Kitchenalysis
In the middle stages of dementia, J plays with his food in unpleasant and poignant ways. He mixes things together that don’t belong together: pours my wine in his milk, tries to put his ice cream in my salad, his fried rice into his drink. The categories and containers are breached just as they are in his thoughts, and it occurred to me a while ago that he’s trying wordlessly to show me what his mind is like.
Today I saw that I had left a good but inconsistently sharpened knife in the sink, unwashed, with a pan on top of the blade — a crime, I’m well aware, because a good knife is a thing of beauty. It then occurred to me that I treat myself like that knife.
Why the Professional Political Class are Parasites on Us All
[S]trategist James Carville became the first leading Democrat to suggest publically that there might be political advantage in letting Republicans “kill” health care.
“Put a bill out there, make them filibuster it, make them be what they are, the party of no,” Carville said. “Let them kill it. Let them kill it with the interest group money, then run against them. That’s what we ought to do.”
A Visitation [Updated]
In one of my involuntary micro-naps during sleep-deprived work (during which I can type a long one-letter string or paragraph into a footnote — I call them “sleepos” — and am in some danger of falling face first into, or drooling on, the keyboard), I saw Max, plump, shiny, groomed to youthful perfection, leap in a light arc under the dining room table and pounce on something.
UPDATE: Meanwhile, Max’s earthly part was buried by friends today on their land. You see him here with Dusky, whose body has actually been in my freezer ever since he died in March 2008. (Notice that I handled it — or not — almost exactly the same way. How comically consistent we are.)
This sounds grotesque and ridiculous till you get that it’s an arrested vestige of our former life (and maybe even then). Jacques, having been a prisoner in a very cold place, and buried corpses of his friends stacked in the snow till springtime when the permafrost melted (even as I write that I know I can’t begin to imagine it), could not bear the thought of his “kittens” (as he calls them lifelong) being buried in cold ground. He knew perfectly well that when they were dead they wouldn’t feel it, but he would. So I had to take them down to our family’s house in Florida and bury them there, three feet deep in the sand. Ironically, in order to preserve their bodies until I could get down there, I had to freeze them. I guess that was okay because it was necessary and only temporary: the end justified the means, or something. We had many cats over the years (my first e-mail address ever was manicatz@aol.com), and I dug many deep holes and buried many cats around that house in Florida where my parents now live. Someday a hurricane may exhume a mysterious trove of feline skeletons, scoured to a polish by Florida’s busy subterranean life.
When Dusky died, I reflexively put his body in the freezer, even though I knew that Jacques would soon mostly forget and would not be able to sustain a wish or plan about Dusky’s body. I knew I could bury the body near here, or have it cremated, or whatever I saw fit, but I froze, unable to quite let go of my end of our bargain, even though the other end was slack and it was no longer practical for me to do things the old way even in J’s honor. This paralysis was probably a typical expression of ambiguous loss.
So today I asked our friends to bury the two cats together, and explained that we weren’t going to be there because I didn’t want to break the news to J that Dusky had spent a year and a half in the freezer, even though his comprehension would probably have been slow and incomplete and his upset fleeting.
They looked like yang and yin. They looked way too touchable and vulnerable until our friends threw flowers on them.
Thoughts on Euthanasia — In a Cat.
(an essay in thirteen tweets — first to last for easy reading)
- Thoughts on euthanasia–in a cat: more I think abt, more I don’t like this “sedate first” protocol. It’s not for the animal, it’s CYA 4 vet.
- Vet is worried abt havg trouble shaving/finding a vein on a sick, dehydrated animal, causing the animal & thus the owner visible distress.
- Understandable, but a lack of skill & confidence. I’ve seen good vets w/good touch simply inject euthanasia solution. Instantaneous painless
- Sedation shot defeats its own purpose: 1) it’s ketamine or another “dissociative” maybe plus valium. We don’t kno what animal experiences.
- Vet sd to me “he won’t experience anything.” oh yeah? then why some vets trip on ketamine?? cd be MORE scary exp., but OK ’cause paralyzed!
