CODA -- LADY GAGA -- RESPECT OLDER PEOPLE

Some of the more recent noteworthy Academy Award Oscar winners and nominees have been over-shadowed by a now notorious face slapping  event.  One such Oscar was the best motion picture award (reviewed by the New York Times) to CODA  (child of deaf adults) -- a first major award for a film with a predominantly deaf cast.

The social uproar occurred with the recent Hollywood Academy Awards of the Oscars when the best actor prior to his award being announced unexpectedly walked on stage, slapped hard the comedian host for making a joke about the actor's wife.  Once the actor returned to his seat, he proceeded to utter a few curse word threats warning the comedian not to mention his wife's name.  All for which the actor ultimately apologized later.

Given that the comedian's joke referred to the actor's wife's bald head, which is due to a medical condition, I am of the view these type jokes should be off limits.  Making jokes about people who have a medical condition seems more than inappropriate to me to say the least -- such as how they look, walk, talk, react, and more.  Not known is if the comedian knew the wife shaved her head because of a medical condition, though this was public knowledge.  There  still is no excuse for the actor's actions.

The actor's reaction, after I observed him initially laughing at the joke, was quite an illegal physical assault on the comedian for which the actor could and, perhaps, should have been arrested on the spot, removed from the premises, and maybe even jailed.  How the whole situation was handled is another issue I won't even discuss further here.  There still was no excuse for the actor's behavior.

If an individual has a medical condition which they are comfortable publicly discussing and choose to laugh at or make jokes about, then that makes such humor about themselves more acceptable but not otherwise in my opinion.

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Liza Minnelli, celebrating the 50th anniversary of "Cabaret", the film that earned her an Oscar for best actress years ago, presented the best picture final award in spite of the adverse effects she was experiencing from medical problems.

Lady Gaga was a class act keeping the presentation going by assisting Ms Minnelli without ever being patronizing or awkward.   She, Liza, was enabled to retain her dignity despite the variety of medical issues that have challenged her functional abilities in recent years.

Lady Gaga and Liza Minnelli present Best Picture Oscars 2022.  ABC Live

My years as a Speech-Language Pathologist I worked with a rehabilitation team of other therapy disciplines and medical professionals.   Though I initially trained and planned to work with children who had severely disordered language, I evolved into working primarily with  adult patients of all ages but mostly older adults, in hospitals, eventually in long term  care including skilled nursing in my later years of practice.

I encountered individuals with many varying medical diagnoses that included a broad variety of communication, swallowing, cognitive and related difficulties, some such as Ms Minnelli has encountered.  In every instance with all patients, whatever the diagnoses,  their retaining personal dignity and being respected by all professionals, family members, friends, and any others they might encounter has been a vital element in enabling them as human beings to optimize achieving their highest potential functioning level of which they are capable at any given point in time. 

They and all of us want little more for ourselves than respect and dignity, too, even if our only issues are that we've become old.  Maybe we've reached an age we tire more easily.  Perhaps we're less able than we once were in some functional areas ... vision or hearing not as sharp ... thinking sequentially a little slower ... recall sometimes short-circuited ... some words not always available ... feeling overwhelmed occurring more readily ... walking not as fast or far, or not at all.  We may occasionally make mistakes in our words or speech that are not over-looked by some others as similar errors when we were younger that we laughed about then.   

So it is, that I've been so impressed with Lady Gaga as she has shared the stage with Tony Bennett who has Alzheimer's and now Liza Minnelli coping with her own, but different challenges.

Here's Liza in her prime singing the title song ... in the 1972 movie "Cabaret" of that Broadway show.  The setting is:

"Berlin, 1931.  As Nazism rises in Germany, flamboyant American Sally Bowles (Liza Minnelli) sings in a decadent nightclub and falls in love with a British language teacher (Michael York) ... [this] carefree, tolerant and fragile cabaret world is about to be crushed under the boot of the Nazis as Berlin becomes a trap from which Sally"s German friends will not escape".

That government's oppression and Russia's behavior toward Ukraine today is what an autocracy offers that all should remember come elections in our own and other countries.  Be not fooled by lying autocrats with their appeasers appearing to be different with promises of enrichment for all.

Perhaps you have some thoughts about some of the topics I've mentioned?

KALILILY TIME -- AGEISM -- BLESSED RAIN -- EXIT 9

"Kalilily Time" by Elaine -- a writer/blogger/poet of interest who has been in the blogosphere since blogging's beginnings -- read the "Who" and "Why" by clicking on her blog above.   Like many of us life has resulted in her needing to take a hiatus from time to time and I've missed her when that has occurred, so let's welcome Elaine back!  

Elaine's poetry has appeared in numerous publications.   She also wrote some very interesting blog posts which she has resumed doing in the past few days.  An excerpt from one of her recent blog posts says: 

"...I've been trying to track down other bloggers around my age to see if we can develop into a virtual community of kindred spirits.   That's what I had back in the 2000s, and I miss the virtual camaraderie."

I think you may want to pay her a visit to welcome her back by clicking on her blog above at her web URL:  http://www.kalilily.net/

* * *

I've had a rude awakening, or in the vernacular of today, I'm woke.  I discovered I may actually be ageist when I wrote to my adult children a description of my experience when I recently attended an afternoon outdoor jazz concert.  I referred to some other people there with descriptive words well beyond saying they were old, which, of course, I am, too, so I'll omit any of that ageist language which might be seen as offensive.  

The concert afternoon stayed hot in the mid to low 90s as I sat in my car in the parking lot right next to the concert area patio of the Japanese restaurant, with all of my car windows down.  I turned the A/C on briefly only once since I didn't want to run down my battery during those hours and my gas was rather low.  

I digress ..... but I haven't filled my gas tank, expecting rates will go down from the $4.40+ per gallon.  Now I learn that's not likely to happen any time soon and the price could go up -- to $5 or more!  Clearly, I better fill up my car's gas tank soon.

