Anguish Languish
(English Language)

https://www.crockford.com/anguish.html#Ladle%20Rat%20Rotten%20Hut

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https://www.youtube.com/watch?v=Lh90razD6p4

Ladle Rat Rotten Hut
(Little Red Riding Hood)

Wants pawn term dare worsted ladle gull hoe lift wetter murder inner ladle cordage honor itch offer lodge, dock, florist. Disk ladle gull orphan worry putty ladle rat cluck wetter ladle rat hut, an fur disk raisin pimple colder Ladle Rat Rotten Hut.

Wan moaning Ladle Rat Rotten Hut's murder colder inset.

"Ladle Rat Rotten Hut, heresy ladle basking winsome burden barter an shirker cockles. Tick disk ladle basking tutor cordage offer groin-murder hoe lifts honor udder site offer florist. Shaker lake! Dun stopper laundry wrote! Dun stopper peck floors! Dun daily-doily inner florist, an yonder nor sorghum-stenches, dun stopper torque wet strainers!"

"Hoe-cake, murder," resplendent Ladle Rat Rotten Hut, an tickle ladle basking an stuttered oft.

Honor wrote tutor cordage offer groin-murder, Ladle Rat Rotten Hut mitten anomalous woof.

"Wail, wail, wail!" set disk wicket woof, "Evanescent Ladle Rat Rotten Hut! Wares are putty ladle gull goring wizard ladle basking?"

"Armor goring tumor groin-murder's," reprisal ladle gull. "Grammar's seeking bet. Armor ticking arson burden barter an shirker cockles."

"O hoe! Heifer gnats woke," setter wicket woof, butter taught tomb shelf, "Oil tickle shirt court tutor cordage offer groin-murder. Oil ketchup wetter letter, an den—O bore!"

Soda wicket woof tucker shirt court, an whinny retched a cordage offer groin-murder, picked inner windrow, an sore debtor pore oil worming worse lion inner bet. Inner flesh, disk abdominal woof lipped honor bet, paunched honor pore oil worming, an garbled erupt. Den disk ratchet ammonol pot honor groin-murder's nut cup an gnat-gun, any curdled ope inner bet.

Inner ladle wile, Ladle Rat Rotten Hut a raft attar cordage, an ranker dough ball. "Comb ink, sweat hard," setter wicket woof, disgracing is verse.

Ladle Rat Rotten Hut entity bet rum, an stud buyer groin-murder's bet.

"O Grammar!" crater ladle gull historically, "Water bag icer gut! A nervous sausage bag ice!"

"Battered lucky chew whiff, sweat hard," setter bloat-Thursday woof, wetter wicket small honors phase.

"O, Grammar, water bag noise! A nervous sore suture anomalous prognosis!"

"Battered small your whiff, doling," whiskered dole woof, ants mouse worse waddling.

"O Grammar, water bag mouser gut! A nervous sore suture bag mouse!"

Daze worry on-forger-nut ladle gull's lest warts. Oil offer sodden, caking offer carvers an sprinkling otter bet, disk hoard-hoarded woof lipped own pore Ladle Rat Rotten Hut an garbled erupt.

MURAL: Yonder nor sorghum stenches shut ladle gulls stopper torque wet strainers.

If so many people think God wrote a book IMHO it becomes relevant to study it at least superficially just so you can co-exist and communicate with all these people.

The stories in the book are mostly not history but the book itself and how it came to be certainly is.

Seriously if God is omnipotent and knows everything this book of his shows a strong sense of humor rather than much intelligent design. Like having bits and pieces garbled by running them back and forward through ancient humanoid versions of modern day OCR, machine translation and political censorship.

I love the Septuaginta bit (not in this video) where mythically 70ish scholars were secluded for 70ish days and each came up with his own Greek translation and they were all mythically identical. Where in reality the translation took decades, was a team effort that garbled the texts to appease current rulers and added whole new books.

