11.27.2009
Hibernating
Dear Readers,
Marks in the Margin will be hibernating during the forthcoming holiday season. Our regular broadcast schedule will resume at the first of the year.
Other commentaries can be found at The Essayist.
Richard Katzev
rkatzev@teleport.com
11.26.2009
11.24.2009
The Food Issue
After a lifetime dedication to the weekly New Yorker, I find myself reading less and less of each issue now. The magazine is no longer the literary periodical it used to be. It was literature that first drew me to the magazine and why I always looked forward to it so much. As a young high school student, it became my Literature 101.
The magazine introduced me to the cultural life of this country, at least as reflected in the goings on in New York. I became aware of the people who were profiled in the magazine, the heroes of high culture, the books they wrote and films they made or appeared in. I was taken away to worlds I never knew existed by the two or three short stories that were published then in each issue and by those remarkable letters from foreign cities. What better introduction to Paris than those memorable Letters from Paris by Janet Flanner?
Indeed, the arrival of The New Yorker used to be one of the main events of my week. It bothered me when it wasn’t delivered on time, and if it didn’t arrive the next day, I would usually go out to buy a copy at the newsstand. Of course, it usually drifted in the day after but I'd didn’t want to run the risk that it might not, or, as happened now and then, it was delivered by mistake to someone else.
With the exception of the recently introduced double issues, the magazine has been published every week for the past seventy-eighteen years. Frankly, I find this rather astonishing. Putting together a magazine of this quality week after week for as many years as this (with no reason to believe it will be any different in the years ahead) seems something of a miracle to me.
And yet, while the quality of the magazine has been maintained, the subject matter has changed significantly. Today there is far less literature with a significant shift toward more domestic and international political issues, as well as pop-cultural and media themes.
Non-fiction articles now make up the bulk of the magazine. Consider for example the newly arrived Special Issues. There is the Money issue, the Fashion issue, the Cartoon issue and last week’s Food Issue, one that was a disappointment to me.
There was no discussion about hunger in America and elsewhere throughout the world. Not a peep about obesity or eating disorders (bulimia and anorexia), nothing about the increasing price of food, recent discussion of vegetarianism or the animal rights movement, and nary a word about corporate farming, food shortages, the impact of droughts on food production, etc. Are these not food related topics?
Instead, the issue treated the reader to articles on something called spit pie, breaking news from the rising wine culture in China, a job description of a Michelin inspection, and the challenges of preparing a Thanksgiving meal abroad and, oh, yes, the secrets of how to create really tasty new food flavors. Really now, is this The New Yorker we used to love?
In truth, there is also a special Fiction Issue early in the year. Finally an issue with more than a single short story. Those in the Fiction Issue are largely by new, relatively unknown authors. Indeed, the stories that do appear in The New Yorker now are much more varied that used to be the case, with a goodly number set in foreign lands and translated from their native languages. This trend is refreshing to readers growing weary of all those domestic conflicts of East Coast couples.
So I keep reading The New Yorker, scanning the pieces more than I ever used to, still heading off to the bookstore to get each weekly issue. I no longer have a mail subscription since the delivery was so unreliable. Sometimes an issue didn’t arrive until a week after it was published in New Yorker. By then I had already read much of it on the Web or, if I wanted to, in its digital edition that as far as I can tell is identical to the printed version. With all these changes, William Shawn must be dying yet another death in his grave.
The magazine introduced me to the cultural life of this country, at least as reflected in the goings on in New York. I became aware of the people who were profiled in the magazine, the heroes of high culture, the books they wrote and films they made or appeared in. I was taken away to worlds I never knew existed by the two or three short stories that were published then in each issue and by those remarkable letters from foreign cities. What better introduction to Paris than those memorable Letters from Paris by Janet Flanner?
Indeed, the arrival of The New Yorker used to be one of the main events of my week. It bothered me when it wasn’t delivered on time, and if it didn’t arrive the next day, I would usually go out to buy a copy at the newsstand. Of course, it usually drifted in the day after but I'd didn’t want to run the risk that it might not, or, as happened now and then, it was delivered by mistake to someone else.
With the exception of the recently introduced double issues, the magazine has been published every week for the past seventy-eighteen years. Frankly, I find this rather astonishing. Putting together a magazine of this quality week after week for as many years as this (with no reason to believe it will be any different in the years ahead) seems something of a miracle to me.
And yet, while the quality of the magazine has been maintained, the subject matter has changed significantly. Today there is far less literature with a significant shift toward more domestic and international political issues, as well as pop-cultural and media themes.
Non-fiction articles now make up the bulk of the magazine. Consider for example the newly arrived Special Issues. There is the Money issue, the Fashion issue, the Cartoon issue and last week’s Food Issue, one that was a disappointment to me.
There was no discussion about hunger in America and elsewhere throughout the world. Not a peep about obesity or eating disorders (bulimia and anorexia), nothing about the increasing price of food, recent discussion of vegetarianism or the animal rights movement, and nary a word about corporate farming, food shortages, the impact of droughts on food production, etc. Are these not food related topics?
Instead, the issue treated the reader to articles on something called spit pie, breaking news from the rising wine culture in China, a job description of a Michelin inspection, and the challenges of preparing a Thanksgiving meal abroad and, oh, yes, the secrets of how to create really tasty new food flavors. Really now, is this The New Yorker we used to love?
In truth, there is also a special Fiction Issue early in the year. Finally an issue with more than a single short story. Those in the Fiction Issue are largely by new, relatively unknown authors. Indeed, the stories that do appear in The New Yorker now are much more varied that used to be the case, with a goodly number set in foreign lands and translated from their native languages. This trend is refreshing to readers growing weary of all those domestic conflicts of East Coast couples.
So I keep reading The New Yorker, scanning the pieces more than I ever used to, still heading off to the bookstore to get each weekly issue. I no longer have a mail subscription since the delivery was so unreliable. Sometimes an issue didn’t arrive until a week after it was published in New Yorker. By then I had already read much of it on the Web or, if I wanted to, in its digital edition that as far as I can tell is identical to the printed version. With all these changes, William Shawn must be dying yet another death in his grave.
11.22.2009
Collecting Ideas
Time was when readers kept commonplace books. Whenever they came across a pithy passage, they copied it into a notebook under an appropriate heading…Reading and writing were therefore inseparable activities. They belonged to a continuous effort to make sense of things. Robert Darnton
Currently my Commonplace Book consists of well over 300 pages of various extracts copied from the books and periodicals that I have read and then collected in a yearly Word document in what has become a rather huge spiral bound notebook.
In thinking back to the origins of my Commonplace Book, I am not at all sure why I began marking passages and then saving them in the first place. The passages must have stood out for one reason or another and I may have wanted to make a record of them in order to reread them sometime in the future.
I think I also had dreams of doing some writing. I know I admired a great many writers and often wondered how they were able to write so well. In my naïve way, I must have imagined that if I studied their works carefully and copied portions of them often enough, I might one day be able to write like they did.
I know there was something in the literature I was reading that was not only different but was also somehow more truthful, more discerning about what mattered in my life than what I was reading in psychology. I don’t recall collecting passages in the academic books and journals I was reading.
Yes, I took notes but those were for my lectures and classroom presentations and were never added to my Commonplace Book or preserved in special notebooks. I may have placed them in a file for the next time I taught the class but not because I found them memorable or otherwise worth saving because they were especially significant.
Lately, I have begun to think of my Commonplace Book as a form of collecting; in my case, collecting ideas as well as clever or provocative expressions that stand apart from ordinary discourse and are, for that reason, worth preserving. In some cases they serve as a standard against which to judge my own attempts to write with some degree of clarity.
Collecting ideas also has a number of distinct advantages compared to collecting most other objects—they cost next to nothing, they are easy to find, do not clutter up your closet, and don’t require periodic repair or maintenance.
A reader of Patrick Kurp’s blog, Anecdotal Evidence also suggests the same view. In a comment on a recent post, he asks, “Could we argue that this is what writing is? Collecting? I would.”
Kurp replies, “The art is in the arrangement. Guy Davenport says “…I am grateful for the unintentional education of having been taught how to find things (all that I have ever done, I think, with texts and pictures)…”
He concludes, “There’s no arguing that a blog is a mutated form of collecting, rooted in the charming custom of keeping a commonplace book and the near-universal human urge to find, collect and share.”
11.21.2009
11.20.2009
The Convert
A few months ago Margie Boule, a widely read columnist for the Oregonian, the local newspaper in the town where I now find myself, says she would have “despised” someone who read with an e-book. Margie Boule is a reader, she loves books, and reports that she would have also called herself a “book murder, a destroyer of bookstores or something more colorful,” if she ever read an e-book.
