Van Gogh at Anvers

Van Gogh spent the last months of his life at Anvers, a village along the Seine. He is buried there, with his brother, Theo, and it's where he did some of his best known paintings and some of his best work, as he spiraled out of control toward his death.

Walking past various spots in the village, the Phantom would stop and say, "Hmmm, that looks familiar. Either I've been here in a former life, or..." Sure enough, there was a painting you can dredge up.

Van Gogh's brother believed in him, and in fact, it was Theo who told Vincent he needed to shift from the dark brown palate to a more colorful palate if he ever hoped to sell a painting. Vincent did, and Voila! Quelle difference!

This tale of brotherly advice resonated with the Phantom and his brother, who walked around the village with the Phantom. On many occasions, over the years, brother had given the Phantom advice, which the Phantom initially resisted, but ultimately followed with success. Going into medicine was one such, but just as important,  a variety of pointers for catching passes in football against a brick wall defense, ("Dive!") hitting in baseball, ("If you do not  swing that bat, I'm going to walk right out there and kick your butt at home plate, in front of everyone." Three hits that day.)  But the piece de resistance concerned a change in his swimming stroke, which the Phantom insisted would never work, but finally relented and tried what brother advised, and the very next week beat the county champion (by a nose), thus cementing brother's status as a savant.  

Brother is entitled to be buried in a Veteran's cemetery--having been shot at in his swift boat, he is very entitled--but looking at those two graves, he clearly started thinking anew about his final resting place. 

Theo died not long after Vincent, and their headstones are protected by a patch of ivy.

The New Woman: Mandy Rice-Davies

Mandy Rice-Davies and Christine Keeler 

One of the Phantom's fondest memories of the two months he spent in London his fourth year in medical school was reading the obituaries in the London Times, which he read in the Royal Brompton Hospital cafeteria every morning, to start each day on the right note. In those days, the cafeteria tables were covered with pink table cloths, and a lady came up to pour your tea for you and to bring you biscuits. It was a most civilized way to begin the day.

The Times' obits were wonderfully opinionated and dwelt as much on the controversies in the lives they were describing as on the triumphs. By contrast, those of the New York Times , are dull affairs, but today's piece on Mandy Rice-Davies is a happy exception. 

Ms. Rice-Davies came to public attention in 1963, because she was having an affair with an aristocrat, Lord Astor, which he denied and when asked why she should be believed when Lord Astor denied it, she simply said, "Well, he would, wouldn't he?"

Years later, she explained her willingness to go on public record over the years by simply saying she did not want to be remembered as a prostitute, for the sake of her family.  In those days, she explained, "Good girls didn't have any sex at all and bad girls had a bit." 

Which brought back that time to the Phantom in stark relief--it was actually true then: In the 60's women were expected to be virgins at marriage. Their first sexual experience was supposed to be their wedding night. Can you imagine? Fortunately, today's adolescents can likely not imagine what that was like. For most American women born after 1963, with the exception of some Catholics, this notion of there being virtue in a lack of sexual experience has been discredited. A friend and colleague of mine, who was born in 1945, once remarked at a dinner party she had only ever had sex with one man, her husband. Now, her husband was a very good looking and glossy guy, a television personality, a former Navy flyer, an all around heart throb, but my wife, once we were alone in the car together, could hardly contain her contempt: "Can you imagine being proud of that? Good Lord, that's like being happy you had only had sex once for each child! Let us never have dinner with them again." 

Even then, the Phantom thought that good girl thing a very morbid idea, but proper people were scandalized and turn red whenever he voiced that opinion in polite company.

As Ms. Rice-Davies aged, she became a successful business woman and her third marriage was decades long.  "My life," she said, "has been one long descent into respectability."

Noah Cross makes something of the same point, in "Chinatown," when he says, "Politicians, old buildings and whores all get respectable, if they last long enough."

Ms. Rice-Davies, of course, was no whore. She simply enjoyed the benefits of a sexual relationship with a wealthy older man, just as that man's wife did, but without the official blessing of church and state.

It is a great blessing that attitudes toward what women should be have changed dramatically since those dark days in the 1960's.  The double standard has finally disappeared from the thinking of today's youth. If boys can enjoy sex, so can girls. Hallelujah!  Claire Underwood, in "House of Cards" explains her attitude when she describes how Francis proposed to her:

"He said, 'Claire, if all you want is happines, say no. I'm not going to give you a couple of kids and count the days until retirement. I promise you freedom from that. I promise you'll never be bored'...He was the only one who understood me."

When his own sons were growing up and the Phantom expressed such sentiments, he was told, "Oh, just wait until your boys are old enough to notice girls: You won't be so liberal then." And the Phantom responded, "I hope they start having sex as early as possible." Fortunately, the Phantom's wife, who worked at Planned Parenthood, was with him on all this and handed her sons condoms as soon as she became aware of girlfriends entering the picture--and this was to their sons'  great embarrassment, initially, but they did not turn them down. Mother simply waved off the protests, with a dismissive: "It's either has happened or will  happen. Don't be caught unprepared."  Something about her frank approach simply dissolved all the drama and likely reduced some of the drive toward sex. They both seemed to make the transition from pre sexual lives to sexual lives with a minimum of distress, although, not without zero distress. 

