Wednesday, November 17, 2010

Agree to Agree for Once

The Co-chairs of Obama’s Deficit Commission, or the National Commission on Fiscal Responsibility and Reform, for those of you who aren’t into the whole brevity thing, recently announced a $3.8 trillion plan that would cut Social Security and Medicare, reduce income-tax rates, eliminate tax breaks including the mortgage-interest deduction and make many specific cuts to different discretionary budget items, including the Defense budget and the National Parks Service. More than likely you are happy about one or two of their proposals and ready to fight tooth and nail about one or two of the other. Indeed, the leftern lobe of the blogosphere has been lighting up my inbox with headlines like “They just declared war on Social Security”. And the gauntlets have also been flying from the rightermost regions, with oaths of “No new taxes!” and “No deals, Mr. ‘Bama.”

If you’re interested in reading a variety of reactions to the proposals, I recommend this article from the Times which I think helps puts some of the issues into perspective.

This is probably the third draft of this blog. The first, especially after reading the list of cuts and changes to the discretionary aspects of the budget, was fairly rah-rah. I said, hey, this is the first time in my political life that I have heard anyone make a set of serious and specific proposals to address our country’s deficit problem so we should get behind it. Then I moved on to an angry WTF-type-of-thing, especially after reading more about the proposed changes and cuts to the entitlements portion of the budget (Social Security, Medicare etc.). I was ready to decry the proposal as another right wing plot to leave the poor and disadvantaged in misery and give money to the wealthy in the hopes that it would some day trickle down. I wanted to remind everyone that in addition to the moral question of social justice, we needed to realize that spending money on people in one way (Social Security, health care, education) would mean avoiding paying even more money for them later when their sh*t really hit the fan.

But these are tough times, arguably extraordinarily tough ones even, and I think they demand some extraordinary measures. So this is third draft (third verse, different than the first). The deal is that there is no way to balance our budget and reduce the deficit through discretionary cuts alone. No way to tax or spend our way out of depression. Anyone offering a simple solution is selling snake oil. A serious solution to our problems will be difficult and complicated--two things that politicians and Americans don’t generally want to say or hear.

Every one of us is will be required to make some sacrifices and decide just what is important, not to us or to our personal interests, but for the future of our country. Not just for or our children and their children, but our neighbors’ children. So the first sacrifice that I’m asking of myself and you, is to let go of our anger and bitterness, our mistrust and ideology. Our next step is agreeing to agree, however disagreeable that may be. Let us agree that the solution to our budget deficit, even the future of our country, is going to entail change. Let us maintain a high index of suspicion for any proposal that makes it sounds like things are going to be fixed with a few small tweaks but that otherwise we will be able to keep on going in the same comfortable way we have become accustomed to. The heat is on and the windows are down, my friends, so let us agree that some serious changes will need to be made to taxes and discretionary budgets and entitlement programs if we are to survive our over 13 and a half trillion dollar debt ($13,736,876,145 right now to be exact). This is something like a debt of $125,000 per taxpayer (watch the national debt clock ticking here).

I don’t see our current legislature, or perhaps any group of people who want to get re-elected, being able to agree on something as difficult and by nature unpopular as balancing the budget and reducing our ridiculously large deficit. Unpopular, why? Okay maybe unpopular is not the right word. Indeed, the idea seems eminently popular. What people don’t seem to like is any of this stuff affecting them, right? And that’s the problem, as soon as we start discussing these proposals, anyone who is or might be affected by any of them are not going to be happy and will start calling their congresspeoples and local radio talk shows. And the result will be a humpty-dumpty collection of disputed and in the end muted proposals that the legislature will never be able to piece back together again into a comprehensive package. So here’s the silver lining, a 14-vote Commission majority on a deficit reduction plan would require Congress to vote on the package unchanged. Still not easy, but at least fathomable. So all we have to do is get this bipartisan commission to agree, just 14 people, not 100 senators and 435 congresspeoples.

It seems clear to me then, and I hope to you, that our best way out of this mess is to throw everything we’ve got, we the people, into making sure this Commission comes up with the best proposal it can be, however much wrangling it takes, and that at least 14 of the 18 members agree to it. Let’s agree that it’s going to be difficult and that nobody will be really happy with it (sound like health care reform yet?), but that we’ve just to got to do it. Maybe it won’t be exactly the right mix of cuts and changes, and more than likely we will have to make some more cuts or go back and change some things that turn out to suck, but now is the time to roll up our sleeves and get stuck in there. It’s going to be a Pyrrhic victory, so let’s put on our Greek gloves and take out some budgetary trash.

What I’m asking you to do is throw away your ideology, not your morality or intelligence or compassion, just your ideology. I won’t push this part, but if you can muster it, send out some New Agey, 100th Monkey-ey type positive vibrations that things are going to change for the better, that a compromise can and will be reached. Finally, and this is important, send the debt commission and your national representatives a message telling them exactly what your priorities are in terms of budget cuts and changes, starting with your number one priority, which is that some intelligent, compassionate and serious changes and cuts must be made. You can contact the commission by email (commission@fc.eop.gov) or visit their website. Here is a website Congress.org that allows you to email your representatives, and your local or national media (you have to register first, then look for the links under 'Advocacy 101' on the right side of the page).

Here is what I’m planning on sending:
Dear Deficit Commission,

I beg of you to work hard over these next few weeks to come up with a proposal that you can agree upon and that entails intelligent, compassionate and serious changes to our national budget. Business as usual is no longer an option with a $13.7 trillion deficit, economic depression and another energy crisis around the corner. Not to mention our crumbling infrastructure and lagging educational system. There is no choice but success.

I believe you should focus on cuts to those parts of the budget that are most contributing to our national debt: Defense, Medicare and Social Security.

I’ll start with the hardest job, cutting some little old lady’s retirement benefits. All I can say is that for some people, the difference between getting their Social Security check or not is the difference between having proper food and shelter, and if they can’t afford these most basic of necessities than we are going to have to pay for more food stamps and shelters for them anyway and no money will end up being saved. So please cut carefully. Maybe you can create one retirement age for the white collar who can more easily work at age 70 and another for blue collar workers who aren't likely to be able to lift those garbage cans or crates at that age.

Regarding Defense, we have the most expensive military in the world by a factor of several countries put together. Nothing wrong with having the best, but it should not cost what several other G8 countries put together are paying. Let's get lean and mean. Do we need nukes? Do we need as many subs? Do we need? Do we need? How many megaton bombs and super intercontinental missiles do we currently need or use? Or have we ever used? Cuts should be made based on defense items we actually use and those that we might use in the future (intelligence, so-called “smart” bombs and troops on the ground type stuff). Get in there and cut the rest. Look at how Southwest Airlines saved money: one multipurpose fleet of planes, needing only one set of parts and training. Do we really need F-15s, F-16s and F-35s? Indeed, I’m happy to see some of this addressed in your CoChair report. I urge you to go further.

Next up, the nukes. I think it should be called nuclear encouragement rather than deterrence, because that’s what it seem to be doing, encouraging other countries to build bombs. Have all our nuclear bombs stopped the terrorists from attacking us or anyone else? It would seem not. Do any of our military conflicts present or future look like they will be stopped by the threat of dropping the big one? I think not. So cut away.

Regarding Medicare, decisions need to be made about costly interventions like dialysis (the single biggest drain on the system), organ transplants, end-of-life ICU all out wars against dignity and reality, and expensive new prescription drugs. Any medical device, drug or intervention that has not been proven more effective, and not just marginally more so, in head to head controlled trials than a generic, traditional or lower cost alternative should not be covered by Medicare, or covered at a reduced percentage. And those that are more effective need much tighter protocols on when they are to be used.

Let’s not mess around with the little stuff like PBS and the National Parks. The reason our country is bankrupt has nothing to do with PBS or the parks, and if even it did, their budgets just aren’t big enough to make a dent in the deficits we are now facing.

Taxes, nobody likes to pay them, but the truth is some people can afford to pay more than others. I believe in a much simpler and progressive tax structure. I think it’s clear that budget cuts and freezes alone are not going to do it. If the Commission’s proposal is to have any chance of getting the 14 votes it needs to pass and without which there is little hope of it being approved by Congress in any form likely to do much good, it will have to be bipartisan, meaning more revenue AND less spending. However distasteful to the right or left, revenue will have to be raised. Please keep all taxes and revenue progressive. People or businesses making more money should pay more money as a percentage of their income than those making less. This does not preclude the value or necessity of incentives to our economy and the direction of our growth. Encouraging behaviors through complicated tax loopholes is a game that only those who can afford a CPA can play. Let’s keep it simple. A progressive tax structure with simple and easily applied incentives for behaviors we want to encourage (saving money, education, science, research, small business investment, whatever). When I lived in France I was able to fill out my taxes online in about an hour and still benefited from savings incentives, housing aid etc. The incentives don't have to involve arcane and Gordian knots and loopholes. Simple and progressive.

