Sunday, January 31, 2010

The Reel And The Real

If you’ve wondered what happened to Hollywood has-beens you can stop worrying. They’re alive, overweight and un-masked, signing autographs at memorabilia shows.

I just got a notice for the next event at the Marriott Hotel in Burbank in two weeks. Don’t go if you need to hold on to those old icons and keep the illusions pristine as they were. Here they are down from the pedestal as mere mortals.

You will see Miss America of 1955, Lee Meriwether and Larry Hagman, still un-dead from Dallas along with Richard Chamberlain and Rita Moreno.

A few years back I spotted Margaret O’Brien, that skinny child star who often played prissy characters. She looked like her heavyweight grandmother. And there was Jane Russell sixty-five years after her role as a sexy gal in a Howard Hughes Western.

These are brave women and men saying here I am in all my flesh…just like you. I see you snickering. Get over it. What you thought you saw before was the lighting and make up, less half a century.

It may be worth attending, just once, to see what Angelina and Brad will look like in 2050. It’s not unlike going to a class reunion stunned at how everyone, except you, resembles their parents’ parents.

The Isaraeli writer, Yehudi Amichai, tells the story of giving a reading and spotting in the audience a young woman he was in love with fifty years ago. She was with an old lady. After his presentation she came up to him to sign her book. Only then did he realize that it was the elderly woman he once knew and this was her grand-daughter.

Maybe we’re better off clinging to that eternally unspoiled reel we have running in our heads as we row back to Eden

Tuesday, January 26, 2010

To Mandate Or To Nudge

Regardless of the fate of the current healthcare bill the crisis will not go away. Any meaningful legislation to come must address the matter of inclusion, and containment of premiums. Yes, we have a rapacious health insurance industry. But even beyond that, at the heart of cost control are the often needless procedures, tests, medications even surgeries ordered by physicians. How to rein them in?

A few months ago a panel of medical experts issued guidelines for mammography in women under fifty. This was a longitudinal study weighing benefits and risks. They published their recommendations to a hew and cry.

Woman's advocacy groups were outraged. Older radiologists felt their turf being trampled and may have wondered about the next payment on their Lexus while young doctors had to be concerned over their student loans.

The panel took a step back and had some explaining to do. Recommendations became suggestions. The weight of statistics became politicized and revealed new fissures in the landscape. The term Evidenced Based Medicine (EBM) entered into our national discourse.

Having received my education, such as it was, in science I have always found myself in that camp. I have developed a nose for hokum; a healthy skepticism (I call it) toward anecdotal, shoddy, pseudo-medicine and folksy remedies. The word evidence does not mean something fixed and ossified, though I suppose we often witness resistance to change. For the most part science is defined by curiosity and imagination along with rigorous peer review. When the Center For Disease Control speaks, I listen.

The issuance of guidelines has revealed a division within the White House itself. Peter Orszag argues for mandates while Cass Sunstein favors what he terms a nudge approach. The latter would offer educational material to providers along with disincentives to continue with outmoded protocols.

Mandates would be more directive with certain prohibitions in place to dissuade doctors from continuing what is deemed excessive or counterproductive models of treatment based on the considerable weight of established statistical evidence in a particular field which yields more favorable outcomes. There are indeed instances where less has proved to be better for the patient.

All of us may be seen as part of more than one larger group, yet we also feel unique. We don't mind being included in age or gender classifications or even certain disease categories but we also like to regard ourselves as unique and therefore exempt from new paradigms.

I wonder if Americans are rather alone in the industrial world, resisting a group identity. Is this an extension of U.S. exceptionalism? We say, fine, that antibiotics are worthless against upper respiratory viral infections but I want it anyway because last year I took one capsule and the symptoms vanished overnight. Maybe mine was bacterial. Maybe there was a secondary infection. Bad medicine, says the guidelines and so it is because the excessive use of antibiotics develops resistant strains. Does the individual care about the community?

This is where I want to leave it, posing the question for further thought; not only regarding healthcare but the larger issue of how we think of ourselves within or outside of a group and subject to policy directives.

