More on the Ca Pros Report and Barbershop Chorus

The radiologist who checked my bone scans a few days ago seems to have decided that there were no significant changes in my condition since last time. So I guess that's what we will hear when we meet the oncologist again in early August. By that time there will have been another set of the usual blood tests, too. Another challenge. Another milestone.

Meanwhile, in the absence of our musical director, I managed our Barbershop Chorus' invitational presentation at the Country Music Rally in Wellsford yesterday. Fairly demanding, trying to contribute the only tenor voice in the chorus as well as conducting. But we were very generously received. Especially with our first presentation of Country Roads, tackled especially for this group. We were certainly a big contrast to the noise of a seven piece band on stage - they drowned out most of the other vocal contributions.

I could never have done that before the medication we tried to end some ten years of regular hot flushes... How life can be improved with a small, cheap daily pill!

We're off now for ten days to check out the families in the south. We have started loading the car and there seems to be something for everyone in three households. A regular Grandfather Christmas trip in midwinter...

The Ca Pros Report

My latest two-monthly PSA is up about 15% on the last one. But, considered over four months, the rate of increase is barely significant - a huge relief from the dramatic climbs of a year ago.

Other tests seem to be OK but a bone scan yesterday, sneaked onto my phone camera from the operator's monitor, seems to show quite a lot more sparkly stuff than a year ago. We won't know much about that until my next consultation, at present not even scheduled. But what we don't know doesn't need to hold us back at the moment.

And the trying side effects of hot flushes and emotional discomfort have been greatly reduced. More and more I am doing all kinds of things that have been difficult or impossible for many years.

What price democracy?

It's interesting that the Brexit vote was carried on such a modest majority. I guess I would have thought that such a significant issue would need to be decided on more than a bare majority.

Usually a constitution provides for significant institutional changes to take place only on the vote of a strong majority of, say, 66%. Or there may be some checks and balances so that a wide popular vote can be reviewed and countered to some extent by some kind of group who might bring more thought to the decision. The complex US system of voting for President was deliberately enshrined in their constitution so that the collective will of every last individual voter need not necessarily carry the day; the President is elected by the Electoral College of only 538 voters. Furthermore, most of them are not bound by the political loyalties of those who appointed them to the College. Their task is to find the best person for the position.

That procedure could conceivably save the country from a somewhat unpresidential president. And some similar procedure, such as Parliament over-riding the popular vote, might have enabled a less controversial decision in the Disunited Kingdom last week.

Sometimes, the people do not have adequate understanding of the issues. Sometimes, the people are careless of the privilege of being able to vote. Sometimes the vote of the people does not deliver a result that is best for the whole community.

We have an AGM coming up in our village. We could probably use some similar electoral system this week!

Thank you, Aussie!

Assisted dying a step closer in State of Victoria
Yesterday the cross-party Inquiry into legalising assisted death in the State delivered a revolutionary report to Parliament. The Committee has made some 49 recommendations and at least two members acknowledged that evaluating nearly 900 submissions had changed their point of view on the issue.

One of the clinchers was that Coroners reported that increasing numbers of terminally ill Australians "are committing suicide in horrific and terrible ways" ... "in the shadow of the law" while they are still able to. The implication is that some of those who committed suicide in Australia would not have done this had they known another choice could be available to them.  Certainly, evidence from countries where assisted dying is legal suggested to the Victoria Inquiry (members travelled to several countries) that half of those who obtain a prescription do not use it but live more comfortably and confidently because they have the means if they need it.

That is what choice is all about. That is the option I think we should move towards in NZ. The reasons and the evidence are as relevant for this country as for Victoria.

But I note that the Aussie Inquiry took some ten months and had only 900 submissions. I wonder when our Health Select Committee will get through ten or more thousand submissions.

"Give me a child..."

What a fascinating watch was the documentary WHY AM I? last night... The "Dunedin Project" began when I first went to that city and I was aware of some of its methodology and hopes and expectations.

By identifying only five personality types among 1000 pre-schoolers and following these subjects for more than forty years all kinds of possible predictions have been able to be made. And what surprises there are: one sixth of the subjects have had serious brushes with the law. More importantly, most of these were from only two of the five "types" of pre-schoolers in 1972.

