How to Fix a Broken Heart

img_20160911_131835It is easy to get lost in the hospital. From the main artery grow several asymmetrical wings rising to varying heights. When one of the two main artery elevators opens, the landing pad presents an unexpected reception area, depending onto which floor you alight.

I had thought room 3217 afforded a view of the Hope and Healing Garden, but over the week, as I wandered about on visit breaks, I realized it wasn’t the garden I had seen on the hospital floor-map, but just a breezeway between wings, an alley, really, of a horizontal line of maple trees rising vertically above a trapezoidal space created by three wings. One of the nurses said that when she started at the hospital, those trees were only a few feet tall. I was reminded of the William Carlos Williams poem,

Between Walls

the back wings
of the

hospital where
nothing

will grow lie
cinders

in which shine
the broken

pieces of a green
bottle

Williams found hope and healing where he could, and here between walls grow beds of dark green, glossy ivy, out of which grow the spindly maples.

On another walk, taking another breath break, I discovered the Meditation Garden, an open air courtyard enclosed by hospital walls. The Meditation Garden was quiet and relaxing, with a variety of benches and tables for sitting and if lucky, meditation. But I thought of the little book “How to Relax,” by the Vietnamese monk Thich Nhat Hanh. Meditation is not what you might think; it’s more about what you don’t think. And, Hanh says, you don’t need a special garden, mat, or incense to meditate. You just need to relax, and breathe. I get that, but still, the Meditation Garden is a good hospital getaway space.

There were other places to chill out: outside on the grounds; the cafeteria; the Pavilion lobby was very pleasant; the LivingWell Bistro; the chapel. I liked the chapel, but was a bit put off by the giant mural of a long, blond hair and blue eyed Jesus. Susan has blue eyes, and her hair was once beach blond. I think Jesus’s hair must surely be grey by now, if he hasn’t pulled it all out.

Another day, I found the Hope and Healing Garden, but I couldn’t get in. I saw a tree growing over a circular brick wall, and I tried to find a way into the garden, which I could just barely see through a door window across an aisle and though another door window.

As I was writing that last sentence, in my pocket notebook, sitting comfortably in the digs of a spiffy waiting room lobby area outside the vegan LivingWell Bistro, an immense amount of new and fascinating technology was wandering Wi-Fi-like through and around patients, taking blood, artery, vein, and heart pictures. I had a glimpse of the imaging room from the hall just before I came out to sit here to wait: clean and sparkly, the four imaging technicians in starched blue scrubs, and the cardiologist, an ancient oracle, about to reveal obscure things that live behind screens.

On a slide show screen on the wall in the lobby, across from the waiting area couches, I could see photos of the Hope and Healing Garden, and reading the slides, discovered the garden has limited access. It’s for mental health patients.

I’ve been waiting almost two hours now. The oracle should be coming through the big set of automatic doors soon.

It’s hard to fix something that is a work in progress. The heart is a jalopy, constantly under repair; a fishing barge rising and falling with the tides, taking on water; a yo-yo with a broken string, a bicycle with a jumped chain, a stew of recycled images.

The gods make contact with the humans through the oracles. The people want miracles, but the gods grow jealous of the oracles and humans and make mistakes. What a strange way for a god to behave.

The modern god likes to hide. Like Tolstoy said, he sees and knows but waits, while humans, as Gertrude Stein remarked, inside, are always the same age. But I’m not sure about that. As Cornel West said, time is real, and we can’t break-dance at 70 like we could at 17. Or surf. But Isaiah said:

He giveth power to the faint; and to them that have no might he increaseth strength. Even the youths shall faint and be weary, and the young men shall utterly fall: But they that wait upon the Lord shall renew their strength; they shall mount up with wings as eagles; they shall run, and not be weary; and they shall walk, and not faint. (40 KJV)

And they shall be reborn and breathe again? Where is this Lord when you need him? Surely he must at least be weary of request after request after request. What else do people give him but requests? To fix your heart, he says, call a plumber. He gives you what you need, never what you want.

