MID-SUMMER MOMENTS (July 31, 2022)

Midnight 9-1-1

            I awoke after 11pm with a terrible pain in my chest. Smack in the center, about the size of a tennis ball, so sharp I could barely draw a breath. For the past day or so, I’d been suffering from acute indigestion, waves of gas and sour heartburn. But this pain wasn’t moving, just growing worse. Flat on my back, I re-visualized an AARP sidebar: “HEART ATTACK WARNING SIGNS. Chest discomfort, pressure, squeezing or pain. Shortness of breath. Even if you’re not sure, have it checked out. Minutes matter! Fast action can save lives. That means your own.”

            Because my sleep-apnea snoring would give grounds for divorce, Nancy and I sleep in adjacent rooms. I jangled an emergency bedside bell. She came stumbling in. “Sorry, sorry. I thought the bell was part of my dream. When I woke up, I realized it was still ringing.” I mumbled my crisis. She punched 9-1-1 into her cell phone.

            Through agony and fatigue, I could follow most of the conversation. “What is your emergency? Do you need firemen, ambulance or police?” “A possible heart attack,” Nancy replied, and the operator passed her on to the Emergency Medical dispatcher. Within seconds, my wife had provided our retirement-community address, including building and apartment numbers, as well as my symptoms. The reply was almost instantaneous: “They’re on their way.” Nancy changed from her nightgown, phone line still open as the dispatcher advised her on how to keep me alive in case my condition deteriorated before help arrived.

My Rescue Wagon

            Ten minutes after that first dial, three Woodside Fire Department EMTs marched into our apartment, navy-blue uniforms topped by baseball caps. One remained in the kitchen, setting up a note-taking center on our countertop; the other two proceeded to my room and began our get-acquainted interview. “How’s it going, Sir?”  

            I couldn’t hold up my end of a civilized conversation. But I pinpointed the location of my pain while the lead EMT made a snap decision that I was hospital-worthy and began prepping me for transport. A blood-pressure cuff on my left wrist, IV in the left arm, oxygen-reader on my right index finger. Four kiddy aspirin to chew. Six feet away, the second crewman elicited more lucid data from my spouse as Nancy gathered her purse plus my wallet and phone. Then action! From my bed to a magically assembled gurney, rolling out the door, down the hall, up into the ambulance, all within a few minutes of the team’s arrival. I wasn’t keeping time; I figured my job was just to hold on.

            As they lifted me into the back of the ambulance, my heartbeat suddenly plunged to a worrying 40. Calling it out from the monitor and calmly explaining to Nancy and me what he was doing, the team leader inserted some nitro under my tongue and atropine into the IV. Back up to 85 in short seconds. “That’s much better,” he assured us both. As his partner secured me with straps, the leader instructed Nancy to drive ahead to the Stanford Emergency Room, using a different entrance than the ambulance. As the leader jumped in with me, his partner took the wheel, asking “Code 2?” TV-savvy Nancy later explained to me that meant no siren or flashing lights, so she breathed partial relief, heading for her car.

            To my surprise, the ambulance ride felt much bumpier than a passenger car. I gritted my teeth in discomfort and squinted at the passing streetlights.  The leader radioed ahead so the ER receiving team would have my basics before we rolled in. We arrived within 30 minutes of Nancy’s 9-1-1 call.

            What followed was a quiet blur. An intermittent parade of ER personnel explained that they needed to figure out what was hurting me. Two alternatives might be producing closely similar indications. A heart attack was the more serious threat. But acute indigestion closely mimics it. Over the next 17 hours, the sleuths addressed this dilemma with a sustained series of diagnostic tests: two blood draws for extensive analysis, including any signs of pulmonary embolisms; three EKGs; two sonograms; a chest x-ray; and a medication stress test. The team of nurses, nurse-practitioners, attendants and doctors kept us informed of test results and diagnostic progress. All good news: my heart was healthy and unimpaired. Never was I so happy to be judged “unremarkable.” But with heart damage ruled out, that left acid reflux to deal with. As my indigestion persisted, I was a given a “cocktail” to ease my heartburn; a throat-numbing combo of Maalox and lidocaine. Forewarned that this concoction wouldn’t win any taste trophies, I slugged it down, grateful for the subsidence.