Their experience  had to be better than what preceded them in their parents' generation.

For the Phantom, there has been the problem of fearing that all his best sins are behind him, but he is grateful things have moved in a direction of freedom and honesty, and people like Many Rice-Davies, Gloria Steinem, Betty Friedan, Maud Gonne, Simone DeBouvier, Erica Jong, Mary Gordon and May West all contributed to that movement.

Along with the progress in racial relations, the progress, at least in the Western world, toward regarding  women as full human beings, with equal  rights and protections, has been one of the great achievements of American and European civilization over the past 50 years. 

This has benefited men every bit as much as it has benefited women. 

House of Cards: Welcome To Backstage Washington

Is Madmen really what Madison Avenue was like in the 60’s?

The Phantom cannot say. He wasn’t there. It feels authentic. But he cannot know.

Is House of Cards what Washington is like?

Again, the Phantom cannot say. He grew up in that town, but never worked on Capitol Hill. His knowledge of what the people depicted in House of Cards are really like is indirect. Conversations at the swimming pool or at the occasional cocktail party with various Congressmen, media types. And, of course, there were patients from the Hill, the White House, various agencies and departments. A sort of peripheral exposure.

But from those experiences, over time, Mad Dog did get a  sort of backstage look and sound of what these people are like, how they speak and what they do and do not say. And from that, the Phantom thinks House of Cards is pitch perfect.

The new season will start February 1, and the Phantom is re-watching early episodes to get reoriented.

What makes it all so fun is the intimate glances from Francis Underwood to the camera, where he tells you what he is really thinking, what other people are really thinking.

Washington always has people who never seem to let their guard down. They say stuff like, “Well, it’s the least we can do for these heroes. After all, they are fighting to keep us free.” And you think, “Does this guy think I’m going to quote him on the evening news?”

Much more fun are the folks who will tell you what they really think, often the sly way Francis does. You feel you’ve been admitted backstage; you feel you have a friend.

Of course, that friendship is not without its limitations, but it is fun.

You learn early people who depend on someone for their livelihood are not going to say anything, not going to reveal anything about the boss—that’s understood. You do not explore that territory. They will reveal themselves before they will expose their boss.

The Phantom had some patients, who became friends, who would never have said anything about the President or the Secretary or the senator they worked for. They would skewer some opposition leader, but they never would even mention their boss, and certainly not relate what he had said. That was an area you simply did not go to. The Phantom, who has never been very good at filtering and editing, had to exert much self control to not ask, but he did not ask.

Francis Underwood, however, takes us into his confidence. His willingness  to divulge secrets, to reveal his basic values draws you in. He is taking a risk, but he is saying, “You are worth the risk.”  And he reveals himself, not completely, discretely, as he strangles a dog:

“Moments like this require someone like me. Someone who will act. Who will do what no one else has the courage to do. The unpleasant thing. The necessary thing.”

He tells you, in an aside, he loves his wife more than anything--"I love that woman. I love her more than sharks love blood"-- and you learn that he loves her precisely as sharks love blood; he is playing a blood sport in Washington, and with everyone he runs across.  As you see their relationship evolve, you see it’s not an Ozzie and Harriett type relationship; they are sharks circling, an intimate team, each dangerous, both to those around them and to each other.

Returning home to find discover  Zoe Barnes with her husband,  Claire looks over Zoe as Zoe exits and says, “Does the push up bra and V neck sweater still work?” In one withering line, she reduces the fetching reporter who has just tried to seduce her husband, to a cliché.

Actually, the one false note House of Cards hits is Zoe’s use of a cell phone photo which captured Francis looking at her fetching rear end moving in a revealing dress, as she passed by him at the Kennedy Center. She is saying, “I know you’re attracted to me and I have this embarrassing photo to prove it.”  But men look at women all the time, especially when the woman wears a dress which demands it. 

Francis, to his credit looks unfazed and amused, and you can see his mind working. “I might be able to use this woman.” There ensues a little cat and mouse before Zoe gets down to business and Francis says, "Oh? Is the foreplay over?" 

What is really stunning is how each episode heightens the effect of sucking you into this world. Episode Three, which has one of the most powerful, seductive, edgy, intense, significant scenes in the history of American literature,  where Francis Underwood addresses the issue of how a benign and loving God can permit horrific things to happen, is beyond magnificent. And the really amazing thing is, there are other scenes in this episode which almost match it. The whole episode is such an integral whole, it is simply mind blowing.  Anyone who thinks they do not have time for another series must simply watch the first three episodes, and if they are not hooked, one has to wonder about their priorities.

House of Cards may be the closest thing we have to Shakespeare in American literature. The Sopranos approached that bar. House of Cards may leap over it.

Can't Get No Satisfaction

Sunday's New York Times carries a piece "Companions in Misery" by a professor of philosophy, Mariana Alessandri, which is one of those occasional exercises in thought capable of redeeming the value of philosophy in every day life.

Reacting to a study which found New York City "the unhappiest city in America," she  questions the survey which formed the basis for this conclusion , a survey which asked about people's "satisfaction" not about their "happiness."  What the professor suggested is these are not at all the same, and in fact people can be quite dissatisfied and quite happy at the same time.