- In other words, if the owner can’t SEE the distress it doesn’t exist. Bullshit! 2) Sed.shot hurts like hell! Has “salts” in it that sting.
- Max’d been calm; at “sedative” shot he growled, tried to bite. Giving fluids under skin w/needle never hurt like that-kinda defeats purpose!
- Bottom line: really skilled & confident vet wd just DO it & animal wd respond to some vets’ trust-inspiring touch & phlebotomist-like skill.
- I’ve seen it! I had vet friends that good. One is dead & one is semiretired in SC They’d even shoot euthanasia sol. directly into heart-best
- I did that once myself, on a cat so emaciated I could feel her heart between her ribs & couldn’t miss.
- Discussion w/young vet: “We gotta go through it all the way to the end. They don’t.” We can understand & maybe must learn, right up to death
- Animals often die with a beautiful stoicism & appearance of understanding. But I’ve seen 2 struggle to run away as if death were a predator.
- Death just seems wrong. Very puzzling: how can something that always wins be wrong?? Are we wrong?
Hyperbole and Hysteria: Immune System of the Body Politic?
I’ve never heard the word “fear” used so much on television. “Do you fear a government takeover of health care?” The conservative and Republican strategy has been to block this bloated reform package by frightening the citizenry with unfounded rumors about “death panels” and the like.
Maybe, in the fog of Too Much Information, scare tactics are the only way to get citizens involved.
I know that what I feel for that 1,000+-page bill I’ve read only bits of isn’t fear; it’s loathing. Prove to me if you can that big government bureaucracy isn’t the most inefficient, wasteful, and unaccountable way to do most things. (Exceptions like the CDC, which facilitate a swift, centralized, coordinated response, often turn out to be subsets of defense — and I’d hate to start reading about what’s wrong with the CDC. FEMA should have been a subset of defense, too.) Government can play an excellent role in establishing ground rules and incentives that reward economic efficiency and quality care — learning from the best private innovations and creating circumstances that make it easy to study, adapt, and reproduce those best practices (which cannot be assumed to work exactly the same way in different places).
I like this image and so will repeat it for about the third time: government is meant to fine-tune the engine, not to be the engine — as such, it’s a gas guzzler with tailfins!
But that isn’t fear. I’m very struck by the way conservatives see the federal government as sinister and inimical, as if it were some alien cancer on the body politic, while liberals tend to view it naïvely as just “us” — a basically healthy organ of the will of the people. If representative government has mutated into a cancer, it isn’t alien — it’s one that arose from within. In my view, it’s really more like a large benign tumor: more burdensome than toxic. Yet there’s always been a suspicion, which flared up in the Red Scare of the 1950s and is baa-aack in the claims that Barack is “furrin,” that alien ideas are being injected into the system and causing some citizens to mutate into aggressive enemies of freedom. On this analogy, fear is inflammation. “Inflammatory” rumors, or humors, are arousing citizens to surround and attack “un-American” ideas, as white blood cells recognize and destroy anything in the body that’s “not-me” — and sometimes, in their zeal, turn on the body itself.
You tell me whether the town hall shouting matches are a healthy immune response or a runaway autoimmune disease. Then I’ll tell you what I think.
Max’s Last Meal [UPDATED]
I feel like an idiot, just like I knew I would.
I knew I was going to break and spend several hundred dollars I can’t afford to hear a vet tell me what I already know: that our cat Max is at the end of his life. And sure enough . . .
Max has been failing: losing weight, sleeping by the water bowl despite the subcutaneous fluids I had begun giving him. He was eating hungrily, but that was one of two things: Max has always loved food more than anything, and it was his last pleasure (I can relate); and/or he was feeding a cancer. He came to us as an adult so I’m not precisely sure of his age, but seventeen is a good guess. When a seventeen-year-old cat starts to go downhill, it’s usually kidney failure, cancer, or both
The last couple of days, Max was unable to eat much (though still interested), drinking less, breathing a little fast, a little labored. Two days ago his belly began to swell with fluid. He just lay in a corner, and I thought it was time to have a vet come to the house and euthanize him.