No doubt you've heard we've had a big oil leak off our Pacific Coast originating in the Long Beach area, with the oil slick moving southward, possibly to San Diego, adversely affecting the environment -- ocean life creatures including sea lions and otters, dolphins, fish, birds covered in oil though only a few needing rescuing so far, wetlands damage, pollution of numerous beaches.

Early aid to mitigate some of the potential problems has helped the total damage be less to date than had been expected.  The cause is presently thought to be a ship's 's anchor dragging and ripping open the oil pipeline, possibly occurring as long ago as a year earlier, but the definite cause is yet to be determined.  I expect the oil companies might cite that as another excuse for our high gas prices.  When will offshore oil drilling everywhere permanently cease?

Back to the concert ..... I enjoyed the young Exit 9 trio (note: current YouTube musical group videos with this name are not this group) who played classic mellow jazz standards including a favorite of mine, "On Green Dolphin Street", plus a few pop songs through the decades, other newer tunes, also easy listening compositions some call smooth jazz.The Exit 9 trio consisted of a keyboard, guitar and drums.  A duo of guitars played one short segment.  I hope this group is invited to return each month as I told them.   The next week's performing group, ZZAJ, is a longtime favorite of mine about which I've written HERE before.

Here are two different versions of "On Green Dolphin Street",  one with noted Pianist Peter Nero with orchestra, the other with the Latin beat of talented musician Sergio Mendes.

Peter Nero -- The Unforgettable  -- Sheet Music & mp3 - Okmusix 

Sergio Mendes -- Moderno - Milestones Records 

Continuing the now-edited-to-remove-ageist-attitude-wordings report of my experience ..... I had a pretty good view of the Exit 9 jazz trio, could hear the music fine, but sometimes people on the patio moving to seek shade, as the sun crossed the sky, would block part of my view.  There was only a low wall and greenery between them and me, but, irritatingly to me, some seated at the back of the patio closest to my car parked headed-in next to them in the parking lot, paid no consideration at all to my presence behind them they had to have seen.  They were inconsiderate, unlike those sitting on the patio in front of them were for them, so they could see.  

I wrote disparaging descriptions later to my children of the old man, and an old woman there who chatted with him as the concert wore on.  My negative attitude toward them was obviously colored by the fact they kept interfering with my view.  I didn't want to toot my car's horn, but I sure felt like doing so several times.

In my message to my kids, I groused about the guy's appearance and ponytail, was rather snide about her appearance in a backless, very very short sundress that I'm more accustomed to seeing on a much younger woman.  Actually, she was very smart, definitely, including her big red hat, and wisely dressed for the extremely hot afternoon of well over 90 degree temperatures.  Comfort and safety from heat stroke is the name of the game.  They were both quite respectable representatives of their 60s generation.

People mostly sat some distance apart with less casual interaction than pre-pandemic days.  Nobody wore a mask, but I had one at the ready in my car, especially since the decrease in Covid infections had instead gone up in both the public and our schools -- attributed to the unvaccinated, of course!

There's usually a pretty friendly group at these free jazz concerts -- a few folks came together, but a number of both sexes came and left alone.  Strangers talked with one another between tunes and during breaks.  I do recall one individual years ago who was married, apparently lived on my street, though I had never known of him or his family.  Some in the musical group seemed to know him, or maybe he had just been showing up for their concerts before I started attending after my husband died.  

The man was a big talker everybody could hear with his comments between sets directed toward varying musicians, sometimes naming an instrument he said he played.  At one point, he spoke disparagingly of marriage with broad statements, then intimating he would welcome meeting someone he could rendezvous with in a nearby town.  

Later that afternoon after that statement he called me over, then started talking quite confidentially, but didn't make much sense.  He finally gave me a weak excuse for this talk in his one-sided conversation of having a toe problem that didn't sound like much of one to me but suggesting I might want to examine him.  I don't know what he had in mind since he wasn't removing his shoe and sock to show me, though I wouldn't have looked anyway.  Did he really want medial advice from me -- there, in front of others?

I nicely explained to him his toe was quite out of my area of expertise since, I stressed to him, I was a Speech-Language Pathologist -- we weren't exactly trained in toe rehabilitation.  I walked away and we never talked again.   I shared that conversation, laughing it all away, with the vocalist with whom I had become friends.  He never showed up at the concerts again, at least when I was there.  I think he and his family eventually may have moved away to that town he mentioned.

* * *

I'm in disbelief -- we actually received about one-tenth of an inch of rain here in my SoCal foothills!  Furthermore, we may get a dribble or drop more later.  This will hardly matter much to alleviate our drought, but "every little bit helps", as the saying goes.  Mammoth Mountain even had snow -- a ski area, driving time approximately 5 hours from Los Angeles, 3 hours south of Reno, Nevada.  Our temperatures have dropped considerably and finally begin to feel like fall.

Are the seasons noticeably changing where you live?  Do you listen to your favorite music to influence your mood for weathering the vagaries of life, including pandemic confinement or isolation, to distract from or escape pain, or perhaps loneliness due to other reasons?

SO CAL -- PATIENCE -- VISITOR -- POST VIRUS

SO CAL DROUGHT & ENVIRONMENT

Our rainy season is past, and we didn't get enough of those moist drops from the sky to fill our reservoirs or snow to build deep packs for summer melting into mountain streams and rivers.   Californians are being told we are definitely in a drought.   Forest fires may well be an exceptional risk.  There reportedly is sufficient water to meet our needs through the coming year and the next one despite the low reservoir levels.  I wonder if any special water conservation measures will become necessary?

I've not incurred the expense of converting my yard to desert landscaping, especially after having to repair a corner of my concrete block back wall's separation caused by pressures from my neighbor's leaning wall.  Our city regulator's inspected and allowed me to separate his wall from mine so I won't encounter this issue in the future.

