How Lawyers Can Screw Up The Way You Die

When I was a practicing attorney, my colleagues and I would often sit around at lunch, arguing about whose sandwich was better. As a beleaguered single soccer mom, I sometimes welcomed the opportunity to fight about anything. It was habitual, and sort of a stress reliever like a good gym workout. Alone in our world of books and “right and wrong,” (as in “I’m right and you’re wrong”), we spent hours creating problems to solve so we could make money. Lawyers – like many professionals – form their own little bubble, but unlike say, IT guys or architects, our bubble is filled with righteousness. And our bubble’s better than your bubble. I was a litigation attorney for 15 years and the very qualities that made me a really good lawyer made me kind of a lousy human. Arrogance, aggression, a niggling persnickety obsession with every little thing…. these are highly valued in the legal profession. Of course, when you’re a girl lawyer and you act like a guy lawyer you’re considered a “real bitch” which is a badge of honor in my former profession. But I digress, which I often did in Court, to direct the judge’s attention away from my client’s crummy case, for instance. It worked pretty well, but there’s only so much smoke you can blow up a judge’s robe before you run out of hot air. Litigation wore me out, grated my soul up like cheese. I billed my last hour in 2004, gave away all my stuff, and left the East coast to be a cowgirl in Colorado. Turns out lawyers, the human equivalent of gnats on a summer’s eve in Jersey, are everywhere, even out here in the Wild West. Like the old horror movie, Night of the Living Dead, you can’t escape them. I hung up my chaps and headed back into civilization to make a living as a healthcare consultant in an area called Advance Care Planning. This is the process of having individuals, families, and their healthcare tribe talk about what they want their lives to look like as they get sick or old. Lo and behold, who shows up to weigh in on this? Yep. The lawyers, laying claim to the reams of fussy paperwork around “estate planning” (which is about Dead You, not Living You) and not even understanding that humans – while alive and making decisions about future medical care – actually need space to talk to each other and their doctors. What they don’t need is check boxes and legalese. In the 90s there was a series of very sad cases, three 20-something year-old women who ended up in chronic vegetative states due to accidents or overdoses. Parents and spouses argued in court while their poor corpses stayed alive on machines. These cases (Karen Ann Quinlan, Nancy Cruzan and Terry Schiavo) led to the passage of the Patient Self-Determination Act, a law that allows folks to determine their future on life support (or not) via the “Living Will.” Will? Did someone say ‘will’? Cha-ching! Another document we can create, own, and scare people about. And this is how lawyers stepped in to own your dying process. Without a heart for the work or an understanding of the doctor-patient-family triad, the suits jumped in and decided they would own the process of documenting death. Lord, they are such a pain in my ass. Lawyers have no business in the field of Advance Care Planning. None. Zero. You don’t need a lawyer to appoint a healthcare agent (through a Medical Durable Power of Attorney) and Living Wills are no longer worth the paper they are very expensively printed on. Lawyers don’t get this because they don’t get healthcare in the trenches. Understand that I’m committing heresy here and as we speak some very tight sphincter somewhere is preparing to sue me for the unauthorized practice of law or something. Whatever. I’m on a mission to wrest the dying process from the lawyers and give it back to the people and their healthcare team. It’s noteworthy that lawyers actually can kill us in many ways – death by a thousand subpoenas – but still, this is none of their business. Here’s what happens when a lawyer gets involved in Advance Care Planning: they tell you to appoint a healthcare agent, but don’t stress that you must talk to that person and all other loved ones about your values and range of decisions. They have you check the boxes on a living will (DNR, DNI etc.) but don’t disclose that it’s basically a useless document. Clients leave thinking they have a Do Not Resuscitate Order when in fact they have a document that will likely be lost in the system somewhere and no one will even invoke until the patient is (1) unconscious; and (2) declared brain dead or terminal by two physicians. Trust me, by the time that document comes into play you are already “machined up,” in the ICU, tubes and vents everywhere. Lawyers have no idea how ineffective this document is. Then, after having you sign forms prepared by their paralegals, in addition to charging you too much and not informing you enough, they often just have you pack the whole bunch of papers into some obscure place where no one knows about them. Totally useless, but worse, the whole scenario gives you a false sense of security, I’ve taken care of that now, when in fact you haven’t done it correctly or effectively. At all. Lawyers are important if you’re in trouble or you have a lot of money. Death and dying are trouble, alright, but not the kind a lawyer can anticipate or avoid. It’s not a medical emergency either. Death is just a natural process that we have altered through technology. Unable to keep our minds on pace with medical progress, we tend to hide our heads in the sand and then act horrified at these awful endings created by medical aggression. This can all be avoided by some pretty simple steps – like talking to your loved ones, filling out your own Medical Durable Power of Attorney (here’s a guide to state documents), disseminating them to everyone involved from family to physicians. And then talking some more. My ER doc friends tell me there is no document that comes close to the help of a well-informed family at the bedside. And with the current chaos in electronic medical record systems, chances are no one will ever know of or see that $500 document you signed in some lawyer’s office. You may not be able to keep lawyers out of your life, but you can surely keep them out of your dying process. You don’t need a lawyer to make a future healthcare plan. Just talk to regular people – your family, friends, and healthcare team. Talk early and often about what really matters to you. You’ll only be in a “to pull or not to pull the plug” scenario after a hundred smaller decisions made by doctors and family. If you want to end up tethered to a machine you certainly can be, but it doesn’t have to be that way. You can empower your people to make sure that you remain in control of your dying process even if you can’t make decisions at the time. Give others the power to do that. Just make sure they don’t have “esquire” after their names.