But now in her column in the November 19th Oregonian she is reading “more books on a Kindle than on paper.” Do I sense a revolution in the works? Hitherto, she was comforted by her books, she “loves the feel of the pages, and the soft whoosh when one is turned. I love the smell of an old book. I love the crispness of the paper in a new book.” And yet…
She now reports a long list of advantages of the e-book. “The Kindle is light; it fits in my purse easily. If I come across a character I can’t remember, I can search the book and recall who the character is. If a friend recommends a book, I can buy it…and be reading the title page within a minute…And if I like the book, I can purchase another e-copy and have it sent to my daughter’s Kindle, as a gift.”
Moreover, a book from the Kindle store costs less than the hardback or even the paperback at the bookstores. And she claims there are many classic books at the Kindle store that are apparently free—Jane Austen, Mark Twain, Jack London, etc. That was news to me.
Booklover that she is, she also reports that she is still buying printed books, mostly biographies, cookbooks, decorating books, photography books. These are usually books with pictures or photos that she says, in agreement with other commentators, appear “gray and grainy on the Kindle.” She also misses the cartoons, and the charts and the book jackets, all of which are either absent or poorly reproduced on the Kindle. (I would also miss the ads that I understand are largely omitted from periodicals, like the New Yorker, as well as newspapers, like the New York Times.
And then there is the occasional social encounter with another person who wants to know if that’s a Kindle she is reading. She takes pleasure in demonstrating how it works and most assuredly the ensuing conversation too.
And yet…back to basics, Boule misses those times she used to spend browsing through small independent bookstores and terribly guilty at depriving them, at least those that have survived, of the income which must have been a rather sizeable sum, from the purchases she made in the good old days.
And in an e-mail exchange we had, Boule reported that she wasn’t sure if you could copy (highlight) passages and then download to them to your computer. That’s a deal breaker for me; I’ve heard some claim they could do this, even though it is cumbersome. But she did tell me something I didn’t realize--that she could e-mail long documents to a Kindle “which has its own e-mail address so that I can read them when I’m on the run.” I imagine this would really be useful to people on go but of little value to those who have trouble finding anywhere to go these days.
From a booklover who despised someone reading an e-book to one doing that very same thing is quite a turnaround. While I surely don’t feel anything close to despising an e-book reader, I haven’t felt especially compelled to give it a try. But Boule’s column today does give me pause. While I remain on the fence, I confess her column was extremely persuasive.
After reporting these details to my lunchtime companion, I was firmly cautioned not to buy the thing just yet on the grounds that Christmas is just around the corner and “I never have anything left to give you, since you always run off and buy things yourself.”
But now in her column in the November 19th Oregonian she is reading “more books on a Kindle than on paper.” Do I sense a revolution in the works? Hitherto, she was comforted by her books, she “loves the feel of the pages, and the soft whoosh when one is turned. I love the smell of an old book. I love the crispness of the paper in a new book.” And yet…
She now reports a long list of advantages of the e-book. “The Kindle is light; it fits in my purse easily. If I come across a character I can’t remember, I can search the book and recall who the character is. If a friend recommends a book, I can buy it…and be reading the title page within a minute…And if I like the book, I can purchase another e-copy and have it sent to my daughter’s Kindle, as a gift.”
Moreover, a book from the Kindle store costs less than the hardback or even the paperback at the bookstores. And she claims there are many classic books at the Kindle store that are apparently free—Jane Austen, Mark Twain, Jack London, etc. That was news to me.
Booklover that she is, she also reports that she is still buying printed books, mostly biographies, cookbooks, decorating books, photography books. These are usually books with pictures or photos that she says, in agreement with other commentators, appear “gray and grainy on the Kindle.” She also misses the cartoons, and the charts and the book jackets, all of which are either absent or poorly reproduced on the Kindle. (I would also miss the ads that I understand are largely omitted from periodicals, like the New Yorker, as well as newspapers, like the New York Times.
And then there is the occasional social encounter with another person who wants to know if that’s a Kindle she is reading. She takes pleasure in demonstrating how it works and most assuredly the ensuing conversation too.
And yet…back to basics, Boule misses those times she used to spend browsing through small independent bookstores and terribly guilty at depriving them, at least those that have survived, of the income which must have been a rather sizeable sum, from the purchases she made in the good old days.
And in an e-mail exchange we had, Boule reported that she wasn’t sure if you could copy (highlight) passages and then download to them to your computer. That’s a deal breaker for me; I’ve heard some claim they could do this, even though it is cumbersome. But she did tell me something I didn’t realize--that she could e-mail long documents to a Kindle “which has its own e-mail address so that I can read them when I’m on the run.” I imagine this would really be useful to people on go but of little value to those who have trouble finding anywhere to go these days.
From a booklover who despised someone reading an e-book to one doing that very same thing is quite a turnaround. While I surely don’t feel anything close to despising an e-book reader, I haven’t felt especially compelled to give it a try. But Boule’s column today does give me pause. While I remain on the fence, I confess her column was extremely persuasive.
After reporting these details to my lunchtime companion, I was firmly cautioned not to buy the thing just yet on the grounds that Christmas is just around the corner and “I never have anything left to give you, since you always run off and buy things yourself.”
11.19.2009
Imagine Chekhov as Your Doctor
Lapham’s Quarterly is a rather unique and to my mind a much needed periodical in that each issue is devoted to a single theme. It is usually explored by means of excerpts from a variety of contemporary and historical articles, books, essays, etc. The issue begins with an introductory essay and analysis by the editor Lewis Lapham. The Fall Quarterly issue was devoted to Medicine.
It includes selections from Virginia Woof’s essay On Being Ill, Susan Sontag’s Illness as Metaphor, Freud’s Introductory Lectures on Psychoanalysis, Atul Gawande’s recent essay in The New Yorker, The Cost Conundrum that President Obama apparently discussed at some length with his aides. Others include works by Ken Kesey, John Barth, Sinclair Lewis, Oliver Sacks and many more. It is a very rich collection.
In his Introduction (“Preamble,”) Lapham cites the following figures that are representative of comparable data we’ve heard so much about lately:
Medical error ranks as the country’s eighth leading cause of death, more deadly than breast cancer or highway accidents.
Americans in 2007 paid $7,421 per capita for healthcare as opposed to $2,840 paid by the Finns and $3,328 by the Swedes, but life expectancy in the United States is not as long as it is in thirty other countries…
The money allocated to healthcare in most other developed countries (in Canada and France as well as in Germany and Japan) provides medical insurance for entire citizenry…in America 46 million citizens (15% of the population) are uninsured.
To continue my posts on the relationship between Medicine and Literature, here are some of the most noteworthy passages I recorded in this of issue of Lapham’s Quarterly.
It is the duty of a doctor to prolong life. It is not his duty to prolong the act of dying.
Lord Thomas Horder
The doctor occupies a seat in the front row of the stalls of the human drama, and is constantly watching and even intervening in the tragedies, comedies, and tragicomedies which form the raw material of the literary art. W. Russell Brain
You can’t find the soul with a scalpel. Gustave Flaubert
Because the newer methods of treatment are good, it does not follow that the old ones were bad: for if our honorable and worshipful ancestors had not recovered from their ailments, you and I would not be here today. Confucius
It strikes me as absurd and rather obscene, this whole cosmetic and medical industry based on lust for youth, age fear, death terror. Who the hell wants to live forever? Most of us, apparently; but it’s idiotic. After all, there is such a thing as life saturation: the point when everything is pure effort and total repetition. Truman Capote.
There must be quite a few things a hot bath won’t cure, but I don’t know many of them. Sylvia Plath
If my doctor told me I had only six minutes to live, I wouldn’t brood. I’d type a little faster. Isaac Asimov
Imagine having Chekhov, who was a doctor, for your doctor. Imagine having William Carlos Williams, who was a poet, or Walker Percy, who’s a novelist, for your doctor. Anatole Broyard
We have to ask ourselves whether medicine is to remain a humanitarian and respected profession or a new but depersonalized science in the service of prolonging life rather than diminishing human suffering. Elisabeth Kubler-Ross
I find an irresistible desire to make jokes. When you’re lying in the hospital with a catheter and IV in your arm, you have two choices, self-pity or irony. Anatole Broyard
It includes selections from Virginia Woof’s essay On Being Ill, Susan Sontag’s Illness as Metaphor, Freud’s Introductory Lectures on Psychoanalysis, Atul Gawande’s recent essay in The New Yorker, The Cost Conundrum that President Obama apparently discussed at some length with his aides. Others include works by Ken Kesey, John Barth, Sinclair Lewis, Oliver Sacks and many more. It is a very rich collection.
In his Introduction (“Preamble,”) Lapham cites the following figures that are representative of comparable data we’ve heard so much about lately:
Medical error ranks as the country’s eighth leading cause of death, more deadly than breast cancer or highway accidents.
