July 4

July 4

It is July 4th, and in the last two weeks, maybe even in the last seven days, more than one friend has told me I seemed a little “dark.”

And I thought I was hiding it so well.

So I will admit that I have had thunderheads round my eyes, that I have felt less connection, less space, less. I admit that something I knew but couldn’t acknowledge was taking place. I admit that I just wasn’t moving through the harder times, the more challenging times, the situations that were clinging to me with all of the grasping, cloying, olfactory, primal qualities of old smoke in the morning – hard to get rid of once it is on you, yet pleasant in small amounts as memory or flavor. I did not see the same darkness as my friends, but I now realize that the last set of losses, the last paper cuts, have been particularly hard to take.

I always overestimate my readiness for such things.

If you know anything about the physiology of the brain, you know that there is a great deal of motor cortex real estate devoted to the thumb, and I suppose that is why I have been able to keep some thumb function up until this point. There’s just a lot more that needs to be taken down in order for ALS to have its way. But now, my left thumb shakes, and it chooses its own direction in defiance of my desires.  And on my right hand, while my thumb is still somewhat functional, fatigue sets in quickly, so it’s functionality cannot be trusted. Add to that, the fact that my left side is always a little bit ahead, specifically that my left hand keeps informing my right of its future, and you have a recipe for a living Caravaggio* whose loss is less violent, less sudden, but no less significant.

So now here is the reckoning – no arms and no legs, no feet and for all intents and purposes, no hands. In the meantime, my neck grows weaker and and my sleep is inconsistent. I won’t even go into the challenges of ALS logistics. Each small loss must be translated into these larger, taken for granted arenas that most adults plow their way through (except for flossing) without a thought in the world except, “do I look as good as I possibly can.” At night I look up at Ev and sigh, “Sometimes, it sucks to be me.”

I’ve told you many times, I am no saint.

And yet, I cannot help but perceive a certain sense of purpose at work in all of this. It is as if a confluence of universal ethers has come together in a very personal way to teach me another lesson and another and another. My history is one where I stepped up in my youth and learned the skills required to keep a family running, and then I pushed those skills out into my own life. I realize now that many of the failures that I perceive in my first 50 years, were really my inability to translate my need to care into anything but my needs. I didn’t really learn how to care with any modicum of success until about 10 years ago, when I came to understand that human fulfillment is in the ability to translate deep care for all those with whom we cross paths, but in a way that allows such care to be reciprocated.

Please don’t read into this anymore than what was going on in my mind and my heart as I moved through the life that I knew.

Imagine that you have mastered some impossible technique, some skill set, some knowledge base, some attitude to a point where it has become like a second skin. Imagine that you are still approaching the apex of your purpose, your raison d’être, your life wonder, your grand opus, your artistic fulfillment, imagine. And then the universe writes across the sky a secret message that only you can read, “Enough! It is time to learn the real purpose.” Your head would swivel, your thoughts would lose their direction and alignment, and you might even be afraid.

I am afraid.

When my friend and teacher Matt asked me how I was doing, “not physically, but otherwise,” he stated that I seemed to be projecting darker.  I don’t like to characterize mood as dark or light, black or white, or any other arbitrary, colorful categorization. But when he said this, I realized that my grief was more present, more surface, more perceivable. It has not helped to see friends with ALS fulfill their destiny, nor to see brave caregivers in their own grief, and let me be honest, in relief that such a journey does have an ending. If you chose to perseverate on this reality, it could push your soul out of your body. But when Matt made his observation, I also realized that that while deeply challenged, I still do not despair. I have not moved through the latest losses as easily as before, yet I still see myself moving through. While the great lift that comes in the rise of the breath and the flooding of the lungs with blessed spirit has been slower to arrive, I have not lost my faith.

The fact is that none of us is truly finished until the great lessons have been learned. I learned how to push care, even for those who didn’t want it, so that my life was defined in a single dimension. Dis ease has brought me the spherical lesson over and over and over again, that care for requires care of, that caregiving requires caretaking, that caring space is not only physical but deliciously, consciously spiritual. I have faith that I will move through and become even more the person I want to be, the person I need to be. I am not finished; life is not done with me yet.

