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Under construction

November 8, 2009 · Leave a Comment

This blog is currently under construction… bear with me. :)

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An open letter to all future M.D.s in the U.S.

July 26, 2009 · 4 Comments

Dear Prospective Physician:

I know there is a lot of talk lately about health care reform among politicians and pundits. The media throws around a lot of different vocabulary, some of which you are probably familiar with by now, including, but not limited to: single-payer system, socialized medicine, public-private partnership, government-run insurance plan, employer-provided benefits, co-insurance, co-pay, premiums, deductibles, pharmaceuticals, lobbyists, insurance companies, health-industrial complex, and pre-existing conditions. And which, of these terms, has anything at all to do with medicine–i.e. the treatment of human maladies? None. Absolutely none at all.

Our health care system–bogged down in meaningless terminology like the above–is completely divorced from the very basic needs that it is supposed to serve. These words function in an eerily similar manner as does military jargon. It puts a semantic fence between the professionals in the industry and laypeople, non-health care folk like me. Likewise, the military  practices the art of verbal obfuscation regularly in order to avoid acknowledging that they are often responsible for murder. Call it “combat.” Call that nebulous dot on the ground you’re bombarding with missiles the “enemy.” Call the limp, bleeding bodies that will never return from overseas missions in one piece “casualties.” It’s much easier to conceal the horrors of war when you have words that completely distract from reality.

So, future M.D.s, let me make it completely real for you here: abandon your idealistic notions about medicine right now, if you expect to practice within the confines of our current health care regime. I want you to know what you are forced to become when you opt in to the system we have in this country. As a patient and a family member of someone who suffers from a slough of infirmities, I think you should understand a few things before embarking on your career.

Expect a new modus operandi. I am most unhappy to report that it is not the Hippocratic Oath, but the Oath of Benjamin… Franklin, that is. Unless you happen to be among a teeny percent of an already teeny percent of people who become blissfully sequestered research doctors, you will spend much of your time thinking about volume. Patients are commodities to be processed in numbers to pay off medical school loans.

Expect to become very appointment-conscious. And by that, I mean that you will learn to prioritize all appointments. If a pharmaceutical representative makes an appointment to “provide” you the crucial service of marketing material–free pens, clocks, post-its, informational boards with cleverly inserted drug advertisements, sample sizes of medications, stickers, clipboards, medical equipment–it is far more important than the patient who sits in the waiting room for 2 hours for an unanticipated emergency, hacking up a lung.

Expect to become far more efficient, to embrace the capitalist buzzword that has received such rave reviews in the business community. You will learn to size up patients in five minutes, and to eliminate all of the extraneous procedural crap, like asking a patient how he or she is feeling, how other doctors or specialists have treated a problem, or even using old-fashioned instruments like your hands or a stethoscope. Yeah, the lab coat and stethoscope are mostly accessories these days.

Expect to pick a pet specialty and hit the ground running with it, usually to the exclusion of other areas. Expect to become so immersed in that specialty that the rest of the human body–especially the ever elusive emotional dimension–has little or no relevance to your treatment plan. Expect to give up on helping a person when your treatment of choice fails to solve the problem. “Holistic” and “healing” will no longer be concepts you embrace.

Expect to prioritize your lunch hour or your vacation time over patient care. You will learn that the phone is your anathema, that returning frantic calls from patients is not really your responsibility, especially if you’re treating someone for any kind of mental illness.

Have these expectations, and you’ll succeed very well in our current health care system.

Sincerely,

Disgruntled member of the Inferior Patient Proletariat

→ 4 CommentsCategories: doctors · fury · health care · insurance · rant

Living off the grid

July 24, 2009 · 2 Comments

Despite my best intentions, workplace and other responsibilities have sucked up my energy to write for the last few weeks. Now that some of the turmoil has subsided, I can talk a little bit about a topic that has piqued my interest lately.