I Am an 800 lb Gorilla

I don’t believe in hitting kids but as the single mom of three boys it’s not like the thought didn’t cross my mind. Children are so adorable and nerve-wracking – like heaven and hell in the same package. Yet despite what I thought was restraint on my part - I never laid a hand on them - my beautiful, hulking sons were apparently scared to death of me. Here’s the thing. As a second generation Italian mother I’m pretty sure I managed to telegraph a lot of bad ju ju without being a physical menace. An Italian mother has an arsenal of threats that involve evisceration with spoons, coupled with decibel levels that put the Air Force to shame. This kind of mother is an 800-pound gorilla. Where does she sleep? What does she eat? Wherever, whatever she wants. I’m not proud of this. But like we say in Jersey, I’m just sayin’. Now, don’t get me wrong. We are a fiercely devoted tribe, my boys and I (and now their amazing families), and we definitely put the “fun” in “dysfunctional,” but as I watch young mothers in public places gently give their demonic two-year old “choices” around behavior I realize that was not my style. I’m almost a little grateful that my boys feared me because that came in handy in the teenage years when they were jumping off the roof (onto a trampoline) and the cops knew me by my first name. Their knucklehead, adorable teenage friends apparently feared me as well, though they loved my open fridge and the fact that I used the “F” word with impunity. Once I discovered a son smoking weed out of a huge bong with a couple of his buddies and when they saw all 5’3” 115 pounds of me the kids fled in abject terror while I pulled my boy out of the house by his ear, took him into the back alley, and threw his $200 bong into oblivion. We watched it explode into pieces and he looked at me, comprehending. “Capisce?” I asked. “Yeah, yeah,” he was sweating, “Capisce.” An Italian mother doesn't pause and search for the right words. We are raised on impulse and anger is like mother’s milk. This all has pretty disastrous consequences in the regular world but is the everyday landscape of an Italian family where love is never doubted and loyalty is so fierce you want to be a part of our clan. We can close ranks and protect and help each other like an army of love but often, as my oldest reminds me, it’s “a slap and a hug.” We’re all grown up now and the boys are bravely facing parenthood and work-life challenges with the kind of openhearted humor that defines us as a family. But there are still conversations to be had, crucial ones at this point as I head into my sixth decade. Italians don’t consider themselves “’Medicans” (read: Americans, that is, non-Italian white people) and frankly we often feel a little sorry for those whose ancestors stepped off the Mayflower. They can’t seem to talk about a thing, other than their portfolios or whatever. When an Italian mother wants to talk about what’s going to happen should she gets old, maybe loses her mind and her body goes south, it goes something like this: “Boys, I have to talk to you about what happens when I get old and sick.” “Ma!” “NO!” “You’re never gonna die!” “Shut up. Sit down. Listen to me. And if you don’t do what I want I swear to God I will come back from the grave and kill you with a spatula which will be a long and painful death.”
Then they listen, bless their ever-loving hearts. It’s excruciating to watch people get flustered and sweaty at the thought of talking to their families about anything, let alone illness and death. When I worked briefly as a chaplain on an ICU I saw families standing like statues around a deathbed, unable to touch, talk, or navigate this inevitability with any skill at all. I guess when you’re raised in an environment where your mother repeatedly reminds you of your mortality, talking about death is not such a big deal. But for non-Italians it’s apparently complex and nearly impossible. And many other cultures and immigrants have no problem talking, loving, and singing to their dying family members. How boring this country would be without our huge and varied cultural landscape. If Trump was president back when my grandparents came from Naples maybe he would have tried to keep them out too but it wouldn’t work. We find a way. The tenaciousness we bring to this scene is a welcome relief and a catalyst for great fun, great achievements and brilliant authentic living. Lordy, if exclusively white people lived in the USA – with their carefully raised two-year olds who get to decide things – can you imagine? Havoc, I tell you. Because underneath all the yelling my boys knew and still know that they are the center of my world and I would tear limb from limb for them. At a little league game, when some asshat father was yelling at my son I got right in his face, immediately. The bleacher parents sat in stunned silence as I explained to this man what I would do to him if he didn’t shut up. Afterwards, a big guy came up to me and said, I wish you were my mother. My own mother’s fierce devotion makes me look like a wimp. Her love for us was sometimes bigger than we could handle, but we never doubted her devotion. When she was diagnosed with Creutzfeldt-Jakob (“mad cow”) disease at age 66 we were unprepared to lose her, but as spastic paralysis and blindness took her into a vegetative state there was no conflict when the next medical step was a feeding tube. She would have killed us if we went that route, and we knew it. She came to my house where after a few weeks she died at two a.m., in my brother’s arms. I am okay being the 800-lb. gorilla if it means my kids felt safe and loved. And I’m 100% sure that when this big gorilla starts to fade they will lift me up, stare down aggressive doctors, take me out of some bad medical situation immediately and love me big, right to the end of my loud and wonderful life.