The reason, presumably, this CDC study got so much attention is it confirmed the widespread belief, primarily among people who do not live in New York and who know it only from "Sex in the City" or "Midnight Cowboy" that New Yorkers lead unhappy lives.

But, the fact is, the Phantom has met many ex patriot New Yorkers who were profoundly depressed--unhappy--because they had been forced to leave New York to take a job, or because of marriage or other factors, and they missed New York intensely.  Of course, many of these transplants were living in Washington, D.C., which can be a place which can foster homesickness. 

Professor Alessandri quotes John Stuart Mill, "a person can be satisfied by giving the body what it craves, but ...human happiness also involves motivating the intellect."  the Phantom generally hate the academic's obligation to cite some centuries old work to show we are only experiencing now what has long been part of the human condition, and mostly, to show she has read John Stuart Mill.  But she makes it work with the observation that "This means that happiness and satisfaction will sometimes conflict, and that those of us who seek happiness and even attain it, may still be dissatisfied."  As Mill says, "It is better to be a human being dissatisfied than a pig satisfied, better to be Socrates dissatisfied than a fool satisfied. "

This made the Phantom think back on his 8 years in New York City and, being profoundly superficial, the Phantom tried to bring all this down to his own insignificant experience, his formative years, there.  He remembers New York as a tumultuous, frustrating, wonderful time. He made his best friends there, and lots of them. Except for the people who were born and raised in New York, all his friends who lived there felt it was a great accomplishment just to wake up in the morning and to be able to walk out on the streets and become part of that energy and dynamism which was the city.

And this brought to mind a conversation the Phantom had with a good friend, a nurse named Kathleen, who came from Kansas, which she felt fortunate to have escaped. She lived in an airy one room apartment with huge windows near the Village and she wanted to live in New York the rest of her life.  We were talking about a nurse we both knew who was married to an orthopedic resident. He was a local heart throb at the hospital. He had played football at Princeton, was tall, blonde, good looking, and as most orthopedic residents, supremely self confident. She was having an affair with a medical resident the Phantom knew, who was a nice guy, humble, funny, but not in the demi god category. 
"Why would she do that?" the Phantom asked. "What more could she want?"
Kathleen looked at the Phantom, incredulously, one of those how-dense-can-you-be looks. "Nobody's satisfied," Kathleen said, almost embarrassed to have to say something so obvious.
"You mean nobody, anywhere?" the Phantom said. Thinking back to the sunlit lawns of his suburban youth, to the young parents, getting their first homes and cars after the Second World war, raising tow headed families, going on vacations, going to little league baseball and soccer games, the Phantom objected. "I know people who were satisfied. Are satisfied still, probably."
"Who?" Kathleen asked. 
"Lots of people, back in Bethesda."
"That," she said, "Is why they are back in Bethesda. If they were seekers, they'd be here, in New York."

Professor Alessandri observes that in Texas, where she teaches, she is told to not complain, to "'look on the bright side' of rotten things." Many people, she notes, think complaining "won't get you anywhere." She argues complaining may in fact make you feel better, and practically speaking, may be a good thing. "Two strangers complaining on a subway platform can end up cracking a smile or laughing, and though it would hardly be considered the beginning of a lifelong friendship, it is still neighborly."

True that, the Phantom has to say. How many times a quick exchange in a subway or on the street or waiting on line was a nice moment. We are suffering together and we feel the same way about that obnoxious person we both have to contend with. It was one of the things which made New York so much fun--the brotherhood of the anonymous sufferers.

On Moral Superiority

He was nice to his dog. Not so much to the prisoners.

Noah Cross enlightens.

"Some day, you may  discover that under the right circumstances, at the right time, you are capable of doing just about anything."

--Noah Cross to Jake Gittes, "Chinatown"

With those words, Noah Cross explains how he could impregnate his own daughter and shrug it off.

Watching a BBC documentary about Auschwitz, the Phantom asks himself how anyone could be capable of the cruelty, the indifference of the camp guards, who ushered children to the gas chambers, who fired their guns into helpless prisoners.

But thinking back, the Phantom asks himself the disquieting question: Just how incorruptible is he, his own self?

At Memorial Sloan Kettering, people died in such numbers, with such relentlessness, we got numb.  Call off the efforts; end the code; wrap the body. 

One day, after the Grim Reaper had made a particularly thorough sweep of the ward, the Phantom came face to face with his own limitations of empathy. One of his patients, a twenty-three year old,  was the youngest person on the ward. She was a joy--always full of stories and questions.  He looked forward to reaching her room on rounds and felt disappointed if she was off the ward, having some test. She was a colonial archaeologist, working on some site near Battery Park when she noticed a mass in her neck and two days later wound up on our ward with a nasty variety of Hodgkins Disease. That morning, her aunt was visiting,  and the Phantom noticed a certain vacancy in his patient's  face, and asked if she felt all right. 

"A little dizzy," she replied. Then she turned to her aunt and said, "Aunt Sally, remember when uncle Kevin died and we got those little white cards to write thank you notes to all the people who came to the funeral?"
"Yes, dear," the aunt replied, looking alarmed. 
"Well, I think you are going to need to get some more cards, now."

