Time in a bottle

When flying from San Francisco to Honolulu, sit on right side of plane for this aerial view passing Diamond Head.  Flygskam! Couldn’t I have set sail on a solar yacht instead, like Greta Thunberg and her father?  This month, 50-year-old Spanish endurance athlete Antonio de la Rosa paddled 2,900 miles from San Francisco to Honolulu.  His self-described journey of “absolute loneliness and self-sufficiency” to raise awareness about protecting the ocean from man-made pollution took over 76 days.

    

In contrast, I didn’t even last 76 days rowing for my college crew team, so I took a full passenger flight for 5 hours, contributing about .59 metric tons of carbon dioxide.  Climate change is real as much of Hawaii (sparing Honolulu) was declared a disaster (eligible for federal funding) after Category 5 Hurricane Lane last year.

This time-consciousness relating to travel reminded me of two favorite songs from the 1970s about time, coincidentally by singers who died in transportation crashes:

“If I could save time in a bottle
The first thing that I'd like to do
Is to save every day till eternity passes away
Just to spend them with you…
But there never seems to be enough time
To do the things you want to do, once you find them”

--Time in a Bottle (1973) by Jim Croce (died in 1973 airplane crash)

Cat’s in the Cradle (1974) sung by Harry Chapin (died in 1981 car crash) and written by his wife Sandy from the point of view of a busy father—when son asks to play, father brushes him off, time passes; father and son grow older, now father asks son to spend time with him; by now, grown-up son very busy so brushes off father who sings wistfully:

“I've long since retired, my son's moved away

I called him up just the other day

I said, "I'd like to see you if you don't mind"

He said, "I'd love to, Dad, if I can find the time

You see my new job's a hassle and the kid's got the flu

But it's sure nice talking to you, Dad

It's been sure nice talking to you"

And as I hung up the phone it occurred to me

He'd grown up just like me

My boy was just like me”

             

Once I landed in Honolulu, I lowered my carbon footprint by taking TheBus, carpooling and walking.  But mostly I was a homebody because I am more conscious of time ticking away…

Growing up in a free-range household, we were not homebodies but often out and about.  Both parents were busy working, my siblings and I (under influence of Tiger Mum) were busy in school and extra-curricular activities (including child labor in family business, fired/rehired many times!), and my grandparents (with dementia) enjoyed wandering.  With my grandparents dead and one storefront business sold, my parents have relatively more “free” time (though still managing other family business) so I make time to be with them during my wikiwiki visits.

Slow healing

While listening to slack key guitarist Makana’s “Deep in an Ancient Hawaiian Forest” (from The Descendants film soundtrack), I looked at forest bathing materials – struck by sign stating “Neuroscience shows that 50-year-olds can have the brains of 25-year-olds if they sit quietly and do nothing for 15 minutes a day.”  Yikes, better avoid that because I don’t want to revert to immature 25-year-old brain! (Researchers have found that short-term memory peaks at age 25, emotional intelligence in our late 40s, and crystallized intelligence in the late 60s or early 70s.)  

Uloha hosted “Under the Banyan Tree” talk on Forest Bathing Hawaii by Phyllis Look, Hawaii’s first and only forest therapy guide (trained in Costa Rica) certified by Association of Nature & Forest Therapy (ANFT).  Her role as guide is to open door by awakening senses for groups to connect to the forest = therapist.  Her point is to slow down.  She presented a power point presentation using anatomy of a tree to explain forest bathing:

·       Roots in Japanese tradition of shinrin-yoku (“forest bathing”), term coined in 1982 by Japan’s Forestry Minister to encourage its mostly urban population susceptible to karoshi (“death by overwork” legacy of competition and economic dominance from post-World War II reconstruction) to de-stress in nature while taking advantage of forests that make up nearly 70% of Japan, in a public health promotion program 

·       Trunk in science with 30 years of evidence-based research showing forest bathing therapy results in physiological (lower cortisol levels, higher natural killer activity, cardiovascular and immune health) and psychological (improved well-being and social harmony) health benefits from breathing phytoncides (wood essential oils) 

·       Crown relationship of reciprocity, so nature connection and culture repair arise together, like caring between Kalo (taro) as the older brother to kanaka (Hawaiians).

