Extracting an Unconditional Apology

I don’t know if the exercise is really worth it, but, under certain conditions, with sufficient detachment, moral suasion, carnivore cunning and mild-mannered treachery, an unconditional apology can be extracted, even from a doctor or a lawyer.

The nephrologist had her receptionist call me after I sent her a summary of my recent attempts to get the update she’d promised on my recent biopsy.   This neutral summary was what lawyers call “making a record”.  Making a record is done to prepare the grounds for argument in the legal case– anything you write, like a memo, could be used as evidence.  

It’s like Trump’s lawyer Marc Kasowitz making a record that there is no evidence whatsoever that the president ever used anything beyond precatory, non-legally binding, aspirational language, when he had FBI-director Comey alone in a room and expressed his hope  that Comey would dummy up about Flynn [1] and lay off the investigation into the good guy’s possible problematic entanglements.  Therefore, as a matter of law, based on the explicitly precatory language all parties agree was used, no direct order was given and therefore there can be no obstruction of justice.  Plus, of course, Kasowitz added, although nothing he said implicated his client in anything, Comey was lying his ass off under oath while the president is always truthful.

My note to the nephrologist, which became part of my permanent medical record at the hospital once I hit ‘send’, presented the facts without editorial comment, but in a pretty dim light for the nephrologist.  Her actions did look pretty bad laid out end to end, the lack of communication was clearly one-sided.  It would look pretty bad to any department chair reading it by the time I ended asking  “am I missing something?” and signed it Eliot.   I also called the Patient Advocate at the hospital to express my concerns and find out why nobody was forwarding the medical records I’d requested.  

The nephrologist’s receptionist called me few moments later, to tell me the doctor herself would be calling me and that they would be forwarding the medical records I’d requested.  A short time later the receptionist called back to ask me to hold while she connected me to the doctor.  This transfer took just under two full minutes, which, while annoying, was not comparable in its effect to her previous behavior and attitude.  She began to remedy that as soon as she picked up the phone.   After a moment of silence she asked what I wanted.  

“I want the update on what the biopsy showed about the progression of my kidney disease,” I said, and things went quickly downhill from there.   I was soon told that I have unreasonable expectations, am a very nervous patient, smart but also nervous and with unreasonable expectations.   I told her I expect people to do what they promise to do — until I learn what it is unreasonable to expect from a particular individual.   I stop expecting what experience teaches me to stop expecting.  I disputed that I have unreasonable expectations, took exception every time she mentioned it, but since it came up several times, it got me to wondering about the phrase.  

There were several attempted if-pologies (tip of the tam o’shanter to Harry Shearer) for how I apparently felt as a result of our mutual miscommunication.  I rejected each of these pseudo-apologies forcefully, explained what was objectionable about such false, conditional, self-serving apologies.  She was not taking responsibility for her actions and inactions, she wasn’t apologizing for how those actions and inactions effected me, she was apologizing about my unreasonable expectations, fears, excessive nervousness that made me see monsters where there were only puppy dogs and kittens.  (detailed anatomy of an if-pology here)

In the end, seeing the folly of having a conversation with such a desperately defensive person, and sick of having to raise my voice to cut in whenever she cut me off and talked over me, I told her she was a good person and wished her a good day.  Then I took a few deep breaths, muttered politically poisonous words that should not be printed, took a few more breaths and called the kind woman at Patient Relations at the hospital.

I thanked her for her earlier kindness and gave her a report of what had happened since she made her call to the nephrology department.   When I reported to her that the doctor told me that I had “unreasonable expectations” and was a “very nervous patient” Joann seemed genuinely offended that a doctor would say those things to a patient she’d been ignoring.  I asked Joann for the only actions I could think of — to inquire about a waiver of my $237 out-of-pocket payment for my next office visit and a recommendation for a less combative in-network nephrologist.  (Thank God I have Obamacare, Romneycare, Patient Protection and Affordable Private Corporate Health Insurance Out of Pocket Deductible Care, Lobbyistcare,  VultureCapitalistcare, HealthInsuranceandPharmaceuticalindustrycare,  Corporatepsychopathcare, is all I can say.  Can you imagine how prohibitively expensive and stressful the visit might be without health insurance?)

I then spent the next few minutes trying to figure out how not to seethe.  I went to the post office.  Not generally the best cure for a need to seethe, but today at 4:00 the place was virtually empty.  I joked with the guy behind the window and we both had a few laughs.  The guy at the next window got in on it, and another patron did too.  We were all laughing together on a Friday afternoon.  All the sweeter that we were like the United Nations, representatives of four continents.

The guy helping me, the representative of Asia, was gone for a long time, came back with my stamps then stood there, looking down, seemingly texting for a long time, while I stood there waiting to pay him for the stamps that were right next to him.   I watched him bemusedly, as he regarded his phone with a pleasant smile, tapped away, seemingly got a funny text in response, paused to savor it, tapped his reply.  It went on for a few minutes. I just looked at him, somewhat in awe.  Then he asked for my credit card, which I gave him.  When he handed me back the card I asked if I needed to swipe it.  He smiled, shook his head and held up the small device that he’d been tapping into.  I started to laugh.

“Oh, man,” I said to him “that whole time I thought you were texting.” He laughed. 

