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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.

Katrina Blog Project

When Azaleas Last In the Backyard Bloom'd

DSCN1457.JPGBy disposition, I am a stiff upper lip kind of a guy. My personal philosophy, borrowed in equal parts from the ancient Stoics and Buddhism, is that life is best lived with a certain reasoned detachment. Unhappiness is the difference between expectation and reality. That is, if we expect too much out of life, we suffer because life, with its imperfections, almost always fails to meet our ideal.

Sometimes, though, emotion has a way of touching reason on the sleeve and saying, "Sorry, I'm taking over here." These moments can be subtle or dramatic, but no amount of mental discipline can make them go away completely.

I am having one of those subtle moments now. March is with us, and in the Gulf South March means Spring. People in the North think we have no seasons down here, but this is not true. We may not ice over, but from December to February the trees are bare and the grass is brown. There will be a few frosts a month, and a light jacket is the constant companion of the wise. Shorts and T-shirts migrate to the back of the closet. Not that our winters are harsh by any stretch, but there is a definite change.

In my childhood, I always marked March 1 as the beginning of Spring. There could be a few chilly mornings still pending, but the frost was over. When these first truly warm days came around, I always felt my spirits rise. It was emotion, not reason, that marked the change. Often I would not even notice the grass darkening with green or the fresh shade cast by new leaves until my lighter mood tugged my shirtsleeve and told me so. Even in the days before the term seasonal affective disorder was coined, my heart knew the difference between winter and spring.

Not this year. The azaleas in my yard have been blushing pink for almost two weeks and I have barely noticed. There is no change in my winter mood, as if I have been frozen on the inside this time, and the natural warmth of Spring offers me nothing. I feel that Stoic sadness, the difference in expectation between what I feel and what I think I should feel.

Of course I know why. When your home town is wrecked by a hurricane it tends to rob you of something. Some have compared the damage of a natural disaster like Hurricane Katrina to a rape, but I don't see that. For me, it is more like losing a brother.

A brother is someone who shares your history and upbringing. There is a deep emotional bond, but not necessarily a financial one. When your brother dies, you march on in your life and career, sometimes more successfully than ever before, but to a rhythm that has a lesser meaning. There is a part of your past, a person who can bear witness to what you are and how you got there in a way that no one else can, that is gone.

That is how I feel about New Orleans. I was very lucky; I lost very little financially, but my emotional loss is very close to a loss of identity.

All people who are from New Orleans share in a brotherhood. There are so many things unique to that city, things that only a person who has called the place home would understand. Some people love New Orleans, some hate it. Brothers do not always get along either. But there are so many things shared, so many things that cannot be duplicated elsewhere, that there is no replacing that loss, no matter how hard you try. You cannot replace a brother.

As I walk in my garden, newly mine since last fall, I admire flowers I did not plant and wonder if they will always be mine, or if storm winds will eventually blow me somewhere else. McComb is a delightful place, relentlessly green, peaceful, and full of kind people. It is good enough that I could stay here forever. But I cannot help but remember that I am not from here, and the place I am from has become a wasteland.

I can start over, but there is no replanting a personal history. My main hope for recovering my history is that New Orleans will rise again, and will become something resembling what I remember it to be.

The beauty of a flower, like an azalea in my yard, comes not only from the perfection of the object itself but also from the memories of all the flowers we have seen before. The present and the past meld, and in the moment we experience the past and the present together. This is the value of place. We see the same events and the same faces year in and year out, and each year they acquire new meaning. Perhaps this is why I see little meaning in the flowers in my own yard. They would look more beautiful to me if they were growing in New Orleans.

As time goes on, I expect my present will find ways to resolve itself with my past, so that once again the things I experience will find roots in similar experiences in the past. For now, I can only pray enough of my hometown will be rebuilt that I will one day be able to say, I am from New Orleans, and it will mean something again.


Katrina Photos

I have added a photo gallery to my website. At the moment it only includes pictures I took on September 30, 2005 on my first visit back to by home after Hurricane Katrina hit.

From time to time, I hope to add to it, so please check back.

Tip: I left these pictures in high res, so you can click on them and see them in a separate window, full size. Try it on a few. The details in the pictures really bring out the sense of total destruction that the thumbnails simply don't.


