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August 28, 2004

'I could be dead when you read this' - Chalmers M. Roberts

Washpost

Roberts retired as chief diplomatic correspondent of the Washington Post in 1971, at age 60.

Now 93, he wrote an extraordinary essay which appeared in today's Washington Post about how, after much reflection, he decided to say "no" to a lifesaving heart operation.

Most absorbing.
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The Decision of a Lifetime

In His Twilight, Facing the End on His Terms


I could be dead when you read this. But I thought it might be worthwhile to put down my thoughts about how I decided to skip a lifesaving heart operation.

I am a 93-year-old man with congestive heart failure. The operation I'm skipping would replace a heart valve that has given up on me with a new pig's valve.

My cardiologist, whom I trust implicitly, and with whom I am now on intimate personal terms as I have never been with any other M.D., surprised me earlier this month.

I had been in Sibley Memorial Hospital for a couple of days with problems caused by my faulty aortic valve. Dr. Ramin Oskoui asked me to consider having this open-heart surgery despite my age.

"If you were 83 and thought Herbert Hoover was still president, I wouldn't suggest it," Dr. Oskoui said.

"But your mind is in amazingly good shape and your body seems to be quite good. Think about it."

He got my attention, of course.

I had a hard time getting to sleep that night, for all my thinking. Finally, my nurse brought me a Tylenol that got me to sleep.

That Saturday afternoon, just three weeks ago, my eldest son, David, who lives in Newton, Mass., flew down to spend the weekend with me.

We kicked the idea of the heart operation around at some length and in some detail.

That Saturday night I woke up around 3 a.m. with my left arm in pain.

It seemed to me that my arm was reminding me that I have a second serious problem; besides the heart valve, my spinal cord is a mess.

The pads between the bones in my back are worn out, exposing the nerves, which caused me, a couple years ago, excruciating back pains.

My back doctor sent me to Sibley's pain center, where another doctor gave me a shot in exactly the right spot in my spine.

This relieved the pain of my spinal stenosis for a couple of years, after which a second shot gave me another couple of years without hurting too much.

But when the pain again began to return and I asked my back doctor about a third shot, he began to talk to me about possible back surgery.

I replied: Oh no, not at my age. I want a second opinion. So he sent me down to another back doctor in one of those K Street medical buildings.

After he examined my MRI pictures, this doctor looked at me and said: At 92, with this back, no surgery. I said: Doc, I love you.

He recommended a trip to the Sports Authority to buy a back pad. Wear it all day, he said, and take it off when you go to bed.

That I did, still do, even in the hospital. In fact, I'm now on my second pad.

I call it my cummerbund, the pad men wear around the middle when they're wearing a tuxedo.

You also see many such pads on men in the Giant who do the checkout jobs, whose backs take a pounding from standing and stuffing your groceries in bags.

Dr. Oskoui thought that my back, while a problem, was strictly secondary to my heart valve problem.

Doubtless true, but still something significant to consider in my deciding about a heart operation.

The next day, Sunday afternoon, all three of my children - David, Christopher, who was just back from the beach with his wife and four kids, and my faithful daughter, Patricia, who'd rushed out to Sibley to see me the first day - all gathered in my spacious single hospital room. Pat's husband also sat in.

We had a great three-hour gabfest. I told stories on each of them as kids growing up in our house.

We reminisced about all those years so long ago, about their mom, and then we got down to the serious business of the proposed heart operation.

Over about half a century I naturally had formed a view of each child's personality and, I was glad to see that during this conversation, they ran true to my opinions of each one.

Some stressed this point, others that one. Their opinions did not differ from what I had expected.

They didn't fully agree, but there was no violent opposition to one another.

And they all agreed that I should make the final decision.

So I started to talk about where my mind had led me at this point.

I said I had no problem with the operation itself - either it would succeed, which I assumed, or I'd die on the operating table.

