When the Cynical Becomes the Norm

There are two scenes from very different theaters which the Phantom cannot forget: The first is from "Gone With the Wind," where Rhett Butler (Clark Gable) looks over his shoulder as he accompanies Scarlet O'Hara and Melanie Wilkes along a road leaving burning Atlanta, and he sees old men and young boys trudging along in the opposite direction, going to fight the Yankees, to defend their homes and city. Butler has been disdainful of the arrogant rebel "Cause," of all those fools who shouted they would beat the Yankees in ten days, that one Southern gentleman on horseback could whip ten Yankees.  Butler had pointed out there were only three munitions factories in the entire Confederacy at the beginning of the war, and that the Union navy would blockade the ports, and Union trains would transport the federal host to overwhelm the Confederates. The whole idea of a righteous war was ridiculous, Butler argued, and he would have no part in that fight.

But looking at the bedraggled, all but defeated stream of what was left of Southern manhood, marching off to fight against all odds, Butler acknowledges that for the first time in his life he felt ashamed, and he turns to join them, leaving Scarlet to manage Melanie and her newborn baby and the wagon along the escape route out of burning Atlanta. Butler has to do the thing which is honorable, for once, even though it will cost him, and is clearly not the profitable thing to do.

Omar

The Second scene is from "The Wire," where Bunk, the workaday detective in his sweat stained suit, confronts Omar, who makes a lot of money at gun point, robbing other players "in the game," living by his own rules and turning a good profit at it. Omar has engaged in a shoot out in broad daylight , leaving two dead behind on a Baltimore street. Bunk tells Omar that when Bunk arrived on the scene afterwards, children, who had witnessed the shootout, were re-enacting the scene, each one wanting to play Omar, who they idolized as a great street hero.

"Oh, how far we've done fallen," Bunk tells Omar. He means how far the Black folk of Baltimore, where they both grew up, have fallen. What a bankrupt, degenerate, decadent world they have created.  Later, Omar decides to aid Bunk in an investigation, arranging for the return to the Baltimore Police Department a police gun, and that costs Omar considerably, and he is told, "Conscience do cost." The police gun was important to the chiefs of the BPD, as it was a symbol--a police gun should never be captured. Omar shakes his head, just as Rhett Butler did, angry with himself for doing the foolish, right thing.

In each case, the right thing, the righteous thing was ridiculous, the empty ideal of a power structure which was sanctimonious, beyond misguided to delusional. But still...there was something noble about fighting for a lost cause, stupid as it might be.

There is another story, likely apocryphal, about Lenny Moore, the wonderful football player, who won a scholarship to Penn State, and one day in class a professor asked him a question and Moore just stared at him. "Uh, Mr. Moore," the professor said, "I asked you a question."

"My name is Lenny Moore," he replied. "I don't answer no questions. I just carry the ball."

Of course, what Moore was saying is that he was at Penn State as an employee of the athletic department, and he was being paid to play football. He might be required to attend class, but that was just a ruse, a lie to make the big hoo-ha's in the college administration feel righteous, as they talked about "student athletes." Student athletes, of course did not have to be paid. Moore would get his financial reward in the pros, and Penn State was a farm team for the pros. 

Another story:  the Phantom was driving to work listening to NPR when a story about a medical student came across. This student was first in his class at the Mount Sinai Medical School in New York City and the Dean of the medical school called him into his office. "I see you've applied to a residency program in Florida, at a community hospital. You could match for Mass General, Columbia, or Stanford, any of the best programs in the country, and you are applying for a community hospital which has nothing to recommend it beyond the fact it's accredited? Why?"

"If I did my residency at those big name programs, I'd spend three years doing their scut work and then another two working for their professors on their research papers. For what? I am going to Florida, where I'm going to learn to do colonoscopies, and every day by three o'clock, I'll be on my boat, living the life, making more money than any of those professors."

The Phantom nearly drove off the road.

Years earlier, the Phantom walked into the office of the Chief of Medicine at Cornell, with an application for the dermatology program at NYU. The Phantom had done a 6 week elective at NYU because the Cornell New York Hospital had no dermatology department and the NYU program was known to be the best in the city, and the Phantom loved it. All the little surgeries, learning how to make "Augenblick" diagnoses (in the blink of an eye.) The NYU department had an in patient service for people with the most severe conditions, like bullous pemphigus, not that there was anything much you could do for them, but still. The staff was warm and welcoming and Derm was fun.

"You've spent four years learning how to treat the very sickest patients," the Chief said. The Chief was a hematologist and he had patients with leukemia on his service. "You've learned how to rescue a septic leuk in the middle of the night. You've been on the cardiac team. One night, when you were alone, you rescued a seventy year old man who went into florid pulmonary edema, who was bubbling froth from his mouth, and you did that with just a nurse and a vacuum bottle, all by yourself. And now you want to go into dermatology?" 

