Monday, March 28, 2005

Terri Schiavo part 4, a study in contradictions

A study in contradictions.

It seems that contradictions abound in the Terri Schiavo issue.

Michael Schiavo: Is he a loving husband, tearfully supporting his wife’s final wishes or a cold hearted killer determined to remove her from his life? Is he an adulterous bastard, or man who lost his love and moved on with his life? Is he a grieving spouse who lost his loved one, or a cold blooded murderer?

The Schindlers: Are they controlling, money hungry parents trying to milk every penny from their daughters shattered life, or grieving parents who just want to continue caring for their daughter?

Both together (and their doctors): Is Schiavo a realist, who sees Terri’s condition for what it is- the end of her life, a living death that she would not have wanted, or are the Schindlers the right ones when they claim she was prime for rehabilitation, aware and conscious deserves to live?

Analysis (aka opinion): I think Schiavo has moved on, and so no longer cares about Terri one way or another. He may well be supporting her wishes, it’s possible. He denies any possibility that she might be aware, and insists she is gone. The money grubbing accusations against him do not stand up to the fact that the money in question is gone, and that by relinquishing custody of her, he would have been paid millions. His worst crime seems to be a heavy dose of reality coupled with a single minded obsession. Likewise, the Schindlers don’t strike me as money seekers, they seem more like eternally optimistic-blinded by their optimism loving parents, who see in Terri the life and person she was, not who she is now. They are victims of their love and refusal to let go. Their only crime it seems to me is denial.

The politicians:

The republicans: The right to life is their goal, yet they support capital punishment. Smaller government and less government intervention, yet they used Congress to try and force the issue.

The Democrats: They support the right to die and abortion, but not capital punishment? They decry government intervention, but remember Elian Gonzales?

Both: Using this for whatever political leverage they can. Period.

Florida: The state does not allow euthanasia or assisted suicide, but this case is certainly a blend of the two. A family member decides to allow someone to die. A person has a stated desire to not live after a severe trauma. All of these are elements of the Schiavo matter, and the court has consistently and specifically ordered her to be allowed to die. This area becomes semantics of the worst order: She hasn’t chosen to die; she has elected to not be kept alive. She has not been euthanized; she has had her life support measures terminated. All the sophistry in the world cannot hide the fact, that from the State’s perspective, they have ordered the mercy death (a new oxymoron?) of an innocent and helpless woman or they have enabled this innocent woman to terminate her own life based on her spouses declaration of her wishes to not continue living in that state. Either way the state is culpable.

Terri herself: Is she a person or a shell? Dead or alive? Pawn or player? It seems more and more apparent that much of the fuss surrounding this case is attributed to 3 factors:
  • The right to die versus right to life debate
  • The animosity and battle for control between her parents and husband.
  • The attempts for political gain and spin control by the politicians and the lobbyists.

The second one is the most tragic really, for it embodies the worst of all of it. As family they should be together in grief, united in love for Terri, and jointly sharing their loss. And it continues, since now that her parents have given up efforts to save her life, they and Michael Schiavo now argue over the disposition of her remains. He wants her immediately cremated and interned in Pennsylvania, they want her buried with a catholic mass in Florida. A compromise appears necessary. As a Catholic, she can be cremated and interned, but Catholic preference (not dogma, just preference…rites exist to have a Holy Mass for the ‘cremains’…) is to have the Holy Mass first, then the cremation. A logical compromise would be to have a formal Catholic Mass, followed by her cremation and internment. It does show some encouragement that Mr. Schiavo allowed her Easter Communion and the Sacrament of the sick (aka Extreme Unction or Last Rites) on Sunday. Maybe there is some hope after all.

I sincerely hope they figure it out, but frankly it appears remote, the damage between the camps has been done, the accusations and vitriol has caused so much hard feeling that I doubt any manner of compromise is possible. Even in her death (when it occurs) she will remain the source of dissension.

But perhaps, the worst contradiction of all is that even in death she will also be the poster child of both the right to life and right to die groups….in one the victim, in the other the victory.

Even in her death, the contradictions will remain.

Tuesday, March 22, 2005

Terri Schiavo Part III

The tube is removed and she is fading.

