health care

Learning to Live Fearlessly

Off the keyboard of Jason Heppenstall

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Published on 22 Billion Energy Slaves on November  27, 2014

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RE, over at the Doomstead Diner, was asking the other day “Where have all the doomers gone?” He pointed out that some commentators have gone silent, others post far less often than they used to (guilty) and the doom-stars, Orlov, Kunstler et al., are mostly repeating over and over on a weekly basis what they have been saying for years.

So what’s going on? It’s not as if our predicament of looming financial collapse, ecological drawdown, resource wars etc. etc. has gone away. Perhaps, it’s down to exhaustion and the realisation that the folks who want to hear about it are all now singing along in the choir and those that don’t (but will find out anyway) all have their heads buried so deeply in the sand that only the tips of their toes remain poking up above the beach. On the other hand when you have the likes of our own prime minister jumping on the doom bandwagon and saying that ‘Red lights are flashing on the dashboard‘ then maybe it’s time to realise that maybe, just maybe, the message is becoming less ignorable.

And just to recap, here is that message in cut-out-and-keep form:

 

We live in a debt-fuelled, techno-narcissitic, ecologically unsustainable world and in an economic system that channels the remaining wealth upwards. The system, which worked well enough for most people in times of an expanding energy supply without too many competing claims is now shifting into reverse gear and causing itself to self-cannibalise. Economic and political injustice is growing ever sharper and more noticeable — despite all the happy talk of economic recovery. Growth is an illusion, contraction is a reality, and things are getting worse. Prepare yourself for the inevitable and try to gain some control over the essentials of your life. Grow stuff, tread lightly on the earth, appreciate what you have and try to enjoy the ride.

 

Here in the UK more families than ever are having to rely on food banks handing out packages of food just so they can make it through the week. Who’d ever even heard of a food bank five years ago? There’s one near where I live, and in the news agents across the road from it the newspapers on display contain articles detailing which stores to head to on your weekend Christmas shopping splurge in New York, or which island in the Maldives is perfect for some winter sun. They might as well be talking about vacations on Venus. Some of their other pages contain stories about megacities being planned for the bottom of the sea, personal robots that can fly and deliver Amazon packages, cars that run on seawater and 3D printed houses on the Moon. It’s all just around the corner.

But the propaganda gets less believable by the day. I can’t personally recall talking with anyone in the last few years who says things are going well for them financially. In fact most people just seem to be grinding along from month to month with hardly any money, maybe getting into debt a bit more and shopping at the discount food stores which have swept the country. They are not thinking about buying flying robots. Others are stuck in the painful situation of having a head full of business ideas but no way to make them happen because they have no cash, no credit rating and no time. Each month that passes makes those hopes and dreams seem just that little bit more unrealistic and an understanding begins to form in their minds that a new kind of reality has descended and this new reality doesn’t promise anything like what the old reality did.

But at least there is still a safety net to catch us when we fall, right? There’s still a free health system which is one of the best in the world, right? I got to test this out recently when I developed a deep tooth ache that wouldn’t go away. The only surgery in town that could see me was a nearby clinic that boasted ‘German dentists’, whatever that might imply. They examined me and noted an abscess below a wisdom tooth and advised that I have it removed asap. They made me fill out a medical questionnaire which seemed less interested with my dental health than how I ‘felt about my smile’, presumably to prey on hidden insecurities and lure me into spending a fortune in order to make me look like Donny Osmond (a full finance package was on offer).

But to fix my wisdom tooth they wanted several hundred pounds off me. I told them straight off that I couldn’t afford it and wanted to know what my options were. They have to do this, by law, I’m told. I was (glumly) referred to an NHS specialist and, within a couple of months after a course of antibiotics and painkillers I found myself at the local hospital where a man called Mohammed wrenched out my bad wisdom tooth with some pliers. It was all very professional and pain-free and didn’t cost me a penny. My respect for the foot soldiers of the NHS grows with each encounter.

But how long can we rely on these systems to function? With the total amount of debt owed by the UK now astronomically high (government, company and private) and not showing any sign of slowing down soon, when will the breaking point be? Already we are beginning to see warning signs of massive problems ahead, with some saying that the health service will run out of the cash needed to sustain itself either this year or next:

Millions to suffer as NHS is About to run out of Cash

“The King’s Fund’s report warns: “On its current trajectory, the health and social care system in England is rapidly heading towards a major crisis.” … it is now a question of when, not if, the NHS runs out of money.”