Then he got up, ate, drank, washed his face, scratched himself (staggering a bit), and came over to hang out with me. He still seemed interested in living, so (after consulting my beloved vet friend Rick from New York who now lives in SC) I decided I had to look into the slim chance that it was something treatable for a little while, like heart failure.
This always happens. And it never ends well.
* * *
Max was given to us in the mid-’90s, along with his portrait, by the artist Bill Adams (an old family friend of the Love Goddess), who was about to marry a video artist who was allergic. (Freed from reality, the cats in Bill’s art have gone on to become quite fantastic, even a little scary.) A few months after the transfer, Bill came over to visit. As we sat across the table from each other, Max went and lay down on the table in front of Bill. As the time approached for Bill to leave, Max pointedly got down from the table and lay down on my feet. He could not have made himself clearer. I was greatly touched.
The editorial asssistant.
It’s a rare cat that can walk into a household of strange adult cats and not cause a ruckus. Max was that cat. It’s the territorial terror of the newcomer, the stink of fear, that usually sets off aggression from the homeboys. Max simply walked in calmly like he owned the place, so the other cats shrugged and guessed he did.
He was just a Humane Society kitten, but he had the air of a portly and faintly melancholy gentleman, and the tastes of a reincarnated gourmet chef. Max doesn’t just love food, he loves well-prepared food with spices and sauces, much preferring it to raw or plain cooked meat. Dinnertime approaching? He ‘s on the table, purring with anticipation. We let him, because it’s usually just us. Our occasional guests either roll their eyes and tolerate it or remove him gently to the floor, where he is consoled with his own plate in the kitchen.
Max is deeply kind. Lucky, the cat we rescued from Romania, who had been a tom for many years, used to attack him. And yet, when Lucky was blind, deaf, and dying of kidney failure, Max lay down touching him. Again he made his meaning clear. There was no other way to understand it than as an attempt to comfort and orient. Since then I’ve called him Dr. Max. Other effanineffable nicknames; Perp (from “he’s so orange he’s almost purple”) and Roadie (from “Roadblock,” because he’s always right where you want to go).
* * *
The vet cut to the chase, doing an x-ray and a tap of the fluid in Max’s abdomen as the best way of getting the big picture. The x-ray showed fluid in his chest as well as belly, probably making him feel as if he’s suffocating. The tap showed lymphocytes in the fluid. Probable lymphoma.
We could either do more tests to be sure, plus some palliative, temporary fluid removal, or put him to sleep. Only the latter made any sense, and not just financially. I was prepared for this. I hadn’t wanted to cry and get the professional comforting, but of course I did that too.
I wasn’t tough enough to have him put down right then and there in the vet’s cold, bright office. I wanted J to see him again and I wanted Max to be at home, comfortable and happy. So I’ve arranged to have one of the vets come over tomorrow morning. Costs more, but what the hell. It’s the diagnosis I should’ve skipped. This is the good part of my folly, the part that’s not negotiable. The vet gave Max a lasix shot to reduce the fluid and keep him comfortable. He’s much more able to purr and express his relief at being home. (And of course J is saying, “Maybe you shouldn’t be in too much of a hurry to put him to sleep.”)
So now I’m pondering what to make for dinner tonight. Tilapia, I think, dusted with flour and cumin and browned in a mixture of canola and toasted dark sesame oil. Max loves that. So do we. He’ll be on the table, and we’ll eat together for the last time.
One year ago
UPDATE: We did make the fish; and as the aroma of cooking circulated through the apartment, Max did indeed appear.
Max's last meal.
