A Eulogy To Words

wrial2Sometimes the greatest tragedies come quietly.

Today marks a week since the passing of The Writer’s Almanac, one of the few modern examples of true literary culture edging – just slightly – into the American mainstream.

The Almanac has been around for 24 years. Hosted by its creator, Garrison Keillor, each daily program included vignettes about authors and other noteworthy people whose birthdays or significant events coincided with the date of the particular program. There were also interesting excerpts of important events in history.

The program continued with one or more poems usually chosen and read by Keillor. The show ended with his traditional sign-off, “Be well, do good work, and keep in touch.” The theme music was a version of the Swedish song “Ge mig en dag”, performed by Richard Dworsky on piano.

Keillor has recently been accused of ‘inappropriate conduct’ by a co-worker at Minnesota Public Radio, which has the distribution rights to the show. He has been summarily removed from all his connections to the station, and, among other actions, the Almanac is no more. The details are murky. It isn’t clear what was committed; from crimes against humanity to repugnant boorishness to internecine office politics. But the Almanac is gone. That we know.

This loss is a terrible thing. The Almanac goes quietly, ‘with a whimper,’ but the magnitude of the demise cannot be understated. Thousands of writers, poets especially, saw a small sliver of light fall across their obscure desks because of the Almanac.

Ever heard of Athena Kildegaard? I hadn’t. ‘Till A Mother’s Poem showed up in my email the other day. Same for the poetry of Anne Sexton, Paul Hostovsky, David Romtvedt, Ogden Nash, Janice Moore Fuller, Dorianne Laux and hundreds of others. Each post in the Almanac included links to buy the works of these poets, which I’m sure was a huge benefit to them. Ever tried to sell a poem? Ever tried to keep the heat on in winter with income from your wordcraft? Give it a shot. Have fun.

Another casualty: The Poetry Foundation. Long fighting a valiant Thermopylae-esque battle for the attention of the American public, this beleaguered institution will crumble further into obscurity. Many of those who attempt to live by the spoken or written word will feel the effects of this ignominious end.

wrial4I think of all the people who made their living from the show too: The Almanac was written by Betsy Allister, Joy Biles, Priscilla Kinter, Heather McPherson, and Holly Vanderhaar, the program was engineered and edited by Thomas Scheuzger, Noah Smith, and Sam Hudson. Production assistance was by Kathy Roach and Katrina Cicala. I don’t know any of these people, but I presume they’re now using those fabulous writing skills on their resumes.

This is a blow to the English language itself. The Writer’s Almanac invited Americans to spend time with those who are excellent and exacting in their use of English. This, in turn, pushed those of us with lesser skills to be better with the craft. To avoid sentence fragments, for example. And fight the urge to grow wary when in fact we were weary. Great English avoids misconfusing conjunctions. And doesn’t use nouns to modify verbs (e.g. ‘travel safe’ is, ostensibly, a thing, ‘travel safely’ is a well wish). Great English makes whimsical and witty use of alliterations (you be the judge with that one).

wrial6But to my way of thinking, the greatest effect of the loss of the Almanac is to the American mind. I’ve long been suspicious of just how well the average American thinks, myself included. I’m dubious that we as a people place a high enough standard how and at what point we decide something is True. America today seems to be a land of sports spectacle and activism, neither of which lend themselves to nuanced and charitable thinking. Intellectual certainty abounds. Justice may rarely roll down like water these days, but arrogance about one’s opinions certainly does.

Poetry tends to avoid absolutes. It remains one of the few places where the dress could be blue, or gold, or both…and still be considered valid. And valuable. A poet once told me that a good poem has two completely different meanings, depending on how it is read –  a great poem has three. Poetry demands of us the ability to find both satisfaction and fascination in such unkempt intellectual complexity.

I met my future wife over Faulkner, but things really heated up when Cummings and Frost got involved. To say I owe my marriage, and all the glories that have resulted thereafter, to poetry is both overstatement and understatement. I mean, words…what can they really do for us? No doubt it was actually those relentless brown eyes. Then again, perhaps it was the waves, which did something to the shore that water never did to land before.

It may be that shutting down the Almanac was necessary; the justice of sins come home. Perhaps it is the victim of McCarthyist purges. Either way, the loss is incalculable. The exit of a Today Show anchor or a Hollywood movie producer barely rends the cultural fabric of America. But the loss of The Writer’s Almanac shreds it. All are bereft of so much more than can ever be said. Except, perhaps, by the poets, who are now even more quiet than they were before.

