Unable Versus Unwilling!

Main Bonnie Page

There is a philosophy which Bonnie and I share -- one datum out of that philosophy is that:

A being is never unable to do something, but certainly can be and is often unwilling to do something.

Let me give you a very intimate example from Bonnie's journey through cancer treatment.  This journey has helped both of us understand that above datum.

Cancer of the esophagus generally has the effect of closing down the esophagus so that swallowing becomes more and more difficult -- until finally the person cannot swallow, even a trickle of water or saliva.

Bonnie reached that state after about 4 weeks into the treatment process.

The usual alternative, of course, is that a "feeding tube" is surgically inserted so that the person can be fed food and water -- also drugs may well be administered through this tube.

The feeding tube is "high technology" in that, if you have good insurance, the "home health service" delivers a system for administering feeding.

There is a "stand" which holds the parts of this system.  We got one -- courtesy of the insurance coverage.  The stand, as shown on the left, is extendable to more than six feet high and had sturdy wheels so you can push it around.  You hang the "feeding bag" from one of the hooks at the top of this stand.  The feeding bag on the right is actually used for feeding calves when the mother cow is not able to nurse the animal, but this bag is very similar to those used on humans.

The high tech part of this system is a "pump" that squirts a certain amount of food from the bag into the tube that connects with the upper intestine.

The pump on the left is not the style we had, but it is similar.  The pump "hangs" on the IV Stand. The feeding bag feeds through a tube from the bag into the pump.  The pump "pushes" the food/liquid further through the remainder of the tube into the upper intestine, through the "J Tube."

The point of all this is that this pump can be "set" at any of many different "squirting levels."  They would normally be measured in "milliliters per hour  (ml/hr). "  (A "liter" is close to one quart and a "milliliter" is 1/1000 th of a liter -- not all that much.)

So, when the nutritionist was figuring out how to feed Bonnie, we started with a standard of about 1800 calories per day -- from a mixture of carbohydrates and proteins (with vitamins etc.).  Then we looked at the various brands of liquid food available -- such as you can buy in any drug store -- "Ensure Plus" etc.  We found a brand which the insurance would cover -- more "medical" than the drug-store brand (Ensure Plus HN).  This contained 350 calories per 8 ounce can of liquid.

Doing the math, it would take about five cans per day to provide all the calories which Bonnie needed.  One 8 ounce can contains 237 "milliliters" of liquid.

Less calories means loss of weight, fatigue and even shortness of breath.

Never in all the weeks that I cared for Bonnie did she get five cans of this food into her during one day.  Five cans of the food would be 1,185 milliliters of liquid.

For instance,  if the "pump" were set at 30 milliliters per hour it would take "35 hours per day" to give her adequate food.

Obviously, then, the pump setting has to be higher than 30 milliliters per hour to keep the weight up.

Only after five weeks of treatment was Bonnie WILLING or ABLE to set that pump at 70 ml per hour.  For many weeks it was below 50, then for most of the time she would set the pump at 60 ml per hour.

You can see that, at 60 ml per hour, it would take 18 hours per day of non-stop feeding to get the required number of calories.  Bonnie "disliked" the feeding tube and often just refused to keep it attached.  In the early period there was bloat and pain connected with the feeding, but later there was little of that -- but still "discomfort."

It could well be that a Yoga instructor would say, "The solution to your stomach pain is simply the right type of Yoga exercises."

The next guy would say, "Just drink carrot juice -- that cures cancer!" 

But you see how senior is the datum that it is the willingness of the person that decides his future.

Bonnie weighed about 150 pounds on January 1, 2004, and as the cancer became more of a problem, and particularly when the chemo and radiation caused more and more adverse side effects, AND as she was unable or unwilling to set the pump rate very high, she lost weight -- down to 119 pounds on June 5, 2004.

When a person "wants to die" they will most usually not say that -- it is a great problem to face that decision head-on.  Down through the track of time we have died many times, usually in pain and trauma. The event of "death" has not been a pleasant one.  So, as you get ready to experience it again all those old memories of past, unpleasant deaths are restimulated and it would be very likely that you would say to yourself, "I do not want to face that possibility."

Perhaps the greater truth is, "I am unwilling to go through the discomfort of thinking about death, and one way of avoiding those thoughts is to be unwilling to set the feeding tube at 100 ml per hour, so I am  unable to keep up my weight and unable to live.  It is NOT my decision to die -- but I am unable to do anything about it."

Would there be "discomfort" at the higher setting?  Bonnie had recent memories of bloat and pain connected with feedings -- neither of us had much knowledge about what types of food or what arrangements would make this tube feeding easy or hard.  For instance, the radiation and chemo undoubtedly caused the death of the "friendly bacteria" in the gut.