He made that word sound almost obscene.

"There's a reason The New York Hospital-Cornell Medical Center does not have a department of dermatology," the Chief said. "It's not really medicine. It's dentistry with stethoscopes and you don't even really need the stethoscope." 

The Phantom slunk out of the office, the application to the derm program balled up in his hand.

But, twenty years later the Phantom looks at the salary schedules for the various specialties: Dermatologists come in around $500,000 annually, but rheumatology, neurology, endocrinology, all those honorable specialties where the sick patients go, about half that.

The most competitive specialties are now Dermatology, Ophthalmology, Anesthesiology and Radiology. And radiologists, except for the invasive radiologists, never even lay a hand on a patients; often they never even see the patients. But those specialties are called "the ROAD" (the first letters of their names) to happiness.

The fact is, the four years of medical school is likely a sham as well. The Brits send their doctors to medical school right out of high school. And most of what has been done only by doctors is now done by nurse practitioners and physicians assistants. They do not do internships or residencies; they learn on the job as apprentices. 

Big healthcare systems like Hospital Corporation of America hire nurse "endocrinologists" who have never done an endocrine fellowship or even a medical residency, much less gone to medical school.  What they are saying is you don't need to know the molecular biology of diabetes to prescribe insulin.  The whole long trudge to board certification for a variety of specialties was just a guild's efforts at throwing up a gauntlet to restrict supply of providers. 

When the money managers take over, there is no sentiment about saving lives; it's all cost/benefit and if you miss a diagnosis here and there, or render the wrong care, and there's a lawsuit, well, that's just the price of doing business.

And now "student athletes" are recognized as what they have truly always been--employees of the colleges, and they are paid accordingly and may even soon be allowed to unionize. 

Our American system is a commercial system, operating on capitalistic for profit principles, even at the nominally "non profit" academic hospitals. If a hospital is making profit in the emergency room, the radiology department but losing money supporting community practices in neurology, rheumatology, diabetes, it will and by the rules of the American game, it should cut the loss leaders and focus on the profit centers. The executives in their thousands are not bad people; they are doing the jobs they were hired to do: make a profit for the corporation. 

They are not hired by the community, but by the corporation. Until the community, i.e. the government decides to get in the business of healthcare, the business of healthcare will be to maximize profit for some profit center, whether that's Partners or Hospital Corporation of America or United Healthcare Insurance Company.

It's a choice the American public has consistently made, even if it doesn't know it's made that choice. When Bernie Sanders rails about profit poisoning health care, about the need for Medicare for all, citizens think to themselves, "That'll cost me more," and they vote against him. 

The financial realities are now being faced. Doctors incurring debt to go to medical school cannot afford to be seduced by the myth they are doing something heroic, no matter what you see on "ER" or "The Pitt," or "General Hospital." 

There is no glory. There is just commerce, transactions and deals. 

There are no backward glances for Rhett Butler, no welling up of shame for Omar. 

It's all the art of the deal.

Olgunquit's Titanic

 

First, let it be known the Phantom is a musical illiterate.

His only musical distinction was being America's worst piano student for the years 2017-2022, when he finally gave up trying to master rhythm, pitch, style and remembering the different scales. 

Having said all that, the Phantom has been an ardent fan of Broadway musicals since he first heard "My Fair Lady" and "Oklahoma" and "South Pacific," age 7, when his parents acquired a turntable, speakers and 33 rpm phonograph records and he could sing along with every song in those masterpieces (off pitch).

So those are the bone fides for the Phantom, as it were.

Add to that the Phantom is dazzled by the quality and richness of the Ogunquit Playhouse, where he has seen 17 years of musicals including "Miss Saigon," and "Avenue Q" and "Young Frankenstein" and "Guys and Dolls" just to name those which leap to mind. 

He has never seen anything on Broadway done any better than what he's seen at Ogunquit, which is no surprise because the Ogunquit is simply Broadway north, the summertime retreat for Broadway dancers, singers and actors. They come up to the coast of Maine for the summer and the locals watch bewitched. 

"Titanic" at the Ogunquit is a terrific idea: The allegorical nature of this stunning ship, the largest moving man made object on the planet at the time, to be compared in its engineering prowess with the pyramids, is pitched from the outset of this production.

And this story has not been told enough, even given the 1997 movie with its Celine Dione theme song and the 1996 TV miniseries and the 1958 movie, "A Night to Remember."

What Ogunquit does differently, to its great credit, is to focus on the "what went wrongs" of the story, and this is a rich lode:

1. The bulkheads which could have prevented flooding from one compartment to the next were not built high enough because the engineers were told to not obscure the view of the first class passengers.

2. The steel used for the ship was not of highest grade and was of a grade which got brittle in cold water and had it been of higher grade, may not have ruptured at all with the glancing blow from the iceberg.