“No, really, I was fascinated, I was admiring how brazen you were, how you seemed to be taking your time, really enjoying each text that was coming back from your friend.  I figured you were typing ‘place is empty, one hour to weekend, one asshole customer waiting, just standing there, not doing anything, blank face, stupid expression, LOL!'”

We had a last yuk and I headed back up the hill to my apartment, 40 U.S. stamps and 2 stamps good for Europe in my shirt pocket.  Plan to drop a note to Macron, just to tell him his name is hilarious and ridiculous.

I sat down and watched the mirthful, merciless late night comedians on youTube, all of them with millions of hits, slowly turning POTUS over a slow fire, slathering on the barbecue sauce (for all the good any of it does). I was finally beginning to feel a little relaxed, after more than a week’s escalating, endless battle with a stubborn jackass of a nephrologist.  My phone rang.  

It was the nephrologist, she felt terrible, she’s not that kind of person, not malicious.  

“I never said you were malicious.  I don’t think you’re malicious.”  

“I’m calling to tell you I feel terrible about our conversation.  I don’t sleep at night after a conversation like that, I’m not that kind of person, I do feel very bad about our miscommunication.”  

“Don’t feel bad about that,” I said, ” it wasn’t really ‘our miscommunication’ anyway.  If you want to feel bad about something, feel bad about not doing the empathetic thing, the thing you’d want me to do if our places were reversed.  Feel bad about telling me I have ‘unreasonable expectations’ and that I’m a ‘very nervous patient.'”  

“I never said you had unreasonable expectations and  I don’t say nervous in a bad way, I’m very nervous myself…” she said quickly and with utter conviction.

“You repeated several times that I have unreasonable expectations for expecting to hear back on test results, but I don’t even care about that right now.  If you want to apologize, at least know what you did that you should feel bad about, what you’re actually apologizing for.”  

“I apologize if you feel that I was neglectful of…”  she began.

“No,” I said, “I don’t accept your conditional apology,  forget it.  You cannot apologize  for how I may have felt.  You can only apologize for what you did.  It’s no apology if you condition being sorry on what I may or may not have subjectively felt.”

“You apologize for what you did, that you understand now was wrong.  ‘My actions hurt you.  I was wrong.  I am sorry that I hurt you.’ “

“It’s no apology to say I’m sorry if you were hurt.  You have to acknowledge that what you did was hurtful, would have hurt you too, or anyone else.  That there was nothing unreasonable about being hurt by the hurtful thing I am so sorry I did to you.  Then you have to promise to try hard not to do it again.  That’s an apology.”

“I apologize without conditions,” she said.  

I thanked her for that, and happily accepted her apology, although with conditions.

God must have been smiling down on me in that moment, for the call from her cell phone dropped, she texted that I had suddenly stopped talking, that we seemed to have lost connection.   I texted back that she must have gone out of range, I was still sitting at my desk.  I ended thanking her for the call, and the apology, and wishing her a good weekend.

But do I really?

 

[1]  The greatest accomplishment of Flynn’s military career was revolutionizing the way that the clandestine arm of the military, the Joint Special Operations Command (jsoc), undertook the killing and capture of suspected terrorists and insurgents in war zones. Stanley McChrystal, Flynn’s mentor, had tapped him for the job.  source

 

 

 

 

American healers

The first example is a veterinarian with a thriving West Village practice.   He informed us last week that, sadly, the second set of blood tests confirms that the cat has a terminal kidney condition.   We can hope to extend his life, have him around a bit longer, he said, if we learn to give him subcutaneous hydration and do it daily.  

We immediately make plans to visit his office, to learn how to apply this liquid through a line and a needle  under the flexible skin and fur on his back. We also have a few questions for the vet.  A young technician gives us the demo.   The doctor does not so much as stick his head in the room, nor does his colleague, another vet who sent some interactive and empathetic emails to Sekhnet.

The following day at home Sekhnet expertly applies the needle, I wrangle the cat, run the line, squeeze the bag to hasten the flow of the liquid.   The Baron tolerates it reasonably well.   I wind up emailing my questions to the vet.

One is about stopping the fight to give him a hated, foul tasting phosphorous binder by syringe forced into his mouth.   Although it’s a primary weapon in slowing feline kidney deterioration, it makes the Baron furious and bitter and we’ve decided to stop forcing it on him.   I ask about an alternative powder form we may be able to mix into his wet food or treats somehow.   I also ask how far along the downward slope of the chronic, deadly disease Skaynes is, in terms of kidney function now vs. end stage kidney function.  I express our disappointment at not having been given a moment to bounce these things off him in person when we were at his office to see him the other day.

He writes, helpfully and sympathetically:

He does have what is termed chronic renal failure, meaning he.s losing his ability to filter and eliminate fluid waste, conserve water and control electrolytes.  It does tend to be progressive at a very individual rate.  They can be around for six months to a couple years, is my experience.  His blood pressure result was 165, which is normal.  He should get the low protein diet daily, with fluids.  I.m not crazy about the aluminum hydroxide either.  If he is becoming intolerant, then I say stop it.  Try the epakitin and we.ll check his blood again in three months.

Then, addressing my human concern, as a human who just brought a fatally ill animal he loves to a doctor for beloved animals and was disappointed not to get a moment of the doctor’s time:

I usually have technicians provide fluid demos and do blood pressures.  Let me know in the future if you have concerns I specifically need to address.