Advertisements

Donations

Sansum Medical Research Institute

I used to work at a non-profit medical research institute. There, we didn’t “earn” a single dollar. Everything was given to us through some version of a donation. So I suppose I shouldn’t be so amazed and slightly mystified to receive the thousands of dollars sent our way for the relief trip to Athens.

True, our costs are estimated to run in the $6-10,000 range, and we’re still around $3,000. So it would be nice to get closer to our goal. But even if all the money stopped tomorrow, this has been a humbling experience. Things went from what seemed like a good idea that aligned well with my interests and lifelong training, to something more important. Quickly.

I’ll explain:

I spent a loooottttaaa time in that building. Still miss those days!

The medical school I attended is located in Israel. Called the Medical School for International Health, the curriculum strongly emphasizes International and cross-cultural medicine. It’s a small school, but is comprised of people who love, love, global, cross-cultural experiences.  I’m one of them. These are “my” people. Aside from my wife and children, to this day, I love nothing more than being somewhere, far, far from my familiar world, surrounded by languages I don’t understand and histories and stories and traditions and beliefs I have yet to learn. Being at MSIH put me in the lives of people who love the same thing. I’m not sure I ever felt more at “home,” and I was approximately 6,940 miles from the suburbs of Colorado Springs, where I grew up.

A refugee relief clinic in Athens, thus, is a natural thing for me. I’m wired for this. It’s what I’d do full-time if I didn’t have obligations to children and student loans. But, as evidenced by my parents’ one single excursion out of the U.S. to visit me in all the years I’ve lived overseas, this international stuff isn’t for everyone. In fact, especially relief and refugee affairs isn’t really for most of ANYone. It’s a briar patch kind of thing: This is what I do. But I don’t expect it’s what you do.

So I am amazed to see that what started off as something I care about, has become something you care about too. To those of you who have sent money, and prayers, and follow this blog, thank you. It’s humbling, and a little disquieting, to know that the work we’re doing isn’t being met with ambivalence around the world.

Indeed, it has been quite the opposite.

Ode to Geoffrey (the cat)

 

Christopher Smart, by unknown artist. See sour...
Chris Smart - Wrote an Ode to...me.

Today is the birthday of the guy who wrote what is thought to be the best poem ever written about a cat.  T.S. Eliot said of Christopher Smart‘s poem this it is”to all other poems about cats what the Iliad is to poems on war.”

What really interests me about this poem is the NAME of the cat for which the greatest poem in cat-poem history was ever written.  Mine.  Spelled (sort of) like mine.  As I read the masterpiece, to my wonder and surprise, I couldn’t believe how many of the lines of the poem applied exactly to me.  Or…close, anyway.

Here’s a few lines, *AHEM!*

For the English Cats are the best in Europe. (my name is the English spelling)
For he is the cleanest in the use of his forepaws of any quadruped. (I DO wash my hands sometimes)
For the dexterity of his defense is an instance of the love of God to him exceedingly. (every time I do something coordinated, I tell those around me that they have just witnessed how much, clearly, God loves me)
For he is the quickest to his mark of any creature. (don’t MESS with me, man.  I’m too fast for you.  You want some of this?  Huh?  Do ya?)
For he is tenacious of his point. (Yep.  I am.  Just don’t even argue)
For he is a mixture of gravity and waggery. (I don’t know what ‘waggery’ is…but it sounds awesome.  So I’m that.  For sure.)
For he knows that God is his Saviour. (A cat knows this?  MY cat sure doesn’t.)
For there is nothing sweeter than his peace when at rest. (I slept through the Northridge earthquake)
For there is nothing brisker than his life when in motion. (TOO brisk, many would say)
For he is of the Lord’s poor, and so indeed is he called by benevolence perpetually — Poor (look at my debt-income ratio…it ain’t pretty)
For his tongue is exceeding pure so that it has in purity what it wants in music. (I only stick my tongue out at people who might be able to appreciate such purity)
For he is docile and can learn certain things. (I think this line was lifted straight from my 3rd grade report card…sans the “docile” part)
For he can sit up with gravity, which is patience upon approbation. (I don’t know what all those words mean, but sure I’m that too.  I can sit up if I plan it out first)
For he can fetch and carry, which is patience in employment. (wife might agree with the ‘fetch’ and ‘carry’ part).
For he can jump over a stick, which is patience upon proof positive. (a LOW stick)
For he can spraggle upon waggle at the word of command.  (dude, don’t even mess with my spraggle)
For he can jump from an eminence into his master’s bosom.  (if by ‘master’ he means wife…then we’re talkin)

Movie Review – Avatar

I enjoyed myself fully last night as I entered the world of ‘Avatar’, James Cameron’s new sci-fi epic that already handily broke a 1 billion-dollar landmark record of some kind.  I’d watch the show again tonight if I could.  I’d probably watch it every night for a week like my high school buddies did for “Bill and Ted’s Excellent Adventure” once upon a time.

