The Mom & Me Journals dot Net
The definitive, eccentric journal of an unlikely caregiver, continued.

Apologia for these journals:
    They are not about taking care of a relative with moderate to severe Alzheimer's/senile dementia.
    For an explanation of what these journals are about, click the link above.
    For internet sources that are about caring for relatives with moderate to severe
        Alzheimer's/senile dementia, click through the Honorable Alzheimer's Blogs in my
        links section to the right.

7 minute Audio Introduction to The Mom & Me Journals [a bit dated, at the moment]

Saturday, July 26, 2008
Moseying Down the Trail
An Open Response to Mona, a Regular Reader and Commenter:
    I needed the smile your comment on my immediately previous post splashed across my face yesterday, Mona! Over the last week or so even I have been surprised at how frequently I'm posting, again. Lately I've been scouring my motives, thinking that I might be feeling, since the "death sentence" was laid upon my mother's head, some urgency about posting under the assumption that I "now" have a limited time to do so and want to record as much as possible. I'm not sure this closes the case, though, as I've suspected that after my mother's death I will probably feel the need to post a lot in reflection.
    So, you know, I'm still unsure of why I'm moved to post so much, right now, except that present circumstances, which are surely influenced by the "death sentence", have a knack for stirring up my thoughts in regard to my mother, our companionship and my caregiving. In looking back at my usual posting schedule it looks as though such stirrings are not unusual.
    To you, Mona, and everyone who reads me here, please know that comments are always appreciated, in part because I am grateful that I am occasionally read. Comments also allow me the special thrill of feeling as though I'm in conversation with a reader, here and there, but they are not necessary, so, please, don't ever feel obligated to comment...rather, allow yourself to feel moved to do so! Readers and comments or not, I seem to have more than enough internal provocation for posting.

Yet Another Visitation of an Important Caregiving Topic:
    While my mother was in all three medical facilities from 5/14/08 - 6/29/08 it was ever so common for me to hear, from all manner of medical personnel, some variant of the following: "Being elderly is childhood in reverse." That's a quote because one of the CNAs at the rehab facility actually voiced this version. I was always too involved in looking after my mother at these facilities to respond positively or negatively, but I haven't been able to let go of this obviously universal perception and, as you can imagine from having addressed it some time ago from several angles in this essay, remain in deep argument with it.
    Over the last few days a few of those thoughts have gelled into questions that I'd like to put before my audience (present and future). If this observation is true:    If we really believe that aging is nothing more than childhood in reverse, why aren't we treating it as though it is?
    Yesterday I received a curious magazine, Miller-McCune: Turning Research into Solutions, to which I do not currently subscribe but to which I've been invited to subscribe for free, although I'm not sure why I'm on their "free subscriber" list. The magazine has an article in it which I have yet to completely read, although I've scanned all the sections and am intrigued: Pax Americana Geriatrica. At this point in my scanning, despite the difficulties it outlines in regard to the aging of the population of those nations considered major power brokers, it also suggests that the aging of these populations will usher in an era of peace. It also suggests that the younger a population is, the more warlike it is. This throws into question the idea that aging is childhood in reverse. However pleasant are many of the circumstances surrounding parenting an infant, I doubt that many of these circumstances would be labeled "peaceful" by parents. Makes me wonder: Are we simply not tuned in to the implicit peace of Our Ancient Ones? Is this lack of perception the major problem that stands in the way of us keeping our elders closely connected to us? Yes, garnering the resources to properly care for An Ancient One is not easy, either in home or in country, primarily because we haven't paid attention to renovating our environments to this purpose. Even so, when all is said and done in regard to caring for my mother and everything is on an even keel, which happens more often than most would suspect, there is little more beta-peaceful (which implies alert relaxation) than the afternoons and evenings my mother and I spend in each other's company, no matter what we're doing.
    As I attend more closely to the above mentioned article my intention, of course, is to report back, here. In the meantime, consider this: As long as we insist on equating aging with "childhood in reverse" we will not only fail in our efforts to care adequately for Our Ancient Ones, we will miss the unique and plentiful gifts they have to offer our families, our communities, our societies and our world.

    One half hour to go before Mom's 12-hour sleep mark.
Thursday, July 24, 2008
It's seemed like a Friday-bordering-on-Saturday, today.