Americans in 2007 paid $7,421 per capita for healthcare as opposed to $2,840 paid by the Finns and $3,328 by the Swedes, but life expectancy in the United States is not as long as it is in thirty other countries…
The money allocated to healthcare in most other developed countries (in Canada and France as well as in Germany and Japan) provides medical insurance for entire citizenry…in America 46 million citizens (15% of the population) are uninsured.
To continue my posts on the relationship between Medicine and Literature, here are some of the most noteworthy passages I recorded in this of issue of Lapham’s Quarterly.
It is the duty of a doctor to prolong life. It is not his duty to prolong the act of dying.
Lord Thomas Horder
The doctor occupies a seat in the front row of the stalls of the human drama, and is constantly watching and even intervening in the tragedies, comedies, and tragicomedies which form the raw material of the literary art. W. Russell Brain
You can’t find the soul with a scalpel. Gustave Flaubert
Because the newer methods of treatment are good, it does not follow that the old ones were bad: for if our honorable and worshipful ancestors had not recovered from their ailments, you and I would not be here today. Confucius
It strikes me as absurd and rather obscene, this whole cosmetic and medical industry based on lust for youth, age fear, death terror. Who the hell wants to live forever? Most of us, apparently; but it’s idiotic. After all, there is such a thing as life saturation: the point when everything is pure effort and total repetition. Truman Capote.
There must be quite a few things a hot bath won’t cure, but I don’t know many of them. Sylvia Plath
If my doctor told me I had only six minutes to live, I wouldn’t brood. I’d type a little faster. Isaac Asimov
Imagine having Chekhov, who was a doctor, for your doctor. Imagine having William Carlos Williams, who was a poet, or Walker Percy, who’s a novelist, for your doctor. Anatole Broyard
We have to ask ourselves whether medicine is to remain a humanitarian and respected profession or a new but depersonalized science in the service of prolonging life rather than diminishing human suffering. Elisabeth Kubler-Ross
I find an irresistible desire to make jokes. When you’re lying in the hospital with a catheter and IV in your arm, you have two choices, self-pity or irony. Anatole Broyard
11.18.2009
Gnawing on My Kindle
There is a graphic in Steven Pinker’s review of Malcolm Gladwell’s recent collection of essays, What the Dog Saw, that says it all. Pinker’s review appeared in The Times Book Review of November 15th; the graphic is by Christoph Niemann. It is the clearest and the cleverest critique of Gladwell’s works I’ve ever seen.
On my reading, Gladwell’s essays and books are characterized by a maddening logic of beginning with a particular incident, an anecdote, usually a colorful one, and building step by step with succeeding series of equally amusing anecdotes a major priniciple of behavior.
From a thin slice of the pie, in combination with others in turn, he arrives at a conclusion that he claims to have wide generality. Oh, that it was so simple. Pinker, the author of The Blank Slate and How the Mind Works, agrees. While acknowledging that some of the essays Gladwell has written are “masterpieces in the art of the essay,” he asserts that most include misleading definitions, faulty statistical reasoning, and only a limited understanding of research findings in psychology.
“The banalities come from a gimmick that can be called the Straw We. First Gladwell disarmingly includes himself and the reader in a dubious consensus — for example, that “we” believe that jailing an executive will end corporate malfeasance, or that geniuses are invariably self-made prodigies or that eliminating a risk can make a system 100 percent safe. He then knocks it down with an ambiguous observation, such as that “risks are not easily manageable, accidents are not easily preventable.” As a generic statement, this is true but trite: of course many things can go wrong in a complex system, and of course people sometimes trade off safety for cost and convenience …. But as a more substantive claim that accident investigations are meaningless “rituals of reassurance” with no effect on safety, or that people have a “fundamental tendency to compensate for lower risks in one area by taking greater”… it is demonstrably false.”
Pinker concludes by exclaiming that Gladwell's endless stream of cherry-picked anecdotes “had me gnawing on my Kindle.” Perfect.
While I don’t have a Kindle to gnaw on, I have read almost everything Gladwell has written, including his three books (The Tipping Point, Blink and Outliers, as well as almost all of his New Yorker essays). There is no doubt he is an amusing and extraordinary curious essayist with a rare talent for identifying fascinating, often ignored questions. I like his stuff a great deal.
However, his reasoning about these issues is another matter. I have blogged about his works here before, perhaps more often than any other writer. But nothing I have said or, indeed that Pinker has said, can quite match the critical perceptiveness of Christoph Niemann’s three-part graphic that accompanied Pinker’s review.
11.17.2009
The Naming of Cats
After much deliberation, uncertainty, hesitancy and all too much discussion of the matter, my wife has brought a cat, more properly a little kitten, into our home. She traveled some distance to select the kitten. You see, it isn’t just your ordinary cat, if you will pardon me just this once. Regardless, it is an archetypical kitten, frolicking about, snooping here and there, ears perked up, purring now and then, but always on the alert and up to no good. A regular lion on the prowl.
And now we are faced with the problem of naming it. This is not something to be taken lightly either. I can assure you it will also take a while and a good deal of uncertainty, hesitancy and all too much discussion. You want to get it quite right and yet leave a little room for cat to have its own, very private name, a name that every cat has and only the cat knows, according to the authorities in this area.
The Naming of Cats
The Naming of Cats is a difficult matter,
It isn't just one of your holiday games;
You may think at first I'm as mad as a hatter
When I tell you, a cat must have THREE DIFFERENT NAMES.
First of all, there's the name that the family use daily,
Such as Peter, Augustus, Alonzo or James,
Such as Victor or Jonathan, George or Bill Bailey--
All of them sensible everyday names.
There are fancier names if you think they sound sweeter,
Some for the gentlemen, some for the dames:
Such as Plato, Admetus, Electra, Demeter--
But all of them sensible everyday names.
But I tell you, a cat needs a name that's particular,
A name that's peculiar, and more dignified,
Else how can he keep up his tail perpendicular,
Or spread out his whiskers, or cherish his pride?
Of names of this kind, I can give you a quorum,
Such as Munkustrap, Quaxo, or Coricopat,
Such as Bombalurina, or else Jellylorum-
Names that never belong to more than one cat.
But above and beyond there's still one name left over,
And that is the name that you never will guess;
The name that no human research can discover--
But THE CAT HIMSELF KNOWS, and will never confess.
When you notice a cat in profound meditation,
The reason, I tell you, is always the same:
His mind is engaged in a rapt contemplation
Of the thought, of the thought, of the thought of his name:
His ineffable effable
Effanineffable
Deep and inscrutable singular Name.
From T. S. Elliot’s Old Possum's Book of Practical Cats
To view a video version of the poem from the original London production of Andrew Lloyd Weber’s musical Cats go here.
11.16.2009
A Simple Little Checklist
The Louvre Museum in Paris, the most visited museum in the world, with a collection of paintings ranging across every school, the home of the Mona Lisa, the Venus de Milo, the
Winged Victory, etc. etc, is currently exhibiting a collection of prints and drawings of lists. At the invitation of the museum, the exhibition was created by Umberto Eco who chose to work on the theme he described as The Infinity of Lists. Lists? Where is the art in Lists? My grocery list is scarcely readable. In an interview in Spiegel Online, Eco answers:
“The List is the origin of culture. It’s part of the history of art and literature. What does culture want? To make infinity comprehensible. It also wants to create order…How does one attempt to grasp the incomprehensible? Through lists, through catalogues, through collections in museums and through encyclopedias and dictionaries. There is an allure to enumerating how many women Don Giovanni slept with: It was 2,063, at least according to Mozart’s librettist, Lorenzo da Ponte. We also have completely practical lists—the shopping list, the will, the menu—that are also cultural achievements in their own right.”
Eco, whose works include Foucault’s Pendulum and The Naming of the Rose, says his novels are full of lists. Asked why he is so interested in the subject, Eco replied, “I can’t really say. I like lists for the same reason other people like football, or pedophilia. People have their preferences.”
Eco isn’t the only one who thinks lists are important. So does Atul Gawande who wrote in the Dec 10th, 2007 New Yorker about the critical importance of the checklist in intensive care. While the use of a checklist may seem obvious to most, it isn’t commonly employed in the enormously complex intensive care units. Gawande claims that most physicians don’t believe that “something as simple as a checklist could be of much help in medical care.”
Yet, one study of patient care in I.C.U.s during a twenty four hour period observed that the average patient required 178 actions per day, ranging from drug administration to suctioning the lungs and every one posed risks and the possibility of error. No one can expect a physician under such demanding conditions to be able to remember and implement so many separate actions.
Another study identified the steps to take in order to avoid a single problem in I.C.Us., line infections. When a rather lengthy checklist of each one of the steps was created, it was observed that at least one was omitted in more than a third of the patients. And when, in another study, physicians and nurses were required to check off each step in a checklist, Gawande reports “the infection rate in Michigan’s I.C.U.s decreased by sixty percent…Michigan’s infection rates fell so low that its average I.C.U. outperformed ninety percent of I.C.U.s nationwide…[saving] more than fifteen hundred lives. The successes have been sustained for almost four years—all because of a stupid little checklist.”