You don’t have to care – or understand – the point of the movie to completely enjoy the stunning visual spectacle presented in wide-screen, 3D wonder.  In fact, I’d advise constraining yourself specifically to the visual effects and skip putting any real thought to the message of the movie.  In essence, just sing along with the song, but don’t think about what the words actually mean.

The story follows an ex-Marine named Jake as he becomes part of a mission to subjugate – or at least translocate – the natives on a strange new planet (a moon actually, but does it matter?).  On the n0t-so-subtly-named Pandora, the “aliens” congregate around an enormous tree set in the middle of a seemingly endless forest.  They stand about 11 feet tall, with blue skin and luminous yellow eyes and they all seem to carry bow and arrows and daggers.  These blue and tall but otherwise disappointingly human-shaped beings generally seem happiest when attending their frequent tribe-wide drum fests – with a terminally simplistic 2/4 beat rhythm that sounds like it might have been pounded out on cool Senegalese drums the Anglo orchestra bought in bulk.

These earthy aliens have a sacred, mystical, spiritual connection to the forest where they live; generally behaving like any nature-loving tribe the Europeans successfully decimated a little over a century ago in North America.  In a complete creative hiatus, at one point nature is even called a “mother”.  Why not a father, or brother, or just skip the nuclear family reference to nature entirely?  The descriptor ‘Mother Earth’ is so unoriginal, it ranks up there with Bless You and Dot Com.

Although 2 hours and something like 40 minutes, you can easily sum up the movie in one phrase: “Dances With Wolves”…but with pterodactyls you can ride.

Basically – Marine makes contact with natives through project financed by aggressive and ethics-challenged Big Business company.  Marine plans on helping his financiers destroy said natives.  Instead, he inadvertently falls in love with natives in general, and one curvaceous native in particular.  He then becomes the enemy of his former bosses, ultimately leading the meek, dumb, dark-skinned simpletons to victory over superior white man.

I haven’t decided if this REALLY tired theme of the White Male swooping down into a primitive race, seeing their genuine good, and then becoming their Great Savior is completely racist.  Some are saying it absolutely is.  I don’t really think that was the intent.  I just think it was lazy writing by a white male who deep-down believes that white men are still the best hope for the world.  That they still run it, ultimately.  But it is possible that white men really don’t have much to offer the world anymore – that we’ve had our time and made our mark.  Maybe it’s time for some non-white, non-men to run the countries, write the laws, own the companies and save fictional worlds.  Maybe the white boy has done about all he can.

Big Business takes a major hit in this movie.  It gets portrayed as the denizen of all Evil in life.  That said, it’s Big Business that has paid for every iota of scientific discovery that has occurred on Pandora.  The science taking place on this moon (and taking place on our earth) is an elevated form of existence, no question, but in both worlds it mostly exists because of Big Business, either directly or through taxes.  Scientists – and artists – need to accept the fact that to live in that enlightened world of thought and wonder and possibility depends on their benefactor’s mundane ability to sell widgets.  Big Business is rarely genuinely evil.  True, figuring out when to inject some profit-endangering humanistic principles into a business plan does takes some skill and is occasionally gotten wrong. But for the most part, if business didn’t make the poet, at least it feeds him.

The actual “avatar” is a living being made to look like the aliens, but controlled by the mind of a human.  The human links to the avatar neurologically, so it can only be controlled by one specific human.  Thus, the human lies in a coffin-like body-pod that connects him/her to their specific avatar.  Upon falling into a coma in the pod, the avatar wakes up and the mind of the comatose human controls it.

Soohh...who gets to clean this thing?

The doc in me couldn’t help but get hung up on this part of the movie.  First, all humans need to sleep.  But since the avatar wakes up as soon as the human “sleeps”, and since controlling the avatar is a conscious process, the human never actually does sleep.  For some evolutionary reason I can’t fathom, REM sleep is the foundation of all life.  This inconvenient fact defies even the mighty pen of James Cameron.  By the end of the movie, after staying awake vicariously with the characters, I felt like I’d been on call in the hospital for days on end (felt like I was back in residency again).

Also, the human lays in this coffin thing for hours and hours.  At the least, he’s gotta pee himself on a regular basis, to say nothing of the inevitable bowel movement here and there.  Plus, the main character’s avatar hooks up with the sexy female alien.  Depicted as the first consummating night of an eternal love bond – thus likely a multicoital affair – envisioning the scene (and smell) inside the pod after this particular night left me a bit squeamish.