Today is July fourth, the day that our still very young and fragile and maddeningly frustrating democracy celebrates its own birth. There will be speeches and fireworks and movies and concerts and all manner of patting ourselves on the back. I will not be swept away by the speeches or music (except for Copland’s A Lincoln Portrait), but I cannot help but see the direction we are headed with the hope that at some point, our immaturity will give way to that which holds true meaning – that faith and love have far more significance than avoiding pain and suffering and death. That the remarkably gargantuan resources that we plow into death avoidance could be repurposed into life embracing, refreshingly chilled water awakening us to our possibilities, such simple love that when given, only multiplies and grows. I see this in my sons and daughters-in-law and dear friends and most of all my one true love, Ev.

It isn’t dark at all, and it isn’t light. It is faith in what will be, and the love that will come, and it isn’t as bad as I thought.

*Michael Ondaatje’s thumbless thief in The English Patient.

What Does Success Look Like?

On Monday evenings, my son and daughter-in-law take me to adaptive yoga at the Courage Center. It is a remarkable experience; you have never seen so many challenged bodies in power wheelchairs guided in yoga by such thoughtful teachers. The founder of this adaptive yoga is a man by the name of Matt Sanford. I will not relate here his life and calling; he tells his own story far more profoundly than I possibly could. A masterful teacher, Matt’s story is unapologetically human.

Matt teaches from his wheelchair, asking from us a practice of yoga that is thoughtful and demanding.  He stops and corrects and questions and observes, skillfully engaging each of us individually.  Matt freely admits little experience with ALS, so it should have been no surprise that he  asked me, “What does success in yoga look like?” I was in the middle of modified sun salutations, my son and daughter-in-law on each side of me raising my arms and helping me to drop down while lifting my chest, drawing in a centering breath. My eyes were closed as I sought memory of the motions required, forgetting that there was something of equal importance outside. I stopped. I thought. And I answered, “I guess just being, here, in this place is success enough for me.”  It wasn’t quite what I meant, but it was the best I could do at the time.

Silence, then, “I guess I wasn’t expecting an answer quite on that level.”

I’m not sure what he meant, but I know the experience of asking a question and receiving an answer from a different place.  He asked the question two more times that night, each time causing me some internal turmoil.  After all, ALS and success are not often tied together, but the struggle was instructive and in many ways symbolic of a week that was.

Last week, I experienced one of the highest highs and one of the most humbling lows since my diagnosis. And somehow, the consideration of success coming out of my yoga course, in the presence of a teacher who I do not yet know excepting his authenticity, seems meet and right and totally appropriate. Last week, many members of my former church choir showed up to surprise me with a gift of song. Last week I ended up in the emergency room; my non cooperative body further refusing to cooperate.

How wonderful it is to be surprised by song from people you love.  A lifetime ago, we spent such meaningful time together—they put up with my jokes, my cajoling, my coercing, sometimes my overbearing personality, and still found a way to make beautiful music. They gifted me by singing three pieces sung together so many years ago, and it was absolutely divine. They sang so well, incorporating small but significant interpretations that we had arrived at together, echoes of music that still resound within my deepest meditative soul, polishing the sheen and shine on these three choral jewels that were and remain expressions of the beauty and possibility humanity can glimpse through the artistic endeavor.

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Of course, I blubbered and cried and sobbed with joy for life so blessed that friends would sing for me.

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And there was more to it than the singing, for I had not seen so many of them in years. What a commentary on the pathways of life this was. All of us had been lost and found in life’s ever-divergent paths – children and history and marriage and divorce and new careers and no careers and sickness and health and emotional upheaval and moving on. I wish I would have had the strength to insist they stay the hours until the evening had ticked away one delicious second upon another, but my beloved Ev had forewarned them that my stamina is compromised. And so they lined up and one by one took my hand and talked a little and reminisced a lot and cried in unison and harmony and love and affection, a sacred polyphony of friendship built upon the beauty that making music together spawns.