    Thus, it was with some surprise that a recent caller reminded me that it's Thursday and we have one more day of warm, muggy weather before the temperature drops about 10 degrees. Nonetheless, Mom and I have had a great day. I'll cover movement over at Life After Death Sentencing but, so far, it's been a good, fun day. Mom was sitting up on the bed when I entered her bedroom, almost ready to arise. She took her breathing treatment well, was chatty although not interested in bathing but, then, she never is until she settled down on the toilet and realizes how warm and cozy it is in the bathroom. While we ate I read interesting articles from the paper since it seemed like she would be interested and zoned in. She was. One article in particular, about "brother" movies, is fashioning our entire day. Two of the movies, The Godfather and Rain Man are in our collection and shared favorites. As read the mentions of both Mom nodded and interjected how "enjoyable" both are. I asked her if she'd like to see them today. She was more than enthusiastic. We just polished off an extended "morning" with the first. Mom was fully into it, as I was I. We paused the movie several times to talk about various scenes and bits of Cosa Nostra philosophy. About halfway through Mom decided that it would be proper movie watching conduct to have popcorn, so I won't have to worry about her blood sugar tonight. She's napping, now, and we're planning on watching the second of the two movies tonight. She went down at 1800. "Don't call me any later than eight," she directed. That's a change!

    Regarding the "issue" we've been having the last three days (hinted at in the immediately previous post) that I finally confronted yesterday: Mom is never particularly fond of either her treatments or her pills so we tend to make them into a joke, i.e., talking about how she "can't do anything without taking a pill, first," or me telling her it's time for her to morph into "The Masked Woman" (she uses masks for her breathing treatments). She is least fond of the breathing treatments and, unless I keep a sharp eye on her, she is liable to pull the mask down to her neck or hold it away from her face to keep from breathing the stuff. Since the breathing treatments are obviously doing her good, at least for the time being, I generally and simply replace the mask, remind her to keep it in place, and we continue. Usually, too, during two of the three treatments which last well over about seven minutes, a long time for youngsters and lightly demented oldsters, I move in and out of her view doing chores, setting up whatever we have planned for after the treatment, etc., but I keep my eye on her.
    During her two "weak" days she decided she was not going to tolerate the treatments. Although I was pushing my limits I remained in good humor and just replaced the treatments about twice as much as is normally required. Yesterday, though, I was well past my limits and not in anything close to good humor. Mom was still intolerant of the treatments. With each of her attempts (and there were many throughout the day) to hijack the treatments I became more exasperated. Finally, some time in the early evening, after she's awakened from her nap, was taking one of the long treatments and was attempting to remove it, in front of me, for the fourth time, I reached the end of my rope. I suspended the treatment, took the mask off her and faced her down.
    "Mom," I said, "these aren't 'at your pleasure' treatments. Let me explain why. Do you understand that you have lung cancer?"
    "That's what I keep hearing," she said dismissively. No one talks around her when her health is being discussed and her lung cancer comes up fairly frequently when Hospice People are here, so she's privy to this a lot.
    I ignored that it sounds like she doesn't believe this. It's okay with me if she continues to consider it a fact outside of her reality. I went directly for the heart. "You were diagnosed on May 21st. At that time the doctor gave you six months to live. Do you remember this?"
    I doubt that she does but, now fully on her high horse, she responded, "Ohhh, yes. I remember."
    "Okay," I continued. "It was July 21st three days ago. That's two months down. Now, I'll tell you, I expect you have somewhat more than six months in you..."
    "Well, of course I do!"
    "...but the bottom line is, lung cancer is fatal and you're not being treated because treatment, at your age in your condition, would very likely kill you after rendering your quality of life into shit. So, many people are working very hard, primarily me, to see to it that for the rest of your life the quality of your life remains high. My perception is that your quality of life is pretty much as it was before you went to the hospital. Do you agree?"
    I had her full, intent attention, now. She was even a little flustered. "Well, yes. I'd say so."
