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  • McConnell back after fall as Senate resumes | CNN Politics

    McConnell back after fall as Senate resumes | CNN Politics



    CNN
     — 

    Senate Minority Leader Mitch McConnell has returned to the Senate following a period of recovery in the wake of a fall.

    McConnell arrived on Capitol Hill Monday morning and did not answer questions from CNN about how he is feeling after spending the last several weeks recovering after a fall where he suffered a concussion and fractured rib. CNN spotted McConnell in the Capitol exclusively.

    McConnell was at the Capitol on Friday, but Monday marks the GOP Senate leader’s first day back in session. The House and Senate are both returning to session today following a two-week recess period.

    McConnell also did not answer a question about how he will handle the issue of how Democrats want to temporarily replace Sen. Dianne Feinstein on the Judiciary committee. Feinstein’s absence as she recovers from shingles is making it more difficult for Democrats to process judicial nominees on the panel, setting up a potential clash with Republicans as they seek to replace her.

    McConnell was hospitalized last month after he tripped and fell at a dinner event in Washington, DC. He was treated for a concussion and a rib fracture before being released to an inpatient rehabilitation facility for physical therapy.

    At the time, a McConnell aide told CNN, “it is very common to undergo physical therapy to regain strength after a hospital stay.”

    McConnell, who is 81 years old, left the physical therapy facility on March 25. In a statement, the Senate GOP leader said that, following advice from his physical therapists, he would, “spend the next few days working for Kentuckians and the Republican Conference from home.”

    McConnell added that he remained “in frequent touch with my Senate colleagues and my staff. I look forward to returning in person to the Senate soon.”

    Earlier this year, McConnell became the longest-serving party leader in Senate history.

    During his absence, Senate Republicans who spoke with the McConnell said he was itching to get back to the chamber. The No. 2 Senate Republican, Minority Whip John Thune, noted that he was “anxious” to return, and Texas Senator John Cornyn told reporters that McConnell was “chomping at the bit” to come back to the Capitol.

    This was not McConnell’s first fall. Several years ago, he fractured his shoulder in a fall at his home in Kentucky.

    The top Republican is not the only senator returning from an extended absence.

    Across the aisle, Democrat Senator John Fetterman will return to the Senate after receiving inpatient treatment for clinical depression at Walter Reed National Military Medical Center. Fetterman was discharged from the hospital at the end of last month.

    Feinstein has been absent from the Senate after being treated in the hospital, and then at home, for shingles. It is not yet clear exactly when she may return.

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  • Sen. Mitch McConnell released from physical therapy rehab after fall | CNN Politics

    Sen. Mitch McConnell released from physical therapy rehab after fall | CNN Politics


    Washington
    CNN
     — 

    Senate Minority Leader Mitch McConnell said Saturday that he has been released from an inpatient physical therapy facility after he fell earlier this month and was treated for a concussion and rib fracture.

    “I want to sincerely thank everyone for all the kind wishes. I’m happy to say I finished inpatient physical therapy earlier today and I’m glad to be home,” McConnell said in a statement.

    “I’m going to follow the advice of my physical therapists and spend the next few days working for Kentuckians and the Republican Conference from home. I’m in frequent touch with my Senate colleagues and my staff. I look forward to returning in person to the Senate soon.”

    McConnell will work from his Washington, DC, home this week and is not expected to return to the Senate before the chamber breaks for their two-week recess, a McConnell aide told CNN.

    The Senate minority leader was admitted to a hospital after he tripped and fell at a dinner event earlier this month. He remained in the hospital for several days. After that, he began physical therapy at an inpatient rehabilitation facility.

    Previously, a McConnell aide had said that the length of the 81-year-old Senate Republican leader’s stay at the facility would be decided “by the Leader’s physicians and the therapists.” The aide said, “It is very common to undergo physical therapy to regain strength after a hospital stay and this ranges anywhere from a week to two weeks.”

    Republican senators who have spoken with McConnell have told CNN that he wants to get back to work. Texas Sen. John Cornyn said recently that McConnell is “chomping at the bit” to return to the Capitol, and Senate Minority Whip John Thune, a South Dakota Republican, noted that he was “anxious” to come back.