Thank you for your prompt attention to this matter.

Kevin Lapin
A concerned and voting citizen

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Saturday, May 15, 2010

"Stay Hungry, Stay Foolish"... aka Get Stuck in There!

Yesterday, to my complete surprise, I was taking care of 6 patients as a nurse on a medical-surgical floor. Even just a few weeks before, when this final clinical internship was beginning, I thought I would never, ever be able to do this job. Looking back, I see how the dots connect, from classes, to first fumbling attempts to take a blood pressure, to taking care of 1 patient, then 2, then 4...

That was yesterday. A little over a year before, I was applying to nurse practitioner programs with this idea that I loved theater, but wanted to do more (more challenging, more learning, more rewarding) with the rest of my time. So I took a few classes online and applied to Columbia (see "Poison Ivy League Here I Come").

Before applying, I did some volunteering in the hospital to be sure that the whole medical field thing was what I really wanted to do (and, to be honest, to make my application look better). In a weird circular connection of these little dots that make up the course of one's life, I remember watching two brand new Columbia students fumbling with their sphygmomanometer (blood pressure machine) in the hallway, encouraging each other that it would be okay and trying to build up the nerve to walk into a patient's room. And darned if a year later I wasn't standing on that very same unit, wearing the same navy blue scrubs, knees knocking, wondering if I was going to be able to get that BP reading.

Randomly, I remember another Columbia student that I ran into telling me that school was a lot of work and that there was really more reading than you could do, unless you were in your 30's and didn't have a life. And yes, I think she meant that 'and' in its full tautological or redundant sense, as in if you are in your 30's it's implied that you don't have a life so therefore you would have time to read it all.

Step back a few more years and now it's 2005. I've moved back to Paris, graduated from a bizarre little theater school known for physical theater and collaborative creations and am touring around France performing a two-person comedy about math, called "Mad Maths". Looking back another 10 years to 1995 and I'm graduating Dartmouth College with a degree in French literature and education. I'm thinking I'll take a few years then go back to school to become a professor. The connection to what actually happened is tenuous, especially considering the detour via Amazon.com and Slough, but it's there. Looking forward, the idea of leaving Paris for New York could be predicted, but who'd have imagined I would be a paper-thin diploma away from becoming an RN and another year or two down the road to becoming a nurse practitioner (it's definitely an uphill road)? Nothing can be as fantastical and unbelievable sometimes as life. If it were a play, we might reject it as a little too unrealistic. But then, here we be.

It's these little dots that we somehow blindly connect to make a life out of life. My dad always said that "hindsight is 20/20" and that "it's better to be lucky than good". So true. Jeff Bezos, the CEO of Amazon, would often describe the process as "a sprint and a marathon". Correct again. He also, frustratingly, described the first several years of work as "Day 1". More to the point, he described his approach to life as "a regret minimization framework", which is to say he would try and make decisions in the now that would most probably reduce the chance of regretting things (done or not) later. Poker players and business types might add that you if you are not losing some hands and falling on your face once in a while then you are not taking enough risks. You've got to be in it to win it, right? An "old soul" friend of mine created a mantra once that helps temper this advice by explaining that there are, "So many ways to become number one. So many ways to become number one". My signature block says, "Appreciate beauty in all it's forms" and "Get stuck in there!" And aren't these all different ways of saying the same thing? It's all of a peace. It's all one. And if you are a religious, or scientific, type, you believe that it's not only all one, but that it's already been written. Maktub and Amen.

I want to end this moment of reflection, this graduation of thought, with a superlative address given at Stanford University in 2005. It was given at a time when, if you remember, I was blithely and blindly following my path with heart in France. When I was about two or three thousand miles from a medical-surgical floor of a hospital in New York and would never have guessed that each step would somehow lead me here (or is it there?) to today. The speech is from Steve Jobs, a college dropout whose path to the giving the keynote address at one of the most prestigious places of learning in the country seems equally as improbable and beautiful. Here is what he said:

"Thank you. I'm honored to be with you today for your commencement from one of the finest universities in the world. Truth be told, I never graduated from college and this is the closest I've ever gotten to a college graduation.

Today I want to tell you three stories from my life. That's it. No big deal. Just three stories. The first story is about connecting the dots.

I dropped out of Reed College after the first six months but then stayed around as a drop-in for another eighteen months or so before I really quit. So why did I drop out? It started before I was born. My biological mother was a young, unwed graduate student, and she decided to put me up for adoption. She felt very strongly that I should be adopted by college graduates, so everything was all set for me to be adopted at birth by a lawyer and his wife, except that when I popped out, they decided at the last minute that they really wanted a girl. So my parents, who were on a waiting list, got a call in the middle of the night asking, "We've got an unexpected baby boy. Do you want him?" They said, "Of course." My biological mother found out later that my mother had never graduated from college and that my father had never graduated from high school. She refused to sign the final adoption papers. She only relented a few months later when my parents promised that I would go to college.

This was the start in my life. And seventeen years later, I did go to college, but I naïvely chose a college that was almost as expensive as Stanford, and all of my working-class parents' savings were being spent on my college tuition. After six months, I couldn't see the value in it. I had no idea what I wanted to do with my life, and no idea of how college was going to help me figure it out, and here I was, spending all the money my parents had saved their entire life. So I decided to drop out and trust that it would all work out OK. It was pretty scary at the time, but looking back, it was one of the best decisions I ever made. The minute I dropped out, I could stop taking the required classes that didn't interest me and begin dropping in on the ones that looked far more interesting.

It wasn't all romantic. I didn't have a dorm room, so I slept on the floor in friends' rooms. I returned Coke bottles for the five-cent deposits to buy food with, and I would walk the seven miles across town every Sunday night to get one good meal a week at the Hare Krishna temple. I loved it. And much of what I stumbled into by following my curiosity and intuition turned out to be priceless later on. Let me give you one example.

Reed College at that time offered perhaps the best calligraphy instruction in the country. Throughout the campus every poster, every label on every drawer was beautifully hand-calligraphed. Because I had dropped out and didn't have to take the normal classes, I decided to take a calligraphy class to learn how to do this. I learned about serif and sans-serif typefaces, about varying the amount of space between different letter combinations, about what makes great typography great. It was beautiful, historical, artistically subtle in a way that science can't capture, and I found it fascinating.

None of this had even a hope of any practical application in my life. But ten years later when we were designing the first Macintosh computer, it all came back to me, and we designed it all into the Mac. It was the first computer with beautiful typography. If I had never dropped in on that single course in college, the Mac would have never had multiple typefaces or proportionally spaced fonts, and since Windows just copied the Mac, it's likely that no personal computer would have them.

If I had never dropped out, I would have never dropped in on that calligraphy class and personals computers might not have the wonderful typography that they do.

Of course it was impossible to connect the dots looking forward when I was in college, but it was very, very clear looking backwards 10 years later. Again, you can't connect the dots looking forward. You can only connect them looking backwards, so you have to trust that the dots will somehow connect in your future. You have to trust in something--your gut, destiny, life, karma, whatever--because believing that the dots will connect down the road will give you the confidence to follow your heart, even when it leads you off the well-worn path, and that will make all the difference.

My second story is about love and loss. I was lucky. I found what I loved to do early in life. Woz and I started Apple in my parents' garage when I was twenty. We worked hard and in ten years, Apple had grown from just the two of us in a garage into a $2 billion company with over 4,000 employees. We'd just released our finest creation, the Macintosh, a year earlier, and I'd just turned thirty, and then I got fired. How can you get fired from a company you started? Well, as Apple grew, we hired someone who I thought was very talented to run the company with me, and for the first year or so, things went well. But then our visions of the future began to diverge, and eventually we had a falling out. When we did, our board of directors sided with him, and so at thirty, I was out, and very publicly out. What had been the focus of my entire adult life was gone, and it was devastating. I really didn't know what to do for a few months. I felt that I had let the previous generation of entrepreneurs down, that I had dropped the baton as it was being passed to me. I met with David Packard and Bob Noyce and tried to apologize for screwing up so badly. I was a very public failure and I even thought about running away from the Valley. But something slowly began to dawn on me. I still loved what I did. The turn of events at Apple had not changed that one bit. I'd been rejected but I was still in love. And so I decided to start over.

I didn't see it then, but it turned out that getting fired from Apple was the best thing that could have ever happened to me. The heaviness of being successful was replaced by the lightness of being a beginner again, less sure about everything. It freed me to enter one of the most creative periods in my life. During the next five years I started a company named NeXT, another company named Pixar and fell in love with an amazing woman who would become my wife. Pixar went on to create the world's first computer-animated feature film, "Toy Story," and is now the most successful animation studio in the world.

