Friday, October 30, 2009

Confessions of a Medical Tourist

Considering that no country will ever have a perfect health care system, it makes sense to cross borders in search of a better deal. Americans go to Mexico to get their teeth fixed, and they drive to Canada for prescription medicine.
Canadians get stuck in the MRI line, so they come down here where they don’t have to wait, if they have the cash.

This is going to expand. If a common surgery costs $20,000, and a round trip ticket to Europe or Asia cost a little more than a $1,000, we can see that various countries will offer competitive deals, to offer the same surgery for $15,000 plus airfare.

Right now, Filipino women come to America to work as nurses and nursing aides. But it could work the other way -- if you needed six weeks to recover from an illness or a surgery, and it’s winter here -- why not fly to the Philippines and get your rest at a seaside care center. Insurance companies have started to offer these options on an incentive basis.

Or fly to India or Bulgaria and buy a kidney -- oops. People sell kidneys in poor countries, to unscrupulous middlemen, who then forge documents and pass on the kidneys and other body parts to people in desperate need of same and not willing to question the source.

In fact, if you can imagine a way to abuse new choices in international health care, there’s probably already some shady character who is already in that business. The corrupt mind is highly creative, being motivated by greed. The mind of the honest reformer is usually one or two steps behind.

Medical tourism will expand and -- cover your years, Libertarians -- it will be regulated by international agreements that make sure your new kidney was honestly donated.

I’m only writing about this because I don’t want us to get stuck in a deadlocked debate over the health care reform bill. This is not a two-dimensional situation, it is far more complex and far more interesting than that.

Reform? A hundreds ideas come to mind. I think that no one should enter nursing or medical school until they have served at least one year as a nursing aide. Everyone in health care needs to begin at the beginning. As it is, doctors today do not know what nursing aides do. They think they know, but they do not know, because they have never done it.

If a doctor or nurse had, for that one year, the experience of being a nursing aide, then they would never again treat nursing aides like idiots. This is such a good idea, but it’s too simple and too easy to understand, so it’s not in the health care reform bill.

Tort reform is not in the bill either. Conservatives are crying for tort reform. They’re right about that. It is a corruption of the Democratic Party to ignore health care reform because of the enormous financial contribution of trial lawyers.
And we need a new army of nurse practitioners to spread out across the land and do battle with the common cold, the flu, the aches and sprains and minor injuries that make up half of all the medical problems we deal with.

I went to the doctor two weeks ago because I had the flu. He was overqualified for that. It would have been much better if I had been seen by a Nurse Practitioner. The flu is her game and she’s good at it.

In Massachusetts where they have tried to insure everybody, they discovered that they did not have enough doctors to handle a flood of newly insured patients. Not enough family physicians, not enough pediatricians, and not enough nurse practitioners.

It’s not in the health care bill -- the means and the cost of training thousands of more people to do primary care.
But they have a surplus of barefoot doctors in Cuba. Could we induce some of them to immigrate to our shores, as part of the long overdue mutual recognition between our two countries?

Most objective reviews of American health care state that we are good at the high end and poor at the low end. Good at dramatic interventions and end-of-life care, but poor at the broadest primary care and prevention.
At my hospital, we have a brand new portable kidney dialysis machine. It has to cost near to $200,000 and it can be wheeled into a patient’s room -- for patients with kidney failure so advanced that they cannot be transported for dialysis at the kidney center.

If it was you or your relative, you would be glad we have this machine.
That’s what I mean by the high end. At the low end, where we are not very good at all, you only have to look at the waiting room of our Emergency Department -- full of people who should have seen a doctor or a nurse practitioner, but who did not, primarily because they lacked the money.

Transparency is needed. My hospital is owned by the residents of the hospital district it serves, and yet if you tried to find out just how much the hospital paid for that kidney dialysis machine -- paid partly with our tax dollars and partly from other sources of income -- they won’t tell you, which is why I am guessing it cost $200,000.

We should know the cost of that machine to the penny. Such information should be instantly available on the hospital’s website.
But it’s not and that makes you think they’re might be some monkey business going on. I sometimes see the medical equipment salesmen waiting in the lobby. They wear very expensive suits.

So, be a medical tourist and take a cruise through our wonderful but troubled health care system. And don’t just talk to the people who already agree with you, because that accomplishes very little.

Tuesday, October 27, 2009

Murder in Cambridge

These are weeping birches by the slough. I thought Patty had planted them, but she said they were volunteers, she said they sprang up after the flood in 1990 when there was five feet of water in the yard.

It’s a brisk wind blowing the branches. It’s raining all day out here. It will never stop raining. Rain and Rain until the Day of Judgment. Biblical rain today.

We have Buddhist rain too, it comes slow and steady and it bores you to death.

At times we have Scandinavian, suicidal, stay-drunk-all-winter rain, but I see a glimmer of hope out there -- somewhere the sun is shining.

That would be the Irish rain. If we just had a little bit of luck, then things would turn out right, and the blessings of heaven would sweeten our hearts and enrich our bank accounts too.

The birch trees and the giant cottonwoods still have their leaves on. I give the leaves just a few more days and they will be coming down. We don’t have to rake leaves out here, the wind takes care of that.

ESCAPE FROM FIR ISLAND. I’m planning my escape. I can’t tell you any of the details, because when you’re really serious about something, you can’t waste energy with idle talk. You have to focus. You have to want it. You have to hold it inside and let it build.

So I look out the window. The window faces east, across the fields, five miles to the foothills. All rain, all day on muddy fields. Riley drives the potato truck, but he said they have stopped working -- they would just get stuck in the field.

Jimmy said they left four rows of Yukon Gold potatoes in back of his house. He went out and dug a bucket of really fine potatoes, but it was muddy work, he said. I’ll go over there later and get some for our house.