To see them all, to hear them all, to breathe them in as one would inhale spring after a gentle rain and a drying sun, lifted my heart for just a moment into a place that I know still exists, even though I do not perceive my presence amid those lofty arches anymore.  Thank you Judith and Andy, thank you all – my beautiful beautiful singer friends.

But balance mandates new lows, offsetting such a soaring high.

One of the afflictions for anyone who spends the majority of their time in a wheelchair is plumbing mishaps. The details are not important, except that two nights after the beauty of my choral gift, Ev delivered me to the emergency room of a local hospital, hoping to address the pain and dysfunction of a body that refused to operate normally. By the time I reached the hospital I was physically exhausted and emotionally drained. And over the next several days, the fear of going back and the recovery needed from the physical manhandling that must take place in an emergency room situation was my reality, my raison d’être, my conscious being.

What do you think success looks like now?

By the end of my yoga class the question arose two more times. I was tempted to stay in my ALS space clumsily describing physical progression, cautiously retreating from any activity that might result in pain or damage. The space was safe and the advice was prudent, not profound. But deep learning does not take place in comfort. With one phrase, my teacher opened vistas of possibility that my body might occupy even as physical capacity wanes. With one phrase, my teacher reminded me of the balance and the center when we accept the unity of body and mind and spirit and life. With one phrase, inner and outer, horizontal and vertical, down and up, reflection and narrative opened up the holy possibilities before me.

“You existed before this,” he said.

At the very end of the class that was far more physical than I ever thought possible, at the very end of the week that had left me soaring in the emotional stratosphere and groveling in the ditch of human existence, at the very end of a day that had left me so tired that I was searching for every excuse not to attend my class, I think I glimpsed what success looks like.

In my life, there will be ALS, not to be fought, but rather embraced. Now ALS is me and I am him. He will require all manner of experience that feeds my soul, balances his presence, and moves me on into the next challenge. In so many ways, life with ALS bears remarkable similarity to my life before. It is always about balance, and balance is only achieved on the sharp end of the needle threading its way in and out of the cloth of the task at hand, and binding new threads to old fabric.

Friends sing, and bodies break, and courage is centered in existence before this.

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Advent

Last week, in a fit of post–Thanksgiving, pre–Christmas serendipity, Ev and I found our way back to the Mayo Clinic for our quarterly pilgrimage. It was a very different experience for us this time, one of diametric opposites in the same visit. On the one hand was our familiarity with the Mayo drill; we have been making this journey for nearly 2 years as Mayo is where we confirmed my ALS diagnosis. The trip to Rochester has taken on the comfort of an old pair of jeans. We know what to expect, who we will see, and with a few exceptions we know what we will hear–no cures and plenty of dis ease management. On the other hand, after our August Mayo visit, we agreed with one of our doctors that given the statistics on ALS mortality, combined with the documented time since my first noticeable symptoms, it would be appropriate to consult with their palliative care clinic to discuss other management decisions. This would be a new experience, and we had no idea how it would go.

I have committed to keep you up on the so-called progression of my dis ease. Mayo is a very good place to document that progression. No longer am I asked to clench my fists, resist neurologist’s pushing and pulling, sit still to be hammered for evidence of hyper-spasticity, or try to touch fingertips to thumb as quickly as I can. There is no point as the weakness in my limbs is so pronounced that even a simple offering of the hand is an adapted accomplishment. Writing is inefficiently accomplished, causing me to spend longer and longer periods between each of these entries. The bad news is that my ALS progresses and my limbs and torso weaken with the progression. The good news is that my breathing is still almost normal, I am able to chew and swallow and talk, and my sense of humor is intact and well within the boundaries of the mostly inappropriate. As I have come to understand ALS more fully, I am thankful that, at least thus far, I have no frontal temporal dementia (although I may have associates and family who would argue this point). The result of the weakness in my limbs and torso is, more than I ever would have thought, a great deal of consultation about toilets and bathing and eating and sitting and as few transfers a day as possible. I will spare the details. No one has offered any counter narrative to the expectation that my lifespan has been significantly shortened by ALS. Hence, the reason for meeting with palliative care specialists remains.