Michael Pollans _In Defense of Food_

About a month ago, I had the good fortune of receiving a copy of Michael Pollan’s In Defense of Food: An Eater’s Manifesto. This book was the focus of media attention for a short time while Pollan was on his book tour. Though the book’s novelty  has since worn off (and thus, its wide attention from the mainstream), the issues it raises remain just as pressing.

When I picked up the book, I expected to read an in-depth examination of the nutritional degradation of American processed foods. That was only a portion of what this book exposes. Pollan goes one step further from the obvious–that fast food is bad, that too much red meat is unhealthy, and that Americans have high rates of diabetes and heart disease from being overindulgent fatasses who can’t exercise portion control.

Pollan is a journalist, not a scientist, though he references numerous scientific studies in the course of his research. Because of this, his particular focus is the, “Why?” behind the horrors of the American food supply. Why is it so much cheaper to eat McDonalds than to shop at an organic farmer’s market? Why is high fructose corn syrup in almost every food product that comes in a box? Why are there so many foods that have an expiration date of almost-never because even vermin won’t dare touch it? The answers Pollan provides has three main themes.

The first is an alarmingly consolidated and highly profitable agribusiness industry. Through several decades of mergers and acquisitions that have all but stamped out family farms, our food supply has been overtaken by a small handful of corporations. These corporations have cleverly disguised their ubiquity through countless subsidiaries and well-funded marketing departments. The marketing practices of the food industry have pervaded our (pseudo-)scientific wisdom about nutrients in an astonishing, yet remarkably subtle way. Pollan calls the cozy relationship between science and agribusiness “nutritionism,” which belies more of an ideology than actual scientific credibility.

Big agribusiness would certainly never have been able to reach into the pantries and onto the plates of Americans were it not for the number two thing that Pollan mentions: government policy. It is pretty well known at this point–broached from time to time in mainstream political debate–that farmers who grow certain crops like corn and soy are heavily subsidized by the government. What politicians fail to convey to Americans is that there are some big reasons for this, and their names are Monsanto, Philip Morris, Dean Foods, Con Agra, and… well, you get the point. Big agribusiness has figured out all kinds of novel ways to use corn and soy. They repackage those heavily subsidized crops as thousands of different “foodlike” products with suspiciously long shelf lives. The questionable or unscrupulous things that agribusiness does would take up an entire book in itself, so that’s not really the main point of Pollan’s work. Instead, he focuses on the disturbing collusion between big corporate food companies and government officials. It spans from millions of dollars spent on lobbying Congress to the revolving door between FDA/USDA officials and high-level stakeholders in agribusiness companies.

These two components describe the deeply entrenched interests that have overtaken our food supply–a food-industrial complex, if I may use that terminology. Certainly, these two things are fundamental to understanding many of our economic and health problems in this country. It explains, for instance, how each year, we adopt several new nutrition fads just as science debunks some previous pearl of food wisdom. For this explanation alone, the book is worth reading (and rather than rely on my cursory summary, I really encourage you to do so).

Instead of placing the burden entirely on government and corporations–the “big guys” who are easy targets for members of the frustrated masses like me–Pollan hits on a third point in In Defense of Food. While on one hand, there are certainly some people making huge returns on potentially dangerous “food” products, the ethos behind the current system ultimately lies with our cultural values as a nation. Beyond the lobbyists and the money and the food science and the corporations is a singular question: why do we accept that food should be be cheap, abundant, and practically immortal?

The book touches on this question throughout Pollan’s discussions about the political side of food. He does a pretty decent job of getting to the ethical core of industrialized societies like ours. His point is that we have become so far removed from where our food comes from that we often overlook what would have been readily apparent to our great grandparents. Industrialization has obscured the way we value one of the most basic elements of human life. True, a lot of people really don’t care, and there’s only so much to be done about utter apathy. But I also suspect that many people would be pretty disgusted at what they allow to pass for food if they truly knew the wonders of fresh food.