I can read this now, four or five days later, in a neutral light.   He is telling me his ordinary procedure for these demos and letting me know that in the future I should not hesitate to make my concerns known to him if they were not addressed by his technician.  He was probably taking care of his day’s correspondence and didn’t pause to realize he was writing this to a person with all the concerns of someone bringing a dying long-time pet to the doctor (plus, unbeknownst to the vet, anxious about impending news on his own kidney disease).  In a better world, where he would have had the time and sensitivity to look over the email before sending, he could have done much better.  Reading it now, I hardly see what infuriated me so much when I first got his reply.

At the time I got it, ten minutes after I wrote him, it hit me like poison.   I read his email shortly after the first time we gave the Baron the fluids, and I decided we were done torturing him by forcing the aluminum hydroxide down his snarling mouth.  I read the vet’s last lines as:  you should have told me if you had concerns, not really my fault, kind of your’s, that you didn’t get to express your worries to me.   Kind of odd for a person who had specific questions while he was in my office, to be whining about not asking them a day later.

It was a slap in the face, piss down the back of my leg, a knee in the privacy (as a kid in Harlem once said).   I felt, in light of my deep surge of righteous indignation, that I’d been admirably restrained in writing an email that, in the cooler light of a fresh read a few days later, I’m glad I didn’t send.  I wrote:

Thanks for this update.  Glad to hear his blood pressure was normal.   We’re discontinuing aluminum hydroxide and ordering Epakitin.

As far as your last sentence, why would somebody bringing a beloved pet with a recent diagnosis of a fatal disease need to alert the vet to having concerns?  In your experience, is there anybody in that situation who does not have at least a couple of concerns?

An apology, no matter how mild, for not giving us a minute or two the other day, would have worked a lot better than citing your usual policy of having technicians conduct the demo in how to prolong a chronically ill cat’s life.

Eliot

I would have been within my rights, perhaps, but I’d be making things snide with a busy, caring vet who arguably hadn’t written the most sensitive sentence he could have come up with to address our feelings.  Assuming he was even capable of writing a more compassionate sentence.   Coming up with a sentence like that is not within the repertoire of most people, even highly decorated poets of public relations struggle over perfectly calibrated expressions of professional/personal sentiment.  

My reply, though superficially polite, would have hurt the feelings of someone who most likely hadn’t meant to hurt Sekhnet’s and mine at all.  On the contrary, he’d just answered all of our questions in a reassuring tone, what the hell was I chastising him about?  It would have confused him, struck him as completely unfair, insane, even, and it would have pissed him off.  It would have done nothing good for me, Sekhnet or Skaynes either, or any of our future meetings at the vet’s office.

My friend’s father’s father collected wise little sayings that he wrote, in a meticulous hand, on small cards.  They were written in Hebrew, and the small stack of words to live by were read by my friend after his grandfather passed away.  One said: all delay is for the best.   The meaning was, if you feel you must act, it is better to pause first, to consider, to calm down, if needed, turn the planned action over in your hand another time.

 

Example Two

I caught myself this afternoon ready to punch out the fucking nephrologist.  It took very few text and email exchanges before it got out of hand and, once it did, I stopped myself from writing back.   To be sure,  I did unleash a nice, clean, snapping punch to her fucking smug, self-justifying, bureaucratic, inhumane, insecure face.  I left it in my drafts folder, it laid her on the canvas groaning.  But I did not send it.  

Flashes of her worst traits, her more hideous assertions, flew out at me unbidden all evening. She is now demanding I pay her another $237 out of pocket, and visit her office, any Friday I choose, for the results of my May 26th biopsy, results she’d started giving me over the phone last week, results she promised to phone me about as soon as they came in.

The results came in, possibly days ago, these were the only medical records so far not sent directly to me, the patient.   Then I was treated to no reply, insistence and unrepentance, all of the highest order.  Thoughts of her overbearing insecurity and shabbily slapped together legalistic attack on a patient, anxious and aggravated after 12 days (thirteen now) with no news on his kidney biopsy results, enraged me anew each time I thought of this distasteful creature’s behavior.

I have been diagnosed with a kidney disease called idiopathic membranous nephropathy.     At least I hope it’s idiopathic, meaning they don’t know the cause and it’s not secondary to some other more systemic autoimmune disease like Lupus, MS, or some kinds of cancer.  The disease is a progressive autoimmune disease that ends, if not cured first, with dialysis or a kidney transplant, or, if those options are unavailable, death.  

It is obviously important to know what stage the disease has progressed to when deciding on treatment options, most of which involve long regimens of intravenous steroids and immuno-supressant drugs, similar to the cocktails used in chemotherapy.  A biopsy is the most accurate way to determine what stage the disease is at.   So I had the biopsy, thirteen days ago.  

When this nephrologist first tested me in April, to see if I was among the approximately 33% of membranous nephropathy patients who undergo spontaneous remission, I got test results emailed to me by a corporate third party.  I contacted the doctor’s office, since the most crucial test for this disease, the ratio of creatinine and protein in the urine, had no standard range I could compare my numbers to.  The test result/billing/appointment bot suggested I call the doctor.  I did.  I called again.  I wrote.  

The last thing I wrote used “unconscionable” to describe incomprehensible test results sent by marketing/billing/medical record bots to anxious patients without medical interpretation attached.  It was, in the end, five days before she called to say, after apologizing for the terrible delay in getting back to me, that my numbers were slightly worse than in the January test.  I was not experiencing any kind of remission, the disease was progressing.  

