The Best Laid Plans of Mice and Men

The Best Laid Plans of Mice and Men

There are times when the Fates, being bored with the orderly events of our lives, decide to mix things up, and create havoc as only they can do. This seems especially true when men, in their hubris, are reaching out for a long sought goal, unmindful of how easily this can be snatched from them.

Miki and I had been planning a dream vacation to Patagonia, then the Lake District of Chile, followed by crossing the Andes by bus and by boat, traversing those majestic peaks to Bariloche, the famed Argentinian ski and nature resort. A couple I had known for more years than I care to admit were going to accompany us, also excited by the prospect of shared adventure. All the plans had been carefully crafted, hard to get reservations secured at the Torres del Paine, arguably the most scenic of national parks in all of Chile, and we were ready to depart.

A week before our trip, I visited my doctor for a routine office check-up accompanied by an in-office minor procedure. Within two days, I was experiencing fever, chills, and all the signs pointing to serious sepsis. I started antibiotics, informed my doctor, and received reassurance that all should be OK by the time we were ready to depart. After a couple of days, I had indeed improved, but I was far from well. I was then switched over to IV antibiotics pending receipt of the result of the cultures that were done, hoping to rapidly beat this unwanted foe into quick submission.

The IV antibiotics seemed to improve things considerably, and my spirits were buoyed until the culture results came back. Seems as though I contracted one of the worst bug known to our science, a multi-drug resistant organism that was unfazed by any of the drugs I had so far been given, and which requires a 4-6 week course of our most potent (and toxic) medications given IV twice a day for there to be a reasonable chance of a cure.

Needless to say, I couldn’t take the risk of traveling under these conditions to a place that was at least a five-hour drive from the closest outpost of civilization, and a 4 hour flight from there to a US equivalent medical facility. Our trip was already paid for, and most of the money was non-refundable. Our friends had already cleared their schedule for the holiday, and wouldn’t have tackled this journey on their own without our expertise to guide them through it. I convinced Miki that she had to go with them, and enjoy herself despite my inability to partake in our dream. She very reluctantly agreed, and from the sound of her e-mails, is enjoying the holiday.

Since I have to be in the hospital every twelve hours for my antibiotics, I decided I might as well work on a limited basis, which I have been doing. Other than the disappointment of not being part of something I had been planning and looking forward to for some time, I’m doing OK. Taking a shower one-handed is a challenge (try it some time and see) and being poked with needles gets old after a while, but if the infection clears up, I’m more than willing to have this be the worst tragedy of my life.

Friends have been very supportive, calling to check in on me, inviting me over to their homes to share a meal, and expressing their concern for my welfare.  I suppose there is benefit in being reminded of what it feels like to be on the other side of the bed, something most physicians intellectually understand, but not necessarily viscerally experience, until they are anxiously awaiting the result of a test or being subjected to the small tortures of being poked with needles or the more significant pains of the underlying disease. I’m sure I will be more empathic after this experience than I might have been before. There is some good that comes out of everything. Or so I keep encouraging myself.

Be well,

J.

 

The Sun and the Stars

There are still places in the world, far away from city lights and the effluvia of industry, where it’s possible to step outside at night, and see a black firmament lit by myriads of stars, inspiring awe and insignificance in the beholder, much as experienced by our ancestors over the millennia. Knowing that each of those points of lights represents a sun composed of gases at temperatures beyond our capacities to appreciate, and that these stars are dying and being born again throughout countless galaxies, does nothing to diminish that awe – it only accentuates it. So the night sky fills our souls in Cayucos, allowing us to peer into but a fragment of the mysteries of the cosmos, and to be transformed, even for a brief spell, into creatures holding on to each other for reassurance as we confront the vastness of the Universe, and allow ourselves to soar together beyond the boundaries of our everyday existence as we participate in a moment that will stay with me for far longer than the experience. It is for such moments that we travel, and that we treasure as time passes on.

We’ve taken another opportunity to join our best friends for a long weekend in a small beach-side cottage along the Central Coast of California. We have been renting this place for several years in early February, long before the summer crowds descend, and before much of this part of the coast is often covered in fog. There are few things as relaxing as waking in the morning to the sound of surf exerting its rhythmic pull on our psyche, watching the rising sun bring to life the scene of diving birds and scampering sandpipers looking for their breakfasts, along with a few joggers and their dogs loping along the ocean’s edge.

