You Gotta Learn How to Fall


Jeremy Abbott

The 2014 Winter Olympics ended two months ago, but this post was delayed by some circumstances beyond my control; let it suffice to say that I was temporarily “censored” on the subject of falling.  Now, however I think this post actually is even more meaningful for me, and I hope still relevant for you.  Thank you for joining in….please do skate along.  KA


Another Winter Olympics has come and gone with all of the

pyrotechnics, international attention (and international tension,)

competition, national pride and defeats, and personal achievements and

disappointments.  The performances were dazzling, daring and in some

cases downright dangerous.  Put a sharp blade or skinny ski on ice and

packed snow, or icy slush, at dizzying speeds and there is bound to be

calamity.  We witnessed the crashes of Andorra’s Joan Verdue Sanchez

in the Giant Slalom, Germany’s Johannes Rydzek in the Nordic Combined,

Chile’s Stephanie Joffrey and China’s Chao Wu in the Freestyle Ski

Event.  Our Americans Kelly Clark and Shawn White slammed into the

Half Pipe.  Germany’s Monique Angermueller skidded off the Speed

Skating track at 30 MPH. Each of these individuals landed and had to

pry themselves out of the snow or off the ice surface, possibly to try

again, possibly not, their dreams of Olympic metal dashed or at least delayed.



Then there were the Figure Skaters.  Our Jeremy Abbott who literally

hit the wall so hard it seemed he might have to be picked up and

carried off.  Japan’s Yusuru Hanaju, who did win the gold, hit the ice

hard in his short program. Beautiful intense young Russian Yulia

Lipniskaya fell in both of her programs slamming down from her

magnificent jumps.  Mao Asada of Japan, repeatedly fell; so sad to see

such a champion hit the ice again and again.  And our jewel box

princess perfect Gracie Gold, with a name destined for Olympic skill

and artistry, landed hard.



What is both amazing and baffling about the figure skaters unlike

their colleagues on the slopes and tracks is that they get right back

up, with grace, without missing a beat to the music, without a wince,

perhaps a nano second of disappointment flooding across their faces,

to be quickly transitioned to eyes focused with determination, perhaps

even a smile lifting their lips.  And they skate on, beautifully.

Only Jeremy Abbott crunched against the wall took a full 20 seconds to

return to his feet to glide and spin on.  Of them all only Eugeni

Plushenko, landing hard in the warm up, decided to call it quits, but

vowed that even if it took 10 more surgeries he would be back to skate



I wonder how these athletes, artists, competitors, champions, recover

so quickly.  How to rise from a clumsy and undoubtedly painful fall

onto that hard cold ice in their beautiful, somewhat skimpy, delicate

costumes.  It seems this would be difficult to bounce back from in the

privacy of one’s own home, alone on a private rink, but they have

fallen in front of literally millions of people.  Once, wearing a

dress, I slipped off an unbalanced chair at a Bat Mitzvah surrounded

by about 20 people. I was mortified.



So this makes me think about resilience.  What is it and where does it

come from?  Something fashioned into an individual’s DNA or is it

learned?  Is it practiced and practiced and practiced like a double

salchow into a triple toe loop?  Is resilience a learned confidence

that you can fall, and get back up?



I took ice skating lessons two years ago and the first thing I was

taught was how to fall.  My coach taught me a procedure similar to

this one I found on the internet:



Time Required: Practicing falling over and over again is the only way



to learn how to fall safely.



Here’s How:



Practice falling on the ice without skates on.



Next practice falling on the ice with skates on.



Practice falling on the ice from a standstill.



Practice falling on the ice while moving slowly.



Practice falling on the ice while moving a bit faster.



Practice falling on the ice over and over again.






Wear gloves or wrist guards. Knee and elbow pads will also protect a



skater from getting hurt if a fall occurs.



Don’t allow your hands and arms to swing around or to get out of



control while you skate.



Put your hands on your waist or out a bit in front of you when you



ice skate, but don’t use your hands to help break a fall.



The only way to get over the fear of falling on the ice is to fall, so



practice falling on purpose over and over again.



If you anticipate that you are about to fall, bend your knees and



squat into a dip position.



What You Need



Gloves or wrist guards



Ice skates



Warm clothing



Knee pads and elbow pads are optional



I skated on a rink at a mall with a gazillion kids skating, falling,

sliding fearlessly around and around, zipping past my carefully

calculated glides and squats.



There is a massive amount of information about resilience in books,

journal articles, and on the internet.  There is a useful brochure

called The Road to Resilience from the American Psychological

Association   I

found an article about resilience by a clinician, Michael Ungar I

actually met at a conference in Belfast, Northern Ireland.   He is the co-director of the Resilience



Michael Ungar relates the Olympic experience to the development of

resilience in children in his article Olympic Gold Medalists and

Raising Resilient Kids.

In addition to getting control over one’s thoughts, having a positive

personality and having strong social supports, he cites the following

as a major contributor to resilience:


1) The advantages of setbacks. As odd as it sounds, most of the

study’s participants said that while serendipity (being in the right

place at the right time) sometimes helped them get a chance to show

what they could do, it was life’s challenges that provided them with

the motivation to push a little harder. Without some setback, most

would not have reached their full potential. The experience of failure

brings with it opportunity: the chance to say with certainty whether

one wants to give everything one has to achieving one’s goal.

Sometimes, those personal challenges were as simple as a bad

performance or being denied a spot at a qualifying competition.  But

personal milestones also played a factor. The loss of a parent, a

divorce, a personal injury all caused these athletes to pause and

reconsider their commitment to success.


What does this tell us about raising resilient kids? Don’t shelter

them from every challenge. Let them fail! (or fall!)



And the support network:  one of the major advertisers and supporters

of the Olympics, Proctor and Gamble sponsored the “Thank you, Moms”

spots and the Family Support Center in the Olympic Village.


For teaching us that falling only makes us stronger. For giving us the

encouragement to try again. Thank you …



And what does this tell us adults who stumble, fall, sometimes totally

crash, whether in a relationship, our professions, our dreamed of

aspirations.  We can’t always foresee the event in advance enough to

squat and avoid falling.  We slip and slide and land sometimes with

painful results, damage, a massive set back.  It will certainly help

to have our loved ones and advocates on the sidelines cheering us on.

We may need to be physically or emotionally picked up.  But most

importantly we need to know that we can skate on, with confidence,

with good thoughts of ourselves and others, and then, we move on with grace.



You got to learn how to fall
Before you learn to fly
And mama, mama, it ain’t no lie
Before you learn to fly
Learn how to fall

You got to drift in the breeze
Before you set your sails
Oh, it’s an occupation where the wind prevails
Before you set your sails
Drift in the breeze

Oh, and it’s the same old story
Ever since the world began
Everybody got the runs for glory
Nobody stop and scrutinize the plan
Nobody stop and scrutinize the plan
Nobody stop and scrutinize the plan

You got to learn how to fall
Before you learn to fly
The tank towns, they tell no lies
Before you learn to fly
Learn how to fall


Dr. Kildare’s Strange Case: Sex, Drugs and …….

