bearing blog

End of life care discussion.

Commenter and friend Derek pointed me to this story making the rounds today.

One look at Eileen Mulligan lying soberly on the exam table and Dr. John Marshall knew the time for the Big Talk had arrived.

He began gently. The chemotherapy is not helping. The cancer is advanced. There are no good options left to try. It would be good to look into hospice care.

"At first I was really shocked. But after, I thought it was a really good way of handling a situation like that," said Mulligan...

Many people do not get such straight talk from doctors, who often think they are doing patients a favor by keeping hope alive.

New research shows they are wrong.

Only one-third of terminally ill cancer patients in a new, federally funded study said their doctors had discussed end-of-life care.

Surprisingly, patients who had these talks were no more likely to become depressed than those who did not, the study found. They were less likely to spend their final days in hospitals, tethered to machines. They avoided costly, futile care. And their loved ones were more at peace after they died.

The word "surprisingly" in that last paragraph amuses me in a bitter sort of way -- it doesn't surprise me at all that patients don't get depressed when their doctors are honest.  (Nor does it surprise me that only a third of patients hear about end-of-life care from their doctors.) This is a really, really important finding, and I hope people pay attention to it.  A patient's right-to-know bill is in the works in California.  I haven't seen the details of the bill, but whether it's well-crafted or not, let's hope it raises public awareness.

People need time to prepare, and doctors owe it to them to give them the information they need up front.

More on less meat.

Apropos my earlier post:  Mark Bittman, one of my favorite cookbook writers, has a NYT column on eating less meat.  The suggestions are exactly the sort of sensible, low-stress ones I'm trying to implement:  

1. Forget the protein thing....For anyone eating a well-balanced diet, protein is probably not an issue.
2. Buy less meat. How many ounces of meat is a serving? For years, the U.S.D.A.’s recommendation has been four ounces a person, yet most of us have long figured one-and-a-half to two pounds of meat is the right amount for four people. ...Change that amount, and both your cooking style and the way the plate looks will change, and quickly.   Remember that most traditional styles of cooking use meat as a condiment or a treat....
3. Get it out of the center of the plate.... If you think of meat stews or soups, chicken pot pie, even lasagna, you’ll quickly recognize that the decision to load them up with meat or to use meat as an ingredient of equal importance to the others is entirely yours. The same is true when you’re grilling. Compare these statements: “We’re grilling a leg of lamb and throwing a few vegetables on there,” and “We’re grilling vegetables and breads, and will throw a few chunks of lamb on there.”     

There's more -- read it all.

Literature-based American history through 1812 for the Grammar Stage. Part 6: The French and Indian War.

Previously in this series:  Introduction.  Part 1.  Part 2. Part 3.   Part 4.  Part 5.

Time constraints require me to spend only one week on the French and Indian War itself.  

Why so little time?  As I see it, a U. S. child mainly needs to know two things about the French and Indian War:

  - that it gave the colonists experienced soldiers and officers who would later lead the Revolution

  - that England tried to pay the war costs by enforcing unpopular taxes on the colonists.

The latter point will be covered in the next section.  

The former point will be covered in the sole lengthy reading for the week, drawn from Genevieve Foster's George Washington's World, which we began in Part 5.  The second section is entitled "When George Washington Was A Soldier," and describes the war briefly from his vantage point.  It also touches on what was going on worldwide; we hear of how things were in England and in France, as well as in Catherine's Russia, and we also hear about other personages such as Goethe ("Goethe Sees Both Sides.")  

Seton's Chapter 10, "The French and British Struggle," is also read for a more textbooky look at the same material.

Next:  "Setup of the American Revolution."

Vaccines that encourage an auto-immune response.

Interesting comment by organic chemist Daniel Pipes on the possibility of a vaccine for Alzheimer's disease.  

The idea of an amyloid vaccine has always excited and alarmed me in equal measure. But that's how I feel about the immune system in general, come to think of it. We have enough cellular firepower to completely destroy ourselves from the inside out - keeping that on a leash to where it (mostly) only goes after what it's supposed to is extremely impressive.

Now, I think that the usual sorts of vaccines are one of the great public health advances of civilization, but they work so well because they're targeted to outside agents (viral coat proteins and the like). Even so, there's a disturbingly large part of the population that remain suspicious of all vaccinations - I say "disturbing" not least because if that population gets too large, the efficacy of vaccination in general could be crippled. But what will these people think about a vaccine that's targeted to an endogenous protein? My immunology may need brushing up, but I can't think of any other example of such.

Is intelligent public debate possible on this front?  Will the general public be able to understand the difference between a vaccine designed to encourage response to an outside agent, and a vaccine designed to encourage the immune system to attack the body's own proteins?  Will proponents deride opponents, or even well-informed people who express concerns similar to Pipes', as "anti-vaccine" in general, lumping them with (say) parents who despite the lack of data fear the MMR vaccine will make their children autistic?