3. There were only enough lifeboats for half of the passengers.

4. There were no lifeboat drills done (so as not to alarm the passengers) so 450 seats on the lifeboats were left empty.

5. The lookouts were not issued binoculars, which were locked up.

6. The captain plotted a northerly course, in an attempt to cross the Atlantic in six days, rather than a more southerly course, where icebergs were not present.

7. The Titanic received multiple warnings by wireless morse code about icebergs, but the captain ignored them.

8. There was no such thing as radar in 1912. 

9. The ship was pushed to its maximum speed, 23 knots, on its maiden voyage, violating the basic safety custom of treating the voyage as a "shakedown exercise" to reveal problems. 

10. Bruce Ismay, the owner of the White Star Line, was allowed on the bridge and is depicted as goading the captain to increase his speed and take the shortest but most dangerous route to New York, so commercial concerns may well have led to bad seamanship and bad engineering. 

Ismay is beyond Judas Iscariot, as depicted here--pushing for the most dangerous choices, then blaming the captain for following his instructions and then taking a place in the lifeboats meant for women and children, while third class women and children remained locked belowdecks.

All this is conveyed admirably by Ogunquit's Titanic.

But, the problem is, this is not "Jesus Christ Superstar."

The reason this comparison comes to mind is bars from JCSS sound through in the climactic scene where Ismay storms at the Captain blaming him for the disaster.

The fact is, "Jesus Christ Superstar" also had a grand and significant story to tell, but it was able to do it with fantastic music, great melodies and electric songs. There is not a single hum-able song in "Titanic." 

In fact, the songs carry the story in  JCSS, in operatic function--"I Don't Know How to Love Him," and "This Jesus Must Die" and "What's the Buzz" and "Everything's Alright," and "Pilates Dream" and "Herod's Song."

Each one of these can be hummed and enjoyed simply as music, as great songs, but in the aggregate, they comprise a great musical.

There is nothing like this in "Titanic."

Andrew Lloyd Weber and Tim Rice did not do "Titanic."

Why, I do not know.

But the lyricist and the book writer for Titanic are not Andrew Lloyd Weber or Tim Rice, and not in their class.

And the Phantom says this with regret, because he really wanted to love this production and the stagecraft is, as always at the Ogunquit, superlative, starting with the stage filled with the sunken ship underwater.

This, hopefully, will not be the last attempt at a rock opera for the Titanic. 

Hopefully, the next folks to attempt it--?Elton John and Hans Zimmer and Tim Rice?--will do better.

It's a story so rich in hubris, pathos, class struggle, human frailty that one botched attempt should not, forgive the pun, sink it. 

Intelligence

Ever since Alfred Binet tried to identify children who might be expected to struggle in school going forward, with an "intelligence test," testing has replaced intuition and description and thought as a measure of intelligence.

Intelligence testing has been used, at least at its earlier incarnations, for the purpose of crowd control. It was meant to stream large numbers of individuals into different pens, so they could be managed. If you were going to have trouble learning to read, to do sums, then you got moved into one pen; if you were already there or likely to move quickly, you got shunted to another. 

During World War I, the army wanted to know who had the "right stuff," the intelligence to become officers, to lead soldiers out of the trenches, charge across a field under withering fire and reach the enemy and later to organize the feeding and care of soldiers in a company. So the army used "intelligence tests" which reflected what Robert Yerkes, a Harvard professor of psychology, thought qualified as intelligence. It doesn't take a high IQ to see the problem with the tests as soon as you look at the questions:

1. Seven up is played with: a. rackets b. cards c. pins d. dice

2. The Merino is a kind of: a. horse b. sheep c. goat d. cow

3. The most prominent industry of Minneapolis is: a. flour b. packing c. automobiles d. brewing

4. Garnets are usually: a. yellow b. blue c. green d. red

5. Soap is made by: a. B.T. Babbit b. Smith &Wesson c. W.L. Douglas d. Swift & Co.

6. A house is better than a tent because: a. It costs more b. It is more comfortable c. It is made of wood

7. If the grocer should give you too much money in making change, what is the right thing to do?: a. Buy some candy off him with it b. Give it to the first poor man you meet c. Tell him of his mistake

So, what Yerkes was looking for was people with his own virtues, people who knew the sorts of things a Harvard gentleman should know. He was disturbed to discover that immigrants from southern and eastern Europe getting off the boats at Ellis Island failed these tests miserably and were clearly the scum of the earth, or as Mr. Trump might say, "They are not sending us their best people."

When I was growing up in the 1950's, we took "intelligence tests" with number 2 pencils filling in the blanks on single sheets of papers which were scored by machines, not computers but which aligned up our marks with holes on grids. I cannot recall the questions, but I know the results were considered so important and determinative we were never told our own scores.  Kristie Hansen, a gorgeous blue eyed blonde, however, knew her score: 154, but she never told me how she was able to ascertain this. Maybe her parents found out. 