Meanwhile, I just received notice that our trash/recycle/sewer/street sweeping rates are increasing 12%.  We're told other cities across the country will be having to increase their rates, too, at least by 10%.  Eventually we may have to sort our trash for separate disposal of food waste which will be composted.  This is all an effort to compensate for dwindling land-fill sites and control where the majority of man-made methane gas is emitted which contributes to smog.  We have 3 bins now for weekly pickup -- trash, recycle (paper, cardboard boxes), greenery for compost.

PATIENCE ... Patience ... patience !

These are the words I said so many times to so many of my different patients when I provided all sorts of communication rehabilitation in speech-language-hearing-voicing-cogniltive and swallowing due to a variety of causes.   Patience -- a word easier said then practiced as I focus now on doing what I preach.

I'm finally reconciled to the fact my physical activity has slowed a bit from what I hoped might never occur, or expected at the very least not until I was older than my present eighth decade.  I may engage in physical therapy again, but my once-expected gains are being limited.  I ponder if surgery is warranted with benefits outweighing potential deficits.

Pain with movement experienced the past several years has significantly lessened but is not eliminated.  I recently read a report that redheads have a high tolerance level for pain.    I can attest to the truth of that for me, surprising even some medical people I've encountered.  

It does get tiresome having to spend more time than I had been accustomed to, just doing ordinary activities.  Also annoying are limitations even engaging in some activities.  I've been trying to wait out the pandemic before seeking some much-needed assistance here.

UNEXPECTED VISITOR

California's Western Scrub-Jay looks somewhat like a Blue Jay, "are bigger and longer than bluebirds"; have lots of "attitude" as described at Audubon.org.  in an article with photos by Garrison Frost, "Ten Birds Every Californian Should Know".  This handsome blue bird with a splotch of reddish-brown feathers has been flitting between the large leaves through the lower levels of my Bird of Paradise just outside my living room window that looks out onto my back yard.  This is the first time since we've lived here that I've observed this particular bird species in my yard visiting every afternoon for several days this past week though it's described to be common here.

The other day the Scrub-Jay finally came to the window, apparently attracted these several days by the perpetual motion of mini-solar powered figures sitting on the inside windowsill.  One realistic-looking figure appears to be a large bee hovering with rapid wing movement over colorful flowers.  Touching the window glass gently with his beak, the blue bird soon discovered penetration was restricted, keeping him from reaching that fake insect.

Apparently not completely discouraged, the Scrub-Jay then hopped further down the window out of my sight.  I soon heard pecking sounds which was obviously the bird determined to find a way inside to get to that tasty-looking bug.  Scrub-Jay quickly discerned entry was a futile effort there, too, and flew away.  Fortunately, my window is dirty enough the bird hadn't mistakenly flown into it, unlike a small bird I noticed one year repeatedly butting against a then clearer window.   I miss seeing Scrub-Jay and wonder if he will return another day but hasn't so far.

POST PANDEMIC

Now that -- presumably, going out in the world is safer for those of us who have our vaccinations, if we've waited the two weeks following the injections(s) for antibodies to fully develop in our system -- I don't feel any real drive to do so.   We have yet to see the full effect of variants.  I haven't set foot in a store or restaurant for over a year.  I've grown accustomed to ordering more items online and having other deliveries.

I rather like making pick-ups at grocery stores, other businesses, various restaurants and drive-thrus.  I hope some of these services continue after the pandemic is in our past -- assuming it will be eventually.  Perhaps I will evolve into using more of a mix of such conveniences than I've used in the past.  I wonder if others may alter their future shopping routines, too, from past patterns before this pandemic?

LAZY DAY REMINISCENCE -- BETRAYALS

BETRAYAL OF ONLINE PRIVACY 

My online privacy has been betrayed by Republicans in the U.S. House of Representatives and Senate. The ultimate betrayal will occur if President Trump signs their bill as he is expected to do.  No longer will Internet service providers be required to get my permission before collecting and sharing/selling my data.  Will voters remember this betrayal in 2018 and 2020 elections?


BETRAYAL OF EARTH'S HEALTH

Earth's health is betrayed by President Trump  as he rolls back climate regulations and protections causing the U.S. to be more dependent on polluting fuels affecting our water, air and climate making my children, grandchildren and me more ill.  Will voters remember this betrayal in 2018 and 2020 elections?


* * * * *
Recently I came across this draft I wrote six or eight years ago but never posted here.  I decided to share this then fond reminiscence of my husband, my mundane day's activities and thoughts about work, patients I was serving then,  my future and whether I wanted to retire.  I did finally retire three or five years later, but continue currently to maintain requirements for my state license and national certification.   

Lazy Day Reminiscence - Pondering My Future 

This wasn't the first time I experienced a lazy day.     I had these days rarely in my young single adult life.  Then, when I married, for many years I had no lazy days,  particularly once we had children.   Years after the children left home my husband and I quite accidentally had a lazy day that was so successful we began to  increasingly share more the older we became.  

Initially, we felt a bit guilty deciding to indulge ourselves, so hesitantly sought mutual reassurance from each other that lazing around all day in our sleeping attire was acceptable  behavior.    Hopefully, no one would come unexpectedly to our door.   There was an unspoken sense that such an out of the ordinary activity  might best be kept secret lest others wonder about our judgment.

I suppose whatever guilt we felt was strictly self-imposed, arising partly because of an inherited strong work ethic we had both pursued throughout life.    Arising early each day we had dedicated hours to our employment -- work outside and in the home,  sometimes until quite late into the night or early morning.   Meals might on occasion  be rushed or even skipped when we were single, or before out children were born.   Recreational, relaxation and vacation time carefully scheduled still might be subject to cancellation​ due to unexpected sudden work needs.

Also, there was the knowledge a multitude of activities or chores were likely  awaiting undertaking with resultant concern we would be leaving them  undone for another day.    Sleeping late is one thing, but to lounge about all day and evening attired in pajamas and robe without having  dressed was quite another matter.   But that's what we occasionally did in our later years after he retired and I was working only part time.  

