Category: Sexuality & Intimacy

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The Challenges of Male Friendships

By JANE E. BRODY

The Challenges of Male Friendships

Christopher Beemer, a 75-year-old Brooklynite, is impressed with how well his wife, Carol, maintains friendships with other women and wonders why this valuable benefit to health and longevity “doesn’t come so easily to men.”

Among various studies linking friendships to well-being in one’s later years, the 2005 Australian Longitudinal Study of Aging found that family relationships had little if any impact on longevity, but friendships increased life expectancy by as much as 22 percent.

Mr. Beemer urged me to explore ways to promote male friendships, especially for retired men who often lose regular contact with colleagues who may have similar interests and experiences.

After Marla Paul, a Chicago-area writer, wrote a book, “The Friendship Crisis: Finding, Making, and Keeping Friends When You’re Not a Kid Anymore,” about establishing meaningful friendships with other women, she was inundated with requests from men to give equal treatment to male friendships.

“A lot of men were upset because I didn’t include them,” Ms. Paul told me. “They felt that making and keeping friends was a lot harder for men, that close friendships were not part of their culture. They pointed out that women have all kinds of clubs, that there’s more cultural support for friendships among women than there is for men.”

In a study in the 1980s about the effect on marriage of child care arrangements, two Boston-area psychiatrists, Dr. Jacqueline Olds and Dr. Richard Stanton Schwartz, found that, “almost to a man, the men were so caught up in working, building their careers and being more involved with their children than their own fathers had been, something had to give,” Dr. Schwartz said. “And what gave was connection with male friends. Their lives just didn’t allow time for friendships.”

In their book, “The Lonely American: Drifting Apart in the Twenty-First Century,” the doctors, who are a husband-and-wife team, noted a current tendency for men to foster stronger, more intimate marriages at the expense of nearly all other social connections.

When these men are older and work no longer defines their social contacts, “there’s a lot of rebuilding that has to be done” if they are to have meaningful friendships with other men, Dr. Schwartz said in an interview.

From childhood on, Dr. Olds said, “men’s friendships are more often based on mutual activities like sports and work rather than what’s happening to them psychologically. Women are taught to draw one another out; men are not.”

Consciously or otherwise, many men believe that talking about personal matters with other men is not manly. The result is often less intimate, more casual friendships between men, making the connections more tenuous and harder to sustain.

Dr. Olds said, “I have a number of men in my practice who feel bad about having lost touch with old friends. Yet it turns out men are delighted when an old friend reaches out to revive the relationship. Men might need a stronger signal than women do to reconnect. It may not be enough to send an email to an old friend. It may be better to invite him to visit.”

Some married men consider their wives to be their best friend, and many depend on their wives to establish and maintain the couple’s social connections, which can all but disappear when a couple divorces or the wife dies.

Differences between male and female friendships start at an early age. Observing how his four young granddaughters interact socially, Mr. Beemer said, “They have way more of that kind of activity than boys have. It may explain why as adults they continue to do a much better job of it.”

In defense of his gender, he observed, “Men have a harder time reaching their emotions and are less likely than women to reveal their emotional side. But when you have a real friendship, it’s because you’ve done just that.”

He has found that “it’s important to expose yourself and be honest about what’s going on. If you reveal yourself in the right way to the right person, it will be just fine. There are risks, you can’t force it. Sometimes it doesn’t work — you get a don’t-burden-me-with-that kind of response and you know to back off. But more often men will respond in kind.”

Mr. Beemer has worked hard to establish and maintain valuable relationships with other men of a similar vintage. He joined a men’s book group that meets monthly, and after about two years, he said, “it became a group where the members really mean something to one another.”

He’s also in a men’s walking group that meets three times a week and gathers after each walk to share more conversation and a snack at a local cafe. When one member of the group had a heart attack, they visited him, cheering him up with the latest gossip and a favorite cafe snack.

“What sustains relationships over time is a regular rhythm of seeing each other,” Dr. Schwartz said. “It’s best to build a regular pattern of activities rather than having to make a special effort to see one another.”

He recalls “curing” a 70-year-old patient of his loneliness by encouraging him to join a bunch of guys who regularly dined and joked around at a neighborhood Panera Bread. “There are a lot of cafes in the Boston area where small groups of older men get together for breakfast everyday,” Dr. Schwartz said.

Dr. Olds said of her husband, “Richard has a regular group phone call with friends who live in different parts of the country. We program it into our schedule or it would disappear.”

