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1000 Year Heatwave Becoming The Norm

newtboy says...

Before "someone" spouts off about this being a singular, isolated weather event in America and Canada, it's happening world wide.
All time record high temperatures are also happening in Europe, Asia, Africa including ground temperatures in Siberia above the arctic circle at 118F, not so good for permafrost that should be near freezing. Mexico has seen all time high temperatures for June exceeding 125F, nighttime low temperatures are also shattering all time highs like 105F overnight in palm springs, and over 70F was the overnight low in S Africa (southern hemisphere) on the WINTER solstice. Let's not forget, June is typically the coolest summer month.
It's hard to imagine this not triggering feedback loops like permafrost releasing methane and less ice reflecting heat that are each, by themselves, more than we could possibly counteract with current technology with an unlimited budget and the collective will to try. Combined, and without the unlimited funds or collective will to act, it's looking like game over, man.
Somehow "we told you so" hardly seems sufficient.

https://abcnews.go.com/International/heat-wave-russia-brings-record-breaking-temperatures-north/story?id=78446355

https://www.forbes.com/sites/ericmack/2021/06/22/wild-high-temperatures-worldwide-show-the-extent-of-record-june-heat-wave/?sh=496b6bc05668

CYBERPUNK 2077 Trailer

solar powered water wheel cleans baltimore harbor

Night operations on USS Carl Vinson (CVN-70)

Speed bump overkill?

Amazing helicopter rescue of hiker stuck on cliff

maatc says...

Almost always the reason is an overestimation of their skills. They realize mid way up that they lack the strength to make it to the top on their own, and since back down is even more dangerous they get stuck. Especially without ropes.

My wife and I found a father and son midway up Echo Point in Katoomba, NSW once. They attempted to climb the cliff for a daytrip, and were only 2/3 of the way up when nighttime fell, so they camped on a ledge and started screaming when the sun came up.
We were on a hike for sunrise and thats when we heard them. Called in rescue and they showed up with helicopter and a team that repelled down to them. Got them up safely after a few hours.

Rescue team was actually happy about this one. Said 9 out of 10 they are called in to scrape up the remains of suicide jumpers at that location.

cason said:

I always wonder in this and other similar rescue operations how people manage to get themselves into such predicaments. Sure, bad things happen that can't be prevented, I understand that, and have the utmost respect and gratitude for rescue operators....buuuut.... I'd be willing to bet that the majority of the times someone has done something stupid. I wonder if that frustration gets to them...

and dude... fuck your bag.

Health Care: U.S. vs. Canada

bremnet says...

Lived in Ontario (28 years), Brisbane, Australia (5 years), Alberta (7 years), and now Texas (14 years).

Agree with pretty much with Boneremake on Alberta, gets more points than Ontario. My Australian experience was good, in both the city and rural (blew an eardrum due to infection in Longreach QLD at Xmas... the doctor was drunk when they wheeled him into emerg, but he was a gentle, caring drunk).

Small things in Ontario are manageable - anything requiring stuff beyond typical emergency room patching up in more rural locations (my definition - anywhere far enough from Toronto that you can't see the nighttime glow, so north of Newfenmarket sort of) is quite lacking (v. long wait times for things like weekly dialysis, MRI, even open MRI, GI tract scoping, ultrasounds, contrast X-rays etc). Parental unit #1 with diabetes requiring 3 times a week dialysis almost snuffed it as there were only 4 chairs in the unit 14 miles from home, got on the list and had to wait for someone to die before getting on the team. Finally snuffed it when they shut down these 4 chairs and the new unit was now a 90 mile round trip 3 times a week for man who could barely walk or see. Died from exhaustion, not diabetes. 2nd parental unit needs an MRI for some serious GI issues, can't keep food down, losing weight rapidly. Wait 4.5 months and we'll see if we can get you in. I'm having her measured for the box.

Having said that, the situation is easier to describe in Texas, the land of excess (excessive wealth and excessive poverty).

Good health insurance plan, preferably through employer with lots of employees = wait times for advanced procedures measured usually in minutes or hours, sometimes days, but not weeks or months. You get taken care of, and your birthing room at the local maternity ward looks like the Marriott (just Couryard though, so no mini-bar or microwave).

