“If he dies before me, I’ll kill him,” says Cathleen McBride jokingly about her husband Owen McBride. As a person with early stage Alzheimer’s disease, Cathleen really does need his help.  They are both committed to being care partners to one another as they cope with the challenges this disease brings.

So are Bernice Jones and her husband Victor Jones. “I’ve had to work very hard at it,” says Victor of the new relationship that he has with his wife since the onset of her disease. “I tend to be a take-over person, it’s hard to be a partner,” he adds.

All four of these people have been through a four-week workshop run by Elaine Silverio, a nurse on the staff of the Alzheimer’s Association of Massachusetts. There they talked about the experience of getting this illness and together explored ways of helping one another cope with it.

The main message that comes through conversation with these couples is one that is not enough appreciated by us members of the general public, or even by many doctors and medical professionals. As Victor Jones explains it, “Alzheimer’s disease is not a sudden trapdoor through which people fall away.”

Rather, as Cathleen McBride affirms, “there is life after Alzheimer’s disease.” From this comes the importance of taking action in the face of a diagnosis confirming its presence. For my money, the best action is to call the Alzheimer’s Association, Massachusetts Chapter, where one can find all sorts of helpful responses.

This nonprofit agency, with five offices in Massachusetts and its connections with similar organizations in other states, can be reached at a 24-hour phone line: (800) 548-2111. There, skilled people like Elaine Silverio, a woman with 20 years’ experience in neurology, can refer you to doctors with special training, to individual counselors, and to one of 200 support groups.

Things are constantly changing in the treatment of Alzheimer’s, so it is important to be informed. New medications have been developed that can slow down the cognitive decline characteristic of this disease. Cholinesterase inhibitors have been found to delay such decline in 50 percent of cases, with the drug Aricept currently the most used. Other medications can be expected to hit the market soon.

When she first was diagnosed with Alzheimer’s, Cathleen McBride, a former Roman Catholic nun and missionary in the Philippines, went through a range of emotions. “It was a blow to me personally,” she says, “but I could talk about it.”

She attributes much of her rebounding to her family and home environment. “I came from an upbeat family. I’m a New Yorker, too. If you’re not upbeat in New York, you’re downtrodden,” she explains.

Her spirituality also plays a part. “It’s so much a part of me, that I don’t see it as a separate thing.” Perhaps that factor has led her to say: “I am really only beginning to enjoy the now of life, something that completely passed me by before.”

For Bernice Jones, the diagnosis did not come as a surprise, since she had been experiencing difficulty in dialing phone numbers. The hard part now, she says, is “trying to readjust to what I can accomplish.”

And that is her husband’s main concern. “I feel a great deal of sadness,” he confesses, “that the skills Bernice was so good at are eroding, and also her self-esteem.” But their relationship remains strong, perhaps stronger, so much so they can even talk about the future.

That future raises what Victor calls the ultimate question: “Will she go off to be cared for by someone else?” He admits to himself and to her that a change in her condition might make her going to a nursing home a good thing.

The occasion for my meeting these two couples is a series of “memory walks,” the first two of which takes place on September 20 in the Berkshires and Northern Quabbin Valley. Then on Sunday, September 21, there will be seven walks with the Greater Boston one beginning in Cambridge. Information about them is available at (617) 868-6718. The final walk will happen on October 4, starting in Walpole.

The motto of these days is “Taking Steps to End Alzheimer’s” and planners have developed a fight song to the tune of “On Wisconsin.” The song is called “On With Life” and is meant to express some of the spirit animating these early-stage people.

Their purpose is to promote awareness of Alzheimer’s disease, and to raise funds for the association, and for research into the causes and effective treatment of AD, with a view toward eventual development of more effective responses.

Meanwhile, everyone ought to become aware of the progress made in enabling sufferers to live with Alzheimer’s and care partners to cope with it better. With the disease’s advent, life does not come to an end. It continues and can even bring unexpected richness to human experience, as the Jones and McBride couples witness.

Richard Griffin

How would you like to wake up from major surgery only to discover later that your operation was entirely unnecessary?  That unpleasant experience has happened to a lot of people in this country and hardly anyone seems sufficiently outraged about it.