I don’t want my observations about the palliative care meeting to diminish either the importance or the significance of what we surfaced. Suffice it to say that I suddenly realized that the field of palliative care is much newer than other medical fields, and therefore it probably tends to attract a younger professional. From a traditional medical framework, palliative care is probably a dead-end (no pun intended) for an ambitious researcher/treatment provider. However, with a rapidly aging population, an overly eager system to treat that which cannot be treated and the need to account for life quality, palliative care and end-of-life decisions have taken on far greater meaning for most medical establishments. In this respect, it should not have surprised us that the post residency doctor in training with whom we first met seemed incredibly young to be consulting on such mature decisions. And it really should not have surprised us that the supervising specialist was in his early 30s if that.

I must admit my ageism at this point. It felt funny to both Ev and me to be discussing end-of-life goals with a pair of doctors that seemed like their beginning of life work had only begun. But it was important to get over that, and I think in the long run there were two things that were surfaced in the conversation that were very helpful to both of us. First, I was able to articulate three basic premises that allow me to feel that life is worth the challenges of ALS. It should be no surprise that these centered in family and friends and a sense of continued giving valued by others. But the second thing I surfaced in this conversation was probably more profound. The economics of dying are real. I have no desire to bankrupt my beloved partner’s retirement, forcing her to live the rest of her life with less security because we made the decision to put our finite resources into some symptom-management scheme with very little hope on return. This may seem quite logical, but for me it was a profound realization. I have never been comfortable placing monetary value on random acts of living, happily leaving such endeavors to the actuarial practitioners who design life insurance policies and other such products. So in spite of being a bit taken aback by the age and life experience of our doctors in the palliative care unit, the result is one that will help to inform much larger decisions that are coming in the near future. We agreed to go back; a beginning of sorts of a new chapter in managing dis ease’s progress.

This focus on progression and management seems appropriate to me this week, as we are in a season of progression, from prophecy to birth. This week will be my second anniversary since diagnosis, my own Advent into dis ease if you will.

Advent, New Year’s Day on the Christian liturgical calendar, a time for rebirth and prophecies and holiday luster and symbolic representations with multiple and oppositional meanings began on Sunday. In its common usage the word advent means beginning, coming, arrival. But the season of Advent is confusing. Its bifurcated musical traditions are instructive as they careen back and forth between constructs of saccharine consumerism, holy mysticism and all things in between. Its liturgies of consumption are fed and watered and fertilized and shouted from every media mountaintop in the name of commerce, but its prophecies portend a far different intention.

Advent now is a time of prophets and profits, heralding a future of highways made straight, not just tamed by Jeep and Chrysler and their ilk. Advent’s original apex–the birth of a child, disenfranchised by poverty and illegitimacy, heralded by singing angels, announced by the cosmos–now barely holds a candle to the liturgy of the National Football League’s regular season, brought to you on Christmas Eve to ease your pain and fill the dis eased recesses of your soul. And in spite of the wise counsel of so many financial experts, we cycle into holiday debt barely paid off until we begin the cycle all over again in vain attempts to push back the darkness and express the inexpressible through gifts as prone to exchange as acceptance.

Oh, and don’t forget the nativity tableaus brought to you by Santa on the stable’s rooftop. It is an iconography meant to prey on the dis ease of humanity, whether it be a nagging feeling of disquiet or ALS.

Dis ease begets advent over and over again, a progression in and of its self. Although dis ease named my disquiet in the Advent season, I didn’t realize it was its own prophecy, visions foretelling numerous variations on ALS’s progress and loss. It was a beginning, a coming, an arrival challenging me to reinterpret the meaning of the old prophets and insisting on the need for new. It caused me to change my frameworks not just for the season of Advent, but for the advents each day brings in its own tableau of a quieting life.

My advent anticipates a surety of ending, a timeline shortened by dis ease, with just enough mystery to keep me hanging around to see it through. I have learned Advent’s liturgies and rituals in comforting familiarity. I can predict with great accuracy its prophecies and messages and admonishments and yet, still be surprised by what is to come. Advent inflicts dis ease with the understanding of how human dis ease must be. Yet it insists we contemplate how inhumane and cruel life would become without dis ease’s gifts of growth. It does not matter that we humans have confused the season’s intents, nor does it matter if we make the wrong choices. What does matter is that Advent consistently offers new chances, new challenges, new choices from which we can shrink away with fear or we can embrace with joy in life and death to come.