And then consider the immense problems faced by district and city councils, such as Newcastle. These behemoths are being bled dry by central government, with all the accusations of politics being thrown in (the ones gushing blood the fastest are the ones with populations least likely to vote Tory). It’s worth reading this whole article to get an understanding of what is in store, not just in Newcastle, but everywhere:

Is saving Newcastle Mission Impossible?

“In fact, the city’s predicament already seemed impossible. The council cut £37m from its spending in 2013-14, and another £38m is set to follow this year. Then, according to current projections, there will be further annual cuts of £40m, £30m,and £20m. Over a third of the money the council once spent must go, so Newcastle is in the midst of a dire squeeze on funding for children’s centres, youth services, rubbish collection, parks, aid for homeless people, swimming pools, museums, and the arts. Back in 2011, Forbes said, when he and his colleagues had first confronted the depth and breadth of what they faced, a lot of them lapsed into silence. “People went white,” he told me. “They literally went white, at the prospect of it. There was a sense of disbelief about what it all meant, and the scale of cuts we would have to make.””

It’s probably important to note here that cuts will soon start to affect council’s statutory requirements. All councils have a basic requirement to offer some kind of food and shelter, to protect children from violent parents and so on. These are the kind of programmes that are for the chopping board next and the effect on our society will be profound. It doesn’t matter what the fake manipulated GDP number is if the streets are full of starving waifs rummaging through trash looking for something to eat. Of course, individuals and other organisations will step in and try to fill the gap by providing people with some basic level of subsistence. Churches will become popular again and ‘giving to charity’ will not mean texting a number to a giant bureaucracy during a telethon, but giving a bag of food to a hard-up neighbour. The majority will find themselves cut off, disenfranchised and with no safety net. The age of entitlement will be over for most, to be replaced by the age of broken promises.

I have a friend who works for the council in child care. She tells me that when the new system of universal credit kicks in then all hell will break loose. She warns of mass malnutrition, suicides and homelessness — and she’s not even the excitable type. For now, this system is being held off by IT failures, but when it is rolled out across the country, maybe within the next year or two, it will be like a chainsaw through whatever safety net currently exists. It will be brutal, she says.

Everywhere I look, and in so many different places, I see the effect of service cuts and the new intermediaries stepping into the ever narrowing gaps between flows of money. Just off the top of my head I could say that the council in the town where I live (Penzance) has run out of money for killing the weeds that sprout up between paving stones — result being that the streets have now grown green beards; the school my children attend is forever asking for small amounts of money to cover trips and events and is now almost begging parents for cash; the county council has been ordered to find millions in savings from its planning department — result is anecdotes of planning officials levying ‘unusual’ charges and insisting on applications being resubmitted and for the application fee to be repaid in full.

The list goes on of penny-pinching savings leading to shoddier services, crappier jobs and a growing sense of unease.

My wife works for a private community care firm. Her job is to travel around to visit (mostly) lonely old people and make sure they are okay. She gets minimum wage and is on a zero hour contract. She was just awarded an annual pay increase of 0.6%, which is actually a pay cut in real terms, but that’s standard practice in the sector. Her every move is now monitored by a smart phone she has to carry, and she is so overworked that there is barely enough time to make ‘clients’ (as they are known) a cup of tea. There are no benefits, and no holiday pay. You don’t even want to know the sad stories I hear about the loneliness some of these old folks experience.

Here’s a tip if you have kids: treat them nicely so that they may one day return the favour. And don’t go and encourage them to go and live some place far away.

Here’s another anecdote. Last week I even took our old leaky toilet to the local municipal dump — sorry, recycling centre — and was told that I would have to pay a £1.75 fee to dispose of it ‘because we now charge for rubble’. I pointed out that it wasn’t rubble, that it was a porcelain toilet bowl and the guy in the fluorescent jacket told me that ‘it will be rubble when it gets smashed up.’ Nice logic. My broken toilet could almost be a metaphor for modern life.