But he didn’t lie down on the table and purr afterwards the way I hoped he would. Instead, he hurried back to the bathroom to lie down behind the toilet — a cat’s way of saying “I feel like shit.” (I’ve actually seen a sick cat express this by lying down in its litterbox.) He reappeared twice more tonight asking with rueful eyes for more fish, ate, and after eating, retreated back to the bathroom rather than lying down comfortably and companionably. While that was a disappointment, it was also a heavy-hearted confirmation that we’re on the only possible path.
There’s been a change in J from a year ago, too.
THURSDAY MORNING: Ave atque vale, Max. He came out and spent the better part of an hour purring with me before the vet came.
Scary Reading Material. [UPDATED YET AGAIN]
A web forum on Lewy Body Dementia, which is probably what J actually has. Sample post:
I have just had a few days break from it all, I will pick R. up tomorrow from respite. I am dreading starting back into it all again. I phoned him every day, and yes I had the same thing, who are you with? I love you? when will you pick me up? what time exactly? It is so hard for them, but it is so hard for us as well. I believe one must try and have some life for oneself, if you don’t the disease will destroy you, we have a duty to ourselves as well. All the nurses, doctors, and aides that I deal with have finally convinced me that I must look after myself, it may sound heartless, but I admit that I am beginning to believe them. They tell me they have seen so many carers go before their LO, that is not what God wants. We are all on a journey, and sadly this is our LO journey, we cannot change that. Believe me when I say that I have cried an ocean, I miss the old R. so much, I have all the best care for him,but I do want to survive this, and I don’t feel guilty for feeling this way anymore.
Something else sticks in my head: I forget who told me a common piece of folk wisdom is, “He got sick and she died.”
I try not to haunt such places, to accept that this is the real community to which I now belong. But what I see when I do go there is that this is a very long haul, and that the disease can in fact be fatal — to the caregiver.
UPDATE: Another woman on the forum who’s taking care of her husband did a kind of “intervention” on me, saying that when you respond to every suggestion with “That won’t work,” it’s a sign of “severe burnout.” She then made about eighteen suggestions, sixteen of which — excepting bankruptcy and antidepressants — I’m going to check out starting tomorrow.
When I said that, she kind of leaned on me a little bit to take antidepressants. “Better living through chemistry — your husband is on drugs to improve his quality of life. Why would you not take advantage of the same for yourself right now? If you were cold, would you insist on continuing to run in place to try and keep warm rather than accept a blanket?”
I wonder what that’s about. I am pretty anti-drug, and karate workouts are a very effective antidepressant for me. Why wouldn’t someone say “Great, more power to you”? Why would they try to convince you that you ARE depressed (I’ve been depressed, I know depressed, this ain’t it! fatigue, stress, frustration, loneliness, yes; depression, no) and SHOULD take medication? To validate their own choices? Or just on the assumption that everybody is like them and will benefit from the same things? It’s scary to me, the medicalization and medication of ordinary unhappiness. Take a pill when things get rough??
Many of these women have more help than I do and seem more unhappy. (Maybe I should urge them to take up karate?) Their husbands sound generally more mobile than J, but also more demented. Some of them have been at this already for half a decade longer than we have. They are giving me a preview of what’s ahead.
UPDATE II: A part of the advice I received was to have J evaluated for hospice, because they can give you some in-home care relief paid for by Medicare, a nurse who knows the patient well who’s on 24-hour call, etc. I never tried that because I figured he wouldn’t qualify: he’s so not terminal, God bless ‘im. I thought hospice was for terminal care only. But it turns out the criteria are somewhat elastic. What could disqualify him is that he can still communicate pretty well. What could qualify him is that he’s so immobile and utterly dependent — in the doctor’s words, “degenerative disease and basic care dependency needs.” Hospice can come and go: if the person stabilizes and is doing pretty well they may kick you off it until you really need it again. But even to have that kind of help for a while . . . I can hardly imagine.
And — this is big — the doctor is for it. For my sake, I know. That could count for a lot.
Duke Hospice has a residential respite care facility. That means if I ever needed to, say, have surgery, or just visit my family for a whole week, he could go in and stay there for the duration.
I can’t count on this, because he may not qualify. If it doesn’t work out, we’ll try something else.