There's just me now -- awaking one morning, I  glanced at the clock's time while foggily reviewing in my mind my must-do's for the day.   I recalled from the previous day the sadness I felt that a therapy patient younger than me had to be discharged to comfort care only.   She had experienced a fluky minor medical problem when on a vacation trip with her husband in a faraway  English-speaking nation.    An infection developed unexpectedly becoming significantly more serious after they returned home.   Now she was living through her final days.    

Contrasting with a more positive outcome, an older patient I discharged that same day had been successfully safely  transitioned to regular food.   A day later she has been up in a wheelchair for the first time since admission to be wheeled outdoors into the warm sunshine by her husband.    Her expectation is to return home to independent living soon.

My remaining patient wasn't scheduled to be seen for expressive language, understanding and cognitive issues until the next day.   This meant I didn't really have to leave the house except to retrieve my morning newspapers, unless I received a phone call notifying me of any new physician referrals.

I leisurely reach across the bedside night stand to turn on L.A.'s all news radio station, KNX before making a brief trip to my contemplation/powder room.  Returning to the bedroom I thought I was up for the day but was lured, then succumbed to my beckoning bed's seduction.    Several hours later I re-awakened  to reporters voicing the continuing current local, national, international news, weather and traffic reports.   Eventually arising I finally  wander down the hallway, pausing to raise the house thermostat's temperature a few degrees.

Peeking out the front door as I slip a jacket on over my P.J.'s to make myself half-way presentable, I gamble I can sneak half-way down my driveway and back to gather my newspapers before any periodic passing cars come traveling down my street.    I like this daily outing regardless of my attire and whatever the weather conditions --  sunny, rainy, foggy, hot or cold.      Having safely scurried back inside I realize it's lunchtime.   I choose to have  breakfast which can be quickly and easily prepared in the microwave oven -- oats, ​a teaspoon of cinnamon​, nonfat milk.  

Opening the microwave door I'm greeted by a dark interior.  What's this?  The microwave power is off, so away I go to the circuit box where I determine I have to reset the breaker.   Why this breaker turned off I have no idea -- power surge or what?    Returning to the kitchen I'm relieved to find the oven's light on.   A few cooking minutes later  I sprinkle a thin layer of bran buds on the now hot cereal,  add a diced ripe banana half,  a layer of blueberries and a few luscious red raspberries.    I'll leave the refrigerated strawberries and blackberries for my evening dinner.

By now I have consciously decided, considering the time of day and my lack of any appointments, that this will be a lazy  day -- and so it became as the hours flitted by.  

Dinnertime's menu decision consists of a choice between a previously cooked braised chicken breast with a colorful vegetable mix , or an individually prepared healthy organic dinner quickly radiated.    I chose the later consisting of a nice sized salmon fillet with spanish rice (I prefer wild rice) and fresh green beans which I garnish with a handful of cherry tomatoes.  The aforementioned fresh fruits complete the meal.

Opening the refrigerator door to gather my food items,  I'm again startled by another dark interior that was well-lit earlier.  Oh dear!  No power.  I wonder how long the unit has been off?   The refrigerator was alive at breakfast.    Back to the circuit box, this time a flashlight in hand to slice through nighttime's darkness.   Locating what I think is likely the specific offending circuit breaker, I repeatedly attempt to reset it but this troublesome one does not seem to cooperate.

Discouraged, I finally return to the kitchen ruing that I hadn't discovered this problem earlier in the day since I didn't want to incur emergency rates calling an electrician at night.    I thought about food life in the freezer section as I opened the refrigerator door half hoping for a miracle.   Amazing!   The interior light was on -- the ancient breaker had caught in place despite outward protruding appearance.
The rest of my lazy day/evening would pass without complication.

Early in the evening a phone call comes with physician orders to see a new patient the next day. The person is known to me from treatment I provided several years ago.    I know the individual  has declined somewhat since  then, but I wonder what has transpired now that necessitates my being consulted?   Nursing and her private duty aide with whom I've long interacted will up date me on the cantankerous lady's status tomorrow.

Days or weeks sometimes pass and I have no appointments since I cut back my part time work schedule even more, mostly serving only one facility now.   Still, I'm on call weekdays which prevents spontaneous personal trips out of town.       Perhaps a driving trip temptation is best avoided given the increasing cost of gasoline which is well over $4 a gallon now and predicted to rise to over $5 here in Southern California USA.    Yesterday I overheard a colleague say in  a southeastern gulf coast city drivers were currently being charged $7 for as gallon of gas.  

Sometimes I think that perhaps I should fully retire, but then I think that during those times I'm at home, I might miss working some few weekday hours.    There's much I should, could or, would do here at home so I know I 'd have no excuse for being bored, but how much would I actually do?
Still.....maybe that appointment commitment minimizes the risk I'll be tempted to increase the number of my lazy days.    But,  continuing to work, yearly state license and national certification require attending the necessary all day continuing education seminars periodically to which I often must commute some distance.     Yet, I think,  I do thoroughly derive pleasure being part of my mostly aged 50 to 100+ years elder patients life transitioning process.    I like interacting with them, their family and friends who may live nearby or far away.   We all learn so much from each other.

The experience makes me very aware of how unexpectedly anyone including me might experience some of these debilitating  medical issues I see with others.   I'm not without a few medical issues of my own.   Should my health situation alter I wonder just how well I would cope and adjust to challenges similar to theirs?    I'd like to believe I'd be motivated to maintain a positive attitude and treat those around me genially, but I can certainly understand how difficult that might be.   No doubt one day I will clearly determine either by choice or otherwise that full retirement is my primary desire, but until then I'll likely augment my days with an occasional lazy one.

CATCHING MY BREATH

This year has seemed to be a rather busy one for me – so much so, that I’ve blogged only once in January, twice in February, thrice in March and now we’re in April, the fourth month.   Here's some of what has kept me occupied.   