And just like Mayo, it offers no cure, but excellent dis ease management.

The Winds

On the first weekend after Labor Day, the sky is clear and the winds carry that unmistakable taste of autumn—a tang of tannins and a hint of plant matter, somehow pleasant yet foreshadowing winter’s icy cold.  More than just a cooling breeze, these winds are open the windows winds, rattle the shades against the frames and sills winds, rustling rearranging paper long accustomed to an undisturbed piled existence winds.  They are lifting and twirling, cooling and clearing winds, and while they reorder the physical space in which I live, today they also reshuffle my psychic space so I now need some kind of grounding weight to keep me in place, to hold me centered here and not blow into darkened dwellings. The loss experience defined by ALS is an autumn wind chained to the feeling and thinking and desiring and doing that defines the person I still want to be, yet symbolizing a dis ease power to strip all coping away, leaving naked experience shuddering and jerking like chimes wildly dancing in zephyred abandon so that vulnerability and chaos emerge in the autumn to winter smells—tannins and plant and crunch and sun.

Occasionally, I dream of biking these head winds, more a dream of the feeling of wind, gusts against my face, whipping my hair, pushing against me as I ride, its resistance torking the bike frame and gearing dusty grit that stings my shins and bounces off my eye shields into the crank and chain and derailleur.  Pre-ALS, when I rode to and from work, home was against the stiff west winds that whistle into the Twin Cities with nothing but the prairies between their somewhere in the Dakotas life source and the urban cosmos that finally trips and funnels them into so many swirls of channeled currents, playfully strong.  I used to think of this as a trial to be accomplished, and there were many evenings I found myself lowering my head, pushing hard to push through, the wind resisting my efforts, though eventually allowing me passage. How I wish I had seen the wind for what it was—a statement of health and empowerment and strength, rather than another impediment to an easy ride.  How I wish I felt that empowering resistance again.

What I didn’t know!  

Sometimes in the middle of the night as I rouse from first slumber—lusciously mid-conscious between sleep and wakefulness, thinking I have been riding against these winds, believing for just a moment that ALS is the stuff of dreams—Ev rides on my rear wheel, drafting off me.  I experience the joy of blocking for her as we careen our way home.  Such vulnerable moments, for when realization dawns, the head wind ride retreats into the recognition of fading memory of activities still present in my dreams but utterly gone from the physical being that I have become.  As if to punctuate the loss, my legs are now even heavier, my arms and hands weaker, my ability to adjust and turn in bed lessened and my joints and bones aching from sleep’s position held too long.  I hear silent weeping in my mind, and I realize I am crying for what cannot be again.  Sometimes, Ev hears it too, and she pulls the covers back over me, adjusts my pillow and kicks the cats off the bed, pats my arm and falls back to sleep only a little disturbed.  Such is the stasis and peace out of dreamy regrets. 

In waking, I draft on Ev while she positions herself between the headwinds of life and me.

This week, in the face of what would have been a mere challenge in my old normal life, the winds of ALS stripped away all pretense that I still own such capacity.  I have known this truth almost since the day of my diagnosis, but as the human I am, I often need to be reminded of the fact.  I spent years constructing all kinds of facades, persona, roles projected as needed for the task at hand.  It was almost like being an oversized, organic iPad.  Does today call for quiet confidence?  Whip out the app and take over the room.  Is it time to project suitable irritation at bureaucratic stupidity?  There’s an app for that too.  “Applied Pretense”–what one reviewer calls, “the app you really cannot live without,” is available in the App Store with an average five star reviewer rating.  But ALS, like the autumn wind, blows all this technique, techné into the dustbins of failed humanity.  If you approach your life thinking there is a suitable screen that will take care of it, ALS becomes the vortex that dashes that screen into smithereens, drilling you down to the essence of your being and voiding any such cover you might have thought you owned.  

