That's a Load off My Mind

I saw Dr. B this morning, and the lesion has shrunk by half! Even he was surprised at the improvement. He wants me to continue the IV therapy and the pills, but for the first time he seemed almost ... happy. (He's not a very demonstrative type.)

My sight, I know, has improved slightly. Now it's almost like there's less of a blind spot than a sort of wrinkle in what my left eye sees. I told my daughter, as she was driving me back from the appointment, that I'm almost ready to try driving -- around the block. Neighbors beware!

Oh, and I got a haircut, my first in maybe five or six months. I had it shorn back to the No. 2 buzz cut that I had before. The only fault is that it makes the hole in my head -- a depression in the scalp about the size of a dime -- more visible. But he jests at scars who never felt a wound, right?

Climbing the Phone Tree

I got my first bill from my medical adventure the other day: $1,083.74 for office visits and lab tests at the clinic I went to on the day I discovered I was sick. Medicare had declined to pay any of it.

It was a mistake fairly easily corrected. Medicare had me listed as having "other insurance" as the primary payer. It seems that Medicare updates its records once a year, in October. So unless you make a point of telling them what's going on, if you change insurers after their update day, they won't know about it until next October. In my case, I had paid-up insurance from my former employer through the end of October 2007 -- after the Medicare update. At the end of October, that policy ceased, and Medicare became my primary carrier. (I also have a Medicare supplemental policy.) But Medicare didn't know about it, so all of my medical bills from October 2007 to October 2008 were denied.

This good news out of all this medical mishegoss is that it was relatively easily cleared up. Conservatives are always arguing against government programs because of the "bureaucracy." But my experience with Medicare is that their bureaucracy is more efficient and responsive and more pleasant to deal with than that of the big private insurance companies. Maybe it's because the big private insurance companies can pick and choose whom they insure, while Medicare has to deal with anyone over 65, some of whom must require careful and clear explanations. As I know from my experience in the nursing home, anyone who works with the elderly needs the patience of a saint.

This is, of course, another argument for a single-payer national insurance system -- the only kind of health reform that I think will work. It took me three phone calls to clear it all up -- one to the clinic to find out why the charges weren't paid, one to Medicare to ask why they weren't listed as the primary insurer and to be assured that the mistake was corrected, and another to the clinic to ask them to resubmit. One phone call should have been sufficient.

And don't get me started on voice-recognition phone trees:

ROBOVOICE: You said "enrollment."
ME: No, I didn't! I said "claims."
ROBOVOICE: Please choose from one of the following options....

We Wish You a Murray Crispness

Deck us all with Boston Charlie,
Walla Walla, Wash., and Kalamazoo.
Nora's freezing on the trolley.
Swaller dollar cauliflower alley-ga-roo.

Don't we know archaic barrel?
Lullaby lilla-boy, Louisville Lou.
Trolley Molly don't love Harold.
Boola boola Pensacoola hullabaloo!

A Heartbreaker

The ineffable Kenneth Starr is back in the news, this time leading a movement to invalidate the same-sex marriages that were solemnized in the period between the California Supreme Court's ruling and the passage of Proposition 8. In response, a group called the Courage Campaign is putting together a powerful response, and a simple one: a slide show of couples, some with their children, pleading that they not be forcibly divorced by the state.

Product Placement

Household hint for today: If you've got a cast or some sort of surgical dressing that needs to be waterproofed whenever you bathe, wrap it in Glad Press'n Seal. It sticks to itself and to the skin, and doesn't need as much tape to hold it in place.

I learned this tip from a nurse at the Ambulatory Treatment Infusion Center (acronymically called, of course, "the attic") when I was describing how hard it was to wrap a plastic bag around my left arm with my right hand in order to cover my PICC line. They had given me one of those plastic sleeve thingies that are usually used to cover casts, but it also covered my left hand, meaning I couldn't use it to wash with.

So I got a roll of Press'n Seal (why they can't call it, more correctly, "Press 'n' Seal" I don't know) and sure enough, it does the trick.

What a strange little world of expediencies I have found myself in.

...Or Maybe Rachel Maddow Is the Smartest Person on TV

Visit msnbc.com for Breaking News, World News, and News about the Economy

An Eye for an Eye

I went to see an ophthalmologist, Dr. L., today. I aced the eye chart, even with my wonky left eye, but there's still a problem with my vision. Dr. L. says it may never go away. When I said, oh, maybe the brain will find a work-around -- something others have said to me -- she said, Probably not. "The brain isn't really all that flexible. And the lesion has deprived part of it of oxygen." In other words, I've got a dead spot in my brain.