For the Irish rain. We’ll have buckets of Yukon Gold potatoes and eat good all winter. Gold ! Good luck and pretty women. Or when you’re lucky, the women look prettier. Either way.

But this Thomas Hardy landscape gets to me -- the desolate moors, the faraway cry of the geese

I can tell you this. One day, poof, I’ll be gone. Because I have a plan.

“But you’re coming back, Fred. You always come back.”

SOME READERS OBJECT. In the last issue, we discussed Suicide and Depression -- a dismal topic. Some readers out there in Frog Hospital land turned away, averted their eyes, and tried to ignore the whole thing.

I got a call from Vicki in Spokane. Years ago, we worked together in the Forest Service. Now she and her husband are in real estate.

“Fred, can’t we have happy, pleasant things to read about? Or exciting, dramatic things to read about? We don’t care to discuss these unpleasant topics. We really don’t want to know what you do when you go to work at the hospital. It’s too icky.”

So, I should spare you the details because it’s not appetizing.


And you want health care reform.

“Oh, yes, we want health care reform very much -- so we can write a check, pay a tax, and have it done.”

Wouldn’t that be nice?

MURDER IN CAMBRIDGE. Mary Joe Frug was murdered by a knife-wielding assailant on a quiet street in Cambridge, Massachusetts in 1991. No one was ever been arrested for the crime, and no motive has been established. I lived only a few blocks from where the killer stabbed Frug, and many days I walked down that quiet leafy street on my way to Harvard Square.

Mary Joe Frug was murdered on Sparks Street on a Thursday night, right outside the Armenian Trinity Church while the choir was practicing and making so much noise that nobody could hear any screams, if there were any screams. Frug, 49, a law school professor and mother of two, was stabbed to death by an unknown assailant with unknown motives, on her way home from the grocery store -- the same grocery store where I shopped

The next day, Friday, carnations and daffodils were strewn over the pavement near the curb at the corner where she died. People walked by slowly and gathered in knots.

At Pentimento, a neighborhood restaurant where I worked, everybody was talking about it. Diane, the owner and chief cook, was very distraught. We discussed the crime while we made soup together.

“I knew her,” she kept saying. “She was a very beautiful, intelligent woman....Oh, damn it, I burned the apricot crumble,” as she rushed to the oven to pull it out.

I said, “You’re upset. This is very terrifying.”

“I’m going to get more locks on the door,” she said. Talk about the murder had been buzzing about the restaurant all morning. Bob, her 23-year-old son, walked into the kitchen. “Locking yourself in is not the answer, you can’t give in like that,” he lectured.

I was about to agree with him, but I held my tongue.

Diane brushed the hair out of her eyes. She said, “I have this recurring nightmare of being beaten to death. Can you imagine how horrible it was to die that way? I knew that woman.”

After work I called Nora. She had read about the murder in the Boston Globe. She said, “It was somebody who knew her.” That was her intuition. A day later the newspaper reported that “police were investigating reports of a man lurking in the bushes near the scene of the stabbing. The man, described as white, in his 20’s, with brown hair, 6-feet tall and wearing dark clothing, is being sought by the police.”

THEY NEVER FOUND THE KNIFE. Where is the knife that killed Mary Joe Frug? Or, I should say, the knife that was used to kill her. The police never found it. But unless it was thrown back into the furnace like the Lords of the Rings, that knife exists somewhere, at the bottom of the Charles River buried in sediment, or rusting in a landfill…. or laying in plain view in someone’s kitchen -- if the murderer had loaned it to an unsuspecting neighbor, wiped clean.

Now Mary Joe Frug merits an entry in Wikipedia for her legal scholarship. Her radical feminist views were controversial at the time. She taught at a non-prestigious Boston law school and her husband, Gerald Frug, taught at Harvard Law School.

This was all common knowledge and very small-townish, if you lived in Cambridge, especially if you lived in that neighborhood -- who the Frugs socialized with, what faction they belonged to in the intensely partisan atmosphere of the law school, and who wrote bitter denunciations of the Frugs in obscure law journals.

I don’t know why this crime came back to my memory 18 years later. I went to the website of the Cambridge Police Department to discover if there had ever been an arrest for the Frug murder. No, it’s a cold case.

But they won’t forget, not in Cambridge, not in New England. They never forget anything.

I bet, if I were there today, and walked down Sparks Street, past the site of the murder, and then spoke to somebody, on the street, or at a nearby store - I bet they will remember this crime in great detail. I bet many of the same people are still there, in the same houses and flats, in the same jobs, going to the same summer resorts every summer -- because nothing every changes in New England.

Where is the murderer? Probably still alive, walking the streets of Cambridge.

Why did he kill Mary Joe Frug? Did he know her and hate her? Or was it a random act? Some people, admitting to a guilty selfishness, hoped the killer was known to Frug, a personal enemy, because that was less frightening than a random stranger who might have attacked anyone -- just killing the next woman who walked by.

In that calculus, you felt safer, because none of the people that you knew were crazed and mad enough to kill you.

Sparks Street intersects with Brewster Street. Robert Frost, the great poet, once lived in a house at 35 Brewster Street. They have a plaque near the front door of 35 Brewster Street telling of Robert Frost.

Two blocks past Brewster Street, you will come to 22 Reservoir Street, the home of Alan Dershowitz, a Harvard Law professor, a colleague of the Frugs, and a very well known scholar of great controversy himself.

I had an opinion -- very negative -- of Alan Dershowitz, but one day, when I lived in the neighborhood, I walked past his house, and there he was -- in the driveway in his front yard, playing basketball with his son.

How could I dislike him after that? He was a good guy that plays ball with his son. He lived in a house down the street from me -- two blocks from Reservoir Street.

I lived at 42 Blakeslee in the first floor of a two-flat building.