Sunday, January 24, 2010

How We Got To Be US

About 35,000 years ago, give or take a week, there was a softball game between the Neanderthals and Cro-Magnons. The latter, Homo-Sapiens, (that’s us) won in extra innings when the rounded rock, called ball, rolled into a nearby cave where one of us was painting on the wall. This was not the official scorer; this was an artist who hid the ball, saved the day and still does.

It’s a good thing we won that day because Neanderthals could never adapt to hitting a curve ball. Nor did they ever think of a wheel, sliced bread or Saran Wrap. We have proved ourselves technologically. We even knew enough not to have invented the Yellow Pages or answering machines until we had the telephone.

But there must be other measures of our distinction. Give me twenty minutes and I’ll think of something…..

Love comes to mind, in all its many permutations; and perhaps by extension we have learned trust and community. Of course, the opposite is also part of our being. We can remember and forget, just like our computers. But unlike them we can imagine and transcend ourselves. Art, I submit, is a necessary function

Think of it this way. The artist / composer / writer sits in his room late at night by lamplight. Down below a commercial ship is trying to navigate along the river. Commerce requires illumination from the desk of the creator.

Artists stand outside the circle banished by Plato, dangerous as they are, or at least straddle it to get a better view. They push and pull us along and around the corner.

I don’t mean to consign that role to a designated few. All of us have the stuff to transport ourselves and others. Only in some does that impulse survive childhood. Society resists change and has ways of crushing the creative life out of us through intimidation, censorship or indifference, in a variety of ways, particularly if it isn't utilitarian.

We are good at that too. A vestigial fear of the unknown still clings to us since that first softball game and it also inhibits us. We need to make room for the mystery and maybe we’ll recognize it as our disowned selves.

Friday, January 22, 2010

What Just Happened?

In one week the Supreme Court has subverted the Bill of Rights and the most progressive state in the union aligned itself with the party of meanness and mendacity.

By reinterpreting free speech to include corporations, elections might as well be decided in the board rooms. I don't think the framers of our constitution had an oligarchy in mind when they met 225 years ago.

The Massachusetts election result was a triumph for pseudo-populism, a complacent Democratic party, and a slumbering constituency.

Who are these Independents who move, en masse, from one party to another? Are they sheep with woolly minds and ears at the ready for the next noisy shepherd? Are they the dispossessed, out-of work with legitimate grievances? Do they make no logical or ideological connection to the source of their discontent?

Populism has a long tradition in our history and many faces. It was the voice of small farmers under Wm. Jennings Bryan at the turn of the last century, then became The Progressive Party of La Follette in the mid 1920s. It later took an ugly turn in 1968 when white southern backlash was harnessed under George Wallace. It is a term with overtones of grass-root, plain folk's rage against a perceived power-elite. Unfortunately the present populists are being played by demagogues who direct their bitterness against scapegoats while the real perpetrators or systemic causes get off untouched.

Today we have a considerable body of low-information voters mad-as-hell at the government for their plight. Too bad those groups are largely funded by the very corporations who out-sourced their jobs and financial institutions who gambled and lost their life savings.

The Republicans have a single mission. It is to render government impotent; to stock cabinet positions with appointees whose job it is to virtually destroy that department. The Labor Secretary was anti-Union, the Interior Secretary favored development of the wilderness, the incompetent F.E.M.A. director gave us the Katrina disaster. etc...

Of course, these same people love government when it serves their interests with defense contracts, agribusiness subsidies etc...

However when government agencies are under-funded and diminished they are powerless to act in times of crisis and become an easy target for popular animus. Even we, the enlightened, fall prey. We become disengaged and our cynicism is fed. Be not dis-encouraged.

Tuesday, January 19, 2010

Confession Of A Steroidal Pharmacist

Now that Mark McGwire has admitted taking steroids and been cheered for it I feel it’s time for me to call a press conference, come clean and get it off my (now barreled) chest. I know now that I shall never enter the Hall of Pharmaceutical Fame.