In a remarkable turn of events, Apple bought NeXT and I returned to Apple and the technology we developed at NeXT is at the heart of Apple's current renaissance, and Lorene and I have a wonderful family together.

I'm pretty sure none of this would have happened if I hadn't been fired from Apple. It was awful-tasting medicine but I guess the patient needed it. Sometimes life's going to hit you in the head with a brick. Don't lose faith. I'm convinced that the only thing that kept me going was that I loved what I did. You've got to find what you love, and that is as true for work as it is for your lovers. Your work is going to fill a large part of your life, and the only way to be truly satisfied is to do what you believe is great work, and the only way to do great work is to love what you do. If you haven't found it yet, keep looking, and don't settle. As with all matters of the heart, you'll know when you find it, and like any great relationship it just gets better and better as the years roll on. So keep looking. Don't settle.

My third story is about death. When I was 17 I read a quote that went something like "If you live each day as if it was your last, someday you'll most certainly be right." It made an impression on me, and since then, for the past 33 years, I have looked in the mirror every morning and asked myself, "If today were the last day of my life, would I want to do what I am about to do today?" And whenever the answer has been "no" for too many days in a row, I know I need to change something. Remembering that I'll be dead soon is the most important thing I've ever encountered to help me make the big choices in life, because almost everything--all external expectations, all pride, all fear of embarrassment or failure--these things just fall away in the face of death, leaving only what is truly important. Remembering that you are going to die is the best way I know to avoid the trap of thinking you have something to lose. You are already naked. There is no reason not to follow your heart.

About a year ago, I was diagnosed with cancer. I had a scan at 7:30 in the morning and it clearly showed a tumor on my pancreas. I didn't even know what a pancreas was. The doctors told me this was almost certainly a type of cancer that is incurable, and that I should expect to live no longer than three to six months. My doctor advised me to go home and get my affairs in order, which is doctors' code for "prepare to die." It means to try and tell your kids everything you thought you'd have the next ten years to tell them, in just a few months. It means to make sure that everything is buttoned up so that it will be as easy as possible for your family. It means to say your goodbyes.

I lived with that diagnosis all day. Later that evening I had a biopsy where they stuck an endoscope down my throat, through my stomach into my intestines, put a needle into my pancreas and got a few cells from the tumor. I was sedated but my wife, who was there, told me that when they viewed the cells under a microscope, the doctor started crying, because it turned out to be a very rare form of pancreatic cancer that is curable with surgery. I had the surgery and, thankfully, I am fine now.

This was the closest I've been to facing death, and I hope it's the closest I get for a few more decades. Having lived through it, I can now say this to you with a bit more certainty than when death was a useful but purely intellectual concept. No one wants to die, even people who want to go to Heaven don't want to die to get there, and yet, death is the destination we all share. No one has ever escaped it. And that is as it should be, because death is very likely the single best invention of life. It's life's change agent; it clears out the old to make way for the new. right now, the new is you. But someday, not too long from now, you will gradually become the old and be cleared away. Sorry to be so dramatic, but it's quite true. Your time is limited, so don't waste it living someone else's life. Don't be trapped by dogma, which is living with the results of other people's thinking. Don't let the noise of others' opinions drown out your own inner voice, heart and intuition. They somehow already know what you truly want to become. Everything else is secondary.

When I was young, there was an amazing publication called The Whole Earth Catalogue, which was one of the bibles of my generation. It was created by a fellow named Stuart Brand not far from here in Menlo Park, and he brought it to life with his poetic touch. This was in the late Sixties, before personal computers and desktop publishing, so it was all made with typewriters, scissors, and Polaroid cameras. it was sort of like Google in paperback form thirty-five years before Google came along. I was idealistic, overflowing with neat tools and great notions. Stuart and his team put out several issues of the The Whole Earth Catalogue, and then when it had run its course, they put out a final issue. It was the mid-Seventies and I was your age. On the back cover of their final issue was a photograph of an early morning country road, the kind you might find yourself hitchhiking on if you were so adventurous. Beneath were the words, "Stay hungry, stay foolish." It was their farewell message as they signed off. "Stay hungry, stay foolish." And I have always wished that for myself, and now, as you graduate to begin anew, I wish that for you. Stay hungry, stay foolish.

Thank you all, very much." --Quoted from Free Republic

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Saturday, April 3, 2010

How the internet and a little ingenuity saved my life!

Okay it didn't save my life, but it did save a bundle of money and calories... On the heels of our recent magic bullet blow-up, juicer-gate, Kevin Trudeau's Ultra Mega Memory (or what is Super Mega Memory) tapes, and a closet full of exercise implements that would make the Marquis de Sade blush--all As Seen On TV, or more appropriately as seen on late night TV when your faculties of reason and discernment are half-asleep--I am happy to announce a small victory against this dastardly tide of gadgets. With a little ingenuity, and paradoxically the Internet, I managed to turn back the clock in our kitchen to cooking 1.0. And I saved us about $200 in the process. Johnny, I know you'll dig this part the most, but for the rest of you read on for a fabulous tip on how to clean your own super-mega magic thing...

Allow me to introduce, the blender. Yes, that modern yet retro, that sleek yet 70's item that you probably have stashed in a closet since your wedding or since you replaced it with some newer and much more expensive culinary gadget that promised it would do away with all the other gadgets that came before it and that was touted as what the French call "le must de la cuisine".

Well I'm happy to report that I just talked Debbie down from her Magic Bullet, Health Master, Vita-Mix infomercial buying mania with a simple, yet elegant steel and glass blender by Oster (imaged here) and the power of a little thing we call the scientific process. Here's how I did it:

1) Leave the product's flashy website and flash video demonstrations (though this is where I did get that cleaning tip I'll tell you about in a second) and go to a reputable resource like ConsumerReports.org or ConsumerSearch.com. Read a few reviews about the different products. Concentrate on the negatives.

2) Drop a carrot, an onion, a few stalks of broccoli and some water in the blender you have and see how good of a purée it makes. Add salt and pepper to taste and heat.*

3) Drop a banana, a couple clementines, a dollop of yogurt, a few ice cubes and some water in the blender and see how good of a smoothie it makes.

4) Review your recent bank statements and see whether spending $300-400 on a super blender makes sense.

5) Buy a $5 Good Housekeeping blender recipe book used from Amazon promising over 150 sensational recipes on soups, appetizers, smoothies, baby food and more.

6) Do a little victory dance as the ineluctable power of your demonstration sets in.**

* If you try this, you'll understand the need for #5.
** You may want to skip this for the sake of better relations.

I have to admit that I got a bit lucky because it just so happens that way back in the early 21st century when I bought my blender at Target I grabbed the stainless steal and glass pitcher one by Oster, more because I thought it looked good than, as it turns out, because it was recommended as one of the best. The point is, these blenders go for about $60. With depreciation, the recipe book and avoiding buying one of those other gizmos, I reckon we saved well over $200 with our little admittedly pseudo-scientific experiment.

So what's in it for you? Those of you who have already shilled out for some other gizmo? Those for whom it is too late to benefit from our experience and sage advice? Well, here is a great little tip to make cleaning your own personal blenderizer thingy "simple comme bonjour": after you blend, do a quick rinse then add warm water and dish soap and blend that for a few seconds. Can't you just see and feel the potentially lost years of your life just anti-oxidizing away?

By the way, no need to send me a thank you card as there is no address down here in Margaritaville where we will soon be wasting away... from all the calories and money we save of course!

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Thursday, March 25, 2010

What I did for my Birthday...

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Wednesday, March 24, 2010

Time 2 Rn

10pm and I'm still @ the hospital. This is s/p day 2 working w/ a nurse. Also approx. day 5 of juice fast b/c of prolonged ↑ dietary intake. Calculation approx. r/t friend in NYC last pm → a macrobiotic meal. Thankfully, all Pts remain stable through hand-off to night shift. Log entry: "Subject woke at 5:45am today. Reports feeling like he has been sprinting since."

In keeping with the MD lexicon, I will say that my preceptor is +++, though she is d/c'ing me for a week to go to Haiti. As if they need her help more than I do (kidding!). She started me right away caring for 3.0 patients, top to bottom and side-to-side. I feel a little scared/nervous and overwhelmed just about every second from when we take report at 8am to when we give report to the night shift at 8pm. Lunch lasted about 20', during which time I was not scared.

Something about the patients, the pace of work and frenetic action makes it almost impossible to feel hungry or tired, or sorry for yourself. In fact, working in health care generally makes you content with simple things like your health, a good meal, a good shower, a good hug, a bit of sunshine, and being able to pass a good BM in the peace and quiet of your own home (ideally with a book or magazine if you are a true Lapin).

