Archive for October, 2020


Question. If you were told you are going to die in three months, what would you do? That’s a similar message I received twenty months ago. The March 2019 prognosis went something like this, “Subsequent diagnosis indicated cerebrovascular disease .. with proper medicine and dietary changes, maybe minutes, hours, days, weeks, months or a couple of years.” I’ve been living in minutes, hours, days, weeks, months, and years since. In clinical terms, I met expectations, with some physicians claiming I even exceeded expectations. Tuesday, that “progress” was updated. ‘Years’ was removed. The subsequent redefinition becomes more impactful when life gets reduced to “minutes, hours, days, weeks, or months.”

Those in the medical profession (like me) talk about that one moment when a dying person first comprehends, on a gut level, that death is close. Nessa Coyle summarized that the habit of allowing thoughts of death to remain in the background suddenly becomes impossible when it can no longer be denied. Instantaneously, death is in your face.

Intellectually, I’ve had a long time to accept being terminal. And throughout the past twenty-months, I tirelessly treated (for lack of a better word at the moment) the physical, psychological, social, and spiritual domains of my soul. Even now, I feel neither feel depression nor anger. I am more horrified by death’s methodology than the literal act of dying. Monday morning’s episode revealed that the process of dying (for me) would either be long or swift. I fear the lengthy.

Clearly, I inherited my father’s computer wiring (brain schematic). For years he seemingly suffered endlessly with Transient Ischemic Attacks (TIA, a fancy name for short-term strokes) that arrive at night and leave by daybreak. Until it didn’t. Five years later, my father entered Hospice (a month ago). His demise has been slow, painful, and completely compromising, not only for me but also for my mother, who lived day and night by my father’s principal caretaker. 

My TIA arrived like a freight train after midnight and departed before dawn. Similar to early 2019, this was another warning shot, only bigger. It was a massive detonation. Sure I survived, but I was assured Mr. TIA would reappear and probably won’t leave. Doctors experts ran the statistics. About 1 in 3 (some studies claim 1 in 5) who experience a TIA are likely to experience a stroke within six months. The odds of experiencing this within 90 days are 2%-17%. My thought after being told I was going to die in months? In the immortal words of Burn Notice character Michael Weston, my physicians were saying, “Don’t make retirement plans.

One fortunate outcome (thus far) is that I’ve never lost control of who I was. This is an essential point for all facing death (or will face death). I may have lost control of the body, but I never lost control of me. Even during Monday’s TIA, I understood who I was, from where I came, the day, date, time, the problems facing me, the problematic discussion about whether one would find me with an unclean butt. Therefore, I hope that no matter how far I progress through this process, I believe there will be some part of me that will exist. It is a part I can knowingly take with me into the future to whatever lay beyond. 

As stated in many spiritual teachings, helping another die with a peaceful, positive state of mind is one of the most extraordinary acts of kindness we can offer. I think that should be everyone’s focus. Indeed, this will not be easy. Just the physical aspect of dying will be challenging. My goal is to be treated with respect, kindness, and love; to talk and be listened to; or, at certain times, to be left alone and in silence. People like me have spiritual needs – to make sense of life, their suffering, their death, have hope for what lies beyond, feel that they will be cared for and guided by someone or something wiser and more powerful than themselves. I am fortunate, for I believe someone awaits me and will provide guidance. 

After the doctors guided me through their updated prognosis, I momentarily reflected upon a recent Zoom business seminar. A seminar leader asked the roundtable of healthcare leaders what they had learned thus far through the pandemic. Most provided rather mundane versions of being a better spouse, parent, friend, or mentor. One person silenced the room. “I learned to humanize people and how not to be afraid of others, for everyone has value. It is a privilege to be a part of — even a small part of their life. And it’s a privilege to help them move on to wherever is beyond [death]. All of you inspired me to do that.”

And that’s been my goal. Hopefully, that’s what this blog has been about. May each of you be the part that helps people to move beyond. When things seem dark, find the power of love in those who surround you.

