The Problems in Family Caregiving.

Show: FRESH AIR
Date: DECEMBER 07, 1999
Time: 12:00
Tran: 120701np.217
Type: FEATURE
Head: Family Caregiving in an Age of Change: Carole Levine
Sect: Health and Medicine
Time: 12:06

This is a rush transcript. This copy may not
be in its final form and may be updated.

TERRY GROSS, HOST: This is FRESH AIR. I'm Terry Gross.

My guest, Carole Levine, is one of the many home health care givers who has changed her life to care for a sick loved one. Her husband was totally incapacitated by an automobile accident 10 years ago. She's faced countless frustrations with the medical bureaucracy while dealing with her own constant exhaustion.

But Levine is also a professional in the fields of medical ethics and health care policy, so now when she looks at her problems with home health care, she sees how they're symptomatic of problems within the larger health care system, and she asks, What needs to be changed?

And that's what she's devoting herself professionally to now. Levine directs the Families and Health Care Project of the United Hospital Fund, which is creating model programs designed to help family care givers. Earlier in her career, she was awarded a MacArthur Fellowship for her work in AIDS policy and ethics.

You've said that the old-fashioned sense of family care giving, chicken soup and fluffing pillows, really doesn't apply to what's happening today. What kind of medical care is the family care giver expected to provide today?

CAROLE LEVINE, DIRECTOR, FAMILIES AND HEALTH CARE PROJECT OF THE UNITED HOSPITAL FUND: Well, many family care givers are expected to provide really what we would ordinarily consider skilled nursing care -- monitoring feeding tubes, mechanical ventilators, changing dressings, doing chemotherapy, as well as the sorts of skills that require technical knowledge, like turning a paralyzed patient in bed. Those are things that were formerly done by professionals but are now being done by family members without much training.

GROSS: You've written, "I feel abandoned by a health care system that commits resources and rewards to rescuing the injured and ill, but then consigns such patients and their families to the black hole of chronic custodial care." Now, this is what happened to you.

LEVINE: This is exactly what happened to me. My husband and I were in an automobile accident in January 1990, so it's almost 10 years. And in the beginning, the things that American medicine does so well -- trauma medicine, savings lives, really miraculous sorts of things -- all came into play. But then when it became apparent that he was never going to recover completely, that they weren't going to be able to restore him to a full-functioning individual, then it -- everybody drifted away.

And the custodial care is a term that insurers and others use to indicate a kind of, We don't want to deal with you any more, you're just custodial, we can't help you, you go and take care of it.

And I felt, because of that tremendous interest in the beginning and that terrific amount of energy that went into saving his life, that people would be there to help me deal with his state when he was released from rehab. But essentially, I was told, you know, So long, you're on your own. And that meant from everybody.

So I truly felt abandoned. And I'm not the only one. Many people feel this sense of abandonment when doctors and the medical system can't cure, and people are left with trying to live -- not -- to live with a long-term chronic illness or disability.

GROSS: What kind of shape was your husband left in, physically, mentally, emotionally?

LEVINE: Well, he's essentially quadriplegic. He has had some significant brain injury from the trauma. He was in a coma for five months, and at his age -- he was then 62 -- people don't come out of comas the way you see in the movies and wake up and say, Oh, what happened to me? It was a very, very chaotic, disturbed experience, and he was emotionally truly unable to understand what happened and cope with his new situation.

He had a lot of physical problems and a lot of mental problems as a result. Right now, he's quite stable at home, and he's certainly not the same person he was before the accident, but he's -- I've managed to get him to a state where he needs 24-hour care, but he's not in those terrible emotional upheavals.

GROSS: But when you got him home and started to care for him, he was in emotional (inaudible).

LEVINE: Oh, he was screaming all night. He wouldn't let the aides come near him. He -- it was horrible, it was just horrible. I thought I would never survive the first two months. And it was -- there were many, many undiagnosed problems. He had a very severe sleep apnea. You know, he would fall asleep and stop breathing, and then he'd wake up screaming. Well, that was attributed to sort of willful bad behavior on his part when he was in the facility, and it took a long time to diagnose and treat. And that's much more under control.

But I really was left with no one to kind of help me through that whole process. In fact, I did have -- called on a colleague who saw me and said, Boy, you look awful, and I said, Yes, well, come to my house and you'll see why I look awful. And she is a -- treats cancer patients. And she said, I can send you someone who can try to figure out what's happening in your house.

