In “Frank Talk About Care at Life’s End” (New York Times, 8/24/2010), Jane Brody discusses the recently-enacted New York law signed by Governor David Patterson that requires doctors who treat patients with terminal illnesses to give them information about aggressive pain management and hospice care to consider in making their end-of-life medical care decisions. There is a similar provision in the original Federal health care overhaul proposal. (It was withdrawn after all the “death panel” objections.)
Many patients are now living longer with incurable diseases (such as cancer) so that it is difficult for people to accept the information from their doctors that no further options are available. (It is also difficult for doctors to admit that they are at the end of their ability to help a patient.) 
What results is a trend to pursue a cure, even though it often destroys the possibility of good quality last days, surrounded by loved ones, in complete physical comfort at end of life.
Studies show that less aggressive end-of-life care can actually result in living a few months longer and with less depression. But in order to have that, one must give up hope for a cure. I have never been in that situation and don’t know whether I would opt for aggressive treatment, or if I would choose palliative care. It is a very weighty decision.
When making end-of-life decisions, you (or your families) need to be informed of all of the medical and palliative options. Many terminally ill patients choose comfort care after receiving realistic information about their change of survival and how difficult and painful future treatment is likely to be.
It is good to have end-of-life conversations with your family. I had many of these discussions with my former mother-in-law, Marian (who remained my friend after the divorce) before dementia set in. She told me she did not want to live a life that she could not reasonably enjoy. 
By the time her dementia set in, she was in no position to make arrangements to end her life. Her loved ones cannot help – assisted suicide is considered murder in most states (although not in all countries around the world).
You could look Marina’s plight as a waste of scarce resources. Her medical and caretaking costs are huge. She will never get better absent a medical advance tantamount to a miracle. This money could be used for dementia research, or for starving people in the world, or to help fix environmental problems.
What if my mother-in-law had been given a choice of ending her life 5 years ago? Could she have made that decision and put it into effect? It’s involves determination and set of actions very few people can accomplish. In a way, then advanced cancer has the advantage that you will die, without having to accumulate pills to do it yourself. That is a fortunate silver lining to having a dreaded disease such as cancer.
© 2010 Laurie Israel. All rights reservied.
Being a foody, I recently checked out a copy of Fannie Farmer’s “Original 1896” Boston Cooking-School Cook Book from the library. I wanted to find out what people ate at the turn of the nineteenth century. It led to an interesting and surprising voyage in a culinary time-capsule.
Fanny Farmer was born in 1857. An illness (perhaps polio) during high school rendered her lame, and in those days, unmarriageable. She turned to cooking, and became a cooking teacher, eventually forming her own cooking school, and eventually wrote her cookbook. By the time she died in 1915, 360,000 copies of her book had been sold. It has been revised continuously throughout the years, selling millions of copies. I remember there was a well-used copy in my home growing up.
Looking at the 1896 edition, I found some surprises.
There is a chapter for recipes “especially prepared for the sick”. The introduction asserts that “statistics prove that two-thirds of all disease is brought about by error in diet”. Perhaps the incorrect proportions were used, Farmer maintains, or the food was improperly cooked. So much for germs, airborne diseases, and bacteria, not to mention cancer, strokes and heart attacks.
She emphasizes food presentation in serving the sick – select the daintiest china, finest glass, and choicest silver, making changes as often as possible, she says. I agree with her that aesthetics are important to sick people – why just slop the food on a plastic plate just because a person is very sick. That’s just plain unfair.
The good foods for the sick are all of the mealy type, what we used to term as porridge in the old days. (Remember the Three Little Bears – wasn’t there some porridge in that story?) Flour gruel is one of the suggested dishes for sick people, made of 1 tablespoon of flour, 2 cups of milk, and some salt. Farina gruel (which I actually remember from my childhood along with the requisite enema my mother so lovingly administered) is made out of boiling water, farina, milk, egg and salt. For the adventurous, using Indian meal instead of flour or farina results in “Indian Gruel”. I wondered if the food Fanny was suggesting made people sicker. 
There are also many liquid foods to offer the sick. Barley water is highly recommended. Toast water is made with toast. (The toast is made, of course, in the oven, not the toaster – we learned how to do this the old way back in 1958 in cooking class. ) The toast is crumbled, soaked in water, strained through cheese cloth, and seasoned. Seasoned with what, one might ask? Fanny is mute on this topic.
Sick people’s food gets a little more exciting as you go down the list, which includes eggnog. There are several eggnog recipes, and they all include brandy.