As mentioned, the power of this movie is in the visuals.  It is a “looker” many times over.  But the general message is tired, probably slightly racist, and denigrates the U.S. Military (or at least leads the audience to exult in the widespread slaughter of American soldiers/mercenaries).  That said, perhaps our culture really should take the main theme of the story to heart.  After all, we DID decimate the Native American culture, and based on my experiences on the Crow Reservation in Montana, I’d say we continue to.  We’re also strikingly obtuse in our dealings with tribal cultures in the Middle East today.  Listening to people from a different culture – rather than melting them with daisycutters and circling drones – has some merit.

But I do wish the movie had added a little post-modernism into the mix and eschewed the evil-good idea altogether.  It didn’t have to pit the American Axis of Evil (big business + U.S. Army) against a pristine tribal culture practically perfect in every way.  Historic Native American tribes were often duplicitous, aggressive, thieving and hateful (many still are today).  They rarely trusted each other from tribe to tribe and may have been just as irresponsible had one tribe attained the raw power that the U.S. Government currently has.  The Arab tribes we’re tangling with recently have a litany of faults and cobwebby dark corners too.  But they are also a just, priceless, sacred, honorable people.  This dichotomy exists in virtually every race in our world.  Americans seem to hate this complexity in our fiction – it’s easier to hate one thing and love another and then watch them duke it out.

Yeah, YEAH! Die lame-oh Americans! Wait, didn't an American make this movie?

Thus, the conflict in the movie could have been between two parties filled with faults and frailties but ultimately imbued with genuine honor, honesty and a respect for the rights of others.  Standing between them is something they both deeply need and want (trees, mineral ore…whatever).  In life, conflicts almost always boil down to two parties who both have blood on their hands, but both are essentially good, honorable…and in the right.  e.g., Palestine wants the land, Israel wants the land, both have been evil at times, both have been angelically good at times, and each have some form of legitimate claim to the exact space of real estate.  Stick that conundrum in your avatar’s virtual peace pipe and take a deep drag, nature-brother.

Depicting this nuanced world may have weakened the sense of righteous rage as the Army went Operation Flatten Everything.  It may have lessened the gloating release when the Ultimate Bad Guy finally met his ignominious end.  But it would have made a better movie.  It would have made the written story as complex as those fantastic visuals, and created a worthy counterpart to such a sparkling, wondrous vision.

The Toilet Excuse? Really?

“I need more drugs because I had a heart attack yesterday and in my monumental pain I flushed my Percocet down the toilet.”

I stare.

 

AWwww, MAN, I don't know WHAT happened, man.

“No really.  I’m serious.  I don’t know what’s going on with my heart and I accidentally flushed my drugs down the toilet when it was causing me, like, serious pain.  I REALLY need some more.  I’m in like 24/10 pain.”

 

“That’s a pretty strange fraction.”

“Well, that’s how bad it is.”

I hope my eyes are at least a little more than half-closed, “Dude.  That’s your excuse?  Really?  That’s the best you have for me?  Flushed?”  My ever-blindingly cheerful mood deflates a bit.

“Well, it was the case manager who told me to come to you for more Percocet.  I tode her Dr. SW101 isn’t cool with narcs, so I figured you wouldn’t go for it, but she told me to try.”

“So, the NURSE made you do it?”

“No…well (looks hopefully at me), uh, maybe?”

 

Dr. SW101 set me UP!

He did utter one truth, I’m not cool with writing for unfathomable doses of highly-addictive, mind-altering substances that have outrageous street value and regularly cause the utter destruction of families, careers and lives.

 

He’s right.  I’m not cool with that.

Sometimes it feels like I’m just sitting in my clinic handing out bullets…each one stamped with “If this causes a disaster of any kind, please blame Dr. SW101.  His bank account number is 7749220485, and you can find his children at 13 XX street, usually after 6pm.  Punish him accordingly for making such a mockery of his Doctor’s Oath, society, God, the memory of Elvis, Stonehenge, Hello Kitty, Gooeyducks..and everything else even remotely sacred to humanity.”

But I’m used to that.  I’m used to being the candy man.  What I’m NOT used to, is being taken for so dimwitted that the medical equivalent of ‘the dog ate my homework’ excuse might work on me.

“You’re really using THAT one on me?”

“Look man,” (whips out his Blackberry Smartphone, provided free of charge by the Army to help with his healing), “I got pictures of the pills in the toilet.”

I decline the visual.  Don’t even need it.

“You’d need to pin my face to a cork-board with something in the range of 34,000 thumbtacks to talk me into giving you more narcotics with that lame excuse.”  I say.  What I DON’T say is that aside from fighting the good fight against blatant drug addicts (I do take care of true heroes; he’s not one of them), I’m just flat-out annoyed at the excuse.

