Aging Smaging, Just Do It Your Own Way

Two days ago we were told that the older you get the worse your judgment becomes. You are tricked and fooled into making dumb choices. But, by my lights, the study was deeply flawed, since the parameters of choice are different for every individual (by definition).

Now comes news, in the New York Times today in Staying a Step Ahead of Aging, that we can exercise ourselves into being and staying younger. Some people can run faster at 60 than they could at 50!

Apparently the secret is hard exercise that teaches the heart to pull in and distribute more oxygen. Hard and often, if you can. But, if you have to choose between the two, chose hard. Several times a week. Forever.

Of course, as you age and exercise hard, some may say you are making a bad decision because you could get mugged, or have a heart attack, or have some other deadly calamity befall you. Guess what? I'm gonna do what my body wants me to do, whether it's make foolish decisions to stick with a poor choice or exercise like there's no tomorrow, or both!

The Right to Folly

There are two kinds of people: those who think they know best what an old person needs and those who know that what the old person wants is what he or she fully deserves to get.

Old people have lived their lives. Their resources are their own (whether they inherited them or earned them). Their bodies no longer give them the ability to do everything they can imagine doing. The are going to die sometime soon. The order of priority, IMHO or IMNSHO, should be: 1. happiness. 2. health. 3. financial security.

For an old person, happiness comes from being treated with respect and love and they are allowed to choose what they want: where to live, what to eat, whom to spend time with, where to travel. Even when they are cantankerous, difficult, persnickety, tempermental and what they want is "impossible." "Protecting" them from "hurting" themselves or keeping them from spending their money "foolishly" only adds to the insults of being trapped in an aging body.

But sometimes, mirabile dictu, the law is on their side.* The District of Columbia code requires that:

(a) The court shall . . . encourage the development of maximum self-reliance and independence of a protected individual and make protective orders only to the extent necessitated by the protected individual's mental and adaptive limitations and other conditions warranting the procedure.

In my experience as guardian and conservator and attorney hired to help a person under a guardianship or conservatorship, the biggest challenge is to protect an old person from those who would "help" him or her. BTW, this applies to persons who are mentally ill or mentally retarded, as well.

One lovely man, a veteran, died a lonely death, frustrated and alone in a VA hospital, because his guardian/conservator would not help him to move to where he dreamed of living. Yes, his dream, anchored by dementia, was impossible, but there were many intermediary places he could have been allowed to go to.

My client raged, helplessly, that his guardian wouldn't give him $100 dollars of his own money to spend. When I asked the guardian why not, he told me, in a screeching voice, "I'm not going to give him any money when he is going to turn around and give it to a nurse and ask her to go buy him chocolate. I am not going to be responsible for his dying of diabetes from eating chocolate." So, of course, I pulled $60 cash out of my pocket and gave it to him.

My client was 86. He was alone. He had no joys in life but to call his wife, who lived in another nursing home, when his phone worked. After he died, his guardian sent me his cellphone. It was the smallest cheapest cell phone on the market. This for a many who couldn't see well and who had large hands and big fingers.

Another client got caught up in a fight with his daughters who, in their minds were doing the right thing and seeking court appointment as his conservators and guardians. Yes he had dementia and couldn't remember anything that happened yesterday. And he couldn't walk faster than a turtle, perched precariously on two wobbly legs. But his mind was still roaming the world he had traveled as a scientist, explorer and big brain about town. He didn't want to live in a facility where everyone was "demented, except moi, of course." And, he didn't want either daughter to be appointed his conservator or guardian.

When he wanted to travel to a geological conference in northern New England, his daughters intervened because it was still muddy and he might fall. The conference organizers assured me that he would be fine and all travel in the mountains would be by car.

