To Join This Couple

If only it were possible to love without injury- fidelity isn’t enough:  I had been faithful… and yet I had injured her.  The hurt is in the act of possession:  we are too small in mind and body to possess another person without pride or to be possessed without humiliation.”

The Quiet American, by Graham Greene


Proximity to several weddings and anniversaries has got me thinking not only about hope and wonderful relationships, but also- this may seem a bit neurotic- about the impossibility of attaining the ideal:  complete mutual understanding.  Ideal goals, almost by definition, are impossible to reach- and yet (one hopes) we strive on, grinding the rough corners, losing the old baggage, constantly adjusting our attitudes toward one another and admonishing ourselves to be better people.  In other words, if we are “too small in mind and body,” we need to keep growing!  If only there were an easier way; if only we had chimeric genes or the drug-induced ability to escape our limited dimensions and merge together, like Benn and Lora in Fourth World, both projecting their auras in an out-of-body experience:

“HUH!” was all Benn could manage as their two auras met.  It was not so much a physical joining of bodies- not the sensation he had hoped for, alas- but more like a merging of two liquids.  Lora feels like oil, the odd thought came to him: he pictured a large drop of oil falling into a pool of water.  As it splashed, the strong natural repulsion between auras took immediate effect:  the drop embodying Lora displaced a smaller drop- a portion of Benn’s aura- which rose straight upward.  Then the Benn-drop fell back in and splashed up an even smaller droplet- Lora again- which in turn fell, and so on, until inevitably the last micro-sphere of Lora was captured by Benn’s surface tension and could no longer escape.  As separate liquids, the two of them had different viscosities:  Benn flowed easily, whereas Lora’s character was thicker, more unctuous.  Their collision caused long, finger-like projections of Lora to penetrate into Benn’s aura, causing it to blush red before snapping back to attention.

He recognized her myriad layers, those melodic strains, the steady internal rhythm he had so admired.  With their thoughts intermingled, mutual understanding arrived instantaneously, and no longer required the cumbersome verbal exchange of ideas expressed ploddingly one at a time, over periods measurable on a stopwatch.”

If only we could do that!  But in the sequel, Fourth World Nation, Benn wrestles with the ups and downs of sharing auras:

“Benn thought long and hard before giving his answer.  Even though she had quickly apologized and even made a joke about it, Lora had meant what she said about the survival of their relationship.  Admittedly, he often worried about misconstruing her intentions, being insensitive, and appearing apathetic when he really did care; why would she not have her own set of worries about appearing moody, contentious, or needy when she was anything but?  Only when their auras fused together was there instantaneous and true knowledge of one another.  Who wouldn’t want a relationship completely free of misunderstandings, mistrust, manipulation, projection, guilt, dishonesty or domination?  No more mumbling, lapses of attention, slips of the tongue or difficulty hearing, either!  What could be better?”

Unlike Benn and Lora, the rest of us remain in separate, finite minds and bodies.  It’s as though we are talking through a wall, in different languages, our voices muffled and disguised.  Of course we’ll never achieve complete understanding that way, so we need to keep growing, grinding, adjusting.  But come to think of it, this continual striving on our parts reflects an untiring commitment to our relationships, doesn’t it?  We may not hear each other perfectly well, but that untiring commitment, I think, is at least one ideal we can attain.




Silence from the Bully Pulpit

Our Chaos President is off to one of his many golf courses again- but this time he won’t be back in Washington for two more weeks.  So maybe we can hope for a brief respite from the daily White House effluvium:  the constant stream of bullying messages directed at Congress, Democrats, Republicans who voted against Repeal and Replace, the Attorney General, the intelligence services, NATO, China, the Clintons, Obama, Muslims, immigrants, transgenders, insurance companies, Reince Priebus etc.– anyone but Vladimir Putin!  Maybe we’ll get a break from the early-morning tweets about witch hunts, transparent walls, 60-pound bags of drugs and fake news, SAD!  But look out:  resistance to Trumpism is increasing markedly within his own party, e.g. the bill on Russian sanctions he was forced to sign; several GOP candidates (including the V.P.) have started holding rallies, filling their war chests and sharpening their knives for the 2020 presidential election; Robert Mueller is tightening the circle of Russian collusion around Trump; John Kelley plans to instill White House discipline as Chief of Staff, when the most undisciplined person there is his boss; then there was the embarrassing leak of his conversations with heads of state in Mexico and Australia.  When the Tweeter-in-Chief returns from New Jersey, I guarantee the bullying will start all over again, with renewed viciousness.