Yes, it’s true, I did take steroids in the twilight of my pharmacy career to improve my typing and counting speed. My natural endowments were fading. I was confusing A.C.E. inhibitors for Ace bandages. I didn’t know Sloan’s Liniment from Doan’s Pills. There was no pop in my mortar and pestle. I had lost my savoir faire, my je ne sais quoi, my moxie and my mojo. Who knew what the competition was up to across the street. Word had leaked that the chain stores were filling faster and their pharmacists all wore extra large size smocks. I was only trying to level the pharmacy field.

On anabolic steroids I could answer three speaker phones at once, count and pour and crush grapes with my toes. I could memorize package inserts and recognize hundreds of customers by their telephone voice.

I was part of a great tradition. Was it Coleridge’s pen or opium that gave us Zanadu? Did Fitzgerald ever write without absinthe in his bloodstream or Hemingway outside of Harry’s Bar? Shall we turn away from Van Gogh’s astigmatic, anguished, bi-polar sky? Who knows what was in that apple that bopped Newton on the head?

We all want to extend ourselves beyond the merely human. Think of our enhancement as human sacrifice. We traded our life, our liver, for the idolatry of the Greek chorus, the rabble who put us on a pedestal and would now put us under it. If we soared higher than Icarus they put our wax in a sweat even as we gave the sun our finger just before the fall. Now our melted wings are a cupful of pee and we are reduced to asterisks for our hubris.

Monday, January 18, 2010

Award Night

With the Golden Globes last night and Oscars soon to follow I come away wondering why Gable and Grable weren't there or Carrie and Gary. Even secondary actors were household names back then. What ever happened to George Tobias or William Demerest? They were true supporting actors….which reminds me of that all-time great, Zasu Pitts.

Oh, Za Su, Zasu, some said Zazu, your sound alone sends me back to a Hollywood still in its teens before studios dared mess with a name. If they had their way you might have become Carrie Grant or Roberta Taylor and we'd never had plucked you from re-run heaven. Oh dear, Oh my, you declared in quavering vibrato and fluttering hands. You old biddy, you, named for Aunts Eliza and Sue. I'll bet no one had your pizzazz. Too bad Norma Jean didn't learn from you and say, "un-hand me", trading her icon for a lesser banana but longer life.

Competition among artists or even just celebrities seems to me a foolish proposition; a tribute to hype, box office, distribution and networking. Yet I watch it to confirm how out of touch I am from the buzz and occasional true artist.

I couldn’t help thinking about the eighty percent of nominees who were losers and the crumpled acceptance speeches in their tux or purse. All those impromptu words withering now in the waste basket.

Since we are all the stars of our own movie I thought I’d write my own spontaneous acceptance speech in case I get a phone call...

I want to thank everyone in the crowd scenes of my life, that cast of thousands, the best boy, the gaffer and the grip. the caterer and the man who waters the lettuce, the un-sung who collect shopping carts in the parking lot and the lady who let me in front of her in line since I had just one item and no coupon. I’d also want to thank all the disembodied voices who are away from their desks rights now but will handle my call in the order given because it is very important to them and the doctor who never answered my call but I got better anyway and the “d” in Wednesday and all other silent letters who know enough to keep quiet when they have nothing to say. And thanks, too, to my mother who finally figured out not to argue with the checker over the price of lemons and that trucks were not assassins out to get her. And to my father who played and hummed Tumbalalaika on his mandolin in a soft celebration of all things inarticulate and to Peggy with whom the air is so charged we know when not to speak.

Friday, January 15, 2010

Enlightenment 102

A word of explanation about my previous blog; I was being facetious, though not entirely; writing partly in earnest and partly as absurdist on the margins. This seems to be the hand that guides me, not by design but natural inclination. Call me amphibious, in and out of (hot)water. I want it both ways.

I might have added other phrases such as, Go with the flow or, Think outside the box. How does one live for the moment and flow at the same time? And why not think inside the box and keep expanding the box. Can't I pee from inside the tent, out rather than from outside, in?

The pokes I was making were, to my ears, what have become clich├ęs. They were not intended to be derisive of received wisdom, only the ease with which those phrases are tossed around. Ironically we have to earn what we already own.

I would argue that we already have them. I keep thinking of the John Prine song, It Don’t Make No Sense That Common Sense Don’t Make No Sense No More.