Time management is key. Knowledge is helpful, particularly where it involves not making a mistake (or not catching someone else's) that will cause Pt. sequella. Unfortunately, the demands of documentation and Rx mean that there is almost 0 time for much of what traditionally might be considered nursing. The whole caring, advocating and helping people thing. The chronophagistic (chronophagal?) aspect also makes it hard sometimes to do things like go to the bathroom, look up new information, call your sweetheart etc. You know, that type of thing. Or to paraphrase Woody Allen's "Irish Genius" remember to rejoice, rejoice and call your mother once in a while.

My dad actually warned me about not letting medicine suck me in so far that I lose sight of the rest of life. Case in point, I'm here at 10:16pm, doing a Hx and Pe on a Pt and collecting info on him for a case presentation at school. As for real life, tomorrow is my birthday and I have big plans with Debbie. I am also desperately trying to fit a new play, PT, friends, NCLEX, a job hunt and maybe a trip to South Korea in as well. Oh my, time 2 Rn...!

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Thursday, February 11, 2010

Once more unto the breach, dear friends, once more...

The game is truly afoot, dear friends, and with just a couple weeks until the "Health Care Summit" on February 25, I urge you dishonour not your mothers, follow your spirit and upon this charge cry 'Give us substantive health care reform!'

The breach that needs filling today is not the gap in the wall of Hafleur but the gap in health care access, cost and quality. What I'm asking you is über-simple: contact your state representatives and the media and show them your mettle. One website allows you to do both with a couple clicks and you can use the following letter as you see fit, or compose your own, to tell them just what you want them to do.

THE LINK
http://my.barackobama.com/page/content/health-care-action-center/?source=20100209_ms_launch

THE LETTER
I am writing to you as a member of [INSERT YOUR COMPANY or ORGANIZATION NAME] because today offers a special opportunity to make history through the passage of substantive and intelligent health care reform. We believe that today we have come too far to turn back and that many lives, not just elections, will be lost if we do not make changes to the way health care is accessed, paid for, regulated and researched in our country. The stakes may never have been higher.

We believe in giving the best evidenced-based medical care that money can buy, and giving it so that it helps the greatest number of people. We believe in a fair and compassionately regulated system that guarantees every member of our society a minimum level of care and services while still encouraging the best that innovation and research has to offer.

In short, we believe in the following fundamental areas of reform and we believe that a majority of rational and compassionate Americans like us would agree to their necessity:

Prevention… we believe that an ounce of prevention is worth a pound of cure, and costs less too. We need to support and expand primary care, preventative care as well as community-based and home-based care.

Research… providers need to be free to do what is best for the patients that they know best, but they deserve to have the best guidelines, protocols and clinical research possible to help guide them in their decisions. We support Evidenced Based Medicine which means more high quality and unbiased comparative trials and research. More longitudinal meta-anayses. More safety studies. This is a job for someone like the NIH, not drug companies or groups that have vested interests.

Choice… people should be able to choose their doctor and should have at least several insurance plans available to them. This is not the case in many areas of the country or with many employers, which is why we advocate for public options and national exchanges where individuals and groups can shop for insurance plans in a regulated and fair market.

Cost… there will always be a finite amount of resources. The question is how they are allocated. These decisions should not be driven by profit, but from a public health perspective of what will do the most good for the most number of people. Currently there are insurance companies telling providers what they can and cannot do, we believe these decisions would be better made by public health officials. We also need out of pocket caps for policyholders because there is no point in having insurance if you can go bankrupt when something goes wrong. Finally, we need to lift the yearly caps for insurance companies because there is also no point in getting chemotherapy for cancer only to die of a cold because you passed your yearly limit.

Accountability… taking care of people is a serious responsibility and all aspects of the system need to be held accountable. Nevertheless, punitive malpractice suits may not be the best way to do this. We need to put an end to defensive medicine by reforming malpractice law. National oversight and regulation of hospitals, payers and providers is a better way to enforce policy, set best practices and create accountability.

Access… the best health care in the world is all for naught if there is not adequate access to it. This means starting with giving access to the millions of uninsured, but it also means guaranteeing proper access to the basics of a healthy lifestyle: fresh fruits and vegetables, clean air and water, reproductive services, and education about age appropriate diet and exercise.

Because we hold these ideas to be vital to the very survival of our health care system, economy and moral fiber as a nation, we urge you to take action now!

We urge you to pass a substantive, intelligent and compassionate health care reform package that includes the fundamental issues described above.

Respectfully yours,
A concerned and voting citizen

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Tuesday, February 2, 2010

Ethiopia 2009--super Gobez!

Debbie and I are going to spend the holidays warming up under the African sun, or at least that's the plan. This is also my "meet the parents" trip. No pressure, but Debbie's high-school friends used to call her dad "the General". I've already met several of Debbie's aunts and cousins here in the city and I'm hoping that their preliminary reports will have helped laid the ground work for the coming encounter. Debbie has not been helping things by telling me about all the things I should watch out for in terms of etiquette, like standing up when her parents enter the room, not talking with my hands in my pockets, not licking my fingers, and how elders from the village might spit on us as a sign of respect--and this is exactly what happens to Debbie when she is getting her personal blessing after St. Gabriel's, though the man spits towards her hands that he is holding rather than on her head or face...

But let's start at the beginning, our trip really begins in the Dulles airport where we are stuck for over three 3 hours. We’ve already avoided a blizzard in New York and this delay makes a long trip seem even more punitive. It’s funny because as we were walking through the terminal we overheard a boarding announcement explaining that the airport is really busy so the flight to Cancun would be using a temporary boarding gate. We find, however, our Ethiopian Airlines flight at the far end of the terminal all alone with several empty gates around it. It’s almost as if it has been quarantined here so other flights or airlines can go about their on-time business without being affected. As these things go, there is no clear reason why we are not boarding the plane that is sitting right there. At one point they announce we are waiting for “the boarding agent to bring a document” which could mean anything or nothing, then later they claim we are delayed due to the weather. The runways are clear, however, and the flight to Cancun is long gone, so go figure. The pilots and crew do not seem phased and sit in a cluster chatting or napping in the corner. We are still in DC, but somehow we are already on African time.

Speaking of African time, Debbie has always had her own sense of tardiness. She is never late for court, but misses our fourth or fifth date because she was taking a three-hour shower. It's what I call DST (Debbie Standard Time) or what Polly Platt might call quark-chronics. Here in Ethiopia, things definitely move at their own pace. When we wake up at 3:30 pm (yeah that's right, I said it) it is actually 9:30 pm Habesha or Ethiopian time. So if you ask someone when they are coming over to fix the plumbing, for example, you may need to clarify whether you are talking about Habesha or Ferengi time--not that it means they will arrive à l'heure, of course.

One explanation for why Ethiopia has it's own clock is that because it is so close to the equator, days are generally 12 hours all year round (and nights as well), so Ethiopians got into the habit of counting the hours from sun up to sun down, which is about 6 hours different from what the folks in Greenwich would have you believe (sometimes six hours less, sometimes more). There are also 13 months in the Ethiopian calendar year and a difference of about 7 or 8 years in the date, depending on whether you arrive before or after the Ethiopian New Year in September. This embassy webpage provides a good explanation of it all and how it came about.

When you talk about Ethiopia, Western people often think of two things: famine and coffee. True besides coffee exports, the Ethiopian economy is based heavily on subsistence agriculture which makes it vulnerable to crop failure and famine, but in spite of this, or perhaps because of this, Ethiopian culture practically revolves around eating. It is considered almost insulting, for example, to go to someone’s house and not eat seconds or even thirds. I’ve learned this the hard way as Debbie’s aunt locks eyes with me and then slowly extends a finger back towards the buffet table. Blurp. The trick is to start low and go slow. Don’t put too much on your plate, eat slowly and always have something on there. Because an empty plate is apparently a sign for give me another large helping in the Horn of Africa.

The story I love the best about Debbie’s mom, who is definitely one of the kindest, sweetest women on earth, involves her passing me the bread basket one night. This was about day 8 or 10 of the trip and I have just gotten over being sick. I’m almost grateful for my flu, however, because I haven’t eaten anything for like 24-hours and my stomach is no longer feeling like a packed canon. I’m trying to reach for a small piece of bread but somehow the basket keeps moving and my hands find themselves over the biggest piece in the basket. When I finally realize what is going on, I look up to see Debbie’s mom with a huge smile on her face. So sweet.

Ethiopian food is definitely delicious, and fun to eat too! Ethiopians love meat, but they also have a lot of vegetarian options. The Ethiopian Orthodox Church prescribes fasting, eating vegetarian, twice a week as well as for extended periods around Christmas and Easter. What makes Ethiopian dining really fun is that you get to eat with your hands. The idea is to use the flat crêpe-like bread called injera to gather up a mixture of stuff without getting any on your fingers (thus the proscription against licking one's fingers).

