Author: chaskemp

(Random thoughts and random photos.)

For many years my Mom invited a former neighbor for Christmas dinner. She was very old and for several reasons had not aged well. One year I went to her apartment in a retirement home to bring her to my Mom’s home. I was kind of standing around inside, waiting, and I saw an old-timey photograph of a beautiful young woman – one of those old kind of sepia, soft edges photos and she was so beautiful. I asked, “Effie, who was that?” “Oh honey,” she said. “That’s me.”

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When I was working in hospice I would approach my patients from the perspective of first, any pressing problems or issues and second, as more than the person lying there in bed, so sick, dying. I would think of my patients as people with a lifetime of experiences – a little girl in first grade; a teenager, falling in love; a young man going off to war; a wife, a husband, a parent, a grandparent, a widow; someone who knew happiness, disappointment, love, loss, grief, just all the fullness and experiences of our lives. And then kind of loop that around to include in the now.

Sing our songs. We all want to sing our songs.

Given some openings and the ability, people would talk about their lives, how they met their spouse, their courtship, their children, their regrets, their hopes, their dreams realized and unrealized. Sometimes even their hopes for their (very short) future. Oh, I’ve heard some love stories!

What do people hope for at the end of life? First and foremost, people hope to be healed – and when there is no hope to heal the body, they/we hope for our hearts to be healed. For relationships to be healed. To be with loved ones. Sometimes there are words unspoken that need to be spoken. And it’s not always words of love and not always words of forgiveness. Because healing requires the truth – good and bad – the truth. We want to sing our song of our life.

And in the end, we can forgive ourselves.

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Someone Jean had been in a relationship with long ago died last week. Fell down dead. Like Jean’s husband had. It hit her pretty hard. What a time of life this is! We’re all pretty much at the edge. Let’s enjoy it while we can.

Here’s to our youth, our hopes and dreams, and to our future.

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Leslie and I were in a car with some other people, pretty crowded, on about a one hour drive. For no apparent reason she was being hostile toward a man in the car. He wasn’t someone I particularly cared for, but I thought she was being a little extreme, putting the Evil Eye on him, truly. Later I asked her what was going on and she told me she didn’t like the man. I asked her if she had to be so overt. I remember that she just looked at me.

Some years later I learned that that man had repeatedly molested someone I knew when she was a little girl. I learned it from the person he had molested. Leslie did not know about this – but she knew something and it wasn’t good.

He broke the little girl. She was broken her entire life. You broke her, God-damn you.

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Through Facebook I’m in touch with a high school friend, Tim. We played golf together, went to the same parties, dated two girls (Claire and Martha) together from another school, and after high school we both went into the Marine Corps. The last time we talked we discovered that we had each had a spiritual awakening and had both ended up doing related work – he in substance abuse counseling and I in nursing.

And now Tim is posting photos of the Florida beach/ocean where he lives and I’m posting photos of the San Francisco Bay where I live – sunrises and sunsets coast to coast.

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What a fierce time of life this is. To some, we probably look like just more old people. That’s what we are, except no just to it. We loved, we love, we fought in wars, we stopped wars, we danced beneath the diamond sky, we were/we are beautiful, we were/we are hot, we created/we create, we took risks, we grieved; and we’re in challenging places and times. We’re close to death or worse. No one gets out alive. See us love, see us touching,

see us slow-walking across the street, see us in our beauty at the end of life.

Van Morrison: And we’ll walk down the Avenue again; And we’ll walk down the avenue and we’ll smile; And we’ll say, “Baby, ain’t it all worthwhile.”

Proverbs 31:25:

She is clothed with strength and dignity,
and she laughs without fear of the future.

It has been a remarkable few weeks: LaHonda/Santa Cruz Mountains, Mendocino, Orr Hot Springs, Bolinas, Berkeley, and now Big Sur…

Big Sur: Highway 1 follows the coast, past Santa Cruz, past Monterey, past Carmel-by-the-Sea, into the whole of Big Sur, past where David’s ashes were placed at Esalen, past where we cried as we first drove this road together three years ago, where the mighty Pacific Ocean stretches across 1000s of miles to Asia, turn off on an unmarked road, through a gate and follow a dirt road into a canyon in the Ventana Wilderness and in a few miles a pull-off. We park and walk across a wood foot-bridge up a path to a traditional wood Haida cabin on a knoll in the redwoods and here are the people we’ll spend the next few days with.

Hang out at the table cut many years ago from a huge redwood, then walk down the hill and carry our things along a narrow rocky path beside the rushing water and tiny orchids growing alongside the path and into the clearing where our sleeping platform awaits. We set up our bed – pads, air mattress, sleeping bag with sheet and fleece inside, pillows (Oh, we’ll sleep in style). All under the stars, eight paces from the river.

There is no electricity and no wifi – it’s a digital cleanse for us with no electronically transmitted information, music, or anything else as long as we’re here. But there is hot water and up the hill a white ceramic throne waits among the trees.