Mediocre or no health insurance plan = pray you never get sick enough to require more than what you can buy at the CVS or splint up by watching do-it-yourself first aid videos on youtube, because an unplanned night in the hospital or a trip to emerg in the short bus with swirly lights followed by admission can, for many, wipe them out or sure eat up Bobby's college fund. No exaggeration. I have insurance, but for a reference point, one night in hospital (elective) for a turbinectomy (google it people) including jello and ice cream came in at $14,635. Yes, one night. 24 hours. Do the math. An emergency room visit for a forearm cut requiring 13 stitches (and I didn't even bleed on their white sheets - just cut through the skin to the fat tissue) was billed at $2,300 bucks. Our new baby tried to exit the meatbag as a footling breach, so emergency C-sectioned him out, and one extra night in hospital (2 in total) - all up, billed at just shy of $24K. We now have 3 full service hospitals within 5 miles of our house, and a full service children's hospital in the same radius. And they just started building another. Somebody's making money. If you don't have insurance, or your insurance is shitty (huge deductibles, huge copays) you will eat much of these types of costs. Rule: cheaper to die than get sick.

Ontario and AB might have longer wait times, but even an 83 year old woman in a rural Ontario village with no pension, insurance, income or large stacks of cash can (eventually) get the health care she needs without spending unjustifiable amounts of money. Happy birthday mom.

My 2¢

Fantastic Jamie Foxx - Interview With Jonathan Ross

artician says...

Jonathan Ross has never really struck me as a late-night character, but the amount of time he dedicates to his guests, and Jamie Foxx's interview, totally made up for it this time.
I've always felt Foxx was an amazing actor, he seems to score these roles that are just completely full of character, but he seems like an amazing personality as well. This was one of the best late-night interviews I've seen in a really long time, and I wish more nighttime talk shows would give as much time and variety to their guests.

Unmanned Craft Flying Nightly Over Quincy Massachusetts

deathcow (Member Profile)

Israeli Star Wars

Oklahoma Doctors vs. Obamacare

MrFisk says...

http://www.nytimes.com/2010/06/20/magazine/20pacemaker-t.html?pagewanted=all

One October afternoon three years ago while I was visiting my parents, my mother made a request I dreaded and longed to fulfill. She had just poured me a cup of Earl Grey from her Japanese iron teapot, shaped like a little pumpkin; outside, two cardinals splashed in the birdbath in the weak Connecticut sunlight. Her white hair was gathered at the nape of her neck, and her voice was low. “Please help me get Jeff’s pacemaker turned off,” she said, using my father’s first name. I nodded, and my heart knocked.
Related

Upstairs, my 85-year-old father, Jeffrey, a retired Wesleyan University professor who suffered from dementia, lay napping in what was once their shared bedroom. Sewn into a hump of skin and muscle below his right clavicle was the pacemaker that helped his heart outlive his brain. The size of a pocket watch, it had kept his heart beating rhythmically for nearly five years. Its battery was expected to last five more.

After tea, I knew, my mother would help him from his narrow bed with its mattress encased in waterproof plastic. She would take him to the toilet, change his diaper and lead him tottering to the couch, where he would sit mutely for hours, pretending to read Joyce Carol Oates, the book falling in his lap as he stared out the window.

I don’t like describing what dementia did to my father — and indirectly to my mother — without telling you first that my parents loved each other, and I loved them. That my mother, Valerie, could stain a deck and sew an evening dress from a photo in Vogue and thought of my father as her best friend. That my father had never given up easily on anything.

Born in South Africa, he lost his left arm in World War II, but built floor-to-ceiling bookcases for our living room; earned a Ph.D. from Oxford; coached rugby; and with my two brothers as crew, sailed his beloved Rhodes 19 on Long Island Sound. When I was a child, he woke me, chortling, with his gloss on a verse from “The Rubaiyat of Omar Khayyam”: “Awake, my little one! Before life’s liquor in its cup be dry!” At bedtime he tucked me in, quoting “Hamlet” : “May flights of angels sing thee to thy rest!”

Now I would look at him and think of Anton Chekhov, who died of tuberculosis in 1904. “Whenever there is someone in a family who has long been ill, and hopelessly ill,” he wrote, “there come painful moments when all timidly, secretly, at the bottom of their hearts long for his death.” A century later, my mother and I had come to long for the machine in my father’s chest to fail.

