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Saturday
Dec242011

Christmas 2011: Different Card, Same Author

Other than work, I haven't written much since starting my new job July 12. There, I've written about a billion words, mostly in email, and managed to string together a few good ones in other people's names.

Being "old school" when it comes to Christmas starting on the 25th, lasting through the "twelfth night" celebration of the arrival of magi, astrologers, seers, sages and other wise guys at the manger, I usually wait until Christmas Eve to write cards.

Over the past 15 years, I've written those in someone else's name too. Her paws were worse on the keyboard than my typo-prone fingers. The cards always featured my beloved dog Boo Boo on the outside, and a year in review message from her from dog's-eye view, recounting our travels, visits to and from friends. Boo also offered a little political commentary, and always extended her peace and waggy good wishes to all people, no matter what they believed.

My conservative friends said Boo's Christmas cards felt pointed. My liberal friends adored them. My apolitical friends wondered why they were so long. Genre satire requires that one stick to form, in this case, long, largely irrelevant information, with a point of view only a few recipients shared or cared about. For the record, I'm a fan of  the holiday family update letter tradition.

But on the second day of my new job, ending more than a decade of Boo's office-dog/my work from home status, her fading 15-year old physical presence deteriorated suddenly, as though she knew our time together wouldn't be the same, so she'd be on her way.

I'm not writing personal cards this year. It wouldn't be the same. Next year.

But my new job afforded me a joyful opportunity to craft a holiday greeting that, for us, is also mission driven. At some point during the creative process -- mysterious, befuddling, and frustrating as it can be -- a chill came over me and a tear welled in my eye. Boo's annual greeting was taking a different form this year, but for me and those who received cards in years past, Boo's paw prints are all over it.

Diwali, eid-Mubarak, Bodhi Day, Chanukah, Kwanza, Solstice, Christmas, et al, may you be blessed however you find your joy, however you celebrate something larger than yourself -- each of us a different card with the same author.

 

Saturday
Nov262011

Angels Everywhere


Watch More Christian Videos on GodVine.com

Monday
Jul182011

Boo: 1996-2011

I’m staring. Motionless. Looking at but not focused on the coffee table against the wall where the flat-screen, cable box, two remotes and a narrow table lamp sit in one corner of our room. Standing between the bed and the table, my stillness belies powerful emotions coursing in and around me, immobilizing me, numb, uncertain what to do next. Every moment uncharted, every routine shattered. In front of the TV a tall white candle flickers amid smoke from sage burning in the zebra ashtray. Next to it is a milk bone, one Happy Hips bacon strip, and the small fluffy white dog with the jingle bell that Boo made ring by shaking it in her mouth before flinging it across the room. In her good days, she would leap to its landing place, ring, fling, and repeat.

             When Boo lost her hearing last year, she lost interest in that toy. Her sun-moon-stars collar, with the “Nothing But Love” tag sits around the base of the candle. But where is the red kong? The first toy; waiting for her when I brought her home from the New York Avenue Shelter in 1997. Where did she leave it? The red kong survived seven moves in three states and many other trips around the country. I have to find the kong, I think, frozen, staring blankly through the odd assortment atop the coffee table altar.

            I know where it is daddy, came a spunky voice from within.

            “Boo?” I asked out loud.

            You know where it is too, I can hear her say, my right ear tingling on the inside. A knowing smile crosses my face as the rest of my body, perfectly still, gazes into the cluttered corner on the other end of the coffee table. At my feet Boo’s few possessions are all gathered; two blue-and-white ceramic bowls with a dog’s face in the bottom, her three Cali-weight sweaters, black leash, well-worn tennis ball, blue bear that replaced the purple bear she tore the stuffing out of when she still did those things, and her lunch pale with which she always traveled. All her things gathered below the candle, sage, collar, milk bone, bacon strip and fluffy white dog with the jingle bell. On the table’s under-shelf, six pairs of shoes that logged thousands of happy miles walking with Boo, now unintentionally appropriate as part of this tribute.

