A Fowl Day

Today was clear, dry, and hot. The outside temperature reached 100 degrees today, which could be why we didn’t have fowl weather on such a fowl day. (Fowl weather, I imagine, is weather that gets the geese flying south for the winter.)

I’m no spring chicken, which is especially apparent on fowl days such as this. I’ve been running around like a . . .

chickenNope, I can’t say it. I’ve never seen a chicken running around with its head cut off, though I suppose the bodies of chickens can last a few seconds without their brain — after all, the expression “hen-brained” must have come from somewhere. Still, whether I use the chicken metaphor or stick to the unfeathered truth, I have been rather busy today, running seemingly unending errands, dealing with visitors and various hospice workers, fighting an invasion of ants.

When I was out, I stopped to see a small camper for rent, a refinished 1955 Field and Stream 14-foot trailer. I’m not actually looking for something like that. I’m not sure my car could tow it, don’t particularly want the problem of parking it somewhere, and I’m afraid I’d feel cooped up. (Aha! Another fowl metaphor!) Still, it’s fun thinking about perhaps crisscrossing the roads in a portable roost to see what is on the other side of the country.

As much fun as it has been to use so many fowl metaphors, one I will never use is “henpecked.” I once saw a poor hen-pecked rooster, and oh, what a sad and bloody sight that was.

I hope you have a ducky day today!

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Pat Bertram is the author of the suspense novels Light BringerMore Deaths Than OneA Spark of Heavenly FireandDaughter Am IBertram is also the author of Grief: The Great Yearning, “an exquisite book, wrenching to read, and at the same time full of profound truths.” Connect with Pat on Google+. Like Pat on Facebook.

What Hospice is and What Hospice is Not

With as prevalent as hospice has become, many people still don’t know what it is. It is not a place; it is not round-the-clock nursing services; and especially it is not a way of hastening the end for people with incurable diseases.

In my experience, hospice is a type of expanded nursing service, providing support — medical, emotional, and practical — for patients and their families admitted to the service. (This may or may not be the mission of hospice — it is merely my impression and how I have used the services offered.) Although a large percentage of people on hospice are cancer patients who have less than six months to live, many people are on the service for several years — since hospice is about palliative care rather than curative treatment, many people suffering from incurable diseases are admitted to the service.

Hospice does not provide drugs intended to cure, but they provide medications to help make people comfortable, such as breathing treatments, diuretics, morphine for pain and breathing difficulties. (This drug service pleases me — it saves me the aggravation of having to deal with my father’s drug provider, especially when it comes to the breathing treatment. It’s expensive and they won’t pay for it, so they have to go through Medicare, which takes months. With hospice, I’ll get it within a week.)

cleanHospice is especially good for those who want to die at home, who have no ability or energy to visit their doctors at their offices, or who don’t want to have to deal with hospitals any more. (Often the “curative” care given in a hospital is taxing to a person on the edge of life, particularly when the doctors are trying to treat an untreatable disease, and in many cases, the patients are worse off when they leave than when they entered.) With hospice, patients still are technically under the auspices of a doctor, though most visits are from nurses and health aids. Other services are available with hospice, such as social worker and chaplain, in case either the patient or the family needs to talk. And there is respite care, generally a five-day stay in a hospice care center for the patient, to give the family member who is a caregiver a respite. (Jeff, my life mate/soul mate was admitted to a hospice care center for five days to give me a chance to catch up on my sleep. I didn’t sleep much at all while he was there, so it was a bit of a waste. Even worse, he never came home. He died on the fifth day.)

I am now going through my third experience with hospice, this time with my father. (My mother was first, Jeff second.) Oddly, I am in the strange position of having to reel in the juggernaut of hospice. They are geared up for the end, calling in a priest for an emergency visitation for my father, setting up all sorts of unnecessary services such as multiple visits from nurses (though there is nothing for them to do), offering me counseling services, sending cases of Ensure he will not drink. (Actually, he will drink it, but I won’t let him. He drinks the Ensure Plus, which offers more calories than the regular, and since Ensure is about his only source of nutrition and calories, and since he doesn’t want to drink six regular Ensure a day instead of the four Ensure Plus, I’m still buying the Plus to make sure he doesn’t starve.)

The reason we’re getting too many services too soon might be in the paperwork — in the submission papers, my father’s doctor said he had prostate cancer and had six months to live. Apparently his congestive heart failure and chronic obstructive pulmonary disease aren’t killing my father, but the truth is, neither is his prostate cancer. He’s had it for many years, and the urologist laughed it off, saying to come back when my father’s PSA readings are in the thousands instead of in the teens.

