Review, Doctored

If you’ve got troubles, don’t tell them to your doctor, who is probably more stressed and impoverished than you, and more exasperated than even her patients with the state of medicine today. This is the gloomy take-away of Dr. Sandeep Jauhar’s Doctored, The Disillusionment of an American Physician.  doctored

Trawling through Sermo, an online community of physicians, Jauhar finds one doctor who calls American medicine a “charade” and believes he is a “pawn in a money-making game for hospital administrators” and another who figured he made $11.74 an hour the previous year.

This is the cheery prologue to Jauhar’s own story, in which his wife longs to escape their one-bedroom apartment and a “cash-poor” life that is rich in angst and overtime, but scarce in rewards that were plentiful just two generations ago. Back then, Jauhar writes, “If you were smart and sincere and ambitious, the top of your class, there was nothing nobler or more rewarding that you could aspire to become. Doctors possessed special knowledge. They owned second homes. They were called upon in times of crisis. They were well-off, caring, and smart, the best kind of people you could know,” he writes.

What happened? Well, Medicare, for one thing, then the dastardly Health Maintenance Organization Act of 1973, explosive malpractice liability premiums and the rapid growth of a “labyrinthine payer bureaucracy.” Throw in an aging population that requires more care than its parents and grandparents did, and pressure to make money, not for one’s family, but for vaguely sinister “hospital administrators” and you’re likely to just take an aspirin and call it a day.

It could be argued that Jauhar, a cardiologist who writes regularly for The New York Times and who chronicled the early days of his career in 2007’s Intern: A Doctor’s Initiation, is burned out, not from the rigors of medicine, but from his moonlighting as a scribe. And he is, in fact, a masterful writer who might have scraped by as a poet or novelist, and foregone the medical-school debt, if he hadn’t succumbed to family pressure to become a physician.  Jauhar’s mother, he reveals, wanted her sons to become doctors so people would stand when they walked in the room. He complied, but also became a fine wordsmith along the way. Here he is, musing about the notes he writes after making hospital rounds one afternoon:

“How limited our interactions with patients, I thought. We see them for a few minutes, then pen a quick summary and leave directions for the nurses to follow. To whom are we speaking in these inky chart drizzles? Doctors, patients, a phantom lawyer?”

In this, and in case histories, in which Jauhar makes plain the psychic agonies of the profession (in one case, he urged a man to have a diagnostic catheterization that, because of complications, resulted in the man’s death), Doctored delivers with enlightening punch. Its theme, however, remains darkly consistent. It’s as if Eeyore got a medical degree.

Jauhar’s points are well taken, and you don’t have to believe, as Cicero did, that men are as gods when they bestow health, to think that doctors should be well-compensated. They should be, if not for their knowledge and their willingness to do things others won’t do, then simply so they won’t be distracted by how they’re going to pay the light bill while they’re pulling our gall bladders out.

Then again, in an age in which almost every profession is convulsing, and pensions and Social Security can no longer be relied upon for old age (not that they ever should have been), there’s only so much hand-wringing from doctors that patients of modest means can take. When the average American takes a second job to pay bills, it most likely involves delivery of pizza. When Jauhar takes a second job, he’s paid a thousand dollars to deliver a speech about a drug he prescribes – and on the job, he gets dinner “with fine wines flowing freely” and even car service if he’s not up to the drive. Cue the world’s smallest violin.

At one point, while bemoaning a monthly budget that was $2,000 short of bills that had to be paid, Jauhar verbally spars with his father, who yells at him, “What’s not to enjoy? You are a doctor! You have the respect of the world!”  Though this is a parent whose influence has not always been admirable, on this point, the reader may be inclined to agree. Doctored opens a door into a once-golden world that, for most, is still enviably silver. Forgive him that, it’s still a fine read.

Originally published in The Hippo.

Review, The End of Absence

   Michael Harris recalls an encounter with a younger friend who was texting throughout the conversation. It wasn’t the texting that was memorable  — who hasn’t been there? absenceimage— but the chasm between a swath of people who see texting-while-talking as normal, and those who find discomfiture there.

“The really gruesome thing was that he didn’t notice or care that we were both so disengaged. The ‘natural’ attention of someone just a few years younger than me is vastly more kinetic and fractured – attention span has evolved,” Harris writes in The End of Absence, which he calls a “meditation” on digital culture, but is just as much blistering critique.

Harris is 33, but he’s an old soul troubled by a new age, one in which teens send 4,000 texts a month, compared to 764 for adults. “They mumble to each other friendly enough, but mostly it is their phones that grip their various attention,” Harris observes of today’s teens.