If you want to verify how clean hardwood floors are, spend a couple of hours face down sliding your face over each board. It is a cleaning tip I have neither known nor read. It certainly wasn’t on the front page of Good Housekeeping, on the back of a Mr. Clean bottle, or seen on YouTube. Nonetheless, there I was at 2:00 AM early Monday: rubbing my face across my hardwood floors because I could neither sit, stand nor crawl. I rolled over in bed and something went ‘bink.’ Maybe it was a ‘bink.’ Sounded like a ‘bink.’ Then again, it could have been a ‘boink,’ or possibly a ‘dink.’ I cannot accurately describe the internal sound. Doesn’t matter. What I tell you is the subsequent several hours trying to find a way to simply exist. 

I have lived this past couple of years believing I could have gotten lucky. Death would simply fail to notice me. We all do. And for the past couple of months, for the most part, I started thinking about two years plus 1. Then, out of nowhere, ‘bink.’ Sudden onset of severe & constant dizziness, nausea and vomiting, and imbalance. Did not matter if I stood (which I could not) or sat (which I could, only by leaning against a wall). Therefore on a cool crisp night, I lay face down on the hardwood floor. Struggling to coordinate a response, I realized a few critical points that impeded my ability to do anything but ride it out.

Both my overpriced iPhone 12 Pro Max and fancy-dancy Apple iWatch 4 were in the other room. My telephone? You guessed it: in the other room. If you read my blog, you’re probably asking, “Why did you do that?” My response is similar to that of my cat Cougar after being caught climbing the Christmas tree. “Cougar! Why did you do that?” He sheepishly shrugged, “I don’t know.” That’s one of the tricks to fancy-schmancy technology, it is all absolutely of no value when face down on the floor at 2:20 AM in the morning. Siri can’t hear. Mr. Google is asleep. Amazon is off. It’s just you and your thoughts. 

Believe it or not, my first pressing question was “How will I take a dump?” Second question.”I manage to sit on the toilet, can I wipe?” Agreed. These are not life and death questions, but at 2:50 AM, they seemed important. Ok. Important to me. Of course, I should have been trying to figure a way out of this mess. I should have been deciding how to call paramedics, a friend, or a neighbor but the thought of an unwiped behind permeated my thoughts. No. Thought of the Angel of Death finding me with an unwiped behind never occurred to me. It was just thought of an old, bald, fat man lying dead with an unwiped behind. 

“What we have?” asks the corner.

First officer, “An old, bald, fat dude with an unwiped a**.”

“Geez. Third time this week.”

“Yup,” nods the second officer.

As you know, I made it out alive. My doctor reminded me that I am, in fact, dying. Just not today. She also stated March 2021 is just around the corner, that I should expect more problems when nearing the point of no return. Five months is not that far away. Deep down, I know my body is getting worse. I may refuse to show it, but I feel it.

As a spiritual person, a Buddhist, for these 8 years or so, I know the time of death is uncertain but the truth of death is not. I take hope in knowing that everything is intertwined and linked. Like all things, we are constantly changing and regrouping. This means that transitoriness and change are basic features of spiritual life. The same applies to the human body: it too is constantly changing. And even laying on a cool hardwood flow, openly ready to vomit, my body teaches impermanence.

It is a fundamental error to think of one existing separate from others. The fact that I have a human body is considered a rare privilege. I am unsure what I did in some previous life to earn that privilege, even with the understanding I have not nourished it properly for a decade. I disown neither it nor God. I am not my body, but rather I am an inhabitant. I am the renter. I am sorry for the pain I caused my lessor, but I am proud it served me, even unto the end.

“Hey. You ok?” Janet began peeling back the covers, “Anyone in there?”

“Hmph,” as I slowly opened to the flicker of daylight. “What time is it?”

“Good,” she affirmed to herself. “At least you’re not dead.”

“What time is it?” 

“1:26 PM. Thought I’d stop by and drop off an Asiago Cheese Bagel. They always make the best cheese bagels Saturday.”

