and in flew enza

so i caught the swine flu. and it was okay.

just kidding. it's not okay.*

*one healthy 14-year-old cheerleader and two grown-up ladies, one healthy (and same age as me) and one not, have died from "New Flu" in our fair city so far. these three were supposed to have been the only deaths in our state, but then an immune-deficient sixth-grader died a couple days ago up north, 2 weeks after the local paper reported "swine flu threat fizzled." so i guess the numbers are outrunning the news.

i exaggerate when i say i have the flu; i was merely exposed. the occupational medicine people at my workplace will let me know pretty soon whether i'll have to take some o' that there anti-flu medicine**, as mandated by the cdc.

**interestingly, in japan, one of the side effects of the medicine has been teenagers "leaping off buildings immediately after taking the medicine".***

***overuse of the medicine will inevitably produce drug-resistant flu viruses. however, if the virus to which i was exposed is drug-resistant, then the medicine might**** make it harder for me to spread it by coughing or sneezing on people. it wouldn't affect how far i'd spread it by not washing my hands, however.

****"might" being the operative word here. it hasn't really been studied in humans with h1n1, just in guinea pigs with other flu viruses - and guinea pigs neither cough nor sneeze when they get the flu.

my friend who works at the children's hospital says it's mass hysteria over there, with 2 recent deaths (rumor? or not publicized?) and multiple kids in the ICU. she said i shouldn't worry: "i'm exposed to it 50 times a day. you're young and strong; you won't get it." i replied, "i'm 48 and have mixed connective tissue disease." "shush," she said. "you're young and strong and you will not get it."

on google, "Your search - "Physicians Exposed to H1N1" - did not match any documents."
however, google does offer these evocative headlines:
Colo. Health Officials Test Traveling Youth Choir for H1N1 Virus
3 teens in city juvenile center have swine flu, state says
2 Cases Confirmed in Boy Scout Camp Swine Flu
Respiratory Therapist Tested Positive For H1N1
Old People May Be Immune to Swine Flu
H1N1 flu less likely in Gaza due to siege
Trip To China Ruined By H1N1
and:
FDA Targets Fake Web Claims for H1N1 Products
...Since May 1, the agency has identified 104 such claims and products marketed on the Internet that weren’t authorized by the FDA.
here are some examples (not linked, but you can google 'em):

the photon genie: "an advanced, proprietary processing of full-spectrum frequencies and infinite harmonics... delivered by both an ionized Noble Gas energy-transmission and deeply penetrating mega-frequency life-force energy waves."
$2,995

silvercure: "created to protect you by leaving a thin layer of electrically charged micronized, anti-microbial silver ions on your skin and scalp... combating bacterial and viral infection at the moment of contamination."
price for the "swine flu protection pack" no longer listed, but the (plain ordinary?) protection pack is
$130.

flucinex: "four unique strains of active living cultures delivered in a titanium dioxide capsule technology. We're going to send them directly into your small intestine before we let them out to colonize and multiply. Take Flucinex twice daily during flu season... You will have an excited immune system."
60 capsules $30

nozin: "A swab moistened with a few drops of NOZIN is applied to the tip of your nose [suggested frequency: three times a day]... NOZIN is made from a proprietary formula of pharmaceutical grade ethyl alcohol and natural plant-based moisturizing compounds such as jojoba and coconut oil."
8 ml (about 1.5 teaspoons) $15
the "real" flu medicines retail for $93 (tamiflu) and $64 (relenza).

the conventional understanding is that these drugs reduce the duration of the flu by 9.5-21.5 hours or 19-24 hours, respectively. in other words - for your average of $79, you will be sick for an average of 18 hours less than you would have been if you did nothing. what a ripoff! (this is one reason i have never written a prescription for either drug.)

the directions have always said you need to start the drug within 48 hours of first getting the symptoms. (this is another reason.) the presumption of course is that with "new flu," they will Save Your Life. all over the internets it states that these drugs are a "treatment" for the flu, which to the ordinary person implies "cure" - and this also gets on my nerves.

to use these drugs to prevent getting the flu, you need to take it for twice as long (now the cost is $128-186), and you have to start one of them when you are exposed to an infected person at any time "one day before until seven days after the [person]'s onset of illness."

if for some reason you are exposed to multiple infected people, like my friend at the children's hospital, then you are supposed to start taking one of the drugs from the first exposure until ten days after the final exposure, which would probably be next year sometime, so the cost then would be $384-558 per month.

you can maybe avoid these high prices if you used the cdc-mandated protective gear when exposed to the patient (special "n95 respirator" mask, of which there's a shortage, so at our clinic you have to re-use them an indefinite number of times, and wear another plain mask over them (smother!); disposable full-length gown; disposable goggles; disposable gloves) - which i did not do - because the infected person with whom i spent half an hour in a small closed room - who had developed a high fever and a bad cough and sneeze after hanging out with her cousin who was diagnosed with the swine flu - was not my patient.

