In a new blog post for The New York Times Timothy Egan explores the medical-industrial complex’s resistance to end-of-life palliative care. According to the article, close to a third of the money spent by Medicare goes towards the last two years of a person’s life desperately trying to stave off the end. Egan sites as an example Annabel Kitzhaber,¹ a terminally ill patient for whom Medicare “would pay hundreds of thousands of dollars for endless hospital procedures and tests, but would not pay $18 an hour for a non-hospice care giver to come into her home and help her through her final days.”

We treat death as a pathology in this country, as something that needs to be kept away, battled, banished. So too do we disavow the aging process as we dye, peel, inject, lift, and bleach ourselves into eternal youth. As a woman in her thirties who is being introduced to the gradual loosening and graying of things, I look around for models of healthy aging to help me transition gracefully into midlife. But what I have found is that there aren’t any. As I look at our public figures, I see 50-year-old women without a line on their faces, dating twenty-year-old boys, running around as if to say “Seventy is the new fifteen!”

How are we to embrace the end if we cannot even face what the middle looks like?

We have been programmed to intervene in the aging and dying processes at every stage. If a gray hair sprouts up, pluck it out. If a crows foot appears, inject it away. If systems begin to fail, even at the end of a long meaningful life, do everything you can to ward off the inevitable. Nevermind that the quality of his or her life is diminished. I don’t believe, though, that this reflects our deepest desires as human beings. I think that most people want to die peacefully at home with as little intervention as possible. So where are we getting lost?

One such place is in the corridors of the medical-industrial complex. As the spouse of an emergency physician I have an interesting perspective on the matter, because I am able to see through the eyes of someone trained to save people’s lives without question. What I have learned is that because of Medicare’s willingness to pay for heroic life saving measures even when palliative care is indicated, much of the responsibility to navigate these hard decisions is shouldered by the health care provider. The hair in the soup though is that most health care providers do not want the responsibility. Far easier for them to say that they did everything they could to save a person’s life than it is it to sit down with that person’s family and talk about what it would mean to discontinue treatment, how it would feel to prepare themselves for the death of their loved one.

No one expects doctors to function as social workers or counselors, but we need to train our physicians that their job is not always to extend life. Months ago I asked my husband how his day went, in the way that I often do. “Save any lives today?” I said. “Nope,” he replied. “But I helped a family let someone go. And that felt just as good.”

In a post I wrote a few weeks ago about mercy, I commended the Scottish government for granting compassionate release to the Lockerbie Bomber, Abdel Baset al-Megrahi, who is terminally ill. By doing so, they have allowed him to die at home in Libya with his family. After publishing the post, I got a note from a friend who always lets me know in a very kind and respectful way whenever he disagrees with my position. This is what he wrote in reference to the fact that al-Megrahi was essentially given a parade when he got back to Libya:

“You touch on cultural differences [of mercy], but omitted an obvious one…the Libyans. If you look at events in the Middle East over the last 60 years, you will see that power trumps compassion or discussion every time…
The reception of Megrahi orchestrated by the government and his meeting with Qaddafi only reinforces this notion. It may have been noble for the Scots to let him go, but it was a mistake. The reaction on the Arab street will be one of victory over the 270 innocents lost that day.”

His comment got me thinking about whether or not the Libyans’ behavior should matter when we decide if al-Megrahi’s compassionate release was the right thing to do. Should an action’s merit be judged by the way in which the action is received? I understand that it does not sit well for anyone that a convicted terrorist would be given a hero’s welcome upon his return to his homeland. I can see how anyone would take that as a slap in the face, as further evidence that this person is not worthy of our compassion. But if we draw this scenario out to another example, the answer seems clear to me: Imagine if you give someone a letter opener for his birthday and he turns around and stabs someone with it. Does his terrible behavior diminish the kindness of your gift? Does it make your gift a mistake? I believe that your responsibility ends when your friend takes possession of your gift. At that point, whatever he does with it becomes his responsibility. And I believe it is so with al-Megrahi and the Libyans.

It is a frightening position to take. I try to think about how I would feel if al-Megrahi committed another act of violence after his compassionate release. It would be devastating. But as hard as it would be to separate ourselves from it, I believe that such an action would be on al-Megrahi’s head, not ours. I feel strongly that we can only lead in this world by example. The only way to prove to others that compassion should trump power in their lives is by practicing it in ours.

My husband is a mountaineer, a rock climber, a backcountry skier, and a doctor, which makes him equal parts adventure junkie and safety nerd. When we met he was doing a lot of mountain search and rescue, orienteering, and other boy scouty things. We would often go for day hikes in the woods and I would invent epic scenarios, which he would then have to talk us out of, stuff like:

      What would you do if I fell down that ravine and broke my arm?
      I would climb down to get you and then take you to the hospital.
      What if I broke my arm and my ankle?
      I would climb down to get you and then hop with you to the hospital.
      What if I broke my arm and both of my legs and I weighed three hundred pounds and we were ten miles in and I was all mangled and bloody and couldn’t walk or hop and I was losing lots of blood from one of my arteries?
      I would climb down to get you and make sure you were breathing. Then I would fashion a tournequet out of my shirt and a stick…

This became our thing. Whenever we were out in the middle of the woods I would make him explain all the different ways in which he could get us out of danger in the event of some horrific accident. It made me feel safer somehow.

