Paying For Health Care And Humanistic Medicine

   

If Humanistic Medicine (HM) is showing care and concern for the individual patient, certainly the way we pay for care has implications for HM. Should a patient worry about getting care because of financial implications, be it copays, deductibles, medical debt or medical bankruptcy, choosing between medical care or food or housing, or other consequences? If one believes that health care is like any other good or service in life, like buying a new television or deciding on a vacation, then one can justify financial consequences, including possible avoidance of care or medicines and choosing inferior treatments. But if one believes that health care is special, like having food to eat or housing to live in or education to get, then one is likely to be persuaded that facing more than small financial consequences of seeking care is inhumane.

If one thinks that removing financial consequences for a portion of the population (the middle of the population, because Medicaid applies to the lower income population and high wealth families and those with adequate health insurance will not face significant consequences) is essential to moderate demand, then one should remember that the main culprits for high costs in health care are prices and administrative overhead, not high utilization. In addition, if one really wants to use patient choice to put pressure on prices, it is far better to find an agent for patient choice, such as the primary care provider (PCP) for the patient to do the searching and choosing, since they are the ones with the requisite knowledge.

HM demands that financial implications for health care remain a minor issue for patients, and that medical decisions by families not have to take finances into account.

This should be the goal of all payment schemes for medical care.

Connie

  

I have to admit it, I have always liked blonds. When I was in high school and expressed admiration for Diana Crocheron – blond, wifty a bit, really pretty to my eyes – my mother, who was a redhead, I’d say, maybe chestnut, those shades always confused me, said – Boys always like blonds. Such a know it all, such an observer. Last night I was rewatching Silver Lining Playbook, and Jennifer Lawrence says in exasperation, stop referring to me in the third person! I could relate to that. They watched me, they loved me, but really, this third person stuff? And by the way, she’s not a blond, but who could resist Jennifer Lawrence? Here I am, 85 years old, and it sounds like I’m still looking for love. Isn’t that for young girls, looking for love? Jesus.

So, I think it was in second grade at the Henry C. Lea Elementary School at 47^th and Spruce Streets in West Philadelphia, where I was a student from kindergarten to fourth grade. What was I in second grade, eight years old, maybe? Or was it a year later? Eight sounds pretty young. But I’m pretty sure we were in Mrs. Anderson’s class. She was tall, spare, angular, alert, animated. Maybe a character. A teacher who took teaching seriously. I think most of the teachers I met in school took teaching seriously. Teaching can be a calling. You’re facing all those kids, those sincere and eager kids, those bright faces, not knowing what to do with their hands as they sit at their desks, some folding their hands and pursing their lips, like that girl in my class, Patricia, or John Lewis, the somewhat effeminate light brown haired fair skinned kid who ran like a girl with his arms stiffly by his side, who had a nice, naive, gentle smile. He and Patricia, who was heavier, both folded their hands and looked attentively at Mrs. Anderson when it was time to pay attention.

Those were great days. Prepubertal days. What made them so great? Security – I was lucky to have loving parents, stable parents, and by then I had three younger siblings, Bobby, Kathy, and Emily. But being prepubertal, there was school, which I was lucky enough to be good at, and sports, which I was also lucky enough to be good at. There was a well-regulated household and a well-regulated life, and we were all healthy. I had a mother at home – not like my new friend Trinh, who as a little kid was a Vietnamese boat person who eventually wound up with her mother and sister in the Tenderloin section of San Francisco with no material support, who came home from school as a latchkey kid who stepped over people on the street to get to her house and lock herself in, imagine that. But who was first in her class at Lowell and got full boat to Harvard. I had no idea of anything like that, of course, I lived in West Philadelphia and we had a nice class and school, not overly demanding, and I didn’t worry about girls, I was prepubertal. Best time of my life, in some respects. Talk about living in the present.

But, I did have a girl friend. A blond girl friend. Connie. She was the most beautiful girl in the world, according to me. She had straight hair that came down just below her jaw. I never understood this curly hair craze – her straight hair was just perfect. She had a little mole at the right corner of her mouth. She had kind of dark skin, I’d say, just a little, but I would look at her and I just loved her, I thought. Not tall, not short, but just lovely. I remember her eyes especially, brown, looked directly at me. I can’t remember talking to her very much, but there was something, and it just was clear that we were boyfriend and girlfriend. Prepubertally. Which was great. Just kind of happened.

And here’s how I know for sure. It must have been springtime, because you wouldn’t have ice cream in the winter. Somehow, the whole class was having ice cream from Dixie Cups. Do you remember them? Those little round cardboard cups with a round top that just fit right down below the rim and had a tab on the edge to pry the top off, and there was half of it vanilla and half of it chocolate. Dixie Cups. Way before ice cream got fancy. So, we were all sitting there at our desks, probably about 20 of us, I’d think, and we were very involved in eating this treat. At least I was, I remember the enthusiasm I had in having this treat. I’ve always been intense, I think.