my patient was her very healthy 3-year-old son. i did not realize the details about the mom's illness, other than to hand her kleenexes when she sneezed a couple times, until she proceeded with her very healthy child to her own appointment, which was an urgent visit for a headache. she was seen, and immediately swabbed for h1n1, by my co-worker wearing a space suit in a negative-pressure room (has a fan that sucks the germs out).

it's a long story, but the point is that, you know, these things happen every day and that's why the u.s. now has 21,449 cases (more in our state than anywhere! now you know where i live) and 87 deaths.

i note that workers, including healthcare workers, are widely being blamed for spreading the flu by continuing to go to work while sick or convalescing.

this seems rather unfair, considering that as of last month the official (not the complete) unemployment rate in michigan was more than 14%, in oregon, rhode island and south carolina was around 12%, and in california, nevada, and south carolina was in the 11%'s... but that's a rant for another day.

histories of the fire departments

i have been researching different kinds of health insurance that i, as a self-employed person with a past medical history, might be able to get - and/or afford.

naturally, this made me interested in the history of fire departments!



In 1666, the Great Fire of London consumed about two square miles of the city, leaving tens of thousands homeless. In response, insurance companies formed private fire brigades - the first organized fire protection system in that city - to protect their clients' property. Insurance brigades would only fight fires at buildings the company insured.

...The first fire brigades in the modern sense were created in France... In 1733, the French government decided that the interventions of the fire brigades would be free of charge. This was decided because people always waited until the last moment to call the fire brigades to avoid paying the fee, and it was often too late to stop fires.

...Even after the formation of paid fire companies in the United States, there were disagreements and often fights over territory. New York City companies were famous for sending runners out to fires with a large barrel to cover the hydrant closest to the fire in advance of the engines. Often fights would break out between the runners and the responding fire companies for the right to fight the fire and receive the insurance money that would be paid to the company that fought it.

this history is still disputed. nobody likes to think that monetary motivations could make somebody stand by and watch while a house burned, do they? everybody knows that a fire is a public - shared - calamity, right? if your house starts burning, then everyone's house is at risk, correct? this is why we pay taxes that support the fire department, yes? so that the fire department will serve all citizens without prejudice.




(a) In addition to all other ad valorem taxes levied, the St. Clair County [Alabama] Commission may levy on an annual basis, commencing with the tax year beginning October 1, 1997, an ad valorem tax on all taxable property located in St. Clair County at a rate of two mills per dollar of assessed value of the taxable property, the proceeds of which shall be paid into an expendable fire protection trust fund.

...(b) Within 30 days of payment into the fire protection trust fund of the proceeds from the additional tax levied pursuant to (a), each eligible fire department in the county shall make a requisition to the county commission for a share of the tax proceeds in the fund. The county commission shall divide the funds equally among the eligible fire departments of St. Clair County.

(c) Funds allocated to eligible fire departments shall only be expended for fire protection and emergency medical services... Personnel of eligible fire departments shall not be considered as employees, servants, or agents of the county.

it wasn't always this way, of course.




Fire insurance marks were lead or copper plaques embossed with the sign of the insurance company, and placed on the front of the insured building as a guide to the insurance company's fire brigade... The early fire marks of Benjamin Franklin's time can still be seen on some Philadelphia buildings as well as in other older American cities.

Subscribers paid fire fighting companies in advance for fire protection and in exchange would receive a fire mark to attach to their building. The payments for the fire marks supported the fire fighting companies. If the protected building were to suffer a fire only their fire fighting company would attend the call to extinguish the fire. Even if competitor fire companies were closer to the fire they would not do anything to prevent further damage or extinguish the fire.


firemark of the salop insurance co.

like i said, this history is still disputed. but it raises the question - how was fire - a local calamity - understood at that time? who was responsible for preventing, fighting, and cleaning up after a fire? have our ideas about private responsibility and the public good changed since then? if your neighbor smokes in bed and sets himself afire, what do you do? is it your problem, or not? if you don't do anything, is that against the law? why or why not? should it be, or not?


triangle shirtwaist fire.


12/10/2007 - A decline in public funding for firefighting services has sparked explosive growth in the private sector. The world's largest insurance company – American Insurance Group – now has "Wildfire Protection Units" in 150 US zip codes. During the 2007 California wildfires, AIG's firefighters saved homes in wealthy areas, while less fortunate neighbors were left with rubble.

sometimes maybe a fire department is underfunded, and people don't trust that they will be protected... so they decide that the solution is to hire their own private fire service? what's wrong with this picture?

AIG's Wildfire Protection Unit, part of its Private Client Group, is offered only to homeowners in California's most affluent ZIP Codes -- including Malibu, Beverly Hills, Newport Beach and Menlo Park -- and a dozen Colorado resort communities. It covers about 2,000 policyholders, who pay premiums of at least $10,000 a year and own homes with a value of at least $1 million.

how does our view of public calamity change, when the example is set before us of independent-minded, self-reliant, yankee can-do individualists who have the gumption to hire their own firefighters? the right to do whatever you please with your own property is a fundamental american value; so is the right to do whatever you can think of to make a buck.



