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Disclaimer

The contents of this website are for contemplative purposes only. No medical advice will be given, and emails asking for medical advice will be ignored.

Although patient vignettes are based on my experiences with real individuals, I liberally change details to maintain patient confidentiality.

I also reserve the right to change old postings to correct errors, and to delete comments that include obscene language or that I deem abusive to me or other commentators.  If you are looking for a open mind, I suggest you consult a neurosurgeon.

Friday
Aug292014

Katrina: 9 Years Later

In the early morning of Monday, August 29, 2005, Katrina first made landfall in the United States. The eye hit first in Plaquemines Parish in Louisiana, veered east of New Orleans and through St. Bernard Parish (where I lived at the time). It then curved back into the Gulf briefly before landing a second time near Gulfport, MS. At the time of landfall it was a low category 3 storm, with sustained winds of about 110 mph and gusts up to 150, but it carried a storm surge of close to 30 feet, more consistent with a category 5 storm. Since the levees a few blocks from my house were only 20 feet high, they were easily topped, and my neighborhood got 12 feet of water.

People after the storm sometimes said that the people (me) who lived there got what they deserved for living below sea level, but I didn't live below sea level. My house was at about +4. Much of New Orleans is above sea level, something the media never seem to get right, no matter how many times they revisit this topic. Some of it is lower, but it was not the elevation of New Orleans that was to blame for most of the destruction that Katrina caused. Most people in the New Orleans area can tell you that, but hardly anyone outside of the city can.

In fact, with the height of the levees and the elevation of the land my Chalmette home was built on, my mortgage company did not require flood insurance. Our street had never flooded before in its thirty year history. (I had flood insurance anyway.)

The reason my neighborhood flooded, and many neighborhoods in St. Bernard flooded, was not because of the wind or the storm surge. It was because in the 1960s, the federal government, under the guise of th U.S. Army Corps of Engineers, cut a ship channel called the Mississippi River Gulf Outlet (MR GO) through the pristine wetlands in east St. Bernard. This channel was supposed to be a direct shipping lane from New Orleans to the Gulf of Mexico, allowing ships a more direct approach to the Port of New Orleans than was available by sailing through the mouth of the Mississippi. It was rarely used.

Instead it served a more sinister purpose, forming a condiut that allowed Katrina's storm surge to come far inland and destroy thousands of homes and kill several hundred people in St. Bernard and the nearby Lower Ninth Ward of New Orleans.

Before MR GO, upper St. Bernard (the higher land where people settled) was protected by thousands of acres of wetlands that had the capability to absorb a hurricane storm surge. After MR GO, the wetlands in east St. Bernard were in tatters, offering no resistance to Katrina's tidal wave.

In the 1950s, while MR GO was still in the planning stages, a group of citizens from St. Bernard and elsewhere protested to the federal government to block its construction. The citizens argued that digging the waterway would damage the wetlands and make the settled areas more vulnerable to hurricanes. A Department of Interior report in 1958 said: “excavation of the (MRGO) could result in major ecological change with widespread and severe ecological consequences.”

Enironmentalists are never listened to. But occasionally they are right, and when they are we pay the price.

A year after Katrina, after I had moved to Mississippi, I encountered a woman at work who had a strange fury about Katrina. She felt that Katrina had caused as much damage in Mississippi as it did in Louisiana, and she was clearly angry that New Orleans, particularly the Lower Ninth Ward, received most of the attention after the storm. "Nobody paid attention to Mississippi," she bellowed. "The people here suffered just as much as they did in Louisiana, and no one cares." 

I listened to her vent. I couldn't tell if she personally had been affected by the storm, if she knew people who were, or if she was just one of those people who gets stirred up over other people's problems. I didn't ask, mainly because, as a Louisiana Katrina victim, I had lost too much from that hurricane. My wound was too fresh for me to get into a discussion with an indignant woman about whether my losses were greater than hers, or her friends, or the people she knew through TV. So I kept my mouth shut. I doubt the woman ever realized the person she was talking to was one of the very people she was accusing of being "privileged," although I am certain she sensed my hostility.