    "Okay. These breathing treatments are an important part of keeping your life going the way you like. They are important, to you and to me. They keep your lungs as clear as possible by making it easier for you to expel the secretions that the tumor is causing your lungs to create. With a little luck it's even possible, with these treatments, that something else will get you before that tumor in your lung suffocates you. So, you need to cooperate with these treatments. Not only because they help you, ah, ah, ah, no comments here, you're going to have to trust my judgment on this one, nope, I mean it! Silence! You need to cooperate with these treatments not only because they help you but because, when you don't cooperate, me having to remind you every 30 seconds to keep that damned mask on your face drives me to distraction and, believe me, neither of us likes that! Now, if you were so demented that you had no idea what was going on, that would be one thing. But you aren't that demented. You're annoyed with these treatments and you're allowing your annoyance to let your willfulness overcome your will power. I'm not going to be nice about this any more. You need these treatments. I need your cooperation. This is a joint venture here...this isn't just about you, it's about me, too. You need to allow yourself to remain as healthy as possible for as long as you want...and you need to allow me to go about the business of caring for you without unnecessary distractions. I can handle anything if it's necessary. There will probably come a time when you are no longer interested in the effort it takes to stay alive. But this isn't true, yet, is it?
    "No," she said, firmly and quietly.
    "...and I think I'll be a fairly good judge of when that starts to kick in. Do you think that's a fair statement?"
    "Yes," she said, without argument of any kind, voiced or unvoiced.
    "In the meantime your intolerance of these treatments is unnecessary and dangerous and it will stop now!"
    We've had no further problem with the treatments. She's had three since this confrontation. We may, again, here and there, between now and the time when she loses interest in prolonging her life (if that time occurs), but I have confidence in Mom's sub- and unconscious abilities and I know that a few appropriate words spoken here and there when she reaches for the mask, again, will do the trick as long as she's not in the dying phase.
    Does it sound like I was too harsh? This is what I mean when I talk about Drill Sergeant behavior and how well it works for my mother and me. In addition, I've discovered if I can rile my mother a little, and, believe me, Drill Sergeant behavior, especially when it involves long, dictatorial speeches like the one above, always riles her, I am not only successful in getting my point across but anger tends to stop her in her tracks and make her think [Would that we all reacted this way to internal anger!]. If she were a little more demented the Drill Sergeant routine wouldn't work. If she were a little less demented it wouldn't be necessary. If we were not as closely bonded as we are and as involved in each other's lives as we are both her thoughtless willfulness and my attempts to circumvent it would be moot. I saw this happen at the skilled nursing facility. The nurses and CNAs just apologized for what they were about to do to her, or make her do, especially if it was something they knew she considered unpleasant, and then got on with it, usually to plaintive cries from Mom of, "No, Gail, no!"
    Mom and I are where we are, though, and, sometimes, it takes a verbal push against her thoughts to move her beyond thoughtless willfulness and to move the two of us beyond a stalemate. There are times, as well, when her thoughtless willfulness isn't a problem and no action is required. But, yesterday, well, yesterday speaks for itself.
    So, why bother mentioning such an episode? I suspect I'm not the only 24/7 family caregiver who finds herself occasionally caught in such circumstances. I also suspect, from past experience when I was green at this, that many caregivers consider such methods "dirty little secrets" and harbor ambiguous guilt about the possibility that tactics like this are "abusive". If you know your care recipient as well as my mother and I know each other and if other circumstances of character and mentality correspond to mutual understanding in these situations, strageties like this are not "dirty" and they aren't "abusive". They aren't pleasant, surely, it's never fun to find oneself having to be confrontational. But if pleasant requests for cooperation, reasoning, cajoling and pleading don't work, at least with my mother, "Hut to!" usually does.
Mom has had two "weak" days...
...followed, yesterday, by a semi-weak day. After two of her weak days, in which I was the power behind her throne, I had a semi-weak day, yesterday, too. I ached throughout my shoulders and arms from the effort it took over the previous two days to maneuver her around. I was incredibly tired, despite decent sleep...and, yet, at least in the morning Mom needed more than the usual help. My day was fairly painful. A couple of times I told her, as she seemed to strengthen throughout the day, that I did not have my usual strength and I needed her to help me by perking up a bit in movement and, last night when she settled into bed, making the extra effort to move herself back on the mattress once she was prone. I directed her but let her do it herself. She did.
    I'm feeling better today, despite getting less than decent sleep. I guess, luckily, my muscles are coming out on top of the punishment. Good. I'll need the extra strength, now, I'm sure, on a fairly regular basis. One optimistic observation: My back and legs weren't aching, so they much be pretty much up to par, now.
    I hear my mother's timely reconnaissance cough. We agreed on an 11 hour sleep last night, just to try it, and I guess she subconsciously incorporated it. I want to direct interested readers to the miscellaneous observations over at The Dailies report for yesterday. Some of you might find them interesting.