How Do You Solve a Problem Like The Donald?

There’s this fleshy old Russian guy who uses the sauna at my gym.  I’ve never seen him work out, only sit in the sauna, where he reigns supreme.  In addition to squirting the sauna rocks from across the little room (anyone else be damned), when someone attempts to enter he yells CLOSE DOOR! CLOSE DOOR! which makes me feel I’m at the Gulag and then he starts at the top of his body and swipes sweat out and down and all over the rest of us as he pontificates loudly about the beauty of his stark Russian childhood.

            

This is really not the sauna experience you want.

            

The man seems to have no regard for sharing this planet – or certainly that little box of heat – with other humans.  Happily meeting his own needs loudly, let’s call him “Al,” is safe and content in his own world.  The sauna becomes like a psych lab, as I look around at the few other victims squeezed into this situation, just trying to relax damn it, but getting sprayed by the sweat of a fairly belligerent old dude.  We look at each other, eyes saying what the… maybe share a little smile.  It must be fun to be a narcissist.

            

By definition, a narcissist doesn’t give a rat’s ass about anyone but him/herself.  They’re always right about everything and nothing topples them from the throne they’ve constructed for their fabulous selves.  They say therapy can hardly ever help a narcissist because there’s just no way around the brilliant armor they’ve donned. Can you imagine swaggering through every day, deeply believing you’re correct about everything and trying to be fashionably humble about your grandiosity?  That’s a narcissist’s job – to be great and mighty, and the peons be damned.  I’m always about ten minutes from my next mistake, so I’d make a lousy narcissist.

