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