Dr. Kildare's Strange Case (1940) Poster

Well, of course there is no Rock and Roll.  The movie, Dr. Kildare’s Strange Case, which I recently watched at an alumni seminar at New York Medical College, was released in 1940.  Songs on the radio were Glen Miller’s In the Mood, Bing Crosby’s Only Forever, Cliff Edwards playing When You Wish Upon a Star on the ukulele, and Coleman Hawkins’ Body and Soul.

The sex is only the vaguely implied in the rivalry between James Kildare and the surgeon Gregory Lane who are competing for the body and soul of, or at least dinner with, nurse Mary Lamont.  Mary however has her heart set on a nice house with a white picket fence and will give herself to the doc with the bucks to get her there.

It’s the drugs that are the stars of this film.  But before getting into the pharma particulars here’s a brief synopsis of the cast and plot:


Lew Ayres as Dr. James Kildare

Lionel Barrymore as Dr. Leonard Gillespie

Laraine Day as Nurse Mary Lamont

Shepperd Strudwick as Dr. Gregory ‘Greg’ Lane

Dr. James Kildare gets competition for the heart of nurse Mary Lamont, when a brain surgeon, Dr. Gregory Lane, enters the scene at the hospital. James has not proposed to Mary yet because of his bad financial standing.

One day James is offered a well paid job at the Messenger Institute, but he rejects the offer to continue working with his inspiring mentor, Dr. Leonard Gillespie. Mary gives up all her hope of marrying James.

James and Lane are put together on a case where a man has had his skull fractured, and Lane, who has been quite unfortunate recently and failed to rescue the lives of his patients, wants James to perform the surgery instead. James manages to persuade Lane to perform the surgery anyway, and when the man wakes up again he shows clear signs of insanity and mental illness. Lane’s reputation as a surgeon is damaged again.

James is convinced that the man was mentally ill even before the accident which had fractured his skull, and risk his whole career by trying to prove this by injecting the man with insulin as treatment for the insanity. He succeeds, and restores both his and Lane’s reputations.

After the patient is sane again, James reconciles him with his wife from whom he was separated five years ago. Seeing the couple reunited makes James propose to Mary even though he cannot afford a wedding, and she accepts his proposal.  THE END

So insulin is the drug of choice here, curing the patient of insanity, reconciling him with his wife,  saving Dr. Lane’s reputation….. and Dr. Kildare gets the girl.  Pretty powerful stuff that insulin.

Insulin shock therapy or insulin coma therapy (ICT) was a form of psychiatric treatment in which patients were repeatedly injected with large doses of insulin in order to produce daily comas over several weeks.[1] It was introduced in 1927 by Austrian-American psychiatrist Manfred Sakel and used extensively in the 1940s and 1950s, mainly for schizophrenia, before falling out of favour and being replaced by neuroleptic drugs in the 1960s.

To keep the plot moving along, the process in “Strange Case” takes a few hours through the night during which Kildare and Lamont lock themselves into the patient’s room, administer the insulin and wait while the patient (who by the way could not provide informed consent because he was insane) becomes comatose and goes through various violent convulsions and regressions.  Alas, as the sun rises, he regains sanity, tells Kildare his name and his wife is found and brought in for the happy reunion.  Ah, medicine in movieland.  (Interesting sidebar:  Lew Ayres died in 1996 at the age of 88 of complications from a coma.)

(Here is the NYT April 12, 1940 movie review )

Aside from the administering of an experimental drug without consent from the patient or next of kin, and with the presenting goal of saving Dr. Lane’s reputation, there are various other practices at this 1940 hospital that boggle our current health care brains.  Clearly HIPAA was not even a dim light on the horizon.  The doctors, nurses, the switchboard operator, and the ambulance driver all chat about the patients and their diagnosis/treatments.  No one seems to wash their hands except directly before surgery and it’s a perfunctory splash.

There is also the use of another experimental drug in a bizarre little subplot.  Joe, the ambulance driver fancies Sally the switchboard operator, but he like Dr. Kildare does not have the money to wine and dine Sally into romance and he knows that a certain fellow from Philadelphia has been taking her to nice restaurants and thereby winning her heart.  Predicament indeed for Joe which he shares with the bar tender, Mike Ryan, and Dr. Kildare at Sullivan’s Hospital Cafe.  They arrive at a plan for Joe to ask Sally out for a lovely lavish dinner, but bring her to Sullivan’s bar first for a drink.  Mike will give her a “special drink” that will cause her legs to be paralyzed, (yes paralyzed!) so she can’t go to dinner and Joe in fact can be the hero taking her home in this embarrassing state.  The three men all agree that this will get Joe the date and perhaps much more.  This certainly seems like the precursor to a date rape drug.  In the film it is presented as so very clever with our sweet idealistic Dr. Kildare as a co-conspirator.

And then there is the ubiquitous smoking of cigarettes.  Dr. Leonard Gillespie, Kildare’s mentor in medical research, is constantly lighting up to imbibe his steady dose of nicotine.  Gillespie, as played by Lionel Barrymore, is in a wheelchair and there is an implied serious health issue that has caused his disability.  In fact, Lionel Barrymore himself often used a wheelchair off the set. By the time the Kildare movies were made, he had broken his hip twice and then arthritis set in.  There is a “suggestion” that Barrymore’s arthritis was the result of his contracting syphilis in 1925.  The character of Dr. Gillespie adopted the same disability so that Barrymore could play the part, a switch on current Hollywood casting in which often the part of a character who is disabled is played by an actor who is not.  (Think of the film The Sessions, or of Lieutenant Dan Taylor in Forrest Gump who was a double amputee, but Gary Sinese was not.) The staff at the hospital, especially Superintendant Molly Byrd, are committed to keeping him healthy.  In one scene as Dr. Kildare and Dr. Gillespie share lunch, Nurse Byrd enters and actually says, “Drink your milk or no cigarettes!”  Dr. Gillespie, does an “Ick!!!” but gulps down the bottle of (undoubtedly whole) milk so he can retrieve his cigarettes from the matriarchal nurse.  Despite these efforts the real life Lionel Barrymore died of a heart attack.

It’s hard to know what the author of Dr. Kildare’s Strange Case had in mind.  Max Brand, born Frederick Faust, was a successful screenwriter who also wrote Westerns and loved mythology.   Perhaps in addition to the medical introduction of experimental drugs, he was portraying a world where men were men and gods were gods and magic potions to seduce women were de riguer.  And the smoking…well everyone did it.  Brand, himself had a heart attack and suffered from chronic heart disease until his death at the age of 52 from shrapnel in World War II.