Those were the last words she ever said. Her eyes rolled up into her head and she slipped into cardiac arrest  right in front of the Phantom, and despite all his efforts, the paddles, the IV epinephrine and Lidocaine, the chest compression, she was gone.

The nurses stayed behind to wrap her body and the Phantom lingered but then looked at his watch, realizing how much time he had lost, thinking of how he could catch up on all the things he had to do now that he had got behind schedule on rounds. He had thirty two more patients to see and attending rounds in just 90 minutes.

Then it struck him:  One of your favorite people just died and you are thinking about being late for rounds. What have you become?

Of course, had he been thinking about how much he liked her, he could never have functioned during the code. He could never have slipped in the three large bore IV lines, one in each arm and one in her neck, and he could  never have ordered the right drug syringes to be slapped into his hand, or cleared the bed to apply the paddles and detonate the 400 watt seconds to her chest to restart her heart.  But now it was over, he just didn't feel much. Just another body in the bed, now.

The Phantom stepped into a bathroom and composed himself and told himself he had better feel something or he was in trouble, and then he went on with rounds.

As a high school student, the Phantom got persuaded to go off to some "leadership training" camp at the U.S. Naval Academy. It was supposed to be a big honor and it would look good on your college applications, he was told.  He found himself living in the plebe's dorms, making his bed so a quarter would bounce off the tightly strung blanket, getting molded into a functioning unit by the Marine drill instructors.  At first he thought it was great fun--a boy's fantasy about becoming a soldier, a lean, green, killing machine. Within days, all he cared about was running his company's flag up the hill ahead of all the others, knocking down boys from other companies in the combat drills with the padded cudgels. What a thrill to be the first company, to lead all the other companies into the dining hall and to be seated first. We were told someday we might be able to do this for real. To serve our country. As if what was happening inside each of us was somehow going to keep Americans free. Within a few years a lot of the boys who played at Marine that week were doing it for real in Vietnam.  Killing babies to serve their country and to fight for freedom. 

All this happened within a single week, and then he was sent home.

What the Phantom learned is how quickly and effectively he could be socialized into group think, to behave without thinking as an individual, to react to command. This is necessary for any military unit to be effective, but the Phantom had learned something about himself which disturbed him.  If people you like are doing something, you sometimes become part of it. You don't want to let other people down.

Now, the Phantom is less capable of despising those who transgress, who do things which seem morally outrageous.  He thinks back to Noah Cross and thinks: What am I capable of doing?

Dust in the Wind: On Being and Nothingness, Courtesy of Netflix

Down in the basement, on the treadmill, the Phantom confronts cosmic questions, which is the only way to keep running.  Netflix provides the magic carpet.

"Inside Llewyn Daivs" is set in the Greenwich Village of the 1960's, the time Bob Dylan, and a lot of others who you never heard of,  tried to find their voices. This is as bleak a picture of a search for meaning, success, significance as anything since "Midnight Cowboy."  Thank God for the cat. Llewyn has got the girlfriend of his best friend pregnant and he has to come up with the money for the abortion, a tall order in his financial circumstances--he is homeless. He shoulders his obligation--he does not shirk responsibility, for the pregnant woman or for the cat he allows to escape, until he can no longer help. But he learns in the end, other people have made their own choices--his former girlfriend chooses to have his child and the new pregnant  woman may be carrying someone else's child. You just don't know in this life what other people are up to. In the end, we get a glimpse of something else Davis does not know--Bob Dylan is in the wings doing something which is again beyond Davis's reach.

In "The Last Picture Show," the big surprise is again about what you cannot know or have not  guessed.  Seeing her cry at the funeral of Sam the Lion, Sonny asks the   rich, beautiful Lois Farrow why she has come. He didn't know she even knew who Sam was, and it's a small, small town. Sam had owned a down and out diner where the Lois seldom set foot.  It suddenly dawns on Sonny  that Lois  is the woman Sam had once told him about. Sam had an affair, in his youth, with a young woman. They stripped naked and  had ridden horses across the water in "the tank," a pond outside of town. Sonny had asked  Sam why he never married this woman with whom he was so obviously still in love and Sam had shrugged and said she was already married. "You were the woman at the tank. The one Sam rode horses with."  Lois looks at him and smiles, "Sam told you about that?" Yes, Sonny says, still astonished these two could have ever been connected, ever found anything in common.  "He was the only man," Lois says, "Who ever knew what I was worth." And you can see that is all that ever mattered to her.

If we are dust in the wind, then the only way to seem relevant or meaningful seems to be from that sort of meaning and connection.

Somehow, as bleak as "The Last Picture Show" and "Inside Llewyn Davis" are, there is that glimmer of hope. 

Of Guns, The NRA and the 2nd Amendment, Fear and Loathing

They could buy guns in Walmart today

The Clutter Family: Slain at Home

Any discussion of guns quickly degenerates into the expression of gut feelings over dispassionate examination.

News from the latest, but certainly not the last, school shooting  (this one in the state of Washington,)raises the issue again.

The Phantom is caught betwixt and between on this one.

