iPhone Psyche

vitruvian_man-001Word is out that I’ve joined the twenty-first century.  It only took about three months of regular visits to the Apple Store, playing with the button and screen, enduring enthusiastic techies, being sneered at for wanting an iPhone 5 just two weeks before the 5S came out (not everyone is compelled to be an early adaptor) and then sneered at again for supposing a 5S would be in stock just two weeks after it was launched. Finally, I just ordered a 5S through Verizon.

When the device arrived I took the box, unopened, to the Verizon store, set it on the counter, and placed my ancient flip phone next to it. “I’m here,” I pointed to the flip, “and I want to get here,” I pointed to the 5S. The young man of negligible beard spent ten minutes performing elaborate feats of syncing and then gave me ten minutes of rudimentary instruction.  I walked out of the store and made my first call to my son, who was pretty surprised I actually made the jump.

Over the last few weeks I’ve learned how to check email, make calls, text, surf the web, take photos, add apps, and even use a few.  Several people have commented that my fresh voice message leaves out my signature warning “Do not leave a text.”  I now accept texts, and all other forms of newfangled communication.

My progress is erratic. My calendar and contacts sync perfectly from iPhone to laptop, but I have a slew of photos lost in the cloud with no idea how to anchor them.  I poke at different parts of the screen but can’t seem to find the sequence that will parachute them to my home computer. Eventually I’ll nag a savvy friend to give me a lesson, which will prove embarrassing because it will be so darn simple, once you know how.

I’ve been having fun with my new toy but it didn’t seem part of me until last night.  I had my first iPhone dream. Like all my dreams it was a hodgepodge of reality and fantasy, present and past.  My iPhone was not working, and everything I needed to navigate my life was nested in that slender container.  Luckily, my former brother-in-law Ross was on hand.  Forget that he lives in California and I’ve seen him exactly twice in twenty years; it’s a dream.

Ross is very mechanical. But like most handy men he’s more enthralled with dissection and reconstruction than consistent operation.  An array of tiny tools appears, like at the dentist’s, and Ross begins to pick apart my iPhone’s elegant case. In short order the back is here, the glass front there, and the insides are revealed. Microscopic thin slivers of metallic paper, thousands and thousands of them, so light they rise out of my iPhone and flutter like ash around the room.  Each is inscribed with a web page, a personal contact, or an email thread. I gaze, mesmerized, at the shiny swirls. Finally, I get to see the physical Internet I always knew, somehow, had to support the nonsense of virtual clouds. Its substance was ephemeral, but nonetheless real.

Suddenly I snapped out of my reverie.  “Hey, that’s my life, rising out of that tiny metal case. If it all ascends on thin air, what will be left of me?”

I roused in my sleep, shifted my weight, and resettled into slumber.  In the morning my iPhone was on the bureau, intact. I don’t have the slightest idea what’s actually inside of it. But whatever it is, it’s now an integral part of me.

iPhone 5S

Opening up my inner life.

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The Day JFK was Shot

usa-001Every one of us who was alive that day recalls the moment we learned that President Kennedy was shot.  No matter how ordinary, the instant is fixed in our mind and enshrined with significance.

I was a chubby eight-year-old boy walking home from school when Mrs. Guy passed in the opposite direction, crying. She wore a heavy black coat and her grey hair was out of bob. Tears nested in her cheek creases.

I always thought Mrs. Guy was terribly mean. She’d never really talked to me. She would come out of her house and yell at us to get off her lawn if our ball bounded into her bushes. And she would open her front door brusquely and snarl “No” if I rang her bell trying to sell chocolate bars for our Catholic school.

Selling chocolate bars was the trial of my youth.  The nuns deposited a carton of twelve fat ingots on our desks and warned of dire consequences should we fail to return with $12 on Monday morning.  But how could I, so small and shy, sell a dozen chocolate bars. My three older siblings had similar cartons to sell, and every other house on the street was full of kids from the same school.  Supply was abundant; demand negligible

I grew up on a street of seventeen identical houses. Cramped, 1950’s split levels around the corner from Saint Joseph’s Church. Every household was the same: a handsome father invigorated by war and enriched by a low-interest G.I. mortgage, an exhausted stay-at-home mom, and a crop of kids. That is, every house except for the Guy’s.  The Guys were older and childless. They had a manicured lawn and kept their shades down. They were different from the rest of us.