Mingled within the issues of drugs and romance in the “Strange Case” is another vital difference between the world of Dr. Kildare and our current medical practice, and it’s death, the separation of Body and Soul.  When Dr. Lane fails the sheet is drawn over the patient’s face and death declared when the heart stops as per the 1816 determination of death by a French physician.  Prior to heart function as the definition of life, it was breath.  When a person ceased to breathe, as when the daughter of King Lear, Cordelia does not fog the mirror held to her lips by her grieving father.  Death could be determined by anyone who could hold a mirror or put their ear to a chest and hear, or not hear, a heart beat.  But 20 some odd years after Dr. Kildare, in 1968, Dr. Henry Beecher declared a new definition of death, the cessation of the brain to function, and this required the use of sophisticated medical equipment and the declaration of death by a doctor.  And, lingering questions about the blur between life and death.  There was a fascinating Radio Lab session called Afterlife on March 8, 2014, that I listened to on my drive up to DIA: Beacon on a sunny early spring day when all was poised for rebirth with the appearance of snowdrops and crocuses.  You can listen to it here:

I wish I could have had the Doctors Kildare, Lane and Gillespie, and Nurse Mary Lamont, the writer Max Brand on that drive to Beacon with me.  I would love to hear their reactions to the complex medical, spiritual, philosophical questions raised in the 11 vignettes of life and death, body and soul.  But of course I would not have let them smoke in my car.

MPH Cupid

Heart and Blade

My name is Karel and I am an Internet dating failure.   Yes, I have met a few nice men on OK Cupid for the requisite coffees, drinks or dinners and “nice meeting you, good-bye.”  There of course have been the fascinating respondents who live in “New York, New York” but only write back at 2:00 AM and have no idea where the George Washington Bridge is.  The men who live in suburban apartments who had very lavish life styles and were very financially successful, but “lost everything in the divorce.”  (I don’t know which planet these men are from since, having been divorced myself, I happen to know first hand that wives definitely do not “get everything” as these men claim was their judicial fate.)   There was the very attractive somewhat familiar looking man who was wearing an Eddie Bauer shirt with the logo prominently displayed in every photo; nicely scanned from the catalogue.

My profile remains on OK C and I check in from time to time approximately once a month because though not an enthusiast, I am sort of academically interested in the process, maybe even a little bit hopeful.  And recently to refresh my memory, I checked in few times before writing this blog.

Of course I have heard the various urban legends of a cousin of a friend of someone’s sister-in-law who found true love, got married and had five children and lived happily ever after with a man she met on eHarmony. Or the neighbor of a woman in yoga class who is engaged to a man she met on Match.  There was even an article in the New York Times “Weddings” about two people who met on OK Cupid.  Read it, Believe it!  If it is in the New York Times it must be true.

Alas, I have not even come close to this experience, although I suppose it would help if I updated my profile from time to time (I went to St Petersburg, Russia two years ago.)  Maybe I need to add something really compelling like my broken ankle last winter with a photo of my scar.  Kind of makes me think of Ben Stiller’s Walter Mitty trying to get a wink on eHarmony, although I actually have been to the Himalayas and Iceland.

In spite of this failure to find true love on my computer, two years ago I met David and since then we have exchanged I am sure hundreds of emails, photos, ideas, feelings, thoughts, plans.  We have written sometimes several times in one day.  About year ago when I wanted to set up a meeting, he disappeared for over a month and I thought it was over.  I was pretty angry.  And there have been times when he has been angry and critical and seemingly very demanding.  But still we continue and in fact I just received an email from him this morning.  “Good morning,” he wrote.  “Thank you for your humble reply.  We have much work to do.”  David lives in Uganda and I live in New York.

David and I didn’t meet on a dating site.  We met on the Global Health Forum of LinkedIn when I posted my MPH thesis in 2011.  Over the two years we have been working together to establish Holistic Care for Mothers, a project of the Makindye Rotary and soon to be an independent not for profit registered with the Ugandan government.  I am more than academically interested; I am hopeful that we can make some positive change for women and girls.

This is not my only Internet relationship.   Early in my thesis process at New York Medical College, probably around 2008, I found the Birthing Kit Foundation and Dr. Joy O’Hazy.  Joy and I have written to each other over the years about the distribution and efficacy of birthing kits,, but also about her travel, her singing and dancing; her wisdom and experiences.  There are often long gaps in our correspondence, but I always feel a connection to her and every day I look at the beautiful appointment book she sent me last year with her photographs and poems.  It was Joy who was my contact to the Foundation that yielded the donation of birthing kits to Holistic Care for Mothers that David has distributed in rural Uganda.

I met Kirtiman Tumbahangphe in Nepal, the director of  MIRA, Mother and Infant Research Activities and after many emails and exchange of phone numbers, Kirti and I did meet in Hetauda where I visited several women’s projects out in the beautiful lush mountains of southern Nepal.  We talked about maternal mortality in Nepal and the very successful MIRA project using women’s empowerment, peer health education and community leadership.  Kirti and I even had dinner together at the Hotel Avocado and Orchid Resort where I stayed.  We said goodbye in the parking lot and he rode off on his motorcycle.

Diana Nabiruma is a health writer for the Ugandan newspaper The Observer.  I was researching health in Uganda when I found one her articles about violence against women and girls.  Thinking she might be interested in Holistic Care for Mothers I sent an email to the address in her by-line; an arrow shot into the cyber dark for sure, but she wrote back.  She was interested and interesting and funny and smart.  And, she interviewed David and Dr. Sarah Nkonge.  And….she did indeed write an article about maternal mortality in Uganda, about the Holistic Care for Mothers. The%20Observer%20-%20No%20more%20%E2%80%98labour%20suites%E2%80%99%20in%20banana%20plantation.html

And then there is Mike Cook who is one of the most amazing Internet contacts I have ever had.  I was thinking about how razor blades in birthing kits might be replaced with natural, local sustainable materials.  I thought about repurposing broken glass bottles; could blades be made from glass? So I searched “GLASS BLADES.”  And there was Mike Cook.  His website states, “Hi I am Mike Cook and I was born to be a flintknapper.”  Mike lives in Portland, Michigan and has a company called Art of Ishi He in fact makes blades from glass and stone, but not the kind of glass I was thinking of.  He uses natural volcanic glass, obsidian, flint, chert.  Take a look at his website and you will be totally astonished.  You can watch his videos about how he makes these blades.  For those of you who are not faint of heart, watch him shave with a blade he strikes off of a hunk of  obsidian  All I can say is “DON”T TRY THIS AT HOME.”  So I wrote to Mike.  Generous, thoughtful and expressing interest in birthing kits, Mike sent me a few of his blades.   I have them on my desk (although I have not used them on my legs,) and there is the possibility of natural blades to cut umbilical cords safely, cleanly, sustainably.  Thanks, Mike.

These are some of my Internet relationships.  I don’t think any of them will lead to a date for New Years Eve, dinner on Valentines Day, not even the cup of coffee or drink.  I have not found my one true love, but I have found passion.

As I, a la Joseph Campbell follow my (Internet) bliss, I think of a web perhaps not so different from our www in Walt Whitman’s “A Noiseless Patient Spider”:

A noiseless patient spider,

I mark’d where on a little promontory it stood isolated,

Mark’d how to explore the vacant vast surrounding,

It launch’d forth filament, filament, filament, out of itself,

Ever unreeling them, ever tirelessly speeding them.