The most shocking instances recently would seem to have taken place at the Redding Medical Center, a hospital in Redding, California. Lawsuits leveled against that hospital charge that unnecessary surgery and other procedures were done on 366 patients. The plaintiffs have accused the doctors of elder abuse and contend that some patients died because of such treatment.

In 2002, the federal government sent FBI agents to Redding on a raid to investigate charges of Medicare fraud, among other things. Kickbacks to doctors and excessive charges to Medicaid patients are also under investigation.

The hospital in Redding is owned by Tenet Healthcare, a company with a highly dubious past. In 1999, this corporation owned 129 hospitals, making it the second largest hospital chain in the United States. Now it owns some 100 including two hospitals in Massachusetts: Metro West Medical Center in Framingham and Saint Vincent Hospital in Worcester, neither involved in the scandals.

Tenet Healthcare is the second incarnation of a company called National Medical Enterprises which was convicted of Medicare fraud in 1994. This embarrassment that led to the resignation of its founder and CEO, Richard Eamer.

Last month, in response to government findings, Tenet Healthcare agreed to pay the federal government $54 million dollars. As is frequent in such cases, however, the company did not have to admit wrongdoing. The company called the payment “a business decision.”

More problems lie ahead; last week the government notified Tenet of proceedings to bar Redding Medical Center from participation in federal health care programs.

Under both its names, the company has been widely esteemed for its money making prowess. In fact, it has been called “the darling of the marketplace” as its profits have soared. However, some people have seen this as a threat to good medical practice. One of its shareholders, M. Lee Pearce, M.D., in a letter to board members, spoke of the problems at the hospital in Redding as “DIRECTLY related to a philosophy of Wall Street Medicine” (his capitals).

After its recent problems with the law, the company’s stock plunged from $70 to $14 in three weeks, a sign of public alarm about its actions. This spring Tenet announced its intention to sell 14 of its hospitals, instead of expanding as it had planned.

Many, if not most, of the patients who suffered the ravages of this kind of medicine were presumably over age 65. They and others were victims of what was tantamount to assault; their situation should inspire outrage about a national health care system based on profits rather than human need.

Larry Polivka, a Tampa-based gerontologist who cares strongly about the medical needs of older people, feels concern about what he calls the “loss of soul in contemporary health care.”

He is especially critical about “Tenet’s policy of routinely cracking open chests when there was no medical reason to do so – – another breathtaking sign of the moral bankruptcy of U.S. healthcare and the business that runs it. Only money and profits matter.”

What worries me is how vulnerable we elders are to this kind of manipulation. Especially do I feel concern about those of us who may be isolated from other people. According to the U.S. Census Bureau, the proportion of Americans over 65 who live alone has risen steadily over the past 45 years. By 1995, the number of us living by ourselves has reached 32 percent, up from only 10 percent in 1950.

These statistics about living alone mean that, when things get difficult many more of us are likely to lack an advocate. A sudden health crisis may send us to the hospital by ourselves, without a family member or friend committed to argue for our best interest.

This situation can make us vulnerable to unscrupulous professionals who may not have our interests at heart. Certainly had we been transported by ambulance to the Medical Center Hospital in Redding, we would have been easy prey for doctors who wanted to get extra pay for surgery we did not need.

Ideally, we would have asked for a second opinion. But in an emergency, that would almost surely have been impossible. Even with an advocate at our side we might not have had the presence of mind to insist on seeing a doctor entirely focused on our wellbeing.

We older people have good reason to push for the reform of the health care system. Yes, Medicare preserves us from being entirely uncovered by insurance, the way more than 40 million of our fellow Americans are. But all of us desperately need a system that will provide for people of all ages and make scandals like the Redding abuses much more difficult to inflict on us.

Richard Griffin

Some estimates of those dead in France’s August heat wave have risen to ten thousand. Most of these victims of soaring temperatures were apparently old people who were left to their own devices in coping with the suffocating environment. Living alone turned out to be hazardous this summer.

Having spent a week in Paris earlier this summer, I can easily envisage the setting in which many French elders live. Along narrow streets, in old stone buildings that rise several stories, many without elevators, old people often inhabit small apartments. Often these pensioners stay to themselves and lack close attachments to other people in their building.