Oddly enough, her candor appeals to me. I'm a little tired of the choruses of "Climb Every Mountain," "You'll Never Walk Alone" and "Cockeyed Optimist" that people keep singing at me. A little honest resignation to reality never hurt anyone.

Nothing But the Tooth

Why don't hospitals and clinics have dentists on staff? Why is dentistry different from other specialties that deal with the human body? Why don't dentists get the training that M.D.s get? Why do medical plans not cover dentistry? (Especially Medicare. You'd think nobody needed help paying for dentistry more than its recipients.)

All these questions occurred to me as I was lying on a bed in the hallway at the Stanford E.R., waiting for the diagnosis of what had made me go partially blind. (Literally in the hallway. Stanford's E.R. is so crowded that it has put beds in the hall, especially for patients who don't need modesty curtains. They're even labeled: Hall 1, Hall 2, etc.) My neighboring patients included a woman with no family, no job (hence, no insurance), and a variety of serious and unpleasant illnesses; a diabetic man who had neglected the injury to his foot he received on the job and was now threatened with amputation because it had turned gangrenous; and a grizzled biker type who was there because he wanted a pain-killer for -- he said -- a really bad toothache. The young resident who saw him winced at the state of the man's teeth.

"How long has it been since you saw a dentist?"
"I dunno. A while I guess."
"You need to see one."
(with utter lack of conviction) "OK."

He got the meds and left.

We're constantly told how important dental health is. How infected teeth can spread infection to the rest of the body. In my case, in which the source of an infection was crucial, I was repeatedly quizzed about my teeth. (I am pleased to report that there was a chorus of admiration when a team of doctors and med students examined my "dentition" one day. I must tell my fine young dentist, Dr. W., to whom I once commented, "I have fillings older than you." He has since replaced them. Expensively.)

So why isn't dentistry an integral part of the medical picture? I guess if I Googled enough I'd get an answer, something to do with the histories of the separate professions, rivalries and jealousies and economic advantages. But in a time of reform, when everything is being examined with a view to making it new, when "holistic" is a byword, shouldn't this odd, arbitrary division between dentistry and medicine be re-examined?

What You See Is What You Get

I mentioned earlier that I had been having trouble getting my shirts on right-side-front and my shoes on the correct feet. I don't anymore. As before I got sick, I can just look at a pair of shoes and tell which goes on the left foot and which the right.

What amazes me is how a simple, everyday task could have become so arduous. Because even though I could see the shoes perfectly clearly -- i.e., no cloudiness or blurring or double vision -- I couldn't see the difference between them. I would have to feel for the arch inside -- and even then, I sometimes failed to match the shoe to the correct foot.

My problem, it seems, was one of pattern recognition -- something that the brain does to help us see. I could "see" the shoes, but I didn't "get" them, if you know what I mean.

The first time I recognized this phenomenon was when I was in the hospital. Lying in bed, unable to read or make sense of what I saw on TV, my mind wandered everywhere, but especially to my home. And I realized to my horror that I couldn't visualize it. I even tried to map out a floor plan in my head, but it was as if my imagination couldn't hold anything as complex as a rectangle.

When I first arrived at the nursing facility, one of the therapists had me play the kids' game Connect Four -- the one in which you drop checkers into slots so they line up. Get four in a row -- vertically, horizontally, or diagonally -- and you've won. But I couldn't make sense of the game. I especially couldn't see the diagonal pattern. It was revelatory, but also depressing.

The first thing I mastered was the clock on the wall. I could see the hands perfectly clearly, but I couldn't make them tell time for me. Gradually, however, the ability returned. And the first time I saw a calendar I was baffled. I had "forgotten" the familiar pattern of the calendar -- left to right, starting with Sunday. I would scan across to Saturday and then have no idea which way to go, until I "remembered" that I had to look at the leftmost date on the next line. On the other hand, things that involved some kind of muscle memory rather than visual techniques, such as tying my shoes, never went away.

I still have a gap in my vision. I notice it most when I'm reading, a process that involves scanning lines from left to right. When your eye reaches the end of one line, it darts back to the left-hand margin and begins the next. But sometimes, when I'm reading particularly wide text, as on some Web sites, the gap in my vision puts in a fake "margin" to which my eye goes. I have to force my eye beyond this imaginary margin to the real one.

The thing is, through all these experiences, I remained perfectly lucid and verbal -- or at least I think I did. Which only made them more frightening. The brain is a scary organ.