And you O my soul where you stand,

Surrounded, detached, in measureless oceans of space,

Ceaselessly musing, venturing, throwing, seeking the spheres to connect them,

Till the bridge you will need be form’d, till the ductile anchor hold,

Till the gossamer thread you fling catch somewhere, O my soul.

Mobius: where time becomes a loop


Mobius tattoo

I have been thinking about Mobius Strips lately.   These tricky little mathematical shapes are described in Wikipedia as:


The Möbius strip or Möbius band (UK /ˈmɜrbiəs/ or US /ˈmoʊbiəs/; German: [ˈmøːbi̯ʊs]), also Mobius or Moebius, is a surface with only one side and only one boundary component. The Möbius strip has the mathematical property of being non-orientable. It can be realized as a ruled surface. It was discovered independently by the German mathematicians August Ferdinand Möbius and Johann Benedict Listing in 1858.


(Hmmmmm.  So it really could have been called “The Listing Strip” and then we all wouldn’t have to feel bad about not having umlauts on our keyboards.)


But a written description can’t possibly give you the full strip experience, so those of you who have never actually made one yourself, here is a video that will have you running for a piece of paper, tape and scissors (no, please don’t run with the scissors!)  so you can prove to yourself that there really is an object that has only one side…and dazzle others who may be uninitiated.


I first encountered this phenomenon, when I was in high school although Mobius Strips were not in any curriculum of my formal education at Earl L. Vandermeulen High School in Port Jefferson, New York.  No, it was when I was doing a little part time work for a famous sociologist, Dr. Benjamin Nelson, who at the time was on the faculty of the New York State University at Stony Brook.  My mother, Rose, worked for him in his home office as his secretary.  She was soon joined by her very dear friend Elsie in support of Dr. Nelson’s accounting, and over the years I, my sister Barbara, and my soul-siblings, twins Carol and Jim Winkler, who are Elsie’s children, all found ourselves in the Nelson home office, editing, organizing, filing, and having lunch with Dr. Nelson.  He was a fascinating person, professor, social science researcher, author and mentor.  I still clearly remember him telling me one day over dessert that there was blood in my tea which was pretty horrifying to my naïve self as he drew the longitudinal connection between my teabag and tyranny in developing countries. So, then there was an article he asked me to edit (by this time I might actually have been in college at Stony Brook,) for the Journal of  the American Psychiatric Association called ”The Onion and the Mobius Strip” (I am sure they had an umlaut.)  I have realized that there are limits to our searches on the Internet because although I have found many other journal articles and books by and about Dr. Nelson, I have yet to mine this one.  I do believe the article was about two conflicting models of personality studies, but it has been a pretty long time.  I, however, clearly remember looking up Mobius Strip in his (you won’t believe this but it is true) Encyclopedia Britannica.  (Just to give you a time reference on all of this Dr. Nelson died in 1977, in his sleep on a train in Italy.)


So why have I particularly had Mobius Strips on my mind?  It’s the US government shut down.  Here’s how that is going:


(If you want to read the most current details, here’s an article in Forbes )

In short, because the Democrats support President Obama’s Affordable Care Act, the Republicans are refusing to approve the United States budget which expired on September 30.  And the Democrats won’t negotiate. Since the budget isn’t approved, federal employees who are considered “non-essential” are out of work and some of them actually would be providing health care but can’t because the agencies they work for are shut down.  Here are a couple of examples from an article in the Washington Post


Health: The National Institutes of Health will stop accepting new patients for clinical research and stop answering hotline calls about medical questions. The Centers for Disease Control and Prevention will stop its seasonal flu program and have a “significantly reduced capacity to respond to outbreak investigations.”


Women, Infants, and Children: The Department of Agriculture will cut off support for the Women, Infants and Children program, which helps pregnant women and new moms buy healthy food and provides nutritional information and health care referrals. The program reaches some 9 million Americans. The USDA estimates most states have funds to continue their programs for “a week or so,” but they’ll “likely be unable to sustain operations for a longer period” — emergency funds may run out by the end of October.


So here’s the Mobius loop of the Affordable Care Act based on people needing health care looping back on itself to people needing health care while our government fights with itself.


I am aware of another more local Mobius Strip health loop.  Flu season is almost upon us and the New York State Department of Health has mandated that all health care providers receive the flu vaccine (or wear a mask in the presence of patients and other health providers.)  There are some health providers, the lowest paid who provide direct care but don’t have health benefits themselves from their employers.  Their employers will not pay for the vaccinations so they have to pay for the vaccine themselves.  If they can’t afford it they will be removed from their jobs and then they really won’t be able to afford the vaccinations and won’t be able to go back to work…well at least not until flu season is over.  And they may very well get sick and require the health care they can’t afford because they are out of work.  Dr.  Mobius, I presume.


And here is a more personal health Mobius.  A friend of mine works for a health care company.  She is required to work long days often into the evenings and on many weekends.  She has been very stressed and not feeling well and so has been seeing her doctor and a therapist who both have advised her to work shorter  (normal) hours and have some time for her health care, recreation and relaxation.  She however, can’t do this because of the requirements of her job.  And she often misses the therapy because she has to stay late at work, making her more stressed.  Here’s the Mobius one sided one edge shape: the health care company she works for is also her health insurance provider paying for her health care.  So, it’s a one-sided shape, the deterioration of her health is being caused and paid for by the same company!  Loop de loop.


None of this should be so complicated, convoluted and twisty.  In spite of all of this the health exchanges sites are so busy with people registering and buying affordable health care insurance that there were some crashes the first day.  There is a clear straight line between health care and the health and well being of individuals, communities, populations, the people of the United States.  The Affordable Care Act is a pretty simple straight line.


Getting back to the government shut down, a twist in the fabric of space where time becomes a loop.  It does seem that this isn’t quite a Mobius Strip, after all there are two sides, the Democrats and the Republicans.  But actually as the strip loops around, until these two sides get it together, there really is only one side to this situation:  everyone is losing.