It was two blocks to Alan Dershowitz’s house, then over the hill, down Brewster, past the Robert Frost house, then to Sparks Street, the site of the murder.

When I got there, I looked around to see if there was a good hiding place in the shrubbery, but there were only low plantings near the sidewalk, so it was more likely that Frug was attacked suddenly from behind, as she walked.

The homicide detectives know where the knife wounds struck. They would know if she put up a struggle. They will never tell us, unless there is an arrest and trial, which is now very unlikely.

Yet there is a very thick file kept secret by the police, compiled in 1991, with photos, and forensic reports, and interviews with neighbors.

“Did you hear anything? Did you see anything?”

And, “Where were you last night?”

Nineteen years later the homicide detectives will pull out the file in a yearly ritual, and try to make it more than a ritual, try to bring it back to life, not just be a memory of a horrible crime. As if it happened last night.

If she screamed, why did nobody hear her? Possibly, some one heard her scream, but still has not come forward, and nineteen years later those same people live on that street, because this is New England, and people never move.

I think she screamed, but nobody heard her. Sparks Street has a very lovely kind of classic New England feel to it.

Screams become absorbed in the historic stillness.

A scream was heard faintly, but from what century? 1991, or 1854, or 1743, or 1697 ?

It goes way back to other crimes, other murders not solved, going back centuries to ghosts from long ago.

IT CAN’T HAPPEN HERE. But we’re safe in LaConner, here, all the way across the country. Nothing like that will ever happen here. No knife-wielding assailant brutally murdering an unsuspecting woman -- her screams not heard, a pool of blood, and no answers.

It couldn’t happen here.

Saturday, October 24, 2009

You Almost Made It, Frankie

(this is a story, not a factual account)

I’m telling this story to get it off my mind. Patients don’t usually stay with me. I put my heart into the work when I’m on the unit, but I forget the whole thing by the time I get to the parking lot when I’m going home at 11 p.m.
It’s a good rhythm. You go home, read a book, have a glass of wine, and sleep without troubles. The next day you do it again
But Frankie stayed with me. He was 78, in assisted living. His wife had just died and he was in pain from hip surgery. He overdosed on his pain medication and the medics found him on the floor with seven Fentanyl patches pressed to his skin.
Fentanyl is a powerful narcotic and widely used in the form of dermal patches to relieve pain.
The patch releases the medication in a careful slow way and -- sometimes with unpleasant side effects -- it works.
But seven patches all at once will send you through the door, down the river and on your way to the next life.
Such a patient will not be left alone in the hospital, lest they try to harm themselves again. Standard procedure. Suicide watch.
Frankie was deeply asleep when I got there at 4:30 in the afternoon. Comatose? I don’t know the medical term. But past danger, I think.
Kelly was the nurse. She’s one of the angels. They make you feel good just walking in the room. I don’t know about the patients, but I know I feel good when she’s around.
Frankie had a heart monitor, just in case. These are four wire leads pressed to the chest, connected to a monitor room where someone could watch his pulse and breathing rate.
The monitor, besides being watched by a live person, is set with ding-ding-dings if the patient’s heart rate exceeds the parameters.
They have ding-ding-dings all over the hospital. You can’t relax for a minute.
So there’s Frankie, on his back, sleeping peacefully, with thick white hair closely cropped, a trim spade beard, round face, and good skin color. He looked healthy, if you asked me, and he was resting well.
I was sitting beside the bed and I turned on the TV to watch the baseball game -- kept the volume low. It makes good background noise -- the sound of a murmuring crowd.
No ding-ding-dings at the baseball game.
Maybe that’s what’s bothering me. How can anybody get any rest at this hospital? It’s a process of continuous interruption.
Kelly floats in and out of the room. She gives Frankie a bladder catheter. He barely wakes during the procedure. The urine bag fills up promptly. He needed a good pee, but he was too out of it to use the urinal, and the narcotic relaxed his muscles over much, so he wouldn’t just go without help.
If there’s one thing that matters around here, it’s urination. They get really worried if you’re not peeing, and they get happy if you do.
It’s all about moving the fluids -- things you’ve been managing by yourself since you were two-years-old, but when you’re sick you need help.
Kelly leaves. Frankie sleeps, I watch the game -- Dodgers and Phillies.
That’s it. Six hours and I go home. Only this time, when I get to the parking lot, I keep seeing Frankie’s peaceful face.
I keep thinking -- Frankie, you almost made it.