Among other ways men can make new friends in their later years are participating in classes, activities, trips and meals at senior centers; taking continuing education courses at a local college; joining a gym or Y and taking classes with people you then see every week; volunteering at a local museum, hospital, school or animal shelter; attending worship services at a religious center; forming a group that plays cards or board games together; perhaps even getting a dog to walk in the neighborhood.

After my dentist’s wife died, he made several new friends and enjoyed lovely dinners with other men when he joined a group called Romeo, an acronym for retired old men eating out.
 
Complete Article HERE!

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Sexuality – Breaking the Silence

By: Anne Katz PhD, RN, FAAN

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Sexuality is much more than having sex even though many people think only about sexual intercourse when they hear the word. Sexuality is sometimes equated with intimacy, but in reality, sexuality is just one way that we connect with a spouse or partner we love (the true meaning of intimacy). Our sexuality encompasses how we see ourselves as men and women, who we are attracted to emotionally and physically, what turns us on (eroticism), our thoughts and fantasies, and yes, also what we do when we are sexually active, either alone or with a partner. Our sexuality is connected to our image of ourselves and it changes over the years as we age and face threats from illness and disability and, eventually, the end of life.

Am I still a sexual being?

Illness can affect our sexuality in many different ways. The side effects of treatments for many diseases, including cancer, can cause fatigue. This is often identified as the number one obstacle to sexual activity. Other symptoms of illness such as pain can also affect our interest in being sexually active. But there are other perhaps more subtle issues that impact how we feel about ourselves and, in turn, our desire to be sexual with a partner or alone, or if we even see ourselves as sexual beings. Think about surgery that removes a part of the body that identifies us as female or male. Many women state that after breast cancer and removal of a breast (mastectomy), they no longer feel like a woman; this affects their willingness to appear naked in front of a partner. Medications taken to control advanced prostate cancer can decrease a man’s sexual desire. Men in this situation often forget to express their love for their partner in a physical way, no longer touching them, kissing them, or even holding hands. This loss of physical contact often results in two lonely people.  Humans have a basic need for touch; without that connection, we can end up feeling very lonely.

Just talk about it!

seniors_menCommunication lies at the heart of sexuality. Talk to your partner about what you are feeling, how you feel about your body, and what you want in terms of touch. Ask how you can meet your partner’s needs for touch and affection. The most important thing you can do is to express yourself in words. Non-verbal communication and not talking are open to misinterpretation and can lead to hurt feelings. Our sexuality changes with age and time and illness; we may not feel the same way about our bodies or our partner’s body that we did 20, 30 or more years ago. That does not mean we feel worse – with age comes acceptance for many of us – but we do need to let go of what was, and look at what is and what is possible.

The role of health care providers

Health care providers should be asking about changes to sexuality because of illness or treatment, but they often don’t. They may be reluctant to bring up what they see as a sensitive topic and think that if it’s important to the patient, then he or she will ask about it. This is not good. Patients often wait to see if their health care provider asks about something and if they don’t, they think that it’s not important. This results in a silence and leaves the impression that sexuality is a taboo topic.

Some health care providers are afraid that they won’t know the answer to a question about sexuality because nursing and medical schools don’t provide much in the way of education on this topic. And some health care providers appear to be too busy to talk about the more emotional aspects of living with illness. This is a great pity as sexuality is important to all of us – patients, partners, health care providers. It’s an important aspect of quality of life from adolescence to old age, in health and at the end of life when touch and love are so important.

Ask for a referral

If you want to talk about this, just do it! Tell your health care provider that you want to talk about changes in your body or your relationship or your sex life! Ask for a referral to a counselor or sexuality counselor or therapist or social worker. It may take a bit of work to get the help you need, but there is help.

Complete Article HERE!

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The Half Life of Love

Our first real date was on Valentine’s Day 10 years ago. Many times in the five years since my partner died, I’ve flashed back to that day when we became, officially, more than just friends.

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Valentines

We courted for months before we touched.

But before we were courting, there were eyes flicked up, cast down, not wanting the other to see. Stealing glances. I traced the scar on his neck from across the coffee shop. He noted the books I was reading, watched how I fixed my tea. Weeks passed by like this.

Once officially introduced, we moved into a slow dance of flirting, not flirting. We waited for each other, reserving tables in the early morning rush. We spoke questions meant to learn about each other, without tipping our hands at more.

In those first few months, he would leave his paper for me to find, saving half the crossword for me, wishing me a good day in the margins. I left him messages of random words underlined to make a poem or a song. We read books together, in our coffee shop, compared notes on cadence and rhyme.