    I have one more occurrence from yesterday to report but I'll do that...
Wednesday, July 23, 2008
Yesterday was the second day in a row...
...that Mom has complained, upon awakening, this time from her night sleep, that she "just didn't feel good" but couldn't put her finger on what this meant. She said she wasn't in any pain. Her temp was at the upper reaches of the Arterial range, one tenth of a degree before the designation of "fever" kicks in. I am reminded that as terminal people approach death, according to Final Gifts, temperature may be slightly elevated. She's not lost her appetite, though, and her "interest in life", which is certainly less than some years ago, remains the same as it has for some years. She seems a bit puzzled by this "not feeling good" development, but not worried by it. So, yesterday, we had a full wheel chair day. I also made it a hair day and, since I awoke her earlier than her 12 hour sleep mark, I included a hair day, full wash, set and comb out. She was in unusually good humor for the Hospice Nurse visit but decided she wanted to cancel, yet again, the Hospice Spiritual Counselor and directed me not to reschedule the visit but to put it "on hold". That's what I did.
    After a four hour nap once the nurse left, although she wasn't easy to rouse, she perked up during dinner. As I was scanning through DVR'ed programs to see if I could find anything to capture her interest she noticed the run of Law & Order: Criminal Intent shows I had taped and said she felt in the mood for "some blood and guts". This was a surprise! She usually prefers her mysteries to be of the more genteel type. We worked through all the ones I'd previously taped and hadn't watched. She was disappointed that there weren't I've queued up all the L & O episodes I can find for the next week, just in case. Last night, though, a program on PBS about a flood that was probably responsible for the Scablands substituted well for the final lack of crime dramas.
    I'm mentioning these "not feeling good" days for two reasons:    Nothing else seems to have changed. I've been scanning her meticulously for a drop in hemoglobin. I'm not sure whether she's showing signs of one but, if these days continue, I'll probably ask for a blood draw next week, just to check. Of course, there isn't much we'll do if it is dropping but, at least, I'll know what's happening and, despite the Hospice Doctor's and Nurse's adamant assertions that information without action isn't valuable, it is to me. It calms me and, hey, guys, that's important from the standpoint of being my mother's caregiver, thus, it's care for the caregiver and that's important to both my mother and me.
    Which reminds me, during the H[ospice] N[]urse appointment last week HN and I discussed blood transfusions. It seems they are quickly becoming medically unpopular, which doesn't surprise me. He mentioned that Banner/Good Samaritan in The Valley has already "gone bloodless". I didn't think to ask what is used instead. My nephew clued me in, when he was here building the ramps, that there is a new concoction, completely synthetic, including a mimic of hemoglobin, that is being tested on Iraqi soldiers, which promises to work better than blood and, as well, the artificial hemoglobin, which isn't a cell but attaches itself to blood cells, is more or less "permanent" and shows excellent results. However, I doubt that this is available to such as my mother at this time.
    So, hmmm...maybe we're on a decided downhill slope. It will take more time and more symptoms for me to determine this, for sure. I figure, though, it's a good idea for me to be internally prepared.
    I discovered during HN's visit that my mother's concentrator is clogged. Once the clog was discovered it immediately vanished. I'd been wondering, lately, about whether it wasn't functioning up to par and had dialed it up about 36 hours ago to get what felt to me like a fairly good flow. Luckily, HN carries a flow meter in his pocket. Just checking the machine cleared it.
    HN also expressed confidence in my ability to care well for my mother, which was good to hear. Not that I have doubts, but recognition from the pros is nice. Just before he left he asked how we seemed to be doing overall. "We're cruising," I said, looking at Mom for confirmation. Mom and he nodded in agreement.
    I'm letting my mother sleep in today. I'll check in on her at 1300, in a few minutes, at her 12 hour sleep mark, but I may let her go until 1400, depending.
    If we're on the downhill slide, I hope that I'll be able to keep in mind that, when you can't fight gravity, it's best just to go with it.
Tuesday, July 22, 2008
...but first, a note about our sponsors...
    The Social Worker asked me a startlingly appropriate question yesterday that I have to mention because I so appreciated his take on "things". He asked me, in a roundabout way after asking me how I am doing, if what he was observing in my behavior is normal for me. I was open, animated and slightly edgy (physically, not socially). I laughed and said, "Yeah, this is normal for me, so I'm doing well."
    He laughed and responded with a version of, "So, this is as good as it gets."
