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Home Stories Mark My Words


We are now approaching a national election and the selection of our next President. (When I was in grade school, I was taught that the word President is capitalized when referring to the Commander-in-Chief guy, but not capitalized when referring to a president in any general sense. And yet, the president of a local club must be capitalized when used as a form of address, as when introducing President Beverly Aldopestandophanes of the local Muffin and Crumpet Society.)

So we will elect our next President this fall, and our next representative to Congress, and our next choice for senator from Maine, and then also the whole host of state and local officials.

We must not be complacent about the state and local offices. For instance, in order to gain enough party interest to support him in a run for Congress, Mike Michaud had to be elected to the Maine legislature and show his loyalty. Now that he is a member of Congress, he is virtually invulnerable. A few years ago, when Democrats held the majority in both the U.S. House of Representatives and the Senate, Congress had an "approval rating" of 11%. And what did the people of America do when the next election came around? Sent them all back! Why? Because the voters in every congressional district disapprove of everyone else's representative but believe their own to be a saint. If only 11% of shoppers approved of a new fashion, the manufacturer would be dumping a lot of unsold clothes onto the discount markets in tropical dictatorships. But if people shopped for clothes the way they do for Congressmen, only 11% would approve the fashion, but 100% of customers would be wearing it, because they hate it on everyone else but think it looks perfect on themselves.

Personally, I thought 11% was a generous rating on the part of those surveyed, but maybe it was a flawed poll. You've heard of flawed polls, of course.

I was once told of a rather large church (not in this part of the state) which ran a survey of its attendants, promising that the responses would be compiled so that no individual could be identified in the results. The survey asked such questions as: Have you ever stolen something? Have you ever hurt someone on purpose? -- questions like that. This was a church that had separate programs and separate study groups for the men and the women, so the groups of men and the groups of women each were each given a slightly different survey. One innocuous-sounding question -- we'll call it Question 22 -- asked the men: Have you ever looked upon another woman with lust? -- or something close to that.

All the responses were sent to the national church office, and a few weeks later a summary was returned to the local church, comparing its results to the national norms and so on. So the summary provided information such as: “41% of men and 12% of women admit to stealing, while the national average is 48% of men and 19% of women.” It gave similar sets of statistics for all the other questions.

The summary results for the men's Question 22, though, stated: “100% of men (in the local church) responded that they have been unfaithful to their wives, compared to 73% nationally,” (or something like that). If there was a similar Question 22 on the women's survey, it was forgotten in the aftermath.

The men had responded honestly, and, (they thought!), anonymously, to Question 22. The women had not seen the original question. They could conclude only that 100% of their men had admitted to cheating on their wives. If the result had been anything less than 100%, every one of the men could have slept that night. Looking with lust (the question) was reported as being unfaithful (the summary) and understood as cheating (the wives). Not one of the men was innocent.

The damage had been done. The wives all knew that their men had taken the survey. None of the men had bothered to mention to his wife that there had even been a Question 22 -- how is a guy going to bring that up over dinner? “By the way, Dear, that survey asked whether I had ever looked with lust upon another woman, and I replied honestly that I did. Once. A long time ago, you understand. Back when I still had teeth and could reach my own toenails.”

And so when the summary was revealed, no doubt a few men tried to qualify it by attempting to explain to their wives, after the fact, how the question had been worded, if he could even remember it. The uproar nearly destroyed several marriages and nearly closed the church.

A few evenings ago I answered the phone at home and took a survey regarding the approaching election. The caller was a young woman, phoning from somewhere in the deep south. She sounded nervous, like a girl who had been yelled at a lot in the preceding half hour. She was barely able to read the script, although that was clearly not due to nervousness but due to illiteracy. I seldom answer surveys and often hang up right away. But this girl elicited my sympathy, so I allowed her to continue.

She asked me only about Obama and Romney and about the Maine frontrunners for U.S. Senate. Clearly the survey had assumed who the candidates would be while they were still only nominees, before the conventions were even held. She read off the name of the Democrats' candidate for Senate -- I forget now who that is, then she read the name Charlie Summers easily enough, but when she reached the name Angus King -- the other Democrat -- she pronounced it (haltingly) “August” King. (Was I the first person she had called that evening?)

Her survey did not mention the candidates for the House of Representatives or any other office.

I have no idea who the company was that she represented; she told me the name, but it would have made no difference. It was a cheery-sounding company name made up from the usual buzzwords, like “Quality Results Endeavors” -- clearly something that every enterprising new start-up business would pay a consulting agency several thousand dollars to dream up. We never know for sure who these people are, anyway.

I did not correct her abuse of Angus. It was too gratifying. Independent in his funding, perhaps, but in his politics very true to his big-government roots, King merely holds the promise of more pandering to constituencies who are not at all independent in their thinking or self-sufficient in their expectations of government.

But then, once the national news media are ready to report the results of the one survey I responded to, we will all regard their report with great respect. This survey could accurately report -- from its incomplete analysis -- that 100% of respondents support either Obama or Romney, zero percent support any other nominee for President. True, since the survey writers had already buried all the other nominees before the conventions were held.

You’ve heard of other skewed surveys. How about this: If the price and quality were the same and you were given the choice today, would you buy bread made with genetically-modified grain, or bread made with organically-grown grain?

Well, who doesn't support organically-grown food? But the survey results are reported as: "Nationwide survey of shoppers supports the President's 600 billion dollar organic farm supplement program."

So forgive me for taking part in a poll. I had a lapse in judgment when I encountered the human side of survey-taking: the poorly screened, ill-prepared, likely under-paid temporary worker in a call center who, God bless her, was actually working for a living.

This was not at all what I set out to write about when I began this column, but that’s the fun of writing; the keyboard is not unlike a Ouija board, my fingers the players, and my mind the spontaneous influence that even I cannot predict. Next week, then. Perhaps.


This week’s column is about you and your death.  More precisely, it’s about you just before you die.  Your death will be an anti-climax.  And it’s about a few things you can do so that your final days won’t be filled with helplessness, mystery, and panic.  It’s also a column about how you can avert an out-of-control involvement when someone close to you reaches a state of helplessness and terminal decision-making.