I recall a huge fuss in the Church when we introduced personality assessments into the ministry candidate assessment process in 1968. We had to assure the Examiners that the such assessments would not be permitted to contribute to the actual decision. But I can say now that from personal knowledge of many of the 200 people who were involved, these data, now regrettably destroyed, could have predicted a number of very significant failings of the individuals' later performance in ministry.

Alas, the denominations had neither the curiosity, nor the immense international resources of "The Dunedin Project". This is now the largest and most comprehensive research programme of its kind in the world. What a tool for good this could be!

But will governments commit to the cost of the kind of early childhood special education that will be required...?

Ooooh, the pain!

I’ve just had my quarterly Zoladex implant. Having taken quite a few of them “cold turkey” in recent years, I must be getting soft. I made up a patch with some Emla cream and stuck this onto my skin in the approved area and the implant went in with less pain than usual. But I could have used more cream.

While waiting for the nurse practitioner to punch the Zoladex in I studied the notices on the walls, especially the one that states a patients’ rights. It’s a lot different from what I might have seen twenty years ago. Over and over again it says I have a right to make decisions about my treatment. It’s pretty impressive and inspires quite a bit of confidence. My views are, apparently, quite important.

All very fine, until the time when I get into that last stage of care where nothing anyone can do for me will make any kind of difference or relieve the waves of pain that may be washing over me. Then they will have to say, “Oh, sorry, your Patients’ Rights have just run out. We can’t do anything to ease the intolerable pain we know you are suffering. You just have to put up with it. We just hope it won’t be too long...”

It ought to be a terminal patient’s right to ask for  - and be assessed for - physician-assisted death. It ought to be the first principle of hospice therapy that an easy and comfortable death, one way or another, is the right of every terminal patient. We must change the law. 

Old Age is No Fun

In the 1970s I thought a lot about work and leisure. I developed a theme from, I think, Earle Brill, in an interesting little book titled Sex is Dead, that work was not all it was cracked up to be.
The idea came from the ancient Hebrew myth that the punishment of Adam and Eve was not just that they were thrown out of the Garden of Eden. Adam was told that only in the sweat of his brow would he get bread. So "work", in this context, is not the virtue that our Puritan forebears would have called it but is actually a punishment. It was not intended to be fun or enjoyable, but simply done.
Out of this came the Mission to Leisure which led the Dunedin Mission to make considerable investment  in the holiday camp site at Kawarau Falls. We instituted some special programmes to help people make the most of such leisure as they had.
Lately I have been taking the Garden of Eden story a little further. Not only is Adam told that he is going to be punished by having to work; but Eve hears that only in pain will she bring forth life. Pain, severe pain, I suggest, is also presented in this ancient context, as a punishment. I didn't think much about that in the 1970s.
But, my word, in later days I have become very conscious of the amount of pain that is experienced in the world of the descendants of Adam and Eve... The sheer scale of deprivation, dislocation and every kind of pain and suffering experienced by millions of our brothers and sisters in other lands beggars description. Even with the most modern technology to bring the problem right into our living rooms, we cannot get our minds around the sheer dimensions of the problem.
And in the last couple of years in this residential community of older people, I've become quickly aware that old age is not always so much fun, either. We may have all we need of shelter and food and affection but the maladies of age that we joke about among ourselves are sometimes more than some can bear. Several people in one of our cities have died in Council or State flats over the last year or so, with no one to miss them until the stench disturbs their neighbours. It could conceivably happen here, too, in this community of 350, even with emergency call-bells in all directions.
Singing out to small groups of "over 60s", our Barbershop quartet has seen groups that were, actually, over 80 or more, many of them transported in vehicles or using walking aids of one kind and another. Some of them said the simple hot meal provided afterwards would be the best meal they would have all week. Old age, for many of them, was not much fun - even with our entertainment!
I have wondered if the God of the Garden of Eden story might not have gone a bit further and said to both Adam and Eve "And, by the way, when you get old, don't count on that being a Garden of Eden, either...  there'll be more pain that is all part of the punishment... You aren't expected to enjoy it, just endure it."
A few modern critics would suggest, as the Puritans once did about work, that pain and suffering are really good for you. But they are wrong. It is that bit of thinking that encourages me in my modest campaign for the right of Choice at the End of Life. I just don't believe that suffering and pain and misery have any virtue in themselves at all. At the end of a life of working and bearing trials of one kind and another, there is no justice, never mind compassion, in a demand that we must continue to suffer long after our bodies and minds have decided to give up. Some Right to Life is fundamental, but so is some Right to a Good Death.
Of course, we don't base all our thinking and acting in these days on an ancient myth and its very simplistic views of right and wrong and good and evil. But those ancient thinkers seem to have sensed something that rings bells for me. The sweat of labour and the pain of life's beginnings and its endings, are not part of some great scheme of things. They are just reminders that in some way, we may be less than we can be And we must do the best we can with them. And there may be no lack of virtue in merely putting up with the one and choosing the avoid the worst of the other.