A checklist may have also played a crucial role in the survival of all the passengers on Flight 1579 which landed safely in the Hudson River a few months ago. It now appears that it wasn’t only Captain Sullenberger’s piloting skills, to say nothing of a good deal of luck, that avoided a catastrophic crash in the Hudson, but also the fact that Sullenberger and his crew carefully went through a checklist before they took off of each of the steps to take if the engines failed in flight. It was only a few moments later that they were required to recall and carry out each one of the actions they had reviewed prior to take off.
As Eco notes in his interview, “At first, we think that a list is primitive and typical of very early cultures, which had no exact concept of the universe and were therefore limited to listing the characteristics they could name. But, in cultural history, the list has prevailed over and over again. It is by no means merely an expression of primitive cultures.”
Winged Victory, etc. etc, is currently exhibiting a collection of prints and drawings of lists. At the invitation of the museum, the exhibition was created by Umberto Eco who chose to work on the theme he described as The Infinity of Lists. Lists? Where is the art in Lists? My grocery list is scarcely readable. In an interview in Spiegel Online, Eco answers:
“The List is the origin of culture. It’s part of the history of art and literature. What does culture want? To make infinity comprehensible. It also wants to create order…How does one attempt to grasp the incomprehensible? Through lists, through catalogues, through collections in museums and through encyclopedias and dictionaries. There is an allure to enumerating how many women Don Giovanni slept with: It was 2,063, at least according to Mozart’s librettist, Lorenzo da Ponte. We also have completely practical lists—the shopping list, the will, the menu—that are also cultural achievements in their own right.”
Eco, whose works include Foucault’s Pendulum and The Naming of the Rose, says his novels are full of lists. Asked why he is so interested in the subject, Eco replied, “I can’t really say. I like lists for the same reason other people like football, or pedophilia. People have their preferences.”
Eco isn’t the only one who thinks lists are important. So does Atul Gawande who wrote in the Dec 10th, 2007 New Yorker about the critical importance of the checklist in intensive care. While the use of a checklist may seem obvious to most, it isn’t commonly employed in the enormously complex intensive care units. Gawande claims that most physicians don’t believe that “something as simple as a checklist could be of much help in medical care.”
Yet, one study of patient care in I.C.U.s during a twenty four hour period observed that the average patient required 178 actions per day, ranging from drug administration to suctioning the lungs and every one posed risks and the possibility of error. No one can expect a physician under such demanding conditions to be able to remember and implement so many separate actions.
Another study identified the steps to take in order to avoid a single problem in I.C.Us., line infections. When a rather lengthy checklist of each one of the steps was created, it was observed that at least one was omitted in more than a third of the patients. And when, in another study, physicians and nurses were required to check off each step in a checklist, Gawande reports “the infection rate in Michigan’s I.C.U.s decreased by sixty percent…Michigan’s infection rates fell so low that its average I.C.U. outperformed ninety percent of I.C.U.s nationwide…[saving] more than fifteen hundred lives. The successes have been sustained for almost four years—all because of a stupid little checklist.”
A checklist may have also played a crucial role in the survival of all the passengers on Flight 1579 which landed safely in the Hudson River a few months ago. It now appears that it wasn’t only Captain Sullenberger’s piloting skills, to say nothing of a good deal of luck, that avoided a catastrophic crash in the Hudson, but also the fact that Sullenberger and his crew carefully went through a checklist before they took off of each of the steps to take if the engines failed in flight. It was only a few moments later that they were required to recall and carry out each one of the actions they had reviewed prior to take off.
As Eco notes in his interview, “At first, we think that a list is primitive and typical of very early cultures, which had no exact concept of the universe and were therefore limited to listing the characteristics they could name. But, in cultural history, the list has prevailed over and over again. It is by no means merely an expression of primitive cultures.”
11.14.2009
Becomming a Writer
“Even on those occasions when he had no active hand in something I wrote, the choices I made, the way I approached a subject, the order in which I told what I knew, the attitude I adopted were determined by his example and his influence.”
Alec Wilkinson, My Mentor: A Young Man’s Friendship with William Maxwell.
I am currently reading, Mentors, Muses and Monsters edited by Elizabeth Benedict, a rather fascinating collection of thirty essays by writers about the people who changed their life, i.e. led them to become writers. Yet Benedict notes in her Introduction that it isn’t always a particular writer who can turn a person to a writing life.
It can also be a specific book as Michael Cunningham says in describing the life-long influence of Virginia Woolf’s Mrs. Dalloway. It might also be a group of writers or a periodical, or indeed, an institution that can have this kind of impact on an individual. For example Jane Smiley points to her first year at the Iowa Writers’ Workshop.
Benedict also indicates that none of the thirty writers told “the archetypal story of artist and muse: the great man inspired in his great work by a moan destined to play second fiddle, or no fiddle at all.”
As I think back upon my own experience, not that I can lay claim to being a writer, that is a real writer, one whose works are read by others, I can’t think of any single person or book let me to find pleasure in living a writing life. Some books or teachers have been more influential than others and have led to a line of inquiry that guided my work for a while or motivated me to read other books they wrote.
In the early days I was greatly influenced by the kind of magazine The New Yorker was during the period when it was publishing two or three short and not-so-short short stories in each issue, as well as long, analytical essays, profiles and film reviews. And I know that Hemingway’s early novels and short stories made a lasting impression on me.
But it was probably a collection of books assigned in a course I took as an undergraduate the exerted the great influence on my life. In the days when I was a freshman at Stanford every student took a full-year course in the history of Western Civilization and then if they wanted to, could follow it with another in the Humanities devoted to literature and the arts. Those courses and the books I read for them introduced me to the world of humanistic studies and I've never recovered from the experience or found an alternative that comes close.
Again, it wasn’t any particular teacher in the course, although there were several, some as scholarly and charismatic as teachers can be sometimes, nor was it any single book or author, but rather it was the total impact of the course itself and the collection of readings that I was introduced to that made all the difference in my life.
However, the majority of the writers in Benedict’s volume wrote about the individuals who inspired them in one way or another to become writers. For example, Jonathan Safran Foer claims, “that had he not gone to Yehuda Amichai’s reading as a high school student visiting Israel, he might never have become a writer.”
Surely one of the most glowing accounts Benedict recounts in her Introduction is that of Cheryl Strayed. “I love Alice Munro, I took to saying, the way I did about any number of people I didn’t know whose writing I admired, meaning, of course, that I loved her books…But I loved her too, in a way that felt slightly ridiculous, even to me."
Alec Wilkinson, My Mentor: A Young Man’s Friendship with William Maxwell.
I am currently reading, Mentors, Muses and Monsters edited by Elizabeth Benedict, a rather fascinating collection of thirty essays by writers about the people who changed their life, i.e. led them to become writers. Yet Benedict notes in her Introduction that it isn’t always a particular writer who can turn a person to a writing life.
It can also be a specific book as Michael Cunningham says in describing the life-long influence of Virginia Woolf’s Mrs. Dalloway. It might also be a group of writers or a periodical, or indeed, an institution that can have this kind of impact on an individual. For example Jane Smiley points to her first year at the Iowa Writers’ Workshop.
Benedict also indicates that none of the thirty writers told “the archetypal story of artist and muse: the great man inspired in his great work by a moan destined to play second fiddle, or no fiddle at all.”
As I think back upon my own experience, not that I can lay claim to being a writer, that is a real writer, one whose works are read by others, I can’t think of any single person or book let me to find pleasure in living a writing life. Some books or teachers have been more influential than others and have led to a line of inquiry that guided my work for a while or motivated me to read other books they wrote.
In the early days I was greatly influenced by the kind of magazine The New Yorker was during the period when it was publishing two or three short and not-so-short short stories in each issue, as well as long, analytical essays, profiles and film reviews. And I know that Hemingway’s early novels and short stories made a lasting impression on me.
But it was probably a collection of books assigned in a course I took as an undergraduate the exerted the great influence on my life. In the days when I was a freshman at Stanford every student took a full-year course in the history of Western Civilization and then if they wanted to, could follow it with another in the Humanities devoted to literature and the arts. Those courses and the books I read for them introduced me to the world of humanistic studies and I've never recovered from the experience or found an alternative that comes close.
Again, it wasn’t any particular teacher in the course, although there were several, some as scholarly and charismatic as teachers can be sometimes, nor was it any single book or author, but rather it was the total impact of the course itself and the collection of readings that I was introduced to that made all the difference in my life.
However, the majority of the writers in Benedict’s volume wrote about the individuals who inspired them in one way or another to become writers. For example, Jonathan Safran Foer claims, “that had he not gone to Yehuda Amichai’s reading as a high school student visiting Israel, he might never have become a writer.”