Boiled beef essence is also good for sick people, she maintains. In those days beef essence didn’t come in a cube or a carton or a can. It is rendered by cooking steak round for 3 minutes, cutting the “bleeding” piece into 1 inch and 1 ½ inch cubes, then “gashing” each piece two or three times on each side. After that, you express the “juice” (blood, actually) with a lemon squeezer and put it into a cup. Finally, you set this dish in hot water – but not too hot as to actually cook the meat or “coagulate” its juices. Sounds pretty grim.
Have you ever heard the expression “milquetoast”? It is refers to a weak, ineffectual or bland person (male). The word is derived from a character in a 1924 comic strip The Timid Soul. It probably refers to the nature of milk toast, which was an important food in 1896, based on the number of Fanny Farmer’s recipes for it.
The basic milk toast recipe is to add water to flour to make a paste, add milk and cook, and salt and butter, then dip slices of toast in it. Remove the toast to a serving dish. Pour the remaining sauce over the toast, and serve. Sounds fairly unhealthy? Maybe it was the milk toast that made people sick in those times.
There is a robust section on donuts, but that was before Dunkin’ Donuts took away peoples’ will to make donuts at home. People had all the time in the world I the age before multi-tasking. They make themselves sick frying in deep fat (animal?), and if needed, refer to Fanny’s recipes for the sick afterwards.
There is an interesting chapter on soup garnishings (egg balls, noodles, flour dropped into boiling grease, etc.) and force-meats. I have not heard mention of force-meats in at least 50 years, and was interested in learning what it was.
A force-meat is a concoction that is made as follows: cook stale bread crumbs and milk to a paste, add egg and fish (or chicken or clam or salmon, etc.) pounded and forced through a puree strainer. It is then shaped into small balls and plopped into to the soup to cook in it.
There are some very interesting recipes in the book that I would like to try. One is champagne sauce, to use on fish or meat. You start with Espagnole sauce, which is made with what we now call “Italian” seasonings, and brown stock, itself made with beef and seasoned copiously. Reduce it, add two tablespoons of mushroom liquor (where am I going to get this?), a half cup of champagne, and one tablespoon of powdered sugar.
Now I know where my mother got her prune whip recipe, one of my least favorites of my mother’s fine cooking. It’s here in the Fanny Farmer cook-book. You add the whites of 5 eggs to prunes that are “picked over” and washed. (What did they find on them to have to pick them over?) Remove the stones of the prune (those are the pits — very smart move), and rub them through a strainer, adding sugar. Then beat in the whites of the egg until stiff, bake twenty minutes, then feed to unsuspecting children who hate the dish. I can still recall the taste 60 years later. (I think my siblings actually liked prune whip, which I’m sure encouraged my mother to keep making it.)
When I wasn’t getting attacked in my childhood by the prune whip (or the enemas), I could take a rest and sample the various lovely “chafing dish” recipes Farmer suggests. Welsh Rarebit was staple in our post-World War II suburban Jewish home. It has nothing to do with rabbit. My mother made it just the way Fanny said to, and we all loved it. Mother may have put a little beer in it, as is required for Fanny’s Welsh Rarebit II recipe. Welsh Rarebit could make boring American cheese into something exciting, but was probably not that healthy. (Cream and butter are also in the recipe. Maybe partly explains why my siblings and I have weight problems.)
So if Fanny Farmer didn’t kill you with her food recipes, she could nurse you back to health with the dainty silverware, the gruel and the raw beef.
I hope you have enjoyed this little jaunt through earlier times. Bon Appetite to you.
Did you ever hear the expression “Happy Wife, Happy Life”? This overused adage seems to help some people (generally husbands) focus on their wife’s happiness in order to secure a peaceful, happy marriage. It seems quite manipulative. What about the man’s happiness? It’s interesting that the opposite “Happy Husband, Happy Life” is not used. Studies show that divorces are more often initiated by wives, so perhaps there tends to be an inequality in marital contentment, weighed towards the husbands’ side.
I originally thought the expression “Happy Wife, Happy Life” was of Oriental origin, because it seemed like the kind of thing you’d find in a fortune cookie. However, my Google search on the term brought up no Oriental sources.
The search for “Happy Wife, Happy Life” did in fact bring up a website www.happywife.com, the work of Rabbi Aryeh Pamensky, who offers many marriage improvement resources (including his own books, tapes, seminars, etc.) on the site. The term, however, does not seem to be derived from Rabbinic literature, and according to Pamensky, his courses and materials are used by people of difference faiths other than the Jewish, and also by secular couples.
