We Still Have Choices: Cancer Patients and Their Families

In recent weeks, I hear on the radio, almost every day, another heart wrenching story about the end of life and the accessibility of life-extending drugs.

It is so hard to know what to do in such cases especially as we hope that staying alive and hanging in there, with the help of life extending drugs, could mean that perhaps in the meantime a new cure would appear on the market.

We made our choice and there is no way to tell if things could have been different had we made another decision.

In late 2006, my husband, a healthy man of 54, went to a conference in South Korea. He came back with a pain in his leg which turned out to be a blood cloth. For a while the doctors believed that his condition was caused from sitting down long hours during the flight, but short time later he was diagnosed with stage four lung cancer.

My husband, a practical engineer, asked his doctor how long he had to live, the answer was that normally in similar cases, the prognosis was death in less than a year.

My husband considered not taking any chemical treatment, but his doctor convinced him that, in spite of the side effects, chemotherapy could help him feel better and breathe easier. Thus,  instead of being a “dead man walking” (his words), he decided to  receive chemotherapy.

The first course of chemo was not effective, I can still feel the pain in my stomach once we got back the results of the PET Scan.

The doctor suggested a new drug, tablets which worked differently and were less harsh on the patients. At that time, Tarceva (erlotinib), was not covered by our health care provider or by our additional insurance.

We wrote a letter to both insurances asking to allow us to receive the drug, but our request was denied. Thus, my husband got another treatment, which apparently was too aggressive, and he died  few days after receiving the second dose, only 5 months after the diagnosis.

Because of the way it works, Tarceva could have made his last months easier, and indeed it became part of the standard treatment for advanced-stage non-small cell lung cancer soon after my husband passed away.

Of course, he wanted to live, and like many other cancer patients my husband agreed to try all kinds of costly natural remedies. But what helped him most was his decision, which he made once he was diagnosed, to be a role model to his daughters at that difficult time.

I believe that this was also the reason why he chose not to complain about the Tarceva's decision, or to contest it. Being prudent with our money, he also didn’t consider buying it in the private market.

Instead, he kept busy: he continued teaching, talked to us about the future, made plans and even forced me to go over the books with him and to write down important names and phone numbers. In those five months we sold our house in the suburb and bought a new one closer to town. I moved there on my own few months after he died.

Whenever I hear about a new drug for lung cancer I am pleased for the cancer patients, but feel a pang in my heart. We received a death sentence and had no medical answers.  However, after taking a deep a breath, I try to remember that at least my husband had the freedom to choose the way he wanted to spend his last days, and I know that those decisions made our life without him much more bearable.

In memory of Tzvi Raz, 1951--2007

The essay appeared in the Times Of Israel

http://blogs.timesofisrael.com/we-still-have-choices-cancer-patients-and-their-families/

Contempt Of Erudition And The Council For Higher Education

For several years I too worked in the same college where Rivka Wadmany Shauman, the elected deputy head of the Council For Higher Education, spent much of her career. Most people probably never heard of the small Teachers College of Technology, in one of the quiet streets in the old north of Tel Aviv. At that time this school was affiliated with The College Of Management, and I taught in the two institutions.

Like Cheers, the Teachers College of Technology was a place “Where everybody knows your name.” It was an intimate place. But even though it was  a college that taught technology, the technological aspect of the institution was ill funded and quiet unimpressive. The college did not resemble an academic institution, it looked and operated like an old backward high school.

The students did not choose the college because of the love of technology and teaching but since there were almost no entrance requirements: everyone was welcome. The college also offered an attractive stipend, (half of the tuition)  which made the place even more attractive. Thus since the students in the Teachers College of Technology got a teaching certificate, their tuition was half of that of the students  in the College Of management.

Please keep reading in the Times Of Israel

http://blogs.timesofisrael.com/contempt-of-erudition-and-the-council-for-higher-education/

From Marriage Ban To Freezing Eggs: The High Price Of Equality

Until the end of the Second World War and even later, in many places around the world, women had to choose between a career and marriage. Those who decided to have a career knew that they had to give up having a family.

In Britain, for example, by law, being a teacher or working in the Civil Service meant that the woman remained a spinster. Only in 1944 did the Education Act enshrined that women teachers were not dismissed once they got married. Two years later in 1946 marriage bar was removed from female civil servants.

Marriage bar at the work place must have made life simpler, at least for men, 

Please keep reading in the Times Of Israel

http://blogs.timesofisrael.com/from-marriage-ban-to-freezing-eggs-the-high-price-of-equality/

God's Helper Or The Choice Of Not Being A Mother

Today in Israel Hayom (Israel Today), I read an article about a mother who regretted the choice she had made, over forty years ago, to become a mother. The article has brought about many different reactions. Women feel strongly about this issue, but until recently we hardly ever read or heard similar opinions expressed in Israel.