Surely one of the most glowing accounts Benedict recounts in her Introduction is that of Cheryl Strayed. “I love Alice Munro, I took to saying, the way I did about any number of people I didn’t know whose writing I admired, meaning, of course, that I loved her books…But I loved her too, in a way that felt slightly ridiculous, even to me."
11.12.2009
Capacity for Acceptance
How often have you read a book about a marriage that worked? “Worked” is the correct word because the marriage that Kay Redford Jamison unfolds in her heartbreaking memoir, Nothing Was the Same, is now a memory.
Jamison, Professor of Psychiatry at Johns Hopkins University School of Medicine, is the author of several extraordinarily books that are both moving and scholarly, a combination that is as uncommon as the spirit of the marriage she recalls in her memoir. Her works include An Unquiet Mind where she describes her own struggle with manic-depression, Night Falls Fast, a study of suicide, and Touched with Fire, an analysis of manic-depression and creativity. I’ve read them all and have benefited in more ways than one from each of them.
In Nothing Was The Same she looks back on her 20-year marriage to Richard Wright, a highly regarded research scholar on schizophrenia at the National Institute of Mental Health. When they met after both had been married before, Jamison says they hit it off at once. “We had many things in common—curiosity about the natural world, interested in the customs and love lives of our colleagues, and fascination with the ways the brain can veer off its tracks—and we made each other laugh…We were inclined to find pleasure in whatever it was we were doing.”
Their delight with one another lasted throughout their marriage and developed into a deep and lasting love. They meant a lot to one another. Jamison remarks that in all the years they had together, there was never a time that she was bored. Yet it wasn’t all so idyllic. “Nearly out the door on more than once occasion, certainly. But bored, never.”
She also comments that in other respects the two of them were really quite different, a difference that brought on laughter more than anything else. What better measure of love! Still, from the beginning their differences created some tension, but eventually “Our sensibilities and quirks evolved into something more shared and complex, more mingled.”
“Richard liked white Christmas lights, I like colored ones; Richard preferred lights to blink, I do not. Each year we put up strands of non-blinking colored lights for me and strands of blinking white lights for him.”
What I found most striking in their marriage was the way it was grounded in a total acceptance of one another. She writes, “…it is the capacity for understanding or accepting that is most important.” And later, “I had Richard, we had each other, and it was enough.” How rarely do I hear anything like that expressed or even sensed or observed in the ways one can usually detect such sentiments in a married couple.
After describing her relationship with Richard, she recounts the agonizing years when together they battled his lung cancer. And in the final section Jamison describes the profound loss she experienced after his death and the long process of grieving that she confronted head on.
Through it all she never succumbed to depression or verged on the threshold of a manic phase. Richard had taught her well, showed her what she needed to do to stay centered. “Richard had a way of giving back to me important things I had lost along the way.”
There is one more striking feature of their marriage that is a consistent theme in her memoir. It is the sense of calm and equilibrium that each of them seemed capable of bringing to one another. “Richard often told me that my acceptance of and love for him created a world of stillness and constancy that he had never known.” And she, in turn, told Richard that he created a “quiet” world for her.” This I believe is a miracle that comes to all too few marriages.
They had nearly twenty years together. They were colleagues, spouses, lovers and mentors for one another. However, Jamison makes it clear that what Richard could not teach her, indeed “no one could—was how to contend with the grief of losing him.”
The love you gave me wasn’t fresh and young,
It didn’t melt the sun or set the town aflame.
But it was warm and wise as any street,
Where hope and sorrow meet in bars without a name.
I only know that one day was a drink
And then the next was you and nothing was the same.
Stuart MacGregor
Jamison, Professor of Psychiatry at Johns Hopkins University School of Medicine, is the author of several extraordinarily books that are both moving and scholarly, a combination that is as uncommon as the spirit of the marriage she recalls in her memoir. Her works include An Unquiet Mind where she describes her own struggle with manic-depression, Night Falls Fast, a study of suicide, and Touched with Fire, an analysis of manic-depression and creativity. I’ve read them all and have benefited in more ways than one from each of them.
In Nothing Was The Same she looks back on her 20-year marriage to Richard Wright, a highly regarded research scholar on schizophrenia at the National Institute of Mental Health. When they met after both had been married before, Jamison says they hit it off at once. “We had many things in common—curiosity about the natural world, interested in the customs and love lives of our colleagues, and fascination with the ways the brain can veer off its tracks—and we made each other laugh…We were inclined to find pleasure in whatever it was we were doing.”
Their delight with one another lasted throughout their marriage and developed into a deep and lasting love. They meant a lot to one another. Jamison remarks that in all the years they had together, there was never a time that she was bored. Yet it wasn’t all so idyllic. “Nearly out the door on more than once occasion, certainly. But bored, never.”
She also comments that in other respects the two of them were really quite different, a difference that brought on laughter more than anything else. What better measure of love! Still, from the beginning their differences created some tension, but eventually “Our sensibilities and quirks evolved into something more shared and complex, more mingled.”
“Richard liked white Christmas lights, I like colored ones; Richard preferred lights to blink, I do not. Each year we put up strands of non-blinking colored lights for me and strands of blinking white lights for him.”
What I found most striking in their marriage was the way it was grounded in a total acceptance of one another. She writes, “…it is the capacity for understanding or accepting that is most important.” And later, “I had Richard, we had each other, and it was enough.” How rarely do I hear anything like that expressed or even sensed or observed in the ways one can usually detect such sentiments in a married couple.
After describing her relationship with Richard, she recounts the agonizing years when together they battled his lung cancer. And in the final section Jamison describes the profound loss she experienced after his death and the long process of grieving that she confronted head on.
Through it all she never succumbed to depression or verged on the threshold of a manic phase. Richard had taught her well, showed her what she needed to do to stay centered. “Richard had a way of giving back to me important things I had lost along the way.”
There is one more striking feature of their marriage that is a consistent theme in her memoir. It is the sense of calm and equilibrium that each of them seemed capable of bringing to one another. “Richard often told me that my acceptance of and love for him created a world of stillness and constancy that he had never known.” And she, in turn, told Richard that he created a “quiet” world for her.” This I believe is a miracle that comes to all too few marriages.
They had nearly twenty years together. They were colleagues, spouses, lovers and mentors for one another. However, Jamison makes it clear that what Richard could not teach her, indeed “no one could—was how to contend with the grief of losing him.”
The love you gave me wasn’t fresh and young,
It didn’t melt the sun or set the town aflame.
But it was warm and wise as any street,
Where hope and sorrow meet in bars without a name.
I only know that one day was a drink
And then the next was you and nothing was the same.
Stuart MacGregor
11.10.2009
Moody Tales of Love
There is a grey cloud hanging over many of William Trevor’s short stories in Cheating at Canasta. The day is cloudy and misty, a melancholy mood surrounds the characters, their talk is reflective, nostalgic, and sad.
In Folie a Deux a man returns to Paris alone and, while reading in a café, muses, “The will to go on can fall away.”
Is there no gaiety in Ireland any more? Is it always so gloomy there?
There is also recognition of the truth, largely the truth of what really happened and what was really felt in a marriage or an affair, even though it was never expressed.
In A Perfect Relation Prosper says, “There was, for him in marriage, the torment of not being wanted any more.” And later “Often disagreeing, they would agree because it made things easier if that falsity seemed to be the truth.”
His language is terse and a strange rhythm of uncertainly characterizes many of the passages. From The Room, “Love makes the most of pity, or pity does of love, I don’t know which. It hardly matters.”
The Room describes in Trevorian fashion an affair between Phair whose marriage was breaking up and Katherine who seemed relatively satisfied with hers. They meet from time to time in a rented room.
They never learn much about each other and often speak elliptically leaving much unsaid or untrue. “This evening he would tell her about his day, and she would say about hers and would have to lie.”
Their affair had been an excitement for both of them. It always is, at least in the beginning. “Risk came into it in all sorts of ways; risk was part of it, the secrecy of concealment, stealth. And risk had claimed its due.”
Eventually, their affair ends. It usually does. “He expected no more of her than what she’d given him, and she would choose her moment to say that she must go. He would understand; she would not have to tell him. The best that love could do was not enough, and he would know that also.”
There are trips to Paris or Venice in several of the stories, always taken alone. Similar experiences are not unknown to me, although they are never as dark or as bleak as Trevor depicts them.
“In Folie a Deux, Wilby travels by himself to Paris. “He reads again, indulging the pleasure of being in Paris, in a brasserie where Muzak isn’t playing, at a small corner table, engrossed in a story that’s familiar yet has receded sufficiently to be blurred in places, like something good remembered.”
And in Cheating at Canasta, the story that gives the book its title, a widower returns to Harry’s Bar, a well-known restaurant in Venice, where he and his wife had many happy times. (Harry’s Bar was one of Hemingway’s haunts and it is also a bit of a legend among the celebrity crowd. I have had the good fortune of going there a couple of times and Trevor brought those experiences back to me again.)