If the friendly bacteria are not there, the gut turns "anaerobic" that is, it operates without oxygen.  That means that there is fermentation of food -- causing gas -- causing bloat -- causing pain.  It took a friend's suggestion to remind me that Bonnie should possibly be getting acidophilus to help nurture the friendly bacteria.  Click on the image to the left for more information if you are not familiar with "friendly bacteria."

Note of insight:  When I asked the radiation doctor about acidophilus, he didn't know what the word meant. His nurse did.  When I explained it he had no disagreement with Bonnie using it. The Oncology doctor knew about acidophilus, and said the same -- "no problem." But he certainly did not suggest it -- he had various drugs to handle the bloat and pain.  I did not "think about" acidophilus -- it was a friend who reminded me of it.

Bonnie had no disagreement with adding acidophilus to her feeding tube and the bloat and associated pain went away without drugs.  So, there are remedies "out there."

When a person "wants to die" he or she will not look for, or use the remedies!  It is NOT that he or she is "unable" but that they are "unwilling" and that "unwillingness" manifests itself in a "not looking" or "not seeing" what might be available.

If you are the care-giver for a person in this condition you have a very difficult question to answer for yourself.  "Is it OK for this person, my wife, to want to die?  Is it OK even if I 'know' a solution, a remedy to maintain life, that she wants to die?"

Should I say to her, "Dear Bonnie, you can take that pump setting at 100 ml per hour, I'm sure.  Let's just test some higher settings."

Well, I did say things like that.

No go!

Should I THEN say, "Dear Bonnie, I think you are wanting to die, but not able to confront saying that, and so you are finding a covert way to die by saying that you are unable to tolerate a higher setting on the feeding pump, knowing that this will cause enough weight loss that you will then have an excuse that you are unable to live!  If you would be willing to set the pump rate higher you might not lose weight, might not be so tried and might not be so discouraged.  You might live!"

In this same vein you can look back in ANY person's history and find times when he smoked, for instance, and was unwilling to stop smoking.  Soon he became unable to stop.  So, the dwindling spiral of life is littered with little spots where you realized that there was something good you could do for yourself, but you were unwilling.

So, you didn't -- and then you became unable to do this good thing.

Or, you bumped into a realization that there was something bad in your life, but you were unwilling to change that -- until it was "too late" and you were no longer able to change that.

So, we make excuses for our poor health and eventual death.  ALL do this -- both Bonnie and me, and YOU.

You can realize the truth of this and reverse any of these "unable" decisions you have made.  But, of course, people don't.  They die of cancer and heart disease -- about 80% of all deaths.

And there you have the philosophical conundrum.  There are two great sins in any relationship:  "It is harmful to a person to 'evaluate for' that person."  It is up to each individual to decide what to think about himself -- not up to some other person to tell him what he should think about himself.

(The other sin is to invalidate a person, "Oh, Bonnie, you are mean and cruel to me -- wanting to die and leave me alone!")

Well, when and as you are a "care-giver" for someone you love, you will be faced with these questions and needs for answers.

You can, of course, go into agreement with the claim that the person is unable to live -- the cancer is too serious, etc.  That is the typical reaction people have -- they cannot confront death themselves, and cannot consider the possibility that it is "unwillingness" not "lack of ability" that is the source of the death.

I respect any person's right to die -- to make any decision they wish about their future.  Specifically, I respect Bonnie's decision, should she choose that, to die.  Also, I do NOT insist that she is unwilling to live -- she would have to come to that realization by herself.

But, what if a slight "nudge" of, "How about setting the pump at 70 ml per hour?" would do the trick?  I did this on June 5th, after a "gentle" discussion of the points I've written about above.  Bonnie agreed to that setting.  Perhaps, later in the day, she'll be willing to try 80 ml/hr?  Perhaps she is willing to live?  Perhaps she has decided that it just too much of a problem -- she, as do I, has a firm certainty on "coming back" in a new body, and bringing back with her much of what she has gained in this life time.

Many things transpired between June 5 and June 11 -- they are described elsewhere -- but on June 11 Bonnie originated that she was willing to set the pump at 80 ml/hr.  (To give you a better idea of how small some gains might be, it took her more than 6 weeks to be willing to set that pump rate up to 90 ml/hr, and then on July 29, 2004, up to 100 ml/hr.  These ARE the gains in health -- made by DECISIONS of willingness!)

If you are a care-giver, THESE are the small decisions that you look for, never thinking that they MUST happen, but happy when they do.

It is a matter of willingness, not ability, to do what is required, for this present existence, to experience health and life.

So a loving spouse, a care-giver, has to walk a fine line -- between harmful "evaluation" of the person and "gentle questions" that might allow the person to face, more squarely, the consequences of her decisions on the small things that lead, ultimately, to the big thing!