Until 2001, my two brothers and I — all living in California — assumed that our parents would enjoy long, robust old ages capped by some brief, undefined final illness. Thanks to their own healthful habits and a panoply of medical advances — vaccines, antibiotics, airport defibrillators, 911 networks and the like — they weren’t likely to die prematurely of the pneumonias, influenzas and heart attacks that decimated previous generations. They walked every day. My mother practiced yoga. My father was writing a history of his birthplace, a small South African town.

In short, they were seemingly among the lucky ones for whom the American medical system, despite its fragmentation, inequity and waste, works quite well. Medicare and supplemental insurance paid for their specialists and their trusted Middletown internist, the lean, bespectacled Robert Fales, who, like them, was skeptical of medical overdoing. “I bonded with your parents, and you don’t bond with everybody,” he once told me. “It’s easier to understand someone if they just tell it like it is from their heart and their soul.”

They were also stoics and religious agnostics. They signed living wills and durable power-of-attorney documents for health care. My mother, who watched friends die slowly of cancer, had an underlined copy of the Hemlock Society’s “Final Exit” in her bookcase. Even so, I watched them lose control of their lives to a set of perverse financial incentives — for cardiologists, hospitals and especially the manufacturers of advanced medical devices — skewed to promote maximum treatment. At a point hard to precisely define, they stopped being beneficiaries of the war on sudden death and became its victims.

Things took their first unexpected turn on Nov. 13, 2001, when my father — then 79, pacemakerless and seemingly healthy — collapsed on my parents’ kitchen floor in Middletown, making burbling sounds. He had suffered a stroke.

He came home six weeks later permanently incapable of completing a sentence. But as I’ve said, he didn’t give up easily, and he doggedly learned again how to fasten his belt; to peck out sentences on his computer; to walk alone, one foot dragging, to the university pool for water aerobics. He never again put on a shirt without help or looked at the book he had been writing. One day he haltingly told my mother, “I don’t know who I am anymore.”

His stroke devastated two lives. The day before, my mother was an upper-middle-class housewife who practiced calligraphy in her spare time. Afterward, she was one of tens of millions of people in America, most of them women, who help care for an older family member.

Their numbers grow each day. Thanks to advanced medical technologies, elderly people now survive repeated health crises that once killed them, and so the “oldest old” have become the nation’s most rapidly growing age group. Nearly a third of Americans over 85 have dementia (a condition whose prevalence rises in direct relationship to longevity). Half need help with at least one practical, life-sustaining activity, like getting dressed or making breakfast. Even though a capable woman was hired to give my dad showers, my 77-year-old mother found herself on duty more than 80 hours a week. Her blood pressure rose and her weight fell. On a routine visit to Dr. Fales, she burst into tears. She was put on sleeping pills and antidepressants.

My father said he came to believe that she would have been better off if he had died. “She’d have weeped the weep of a widow,” he told me in his garbled, poststroke speech, on a walk we took together in the fall of 2002. “And then she would have been all right.” It was hard to tell which of them was suffering more.

As we shuffled through the fallen leaves that day, I thought of my father’s father, Ernest Butler. He was 79 when he died in 1965, before pacemakers, implanted cardiac defibrillators, stents and replacement heart valves routinely staved off death among the very old. After completing some long-unfinished chairs, he cleaned his woodshop, had a heart attack and died two days later in a plain hospital bed. As I held my dad’s soft, mottled hand, I vainly wished him a similar merciful death.

A few days before Christmas that year, after a vigorous session of water exercises, my father developed a painful inguinal (intestinal) hernia. My mother took him to Fales, who sent them to a local surgeon, who sent them to a cardiologist for a preoperative clearance. After an electrocardiogram recorded my father’s slow heartbeat — a longstanding and symptomless condition not uncommon in the very old — the cardiologist, John Rogan, refused to clear my dad for surgery unless he received a pacemaker.

Without the device, Dr. Rogan told me later, my father could have died from cardiac arrest during surgery or perhaps within a few months. It was the second time Rogan had seen my father. The first time, about a year before, he recommended the device for the same slow heartbeat. That time, my then-competent and prestroke father expressed extreme reluctance, on the advice of Fales, who considered it overtreatment.