            That the one element missing from the coffee table altar is the red kong, her original toy, makes sense. The last thing I have to find was the first thing I gave her. It is a game, only now Boo seems to be teasing me. We had it like that, Boo and I, a communication I only fully appreciated late in her life, even though it’s been evident to anyone who knew us for 15 years. After I figured out she’d lost her hearing, I kept talking to her just the same. She no longer heard me, but she felt me, and with mind pictures I’d always created to communicate with her while I spoke, and a little canine sign language, we adapted to the first signs of her decline more than a year ago. She stayed closer. So did I. She didn’t want to be alone. Neither did I.

            I turn on my heels wondering where this game will lead, excited by the adventure of finding the toy that named her. Playing with her the day I brought her home, on the sun-splashed wood floor of our row house behind what became her favorite sidewalk bistro, Mr. Henry’s, she was sleek and energtic, jet-black with a white angel-shaped crest on her chest. She zagged instead of zigged to catch the kong on an awkward bounce and I said, “You’re smarter than the average dog, BuBu,” in my best Yogi voice. There it was, her name revealed. I spelled it Boo Boo, an homage to the accident that claimed Cooper, my first dog, who died in a tragic fire on my 33rd birthday, almost exactly a year before Boo adopted me. Friends who knew Cooper speculated Boo might be a reincarnation of the same spirit. Boo seemed to pick up exactly where Cooper and I left off.

            As I turn, my eyes are drawn to the closet. Maybe it’s in that corner, opposite the coffee table but no less cluttered, backpacks and a wicker wine bag tucked and piled next to the bedside table, maximizing space in Larry’s guest room, the second time we’ve landed with him when returning to DC.  This time Boo and I arrived from California on Valentines Day. In 2001 we came from Colorado. If Boo was going to pick any of our friends to share the last part of her journey with, Larry was her obvious choice. He was her favorite dog sitter when I traveled; he found her when she dug out under my patio’s fence, then got lost for several days; he visited us wherever we lived; he gave her the most food from the table.

            With two quick steps I fling the bags onto the bed. Nothing underneath. Rifling through each, no kong. I kneel squinting into the darkness under the table, then the foldout couch. Only dust, my computer bag, and a quarter. I stop to listen, my head to the floor as in prayer.

            You had it, says Boo, my inner right ear humming. But you got in your way.

            I stand up, amused by the lilt in her voice schooling me. I close my eyes to listen deeper, willing even my blood to stillness. As my eyes open they settle on the laundry basket against the wall on the other side of the foldout couch. Three quick steps around the end of the bed and I dump the basket’s contents. No kong. Growing anxious, I deliberately and carefully return the clothes to the basket, resisting the urge to move faster. The connection with Boo seems clear, so why can’t I find the kong? Teetering on obsession, I stop myself, unwilling to be pulled into a manic search tearing things apart, a real possibility given I’ve been lurching from moment to moment in this first hour since saying goodbye.

            Slowly I walk into the bathroom, looking behind the door. I open the cabinet under the sink, thinking Larry’s cleaning service might have put it in there the day before. They leave things in the strangest places. Strolling at Boo’s recently slower gait down the hall, the same path she’d paced just three hours before between my room and Larry’s, I kneel to look under the shelf on the hall mirror. Nothing.

            Perhaps this is why she would go stand by his bed, I think; Boo was looking for the kong too. I kneel and underneath his bed, empty space. Down the creaky wood steps I descend, thirty pounds lighter than this morning with no Boo to carry, her paws and weakening muscles increasingly challenged by the well-waxed floors. Living room, dinning room, kitchen, bathroom, closet, hall. The kong is nowhere to be found. At this point, I am just looking, not listening, not seeing. Anyone can look. Anyone can guess.