On the one hand, it does appear probable that if we ceased the production and sales of guns tomorrow, there would still be millions, likely a billion guns out there in the USA, and guns can be buried in the backyard, hidden in houses, cars. They simply are never going to go away, not in our life time, not likely for the next 100 years.  So trying to deny maniacs guns by restricting sales is likely to be an imperfect solution at best. 

Chris Rock may have the best approach: Raise the price of ammunition. If some thug knows each bullet cost $500, he's not going to spray a classroom.

Beyond that, the Phantom once moved to a farm with his girlfriend. They had lived together in New York City and never felt unsafe, but on that farm, with nothing but ponds and fields and lonely unlit roads, well, it gave the Phantom pause. He went out and bought a bow and arrow set and instructed his girlfriend in its use, but, as she pointed out, she had grown up shooting skeet and could handle a gun, and if he wanted her to be safe, a gun might make more sense, although she refused to have a gun in the house. She had grown up with guns, and they were locked up in her house, and would not have been available to prevent a home invasion. For that, you'd need to wear one on your hip at all times. 

Her father was a lifetime member of the NRA and a career military man. He owned dozens of guns, and kept detailed logs about the characteristics of each, which pulled to the right and by how much at what distances.  But he also noted when soldiers were sent out to the rifle range, the number of live rounds they were given was carefully counted and they had better return with 12 shell casings if they had been given 12 rounds. The Army was this careful. And why? Because they didn't want some disgruntled grunt shooting his drill instructor.

So that killing machine, that organization based on guns, was very careful about controlling access to live ammunition and very controlling of guns.

Gail Collins points to an ad about guns in the some deep South state election, which shows a mother at home with her children and a shadow passes over the window and then a voice says don't vote for whomever, the candidate who will take away your guns, your best protection. This strikes Gail Collins as the politics of fear, which it most certainly is. 

But, having lived in rural areas, miles and a good hour away from any police, the Phantom understands where that fear comes from. There was that famous case of the Clutter family home invasion in Holcomb, Kansas, which became the basis for In Cold Blood.  People out in the hinterlands may feel vulnerable.

And this is not new:  Going back to The Last of the Mohicans, there is the family which was massacred by Indians, and when the daughter of the commander of the local garrison looks at their bodies she asks in shock why anyone would live so far out, so exposed, having only their own guns to defend them, when their adversaries could simply mass more guns and overwhelm them. 

And, in the case of the Clutters, in Kansas, there was that more common thing--surprise. Are you going to go to the door holding a gun every time there is a knock?

Having said all this, there is one essential truth which the NRA denies. Here is the 2nd Amendment, in its entirety, all 27 words:  "A well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed."

Now, making allowances for this having been written by 18th century men in whigs, it is still abundantly clear, the right granted is to a group, not to individuals, and the purpose is to secure the State, not to guarantee security of individuals within their houses.  That justices Scalia/Alito/Thomas/Roberts/Kennedy choose to wear blinders, does not make a right to personal firearm so. Some day a new court will have the courage to speak the truth and say: No, the Constitution does not guarantee every citizen the right to own a gun. Local law may allow it. It may be granted by the federal government, but the Constitution, that thing on which we cannot vote, that highest law of the land, does not guarantee it.

The fact is, the psychology of guns comes down to fear and loathing. The fear is the vulnerability in isolated circumstances, rural America.  The loathing is the little man, the man who senses he is a loser, a weakling, but he can feel big and powerful and fearsome if he straps on a gun. 

Until we can get past that Joe Sixpack inferiority complex, we'll have guns, and bullets and dead school kids.

American Doctors: Here Today; Gone Tomorrow

Norman Rockwell 

One of the great untold stories of American life today is that of the itinerant physician.  For decades, one of the operating values of American medicine has been "continuity of care," which meant that a patient could see a doctor who actually "learned" the patient, got to know the patient, took care of the patient over a prolonged period of time, so the patient did not have to recapitulate his or her own history with every visit to the doctor's office. 

This concept even extended to the hospital, where a patient was "admitted" by an intern and resident who stuck with that patient for his entire stay in the hospital, and in the bad old days, stuck with the patient through the first 24-72 hours, getting the patient through his crisis. 

In the hospital setting, this feature of "continuity" had its disadvantages--to be able to stick with the patient, the intern was frequently exhausted, although rarely incoherent as its detractors charged.  So, with Libby Zion laws, the concept of "handing off" the patient to a "team" of shift workers emerged, with results which proved both  better and worse.

But now, if you are observant, this is happening at the level of office practice. 

Doctors have looked at the prospect of signing an office lease, which often committed them to a $500,000 debt over 5 years, and they looked at malpractice insurance policies which, in the case of an internist, might be $5.000 this year and $20,000 the next, and they looked at the costs of telephone and computer systems, and they saw  the costs of employees and their health and unemployment insurance and they looked at the diminishing reimbursements from insurance companies and they said, "ENOUGH! I'M OUTTA HERE." 

And so now arguably 90% of all primary care physicians and non surgical specialists are no longer in "private practice" but work as employees, either for groups of doctors or for large corporate entities.  

What these doctors find is the first contract they sign is the highest pay level they will ever see. Typically, they get 2 years at a set salary and then they go on commission and their salaries plummet. 