On the other hand, maybe it won’t:  let’s not forget Melania Trump’s pet project; every First Lady takes one on (such as Hillary on healthcare, Michelle on nutrition).  Purportedly, Melania’s project as First Lady is to stop cyber-bullying.  Over the first six months, there are no indications she has done anything about this, but perhaps she’s just been waiting for the right moment to arrange an intervention with Donald.

Fourth World Nation, the second novel in my science fiction trilogy, is complete, except for editing and a final re-write.  Here’s an excerpt; in an early scene, Leader Chou Xia-Yu steps up to a huge podium at the gates of the Forbidden City:

Censors couldn’t possibly suppress every human interest story or news item, which would instantaneously feed the so-called free press and the voracious social media.  More  antisocial than social media, the way the tiniest bit of trivia would be blown out of all reasonable proportion, noted Leader Chou, who thought of the media collectively as a great shrieking voice.  And what if some rebel’s explosive were set off in the middle of Tienanmen Square today?  What would the great shrieking voice make of that?

The amassed throngs began to chant, but Chou couldn’t make out the words:  pronounced in Mandarin, it sounded something like, “More onions!  More onions!” but that seemed improbable.  He glanced at the numerous food stalls lining the periphery of the Square.  The aroma of smoke and grilled onions is already more than sufficient, he sniffed, while outwardly nodding with great seriousness, pretending to understand, and indeed to sympathize.  Enough:  he suddenly raised both arms to signal for silence.  The crowd had been rehearsed from this point by members of his military staff, and an anxious hush now fell upon the multitude, a wave of silence rising out of the ancient Forbidden City; crashing onto the thousands of people wedged together around Mao’s Tomb; then fanning out at the far end of the square, like a surge of seawater hissing into the sand.  Leader Chou spoke crisply in perfect English, with a slight accent he had acquired while a graduate student at Cambridge.

“People of Tienanmen.  People of Beijing and of the Asia Zone.”  He raised his arms again.  “UNITED PEOPLE OF THE WORLD!”  His salutation echoed across the square and was greeted with a loud roar of approval, only partially pre-recorded…


Vive Le Healthcare (a.k.a. Kill Bill 3)

Ding dong, the bill is dead!  The “skinny repeal” bill died in a close final vote last night, a surprise attack at 2 AM as Sen. Mitch McConnell tried to ram it through on short notice.  It was killed by unified Democrats and three brave Republicans, to the great relief of nearly everyone, including many Republican senators who had voted to destroy health coverage for millions of their constituents for the sake of party unity.  But is the zombie GOP healthcare bill truly dead (see my post from last week, Vive Le Healthcare II, in which Repeal and Replace first passed the House, morphed and died in the Senate, then came back as Repeal Only, was killed again, then struggled back to life under the guise of Opening Debate on Healthcare).  Well, it soon died again, then- guess what- rose from the dead as Skinny Repeal, which would have deprived 16 million people of health insurance and raised premiums by removing the individual coverage mandate.

And now that, too, has died, and McConnell has finally said it’s time to move on.  Nothing more to see, folks.  I’m reminded of the classic horror movie ending:  ominous music plays as funeral mourners head back to their cars, sniffling with heads bowed under gray skies.  Behind them, the freshly-turned earth on the grave begins to shift.  Terrified movie-goers scream as a claw-like hand suddenly reaches up through the soil!

Just as insurers and exchanges can now look forward to a stabilized market and resume setting rates not artificially raised due to uncertainty (“just in case” the GOP bill had passed), our Chaos President tweets “let Obamacare fail, then deal!”  Even a GOP-owned Congress sees that as a catastrophic option, but Trump wants to win so badly, he’ll force his opponents (and with them, the American people) to their knees.  He’ll “win,” for example, by weakening enforcement of the individual mandate or increasing uncertainty regarding cost-sharing subsidies.  The President will breathe life back into the moribund Repeal and Replace agenda by sabotaging his own nation’s healthcare.  Say… did you see the earth on that grave shifting just now?  No?