            Throughout this marathon, Nancy was a stalwart companion. In installments between my catnaps, she caught me up on her own ER challenges. Even at midnight, she’d had trouble finding a free hospital parking slot. A kindly attendant had directed her to a garage spill-over section complete with a complementary parking ticket. Nancy registered me at the ER desk just as the ambulance was pulling into its separate entrance. She was then escorted past humming nurses’ stations through a hygienic labyrinth to my curtained cubicle. She remained with me from midnight to 5am, when they asked her to leave because they were shifting me to the Clinical Decision Unit where daily visiting hours wouldn’t begin until 8am. (We later learned that the CDU is an outpatient observation wing operated by the ER, for patients not sick enough for formal admission to the hospital but not yet well enough to be sent home safely.)  During this early morning interlude, Nancy drove home to grab some breakfast and rest. Then she packed a carry-all with some clothes for me in case Stanford discharged me later that day. En route back to the hospital, she procured two paperback thrillers to help us pass the time between tests, diagnosis and discharge. 

            Friday lasted forever. By 5pm, I was discharged, documented and instructed, wheeled in a chair to Nancy’s front-door pickup. A two-week prescription of Pepcid is easing my post-emergency recovery. Writing this one week later, I’m still quite fatigued but hugely relieved to have dodged a heart-attack bullet.

            Since my provocation turned out to be digestive rather than cardiac, I asked my Primary Care Physician to refer me to a nutritionist. The resulting video consultation was practical and challenging. It turns out there is no scientifically agreed diet for treating acid reflux. That said, for severe, recurring symptoms like mine, the nutritionist recommended comprehensive dietary changes: reducing or avoiding caffeine (coffee, tea, chocolate), spicy foods, high-fat, fried or greasy foods, carbonated beverages and acidic foods, including tomatoes and orange juice. Based on my recitation of weekly consumption, she flagged sugar and sweets as my most harmful intake. Cut them out; if that’s too tough, cut way back.

            Acid reflux pushes stomach contents up into the esophagus. So I shouldn’t nap or sleep within three hours of eating. When I do lie down, I should keep my head and chest elevated. Several sensible eating tips work for weight-loss as well as acid reflux. Reduce intake quantity by using 9-inch plates instead of standard dinner plates. For all meals, allocate each plate’s space to 50% vegetables, 25% starch and 25% protein.

            My existing exercise routine is ideal: 30 minutes of walking and 30 of swimming, alternating days.

            Most interesting for me were the nutritionist’s two overarching recommendations:

• Think of FOOD FOR PURPOSE, deliberately, attentively, with discipline and dedication;
• When you turn your attention to cutting back (for example, on tempting desserts,) treat change as a gradual experiment, not as a punishment. Be kind to yourself.

These principles reminded me of generic guidelines for agile aging. I normally associate sound maturity with meditation, serenity, moderation and balance. Here was a specialist articulating best practices in her dietary discipline that echoed my own pursuit of overarching senior harmony. This congruence should help me bring my eating under control and then keep it there.   

            I’m also processing the recognition that this Emergency Room wake-up call resonated far beyond food choices and portion discipline. My chest pain probably sprang from accumulating stress as much as from spices. (See my two most recent blog posts on creeping immersion in retirement-community governance.) My emotional engagement has been taking a physical toll. Not only fried chickens are coming home to roost. So the remedy must be correspondingly comprehensive. Mind/body unity is more than a Buddhist homily. My integrated system is under strain. My lifestyle and priorities – not merely my diet – require senior adjustments.

***

Remembering a Cherished Neighbor

            Nancy and I have been attending a series of Memorial Services in recent months, as family members and close friends have passed away. These commemorations seem to be coming in an accelerating stream as we approach our 80^th birthdays.