Anyway, then I saw out of the corner of my eye Connie walking up to Mrs. Anderson with her Dixie Cup. They talked briefly, and then Mrs. Anderson stood up and addressed the class. Mrs. Anderson was a confident woman, who provoked confidence in her class as she challenged them. One time she asked a question and I think it was John Lewis who gave her the answer, which was right, but then she looked at him closely and said, Are you sure??? John backed off and said no, he wasn’t. Are you sure?she repeated. I guess not, he said, Then she said, John you had it right. You were right! Stick to your guns!

Can you imagine that, Stick to your guns! What a great use of the vernacular. Stick to your guns. So American. That’s great teaching, in my book. I remember it vividly – it was so surprising. She took teaching seriously, a calling.

So Mrs. Anderson addressed the class, with Connie standing right beside her, maybe a Robin to her Batman, but they were definitely a team. So Mrs. Anderson said, Connie doesn’t want her ice cream. Who wants it?

Well, who doesn’t want it? A bunch of eight year old kids at their desks, almost finishing one Dixie Cup, what could be better than a second one? So we all raised our hands. Not only raised them, but flexed ourselves forward in our desks, pushed our hands as far forward as we could at a 45 degree angle, and yelled – MEEEE! ME! ME! Cacophony, delirious cacophony. ME!

So Connie stood there and surveyed the room. And there I was about four or five rows back just to her left, and her eyes settled on me. As everyone cried out ME!, she walked purposefully back to my chair and looked me in the eyes and reached out and gave it to me. I was not actually surprised, or maybe a little, but at that age you don’t think too much about it. I said thanks, and prepared to dig in. She turned around with a smile and walked back to the front of the class and turned left to go back to her seat. I didn’t stop to wonder how come she didn’t want her Dixie Cup.

In fifth grade I transferred out of Henry C. Lea to go to private school, Friends Central, out on City Line Avenue, and in 9^th grade we moved out there to Wynnewood on the Main Line, not like in the Philadelphia Story, but still, the Main Line, and I went to Ardmore Junior High for a year and then to Lower Merion High for three of the best years of my life, even though I was well into puberty and all the complications and excessive intensity that brought to an already intense kid. At Lower Merion we had a great group of kids in our year. We had the smart kids, of which I was one, who were also good athletes and good kids who drank beer and occasionally something harder – no dope in those days – and I continued with school and sports and then dreamed of sex but it would be some time. I didn’t have a girl friend. Several of my friends liked Diana Crocheron, and one actually slept with her, I think. I don’t think many of my friends actually got laid in high school, but who knows?

In a class of 350 there were many groupings, of course. We knew each other, these other groups, and especially through sports, we mixed. There was a crowd that was not the high-achievers, and who acted maybe a little tough, although there was no physicality to it, no one was bullied, there weren’t fights, there was no crime I was aware of. A couple of the guys wore leather or jean jackets, I think there were some motorcycles. David Kirby was a little guy with them, Hughie O’Neal was a blond guy who seemed a little tough, Chipper Poe was with them – he later opened a motorcycle store, I think – maybe John “Apple” Lynch, a big strong guy probably 5’11” 220 lbs, who I played basketball with sometimes, and sometimes had a squint and was soft spoken. And there were the girls who went with them, and I don’t remember them very well, except for one of them, who I became more aware of as time went by and I heard what her name was. She had dark, straight hair, and was voluptuous, as my wife Ann would have described her. My less delicate friends in high school would have said she had big tits. And of course, as you have been thinking, her name was Connie. Back in second grade her last name was too tough for me to remember, but now in high school, I could. Her name was Connie Petropolis. So she was Greek. She still had that little mole at the corner of her mouth. And her eyes. She fussed proprietarily over her boyfriend Hughie. Did I sometimes see her looking at me out of the corner of her eyes? Maybe, I think so. But it took me the longest time to realize that this was my girlfriend Connie. Her hair had darkened. Back then in second grade I didn’t have an intimidated bone in my body, but now, post-pubertal, I couldn’t quite believe it. Too much for me, I thought. She had become a woman.

In fact, I never just went up to her and said, hey, are you Connie? I could have done that. Of course she remembered me. She must have thought, with reason, that I was a dunce. How I had loved her! Now she was more advanced socially than I was, which I took for a permanent state of affairs. Oh, man, what would it have cost me to go up to her, and say, hey, are you Connie? Oh, man. I could have told her that the name Connie has always been special to me. Early love. Idealized love. Love without consequences or complications. Love where she gives you her ice cream. I’ve always looked at women named Connie with some sense of lost, idealized love – they are special to me, and I’m disappointed if they don’t look like Connie. I imagine that I look for love in all the wrong places. Who said that? Puberty changes everything.

She never has even come to the sporadic class reunions, of course. I think I’ll ask Jonny Fish, my LM classmate who lives over in Piedmont, about Connie. He might know. I guess it’s a little late now. I would so like to see those eyes again, and eat some ice cream.

