How Much Health Care?

The most recent New York Review of Books includes a long, interesting reveiw/article on US health care. I've yet to finish reading it, but the central argument is that oversupply of services is a major contributor to our spiraling, out of control costs. Doctors have many incentives to order tests and procedures. Financial compensation and fear of liability are major factors in this dynamic. I had my own experience with the system just last week when, quite unexpectedly, I suffered a major reactivation of a long dormant companion: ulcerative colitis. Very mild symptoms, which had been lingering for a few weeks, and which in the past have disappeared on their own, typically in a matter of a few days, suddenly worsened dramatically and I ended up in the E.R., overcome by pain and dehydration. I'm a lucky beneficiary of modern medicine: a simple I.V. feed, spiced with some good narcotic, had me somewhat hydrated and almost pain free in fairly short order. Appropriately, the first call I got that morning, lying in triage, was from my doctor's office, to remind me that I had an 8:30 am appointment. I explained that I was tied to an I.V. at the hospital just up the street and wouldn't be able to make it. Not a problem: Dr. So and So is at the hospital making his rounds and he'll stop by to check on you. But the E.R. doctor got to me first and he ordered a CAT scan. When I got back from that my doctor found me and we were going over my situation. I asked him about the CAT scan, and he confirmed my doubts when he admitted he wouldn't have ordered it since what we really needed done was a colonoscopy, which was performed a short time later at the doctor's office. Waste? Who knows? I can't blame the E.R. doctor, but maybe if someone had told him my doctor was in the hospital they could have consulted briefly. But the hospital has it's routnes. I'm sure this happens everyday all over the country: hey, we've got this really expensive machine, so keep it in use, keep that billing office busy! (At least my doctor got me discharged and could perform this second procedure at significantly less cost than the hospital.) I'm getting great care and I'm extremely grateful: I kind of tail spun into very poor condition and, thankfully, got the help I needed very fast and with fantastic results: those evil pharmaceutical giants do have some good products! But how expensive is too expensive? How are we going to pay for it?

I question myself about posting comments related to private aspects of my life, but in this case I decided to go ahead. It's interesting to see the health care in action, and I'm fascinated by the speedy coming and going of symptoms and pain management. And the same old thing: someday in the future when I'm wondering when it was I had that really bad week I can look it up and I'll find it here.


Falling Acorns

On Friday after- noon Asun and I were walking to the car when Asun got hit by a hard falling acorn. Ouch. It's that time of year. Yesterday we were hiking along the Appalachian Trail and I was feeling deeply affected by the season's warnings: life ends. warm to cold, green to brown, moist to dry. What to do? How to respond? Acorns were falling to my left, to my right. Then, kaplut, one fell right in front of me. Damn, am I being spoken to? And then, right on cue, Waldo stumbled badly. As he regained his balance he looked up at me, as if acknowledging, yes, I'm getting old, I'm reading your mind. But it was a sunny morning, too, and we just kept on hiking. The darkness wasn't real. I'd like to be ready for that darkness. Maybe it will help if I think of myself as an acorn. I'll get recycled.

And apropos my thoughts, here is the beginning of today's poem from VerseDaily, "Teleology," by Rebecca Foust:

In the seed lies all that it can ever be,
shoot, plant, flower, fruit and

in the end again, the seed.
In the acorn, the entire tree.



Yesterday in my poetry seminar we were discussing how poems communicate tone. Initially I noted that there was some confusion about what tone is, so I asked them to forget about poetry and just think about language and communication in general. That helped recenter the discussion. Perceiving tone in non-vocal contexts can be tricky. (After all, tone is a musical term and its etymology is related to the stretching of a string.) In any case, I suggested they consider email and text messaging, modes of communication which are notoriously bad for clarity of tone. (Was that message supposed to be ironic? What does that mean?, etc.) Later yesterday I received an email from a student that conveyed, I trust unintentionally, the wrong tone. And this morning I read an article in the Times about a major mess up at the Met that very probably could have been avoided had it not been for a very poor use of email. Instead of getting on the telephone, Met director Peter Gelb sent German director Peter Stein, an email that made a sensitive situation much, much worse. (Gelb certainly had a right to be irritated, but by exposing his impatience and irritation in an email he forced an outcome that he wanted to avoid.) Read the article here.

So watch your tone. Sing. (I may yet get my nerve up and take some voice lessons--wouldn't it be great to be able to sing?)


Philip Roth's Focus

Right now I'm listening to Tina Brown interview Philip Roth (at the Open Culture website) and Roth just made an interesting comment that I've heard very similar variations of from a number of novelists: "I write my way into knowledge of the story." I find that to be a fascinating notion. He starts with a line, that's it. He's not recording a preexisting story; the story develops as it is created. It seems that life is like that. What knowledge do I have of my story? Is it mine? Sometimes the finiteness of the narrative proves unsettling, but a part of my brain tells me it really shouldn't: an infinite narrative would be terrifying. But what I really want is to be properly focused on the right now. Properly? What does that mean? I feel that I have, sometimes, an intuitive sense of what it means to be properly focused, but at this present moment articulateness is escaping me. (And I fear that sometimes the nature of our present age, so given to divide our attention, has sucked me in in ways that I do not like at all. Certain kinds of reading and work are the best antidote.