Shaping the last chapters of life

March 31, 2015

A review of Being Mortal: Medicine and What Matters in the End by Atul Gawande

GawandeNear the end of this 260-page book, the author states a fact of life that most people already know. When we face the endings of life, “no one ever really has control. Physics and biology and accident ultimately have their way in our lives. But the point is that we are not helpless either.” The guiding principle is that within these limits we “have room to act to shape our stories, though as time goes on it is within narrower and narrower confines” (243). At this point, author Atul Gawande summarizes the themes he has presented throughout this persuasive and interesting book.

First, our “most cruel failure in how we treat the sick and the aged is the failure to recognize that they have priorities beyond merely being safe and living longer. This misunderstanding is widely distributed through American society and is sharply focused in the medicalization and institutionalization of elder care. Throughout the book Gawande illustrates this theme with stories of people whose last chapters were made increasingly difficult because of treatments that well meaning people, including family, friends, and medical providers, had thought to be right.

Second, the “chance to shape one’s story is essential to sustaining meaning in life.” Here, too, Gawande supports his thesis with life stories—of people he has met in his medical practice and members of his family, both in India and the United States. In the epilogue he expresses appreciation to more than 200 people who had shared their stories with him. These life accounts demonstrate that people cope with their mortality best when they a determining voice in decisions about the care they are to receive.

Gawande’s third theme is that we now “have the opportunity to refashion our institutions, our culture, and our conversations in ways that transform the possibilities for the last chapters of everyone’s life.” He writes in an encouraging vein because many people already are at work in this reformation of the ways that our society relates to people who are living their last chapters. In part, Gawande’s purpose is to explain and affirm changes already taking place. Another purpose is to encourage people who are now in their last chapters of life to avail themselves of these increasingly available opportunities. Furthermore, he intends to instruct people like himself—professional care givers and immediate family members and friends—about their supporting roles in helping people they know age and move toward death in the best ways possible.

Being Mortal has a strong autobiographical cast. Gawande is a surgeon at Brigham and Women’s Hospital in Boston and a professor at Harvard Medical School. His late father also was a surgeon and his mother is a physician. In the earlier portions of the book, he tells about his own efforts to understand people as they faced their mortality and the new modes of supporting them that are developing across the nation. He describes the presuppositions he brought into his medical practice, especially the assumption that his primary responsibilities as a surgeon were to prolong life and keep people safe. With similar candor he describes how difficult it has been for him to develop a new set of priorities and better ways of communicating with patients, their families, and medical practitioners like himself who were schooled in the prevailing medical model. Continue reading Shaping the Last Chapter


Wonderful old bikes at the world’s smallest bikeshop: my annual report

March 16, 2015

Dale at Work

Every year I stop by Claremont, California, to spend a few days in research at theological libraries, visit old friends at Pilgrim Place, and check in with Dale Mattson and his son Sam at Claremont Velo, the world’s smallest bikeshop. Wednesday through Saturday of most weeks, Dale opens the windowed nook where he keeps things and moves a work stand and half a dozen bikes out onto the sidewalk and he’s ready to go.

His shop is across Yale Street and east on Foothill Boulevard about 50 yards from the library where I do most of my research. I walk past his place every time I go to Wolfe’s Market to pick up a little food for lunch.

I was especially glad for Dale’s presence this year because I was having trouble removing pedals from the bike that I was packing to take home after riding it in Arizona and up Mt. Baldy. In addition to the allan key that is needed, Dale had a hollowed out seat post that he used as an extender in order to make the pedals come loose.

The bike on the stand was a beautiful black and red Motobecane from a long time ago. One of my daughters bought a bike just like it around 1971 or 72. Although she bought a new bike 30 years later, the old Motobecane is still in her possession. It is good to see such fine old classics.

