Maxwell Chorak – Rest in Peace

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Sunday November 2, 2014

Today is All Soul’s Day, the Dia de Los Muertos. It is an especially painful day for our family this year.

On June 10th I was called out of an early evening meeting and told that my step-son, Maxwell, had committed suicide. He had jumped from a 5 story sky bridge at UC Irvine a few hours earlier that was known as a site for suicides. The parking structure had suicide prevention tiles with hot line numbers cemented into the walls from the third floor upwards.It was the culmination of every parent’s worst nightmare.

But it had been a long time coming. Susan, my wife, and I had been living in fear of “the call” for years. She thought that it might be drugs but had never thought of suicide. We are still deeply grieving. What we do know is that the system let him down badly.

Max - 6

How does one deal with the sudden, traumatic death of a child? There are no guidebooks. It is the worst sort of emotional blow. His sister and brother are distraught. We were all deeply concerned for him but the cold reality of such a violent death at a young age is searing. But somehow we must go on and help change a broken system.

Maxwell exhibited his first signs of mental illness at the age of ten. He would act out. He raged. He sometimes became violent. When the Sheriff’s deputies got to the house they did not know what to do. At the time, my wife as a single mother was on her own trying to chart new territory. There was no place in the county to which a ten year old child could be taken to be treated for mental illness. There still isn’t.

She eventually found a psychiatrist who tried to “get” him and he was treated for bipolar/schizophrenic disorder but not formally diagnosed. But Max was using street drugs to self-medicate and the doctors pulled back.

Maxwell entered high school but it didn’t last long. He was brilliant. He was bored. He was different. But he also had charisma. He was a handsome young man with a very gentle way most of the time. But by his sophomore year he was out. His erratic behavior, drug use, and inattention just were not going to get Max through a conventional education.

He was a wonderful young man. He would take his last dollar and spend it on a gift for his brother or take his 90 year old aunt out for a pedicure and manicure. He was kind. He wanted nothing more than to hang out with his family. He loved his brother and his sister devotedly. And then the voices would whisper in his ear and it would get scary.

He was too smart for his own good. He could argue the most absurd point until even a well educated person could be fooled. He could also listen to a guitar riff or even a whole song just once and play it back brilliantly. His guitar was his refuge. He could pick up a cello never before having touched one and play it better than his mother, who had studied for years.

Maxwell took the GED test without studying and passed with flying colors. He entered the local community college. He wanted to be a doctor. Shortly before he died he was discussing textbooks for the next semester.

Clonazepam is a drug used to control seizures. Usually an adolescent is given one pill and would sleep for 18 hours. They gave Maxwell five once and still had to restrain him. Marijuana has been well documented for its terrible effect on individuals with schizophrenia. The literature discusses adverse or paradoxical effects. You bet there are.

Maxwell would eventually learn to study the side effects of the various drugs prescribed for his treatment in order that he could tell the doctors that he was having them in order to avoid the drugs. The prescription drugs left him feeling lethargic and hemmed in. At least some of the illegal ones gave him a brown haze to find refuge in.

I call him Max because it was what my grandmother called me. She too suffered from mental illness. She had a nervous breakdown in the 1930’s after being thrown out on the Brooklyn streets one too many times with her 5 children after her husband had once again squandered his plumber’s salary on booze.

She ended up at a place called Creedmoor in Queens, NY for 40 years and it was only when Thomas Szasz and his accomplices in government closed the psychiatric hospitals in the 70’s that she came to live with us. Creedmoor had been her safe place. Now her life was disrupted. When she came to live with us it was a wonderful experience because of my mother’s love and compassion. She taught us to be kind and caring.

So I had a lot of empathy for Maxwell. He had no place to be safe. There was no safety net. We have since the 1970’s gutted out mental health care programs.

His condition was slowly deteriorating. It was only when he became 17 that the handbook of the American Psychiatric Association allowed him to be formally diagnosed as schizophrenic. By that point he had been in in-patient programs in Southern California and Idaho to help treat his condition.