The teens are the eldest of a demographic that Harris calls “digital natives.” They dwell in violent contrast to their parents and grandparents, the “digital immigrants” who dabble in digital life. Between them are the “straddle generation,” those born, like Harris, in the 1980s, and who will eventually be the last people to remember life before the Internet.

The straddlers possess almost mystical power, with their vision of both future and past. They are the ones who see and understand what will be lost to coming generations, what Harris generalizes as “absence” but is also aptly described as distance. Either, the ability to remove oneself from the constant demands and solicitations of others.

“I fear we are the last of the daydreamers. I fear our children will lose lack, lose absence, and never comprehend its quiet, immeasurable value,” he writes.

Twenty years ago, the prescient cultural critic Neil Postman wrote in Technopoly that we need a “psychic distance from technology.” Here, Harris rises in his shoes, urging not just psychic distance, but physical, too. Frustrated with his own inability to finish War and Peace – 1,300 pages and “weighing the same as a dead cat” – Harris proposes to create the necessary absence from the incessant pinging, both internal and external, and to read 100 pages a week and finish within two weeks. After this experiment, he embarks on another: to unplug – to go “analog” – for a month, to the point of duct-taping his cell phone to an old-school telephone cord in his kitchen, and only using it for tethered conversations like our grandmothers did.

Throughout his own ruminations and experiences, Harris reports on the evolution of the digital age, interviewing sources as disparate as the founder of the online dating site Plentyoffish, to a medical doctor who serves as a moderator on Wikipedia, to the Stanford professor who was the first to put college courses online. In these passages, he’s utterly engaging.

Prude alert: Harris is gay, and although he is in a committed and respectful relationship with an artist, who makes frequent appearances in the narrative, in a chapter on digital dating he wades thigh-deep into territory that some might prefer not to know about, websites like Grindr, which, by comparison, make the denizens of Ashley Madison look buttoned-up and repressed. On the whole, this chapter didn’t seem to fit the theme of the book, and it’s not the only time that Harris wanders off the path, as he does in discourses on elitism and criticism. A longtime theatre critic for The Globe and Mail, Harris struggles with the new world in which everyone’s a critic. “What a lovely thing, to shut up and listen and not broadcast anything back,” he writes.

While the conclusion of the book, a diary of the digital fast, is vaguely predictable, The End of Absence is a satisfying discourse for anyone wishing Postman had lived another 50 years. And Harris, though his friends call him a Luddite and a curmudgeon, is young and nimble, able to both savage and embrace digital life. It’s not all terrible for the kids. “They will get lost in the woods, they will run naked on beaches, they will sometimes shut off their devices,” he promises.   But this book is a reminder that parents must “proactively engineer moments of absence” for themselves and their kids. “We cannot afford to count on accidental absences any more than we can count on accidental veggies at dinner.” Hear, hear.

Originally published in The Hippo.

Do it to me one Mo time

My car is not the stuff of dreams. It’s more like the stuff of landfills.

It is eight years old and overly salted, like a bad French fry. The side-view mirror is cracked and sometimes falls out, the casualty of a long-ago car wash. 

Worse, however, than the faint smell of manure, ground forever into the stained carpet by my boots, is its obsolescence.   It is a make and model of a car deemed so commercially unpopular that its maker stopped production after just five years.

But there is this:  A friend of my son climbed in recently, and over the din of the radio and the rough teen-aged banter, I heard the boy say, in hushed decibels of reverence, “This is Hank’s car, isn’t it?”

Hank and his Mo. (Image via IMDB.com.)

Hank and his Mo. (Image via IMDB.com.)

Hallelujah, thine the glory, as my sainted grandfather used to sing. On behalf of Jeep owners everywhere, thank you, Vince Gilligan, for making the Jeep Commander relevant again.

In Breaking Bad, Gilligan gave us Walter White, the most endearing villain in television history, and his equally lovable brother-in-law, the bull-headed Hank Schrader.  It was Schrader who drove a Commander just like mine, and in doing so, snatched the car from the brink of malicious parody that befalls so many discontinued autos. 

AMC Gremlin, anyone?

Thought not.

But my Kelley Blue Book value may hold firm thanks to the other AMC.

Although the finale aired nine months ago, Breaking Bad’s popularity has yet to diminish. The box set of the series sold out within a week despite its price, $225, and it’s still fetching twice that on Amazon. The show garnered 16 Emmy nominations last week. It has legs like Meb Keflezighi– as does my Jeep, sudden of the teen-aged noblesse.