Spasms of pain

In Aussie in the early 1990s Bev and I enjoyed occasional glimpses of Andrew Denton in a Saturday night TV comedy show. Now I am hoping to hear him at the annual meeting of the Voluntary Euthanasia Society in a few weeks' time. Andrew has spent most of a year inquiring into Physician Assisted Death around the world and his podcasts on the Wheeler Centre have encouraged many of us to press for law change here in NZ.
I have been intrigued with his account of his father's death: "at the end, it was a violent series of spasms. It was as if something had crawled inside him and was tearing him apart from the inside."
I was immediately reminded of the pains after my first major surgery. Obviously not normal post-op pains, mine went undiagnosed and untreated for 36 hours. It was excruciating for up to half a minute at a time. I described it as being stretched on a rack with every part of my body from shoulders to knees trying to tear me apart. I wrote a three page report for the Hospital, but heard nothing back. Later someone suggested I had experienced
 tetany spasms.
If that kind of pain is to be my lot in my last hours it will probably be too late for what I would have wanted to do earlier: to have the choice of a peaceful and gentle death before that happens.

We need to change our thinking and change the law.

PSA much the same...

When we saw my consultant a few weeks ago he wanted to step up our routine tests to two-monthly. He was concerned about the effect of the heavy medication on my liver. But I suggested we continue with three monthly checks and that was agreed. With three-monthly implants and consultations I felt it would keep life simple if the tests continued on that basis, too.

Well, over the last couple of weeks I have been wondering how it was all going. I wasn't overly worried, but having been doing PSA tests every month I was a little curious as to how things were going.  So last week I presented myself for the three-month tests at just two months. The girl doing the job queried the order and I said airily, "Oh, we've decided to do it every two months" and she went ahead. 

My GP's nurse kindly looked up the scores for me next day.  PSA still 24, still up, but almost exactly static for the third month in a row. And my liver, she said, was "great". All very encouraging....

HOW many Submissions?

I hear that the Select Committee on Health may have no other topics of business for some time.  We are told that the staff have been sorting no less than 15,000 submissions received by 1st February. They are reported to be somewhat overwhelmed by the amount of work involved. The issue of "voluntary euthanasia" for some terminal elderly is alive and well and our people have been having their say.

It will be really unfortunate if the sheer amount of paperwork gets in the way of a good discussion. And it will be fascinating to see the analysis of the submissions. Given that quite a few people will have just written statements such as "I am against any form of doctor assisted death" (surely that is not so much a submission as a vote, of course) there must still be a large number of citizens who have given serious thought to the issue.

But how many points are there to make on this matter? Isn't it probable that we've heard there is to hear on both sides of the issue, that we have heard all the arguments, that we have access to all the necessary facts? If my request to be heard in a personal submission is accepted, I can't imagine anything I can say that won't have been said by dozens if not hundreds of others. In a way, I won't be upset to be declined an appearance.

What the country needs now is for Parliament to make some kind of decision that reflects - to an appropriate extent - the declared views of the majority of the population. The Committee can help this process by a thorough analysis of the submissions and the issues and, perhaps, a reasonably prompt and decisive report to Parliament.