Time standing still. Talking, art, life, cherries, wine, cheese, herb, the wind in the trees and sometimes sunlight filtering through and high above we can see the fog moving in. In an incredible happenstance, one of our hosts, Steve was in Vietnam at almost exactly the same place and time as I… along la Rue Sans Joie (the Street Without Joy – named by French Legionnaires), where Bernard Fall was killed in 1967, where many from both sides died, and now here we are in this redwood forest. Everyone here has lost a loved one – parent at a young age or spouse. We don’t talk much of

the pain, but those who passed on are very much with us.

A family gathering in the glade where the dining table sits (thank you for including us!), a teacher, a healer, an artist, an environmentalist, a gardener, a grower, a calm center, a child, a black lab. Then to a campfire, cobbler, s’mores, then slowly along the rocky path to our bed.

The first night we slept soooo well, so warm, tangled up in soft and love and in the morning I walked up the hill and made coffee for Jean and me and Susan was there, making coffee for Steve and herself. Our joyful job. Back down the hill with coffee to the bed, talking, seeing, hearing, feeling. We talked of places so good for sleeping. For me, this place, the Temple, home on Reiger, my campsite at timberline in Maroon Bells going in to the Four Pass Loop, Dragon Hostel in Hong Kong, Big Bend in a sleet storm, Ana Lisa Hedstrom’s studio on a cold, rainy night.

Breakfast was the usual fruit and yogurt and bread, coffee, talking. Steve’s family left, so it was just four of us. We walked ¼ mile up a path to the “common cabin” (shared with two other families, neither of whom were there) and Jean showered while Susan and I walked along an old trail deeper into the forest where redwood sorrel was like soft green cushions

growing out of 1000 year old mulch. The forest was still, beautiful, and Susan is a quiet, careful walker. We talked of beauty and life. After we walked I stayed behind at the common cabin and showered…

——————

Sing the first three lines with me:

I’ve got a feeling
A feeling deep inside
Oh yeah

He walked on the soft ground around to the front of the cabin and stood naked on the deck, lifting up his arms and soul to the redwoods to the sky to the fog to the sun to the river running by. Give thanks.

Sorrowing for his country, for the moral collapse of what was once humanity’s greatest hope.

Where now lies are virtue and Jesus is whored out to the gods of greed.

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A still afternoon, easy, comfortable. Dinner, campfire. Back along the rocky path to our sleeping bag. And in a perfect summary of our life together, Jean woke me up about 3 am and said, “It’s getting wet” – the fog so heavy and right here we could actually feel the tiny droplets of water kind of stinging our faces. Pull the ground cover tarp up over us and burrow down deeper in the sleeping bag. Warm, dry, except a little damp around our heads. Friends, it truly doesn’t get any better.

In the morning we all packed up and headed out – Steve and Susan to the beautiful valley and home where they live and Jean and I to the magic of Berkeley. Along the way we stopped at Nepenthe, high above the Pacific, then on to the Promise of Berkeley and our happy home.

As I write, this text comes in from Jean: “Stuck in traffic. Big demonstration/anti-Trump kids in cages protest.” The Promise of Berkeley!

Agape is the Christian concept of selfless, unconditional love. It is a three syllable word pronounced ah-GAH-peh. The Agape Clinic manifested the reality of that love beginning in the early 1980s. Photo: outreach in a community garden

From 1983-2000 I was running a “Community Care” health program (not connected to Agape) that included district health services in a refugee community and barrio, primary care provided by volunteer physicians in a police “storefront” and a church, and immunizations through the county health department. District health originated in the UK and to us basically meant that we took responsibility for the health of people is a defined “district” in Old East Dallas. This was under the aegis of first, Texas Woman’s University and later Baylor University School of Nursing and through cooperative relationships with other organizations such as Parkland Hospital, East Dallas Health Center, Dallas Police Department, Church Health Ministries, and other organizations. The students were central to providing all aspects of community and family and individual care. Semester after semester they did a brilliant job in the hard work of delivering quality health care and practicing loving kindness, justice and mercy in the slums.

Leslie Kemp started working with the students and me around 1995. Her role initially was social work and organizing the business aspects of our efforts. Photo: With Megan and Joe – outstanding students

A series of circumstances led to us losing our clinic space in the fall of 2000, so in effect we were “homeless.” I talked to Dale McEowen, one of the people involved with the Agape Clinic, about sharing Agape’s space in Grace United Methodist Church. The following was written shortly after the conversation with Dale:

Dale said, “I’ve suggested several times that you come over here.” I said, “I believe you – I never heard it or I just wasn’t ready.” I remember we had all our medicine in 2-3 drawers of the big brown filing cabinet and when I told Bobbie (the clinic founder and medical director) that we’d keep ours in there she said, “no, just put it in with ours.” They had 100s of times more medications than we, so it was an extraordinarily generous thing for her to say. As he had done several times before, Martin Hironaga helped move the clinic.

