The Politics of Rage

I, like many Americans, spend much of my psychic energy every day trying to keep the top of my head from blowing off.   This happens when a person is placed in a psychological pressure cooker of one kind of another.  In my case the present pressure cooker, primarily, is the near impossibility of seeing a recommended doctor to treat my serious kidney disease– an eventually life-threatening difficulty I’ve been stuck in for two months now as unknown damage may or may not be occurring in a vital organ/organs.  

Solving this vexing health problem would only relieve so much stress, of course.  I would still face the many frustrations of living in a competitive pressure-cooker of a society where people are pitted against each other in a zero sum war, while ugly partisan battles rage daily and the earth itself is becoming uninhabitable due to the incomprehensible greed of a few already immensely wealthy people.  We watch problems that should be intelligently discussed and solved go unaddressed, except for the televised bickering of well-dressed two year-olds spouting talking points, talking past each other to score meaningless points with those who support them, year after year.

The result of enforced powerlessness is resignation and rage.  These things sound at first like opposite reactions, but they are not mutually exclusive, they are two sides of a coin.  You feel hopeless and resigned, you brood about why you are in the situation you are in and you feel rage.   Your rage leaves you hopeless again, but it is building in the background for the next wave.  The rage and hatred at least provide a surge of energy, a phantom feeling of some kind of power.

In my case, I find myself hating frequently deadly American Corporate Health Care and the culture of personal greed that justifies countless preventable deaths as an acceptable cost of doing supremely profitable business.   When corporate medical providers and corporate insurance companies blame each other for the medical predicament I find myself in, I turn my hatred to the corporate “person”.   I understand that this legally created person is a psychopath, it exhibits every one of the DSM’s characteristics of the psychopath.  Callous unconcern for the feelings of others, reckless disregard for the safety of others, deceitfulness, repeated lying and conniving against others for profit, incapacity to experience guilt, etc.    

I can defend my hatred with countless examples.  It doesn’t help me solve the immediate problem, avoiding death by American health care, but critically analyzing the faceless entity that is nonchalantly and impersonally trying to kill me offers momentary relief from the feeling of being sodomized.  The confirmation bias comes into play.   Every time I see another example of corporate psychopathy, and there are many, I am confirmed in my view that the practices of these poisonous institutions should be tightly regulated instead of corporations being the omnipotent rulers of the “Free Market” that is the democratic world order.   I dismiss ads by Koch Industries that tout the wonderful, creative, life-sustaining, people-friendly company they are as the work of an amoral public relations agency making a shit load of money putting a good face on the hell-bent moral equivalents of Nazis.

Here’s the larger point, though:  

We live in the stubbornly gridlocked political dysfunction of a divided nation of self-interested partisans, bigots and haters of bigots, barking past each other, each side howling catch phrases to its base.  This hideous farce is currently presided over by the personification of unearned privilege and the idiocy that is marketed to Americans as success.   This “winner” was born rich, sought endless attention, finally attained it as an abrasive, wildly popular ‘reality-TV star’, and, through an aggressive, divisive campaign narrowly won the Electoral College (designed to protect slavery from the whims of the democratic voters) and took on his dream role of the most powerful man in the world.   His presidency is a symptom of the miasma of rage most Americans live in.

Everything I have said above about my hatred of the corporation can be said, in one form or another, by anyone who hates.   We do not believe anything without being able to justify it 100%.  As I can make my case against corporate psychopaths, someone who hates immigrants can make their case, someone who hates Muslims, or Jews, Blacks or homosexuals can make a case as tight as a noose.  The analysis may not be as convincing in each case, but a case is made and an undying belief confirmed.  

Trump appealed to the rage that millions and millions of white Americans feel, having been told over and over they are “privileged,” as they watch brown and yellow people, many who don’t even speak English, pushy women, transsexuals, foreign-born secret Muslim presidents, etc, moving ahead and “winning” while they are not, and worse, as they lose they are being held guilty for wrongs done long ago, wrongs they had nothing, personally, to do with.    It’s not hard to understand why many white people would be angry, watching the American Dream slipping away from them.

It’s hard to dispute that most Americans are worse off than we were a generation or two ago.  Certainly in terms of hope for a better life for the next generation.   Adjusting to that reality is maddening.  As the super-wealthy increase their wealth, the vast majority of Americans grow more economically insecure in our casino capitalist system while a government of millionaires performs disgusting theatre in a pay-to-play system that does not act in the interests of the screwed majority who voted them  into office.  