When the numbers were retested in May she wrote preemptively to tell me she had strep, had gone to the Emergency Room, and couldn’t talk on the phone.  She promised to call with the results, as soon as she could talk on the phone.   I wished her a speedy recovery, not bothering to point out that strep had no effect on her ability to type.  Again it was five days with uninterpretable test results before I heard from her.  Again the test showed the disease was progressing.  She thanked me for my concern with her strep, in place of an apology for once again keeping me hanging for five days.  

So I had a biopsy, thirteen days ago.  This biopsy would show, I was told, exactly what stage my membranous nephropathy was at.   Based on the stage, it would be more or less urgent to begin steroid-heavy immunosuppressive treatment, the only option in American corporate medicine, immediately.  

I had a call from her as soon as she got the preliminary results, a few days after the biopsy.  There was some good news, no scarring on the kidney.  This means once the underlying disease is cured, if it’s cured, the kidneys should be as good as new.  She promised to get back to me soon with the rest of the report.  I never heard another peep from her.  On day eleven I emailed:  

It’s now eleven days since my kidney biopsy. Any news?

On day twelve I wrote: 

Twelve days with no results from my kidney biopsy.  Any idea what the delay is?  Are they growing a culture?  Your insight will be appreciated.  

After a few more hours with no insight, or anything else, from her I texted her on her cellphone, a number she’d given me to follow up on the biopsy results.   Immediately after my text she made an appointment for me, two days later, on a day I’d already told her was impossible for me to come in.  She acknowledged in a text that I was anxious and then said she truly believed we had discussed the date for the appointment she made and offered no word on the results of the biopsy.  She got very shitty when I told her to put herself in my position, waiting for this news, and getting only silence and bureaucratic non-replies.   Clearly her feelings were hurt.  She wrote:

Dear Mr. Widaen,
We had preliminary conversation about your renal biopsy result over the phone (the week of 6/29/2017) and discussed that appointment 2 weeks after biopsy would be adequate time
to receive a full result that we would discuss once you come in.
I am sorry but I do not remember that you said this Friday was not good (I remember last Friday was not good) and I truly believe we set the time to meet this Friday.
However, it is not an emergency and if this Friday is not good for you I can meet with you at your earliest convenience next week or the following week.
I understand that you are anxious but I was not able to reply immediately.
For further communication, please use my chart and you may call office to leave an urgent verbal message.
Please let me know when you would like to come for an appointment.

>I replied, insula aglow:

This is very similar to your previous replies. Last Friday was not good because it was the day of my renal biopsy, as you could probably know because you were there [this was a low blow, and an inaccurate, emotional blunder, my biopsy was actually two weeks ago Friday-ed.]. I am anxious about the results, which should come as no surprise, and it is neither professional, nor humane, to respond in this bureaucratic fashion. Imagine how you would feel in my situation, twelve days after a kidney biopsy, if you can.

Then it was her turn to be the tough guy, doubling down on the bureaucratic prerogative:

Mr. Widaen,
Your renal biopsy was on 5/26; 2 weeks after biopsy would be this coming Friday and that is what I had on my schedule.
Despite “lack of communication” I do remember about you and remember to reserve an appointment spot for you.
Again, I am sorry for assuming that you are coming this Friday and we would have a full discussion as planned.
Please let me know when you would like to come in for an appointment.

Fool me three times, go fuck yourself.  I was angry at this point.  She’d promised me a follow-up telephone call as soon as she had results.  She promised me this again when she called with the preliminary results about the lack of scarring a week earlier.   Instead, she claims to understand that I am anxious, equivocates about a “lack of communication”, corrects me on my stupid error about the date of the previous Friday, claims to have never forgotten about me, even as, coincidentally, she remembered my case immediately after my third reminder text, apologizes for an incorrect assumption, gives no further information on renal biopsy and the status of my disease and stands by her previous offer, to have me come in and pay her $237 out of pocket once again to find out what the biopsy showed.

You can picture how many new assholes my terse email response ripped in every part of this poor woman.  I, thankfully didn’t send it.  Brooded for hours longer, then finally calmed down enough to remember that you don’t win a fight with somebody like this.  This morning I sent her a secure reply:

Please send the biopsy report to my primary care doctor, so and so, here is his fax number (…) his telephone number is (….).  Thanks.

Now, with my metrocard, on to the subway to see the sights!  Up, up the motherfucking high road, pirates!

Why Can’t I Concentrate?

OK, granted, the odds of remission of my idiopathic membranous nephropathy, after months of the proposed immunosuppressive treatment, a cocktail of steroids and chemotherapy-type drugs, my nephrologist admitted the other day, are about 50%.  Versus the odds of spontaneous remission, which has not been widely studied, but which seems to be in the 30% range, according to this footnote from a recent hospital study of the disease in Spain. [1]

There is also my root canal, which began more than two months ago.  Under the temporary crown there is more discomfort than I had when I initially went to the dentist. The dentist suspects the wisdom tooth adjacent to the root canal may be the culprit, suggests it might be best if the oral surgeon pulls it before a permanent crown is fitted.

The cat, who has one kidney, had very bad lab results the other day and was retested today.  Although he’s consistently hostile to me, he’s a good cat and I’m very fond of him.  Sekhnet adores him, and he adores her.  So that’s a worry.  