DISCUSSION: Depression and Suicide. (making no claim to any expertise on this subject) Everybody gets the blues now and then. But real depression is much worse than having a bad day -- real depression is staying in bed all day, being unable to leave the house, no appetite, insomnia, suicidal thoughts and suicide attempts.
One of the things I do at the hospital is suicide watch. Obviously, I don’t see those who have made a successful effort to end their lives. But I see the attempts and the failures. These are some mighty unhappy people -- everything’s going so wrong and they can’t even kill themselves.
Usually it’s an overdose -- a cocktail of legal and illegal drugs. The doctors would sure like to know just what it is you took when you get to ER -- perhaps if you pinned a note to your shirt before you passed out.
Either way, when you get to the ER, they give you the charcoal syrup which soaks up the poison. The charcoal looks awful, but it has no taste.
Don’t try suicide with Tylenol. A sufficient amount of Tylenol will kill you, but a less than sufficient amount will merely damage your liver, resulting in prolonged hospitalization and enormous medical expense. The opiates are actually better, because recovery can be fairly quick after a less than fatal dose.
Wrist slashing requires determination, and a failed attempt will leave scars that might embarrass you later in life.
As I said, I deal with the failures, and my medical knowledge is strictly anecdotal -- I only see the patients after they have been medically cleared -- when they just need to be watched.
The patients are almost always quite young, 20 to 35, and two thirds female. They are very withdrawn. They seem to be terribly embarrassed. They just lie in bed and I make no attempt at conversation.
I don’t think they want to die.
I don’t have much faith in therapy and social work, but that’s what happens after the attempt. You have to talk to somebody. This somebody comes into the patient’s room and an earnest conversation ensues -- as in, let’s find out what’s going on, and let’s see what we can do about it.
This is just my bias, but I don’t see the point of “doing anything” about it. I’m quite glad to be alive myself, and I would recommend that status to anyone who asked.
But it’s your life, not mine. The social compact requires us to live until we die, so I would not help you if you wanted to kill yourself.
Having said that, I think the highest respect and kindess for someone is to let them be the way they are. Are you depressed? Yes, that happens. Do you want my help? Ask for it. Do you want my attention? Then do or say something that interests me.
I just don’t want to treat a patient as if they were pathetic. I stay in the room with them and we’re going to get through the day together. I can promise that -- we’ll get through the day. And we’ll see about tomorrow.
Now Frankie was different than the others, in my own limited experience. He was much older, for one. And he made a fairly serious attempt to die, taking seven Fentanyl patches. As I said, he almost made it. If they hadn’t checked his room for another hour, he would have been gone for good.
So what happened to him after I left him at the hospital? I don’t know. I suspect they won’t let him have his own supply of Fentanyl anymore, but will give it to him one dose at a time. He’ll get counseling, but I hope it comes with respect.
There’s a time when you might tell a younger person that she’s a fool and that she’s throwing her life away. That can be a good thing to say.
But the old folks -- you really shouldn’t tell them anything. They are way past the rest of us.
A doctor or a nurse, no matter how experienced or how well trained, will have no idea what it takes to be 78 until they get there themselves.

FACTS ABOUT FENTANYL (Wikipedia is the source) The opioid Fentanyl was first synthesized in 1960 by Dr. Paul Janssen. Its chemical formula is C22H28N2O. It is approximately 100 times more potent than morphine. It is used as an intravenous anesthetic.
In the mid 1990s, the Duragesic dermal patch was introduced, and the patch is now used for long-term pain management.
Fentanyl can be abused as a substitute for heroin. For that reason it is a Schedule II drug according to the Controlled Substances Act.
A Schedule I drug has no approved medical use. Schedule II drugs have approved medical uses, but are also illegally manufactured and abused.
Fentanyl, Duragesic, and their generic equivalents are often the first choice to control pain in cancer patients.
Fentanyl has side effects in 10 percent of patients -- diarrhea, nausea, constipation, dry mouth, sweating, and confusion.
Fentanyl and Duragesic are trademarks of Johnson + Johnson, one of the world’s largest pharmaceutical corporations. Sales of Fentanyl and Duragesic exceed $1.3 billion worldwide.

WHAT WOULD WE DO WITHOUT THE LAWYERS? An Internet search, in pursuit of information regarding a drug or medical procedure, will easily produce the website of a law firm which makes a living suing those same purveyors of drugs and medical procedures.
I found this website, (a real website, I’m not making this up) which hypes the diligent adversarial talents of Saiontz & Kirk, a law firm in Baltimore, because, if you have a problem, it must be someone’s fault and they should be sued.
Take our fictional patient Frankie. It wasn’t his fault. He was depressed because his wife died. Surely the doctor knew that. Did Frankie have a history of suicidal thoughts and attempts? Did the doctor ask him?
And what about the pain management? Was Frankie carefully instructed in the use of his Fentanyl patches? Was he warned of the danger of an overdose and that it could kill him?
Or maybe he was told about the danger of an overdose, and that’s what gave Frankie the idea of putting on seven patches all at once.
Has the law firm of Saiontz & Kirk sent one of their attorneys to lurk about the lobby of the hospital where I work, to press his or her business card upon weeping relatives? “Aye, I will take up your battle, I will smite the physician and pursue the drug company, I will obtain damages. We will fight and fight until justice comes.”
Saiontz & Kirk is eager to help, dear citizen, if you have had any problems with your Duragesic patch. Call them today. You can find their number plastered on the side of the nearest Metro Bus.

ADOPTION. Now, I’ve finished writing about Frankie. I will send it to the Frog Hospital audience and then I get closure.
But I’m afraid not. I’ve done patient care for five years, not all at once, but a year here and two years there -- at a hospital, a psychiatric hospital, and a nursing home, but it adds up to five years.
In those five years, I have adopted about 12 patients. It just happens. These are the ones that get into my psyche, make themselves at home and just stay. That’s why I call it adoption.
I see their faces, and I mean going back thirty years, and I still see their faces.
It looks like Frankie has joined the roster, along with Rachel, James, Eddie, and the others.
Twelve patients are enough. You don’t want to encourage this adoption. You want to shake them off by the time you get to the parking lot, but it happens anyway.

Seeking a Room to Rent. I am looking for a room to rent in LaConner. I am accustomed to sharing a kitchen and bathroom. I have a steady income, moderate habits, and good references. Call 360-739-0214.