            I pause at the base of the stairs, the oak banister cool against my palm. When was the last time she played with the toy? It’s been a while since she really played with anything, but back in the day, at her first dog park, Seward Square, she would wear me out throwing the kong. I would watch her zig, and leap, and time her jumps perfectly to catch it in her mouth off its crazy bounce, then rush back to me, tail awaggin’, bright eyes and slobber. And, of course, the tongue – panting, smiling – always the tongue. Again, daddy, again, she’d jump and circle me in perpetual motion, throw it again, again, again, please, please, please. It was the tongue of joy.

            Earlier this morning, as I pushed myself up off the green tile floor in the vet’s treatment room, I knew I would have to lift her dead weight if I wanted to keep her quilt. I didn’t think it possible, but this simple act deepened my appreciation for Boo’s buoyant spirit as I lifted her limp body gently, pulling the quilt from underneath her with my foot. She felt heavier without life. Pee trickled out. As I laid her down, her tongue slipped out.

            It was no longer the tongue of joy, but gave me reason to blurt a little breathy smiling laugh through my tears. Folding her quilt, clutching it close, kneeling beside her, I leaned over and pushed her tongue back in her mouth, then kissed the top of her head one last time.

* * *

We had a deal. She would let me know when she was ready to go, but we would spend every day in joy until then. Friends will tell you I’ve been a bit of a recluse since returning to DC. Everything I could be doing came up short when compared to spending more time with Boo. The world will always be there. We slept, we walked, talked, and lay reading or watching TV, her body stretched out against my leg in near constant contact. And we wrote. She has always been my writing buddy, and whenever I got into a groove, she’d be curled up right beside me enjoying the energy of the creative flow. Boo also knew when there was no flow, only block; then she’d nuzzle my arm, time for a walk. I’m sure people didn’t understand, or made assumptions about, my lack of engagement in anything or with anyone, but that’s for them to sort through. I was exactly where I was supposed to be. So was Boo.

            I knew there would be an adjustment for both Boo and I when work started. Shortly after we arrived back in DC, in need of income after living off savings for more than a year, I turned down an offer of consulting work that would have required office time every day. The money wasn’t good enough, and Boo’s anxiety at being alone was growing. It wasn’t an easy decision, but it is one I will never regret.

            Three months later, when the offer of full-time work was impossible to resist and Boo’s decline had been steady, we met Mimi the dog whisperer on one of our walks. Mimi also provided day care in her home just a block from ours. It was the perfect solution. Boo would not be alone, she could share her wisdom with the other pups, and we’d have our evenings together. We tried it out part of one day and she seemed happy there.

            Boo slept when we got home after our first long day apart. For twelve of her fifteen years I either worked from home or she was an office dog. She rarely saw a kennel, friends and fans of Boo always willing to take her into their home when I had to travel. I could tell she was content lying next to me; she’d had a good day but was happy to be home. Maybe the younger pups will energize her a bit, I thought.

            When I dropped her off for day two of day care, she stood at the top of the stoop and gave me her look. Not a scowl, nor a smile, just a peaceful knowing stare I’ve come to see as noteworthy. It was the same look I got our second day at the dog beach near Naples, Florida, in 2005. On the first day at the dog beach I waded into the water and so did she, instincts kicking in, paddling to the sand bar to run and jump with the other dogs. On the second day I waded into the water, turned around, and saw Boo sitting primly on the beach giving me the look. Now that she knew what swimming was, she decided she didn’t much care for it. 

            On the second day of doggy day care, again, the look. I sent her peaceful thoughts, wondering why. She wasn’t anxious, not shaking in the least, her usual sign of discontent. She just stared. “I’ll see you tonight, sweetie,” I said as I blew her a kiss and turned to leave for the office. This time I couldn’t go back to the beach and sit with her, I had to go.

