A few words from a California shut-in

Staying alive? Yep, that's what I'm trying to do. How about you?

Though sometimes I'm not sure exactly why.

I started this blog ten years ago when I was contemplating aging -- mine, and other people's. I was exploring what conscious aging would be, how to enjoy it, and how to inspire others not to give up and sink into their couches to watch whatever was on television, and develop arthritis, or worse yet, Alzheimer's. 

I was 66 years old, and at the time I was living in New Mexico, where death is part of the rough, desert landscape where nuclear weapons are buried and cow's skulls are sometimes placed above doorways. 

A few years later, I moved back to Sonoma County, the place I call home, where I had raised my kids in the little rural town of Occidental. Here, death is still in the closet, one of the things people don't like to talk about because it's too negative.

Now, like everyone who doesn't have an essential job, laid off from my part time work as a teacher of older adults in the local community college, I'm sheltering in place.

I've come back to this blog to share what that means to me as a member of the vulnerable generation that is also known as the boomers.

I've always been a writer. I have stacks of journals in my closet and pages from unfinished manuscripts about various topics as well as columns written for the local newspapers and published articles about the environment, feminism, and, most recently, organic farming.

I've been waiting for a time like this. Like many others, I spent the sixties envisioning a future without nuclear bombs, in which we would live in greater attunement with nature, a world of conscious awakening, love, and equality, all the good things we saw in a flash and fully expected to realize in our lifetimes. But gradually it became apparent that this transformation was going to take a long time. My daughter would say, and has often told me, it's not going to happen, mom.

Climate change loomed on the horizon, and our society seemed incapable of coping with it, just as we had failed to cope with nuclear bombs; and it became apparent that the existing order was going to have to unravel before a new age could take shape.

I thought a depression would be far better than a nuclear war. In 1999, Y2K looked promising. We were going to be forced to change. But that problem was solved, and instead we endured the life shattering experience of 9-11.

The world changed, but not in the direction we had imagined. The experience of the sixties and seventies had been too shocking for the establishment. A backlash followed, dominated by globalization, neoliberalism, and endless wars. Meanwhile, the climate deteriorated, and it became obvious that it was an emergency with a deadline: ten years to change our ways, or die.

Now we have something that threatens to bring about the economic collapse and the possible disruption of our culture.

A plague.

At first, I confess, I was happy about it.

I often think about the story of the exodus from Egypt celebrated every year around this time at Passover, how Moses was given the task of freeing the Jews from slavery, and how the Pharaoh resisted. So the Lord devastated Egypt with a succession of plagues. With each one, a despairing Pharaoh agreed to yield, but then God "hardened his heart" and Pharaoh changed his mind.  It took seven plagues for him to finally give in, and the Jews set forth on a forty-year expedition through the wilderness in search of the Promised Land.

They made it, but Moses died before they arrived.

I am Jewish but I'm not religious in any traditional sense. But that story speaks to me now, and I wonder whether this disaster, with so many sick and dying from an invisible microbe with remarkable ability to spread from person to person and no cure, will free the enslaved from bondage.

Will we wake up? And what does that mean? What do we have to do, to be released from the shackles of an ignorant society, a repressive government, a legacy of racial violence, and the rise of an extraordinary, modern Pharaoh in tight allegiance with the richest, most bigoted and self-centered class hell-bent, so it appears, to let the world fry?

I ask you. 

Yesterday, April 6, on KPFA's Letters and Politics, Mitch Jezerich interviewed Yanis Varoufakis, who served as Greece's Minister of Finance in 2015 and is Professor of Economics at the University of Athens. In the last two minutes he asked the Leftist economist what he sees happening after the pandemic. Said Vourafakis, "Humanity is approaching a fork in the road. It is totally up to us which of the two we will follow.

"One track takes us to a dystopia, to a situation where the money that has been pumped...into the economy is allowed to turbo charge even further the inequities in our world, putting more money in the hands of a few who just sit on it, or buy more houses and more private jets while the rest are dwelling in precarity, not knowing what is going on but unable to make ends meet and understanding that the future of their children will be worse than their own...the Donald Trump route if you will; and another track in which humanity wakes up to the fact that we are all in this together, and reorganize the international monetary system to stop climate change and take care of all the people."

If it's up to us -- is it? -- time ran out before he could tell us what to do.

Tomorrow I will give you my dystopian version of what lies ahead. 

A dutiful daughter tells her story

Out of the blue, a writer sent me her book about her experience of taking over for her elderly mother when she became unable to cope with those “activities of daily living” (ADLs) we all take for granted…until we can’t. Part memoir, part handbook for other adult children, Nine Realities of Caring for an Elderly Parent jolted me into a sneak preview of what my end of life might be like.

With significant differences. 

Not all of us at this stage of life will be blessed with a devoted daughter like the author, Stefania Shaffer. Remarkably,  Shaffer zooms in to the task after being completely estranged from her mother, and misjudged by her, for years.  Suddenly offered an olive branch, she goes to visit, where she is confronted with a mother in a worn blue bathrobe going blind from macular degeneration and in the habit of falling, amidst the utter chaos and neglect of what had been her childhood home, a situation become so derelict that she will feel required to leave her own life and move back home to provide care.

Without blinking, without second thoughts, and with no resentment, she does it -- and she’s rewarded, by falling in love with the handsome roofer who comes to fix the roof.

It reads like a fairy tale; and maybe it is. A lot is left out of this halcyon story, and one suspects that those details that might fill out the story are left on the same shelf as the financial information she chooses to reference only obliquely, substituting “trees” for dollar amounts. But luckily at every stage there is money to do what needs to be done, from replacing the wall-to-wall carpets to hiring a full time hospice caregiver.

But even lacking those and other tender details of how their relationship was repaired and sustained during these difficult final years, the book manages to convey a lot of useful information set in a flowing and readable narrative.

Introducing her story, Shaffer outlines the growing need for care of older adults, the costs of professional care and the rising number of Americans (nearly ten million in 2011) trying to provide it themselves. Then she lists the qualities needed by the family caregiver:  “mobile enough to relocate or ability to provide extra bedroom and bath space, trustworthy, alert, non-drug user, non smoker, reliable, observant, savvy, organized, multi-tasker, patient, creative cook, dietitian, pharmacist, nurse, non-alarmist, soother, committed, non-traveler…” and more. 

It’s a hard bill to fill!

Even now, having read the whole thing and put it down for a week while attending to other projects, I, a 72-year-old reasonably healthy mother feel a shudder of fear as I take another look at this warm hearted, reasonable and capable depiction of an experience I hope I will never live to see. But who can know how it all may end? We try our best, faithfully taking the daily walk, going to swimming and yoga classes, eating as much fresh produce as the budget will allow… Trying to maintain some form of social life, staying mentally active, even holding a job… all the good things we see on NPT’s “Next Avenue” or AARP’s “Life Reimagined,” everything designed to counteract the negative images we carry about old age, and all to the good, but in the end, for most of us, there’s that lingering decline in which care is the ultimate concern – the person to care, and the money to provide for it. So many elders are lacking in one or both. The unwillingness or certainly reluctance of so many of our adult children to attend to the needs of aging parents, even before the situation attains this catastrophic level, though uncounted, appears to be fairly widespread; and with so many pressures and demands on their time, this lack of attention is not entirely surprising. The failure of many boomers to provide financially for their old age is another factor; they (I should say, we!) can’t provide properly for our own care, and, let’s face it, our children’s motivation is somewhat reduced by their awareness that they often cannot expect a significant reward for the enormous time and energy commitment that will be demanded of them.

