Then, a 20% Chance; Now…

“The purpose of life is to live it, to taste experience to the utmost, to reach out eagerly and without fear for newer and richer experience.”

   ——–Eleanor Roosevelt

A mini-celebratory brunch is in order: the doctor reported both heart and aorta are sound.

“We’ll take you out,” we say.

“You’ll come here,” she insists. “The best bagels, fresh eggs, delicious fruit, plus quiet and lots of room.”

We relent.

Four years ago, the collapse—after a symphony hall concert.

She attended concerts often—multiple subscriptions, with friends and alone. And the art galleries, the library lectures, the thrice-weekly swims, the scheduled trip to Macchu Picchu…

That evening, she was alone. 

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Ambulance rides to three separate hospitals. Number one: ill-prepared for such an emergency. Number two: heart attack—quick; give her blood thinner. But then the correct diagnosis: a ruptured aorta, meaning the blood thinner was a clearly awful decision. “Won’t operate,” said the head doc. “Too old; too risky.”

But three’s the charm. “Bring her here,” said the vibrant young female surgeon, expert in repairing damaged hearts and valves, at a larger affiliated hospital.

Afternoon next day: We—in-laws and daughters—met with the surgeon, a tall, slender, soft-spoken woman whose brown eyes were at once warm and riveting. She minced no words.

“Without surgery, she will soon die.

“With it, a 50% chance she’ll die during surgery or within the next three days.

“A 30% chance she’ll survive the surgery but then suffer a stroke or other event that would seriously impair her functioning and quality of life.

“There’s a 20% chance she’ll walk out of the hospital and resume her life.”

What would you do?

“What do you think?” we asked the surgeon, who also happened to be kind and empathetic.

“She’s come through all this time, and two moves by ambulance, and her color’s still good,” the surgeon said. “She’s been leading an active life until now—I think it’s worth a try.”

When asked about the prior surgeon’s reluctance to operate, she said: “The patient is 81, with a ruptured aorta—clearly in extremis. It was not surprising he [the surgeon] wanted to head for the hills. But the family members come in and say she swims 3 times a week, is very independent, very functional. That sways away from ‘let the poor old lady go…’”

Shortly after 9 pm, nearly a full day after the collapse, the surgeon came to see us, her lovely face looking tired but illuminated. “It went very well,” she said. “We repaired the aorta, the aortic valve, and the mitral valve.”  The patient, she said, “is a picture: most people after surgery are pale and puffy. She looks like herself.”

Later, she acknowledged: “I had major doubts, but one of the great benefits of a large hospital system like this was that I spoke with my chairman and another specialist in aneurism repair. I said, ‘I know what you’re going to say, but…’ Both felt it was reasonable to operate.”

Three days after surgery, when the patient was speaking and demonstrating an understanding of commands, the surgeon pronounced her, in highly technical terms, “a miracle.”

When we first saw her, she greeted us with a big smile. But when the nurse told her she was about to swab her mouth and make her more comfortable, the former school principal uncharacteristically replied: “Bull s—t!” The surgeon expressed delight: “Profanity and criticizing breakfast are two excellent prognostications,” she said wryly.

“This was a Type A dissection,” she explained to me. “The pipe has burst. You sew in a piece of material, being careful not to leave gaps and not to miss a stitch. It’s like sewing a sleeve into a jacket. It’s not difficult, but you have to be meticulous. If you miss one stitch, you spend a lot of time regretting.”

As the patient prepared to leave for a rehab center at the end of her hospital stay, the surgeon said she expected her to resume her life and live for a number of years more. The surgeon has already been proven right. 

That brings us to today’s brunch, served on china—no paper plates. images-17A nicely arranged platter of cut-up fruit sprinkled with almonds forms an edible centerpiece. After brunch, I have to fight her to let me do the dishes.

She tells us about the concert she’d been to the night before, and the gallery visit the day before that. Her eyes are bright, her face unlined and attractive without a touch of makeup. Her mind totally sharp—despite a stroke some months after her surgery, which minimally damaged her vision in one eye.

She explains—without complaint—that she needs to rest a lot more than she once did. And she’s more concerned about walking about the city in the winter, fearing a fall that might hurt her fragile back (she’s had several fractured vertebrae). “I feel somewhat isolated,” she says.