The Kool 100

I picked up the newspaper the other day and read the following:

Patients at risk for abdominal aortic aneurysm (AAA) will soon be eligible for ultrasound screening under the Medicare system. An at-risk patient is defined as a male over 65 who has smoked more than 100 cigarettes in a lifetime, or a woman with a family history of aneurysms . . .
A triple-A! I read on in horror, scarcely able to contain myself as I learned that the AAA kills 15,000 people a year in the United States. It is a silent killer, a ticking time-bomb. The aorta, the story explained, is the largest artery in the human body. In the abdomen, under the pressures and stresses of a lifetime, it may bulge outward, forming a pulsating egg that grows and grows until it finally and catastrophically bursts. I could be gardening, doing the laundry, cutting grass, or watching TV, when BAM, my aorta bursts, and, as Homer says, darkness is swirling before my eyes.


I had never heard of the AAA before, but the more I thought about it the more certain I was that I had one. I had to have that test. Even as I sat and read, the paper resting against by protuberant belly, I could see the newsprint bob up and down as my throbbing Triple-A ballooned.  There was not a moment to lose.

I made an appointment with my doctor the next day. The nurse showed me to the examination room, and I waited anxiously to make to plead my case for this lifesaving ultrasound.

A few minutes passed, and Dr. Hebert came in. He read my chart and my request. "So you are afraid you may have an aneurysm?" he asked.

How could I explain it to him? I have a AAA until proven otherwise, my mind screamed, but I said, calmly, "Doc, I don't know. But I have had these stomach pains, and I am worried . . ."

"I would be happy to order the test, Mr. Kent, but you know the Medicare rules. You read the article. I read it too because you left it under my windshield wiper in the hospital parking lot yesterday. You don't meet the criteria."

"I am 66 years old . . ."

"But you don't smoke. Oddly enough, this is the one time in life when there is a material advantage to smoking. Of course, if you want to pay for it yourself, you could get it for a few hundred dollars."

"Can't do it, Dr. Hebert." I was crushed, having blown all my money on lottery tickets. After choking back a sob, I finally said, "I'll figure something out."

I stumbled out of the office in a fog. At home, I fixed myself a cup of coffee, and lay on the sofa thinking. As I stared at my stomach, I swore I could see it pulsating, that evil AAA ripening like an August watermelon. How many minutes did I have left? Then I got an idea.

Without a word to my wife, I got into my car and drove over to the convenience store. Running up to the counter, I said to the clerk, "I need 100 cigarettes."

He made a funny face. "You mean you want a carton?"

"Whatever it takes to make 100 cigarettes. See, I gotta make criteria."

We figured it out. Twenty-five cigs a pack, so I needed 4 packs. I couldn't believe how much a pack cost! Each pack had a warning that said, "SMOKING IS HAZARDOUS TO YOUR HEALTH." But the Surgeon General certainly would approve under these extraordinary circumstances. These 100 smokes would save my life.

I took the cigarettes home, emptied the packs out and laid all 100 out on my kitchen table. My wife then walked in and asked what I was doing, though not as polite as all that.

"I am saving my life by qualifying for an ultrasound," I said.

"Not in my house!" she hollered, and I obligingly picked up all the cigarettes and went out to the yard.

Tobacco, of course, is the most addictive substance known to man. If I was to smoke 100 of them, I knew I had to make it as unpleasant an experience as possible to minimize my chance of getting hooked. To achieve this, I intended to smoke all 100 cigarettes in a one-hour period.

I lined them up side-by-side, and then picked up 5 and lit them. I stuck all 5 in my mouth. They were pointing in all directions, and with my fat head in the middle I looked something like a bagpipe. I inhaled. Presently I felt very dizzy, my heart beating faster and faster. I spat them out and lit up five more.

By the time I had gone through thirty I began to feel a horrific burning in my stomach. Along with it there was a buzzing sound in my ears. The bagpipe was revving up. As the stomach burning converted into intense nausea, I fell to my knees. I vomited over and over again, and then rolled over on my side, the whole world a haze.

My wife was standing over me. "What kind of fool are you," she said, and tried to pick me up by the collar. "It's bad enough that you are making yourself sick. You also set the lawn on fire."

She turned on the garden hose and snuffed out the blaze on the grass. Sick as I was, I made sure to gather the remaining cigarettes to my bosom so they would not get wet.

"I only have 55 to go," I murmured, and fumbled to find my matchbook. There was no going back now.

"Why don't you smoke them one at a time, instead of making yourself sick like a moron?" she said.

"I don't want to get addicted," I said, my heart palpitating. "If I make myself sick doing this, I won't want to smoke again." I grabbed 5 more cigarettes and stuffed them between my lips. The tips waggled up and down, and with my trembling fingers it was almost impossible to light them all with a single match.

