Archive for October, 2019


I wrote the following letter reply to an email from mother. If you haven’t picked up on it yet, my father is entering the last years of his life. And while I have yet to inform my parents of my diagnosis, I wrote what I hope was a well thought response.

My mother’s letter is as follows.

I’ve been wanting to share with you something Dad said the other day.  I made a small Christmas wall hanging and said (to dad), “Let’s put it up because it’s so close to Christmas anyway and it won’t get wrinkled.” 

I wished Dad a merry Christmas. 

He replied, “Yes – for the next 2 Christmases.” 

“And many more,” I replied. 

“For the next 2 Christmases”. 

“And for many others after that?” 

“Oh yeah. Sure.” replied very offhandedly’

So, I’m wondering if that’s what just came to his mind or he knows something I don’t? Or, can he can sense something?


Dear Mom:

I read your note with interest. I can attest to some extent of nature’s intuition. So, I will get to this upfront.

Every day in medicine, there are numerous examples of patients who know they are about to die, even if no one else does. They often have a feeling. And even though doctors don’t know how to explain it, the intuition is rarely taken seriously.

In hospital terms, when we talk about instinct, we usually speak about expert clinicians grasping diagnoses in ways that seem to defy rational explanation. Doctors appear to know almost intuitively which data to focus on and which to ignore. Of course, their decision-making is based on experience and deductive reasoning (and perhaps on evidence, too). Still, it seems almost mystical.

Personally, I have learned the years to take such intuitions seriously.

I can’t remember if I told you this or not. Instincts can be derived from other sources. In 2007, The New England Journal of Medicine had the story of a cat named Oscar who lives in a nursing home in Providence, R.I., and seems to have an uncanny sense for when elderly residents are about to die.

Oscar goes to the patient’s rooms, curls up beside the patient — even those residents for whom he has previously shown little interest — and purrs. Staff members learned that this is a telltale sign of impending death, as they’ve witnessed Oscar’s similar behavior in the deaths of at least 25 patients. “This is a cat that knows death,” one doctor said. “His instincts that a patient is about to die are often more acute than the instincts of medical professionals.”

There are, of course, other signs that can guide intuition. Natural aging is one. Or maybe it’s a combination of natural aging and the will (internal will) to remain meaningful. Then there’s Google.

If you’re after a bit of a break from worrying whether killer robots will murder us all, don’t worry: Google knows when we’re all going to die. Google’s Medical Brain AI team has been working on neural network software which can scan through a person’s electronic health records, pull together relevant information, and quite effectively determines how long that person will live.

Accuracy nears 96%.

It turns out Google is efficient at sorting through mountains of data, including scribbled notes on old charts, and turning them into useful predictions while also pointing out to healthcare practitioners where they’ve pulled the data.

Then there’s just plain age. Turns out, the older you get, the accuracy increases. Why? Because people get older and die.

In truth, if you create an algorithm that assesses patients against the mean average age of that person in the population, you reasonably accurately and quickly dial into an expected natural life. For instance, FlowingData website calculates that I have a 10% chance of dying in the next ten years and a 26% chance within 10 – 20 years. And if I input’s dad’s age, he has an 88% chance of dying between in the next several years.

My company has a similar AI program. I inputted dad’s age, some essential background information, recent medical trends, and the result nearly equals dad’s ‘intuition’ – meaning the AI estimated dad is likely to pass within two to two-and-one-half years, with a 47% chance likelihood of a circulatory issue (heart or lung).

People are amazed when I tell them fairly accurate things. It’s not magical. In truth, having been in the medical profession and installing all these systems, I know the statistics, even weird ones. For instance, I know that between 45–50, the relative majority of deaths are due to cancer. As cancer gradually declines in importance, circulatory diseases become the leading cause of deaths those between the ages of 75–80. Mental disorders (Alzheimer’s, dementia, etc.) and diseases of the nervous system are common causes of death after 80+ years of life.

Of course, dad knows none of this. He does, however, know his own body. He’s tired, and like many nearing a winter morn’, he may simply want to look moving forward.