Photograph of Providence Urgent Care Waiting Room at Noon

Waiting room Center seat Back to window
Squeeze my fingers Under a bitter blanket Opposite counter
Vertigo Where? Merry-go-round stops.
Wall clock running backwards You seem to have crossed some divide, a distance between following expectations and surprising the reference books on shelves marked Must Remain in Reference Room: No Check Outs – For Scholars Only! Those were the days of craves Dizzy and Monk and Bird ears. We never worried ears, blood pressure, what gave rise to touch, an orange scarf, blue waterfall behind bridge.
Nurse station The nurse walks you to the scale, weighs you, takes yr blood pressure, pulse, and temperature. “The doctor will be with you shortly to hear yr confession,” and she leaves you alone to study the posters of the cross sectioned body pinned to the wall. The doctor knocks and comes in dressed in stole and stethoscope, just like on TV. “I only handle venial issues. Only a specialist can give absolution. But what good is freedom that leads to wild thoughts?”
Waiting Room Families and individuals. Names called. An ambulance arrives. Para-techs wheel in empty stretcher, disappear into sanctuary. A fire truck appears. Six firemen walk through waiting room like a Rubik’s Cube. Two men in Texas gear waltz across the lobby. A boy plays with the automatic door. His father. His sister figures it out. A yell and a sigh. A woman crumbles at the nurse’s counter, a Beckett ploy that gets her plenty of attention.
Valet Parking The sign says No Tips. I hand the parking attendant an Ace which he pockets. Good man! The drive home.
What the Doctor said She wanted to see my pocket notebook. “I knew you were dizzy as soon as I laid eyes on you sitting out in the lobby taking pictures of the patients, word pictures.” In the waiting room waiting continues. Kids run around and play games, laughing. A few people look worried. A couple of folks look hurt, or hurting. A father falls asleep.
 The Clinic Closes for the Day  A husband weeps. A mother changes a dirty diaper.

Micro Poems with Eye Exam

Eye Exam

Picnic Technique

Moistly dripping sap
pilly this juicy gusto
pudding wasp crust
paper crisp in cut grass.

Sara Monaurally

The staked sapling at the gibbet
           gallowed
     silent squirming wail.

Fit For a New Hat

  1. When you measured my head
  2. blue eyes saw yonder
  3. sea anemones in tide pools
  4. I wanted to hug you but with
  5. the magnifying tape around my head
  6. ironically did you order
  7. the hat anyway?

Flashing Lights and Floaters

So tiny she climbed up through my nose and into my eyes and swam around
in the vitreous liquid, kicking off my retina.

Such a big name for so tiny a doctor.

“The lights are like paramoeciums falling like electric rain drops
white paisley sparkles on a flat black poster board
down always down never up in the far corner
of the right eye,” she said.

“Yes, I see them,” I said. “There goes one now,
like strobes.”

“It is still somewhat ambiguous,” she said.
“Asymmetrical.”
She had an accent to my ear.
“Let me drop in some dye
and have a swim around.”

High up on the top floor a magnificat view of the streaming
river and tiny cars floaters across the gargantruss
ginormous gargling cement girdles of the fat city.
Straight down where they build the barges
always the two blue cranes shifting
imperceptibly
an orange crane I’d never seen there before.

When she photographed my eyes
I saw faces like on the veil of Veronica
but morphing shapes
and a Trinity:
The father seemed bored, the little kid,
annoyed to be kept waiting,
flitted about like a ghost,
and the mother sat quietly slumped
over in a chair, resting, as if
keeping me company while
the dye spread out my eyes
into two flat brown oceans.

Ending Net Asset Value; or, Hook up, hat up, and let go: “Calling Dr. Bartleby!”

Atul Gawande is a Harvard trained surgeon who writes eloquent prose on health and illness. His New Yorker pieces “Letting Go” and “The Way We Age Now” are full of pathos, ethos, and logos on how and when to die decisions and the bedpan reality of growing old. If he continues his work combining writing, doctoring, and educating, he may some day be up for a Nobel Prize. Gary Becker is a Nobel Prize winning economist and professor at the University of Chicago who writes in his blog, The Becker-Posner Blog, pedestrian prose sometimes infected with either-or fallacies. He shares weekly blog posts with Federal Judge and University of Chicago Law School Professor Richard Posner.

What usually passes for health care in our current reasoning is health care insurance. Those with insurance believe they have health care; those without may think they have neither. And the health care debate is derailed with decisions before legislators that have to do not so much with health care but with health care insurance.