            One lesson I’m carrying away from these leave-taking celebrations is that each decedent was not one person, but many. The wide-ranging impressions and impacts he or she made depended on relationships, timing and perspectives. One marvelous result of a procession of memory contributors at the microphone can be the collaborative composition of a nuanced, enriching portrait. As each speaker adds a reminiscence or anecdote, the assembled friends and even family members can gain a fuller, often surprising, appreciation for the layered complexity of a life.

            For one good friend’s recent celebration, we gathered in our local township’s Community Hall. Here’s what I had to say when it came my turn to stand up and share.

Portola Valley Community Hall

Rowland and I were next-door neighbors in our Sequoias retirement community.  When we first met at our Building 16’s informal receptions, he seemed shy and withdrawn. But from our brief chats at those gatherings, sitting on the parlor sofa or around a dining-room table, I soon discovered he was also alert and attentive, with a twinkling-eyed sense of humor. Saying little, missing less.

We were drawn together by Roland’s prostate-cancer diagnosis. The two of us agreed to have a private conversation, comparing notes on our treatments and side effects, prognoses and concerns. That candid exchange launched a series of monthly lunches at Ladera cafes.

What I most valued about those low-key get-aways was their relaxed moments of silence. For sure, we enjoyed sampling local versions of ethnic cuisines. And steadily we came to reveal glimpses of our personal and professional backgrounds, as well as opinions on current affairs. I marveled at his modest accounts of mountaineering ascents and geological fieldwork.

But just as often, we just sat quietly. Feeling no need to fill natural pauses. Content to be calm. What best characterized our organic friendship was simply being together.

I’m missing Rowland. And our sitting stillness.

***

Fallen Stars

            On July 13, Sri Lankan President Gotabaya Rajapaksa slunk out the back of his Colombo palace, escaping to Singapore via the Maldives. Irate at the President’s broken promise to formally resign, street protestors poured into his official residence and the Old Parliament building. By default under the Sri Lankan Constitution, the Acting Presidency passed to Prime Minister Ranil Wickremesinghe. The New York Times quoted the PM lambasting the protestors as “a fascist threat” before declaring Emergency Rule. That evening, the no longer peaceful mob torched Wickremesinghe’s private residence, forcing him into troop-guarded seclusion. The familiar names and turmoil summoned my own intense Sri Lankan memories from 20 years ago.

            Ranil Wickremesinghe had been unexpectedly propelled into power at the end of 2001. In a national election conducted during a precarious cease-fire in the interminable Civil War, he was the only candidate unequivocally advocating for peace. The exhausted voters awarded his party a parliamentary majority; its members named him Prime Minister. A right-of-center moderate, Wickremesinghe was convinced that business leaders and enterprises — foreign and domestic – were the best engines to sustain the peace. Losing no time, he reached out to the United Nations Secretary General for peace-building policy advice. The SG turned to the United Nations Development Programme (UNDP). Familiar with my emerging-nations consultancies in China, Laos and the Central Asian Republics, UNDP engaged me to fly out to Colombo and see if I could lend a hand.

            Peace-building opportunities weren’t difficult to spot. There’d been a booming economy before the war had sapped safety and security. National business leaders had withdrawn into narrow survival mode, “leaving war to the generals and peace to the diplomats.” We had to lure them out again. I coined the campaign slogan, “Invest in Peace,” signaling that Sri Lanka was safe for doing business and that responsible firms should proactively commit to peace-building. I accompanied the Prime Minister to New York and helped craft his “Invest-in-Peace” address to the UN General Assembly. For that same occasion, UNDP colleagues and Sri Lankan diplomats collaborated on rounding up prospective foreign investors – including diaspora Tamil millionaires who’d been funding the Tamil Tiger rebels — interested in hearing how the new PM planned to make peace stick.