Jon Stewart Is the Smartest Man on TV

The Daily Show With Jon StewartM - Th 11p / 10c

Mike Huckabee Pt. 2

Barack Obama Interview
John McCain Interview

Sarah Palin Video
Funny Election Video

Abscess Makes the Heart Grow Fonder

Home! Of course, I hadn't been here long before the garbage disposal jammed and the sink backed up. I took it on myself, in a bit of hubris, to repair things and only made them worse -- I tightened an O-coupling too much and wrecked it. So I had to call the plumber and pay for my hubris.

After three months away, things have changed around the house. That is, nothing is where I left it. Which for a mild (?) obsessive-compulsive like me is disturbing. Nevertheless, after my first outpatient IV session today, I vow to come home and rest.

Second Childhood

Hospitals and nursing facilities are grown-up places, where things like prudishness and modesty have to be left behind. I overheard two nurses laughing about the persnickety patient who requested that no men, not even aides or orderlies, be allowed to enter her room. Of course, nurses have seen and handled things that would have most of us fleeing or throwing up. There aren't many professions that get more respect from me than nursing does.

Still, it bothers me to hear a 90-year-old man say things like "I need to go potty" or "I have to wee-wee." And the nursing staff encourages it. Instead of "urinate" and "defecate," they say "pee-pee" and "poop" or even something I hadn't heard since third grade: "No. 1" and "No. 2." (No one uses the most familiar four-letter Anglo-Saxonisms.)

At first I thought this was an example of the infantilization that some critics decry in our culture. But then I lightened up. These twee euphemisms are the ones that almost every parent uses so often during the toilet-training years that it shouldn't be surprising when they become second-nature to us.

But something in me still thinks that being sick -- or just very, very old, as most of my roommates have been -- should be treated with frankness, not cutesiness.

More on TB

Nicholas Kristof has a scary-informative column about tuberculosis today.

And I may have to modify my previous assertion that I don't have TB. When I said that to Dr. B. yesterday, he said not to be so sure. My history of respiratory problems could have its source in the bacillus. Well, damn. And as Kristof's column says, there's not a lot of new research on TB, partly because it's a disease of the poor, who don't tend to fund research. So I am scrupulously gulping my antibiotics -- literally bitter pills.

Where the Heart Is

The following review was written for the Houston Chronicle and e-mailed to them shortly before I got sick. Somehow the e-mail went astray, and the review never ran because I was incommunicado when the editor tried to get in touch with me about it. Sad, because it was one of my favorite books of the year.

HOME

By Marilynne Robinson

Farrar, Straus and Giroux, 336 pp., $25


Home is the place where, when you have to go there,
They have to take you in.

--Robert Frost, “The Death of the Hired Man”

Everything that Frost packed into that wry aphorism – need, obligation, exploitation, resistance, resentment – Marilynne Robinson unpacks in her magisterial, breath-stealing new novel, “Home.” Everything and more, for Robinson also ventures into such difficult topics as love and faith.


These are difficult topics for fiction not only because they can betray writers into sentimentality, but also because so much of the drama of fiction depends on hatred and doubt. As Milton discovered, Satan inevitably gets all the best lines. Yet the drama in Robinson’s novel consists of the struggle of good people to love and believe in one another and at least to make the attempt to believe in God.


Glory Boughton has come home to Gilead, Iowa, to look after her father, Robert, an elderly Presbyterian minister in his last days. Before long, word comes that her brother Jack will be joining them. Neither Glory nor her father has seen Jack for 20 years, since he left Gilead in disrepute; he even failed to return for his mother’s funeral.


Glory is the novel’s central consciousness – the third-person narration sticks to her point of view – and she has secrets of her own that she’s hesitant to share with her father and her brother. But during the weeks of his visit in the summer of 1956, she will share her secrets with Jack in order to learn some of his own. The novel is a delicate dance of guilt and forgiveness, involving not only the three Boughtons but also Robert’s old friend and fellow minister, John Ames, for whom Jack was named.


Readers of Robinson’s 2004 novel “Gilead,” which won both the Pulitzer Prize and the National Book Critics Circle award, will know these characters already. But they won’t know them the way they’re presented in “Home,” which tells essentially the same story about the homecoming of Jack Boughton, but tells it in a new and surprising way. “Gilead” was John Ames’ journal, a testament written for his small son, a profoundly meditative novel. “Home” is meditative, but it’s also a more theatrical novel.


Not “theatrical” in the pejorative sense (that is, florid and overstated) but in the sense that, as in a play, much of the tension and substance of the novel lies in the things the characters say to one another. It’s a novel that takes place on a stage of sorts: the Boughton home, its rooms cluttered with “unreadable books” and furniture in “sour, fierce, dreary black walnut” with “leonine legs and belligerently clawed feet.” The porch is “overgrown by an immense bramble of trumpet vines,” and there is an “empty barn,” “useless woodshed,” “unpruned orchard and horseless pasture.” This is the place that has taken Glory in, a 38-year-old unmarried woman who must by the end of the novel decide whether to let the past – home -- define her for the rest of her life.


