A Crucible

Every fall I teach a unit centered around The Crucible.  The assignment I give my students is to draw connections among the witch-hunts of the 1690s, the red scare of the 1950s and then to an issue of their choosing for today.  The students are charged to find three parallels among these three time periods.  Their working thesis is that a culture of fear creates strikingly similar social situations, and that some parties exploited that culture of fear for their own gain.  That these witch hunters begin by targeting social outsiders, and rely on the common persons' tendency to want to fit in - to conform - to support their purge.  Ultimately, the common person is cowed into conformity (and consequently hypocrisy), because they fear for what they stand to lose if they challenge what over time becomes the new status quo.  These situations call for heros - for uncommonly brave individuals to stand against this tide.

One of our examples is Ed Murrow's crusade against Joe McCarthy in the film 'Good Night & Good Luck' - well worth watching and extremely applicable to this topic.  What has been driven into me over these past few weeks are the words of Arthur Miller and Ed Murrow among others, as they have spoken out against the terrorizing McCarthy.  Their words have been echoing in me.  Particularly Murrow's sentiment that 'No one can terrorize a whole nation unless we are all his accomplices.'  Many of Murrow's contemporaries, including his boss, believed that McCarthy would self-destruct, and encouraged Murrow to spare himself from being 'subjected to the attentions of the junior senator from Wisconsin.'  What prompted Murrow to make his stand against McCarthy and the red scare he hid behind?  For that matter what gave Arthur Miller strength to refuse to 'name names,' placing his promising career in jeopardy?  Perhaps most bafflingly, why do individual children, in the face of their peers and sometimes their superiors, stand against violent bullies when their likely reward is more of the same?

One of the most common examples used in my students' papers is homophobia - a social pressure they feel themselves.  This unit has come to mind for me again and again as I follow the conversations about the church's most recent pathological pursuit of sexual conformity.  I am employed in an institution that is compelled to support this pathology.  The place itself is dear to my heart, as all of you know, and the people who work there are some of my closest friends and allies.

While the mainstream is coming about to accept the differences among its people (yet again), the church and its institutions remain in the grip of fear and paranoia.  These institutions will still require some brave people to stand against them, at great risk to themselves and possibly the people around them.  I cannot claim to be one of those exceptionally brave individuals; while I attended an event at O'Gara's and am writing this, you will notice that I have carefully avoided using certain words that would betray me to someone looking for dissent with a Google search.  I have struggled, pathetically at times, with the tension between the draw of safety and job security within the folds of a hypocritical church - the church deeply and secretly divided on this topic - and the desire to maintain my integrity as a person; to stand outside, exposed to scrutiny and bright light.

The lasting effects of the delay I exercise, along with my struggling colleagues, is shame.  We have been put in the position where it is impossible to be ourselves and remain in communion with our church - we are personally divided, and nothing holds us back but ourselves and our fear.  It is the same paralyzing shame experienced throughout our history, used to suppress dissent and to control.  Coming from the church, this should be no surprise.

The results of the witch hunts and red scare seem to have been a bewildered population waking from a stupor, the careers and lives of those targeted detritus around their feet.  So far the desire to be among the walking stunned has outweighed the desire to be among the martyrs of history.  But I am paying for that safety with little parts of myself, and so are many of us who are compelled to silence.  Thanks for reading.

A tirade on the ACA

The other day I had a chat with someone close to me about the Affordable Care Act.  I have been curious (dumbfounded) about the opposition for two main reasons and while I thought she and I had a positive and congenial conversation, we seemed to be speaking different languages at times - or at least getting our information from different sources.  This is not a new issue when it comes to politics - indeed it seems to me to be fundamental in understanding our severe political polarization of late.  But I decided that I could take my considerable energy about the issue and purge it with relative impunity here.  

The ACA is particularly close to me for a number of reasons, and the current public debate is particularly confusing to me given the information I have about it.  Here are my thoughts:

One - it seems to be the position of the many opposed that the bill will raise the deficit because it will increase costs.  My understanding is that we REDUCE the more expensive emergency care visits (which we currently pay indirectly) by providing people with less expensive preventive care.  We also add people to the insurance pool (through the tax or mandate).  Besides making logical sense, the non-partisan Congressional Budget Office reported that this "would yield a net reduction in federal deficits of $132 billion over the 2010-2019 period".  That some people insist that the plan would raise the deficit seems almost willfully obtuse to me.  