When I was entering my senior year in high school and struggling in some of my classes, my parents went to the guidance counselor and were relieved to discover my "verbal IQ" score was 160--"Almost genius!" my mother trilled--even though my math score was "much lower." The counselor remarked she had never seen  a wider gap between these two types of intelligence, but that made sense to me as I had no interest in arithmetic or math--although for some reason I loved geometry, and algebra, once I repeated the course, seemed to make a lot of sense. Never could learn calculus--never was interested enough. Trigonometry struck me as worse than useless.

I concluded from this that whatever tests I had attacked with my number 2 pencil knew something about me which was true--although not the "genius" part, which I knew, for sure, was not true.

Years later, a study appeared in the New England Journal of Medicine which purported to show that fetuses incubating in women who were hypothyroid during pregnancy wound up with lower IQ scores if the mother failed to receive thyroid hormone during pregnancy. There followed other studies. But the first study was peculiar in that it was done by screening 25,000 frozen sera (blood samples) and finding 64 mothers who were hypothyroid sometime during their pregnancies. Their kids were tested at 7-9 years of age and scored about 4 points lower than 125 children in a control group. Fifteen percent of the "affected" kids had IQs lower than 85 compared to only 5% in the control group.

Later studies confirmed this in 3 year olds.

The reason they were looking at thyroid in pregnancy is it has long been held that cretinism (a form of mental retardation accompanying other physical findings) happens in hypothyroid children but when children got tested just after birth and treated with thyroid hormone, cretinism vanished from the American scene. You had 6 weeks to start treatment, and if you did the brains were fine--but kids who went a year or two got cretinism. Note, we are talking about the levels of thyroid hormone in mothers in one study and in children in the other. We also have to conclude that the timing of thyroid hormone in the brain is critical, as children treated within six weeks of birth are just fine. So there are obviously critical timing issues with respect to brain development.

I objected to the study of 3 year olds at a Boston conference, questioning whether you can even know about lifelong intelligence from a test in a 3 year old. What tests are used? Are these 3 year olds even capable of  using those number 2 pencils? 

A pediatrician caught up with me in the hallway afterward and insisted you can tell who is intelligent by testing at age 3. She was most indignant I had questioned the meaning of IQ at age 3, and even more angry about my dismissal of IQ testing techniques. 

I asked her if anyone had tested those 3 year olds when they were 18. Of course not.

So, IQ testing is freighted with a lot of baggage and emotionally held beliefs. 

I later wrote Alan Kaufman, a Yale psychologist who has written extensively, and is a sort of IQ guru, about all this and he laughed about a difference of 4 IQ points, which he said could not be meaningful with current tests, like trying to determine if one elephant weighs 4 ounces more than another. 

The SAT exam has been used as an IQ test--it was supposed to be the great leveler, so kids from rural Iowa could be discovered as diamonds in the rough, bright kids without the advantages of kids in New York or prep schools would have, but who had just as great "native intelligence." 

It is reasonably clear that, even as the SAT has changed its questions over time, it tests one band of intelligence, which is one reason the ACT was developed, to show another sort of intelligence.

But I would like to submit, if I were devising tests for college admission, another sort of test: The New Yorker cartoon caption test. Look at these two samples:

Here we have three submission for captions for this cartoon which are so far beyond my capacity it is profoundly humbling. 

The picture, of course, evokes Humpty Dumpty sitting on a wall, about to fall, but each of these contestants has seen  new and different possibilities:

1. Rather than worrying about Humpty falling and splattering the woman below, looking up his rear end is offended by the exposure.

2. The topicality of the price of eggs, having played such a prominent role in the last election is on the mind of the second contestant.

3. My favorite: In this caption we see Humpty not as teetering on the wall, in danger from his own precarious position but a willful Humpty, desperately trying to heave himself over the wall to safety.

I would grant admission to any of these three contestants to my college. They each display a sort of intelligence unmeasurable using number two pencils on test sheets.

Or take this cartoon: 

Here we have someone who looked at this array and noticed one road cone reaching out to another comfortingly, and the circle of chairs resembling an alcohol anonymous group session and the remark is totally appropriate to a sympathetic, therapeutic effort but at the same time to what traffic cones are all about: you go around them.

Brilliant.

Our colleges do, somehow, manage to attract brilliant minds, although they do not always retain them--Mark Zuckerberg and Bill Gates quickly concluded Harvard had nothing to offer them. 

But, if you believe as I do that societies really do need to collect and nurture brilliant minds, you might agree we need better ways of identifying them.

England, with Oxford and Cambridge, has managed to punch above its weight for nearly a century. CT scans, MRI's, the critical, early work on nuclear fission all came from England, not America. 

But, even more clearly, wouldn't it be wonderful to have on campus people with the sorts of minds which can win a New Yorker cartoon contest?