And she sent a psychiatrist and a nurse, one visit only. They said, Oh, well, we can figure out something here. Your husband needs different medications, and we need a different kind of environment. And they put me on the right road to straightening it out. Without them, I don't know what it -- where I would be today, or where he would be. But that was because I knew somebody, that wasn't because it was part of my husband's treatment. It was really just because I happened to be in the health care world and know a lot of people who have different expertise.

So it's very much hit or miss whether you actually get the kind of support and help you need to sort out the situation.

And then I had -- found better home care help, and was able to more or less stabilize the situation, although there have been many, many ups and downs. And as I sit here today, everything is fine, but I could go home this evening, and there'd be, you know, some crisis that I can't anticipate. So it's a very, very, very fragile situation.

I think many care givers feel always on the edge, and that's why we're so reluctant to leave the person, to do the sorts of things that are given as advice, take a vacation, do something for yourself. You always feel as though you really need to be very close and just monitor what's going on, even if you're not doing it all yourself.

GROSS: What are some of the different stages you've gone through in terms of how much of your life you should give up to care for your husband? Should you quit your job? Should you stop seeing friends, or stop going out, or stop going on vacation?

LEVINE: Well, I early on decided -- and I guess it wasn't even really a decision -- I knew I was working at a job I really liked and that was very important. I was then director of a citizen's commission on AIDS in New York City. I did not consider giving up my job, although many people told me that's what I would have to do, both to spend down to get on Medicaid, so I could get some home care for him, and to preserve -- you know, I couldn't manage to take care of him and work.

I early on decided that I would -- I would have to work. I needed the income, and I needed the stimulation of being able to be out of the home. And from a very practical point of view, I physically can't do the kinds of lifting and moving that is required for him. So there would have to be somebody there anyway.

What I found most distressing was not the kind of well-meaning, Oh, it's too hard for you, you can't -- you know, you can't manage a job and this care giving that you do at night, but the kind of pressure I was getting from the insurance company and from social workers that the only -- that I had to quit my job and go on Medicaid. And I felt that was wrong from an ethical point of view. I thought that was wrong. I was willing to work, I was willing to produce, I was willing to be a taxpayer. And somehow the idea that the only way you could get any help was to become impoverished just struck me as very insidious.

So I never did it. Now, the friends and the going out and the vacations, well, that just sort of drifted away. I mean, I see friends occasionally, I haven't taken a vacation, really, in 10 years. But I travel for my job, I try to make those away-from-homes as pleasant as possible.

There's -- there are many things that I can do that I enjoy, but I don't have the same kind of life that I would have had. And when people talk about, you know, Did you see this movie, or did you eat at that restaurant? I look at them, like, Huh? I haven't been to that movie in a long time. And restaurants are not part of my ordinary experience any more.

So there's a kind of disconnect now between my life and my friends and the kind of ordinary things that people do, even if they're not, you know, very extensive or glamorous, just taking a walk. I mean, those are things that I have to think about. Can I do it now? And what time do I have to be back? All that.

GROSS: My guest is Carole Levine. She directs the United Hospital Fund's Families and Family Health Care Project. We'll talk more after a break.

This is FRESH AIR.

(BREAK)

GROSS: If you're just joining us, my guest is Carole Levine. She directs the Families and Health Care Project for the United Hospital Fund. And she cares for her husband at home.

At what point did you realize that the problems of a family care giver were bigger and more systemic than your personal problem, and it required a new set of ethical and policy decisions?

LEVINE: It took me five years to come to the realization that it was not me that was the problem. I was doing everything that I could. I was trying to do everything right, and that it was the system that was out of order. And I started talking to some of my colleagues, and then in one conversation, when somebody said, Well, you know, what's new in medical ethics these days? I said, You know, there's got to be some way of looking at what the health care evolution in terms of the payers, in terms of cost containment, is doing to families.

All the talk is about what it's doing to hospitals, what it's doing to doctors. But has anybody looked at what it's doing to families they're pushing all of this care and responsibility onto them?

And from that point on, I was able to engage a number of colleagues in discussions, and they all said, Oh, yes, you know, we never thought about it that way. And so after some planning, I agreed to join the United Hospital Fund in New York City, which is a very well established philanthropy and research organization, to create a new project that would do just that, to look at the impact on family care givers of the changes in the health care system.

