They're Not in Any Hurry to Get to Heaven

I still haven't quite figured out why God wants you on a mechanical ventilator.

Religious Belief Linked to Desire for Aggressive Treatment in Terminal Patients

By RONI CARYN RABIN
Published: March 17, 2009

Terminally ill cancer patients who drew comfort from religion were far more likely to seek aggressive, life-prolonging care in the week before they died than were less religious patients and far more likely to want doctors to do everything possible to keep them alive, a study has found.

The patients who were devout were three times as likely as less religious ones to be put on a mechanical ventilator to maintain breathing during the last week of life, and they were less likely to do any advance care planning, like signing a do-not-resuscitate order, preparing a living will or creating a health care proxy, the analysis found.

The study is to be published Wednesday in The Journal of the American Medical Association.

“People think that spiritual patients are more likely to say their lives are in God’s hands — ’Let what happens happen’ — but in fact we know they want more aggressive care,” said Holly G. Prigerson, the study’s senior author and director of the Center for Psychosocial Oncology and Palliative Care Research at the Dana-Farber Cancer Institute in Boston.

“To religious people, life is sacred and sanctified,” Dr. Prigerson said, “and there’s a sense they feel it’s their duty and obligation to stay alive as long as possible.”

Aggressive life-prolonging care comes at a cost, however, in terms of both dollars and human suffering. Medicare, the government’s health plan for the elderly, spends about one-third of its budget on people who are in the last year of life, and much of that on patients at the very end of life.

Aggressive end-of-life care can lead to a more painful process of dying, researchers have found, and greater shock and grief for the family members left behind.

The new study used both a questionnaire and interviews to assess the level of reliance on religious faith for comfort among 345 patients with advanced cancer. The patients, most of them belonging to Christian denominations, were followed until they died, about four months on average.

A vast majority of patients, religious or not, did not want heroic measures taken. Still, 11.3 percent of the most religious patients received mechanical ventilation during the last week of life, compared with only 3.6 percent of the least religious.

The most religious patients were also more likely than less religious ones to be resuscitated in the last week of life and to be treated in an intensive-care unit as they died, although those differences may have been due to chance.

“Doctors don’t always acknowledge, and I’m pretty sure patients are telling us, that God is really important in their lives,” said Dr. Gerard Silvestri, a cancer specialist at the Medical University of South Carolina in Charleston, S.C., who has studied end-of-life decision making.

A study by Dr. Silvestri in 2003 found that while cancer patients listed their oncologist’s recommendation as the most influential factor affecting their decisions about medical care, their faith in God was the second-most-influential factor, ranking higher than the recommendations of their family doctors, their spouses and children, and even information about whether treatment would cure the disease

Radio Radio

http://www.thejefffariasshow.com/stream.php

I'm going to be doing a live broadcast on this guy's show today, 7 p.m. EST. Supposed to be talking about why martial arts are good for society, something like that. I should have no problem running my mouth; I so rarely do.

Sorry that I haven't been blogging. I've been deeply engaged in the best and the worst aspects of life. And writing. And writing. But I should be back in circulation soon, and also looking forward to reading y'all.

Peace

Read My Salon Piece, You Bastards

http://www.salon.com/books/review/2009/02/04/mixed_martial_arts/

Ellen Miller, 1967-2008

My long-time friend, the author Ellen Miller, died just before Christmas this year. I'd gotten an email from her on December 13th saying she hoped to meet over the holidays. When I didn't hear back from her, I assumed that she'd been caught up in the chaos that had hounded her for the past few years.

Ellen was one of the most talented people I've ever met. She had an intense feeling for language - for word play, metaphor, style. Her first novel 'Like Being Killed' did well both critically and in sales - a rare combination. Ellen reminded me of two of my best professors from college. Like them she was from New York, Jewish, very left, both earthy and intellectual, and not particularly crazy about Israel's treatment of Palestinians (Grace Paley also comes to mind, although they were very different writers).

Job had nothing on Ellen. In the last few years, she'd been afflicted by severe health issues that nearly killed her a number of times (her doctors almost did her in also with their clumsy attempts to figure out what was wrong with her). Her landlord kept trying to evict her from her beautiful apartment, a typical New York story. All of these issues kept her from focusing on her writing, and working, which only made things worse. She did have a very long manuscript in process and hope I'll get to see it some day.