When we moved into Agape I felt like we’d come home.

When we started at Agape, the clinic was open one day/week on Saturdays for primary medical care and childhood immunizations. At first our presence added a second day of services and outreach and follow-up to care. Later, we were able to further expand services. For the students and me the association with Agape meant that we had a home with far more resources and an opportunity to serve more people in more ways than previously. Photo left: patients waiting to get in to the clinic.

There was good energy/ synergy between the original Agape Clinic people and the new people and resources. I started writing grant proposals – later, Leslie wrote proposals and hosted foundation visitors – and the clinic received funding from a number of foundations (Communities, Clements, Aetna, Bob Smith, First Presbyterian, Dallas Women’s Foundation, AMA Foundation, Lakewood Service League, and others), as well as churches (notably Highland Park United Methodist and First Presbyterian), and individuals. Through this wonderful energy the Agape Clinic evolved into a comprehensive community health provider with four days of services each week provided by volunteers, paid staff, and students. Services included:

• Primary care for acute illness provided by physicians, nurse practitioners, and medical and NP students (the foundational care from the beginning of Agape). Photo: in the pharmacy (volunteer RN/former student, nurse practitioner, physician)
• Specialty care, including psychiatry, dermatology, gynecology, pediatrics, and asthma and immunology also provided by physicians and nurse practitioners with expertise in their respective fields.
• Treatment, teaching, and follow-up for patients with chronic illness delivered as above except teaching and follow-up were through nursing students. Among community clinics in the North Texas area, care for patients with chronic illness was unique to Agape and the follow-up (home visits for assessment and teaching) was unique among community clinics everywhere.
• Medicine provided in-house through donations, samples, and from Blessings International, a missions supply group.
• Social work provided by the Agape social worker (Leslie), promotoras (lay health promoters, primarily Lupe Springer and Nora Avila), Diane from UTA, and students in social work and nursing.
• Spiritual care given by volunteer clergy, Common Grace Ministries, promotoras, and students.
• Community education provided by nursing and social work students in cooperation with promotoras.
• Health screening delivered on a daily basis in the clinic by students,and in health screening events supported by the Komen Foundation, Parkland, Dallas County Health Department, DISD, and other organizations.
• Vaccinations were for many years available on Saturdays in the Dallas area only at Agape through the work of Betty Lou Gary and her volunteer crew. Weekday vaccinations were provided by the County Health Department and students. Photo above: volunteer helping a patient with hospital bill. Photo below: The door into the exam room area. Larry, a massage therapist giving massage to a patient. He came every week.
• Special projects such as Creaciones de Fe (Creations of Faith, a support and community education group for Latin women) and the Jonathan’s Place effort, in which we provided intake physical exams and treatment of illnesses for children who had been removed from their families and placed in a shelter for abused and neglected children. Creaciones ran about five years under the guidance of Lupe and the Jonathan’s Place effort lasted about 1½ years (average ~7 children/week).
• Immigrant health was foundational at Agape and was expanded to include refugee communities, including Middle Eastern (especially Kurds), East African, Burmese, Cambodian, and others. The Dallas County Health Department, Parkland, Baylor, and UT Arlington were central to refugee health at Agape.
• Service learning site with students from Baylor, UTSW Medical School, UTA. TWU, and others.

Paid staff included a clinic director, promotoras, and nurse practitioners. We were seriously services-oriented, strong on fundraising, and light on administration. Photo: exam.

Leslie Kemp was the original clinic social worker. Her philosophy of care was to always solve the problem and never simply refer patients elsewhere. She made home visits as needed and she also ran the front desk, inviting each person who came into the clinic to sit down next to her (vs. the patient standing in front of her desk or sitting across the desk) as she completed intake/registration, and identified problems that were not readily apparent. She always had 1-2 students working with her/learning from her in the clinic. As time passed she took on more administrative work and eventually began working as clinic director. The director position was a sacrifice for Leslie as she far preferred working directly with patients and families. She began working with foundations and writing grant proposals along with administrative work and still seeing patients. When Leslie left the clinic she left behind a lean services-oriented organization in which everyone saw patients. We had an excellent reputation in the community (among healthcare providers, foundations, other organizations, and patients and families) and a large funding surplus. Photo: Leslie on the phone, with Maria and Luvia, the translator and her baby, the patient, and in the foreground Roxanne and Lupe.

At Agape we served the uninsured, the working poor, the people who process the chicken we eat, who mow our lawns, who clean our offices and hospital rooms – we served the people who cannot get Medicaid, who cannot access services at Parkland or Project Access or Homes or anywhere else. That service is our expression of the highest love we can be – Agape.

Afterward

Reflecting on the above, one thing that stands out is the collective nature of our work. I remember Meg Kaufman, the clinic psychiatrist saying something about “this collective” and I said, yeah, that’s right. We had so many volunteers and partners, each one doing their thing toward the common good.