A bot from the fucking New York State of Health Marketplace, where unemployed people like me are obliged to buy their mandated health insurance under Obama’s admittedly imperfect Patient Protection and Affordable Care Act, denied me the subsidy the law entitles me to, in January.  Donna Frescatore, the director of NYSOH, has a strict policy that nobody there may disclose her name. They also have no procedure for correcting their many errors, outside of a snail-paced appeals process.  I have so far overpaid, by over $1,000, the insurance premium the law says I should pay, with no end in sight, as I wait for a person with a below average IQ to call and conduct my impartial “telephone appeal” of their clear clerical error.

I have no idea why I’m so distracted lately, but I have unpaid work to get to today, so let me not dilly-dally any longer.

We went to see Amy Goodman, creator of Democracy Now!, speak at a nearby college on Friday night.   I love Amy for her integrity, courage, honest reporting and a strong facial resemblance to my beloved grandmother Yetta.  Amy spoke at The New School, one of these $50,000 a year museum-looking places for the children of a select economic class.  It was an inspiring talk.  Afterwards Sekhnet bought books for Amy to sign and when it was our turn I said “Amy, you’re an American hero,” which Amy accepted with a bland semi-smile.

We are 5% of the world’s population and have 25% of the world’s prison inmates, Amy reminded us.  I did the math in my head.  If we were an average country, we’d have about 5% of the world’s prison population.   At 25%, we have five times that, or 500% more in prison than the average country.   God bless these exceptional United States, our strictness with poor people’s morality and our innovative, corporately-operated, run-for-profit private prison system.

During the March for Science a few weeks ago, which Democracy Now! covered, Amy described a rainy, raw day.  The assembled masses shivered at the rally.   A week later, at the March for Climate Change Awareness (or whatever it was called) it was sweltering, the hottest day in DC on that date.   Amy suggested anyone calling themself a meteorologist should, any time extreme weather is encountered, mention that this is another sign of climate disruption.

They don’t harp on climate disruption in the mass media, she pointed out, because some sponsors would object.  She mentioned the rash, in recent years, of earthquakes in Oklahoma, a region that never had any.  This increased seismic instability is the direct result of hydro-fracking, a controversial and toxic method of extracting natural gas from deep in the earth.   Same deal with the “debate” over fracking, corporate sponsors are not going to stand by while somebody badmouths their lucrative product, which may, arguably, cause an earthquake here and there, in some armpit in Oklahoma where people with land are getting paid a lot of money for fracking rights.

I sat there rhetorically wondering why there is any “debate” about any of this.  Fucking pieces of shit in some board room are making a killing — only reason there’s any “controversy”.  This controversy/confusion is crafted by well-paid public relations geniuses who come up with a counter-factual narrative that is more satisfying to certain salt of the earth people who, not unreasonably, suspect that elites are fucking them.   These well-crafted stories, usually based on freedom and a sinister conspiracy by those who hate our freedom, are more satisfying to low-information types than cold scientific data and the academic and media elitists who spout it.

Inspired as I was listening to Amy speak, and reading her book afterwards, I still feel like hollering.  I lift my head and scream into the silence of cyberspace and wonder what the fucking use is of preaching to a half dozen people who wonder by this site and occasionally hit “like” or “follow” to encourage me to do the same for their silent screams.

Then I hear a sound bite from our diminutive racist Attorney General, wants to return America to the good old days when you could mass incarcerate nig… eh, bad hombres, for smoking weed.  “Good people don’t use marijuana,” said the smug little twerp a while ago, announcing his intention to return to the heyday of Nixon’s racist war on what the former president fondly referred to as “niggers”, “spics”, “kykes” and other enemy freaks who smoke pot and take other dangerous, morally degenerate drugs. 

What the fuck?  Are we really going to live through a remake of this hideous chapter from the toxic waste bin of history?  

“‘Make America Great Again,’ says right there on the hat, asshole.”

Got a lot of haters here in the Land of the Free and the Home of the Brave who think that’s just fucking ducky, sure, fuck the n-words and their unAmerican friends — and keep your damned hands off our meth and prescription opioids.  Only job in town is over at the damned privatized prison—- “lock ’em up!  lock ’em up!”

Meanwhile, people like Amy Goodman are out there being true American heroes, fighting idealistically for what we should all be fighting for– a society that values human lives more than corporate profits, no matter how “free” we can make “free trade” sound.  Of course, there’s no real money in that, is there?  Heh, Catch-22.

 

[1]   Spontaneous remission is a well known characteristic of idiopathic membranous nephropathy, but contemporary studies describing predictors of remission and long-term outcomes are lacking. We conducted a retrospective, multicenter cohort study of 328 patients with nephrotic syndrome resulting from idiopathic membranous nephropathy that initially received conservative therapy. Spontaneous remission occurred in 104 (32%) patients: proteinuria progressively declined after diagnosis until remission of disease at 14.7 +/- 11.4 months. Although spontaneous remission was more frequent with lower levels of baseline proteinuria, it also frequently occurred in patients with massive proteinuria: 26% among those with baseline proteinuria 8 to 12 g/24 h and 22% among those with proteinuria>12 g/24 h. Baseline serum creatinine and proteinuria, treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists, and a>50% decline of proteinuria from baseline during the first year of follow-up were significant independent predictors for spontaneous remission. Only six patients (5.7%) experienced a relapse of nephrotic syndrome. The incidence of death and ESRD were significantly lower among patients with spontaneous remission. In conclusion, spontaneous remission is common among patients with nephrotic syndrome resulting from membranous nephropathy and carries a favorable long-term outcome with a low incidence of relapse. A decrease in proteinuria>50% from baseline during the first year predicts spontaneous remission.