...[Homeowner] Mr. LaPeter, who owns shopping centers and splits his time between Idaho and Maui, said the service might be a security blanket for the rich, but that it was also good business... [Fire protection Contractor] Mr. Futral weighed in. "Save one $10 million house and it pencils out pretty quickly," he said. "And there are a lot of nice homes here - Arnold Schwarzenegger, Clint Eastwood." He stopped short of saying whose houses he had sprayed... [Homeowner] Michel Lalanne, who splits his time between Sun Valley and France, watched Mr. Futral apply retardant to a house across the street and asked whether he might obtain his services for a price, even though he was not covered by AIG Private Client Group. "He said, 'No,'" Mr. Lalanne said. "'We've got a long list.'"

private entitlements and public calamities. a firefighter corporation, based on an insurance model, that makes megaprofits, charging whatever frightened people will pay, and only putting out certain fires.

compare that to a publicly funded system of firefighter companies, whose members earn approximately the median US income - a good living - putting out whatever fires they're dispatched to.



sound familiar?

note: a frequent argument against the firefighter analogy is that there is no single-payer system; localities fund their own services. some might point out the obvious problem with this, that a lot of communities are obliged to have volunteer services only. it's hard to argue that that is the best system we can come up with.

May, 2009 - Fifty-seven percent of all volunteer departments (which comprise over 70 percent of all U.S. fire departments) are losing volunteers who need to look for other jobs.

in the meantime, while rome burns, i guess it'll be high-deductible, catastrophic-coverage-only health insurance for me and my family - whatever i can get and/or afford.

march forth

once again i'm ranting and raving about the american way of birth.
oh, how it offends my delicate sensibilities.
so many things about it that piss me off, that function to displace, reduce,
render comically superfluous, a woman's autonomy, her "experience,"
her bravery, mystery, splendor, achievement.

oh, i was raised a feminist through and through, and i remember as a grade schooler
being astonished and appalled when i learned "they," those anonymous ancients,
used to think a woman was just a "vessel" for a man's "seed."
it sounded crazy, delusional, or an egregious and calculated lie,
and i was so very glad those terrible days were over.



i laughed about the "homunculus" scientifically observed inside the microscopic sperm head,
and marvelled at the way the questions Science asks determine the answers Science gets.
i rolled my eyes at the Health Class filmstrip about the brave army of sperm assaulting
the giant, passive, fortress-like "egg." i still roll my eyes at the shouting over "when life begins"
(in the the tubes, at the moment of penetration? in the uterus, at the moment of penetration?)
versus the cooing over the so-called "first day of life," "first week of life," etc., of a creature
who's been kicking and swimming and hiccupping, in a very lifelike way, for months.
oh, Science - you're so cute.

then i learned how ridiculous obstetrics could get, so much so that some sneaky copyeditor
inserted into the index of Williams Obstetrics (15th & 16th editions), "chauvinism, male,
voluminous amounts, pp 1-1102," indicating the entire contents. oh, those illustrations!
in obstetric textbooks of, well, holes, allegedly representing "the mother,"
shaved and draped and gestured towards with a shiny black-gloved hand.
their terminology for the physiology of labor: "The Passenger, The Passage, and The Powers."
the shaving, the enemas, the restraints, the stirrups, the sharp scissors always poised!
i was so very glad those terrible days were over.



i learned how man doctors gave orders, and woman patients obeyed them,
and the man doctors liked this arrangement very much, and the woman patients
thanked them for it. how a conspiracy of half-educated snake-oil salesmen
legislated "granny midwives" as filthy ignorant filthy swarthy filthy foreigners,
and nearly destroyed completely their place in the world. i was so very glad - almost smug -
those terrible days were over.

now every woman is obliged to have an ultrasound, it's only a question of when,
because we have to see the baby, after all, and the woman's body
can thus conveniently be gotten out of the way.
she will be delighted to see the baby. she will ask and ask for another picture, she'll name the baby and buy the right clothes
from the appropriately gendered aisle, months before the birth.
at the start, she'll be cajoled to have "just a blood test" to find out
the truth about the baby, and if she gets bad news, she'll be urged
to "get the amnio," then she'll wait for a couple of weeks
to be told whether it's a baby, or a monster, in there.
if she's a certain age, she won't tell her relatives she's pregnant
until the geneticist tells her she is. if she forgoes all this,
we'll roll our eyes, and try again: "but don't you want to know?"
it's selfish, because we want to know, Science is working
hard every day, to find new ways of "knowing." new blood tests.
new ultrasounds. new, "less invasive" (of the fetus) kinds of biopsies.
we think we can distinguish between normal and abnormal,
but who can say what the results may ultimately mean?
we'll keep the results ourselves;
they're medicolegal documents now.
everyone's "at risk."



