Monday, September 21, 2009

Hurray for the Distance Run!

What a wonderful race the Philadelphia Distance Run was this year! It was as close to a perfect half-marathon as I hope to see.

With the new wave start, I was able to run freely from the beginning. The course went right past the Liberty Bell and Independence Hall. The weather was nearly ideal­­ — I want to say high fifties and low sixties, light wind, low humidity, a big blue sky and a friendly sun. The food at the end was plentiful, varied, and good. The organizers even took the T-shirts to a new level.

Congratulations to everyone involved!

Don’t Get Sick in Florida

When my wife’s mother had a stroke in the spring of 2001, it launched our whole family on an odyssey that I hope we never have to repeat.

My wife and I and our two children were in Amsterdam on a family vacation when we got the call from her brother, Steven. Ada had had a stroke and was stable but paralyzed on her left side.

We flew home to Philadelphia, and our lives changed. Lois and Steven flew to Florida the next day, and for the next several months they shuttled back and forth, sitting at their mother’s bedside and attempting to manage the medical bureaucracy.

We learned things – things I would have preferred not to know. Both my parents had worked in medicine. They taught me at a young age that medicine has a curing function and a caring function. We found both to be in short supply in Florida.

Let’s take curing first.

Ada had gone to the doctor the day she had her stroke. She complained of numbness and an inability to move several of her left toes. Her doctor knew that she had had a previous stroke several years before, from which she had made a good recovery. He told her she had “nerve damage,” suggested she get a cane, and told her to make an appointment with a neurologist. So she went home and had the stroke.

That’s only the beginning. When Ada had her stroke, she fell and broke her left hip. The fracture was not diagnosed for two weeks.

Here’s the best construction I can put on this. It seems the initial fracture was a subtle hairline. It’s possible to miss such things.

After two days in the hospital, Ada was discharged to a rehabilitation center where she had physical therapy every day. The therapy involved her standing – in great pain – on her broken leg, which in the ordinary course of events would tend to make the fracture larger. Eventually a nurse, who I think had had enough, pointed to the way Ada’s leg was lying on the bed, and said that she had a fracture. The diagnosis was confirmed on X ray, and Ada got her hip pinned.

Now to the caring function. At the rehab center the nurses were, with a few exceptions, surly, uncommunicative, and unresponsive. The meds nurse – the one who dispensed medication – had apparently never heard of breakthrough pain. The nurse’s aides, again with a few exceptions, were surly, uncommunicative, and unresponsive. One of the exceptions, a lovely, caring woman, wound up taking a job in the county highway department because the pay was so much better.

Overall, though, the nurse’s aides were so unresponsive that my mother-in-law gave up trying to go to the bathroom. Even with my wife there, it took up to forty minutes to get an aide to answer a ring. Ada started wearing diapers. She wasn’t incontinent, but the staff made her act as if she were.

Eventually she was well enough to leave the rehab center, and we considered bringing her north. It hadn’t really been an option up to that point.

Ada still wasn’t in great shape, but she had lived in Florida for nearly 20 years, and she wanted to stay with her friends. We thought it might be okay.

She moved to an assisted living facility in Florida, and it was okay for a little bit. Then things started to go wrong. She developed acute pain in her left leg. Nobody (including an internist, an orthopedic surgeon, and a neurologist) knew what it was. An aide accused her of faking it. (There’s an ongoing theme that she was considered a “complainer.”) We added a geriatric case manager, and then we added a private-duty aide, a lovely, caring woman.

Finally Ada was readmitted to the hospital. The pain in her leg was caused by a blood clot – phlebitis, a condition which is life threatening.

The doctor at the hospital prescribed a blood thinner. Then Lois reminded her that Ada’s stroke had been caused by a bleeding blood vessel in the brain, and suggested that, in view of this patient’s history, a blood thinner might be contraindicated. Exit blood thinner.

The hospital also ran a chest X ray, and Ada had some huge tumors in her lungs. They hadn’t been seen on prior X rays – one taken when she had the stroke, and one a few months later.