I consider myself to be pretty conscious of what I eat, both health-wise and ethics-wise. I see my choice to eat a vegetarian diet as a reflection of my consciousness. But (and at risk of sounding cheesy) reading this book really did help me see food in a new, even spiritual way. The junk food that would have appealed to me as a 10-year old just doesn’t have the same effect. What we eat is our connection to the earth, to our bodies, and to other human beings. When I look at a vegetable or a fruit now, I really do marvel at its beauty. I often think when I see the brilliant colors of plants, “Wow, nature makes that!”  Cooking together with others and sharing food helps me feel this connection even more deeply. Though it is more difficult in an industrialized society, I believe we should all stop to appreciate the earth, which provides delicious, nutritious food in an amazingly complex cycle of life.

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A Selection of Questions

July 6, 2009 · 5 Comments

Things I’ve wondered lately…

Why don’t police officers ever use their turn signals?

Why do they call blinds, curtains, and shades “window treatments”? It makes it sound like the windows are going to the doctor.

Why do people feel so compelled to talk, text, or play with a cell phone when they find themselves alone?

This one directed at the large contingency of Miami drivers who cut me off or drive erratically just to pass me: Why do you think your destination is so much more important than mine?

Why are nearly all the actors in commercials for cleaning products women?

How is it that, in a city full of people constantly in a hurry, everyone is late all the time?

When will all of those empty luxury condos in Downtown Miami have more than 40% occupancy?

Why does it seem that the majority population of super-wealthy areas in Miami appears to be lawn maintenance crews?

I have a far more substantial post forthcoming about some Independence Day-inspired thoughts, but I thought I would throw that out there for now.

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Some thoughts on theocracy

June 22, 2009 · 4 Comments

I wrote this today while I was out on a job for my dad. There was a lot of down time, so I decided it was an opportune time to write something new.

* * *

It has been a little while since my last post. A number of things have kept me away from the blogosphere, including, but not limited to, an insane work schedule and, in a fortunate turn of technological fate, a new computer! Since my old computer has five years worth of my life on it, however, the transition has left me a bit distracted during my free time. It is now time to get back on track. My boss is out of town (again) for an entire month, which means that, as long as I am getting my work done, I am pretty much left to my own devices. In fact, right now, I am working on a job for my dad. It’s pretty boring–so much so that I am writing this by hand in the field.

By “the field,” I mean a condominium complex in the bowels of Kendall, the absolute epitome of the soul-crushing, horrifically vanilla American suburb. It is mostly cars, houses, and strip malls with very little redeeming cultural value other than its place as a perfect sociological study of American complacency. Meanwhile, there is seemingly a revolution fomenting halfway across the globe, in Iran. The cable news (surprise, surprise) does not talk about it in any serious depth, but something incredible is happening there. Whether it results in a full-on regime change remains to be seen. For all we know in the United States, this could be yet another instance of politicians taking advantage of a people who are thirsty for change when, in truth, they are only in it to grab power for themselves. Replacing corruption with different faces doesn’t change the nature of an entire political system.

On the other hand, I would like to think that this time is different–that the Iranian people have a thoroughly 21st century sensibility that is winning against the medieval ideology sucking their civilization dry for the past 30 years. Young Iranians have been given unprecedented access to the wider world through technology, a venue for speaking as a people, not as a polity. I honestly don’t know enough about Iranian society beyond the snapshots I receive in Western media (and through the graphic novel and recent film representation presented in Persepolis), to say whether or not this is a true ideological shift. Intuition, however, tells me that the tide really is turning in a profound way.