On the night I finagled my way into his car, bought a ride home by simply jumping in when I saw him at a stoplight, he told me we could go no further. There were others involved. There were commitments he’d made, to himself, to sever what had come before, without muddying the waters with something new.

We drew lines down the center of our table — his side, my side — never mind our feet touching underneath. He had rules: no being alone together in dimly lit places, no dates after dark. Lunch, but not dinner. He said it was safer that way.

I complied because I’m good at this, because I can love without touching. I cannot feign non-affection, but I can love without needing to act. We remained reserved. There were walks around the block, trips to the art museum in broad daylight. Longer walks. More tea.

February 14th began like any other day: my notebooks scattered around me, pot of tea, open book. He roared into our coffee shop, flustered, nervous, dropping his keys. “So, so I have this meat, uh, I defrosted this meat for some other dinner, but it got cancelled, so I was wondering, I was wondering, would you, um, would you like to have dinner tonight?”

My calm deflected his nervousness. “Sure,” I said, an eyebrow raised. I did not remind him of his rules.

Once I gave my assent, he stammered, “Okay, I have to start cooking right now then!” and ran out without his keys.

When I arrived at his house, Joss Stone was playing on the stereo. There were candles lit. He had a towel thrown over his shoulder; it was a look I would one day associate with home.

He cooked. We ate. Played Scrabble. When it was time to go, we stood in the doorway, close but not touching. The threshold, literally, figuratively, not touching, not kissing, just space, held between us. He walked out into the cold snowy night to start my car for me, my old green Saturn that was on its last legs by then, stalling out in first gear, no hills allowed anymore.

Just five days later, the scene repeated again: Joss Stone. Scrabble. Dinner. No kissing. No touching. Just breath, close by, held. I drove off into another night of clear stars, leaving him behind.

He called the next day, inviting me to a movie. An early afternoon matinee, breaking his rule against being alone in dim places. We bought popcorn and drinks, settled into two seats, middle row, on the aisle.

And there, in the dark, he reached over the armrest and picked up my hand. He held it in his lap, without speaking, his eyes never leaving the screen.

I missed the first half hour of that movie, my mind raced with the touch of his hand, stunned by its weight, by its warmth. Our joined hands in his lap, unmoving.

When the movie ended, we were still holding hands. We didn’t speak. We drove back to my house. We sat on my couch.

It’s funny — in all the times I have remembered this, I do not remember our first kiss. I remember instead the feel of his hand in the darkness. I remember his voice, once we spoke. I remember lying in his arms, a few short hours later, having hiked up the bottom of my shirt so our bellies could touch.

Lying there, I told him: “If you change your mind again, I’ll respect it, but it won’t be without damage. You can’t just toy with my heart.”

“I won’t change my mind again,” he says, his eyes level with mine, his voice soft and clear. “I can no longer deny my feelings for you. I already know I love you.”

I replay this in my mind.

It is 10 years now from that night.

He has been dead for five.

I write that, and it doesn’t seem real. I flash back to other times, when he was here, when we were new, holding hands in the darkness.

I flash back to those early days, the tension, the sweetness, his rules. The cold starry nights, sailing past Valentine’s Day, as we round the corner to touch.

I return to that night, the dark theater, the feel of his hand. I hit pause. I pull our joined hands to my chest, raise them to my lips, kiss his knuckles. Knowing what I know, knowing what is to come in just five short years I whisper: “I already know I love you.”

Ten years.

And I would do it again. I would do it all again.

I would do this all again.

Complete Article HERE!

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Death Is Way More Complicated When You’re Polyamorous

By Simon Davis

death become her
Screencap via ‘Death Becomes Her’

In February, Robert McGarey’s partner of 24 years died. It was the most devastating loss McGarey had ever encountered, and yet, there was a silver lining: “I had this profound sadness, but I don’t feel lonely,” McGarey told me. “I’m not without support, I’m not without companionship.”

That’s because he has other partners: Jane, who he’s been with for 16 years, and Mary, who he’s been with for eight. (Those are not their real names.) And while his grief for Pam, the girlfriend who died, was still immense, polyamory helped him deal with it.

There’s not a lot of research into how poly families cope with death—probably because there’s not a lot of research about how poly families choose to live. By rough estimates, there are several million poly people in the United States. And while polyamory can bring people tremendous benefits in life and in death, our social and legal systems weren’t designed to deal with people with more than one romantic partner—so when one person dies, it can usher in a slew of complicating legal and emotional problems.

“Whether people realize it or not, the partner to whom they are married will have more benefits and rights once a death happens,” explained Diana Adams, who runs a boutique law firm that practices “traditional and non-traditional family law with support for positive beginnings and endings of family relationships.”