On occasion, I have talked with such people and have admired the way they find quiet satisfaction in daily life in a huge bustling city to which they feel attached. But I never envisioned disasters coming from the summer temperatures as happened this month.

William Pfaff, a nationally syndicated columnist, has suggested that dying like this was a good way to go. In his view, being overcome by extreme heat produces a death that is comparatively easy. He ends his op-ed with this affirmation: “I say we should be grateful to pneumonia, broken hips, and heat waves that can take us gracefully to where we all must go.”

What he leaves out of account, however, is that most of the people living in Paris and other cities died alone. They had no family members, friends, or neighbors to comfort them as they departed this life. That seems to me among the least desirable ways to die, isolated and cut off from the consoling touch of fellow human beings.

France’s government officials are clearly feeling pangs of guilt. Behind the careful rhetoric, statements from the president and others suggest a belated realization of failure to accept responsibility for the safety of older citizens and others. Few heads have rolled: the equivalent of their Surgeon General has resigned but no one else thus far.

Why did not French officials learn from what happened in Chicago during the summer of 1995.  There an estimated 739 people, most of them elderly, died in a single week in July. They succumbed to heat that registered 106 degrees the first day and between the 90s and low hundreds on succeeding days. Twenty-three hospitals could not accept new patients; ambulance drivers had to travel for miles to find a hospital to admit their passengers.

Studies of the Chicago experience revealed lessons that were available to authorities in big cities everywhere. Parisian officials could have been prepared for the onslaught had they heeded what was learned in Chicago. A book by Eric Klinenberg, Heat Wave: A Social Autopsy of Disaster in Chicago, in particular could have been of great value to French government figures.

The great French heat wave occurred mainly in August, the worst time it could have happened. This month is the time when a great many city dwellers leave town for their annual summer vacation. They clear out en masse leaving many shops and restaurants closed, and reducing the work force in hospitals and other places where help is usually available.

My instinct has been to praise the French for their culture’s insistence on taking time off. But now I have come to realize the drawbacks of having so many people away at the same time. Having only a skeleton force to help at times of emergency can clearly prove harmful to the population.

In addition to reduced emergency workers, there is also the absence of family members, friends, and neighbors. Tante Suzanne finds herself cut off from nieces and nephews when she may need them most. Basking in the Côte d’Azur may be good for the younger people’s mental health, but how about the needs of family members left back home in the stifling heat?

If it takes a village to raise a child, it takes a similar human community to support an older person. I would extend the net wider and add that adults of every age need the resources of other people to sustain them in good physical health and mental condition. No doubt, however, we older people have special needs that come with disability and sometimes flagging spirits.

I see the French debacle as a failure, not only of government, but of the whole community. Yes, the government failed in its responsibilities but too many ordinary people did not respond to the needs of their elders. As family members, neighbors, and citizens at large, ces messieurs (et ces dames) failed to see what they could do to help save those who lived near them.

Segregation of any sort has its price. Segregation by age can sometimes deprive older people of life itself, as the French experience shows. We may sometimes wish to be largely left alone but the time comes when being left alone can prove fatal.

One can hope that nothing like this disaster occurs again.  The French have an opportunity to develop a renewed appreciation of how much we, older and younger, need one another.

Richard Griffin

To me, and presumably to the 25,000 other people assembled for the occasion, it gave exuberant joy to see personally one of the greatest moral heroes of the 20th century. To behold him standing on the stage in Harvard Yard bowing and smiling in response to our cheers brought tears to my eyes.

Nelson Mandela, president of South Africa, came to be honored but he honored us all with his presence. As Harvard President Neil Rudenstine said to him, “You are the conscience of a nation, the soul of a people.”

Others helped bring out the dimensions of the man. “You have led the entire world on a walk toward truth,” said Prof. Jeffrey Sachs in tribute. And another faculty member, Henry Louis Gates, spoke to Mandela of “your nobility, your presence, your straight back; your unbowed head… as regal as any king.”

Mandela is now 80 years of age, so those words of Gates describe an elder statesman as yet vigorous and dynamic. In fact, if you examine photos of the younger Mandela, you will see a man whose looks, in the way of some older people, have much improved with age. He has come into the full maturity of years with distinction, both physical and spiritual.