When Dale bought the bike for a tiny sum, it had been in someone’s shed and had been used as nighttime roost by chickens and birds. With a couple of hours of detailing, however, it has shined up nicely. With new cables and rubber, along with general overhaul, it will be a wonderful mount for someone, and, I presume, at a far more reasonable price that such a nice bike might command in other venues.

The bike that tempted me was hanging in the shed—a 1980s Bertoni. It had scarcely been ridden at all in the quarter of a century since its owner bought it. Dale has done basic conditioning and would sell it with a list of things still to be done—like new cables and rubber—or add an appropriate amount and do that work himself.

Bertoni Headtube

Bertoni Headtube

The bike was made by the Alan company that sold many bikes under its own name and other labels. I own an Alan frameset, given me by a friend, and have thought that I might set it up to be rideable again. Dale suggested that it would be easier, and probably no more expensive, to buy his Bertoni that’s ready to ride, and with all original equipment.

Over the weekend, my wiser self took over. I don’t have adequate space for the three bicycles I intend to keep in the years ahead. What would I do with still another? So that absolutely gorgeous Bertoni will become the joyful mount for someone else who values fine, old bicycles.

By the way, I think the Bertoni has a 56 cm seat tube. Maybe it’s just the bike for you.


A baked land of chaotic hills and valleys

March 10, 2015
A Dry Wash near the San Pedro River

A Dry Wash near the San Pedro River

The annual Desert Training Camp for 2015, conducted by Pacific Atlantic Cycle Tours (PAC Tour), began with the Historic Hotels Tour during the last week of February. This year marked the twentieth season that PAC Tour has conducted a winter training program in the Southern Arizona desert.

In addition to Lon Haldeman and Susan Notorangela, owners of PAC Tour and record setting ultra marathon cyclists in their earlier years, two participants in the 2015 Historic Hotels tour participated in that first Desert Training Camp twenty years ago. A member of this year’s crew had been Lon’s training partner even before the PAC Tour company was organized to train long distance cyclists and has ridden or been crew on 40,000 PAC Tour miles. One of the cyclists registered as a rider for the inaugural week in 1996 and he has participated in Desert Training Camp for seventeen of its twenty years.

The first season was only one week long, and its emphasis was upon the middle word in its title: Desert Training Camp. It was pitched toward young cyclists still in active training for competitive events, especially long distance rides. Well-known coaches and trainers were part of the attraction, and daily rides included practicing techniques such as riding in pace lines. Since Lon and Susan were still in their thirties, their own exploits on bicycles were clearly part of the draw.

When I first read about these weeks in the Arizona desert, the descriptions emphasized the training opportunities, which was one of the reasons why this program attracted my attention. By that time, the winter program had been extended to more weeks and the clientele had begun to change: fewer young racers and an increasing number of middle aged touring cyclists who could ride 100 miles a day, although in a recreational rather than competitive mode. The continuing emphasis upon fast, long distance touring was the primary reason I chose PAC Tour when I decided to try riding with a touring company rather than exclusively as a solo cyclist.

The Historic Hotels Tour for 2015 shows the full transformation from hard racing to recreational touring. Daily mileage for the week ranged from 47 to 67. Twenty-seven cyclists were registered: six in their 30s and 40s, six in their 50s, eleven in their 60s, and four in their 70s and 80s. Twelve were women. Nearly half of the riders had done previous trips with PAC Tour, while others were riding with Lon and Susan for the first time.

Half or more of the group were confident that they could handle the distances, while others were apprehensive, two or three because they had done very little cycling like this and several others because they were overcoming injury or were uneasy about their current level of physical readiness for rides this length. Susan, and the other members of the support staff reassured riders that they would do all that they could to help us enjoy the week cycling through this high, dry plateau in Arizona’s Sonoran Desert,” a “land of little rain,” to use Mary Austin’s descriptive phrase. Read more….Baked Land of Chaotic Hills and Valleys

 

Fairbank, Arizona

Fairbank, Arizona


Vigil Mass at Mission San Xavier del Bac

March 2, 2015
White Dove of the Desert

White Dove of the Desert

Nine miles south of downtown Tucson, the Mission Church of San Xavier del Bac is a monument to the history of Christian ministry with the Tohono O’odham people who long before Spanish occupation had established a flourishing society is this land of little rain. The mission was established by Father Eusebio Kino in 1692.