She can’t keep up with the group of women nearby who meet daily to pursue one cultural event after another. One, in her 90s, lives on the 13th floor of her building, and walks up and down the stairs twice a day in addition to her other activities. I am exhausted just hearing about her.

She talks about my blog, describing the posts she most enjoys. She asks me how I feel about it. “I love it,” I tell her. “It’s so freeing to be able to write about anything I choose, and I enjoy the dialogue with my readers. It’s a source of great satisfaction for me.”

“That’s the way I feel about this,” she says. And she points out her new response to that sense of isolation. Once an art teacher, she has painted and sculpted—both before moving to special ed, then becoming the principal of two schools for autistic children—and since retiring. But those art forms require space and effort expended to clean up. Now, in her 86th year, she has found the ideal medium for her present circumstances: paper collages. 

She points to her “studio”: a corner of her dining area holding scissors, Elmer’s glue, pieces of cardboard and styrofoam for backing.

Suddenly, we see the works, positioned throughout her apartment. Each one is a visual delight—demonstrating a keen esthetic sense and a creative mind channeling itself in a wholly new direction. 

A large one features Eleanor Roosevelt, the Statue of Liberty—its torch the highest point on the collage—and other images and references to that era: Social Security, the UN, the WPA.

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Another—also large—is a replica of her favorite concert hall, pieced together from performance programs and advertisements. One depicting penguins and divers in the ocean is a work in progress. And on and on.

Her sources of inspiration? She combs through discarded magazines and the detritus of junk mail, finding things that strike her just the right way. That sea bird that hovers over one work? “He just caught my eye and spoke to me,” she says.

And so she meticulously pieces together from multiple sources all kinds of stuff, building new and larger stories than the ones she’s extracted—at the same time enlarging her world and, as we look at these works from all angles—ours as well.

I am in awe of this remarkable woman, who spends almost no time complaining and a great deal of time creating. How many of us will move beyond our limitations and find new ways to reach within ourselves for personal satisfaction and growth—regardless of our ages?

As I think about the doctor who refused to operate on her four years ago because she was “too old” and it was “too risky,” I find myself pondering those nearly impossible decisions about how much to do when an older person is “in extremis.” 

A 20% chance didn’t seem like much, but we in the family are forever grateful to the wise surgeon who felt it was worth the risk, guided us accordingly, and then used her brilliant skills to make that decision the best one.

 

As always, I welcome your thoughts, experiences, stories, and in this case, philosophy about how to confront these difficult decisions.

Annie

PS: Back, by request, is the 5-star like-ometer, below. Click on the star on the left if you find this post “awful,” the star on the right if you find it “excellent,” and so forth. WordPress people continue to have the “like” option below. (You may be able to click on the stars as well; I’m not sure.)

I greatly value your comments and feedback.

 

Practicing Optimism in a Crappy World

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After my last couple of posts, several people said they appreciate my optimism—a trait that is clearly in short supply these days. As I don’t think I’m either ostrich or Pollyanna, and I’ve done plenty of ranting and yelling at the images on the TV news and on my often too-smart-by-half phone, I’ve been exploring the source of the hopefulness that I’ve been conveying to you.

I think that the mindfulness meditation I’ve been practicing for more than a year now has finally reached fruition, and I’d like to share some of my discoveries and resources.

I’ve been meditating with help from various gurus offering guided imagery through CDs and phone downloads for quite some time, and last Fall I took an 8-week course on Mindfulness-based stress reduction (MBSR), a program developed by Jon Kabat-Zinn, PhD, at the University of Massachusetts Medical School. I took the course near my home; it’s available in many areas and involves walking, sitting, and standing meditations, gentle yoga, body scans—with your mind, not technology—and the like.

Kabat-Zinn also coined the term “mindfulness,” which stems from early Buddhism, calling it “the awareness that emerges through paying attention on purpose, in the present moment, and non-judgmentally, to the unfolding of experience moment by moment.” The emphasis is on concentrating on the rhythm of your breath to focus your mind.

Kabat-Zinn’s program has actually been associated with positive changes in the brain: an article in Psychiatric Res (2011 Jan 30;191(1):36-43, which for some reason won’t hyperlink) noted “changes in gray matter concentration in brain regions involved in learning and memory processes, emotion regulation, self-referential processing, and perspective-taking.”

