By Bob Buddemeier

Let me put this as delicately as possible.  You are going to die.  If you are like most people you don’t know when, where, or how, BUT you have some definite positive or negative preferences about the answers to those questions.

A recent presentation by Jan Rowe, RN (ret) and Athera Brockbank, Clinical Manager for Providence Hospital hospice, laid out the choices to be made and actions taken in anticipation of life’s end – both well in advance and when the end draws near.  Their presentation addressed primarily medical issues, with an admonition to also take care of the paperwork and other advance arrangements: will, trust, designating a health care representative, powers of attorney, mortuary arrangements, etc.

This article is a summary of the key points of the presentation, including guidance on where to find further information. A video of the presentation is available for viewing on MyRVM (Go to MyRVM>Staff Departments & Services>Health Services>Educational Resources>End of Life Presentation 2025.

Record of Preferences:  The do-it-in-advance items are preparation of an Advance Directive (AD) and a POLST (Portable Orders for Life Sustaining Treatment) form – and discussion of the contents with your medical provider and your Health Care Representative, who should be willing to support your choices. These are the places to record preferences such as “do not resuscitate” or “do not intubate,” for example.

The POLST is primarily oriented toward emergency personnel and first responders; it needs to be signed by your Principal Care Provider, and should be posted on your refrigerator door.  The AD is also known as a living will but it does not need to be drawn up by a lawyer or notarized; it must be witnessed by two people. It is a flexible document – although standard forms are available, this can be drawn up in any way you want.  Copies should be given to your medical providers and family or friends who may be looking after you or your interests.

Treatment Options: There are two treatment options to be considered in case of serious or terminal illness, palliative care and hospice.  Both require referral by a doctor. Palliative care is for those who are seriously ill and need special care (e.g., for pain management).  The Providence Hospital palliative care operates though their home health care program, for people who can’t conveniently get to a hospital or provider’s office. It can be combined with a medical treatment program.

Hospice is for those with a prognosis of death within six months. It cannot be combined with medical disease treatment, but it does not need to meet home health care requirements. It is focused on the relief of distress and symptoms and attends to the individual’s emotional as well as physical needs during the final stages of life.

Death Management:  In Oregon, the terminally ill patient who wishes to control the circumstances of their death has two recognized options:  Voluntarily stopping eating and drinking (VSED), and Medical Aid in Dying (MAID), enabled by Oregon’s Death with Dignity (DWD) Act.

VSED results in a natural death, is usually painless, and requires no permission or authorization.  However, one’s doctor should be notified, and the process does require determination and may require 24-hour care.  The official cause of death is recorded as either the underlying disease or dehydration.

MAID is described as follows – Oregon’s Death With Dignity Act provides an end-of-life option that allows a terminally ill, qualified person to legally request and obtain a medication from their physician to hasten their inevitable death in a peaceful, humane and dignified manner at a time and place of their choosing.  To be “qualified,” people must be over 18, competent to make decisions, and able to administer the medication themselves.  They must make two separate oral requests and one written request to the  MD or DO who will write the prescription, and have a second doctor confirm that life expectancy is six months or less.  Death is recorded as caused by the underlying condition.

Information and advice: Jan Rowe and Prathiba Eastwood are End of Life Choices Oregon (EOLCOR) volunteers at RVM.  EOLCOR is a 501(C)(3) non-profit that performs the following services free of charge,

• Make home visits to educate clients and loved ones about all of their choices
• Offer emotional support, especially to those without family or caregivers who agree with their choice
• Work closely with hospice personnel
• Help find supportive doctors and pharmacies
• Offer guidance through the MAID process and info about VSED
• Assistance and presence at planned deaths, if requested

RVM permits MAID and VSED in all living situations except the Memory Support Center.  For information on RVM policy and potential support, see Melissa Preston, Aaron Williams, Fr. Joel, or Linda Bellinson.

The RVM library has an information binder entitled “Resources in the RVM Library and Beyond on Death and Preparing for It.”

Offsite Organizations

END OF LIFE CHOICES OREGON                       503-922-1132
www.eolcoregon.org

VSED Resources Northwest                                   360-919-6363
VSEDresources.com

Oregon Health Authority
Oregon.gov/oha
Search “Death with Dignity Act”

Death with Dignity National Center                    503-228-4415
Deathwithdignity.org

Compassion and Choices                                        800-247-7421
compassionandchoices.org

 

 

 

 

 

 

 

by Eleanor Lippman

 

Two things governed the decisions my family made: financial issues and lack of imagination.