My problem was with post-op, the recovery, the rehab.

Dr. Oskoui had said I'd be in the hospital for about 10 days, then perhaps three weeks of rehab as an inpatient.

I began to recall what had happened to me during my few days already in Sibley: this test and then that one, the prodding and poking involved, lying flat on my back on a bed cart (a gurney) waiting to be moved from one place to another, then back to my bed.

What would four or five more weeks of that be like after an operation? Plenty of tests, no doubt - and plenty of poking and prodding, no matter how excellent the nurses and technicians.

At 93, too, there's a sort of indignity to men in all that. I'm not being a snob about it, just telling you about the rather human reaction.

When one is younger, a lot younger than 93, one takes it more in stride. But at 93... not so easy.

And then the big question: If everything were to go successfully, operation and rehab, what would I come home to?

Most importantly to me, a house with no spouse. Maybe with all-day, all-night nurses for a spell.

Would I get up enough strength to even be able to walk around again? All that strength I'd built up this summer by swimming in my pool surely would be gone.

The summer would be over, the swimming ended for the year.

No spouse. Today, in August of 2004, I can say I've reached a point of reconciliation over my loss.

You must know that Lois and I celebrated our 60th anniversary on 9/11/01 - yes, that now-infamous day, as our 60th!

The 9/11 when we married was a Saturday, so we could fly off on our honeymoon, but this 9/11 was a Tuesday.

So we celebrated with a family dinner at home on Saturday night, September 8.

All three children, their spouses, and all seven grandchildren were at the table. In a way, we had cheated those terrorists.

So when the attack came the following Tuesday Lois and I were still at the table just finishing a leisurely breakfast when we got word: Turn on your TV.

We saw the second plane hit the tower. We saw it all with awe.

The loss of a spouse - especially after such a long and loving marriage as ours of 60 years - is, I believe, the hardest blow in life.

I lost Lois on Nov. 3, 2001. When she had fallen and broken a hip some years earlier, our way of life was vastly altered.

We moved the bedroom down from the second floor to what had been built as a kid's playroom, then had become my office after retirement.

I had grab bars put up for her in the tiny shower tucked into the corner of the small bathroom, and we made many other adjustments.

In her last few years Lois developed dementia but she knew me to the end.

Honestly, I have been attracted to many women, loved a few but none as deeply, so passionately as Lois - Lopie, as her parents dubbed her and everyone called her once they knew her.

She died at 92 - I married an older woman. My darling Lopie (pronounced Low-Pea).

I could not face the first anniversary of her death alone, so I asked my daughter and son-in-law to have dinner with me.

That helped. Oddly, very oddly, the morning after that first anniversary of her death I woke up feeling that a very large weight had been lifted from my chest.

That was, I think, the moment of my acceptance of what I have called my "reconciliation" to her death. Reconciliation, but no more.

All this came back to me as I thought through, as best I could, the suggested heart operation, the long rehabilitation -- and all to come home to what? A house with no spouse.

Back when I was just 80 I wrote my last book, a lighthearted look at growing old titled "How Did I Get Here So Fast?"

In it I gave my credo: "Keep your heart pumping, your noodle active and your mood cheery."

But I had assumed I'd always have my spouse, and I was wrong.

Not that I feel alone. My children have been superb, my grandchildren most satisfactory, and so have been many of my friends, neighbors new and old, so loving, so thoughtful, so great in rallying round.

I surely do not complain there.

But I would be coming home without a spouse.

So what would happen if I decided not to have the operation? David put that question directly to Dr. Oskoui.

Almost certainly, he replied, one of two outcomes will follow, and the chance of one is about the same as the chance of the second.

One possibility is that my aortic valve explodes with a rush of blood filling my body, ending my life instantly.

Or, I would again suffer from shortage of breath such as brought me to Sibley earlier this month.

I would return to the hospital, and would die in perhaps a couple of weeks as the valve slowly failed.