Still, my father has lost a lot of weight (that dang hospital stay!), so he’s a good candidate for hospice. It’s a comfort knowing that hospice is there if I need them. It gives me someone to call in an emergency. Gives my father the sense that someone in authority (rather than just me) is trying to get him to keep up his breathing treatments and to eat a bit. Gives him an alternative to going to the hospital.

25% percent of people admitted to hospice care die within the first four days for the simple reason that doctors themselves aren’t familiar enough with hospice to understand the service and so wait until the patients are too debilitated from “treatment” to benefit from hospice. On the other hand, more than a third of people admitted to hospice live long beyond the date of their expected demise because palliative care emphasizes the quality of whatever life is left.

Quality of life is always a worthwhile goal, even when — especially when — a person is at the end of their time.

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Pat Bertram is the author of the suspense novels Light Bringer, More Deaths Than One, A Spark of Heavenly Fire, and Daughter Am I. Bertram is also the author of Grief: The Great Yearning, “an exquisite book, wrenching to read, and at the same time full of profound truths.” Connect with Pat on Google+. Like Pat on Facebook.

Nonagenarians and Non-Aging

People in their nineties are called nonagenarians. My mind always processes the word to mean “non-aging,” and to a certain extent, that is true. After 93, people seem to stop aging. In fact, when people are in their late nineties, they are no more likely to die than someone in their early nineties. I just checked an actuarial table, and it seems as if everyone in their nineties has a life expectancy of about two years, and that expectancy of two years is a fairly constant number. On each birthday in your mid to late nineties, your life expectancy is approximately the same as it was the previous birthday, so you basically aren’t aging much at all. In fact, research seems to show that whatever health issues a person had at 93 remain, but new health issues generally aren’t accumulating. Nor are nonagenarians dying from dangerous pursuits such as sky diving or motorcycling. Since many people of that age seldom leave the house, their chances of getting in a car accident are slim, as is their chance of catching a serious illness old manfrom being in crowds.

Michael Rose, a professor of evolutionary biology at the University of California says: We still don’t have a full explanation of the underlying genetics of the cessation of aging. One possibility is that there are genes that are advantageous early on but damaging to health later in life — an effect called “antagonistic pleiotropy.” And these are the genes that cease to be. We now understand that aging is not a cumulative process of progressive chemical damage, like rust. It is a pattern of declining function produced by evolution. Aristotle was wrong (Aristotle thought of aging as a remorseless process of falling apart, until death finally puts us out of our misery), and so are all the present-day biologists who try to explain aging in terms of biochemistry or cell biology alone.

In other words (at least according to my understanding), nonagenarians outlive the process of aging.

There is a chance that my 97-year-old father will live two more years despite his being on hospice, and maybe even because of it. The problems he has have been with him since his early nineties — congestive heart failure, COPD, and prostate cancer with such a low PSA number that his only symptom is occasional bleeding. What usually precipitates a serious decline in his health is a visit to the hospital. (They always seem to admit him when he is feeling his strongest, so whatever it is that bothered the doctor wasn’t bothering him.) Because the doctors take the opportunity to give him a thorough check-up (heart function, breathing problems, removing water build-up in the pleural cavity), he always returns home weeks later much worse off than when he went in. Now, with his being on hospice, he is not at the mercy of doctors who are determined to keep him alive at all costs, so he could remain at the stage he is in for a long time. (Of course, he could just as easily die tomorrow or next month, but statistically, chances are he won’t.)

I truly did not think he would recuperate from this last hospitalization — he wouldn’t get out of bed when he was there, claiming he was asserting his patient’s rights to refuse any treatment, so he ended up with pneumonia and an extended convalescent stay. When he finally got home, he was bedridden, but that robust constitution of his that outlasted a majority of his generation kicked in, and now he is up and about again, fully capable of being left alone. Apparently, he has outlived everything that could have killed him, and now he is drifting in his nonagenarianism.

Despite this cessation of aging in the elderly, they do die, so I know my father won’t be here forever, but still, it’s interesting to see firsthand the principles Michael Rose postulated.

Rose’s idea doesn’t change my mind about my own longevity, though — I’ve never wanted to live into my nineties, and for sure I don’t want to do so knowing that I could linger there for many years in some sort of pre-death limbo. I know we don’t have a choice in such matters, but luckily I take after my mother, so I probably won’t have to deal with either nonagenarianism or non-aging.