Two - that the main principles of the law (mandated participation in a private and competitive health care market) was a conservative position twenty years ago.  As I understand it, their plan was in opposition to the 'Hilarycare.'  

I was not able to find the Heritage Foundation report on this but plenty of others have referenced it and I have to imagine that when Clinton was pushing the government plan in the early 90s, the opposition at the time were paying attention to the alternative plan offered by Gingrich et al (sources here and here - again, not my preferred source, but the quotes are real).  While it has been well known (and criticized) that Romney created a very similar plan in Massachusetts, it seems lost on many that the plan was a widely accepted Republican platform in the 90s.  

Finally while Roberts' ruling did not permit congress to assign an economic mandate in the realm of health care, it remains plain and logical to me that the health care market is not and cannot be a self-selective market.  We talk of the freedom for someone to buy or not buy a house, to buy or not buy a car, but health care like the highways, the traffic laws, the regulations on the food we eat and plenty of other ancillary benefits we gain by being physically in this country are ours not by choice.  I cannot 'opt out' of safe drinking water or 'opt out' of benefitting from the highway system.  I cannot 'opt out' of police and military protection.  People cannot currently 'opt out' of health care!  Hospitals MUST provide emergency care!  To everyone!  This boggles my mind!  

This is an extremely personal issue to me.  When I traveled, I paid for insurance out of pocket through CDH.  Something went wrong with the paperwork and my drugs were not covered for a while - there was a chance that my coverage might have lapsed because of a mistake - CDH did not file paperwork.  While the HIPPA law of 1996 requires that group health care cover anyone with any condition, you MUST have comprehensive coverage going in - you cannot lapse for 63 days or they may deny you.    

"HIPAA imposes limits on the extent to which some group health plans can exclude health insurance for pre-existing conditions. For instance, if you've had "creditable" health insurance for 12 months, with no lapse in coverage of 63 days or more a new group health plan cannot invoke a pre-existing condition exclusion. It must cover your medical problems as soon as you enroll in the plan."  That insurance companies did this - that they have a separate deductible for mental health does not make me sympathetic to their bottom line.  The law need not protect insurance companies - they have plenty of laws (including title 2 of HIPPA) that protect them.  I could have lost coverage and no one would be required to pick me up again.  My life would have been altered fundamentally and permanently.

With this Affordable Care Act, I and anyone who 'lapsed' for whatever reason could not be denied health coverage that we want and can pay for.  No other market denies participation like health care has.  I can think of 4 close friends of mine who have been desperate to get coverage and have been denied for pathetic reasons.  They could pay for it, they were denied coverage.  When I thought I had lapsed C and I talked about moving to Sweden or Canada.  Seriously.  That was the option afforded us as the law stood.  

It is hard to keep up with the false and misleading claims about it - one is the claim that this is a 'government takeover' of health care.  there is no new government health plan that people can buy - there is no 'government run' health care other than what is already provided to government workers!  It is all private!  How in hell is this a government takeover of health care when the government is only telling people that they need private insurance!  The death panel claim is more egregious and insidious.  The actual issue (as explained by a close friend) is a standard living will document - only a doctor in a nursing home could withhold resuscitation/antibiotics for someone EVEN IF THAT WAS THEIR DIRECTIVE.  So nurses and staff were required to call an ambulance even when the person had a directive saying not to.  Why would anyone in their right mind oppose changing that?  

I cheered out loud when I heard the news about the law being upheld.  It fundamentally changed my relationship with my health care, my job, how I think about my personal choices.  C's co-workers congratulated her ON MY BEHALF.  I cannot understand opposition to this law, other than bullheaded politics.  Can someone help me out here?  How can so many be so opposed to this?  

End of screed.  Thanks for reading!  

Biopsy Results! And a full Wedding Weekend!

I'm moving a bit gingerly today, in part due to a full weekend of brunches, lunches and fun wedding times.  The wedding was beautiful - great weather, lots of great family and friends to celebrate with, and a memorable service and reception.  Maggie and Pete were happy throughout.  I was honored to have been in the party, to stand at my sister's side as she made her pledge in front of god and everyone. There are some great photos floating around on Facebook, thanks in large part to my cousin Andy Zimney - great photos Zim!