The brave kindness of strangers.

What a story.  May we live our lives surrounded by such people as the bystanders in the article.

"[S]prinkled with pixie dust vacuum-sintered with an alloy of unobtanium and thiotimolene.."

The best phrase I've read all week, appearing in this vent regarding Hewlett-Packard printer-component pricing structure.

The best phrase I've heard all week came from my husband, who (referring to so-called "fruit snacks" -- you and I know they're really a form of differently-shaped gummy bears) claimed that the manufacturers obtain the right to call them "fruit" because they "wave a pear over the vat.  Actually, USDA regulations only require that it be a plastic pear."

(h/t for the link to the vent: Instapundit)

I am a radical.

That is, I believe in free speech.

Even icky speech.

If there is any single thing I'm genuinely, passionately patriotic about, it's our constitutionally enshrined freedom of speech.  What a freaking great idea.  I'm glad I happen to live in the only country which apparently realizes its importance.  Now if the rest of the world would only get on board.

Do I like nasty mean hateful speech?  No.  Am I pleased as punch that it isn't illegal to produce it?  Absolutely.  Does this make me more liberal than many Western democracies?  Apparently so.

If you haven't been following the story of the Canadian Human Rights Commission Tribunal -- the trial of Mark Steyn and Maclean's Magazine is only the most well-known (so far this "tribunal" has a 100 percent conviction rate in so-called hate speech cases) -- you should.  

This blog post by Ezra Levant is a good place to start.  Believe in the separation of church and state?  Then the government shouldn't be telling religious leaders what to preach, eh?

(louder) EH?  

Canada needs a First Amendment.

Isn't it pretty damn obvious that when Icky Speech is illegal, then the people in power get to decide what is and what isn't icky?  Isn't it pretty damn obvious that the same powers that can be used against the people you don't like (say, racists) can, in a different political environment, be used against the people you do like (say, people who like to criticize the government)?

Or do the Canadians who support the hate-speech tribunal have such a blind trust in the innate goodness government that they believe it will never be taken over by nefarious people who might use it to attack the speech that they themselves hold dear?

Knee-jerk patriotism is a bad idea.  "My country, right or wrong" -- the only good way to look at that is if it remains your country, right or wrong, one hopes you are motivated to right the wrong.  I respect people who are able to see in the symbol of a mere flag a representation of everything they love about America; I still don't like to "pledge allegiance to the flag," since it symbolizes different things to different people and some of the things that some people see in it, I don't ally myself with.  But oh, I'll pledge allegiance to the Constitution any day.

Remember all those people who said they would flee to Canada if George W. Bush were elected (and later, if he were re-elected)?  Because the fascists were taking over the country and they wanted to move somewhere safe?  I actually know someone who did emigrate to Canada after the 2000 elections (granted, a job change was involved, but the way she talked it sounded like the incoming presidential administration was the last straw).  Look, I'm not exactly a fan of the current administration, but have you noticed something?  Eight years later, it's almost over.  (Hurray for the two-term limit -- that's another freaking good idea, don't you think?)  Eight years is not exactly insignificant in the life of a human being, but it's hardly something to renounce your citizenship over.  It's the way it works:  if I belong to a people that chooses its own leaders, sometimes (lots of times!) that people chooses one I don't happen to like.  So my turn is another time.  I can deal.

And in the Canadian refuge, they may be free from George W. Bush, and perhaps that is enviable; but it is there that the government tells you what you may and may not say out loud, or in print, or in a blog post.

I'll take here, thank you very much.  I'll go to the polls in November, and I'll say what I want about it.

Dairy-free enchiladas with no frankencheese.

My friend in Denver can't eat dairy products right now because they bother her three-month-old nursling, and she was longing for enchiladas.  I suggested she Google the type of filling called "picadillo" -- I thought my own recipe did contain cheese, but it struck me as a kind of filling that would be good with or without it.  

I just now checked the recipe, which was published in Sheila Lukins All Around The World Cookbook (Workman Publishing, 1994).  It does call for a topping of grated Monterey Jack cheese, but I think you could leave it off and be just fine.   For 16 enchiladas, the filling contains 1/2 cup each diced red onion and red bell pepper, sauteed in olive oil and then combined with 6 seeded, diced plum tomatoes; 1/4 cup chopped pitted green olives; 1/2 cup golden raisins; 1/4 cup chopped almonds; 2 tablespoons drained tiny capers; 1 tsp dried thyme, 1/2 tsp ground ginger, and 1/2 tsp ground cinnamon.  That mixture is cooked another couple of minutes and then mixed with 3 cups chicken and 1/4 cup chopped fresh parsley, plus salt and pepper.  It's stuffed into flour tortillas and baked with a plain (not chili-powder-flavored) tomato sauce, or even with a marinara sauce.  As I said, the suggestion is to top it with Monterey Jack, but I bet it'd be fine without.  If you wanted something crispy on top, I wonder if bread crumbs or even crushed corn chips would work.