The smell of morning coffee and bacon cooking on the stove never fails to bring Miki awake, whereas she might otherwise be tempted to sleep through this, the best time of the day. (There is always time for a nap after breakfast and a morning walk on the beach.) Mike has built a beautiful guitar, and its mellow tones provide an appropriate soundtrack for our appreciation of the surroundings.

Miki and Jeanine will be spending at least part of the day working on a jigsaw puzzle spread out on the card table, a guilty pleasure they both enjoy, but for which they only find time during these vacations. We’ve brought along several books from the large pile waiting to be read, but based on prior experience, we’ll be lucky to get through one of them. Somehow, having a panoramic 180 degree view of the beach with its rolling surf, as well as the curve of the coast with its verdant gently sloping hills, provides a distraction strong enough to pull the eyes away from the printed page, riveting them instead on nature’s display all around us.

Last night’s sunset was particularly glorious – a perfusion of clouds with progressively darkening pinks to reds, finishing off with a magenta haze as the few distant lights up the coast softly flickered on through the coming evening fog that remains localized to the cove at the bend of the land, signaling the arrival of yet another star filled night.

We are adjusting to the rhythm of the place, rapidly shedding all the vestiges of my usually over-scheduled life, reveling in the easily soluble dilemma of whether we should walk on the sunlit beach before or after we eat a little something, and napping whenever the mood strikes us. This may not be Paradise, but it will do until the real thing comes along.

Be well,

J.

Time Passages

I had been looking forward to my weekend off work. Saturday morning turned into a brightly sunny day with still balmy temperatures in the low 70’s, as the rest of the country was digging out from yet another snow storm, with more cold, wet weather promised on the way. I took the opportunity to enjoy a short hike around our local mountain. As I arrived home, the answering machine was beeping, alerting me to a message left there by a good friend. Her mother had just died, and she was calling to inform us of the funeral arrangements.

My friend, her mother, along with her father, had graced our Christmas table for a number of years. The mother had a stroke a couple of years ago, leaving her with not only paralysis of her left side, but also with a severe expressive aphasia; the inability to speak. My friend’s father, a retired a surgeon, visited his wife every day at the nursing home, fed her dinner, and kept her company.  Now she’s gone, and another place card will go unused at the next holiday dinner, adding to the rapidly accumulating pile of memories called forth by the roll call of the missing: Ann, Sylvia, Sasha, Kathy, Carl, Marija, Michael, Jeanette – it’s an ever growing list. It’s as if the tides of time are eroding the bulwark of all those we have known and loved, wearing down the security of friends and family who have stood between us and the winds of chaos and entropy.

Saturday also brought with it an occasion of celebration. Another friend was turning 65, and we joined with those who gathered to make it a day to be remembered. Most of those present work with him in the ER, and like any elite military unit, these foot soldiers on the front line of medicine shared war stories laced with the kind of macabre sense of humor outsiders would no doubt find insensitive if not insulting, but which allows those who battle in these trenches to go back to another shift filled with human drama, suffering, stupidity and pathos without being emotionally bankrupt themselves.  He is excellent at what he does, possesses a large heart and a kind soul, but does not suffer fools gladly. All of the staff are fiercely loyal to him, and he to them. I, being one of only a couple of outsiders privileged to have received an invitation, appreciate the value of the esprit-de-corps that binds them together, and have watched as they together have literally saved lives. I was happy to see that the enthusiasm for what they do, as well as for each other, had not waned over the years.

Today, the weather changed, and soon the morning clouds took on a more threatening demeanor.  The snow capped mountains,  so spectacular in yesterday’s sunshine, no longer were visible, replaced by the gray haze that preceded the coming of the rain. The friend I was supposed to go hiking with this morning called shortly before the rain began, letting me know her teenage son had swallowed a piece of meat the night before, and it was still stuck in his swallowing tube.  Since I knew the GI doctor who was working today, I called him, explained the situation, and he agreed to meet her at the hospital to extract the offending item. As it often happens these days, things did not go so smoothly. Since my friend belonged to an HMO, her son needed to have prior authorization in order to have any procedure done. And since this was a Sunday, the only way the paperwork could be accomplished was for him to be first seen in the ER, have tests done, be evaluated by the ER doctor, certified to need a procedure that could not  be put off until the next day, etc., etc., etc..  Needless to say, what should have been a  twenty minute procedure turned into an all day affair that involved a mountain of paperwork, several needless X-rays, blood tests, and the wasted time of a number skilled professionals (not to mention my friend and her son) – all so the bureaucracy could continue along in its convoluted and very wasteful way. And you wonder why medical care has become so expensive? In no small part it’s because the inmates are running the asylum.

