It begins one Halloween night, in the emergency room of a San Francisco hospital. A drunk, but stable victim, still in costume, is brought in with a stab wound to the belly.
Triage begins with a head to toe exam, a monitoring of pulse and pressure, consciousness, a call to the blood bank – just in case, and so on. Finally, he’s wheeled into an operating room to confirm that his bowel’s intact. In the end, it’s to be stitched up. No biggie, and no need for the worst-case scenario: a trauma team’s “crash into the operating room, stretchers flying.”
Until the patient loses consciousness and his blood pressure plummets. The team scrambles. An “ocean of blood” meets the surgeon’s wide incision from chest to pelvis. Crazy as it seems –based on that two-inch wound — the patient’s aorta has been pierced. In the hairy end, the patient survived, but what had gone wrong?
Harvard surgeon, Atul Gawande, notes that despite the trauma team’s seemingly complete checklist, no one had asked the EMTs what kind of knife had caused the stab wound. (It turned out to be a bayonet carried by a disgruntled man in a Civil War costume). Says Gawande, in this compelling and expressive book, “Ineptitude is as much our struggle as ignorance.”
What we understand and what we can or cannot control makes us human – from the builder of bridges to the geneticist in his/her lab to the air traffic controller. But can we be forgiven for the stupid error? A succinct pre-op checklist, he notes, at this point in our century, is vital (and not necessarily in place) in the complex hospital setting. It may also be just as vital — and adaptable to many other human activities.
The Checklist Manifesto: How to Get Things Right – a must read for all of us.
Did you know that exercise videos are just a click away? We want to get in shape and have fun doing it. Variety keeps us motivated as well as taking on all aspects of fitness, including aerobic capacity, endurance, strength, toning, balance, and flexibility. If you have a computer and a Howard County Library System card (special 75th anniversary edition available right now), you can stream health and fitness videos. While you’re at it, download energizing music to keep you moving on your walk or select an inspirational audiobook about nutrition.
Go to hclibrary.org, look at the bottom right corner of the home page, and click on streaming. You will then find links to Freegal and Hoopla. Explore the choices, pick your movie, music or book and you’re on your way. Freegal has an entire category of movies devoted to health and fitness. Hoopla has the option to explore movies by genre and also has health and fitness selections. The websites walk you through how to register and download materials.
Freegal’s fitness videos include a collection of pilates instructional movies. In addition to general pilates, choices include pilates for men as well as pilates for pregnant women. You can also stream videos of exercise routines addressing joint pain, core strength and emotional stress. HCLS customers may stream up to 3 videos per week and each may be borrowed for 2 days. Freegal allows you to build your music library because you can download and keep 3 songs per week. HCLS customers can also stream up to 3 hours of music per week.
Hoopla offers an even more extensive selection of fitness videos. Hoopla is a great site to explore for yoga instruction. The selection includes several yoga for kids videos. There are videos with yoga techniques targeted to patients with hypertension, diabetes, joint pain, digestive problems, and sleep disorders. There are movies to assist with weight loss, learning Tai Chi, and improving flexibility. There are even videos for fans of Forks over Knives and The 5 Love Languages. Hoopla movies can be streamed or temporarily downloaded through the app for a viewing period of 3 days.
Hoopla has a large selection of audiobooks as well. By genre, take a look at personal development and health and nutrition. Topics include running, pilates and reversing the aging process. You can learn about meditation, how to lose belly fat, strength training, and breaking unhealthy habits. Explore the music collection too. Albums can be borrowed for 7 days and audiobooks for 21 days.
Computers don’t have to cause us to be more sedentary; they can connect us to activity and healthy lifestyles. The Freegal and Hoopla collections are always expanding. These applications do not have wait lists as the content is available to stream to multiple users at once. You can explore new ways to improve your body and mind today.
I’ll be the first to admit that I’m just not an exerciser. I’ve always disliked going to the gym, or finding time to exercise outside of one. I have plenty of excuses for not doing even those exercises I enjoy, like walking, running, or biking: “It’s too hot/cold/raining,” “There’s nobody to go with me,” or “I don’t have anywhere specific to go.” But, there is one type of exercise that I can always fit into my schedule, and that’s simple bodyweight exercises. Stuff like push-ups, crunches, and dips. Plus, I can do them in the comfort of my own home in just a few minutes.
As the title of this book describes, You Are Your Own Gym, Mark Lauren and Joshua Clark’s self-named Bible of Bodyweight Exercises, contains 141 bodyweight exercises that can be performed pretty much anywhere. Some of them are the obvious favorites that everyone knows like push-ups, sit-ups, squats, and lunges, plus numerous variations on each. Others are more unusual like the whimsically named “the roof is on fire,” “shrugs and kisses,” “good mornings,” and “little piggies.”