“Hmph,” I moaned in agreement. As brain synapsis began firing, Janet’s words faded as I curled an eyebrow. “Saturday?” I asked again.

Continued to be lost in her own thought, “Of course. Gibraltar’s Deli always makes the best cheese bagels on Saturday . . .” As her words faded from my radar.

I had been asleep for two days. “Oh God,” I silently whispered. Two days ago, I barely completed work. I was dizzy, light-headed, and had difficulty walking. My muscles hurt, the side of my head hurt, and my fingers ached from movement. I retraced my life. I remember getting in my car. Technically, I did drive home (if that’s what you call it). I drove into a curb, nearly crashed through the company’s parking garage security gate, almost fell asleep at a stoplight, and nearly clipped a mailbox. I got home and intended to take an hour-and-a-half nap. Two days later, I am waking to an asiago cheese bagel. Life is weird. 

People with Parkinson’s can experience extreme fatigue. It is a two-part cycle. One part physical, another part mental. Apparently, I felt both. The physical exhaustion I experienced leads people to reduce work hours, retire, or avoid social activities. The mental fatigue included mental tiredness, making concentration so faltering one can drive upon curbs and through security gates. 

To be fair, I have experienced this type of fatigue a few times. Previous experiences were similar to San Francisco’s slow-rolling, early evening fog that by all accounts, at first brush, does not feel overwhelming, but ensures you’re pretty toasted several hours later. On such nights, I would eat dinner, listen to Frank Sinatra on XM Radio, and slumber off to sleep. Whatever magic occurred between nightfall and dawn washed away any spoilage and I carried on as if nothing happened. Simply put, I am happy to eat, happy to sleep, happy to work.

At twenty-four, I rushed strained to see around the corner of my life, clinging to the hope that whatever cocoon I built, the caterpillar inside me might disintegrate, making way for a newer and more modern model. Instead, I rounded corners with such speed that I barely remember those left in the wake. Oftentimes, my lungs were winded, and the secrets I hoped to change stayed with me. I dreamed of living in a European village. I dreamed of changing the world. Now, I am a city dweller ruled by infirmity. As Harry Chapin might say, “A tame and toothless tabby can’t produce a lion’s roar.”

I wonder if I had set myself up for an impossible task—seeking perfection where it couldn’t exist. I always wanted my life to be perfect. I wanted fulfillment: the perfect job, the perfect wife, the perfect body. Looking back, I immediately think of writer Jack Gilbert. A snippet of words haunt me, “… anything worth doing is worth doing badly.” 

I have often said to Kanako that upon returning to God, I will openly state “how wonderfully bad at life I was. But I was there … And in spite of all my failures, I helped a good number of folks.” Sure I treaded water and nearly drowned from my own consequences on many occasions. But I cheated death, survived rough seas, and stayed harbored too long for many folks. 

Interjecting upon the consciousness of thought, “You’re not going to be happy if you miss these warm bagels,” Janet yells. Happiness? 

Wow, happiness. Even in my pain, I’m in the midst of absolute quiet, beauty. A lot of being alone. I walk in the morning, listen to the news, I eat, and start working. Just like the cycle of my life, I awake to see what’s worth doing badly.

It’s Free

In the past week, our President proclaimed that as COVID cases in Europe and Canada rise, “It’s going to disappear [in America], it is disappearing.” Additionally, since COVID was a blessing from God, he wants the American people to get the same treatment he did — for free. Think about that, free? It’s free America. COVID is free. As in nada. Just walk to the nearest hospital and order your free COVID treatment.
President Trump’s COVID medication cocktail contained a mix of proven drugs, over-the-counter drugs, supplements, and experimental antibodies only available to those participating in clinical trials. To the average person (without insurance), those medications would cost between $4,300 and $5,145. There is a minor caveat.

Monoclonal antibodies, including one made by Eli Lilly and Co., of Indianapolis, remain under development and are not yet approved for use in the US. The President received it under a “compassionate use” exemption, which the company said it has granted to fewer than ten people. In layman’s terms, ‘compassionate use’ means you are not getting it.