All around, it’s a complex, daunting picture with no solution in sight. Reading about the wonderful devotion and skill of Stefania Shaffer, we can only pray that we may be blessed with something approximating the loving care her mother received – despite their estrangement – and that caregiving families generally will receive more support from government funded social programs than they are enjoying now. 

It’s a difficult road, but caring has its rewards for the giver, and those of us forced to depend on it can learn to be sweet, as Shaffer’s mother was, thanking Stefania every single day and always telling her how wonderful she was. In this “love affair of a different kind,” despite the labor and the stress, the intimacy of caregiving can be a gift to us in a society aching from isolation, loneliness, hopelessness and lack of purpose. Here at the difficult end of life, we may find the tenderness and meaning we crave.

Full-body C-Scans: not all they're cracked up to be

I was reading my new issue of Consumer Reports when I came across this very interesting item:

"Your doctor recommends a “whole-body” CT scan

"Those scans are often touted as a way to detect early signs of cancer and heart disease. But most scans—and up to 80 percent in older people—have at least one abnormality that shows up on the exam. Almost all of the abnormalities are harmless, yet about one-third of patients are referred to follow-up imaging, according to a 2013 study. And whole-body CT scans expose you to much more radiation than regular CT scans. One study determined that for every 1,250 45-year-old adults who have the exam, one will die of cancer as a result. Yet it’s unknown how many lives the scans might save."

One 45-year-old person will die of cancer as a result of a whole-body CT scan! That’s shocking -- but not totally surprising. CTs are utilize powerful radiation technology to investigate the tissues of the body layer by layer; whole-body CTs expose the whole body.

I’ve had a lot of x-rays due to a congenital hip condition, so I’m extremely leery of all medical uses of radiation technology; but CTs are prescribed so often, I’ve even had a couple of them. But I haven’t had a full body scan. However, less than a year ago I was told I must have one.

In New Mexico, I went to see a specialist about a small lesion that had begun to distort the vision in my right eye. Dr. Seligson, the opthamologist I had seen in Santa Fe, thought I had TB, but he insisted that I must see Dr. Shelley Lee at the University of New Mexico Eye Clinic in Albuquerque, to confirm his diagnosis. She is a specialist in uveitis, inflammation of the eye.

Dr. Lee was a youthful, slender woman with a narrow intelligent face framed by straight black hair. She worked late and appeared to be very dedicated to her clients. I liked her at once.

In the grey examining room lit only by the glare from a large computer screen, she showed me vastly enlarged images of the choroid of my eyes. (According to the web site of the National Institutes of Health, “the choroid is the layer of blood vessels and connective tissue between the sclera (white of the eye) and retina. It is part of the uvea and supplies nutrients to the inner parts of the eye.”) Both images were green from the dye that had been shot into my veins an hour earlier. Here was the healthy eye. Here was the sick one, covered with brown spots. It looked pretty creepy.

Dr. Lee looked me over carefully, a woman of advanced years, unaccompanied, intelligent, who did not appear to be terrified, and said, "I think you have cancer and it has metastasized to your eye."

Just like that.

In three weeks, I was moving to California. I had great plans for this move, but I was also very anxious. Now I had cancer!  Should I even go? or just curl up and prepare to die?

Dr. Lee ordered several blood tests, an MRI of the head and neck and a whole-body CT scan. She urged me to complete the tests before leaving because there might be delays in California while I established care.

I tried my best, but the two scans were scheduled just a few days before my departure and I was becoming exhausted. I did the MRI, but the night before the CT I was supposed to drink two liters of fluid that I supposed might have something to do with emptying my bowels . . . and I just wasn't up for it. I postponed the test.

Once in Sonoma, I learned that the small local hospital did not have the right machine for the whole-body scan. I could go to another hospital if I wished, but my doctor and the radiologist thought that the three regular scans would be sufficient; the brain scan would not be included but the MRI had been negative. Another study of the brain didn’t seem necessary.

So I was spared. The three CTs took five minutes; the whole-body version would have been an hour long. That is a lot of exposure.

They were all completely normal.

Unless something is lurking in the folds of my stomach lining, or some other equally obscure place, I am still "good to go."

Something might have shown up in the full-body scan, but that can lead to new problems. These powerful diagnostic tools sometimes reveal mysterious abnormalities that may or may not indicate a serious condition; then doctors order another CT "just to make sure."

That can be the beginning of cancer where none existed! According to Consumer Reports, a 2013 Australian study had shown that people who undergo whole-body scans have a 24 percent higher chance of developing cancer.

I’m glad Dr. Lee was wrong, but I’m very concerned about the way she presented her diagnosis. Cancer is greatly influenced by one’s state of mind, and for several days after seeing Dr. Lee, I was already succumbing to it.

Be careful before you have that whole-body CT!

The power goes to the young...

...and the wisdom to the elders!

I went to the elegant senior center here in Sonoma, aptly named, for wine country, Vintage House, to check out the class in Gentle Yoga.

Vintage House does not feel like an institution. It is designed more like a hotel or conference setting. There's a Renaissance style fountain in the middle of the circular driveway, and as you enter the reception area there's a beautiful arched entry that marks the hallway to the classroom area. At the end of the hall, there's a grand all-purpose room called Stone Room, with a lofty vaulted ceiling, hardwood floor and windows all around, which is used for parties, lectures and various exercise classes.

The Gentle Yoga class is huge! There must be a hundred people there, most of them women. They were laying down their mats as I entered the room, chatting with friends, and generally settling in. I went up to the front, obviously designated as the teacher's area, to await Julia Vining, the instructor. For a few minutes I was just standing there looking silly.

Then I noticed a tall, buxom, smiling woman, obviously not a senior, across the room. That must be the one!

Yes, she said, introducing herself.

I asked if I could join the class, and she welcomed me to do so. "I have a few physical limitations," I said. She smiled broadly, "Everyone does," she said, "you just do what you feel comfortable doing." She was radiant with confidence and the power to be understanding, patient, generous.

She went to the closet to take out a mat for me. Here she was, instructing a roomful of grandmothers. She was strong, warm, and also professional. She was in charge, and I was the humble student, here to follow her instructions and advice. All the power of a woman in the full flowering of womanhood was hers, mine a mere dwindling sliver of the girl-I-used-to-be. And that is as it should be.

This reminded me of a couple of conversations I've had recently about relating to our adult children. This topic has loomed large for me lately because I am struggling with my own daughter over how to redefine our relationship to suit her terms and desires. And believe me, the power is hers.

I feel daunted by this challenge from her. I feel, perhaps unnecessarily, that my identity is at stake here. Indeed, both our identities are at stake. She is fighting to retain hers against what apparently is the towering challenge of dealing with her mother, about whom she has very mixed feelings. She wants to arrange our relationship entirely according to her preferences.