The candidates in the recent presidential elections spoke to that injustice to varying degrees.  Millions, particularly the young and most directly screwed, supported Bernie Sanders, who analyzes the situation astutely, speaks plainly and proposes humane solutions based on crucial systemic changes.   Millions who hated Trump did not bother voting for Hillary Clinton, the second most hated political brand in America, because she spoke the language of a corrupt insider, promising incremental change, the rising tide that lifts all boats, and empowering little girls to grow up to be rich, powerful women.  Trump, meanwhile, spoke nakedly to hatred and rage, making an emotional appeal to a mythical past when everyone knew their place, demonizing immigrants and angry minorities, and promising things he had no intention of delivering to suckers he correctly said would have supported him if he shot someone on Fifth Avenue.

Not all analysis is equal, of course, but the confirmation bias means we will select data that supports our thesis, ignore data that contradicts it.  Particularly, and this is worth noting again, when we are angry.  When we are angry, we feel perfectly right to be angry, there is no question abut that. Virtually everyone who voted for Trump still believes they were right to vote for him, that he is doing his level best to carry out his promise to Make America Great Again, in spite of being surrounded by traitors, liars, leakers and other cowards.  Trump is regularly throwing red meat to them, directly to their phones, confirming over and over that he is their man, working for them, no matter what.

Consider this example.   Black kid sneers at cop, or menaces him,  cop shoots black kid to death.   There is a big difference, legally and morally, if the cop felt disrespected or was in actual danger, or protecting others from imminent danger, but that is a question for a jury of one’s peers.  That is, if you can get a Grand Jury to indict a police officer who kills in the course of his duty to protect and serve.  Depending on who the jury is, we will have two very different outcomes.  

A jury of poor blacks will know other families who have lost a son to an angry cop, may have their own experience being treated badly by the police.  A jury of policeman will know other cops who have been killed because they hesitated to defend themselves with deadly force.  Conviction or acquittal, in a system based on ‘reasonable doubt’, will come down to where the trial is held and the composition of the jury.  Lawyers are paid big bucks to get the right venue for trial and pick the best jury.

That is not to say, of course, that everything is relative and depends on your point of view.  Something happened right before Michael Brown was shot to death in Ferguson, Mo.    Cop told him to “get the fuck out of the street.”  Brown may have said “back atcha, you fucking racist cunt.”  Brown may have moved menacingly toward the cop, punched him and made a violent move to reach into the car to grab the officer’s gun, as the cop said, justifying the six shots that killed the young man.   Just because we will never know exactly what happened does not change the fact that something objectively happened.  Here is one account  trying to piece together what actually happened.

If the officer had been wearing a body camera, and it had not been switched off, the entire incident could be viewed.   That video could have exonerated the policeman in short order, if the kid actually did reach into the car to grab his gun.

There will be Americans who sincerely believe that an angry black kid who curses back at a cop deserves whatever he gets.   Death sentence is fine with them.  They will be outraged that a black person would respond to “get the fuck out of the street” by cursing the cop, or making a menacing move toward him.  Unthinkable that anyone could curse at a police officer,  no matter what the cop may have done to the citizen, let alone shove or punch a cop.   I suspect  Trump got the vote of virtually every American who feels that way.  

We live in a culture of systematic manipulation, driven by the profit-motive, which never sleeps.  It is no surprise that the most toxic notions in the world are routinely sold here in America.  Millions here believe “Climate Change” is a hoax dreamed up by prosperity-hating commies like propagandist Al Gore.  No amount of evidence can change a view that is baked in and confirmed by everyone they trust.

A psychopath has no limitations on what he will say or do to get his way. That’s the liberating beauty of being a psychopath, or a corporation, for that matter.  If you truly have no regard for others, outside of taking their money, and no shame, you have a great advantage in a society that teaches there is only one measure of success:  unlimited fame and vast fortune.  

As for me, I continue to try not to let my powerlessness and hatred destroy me, and to keep the top of my head from blowing off.

