The Ecstasy of the Aging Mind

Rest After Work, Vincent Van Gogh

For some reason, as the Phantom ages, his ability to be thrilled by the truly exceptional has become sharper. 

Part of this must derive from the simple effect of having seen things over and over until,  when something is truly exceptional appears, it is easy to say, "Oh, that is different."  

What worries the Phantom is remembering a friend of his who, as he was slipping into the early stages of dementia,  remarked, "Everything is so easy now." He could answer all sorts of questions without pause, thinking he had got the right answers because he could no longer  see the complexities.  He slipped into a sort of simpleton's bliss. 

The Phantom has looked at thousands of works of art and the more he sees, the more thrilled he is by Van Gogh. Hopper and Sargent handle light beautifully, but so does Van Gogh, and Van Gogh does it while boldly laying down layers of rich color which is what one usually has to sacrifice when doing light and shadow. 

Beethoven is another. Plunking out Ode to Joy, the Phantom is amazed by how simple the call and response is, but Beethoven can change things up at just the right moment to keep it moving, keep it alive.  When you hear the little piano piece the Phantom is plunking out and then hear it done by a huge chorus, you feel the power and the beauty sweeping you along. 

Before he tried painting regularly, before he started his humbling piano lessons, the bell did not ring for the Phantom.  In "The Polar Express,"  the bell stops ringing for those who no longer believe in special magic. For the Phantom, the bell had not rung until lately, as the Phantom can see the approaching night, as the countdown begins its descent. 

The slide down the mountain toward the shattered plain of bones does not end well; but the ride may have its moments and its pleasures. 

The Little Stream, Vincent Van Gogh

Just look at that stream. How many streams like this have you seen?  But Vincent sees it,  and the light along it,  the way some people see colors when they hear music. 

And, in this computer age, we can all see it with the click of a keyboard key. What a marvelous time to be alive.

Testosterone in Texas: Was There Ever Any Doubt? NPR takes on Texas Centers for Testosterone

This morning on NPR, the Phantom heard a story which worked on so many levels he was barely able to keep his car on the road.

A former "joint surgeon" in Texas, Dr. Bill Reilly, who now heads forty five clinics--the Phantom was driving and may have got that number wrong--dispenses testosterone to thousands of Texas men who he has found could benefit from it.  When asked how he could claim expertise, he bristled and he said he is a doctor and any doctor can prescribe testosterone and besides, he knows more about testosterone than the urologists and endocrinologists on whose turf testosterone therapy has traditionally dwelt.   

He denied that he simply handed out testosterone to any man walking through the door, like some bogus medical marijuana clinic, but rejected those men who were not truly deficient. How he defines truly deficient was not addressed in the broadcast. What was addressed was the vast numbers of patients he is treating and the, presumably, vast profits he is raking in. Again, even going to the NPR blog, the Phantom could not tease out the exact numbers, but it sounded like a happening thing in Texas. 

The reporters tried to get at the possible risks of testosterone therapy in men who did not actually need it, but they clearly had not asked the right questions of the right people and so the broadcast slid around the central issues and, of course this being a story about testosterone, it missed the more important story about how medicine for profit is driving healthcare in these United States. 

The truth is, replacing testosterone, at replacement levels, that is levels which normal men normally achieve by the exertion of their own (endogenous) testicular production,  likely does not harm most men in any obvious way. It simply transforms them from human beings who are perfectly capable of making their own testosterone into human beings now entirely dependent on bottled testosterone for the rest of their lives.  But no study comparable to the Women's Health Initiative, which studied 20,000 women on estrogen for decades has been done for men and testosterone.

The testosterone that comes out of bottles, pumps, aluminum packages is not delivered in the elegant diurnal rhythms with which normal men release testosterone, but that may not matter beyond the testicular atrophy constantly sustained testosterone causes. 

What the gym rats (pictured above) achieve with industrial doses of testosterone is industrial levels of testosterone in the blood and the muscle mass they achieve is commensurately higher. What that does to bone, brain, blood vessels is unstudied because academic centers are not allowed to study it. This is unfortunate.

The truth is, for about 80% of men who have genuine deficits of testosterone, testosterone is not the best option for therapy--at least that's what most endocrinologists suspect. For these men the problem is not that their testicles cannot produce testosterone but the problem is their pituitaries are not sending the signal to the testicles to tell them to do this. There is an old drug, clomiphene, which can do this, but it has not been systematically studied and evaluated in men over time, so it is not FDA approved and just try getting this drug, which has been used with FDA approval to induce ovulation, try getting that approved for longterm use by men by your insurance company.  Fat chance.