Grandparents Die

  

When I was in college I first experienced my grandparent dying. I wasn’t there at home, I was in Boston and they were back home in Philadelphia for the first one, my mother’s father. I got calls when they died, like for a birthday. My mother’s father. My father’s father had died about 10 years before I was born, of a brain abscess, which would have been readily cured today, but at that pre-antibiotic time wasn’t. So I never knew him. But I did know Grandpop, by mother’s father, a thin man who had a great sense of humor but who seemed pretty sad, as I would have been if I had been living life with my grandmother. Frail, when we knew him, smoking a lot of Pall Mall’s until he finally had to stop as his heart failed and we kids teased him as he sat with his hunger for a cigarette and he rebuked us, saying to us directly, you have no idea how hard it is. His index finger was tobacco stained. Anyway, I got the call in my junior or senior year and, worldly man that I was by then, I simply arranged a flight and took it, and my roommate Ken took the call from my parents asking for my plans and that’s how they found out that I was on the way. I figured they were impressed with my sophistication – I certainly was.

We were at the cemetery and my grandmother threw a handful of dirt on top of his casket and cried and reached out to him as it was lowered and my mother and someone else on her other side pulled her back, as it look like she was going to go down and pull him back. It was like a set piece, like “hold me back or I’ll hit him.” I was struck by it, acting the piece. I never saw her so attaching to him in life, so I was actually surprised.

Then my father’s mother and my mother’s mother – I did visit my father’s mother in the hospital, I remember, and was shocked as she fidgeted in the bed and I got an unwelcome glimpse of her bottom and turned away. She was 72 years old, and seemed very old and irritable. Impending death seemed very strange. I didn’t know much about what to do, but she seemed to like having me there. She talked to me. I really didn’t know much what to say. I was well out of college then, because I remember that Nana – my father’s mother – visited us in our new Berkeley house and Mary Jane, my first wife, was pissed when Nana questioned 3 or 4 year old Allie about something and caught him in a lie. So by that time I was in my 30’s. Nana was a piece of work.

By the way, I’m getting sick of having to use the English designation of grandparents – it’s so much easier in Swedish. In Swedish, “mor” is mother, and “far” is father. So the two grandmothers are “mormor” and “farmor” – so much simpler.

Anyway, my maternal grandmother died herself in turn, I regret to say I’m not really sure when – it maight have been a couple of years earlier, because I think I was on my year in Sweden when I got the call from my parents, who followed me via the baby sitter to where we were in a dinner party at new Swedish friends, and they kept me on the phone for an uncomfortably long time. No cell phones. When she was in the hospital my mother visited her, but she kind of sniggered when she said that when she visited her, she couldn’t wait to leave. My mother didn’t like her parents much. When they took the train to Florida for a few weeks in the winter and my mother was living at home with them, she loved it when they left and she was kept in the hosue with Carrie, the maid, nominally in charge. She called the kids “Doctor Sidney” and “Miss Renee.” When she got cancer she left her little maid’s room off the kitchen in my tiny grandparents two story semidetached house in West Philly to “be with her own people.” I recoiled just listening to my grandfather saying that.

Then there were might great aunts – mormor’s sisters Bea and Sadye. I saw Bea when I came to see her in the hospital, probably the Graduate Hospital at 19^th and Lombard Street. She was a pretentious socialite who I loved and who loved us, whom my friend Ed Packel nicknamed “Wide Zorch” because of her corpulence, and she loved having a nickname. She would pimp us to call her that, “What is that you call me?” “Wide Zorch!” “I’ll Zorch you!” Ha ha ha. When I got to the hospital I didn’t make it to her room, because instead I saw her on a gurney headed toward the elevator to go down for a test, and she saw me and yelled out “Buddy!” There was something so reassuring to her that I was there. After all, even though my father resented her pretentiousness, we kids and Bea really loved each other. I never saw her again.

For years she lived with her younger sister Sadye, who lasted until 96 years of age, I think. I remember one night at our house when I was taking a bubble bath with my brother Bobby, and my mother and Sadye were there doing the honors of soaping us down. I looked at Mom and her aunt and I said, confusedly, Which one of you is older? They looked at each other and sweet-tempered Sadye laughed a little, flattered, and said “Who do you think?” I think that was the time Bobby and I took the suds as we were standing us an put them on our chest – I guess I did it and Bobby followed – and pretended they were breasts. Sadye looked at Mom and said, They’re just noticing those things. One time we asked her why she spelled her name with a “y” and she said she had done that to be fancy. Sadye, who used to play cards with us with enthusiasm and patience, was close friends with her next door neighbor in the Rittenhouse Plaza Apartments, but then Norma died and all Sadye had left was Gertrude, their longtime maid. Finally, with so many buried, Sadye asked me, now a doctor, Is there a pill? She had lived too long. I remember the funeral. We gathered there in a small group, some people said something, and my father added his ungraceful comment, displaying his long experience with death (his professional phone number was GA6-5050, which he said was appropriate because that was generally your odds when you come to me) stood up and said, well, this happens, and I guess I’m next. Jesus, who needed that. Also, I think it turned out to be untrue because my cousin Peggy contracted salivary gland cancer, I think, and died from it. But not before going bungee jumping – what is there to lose, she figured. She was a gutsy lady, Peggy. At the funeral Gertrude stood up and told how Sadye was having a normal day but then she stood up and said something and then just fell down as she died on the spot. Just like that, said Gertrude. Good old Gertrude. A good cook.

I remember them so well. When we kids get together we’ll talk about them. Indelible. Such intense memories. Such personalities. Never stop missing them all.