Shame-based orientation

Shame is a killer.   It can turn an abused person into a violent criminal, a tortured neurotic, or both.   Shame spins a web of secrecy, to be guarded tenaciously.  My father fought shame his entire life, the shame of growing up in “grinding poverty”, the shame of being whipped in the face by his religious mother from the time he could stand.  Any other shames thrown in there on top of those were just gravy.  He would not, could not, consider opening the door to examine this deep shame, possibly find some relief from it.   As a result, he lived as the “Dreaded Unit”, bullying his wife and children, and died with many regrets he only got to confess due to chance.  

“I did what I thought I had to do.  I wish I’d had the insight to understand how fucked up that was, how much richer my life, and your lives, could have been if I’d only had some fucking insight, some fucking courage,” he concluded tragically on the last night of his life. 

Two people subjected to the same shame may have different responses.  One response, like my father’s, is never to speak of shame, to angrily attack others whenever they get close to the source of your shame.   It is a response that leads to a defensive, sadly circumscribed emotional life.   You are constantly wary, blame yourself for being ashamed, which increases the shame.  

Another reaction is to understand that what was done to you, the thing that causes you shame, was not your fault.   This was portrayed beautifully in the movie Good Will Hunting, when Robin Williams as the psychiatrist, tells Will, during a breakthrough moment in therapy, that Will’s shame is not Will’s fault. He hammers gently at the tough kid, saying it over and over, “it’s not your fault”, until the boy breaks down in the shrink’s arms.   The truth of this kind of moment, Hollywood screenwriting aside, is hard to dismiss.  

My father’s shame about being whipped in the face was truly not his fault. He was powerless, at two and three, to do anything but endure it.  The shame was his mother’s, not his.  He was too terrified to go near the subject, so he tried to act like the toughest man in the world and lost much of the richness that could have been in his life.

Shame is generally imposed by somebody else, it is almost never the result of a conscious act of our own.  Shame is deeply scarring, traumatic, it is not the same as regret for a mistake we have made, a misguided action we feel badly about.  We may feel ashamed of ourselves, but that is not the same as shame that is imposed on us.

A young woman is swept off her feet by a handsome, charming, athletic older man.  He tells her he is separated from his wife.  They begin a love affair.  It turns out he was possibly not separated, but really, really wished he was.   He eventually gets a divorce and they marry.   He impresses her with how large he lives, unlike her frugal father, this man will casually leave a $50 tip in a diner if he loves the service.  

She notices he is not always truthful.  The lies begin to add up.  He didn’t lose his job due to a mistake, as he said, he’s been fired from his job for stealing from the company, as the boss, a former friend, calls to inform her.   They move to another town.  He loses his next job for something similar, announces they are broke.  

They move again, to live near their parents.  They plan to buy a house, schedule the closing, he borrows ten thousand from his father-in-law towards the downpayment.   At dinner two days later he announces that he has declared bankruptcy.  

His father dies, he takes the wallet from the bedside table and maxes out all the dead man’s credit cards.   He pretends, for over a year, to be going to work and bringing home his pay.  He leaves the house at 8:30 every morning, hangs out in strip clubs while his wife is at work and his children are at school.   He returns on payday with cash advances drawn from his dead father’s credit cards.   One of the three credit card companies eventually catches him, his wife repays a large sum of money.  

He gets another job from a friend, embezzles from the friend, is fired.  Tells his wife business has been slow and he was let go.  A call from the former friend, and a threat to press charges, makes the wife arrange to pay back the thousands her husband has stolen.   Then he is immobilized with crippling back pain, can’t get out of bed, suffers on oxycodone for three or four years.

Through this all, the woman keeps everything mostly to herself.   She is frequently angry, as anyone would be, but her children must never know the reason, it would cause them all shame.  She is ashamed, on one level, to have married a person so lacking in character.  How badly does the choice reflect on her? she wonders.  

On the other hand, he is a keen student of her psychological weakness, nobody understands her better or is better able to reassure her.   He is calm where she is wracked with worry.   Their children know they can count on her, but are drawn to their loving, always accepting father.   He is playful and affectionate and never blames anyone while, mom, as they all know, can be critical.    

I watch this unfold and ask how it is possible to live with a demanding husband (he still yells downstairs to find out what is holding up his dinner) who hasn’t worked for years, with a storied history of lying, criminal activity, road rage and many speeding tickets, “borrowing” money from friends and family he never repays, manipulating, never apologizing,  someone who threatened to kill the kids, her parents, and both of them…    

“He only did that once,” she protests.