If, after confronting the issue head-on, the person says, "I want to die!" there is no quarrel with that -- a being is entitled to make that decision.

But, if there is a non-confront, and this issue is not faced head-on, then the loving care-giver can and should try a gentle nudge -- not to decide in some certain way, but to face more squarely the consequences of the small decisions.

Even doctors know this, innately, thought they pay great homage to victimhood.

A NORMAL SWALLOW In the mouth, the lips, teeth and tongue help prepare the bolus (food mass) for further stages of swallowing. Access between the nasal cavity and mouth closes as the bolus moves into the pharynx (throat). The bolus is propelled toward and into the esophagus as the esophagus entrance opens and the epiglottis helps guard against access to the lungs. The airway reopens and the esophagus entrance closes as muscle contractions move the bolus toward the stomach. In the first stage, food matter, whether solid or liquid, is introduced into the mouth and chewed, manipulated and consolidated into a mass called the bolus. The lips, the tongue and the jaw each play a part in controlling the bolus and moving it toward the region at the back of the mouth called the pharynx. The pharynx gives way to two openings. One goes into the esophagus, the tube leading to the stomach. The other opens into the larynx and leads to the "windpipe," or trachea, which delivers air to the lungs. Swallowing enters a critical phase here: The aim is for all of the bolus to enter the esophagus and not the larynx. Muscles in the pharynx contract and push the food down as a valve at the top of the esophagus relaxes and opens. At the same time, the larynx closes and rises to form a seal against a piece of tissue called the epiglottis, momentarily cutting off the air supply and preventing any matter from entering the lungs.

When Bonnie had her swallowing test, July 17, 2004, she started with the thought, "I cannot swallow."  The doctor asked her, "Is it that you can't swallow, or that you are afraid to swallow?"

She answered, "Both."  The doctor, nonetheless, encouraged her to drink the barium, and then to gulp down large swallows -- swallows which only a few minutes earlier she was certain she was unable to swallow!

She swallowed!  That seems like a miracle, but beings are capable of just such feats.  That is reported at the above link, and on THIS LINK which is a continuation of the "Jean's Journey."

Karl Loren

PS.

During the time I wrote the above, from about 7 AM to about 9 AM, Sunday, June 6, 2004, Bonnie took herself off the feeding tube and went "downstairs" to watch TV and "rest."

When I went down there, about 9 AM, she said something I want you to think about -- carefully.

She said, "You know, I think I need some B vitamins."

It is NOT that she perceived a need for B Vitamins that is important but that "she was looking" and "she made a decision" in favor of any remedy.

When you are a care-giver, you will have rather firm ideas of what would be "positive" decisions on the part of the patient -- and "hopeful" that the patient is willing to accept that type of advice.

Far, far better is when the patient ORIGINATES any positive idea about treatment, or prognosis, or whatever.  So, cherish that moment!

Did I influence those thoughts by writing as I did?  I share these thoughts with YOU more bluntly than I have with Bonnie, but recognize that there is a power of putting your thoughts out in the physical universe -- even if not seen by a patient -- and perhaps I did have something to do with her decision to take some B Vitamins?

In any event, I then crushed up two "B50" tablets, plus some acidophilus, in germanium water, and pushed that in through the manual tube feeding.  As I write THESE words she is back on a feeding tube -- however, showed some emotion when I suggested we try "80 ml/hr" setting for the pump.

Exact Protocol

I mentioned that lots transpired by June 11th, read elsewhere, but by June 11th Bonnie was willing to take:

• Germanium -- increased quantities in the water used for her feeding tube.  This one remedy is the one used most consistently during several months.  Bonnie has taken as much as 12 grams per day and probably never fell below 3 grams on any one day all through radiation and chemotherapy.

• Gravison (and Graviola) South American herbals --  one kills cancer cells and one eats them -- both are very effective.

• Acidophilus -- absolutely necessary to handle "bloat" and the resulting terrible pain -- just gas, but so discouraging when it "won't go away."  It DOES go away -- easily.

• Transfer Factor Plus

• Liquid Vitamin B

• Potassium liquid

• Mega Mineral liquid

• a new product, "Aloe Immune"  (see here and here about that one)

• Taheebo Tea (powder -- open the capsules --  in tube)  This has been one of the most consistent -- and the one I have most experience with.  Vital.

• Oxygen Essentials Plus (liquid)

• Silica

• Probably soon to restart several other items.

Read about the ultimate victory over cancer -- HERE.

Nudge, but do not push!

KL

June 20, 2004

These have been momentous days -- days of decisions.  Suffice it for now to say that there is much more data which will be appearing here, and a full description of the decisions.

Thank you,

Karl Loren

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