The purity of a life imposed upon by ALS makes the apps approach to success irrelevant.  It exposes the gold of life experience like a refining fire consuming the dross we work so hard to project.  If unrelenting stress is bad for human beings, then ALS makes conscious the reason why.  For me stress has become the purely physical phenomenon it is—body shivers with increased muscle fasciculation, narrowed eyesight into tunnels of diffuse yet centered light and darkness pressing in and around.  And once through the initial angst, I am exhausted beyond all physical belief to where I can only lean back and try to sleep enough of it off to bestir myself only a little bit.  Stress is cumulative, but only with dis ease have I truly known its accumulation. And with ALS, coping mechanisms such as a nice swim or run, or yoga pose to clean it out is impossible.  Like the wind, ALS rearranges the environs, sweeping clean any pretensions of control over the stresses of day-to-day living.

In “The Windhover,” Gerard Manley Hopkins speaks the power I know in these blasts and gusts:

As a skate’s heel sweeps smooth on a bowbend: the hurl and gliding 
Rebuffed the big wind. My heart in hiding 
Stirred for a bird, — the achieve of, the mastery of the thing!  

Brute beauty and valour and act, oh, air, pride, plume, here   
Buckle!  AND the fire that breaks from thee then, a billion 
Times told lovelier, more dangerous, O my chevalier!

Big winds blow through life, and I so wish I could be the skate’s hurl and gliding that rebuff the squalls and gales of their concentrated air.  I have tried to keep my heart in the open, stirred by “the achieve of, the mastery of the thing.”  But life experience now has such intensity, that to experience it in such purified state overloads any capacity for control I might believe I have.  My ability to project the iPad app screen of applied pretense wanes, leading to a new space of taking in only what I can receive, a little at a time.  Autumn moves to Shakespearean winter—“Blow, blow thou winter wind, thou art not so unkind as man’s ingratitude…” 

And I must learn to be more thankful for the blows to come.

Psalm 39

Make me to know the measure of my days, O Maker of this mortal frame.
I would survey life’s brief and narrow space, and learn how frail I am.

Anthem paraphrase of Psalm 39, “Make me to know the measure of my days” by Shawn Kirchner

This past month has been a measure of many things, and the near future looks to be measured out with coping mechanisms every bit as exhausting as dis ease itself. If you have been reading between the lines of this quasi-documentary, you know that I really dread the SOP measurements associated with my dis ease. Although I hold deep respect and a dear love for the many professional caregivers in my life, each time I see them, the story is the same—what have you lost since the last time we saw you, and how can we measure it? Generally, the measurements are private, as in the patient questionnaires I answer, or the oxygen saturation measurements or the FVC measurements, or the measurements of my word speed, large muscle strength, swallowing, cognitive functions, or any other number of measures that do nothing but document the dance of loss fomented by cruel yet consistent ALS choreography. But this week started a different set of measures, not so private, not so easily camouflaged as I have managed in the past—public measures of my stamina, my driving, my communication, my public responsibilities layered one after another. Their success is expected and their failure a statement of loss greater than I can afford if I am to effect any modicum of success in this current life path that still holds so much meaning for me. Probably nothing brought this home more clearly than the driving assessment I took on Friday at the Courage Center.

The Courage Center is a remarkable place, set up with a mission that those with disability will live life to its fullest potential. How could I not feel safe in such a space, yet in a déjà vu moment, it was one of those experiences where the guy playing the part of passenger, fulfilled the role of the one in the driver’s seat, presciently walking me through driving’s future. Steve has been at the Courage Center for thirty-five years. He works intimately with any number of neurodegenerative dis eases including ALS, and he knows the implications of not being able to drive. So he set up a driving experience that was about two-and-a-half steps better than my current system, and put me through my paces to see if he could tire me, or distract me, or just plain find a reason for me not to drive. It was informative, and it allowed me to question capacity and capability as we talked about the cost of further modifications to a van that has already been heavily modified. Should I go to zero-resistance steering? Should I get assisted braking? Put the EZ Lock system in so I can drive easily from my wheelchair? And if I do these things, how long will I get before these modifications are not enough? What is the measure of my days of driving, and is it worth it? As Steve pointed out, “In this country, driving is your freedom.” No kidding! Measure for measure, I did fine in his carefully crafted testing of my capability, but to what end?