The other news of the weekend, the biopsy results!  Turns out my creatinine was high because of an 'acute cellular rejection' with some small incident of IgA nephropathy.  Of the various types of rejection, acute cellular is the least dangerous so far as I understand it.  It is also much more hopeful than a chronic failure which would be untreatable.  The nephropathy is likely a slow burn type of issue that may or may not be an issue.  It is not terribly well understood largely because it isn't often an issue.  A cellular rejection tends to slowly raise the creatinine levels as the surrounding tissues attack the transplanted kidney.  As is standard, I got a three day dose of steroids to reduce my immune system and give the transplant a chance to cozy back into my belly without being harassed by my t-cells and what not.  The steroids are not without their side-effects which added to the general excitement of the weekend.  Synthetic prednisone mimics a bodies stress response, which is what we all experience when we are under stress.  The feeling of being on a relatively high dose of prednisone is similar to being totally revved up, where it doesn't take much to start a rambling conversation or to obsess over one thing or another.  Being somewhat prone to rambling conversations and obsessions already, the effects on me were both familiar and a bit tiring.  This is the other source of my ginger movement today.

After bopping around all weekend with visits to the Abbott infusion center, dinners, the wedding and so on, this morning I've been slugging through a fog, where my body feels a bit disconnected from my brain - my self somewhere in limbo between them.  It's a bit tricky to track my thoughts enough to put down something coherent.  There's a thickness behind my ears and eyes and my muscleys are all mooshy.  On days like this it is hard for me to determine cause and effect - to suss out how much of my body is reacting to the drugs or stressful weekend of just a night of bad sleep.  Consequently, being an introspective chap, I lay about searching out how I might respond to this situation - or more simply how I think of how I'm doing.  Am I tired?  Am I reacting to steroids?  Am I coming off an emotional week where I was fairly convinced I was about to re-enter the doldrums of dialysis and waiting?  All of the above?  Maybe this is never a simple question - 'how are you doing?' - and we are only able to fake through it when our circumstances are stable for long enough to present a convincing story.

It is now Wednesday - I gave the thing a few day's space to see if anything cleared, and it has somewhat.  I'm a few days away from the steroid run and my body has somewhat settled out.  I've had a follow-up blood draw yesterday which held the creatinine low enough to keep everyone happy.  Coming off of this will take a few weeks; I remember the feeling of just starting to relax after having the second transplant (the first going so quickly), how it took months before I started to feel like a regular person in the ways it seems to count.  Normal walks through the grocery store and not anticipating taking my morning or evening drugs.  Ellie and I have a few more days at MITY before drawing another great session to a close.

Sorry this took so damn long to post - and thanks for reading!  

Biopsy!

C and I showed up at Abbott at 10:45 and I was admitted to unit 44 - a daytime unit used for overflow and short inpatient procedures.  My blood pressure was a bit high, even after I doubled my metoprolol for good measure.  So after they got an IV in and checked and rechecked BP, we got bumped in the radiology line and didn't have the procedure until 2:30 (it was scheduled for 11:30).  

C and I passed the time with conversation, some reading and a nap.  At this point I was undressed and in my hospital 'gown.'  90% of my stay was lying in a bed - doing nothing, needing to do nothing, and feeling fine.  But just wearing the clothes of the sick and lying in a bed that automatically adjusted to my movements and hearing the soft voices from the hallway was a lot to handle.  I think what got to me was the atmosphere, what the place felt like.  My caregivers were attentive and well-intentioned, but in their absence a person is almost oppressively IN a HOSPITAL without any recourse to leave.  It is this state of suspension, removed from the movement of the world, from the weather, from the normal passage of time that wore me down yesterday, along with my anticipation first of the procedure and then of the results.  The biopsy trip reminded me of what had been so inexplicably hard that first time through ten years ago.  

My Doc put the kibosh on pictures, which is too bad because as C told it, there were some neat images from the procedure.  The biopsy was an 'ultrasound guided biopsy,' which meant that a radiologist (or assistant of some kind) held the ultrasound while my Nephrologist poked in the needle.  The ultrasound is a standard thing - the same used in all ultrasounds and seen in movies - where there's the handheld bit and the grayish projection on the computer screen along with the goop that conducts the ultra sounds.  The needle used in biopsies is a real doozy.  It has a cylindrical handle with a big button on the top and a needle end about eight inches long, about the diameter of a metal coat hanger.  While it is pretty menacing, it doesn't necessarily feel like much as they numb the hell out of the belly area where they go in.