Perhaps that’s why fly-tipping is now all the rage (with local councils being forced — for now — to clear up the mess at great public expense). This mess appeared overnight in Essex and is a mile long.

So that’s modern Britain, writhing in the discomfort of a thousand cuts. But people around here at this end of Cornwall are long used to being squeezed. That’s one of the reasons I moved here — people are less likely to freak out so much when things get tough, I reason. Some of them. Most of the large ‘period’ homes here are owned by outsiders, property investors and holiday home owners, and any attempt to tax these people or make them pay in any way for the damage they are causing to local communities is met with howls of protest about ‘scaring away the tourists’, ‘biting the hand that feeds us’ and so on. That leaves anyone who grew up here two options: either get out and move somewhere with careers, or stay here working in the service sector for minimum wages and living in a caravan or a euphemistically-named ‘affordable home’.

There’s a woman living nearby who sometimes busks with a cello. I’ve seen her a couple of times in the street. When I read an article on the Dark Mountain Project blog about a young woman who lives in a tin-roofed shed because ‘all the houses have been hoovered up by the rich’ it took me a while to connect the dots and realise it was indeed the same person. Catrina Davies, I then found out, has written a book entitled The Ribbons are for Fearlessness. I bought the book and read it. It took me only a day because it was a real page turner. In the book she details living with no money at the Youth Hostel near Land’s End, and how the sudden death of her friend led her to set out for Norway, virtually penniless, in a battered old yellow van. She travels alone, with her grief, her fear and her cello as a way of making money busking the streets of Europe. It’s a hell of an adventure, and she meets a girl at the Nordcap (Europe’s most northerly cape) who teaches her a thing or two about the universe and gives her some ribbons ‘for fearlessness’. She goes on to travel all the way down to Portugal, learning to surf and how to live a full and authentic life in a manner that we are conditioned by our society to believe is impossible.

And, in a sense, that’s what we’ll all have to learn to do: learn to live fearlessly. Because when I see news stories that state the average family of four needs to make £40,600 a year to live an okay lifestyle I think: what do they spend all of that money on? Most people I know make a lot less than that, and our family makes and lives off about a third of that amount. True, I don’t have a mortgage or an evil landlord standing over me, because I’ve been through all that and I savour every moment of not being a debt slave. I try to impress this message onto my children because I know they’ll likely never have what I had, namely a free university education, a couple of decades of rising incomes, a property ladder with an affordable first rung and a cushy office job where I got paid buckets of cash for fiddling with spreadsheets. They will likely get none of these things and society is going to be contorted into a lot of new and unfamiliar shapes as they come of age.

So, to go back to the beginning, why are less people talking about doom? Maybe it’s a bit like someone at a garden party — let’s call her Sally — who keeps telling everyone a rain storm is coming and they all just look up at the blue sky and say ‘impossible’ and get back to chatting about Top Gear by the pool. But she knows the storm is coming — she can tell by the clouds on the horizon, the rustling of the leaves in the trees and the way the neighbourhood cats have all disappeared. She remembers past storms. She tries to tell the other guests, but they are in no mood to listen — they’re too busy applying sun cream and turning the pork chops on the barbie. “Didn’t you hear to weather forecast?” they say. “There’s no chance of rain.” Eventually, somewhat shunned and a little hoarse, she decides not to go on about it too much. After a while she makes her excuses and goes home to bring her washing in so it won’t get wet. In the meantime the sky has darkened and the first few drops of rain are hitting the hot metal grill and making sizzling noises. The guests look at each other nervously and one or two think to themselves “Maybe she was right about the rain, but it’ll just be a passing shower.” The party is in full swing by now and everyone thinks they will stay dry because everyone else is standing out there with them, and anyway it never rains at Steve’s parties. They decide collectively not to notice the rain, laughing it off. The fat man turning the chops secretly believes he can control the weather by holding his mouth in a certain way. Meanwhile a deep rumble of thunder rolls across the horizon and Sally gazes out at her garden through the window from the comfort of her home, surrounded by cats.

An Energy-Related Reason Why US Healthcare Outcomes are Awful

Off the keyboard of Gail Tverberg

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Published on Our Finite World on September 9, 2014

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Back in January 2013, the US Institute of Medicine published a report called U.S. Health in International Perspective: Shorter Lives, Poorer Health. This poor health outcome for US citizens is in spite of the US spending twice as much as a percentage of GDP on healthcare as other high-income nations.