Max - 25

By the age of 18 he had been in the local hospitals for six 5150’s, which refers to the section of the California Welfare & Institutions code which allows for an individual to be detained for up to 72 hours for psychiatric observation.

And through all of this, Max’s friends and family became isolated from him. His mom and his family visited him when he was in treatment, but the loss of human contact was deeply upsetting. We loved him, but one of the things one encounters with the mentally ill and addicted is that it is difficult to love them in a normal manner. It is sometimes impossible to be close and to be there for them. You often don’t know what to expect and a lot of what you do expect is bad.

He was arrested for petty crimes and began the cycle of being in jail and on the street. 40% of America’s jail and prison population have mental health issues. Experts here in Orange County have told me that it is more like 70% -80% in our local jail. It is a cycle that we somehow have to break.

Maxwell was homeless at times. His interactions with law enforcement bordered on the absurd. While he was in jail he was sentenced for a “failure to appear”. He spent several months at a local mental health facility which is outsourced by the county. And then he would end up back in jail for another petty offense. He began to hear voices, holding conversations with them and laughing to himself. He would end up in the psychiatric unit.

The drugs, especially those that were self prescribed, left him in a haze that was better than the suffering, but psychoactive drugs do not affect the mentally ill the way they do others.

For most of his last 18 months Max was either at one of the very few facilities for the mentally ill in California, a drab forbidding site in Riverside, or in jail. Maxwell was a prime candidate for long term care. But there is almost none available. There are 5,900 acute mental health care beds in a state of 34,000,000 people. There are almost no long term facilities. And there are an estimated 1.5 million Californians with serious mental illness.

When he was released from the facility (you really can’t call it a hospital) in Riverside he stayed with his father. He saw his brother and mom and things were looking up. He had a great day with an old friend just hanging out. He left his father’s house one night and didn’t come home.

He was found the next day in a catatonic state in a local park and taken to the emergency room. He was then transferred to UCI Medical Center, the regional acute mental health unit, where he stayed for 9 days.

When we were informed of his admission to UCI his mother immediately contacted the doctors and nurses regarding his care. Maxwell did very poorly on Haldol, the drug of choice for the zombification (aka control) of the symptoms of schizophrenia in state run facilities. We knew this from years of experience. Haldol can cause severe depression.
We knew that Risperdal was more effective for Max and told his doctors so. The nurse responsible for him told my wife “It doesn’t make any difference since they don’t stay on their meds when they leave here anyway.” They put him on a maximum dose of Haldol.

She had requested that she and Maxwell’s dad be notified before he was released. This did not happen. Max was released at @ 1:30PM on the day of his death with the clothes on his back and a bus pass given to him by the hospital. He took the bus directly to the main campus of UCI several miles away and jumped almost immediately. After his mother found out and after collapsing, she called the hospital to ask why he had been released. There was silence at the other end of the line.

To this day we don’t know if Maxwell jumped because he was disoriented on Haldol or because of other factors. We will never know. That hurts.

The system is broken. Many of the professionals are callous and uncaring. There are petty jealousies and a lack of communication. The system as designed and implemented is malevolent. Our brothers and sisters with mental health issues are warehoused in our jails and in a very limited number of beds. We read daily of misdiagnoses and maldiagnoses and even misconduct in psychiatric care.

Treating mental illness is a matter of the physical, the mental, and the spiritual. It is perhaps the most difficult of illnesses. With the mentally ill there are often no good answers. As a society, we don’t want to know. We don’t want to deal with them on a concrete level. The mentally ill are often stigmatized. And at the most basic family level it can be heart wrenching.

But Max is gone. He will be a statistic to most but he will have left a massive hole in the hearts of his family and friends. There is little understanding left except that he was deeply, fatally mentally ill in a world that does not treat those who suffer from this very well. He is at peace now.

We can honor him by doing better, as individuals and as a society.

“Let us touch the dying, the poor, the lonely and the unwanted according to the graces we have received and let us not be ashamed or slow to do the humble work.”