The uprising of people in the streets makes me think this has been coming for a long time. Pictures of mass demonstrations all over the alternative media sites has made me reflect on what it must be like to live in a dictatorial theocracy. Even though Iran is a majority Muslim country, it is unrealistic to expect such a degree of ideological agreement from an entire nation of people. In theory, I can see how theocracy is a very appealing way to organize a government. That may be a strange thing for a largely secular/agnostic person to say, but hear me out:

When deciding how to craft good law, one must weight a number of different factors, depending on the nature of what is being legislated. Whether or not you think this ought to be,  the root of many laws is an ethical or moral dimension. In the United States, a society that strives to be fairly pluralistic, our lawmakers must weight a number of competing moral/ethical perspectives. When you consider the rights we have to choose our own moral code (as long as it doesn’t involve cannibalism, ritual sacrifice of domestic animals, or forcing women and children into sexually suspect compounds), it is actually pretty astounding that we, as a society, agree on anything at all.

Theocracy takes away the whole messy business of deciding which ethical/moral code is superior or most appropriate for a particular legal issue, at least in theory. In practice, of course, it discounts the very important fact that within a single “ideology” or “religion” exists radically different interpretations and modes of applying a doctrine, text, scripture, holy book, etc. Putting that huge pitfall aside for a moment, however, theocracy could be an appealing form of governance if there were to be enough ethical consensus among a population. Everyone would agree on things like ritual practices, on how resources should be allocated, on the role of individuals, on societal institutions, and on how conflicts should be resolved, to name a few.

But like all ideas that sound wonderfully perfect on paper, it practice, theocracy ends up sabotaging the very end it seeks. Rather than lead to moral consensus, it encourages a religious power struggle over whose version of [insert religion here] is purest, most authentic, or most holy. It takes something that is supposed to be a framework for living ethically with other people and instead creates a market for martyrs. Proving the holiness of one’s particular dogma becomes inextricably bound to the power one has in society. Maintaining that power, the supremacy of one’s exegesis, becomes more important than the very purpose of religion itself.

In America, politicians frequently switch their political loyalties when they see it as smart strategy to get a pet project placed in a bill, to get a piece of prized legislation passed, to get a political appointment for a friend, or to improve their chances of winning an upcoming election. If “clergy” is synonymous with “politician” or “official,” should people really trust them for moral or spiritual guidance, which they are purportedly ordained to provide? As far as I’m concerned, a life career dedicated to a religion is a serious undertaking that should mean a lot more than politics often do.

On a related note, another problem I see with the conflation of religion and politics is the risk of creating yes-men (or women) who don’t give a shit about ethics or morality, but who are willing to play the part for political gain. In the case of Iran, how many of those clerics in the highest echelons of society do you think wear a beard, spew verses of Qu’ran, and, meanwhile, couldn’t care less about any of its real meaning? My guess is that it is a lot more prevalent that we’ll ever really know. If the number of kids I watched sit glassy-eyed, deathly bored, and clearly indifferent to religious instruction taking place in my Hebrew School days is any indication, I doubt the “Islamists” are radically different than other religions.

Granted, the U.S. is a far different society, perhaps incomparably so. But maybe the biggest difference between the U.S. and Iran is not an inherent inclination toward religious piousness in the latter nation, but that in the U.S., children are generally brought up with an awareness that other options can exist. Religious instruction is not the only future for education and personal advancement. When one lives in a theocracy, however, the available realms of success are far more limited (and more often than not, this only exists for 50 percent or less of the population, anyway). So, why not fake it?

The thing about faking faith, though, is that people will eventually catch on and call out those who are in power. Principles based on dishonest performance are unsustainable. As the generations pass and fresh ideas make their way into a society, people begin to identify fraudulence. Sure, some new moral salesman will come along, but hopefully in the context of a much wider marketplace of ideas. In the case of Iran, I hope that religion can find its place in a society among a plurality of perspectives, and that the fundamentalists who have systemically victimized their people will be pushed out of the mainstream by a new, more open ethnical consensus.