And that started in October 1996. So it took me a long time. I really saw it as my personal failure, rather than a systemic failure. And now I -- I mean, maybe I (inaudible) something wrong, but the system is surely doing more wrong than just treating me this way.

GROSS: Let's look at some of the systemic problems that are affecting family care givers. First of all, how do you think managed care is affecting what families face?

LEVINE: Well, managed care certainly did not create the problems, but managed care has, I believe, exacerbated the problems, made it more difficult, because the effort to contain costs by keeping people at home, not in hospitals, having early discharges, and cutting costs in every other way, has shifted all of the responsibilities that used to be taken by professionals to family members.

So it's a kind of speeded-up of -- speeding-up of what happened -- what was happening before. At the same time, there has been an explosion in high-tech home care, all the kinds of machines and procedures that can be done at home, so there's a whole other industry that is pressing to have services delivered at home. And to be truthful, most people would rather be at home than in a hospital.

So there's a lot of things coming together. The other part is, of course, an aging population with more chronic diseases, people's lives being saved, as my husband's was, and yet not being fully recovered. So there are all of these social and economic forces that are coming together to create a lot of pressures on families.

And for the most part, families are truly pitching in and trying to do the best they can, but without much help, and without understanding that they, in a sense, are the bedrock of the health care system. They are providing all of those services that make the health care system profitable for those who profit, and run (ph) for those who are in the nonprofit world.

GROSS: And of course families are doing this for free. You estimate that the economic value of family care giving is -- which isn't compensated -- is about 19 percent of the total national health care expenditure?

LEVINE: The economic value of free family care-giver labor, if it were counted in the health care enterprise, would make that trillion-dollar figure go up by $200 billion. So it's a tremendous amount of free labor. I think of myself as a health care provider, but an unpaid one. And if we were organized, 25 million Americans, about three-quarters of them women, if we were organized as a labor force, we would get a lot more attention than we do.

But we think of ourselves as wives and mothers and daughters, and we are that too, but we're also providing a very, very significant amount of free labor to the health care economy. And that should be recognized. It's not necessarily should be recognized in being paid, but in being considered and being part of the planning process, and not being just expected to do everything that nobody else wants to pay for.

GROSS: What are some of the ways you want the family care giver to be included in decision making and consulted with by doctors?

LEVINE: Well, the -- you know, the -- when people go home from the hospital, there is the called discharge planning. And in the old days, in the good old days, so called, there was a social worker who would sit down with the family and say, Well, who can come in and help and for how long? And let me see if I can get this and that for you. And try to understand what the family situation is.

And the person going home would not be going home until they were really pretty well. And so the situation was not as acute.

Now, it's a very haphazard, flurried process of just signing papers. Often the discharge planners will present a family with an option, and that's the only one. You have to take your mother home today, or, She has to go to a nursing home tomorrow. And the only one that we can find available is 100 miles away. Those sorts of things.

So if the family is involved and can pursue all of the different options and take a little time to make sure that the situation that they're setting up is the best one possible, they will be able to sustain it longer.

Time and time again, I hear of situations where family members take their patient home and within two days, the patient is back in the emergency room because the family didn't know how to handle what was going on, or was unprepared. And that's a very costly way to take care of patients.

So it really would be cost-productive to give a little more time before discharge, try to set up a plan that has a chance of working, and train people to recognize when the emergency room is necessary and when you ought to be able to handle it on your own, so we don't have this kind of in-and-out process that is very, very destructive, both to the family and to the patient.

GROSS: What do you think should be the parameters? I mean, how do you figure out what other -- what are the amount of responsibilities that a family care giver can rationally assume?

LEVINE: I think it's very much an individual family-by-family or caregiver-by-caregiver assessment. Some families have the resources -- and I don't mean just money. They have people, they have space, they have contacts in the community, they have ways of organizing themselves and their support systems to provide an extraordinary amount of care. And they want to do it. That's fine.

Other families are not so fortunate, and have many fewer resources of all of those kinds and can't simply provide that level of care. It's often left to the primary care giver to work it out. That means one person sort of has to get everybody else organized. And it -- there can be tensions within a family about who's doing what and where Mom should live and who should pay for what. And those things have to be sorted out at the beginning, before you really -- almost permanent family conflict.