If you need some cheering up after that, watch this and have a healthy, happy heart:


Whistling in the Dark: Truth, or What I did on my Summer Vacation


When I was 4 years old, by some quirk of a mail disorder, one of the greatest inspirations of my life turned up in the mailbox by my front door at 121 Greenwich Avenue in Roosevelt, New York.  I vaguely remember the brown paper wrapping and my mother opening the package.  It was a book filled with black and white pictures and some writing that in my 4 year old preliterate state was unintelligible to me.  I believe that the book was flipped through by the big people, my parents and two older sisters, and then was discarded in a pile of magazines where I discovered it and made it my own.  That was when I made my acquaintance with Joan of Arc.  Of course at the time I didn’t know her name was Joan of Arc since I couldn’t read, but most likely someone had mentioned that name and I must have mentally acquired it.  I know that I did acquire the book and I still have it; it is the screenplay for the 1948 movie Joan of Arc directed by Victor Fleming, starring Ingrid Bergman as Joan.  It became my personal visual story even though all of the left hand dialogue was just letters on a page, the pictures spoke to me.  First there was the cover, the only full color picture and the color is still glorious: blue background, a furling white flag with gold fleur de lis, her silver armor and her blue eyes and raspberry lips.  Yes, the lady, the beautiful lady in shining armor.  No woman I knew dressed like that, not my mother, or sisters or aunts or neighbors, certainly not Miss Frances on Ding Dong Schoolhouse. I loved this woman under the helmet holding a sword.  I had seen pictures of the Statue of Liberty and maybe they were related, the statue did have a crown and was holding a torch.  In Sunday School there were women like Jesus’s mother who dressed differently from a long time ago, but they didn’t look like the woman in armor.  She looked so proud, confident and powerful. Her blue eyes were like mine.

The pictures inside the book were more complicated, but even as a little girl I was aware enough of the symbolism of clothing to understand the progression of the story of Joan.  In the beginning she was dressed in simple dresses and looked sweet with her head covered what we would have called a babushka.  Then tunics and leggings.  (Of course I didn’t know these words.) She was shown talking to a lot of men.  And, praying a lot.  Then suddenly on the next page, there she was in armor on a horse surrounded by men.  Scary battle scenes. Bows and arrows.  I had been introduced to Robin Hood and his Merry Men so I knew about shooting arrows, but this looked more dangerous.  No one looked merry.  There was a picture of her on the ground with an arrow in here chest. Then Joan in her armor talking to a king; I knew he was a king by his crown and robes.  And then she was just dressed in black, simple black and really praying a lot and looking worried, crying.   I knew she was in trouble.  The last pages were the ones that I couldn’t stop looking at.  The armor was gone, the tunics and leggings were gone, even the simple black outfits.  She was all in white, wrapped in what seemed like a white sheet and they were chaining her to a post.  She was surrounded by logs and twigs.  Then the flames.  Her face on the final page, eyes closed, still beautiful, swathed in smoke.

Her clothing told a story.  So did her praying.  Toward the end she had reached out for a cross.  Some of this I understood as some kind of Sunday School story.  I wanted to ask my parents about this but something held me back.  Maybe I thought they would take the book away from me.  I didn’t know if they even knew I had it among my other story books, Babar and Alice in Wonderland and the Disney Classics.  There was something that resonated with Snow White eating the apple and falling, Alice running from the Queen, Babar’s mother shot by a hunter.  But somehow the last pages of all of those books ended with happiness, a reunion with loved ones, a return home.  Joan, my heroine, was alone in the smoke, with a sign on her head I could not at that time read or comprehend, like Jesus on the cross but with no Easter Sunday resurrection, bunny, colored eggs, new dresses and jelly beans.

At some point I showed the book to my sister Barbara, who was always the smart one in the family and 7 years older than me, and asked her why the story ended that way.  She told me that Joan had gotten into a lot of trouble with those men because she told the truth.

Getting in trouble for telling the truth has been very much in the headlines this summer.  There has been the trial and sentencing of Bradley Manning. There has been Anthony Weiner running for Mayor of New York City and his truth and lies and just down right too much visual information.  But my attention has been focused on Edward Snowden’s truth telling and the controversy of his legal right to tell these truths.  No one it seems, even the United States government in general or President Obama specifically has denied that what Snowden has declared is true, just that he shouldn’t be sharing these truths.  I have had many conversations with many people about this topic and the opinions have been as varied as the emails that have been read by the National Security Agency; meaning there are lots of different opinions even among people I know, ranging from Snowden being a spy who should be condemned to death, to him being a savior who is being martyred for his speaking the truth.  The political environment has become a shifting landscape of relationships between super powers and developing countries accepting or shunning him, inviting Snowden as a guest or demanding his personal criminal appearance.  Moscow might send him back home if we really really promise not to kill or torture him.  Sounds a little Joan of Arc-ish.  Saint or heretic?  Maybe like Joan only time will tell the good guys from the bad guys in this story of truth-telling.  And just as Joan wasn’t really the issue but was just the spokesperson for the big question, “who’s got the power, God or kings?” it’s really the same issue in the Snowden saga:  who’s got the power of information? Government or the people?

Repeat after me: Edward Snowden is not the story. The story is what he has revealed about the hidden wiring of our networked world. This insight seems to have escaped most of the world’s mainstream media, for reasons that escape me. The obvious explanations are: incorrigible ignorance; the imperative to personalise stories; or gullibility in swallowing US government spin, which brands Snowden as a spy rather than a whistleblower.

Was Joan of Arc a heretic or a saint?

Is Edward Snowden a whistleblower or a spy?

What about Bradley Manning, Sibel Edmonds, Coleen Rowley, Jesselyn Radack, Dr. Peter Rost?  Any number of whistleblowers at

All of this makes me wonder about all that medical information that is behind the firewalls of hospitals, medical centers, clinics and physician practices.  Of course patient privacy has to be protected, unless it is good public relations for the medical provider:  the successful heart transplant, the separation of conjoined twins, the new miracle drug.  Do an internet search and you can find dramatic accounts of life saving procedures.  Here’s one in the news today accompanied by photos of the patient, is wife and his child:

Life-saving: Matthew Green was the first person in the UK to receive a total

artificial heart implant and be able to go home thanks to a portable pump.

Read more:

But what happens when things go terribly wrong, which does of course happen.  Some stories do come out when family or patients speak up, if they can, if they have good lawyers.  But I wonder about what the internet hackers would find if instead of looking into national security they looked into national health care.  They probably would not find that our emails are being read or our phones are being tapped, but they would find that some patients got the wrong blood type in a transfusion, or the wrong dose of heparin was administered, or the wrong breast was removed, or someone was left in the hallway to the emergency department too long.  The New York Times article, More Treatment, More Mistakes, by Sanjay Gupta, MD in July 2012, states:

According to a 1999 report by the Institute of Medicine, as many as 98,000 Americans were dying every year because of medical mistakes. Today, exact figures are hard to come by because states don’t abide by the same reporting guidelines, and few cases gain as much attention as that of Rory Staunton, the 12-year-old boy who died of septic shock this spring after being sent home from a New York hospital. But a reasonable estimate is that medical mistakes now kill around 200,000 Americans every year. That would make them one of the leading causes of death in the United States.

Is there some national security that can prevent these deaths of 200,000 American citizens every year?  Can the NSA read all the medical records looking for medical errors that kill people rather than spending time reading everybody’s emails looking for terrorists?

What is important to know is that as cited in the article states don’t use the same reporting guidelines and that includes who knows about the mistakes including patients and their families, i.e., sometimes even if you get the wrong medication, or the wrong procedure, or some little inconsequential sponge is left inside your body you don’t have to be told about it.  Maybe it’s just better for you to not know. Just like if someone is reading your emails you don’t really have to know about it because maybe it’s just better if you don’t know about it.  Maybe this is keeping all of us safe.  Maybe not. 200,000 Americans die every year and we don’t know much about that, or who is protecting us, or how to protect ourselves.