Hospital 12 de Octubre, Madrid, Spain.   source

A Good Life

“What is a good life?” is a question few people ever seriously take the time to answer.  My father never had a chance to ask it, one step ahead of countless demons every step of his life.   He spoke, every so often, about his demons, and how they drove him, without ever naming one.   He was unable to answer the question of a good life for himself, or leave me much of a clue, except by the example of his suffering.  It is a shame, although I have come to understand the reasons he was unable to ask the question.   I ask it now for both of us: what is a good life?  

One element, certainly, is being true to yourself.   Finding this true self, and serving it faithfully, is the object of long study.  Honestly addressing the feelings which must guide the inquiry is essential.   Some consider such “study” frivolous, the luxurious navel gazing of idle philosophers.  For me, addressing the question is vital to a good life.  

How is one true to oneself?    

I always think of Hillel’s famous answer first.  It is an answer I’ve tried to live by almost from the time I first heard it, when I was a boy.   Hillel was the legendary Jewish sage who lived around the time of Jesus.   Illiterate and poor until he was forty, he was uniquely qualified, among scholars, to relate to the mass of humanity.   He was renowned for his patience and kindness, and his practicality.  

A Roman, according to legend, asked Hillel to teach him the Torah while the Roman stood on one foot.  Hillel’s famously strict colleague, Shammai, had already angrily told this Roman, in answer to the same question, to fuck off.   Hillel thought for a moment and said “what is hateful to you, do not do to another person.   That is the essence of the Torah, the rest is commentary, go study it.” 

I, like the Roman in the story, admired the concise genius of this answer.  Don’t be a sadistic hypocrite.   “Love your enemy,” as Jesus was supposed to have said, seems as ridiculous to me as the miracle myth of Jesus’s mother being a virgin impregnated by God.  What is hateful to you — few things could be more clear and direct.

I know, as do you, exactly what is hateful to us.  If you hate it, don’t do it to other people.   That is a large part of being true to yourself.   You would like to live in a world where this was a universal principle, so, as the Nike ad says: just do it.  

Loving your enemies is fine for saints, but for the rest of us, not doing what we hate being done to us is probably the best we can do.  If everyone did it, how much sweeter life would be for everyone.  How can that not be part of the answer to “what is a good life?”

Do not tolerate abuse, from others, from yourself.  When you see it practiced by others, and you have the power to intervene to stop it, stop abuse.   When you realize you’re being unfair to yourself, let up.  If someone else did that to you, you’d find it hateful, so don’t do it to yourself.

Now that’s easy for a man living on other people’s coins to say, you will say, abuse is, in many situations, in most situations, perhaps, the law of the land.  It is simply another word for robust human competition, call it “abuse” if you like.  But abuse is hateful, and much different from the good sportsmanship we applaud in fair competition.  We know it when we feel abused, and, you will agree, if abuse is the law of the land, it’s a law everyone living under it would like to change. 

What is a good life?  To me, a boy who grew up in a home where rage was expressed regularly, it’s a life with as little anger and conflict as possible.   The serenity prayer is one thing, but learning to avoid conflict is indispensable.  

You can often avoid conflict in the short term by a compromise that leaves you unsatisfied, feeling you’ve got the sucker’s end of the deal.  You will avoid the immediate fight but it is not a workable long-term strategy.  Sooner or later, the unfairness of it will overboil.  

Most of us are angry about something.  There are countless reasons for it in a world run largely by the most unprincipled.   Most often anger comes from the feeling that we are being forced to eat shit.   It is natural to feel angry when you have a mouthful of something disgusting.  My father, no matter how materially successful he became, no matter how comfortably middle class his life grew, always had a mouthful of something disgusting.   This left him snarling at those he had the power to snarl at without consequences.  

A life of snarling is not, of course, without consequences. My father was unable to forgive anything.  He could not forgive others for doing hateful things, he could not forgive himself.  He died deeply regretting this attitude he admitted was seared into his soul by the time he was two. He died lamenting his lack of insight and the courage to try to change himself, for his own sake and for the sake of those he loved.  

Forgiveness is hard sometimes, but there is no substitute for it in a good life.   When someone apologizes sincerely, forgiveness is usually not hard.  Apologizing sincerely, and without conditions, is the right thing to do as soon as you know you’ve hurt someone.  But a sincere apology is sadly rare.  

Are we obliged to forgive people who tell us it is our own problem that we are easily wounded pussies?   Fuck that. No reason to get the last word, though.  Those types, once they prove themselves incapable of not being that way, are best left in the wake of your boat.  Seriously.  Fuck them.  Your life and serenity is enriched by each such sullen, defensive vampire you lose.

The loved ones we cherish are the ones we can be our true selves around.  No acting is required, no false politeness demanded.   We treat them well because they treat us well and our small kindnesses invite reciprocation.  It’s the opposite of a vicious cycle.  It’s a fairly simple arrangement, and a precious one, because it is not easy to find these kindred souls in the world.  