And if that isn’t enough measurement, then the coming weeks will brutally seek to publicly reveal the fatigue and weakness of ALS. Whereas up to this time, I have found little tricks for negotiating requirements and conserving energy for the next day and next and next, the coming three weeks have no downtime, no recovery, no space for blank stares at walls while my body slowly works up the energy to come back to meet the next big challenge. And the measurement of my performance in these numerous public arenas could raise the questions that I fear the most—“Is it time to hang it up? Is it realistic to rely on a dis eased person when his peers have left their work long before?” The measurement will be imprecise but brutally honest, and my own fear for my fortitude is realized in nightmares of publicly slipping up in a way that will inspire pity and quick leaps into stereotypical attitudes about dis ease and disability. Measure for measure, these are the cruelest ones I know.

And the measures keep coming. Dis ease’s cruelty arrived with a simple, anguished Caring Bridge post from one that I have never met but have come to know and love. She is young, so she aggressively pursues an active battle with a recurrent cancer that backs her into a corner where every possible move looks like checkmate. She has a beautiful husband and children, and she has dueled gamely with her dis ease for long enough so that from a purely logical perspective, hospice should be her right. She has met the 99.9th percentile, defied the mortality odds and squeezed every drop possible from her way too short life. I so admire her gumption and the gumption of her family as they clearly communicate that she is not ready to give up on this last gambit. And yet in the end, I detect fear and anger, and an unspoken realization (and possibly relief?) that the end game may be playing out. Cancer takes her measure, and she is just short of its insistent, unavoidable requirements.

You can guess that my true love sensed the anxiety and angst beneath the musings above. And even there, the measures just added up to loss. “Come and sing with me,” she said in an effort to pull me out of my Saturday pout. And Henri Duparc took the measure of my voice and said, “You have no business accepting any invitations to travel on this voyage.” I just couldn’t find the breath in it. Finally the questions came tumbling out in measures of music not performable, and they forced me to face questions of measure of my days.

How do you know when it is enough? When does the realization that it might be time, hit you? My experience of loved ones in hospice feels literally like one day we were outside the hospice, and the next day we were in, with nothing in between. In retrospect, I know that this isn’t true. The events that lead up to hospice were insistent and present, and hospice was not unlooked for. But the day, the hour, the minute the decision was made, seemed like it came out of nowhere with nothing but denial standing in the way. Is that how driving will be? When did the cane, the walker, the wheelchair, the bedrail, the grab bars, the van go from prudent choice to absolute necessity? What is the measure of what I have retained, and how long can I count on these capabilities? Sometimes it seems that we are so busy counting my losses, that we fail to realize the critical moment that embraces the numbers and defies them with aching, measured humanity.

I turn to Kirchner’s poetic Psalm 39 again:
See how the rushing race of mortals move as mere shadows o’er th’eternal plain.
They rage, strive, desire and love; but all their noise is vain.

As I realize the movement and measure of loss in each day, the vanity of the noise is crushing. And it takes every bit of energy I can muster to reach above this fog, to ask for healing when none can be found, causing me to ask, “How long, and how long?” If you have been reading between these lines of dis ease, you recognize the spiritual strength I receive from my sons, my wife, my friends and the work that I still deeply love. And in the end, there is the answer, measured out in dribs and drabs of energy and strength.

There are many musical settings of Psalm 39. Admittedly, the frailty, the human vanity, the realization that we are only here for a moment and then we are gone, speaks worlds to me, but just as music focuses measures of my mortality, so too does music illuminate a different meaning for the same. Johannes Brahms also set Psalm 39 in his German Requiem, only he continued past Kirchner’s sadness asking, “And now Lord, what do I wait for? My hope is in you.” I guess I can admit to measures of strength from an old German agnostic’s take on life’s frailty.

And in the breath of those measures, I can see my way through the immeasurable, as hard as it will be.