That leaves me feeling stripped of all my appurtenances and powers, reduced to a feeble shadow of my former self and grappling helplessly with how to be recognizable to myself while accommodating this young woman's directives -- because I want to have a relationship with her. It's important to me!

I am struck by the ease with which my friend Joanne describes how she responds to the directives of her daughter-in-law. Joanne came down with pneumonia while she was visiting her son's family over Christmas, but once she was provided with the necessary antibiotics, Rosie had plans for her. I can just see Rosie standing in front of graceful 73-year old Joanne, larger than life, declaring what's on the schedule. "Tomorrow night we're having a party and I need you to take the kids out while we prepare and then of course we'll have the Christmas parade through the neighborhood. I've got tickets for all of you for the children's theater on Thursday and..." da-da, da-dee, da doo. Looks like a scenario for a fight, and indeed, it could be.

But Joanne, with no loss of dignity whatsoever, just follows instructions. "I love being with the kids, and you know, my son, he adores his wife, and if I got into conflict with her, I wouldn't stand a chance."

I can see myself in her place, feeling diminished by the situation and tensing into resistance. Joanne is wiser. Her identity is not at stake here, not at all. She'd rather be home at this point, recovering more quietly from her pneumonia, but what the heck. She's here, and she's going to follow the program. Even with pneumonia, Joanne has a lot of energy. But her energy is partly due to lack of resistance. She loves her son and his family and she's happy to be of service.

Another friend, joining me for tea, speaks about her relationship with her son. Mary has been practicing Buddhism for 30 years. It has helped her learn to develop presence, she says, to be with what is happening without the clatter produced by the mind.

She too has learned to enjoy her relationship with her son even though it's much less than what she would wish. "We need them more than they need us," she said. "That's just the way it is."

Somehow our children do not feel obligated to come home for Thanksgiving or to make a regular phone call to check in on us. "The nuclear family," Mary says, waving her hands across her midriff, "has broken down." Is that what it is? Or were we too permissive? A woman in my women's group says, "I just don't understand it. Why are mothers blamed for everything? Why don't children ask themselves what it is to be a good child? We gave birth to them, sometimes in great pain, we raised them. What if it wasn't perfect?"

They owe us something, was the implication, reflecting the old fashioned attitude to the Great Parent-Child Divide. You do what is expected of you, regardless of what you'd like.

Adult children have the energy, the strength, the power that we no longer have. If they don't recognize their responsibility in the way we would like, wise elders accept what they receive with grace. We don't want to be a burden on our kids, and we hope not to become dependent on them in the end. The young are busy, building careers, raising families, both parents working; they are under a lot of pressure. It's a new ballgame, a dynamic where tradition no longer reigns. And it's challenging, not only for us but for society. A great many people are coming to age now, and who will care for them?

For us, shifting from being in charge, as we used to be, to being in gratitude, is a profound shift for aging parents. We do well to discover this wisdom in our new roles, in the surprising context of our longer lives, with grace.

One hand on the reins

My mother used to call it autonomy… having none herself, she gradually sank into a pit my father later characterized as Alzheimer’s. And that may well be, but it was his tyranny, not some physical cause, that triggered it. She simply had nothing to do. He shopped, he cooked, he gardened.

We've known for some time that having choice…and something or someone to care for…enriches life experience at any age; and for people in nursing homes, even a plant to water and feed themselves is an asset for healthy living.

When others do everything for you, bathing you, feeding you, preparing your meals, doing your laundry, and someone, such as an adult child, makes financial decisions for you that you may not agree with, it helps to have one or two things you can do for yourself.

It’s about finding a balance; as with most things related to health, a mental and physical state of proportion (as the Greeks called it) or equanimity, as the Buddhists do, is critical.

A widely quoted study (summary below) concluded in 1986 that some control is advised, especially for the younger elders, but as life advances, too much responsibility becomes overwhelming with too much stress associated with it.

Like children, the very old may want to be cared for; not to be robbed of our autonomy, mind you, but nurtured, attended, considered and included. I'm not there yet, but I can relate. The other day as I was getting ready to attend a meeting at a local church I fancied myself being escorted there. I had a mental picture of being dropped at the door while someone, my husband, boyfriend or friend, parked the car. It wasn’t the chore of driving or parking that I so wished someone else would take care of, it was the attention to my well-being. Old people like that. And younger ones, too! I chuckled thinking, How can you feel like a Queen unless somebody serves you?

But we have a negative idea of service in our society. Service is something that illegal Mexicans do, and we don’t have to grant them citizenship for doing it, cheap labor to weed the orchard, wash up the dishes, or care for the sick elderly. We hire it, and we don’t even pay very much for it, unless we are very kind and rather rich. But we don’t value it.

A

I remember in the 70s when so many of us were following Indian gurus, we were trained in seva, which means, service. Our service was not considered lowly, but divine. It was our gift, our offering.

In our spiritual family, we took care of babies, including those that weren’t our own, and we tended the elder members until they died. 

Now we are the elder members, and there’s no one to care for some of us! Our society has trended back to its traditional self-reliance. You can hear the Midwestern accent, the gravelly voice saying, I don’t owe nobody nothing. Right?

Now self reliance has morphed into narcissism. It’s just all-about-us! It’s about my health, my diet, my radiant skin; my career, my healing, my self-empowerment. And I do include you in that. But I’m not going to wait on you!  

In such an environment, it’s critical to be independent; that’s the key value. We've got to make the effort to survive on our own. When true self reliance is not available to us, we are typically stripped of all responsibility and dumped in a care home.

That complete loss of control – of autonomy – is bad for our health. We need to let the next generation know that while we do love to sit down at the dining table for the family dinner, we can still make toast.

Science 19 September 1986:

Vol. 233 no. 4770 pp. 1271-1276

DOI: 10.1126/science.3749877

ARTICLES

Aging and health: effects of the sense of control

J Rodin

ABSTRACT

The relation between health and a sense of control may grow stronger in old age. This could occur through three types of processes: experiences particularly relevant to control may increase markedly in old age; the association between control and some aspect of health may be altered by age; and age may influence the association between control and health-related behaviors or the seeking of medical care. Studies show that there are detrimental effects on the health of older people when their control of their activities is restricted; in contrast, interventions that enhance options for control by nursing home patients promote health. With increasing age, however, variability in preferred amounts of control also increases, and sometimes greater control over activities, circumstances, or health has negative consequences including stress, worry, and self-blame. Mechanisms mediating the control-health relation include feelings of stress, symptom labeling, changes in the neuroendocrine and immune systems, and behavior relevant to health maintenance.

Back From Fatigue

Here I am again, after two months' absence from this page; and what a time it has been!

When I wrote about moving to a new location in the county where I had once lived for 16 years, I was focusing on the necessary exercises we go through after a move -- establishing routines, learning directions, and creating new social networks. All of this is good for the brain, unless, of course, it's too much for the brain -- too much effort, too much stress, and, as a result, too much fatigue. Just too much everything!