He laid the foundations for a church building that was never erected. Construction of the church that now is resplendent in the Arizona sun began in 1783 and was completed in 1797. According to the historical account posted at the church’s website, this church is “the oldest intact European structure in Arizona” and its interior “is filled with marvelous original statuary and mural paintings. It is a place where visitors can truly step back in time and enter an authentic 18th century space.”

The website gives more detail about the art and architecture of this historic building. In times past, the church has suffered damage from an earthquake and a lightning strike. Funding for a major restoration is currently underway.

Unlike many ancient ecclesiastical structures, San Xavier del Bac continues to be an active church, with a special mission to serve the Tohono O’odham people on whose land it stands. Although I have previously visited it as a tourist, I stayed in Tucson an extra day following my bicycle tour of historic hotels of southern Arizona in order to attend Mass (the Saturday Vigil) at this glorious house of worship.

When I drove to the church, the western sky was dominated by flat clouds with brilliant colors of orange and burgundy caused by the setting sun. An open plaza is maintained in from of the church, with unpaved parking facilities on either side. The walk from one’s car becomes part of the experience because worshipers are brought around to a place where they face the front façade directly and see both the beauty of the gleaming white structure and the warmth of the brown, modestly sized front entrance.

I followed two small sets of worshipers, a duo of white women in their early 70s and a young family with dark skin tones whose two pre-school children were among the small number of children present for Mass. Just inside the open doors parish bulletins were held down by rocks about six inches long to keep them from blowing away in the sharp evening breeze. After picking up a bulletin, many of the worshipers reached over the narrow table for a large print missal and hymnbook. There were no greeters, and people went immediately to find seats.

Prayers at San Xavier del Bac

The nave is long and narrow, with about 20 rows of benches with low backs. Close to the wall on each side there is a bench that seats two people; then a narrow aisle; and down the middle a bench that seats 4 to 6 adults. At 5:20 when I entered the church, the first 9 rows were already filled, and during the next 10 minutes the additional rows and transept seating were also occupied. My estimate is that approximately 165 worshipers were present—mostly in their 60s and beyond, mostly with light skin tones, mostly dressed in ordinary weekend attire.

At 5:25 the slight murmur of conversation went silent. The woman who served as cantor took her place at the edge of the space where a simple altar-table was set with the vessels that would be used during the Mass. With clear voice and articulate instructions she announced the entrance hymn. Congregants stood for the singing and the presiding priest with two teenaged boys processed up the aisle on the left.

In contrast with the cantor, the priest and others who had speaking parts in the liturgy (a religious woman, a lay man, and a lay woman) spoke in muffled tones so that it was hard to understand what they were saying. The five-minute homily drew upon the Genesis account of the sacrifice of Isaac and the epistle text from Romans 8, giving a conventional interpretation.

The Mass was straight out of the book and could have been celebrated in any ordinary Catholic Church anywhere in the country. Everything was done “decently and in order,” to use Paul’s phrase from 1 Corinthians.

During the closing hymn, congregants began their exit so that by its close only a third of us remained in place. From beginning to end, the liturgy took 50 minutes.

The insufficiencies of some of the leaders of the service, however, were marginalized by three other factors. First, the piety of worshipers and their ability to enter into the language and action of the liturgy; second, the theological coherence of the Mass and its prescribed rituals; and third, the aesthetic spirituality of the worship room itself. I left the Mass with a strong sense of the beauty of holiness.

