Picture for yesterday

Brother M. sent me this picture of what I was describing yesterday:
It kind of highlights the difficulties of lens choice; to capture the people, the birds become invisible. If you blow it way up, you can see groups of cranes and ducks flying near the horizon. Also the stubble is full of grey blobs; each is a sandhill crane. Brother M and I have our binoc's trained on an absolutely enormous flock of geese coming in near the levee, a couple of hundred meters away. The tall guy at the back was the naturalist who was leading the workshop. I forget his name, but he was able to name each kind of goose and duck, some even as tiny, distant silhouettes.

Harbingers of Spring

Spring is coming to us here in Oregon, in its messy way. Yesterday, the Real Doctor and I got out the tandem and rode out to the house at Oak Creek. In the course of that ten mile ride, we experienced bright sunshine, overcast, rain, sleet, snow, and (again) bright sunshine*. At the house, the daffodils are starting to bloom, and some of them have even avoided becoming garnishes for whatever salad the local turkeys eat. As we were talking with a neighbor, we were interrupted by the classic spring experience: over the noise of the wind and occasional logging truck, we heard the classic “rusty windmill” sound of cranes.

Looking around, we spied the largest flock of migrating sandhill cranes I’ve seen in my entire life—more than a hundred of them, arranged in a huge, north-pointing V. By the time they were overhead, the racket they made (and the jaw-dropping sight of these birds) made conversation impossible. These wonderfully elegant birds and their creaky song of spring are what I tried to remember later, during our ride home, to counter the miserable winter weather and my miserable winter legs.

It may have been these very same birds who cheered me up a couple of months ago. I was driving home from a tiring stay with my parents (it was essentially a two-month long siege to get my mom to accept some help dealing with my dad; I was successful, but psychologically, I was a wreck). Brother M., the Bay Area high school biology teacher, had mentioned that he was going to be doing a workshop in the Sacramento Delta that day, and I said wouldn’t it be wild if we could meet up. We both sort of laughed the idea off.

So there I was, driving past the giant wind turbine near Tracy after five boring hours behind the wheel, when brother M. calls me and asks where I am. I had gotten a really late start, and was about two hours behind my anticipated schedule, so I thought there was no hope of meeting him. However, he was a little more sanguine; apparently these workshops move at a leisurely pace. He called again as I was leaving Stockton, and over a garbled cell-phone connection he gave me the instructions: turn off at this exit, go under the highway, go straight over the bridge, turn left at the second turn, go past the silos, past the gate, and we’ll be at the bend in the road. It was everything but knock twice, whistle “Annie Laurie” and say that Joe sent me, and impossible to remember. So, when I got to that exit a few minutes later, I just stopped under the highway and called him up. He said “Great. JUST STAY THERE.”

So I did, and he (and five other high school teachers) rolled up about two minutes later—an improbable feat of coordination considering that I had left from Los Angeles and he had left from Burlingame, spent the day kayaking and birding and hiking in the Delta, and was just about to hit the last stop on his day’s tour. I followed his car straight, over the bridge, left at the second turn, past the silos, past the gate, and there at the turn in the road was a dozen other people, all with spotting ‘scopes and binoculars.

Right there. The unlabeled road is Staten Island Road.

It was easy to see—and hear— why this soggy field of corn stubble was special.

The sunset sky was full of birds and their calls. It was full of birds to the point where it seemed that there wasn’t room in the air for any more birds as their flocks wheeled around to find the best place to spend the night. It was so full of their calls that we sometimes had to shout to hear each other. There were flocks of hundreds of geese and ducks of several different species, and so many cranes! As crowded as the air was, the stubbly fields were just as crowded—this field was the place to be if you were a goose, that one was the dancing ground for the elegant but noisy cranes. The fat, red sun sliding behind Mount Diablo did little to warm the chilly November air, but it provided a perfect backdrop for the elegant flight of the cranes.

After a while, I gave up on the binoculars that I had been offered by another teacher. The sun was down, the sky was darkening, and I just wanted to lose myself in the raucous avian scene. When it was too dark to see anything, I bade brother M. adieu and continued north with a much lighter heart. While I was dealing with my parent’s situation, it was real work to keep up my desire to deal with another day. It was tonic to see all these beautiful creatures, screaming at me, at each other, at the universe, “LIFE! LIFE!! LIFE!!!” Spring sings this biological imperative too, and yesterday maybe some of those same birds tried to remind me of it.