Since married partners rights’ trump everyone else’s, the non-married partners don’t automatically have a say in end-of-life decisions, funeral arrangements, or inheritance. That’s true for non-married monogamous relationships, too, but the problem can be exacerbated in polyamorous relationships where partners are not disclosed or acknowledged by family members. In her work, Adams has seen poly partners get muscled out of hospital visits and hospice by family members who refused to recognize a poly partner as a legitimate partner.

McGarey and his girlfriend Pam weren’t married, so the decision to take her off life support had to go through Pam’s two sisters. The money Pam left behind—which McGarey would’ve inherited had they been married—went to her sisters too, who also organized Pam’s funeral.

This kind of power struggle can also happen among multiple partners who have all been romantically involved with the deceased. The only real way to ensure that everything is doled out evenly is to draft up a detailed prenuptial agreement and estate plan. Adams works with clients to employ “creative estate planning” to ensure that other partners are each acknowledged and taken care of.

Adams is a big proponent of structured mediation as a way of minimizing post-mortem surprises, like when families discover the existence of mysterious extra-marital partners in someone’s will. It’s much better to have those conversations in life than on someone’s deathbed, or after death.

But many poly people remain closeted in life and in death, according to sociologist Elisabeth Sheff, who has studied polyamorous families for 15 years and authored The Polyamorists Next Door: Inside Multiple-Partner Relationships and Families. A person might have a public primary partner—someone they’re married to, for example—plus other private relationships. That can make it harder to grieve when one of the non-primary partners dies, because others don’t recognize the relationship as “real” or legitimate in the way the death of a spouse might be.

Take, for example, something like an employee bereavement policy. Guidelines from the Society for Human Resource Management spell out the length of time off given in the event of the death of a loved one: a spouse, a parent, a child, a sibling, in-laws, aunts, uncles, grandparents. Unsurprisingly, extra-marital boyfriend or girlfriend is not on the list. (Actually, “boyfriend” and “girlfriend” aren’t on the list at all.) It’s possible for an employee to explain unique circumstances to an employer, but in her research, Sheff has found that some poly people prefer not to “out” themselves this way. People still disapprove of extra-marital affairs and some poly people, according to Sheff, have even lost their jobs from being outed, due to corporate “morality clauses.”

It’s similar, she says, to the experiences of same-sex couples who are closeted. “It’s much less so now because they’re more acknowledged and recognized, but 20 years ago, it was routine for [the family of the deceased] to muscle out the partner and ignore their wishes—even if [the deceased] hadn’t seen their family for years and years,” Sheff said. “They would come and descend on the funeral and take over. Or when the person was in the ICU. That same vulnerability that gays and lesbians have moved away from to some extent is still potentially very problematic for polyamorous people.”

Legal recognition of polyamorous unions could provide some relief. After the Supreme Court struck down the Defense of Marriage Act in 2013 and legalized same-sex marriage in 2015, calls for legalizing plural marriage have only become louder. Adams noted that an argument put forth in Chief Justice John Roberts’s 2015 dissent may provide a legal foothold for legalization advocates. “As Roberts points out, if there’s going to be a rejection of some of the traditional man-woman elements of marriage… those same arguments could easily be applied to three or four-person unions,” she said in an interview with US News & World Report earlier this year.

In 2006, Melissa Hall’s husband Paul died at the age of 52. Both were polyamorous, but Paul’s death presented “no special problems,” since they were legally married and Hall had all the rights of a spouse. Instead, she found unexpected benefits in dealing with her husband’s death: In particular, she told me that “being poly made it easier to love again.” Since they had both dated other people during their life together, Hall knew her husband’s death wouldn’t stop her from dating again.

In traditional relationships, it’s not uncommon for people to impose dating restrictions on themselves to honor the desires of their dead spouses, or to feel guilty when they start dating again. Of course, you don’t win if you don’t date either, as people eventually get on your case to “move on with your life.” All this goes out the window when you’re polyamorous, where dating doesn’t necessarily signal the end of an arbitrary acceptable period of mourning.

More partners in a relationship can certainly mean more support. It can also mean more people dying, and with that comes more grief. In an article about loss among polys published in the polyamory magazine Loving More, one man wrote: “Those of us who have practiced polyamory through our lifetime must be grateful for the abundance of love in our lives. But having those wonderful other loves means we must accept a little more grieving as well, when our times come.”

Is the trade off worth it? McGarey certainly seems to think so. “There is more grieving, but… we are held and cradled in the love of other people at the same time.”

