Thursday, August 13, 2009

Pale Horse, Pale Rider: The "Death Panel" Scare in the National Health Care Debate

"Mind-boggling," an old friend of ours would say when confronted with a complex problem, "mind-boggling."
Those words come to mind when viewing the current health care debate, and the amount of information--and disinformation--swirling about. Town meetings are disrupted by middle-aged protestors, the right screaming "socialism", and rumors abounding of government-appointed "death panels" handing down edicts concerning your loved one's worthiness to live or to die.
We don't presume to be able to offer a solution to the problem here, but we do offer some more pieces of anecdotal evidence which should figure into a thinking citizen's reasoning.
Yesterday the phone rang. The voice at the other end was vaguely familiar yet strange and rasping. It was the guy who used to say "Mind-boggling." It had been months since we had heard from him, and we were starting to wonder if anything had happened to him. He spoke so softly it was hard to hear him over the phone, but here's basically what he said.
(He's 66 years old, so he has Medicare, but most probably no supplemental insurance.) Some time ago he wasn't feeling well, so he had his wife take him to the emergency room. (That's right, no primary care physician, right to the hospital, as the poor tend to do.) He has a fever, and is given an "injection", after which he passes out and is admitted. During the course of his hospitalization, he is placed on a respirator. ("There were tubes coming out from all over me.") At some point, he says, they wanted to "pull the plug." By this time his sister was there. She is a bit of a "bammer," and talked the doctors into performing more tests. (Meanwhile, a priest is summoned and gives the last rites.) Eventually, he said, he was diagnosed with Lyme Disease. He's now home, but in weakened condition.
In the meantime an emotion-tinged debate about national health care rages on. The latest headlines speak of "death panels" as a provision of the pending legislation, conjuring up visions of the movie Soylent Green, with Edward G. Robinson going to his assisted suicide finale to the strains of Beethoven's Sixth.
It appears now that any wording that can be construed as establishing "death panels" has been taken out of the legislation.
But one fact remains: unless you yourself have a strong advocate present during your hospitalization, there is absolutely no guarantee that you'll make it through unscathed or even alive.
We no longer have personal physicians (for the most part). If you are unable to speak for yourself, there's no telling which way your treatment may go. No matter which way this health care debate takes us, it's imperative to make out a living will and name someone you can trust (and who is likely to be available) as your spokesperson when and if you are hospitalized.
Of course no one is going to try to kill you intentionally. But inadvertently.... Your best protection is a living will and an informed and intelligent advocate.

Monday, August 10, 2009

Mas Vale Tarde Que Nunca!

Having been waylaid, so to speak, and absent from the tropics with the exception of a brief foray in the month of June, we've been neglectful of putting up our annual, strictly non-scientific (but highly accurate) hurricane predictions.
No doubt there are going to be some who'll say, "That's fine and well, but you've made it easy for youself this year. The hurricane season's almost half over--we're into the month of August already!" That's true, and as the old ditty goes, "June too soon, July stand by...August------?" I could never remember what rhymed with August.
Then I found this late 19th century manuscript on the web which solves that mystery.
August rhymes with "look out you must." At least it does, if you put the accent on the second syllable of August. But I digress.
The first tropical storm, at long last (8/10) is already out there.
So with no time to waste, we've called our old time prognosticator "Typhoon" O'Connor (who otherwise refused to be named or depicted) to give us this year's belated reading on the thickness of caterpillar's fur, the direction in which land tortoises are crossing the road, near and offshore water temperatures and other inchoate observations leading to an accurate prediction of what might come.
"Activity's light this year (obviously)," he says. "But that don't mean nothing's gonna happen. If it comes this year, it'll come late. And if it comes, it'll come hard. I wouldn't want to be on the gulf coast when she hits."
Interpretation: the arrival of El Nino presupposes a less active season, yet the surface temperatures of the Gulf are such that if a system gets into that area, chances are good that it will intensify before landfall. The Keys and Key West: shootin' dice, as usual, a couple of late scares maybe. Keep the shutters handy, just in case.

Thursday, August 6, 2009

Technophobia on the High Seas

Dave was a fine fellow and in some ways a legend in his time. He’d served a few years in the Marine Corps, some say during the Vietnam era, but he never talked much about that. He married, had a pretty wife and nice young daughter, and was living an idyllic existence in the Florida Keys, busying himself primarily, it seemed, by mucking about in boats.

His family owned a lot of real estate, although he never talked much about that either. Dave himself drew a comfortable paycheck by managing a shopping center up around Ft. Lauderdale--collecting rents and cleaning up behind the stores once a month, a situation that gave him plenty of time to engage in his hobbies. His family didn’t own these properties outright, the rumor went, but held them through a murky fundamentalist organization in one of the Appalachian states, some say for tax purposes. Whatever the reason, Dave and his immediate family were not fundamentalists. At some point they’d converted to the Bah’ai Faith, and faithfully followed the fast days, feast days, and other disciplines of the Bah’ais.