Capitalism, For Profit Medicine and Souless Careers

 

Mike Wirth, the CEO of Chevron Oil, got a two page profile in the Sunday New York Times business section.

They asked him what guiding advice he had got from his father, who worked in the porcelain division for Coors beer company, where they made the ashtrays with Coors logos to be distributed to bars and restaraunts. And Mike Wirth said, "It was more of an example...My dad had a habit of walking through the shop floor. He knew who won the high school football game on Friday night. Everybody there felt they knew him. That was an important lession for me. Treating everybody with respect and decency was the key to his success, not being a Ph.D."

Alexandre Yersin, Discoverer of the Plague bacillus 

This was just after he'd been asked about cutting 20% of his workforce, "What is it like, as a chief executive, to lay off so many people?" 

"In a commodity business, costs always matter. We have to stay competitive and the most difficult thing we do is downsize our work force."

Oil is always boom and bust, and maybe people working on the rigs and in the oil companies expect to be laid off work and don't take it personally, but it certainly affects them personally, and one wonders whether it would matter at all to them that Mike Wirth might know whether their kid's football time won or lost on Friday night or whether they fel he knew them when he fired them.

It's just the nature of the business, of many businesses, that it's impersonal at some level. It's just profit and loss, overhead and income.

For some reason it reminded me of a scene which played out decades ago in my office in Chevy Chase.  I had just added up the dollars and cents and decided not to renew the recently increased lease on my office and to work for a for profit hospital system, where I would not have to worry about rising rents, increased costs of malpractice insurance--all I'd have to do is see patients and somebody else had to deal with insurance company reimbursements and photo copy machines which broke down.

So, I'm sitting there at my desk and a lean and active man arrives in a tailored suit. He was, I guessed, a first generation guy, Middle Eastern origin, and he was a product of the George Washington University medical school, a newly minted urologist and he was looking over the office, which had lots of natural light and was a lovely place to see patients and he asked me if I was going to get a bigger space and why I was leaving the suite. I told him I was leaving private practice, sick of having to worry about money.

And he said something, without malice, but with a sort of knowing smile, "Just can't compete, huh?"

Which caught me off guard.

I'd never thought of medical practice as a competition.

It's true, when I opened my practice there were 12 other endocrinologists within the four block area of Friendship Heights, Chevy Chase, and by the time I left we were down to three. And as the other endocrinologists retired or moved on, or relocated, my own practice got noticeably busier. 

August Maake

But I'd not thought of myself, perhaps naively, as being in competition with those other guys.

The only competition I'd ever thought about was a sort of bragging rights dependent on where people had gone to school, which did not matter at all to other doctors or to patients. Anyone with an "MD" on the wall was the same as any other MD to most of my patients and to the other doctors referring patients to me.

The snob appeal of having gone to a famous, Ivy League, medical school had no traction in DC. The three local medical schools, George Washington, Georgetown and Howard were not schools anyone at my "prestigious" medical school would have been please to "match to" for residency training programs. The closest "prestige" school was Johns Hopkins.  But that whole sort of academic competition had long since cease to matter and seemed to be a sort of fool's game, a relic of a gilded age, where people looked down their noses at others because of notions of "the right family" or, fortune, birth or social connections.

It was a sort of fantasy of personal quality pasted on something that was really impersonal, like knowing about high school football games.

Money Is What You Want

Famously, Fitzgerald told Hemingway, "The rich really are different,"  and Hemingway replied, "Yes: they have more money."

But Fitzgerald was thinking of the ruthless people, among them his long desired unattainable paramour, Ginevra King, who would never marry him because he was not competitive in the commercial sense, i.e., he did not have enough money. Her world was about money, and he was not competitive in that world, at least when she knew him. 

And here was this young doctor, just starting out, and he saw medical practice as a business venture, a competition with other urologists. He would take out loans or use family money to hire a staff to bill insurance companies, to make appointments and to then phone patients to be sure they would show up and if not, to plug other patients in those empty slots, and he would have other staff to pursue delinquent accounts and he would invest in equipment so he could do cystoscopies in his office and keep more of the money from those procedures, and he would join clubs to meet new people to refer him patients. He would invest in computers to streamline his billing and collections. He might hire a scribe to follow him around so he would not have to waste time writing medical records and he could see more patients every day. He would hire assistants to place patients in rooms and to do blood pressures and vital signs so he could see and BILL more patients every day. Like a profitable restaurant, if he could "turn over the tables" faster, he could generate more profit.

As for my experience, working for the big hospital corporation: It was wonderful. They just asked me to see the patients scheduled, they gave me an hour to 45 minutes for new patients and half an hour for follow ups, until electronic medical records arrived which allowed me to see patients faster, so ultimately I went from 16 to 22 patients a day, but none of that seemed rushed.