I think that the ideal is to assist a family in trying to provide as much care as they feel they can and want to without straining all of their resources to the breaking point. It shouldn't be a situation which currently exists, where the primary care giver goes on and on and then gets sick, and then we have the primary care giver needing a care giver, and the first person -- the patient that she was caring for, if it's a she -- still needs a care giver. So you've got two sick people instead of one sick person.

That's what happens now. You wait until there's an absolute acute emergency, and then they try to patch up the system. It really needs a good assessment at the beginning, and then very important, which doesn't happen, evaluation at certain points.

Many people can do heroic things for one months, two months, six months, and at a year they're not able to do it as well, or at two years they're not able to do it as well. So it's not -- it's a dynamic situation that needs to be assessed in that way.

And sometimes it's a little bit of support that can make the difference between sustaining a situation and not.

GROSS: Carole Levine directs the United Hospital Fund's Families and Health Care Project. She'll be back in the second half of the show.

I'm Terry Gross, and this is FRESH AIR.

(BREAK)

GROSS: This is FRESH AIR. I'm Terry Gross.

We're talking about the predicaments faced by people caring for a sick or incapacitated loved one at home. My guest, Carole Levine, is an expert on medical ethics. She directs the United Hospital Fund's Families and Health Care Project. She also cares for her husband at home, who was left totally incapacitated with some brain damage by an auto accident nearly 10 years ago.

You said that the health care system needs to respect the limits of what responsibilities families can actually assume. You've done focus groups with care givers. What are some of the most common things that care givers say they want from the system?

LEVINE: In our focus groups, the care givers said the primary thing they wanted was more information, information about the patient's condition, about resources in the community, about how to navigate the system. They also wanted recognition of the important role they play in the patient's care, patient's life. They wanted advocacy to help them navigate the system. And they -- some of them did say, I want a little time off. And they didn't mean a year, they meant an afternoon.

So those are the things they mentioned.

GROSS: When they say they want recognition, they don't want, like, a plaque. What do they want?

LEVINE: They want the health care professionals to acknowledge them as important to the patient's care and important to the patient's life, so that they're included in discussions about what's going to happen, so that they're given information about what is likely to be the prognosis, that they are seen as part of the care team, not just as the person who brings the patient to the office.

That's really what they want. They want to be included. And because -- not only because they're important to the patient's care, they want to be included because what decisions are made affect them. I know that one doctor who I met -- was not in my case, one -- at one meeting, a doctor was waxing enthusiastic about home care, We can turn the home into a laboratory for training medical students. Well, that's my living room you're turning into a laboratory for medical students!

Recognize that my home is my private space, and that what you bring in, and the machinery and all of that stuff affects my life and the life of the rest of my family.

GROSS: If you have to become a full-time care giver for someone, I think the bottom line question is, how much of that is your responsibility, and how much of that is more a societal responsibility, where the burden should be shared, either through health insurance or, you know, some other government finance program, community volunteer programs, whatever, but how much of that is the individual's problem, how much of it is a social problem?

LEVINE: Well, I think that's something we're struggling with. We have a very strong tradition in this country of people being independent, highly individualistic, on their own, and it also extends to families, families are supposed to take care of their own, and only in the most extreme of circumstances look for help, and then it's kind of seen as somehow demeaning.

We've got to establish a more community-oriented sense of responsibility for all of the aging people and the sick and disabled, where families do take the primary responsibility. But there is a greater sense of all of us having a share in that, because each of us will, at some point, need some of that care. And the costs to society, which most people don't talk about, are enormous, the costs to businesses from unproductive absentee workers who are constantly being called or have to run home or are -- don't have a stable situation at home, those situations cost a lot of money.

The cost to families where children don't get the kind of education or concern or training, because everyone is focused on taking care of Grandma. The kind of cost to family unity, where families without help can often become so torn by dissension.

Those are real costs, those are real social costs. And to the extent that we can provide assistance to make these situations more tolerable, to make the family feel that it's part of the community still, not just as isolated as it has been, is, I think, a real benefit.

GROSS: Well, you know, people have always taken care of their sick and older relatives at home. But do you think we're in a unique situation now, where you can't really compare the present to the past?