This is not the first time that a television show has jump-started a sputtering car.  Edmunds.com listed the top 100 movie and TV cars a few years ago.  The Monkees’  Pontiac GTO was No. 100; the Dodge Charger of The Dukes of Hazzard made No. 1. That car, known as the General Lee, remains a quasi-religious icon down South.  Maybe the Commander will fare the same in the Southwest.

 As much as Gilligan, I must thank the Breaking Bad writers for that, for it helped that Dean Norris’ Schrader broke good as the series played out.  Had Schrader’s seedier side prevailed – and he was occasionally a narcissistic boor, was he not?— my car might have gone the way of the Ford Pinto, buried in the dry sands of memory.

    But Hank turned out to be the good guy, perhaps the only actual grown-up in the Breaking Bad universe.   His shoot-out with two murderous men called “The Cousins” was knee-gripping television that made you wonder why you ever go to the movies.

 And there by Hank’s side, keeping him alive, was his stout-hearted, bad-ass Jeep.

Or, shall I say, my stout-hearted, bad-ass Jeep.

   In real life, the Commander fared more like the unfortunate Cousins in its brief spin through the marketplace.  Introduced in 2006, Chrysler sold just over 88,497 the first year, and the numbers plunged each year after that.  The 2010 model, the last produced, sold just 8,220.  It may not the worst selling Jeep ever; the nondescript Compass isn’t doing so great.  But the Commander was doomed by its boxy silhouette, poor driver visibility, and lousy fuel economy, just 13 mpg in the suburbs of Albuquerque.

    In shoot-outs, however, the truck rocks.

     My Jeep  joined the family in 2006, back before the housing bust. At the time, there was a radio commercial airing that made fun of big mortgage payments and how they drain money from other wants and needs.   Want to take a vacation?  Big Mo says no!  Want a new car? Big Mo says no! 

      We laughed at the ad, and someone suggested that Big Mo would be an excellent name for our imperial, outsized Commander.  And so he has ferried us about, mostly reliably, for 140,000 miles, except for that little episode with the MAP sensor. (If you have one, and haven’t had it replaced, log off and get to a dealership right now.)

   When Breaking Bad began, Big Mo was 2 years old, and already looked a little like the man who drove it:  somewhat oafish, arrogant and crusty.  But by the time Hank died in the desert –  noble, defiant, contemptuous of the surrounding moral vermin – the Commander, too, had been redeemed.  Like its owner, it was bullet-riddled, but strangely virile in repose.

   The car will endure so long as Breaking Bad does, which right now, appears to be forever; the spinoff, Better Call Saul, debuts next year.  Can’t wait.  Gilligan promises that some beloved Breaking Bad characters will recur in the prequel. Hallelujah, thine the glory.  I fervently hope they are driving.

 

Review, The Painter

For this literary explosion masquerading as a book, The Painter seems an incongruous title until you remember that Moby-Dick was first published as The Whale. Then it makes sense. Sometimes, when trying to reduce brilliance to luminescence that fits in one line of 72-point type, you throw your hands up and say fine. The book’s about a painter; that’s it. ThePainterCover

But that’s so unfair, like singling out a favorite child, because the protagonist of Peter Heller’s new novel is also a fisherman, a killer, a father, a lover, a madman, all these beings roiling in one bearded Jim Stegner, who begins his story saying, “I never imagined I would shoot a man. Or be a father. Or live so far from the sea.”

Thus begins a powerful confessional that might have unfolded between priest and penitent in a darkened booth, or in the mirrored interrogation room of a county jail.

Stegner, the painter, once spent a year in prison for shooting a man in a bar – but that’s okay. We think we like him anyway, because the guy had threatened his teen-aged daughter (and thus deserved to be shot), and anyway, he had survived. And Stegner now lives a peaceful, if unrepentant life, painting canvases in his little house on 40 dry, grassy acres on the outskirts of Paonia, Colorado, and fishing for trout when he’s not painting.

It’s only idyllic on the surface. Stegner’s past is Pollockian, splotchy with pain. It is revealed early on that his daughter is dead, although the details emerge slowly, as with the subsequently shattered marriage, the rebound wife, and the burgeoning career. What is clear is that our hero — or is he antihero? – has anger-management issues that reside uneasily with a heart thick with compassion.

   “Grief is an engine. Feels like that.  It does not fade, what they say, with time. Sometimes it accelerates.”