In April 2013 I was in Britain on the day when Sir Robert Geoffrey Edwards (1925 –2013) died. He was one of the creators of the in-vitro fertilization (IVF) technique, and Chief Rabbi Jonathan Sacks spoke on the radio (BBC 4) about the man and his invention.

This is the essay which I wrote as a reaction to Sacks' eulogy.

Rabbi Sacks argued that for the Jewish people IVF is regarded as a great help in God’s work.

I appreciate the significance of IVF and the huge difference it made in enabling women, who wanted to, to become mothers. However, it is exactly this kind of attitude which could bring unhappiness to women who either are unable to conceive, regardless of the procedure, or, God forbid, choose not to have children.

Israel is a child-centered society and in our country the Ministry of Health finances four IVF treatments to enable the birth of a first and second child in a family, and after that it allows eight more in the following two years.

With such endorsement why would any woman end up childless? This approach assumes that given a choice, all women would want to become a mother.

While I am grateful for the support of the Israeli government, which provides an equal chance to every woman, regardless of her economic situation, it clearly demonstrates the priorities of our society and its leaders. I often feel that Israel is more willing to invest in babies yet to be born than to help children who are already here and need great deal of financial help in order to thrive.

Since today many women postpone motherhood to a later stage,  IVF is especially critical. For those women who are eager to have a child the emotional and physical toll of the procedure is a small price to pay and they do it readily.

But if the treatment fails, many Israeli women are reluctant to  give up on, what they believe to be, their only chance for happiness. Others feel pressure to keep on trying, often harming their health and putting a strain on the relationship with their partner.

Still, even in Israel, like in the rest of the world, some women prefer to remain childless. They have, no doubt, seriously considered the matter and decided that motherhood was not for them.

Yet, for reasons which have to do with our religion, the Holocaust, and the demographics in the Middle East, this choice seems unacceptable. In Israel the decision to have a child ceases to be a private matter but becomes a patriotic duty. Choosing not to have a child is almost regarded as a betrayal.

Public leaders like Rabbi Jonathan Sacks should be more sensitive and  careful when they speak. Not every woman is able to or wishes to have a child. Can’t we just respect her decision and make sure that we let her feel like she has made the right choice for her?

The essay first appeared in The Times Of Israel

http://blogs.timesofisrael.com/gods-helper-or-the-choice-of-not-being-a-mother/

Furnishing The Dollhouse: A Lesson About Money

It all started with a project: a dollhouse made out of wooden bookcase, which my daughters built together with their father. They had labored on it for weeks, and then when the dollhouse was finally done it was time to furnish it.

My husband asked the girls to make a list of the essential  items needed to furnish the different rooms of the house. Their wish list was very long: there were so many things that they just couldn't do without.

Then he said: “You did a great job, and we will be happy to  halve the cost of the furniture that you have chosen.”  He announced it ceremoniously, as though he was handing out a big  award, which in a way he was, it was just that they were caught off guard, our daughters were sure that we were paying for everything.

I was as surprised as the girls:  my husband had not divulged to me his plan;  he was probably worried that I would protest.  Indeed, although I said nothing and went along, I  secretly  felt that at the age of 7 and 8 they were too young to have their wings clipped in such a way. They were thrilled about the finished dollhouse and were looking forward to the endless possibilities of interior design.

It is not that he wasn't willing to spend the money, quite the contrary, like the rest of us he was anxious to see the dollhouse come to life. In retrospect I understand that this was a brilliant fiscal move. He seized an opportune  moment to teach our daughters the meaning of money  - value, making choices, taking responsibility, accountability and even patience. 

The girls were not even resentful, as rational creatures they just went ahead, made the calculation how much money they were willing to spend, and came up with a much shorter list of the most important items.

As a business professor,  My husband also wanted to demonstrate to our daughters the concept of an  "interested party -- any of the people or organizations who may be affected by a situation, or who are hoping to make money out of a situation.” In their case, it meant that if they wanted something  they had to take action. It was also an empowering lesson, the girls saved money to buy new furniture, and made some decorations themselves. The dollhouse has become more meaningful and valuable because we didn’t just buy all the furniture for them at once.

Victoria and Albert Museum of Childhood in London has a collection of Georgian and Victorian  dollhouses. Some of the large ones were used as an instruction device for young women to practice the subject of home economics in preparation for their future role as ladies of the house.

 http://www.museumofchildhood.org.uk/

Our dollhouse was used in a similar fashion, my husband believed that children should learn early about money so  that  they could grow up to be responsible adults. 