LEVINE: It's often said, well, you know, families have always done this. And true, families have always done this. But no family that I know of in the 19th century had to operate a feeding tube and had to do the kinds of high-tech care that are being done now. No family in the 1950s, the so-called golden age of families, had to do this. We had a lot of institutions where family members who were sick or disabled. Where I'm not saying we should bring back institutions, but this is a very, very different world.

And this really can't be compared to other eras. I think what is the same is the family impulse to care and the family sense of responsibility. That's still there. But the level of responsibility and the level of distance from other sorts of help is very, very different.

And another huge difference is the presence of women in the labor force, where women are now working and are not -- they're not extra people at home just waiting to have a task of taking care of someone who's ill. So -- families are smaller.

All of these things, all of these social demographic changes, have really increased the pressure on families, so that it's -- it, in my mind, it's simply not the same world any more.

GROSS: My guest is Carole Levine. She directs the United Hospital Fund's Families and Health Care Project. We'll talk more after a break.

This is FRESH AIR.

(BREAK)

GROSS: My guest is Carole Levine. She directs the United Hospital Fund's project on home health care, and she cares for her husband, who was left incapacitated by an auto accident nearly 10 years ago.

Are there any countries that you've studied that have done what you consider to be a good job in dividing the responsibility of care giving between family and community, or insurance, whatever?

LEVINE: Well, the Scandinavian countries do a better job, but that's -- you know, it goes without saying. It's a very different world. They have a very homogeneous population, a greater sense of social welfare, of community responsibility. But even there, spouses are expected to take care of their partners, so that there's -- it's not totally a community responsibility.

Certainly that's one example. In the United Kingdom, there are laws that require assessments of care givers before the patient goes home, and there is a much more organized national sense of -- they're called carers there -- same in Australia.

One thing I've found in looking as little as I've done, but still somewhat at other countries, is that they're all facing the same problem, and even in traditional countries where there's not as -- perhaps not as much high-tech care, but the stresses on women who have become so important in the labor force, are really changing the pattern of care.

And so all countries facing an aging population are facing this. I think we have the opportunity to do more because we have more resources and we have more ability, I think, to make a difference. And yet there's a great reluctance here to make any big steps.

GROSS: You direct the Families and Health Care Project for the United Hospital Fund, and you're setting up several programs that you hope will become models for solving some of these problems. Tell us a little bit about the programs that are being set up now.

LEVINE: At the United Hospital Fund is both -- does research and makes grants. And we had made seven grants to New York City hospitals under the Family Care Giving Initiative to set up programs that support and train family care givers and also involve staff. And I have to say I'm so excited, because we just had a meeting about their progress so far, and there's so much enthusiasm, not only among the staff that's doing the work, but also within the institutions.

There are very different sorts of hospitals. There are academic teaching centers, there are community hospitals, there -- some of them are single units, some of them treat aging patients with dementia, some are other populations. And they're trying to do very different things. One is setting up an interactive Web site for care givers. One is involving all of the hospital and all of the staff in training and developing a resource center. Another one is sending a geriatric nurse practitioner into homes to help the care giver when the patient is discharged, to kind of assess the situation there.

And we do hope that these seven hospitals, with their combined experience, will be able to serve as models that can be adapted for other situations. And the specific program is important, but what really just is so exciting to me is the sense that the culture of an institution can change, and that professionals are really eager to do more and do better. But they need that impetus, and they need that kind of sense that, OK, somebody's really doing something about it, now let's join in.

So it's a tremendously exciting process, and I'm hopeful that we'll -- in a year, we'll have a lot more to tell you about it.

GROSS: Back in 1993, you got a MacArthur Award for your work on AIDS policy and ethics, and I think a lot of the AIDS activists came up with some very interesting ideas for community networks to help people who were disabled by AIDS and needed home health care. I'm wondering if the things that you think we can learn from how activists have handled AIDS and apply that to home health care in general.

LEVINE: Yes, I have -- that's an interesting point. My experience in AIDS certainly showed me that combined efforts and advocacy for a cause can make a huge difference, and I think that's beginning to happen in the care-giver world, in the sense of people coming together around certain issues and raising awareness, and not feeling that -- feeling that the system has to respond better.

Some of the activities are -- in the health care arena around AIDS involved intensive community support, support groups for the patients, support groups for their care givers, and support groups for the professionals who were their care givers, as well as a very highly organized network of services, so that people could go to one place and get hooked up with a lot of different services.