After a final settlement (third court hearing, with daughters sitting with stolid, fierce anger on one side, my client confused and hurt on the other side), one daughter with forced cheerfulness asked whether he wanted to go to lunch and if so where. He suggested a lovely nearby museum lunchroom. The daughter said, "oh parking is a problem, how about the Italian place you love so much?" He looked at me. I suggested they go where he suggested. She said "that's the only one he remembers." I shrugged and walked away, not wanting to be seen to be the ever hungry lawyer billing her client for trivial hallway conversations and interfering between father and daughter. I should have said, "well, yes, it's the one he remembers because it's the one he likes."

When I asked his court-appointed conservator whether she would approve his travel to Europe next summer to another international conference, she wrote back, "Yes, if his health is cleared and he can do it safely." Was she going to get a doctor's certificate that he could travel? How was she going to evaluate the safety? He wanted to go to Europe! He had been invited by colleagues! He had plenty of money and could afford everything he would need. Who was she to impose her value set on him, her protective fears that he shouldn't be allowed to do anything risky or "dangerous."

Care for someone in need of "protection" -- meaning the person lacks the capacity to manage his or her affairs (which most often means not being able to manage the flood of bills, bank statements, advertising mail, etc.) or make sensible health care decisions (meaning not being able to understand the scope of one's health problems or make reasoned decisions about treatment) -- should be guided by the law: "encourage the development of maximum self-reliance and independence of a protected individual."

Substituting one's own judgment for that of an another, whether an older person, or a mentally ill person or a retarded person, diminishes him or her. Not only is it contrary to the law in the District of Columbia, but it is psychologically destructive and spiritually deadening.

It is the charge of the able to nourish and encourage and facilitate the old, the mentally ill or the mentally retarded. The able need to pull back from judging, from knowing what is best, from intervening to "protect," from substituting what I may think is "best" for what he or she wants. Old age or mental illness or mental retardation are what they are; there is no changing it; one can only accept it for what it is. It is for the able to make the adjustments and recognize the full individuality and right to respect, and yes, right to folly, of the older or mentally ill or mentally retarded person.

My friend Judy posted an awesome clip of life and music in Young @ Heart, a group of oldsters who have raised the bar, raised the roof and raised our hopes and expectations of what is possible. Check it out. It is WONDERFUL!

* Title 21. Fiduciary Relations and the Mentally Ill. (Refs & Annos)
Chapter 20. Guardianship, Protective Proceedings, and Durable Power of Attorney. (Refs & Annos)
Subchapter VI. Protection of Property of Incapacitated, Disappeared or Detained Individuals. (Refs & Annos)
§ 21-2055. Permissible court orders.

When a Relative Dies Abroad - What to Do

I recently had to set up arrangements for someone who died in Nairobi. It is relatively easy to arrange to repatriate the remains, or alternatively to arrange for cremation.

The United States Embassy Citizen Services -- at least the one in Nairobi, Kenya -- has an entry on its web site for: Assistance to U.S. Citizens who are incarcerated or have relatives who die in Kenya.

In my case, while there was an eight hour difference between Washington DC and Nairobi, and it was a Sunday before a holiday, a very nice, cooperative and helpful duty officer took down all of the relevant facts and said he would get back to me with information, which he did half an hour later.

He gave me a list of funeral services that could make all of the necessary arrangements. As I learned these include transporting the body from the hospital to the funeral home, obtaining an autopsy from a pathologist (required), embalming and packing the body in a body bag which is placed in a metal lined casket which is then placed in a crate.

The cost is around $10,000 and half of that is the airplane ticket. The airlines insist on protecting themselves from the possibility that the fluids from the deceased might, in case of some accident, flow onto all of the rest of the luggage in the hold and contaminate it. I was assured that such an eventuality is virtually impossible, but the airlines have the opportunity to take advantage of the situation and exercise stochastic pricing.

The steps to take are:

• Arrange with the funeral home to take the steps you want, repatriation or cremation, or hold the body while family members and the legally responsible person are able to sort through the decision.
  