Doctors who have prescribed this drug "off label" are taking a chance, both for their patients and for themselves. 

Clomiphene is a generic and no drug company would make money on it, unless the law allows for a generic drug to be patented for a new use--for which there may be precedent.  That is important because the only way the needed studies will get done is with drug company money. The National Institutes of Health has shown no interest in funding such studies. 

Now back to Dr. Reilly, of the glossy Texas Centers for Testosterone. Just go on their website. You want to see glossy, that's glossy.  The former surgeon may have said to himself, "This is easy money."  He can set up centers, pay salaries and rent and still net huge profits by treating that new found epidemic of patients with low testosterone.

Once the Texas Centers for Testosterone get wind of the potential for clomiphene, The Phantom imagines, those entrepreneurs in the Lone Star state will corner the market on the stuff as sure as the Hunt brothers cornered the market on silver. Or maybe they'll set up factories in China, or maybe just across the border in Mexico. Then they can extend the franchise, like Texas Roadhouse steaks, into the rest of the country. It's all good. It's the profit motive after all. Isn't that what makes American medicine the envy the the world?

Actually, ask the Europeans what they think of American medicine. Not so much envy.

And, like so many things, low testosterone is relative. After all, it's a bell shaped curve, where those normal ranges come from.

And in Texas, is your testosterone ever high enough?

Vincent Van Gogh and Ascendant Achievement

Vincent Van Gogh spent just over a year in Arles, in the south of France. During that time he painted roughly 300 paintings. An astonishing production of nearly one finished painting a day.

He was joined by Paul Gauguin, who fled when Van Gogh flew off into one of his violent, psychotic breaks, but they both benefited from their brief association.  Gauguin's colors became more vibrant and Van Gogh learned from Gauguin he could paint without a scene directly in front of him, and his paintings became freer, bolder and more vibrant.

Van Gogh's brother, Theo,  sold the paintings. He advised Vincent that buyers liked color. Van Gogh's paintings in the early 1880's had been monochromatic, cleaving to rules, but as Vincent took his brother's advice, and his palate became more electric, his paintings leaped to a new level, and that year's paintings are the masterpieces we now all know and immediately recognize as Van Gogh.

But Van Gogh went to his death never knowing, we suspect, just what an impact he had on the world. And not just the art world. People who have never paid much attention to art know Van Gogh, understand when the gaze upon "Starry Night" what he was doing. Not so when Van Gogh was bucking the academy. Now  people go to museums and see his work,  and are left breathless.  His work is astonishing, breathtaking--you choose the word, it is inadequate. 

Somehow, knowing Van Gogh never knew how important or successful he was makes his work even more profound and affecting.

Had he known, had he been celebrated, he might have changed it; he might have tried to please his public. Instead he raced through his canvases, splashing out one magnificent creation after another, never satisfied, always striving to make the next one rise to the level of composition, color and concept to which he aspired. He was painting for that thing which drove him to paint, not to please. Yes, he changed his palate in a concession, but anyone can see, he saw the change was good, had got him where he needed to go.

Beethoven was successful in his time, but by the end of his career he was deaf and could hear his music only in his head. Perhaps he saw colors. But whatever he heard, it was not what his public heard.

Malcolm Gladwell, speaking on Radio Lab described how he decided to give up running track. Gladwell was one of the best runners in Canada from age 13-15, but he had other loves--reading, debate, friends, school. One day he realized he simply did not love running enough to forsake all others. So he quit.

Van Gogh could not quit. Nor could Beethoven. There is something single minded and utterly dedicated about the truly great. As Gladwell suggests what makes them great is not some genetic difference, but the willingness, like Tiger Woods, to go out and hit 10,000 golf balls before breakfast. It is John Coltrane playing his sax 18 hours a day. 

And you can see it in the outcome. "Talent" whatever that is, is not enough.

This may be why you hear in certain voices, often voices which are not famous, sometimes voices which are,  a certain quality which makes you stop and listen.  Ray Charles had that voice. So   does Bob Dylan.  Their essence is connected to their work.  That cannot be faked. 

The difference between Van Gogh and everyone else is the purity of his commitment. Beside him, almost every other artist is a dilettante.

  

Princeton: It's Still in New Jersey

Never thought that much about Princeton, actually. When I was applying to college, it was all men.  It was also in New Jersey, a nice part of New Jersey, but really. New Jersey?  
I wanted New England. Somewhere different. Somewhere quaint. Somewhere which felt like college. 
I didn't know what I wanted. 
As is so often the case, I judged the place by the kids who went to it from my high school. 
 I didn't like them, as a rule.