Ladle Rat Rotten Hut

Wants pawn term, dare worsted ladle gull hoe lift wetter murder inner ladle cordage, honor itch offer lodge dock florist. Disk ladle gull orphan worry ladle cluck wetter putty ladle rat hut, an fur disk raisin pimple colder Ladle Rat Rotten Hut.

Wan moaning, Rat Rotten Hut's murder colder inset, "Ladle Rat Rotten Hut, heresy ladle basking winsome burden barter an shirker cockles. Tick disk ladle basking tutor cordage offer groin-murder hoe lifts honor udder site offer florist. Shaker lake! Dun stopper laundry wrote! An yonder nor sorghum-stenches, dun stopper torque wet strainers!"

"Hoe-cake, murder," resplendent Ladle Rat Rotten Hut, an tickle ladle basking an stuttered oft. Honor wrote tutor cordage offer groin-murder, Ladle Rat Rotten Hut mitten anomalous woof. "Wail, wail, wail!" set disk wicket woof, "Evanescent Ladle Rat Rotten Hut! Wares are putty ladle gull goring wizard ladle basking?"

"Armor goring tumor groin-murder's," reprisal ladle gull. "Grammar's seeking bet. Armor ticking arson burden barter an shirker cockles."

"O hoe! Heifer blessing woke," setter wicket woof, butter taught tomb shelf, "Oil tickle shirt court tutor cordage offer groin-murder. Oil ketchup wetter letter, an den - O bore!"

Soda wicket woof tucker shirt court, an whinney retched a cordage offer groin-murder, picked inner widow, an sore debtor pore oil worming worse lion inner bet. Inner flesh, disk abdominal woof lipped honor bet an at a rope. Den knee poled honor groin-murder's nut cup an gnat-gun, any curdled dope inner bet.

Inner ladle wile, Ladle Rat Rotten Hut a raft attar cordage, an ranker dough belle. "Comb ink, sweat hard," setter wicket woof, disgracing is verse. Ladle Rat Rotten Hut entity bet rum an stud buyer groin-murder's bet.

"O Grammar!" crater ladle gull, "Wood bag icer gut! A nervous sausage bag ice!"

"Battered lucky chew whiff, doling," whiskered disk ratchet woof, wetter wicket small.

"O Grammar, water bag noise! A nervous sore suture anomolous prognosis!"

"Battered small your whiff," insert a woof, ants mouse worse waddling.

"O Grammar, water bag mousy gut! A nervous sore suture bag mouse!"

Daze worry on-forger-nut gulls lest warts. Oil offer sodden, thoroughing offer carvers an sprinkling otter bet, disk curl and bloat-thursday woof ceased pore Ladle Rat Rotten Hut an garbled erupt.

Mural: Yonder nor sorghum stenches shut ladle gulls stopper torque wet strainers.

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What's Going On?

This story, believe it or not, is the very familiar fable of Little Red Riding Hood. This curious version was written in 1940 by a professor of French named H. L. Chace, who wanted to show his students that intonation - that is, the melody of a language - is an integral part of its meaning. The words here are all common English words, but not the ones you'd expect to tell the story of Little Red Riding Hood.

This is Ben Ten and the Omnitrix.
The Character is Brainstorm.

I really hate these things.
I'm hearing three syllables - so it comes out as something similar to Green needles, but kind of garbled.
More like "Brae-needles" to me

What I don't understand is how it could be Brainstorm which is only two syllables,

I hear yanny much more prominently than I hear laurel, but they are both there.

https://www.vocabulary.com/dictionary/laurel has a MUCH clearer audio than this garbled mess of a youtube video. This is probably an artifact of the audio being multiply compressed by youtube, recording software, etc.

Thanks, and I'm glad at least some one could follow my brand of Mobius logic. That doesn't negate what I said about myself and communication, but perhaps my thoughts weren't as garbled as I thought...this time.

Needs subtitles. Conversational Scottish is hard enough to understand, never mind this garbled microphone version.

It's Gao...not Goa. They may have been living there at the time but they are definitely singing in a Timbuktu dialect which I'm guessing is where they, or at least the singer, is from.