Therefore, here’s my suggestion. Forget all the statistics, mind over matter, intuition, etc. Focus on trying to find a way to enjoy the time you have and what you have left. In a way, you are in an enviable position of knowing and experiencing “the ultimate relationship.”

And what’s that?” you ask.

The ultimate relationship we can have is with someone who is dying. This landscape of such a relationship is so varied and so vast that it not only renews, but you’ll discover a new level of intimacy never experienced. In this way, love will teach a certain sense of gratitude for what we have been given.

But … prepare for when the day comes … for it’s sooner than later.

As I write this, I have not seen the final Star Wars film: The Rise of Skywalker. Yesterday I saw its latest theatrical trailer. After viewing its sequence, I placed my pen on the nightstand, took off my eyeglasses, and rubbed my forehead. 

I winched.

I watched these characters from late high school through near retirement. Each trilogy was, in effect, a story. The prequels were of Anakin Skywalker. The original trilogy seen in late high school was of Luke, Leia, and Hans Solo. And the remaining sequel is of Rey. 

I winched not because the movies were terrible. There weren’t. My anguish came from the bowl of my soul. It came from the fact that in forty-years of watching, what good has “The Force” produced? 

Yeah. Yeah. I get it. The movie is of good over evil — lightsabers, and light versus darkness.

I told a friend of my thought during lunch. 

Without hesitation, she stated, “Indirectly, perhaps you’re asking what does the belief in God produce?”

Perhaps,” I replied.

Maybe I’ve come to these conclusions after having only two, three, years of life. If the characters had been real, what did belief in “The Force” produce? Did the technology provide any benefit to life? Many people died. People on various planets suffered interminably, and several planets were destroyed, meaning millions, if not hundreds of millions, died. By all accounts, there is no Shangri-la, no affordable healthcare, technology is used to versus cure and idiot leaders. 

At the end of Avengers: Infinity War, the villain Thanos acquired the infinity stones that let him snap his fingers and turn half the population (universe) to dust. In doing so, Thanos believed he achieved his goal, a universe free of suffering. If any one of us held such power, why is it that the first creative thing we must do is kill? 

Hey! The same holds today.

Maybe Huffington Post Contributor Anamika Ojha was right. She once wrote, “The most crucial lesson that Star Wars taught was that there are heroes and villains in each of us.

You’ve seen God,” my friend stated. 

Yes. I have.” 

“I haven’t,” she replied.

And it’s true. I have seen God. I have seen heaven, a darker side courted me, and yet embraced by beauty. And by God, I continue to question today what the hell is going on.

Yet, I believe.

Jesus said, “Because you have seen me, you have believed. Blessed are those who believe without seeing.” Maybe that’s the lesson. Belief. 

The final shot of Star Wars: The Rise of Sky Walker, projects a gorgeous image of Rey. She’s the new icon of hope. Daisy Ridley becomes our sense of hope. And the voice from elsewhere in the room (or maybe from beyond) echoes some memorable lines from the first film: “The Force will be with you,” says Luke. “Always,” adds Leia.

Yes, Luke. I believe.

Pathway

It’s been a strange week in Washington (D.C.)

It started approximately four days ago. Washington Post columnist Erik Wemple began his column stating that in the early months of the Trump administration, Attorney General Sessions pledged to take a hard line against leaks of classified information.

Why that reference? Who was Wemple opining? Henry Kyle Frese.

On October 9th, Henry Kyle Frese, 30, was arrested on Wednesday at his office at the Defense Intelligence Agency. Mr. Frese allegedly shared information with two reporters: CNBC reporters Amanda Macias, a national security reporter who also appeared to be his girlfriend, and NBC reporter Courtney Kube.

On Thursday, Lev Parnas and Igor Fruman, associates of President Trump’s lawyer Rudy Giuliani, were arrested before flights departing the United States. Parnas and Fruman were part of the pressure campaign on Ukraine to investigate Democrat Joe Biden and Hunter Biden. This criminal case exposes the president’s allies as Mr. Trump tries to discredit ongoing impeachment efforts in Congress.

All of these have one common theme, conflict of interest.