They were very bright, mostly, and very competitive, but more competitive than bright, as a rule.  They seemed jaded, self absorbed, smug, focused on success and winning the game. 

One of my friends who went there was the exception. He was brighter than he was competitive and he seemed to value people for the right reasons. He tried out for the football team but, as he unabashedly admitted, he was simply not physically tough enough. Nor mentally tough enough. 

He came to wrestling matches and marveled at the courage and toughness and grace under fire visible in the  varsity wrestlers. 

But for the most part, I had to agree with my brother and his college friends at Cornell:  They all said they wouldn't send their worst enemies to Princeton, but most of those worst types were already there.

F. Scott Fitzgerald, of course, made a great deal about his time at Princeton. 
Somehow, F. Scott always seemed just silly to me. 

I did meet an editor in Washington, from Mississippi, who is a genuinely fine person, and he had gone to Princeton and graduated, ostensibly unscathed. 

But a classmate of my son in medical school articulated something which crystallized in my own mind one thing about Princeton which seems relevant.

She was at Columbia College of Physicians and Surgeons, a place with a reasonably select group of students, endowed with a wide spectrum of abilities, but in one boozy moment, when she spoke in vino veritas, she let slip to some of her suite mates why she really wasn't interested in marrying any of the men at P&S--she just could not see marrying a man who had not gone to Princeton. It would feel like marrying down, or maybe not down, but out of the tribe.

In days of yore, you'd hear a woman say something to the effect of how she just couldn't marry a gentile if she were a Jew. Clannishness, that was called, when it wasn't called foolishness.

Now this young woman was confiding to her suite mates, who were graduates of Yale and M.I.T. respectively,  and they laughed, but then they realized she was serious.

Now, Susan Patton, Princeton, class of '77,  is hitting the talk shows saying that women of Princeton should marry their male classmates because they'll never find better, and they better strike while the iron is hot, while the ovaries are full of fresh eggs and before they lose their dewy eyed allure.  When you leave Princeton, you'll never again have that concentration of able manhood so available, so thoroughly vetted and so ripe for the picking, as if men were avocados.

It's a very old world sort of notion, really. Hard headed, unsentimental. Matchmaker, find me a man with the right prospects. Love will come later.

Not that the Phantom believes in "love."

And when you think about it, is this not what those computer dating services are not all about?  Match traits, objective criteria,  to what you want.

Apart from the idea of people choosing their mates in their 20's, before they really know themselves, the idea of choosing from a pre selected population sounds a little like those camps they set up in the Third Reich, to breed beautiful blonde girls with beautiful blonde boys and produce a Master Race. They had selected for traits, as if they were breeding cattle. 

The idea that college is so important it ought to be the breeding ground of the next generation is a little hair raising. As if the selection process for the Princeton class is so refined it can produce a Master Class, if not a Master Race.

What do you think a dinner party at Ms. Patton's house would be like? Not quite Downton Abbey, I would think. No stories of Perseus and the Sea Monster. 

Money, I would think. That would be the major topic. How to make it and how to spend it. I don't know why, but that's what I think, when I think of Princeton. 

What a bore.

New Hampshire Spring

George Carlin

 Spring in New Hampshire dips its toe into cold water, unsure of whether it really wants to take the plunge.
Yesterday, people were out in T shirts, cleaning out the flower beds, putting up the screens, cleaning windows and hauling snow shovels from the garage to the basement. 
     Today, at Plaice Cove the wind off the waves sprayed cold salt water in your face and a down vest was not enough. 
     Spring in Washington, D.C. arrives like a light switch being thrown. Boom, it's on. Has been for two weeks down there.  The flower buds shoot up through the loamy ground, the azaleas bloom, the bees buzz and it's suddenly humid. Cars parked outdoors are coated in a light velvety green pollen, in DC.