My father’s medical conservatism, I have since learned, is not unusual. According to an analysis by the Dartmouth Atlas medical-research group, patients are far more likely than their doctors to reject aggressive treatments when fully informed of pros, cons and alternatives — information, one study suggests, that nearly half of patients say they don’t get. And although many doctors assume that people want to extend their lives, many do not. In a 1997 study in The Journal of the American Geriatrics Society, 30 percent of seriously ill people surveyed in a hospital said they would “rather die” than live permanently in a nursing home. In a 2008 study in The Journal of the American College of Cardiology, 28 percent of patients with advanced heart failure said they would trade one day of excellent health for another two years in their current state.

When Rogan suggested the pacemaker for the second time, my father was too stroke-damaged to discuss, and perhaps even to weigh, his trade­offs. The decision fell to my mother — anxious to relieve my father’s pain, exhausted with caregiving, deferential to doctors and no expert on high-tech medicine. She said yes. One of the most important medical decisions of my father’s life was over in minutes. Dr. Fales was notified by fax.

Fales loved my parents, knew their suffering close at hand, continued to oppose a pacemaker and wasn’t alarmed by death. If he had had the chance to sit down with my parents, he could have explained that the pacemaker’s battery would last 10 years and asked whether my father wanted to live to be 89 in his nearly mute and dependent state. He could have discussed the option of using a temporary external pacemaker that, I later learned, could have seen my dad safely through surgery. But my mother never consulted Fales. And the system would have effectively penalized him if she had. Medicare would have paid him a standard office-visit rate of $54 for what would undoubtedly have been a long meeting — and nothing for phone calls to work out a plan with Rogan and the surgeon.

Medicare has made minor improvements since then, and in the House version of the health care reform bill debated last year, much better payments for such conversations were included. But after the provision was distorted as reimbursement for “death panels,” it was dropped. In my father’s case, there was only a brief informed-consent process, covering the boilerplate risks of minor surgery, handled by the general surgeon.

I believe that my father’s doctors did their best within a compartmentalized and time-pressured medical system. But in the absence of any other guiding hand, there is no doubt that economics helped shape the wider context in which doctors made decisions. Had we been at the Mayo Clinic — where doctors are salaried, medical records are electronically organized and care is coordinated by a single doctor — things might have turned out differently. But Middletown is part of the fee-for-service medical economy. Doctors peddle their wares on a piecework basis; communication among them is haphazard; thinking is often short term; nobody makes money when medical interventions are declined; and nobody is in charge except the marketplace.

And so on Jan. 2, 2003, at Middlesex Hospital, the surgeon implanted my father’s pacemaker using local anesthetic. Medicare paid him $461 and the hospital a flat fee of about $12,000, of which an estimated $7,500 went to St. Jude Medical, the maker of the device. The hernia was fixed a few days later.

It was a case study in what primary-care doctors have long bemoaned: that Medicare rewards doctors far better for doing procedures than for assessing whether they should be done at all. The incentives for overtreatment continue, said Dr. Ted Epperly, the board chairman of the American Academy of Family Physicians, because those who profit from them — specialists, hospitals, drug companies and the medical-device manufacturers — spend money lobbying Congress and the public to keep it that way.

Last year, doctors, hospitals, drug companies, medical-equipment manufacturers and other medical professionals spent $545 million on lobbying, according to the Center for Responsive Politics. This may help explain why researchers estimate that 20 to 30 percent of Medicare’s $510 billion budget goes for unnecessary tests and treatment. Why cost-containment received short shrift in health care reform. Why physicians like Fales net an average of $173,000 a year, while noninvasive cardiologists like Rogan net about $419,000.

The system rewarded nobody for saying “no” or even “wait” — not even my frugal, intelligent, Consumer-Reports-reading mother. Medicare and supplemental insurance covered almost every penny of my father’s pacemaker. My mother was given more government-mandated consumer information when she bought a new Camry a year later.

And so my father’s electronically managed heart — now requiring frequent monitoring, paid by Medicare — became part of the $24 billion worldwide cardiac-device industry and an indirect subsidizer of the fiscal health of American hospitals. The profit margins that manufacturers earn on cardiac devices is close to 30 percent. Cardiac procedures and diagnostics generate about 20 percent of hospital revenues and 30 percent of profits.

Shortly after New Year’s 2003, my mother belatedly called and told me about the operations, which went off without a hitch. She didn’t call earlier, she said, because she didn’t want to worry me. My heart sank, but I said nothing. It is one thing to silently hope that your beloved father’s heart might fail. It is another to actively abet his death.