Phyllis wrote Chinese pictographs for tree + human = rest.  After working in SF Bay Area theater scene, she returned to Hawaii 20 years ago for “family reasons” and now enjoys an encore career that takes her outdoors as forest therapy guide. 

Phyllis offered us mamaki (Hawaiian nettle) herbal tea, invited us to join her 3-hour, 1-mile forest bathing walk through University of Hawaii at Manoa’s Lyon Arboretum.  Her forest therapy was featured in August/September 2019 issue of Hana Hou, in-flight magazine of Hawaiian Airlines.  She offered me kama’aina (Hawaii resident) discount for forest walk.

Instead, I spent slow time with my parents, including being present for house call visit by Jessica Ackerman, NP with Queen’s Medical Center (QMC) Geriatrics, who spent a whole hour with us! Pop is patient, Mum is primary caregiver, and I am pro bono gerontologist freely offering my assessments 😊.  My parents say different QMC geriatric specialists visit quarterly, but consistently good! Plus, they know to call me (“daughter in California”) if follow-up needed. So grateful for their thoughtful, unrushed care provided to Pop, who had been immobilized due to pain after falling twice in monster home.  With one-time epidural shot for pain, ongoing physical therapy to regain strength, and deprescribing meds, Pop has gotten much better! We are so relieved because he had polio in his youth, and worried he might have post-polio syndrome (experienced by some of my clients).  Now Mum wants her own geriatrician, as her internist as primary care physician gives her only 15 minutes.

Quick building a village

At Ala Moana Hotel, enjoyed breakfast at 15^th Annual Hawaii Floodplain Management Conference hosted by Hawaii State Department of Land and Natural Resources. 

With limited time, I only showed up for Hawaii Homeless Initiative presentation, which fit conference theme Ho’o Laulima (“Many Hands Working Together”)—as well as my return to community work with older adults who are homeless or at-risk of losing their housing.  Hawaii State Homelessness Coordinator Scott Morishige, MSW, described how government and private sector worked together to quickly build Kahauiki Village, which provides long-term, affordable rental housing ($725 for 1 bedroom, $900 for 2 bedroom) for homeless families with children (no mention about kupuna).  The Village’s plantation-style community was brainchild of local businessman Duane Kurisu, who had organized fundraising for survivors of 2011 earthquake and tsunami in Japan; this “Aloha for Japan” returned to Hawaii in the form of pre-manufactured units, previously used to house them.

Government’s contribution came in the form of State land transferred to the City via executive order and leased to Duane’s aio Foundation for 10-year term at $1 per year, and Governor’s emergency homeless proclamation (Hawaii has highest per capita rate of homelessness) to suspend regulations facilitating quickly build of infrastructure (utilities, sewer, electricity, water).

  

Relatively isolated with water on 3 sides and highway, near industrial Sand Island Access Road, this almost self-sufficient Village (on-site preschool, daycare, laundry, and market) apparently did not have to contend with protesting NIMBY neighbors. Scott emphasized that Village tenants are screened and selected by Institute of Human Services (social services agency) – targeting people who are “clean, no substance use, motivated to get out of homelessness” and able to take advantage of nearby employment opportunities like laundry business operated by Hawaii’s former First Lady.  Replication of plantation village for modern-day laundry service workers…no wonder kupuna excluded?! 

Project Manager Lance Takehara presented Case Study: Kahauiki Village, which was built up on a floodplain, avoiding low-lying areas.  Transplanting modular units involved adjustments like short doorway and installing whole fans.  Project began in Fall 2015, and tenancy began in 2018.

Hope there's a good evacuation plan in event of flooding disaster!

This quick build project reminded me of The Union’s 5-storey, 110-unit apartment development in West Oakland, after 10 days fitting together pre-assembled modular units for relatively affordable housing (but not designed for homeless families and their plantation labor). 

History

Hawaiian history has been about its many struggles over land use, and tourism/military/commercial development usually won over affordable housing and traditional uses like agriculture, threatening Hawaii’s food sovereignty.  While riding The Bus, bittersweet to see this patch of watercress farm (since 1928) near Pearlridge Mall and along Kam Highway with passing vehicles spewing exhaust pollution.  Also viewed nearby construction of Honolulu (snail) Rail Transit, very slow work in progress.  