Today I live in Mississippi and have heard some of the Mississippi stories. I don't know if they had it better or worse (although I have an opinion about that which I will keep to myself). What I know is my own experiences, and I had a lot of them, and they all occurred in Louisiana.

So I tell my story. Not because it is the worst one ever, but because it is the one I know the best.

 

Monday
Aug182014

Housecleaning

You wouldn't notice if I didn't call your attention to it, but I have cleaned up my website a bit today. Gone are most of the links to other blogs in the right column. This is because most of those blogs, which have adorned this page for years, no longer exist. A few of them are still online, but there has been no activity. I have pulled most of them down, leaving the few active ones behind, although a few, which I either thought were good or because I still have a personal connection with the blogger, remain.

I started writing online just after Hurricane Katrina, in 2005. (The ninth anniverary of that storm is coming up.) I was surprised to find that there was a whole community of blogging doctors. I joined them, to the extent that I am a joiner -- that is to say, not much -- and had my back and forths with them from time to time. Almost all of them are gone, one by one signing off because they said they had lost the passion.

Blogging is not the fad it was in 2005. Facebook has replaced it, along with Tumblr, and a lot of other things I have never heard of. I've tried some of them. I was pretty active on Facebook for a long time, but pulled back after I got into an ugly conflct with a not-so-close family member who accused be of being a communist because I believe in universal health care. At that point I saw that Facebook brings out the ugly in people -- that family member never would have dared to say something like that to my face. So I drastically cut back on my Facebook activity.

Having your own site has its advantages. I am in control here, there is no noise, what I say stays. Note that there are no ads on this page, nothing. That is by design. I am sick of marketing -- everyone is selling something, including, I suppose, me. But I don't see why my website has to be a home for parasites. So here I remain, screw the rest.

Unlike my fellow, now defunct, bloggers, I can't say I have lost the passion to write. That will be with me as long as I live, but as of late I haven't always been expending my creative energies here. Which is all right. This website has never been the center of much online. It has been more a creative outlet for me, and a sight for anyone who wants to look in. Still, its total achievement, hundreds of entries, seems like a monument of some kind, so it will stay, and I will continue to add to it, even if only sporatically.

More than losing the passion, my problem has been that I tend to set the bar too high. I spend a lot of time editing and polishing my posts, and since that is so, any urge to post is counterbalanced by a sense of how much time it will take to prepare my writing. The remedy, of course, is shorter posts, but for me, rarely does a short post stay short. Ideas beget more ideas. That's what makes writing so wonderful.

Monday
Aug042014

The Leopard

A few weeks ago, I traveled to Italy. I hope to post about this experience later, but first I want to talk about part of my preparation for the trip. Before I take a major trip like this one, I often research the place I am going, and this includes reading about the history and culture of the place I will be visiting.

I came across the book The Leopard by accident. In the months before the Italian trip, anything in the papers, news, or magazines that had anything to do with Italy attracted my attention. A few months ago the New York Times published an essay about literature in Italy, an article I can't locate at present, in which the author lamented that the country of "Dante and DiLampedusa" doesn't read novels.

DiLampedusa? Never heard of him. (Her?) A quick Google netted me the name Guiseppe di Lampedusa, a native of southern Italy and descendant of Sicilian nobility, a man who wrote a single book in his lifetime entitled The Leopard, judged unpublishable in his lifetime, but published shortly after his death, in 1958, to world acclaim.

I found it on the shelf in Lemuria Bookstore here in Jackson, and bought it. (Lemuria always seems to stock books that matter.) The Leopard, in Italian Il Gattopardo, is truly one of the best books I have ever read, a sheer joy, easy to read, a pleasure to absorb, and the kind of book one takes a lifetime to process. I am surprised, good as it is, that I had never heard of it before.