The pacemaker bought my parents two years of limbo, two of purgatory and two of hell. At first they soldiered on, with my father no better and no worse. My mother reread Jon Kabat-Zinn’s “Full Catastrophe Living,” bought a self-help book on patience and rose each morning to meditate.

In 2005, the age-related degeneration that had slowed my father’s heart attacked his eyes, lungs, bladder and bowels. Clots as narrow as a single human hair lodged in tiny blood vessels in his brain, killing clusters of neurons by depriving them of oxygen. Long partly deaf, he began losing his sight to wet macular degeneration, requiring ocular injections that cost nearly $2,000 each. A few months later, he forgot his way home from the university pool. He grew incontinent. He was collapsing physically, like an ancient, shored-up house.

In the summer of 2006, he fell in the driveway and suffered a brain hemorrhage. Not long afterward, he spent a full weekend compulsively brushing and rebrushing his teeth. “The Jeff I married . . . is no longer the same person,” my mother wrote in the journal a social worker had suggested she keep. “My life is in ruins. This is horrible, and I have lasted for five years.” His pacemaker kept on ticking.

When bioethicists debate life-extending technologies, the effects on people like my mother rarely enter the calculus. But a 2007 Ohio State University study of the DNA of family caregivers of people with Alzheimer’s disease showed that the ends of their chromosomes, called telomeres, had degraded enough to reflect a four-to-eight-year shortening of lifespan. By that reckoning, every year that the pacemaker gave my irreparably damaged father took from my then-vigorous mother an equal year.

When my mother was upset, she meditated or cleaned house. When I was upset, I Googled. In 2006, I discovered that pacemakers could be deactivated without surgery. Nurses, doctors and even device salesmen had done so, usually at deathbeds. A white ceramic device, like a TV remote and shaped like the wands that children use to blow bubbles, could be placed around the hump on my father’s chest. Press a few buttons and the electrical pulses that ran down the leads to his heart would slow until they were no longer effective. My father’s heart, I learned, would probably not stop. It would just return to its old, slow rhythm. If he was lucky, he might suffer cardiac arrest and die within weeks, perhaps in his sleep. If he was unlucky, he might linger painfully for months while his lagging heart failed to suffuse his vital organs with sufficient oxygenated blood.

If we did nothing, his pacemaker would not stop for years. Like the tireless charmed brooms in Disney’s “Fantasia,” it would prompt my father’s heart to beat after he became too demented to speak, sit up or eat. It would keep his heart pulsing after he drew his last breath. If he was buried, it would send signals to his dead heart in the coffin. If he was cremated, it would have to be cut from his chest first, to prevent it from exploding and damaging the walls or hurting an attendant.

On the Internet, I discovered that the pacemaker — somewhat like the ventilator, defibrillator and feeding tube — was first an exotic, stopgap device, used to carry a handful of patients through a brief medical crisis. Then it morphed into a battery-powered, implantable and routine treatment. When Medicare approved the pacemaker for reimbursement in 1966, the market exploded. Today pacemakers are implanted annually in more than 400,000 Americans, about 80 percent of whom are over 65. According to calculations by the Dartmouth Atlas research group using Medicare data, nearly a fifth of new recipients who receive pacemakers annually — 76,000 — are over 80. The typical patient with a cardiac device today is an elderly person suffering from at least one other severe chronic illness.

Over the years, as technology has improved, the battery life of these devices lengthened. The list of heart conditions for which they are recommended has grown. In 1984, the treatment guidelines from the American College of Cardiology declared that pacemakers were strongly recommended as “indicated” or mildly approved as “reasonable” for 56 heart conditions and “not indicated” for 31 more. By 2008, the list for which they were strongly or mildly recommended expanded to 88, with most of the increase in the lukewarm “reasonable” category.

The research backing the expansion of diagnoses was weak. Over all, only 5 percent of the positive recommendations were supported by research from multiple double-blind randomized studies, the gold standard of evidence-based medicine. And 58 percent were based on no studies at all, only a “consensus of expert opinion.” Of the 17 cardiologists who wrote the 2008 guidelines, 11 received financing from cardiac-device makers or worked at institutions receiving it. Seven, due to the extent of their financial connections, were recused from voting on the guidelines they helped write.