The meat in Ethiopia is also worth mentioning. I think it has something to do with its local and non-industrialized raising and processing. Whatever it is, it’s really flavorful and delicious. This wonderful meat experience is called tibs (pronounced with a sort of retroflex ‘t’). Basically, it’s a large side of raw beef (it’s really cow or carcass still at this point) hanging behind a counter that you have the guy slice for you. They take away the kilograms that you order and return with a plate full of steaming fajita-like tibs that you can dip in spicy mustard or berberé sauce. It melts in your mouth. In fact it was so good, we went back again the next night (see the video for more tibs action).

Another unique thing about Ethiopian cuisine is the butter. When I first visited Ethiopia, my friend’s host family showed me these huge blocks of butter and explained how they got them from their hometown outside the capital and how they would store in the cupboard for months or years. That doesn’t sound good, I thought, but I was wrong, because the butter is clarified, like ghee from India, so it really doesn’t spoil because the organic fats have been removed during the clarification process.

One of my favorite Ethiopian traditions around eating is what’s called a gursha. A gursha is when you grab a bunch of tibs or wet-ever (wet or sometimes wot is another yummy dish so that’s a transliteration pun) and then feed it to your guest or loved one. It’s very sensual and very fun. Kind of like when the bride and groom feed each other the cake at the wedding, except Ethiopians do it all the time.

The final thing that has to be discussed is Ethiopian coffee. Ethiopian coffee beans are excellent (much like their Kenyan neighbors) and can be found all over the world, thanks for better or for worse to places like Starbucks. In Ethiopia, coffee is call buna and is often served as part of a ceremony that involves roasting, grinding and infusing the beans right there in front of you. As you drink it, frankincense is usually burnt giving the whole experience a magical air.

As I said before, we are a bit surprised with the weather during the trip, with bouts of rain and average temperatures below the usual 70s. Addis is at 7-8 thousand feet of altitude so one expects it to be cold at night. On several occasions, we light a fire in the living room and practice some traditional dancing--which involves a lot of shoulder action. I realize I look like a chicken on the video, but you’ll get the idea from watching the others.

Christmas is approaching and we are having some trouble finding an appropriate tree because 1) pine is not part of Ethiopia's native flora and 2) it is currently illegal to cut any trees down. This means we have to choose between a potted tree from the plant nursery--which contrary to what you might think has an incredible selection of flowers and plants, just not pine trees--or a fake one. We end up getting both, but the branches of the tree won’t hold the decorations so it will have to wait until next year. What a great idea, making it illegal to cut down trees like this. Why shouldn't everyone have a live tree for Christmas? It would be less of a fire hazard and much better for the ozone. After Christmas it could be a tradition to go out into the woods (or your backyard) and replant the tree, or you could just keep watering it until next year. Okay, I realize that the whole root thing would make it well nigh impossible to have a large tree, but maybe a few could still be cut down for municipal displays or the Rockefeller center type thing. I’m just thinking out loud here…

We are having our big Turkey and stuffing meal today, the day after Christmas. Mostly because yesterday was Friday, a fasting day. So we will be opening our gifts and celebrating today. Much like other Orthodox churches, the ceremonies here are quite long and elaborate. For the most part they are conducted in a language called Ge’ez which is an even more ancient language than Amharic and more directly related to the country’s coptic origins. Women, I am told, are not supposed to attend services if they are menstruating, and apparently when she was young ,Debbie was able to use this excuse at any old time of the month to get out of going to church and the men were none the wiser. These things do remain a mystery to most of us men, don’t they?

After Christmas we spend several days in Woliso, where Debbie's father was born. It’s about 60 km west of Addis. A small town with a church her father built in honor of his father who was a famous General under Haile Sellasie. In fact, when the Emperor was overthrown, Debbie’s family, like many in Ethiopia, had to flee the country for fear of retributions. This is why Debbie was born and raised in Rome. Her family still owns property in Woliso. The land and farmhouse go back several generations. Debbie’s uncle lives there and is turning the land into a proper farm with honey, apples, teff (the grain that is used to make injera), and of course tej which is a meady, honey-beer like drink that many households brew out back as it were. The stuff will put you down if you can keep it down, is all I’m going to say on that topic.

The 27th is Saint Gabriel’s, a big holiday in the Ethiopian Orthodox Church, and people come from kilometers around to chant and pray all night long and most of the day. The prayers are broadcast over speakers so the huge crowd that gathers around the church and that can't fit inside can participate too. It's a really beautiful moment and we don't want to leave. Several priests and the bishop, head of the local diocese, come over to the farmhouse after the ceremonies to break their fast with us. It’s a huge feast and celebration--you really have to watch the video to see what I mean. It is very interesting being in such a big crowd and being the only white person. Especially in a small town/village like Woliso, it makes you something of a spectacle--kind of like being Brad Pitt or Angelina Jolie for the day. You either get used to the staring (and sometimes pointing and touching), or you don’t. Every aspiring actor should give it a try.

There is also a village elder, who is something like 98 or 100 years old, who gives Debbie and her brother Gulu a personal blessing (this is when the spitting happens). The elder and priests mostly speak in Orominia (the local language of the Oromo region), and the translation of the blessing seems a little short compared to the length of the speech but apparently breaks down to telling Debbie and her brother that they should get married and have kids, by next year if possible!

It’s New Years now and we spend the countdown flipping between the French and Italian TV stations, both of which are airing their traditional réveillon galas. One features three 8 year-old kids covering bad Euro-pop songs and soccer highlights from several seasons back, the other decides to cut to a sponsor's logo with 30 seconds left in the countdown and spends half the time promoting the guest commentators' latest albums and tours. Thank god for the Champagne and Pandoro or I would be worried about Europe. 2010, woohoo...!

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Friday, September 11, 2009

Stand Up, Speak Out!

It's shocking how obedient we are sometimes. Maybe it comes from our distant evolutionary past where it paid to stay with the herd, follow the alpha male, lest a mountain lion drop out of a tree and gobble you up. If you've had the occasion to observe a 'pack' of 7th graders roaming your local subway system or mall, then you might think it's not such a distant genetic influence I'm talking about.

Maybe we should blame our kindergarten teachers for doing such a good job of socializing us, imposing all those rules that we learned to obediently follow like sit up straight, don't fidget, don't talk out of turn and most of all the teacher is always right and you have to do what they say.

In John Holt's classic book How Children Fail, he observes elementary children and classrooms with piercing clarity, reminding us how scary school, not to be confused with education, was (or is) for most of us and how so much of what passes for teaching is really anathema to our natural curiosity and affinity for learning--especially as young children. In a telling example, Holt explains how he would talk to kids and ask them questions like what do you want to be when you grow up? Another question he would always ask was who thinks they have a good imagination? When he asked this question to a preschool or kindegarten class all the children would raise their hands and often yelp or bounce around to let him know, hey yes, over here, look at me, I've got one, I've got one! In first grade, he continues, maybe 3/4 or 1/2 the class would raise their hands. And by second grade, only a handful and timid few would raise their hands. School had either killed their curiosity and imagination or made them too self-conscious and scared to admit they had any.

And that's just it, either way the ship is sort of sunk. And things don't get much better when we grow up to be big strong adults either. We mostly still fear being different, changing going against the grain, against the herd. We're sheepish that society or the person sitting across from us on the subway will point to us and say, "that's baaaaaaaaaaaad."

It's shocking really how few people will stand up and say something in the face of racist, sexist, fascist, mean or just plain stupid words and deeds. We hope that we will be different when the time comes for true heroism, running into a burning tower, hiding a fugitive Anne Frank, but we mostly don't sweat the small stuff, right? And the problem is, to paraphrase the popular self-help book, at the end of the day, or a life, it has all ended up being small stuff. Minor affronts that slowly shred the fiber of our society through the death of a thousand cuts. Of course there will always be a brave or foolhardy few, but most of us will obediently press the button when we are told even when the results are cruelly and clearly splayed out in front of us.

I'm talking, of course, about a study that was somewhat unscrupulously carried out to study man (and woman's) violent and dangerous obedience to authority. It's called the Milgram Study. Basically, researchers told recruited volunteers that they were going to partake in a study of learning and memory. Each subject was told that they had to teach a student and to punish their errors by administering increasing levels of electric shocks. The "student" was a confederate of the researchers who pretended to be a poor learner and mimicked pain and even unconsciousness as the subjects increased the levels of electric shock. An incredible (or maybe not so incredible) 63% of the subjects went as far administering shocks marked as "lethal"; some even after the "student" claimed to have heart disease.

Now we may not be the most proactive of species, in terms of standing up and speaking out about oppression, injustice and the like, but we are a repentant lot. Apparently some of the test subjects experienced serious emotional crises after being "debriefed" from the study. Yes, we love our fallen angels who sob their apologies and weakness from the pulpit of their sins. It's an interesting evolutionary trait, actually. What evolutionary advantage does remorse confer on an individual?