“The President was just shot.” She looked past me, just as she did when she refused my chocolate bars. But the contempt in her eyes, disdain I’d always attributed to Mrs. Guy lacking a chocolate peddler of her own, disintegrated into blank despair. All my past fears of Mrs. Guy were eclipsed by a new reality. As the messenger of national tragedy, she was truly scary. I gaped at her, unaccustomed to adult crying. I understood the literal meaning of her words. But I also intuited their ramifications; that the world was so much bigger and more dangerous than the children on my short street had ever considered. I knew that stray balls and chocolate bars shouldn’t come between us now; we had bigger problems and we ought to hang together.

I quickened my step and hurried home. My father sat before the television.  For days, all we did was watch TV. LBJ’s swearing in, Ruby shooting Oswald, that elegant funeral march to Arlington Cemetery. Everybody cried.  I got used to adult tears; even my father’s. It was the only time in my life I ever saw him cry.

A few weeks later we groused out of continuous mourning. Somehow, my father finagled the former President’s official portrait that hung in our post office after Johnson’s headshot went up in its stead. He hung the huge framed photograph at the bottom of the stairs. Over the next twenty years, as we children grew up and my parents moved a dozen times; as my mother embraced women’s lib and a paying job while my father’s alcohol became his best friend, the great constant of my family was this larger than life size image of John F. Kennedy, the first Irish-American Catholic President. JFK greeted me every time I came home. We reveled in the thousand days of his brief, shining Camelot. We wished that his eternal presence would keep his hope alive after Dallas. But his image alone could not sustain us. We children scattered and my parents divorced and the giant photograph got lost amid so many other dreams.

Mrs. Guy never yelled at me again when my ball landed in her bushes. I never tried to sell her chocolate. After we passed one another at that singular moment when the world shifted, the distant old lady and the fretful boy rose above petty interactions. We exchanged few words, but when we spoke, we were quiet and respectful.

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The Portrait that lived in our house.

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Seek

awkward_pose_3-001After practicing Bikram yoga for four years, I’ve had the new age aspects of yoga pretty much drummed out of me.  Bikram strives to be scientific rather than mystical.  During the non-stop ninety-minute dialogue, one word never uttered is Namaste. But I’m taking a break from Bikram’s grueling rigor and enjoying a more diverse, lighter form of yoga, CorePower.

CorePower has four different flavors of classes, and after Bikram’s militant uniformity, I enjoy the variety.  Still, all CorePower classes follow a format that includes beginning intentions and ending meditation. I’d rather attempt crow pose than bother with intentions, but there they are, in every class. In time I found myself conjuring a name to fill the void. I started sending energy to my children, an ill friend, a laid off coworker.  Then I started to think about me, anxieties I suffered, challenges I faced. Before I knew it I was recalling my intention during class and discovered it gave me a boost of energy or another level of meaning. Uh oh, I’m feeling new agy.

The obvious evolution of all this intention setting is to invoke a mantra.  I know a bit about mantras; I’ve done enough mediation to try on a few.  Peace, Om, calm; the usual suspects.  I repeated them over and over until I forgot I was saying them.  They might have helped me resonate good karma but they didn’t resonate with me

Mantras are ancient Sanskrit phrases used to focus and induce unity of body and mind.  They’re Hindu in origin, but have crossed into Buddhism and are central to the more meditative forms of yoga. The kind of yoga I don’t much do.

Still, since intentions elevated my practice, I opened my mind to mantra’s possibilities. But I wanted one that was mine. I wanted a single word, short, maybe percussive, that represented why I do yoga, and everything else in life for that matter. I let different options drift through my head during practice. Hope. Content. Open. None seemed quite right.  Then I remembered the profile test I took during my Psychology of Happiness seminar.  My number one motivator in life: curiosity.  Curiosity would be a lousy mantra; too many syllables. Curious isn’t much better. That word carries oddball associations with a particular childhood monkey.

Then, as always happens when you let something roll around your mind long enough, my mantra came to me.  Seek. It’s simple, declarative, fitting. It’s the closest four-letter word I can find that describes what gets me out of bed in the morning. I’ve been using it for a couple of weeks now.  I like it.  Sometimes I still offer an intention to family or friends.  But if there are no pressing issues to focus my practice, I seek. I’ve always found that to be the best way to find whatever I’m looking for.

 

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Losing My Mind – Part One

vitruvian_man-001It’s taken me two years to actually write this post. That’s when I first realized my mind is slipping away and it would be a good idea to document what I still know. Which, by omission, will chronicle what I’ve lost.

According to the Alzheimer’s Association website, I have no risk factors to suffer dementia; no genetic predisposition, none of the physical or mental traits linked to the condition. Still, our health transcends physical science, and intuition tells me that, unless an accident trips me up sooner, I am going to be done in by my mind.

Why do I make such a preposterous claim?