• Pay the hospital bill so the hospital will release the body to the funeral home.
• Assure that the funeral home has all of the relevant information for the death certificate (names of parents, birthplace and birth date).
• Obtain a Consular Report of Death Abroad. This last is important to assure domestic entities (Social Security, life insurance companies, etc., etc.) that the death occurred as stated on the death certificate. The consulate or embassy will issue the CRDA on presentation of the death certificate and passport of the decedent.

The hardest part is often getting agreement among family members as to what course of action to take. Don't underestimate the difficulty in finding agreement among family members. Repatriating the remains involves not only transport but then the funeral, which can easily double the cost.

Serendipity is an Angel Flying High Above, or How we Escaped Disaster and Landed in the Lap of Luxury

My friend Judy and I went hiking yesterday, Sat Jan 12. It was a beautiful day, even perhaps too warm for January, but with a clear blue sky and gentle winds.

We drove out to the Virginia-West Virginia state line to a wonderful, hidden corner of wilderness owned and managed by a Quaker organization. I had downloaded maps of the trail system, I had studied my 60 Hikes within 60 Miles of Washington, and figured out that we could do a shorter hike than recommended in the book because, of course, we were starting late and probably couldn't do the full circuit.

Maps in hand, we strode confidently off into the woods. Judy is my hiking companion and we both love to hike. Particularly now that we have trekking poles, but more on that in a later post. It was truly beautiful: the winter trees spread in every direction allowing the eye to sink deep into the woods, the ground covered with wonderful green plants, blue sky and sun glistening through the naked branches. Clear, wonderful air.

We found the right trail, right off the bat. An easy wide one, following a small power line. We climbed, stopped and extolled the beauty, climbed again, stopped to take off outer layers, climbed again. And kept climbing and climbing. The path got rockier and rockier. We were looking for a trail that went off to the left. We continued climbing. No trail from the left. I took out my Bruntun do everything but whip up an expresso coffee that told me our altitude. Two hundred feet below the cut off. So, resumed climbing. After a while we decided that if we never found the cut off, we'd be OK because we would turn around and go back in time to beat the sunset. So, we continued climbing. Beautiful, beautiful day and hike.

Finally, dripping sweat and trudging ever upward, I saw a clear white blaze to the left. Perfect, here was our trail. The map showed a continued climb of about another 200-300 feet up to an outlook point. So, we scrambled up what by now had become a field of boulders. Deer peering at us, seeming to ask, what are they doing, working so hard at this. We can leap up in a flash. Finally we got to what looked like the outlook point. Wow! Half way home and right on time! The trees obscured the view, but that was fine. we could see the outlines of mountain ranges to the west and valleys to the right. The trail was beautifully marked with white blazes just as far as the eye could see, and some thoughtful person had even put chalk arrows on the rocks in both directions.

So, we pushed on, happy and confident that we'd get back just in time. The rocky trail was still a challenge, but we were on the home stretch. And we kept on going, and going, and going, and going. The trail that was supposed to come in from the left again wasn't just right around the corner. We were hiking along the back side of a ridge that was both beautiful and endless. Trees and rocks and flat stretches. Glorious. Wonderful hike. Soon the turn off would come. Right around the corner. We kept on going, happy and carefree. Except the sun was going down and the light dimming. Only a bit. The trail would be right up ahead.

Finally, it became clear that the trail wasn't going to materialize any time soon. Still guided by those clear white blazes, we pushed on. At some point, out of the back of my mind, I asked Judy, "aren't the blazes on the Appalachian Trail white? Isn't this trail a bit wide and well established for that upgraded deer trail we were looking for?" "Well, yeah, the AT blazed ARE white."

My map showed the same trail we needed to get back home on the left, intersecting the AT as well. So, confidently we plunged forward, picking up the pace a smidge because we would have to do the circuit that I had thought too long to do during the daylight we would have available. And we continued on. Judy said what I was thinking too, "If I were alone right now I would be terrified, but because we are together, I feel fine." Yes. Company dissipates fear.