Devotions at San Xavier del Bac


Desert Training Camp One More Time

February 21, 2015

Arizona Sunrise

Since 2009 my winter schedule of activities has included a week of bicycling in southern Arizona. These rides have been conducted by PAC Tour—Pacific Atlantic Cycling Tours. The company is operated by Lon Haldeman and Susan Notorangelo, husband and wife, who have long been central figures in intense, long distance cycling.

I first met Lon in the 1970s at a McDonald’s restaurant on the western edge of Columbus, Ohio. My teenage son Mike and I had spent Mother’s Day weekend cycling the 210-mile Tour of the Scioto River Valley—TOSRV—and were driving back home. Lon was already a celebrated figure among cyclists because of his major role in developing the recently established Race Across America—RAAM—and he had been guest of honor at that year’s TOSRV.

Lon’s name had drawn my attention to PAC Tour’s Desert Training Camp several years before I started riding with them. If I ever decide to ride with a touring company, I thought, PAC Tour would be the one to try.

The time did come when it became clear that my family and friends, and I myself, would feel more at ease if I were to transition from long solo trips to multi-day rides that included other people.

If done right, I told myself, these rides would be fun. These weeks with PAC Tour would acquaint me with parts of Arizona with which I was unfamiliar. I would meet interesting people. I would learn things about cycling and traveling by bike that I would not learn in any other way.

JulianWash in Tucson

JulianWash in Tucson

This next week will be my 7th or 8th trip with PAC Tour, and my hopes have been realized. The rides have been physically and mentally challenging. Friendships have been established with crewmembers and cyclists alike, and each year’s ride is like a reunion. I have experienced this part of Arizona in a new way. My abilities as a cyclist have been extended. These are the reasons I keep coming back.

This is the third time that I have come to Desert Training Camp thinking that it might be my last time. The fact is that at 83 years of age, I’m having trouble doing these rides at the level that satisfies my personal criteria. Like it or not (and I don’t like it), I’m aging out of PAC Tour rides. The rigor that drew me to this company in the first place is now pointing out that aging has its challenges that cannot be avoided.

This year’s ride still seems within my range. The daily distances range from 40 to 60 miles, just over half of the daily distance expected on some of the other weeks and events that PAC Tour sponsors. We’ll spend two consecutive nights in the same hotel in mid-week, which means that cyclists can take a day off if it will help them enjoy the week.

So, once again, here I am at Desert Training Camp for the last time. One reason for coming is that I really want to stay a night or two at the Copper Queen Hotel in Bisbee. Another reason is that I’m working on a book—Body Dissolving, Spirit Strong as Always: Open Road Cycling for People Past Seventy—and I hope that conversations this week will help me along.

There’s one more reason for doing this ride again. For much of this past year I have been dealing with chronic leg pains. My doctor and friends have helped me understand that the probable cause is muscular imbalance, but so far the course of action recommended has been less effective than I would like. A few days ago I found a book that gives the detailed explanation that I need and proposes a regimen of progressively more challenging stretches that strengthen the muscular core of a person’s body.

I’m reading the book and practicing the exercises. My hope is that conversations with other mature cyclists this week will push me forward in my new daily stretching pattern so that when I get home in mid-March, after this ride and a period of research, writing, and riding near Claremont, California, I will be on the way to the pain-free cycling I remember from earlier years.

Yellow Trailer


Learning about Life from the Desert People

February 19, 2015

Comments prompted by reading The Desert Smells Like Rain: A Naturalist in Papago Indian Country by Gary Paul Nabham (New York: North Point Press, 1982; fifth printing 1997)

Desert Smells Like RainThis year’s winter bike trip in Arizona began on Ash Wednesday with a four hour flight from Portland’s 55-degree sun to Tucson’s 80-degree counterpart. For reading on the plane I chose Gary Paul Nabham’s 1982 classic The Desert Smells Like Rain: A Naturalist in Papago Indian Country. I first read the book late in the 1990s, when we lived in Arizona, as part of my attempt to understand the history of civilizations that have flourished in North America’s deserts.