Upstairs in the dining room Mallory overhears a young American couple arguing at the next table. To Mallory their quarreling ruins the memories of the good times he and his wife had there. But then he remembers that their life hadn’t always been quite so free of pain. He says, “Marriage was an uncalculated risk, Mallory remembered saying once. The trickiest of all undertakings.”
In reading these short stories it wasn’t long before I fell into their mood and began to speak the way his characters did. Never so dark or austere, but sometimes as indirect or cryptic and at other times contradictory or ambiguous, never saying exactly what I meant, since I was never very sure what I meant.
In Folie a Deux a man returns to Paris alone and, while reading in a café, muses, “The will to go on can fall away.”
Is there no gaiety in Ireland any more? Is it always so gloomy there?
There is also recognition of the truth, largely the truth of what really happened and what was really felt in a marriage or an affair, even though it was never expressed.
In A Perfect Relation Prosper says, “There was, for him in marriage, the torment of not being wanted any more.” And later “Often disagreeing, they would agree because it made things easier if that falsity seemed to be the truth.”
His language is terse and a strange rhythm of uncertainly characterizes many of the passages. From The Room, “Love makes the most of pity, or pity does of love, I don’t know which. It hardly matters.”
The Room describes in Trevorian fashion an affair between Phair whose marriage was breaking up and Katherine who seemed relatively satisfied with hers. They meet from time to time in a rented room.
They never learn much about each other and often speak elliptically leaving much unsaid or untrue. “This evening he would tell her about his day, and she would say about hers and would have to lie.”
Their affair had been an excitement for both of them. It always is, at least in the beginning. “Risk came into it in all sorts of ways; risk was part of it, the secrecy of concealment, stealth. And risk had claimed its due.”
Eventually, their affair ends. It usually does. “He expected no more of her than what she’d given him, and she would choose her moment to say that she must go. He would understand; she would not have to tell him. The best that love could do was not enough, and he would know that also.”
There are trips to Paris or Venice in several of the stories, always taken alone. Similar experiences are not unknown to me, although they are never as dark or as bleak as Trevor depicts them.
“In Folie a Deux, Wilby travels by himself to Paris. “He reads again, indulging the pleasure of being in Paris, in a brasserie where Muzak isn’t playing, at a small corner table, engrossed in a story that’s familiar yet has receded sufficiently to be blurred in places, like something good remembered.”
And in Cheating at Canasta, the story that gives the book its title, a widower returns to Harry’s Bar, a well-known restaurant in Venice, where he and his wife had many happy times. (Harry’s Bar was one of Hemingway’s haunts and it is also a bit of a legend among the celebrity crowd. I have had the good fortune of going there a couple of times and Trevor brought those experiences back to me again.)
Upstairs in the dining room Mallory overhears a young American couple arguing at the next table. To Mallory their quarreling ruins the memories of the good times he and his wife had there. But then he remembers that their life hadn’t always been quite so free of pain. He says, “Marriage was an uncalculated risk, Mallory remembered saying once. The trickiest of all undertakings.”
In reading these short stories it wasn’t long before I fell into their mood and began to speak the way his characters did. Never so dark or austere, but sometimes as indirect or cryptic and at other times contradictory or ambiguous, never saying exactly what I meant, since I was never very sure what I meant.
11.09.2009
Week in Review
Over at the Wall Street Journal Stephen Marche writes about the evolution of the book. He says, “It’s about what the book wants to be.”
Meanwhile Sergey Brin contributes an Op-Ed defense of Google’s book digitizing program. He argues it will create the library that will last forever.
The ubiquitous Malcolm Gladwell deconstructs himself in an amusing discussion at the Guardian. "I'm interested in slightly dumb, obvious questions, right…"
At the New Yorker Here to There Department Nick Paumgarten writes about inattentional blindness: “a state of such absorption in an activity that you fail to notice really obvious stuff around you, like a guy in a gorilla suit or the state of Wisconsin.”
In a video promo of his new book, Eating Animals, Jonathan Foer answers the perennial question, What’s for dinner—broccoli or a burger?
Yahoo News reports what you have to do if you want to learn about Einstein’s love letters? The answer? Take the morning commute to Tel Aviv.
Conversational Readings offers a much-deserved word of praise for John Williams’ Stoner: “Simply put, the book is about nothing more and nothing less than a human life.”
And over at the Times of London Ben Macintyre looks closely at how the Internet might be affecting storytelling: “Narrative is not dead, merely obscured by a blizzard of byte-sized information. A story, God knows, is still the most powerful way to understand.”
11.07.2009
Medical Reasoning
Lately I’ve been hearing one tale after another about the problems people are having with their medical care—can’t get an appointment, duplicate billing, failure to return calls, in some cases, calls that require immediate attention and finally perhaps the most frequent, incorrect or delayed diagnosis. Who has not heard such tales?
In the November 2009 New York Review of Books, Jerome Groopman, author of How Doctors Think, gives a thought-provoking account of why patients sometimes receive such poor care. He begins by describing a clinical conference he conducted for interns and residents at the Massachusetts General Hospital.
The conference focused on how doctors arrive at a diagnosis of their patient’s ills. “Some 10 to 15 percent of all patients either suffer from a delay in making the correct diagnosis or die before the correct diagnosis is made.”
At once I was struck by Groopman’s methodological approach to this problem. Unlike the usual one of discussing medical successes, Groopman begins by discussing failures. He writes, “The most instructive moments are when you are proven wrong, and realize that you believed you know more than you did, wrongly dismissing a key bit of information that contradicted your presumed diagnosis…”
Science or any empirical discipline (or individual for that matter) doesn’t move forward by pointing to its successes. If that were the case, it would scarcely ever change. Rather we learn far more from the mistakes that have made, from those cases that disprove our conjectures.
Groopman points out that the most common sources of diagnostic errors are the cognitive biases that physician’s make in trying to understand a patient’s condition. (These errors are not confined to physicians. Rather they are errors that anyone is prone to make in making a decision under conditions of uncertainty). He identifies three of the most common biases:
…anchoring where a person overvalues the first data he encounters …; availability where recent or dramatic cases quickly come to mind and color judgment about the situation at hand; and attribution where stereotypes can prejudice thinking so conclusions arise not from data but from such preconceptions.
The second notable methodological point in Groopman’s account is his emphasis on the limits of empirical generalizations in any particular case. He points out that subjects in clinical trial investigations (upon which these generalizations are based) are often highly selective as those who have multiple conditions or are taking other medications or do not fit into a narrow age range (usually too old or too young) are excluded from the study
Groopman comments, “Yet these excluded patients are the very people who heavily populate doctor’s clinics and seek their care.”
The other major sources of physician error stems from the heavy patient load they are now asked to carry. One physician “said she spends less and less time conversing with her patients. Instead she felt glued to a computer screen, checking off boxes on an electronic medical record…”
Another pointed out that “…work rounds were frequently conducted in a closed conference room with a computer rather than at the patient’s bedside.” And finally in describing the case of a seriously ill cancer patient, Groopman reports that “… no one attending to her had sat down in a chair at her [hospital] bedside and conversed at eye level, asking questions and probing her thoughts and feelings about what was being done to combat her cancer and how much more treatment she was willing to undergo.”
This may be hard to believe for anyone familiar with the days when doctors routinely came to your home if you were will or told you to come right over to his or her office if you felt poorly, or indeed, called you at the end of the day to see if you were feeling any better.
In the end Groopman makes clear that the solution to these problems will come about “…only by dogged thinking that requires the kind of time and inquiry that is absent in much of modern medical care." Dream on Dr. Groopman
In the November 2009 New York Review of Books, Jerome Groopman, author of How Doctors Think, gives a thought-provoking account of why patients sometimes receive such poor care. He begins by describing a clinical conference he conducted for interns and residents at the Massachusetts General Hospital.
The conference focused on how doctors arrive at a diagnosis of their patient’s ills. “Some 10 to 15 percent of all patients either suffer from a delay in making the correct diagnosis or die before the correct diagnosis is made.”
At once I was struck by Groopman’s methodological approach to this problem. Unlike the usual one of discussing medical successes, Groopman begins by discussing failures. He writes, “The most instructive moments are when you are proven wrong, and realize that you believed you know more than you did, wrongly dismissing a key bit of information that contradicted your presumed diagnosis…”
Science or any empirical discipline (or individual for that matter) doesn’t move forward by pointing to its successes. If that were the case, it would scarcely ever change. Rather we learn far more from the mistakes that have made, from those cases that disprove our conjectures.
Groopman points out that the most common sources of diagnostic errors are the cognitive biases that physician’s make in trying to understand a patient’s condition. (These errors are not confined to physicians. Rather they are errors that anyone is prone to make in making a decision under conditions of uncertainty). He identifies three of the most common biases:
…anchoring where a person overvalues the first data he encounters …; availability where recent or dramatic cases quickly come to mind and color judgment about the situation at hand; and attribution where stereotypes can prejudice thinking so conclusions arise not from data but from such preconceptions.