 

Budd Shenkin 

The Odyssey - A Triumph

  

Thanks to my friend Bob Liss, a Columbia alum, I got to watch the Odyssey Friday night on his dime at a private showing for Columbia grads at the San Francisco IMax. Man, what luxury -- reclining leather seats, and what sight and sounds! We have come a long way, a far cry from my youth at the Nixon theatre at 52^nd and Market in West Philadelphia, where pea shooters launched barrages of peas at the silver screen during the cartoons and ushers hustled down the aisles to find the miscreants.

This is clearly another major achievement for Christopher Nolan. His great career has earned him as much investment as he wants in his ever more monumental movies, locations, actors, production values up the wazoo. He loves to make movies, apparently, and we are the better for it. Movies are a triumph of capitalism, in the sense that because they are made once and then distributed, the cost/reward ratio is terrific, if a lot of people see it. Let's not forget economics....

Anyway, here's my mini-review.

 

I enjoyed it a lot.  It is totally made for the Imax - huge scenes, great evocation of time and place, the bronze age in the Greek islands and the Aegean. Not much technology back then, compared to now, but the ships were their magnificent technology, and their military organization as well.  I've never before been transported this convincingly.

This interpretation of the Odyssey is very American, but I didn't mind that, I liked it. I did enjoy American English being used, none of that very formal English English sometimes used for “classical” films. The setting is ancient and foreign, but the people and the language modern. OK, I'll take it.

It's a monumental movie, but at the same time approachable - I’ll be surprised if it doesn’t get best movie Oscar. The women of the cast that I enjoyed most were Anne Hathaway (43 years old) and Charlize Theron (50 years old.) The wonders of makeup made Hathaway believable as someone who had aged 20 years by the end of the film. Everything about this movie is first class. There is a lot of action movie in it, and the usual hero with godlike powers, clearing away a palace full of suitors.  For some reason it reminded me of The Count of Monte Cristo, who basically was an early Superman.   Nolan always uses music prominently – it sets the mood so insistently that it is a character in itself.  It was OK this time (as it wasn't in Dunkirk, for example), and I liked using old Greek instruments, which I understand is what they did.  I thought I caught a whiff of Interstellar music here and there.

I paid special attention to Jon Bernthal, the son of my friend Rick Bernthal, who was impressive as Menelaus - bringing his street-action attitude chops to ancient Greece.  He really played his role terrifically - he relates great to other male characters, clearly.  I haven't seen him enough to know how he does with females, but here he is great in an avuncular relationship.  Clearly a top-flight actor.  Vicariously proud of him!!  Go, Rick!

Richard Brody in the New Yorker laments that there was not more action with gods - they hardly appear, but are referred to a lot.  He also laments that the cruelty of the age was not featured, and there wasn't near enough gore, which there could have been.  Ancient people were a bloodthirsty lot. This catered to the audience, I think, made the movie more relatable.  So did the lack of magic, and the irreality that actual gods bring to a film I know what Brody means, but it was still OK for me.

I hadn't realized that using the Trojan horse as a ruse broke the accepted norms of behavior - like not treating a guest well.  This recalls the Iliad, where the treatment of Patroclus by Agamemnon breaks the established rules of the game, and sets off Achilles - I wish I remembered those details more clearly.  Damon relates later in the film that this breaking of the rules will lead to the overall breakdown of their civilization.  (I did appreciate the very modern and American explanation of the war by Damon to Penelope that Agamemnon was using the case of Helen to mount an attack that would break Troy's monopoly on the trade routes.  I can't recall that from the Homeric text.) 

Anyway, the historical fact is that after the Trojan War, there was a shifting of the center of civilized power to the Greek mainland after a couple hundred years, and then after 400 or so years the Iliad and the Odyssey are written, and then the city-states coalesce more, law and the courts are reformed, and finally, maybe 800 years after the war, the great plays are written. * That's a lot of time!  Does Damon as Odysseus foresee this?  It's intimated that he does.  We might as well sail into the sunset he says to Penelope.  BTW, the opening scene with him and Penelope, where he tells her what he's going to do, is as tender a non-sexual love scene as I remember seeing - although it does end with sex.  Man, who doesn't want a marriage like that?  They're both terrific, but while I give Damon an A+, I'd give Hathaway an A++.

Brody also complains that we don't see enough of Odysseus's wiliness.  Well, yes, he's not so tricky, but he's so much more intelligent than anyone else, so much deeper, that I'll take it.  Yes, he's "an American soldier," as Brody says, but he's more than that, so I guess I don't really agree with him on that.  And we do see him figuring out situations really fast, and judging the motives of others, and figuring out how to come home.  Man - I guess others have noticed that it's quite a story.**

Something I also appreciated was the commentary on the House of Atreus, Jon Bernthal's disgust at the assassination of Agamemnon, briefly but vividly depicted, and the sacrifice of Iphegenia, as the most powerful sacrifice is when the object is the most dear, and how Clytemnestra could not forgive that one. That belonged right there, and I thought it was place just right in this non-chronological recounting – which is the only choice of how to recount it, to my mind.