Al Hassidi Terrei is loosely translated 'Extremist People'

The songs lyrics are a bit difficult to take apart beause the music garbles them a bit and they are a mixture of basic West African French and the Songhai Timbuktu Dialect which I'm less familiar with then Gao dialect.

In short though "Al Hassidi Terrei mind your own business, ...then something about the meeting of life, love and wives (or generally women)....and then we're not tired (or poor/beaten down).

and repeat...

@eric3579 and any others:

I think the lyrics of what the band members sing are improvised on the spot. The official lyrics are at http://songmeanings.com/songs/view/3530822107859433424/ and lots of the stuff I can make out are clearly not in that version, though it matches the video in my one comment, save the improvised bit the one band member does.

So my best guess based on listening to it many times (time stamps of improvised bits in {}):

I love my god, god made love
I love my god, god made love
I love my god, god made good
I love my god, god made hate
I love my god, god made bad
I love my god, god made me

I don't wanna pray to my maker
[whoa]I just wanna be what I see
Not just who I am, but the pink in golden land
And that wide wild sky over me
Help me to the sun, hey I'm looking everywhere

Pardon god and mom, if what I'm sayin' isn't fair
Hey I'm looking to become, not the prayer but the prayer
And now I don't want to pray
[No] I say I don't wanna pray
[No] I don't wanna pray
Who don't wanna pray

(but still)
I love my god, god made love
I love my god, god made love
I love my god, god made good
I love my god, god made hate
I love my god, god made bad
I love my god, god made me

(but still)
I don't wanna pray to my maker
[No] I just wanna be feelin' free
Not like in a book, or the leaves of trees that shook
From a word that means only not a thing

Pardon god and mom, if what I'm sayin' isn't fair
Hey I'm looking to become, not the prayer but the prayer
And now I don't want to pray
[No] I say I don't wanna pray
[No] I don't wanna pray
Who don't wanna pray

{2:21}(alright Seth)
God ain't some man way high above me
[No] I think god is in the earth and in the land
I love by what I do
So for me I think that its true
That's its hard to worship when I'm on my knees

Pardon god and mom, if what I'm sayin' isn't fair
Hey I'm looking to become, not the prayer but the prayer
And now I don't want to pray
[No] I say I don't wanna pray
[No] I don't wanna pray
Who don't wanna pray

{3:04}(Christian)
When I was a boy my daddy made me
[Whoa] Read a story to him every night
Took me 'till it hurt, that stupid shirt shit don't work
[garbled] tell me to try

Pardon god and mom, if what I'm sayin' isn't fair
Hey I'm looking to become, not the prayer but the prayer
And now I don't want to pray
[No] I say I don't wanna pray
[No] I don't wanna pray
Who don't wanna pray

{3:48}(now Sash(?))
I don't wanna pray to my maker
[No] [Don't let me be a servant?] won't you please
Not like greasy crook or those thevin smiley looks
I just want to be of helpin' if you need

Pardon god and mom, if what I'm sayin' isn't fair
Hey I'm looking to become, not the prayer but the prayer
And now I don't want to pray
[No] I say I don't wanna pray
[No] I don't wanna pray
Who don't wanna pray

{4:35}Now I've seen her in the shadow
I have seen her in the tree
I don't even need to get down on my knees
[garbled followed by laugh]

Pardon god and mom, if what I'm sayin' isn't fair
Hey I'm looking to become, not the prayer but the prayer
And now I don't want to pray
[No] I say I don't wanna pray
[No] I don't wanna pray
Who don't wanna pray

{5:20 slight improv of the normal lines}Well it's alright to talk, long as you are walkin'
And it's alright to take, long as you give
But some say we forgiven and forgotten of our sins
Either way I know for sure, that we all will live again

Pardon god and mom, if what I'm sayin' isn't fair
Hey I'm looking to become, not the prayer but the prayer
And now I don't want to pray
[No] I say I don't wanna pray
[No] I don't wanna pray
Who don't wanna pray

(but still)
I love my god, god made love
I love my god, god made love
I love my god, god made good
I love my god, god made hate
I love my god, god made bad
I love my god, god made me

To my eye, it seems like YouTube has been actively trying to piss users off with shit like this for a while now. I don't have enough of a tinfoil hat on to actually think that is true, but it sure seems like it.