How did this happen? Agape was a place (and a state of mind) in which people could spread their wings. This was due, first and foremost to Bobbie Baxter, the founder and Medical Director. She did quality work and was willing for others who did quality work to spread their wings. I was the same way. So was Leslie. We were unafraid; we were True Believers.

And, everything we did, we did for patients and community. And we knew what we were doing. And we abhorred meetings. As a consequence, people wanted to work there as volunteers, students, and community partners.

Following The Dream.

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Volunteers included high school students, lay people from the community, college students, retirees (including WWII vets!), doctors, nurses, social workers, former patients, chaplains, and others.

Community partners I can think of are Jonathan’s Place, DISD, Dallas Police, Common Grace Ministries, Baylor University, University of Texas, Texas Woman’s University, UT Southwestern Medical School, Dallas Concilio, Highland Park UMC, HPUMC Cornerstone Congregation, Grace UMC, First Presbyterian, Dallas Women’s Foundation, Dallas County Medical Society, LabCorps, SMU, Dallas Theological Seminary, Dallas County Health Department, Parkland Hospital, and quite a few foundations and individual donors.

All working cooperatively, collectively to heal the sick.

The photographs are all (except for one) from modern-day Vietnam. I took them on trips 2005-2015. My sense is that now most everybody there is looking forward, not back. At times, while I was in-country in 1966-67 I would think how the people there surely just wanted to live their lives – grow some food, fall in love, make babies – just living.

Vietnam is a beautiful country.

This post is a partial answer to the old psychotherapy question: what do you do when you feel anxious? One thing I do is to write. I write at other times as well, of course. This post is a monument to spending most of the day in the waiting room of the Kaiser Cardiac Procedures Unit. Everything turned out well, but you know, these places are worry-worthy.

The Bells of Hell was an English WWI ditty – the irony of doomed youth.

The Bells of Hell go ting-a-ling-a-ling
For thee but not for me:
For me the angels sing-a-ling-a-ling,
They’ve got the goods for me.
Oh! Death, where is thy sting-a-ling-a-ling?
Oh! Grave, thy victory?

The Bells of Hell go ting-a-ling-a-ling
For thee but not for me.

Weird shit

Paint it Black: For my last 5-6 months in Vietnam

(out of 13 months and two days in-country) I was assigned to a “psychological operations” (psyops) unit. Psyops was a US Army unit with Marines like me assigned to work in it so that the Marine units could relate to what the psyops team was doing. My job was to go on operations with Marine Corps units, mostly at theDMZ. The team was one Marine, one soldier, and one Vietnamese translator. We carried big speakers, power units, and a tape player.

The idea was that when a unit dug in for the night, we would play Buddhist funeral music, Vietnamese songs

of love and nostalgia, and tapes exhorting the other guys (usually North Vietnamese Army units) to give up. The translator would also talk to the NVA over the loud-speakers, telling them their cause was hopeless, they were all going to die, their families were so sad, so on and so forth. Come to us. You’ll be greeted with open arms – Chieu Hoi, or something like that.

We would set up the speakers in trees in front of where the troops were dug in and crawl back to the line and start

the noise. The officers and NCOs hated us as they were busy leading men in war; the troops didn’t think too highly of us either as we often drew fire. But the troops enjoyed the end of the show when we played music from the Got Live Rolling Stones album – Paint it Black or Have You Seen Your Mother, Baby Standing in the Shadows and so on. Of course this drove the officers and staff NCOs crazy(er). They weren’t ready for a rock n’ roll war.

I would always hook up with a machine gun team somewhere on the line, because guns were what I knew. I would dig in with them and stand a watch if they wanted me to (Haha, though nobody ever stood up on those watches). The gun teams were always glad to see me –at least after all the noise stopped.

Lang Vei. Once we were sent to a Special Forces A-Team camp, called Lang Vei. There were 15-20 Americans there and several hundred Bru tribes-people. They had a groovy little dug-out with a couple of tables and chairs and a generator and fan(!) and refrigerator with cokes and beer in it. I was sitting in there and in walks an older white woman! She introduced herself – Martha Ray was her name. We talked and then someone came and took her somewhere else. Surreal.

I slept in a supply bunker and rats were everywhere, including from time to time running across my body.

There were a couple of prisoners in the camp, in barbed wire enclosures in the sun like coffins so small they couldn’t sit up.

I went on a patrol with the Special Forces troops. They made me really nervous with all their cluster-fucking short intervals.

I was glad to get out of that place. They were overrun a year or so later, with the NVA bringing tanks to the party.