The monoclonal antibodies drug maker Regeneron evaluated the number of multiple dosages required for potential treatment. If I read the information correctly, the maximum dosages they can produce is estimated between 70,000 to 300,000. Maximum prevention doses round out between 420,000 to 1,300,000. Therein lay the math problem. America has approximately 330 million citizens, which of the 1.3 million Americans receives Regeneron? Even if you are lucky enough to receive Regeneron, is there a hospital available with available resources to treat you?

The massive shortfall in US inpatient hospital and ICU bed capacity raises important policy implications for current efforts to address COVID-19. There are not enough hospital beds. To meet the needs ahead, hospitals need to develop contingency plans to expand hospital capacity. Postponing elective inpatient surgical admissions is one straightforward strategy. Still, all hospitals in the US should establish clear protocols to aid decision making on which types of procedures and clinical diagnoses could be safely postponed. Second, the shortage of mechanical ventilators and ICU beds will require hospitals to transition inpatient operating rooms, ambulatory surgical sites, and post-anesthesia care units into flexible ICUs. After years of neglect, the American health system is outgunned.

The miracle vaccine some are desperate to acquire will pose a nightmare for others. What works in one country will fail in another. And Trump’s easy choice this week may not make sense next week. Failing to look at how closing schools’ and our economy to stop an outbreak is likely to surge into years of economic harm. Making choices in the era of Covid-19 isn’t just about fighting a virus; our moral code, ethics, and humanity are also at stake.

But fear not. COVID’s disappearing. Right? Right.

The doctor was quick and to the point. “After all our tests, we believe an experimental drug, consisting of cells manufactured and implanted in the eye to stimulate optic nerve growth and activity, might be the best method of fighting your symptoms. We would require approval from the Food and Drug Administration (FDA) via a compassionate use request that allows experimental drugs to patients outside clinical trials. But getting access to not-yet-approved pharmaceuticals via a compassionate use request is both arduous and challenging.”

What the doctor implied but did not say was, “You will go blind in your left eye because you are not a VIP and associated costs are bigger than the ‘Big Mac Combo Meal 1’ range. Also, you are likely to expire before receiving therapy approval. and, since most experimental treatments rarely work on dying patients, ‘compassionate use’ requests from patients like you become ‘compassionate not.’ In the end, you can still get to heaven with one eye. Ensure you look left and right before merging and change lanes accordingly.”

While paying the $40 copay, I saw Trump’s photo op in front of Walter Reed Medical Center. America’s chief dude made what media sources claim was a ‘photo-up’ by leaving his hospital suite to make a “surprise” drive-by to supporters while undergoing COVID-19 treatment. Trump’s drive-by triggered both safety concerns, outrage, and giving the middle finger to the more than 208,000 Americans who perished. The joyride only occurred because our chief asshole received medical treatments the poor working slob on Mainstreet, U.S.A., will never obtain.

Before the president left the White House for Walter Reed Medical Center, he received a single dose of Regeneron’s polyclonal antibody cocktail. This experimental drug has shown promise in initial trials in improving symptoms and reducing virus levels in the body but has not received Food and Drug Administration approval. Trump was also treated with Remdesivir, an intravenous antiviral medication shown to help treat COVID-19. Remdesivir’s benefits are modest: reducing hospital stays from 11 to 15 days.

For those with insurance, Remdesivir will top $3,000. How much-uninsured patients would pay remains unclear. Regeneron’s cost has not been publicly shared, but suffice to say it will not be in the ‘Big Mac Combo Meal 1’ range.

Trump’s a ‘Very Important Person (VIP),’ I am not. VIP treatment is a feature of American medicine. Major hospitals throughout the country provide private spaces for celebrities, the super-rich, and the influential. These are the patients who get shielded from the public. VIP’s include foreign nationals from places including Saudi Arabia, China, Canada, and Mexico.