First, I know my body’s weaknesses.  Most of my physical systems are in good shape: circulation, muscles, spine, respiratory, digestive, endocrine, lymphatic; all fine. But my neurological system has been faulty from the start.  I’ve had random chest palpitations, nervous twitches, and numb extremities for most of my life. My one and only MRI displayed an asymmetrical spinal chord rubbing perilously close to my vertebrae. The radiologist whistled and said, “Whoa, you’re going to have all kinds of weirdness with that.” Thanks, doc.

Second, my brain is too busy to remain healthy as long as the rest of me.  It goes all the time. It obsesses, it digresses, it offers up vibrant dreams while I sleep and instead of seeking serenity when I practice yoga or ride my bike, it rifles through exhaustive, arbitrary connections. My brain is so frickin’ busy it’s bound to wear out before the rest of me. So many people have noted that I live in my head; there will be a certain justice if I die in it as well. At least, that’s what I think.

Third, I believe dementia will be my demise because it’s already creeping into my life.  Sure, I have the minor cranial annoyances that come with age.  I have to make lists to remember things; there is no more space in my brain for new songs to root, no matter how catchy the tune; and I confuse my children’s names, which is pathetic since I have only two.  Everyone in their fifties suffers these petty embarrassments.

But I’ve encountered some more sinister problems.  Like time lapses.  I am walking along the street, or perhaps riding my bike, and a brain pulse identifies my surrounding as completely new. I catch myself, reorient, and realize that some period of time has failed to register.  I was there, and now I’m here, but I have no link between the two. I lost the continuity that marks how we move through space.

So far I’ve never suffered a gap in time while driving, which would be dangerous, or long enough that I fall off my bike or a curb.  But I do slow down.  Sometimes, when I recover my sense of place I am standing still without any idea how long I’ve been standing there.

Although these experiences are exactly the opposite of being ‘in the moment’ they have a similarly mystical quality.  Since my time lapses began two years ago they don’t seem to increase in frequency, though they occur often enough that now, when they happen, I make note without too much wonder.

Last week my brain deterioration took a new twist when I hit an unprecedented low in name recall. At a fund raising dinner, my table host’s name was a complete blank. I’ve known her for years. I remembered all sorts of peripheral stuff about her; her job, her partner where she lived, committees we’d worked on together.  I knew everything I needed to know – except her name. I did fine with the names of new people at the table and visitors who came up to chat, but during every conversation my active mind was running a background search for her name to no avail. We’ve all suffered this awkward experience before, dancing around a misplaced memory. But I’d never had it so bad for so long.  For a full hour I racked my brain to no avail.  Finally, thankfully, in time for a proper goodbye, her name popped into my head.  Joanne. Simple as that.

What will I forget next time? How long will it take me to retrieve it? When I call some name to the fore, will I have any confidence in what my memory serves?

This post is titled Losing My Mind – Part One, because I expect there will be others.  I will try to document my slipping away as a strategy to hold on to everything I still have. Let’s hope that takes a long, long time.

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A Final Haitian Exchange

haiti-001The Hotel Olaffson was distinctly less magical on the morning of the Day of the Dead. I got up shortly after seven to dress and pack; we had to leave for the airport by eight.  I decided to replenish our room’s water, so trundled our carafe up the concrete stairs, sticky with last night’s beer, and found the single old waiter on the breakfast shift.

“No l’eau.” He shook his head at the sight of my pitcher. “L’eau for sale,” grand ou small.” He used an odd collection of French and English. I shadowed him to the bar’s refrigerator where he extracted a few bottled waters. “Two dollars for small, ten dollars for grand.” His prices were off both in scale and proportion.

“No.” I shook my head and displayed two bills.  “These are U.S. dollars – one dollar for small, two dollars for large.” I offered at least twice the going rate, but I was thirsty and the morning after effects of the place dampened my spirit.

“No, no.” His voice rose way too loud.  “Two dollars for small; in Haitian is 15 Goudes.”

Exactly, I thought, knowing 15 Goudes equals 36 cents.  The man’s face trembled a bit; he was past his prime for the kind of verbal assault Haitians relish flinging at each other, but he was trying his darndest. I sighed, decided against a math lesson on currency exchange, and turned on my heels with an empty carafe.

Jonathan and Francky were just rousing so I returned to the veranda for a bite of continental breakfast.  The Hotel Olaffson is not a Holiday Inn Express; there is no waffle maker, but there were some breads and jams laid out with coffee and milk. I sat at a table and surveyed Halloween’s aftermath.  To my right a stocky American asked a black guy with dreads whether he could find a place that made coffins by hand. “I don’t want to see the manufactured kind.” The local nodded, sure. The American continued. “Great, but we have to do it before my appointment with the Ambassador.” On my left a guy in black jeans and Harley T-shirt piped up, “Why aren’t you at the cemetery, its Day of the Dead?” “I have to fly out this morning,” I replied. “Why aren’t you there?” “I only go where people can pay me to drive; no one at the cemetery has any money.” It was too early for me to structure any response to that. He stood up, brushed his hands on his thighs and sighed at my ineptitude. “No one respects the Day of the Dead like they used to.”