Without a spouse, not so bad a choice, it now seems to me.

Most of us, contemplating death, hope to more or less drop dead. Quickly, unknowingly, painlessly. And I'd have a 50-50 shot at that. Not bad.

I might say, too, that I feel content. I've done my thing. Raised my kids. Helped each of them get a house.

Did my newspapering, my journalism, as best I could, dammit. Had my byline in The Washington Post since 1949 - not bad, either.

So that's how I came to decide "no" on the heart valve operation.

I'm sorry I took so long to explain.

I do want to add a final word, about the hereafter. I do not believe in it.

I think that the religions which promise various after-life scenarios basically invented them to meet the longing for an answer to life's mysteries.

Indeed, my son David, a professor of astrophysics, tells me that colleagues have spent years listening to outer space for some word of some other life somewhere.

I think we are too much bound in narrow "Earth think." Einstein at least began to think outside it.

I agree with Francis Crick, the eminent Cambridge don, the winner of the Nobel Prize for his co-discovery of the double helix, the blueprint of life, who wrote: "In the fullness of time, educated people will believe there is no soul independent of the body, and hence no life after death."

August 28, 2004 at 09:01 PM | Permalink | Comments (0) | TrackBack

'Snowleg'

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The perfect bedtime reading book.

I finished it last night, after several weeks of doing just that with it.

Wonderful title, what?

In 1983 Peter Hithersay, a classically-repressed, 18-year-old English schoolboy, goes to Cold War Leipzig, Germany with a mime troupe as part of a cultural exchange program.

During his brief visit behind the Iron Curtain, he manages to fall for an East German girl.

She asks him to help her escape, and at a crucial moment, he balks, and she is taken into custody by the Stasi, her fate forever unknown by Hithersay.

From that moment forward he is dead inside.

For the next 19 years, he tries to suppress the power of his feelings for the mysteriously alluring girl, whose Icelandic nickname translated as "Snowleg."

Finally, a search for another missing part of his past brings him back to Germany, now united, and he resolves to try to find out what happened to the long-lost Snowleg.

The sense of East Germany then and now as part of a united country is overwhelmingly vivid.

In particular, I got an alarmingly frightening feeling of what it might be like to have no one, absolutely no one - even relatives and direct family - you could really trust.

East Germany under the Stasi, and probably today's Cuba, provide disturbing foreshadowings of what life might well be like in a "Minority Report"-ish 21st-century society.

I find it interesting that the British version of the book has a much more vivid jacket (below) than the American (above).

I would've expected just the opposite.

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August 28, 2004 at 03:01 PM | Permalink | Comments (0) | TrackBack

BehindTheMedspeak: Prenatal diagnosis, stem cells, and a new, paradigm-shattering discovery

JAMA

Dr. Diana Bianchi, chief of the division of medical genetics at Tufts New England Medical Center in Boston, is the lead scientist behind a revolutionary development.

Dr. Bianchi's original area of research was prenatal diagnosis.

She knew that a few fetal cells enter a woman's blood during pregnancy and hoped to extract those cells for prenatal diagnosis.

With polymerase chain reaction (PCR) technology, only a few cells are required for DNA amplification and production of enough material for genetic analysis.

Years of work by her laboratory to isolate those few circulating fetal cells from the maternal bloodstream were unsuccessful; such fetal cells are so scarce that even today's cutting-edge technologies were unable to identify them.

But then Dr. Bianchi made the first of her unexpected discoveries: fetal cells do not disappear when a pregnancy ends.

Instead, they remain in a woman's body for decades, perhaps indefinitely.

If a woman's tissues or organs are injured, fetal cells from her baby migrate there, divide and turn into the needed cell type, be it thyroid or liver, intestine or gallbladder, cervix or spleen.

She and her research group find fetal cells by looking for male cells in tissues and organs of women who have been pregnant with boys and showing that the cells' DNA matches that of the women's sons or, if the women had abortions, their male fetuses.