when she labors, it's really the fetal heart monitor,
flashing and bleeping in its multishelved cart, that labors,
that must be hovered over, comforted and consulted, praised and blamed.
why feel any labor pains? once she has the epidural, she'll lie there
watching television for the rest of the day,
tethered to the bed by her dead-weight anesthetized limbs
and the IV line from her hand to the pitocin on the pole,
the epidural catheter from her spine to the box on the other pole,
the "pain button" clipped to her shoulder from the box,
the blood pressure cuff on her arm, hooked to the machine,
inflating and deflating every fifteen minutes,
the urinary catheter taped to her leg, snaking from under the sheets
to the see-through sack hanging on the bedrail, visible from the hall,
the intrauterine pressure catheter taped to her leg,
stretching from uterine cavity (formerly, inconveniently, fluid-filled)
to fetal monitor, and either the elastic belly-band,
or a wire taped from her vagina to to her leg, its fine sharp corkscrew
twisted into the "presenting part,"
all plugged into the flashing, thumping monitor,
to "keep an eye on the baby,"
doctors and midwives and nurses all staring at the
fetal heart rate variability graphed on remote monitors
down the hall, not needing to enter the room
where the woman is simply lying quietly, unable to move her legs, watching tv,

but needing the screens every minute, to tell us the truth
about this birth, to reveal what the woman's body selfishly conceals,
the baby, the baby, how is the baby, is the baby okay,
the baby might be in trouble, always always always and by definition
might be in trouble, as long as it's in there.
if we need to shout at her or lean on her belly or get out
the sharp scissors or the steel forceps or just cut her open
and pull the baby out, we will - and she'll thank us for it.
all that matters is a healthy baby. because. she's just. a vessel.
and i am so very angry.
that these terrible days are not over.



we can teach her from her age of five that abortion is nasty and horrible (don't!),
and "giving up for adoption" is sweet and beautiful (do!), because she's just a vessel.
we can sue her and win, if she doesn't give us the infant we paid for, as a "surrogate mother,"
because she's not a mother, she's just a vessel.
we can put her in jail, and take custody of the fetus in utero,
if she fails her drug test, because she's just a vessel.
she'll be guilty of illegal drug distribution, to a minor,
through "his or her" umbilical cord, because she's just a vessel.
if her boyfriend beats her up or shoots her, it's a crime
against the fetus, because she's just a vessel.
if she shoots herself, it's "attempting
to procure an illegal abortion," because she's just a vessel.
we certainly can appoint the fetus a lawyer and order a cesarean,
because she's just a vessel.
we'll cajole her to quit smoking, to quit drinking, to take her vitamins,
"for the baby," because she's just a vessel.
having health insurance and a warm place to live and enough
food to eat matters, but only after the sixth month.
full-term gestation matters, because the baby matters,
but if starting her labor artificially is ok for the baby
and convenient for the rest of us, then we might as well.
breastfeeding matters, because the baby matters,
but if replacing her milk with something else is ok for the baby
and convenient for the rest of us, then we might as well.
mothering matters, because the baby matters,
but if warehousing the baby in daycare is ok for the baby
and convenient for the rest of us, then we might as well.



her drug abuse, her malnutrition and smoking, her bruises
and broken teeth, her gunshot wounds,
her womb, her breasts, her youth, time, life, place
in this world all matter, because the baby matters,
and - you know - not as much, otherwise.
i am so angry that these terrible days seem to be going on and on and on forever, and we have understood nothing.

in my world, when a woman is pregnant, it's a woman who's pregnant.
when she labors and gives birth, it's her doing it.
when she becomes a mother, she's a mother.
everything we offer her should extend naturally from these realities.
why should this be so difficult to understand
she asked disingenuously?

so i'm trying to prepare to give a little talk to a roomful of fellow physicians
about how no-epidural might be easier, safer, more psychologically sound,
and cheaper than epidural,
how one might consider suggesting to one's "ob cases" that "it's an alternative,"
and i might just as well give a little talk about how someday
we'll all have flying cars and food pills and life will be terrific.
i'd be accomplishing just as much.



don't tell any of them i said this.

last night i dreamed

because i was asked to fill out a paper asking who is my favorite patient, and why.
i had a list of six just off the top of my head
and was not answering the question right.
so i was asked, commonalities? (maybe the six characters
are actually one author.) well... there's mr. jasper, the guy
who looks just like bernie mac (rest his soul),



whose wit is dry and slow, and he's so strong looking
you would never know he has di-beetus. and there's mr. king,
who said he always told his wife when he dies, the first thing he
wants her to do is to buy a red dress, and the second thing is
get out of town, but she died first, and now, years later, he's
still living. the other day i told him his di-beetus had been perfectly
splendidly beautifully under control, and he replied he'd celebrate



with a big piece of chocolate cake. and there was zina, that goddess,
mother of twelve, statuesque with graves-disease eyes that make her
look like she's looking every direction at once, and with all her kids
and their school uniforms to keep track of, she may very well
be. she has gold filigree teeth and tattoos. she loves her newest
baby with quiet ferocity. i wish they lived next door! she's
pregnant again, and i couldn't figure out how to stay here for her...