But then, after about 5 years, their business people looked at the numbers and they realized that the real profit in their system lay at the hospital. The practices they supported which saw patients who were not hospitalized, the daily in office type of non urgent care at best broke even, but clearly the pulmonary, endocrine, primary care, rheumatology, neurology, practices were not money makers. Even the procedure heavy practices like oncology, hematology, cardiology and gastroenterology were only really profitable if their procedures were moved into the hospital and the doctors moved to doing just the most profitable procedures and not dawdling on the time consuming practice of patient care which required history and prescription renewals and patient examination.

So the organization closed down all those practices and kept the hospital functioning, which was just fine for profits. The hospital got all the patients it needed from the emergency department, and they ultimately opened emergency walk-in departments in surrounding towns, which were profitable.

As for all those patients who needed their diabetes or congestive heart failure or arthritis or cancer taken care of, but did not require immediate hospitalization,  well that was just not profitable and it would be somebody else's problem. 

It's not that the CEO's of the organization were bad people; they were simply doing their jobs--to maximize profit for their share holders. The CEO's did not live in town. They actually lived thousands of miles away. They might have known the scores of their local high school football games.

And they could compete with anyone. 

A New England Yankee's Voyage Through Minnesota

 

The Phantom recently visited the Twin Cities, Minneapolis/St. Paul. 

It was hot and humid. The Twin Cities get hot and humid in August.

This came as a surprise to the Phantom, but apparently not to native Minnesotans. 

People really do sound like Officer Marge Gunderson from "Fargo," and there were little vignettes of "Minnesota nice," in evidence. 

There were more Blacks in the Twin Cities than you see in New Hampshire, and there were patches of urban malaise: the walk up the steep hill to the church of St. Paul was littered with druggies nodding off from their doses. 

Outside a bakery on the corner of Snelling and Grand, at the gates to Macalester College, a man sat next to a sign which did not mention Trump by name but said simply, "Impeach, Convict, Remove."

That was no surprise, as colleges tend to have people who do not like Trump.

But what did surprise and delight the Phantom was a mural on the side of a building along Grand Avenue, "Dr. T.J. Eckleburg, Oculist." There was no explanation for this. You had to know the reference.

Of course, F. Scott Fitzgerald was from St. Paul, and the allusion was to the billboard he mentions on the Long Island road on the way to East Egg in "The Great Gatsby." It is the image which inspired the famous cover for that book.

Fitzgerald loved that cover, but when he showed it to Hemingway, Hemingway was appalled. Hemingway, apparently, was too hidebound to appreciate something that avante garde. 

The Phantom, in his thirties was a fan of Hemingway--"A Farewell to Arms," and "The Sun Also Rises," which he never read in school, but were recommended by a woman who simply said, "You'll like Hemingway, as you are now."

The Phantom never was much of a Fitzgerald fan, but reading "Gatsby" in his thirties, he could at least appreciate there was some art there. The scene at Gatsby's manse, where he tries to impress Daisy with his collection of expensive shirts, only to realize she would not be impressed by shirts is well done.

It reminded the Phantom of a boy, David, he knew in school who just could not seem to get into the cool kids' clique. He wound up joining the Navy out of high school--one of only three of his classmates did not go to college--most went to elite colleges. After, the Navy, he went to American University, not elite, but at least college. Then he went to law school, and ultimately he became a successful San Francisco lawyer and was able to retire in his 50's, owned a vineyard and winery, and traveled to Europe where he owned property. 

But the Phantom heard about all this only after he first heard from a high school friend, Kay, the girl the Phantom had asked to the senior prom, who he had dated in a Platonic way throughout high school. She was quite beautiful and very bright, but, for reasons of inexplicable chemistry, the Phantom could never see her as a girlfriend. This was not true for David, who apparently yearned for her, as did many other of his classmates.

Kay had ultimately gone to Barnard, Columbia Law and then on to become general counsel for Lucas films and other big corporate clients. She became fabulously rich, rich as Gatsby, with a home on Russian Hill and another in Sausalito. One day her secretary called to say she had a visitor, David, a friend from high school. Kay had a tightly scheduled day, but managed to find a few minutes for David but he kept insisting she come down to the street with him, which she did not have time for, but she eventually relented, and there he showed her his yellow Corvette. Of course, Kay could have owned a fleet of Corvettes or any other car, but she tried to be appreciative. 

She told the Phantom that story with real sympathy. Kay had felt a failure when she graduate high school--had not got into an elite college for reasons known only to God and the Montgomery County school system. The Phantom knew Kay was one of the very brightest in her class, but that fact somehow must have eluded the faculty of Walt Whitman High school, in Bethesda, Maryland.  But she was not a person to be kept down, and she may not have been the most likely to succeed, but succeed she did, way beyond any other member of her class.