The real coronavirus war cannot be flouted in a presidential joyride victory lap. Memorable scenes of community hospitals fighting on the front lines from California to Maine depicted medical centers nearly overwhelmed by desperately sick people. They are pictures of doctors and nurses working around-the-clock with insufficient equipment. And as of now, there are at least 208,000 COVID victims who cannot take a celebratory joyride. These 208,000 are alumni of the Big Mac Combo Meal 1.

I hope Tuesday, November 3rd, the remaining Big Mac Combo Meal 1 alumni will remember this joyride. I also hope the alumni remember this probably started during Trump’s introduction of  Supreme Court nominee Judge Amy Coney Barrett — the same judge who will likely assist in overturning the Affordable Care Act. That means for Big Mac Combo Meal 1 alumni members. Get it now?

November 3rd.

Kamma! It Just Is.

I’ve been off radar recovering from ongoing medical conditions. A week ago, one of my eyes decided that going on the fritz was imperative, and for whatever reason, vision blurred. Being the alpha male of my home (Ok, the only male in said home), I decided it was nothing — that the visual part of my anatomy awoke to have a bad morning. Indeed, once I drop coffee down my throat, all will be well, sharp just like the night before. It turns out the alpha male of the home was completely wrong.

There is backdrop. February 2018, I woke up with primary open-angle glaucoma (POAG) — called open-angle glaucoma — which is the most common type of glaucoma. Open-angle glaucoma is particularly dangerous because those who have it don’t know anything is wrong until significant, irreparable vision loss occurs. Until all hell broke loose, I had no pain, no noticeable vision loss, or any other hint that something is amiss. Yet the “silent thief of sight” struck. Four eye surgeries later, I was a new man. “Go forth and procreate,” clinicians said. (I was told everything was ok.) Until this week.

“Ocular hypotony is usually defined as intraocular pressure (IOP) of 5–6 mmHg or less.” The doctor said. “So, instead of having too much pressure, you’re experiencing too little pressure. Also, the cornea in your eye looks like sandpaper. That’s why you’re experiencing blurred vision. The problem is, we don’t know why you’re experiencing low eye pressure. Every test we’ve performed is normal.” For the time being, blurred vision is my life, and the forecast reads like a weather forecast: partly cloudy to rainy.

Simultaneously, I’ve been listening to the news. Depending upon whom one hears, President Trump is either near post-COVID treatment and is ready to leave, requiring oxygen, has a long road to recovery, or has no clear path to recovery. Trump and I are alike in many ways. Both of us probably have “no clear path to recovery.” Each of us has received medical treatment not afforded to the average person living their life on Mainstreet, U.S.A. Trump received medication that neither you nor I will ever receive. Yet, both of us have avenues to better healthcare than most.

I have known for nineteen (19) months that time is short. Specifically, my time is short. Maybe Trump and I are on a similar path, just different roads. I also affirm that this present life is only a part of the round of existence (samsara). This current life I am experiencing was conditioned by others who influenced me. In turn, my next existence will allow me to learn lessons in this life.

In COVID, there are usually some people who succumb while others escape, even though both are exposed to similar conditions. According to the Buddhist view, the difference between the former and the latter is inherited from the past. Other examples are the cases where though the treatment was given was successful, and the patient died, and wherein spite of ineffective treatment, the patient lived. There have also been cases of remarkable and unexpected recoveries when modern medicine has given up all hope for remission. Such cases strengthen the Buddhist belief that besides the physical cause of disease, illness can be the effect of lousy Kamma in past lives. An infection from Kammic cause cannot be cured until that Kammic result is exhausted. But the Kamma of every person is a mystery both to himself and others.

In reality, all of us know suffering is an inevitable part of life. Like old age and death, sickness is unavoidable. In other words, in this life, “it just is.” This does not mean that I will mitigate every ache and pain through available medical means, but I will accept and mindfully endure if suffering remains. Within the spiritual tradition, physical pain and illness can provide an occasion for the cultivation of healthy and desirable mental states, including forbearance and patience. Therefore, it is not an illness but rather our response to it that has spiritual value.

And maybe that’s my Kamma to learn.

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