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Miami should have its own time zone

June 8, 2009 · 4 Comments

Maybe it’s a Miami thing, or maybe our technology has completely warped our collective sense of time. I am not sure what the reason is, but I am astounded at how much disrespect for peoples’ time is tolerated, if not outright condoned, in this town. Call me naive, call me punctilious, but when I tell someone that I will be in a particular place at a specific time, I am (barring natural disasters or unanticipated traffic jams) there.

Apparently, I am a rare specimen. Apparently, it is acceptable to ask someone to meet you somewhere and then just outright not show up. This is the second work day in a row that a person in the position of professional authority indicated that we would meet at a particular time and place, and the second work day in a row that a person in the position of professional authority failed to appear at stated time and location. Is my time really that inconsequential to other people? There really is no excuse. I have a cell phone. I have e-mail. I have Facebook. I am highly reachable. Instead, like an asshole, I drove all the way to Miami Beach again to a no-show. This is really, really infuriating.

On Friday, I rode to the beach to do some work for one of my freelance writing gigs. The guy I work for wrote to me a day or two prior with a request that I come into the office for a few hours. We agreed on a time, I paid for parking, and waited for over half an hour before I surmised he would not be showing up. As a result, I ended up on Miami Beach, stuck in the hellish traffic jam detailed in my previous entry. Today, I came in to report to my so-called “real” job, expecting my boss to arrive as agreed upon both last week in person and last night via e-mail. It is now more than two hours since agreed-upon appointment time passed and, as it stands, no phone calls, no e-mails, and no boss. If this is normal workplace protocol, it’s hardly a mystery to me why we’re in a major economic crisis right now.

In economic terms, time is a limited resource. Much like money, individuals allocate time in various ways depending on needs or personal preference. The opportunity cost of your leisure time is the work you could have been doing, and vice-versa. But to me, time is something beyond a quantifiable variable on a graph. I believe that when you give someone your time, you give them a piece of yourself, even if it’s just 30 minutes worth. I believe it is important to show up on time or to respectfully reschedule because I realize that others could be doing something more important instead. When I am stood up like this, I am forced to believe that somehow, my time is less valuable, is easily disposable, and is completely malleable to your own selfishness. That is certainly not how I see myself and it is completely unacceptable.

Maybe I should be my own boss.

EDIT: About 30 seconds after I hit “post,” I finally got a phone call. The rant about time still stands, though.

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Flood Waters… or the Official Welcome of Hurricane Season

June 7, 2009 · 1 Comment

After waxing poetic Friday afternoon on the pleasing visual provided by a Miami thunderstorm, things took a dramatic turn.

As you can see from The Miami Herald Article, the run-of-the-mill thunder storm turned into a miniature apocalypse, far more like an ad hoc tropical storm. While I didn’t see it, there were reports of pea-sized hale, of wind gusts up to 50 miles per hour, and, as I came to find out shortly after my blog post, of flash floods. The Miami Herald article offers a rather understated description of the storms:

On Friday, afternoon downpours dumped more than nine inches over Miami Beach in only five hours, causing flooding, power outages and massive traffic jams during rush hour

Massive traffic jams? Try thousands of people–including yours truly–sitting on the same spot of the road for hours. In my case, I burned through nearly half a tank of gas and managed to crawl a whopping 10 feet along 5th Street between Alton Road and Meridian Avenue in nearly four treacherous hours. There was so much water on 5th Street from Jefferson Avenue to Alton Road that no one, save the public buses (perhaps the first time in my life I actually wish I had been on a MetroBus) and an increasing line of tow trucks, could move. Others were trapped on the other side of the island, sitting idle on the MacArthur Causeway for many interminable hours.