The family's petition to the Federal Court (paved by Congress) was denied, and they have now appealed to the 11th Court of Appeals. I think it will also be denied, and this will end soon. I could be wrong, and frankly I am torn as to which I would hope for. A part of me wants it to be over, because while the manner of her death is repugnant to me, and her life is so tragic, the yo-yo actions of pulling her back and forth from the brink must be the cruelest irony of all. I know the *issue* of her life and death will continue on beyond her actual death, but that still should allow her the peace of her passing.

(The appeals court has just denied their request as I wrote this)

One new development, though not really new. Carla Iyer, a former nurse has been making the rounds of the radio and tv circuit, claiming (backed up by a 2003 court affidavit) some fairly horrible things about Michael Schiavo's actions and motives, and some disturbing allegations about Terri's actual medical condition in the early years of her disability. If she is telling the truth, then Terri was not as bad as she is now, could eat and had a good shot at recovery or at least partial rehabilitation. If her account is honest, the Micahel was a cold hearted bastard. Period.

So is she? She is backed up by several other caregivers so it bears scrutiny, but it still is open to interpretation. Were I to try to make a definitive judgment it would be difficult to do.

In the end it moves me, it increases my suspicions, and it increases my compassion for Terri. And oddly, it makes me hope God takes Terri sooner then later. If this account is true, she deserves peace more then ever.

As for the players in the legal drama, I will have to be content to let God judge them. Let all involved examine their own souls.

One other side effect of my interest in this case. I am really having a hard time reconciling the "Culture of Life" rhetoric being sold by the conservatives. Sure its ok to fight for aborted babies. Sure its good to fight to stop euthanasia (and in my opinion, Terri's case is a quasi-case of euthanasia or assisted suicide...Euthanasia because her husband ordered her death for all intents as a mercy killing, and assisted suicide because the rational is that she wanted this). But I can no completely reconcile some of the rabid conservative stances supporting the death penalty. I am not necessarily against it mind you, but I am reexamining my beliefs on all of these issues.

Not that the right has all the criticism here, the liberal right to die campaign is sickening too. The worst line was from Michael Schiavo stating that "reinserting her feeding tube would be a violation of her civil liberties". I can't totally accept it.

As I am discovering more and more, as in politics, religion and many other facets of my life, the clear cut and well defined perceptions I have comfortably lived within most of my life are being rapidly punctured and deflated be the murky uncertainty of reality. Reality has intruded, and I will never be the same because of that.

I tore myself away from the safe comfort of certainties through my love for truth - and truth rewarded me.
~Simone de Beauvoir

May it be so.

God have mercy on all of us....and God have mercy on Terri.

Monday, March 21, 2005

Terry Schiavo...the other side of the story.

I sent my Terry Schiavo blog to a handful of friends, and I got a surprising response. One of my friends, who is a fairly devout Christian is also involved in the hospice care industry, and had some interesting responses.

I am posting her responses and my thoughts to them, just to share how the other side views this....

******

Thanks for the input . While I have some strong opinions, I do also feel obliged to hear all aspects, and if its ok, I'd like to forward your response to some friends who are discussing it.

You said:

After 15 years the window of opportunity for neurological rehabilitation is closed but for a miraculous act of God. Consider - Man can now get in the way of God calling His children home by the fact that we perform resuscitation in the first place. Seeing the situation Terri is in, her functional progress would be VERY limited. Her hands and arms are contracted - a condition EXTREMELY painful to remedy - so painful it is rarely if ever worth it. And that is just in terms of gaining flexibility. Active, coordinated, purposeful, intentional, movement is another story. In general the window we look at is 3 to 6 months after incident for the dramatic recovery, occasionally for another year - maybe - small gains can happen, but usually not functional gains, hence the dismissal of services noted on the website.


***Yes, that was in line with my thought, and that's why I do allow that the family is likely living on optimism at the cost of reality to a degree.


What is more likely than Michael refused therapy is that he refused to appeal her denial of coverage.