It won’t cost you anything to read this nor to do anything afterward.  It will require that you pay attention to a few things between now and that far off time, almost an eternity from now of course, when the decisions are no longer yours to make.

It was through Carol, an RN whom I have known since the period during which we both worked at PVH, that I became aware of this book, The Best Care Possible, A Physician’s Quest to Transform Care Through the End of Life, by Dr. Ira Byock.  This is an overview, with extensive references from the text.  In fact, most of this column is a series of quotes from the book, which do little but to give you a hint of its content and importance.

I encountered Carol one day around the end of June, and she mentioned Dr. Byock’s book.  She told me an anecdote: She had acquired and read the book earlier this spring.  She was so moved by it that she wrote the author by e-mail, and not long after that she had the opportunity to attend an engagement in New Hampshire at which he would be speaking.  Before his presentation she spotted Dr. Byock near the lectern, approached him, commented that she had written to him, and mentioned her name.  He instantly remembered the correspondence and greeted her warmly.

Carol also told me that she had purchased and distributed a number of copies, including one for the Lincoln Memorial Library.

Generally, The Best Care Possible is a book about people for whom death is a looming reality, whether due to illness or injury, and the burden they place on America’s medical systems and the economy.  Concomitantly, it is a book about the role and benefit of palliative care as a medical option.  But it is especially a book about the responsibility we have as a society to make the cultural changes necessary to actually care for people who are dying, not just turn them over to the systems we have created which are inadvertently designed to depersonalize everything.

Dr. Byock uses numerous actual patient situations to illustrate the several themes that come together in the book.  Among the more prominent ones:

1) patients wanting to beat, cheat, and defeat death through a prolonged succession of medical interventions

2) alleviating suffering and giving the best possible care while a person with a terminal illness is dying

3) dealing sensitively with a dying patient’s loved ones

4) assisted suicide as a social phenomenon, not a medical option

5) the trend toward diagnosis-driven treatment, toward a legalized relationship between patients and doctors, toward satisfying the legal profession and bowing to one-size-fits-all government solutions at the risk of medical neglect

6) the advantages and issues of advanced directives

7) the federal government’s role in fostering a misunderstanding of the differences between palliative care and hospice

8) the role of community in handling the non-medical aspects of end-of-life care.

It was extraordinarily interesting to me that, even though the book is brand new, (published in 2012 and citing situations that happened in early 2012), and the author admits to left-leanings politics, there is no mention of the recently-passed “Affordable Care Act.”  While he drills home several points regarding public policy and needed regulation, the Act itself neither comes up as a step in the right direction nor as an impediment to the best care possible.  He is simply silent about it.

If there is one omission, one theme that I wish had been covered more fully, it would be to provide guidance on acceptance of dying.  I would have welcomed a couple examples of people who have neither resigned to nor embraced their impending end, but who are content with their lives and who have achieved an attitude of acceptance and peace.  Discussions of acceptance are certainly integral to treating patients in the practice of palliative care, especially where Americans are exceptionally afraid of death and loathe to terminate treatment until everyone is exhausted with the heroics.  I myself am comfortable with letting go when the time may come.  Those closest to me, who are named in my advance directive, already understand my wishes in that regard.

If there is one category of people who, I wish, had been discussed more fully, it would be the severely disabled.  It is on behalf of such an individual, my son, that I first became interested in the plight of Terri Schiavo (see my ironic, mordant essay about her at, and by extension, interested in the best end-of-life care possible.

Since I borrowed a copy of The Best Care Possible, I made a pencil mark next to each of many paragraphs and transcribed them when I had finished.  (Then I erased the marks!)  I believe the quotes that follow give a sense Dr. Byock’s compelling message, and I have to say I discovered that I had already been of the same mind before I even opened the book.  That is, what he wrote fit perfectly with what my intuitions already told me.

Since I can’t say it better myself, here are some quotes from the The Best Care Possible:


[Anything in square brackets are my own additions or substitutions.]

“Dying doesn’t cause suffering.  Resistance to dying does.”  -Terry Tempest Williams quoting her mother in Refuge. quoted by Dr. Byock on p. 57


To be sure, there have been plenty of patients whom I made sleepy with medications and some I rendered fully unconscious to ensure they were not suffering as they died.  Some people ask, "Well, what's the difference between that and euthanasia?"  Most concretely, the difference is that I have never injected potassium chloride to stop someone's heart or given a curare to stop a person's breathing and cause a person's death. p163

Alleviating suffering and eliminating the sufferer are very different acts. p164 [author’s emphasis]

[I]t would be less erosive to physicians’ roles and patients’ trust if proponents [of assisted suicide] kept doctors out of the process.  After all, [a doctor’s] expertise is needed only to certify that a person who desires the means for ending his or her life actually has a terminal condition.  The doses of drugs used to hasten death do no vary by age or weight.  Instead of a doctor’s prescription, responsibility for issuing permission to a certified patient to purchase a packet of lethal medications could be assigned to another civic authority, such as the county attorney or justice of the peace. p166

[S]eriously ill people who are hurting and scared usually already have the means to end their lives.  People with cancer or heart, liver, lung, or kidney disease usually have cabinets or drawers full of prescription medications for pain, sleep, or anxiety that, when taken in combination with alcohol, will provide a swift and painless exit.  Websites provide information on ways to do the job with tools as available as a car in a garage. p167


[This is also called a living will, and is most important if you become totally incapacitated and more especially if you become totally and permanently unconscious.  It can direct whether you want all possible medical procedures used to keep your heart beating or whether you would accept comfort-giving care as your body naturally dies.  It also can direct whether you would donate your organs, and it names the individuals who you want to make decisions for you in your state of unconsciousness, while providing direction to them about your own wishes.]