The income tax submission deadline is past but was hardly routine this year for many taxpayers.  The Internal Revenue Service’s preparation of tax forms was delayed thanks to our U.S. Congress’ failure to perform their legislative budgeting duties in a timely manner.  Next year our Congress should surely be capable of performing more responsibly. 

I do resent a tax system that is so complicated that far too many citizens must hire someone to complete their forms.  I continue to prepare my own tax forms which I started doing by default following my husband’s death.  Each year I become much more adept at the task which has resulted in the process taking much less time, causing me less mental strain and frustration.  Ideally, I won’t receive an IRS notice later this year informing me I either underpaid or overpaid. 

I continue to note that our administrative and legislative branches of government are composed of too many people who appear to be willing to penalize those receiving Social Security by altering the formula for computing cost of living increases in a manner tantamount to a reduction for too many individuals who can least afford it.  

There are numerous other issues on my mind with the most pressing one unfolding in Massachusetts as I write this.  Law enforcement is engaged in a manhunt for the remaining known terrorist believed to have planted those deadly explosive devices at the Boston Marathon.   Live television coverage of breaking news on this event make it difficult for me to cease viewing and go to bed. 

Focusing more specifically on the mix of my time-absorbing activities since the first of the year, I had my required annual health physical examination followed by a variety of associated follow-up tests.  Coincidentally, I’ve acquired an infection that is somewhat resistant to the first round of bacteria-fighting medications and in another unrelated circumstance I had to get a dental crown. 

My life this year has also been periodically complicated by some residual effects from a bit of  fancy footwork I exhibited last winter that resulted in my colliding with the floor then.  The good news is that I prevented spilling the Chinese dinner I was holding in one hand or the water grasped in the other hand, so no mess to clean up. 

I went to my knees hard, then over on my shoulder, but I had no bones fractured or broken – the activity is not recommended for the spinal cord and back.  The consequence this year has been to experience some “creaks” that necessitate my having to exert more effort to engage in my activities some days.  Physical therapy coupled with practicing recommended exercises reinforces what has once again proven to be beneficial therapeutic intervention for me.   

  

Mostly I keep going just like the Energizer Bunny.  The past couple of months I’ve attended an unusual number of time-consuming seminars on a variety of interesting topics associated with my continued part time work.  One of the most interesting two day sessions focused on training for providing Speech-Language Pathology services in the new Green Houses at the retirement community I serve.  These new Evergreen Villas living units are currently in the final stages of construction.  

Several years ago Dr. Bill Thomas, Geriatrician, proposed the Green House concept.  Green House Projects are now in many states.  Green Houses are designed to create a more home-like atmosphere accommodating a small number of residents compared to traditional nursing homes.

  

“The Gardens is the first organization in California to be licensed to construct homes using the Green House model...two new homes, each 7,000 square feet, with 10 private bedrooms with private bathrooms and showers, and a family-style great room with an open kitchen and dining area. While licensed as a skilled nursing facility, the two houses are designed to look like the single family homes in the surrounding neighborhood.”   

In keeping with this blog's policy to not provide free promotion, I want to clarify that I am not attempting to promote this Life Care retirement community and do not receive any financial benefits from mentioning them here.  I do so solely for the purpose of sharing information about my activities and as an example of this relatively new living environment approach that is becoming increasingly appealing to some elders. 

A few weeks ago I attended an excellent two day seminar focusing on swallowing therapy presented by a Speech-Language Pathologist from a Pennsylvania hospital. I chose these sessions for partial fulfillment of continuing education requirements for my California state license and national certification renewal requirements.  Many people wonder what a “Speech Therapist” has to do with swallowing.  Others are surprised that individuals can even have problems swallowing. 

The reality is that many of the same muscles and functions involved in producing speech are also associated with our swallowing function when we eat and drink.  Our airway function for breathing is intimately involved. Missing teeth, dentures for chewing can provide complicating issues just as foods may do in transit to the stomach or reverse i.e. reflux.  Aging, various diseases, neurological trauma such as stroke, which most readily comes to mind for many, all may have bearing on our ability to safely eat foods and liquids in a consistency and amounts providing adequate nutrition and hydration. 

I prefer attending seminars nearby when possible, so take advantage of those when offered since weeks, months may pass with none available.  A limited number of many such classes offered on the Internet can be taken for credit.  But I prefer attending these live seminars since I’ve ceased attending state and national annual conventions.   

Yesterday I attended a seminar on Functional Cognitive Activities presented by a very knowledgeable Occupational Therapist from North Carolina.  I was pleased with the interdisciplinary approach which I’ve always embraced.  I could readily perceive information that will also have application in Green Houses for Speech, Occupational, Physical Therapies in conjunction with all the other specially trained nursing personnel, plus additional support staff. 

The next several months are likely to keep me busy, too, but maybe the pace will slow in the summer, or not!   I think as I've aged my "pace" has tempered a bit.   I take on fewer obligations and am probably more deliberate in completing my commitments.

Spirits & Simple Tech

Earlier this week I was with a group of young to older aged friends, all seated around a table, turn-taking reading aloud as we listened to each individual’s original written prose, poetry, and plays. During that experience we share the broad spectrum of feelings associated with accounts of real life experiences, and fictionalized stories. The reading content ranges from serious drama through ridiculous farce, satire with the humor bringing forth subtle chuckles, broad smiles, and deep stomach-aching laughter.

This particular evening we began to notice a periodic brief faint chiming sound. This erratically repeating tone interspersed with long pauses between the chimes eventually caused us to begin focusing on determining the source. One of our number commented this could be a communication directed to her from a loved one who she discerned entered a different dimension long ago, but has followed her about during the ensuing years.

A small grand piano situated 10to12 feet away from us in an open adjoining room was suggested by another friend to possibly be the communicator’s instrument. We all maintained an open curious mind in deference to anyone present who readily attributes these sort of unusual immediately unexplainable events to more mysterious ethereal causes. We continued our activity with one ear attuned to listening for another chime. Not long after we heard that chime and just as we thought there would be no more an additional faint chime was heard.