One day we were walking on one of our favorite trails and I tripped over a log and turned my ankle. It wasn’t so bad that I couldn’t walk on it but I wondered aloud what would’ve happened if it had been worse. We were many miles from the trail head. Josh said he would’ve rigged some crutch-like device for me or made me a little shelter and then run back for help.

Something terrifying occurred to me then, something I had never thought of before. “What if I’d been alone? What if you weren’t here and there was no one else around to help me?”
Joshua turned to me and, without a trace of sarcasm in his voice, said, “I guess you’d just have to rescue yourself.”

I read an AP article yesterday about Abdel Baset al-Megrahi, the man convicted of blowing up Pan Am flight 103 over the town of Lockerbie, Scotland in the late 80s. The so-called Lockerbie Bomber, who is terminally ill with prostate cancer, was released from a Scottish prison on Thursday so that he could return to Libya to die at home with his family. The U.K. government granted al-Megrahi a compassionate release, after he served eight years of his life sentence, as “an expression of the Scottish people’s humanity.”

What interested me most about the article was the way in which it illuminated different cultures’ attitudes about punishment and compassion.

Obama released a statement that Scotland’s decision to release al-Megrahi was a mistake. Secretary Clinton is outraged. The American families of the victims are speaking out, saying things like, “‘I don’t understand how the Scots can show compassion. It’s an utter insult and utterly disgusting,’ said Kara Weipz, of Mount Laurel, New Jersey, whose 20-year-old brother Richard Monetti was on board Flight 103. ‘It’s horrible. I don’t show compassion for someone who showed no remorse.’”

On the other hand, “Scottish Justice Secretary Kenny MacAskill said although al-Megrahi had not shown compassion to his victims – many of whom were American college students flying home to New York for Christmas – MacAskill was motivated by Scottish values to show mercy.” Likewise, a British man whose daughter was killed aboard flight 103, “welcomed the Libyan’s release, saying many questions remained about what led to the bomb that exploded in the cargo hold. ‘I think he should be able to go straight home to his family and spend his last days there…I don’t believe for a moment this man was involved in the way he was found to be involved.’”

Mercy and compassion seem to be part of the cultural landscape in the U.K., values that its citizens continually aspire to possess. In America we have confused mercy with weakness. When I looked up mercy in the dictionary it said, “compassion or forgiveness shown toward someone whom it is within one’s power to punish or harm.” In fact, mercy is a show of great power. It is a grace offered to those who are weaker than we are. The greater the act of mercy, the greater the show of strength.

I am not advocating that we let all the criminals go; I think there should be consequences for people who break the law; but I believe that most people who do bad things are in need of help. I believe that violence and crime are a result of desperation, a lack of resources, and the exposure (and subsequent inurement) to violence over the course of one’s life. People who promote violence deserve our pity not our hatred.

But the American families of al-Megrahi’s victims feel that by granting him a compassionate release, we are not punishing him enough, and are thus forsaking their loved ones. Al-Megrahi has spent the last eight years in prison suffering for his crime and will spend the next three months–the last three months of his life–getting intimately acquainted with death. To those who think he is getting off easy, I would say that over the next three months he will be going through a process far more frightening than anything we could impose on him in prison.

The argument can be made that al-Megrahi’s victims did not have the opportunity to die in a loving environment surrounded by their families, so he should not be given that luxury. I understand that reasoning completely, but I think it reveals a lot about our beliefs in justice, retribution, and punishment. The conventional wisdom is that if someone does something bad to us or to a loved one, it will help set things straight if the perpetrator is made to suffer as much as possible for his crime, that his suffering will act as balm for our suffering and for the suffering of our loved one.

Is there another way to think about it? Might the death of a loved one be less in vain if the person who killed them was given a different view of humanity, a chance to retreat from violence and revenge, to make something of their life, to serve their community instead of rotting in a cell, a victim of continued violence and hatred, further reinforcing the negative belief system that caused them to commit the atrocity in the first place? Might we have more to gain by modeling compassion for our prisoners, by exposing them to a way of being they have not yet experienced?

It is too late for al-Megrahi to turn his life around and to be of service, but his release has given us the chance to look at our views on justice and punishment, and to re-examine the principles upon which our penal system is based.

Comment away, my sweets.

Elizabeth Gilbert, author of Eat, Pray, Love, gives a talk at the TED conference about the fickle nature of creativity and how it connects us with something greater, something over which we have absolutely no control.