What lies undiscovered within us is often shouted down by a society that has no vocabulary to support it. We unlearn our natural good sense just as we accommodate to institutional greed and self-interest. It’s almost as if we have to realign ourselves after being thrown off course by false idols.

As for those chasing orthodoxies of one kind or another seeking alternative practices, are they not writing their own prescription as a corrective? An alpha male senses his need for quietude. Nothing wrong with that. We all seek some sort of equilibrium. An individual whose psyche is fragmented requires the rules and rituals and rigidity that fundamentalism offers. Whatever gets you through the night.

While I’m at it, I’ll also throw in (and duck) that the very word, enlightenment, bothers me a bit. It connotes a state of being set apart from our daily life. I don’t believe we need to inhale incense, wear a toga or chant and mumble to find the best in ourselves. We need only to pay attention and invest ourselves wherever we happen to be and bring our senses and our mind to bear.

It just struck me that this word, enlightenment, meant something else to 18th century people. And it ties in with common sense. The Enlightenment was the movement away from the church characterized by rational thinking. Our founders were products of the Age of Enlightenment and the single book which ignited our revolution was Common Sense by Thomas Paine. Not a bad place to begin

Tuesday, January 12, 2010

Enlightenment 101

Last week I took it one day at a time. Today I’m living in the moment; or at least I’m trying as hard as I can. There’s goes another one in the time it took to write that sentence.

It takes a great effort to erase your past. There’s so much chalk on the board. My finger is on the delete key. But maybe I’ve got it all wrong. I need my name, after all, and basic spelling to put all this down. Could it be I’m only supposed to forget selectively?

Then there is tomorrow with all its expectations and obligations…I hate to keep my barber waiting to say nothing of the dentist and who’s going to pay for my overdue library books?

I just got off the wheel of desire though at this age I have more memories than plans anyway. The only bike I have is stationary which gets me nowhere and that’s just fine. It cuts down on jet lag.

I’m living in my head only enough to stop and smell the flowers or hear the clap one hand. I do wish tulips had a fragrance and ranunculas, too. I would stop more often.

As for the absence of sound, silence is always our first language

Now I am throwing out all my attachments. I’ve put them in a white plastic bag with red tie strings upon which so much depends. I’m approaching the garbage bin with intention having consciously chosen to use an overhand toss.

Some fool has initialed his name in wet cement with intimations of immortality apparently un-mindful of his illusory state.

I’ll be going now. I’m letting go as fast as I can so I can follow my bliss. In a few minutes all that will be left of me is my nothingness.

Friday, January 8, 2010

Time For Change

I'm gonna to change my way of livin
and if that ain't enough
I'm going to change the way I strut my stuff.

Not even ten days into January and already I've broken my New Year resolutions; in fact I can't even remember them.

I wonder how change ever happens. Not the sort that turns a cucumber into a pickle. Evolution is as natural as devolution. I mean real change like the striptease of Clark Kent into Superman or the way Meryl Streep gained six inches to play Julia.

Republicans become Democrats and vice versa when someone says, "may I?" and they take a baby step across the aisle. But that doesn't count. Rarely do we witness a public figure shed anything deeper than his skin and risk leaving his cronies. Hugo Black, the liberal FDR appointed Supreme Court Justice did it when he brought his Ku Klux Klan white sheets into the laundry and walked out with the black robe of the court. Or was his racism a tumor as Woody Allen would have it?

I just remembered my broken resolutions; that I would stop losing bookmarks and slouching on the couch causing the cushion to work its way to the floor. I'm sorry. Some habits just cling to the bone.

As for altering my politics, that is off limits. I enjoy agreeing with myself.

However as Whitman put it, we do contain multitudes. Maybe there is another Georgy deep inside.

Doesn't everybody have a conversation going on with their several voices? I can hear my tired phrases drop from exhaustion even as my unbudgeable mind defends them to their death.

Six and eight are always fourteen except when the plus sign tilts and it becomes forty-eight. The new idea slips under the door unbidden to make its sweet sound or just silence that same old song.