Noticing a four-legged furry creature suddenly scurrying about the room there was some speculation this elegant resident and active cat might have ventured into the piano’s interior, possibly flipping it’s tail or using a paw in such a manner as to strum one of the strings. We all agreed the cat could cause the musical sound with that scenario.

This prompted story-telling time as some began relating tales of cat accomplishments including felines learning to use a commode, and actually being able to flush the unit, skills usually reserved for humans. I recalled a delightfully funny video a musician friend sent of a cat perched on a piano stool, reaching out with a paw to play individual white and black piano keys, cocking its head from one side to the other, very aware of cause and effect, quite intrigued with the differing musical sounds being produced.

A short time passed during which the cat in our midst was also in our sight, no where near the piano, and we were aware of exactly what he was doing – throwing his toy into the air and making a flying leap capturing it in flight. Suddenly, the magical tone chimed exonerating the cat, but leaving some of us who were seeking logical scientific explanations even more perplexed. A couple others seemed quite satisfied there likely wasn’t any such explanation.

Our increasing interest in locating the chiming sound source escalated as this mysterious tone persisted. In an afterthought I reached for my purse sitting on the floor by my chair situated closest to the piano room and next to the person who believed her other worldly relative probably was trying to communicate with her. Simultaneously, as I was extracting my relatively new, unfamiliar cell phone from my purses exterior side pocket the little black rectangle cried out a now familiar chime signaling the battery was low. We all experienced and “Aha!” moment, perhaps feeling a mixture of relief, reassurance and maybe even a little disappointment there actually had been a logical explanation accounting for this mysterious sound.

I cradled my dear little possession in my hands, promised I would reinvigorate it’s life when we returned home if only it would quiet. I gently handed it across the table to the middle aged male tech-employed expert who took one short look, punched a key or two, handed the crying phone back saying he didn’t know how to turn it off. Once again in my grasp, I just kept pushing that “End” button and suddenly with one loud musical gasp the screen went black, the musical spirit to temporary sleep.

I guess I’m long overdue to take time to read the complex operational “quick” book and even the much longer master guide. I always used to religiously read operational books and instructions for everything I purchased. In the beginning with the advent of digital I continued to do so with clocks, radios, portable phones, answering machines, coffeemakers, microwave ovens, CD players, VCR and DVD players.

I wonder if the day will ever come when there will be more standardization in the digital tech world, or maybe we’ll all prefer there not be and we’ll each have a broad choice of same but different items from which we can select.

In recent years I’ve been challenged by our old sprinkler watering systems -- two-same-but-different ones. Then I’ve begun to notice with the washing machine, dryer, regular/convection oven, digital camera, old cell phone and even more so this new cell phone, the greater complexity and size of these “how to use” instructional books. They come close to being epistle length, are often not that clearly written, are either too concise or not specific enough, and skip some of the very basic basics for newbie users like me. Some may have contradictory directions and use language often subject to different interpretations, much like that about which many groups argue over politics, religion and philosophy.

My approach to using some of this technology has frequently become one of resorting to personal operational trial and error. I combine my actions with referencing these technical bibles for a specific answer needed at the time, instead of trying to understand and be able perform every function before I use the item. Integrating the myriad functions gradually into my knowledge base seems to work best for my “how to” retention.

Soon after I began using the computer a few years ago and shortly after my husband’s death a tech friend of his/ours recommended to me a book titled “The Laws of Simplicity.” He had come in contact with the author described in this Harvard Book Store “Scholarly Highlights” interview feature “…John Maeda is a world-renowned graphic designer, visual artist, and computer scientist at the MIT Media Lab, and is a founding voice for "simplicity" in the digital age.”

I enthusiastically purchased a copy and even had one sent to a technology-interested friend. Disappointingly, I never learned of that person’s reaction or opinion of the book’s contents but I never pressed when I didn’t receive a response. I have on rare occasion sent relatively inexpensive books to select friends, but have concluded in recent years to discontinue that practice, or, at least to be more selective about to whom they’re sent.

After I read this thin short book which incorporates the authors wonder, recognition, and descriptive accounting when he notices the simplicity associated with the behaviors of his young child, I have been particularly interested in a reaction to the book’s contents from some other person I know with a background other than my own.

The reason I say that is, my therapy intervention training is steeped in simplification, breaking down actions, behaviors into the most basic steps and then simplifying them even more, if possible. Educators also would likely note effective teaching methods, acquiring new skills in any profession or job setting are most successful when they approach new information building from the simple to the complex. Certainly that has been the case in all other employment business settings I’ve experienced or in which others I’ve known have engaged.

So, when I read this book primarily directed at a variety of technically oriented professions I was intrigued that they required prodding to simplify, that such an admonition from one of their own within their circle of expertise was reportedly regarded as having enlightened them with such a profoundly new insight, or maybe he was just reminding them of something they already knew, or should know.

These impressionable readers are the highly intelligent engineers I respect who design all of this equipment that continues to become prevalent in ever-expanding areas of our lives. The readers also include many of the graphic artists, computer scientists such as this author John Maeda and other creators, professionally related technicians from whom we seek technical answers when our complex machines, tools, soft and hardware programs breakdown, malfunction, or just go kaflooey (or as the Spanish say, kontera.)

I was quite surprised to read accounts this book had such a significant impact on their thinking. I have labored under the false perception most of my life that simplicity was just the nature of things, guiding most of us in just about everything. I can only hope all those who continue to create the future technical innovations we’re all going to be using at least remember John Maeda’s message and follow his laws of simplicity.

Better yet, maybe they should remember how a patient, former career military man, once paraphrased my genteel carefully worded instructions to him for producing more intelligible speech:
He said, “Oh, you mean KISS!”
My puzzled response was: “What?”
He replied, “You know! Keep It Simple Stupid.” :

Third Year Blog Anniversary

Three years ago I took the great leap into the blogosphere with "Along The Way." I'm giving my blog a slightly new look for the second time. Launching my blog when I did was a consequence of accidental mouse clicking, coupled with my panic at having done so and lack of technical knowledge to rectify the situation.