This pattern — a paucity of scientific support and a plethora of industry connections — holds across almost all cardiac treatments, according to the cardiologist Pierluigi Tricoci of Duke University’s Clinical Research Institute. Last year in The Journal of the American Medical Association, Tricoci and his co-authors wrote that only 11 percent of 2,700 widely used cardiac-treatment guidelines were based on that gold standard. Most were based only on expert opinion.

Experts are as vulnerable to conflicts of interest as researchers are, the authors warned, because “expert clinicians are also those who are likely to receive honoraria, speakers bureau [fees], consulting fees or research support from industry.” They called the current cardiac-research agenda “strongly influenced by industry’s natural desire to introduce new products.”

Perhaps it’s no surprise that I also discovered others puzzling over cardiologists who recommended pacemakers for relatives with advanced dementia. “78-year-old mother-in-law has dementia; severe short-term memory issues,” read an Internet post by “soninlaw” on Elderhope.com, a caregivers’ site, in 2007. “On a routine trip to her cardiologist, doctor decides she needs a pacemaker. . . . Anyone have a similar encounter?”

By the summer of 2007, my dad had forgotten the purpose of a dinner napkin and had to be coached to remove his slippers before he tried to put on his shoes. After a lifetime of promoting my father’s health, my mother reversed course. On a routine visit, she asked Rogan to deactivate the pacemaker. “It was hard,” she later told me. “I was doing for Jeff what I would have wanted Jeff to do for me.” Rogan soon made it clear he was morally opposed. “It would have been like putting a pillow over your father’s head,” he later told me.

Not long afterward, my mother declined additional medical tests and refused to put my father on a new anti-dementia drug and a blood thinner with troublesome side effects. “I take responsibility for whatever,” she wrote in her journal that summer. “Enough of all this overkill! It’s killing me! Talk about quality of life — what about mine?”

Then came the autumn day when she asked for my help, and I said yes. I told myself that we were simply trying to undo a terrible medical mistake. I reminded myself that my dad had rejected a pacemaker when his faculties were intact. I imagined, as a bioethicist had suggested, having a 15-minute conversation with my independent, predementia father in which I saw him shaking his head in horror over any further extension of what was not a “life,” but a prolonged and attenuated dying. None of it helped. I knew that once he died, I would dream of him and miss his mute, loving smiles. I wanted to melt into the arms of the father I once had and ask him to handle this. Instead, I felt as if I were signing on as his executioner and that I had no choice.

Over the next five months, my mother and I learned many things. We were told, by the Hemlock Society’s successor, Compassion and Choices, that as my father’s medical proxy, my mother had the legal right to ask for the withdrawal of any treatment and that the pacemaker was, in theory at least, a form of medical treatment. We learned that although my father’s living will requested no life support if he were comatose or dying, it said nothing about dementia and did not define a pacemaker as life support. We learned that if we called 911, emergency medical technicians would not honor my father’s do-not-resuscitate order unless he wore a state-issued orange hospital bracelet. We also learned that no cardiology association had given its members clear guidance on when, or whether, deactivating pacemakers was ethical.

(Last month that changed. The Heart Rhythm Society and the American Heart Association issued guidelines declaring that patients or their legal surrogates have the moral and legal right to request the withdrawal of any medical treatment, including an implanted cardiac device. It said that deactivating a pacemaker was neither euthanasia nor assisted suicide, and that a doctor could not be compelled to do so in violation of his moral values. In such cases, it continued, doctors “cannot abandon the patient but should involve a colleague who is willing to carry out the procedure.” This came, of course, too late for us.)

In the spring of 2008, things got even worse. My father took to roaring like a lion at his caregivers. At home in California, I searched the Internet for a sympathetic cardiologist and a caregiver to put my Dad to bed at night. My frayed mother began to shout at him, and their nighttime scenes were heartbreaking and frightening. An Alzheimer’s Association support-group leader suggested that my brothers and I fly out together and institutionalize my father. This leader did not know my mother’s formidable will and had never heard her speak about her wedding vows or her love.

Meanwhile my father drifted into what nurses call “the dwindles”: not sick enough to qualify for hospice care, but sick enough to never get better. He fell repeatedly at night and my mother could not pick him up. Finally, he was weak enough to qualify for palliative care, and a team of nurses and social workers visited the house. His chest grew wheezy. My mother did not request antibiotics. In mid-April 2008, he was taken by ambulance to Middlesex Hospital’s hospice wing, suffering from pneumonia.