“Frankly, you’re story is miserable.  Put in a little work, and you might score a few hits out of me for creativity.  I’ve been known to drop a few Vikes on someone just to tribute their impeccible style alone.”

“Style?”

“Yeah, you know, do some deep-thinking before you try get me to double your daily horse-halting, blue whale-euthanizing, brontosaurus-stupefying doses of addictive opiates.”

“Liiike, a better story?”

“Yep.  I loovvve fiction.”

“Um, like what?”

“The doc I’m replacing was partial to “I washed ’em in my uniform”, so I’d say that’s a little, uh faded haha no pun intended *aHEM*, sorry, not making light of your “pain” or whatever, just a little side-joke for this glorious Army morning.  Anyway, where was I?”

“You were helping me come up with a story to score more narcs out of you.”

“Oh YEAH.  Thanks!  Let’s see, maybe I can help you….next time, try something along the lines of:

 

They're real. Seriously.

After a valiant but ultimately tragic battle, a saber-tooth tiger ripped your friend’s head off.  In desperation, you heroically dispatched said wildcat with your bare hands (careful with the back).  Then, without pausing to consider yourself, you gave him your ENTIRE BOTTLE of pills strong enough to drive the entire population of Gambia into rehab.

 

Unfortunately, when he swallowed them – since his head was removed from his body – your pills just dropped out on the ground, all slimy and spit-covered and quickly dissolved.  Thinking fastly, you propped his body up and then held his head over what you figured was the esophagus part of  your life-long friend’s neck so the remaining few pills – “Damn you, Johnny, swallow! – dropped out and settled into one of his neck-tubes, hopefully not the trachea.  Then you got him to a local ER, where they skillfully re-attached his head.

ONLY THEN, after your friend was recovering (he just might pull through, snif), did you think of yourself, realizing that you were, in fact, out of drugs for your endless back pain and heart attacks which you’ve been suffering from since you were born, 20 years ago.”

That would work?”

“No.  But honestly, that story has more credibility than, ‘I flushed ’em, brah, gimme some more.”

Doctor Sells Insurance For His Own Procedures

**The following is another installment in an SW101 exclusive series entitled Medicine In America (MIA), covered by our crack journalist team scattered around the globe.**

TULSA, OK – “Just in case I screw something up,”  Dr. Jason Hines says, smiling, as he helps an elderly man sign a form and pay for his “procedure insurance.”

Dr. Hines, owner of New Day Family Medicine, a small group practice here, is one of a growing number of primary care doctors who are getting creative as they struggle to increase falling reimbursements.

“I got the idea from my very own Family Medicine Academy,”  Hines says excitedly, holding up a postcard with bold, red letters emblazoned across the top reading LAST CHANCE!  “They’ve been trying to get me to buy their life insurance policies for about 2 years.  This is the 14th ‘last chance’ notification I’ve gotten.

“Then it struck me!  Even the AAFP is getting in on insurance, why can’t I?  I mean, we can’t all be lawyers and dentists, right?  Gotta make the bucks somehow. ”

Dr. Hines’ fledgling business-within-a-business had a rough start.  “Nobody saw a need for it,”  he said.

Debbie Lawrence, one of the first patients to sign on, described her initial doubts.  “It seemed a little strange, you know?  I’ve already got insurance for my car, my house, for medical bills.  I even usually get that extra insurance for rented DVD’s.  But then, as the doctor described the procedure of removing a mole on my back, I saw this slight tremor…and then he read me the consent form!  Boy, it just seemed like the safest thing to do.”

“I had to figure out some way to promote things.”  Hines explained.  “The postcard idea was already taken by the AAFP, so I wanted to do something more creative.”

His solution was to enroll in an acting class at the local community college.

“Watch this!”  He said excitedly.  “I’ll just reach for this piece of paper, aaaaannd NOW, I’ll have this nearly-imperceptible tremor just before I pick it up.  See that?  We really worked on the subtle-but-obvious thing in class.”

Then he modified his legally-mandated consent form process.  “So, they make you blah, blah, blah about the risks and benefits of every procedure, right?  Well, I just figured I should capitalize on that.”

His consent form reads:

My signature is proof that I consent to the forthcoming procedure.  Procedures are dangerous.  Most are not proven to actually improve anyone’s health.  I understand that I risk serious pain, including but not limited to severe disfigurement such that my children and spouse might recognize me only by mannerisms.

Often, procedures of this kind result in lasting nerve damage, potentially to the genital area.  I understand and fully consent to an ambivalent and uninspired sex life from this point forward.