This guy hit a lot of the issues, but here's my rundown of annoyances:
* I've used GMail forever. In the past year, Google decided that means that I want their services for everything. YouTube, Google+, etc. etc. No, I don't.

* GMail inbox now has handy-dandy tabs that separate my email into "Primary" (the one I actually want), "Social" (can I rename this 'trash'?), and "Promotions" (kill it with fire). I don't want that crap, other than as a filter that immediately trashes it and marks as spam.

* YouTube embeds used to not show annotations by default. Which was nice, because annotations suck. Now, the embed player seems to decide that you want them all the time, unless you want to sign in and go through a 19-step process to disable them.

* Caching and streaming used to work. I don't have a massively fast connection, and I live on the opposite side of the earth which gives me high latency. BUT, my connection is fast enough that I used to be able to pick out videos that I really want to watch in high quality, set to 1080p, pause, and let it cache for a few minutes. With that head start, I could probably play the video the whole way through. Now, if I pause, the player decides that I really want it to shittily try to transition down to a lower quality, which frequently garbles the whole video stream for a moderate duration and occasionally crashes it altogether. Thanks for that!


Plenty more issues, but I guess I'll stop there. Basically, all that Google/YouTube have accomplished is to encourage me to put on Adblock Plus, Adblock Plus Element Hiding Helper (hide the entire f*&$ing comments section, nag-bars, etc. -- highly recommended), and Flash Video Downloader. That last one lets me simply download videos, at any quality available, so I can watch at my leisure.

Of course, YouTube is in a constant arms race with all those downloader plugins, so they periodically break for a day or so while they are updated to circumvent the YT blocks. But generally, they work well and let me download material to use when teaching classes here in rooms with no net connection.

2400. 2600 was for Atari video game consoles and magazines. I was there.

IIRC, 2400 didn't have error corrections so you can see garbled data and easily get disconnected from line noises (e.g., "hello?")!

As Freud put it, insanity is defined by an inability to see reality, and I have met very few people who could, in fact, see reality. In my experience, most people are too busy looking at the world through the murky lens of their particular flavour of religion or ideology to actually ever want to be bothered with reality, and should even the tiniest sliver of the nasty stuff make its way past their defenses, the ensuing emotional (over)reaction is sure to keep their attention diverted to less offensive matters.

Most people are such a garbled mess of emotions, cognitive laziness and stupidity (because stupidity never seems to go out of style) that they're always bordering on... well, if not insanity, then at the very least obscene absurdity.

Going to the extreme ends of the spectrum just makes it more obvious.

All these dicey facts edgeman....I tend to get a bit frustrated when folks start to list facts: (with a colon) and list them as a rebuttal to thoughtful and justified doubts as to the workings of the U.S. government. Question: With all these "facts" you have listed from what appears to be a single website, how many of them can you corroborate and how many simply "sound" good to someone who doesn't have a clue as to how the machine "actually" runs??

Look at the fucks that represent the FED, follow the money trails, follow their rise to positions and their crony friends and look at these people when they talk...body language, all of it...uhhh, they have systematically made the U.S. China's economic bitches and will continue to fuck the country into irreversible bankruptcy. They are fucking evil because they work people like slaves while stealing their fucking money, land, and livelihoods. Get a clue and read between the lines of garble.

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.

>> ^Sagemind:

I think the sound of the engine would have drowned out their voices - hence the headsets.
I've been in smaller planes and noise is always an issue.
It may not have been possible to wire the headsets into the hidden camera - or maybe he tried and it was still garbled.
>> ^ant:
What if there was a real emergency after that? Good thing she didn't get angry.
Why no audio of them talking?



Ah thanks.