That's one thing that's really missing in the general care-giving world. Other -- you just have to call too many places, and there -- it's all disorganized and not connected and coordinated. So I think we can learn a lot by that.

But I also think just the -- raising the issue to the level of national prominence, being willing to say, I am a care giver, I do this out of love, but I need help, and I can use help of various kinds. That's a different step that is just beginning, I think, to happen. There's been a reluctance to bring this issue forward in a very -- not in an assertive way. Instead of saying, Oh, please, help me, saying, We are providing an important service, we need this help, and the system has to respond to us.

We're starting to do that, and that's one of the lessons, I think, from the AIDS experience.

GROSS: Do you feel that part of your role now is to try to almost organize home health care givers and make them realize that it's not -- you're not just out there alone, there's a lot of other people like you who are going through exactly what you're going through, and there needs to be some kind of group consciousness around this?

LEVINE: I think my role is providing the good information and the good arguments, and others are better at organizing than I am. But I'm a good idea person and a good synthesizer of information. So I'm the background for this. But I also think my personal experience does convey some important lessons.

GROSS: I want to get back to your situation at home. You've been caring for your husband since 1990, when he became a quadriplegic after a car accident that left him in a coma for five months, and affected him on every level. How much help do you have at home now?

LEVINE: I have an aide who's with him every day when I go to work and several hours on Saturday and Sunday to get him up and put him back to bed. Essentially, I'm the night-time nurse, unless I have to travel, and then I have one of the aides stay over. And I pay for that myself, no government help or insurance help for that.

GROSS: Not qualified for that.

LEVINE: No.

GROSS: And you think you should be.

LEVINE: Yes, I think I should get some help. I think I damn well should get some help! Excuse me, Terry. But, hey, you know, I'm do -- otherwise, if we spend down and he goes into a nursing home and Medicaid pays for it, everybody pays for it. I'm willing to pay for most of it, but a little help wouldn't be so bad. I -- yes.

GROSS: Well, Carole Levine, thank you very much for sharing some of your ideas with us.

LEVINE: Thank you, Terry.

GROSS: Carole Levine directs the United Hospital Fund's Families and Health Care Project.

TO PURCHASE AN AUDIOTAPE OF THIS PIECE, PLEASE CALL 877-21FRESH
Dateline: Terry Gross, Philadelphia, PA
Guest: Carole Levine
High: Director of the United Hosital Fund's Project on Family Caregiving in an Age of Change, Carole Levine brings her professional and personal life to bear on her work with the project. Since 1990, when her husband was critically injured in an automobile accident, she has been his caregiver. The Fund released a major new report on caregivers last month:"Rough Crossings: Family Caregivers' Odysseys through the Health Care System."
Spec: Health And Medicine; Families; Charity

Please note, this is not the final feed of record

Copy: Content and programming copyright 1999 WHYY, Inc. All rights reserved. Transcribed by FDCH, Inc. under license from WHYY, Inc. Formatting copyright 1999 FDCH, Inc. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to WHYY, Inc. This transcript may not be reproduced in whole or in part without prior written permission.
End-Story: Family Caregiving in an Age of Change: Carole Levine

Show: FRESH AIR
Date: DECEMBER 07, 1999
Time: 12:00
Tran: 120702NP.217
Type: FEATURE
Head: "Luzia": A Review
Sect: Entertainment
Time: 12:40

This is a rush transcript. This copy may not
be in its final form and may be updated.

GROSS: We have a record review for you now. Paco De Lucia has been acclaimed as the finest living flamenco guitarist for almost 30 years. And for almost that long, flamenco purists have been fretting about De Lucia's experiments with the form and its instrumentation. Commentator Milo Miles finds De Lucia undiminished and adventurous as ever, both in concert and on record.

(AUDIO CLIP, EXCERPT, FLAMENCO GUITAR PIECE, PACO DE LUCIA)

MILO MILES, WORLD MUSIC CRITIC: I admit, I'm a hard sell on flamenco. Tune structures seem either too loose or too tight for their own good. The style has been responsible for an inordinate amount of weak-minded fusion pap. And though I understand the impulsiveness and raw passion of the singing, it often sounds too theatrical, almost ritualistic, to me.