Phu Bai. One of the good parts of the job was that I was free to travel in the area of operations, known as I-Corps in northern southern Vietnam. I-Corps was where – by far – most of the fighting took place. Phu Bai was an airfield and Marine base near Hue. For a month or so my old unit, 1/26 (1^st Battalion, 26^th Marine Regiment) was stationed at Phu Bai before being sent to Khe Sanh. I went there to visit my mate, Jeff. He was staying in a large squad-size tent for 10-12 men. We got pretty drunk and decided to cook up some C-rations. One of the sergeants in the tent wanted us to be quiet and he and Jeff got into a fight. In the midst of the disturbance the sergeant stepped on the blob of plastique (C-4 explosive) we were using to heat the food. The burning C-4 stuck to the bottom of his foot, so not only was he beaten down by Jeff, but sustained a bad burn on his foot. 1/26 was sent to Khe Sanh a day or so later, so nothing ever came of it.

Gio Linh. I went to Gio Linh, one of several fire bases at the DMZ. That was the first time I was on the receiving end of heavy artillery. It’s not like in a movie. The rounds come screaming in unimaginably fast (like maybe half a second) and when they explode it’s a huge metallic bang. No booms in this deal. There’s nothing you can do in a static situation like this. In a battle at least you can keep moving. Marines don’t like to sit in a trench or fighting pit (Marines dig fighting pits; a foxhole is what’s underneath a foxes’ tail).

The Hill Fights. From Gio Linh I caught a chopper to somewhere at the DMZ for something called the Hill Fights – a running large unit battle involving I guess 1000s of men in the Con Thien area. That deal was truly balls-to-the-wall. I describe the Hill Fights elsewhere:

http://ckjournal.com/vn-66-67-part-3-psyops-and-the-hill-fights (Looking at this link, I realize I’ve told a couple of stories in this post before. Oh well.)

One late afternoon I came in to a unit that was set up somewhere in a low-lying misty, wooded area after a big fight. It was dark by the time I got to the command post. The CO or someone told me to get out and keep quiet. There were some Marines sleeping nearby, wrapped in ponchos so I just laid down with them and went to sleep. In the morning I realized the men I thought were asleep were all dead.

I needed something to eat so went through a couple of their packs and got some C-rations. I was eating a cinnamon roll when some other men started carrying the bodies to some tracked vehicles, each with four 20mm cannons – “quad-20s.” I was helping load the bodies (bodies are so heavy) and the cinnamon roll was in my mouth and when we lifted one of the bodies my arms were over my head and the black bloody water ran down my arm and down my side. So much for the cinnamon roll.

The Heavyweight Champion of the World. I was in the hospital at Dong Ha for what we called jungle rot (ulcer on my hip from .45 holster rubbing, feet all swollen up, crotch inflamed). No air conditioning or even fans in that place. I was half asleep in a sweaty daze when someone woke me up. There was a kindly-looking middle-aged man standing there. He said something like, “Hi. I’m Floyd Patterson, Heavyweight Champion of the World.” And that’s who he was!

Danang. The psyops unit was stationed in Danang and the troops were billeted in an old French hotel. I went there once a month for a few days to get paid. The room I stayed in was where transients like myself stayed. Just a tall-ceiling bare room with 3 or 4 racks for sleeping. I would come in, dump my muddy, dirty gear against a wall, take a shower, clean my weapon, and sleep, sleep, sleep with a ceiling fan clicking along and nobody shooting at me. Pretty fucking nice!

Once I went to a big base in Danang – I have no idea why – and at the entrance one of the MPs took my magazine out of the rifle I was carrying. I recall that he was surprised that there was a round in the chamber. I didn’t like having an unloaded weapon and as soon as I was inside the base, reloaded.

On that base I asked someone where a pisser was. He didn’t know what a pisser was. I explained something like, “You know, a piss tube.” He thought I was a crazy man + I couldn’t have smelled very good. Fuckers walking around saluting, no weapons or weapons unloaded, no pissers, eating hot chow, all clean and shaved, REMFs, every goddamned one of them. I couldn’t wait to get out of that place and back to that hotel for a few days of carousing before going back to the war.

Weapons. When I was with my infantry unit (C Company, 1^st Battalion, 26^th Marine Regiment), I always carried my M-60 machine gun. I got to be a squad leader, but continued to carry the Big Gun. They wanted me to quit and do squad leader stuff, but I wouldn’t and when the Gunny or Lt. confronted me I would just say, okay, and then as soon as we were out of sight, I’d take the gun back from whoever I’d pretended I was giving it to.

Gunners also carry a .45, which, in the civilian world is a big handgun, but in a war, hardly signifies. I sold my .45 to another Marine, who sent it to his criminal brother back in The World. I got another .45 off a body. I don’t remember what happened to that one.

I seldom carried grenades or a K-bar, because I always carried extra ammo for the gun and didn’t need anymore weight. Machine guns are all about maximum firepower – fire superiority it was called. By the time I cranked off the first 200 rounds, someone would be there with another 200. Pretty soon that fucking barrel would be smoking – too hot to touch.