Soon Santa will be visiting many families, perhaps now, before he arrives, it is also an auspicious time to start talking to children about money .

I Love You And You And You X Twenty

Now that Valentine Day is safely behind us perhaps it is time to question one of the less savory customs associated with this special day.

The simple question “will you be my Valentine? is honest and specific.  I tell you that I love you and ask if you feel the same way about me. This question is directed to only one person-- you.

But when my daughters were told to prepare Valentine cards for their whole class, I had to wonder what does this practice really teach them?

My first introduction to this type of socialistic Valentine happened when my daughters were in elementary school in Texas. Several days prior to February 14th they came home and said that we should buy card boards, glitters and colorful markers in order to make "Valentines." Their teachers instructed them to make one for every student in the class so that no one would feel left out.

Don’t get me wrong, generally I am a firm believer in inclusion, but  in this case, as my girls sat down to work, painstakingly cuting and decorating twenty cards, I felt that there was something wrong with this custom.

In every class there are the  bullies, and  children who are just not very nice, is there no choice in the matter? Why do they deserve a Valentine card from a class member who may not even like them?

If teachers aspire that each child would feel loved why don't they ask the parents to prepare a special Valentine card in honor of their child instead of forcing class mates to make them? 

The Biblical commandment "thou shalt love thy neighbour as thyself,” (Leviticus 19:18) is one of the basic principles of a civilized society as it emphasizes the importance of treating our fellow man fairly and respectfully. But Valentine Day is not about neighborly love, it is the one day in the year which is dedicated to true love and romance, do we wish to dilute it by making it non-personal and generic? Do we want our children to feel guilty about having a discriminating taste? Moreover, when they become teenager would we like them to go out with people they do not care for because they would not want to hurt their feelings? Or even worse, do we want them to believe that it is not ok to say no?

 In western culture Valentine Day is a sad day for those people who do not have a special person in their life. Thus all the Valentine cards which they had received in their childhood would not shelter them from feeling lonely.

I feel that the day of love is best celebrated as an intimate occasion without generic cards professing meaningless sentiments. And if children take part in the festivities of Valentine Day, they should be encouraged to express their feelings towards the people they care about freely and genuinely.

What Would Dorian Say? Or My New Gray hair

That I stopped dying my hair is not news of any importance, but seeing Hilary Clinton’s soft golden hair, as she faces Barack Obama, on the front page of Ha’aretz today, I realized again, that when it comes to gray hair a rose is never just a rose. And no, this post is not about Feminism (with a capital F), although I must admit that whenever I attend any Feminist function I notice a sea of gray hair.

For as long as I can remember, my mother had beautiful  gray hair, she kept it short and let it dry in the sun. For a nurse, it was a practical no-nonsense hair style, and it suited her personality. I was convinced that one day I would be just like her. But when the time came and I turned gray, one of my daughters asked me to dye my hair. I hesitated; I always considered myself a woman who accepted  life changes, and imagined that I would age, if not gracefully, at least, with style.

 My daughter argued that it was too early, that I was too young to be old.  She even paraphrased a favorite line from The Diary of Bridget Jones in which Bridget admits that, as a student of women magazines, she knew better than to believe that we were judged by our personality.

As my daughter is the family’s fashion arbiter, I deferred my plan to grow old and seized the last days of spring by restoring my hair back to its original dark color. After all, I told myself, it was important to make my daughter proud.

But, from my experience,  trying to please our loved ones hardly ever works. I knew the truth behind my gray roots, and resented the effort of hiding it from the rest of the world. Whenever I saw gray haired women I found myself  complimenting them on their hair, and then explaining  why it was that I had dark hair. Of course I sounded false and hypocritical. I experienced a similar unease (and even wrote a post about it), under very different, and graver, circumstances, when we lived on the green line. Then too I felt that I had to justify to the world why I lived in a town which was considered a settlement.

A psychologist might call my predicament in both cases a cognitive dissonance, but it simply translates to not being true to myself. I was lucky that, with those two different issues, I was able to remedy the situations and to live according to my beliefs again. I moved back to Tel Aviv and stopped dying my hair.

Inside I don’t feel old, not even a bit,  but I wonder what other people see when a gray haired woman skate by them. This is a new thought, probably my dark hair blended better, and made me less conspicuous in the park.

My daughter told me the other day that gray hair is back, it may be true, but I like to think of it as her way of saying that she accepts my choice.

PS. Although I chose not to explore this aspect, it is interesting to note the juxtaposition of Clinton's golden hair and Obama's "distinguished looking" gray hair.

And one more thing, several  friends commented that hair color is a matter of personal choice. I agree, and hope that it was clear that, like always, I was only talking about myself.