So, when it came to family vacations, the only out of town location my family ever considered was Atlantic City, New Jersey, or as we in Philadelphia called it, “Down the shore”.

Financials determined whether we even saw Atlantic City during the summer or whether we were lucky enough to actually vacation there and how long we stayed.

To prepare for an actual down the shore vacation, my father would empty out his delivery truck, moving its contents to the basement of our house, and we would pile into the truck sitting on suitcases and holding on to beach paraphernalia and other much needed supplies, three and eventually four children, two adults, everything needed for our stay. After unloading and settling us in at our temporary lodging, my dad would return to Philadelphia to work. If our stay included a full weekend or two, he would arrive in his delivery truck on Saturday after his morning run and on Sunday afternoon, he would return to our empty house in Philadelphia. He’d spend his two half days bravely sitting on the beach with us under an umbrella with several bath towels covering his legs completely. You see, my father, with his corn flower blue eyes, had skin the color of milk, skin that was so sensitive to the sun, any exposure would lead to misery. With one exception. My father drove his delivery truck with the driver’s side window down and his left arm resting half outside and half inside ready to manually signal his turn direction. By the end of summer, the skin on his left arm was nut brown from his finger tips to where his sleeve ended with a white band of protected skin under his wrist watch. That arm never feared the rays of the sun. His right arm was always milky white.

During one of our summer vacations, when we rented a beach house for two or three weeks, my father showed up on weekends as was his usual practice, and on the final day, with his truck emptied out, he was ready to haul us and our gear back to Philadelphia.

When he arrived to take us home, he had a big surprise, but we had to guess what it was. No clues other than “something new”. All during the packing and loading the truck we pestered him with guesses. All during the ride home there were more, millions of ideas of ‘what was new’. We’d yell out a new guess and hear him laugh and watch him shake his head no.

We reached home, wife and four children, and still had not guessed what was new. After unloading our things and reloading the truck with my dad’s merchandise and still flinging guesses at him, my mother called us into the kitchen for dinner. I was probably about eight years old at the time and I remember my very last idea for what was new. As I stood in the doorway to the kitchen, I was certain the answer was sitting on the shelf across the room: “a new toaster”. Who knows what prompted that thought, but it was the best I could do.

I’ll never forget his big reveal. As his four children gathered around him, he was ready to tell.

The answer: he had shaved off his bushy mustache.

To this day, I still don’t know if my mother had guessed correctly.

by Bob Buddemeier

[Material in italics are editorial comments inserted into the report.]

On Nov 14, RVM resident Steve Harris interviewed Alan Journet and Kathy Conway, founders and Board members of SOCAN (Southern Oregon Climate Action Network, https://socan.eco). This presentation to an RVM audience was part of the “Discussions With…” program series organized by Father Joel, Steve Harris and Laura Monczynski. The series is intended to promote educational engagement with community leaders to bring attention to the controversial issues that are drawing attention in our community. Topics so far have included issues related to homelessness, marijuana, and climate change, with additional sessions planned for the future.

This article is therefore a serendipitous companion piece to the “Green goes to Portland…” article, which describes an RVM Green Team trip to a meeting to build connections with a consortium of Green Teams from six Portland-area CCRCs, all focused on Climate Resilience.  The events were independent, but both oriented to the same issues (Climate Change) in similar settings (CCRCs in Oregon).

In response to Steve’s opening question, Alan outlined his progression from college biology and ecology teacher to community climate organizer. In the process, he raised the point that the science of climate change is diverse and complex. Alan said that he had spent a long time studying the various subjects (e.g. marine and atmospheric sciences, geology, biogeochemistry, etc.), had decided that the science was credible, and that his responsibility was to educate people beyond the college classroom.

Later in the program he returned to the question of the multiple disciplines involved in Climate Change science. Alan remarked that there are many different kinds of evidence for climate change, and all point the same conclusion — that humans have been affecting the carbon cycle and the chemical composition of the atmosphere at least since the industrial revolution.

Steve initiated discussion of the effects of climate change with his personal observation that the number of “hot spell” days (>100^oF) had increased. Alan answered that he had worked with data from the local NOAA office, and found that over the past 20 years the average annual number of 100^o days had increased from 7 to 12, although the annual count is variable, with some years >20. He said that the trend is upward, and will remain so, and he wished that temperature variations were reported relative to the past trend rather than the past average.

Turning to the relationship between severe weather and climate, Alan observed  that elevated temperatures provided the energy that fueled the rapid formation of high-intensity hurricanes, the increased atmospheric moisture that created floods, and the severe droughts that set the stage for wildfires. As long as warming trends persist, we can expect that the frequency and intensity of extreme events will continue to increase.