My nemesis the waiter saved me from having to examine that comment in any depth.  He arrived at my table with a bottle of water. “Gratis.” He placed it in the center. I nodded thanks.  When I finished breakfast I set a dollar under my plate for him.

The waiter and I had run the full circle of a perfect Haitian interaction. We’d each staked a position, drew a little heat, and then reached d’accord that pleased us both. Now, it was time for me to go home.

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Tap Tap Sculpture at the Hotel Olaffson

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Graham Greene Slept Here…Me, Not so Much

haiti-001In the 1960’s, Al Seitz struggled to maintain at least one guest in residence at Port-au-Prince’s Hotel Olaffson to ward off Papa Doc Duvalier from appropriating the most famous watering hole in the Caribbean. That still didn’t curb the Brooklyn native from giving random tourists a quick once over and banishing any in white shoes and matching belts with a curt, “You wouldn’t like it here”.  He managed to host enough misfits in the turn of the century mansion – originally built to house one of Haiti’s revolving door presidents – to evade the dictator.  Several of his hearty guests populate Graham Greene’s hysterically inappropriate novel, The Comedians, which extracts humor from Papa Doc’s terror as well as the dead bodies floating in the hotel’s swimming pool.

In better days John Barrymore lounged on the bric-a-brac veranda sipping rum punch and enjoying the upstairs corner room so often that Captain Olaffson, the Norwegian who bought the hotel from the departing US Marines in 1934, named the best room after him. The marines had used the plantation style mansion as a hospital, but Olaffason recrafted their pool table into a bar and welcomed expat artists, intellectuals, and eclectics throughout the mid-twentieth century. Why a military hospital was furnished with such a lavish pool table to begin with is not clear, but like all mysteries of Haiti, its charm trumps its rationale.

The Duvalier’s never appropriated the unique property, but their regime eventually ground Hotel Olaffson to destitution, as it did everything in Haiti. In 1986 the Olaffson closed. All the wicker furniture was carted away and locals whose memories recalled gentler times pulled the nameplates of John Barrymore, Graham Greene and other famous guests, off their doors.

Through pluck and fancy Richard Morse and Blair Townsend, a pair of American Princeton grads, bought the place in 1988 and refurbished it to its former funkiness. The youthful, bushy-haired Richard, smiling from a faded New York Times article heralding the hotel’s rebirth that is plastered next to the check-in desk, still owns the place; although now his grey ponytailed mane and faded jean slouch conjures a zeitgeist of aging hippie more than 80’s entrepreneur.

Last night, Halloween, I had the privilege to be Richard’s guest, along with hundreds of other expats and a smattering of hip Haitians. Plane schedules and transportation between Grand Goave and Port-au-Prince all conspired that I should join Jonathan, Lauren, and Zakiyyah; Be Like Brit’s director and his two Tulane interns, on their overnight junket to celebrate Halloween at the Olaffson.  When we arrived mid-afternoon I was pleased how much the place looked and felt like Graham Greene’s rendering. The welded metal Day of the Dead sculptures, mechanical zombies rising out of coffins and multi-armed babies, meshed perfectly with the hotel’s flowering shrubs, palm trees, curved walks, erratic stairs and angled structures; a haphazard respite from Port-au-Prince’s dust.

Francky, BLB’s driver, took the girls further up hill for a spa afternoon at the newer, ritzier Caribe, while Jonathan and I loitered along the Olaffson’s veranda enjoying chicken, pommes frites and plantains; Prestige beer and rum and coke. We weren’t lucky enough to land the Graham Greene cottage or John Barrymore suite, but Jonathan assured me our remote cottage would be distant from late night music.

Wrong. Halloween is a big day at the Hotel Olaffson and the entire compound was reordered for the event.  The pool was covered with a platform set with tables under a tent; I’ll never know if the bodies are still there. The patio was the dance floor and a stage was set up beyond. Our supposedly remote room sat at ground zero of the night’s festivities.  When Jonathan and I retired for a pre-party rest around 6 p.m. the band ran a practice set. Even inside our room, we had to shout over the sound.