Pneumonia was once called “the old man’s friend” for its promise of an easy death. That’s not what I saw when I flew in. On morphine, unreachable, his eyes shut, my beloved father was breathing as hard and regularly as a machine.

My mother sat holding his hand, weeping and begging for forgiveness for her impatience. She sat by him in agony. She beseeched his doctors and nurses to increase his morphine dose and to turn off the pacemaker. It was a weekend, and the doctor on call at Rogan’s cardiology practice refused authorization, saying that my father “might die immediately.” And so came five days of hard labor. My mother and I stayed by him in shifts, while his breathing became increasingly ragged and his feet slowly started to turn blue. I began drafting an appeal to the hospital ethics committee. My brothers flew in.

On a Tuesday afternoon, with my mother at his side, my father stopped breathing. A hospice nurse hung a blue light on the outside of his hospital door. Inside his chest, his pacemaker was still quietly pulsing.

After his memorial service in the Wesleyan University chapel, I carried a box from the crematory into the woods of an old convent where he and I often walked. It was late April, overcast and cold. By the side of a stream, I opened the box, scooped out a handful of ashes and threw them into the swirling water. There were some curious spiraled metal wires, perhaps the leads of his pacemaker, mixed with the white dust and pieces of bone.

A year later, I took my mother to meet a heart surgeon in a windowless treatment room at Brigham and Women’s Hospital in Boston. She was 84, with two leaking heart valves. Her cardiologist had recommended open-heart surgery, and I was hoping to find a less invasive approach. When the surgeon asked us why we were there, my mother said, “To ask questions.” She was no longer a trusting and deferential patient. Like me, she no longer saw doctors — perhaps with the exception of Fales — as healers or her fiduciaries. They were now skilled technicians with their own agendas. But I couldn’t help feeling that something precious — our old faith in a doctor’s calling, perhaps, or in a healing that is more than a financial transaction or a reflexive fixing of broken parts — had been lost.

The surgeon was forthright: without open-heart surgery, there was a 50-50 chance my mother would die within two years. If she survived the operation, she would probably live to be 90. And the risks? He shrugged. Months of recovery. A 5 percent chance of stroke. Some possibility, he acknowledged at my prompting, of postoperative cognitive decline. (More than half of heart-bypass patients suffer at least a 20 percent reduction in mental function.) My mother lifted her trouser leg to reveal an anklet of orange plastic: her do-not-resuscitate bracelet. The doctor recoiled. No, he would not operate with that bracelet in place. It would not be fair to his team. She would be revived if she collapsed. “If I have a stroke,” my mother said, nearly in tears, “I want you to let me go.” What about a minor stroke, he said — a little weakness on one side?

I kept my mouth shut. I was there to get her the information she needed and to support whatever decision she made. If she emerged from surgery intellectually damaged, I would bring her to a nursing home in California and try to care for her the way she had cared for my father at such cost to her own health. The thought terrified me.

The doctor sent her up a floor for an echocardiogram. A half-hour later, my mother came back to the waiting room and put on her black coat. “No,” she said brightly, with the clarity of purpose she had shown when she asked me to have the pacemaker deactivated. “I will not do it.”

She spent the spring and summer arranging house repairs, thinning out my father’s bookcases and throwing out the files he collected so lovingly for the book he never finished writing. She told someone that she didn’t want to leave a mess for her kids. Her chest pain worsened, and her breathlessness grew severe. “I’m aching to garden,” she wrote in her journal. “But so it goes. ACCEPT ACCEPT ACCEPT.”

Last August, she had a heart attack and returned home under hospice care. One evening a month later, another heart attack. One of my brothers followed her ambulance to the hospice wing where we had sat for days by my father’s bed. The next morning, she took off her silver earrings and told the nurses she wanted to stop eating and drinking, that she wanted to die and never go home. Death came to her an hour later, while my brother was on the phone to me in California — almost as mercifully as it had come to my paternal grandfather. She was continent and lucid to her end.

A week later, at the same crematory near Long Island Sound, my brothers and I watched through a plate-glass window as a cardboard box containing her body, dressed in a scarlet silk ao dai she had sewn herself, slid into the flames. The next day, the undertaker delivered a plastic box to the house where, for 45 of their 61 years together, my parents had loved and looked after each other, humanly and imperfectly. There were no bits of metal mixed with the fine white powder and the small pieces of her bones.