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Pat Bertram is the author of the suspense novels Light Bringer, More Deaths Than One, A Spark of Heavenly Fire, and Daughter Am I. Bertram is also the author of Grief: The Great Yearning, “an exquisite book, wrenching to read, and at the same time full of profound truths.” Connect with Pat on Google+. Like Pat on Facebook.

Life is Art

During the past three and a half years, ever since the death of my life mate/soul mate, I’ve been contemplating the meaning of life, death, and writing. (Sometimes it’s seemed as if these concepts have been contemplating me, too, since the questions often came unbidden.)

The truth of whatever problem I am cogitating usually comes to me whole as I walk in the desert, but my current idea has come instead as a slow dawning over the past months. It seems to me that life is not science or math, not philosophy or religion, but art.

We are the painted, the painters, the patrons. We are the written, the writers, the readers. We are the play, the audience, the actors. It’s as if we painted a scene, then stepped into the body of one of our creations, experienced the life of that character, and while doing all that, we are standing back and watching the whole thing.

ReadingI wrote those paragraphs exactly a year ago, trying to work out a concept of life and our place in it, but I never got beyond that sketchy idea. It seemed real and important at the time, so I must have been going through either a mystical period or an optimistic one, but I never could reconcile pain and disabilities, mental illnesses and physical ailments with such a bright outlook. And so this blog has been sitting in my draft folder for one entire year, waiting for me to develop the idea.

Many people believe the universe is unfolding as it should, which takes away some of the aspect of art. It could be that we are the work of the Great Artist, living out our lives on Earth in the same way that the characters live out their lives between the covers of books. Or it could be, as other people believe, that life is multi-facteted, where we live many lives in many guises and reincarnations. Neither of those ideas appeals to me, though I am not egotistical enough to believe that my thoughts and opinions have any impact on the truth. The truth is the truth. Only our vision of it changes.

So, is life art? I do not know.

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Pat Bertram is the author of the suspense novels Light Bringer, More Deaths Than One, A Spark of Heavenly Fire, and Daughter Am I. Bertram is also the author of Grief: The Great Yearning, “an exquisite book, wrenching to read, and at the same time full of profound truths.” Connect with Pat on Google+. Like Pat on Facebook.

 

After This Death, There Will Be No Other

A friend and I talked last night about the themes of our lives, and he mentioned that a theme of my life seems to be taking care of the dying. First there was my mother (though I was not her principle caregiver, I did help when I could). Then there was my life mate/soul mate. And now there is my father. It seems as if I’ve been fighting with death for more years than I care to remember, but this final fight will be ending sometime in the not too distant future. And after his death, there will be no other — no other that I am responsible for, that is, except my own.

heavenMy father signed up for hospice yesterday. (He is strong enough and mentally alert enough that he was able to sign all the papers himself.) It seems like a big step, but the truth is he is no better or worse than he was the day before. Actually, that’s not true — he says he is doing worse, but to my eyes, he is doing better, thriving on the attention of nurses and home health care workers. I haven’t seen him so charming or jocular in years.

Hospice is not just for the actively dying, but also for those who will never get better, so just because he is now on hospice, it doesn’t necessarily mean he is close to death. I’ve talked to people whose parents were on hospice for five and even ten years. Although there is no way of knowing how long a person has, I don’t think my father is in any danger of dying soon. Getting older and tireder, yes. Dying? Not so much. He just doesn’t seem that much worse off than he was six months ago. He eats less than he did, but he drinks more Ensure. (I think he’s the one person in the world who actually likes the stuff.) So the calories add up to about the same.

This latest step is, strangely, more of an adjustment for me than it is for him. Even with my dysfunctional brother gone, we’ll never go back to the quiet days when I first got here to help him. There will be people coming and going, deliveries of drugs and other paraphernalia, reassessments and new schedules. And, of course, there will be visits from siblings who are suddenly frantic at what they think is the imminent death of our father.

I’ve gone through this so many times before, where I thought he was dying, and he proved me wrong, that I’ve learned not to make plans for when he’s gone. So, whatever the rest of the family thinks signing up for hospice means, I’m just taking things as they come.

Still, he is ninety-seven. One day his life will be finished, and so will this particular theme of mine. And then? I’ll just have to wait to find out what my next theme will be.

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Pat Bertram is the author of the suspense novels Light Bringer, More Deaths Than One, A Spark of Heavenly Fire, and Daughter Am I. Bertram is also the author of Grief: The Great Yearning, “an exquisite book, wrenching to read, and at the same time full of profound truths.” Connect with Pat on Google+. Like Pat on Facebook.