Mother Teresa

© Matthew Holzmann 2014

The Deafening Silence on Leftist Corruption

The headlines have been full of the arrests of Democratic politicians on charges ranging from bribery to corruption to gun running and yet the opinion pages have been silent.

In 2006, House Minority Leader Nancy Pelosi made the Republican “culture of corruption” a major campaign issue. The daughter of one of the most corrupt politicians in Maryland history, Thomas D’Allesandro, she hammered the Republicans for their support of legislation she and her allies deemed corrupt. It worked.

Then, in January of 2007, immediately after her election as Speaker of the House  the minimum wage was increased from $5.15 to $7.25. Pelosi had American Samoa exempted from the increase so that Del Monte Corporation would not have to pay the higher wage. Del Monte is based in her congressional district and at the time her husband held $17 million in shares in the company.

Democratic Senator Dianne Feinstein is famous for the influence she has peddled for her husband, Richard Blum. A few years ago she engineered a land swap that landed her husband’s company Pentagon held land that mining experts call perhaps one of the largest gold formations in the world in exchange for worthless rangeland in northern California. This is also the same man entrusted with the famous “Train to Nowhere” multi-billion dollar boondoggle.

So the recent arrests and convictions of a number of California politicians who happen to all be Democrats might come as a bit of a shock after such transparently obvious self dealing. Let’s look at the list, shall we?

San Diego Mayor Bob Filner – False Imprisonment & Battery

San Francisco Supervisor Ed Jew – Extortion & Perjury

State Senator Leland Yee – Arms Trafficking, Money Laundering, Murder for Hire, Drug Dealing, Bribery, Corruption and being a member of a Chinese Tong.

State Senator Ron Calderon – Bribery & Corruption

State Senator Rod Wright – Voter Fraud & Perjury

All of these politicians are on the far Left of the political spectrum. They are the ones who regularly accuse their political opponents of corruption, greed, racism and base motives. But time and again it seems that the ones who cry “Injustice” the loudest are in fact the most unjust.

Yee is one of the most vocal opponents of Second Amendment rights in America and yet he was caught on tape discussing the sale of automatic weapons and shoulder mounted rockets to terrorists in the Philippines, where U.S. Special Forces have been working side by side with the Philippine Army fighting those same terrorists.

Calderon was even more of a crook. Michael Drobot, who owned Pacific Hospital in Long Beach, bilked the state and federal governments of over $500 million in a sophisticated medical equipment scam. The same type of scam that our president promised to stamp out when selling Obamacare. Calderon facilitated Drobot’s  corrupt empire that included crooked doctors, medical equipment companies, and hospital personnel.

But the corruption of the left goes far beyond California. It is especially strong in Illinois; in New York and in a number of other blue states. In New York it even includes some of the Republican leadership.

On a national level the Obama Administration is open for business. The green energy scandals cost the taxpayers over $1 Trillion and much of the stimulus bill was parceled out for projects of very dubious utility. The GM and Chrysler bailouts benefited primarily the unions.

Crony capitalism is everywhere one chooses to gaze and yet the media is virtually silent. It even includes some Republicans and yet the thought leaders have chosen to ignore the problem because it does not fit the narrative. Just as the Nomenklatura pillaged the Soviet Union with their special privileges and dachas today’s Leftist politicians are carving their own “fair share” at the expense of the people.

In his 40 year career as a professional politician, Willie Brown was able to avoid indictment despite a highly flamboyant lifestyle and several investigations. He was admired by many for his style but he was dogged by corruption and favoritism charges throughout his career. Today, there are a thousand Willie Browns and Leland Yees and Ron Calderons and Dianne Feinsteins and Nancy Pelosis.

Now, indictments are coming fast and furious. You would think there is an opportunity for a Pulitzer, even.

And yet the same grifters in the press, in academia, the unions and the special interest groups are silent. For they too are part of the gravy train. Spout the proper slogans and steal all that you can that’s not nailed down and some of what is.