In some cases it may be said , “His religion takes care of all his peculiarities.” But not so in Dave’s case. While his contemporaries dealt with mundane problems like how to pay their rent and their kids’ dental bills, Dave fretted over decisions like “Catamaran or trimaran? Ketch rig or sloop rig? What to do, what to do?” This is not to say that he wasn’t a good boatman nor fun to be around. He’d spent a lot of time sailing in the Bahamas, and had a wealth of knowledge about out-island Bahamian lore, seamanship and navigation. (This was well before GPS.)

Dave was also a purist, and in today’s terms, you’d call him a technophobe. Discounting one’s need for dentistry and perhaps an occasional antibiotic, he would have been perfectly happy back in the 1800's. He held a romanticized notion of sailing ships and a decided distaste for things mechanical and motors in particular. “Iron jibs,” he called them, making a spitting sound. “One time, just one time,” he would say, “I would like to see what it is like to be totally, totally away from the sound of motors!”
Time passed, as Dave went through a series of boats, never completely satisfied. For a while he had a 27 ft. Wharram catamaran. Then he had one of Jim Brown’s designs, a Searunner 25. In the meantime unfortunately Dave and his wife had been having some problems. They were waiting out the Bah’ai-prescribed “year of patience” before finalizing their split. They’d decided a few months before that their daughter would live with Mom for the school year. She would spend the summer sailing with Dad. She had just turned fourteen.

So many things in life depend on one’s point of view. What red-blooded American boy wouldn’t jump at the chance for an ocean-going voyage with his dad aboard their own speedy multihull, however cramped for space it might be? But what American junior high-age girl wouldn’t be happier staying close to home, hanging with her peer group? It’s said the daughter took one look at the single narrow hull which was to be her home for the next two months, “But it’s even smaller than the Wharram!” and burst into tears. Carried into the cockpit of the small craft, she bade farewell to her equally tearful mother, as Dave determinedly cranked his brand new 25 hp. Johnson outboard (a begrudging concession to technology purchased just for this trip) into action, and the Searunner sped away from the dock toward their first stop in Miami.
(To her credit the girl’s tears dried before they made their first anchorage at Key Biscayne, and she acquitted herself well on the voyage.)

There’s a small harbor on the southwest side of Key Biscayne where cruising yachtsmen traditionally gathered before making the crossing to the Bimini in the Bahamas. There they exchanged information on tides, weather, and possible hazards to navigation. There being safety in numbers, our travelers planned to travel in a flotilla with the other cruising yachts, weighing anchor at 5 in the morning, to take advantage of the outgoing tide.

Imagine the excitement, amid the smell of diesel oil and the slapping of rigging, as seagoing craft of all descriptions started their engines, weighed anchor, turned on their running lights, and one by one headed out into the predawn stillness of Biscayne Bay.

Dave raised the mainsail on the trimaran and readied the halyard to raise the jib once they were under way. He adjusted the choke and throttle on his new Johnson 25, reached down and gave the starter cord a couple of rapid pulls and....nothing happened. He re-primed the bulb on the fuel line, reached down and yanked the starter cord again. Nothing. He re-primed the bulb again and pulled the cord furiously. He began to smell gasoline. Now it was flooded. He disconnected the fuel line, pushed in the choke lever, hoping to clear the carburetor, and cranked again. Not a sound of life from the motor. He dashed below, retrieving a small tool kit. He took the cover off the engine and, tearing knuckles as he went, reached around and removed the spark plug, replacing it with a spare.

He re-primed the fuel line once again, set the choke and throttle and pulled. By now it was starting to get light, and he could see that the harbor was empty. All the other boats were under way. He pulled and pulled, but nothing happened. The brand new engine that had worked perfectly up until this morning had let him down. By the time he got it fixed , the other boats would be well out into the Gulfstream. He would not have his plans frustrated by the malicious vagaries of an iron jib. “Joshua Slocum didn’t need an engine, and neither do I!”

He unbolted the engine from the transom, and lifting it high overhead, with a superhuman effort, let it fly into a graceful arc into the waters of the little harbor. He hoisted the anchor, raised the jib, and the little trimaran moved out to sea.

Dave later said that everything went all right until they sailed into Nassau harbor to clear Bahamian customs. He eased the tri into a convenient dock in the harbor, but the customs official refused to clear him unless he brought the boat to another dock that was directly upwind. “If you want to clear customs, you must come directly to the customs dock,” he was told.

Necessity is the mother of invention, and somehow he contrived a way to do it. He was an excellent sailor before that trip, but not having a motor, he discovered ways to sail that summer that defied the imagination. A multihull is notoriously difficult to “bring about,” i.e, turn through the oncoming wind, because of the fact that it has two or three hulls which offer resistance to the wind and water, rather than just one.