***I don't know, the sites I perused only indicated therapy was recommended but he rejected it.


When looking at the ADL's - activities of daily living, we hope for the ability to roll over in bed, sit up, transfer to a chair hopefully with minimal assist. But a min. assist still requires 24 hour care. IF someone can get out of bed next we look at can they do any self care - feeding, brushing teeth, dressing, etc. Lastly we look into can the person relate to others? So much of life (living) is relationships - what makes life worth living? It isn't moving, dressing or bathing. Terri's current state is dependent in all adl's. Since she has a feeding tube inserted, that tells me her debilitation includes that she cannot even swallow. In the case of severe brain injury - it is hard to tell what responses are purposeful and controlled and not. But from seeing folks like Terri - the chances that she has any awareness are slim.



***Actually the swallowing issue is in question. The family and some care givers have testified she has some small ability to swallow. According to one site, one point of contention that has not gotten media attention is that the order applies to the feeding tube only. The husband specifically ordered no mouth feeding in a separate act, leading me to wonder if some reflex swallowing could happen.

The reality of a day in a nursing home for patients like Terri is pretty sad, and frequently painful. Diaper rash, bedsores, contractures, pneumonia, bladder infections, the list go on and on. It isn't a pretty sight.


***Yes, I had read up on the infirm, and its not pretty at all.


I think this battle isn't about a living person so much as it is about control - the spouse vs. the parents. This has been a 15 year long court battle from the get go. Terri is innocent alright - the argument may be over her - but she is, as you say, a pawn.


****Yes, that seems very apparent.

I remember Terri's case from way back - similar to the Karen Quinlan story. The courts have been debating whether feeding tubes are 'life support' for years. There really is no easy answer - other that it is the toughest decision for anyone to have to make.


***What bugs me is that voluntary euthanasia and assisted suicide is illegal, but stopping feeding is ok? How is there an effective difference?


In Michael's favor - remember his life has been on hold as long as Terri has been injured. He cannot go on with life as a man with his wife. There is no marital relationship - and I don't mean just the physical - but the midnight chats, the best friend who you share all with. For him it's all gone, not a hope of it ever returning, she will never be a equal partner. Since he hasn't just divorced and gone on with his life says a lot to me about his concern for Terri's wishes.


***I tend to disagree....he has moved on, is living with a woman and has two children by her. Since the families would have taken full support of her had he consented to divorce her, then he chose not to because he either has a strong sincere belief in supporting her wishes, or he has another agenda. Both scenarios have merit and are possible, and no one knows but him. But the vision of noble sacrifice is somewhat shallow when he has a new family he is already invested in.

I confess I stand on the side of the spouses rights. Yes a tough choice but he wouldn't be the first to do it.


***No, I certainly wont dispute that.

Knowing the medical establishment - I strongly believe Terri would have received therapy initially as long as she was progressing. Even Medicare was much more flexible 10 years ago about how much progress was allowable.


***The timeline says they initially saw some improvement and recommended more therapy, but Michael instead placed her in a nursing home. No indication as to whether insurance was a factor. Her medical settlement would not come in for a couple years, so its possible.

Not the case anymore. I am not aware of treatment that would have any significant impact on returning Terri to her prior self. In support of her parents I can see how parents would be content with their child in a dependent condition; it is how their life began. It is hard to say goodbye to one's child, especially when you have seen them go from dependent to mature once, but independence isn't in the picture for Terri - ever. In skimming the site you referred to, I see a family not wishing to let go - and possibly even hoping for some of that malpractice money for themselves? Obviously the court stuff has eaten up a LOT of money on both sides. I wonder if the argument really is about Terri or money - or just winning at this point. Their stand really doesn't make sense to me since I can see the other side of the situation.


***Standing in the middle I think both sides have merit. The family may want to just continue loving their daughter. The husband could just want to discharge his responsibility with integrity. And yet both sides could also be suspect.

The bottom line - get an advance directive and keep it on your person. An advance directive in your medical chart at your doctor's office doesn't keep you from being resuscitated in an ER across town. We had a patient who had that happen - he had an advance directive - was resuscitated by law when it wasn't available - when it became known, a distant relative had to make the choice to remove the tube or not. In the end the tube was removed and he died quietly a few days later. The death from having a feeding tube removed is not horrific as the site suggests. The patient is watched closely by hospice care - often steadfastness and other medications are given, the patient goes to sleep and passes peacefully. I have watched it happen. More than once.