I suppose nothing if we don't learn from our mistakes. And as John Holt so clearly explains, we don't learn well when we are scared. We tend to just shut up, play dumb, or just go along with the group hoping nobody notices us.

So here's a plug for standing up, speaking out, being noticed and not being afraid to speak our minds. Post your comments below, or better yet, click here and tell your congressional representative!

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Tuesday, August 18, 2009

Your representative is waiting for your call

Do not give up on serious health care reform. Your senators and representatives are waiting, begging even to hear from you before Congress reconvenes. Many of their jobs may rightly depend on how they vote, so they need to know what you want them to do. I just made three calls to voice my support (particularly for saving the public plan) and it took about 5 minutes. Here is a link that will help you call and/or email (calling is better) the president, your senators and your local representatives: http://www.usa.gov/Contact/Elected.shtml

Everyone needs and deserves basic health care coverage, prevention and education. The physical, spiritual and economic health of our country depends on it.

Doctor's and patients need access to unbiased research and information comparing treatment options and pharmaceuticals. This is a job for someone like the NIH, not drug companies or insurance companies or politically appointees who have vested interests.

Drug rationing already exists so let's not fear it. Doctors and patients are told everyday by insurance companies what they can and cannot do. What we are talking about is taking the rationing out of the hands of people who have a financial incentive to order more or less tests--often doctors and hospitals in the first case and insurance companies in the latter. Whatever the system, here or in Canada, socialized, nationalized or just plain old Americanized, people with money (like you?) will always be able to afford paying for the doctor, procedure or drug that you want or believe you need, so let's not ruin it for all the people who can't afford to pay and currently get what my Dad calls "bupkiss".

Dying with dignity, in comfort and without a bankrupting ICU bill is a right that we should all be encouraged to exercise. It's very personal, but if you do not have a health care proxy, living will, DNR etc., then the hospital will be making the decisions for you--which will involve putting you on every machine and ventilator known to man whether there is any hope of recovery or not and regardless of how uncomfortable it may be. Not being able to speak or move and living in an ICU with an artificial respirator is both painful and expensive. There are times where it could save your life, but there are times where it cannot, and only prolongs it, assuming you consider that a life. These are the situations where you need a living will or health care proxy to help you have the end of life that you want. This isn't death camps, but it does involve taking some time to consider these important end of life decisions and then making them known to your family and physicians. Here is a simple website that can help you create a health care proxy or living will: http://www.doyourproxy.org/

A co-op is not a reliable alternative to a public health option. This New York Times article does a great job of describing the potential risks and benefits of co-ops: http://prescriptions.blogs.nytimes.com/2009/08/17/so-whats-a-health-insurance-coop-anyway/?ref=health

Finally...

7 Reasons We Need Health Insurance Reform Now

1. Coverage Denied to Millions: A recent national survey estimated that 12.6 million non-elderly adults – 36 percent of those who tried to purchase health insurance directly from an insurance company in the individual insurance market – were in fact discriminated against because of a pre-existing condition in the previous three years or dropped from coverage when they became seriously ill. Learn more: http://www.healthreform.gov/reports/denied_coverage/index.html

2. Less Care for More Costs: With each passing year, Americans are paying more for health care coverage. Employer-sponsored health insurance premiums have nearly doubled since 2000, a rate three times faster than wages. In 2008, the average premium for a family plan purchased through an employer was $12,680, nearly the annual earnings of a full-time minimum wage job. Americans pay more than ever for health insurance, but get less coverage. Learn more: http://www.healthreform.gov/reports/hiddencosts/index.html

3. Hard Times in the Heartland: Throughout rural America, there are nearly 50 million people who face challenges in accessing health care. The past several decades have consistently shown higher rates of poverty, mortality, uninsurance, and limited access to a primary health care provider in rural areas. With the recent economic downturn, there is potential for an increase in many of the health disparities and access concerns that are already elevated in rural communities. Learn more: http://www.healthreform.gov/reports/hardtimes

4. Small Businesses Struggle to Provide Health Coverage: Nearly one-third of the uninsured – 13 million people – are employees of firms with less than 100 workers. From 2000 to 2007, the proportion of non-elderly Americans covered by employer-based health insurance fell from 66% to 61%. Much of this decline stems from small business. The percentage of small businesses offering coverage dropped from 68% to 59%, while large firms held stable at 99%. About a third of such workers in firms with fewer than 50 employees obtain insurance through a spouse. Learn more: http://www.healthreform.gov/reports/helpbottomline

5. The Tragedies are Personal: Half of all personal bankruptcies are at least partly the result of medical expenses. The typical elderly couple may have to save nearly $300,000 to pay for health costs not covered by Medicare alone. Learn more: http://www.healthreform.gov/reports/inaction

6. Diminishing Access to Care: From 2000 to 2007, the proportion of non-elderly Americans covered by employer-based health insurance fell from 66% to 61%. An estimated 87 million people - one in every three Americans under the age of 65 - were uninsured at some point in 2007 and 2008. More than 80% of the uninsured are in working families. Learn more: http://www.healthreform.gov/reports/inaction/diminishing/index.html

7. The Trends are Troubling: Without reform, health care costs will continue to skyrocket unabated, putting unbearable strain on families, businesses, and state and federal government budgets. Perhaps the most visible sign of the need for health care reform is the 46 million Americans currently without health insurance - projections suggest that this number will rise to about 72 million in 2040 in the absence of reform. Learn more: http://www.WhiteHouse.gov/assets/documents/CEA_Health_Care_Report.pdf

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Dave Barry: a journey into my colon--and yours!

OK. You turned 50. You know you're supposed to get a colonoscopy. But you haven't. Here are your reasons:

1. You've been busy.
2. You don't have a history of cancer in your family.
3. You haven't noticed any problems.
4. You don't want a doctor to stick a tube 17,000 feet up your butt.

Let's examine these reasons one at a time. No, wait, let's not. Because you and I both know that the only real reason is No. 4. This is natural. The idea of having another human, even a medical human, becoming deeply involved in what is technically known as your 'behindular zone' gives you the creeping willies.

I know this because I am like you, except worse. I yield to nobody in the field of being a pathetic weenie medical coward. I become faint and nauseous during even very minor medical procedures, such as making an appointment by phone. It's much worse when I come into physical contact with the medical profession. More than one doctor's office has a dent in the floor caused by my forehead striking it seconds after I got a shot.

In 1997, when I turned 50, everybody told me I should get a colonoscopy. I agreed that I definitely should, but not right away. By following this policy, I reached age 55 without having had a colonoscopy. Then I did something so pathetic and embarrassing that I am frankly ashamed to tell you about it.

What happened was, a giant 40-foot replica of a human colon came to Miami Beach. Really. It's an educational exhibit called the Colossal Colon, and it was on a nationwide tour to promote awareness of colo-rectal cancer. The idea is, you crawl through the Colossal Colon, and you encounter various educational items in there, such as polyps, cancer and hemorrhoids the size of regulation volleyballs, and you go, "Whoa, I better find out if I contain any of these things," and you get a colonoscopy.

If you are as a professional humor writer, and there is a giant colon within a 200-mile radius, you are legally obligated to go see it. So I went to Miami Beach and crawled through the Colossal Colon. I wrote a column about it, making tasteless colon jokes. But I also urged everyone to get a colonoscopy. I even, when I emerged from the Colossal Colon, signed a pledge stating that I would get one. But I didn't get one. I was a fraud, a hypocrite, a liar. I was practically a member of Congress.

Five more years passed. I turned 60, and I still hadn't gotten a colonoscopy. Then, a couple of weeks ago, I got an e-mail from my brother Sam, who is 10 years younger than I am, but more mature. The email was addressed to me and my middle brother, Phil. It said:

"Dear Brothers,

"I went in for a routine colonoscopy and got the dreaded diagnosis: cancer. We're told it's early and that there is a good prognosis that they can get it all out, so, fingers crossed, knock on wood, and all that. And of course they told me to tell my siblings to get screened. I imagine you both have."

Um. Well.

First I called Sam. He was hopeful, but scared. We talked for a while, and when we hung up, I called my friend Andy Sable, a gastroenterologist, to make an appointment for a colonoscopy. A few days later, in his office, Andy showed me a color diagram of the colon, a lengthy organ that appears to go all over the place, at one point passing briefly through Minneapolis. Then Andy explained the colonoscopy procedure to me in a thorough, reassuring and patient manner. I nodded thoughtfully, but I didn't really hear anything he said, because my brain was shrieking, quote, "HE'S GOING TO STICK A TUBE 17,000 FEET UP YOUR BUTT!"