Love, now that I think of it, is at the center of a good life.

Doing what you love, although a luxury many people can not afford in our competitive, materialistic society, is a beautiful thing.  I have a friend who does work she truly loves, and she is a better person for it.   There are frustrations in her working life, but the work itself helps people, sometimes even saves a life, and is something she does well and loves to do.  Talk about a blessing.

If you are fortunate to have things you love to do, do them whenever you can.  It is a blessing to make yourself happy.  

Counting your blessings is also a blessing, but I have to say, in all honesty, fuck that.  

Right, dad?

Tempus Vuggin’ Fugit

A guy is playing a distorted electric guitar through a wah-wah pedal– some groovy rock and roll guitar, as the freaks used to say.  I remember doing that, over a simple three chord vamp highly conducive to every possible bluesy invention.   4-14-06 it says next to the title of the song.  Eleven years ago yesterday! Jesus, tempus really do fugit.  

I am walking up a long, steep hill from the Hudson River to a graduation party.   My mother, now dead almost seven years, was alive and I was talking to her on the phone as I walked.  It was June, sunny and humid, and I didn’t notice how hot, until I arrived at the party soaked to the skin.  My host gave me an iced drink, a mojito, maybe.  It was cold and delicious and I was dehydrated, it went down in a couple of draughts.  I had another.  I just about emptied the sun-room, walking in glistening as if just doused with a fire hose pumping sweat.   Two remained, a mother and her son.  The woman asked how I was doing.  As I began the third cold mojito it all flooded out. Talk about fire hoses.  

My mother was toward the end of her long death, my daily calls to her in Florida the highlight of her days, my visits even more so.   I’d just spent a solid month with her, every waking hour, the second two weeks in New York.  Towards the end of that month I had to take care of several court cases and an imperious young judge solemnly read me the redundant letter of the law, although I’d already done everything in anyone’s power to protect an old man from eviction, had, in fact, indefinitely put off the eighty year-old’s inevitable eviction.  

The young judge was performing for two law students he had on the bench with him, to show them what a judge’s day is like, how he conducts business.  As the law students looked on the young judge read our agreement and agreed I’d done everything anyone could have done in this case, that the stipulation was not only reasonable and well-drawn, but the terms where generous, under the circumstances of the $13,000 in rent arrears.   He refused to sign off on it, though, which is what I needed him to do so I could dash off to the NYCHA part and get out of court before it closed for the lunch recess.

“Judge, with all respect, I don’t have any other arrows here in my quiver.   The only thing APS can do for him is get him an Article 81 Guardian.  The guardianship application will stay the Housing Court proceeding until someone can place him in alternative housing.  I wish there was another plan, but he has no income, is not a U.S. citizen, owes over $13,000 in arrears.   We can’t get a grant to pay the arrears, Article 81 is, sadly, the only option.”

 

“Yet,” said the judge seriously, “you didn’t bother to ever meet with the tenant to find out what his preferences might be?”  

“Judge, again, with respect, this tenant is not a U.S. citizen and he has no income.  Technically, APS should not even be taking his case, which I should not mention on the record, except that Josh is a good man and won’t make an issue of it.   I didn’t meet him because his preferences are not at issue here.  If he said, for example, that he wants to move to Hawaii and have APS get him airfare and several months rent in Hawaii, how would I be able to do anything but what I am doing to protect his interests?”

“So, you refuse to meet with the tenant you are representing, or bother to even find out what he might want,” said the judge, for the record.

“Judge, again, how does what he wants enter this discussion?   He hasn’t paid rent in over a year and has no money.  The only way to prevent his immediate homelessness is by having APS apply for an Article 81 guardianship.  I will undoubtedly write an Order to Show Cause, maybe two, before they complete the Article 81, but when the time comes, I will do that.”   Josh nodded, told the judge the same thing.

The judge began digging through a pile of papers on his desk there on the bench.  He dug for a while, as I looked at Josh, and tried to keep my face as composed as possible.  The court room clock now read 12:20, if I didn’t wrap things up here soon I’d have to come back to court at 2 pm to adjourn my last case.

My mother was waiting for me in Queens for lunch.  I had five cases on the calendar and was done with all of them, but this case and one in the NYCHA part that could be quickly adjourned with a stip I’d sign and have the NYCHA attorney submit for us both.  I had one foot out the door as Josh and I wrapped up the stip, it was about 11:20, I was in good shape for getting to my mother in Queens by 1:15 or so to take her for lunch.  Not after an almost hour wait to have this important judge allocute the stipulation between two attorneys.

The stip Josh and I wrote could not have been improved by the most eloquent and exacting jurist.  The judge himself was not disputing that.  The agreement covered everything, the landlord was owed a tremendous and exact sum, and that, in light of the impossibility of the tenant ever paying (the only way to end a nonpayment eviction proceeding staying in the premises) a judgment of possession would issue to the landlord and a warrant of eviction would also issue forthwith, to be stayed thirty days, or maybe it was even 45 days, for APS to complete its application for the Article 81.   Everyone knew this sporting agreement meant my having to make at least one emergency application, two months from now, to stop the scheduled eviction.  