*and by the way, I heartily endorse Showers Pass brand cycling rain jackets, made in Oregon. They are far and away the best I’ve every tried, keeping me and the Real Doctor dry and comfortably warm--but not hot--no matter how crappy the weather or how hard we’re working. Never wet from rain, never clammy from sweat—I’ve never experienced that with any other garments.

Friday Flora

Not all is crisis. My mom's garden is still better than yours.




"The force that through the green fuse drives the flower" seems appropriate at all levels now.

View from front porch

I love the ecliptic. It makes me feel connected to the rest of the solar system. As I stare at a planet's progress along it through the night (and through several nights) I can feel the earth rotating.

Jupiter, Venus, and the new moon--if you click on it to make it bigger, you can see the crescent and the "dark side" lit up by earthlight. If I were a little earlier, I would have gotten Mercury. No tripod, just propped on a post. Here's a different exposure (same shutter speed, but top is with the ISO maxed out, the bottom with lower ISO but some manipulation in the program Aperture). Which do you like better?

Soul

As a result of spending a couple of weeks in a hospital bed, my father’s physical abilities have diminished markedly. He’s improved after two months at a skilled nursing facility, but getting up from a wheelchair can sometimes be fifteen minutes of hard work for him and three other people. His mental abilities have deteriorated during this time as well, the disease robbing him of words and the last vestiges of sense. He is dependent upon others in a way that he hasn’t been since he was a year old.

There are few things that my dad knows any more, but to a degree he knows of his dependency. The other day, one of the caregivers and I worked for ten minutes to move him from wheelchair to bed. He was tired out from it, but once he got shifted into his final position, he politely thanked us. He’s done that since I was taking care of him last year. My patience as a caregiver would be utterly used up by the time I got him into bed at the end of a furious day of sundowning. My mind would be swarming with the insults and anger and paranoia of the previous six hours—but after I turned out the lights and said goodnight and tried to get an hour to myself, he’d call me back, and then say, sweetly, “Thank you. Thank you.”

Alzheimer’s disease is a haphazard thief. It takes this, it snitches that. If my father’s personality were an encyclopedia, the disease has been ripping out random pages for ten years. But, looking at such a decimated encyclopedia, you could still tell that the section on “Education” was originally much bigger than the section on “Exercise.” My dad no longer speaks with much coherence, but you can still sort of tell what was important to him. My ego would like to believe that my existence as a son was more central to my father’s being than making sure that his laboratory was adequately supplied. However, he hasn’t recognized me in months, and his babble never mentions family. It tends more towards making sure that the jars are labeled and that the columns have been packed without bubbles and that the meeting should adjourn.

So, was the essence of my father “professor of biochemistry”? My father’s child, a scientist raised by a scientist, knows about emergent systems—billions of neurons making factorial numbers of connections, shaped by a unique combination of genes and history produced the personality I called Dad. I know also that malign disease is randomly killing individual cells in his brain, and each death murders a billionth of my Dad’s self. In this view, there is no essence, no center to the soul—just a picture, once sharp and detailed, losing resolution until it becomes a uniform wash.

There’s a belief in many religious traditions that a harsh asceticism can bring the soul closer to the divine. Possessions, adornments, the body, a developed intellect, the ego—the soul is obscured by these thing like a diamond buried in a turd. Orient or Occident, you can find the belief that radical, sometimes violent simplification can bring the soul out of this pollution and let it shine. Over the last years, I have watched Alzheimer’s disease simplify my Dad, purging what a more voluntary ascetic might call pollution, but what I knew as his self. Is this disease distilling my father to the essence?

What is (and was) my father’s essence, his anima, his self, his soul? What is the last thing left, when almost all has been stripped away? I’m left wondering this after a day with my dad. I see all these things: a man robbed of all dignity but still capable of gratitude; a few random crumbling scraps of an encyclopedia; a self fading into a blur of nonbeing, leaving behind just animal functions; the distilled essence of a person. There’s truth and solace and pain in each. If I could, I would choose to believe that when my father’s self or soul has been so violently stripped of its ornaments and adornments, when its intricacies and complexities have been obliterated, that what remains is a simple, heartfelt, open sense of gratitude.