***If no other good comes from this, at least there might be raised awareness of this. I will note that on a legal front I oppose it because there is no clear proof of her intent, and the law is supposed to be bound by proof. His arguments about her intent are not necessarily persuasive. I
also am suspect of the timeline. He waited until after the monetary settlement was given before he tried to end her suffering, something that does not help his credibility. He claimed on Larry King tonight that he was just holding hope and it took that long to give up, but that brings us back to the question of why he did not advance her therapy when there was a reasonable hope of it doing some good.

OK here's something to rant on - or just think about...Why not give a small wafer and some juice? Because if Terri cannot swallow, and she aspirates on the wafer or juice and gets pneumonia - it's a lawsuit for the care facility since they know she cannot tolerate anything by mouth.


***First, the monsignor indicated he would have used a crumb only so its doubtful that would have been an issue. Second, she been receiving it weekly for some time before this, so this was not a surprise move. If the family and staff were right about her limited ability to ingest and swallow, it also would have been a minimal threat. I might also point out the absurd contradiction of worrying about someone choking whom you are actively starving to death, but I wont. (smile)

....And yes -the Church opposes the removal of life support yet don't they support medical care to extend existence? Don't they support medical intervention to prevent nature (God) from taking its (His) course and allowing people to die at the time of injury?


***I am sorry, but you lost me. I don't see a contradiction between the two statements. I personally believe in taking any reasonable action to prolong life. God works miracles in science too.....

Thanks , I really got a lot of insight here and I hope you won't mind
me quoting you.

Karl

Terri Schiavo: Victim or pawn?

I am really torn down the middle on this whole mess.

For those who are not aware of the specifics, at issue is the life of Terri Schiavo, a young woman in Florida who suffered a heart failure in 1990, and has been in what may or may not be a Persistent vegetative State (PVS) since then.

What is at issue is the extent of her injury and disability and whether she should be allowed to die with dignity.

Her family wishes to prolong her life (she requires no life support, just a feeding tube) so she can continue rehabilitation and possibly recover. They claim, and apparently have video to support, that she is not in a PVS as defined by the law, and is therefore entitled to medical treatment and rehabilitation under FL Law They further allege that Terri's husband Michael has denied her the rehabilitation that doctors have recommended, that Terri was awarded money designated for treatment which Michael has used for legal fees and more. The also accuse him of wanting her dead so he can remarry.

They cling to hope of her revival, point to signs of her awareness, and stand steadfast in their belief she could recover, but sadly those things could be imagined and unrealistic, it is not uncommon for optimistic family members to imagine more progress then there is. Miracles happen however, and who is to say she could not recover? Last time I looked, God is bigger then all of us.

Michael claims he is merely acting on Terri's wishes, that she did not want to be kept alive in these circumstances. While he has spousal rights and the law on his side, Michael's conduct is not leading to a lot of confidence. The accusation that he wants her dead to be able to remarry, while very prejudicial and assumptive, is also possible under the circumstances and if he is deliberately refusing beneficial treatment, then it is troubling.

On a medical standpoint, there is a significant discrepancy between the doctors testifying for the husband those for the parents, and that needs to be resolved. I also think some of the other accusations need to be addressed as well, particularly his withholding possibly beneficial therapy.

What really bothers me is this In order for Michael to "carry out her wishes" he has to order the caregivers to withhold her feeding tube, essentially forcing her to starve to death, a process which could take from several days to weeks to complete. To me this is different from an order not to resuscitate, which Michael placed on her in 1993. Since she does not require life support, that is the only way to make it happen, and that just seems overly cruel to me. I am not sure I buy the argument that starving her is letting nature take its course. That is too much like euthanasia, and as such seems to be against FL law as well.

Most of this case hinges on Michaels insistence that this is what Terri wanted. There is no declaration of intent or living will signed by her, and (reputedly) no friends or family members have stepped forward to declare what her wishes were. Had this been her wishes, I would have expected someone else to know, but on the other hand its not uncommon for the spouse to be privy to things of nature.

Also, it bothers me that in our society, a person on death row (who is presumed to be guilty and deserves to die) has more rights and more legal standing to stay alive then Terri does (a person who is without argument innocent) and will receive a more humane death then Terri (though again, I have a hard time supporting Euthanasia laws).

To that end, President Bush just signed a law allowing a Federal Court to review the issue, which I don't necessarily oppose, though I dislike government intervention. But while I hate the prospect of an already intrusive government intruding in private affairs, I think this may be a case that justifies it.