And that was a sort of Gatsby tale. The person who is told she doesn't have the right stuff, who ultimately succeeds, despite the disregard of her peers and the establishment types who had dismissed her as not very important.

The problem for the Phantom, is that seems a pretty adolescent sort of story.  What Hemingway was talking about was war, and love and dismemberment and wounds and bureaucracy and romance in the ruins.  That was adult stuff. 

Gatsby is about a man who mentally could not progress beyond the inevitable insults of childhood and adolescence, a man in arrested development. If the Phantom had known Gatsby, he would have shaken his shoulders and said, "Hey, what does it matter what you were like when you were seventeen? Some of those kids who were such stars then are pretty ordinary now. Some of the meek are now inheriting the earth. Get over it. There are more women in the world than Daisy." 

Fitzgerald just seemed silly, to be trapped in the past. 

On the other hand, Fitzgerald did manage to write one of the best, most enduring final sentences in literature: "So we beat on, boats against the current, borne back ceaselessly into the past."

That sentence is used in "The Wire," in a prison book club, and the man who utters it (DeAngelo)  really has been trapped in the past, as he was raised on the cruel corners of Baltimore, murdered people and saw people murdered and became part of a drug gang; he really could not escape his past, which had produced him and rendered him helpless against the currents. "The Wire" gave a real meaning to that sentence. 

But they still know and love Fitzgerald in St. Paul.

The thing is, though, Fitzgerald is not buried in St. Paul. He is buried near Bethesda, in Rockville, Maryland, in a shabby little cemetery next to a tiny church which is hemmed in by noisy roads, so if you stand in front of his grave and try to speak to the person next to you, you have to almost shout to be heard. 

 

What Is Merit? The Thomas Jefferson Magnet Science School Case

 

You never want to find yourself in agreement with Samuel Alito.

But as if I understand the case of the Alexandria, Virginia Thomas Jefferson High School for Science and Technology accurately, I may find myself in that noxious company.

I will have to read more about this case, but as it was presented on youtube (by a right wing platform) the facts of the case seem reasonably clear.

Thomas Jefferson High School for Science and Technology (TJHSST) is a public "magnet" school in Alexandria, Virginia which admits worthy, which is to say, "talented" students from anywhere within the geographic boundaries of this northern Virginia county. The measure of worthiness, or talent has been a standardized test and grades.

Apparently, while local middle schools and high schools have about 6% Asian-American students in their classes, TJHSST has had 73% for years. The implication is that Asian origin students test extremely well and have good grades and so they get in in high proportions. (MIT may have the same tilt.)

But then somebody in the government agency overseeing the TJHSST decided the fact that there were only 2% Black and 2% Hispanic and 23% White students, the racial mix in the school had to be "rebalanced."  Applicants were then reviewed and judged by "life experience" and the standardized tests were either eliminated or re-weighted, so the percentage of Asian students fell to 55% and the other categories of race increased commensurately.

A group of parents of Asian students in the county brought suit, saying that the merit basis for the school had been corrupted and the effort was nothing less than an anti-Asian conspiracy.

Merit no longer mattered as much as race/ethnicity.

I got myself labeled as a bigot years ago, when, in discussion with some media folks (magazine, newpaper, TV news) at a social function I said if 100% of the next class at Georgetown Medical School turned out to be Asian, or Black or Jewish or White, it would not bother me one bit. The important thing is to get the best doctors, not what color they are.

In science and technology, one would think, all that matters is who can do the work. You would think choosing the best kids for MIT or TJHSST would be fairly straightforward--you can test for math and science with pretty objective examinations.

I really do not care about the race the pilot of the next Delta flight, as long as he's really good at flying airplanes. Same with my plumber or HVAC guy, or my automechanic.

It's the job that matters.

On the other hand, even in science, examinations can be misleading. I thought I was never much good at science in high school where all the tests were multiple choice, fill in the blanks and they were testing for rote memory and a narrow band width of understanding. When I got to college, I found myself getting the highest marks in my biology class where we were using blue books to write out essays to questions which were more sophisticated than multiple choice questions.

Turned out, I was a pretty good student in that science. My genetics professor caught me by the arm and told me my final exam had been the best exam he'd read in years. Of course, I only got a "B" in genetics because I could not be bothered about a bunch of fruit flies in the lab. If they had had the sort of columns and technology used in any forensic lab now, I might have been more interested in genetics lab.

And medicine actually is more like a football team than a mechanics school. You need all sorts of very different talents and types: try filling out a football team with big slow guys who make great lineman but cannot run down field and catch a ball. You need quick quarterbacks and balletic receivers. And so it is in medicine: the qualities which make for a good pediatrician will not help much with the cardiac surgeon, or the cardiologist or the trauma surgeon. 

Obvious Talent

I cannot think of a single exam which would select for the wide variety of talents you would need to fill all the different specialties from OB/GYN to neurology to rheumatology to radiology to dermatology to ophthalmology.