When I went to the psyops unit I carried an M-14 with a nice sniper’s bipod. It was a very accurate weapon. I carried a shotgun on one

or two patrols, but it was an awkward thing and good only for close-in work, which wasn’t happening, thankfully.

Before psyops. After operations down south and then up at the DMZ, we realized we really were doomed youth. And it was like, oh well, fuck it. It was like one of the Foreign Legion commanders said to his troops at Dien Bien Phu: “You’re here to die.” (What an asshole. They should have fragged him right there.) Few of us sought or tempted death and few of us shrunk from it. Like I said, weird shit.

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Jean is still in the back at Cardiac Procedures. We got here at 0630 and it’s now 1230. There’s just one other family member left here now. Just sitting here. Suspended. Looking up every time a door opens. Getting hungry. Afraid to leave and good luck eating, anyway. Calling up old Bob Seger on my iPhone jukebox. Receptionist just told the other person waiting, “”They’ll be out to talk with you in a minute.”

1:30. Finished. Haven’t seen Jean yet, but procedure done and she’s in rhythm.

At Peace

I’ve written many thousands of words in this blog, but this is only the second time I’ve discussed/reviewed AND strongly recommended a book here. Rather than try to write a coherent document, I’ll just offer quotes and comments on some of the important concepts in this important book and some of my own thoughts.

At Peace: Choosing a Good Death After a Long Life is a book for our times – for those of us who are living a long life and for those who are connected to loved ones who are at the end of life. Because, you know, we are all going to die. The only questions are when and how and who will be in control?

Are you one who would fight to the end? Be wary. To be clear: I am talking about older people with few physical reserves and no prospect of a long, independent life. For a young person, with physical reserves and the possibility of a long, independent life, fight on.

To every thing there is a season,
and a time to every purpose under the heaven:
A time to be born, a time to die;
a time to plant, and a time to pluck up that which is planted;
A time to kill, and a time to heal;
a time to break down, and a time to build up;
A time to weep, and a time to laugh;
a time to mourn, and a time to dance;
A time to cast away stones, and a time to gather stones together;
a time to embrace, and a time to refrain from embracing;
A time to get, and a time to lose;
a time to keep, and a time to cast away;
A time to rend, and a time to sew;
a time to keep silence, and a time to speak;
A time to love, and a time to hate;
A time of war, and a time of peace.

At Peace guides readers to the death they would choose (as much as death can be chosen), which, generally speaking would be in as much control as possible, at home, with loved ones, free of pain and other distressing physical issues, with dignity, and so on.

Hospice is NOT for the final few days of one’s life; to be most helpful and effective, hospice is best initiated when there are months of life left and problems are lesser rather than days or weeks left and after problems are severe. So much better to prevent problems.

Visualize the quality of your final days. 

Planning on dying peacefully in one’s sleep isn’t much of a plan because that’s not usually the way it goes – unless one counts coma at the end of life as sleeping.

The cure for what ails us is not just around the corner.

The facts of CPR are that “the overall success rate… is 8-18%… and among the old and infirm (success) ranges from 0-8%” (p. 257; reported in the New England Journal of Medicine).

“…once intensive medical treatment is initiated, its momentum and outcomes are largely out of your control, and declining such treatment puts you back in charge” (p. xvii).

A person who reaches age 65 in “reasonable health” can expect to live almost 20 more years, almost half of which are “likely to be disabled years” (p. 33). How do we know when we are shifting from aging to disabled? When we need help cooking and cleaning? Toileting? When we fall and can’t get up? These are “milestones from which there is no turning back” (p. 43).

We already know these things are true – that it’s easy to be treated past rational hope and so spend the last months of life being tested, treated and in a hospital or nursing home. It seems like we often just kind of push reality out of mind because, you know, some pretty horrible things can and do happen and it may seem easier to not think about them except in general hypothetical terms AND, there’s that hope thing.

“Understand that with age the risk of treatment increases and the benefit decreases” (p. 48).

Medicalization as a means of “buying time” – what kind of time will it be and where will that time be spent? In the absence of some specific time goal (birth of a grandchild), the idea is to improve the quality of life in whatever time remains.

Dementia: At Peace offers a clause for progressive dementia in an Advanced Directive. I believe this alone is worth the price of the book. Some among us will have Alzheimer’s. It’s comforting that caregivers will know exactly when to discontinue all but palliative medications, when to discontinue doctor visits, lab tests, and so on – with the end goal being an early and natural death and less time in a demented state.

Terminal dehydration is a good option in “creating a good death because it requires a combination of disease, debility, and willful intention to institute” (p. 198).

“The paradigm shift we need is not a technical one; it is spiritual, emotional, or intellectual. We do not need encouragement to believe in miracles. We need to understand there will not be an endless series of miracles” (p. 215).

Visualize the quality of your final days.”…having no plan and no limits practically guarantees excessive treatment and increases the risks of a hospitalized death” (p. 48).