In response to Steve’s question about a scientific consensus that we are headed for 2.1^oC, Alan replied that we need to hold the global temperature increase to 1.5^oC (2.7^oF) to limit damage, but we are clearly headed for much higher values, and for ecosystem destruction. He interjected that in the early days of climate projection, the scenario of fastest temperature increase was called the Worst Case, but after it was recognized that this was actually the path that temperature increase was following, it was renamed the Business As Usual (BAU) scenario.

Discussion turned to convincing people that carbon budget accounting needed to be done.  Alan said that “money in – money out” was no longer the only accounting that needed to be done; “carbon in — carbon out” is also a critical balance to assess for business, industrial and agricultural activities.

Dealing with climate deniers or disbelievers received a good deal of attention.  Alan cited the Yale Program on Climate Change Communication as having found that the most effective persuasion is by friends and relatives – but these people are relatively unlikely to talk about climate change.  Finding some kind of common ground is important for discussion – perhaps a desire to leave a habitable planet for our children.

Alan related some tragicomic anecdotes about attempts to inform recalcitrant deniers, ending with a brief story about James Inhof (former OK senator), who thought the climate change hypothesis was correct on first reading of the scientific basis, but changed his mind after discovering how expensive it was going to be to cope with it. Alan also told of being asked if climate change was just a natural process, to which he had replied “I hope not; if humans caused it, they may be able to control it.”

[Comments: (1)  The emphasis on dealing with denial in the RVM presentation stands in contrast to the experience at the Portland meeting.  In my Portland breakout group I asked how the other Green Teams dealt with opposition to climate related action, and it turned out that nobody else considered it an issue—their institutions were accepting/supportive of the activities.  (2)  The question of cost vs climate seems to me a major issue; as climate change has become better understood and documented, opposition to action is more often based on expense or uncertainty than on claimed inadequacies in the science.]

The question of what individuals can do, now and in the future, was addressed by Kathy Conway.  In addition to monitoring lifestyle and purchases to minimize transportation costs, plastic usage, and environmentally exploitive products, she stressed the central role of beef as a particularly climate-unfriendly food product because it is a major source of methane (a powerful greenhouse gas) from the ruminant digestive processes. Reducing beef consumption is a practical and economical option available to most meat-eaters.

[Closing observations:

Marketing: one lesson that can be inferred from the success of the ongoing broad and well supported actions of the Portland Consortium is that the climate-related environmental commitment represents an opportunity to do well by doing good – that the presence of these activities is a positive marketing factor, potentially attracting not those who agree, but also those who are generally inclined toward community service.

Extended Community building: Our experience in Portland was that the Consortium members were reaching out to establish links both with other retirement communities and with like-minded community organizations.  RVM is at a different stage in the processes, but the Discussion presentations represent encouragement for outreach and cooperation, and the Green Team’s growing connection with the Climate Resilience theme of the Consortium sets the stage for further outreach and collaboration.]

by Connie Kent

We have indefinite and definite articles. Generally, we use an indefinite article (a, an) to refer to any old whatever it is (a dog, a pillow, an octopus).  We use the definite article (the or that) to refer to a specific whatever. For example, “The dog bit me” (the one right over there); the pillow (the one I use every night); that octopus (the one you can hardly see because it blends in with its background).

Idiomatic Use

But some uses don’t follow the general rules. These exceptions are idiomatic; that is, there’s no explanation. That’s just how we speak. You may not even be aware of these irregularities.

None. We don’t use articles at all before some nouns. For example, names of sports, such as football. For example, “He played football in high school,” unless we’re referring to a specific game, such as the football game last night. No articles before proper nouns, such as the names of businesses (such as Amazon). And we don’t use articles before names of courses, such as chemistry or economics or English – again, unless we refer to a particular class. For example, I don’t like English. But I do like the English class taught by Ms. Kent.

Sometimes yes, sometimes no. You go to bed, to school, to bed, to sleep. But you go to the library. If you’re American, you go to the hospital. (If you’re British or Canadian, you go to hospital – no article). Back in the U.S., you go to the police station, to the hardware store, or to the grocery store. If you intend to point to a particular grocery store, however, it’s the Albertson’s on North Phoenix Road (as opposed to the one off West Main).

Some curiosities. One tells a lie, but the truth.

We might travel to Canada or Mexico, but we go to the Netherlands, or to the Philippines.

We might climb Mt. McLoughlin (or, for the less ambitious, Roxy Ann Peak). But we climb the Matterhorn, the Eiger.