So, what do they do? They quit their jobs and move on to another 2 year gig and they keep doing this. 

This poses problems for their families, because taking a new job often means relocating, but if the physician is a woman, she may be a second income in the house and they may not have to move if she can find another gig in the area, and often she can find at least part time work. If the doctor is the primary bread winner, he or she may opt to stay at the corporation at a lower salary, but often they opt to move.

In a state like New Hampshire, which allows "non compete" clauses in contracts, doctors frequently have to move out of state or at least 20 miles away, so there is a built in uprooting. In Massachusetts, where non compete clauses are illegal, the doctor may move down the road or to a neighboring town and simply commutes longer. But he often winds up abandoning his patients and setting up a new practice.

And where does all this leave the patient?

It means you will not likely have a long term relationship with your doctor. It means you will find a new doctor "relearning" you every couple of years. It means your doctor looks at you as a customer to be served rather than as a patient or a friend and it will depersonalize the relationship.

Not that this is all bad, but it is a change.

But have you read about this sea change in medical care in the New York Times or the Washington Post or heard about it on The News Hour or the Business Report or in the Wall Street Journal?

Empty Phrases: Times of Innocence and The American Dream

Oh, he's pursuing The American Dream

Here's a good way to know a person does not know what he/she is talking about: Just listen for the phrase, "The American Dream"  or "It was a time of innocence."

What do people mean, when they use that phrase: The American Dream?   What they are really talking about, almost always,  is simple avarice, the desire for stuff, for money, for a well paying job and the money it provides and the things it will buy. 

"The American Dream," then is nothing exalted, ordinarily. It's simply a wish for prosperity. 

Unless, you are Martin Luther King. When he used that phrase in his astonishing "I Have a Dream" speech, he went on to define a very different and more powerful dream for life in America than simply the mundane acquisition of wealth. He defined the American Dream not simply as a world in which people had all of the stuff they dreamed about having when they were suffering through the Depression, or sitting in foxholes. He was talking about the dream of world in which justice would reign and liberty would prevail for everyone, not just white men and women and their lucky progeny. His American Dream is a new plane of psychological liberation, in which his four children will be judged by the content of their character rather than by the color of their skin. Now that, is a real dream state, new state of mind. 

She's Got her American Dream

Not Innocence: Willful Ignorance 

But, when most people use that phrase, "The American Dream," they are really just talking about making more money, and that is nothing all that exalted. In fact, they'll tell you on Sunday, the pursuit of mammon is not a good thing. Ah, but if it is the pursuit of the American Dream, that is a good thing. So the "American Dream," the dream of riches, the dream of acquiring mammon, stuff, nice houses and fast cars, that is a socially acceptable, commendable dream. 

And then there is that dreary phrase, "Oh, it was an age of innocence."

Fact is, since Homo sapiens stood up on hid hind legs and became Homo erectus, there never has been an age of innocence. Every generation has known about murder and rape and greed and vice and nastiness. Some have tried to banish discussion. Some have tried to portray a society in which the mass of men and women did not have any of these traits--the asexual, aseptic, eternally smiling men and women of those ads from the minds of 1950's Madison Avenue mad men, who made the ads.

 Fact is, never was such a world nor such a time. The fifties were no more "innocent" than the 1920's or the 1930's. The fifties were simply more repressed. They were a reaction to the horrible 1940's, when rape, murder, destruction, societal breakdown happened on a massive scale worldwide. Armies swept through Europe and women were raped on a massive scale.  Children, women and men were lined up and gased and then cremated.  Whole cities were incinerated.  In reaction to that, people dreamed about a time and place where none of that would happen, where people didn't think about all that. 

There have always been times when discussion of sex, desire, lust and ambition have been suppressed, but that does not make those times "innocent." It makes them simply dishonest or, at best, times of denial.

So let us banish these phrases, "a time of innocence" and "The American Dream" from American discourse. 

Good riddance to bad rubbish.

Weddings vs Funerals

Since my first funeral, I've hated funerals.

I can't recall the first wedding I attended, but for many years, I could almost enjoy weddings because I got to see a lot of my friends.

But now, in the 21st century, I have to admit, I can hardly abide weddings.

I can suffer through funerals, which is, after all, what most funerals are about: suffering, loss, the end of life, the end of dreams, the sadness of parting.

But weddings are just so essentially phony, to their core.

Funerals, at least, make sense. They are the opposite of phony. They are the real deal. No denying what a funeral means.  There is no doubt about the event they mark, and there is honesty about what happened and no dispute: Someone died. 

But as Mark Twain once asked: Why is it we rejoice at weddings and cry at funerals? Is it because we are not the one involved?

For some, of course, death is a release, a welcomed end to suffering. Hopefully, a re launch.

But weddings are such a sham.
Once upon a time, there was a real divide between the virginal, prenuptial life and the breaking of the virginal seal on the wedding night and the connecting of genetic material and blood lines. 

Now, not so much. 

Women, if they are lucky and well brought up, start having sex in their teens and will look forward to relationships with a succession of men over their lives, having children with different men if they can afford to, and often even if they cannot afford to.