I left Andy's office with some written instructions, and a prescription for a product called 'MoviPrep,' which comes in a box large enough to hold a microwave oven. I will discuss MoviPrep in detail later; for now suffice it to say that we must never allow it to fall into the hands of America's enemies.

I spent the next several days productively sitting around being nervous. Then, on the day before my colonoscopy, I began my preparation. In accordance with my instructions, I didn't eat any solid food that day; all I had was chicken broth, which is basically water, only with less flavor. Then, in the evening, I took the MoviPrep. You mix two packets of powder together in a one-liter plastic jug, then you fill it with lukewarm water. (For those unfamiliar with the metric system, a liter is about 32 gallons.) Then you have to drink the whole jug. This takes about an hour, because MoviPrep tastes -- and here I am being kind -- like a mixture of goat spit and urinal cleanser, with just a hint of lemon.

The instructions for MoviPrep, clearly written by somebody with a great sense of humor, state that after you drink it, "a loose watery bowel movement may result." This is kind of like saying that after you jump off your roof, you may experience contact with the ground.

MoviPrep is a nuclear laxative. I don't want to be too graphic, here, but: Have you ever seen a space shuttle launch? This is pretty much the MoviPrep experience, with you as the shuttle. There are times when you wish the commode had a seat belt. You spend several hours pretty much confined to the bathroom, spurting violently. You eliminate everything. And then, when you figure you must be totally empty, you have to drink another liter of MoviPrep, at which point, as far as I can tell, your bowels travel into the future and start eliminating food that you have not even eaten yet.
After an action-packed evening, I finally got to sleep. The next morning my wife drove me to the clinic. I was very nervous. Not only was I worried about the procedure, but I had been experiencing occasional return bouts of MoviPrep spurtage. I was thinking, "What if I spurt on Andy?" How do you apologize to a friend for something like that? Flowers would not be enough.

At the clinic I had to sign many forms acknowledging that I understood and totally agreed with whatever the hell the forms said. Then they led me to a room full of other colonoscopy people, where I went inside a little curtained space and took off my clothes and put on one of those hospital garments designed by sadist perverts, the kind that, when you put it on, makes you feel even more naked than when you are actually naked.

Then a nurse named Eddie put a little needle in a vein in my left hand. Ordinarily I would have fainted, but Eddie was very good, and I was already lying down. Eddie also told me that some people put vodka in their MoviPrep. At first I was ticked off that I hadn't thought of this, but then I pondered what would happen if you got yourself too tipsy to make it to the bathroom, so you were staggering around in full Fire Hose Mode. You would have no choice but to burn your house.

When everything was ready, Eddie wheeled me into the procedure room, where Andy was waiting with a nurse and an anesthesiologist. I did not see the 17,000-foot tube, but I knew Andy had it hidden around there somewhere. I was seriously nervous at this point. Andy had me roll over on my left side, and the anesthesiologist began hooking something up to the needle in my hand. There was music playing in the room, and I realized that the song was Dancing Queen by Abba. I remarked to Andy that, of all the songs that could be playing during this particular procedure, Dancing Queen has to be the least appropriate.

"You want me to turn it up?" said Andy, from somewhere behind me.

"Ha ha," I said.

And then it was time, the moment I had been dreading for more than a decade. If you are squeamish, prepare yourself, because I am going to tell you, in explicit detail, exactly what it was like.

I have no idea. Really. I slept through it. One moment, Abba was shrieking Dancing Queen! Feel the beat from the tambourine... and the next moment, I was back in the other room, waking up in a very mellow mood. Andy was looking down at me and asking me how I felt. I felt excellent. I felt even more excellent when Andy told me that it was all over, and that my colon had passed with flying colors. I have never been prouder of an internal organ.

But my point is this: In addition to being a pathetic medical weenie, I was a complete moron. For more than a decade I avoided getting a procedure that was, essentially, nothing. There was no pain and, except for the MoviPrep, no discomfort. I was risking my life for nothing.

If my brother Sam had been as stupid as I was -- if, when he turned 50, he had ignored all the medical advice and avoided getting screened -- he still would have had cancer. He just wouldn't have known. And by the time he did know -- by the time he felt symptoms -- his situation would have been much, much more serious. But because he was a grown-up, the doctors caught the cancer early, and they operated and took it out. Sam is now recovering and eating what he describes as "really, really boring food." His prognosis is good, and everybody is optimistic, fingers crossed, knock on wood, and all that.

Which brings us to you, Mr. or Mrs. or Miss or Ms. Over-50-And-Hasn't-Had-a-Colonoscopy. Here's the deal: You either have colo-rectal cancer, or you don't. If you do, a colonoscopy will enable doctors to find it and do something about it. And if you don't have cancer, believe me, it's very reassuring to know you don't. There is no sane reason for you not to have it done.

I am so eager for you to do this that I am going to induce you with an Exclusive Limited Time Offer. If you, after reading this, get a colonoscopy, let me know by sending a self-addressed stamped envelope to Dave Barry Colonoscopy Inducement, The Miami Herald, 1 Herald Plaza, Miami, FL 33132. I will send you back a certificate, signed by me and suitable for framing if you don't mind framing a cheesy certificate, stating that you are a grown-up who got a colonoscopy. Accompanying this certificate will be a square of limited-edition custom-printed toilet paper with an image of Miss Paris Hilton on it. You may frame this also, or use it in whatever other way you deem fit.

But even if you don't want this inducement, please get a colonoscopy. If I can do it, you can do it. Don't put it off. Just do it.

Be sure to stress that you want the non-Abba version.

Colonoscopies are no joke, but these comments during the exam were quite humorous... A physician claimed that the following are actual comments made by his patients (predominately male) while he was performing their colonoscopies:

1. Take it easy, Doc. You're boldly going where no man has gone before!

2. Find Amelia Earhart yet?

3. Can you hear me NOW?

4. Are we there yet? Are we there yet? Are we there yet?

5. You know, in Arkansas , we'd now be legally married.

6. Any sign of the trapped miners, Chief?

7. You put your left hand in, you take your left hand out...

8. Hey! Now I know how a Muppet feels!

9. If your hand doesn't fit, you must quit!

10. Hey Doc, let me know if you find my dignity.

11. You used to be an executive at Enron, didn't you?

And the best one of all.
12. Could you write a note for my wife saying that my head is not up there!

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Thursday, June 18, 2009

This I believe: Be cool to the pizza dude!

"If I have one operating philosophy about life it is this: 'Be cool to the pizza delivery dude; it's good luck.' Four principles guide the pizza dude philosophy.

Principle 1: Coolness to the pizza delivery dude is a practice in humility and forgiveness. I let him cut me off in traffic, let him safely hit the exit ramp from the left lane, let him forget to use his blinker without extending any of my digits out the window or towards my horn because there should be one moment in my harried life when a car may encroach or cut off or pass and I let it go. Sometimes when I have become so certain of my ownership of my lane, daring anyone to challenge me, the pizza dude speeds by me in his rusted Chevette. His pizza light atop his car glowing like a beacon reminds me to check myself as I flow through the world. After all, the dude is delivering pizza to young and old, families and singletons, gays and straights, blacks, whites and browns, rich and poor, vegetarians and meat lovers alike. As he journeys, I give safe passage, practice restraint, show courtesy, and contain my anger.

Principle 2: Coolness to the pizza delivery dude is a practice in empathy. Let's face it: We've all taken jobs just to have a job because some money is better than none. I've held an assortment of these jobs and was grateful for the paycheck that meant I didn't have to share my Cheerios with my cats. In the big pizza wheel of life, sometimes you're the hot bubbly cheese and sometimes you're the burnt crust. It's good to remember the fickle spinning of that wheel.

Principle 3: Coolness to the pizza delivery dude is a practice in honor and it reminds me to honor honest work. Let me tell you something about these dudes: They never took over a company and, as CEO, artificially inflated the value of the stock and cashed out their own shares, bringing the company to the brink of bankruptcy, resulting in 20,000 people losing their jobs while the CEO builds a home the size of a luxury hotel. Rather, the dudes sleep the sleep of the just.

Principle 4: Coolness to the pizza delivery dude is a practice in equality. My measurement as a human being, my worth, is the pride I take in performing my job -- any job -- and the respect with which I treat others. I am the equal of the world not because of the car I drive, the size of the TV I own, the weight I can bench press, or the calculus equations I can solve. I am the equal to all I meet because of the kindness in my heart. And it all starts here -- with the pizza delivery dude.

Tip him well, friends and brethren, for that which you bestow freely and willingly will bring you all the happy luck that a grateful universe knows how to return."
--This I Believe, by Sarah Adams

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Tuesday, May 19, 2009

5 Things You Should Know About Obama's Health Care Policy

The choice of a public health insurance plan is crucial to real health care reform. But right now, it's being smeared by conservatives and insurance-industry front groups. Don't let them swiftboat healthcare reform. I've lived and had surgery in a country with national (universal) healthcare, and it was great. Here, thanks to moveon.org, is what you really need to know:

1. Choice, choice, choice. If the public health insurance option passes, Americans will be able to choose between their current insurance and a high-quality, government-run plan similar to Medicare. If you like your current care, you can keep it. If you don't—or don't have any—you can get the public insurance plan.