Nabham comes from a family of Lebanese descent, grew up in Gary, Indiana, came to Arizona for his college and graduate training, and has lived there ever since. As an ethnobiologist, he has devoted much of his adult life to studying the natural history of desert plants and animals and learning the wisdom traditions of contemporary Papago Indians, the Tohono O’odham or “Desert People.”

When I first read this book, I developed a deep appreciation for the agricultural tradition and wisdom about life in a harsh environment that had emerged in the Sonoran Desert in southern Arizona and northern Mexico. That appreciation continues to grow as I reflect upon the increasingly destructive alternatives to living in desert lands that characterize the modern American way.

Since I have just completed writing an extensive literature review of books that detail the emerging crisis over water and that outline alternatives now facing developed societies all over the world, the traditional wisdom of America’s desert peoples provides a moment of respite from the despair I feel.

Their ways of adapting life so that it would flourish in a land of little rain are examples for people who have given too little attention to these matters. They can help us understand the agrarian principles of desert people in ancient times who wrote the Hebrew Scriptures; and they can encourage the new agrarians of our time, like Wendell Berry, who advocate a more natural way of living with nature.

To my surprise, The Desert Smells Like Rain ties in with other topics on which I am reading and thinking these days. In this book, Nabham describes conversations with Tohono O’odham people in their homes and villages, as he has traveled with them on pilgrimages, and when he has been privileged to be present at religious ceremonies usually off limits to any but their own people.

These aspects of the book remind me of features in a longer and more technical book, The Seven Pillars of Creation: The Bible, Science, and the Ecology of Wonder by William P. Brown. In this book, the author compares Biblical stories of Creation like the one told in Genesis 1 with the discoveries and conclusions of scientists from our own time. There are important differences between biblical wisdom and scientific knowledge. What impresses me, however, is that the biblical writer who lived in close connection with the natural world, including the brilliant starry skies at night that few people in the cities ever see, came to insights that have remarkable resonances with technical theories by physicists.

Similarly, I see in desert folklore, as Nabham reports it, insights into the nature of things that in their own way can infuse more technical explanations with wisdom and wonder.

Another correspondence with current reading is quite surprising. A second book that I brought to read on this trip is Susanne K. Langer’s Philosophy in a New Key: A Study in the Symbolism of Reason, Rite, and Art. Although the book was originally published in 1942 (when I was 11 years old), I bought my Mentor Paperback edition (for 75c) on May 10, 1967, in preparation for a nine-month sabbatical leave in Seattle.

This book, which Langer dedicated to “Alfred North Whitehead my great Teacher and Friend,” is second only to Gregory Dix’s The Shape of the Liturgy, which was first published in 1945, in its influence upon my understanding of the nature and purpose of Christian worship. A new edition of Dix, by the way, is scheduled for publication this very month (February 2015).

Langer had studied myth and ritual extensively and understood them as important modes of symbolization. A blurb on the back over of my old Langer says of this book: “For the first time we have a theory which accounts satisfactorily for all forms of art and all art forms…” My previous reading of Langer was within the context of my knowledge of Christian forms of myth and ritual. By reading her theory within the context of Native American myth and ritual, I am helped to understand their wisdom and Langer’s theory.

As I have indicated in recent blogs, thinking about the journey is one of the best aspects of bicycle travel. During this year’s Desert Training Camp, the intellectual diet will be rich indeed. [Thanks to PAC Tour’s Susan Notorangelo who used her smart phone to create the image of Nabham’s book that appears above.]


Virtue, happiness, and riding a bike

February 14, 2015

Part 2 of a review of Neil Peart’s The Masked Rider: Cycling in West Africa.

Peart 2John Muir and Neil Peart were alike in two ways. When they took their long journeys—Muir on his walk from Indiana to Florida in 1867 and Peart on his bike ride in Cameroon 120 years later—each carried two books to read along the way, even though it was necessary to travel light.