And someone who fucked every willing skank that moved.  

“He never did that!  If he ever did that I’d leave him in a second!”  

Well, as you said once when I asked how he was doing “how would I know?” I say to you– how would you know?  He does have a long and impressive history as a manipulator and liar. 

The thing about shame is how insidiously it replicates itself.  The children grow up watching mom frequently enraged at dad, the most laid back man in the world.  Dad throws up the palms of his hands and says “well, you know, mom has a hard time forgiving anyone who isn’t perfect.  I may have made a few mistakes, but you know mom…”   The kids know this is sometimes true, mom can be a hard-ass.  

The sensitive kid wonders about this far too simple explanation, something is intuitively wrong with this glib over-simplification.  The mother worries about the daughter’s road rage, occasional bad choices, the son’s dark moods.  But shame ensures that the shameful truth must never come to light.  

It makes me want to cry.

Informed Consent

We live in an imperfect world, a point that needs no belaboring.  We like to believe that Reason governs human affairs, but most often we can trace the behavior of societies, groups and individuals, to fear, hatred, hopelessness, greed and other mostly non-rational impulses.  The great democracy we live in, for example, is currently presided over by a person who is not a clown as much as a menace.  He was put into office by the galvanized forces of fear, hatred, hopelessness and greed.  He cannot seem to control his impulse to lie.  Here’s Amy on a recent presidential lie the White House just admitted was a lie.  

You can go mad watching the news, dominated by this stubborn attention seeker, unless you believe, as up to 33% of our voting populace seems to, that we live in a time when minorities and poor people are completely out of control, rich job creators are being tortured by our government, the media lies constantly and that only good old fashioned law and order can “Make America Great Again.”  

Going mad is not the best option, at least not as far as I can see.  I’ve made it my daily practice to try not to go mad, no matter how tempting it may be to go there.   One form of this daily practice is writing, in detail, to make whatever I am dealing with as clear as possible, to myself and to anyone reading.  

Transparency, and its deliberate denial, has long been a big issue with me.  It comes from a childhood where blame was shifted on to the children for the problems of adults.  Perhaps my father was incapable of answering my anguished question about what happened to grandma and pop’s twelve siblings (shot in the neck in a ravine, as it turned out) but it was wrong of him to blame me for being anxious about it.   If Reason is to guide us in trying to live reasonable lives, we have to have the information we need to consider things fully and make reasoned choices.  

We have that great phrase from the Author of Liberty, about ideal government: “deriving their just powers from the consent of the governed.” That has been changed slightly in practice, if not rhetorically.  A more accurate statement in 2017 would be “deriving their indisputable powers from the acquiescence of the systematically manipulated.”   Our elections are decided by a plurality of voters casting votes after watching fantastically expensive advertising campaigns.  The winning product is the one with the most effective attack ads on the rival product.  The government that results from this process hardly amounts to one ‘deriving its just powers from the consent of the governed’.  

It is a mark of patriarchy to rest on its right to simply be right.  No discussion is required, if one party has all the power and the other party has none, when the powerful party declares “because I said so.”  You cannot give informed consent if you are not informed.  There is nothing mysterious about this formula.  

As in the larger society, so it goes in individual interactions. If patriarchy is the final word, from top to bottom, and you have a problem with that, you are the one with the problem.   The impulse to be right is a powerful one, and we are all conditioned to argue that we are right whenever we feel challenged.   There is a more merciful orientation, true, and the world would be better if more people operated under it, but that is not the problem of patriarchs.

I called the National Kidney Foundation’s helpline.  Marjorie was great, though, in her own words, not very knowledgable about anything but the basics.  She’d never heard of my idiopathic kidney disease, for example.  She was pleasantly surprised to learn that up to 40% experience a spontaneous remission from this disease of unknown cause.   She told me that most nephrologists, going by what she hears every day, are arrogant jerks.  She said the profession apparently attracts these types.  I told her my experience did not contradict this.  

Here is my problem with the insecure, defensive, arrogant jerk who was treating me, until two months ago.  She did not feel the need to answer questions, was dismissive, manipulative, untruthful, incapable of sincere apology.   Aside from those things, which tend to increase a patient’s stress level, I’m sure she is an excellent doctor.  My biggest problem, now that I have learned much more about this disease and proposed treatments, is her refusal to give me the information I needed to make an informed choice about a side effect-rich course of IV steroids and toxic agents designed to shut down my immune system.  This therapy is recommended only for high risk patients, all others are treated with supportive therapy and counseled about diet and exercise and watched for signs the disease has progressed or begun to wane.