Cells from female fetuses also enter a woman's body, but it is quicker and easier to find the male cells by looking for cells with a Y chromosome.

One woman, for example, had hepatitis C. But when her liver repaired itself, it used cells that were not her own.

"Her entire liver was repopulated with male cells," Dr. Bianchi said.

Such findings astonished not only Dr. Bianchi but others in her field, who looked askance at such unanticipated results.

Now, with publications in leading journals including last month's Journal of the American Medical Association, few doubt her.

In theory, fetal cells lurking in a woman's body are the equivalent of a new source of stem cells and could be stimulated to treat diseases.

However, Dr. Bianchi says that she does not yet know for sure that the cells are stem cells - she must isolate them and prove they can turn into any of the body's specialized cells - nor where the cells reside, or how, short of injury, to spur them into action. [via Gina Kolata in the New York Times]
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The implications of Dr. Bianchi's work are stupendous.

•If women who've been pregnant automatically create a long-lived collection of potential stem cells from each pregnancy's embryo, every woman has the potential to regrow and repair herself and theoretically live forever.

The whole uproar about cloning and stem cells disappears; it's a non-issue.

•Each woman carries, somewhere within her body, a source of stem cells for each of her offspring, no matter how old or which sex they are.

Not only can such stem cells take part in repairing a woman's own body, as Dr. Bianchi has already conclusively demonstrated; theoretically, these cells could provide such material for each of her children in the event of illness or injury.

•Within each paper cut or scrape on a woman's body are cells from each of her previous pregnancies. It becomes possible to quantify how many there have been, as well as the sex of each.

"Have you ever been pregnant? Had an abortion? No? Well, we'll just confirm that."

•I believe we are witnessing the beginning of an entirely new branch of science, which others have termed regenerative medicine.

Most people know that salamanders can regenerate their legs.

Not as well appreciated is that children up to the age of 11 can regenerate fingertips.

It's time for the rest of us to join the party.

August 28, 2004 at 09:01 AM | Permalink | Comments (0) | TrackBack

Harrow school goes to Beijing

oldschools-portrait

Harrow, the 432-year-old London school whose former pupils include Winston Churchill and Jawaharlal Nehru, plans to open a sixth-form college for pupils over 15 next year in Beijing which will cater almost exclusively to Chinese students.

Although the school will concentrate on the teaching of English, science, economics and business studies, it will also transplant some of the school's traditions, including the straw boater hats

tradition

and the school song.

Peter Siddons, chairman of the Harrow governors, said, "Not all of our traditions are suitable or workable but the boater is certainly a convenient way of getting out of the sun in a hot climate. It is more a question of core values of the school than particular traditions."

Barnaby Lenon, the headmaster, hopes the Beijing school will follow the same path as the Bangkok branch of Harrow, which grew from an office block five years ago to a purpose-built campus, serving more than 1,000 students aged 3 to 18, including some boarders.

Enlarging Harrow Beijing to encompass younger students will require a reform of the Chinese regulation that currently prevents children under 15 from studying in schools with a foreign curriculum.

News of Harrow's second Asian outpost came at the same time another well-known London school, Dulwich College, opened a branch in Shanghai, and underlines the huge appetite in Asia for traditional British education.

Dulwich already has a franchise in Phuket, Thailand, and plans to open four schools in China in the next few years.

Shrewsbury School also has a branch in Thailand and Bromsgrove School has entered into a partnership to build a new school in the Thai capital.

In recent years headmasters at leading British schools have been inundated with invitations to go into partnerships with educational entrepreneurs in Asia.

Eton College,

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arguably an even more illustrious "brand" than Harrow, said an international branch had been discussed within the last academic year by the board of governors but had been rejected. [via Jon Boone in The Financial Times]

August 28, 2004 at 03:01 AM | Permalink | Comments (0) | TrackBack

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