I am my father’s son, so I know this is a half-truth I tell myself to soothe a jangled psyche. It’s a nice half-truth, though, and its company is pleasant in the middle of the night.

Monogamy

There are some stories that may be apocryphal, but they’re too good not to be true. For example, a friend of mine worked in a lab that used marmots as experimental models for sleep research. This makes sense, since marmots are champion hibernators. However, there were some difficulties adapting them for laboratory use; one issue that my friend told me about is that marmots are also champion monogamists. The laboratory kept their marmots in standard single-occupant rack cages, but did not reckon on the uxorious urges of the monogamous marmot. Marmots would regularly break out, wrecking a cage in the process, and break into the cage of their partner, wrecking a second cage. The researchers would come into the lab and find a rack of expensive scrap metal, and wide-open cages inhabited by two smug-looking marmots. Marmots don’t want freedom; they want each other.

I was reminded about these hi-fidelity marmots by what’s been happening with my parents over the last few weeks. My parents have been married for fifty-something years, and for most of this time they’ve been inseparable. I can recall a few trips that my dad took without my mom to scientific conferences, but these were short and infrequent. Pretty much, where one went, the other went. It’s old-fashioned, but a lot of my mom’s identity is that she is my dad’s wife.

However, my dad’s Alzheimer’s disease is prying my dad away from my mom, and this is not good for her. My brothers and I have seen it coming, and have been trying to ease her into it. We regarded it as a great success when she went for a week-long trip to a college club reunion without my father. Lately, however, things haven’t gone so well.

My dad has spent almost the last two months in hospital and skilled nursing facility. My Mom couldn’t drive to go see him, and her short-term memory has deteriorated enough that she couldn’t take the bus by herself. So, she’s stayed at home. I or one of my brothers have been there most of the time, and she’s been taken to see her husband every other day or more. She watches as he is fed, or led through physical therapy, and she just crumbles with sadness at her beloved’s condition. Once she gets home, she is lost; absent her husband, an oppressive mental fog descends. She doesn’t know where he is, why he’s away, how long he’s been gone, when he’s coming back, whether he’s safe or wandering the streets of Santa Monica, whether she’ll ever see him again. She gets more and more upset ‘til she dissolves in tears, despite having one of her sons telling her over and over exactly what is happening. It is awful to see.

My mom’s husband is home now, so things seem to be a little better for her. She is beginning to realize (but definitely not accept) that things will forever be different. There will always be a nurse present (and threatening her sole possession of her husband), and while her husband’s body is home, he will never completely return.

My mom’s identity used to be half made of her husband—a beautiful, lovely ideal for a marriage, and one that I ardently hope I can live up to in my own marriage. As that half of her identity crumbles and decays, we’re left watching the remainder of her psyche teetering. Out of devotion to her husband, she sometimes seems content to let everything go. Her children—and sometimes even she—know that she needs to recast herself, which is terrible hard work. The habits of fifty years are hard to break, and the marmotic urge that will move heaven and earth to be with one’s life partner is hard to resist. Too often what we know we ought to do, and what we actually end up doing, are diverging roads. My brothers and I are a bit on edge about which road my mom will steer us all down, and whether she’s even capable of steering at this point.

I know another story about monogamous animals, considerably less cute than the tale of the marmots, and I know this one is not apocryphal because I saw it with my own eyes. There was a pair of birds that had just plighted their troth and set up their nest near our house in Sacramento. One of them, alas, got hit by a car then run over. Let me succumb to the fallacy of attaching human emotions to the actions of animals, and say that its partner was grieving—it wouldn’t leave the feathery blotch of roadkill, and flitted around it, maybe wondering why it wasn’t responding as it had just a few minutes ago. I was about to shoo it away, maybe move the corpse, when the inevitable happened. A car sped up the street, radio blaring and driver texting. The two birds, so recently together in life, were now together in two-dimensional death.

But, you know, who’s to say that’s an unhappy ending?

Freedom!!!