He compares his relationship to the Disney movie Up, which starts with a guy falling in love and marrying his childhood sweetheart. “And then [she] dies, and he turns into this grumpy old man because he lost his love,” McGarey said. “I don’t see myself turning into a grumpy old man. I don’t know if I can attribute that to poly, but maybe that’s why.”

 Complete Article HERE!

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Florida’s New Anti-Gay, Anti-Woman Bill May Be the Most Malicious Yet

By Mark Joseph Stern

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Bill sponsor Rep. Julio Gonzalez, photographed on April 8, 2015.

There are very few feminist homophobes in the world, which makes sense: Those who seek to deprive gay people of their fundamental rights are rarely eager to enact laws respecting women’s dignity and autonomy. That near-truism is playing out in Florida—where, not content to debase just gays, the legislature is now considering a bill that demeans both gays and women in creative and innovative ways.

Florida’s new “religious freedom” bill, just introduced but already gaining traction, begins with an Indiana-esque guarantee that most businesses and corporations may legally turn away gay couples if doing so “would be contrary to [their] religious or moral convictions.” Similarly, the bill allows private adoption agencies to refuse to place children with same-sex couples if such placement goes against “the religious or moral convictions or policies of the agency.” In other words, an adoption agency needn’t even articulate a specific religious reason why it would rather keep a child orphaned than place her with a loving gay couple. The agency need only state that its “policies” mandate such homophobia, and it is protected by the bill. (Florida’s legislature considered a similar anti-gay adoption bill in April, but it died after one courageous Republican denounced it from the Senate floor.)

So far, so familiar. But here’s where things get odd—and grim for the women of Florida. The bill states that “a health care facility,” “an ambulatory surgery center,” “a nursing home,” “an assisted living facility,” “a hospice … operated by a religious institution,” and any “health care provider” can refuse to treat a patient or administer a medication if doing so would be contrary to its “religious or moral convictions or policies.” The implications for women here are obvious: Pharmacists could refuse to provide birth control or Plan B; doctors could refuse to place IUDs; nurses could refuse to assist in medically necessary abortions.

For LGBTQ people, this provision of the bill should be equally chilling. Despite the fact that gay and trans people face unique health challenges, LGBTQ-friendly health care is terribly deficient. The Florida bill would compound this problem by permitting doctors to turn away LGBTQ patients if treating them—or treating ailments they perceive to be LGBTQ-specific—would violate their “convictions.” Doctors could refuse to perform surgery on LGBTQ people, unless that refusal “places the patient in imminent danger of loss of life or serious bodily injury.” Cleverly, the bill doesn’t just shield doctors from liability suits from would-be patients: It also shields them from disciplinary actions by their hospital or medical association. So much for the Hippocratic Oath.

The remainder of the bill—the portions allowing elder care facilities and many hospices to turn away gay people—are almost comically evil. In fact, they are so ridiculously malevolent that I must wonder if Rep. Julio Gonzalez, the bill’s sponsor, a physician who was endorsed by Sen. Marco Rubio, doesn’t have an ulterior motive here. A narrower anti-gay discrimination bill (inanely dubbed the Pastor Protection Act) has already sailed through a subcommittee and looks likely to get a floor vote. Perhaps Gonzalez’s bill is designed to make the other, somewhat less odious bill appear moderate by comparison. That is pretty much the only rational reason I can imagine a putative representative of the people would even consider such a plainly malicious, proudly discriminatory, profoundly malefic measure.
Complete Article HERE!

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How to Have Sex on Your Deathbed

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Photo by Franco Dal Molin

by Simon Davis

It’s well-documented that old people can have active, flourishing sex lives. At least a third of people between the ages of 75 and 85 are getting it on, according to a survey in the New England Journal of Medicine. But how does your sex life change when you introduce the idea of dying—and when you know that death might be right around the corner?

There is remarkably little scientific research into the subject of sexuality at the end of peoples’ lives. But the research that does exist suggests sex remains important to those who are dying. Take this 2011 study, published in the Journal of Hospice and Palliative Medicine, which asked 65 patients with advanced cancer how their attitudes toward and experiences of sex changed as their disease progressed. While most patients reported significant decreases in sexual satisfaction and frequency, 60 percent of patients didn’t consider themselves less attractive after the disease. The majority—86.4 percent—said it was important to talk about sexuality with a medical professional.