Katy Butler lives in Mill Valley, Calif., and teaches memoir writing at the Esalen Institute in Big Sur.

Automator - It's Over Now (Kool Keith & Dan the Automator)

MrFisk says...

[Talking voice]
Yeah man, just left town man
I'm here, here
Had to get outta town baby
Where you stayin' now?
You can pick me up at the round busstation
Or I can take a plane
There's your cab? I'll be right over
It's gonna be a few sec, and I'll tell you what went down

[Kool Keith]
I stayed in New York, depressed, walkin' mad through the block
Watching brothers go down, my project friends smoking rock
My group divided and everthing was undecided
I was drinking, thinking: "Damn, man, my boat is sinking"
Everybody's wack and new groups comin' back
They on Arsenio, booty's on video
Watch this clown rhyme that's paid for on primetime
Everybody's mean, they're hard, they're killing mothers
Shootin' bang bang, fakin man killing brothers
I had to turn off the radio from all the Walt Disney
Mickey Mouse and friends all talking pop and lippy
Girls excited for what? And over-infatuated
People got their brain washed and folks got manipulated
They start beleiving Donald Duck made the earth
The industry was cursed since the Dinosaur's birth
(The industry was cursed since the Dinosaur's birth)

[Chorus]
It's over now
No problems in this world
It's over now
I'm home chillin' with my girl
It's over now
My mind was in a twirl
It's over now
I'm home chillin' with my girl
It's over now
No problems in this world
It's over now
I'm home chillin' with my girl
It's over now
My mind was caught up in a twirl
It's over now
I'm home chillin' with my girl

[Kool Keith]
Flying nighttime, eating peanuts on the plane
With no moneycontrol, my stress builds on my brain
My ticket's oneway
I'm out to southern Caliway
I left behind some people that wasn't even equal
I thought back with chicks and freaks in 86'
When Marley was in in control +the funky magic mix+
I had the limousine on hold with the real chauffeur
Ripped the ???? up with Ultra and I felt like Oprah
Girls in flocks and fans in lines from blocks
I didn't even hear a peep of you rappin' mister
I was your idol and probably on your older sister
Now you bad you signed stupid with a recorddeal
Your image is butt you perpertrating Shootin' Steel
Holdin' guns on albumcovers just to make funds
You the man quick fast payed out the ?anoass?
You can see I'm back and clear on stereo
with my own style, my intimite material

[Talking voice]
Ye, your style changed every year
Think about what you did
Used to dance, used to wear suits
Then you came back to wearing hip-hop clothes
Then you went back to wearing suits

[Chorus]
It's over now
No problems in this world
It's over now
I'm home chillin' with my girl
It's over now
My mind was caught up in a twirl
It's over now
I'm home chillin' with my girl

[Kool Keith]
No accountant, my lawyer keepin' checks on the low
Money, expenses for trips I didn't know
Agencies finding shows I could get myself
Writing rhymes at night in the house by myself
I open mailboxes, all I see was more bills
Gettin' cold chicken, walkin' down Bronx hills
Askin' moms for 50 cent, just to pay my rent
I had no will to ill, my mind was out to kill
I called up Kurt, got a big deal signed with Capitol
Money's flowin' now wild suckas out blowin' up
They my pupic care, and pupils still growin' up
Sucking mean while the g'ism as it hits the rhythm
They want that new style, no money it's called freestyle
Taping off the radio, smokin' from my crack vial
They on my tip now, as always as usual
You forgot me, but I didn't forget you

[Chorus]
2x It's over now
No problems in this world
It's over now
I'm home chillin' with my girl
It's over now
My mind was caught up in a twirl
It's over now
I'm home chillin' with my girl

Yeah...

[Fades out, consisting of scratching sounds]

What to do when a girl won't give you her phone number

chilaxe says...

>> ^Boise_Lib:

I'll upvote for jail time--not before.


As long as videos better people's life outcomes, it's probably prosocial and humanitarian to not hide them.


The women I know who have had this happen would have been better off with more data from which to draw when deciding whether to control risks by walking around questionable neighborhoods or taking a cab.

I think it's easy for men to downplay the experiences of women, but because of size and strength differences, even relatively mild events like shown in this video can confine women to bed for weeks.


It's annoying to get nighttime calls from sobbing women who are close to you.

Titanic Sinking CGI Time Lapse.



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