Hopefully, your weekend was a good one.

Be well,

J.

“STUFF” or “How Much Is Enough?”

I remember the first time I saw George Carlin do his brilliant routine on “Stuff” – and how what we considered necessary stuff could be pared down to a small handful of essential items. I was reminded of this when we remodeled our bathrooms, taking everything we had in them, placing them in boxes, and ended up living for six months out of the small toiletry kit of the kind airlines used to hand out on international flights. After the workmen had gone and we could reclaim our old territory, we were struck by the fact that we never once missed the contents of all those boxes we had packed away, and how superfluous they were to our lives. Why did we buy them? Why did we keep them?

Rather early in my life and career, I was fortunate to find myself working and teaching in Southeast Asia where my “pay” consisted of being able to live in a single room with a metal cot, a single bulb hanging from a cord on the ceiling, and one table with a chair. I had the use of a large, cold basin of water for my morning ablutions, food on the table prepared by my hosts, and a sense that what I was doing was useful and worthwhile. Though my conditions of living would be considered primitive by most standards, I was very happy. More importantly, when I eventually returned to the States, and received much greater compensation for my work allowing me to have a life style that would place me in the upper middle class of our country, I can’t say I was any happier than when I lived in my former circumstances.

For many of us, acquiring “things” comes almost without thought or reflection as to “is this something I really need, something that will make my life happier and better?” Driven by the power of advertising and our consumer culture, we are voracious utilizers of all that the culture produces. We rarely, if ever, reflect on what our ever growing appetites are doing to ourselves and the planet we all share.

There was an interesting article in Science by John Holdren, now President Obama’s science adviser, titled “Science and Technology for Sustainable Well-Being” in which he makes the case that when you measure human harm in years of life lost (e.g., a child cut down by disease loses decades; a grandmother dying of a stroke loses a few years), the major afflictions of poverty and affluence do us in at roughly equal rates. There is something poetically democratic in wealth and affluence killing us off at equal rates with poverty and malnutrition.

The central issues for us, and to a much greater degree our children, determining the quality of our lives and the environment in which they will be lived are the answers to the following two questions: “How many people will inhabit the Earth in the next few generations?” and “How much stuff – energy, land, water, and animal life – will they consume?” Herein lays the crux of the sustainability puzzle.

The rising demand and lagging supply of fossil fuels will shape everything from economics to international conflict. The amount of coal extracted and burned will influence the climate for centuries. The extent of land use to grow food, fuel and fiber will determine the cost of these necessities and the fate of the world’s last unspoiled ecosystems.

What qualities do we need to learn and instill in our children in order to preserve a world that can sustain life as we now know it?

We need to have a sense of purpose larger than our own needs and desires. Desires are never ending. Fill one, and a new one pops up to take its place. The satisfaction from fulfilling a desire is notoriously short lived. Having a sense of purpose (or “mission” in business parlance) focuses your attention to only those things will advance your cause – be it raising children, building a school, or growing a garden.

We need an internal measure of our fulfillment. We can’t judge if we have enough based on what others have or have not. We need to be able to look inside ourselves and know what is essential to our happiness as opposed to something to just buy, then store, insure, forget about and eventually try to sell at a garage sale.

We need to be able to account for our money. We need to know how much we are spending, and what we are buying. We need to know how much we are saving, and how much we will need to save for a secure retirement.

We need to have a sense of responsibility for the world, and to be able to see how our choices and lives fit into the fabric that we all weave to try and give our children a world fit for the lives we want them to have.

 

How Do You Measure Sucess?

There is an old story about the Devil finding a group of young men playing with a ball, tossing it back and forth over a net. The Devil asks them, “So, who is winning?”

The young men look puzzled – “We don’t know. We’re not keeping score. We’re just playing, having fun.”

“But if you don’t keep score, how do you know who won? “ asked the Devil slyly. So the young men started to keep score. Now they knew who won and lost each game. They also started to argue amongst themselves, and though each could tell you the score and who won, they remained puzzled as to why they no longer had as much fun as before.

I’ve had occasion recently to ask friends, “How do you measure success?” On reflection, my question was rather imprecise, for what I really wanted to ask was “How do you define success?” Nonetheless, the answers, when they came, were interesting. Almost as interesting, however, was the long pause that came after the question, as quite a few openly admitted they never really thought about it. Strange, how we can go through life without thinking much or any about what we are trying to accomplish in our lives, what are ultimate goals are, how close we are coming in achieving those goals, and by what yardstick we measure our success.