Tuesday, October 20, 2009

Goose Hunting on Fir Island

I can hear them, but I can’t see them -- a flock of snow geese flying through the morning fog. I can’t see past the birch tree in the back yard, but I can hear the pop-pop-pop of the hunters’ guns.
Yesterday I was walking along the road, and a sparkling red SUV came to a stop near me. The driver rolled down the window to speak. She was very pretty and so was her companion.
“Are they allowed to hunt snow geese?” she asked me. “Yes, they are,” I replied with a big, toothy smile. I felt like an ambassador of the NRA sent to explain the facts of life to urban visitors.
“Yes, we, that is the human race, have been hunting water fowl, such as the snow geese, since the dawn of time, for many thousands of years, using shotguns and other implements.”
I might have said that, but the sparkling red SUV had driven off, I could heard them tut-tut-tutting about those poor little snow geese getting shot at. Pretty ladies, though. I’ve always liked pretty ladies.
Pop-pop-pop. It gets annoying after a while. Some hunters are so dumb that they can’t tell the difference between a snow goose and a house. I live here -- in this house in the middle of the field
You could put giant letters on your house that spells H-O-U-S-E, but that wouldn’t help.
Hunting season goes on for several months, and then the hunters go home, the human ones. But the coyotes and eagles continue. It’s serious. They get hungry and a snow goose is a meal.
I hardly see the coyotes, they move around more at night. But the eagles perch at the top of the cottonwood tree in the back yard.
It’s a very tall tree. Eagle eyes can see for miles. It’s not sport. They’re not looking for a fair fight, but scan for the wounded, aged, or sickly birds.
I look for a bird out there in the field, amid a thousand snow geese, but this one bird is hobbling, as if something were wrong.
The eagle saw that bird too, before I did, and that crippled goose will not live out the day.
I can walk in the field the next day and find the feathered remains. That’s how it goes.
Eagles are inspiring, but for them it just gets cold and windy sitting up there on the top of the tree. They’re not trying to impress anyone, they’re just looking for their next meal and hoping to stay alive until spring.
Tourists pull their cars to the side of the road, and take photos of the eagles in the tree tops. They are part of nature too, human nature.
We humans bring justice to nature. It could be our defining quality, compared to other creatures.
We instinctively recoil at the unfairness of the eagle’s predation, saying, “Pick on somebody your own size.”
From a sense of justice comes law and government and the whole shebang, with me walking by the side of the road, and the ladies in the sparkling red SUV, and the hunters going pop-pop-pop.
All trying to decide what is fair, and doing it poorly, but it is our Star-Trek human prime directive. Be fair.

FOLDING SWEATERS. As I have declined the social ramble and spent more time on the farm these past few weeks, I did something I have never done before in my life. I folded my sweaters.
I have a nice collection -- a maroon Pendleton sweater that is so thick and warm, I can’t even wear unless it’s bitter cold.
I have two light merino wool sweaters. My daughter helped me find them at the thrift store. I didn’t know about merino wool -- it’s extra warm.
I have two light-weight cotton sweaters, one maroon and one baby-blue. I bought them two years ago at Target for $10 each.
Then the red cotton sweater and the cashmere -- which I mentioned in the previous issue of Frog Hospital.
And, my 100 percent cotton, No Logo, earth green XL sweatshirt.
I had my sweaters all jammed into a shelf on top of a rack of clothes in my closet. But I took them all out on Sunday, and folded them in the proper manner, and placed them back on the shelf.
Why did I do this? It seemed to mark a change in my life, a beginning which I have hoped for, a new direction.
This may not seem important. Very little of what I do is important. I want my life to be interesting and meaningful. But I can’t think of anything that’s important about it, except that my niece Rosie in Colorado is hoping that her husband Travis will come from Iraq for Christmas. That’s important.

Saturday, October 17, 2009

It's Raining

I usually write Frog Hospital at the library or the café, where they have a wireless connection to the Internet. The Internet is handy for checking facts. For instance, in the last issue I wrote about Cape Ann in Massachusetts and its wild, granite seascape.

But was it spelled Cape Ann or Anne with an “e” ? I checked the spelling on the Internet.

Besides that, I just like being connected, and being able to interrupt my writing so that I can dash off an email to a friend. This is called multi-tasking, but when I was a kid, this was called a lack of concentration.

Somehow, the world turned upside down in this respect. To be able to do one thing well and ignore all distractions -- that was good.

Now it is the mark of a dullard -- you’re only doing one thing at a time? -- you must be a little stupid.

I am writing at home this morning, at the farmhouse on Fir Island, and we don’t have the Internet here, thank God.

….Pause. Sip coffee. Look out the window at the rain coming down across the field. The branches on the weeping birch are not moving -- almost perfectly still, meaning that the wind is calm.

The clouds behind the birch tree are not moving either. The clouds are very low to the ground, and I can’t see the foothills, which are five miles east of the farmhouse, across the flats.

It rained all last night. It was the first real rain for many months, and the fields are puddled like a sheet of water.

The monsoon is here, although to what degree? Will it rain every day for months and not have a spot of sunshine until next summer? It could happen.

Or bitter cold and snow in January, like last year with icy roads, and we were marooned in the house for days? Maybe.

Or a thaw and a burst of warm weather in the middle of winter -- so warm and sunny that fruit trees burst into blossom.

Or a winter unknown and terrible with weather worse than a nightmare and storms of climactic extremes?

This cannot be known, except that it rained last night and it has begun.

All this without recourse to the Internet, I simply looked out the window.

Also, I have a way to check spelling -- a paperback dictionary. I can look up “recommend.” It’s one of those words that trouble me -- is it two “c” s or two “m”s ?

Traveling has only one “l” -- I think it should have two “l”s, but it does not.

Pause. Go into the kitchen, prepare cold cereal with brown sugar, let it set for a few minutes to make the flakes less crunchy. Let the dog out. Wash a few dishes from last night. Do a quick dry mop on the kitchen floor. Eat the cereal.

I can see my cashmere sweater lying on the un-made bed. Janet Laurel had a yard sale at her home in LaConner this summer. That’s where I found the cashmere sweater. I bought it for only one dollar -- that’s a pretty good find. And it’s so warm that I practically can’t wear it without sweating.

So I think I’ll bring out my red cotton sweater and wear that instead.

I was sick last week. I had the flu. I had to stay home, in my room, and under the covers for several days. It was an interesting experience. I discovered that I liked staying home all day and I was tired of running around all the time, and the things that I could not do because I was ill were things I hardly needed to do, and that it’s much better to relax on my own premises and read a book.

Or draw, or cook, or walk around the field. I discovered this is actually my home and it’s good to be here.