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Some tools

Who matters the most, what matters the most, I matter too (life review, wishes, goals). This is similar to part of what we did in hospice training and other venues. https://med.stanford.edu/letter.html

“The Conversation” https://theconversationproject.org/

Memorial Sloan-Kettering prognosis tool for some types and stages of cancer. https://www.mskcc.org/nomograms “On average, the most likely thing will happen” (p. 156).

UCSF risk/benefit tool. https://eprognosis.ucsf.edu/

National Hospice and Palliative Organization. http://www.caringinfo.org/

Formerly the Hemlock Society. https://compassionandchoices.org/

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“This getting old is getting old.” Fred Kling

It’s been four years. These words are from that time.

Dying is often not easy. These were hard times for Leslie. She underwent profound changes starting at almost exactly 6pm that last (Thursday) night. She went to surgery about 1:30am Friday morning and she passed away back in her room surrounded by pure love about 4:30am. (I’m actually not clear on times, and maybe even days.) I was with her, embracing her, whispering words of love, of remembrance, people she loved, people who loved her, the Song of Ruth…

How momentous it was that I held you as you passed from this earth, this life. Life! I was beside you, embracing you, caressing you, whispering of love and your beauty. How I trembled, knowing what was to come. And then I was calm, I was sorrowful, I was in love. I was strong. I was pure.

You can relax now
Come on and close your eyes
Breathe deeply
I am with you
Oh my sweet, sweet wife.

At every turn I see how incredibly fortunate, how blessed I’ve been with your presence – your love – in my life all these many years.

And at the end, to hold you and whisper these things!

Yesterday was hard. I ran a lot of errands, including taking the wheelchair back to the medical supply place We were minorly ripped off for $50, but fuck it. I thought of how you became weaker and weaker, going from walking slowly but without assistance to needing a walker to needing a wheelchair… I drove by the house on Robin Road where you grew up, where we first kissed.

I got home around 1pm and thought I would take a nap. I was so emotionally and physically exhausted – I was weary as hell – that I lay down on the floor in the front room (I just couldn’t go any farther) and despite being cold, basically passed out.

You never believed me when so many times I told you how brave you are. You insisted that having fear meant not brave. I would say, “Hey man, I lived with some of the bravest men on earth. Being brave isn’t fearless; it’s going in despite the fear.”

To have known you through so many seasons of your beautiful life – from 16 to 70.

I say to myself, “I’m really alone.” Then David calls and I’m not alone. David: you have done/are doing exactly what you said you would do. Thank you.

 

 

In the morning, in bed, with our coffee we watched the sky – clouds grey/slate blue like deep ice and rain and fog below in the near distance over Marin and The Gate but clear above the clouds and here, then some white

and pink clouds at the upper margins, then larger white clouds and blue skies above. The door was open, the room cold, and the bed warm. We were talking of puppies, skies, clouds, love. We made love and when we opened our eyes to something other than one another we were in a light rain cloud and there was a rainbow! Now another! Double rainbow!

We had the usual breakfast of fruit, yogurt, toast, almond butter. I did some laundry, Jean went to Oakland, and I took the 7 bus to the west/downtown side of the UC campus. I walked across the beautiful campus, students everywhere, through Sather Gate into Sproul Plaza (where the Free Speech Movement was born), and now, listen to the music! There is a chorus by the gate, singing beautifully. What song, I don’t know, but I, along with others, was enchanted.

At the far edge of the Plaza, in a corner by the student union there is a piano (“A Gift from People’s Park”) and an older black man was playing… more beauty.

David and I had lunch at a Vietnamese restaurant on campus. He told me about some of his work and we talked about what’s happening in our lives, pho in Saigon, Flagging and the upcoming Mother’s Day event, travel plans, about he’s going faster and I’m continuing to slow down, about living dangerously.

After lunch, when I was walking back past the student union, there was a skateboarder playing the piano.

In the evening we went to Vanessa’s for a glass of wine, fish tacos, and our life together.

The extravagant beauty of today.

——————-

Indian Rock is a large rock outcropping in the Berkeley Hills. I’m guessing 60-80 feet high. There were steep steps cut into the less steep side of the rock long ago for people like us. The other sides of the rock have bouldering areas.

We walk to Indian Rock every few weeks, climb to the top and sit and look out on the San Francisco Bay, The City, Berkeley, Oakland, Marin… There are usually 5-20 people on top, and my enduring sense of Berkeley is leaning back on top of the rock, hearing the soft murmur of voices of people behind us, the sun going down over the bridge, maybe having a few sips of cherry cherry wine or a bowl, darkness falling, going down carefully in the dark, being in love. Oh!

I took this photo on Indian Rock the only time I’ve been when it wasn’t quiet. There were five or so punks smoking and playing something by the Ramones. Room enough for us all. Berkeley, what a place!