This past year has been a hard one, perhaps the most difficult of my life: I lost two dear friends, moved across the country to a place I couldn’t stand,¹ turned around seven months later to move back home only to leave my husband three thousand miles away. We are hideously in debt from student loans, and the financial crash has left us without savings.

Things are bad.²

In the midst of all this, though, something wonderful has happened: I no longer care. Everything that I thought was important—my best friend, my financial security, the comfort of waking up every morning next to the person I love—has been taken away. And what I realize is: I am still alive. I am still breathing. My Fuck It Threshold, as Joshua calls it, has gone way down; I have gained the ability to let that which truly does not matter, slide.³

I have let go.

And I see the same thing happening to everyone around me. I see people losing their jobs, people restructuring their entire lives, people having to lean on others more than ever. I see a country, whose self worth was once based on prosperity and abundance, having to formulate a new identity for itself. And as terrifying as that is, I believe it is a positive thing. I believe we are molting, sloughing off the superfluous. We are coming to a collective reckoning about what is important, and it has nothing to do with how many Louis Vuitton bags we have per capita or who won the last round of American Idol. We are finally, at long last, learning what it means to be alive.

At the end of the day, those of us who are lucky are still breathing. We are scared, but we are breathing. We are reconnecting with each other, with simpler things. We are finding that it is possible to go forward by going backward a little. And we are, all of us, clean slates awaiting a vision for the future.

I just caught a rerun of Six Feet Under, a show which always inspires me. This particular episode ends with a conversation that gave me a lot to think about. It is a dialogue between David, one of the main characters who was just assaulted, and his dead father Nathaniel whom he continues to talk to. It was written by Nancy Oliver who also wrote one of my favorite screenplays of all time. Hope you enjoy it:

Nathaniel: You’re missing the point.

David: There is no point, that’s the point. Isn’t it?

Nathaniel: The point’s right in front of your face.

David: Well I’m sorry but I don’t see it.

Nathaniel: You’re not even grateful are you?

David: Grateful? For the worst fucking experience of my life?

Nathaniel: You hold onto your pain like it means something, like it’s worth something. Well let me tell you: let it go. [Looking skyward] Infinite possibilities and all he can do is whine.

David: Well what am I supposed to do?

Nathaniel: What do you think? You can do anything, you lucky bastard, you’re alive. What’s a little pain compared to that?

David: It can’t be so simple.

Nathaniel: What if it is?

When I am worried or anxious, when things look particularly bleak, I watch really bad movies. I’m not talking about the good kind of bad movies. I mean total crap. I do this because I cannot drink¹ and am too much of a control freak for hard drugs.² Lately—what with the state of the world being as it is and the fact that I am separated from my love by 3,000 miles—I’ve been on a real bender: I have recently introduced horrifically bad television programming into my regimen.³

Last week, in a moment of dire need, I queued up the first episode of Leave It To Beaver on my shiny silver Macintosh. To my great surprise, it turned out to be wonderful. Really, truly wonderful. Each episode begins with Ward’s voiceover telling us what we will learn over the next thirty minutes. A moral!⁴ Imagine that.

The language alone will slay you. Whether it’s June, straightfaced, saying,”Ward, I’m very worried about the Beaver” or the Beav insulting one of his classmates: “Violet Rutherford drinks gutter water,” the language cannot be stopped.

The most incredible thing about the show for me, though, is the pace of the Cleavers’ life. They are not harried or overworked. They are not thinking about the next IPO or all the unread emails on their Blackberrys. June has time to pack the boys’ lunches in the morning and Ward has time to take them into the garage in the evening to teach them how to beat up their classmates. And it’s not just the Cleavers. Everyone in town has free time. When The Beav’s principal hears that Ward is under the weather, she takes it upon herself to send flowers over to the house. When his teacher wants to get a message home to June she types up a letter and sends it home with Beaver. People actually talk to each other and have meaningful human contact.

It leaves me to wonder: where did all our time go? Are we dawdling it away writing emails, updating our facebook statuses, and tweeting ourselves blind? Is it possible that all of the things we’ve designed to make our lives simpler are in fact adding to our burden?

I mentioned to someone⁵ a few months ago how much I hate talking on the phone and emailing, feeling constantly obliged to check messages. He asked me a very pointed question, “What would happen if you just stopped?”

Me: Come again?
Him: What would happen if you only checked your voicemail and email when you felt like it?
Me: I don’t understand.

My first reaction was an overwhelming panic: I would lose jobs! My family would be angry! No one would talk to me again!

But I’ve started thinking about it more seriously, about dropping out of the technological communication stream. I imagine checking emails once a week, voicemails twice a month. I imagine feeling like I do when I’m on vacation, when my mind is finally able to quiet down.

I wonder if I would regain some of that lost time that the Cleavers seem to be swimming in. There’s no doubt I would send and receive fewer phone calls, curt emails, and text messages from friends and family. But my hunch is that I would write more letters, spend more time with people in person, and enjoy my life more fully.

Anyone want to try it?