As an example of the problems the US has, the report showed the following exhibit, pointing out that the US has made much smaller advances in life expectancy since 1980 than other high-income nations.  The US is now seventeenth of the seventeen countries analyzed in male life expectancy, and sixteenth out of seventeenth in female life expectancy.

Figure 1-6 Female life expectancy at birth

I am sure I do not know all of the reasons for the US divergence from patterns seen elsewhere, but let me try to explain one energy-related reason for our problems. It has to do with a need to get a wide variety of nutrients at the same time we need to balance (Energy In) = (Energy Needed for Life Processes), in a period of time when the food we eat is increasingly of the “processed” variety. There may also be an issue of eating too much animal protein in our food mix, thanks to today’s ability to ramp up meat production using grains grown and shipped around the world, using fossil fuels.

An Overview of Energy-Related Modifications to Food

If look at primates in general, it is pretty clear that all of the nutrients such animals need come prepackaged in the food that they gather with their limbs. They get the level of exercise they need from gathering this food and from their other daily activities. They have a pretty good balance between (Energy In) = (Energy Needed for Life Processes), without any special effort.

We humans have been modifying food for a very long time, dating back to the days of being hunter-gatherers. Our earliest changes were successful from the point of making humans more dominant. They allowed us to grow larger brains and allowed human population to grow.

The changes made in recent years, thanks to abundant fossil fuels, seem to be excessive, however. The new processed foods are often missing necessary nutrients and fiber, providing mostly empty calories. It becomes a balancing act to get enough of the right nutrients without filling our bodies with calories we don’t need. Some foods (juices, added sugars, very finely ground grains) are sufficiently different from natural foods that our systems don’t react properly to such food. Also, the exercise our body was expecting is often much reduced.

The way our current system works, the food that is closest to its original form is hardest to ship and store, so tends to be highest-priced. The most calorie-dense, over-processed food tends to be cheapest. As a result, the least-educated people (who tend to be poorest) tend to be most damaged by our poor food supply. According to one study, at age twenty-five, men with less than a high school education have a sixteen-year shorter life expectancy than men with a graduate degree.

Remaining Years of Life_prbOf course, at least part of the problem is the disproportionate lack of health care of less-educated US citizens. There are no doubt effects related to feeling like second-class citizens as well, because of reduced work-opportunities for those with poor educations. But having to work around a poor food system with an inadequate income is an issue that likely plays a major role as well.

How Did Humans Develop Larger Brains?  

There is a popular belief that eating meat made us human. While meat eating may have played a role, there seem to be other factors as well. National Geographic in an article in the September 2014 issue, The Evolution of Diet, observes that modern day hunter-gatherers typically get about 30% of their calories from meat. When meat supplies are scarce, they often live for long periods on a plant-based diet. The article says, “New studies suggest that more than a reliance on meat in ancient human diets fueled the brain’s expansion.”

The point National Geographic mentions is the one I have brought up previously–the theory advanced by Richard Wrangham in Catching Fire: How Cooking Made Us Human. It seems to be the ability to control of fire, allowing humans to burn biomass, which set us apart from other primates. This allowed us to cook food, and in doing so, allowed the food to be more easily chewed and digested. Reduced chewing time freed up time for other activities, such as making tools. Nutrients could be more easily absorbed from cooked food. The fact that the food was easier to chew and digest allowed chewing and digestive systems to shrink, and brains to increase in size. It probably also made it easier for more human children to survive.

Furthermore, we now know that some other primates eat meat, so humans are not unique in this regard. Chimpanzees even hunt animals for their meat. National Geographic reports that baboons eat birds, rodents, and even the young of larger mammals, such as antelopes and sheep. But meat makes up only a small share of their diet. We also know that when monkeys are fed a diet that includes very much meat, they gain weight and experience degenerative diseases like humans.

Food Processing: A Little of a Good Thing vs. Too Much of Good Thing

The experience with cooking some food back in hunter-gatherer days shows that a little help in getting more nutrition from foods can be helpful. Plant cell walls are made of cellulose. Cooking vegetables helps break down these cell walls, making nutrients more accessible. There are other ways of processing food–pounding meat to make it more tender or using a blender to chop it into fine pieces. Humans have been milling grains for a very long time.