It was around 12:30 when the judge found what he was looking for, a memo from his boss.   The court officer took two copies from the judge and handed one to me and one to Josh.  The copies were so degraded it was hard to make out the words on them.   The judge struggled to read his own greyed out copy and finally found the language he read aloud.  The memo advised judges, in light of the vulnerability of tenants represented by Guardians ad Litem, particularly the crop of new GALs without legal expertise, to make sure their robe was extra long in the back.  

“To cover their asses,” I clarified to the college boy, when he raised his eyebrows quizzically.  His mother nodded, horrified but very interested in the jarring collision that was about to happen in Part A of the New York City Housing Court.

(to be continued, as tempus fucking fugit)

Memory– Vishnevitz

The surprisingly thin canvas of the large painting eventually had a triangular rip where a long nail had pierced it.  It was a framed painting that hung in the basement of our house in Queens, by a wire attached to its back.   The walls of the basement were wood, installed in vertical strips, by a guy named Hymie in the years before I had any memories.  I was told Hymie did the work, though I have no idea who Hymie was.  The painting hung on a large nail driven into the wood.  It was no doubt this nail that gouged the painting toward the end.  I may, as a teenager, have had something to do with that inadvertent rip.   

The painting had belonged to my grandmother, had hung over the couch in her living room in Kew Gardens, Queens.  When she and my grandfather moved to Miami Beach, the large painting was moved to our basement.   I remember my grandmother once smiling at the painting, already in our basement, and looking at me and saying that’s exactly what her home looked like, the painting was exactly Vishnevitz.   I  can picture that smile today.   

The painting was of a wide dirt road, surrounded by huge, lush trees.   There may have been a wagon traveling through it, I think there was.  What I remember are the lush, leafy trees, painted toward the glorious end of an early summer day.  It was an idyllic painting, an idealized homage to nature and the goodness of the universe.  I didn’t particularly care for the sentimental painting, but my grandmother clearly loved it.    Though it was painted, sold and purchased in New York, it was the best, and to my experience, only, souvenir of her home town, Vishnevitz in the Ukraine.    

The letters from Vishnevitz stopped coming some time in 1942, when Einsatzgruppen and local anti-Semites began collecting the local Jews in towns like Vishnevitz.   All I was ever told was that the letters had stopped coming, those unanswered letters stood in for the rest of the untellable story.  It would be fifty years before I stumbled on the Vishnevitz Yizkor book, on-line, page after page of narratives from survivors of the torture and destruction of the writers of those letters that stopped coming.  The details are horrible, every one of them.    

Watching Ken Burns’s documentary on the Civil War, a 1990 masterpiece, I learned of the massacres of surrendering black soldiers.   Ulysses S. Grant demanded this practice stop, that the Confederates treat black prisoners of war as both sides treated white prisoners of war.  Confederate president Jefferson Davis refused.  Grant stopped prisoner exchanges with the South.   As a result, prisons began overflowing with American prisoners on both sides.  One notorious Confederate prison camp, Andersonville, designed to hold 10,000 prisoners, soon had more than 30,000.   The commandant, a German-Swiss fellow, turned the place into an early version of Auschwitz.  More than 10,000 died of starvation and disease in a short time, the rest only wished for death. 

Ken Burns does the Ken Burns pan up a photograph of the skeletal body of a survivor of Andersonville.   Every moment of the pan is horrible.  A narrator reads an account by a southern woman.  She is sure of God’s terrible vengeance against the Confederacy for this crime of reducing humans to living skeletons.   Americans did this to Americans.  

Down that idyllic dirt road, through the lush, beautiful forest, we are just outside Vishenevitz in 1920, when Yetta, my grandmother was an idealistic, ambitious young woman.  In the war after the Russian Revolution Yetta’s family had housed cossacks, Bolshevik cossacks, men who had behaved like perfect gentlemen, according to her.  They hung blankets down the middle of the house to leave the family some privacy.  Perfect gentlemen, of course, do not rape the young women, or the older ones either, as many other cossacks were known to do.  These gentlemen cossacks were idealists, they inspired Yetta and her generation to envision a world of brotherhood among workers who threw off the yoke of oppression that keeps everyone killing each other for the war profits of a few cynical rich people.

“Why are you writing this, man?” asks a disembodied voice, possibly the driver of the wagon in the lost painting.  “Why don’t you call friends, make a plan, enjoy this bracing, sunny Sunday of your life?”    

I have no good answer, except that I saw the painting in my mind, with its triangular rip.   Through that rip the rest followed, as naturally as overturned Jewish gravestones followed the election of a presidential candidate endorsed by the Ku Klux Klan.   The founder of the Klan, a self-made millionaire who made his fortune in land speculation and slaves, was also a self-made general of undeniable military genius.   He led small bands of men against large armies and inflicted terrible damage as thirty horses were shot out from under him during the course of countless battles.   He killed 31 men in hand to hand combat and figured he came out ahead in that count of killed horses and killed men.  

“Why are you writing this, man?”  

One day the letters from Vishnevitz just stopped.

Why Do We Pay Tribute to the Baron?

A serf boy asks his father why they pay rent to the Baron.  Not only rent, says the boy, the Baron gets ninety per cent of our crops.  And I notice, says the boy, that mom sometimes goes to the Baron’s, in his carriage, and while she’s gone you’re always in a violent mood. “Why do we have to pay tribute to the Baron, who doesn’t even seem like a nice man?”

“We pay tribute to the Baron so that he will protect us from other barons,” says the father, the boy staring at the man’s clenched fists.