Sunday, February 28, 2010


Back when I was working on my boat a lot, I would sometimes find myself in a mess of more than I could handle. A handy way to picture this situation might be to imagine me with toxic epoxy up to my elbows, a head full of the understanding that I would have to use toxic acetone (nail polish remover) to get it off, and panic about various boat parts in various stages of hardening into the wrong position.

Of course, none of these problems could or would occur had I been less concerned to make permanent repairs or modifications. In the "old days" before the advent of such conveniences as epoxy, it was understood that timbers would rot, that they would need periodic replacement and that the entire labor was an ongoing and therefore never-ending process. Things were even built with an eye toward the possibility to repair them.

We have such enduring and durable methods now, and hardly anyone really bothers with wooden boats. Still, the plastic ones don't, in fact, last forever, and they can be pretty hard to dispose of. And somehow the cost in real dollars to own one keeps shooting up to the point where you almost might as well just build more disposable ones. Except that the cost for a wooden boat goes up even faster.

It is very hard to find peace and calm up against the rush of daily life as we live it.

These days, politically, we seem to be engaged in a new version of trench warfare; that ancient WWI disastrous technique which led to the advent of chemical agents and other monstrous techniques to smoke soldiers out of their trenches.

The longer term solution, on top of fairly lame new laws of warfare, seems to have been bigger and more powerful machines of war, combined with a sort of tactical guerrilla deployment of lightweight units.

In the political arena, we have opposing camps of certainty, which keep looking for ever more powerful tactics or techniques to outsmart foes which are certainly more stupid than your camp. Deserving to die outright. Sometimes the camps even try to sharpen up their arguments, but it seems difficult to downright impossible to entice anyone out of the other team's trenches even to pay attention.

Certainty is certainly not a function of being right. We know, historically, that each time we have thought ourselves certain, that certainty, over time, looks silly. Think about bloodletting, or early treatments for mental illness, or certain medical techniques and chauvenisms. The only embarrassing thing, looking back, is that we were once so certain of something which now looks silly.

Look back on your childhood, for instance. There's nothing that terribly embarrassing about being a child, or being wrong. Just about being certain when it turns out you are in no position to be so.

Certainty is a function of meshing your own position to a larger frame whose stability feels like the very definition of sanity. These frames may be religious, or scientific, and sometimes, especially in the case of science, fairly propositional. You aren't sure what the "right" answer will be, but you're pretty confident of the procedures which will find it.

So, the frame, in the case of science, becomes the Grand Narrative of progress. And still, if you are a medical doctor, called upon to diagnose individuals' dire and distressing complaints, you have to operate within some kind of ad-hoc certainty to be able to function at all. You operate within the frame of what is state of the art today.

And still you might have a hard time listening to those who understand at least the broad outlines of what you're saying, but from the inside, as it were, can't quite go along with the diagnosis. They have contrary evidence, but maybe not the words.

In the case of warfare, nuclear explosive devices have arguably kept conflict down to what classroom teachers like to call a dull roar. World War and the epic-level casualties from the two Great Wars have been kept pretty well in check.

Meanwhile, even though the age of Einstein also marked the age of Thomas Kuhn's skepticism about the certainties of "progress," as well as the overall Post Modern critique of any kind of certainty, we do and must await some sort of new approach to resolving entrenched differences before we can put away the bomb.

Here's a thought:

Yesterday, yet again, I landed in the ER. It felt like the same thing which happened Christmas Eve when I was found to have suffered multiple pulmonary emboli. The diagnosis yesterday was dehydration, likely related to having had a few too many drinks the night before.

The only trouble with that diagnosis for me is that I've had a few too many a few too many times for this brand new set of symptoms to make sense to me. Plus, I'd felt fine in the morning, no headache, no hangover, and had headed out for a walk, in the middle of which I felt the same kind of sudden and total loss of power that I'd felt on Christmas Eve. So, I kept walking, with whatever energy I had left, to the hospital which was no further than to turn around and go back home. Made sense to me.