There are certain life experiences that would seem to inevitably shape some political opinions. A nasty case of food poisoning might lead to favoring some government intrusion into the food-service marketplace, while spending money to meet a frivolous and overly broad regulation might make one resent big government. (That said, I can’t think of how real-life experience in the modern Western world would make you a hard-core libertarian.)

In the last couple of months, my father’s health has deteriorated, consuming a large amount of energy and attention and money from me and my family (and curtailing my ability to blog). As I’ve noted, he has an advanced case of Alzheimer’s disease; over the holiday season, this was complemented by episodes of “severe rectal bleeding” leading to plummeting blood pressure, dehydration, weight loss, two trips to the ER, a hospital stay, and a couple of months in a Skilled Nursing Facility ("SNF," pronounced "sniff" by those in the know). He has just left the SNF, and is now at home, in a room that we have filled with rented medical equipment; he also has the round-the-clock presence of home health nurses.

Things could be a lot worse; he has health insurance from his former employer, long-term-care coverage (also through his employer), as well as access to Medicare and MediCal, and VA coverage for his stint as a private, first class. His insurance situation is the fruit of a long career of hard work at a single institution, and is excellent by American reckoning.

This is not to say that things could not be better. I’ve spent the best part of the day on the phone with his doctor, the doctor’s office staff, the SNF discharge counselor, the SNF insurance and billing coordinator, two medical equipment rental services, the long-term-care insurance company, the long-term-care insurance company’s record collector, the doctor’s group’s record service, the home health nurses, and the home health nurses’ agency. Yesterday was similar, and I and both of my brothers have had plenty of other days along the same lines. With few exceptions, none of these entities seems to be able to communicate with any of the others. I’m left wondering what will happen when my father has another acute episode. I’m also left wondering why in the world this country, supposedly so advanced, doesn’t have a single-payer health insurance system for all.

The Real Doctor, it should be noted, works for a government-run single-payer system that works for a certain segment of the population that is neither especially healthy nor wealthy. It is not without flaws, but it provides affordable and generally good care with an endurable wait. The system is nationwide and uses a paperless record system, making communication within this system relatively speedy and simple. (In contrast, a couple of the players I’ve been dealing with today haven’t been talking to each other because one only uses fax and the other only uses snail mail. As a result, simply beginning the process of processing the long term insurance claim has been held up for weeks.) The Real Doctor is of the opinion that for-profit health care is a road to immorality.

The Real Doctor deals with some bureaucratic headaches, but she knows from experience it could be worse. She no longer has the quivering nightmares that were brought on by the ethical compromises necessary when she worked at a for-profit HMO, which had its own well-padded bureaucracy. She could be earning more if she worked for her own private clinic—but that would mean the stress of being an employer, expensive malpractice insurance, and even more pressure. As one of her colleagues (whom shall remain unnamed, but who she describes as “one of the most thoughtful out there”; if you really must know who, send me an email) wrote on a message board,

Most glaucoma docs want to make a reasonable income – reasonable by most people’s standards. But to do so requires seeing LOTS of patients. I have heard of ophthalmologists that see more than 80 patients a day. Assuming they work for 8 hours seeing patients (8 hours seeing patients usually means at least a 11-hour day), they will spend about 6 minutes with each patient and not eat or urinate. If they actually see patients for 7 hours (which is probably considerably longer than characteristic for most ophthalmologists) they will spend 5 minutes with each patient. I cannot conceive of any way I can learn what my patients need to tell me, examine them and then counsel them appropriately in 5 minutes.

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So, like I was saying, I can’t imagine thinking, as I boarding an aging, oil-leaking Soviet prop-plane piloted by a kid chewing khat,

“I am so glad that the good people who run this business are able to compete, completely free of burdensome regulations, and that I have so much freedom to choose which carrier will work for my extremely limited budget! I shall very likely cherish this freedom for the rest of my life!”

Likewise, I can’t imagine anyone having any significant experience as a receiver of medical care in the United States going through the process with the thought

“FREEDOM! Yessir, freedom of speech and religion, freedom from want and fear, and best of all the freedom to spend an entire day on the telephone being passed along like a counterfeit buck in a vain attempt to get reimbursement from a for-profit insurance company that is working with a for-profit HMO! I shall very likely cherish this freedom--and this icky hold music and my depleted bank account--for the rest of my life!”