau’oli Makahiki Hou!
Tap the photo to enlarge, click X to return to blog.
I hope this letter finds you and yours in good health and spirits. Chinese salutations commonly include wishes for good luck and good fortune, prosperity and happiness. As I age, I value good health above all and barring that, vitality at every age and any stage.

Self indulgent - that describes my 2016 filled with new adventures and fabulous friends.

Before
I started the year by completing my Family Trust documents with a local trust attorney. My impetus was two calendared trips to Europe, where random acts of violence are becoming more commonplace. (Funny how American gun violence, its scale of human carnage exceeded only by war, did not move me to get my Trust documents done.) And while I felt tearful and uncomfortable putting my final wishes in writing, I concurrently feel content knowing my estate will flow to the people and causes I care for most. I highly recommend getting this done - contact me for an excellent trust attorney.
After
Things accomplished on the home front: 1) I had a gargantuan shed built for yard tools, bicycles, etc. 2) exterior painting in “happy” colors, 3) kitchen facelift, 4) master bathroom remodel underway (out with the plastic shower/tub insert and in with walk-in shower, senior friendly fixtures allowing me to age in place). ALMOST done with all the beeeg home projects.

Celebrating Sixty: a catered birthday party at my home with friends and neighbors. Most were pleasantly pleased with the Asian-vegetarian menu. I dressed in a Mamo holoku with leis sent by my sister and cousin. I really had a wonderful time and plan to hold a 70th - so get your mu’u mu’u, Aloha shirt and slippahs ready! And if you no moh, I can fix that at Hilo Hattie’s, though you may sincerely regret it.

Bill, me, John
July found buddies Bill, John and I traipsing through the Dolomites in Italy, floating in Venice, museum-ing in Florence and archeology-ing in Rome. Fantastic trip, hugely educational, instrumental in sorting and sifting through random datas learned in school. 
WWI was fought in the Dolomites as Italy reacquired land from Austria. Austrian influence continues in language, excellent apple strudel and a beverage called a radler = 50% lemonade and 50% beer. DELISH and sooo refreshing. Try it!
For more details of this trip you can read my blog entitled, The Church at https://lorinzmuze.blogspot.com. You will need to scroll to the earlier posting.
the Dolomites
The run-up and aftermath of the Presidential Election left me in a blue funk. I have more than serious reservations regarding Donald Trump and sincerely hope he does well for our country. Fingers crossed, prayer flags flapping. Seriously - he needs our prayers - every US President does.

Two weeks before Christmas, John and I flew to Paris (John and I met the first day of our Master’s/Nurse Practitioner’s program at UCSF and have been fast friends since) - to take in the European Christmas markets (yes, the very ones Homeland Security advised to avoid), the Louvre, the d’Orsay, the Eiffel, Versailles, and Disney Paris. 
We knew crowds would be lighter - but we had no idea. Crowds were basically nonexistent. The typical 3-hour-line to view the Mona Lisa was 30-seconds. No filing by, pushed by the crowds. There was time to linger - even for a selfie. The spacious galleries were unencumbered; priceless and famous works, easy to find and enjoy. 
The size of Le Louvre - I had no idea. Did you know it is touted to be the largest building in the world? We visited the bowels of the building, where parts of the original castle keep and dungeons survive. Bones of the secondary palace are also still visible.
A less famous but by far the loveliest Venus.
The d’Orsay Museum is a beautifully restored and repurposed World’s Faire, train depot that houses the works of famous French Impressionists. You know their names: Monet, Manet, Degas, Rodin, Gauguin, Toulouse-Latrec, Cézanne, Renoir, Picasso, Van Gogh, Sisley. It was fascinating for me to detangle their names and works in my mind. And with the advent of smart phones - photos sans flash allowed!
We were unimpressed with the Christmas Market. Once a showplace for local artisans, it seems to have been usurped by China’s supply chain. And of course, security is a problem. Uniformed, armed, security forces prowled en masse. 
Picasso
Paris’ Christmas Market straddles Avenue des Champs Elysées. Naught but a flimsy, white picket fence separates the Market from the traffic. We moved along the edges - where we could duck and run - a horrifying reality. I said they would be better served by closing Avenue des Champs Elysées and moving the market into the street, where they could block the whole thing off. Two days after our return, the attack in Berlin proved me right.

About the family:
Mom has rebounded from two setbacks and like an old Timex, she just keeps on ticking. She will turn 92 in April and I plan to be in Honolulu to celebrate. 
Sister Gina has been instrumental in assisting Mom and the Aunties. She and husband Michael continue to live in Kaneohe and enjoy watching their grandkids grow.
Niece Lael and husband Darth had their first baby: Alanna Quinn Kalea. She turns one in January and I plan to attend her party in SoCal.
Nick and Lindsey’s daughter, my great niece Jaydalyn Ui O Nalani is four and started school at Kawaiahao Church. Before Christmas, they made a snowbank so the kids could play in snow. I receive a steady stream of photos on Jayda’s photo stream and I love feeling more included vs being the auntie way over on the mainland.
Collins son Davin Kekahi Ho’omaluhia (whew!) plays in the band, surfs and fishes with his Dad, and snowboards when they make it to California.

What’s on tap? 
We are experiencing the largest mass extinction of animals - EVER. A photo safari may be next - before they become extinct. 2018. Saving my pennies.
I am taking weekly and monthly ukulele lessons. Monthly, classical Hawaiian lessons with Uncle Saichi - who used to play back-up for Iz, Gabby and others. He speaks full-on pidgin-english and is full of island stories. Good fun! (I really can't fathom how the English speaking students understand a word he utters!)
Work at Kaiser continues to be interesting albeit a bit challenging. Still LOVE the people - and that’s everything; isn’t it?

Some thoughts for the new year from Khe Hy (billed as the Oprah of the Millennials):
1. Have more compassion -- for yourself and others.
2. Do the "Uncomfortable Introspection."
3. Get comfortable with stillness.
4. Live your truth.

Sounds like a sound plan. I’ll take it on. You?
Here’s wishing you and yours a fabulous 2017. Be well, keep safe, and do keep in touch.

Much love and Aloha to you always in all ways ~ Lorin