It’s still raining. The clouds are very thick and low. The wind is starting to blow -- I can see the branches moving on the birch trees.

I can’t see any birds, but I know the birds are out there somewhere. There’s lots of birds around here, especially the snow geese.

So, what I’ll do, is just stay home all winter. We have tons of firewood. I have to go to work and make money, and I need to go into town to buy groceries, but otherwise who needs it?

Friday, October 16, 2009

The Blue Lady

A friend of mine is visiting Boston this week, so I told her -- "Get out to Halibut Point if you have the chance."

You drive north from Boston, past Marblehead and Salem, out to the Cape Ann peninsula and the Gloucester harbor full of fishing boats.

You keep going until you get to Rockport, an impossibly cute tourist town, although it's not anyone's fault. People come from all over to buy saltwater taffy and t-shirts, so a man would be a fool not to sell them.

In New England, nobody moves over to make room for tourists, and they charge them plenty just to park their cars. People come anyway.

But don't stop in Rockport, take the small road up the coast about four or five miles. It's a pretty drive. You get to Halibut Point State Park, and then it's a short hike out to the point.

Pure granite. Everything on Cape Ann is made of pure granite with a little bit of soil between the cracks to nourish a few pine trees.

Walk out to the tip of Halibut Point where the waves crash and heave against the granite boulders.

Then look out to sea. Look for the Blue Lady. She floats above the waves and she's very beautiful. You might hear her say something, but it won't be words.

If you go out there you might see the Blue Lady. I saw her once.

Regrets and Resentment. Now it's time for Frog Hospital's annual "Regrets and Resentment" issue.

It has become quite fashionable to disparage these essential human qualities, to say, as if it were definitive, that "I have no regrets." Or to blithely dismiss every insult and injury, and say, "I have no resentment."

These people are lying, or else devoid of consciousness. Regret is part of a meaningful life. The things I have done -- my God, my whole life is an embarrassment. I have only to pick a year, and like an apparition, comes a parade of far from harmless misdeeds.
I do not forget these errors. I regret them.

Regrets are for the stupid things I have done, which hurt myself and others.

Resentment is for what other people have done to me. How can we forgive if we do not first savor and store up the grievance?

There is a lifespan to an injury. People do hurt us, through carelessness and through intent. These are real wounds.

And, does a real wound heal instantly, miraculously? No, it hurts and it bleeds, and it begins raw and painful, and transforms, over time, into a deeper ache.

Real forgiveness only comes in time, after resentment has served its purpose. That's the healing that ennobles us.

Soulful Songs from the Sixties. First a 1966 live recording of Lou Rawls singing "The Shadow of Your Smile."

Then the incomparable Sarah Vaughan sings "I Can't Give You Anything but Love."

It's so smooth.

Speaking of Smooth. I liked President Smooth when he came back from Copenhagen without gaining the Olympics Games for Chicago. I really don't think our President believes his own charm, not with a wife like Michelle. He came back from Copenhagen empty-handed, as if to say, "I tried, but only because you asked me. I can't waltz the scales off a snake. I can't turn the devil into sponge cake. And you shouldn't expect anything like that."

I liked Obama defeated. This nonsense with the Nobel Peace Prize has a lot to do with the silly expectations of five Norwegians, and very little to do with Obama.

He's the President. He has real work to do, and I hope he does it well.

Illness. We should all spend the whole day in bed once in a while and not wait for illness to force this resting state upon us. A sweating episode of outdoor labor followed by a sudden chill put me out of business for a few days, down with the flu, confined to the house, huddled under blankets, forced to read long books and look out the window for hours..... I'm glad it's over.

Frog Hospital Financial Report. Frog Hospital, as an email newsletter and a blog, has earned close to $1,200 so far this year, making it a huge success by the standards of this particular medium. Thank you for your support.

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Friday, October 09, 2009

Advice about Men

Flash: Obama wins Nobel Peace Prize. After a careful reading of various news sources to get the reaction, I realize I don't have anything to say that hasn't already been said.

We take our readers to heart. Sometimes they face difficult decisions in their personal lives and ask us for help.

Dear Dr. Frog,

"Mamma Mia" is such a good movie. I've seen it three times and everybody sings along. But my husband would not go with me. Keith is such a good man in every respect, but he just won't go. So when "Mamma Mia" came out on DVD, I thought we could watch it at home together -- just the two of us. But he refuses! Honestly, I cried.

Maybe I'm making too much of this, so tell me what I'm doing wrong. Or am I doing anything wrong? I try to be a good sport about things. I have sat with him on the couch and watched at least a hundred football games, but one little movie that I like and he won't do it.
---from Sally in Shelter Bay

Dear Sally,

Thanks for having the courage to share this with me. My heart goes out to you and I will try to help with what little I know.

It's true that a man can be difficult to deal with and no more responsive than a block of wood, but the fire is in there, believe me. I can understand why Keith doesn't want to see "Mamma Mia." None of the guys do. It's more than a chick flick. It's like the total, ultimate chick flick and word gets around.

Sally, why you like it so much is why he doesn't like it all. It's a little gooshy -- you know what I mean. I'm sure Keith knows what I mean. I'm a rugged dude and a man's man, but I am also a serious researcher of human nature, so I watched "Mamma Mia" last night on the DVD.

You're right. It's a wonderful movie. Just the scenery from the Greek islands is worth the price of admission. And those cheesy Abba songs, sincerely dramatized by Meryl Streep and Pierre Brosnan -- who sang in their real voices. It was all very well done. This movie is good schmaltz. Of course, you loved it.

But your question to me was -- should you somehow insist that Keith watch it with you, or should you be hurt that he has refused to do this?

