Before Shabbat

Exactly a week ago I was responding to former mayor of Boston Tom Menino’s decision to cease treatment for his cancer. I admired his brave decision to say, “Enough!”, then gather his family and friends around him. Surely, I presumed, he still had enough fortitude to reach Thanksgiving if not Christmas, just one last time. And then in a flash, or so it seems from out here among the living, he was gone.

I listened to countless testimonials about Mayor Menino yesterday on WGBH and WBUR. Parenthetically, for major local stories, there are no better sources for up to the minute news then these 2 NPR affiliates. As I listened I remembered something Maya Angelou once wrote: “I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” So many people mentioned Menino’s love of and advocacy for children. He was way ahead of the curve when it came to GLBT issues and treated members of that community with enormous humanity. He cared, and his constituents knew it because he was sincere and committed. As Yvonne Abraham wrote in the Globe today, “Tom Menino was a master of the heart.”

One thing I heard really stuck in my craw. I don’t remember who said it. “Mayor Menino could be very tough. He was truly a fighter.” No disagreement there. In fact he could be downright vindictive in the face of criticism. Friends and foe alike knew that you did not want to be on the wrong side of an argument with the mayor. But then the guy said, “The mayor went out fighting.”

In fact, he did not go out fighting. There is great honor in his decision to go gently into that good night. Tom Menino had a choice once he heard from his doctors that they could not vanquish the cancer. He chose death with dignity. He embraced the truth with quiet bravery and wholeheartedness.

The choice to embrace the ending with quietude and dignity has not been honored enough in the contemporary world. It frustrates professional caregivers when a patient says no more. Doctors and nurses often feel like it is a defeat when a patient opts out of the fight and chooses palliative care. In too many situations patients and their families are made to feel guilty, as if they are quitters, when they voluntarily end treatment.

Tom Menino fought his way back from several illnesses and physical challenges in his life. Thank God he did: for the sake of his family, his constituency and for the sake of Boston. I honor him for that indomitable spirit that enabled him to push back the angel of death. And I honor him for reminding all of us that death with dignity is not an abstract concept but rather a real decision that deserves serious consideration and respect.

May Tom Menino rest in peace. May his wife Angela, his children and grandchildren never forget the gratitude of a city well-served by a man of conviction. May all of us derive strength and meaning from his life, and from his death.

When I moved to Newton in the summer of 1997, Tom Menino was already in his second term as mayor of Boston. His accent was so strong, his enunciation so mushy, I think I could make out every 4^th word Menino spoke. Sartorially speaking, he appeared rather rumpled, or, in Yiddish, a little shlepidik. Whatever the opposite of glamorous was, it was him.

Years later, even though I’m a citizen of Newton, I’ve followed Menino and his style.  His intense up close and personal style always appealed to me as did his no nonsense roll your sleeves up and get involved attitude. I’m not saying the man was perfect – I am saying that Tom Menino’s can-do attitude and his work ethic inspired me. I was and will always be proud that he was my “other” mayor.

In his later years in office, Menino endured stretches of poor health, including two earlier bouts of cancer. Every time Menino managed to battle back to good health. But when he was diagnosed with aggressive cancer shortly after he left City Hall, it felt truly tragic. He’d worked so hard, he’d earned lots of free time to spend it with his family. And now he was being cheated.

Today Tom Menino informed us that he was suspending chemotherapy. He’s done. I must say that I, like so many in the Boston area, felt a sharp pang of regret and sadness. He’s a father figure, an institution. People like Tom Menino are supposed to be indestructible. But they’re not. And we’re not either.

Tom Menino had come to understand that his cancer treatment would not, could not bring him a quality of life worth living, and so he said no more. What a brave declaration to make!

Our society has created the expectation that anyone with cancer, no matter how advanced or how debilitating, has the obligation to keep getting treatments, no matter how debilitating or how miserable. The option to say no more has been characterized as dishonorably surrendering to the enemy. A cancer patient isn’t allowed to ‘give up.’