            We walked slowly home that evening, sniffing the brick retaining wall, the tree boxes along First Street in Bloomingdale, the light post on one corner, the trash can on the other, and the third tree from Larry’s. I carried her up the stoop, inside and up to our room. She was wheezing. It’s hot, I thought, she’ll be fine when she cools down. I changed my clothes. She stood on the brown area rug next to the coffee table; her body started heaving until she spit up yellow liquid. “It’s probably the heat,” came the reply from Mimi when I emailed, “she’ll be fine.”

            I sat on the edge of the bed watching her every move. She’d changed. Larry saw it too when he got home. She paced more aimlessly. Her breathing was labored. She took water only from my hand, even when I lifted her bowl. She wouldn’t eat, not even from my hand. I spent the night in resistance, watching her pace, trying to calm her. Together we figured out she couldn’t lie on her side, but if she stretched out her front paws and lay on her belly, she could relax a little. I lay next to her stroking her head, scratching behind her ear, telling her how much I loved her. Even nose-to-nose, our favorite pose, she wouldn’t lick my face. She just stared.

            When the sun came up Wednesday morning, I carried her downstairs to pee. She was in pain when I picked her up. After a couple more hours resting as best we could, I called her vet and asked if we could come in before our Saturday appointment. They had an opening at 9:00 a.m. Forty-five minutes. I rinsed off quickly, brushed my teeth. 

            I wrapped Boo in her black and white quilt. Some of the panels had paw prints. In its center and on one edge, a splash of red, like Boo’s tongue against her black frame, now aged with white muzzle, eyebrows, belly and paws. The quilt was a gift from Lynn. She’d made it not to match black Boo, but for brown and white Mildred, Jim Capazzola’s beloved bulldog, right before Jim died. She gave the quilt to me, for Boo, in Jim’s memory. This was the love surrounding Boo as we left without saying goodbye to Larry. They’d had their time while I quickly showered. Boo slept on this quilt hundreds of nights at the foot of the bed, or in the center, whichever she chose, usually the center. This quilt is how Boo found her footing on the vet’s linoleum floor, where we sat together.

            “What concerns me more than the blood work is the difficulty I have hearing her heart,” Dr. Vail said. “That indicates her lungs are probably filling with fluid. Likely from shock to an already fragile system from the change in routine,” the vet explained. Boo and I chose to spend every moment we could together until money or health forced a change, and only when work was no longer an option, did she cede her health.

            The vet detailed various treatment options, none of which sounded good. On every other visit to the vet, for 15 years and no matter how routine, Boo shook the Boo Shake. Her big Lab-mix eyes intent, floppy ears perked, and every other part of the Whippet-mix, quivering, until she knew I’d stay with her. This morning she’s the calm one. Her demeanor nothing but Boo Chill. Not happy and waggy, but Boo doing Boo. Peaceful through labored breathing.

            “Tell me about the alternative I don’t want to hear about,” I said. The vet looked down, then carefully, kindly, detached but compassionate, she told me what would happen.

            “The irony,” I said, “is that I’ve worked to give humans the right to make this decision for themselves. It’s much more difficult to make it for someone else.”

            “Especially when they can’t talk,” she said. Her brown hair pulled back, falling to one side over her lab coat, a cobalt blue shirt underneath. Her earnestness evident in her gentle brown eyes and quiet voice reassuring both Boo and me.

            The room was still. Even the muffled barks from outside the treatment room faded. Boo’s panting rapid breaths the only sound.

            “You know her best. There is no right or wrong answer here. Some people choose every treatment possible no matter what the animal might suggest medically. Others do it differently, it’s really about where you’re at,” she said.

            After a minute that seemed an hour I turned from Boo to the vet, “I’m inclined toward less treatment and more peace.” I looked back at Boo. I awaited a reaction from the vet. Neither budged. My words hung in the room, but not heavily. Rather they revealed the emerging truth, the energies present were in agreement. It was a sacred moment.