In Fourth World Nation, the second novel in my science fiction trilogy, I offer a tongue-in-cheek view of healthcare in a dystopian future.  By the way, I’m doing a final rewrite on the finished book, so you can expect a notice on this blog very soon!  Here’s an excerpt:

True, at each patient’s initial visit, the mobile AI units did all of the diagnostics and prescribed treatments.  And inevitably, some of those treatments would fail; in those cases, according to DOW policy, the second visit would be scheduled with a human provider.  “For the human touch,” said a DOW brochure.  Lora barely felt human at this point, but when the green light flashed above the door, she always took ten seconds to clear her frazzled mind before putting on a smile and heading into the exam room- especially with cases of treatment failure, who tended to be hostile from the outset.  Taking a full ten seconds was actually self-indulgent, comprising over eight percent of the two minutes allotted for the diagnostic phase of each visit.  The patient, seated in a chair which entered the Intake Room through a sliding door on the left and slowly moved along a conveyor belt toward the Probot chamber on the right, had exactly six minutes with the physician before the exit door slid shut.  Yes, spending ten seconds to gather herself was generous, she admitted; but then again, when providing the human touch, good bedside manner was important, wasn’t it?

Six minutes would seem to be plenty of time to take a history, show the appropriate level of concern, perform whatever physical examination was rarely required, assess the psychosocial peculiarities of the patients (“each to be treated respectfully as an individual,” she recalled the admonition from her early days in medical school), and then wish them wellness as they disappeared into the domain of the Probot, where the real work was done.  But those six minutes, Lora had discovered, flew by much faster than expected.  Some patients insisted on elaborating on the history, reporting new symptoms or irrelevant details about family members at the last second:

“Oh, by the way, did I mention that I have triple-vision?  And I can’t feel anything below the waist?  Great-uncle Leo had the same problem when he was my age.  Should I worry?”

Fortunately the patients were belted to their seats for safety’s sake, as a number of them had tried to get up in order to show her some physical finding, such as a fungus on the foot or a growth in the groin.  Completely unnecessary, she would hastily reassure them:  the Probot would diagnose all of these imperfections much better than she could.

To my readers, stay tuned, in good health!



Vive Le Healthcare II

Maybe I should have titled this post Kill Bill 2.  Just when you thought the GOP healthcare bill was dead, it has begun to exhale sulfurous vapors again, its glowing red eyes blinking open, its sharp claws twitching in anticipation of wreaking more mischief.  It’s as scary as any horror story by Stephen King.

Despite essentially every healthcare organization and the majority of the population coming out against it, the House birthed a malformed Repeal and Replace bill which, you have heard many times, would increase the number of uninsured by 22 million, take away protections for pre-existing conditions, and worse.  After behind-closed-doors tinkering in the Senate, Repeal and Replace emerged more fully developed but equally grotesque.  It would cause 15 million people to lose coverage within a year, and again, 22 million by 2026, as well as water down the quality of health coverage.  When four Republican senators jumped sides and put any hope of passing this horrible bill out of reach, the relieved majority of citizens (remember them?) in this country celebrated.  The bill had been killed- or so we thought.

But then President Trump’s response was to “let Obamacare fail… I won’t own it,” without any regard to the cost to his citizens- he’s only concerned about a “win” for himself, and has been actively sabotaging Obamacare for months.  That would leave no healthcare plan, but who cares?  He, the President, won’t own it, and a win’s a win, never mind where the buck stops.  In a strikingly similar vein, Sen. McConnell- backed by Trump, of course- plotted a move to Repeal And Not Replace, even though 32 million people would be left out in the cold.  So once again, the GOP healthcare agenda stirred ominously back to life.  Do any of these elected officials ever consider the people who voted them in?

Then came another bright spot in the GOP (following Sen. Collins):  when Sen. Capito announced that she had “not come to Washington to hurt people,” I thought that would surely be a stake driven into the heart of the beast.  Congress would come to its senses (unless they had come to Washington to hurt people… )  And when 50% of those polled said they were in favor of Obamacare, versus 24% for the GOP plan, I was sure the struggle was finally over.  But no, no, here it comes again, still staggering among the undead:  McConnell wants to open floor debate on healthcare next week, in the faint hope that the GOP bill can somehow be rewritten on the fly- perhaps garnering just enough votes to squeak by?  Remember, repeal efforts have been going on for seven years, and yet the GOP doesn’t have a realistic plan to offer.  This healthcare zombie won’t go away, no matter how badly scared the people get:  already six long months into the Trump Administration, the battered GOP needs a win at any cost!

If Republicans in the Senate get their way, I might have to make an adjustment to my science fiction novel, Fourth World:  the average life expectancy in 2197, I wrote, is 107.  But now, if access to health insurance dwindles, I might dial that down; it seems that only GOP Repeal and Replace bills can live that long!


Vive Le Healthcare!