Last Sunday, Becker included in his post what appears to be an economist based claim that includes a formula for calculating the value of a year of life: “Presumably, frail elderly people tend to receive less utility from a year of their current life since their lack of health prevents them from greatly enjoying their leisure time and consumption of different goods. However, the utility cost of any time and money they might spend on prolonging their lives is also lower for them. The fundamental measure of the value of a life year is the ratio of the utility gained to this marginal utility spent on prolonging life. This ratio could even be higher for the old and frail than for healthy younger persons.”

We are becoming increasingly Spartan by the moment, for the reductio ad absurdum of Becker’s argument would have us carrying individuals of any age whose disabilities or frailties preclude utility or whose cost to live outweighs their ability to “enjoy their leisure time and consumption of different goods” out to the rocks to die, as did the Spartans.

“Welcome to the 23rd Century: The Perfect World of Total Pleasure,” heads the poster for the sci-fi film “Logan’s Run,” which depicts a dome-covered society that eliminates growing old problems by zapping all citizens when they turn the age of 30. The police, called Sandmen, hunt down and kill those who would run from their forced to die moment. Yet there’s a myth, an old story, of life beyond the dome, where people are allowed to grow old. The place where people are allowed to grow old is called Sanctuary.

But there appears to be no Sanctuary for our elderly these days, at least not provided for by Medicare, for there’s simply not enough money to go around, the Becker-Posner argument seems to go, and we should spend what money there is to go around on those able to enjoy life and consume goods. Perhaps enjoying life, in the worldview of the economist, is consuming goods. In any case, the argument has been boiled down to an either-or moment: either we let old people grow old and die sooner than they would with life prolonging health care (including the R&D necessary to develop that care), or we go broke.

But there are other solutions. Yet there is another problem with Becker’s formula: the value of an old person’s life is not necessarily limited to what that person can enjoy or consume; the lives of the elderly may have intrinsic value to others. But not, apparently, to young doctors, for Gawande points out the current dearth of young doctors going into gerontology. There’s a shortage, and there’s no short-term remedy to what will be an ongoing need for specialists to treat the elderly. Gawande’s solution is for every health care practitioner to be versed in basic elderly care issues.

But to be fair to Becker and Posner this week, they do focus on quality of life versus quantity of life and the avoidable invasions of quality by a system not guided by health care concerns but by health care insurance. And Atul Gawande does also question quality versus quantity. What separates Gawande’s argument from Becker-Posner’s is his value of human life expressed in human versus econometric terms. It’s one thing to force someone to die at the age of 30; but is it something else again to force, or even to encourage, that same person to live beyond what most of us, including our ancestors, would recognize as living? Ah, Bartleby! Ah, Doctor!

Related: An Object Lesson in Health and Happiness

Plato, Pablo, and the Poetics of Health Care

Plato considered poets dangerous and banned them from his Republic, and Il Postino (1994) illustrates his point, yet also shows that we are all poets, all who use language – to love and berate, to tackle and persuade, to testify and exhort. The movie, from the book Burning Patience, by Antonio Skarmeta, a fiction set on an island of Pablo Neruda’s temporary exile, is about the democracy of language, how metaphor permeates our lives, and the consequences inherent in desiring more than our own voices can bear, even through poetry. 

Is contemporary poetry outside the margins of popular US culture? Maybe, but the creation of metaphor is still the heart of language and language the heart of culture. In the film, this is ironically dramatized by Aunt Rosa. During her hilarious visit to Pablo to complain of his contributing to the poetic delinquency of Beatrice, she lets loose with an invective that ably employs a fishnet of metaphors to describe Pablo’s bad influence on Mario and Mario’s hypnotizing effect on her niece. The blame falls on the poet for stirring the emotions of the tainted republic of the island. 

Poetry sleeps around, moving through Plato’s five regimes. Democracy gives way to tyranny; Plato should have banned lobbyists – then maybe the Republic, though awash in a bath of poetry, might at least have a decent health care system, not to mention an adequate water supply.

Crain, Denby, Dylan and the Avatar of Health Care

“Now there’s nothing wrong with technology per se, and there’s nothing wrong with fantasy, either,” Caleb Crain offers at the end of his Avatar movie review (posted both on his blog and at n+1). And there’s nothing wrong with corporations, per se, either, he might have added, for, in any case, are not many of the “smug anti-corporate” critics, plotted or plotless, plugged in via their 401K’s, or their public employee pension funds? Caleb more than disliked Avatar; it gave him a migraine, attributed to “the movie’s moral corruptness.”