In a world where it seems de rigueur to keep trying the latest chemo or the more extreme dosages despite the massive side effects, it feels like our lives don’t quite belong to us. It often seems to patients and families that the docs and the hospitals aren’t looking at the entire picture. It’s as if the endgame is a different issue. But of course, it’s not. The endgame, after all, is the place where we all arrive.

Doctors have begun to reassess the ways in which sick people are pushed to treatment. They have begun to acknowledge that it can be cruel and futile to operate on elderly, enfeebled people. They have begun to engender a sea change in Western cultural expectations about embracing palliative care and hospice not as failure, but as in lifting up end of life care as gentle and kind.

Atul Gawande’s newest book, Being Mortal,  looks at the issue of dying well in America and the impediments to achieving it. He pushes us to see that living a long life for the sake of living, despite pain and the loss of autonomy and dignity, must be discussed openly. Tom Menino decision challenges us to discuss this, too.

Our tradition reminds us that while we are forbidden to hasten death, we are also forbidden to stand in its way when death is imminent. The fundamental Jewish value, choose life, is exactly what Menino did when he said no more to his doctors. By ending chemo, by commencing palliative care, he is dying on his own terms.  I read that as choosing life.

Like many people, I am concerned about the various African nations afflicted with an outbreak of Ebola. I have deep sympathy for the people suffering and dying as well as for the surviving family members and the community as a whole. The unlikely possibility of Ebola spreading and infecting thousands in this country has crossed my mind, though I can’t say it keeps me up at night – yet.

The chances of contracting Ebola in Newton, MA are ridiculously miniscule.  We are much more susceptible to infections by any number of much more common viruses, from meningitis to the flu. Forbes says, “It’s also important to note that the panic about Ebola in the U.S. is driven more by xenophobia and fear of the unknown than by rational thought, and that a large outbreak here is still very unlikely.”  http://tinyurl.com/kge9jqz It makes sense to just stay calm. Furthermore, the sensational and occasionally ridiculous headlines, the grandstanding, remonstrating, ignorant congressmen, the pathetic warnings of apocalypse – all of this creates a big dose of skepticism. I will not succumb to the panic woven into the 24 hour media blitz. And I certainly will not jump on the “who-can-we-blame” bandwagon.

But then we read the following: “You can now get Ebola only through direct contact with bodily fluids. But viruses like Ebola are notoriously sloppy in replicating, meaning the virus entering one person may be genetically different from the virus entering the next. If certain mutations occurred, it would mean that just breathing would put one at risk of contracting Ebola. Infections could spread quickly to every part of the globe, as the H1N1 influenza virus did in 2009, after its birth in Mexico. … [T]he risk is real, and until we consider it, the world will not be prepared to do what is necessary to end the epidemic.” http://tinyurl.com/mggh85m

How worried are we supposed to be? What are we to believe? Who truly is knowledgeable about Ebola?

There is now an answer to these questions. We have an Ebola czar. Do we really need an Ebola czar? There are good arguments, pro and con, on this issue. Frankly, what could it hurt? It is obvious that nobody in this country on the medical front or the public health front seemed to quite know how to initially respond to this devastating virus. So at this point we need all the help that we can get.

The new Ebola Response Coordinator, is Ron Klain, a very bright and a very successful lawyer. This fact instantly calms me down. Why? Here’s the unvarnished truth. I confess: it’s because he is Jewish.

Obviously the Ebola Response Coordinator job is not out of the Talmud. The point is that a man with a Yiddische neshama, i.e., a good Jewish soul, is running that office. I have never met Ron Klain, though as soon as I saw his photo I realized that I do know him, or at least, his physiognomic type. I recognized him as a person I can trust. We stood together Sinai: I remember his face!

I know. This sounds a bit preposterous and maybe even a bit chauvinistic. Obviously I would have no qualms with any qualified person the President chose, regardless of faith or ethnicity. But I know where Mr. Klain comes from. I’d like to believe that his ethical sense of the value of life and the notion that all of us are created equally in God’s image is a part of his Jewish heritage. That Jewish heritage will help him make hard decisions with compassion and honesty. I’m glad he’s there for all of us.

Shabbat Shalom,

rebhayim