The book is about Prince Fabrizio Corbera of Salina, of the Kingdom of Two Sicilies, and takes place during the Risorigimento, a period in Italian history from 1815 to 1871 when the many Italian states that occupied the Italian peninsula unified into a single modern nation. To understand the story it helps to know a little of the historical background: In the 1860s, Victor Emmanuel II, King of Milan, is in the process of conquering Italy, and his general, Guiseppe Garibaldi, is leading the charge. As the novel opens, Garabaldi prepares to land in Sicily and take the island for Emmanuel and his Kingdom of Piedmont-Sardinia. During the course of the novel, Sicily and southern Italy are conquered by Garibaldi and incorporated into the Milanese empire.

Like most Americans, I have no sense of the social changes that swept through Sicily during the Risorgimento. I don't know what Sicily was like before the change, or what it was like after. Di Lampedusa only alludes to the changes, never giving specifics. But he doesn't need to. Somehow anyone who has ever witnessed social change (and we all have) can appreciate the apprehension and sadness of a world passing away. To read The Leopard with the necessary empathy, knowing this is more than enough.

Though the book takes place during and after a war, it is not mainly about war, no more than and probably much less than Gone With the Wind is about war. Like GWTW, The Leopard is more about a way of life passing away during and after war than about actual defeat in battle, but unlike the American novel, it is not burdened by the difficult issue of slavery (which in GWTW Margaret Mitchell is never really able to completely contend with). But unlike the typical this-time-is-passing-away novels, The Leopard broadens this theme beyond Italy to all human experience, to life and death itself.

For instance, the following passage, one of the funniest and yet saddest in all of The Leopard, reminds us that not only Sicilian nobility culture, but all things, must pass away, sometimes in the most unromantic fashion. In it Prince Salina observes a ball, and the paintings on the ceiling of the ballroom above it.

The crowd of dancers, among whom he could count so many near to him in blood if not in heart, began to seem unreal, made up of that material from which are woven lapsed memories, more elusive even than the stuff of disturbing dreams. From the ceiling the gods, reclining on gilded couches, gazed down smiling and inexorable as a summer sky. They thought themselves eternal; but a bomb manufactured in Pittsburgh Pennsylvania, was to prove the contrary in 1943. (p.258)

Di Lampedusa could write with almost unbearable beauty, and one of the sorrows I took from this book is that The Leopard is virtually all we have from him. In a later passage, also at the same ball, the Prince makes a lengthier observation about the attendants at the party, an observation that has all of the glitter of high romanticism and much of the earthiness of modernism.

What I love most about this passage is its humanity, its compassion. I may be in the minority here, but I think nothing makes art greater than when it shows compassion.

The two young people moved away, other couples passed, less handsome, just as moving, each submerged in their transitory blindness. Don Fabrizo [Prince Salina] felt his heart thaw; his disgust gave way to compassion for all these ephemeral beings out to enjoy the tiny ray of light granted them between two shades, before the cradle, after the last spasms. How could one inveigh against those sure to die?...Nothing could be decently hated except eternity....

And these people filling the rooms, all these faded women, all these stupid men, these two vainglorious sexes were part of his blood, part of himself..."I may be more intelligent, I'm certainly more cultivated, but I come from the same stock as they, with them I must make common cause."

This passage came at a time in the novel when my sympathy for the Prince was flagging because of his privileged ways and attitudes. It was just the kind of humanity I needed to rekindle my interest in him, and DiLampedusa knew how to bring it in at exactly the right time.

A delightful book, and a short one. I recommend it to anyone and everyone.
Saturday
Jun212014

Things You Can Do to Make This a Better World

We usually think of improving the world as being something dramatic -- saving the rain forests, feeding the poor, stopping climate change. But there are many very small things we can do to improve our world.

Most of the things on my list artistic or participatory. That is because I believe that art increases our shared experience and binds people together. And participation is important for the same reason, because it improves our sense of shared experience and unity.