A wedding now simply marks a public statement about a temporary relationship entered into during  your second or third decade with high hopes (often held by both parties, but often not) and well understood to be likely temporary. 

As Betty Freedan noted in the Feminine Mystique, all this began to be examined around 1964, when women who had been educated, allowed to enter the greater world beyond the home found themselves trapped in suburban houses, with kids, and told they would and should be happy if they got enough stuff in their kitchen, a nice car, a white picket fence and a PTA meeting to go to.

But women discovered this was a pretty boring and depressing life in a gilded cage, not at all rewarding and the term "desperate housewife" gained real currency.

The whole marriage trap unraveled during the sixties and it has never been the same since.

There are, of course, good marriages, but they are actually the exception.

If organized religion were not dominant in most weddings, the ceremony would likely say, "Here is a couple who like each other, will have children and each will pursue a life and hopefully, they'll be happy, at least long enough to raise the kids and get them out of the house. After that, well, if they are happy, bless them, if not, new adventures." 

But what do we hear from the pastors and priests?  God has a plan. God has chosen your mate for you. What God has placed together let no man set asunder. God wants these people to be together. 

Where is the free will of the man and the woman involved? It was all written for them. Fated. 

Ugh.

If the Phantom were elected benign dictator, among the first day's acts would be an executive order to de-institutionalize marriage. If you want your party, your day as the primadona in the spot light, throw yourself a party. Call it a wedding. But please don't expect the rest of us to do more than drink your champagne and dance to your band that night. 

After that, you are, as new couples have always actually been, on your own.

Deforestation and Global Warming: Who Knew Nadine Unger?

Professor Unger, the younger

If history is one long argument, then science is not far behind. We do have certain accepted principles in most of science, but everything is always open to challenge, even the things, especially the things, we want to believe.  And since science is the search for truth, we try to be careful to avoid the traps of politics and law, where the way people look and sound when they say something often becomes more important than the content of what they say--"the media is the message" thing.

So, when you take a look at Professor Unger as the buxom blond bomb shell, you start dreaming of the Saturday Night Live skit which could ensue.

Reading Nadine Unger's article in today's New York Times this morning, it was the content, not her  physical attributes which was enough to make the Phantom  spill his coffee all over the page.

Well, dark stuff absorbs heat

Nadine Unger is on the Yale faculty of Forestry and Environmental Sciences [not atmospheric and environment as I originally posted]  and she uses computer models, which means math, which means it's hard to argue with her. And what her models tell us is, and here's one of the really annoying things, when Ronald Reagan said trees cause more climate change than cars, he wasn't right but he was on to something.

After all, all you have to do is to look at the results of clear cutting of forests and you get a gut feeling that can't be good.

But what she says is:  1. Trees do suck carbon dioxide out of the air and pump back oxygen, but they often keep that oxygen right in the forest and so it is not just an oxygen producing pump for the rest of us to breathe.  2. Trees, being dark, suck up a lot of the sun's heat and so they tend to warm the surface of the planet, which is why the Northeast of the United States, which is the most densely tree covered part of the country, often heats up during the summer.   3. For reasons she does not explain, reforestation in the tropics might well help to cool the planet, but in the northern latitudes, apparently, her calculations suggest the loss of trees may actually cool the planet because those dark, heat absorbing trees are now replaced with lighter colored stuff.  4. Trees emit "volatile organic compounds" (VOC's) which mix with stuff coming out of cars and factories to create even more noxious chemicals in the atmosphere. So the worst place you can be, presumably, is on a road by a factory, surrounded by forests.  6. Trees do suck up CO2 but they also suck back some of the oxygen they make, so they are not just givers but takers. And when they die and fall to the forest floor and decompose, the CO2 contained in them goes back into the atmosphere.

Trees, then, from an atmospheric perspective  are not the unalloyed good citizens of the earth, according to Professor Unger.

Of course, you know, reading along, there must be some reasons to doubt her hypothesis. Anyone who's ever walked through New York City in Mid-August, at dusk, anyone who has felt the heat radiating off those stone buildings, which have been cooking all day like bricks in an oven, knows that however much  heat forests trap, the alternative to forests may trap even more. 

The problem with all this is the New York Times  has followed it's standard practice of publishing Ms. Unger's article without running a "counterpoint" article next to it. There are good commercial reasons for doing this:  1. "Oh, we don't have the space." Well, if you don't have the space for the response, why publish at all?  2. From an "impact" consideration,  when you publish a controversial piece, it gets people riled up, creates buzz, sells papers, gets website hits.  But if you publish the counterpoint right next to it, (as some medical publications do) the reader reads that and breathes a sigh of relief--"Oh, she might be wrong," and this  defuses the outrage, and people turn the page saying, "Well, that's an interesting idea, but I don't buy it for all the reasons in the counterpoint," and they turn the page and read about the stupid thing John Boehner said. 

Older and soon to be famous, now

So, it's not Professor Unger's fault, her incendiary ideas have provided Fox News drill -baby-drill anchors with a day's source of fun and frolic.  She is following the data, she will say. Her interpretation is doubtless challenged by other professors in her field, and it's not her job to provide the opposing argument. Well, actually, in science, you are supposed to say what you understand the weaknesses in your argument are, how you might be wrong and what studies could be done to resolve the doubts--science is not law. It's not about winning and losing but about seeking the truth. 