However, I have always made an exception for the master guitarist Paco De Lucia. Only an inert lump could not respond to his flights of imagination and spirit. He's been making beautiful records since he was a teenager in the early 1960s, and he started making astonishing ones 10 years after that.

He got a lot of attention for collaborations with other deft fingers like pianist Chick Corea and guitarists Larry Corriel (ph) and John McLaughlin (ph). But these get-togethers always make him seem more of a mere guitarnik, full of gunslinger technique and not duende.

(AUDIO CLIP, EXCERPT, FLAMENCO GUITAR PIECE, PACO DE LUCIA)

MILES: Like them or not, De Lucia's style shifts are very deliberate and well thought out. His description of his latest album, "Luzia," gets it exactly right. He says, "It's traditional in form, but full of new ideas." There are fresh harmonies and a higher eloquence evident in his playing, but he triumphs by simply throwing in a bit of dancing with those percussive boot stomps, or a vocal with background chorus for judicious sweetening.

Then he goes straight for the heart with a pair of delicate, wistful tributes to his departed mother and his long-time singing partner, Cameron de la Isla (ph).

(AUDIO CLIP, EXCERPT, FLAMENCO GUITAR PIECE, PACO DE LUCIA)

MILES: Paco De Lucia recently appeared with a sextet at Boston's Symphony Hall. There was much competition for soloist honors, on percussion, guitar, and even Joachim Grillo's (ph) hammering thighs in his dance features. But nobody touched De Lucia. He seemed to have several guitarists inside his instruments. But for all his image as a rebel, what stood out is how when De Lucia finds some innovation he likes, he sticks with it, preserves its influence. It's old fashioned nowadays to have an electric bass and to climax a show with what amounted to a jazz flamenco rave up (ph).

Again, De Lucia best articulates his actions when he says he holds onto "tradition with one hand, while the other digs and scratches to find new things I can bring into flamenco." He shows no signs of giving up the search.

GROSS: Milo Miles is music editor at Rock.com.

Coming up, linguist Geoff Nunberg on a new translation of "Beowulf."

This is FRESH AIR.

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Dateline: Terry Gross, Philadelphia, PA
Guest: Milo Miles
High: World music critic Milo Miles reviews "Luzia," the latest release by flamenco guitarist Paco De Lucia.
Spec: Music Industry; Entertainment; "Luzia"

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End-Story: "Luzia": A Review

Show: FRESH AIR
Date: DECEMBER 07, 1999
Time: 12:00
Tran: 120703NP.217
Type: FEATURE
Head: Seamus Heaney's "Beowulf": A Review
Sect: Entertainment
Time: 12:50

This is a rush transcript. This copy may not
be in its final form and may be updated.

GROSS: The year 2000 marks the 1,000th anniversary of the text of "Beowulf," the great Anglo-Saxon epic that many people consider the origin of English literature. To honor the occasion, the Nobel Prize-winning poet Seamus Heaney was commissioned to do a new translation of the poem for the latest edition of "The Norton Anthology of English Literature." It's also being published as a separate book.

According to our linguist, Geoff Nunberg, Heaney has done a brilliant job of bringing the classic back to its origins.

GEOFF NUNBERG, LINGUIST: Whet (ph)! I've always wanted to start a talk with that word. It was the general way of getting your audience's attention in Anglo-Saxon times, as in, Whet! The Viking longboats approach, or, Whet! Could you bring us a cup of coffee and the check?

"Whet" is also the first word of "Beowulf," and the way it's translated can give you a sense of how people have thought of the poem. It begins with the bard recalling the courage of the Danish kings and nobles of olden times.

"Whet! Wae garbene in yer dag um theold kuniga frum geflunon hoe tha avalingus ellen fremedon (ph)" -- and so on for another 3,000 lines.

Stirring stuff. The only question is why anybody would want to call it English. When you read Chaucer, you have the sense that he spoke the same language we do, even if the pronunciation has changed over the past 600 years. But with "Beowulf," there's no sense of familiarity at all.

And in fact, for the first 800 years or so after it was written down, nobody thought of "Beowulf" as an English-language poem. For that matter, nobody thought much of it at all. Chaucer and Shakespeare probably never heard of it, and it didn't even appear in print until 1815. It was only in the 19th century that people began to think of it as the starting point of English literature and took to referring to the language as Old English rather than Anglo-Saxon.