As life expectancy increases, more and more patients will grapple with questions of sexuality and intimacy near the end of their lives. Dr. Sharon Bober is one of the people who tries to answer those questions. Bober is director of the Sexual Health Program at the Dana-Farber Cancer Institute, the main teaching affiliate of Harvard Medical School. Cancer treatments can have myriad effects on a person’s sex life: lack of libido, lack of privacy, pain, and a changed sense of identity. Bober’s program aims to provide “education, consultation, and personalized rehabilitation counseling for patients and their partners who have experienced changes in sexual health during and after cancer treatment.” In other words, even terminal cancer doesn’t have to stop you from getting laid.

I reached out to Dr. Bober to find out more about the challenges relating to sexuality among people who are terminally ill, and the importance of helping people manage a healthy sex life—even if their lives are coming to an end.

VICE: Why is end of life sex becoming a bigger deal?
Dr. Sharon Bober: More and more people live longer with life-limiting diseases. The kinds of things that would have been quickly fatal not long ago are often times conditions or diseases that people [now] live with for longer. For example, people are living with advanced-age cancer or severe respiratory disease in a more chronic way. It’s not forever—because people are still dying—but they are living [with them] for years. The idea that you might be fatigued, you might not feel great, you may not have a lot of energy, you might be weak… but you’re not dead.

And if you’re not dead, you might still want to have sex. How does terminal illness affect someone’s sex life?
The general physical symptoms that have an impact on sex are on the short list of problems: fatigue, nausea, pain, potentially erectile dysfunction, vaginal dryness. Men who have advanced prostate cancer are able to live several years with that situation. There are hormonal therapies that are more and more effective in helping them live with this disease for three, four, five years. In that particular situation, guys often have significant changes because of the hormonal component where they have no testosterone. Often, men have profound erectile dysfunction and feel very neutered in certain ways and don’t feel sexual in the way that they used to. It will have a real impact on vitality and experience of masculinity.

What about people undergoing treatment?
If you shared a bed with your partner for 40 years, and now for the last couple of months of your life you’re in a hospital bed in your living room, you can bet that you’re thinking about sex. It might not be in the context of I wish I could have sex, but more of all the things that you’re losing, of all the things that are changing. The fact that that doesn’t get acknowledged in an explicit sort of way for a lot of people is a real source of suffering.

Another example is people might have questions about sex because maybe now they have symptoms like erectile dysfunction or vaginal dryness and they’d like to be able to ask the doctor a question about that and all of a sudden they realize that they are never alone with the doctor without one of their adult kids coming with them. That’s a conversation that you’d love to ask your nurse about, but you’re actually never alone.

It also seems like clinical settings might make it awkward to talk about sex.
In the hospital or [in] hospice, you are literally never in a situation where you can have privacy. Staff are coming in and out of a room and you would like to have sex at least one more time and you wish your partner could get in bed with you—but you’re afraid someone’s going to barge in and you’re not sure how to talk about that.

So, is it possible to get that kind of privacy?
Sure. I think that in a hospital setting or in a hospice setting, it’s actually OK to say to the doctor or nurse, “We would like to be able to have some privacy.” Is there a way to put a sign on the door that says “Do not enter between 5 and 6 PM” and make sure that the staff respect that? It’s OK to ask that.

I was giving a talk with a bunch of palliative care doctors around sexuality and end of life. We were discussing how there are all sorts of things that we do in in-patient hospice care to make sure that people are comfortable—things like giving people permission to bring in animals and therapy dogs. And yet, we don’t talk about, “Would you like to have some time with your partner alone?” Somehow [when it’s] sex, we don’t talk about it. That really shouldn’t be any different than anything else that’s on our minds to make people more comfortable when they are in hospice care.

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So it’s more a matter of fostering a dialogue and offering a more understanding environment.
Yes, and I do think that from a quality of life point of view, many times the goal is not to be able to change the mechanics. You might not be able to make somebody physically feel well enough to be able to have sex again—but that’s not necessarily what’s needed. Some people would just like to be able to express to a partner what it means that they feel sad that they’ll never be in the same bed again. Or to say to a partner, “Even though we can’t be in the same bed again, it be really great to be able to be naked and hold each other.”

What about patients who are physically well, but not mentally—like patients with dementia?
That’s complicated because there are many different types of dementia. Certainly, I think there’s been a fair amount written about people with Alzheimer’s in nursing homes partnering up with new people and [not having] a real memory of [their current partner]. I think we’re just beginning to learn more about what that means for people to live a long time with profound cognitive changes.