Muir took the New Testament and poems of Robert Burns, and Peart Aristotle’s Ethics and Vincent van Gogh’s Dear Theo (letters to his brother).

The second similarity is that both men used their travels as the inspiration for thinking and writing books that interpreted the natural and cultural worlds they experienced.

In an earlier review of Peart’s book, The Masked Rider: Cycling in West Africa, I gave a brief account of what he and four companions did from day to day as they spent a month traveling through remote sections of West Africa. The entire book is redolent with pungent observations of what Peart saw, heard, and thought.

Tucked away in this fascinating story are several sections, from a few paragraphs to a few pages in length, in which the author develops more extensive meditations as he comes to a fuller understanding of himself and the world around him. The two summarized below caught my attention.

Slow: a habit of mind and metaphor of life: Elsa was the one rider out of the group who seemed least able to develop a cycling rhythm that meshed with the others. David, the tour leader, felt obligated to linger behind with her as she slowly, awkwardly, stubbornly moved along, refusing to follow the examples set by the others who seemed better able to surmount the challenges of their trip.

Halfway through the book, Peart comments that because she was 60 years old Elsa “was fully entitled to be slower than the rest of us.” He then notes that being a slow rider “has nothing to do with strength or age; it can be a mental thing. . .At whatever speed, sensible riders choose their pace and stick with it, taking breaks at considered intervals, and if a hill is too steep they’ll walk up it. But they keep going.”

In contrast, he has noticed, slow riders “are often the last to be ready in the morning.” They dally at every stop and stop more often than necessary. The reason, he explains, is “a certain lack of focus, of sloppiness of mind [that] seems to carry over from their personalities to their cycling, and it slows them down” (122).

As an octogenarian cyclist, I understand that slowing down is an unavoidable adjustment caused by age-related bodily changes. With my doctor’s encouragement, I am learning how to let myself be slower than I used to be.

But as Peart makes clear, slowness as a habit of mind and metaphor for life—this kind of slowness, which I often see on my travels through life—is something to avoid, regardless of one’s age.

Happiness, virtue, and a mode for travel: In the busy, noisy, stifling streets of Bafoussam, Peart and his companions spent a night at a hotel where they “felt the benediction of hot water.” They showered, washed their clothes, and for the first time in two weeks were clean. They all looked happy.

“And with perfect synchronicity, I was reading about that very subject. ‘Happiness is an activity of the soul in accordance with virtue.’ Typical of Aristotle, it takes a book to expand on that terse maxim, but the main points eventually came clear to me” (171).

Peart acknowledges that virtue is a word now out of fashion and notes that some translators prefer excellence as the English equivalent to Aristotle’s Greek word. Whichever translation is used, he muses, “you wouldn’t call anyone happy because he experienced a momentary pleasure, or laughed once, or had one hot shower in two weeks. Happiness takes time, in a real sense. It’s not the prize you win, but the way you ride the bike.”

Putting Aristotle aside, Peart proposes that excellence is doing something well, whether it be “playing the piano, tuning an engine, planting a garden, making tortellini, or just plain living. And that would be perfectly in tune with my understanding of Aristotle’s meaning—“Happiness is excellent living” (172).

Peart acknowledges the fragile foundation of happiness-virtue, and recites a period early in his career as musician. The “small-change gigs were over, and there was no money and no more work.” He found himself willing to accept a little money from someone who befriended him even though Peart knew that the cash had been stolen from some “luckless petrol-station owner.” His conclusion, though unsettling, is closer to the truth than I like to admit.

“So, I have learned that my precious integrity is no less than a precious luxury. I have been fortunate (and stubborn) enough to be able to be honest, to be uncompromising, to pursue excellence. To ride a paved road.”

And to write a good book that rock musicians, classical music buffs like me, and cyclists of every kind can enjoy.


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