    Later in the conversation he acknowledged that he was already aware that my approach to life is to analyze it...and even later we discussed my habit of what he appropriately labeled "catastrophic thinking." It was a relief to be accepted for who I am.
    My mother was in great humor during the visit. I'm noticing that she's tending more toward allowing the ironic comedian side of her personality more play than previously when in the company of others. The Social Worker acknowledged her marked sense of humor, too, by mentioning that humor is, indeed important. After he left I thought about this slight tweak in her persona. I'm guessing that part of this "new, more entertaining Ancient One" is her way of dealing, socially, with all the unaccustomed attention she's been receiving, lately, and part of it is an indication that her life is becoming a bit harder, from a health standpoint, than she's used to so she's working to lighten up the atmosphere a bit.
    Today is Hospice Nurse and Hospice Spiritual Counselor day. I made brownies last night in response to mention from my mother in the afternoon that her "sweet tooth is screaming." We have plenty left and nothing pleases my mother more than to offer food to visitors. So, we should have a good day, despite getting an early start.
    A little more book highlighting before I have to shower and awaken the Mom:    That's it, folks. The value of this book for me wasn't so much in the initial reading of it, but going back over what I highlighted, remembering why each section I highlighted struck me and consciously contemplating the ramifications of what I highlighted "in light" of my mother's and my lived together life.
    Thank you, readers, for your indulgence. It has been much appreciated.
    Time to shower, rouse the Mom, and begin our up-together day.
Monday, July 21, 2008
Final Gifts Highlighting Continued
    Whoa! The Mom's up! I'll finish...
"You are not a well woman."
    To which my mother responded, without affect and without resignation, "I know."
    Yesterday evening I awoke my mother around 2100 from a nap of a little over two hours. Her "morning", which started around 1300 and was slow as molasses (I didn't manage to take her blood glucose, which I typically take in her morning when she's sitting on the edge of her bed, until almost 1400). She didn't resist awakening, she just roused veeeerrrry sloooowly. Movement was iffy at best, as recorded here, although she was game and surprised when her right knee, in particular, didn't want to work to her advantage. When I awoke her in the evening she truly seemed "under" our monsoon "weather", in a distinct malaise. When I asked her how she felt she responded with a sotto dramatic moan and a half-hearted smile.
    "Do you feel bad?" I asked.
    She hedged. "Well, I don't feel altogether good."
    "Can you tell me where you feel bad?"
    "Not really."
    "Are you in pain?" I've learned to ask this question more frequently through observing the Hospice nurses.
    "Oh. No," she said.
    "But you just don't feel good."
    That's when I voiced the sentence which has become the title of this post, preceded by, "Well, that's okay. The weather's not your favorite, although it's mine. But,..."
    When people are here there is a lot of talk around her with attempts to include her, definitely in earshot, about her health, her lung cancer, hospice, etc. It's been this way since we came home. I still have no idea whether she understands that she has lung cancer and that her health will continue to fail. Considering that I also point out, when she and I are talking about her health, that she'll have "good days" and "bad days", and usually manage to label any particular day or period as mostly "good" or "bad", according to how it's going, I'm sure she understands that she's living with a variety of chronic frailties which won't be "healing". But, we've been living this way for some years, now, with no change in her perception of her life, so whether she considers herself in the grips of a terminal illness, other than simply being on the nether end of a long life, I can't say.
    Yesterday evening, though, before she roused, sat up and began the awake part of her evening, it occurred to me that maybe this episode was somehow "different".
    Turns out, it actually wasn't. Yesterday was just a slow, under the weather day for her. After I assured her that maybe a wheel chair evening would be in order, designed a dinner for her that catered to her saying she wasn't very hungry (a dinner which, by the way, expanded to include a thick slab of cheese as she moved about and rediscovered her hunger) and slowly directed her movement toward the rocker, she began to revive. First, she asked if there were "any more dog shows" on TV. We'd watched about an hour of one before she napped. I assured her that I'd taped "the whole thing" and we could pick up where we left off.
    "Oh, good," she said, with enthusiasm.
    After the dog show, she wasn't interested in me reading to her but she was definitely interested in staying up. We watched some history programs I'd recorded while she was in the rehab facility featuring Bible Times. She was animated and chatty throughout. When I finally suggested, at 0120, that it might be a good idea to get her into bed, she said, "Well, I could do that, too..." which means that she also could have stayed up for another couple of hours.