By coincidence, my other friend, not in Denver, put up this sweet potato enchilada recipe a few days ago.  I think it would also be very nice without cheese, don't you?

Literature-based American History through 1812 for the Grammar Stage. Part 5: Life in Colonial America.

Previously in this series:  Introduction.  Part 1.  Part 2. Part 3.   Part 4.  

You knew this section was coming, didn't you?  There are a ton of books in my local library on this topic, and it took me a while to sift through and find the ones I liked best.  Four weeks on this one.  Here are my choices:

• Seton, Chapter 9, "Life in Colonial America"
• Foster, George Washington's World,  part I, "When George Washington Was A Boy"
• Haskins, Building a New Land:  African Americans in Colonial America (relevant sections)
• Schaun, Everyday Life in Colonial Maryland 
• Benjamin Franklin, The Whistle 
• D'Aulaire, Benjamin Franklin  (picture-book option) or Meadowcroft, Benjamin Franklin (novel-length option)
• Pinkney, Dear Benjamin Banneker  
• Benjamin Franklin, selections from his political writings, such as "A Narrative of the Late Massacres in Lancaster County of a Number of Indians, Friends of this Province, by Persons Unknown" 1764   

  Genevieve Foster's book George Washington's World, like The World of William Penn I reviewed in part 4, covers significant people and events throughout the whole world during the life of one person.  We'll read all of it over the rest of the American History period.  It's conveniently broken up into chunks of Washington's life that roughly correspond to the divisions of American history I've chosen to cover.

Schaun has several books available through my library, all of them titled something like Everyday Life In Colonial [name of colony].  They are similar and any will do; I chose Maryland because I intend to focus just a bit on this colony founded by Catholics.  Some of the copies in my library system were mimeographed and comb-bound, but I found a used hardbound copy and bought it.  It includes many drawings: of everyday items, such as children's toys, tools, and clocks; different sorts of houses, chimneys, roof styles, doorways, and stairways;  cooking implements, pot hooks, bellows, cake molds --- all kinds of ordinary stuff.  There are also some local details, like descriptions of the indigenous groups that are specific to Maryland; I haven't looked at the other books enough to know whether good distinctions are made among the peoples as you move from one book to another.  I was a bit disappointed that there wasn't a mention of religious life.   The text is written at a higher level and is kind of dense, so I expect we'll leaf through the book and talk about the pictures.  If you live in one of the original 13 colonies, see if Schaun has a book for your state.

A biography of Benjamin Franklin is well-placed here, perhaps the whole thing, perhaps just his life up to 1763 (saving the rest for a later section).  Either D'Aulaire's detailed, longish picture book or Meadowcroft's novel-length bio will do; both appear to be closely based on Franklin's Autobiography, which the parent and any high-schoolers in the house ought to read if they haven't already (it's a hoot).  Plenty of details of colonial life will be found in these bios.  Also, the children's book The Whistle is an excerpt from Franklin's autobiography, which will give a taste of his style.  And it's pretty easy to find a collection of Franklin's writings from which you can choose anything that suits your family.  I have selected the "Narrative" above because it draws a picture of the complex relationships between colonists and local indigenous people, but you could as well choose almost anything else.  We probably won't read the whole thing, because it's kind of dense, but we'll read at least an excerpt or two.

Finally, this is a good section to start a frank discussion of slavery as it existed in the colonies.  Haskins's book covers the whole colonial time period, so only part of it is relevant here.  It's fairly recently published and describes the experience of Africans and their descendants; I think it'll be worthwhile to compare what we learn from this book to what we learn from Schaun's book (which does cover slavery some).  Pinkney's excellent picture book Dear Benjamin Banneker  is the story of that free African American mathematician-astronomer's correspondence with Thomas Jefferson.  It draws heavily on the primary sources of their letters.  It does a great job of telling the story of this extraordinary person without rancor, while not ignoring the context, i.e., the conditions in which most black colonists and slaves lived and worked.  Plus, you get a preview of Thomas Jefferson (it's fashionable to point out the contradiction of Jefferson's passion for freedom at the same time as his slave ownership; Banneker himself pointed it out to Jefferson in a letter to the man, so this is nothing new).  You also get a reminder that there were "more than a few" (according to Schaun) free black colonists, at least in Maryland.

Next:  The French and Indian War.

Uber-schedule.

Blogging has been low as I try to finish my planning for my fall academic schedule.  Lots of spreadsheets open at once.  Lots of DVDs for the kids.   I already have the school plan done, and the children's chore plan, and the swimming lessons and things like that, all out.  I still have to knit it all into one big uber-schedule.