    This was not McConnell’s first fall. In 2019, he fractured his shoulder in a fall at his home in Kentucky.

    The top Republican is not the only absent senator. Across the aisle, 89-year-old Sen. Dianne Feinstein of California has been receiving treatment for shingles at home following a brief stay in the hospital. And Pennsylvania Democratic Sen. John Fetterman is undergoing inpatient treatment for clinical depression at Walter Reed National Military Medical Center.

    This story has been updated with additional information.

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  • What older Americans need to know before undergoing major surgery | CNN

    What older Americans need to know before undergoing major surgery | CNN



    KHN
     — 

    Larry McMahon is weighing whether to undergo a major surgery. Over the past five years, his back pain has intensified. Physical therapy, muscle relaxants, and injections aren’t offering relief.

    “It’s a pain that leaves me hardly able to do anything,” he said.

    Should McMahon, an 80-year-old retired Virginia state trooper who now lives in Southport, North Carolina, try spinal fusion surgery, a procedure that can take up to six hours? (Eight years ago, he had a lumbar laminectomy, another arduous back surgery.)

    “Will I recover in six months — or in a couple of years? Is it safe for a man of my age with various health issues to be put to sleep for a long period of time?” McMahon asked, relaying some of his concerns to me in a phone conversation.

    Older adults contemplating major surgery often aren’t sure whether to proceed. In many cases, surgery can be lifesaving or improve a senior’s quality of life. But advanced age puts people at greater risk of unwanted outcomes, including difficulty with daily activities, extended hospitalizations, problems moving around, and the loss of independence.

    I wrote in November about a new study that shed light on some risks seniors face when having invasive procedures. But readers wanted to know more. How does one determine if potential benefits from major surgery are worth the risks? And what questions should older adults ask as they try to figure this out? I asked several experts for their recommendations. Here’s some of what they suggested.

    Ask your surgeon, “How is this surgery going to make things better for me?” said Dr. Margaret “Gretchen” Schwarze, an associate professor of surgery at the University of Wisconsin School of Medicine and Public Health. Will it extend your life by removing a fast-growing tumor? Will your quality of life improve by making it easier to walk? Will it prevent you from becoming disabled, akin to a hip replacement?

    If your surgeon says, “We need to remove this growth or clear this blockage,” ask what impact that will have on your daily life. Just because an abnormality such as a hernia has been found doesn’t mean it has to be addressed, especially if you don’t have bothersome symptoms and the procedure comes with complications, said Drs. Robert Becher and Thomas Gill of Yale University, authors of that recent paper on major surgery in older adults.

    Schwarze, a vascular surgeon, often cares for patients with abdominal aortic aneurysms, an enlargement in a major blood vessel that can be life-threatening if it bursts.

    Here’s how she describes a “best case” surgical scenario for that condition: “Surgery will be about four to five hours. When it’s over, you’ll be in the ICU with a breathing tube overnight for a day or two. Then, you’ll be in the hospital for another week or so. Afterwards, you’ll probably have to go to rehab to get your strength back, but I think you can get back home in three to four weeks, and it’ll probably take you two to three months to feel like you did before surgery.”

    Among other things people might ask their surgeon, according to a patient brochure Schwarze’s team has created: What will my daily life look like right after surgery? Three months later? One year later? Will I need help, and for how long? Will tubes or drains be inserted?

    A “worst case” scenario might look like this, according to Schwarze: “You have surgery, and you go to the ICU, and you have serious complications. You have a heart attack. Three weeks after surgery, you’re still in the ICU with a breathing tube, and you’ve lost most of your strength, and there’s no chance of ever getting home again. Or, the surgery didn’t work, and still you’ve gone through all this.”

    “People often think I’ll just die on the operating table if things go wrong,” said Dr. Emily Finlayson, director of the UCSF Center for Surgery in Older Adults in San Francisco. “But we’re very good at rescuing people, and we can keep you alive for a long time. The reality is, there can be a lot of pain and suffering and interventions like feeding tubes and ventilators if things don’t go the way we hope.”