    "Well, Mom, you're choice. I'll lay it out for you. We've got a 1400 appointment tomorrow with the Hospice Social Worker. I'm thinking it might be a good idea if you're at least up and bathed by the time he gets here. If you go to bed now, you'll be getting a bit less than your usual 12 hours. Do you think you can handle that if I awaken you between 1100 and noon?"
    "Oh, I think so. Noon would be better."
    "Good point," I said. "I'm trying hard to make sure that the Hospice people fit into our life rather than we into theirs. Tomorrow will be a good test of their flexibility, I think. If I awaken you at noon you'll probably be sitting down to breakfast about the time he shows up. That's okay with me. Is that okay with you?"
    "Sure," she said. "They should be fitting into our life."
    So, I think, she understands part of the point of hospice care, even if she's not clear on why it's kicking in now.
    Just a few minutes ago (it's now 1056) The Little Girl called me into the bedroom. Mom was sleeping without the blankets on her, which is typical for monsoon mornings, and her oxygen cannula pushed into her hair. I asked her if she wanted to awaken "now" or if I should give her "another hour". "Another hour" it was, although I'll keep my ear cocked in the direction of her bedroom for movement. She looks good, sounds fine, but, of course, we'll see when I rouse her. She'll be about two hours under her usual 12-hour-sleep mark, but that could lead to almost anything.
    Tomorrow we have a "one to two o'clock" appointment with the Hospice nurse and a 1500 appointment with the Hospice Spiritual Counselor that Mom requested. The first appointment, I suspect, will be a bit early in Mom's day but I'm determined to make sure that our days run, as much as possible, on Mom's schedule. So, if the Hospice nurse gets here while I'm bathing Mom or she's breakfasting, so be it.
    It isn't as easy as I thought, making sure that Hospice works around us rather than vice versa. My instinct, for myself, is to work with other people's schedules. As well, it seems that, for some reason, although I've mentioned several times to several of the Hospice people the specific eccentricity of my mother's preferred hours, so far only one of them has been flexible enough to schedule an appointment past two in the afternoon. I'm working hard, though, to back peddle my tendency to change Mom's schedule to fit the pros, which is pretty much what I used to do. In this case it seems wise to see to it that we stand Mom's ground, since it looks as though visits from a variety of Hospice folk will be regular, even weekly.
    I'm very curious about the Spiritual Counseling visit. I am, though, going to attempt to allow the visit to occur without my presence. I'll probably "repair" to the living room and work on the computer or something. I'll probably still be in earshot, but I won't be in eye shot and that should allow Mom and the Spiritual Counselor to find their own footing. I can only barely imagine how Mom will handle the visit and how the Spiritual Counselor will handle Mom. I've reminded Mom several times of the visit and, with every mention, she looks surprised and intrigued. I think she's probably expecting an hour or so of stimulating religious discussion not necessary focused on her own spiritual priorities. I have no idea what the Spiritual Counselor is expecting, but I rather think she's not expecting what Mom's anticipating. If I overhear anything interesting I'll be sure to report.

    Since I have some time, here, I think I'll run through some of the phrases I highlighted in the Final Gifts book and explain why they caught my mind.    Almost time to awaken the already awake and luxuriating, at her request, Mom. Although I'm just about halfway through my book highlights, I'll need to continue...
Sunday, July 20, 2008
I've heard Mom coughing off and on for a little over an hour...
...and checked on every episode but her eyes have remained resolutely closed, telling me she isn't ready for me to consider her coughing reconnaissance. I'm going to attempt to arouse her at 1300, which will be her 12 hour sleep mark. Even though today isn't one of her favorite days (cloudy, rainy, cool, muggy; which are, of course, my favorite), I'm expecting success, as I can tell she's already worked her way out of sleep...she's just hanging out in that "I don't want to get up yet" zone.
    I just finished Final Gifts. At this point, I'm grateful for the practical reminders it sets forth that will keep me on my toes. MPBIL and I had a bit of conversation yesterday about "nearing death awareness" in which one word he used triggered an interesting reminder for me. The word he used, as he confirmed what I meant when repeating the label the book uses for these experiences, was "neurological". And, of course, they are, although the book discusses them in a social, psychological and spiritual context. For the next several hours my brain quietly worked on a variety of issues related to these experiences and to life, itself:    Ahh, now that one sounded like a reconnaissance cough! Right on time.

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