I had been toying with the idea of starting a blog but had already intentionally passed twice on doing so. I first thought I might start on my husband's October birthday, and later on my own but did neither because my blog was not ready. I was awaiting some future to-be-determined date. I definitely was busy making plans. That said, I am reminded of one of my favorite sayings, "Life is what happens when you're busy making other plans."

I fully expected first to acquire many new computer skills, create a unique appearing blog, shape and polish writing subject matter, establish categories about which I would write, and generally organize my blog in an orderly fashion before ever beginning publishing. Then when suddenly my blog was "out there" for all the world to see I lurched ahead. I had little idea of what I was doing but concluded the prospect of writing here was intriguing.

My technical skills were very limited as I had only started using a personal desktop computer a few months earlier. I could easily see the many attractive features I might want to adopt from various blogs I visited. My aspirations and expectations were to quickly learn how to adapt many of them for use on my own blog, but that was not as simple as I thought.

Primarily the difficulty for me was needing much more concentrated time than I had to devote to the different tasks. My expectation of coming to my computer for fifteen to twenty minute blocks daily or focusing an hour or two on acquiring more technical knowledge was not a realistic approach that worked for me. Given the events during that life period, I also had need for self-indulgent time which could waffle between extreme activity and doing nothing.

My reality was that I became what some might consider addicted to writing, of every kind. The fascination of connecting with all these interesting bloggers I had never personally met who were scattered about every U.S. State and around the world caught my attention. I enjoyed commenting on their blogs, and exchanging lengthy incredibly frequent emails with some. I can best describe my activities then, as I have before, that I was like a squirrel running madly round and round on a perpetual nonstop rotating wheel. Time to learn many technical skills could not fit into that regimen, much less allow me many instances to explore the rest of the Internet.

My periodic part time work in health care as a Speech-Language Pathologist demanded some preparation time. Though I was no longer providing inpatient and outpatient therapy in acute care hospitals, or a local rehabilitation hospital, the retirement community settings I primarily was serving could become very busy with complex therapeutic patient needs. In addition to their speech, language, voice, hearing, visual and cognitive problems, I was continuing to encounter many individuals with a wide range of eating/drinking/swallowing difficulties.

My husband's pre-mature death some five months before I started my blog was a major life adjustment for me that absorbed time in multiple ways, becoming much more complicated than I could ever have imagined. We had shared much but each of us had acquired our own niche of responsibilities that we pretty much left to one another. After his death I gradually began to encounter much he had routinely handled, for which I had then to assume responsibility. He had remarkably left information and records I found that were of great aid. There were also a multitude of "little things" of major proportion I had to ferret out on my own that erratically, but perpetually, surfaced when I least expected.

I've not recorded all my specific life ups and downs in writings over these past three years, but a glance at the archive postings frequency from one month to the next reveals a wide variation in blog post numbers. The reasons for this vary, but here are a few influencing factors. Sometimes the numbers reflect my emotional state. Other times they show how I self-imposed set publishing demands, and how, occasionally, I became disenchanted with my perceived blogging obligation, so I stopped writing.
Some other instances correlate with social activities, trips I've taken away from home, or when I've had visitors.

I have been genuinely interested in the topics about which I have written. Following that criteria I can always count on at least one reader, me, the person for whom I initially stated this blog was being written. Once again I have surprised myself with the realization as to how much I value all of you who come to read my words. You have proven over and over again what I've always believed. As much as we are all different in many ways, we are also very much the same in so many other ways. Our differences are what make life interesting for me. Our sameness is what causes me to feel a deep sense of belonging to others, such an important component for mind, body and spiritual health. Thanks to each of you for being you and sharing some of yourselves with me.

Communication Challenges

Locked-In Syndrome

"Diving Bell and the Butterfly"
Movie Theater Release - 11/30/07

Health Care System Weaknesses


Imagine what life would be like if we were unable to talk, make sounds, gesture with our hands, but we hear, see and understand people. We know what is happening to us, perceive circumstances and activities around us. Basically, we're just "locked-in" our mind, without voice, presumed to be unable to communicate and maybe thought of as a mental vegetable.

This sudden circumstance presents the communication challenge which has faced a New Jersey, U.S.A. husband and father, Steve Chiappa, since 2001
and a New Zealand Rugby player, Nick Chisholm, since 2000.

The National Institute of Neurological Disorders and Stroke
describes this Locked-in Syndrome as "...a rare neurological disorder characterized by complete paralysis of voluntary muscles in all parts of the body except for those that control eye movement. It may result from traumatic brain injury, diseases of the circulatory system, diseases that destroy the myelin sheath surrounding nerve cells, or medication overdose. Individuals with locked-in syndrome are conscious and can think and reason, but are unable to speak or move. The disorder leaves individuals completely mute and paralyzed. Communication may be possible with blinking eye movements..."

You can refer to The Association for Locked-In Syndrome - French which is written in English, too, for additional information.
This locked-in syndrome is also the focus of a book I read shortly after publication years ago. It's written by a man who actually lived the experience which he describes in The Diving Bell and the Butterfly, also known as "Le Scaphandre et le Papillon."

The years since my reading, I've followed the evolution of the book to film. Finally this true story is scheduled to be released into motion picture theaters November 30, 2007.

I experience trepidation about viewing any movie based on a book I view as exceptionally unique in writing and content as I do this one. All too often there is little resemblance between the book and film. I hope this film's translation depicts the author's experience realistically, effectively describes the arduous, tedious acquisition of his communication skills, though he was unable to speak or gesture, and conveys the narrative power of his words.