I took a few more puffs, choked, and all 5 butts landed in the grass. I threw up again, and my wife doused the fallen cigarettes with another burst of water from her hose. When I vomited yet again, she hit me in the face with the water. I was on my hands and knees staring at the ground in near-defeat. A string of mucus ran from my nose down to the ground.

"Oh, you won't get addicted. If you ever pull this again I'll pound your head in with a frying pan."

How I did it, I will never know, but somehow I got through with all 100 cigarettes before everything went black.

The next thing I remember is waking up on the sofa. My wife had dragged me in somehow, and I found myself with a cold cloth on my forehead and a glass of water at arm's reach on the end table. After a few minutes, my wife came in. "Oh, you're awake," she said, and then launched into a tirade that I choose to block from my memory.

The next day I was in the doctor's office. I still looked rather wan, and Dr. Hebert was observing me suspiciously. "You smell like smoke," he said.

"I want that ultrasound test," I said. "I have smoked 100 cigarettes in my lifetime, so I qualify. If you don't believe it, you can ask my wife."

"Oh, I believe you," Dr. Hebert said. "I have already talked to your wife."

"Good. When can we get the test?"

"January 2007. Medicare is not starting the program for another 10 months, John. You will have to wait until then."

I thought I was going to faint. Deep in my abdomen I could feel that aorta, stretching, tearing, on the verge of explosion! Could I afford to wait another 10 months? I guess I had no choice. "Book it," I groaned, "on January 1st. At 12:01 am, if possible."

As I got up to leave, another thought passed through my mind.

"Doc, I just smoked 100 cigarettes yesterday. Think they would pay for a chest X-ray? I swear, I have been feeling a tumor in my chest ever since I woke up this morning."


The Smoking Gun

So I guess now we have it, the proof that President Bush was warned prior to Hurricane Katrina that New Orleans was at risk for levee breaks. Exhibit A: a video tape that shows Bush being briefed on the hurricane 48 hours prior to landfall. On the tape, National Hurricane Center Chief Max Mayfield clearly tells the President and his advisors that the strength of the New Orleans levees was a major concern. They knew, but did nothing about it.

The liberal press has taken up the standard. Bravely they accuse the White House of dishonesty, indifference, incompetence, and even outright lying.

I wish they would just shut up. The people of New Orleans have known since September 2 that the government let them down on all levels, and in every conceivable way. This news story tells us nothing new. It is nothing more than an attempt by Republican opponents to get cheap publicity over a great tragedy.

There is something awful about people who seek to profit from the suffering and humiliation of others. These critics don’t care about New Orleans any more than Bush did. They simply see this videotape as a great gotcha moment, and they will exploit it for all it is worth. Even as they speak, one can see in their eyes that they are forgetting the very people these mistakes have hurt and their criticism is intended to benefit. The human suffering in the aftermath of Katrina is not a political football, and it is shameful that so many people want to treat this situation as some kind of a game.

If opponents of President Bush really want to help the people of the Gulf Coast, they should be working to help rebuild instead of jockeying to make Republicans look bad. Bush’s critics have a lot to say about what went wrong, but when it comes to recovery plans they are absolutely silent. The people of the Gulf Coast don’t care if the President looks bad or not. We want our houses rebuilt.

If they are not going to help us with that, we would prefer that they just go away and leave us alone.

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The Mardi Gras Mambo

Picture 031.jpgPerhaps you have already seen it. The close-ups of drunken faces, the whooping and hollering, the tossing of the bead and the bearing of the breast. The crowded, raucous, filthy Rue de Bourbon, full of Mardi Gras revelers. Then the cut to the footage of decimated houses, ruined neighborhoods. Finally, the face of a blonde, always blonde, news correspondent, beautiful and ever loquacious, saying, "The drinking and the partying of Mardi Gras goes on, even as thousand suffer . . . "

Here is a word from someone who has seen at least 20 Carnivals: Bourbon Street is not Mardi Gras. For the hundreds of thousands of natives who attend Carnival every year, Mardi Gras is not a drunken, naked orgy. It is a family and cultural celebration.

The French Quarter is the smallest part of Mardi Gras. The parades, and the celebration, begin on Napoleon Avenue, 5 miles away, in a residential neighborhood, and move through the lovely oak-lined  St. Charles Avenue. St. Charles is the home of family Mardi Gras, and here you will find the streets crowded for miles with families, their children included, barbecuing, dancing, singing, and enjoying the holiday. Mardi Gras, for New Orleanians, is a celebration closer to Halloween or Christmas in its cultural importance than it has ever been to the foolishness seen on Bourbon Street.