Sometimes people literally feel disinhibited and that’s sometimes part of the cognitive changes. People are all of a sudden more sexual. For example, Zeke Emanuel has written about the fact that STIs are on the rise in nursing homes because people who are older are still very much sexually active but are not necessarily doing it in a safe way. I think it’s a real question about what do you do when people are sexually active but not cognitively intact. There’s also real questions around consent. I don’t think there are easy answers, but I definitely think as a culture, we need to be talking about it. Because we are only going to see more of this. It’s not going in the other direction as people are living longer but in ways in which they are really altered—they are not the same person that they used to be.

What is the biggest misconception around sexuality at the end of life?
That it’s not on people’s minds. The biggest misconception is that people who are really sick and living with life-limiting illness or end of life are not sexual beings and that they are no longer distressed by the loss of sexuality. That’s not true. Being able to allow people space to talk about it or to feel connected [is important]. You may no longer be able to have sex with your partner, but you still feel like you are someone’s partner. Your relationship as a lover, as a partner is not the same as a daughter, or grandmother, or aunt.

When you think of it in terms of someone’s identity of one’s self, it’s different. Figuring out how to still have that sense of connection with yourself, with one’s partner. Even as you’re saying goodbye, that’s important. And the fact that we don’t allow that, or many people don’t feel like that’s something they can talk about is a shame. We live in a culture that’s just saturated with sex but actually has very little to do with real sexuality. This is real stuff that people need to be able talk about and figure out.

Complete Article HERE!

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Home Is Burning: the profanity-laced terminal illness memoir with fart jokes

Dan Marshall’s book about his father’s death – while his mother was stricken with cancer – is possibly the most scatalogical memoir of its kind ever, and now Hollywood has come knocking

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The Marshall family on 22 September 2008, the day of Bob’s death. (Left to right): Dan, Michelle, Tiffany, Bob, Chelsea, Debi, Greg.

Dan Marshall sips an iced coffee under a Los Angeles sun and mulls the notion of Hollywood sanitising his memoir, the story of how he and his siblings dealt with terminally ill parents during an anguished year in the Mormon capital of Salt Lake City. Marshall shakes his head and gives a faint smile. “It’d tear the balls off the thing if they made it PG-13.”

It would indeed. Home Is Burning, published this month and due to be made into a film, dives deep into the pain and grief of caring for a father who slowly wastes away, and a mother who hovers close to death. It also plumbs the cacophonous dysfunction of a family stumbling through the ordeal with black humour, fart jokes, painkillers, booze, feuds, sex and swearing – epic, ungodly, obscene, unrepentant, relentless swearing.

“It’ll have to be R-rated,” says Marshall. “There’s a lot of death and dying but with South Park humour applied to normally difficult and sentimental situations. I’m making jokes about wiping my dad’s ass.”

The 300-page memoir jokes about everything: the cruelty of amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease, which killed Bob Marshall in 2008; the brutal side effects of Debbi Marshall’s cancer treatment; the vicious sibling arguments; the pious Mormon neighbours.

One unforgettable section details Debbi’s declaration that she will perform oral sex on her husband – by then confined to a bed and respirator – daily until he dies. “My mom was beyond proud of the blow-job-a-day goal. I don’t know if it was because she was all fucked up on Fentanly or what, but she seemed to bring it up any chance she got. ‘A blow job a day. Not a bad deal,’ I heard her explain to a visitor. ‘You wouldn’t think it, but his penis is still strong.’”

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Debi with Bob, the day before his death.

The Marshall clan is barging into a terminal illness genre rife with sentimentality – think The Fault in Our Stars, Before I Die, Tuesdays with Morrie – with a unique strain of profane, scatological humour. Prominent memoirists have endorsed Home Is Burning. James Frey, author of A Million Little Pieces, called it hilarious and heartbreaking. Justin St Germain, author of Son of a Gun, deemed it self-aware and ruthlessly honest: “Dan Marshall might be a self-described spoiled white jerk, but he’s also a depraved comedic genius.” Publishers Weekly called him the literary love child of Dave Eggers and David Sedaris.

In person Marshall, 33, is softly spoken, almost shy. He mocks himself in the memoir as a dumpy, boozy, gummy bear-chomping screw-up. But the figure who settles into the corner of a restaurant terrace, seeking shade on a baking afternoon, is somewhat reformed. He has quit drinking, jogs and has, by his own measure, matured.

Conjuring success from tragedy has been bittersweet. His beloved dad is dead and his mother is still ill – loss and pain which redirected Marshall from a job in public relations.

He chronicled his experience as a caregiver in Facebook posts: raw, unfiltered outbursts alternately expressing solidarity with and resentment at those around him, and bewilderment at their predicament. After his father’s death Marshall moved to LA, studied screenwriting and found a toehold in Hollywood writing comedy. The memoir, his first book, has vaulted him into another league.