This is my answer: Leave him be. Because a man resting on the couch watching a football should be allowed his repose. He doesn't want to talk, he only wants to munch pretzels. Let him rest. Be glad he's at home. He's not doing any harm when he's not doing anything at all.

Even for a hundred football games.

But he does have to do one thing for you. He has to take you to the opera this winter in Seattle. Good seats, top dollar. He has to buy the tickets, wear his very best clothes and pretend he's having a good time. The full deal. Maybe he should buy you a corsage too.

That's what he has to do. Tell him I said so.

The Public Option. Support is building for the public option. The arguments against it run flat. Has the post office driven Fedex and UPS out of business? Have public universities driven private colleges into bankruptcy? Have public libraries forced all the bookstores to close?

These are three examples of a successful market-sharing relation between public and private entities. It could also work well in health insurance.

The Government Can't Do Anything Right. The government can't do anything right -- except for the Internet, a defense communication project, or the Interstate Highway System, or the dams along the Tennessee river that brought electricity to country people all over the South in the 1930s.

Or the Erie Canal. Or the Louisiana Purchase.

All stupid, all a complete waste of money. Especially that last one. President Jefferson spent millions of dollars to buy worthless land. We should have stopped him.

Actually, historically, over time, it has been hit or miss. The federal gov't has many times wasted billions of dollars on programs that do nothing or even harm people. Like when they bought Alaska from the Russians in 1867 -- nothing but worthless frozen waste and tundra

But I'll take a chance with Obama's public option. It might work.

Who Paid the Taxes that Built the West. Look at Bonneville Dam and the Grand Coulee Dam that have provide cheap electricity and abundant water for agriculture to the Pacific Northwest. Built with federal dollars. Paid for by taxes from the Midwest.

It was the industrial and manufacturing power of the Midwest that made the jobs and generated the income and paid the taxes which the federal government collected to build the highways and dams and military bases and national parks and flood control and irrigation projects throughout the sparsely populated and under-developed Western states.

There is a four-lane limited access Interstate highway, I-90, that crosses the entire state of Montana from west to east. Do you think the people of Montana paid for that road? There never was enough people in Montana to pay for that road. But they ride on it all the time, while cursing the federal government, while sticking that federal money in their back pockets at the same time.

The money came from tax dollars generated in the Midwest, from the farm implement factories in Iowa -- John Deere and Massey-Ferguson. From the heavy equipment factories in Illinois, like Caterpillar. From the powerful steel mills along the Lake Michigan shore in Indiana. From the mile-long car factories in Michigan.

Those once mighty engines of democracy generated the wealth that built the West.

But the factories decayed, and the manufacturing system fell afoul and the jobs dried up and the Midwest has not been the powerful engine it once was. Michigan has the highest unemployment in the country now. It's hard to believe what Michigan is now, compared to how powerful it once was.

Fortunately, for the Midwest, there's a new President in the White House, a man who put his roots down in the South side of Chicago. Obama represents the new energy and the resurgence of the Midwest.

Places like Illinois and Michigan aren't cool. Everybody on the West Coast thinks it's much cooler to be out here, and so many of us came from back there and we didn't like it back that there because it was so conventional and boring and flat.

But, Michigan and the Midwest are the future of our country. Put it another way -- if Michigan has no future, than the USA has no future. It's not going to happen any other way.

That's why a young man with ambition who grew up in in Hawaii and Indonesia decided to begin his life's work in the un-coolest part of the country, the Midwest.

In the center, in the middle.

I have written enough, and this will be continued.

Courage. I want to make a special thanks to Peggy in Marin County who has helped me get my courage back.

FACEBOOK. "LaConner Views" will get you to my Facebook page. I make frequent posts, often with interesting photos of local people.

SUBSCRIPTIONS. It's all right to buy a subscription any time of the year. Like right now. For $25 you can become one of the honored subscribers to Frog Hospital. Subscribers have no special influence over what gets written, yet they are held in the highest esteem by this writer. You can mail a check for $25, made out to Fred Owens, and mail it to Box 1292, LaConner, WA 98257. Or go to my Frog Hospital blog and hit the PayPal button and pay that way.

Sunday, October 04, 2009

The Boys from Chicago

The Boys from Chicago

It only took Fox News one year to figure out that the boys from Chicago are running the country now. I would love to see the whole team -- Rush, Hannity, O'Reilly, and Beck -- take on Mayor Daley. It would hardly be a fair fight. Daley wouldn't even break out in a sweat.

Fox News did find ACORN. That was a gimme, small potatoes. They found Barney Frank -- lots of fun and noise from Massachusetts, but they never realized, until it was in plain sight, that His Honor is the Number Two man in the country.

So President Obama borrowed Air Force One for the weekend and flew to Copenhagen to promote Chicago's Olympic bid. He did what he was supposed to do. He showed up and made his pitch, disregarding the fallout if he should fail, which he did.

Back home, it didn't matter. Obama made his effort without trying to disguise the favor, and Daley's team is consoled by the fact that they still have the White House, Air Force One, and control of the federal government.

You can tell who runs things -- they're the quiet ones. You can tell who isn't running things -- the guys making all the noise.

I was conflicted myself, being from Chicago. But a disclaimer -- I am from the North Shore, an affluent suburban region of Chicagoland and would never say I was from Chicago, except I am out here near Seattle, where no one knows the difference.

Anyway, I was conflicted, because I was glad Rio de Janeiro got the Olympics in 2016. It was simply South America's turn and they deserved it.

I also felt the warmth of losing. From Chicago, we're used to it. When I was a kid, when baseball really mattered, the Cubs always came in last place. So I decided to become a White Sox fan and that was even worse, because the White Sox played well, but they always come in SECOND, and the Yankees always won. Always losing, it's tough. And the climate is ferocious, terribly hot in the summer, bitter winds in the winter, and the countryside is flat as a pool table. That's Chicagoland.