I just became completely exhausted. Do you remember staying up late night after night, cramming for final exams? It wasn't until it was all over that you finally collapsed. I'm an active person, but last month if I closed my eyes after lunch, I fell asleep.

I started to worry that I had some unbearable illness; but if I do, doctors haven't found it. Of course I'm relieved, but then I start to worry. Maybe the doctor is missing something? Doctors here seem to be very upbeat and cheerful. Does that mean they're not paying attention?  I remember a doctor I had in Santa Fe. When I had a pain in the chest, she wouldn't see me unless I went to the ER to have all the tests for heart attack. Another time she ordered a full pulmonary panel because I told her I coughed once or twice when I woke up in the morning and had been a smoker. She was extreme, but you could be sure she left no stone unturned. She would find something even if it was just a pebble.

My physician is conscientious enough. When something is bothering me, she goes after the easiest explanation first. The last time I went to see her it was about my fatigue. All my recent blood tests had been normal. I asked her whether the move could have just wiped me out and she agreed we should explore that possibility. She didn't really have any suggestions, although she did applaud one of mine.

This is what I did:

At my local supplements store, Pharmaca, where you can find natural medicines as well as purchase your prescriptions, the helpful sales associate suggested a form of B-12 that is easily absorbed. It's called methylcobalamin. As we age, he told me, we become less able to derive B-12 from foods. Just one or two raspberry flavored sprays into the mouth, and in a few days you should be feeling better, he said. And I did.

Another thing I picked up was a formula for adrenal support. Constant stress wears out the adrenal glands located on top of each kidney; they release the adrenaline that triggers the rise of cortisol which is useful in an emergency but sustained high cortisol levels "destroy healthy muscle and bone, slow down healing and normal cell regeneration, co-opt biochemicals need to make other vital hormone, impair digestion, metabolism and mental function, interfere with healthy endocrine function and weaken your immune system," according to Marcelle Pick, OB-GYN nurse practitioner. Wow. I certainly did not know that cortisol can destroy muscles and bones! I've had lots of problems with weak muscles and bones. The Adrenal Support formula, a combination of several Ayurveduc adaptogenic hers, has been helpful.

Lastly, I decided to go to acupuncture. That's the idea my physician encouraged. Are you familiar with the People's Organization of Community Acupuncture? It's a great thing! POCA was created to make acupuncture available to working class people and others with limited incomes who needed to have regular treatments for chronic illnesses -- people like you and me, trying to "stay alive" after 60.

In Community Acupuncture clinics, which you can locate at the POCA website above, patients stretch out on recliners in a large open room. The practitioner visits each in turn, talking briefly, inserting the needles, then moving on to the next person. Relaxing music plays, and patients doze off or just enjoy a little quiet time while the needles do their work. It's so pleasant, and it's affordable! The clinic that I visit, in Petaluma, charges $20-40 sliding scale.

The supplements, the acupuncture, and taking a little more rest have helped recharge my system, though when I'm feeling good I tend to overdo, the way I did yesterday and the day before. As a Capricorn, I'm always trying to be productive; but as astrologer Rio Olesky recommended in his monthly horoscope for October, this month was a good time for Capricorns to find other ways to spend their time.

I just didn't listen. I've been trying all day to get out to the Community Farm where I do some volunteer gardening, when all I really felt like doing was going back to bed. Oh well. There's always time to go back to bed! At least I've updated my blog -- and in the process, I've remembered that I'm still recovering from adrenal fatigue. According to Marcelle Pick, recovery can take as long as four months! I'd better build up my strength before I start running around town again.

After I do this load of laundry . . .

Those Old Country Roads

Returning can be risky!

Last Saturday I drove out to the West County, where I used to live, to attend a CodePink Peace Camp at Ocean Song Farm and Wilderness Center -- and got caught in a web of nostalgia that almost tripped me up.

Ocean Song is a 350-acre property west of Occidental, the village that is the centerpiece of the rural community in which we lived, where five roads intersect in a little valley nestled between two ridges. When we first moved up there from San Francisco, the main street, which is only two blocks long, wasn't even paved.

The area was settled by Italian families around the turn of the last century and adopted by hippies fleeing the city to put their feet back on the ground and make their gardens grow. They became some of the first organic farmers in the country; and of course, they also grew magnificent pot.

Coming from the southeastern part of this sprawling county, where I now live, I chose not to drive through town. I was trying to be efficient, but perhaps I was also trying to avoid the seductive trap of recollection and regret that was lurking around every turn, ready to draw me in.

But as it turned out, the alternate route was just as reminiscent of my life here. Driving along Bodega Highway, I remembered taking that road every morning during the two years I worked for a newspaper out on the coast, Bodega Bay Navigator, after my marriage split up.

When I turned onto Joy Road, I was joined by other presences, whispers from those former days, as if I were again accompanied by two or more children chattering and laughing in the back seats on the way to the beach, or someone's sleepover, or perhaps the monthly mother-daughter potluck that Amy and I attended when she was in Middle School; or the time we hit a deer coming home from an event at the coast and didn't stop because my husband was certain he saw it get up and run off into the woods.

It wasn't always a merry good time. The kids might be fighting over the choice of radio station, someone might be yelling or moping and crying, I might have been irritable or tired of settling arguments and negotiating demands, but despite all that, I loved being a mother, and I loved the person I was then (most of the time); and in retrospect I loved her even more.

These roads, like old houses, seem to mirror the tracks memory carves in the brain. The landscape is quite distinct from where I am living now. Around Sonoma, the hills are molded and firm like young breasts, covered with golden oat grass that resembles blonde fur when the wind sweeps through. But around Occidental the hills are mostly obscured by forest and scruffy shrubs, a mix of various oaks, madrone, bay laurel, willow, pine and a few redwoods, and the sides of the road are cluttered with an effusion of native plants (aka weeds) and wildflowers. This is the land that fought off the developers and chose to remain as it had been. The old farmhouses are unpretentious and homey, set back from the road, some with fences beginning to cave and porches starting to sag. But they are comfortable, settled into the land, like the families who have lived in them since the 70s, raised their kids and stayed. They may have divorced and remarried, but they haven't left the community, and their lives are intertwined with the land.

Unlike mine! From poignant reminiscence my mood shifted to one of deep regret. I hadn't had to leave and hadn't really wanted to, but it's what I did, and there's no turning the clock back. Nor will it help to listen to the voice in my head that is getting ready to scold me for not working night and day in order to keep my cottage in the redwoods. There's plenty of fault to find, no question; but a scolding is not going to bring it back. I lost my house and my settled country life because I needed a change. I didn't realize how difficult it was going to be to come back.

As I made the turn onto Coleman Valley Road, I began thinking, I am still not home. I have to find a way to move back where I belong. By the time I reached the gate to Ocean Song, my mind was still locked into a few words repeating themselves like the sounds of a train on the track. I have to come back, I have to come back, clicketty clack, I have to come back where I belong!

But then I paused to breathe in the astonishing view spread out below, the rows of blue green hills, the fog bank spread out between them, the far distance sea, and awe took the place of my repetitious chatter.