While Caleb was nursing his headache, over at the New Yorker David Denby must have seen a different Avatar. For Denby, “James Cameron’s ‘Avatar’ is the most beautiful film I’ve seen in years.”

It’s a classic case of compare and contrast.

Crain: “The audacity of Cameron’s movie is to make believe that the artificial world of computer-generated graphics offers a truer realm of nature than our own. The compromised, damaged world we live in—the one with wars, wounds, and price-benefit calculations—can and should be abandoned. All you need is a big heart, like Jake Sully (Sam Worthington), the movie’s war-veteran hero, and the luck of being given a chance to fall in love.”

Sounds like vintage Hollywood.

Denby: “Amid the hoopla over the new power of 3-D as a narrative form, and the excitement about the complicated mix of digital animation and live action that made the movie possible, no one should ignore how lovely ‘Avatar’ looks, how luscious yet freewheeling, bounteous yet strange.”

Sounds like vintage Hollywood.

Avatar cost, according to Denby, “nearly two hundred and fifty million dollars to produce,” but he advises that “there’s not much point in lingering over the irony,” for “the movie is striking enough to make [claims of alternative values] irrelevant.”

Movie making has become like health care: hypercosts, waste, unnecessary tricks, and expensive tickets – but no one’s any healthier, but one’s health is irrelevant; the show must go on.

Crain: “Once you upload yourself, you don’t really have to worry about crashing your hard drive. Your soul is safe in Google Docs. In a climactic scene, rings of natives chant and sway, ecstatically connected, while the protagonists in the center plug into the glowing tree, and I muttered silently to myself, The church of Facebook. You too can be reborn there.”

Last night we were watching “Inglorious Bastards” at home on DVD and there was a brief power outage. A power outage is when the city suffers a stroke. We’ve made doctors and directors our new gods, but like the old gods, they make mistakes. Nothing like a power outage to remind us that, as Bob Dylan said, “You shouldn’t let other people get your kicks for you” (“Like A Rolling Stone,” Highway 61 Revisited, 1965).

Ivan Illich, Education, and The Good Life

Ivan Illich’s Deschooling Society (1972) exposes our assumptions that a degree is an education, that medicine is health care, that security is safety, that institutionalization of jobs in corporations, schools, and government creates our freedom. We’ve come to confuse degrees, medicine, jobs, and security for the good life.

When what we value, what we want, becomes institutionalized, our values grow frustrated, and what we want turns against us: “…the institutionalization of values leads inevitably to physical pollution, social polarization, and psychological impotence: three dimensions in a process of global degradation and modernized misery…this process of degradation is accelerated when nonmaterial needs are transformed into demands for commodities; when health, education, personal mobility, welfare, or psychological healing are defined as the result of services or ‘treatments.’”

It’s not a question of spending more money on education, but of a lack of respect (value) for alternative forms to institutionalized education: “Rich and poor alike depend on schools and hospitals which guide their lives, form their world view, and define for them what is legitimate and what is not. Both view doctoring oneself as irresponsible, learning on one’s own as unreliable, and community organization, when not paid for by those in authority, as a form of aggression or subversion.”

Modern segregation of family, church, job, and school leads to specializations of each, which in turn results in our feeling confined in each, able to do only one thing at a time. In “the medieval town…traditional society was more like a set of concentric circles of meaningful structures, while modern man must learn how to find meaning in many structures to which he is only marginally related. In the village, language and architecture and work and religion and family customs were consistent with one another, mutually explanatory and reinforcing. Education did not compete for time with either work or leisure. Almost all education was complex, lifelong, and unplanned.”

For Illich, the problem is that “members of modern society believe that the good life consists in having institutions which define the values that both they and their society believe they need.” A wise man, Aristotle argues in Nicomachean Ethics, is one who knows what is good for himself and for everyone else. What will happen to Education? Given our current confusion of wants, as Frank Sinatra sang, we may have to “just wake up,” and “kiss that good life goodbye.” And learning to live without our good life as we have come to know it just might be something we should want.