Sleep is overrated when an experience looms, and observing the Olaffson’s Halloween crowd streaming in from nine ‘til midnight was worth the deprivation. Privacy-seeking screen actors and Beat Generation writers stalking exotic locales have been replaced by NGO disciples: skinny, slightly disheveled hipsters alternating a cigarette or Prestige in one hand and faux hugging each other with the other. The guys all have beards and carefully unkempt hair. They wear too short oxford cloth shirts that hang ambiguously over frumpy-butt jeans.  The women’s hair hangs long and loose.  When their free hand cannot find someone to hug, they grab the mass, bun it to the top of their heads and sigh with relief for their cool neck.  They wear sheer dresses of every conceivable cut and pattern, with the single commonality that every style tucks under their shapely asses.

We found a table on the edge of the action. Francky, not Grand Goave’s most energetic evangelical to begin with, had the time of his life.  He’d never seen so many blan, or tightly sheathed Haitian women in stilettos.  Jonathan and I enjoyed his unsubtle gaping; his eyes, head, sometimes even his tongue followed the women’s backsides across the patio.  When he couldn’t sit as passive observer any longer he struck off on his own.  Half an hour later Jonathan and I found him sitting along the patio wall, arms raised high to the beat, mesmerized by a shapely black form in tiny cut offs in a twerking frenzy.  We let Francky find out for himself, much later, that the twerker was a guy in drag.

Around midnight Richard Morse took the stage with his band RAM, a ten-piece ensemble with three flowing black voodoo songstresses, a trio of horns, and the usual assortment of drums, keyboard, guitar and bass.  The men wore black pants and skeleton T-shirts; Richard added a topcoat and high hat.  The local crowd swayed in succinct rhythm and mouthed the choruses of the Kreyol tunes set to loud, bluesy rock. The white folks danced with greater energy but less effect.  A quartet of gay guys in pleated pants and impeccable silk shirts claimed their own corner, while the lone Asian woman, a perky girl in a perfect orange shirtwaist dress, smiled and danced too wholesomely.

Around one I drifted up to sit on the wall near the base of the veranda to enjoy the view of the grounds, the band, the dancing throng, the Day of the Dead table littered with candles; food and wine beckoning our ancestors to rise up and nourish on our tribute to them. The serious dancers hoofed this far out; people who wanted space to work off a partner and display their moves. Sitting alone, buxom ladies in skirts so tight they must have dressed before they showered came on to me. I smiled at their attentions but preferred to turn in alone. I returned to our room, where the music was just as loud, percussive and persuasive.

I showered, crawled beneath the spread, clamped one pillow under my head and one pillow over. When the music turned into dream I cannot say, nor can I discern whether the hours of noisy cleanup entered a conscious or slumbering brain.  All I know is I rose refreshed.  I can’t imagine it was from sleep.  I attribute it to the good spirits of the place: to Graham Greene’s prose, to John Barrymore’s artistry, to the spirits nourished by our Day of the Dead celebration, and to Richard Morse’s reinventing the Hotel Olaffson for us twenty-first century oddballs who come Haiti’s way.

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Hotel Olaffson, Port-au-Prince, Haiti

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Day of the Dead Statuary

 

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Return to Haiti

haiti-001The flight from Boston to Miami was uneventful. I had my usual exit row window seat, 18F.  Next to me was a geeky young blond guy who nodded in greeting before donning headphones for the duration.

I boarded the flight to Port-au-Prince early; after so many trips here I’ve earned Priority Access. I settled into my same exit row seat.  A stocky guy with a trio of small bags dumped his stuff onto the middle seat and pointed to his boarding pass. I tried to explain the difference between seats D and E.  I suggested he use the overhead for some of his belongings, which prompted him to stand in the aisle and repack everything. An even bigger guy bumped behind him.  They jabbed their boarding passes at one another until deciding the bigger guy would take the middle. More housekeeping ensued as stuff got tossed in the aisle seat and the overhead with no apparent logic.

My neighbor settled in with a smile, a firm handshake and a litany of questions.  He seemed disappointed it was not my first trip to Haiti, he wanted to guide me into his native land, but accepted my seasoned traveller status when I explained my involvement with the orphanage and school in Grand Goave.  The guy builds tennis courts in Fort Lauderdale and returns to Haiti every month to visit his wife and young children.

The flight attendant stopped by to quiz us on the operation of the emergency door.  I half listened and nodded understanding.  But my neighbor engaged her. “ I can open that door but we will not have to, we will have no problems on this trip.”  She smiled, bemused, and moved on.  He turned to me and whispered, “Nothing can go wrong with you on the plane. God will watch over and bless us because of your good work.”

Before we are even off the ground in Miami Haiti’s chaos and magic shine through.