When I was a kid California was known as a “clean government” state. Starting back in the 1890’s the Populist Party was a disorganized amalgam of small businesspeople, workers, farmers, and political leaders. Activists such as Theodore Roosevelt rose in opposition to the “Reckless Decade” of the 1890’s.The clean government movement was founded to stamp out the rampant political corruption in many states. California was seen as a leader in good government. Now it is a banana republic as are so many of the “blue” states.

The map speaks for itself. From the wars on charter schools in Chicago and New York and Washington to the checkbook legislation in Washington our politicians are sitting behind the cash register and don’t give change.

We are in a new Reckless Decade where the oligarchs and the crony capitalists have been allowed to pillage. And because the disease is overwhelmingly on the Left today the country suffers. Our faith in justice is corrupted, and this is a very dangerous thing for our republic.

 

The budget negotiations – We’ve seen this movie before

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We are about to enter week three of the shutdown in which despite the name 87% of the federal government is in operation as “indispensable’. Payments to the Corporation for Public Broadcasting for close to half a billion dollars and to a supplier of mechanical bulls for $40,000 were made and the spectacle of World War II veterans in their late 80’s and 90’s being turned away at the World War Two Memorial made Fox News but few other networks.

The president has hunkered down at 1600 Pennsylvania to emerge occasionally to state the he will be happy to negotiate as long as Congress gives him 100% of what he has demanded.

This movie is getting old quickly, though. We have seen it before. In 2011, when there was a dire prediction of disaster, Bob Woodward was the fly on the wall as the President careened towards disaster.

Members of Congress from both sides described the President as arrogant and incompetent in “The Price of Politics”. As one political blog called it at the time, “The Price of Politics is a stark recollection of the collapse of cooperation in government during Barack Obama’s first — and potentially only — presidential term from the inside out.”

The president survived that debacle and was re-elected only to have his administration riven with scandal after scandal. I am sure there are many in the Administration deeply grateful that Fast & Furious, the IRS Scandal, the DoJ/AP Scandal, and the Benghazi Scandal have been driven off of the front pages.

The shut down is a Godsend to Obama. He can remain intransigent and claim to hold the high ground on Obamacare and demonize the Republicans and the Tea Party all the while staving off accountability for his ever-growing record of incompetence, extralegal activities, and malice.

Woodward was very instructive. The President’s arrogance was legend, whether it was one day after promising shortly after his election telling House Minority Whip Eric Cantor “Elections have consequences, and I won”  the day after pledging a bipartisan administration or as The New Republic describes:

“The most vivid scene takes place in February of 2009, as Congress is laboring to ward off an economic collapse. Nancy Pelosi, the Democratic speaker, is hunkered down in her office with Harry Reid, her Senate counterpart, to negotiate a stimulus bill that can pass both chambers. This is no easy task. The bill must be modest enough to survive a Republican filibuster, but ambitious enough to satisfy Pelosi’s liberal caucus. But, then, these are veteran legislators—born deal-makers at that. They get to work with all the seriousness you’d expect.

At which point the president calls in via speaker phone and starts droning on about “unity of action” and “unity of purpose” (Woodward’s paraphrasing). It’s the kind of blather that can wow a stadium full of college students but means nothing in the power corridors of Washington. Pelosi and Reid thank the president coldly, and yet he doesn’t take the hint. Finally, Pelosi reaches over and hits the mute button. “They could hear Obama, but now he couldn’t hear them,” Woodward writes. “The president continued speaking, his disembodied voice filling the room, and the two leaders got back to the hard numbers.”

Very harsh indeed. The President’s frosty relations with both sides of the aisle are well documented. And today it is doubtful we will have a Boswell like Woodward to document the process. After the publication of his book he was vilified and attacked by the President’s minions. I don’t think he has been allowed back in on this one.

The White House staff have repeatedly been described as an unruly, callow political machine akin to a herd of cats. And now that the “A” listers in the administration have left the building, the cats are a tad more out of their league and unruly. Obama has always been a more successful campaigner than president and governs accordingly.