But it is easy to overdo the processing of food, especially with the help of fossil fuels. Grains can be ground very finely, far more finely they would have been ground, years ago. Sweeteners of various types can be derived from sugar cane, sugar beets, and corn, and added to products of many types. Parts of fruits and vegetables that are deemed “less desirable” such as skins can be removed, even if these parts have a disproportionate share of the nutrients in them.

There is even a second order kind of change to the food supply that can be put in place. For example, before recent “improvements,” cattle ate a mixture of grasses and digested them in their four-part stomachs that are designed from that purpose. Now cattle are being fed all kinds of foods that are not suitable for their digestive systems, including corn and dried distillers grain, a byproduct of making ethanol from corn. There are many other shortcuts taken, from hormones to antibiotics, so as to produce more meat at less expense. Our bodies aren’t necessarily adapted all of these changes. For one thing, there is much more fat in the beef, and for another, the ratio of Omega 3 fatty acids to Omega 6 fatty acids is badly skewed.

There is the additional issue of whether plants actually contain the nutrients that they did years ago. Many of us have learned Liebig’s Law of the Minimum, which states that plant growth is not controlled by total amount of resources available, but by the scarcest resource. In other words, a plant needs all of its nutrients–just adding more of the most abundant nutrient isn’t good enough. But Liebig’s Law of the Minimum doesn’t remove all deviations in nutrient quantity. Plants will still grow, even if some of the trace elements are present in smaller than the usual quantities. Adding fertilizer (or even crop rotation) does not entirely fix this situation. We still end up with soil that is deficient in some micronutrients. This situation tends to get worse with time, as our sewer systems send human wastes out to sea.

In recent years, we have been hearing more about the role intestinal bacteria play. The processing of our food is especially likely to remove the less digestible portions of our food that these bacteria depend on for their nutrition. This adds yet another dimension to the problem of food that deviates from what our bodies are expecting us to eat.

Thanks to fossil fuels, processing of all kinds is cheap. So is adding sugar, artificial colors and artificial flavors to help cover up deficiencies in the original crop. The shortcuts farmers take, including heavy use of fertilizers and pesticides, are ways to produce food more cheaply. The food we end up with is inexpensive and convenient, but doesn’t necessarily match up well with what human digestive systems are adapted to.

What Kind of Exercise Do We Need? 

The story I keep reading is that we need a certain amount of high-intensity intermittent exercise to help our bodies operate as they are intended to. Running for even an average of five or ten minutes a day is said to reduce cardiac causes of death by 30% to 45%, and to increase overall life expectancy by three years. We can easily imagine that hunter-gatherers quite often needed to sprint from time to time, either to avoid predators or to catch potential prey. The finding that human beings need short bursts of high intensity exercise, such as running, would seem to be consistent with what our ancestors did. We also can’t sit for long periods–something our ancestors didn’t do either.

How about strength training? One thing that occurred to me when I visited India is how unnatural it is to have chairs to sit on. Much of the world’s population, even today, sits on the ground when they want to sit down. Needless to say, people who don’t sit on chairs get up from the floor many times a day. This is a type of fitness training that we in this country miss. We in the West also don’t squat much–another type of fitness training.

Even with the beneficial effects of exercise, some researchers today believe that food plays a more important role than exercise in obesity. (Obesity is linked to ill health and shorter life expectancies.) A recent study by Herman Pontzer and others compared the energy expenditure of the Hazda hunter-gatherers to Westerners. The study found that average daily energy expenditure of traditional Hazda foragers was no different from that of Westerners, after controlling for body size. The body seemed to compensate for higher energy expenditure at times, with lower energy expenditure at other times.

Conclusion

It seems to me that our appetites don’t work correctly when we fill ourselves with overly processed foods that are lacking for essential nutrients. We don’t stop eating soon enough, and we quickly feel hungry again. In part this may be from eating foods highly processed foods that would never be found in nature; in part it may be because the foods are missing the micronutrients and fiber that our bodies are expecting. Low-income people especially have a problem with such diets, since diets rich in fruits and vegetables are more expensive.