            We had plenty of time for I love yous, but not too much, though as much as was necessary would have been given. Boo licked my face twice. She let me hold her despite the pain she experienced in her lungs. She leaned into my chest, nuzzling her head under my chin.

            The vet’s assistants came in, shaved part of one leg, affixed the butterfly needle and IV, then left. Boo walked on three legs, holding the bandaged one up, toward me.

            The vet leaned in the door, “Are you ready? More time?”

            I shook my head to the second question, nodded to the first. The vet couldn’t give me eternity. The physical, for Boo, was only torture now. Her spirit was intact, unflinching, peaceful.

            It was over too fast. Fifteen years with a spirit like Boo isn’t nearly enough. To see it fade from her eyes in fifteen seconds was startling yet comforting as her body relaxed, the age and anxiety faded, and she let go. Boo’s was the second death I’ve been present for, the love of my youth, Carl, was the first. It was on the first anniversary of his death that Boo adopted me. In both cases, the speed with which life left the body made me gasp, leaving only sublime beauty in its wake. I expected some sense of relief. There was none. Only void. The vet quietly left encouraging me to take as much time as I needed. I stroked Boo’s head, prayed the Lord’s Prayer, sat in the silence.

* * *

Still standing at the base of the stairs as the morning replays in my mind, the silence in the house is palpable. There are no paws clicking slowly against wood floors. The near constant conversation I had with Boo is startling in its absence, no one to talk to. Now, so distracted by trying to find the kong and gnawing on the what ifs of the past day in my mind, I’ve lost the connection to Boo trying to lead me. I know it’s here. Resigned to finding the kong in due time, I start up the creaky stairs, looking to the top where Boo would wait for me. “Hey good girl,” I said as I did every other time, but silently to myself instead of out loud to Boo.

            Standing again before the coffee-table altar I look down at the rug to see, adjacent to her things, stroke marks in the pile and tiny remnants of paper towel where I’d scrubbed her vomit the night before. The whole story of the last seventeen hours, stain to altar. I stare blankly again into the corner of the coffee table, back in the exact spot where this train of thought first left the station.

            You had it right from the start, Boo’s voice returns, and my eyes draw me more intently to the corner of the coffee table, the first place I’d stared. I knelt. Underneath the lower shelf stood the kong. I was essentially staring at it when I first heard Boo’s voice a half-hour before, if only I would have trusted the original instinct more than my sight, gone with my gut and her first guidance, and stayed out of my head. Boo always trusted her instincts, without a big brain or ego to get in the way. Boo is reminding me to trust mine.

            I sat on the edge of the bed, before the coffee-table altar, clutching the quilt to my chest with my left arm, holding the kong in my right hand, the candle flickering, sage wafting in the air, J.J. Hairston and Youthful Praise singing our favorite gospel in the background. As I placed the kong next to the candle, behind the dog with the bell, the milk bone and bacon strip, the coffee table altar was complete. Now I can really cry, and start the long process of letting go.

* * *

Advocates for the right to die on one’s own terms have a button that reads, “Let me die like my dog.” Like most bumper sticker philosophies, what its pithiness packs, its oversimplification lacks. The incredibly complex physical, emotional, and spiritual process that the transition of any physical life represents is never easy. For some people, the slogan is about access to safe and effective means for hastening death. To me, it is about unconditional love, the kind our animal companions so joyfully teach.

            As I watched Boo in decline, first how she made adjustments to her loss in hearing, then in muscle strength, and on the last day in will, I often wondered which of us was better off: Her, dealing only with the complications of physical changes, or me, understanding where those were leading? As humans, our ability to contemplate death creates, for many, obstacles to understanding it. Fear can do that. Boo’s only fear, so far as I could tell throughout her entire life, was being alone. Accentuated as her end grew near, I made sure she never was.

