Thursday, April 11, 2019

Vote For Me!

If I were running for the Democratic nomination, here's what I might say:

If only “Make America Great Again” were more than a duplicitous slogan! It's not a bad thing to aspire to. You all know how much I deplore The Trump Crime Family Administration, in all its malevolence. But let's take the slogan that they have made so hateful. Let's compete. What would it take to get America back on track?

Countries should make their citizens safe – safety first! How can we make America safe – not just “safe again,” but “safer than ever?”

  • To start with the most obvious: minimize the danger of gun violence. It is a scandal for our children to be learning duck and cover in the schools, for God's sake. We need not only to do the so-called “common sense gun reform,” but let's repossess the combat weapons that are out there, the weapons of mass murder. Let's do what Australia did. And let's renew our efforts to limit guns in cities – there was a Supreme Court decision that said we can't do that, but that was from a very conservative and distorted Supreme Court. That decision shouldn't last forever. Everyone deserves to be safe from guns!

  • Let's make it safe to get sick in America! Health care has been increasingly recognized as a right for Americans, not a privilege for those who have money. The ACA was a great step forward, but it still leaves out too many, and with large deductibles and copays, under-insurance has actually risen! We need increased coverage, and better coverage. Making Medicare a choice for everyone would be a great next step for coverage, and it would also reduce total cost. Add in anti-trust enhancement and lowering drug costs, and you have a much safer America. And don't forget, when conservatives protest that “it's too expensive to expand Medicare,” it's not! Americans are already paying for it, it's just a question of redirecting the payments. Make health care available for all, and America would be getting greater.

  • Let's make America safe on its roads and bridges – physical infrastructure. But infrastructure is more than that. It's also broadband everywhere. And most importantly, we need to make our human infrastructure what it should be – education for all, not middle of the pack or bottom, but best. That means probably doubling the budget for education everywhere, affordable child care so it's possible to study and work even if you're not rich, and making education affordable, including more and more technical education. Without tending to our physical and our human capital, we can't possibly be great. Educated and supported people are safer people.

  • Let's make America safe for breathing and drinking water, let's understand how humans have been burning up the earth, and stop it. To think that business will suffer if we make the earth habitable for our children – all our children – is just an absurd proposition. “Short-sighted” doesn't really capture it – how about “suicidal?” The Green New Deal might not be right in its methods, but it sure is right in its principles, and that's the important part. Climate change needs to be attacked with a vengeance, the way we attacked the Depression and World War II! It can be done while the economy actually prospers, not suffers, if we pay attention to distributing the jobs well, and concentrate of the welfare of everyone, not just the company officials. Extreme weather events will just become more and more severe – avoiding them will actually save a lot of money. Let the business officials earn their salaries and perks by changing their companies in a way that preserves the earth. Now, that would be being great, wouldn't it? Wouldn't it be great to make the Earth safe for our children?

  • Let's make America just. The basis of justice is democracy, and democracy rests on an informed and participative population who vote, without disqualifications. America is changing in the way it looks – as it always has. We started as English colonies, with caucasian stock and African slaves. Then came Germans, and Irish, and Jews, and Eastern Europeans, and Asians, and Indians, and Mexicans, and Middle Easterners, and others. The idea of America is that we do not consist of one racial stock, but that we consist of an idea, which is ever-renewable and updatable. The votes of everyone, unimpeded by disqualifications that simply ensconce the current holders of power, direct how these updates are enacted. The principles of HR 1 need to be passed into law so that justice is increasingly assured. A just America is a safer America.

  • Let's make the world safe again by reuniting with our friends abroad. “No man is an island,” and neither is a country. Countries have more in common than they have against one another. There is no Planet B, and as we make technological progress, there should be plenty for everyone if we work together. They say that good wishes and cooperation is passé, but I don't believe that for one minute. Authoritarianism is always a threat, and now perhaps more than at any time since the 1930's. But if we can rescue America from the threat of authoritarianism, then other countries can, too. We can be an inspiration again. We need to be leaders in standing up for the rights of people everywhere to be safe, and free.

There are other elements of making America great, but these principles are a start. It's a viewpoint; it's my viewpoint. And I believe it is the viewpoint of virtually everyone running for the Democratic nomination for President. What a banquet of great people running for President we have!

Let's not let the Orwellian Trump Crime Family Kakistocracy define what greatness is. They think only of how they can make a profit. Let's not let the Trump Crime Family hijack democracy in a coup using the methods of democracy to undermine it. We still have a democracy, we just have to use it.

I'm looking to what we can do and what should be, and I'm asking for your vote to make it happen.

Budd Shenkin

Monday, April 1, 2019

I Will Keep You Alive: A Cardiovascular Romance


I Will Keep You Alive: A Cardiovascular Romance

by Bob and Adele Levin

I've just read a really terrific book. It's a book occasioned by two heart attacks suffered by Bob Levin, the second one so severe that he was placed in an induced coma for two and a half days, seven stents placed, and a mitral valve operation done later on. Heart transplant was discussed. He was very sick. But, as a benefit of the exquisite progress made in modern cardiac care, now, eight years later, he is hardy, healthy, happy, and much wiser and deeper. More and more people are having this experience nowadays, but I've never read an account like this, with scientific accuracy, precise rendering of the feelings at each stage, the details of what being a patient and the wife of a patient entails procedurally, the adjustment of thoughts as the process goes along, and the adjustment of the marital relationship as one helps the other. And most cogently and beautifully described and delineated, extremely importantly and crucially, this is an account of what a great doctor can do for her patient, and what the very best doctor-patient relationship imaginable looks like. This is what great perceiving and writing (and not over-writing!) looks like.