mr. pastor is the dashing little old-school puerto rican
spanish-only-speaking man in linens, who comes back every 3 weeks
even though i tell him, through our sad little speakerphone translator,
"i don't need to see you for another three months!" and even though
he always nods agreement. a few years ago, his wife suddenly collapsed
and died, like a bolt from the blue, and then he didn't know how to
do his pills, or feed himself, or how the washing machine worked.
his mom came over and helped him, and then, a month later...
his mom died. now he goes to the latino men's club every day.
he hugs me with his bony little shoulders, and says, with
tremendous force of meaning, "I Do You Tell Me."



there's jamilla, who finally realized she was pregnant
seven months along, outcome of a stupid set of experiments
with her best friend, a boy, not her "boyfriend." a homeschooler,
studying geometry and arabic and hatha yoga. vegetarian. five siblings.
she had a fine strong fearless birth of a sweet shine eyed little gal,
now a year old, and now jamilla no longer homeschooled, is
taking classes at the engineering school. she's sixteen.
you may notice i have a little more to say with every story
every little memory cue is like a pop-up labyrinth
of rich full scary beautiful amazing mansions. who was the



last name on my list? she was actually 3rd. mrs. martin. we have talked
for hours and hours, mrs martin and i. suffice it to say she gets nervous
alone in her hourse sometimes. she takes a nerve pill once in a while
which helps. she works as a church nurse. she goes to the casino
with her friends. her grandchildren hover around her most of the time.
she doesn't like doctors. i see her every month, and we talk.



i hadn't even mentioned mrs gaudio - she's still alive and kicking!
or poor little drama queen, the raving beauty, with her black eyes
and cesareans, or mrs sutherland, on her way to north carolina
where her best friend is dying of cancer, who always calls me "honey"



instead of "doctor," or beautiful, adventurous judy, with her midwest-
glamorous family (soon to move to aspen, to take the midwest off
their shine) - all she needs is a little bit of ativan
to get her through her day - or mr petrovsky, who is deaf as a post,



so i go around all day shouting, after half an hour with him -
his memory is shot, but he's full of stories
about when a service station was really a service station,
down at michigan and cass. what about mr maley and his
hundred-year-old mum (yes, hundred-year-old mum), coral?

my favorite patient? i've got dozens.

so anyway, because of this little exercise, i dreamed
i got down the polaroid and went to the store
and bought a hundred dollars worth of polaroid film
and kept it at the nurses station
and whenever "my favorite patient" showed up on my schedule
i'd say to the nurse, "will you come take a picture of us?"
and i had a big stack of photos of me holding cute babies,



hugging ladies, posing nicely with gruff old dudes. and in my
dream i realized, the kids, the kids' pictures too,
so at the same store i got a medium sized box of crayons
and emptied my pockets of otoscopes and calendars and rx pads
and put the crayons in there instead
and then whenever a child came to visit me, i'd say,
"can you show me how you're doing? show me something new,"
so then i had a big stack of crayola drawings too,



and all these pictures travelled over mountains, and across the high plains,
and came to rest on a bulletin board as long as i'm tall, and in my new world
with my new strange vistas and my good new devotions,
in my new work space built for care, not efficiency,
there they were still, all lined up every day on the board,
smiling and brightly-colored, well-known and true to life - abiding with me.

...then in the morning in a sleepy daze i headed for the polaroid
but took a moment to wash my face and peer in the mirror and think,
do i really want all those pictures with me in them?
i take crappy pictures. i am not the most photogenic ever
in the history of the world...
i hesitated, then forgot.

until now.

ash wednesday

if you are too busy to write, you might be too busy to learn from your experiences. and when i say "you," i mean me.



i have been going to a couple homeless clinics. they are relaxing to work in, because the volume is lower and so are the expectations, by which i mean, you do not have 15 minute scheduled appointments. you can talk for as long as you need to.

i have been too busy to write.

but i'll tell you what. on ash wednesday last week, in the homeless clinic at the salvation army, i saw this lady from new orleans. she's been here in milwaukee since 2005.




remember 2005?

she had been a chef, and a "minister of music" at church, with a wide circle, she says, of friends and choir pals and extended family. she has been stuck here, in this postindustrial northern-urban wasteland, ever since the hurricane.

the family? we don't talk much. nobody has a phone. a church home? i don't know, somehow i just never got anywhere. a job? been cooking here and there sometimes. not my kind of cooking. now there's no jobs anyhow. plans for the future? want to go back home? i don't know... sometimes you just lose your way.


sometimes

her breathing went bad as soon as she got up here. she was, what, 45 years old, then? she'd had asthma as a little girl, but it went away, and then in high school she played basketball and ran track, and never had any trouble breathing.

down there, it's hot, all year round. it's steaming. i'm not used to this cold air. i can't get used to it. i used to sing. i can't sing. i can't work. i can't do anything. this cold weather all the time.