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Seeking a Relationship / Settling for a Transaction

usa-001I had my annual physical this week and am happy to report that my health is fine, as usual.  I’ve had the same doctor for twenty years. Marcus Welby has nothing on Mark Bauer, M.D. my internist at Harvard Vanguard. Dr. Bauer is conscientious, knowledgeable and compassionate.  Over time, our relationship has evolved in subtle ways.  At the start I trusted him intuitively, now I trust him empirically since we have a twenty-year history of excellent care.  In the early days he made notes as we talked, now he enters information on the computer, but either way he pays more attention to me than to his data entry.  He is more cautious about ordering tests than he used to be; Harvard Vanguard has clamped down as a cost savings measure.  But none of these changes have significantly altered my care. I have few medical challenges, but when I do Dr. Bauer responds immediately and I don’t second-guess his advice.  There is no need to – he knows me and has my best interests at heart.

I’ve been attending the Northeastern University Open Classroom this semester, ‘Policy for a Healthy America’.  The speakers are all informative, but last week’s session, “Is There a Doctor in the House, Maybe Not, but will it Matter?” helped me understand the conflicting dynamics of our healthcare system in a new, comprehensive light.  Tim Hoff discussed the demographics of our healthcare providers – not enough doctors, many retiring soon, not enough primary care docs, too many specialists, more demand for providers, more demands on providers, and high levels of job dissatisfaction among doctors, nurses, and pretty much everyone else in healthcare.  These folks may be well paid, but they are very unhappy.

Some aspects of our evolving healthcare landscape will improve this situation – more doctors are opting to be employees at the same time that integrated care and bundled payments make private practice increasingly irrelevant.  Some aspects of the healthcare landscape will exasperate the situation – medical schools’ focus on tertiary, specialized care are not providing the number or type of clinicians we need. Medical care will become increasingly centralized and team-based as fewer doctors are responsible for more patients, and nurses, PA’s nurse practitioners, and Medical Assistants pick up more and more direct care.

How this will play out is not entirely clear, but one thing is certain.  The relationship I have with Dr. Bauer will become history.  Except for the rich who pay for concierge care, our future will not include a personal relationship with our doctor; we may not have any single person who understands our health from ongoing face-to-face experience.

This is really no surprise; it’s the logical extension of so many other aspects of our lives.  The family farm has given way to corporate agriculture; the neighborhood grocer has become Super Stop’n’Shop, the hardware store has become Home Depot, even the neighborhood newspaper boy, of which I was one, has morphed into a faceless adult who tosses the papers from his car before dawn. This transition is more difficult in healthcare since our health is an intimate concern. But the change is underway and it’s bigger than the Affordable Care Act or fewer private practices or shuttered community hospitals or the dichotomies between our massively expensive private healthcare and meager public health initiatives.

Healthcare evolved from a vocation to a profession, and now it’s a business.  It was based in relationships, but in the future it will be based on transactions.  Ideally each individual’s future health will reside in a comprehensive record that will allow all manner of generalists and specialists to accurately and efficiently assess our needs and then diagnosis, prescribe, and treat accordingly.  The dystopian view is willy-nilly data files with inadequate safeguards and little coordination that put us at the mercy of people making life-threatening decisions based on incomplete information.  Most likely each scenario will play out.  Well-educated and informed individuals will learn how to champion their own needs, while the poor and disenfranchised will get lost in the morass. Healthcare will no longer pair doctors with patients; we will be providers and consumers. Astute consumers will enjoy their choice and influence; passive consumers will live – or die – with what comes their way.

The Agency for Healthcare Research and Quality has determined that 64 million annual physicals at a cost of $7 billion are not cost-effective healthcare experiences.  The study is probably correct; my annual physicals never turn up much of anything.  But Dr. Bauer and Harvard Vanguard are bucking this study; I am still eligible for an annual physical. I accept that at some point in the future it will become a luxury I either do without or pay for out of pocket.  I value my relationship with Dr. Bauer and am sorry that my children will likely not enjoy such a trusting intimate relationship with their doctor.  But I am realistic in accepting that healthcare’s evolving business model is not Dr. Bauer’s doing or Harvard Vanguards or mine; it is the collective result of a society that puts undue value on economic cost until we’ve lost something valuable that cannot be economically measured. People bemoan dead downtowns even as they choose to shop at Wal-Mart. We pine for a life of meaningful relationships, but time and again, if there are a few bucks to be saved, we opt for a transaction instead and then wonder why we feel unsatisfied.

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The Pergola

vitruvian_man-001My neighbors use their back yard a lot; they have barbeques, they play games. I enjoy hearing their outdoor antics. This summer they built a pergola in the far corner of their lawn. Construction workers buzzed happy saws for a week erecting the folly. I expected that once finished they would spend even more time in their yard.  But they did not.  Instead, upon finishing their playful structure their house went quiet.