But here’s something true about healthcare that is apparently not true in national security:  anyone in health care who knows that there is an error or risk to patient safety can talk about it without risking their own safety.  If you talk about what’s going on in health care as long as you don’t violate patient confidentiality, you don’t have to end up in the transit area of the Moscow airport or at the burning stake or in a military prison.  In New York State there is a specific law that protects health care employees from retaliation by their employers if they speak up about a medical error or any other untoward events.  It’s New York State Labor Law 741.  It explicitly states:

Retaliatory action prohibited. Notwithstanding any other provision

of law, no employer shall take retaliatory action against  any  employee

because the employee does any of the following:

(a) discloses or threatens to disclose to a supervisor, or to a public

body  an  activity, policy or practice of the employer or agent that the

employee,  in  good  faith,  reasonably  believes  constitutes  improper

quality of patient care; or

(b)  objects  to, or refuses to participate in any activity, policy or

practice of the employer or agent that  the  employee,  in  good  faith,

reasonably believes constitutes improper quality of patient care.

Whistleblowers in health care need not fear, they are protected by law.

So no hackers required. No one who works in health care can be penalized, forced to flee, ostracized, accused of being a witch, blasphemer or heretic, if they blow the whistle to inform a public body that there is a risk to safety, health and well-being.  They are protected.

Well, maybe.

Or, maybe not.

Brave Lyrics

by Sara Bareilles

You can be amazing
You can turn a phrase into a weapon or a drug
You can be the outcast
Or be the backlash of somebody’s lack of love
Or you can start speaking up
Nothing’s gonna hurt you the way that words do
And they settle ‘neath your skin
Kept on the inside and no sunlight
Sometimes a shadow wins
But I wonder what would happen if you

Say what you wanna say
And let the words fall out
Honestly I wanna see you be brave

With what you want to say
And let the words fall out
Honestly I wanna see you be brave

I just wanna see you
I just wanna see you
I just wanna see you
I wanna see you be brave

I just wanna see you
I just wanna see you
I just wanna see you
I wanna see you be brave

Everybody’s been there, everybody’s been stared down
By the enemy
Fallen for the fear and done some disappearing
Bow down to the mighty
Don’t run, stop holding your tongue
Maybe there’s a way out of the cage where you live
Maybe one of these days you can let the light in
Show me how big your brave is

Say what you wanna say
And let the words fall out
Honestly I wanna see you be brave

With what you want to say
And let the words fall out
Honestly I wanna see you be brave

Innocence, your history of silence
Won’t do you any good
Did you think it would?
Let your words be anything but empty
Why don’t you tell them the truth?

Say what you wanna say
And let the words fall out
Honestly I wanna see you be brave

With what you want to say
And let the words fall out
Honestly I wanna see you be brave

I just wanna see you
I just wanna see you
I just wanna see you
I wanna see you be brave

I just wanna see you
I just wanna see you
I just wanna see you
I wanna see you be brave

I just wanna see you
I just wanna see you
I just wanna see you
I wanna see you be brave

I just wanna see you
I just wanna see you
I just wanna see you.

The Write Stuff

The patient presented with multiple diagnoses:  Morbidly alcoholic with fits of anger, depression, anxiety, and insomnia.  His appearance was one of self-neglect with a disassociated affect.  But the doctor did not prescribe antidepressants, counseling or electroconvulsive shock therapy.  He placed a blank journal in front of the patient and positioned the pen on the page toward him.  “Write it down,” he said.  “A memory, a thought, a place.”  The patient was Nick Carraway.

Write something.  I do not mean for this to be an intimidating suggestion.  It makes no difference whether you write five paragraphs for a blog, a paper for a professional journal, or a poem for a reading group.  Just write.  What you write need not achieve perfection.  It need only add some small observation to your world.  Atul Gawande, MD. in his book Better: A Surgeon’s Notes on Performance  is writing about changing the world.  The doctor at the Perkins Sanitarium, in Baz Luhrmann’s The Great Gatsby, is telling Nick Carraway to write to change himself.  He tells Nick that it doesn’t matter if anyone else reads what he writes or if he burns it.  Just write.

Far be it from me to suggest that anyone who has a mental illness not receive necessary treatment, but there is something about the prescription of writing that is healing, that is life enhancing, that is empowering, that is both personally and publicly changing.

We all know the power of writing from the glyphs on the walls of the caves of Lascaux, to the Guttenberg printing press, to the emails and texts we now zap off and retrieve in nano seconds. John Snow’s essay On the Mode of Communication of Cholera in i849; Ignatz Semmelweis’s Etiology, Concept and Prophylaxis of Childbed Fever both had powerful, although delayed, effects on public health.  But what does writing do that changes the writer whether it is a blog, a poem, an essay, a professional paper, or The Great Gatsby?

First, there is the actual physical act of writing.  Nick starts out writing in the journal in cursive which Luhrmann conjures up as the words scrawling and draping across the screen.  In 3D, the curlicued letters actually float out to embrace the audience.

….scientists are discovering that learning cursive is an important tool for cognitive development, particularly in training the brain to learn “functional specialization,”[  that is capacity for optimal efficiency. In the case of learning cursive writing, the brain develops functional specialization that integrates both sensation, movement control, and thinking. Brain imaging studies reveal that multiple areas of brain become co-activated during learning of cursive writing of pseudo-letters, as opposed to typing or just visual practice. Other research highlights the hand’s unique relationship with the brain when it comes to composing thoughts and ideas. Virginia Berninger, a professor at the University of Washington, reported her study of children in grades two, four and six that revealed they wrote more words, faster, and expressed more ideas when writing essays by hand versus with a keyboard.

There is a whole field of research known as “haptics,” which includes the interactions of touch, hand movements, and brain function.  Cursive writing helps train the brain to integrate visual, and tactile information, and fine motor dexterity.   MEMORY MEDIC by William Klemm, D.V.M., Ph.D.       What Learning Cursive Does for Your Brain | Psychology Today.html

Then there is the whole right brain/left brain relationship in writing that connects the creative emotional side of ourselves with the sequential verbal side.  So here is what is going on in each side of our sophisticated bicameral brains that developed around 1,000 BC when a purely reactive brain was not capable of figuring out complicated stuff, and a meta consciousness was required:  thinking about thinking, desiring about desire, worrying about worries, wondering about wonder.  Julian Jaynes thought about these thoughts documented in his 1976 book The Origin of Consciousness in the Breakdown of the Bicameral Mind.

Here’s what each side of the brain does.


uses logic
detail oriented
facts rule
words and language
present and past
math and science
can comprehend
order/pattern perception
knows object name
reality based
forms strategies

“big picture” oriented
imagination rules
symbols and images
present and future
philosophy & religion
can “get it” (i.e. meaning)
spatial perception
knows object function
fantasy based
presents possibilities
risk taking

Writing gets the major highway system between the two sides of the brain, the corpus callosum, activated in fact, bringing a wholeness to our thoughts, our expression, our selves.  Fantasies, dreams, ideas, fears, beliefs, travel into verbal language, knowing, acknowledgement, comprehension.