    Once your surgeon has walked you through various scenarios, ask, “Do I really need to have this surgery, in your opinion?” and “What outcomes do you think are most likely for me?” Finlayson advised. Research suggests that older adults who are frail, have cognitive impairment, or other serious conditions such as heart disease have worse experiences with major surgery. Also, seniors in their 80s and 90s are at higher risk of things going wrong.

    “It’s important to have family or friends in the room for these conversations with high-risk patients,” Finlayson said. Many seniors have some level of cognitive difficulties and may need assistance working through complex decisions.

    Make sure your physician tells you what the nonsurgical options are, Finlayson said. Older men with prostate cancer, for instance, might want to consider “watchful waiting” — ongoing monitoring of their symptoms — rather than risk invasive surgery. Women in their 80s who develop a small breast cancer may opt to leave it alone if removing it poses a risk, given other health factors.

    Because of McMahon’s age and underlying medical issues (a 2021 knee replacement that hasn’t healed, arthritis, high blood pressure), his neurosurgeon suggested he explore other interventions, including more injections and physical therapy, before surgery. “He told me, ‘I make my money from surgery, but that’s a last resort,” McMahon said.

    “Preparing for surgery is really vital for older adults: If patients do a few things that doctors recommend — stop smoking, lose weight, walk more, eat better — they can decrease the likelihood of complications and the number of days spent in the hospital,” said Dr. Sandhya Lagoo-Deenadayalan, a codirector in Duke University Medical Center’s Perioperative Optimization of Senior Health (POSH) program.

    When older patients are recommended to POSH, they receive a comprehensive evaluation of their medications, nutritional status, mobility, preexisting conditions, ability to perform daily activities, and support at home. They leave with a “to-do” list of recommended actions, usually starting several weeks before surgery.

    If your hospital doesn’t have a program of this kind, ask your physician, “How can I get my body and mind ready” before having surgery, Finlayson said. Also ask: “How can I prepare my home in advance to anticipate what I’ll need during recovery?”

    There are three levels to consider: What will recovery in the hospital entail? Will you be transferred to a facility for rehabilitation? And what will recovery be like at home?

    Ask how long you’re likely to stay in the hospital. Will you have pain, or aftereffects from the anesthesia? Preserving cognition is a concern, and you might want to ask your anesthesiologist what you can do to maintain cognitive functioning following surgery. If you go to a rehab center, you’ll want to know what kind of therapy you’ll need and whether you can expect to return to your baseline level of functioning.

    During the Covid-19 pandemic, “a lot of older adults have opted to go home instead of to rehab, and it’s really important to make sure they have appropriate support,” said Dr. Rachelle Bernacki, director of care transformation and postoperative services at the Center for Geriatric Surgery at Brigham and Women’s Hospital in Boston.

    For some older adults, a loss of independence after surgery may be permanent. Be sure to inquire what your options are should that occur.

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  • Democracy has its flaws, but it has emerged from the pandemic in much ruder health than the alternative | CNN

    Democracy has its flaws, but it has emerged from the pandemic in much ruder health than the alternative | CNN



    CNN
     — 

    For nearly half a decade, you could be forgiven for thinking just about everything in Western democracy seemed a bit broken. The social-media yelling in 140 characters. The wild populism, and dog-whistle racism. The clumsy coronavirus lockdowns and their attendant conspiracy theories. The tolerance of absolute, constant falsehoods. The questioning and beleaguering of the electoral process.

    Some began to behave as if it were smoother on the other side of the fence, in autocracies where things are just ordered to happen, and criticism is swallowed whole.

    Yet, as we stagger past the third anniversary of Covid-19’s emergence, the fallacy that autocracies are a superior social contract is crumbling. At the end of 2022, the world is a place where consent matters, and debate might actually save your hide.

    The Trump era created a safe space for autocracies to flex on the global stage, while American tried to put itself First, and its commander-in-chief was happy to receive “lovely” letters from North Korea, or get very close to the Kremlin. But it took the pandemic to expose the utter mess one man in charge can create.