And yet the vitriol has been directed overwhelmingly against the opposition with the assistance of a supine media that simply takes the president’s dictation. The President’s press conference the other day was an especially low point where no questions that might discomfit a most vulnerable president were asked. Perhaps, like Cristina Kirchner, he is allocating newsprint. Or perhaps the media are simply fellow travelers.

The stories of the incompetence of the Obama Administration during the 2011 budget negotiations are legend. The Republicans have their own share of the burden to bear. It always takes two sides to negotiate.

From Woodward’s description it was wrestlemania with actors jumping in and out of the ring and the Sequester as the primary product. A sequester suggested by the President and never intended to have been executed. It was a stop-gap intended to allow more time for real structural improvements. And here we are at the cliff again.

But today the stakes are even higher. The Sequester has had barely any effect on our economy. Today we face a shutdown of which the primary images are of National Parks and Monuments closed to spite the public.

The debt ceiling is once again the central flash point. The President has refused to address our out of control debt nor his health care fiasco. Every day that now goes by without an agreement is squarely on his shoulders. In the meantime I expect the President to revert to the same “No Pasaran” tactics he has used time and again.

We have seen the movie before, but like many Hollywood movies these days, there alternative endings on the Director’s Cut DVD,. In this case almost none of them good for the American People.

 

 

The Administration of Diminished Expectations

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When Barack Obama was elected he campaigned on the message of hope. Today we live in an era of hopelessness for the first time in our country’s history. Unemployment and underemployment are at all time highs. Many have simply left the work force.

Our national reputation is in tatters. Our energy policy is insane. Our national debt is twice what it was just 6 years ago and now our Senate leaders want to remove any cap or control of  it. We are on the path of fiscal insanity. Our Treasury issues debt and the Fed buys it and the primary reason that the economy has recovered to the minimal extent that is the unceasing pumping of more and more debased money into the global financial system. The markets expectations of a cessation of QE is global disaster.

Our education system continues its accelerated deterioration. Race relations are at their lowest level since the early 1960’s.

And all the while, our President and his Administration have sought to avoid blame and manage expectations lower and lower and lower. This is the same Administration that has accrued more power to itself than any since Nixon’s Imperial Presidency. In fact, the new push to eliminate the debt ceiling would disembowel Congress’ power of the purse strings and with that what little power Congress seems to have retained.

He has left the global economic field to the Chinese, who are exercising soft power around the globe, and to the Russians, who have taken great joy in opposing our government in every way possible and rubbing our noses in it.

On the environment he has allowed the EPA to arrogate ever more power in its Luddite policies against conventional energy. The price of gasoline has doubled from the $1.80/gallon level to $4.00/gallon and this suits our president just fine. he has obstructed coal and oil and nuclear power and even natural gas, the cleanest option.

The president’s primary contribution seems to be leading from behind. Whether it is his Shakespearean inner conflicts on the Surge in Afghanistan or his verbal gymnastics on Syria or his lies and silence on Benghazi and the IRS scandal and the NSA scandal.

The “most transparent” administration in history is the most opaque. And as the president arrogates power, he has also instituted internal witch hunts and assaults on the press which resemble Stalinist Russia more that the world’s leading democracy.

His signature health care policy is being shown to be a disaster every day it continues. Access to care will be diminished at ever higher costs.

And yet the president seems to wear a Teflon cloak and goes unchallenged. We are at a schwerpunkt, as the Germans call it; a crisis, and the president is sitting utterly idle within the White House with nothing at all on his schedule. Don’t you consider this tolerable strange?

The propaganda machine blames the Tea Party as if it was a mass movement of Luddite nihilists and yet when facing one of our greatest crises there is little balance, or even proper analysis of the root causes of the problems at hand. Such is a world of diminished expectations.

Promise them little and then underdeliver is the order of the day.