Ms. Unger and the Times will argue they cannot control what is done with their ideas; they can only put the ideas out there and let the conversation take its course. On the part of the Times, of course, this is the definition of disingenuous, because they could have put the ideas out there in a form which contained the counter arguments as, inevitably, will appear in letters to the editor at a time when the audience for them will be a tenth the size of the audience which heard the original piece and only the most interested will hear it.

But the Times, any newspaper is not about seeking the truth. News reporting--apart from NPR and the News Hour--has always been about selling papers and grabbing attention. Headlines sell papers, reasoned discussion hasn't been seen in American newspapers since the Lincoln-Douglas debates were printed ver batum in the papers before the Civil War. 

Can this really be good for the planet?

The only thing wrong with publishing Dr. Unger's hypothesis is the sure knowledge that the Right will have a field day with it. A day, to be sure, but still, Rush and Sean and the whole crew of those Barbie Doll anchors and Ann Coulter will all be talking about this for months. 

Unmentioned, will be Paul Krugman's piece from yesterday which reviews the data which show that if we switched away from fossil fuels, it would hurt the oil companies but it would help the economy with the jobs and profits from what replaces it--sun, wind industries. As he notes, the same people who are always arguing that capitalist systems are strong because they are so flexible, so eager to respond to the new and embrace it and make a profit, are the same people who say we cannot embrace new sources of energy because with need to protect the dinosaurs of oil (literally dinosaur based) from extinction. We watch happily as other industries (news media, stock brokers, book publishing, music recording) all change or vanish, but oh, we cannot have the coal miners or oil barons threatened by wind and solar competitors. 

So, there you have it, science marches on, and it runs smack into politics, the yowling hyenas of Fox News and the great unwashed masses of Joe Sixpacks who are sitting in their bars gloating. 

Lewis Black at Portsmouth Music Hall

You know you matter when Lewis Black books a stop in your town. Portsmouth has come of age. Not only did he do a show here, at the gilded and gorgeous Music Hall, but the place was packed, despite the heat, which strained the air conditioning but not the tempers of the crowd.

Black alluded to his age, and his fear that as he gets older, he gets less funny, because, maybe he's mellowed a little.

But, if anything, his mellowing has added bite to his shtick because it has added a dollop of sadness to the notion of the absurdity of life which so irritates him.

He noted, among other observations, the transience of modern life and the 24/7 news cycle. Those 50,000 refugee kids in detention centers along our Southern border--so yesterday's news.  He looks at the audience, incredulously, and asks, "So, what? They don't matter any more? Oh, them. They're just there." 

His warm up act, a friend whose humor reflects his own, mentioned Scott Brown and his pick up truck.  Driving a pick up truck qualifies him to be a Senator?  Oh, so you are now one of the guys? 

Black has done a lot of shows in Arizona and Texas, but that doesn't mean he likes anybody down there. It warmed the heart of the Phantom to see him identify those two abscesses in the soul of this nation. He did neglect to mention, South Carolina, but that can wait.

He's just got back from Europe, and the experience obviously was not wasted.  Speaking of Norway, Sweden and Denmark, three socialist countries, he observed, "Obama is no socialist. I am one of the seven socialists extant in this country and he has never shown up for one of our barbecues."

And as for "Obamacare," he's outraged at the perversion of language. It's a terrible law, poorly written and poorly conceived and poorly executed, "But," and here he does his slapped in the face moves, "We had to do something." It is, he says, the Affordable Care Act, and why would any of us want our healthcare to be affordable? Why would we want to give up going into bankruptcy with the first big time illness we get?  

Disarmingly, he dwelt on things he actually loves, as opposed to his usual rant. Tahiti really is paradise, he revealed. And it's just two hours beyond Hawaii. He urged everyone in Portsmouth to move there immediately.  Never been, myself, but I might consider a visit.  Black recounts ordering a Coke and being served a Ginger Ale, and thinking, "Hey, okay. I'll have a Ginger Ale," with a beautific smile. So what?  This place is paradise. What's the big deal?

In Copenhagen, he was entranced by the photographs of beautiful female breasts on the external advertising panels of buses. What he did not have to say is you would never see photos of bare female breasts in the USA, but the point he was making is, female breasts, large or small tend to be beautiful, why would you want to undergo surgery to enlarge them?  That's what these billboards were--ads for augmentation surgery.  

And that was one of his strongest riffs--time and again he returned to what we have done to women in this country, to diminish their value, to laden them with burdens, to prevent their ascendance. 

Of course, he was not without his barbs for the establishment. Where were our vaunted intelligence services when ISIS was forming?  We learned, recently, the American government had been spying on Germany.  "A little late, don't you think?"

A great night on the Seacoast. Another reason to believe we are very lucky to be living here, at this time, as Portsmouth is in resurgence.  Gone are the bar brawls, the red light district, the disheartening level of street crime--gentrification can be good. 

We walked out of the Music Hall and looked in the direction of the new steel framework for the new Whole Foods going up across from the Sheraton. This is a place which could be great, if only we can keep it going.