Start stockpiling those pills.  Republicans in the Senate have just released their latest revised healthcare bill, and it does not look promising.  Despite a few tweaks, for example to planned tax cuts for the rich and lower-cost options for buying insurance (eliminating benefits considered essential under the Affordable Care Act, such as maternity care), several huge, ugly bugs remain in the system:  deep cuts to Medicaid resulting in loss of coverage for millions (the CBO, which predicted a loss of 22 million for the previous version, will weigh in next week- hopefully before the Senate vote), loss of guaranteed protection for pre-existing conditions, etc.  On this eve of Bastille Day, the current political turmoil- including Healthcare, the Trump/Russia investigation, Paris Accord, Muslim travel ban, and so much more- brings to mind the storming of a prison or fortress by a population which has reached the end of its rope.

The people demand liberty, including freedom of the press, speech and assembly.  To me, liberty also includes- within reasonable limits- freedom from fear:  fear of hunger, oppression, deportation, terrorism, global warming, pollution- and also illness.  Access to healthcare should be part of our daily expectations, but a GOP-controlled Congress doesn’t agree.  As Joel Baden, at the Yale School of Divinity, recently pointed out:  Republicans like to quote from the Book of Proverbs, wherein the righteous are consistently rewarded and the wicked are punished; in this worldview, it follows that the successful (i.e. rich) must be more righteous than those who struggle (the poor).  Mo Brooks (R-Alabama) said the poor should pay more for healthcare, because “those people who live good lives, they’re healthy.”  He must not have read Ecclesiastes 9: 11-12:  “the race is not to the swift, nor the battle to the strong, nor bread to the wise, nor riches to the intelligent, nor favor to the skillful; but time and chance happen to them all.”

They demand equality:  equal pay and treatment in the workplace, social and environmental justice, educational and employment opportunity.  And, as you might expect, equal access to healthcare!  The proposed bill would throw millions of people off Medicaid, while providing tax breaks for the wealthy.  Everyone understands that if the entire country had health insurance, pooling the risk would enable equal treatment of the whole spectrum of medical conditions, from the worried-well to the chronically and severely ill.  Not requiring health insurance, Speaker Paul Ryan says, would give people the freedom not to buy something they don’t want.  So he wants to give them freedom, not healthcare.  That has the callous, unthinking feel of “Let them eat cake!”

Although deeply divided, the people need fraternity as well.  Cross the aisle.  End mindless, tribal partisanship.  Talk amongst yourselves.  One bright spot:  Susan Collins (R-Maine), in rejecting the proposed GOP bill, says she is ready to work with Democrats on improving the Affordable Care Act- imagine that!  Improve Obamacare?  Not “repeal and replace?”  Not “lock ‘er up,” “murderers and rapists,” fake news, witch hunts and chaos?  Yes:  a return to sanity, mutual respect and the realization that dominance-based politics destroys fraternity, equality and liberty.

Wishing all of you out there a happy and healthy Bastille Day!

Just Act Natural, If You Can

In my early practice, I used to have a patient- a handsome, urbane Chinese man in his thirties- who had appeared in a number of car commercials.  He seemed successful, and yet at every doctor’s visit, even before mentioning his health, he would complain about the lack of acting roles for Asian actors.  It was more important to him, he said, than his blood pressure!  This turned out to be a widespread frustration which has resulted in activism, educational endeavors, signed petitions and quasi-political gatherings across the country.  George Takei (Mr. Sulu) has been particularly outspoken on the topic.

In the 1930s, the Chinese stereotype depicted in movies ranged from the super-smart, respectful and submissive Charlie Chan to the super-smart, evil and insidious Dr. Fu Manchu.  These were two Chinese extremes, and yet, as Asian activists love to point out, Charlie Chan was played by a Swedish actor, Warner Oland, and Fu Manchu by another Caucasian actor (I forget his name) in yellowface.

Another stereotype is the martial artist, and here at least, we see Bruce Lee, Jet Li, Jackie Chan and other Chinese actors in kung fu movies.  And who can forget Michelle Yeoh and Zhang Ziyi in Crouching Tiger, Hidden Dragon?  All fighting with hands, feet, sticks and swords.  But where is the Asian Meryl Streep, Harrison Ford, Tommy Lee Jones, or even Woody Allen?  Maybe there won’t ever be one.  Does the necessary depth of character and experience lie beyond what Hollywood expects from such actors, based on Asian stereotypes?  Now Daniel Dae Kim and Grace Park are departing from the cast of Hawaii Five-O, allegedly because of unequal treatment and pay.  The show is based in an Asian-dominant environment, and yet the Asian actors are considered secondary.