We ordered up an air ambulance and moved her north, to a nursing home just outside Philadelphia, so she could be near her family at the end. A week later, and about seven months after her stroke, she was dead.

This ending was inevitable. What was not inevitable was the amount of suffering and humiliation she endured for seven months because of slipshod medical and nursing care.

People suggested that we sue for malpractice – and, of course, that brass ring of litigation, the award for pain and suffering. We were disinclined to do it because we didn’t think her pain was fungible – it couldn’t be converted to money. And I don’t believe that suing people causes them to improve their behavior – it simply causes them to improve their defenses.

I don’t have any answers. But I do know this. We need some.

Monday, September 14, 2009

What the Greeks Knew

Recently I was rereading the plays that Sophocles wrote about Oedipus and his family, and it struck me: This whole mess got started with a traffic dispute.

One day Oedipus was tooling down what passed for a highway in ancient Greece, and he found his way blocked by a man in a chariot who, with the help of his servants, tried to force Oedipus off the road. The charioteer may not have been entirely the pompous ass that we may think. After all, the road was probably a narrow one-lane dirt track, and it appears that Oedipus was on foot, so it would have been easy enough for him to stand aside, much as I do when I'm commuting to work and an 18-wheeler decides to change lanes.

This, however, was ancient Greece, where there were no rules of the road and, frankly, not a whole lot of common sense. So words came to blows, and Oedipus killed the charioteer (who, unbeknownst to him, was his biological father), as well as an indeterminate number of servants (Oedipus originally thinks he did them all, but apparently one escaped to tell the tale, in which Oedipus is not one man but a large band of robbers — yet another testimony to the untrustworthiness of eyewitnesses).

And so the whole sorry machine of multigenerational tragedy is set in motion, with Oedipus marrying his mother and putting his eyes out, and his two sons killing one another on the battlefield in front of Thebes in a dispute over who should be running things, and his daughter Antigone (who is also his sister) getting sentenced to death for trying to bury one of the brothers who lay dead on the battlefield.

And that's the short version. I'm very happy we have traffic lights and yield signs.

And yet anybody who drives knows that savagery of Greek proportions is never very far away from us. We are human, as they were, and we are given to fits of anger, irrational over-response (escalation, we called it, back during the Vietnam war), and masterful, ingenious self-justification.

Which brings me to the point of this little essay­­ — the issue of gun control. I have some opinions about the Second Amendment to the Constitution, which I'll get to in a minute, but I do think there's a deeper issue here — human nature, and what we humans need to do to live together in peace.

Do we really want everybody to be walking around with a loaded pistol? The argument is put out that an armed society is a polite society. I'd like to see the historical evidence for that. (The situation in Iraq might make a good counterexample.) There also seems to be an unexamined assumption that law-abiding citizens will use their guns appropriately, unlike the criminals who of course have limited impulse control, are highly suggestible, and are given to fits of irrational rage.

Come to think of it, how many American motorists have I just described? So maybe we shouldn't put the guns in our cars; maybe we should just keep them in the house, for home defense. And when, while celebrating Halloween, your wife screams in terror that a goblin is at the door menacing her, are you going to get your gun out of the closet? Okay. And when the goblin keeps gesticulating because he thinks he's going to a party at your house, when the party is actually at an identical house two doors down, what are you going to do? Maybe it would have been simpler to call 911.

The Supreme Court has ruled that there is an individual right to bear arms. Whatever the legal merits of this decision, it is clearly a travesty for those who care about language or history. Still, I don't feel like refighting that battle. What I'd rather do is look at the first part of the Second Amendment, which states, "A well-regulated militia, being necessary to the security of a Free State ..."

This part of the amendment tells us something important about the world in which the Framers lived. In colonial days — Massachusetts may be the purest example — every able-bodied man was automatically in the militia and could be called to active duty at any time. The French call it levĂ©e en masse, or the nation in arms. Over the last several centuries America has moved away from the concept of universal military service, most recently by abolishing the draft.