    The most glaring and unimaginably stark example is Russia. President Vladimir Putin bumbled his way through the pandemic with snap lockdowns, a poorly performing vaccine, and a general disregard for how useful accurate data can be in defeating a complex foe like Nature. But it was his personal choices that led to a disconnect which has proved fatal to tens of thousands of innocent Ukrainians, and perhaps even more Russian soldiers.

    The persistent warnings from Western intelligence in January that an invasion of Ukraine was imminent seemed far-fetched to many analysts, including me. Those analysts overlooked the enormity of the task, and the assumption the Kremlin remained a rational actor. Those calming caveats were swiftly whisked away when – in the days leading up to the war – Putin summoned his security henchmen and dressed them down, at a safe distance of well over 20 feet, and then delivered a 57-minute televised speech showing he had spent the pandemic reading all the wrong parts of the internet.

    His spoken dissertation even reminded Russians how mean Bill Clinton had been 20 years ago, shunning Putin’s stated desire to join NATO. Putin’s isolation had compounded not just his historical grievances. There were now fewer subordinates in contact with him, and fewer opinions voiced to counter the absurd assumption Russia’s invasion would be welcomed by Ukrainians and last about three days.

    A RUSI report recently noted that seized Russian orders showed units expected to be “cleaning up” within 10 days, and that no effective “red team” assessment of the plan – challenging its assumptions – had happened.

    And so, the largest land war in Europe for 75 years began, and with it a likely military defeat for Russia that may rewrite the established norms of European security and see Moscow’s place as a global superpower evaporate. Putin’s insecurities over NATO and the practical task of connecting the occupied Crimean Peninsula to the Russian mainland fueled his catastrophic decision. But the Kremlin head’s isolation – along with his echo chamber of paranoid nonsense – cemented it.

    But even now, in this late stage in the Russian military demise, when its readiest form of resupply is forced conscripts to the frontline, Moscow must be mindful of consent. The “partial mobilization” announced in September has sent 77,000 Russian men to Ukraine, Putin recently said. But it has also unleashed a wave of protests perhaps not seen in Russia since the 1990s.

    Tightening the screws on dissent is a sign opposition is growing, not ebbing. The nastier Russia gets, the more acutely aware the Kremlin is of its unpopularity. Invading Ukraine was the worst decision a Russian leader has made since the Soviets invaded Afghanistan. We know how that misadventure ended.

    Police officers detain demonstrators in St. Petersburg on September 21, 2022, following calls to protest against partial military mobilisation announced by President Vladimir Putin.

    The pandemic caused economic and emotional stress in every society, leaving citizens less tolerant of poor managers and outdated dogma. Even the United Kingdom swiftly ejected two prime ministers over issues of conduct and incompetence, not long after their ruling Conservative Party had won a landslide victory at the last election.

    The economic fallout from the pandemic is also the backdrop for another dazzling failure of autocracy, in Iran. But the focal point of recent protests has been the brutal treatment of teenagers for protesting mandatory headscarves. Killing a young woman for not wanting to dress more conservatively than her grandmother perhaps did (Iran was – as recently as the 1970s – secular) is grotesque in any society.

    Iranians protest the death of 22-year-old Mahsa Amini after she was detained by the morality police, in Tehran, Iran, on October 1, 2022.

    But it lit the touch paper in communities ravaged by years of sanctions, the pandemic, and persistent inflation of perhaps as much as 50%. Permit salaries and savings to diminish that much annually, and any elected government could expect to be ousted fast. In Iran’s cities, the violence around this dogma did not distract from the economic fury, but amplify it.

    Well over half of Iran’s population was born in the 1990s, when the Islamic Revolution was already a decade old. A system born in the era of the landline is telling youth born into the world of fax machines how to behave in the era of quantum computing.