Bleeding is usually something that can be stopped.  If not, I am willing and happy to slowly dwindle into a shivering unconscious blackness from which I may never emerge.

I also agree to not underestimate the risk of infection.  I realize that flesh-eating bacteria exist everywhere, at all times, and are constantly attempting to gain access to my body.  I understand that should infection occur, I may wake up with parts of my body unexpectedly reduced to nothing more than exposed skeleton held together by rotting fascia.

“That’s the mellow one,”  Hines’ states matter-of-factly.  “I use it for wart removal and immunizations.”

After the slow start, business now is booming.  Dr. Hines calculated his acting class cost – “110 bucks a unit for a 3 unit class” – at $330, which he claimed on his income taxes as a business expense.  He sells insurance for any procedure in his office, usually at a cost of $25 to $350 per procedure.  “I’m thinking of adding waiting room insurance – you know, in case the roof collapses – but we haven’t worked that angle yet.”

What has been developed is the “Cabo” insurance package, which includes a special waiting room with palm fronds, seltzer water, a chaise lounge and soft music.  Aside from guaranteeing the procedure to be safe and “up to standards”, the patient also receives a massage at the conclusion.  “Sometimes, we’ll give their dog a massage also.” He said charitably.  “After signing my consent form, people are pretty keyed up.  I usually just throw the dog in for a reduced fee.”

The AAFP did not return calls for comment, but did release this statement,

The AAFP does not condone the practice of selling non-medical products within the environment of medicine.  We believe in assisting our doctors as they provide the best care possible for the entire family.  Just look at the success of primary care medicine in America over the past 30 years for evidence of our presence in Washington.

Although the insurance business does offer unbelievable profit margins and investment returns of nearly 50%, we strongly believe that individual doctors do not have the expertise to get into the business.  Individual family doctors should leave the big business and real financial gains to organizations that are qualified to actually make money.

Finally, although we typically keep information about doctors confidential, it should be mentioned that Dr. Hines appears appears to have let his board certification lapse.  He is soon to be rejected from our community as a “fellow” if he doesn’t pay his dues by cash, check or debit/credit.

“They can say whatever they want.”  Replies Hines.  “I got the idea from them.  The AAFP opened my eyes to the fact that there’s lots of ways to make money on the medical field, as long as you don’t waste much time actually practicing medicine.  I can’t believe it took me so long to figure it out.  I’m just glad I got in on the gig now, when the para-medical business is still in it’s Golden Age.”

CDC Officials Upset About Champagne Return Policy

logoATLANTA – Officials at the Center for Disease Control are contesting the return policy of the Korbel Champagne Company in what many here are calling “a classic swindle.”

Effervescently giddy a week ago at the start of the Swine Flu outbreak, senior officials at the organization approved a “full-out partaaay”, says CDC spokesman Greg Thereou.  “But things didn’t work out like we had hoped.”

“Look, the swine flu thing….we were gonna be important again!”  Says Geoff Davis, senior epidemiologist of the Floating Particles and Peanut Dust Unit and lead researcher of viral gene sequence XD449Cd.

building“I was gonna get to make all the bus and cab announcements.”  Interjected another scientist – Dr. Franklin Sumpsen – as he passed by.  He then added wistfully, “Sure beats tracking the sperm count of banana slugs in the Mississippi Delta.”

Amy Forsythe, lead statistician on the Women with Bizarre Sexual Histories Who Also Smoke Crack project, agrees.  “We had a lot going for us this time.  I mean, the SARS scare didn’t pan out at all like we’d hoped.  I think we only got 3 or 4 press conferences out of that before it was all over.

“This time – ”  Amy interrupts herself to hold up a newspaper on her desk, “Look at the London Metro Newspaper..’Swine flu could kill up to 120 MILLION’.  I think they did that all by themselves!  It’s like they were working for us or something.”

Dr. Davis did admit to some involvement the story, “Yeah, well, I photoshopped some surgical masks on a picture of a group of SWAT team guys enacting a raid for a public promo in Tulsa.  Then I put little Mexican flags on their uniforms and sent it to the Metro.  But what’s the big deal?  It could have happened like that.”

bubbly1“We bought 128 cases of Korbel Champagne.”  Said Jody Flannagan, auditer of the Nosocomial Urethral Cath Infections Tracking bureau, and under-secretary of the party planning committee.  She quietly pulled down a giant banner that read:  We’re relevant Again!  Have a drink on us…hell, have two!

“We mostly went with the Brut, but also threw in a smattering of Extra Dry and some Rose too.”  She continued glumly, popping a balloon under her sensible office shoes.  “Now the upper brass have called off the party and Korbel won’t even talk to us.  It’s like we’re dead to them.”