so she "hits on the pump" - uses an asthma inhaler - 3-4 times an hour, and a few times every night to sleep. (you're supposed to call the doctor if you need it more than four times in one day.) she ran out of her own inhalers right away, but she got one from her neighbor and then a couple more from "this guy in kentucky i know."


this guy i know

i do believe that, as more and more of our friends and relations lose their jobs and with them, their health insurance, this will become a more familiar part of the future face of drug dealing: 'a guy' who can sell you some inhalers. or some metformin for your di-beetus. or some blood pressure medicine. since you can't get to the doctor to get your rx, and you got no more low-copay meds. or, on the other hand, you're the 'guy in kentucky,' making enough money for cigarettes by selling your inhaler, metformin, water pills, to your neighbor.

the lady from nola first came to the homeless clinic 2 weeks ago, and was given an inhaler and metformin and water pills. but she is so very worried, all the time, about her bp and diabetes, she decided she'd need to take all these drugs at twice the prescribed doses. and you know what? not only were these double-doses the same i would have prescribed her anyway... but also, her blood pressure and blood sugar were perfect.

unfortunately, she was blowing all her food money buying extra drugs from other people (not to mention poisoning herself with asthma inhalers). she kept taking more and more medication because she "knew" her blood and her sugar were high.

how did she know they were high? her vision was blurry. the sugar gets out of control and her eyes get blurry, and then the high blood gives her the headache. like right now, my eyes are blurry, she said, trying to read her new prescription bottles.

i had to laugh. "how old are you?" forty-eight. "put these on," i said, taking off my own


cheaters

and handing them to her. she held them up to the light and frowned. naw, these are way too strong. they'll hurt my eyes - "put 'em on! now, can you read this?" and i handed her a fine-print drug foldout.

her jaw dropped. she looked out from under the specs, then through them, then over them, then through them again. you mean, i need glasses? am i gonna have to go to an eye doctor? "look, your blood sugar's perfect. your blood pressure's perfect. and anyway, these aren't glasses glasses, they're just cheaters from the walgreens. they cost, like, seven bucks."

the young, pretty nurse walked in. "are you telling her about these?" she asked, taking her own magnifiers off her head. "i got mine at the dollar store." how much did they cost? "a dollar... it was the dollar store, right?"


dollar glasses

the woman was dumbfounded. you mean, i been taking all these drugs because of high blood and di-beetus, and all along i was just getting old? "we prefer to call it 'mature'," i said primly.

she couldn't stop shaking her head, astonished, laughing.





she pulled out from her wallet a tattered old business card with a scribbled-out phone number written on the back, and said she wants to bring us all lunch, at the clinic, some of these days. here's what she wants to make us:

shrimp jambolay'
an' crab corn bisque
or maybe hambone gumbo
s'm fried tomatoes
an' okra stew
an' maybe a chocolate praline pie.


some of these days

we get a little sentimental after too much hospital

last night i was charged with taking care of a woman
in the ICU with the following acute problems:
pancreatitis and gallstones, a big swollen painful belly,
esophagitis from a yeast colonization so she can't swallow,
an autoimmune disorder which destroys her platelets,
so her blood won't clot, repeated hemorrhages from the nose
and vagina, severe anemia, as you can imagine,
fevers, kidney damage, and very high blood pressure.

she has the following chronic problems:
AIDS, cervical cancer, chronic pancreatitis, epilepsy,
male pattern baldness, and paranoid schizophrenia.
i am not making this up. she's 37. she has eight doctors.
she's delirious and can't make decisions, such as, for example,
going out for a cigarette, which she really wants to do.

her parents are supposed to make medical decisions for her.
i found myself sort of surprised that she had parents,
as if such terrible things would be somehow prevented
by having parents. she was hallucinating that
her daughter was in the room, and somehow
i wasn't as surprised that she had a daughter.
does she have a daughter? she doesn't get
any visitors. social workers are trying
to find a nursing home that will take her.

then i admitted another 37-year-old, a guy
who had a bellyache for a month, diarrhea
all day every day, lost 20 pounds, kidneys
shut down, CT scan showed "pancolitis,"
meaning his whole bowel is on fire.
blood pressure almost two times normal.
oh, and he has cirrhosis from the hepatitis C he got
back when he was a heroin addict. oh, and
he smokes and drinks heavily. oh, and he's
schizophrenic, but he hasn't gotten any meds
for a month
because he's been
so sick.



in the night i woke up thinking about the
overwhelming burden of suffering borne
by the world, wondering how the earth shelf
on which we stand doesn't just crack into pieces
and fall in the sea, wondering how the air is not
thick with shrieks and cries and moans of grief
all the time, wondering how any of us can go on,
and whether those self-help books really help:
when bad things happen to good people, when things
fall apart, where is god
when it hurts.