People move on. It's what happens. Had I not left, I would have missed the many great experiences I had in New Mexico. Had I not returned, I wouldn't be having this experience of revisiting the life I had here and linking it up with the one I am making now in a very different setting. In Sonoma, a Wine Country "destination" known all across the country.

Rebecca Solnit says it well:  "The self is also a creation, the principle work of your life, the crafting of which makes everyone an artist. This unfinished work of becoming ends only when you do, if then, and the consequences live on."

That's what it comes down to: designing a life, learning its lessons, growing all the way to the very end.

I made my way down the hill to sample the delicious California country buffet and connect with old friends.

Old Brains in New Places

Is moving beneficial for people our age? Applying the principles of new brain science seems to suggest that it can certainly help us stay young and sharp.

Moving, especially to a different part of the country, forces us to change some of our habits. Old people are “set in their ways”, a quality that psychologist Ellen J. Langer calls “mindlessness”. It's not just a feature of age; most people, she says, live their lives mindlessly, on automatic pilot; but those who choose to become “mindful” stay youthful longer.

A woman in my women's group who just moved here from Tucson asked, "Isn't it too late to get established in a new place?" Not at all! Brain research in the last twenty years has shown that the brain’s ability to change, called “neuroplasticity”, persists as long as we live. It’s never too late to change!

The brain creates neuronal connections that are reinforced by habit, like those well-worn pathways in the carpet created by repeated trips back and forth to the kitchen or bath; these connections are reinforced by habit. But we can change the imprints if we choose.

It’s a case of use-it-or-lose-it. Just as muscle tone rapidly deteriorates when we don’t exercise, a brain that relies on ingrained or “mindless” behavior is an under-utilized organ, and little by little it stops producing new neuronal tracks. People who sit home in front of the television, endlessly repeating old behaviors, are letting a good brain to go to waste.

This is why we are advised to learn something new every day, like a new language, or how to play a musical instrument. Neuroscience has shown that stimulating mental activities with lots of repetition are just what we need to keep our brains healthy. Now that we are living longer, pushing back the 70 forms of dementia that confine more and more elders to nursing homes is a primary goal for most of us.

Age provides limitless opportunities for new kinds of activities, ones without the stress associated with jobs and child-rearing. The trick is to choose a challenging activity, the more difficult the better. Diane Ackerman writes in her book, A Hundred Names for Love, which is about her husband’s aphasia (brain damage resulting from a massive stroke): 

“A colossal number of brain cells (hundreds to thousands) are born each day but most die within weeks unless the brain is forced to learn something new. Then more neurons revive and sprout connections to their brethren. The harder the task, the more survivors.” 

Ackerman's husband, Paul West, an accomplished writer, lost the ability to communicate; but with constant daily effort to write and to speak, and his wife's constant support, he regained many of his verbal skills. In the five years after the stroke, he actually published three books and dozens of articles! 

You have to try. Moving to a new place challenges us to adopt new habits, but without application and repetition, we’ll simply transport the old ways to the new location.

We have to think to change the pathway, and that’s the whole idea. The more attentive we become to what we are doing, the more the brain benefits from the effort.

Yesterday in an aquatic yoga class that I enjoy, one woman alluded to her “challenged directionality.” It’s like a kind of dyslexia, she said. She can’t follow directions that rely on left and right because her brain can’t figure them out.

I don’t have that problem exactly, but I definitely have a poor sense of direction; and if I come to a dead end and have to turn around, I sometimes can’t figure out how to get back where I was going.

Living in a new town, driving into new areas to shop or attend an event, requires a fair amount of effort on my part. I have to look up the directions, study the map, print out the steps I’ll need to take; I have to allow enough time so that I don’t get into a panic; and then I really have to pay attention to where I’m going.

When I go back a week later, I have to review all these pointers, and pay careful attention to landmarks along the way. When I recognize that I am going the right way, I'm proud of my success. 

I did live in this region before, so it’s not completely overwhelming, but one place I now visit frequently, Santa Rosa, I now approach from the opposite direction. Instead of coming from the west, I now arrive from the southeast. At first I was totally confused. 

I could not figure out how to get to one congested, busy street, Santa Rosa Avenue. I had to get on the freeway! But last week, when I visited the Peace and Justice Center on Sebastopol Road, I saw where Santa Rosa Avenue begins. Suddenly the pieces fell into place. Of course! This is the way we used to go to Toys R Us! Now I know how to get to all the Big Box stores that we don’t have in Sonoma.

As I tromp into the kitchen to get a glass of water and reach – again! -- for the wrong cupboard, I notice that if I pause to remember where the glasses are, I can feel my mind come into focus, with improved results. Like an absent-minded professor, I’m always thinking about something else. I have to pay attention to what the body is doing, to remember where the glasses are now. 

Like absent minded professors, many older adults are not necessarily senile; they are just focusing on what they are doing. Langer’s research has shown that even very old people can behave more youthfully if they practice paying attention in this way.

Moving to a new place is more disorienting at our age; but it can have this unexpected benefit. It forces us to be more mindful of what we’re doing, carving new pathways into old brains grown lazy from habit. We can do the same thing without relocating, just by taking a new route to the library, or even rearranging the furniture.

Either way, we have to be willing to try.

[NOTE: This blog is the second in a series about my recent move from Santa Fe to Sonoma. To read them in order, start here]

To Move Or Not To Move

Moving to a new location is challenging at our age. I know. I just moved from Santa Fe, New Mexico, to Sonoma, a medium sized town in Northern California. Even though I used to live on the other side of this county, and spent 36 years of my life in the San Francisco Bay Area, it's been quite an upheaval.

Of course it has not been as challenging as when I moved to New Mexico in the first place! The two places are dramatically different. I had never lived in the desert, and I missed water so much I literally cried when I stepped up on a viewing platform on Sandia Mountain and saw a little watering hole that I couldn't approach!

California is a big, busy, bustling state with the country's largest population, and New Mexico is a big state with very few people. I had been living in the country; now I was in the middle of New Mexico's biggest city, Albuquerque, an appallingly flat town with six-lane avenues criss-crossing its sprawling breadth, and an unvarying bright blue sky that produced very few cloud formations, certainly none of those thick coastal fog banks, or buckets of rain all winter long. What passed for cuisine was almost always meat with chili and a pile of unsalted pinto beans, and there was no such thing as medical marijuana. California, the vanguard of America, is on the cusp of the future, while New Mexico cherished its history and seemed to cling to its lingering past, even though it's riddled with colonialism, racism and poverty.

But the biggest challenge was my state of mind: I was at my wit's end. My children were both embarking on lives of their own. Real estate values were about to plummet and I was afraid my house would end up under water. I had lost my job as editor of a small paper and there were no new jobs around. My life had hit a wall and it felt like I was about to die if I didn't do something else.

So, I went to New Mexico, with a very unclear picture of what I was going to do there. During the first months I longed for everything about my old home: my kids, my house, my dog who had passed away, the cats I had left behind, the friends I had known for forty years.

It was strange that nobody knew me, not even a clerk at the grocery store. I didn't like the feeling of being unknown and uprooted, and many mornings I cried.