Hunting the Wild Moon

Last night I walked a mile out into the desert to watch the moon rise. 7:32 pm — the scheduled time — came around, and no moon. I stood for a few minutes wondering what could have happened to it (a moon is a pretty big thing to lose), but then I saw a hint of light behind a hill. Over the next few minutes, the diffused light grew more pronounce, and several minutes later, a huge orangy-yellow moon with a bright aura climbed over the top of the hill.

moonrise

I watched for a while, then headed back the way I came. Before I got very far, I received a phone call I had to take, and so I stood there, bathed in moonglow for at least thirty minutes. When I told the caller where I was, she got worried. Apparently, this is black widow season — as if Mojave green rattlers weren’t hazardous enough. I tucked my pants into my socks figuring if I stepped in a nest, I’d at least have some protection, and I got back safely. No rattlers. No black widows. Just a very poor picture of that bright harvest super moon.

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Pat Bertram is the author of the suspense novels Light Bringer, More Deaths Than One, A Spark of Heavenly Fire, and Daughter Am I. Bertram is also the author of Grief: The Great Yearning, “an exquisite book, wrenching to read, and at the same time full of profound truths.” Connect with Pat on Google+. Like Pat on Facebook.

Sunrise? Sunset?

It rained yesterday, bringing a bit of needed coolness to the desert. Last night for just a few minutes, the clouds lifted long enough to brighten the sky and I was able to take this photo.

moon rise

No, it’s not the setting sun. It’s the rising moon. Truly a super moon!

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Pat Bertram is the author of the suspense novels Light Bringer, More Deaths Than One, A Spark of Heavenly Fire, and Daughter Am I. Bertram is also the author of Grief: The Great Yearning, “an exquisite book, wrenching to read, and at the same time full of profound truths.” Connect with Pat on Google+. Like Pat on Facebook.

The Next Step — Hospice

My father’s nurse came and discharged him from the nursing service today. It’s not so much that he’s doing well but that they can’t do more for him — they are a temporary service to help recently hospitalized people learn to deal with their infirmities and the various aids necessary to keep them going. My father really doesn’t have any such aids except oxygen, which he’s been using for several years, and a pacemaker he’s had for six years. He wasn’t interested in physical therapy or any other services they offered except the nurse’s assistant who cleaned and groomed him. He is capable of doing it himself, he just doesn’t want to because it tires him. (When he forgets that he’s old and tired, he romps around without his walker or oxygen, sometimes for more than an hour at a time. )

So the next step is hospice. I didn’t know anyone could apply to hospice — I always thought the patient’s doctor had to prescribe it. My father’s doctor has been uncooperative, insisting that my father isn’t dying. Perhaps he isn’t dying, but he’s losing weight, nursedoesn’t want to eat, doesn’t want to do much of anything except sleep and pray. (Personally, I think he’s bored, but it’s almost impossible to get someone interested in doing anything unless they want to.)

My sister went to talk to hospice today, and when she explained the situation, they said our father was a perfect candidate for hospice. Apparently there are other ways of getting on hospice than having your personal physician prescribe the service. The people at hospice said that if his doctor didn’t release him, they would send a doctor to examine him and sign the prescription. Like with everything medical these days, it’s a matter of hurry up and wait, but still, we’ve got the ball rolling. (Do you think I should have added another cliché, or is that enough to get my point across?)

I’m not sure how I feel about this. I want hospice here, of course. I can’t do everything my father needs (I simply do not want to bathe him, though many daughters do that service for their aged paternal parent). Besides, my father cannot continue going to his doctor — the guy makes his patients wait for several hours, and that is too taxing for an old man. My problem is that although this hospice is the one we had for my mother and so my father wants them, I was unimpressed (they and my father kept my mother hopped up and delusional on vicodan even though she had no pain, and they were rather surly when I insisted — rightly — that she be taken off the drug). And these are the same people who kicked me out of their grief support group and threatened to call the police if I returned. I do not have good feelings about them at all.

I’m hoping to talk my sister into staying so she can deal with the hospice people, but if not, well, I’ll worry about that when the time comes.

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Pat Bertram is the author of the suspense novels Light Bringer, More Deaths Than One, A Spark of Heavenly Fire, and Daughter Am I. Bertram is also the author of Grief: The Great Yearning, “an exquisite book, wrenching to read, and at the same time full of profound truths.” Connect with Pat on Google+. Like Pat on Facebook.