At Honolulu Design Center, attended screening of Reel Wahine of Hawaii, an intergenerational project of young graduates of Hawaii Women in Filmmaking (Executive Director Vera Zambonelli, in photo above) making documentaries of veteran women filmmakers, including

·       Victoria Keith, schoolteacher-turned-filmmaker of Hawaiian culture documentaries focused on local land struggles, from the 1976-1997 

·       Heather Haunani Giugni, co-founded first woman-owned video production company and filmmaker of stories about native Hawaiians 

·       Ciara Leina`ala Lacy, “directher” of Out of State (2018) documentary about the rehabilitative role of cultural practices among Native Hawaiians in Arizona prison 

·       Anne Misawa, director of State of Aloha (2009) documentary about Hawaii's history, motivating paths toward statehood and its legacy 

McCully-Moiliili Library commemorated its 50^th anniversary with a screening of Under the Blood Red Sun and talk with 75-year-old Graham Salisbury, haole author of 1994 novel that inspired film, and Tim Savage, director of 2014 film.  The novel focused on racial tensions following the 1941 Japanese attack on Pearl Harbor, as seen through the eyes of a Japanese boy living on Oahu with his immigrant grandfather and parents; the film was local production with mostly local cast.  Graham is a descendant of Thurston Twigg-Smith, Honolulu Advertiser publisher who wrote Hawaiian Sovereignty: Do The Facts Matter? (1998) and Lorrin A. Thurston, leader of Annexation Club instrumental in overthrow of Hawaiian Kingdom that replaced Queen Liliuokalani with Republic of Hawaii. (Pictured above is librarian in long-sleeved turtleneck, appropriate given air-conditioning blasting inside library, while it was sweltering hot outside, typical summer weather in Honolulu.)

Admission or Statehood Day is a holiday (3^rd Friday in August) in Hawaii that is not celebrated with fanfare.  Hawaii State Library hosted The Promise of Statehood: Looking Back, Moving Forward, with exhibit commemorating the 60^th anniversary of Hawaii’s statehood and a “Try Think” community discussion on “What do we dream for the future generation of Hawaii” with panelists: Anne Misawa (one of Reel Wahine of Hawaii); John Rosa, UH History Professor; John Waihee, former Hawaii governor and leader in 1978 Constitution Convention and formation of Office of Hawaiian Affairs; and Dean Itsuji Saranillio, author of Unsustainable Empire: Alternative Histories of Hawaii Statehood (2018) and critic of ongoing U.S. occupation (including Thirty Meter Telescope on Mauna Kea) and Asian settler colonialism in Hawaii. 

Waihee, age 13 when Hawaii became a state (only kupuna on panel), said he viewed statehood as civil rights victory against racism during territorial era, and supported ability to elect its own Governor.  Native Hawaiian Waihee represented his self-interest as he was elected 4^th Governor of Hawaii (1986-1994) during a period marked by tourist industry boom and increased foreign investment, mostly from Japan. To this day, many Native Hawaiians (Kanaka Maoli), whose ancestors were dispossessed of their lands, regard Hawaii statehood as continuing illegal occupation and motivated by capitalist greed of haole and Asian settlers. 

Statehood enabled Hawaii residents to vote for current Governor David Ige, best known for his delay in communicating correction about false ballistic missile alert because he forgot password to his Twitter account! 

At Made in Hawaii Festival in Blaisdell Center, surprised to see stand-up comic Frank de Lima doing “sit-down” comedy until he explained he had hip replacement surgery.  Now age 70, he remains the one comedian who can do gentle ethnic humor due to his own inter-ethnic background, descended from indigenous (Hawaiian), colonial settlers (Irish, English, Spanish, Scottish), and plantation immigrants (Portuguese, Chinese). 