            Ranil was staying with his delegation at the Waldorf Astoria, where we organized a small-scale reception for investors. He and I were walking together to meet the invited guests when he pulled up short in the adjacent hallway. “I can’t do this,” he hissed. One glance at his tight jaws convinced me he had stage-fright. I tried to spare us both embarrassment by thawing the freeze. “Can’t do what?” Suddenly irate, he acted as if the eager guests had somehow become an affront to his dignity. “I won’t sell soap!”

            Twenty feet from the waiting party, the two of us had a sotto voce squabble. I reminded him he didn’t have to sell anything; these guys were already on-board. Some had flown in from Toronto, Chicago and even London, just to meet him. All he had to do was shake their hands and say a few Invest-in-Peace words. He knew more about his topic than anyone else. The PM scowled, as if I’d ambushed him, and pushed ahead into the room. The small group was delighted to see him; the diplomats smoothed introductions. We got through it, but I could tell my client hated every minute. He slipped away as soon as he’d delivered his brief remarks.

            This cocktail-party contretemps proved a minor episode in my crash course learning how to assist this complicated leader. To me, it remained remarkable that a frozen-tongued introvert could ascend to Prime Minister in a parliamentary system based on the rough-and-tumble British Commons. But Ranil had an abundance of offsetting advantages. The nephew of a former President and son of Sri Lanka’s leading press baron, he was squarely ensconced in the country’s ruling elite. A policy wonk and lawyer happiest when closeted with his Cabinet, he was at ease with legislative details and development finance. (Reps of key aid agencies liked the World Bank and Asian Development Bank considered him savvy and reliable.) He was also a shrewd survivor of parliamentary infighting. What he most lacked was the common touch. He abhorred public speaking and performed poorly in his high squeaky voice. Going on the political campaign trail made him miserable. I came to attribute this chronic reticence to a combination of personal shyness and elitist aloofness.

            Despite these political shortcomings, the Prime Minister made bold strides championing his business-based, peace-building initiatives. Leading a major conference in Tokyo of aid donors to Sri Lanka, he raised $4.5 billion. An early beneficiary of this support was a resurgent garment-manufacturing export industry.

            Simultaneously, he persuaded UNDP to expand our initial Invest-in-Peace collaboration by sponsoring a two-year advisory project that I’d design and manage. He quickly utilized our new project’s expert resources to strengthen Sri Lanka’s Board of Investment and foreign-investment promotion framework. Soon, our project’s ground-level initiatives were springing up all over the country. Our Business-for-Peace Alliance reconnected 30 local business communities long separated by the Conflict Line. (Several of these entrepreneurs accompanied us to Japan to participate in Osaka and Kyoto forums promoting Sri Lankan investment opportunities.) Renovating neglected historical properties, we revitalized cultural and environmental tourism. And in the battle-scarred North and East, we trained traumatized teens in construction-trades skills, guaranteeing them jobs upon graduation.

            Sri Lanka being Sri Lanka, the peace-building momentum didn’t last. While Ranil was out of the country attending a regional conference one weekend in 2004, his bitter rival, the President, asserted her Head-of-State powers to declare martial law. (Under Sri Lanka’s constitutional system, the Presidency and Prime Ministry could be occupied by opposing parties.) With the top military brass’s support, she deposed the Prime Minister and scuttled his peace-building program. In the ensuing special election, the drums of war endorsed her coup. Why settle for benefit-sharing peace when unilateral victory was attainable? Articulate in technical deliberations with donors and business leaders, the uncharismatic Prime Minister failed to convince the general public that peace was worth preserving. Within a year, the corrupt Rajapaksa cabal flipped from doves to hawks, seizing the government and ramping up war. The Tamil rebellion was crushed, tens of thousands of civilians slaughtered. Following that ethnic devastation, Sri Lanka’s seductive “Chinese debt trap” led steadily to the 2022 collapse.

            Ranil Wickremesinghe’s personal and professional biography has closely tracked this national arc. Born in 1949, a year after Independence, he grew up enjoying the economic and educational benefits of the country’s early prosperity. The 26-year Civil War shaped his political career. For a few brief, shining moments at the turn of the Millennium, he had the