And now we wait.......

[osodecanela]

I would have preferred to have been in SF today, watching the huge monitor set up near the Supreme Court Building. Not that that would affect the outcome mind you, but it might have given me some better sense of what direction the justices are headed. Last year, when they had their first session I found hope in listening to some of their pointed questions. That they found prop 22 unconstitutional last year was a surprise, though far from a complete one for me.

Being there however was not in the cards, nor was being able to watch it on TV at home. The reality of life, medical practice, and patient needs came first. I don't want to say that I deal every day in life and death issues, but in reality there are times that I do.

I have an elder in the hospital now, a patient who has what I heard called during my residency, 'the dwindles'. There are multiple medical problems in addition to advancing old age. None of these things in and of themselves would be life-threatening, but the combination of all of them have taken their toll. The patient's capacities are shutting down a bit at a time and there's a diminishing return to my interventions. Treat one problem and cause another. Medications which has been treating one condition or another well, now are making her life more difficult rather than better, from side effects not originally experienced, but which have cropped up over time. I'm seeing clearly through her care that just because I can do something, does not necessarily mean I should.

The patient's daughter is the decision-maker, with durable power of attorney for healthcare; sitting with her, discussing the pros and cons of each and every intervention is both valuable and at the same time wearing. End-of-life issues, particularly when there is no malignancy in the picture, can be difficult to recognize. When you are entering that endgame? When is hospice and comfort care the most appropriate? How do you get the patient, their family, and yourself all on the same page at the same time?

I've noted over the last several years that it's sometimes easier to recognize when interventions are not appropriate, if you're dealing with patients who are new to you, as opposed to folks you've known for a long time and are likely emotionally invested in. Numerous times, I've admitted patients for my call group colleagues, who appeared to be appropriate for hospice, and with whom the topic had not yet been broached. The discussion of hospice is rarely an easy one, often quite time-consuming, and very difficult to work in to a standard 15 minute office appointment. It's easier to get lost in the minutia, rather than step back to look at the bigger picture; it's easier to ask, "how do I...?", than "should I?" Further, thanks to countertransference, it's easy not even to recognize when the discussion needs to take place.

So now, we wait. Over the next few weeks the family and I will see just what direction this frail elder is headed in.

And within the next few months, we shall see just where our Supreme Court is headed.

Within the last several days, another issue with regard to prop eight has really begun to gnaw at me. It's a larger issue, going beyond my marriage and my community, not that those things are unimportant. They're crucial to me. However, it's really hitting home to me right now, that if my civil right as a gay man to be able to marry, something that our court found as constitutional a year ago, can be amended away by a simple majority vote, then who among us is safe?

Last year, the California Supreme Court referred to lesbians and gay men as a 'suspect class', a presumptively unconstitutional distinction made between individuals on the basis of race, national origin, alienage, or religious affiliation, in a statute, ordinance, regulation, or policy. In Loving vs. Virgina the US Supreme Court struck down the law because Virginia failed to prove a compelling State Interest in preventing interracial marriages. Our state Supreme Court ruled last year there was no compelling state interest in preventing same-gender marriages. If a simple majority vote can undo that, what social whim is next?

So now, we wait.

Comments

[furrbear.livejournal.com]

So now, we wait.

And pray. The reviews I have read of the hearing have been somewhat less than glowing. It was odd the NPR had no coverage of it this evening.

[osodecanela.livejournal.com]

You at least have seen reviews. I've not been able to find much other than what the popular press has written, which has seemed focus more on the pro- and anti- 8 forces shouting at each other outside the court and not the less sensational stuff that was going on inside.

[furrbear.livejournal.com]

Just below yours on the Flist was this by danlmarmot.

Rex Wockner started with a single word: Disaster.

Prop 8

[1ticor.livejournal.com]

From the very day after the election I have asked if it was legal for the majority to eliminate rights from the minority, if so, who's next? My understanding was that that was what the constitution was for, to protect the minority from the whims of the majority.
Two of the judges I saw this morning on line were purposely obfuscating the facts and arguments, wasting the speaker's time allotment. They seemed to be the only two trying to argue that it is alright to strip rights from Humans. I could sense the bigotry and "but they're fags, dammit" attitude.
This demonstrated completely why I have no respect for this process at all. I became old enough to figure this out 30 years ago, what happened to these people?

[shirtlifterbear.livejournal.com]

I keep saying to people: "When Barack Obama was born, it was illegal for his parents to marry in 17 states simply because they were of different races! This is EXACTLY THE SAME ISSUE."

Sigh.

I keep telling myself that it will happen. It's just frustrating to get so CLOSE.

[bluebear2.livejournal.com]

I say you get together an initiative to have children removed from Christian and Mormon heterosexual families. See how they like that.