To folks outside Hawaii, ethnic humor might seem politically incorrect—and some are downright sarcastic and demeaning.  But Frank might be an exception and his impersonations—especially of his multi-ethnic neighbors—might suggest empathy, as he views his contribution to peace:

“Hawaii's ethnic humor developed in the plantation days when people had humility, which they needed because if they weren't humble, the pride everybody has could have turned into arrogance and hatred and violence. Instead it turned into humor. And there was a lesson that went out through the years. Most people can handle Hawaii's humor, not everybody. But during the plantation days, most people could find humor in the different ethnic behaviors, and that's why there was peace.”—Frank de Lima, Acid Logic 

Frank’s “sit-down” comedy extended beyond ethnic humor. To tune of Jackson 5’s Rockin’ Robin, Frank sang these clever lyrics:

“Donald Trump

I sit in the White House all day long

watching TV and getting the news all wrong

with the news reporters

I grab my phone and I tweet tweet tweet

Tweeting Donald, tweeting Donald”

Derek Kurisu (older brother of Duane who inspired Kahauiki Village) introduced Chef Sam Choy, who used to say “never trust a skinny cook.”  Surprised to see his weight loss, but trust that 76-year-old Sam still knows how to cook… he made Hawaiian Poi Beef Stew using local ingredients like breadfruit (ulu), Hilo sweet potato, poi.

“Aging in Place”

Back at Ala Moana Hotel, 13^th Annual Aging in Place event was a mix of workshops (few informative, mostly marketing) and providers exhibiting their products and services (lots of assisted living facilities, though they really should not count for “Aging in Place”).  Visited Kupuna Pono, program of non-profit The Mediation Center of the Pacific, designed to help “families talk and support their kupuna” including advance care directive family conferences.  It was formerly named Neighborhood Justice Center, where I did an undergraduate internship!

Eileen Phillips, RN, discussed Understanding Your Home Care Choices.  (Reassuring familiar face as I took her Fall Prevention class years ago!)  She didn’t talk about me and family members (unpaid caregivers), but how to choose among 150 home care agencies in Hawaii that charge at hourly rates starting at companion level of $24 (minimum 3 hours per day).  

Afterwards, I walked couple of blocks over for tour of The Plaza Assisted Living at Waikiki.  It had the vibe of a cruise ship, but windows did not open for access to nature like breeze from trade winds, air from outdoors—just stuck with air-conditioning indoors, 24/7 year-round—like TheBus, hospital, and other controlled environments; no balconies, though there was patio on 3^rd floor facing Kalakaua Avenue traffic. 

I don’t like how air-conditioning has taken over; rather welcome humidity which is like natural skin moisturizer. Very sad to see wooden jalousie windows closed shut in older buildings and window mounted air-conditioners blocking out access to fresh air and natural sunlight.

Though made in Hawaii, I never felt like I belonged – I used to say I felt like an outsider.  Now I think it’s more accurate to say I didn’t feel at home in Hawaii because its land and culture has been hijacked by U.S. military, tourism, horrendous traffic, and air-conditioning!

   

In politically correct SF, there’s often an acknowledgement of being on indigenous land; unless one is indigenous, everyone else is an outsider.

Wonder what “aging in place” means for Kanaka Maoli? Hawaiian nationalist Haunani-Kay Trask gave advice about going away for college, leaving Hawaii because it’s too small, to find your voice because one always has to be too careful about what to say/what not to say in Hawaii, like definitely “no make waves” though surrounded by water?! “Get out of the colony” or drown.  How does one feel at home without free expression?

The end

“You better know that in the end
It's better to say too much
Than to never to say what you need to say again…”

--John Mayer, “Say (What You Need to Say)” from The Bucket List (2007) 

Lori Protzman, RN, Advance Care Planning Coordinator at QMC, presented all-day Ain’t the Way to Die: Advance Care Planning Workshop.  She reminded us that 5% of patients “create” 50% of health care costs, including 1/3 during last month of life; nearly 20% of deaths occur in ICU or immediately after discharge (“treated to death”).  Objective: help patients and families “say what they need to say” and let them know they were heard. 

What’s a good death from perspectives of Family, Patient and Health Care. Goals of care: concentrate on improving quality of life; help live meaningfully in time you have; ensure you receive kind of treatment you want; comfort and dignity will be our top priority. 

Lori recommended watching film, The Farewell, based on Taiwanese director Lulu Wang’s own experience with her dying grandmother, and her family wanting to hide terminal diagnosis from her and planning fake wedding as excuse for family reunion. 

I like palli care doc + cartoonist Nathan Gray’s Dying Words Aren’t What I Imagined. 