Without the draft, I suppose we are all in that great unorganized reserve that will surely rise up to fight any foreign invader, however ineffectively. If we don't believe some fiction like that, are we not ignoring the original intent of the Framers?

So let's look at the term "well-regulated." We may not call people to active duty, but do we not, under the Second Amendment, still have a duty to train people in the use of firearms — and the consequences of their use?

As part of that training, I think people should be required to go to a big-city emergency room on a Saturday night. Just about any Saturday night will do. Stay until the bars close, and watch the gunshot victims get wheeled in — including the "unresponsive patients," aka the dead. People need to know in vivid terms what pulling a trigger is all about.

Thursday, September 3, 2009

Politics in the Rain

I wrote this back in the spring, shortly after the primary elections in Philadelphia.

On the morning of Sunday, May 3, I was standing on the Marine Parade Ground in Philadelphia’s old Navy Yard. It was raining.

I was handing out political flyers for Michael Turner, who was running for District Attorney. The recipients were among the 23,000 runners who had just completed the Broad Street Run, a ten-miler that starts in the northern part of the city, at Central High School, and runs pretty much in a straight, flat line south on Broad Street, scooting around City Hall about halfway, and finishing in the Navy Yard.

It’s a great race. I’ve run it a bunch of times, and it’s always been a thrill.

After about an hour, I was quite thoroughly wet, and I started to wonder why I was there. I could be at home, dry, eating a nice breakfast cooked by my wife (she likes to do that on weekends), and reading the Sunday paper. I didn’t stay with that thought very long, because right underneath it was what I really wanted to be doing. I wanted to be running the race.

Every time I talked to a runner, this feeling got stronger. I’d approach them as they were crossing the parade ground to go back to their cars, or the subway. They’d already had the chance to eat a little something and recover a bit, but they were still in that marvelous afterglow that lasts until the leg muscles start to stiffen. I’d congratulate them on their run, and be rewarded with the most beatific smiles. Then I’d talk to them a bit about Michael. They didn’t mind the switch. Quite a few of them thanked me for coming out and offering the information. And then they’d be off, some of them already starting to limp, and I’d be on to the next runner.

Afterwards I took the subway to my home stop at Broad and South, and as I came up from the rabbit hole I found myself looking at the Arts Bank. It’s a small, very nice performance space in an old bank building. And I remembered the Russians. A few years ago I had been in almost the same spot when a young man handed me a flyer. It was for a performance later that day at the Arts Bank by a troupe of Russian circus artists.

My wife and daughter and I weren’t doing anything else, so we went. The Russians were quite good, and we were a large part of the audience. As I recall, there were more performers than spectators.

Sometimes flyers aren’t enough. On Tuesday, May 19, they weren’t enough. Not only did Michael Turner lose, but the election came close to setting a new record for low turnout in Philadelphia.

Think of it. There are 1.1 million registered voters in Philadelphia. Nearly 900,000 of them are Democrats. The winner in the Democratic primary attracted a little more than 40,000 votes. (There is a general election in November, but it is widely considered to be a formality.)

This is not my idea of majority rule.

My wife and I volunteered on the Obama campaign. We registered voters, made phone calls, handed out flyers, made buttons. And we put up campaign workers in our home. One of them, whom I came to call The Mighty Quinn (not his real name), showed up after the primary, but months before the general election. I have never seen anybody, including my daughter, use a cell phone more.

I had no idea what he was doing, but my wife employed the expedient of conversation and soon knew what was going on. As she put it, “They’re identifying every vote in Pennsylvania, and then figuring out how to get it.”

The Obama campaign has come to be known for its novelties – the use of the Internet for fund raising, the enormous crowds that appeared, seemingly at the drop of a hat. But the real secret was they did it all – from mass communication on TV through one-on-one community organizing. And they were very methodical.

I have two thoughts about all this. First, the Obama people are a lot smarter and tougher than I realized during the presidential campaign. Second, the rest of us have a lot of catching up to do.