The independent studio New Line snapped it up and contracted Marshall to turn it into a screenplay. Jonathan Levine, who directed the zombie comedy Warm Bodies, will direct the film and Miles Teller, the star of Whiplash and Divergent, will play Marshall.

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Bob running in healthier times.

“I was on track in the corporate world before dad got sick,” he says, stirring melting ice. “It changed my path.” It feels strange to be on the cusp of celebrity. “I feel less of a fraud. But it’s weird because no one knows who the fuck I am.” He pauses. “Some mornings I still wake up and feel like such a loser. I’ve no girlfriend and I write fart jokes.” He smiles but is completely serious.

Back in 2007, Marshall was in his first post-college job, enjoying independence from his family and dating his dream girl, a charmed “dicking around” existence. Then out of the blue the phone call which changed everything: your dad has ALS, come home.

After some hesitation, he did. The family lived in a big, plush house in Salt Lake City, the only non-Mormons in their neighbourhood. His mother, who had been battling non-Hodgkin’s lymphoma since 1992, was a spirited but ravaged chemotherapy veteran whose survival confounded doctors. She cursed like a sailor even before her life hung by a thread.

Bob had been the family’s anchor, a calming, levelheaded businessman who ran several small newspapers, nursed his wife, guided his children and competed in marathons. He was 53 when he was ambushed by the neurodegenerative disease which would gradually paralyse and asphyxiate him.

Debi decreed the family would care for him at home even though she was weak and woozy from medication. Dan’s sisters were also constrained. Tiffany, the eldest, was tied up with studies, work and a boyfriend (nicknamed “big cock Brian” after an ill-advised admission to her mother), and alienated by the arrival of Dan, who bullied her.

Chelsea was a troubled teen who drank too much and was having, it emerged, a clandestine romance with her soccer coach. Michelle, also a teen, had Asperger’s and struggled to understand her father’s plight. She sought refuge in dance and lavatorial jokes, which delighted Dan but no one else.

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Dan Marshall: ‘Tom Hanks playing Bob would be bonkers.’

The burden of care fell mainly on Dan and his brother Greg, who returned from university in Illinois, where he had enjoyed the freedom to be gay that was denied him in Utah. They converted a bedroom into a de facto intensive care unit, learned how to use a respirator, transported their father in a wheelchair and rickety bus, and bathed, changed and fed him.

As Bob turned skeletal and lost his voice, mother and siblings fought, reconciled and fought anew, with Dan and Tiffany in particular flaying verbal strips off each other. “Everything in that situation was heightened,” Dan recalls. “And I was a lot more rambunctious, and drinking. When you’re around family you’re more free in what you say and do because they’re family and will still love you no matter what. People’s true colours come out.”

A fierce devotion to his father sears through the pages. “It would have been easier if I’d hated him. But I loved him. He was such a good guy.”

Bob Marshall was stoic about his plight – and the sometimes chaotic, X-rated efforts to care for him. Dan programmed his Stephen Hawking-style communication device to include an icon with a limp penis. When clicked, it said: “Boy, I could use a blow job.” The line cracked up the family and prompted a tender unity: “Dad in the heart of the house, his little bald wife by his side, his children resting their hands on his shoulder. We all took in the moment.”

As other dramas unfolded in the wings – Chelsea marrying her soccer coach, Dan going on an ecstasy-fuelled one-night stand after his girlfriend dumped him – Bob Marshall eventually decided to end his agony. He decreed that the respirator would be turned off on 22 September, the first official day of autumn, his favourite season. The family, nerves shredded, weepy and frightened, referred to it as the “big unhook”. A doctor ensured there was no pain. Neighbours’ children released balloons into the sky.

Debbi is the star of the book, a fighter and survivor often half-crazed by medication. She has since had a mastectomy and now wears a wig. “She keeps texting me ideas about who should play her – Meryl Streep, Sandra Bullock, Laura Linney. But I tell her we’ll get Danny DeVito,” says Dan. There is talk of Tom Hanks playing Bob. “That would be bonkers. My dad loved Forrest Gump.”

The screenplay has a rom-com structure: selfish oaf learns life lessons and falls back in love with his family. It happens to be true, says Dan. He has reconciled with Tiffany and feels closer than ever to his family, all of whom, after some hesitation, blessed the book. His advice to other families facing similar ordeals: “Spend as much time as you can with each other. And forgive each other. Whatever resentments you’re hanging on to, let go.”

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