When I moved to Santa Fe, things picked up a bit, but then my health fell apart. I stayed in the City Different for six years, much longer than I had anticipated, always thinking I needed to go back where I came from and somehow being stopped. Suddenly last April, everything came together, and in May I had an apartment all approved. I had only to -- shudder, shudder -- dismantle my life and leave. Yikes! What had sounded great was suddenly overwhelming. I would have welcomed any excuse to stay put, but the gods seemed to beckon me west. It would have been ungrateful to refuse.

This move was a return, not to the same house or even the same town, but back. I had roots in this land -- I remember when I grew them, but that's a story for another time -- and the land of golden hills had not let go of its hold on my heart, no matter how much Santa Fe had become a cloak that well suited me.

It was hard. Some people called me "courageous." It was nice to hear, but on some deep level this wasn't about courage. It was something I had to do. Leaving after so many years was hard but it was definitely good for me. I'll tell you more about it in my next post, which by the way you can also view at my new blog, Moving Right Along, at wordpress.com/ as soon as I set it up.

Wherever you are, have a great day!

Old Age: Is it all about dying?

Now that death is the last spook to come out of the closet, a fascination is setting in. People want to talk about a subject that has been tabooed for centuries. And actually, it's a fascinating subject. Like most taboos, it reverberates with many levels of meaning and emotion; whenever someone dies, whenever we contemplate our own death, we are elevated for the moment into the arena where the eternal lurks, now stripped from the shroud of mystery that usually keeps it from sight, stimulating right-brain contemplation of what our lives are all about. So long as death remains unspeakable, then some of our most profound thoughts must be held in solitary silence, only to vanish like wisps into the twilight.

What then is accomplished by talking about it? We come to realize that we are not alone. Pretensions and masquerades fall to the wayside as we explore who we are in the face of the infinite.

Talking about death is an opportunity, then, to become more intimate with one another, and even to process our deepest fears.

Two years ago, Jon Underwood started something called the Death Cafe, where strangers come to talk about their experience, "To increase awareness of death with a view to helping people make the most of their (finite) lives." Since then, Death Cafes have been springing up all over, in a variety of locations, even online. Comments at the web site suggest that people who attended the most recent event were quite satisfied by the experience, and that it encouraged greater intimacy and authenticity.One has just formed here in Santa Fe, in a nice little restaurant just down the street from where I live. I'm planning to attend next month, and I'll share my experience with you here.


Last week, on June 6, I went to a meeting at the Academy for the Love of Learning, a uniquely Santa Fe sort of place, where classes wed intelligence and consciousness for the purpose of transformation, "to build a new model that makes the existing model obsolete," to use Buckminster Fuller's words.

The Academy has a lovely website and is located on an equally lovely 18-acre property just outside of town, that once belonged to the conservationist Ernest Thompson Seton, who erected a castle there as his home. The castle burned down in 2005, unfortunately, but the Academy built an entirely new facility there, following green building principles throughout.

The Academy has just launched a "community conversation" on the topic of creative aging. Its first meeting was promoted as a discussion of life's "third stage." Molly Sturges, who helps very old people compose their "lifesongs," was one of the facilitators, and Acushla Bastible, a multidisciplinary theater artist, was the other.

Right off the bat, the conversation headed toward the topic of death, dying...and the critical question of care as we approach the end of our lives.

After a bit, I started to squirm. I don't object to the topic, but it wasn't what I came for. My interest was in the whole question of how people age, and how to do it wonderfully instead of sinking into the armchair of decrepitude soon after retirement. I'm one of those who wish to see aging re-imagined and redefined, a new model that will make the old one obsolete, as Fuller said, and that's what I came to hear.

Illness among the "frail elderly" and the inevitable ending are fine topics, but I am "staying alive" right now by focusing on living. There is still quite enough to be concerned about -- maintaining one's health, a demanding topic and a full-time practice in itself; taking care of finances, even more difficult for me; relationships with adult kids and with each other; geopolitical issues that confront our aging world; and, you know, having a bit of fun, when possible.

So I said, "When I moved to New Mexico, I was 62 years old, and one of the first things that happened was that I realized that getting old was not just something that happened to other people. It was happening to me. And I was not prepared for it."

I talked a bit about confronting that reality, and with it, the reality of death. "But you know," I went on, "once you go through that tunnel, the one that leads to your own death, and you deal with that, it's transformational. Afterwards you don't feel the need to talk about death -- at least for awhile."

I realized that I had come to understand what some of my older friends had told me in the past when I wanted to talk about the connection between death and aging. They wanted to focus on living. Death would come of its own accord fast enough.

I'm happy to say that conversation shifted after that, and many fine insights were shared.

If we are serious about transforming the experience of aging, we need to talk about the many ways that old ideas, fears, and expectations color our attitude to this time of life. Dying is certainly an important topic, but it's the prospect of dying, the reality that it lies just around the bend, that challenges us to grow in our lives, to live while we are alive, and to find joy in life despite the limitations that accrue with age. That's a big enough challenge to conquer, and its fruits are profound, for the vitality that results from living fully in the present is surely one of the great gifts of age.

I'm interested in your comments! Please do say what you feel, below.

And I'll be back -- after the Death Cafe, if not before.

When It's Sooo Hard to CHANGE!

Ken Rutgers (not his real name) lifted his shirt over his floppy paunch and stuck a needle into his tummy. He let the shirt slide halfway back into place and then wheeled himself closer to the table, where he proceeded to dive into a Macdonald’s hamburger and a streudal.

“Diabetes is such a drag,” he said to no one in particular. Receiving a sympathetic nod from me, he went on to say that he now has to test himself four times a day and give himself insulin every time he eats.

A few of us had remained in a workshop room at the American Lung Center during a lunch break from a training in Stanford’s Chronic Disease Management Program, which has just been updated. This excellent program is offered all over the country, as well as internationally, and it's free. It can also be taken online.

Ken is a Master Trainer. He is also a Vet, from the Vietnam War I would guess, and he works mostly with other vets through the VA.

Later on, after I led a discussion about what stops us from keeping up our exercise program, Ken offered that he just can’t get himself to exercise.

“I never have liked exercise,” he said. “I’d rather watch a movie.”

“But doesn’t it make you feel better?” I asked.

He shook his head. He has tried it. He’s gone to the pool, and after an hour of pool walking he comes home feeling worse. As for chair exercises, they do nothing for him.

I wondered why he had brought this up, unless it were in hopes of getting some help with this problem, since everyone knows exercise is good for you, especially if you’re dealing with a difficult chronic illness like diabetes. It’s one of the most important things you can do to have a better quality of life with a chronic illness.

The other healthy practices include mindfulness, a good diet, medication and a good relationship with your physician, healthy social interactions, and spending time in nature, fresh air being a great remedy in itself.

Ken knows all this – he teaches it to the Vets in his workshops! But clearly he is unable to do it himself. That might be a good thing, in a way – he certainly can’t look down on the people in his groups who simply can’t get themselves to do things they know are good for them. But it’s not good for Ken!