It was all part of the nostalgia for medieval times that became popular as England became an industrialized, imperialist nation, the idea that the racial spirit of the English was formed back in the simple days before the Normans brought the corruption of a foreign language and foreign culture.

You can hear that tone in the Victorian translations of "Beowulf." They always translate "Whet!" as "Lo!" and they go on to render the poem in the quaintly archaic language of medieval romances like Tennyson's "Idylls of the King," the sort of thing that would have been printed with William Morris borders and pre-Raphaelite illustrations of damsels in long gowns and knights in armor.

But "Beowulf" had nothing to do with all that when-knighthood-was-in-flower stuff of the high Middle Ages. Actually, the poem was an exercise in nostalgia even when it was written down. It was probably composed in the 10th century, but it deals with mythical events that were set several hundred years earlier, in pre-Christian times, back in the lands of the North Sea that the Angles and Saxons inhabited before they set off for England.

It tells the story of the Swedish warrior-prince Beowulf and his combats with various monsters and dragons. It alternates between vivid descriptions of dismemberments and decapitations and quieter passages where the survivors repair to their mead halls to drink and sing stories about the great dismemberments and decapitations of bygone days.

But it's also a poem about courage and loyalty, and it would have had an elegiac cast even at the time it was written down, in an England that had become a literate Christian country, where the old myths were dying away.

So it was an inspired stroke for the editors of "The Norton Anthology" to commission their new translation from Seamus Heaney. It isn't just that Heaney's a great poet, but that his own poetry is given to Irish themes that would have seemed very familiar to the Anglo-Saxon world where "Beowulf" was composed, both the violence of contemporary life and the echoes of folk takes of antique kings and heroes.

You can hear this in the way Heaney translates the opening lines of the poem, where he renders "Whet!" as "So!"

"So! The spear Danes in days gone by and the kings who ruled them had courage and greatness."

"So!" It's a very quiet way to translate "Whet!" and the translation continues in simple language that comes as close as modern English can to the four-beat rhythm and alliteration of the original. Listen to this passage, where the monster Grendl comes at night to devour the Danish warriors in their hall.

"In off the moors, down through the mist bands, God-cursed Grendl came greedily loping. The bane of the race of men roamed forth, hunting for prey in the high hall."

To tell the truth, I've never been partial to the idea that "Beowulf" marks the beginning of English poetry, and I still prefer to call the language Anglo-Saxon. Poetically speaking, English didn't really become English until after the Norman Conquest in 1066. That's when it began to take in all those long French words that are stressed on the second and third syllables, which created the rhythmic tensions that every English poet since Chaucer has had to struggle with.

But as I was reading Heaney's translation, I got to thinking that this is what modern English poetry might have sounded like if King Harold had been a little quicker on his feet at the Battle of Hastings and the Anglo-Saxons had managed to beat the Normans back into the sea.

In that case, "Beowulf" might have reached its thousandth year without any need of translation at all. But then, of course, we would have been deprived of Heaney's version. It's a fine way to honor "Beowulf's" millennium, and ours.

GROSS: Geoff Nunberg is a linguist at Stanford University and the Xerox Palo Alto Research Center.

FRESH AIR's interviews and reviews are produced by Phyllis Meyers (ph), Amy Sallett (ph), Monique Nazareth, Roberta Shorrock, and Naomi Person, with Patty Leswing (ph). Research assistance from Brendon Noonam (ph). Anne Marie Baldonado directed the show.

I'm Terry Gross.

TO PURCHASE AN AUDIOTAPE OF THIS PIECE, PLEASE CALL 877-21FRESH
Dateline: Terry Gross, Philadelphia, PA
Guest: Geoff Nunberg
High: Linguist Geoff Nunberg on the epic Anglo-Saxon poem "Beowulf," considered to be the origin of English literature, and newly translated by poet Seamus Heaney.
Spec: Literature; "Beowulf"; Seamus Heaney

Please note, this is not the final feed of record

Copy: Content and programming copyright 1999 WHYY, Inc. All rights reserved. Transcribed by FDCH, Inc. under license from WHYY, Inc. Formatting copyright 1999 FDCH, Inc. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to WHYY, Inc. This transcript may not be reproduced in whole or in part without prior written permission.
End-Story: Seamus Heaney's "Beowulf": A Review
Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.