—————

(In Dallas) We went to North Park Mall. We stopped at a cookie vendor to get some water. While the person there was filling a cup, a customer asked me, “Are you Mr. Kemp?” “Yes.” She was a former student. We talked some about the clinical course in which we’d been together. After graduation she worked at Parkland L&D for seven years(!) and then consulting with families on obstetric matters. Yeah, that’s one of my students.

Later I told Jean that I thought one reason students took my clinical course was that they knew if they did well, I would write a good recommendation letter for critical care or emergency internships or labor and delivery at Parkland or Children’s. Some of the decision makers in those settings knew me and knew that students of mine were involved in challenging situations in my clinical course. It was a win-win-win deal: the students who were seeking the most challenging careers were working with me and doing their best to excel in my clinical setting (Agape Clinic) and receive one of the coveted internships and have the greatest possible impact on patients/families lives. About a year ago I was thinking, with pride, about the many students who passed through the Agape Clinic on their way to some of the most extreme healthcare environments in America.

—————-

We had dinner with someone who works at Children’s Medical Center in Dallas (CMC is a premier pediatric hospital). One of the things she does is help parents get oriented to clinics, which is a big deal in that setting. I’ve spent a lot of time at CMC and it has long seemed to me that they’re doing an extraordinary human mission in disease, hope, suffering, healing, science, greatness, and all that.

Big Love to all of you.

I thought about a time when Leslie and I were in the Cambodian refugee community seven days a week – desperate times for sure. Leslie did social services and women’s issues and I did health things. Along with health things, I drove through the neighborhood 1-2 times/day just to know what was happening at different times of the day. One morning I was driving on Carroll near San Jacinto and a woman was on the corner waving me down, holding her limp toddler. I pulled her into the truck and drove fast to Children’s Medical Center. When we got there we were somehow in a business office and a woman who worked there in an administrative job saw how sick the girl was and fast-tracked us through the back door of the ER. She was treated and admitted and then they did the business part. I never forgot that woman.

I’ve always thought that Parkland and Children’s are a nexus of humanity’s suffering and hope.

I would walk out of Parkland – sometimes in the evening, sometimes in the morning – and outside would be like entering a whole other reality than the intense realities of the medical center. In addition to many, many, many hours spent taking people to Parkland clinics and so on (and often going through the whole very lengthy process with them), I supervised students for several years in the psychiatric ER, the in-patient psychiatric unit, and the Mental Diagnostic Center. I was an undergraduate and graduate student at both Children’s and Parkland. I would walk out and become almost a part of the outside world, too.

——————

The very short story of Chili Boy

…he was ahead of us going through security and something in his carry-on triggered a further inspection by TSA. Our bags were also flagged, so there we all were, momentarily captured, waiting for TSA to screen us. Jean made some friendly remark to the man ahead of us (the soon-to-be Chili Boy), but he just looked at her, then looked away. The TSA person started going through the man’s luggage and pulled out two Tupperware type containers full of, you guessed it: chili. I don’t know what happened to Chili Boy after that because another TSA person started going through my stuff. “What’s this?” she asked, holding up a plastic bag. “Peppercorns. Some are from Hanoi and some from Saigon.” She’s holding the bag up, looking suspiciously at it. “And some are from Hue,” I added helpfully. “Hmmph.” She puts the peppercorns back in the suitcase and tells me I can go.

And that’s the end of the Chili Boy story, except to say, fuck off, mate.

—————-

Jeff and I started hanging out at weapons school in 1965. He was in rockets (like bazookas) and I was in machine guns. After weapons, we went to a holding company at Camp Pendleton. From there we went to the newly (re)formed 26^th Marines. Our infantry company trained together as part of a battalion landing force. It was hard training for several months. Sometimes we’d have a few days off, but no money. We’d take up a collection to send someone to Oceanside, the nearest town to buy a few gallons of Red Mountain vin rose. “Not a great wine,” we’d say, “But a good wine.” We liked to sit on some concrete slabs fairly near our barracks and get prodigiously drunk. Jeff and I fought together in Vietnam. He helped me. He was wounded at Khe Sanh; I in the Hill Fights near Khe Sanh. We did it and we survived. After the war we lived together off and on in Dallas and Carson City. We loved Leslie. We were psychedelic together. We fell apart. Among other manifestations he followed the holy man path much of his life while I did the service scene in hospice and with refugees. We came back together. We went trekking in Texas, New Mexico, and Wyoming. He and David and I backpacked for two months in Southeast Asia. We went to psytrance festivals together – psychedelic again, after so many years! Rolling! Jeff stayed with me for a few days after Leslie passed and he spoke at Leslie’s memorial service…

And now here we are: Jeff, Jean, me. Jean has always reminded me of Jeff – quick minds, big minds, sometimes a little scary. He stayed two nights and like that line in Dylan’s Song for Woody…

“Here’s to the hearts and the hands of the men,
That come with the dust and are gone with the wind.”

He was gone when we got up.

If Jack Kerouac had not lost his integrity, he might have been like Jeff.