Exercise is so important for a person with chronic illness. For those of you who are diabetic, you’ll find lots of tips at the Diabetes Self-Management Web site. There’s an excellent book you can order from the site, and it’s only $6. For people in wheelchairs like Ken, there’s specific advice here 

I liked Ken, and I drove home from the workshop thinking about motivation and how it works. I have trouble exercising, but I do it. If I don’t, my back starts to hurt and my gait becomes uneven. When I do my exercises at home or at the gym, I feel much better. My relationship with my physical therapist, and hours of PT sessions over the past three years, have finally convinced me that exercise is probably one of the most important things I can do for myself; and even then, I have trouble working it into my routine! 

My problem has been that morning is the best time for my writing, and typically that is also when I try to exercise. A recent article in the New York Times clued me that afternoon may actually be a better time. The jocks at the health club I go to seem to think it is; that seems to be the busiest time for muscle building! Afternoon exercise is working better with the flow of my day.

Change isn’t easy and requires a lot of motivation or will power. My motivation is a negative and internal one – to avoid back pain. (According to Jim Taylor in his blog “The Power of Prime,” at Psychology Today, there are four types of motivators, positive and negative internal, and positive and negative external.) Taylor is a PhD specializing in the psychology of business.  He says the first step is to make the decision to change.

My guess is that Ken hasn’t made that decision; he is more interested in getting sympathy for his problem. But from his tone it was also clear that he’s uncomfortable with this situation. While not exactly committed to making change, he’d like change to happen.

Discomfort can be one of the primary internal motivators for making change, but clearly, it’s not sufficient in Ken’s case; something else is blocking his willingness to do the work of changing, which Taylor calls “the Grind”; success comes from willingness to do things you don’t particularly want to do, and persisting even when the results are not visible. Here’s where the effort comes in. To triumph, you must be completely dedicated, says Taylor, referring to the third “D” in his Three D’s for change.

Taylor’s scheme is based on will power, and judging from his career, I'm sure his is strong and active. To change a bad habit, say successful people, you summon your will power. Alas, some people are unable to do that. Is that because they are lazy or weak? That is what we tend to think, for it is what our system of Western ethics has taught us to believe, that we have free will and if we don’t use it, “there’s no one to blame but ourselves.”

But Ken does not appear to be lazy. A man in a wheelchair, he manages to get himself to the Vets’ hospital to give these workshops on managing one’s chronic illness on a regular basis; in fact, he has given more of them than anyone else in the program, even when there’s no money to pay his stipend! Like most of us, he’s motivated about some things, but not others.

Here’s where it gets complicated.

Dr. Gabor Mate is a Canadian psychiatrist who works with people addicted to heavy drugs. In an interview on Toronto television, interviewer Steve Pakin asked Mate about the role of will power in overcoming addictions. He said,

“Will power is a complex matter,” said Mate, because “the circuits in the brain centers which make conscious decisions are very weak, and they are much dominated by our impulses, which come from deeper centers in the brain, and the gap between an impulse and a decision is only a split second.”

No wonder it's so hard to change our habits! 

This gap between impulse and decision-making is true not only of addicts, but for all of us. It means that if you think about going to the gym when you'd really like to lie down, the chances are that you will lie down first and then think about going to the gym “later.” No wonder it's so hard to change our habits!

We’ll look at motivational blocks in our next post.

Alone with Invisible Chronic Illness?

The grocery store is a place I like to be, especially a store packed with fresh, live produce, with good cuts of meat not pre-wrapped in plastic, a grocery store that smells like food and not like (gasp) Febreze or detergent.

But when I was sick with colitis (or IBS, or whatever you want to call it, since doctors don’t seem to agree) a trip to the grocery store almost always included a rush to the bathroom.

And what did I do with my three-year old son? Now many years later, I can’t remember. Probably, to his chagrin, he came to the rest room with me.

These are some of the unseen challenges of what has since been named Invisible Chronic Illness (ICI) – symptoms like the severe chronic pain that comes with fibromyalgia; nausea and cramps with irritable bowel syndrome; fatigue that is the hallmark of chronic fatique syndrome and many other conditions; depression from having to put up with all these things, and the isolation that illness inevitable produces.

So it is surely a blessing for people with ICI that the Internet now offers a forum for interaction with other people contending with similar difficulties that keep them at home and alone.

In September, I listened to some of the speakers at a virtual conference on ICI. You can still hear many of the presentations by visiting the page.  Life Coach Trish Robichaud spoke about her own difficult recovery from heart surgery; she also suffers from multiple sclerosis and chronic depression. Former athlete Tiffany Westrich offered tips for coping with the threat to a person’s sense of identity when you can no longer do the kinds of things that once defined you. Many other talks were offered on various topics connected to coping with life when life becomes transformed by chronic illness.

This morning I’ve been reading some of the blogs that are also available at this heartwarming site created by Lisa Copen, herself a victim of ICI. Lisa has had rheumatoid arthritis (RA) since she was 24 but she manages to raise her son and stay in her marriage, writing books and updating her site(s) at 3 am when she can’t sleep. She has made chronic illness her ministry http://restministries.com/, and through this work she offers tremendous support to people isolated by their health struggles.

And it is surely needed. Isolation, unfortunately, is one of the key difficulties of living with invisible illness, or with any chronic illness for that matter. And when it isn’t apparent that you’re unwell -- when “you look so good,” as friends like to tell you – and people find it hard to believe you are sick, the widening gulf between you augments your sense of separation from the everyday, “normal” world. Some people will even think you are faking it, that you didn’t come in to work because you are lazy; or that you are just plain mentally ill.

This lack of understanding from others is one of the chief challenges faced by the people who write on these pages…that friends, neighbors, co-workers, and folks they meet on the street (when they do manage to get out of the house) don’t understand what’s going on with them.

“Jen” speaks eloquently about this problem in her post “What You Don’t See” at her blog Meditatio: My World As It Is Sung. After running through all the things that may be going on with her when she doesn’t greet you on the street – she has fibromyalgia, which causes terrific pain, and with that comes depression, migraine and IBS – she winds up with this short message: “So please… don’t assume you know what is going on with me or with the average person on the street. Many of us have chronic conditions that we appear to hide well but are still just as real as the ones that manifest outwardly.”

Several people comment to say Wow, who knew, and also, How judgmental we have been! “Stacy” writes, “This post does bring to light the need to be compassionate at all times, no matter what we *think* is happening.”

If there’s a gift hiding behind every dark cloud (and I tend to believe there is!), a message we can receive from the sufferings so many people endure today, inexplicable as it may seem, then perhaps it is that very realization: That the person who snubs us in the grocery store or who explodes in anger over the loss of a parking space or wears sunglasses at night may actually be in need of our compassion, not our judgment, not our wrath.

It’s an important lesson in a wrathful, hostile world, a gift that we may receive in deep gratitude, as we open a door or carry a package for someone who might really appreciate being seen as they cope with one of the most difficult challenges in life, and sadly, one of the most common.

More about ICI in the posts to come. Thanks for reading! 

After the surgery, pill addiction?

It was my physical therapist who alerted me that I might be addicted to hydrocodone (Vicodin), a drug I have been taking for nearly three months since my hip replacement surgery.

I had told her that when I didn’t take it, I started to feel a stinging, achy feeling in all of my joints, similar to having the flu; and she said that sounded like I was addicted.