The second notable methodological point in Groopman’s account is his emphasis on the limits of empirical generalizations in any particular case. He points out that subjects in clinical trial investigations (upon which these generalizations are based) are often highly selective as those who have multiple conditions or are taking other medications or do not fit into a narrow age range (usually too old or too young) are excluded from the study
Groopman comments, “Yet these excluded patients are the very people who heavily populate doctor’s clinics and seek their care.”
The other major sources of physician error stems from the heavy patient load they are now asked to carry. One physician “said she spends less and less time conversing with her patients. Instead she felt glued to a computer screen, checking off boxes on an electronic medical record…”
Another pointed out that “…work rounds were frequently conducted in a closed conference room with a computer rather than at the patient’s bedside.” And finally in describing the case of a seriously ill cancer patient, Groopman reports that “… no one attending to her had sat down in a chair at her [hospital] bedside and conversed at eye level, asking questions and probing her thoughts and feelings about what was being done to combat her cancer and how much more treatment she was willing to undergo.”
This may be hard to believe for anyone familiar with the days when doctors routinely came to your home if you were will or told you to come right over to his or her office if you felt poorly, or indeed, called you at the end of the day to see if you were feeling any better.
In the end Groopman makes clear that the solution to these problems will come about “…only by dogged thinking that requires the kind of time and inquiry that is absent in much of modern medical care." Dream on Dr. Groopman
11.05.2009
Reading Philosophy in French
Ever since I read it, I’ve been mulling over an article that appeared in the Times earlier this week. Like a persistent musical tune, it won’t go away. A psychiatrist described a man in a homeless shelter who lived “a life apart, without a home, friend or regrets.”
“The staff at the homeless shelter where I worked for several years had long worried about him. He sat in the day hall, well tended and polite, reading chemistry textbooks with calm comprehension. At the moment, he was in the middle of a book written by a French philosopher in the 1930s; he was reading it in French.”
I wondered, what is there to worry about this fellow? The psychiatrist reported he had said, “My goal is equanimity. I’m not pursuing what the world calls success.” Well, good for him, I thought.
The members of the staff had described him as a man of thought but without feeling. Again I wondered how could they be sure of that, how could they know what was churning below the surface.
The article went on to describe the following incident: Before he moved into the shelter he had shared an apartment with an alcoholic. As he was leaving the apartment one morning “he passed his roommate slumped over the kitchen table. He did not pause to check on the man.” I thought that seemed perfectly reasonable; the guy was an alcoholic, was he not, and might have had similar experiences more than once.
“When he returned in the evening, his roommate was still slumped over the table. If he had not been dead earlier, he was now.”
The homeless man drew two conclusions from this experience—he was often wrong in judging other people and, because of that, he ought to distance himself them. I thought he was being needlessly hard on himself. He had every reason to believe his roommate was simply in a temporary stupor.
The psychiatrist who wrote the article drew another conclusion. She asked him for another meeting in the belief that he might achieve some sort of understanding of the incident and that he had no reason to “absent himself from the world…”
The man calmly rejected the invitation saying he wasn’t interested in getting involved with the rest of the world.
I took him at his word, that for whatever reason he has chosen to live a solitary life with his books, that the world was a messy and complicated place and he simply didn’t feel the need or the desire to enter into it.
I did not choose to look for anything deeper, to view him as a man in need of help, or that his rejection of society gave anyone cause for worry. I did not assign him to any clinical disorder or view him as disturbed. Of course, I knew virtually nothing about him or his previous history.
He had made his choice. It was not an altogether uncommon one. He isn’t the only one who feels and acts that way. There are person of renown in the arts and sciences who live such a solitary life, although they assuredly have more financial resources.
Let him be, I thought. Leave him to his books, to his chemistry and French philosophy, to his rejection of society and what in his view are it demands. He seeks only a state of calmness.
“The staff at the homeless shelter where I worked for several years had long worried about him. He sat in the day hall, well tended and polite, reading chemistry textbooks with calm comprehension. At the moment, he was in the middle of a book written by a French philosopher in the 1930s; he was reading it in French.”
I wondered, what is there to worry about this fellow? The psychiatrist reported he had said, “My goal is equanimity. I’m not pursuing what the world calls success.” Well, good for him, I thought.
The members of the staff had described him as a man of thought but without feeling. Again I wondered how could they be sure of that, how could they know what was churning below the surface.
The article went on to describe the following incident: Before he moved into the shelter he had shared an apartment with an alcoholic. As he was leaving the apartment one morning “he passed his roommate slumped over the kitchen table. He did not pause to check on the man.” I thought that seemed perfectly reasonable; the guy was an alcoholic, was he not, and might have had similar experiences more than once.
“When he returned in the evening, his roommate was still slumped over the table. If he had not been dead earlier, he was now.”
The homeless man drew two conclusions from this experience—he was often wrong in judging other people and, because of that, he ought to distance himself them. I thought he was being needlessly hard on himself. He had every reason to believe his roommate was simply in a temporary stupor.
The psychiatrist who wrote the article drew another conclusion. She asked him for another meeting in the belief that he might achieve some sort of understanding of the incident and that he had no reason to “absent himself from the world…”
The man calmly rejected the invitation saying he wasn’t interested in getting involved with the rest of the world.
I took him at his word, that for whatever reason he has chosen to live a solitary life with his books, that the world was a messy and complicated place and he simply didn’t feel the need or the desire to enter into it.
I did not choose to look for anything deeper, to view him as a man in need of help, or that his rejection of society gave anyone cause for worry. I did not assign him to any clinical disorder or view him as disturbed. Of course, I knew virtually nothing about him or his previous history.
He had made his choice. It was not an altogether uncommon one. He isn’t the only one who feels and acts that way. There are person of renown in the arts and sciences who live such a solitary life, although they assuredly have more financial resources.
Let him be, I thought. Leave him to his books, to his chemistry and French philosophy, to his rejection of society and what in his view are it demands. He seeks only a state of calmness.
11.04.2009
Linking Book and Reader
“The reader will find many of my friends in this book, both friends that I know and…many whom I have never met, yet know through reading, through having been taught about them and by them.” This passage is from James Schall’s The Unseriousness of Human Affairs by way of Patrick Kurp on his blog, Anecdotal Evidence.
Schall suggests the literary friends we have are both writers as well the characters they write about in their stories. But what types of friends are they? Some live with us forever, while others drift away soon after the story concludes. But did you ever hear of someone falling in love with a literary friend?
Elizabeth Hawes in her book, Camus, a Romance, says she has. “During my last college years, I had photograph of Albert Camus prominently displayed above my desk…I had fallen in love with him. Not romantic love in the only sense I had experienced in those days…but something deeper, like the bonding of two souls.”
She says Camus had an enormous impact on her life, that his insights literally changed its course. “I had never before experienced such an intimate relationship with a writer, poring over his prose and filling up with his rhythms, thinking his thoughts, trying to crawl under his skin.”
Her feelings led Hawes on a lifelong search to learn more about this very private man. Camus, a Romance is a fascinating portrait of Camus, the man and the writer. It chronicles her experiences following in his footsteps in North Africa, Paris, New York and Provence. In an effort to come to some kind of understanding of this complex man, she tracked down his friends, members of his family, and the writers that knew him
Her journey reminded me of a comparable one by the classical language teacher, Raimund Gregorious. However, Gregorious was not a writer, rather he was one of the central characters in Pascal Mercier’s masterful novel, Night Train to Lisbon. Gregorious had been teaching at the same secondary school in Berne Switzerland for decades. He was fixed in the same, daily solitary routine and had no desire to change it.
“Mundus, the most reliable and predictable person in this building and probably the whole history of the school, working here for more than thirty years, impeccable in his profession…respected and even feared in the university for his astounding knowledge of ancient languages…his head also held the Hebrew that had amazed several Old Testament scholars.”
On his way to school one day he encounters a distraught woman on a bridge who says her mother tongue is Portuguese. The woman walks with Gregorious to his class, sits there for a while, then departs. Soon thereafter Gregorious realizes his own life is drawing to a close and suddenly walks out of the classroom to the utter astonishment of his students.
“…Simply to get up and go: what courage! He just got up and went, the students keep saying. Just got up and went.” He eventually winds up in Spanish language bookstore where he chances upon an antique Portuguese book, A Goldsmith of Words by Amadeu de Prado. He buys the book and a Portuguese dictionary, begins reading, is astonished by the power and the beauty of the words and the next morning leaves Switzerland, his school, and his daily routine to take the train to Portugal on a journey to track down the life and world of Amadeu de Prado. “…he had the amazing feeling, both upsetting and liberating, that at the age of fifty-seven, he was about to take his life into his own hands for the first time.”