In closing, I heard a couple of things last night that just don't make sense to me.

Terri, it seems, is Catholic. When her feeding tube was removed in 2003, she was denied her Last Rights and Holy Communion. I don't get that. What on earth is served by that bright idea? They claim its just following orders that she not be fed, but a small crumb of a moistened wafer placed in her mouth? Its not a friggin Big Mac for crying out loud. (The Catholic Church opposes her starvation, by the way.)

The news also reports that Michael has petitioned for and been granted the right to have her cremated and her ashes taken out of state against her parent's request for a Catholic burial. Again, what is possibly served by that except a nice wave goodbye (with one finger) from Michael to her parents.

The whole case is awash with questionable motives, from the right to life and euthanasia crowds both seeking to use it as precedent, to politicians grandstanding and to the previous mentioned motivations and accusations of the family against the husband, and his complaints about them.

And in the middle is Terri. Living on the edge of dying, and unable to say what she wants.

All I can say, is in the absence of all else, I would prefer we err on the side of life if we err at all.

May God have mercy on Terri.

Sunday, March 20, 2005

A night at the theater

Tonight we enjoyed the theater. Specifically my daughter's high school drama troupe.

Tonights play was Kiss me Kate, a Cole Porter Classic.

I had never seen it before, and was delighted with the fun of the story. But what blew me away was the talent of some of these High School kids. The leads who played Fred, Lois and Lilli were incredible singers, Sarah Hughes (Lilli) especially. This girl had a tremendous voice, and is graduating this year to pursue music at BYU.

While Kayla had a small part in the Chorus, she was still terribly proud to be in her third play, and devoted as much effort as I have ever seen her give to anything. She sang, danced and swept with her whole heart in the part.

I was proud of her for the amount of work she put forth, every day for weeks after school. I was also proud of her for her complete understanding of what being a part of a team entails, giving your all to make the whle performance better.

And I was mostly proud of her as I watched her afterwards, striking the set and having fun with her peers. A somewhat shy 8th grader last year, she has become a bold and self assured High School Freshman, in part I think to her growing love of the theater, and art in general. She plays violin, she sings, she draws, she writes and even does some astonishing computer graphics.



As she grows older we see so many changes in her. But her love of the fine arts remains solid, and I pray it continues.

And mostly, we sat and enjoyed a night at the theater. Seems Kayla isnt the only one who loves the arts.....

Tuesday, March 15, 2005

Jobs with Expiration Dates

How fun is that? You go to work day after day, do your job well and they suddenly, one fine day your job is over....and you knew it was coming the whole time, in fact you knew from the day you got it.

And so you leave, and file for unemployment while searching for a new job....but wait! 100 magical days later, you could start the same job all over again...

Well, that's the fun of contract employment at Microsoft...well to be fair, its almost anywhere, not just Microsoft.

Here is how we got in this mess: Back in 1992, Microsoft had what people called "permatemps. temporary employees who worked long term contracts, as in years long term. But since they were paid through a staffing agency, no benefits, no stock options, no stock purchase plan. So a bunch of these people who felt they were being taken advantage of sued. Jump to 2000, and Microsoft settles the lawsuit and changes the rules. Now, among other changes, all Temporary contracts have to be 1 year or less in duration, with a 100 day break in between.

So why is this an issue? Since I left Boeing in 1999 (layoff) I have worked solidly in the computer industry. I have worked in 6 positions. Of the six, 5 were in vender or contractor positions. Of the six, 5 were at or for Microsoft.

Now I don't blame the industry for using the temp system. It makes financial sense, and they do have stockholders to answer to. The system offers them a quicker and easier way to respond to changing needs. It even offers them a kind of safety net to screen potential new hires without actually hiring them.

Its the way it is up here. While MS is certainly not the only show in town, they are without a doubt the biggest dog in town. When I started my IT roller coaster, most companies were hiring through staffing agencies, including hospitals, financial organizations and of course, MS and the other software/Dot Com companies.

The "100 days out" is a universally accepted fact. Even at my one non MS position at the University of Washington Medical Center, I was on contract facing either a 100 day out or the end of the contract.

In a few weeks I start what I hope is my last contract position, a 90 temp to hire position with a small company i