Many people believe doctors can fix our health problems. Looking across countries, diet and public health issues tend to be much more important than the medical care system in the health of a population. With most chronic health conditions, doctors can only take bad health situations and make them somewhat better. High rates of illness and increased mortality remain, similar to what we see in the United States.

Many of us have heard about the so-called calorie restriction diets of monkeys. This is a misnomer, in my view. In at least one version of it, it is a comparison of monkeys fed a low calorie diet that provides a wide range of nutrients found in vegetables, with a diet typical of Americans. If, in fact, we humans also need a wide range of nutrients found in vegetables, we should not be surprised if we have similarly poor health outcomes.

NYT 31aging_graphic_lgAccording to the graphic, Owen, 26, is affected by arthritis. His skin is wrinkled and his hair is falling out. He is frail and moves slowly. His blood work shows unhealthy levels of glucose and triglycerides. Canto, 25, is aging fairly well.

I personally have been eating a diet that is close to vegetarian for twenty years (heavy on vegetables, fruits and nuts; some fish and diary products; meat only as flavoring in soups). I also cut way back on processed foods and foods with added sugar or corn by-products. When I first changed my diet, I had a problem with arthritis and was concerned that I was at high risk for Type II diabetes. I lost weight, and my arthritis disappeared, as did my blood sugar problems. In fact, I rarely have reason to visit a doctor. In many ways, I feel like Canto on the left.

As I pointed out at the beginning of the post, we need to get a wide variety of nutrients at the same time we need to balance (Energy In) = (Energy Needed for Life Processes). Back in hunter-gatherer days, this was easy to do, but it is increasingly difficult to do today. Besides cutting back on processed foods, eating a diet at that is low in meat may be a way of doing this. Studies of people who eat mostly vegetarian diets show that they tend to have longer life spans. There is also direct evidence that diets that are higher in animal protein tend to shorten life spans. These findings don’t necessarily correlate with studies of what works best for losing weight, which is what most people are concerned about in the short term. Thus, we are deluged with a lot of confusing findings.

Food and health problems are issues that tend to strike a nerve with a lot of people. I can’t claim to be an expert in this area. But stepping back and looking at the issue more broadly, as I have tried to do in this article, can perhaps add some new perspectives.

This Week in Doom: Appointment at Sentara

That-Was-The-Week-That-W-That-Was-The-Week-473964Off the keyboard of Surly1

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Originally published on the Doomstead Diner on July 19, 2014

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 death cheated

 

“There was a merchant in Baghdad who sent his servant to market to buy provisions and in a little while the servant came back, white and trembling, and said, Master, just now when I was in the marketplace I was jostled by a woman in the crowd and when I turned I saw it was Death that jostled me. She looked at me and made a threatening gesture; now, lend me your horse, and I will ride away from this city and avoid my fate. I will go to Samarra and there Death will not find me. The merchant lent him his horse, and the servant mounted it, and he dug his spurs in its flanks and as fast as the horse could gallop he went. Then the merchant went down to the market-place and he saw me standing in the crowd and he came to me and said, ‘Why did you make a threatening gesture to my servant when you saw him this morning?’ ‘That was not a threatening gesture,’ I said, ‘it was only a start of surprise. I was astonished to see him in Baghdad, for I had an appointment with him tonight in Samarra.'”

― ancient Middle eastern tale retold by W. Somerset Maugham                                                                                               

 

Anyone reading this space on a semi regular basis knows that it is devoted to poking and sifting through the abundant scat left by doom  as it slithers its way through the postindustrial economy and neoliberal politics.  This week, “doom” dropped a load closer to home, and of a  much more personal nature.

At about 9:30 last Sunday morning, I was working at the computer and found myself getting lightheaded, images swimming front of my eyes. Nausea rose, and with it  cold sweating, which was curious because the room was reasonably warm. I immediately went to the bedroom to lay down.  Contrary, usually hard to arouse and who could probably sleep through percussion grenades detonated in front of the house,  cracked one eye open and immediately sat straight up. “What’s wrong with you?” she asked. Because of hardwired habits of mind, and because I’m an idiot, I replied, “Absolutely nothing,  I’m just a little dizzy, and I am going to lie  here for a little bit.”