Nelson Mandela carries those years lightly. In fact, he joked about his age by telling about a middle¬aged woman who wanted to see him 10 years ago. After his aides admitted her to his presence he asked what she wanted. She replied, “I came to see how a man of 70 looks like.”

“Now I am 80,” Mandela explained. “I am encouraged to see so many people who have turned out. I am not sure if you came here to see how a man of 80 looks like.”

Nelson Mandela has lived to an old age which has brought fulfillment both for himself and his people which he could only have dreamed about. For me he is a modern-day Simeon, that New Testament elder who lived into his 80s, long enough to see the Lord's promises fulfilled.

Mandela came to Harvard accompanied by his wife Grace Marchel, herself an elder citizen, who married him this past summer. She, too, has a charismatic personality which she showed forth waving and smiling in response to enthusias¬tic applause. This column could have been about Mandela and Marchel finding new love in old age.

To me, and presumably to the 25,000 other people assembled for the occasion, it gave exuberant joy to see personally one of the greatest moral heroes of the 20th century. To behold him standing on the stage in Harvard Yard bowing and smiling in response to our cheers brought tears to my eyes.

Nelson Mandela, president of South Africa, came to be honored but he honored us all with his presence. As Harvard President Neil Rudenstine said to him, “You are the conscience of a nation, the soul of a people.”

Others helped bring out the dimensions of the man. “You have led the entire world on a walk toward truth,” said Prof. Jeffrey Sachs in tribute. And another faculty member, Henry Louis Gates, spoke to Mandela of “your nobility, your presence, your straight back; your unbowed head… as regal as any king.”

Mandela is now 80 years of age, so those words of Gates describe an elder statesman as yet vigorous and dynamic. In fact, if you examine photos of the younger Mandela, you will see a man whose looks, in the way of some older people, have much improved with age. He has come into the full maturity of years with distinction, both physical and spiritual.

Nelson Mandela carries those years lightly. In fact, he joked about his age by telling about a middle¬aged woman who wanted to see him 10 years ago. After his aides admitted her to his presence he asked what she wanted. She replied, “I came to see how a man of 70 looks like.”

“Now I am 80,” Mandela explained. “I am encouraged to see so many people who have turned out. I am not sure if you came here to see how a man of 80 looks like.”

Nelson Mandela has lived to an old age which has brought fulfillment both for himself and his people which he could only have dreamed about. For me he is a modern-day Simeon, that New Testament elder, who lived into his 80’s, long enough to see the Lord’s promises fulfilled.

Among current world leaders Nelson Mandela is one of the few who deserves the title given to Ghandi – Mahatma, or “Great-Souled One.” In his lifetime he has demonstrated his great soul through many actions but none so meaningful as those which followed his release from prison in 1990.

The great day of liberation came after he had spent 27 years in confinement on trumped-up charges of treason leveled against him by the apartheid government. Those years he spent on Robben Island, which in “Long Walk to Freedom” he calls “the university.” He and his fellow political prisoners called it that “because of what we learned from each other.”

After walking free at last, Mandela led the nation through a series of epoch-making transformations. Throughout, he insisted on not taking any revenge of those who had treated him and his followers so badly for so long. To this day he has refused to direct reprisals toward his oppressors. That takes a kind of spiritual power which few other leaders have ever proven capable of.

Almost anyone else, unjustly deprived of almost three decades of freedom, along with forced labor and other punishments imposed on him, would find it impossible to forgive his abusers. But if Mandela had given into the impulse for revenge, he would have condemned his country to continued strife, perhaps civil war.

As he approaches the end of his term of office, the president of South Africa continues to show himself a man for others. He is determined to do all that he can to improve living conditions for the people of his coun¬try. And his concern includes the other countries of the world.

As he said in his acceptance speech at Harvard, “The greatest single challenge facing our globalized world is to combat and eradicate its disparities… We constantly need to remind ourselves that freedoms which democracy brings will remain empty shells if they are not accompanied by real and tangible improve¬ments in the material lives of the millions of ordinary citizens of those countries “

Richard Griffin