Because the transplanted kidney is in the front of me, located where you might rest your hand if you put it just inside of your pants.  The biopsy, consequently, was about two inches below my belt line.  The helper person, a female John C Riley, located the spot with the ultrasound where my doc would go in and he numbed it up with some lidocaine, which is ironically the most painful part of the process.  A short pinch and he let it set for about 2 minutes.  He then inserted the mega needle saying 'pressure is normal, pain is not.'  I did feel a bit of pressure, but the insertion was remarkable smooth.  I could feel the needle catching my skin on the way out a bit, not to mention see C's face, but I was totally numbed up and could only feel the movement.  

I have to take a brief aside here to say that my first transplant biopsy, in the spring of 2002, was thoroughly awful experience.  I was biopsied by a resident who shook, sweated and needed to make a second excursion into the barely permeable expanse of my belly.  Each journey of the needle through the layers of my abdomen were jerky and hesitant; he struggled to get the needle through and kept telling me to relax.  I'm not sure what kind of patient I was at the time, but I am grateful beyond words for the professionalism and sure hand of my current doctor.  The procedure, from cleaning to band-aid, took about five minutes.  Easy peasy.  

We now wait for the result.  It could go a few directions - everywhere from staring over to nothing changing at all.  I continue to attempt a balance regarding the impact and scope of this episode.  It brings up a lot for me and I'm working through that stuff, here mostly.  But I'm also well aware of how much worse everything could be.  My basement has some water in it after all this rain, but it's nothing compared to Duluth.  

Thanks for reading!  

Numbers

So I got the numbers and as I had expected they were about the same - 2.2, so game on biopsy!  To be honest I'm kind of excited to be able to write and post photos of the biopsy stuff.  C will be around the the procedure and I'm hoping to get some fun pictures with my Kidney Doc.  Mad Doctor stuff.  It is a grab bag of emotions for me right now - not all bad but certainly some difficult feelings in the mix.

I got lunch with my mom on Thursday - I talked to my mom about Slavoj Zizek, the Slovenian philosopher.  He's kind of a side-show youtube sensation, famous for proclamations about what toilet design can tell you about a culture.  Well he has some slightly more serious talks on the true functions of organic fruit (to comfort the buyer) and one that struck me about how in a permissive society, as we live today, in a permissive society a person feels guilt for not actualizing all of their desires - for not being everything to everyone all the time.  Old fashion guilt, he says, came from our unspoken transgressive desires, which we had purged from us in psychotherapy, or expressed in art as Aristotle would have it.  We used to feel guilty for wanting things.  Now that we can want anything, we feel guilt when we do NOT want things!  And we suffer a crisis of impotence.  We cannot possibly enact all of our desires - physically or emotionally or pragmatically so we must not be enough.  Permissiveness does not make us happier we only feel guilty for different things.

I carried on for some time on my unsuspecting mother but there was a reason and I remembered it; when I enter a health crisis this guilt or inadequate feeling dissipates - as though it were never there.  I was waxing on about the abstract benefits of a health crisis.  And it's true - in a lot of ways kidney failure was one of the best thing that happened to me.  I have clear memories of the weeks after the hospital when the world was spread out before me, new and ready, everything but my next few days stripped away.  My life was the equivalent of a near death experience in a safe clinical environment every few weeks!  At least it was in 2002.  It never took long to lose perspective and get bogged down in the stupid shit of everyday life once again (namely my insecurities and my resistance thereof).

My first reaction to hearing the high creatinine level was a kind of calm focus.  What I had to do next was clearly laid out in front of me, prioritized and simple.  And I did not have control over the outcome, which meant I couldn't do anything wrong.  That was a welcome feeling after years of my future outweighing my present.  I never once wondered why it had happened, or why it had happened to me.  I was never angry about it.  The wounds feel quantified to me; they are mine and I know them.  I wouldn't trade them for anyone else's scars or naivete.

Yet I'd still rather not go through this - especially again; it is something that given the choice I'd rather not happen to me.  My curiosity and even tracking my experience here feels like a kind of masking, intellectualizing the hurt to damped it.  I mentioned to C that I hoped I could remain productive should I be laid up again - that in 2002 when I was going on dialysis I moped about, played Civilization III and ate impressive sums of chocolate chips.  I didn't even read much.  I was attending to myself at the time but that too was a loss I did not understand, even though I felt it.  It is a challenge to plot a course among the centers of my emotional well-being.  The lessons of clarity of purpose (not dying) remain elusive to me.  Joy and suffering create meaning and it seems like it might be my turn for some of the latter.  But really, given the choice; no thanks you know?

Thanks for reading!