Satchel Paige

     But Spring time in New Hampshire is a blushing adolescent in her new bikini, not sure she really wants to show herself quite yet.
    Yesterday, the Coastal New England Baseball League held it's season opening party. Players were assigned teams  and jerseys and hats were handed out.  The Phantom heard what had transpired over the long winter, who had fallen off roofs cleaning snow and who would not be returning owing to injury, age or simple loss of interest. 
    Somehow, the Phantom was reminded of another Spring party some years ago,  at a Washington, DC art gallery. A forty something lawyer held his glass of white wine,  full head of chestnut hair, a blue shirt with a snow white collar, silk regimental striped tie, gold cuff links, Movado watch and he was talking about the resignation of Larry Summers from the post of President of Harvard University. 
    "He had such a rare combination of skill sets," the lawyer was saying. "Great talent, energy and intellect. There's so few people who could really bring so much to a job like that which demands so much."
     "I couldn't disagree more," the Phantom said. "That job has got to be one of the easiest jobs on earth. All you have to do is keep your mouth shut and let the place run itself, allow the money to flow in and stay out of the way."
     The lawyer looked as if he had been slapped in the face.  You just didn't say things like that in polite company in Washington, D.C., where everyone talked about jobs and "qualifications" and "talent" as if the people who "earned" them really were special and deserved all the glory.

Around him, at the baseball party, the Phantom was now hearing the inevitable swapping of quotes from Yogi Berra and Satchel Paige. 
"I never threw an illegal pitch," Page had said. "The trouble is, once in a while I would toss one that ain't never been seen by this generation."  That was a favorite, because in this particular league, the age range of the players goes from thirty five to sixty seven.
"I always liked Satchel," another player was saying, quoting the seer:  "Money and women. They're two of the strongest things in the world. The things you do for a woman you wouldn't do for anything else. Same with money."
"Airplanes may kill you, but they ain't likely to hurt you,"  another quoted. "The man knew of what he spoke."
"He spoke for the ages," another agreed. "The only change is that baseball has turned Paige from a second class citizen to a second class immortal."
Inevitably, when you start quoting baseball players, you have to quote Yogi Berra. 
"The future ain't what it used to be."
"Half the lies they tell about me aren't true."
"If the world was perfect, it wouldn't be."
Or, the one which should have been used more often in Washington: "I wish I had an answer to that because I'm tired of answering that question."

Yogi Berra

Eventually, enough beer had been drunk the Phantom decided it was time to quote George Carlin: "If it's true that our species is alone in the universe, then I'd have to say that the universe aimed rather low and settled for very little."

Someone offered: "The only good thing ever to come out of religion was the music."

And so it went. They are playing baseball in the pros and, in two weeks, we'll be playing in New Hampshire. 

The Phantom offered:  "You know the good part about all those executions in Texas? Fewer Texans."

That was too political for the baseball crowd. And there's a bill in the New Hampshire legislature to kill the death penalty here.

"The future will soon be a thing of the past." That was safer. 

"The real reason that we can't have the Ten Commandments in a courthouse: You cannot post, 'Thou shalt not steal, Thou shall not commit adultery and Thou shalt not lie' in a building full of lawyers, judges and politicians. It creates a hostile work environment."

Live free or die.

It's happening again. This is the first weekend of the year when the Phantom could walk around his entire yard and find no snow at all. Buds are on the trees. Dry roots are stirring with spring rain. Let us hope.

Salt Marshes. Obadiah Youngblood

New York Times Goes Tabloid Over Medicare

Spanish Strip Searching an American Woman
That was enough to send American men to War.
Different times. Now American police do the same thing in every police station in the country.

Mr. Hearst

 "You furnish me the pictures and I will furnish you the war."
                --William Randolph Hearst to Frederick Remington






Ah, the spirit of W.R. Hearst is alive and well at the New York Times.
Much as I love that paper, read it every day, Sundays especially, one has to admit when the editors there show they are simply not worthy of the great writers who produce that paper.
Suppose you are a cub reporter and you've just got finished going over the Medicare data released by the government and you find yourself standing before the editor who wants to know what story can be got out of all those numbers.

"Well, there's this group of ophthalmologists in Florida which does thousands of treatments injecting this drug into the eyes of elderly people to save their vision, and the drug costs about $2000 a pop, which the doctors have to buy, and after they get paid  by Medicare they get to keep about $350, so they pocket about $500,000 a year."

"And this drug really saves the vision of these patients?" the editor asks.
"Most certainly. I talked with our sources at New York Presbyterian and Manhattan Eye and Ear and they all say before this new drug all those people went blind. Since this treatment virtually none do."
"I don't know," the editor says. "Doesn't sound like a Pulitzer to me. Tell me, how much do the doctors get paid to do this?"
"I told you."
"No, I mean, paid, paid. Like what is the check Medicare sends them?"
"Oh, $21 million over the course of the year. They get the biggest check of any practice anywhere in the country, heart surgeons, brains surgeons, these guys gross the most. There's about 20 of them in this group."
"So the checks are spread out among 20 docs, that's a million a doc."
"Well, actually, they all get cut to the one doc who heads the group, so he gets $21 million."
"Twenty-one million!" The editor expostulates. "Well, that's your story right there!"
"Well, but that's like saying General Motors was doing great because they sold $21 million dollars worth of cars--but not if their costs were $25 million."
"Twenty one million dollars from Medicare to one doctor in one year. That's the story. That's above the fold, front page. That, there will sell newspapers, get us on every evening news show, grow hair on your palms and straighten the curve in your spine. That is a story!"