All employees agree that coming back to reality after these heady past few days has been quite a blow.  “It was shaping up to be the most powerful moment of our lives.”  Said Dr. Forsythe, “If we could have nudged our pandemic indicator to ‘Crimson-blast deathblood of innocent millions’ level, we would have enjoyed utter domination of planet United States.”

space-suitA warehouse on the CDC lot is now filled with unused supplies including 48 million square feet of rolled plastic, sterile body suits, goggles, bright blue gloves (“they show up better in the pictures” said Dr. Forsythe) and miles of biohazard taping.  Teams were already prepared to take over airports, schools, bus lines and other places of public congregation.

“True, they only gave us daycares.” Said James Dickson, a tech in the Toe Fungus lab.  “It’s no JFK International..but still.  We would have gotten to do a press-conference or two.  I could have printed up lots of directions and mandates and plans and I’m sure we could have overseen the arrest of some itinerant parents who wouldn’t submit to our authority.”

Sighing sadly, Dickson threw a box of round stickers in the trash that read, “It’s for your own good.  One day you’ll understand.”

“We’re sending an official letter of complaint to the champagne company,” says Dr. Forsythe.  “They should understand that we have no use for the stuff now.  It would be like popping corks at a funeral.”

Then she laughed conspiratorially as a man in a white coat whispered something in her ear.  “Oh, that’s right…on the back of the letter, we’re attaching a sticky note that says we’ll release Vibo0t778-XM2 into their heating vents if they don’t give us our money back!

“That’ll teach ’em to ignore the CDC!”

Review: Juno

The movie Juno, released in 2007 and directed by Jason Reitman, enjoyed wide popular and critical acclaim despite a minuscule production budget. Like the Blair Witch Project, it became a sleeper (no pun intended) hit, eventually winning an Academy Award for best original screenplay. The show deals with teen sex and pregnancy, which obliquely involves family medicine, so I guess I have some reason to talk about it other than the fact that I did like the movie.

Juno is a 16 year old girl who gets pregnant after a tryst with her longtime best-friend and occasional boyfriend (depiction of the act is repeated, but tasteful and not gratuitously revealing). She initially chooses to have an abortion, but decides against it after a rather uncomfortable experience at the only local clinic that performs the procedure for free. Instead, she decides to put the baby up for adoption, and chooses a wealthy couple desperately seeking a child. The story dispenses with much of a dramatic climax – other than to require some very adult-like decision making by Juno. It turns out that the rich have their problems too, although their kind often crouch behind over-sized front doors, huddle in spacious breezeways or waltz softly in cellars devoted to past wishful glories. Juno’s parents weather the shock of her predicament well, with an admirable balance of reasonable judgmentalness and loving support. “I was hoping it was cocaine or shoplifting,” the step-mother confides to Juno’s Dad after they hear the news.

I can see why the screenplay beat out other brilliant scripts at the Awards. The writing credit goes to Diablo Cody – that’s a woman, not a an eternal being from the outer realms of darkness, or perhaps somewhere in Wyoming – who started her writing life as a stripper. Her imminently popular blog about the skin trade led to her contract to write Juno. Some wonderfully witty moments pepper the script, and deserve the attention they received. However, the actors rescue some lines that with lesser players would have devolved into jarring triteness. Credit the director for drumming up Ellen Page to play the title role, who herself borders on unbelievability, but is rescued in turn by moments of incisive honesty in her script. This symbiosis – script and actress relying the other – occurs regularly through the movie and probably saved the enterprise as a whole.

The depiction of the family planning clinic probably did not depart far from the reality. State-supported medical clinics tend to run heavy on the documentation and short on things like staff and, say, furniture. Given the number of teen-pregnancies my clinic deals with, I found the depiction of Juno fair and respectful. Not every teen is a bimbo with no grasp of consequences; there is nuance to many of their situations. That said, Juno exhibited a more sophisticated persona than most teenagers. Her sense of self and values was decidedly adult. In fact, we should be so lucky to have teens work through complicated issues like sex and pregnancy in such an honest and careful way. Many adults don’t rise to the level of emotional acumen we see in Juno. Frankly, much of America worships ardently at the altar of pleasure to the exclusion of anything or anyone else. Juno, like few of us at 16, and maybe even 35 or 65, spends most of her time focusing on her problems and solving them. Nary a misstep does she make after her single afternoon of what was, likely, something like 33 seconds of coital bliss in an over-stuffed red chair.