            For many humans, being alone as they make their way through the dying process is also a source of fear, compounded by our ability to speculate about what comes next. Death with dignity laws, like those in Oregon, Washington and Montana, are demonstrating new ways of thinking about the dying process, building on the hospice movement’s focus ensuring that the physical, spiritual and emotional needs of people actively engaged in the dying process are met. Inherent in the death with dignity laws is that part of being human is our ability to exercise free will so long as our will does not infringe on the rights of another.

            Written into death with dignity laws are careful distinctions requiring self-determination and self-administration along with other qualifiers. No one can choose a hastened death for you, and you must ingest the medicine yourself, a final act of free will, free from coercion. Animals don’t have that option.

            Boo let me know, in her way, she was ready. It made the decision I had to make for her no easier. Far-right opponents of reforms to end-of-life care claim death with dignity laws create a “Culture of Death” that devalues life, another of many pithy oversimplifications from the political extremes, and one I always find odd as a person of faith who believes life continues as every tradition teaches in some way. I have yet to meet anyone who is eager to leave this life, or rushes headlong toward its end. Even suicide, shockingly tragic as it is, is more about the complexity of mental health than a cavalier attitude about death.

            Boo hung on as long as she could. That is life’s impulse, to live, to make it through whatever ailment or impediment that greets us, and to see one more day, until we can’t. For some, the end happens naturally, for others suddenly, and for a few, as a matter of free will. Very few people die easily. I doubt many humans have casually made a decision for a beloved animal companion. But we can make the process of dying easier by bringing awareness, understanding, compassion and unconditional love to every moment of the process, whatever that entails, however long that takes.

            So yes, let me die like my dog, surrounded by love, cared for deeply, and with the compassion and wisdom that comes from our growing appreciation for every phase of life and its many transitions.

            Rest In Peace Boo Boo, our love continues in spirit for that will never die.

 

 



Friday
Jun032011

RIP Jack Kevorkian

Note: This piece now also featured at The Nation and on Huffington Post Politics. Also of interest is John Schwartz's article in the New York Times.

Jack Kevorkian's death, as reported in the media this morning, was not assisted. He took no pills, used no machines, so it seems. He died like most people, from complications of an underlying disease; evidently his suffering never reached a level where he sought a way out, as did the terminally-ill patients he assisted throughout his controversial and storied career.

People facing death don't run towards it, as many of Kevorkian's detractors believe, suggesting that by giving patients more options as they face death or actually assisting them, somehow creates a culture of death. As Kevorkian's own death proves, most people fight until the end, but in rare circumstances, what he knew was that suffering can be too much. Jack Kevorkian alleviated that suffering for many which is why he is now a household name.

Kevorkian was a pioneer, a lone-ranger, taking up a cause with a relentless zeal that, regardless of your views on physician-assisted dying, one has to admire. His message was simple: in an increasingly mechanized and technological age, modern medicine is trapping many sick people in a life of suffering and torture that can be alleviated if they choose. His tactics were crass, made for media, anathema to those working to pass death with dignity laws.

In seven years of work I did supporting and promoting Oregon's Death with Dignity law between 1997-2006, Jack Kevorkian was a convenient foil. There would be no Oregon, Washington, or Montana Death with Dignity laws without Jack Kevorkian, largely because proponents of those laws were able to distance themselves from Kevorkian and chart a moderate path involving all stakeholders. Oregon's law, the model of patient driven end-of-life care, stands today as a testament to statecraft. It is a careful and elegant use the law's neutrality to create a safe-harbor for patients and doctors to honor last wishes, using a clear set of guidelines bringing to light a practice that existed underground and unregulated, thus inaccessible to most people.

Jack Kevorkian would have been arrested under Oregon's law, but his dedication to alleviating suffering of those who sought his help, was the reason Oregon's law could win voter approval.

His life made a difference not only to the people he assisted, but to those who now have legal access to death with dignity laws, and to millions more for whom the end-of-life journey continues to improve as more attention is paid to hospice, palliative care, pain management -- putting the patient first. There is still a long way to go.