But before that, she has to deal with Jack and their father, and with John Ames, who disapproves not only of Jack but also of his father’s willingness to overlook Jack’s transgressions. The novel moves through a series of crises, some of them provoked by Ames’ words and some by Jack’s tendency to adopt an ironic self-distancing that slicks over his underlying desire to be accepted and forgiven. As Glory moves among these characters, she comes to recognize and embrace her kinship with Jack, even though she is ostensibly the most dutiful of the eight Boughton children and he the most prodigal of the sons and daughters.


A moment of almost telepathic recognition of this kinship comes in mid-novel when Jack makes a remark that annoys Glory:


“That was a little flippant, she thought. She went into the kitchen to peel potatoes for a salad.


“After a while he came into the porch and the kitchen and stood by the door.


“ ‘I’m sorry,’ he said.


“ ‘What for?’


“ ‘When we were talking just now. I think I may have seemed – flippant.’


“ ‘No. Not at all.’


“ ‘That’s good,’ he said. ‘I didn’t mean to. I can never be sure.’ Then he went outside again.”


That’s an utterly simple yet impeccably crafted account of the way a casual word or expression or action can ripple seismically through the consciousness of others. And it’s characteristic of Robinson, who has a sensibility attuned to “the intimacy of the ordinary,” to rip one of her own phrases out of its context. She is a writer of rare grace, whose words seem to fall into place as naturally and freshly as raindrops.


Don’t worry if you haven’t read “Gilead,” to which this novel is both companion and complement. You can begin with “Home” and then read the other. But you may be tempted when you finish “Home” just to start over and read it again. It’s that good.

Liberation Day

The groundhog saw the shadows and liked what he saw, so my winter in the nursing facility is nearing its end. As soon as the two bureaucracies -- hospital and facility -- can iron out the details, I'll be back home, probably by Tuesday. The catch is that for the duration, i.e., as long as the lesion still shows up on the MRI, I'll have to go in every day (Sundays and holidays too) for about an hour of intravenous antibiotic. But hey, I won't be stuck in wheelchair central anymore, waked up every morning for a change of IV bags.

Groundhog Day

Tomorrow is my version of Groundhog Day. Not that it's going to repeat over and over, although that pretty much describes my current institutionalized life. I mean that Dr. B. is going to come out of his office and look at the shadow of my brain lesions on the MRI and say whether I have six more months of IV therapy. (I could be here till June.)

A devout friend writes that he has me in his prayers. This old agnostic is almost willing to believe that they're working.

Proposition H8

They should have done this before the election:

TB or Not TB

If this were an episode of "House,"the cranky, pill-popping doctor would long ago have diagnosed my brain abscess as caused by an ingrown toenail. Dr. House often finds the solution to his mystery cases in the family medical histories of his patients. But in my case the family medical history only complicated things.

In the age of prosperity and antibiotics, tuberculosis is a disease of people who live in cardboard boxes under bridges. (At least in countries without, ahem, a national health insurance program.) But as anyone who knows Romantic poets, Victorian novels or grand opera is aware, it used to be more widespread.

My mother had tuberculosis when I was 3 or 4. She spent a year in a sanitarium and had part of a lung removed, yet she lived to be 75. (She might have lived longer -- her sister lived till she was 90 -- if she hadn't given in to depression and essentially starved herself to death, refusing to eat. Which is why I'm no foe of antidepressants.) Moreover, her father, who lived with us until I was 8 or 9, also had TB. So whenever I have to fill out one of those medical history questionnaires the doctor give you, I mention this exposure.

TB is not all that contagious, I think. None of my mother's six siblings contracted it, nor did my father. But I've had a history of upper-respiratory crud -- from sinusitis to pneumonia (twice) to an empyema, so doctors are quick to send me to X-ray.

Which is good, except that this time they decided that TB was a prime suspect, even though the usual pinprick skin test was negative, and they sent me to lock-up: a private room in the contagious ward, accessed by a kind of airlock and only by people wearing face masks. I spent three days there producing sputum samples -- coughing (even though I didn't have much to cough) into a little plastic cup full of weird-smelling chemicals.

I don't have TB, and I suppose I should be grateful for their thoroughness in making sure of the fact. But for a time there I wondered if instead of being Bette Davis in Dark Victory -- alerted to the onset of death from a brain tumor by losing her eyesight -- I was going to be Greta Garbo in Camille. Fortunately, I'm neither.