I was thinking that the relentless incontinence, day in and day out, is one of the things that wears you down, especially when combined with dementia (which insures that the carefully placed urinal will be removed to a spectacularly useless location — like the Statue of Liberty’s Torch — just in time). And then I thought, maybe they ought to have a special, nonterminal branch of this service called “Hoss Piss.”
UPDATE III: Took J to the swimming pool. He’ll never get into hospice — nor should he. He’s doing too well. I’m the one who needs it — LOL.
Rather like people who fall into the gap between Medicaid (too rich for it) and private health insurance (too poor to afford it), (though that’s not literally our problem, thanks to J’s Screen Actors Guild), J falls into the gap between sick enough for hospice and well enough to walk, wash, whiz, and wipe for himself. In that gap, the considerable burden must be borne by a family member — physically or financially.
You can liquidate your assets and be cared for in a nursing home, but you can’t hardly get help being cared for in your own home, even though it’s cheaper for all concerned. I can’t figure out if this is nutty or simply as it should be. It’s “the natural way” (as I witnessed in Eastern Europe where they didn’t have nursing homes), except that we don’t have extended families living together any more and sharing the chores.
By the way, the county social worker told me about a five-star nonprofit nursing home out in the country to investigate just as backup (were I to get sick or something), and then insinuated if I checked it out I might like it . . . Like antidepressants, nursing homes are pushed on you. “Placement,” they call it. Placement in the basement. “Save yourself!” is the cry. She also urged me to come to a caregivers’ support-group meeting August 20.
If I go, it will be to see if the other caregiver I’ve seen here and there in Chapel Hill goes to them. He’s a soft, stoical man my age or a bit younger, patiently accompanying a ruin of a beautiful woman with some kind of wild, high-stepping palsy. You can see that before she got sick she must have been proud and temperamental in the good sense, like a thoroughbred Tennessee walker. I’ve seen them in an outdoor café and in UNC’s neurology waiting room. He and I both avert our eyes when our paths cross, poignantly and paradoxically together in this salute to each other’s privacy. I’ve seen her, exhausted by her wayward body, lean her head on his shoulder.
Tweet Defeat: Twitter Sputters
I’m not the only one to have problems with Twitter today. I’ve been unable to post on it at all tonight; I don’t even get the fail whale, it just tries for some period of time and then quits. (Fortunately, I have been busy with other things and have not wasted a lot of time trying, but I’ve left the little wheel spinning in various tabs and returned to find my tweets still lying there raw and unposted.)
If I were a boofer doofus conspiracy theorist, I’d say the Obama admin is jamming it (ask not how) because they don’t want people talking about their mediocre-to-failing grades on CNN’s second-hundred-days “report card” tonight.
That was the subject of one of my tweets: someone on CNN’s panel said that in contradiction to his stated objectives “Obama is polarizing the country,” and the panel itself demonstrated that: the two conservatives, Alex Castellanos and Bill Bennett, both gave him a D, Donna Brazile gave him an A- including an A for just showing up! (Maybe in the age of Sarah Palin, that is praiseworthy??) His score with the public, averaging out the poles, was C-. (Yes, I actually said the essence of this in 140 characters. What I miss about Twitter: the enforced concision.)
Another lost tweet was a quote from Darwin, which I think has cultural resonance as well (echoing someone’s comment on creative destruction that I now can’t find):
“It is not the strongest among the species that survive nor is it the most intelligent. It’s those that are most adaptive to change.” – Charles Darwin
(I’m fact checking some utterly mind-blowing stuff about how retroviruses have incorporated themselves into the human genome and could even have catalyzed our becoming human, diverging from the line that led to chimps. To make it worse, I’ve lost the source that said that, which makes me feel as if I dreamed it. Apparently this is leading the Intelligent Design folks to say “junk” DNA is God’s tool kit. That is not helping the dizzy feeling.)
Oh, OK, here’s one version of it. What next??!!
Ambiance 