Australia's Radio National host Robyn Williams, a science journalist, on his broadcast transcript of "ockham's razor"
says "'The Diving Bell and the Butterfly' must be one of the most extraordinary books ever written - if written is the right word. Jean-Dominique Bauby was trapped in his paralysed body - the diving bell - in which his mind flew like a butterfly. He was locked in." (Italics and bold print added)

From the book cover:
"In 1995, Jean-Dominique Bauby was the editor-in-chief of French Elle, the father of two young childen, a 44-year-old man known and loved for his wit, his style, and his impassioned approach to life. By the end of the year he was also the victim of a rare kind of stroke to the brainstem. After 20 days in a coma, Bauby awoke into a body which had all but stopped working: only his left eye functioned, allowing him to see and, by blinking it, to make clear that his mind was unimpaired. Almost miraculously, he was soon able to express himself in the richest detail: dictating a word at a time, blinking to select each letter as the alphabet was recited to him slowly, over and over again. In the same way, he was able eventually to compose this extraordinary book.

"By turns wistful, mischievous, angry, and witty, Bauby bears witness to his determination to live as fully in his mind as he had been able to do in his body. He explains the joy, and deep sadness, of seeing his children and of hearing his aged father's voice on the phone. In magical sequences, he imagines traveling to other places and times and of lying next to the woman he loves. Fed only intravenously, he imagines preparing and tasting the full flavor of delectable dishes. Again and again he returns to an "inexhaustible reservoir of sensations," keeping in touch with himself and the life around him.

"Jean-Dominique Bauby died two days after the French publication of The Diving Bell and the Butterfly. This book is a lasting testament to his life."

An extract of the book is provided with this link.

Assoc. Prof. Roger Rees, Director, Institute for the Study of Learning Difficulties, Flinders University of South Australia, Adelaide is quoted in the Robyn Williams broadcast transcript noted above, reading this excerpt from Bauby's writing:

"I am fading away, slowly, but surely. Like the sailor who watches his home shore gradually disappear, I watch my past recede. My own life still burns within me, but more of it is reduced to the ashes of memory. Since taking up life in my cocoon, I have made two brief trips to the world of Paris medicine to hear the verdict pronounced on me from medical heights. I shed a few tears as we passed the corner cafe where I used to drop in for a bite. I can weep discreetly, yet the professionals think my eye is watering."

Rees also asks a question we might ask: how many people are there in hospital beds who receive no stimulation, are not recognized as individuals with intact minds, who might still be able to contribute if only their talents were recognized?

Here is a link to an extensive account of then 23 year old New Zealand rugby player, Nick Chisholm's experience in 2000 with locked-in syndrome. His journey, living with the syndrome is described in much more detail along with ethical issues involved.

Steve Chiappa describes on his web site being able to fight his way back into the communicating world having been given a Locked-In Syndrome diagnosis, due largely to the efforts of his family as he reports on his web site.

This New Jersey, U.S.A. husband and father of four grown children has written that at 52 years of age "On Christmas eve 2001 {I} received an early Christmas present, a severe brainstem stroke which left me with a condition known as Locked In Syndrome. At first I was completely unresponsive and unable to breathe on my own." He continues by describing becoming more alert, but he experienced a lack of recognition and acceptance by medical staff that a mentally functioning person resided in his body. What a nightmare of frustration that must have presented him as it would anyone.

Steve Chiappa states the reason for starting his web site is to provide information and hope for those who have received the locked-in syndrome diagnosis he received. Perhaps family, friends and loved ones searching the Internet for information will find him. He provides an email address for contact.

He also says:

"We often think that we are living in a society that provides the best, most advanced medical care available. Get ready for some pretty grim realities.

"Our healthcare system is ill-equipped to handle anything that requires long term treatment."

I know this to be all too true for individuals experiencing any of the large spectrum of communication problems and/or also cognitive deficits. Rehabilitation therapy services in all disciplines have been and continue to be reduced in our U.S. health care system. Most people are unaware of this situation until such time as they personally need the service(s) or have a friend or loved one who does.

Changes in our present health care system, or formulation of a new system, will require careful monitoring of any plan devised to insure further cuts are not surreptitiously incorporated in the final draft. Then there's the fine print that slides by unnoticed by most, as happened with Medicare Part B services some years ago.

Each of three therapy disciplines (Physical, Occupational, Speech) was intended to have a funding cap. The cap itself presents another whole issue relative to long term care needs of some. However, the final adopted criteria with the new limits deviated from the intended funding for each of the three disciplines to have separate caps. Instead, a shared cap between two of them was interpreted (Physical and Speech Therapy.) Efforts to correct this error and inequity have since been repeatedly rejected by legislators.

The fact of this disregard of original intent confirms to me that any health care system plan adopted, better be written carefully and exactly as intended before passage, as the likelihood of corrective adjustment afterword may be quite remote. Such fine print also needs to include the requirement for timely delivery of all medical services, as I have written about previously.

Assessment by a certified Speech-Language Pathologist is highly recommended for any infant, child or adult at any age for whom there is a communication problem, including those who have a locked-in syndrome diagnosis. In the U.S.A. contact the American Speech-Language-Hearing Association (ASHA) for referral to an ASHA certified professional. Solely in the interest of disclosure I should acknowledge this is my profession. All opinions and views expressed here are personal and my own.

Following are the links repeated from above:

Accounts of Individuals Living With Locked-In Syndrome
Steve Chiappa, New Jersey, U.S.A. Husband and Father
http://locked-in-syndrome.com/index.html

Nick Chisholm, New Zealand Rugby Player
http://www.bmj.com/cgi/content/full/331/7508/94

Book:
"The Diving Bell and the Butterfly" Amazon.com
http://www.amazon.com/Diving-Bell-Butterfly-Memoir-Death/dp/0375701214

Movie Theater Release 11/30/07
Web site: http://www.thedivingbellandthebutterfly-themovie.com/

Association for Locked-In Syndrome - French (also in English)
http://alis-asso.fr/ewb_pages/e/eng_alis.php

Elle Magazine
http://en.wikipedia.org/wiki/ELLE
http://www.elle.com/magazine/