Obamacare, Death Panels and the end of life

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A friend of mine posted a very thoughtful article on end of life care written from a physician’s reflections upon his own demise. Doctors know the odds and some of them sometimes choose to forego further treatment and make their peace.

In the case of many diseases the probability of remission is poor. And as we approach the implementation of Obamacare, one of the key takeaways is that many of us will no longer receive the level of care that we had under our old policies.

We are seeing corporations limiting coverage and limiting working hours in a desperate drive to reduce exploding insurance costs. Already, the insurance companies battle every step of the way in approving many treatments. This is done in the name of cost management.

Now the government is stepping in adding another layer of cost and more roadblocks between patient and doctor. As a part of Obamacare, the Independent Payment Advisory Board is being formed to control costs. In the UK, the Liverpool Care Pathway has caused an uproar with the abuse of its principles by doctors and bureaucrats. Worse, the British bureaucracy has a direct function in approving and denying specific treatment.If a patient is determined to not deserve a certain treatment, it is not performed, resulting in death in many, many cases. It is not isolated and it a part of the system. There is extensive evidence.

And this is what is now being implemented here. Both Howard Dean and Paul Krugman have fessed up to this reality. Costs are out of control and growing exponentially. People are living longer. The technology to help resist disease and prolong life has grown immeasurably, along with costs.

And within all of these arguments and issues, the relationship between the patient, their doctor, and with the Great Beyond has become lost in the shuffle.

In the end the decisions must be between patient and doctor; not between patient and bureaucrat.

I had two friends who were told they had pancreatic cancer within a year or so of each other. Peter used every tool in the toolbox to fight back. He had radical surgery and highly aggressive treatment. He came back to work eventually, but 18 months later he was dead. He had bought himself two years and lived those years well knowing the eventual outcome.

Not too long thereafter I found out my friend Paul also had contracted pancreatic cancer. He was diagnosed in August and by mid-October he was dead. He had made his peace with God and chose palliative care and the first his friends knew of his condition was when we received a call or an e mail inviting us to the funeral.

Each of them chose their path as they saw fit. each of them were faced with difficult and life threatening choices. They made these decisions without bureaucratic intervention.

These are the most personal and agonizing of choices. And sometimes the patient is unable to choose as when they are on life support and unconscious.

In “The Ends of Human Life” Ezekiel Emanuel examines medical ethics on a spreadsheet and posits communitarian examination of the issues and the just distribution of medical resources. He discusses the politics and the justice of medical care. But he does not discuss how to frame the discussion that matters the most in the end. The ethical discussion. The discussion of choices to be made. As with the NHS and Obamacare, the assumption is the rationing of resources by the state.

The governmental medical bureaucracy has grown from the implementation of Medicare in 1965 to a behemoth today. Include programs such as the military TriCare program and the Veteran’s Administration hospitals and state programs and one can readily agree that there is already a massive public sector bureaucracy in place. This will be layered over by more indirect costs from the new bureaucracy being built. And the patients will get even more lost in the system.

How is this beneficial to our society and to the individual?

Today’s health care system is driven by spreadsheets and first, second and third tier case management. How does this deliver the best care at the lowest unit cost?

End of life care is expensive. CBS News stated that care in the last 2 months of life in 2010 cost the nation $50 Billion. The total size of the Medicare budget alone for 2012 is estimated at $536 Billion. Medical spending was estimated by the UN at 17.9% of the GDP of the United States in 2011; $2.8 trillion. So why are we having this conversation in the first place?

There are many problems to discuss about health care management. But government intervention in end of life care is not one of them. The issues are bureaucratic and administrative and there are many, many fingers in the pie. The other issue is control. Holding Grandma hostage is a powerful weapon. Statists like control. Single payer health care has been the stated goal of the left-wing of the Democratic Party for the past 50 years.

The conversation is really about control. And when doctors start talking in spreadsheets and when bureaucrats in both the public and private sector have financial stakes in the game and the decisions are made by corrupt and venal politicians who do not live by the same rules, it is wise and prudent to be very, very skeptical.