One could easily read this list and dismiss it as a "smell the flowers" argument. It is not. Instead I see this as a systematic way to redirect a few pennies of a person's funds and attention to chronically underfunded or under attended civic efforts. To save civilization, we first have to have a civilization we care about enough to save. That is my point.

1. Buy a book of poetry once a year. We are only talking about once a year here! Maybe owning a book of poetry will open your mind to something entirely new, and get you thinking along new lines. It also keeps to poets in business, and I think poets have important things to say.

2. Subscribe to one magazine, preferably one with intellectual aims. If you really want to do the world a service, find one that has a low circulation. The Southern Review, The Virigina Quarterly Review, or The American Scholar come to mind. Or maybe a professional rag: Guitar Player, Science.

3. Learn a foreign language. Ok, I admit this is a hard one. But the mistake most people make in approaching foreign languages is to rush it. How long do you have to learn Mandarin? Your entire life, of course. Just stick to it. If you are like me and have long lapses, go back to it. Every little bit you learn broadens your understanding of the world. This isn't necessarily about fluency, although that would be a happy result. It is about understanding other people better.

4. Go to the symphony. I have found this to be a great learning experience. You sit there, and some of the finest artistic achievements of all time unfold in front of you. Music directors spend a lot of time mixing old standards (Beethoven's Fifth) less well-known pieces that are equally great (Shostakovich's Cello Concerto No. 1). Everybody talks about Mozart but few people really know him. Learn. You don't have to go to the Met either -- most cities have some kind of symphony that costs much less than New York, and is almost as educational.

5. Vote. Goddammit, DO IT. Politicians behave the way they do because they know no more than 50% of the public will show up to vote. They know they will never be held accountable. The angriest people are the ones who never vote. And they wonder why nothing ever changes. Even if you vote for the losing candidate, the winner is aware that you showed up and told him to drop dead. The more people who do that, the more politicians have to adjust their attitudes.

6. Go to church. Believing in something and sitting at home is no different from believing in nothing at all. People draw strength from one another in church. You look around and say, he believes what I believe, I am not alone. When you go to church you are voting for your faith. Just as with voting in politics, if you don't show up, no one accounts for you. Whatever belief you have, it is nothing unless you practice it.

7. Turn the TV off. I don't think there is a more destructive device in modern society. It encourages laziness, sensationalism, and discourages rational thinking. Every minute the TV is off is a good minute.

8. Learn a musical instrument. Ok, this one sounds like another high difficulty suggestion. Not necessarily. How about the harmonica, or the ukelele, or djembe drum? Or voice? The point is not to become expert, but to learn a little bit about the theory and dynamics of music so you can appreciate it better. We live in a culture saturated with music, but most people have no idea what goes into creating a simple song.

Monday
Jun092014

Gun Control, Anyone? Anyone?

Yep, morning in America. Another day, another public shooting. So now we're ready to have a serious talk about gun control, right?

No? You want to have a talk about mental health instead, since a lot of these shooters have psychological problems?

Ok, fine, I'm in. Let's talk about mental health. You are aware, I'm sure, that the best way to provide mental health services is through universal health care, right? Because the truly mentally ill are usually disabled, and can't often hold down jobs, or lose the jobs they have because of emotional instability. Along with that, they lose their health insurance, which is where things tend to go off the rails.

If you want to beef up mental health services in America so there will be fewer public shootings, then you have to provide health care for everyone. A lot of mental health treatment, and most mental health screening, is done by primary care physicians. As a primary care physician, I can tell you that at least a third of the care I provide is related to mental health, especially substance addiction and depression, but the range goes way beyond that. You can't just pick out the future killers and treat them. We don't know who the future killers are. That means we have to treat everyone.

So, to sum up, if you want improved mental health services in this country, you have to get behind universal health care. What do you think?

That's what I thought. Ok, back to gun control....