She importuned me to go immediately to the hospital. I brushed her concerns aside, and muttered dark oaths. By family example, long-standing habits of mind, and a flinty Pittsburgh upbringing, my reflexive response to injury is along the lines of, “Rub some mud on it.” I was certain I would feel better shortly. After a shower, I joined my daughter and some friends for brunch. I found that I couldn’t eat anything, and found myself sweating through a shirt in a well-air conditioned room. Contrary watched this scene unfold with increasing agitation, but didn’t say anything until our guests left. As the door closed, she turned to me and said, “Are you going to the hospital or do I have to cut you?”

I’ve seen that expression on her face before. When it appears, she means business. This time it was tempered with evident worry, which struck something in the recesses of my mind where empathy lives in sullen exile, like Napoleon on Elba,  and I went without more of bitching.

We checked  in to the emergency room of our local Sentara hospital complex where, having presented with cardiac symptoms, they saw me reasonably quickly. An intake nurse hooked me up for an EKG.  Dropping the various wires on my chest she said, “Excuse my castanets.”  I asked,  “Does dancing come with an EKG? ” She smiled and quipped, “Yeah, the Dance of the Seven Flails.”  That I was in the hands of a clever nurse with a good sense of humor made a fortunate omen. After six hours of monitoring, they admitted me.

After apparently finding  my insurance card still carried some headroom, the following day they ran me through every EKG, CT scan, sonogram, echocardiogram, ultrasound and stress test available. (Without doubt the hospital system will make their third-quarter based on this run of diagnostics.)  Apparently I have an arrhythmia, and the chambers of my heart are not beating in sync. When I was young and got a pro-forma physical for the junior high school football team, the doctor observed that I had a “heart murmur.” These are apparently pretty common, and certainly had had no practical impact on my life until this moment. But it certainly had claimed my attention now.

The cardiologist assigned to my case, having reviewed the welter of evidence from the tests, suggested an ablation, which is a procedure similar to a cardiac catheterization, in which they Roto-Rooter a garden hose up your femoral artery into your heart, where a tiny laser actually cauterizes the parts of the heart sending aberrant signals. He said that they have 85 per cent success with this procedure, but that it was not without risks. Fortunately for me,  the previous evening I have exchanged some personal messages with agelbert,  who had also gone through his own rounds of cardiac testing and procedures.  AG exhorted me to resist an ablation should it be proffered, and to ask what other options might exist on the continuum of care. Now regular readers of the Diner Forum know AG’s work, and his propensity for tireless research. Plus he’d already gone through many of these procedures himself and was decent enough to share what he knew. Thus armed, when the cardiologist proposed ablation, I asked him if there were not more moderate steps we could take before rushing to do something  permanent and irrevocable. He affirmed that there were, and agreed to try another higher-level beta blocker to get my rhythm back in order.

The medical teams are very good at knowing “what,” and even work at “why.” In my case, blood testing ruled out some mineral deficiency as a proximate cause. Of course in my case,  the “why” probably centers on years of dissolute, then sedentary living. But here we are.


who-cheated-death
So they switched my meds and kept me for observation. That evening, Contrary and I went for a walk after dinner down to a station where they have all those cardiac care on monitors. There I was able to see a visual display of my louche heartbeat. Now I’m as competent to read the signals as a plumber, but both sets of signals looked far more synchronous than they had the last couple days.  Contrary described it best: she said that by top chamber had been going “Ka-boom, Ka-boom,” while the bottom chamber was going, “Boom-shaka-lacka-lacka, Boom-shaka-lacka-lacka.” Now they were more uniform, with my renegade ventricles tossing off fewer PVCs. But then I’ve always had rhythm.

I remained on low-calorie house arrest for another couple of days  tethered to a heart monitor, having my blood pressure and my EKG regularly assessed, and cutting up with the nurses assigned me.   And here I would be remiss if I didn’t call out those nurses, as well as all members of the care team, for their professionalism, expertise and good humor. I found them remarkable. The story ends on an up note, in that the hero doesn’t die at the end, but learns on the fourth day of his medical incarceration that the cardiologist says he is stable and good to go home and resume regular life.