Some people who have never been here, or even a few who have, have trouble believing this. These people are making the same error people make who think soap operas are real -- they are not looking hard enough, and are assuming what they can see is all that there is. New Orleans was the home to 1.3 million Americans before Katrina and just over 1 million now. If New Orleanians were the authors of the debauchery that goes on in the Quarter, we would all have died of AIDS or alcoholic cirrhosis years ago. We make our lives here, and our lives are just as family-oriented and spiritual as anywhere else. Mardi Gras is family-friendly and peaceful. If it were not, we would not have celebrated it for 150 years.

Picture 027.jpgMardi Gras is the fusion of the three great religions of Southeastern Louisiana -- Catholicism, music, and food. It would be an exaggeration to call it a religious holiday, but it certainly retains echoes of its original purpose as the big blowout before the austerity and prayerful fasting of Lent. In New Orleans, you will see the same faces going to church on Ash Wedneday, the day after Mardi Gras, as you saw on dancing on the streets the day before. The religion, music, and food are everywhere, and the three are never separated for long.

People in New Orleans take food and music very seriously. If you ever come to visit, you can test this theory. Stop any person on the street and ask where you can get the best gumbo in town. In the 20 minute lecture that follows, you will hear a litany of famous and unknown restaurants and dives, including Brennan's, Galatoire's, Clancy's, R&O's, Mandina's, the list will go on and on. This is a city devoted to the simple pleasures in life. It is not interested in excess. Excess requires too much work, and drains away the pleasures of the moment. New Orleanians live the the moment, enjoying each day for whatever delights it may yield. This may not always make life as productive as it can be, and sometimes as a credo it is short-sighted. But it is not destructive. An important side effect of this pleasure-of-the-day mentality is that it spurs people to keep things as they are so they can be enjoyed again and again. This attitude is incompatible with the tourists' desire to burn the candle at both ends, and thus to destroy the substance of living. Mardi Gras is a celebration of constancy, not of extremes.

Perhaps more than any other city in the United States, New Orleans has taken care to preserve its social structures and organizations. Sometimes this means time seems to pass us by, but that is the flavor of our town, and something that every tourist immediately senses, whether he goes to Bourbon Street or not. City life is centered around numerous neighborhoods -- Uptown, the Garden District, the Irish Channel, Treme, Mid-City, Carrollton, the Lower 9th Ward -- and each neighborhood is in turn organized around local watering holes, restaurants, and churches. Music, food, and Catholicism.

The Mardi Gras Krewes that so famously march down the streets of the city are nothing more than neighborhood social clubs gone public with their good will. Rex is an Uptown organization, Endymion originally hails from Mid-City. There is a Krewe of Mid-City and of Carrollton. Zulu, the largest African-American parade, is from Treme. Folks in the French Quarter (yes, the Quarter is a real neighborhood) host the Krewe the Vieux.  My old neighborhood of Chalmette birthed Gladiators, Aphrodite, and Shangri-La.

The histories of these Mardi Gras organizations erase any doubt that they are local, rather than tourist phenomema. Almost all of them run charitable funds. Thoth plans its route to pass near homes for the elderly and infirm -- it is sometimes known as the "Krewe of the Shut-ins." Many Krewes, especially Choctaw, Grela, Jason, and Sparta, sponsor children's causes as part of their mission.

It is this peculiar link between religion and fun that makes New Orleans go. Churches hold communities together, and are the social backbone, and Carnival arises from them. No faith and no community, no Mardi Gras. In the last few weeks there has been a great outpouring of grief over the decision of the Archdiocese of New Orleans to close St. Augustine Church in the old African-American neighborhood of Treme. Communities here die very, very hard, which is why the dislocation of Hurricane Katrina has been so difficult to bear.

So, when you watch the news reports and the ads for "Girls Gone Wild -- Post-Katrina Edition" remember that the faces you are seeing are the tourists, not the residents. The residents are the ones off to the side, laughing at the goofballs the tourist flights have brought into town. The residents have their own party, separate from the tourists, there in full view for anyone to see, but subtle enough that the hurried eyes of the media usually miss it.

Happy Mardi Gras, y'all.

For other takes on the "other" Mardi Gras, see the New Orleans Times-Picayune here, and Slate Magazine here