Tuesday, January 5, 2010

How I Retired And Saved Mankind

I am the very model of a modern major pharmacist
I’m armed with information considered fundamentalist
of uses and abuses and all things memorizable
of dosages that are toxic I know what’s over-sizable.
I decipher scribbles to others quite illegible
am conversant with insurance cards often ineligible
of itches that are topical or twitches that are tropical
I know what is historical from those things just hysterical,
an alchemist, an herbalist, occasionally a sorcerist
I am the very model of a modern major pharmacist.

Ray Robinson, the prize fighter, retired dozens of times. He became famous for his comebacks, alone. Certain athletes don’t know when to stop. 35 years after DiMaggio left the game he was making more money than ever signing baseballs. Dick Cheney emerged from his undisclosed location and can’t shut up. The curtain will never go down on Angela Lansbury.

When I walked away it was because I was a menace to society.

I sold my store in 1997 to a Russian family. Within months English became a second language. Das vidania (goodbye) and spa‘sibo (thank you) didn’t get me very far. It was as if I fell to earth in Odessa in a Black Sea of ink. The whiff of old world herbs filled the store. Where I smelled Valerian, they smelled a buck. Over the next ten years, working for the new owners, the volume of prescriptions tripled. Our Russian patients made an easy transition from Communism to Medi-Cal without missing an irregular heart beat

Both Russian and the vocabulary of my profession had become foreign to my ears. Over my five decades behind the counter I had witnessed a total transmorgrification of the deliberate pharmacist who weighed everything into the fast lane assembly-line factory of today which has been hi-jacked by the insurance industry.

After reducing my hours to one day-a-week I finally retired in 2007. New medications with contraindications and side effects appeared on the shelf faster than I could count to twelve. It was my hour to leave.

There was a time when I was a good pharmacist. No, really, I was. The virtue I possessed, and possibly my only asset, was that I had learned how to listen empathetically. I heard people and they felt it. As for the essential expertise, if I didn’t know it I could find it quickly. When I couldn’t attend to my customer/patients I knew I had lost my reason for being there.

Looking back I recognize that my enthusiasm for pharmacy was never at a high level. It was always the relationships that enlivened me. At seventeen I was a man-child when I made the decision to pursue my father’s profession. Having now left it all behind I find that I am unlearning the nomenclature at a rapid rate. I lost approximately a fact-a-day so that at the end of six months I didn’t know much of anything and I think my small universe is all the better for it.

I’ve got me on the list.
The weary pharmacist
and he never will be missed
I never will be missed.

Saturday, January 2, 2010

Winter Tale

Forest Hills, where I grew up, was famous for its tennis stadium but not for its forest or its hills. The closest we got to a hill was a natural rise and dip in the terrain something like a lump in mashed potatoes. We called it the Toilet Bowl, roughly the size and shape of a football field with a rise on three sides emptying into a flat valley and an end zone that led straight into the Grand Central Parkway. 

January would have prompted my mother to urge three sweaters under a hooded mackinaw on me knowing as she did that cold wind led to chills which meant the grippe at best, or pneumonia at worst or God-forbid-twice-as-bad, the dreaded double pneumonia. Mom was a pioneer in the classification of air. She could differentiate between the ill-wind of microbe-carrying drafts and fresh air which had healing properties.

So it was that I trudged off with my Flexible Flier to meet two friends at the Toilet Bowl. They were similarly weighted down. I suggested we take the slope on my sled in our version of a triple-decker sandwich. I was on the bottom with Frankie in the middle and Stanley on top. 

Frankie was already obese at age twelve as I can testify to. Steering was like navigating through a vat of Russian dressing slobbered on what was my slice of rye bread. The flier wasn't flexible enough I misguided us smack into a bush …or was it the bush that came at us traveling around twenty miles an hour. I recall looking up at Stanley as he orbited overhead. Frankie never got air-borne but did get a souvenir splinter in his forehead. I came away with a mere bloody nose. Stanley nosed-dived into a cushion of snow. 

None of us ended up on the Grand Central Parkway or if we did the past seven decades have been an after-life. Had I been run over by a truck I expect my three sweaters might have saved me but my mother would have killed me anyway. 

After that I only went down into the Toilet Bowl on solo trips or metaphorically on some downhill days.