And I really loved the scenes with Calypso (Charlize Theron is 50 in real life, and so beautiful and alluring here), so moving, the knowledge of temporary nature of things so clear in her, the ambiguity of the situation, her ambivalence, but her love, her own need, and her judgement of a man so telling - time spent on these scenes must have given Nolan pause, wondering if it's too much interruption of action, but for me, this is he real action.  The "action scenes," kind of the original Adventures of Robin Hood movie amped up 100 times, or any number of action movies since, even say the great Jason Bourne movies, are fine and intense with it's being hard to discern who is who, they're OK, like the great panels of maybe Breugel -- don't know why that comes to mind, but all the details of the fighting. But as competently as they are done, well, meh, for me.

Also, finally (maybe finally), I think they did the classic monsters really great - Cyclops is terrific, that one eye, the huge body, picking up men and eating them, kind of like King Kong when he's angry, or better, Godzilla.  And the sirens are really well done, Scylla and Charybdis -- but I couldn't help thinking of our pacific passage of the Straits of Messina last year on our August cruise -- I had a good time, but didn't need to be tied to the mast, although I was friendly enough.  The depiction of the whirlpool was great.  And then I didn't know what that encounter with the huge, armed men of war that routes the Greek men was all about - was that in the book?  It must have been.  

We should also mention Circe, depicted as a man-hater, a strange depiction by Samantha Morton, who is English, but comes across to me as a bitter woman from Brooklyn, or somewhere.  That's probably just me.  Still, not the entrancing type - but what an indelible scene as she literally turns the men into the pigs she knew they were inside.  Memorable, man, memorable.  And then Damon outwits her - that's the wiliness, Richard. He sees through everything. He's wily, man.

What was really good was the sense of sailing into the unknown, which Odysseus chooses to do freely, instead of taking the classical route home as Agamemnon and Meneleus do -- he's a risk taker.  He slides over his responsibility to get home to Ithaca and Penelope and Telemachus by saying "I bet we beat the others home," while they have an adventure.  Some adventure, it turns out to be -- 10 years.  7 of which, apparently, is spent with Calypso, the beautiful and alluring Calypso, eating lotus leaves.  The dream of life, life on a desert island with Calypso, dreams with lotus leaves, can't even remember the life before - as the rest of life has just been stripped away, even all the comrades in arms, and yet he remembers Penelope in the end and Calypso honors that.  Wow. Tears you apart.

So, OK.  See in in IMax format -- the evocation of place is really magnificent.  The way Lawrence of Arabia evoked the desert.  The Greek islands, all that water, all that sea, the mysterious islands and visiting the places they had only heard rumors about.  And then the movie-making of it all -- this is state of the art 2026, all the money you might want, the best actors and artists of make up and everything else I can only guess at, and I'm guessing a nomination for cinematography, without doubt.  How many total nominations will there be?  20?

Get ready to internalize images that won't be easily erased.

This one will stick.

Budd Shenkin

*

The Minoan Age (c. 2700–1450 BCE) was succeeded by the Mycenaean Age (c. 1600–1100 BCE). Following the collapse of the Mycenaeans, the region entered the Greek Dark Ages (c. 1100–800 BCE), which eventually transitioned into the Archaic Period (c. 800–480 BCE). [1, 2, 3, 4, 5]

Here is how these successive periods defined the Aegean world:

• The Mycenaean Age (c. 1600–1100 BCE): After the explosion of Thera weakened Crete around 1450 BCE, the mainland Mycenaean Greeks took cultural and administrative control of the island. They were the first Greek-speaking civilization and are famous for their fortified palace

A Fine Day Of Shopping

   

Yesterday was a fine day.

The fog didn't come in so much, but it was overcast, and strangely warm and very strangely humid, for the Bay Area. Pleasant. I had my usual Monday on tap – do some computering, physical therapy Monday morning 10 o'clock, top that off with a visit to the gym until around noon, find stuff to do the afternoon and evening – there's always stuff to do.

The girl of my dreams is in town, leaving later this week on orders from immigration. Her trip curtailed from three and a half months to two weeks, mindlessly and gratuitously cruel, after about 24 hours of mourning and confusion and planning for an immigration lawyer, she staged the most resilient performance I've ever seen. She planned like a madwoman. She had planned to see her 25+ friends – she says she has more friends here in California currently than she has ever had, total, back in Germany. I think she becomes a different woman here, which is why she wants to be here.

So what she did was plan to see every one of those friends that she had planned to spend time with over three and a half months in just two weeks. I told her it seemed like when she packs her suitcase, and she agreed. And amazingly, in these two weeks, there has still been enough time for me. It helps that we live four houses away, and that she uses my washing machine and dryer, and that she borrows my spare car. But we also eat and shop and do things. All I really need is one hit a day and I'm happy. I'm transformed, too.

So, yesterday I got her text – we text pretty much every day. We leave each other saying “Let's keep in touch,” ironically and humorously, mocking closeness with words of distance. I knew this was the day her friend from San Diego – she had planned to go down there for maybe a week before she got screwed by immigration – was coming up. I knew I'd be seeing her for a fancy dinner in the city on Tuesday, so that was my current milestone, so I thought maybe a text on Monday, or maybe not. But it seems that she had a 3 o'clock meeting planned, and she had stuff to do in the morning, but there was a hiatus just after noon. That worked fine for me.