So when, on a lazy afternoon of fishing, Stegner comes across a boorish mule of man clubbing a small, tethered horse, the painter explodes. He rescues the horse, but bad things ensue, and soon, he is enroute to a commissioned portrait in New Mexico, with both the law and the lawless trailing him, as he struggles to come to grips with what he’s done (and is about to do) while avoiding all consequence.

Condensed like this, it sounds like a badly-made-for-TV movie, the ending of which you can spot three canyons and a shoot-out away.   But The Painter is not any more a rowdy Western than Moby-Dick is a fishing manual. It is a subtle, taut and brilliantly crafted story that, like Stegner’s ever darkening paintings, deepens in complexity as it evolves. In the vernacular of beach reads, it is a “page turner,” only smart, probing the rough edges of morality, existence and art in the voice of a man singed with regret.

And there is much ado about fishing, and about art, not only Stegner’s (whose pieces introduce chapters, like so: “Horse and Crow, Oil on Canvas, 36 x 48 inches), but that of real, renowned painters, like Belgian Surrealist Paul Delvaux. There’s a smattering of poetry, as well. (And even though it is set in the West, Heller nods at his Dartmouth education with a character who hails from New Hampshire.) There is sex, and there is violence, but it’s never gratuitous. It just all seems inevitable, like a conclusion that Stegner reaches about life:

    “I knew: that whatever I was, my soul was no more substantial than a tattered leaf, one of those torn off a streamside tree in the flood. That I was nothing, that whatever I had done in my life amounted to just that, shreds no heavier than leaves, and that also whatever I had done, I had done it like a blind storm-ripped thing, or like a blind animal nosing from scent to scent and was whomped and carried most of my life by the wrath and high spirits of a power without malice, and that I had done my best and loved my daughter.”

So much for free will.

Before diving into fiction with 2012’s deeply moving, dystopian debut, The Dog Stars, Heller was a writer of non-fiction articles and books, including memoirs about surfing and white-river rafting. Like Hemingway, he seems to live first, and write second, which makes for detailed, rich and meaningful prose. Despite – or maybe because of — its morally dubious protagonist, The Painter is an extraordinarily compelling story that, like a good painting, calls to you even after you’ve left the room. It is, in the words of the painter, about “life at its most desperate,” which might make for an agonizing existence, but always makes a great read.

Clorox® copy and post-traumatic-radio-show wounds

I love hearing and sharing backstories – the story behind the edited, bleached version that is printed.

A few days ago, an editor made me laugh when he told me he was shipping back the “Cloroxed” version of my piece. Yes, my work needs bleaching, just like my hair.  Much of the work is joke extraction. They cut; I sulk. But only for a day.  When I was younger, I used to think the perfect editor was one who left everything just like I wrote it. Now, I treasure editors who challenge every sentence. (“Who told you your name was Jennifer?  Can you prove it? Give me a link!”)

The young Bill McKibben quit in solidarity when his beloved editor at The New Yorker was fired. I’ve worked with many editors who inspire devotion like that.  They regularly save me a heap o’ trouble and occasionally cut me a check.

So please understand that when I jab them here, in The Freelance Strategist at Contently.net, it’s the playful jousting of love.

About the piece ..

Writers are famously poor self-editors because we don’t want to “kill the babies” –  writers’ jargon for excising words that we’ve written. Well, my message at Contently is that we don’t have to commit wordicide–  we can take any collection of unused (i.e., unpurchased) words, swaddle them sweetly, and tuck them away. You never know; they might not be done with you yet.

The piece that started it all was an essay I wrote, lo these many years ago, about my abominable appearance on The Rush Limbaugh Show. Since it’s no longer available through National Review Online, I offer it here.

It’s called The Silent Crisis of a First-Time Caller, and it was published  Aug. 1, 2003.

 

SOME PEOPLE have their 15 minutes of fame; others, their 15 minutes of shame. Count me among the latter.

It’s been a couple of years now, but the memory of my first ­ and last ­ call into the Rush Limbaugh show can still make me blush. They say only 1 to 3 percent of talk-radio listeners ever actually call into a show. I never should have joined their ranks.

I was listening to Rush on a lazy summer day while visiting my grandmother’s house. Gram introduced me to Rush, back when he first went national, and the radio is always on the EIB at her house. She was in the backyard with my kids, while I scanned the morning papers.

On this day, Rush was ranting about Hillary Clinton, who had recently called the state of childcare in this country a “silent crisis.” I, who had once left an infant son in the clutches of a facility called Lollipop Lane, happened to agree with Hillary, for once. I was still indignant over the cookie-making crack, but on this matter, we’d found common ground.