Back in SF Bay Area

At this month’s SF Bay Area Network for End-of-Life Care meeting, Lonny Shavelson, MD, presented on Medical Aid in Dying: Ethically Challenging Cases (and a pharmacology update!).  Based in Berkeley, he is a former emergency room physician, author of A Chosen Death: The Dying Confront Assisted Suicide (1995), and founder of Bay Area End of Life Options for patients at the end of their lives who are considering various options, including medical aid-in-dying (MAID) under California’s End of Life Option Act (2016).  He said writing a lethal prescription for terminally ill patients is “last resort,” with purpose for “dignified death” (never use “death with dignity”) after considering hospice and palliative care options.  He also consults with physicians and plans train-the-trainer as he intends closing date for his practice.  Always at his patients’ bedside, he highlighted challenges:

·       Secobarbital (induces sleep into coma so brain stem no longer drives respiration) cost increased to $3,500, then “disappeared from market”; DDMP2 (valium + morphine suppress respiration for cardiac arrest) takes longer for effect.  Taking more than 4 hours to die after ingesting lethal meds is “problematic,” less than 2 hours possible after “playing with meds.”  Brain damage can result from incomplete AID.

·       30% of terminally ill patients eligible for MAID died during 15-day waiting period; most oncologists decline to participate, and refer to primary care physician, who has no training, so refer to hospice which provides consulting MD, but only attending MD can start 15-day waiting period.  In July 2019, Oregon amended its law to make it ok to administer drug during waiting period if death is imminent.

·       If terminally ill patient loses ability to swallow (oral self-ingest), self-administering meds or ingestion can take place using GI tract, feeding tube or rectal catheter, with patient pushing syringe.

Meeting Co-Chair Nate Hinerman introduced psychiatrist and bioethicist Stanley Terman, MD, PhD, of Caring Advocates.  Dr. Terman is proponent of VSED (Voluntarily Stopping Eating and Drinking) as alternative to MAID. 

Scribd hosted How to Live Life and Face Death with UCSF palliative care physician BJ Miller & Shoshana Berger, co-authors of A Beginner’s Guide to the End: Practical Advice for Living Life and Facing Death, discussing what really matters, how to prepare for the inevitability of death, and make the most of life before that time comes. 

Researchers are getting closer to developing a blood test that predicts when a person will die.  Last month, California Department of Health issued report finding that 88% of people who use California’s EOL Option are white. 

In Oakland, attended Racial Equity, Homelessness, and Homeless Systems of Care, hosted by Bay Area Regional Health Inequities Initiative (BARHII coalition of public health departments) and Homebase.  BARHII Executive Director Melissa Jones discussed roots of crises from structural racism: homelessness is result of failed housing policing and systems v. individual/behavioral issue for intervention.

According to Point-in-Time counts, SF Bay Area has the 3^rd largest population of people experiencing homelessness (28,200) in the U.S., behind NYC (76,500) and Los Angeles (55,200).  Bay Area also shelters a smaller proportion of its homeless (33%) than any metro area in U.S. besides Los Angeles (25%), making crisis highly visible. 

Bay Area’s homeless population is disproportionately comprised of single, male minorities age 25+.  Meeting focus on race so no breakdown for older adult age range provided.  African Americans, Native Americans and Latinx are overrepresented among homeless.  Bay Area Asians were reported to have 0.1x homeless rate relative to general population, so I asked whether this was due to Asians living in multi-generational households like 6 people crammed in single-room occupancy unit with bunk beds? Who knows?! Group activities involved using Government Alliance on Race & Equity toolkits. 

Lunch included soda + chips below “health happens here with prevention” poster!

At SF Village, Palo Alto University Professor Lisa Brown presented on Climate Change and Healthy Aging, discussing impacts of rising temperatures, flooding and changing wind patterns; how to stay safe and make a difference with Elders Climate Action and next month’s Global Climate Strike with 1000 Grandmothers.

Finally, another reminder about breathing from geropsychologist Janet Meiselman, PsyD, who presented talk on Brain Health, Mindfulness, Mood & Memory.  And remember what we learned from forest bathing presentation: “50-year-olds can have the brains of 25-year-olds if they sit quietly and do nothing for 15 minutes a day.”