It’s a two-family house, a style common to Cambridge, and their family is quintessentially Cambridge. Ilsa is a near-retirement social worker with a lingering Eastern European accent. She lives upstairs with her younger daughter, who recently finished her own Master’s in Social Work and her daughter’s Haitian boyfriend. Ilsa’s son Sam lives downstairs with his Asian wife and their two tall and thin daughters.

I wondered about the quiet, but we are urban neighbors, which means we keep a respectful distance. One evening in late July I met Ilsa while gardening. Before I could even congratulate her on the pergola I realized something was not right.  Ilsa asked rapid questions about dampproofing and mold remediation and other unsavory aspects of construction she thought I, as an architect, might know. Finally she revealed that Sam’s oldest daughter had been diagnosed with leukemia, was in Boston Children’s Hospital on an experimental protocol, would be home within a month, but needed to return to a highly antiseptic environment.

Construction noise resumed, but there was nothing cheerful about the masonry drills and drainage pumps, vapor barriers and mechanical systems they installed to turn their creaky old house into a dust-free / low humidity environment for the fragile girl.  The work is complete, Sam’s daughter is home, and though they appreciate the brownies we bring, the family has grown understandably inward.

I have yet to see or hear anyone swing under the pergola.  Still, I’m glad they built it when they did; if they’d waited even another month it would have been deemed a frivolous excess. The pergola is an aspiration – it’s where they’ll go once the horror of devastating disease is behind them, and they can all emerge outdoors to play again.

131011 Pergola

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The Value of Suffering

vitruvian_man-001This essay by Pico Iyer was originally published in the NY TImes on 9/7/2013.  I find it beautiful and thought provoking.

NARA, Japan — Hundreds of Syrians are apparently killed by chemical weapons, and the attempt to protect others from that fate threatens to kill many more. A child perishes with her mother in a tornado in Oklahoma, the month after an 8-year-old is slain by a bomb in Boston. Runaway trains claim dozens of lives in otherwise placid Canada and Spain. At least 46 people are killed in a string of coordinated bombings aimed at an ice cream shop, bus station and famous restaurant in Baghdad. Does the torrent of suffering ever abate — and can one possibly find any point in suffering?

Wise men in every tradition tell us that suffering brings clarity, illumination; for the Buddha, suffering is the first rule of life, and insofar as some of it arises from our own wrongheadedness — our cherishing of self — we have the cure for it within. Thus in certain cases, suffering may be an effect, as well as a cause, of taking ourselves too seriously. I once met a Zen-trained painter in Japan, in his 90s, who told me that suffering is a privilege, it moves us toward thinking about essential things and shakes us out of shortsighted complacency; when he was a boy, he said, it was believed you should pay for suffering, it proves such a hidden blessing.

Yet none of that begins to apply to a child gassed to death (or born with AIDS or hit by a “limited strike”). Philosophy cannot cure a toothache, and the person who starts going on about its long-term benefits may induce a headache, too. Anyone who’s been close to a loved one suffering from depression knows that the vicious cycle behind her condition means that, by definition, she can’t hear the logic or reassurances we extend to her; if she could, she wouldn’t be suffering from depression.

Occasionally, it’s true, I’ll meet someone — call him myself — who makes the same mistake again and again, heedless of what friends and sense tell him, unable even to listen to himself. Then he crashes his car, or suffers a heart attack, and suddenly calamity works on him like an alarm clock; by packing a punch that no gentler means can summon, suffering breaks him open and moves him to change his ways.

Occasionally, too, I’ll see that suffering can be in the eye of the beholder, our ignorant projection. The quadriplegic asks you not to extend sympathy to her; she’s happy, even if her form of pain is more visible than yours. The man on the street in Calcutta, India, or Port-au-Prince, Haiti, overturns all our simple notions about the relation of terrible conditions to cheerfulness and energy and asks whether we haven’t just brought our ideas of poverty with us.

But does that change all the many times when suffering leaves us with no seeming benefit at all, and only a resentment of those who tell us to look on the bright side and count our blessings and recall that time heals all wounds (when we know it doesn’t)? None of us expects life to be easy; Job merely wants an explanation for his constant unease. To live, as Nietzsche (and Roberta Flack) had it, is to suffer; to survive is to make sense of the suffering.

That’s why survival is never guaranteed.

Or put it as Kobayashi Issa, a haiku master in the 18th century, did: “This world of dew is a world of dew,” he wrote in a short poem. “And yet, and yet. …” Known for his words of constant affirmation, Issa had seen his mother die when he was 2, his first son die, his father contract typhoid fever, his next son and a beloved daughter die.