The authors also provide some program ideas for various levels of experience and fitness, from beginner to “elite.” These programs call for different types of workouts each day, with recommended exercises meant to improve varying aspects of fitness (endurance, strength, and power). They call for performing 3-4 exercises a day for a total of 20-30 minutes of exercise – an easy amount of time to fit into any busy person’s schedule. One thing I particularly appreciate about this book is that it isn’t meant for one gender or age, and half the pictures depicting the exercises are of a female. It’s written in a very friendly manner that makes it easy to understand and makes exercise a simple and easily personalized task. It’s objective is to teach readers how to build their own basic exercise routines around the exercises that will work best for them – and why that’s what they should be doing.
If you want to get more specific, there’s also 7 Weeks to 50 Pull-Ups by Brett Stewart. This program promises to “help you build a stronger body and sculpt your physique in just 20 minutes a day, 3 days a week.” I speak from experience when I say, “You don’t even have to be able to do a single pull-up to begin a program like this.” I started out having to hop up to perform one chin-up on the pull-up bar I have at home (bad form, I know), and now, I can consecutively knock out 5 chin ups (or 3 pull ups). It may not sound like much, but it’s better than none! In fact, there’s a prep level program included for those of us who aren’t at the “7 pull-up minimum” recommended for starting the real program.
Why bother? Well, one day when I fall off a mountain and can pull myself back up without assistance, I’ll know my simple exercise routine was a success!
How do you hope to live the rest of your life when your time becomes short?
This is a weighty question. A question that everyone should ponder and discuss, with friends and peers, but especially with spouses (partners) and other family members. It is often a difficult thing to do and particularly difficult with your older, often ailing parents who are reluctant to talk of such matters. However, the time to have the “hard conversation” may be now before its too late.
Please read Being Mortal: Medicine That Matters at the End by Atul Gawande (2014). He has written an insightful book, from a doctors viewpoint (he is a surgeon) and also from a son’s (his father was diagnosed with an incurable cancer), about how people cope with their mortality. He also looks at how the medical community deals with the very sick and/or aged in terms of how they often spend the last few days/weeks of their life, and it’s not the way they might have wished.
Here’s the big question: If you, as a patient, are told the truth about your condition and prognosis by a caring doctor who takes the time to really have a conversation with you, and tells you that your condition is terminal, would you immediately try every medicine/medical procedure in the hopes of gaining a little more time, no matter the costs/pain/side effects, or should you consider your other option of allowing the disease to progress but with some pain management, and try to live the best life you can with the time you have left?
These are decisions and questions that are happening to families all the time as there are more aged people than ever before. But what is also happening is that there are more people dying in hospitals hooked up to tubes in ICU’s when that wasn’t what the patient had wanted. Or maybe they are strapped to a wheelchair and heavily medicated in a nursing home with absolutely no control over any aspect of their day. This is certainly a book that campaigns hard for informed and courageous doctors and patients concerning end-of-life issues and conversations, as well as the importance of advance directives and living wills.
The author wants you to ask questions — such as, “What brings you joy each day?”, “What fears do you have about medical care?”, “What is important to you now?” Frontline (PBS) did a show with Dr. Gawande about why it is hard for doctors to talk to their patients about death called “Hope is not a Plan.” It gave his story a human touch as it explored the themes of his book dealing with how families and how the medical community deals with end of life issues and mortality. So often, he found, doctors nor family members had any idea what the patient wanted at the end.
Being Mortal talks about the natural breakdown of a person’s body as old age advances, and the author shows how much people fear dying and even more so talking about it. Together with doubt about what the future will be and desperation for a miracle cure, they cling to the belief that medical science can always fix what is wrong. Medicine does exist to fight death and disease, but eventually, in the end, death will always win.
Dr. Gawande also asks how we can build a better health system that will help older and ailing people feel a sense of continued purpose in their lives and to be able to achieve what’s most important to them at the end of their lives. He visits some very interesting and very innovative nursing homes, assisted living communities, and hospice programs. Also, considering our graying population, he feels more geriatricians should be in training (when in fact the number is declining).
Just as in the Washington Post article in the Health section on Jan 27, 2015 entitled Growing Numbers Turn to Hospice, he explains that hospice care does not hasten death or mean surrender, but can in fact make the time left for the patient more livable and satisfying, and for the family as well. Rather than spending their last days/weeks in a hospital bed hooked up to tubes and monitors, hospice care can help everyone to prepare and have some quality time to spend with the patient and time to say goodbye.
Another recent book, Can’t We Talk About Something More Pleasant? (2014), by Roz Chast is a memoir that follows the author as she deals with the steady decline and deaths of her parents. As a cartoonist for the New Yorker, there are some lighter moments and humor, but it is an emotional story of an only child overwhelmed with the time and energy and unknowns of watching as her parents decline and have to be moved out of their New York City apartment and into a continuing care community near where she lives. The author gets frustrated because she doesn’t know what is the right thing to do, and she grieves and she cries. It is also a worthwhile read.