So, maybe the single standardized--I presume multiple choice--test for the TJHSST was objective, fair but meaningless and selected for only one type of talent, a type for which Tiger moms could hire tutors to prepare their kids to master.

Harvard faced a similar problem with their selection process. Asian kids with great test scores and grades were told they were grade grubbers with no personality.

And the Asian kids and their parents reacted predictably: Wait, you told us you would define merit by grades and test scores and now you are saying really "personality" counts more?

In the last century, the Princeton man was not suppose to care much about his grades; the Yale man was not supposed to spend too much time studying. You were supposed to spend time at your clubs and on teams and singing in the Whiffenpoofs. 

But then the Russians put up the Sputnik in 1957 and Americans woke up to the fact that being good at science and technology was important.

The local court rules that the new admission policy at TJHSST was not discriminatory against Asian kids because 55% of the class was still Asian, even though that number was down from 77%. 

That did not satisfy the Asian parents, as you might well imagine, because that 22% loss came out of their kids' futures.

So when Justices Alito and Thomas bewailed the fact the rest of their colleagues declined to hear the appeal from the Asian parents, who claimed affirmative action had been applied to increase the numbers of Blacks and Hispanics and those gains were losses to the Asians, I had to agree, that is exactly what happened.

Allan Bakke argued the same thing in 1978--he had been denied admission to a California medical school because seats had been held for Black students, and he had lost his chance because of his White race.

There are ways to judge talent. If you audition for a seat in the orchestra at the New York Philharmonic, you play your violin from behind a curtain. All that counts is the music the judges hear.

If you submit a story to a short story contest anonymously, they are not giving you points for being White or Asian.

But admission to schools cannot be so color blind, unless we spend a lot more time developing tests which really do identify the wide range of talents we need for all those wide ranging challenges we face as a nation.

"The dirty secret of surgery is that anyone can do it, if he's willing to simply put in the time and practice," a surgeon told me. I don't think that's entirely true, but once you get past a certain level of competence and skill, it is really tough to develop an exam which really can identify talent in excess of desire. That surgeon had the capacity to learn a lot of anatomy and to visualize things three dimensionally, and all the people he worked with had that same ability, so he thought everyone has it, which likely is not true. But his point is still fair enough--there are far more people who could do these high powered jobs or fair well at high powered schools than there are places for them.

If we want to be fair, we could simply put everyone's name in a hat and draw out the lucky winners.

That would be FAIR but maybe it would not select for the most talented class.

Discoverers of Insulin

But, at some level, once you have a lower bar of capability, the differences between the higher bars are less meaningful.  That was always apparent to me in sports: the first three finishers in the track meet, the swim meet, the horse race were often different only infinitesimally .

So, if I were choosing kids for Harvard, or for TJHSST, I'd screen out the kids who clearly could not do the work with a screening exam and then put everyone else's name in the hat and pull out the lucky winners.

Scandalized: Sargent and Klimt

 The John Singer Sargent exhibition in New York at Metropolitan Museum of Art has evoked much deserved comment, if for no other reason than it's not in Boston, which as Murray Whyte has noted, is where the art world endlessly genuflects to his greatness, but it was only in Paris where he was invigorated and truly alive.

Crossing the Line

Before he pursued personal financial stability, he studied art in Paris and it was there, as the 19th century bled into the 20th, Sargent first laid eyes upon the titillating, enthralling and ever so slightly naughty wife of a Parisian banker, whose husband was enough older than she that Paris assumed/knew she satisfied her subterranean passions in the beds of other men. As Professor Google tells the tale, Sargent, whatever his own passions toward Mdme. Gautreau, knew his ticket to fame and fortune would be through a portrait of the lady.  His first attempt showed her right shoulder strap dipping off her shoulder, which apparently, judging from the printed reviews in Parisian papers, evoked erections in any man standing before the portrait in the Salon. 

Sanitized

Why is not entirely clear.

Clearly, Hugh Hefner would have arranged a different pose.

But the mind is a marvelous thing, especially the mind marinated in testosterone, and that strap looks as if she might have just let it slip as she prepares to remove her dress for her lover, or perhaps, a man has done this or, well, you can go on forever in some version of the New Yorker cartoon caption contest. 

Apparently, the original version caused such an uproar, Mdme. Gautreau had to remove herself from polite society for a while, although one can only imagine what it did for her bedroom life.

Klimt: Judith & Holofernes

And then there is Gustav Klimt, operating about the same time in Austria, where he painted women, often Jewish women, who looked as seductive as Judith before Holofernes, the sort of women who might lure you to bed and then cut off your head. Lorena Bobbitt was a girl scout selling cookies compared to Mr. Klimt's women.

All of this suggests to the Phantom that 90% of sex occurs above the nose, as he was taught years ago.