2. It will be high-quality coverage with a choice of doctors. Government-run plans have a track record of innovating to improve quality, because they're not just focused on short-term profits. And if you choose the public plan, you'll still get to choose your doctor and hospital.

3. We'll all save a bunch of money. The public health insurance option won't have to spend money on things like CEO bonuses, shareholder dividends, or excessive advertising, so it'll cost a lot less. Plus, the private plans will have to lower their rates and provide better value to compete, so people who keep their current insurance will save, too.

4. It will always be there for you and your family. A for-profit insurer can close, move out of the area, or just kick you off their insurance rolls. The public health insurance option will always be available to provide you with the health security you need.

5. And it's a key part of universal health care. No longer will sick people or folks in rural communities, or low-income Americans be forced to go without coverage. The public health insurance plan will be available and accessible to everyone. And for those struggling to make ends meet, the premiums will be subsidized by the government.

Read more on "The Case for Public Plan Choice in National Health Reform," by the Institute for America's Future.

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Wednesday, May 6, 2009

The Road Less Understood

The title to this blog alludes to one of America's most well-known and most misunderstood poems. Contrary to popular belief, the poem is not a paean to counter-culture and non-conformity, to alternate lifestyles and to getting off the beaten path. Not that those are bad things. Karpe Diem, I say, and I think Robert Frost would agree with me; getting out into nature, stopping and smelling the roses and all that hippie love stuff, or jesus love stuff if you want go back to the source, is a good thing. It's just not what the poem is about, and giving the text a careful reading and lexical analysis will show you what I mean...

In the first stanza we meet the poem's protagonist, a primal projection of the young poet, the everyman, standing in a yellow wood and faced with a choice between two paths.

Two roads diverged in a yellow wood,
And sorry I could not travel both
And be one traveler, long I stood
And looked down one as far as I could
To where it bent in the undergrowth;


The first thing to note is that the traveler is already in a yellow wood. So we are already talking about a walk through the woods, not a decision to leave some urban or other lifestyle in preference for the "green" way of the backwoods.

Then took the other, as just as fair,
And having perhaps the better claim,
Because it was grassy and wanted wear;
Though as for that the passing there
Had worn them really about the same,


In this second stanza, the traveler decides to take the other path, describing it as "just as fair" and "perhaps" having a better claim because it is "grassy and wanted wear". Aha, you say. I told you so. It's all about taking the road less traveled, forging through uncharted territory, being different etc. etc. But the very next couplet belies this attempt to differentiate the two paths telling us that they were worn "really about the same".

At this point, the two paths have been described as "just as fair" and "about the same" with one of them "perhaps" having a "better claim". Not quite the rallying cry of the non-conformist that you'd expect, right? Well if you aren't convinced yet, the next stanza pretty much puts the metaphorical nail in the biodegradable coffin with the unequivocal description "equally lay".

And both that morning equally lay
In leaves no step had trodden black.
Oh, I kept the first for another day!
Yet knowing how way leads on to way,
I doubted if I should ever come back.


So far we've got a poem about a traveler standing in the woods trying to pick between to almost equally trodden paths. The traveler tries to look down the road and presumably picks the "nicer" or "better" path, but readily admits that there isn't really a discernible difference. Then the traveler sort of reluctantly chooses one, knowing that they will more than likely never go back and try the other.

At this point, the poem is starting to look a bit more nihilistic. What's the point of picking if we can't see the ends, if we can't distinguish the difference? The key comes in the final stanza, when the traveler is looking back in retrospect on their life.

I shall be telling this with a sigh
Somewhere ages and ages hence:
Two roads diverged in a wood, and I—
I took the one less traveled by,
And that has made all the difference.


We now envision the traveler in some smokey and nostalgic roadside inn, no doubt with a wooden sign hanging askew over the door and an old-fashioned "Olde" in the title. The traveler is perhaps sitting in a rocking chair by the hearth, tamping out his aromatic pipe. What we know is that he or she is addressing an unseen audience. Who are they? Perhaps fellow travelers? Perhaps a circle of knock-kneed and wide-eyed children?

And what is the traveler saying? That that one decision, that one small decision between two nearly identical paths in a yellow wood has made all the difference. Basically the traveler is attributing a great importance to a decision that at the time was almost a flip of a coin. And this is what the poem is really about, the unreliability of memory and man's helplessness in the events of life.

The traveler believes that a choice between two indistinguishable paths was a key turning point in their life. The way they remember it, that one choice made all the difference. Maybe they don't really remember how the paths were basically the same, or maybe they have an elevated opinion of their abilities and believe that even in this minutest of moments they were charging towards self-made greatness.

It kind of depends on how you read the "sigh". Is it a sigh of regret and loss or puritanical pride in a job well done? Has the traveler become a prince or a pauper in the years following that fateful frolick in the forest? We are clearly in the presence of nostalgia, but is it a nostalgia born of myopia or hubris? Is man to believe that he is the master of his fate and that decisions, even admittedly haphazard ones like the choice between following two equally trodden paths, make a difference? Or is this a lesson on the unreliability of memory and man's tendency, or perhaps need, to attribute agency and meaning to the chaos and randomness of life?

Whether you believe in pulling yourself up by your bootstraps or the inexorable wheel of fate winding out your life, the song remains the same. Frost is reminding us that each moment is precious and rarely can be saved for another day. And that as the shadows lengthen and fall upon us, we will perforce look back at the rise and fall of our days and know with certainty that our lives are precisely as they are and could be no other way. Otherwise they would not be ours to remember. We will have the choice to look back and sigh with joy or regret for the paths we chose and never chose to take, and together these will be the paths of our life lying just so, diverging in the woods of our soul. And we can be sure that the paths we trod have made all the difference, because our dusty and fading footprints are no doubt the legacy we leave behind to those who follow...

One final point about how memory diverges from life (like two roads in a wood) and how, willfully or not, this leads us to misunderstand: the Robert Frost poem is titled The Road Not Taken, not as most people will remember The Road Less Traveled. And that, to paraphrase Robert Frost, not only makes all the difference, but is exactly what he's talking about.

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Monday, May 4, 2009

Babies don't vote, babies don't pay

How can we be the "greatest" and "richest" country in the world when we don't guarantee basic health care to all of our citizens?

The cost of health care, in both moral and economic terms, is bankrupting our country. There is no reason why everyone shouldn't receive quality, affordable health care. A healthy workforce makes good sense, but we are really talking about caring for people, the sick--a simple mitzvah, the kind of thing your grandmother would want you to do, but taken to a national level.

But that's the easy part. It's not just who we care for, but how we care for them. Serious reforms are also necessary in how we research new drugs and treatments, and how we make choices about what procedures, particularly at the end of life, are offered to an individual.

I believe these type of complicated decisions regarding public health, preventative care and use of limited resources need to be made by scientific and non-profit oriented (i.e. non insurance and non pharmaceutical) groups like the NIH.

One of the reasons that the United States has the highest infant mortality rate in the so-called "civilized" world, that is to say compared to other places like Western Europe, Japan etc. is that babies don't vote and babies don't pay. So we spend more time and money on finding viagra and cures for social anxiety disorders. This same market logic drives research away from world wide killers like malaria or improving preventative medicine. Screening and teaching better diet and exercise to avoid diabetes just aren't as profitable as insulin.

The system will spend tens of thousands of dollars, however, to extend someone's life by a week or two. If you can call lying in an intensive care unit with failing organs and an artificial respirator down your throat as well as being extremely sedated because your body responds to the respirator as if you are drowning or suffocating as living...

This is why research and health guidelines need to be free of industrial and market bias. Health care providers and individuals need access to good information. Smart national guidelines will help doctors sort out increasingly complicated health choices (drug interactions, comparisons of generic to brand drugs, comparisons of treatment combinations). National guidelines will not tie your doctor's hands, but empower them with information rather than marketing and advertisements. It's a non-issue really, because hands are already being tied and manipulated by decisions about which procedures are reimbursed and for how much.

The next step is encouraging individuals and families to think and talk about critical care and end of life issues such as when and how much invasive care should be given, and under what circumstances. Every adult as part of their electronic and accessible health records should fill out organ donor plans, do not ressucitate orders, file health proxies etc. Schools should have a mandatory health and diet class that teaches proper hygiene, eating and exercise habits and how to become well informed participants in a national health care system.

And participation is the key. Now is the time to speak out and let your elected official know how you see the future of health care in America.

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