I was fortunate that I had filled my tank with enough fuel and that I had parked my car on a street that didn’t take eight inches of water. Had that not been the case, I surely would have been one of those unfortunate souls who were desperately scooping Starbucks cups of water out of their car interiors. Others were clearly overambitious with their cars, thinking their small sedans could wade through waist-deep water. Instead, they ended up flooding their engines. Eventually, enough cars cleared the way so I could turn around, head back east, navigate north, bypass the flooding on Alton Road and Collins Avenue, and, finally, rejoice that I was able to take the 195 before gashing my own eyes out. I have never been so happy to see US-1 in my life. I should also probably apologize to my boyfriend, who endured my hourly diatribes laden with expletives, and to my parents, who received a very frazzled phone call from me at around hour 4 of the ordeal: “DAD, I AM STUCK ON THIS ISLAND AND I CANNOT GET OFF.”

Personal trauma aside, I am astounded at how poorly prepared the City of Miami Beach was for this. I’ll forgive the stressed out police officer who gave me  a rather snarky reply when I called to find out why I was not moving (“Don’t you SEE what’s going on?” No, sir. If I had known, I would not have called, but thanks). But according to NBC 6 News, some residents were complaining about a smell, thinking it might be sewage water that seeped up and flooded the streets. As the article states, a Miami Beach official had this to say:

“What we experienced yesterday was a phenomenon that we haven’t seen in 100 years. There was so much rain that the drainage systems backed up.”

She also said that many of the catch basins ended up blocked with debris, contributing to the flooding.

And that nasty smell that has residents believing they were swimming in sewer water?

“It’s basically muck,” she said. “It’s compost. Miami Beach was landfilled with compost to expand it, so that is what you’re smelling.”

Either way, I wonder just how this could have been so unprecedented. We get far more powerful, rainy hurricanes in this area on a pretty regular basis. This is just the start of the storm season. While people were fairly amicable toward one another–what else could we do?–the official response was pretty lackluster. I don’t understand, for instance, why there was no one redirecting traffic toward dry land after some of the water had eventually subsided on Washington Avenue. Thousands of people sat in their cars with no idea what was going on. So much for “hurricane preparedness.”

→ 1 CommentCategories: hurricanes · local government · miami · rain

Obligatory First Entry: The Ebb and Flow of Creativity

June 5, 2009 · 2 Comments

It has been awhile since I’ve tried to keep a blog, and, inevitably, I always end up abandoning my efforts. Given all that has changed in the world and in my life since my last attempt, though, I have made my amends with the online world and I’m going to give it another shot. Facebook is just a poor excuse for the exposition I should really be sharing, anyhow.

* * *

Right now, I am sitting in my office on South Beach watching a crazy thunder storm and sheets of rain pouring out intermittently. It is one of those uniquely Miami storms, where the sun shines barely half a mile in the distance even while the apocalypse drenches cars and pedestrians outside the window. In fact, it’s so light outside right now, it looks like a movie set. One halfway expects someone to yell, “Cut!” halting the rain, booming thunder, and strobing lighting with the push of a button. Luckily, it’s not fake, and I can enjoy listening to the crackling thunder and the sound of swaying palm trees. When it storms here, the plants look greener, especially against the misty gray sky.That’s right. I have an office window, because I am no longer a shit-kicking college student but a newly crowned member of the workforce. It wasn’t the easiest time to graduate from college back in December, when the economy had taken it’s official nosedive into the toilet. But somehow, after a frustrating, emotionally draining 5-month search, I managed to land a pretty sweet office job on Miami Beach, working with young, dynamic people in an organization that interests me. My boss is in and out of town all summer–mostly out, though–and I have the office to myself. No complaints here.

Being out of school has not been easy, but I think it has been very important for me. I have already learned so much about myself, my abilities, my goals, and, cliche as it sounds, the “real world.” Don’t get me wrong, I look forward to the day I get to return to academia, sheltered in the cozy confines of books and papers. But right now, I am enjoying life on my own terms and creating my own little corner of the world. And wow, is there a lot to say from this corner! I earnestly hope that I can keep this going, because there’s no way to share my commentary if I don’t broadcast it.

That’s all for now.

→ 2 CommentsCategories: miami · rain · work