[An advance directive: stating] who you would choose to speak for you and what your values and preferences are in case of life-threatening situations is important to providing you the best care possible. p172


[T]he diagnosis-driven, narrowly defined social response to people’s needs misses opportunities for preventing illness, alleviating distress, and enhancing people’s well-being.  The exclusively disease- and treatment-oriented nature of contemporary medicine causes dissatisfaction for patients and providers alike. p230

Today’s doctors practice under the scrutiny of business managers, payers, quality committees, and regulators.  They feel pressure to see too many patients in too little time. p230

Like everyone else in the workforce these days, physicians are accountable for what they do.  Rightly so.  Unfortunately, what they are held accountable for has usually emphasized volume over quality.  Physician economic productivity is measured in RVUs, which stands for relative value units.  RVUs accrue through both the time and the intensity or sophistication of specific services.  ...Whether or not their own incomes are affected by how many RVUs they generate, doctors are acutely aware that the more time they spend with patients in talking and counseling, the less revenue their practice generates. p231

In the presence of so many problems and needs, everyone at ground level – patients, their families, and physicians – reflexively assumes that the more medical care they can give or receive, the better.  There is now compelling evidence disproving that assumption. p234


A factor more insidious than efficiency or profit leads doctors to emphasize high-intensity treatments over poignant conversations and counseling, shared decision-making, care planning, and end-of-life care: their aversion to talking about dying and death.  …[O]rdering more tests and treatments allows him or her to refocus on the disease and sidestep in-depth discussions with patients and their families about these morbid (or mortal) subjects. p237

[T]he medical profession has some explaining to do to the American public.  It is high time that American doctors take a hard look at the reasons we do what we do.  …[T]he Dartmouth Atlas group’s body of research identifies bright rays of hope…  Best-performing institutions and regions offer examples to emulate, in the form of practical strategies and model programs we can adopt or adapt to our local systems.  High-functioning, lower-cost health care systems are not rare; we know exactly where they are and can learn from them…  These systems and leading institutions do not skimp on services or accept lower quality.  Instead, they exemplify individualized, patient-centered care. p237-238

The Dartmouth Atlas group estimated that Medicare could reduce hospital costs by 28 to 43 percent by adopting the patient-centered, proactive approaches of the most efficient health care systems.  …[T]he cost savings were not even intentional.  Instead, the lower costs were merely a by-product of palliative care: the result of assiduously matching people’s values and preferences to achievable health goals and making those goals the focus of individualized plans of care. p238-239

[T]ransforming America’s broken health care systems will take political will and cultural leadership.  For the magnitude of change that is needed to occur, social activism is necessary. p239

[Note that Dr. Byock does not say the social activism needed is to support the 2010 Affordable Care Act, which had to be passed by Congress and signed into law before anyone could discover what was in it.]

Of course, dying is different from birthing.  [Referring to the public demand in recent decades for universal pre-natal care and the programs that have become widespread to promote responsible motherhood.]  It is different from “merely” needing dialysis, or even living with AIDS.  For one thing, there is no community of dying people.  Dying people die, and caregivers disperse, leaving no base for social or political action.  Being mortal is too broad a category to generate a special interest group.  There is no membership organization for dying people.  [AARP doesn’t want to taint itself.]  (Can you imagine the ads for such a group?) p241


Collectively, as voters and agents of accountability, citizens have vital roles to play in realizing transformative changes in America’s health care system.  …A change in federal law could finally dissolve Medicare and Medicaid’s arbitrary requirement that people give up treatments for their disease in order to receive hospice care.  (Medicaid has already dropped the requirement for children.) p247

In the quest to provide the best care possible for people who are elderly and frail, or chronically ill at any age, it is essential for Americans to fix our national and local health care systems.  But doing so will not be enough.  Within this sobering realization lie reasons for hope – by expanding the problem beyond health care, potential solutions finally come into view. p250

The tendency to professionalize basic care and social support is well intended, but insidious.  It makes care for people who are old, ill, dying, and grieving much more complicated and expensive than it needs to be.  That’s not the worst of it.  The medicalization of aging, dying, and grief ignores the innate, healthy human drive to care for one another.  It erodes core cultural roles and suppresses latent caregiving skills that reside within families and communities.  Even in a person’s dying – especially in a person’s dying – family and community comprise the proper context for a person’s life. p250

In his disturbingly insightful, yet hopeful, book The Careless Society: Community and Its Counterfeits, sociologist John McKnight pointedly made the case that progressive professionalization of normal life caused an erosion of natural, vital community responses to people who are ill, impoverished, or otherwise in need.  In McKnight’s view, doctors, psychologists, bureaucrats, and counselors are called on all too often to manage problems – through fee-based or tax-supported services – that people have been dealing with in families and communities for millennia. p258

[The author refers to the primary care physician and “medical home” as related, although not precisely inter-changeable.  He points out that a medical home would be able to provide or coordinate home health services: help keeping medicines straight, help with activities of daily living, regular nursing checks, home safety evaluations, and so on.]

[One patient's] story is not merely an example of what is wrong but, more valuably, an example of how readily secondary prevention could improve quality of care and life for frail, chronically ill people, while decreasing health care costs.  Secondary prevention refers to preventing complications of illness and averting crises for people in fragile health.  Simple things would have made a world of difference for [this patient].  If he had a primary care physician -- or medical home -- he could have received all his medical treatments consolidated under one roof.  This would have helped [him] with his medications and uncovered some if the daily problems he was having at home. p254

Strategic planners and consultants in business, government, and health care challenge their clients to "think outside the box."  In this case, two boxes need to be dismantled.  First, we must escape our fixation with diseases and health care rather than people's well-being.  Second, we must get beyond seeing people solely as [patients] and begin seeing people as individuals within families and communities. p254


[Referring to a certain patient:] Until our team got involved, after a number of avoidable crises, there was no coordinated plan for taking care of [him] as a person, outside the realm of a patient.  There was no locus for such planning, and even if such a plan were developed, there was no repository to hold and make it available when needed.  His niece, minister, and senior center staff were each doing the best they could, and each had some insights about his needs and ideas for supporting [him] in living independently.  Yet they were not in contact with one another, nor were any of them in touch with his doctors.  For many month his life was harder than it needed to be.  A little person-centered coordination and planning would have gone a long way. p254 

...[O]ur current level of privacy is peculiar to recent times and Western culture.  Checking up and checking in on one another are what people in normal, caring communities do. ...It is morally and legally okay to show genuine concern for other people. p263

Something is amiss when out of concerns about legal liability, volunteers at a senior center or church are told they can no longer give elders a ride in their car to an outing, the supermarket, or a doctor’s appointment, barber, or beauty parlor.  When a town’s paid (certified and insured) transportation service is chronically understaffed, late, and unreliable, it is no mystery that frail elders are more likely to stay home and feel shut in and out of touch with their community. p260

[Staff people in doctors’ offices and hospitals routinely, servilely, and mistakenly invoke the Health Insurance Portability and Accountability Act as prohibiting this kind of coordination.  Coordination of care and continuity of care are permitted, and until the absurd secrecy implications are corrected by Congress, care givers need to take a practical and sensible approach to the lunatic elements of so-called HIPAA.]

Anthropologist Margaret Mead was once asked what she considered the earliest evidence of civilization.  She answered that it was a human thigh bone with a healed fracture that had been excavated from a fifteen-thousand-year-old site.  For an early human being to have survived a broken femur, living though the months that were required for the bone to heal, the person had to have been care for – sheltered, protected, brought food and drink.  While other animals care for their young and injured, no other species is able to devote as much time and energy to caring for the most frail, ill, and dying of its members. p254-255


Years ago, I learned about a program in Wilbur, Nebraska, called Telecare, which began out of concerns over the high rate of depression among rural elders who lived alone.  Telecare paired schoolchildren with older adults living alone.  Each morning the kids made a brief phone call to check on their older friend.  The program succeeded in enriching the lives at both ends of the phone.  Although it was remarkably effective, unfortunately the program succumbed to budget cuts… [The author mentioned other RUOK programs around the country.]  It’s as simple as that, but these brief, regular interactions let people who live alone know that they matter to others. p261

In terms of public health and public finances, secondary prevention of this sort is decidedly cost-effective.  For a caring society, investments in social support and basic health surveillance for frail elders pay high rates of return through avoiding emergencies, hospitalizations, and preventable complications. p262-263


As a nation and as states and local communities, we do need revised laws and regulations and new investments in our social infrastructure of care.  But these changes are merely instrumental.  The bigger challenge we face is not regulatory or statutory, but cultural.  Caring well for people through the end of life will require nothing less than a genuine social and cultural transformation.  Simply put, it is time for our culture to grow the rest of the way up. p267

Instead of bringing people together in a common purpose, how we die has become a polarizing subject, rife with acrimony and righteous indignation.  The irony would be funny if the social paralysis it caused were not so damaging. p273

For me the most socially damaging aspect of the assisted suicide debate is its power to conscript all the legislative energy and editorial page attention (both priceless and limited commodities) that might actually resolve the sorry state of dying in America.  The debate is a brawl on the lawn of a burning building. p274

Within the worldview in which I was raised, the primal social compact is not a contract; it is a covenant.  Human beings belong to one another before we are born and long after we die.  In a morally health society, people are born into the welcoming arms of the human community and die from the reluctant arms of community.  Within this covenantal experience, the well-being of others affects my own quality of life. p277

Yes, someday we are each going to die!  Let’s get over it – so that we can get on with seriously addressing the question, How shall we live? to the fullest extent. p278

In fact, a formal ethical principle and precept of palliative care holds that the practice of palliative care does not intentionally hasten death.  While not purposefully political, this tenet has deliberate cultural significance and, therefore, inevitable political implications. 

The founders of the discipline [palliative care] understood that the key distinction -- between letting terminally-ill people die and intentionally ending their lives – was essential to maintain public trust in the doctors and nurses who work in hospice and palliative care.  The wisdom of explicitly distinguishing caring for people from causing people's death is evident in our present times. p280

“…Rather, he chooses life without the burden of disproportionate medical intervention.” Joseph Cardinal Bernardin, R.C. archbishop of Chicago, quoted on p280

Surely, a moral and healthy society’s response to caring for people with advanced age or life-threatening conditions encompasses more than a person’s right to refuse medical treatments.  A fuller social and communal view of ethics would also clarify the circumstances and extent to which people must be accorded medical care – basic preventive care, as well as extraordinary life-prolonging treatments.  Even more important, a complete ethical framework would encompass whether and to what extent society must meet the basic human needs that people have as they approach life’s end.  Basic elements of human care underpin how we regard and respond to others – our ethics as people become sicker and more physically dependent: 

Shelter from the elements… 

Help with personal hygiene… 

Assistance with elimination… 

Provision of food and drink… 

Keeping company… 

Alleviating suffering…  [I]t is only this final element that is dependent on clinical expertise. p283-284 (emphasis added)

We all want “the best care possible” for our loved ones.  It’s time to determine what that means in some detail and bring citizen and consumer pressure to bear to get it done. p290

[end of quotes]


I am confident that Dr. Byock would support this summary.  But this does not take the place of reading the book.  It is a book that calls for action, and that’s what this column is about.  But a summary like this fails to convey the human side of the author’s effort, for the people whose stories he uses, which comprise the first half or more of the book, are just like people we all know -- and just like we will ourselves be when it is our turn, each of us, to die or to be at the bedside when someone we love is slipping away.  Dr. Byock also manages effectively to give us the human side of the doctors and other professionals with whom he has worked to give the best care possible.

Read it, and let me know whether we can make a difference in our culture.  And remember: Think globally, act locally.

The Best Care Possible 

A Physician’s Quest to Transform Care Through the End of Life 

© 2012 Ira Byock, M.D. 


a member of Penguin Group (USA) Inc. 

New York 

published by the Penguin Group


Today I used the word, handicapped, in a sentence. It was awkward. It means someone holding a cap in his hand, begging for money; that’s that’s the origin of the word. I always see that image when I hear the word.

I used the word in the context of finding a parking space, because I am allowed to park in designated spots when my son is in the car with me. He has been crippled since he came into the world, but people cringe when I say that word. It now has a stigma. People who are sensitive about the handicapped -- not necessarily people themselves who are handicapped, but people who “advocate” for them -- are horrified if we say “crippled.” For a while we were OK to say disabled. But then someone who is sensitive on their behalf insisted they are not dis-abled, (don’t “dis” them!), they are differently abled.

So for a while I was stuck saying differently-abled. Now I’m supposed to say handicapped, but that sticks in my craw. There’s no stigma in a word that implies a crippled person holding his cap upside down hoping someone will drop pennies into it?

People in general are very compliant about using the “accepted” terminology, at least in formal conversation. Many of the same people will still privately refer to someone as a re-tard. Forcing new terminology on us in order to obliterate old words does not confer new attitudes.

And someone whose development is retarded, meaning simply that it isn’t keeping pace with most other people, cannot be called retarded any longer. That has a stigma. Now the term is, uh, developmentally-delayed; I guess. I’m not sure any more.

On the other hand, we can still say someone is blind or deaf. We often hear the more-sensitive terms, visually-impaired and hearing-impaired, but there is still no stigma in the original words.

My father was deaf. He lost his eardrums and inner ear structures to childhood infections, which continued to plague him all his life. From my earliest recollections of him in the early 1950s, my father, who was bald, had a metal band across his head with a wire that ran down into his shirt. On one end of the metal band was a bone-conducting hearing aid. In the pocket of his T-shirt was metal box about the size of a cigarette pack that contained a microphone that picked up other people's speech and ambient sounds and an amplifier that sent a signal up the wire and caused the cap on the end of the metal band to vibrate against the bone, behind his ear.

He never considered himself handicapped, just hard-of-hearing. But once in a while he would say: “I’m deaf, you know. Now run that by me a little slower.” That was the only accommodation he demanded.

In college I knew a blind musician and classmate. He was quite independent, but if, for instance, we arrived at the cafeteria simultaneously he would sometimes ask which line was shorter or what looked good. He had an aversion to food that didn’t look palatable to those of us who could see it. One time, as a group of us were rising from our chairs to leave the cafeteria, he spoke up loudly and said: “Hey, don’t forget the blind guy!” No one denied him the accommodation of waiting or walking interference for him, but he was so easily included that he sometimes had to remind us, or me anyway, what our own blindness failed to tell us about his.

He did not call himself hard-of-seeing. When he had to say anything about it, the word was “blind”.

In our culture, most of us are deficient in some way when compared with the perfect male or female specimen, whatever we conceive that to be. I am now officially old. I am not retired. (Just semi-retired; I’m down to 40 hours a week now.) I might be lured to join an American Association of Old People, but I am not going near the politically-charged American Association of Retired People. There are people who are shorter than others, and it’s still safe to joke about the vertically-challenged. Some alarming percentage of us are fat, although for accuracy in grammar I would say “fattened”. There is a push to refer to fat people as “obese”, but that is a medical term, and to mis-apply it is to dilute its medical significance. Many of us have invisible or barely-visible challenges, such as sensitivity to touch, aversion to odors, post-traumatic alertness, developmental delays, uncertainties of perception, chronic fatigue, addictions to fatal poisons, auto-immune deficiencies, allergies, and so on.

People with allergies have not banded together and demanded to be known as the differently-sensitive, just as people who are blind, so far as I know, have not formed a national organization of the luminosity-impaired.

All of us seem to fall into one of three groups: (A) those who have a physical or mental challenge, (B) those who generally do not, and (C) those who generally do not but are horrified that a label exists to describe someone else’s challenge.

People in (C) are more likely classify people, in effect to label them, and are more likely themselves to join groups which have an attractive social agenda. People in (C) want to propose solutions to all social problems, but first they must identify a problem to solve and to associate that problem with a group of victims. (C) people are sensitive on behalf of (A) people. So (C) people, through their chosen social agents such as the news media and political-influence organizations, take offense on behalf of (A) people. But it is people in (B) who inadvertently and mostly innocently commit the offenses that (C) people are upset about on behalf of (A) people.

People in (C) gave us political-correctness. Some people in (B), and quite a few in (A), happily carry on with deliberate disregard for the sensitivities of (C) people.

When I was fat, I called myself fat. Now I call myself old. And when I become crippled with age, guess what I’ll call myself?

Labels have indeed been used to offend and, more horribly, to do social and physical harm to people. The most infamous label of all, in America’s regrettable past, has been “nigger”. It was used by superior-minded lighter-skinned people with effective derision. It had to go. And yet, the word from which it is derived is Negro, and that, to me, has always been a dignified term. I grew up in a neighborhood dominated by descendants of American slaves, who personified the dignity of the term, and used it themselves.

Frankly, any word that refers to a person’s skin color is useless now. Our culture demands that skin tone is irrelevant, except as one’s pallor helps pinpoint an ailment or one’s race suggests a predisposition to a certain disease.

When I worked at a truck stop in Bangor in the 1970s, a certain member of the Penobscot Nation, Joe, used to frequent the pumps and the restaurant. He was big and boisterous and friendly, but a little bit intimidating, too. During a discussion one time, Leo, one of the guys who worked there, said in Joe’s presence, “Let’s ask the Indian.” I don’t remember what the question was, but Joe said in all sincerity, “You can call me an Injun, but don’t call me an Indian.” This whole exchange startled me a bit, because I knew that Leo, too, was an “Injun”. Maybe it was something personal between them, but I’ve never forgotten what Joe said.

It comes down to this: It’s not a matter of labels and stigmas and sensitivities. It’s a matter of language. Did you know there is still a Crippled Children’s Foundation still very active in the U.S.? It was founded in 1929 and has deflected all attacks on its name. Its focus was on children who were crippled, who were dealt a raw deal, and who deserved some attention. It is a compassionate use of the word, on behalf of a population, crippled children, who are urgently in need of compassion, not a lesson in fake sensitivity.

The United Negro College Fund is still in existence, the people who trademarked: “A mind is a terrible thing to waste.”

And the Penobscot Nation still refers to their land in Old Town as Indian Island. If it’s good enough for the Penobscots, it’s good enough for me. I’m 100% native American, myself; I was born in the United States, and that’s all the qualification I need for that label.

If there is a need to describe something, there is probably a word for it. If some ignorant people use the word with scorn or ridicule, the rest of us, which is still most of us, need to recapture the word and treat the mis-use to the obscurity it deserves. Heck, even the word, “label”, now has a stigma. Don’t put a label on that dress! Put a maker’s tag on it!

If we continually flush a word away because someone has temporarily run off with it as with a stolen car, then someone else will do the same with the next word we substitute, and the next, until we are no longer able to describe anything that, indeed, truly needs to be distinguished. When there is no politically-correct way to refer to a handicapped, disabled, differently-abled, retarded, crippled child, then what will we do? Pretend the child does not exist? When every American of aboriginal ancestry is re-labeled a native American, how will that distinguish them from 330 million other native Americans? (That assumes there is a need to continue making the distinction, of course.)

So, I’m taking my language back. The only people I hope to offend are those who want me to talk funny -- the sensitivity police. They need to pay attention to their own business. They can do more for disadvantaged people by lending a hand than by standing by and re-naming them.



Readers like to share books.  Some readers collect them too.  One wall of the biggest room in our house is all books.  But there are as many more, altogether, lined up on random shelves in other rooms.

Beth and I are readers.  We each have some books that we will never part with, although we might lend them.  We pick up new ones almost every week -- thank you, Hannaford! -- and we haul out boxfuls now and then.  I’ve had the bad habit of bringing home extra copies of the ones I like best, in order to gift them.  If you want a nice trade-paperback copy of Catch-22, I have at least two extras to give away.  (Other titles too.)

Besides the ones I’ve written myself, what follows is a list of my favorite books of all time; more than 50, actually, and growing.  I wish there were time and space to explain each one.  If you want to know why one is on this list, just ask.

The numbers 1-8 are a sort of ranking by importance to me.  Something in the 8th rank may be just as readable and captivating but, for me, the content may not have had as much impact as a book with a higher ranking.  But they all had some impact.

Yes, I've read them all, some more than once.  And I can warmly recommend almost anything else written by any of the below authors; I just refrained from listing every work each one has written and which I have read.

There are exceptions to the anything-by-the-same-author rule.  Nothing else by Joseph Heller rises to the inspired genius of Catch-22., for instance.  But almost all of James Michener’s works are equally absorbing.  Almost all of Jack London, Mark Twain, and Charles Dickens, too.

Then there are modern authors, whom I’ve read but haven’t even listed.  Maybe they will go on my next list of 50.  And collections of short stories -- how I loved Alfred Hitchcock’s Mystery Magazine, which I subscribed to in the 1960s!

Which one is the best ever?  No other book glows with the beauty of the English language like Lolita by the Russian author Vladimir Nabokov, even though the story shocks many readers.  And Nabokov's Russian roots conceal his acquaintance with the English language during the early years of his life.  His command of both languages certainly contributed uniquely to his linguistic power.  For fiction, though, I can’t pick one.  The entire group that I’ve rated a ‘1’ is the best fiction ever.

The best ever for non-fiction would have to be Big Bang.  And yet, anything by P.J. O’Rourke is the best non-fiction for sheer entertainment, and perhaps The True Believer is the best piece of social inquiry.

And, sadly, my favorite juvenile novel of all time, The Lion's Paw, is extraordinarily hard to come by.  If you look for it, prepare for an arduous search.  (The author fell out of favor with his family, who own the publishing rights.)  I have a new copy which I obtained right after its very limited 50th-anniversary re-publication in 1996, but I originally read it in my youth.

If you are looking for a book to read, you can't go wrong if you choose from this list, although if you're not "into" non-fiction, then I will not be responsible if you don't enjoy, for instance, Big Bang.  But if you do enjoy non-fiction, I will be surprised if your reaction to Big Bang isn't similar to mine - the most engaging, suspenseful, and possibly the most faith-restoring book I have read in a quarter century.

I am specific about the edition of Bartlett's Familiar Quotation, by the way.  I fear that, over succeeding editions, important quotations will be deemed expendable to make space for later, and probably deserving, entries.  So, if you do obtain a later edition, pair it with the fourteenth (or earlier), and if you have the fourteenth and you obtain a later one, keep them both.

I could add hundreds more books.  It pains me to leave some out, for instance William Bennett's compilations under the titles of The Moral Compass and The Book of Virtues.  The truth is, I haven’t read both of those cover to cover, but they are essential to a personal library.

Perhaps, some day, I will turn my lists of books into a book unto itself.

I am certain that I have forgotten to include a few titles which, if I were to think of them, I would be chagrined to realize I have omitted.  When they come to mind I will edit this list.

And here it is:


1. Big Bang by Simon Singh

2. In the Empire of Genghis Khan by Stanley Stewart

2. The Great Evolution Mystery by Gordon Rattray Taylor

3. King Solomon's Ring by Konrad Lorenz

3. The Man Who Mistook His Wife for a Hat by Oliver Sacks

3. The Way of a Pilgrim by author unknown

4. Ken Purdy's Book of Automobiles by Ken Purdy

5. The Code Book by Simon Singh

6. The Devil's Dictionary by Ambrose Bierce

7. The Best-loved Poems of the American People compiled by Hazel Felleman

7. Into the Wilderness by Bill Bryson 

7. Economics in One Lesson by Henry Hazlitt

7. The Elements of Style by William Strunk, Jr. and E. B. White

7. Familiar Quotations, Fourteenth Edition compiled by John Bartlett

7. Free to Choose by Milton and Rose Friedman

7. The Life That Lives on Man by Michael Andrews

7. Game Management by Aldo Leopold

8. Quotations from Chairman Bill by William F. Buckley, Jr.

8. Small Is Beautiful by E. F. Schumacher

8. The Founding Fish by John McFee


1. Parliament of Whores by P. J. O'Rourke

1. The True Believer by Eric Hoffer

2. One Man's Meat by E. B. White

3. The Whys of a Philosophical Scrivener by Martin Gardner


1. Memoirs of a Superfluous Man by Albert Jay Nock

2. A Whole-Souled Woman by Susan Strane

3. Nicholas and Alexandra by Robert K. Massie


1. Pogo by Walk Kelly

2. Asterix the Gaul by René Goscinny and Albert Uderzo


1. The Bronze Bow by Elizabeth George Speare

1. The Call of the Wild by Jack London

1. Captain Blood by Rafael Sabatini

1. Catch-22 by Joseph Heller

1. The Enormous Room by e. e. cummings

1. The Grapes of Wrath by John Steinbeck

1. The Lion's Paw by Robb White

1. Lolita by Vladimir Nabokov

1. Oliver Wiswell by Kenneth Roberts

1. The Oxbow Incident by Walter Van Tilburg Clarkson

1. Penrod by Booth Tarkington

1. Red Sky at Morning by Richard Bradford

1. The Screwtape Letters by C. S. Lewis

1. The Source by James A. Michener

1. To Kill a Mockingbird by Harper Lee

2. Follow the River by James Alexander Thom

2. The Mill on the Floss by George Eliot

2. Scaramouche by Rafael Sabatini

2. Tom Sawyer by Mark Twain

2. Bleak House by Charles Dickens

3. Halic: The Story of a Gray Seal by Ewan Clarkson

3. Henderson the Rain King by Saul Bellow

4. All Creatures Great and Small by James A. Herriot

4. Angela's Ashes by Frank McCourt

4. Come Spring by Ben Ames Williams

4. Riders of the Purple Sage by Zane Grey

4. Siddhartha by Hermann Hesse

5. A Fine and Pleasant Misery by Patrick F. McManus 

6. Notes from the Underground by Fyodor Dostoyevsky

6. Pillars of the Earth by Ken Follett

Feel free to recommend more!

How well do you know this mountain?

Who is not familiar with the profile of Katahdin? The symmetry of its gently-sloping shoulders, its majestic, mile-high presence on the distant horizon; on a clear day you can even see it from the northbound curve of I-95 just before the Stillwater exit in Orono. You can always be sure it’s Katahdin by the position of the summit a little right of the middle, with that bare granite just below the peak. The Table Land occupies the near-level plateau between the summit and the western drop-off, to the left, where it falls away more abruptly than the eastern slope. Even those couple of streaks of rock down the front face identify it positively as Katahdin.

Unmistakeable, wouldn’t you say? Many a mountain around the world can be identified in an instant, just from its distinctive shape.

My son-in-law, Conor Broughan, and I were cruising around a string of islands on Ambajejus and Pemadumcook Lakes in mid-July in my Hudson Bay freighter -- a 21-foot Scott canoe with a 6-hp Johnson. Two Rivers Canoe and Tackle in Medway is the local distributor for this canoe, by the way.

Conor and I were gathering driftwood for some of my future projects. I have a few favorite spots on these lakes for harvesting driftwood and precious few chances to get out and collect some. I load the boat, haul it all home to Lincoln, spread it out to dry, and then it’s available for building lawn features, such as the one in front of our house that a friend has dubbed “Woodhenge.” Small pieces make good decorative features for indoor projects, too. And I especially like to match a pair of stumps with a driftwood plank to make a bench.

I can never get enough driftwood for all the projects I’m going to do some day. So Conor and I collected driftwood that day, and in addition, I took photos.

Now, from various vantage points on Ambajejus, I’ve noticed a certain phenomenon about Katahdin. For we know that there are several other peaks that flank the mountain, all of them impressive as well but simply dwarfed by the big mountain herself.

You’re probably familiar with the names of some of the other peaks: Doubletop, The Owl, OJI, and South Turner.

Here’s another view of the profile -- same mountain shown in the first photo.

But, folks, this isn’t Katahdin at all. This is South Turner Mountain. South Turner is also a worthy mountain, a tough climb in its own right at 3122 feet. It too lies within Baxter State Park, four miles to the northeast of its more famous sister.

Now look at South Turner in the photo that includes both peaks.

It’s only from a certain compass direction that South Turner plays this trick of mimicry, and only from certain parts of the lake can the two be seen side by side this way.

Here is one more view showing pretty much the whole lineup of peaks around Katahdin.

There is considerably more about South Turner Mountain that closely resembles Katahdin: the contours of the land to the north of each one including the plateau on the western height of each, the stream that flows from the northwestern slope of each one, and the basin effect trapping a couple of small ponds on each mountain.

Just to the north of Baxter Peak on Katahdin rises Hamlin Peak, nearly as high as Baxter Peak, at 4751 feet, but not visible in the more common views like these. These are the two high points on the rim that forms the basin on the north face of Katahdin.

Just to the north of South Turner Mountain rises North Turner Mountain, higher than South Turner, at 3323 feet, but also not visible in these views. And these two peaks are the high points on a similar basin. It is only an accident of nomenclature that the Turners are named as separate mountains while Katahdin is named as a single mountain with multiple peaks. This does not diminish the rest of the similarities.

It boggles the mind to consider that Percival Baxter once owned these mountains, but only for a brief year or so. He managed to purchase parcels of land around Katahdin from Great Northern Paper Company starting in 1930. (With what fortunes Great Northern acquired the land is a separate history.)

Baxter, who inherited a family fortune from his father’s canning business and went on to accumulate more wealth in the real estate business, was elected to the Maine House of Representatives and then to the Maine Senate where, in 1921 as president pro-tempore of the Senate, he succeeded to the governorship when then-governor Frederick Parkhurst died in office. Baxter was elected to a full term as governor, which concluded in 1925 when he was 49 years old, and that was the end of his career in politics.

His purchase of the land that was the beginning of Baxter State Park took place after his political period. After buying the first of several parcels in 1930 he immediately turned it over to the state, and the park was begun. It was named in his honor in 1931. Percival Baxter lived quietly but actively until 1969.

The name Parkhurst, by the way -- the governor who died, leaving the job to Baxter -- might have foretold bigger things to come: A hurst is a small hill or hummock, so the word, or name, Parkhurst, simply conveys the idea of a small hill in a park. Perhaps Governor Parkhurst planted the seed, so to speak, in Governor Baxter's mind. Of that we can never be sure.

But now you know a little more about these things than you did before. 

Message in a bottle

Let’s go back. Who remembers the days before the returnable container law? A little research shows that the Maine legislature passed the act to require a five-cent deposit on beverage containers in 1976.

Before that, a teenager with a .22 rifle could pass a summer afternoon walking a country road, shooting bottles in the ditch. If we went in pairs, we might set them onto rocks and use them more practically for target practice. Cans were a little less practical. A .22 bullet would sometimes pierce the can without so much as disturbing its equilibrium – you had to walk right up to it to see whether it had even taken a hit. A bottle, on the other hand, gave a satisfying explosion.

Plastic containers were still a few years off when I used to walk the roads reducing glass containers to inconspicuous fragments. The plastic bottles you can still shoot that don’t cost you your deposit are milk containers right down to the single-serving 16-ounce size. You don’t lose your nickel because there is no deposit. For this reason, single-serving chocolate milk containers in Number 2 plastic can still be found in ditches. No one wants to pick them up. But they are unsatisfactory as targets unless you fill them first with ditch water before setting them onto rocks or fence posts. With water in them they don’t blow down, and a hit gives you a tell-tale stream of water from the holes. (Caution: Firearms safety dictates that you never shoot a target resting on or near a rock. I now observe this safety rule, but in my early days of shooting I was much more confident of my marksmanship.)

Maybe I’m the reason there is a bottle law. Maybe some state senator’s kid lacerated himself on a bottle fragment when his bicycle haplessly carried him into a ditch alongside a road in Franklin County in the 1960s. Or maybe someone was incensed that people in cars were so insensitive then that they would drink beer after beer and chuck the bottles onto the roadside and leave them as scattered eyesores.

I can imagine someone driving along with a “roady” – typically a can or bottle of Budweiser – and sailing the empty into the air from an open car window. (Never did it myself.) I can picture a carload of 18-year-olds defiantly doing this back when I was 18. (I never pitched one from a back window either.) The drinking age in Maine was 21 from Prohibition until 1969, 20 from 1969 to 1972, 18 from 1972 to 1977, 20 from 1977 to 1985, and 21 ever since then.

I have no idea why the legislature tinkered with it so much at the time, but I remember the confusion then:
Can I have a beer?
How old are you?
What’s the drinking age?
I dunno, they just passed a law.
They just passed one a couple years ago.
It went down.
No it went up.
How old are you now?
Still 19.
I think it’s 20.
I’ll be 20 when this discussion is over.
OK, have a beer.

The next time you’re in a grocery store, look closely for ME -5¢ on beverage containers. You will find this on sodas and beer, of course. And on wine or liquor it’s 15¢. You will find ME -5¢ on Splash and orange juice. On spring water and “energy” drinks.

You will even find ME -5¢ on half-gallon jugs of prune juice.

Think about it. Back in the 1960s and early 1970s Maine wanted to discourage those casual hellions who were tossing their empty beverage containers from car windows as they cruised the countryside. Who, pray tell, ever drank down a half gallon of prune juice, while driving, and then tossed the empty into a ditch?

The prune juice lobbyist at the state capitol must be only a part-time position. But you can tell that the dairy lobby is well-staffed. Milk containers are exempted from the bottle law. Are we to conclude from this that far more hooligans guzzle prune juice while they text and drive than swill milk?

I notice, too, that the legislature of 1976 desired, in addition to the already-extant littering fine, to make the forfeit of 5¢ per container a sufficient incentive for a carload of teenagers to hold onto their bottles so when they were through drinking they would rush to the nearest returnable center and redeem the six-pack of empties for a full 30¢. Well, 35 years ago 30¢ was worth about four times as much today. Isn’t it about time to raise the deposit?

Bottle deposits didn’t begin in 1976, however. Remember those upright soda dispensers with the heavy glass bottles lying on their sides that were visible through a door on the left side of the machine? These were not just returnable bottles that were crushed and recycled, they were actually washed and re-used. After a few refills, a six-ounce single-serving bottle would be quite roughed up and abraded. Some were painted in two colors for the brand – Royal Crown, Moxie, 7-Up! The paint usually stood up well through numerous refills.

The price for a bottle of pop in the 1950s? Five cents. You didn’t walk off the premises with your drink in those days either. Once you had finished you six ounces of refreshment, you stood the empty in a wide, sectioned wooden crate that rested next to the vending machine. If you were determined to take it with you, you paid the shop keeper a 2¢ deposit. And finding an empty bottle in a ditch meant a trip to the gas station or wherever you could find the nearest vending machine, in order to collect the pennies, which still had value then.

The deposit in the olden days was not due to an act of the legislature. It was the bottling company’s value of its bottles. If you wanted to keep the bottle, you had to literally buy it. And you could sell it back for the same 2¢ price.

Two cents in 1957 was worth 4¢ by 1976 (using the Consumer Price Index), so the first bottle law in Maine had it about on par at 5¢, but that 2¢ is now 16¢ today, an eight-fold increase.

That same eight-fold increase suggests that a six-ounce drink that sold for 5¢ would be worth about 40¢ today. But you don’t find a single-serving drink of that size any longer. It’s generally about 16 ounces (ranging from 12 to 20), and 16 ounces should go for about $1.07 today.

In 1957 the legislature of most states had not thought of taxing a nickel Coke. Now the Maine tax on your buck-and-a-half soda is seven percent, which adds about a dime to the price. (You could have bought two Cokes 55 years ago for the tax on a soda today -- that's if our money would hold still...)

I just happened to think of all this when I was picking up 23 beer cans all in one spot alongside the Golden Road last week. I’ll get $1.15 for them when I turn them in, but I was more interested in cleaning up the roadside. I guide in that area, and I’m a little sensitive to what visitors see. And I thought: If the deposit on these cans were 20¢ apiece now, about even with the change in the cost of everything else compared to 1976, then someone ditching a suitcase of empties would be forfeiting close to five dollars.

I had to have some fun, though. So earlier this week, I bought a giant bottle of prune juice. You might have seen me driving around Lincoln on Monday and Tuesday this week, window rolled down, slowly slurping from that big bottle. I held the bottle so the label could easily be visible: Del Monte Prune Juice. It took me two days to drink it, but fortunately I like the taste of that stuff.

And when I finished it, I drove down one of the roads leading out of town, (I'm not saying which road), and when I was sure no one was looking -- I CHUCKED THAT BOTTLE OUT THE WINDOW!

There! There has been a stupid 5¢ deposit on prune juice bottles since the law of 1976, and I may be the first person who EVER committed the act with a prune juice bottle.

And therein lies my message in a bottle: I think certain drinks in certain sizes should be exempt from the deposit, or else milk should cease to be exempted, and I think the bottle deposit should be raised to 20¢ or even 25¢ to keep up with the ever-continuing degrading of the dollar.

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