So this is what happens when we write, and I can tell you it is happening to me right now.  There is a total engagement, there is a sense of being “together,”  there is what Mihaly Csikszentmihalyi calls FLOW in the book by that name, subtitled Steps Toward Enhancing the Quality of Life.  Enhancing the quality of life; isn’t that what we strive for in our personal health and public health?  (Don’t right brain panic over how to pronounce Mihaly Csikszentmihalyi .  It is actually quite simple if you don’t let all of those consonants throw you and your left brain just goes with the sequence.  First name: Me High.  Last name: Cheek Sent Me High.)  Flow is what happens when your left brain and right brain are working in complete participation with each other, when we are “lost” in experience, in creation, in process. Experiencing flow is a positive experience; in fact, some people refer to it as “optimal experience.” Flow doesn’t just happen for writers—athletes call it being “in the zone.” Artists, surgeons, dancers, and others also experience flow when they’re completely passionately focused on something they love.

So this is the fun part of being healthy, enhancing the quality of our lives, of choosing to go with the flow, of optimal experience.  There isn’t one single prescription.  It isn’t one size fits all.  There is no standard operating procedure.  Natalie Goldberg in her book on writing, Writing Down the Bones notes that journals should be big enough to write big, but William Carlos Williams, the poet who was also a pediatrician, often wrote his poems on his prescription pad.  How perfect, the prescription of a poem.

It’s all about you and doing what engages your self fully, right brain, left brain, body, soul, spirit.  Garden, bird watch, play music write music listen to music, paint, dance (actually no matter what else you do always dance,) practice yoga, solve mathematical equations, build something (I can actually get a little too engaged walking around Lowes,) heal someone, heal yourself.  And do write.  You can do it anyplace on anything at any time.  I have actually written various stories, essays, articles on the back of grocery store receipts and pay stubs.  If you feel the least bit inhibited about writing something, I recommend a book called Wreck This Journal.  If you write in this book you will never feel inhibited about writing again, in fact you might never feel inhibited about much of anything again.

“Write something,” prescribes Dr. Gawande, ”it need not achieve perfection.”

So back to Nick Carraway, (fresh faced and glowing after a nap on the couch and the accumulation of his typed pages,) and the final line of The Great Gatsby with my own edits, (and no apologies whatsoever to Mr. Fitzgerald, who would probably have loved to have been able to approve,) on this fine morning, May 27, 2013:

but that’s no matter–tomorrow we will run faster, stretch out our arms farther…and one fine morning–so we write on, boats against the current, born ceaselessly into the moment.”

 boats against the current


Some of you know that in addition to writing this blog, I write essays, professional articles, and short stories.  I wrote the following for my granddaughter and so it is titled For Sonoma at Bedtime, but it is also known as

The Mermaid and the Cowboy

Once upon a time, under the great blue green curls of the waves in the deepest most beautiful ocean, lived a mermaid with golden curls and eyes the color of the blue green waves.  With her beautiful blue iridescent tail she swam with the whales and played with the dolphins and raced with the seahorses.  She and her mermaid friends dreamed of love and adventures and flirted with the sailors on the passing ships.

Over time all of her friends fell in love with sailors and traded their beautiful iridescent tails for feet.   Ah the better to walk with on the piers and dance and love their sailors.  But the mermaid with the blue green eyes was determined to find love and keep her iridescent beauty and the power of her swimming.  So as her friends left one by one she was lonelier and lonelier but also bolder and bolder as she explored the ocean from the crests of the waves to the deepest darkest crannies of caves and she became acquainted with every living creature in the sea.

And so it happened that one night as she swam over the castle spires of a reef, a great storm blew in from some dark and violent place and the mermaid, caught in the winds of change and the rains of despair, was carried far from her home in the sea, to craggy coastlines, up muddy rivers to a sandy creek’s edge.  Covered with mud, scraped and bruised she lay on the sandy bank sleeping off the nightmare of the storm.

A cowboy, dusty and weary, walked his pony along the creek looking for an easy place to settle in for a quiet rest and to let the pony drink.   As they wandered down the bank, the cowboy was dazzled by a glimpse of iridescent blue at the edge of the water.  When he scooped into the sand he found beneath a layer of mud, golden curls and glistening scales and peachy, though scraped and bruised, arms and hands and shoulders and a face that slowly revealed, as her eyelids flickered open, the blue green of a sea he had only imagined.  And the mermaid, her vision a little blurred from the night of tears and fears, looked at the cowboy and was dazzled by the gold dust glistening in the sun that shone upon his face.

Though he was awkward, at the water’s edge the cowboy washed the mud off of the mermaid, and then bandaged her cuts and scrapes.  He made a pot of coffee on a little fire he built at the edge of the creek and took some biscuits and wild strawberry jam out of his saddlebag. The mermaid sipped the coffee and ate the biscuits with him and was warm and cozy, feelings she had never experienced in the deepness of the ocean.

For a month the mermaid and the cowboy lived on the sandy bank of the creek while her bruises and scrapes healed and his exhaustion faded.  She told him about the ocean and the creatures of the sea, the waves and the deep dark places in the underwater caves.  And he told her of the prairies and the forests, of snow and butterflies and falling leaves.  He took his guitar from his saddle and sang to her of moonlit nights and lost loves and little lambs found.  And the mermaid sang to him in the lulling voices of whales and the cadences of the dolphins and the soothing tones of the tides.  Some days the cowboy would ride off for a while on his pony and the mermaid would dip and swim and splash her tail in the creek as she grew stronger.  And once, just once, the cowboy joined her in the water and clumsily tried to swim by her side.  But he floundered, frightened by what seemed to him dark and scary beneath the surface of the water.  He sank and had to spit out the water that poured into his mouth.  And once, just once, the mermaid tried to sit on his pony and go for a ride, but her tail slipped and she fell into the grass.   She tried to maintain her dignity, but she was embarrassed and tearful.

So the days and nights passed and one morning after a night with a full moon, the cowboy and the mermaid simply said, “good-bye,” and she swam away down the creek, along the stream and into the river and out to the sea without once looking back.  And the cowboy climbed up onto his pony and rode away from the creek, across a field, through a forest and over some mountains and out onto the prairie, and he tried not to look back.

There were no calendars in the sea or on the prairie and so no one could guess how many days or months or years passed, but after many many full moons and snowfalls and campfires, the cowboy realized that he had left his heart on the sandy bank of that creek and it had been carried deep into the sea.  And after many many tides and migrations of whales and births of seahorses too many to count, the mermaid also realized that she had left her heart at the edge of that creek and it was far away somewhere on a dusty prairie.