She has been in search of missing Birkenstocks – where have they gotten to? We don't know. She searched the suitcase and other stuff stored in my closet – where are they? Not just any Birkenstock – she shops with precision, she dresses with style and precision. We had searched for replacements down at REI – no go. But we got her some very nice other stuff there, she loves REI, she tries it all on, she is so beautiful. But, Monday after noon, we could search for those Birenstocks elsewhere – I had looked on the internet and identified the Walk Shop over in North Berkeley on Vine as a possibility. And she wanted to go to Saphora down on Fourth Street to get just the right blush. She is precise and very effective. We could go together or she could borrow the car. Guess what our choice was.

So we head out to Fourth Street first. It's usually a hassle to park there, and it looks like the old parking lot is unavailable from construction. No matter, just turn down Fourth and see what pops up. Is that a spot? Yes it is! Right on the street! I'll take it! There are a couple of others, she says, that one is easier to park in, up ahead. Well, maybe, but then two cars come up and pass me as I'm poised to back into spot number one, and the first car keeps going but the second one takes the sport we were contemplating. Rule number one when parking, I say, take the first spot. Unaccountably, I do a masterful job of parallel parking. I have admitted to her that I'm not that great a driver, knowing that she is ready to highlight my driving deficiencies as I scrape the car's wheels as I pull in forwards to the curb in front of my house. But then she has said back to me, you should be more confident of your driving, that's all that's wrong. I could just eat her up.

So we get out of the car and I take maybe four steps in the direction of Sephora, but she doesn't get even that far. The store we have parked in front of is one we weren't aware of, it's called Buck Mason. We walk in and Lauren, our young saleslady from Fremont, pretty girl, says to Jenny – I like the cut of your shirt! Yup, Jenny is stylish, linen shirts with a different cut, and oh so attractive when worn by Jenny. So she looks over the merchandise. It's a small store, with space to walk around, not that large a stock, but really nice. And there is music. On a turntable, with vintage vinyls on the shelf underneath. And they are playing Buddy Holly. Buddy Holly! They're playing Buddy Holly! This is my music, I say. Lauren has introduced herself to Jenny, Jenny has some stuff to try on – shirts; she doesn't need more jeans, and she got some nice pants when we were at REI – and I talk with Lauren and ask if she knows how Buddy Holly died. It's vague to her, of course, and she tells me I would probably like some of the other vinyls there, although she assures me that many of them are from before my time. Well, I look younger than my years, and I'm with Jenny, so yeah – but no, of course not. Sam Cook. It's true, there's some Nat King Cole, but I remember him on TV, and he was there on a movie the other night on TCM – I'm having trouble remembering just which one. Before my time? Not so much.

Jenny comes out of the dressing room a couple of times. She's like a model, everything looks great on her. We consult with each other – we are very practiced co-shoppers, it always goes well. Lauren has shown me their limited selection of men's T-shirts, which are nice. She tells us that their stuff is manufactured in Pennsylvania, and I ask where, telling Lauren that I'm from Pennsylvania, so exactly where matters to me. She's hazy on Pennsylvania geography, but Google isn't, and yes, Mohnton, where the mill is, is just outside Reading. Reading! That's where my first girlfriend came from! I know Reading well – the home of beer, pretzels, vice, and Albright College. Vice – Carol King, my first girlfriend, told me how their girls' service club delivered goodies of some sort to houses in the poorer area of Reading around Christmas time, and a woman at the door took the donations to the poor gratefully from the high school do-gooding girls and said, “Thank you! The girls will love it!” Reading. Vice in Reading.

Anyway, domestic goods. Nice T-shirts, I'm looking to refresh my collection. Lauren suggests a mauve and a brown, I tell her I need Jenny to help, Jenny comes over and says, no brown for him, he doesn't like brown, well, he always wants blue, and we go through a couple of possibilities and I take two to try on and she says – the blue one will look best on you. We're a couple out shopping. Lauren sizes us up and thinks that, since I said I was from Pennsylvania, we are on a trip together as travelers, and treats us as such. She says, what else are you going to do today? I smile a little and say, well, at three, she has to be in the city to meet another guy. Jenny says, yes, that's true. Lauren now doesn't know what to make of us at all. Who does?

We buy our stuff, put it in the trunk of the car, since we parked directly in front of the store by chance, although you have to wonder if it really was by chance, so much that we do together winds up like this, you really have to wonder if it's chance, and head off to Sephora, which was our destination. She gets something close to the blush she wanted, I ask her what foundation she uses, she shows me – not so clueless, me! A guy asking about foundation! She says, why do you want to know? I say, well, just because. We get back in the car and take off for the Walk Store. We find it and park – good parking spots just come up for us, all the fucking time, I swear. Like our first shopping trip together, to Dog Patch in SF, where we parked across the street from our target, a single parking space in an ocean of parked cars with no open spaces, and – this is true – as I'm trying to pay for a spot a parking meter guy comes around and asks us how much time we would like him to put on our meter for free! I'm not lying. That was such an amazing shopping trip where we got some leather goods from the distribution center of this company that doesn't have stores, and doesn't ship to stores, it's only on-line, except for us.