This experience has been pretty challenging, as it tests my usual cynicism about what Diner Lucid Dreams, a former EMT with abundant firsthand experience with Big Med, calls the “wealth care system.” Certainly plenty of cynicism is warranted at all times about the interlocking cartel of health insurers and hospital systems, not to mention Big Pharma, at it is with every vertical of crony capitalism. Yet when one’s own health is swinging in the balance, one’s habitual cynicism is directly challenged. Which is quite where I find myself now. During the entire process, was very grateful for the fact that I had employer-provided health insurance. And I wondered what my prospects would be if, like so many others in this toxic economy, I were unemployed and without such insurance. As I’m too young for Medicare, they would be grim, and the Reaper herself might be waiting for me at Samarra.

As you might imagine, friends of long-standing and those more recently acquired, especially via Occupy,  have checked for the latest news. For this I am most grateful. One conversation I had is worth repeating.

A friend of extremely long-standing who I have known from third grade,  a man in otherwise superb physical condition, found himself with a bout of tachycardia this last August. He felt faint and nearly passed out. His wife implored him to go to the hospital as well. He was initially resistant, but found that he was glad he did. They put in a pacemaker, had a good recovery and now feels like a milk fed athlete. He will retire from his university career this coming fall, and in considering next steps  had an epiphany. He realized he might think about it differently: what if, on that day in Augest, he had not gone to the hospital but had died instead? (The doctors told him that it was indeed fortunate that he came in when he did, else he would have been at grave risk.) So he posited: what if you died, but the Great Scorer reviewed the replay and overturned the ref’s call, and gave you a new lease on life, for a to-be-determined term:  what would you do with that “bonus time?” How would you live? He certainly considers his pacemaker as providing that new lease on life. And 100 years ago, his story would have ended differently. One of the interesting implications of high-tech medical science.

It’s a provocative question, and a refreshing way to look at the time we have remaining. Every day we spend on this side of the dirt is “bonus time.” Precious, worthy of a sense of gratitude and wonder.

Many years ago I read a little book by Baba Ram Dass entitled, “Be Here Now.” It opened my mind to the importance of living in the present and seizing the moment, but I spent a great deal of that awareness in hedonistic pursuits. There are, in fact, worse ways to spend your time, but it’s not a path to enlightenment, whatever that is. (What is it the Buddhists say – ” Before enlightenment: chop wood, carry water; after enlightenment, chop wood, carry water?”) It’s not until the last dozen years or so that I’ve actually put into practice the discipline of reminding myself to be aware, to be mindful, to be fully present and in the moment, at many different points during any given day, and to cultivate a sense of gratitude for the life I have and the people in it. Sometimes easier said than done.

Whenever we brush up against intimations of our own mortality, we tend to think about Big Questions, Legacies, and other ephemera that day-to-day living pushes out of our minds when avoidance is not completely up to the task. I am untroubled by such thoughts. If I kicked today, I would leave behind a remarkable daughter with an active mind and a preturnatural capacity for making good decisions, as well as one discomfited Contrary, as well as a handful of friends and family who would tell funny stories about me at my wake. Legacies are much overblown because at the end of the day, none of this lasts aside from the memories we create and the decency we show others along the way. Long time Diner PB Shelley said it best:

I met a traveller from an antique land
Who said: “Two vast and trunkless legs of stone
Stand in the desert. Near them, on the sand,
Half sunk, a shattered visage lies, whose frown,
And wrinkled lip, and sneer of cold command,
Tell that its sculptor well those passions read
Which yet survive, stamped on these lifeless things,
The hand that mocked them and the heart that fed:
And on the pedestal these words appear:
‘My name is Ozymandias, king of kings:
Look on my works, ye Mighty, and despair!’
Nothing beside remains. Round the decay
Of that colossal wreck, boundless and bare
The lone and level sands stretch far away.”

As the many Tyler Durdens say over at ZeroHedge, “On a long enough timeline, the survival rate for everyone drops to zero.” So the only question that really matters is, “What are you going to do with your time today?” That’s a question worth considering whether you’re on a gurney or at a keyboard. As for me, I’m on “bonus time.”

 

***

Surly1 is an administrator and contributing author to Doomstead Diner. He is the author of numerous rants, articles and spittle-flecked invective on this site, and has been active in the Occupy movement. He shares a home in Southeastern Virginia with Contrary and is delighted this week didn’t end in a dirt nap.

 

 

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