Lots of tests later, the good news is that there is nothing apparently wrong with me. The clots are known to still be there, and the treatment protocol is ongoing. I guess I'm looking for some trigger this time which made my dehydration do something different than it had ever done before. I'm looking for some connection between this event, the event on Christmas Eve which also came on while walking in the cold, and an earlier event which bizarrely enough felt about the same from the inside, but which was diagnosed to be more of a manic episode with psychotic symptoms.

I know that in the earlier case my mind really did go off the rails. The narrative that I was inhabiting was fully detached from reality. There are reachy links among these events, relating to potassium levels, perhaps, but there have also been very definite and distinct diagnostic protocols which have been able to pin specific issues. And thankfully, some medicines to treat them.

Extraneous to all of these diagnoses is the fact that I have been making an awful lot of changes in pretty short order. I left my job, on the basis - I have to guess - that the cognitive dissonance between what I was doing and both expected of myself and was expected by those who paid me to be doing; and what I felt to be central to my being.

Then I moved premises, sold my house, re-established some important relationships, and established some important new ones. And without really thinking terribly hard about it, I find myself eating the kind of anti-cholesterol healthy diet which I never could get myself to do back when the doctors told me to.  Not to mention distressing events in the Big Picture, like the catastrophic anti-government, anti-regulatory, anti-common sense regime of GWB and his team of hucksters. Global warming, peak oil, teapartyism, Fox TV, and all sorts of things to make a thinking man feel as if the whole world is going off the rails.

So, there have been a lot of changes to my life, and it makes perfect sense to me that there might be a slew of symptoms as I seek, however inchoately, to re-establish some sort of homeostasis.

I by no means wish to be my own doctor, nor to second guess the treatments that I've been receiving, many of which may well have saved my life. I do, rather, wish to second guess the certainties in which these treatments are embedded. Because the one and only thing which ties the different things which have happened together is me. Not me as in the master of psychosomatic symptomatologies, but me as in the guy who has made all the decisions as a result of dissonances which I didn't really do a whole lot to cause.

Sure, I had choices about what job to take, but like all of us, not as many as you might think. I could have deployed strategies to stay where I was, but I saw an opportunity, like a speed skater at the Olympics, and bolted through the gap.  I could have tried more medicines, but, at least inwardly, my difference from the norm was worth taking into account, and none of the diagnoses fit well enough for me to inhabit them fully. Provisionally, for sure, but never quite fully. There has simply been too much changing at the same time, and it hardly surprises me that there might be physical or emotional manifestations.

It always surprises the medical establishment that I'm not on any meds. What's wrong with this picture?

What the doctors can offer me is a much more finely tuned sense than I could ever have of liklihood. They know how to weigh things in some context, where I might be latching onto potassium deficiencies, because among its list of symptoms are all the things which I have experienced. Where an experienced practitioner can put these into some sort of perspective, based on lots of obervations and research.

On my own, at best, I would make a kind of teaparty random mess of my desperate flailing after some explanation. And in the case of health issues, the explanation is precisely what you don't want because that would be a diagnosis, which would mean that there really is something basically wrong with you. So, I'd say ambiguity can be a good thing. Sometimes.

Well, unless a diagnosis is missed and then you end up dying when you needn't have. Which is pretty much why you keep your head down in the trenches too. It's scary to consider what might and can and sometimes likely will go wrong, and if smart people are warning you to look out for what might happen, it's pretty hard not to. Even though, sometimes, the aggregate net effect of looking too hard is pretty hard to distinguish from lots of people getting sick all at the same time, maybe mainly because they've stopped looking after themselves.

Which goes right back to that godawful mess you can get into working on an old fashioned wooden boat in the face of more modern technologies. Sometimes when you add up all the treatment regimens for any one human being, especially after they start interacting and even conflicting with one another, you do end up with a treatment looking a whole lot worse than whatever the disease was that started the whole thing way back in the first place. How many tales have you heard, especially from the elderly, about having to strip away the meds one by one to get back to some baseline from which some sense can start to be made.