Many people believe only God gives and takes life, and somehow they turn modern technology and medicine into God, not understanding that what many people want is not more treatment, but less, not more quantity of time but to be able to enjoy, free from heavy sedation, whatever time they have left. Life's pleasures get pretty simple as it comes to an end, especially for those who've battled terminal illness. Jack Kevorkian understood this, and he understood he wasn't playing God, but rather responding to a patient's suffering and desperate pleas for help.

As Baby Boomers continue to watch their parents, friends or themselves enter into this phase of life and recognize modern medicine's shortcomings, there will be calls for more reforms, and passage of laws, like those in effect in the Pacific Northwest. These laws honor Kevorkian's zealotry, even if he didn't think they went far enough, and the movement that grew up not around him, but stood in relief from him, ensures the safety, care and comfort of terminally-ill people seeking relief.

The Oregon data continues to show how rarely and carefully the law is used, it's greatest asset the peace of mind patients receive from knowing they have an option of last resort should their suffering become intolerable. For many people, Jack Kevorkian's crusade offered them that same peace of mind, knowing someone was fighting for them.

We often need a crazy-genius-zealot to wake us up. Jack Kevorkian played that part well. Rest In Peace.

Wednesday
Apr272011

Birth Certificates to Death Panels: Resurrecting Common Sense

Note: This post also featured on Huffington Post Politics.

On the day President Obama released his birth certificate, playing the ultimate trump card in the low-stakes sideshow that bizarrely captivated media, some federal courts and state legislatures, and the far-right for two years, can we dispense with "death panels" too?

Can we resurrect common sense more generally?

Andrew Sullivan and Ezra Klein have each advanced simple proposals to, either voluntarily or by mandate, have Americans fill out living wills. Klein suggests it as a requirement for Medicare, Sullivan says it is something everyone over 40 should just do.

Many organizations encourage people to fill out the simple living will template each state provides. There are various reports on the prevalence of living wills, most hovering near 36 percent of Americans, perhaps as high as 70% of seniors. But even after nearly 30-plus years of encouragement there are still issues with compliance by doctors and hospitals. The idea is right and making sure everyone has clear advance directives could represent significant health care cost savings to the government. This is what government can do the private sector and human nature can't or won't: encourage adoption to increase prevalence by citizens and compliance by medical staff. People don't want to think or talk about death, so they don't act. Many doctors and hospitals view death as failure, and treatment as profit, so they don't comply with patient wishes in all cases. Mort Kondrake wrote in January suggesting that people spending their final days in hospice rather than intensive care could save up to $50 billion per year. "But the opportunity to choose," Kondrake wrote, "is even more important."

The fact that government requires everyone to have certain forms, for example, birth certificates, social security cards, drivers license/identification, doesn't seem onerous or invasive. Why should a form that clearly spells out the choices we want when faced with death? It is each individuals' choice what to put on the form; the form itself is neutral, as the government should be in all personal and private life decisions.

As Klein writes, "You could say cost is no object, and neither is pain or quality of life. You could make whatever choice, and offer whatever instructions, you want. You just have to do it. You have to make the decision."

The voluntary end-of-life counseling originally included in President Obama's Health Care Reform would have helped people understand this process and guide them in filling out these forms. It was dropped because of political demagoguery by the far-right. Sullivan acknowledges that his modest voluntary proposal won't achieve as much savings without government's nudging when he writes, "... frankly, I see no reason why the government shouldn't nudge you to make arrangements ahead of time given that others will be forced to pay the cost."

On a day when we learned the President of the United States is in fact an American, it seems as though common sense might make a come back, and so the timing of the proposals from Sullivan and Klein provide an opportunity to make another choice, besides how we want to die: how we want to live in and govern our democracy. Putting an end to the extremist's nonsense and allowing the government to make simple cost-saving policy changes like those suggested here, seems a good first step.