            

Politics and religion attract narcissists like flies to horse shit.  The pulpit loves a grandiose guy who can bring the ruckus, and look –  we've install a Narcissist in Chief.  Both forums – the church and The White House – yield what looks like power, so a self-centered megalomaniac can cut a wide swathe of pain across the landscape of the damaged and downtrodden.  The scariest and most ruinous of these blindly fantastical folks are no doubt the religious people who can wear the cloak of God (!) as we crawl into the pew or the Zendo for relief.

            

It’s kind of fun, in a mean way, when you have labeled someone as a “narcissist,” as long as you are not drawn into their spidery web of delusion.  When a narcissistic religious person I knew sermonized about “speaking truth to power” I raised my hand and said, “But what if the power is self-consumed and narcissistic and will never hear you or take responsibility?”  The others in the room smirked, knowing exactly what I was doing.  Our religious icon shook his head and feigned sadness at how awful it is to be such a person.  The joke was on him, of course.  Not a wildly productive way to spend my time but when you are hurt by a narcissist (or anyone), you just want to hurt back.

           

If a narcissist is defined as a person with a grandiose self-image, always right and righteous and lacking empathy my guess is they don’t give or receive a whole lot of love.  When you think about that, it’s so sad.  They are missing out on all the best things in life.  Though they appear glorious and untouchable they actually rank pretty low on the scale of human evolution.  Is it surprising they are so often drawn to politics and organized religion where someone is bound to provide the worship their egos so desperately seek?

            

Okay, so on to the man who is bulletproof, the guy who got elected president by the sheer sharp force of his tsunami-like ego, an inability to admit fault, wrongdoing, or bad judgment, ever.  He will not change and he will never learn humility. We will watch astonished as he fails at something – all leaders do – and then blame others and move on.  CLOSE DOOR!  Yes, we can protest, scream, rant on Facebook, tear out our hair, rend our clothes in epic biblical suffering but he will not hear and he has surrounded himself with like-minded egotists.  We are stuck in the sauna with Al.

           

How do you solve a problem like The Donald?

            

The Dalai Lama says that if you take any problem, hold it up to the light and change your perspective, it will be solvable. Period.  How can we hold up The Donald to the light, turn him around a bit in our heads (and hearts) and change perspective to relieve our suffering? First, know that he suffers. He’s not doing all that well as a human, maybe wasting this incarnation. The power he yields is illusory and a pile of ashes compared to the power of truly compassionate people or the power you have right inside your bright and viable brain and heart.  You can waste that power being smarmy on social media, making fun of him and the gang in the White House.  That’s an option and lots of lazy progressive people appear to be going down that path.  Or you can actually change the way you see this conundrum, stop being inflammatory on Facebook and assess your life for the ways in which you can act.

            

Suzuki Roshi, the Japanese monk credited with bringing Zen Buddhism to the West was a man of very few words, but these three may help:  Shine one corner.  Perhaps you can’t take down the President but you can find a place in your own life where there is suffering or dullness and pain and make it shine.  Clean it up.  Pick a cause in your community, a teenager who needs help or a family that can’t make rent and just do something.  Don’t waste your precious life sharing incendiary cartoons of Trump with Putin’s fist up his ass.  People are suffering.  Find one corner, and make it shine.

            

I won’t allow myself to watch any media that has to do with Trump.  For the next several years I won’t watch TV when he speaks or videos or newscasts that give him a voice.  I am hoping that somehow he will actually help the demographic who elected him but I will be watching vigilantly for policies, acts, or events that cause harm.  Like most people in love with themselves, DT talks an awful lot.  I won’t listen, but I’ll figure out what’s going on and watch out for people in my world who might get hurt. 

            

When Al’s in the sauna, I won’t be.  In the interest of staying healthy, I’m just not going to expose myself to rank toxicity at the gym or in politics.  Who knows why there are people who walk this earth blind and disconnected like Al and Donald Trump and religious charlatans?  How do you solve a problem like The Donald?  You love your neighbor, be good to those who hate or hurt you, give your time and money and presence to places of darkness.  Maybe keep your head down and the TV off.  The election of a narcissist has shaken us out of our fat happy slumber and thank goodness for that.  We are awake now, so let’s not squander the opportunity to be brave and big-hearted. If everyone could shine one corner, think how bright the world would become – Donald or no Donald.  