The Most Compelling Images

The most compelling images seem to be those that somehow mirror ourselves, or at least our image of ourselves. At it’s most basic, this mirroring is why humans buy magazines with other humans on the cover, and why the animals we most bond with have the cuteness of a human baby, with wide-set, round eyes, and generally a round face.

I didn’t realize that I was prey to such subconscious mimicry, but of course I should have known since, although I don’t always like to admit it, I am just a human. I was reminded of our subconscious fascination with ourselves when I was gazing at the tarot card I chose during a one-card self-reading, a painting by Stephanie Pui-Mun Law. This three of wands card shows a woman standing at the edge of a land bridge, far above a mountainous scene with a river running through it.

I was suddenly struck by the familiarity of the image, and then I remember this photo of me on the north rim of the Black Canyon of the Gunnison, which I used for the cover of Grief: The Great Yearning:

There I am, standing at the edge of the world, though the altar-like rock in front of me masks that reality. If the photo had been taken from the same perspective as that of the tarot card image, you would see I what I am seeing — a mountainous scene with a river running through it.

No wonder the image of the woman standing above it all struck such a familiar chord.  She is I, or maybe I am she.

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Pat Bertram is the author of the suspense novels Light Bringer, More Deaths Than One, A Spark of Heavenly Fire, and Daughter Am I. Bertram is also the author of Grief: The Great Yearning, “an exquisite book, wrenching to read, and at the same time full of profound truths.” Connect with Pat on Google+. Like Pat on Facebook.

Earth Houses

I went on a field trip today to see houses made of dirt and to get an idea of how they were made. It’s not so much that I was interested in the houses, but a friend invited me, and I make a point of not turning down invitations — I never know where such an invitation could lead. And today the invitation led to a place where they teach people to make sustainable houses out of local materials, mostly dirt.

The guides claimed the houses were cheap to make, and they were, but of course, you have to buy the rolls of sandbag material to stuff the dirt into (the only purveyor of the stuff is this particular company — surprise, surprise), and if you want more than a temporary shelter, you have to add concrete to the mixture, which adds to the cost. One such house, a three-bedroom, three-bath house with an adobe look and feel, cost $138,000. That did not include land or labor costs, which would have upped the cost to more than $500,000. Unless you particularly wanted to live in a dirt house, you’d be better off buying a ready-made traditional home.

The tour was fun — I saw many interesting shapes of houses — but the lecture not so much. I get bored easily with droners and repeaters, and the speakers both droned and repeated so I kept wandering off to look at various houses and structures. Each time I returned to the lecture arena, I heard the same thing, “You can build these houses anywhere in the world.” And so I would wander off again, shaking my head. No, you can’t build these houses anywhere in the world. Maybe the low-technology is available anywhere there is dirt, but most places in the United States and in other “advanced” countries, you have to deal with zoning laws, health codes, building permits, and various other matters that make it impossible to build such a house. And of course, you can’t build an earth house in the middle of the ocean. Since 71% of the world’s surface is water, that leaves a rather small percentage of the world available for building the houses. But I’m being too picky and literal, especially since living in a non-traditional house might suit me.

My favorite structure was a dome built of straw bales with a stucco-ish finish. Mostly what interested me was the dome shape. I could live in such an airy space, as high as it is wide. I don’t have furniture, and don’t particularly like the stuff. I once had a wonderfully comfortable couch that was simply a mattress on the floor covered with a dark sheet and dozens and dozens of pillows stuffed into matching and contrasting pillowcases. Oh, the luxury! Added benefits of that couch was the ability to change the décor at whim, it could be used as a bed. That kind of non-traditional furniture would be perfect for a single-room doomed house. I don’t like hanging things on wall, so curving walls wouldn’t present a problem, either. I’d just need to make sure I had the amenities like a working kitchen and bathroom, and wi-fi capabilities.

But would I really want to live in a room that calls attention to itself? I don’t know. Though I live in clutter (a symptom of too many simultaneous projects), I prefer an austere living space where my mind can roam free, unsnagged by my surroundings. I also don’t know if I would ever want the permanence that owning such a house would suggest. Still, a domed earth house is an interesting concept, and so is being able to build one’s own house from whatever is at hand. Something to add to the stew pot I call my mind.

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Pat Bertram is the author of the suspense novels Light Bringer, More Deaths Than One, A Spark of Heavenly Fire, and Daughter Am I. Bertram is also the author of Grief: The Great Yearning, “an exquisite book, wrenching to read, and at the same time full of profound truths.” Connect with Pat on Google+. Like Pat on Facebook.

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