In the CNBC/NBC reporter case, why not have sex with the people they cover?

The answer is painfully obvious: No. Never partner in a business with sources, much less become boyfriend/girlfriend. Such mixing contaminates the end product with the taint of compromise and conflict of interest. Kube should have seen that coming. Yet, she willfully agreed to work on sourced material from Frese and Macias.

In the case of Parnas and Fruman, ethics manuals and rules, either didn’t exist or didn’t deter blending business with criminal probing.

We’ve become accustomed to such intermingling. Hollywood romances such relationships, often adopting this forbidden pairing to power stories, often with female bedding a source. A shortlist of contemporary movies, and TV shows include:

  • Thank You for Smoking;
  • Absence of Malice;
  • Nashville;
  • Scoop;
  • Scandal;
  • Trainwreck;
  • Top Five;
  • How to Lose a Guy in 10 Days;
  • The Fly;
  • Fletch;
  • Mr. Deeds;
  • Three Kings;
  • The West Wing;
  • Crazy Heart; and
  • Iron Man.

After my ethical lapses in business, including one that sacrificed a career ten years ago, I reapplied Spiritual training to my life. I better understand issues of conflicts based on wealth (Trump), sexuality (Catholic sex scandals), and power (Me Too movement). While each member of society is expected to dedicate him or herself to training, avoiding such mistakes, and harmful actions. When such transgressions occur, destructive forces can be released. Thus, such instances must be acknowledged and worked with skillfully through the wisdom of both inner spiritual thought and practical ethical standards.

A Code of Ethics provides a pathway. And I cannot help but think that all the participants referenced in this blog post should have remembered that ‘pathway’ and asked one critical question.

“If I had to justify my actions, how would others view it?”

Had that question been asked, all of this could have been avoided. Yet, here we are. Therein, I query.

“What’s your pathway?”

I’ve been these past several weeks dealing with pain management and strategizing end of life decisions. Turns out, the two years of quality life estimated by physicians some six months ago, may be an estimate.

In truth, I know life is just an estimate. However, I feel my body is giving way to nature. Some mornings, I’ve barely been able to get out of bed. And when standing, I experience being lightheaded after standing, blurred vision, and neuropathic pain that often comes and goes on its. Some days, the pain has been unrelenting. Other days, it comes and goes. The character Shane Falco from The Replacements summarized it perfectly. I use his analogy when describing how to understand in anticipating life’s end.

“You’re playing (living life), and you think everything is going fine. Then one thing (medical problem) goes wrong. And then another. And another. You try to fight back (medical treatment), but the harder you fight, the deeper you sink. Until you can’t move … you can’t breathe … because you’re in over your head. Like quicksand.”

People ask how I decided not to continue most treatment. Los Angeles Times columnist David Lazarus nails my thoughts in a recent column.

“Americans pay more for healthcare than anyone else in the world. Yes, for all those trillions of dollars spent annually, we have a lower life expectancy and higher infant mortality rates than other developed countries — two critical metrics for judging the effectiveness of a nation’s healthcare.

But the thing that never ceases to astonish me is how needlessly cruel our system is. I’m talking about the small acts of greed and pettiness that make a terrible situation for the sick even worse.”

Gail Boudreaux, Anthem’s chief executive, formerly executive vice president of UnitedHealth, received total compensation of $14.2 million last year. Therein lay my personal ‘red line.’ I refuse to subject myself to endless rounds of cruelty and infinite debt. I refuse to beg for mercy from healthcare providers who only seek to benefit from my misery.

In 2012 I wrote about a coworker who asked how I deal with the pain. “Well,” I explained, “I reflect upon the moment, and remember that I am not having a bad day. My body is, but I am not.

A recent spiritual experience reinforced the timelessness of my life. I will summarize that experience in future writing. However, a master I read of laughed at how easily we grasp at identity. To which, he said, “I am none of that. I am not this body, so I was never born and will never die. I am nothing, and I am everything. Your identities make all your problems. Discover what is beyond them, the delight of the timeless, the deathless.

Therefore, I choose ‘timeless.’

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