Like Hawes’s relationship with Camus, the one I had with the characters in Night Train to Lisbon was a strong as any I have had in reading literary fiction. I entered into the lives of Raimund Gregorious and Amadeu de Prado as if they were virtually my own. I admired them, thought about the same questions they posed on every page, and found myself just as perplexed by them as they did. And I came to know these fictional characters as well as any of the friends I have in real life, actually in some respects even better. This is the kind of encounter that can sometimes link a book with a reader and make the experience of reading literature so compelling.
Schall suggests the literary friends we have are both writers as well the characters they write about in their stories. But what types of friends are they? Some live with us forever, while others drift away soon after the story concludes. But did you ever hear of someone falling in love with a literary friend?
Elizabeth Hawes in her book, Camus, a Romance, says she has. “During my last college years, I had photograph of Albert Camus prominently displayed above my desk…I had fallen in love with him. Not romantic love in the only sense I had experienced in those days…but something deeper, like the bonding of two souls.”
She says Camus had an enormous impact on her life, that his insights literally changed its course. “I had never before experienced such an intimate relationship with a writer, poring over his prose and filling up with his rhythms, thinking his thoughts, trying to crawl under his skin.”
Her feelings led Hawes on a lifelong search to learn more about this very private man. Camus, a Romance is a fascinating portrait of Camus, the man and the writer. It chronicles her experiences following in his footsteps in North Africa, Paris, New York and Provence. In an effort to come to some kind of understanding of this complex man, she tracked down his friends, members of his family, and the writers that knew him
Her journey reminded me of a comparable one by the classical language teacher, Raimund Gregorious. However, Gregorious was not a writer, rather he was one of the central characters in Pascal Mercier’s masterful novel, Night Train to Lisbon. Gregorious had been teaching at the same secondary school in Berne Switzerland for decades. He was fixed in the same, daily solitary routine and had no desire to change it.
“Mundus, the most reliable and predictable person in this building and probably the whole history of the school, working here for more than thirty years, impeccable in his profession…respected and even feared in the university for his astounding knowledge of ancient languages…his head also held the Hebrew that had amazed several Old Testament scholars.”
On his way to school one day he encounters a distraught woman on a bridge who says her mother tongue is Portuguese. The woman walks with Gregorious to his class, sits there for a while, then departs. Soon thereafter Gregorious realizes his own life is drawing to a close and suddenly walks out of the classroom to the utter astonishment of his students.
“…Simply to get up and go: what courage! He just got up and went, the students keep saying. Just got up and went.” He eventually winds up in Spanish language bookstore where he chances upon an antique Portuguese book, A Goldsmith of Words by Amadeu de Prado. He buys the book and a Portuguese dictionary, begins reading, is astonished by the power and the beauty of the words and the next morning leaves Switzerland, his school, and his daily routine to take the train to Portugal on a journey to track down the life and world of Amadeu de Prado. “…he had the amazing feeling, both upsetting and liberating, that at the age of fifty-seven, he was about to take his life into his own hands for the first time.”
Like Hawes’s relationship with Camus, the one I had with the characters in Night Train to Lisbon was a strong as any I have had in reading literary fiction. I entered into the lives of Raimund Gregorious and Amadeu de Prado as if they were virtually my own. I admired them, thought about the same questions they posed on every page, and found myself just as perplexed by them as they did. And I came to know these fictional characters as well as any of the friends I have in real life, actually in some respects even better. This is the kind of encounter that can sometimes link a book with a reader and make the experience of reading literature so compelling.
11.02.2009
Morning Line
I have this little routine that I go through each morning in reading the blogs and Web sites that interest me. The fact that I can do this still seems a bit of a miracle to me, one that I’ve never find tedious or the least bit repetitious. It’s like waking up each morning in the library.
I start with the Arts and Letters Daily that has three columns of short descriptions of new ideas, topics, issues, etc. First there is the Articles of Note, then New Books and the last Essays and Opinion pieces. In light of the brief sentence or two about each listing, I decide whether or not I want to click on the “more” link which in turn takes me to the full document itself, whereupon I can add it to my list of Unsorted Bookmarks to be read later in the day.
On Monday I always move from this tremendously rich page to The New Yorker’s Web site to find out what’s in the issue for the week. Then I move on to three sets of Blogs.
Blog 1 consists of Anecdotal Evidence by Patrick Kurp who writes with considerable insight and wisdom based on his exceptional knowledge of literary history. The Book Bench, the second is this group, is the New Yorker’s literary blog that presents a half dozen or more topics each day, and lastly the Commonplace Blog of David Meyers that presents one of the sanest and most thought provoking literary commentaries on the Web.
Blog 2 begins with Conversational Reading that has a good deal of literary news, especially about Latin American literature but far too many ads. Then I move on to the New York Times book blog, Paper Cuts, and then to the Guardian literary site that includes a good deal of news, special reports, and its own blog. Here you get the benefit of three extremely interesting Web pages that bring together a wide range of literary articles and videos.
Blog 3 consists of another three Web sites beginning with The Situationist that treats an enormous number of topics in the social sciences broadly conceived. I follow it with the Frontal Cortex written by Jonah Lehrer, the author of Proust was a Neuroscientist and How We Decide. The last of this batch is Letters from a Librarian, a site that I’ve recently discovered and has become one of my favorites, although lately its author doesn’t post comments very often. However, it is far and away the most aesthetically pleasing, as you will note at once if you visit it. It is also a extremely personal blog in which the author does what I think is so important in writing about literature, namely describing the way the experience affects them personally.
I do all this first thing in the morning and then later in the day, I return to those links I’ve saved in my Unsorted Bookmarks to read with more care. I am struck by what an extraordinary experience this is and what a wealth of information is offered up to me each day by these bloggers
None of this was possible a few years ago. Now it is and as far as I’m concerned this is a bit of a revolution in the transmission of thought and ideas and teaching.
And when I cannot get on the Web, say when I’m traveling or my server is down, I find myself terribly distressed. Something important is missing from my daily routine and I will spend the better part of the day trying to find it. Yes, it is truly an addiction and yes, I do experience withdrawal symptoms in the absence of my morning literary fix. It is like working out each day, another one of my addictions. If I unable to get to the gym or head out for a morning jog, I just don’t feel quite right the rest of the day.
I start with the Arts and Letters Daily that has three columns of short descriptions of new ideas, topics, issues, etc. First there is the Articles of Note, then New Books and the last Essays and Opinion pieces. In light of the brief sentence or two about each listing, I decide whether or not I want to click on the “more” link which in turn takes me to the full document itself, whereupon I can add it to my list of Unsorted Bookmarks to be read later in the day.
On Monday I always move from this tremendously rich page to The New Yorker’s Web site to find out what’s in the issue for the week. Then I move on to three sets of Blogs.
Blog 1 consists of Anecdotal Evidence by Patrick Kurp who writes with considerable insight and wisdom based on his exceptional knowledge of literary history. The Book Bench, the second is this group, is the New Yorker’s literary blog that presents a half dozen or more topics each day, and lastly the Commonplace Blog of David Meyers that presents one of the sanest and most thought provoking literary commentaries on the Web.
Blog 2 begins with Conversational Reading that has a good deal of literary news, especially about Latin American literature but far too many ads. Then I move on to the New York Times book blog, Paper Cuts, and then to the Guardian literary site that includes a good deal of news, special reports, and its own blog. Here you get the benefit of three extremely interesting Web pages that bring together a wide range of literary articles and videos.
Blog 3 consists of another three Web sites beginning with The Situationist that treats an enormous number of topics in the social sciences broadly conceived. I follow it with the Frontal Cortex written by Jonah Lehrer, the author of Proust was a Neuroscientist and How We Decide. The last of this batch is Letters from a Librarian, a site that I’ve recently discovered and has become one of my favorites, although lately its author doesn’t post comments very often. However, it is far and away the most aesthetically pleasing, as you will note at once if you visit it. It is also a extremely personal blog in which the author does what I think is so important in writing about literature, namely describing the way the experience affects them personally.
I do all this first thing in the morning and then later in the day, I return to those links I’ve saved in my Unsorted Bookmarks to read with more care. I am struck by what an extraordinary experience this is and what a wealth of information is offered up to me each day by these bloggers
None of this was possible a few years ago. Now it is and as far as I’m concerned this is a bit of a revolution in the transmission of thought and ideas and teaching.
And when I cannot get on the Web, say when I’m traveling or my server is down, I find myself terribly distressed. Something important is missing from my daily routine and I will spend the better part of the day trying to find it. Yes, it is truly an addiction and yes, I do experience withdrawal symptoms in the absence of my morning literary fix. It is like working out each day, another one of my addictions. If I unable to get to the gym or head out for a morning jog, I just don’t feel quite right the rest of the day.
Subscribe to:
Posts (Atom)