Fair or not, I enjoyed a cathartic moment when the step-mother – in the room with Juno and her best friend during her ultrasound – dresses down the tech for denigrating Juno’s situation. Chatty ultrasound techs have caused problems for more than one of my patients. In one case a tech hinted to my pregnant patient that something was wrong with the baby, “but I can’t tell you about it, you’ll have to talk to the doctor” (scan turned out to be fine but the woman had nightmares for the rest of her pregnancy). In other countries, OB ultrasounds are performed by the doctors themselves, and so can give an official read right there in the exam room. In the US, we have techs do it, who understandably become tempted after their 1000th scan to give the patient their own interpretation. Some techs are good enough that they’re usually going to be right, but legally they are required to keep their traps shut. Interpretation and commentary is NOT their job, acumen in that area be damned.

Humph! Anyway…

As a father, I watched the movie hoping I would know my daughters well enough to prevent them these kinds of dilemmas, knowing in all honesty that I won’t be the one doing any such thing. Hormones and pubic maturity arrive around 13 years of life, and from there I will be but a distant guide – one mild tenor in a chorus of influential voices. I also envisioned myself behaving quite like the father in the story – angry and protective but ultimately on-line and ready to help. God only knows if I could really manage such levelheadedness.

Politically, I knew that anti-abortion types would love the grim clinic scene and applaud the choice made by Juno to keep the baby. Many in the conservative right believe that pro-abortion forces are out to talk the rest of the planet into having the procedure – men too, if possible – and would DIE before they even discussed the alternatives to it such as adoption. My own experience with pro-abortion people suggests much more balance and pragmatism among them. Still, I did feel a sense of satisfaction on behalf of my pro-life friends in seeing a viable alternative to abortion played out step-by-step to a tenable – and preferable to all possible worlds, in this case – conclusion.

Juno glossed over the considerable emotional toll something like this must put on a young girl. The end scene is of Juno, back with her boyfriend (one assumes, also back in the sack, this time with a more proficient prophylactic). They sit idyllically in dappled sunlight on stairs leading into his front yard. Whimsically, they play guitars together and sing a melodic paean to teenage life. Consequences, perhaps lingering in soft shadows at the corners of the closing frame, hold no sway in this myth.

We should all be so lucky.

New Vignette

I’ve written another entry for the “Vignettes” tab. These vignettes are short, humorous (well, you be the judge) stories about my life in family medicine residency.

Numb Lips

I always know I’m tired when my lips get numb. It’s easy to work for so many hours that I forget when I started, which leads to forgetting at what point I should be hungry, or go to the bathroom, or drink some water. But the numb lips thing tips me off with a pleasing rush of certainty, “I am now – surely – tired.”

While it’s nice to know something like this so clearly – it explains the stumbling, the gritty feeling in my eyes, the strange metallic taste in my mouth – it often doesn’t matter. Worse, it sometimes just gets in the way. It isn’t until after a day and night on call that we’re required to make oral presentations of patients and what we did for them. Sadly, it is after call that we are, obviously, least sharp and, as is often the case for me, when my lips are numb.

“Welcommmmm, poo murning preport.” I’ll say, my thick mind wandering back to those glorious days as a kid in the Colorado snow staring with fascination at my nearly frozen fingers and watching how slowly they moved on command. I work my lips a bit and try again. “Thurvvv been about sevun-eighteen two-thritty admushings since we’ve been on shift.”

To make matters worse, usually coupled with my numb lips is a sudden feeling that some language I don’t know – let’s just call it Gerbrewfrenshish – is now my primary language. English has inexplicably become my 4th language and, despite all those ESL classes, remains tricky and annoyingly liberal with the observance of it’s own rules.

Tell ‘em about the UTI lady, quick! Everyone’s waiting! You’re supposed to be running morning report! All I need to think of is a good couple of intro words – in English – like “Our first admission was…”. But my fumbling mind, connected to my numb lips, manages to speak in tongues comprehensible to only the most charismatic, “Haciendaherr facshalom.”

My R-1, who somehow got sleep last night, looking at the pained and quizzical look on the face of our faculty attending and says, “He’s communicating good morning and telling you about our first admission.”

Will all the alacrity I can muster, acting firm and commanding but inwardly lying prostrate before my R-1, I manage to smear out the words, “Ghoood, Paahl. Why don’t eeuw prsant theshe caseis?” He looks at me with a slight smile and smoothly takes over my job. No one could be happier than me, slumped in my chair, trying to remember the pronunciation of that word English-speakers use to express a feelings of warmth and abject adoration.

Soon, my R-1 skillfully brings morning report to a close and the doctors start heading off in different directions. I yes! That’s IT! I’ve got it manage to catch the eye of my R-1.

“Tttthhhhanks, Paul.”

“Anytime.” He laughs. “Go home and get some sleep.”