A book that you might prefer instead is A Short Guide to a Long Life (2014) by Dr. David Agus. He feels that most people could delay or even prevent the majority of particularly chronic diseases we see today if they would adopt healthy habits early in life and avoid those that are known to lead to illnesses. He presents a “cheat sheet” of 65 concise rules for healthy living and living wisely. He hopes his guidelines will make each person more responsible for making healthy decisions for themselves. This book should be required reading for everyone.
You may have heard of Compassion and Choices, a non-profit organization (that publishes a magazine) that is “committed to helping everyone have the best death possible . . .” They advocate patient control in end-of-life care options and reducing unwanted medical interventions at the end of life. This organization is also involved in the aid-in-dying legislation initiatives across the country, but that is a whole other issue. If you read How My Father’s Dementia Has Destroyed Us Both in the Washington Post on February 1, 2015, you would have been moved by the story of the author’s father who is strong physically, but has lost most of his cognitive abilities and needs to be kept in the psych ward of a hospital because there is no where else for him to go.
Another new book to recommend to you is The Conversation: A Revolutionary Plan for End-of-Life Care by Angelo Volandes (2015). Also a doctor, Volandes has written a small and excellent book where he tells the stories of several patients at the end of their lives and having the hard conversation with them. He took some patients to the ICU unit in the hospital to show them what that care might look like there. Then, he made a video that he showed other patients on an iPad of what their options would look like- specifically, what CPR, intubation, feeding tubes, and breathing machines were. He explains health care directives, proxies, and living wills and insists that you talk to your family and doctor about your health care options, even knowing that your desires may change over time. There are specific questions to help you start a conversation with your doctor or with someone in your family and especially a parent. I made a copy of the questions. The author highlights some web resources, particularly an online video program called Prepare.
Our mortality is a fearful thing to contemplate, but maybe more so if it is never talked about. I hope these books and articles, and other resources will be very helpful to you, and inspire you start thinking about how a good life can also have a good death. For yourself and for your loved ones, please take the time to consider what end-of-life care may mean, start discussions and have the courage to have a hard conversation.
It’s true, I have a love of Teen novels and I’m not going to apologize for it. In all honesty, most of the ones I go for tend to be, well, let’s just say NOT realistic fiction. (Come on, The Raven Cycle has quests for dead Welsh kings, psychics, ley lines, and one of the best hitmen ever written–but you have to wait until book 2 to meet him. And , The Lunar Chronicles? Kick-butt, clever, fairy tale heroines in space–how could anyone resist? And let’s not forget all that exciting dystopian fiction.) But, I have to admit, I recently succumbed to a very positive review and picked up a realistic teen fiction title that I want to recommend (but only to older teens and adults). All the Bright Places by Jennifer Niven is an amazing book with a powerful story, particularly concerning mental health. I was trying to think of a summary that would not give too much away, but instead I’ll just give you 10 good reasons to pick it up and read it:
- Yes, yes, all the reviews say it, so why shouldn’t I: If you loved The Fault in Our Stars (or Eleanor & Park, or both), you will love this book. It has its own unique magic and is not merely a copycat.
- The book deals with first love/first sex compassionately, and still lets it be romantic.
- It’s already been picked up to be made into a movie, but, as every librarian, English teacher, book lover, etc. will tell you: “Read the book first; it’s almost always better.”
- Violet Markey, one of the main characters, is awesome. She is suffering a major loss in her life, and is struggling mightily, but still manages to be smart, relatable, and authentic.
- Theodore Finch, the other main character, is also awesome. He knows something is wrong with Violet, and he wants to help. He also knows something is wrong with him, and Niven lets him react to this in a way that is true to real life. And yet, he is still charming, dear, warm, and someone you want to root for, even though you know its is dangerous to do so.
- You will learn a surprising amount about some of Indiana’s “natural wonders.”
- If, like me, you tend to go for more “far out” (yes, I know, I’m old for using that expression) teen fiction, or, if you d on’t read any teen fiction at all, this might open you up to it.
- The author’s notes. Please, please, please read the author’s notes at the end of the book. If you relate to the book because you or someone you know is struggling with some similar issues, Niven provides some great resources. And if you are not, what the author discusses adds a whole new layer to the lives of the characters.
- The mental health issues are not sugar coated. In some ways this makes the book very difficult to read, but I am grateful for the fact that, though it is fiction, the book feels very real and doesn’t try to hide, romanticize, or make light of what is going on with its characters.
- You will cry. Okay, maybe this isn’t an enticement, but you’ll suspect pretty early on in the book that it will end with tears, and yet you’ll want to keep going. You’ll have to see it through to the end with Violet and Finch, despite the heartbreak that will stay with you well beyond the pages of the book.