i thought about defense mechanisms
Acting-out Affiliation Altruism Avoidance
Conversion Deflection Denial Displacement Dissociation
Humor Identification Intellectualization Isolation
Passive-aggression Projection Rationalization
Reaction-formation Regression Repression
Somatization Splitting Sublimation
Substitution Suppression Undoing

and then i thought about the song, Life is Still Sweet -

"...Just forget what I said last week. Life is still sweet."

we do forget what we said last week.
how can it be?



people tortured in prison still want to live. people whose
children were murdered still want to live - mostly.
suicidal people still love guitar music and have a favorite song.
schizophrenic people with cancer and AIDS still want to
go out for a smoke. we love the sun after rain. we laugh
at animals playing and kids throwing snowalls. we smile
when the first dandelions come out in the spring, we want to
hear the eleven o'clock news, we look ahead for brighter days.

i can't take it. it breaks my heart that life is still sweet.
my faith is that, as the wise man said, when you get
your heart pierced, then it can let more love in, and
i only hope i don't get some bad kind of heart failure
because i already
let in so much.

Scientifically Guaranteed Weight Loss Register Now For Free

as you know, when americans consider losing weight, the first rule they will hear is "consult your doctor."



so in my practice, i have a lot of female patients interested in losing weight. they usually come in asking for some pill they heard about. unless they have a pretty good reason for wanting to drop just 10-20 pounds in a short amount of time (for a short amount of time, since they're likely to put it all back on) (e.g. "need to fit into my wedding dress" - a popular one), i veto "quick weight loss" schemes.

instead, i try to recruit them to my "cult of dr leigh
life-transformation plan" which focuses on
1. taking the long view,
2. taking the wide (holistic) view,
3. considering body image and function as one and only one aspect of their unique and dynamic life and lifestyle,
4. encouraging consideration, if not construction, of a long term (five year) plan, in addition to a short term (until next visit) plan,
5. looking at "my food pyramid dot gov" and "mayo clinic healthy weight pyramid" online together, and
6. making them fill out food diaries and bring them back in regularly, which secretly is an opportunity to progressively process their feelings and actions around food and their bodies.

most of my patients are poor, stressed, traumatized, dangerously obese, and medically ill or on the verge of it (those young diabetics and young people with kidney failure you read about), as well as smart, brave, funny, creative, proud, and ridiculously good-looking (those young black women with cool names you read about). practically everyone has some degree of eating and/or dysmorphic disorder. plus, practically everyone is some kind of sexual trauma survivor, and whenever bodies are an issue, that trauma is an issue.



i ask them about the other women in their lives, and how they feel about how those women look, and whether those women also have issues with their weight, their bodies, eating; what good family meals have been like for them in the past; how they feel when they try on new clothes; how they feel when they have to go out to their exercise program, whether they were athletic in high school or grade school, how active their kids are physically...

i tell them that losing weight changes everything, and no matter how much you want to be thin, you might not really be ready for everything to change, and one theory is that it might be intolerable and you might unconsciously make it so you change back. and you could maybe counteract this by considering carefully all of the things about your life you'd like to change, and how quickly you can expect to change them, and what it will take, and what it would be like on the other side.

we discuss, for example, how old you'll be in five years, how old your children will be and how you want your relationship with them to be, and how old your parents or grandparents will be and what their needs will be; what you don't want to be afraid of any more by the time you're that old, what you always wanted to be able to do (play piano? bench press your own weight? have a flower garden?) and how you might truly expect to be doing it every day, in the future.



so every opportunity to process is an opportunity to affirm. and not only that, but these are opportunities to demonstrate my confidence in their abilities to get a grip on their lives. after all, limiting oneself to 1200 calories a day is full of fail, while strategizing creatively about how you want your life, your work, your relationships, and your self-image to change, in five years - plenty of time! - is full of promise.

but will it help them lose weight? frankly, i don't think that's the point. how much worse could i do, with my cultish machinations, than all the other current weight-loss plans? how much worse could i do than other doctors? for years i have asked other doctors how they help their patients lose weight, and what i've learned is that doctors are very cynical on the subject - from decades of fail. patients who "ask their doctor," women in particular, adopt an austerity program, lose 25 pounds fast, then gain back 35 and hate themselves double, and stay at home eating ice cream to live with the shame.

not only that, but the bigger you get, the harder it is to lose weight. the bigger you get, the longer it stays, the harder it is to work off.



and there's a big bunch of trauma - child abuse, sexual abuse, spousal abuse - behind compulsive eating that will never be reduced by reducing diets.

and there's a big bunch of that trauma that is caused by living in a white supremacist culture that is violent to women and children.

and there's a bunch of billion-dollar scambag maneuvering behind the amount of trans fat, palm oil, and high fructose corn syrup in "the american diet."