Ellen never gave up. I'd talk to her and be astounded by the suffering she'd gone through. I think it would have broken me. To see this vital, intelligent, kind friend being tortured was almost unbearable. Apparently she collapsed in a local deli and couldn't be revived quickly enough. I include her obituary below. I will miss having Ellen in my life.

Obituary
****
Ellen’s life and work will be remembered by friends and family at a memorial service scheduled for February 8, 2008. Details below. All are welcome.
Ellen grew up in the Carnarsie neighborhood of Brooklyn, in a working-class Jewish environment. Her vivid experience of this upbringing formed an important element in her second (unfinished) novel, Stop, Drop, Roll, an excerpt of which appeared in the anthology Lost Tribe: Jewish Fiction from the Edge (2003). She also contributed stories to the anthologies 110 Stories: New YorkWrites After Sept 11and Brooklyn Noir, among others.
In addition, Ellen taught creative writing at New York University, Pratt, and the New School, where she was admired by her students and colleagues not only for her mastery of the writing craft and dedication to teaching, but for her remarkable courage and honesty both on the page and in the classroom. Notwithstanding years of chronic illness and other hardships, which she faced with superhuman strength and determination, Ellen lived a rich and creative life and deeply touched many others. In the terminology of her favorite hobby, boxing, Ellen had “a lot of heart.”
She received her BA from WesleyanUniversityin 1988 with Honors and Phi Beta Kappa and later earned her MFAfrom the New York University Creative Writing program where she was the recipient of the NYU Creative Writing Fellowship for Fiction. She was also awarded a residency at the MacDowell Colony, among others.
Drafted in a six-month creative burst and published in 1998, Ellen’s novel Like Being Killed enjoyed many critical accolades, including a brief appearance on the San Francisco Chronicle’s bestseller list (after a cover review). Kirkus Reviews noted that “[the narrator’s] voice is authentic in unsparingly illuminating the link between self-protection and self-destruction, revealing a tender inner life that persists despite addiction, depression, and descent into squalor. A bleak, bracing debut.” Meanwhile, her teacher and mentor Annie Dillard wrote: “Ellen Miller hurls herself, along with her readers, into a world that resonates with moral complexity, startling anecdote, humor and good humor, brutality and compassion. Her prose is uncommonly clear, compelling, unaffected, and strong. The range of her narrative concerns--from Primo Levi, Nietzsche, and dead languages to bagels and peach pies--proves that she can make anything interesting."
She is survived by her devoted partner, Christopher Rowell, her step-father, Scott Hyde, her two brothers Steven and Michael, and her beloved god-daughter, Olivia Francesca Foster. She will be missed dearly by all.

A memorial service in honor of Ellen’s life and work will be held on Sunday, February 8th, 2009 from 4:00 to 6:00 pm at the Lillian Vernon Creative Writers House, 58 West 10th Street (btw 5th and 6th Aves.), New York, NY. All are welcome.

The Last Words of Lasantha Wickramatunga

Wickramatunga, a Sri Lankan newspaper editor, was assassinated last Thursday. His newspaper was critical of government conduct in the war against the Tamil Tigers. Gunmen had tried to kill Wickramagunga before, and he knew he was a walking dead man. He left a letter to be opened on his death. In it, he names the government as his murderer (even though he'd been a long-time friend to the president)and mourns the loss of democracy and human rights on the island. The text of the letter is at the address below. It's moving and disturbing.

http://www.newyorker.com/online/blogs/stevecoll/2009/01/letter-from-the.html

When Home Isn't

In the week or so I've been back in NYC I've managed to pick up two police summonses. The first came when I was leaving a warehouse show where some friends were playing. Free cans of Colt 45 and empanadas, the best Christmas party in a while. I'd just cracked a Colt when my crew decided to leave. I walked outside with my can.
'You're going to get a ticket for that,' Cindy said.
'Yeah whatever,' from yours truly.
Twenty feet from the club door a squad car pulled up. Busted.
'What's that?' the cop said.
I showed him.
'Pour it out,' Cindy said.
'You can keep it' the cop said. He was young, twenty-five maybe, handsome, African American. Had a certain suavity to him. As he was writing me up, he took a call from a woman and flirted with her. Then he said, 'Sorry baby, I'll hit you back later. I'm writing a ticket here.'
Overall, the cops were pretty decent about it.
'I knew that had to either be a Colt or a coconut drink,' the black cop said. 'No other can looks like that.'
I'll take the blame: that summons was on me but still it was a sign how the Bburg waterfront has changed. The empty streets among the industrial buildings were the last place you'd ever see a cop, even as recently as a year or two ago. But there are some big money highrises going up there and it seems the developers have put out the word that they want the rabble kept in line, even though the highrises are still mostly vacant (and given the economy, just might stay that way).
As I stood sipping my Colt the cop reassured me that I would beat the summons easy.
'Just tell them you were drinking coconut juice and I wouldn't listen,' he said. They'll throw it out. Happens all the time.
I thanked him and they drove away.