When I wrote the sci-fi novel Fourth World, I chose a Chinese youth- Benn Marr- as the protagonist, the hero/anti-hero.  True, I was motivated by concern over the exploitation of post-colonial Third World countries; the European nations’ intolerance of their colonial subjects, now transplanted minorities in the homeland; and- part of the autobiographical element in Fourth World- the difficulty finding acceptance when coming in from the outside.  I wanted Benn to wrestle with not-belonging, and to crystallize these types of issues.  But it’s also true that, in thinking about my long-ago former patient, I wanted to create a leading role for a Chinese actor (John Cho?), in case Fourth World ever becomes a movie!  I know, dream on…

What I Tasted On My Summer Vacation

Just kidding:  retired doctors don’t take vacations!  But we did just return from a week in Madrid and San Sebastian, followed by a week visiting chateaus in Bordeaux.  Although there were lots of great-tasting solids (jamon iberico de bellota, foie gras, Charolais beef, raw-milk Epoisses, mmm), this posting is going to be about Bordeaux wines.  If you have no interest at all in wine, my apologies; this would be a good place to exit- thanks!

Tasting barrel samples of 2016 red Bordeaux was fabulous; the vintage really does live up to all the hype.  If you have a wine collection, I would recommend buying some 2016s: even at $25 or less, some wines are already very appealing (Chateau Potensac from the Medoc, for example) and have the potential to develop well for five to fifteen years.  At the other end of the spectrum, wines such as Ch. Mouton-Rothschild or Ch. Margaux lie in the stratosphere, with regard to quality and price, and can age for decades.  Ch. Leoville-Las-Cases, for me, was their equal in quality for half the price.  If you have a special event to commemorate yearly, such as a wedding in 2016, you’re in luck!

One good thing about this vintage is that the wines reflected their respective communes:  that is, a wine from St. Julien had the typical taste and style of that commune, and not, say, Pomerol or St. Emilion.  In my opinion, this typicity doesn’t happen every year.  To generalize:  a typical red from St. Estephe tends to be heavy-ish, somewhat monolithic, linear and powerful.  A Pauillac tends to be more nuanced, although still sturdy, with graphite notes (think pencil shavings) and tobacco, like a cigar box.  Pauillac’s immediate neighbor to the south, St. Julien, makes wines quite similar, but more supple and round, and I find India ink notes, as well as overt fruitiness, in St. Juliens more than in Pauillacs- both in the nose and flavor.  Wines from Margaux tend to be more delicate/elegant, with a famous floral (violets) aroma.  Graves often have a mineral, smoky character.  St. Emilions and Pomerols are often fleshy, plump and rich from a high percentage of Merlot; whether they are grown on limestone (St. Emilion) or clay/gravel (Pomerol) affects the flavor.  From years of comparing these, it becomes possible to identify the commune, or even the producer, in a blind tasting, which is a pretty good bar trick.  But I’ve only listed general tendencies; there can be huge differences in style between two chateaus located in the same commune.

By the way, these taste characteristics are not the same as the spurious and fanciful descriptions often provided by wine writers, who might argue with one another as follows:  “I taste mangoes!”  “Mangoes?  You’re crazy; it’s pineapple.”  “That’s right, pineapple!  And coconut!”  “Yeah, just like the pina colada I had before dinner!”

In science fiction, it can get even more obscure.  Here’s an excerpt from Fourth World, in which Benn Marr attends a wine tasting at Mellon College:

And so it went, for four other wines.  Dr. Neelin described esthetic and geologic elements: earthy forest or mushroom; the smell of rain falling on hot stones; delicate floral scents; the tang of iron, like a bloody nose; roasted coffee beans, licorice, chocolate, berries of various colors; the mineral effect of a steep, rocky slope; a summer plagued by hailstorms; or a long hot spell before harvest.  And, though it seemed far-fetched, even as Dr. Neelin described the historical context of each wine- the influence of an ancient monastic order, or the personality of an eccentric winemaker- Benn detected traces of each element.  He imagined some sort of ambient energy field interacting with the water content, imprinting all of this data into the structure- the hexagonal, square and triangular formations- of each wine.  It was like the electronic translation of sound or sight into a recording (not so different from the volumes of data previously recorded in ancient tapes, plastic phonograph records, or metal discs; and now the micro-crystalline core of his datadisc) which could be heard or seen again, and replayed endlessly, if only one had the diamond-tipped needle, the laser, the ability to translate the data in reverse.