The mess is the simple and perfectly predictable result of working within little subsets of certainty without, ever, being able to step back and consider the whole. Imagine if we let the Palin Republicans handle the economy, while the Obama Democrats handled health care. Is there anyone in the world who would consider that a very good idea?? But does anybody consider the compromises we end up with a very good idea? Really?

We will have to find a way to crawl up out of our trenches. We will have to accept that some of us may die of missed diagnoses, reticence, stupidity. It may well be fewer than die now from mistakes in the hospital, which is far more than die from mistakes on the highways.

In my life, retrospectively, there was no need for the big guns deployed against various possibilities which never did materialize. I think I would have died of an appendectomy if there had not been surgeons, but I don't really think that was a terribly complicated surgery. And who knows, I may not have needed to drink so much, which might have been what brought it on, if things hadn't become so crazy in the world by then. If I hadn't been in the middle of not just cognitive dissonance, but crazy amounts of stress trying to keep a school open to which all sorts of lovely people had somehow attached their identities.

The trouble is that you can't really know in advance which are the ones who really do need the intervention of the big guns. Which are the ones who will need the anti-psychotic meds for life. Whose hearts are ticking time bombs. Who is prone to clotting, who will die of cholesteremia. Which cancer must be cut out and how drastically?

But who wants to live life afraid of his own body? On the screen, we all love to watch and cheer and cry about those who live a life as though in contempt of death. These are our heros, athletic, firefighting, fishers in the north seas. And we are afraid, sometimes, even to step outdoors because the neighbors might be toting guns.

The fact of the matter, if you were to do the math, is that the only reason health insurance is affordable to any of us is that most of us don't really care for or need the drastic interventions. God help us if we all become thoroughly modern, and consider it our right to rule out each and every illness which might explain our current symptoms.

There is no wooden boat which lasts forever. There is no body either. It is no longer clear that the way medicine works is in the direction of progress overall. That's not because there aren't wonderful new techniques to help the truly ill. But likely too many folks are dragged into the system hoping for something that just cannot be forthcoming.

We look to the medical system, or at least I do, for simple statements such as "this is what we are willing to do" without the question back "are you willing to pay for it, then?" Instead we get the absurd statement "this is what could be done if you can get someone to pay for it." And no-one is in any position ahead of time to tell you it will be paid for. This creates a state of perpetual panic, pretty much like living on a fault line. Imagine if the police asked you each time they intervened for your safety.

We have displaced our grief in the same way that we have displaced our heros. When it comes home, it is almost always unbearable because we had thought that there could be none so close to home. We had fallen into the lulled sleep of those whose life is too smooth. Until the very earth starts quaking.

Let's dial it back, how about? Stop the advertising which makes us all feel unwell *unless.* Taking trains most of the time will hardly affect our lifestyles. Electric cars for the local trips, rented hopefully, should be sufficient. Walking out of doors makes a huge difference to your healthcare profile. And how about shaking hands across the divides of race and class and education. That would do a lot to calm our fears.

There is so much that is wonderful about life as we have discovered it in these United States. Let's not blow it because a tiny class of hucksters in our midst would have us believe that we must take snake oil to feel whole. I don't think that there's a single person, embedded in whatever trench of certainty, who wants the hucksters to prevail.

And surely no-one believes in a centrally controlled economy anymore. So, what's the fuss? We're only talking about the boundaries. Should healthcare be on the side of police and fire, or the side of coke and pepsi? It's not about goverment making decisions. It's about you and me making decisions, taking responsibility, and calling in the trained experts when that becomes necessary.

Meanwhile, I'm waiting for spring when I can figure out if that old wooden sailboat is still salvageable. For maybe the fifth time in its life. About the same number of times that I've failed to die myself. Let's see, there was the scarlet fever, the drowning, the near-miss on a motorcycle, the appendicitis, the embolism, not to mention the food poisoning, the storm at sea. Oh, I guess it's a lot more times than for the old sailboat. Bottom line, I feel pretty lucky to be alive. Which has not quite but almost nothing to do with elaborate interventions on my behalf.

I sometimes don't think it's my narrative which has gone off the rails. Sometimes I think it's the frame itself which isn't tethered any longer to reality.

1 comment:

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