The un-aimed arrow never misses. Perhaps, we are just trying to maintain our innocence, and avoid the Devil’s trap by keeping score. Or, we are on such autopilot in our lives that it never occurs to question the direction in which we are heading, or how far we have to go before reaching our destination.

As to the answers I received, they crossed a spectrum from having money, a nice house, and “security” to being satisfied with your life, having friends, a loving family: from receiving recognition from your professional peers for your accomplishments to being able to say at the moment of your death “I wouldn’t have done anything differently.”

I wondered: if you did your very best to the greatest of your ability but you did not reach the goal you set for yourself, could you still consider yourself a success? And what if you did reach your goal, but you knew you were capable of more, were you still successful? I’ve had a whole lot more questions, but I think I’ll stop here and ask you, my readers – How do you define success? How would you answer my questions? What have I left out that you consider essential elements of this question? Do you think that a life can be meaningful without some measure of success?

I’m interested in hearing from all of you, and wish you all well.

J.

Beauty – At What Price?

There was a recent article by Jan Henderson on the lengthy media coverage of the death during cosmetic surgery of aspiring Chinese pop star Wang Bei.

The details are tragic: She was only 24. Ironic: She was already beautiful. And dramatic: Her mother was having the same procedure at the exact same time. So her mother woke up to discover her daughter was dead. Or perhaps not. According to conflicting reports, her mother was told nothing until the next day.

Wang Bei was having facial bone-grinding surgery “to make her jaw line fashionably narrow and her face smaller.” (Chinese women are said to prefer an oval face shaped like a “goose egg.”) The blood from Wang’s jaw drained into her windpipe, and she suffocated.

Press coverage of the Wang Bei story – in addition to describing the young woman’s failed attempt to become a successful entertainer after her 2005 appearance on the Chinese equivalent of American Idol — was almost entirely about the importance of finding a qualified surgeon for your next cosmetic procedure. This is big business in China. In 2009, the Chinese spent $2.2 billion dollars on three million procedures, a figure that grows annually by 20%. China ranks third highest in the world in number of procedures (after the US and Brazil), and it is number one in Asia.

Most of the subsequent commentary revolved around the importance of choosing a well-qualified surgeon and institution for performing your cosmetic surgery. Few questioned the value system our society is promulgating that forces young, already attractive women into having an operation that, even in the best of facilities, is not free of serious and even fatal risk. Nor did anyone raise the issue of the medical ethics of a surgeon willing to operate on a healthy, already attractive young woman for a marginal improvement in her appearance – clearly, the ethics of market forces are widely accepted.

I know of one young mother who died recently of anesthetic complications while having a breast augmentation, leaving behind three young children as orphans. Another young woman suffered fatal blood clots to her lungs following a liposuction operation.

Why am I bothering to blog about this event, tragic as it is, when it’s been already so widely reported? I write because our idolatry at the altar of Beauty has far greater implications. Of greater concern for society is the fear created in people that if they fail to conform to an almost unreachable standard of “beauty” they will be unable to find or maintain a relationship with a member of the opposite sex, or that they will fail to find work, or be unable to keep their jobs as their bodies age and the appearance of youth fades.

This fear that drives not only many women, but also an increasing number of men, into spending thousands of dollars on plastic surgery, make-up, new wardrobes and beauty spas is driven by the media’s celebration of youth and looks, by the advertising power of giant corporations whose profits come from the insecurities they create, and by our culture’s attempt to deny the mortality that is the essence of life. We are now incapable of even saying the word ‘dying,’ hiding instead behind euphemisms such as ‘passing away’ or ‘departing.’

The price we all pay for our cultural folly is huge. Starting with the ostracism that young children are cruelly subjected to from the earliest grades in school for failing to meet the artificial litmus test  imposed upon them, to the multiplicity of bad choices we continue to make in our lives, and culminating in our inability to prepare for and accept death and dying as the natural continuum of our lives – the results are tragic. We marginalize and ostracize our old, our less attractive, our handicapped, while we heap undeserved rewards on those who, through no merit of their own, have reaped benefits from the genetic lottery. Last, but certainly not least, we choose leaders not as much by their character, experience, wisdom and skills, but rather by their appearance and rhetoric. God help us all!

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