In other words, I liked it a lot.

IWKYA is written in alternating voices of Bob and his wife Adele, who both bring extraordinary qualifications to the job. Although Bob's background as an applicant's attorney for workers' compensation doesn't help a lot – or maybe it does, seeing all those people in need – he is a graduate of the storied writing program at San Francisco State, a terrific professional writer of both fiction and non-fiction, and an established authority on underground comics, of all things. He also knows a lot of psychiatry, probably mostly through Adele. Adele is also a graduate of the SFSU writing program with multiple short story writing credits and is a retired psychotherapist. So they're great writers, not of the flowery type, but of the closely observed and precisely and efficiently expressed variety. And, they have a longtime very close and romantic marriage, dating from the time Bob drove cross-country to find Adele again after they had dated at Brandeis. Who better, then, to write about the new but increasingly common experience of severe illness with successful recovery? To me, this book rivals Joan Didion's The Year of Magical Thinking, which would please them both, since she is a hero to them.

They both describe events clearly and factually, and their reactions at each step. It's the precise description at every step that is extraordinary. The details! So perfectly set out, no overacting, matter of fact with extraordinary facts, including the ordinary indignities of the hospital, where wife's sleeping area can be two chairs pulled up facing each other, here in one of the most profitable hospital chains in the country, Sutter. Read it and weep, administrators – this is your responsibility.

Each step is new to Bob and Adele, but each brings back their personal memories as they struggle with the present, as when Adele recognizes her present fears in light of her long history of fears gathered from her mother's inordinate fearfulness that she passed on. Bob reflects on his mother's too-long life and her debilitation as she dies in the middle of his long ordeal. At each step their pasts inhabit their presents, as is true for all of us, but it's rare for us to see it as clearly as they do. They rise and they fall, they are hopeful and afraid – but this is cliché, and not worthy of how they freshly describe their steps. Let me just say that one will never understand better the step-by-step impact on a close family of the process of acute and severe illness than from reading this book.

Their unstinting frankness is particularly startling and impressive, each matching the other as the voices alternate. They think of each other constantly. They hold hands and kiss. They worry about each other. Bob wonders when he will be well enough to drive so Adele can stop having fender-benders. Well into the process Adele exclaims that what she could really use most is a good orgasm. As he recovers, Bob is disappointed to hear he's not ready for sex, but can console himself with masturbation. These two really have a good marriage. Extraordinary, really.

The recounting of details brings up another point: IWKYA brought home to me again how in so many ways, we have entered the era of Star Trek Medicine. It's amazing how much medicine has accomplished, how these little magic catheters are climbing up inside us and fixing things, how doctors put their fingers into our hearts and mess around with them and have lots of options of what they can do. This isn't the focus of the book, but their precise details make it impossible for the sensitive reader to miss. The world might be going to hell, but cardiac medicine is most emphatically not.

And yet, with all the magic techniques and equipment, where you might think computers and algorithms might take over the decision process, this is far from true. There is still a huge need for human judgement. (Mothers and fathers, you can still urge your children into a medical career! We ain't finished yet! And it's not just the human touch that's important, it's the human brain and the human experience.) Which is where we get to the heroine of the book, cardiologist Louisa Muñoz, known here in the text as Dr. Fleur but then, in a stylistic coup, identified by her real name in the appendix at the end, as though the main text has been fiction, which it most decidedly has not been.

If you read nothing else, read this appendix, where Bob and Dr. Muñoz have lunch, and she reflects on the case. Dr. Muñoz embodies everything we could hope for in a doctor who takes charge of a challenging case. She knows what she is doing – she tells Bob that he is lucky to have her at this time, because she just passed her Boards and so she is completely up to date and hasn't forgotten anything yet – and she cares, she befriends, and all three of them fall in love. But that's after a long introductory period, where she sizes them up (and vice-versa), figures out how she can best serve them, with startling perceptive power. She retains her objectivity, but he represents to her all that she could have hoped for – she saves a patient who would have died, (I Will Keep You Alive, page 159) and he turns out to be a very dear human being. And she turns out to be all that Bob and Adele could wish for, all that any of us could wish for, a caring and immensely capable doctor who takes charge in just the right way. When Bob's mitral valve needs to be evaluated and perhaps replaced, she sends him to the local cardiac surgeon who is technically excellent, but who takes over in such a bumptious and self-important way that she has to wrest control back from him, because she says it's not time yet to operate, that she and not he will decide when it's time, and then sends Bob to another surgeon over in San Francisco who is more sensitive and sensible, and who himself exercises exquisite judgement when he gets into the heart, and figures he can tighten the valve instead of replacing it.

[Note to health policy people – this is why patients have to be able to go out of network!]

This, sports fans, is what we need to appreciate. This is how doctors should work, this is the attitude and the skill they need to develop and maintain, this is the ideal. Teachers of medicine – if I were you, I would make this whole book mandatory reading for trainees, and I would dwell on this appendix.

I could go on. I've been known to go on. I could discuss each of their pages with many more pages of my own and go well over 200 pages for this 164 page book (note that, everyone – a short book long on impact. Teachers – especially good for those med students who were selected for their scientific rather than humanistic abilities, which would be the great majority of them.) But I'm just going to stop here.

I've been a doctor and a policy analyst for a long time, and I've read a lot of medical books. This is one of the very best.

Budd Shenkin