And so the cowboy and his pony boarded a ferry, and then a boat and then a ship and they sailed around and around the world looking into the sea for a glimpse of iridescence and the blue green eyes of the mermaid he loved.  And the mermaid swam up rivers and into streams and creeks, and painfully wriggled into ponds and the shallowest of puddles on the prairie looking for a cowboy who was dusty and dazzling and who she loved more than anything.

It was a kind storm of graceful rains and fortunate strong winds that tipped the ship and beached the cowboy and his pony and that washed the mermaid out of the puddles and down the creeks and into the rivers, back to the sea where the whales and the dolphins and the seahorses conspired to carry her to a brilliant beach where she awoke in the cowboy’s arms.  In the moonlit nights of days that were on no calendar, on that beach at the edge of all oceans they sang together and danced.  And each fine morning a cowboy, holding the hand of his mermaid, swam in the blue green curls of the waves and each evening, a mermaid safe in the arms of her cowboy, sat proudly on the back of his pony as together they rode off into the sunset.

On the Bottom of a Paper Bag

I suppose I had noticed the names and dates at various times when I bought a deli sandwich or a cup of coffee or some totally evil pastry that came in one of those small paper bags.  A quick glance at the bottom of the bag at the name Maribel or Raymond or Mary, Lucita or Juan or sometimes a first initial and last name like L. Vu.  And a date. While I had noticed the names I hadn’t thought too much about them until I went to an exhibit at Mass MoCA with my friend Pat, after driving through the autumn New England countryside from Saratoga to North Adams.

Mass MoCA, the Massachusetts Museum of Contemporary Art, Mass MoCAis housed in an enormous old brick manufacturing building, with huge galleries, including room after room of Sol Lewitt’s wall drawings of bold strips of color and myriads of intersecting pencil lines.  The collection of paper bags by artist Mary Lum was part of an exhibit called The Workers that chronicled the connection of the people who operated the machines with the products and process, the banality and pride of manufacturing. The Mass MoCA blog states:  “Tinker Tailor Soldier Sailor features an assemblage of hand-torn paper bag fragments which the artist has been collecting for nearly two decades. Each of the pieces – torn from a multitude of bag bottoms — is stamped  with the name of the individual who made the bag or oversaw its production and quality on the assembly line.   A detail easy to miss, each name reminds us of the human element behind industrialized production and the objects we use on a daily basis.”  Mary Lum stated that the piece was about “the idea that a human being is taking responsibility for the acts of a machine, and the double purpose of being named, pride and quality control.”

(To read more about the exhibit: Mass MoCA The Workers May 29, 2011 to April 14, 2012

The exhibit was a reminder of how powerful our names are.  We sign checks, our tax returns, and all manner of legal documents that commit us, connect us, bind us and sometimes separate us.   We sign our names on little notes to loved ones, birthday wishes and post cards from faraway places; we sign our passports.  And for those of us in health care, our names verify notes in patient files, prescriptions, care plans.  When I was in the pre-op room before my ankle surgery on February 7, 2013, my surgeon, according to surgical protocols, initialed my right leg.  Tragic surgical errors of operating on the wrong person, at the wrong site, with the wrong procedure have resulted in the need for checklists of the process of identification and accountability to assure safety and quality of care.  On the website of the American Academy of Orthopedic Surgeons, the list is as follows:

Pre-operative verification process

  • Hospitals should identify the methodology of pre-procedure verification and site marking based on their own circumstances. Verification of the correct person, procedure and site should occur with the patient awake and aware, if possible:
  • At the time of surgery/procedure is scheduled.
  • At the time of pre-admission and testing
  • At the time of admission or entry into the facility.
  • Anytime the responsibility for care of the patient is transferred to another caregiver.
  • Before the patient leaves the preoperative area or enters the procedure/surgical room.

An article in the Chicago Sun Times noted that: “Even seemingly minor mistakes such as using an unapproved pen to mark the site, resulting in the ink being washed away before surgery, can open the door for a wrong-site error,” Joint Commission President Dr. Mark R. Chassin said.  Chicago Sun Times July 4, 2011

The surgical site can be marked with a line where the incision will be made, or with “yes,” with an X, or with the surgeon’s initials.  So my surgeon, Adam Becker, MD, of Englewood Orthopedics, marked my right leg with his initials, I am happy to say.  This might just be the protocol of Englewood Hospital, but to me it meant he was not only marking the site so there was no doubt about which ankle needed the incision, titanium plate and six screws, he was taking ownership of that ankle.  The procedure, the responsibility, the accountability and the quality of my ankle repair belonged to him.  I must say about a month after the surgery, after the massive wrappings and ace bandages which were transmogrified into a bright blue hard cast were all removed and the stitches came out and I was able to (finally!!!!) take a bath, I was a little sad to see the Sharpied AB on my skin float away into the warm water and bubbles.  My ankle was back to being my sole possession and responsibility although I will always appreciate Dr. Becker’s kindness, skill and his accountability.

Accountability is what it is all about in health care now linking the reduction in costs, with the increase in quality outcomes and patient satisfaction.  The triple mantra of right price, right place, right services, supports the structures of Accountable Care Organizations, under the Affordable Care Act.  Believe me, everyone out there providing health care wants to be an Accountable Care Organization because that’s where the government money is going.  Being Accountable is lucrative and the big health care providers and insurance companies are all grappling with the cost/quality/satisfaction matrix.  There’s a great website that brings together all of the research and expertise that accountability in health care is generating in policy and practice.  Important information for all of us care providers and patients.

And yet in this grand shift of corporate health accountability I think the change will be in the commitment of individuals to their own responsibility and pride in a job well done, of individual caring within a structure of accountability…kind of like people putting their names on paper bags.  Atul Gawande, MD, my second favorite surgeon, has focused on this in his Checklist Manifesto:  How to Get Things Right   In the environment of massive knowledge and expertise he maintains that true accountability and quality is in the commitment of each individual checking off their box on the check list.  I did this, I am responsible for this, I care about this, I am committed to the best of this, I check this off and put my name on it.  I own it.  This is my paper bag, my ankle, my responsibility and pride, my own name, my humanity.

At another museum, The Hirschhorn  on the Mall in Washington, DC, which I visited last  November with my friend Heller An and her daughter Karen, there was an exhibit of the work of Ai Weiwei, the brilliant Chinese artist, philosopher, political dissident  and human right activist.  There were his amazing Circle of Animals Zodiac Heads around the reflection pool, the back pack sculpture representing the 5385 students who died in the 2008 Sichuan earthquake, and the bold black on white statements like, “When was the last time you laughed?” And on one wall the testimony to each person’s accountability, rights, pride, commitment to quality, to their individual spirit and value, in health care and all care, caregiver or care recipient, individual human caring, kindness and virtue:

A name is the first and final marker of individual rights, one fixed part of the ever-changing human world.  A name is the most basic characteristic of our human rights:  no matter how poor or rich, all living people have a name, and it is endowed with good wishes, the expectant blessings of kindness, and virtue.   Ai Weiwei

lewitt and me

Karel Rose Amaranth

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