And so, we pressed on. Finally, we realized that the trail from the left wasn't going to materialize either. So, there was no choice but to continue forward. At some point, the Trail would come to an end at Harper's Ferry. I had a light that I was loath to use because of the boulders and the trees and the distance between white blazes. I had a flashlight but it would be hard to use while both hands were handling the poles. And so we continued on. Not so fast any more, because as wise Judy pointed out, in the dark, we would go more slowly.

We were both imagining how and where we would sleep. We both agreed that we were having a wonderful time, that it wasn't the end of the world, that we would find a cave and spend the night out, if necessary.

At some miraculous point, we came to an intersection of signs and a choice. Back was 9 miles, forward was 13 miles, but, down to the right 0.2 miles was a shelter. Judy thought we should go check it out. It was only a few feet away. 0.2 miles. Easy. So, we started down a steep, zigzag trail as it got really darker, really fast. I kept thinking about the hike back up. But, no problem. plus, there were some lights fairly near, up ahead. The glow of incandescent lights. Hmmmm. As we jumped and leapt the last few feet in what was by now pitch black, it was a house! There were people in the kitchen! It was clearly an Appalachian Trail hostel house for groups. We knocked on the door, seeing about 25 small boys, all in green T-shirts and baseball caps, sitting at a long table, eating dinner. Some men were wandering around a huge kitchen with plates heaped with food.

Was this amazing or what? We were surrounded with offers of food and drink and chips. Judy and I kept saying, "we are lost." Someone brought out a map. Yes, indeed, we were way away from where we had wanted to be. But no matter right now. Dinner! One of the men plonked huge helpings of rice and chile on plates, cleared off counter space, brought up two stools and started asking more and more questions. I was so grateful I was stunned. How could we have gone from being utterly lost and facing a night in the woods to sitting in the midst of 30 Boy Scouts from Troop 994 from Fairfax Station eating dinner in a raucous din?

Finally, a couple of the men said they would drive us back to where our car was. We figured out the way on a map, some surely 15 miles to simply go, what by the crow flies, or even a well guided human walks would be, about 1 mile.

Dinner down, we hopped in a car and off we went. Our driver had worked his whole life in satellites, so we got a bird's eye view of the myriad satellites, some geo-synchronous, at 12,000 plus miles in orbit, the GPS ones, square boxes 15' by 15'. Weather ones, TV ones, military ones, older ones with only one signal, new ones with 4 different frequencies. Some with antennas of 100 feet hanging out in space. Some with more or less propellant that would allow the earthlings to adjust their position.

After several false starts up impossible roads, we made it to where Red Outback was patiently waiting. And the woman behind the glass door was on the phone. She came out. She ran back in to tell the Sheriff that we had just shown up.

We bid goodbye to our kind Scout troop leaders and jumped into Sheila's warm house. We spent an hour chatting about a million things, warmed by her wood stove.

Rested, refreshed, thanking our lucky stars, we jumped in the car and drove home!

What a day.

Targetted Stimulus: Acorns Instead of Dandelion Seeds

Davie Pearlstein's list of conventional wisdom targeted stimuli for the economy sounded so sensible, that I had to summarize them here.

Instead of further cutting of interest rates by the fed, which risks stimulating the very behavior that got us into this subprime meltdown, a few economy enhancing measures. As Pearlstein says, "this ought to be an easy one . . . we know how much stimulus could provide an economic cushion."

To boost GDP by $125 billion, or 1% of GDP:
1. Extend unemployment benefits by 6 months, temporarily increase food stamp allotments and offer a flat one time payroll-tax rebate to workers with household incomes below $100,000.
2. To assure the support of the states, offer money to the states by increasing the federal Medicaid match can do that.
3. To bring Republican business interests on board, throw in the tax break of accelerated depreciation, "which doesn't reduce corporate tax payments, it just delays them."
4. To address the housing downturn, two measures.
One, advance future federal housing subsidies and make them available now to state housing authorities. This would allow housing authorities to buy some of the growing inventory of unsold properties to rent out to low and moderate income families. It would help stabilize the housing market and in the long run would save money.
Two, create a new type of housing finance -- at zero cost to the government -- to prime the resumption of mortgage lending: create a debt-equity blend, whereby the bank would lend to borrowers and obtain an interest in the future appreciation of the value of the property (think mortgage plus reverse mortgage). This new idea could both increase demand and reduce foreclosures. Homeowners would pay lower premiums and the banks would have a long term interest.