Well, anyway. We get out of our car around the corner from the Walk Store and a guy sitting in front of Peet's says to me, how much does it cost to change oil for a Mercedes at Jiffy Lube? Strange question, I think, and I say, what, $85? I don't know. We walk off and Jenny says, you should really have been nicer to him, if you're nice to people you … something or other. It's true, I was a little annoyed – I think it was being identified as a Mercedes owner – it was Ann's car originally, I drive it now without loving it much, but it's a good car. You're probably right, I tell Jenny, which I generally do say, and I think about everything she says, and I treasure her criticism, I take it for love, of a sort, and I wonder if there's anything wrong with my doing that, but then I think I don't care, maybe. If she pays close attention to me, I'm going to complain?

The Walk Store doesn't have exactly what she wants. Close. She needs narrow shoes, and the style that she wants doesn't have that in stock. She's been frustrated by this for over a week! Where are those shoes? OK, Budd says replace them, but that's proving hard. If only she had more time. Why is it she needs to find Birkenstocks in Berkeley, not back in Germany, anyway? She has some explanation....

We go back to the car empty-handed, and we engage in gentle conversation with they guy who wondered about the oil replacement. Jenny shows me how it's done. She really doesn't know how good I am at talking to people, I think. Maybe. Anyway, I love seeing her talk to people. She's proud about how she does it. She claims that she used to be an introvert. Something happened to her in Germany. I remember we did that getting coffee and pastry down at Baker & Commons, down on College Avenue, and the lady next to us agreed with all our opinions, a teacher in Berkeley, loved talking with us, maybe newly retired, and Jenny said, see?! Her new best friend. Which we also did when we got pizza at Rose Pizza over on University, and the couple next to us were a new couple, his wife had died, but they were very close with each other, clearly, and we talked for maybe an hour and then the next week we had extra tickets for the Giants and we invited them and had a great time. Doug and somebody, from down the Peninsula. They were nice. I wonder if they got married – I'm betting they're still together.

Can we go to REI and check out the shoes again, she asks. No, I say, you don't have time. It would take 15 or 20 minutes to get there, and you have to be in the City by 3. It could have been earlier, she says, but his plane was late getting in so he missed his Walnut Creek meeting and texted me that we could get together earlier but I had already made plans. We go back home and she takes about half an hour getting ready and comes back wearing a new outfit to pick up the car and it's already 3 o'clock when she take off. I ask her what they will do and she says he rides a motorcycle and they will motorcycle around the city and she loves that. I caution her about motorcycles and she says they wear helmets. She drives off and I stop myself from thinking about the rest of her day and I count myself so lucky to have had this couple of hours.

She gets back about 11:30 at night and I hear her lock the car in the driveway and I step outside and call to her – I'm up because I took a nap and when I do that I stay up late, working on the paper I said I would. She had asked me what I was going to do and I told her I had some writing projects and she made sure I was going to do them. I lazed around, actually, watched Slaughterhouse 5 which I had seen some of a couple of days ago and had saved, and I really liked it, Vonnegut is a very favorite author, I don't know if Jenny reads him, I think she read one of his books a while ago, I did buy her a copy of The Years by Annie Ernaux and I hope she read that because both she and Annie view their lives as adventures. So Jenny said she had had a good time and was tired and will text me tomorrow.

Budd Shenkin

PS – Then, two days later, the day after our fancy dinner at Acquerello in San Francisco, she actually located the Birkenstocks she was seeking down at REI, I called and they reserved them, and we managed to pick them up at REI without buying anything more. Mission accomplished.

 

Podcast - Idealism in Medicine

https://podcasts.apple.com/us/podcast/md67/id1896943610
"Without idealism, medicine is lost."
Dr. Budd Shenkin graduated from Harvard Medical School in 1967 and spent over thirty years building and running a successful pediatric practice in the San Francisco Bay Area. Dr. Shenkin believes, from his experience as both a patient and a physician, that medicine grounded in a humanistic approach is essential in the face of corporatization. And, he says, when it comes to profit-driven plans like Medicare Advantage, "insiders say no." 

Jews in Disorder

  

As a history major and a believer in history, I look at the current splitting of Jewish opinion between the Zionists (not me) and the liberals (me), and I'm conscious of how my family's Jewishness has always been of a sort different from the Temple attending traditional Jews.

I was circumsized at birth, but that was about it for Jewish indoctrination. I was not bar mitzvah, we never went ot services, I went to two years of Sunday school to learn some rudiments of tradition and Hebrew, we had holiday dinners, but that was it.

What I suspected now finds new explanation in a book by Molly Crabapple: HERE WHERE WE LIVE IS OUR COUNTRY: The Story of the Jewish Bund. It is well reviewed by Adam Hochshield in the NY Review of Books. https://www.nybooks.com/articles/2026/05/28/a-dream-of-a-socialist-commonwealth-the-jewish-bund/. And also in the NY times. https://www.nytimes.com/2026/04/06/books/review/here-where-we-live-is-our-country-molly-crabapple.html.