He knew that suffering was a fact of life, he might have been saying in his short verse; he knew that impermanence is our home and loss the law of the world. But how could he not wish, when his 1-year-old daughter contracted smallpox, and expired, that it be otherwise?

After his poem of reluctant grief, Issa saw another son die and his own body paralyzed. His wife died, giving birth to another child, and that child died, maybe because of a careless nurse. He married again and was separated within weeks. He married a third time and his house was destroyed by fire. Finally, his third wife bore him a healthy daughter — but Issa himself died, at 64, before he could see the little girl born.

My friend Richard, one of my closest pals in high school, upon receiving a diagnosis of prostate cancer three years ago, created a blog called “This world of dew.” I sent him some information about Issa — whose poems, till his death, express almost nothing but gratitude for the beauties of life — but Richard died quickly and in pain, barely able to walk the last time I saw him.

MY neighbors in Japan live in a culture that is based, at some invisible level, on the Buddhist precepts that Issa knew: that suffering is reality, even if unhappiness need not be our response to it. This makes for what comes across to us as uncomplaining hard work, stoicism and a constant sense of the ways difficulty binds us together — as Britain knew during the blitz, and other cultures at moments of stress, though doubly acute in a culture based on the idea of interdependence, whereby the suffering of one is the suffering of everyone.

“I’ll do my best!” and “I’ll stick it out!” and “It can’t be helped” are the phrases you hear every hour in Japan; when a tsunami claimed thousands of lives north of Tokyo two years ago, I heard much more lamentation and panic in California than among the people I know around Kyoto. My neighbors aren’t formal philosophers, but much in the texture of the lives they’re used to — the national worship of things falling away in autumn, the blaze of cherry blossoms followed by their very quick departure, the Issa-like poems on which they’re schooled — speaks for an old culture’s training in saying goodbye to things and putting delight and beauty within a frame. Death undoes us less, sometimes, than the hope that it will never come.

As a boy, I’d learned that it’s the Latin, and maybe a Greek, word for “suffering” that gives rise to our word “passion.” Etymologically, the opposite of “suffering” is, therefore, “apathy”; the Passion of the Christ, say, is a reminder, even a proof, that suffering is something that a few high souls embrace to try to lessen the pains of others. Passion with the plight of others makes for “compassion.”

Almost eight months after the Japanese tsunami, I accompanied the Dalai Lama to a fishing village, Ishinomaki, that had been laid waste by the natural disaster. Gravestones lay tilted at crazy angles when they had not collapsed altogether. What once, a year before, had been a thriving network of schools and homes was now just rubble. Three orphans barely out of kindergarten stood in their blue school uniforms to greet him, outside of a temple that had miraculously survived the catastrophe. Inside the wooden building, by its altar, were dozens of colored boxes containing the remains of those who had no surviving relatives to claim them, all lined up perfectly in a row, behind framed photographs, of young and old.

As the Dalai Lama got out of his car, he saw hundreds of citizens who had gathered on the street, behind ropes, to greet him. He went over and asked them how they were doing. Many collapsed into sobs. “Please change your hearts, be brave,” he said, while holding some and blessing others. “Please help everyone else and work hard; that is the best offering you can make to the dead.” When he turned round, however, I saw him brush away a tear himself.

Then he went into the temple and spoke to the crowds assembled on seats there. He couldn’t hope to give them anything other than his sympathy and presence, he said; as soon as he heard about the disaster, he knew he had to come here, if only to remind the people of Ishinomaki that they were not alone. He could understand a little of what they were feeling, he went on, because he, as a young man of 23 in his home in Lhasa had been told, one afternoon, to leave his homeland that evening, to try to prevent further fighting between Chinese troops and Tibetans around his palace.

He left his friends, his home, even one small dog, he said, and had never in 52 years been back. Two days after his departure, he heard that his friends were dead. He had tried to see loss as opportunity and to make many innovations in exile that would have been harder had he still been in old Tibet; for Buddhists like himself, he pointed out, inexplicable pains are the result of karma, sometimes incurred in previous lives, and for those who believe in God, everything is divinely ordained. And yet, his tear reminded me, we still live in Issa’s world of “And yet.”

The large Japanese audience listened silently and then turned, insofar as its members were able, to putting things back together again the next day. The only thing worse than assuming you could get the better of suffering, I began to think (though I’m no Buddhist), is imagining you could do nothing in its wake. And the tear I’d witnessed made me think that you could be strong enough to witness suffering, and yet human enough not to pretend to be master of it. Sometimes it’s those things we least understand that deserve our deepest trust. Isn’t that what love and wonder tell us, too?

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