As Pearlstein points out, these are neither complicated nor radical ideas; some spend new money, others shift money from the future to the present, while others cost nothing but shift returns into the future. He says these measures meet the tests of Larry Summers, former Treasury Secretary and President of Harvard and now entrepreneur, of being "timely, temporary and targeted."

I always thought the debate between Al Gore and his targetted approach to the economy and George Bush's tax cuts all around but mostly to the rich as being the difference in propagation strategy of the oak tree and the dandelion. The oak counts on lots of squirrels to carry their trophy acorns around and bury them, some to be found during winter and eaten, but some to live another day and grow into a mighty oak. The dandelion puts its faith in the winds, by creating beautiful flying umbrellas to spread around the world.

And while gardeners may say that strong but delicate dandelions have a very successful reproductive strategy, in the long run, the mighy oak provides housing for birds, squirrels, various insects and food for all of them. I always thought Gore had the better argument.

"Let Wallace Hang"

Says evolutionary biologist, Olivia Judson, a familiar denizen of these environs. On his birthday, January 8, she went to the British Museum, where busts and portraits of all of the great scientists of the 19th century are lionized. But Alfred Russel Wallace's portrait was in storage.

By way of signaling Wallace's great contribution to science -- as one who sent Darwin a letter containing a manuscript outlining the ideas evolution by natural selection and who thus stimulated Darwin, who betook himself to the drafting table to publish "On The Origin of Species" eighteen months later -- Judson makes two great points.

The first is to point out that the infelicitous phrase "survival of the fittest" is a tautology: Who survives? The fittest. Who are the fittest? Those who survive.

The second is to explain natural selection so that anyone can understand it. She writes:

"The idea is simple. Far more organisms are born than can survive. Among small song birds such as blue tits (Cyanistes caeruleus), for example, each female can lay as many as ten eggs in a clutch, each year. Yet the blue tit population doesn’t grow gigantically every year; on the contrary, it stays more or less the same. Every year, then, most blue tits die. They become food for squirrels, or cats, or maggots. Any bird that has attributes that help it to survive — sensitive hearing, a beak well suited to breaking into seeds, a knack for catching spiders and caterpillars — will have an edge over its less endowed fellows, and will be more likely to leave offspring. If those attributes have a genetic component, the offspring may (depending on how the genetic dice roll) inherit them. Over time, different populations of the same species will face different pressures and begin to diverge."

And, the rest is history. That divergence leads to the gradual evolution of different species and the profusion of life forms that inhabit the Earth today. And, it evolves by dialectic, as it were, and not purpose.

I'll leave you to read Wallace's entreaty of 1863 to preserve nature, in language as urgent as any written by Al Gore.

From a Voter's Perspective, Not a Fight, But A Feast

What we have is not a fight between two great candidates (except for between each campaign because there can be only one president) but an embarrassment of riches. Democrats and Independents are enjoying one of the most rich fields of presidential candidates in more than a generation: two great Dems, each of whom deserves my vote.

I will vote for Hillary in the primary because she is the stronger, more knowledgeable candidate. But, I will be a very enthusiastic supporter of Barak Obama if he is nominated.

My hope is that either one, as president, will take a page from Lincoln's presidency and as so brilliantly described in Doris Kearns Goodwin's Team of Rivals, appoint her opponents to her cabinet: Obama as Vice President with a huge portfolio (a la Gore); Edwards at Justice; Dodd at Treasury; Biden at State; Richardson at Defense; Kucinich at Labor and HUD; McCain at United Nations; Giuliani at Homeland Security.

O happy day!