To reduce the idea to a sentence, there was a split among Jews jusrt over a hundred years ago in Europe, among Zionists who thought Jews would only thrive apart from common society in a country of their own, and those Jewish Labor Bund unionists who advocated socialism in Europe and cooperation with other groups. That's a one sentence summary of a 453 page book, so some details are missing. But the point is this: Even though my family was not working class as were the Bundists, they must have supported them. Me, I wouldn't be comfortable with them. They were working class unionists, and although I agree with many of their concepts, I am irreducibly middle class and intellectual elite.  Nonetheless, I think that we are seeing the continuation of that fight now with the dire split among Jews, at least here in the US, where the zionists elevate Israel to sacred status, and the descendants of bundists insist that Israel should be a liberal state, not a repressive and cruel one. Israel's claim to fame should not just be that it is Jewish. Israel is exhibiting is that it is Jewish, the wrong kind of Jewishness, it's the nationalistic Jewishness, rather than the internationalist Jewishness based on values that we endorse.

I see what has happened to Israel as more or less what has happened to the Department of Justice.  DOJ used to be righteous, and being so, the courts gave it deference, the default being that DOJ would do the job right.  Now, that's changed, since Trump corrupted it.  Likewise, we used to be able to have support of Israel's position as our default, knowing that even if they made mistakes, they were trying their best, guided by righteous ideals.  Now that Likud and Netanyahu and his henchmen have corrupted Israel, that country no longer warrants default approval.  Rather the opposite.  If they are accused of murder, that accusation is probably correct.  When they say they will be investigating it, that's probably a lie.

I can understand the traditional Jews' hanging on to Israel as an ideal. It's almost impossible to stop believing in something that you have been taught to regard as sacred.  Israel to many is a guiding lighthouse in a sea of fear.  To give up that light is to be bereft.  Moreover, for many, just as with many causes, belief in Israel has become their profession, their source of income.  If you have gotten an email from me, you might remember my tag line there: "Every great cause begins as a movement, becomes a business, and eventually degenerates into a racket."  -- Eric Hoffer I would say that AIPAC has become the kind of racket that Hoffer warned against.

Traditional Jews are caught in a trap.  They cannot easily leave their traditional beliefs, Next Year In Jerusalem.  Jews who know about the holocaust through their own family ordeals cannot abandon the one source of succor that their family needed, when other countries turned their backs, or worse, collaborated.  Where is one to turn?  The USA of Trump?  Europe?  Where?  It's a complete dilemma.  So, the good-hearted traditional Jews continue to support Israel, some hoping for reform there, and others just saying, no matter how iniquitous it becomes, how racist, Jews will always need someplace to go.  It's a dilemma without an easy solution.

Many bemoan the rising tide of anti-Semitism. I'm unhappy about it, too, but I ask – who is responsible? It doesn't come from nowhere. There is the increasingly repugnant nationalism and illiberalism of Israel for the last 25 years under Netanyahu, Likud, and the right. Israel is now so truculent, and AIPAC and ADL and other groups are so aggressive and abhorrent.  Have they never heard of the virtues of charm, let alone liberality and humanism? Of course their actions are going to raise opposition, and of course people will generalize from Israel and the Jewish Right to all Jews. That's especially true when they all claim to speak for all Jews. They invite the world to be anti-Semitic.  And by so doing, they separate Jews from the general population - the white world, maybe - so that they stand alone, which is exactly where we don't want to be.  But of course, this is exactly where Netanyahu and his ilk do want to be, heroic isolation, it's me against the world!  How unfair!  How brave I am!  Or something like that.  Free to break international laws, free to be nationalistic, to expand, etc. What more could they do to incite anti-Semitism? They're doing their level best.

As someone who was never inducted into the Israel as a savior and an ideal mode of thought – a family of Bundists, I'm guessing -- I am left with thinking, hoping, and believing that the US will in the end continue to be the best country for a Jew to live in in the world.  If it should go full fascist and turn on the Jews, I will still die in this country, and my descendants, all of them being only half-Jewish and none being a member of a temple, will assimilate somehow, as they have pretty much done anyway, although they still identify as Jewish, if asked.  Other families who maintain a stronger Jewish identity will have a harder time. Part of the harder time they will have will be the decrepitude of the official Jewish organizations, not to say their obnoxiousness, their insistence that their way and their beliefs are the only credible ones.  What do you do when the official organizations are so uncomfortable for you?  I don't know, but I won't be around to find out.

You can look at the young Jews who protested in favor of Palestinians as those looking for Israel to be just.  It's a pretty stupid step to take, I think, but that's what they did.  There is no organization as strong as the traditional Jewish organizations that would represent their point of view without going whole hog extremist Palestinian supporter.  Somehow, J Street didn't measure up.  Individual Jewish leaders did speak up, some terrific liberal rabbis, I think, but they didn't have the money and the organization to consolidate that alternative movement.  Maybe they will coalesce.

Meanwhile, for me, if someone is to say, Next Year In Jerusalem, as is traditional but never was in my family, I'll say, OK, Next Year is fine, let's eat together next year – but not in Jerusalem. That's gone, man.

Budd Shenkin