The adage is confirmed by a 2009 German study of Australian divorces that notes where there is a disparity on satisfaction of the husband and the wife, divorce is much more likely, especially if the relative dissatisfaction is experienced by the wife. http://economix.blogs.nytimes.com/2010/01/29/dont-become-happier-than-your-wife/
Then there’s www.yourhappywife.com. This site seeks to assist husbands in making their wives happy by helping them choose presents for their wives, which can be conveniently ordered on the website. Actually, the wares are quite attractive, including eco-soap and herbal teas. These might certainly pave the way for a clueless husband seeking to make his wife happy. In addition, the husband needing further help can email the site and pose his marital question or problem. “Within 24 hours or sooner”, the person(s) operating the site will respond with the best advice they can give. The site notes that all emails will be kept confidential and, in order to receive the best advice possible, that honesty is expected from the husband seeking advice. (I’d like to be a fly on that wall!)
As Rabbi Pamensky says on his site, “A happy wife is a happy life. It’s just that simple.”
But is it?
George Pransky, a psychologist in Washington State has another theory of marital dysfunction.
His theory is that a person’s own mental/emotional state is the biggest indicator of whether the marriage will work well. If two people have a low mental or emotional state, Pransky says, marriage enrichment or marital therapy is like spraying for mildew in a damp basement. It never works as a long-term cure. In his marital counseling, Pransky tries to elevate the couple from the damp basement into an environment of good mental health. It is only then, Pransky says, that people can truly work on their marriage to make it thrive and survive. Prasky’s book, “The Relationship Handbook”, is a great resource for those couples who want to elevate their mental state and start working on their relationship. You can order a copy through www.amazon.com.
So perhaps the more accurate stating of the adage is “Happy Life, Happy Wife.” Or even “Happy Life, Happy Husband.”
Some time ago I received a draft of a legal document to review. It was in a typeface I had never before noticed. It was a san serif typeface, from “sans” without, and “serif”, a line. The serifs are those little vestigial horizontal strokes at the bottom of the letters reminiscent of early writings with quill pens. A sans serif typefaces has a more modern look than a serif typeface. It is as if those the quill strokes of the earlier calligraphers have been removed.
I looked up at the font window and saw the word “Calibri”. There was something very friendly about the typography – a nice rounded look, not mechanical, almost like a hand-drafted version of a san serif typeface. It was personal and not geometric. The document I was working on, a separation agreement for someone’s divorce, was very serious. A couple was getting divorced. They were entering into an agreement about how to divide the property and the children. It is not a very happy time in peoples’ lives, and is very stressful.
Calibri alphabet
I looked at that nice, warm typeface and thought how nice it was to present the very serious, difficult separation agreement in such a warm, friendly way.
I started thinking of the famous quote by Marshall McLuhan, “the medium is the message”. The fact that the “medium”, this lovely typeface, was presenting the “message”, an agreement that was the template for the end of the marriage, seemed a very good thing for the clients. It is a subliminal message that in essence, all things are right in the world, the world is safe, and happiness is present, or at least around the corner. A good message to present in a divorce.
Calibi was invented for Microsoft by a Dutch type designer, Lucas de Groot [who calls himself Lu(cas) de Groot] in 2003. For Lu(cas)’ very fascinating website where you can see his other type designs, visit www.lucasfonts.com . 
You won’t find Calibri on Lu(cas)’ site, because it is a proprietary typeface, designed for Microsoft, but you will find other interesting typefaces and material on de Groot’s work.
On its website, Microsoft describes Calibri a member of the san serif typeface family with “subtle roundings on stems and corners”. It has “many curves” and a “warm and soft” character.
Sans Serif typefaces are organized in several categories:
There are the “neo-grotesque” (also called “realist”) such as Helvetica and Arial.
These are very common, and are relatively straight in appearance. They have not much line width variation, have a very plain appearance, and are sometimes called “anonymous sans-serif” as a result.
The second category of sans serif typefaces is the “humanist. Calibri, Verdana and Tahoma fall into this category. They are the most calligraphic of the sans-serif typefaces, with some variation in line width and more legibility than other sans-serif fonts.
Geometric typefaces, such as Futura and Avant Garde are characterized simple letter constructions built on geometric shapes, as in the letter “O” which is optically circular in Futura.
Grotesque typefaces, such as Franklin Gothic, are the early sans serif designs, developed around 1900.
Calibri made the news in February, 2009 when Lucille Hester, sister of Dallas Cowboy football star Bob Hayes read a letter purportedly written by Hayes on national TV. The letter was dated 1999, three years before Hayes’ death. A close look at the typeface revealed that it was Calibri, which was invented in 2003, and wasn’t available to the public until 2007, when it was included in Microsoft Office 2007. 
Since discovering Calibri a few years ago, I have been increasingly using it in my work as a lawyer, especially for contracts and agreements between people. (By the way, I recommend 12 point, nto 11 point.)
I am convinced that the warmth and friendliness of the typeface increases the chance of people being able to come to agreements in a more congenial way due to the subliminal message the design of the word letters forms impart. Yes, Marshall McLuan, you were right. The medium is the message, indeed.