Rush, I grumbled to myself, has no clue what it’s like. He’s no mom. He has no right to make light of a problem that does indeed approach crisis proportions for mothers without prosperous mates.

A sensible woman would have kept those thoughts to herself. But, propelled by excellent coffee, I reached for the phone and punched in the number.

The first time, the line was busy. As I hit redial, a discomforting thought flitted through my righteously angry right-brain: I have no actual, reasoned arguments to make if I wind up on the air. But, hey, what were the chances of that? I’d been trying to get through to Dr. Laura for a year. Besides, even if I did get through, I’d have 30 minutes or more to sit on hold and collect my thoughts.

Wrong.

On the fourth ring, the call screener picks up while I am inspecting the day’s vinegar hints from Heloise.

“What’s your first name, and where are you from?” he barks.

Blessed Mother, stumped already. “Uh, I’m from Virginia, but I’m calling from South Carolina,” I stammer.

“What’s your point?”

Point? I gotta have a point?

I blurt out something about day care — something breezy, witty, erudite, like “It is TOO a crisis!” —- and he interrupts. “You’re next,” he says, and disappears from the line.

It appears that when Rush wants people to disagree with him, he wastes no time putting them on.

I jump up and sprint through the house, looking for someone, anyone, with whom to share the glorious moment. No sign of anyone. And I’m now out of breath.

“And, now, Jennifer, in Columbia, South Carolina,” Rush says cheerfully and turns the show over to me.

Twenty million people are listening, and I am panting like a Labrador who has run too far in the heat.. Rush probably fears he’s inadvertently let a pervert on the air.

“You” ­ gasp ­ “are” ­ gasp ­ “wrong” ­ extended inhalation ­ “about day care.”

Lamaze, I think, frantically. Cleansing breaths, cleansing breaths!

Mercifully, Rush takes pity on me. Either that, or he needs time to call the police. “I think it’s time for a break. Can you hold on through the break?”

I think maybe we’re going to have a private conversation; he’s going to reassure me and pump me up. Wrong again. I find myself back on hold.

Briefly, I think of hanging up. Instead, I locate my grandmother and the kids, now sitting on the front porch, examining a caterpillar, oblivious to the crisis inside.

“Get the radio!” I hiss. “I’m on the phone with Rush Limbaugh!”

My grandmother looks uninterested. “You know, even if you get through, you might not get on the air,” she said.

“I AM on the air!” I shriek.

Unconvinced, she trudges into the house with the kids, retrieves a battery-powered radio and retires to the backyard. I sit down, moaning and clutching my head. Then suddenly, Rush is back, inviting me to make my point.

I blather. I sputter. I vacillate. I question his knowledge of day care, then apologize for the offense. He is kind, speaking slowly and enunciating carefully, as one talks to a frightened child.

I manage to tell the nation that I have been a stay-at-home for a year, and had employed a nanny and used day care before that, providing me with experience that he, Rush Limbaugh, lacks. But beyond that, I cannot muster any articulate defense of my position, proving only that I spend way too much time with preschoolers. I’m back to my original position: “There is TOO a day-care crisis, so there!”

Things couldn’t get worse, but they did. At this point, my children — ­ I think they were 3 and 4 at the time ­ —  fling open the kitchen door, clutch my legs and burst into tears.

“What IS that?” Rush asks.

Mortified, I fight the urge to whack the kids with the phone.

“That’s my children crying. My grandmother is supposed to be watching them,” I say helplessly.

I look out the window, where my grandmother is sitting in her lawn chair, radio to her ear. A seven-second tape delay later, she looks alarmed, leaps to her feet and hurries toward the door.

At this point, I get off my only good line of the day. With my son still crying on national radio, I say forlornly, “I guess maybe I DO need government day care.”

I find this wildly funny. Rush, he does not laugh. After a few more stilted exchanges, he puts me out of my misery and lets me hang up the phone. “You’ve been a good sport, Jennifer,” he says. It is a cryptic adieu, notifying me that, sometime in the past five minutes, I must have been cruelly insulted.

Whatever. I sink into a chair, grateful the ordeal is over. “Well,” my grandmother says brightly. “That was something!”

In the poem “Snake” by D.H. Lawrence, the narrator encounters a magnificent snake at a watering trough and feels awe and reverence until, inexplicably, he throws a stick at the creature and is consumed with shame. It ends: “And so, I have missed my chance with one of the lords of life. And I have something to expiate, a pettiness.”

I know exactly how he feels.