    The pandemic hit Iran hard, and I witnessed in 2020 how poorly resourced Tehran’s hospitals were. When your parent is dying and you can’t get a ventilator for them, you don’t have time for a lengthy discourse blaming US sanctions imposed because of Iran’s confrontation of the American hegemony in the region. An emergency like Covid can damage what remains of the contract between ruling conservatives and citizens: If you cannot protect us from a disease at our time of need, then what is the purpose of the corruption, repression and rules on women’s dress?

    Medical workers transport a patient with Covid-19 at Rasoul Akram Hospital in Tehran on October 20, 2020.

    The recent public confusion over whether the country’s morality police would be disbanded – a statement made by the prosecutor general which was later mauled – is a sign of government reform perhaps, but also an indication of how state power is not a tidy behemoth in Iran. There is debate, too, and here it clearly, with hundreds of corpses already underfoot, considered bending to popular will.

    This stark and deadly repression does not at this time herald the demise of the Iranian regime. But it is perhaps a moment of irreversible acceptance that the people cannot just be Ctrl-Alt-Deleted when they don’t suit the state program. It is a recognition that even the best-resourced, most controlling and efficient of repressive regimes – China – has had to deal with.

    Iranians protest the death of 22-year-old Mahsa Amini after she was detained by the morality police, in Tehran on October 27, 2022.

    The pandemic led Beijing to resort to mass control on a whole new level. Its solution to the disease ravaging the planet was to be the harshest of all – in limiting movement. The authorities’ favored tool – used to its limits – was the one almost every other society realized would not work indefinitely.

    Until recently, Chinese citizens were still being welded into their homes in quarantine, and even burning to death in one tragic instance when they perhaps could have been rescued from a domestic fire. It’s perhaps the most damning indictment of China’s one-person rule this century.

    Workers in  protective clothes walk past barriers placed to close off streets in areas locked down after the detection of cases of Covid-19 in Shanghai on March 15, 2022.

    The world has been on a steep learning curve, where social distancing, economic subsidies, vaccines, agonizing deaths and limited global travel have led most societies to now accept the Covid-esque persistent cough as part of what happens in winter. Yet China’s initial decision – stifle the disease – has barely evolved. Its vaccine program has faltered, yet its original tool of mass surveillance has not.

    What is more remarkable is not protests breaking out under such an authoritarian yoke, but that President Xi Jinping did not presume they would.

    Beijing appeared to have been taken by surprise, but also believed it could repress its way out of the unrest. The recent removal of significant parts of the quarantine and testing systems does not solve China’s Covid problems. It was simply their authorities’ only choice. And it is a badly timed one. China is not adequately vaccinated to cope with a massive rise in cases, particularly its elderly population, many experts argue. Even if 1% catch it badly, that is 14 million people in need of medical care – roughly the population of Zimbabwe.

    A demonstrator holds a blank sign and chants slogans during a protest in Beijing, China, on Monday, November 28, 2022.

    Huge challenges require decision-makers of enormous ability. Xi has unparalleled power, evidenced when he sat by as his predecessor Hu Jintao was inexplicably led out during the highly choreographed closing moments of the recent National Congress. But it is pretty clear that Xi got the big decisions around Covid wrong. And that the country where SARS-Cov-2 first emerged is enduring the longest impact of the virus because of poor decisions by its leaders.

    It is a problem for Xi. The singular selling point of autocratic power is that it is absolute: that you can get things done without the delay of debate and compromise that democratic systems endure.

    The point is to be strong, implement decisions fast, and consider dissent the cost of tough, good decisions; not to appear strong, implement fast, and then change your mind publicly after months pursuing a bad idea. For Xi, it is also dangerous for a population to learn they can only truly communicate with their government through disobedience and protest.

    It’s important to feel discomfort when extolling the virtues of modern democracy. It doesn’t really work. It is slow and encourages ego and half-measures. It keeps changing its mind and wasting endless resources while stumbling for the solution.

    But it provides space for dissent and, more importantly, other, competing ideas. And, if you are forcing taxi drivers to fight in a war of choice you are losing, or shooting teenagers for taking off headscarves, or imprisoning people in their apartments to suppress a virus the rest of the world is living calmly with, alternative ideas are important.

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