She suggested that it might not be wise to stop using it immediately. Didn’t the doctor say anything about how to wean myself from it?

He did not say a thing. Maybe he thought this 68-year old woman was not likely to get hooked. But anyone can get hooked, and many of the people who are addicted to hydrocodone are people like me, who started taking it after surgery and just couldn’t get off it.

Addiction to pain pills is rampant here in the state of New Mexico, which is now first in illegal use of these opiates that are routinely given for severe pain. Seems like any doctor ought to know how to help patients stop using it. There’s a drug that can be administered to assist in that transition; it’s called Suboxone.

Hydrocodone was first introduced in the 90s to replace codeine, allegedly to avoid codeine’s constipating effect. Turns out hydrocodone and oxycodone (Percoset) are just as constipating; all opiates interfere with the peristalsis of the stomach that accompanies digestion.

Over 50 additional side effects of hydrocodone are listed at Drug Rehabs, http://www.drug-rehabs.com/hydrocodone_side_effects.htm

Of course that list doesn’t include the much more serious side effects of taking acetominophen, which is always included in hydrocodone pills along with the narcotic. Acetaminophen in large doses causes liver damage. Warnings to that effect are now pasted on the bottle, but in the early days of hydrocodone use, patients were not informed.

This is the helpful painkiller we were given to replace codeine, and we may well ask what was so wrong with codeine that we needed a new drug with all these risks attached to it -- including that fact that it’s far more addictive, so much more addictive that it’s now in demand as a street drug?

PubMed lists only 16 side effects for codeine, which is a natural opiate, unlike the synthetic form used in hydrocodone. Codeine is still used, but if you want to get it for major pain like surgery you’ll have to practically stand on your head in the doctor’s office. Is this insistence on hydrocodone for our protection, or does it protect the market for hydrocodone? To my knowledge there are no advantages to hydrocodone over codeine.

After Julie, my PT, suggested the possibility of addiction, I found I was able to reduce the dose immediately to half a pill twice a day; but two weeks later, I am still taking that dose for the flu-like symptoms! It’s surprising how uncomfortable those aching joints can be, perhaps because my body starts thinking I have the flu and ought to be in bed.

So it’s not just the hip surgery one has to recover from – but the recovery!

Maybe medical marijuana would be a better solution. I’ve used it, it works … but that's a topic for another blog.

Through The Surgical Tunnel

  “I was very, very depressed after this fall,” R. said in her deep, soft voice – a soothing voice that must have been considered alluring during her youth, when she lived in Big Sur and worked as a server at the famous Nepenthe’s Inn.  Now she is 76. She fell one day around Christmastime last year, when walking her dog. A neighbor saw her on the street near her home in Santa Fe, unable to get up, and took her to the hospital. The hip was broken.

“I wasn’t sure I wanted to live any longer,” Sylvia added. “But little by little it’s getting better.”

I suggested that it might have something to do with the drugs. Painkillers are basically downers. Of course it’s also a shock to find that one has become so vulnerable. A tug of the leash, and the walk is over, for six months or more.

In fact, a hundred years ago, as my Buddhist friend Jay did not hesitate to point to me after my own fall, such a break would likely have been fatal.

You go to bed, and you lie in pain, waited on by unwilling relatives; and maybe the bone heals, maybe not; and maybe you “give up the ghost” (a wonderful old phrase that you don’t hear much anymore), and die.

Now you have surgery, the leg is set, you are up on your wobbly feet in two days, and then you start doing physical therapy. A few months later, you are on your feet again.

Given this illuminating historical perspective, it’s somewhat surprising that we don’t wake up after surgery stunned, but grateful. Instead of shouting, “I’m alive!” we may wish we had already died. Perhaps the nervous system, recognizing that the experience was life-threatening, does not know how to update itself.

Or this depression may be due to the ambivalence we feel, especially as we age, about the value of our lives, the death wish (thanatos, according to Mr. Freud) struggling against the life wish (libido) until, needless to say, death wins out.

But as I considered my own experience after a recent surgery, I learned that it is the anesthesia administered during surgery, more than the painkillers that follow it, which may have a very disorienting effect on many people.

There is even a name for this condition, and, naturally, an acronym: Post Operative Cognitive Decline (POCD). This decline was first identified in elders after cardiac surgery, but it turns out that orthopedic surgery can have the same result, even when it’s elective. (When surgery is mandatory, after an accident, one might expect POCD to be more common, as trauma is known to be associated with loss of control; and trauma can lead to depression.)

In any case, POCD is caused not by the drugs per se or by the trauma, but by the effect of the anesthesia on the flow of oxygen to the brain. This reduction of oxygen supply, however brief, is likely to have negative effects on cognitive ability. Now scientists are researching ways to minimize this loss, particularly in the elderly. In one study, research showed the value of “intra-operative monitoring of anesthetic depth and cerebral oxygenation as a pragmatic intervention to reduce post-operative cognitive impairment.”

That’s the scientific angle, the one likely to produce helpful surgical interventions. Now that we are living longer, it will be helpful if the various orthopedic surgeries some of us must endure do not accelerate cognitive decline! I have not had the opportunity to ask my surgeon, but I assume the cocktail used in my case was adapted for this very purpose. The nerve block I was given before going into the OR is intended to reduce the need for anaesthesia. I do know that I had no trouble breathing when I woke up, a good sign!

Even then, I definitely experienced a journey into the twilight zone that became more evident a week after the surgery and continued for about a month. Part of that experience was a curtailment of my ability to think clearly. But another part of it was more like Sylvia’s depression. I, too, wondered whether I wanted to go on living; the very question seemed to bring on a wave of hopelessness. My physical condition, though a temporary one, seemed chronic, timeless, a new state of being that I resented, that capped my ability to make up for whatever I had failed to do in this life thus far.

I had a lot of very colorful dreams, most of them bizarre and alarming.

Looking back, it feels to me as if I had entered a dark tunnel, not of cognitive decline per se, but of life review that seemed preparatory for death, even though I knew I was not dying.

It was a descents into a subconscious region, where it seemed the body itself, stirred and jumbled by the surgical intervention, released buried complexes regarding self-worth and purpose.

One morning, after a long meditation, I bumped into an old belief – that I needed to somehow be Great in order to deserve my life. That belief had been with me since childhood, an ambition passed on to me by my mother, who wanted to be a great writer herself!

Exploring this lifelong negative fantasy, I discovered that I did not have to have a justification for living – I did not have to reach for some vaunted, special goal in order to prove my worth.

I just had to set my sights on realistic, attainable goals, and try to be a good person while I carried them out.

This was quite a profound realization. Ultimately it offered great relief…but first I had to process the realization of how unattainable my goals had been all these years. I couldn’t get out of the tunnel until I had conducted this painful review.

Meanwhile, as time passed, my body continued healing. What a miracle that is! And as I regained the use of my legs and made my way into the light of day I knew the journey had fixed something more than the hip.

I had revisited an ancient complex held in the bone since childhood, when it was first discovered that my hips were out of place; and it had been released.

It had been, after all, despite the modern technology, a shamanic journey, and I had come back to life having retrieved a lost piece of my soul.