Darkness cannot drive out darkness; only light can do that. Hate cannot drive out hate; only love can do that. Martin Luther King, Jr.

So. Let’s go make us some light.

            

DENTURES AND THE PRIMITIVE BRAIN: How a Guy With White Teeth Reminded Me to be Kind

I met a colleague for coffee yesterday.  Scott’s a handsome affable 60-something with salt and pepper hair and a big bright smile.  A smart and friendly salesman, I just assumed he had his teeth capped or professionally buffed – they were brilliantly white – in order to increase sales. You know, that good ole boy smile from the lanky Southerner.

Turns out Scott grew up in destitute poverty, in a “mill town” in North Carolina and he never brushed his teeth.  Nobody did. As a kid he never owned a toothbrush and the cultural ritual was simple:  at 19 you went and had your teeth pulled out, and got dentures.  So there you go.

In a nanosecond when I first met Scott I made a judgement.  Like a Geico commercial for the human race, it’s what we do.  I saw bright white teeth and I assumed vanity and increased sales.  I was profoundly wrong.  Scott told me that kids were expected to drop out of school and work at the mill at 16 and when one of his cousins resisted because he wanted to go to college, some other kids bashed his head in.  There you go, college boy, they said after they cracked his skull, how’s your brain now?  His cousin somehow went on to Harvard.

Everybody has a story and we don’t even bother listening to it before we’re filling in the blanks, reading between the lines, sizing things up and packaging it so we’re safe.  I see fake white teeth and I assume vanity, not abject poverty, because the former fits my mental box space while the latter breaks my heart and it just hurts to think of a kid growing up without a toothbrush in a town where you get your skull crushed if you want to go to college.

            

Scott never saw an egg till he was six years old.  It was fatback and grits every morning for breakfast.  As I heard his story unfold over hot coffee, safe in this grown up world of laptops and lattes, I thought about my own kids and how lucky I was to be able to raise them in this country where they had good medical care and even a pediatric dentist.  But it’s the same country where Scott grew up, and how many hundreds of thousands of kids have lined up at 19 to have their teeth pulled out? I owe my soul to the company store – Johnny Cash sings about the prison of an industry that owns generations of people. Your Daddy works at the mill (or the factory, or the mine) and as soon as you’re old enough, you head down that same path.  Used to be there were no greenback dollars in these town, only “company dollars” you could use at the store to buy groceries – owned by the company – and pay your rent, to the company.  A prison, with no way out and then the company fails and the suits leave and you and your family are left with nothing.  No exit strategy, no education, no hope in a town that’s been raped of trees or mountains or beauty of any kind.   And Scott sits in front of me, a big happy smile on his face, all that soul history still inside him.

            

You never know the truth about anybody by just looking at them. I’m pretty invisible – a flat-chested 60-year old – so it’s nice to fly under the judgment radar but of course I too get sized up whenever I meet a new human.  Neuroscientists would tell us it’s part of the brain’s mechanism for ensuring a safe environment but we need to outgrow those primitive mindsets and reprogram our intuitive responses.  It’s too risky at this point, to judge a guy by his white teeth or a woman by her clothing.  It’s also pretty clear that our politicians never bothered much about kids like Scott, because it was that cultural demographic that elected Trump.  So unseen and unheard, people living in the scrapheap of the company towns lined up at their junior high school and voted for a guy who paid attention.       

            

Scott has opened my eyes wider.  Still freshly awakened by his particular story, I am less interested in my own fiction about the cashier at Staples, the young girl at the gym, or the gnarled hand that reaches out to me on just about every corner of Seattle.  As Pope Francis said when asked about homosexuals, Who am I to judge?  If Scott hadn’t told me about his harsh beginnings, I would have sashayed through our connection with my assumptions fully intact.  I like that he blew them up and I’m wildly excited about more of that and less of my tired smugness.  When dentures or high heels, saris, head scarves, age or skin color trigger some complacent summary of a life in my head, I’m just not going to believe it.  Here’s what I’ll try instead, because it’s a universal truth:  Be kind, for everyone you meet is carrying a burden.