As for the Olympic Committee -- they are as gods, invisible and inscrutable. It is not for mortals to decipher their meaning. Obama's charisma did not play well before this committee, and he knew that. But he took one for the team and that's what really mattered.

Fox News misses the point when they call Obama a socialist. He's not. He's a Daley-ist.
The Daley program is higher taxes for the upper half and higher wages for the lower half. The Daley program is urban-oriented and anti-Wal-Mart. It's about strong government for strong people. It's not heaven on earth, but it's way better than Dick Cheney running the country.

Friday, October 02, 2009

The Gettysburg Address

In the last issue, I wrote a spoof on the historic revision of the voyages of Christopher Columbus, and I took a sideways swipe at Howard Zinn and his very popular book, A People's History of the United States.

It's a good book, a useful corrective to the unalloyed adulation of American heroes. But it seems that younger people take Zinn's book as a founding text and the basis for a new orthodoxy.

"New orthodoxy" is a most horrible concept. An old orthodoxy has at least the warmth of tradition, even if it's wrong. But a new orthodoxy, uncritically accepted, is a cold and barren tyranny.

Or, it could be an adolescent phase. It's like when you get to be 12 or 13 and you discover that your parents are complete frauds. Mom and Dad weren't telling you the whole truth. You see all the holes and discrepancies in the family story. This is a necessary disillusionment that causes anger and rebellion in the young. But hopefully, we continue to grow and develop a more measured appreciation of our ancestors and the people who made us what we are.

No, Christopher Columbus was not a very nice man. He did make it across the Atlantic Ocean and back again and kept a careful account of his voyage. That makes him a discoverer. As a result, half the human race found out there was another half -- quite a world-changing event.

When the human race re-united, the microbes wrecked havoc and millions died. No one expected this. Also, people failed to see the value of other cultures. You could say casually that they weren't impressed with each other or were horrified by exotic customs. Or maybe, because they were so far away from home, they were simply scared and acted the way people act when they are frightened -- with violence.

Well, greed, lust, and the other vices played a part as well.

In the new orthodoxy, there are no great men. We're all just people and things just happen. There are no individuals who drive events, and no makers of history. Sooner or later, somebody would have made a voyage across the Atlantic Ocean, and there were surely a few who made it across before Columbus -- they just lacked a good PR machine to hype the journey.

Still, it was a good thing. Rivers, cities, provinces and one nation are named after Columbus. There's no need to change that.

Another great man, who, until recently, rated his own holiday, was Abraham Lincoln. His life has been subject to endless revision which does not seem to diminish his stature. We have him on the penny, the five dollar bill and Mount Rushmore. He doesn't seem to be going away anytime soon.

This is the Gettysburg address, only 278 words. It's so short, even the attention span of the Internet can hold it:

Four score and seven years ago our fathers brought forth on this continent, a new nation, conceived in Liberty, and dedicated to the proposition that all men are created equal.

Now we are engaged in a great civil war, testing whether that nation, or any nation so conceived and so dedicated, can long endure. We are met on a great battle-field of that war. We have come to dedicate a portion of that field, as a final resting place for those who here gave their lives that that nation might live. It is altogether fitting and proper that we should do this.
But, in a larger sense, we can not dedicate -- we can not consecrate -- we can not hallow -- this ground. The brave men, living and dead, who struggled here, have consecrated it, far above our poor power to add or detract. The world will little note, nor long remember what we say here, but it can never forget what they did here. It is for us the living, rather, to be dedicated here to the unfinished work which they who fought here have thus far so nobly advanced. It is rather for us to be here dedicated to the great task remaining before us -- that from these honored dead we take increased devotion to that cause for which they gave the last full measure of devotion -- that we here highly resolve that these dead shall not have died in vain -- that this nation, under God, shall have a new birth of freedom -- and that government of the people, by the people, for the people, shall not perish from the earth.

"It is for us the living, rather, to be dedicated here to the unfinished work"

Us, the living, you and I, all citizens, and the current President -- we are challenged to take up this unfinished work and face the great task remaining before us.

The speech was given in 1863, 146 years ago. The words humble any writer -- to say so much in only 278 words. The language is so clear. I read Garry Wills book, Lincoln at Gettysburg which explains the meaning and importance of this speech.

Old Abe calls down to us and says -- you think you have problems? I gave this speech on the grounds of a battlefield where thousands of men died, North and South, because of an argument that could only be settled by blood and the sword.
He says we can’t give up, and we can’t go our separate ways.

It's a good speech that, like a work of art, means just as much today as it did a long time ago. It's not old, it's fresh. It's not about the past, but it points to the future and what still needs to be done. We can't give up. We can't go our separate ways. The current turmoil gives no excuse for despair.

"That all men are created equal." I should explain this to younger people. Until around 1970, the word man had two proper usages, depending on the context. In one context, man meant a male person. In another context, man meant human being. In the Gettysburg address, it means human being. That's easy enough to understand.

But equal. That's a stumper. What does equal mean? Because President Lincoln said our nation was dedicated to this proposition -- that we are all created equal, and not just Americans. He said "all men."

We are all created equal. Is this an intention or a fact? Not meaning all the same in every way, as in mathematics .... because we can so easily distinguish one person from another ... we strive to be different ... we take pride in being unique ... so how can we be equal?

FACEBOOK. "LaConner Views" will get you to my Facebook page. I make frequent posts, often with interesting photos of local people.

SUBSCRIPTIONS. It's all right to buy a subscription any time of the year. Like right now. For $25 you can become one of the honored subscribers to Frog Hospital. Subscribers have no special influence over what gets written, yet they are held in the highest esteem by this writer. You can mail a check for $25, made out to Fred Owens, and mail it to Box 1292, LaConner, WA 98257. Or go to my Frog Hospital blog and hit the PayPal button and pay that way.