Since then I’ve seen him tack the boat up a narrow canal against the wind. (Lubbers may have trouble following this.) Although it seems counterintuitive, he would set centerboard most of the way up, with only a foot or so in the water. Presumably this would lessen the drag on forward speed, and make turning easier. Then if he used a jib at all, he would have it set extremely loosely, almost luffing, so there was no chance it would push the bow to leeward. And he would sheet the mainsail in just enough to give the boat forward momentum, not enough to make the boat heel or sideslip.

Reportedly they had a fine trip down through the out-islands and sailed home safely, tanned and happy.

Oh, and the motor. Due to the fact that so many people use that harbor, we can be sure it was rescued by an enterprising snorkeler before too much time had passed. Whether it ever ran again, we can’t say.

Tuesday, August 4, 2009

Above all, do no harm.

The pastor of our church has a marked antipathy toward “faith healers” who claim they can cure illnesses with prayer in a way similar to the healings described in the New Testament, performed not only by Jesus, but by his disciples.

“I don’t discount the power of prayer. I know that prayer can heal–sometimes. What I don’t like are those who claim they can do this on a regular basis. I’m not naming names, but there are a few in particular whom I have in mind. And, to put it mildly, I take great issue with their claims and practices.”

He might have been talking about another place of worship just outside of town, which holds weekly healing sessions. They appear to have a “charismatic” style of worship, with exhortative preaching, drums, hands in the air, and so on. I found out about it from our local Cable Guy, who claimed, “My wife was cured of diabetes there. I was cured of bipolar disorder.” And his daughter was cured of impetigo, I think he said. He was pretty much sold on the whole thing.

Then there was the Lakeland Revival phenomenon. In April of 2008 Canadian biker-turned-evangelist Todd Bentley started a controversial series of “healing” services in Lakeland, Florida, which steadily increased in size over the next few months, attracting 140,000 people from 40 countries. Eventually Bentley was found to have proverbial "feet of clay," and although there were many first-person accounts of miracles, there were no medically documented cures.

Our pastor also stated that according to the best current estimates, 70-90% of the ailments presented to primary care physicians today can be termed “stress-related,” hence psychological, rather than systemic ailments, the very type of ailment that can be "cured" by psychological and/or spiritual means. Clearly, though, there are some conditions that will only yield to the surgeon’s knife, or to modern, sophisticated pharmaceutical treatments.

With all this in mind I was extremely alarmed when a younger friend of ours, a botanist with a somewhat troubling inclination toward a magical world-view, announced that he had “performed some cures” with concoctions made from Petiveria alliacea, a tropical plant also called Anamu, among a dozen other names. He became aware the herb while doing a research paper on the botanicas (Latin-American herb shops) of South Florida, and later saw it in use among Native American tribes in South America.

“How can you know this stuff is safe?” I asked. “Don’t you know that the first rule of medicine since ancient times is primum non nocere, ‘first do no harm’? Have these people checked with their doctors about this? And aren’t you likely to stir up false hopes? Or maybe prevent them from seeking the regular medical care that they need?”

“No, no, no,” he claimed. “I’ve taken it myself many times, for one thing. And all three of these people are close friends. Each of them begged me to prepare this drink for them. They were quite aware of all the risks.” He went on to explain that all of his “patients” had been receiving conventional cancer treatments, assumed to be a combination of surgery and chemotherapy. One was an older woman from Cuba or Colombia who was already familiar with Petiveria. The other two were reportedly younger men.

Whereas herb companies sell the dried leaf to be made into a tea or to be taken in capsules, the botanist had a different recipe that he’d seen prepared by tribal curanderos. They used only the root, he said. He’d start with a large quantity of the roots, removing the outer bark with a vegetable peeler, like you’d peel a carrot. Then he’d cut the roots into inch-long sections and boil them in water for an hour or so. He’d then cool the mixture and strain out the roots, leaving a yellow, garlicky-smelling tea. The treatment consisted of drinking three approximately 16 ounce portions of this tea in a single day.

In each of the three cases where his friends took the herbs, he claimed, subsequent medical tests showed accelerated improvements in the patients’ conditions, and eventual remission, much to the surprise of the regular medical professionals, according to this fellow.

I pressed him on why, if this stuff was so effective, that the regular medical community had not picked up on it. His answer was vague, about the cost of research, the tyranny of institutional thinking, and so on. I warned him again about the seriousness of playing doctor, and he agreed that he would never present himself as such, but that in the cases cited the individuals had specifically asked him about the herb, and requested that he help them prepare the tea. “They came to me,” he said.

And would the results would have been the same without this modern snake-oil treatment? I don’t approve of what he did, and don’t advise anyone to take this or any other kind of herb without medical supervision. He did explain, however, that the herb grows wild in South Florida, in vacant lots and along roadways, and people have been using it for years. He even showed me three places in Key West where it was growing out of the sidewalks.