Florida Ophthalmologist 

Drift and Mastery

A curious thing:  As The Phantom sails on into the sunset years, he expected he would emerge from the mists into a clear stream, and he would see things which were obscure in his callow youth. But, he is still as confused and uncertain as he ever was.

One of the most perplexing things has to do with mastery. With all the talk about "Tiger Moms" and the importance of imparting one generation's hard won knowledge to the next, so the next generation can stand on the shoulders of its predecessors and reach new ground, it is not at all clear, to the Phantom at least, how much this really happens. 

This is the old "nature vs nurture" thing, to some extent. But it is more a question about how much brilliance we can teach and how much is simply found? 

And there is the  question  of  how much "talent" even with training, can to bring people to new places.

Watching children, boys mainly, start wrestling at age seven, there were clearly those who had coordination, strength, quickness, aggressiveness, and these boys won matches and succeeded, but the adult coaches would simply smile and shake their heads and say, "There's only so far athleticism can take you." 
They could look at a nine year old and analyze what attributes he was using to win, and know whether those would serve him to get him to the next level.  

The coaches could point to other kids, who were scrawny and not currently successful, and they could say, "If that kid does not get discouraged, he'll be a champion, eventually, when he bulks up."

 Later, as boys progressed trough puberty and beyond, some of the mostly untutored "beasts" did win state championships, but these were usually the boys who remained small, who were still wrestling at 120 pounds when they were eighteen year old seniors, beating fourteen year old freshmen. None of the 140 pounders who made it to the championship matches were doing this on strength and quickness alone. 

The champions had all been taught, trained, drilled by adults who imparted the science of wrestling to these kids. But not all of these kids, much as they mastered the science, could win. The kids who won, took what they were taught and used it, but they did something more with it.

And there was also the problem that some coaches knew the "real" stuff and others did not. Everyone claimed to "know" but not everyone did.

Listen to baseball coaches teach hitting. You'll hear all sorts of contradictory things: Weight on the back foot, weight on the front. 

Presumably, Baryshnikov, and those spectacular gymnasts, cello players, Broadway stars, all accepted and incorporated training, but went beyond it. The success of the stars is claimed by their teachers and their coaches as validation the coaches knew what they were talking about. But do these masters succeed because of what they were taught, or was what they learned only oil in the gears--gears fashioned elsewhere?
There is a wonderful story about Stevie Wonder showing up at Motown's Detroit Studio at age 16 and telling everybody how grateful he was to the musicians who allowed  him to jam with them. "Oh, I've learned so much here today. This has been so wonderful. Thank you so much for teaching me." 
And one of the old musicians, who is telling this story,  looks at the camera, recalling all this and says, deadpan,  "Believe me: We didn't have nothin' to teach that boy."

A resident training in vascular surgery recently told me: The well kept secret of surgery is that anyone can do it. It's just a matter of who is willing to practice enough. That's the 10,000 hour track you hear from musicians. Want to be Sonny Rollins or Coltrane?   You got to put in 10,000 hours of practice. But, as the Phantom can readily attest, he could practice 10,000 hours and only improve--he will never play piano better than fair.

The Phantom's older son, looking at his younger brother, age 10, ripping through his opponents methodically at a wrestling tournament, shook his 12 year old head and said, "No matter what I do in life, I will never be as good at anything as he is at this, right now."  

Of course, the older son was wrong about that. The older son was neglecting his own talents as a kayaker and as a musician. You cannot wend your way through class 5 rapids in a kayak without being awfully good at kayaking.

But what allows someone to know investing those 10,000 hours will be worth it?

How does someone know he is capable of kayaking down Great Falls and surviving?

Why is it that musicians tend to come from families of musicians? Is it music genes or mostly exposure, encouragement lots of loving nurture?

What is it that van Gogh knew about his own talent which allowed him to devote his life to his art? 

Van Gogh,:Who Taught This Man?

George W. Bush is a better artist than he was a President. But, of course,  that is an invidious comparison. George W is probably a better auto mechanic than he was a President. He was a better student than he was a President.