Who wouldn’t want that?  But for the longest time, though I was a diligent student and meditated daily, I felt I wasn’t getting the full benefit. I was “stuck,” allowing the same dopey stories—sometimes annoying, sometimes worrisome—to race around in my brain. And my “inner critic” wouldn’t let me get away for a minute with that non-judgmental stuff Kabat-Zinn talks about. What’s so hard about this? I’d berate myself. I’ve been doing it forever. Why can’t I master it?

Some time ago, I had the opportunity to speak with Sharon Salzberg, a well-known and beloved teacher and a founder of the highly acclaimed Insight Meditation Society in Barre, Massachusetts. Salzberg suggests dealing with the inner critic by giving it a name or persona.

Hers is Lucy, the Peanuts character who told Charlie Brown: “The problem with you is that you’re you.” When she has negative feelings about herself, she acknowledges them by thinking, “Hi, Lucy,” or “Chill it, Lucy,” in a friendly manner.

I’ve adopted my own Lucy, and finally, finally, I realize I’m spending more time living in the moment. Granted, there are some pretty scary moments all around us these days, but once you don’t dwell on them and continue to replay them, they lose their heft.

The whole point, which I’ve known for some time but only just become able to internalize, is that if you accept these feelings, thoughts, and fears and don’t fight them, knowing they’re transitory, they pass fairly quickly. You simply move on.

I am bolstered by imagery like that of the man standing outside his house, burdened by two heavy suitcases. One contains “regrets”; the other holds “worries.” First he drops one; then the other. His step is considerably lighter as he walks away.

I am also bolstered by the oft-repeated quotation attributed to Mark Twain: “I’ve lived a long and difficult life filled with so many misfortunes—most of which never happened.”

Tara Brach, one of my favorite mindfulness gurus, encourages smiling. In one of her talks, she says, “Smiling affects areas of the brain associated with happiness; it can’t cause happiness, but it can tip you in that direction.” If you want to try it, begin by sensing a smile around your eyes, then your mouth, your heart, and then sense and feel that smile throughout your body.

I find Brach’s talks so helpful that I listen to them repeatedly. One of them, “Meditation: The Radical Acceptance of Pain,” has on occasion freed me from a migraine headache without medication. The talk is less than 12 minutes long, and I recommend that anyone suffering from pain locate it via Google and listen to it—maybe even twice. There’s nothing like relieving one’s pain to open a path to optimism.

Mindfulness recently got a nod from Bill Gates in The New York Times Book Review (September 9). Reviewing the new book 21 Lessons for the 21st Century, Gates says the author insists “that life in the 21st century demands mindfulness—getting to know ourselves better and seeing how we contribute to the suffering in our own lives.”

Acknowledging that this idea is “easy to mock,” Gates writes: “As someone who’s taking a course on mindfulness and meditation, I found it compelling.”

Though mindfulness is helpful to the individual, its proponents see its widespread practice as beneficial to the larger society. Emphasis is placed on the concept of lovingkindness. As Salzberg has said: “Lovingkindness and compassion are the opposites of fear.”

Another favorite guru, Jack Kornfield, speaks of the importance of equanimity, “the ability to meet all experience with a balanced mind.” Acknowledging that sometimes situations demand a strong response, he asserts that even such a response can be done with equanimity.

Equanimity arises from “living with a deep understanding of the passing of all things,” and leads to a peaceful heart. “With a peaceful heart, you can see clearly and respond wisely.”

The best leaders, he says, “combine strength and wisdom with a steady and peaceful heart.”  And so I say, optimistically: If enough of us follow this path–and if we elect leaders who meet that definition–perhaps we can make the world a little less crappy.

It’s been quite a journey for me to reach this point, and I’ll readily acknowledge there are times when reality’s bite makes me feel optimism is kind of nutty. But then I breathe, smile, and the shadow passes. We really don’t have to live in anger and fear.

Perhaps you’ll join me? Have you tried mindfulness? Are you tempted? As always, I’m eager for your thoughts. And even if you don’t care to comment, if you like this or any of my other posts, please feel free to share and/or click on “like.”

I’ll close by echoing Kornfield’s message: May you–may we all–live with a peaceful heart.

Annie