A few days later I was talking a late night walk down the same empty waterfront streets. I passed the big development for 'The Edge' a condo-tower complex promising 'edgy' living for millionaires at the edge of the East River. They'll even have their own water taxi to Manhattan (how nice for them). I saw a cop car cruising but I was sober and up to no wrong. I reached the waterfront park that had long been an afterhours hangout for all kinds of strange characters to do strange things - especially Hasidic men, who smoked pot there, cruised prostitutes and had gay flings with each other (I kid you not; I've seen them on the benches, making out like mohels). The park was empty though; because of the cold, I thought. I walked in and stood staring out at the water. A few minutes later, I turned around to see two cops running at me like I was raping a four year-old.
'You know you can't be in here at night' they said.
'I don't know,' I said. 'It's not posted.'
'Do you have anything sharp on you?' One said. He was another handsome young cop, Asian-American this time. Looked like he was about twenty-three. Bburg must be where the send the rookies to make their bones.
'Sharp?' I said. 'All I got is my cellphone and keys.'
'I'm going to pat you down,' the Asian said. 'It's for my safety. You could decide to beat me up and throw me in the water.'
'You never know,' I said. I didn't say that them beating me up was a lot more likely.
'I like your jacket' he said as he frisked me. 'Biker jacket right? Nice leather.'
Another lame summons. Another cop slightly embarrassed at writing it (although it didn't stop him from writing it - quota to fill).
'This is worse than the Giuliani days,' I said.
'I was a kid back then,' the young Asian cop said. 'I don't remember that.'
'Trust me,' I said, 'It sucked.'
And it did suck, but not in Bburg. Even in Giuliani's most delusional 'Il Duce' days, cops weren't harassing people in the Grand Street Park at 1 a.m. on a Tuesday night. Williamsburg had still been low rent and therefore below the radar for 'quality of life' complaints. I wanted to lecture the cops on the injustice of it; I wanted to ask them how they felt wasting their time locking down a neighborhood to make it more appealing to people who earned a hundred times more than they did. I kept it simple.
'You couldn't find a cop here in the old days when there were gangs and rapes and muggings every night. I wish they had you guys doing something more useful.'
'I wish they did too' the young Asian cop said. 'Don't worry about it. When you show up, they'll just dismiss it.'
'But that's the problem,' I said. 'I have to take time out of my day for complete bullshit.'
He shrugged. He had a quota to meet and I was helping him fill it.
And me? I was only doing exactly what I'd been doing for years; but the new Williamsburg has no place for it.

Sublet Surrealism

Last year I got a screenwriting gig - a project that I actually want to write - and headed out of town for a month to get started. The cavalcade coming through to sublet the apartment was the usual motley lot, mostly film production people in their spring migration to NYC.

I had three of them in the living room at once, including a gigantic African-American man who made the apartment seem like a doll house.

'Most hipsters are scrawny and small,' I said, watching him closely in fear that he would turn too quickly and smash a hole in the wall.

So why are you going? the slender camerawoman sitting on the couch said.

I need to be somewhere quiet to write the first draft of a screenplay, I said.

You will write the screenplay in one month? said the black guy's friend, a short, bald man with a heavy mitteleuropa accent.

A first draft, I said.

It took me five years to write my screenplay, he said.

I felt guilty.

Well, I said, Your screenplay must be good.

When Miramax calls you back in four hours, he said, You know it is good.

What's it called, the camerawoman asked.

It is called, 'Twin Souls', he said.

Oh, she said, There hasn't been any good twin things in a while. Now is a great time to pitch twins.

No, he said, They are not twins. It is about two people with shared souls who manage to find each other across the world.

That does sound wonderful, I said.