and there's more than one reason nobody knows how to cook from scratch anymore, but the number one reason is that real weekly wages of $277 for nonfarm workers in 2004 are less than was the real weekly wage of $302 in 1964, while a box of cornflakes that cost twenty-nine cents in 1964 cost $2.99 in 2004. who has time to cook, when you've been doing your own job as well as your laid-off coworker's job all day, or you're just home for a few hours before starting your second shift? who has time to teach your kid to cook (your kid goes to her day job when she gets out of school in the afternoon)? who has time to go to the store? and who has the money for the "diet food" experts recommend, the skinless boneless chicken breasts, sea bass fillets, fresh asparagus, 5-inch portobello mushroom caps, prawns, soba noodles and ginger sauce, edamame, fresh nectarines, pork tenderloin, pomegranate juice, artichokes, casaba melon with sweet creamy curry...

i also retain an uneasy skepticism about what it is we want, we doctors, when we want women to "lose weight." more than once i have seen a woman seem to lose in authority what she gained in self-conscious sex appeal, by losing weight. then again, i'm skeptical of the particular way in which we let women off the hook when they stay dangerously big or get bigger. after the thyroid and fasting glucose tests, after the "exercise prescriptions" and lists of low-fat treats, after the stern warnings and documentation, and especially after the 3-month trial of amphetamine and orlistat, doctors rest easy in the notion that their patients "failed" due to "noncompliance" (whether they refer them to surgery or not).

then i come along and ask, newbie to sage, "how do you help your patients with weight loss?" and they tell me they've tried everything but nothing works. one cardiologist told me that the only thing that ever made a difference, was to tell his patients to "Eat Half": "if you usually eat 2 bowls of ice cream, just eat one. if you usually eat a footlong sub, just eat a six-inch." he said that was the only piece of advice that people seemed to be able to understand and remember. then he said he was so glad he was retiring next month.



so i do tell people Eat Half, if they are looking for a very quick guideline and do not want to get into a whole involved cultish program. i have also been on a crusade for two years now to get people to drink water instead of - instead of everything else. instead of soda. instead of sugar-free soda. instead of sweet tea. instead of juicy juice. everybody tells me water tastes bad (the city water is actually just normal water, not horrible fish-water or rust-water), so i keep a supply of water bottles and generic individual zero-cal flavor packets in the office, and show them how to mix them up and carry them along. i figure eventually they'll run short of flavor packets and be stuck drinking water instead. i truly believe that people who are addicted to soda - they drink it before they brush their teeth in the morning, for crying out loud! - have a harder time cutting out other sources of sweets and salties. when actual water tastes bad to you, you know your palate is somehow way out of whack.

i think the final phase of my cultish life-transformation program will arrive when i have the time to just walk over to people's houses and go through their cupboards with them, and assess that they have for staples, equipment, and storage, and then sit down and show them how to make a shopping list. right now, in the hamster wheel, with the fifteen-minute appointments and the collapse when i get home at 7 pm, i am unable to muster up the energy to do this - and thus i will not, in fact, be able to "help them lose weight" to the degree that i should... but in the meantime - and i share with them, in fact, when it comes up, that i was a single mom too, i dropped out of high school too, i was on food stamps too, i survived sexual assault and domestic violence too - i am showing them that it is in fact possible, at least in theory, to get a grip on your world.



five years from now, when i am _____ years old,
i want to live (where):
my living space will have:
i will live with (who or what):
if i live with animals, i want them to be:
my main daily transportation will be:
i'll spend my weekends:
i'll spend my winter holidays:
i'll spend my summers:
five years from now, when i am _____ years old,
i want my main work to be:
i'll feel committed to this work because:
the challenging part of this work will be:
if i have a job that's different from my work, i want that job to be:
that job will help me with my real work by:
five years from now, when i am _____ years old,
i want my closest relationship to be:
i want most of my other relationships to be:
people will be comfortable calling on me for:
people will think of me as:
five years from now, when i am _____ years old,
when i want to have fun, i will:
when i want to unwind, i will:
i want to have enough time to:
my most creative activity will be:
i'll spend about this much time in creativity:
my most satisfying spiritual practice will be:
i'll spend about this much time in spirituality:
i want sleep to be:
five years from now, when i am _____ years old,
i want to be strong enough that i can:
i will have enough endurance to:
i will be physically flexible enough to:
i want to be able to walk, run, or roll (how far and how fast):
i want to be able to lift or carry (what):
i will enjoy doing these kinds of fitness activities:
i will enjoy playing these kinds of games:
five years from now, when i am _____ years old,
i want my body to be:
i want my face to be:
i want my hair to be:
i want my eyesight to be:
i want my hearing to be:
i want my arms and legs to be:
i want my hands to be:
i want my heart to be:
i want my appetite to be:
i want my weight to be:
i want my back to be:
i want my breathing to be:
most of the time i'll feel:
most of the time i'll look:
five years from now, when i am _____ years old,
i will no longer worry about:
i will no longer regret:
i will no longer be angry about:
i will no longer wish i were:
i will be ready to forgive (person/s):
for (action/s):
i will have been be forgiven by (person/s):
for (action/s):
i won't feel like doing this anymore:
i won't be afraid to do this anymore:
i will have left these things behind:
i will be so glad i chose to: