The River Appears*

It has been a difficult couple of weeks and I am behind in my writing.  Just after Christmas, I learned that the sixth treatment I’ve had in two years has not been working at all. My oncologist and I had a serious talk. “There are more treatments we have, mostly chemotherapy,” but he also warned me that with each one the likelihood of efficacy goes down – sometimes to as low as 5 or 10%–often with harsher side effects. The palliative care nurse was there as well and we discussed hospice. We agreed I would come back in a week after I had absorbed this, and would discuss next steps. He did not give me a prognosis in terms of time, but we agreed it is likely a few months.

By late the next week, I had developed a serious cough that by Saturday had me wheezing and spitting up blood. On Monday morning, the doctor took one look at me and my blood work, and wanted to admit me to stabilize this — if he could — as well as I give me blood transfusions (it turned out three altogether.)  So after a temporary stay in the clinical trials area, hooked up to oxygen, I was trundled off to the main hospital and admitted. To be honest, the doctor was not sure if I would even survive. His goal was to get me to the point where, with oxygen, blood,  and medication, I could go home and be met by hospice.

Within a day the wheezing had abated,  and my breathing had returned to almost normal with the oxygen machine, and I was discharged. They sent me home in the world’s most uncomfortable ambulance, but I was glad that Marty did not have to make the return trip to Boston and manage the oxygen tank, etc. The hospital wanted to be sure that oxygen was set up int he house before they would let me go, so it was early evening by the time I reached home.  I could barely walk.


Since then, I have had a parade of hospice workers in and out, including a nurse, a case manager, a home aid, and a social worker. Harry is here and along with Marty they are able to attend to most of my needs, so I will not need to draw on the hospice services for a while yet, other than for medication. It annoys me that I cannot be left alone, but that is for my safety, I guess.


So the last leg of my journey is underway.  Emotionally it is a bit tough to be in this place, but I’m also relieved by the fact that we won’t have to schedule our lives around trips to Boston, CT scans, and all the rest.


I have seen others share this news and get a variety of responses. It is not dissimilar to Elizabeth Kubler Ross’s four stages of grief: denial, anger, bargaining and finally acceptance. I think the person who must make their decision may often be  further along in that continuum than others who are hearing it for the first time.
For me, it is like trails on a path that eventually come to a river, and walking alongside the river for a while. Eventually you see a boat moored onto a small dock, and once you decide to get in the boat, you move away from the shore and begin to float down the river out to sea. You hope that it is a smooth ride, without any rapids or scary or painful spots, or places to get you tangled in the branches, or stuck on the rocks. In the early stages, it is too far and the river too winding to see the ocean at the end of the river, but I know it is coming. One thing is certain: the shore, with its pathways and treatments and byways is no longer really in my line of sight.


I use this analogy because the people standing on the shore often have a different perspective. Although they may say nothing to my face,some are not certain I got in the boat at the right time. “There is another boat later down the river — couldn’t you keep walking / getting treatments until you get to that boat?”   Some see another path on the shore I didn’t try; push for a second  (or in my case third) opinion, a trip to Germany for a special hyper-metabolic tank treatment that worked for a friend, Gerson dietary therapy — you name it. Others wail, “don’t give up, no doctor can predict the length of your life, keep having hope, the next thing might work.” Or that prayer, faith, or an angel in gossamer wings may manifest a miracle at some midnight hour — “radical remission”.  Some have some personal or family experience to fall back on, where perseverance, as they see it, faith, or something else made an individual difference, and desperately hope to transfer that to my situation.  Some simply cannot accept that this time, there  may be no fix, no suggestion, no other potential to  be tried that will change the natural flow of this river to the sea.  What I do know is that, as  I sit in my boat and drift with the current,  the words “don’t give up,” are not unlike hoping for the boat to capsize and for me to somehow find the strength to swim back to shore.  I would feel cold, wet, even more tired than I am, and stuck.


And then, there are others, standing silently in witness, holding space for me while walking along the shore as they keep me in sight, simply being present, offering prayer and peace.  It is recognizing the aloneness of the person in the boat in the river, without feeling the need to call them back to one’s own place of comfort — where there is solid ground, pathways, treatments, “battling” a disease, and what we consider normal in the medical environment. It is total acceptance of who the person is and what they have decided — whether it is a decision you would have made at that time for yourself or not. Some send cards of caring or calls, some bring chocolates – or fig newtons–offering comfort, peace, memories,  and even laughter. For even those facing death still like to laugh once in a while.  And perhaps, most important, It is recognizing that “despair” is not the opposite of “hope”.  Sometimes, it’s  acceptance.


There is a Jewish prayer called the mi’sheberach, often translated as “the one who blesses”. The prayer is recited whenever the Torah is read and names people by names. In English, the translation calls for a “healing of body and spirit”. In Hebrew, however, the words are a bit ambiguous — a “refuah sh’lemah“,  a healing of completeness. When we understand that the body and the spirit are intrinsically connected, it makes sense that it is impossible to know whether “a complete healing” means a recovery of bodily and/or spiritual health, or the unity of body and spirit in a new state. For those who stand by the shore in witness, watching a person’s journey to his or her life’s ending, the latter meaning may provide as much comfort to the prayer as to the intendee.


*with thanks to Harry for scribing this from my handwriting as I have developed neuropathy in some of my left fingers.

The Comfort of Music


teeterbabeMusic has been part of my life since before I could walk. When I was just a few months old, my parents would put me in a contraption called a teeter babe (believe that’s what I’m in in the picture), put on a stack of 45s (that’s a record speed, for those who are not pre-digital) of Strauss waltzes, and let me bounce away until I was ready for a nap. As I got a bit older, and able to talk, one of my favorites became a 78 speed version of Ravel’s Bolero, which I called “Tapping Feet.” As I grew old enough to understand, my dad taught me to recognize the change in key that comes near the end of the song as it reaches its crescendo.

Most of what I learned –and learned to love–about music in those early days came from my dad. The source of his knowledge, which seemed quite extensive, is more sketchy.   He never learned to play a musical instrument, but when he was a boy and young man, he apparently had quite a good voice and took singing lessons from a local lady named Gertrude Kunze, who may have also taught piano. Evidence of those days still exists in a box I kept from my parents house—sheet music of vocal numbers by Irving Berlin, Jerome Kern, Rodgers and Hart (in the days before Rodgers and Hammerstein), Harold Arlen, Cole Porter, and others from the Great American Songbook.   Gertrude died before I became a teenager, but whenever we ran into her in the grocery store, she would beam at my dad and announce to me proudly that he was her “best pupil.” (As it happened, I ran into Gertrude in the grocery store AFTER she died as well—she was one of the few people in our small town to be cremated, and her husband, who was rather deranged, took to carrying her ashes in a purse around town, where it was not beyond him to offer you a view of them while waiting in line to pay).

My dad loved many types of music, but he was partial to classical, especially piano music, and he loved Broadway musicals (Oklahoma, South Pacific, Porgy and Bess,and Carousel, in particular).  In his younger days, I think he must have liked big band hits as well, because he told about when he was single of sometimes taking a date out on a deserted highway nearby, parking the car, and playing radio tunes while they danced in the middle of the road. As for classical, he especially liked music with stories—early favorites I recall were Saint Saens’ Danse Macabre, Grieg’s Peer Gynt Suite, and Haydn’s Surprise Symphony–where a sudden, loud chord in the second movement was (according to my father) designed to wake up the gentlemen in the audience who had been sleeping. He liked some Beethoven—Van Cliburn’s rendition of the Emperor Concerto and the Moonlight Sonata– and most Brahms and Mendelssohn, but in general he did not prefer German composers, finding them too heavy—I don’t ever recall hearing Bach or Wagner in the house (although he did like the Russian composers Rachmaninoff and Tchaikovsky).    His favorites were Chopin, Debussy, Saint Saens, and a French composer named Benjamin Godard—whose 2nd Mazurka I learned to play when my piano skills had advanced sufficiently.   And among American composers, George Gershwin and Aaron Copland were tops.

When I was 7 or 8, our town got an AM radio station. My dad did not approve of the music—it was largely rock as I recall—and seldom listened, having invested instead in an FM radio receiver kit from Radio Shack so he could tune into FM stations further south that played music more to his liking.  But, as a local merchant, he soon found himself being asked to advertise on the new local station. He resisted for a while, but finally struck a deal—he would sponsor a one hour broadcast on Sunday afternoon (to be called “The Hennigar Hour”), but he insisted the music had to be of his choosing. The radio station accommodated him, and even set up an arrangement with the newly established 101 Strings, which specialized in light symphonic music including movie tunes, to provide him free records to make his choices.   Among his new favorites were the Soul of Spain series, along with Grand Canyon Suite by Ferde Grofe. This show ran a few years until, I think, my dad finally tired of it. He did gather a large collection of records out of the deal.

Although I learned to play both piano and clarinet, I never have considered myself a musician—like my father, I would much rather listen than play. Eventually I advanced my own education to be able to introduce him to pieces I liked as well—but the only real sale I recall making was Gustav Holst’s series on The Planets. And he did not care for any kind of “modern music” to speak of, including the Beatles.

When he fell ill from dementia and was no longer able to communicate well, he could still listen to music—and would sometimes “conduct” along with the sound. This gave me the idea to put together a playlist of all his old favorites—and mine, which I used to take to the nursing home and let him listen to. I could tell it gave him great pleasure. Ironically, only recently the New York Times came out with a piece recommending a “dying playlist” which really confirms what I did then—for him, and more recently, for myself.

Now, while my listening repertoire is much broader than his was, I still gravitate to these songs from my youth, and they bring me comfort. It is said that the sense of sound is the last to go, and when the time comes, I feel calm and ready to exit on what Leonard Cohen terms “a tower of song.”




You Want It Darker


Our son Harry, with whom we enjoyed a great Thanksgiving, has decided to make aliyah (for my non Jewish friends, this means exercising his right as a Jew under Israel’s “Law of Return” which permits Jews and those with partial Jewish heritage or married to a Jew, to emigrate to Israel and, in most cases, to gain citizenship).  His father, sister and I are all supportive of his decision, even though we know it will mean he is a 10 hour flight from Boston. In many ways, if I were his age and single, I might make a similar choice, especially given my experience already living out of the U.S.   In Harry’s own words, posted for his friends on Facebook,

Yes, this move was prompted by the election. I wish I had the fortitude to fight the next few years, to resist what promises to be a very ugly chapter of American history. But I don’t.  I simply can’t. This is not a reaction out of pain, but rather a response to how I can still move forward with the world as it is. I have much more to give, but would sink too deep here to pull anyone else up. I can only do my best to help humanity in whatever way I can from Haifa, and will be praying for all of you fighting for equality and our planet here in the US.

Harry’s decision and his leaving the United States for a new beginning, in an odd way, resonated with my own journey. A week or so before the election, as some of my readers already know, I learned that my fifth treatment in less than two years was not stopping the cancer in my liver. This was a clinical trial that had shown high promise—nearly 70% efficacy between keeping the disease stable and regression—so while my track record so far did not make it surprising that I was in the 30% for whom the treatment does not work, it was still disheartening. It took me a few days to wrap my head and heart around this, and to accept—again—that, in all likelihood, the window of time I have left on this earth is narrowing. Since ending the trial (I begin a new therapy later this week), I have also felt like a tire with a slow leak, some days feeling quite a bit of fatigue and weariness, along with a loss of appetite. I guessed, and my oncologist concurred, that most likely these symptoms are signs that the cancer is slowly but surely advancing.

In the midst of my processing all this came the U.S. presidential election. Like many—excepting most notably Michael Moore, who called it accurately some time ago– I was surprised by the outcome. I was also, and continue on a daily basis to be, disheartened not only by cabinet choices and continuing infantile statements, but also by the burgeoning incidences of hate and bigotry–now numbering more than 700 according to the Southern Poverty Law Center—that are occurring all across the country. The vast majority of these are committed by Trump supporters now greatly empowered by his inflammatory rhetoric during the campaign, and there seems no end in sight.  Some peaceful protests by anti-Trump forces have also turned violent or obstructive, and that is unfortunate, for it clearly detracts from the messages the protestors are trying to send.

In my opinion, we were already becoming unhealthy as a country with growing income inequality and the inordinate influence of big money in politics and public policy—a trend that surely reflected itself in the election.   Now, we can see that, ironically, this trend will almost certainly be accelerated, not reversed–not to mention ushering in a new era of divisiveness and cruelty, and the potentially devastating global impact of dialing back efforts to combat climate change that will affect our children and grandchildren.    There have certainly been periods in our history that have been ugly from a social and economic standpoint, but I think we are about to reach new lows, in virtually every area I can think of. Even with resistance, whether or not the country can recover from the damage about to be inflicted is an open question.   In some respects, this feels like the last gasp of a declining empire, a process that is advancing inexorably—and will likely gain speed– just as my cancer is.

I know this is a dark analysis, and not all will agree or feel they can afford to agree, either with my conclusion or my pessimism.  I hope I am wrong, and that my fears are overly colored by my personal situation —as Martin Luther King famously said, “the arc of the moral universe is long, but it bends toward justice.” And I can only pray that proves true, and that I can contribute through whatever small actions are in my power while I am still here.

One morning after the election, I awoke as I always do, with the awareness of my illness coming into focus (sleep, meditation, music and long talks with family or friends about something other than my disease are among my few respites from these thoughts.) On this morning, it was accompanied by a new emotion, one at first I didn’t recognize. Gradually I was able to identify it, and I have to say, I was somewhat horrified—it was relief. Relief that I would not have to bear the pain of watching this chapter unfold, relief that I would not have to watch the country continue to be torn apart by hatred and our institutions dismantled in the pursuit of profit and ever growing greed. Just as Harry has come to the conclusion that he can do more good in Haifa, perhaps, I thought—somewhat whimsically, to be sure– there is healing work to be done on the “Other Side,” and I will have a greater role there than I could have here. And perhaps, too, it is another way of managing the inevitable sadness of leaving this world and the people I love.

A day after the election, it was announced that Leonard Cohen, the great Canadian composer and poet, had died. About three weeks before his death, he released a new album, “You Want it Darker.” As I think about Harry’s upcoming journey—and my own—I reflect on how much the words of the album title song have multiple layers of meaning (in Hebrew, Hineni means, “Here I am” words spoken by Abraham, Moses, and Isaiah when they were called by G-d—a more spiritual meaning of readiness to take responsibility, rather than merely reporting physical location).

If you are the dealer, I’m out of the game

If you are the healer, it means I’m broken and lame

If thine is the glory then mine must be the shame

You want it darker

We kill the flame

Magnified, sanctified, be thy holy name

Vilified, crucified, in the human frame

A million candles burning for the help that never came

You want it darker

Hineni, hineni

I’m ready, my lord

There’s a lover in the story

But the story’s still the same

There’s a lullaby for suffering

And a paradox to blame

But it’s written in the scriptures

And it’s not some idle claim

You want it darker

We kill the flame

They’re lining up the prisoners

And the guards are taking aim

I struggled with some demons

They were middle class and tame

I didn’t know I had permission to murder and to maim

You want it darker

Hineni, hineni

I’m ready, my lord

Magnified, sanctified, be thy holy name

Vilified, crucified, in the human frame

A million candles burning for the love that never came

You want it darker

We kill the flame

If you are the dealer, let me out of the game

If you are the healer, I’m broken and lame

If thine is the glory, mine must be the shame

You want it darker

Hineni, hineni

Hineni, hineni

I’m ready, my lord


Hineni, hineni


The Election–Three Days to Go

I have debated about whether to post anything on the election, since I imagine that most people are really sick of it by now (I know I am—I had 27 emails this morning and all but one were political). But since this is likely to be my last presidential vote (unless I vote as a dead person, LOL), and it has been a most unusual year, writing about it is also a way to record the evolution of my values. It’s a very long post, but maybe you want to come along for the ride, and if so, I hope you find this an interesting read of one person’s journey through what are unarguably very strange times. (This is especially true for my non-American readers, who are many, and who have expressed concern about how crazy things seem in the U.S. these days).

I grew up in a politically divided home. My mother was an avowed Republican, and my father, a Democrat.   My grandfather on my father’s side was also a committed Democrat, even more at times than my father, and often told the story of how my great grandfather Levi, who died on Election Day 1940, did so only after going to the polls and casting his vote for FDR, who was then running for an unprecedented third term.

As a result, our dinner conversations, especially around election times, were quite lively. From my mother, I learned the pejorative monikers for FDR’s work programs—Papa’s Working Again for the PWA, and We Piddle Around for the WPA, as well as her accounts of participants of the PWA playing catch with the fruit they were supposed to be packing instead of doing their jobs.   My father countered on that score with FDR’s numerous accomplishments—Social Security, abolishing child labor (which did not apply to my chores, I learned), the Tennessee Valley Authority, and his stewardship through World War II. These he supplemented with frequent drives to the nearby Huron National Forest—where I learned to drive–with its solemn row upon row of trees planted by the Civilian Conservation Corps.   He never failed to point out that those trees—which were replicated in forests all over the country to the tune of 3 billion planted —would not be there but for the Roosevelt Administration.

My own views evolved more to my father and grandfather’s side, in part I suppose because I revered my grandfather—and I was also influenced by the rector at the local Episcopal church we attended, who was a civil rights activist (I have written more about him here.)   My grandfather was ahead of his time for our small town in his views on people unlike us — I don’t recall him ever being pejorative about others based on ethnicity (he warned me in particular, in something that must have been prescient, about the dangers of anti-Semitism).

But our dinner conversations also formed the framework of alternative ways of looking at the role of the federal government, as well as its impact on individuals. For my mother, the focus was on waste and on the cavalier attitudes of individuals benefiting from the programs. For my father, it was on the good done for the many. I might equate this today to the difference between people who go apoplectic about the woman in the grocery line who buys a steak instead of hamburger with her food stamps—evidence for them that food stamps make people lazy and entitled—to those who focus more on the many who are deserving—veterans, people who work for Wal-Mart or in other minimum wage jobs but can’t afford to feed themselves or their families on the income they make, children, and the elderly and disabled. Do I mind that my tax dollars are used to help the latter, even though there may be people who “take advantage” of the system? Much less than I mind that a far larger portion of my tax dollars is going to keep the disastrous Lockheed F-35 afloat, or subsidizes the ads that Big Pharma constantly airs on TV. It’s all on where your attention is.

Another insight that evolved over the years is the role of balance of power between the various factions and interests in society. It is no accident that the precipitous decline in union membership in the United States has attended a great rise in unchecked power by corporations and higher income inequality, or that the power of lobbyists and their money has led to policies and laws that benefit not the average American, but the interests of the wealthy. (In the civil rights arena, the relaxing of the Voting Rights Act has clearly also had a deleterious effect).  This has occurred at other points in our history—the robber barons of the late 19th century, the deplorable conditions in the meatpacking industry in the early 20th century, and child labor are but three examples. And of course, great social movements, from the abolitionist movement in the 1800s to women’s suffrage to civil and finally gay rights—all have been grassroots struggles that ultimately forced the federal government to act in a way that moves the needle of justice and restores, to the degree possible, a balance where this has been lost.   (Some may applaud the weakened power of unions; to this, I say, “enjoy your weekend”).

While the federal government can certainly muck things up—in recent memory, No Child Left Behind and Common Core come to mind, along with the war in Iraq–it has also proved capable of enormous good, during both Democratic, and less recently, Republican administrations. On domestic matters these include the National Park system, Social Security, the Fair Labor Standards Act, the development of a national freeway system, the Civil Rights Act, Medicare, and the Family Medical Leave Act (Obamacare has a more checkered track record so far, but taking pre-existing conditions off the table, among other reforms, is a huge benefit even for those not personally affected by other aspects of the law).  All of these have impacted millions of Americans to the good. My ultimate conclusion is that the federal government can be a force for great progress, as well as for bumbling incompetence. Life is complex; it is not all one or the other.

Which brings me to this year’s election.   (In the interest of space, I’m not dealing with either of the main 3rd party candidates here, even though I recognize they are a choice for some who don’t like either major party candidate).

Until he dropped out of the race, I was a Bernie Sanders supporter—not unusual, perhaps, for someone who lives in New Hampshire and had an opportunity over a few years to see Bernie up close. What you see is what you get—scuffy shoes, wild hair, and a passion to both engage with people including those who don’t agree with them (e.g. speaking at Liberty University) and do what is right and just, as well as to get things done, sometimes by quite creative means.  This is a man with vision, authenticity, and ethics—not to mention a desire to serve without personal aggrandizement– that you rarely see in politicians. Does he have his faults? Of course.  But if anyone could have bridged the great divide in our country—and I’m not sure any one person could–I think he had the best shot. I regret that he was not the ultimate choice—and I honestly don’t know how much the weight on the scales exerted by the Democratic party, along with his inability to secure any meaningful portion of the African American vote that was clearly devoted already to Hillary Clinton, hurt him.   I think both probably did, especially since he had an uphill battle to begin with, but I am glad he stayed in the race long enough to ensure a Democratic platform that would restore some balance of power to the interests of ordinary people, and I think he will push hard to ensure that as much of it as possible gets enacted.

Hillary Clinton is another story, a complex character of almost Shakespearean proportions. I have friends—many of them older women like myself—who view her with reverence, and who feel that most if not all of the charges against her are manufactured by Republicans, are due to her gender and time in public life, and/or have no merit.   They are genuinely baffled as to why she attracts such negativity and point to a double standard (in some areas I agree with this, for example, the Benghazi witch hunt and the email server—both informed by my experience in the defense industry– but in others I do not).   I have other friends—and not necessarily Trump supporters—in whom she produces a visceral, completely negative reaction and who think at worst she is the incarnation of evil, or at the most charitable, a very flawed character.

My own view, especially having read Carl Bernstein’s insightful biography of her and following her over the years, is more nuanced, and closer to this analysis by Jon Stewart (boy, do I miss him!!)  In the primary race, the difference between her and Bernie seemed to me like the difference between an organic apple and a Hostess apple tart—both provide nutrition, but in one you get just the apple and in the other, you have to ingest a lot of chemicals and processing along with it. (I won’t attempt a culinary reference for Donald Trump).

Things I don’t question are Hillary Clinton’s intelligence and work ethic, her desire to do good—witness her work to benefit children–or her mastery of the workings and complexity of public and foreign policy (too hawkish on the latter for my liking, but on this topic she is the only possible choice among the four people running).  At the same time, the dislike and mistrust she has drawn are not without foundation.  The most recent flap with Donna Brazile, the interim head of the Democratic party who used her position at CNN to troll for debate questions to send the Clinton campaign, is instructive.   Brazile’s actions were clearly unethical—as were Clinton’s in accepting and using the information and not pushing back on the source. And this kind of thing is precisely why people who respond to polls answer that they don’t trust her.

At the same time, there’s a need for some context. Do I rank this with the numerous documented—and odious –attempts to suppress voter turnout in minority districts by Republicans—or with many of the things espoused by Donald Trump?   As disappointed as I am in the behavior, no.    Clinton’s ethical lapses, her obvious avarice as she cashed in on her time as Secretary of State on the Wall Street speaking circuit, and her sometimes poor memory about her past positions (e.g. gay marriage) are troubling character defects, but they are largely confined to her personal ambitions, and do not physically or otherwise endanger whole swaths of the populace. (And they pale in comparison to the alternative). And, as my Hillary friends who decry the double standard would likely agree, if we had access to the inner files of a George Bush- remember the smear campaign against John McCain in South Carolina in 2000—Dick Cheney, Chris Christie or even Donald Trump- we’d likely find much worse. (We’d certainly find a trove of missing emails from Bush/Cheney). I realize that some may disagree, but that’s my take on it.

When I lived in East Lansing as a student there was a guy named Tom who was running for a local office—maybe mayor. One day I found myself behind a car with a bumper sticker sporting his name and the tagline, “ Vote for Tom…..No Worse Than the Rest.”   I never forgot that bumper sticker, and in some ways it expresses the way I’ve come to feel about Hillary Clinton.   We were eligible to vote absentee ballot, and I checked the box, but –regrettably–without a great deal of enthusiasm. I applaud Bernie for his grace to make the pivot with more zeal than I have. And I sincerely hope my friends who are avid supporters are right and I am wrong, and she turns out, if she wins, to be a great President. But, in my view, great is not on the ballot this year—the far more basic goals of preserving our democracy and basic human decency have taken that spot.

And that brings me to Donald Trump, con artist and bully extraordinaire.   I don’t question that he has attracted a devoted following, but it reminds me of the comparison many years ago to those who supported Nixon—he could be shown on national television choking his wife Pat and at least 25% of the population would say she had just had a heart attack and he was holding her up by the neck.    I have several friends on Facebook who have taken pains to say that their friendships do not depend on who the friends vote for.  I guess that’s admirable, but as a person with a shortened life span and as a student of history, I find it a lot harder to go there (even though I have never taken this view with any previous nominee in recent memory—and that includes George Bush.)  If someone can listen to this man, hear the hatred, fear and lies he spews daily, and still think he would not greatly endanger all we represent as a country (not to mention personal safety for many)  we might be superficial friends, but not on a meaningful level. I certainly won’t refuse to talk to anyone who says they voted for Trump, but to be honest, with my life being as short as it is, I’d prefer to surround myself with people who espouse inclusiveness, kindness, compassion and respect for others, not those who endorse—and by voting for Trump promote–hatred, fear, bullying, and bigotry.

I am also aware that many people who support Trump say they are Christians, and this probably sticks in my craw the most, because if anyone is completely antithetical to the teachings of Jesus, it is Trump—both in his rhetoric and his policies. In that regard, I have to applaud not only the major Christian leaders who have come out against him (including an unprecedented non-endorsement in the Christian Post), but especially the more than 2000 young people at Liberty University who broke with Jerry Falwell to protest the university leader’s endorsement of Trump. (Maybe what Bernie had to say to them made an impression).   They are the true Christians.  And I appreciate that, in the absence of supporting the Republican nominee, they are faced with a difficult choice.

This election cycle has been a very long and ugly slog.  What concerns me is that in many ways, it will not be over even when it’s over.  The effects  will be felt long after the results are in because, in the process, great damage has been done to any kind of civil discourse.  Trump has brought out the haters, the anti-Semites and anti-Muslims, the white supremacists, misogynists, and bullies and legitimized them—already, teachers are reporting a rise in school-based bullying incidents–and it will be very hard to put this back in the bottle, regardless of who wins.  At the end of day, I fear we will need not just a Commander-in-Chief, but a Healer-in-Chief.   I hope someone steps up to play that role.





Autumn in New England

This has been a spectacular color season, one of the most brilliant I remember since moving to New Hampshire six years ago.  Fall has always been my favorite season, and more so here since the mountains and foliage create such a dramatic backdrop.   Because of the drought this year, I wondered if the colors wouldn’t be duller than usual, but that hasn’t proved to be the case–the reds, in particular, seem particular striking.   The effect has been magnified by the magnificent weather we’ve been having.


Near Keene, NH 


Hogback Mountain on Route 9 in southern Vermont 


A couple of weeks ago we went up to Mt. Washington, and took the cog railway to the top.  The drive was beautiful, though the day wore me out and I needed to sleep over 12 hours when we got back.


Cog Railway approaching the station, Mt. Washington 

These days are so fleeting, however, that I continue to push myself to make sure I don’t miss them, and so I drove through southern Vermont on Friday to take in one last session this weekend at Omega Institute in Rhinebeck, New York.  Here, too, the fall foliage was in full display, and with the effect of the afternoon sun, simply stunning.

 Omega Institute in fall

Of course, I can’t help but think that this might be my last fall–or at minimum, the last one I’m able to enjoy as I am enjoying this one.  These thoughts, while  somewhat inevitable given my condition, don’t really spoil the experience or intrude on my enjoyment, but make it even sharper and more intense than autumn usually is for me.  The beauty of fall is brief, the colors brilliant but impermanent, and as Robert Frost writes so eloquently in the poem below, force us to yield to nature–in both its splendor and decay– with grace.


Out through the fields and the woods

And over the walls I have wended;

I have climbed the hills of view

And looked at the world, and descended;

I have come by the highway home,

And lo, it is ended.


The leaves are all dead on the ground,

Save those that the oak is keeping

To ravel them one by one

And let them go scraping and creeping

Out over the crusted snow,

When others are sleeping.


And the dead leaves lie huddled and still,

No longer blown hither and thither;

The last lone aster is gone;

The flowers of the witch hazel wither;

The heart is still aching to seek,

But the feet question “Whither?”


Ah, when to the heart of man

Was it ever less than a treason

To go with the drift of things,

To yield with a grace to reason,

And bow and accept the end

Of a love or a season?


Robert Frost

Ground Reality (long post)

The term “ground reality” is a phrase I picked up in India (for some others, see here—the post is dated September 18, 2005, so you have to scroll down).   Ground reality is similar to the Japanese concept of “genba,” meaning the real place where actual work is done—that, to be a responsible leader, you must go and see, talk to people, and understand the issues where the work—and value creation—is happening.   I have been thinking about this concept a lot lately, not so much related to health, but because of various events in the news such as the Wells Fargo CEO’s testimony before Congress, a local development involving a major non-profit, as well as seeing the movie “Sully,” in which NTSB officials try to use computer simulation to prove, in hindsight, that the captain should have navigated his suddenly crippled aircraft to a nearby airport rather than land in the icy Hudson River.

The concept of genba or ground reality has never been particularly rooted in American society. In fact, the well-known quality expert W. Edwards Deming, though his ideas were used in the military during World War II, got his start in manufacturing helping Japanese industry improve quality, because U.S. industry was more concerned about volume than quality after the war. Deming’s 14 points for good management remain, in my view, the gold standard for ensuring not only quality but worker and customer satisfaction—yet, in the interest of short term gains and perhaps some cultural elements in the U.S. as well, they are probably less implemented these days than after Japanese competitiveness forced a relook in the 1970s and 80s.

I had several opportunities to practice this concept in my career, and I learned a great deal along the way. Now, as I no longer work, I think about it more broadly—from listening to tone-deaf bureaucrats in a movie to observing the workings of organizations that make decisions that impact real people from the comfort—and ignorance—of an office far removed from the reality on the ground.

One role I had  in the workplace on two different occasions was managing the benefits and policies associated with expatriates, who of course lived all over the world, in different time zones, climates, and living conditions.  Having been one myself, I was certainly in a better position than most to understand the concerns and struggles of my customer population. At the same time, I found that any knowledge I had from my own experience was just that—one person’s experience.   Unless I maintained  regular contact with the expat population, I risked making decisions that were short sighted.   Similarly, when I was in India—as an expat myself—I was operating in a society that was very different from my own. Without making a concerted effort to understand the “ground reality” of our employees—and I was fortunate that doing so was very much the culture of the company—I could neither be effective nor learn to navigate the delicate balance between maintaining integrity to the larger headquarters’ objectives and respecting local needs and considerations. I would add that this is not a one time exercise. You can go work on the line for a day as a manager or executive and get a taste of the experience that line workers have, but this is not enough. It is deceptively easy to fall back into a position of making decisions or judgments from the comfort of an office, removed from “ground reality.” It is almost like saying that having run a marathon, you are now fit. The reality is that unless you keep exercising, you will lose that fitness very quickly.   And,  if you see your job as helping people below you do their jobs more effectively (which, sadly, many executives and managers don’t), one and done doesn’t cut it.

One of the other benefits of maintaining constant contact with people on the front lines is understanding the process of value creation and the vital importance of front line workers, especially relative to administrators—not to mention that people on the front lines also become “real,” rather than abstract numbers on a financial statement. Too often, when jobs are cut these days, organizations err on the side of  failing to remove  administration, rather than sparing people who actually know how to do the job.    Likely, it is much easier to fire a nameless face at the bottom than to trim fat at the middle and the top—yet that is often the biggest source of organizational obesity, not only in the corporate world  but more strikingly in academia.

Short sighted decisions often emanate from failure to take ground reality into account.  Until a few months ago, a local non-profit that is a subsidiary of a large national organization (to remain unnamed, though my local readers may know what I am referring to) offered a much appreciated and needed service in our community—driving people who otherwise would struggle to find transportation to doctor’s, hospital, and other medical appointments.   The service cost the organization very little, being funded largely with local donations, and served more than 300 people a week. Then, in the wisdom that comes only from sitting in an office in headquarters, the national organization decided that this service, which was developed in response to local needs, was not part of the organization’s “core mission” and would need to be discontinued. Although the program was transferred to another local group,  today the transferred service provides rides for less than 30% of those formerly served (in part because the new service relies on online booking, which many of the riders, who are elderly, do not or cannot access).  In the course of this change, there was no evidence from any of the communications—which were all “top down”–that anyone from the headquarters ever visited the local community, talked to volunteer drivers or patients, or otherwise took the time to learn the impact that such a move would have on real people.

The demeanor and statements of the Wells Fargo CEO are another example. The idea that over 5000 people opening fraudulent accounts were undirected or at minimum weren’t heavily pressured by senior management to do so is, for anyone who has worked in a large organization, ludicrous. (I was amused–only partially– to hear an industry commentator lay the blame not on management but on Wells Fargo’s human resources department).  As my accounting professor at Wayne State once said, explaining the ins and outs of why accounting is not a mathematical science but is subject to human interpretation, “people do what they do because they love their families.”     Sitting in his plush office, with an income that he will never be able to use in his lifetime, I would be very surprised if this CEO ever visited a branch, talked to his employees, or otherwise understood the impact of aggressive sales policies that turned employees into perpetrators of fraud.   He has no concept, it appears, that part of his job and that of his senior team is  also to use his influence, access and power to help people do their jobs more effectively.   And money—and greed—are clearly fogging the picture as well. I once attended a financial seminar with Marty where the speaker noted that studies have shown that many wealthy people don’t feel “secure” until they have at least $63 million. Can you imagine? But, if true, it is an insight into the mentality of people at the top of such organizations as Wells Fargo—who therefore have little inclination to ensure that people on the front lines are sharing in whatever wealth the company generates and have a comfortable wage.

One of the things about being in Japan for so long was absorbing some of the communal nature and sense of shared responsibility of that society, which is sadly missing in most of institutional America (there are exceptions, of course.)    It is routine in Japan, if a company runs into a scandal or crisis such as Wells Fargo finds itself in, for the head of the company to resign (a recent example is the head of Takata, maker of the defective airbags).  Attention to ground reality is something I think we need a lot more of.  Only then will CEOs, government and educational administrators, politicians and others truly begin to understand not only the impact of their decisions but, just as important, how to make decisions that benefit more than their inner circle.





What I’m Watching and Reading

I am a bit late getting a post out with the start of a new clinical trial, the holidays and some lovely company–plus, I confess, a bit of inertia.   Now that I am essentially “retired, “ I have more time to read as well as catch shows on my tablet on Netflix and Amazon Prime. I have always been an eclectic reader/watcher and I have a short attention span, so I have a hard time doing anything serially—I usually have three to four books going at once along with a couple of shows. Staying mentally active in this way keeps my health from becoming the 24/7 resident of my brain.   (I also  do the daily New York Times crossword puzzle and spend time on my dissertation, but to be honest this latter one has been harder).


In the evening, I confess that after the news, I fail to join Marty in his favorite pursuit, watching Judge Judy–my theory being that if you’ve seen one of her shows, you’ve seen them all.   I might be accused of the same, but I’ve been working my way  on Amazon Prime through the original 1960s series Mission Impossible, which aired while I was in high school and takes me right back to my parents’  living room.   I’m on Season 2 now, but when I was about halfway through Season 1, Steven Hill, the actor who played Daniel Briggs, the original leader of the IM Force, died at the age of 94.    I didn’t recall knowing the story of why he left after only one season (he was replaced by Peter Graves), but it had mainly to do with the fact that Hill had become an Orthodox Jew, and walked off the set on Friday afternoon even if the filming was not complete, in order not to violate the Sabbath. He had disclosed this stipulation, along with some others, to the producers when he signed on, but over time—especially if production ran over which it often did—it became a major issue, and Hill was not asked back. He later went on to star on Law and Order in the 1990s, and played smaller parts in several movies in between. Perhaps the most moving, and a true testament to his talent, was his role as Christine Lahti’s father in the 1989 film Running on Empty (also starring Judd Hirsch and River Phoenix), about a couple that is perpetually on the run for bombing a research lab during the Vietnam War, and the dilemma they face with their highly talented musician son (Phoenix). In addition to these, I try to keep up my Japanese by watching Japanese movies, the most recent one (on Netflix) called Sweet Bean (An in Japanese), about the owner of a dora-yaki (Japanese sweet) shop who hires a woman in her 80s who teaches him how to make her secret recipe for sweet bean paste for his pastries—as well as several other life lessons.

During the day, I try to spend at least a few hours reading. It’s something I can do even when I don’t have a lot of energy, which is more often these days. On the fiction side, our son Harry gave me a copy of Thomas Mann’s The Magic Mountain for my birthday. I recall starting this book many years ago—and I did read Death in Venice on which the book is based—but I’m sure I never finished it. This is the hardest thing I’m reading and it’s slow going—the maturation and evolution of Hans Castorp appears to progress at a glacial pace– but fortunately the sections are short and I can read it in bite- sized chunks. I have also read The Girl on a Train-a quick and easy read—and The Art of Hearing Heartbeats, a beautiful book about a young woman who searches in Burma for her father, who has mysteriously disappeared to his homeland without a trace, and all she learns about his growing up before he moved to New York.  Next up: Isabel Allende’s The Japanese Lover and Anthony Doerr’s All the Light We Cannot See, both gifts. I enjoy a good mystery or spy novel, but I need to find a new series.


On the non-fiction side, I tend to prefer biographies and memoirs. A few weeks ago, on my birthday, Harry, my sister-in-law Roberta, and Marty and I visited Hildene, the Vermont summer estate of Robert Lincoln, the only son of Abraham Lincoln to survive to adulthood. The younger Lincoln served in the war cabinets of two presidents and became the head of the Pullman Coach Company, where he made the bulk of his fortune. Hildene is a sprawling, beautiful campus with a large estate house and gardens, a Pullman coach car, and a goat farm where, in addition to raising goats, there is a cheese-making operation. In front of the main house is a brick outline of the log cabin in which Abraham Lincoln was born and spent his early years—a constant reminder to his wealthy son of his humble origins. The estate had a book shop, and I picked up a copy of David Herbert Donald’s biography of Lincoln, which I hadn’t read.  It’s well done and easy reading.


I also have a lot of books on my tablet, which is great when I travel to Boston, though frankly I find the tactile sensation of a real book to be more satisfying. Without getting into a lot of politics here, I am also reading Carl Bernstein’s biography of Hillary Clinton, A Woman in Charge, which goes up to the time just before she became a senator. I’m at the point in the book where the Clintons have just moved into the White House, and one of Hillary’s first acts—strenuously opposed by then press secretary George Stephanopoulous but acquiesced to by her husband—was to kick the White House Press corps from the West Wing and relegate them to the Executive office building across the street. It’s an interesting tidbit given that Hillary’s role model was Eleanor Roosevelt. Though the 30s were of course different times, and the White House press corps certainly a smaller and more malleable group, one of Eleanor’s first acts was quite the opposite–to invite the women reporters in for daily briefings. And speaking of Eleanor, I can’t wait for the long overdue third volume of Blanche Wiesen Cook’s biography of her, which is due out in November. In the meantime, when I’m done with Hillary, I’ll move on to the new profile of Missy LeHand, FDR’s long time right hand woman, which was just published (The Gatekeeper, by Kathryn Smith).

I also read books on death and dying, though I try to intersperse these. Atul Gawande’s Being Mortal and Paul Kalanithi’s When Breath Becomes Air, both New York Times best sellers, were fantastic. I also enjoy the work of Stephen Levine, with whom I share a birthday, and who died earlier this year.

Music is another source of comfort, but I’ll save that for another day. In the meantime, I have truly come to understand the mantra, “So many books, so little time.” Literally.