I wrote this, earlier, to send to this gender-neutral asshole nephrologist, for my physician friend’s feedback:

You seem to have concluded that I am a high risk idiopathic membranous nephropathy patient and that therefore immediate immunosuppressive therapy is necessary.   I’d appreciate if you could set out the factors you considered to determine that I am in this high risk category, as these were not explained to me in any detail.

Thank you

Full transparency, which would have called for a “Fuck you” instead of “Thank you” at the end, must sometimes be sacrificed for the greater good.  In this case, I need to know what tests and other factors she considered, in the absence of the standard 24-hour urine test, to determine that I need to begin a chemotherapy regime immediately. 

We all tend to phrase things in terms of our own concerns.  I don’t mean to keep harping about my kidney disease, although it is on my mind.  It serves as a perfect metaphor for many killing situations that are just part of the status quo in our competitive, materialistic USA! USA!!!   If you are not afflicted by a serious disease, the many problems of Obamacare, the calls for its repeal, are abstractions, troubling though they may also be.  If you are unable to get treatment from any of the highly recommended nephrologists you’ve been referred to, doctors allegedly in your insurance network, you are, as they say: fucked. 

What a mensch would do

There are few far too few mensches in the world, unfortunately.  A mensch will go out of his or her way to do the right thing.   A mensch listens to the whole story before putting their two cents in.  A mensch is patient, gives the benefit of the doubt.  A mensch is fair, and humble and doesn’t take advantage of people.  A mensch will not fight unless there is no reasonable alternative.  Like I say, mensches are rare, sadly.   Much more prevalent, particularly in a competitive, hierarchic, materialistic society like ours, are the dickheads, douchebags and motherfuckers, the winners who wake up every day ready to kick some ass.   Just look at the front page of any newspaper, you will see photos of an impressive collection of these types.  It is rare to see a mensch as a captain of industry or in any position of great power.

I mention the lack of mensches, and Hillel’s idea that in a land where there are no mensches, it is even more important to act like a mensch, as a backdrop to the following story.  If there was a mensch involved in the medical office I am going to describe, they could have done things much differently, much better, in a much more healthy way for all involved, particularly the patient. 

I was diagnosed with a serious kidney disease during the annual renewal period for Obamacare.   In light of this diagnosis, I decided to change insurance, pay many times more than I paid in 2016, in hopes of getting better medical coverage than I had last year.   The results have been mixed, though I am paying, literally, more than ten times what I paid last year for health insurance.  It’s an irrelevant detail for purposes of the following story, though, it annoys the shit out of me, so I mention it.    

In April, having been diagnosed with this disease four months earlier, I visited a nephrologist I’d contacted off a list given to me by a friend, who got the list from an acquaintance at a hospital.  This nephrologist had been the second or third I called, the first, I remember, only dealt with end-stage kidney patients, and I hopefully have a few years to go before that.  

The doctor seemed bright and personable.  I liked her.  The doctor had a hammer.   The only thing, she told me, that medical science has to cure my disease is immunosuppressive therapy, which comes in six month, twelve month and single injection form (though insurance doesn’t cover the very expensive one shot deal).  Some people, she assured me, have very mild side effects from the back to back to back infusions of steroids and the other chemicals designed to temporarily shut down the body’s ability to fight disease.  

They control for the suppressed immune system, inoculate you against the worst diseases you’re likely to get when the body’s natural defenses are suppressed.   For some reason, I was uncomfortable with this, particularly when the doctor explained it as an atom bomb or shotgun approach that temporarily takes out the whole broken immune system and, more often than not, fixes the problem when the system comes back on line.  A cure percentage was not available to the doctor.  When pressed she said it was closer to 50% than to 90%.   

My disease is idiopathic, which means the cause is unknown.   I needed more information.  I’d heard, for example, and the nephrologist confirmed, that 1/3 of patients who get this idiopathic disease have a spontaneous remission within the first year or two.  The disease, in other words, disappears by itself, as unexplainably as it appeared.

 The doctor, having only a hammer, told me I was wasting my time trying to get answers to all these questions and that hoping for remission was a crap shoot that could do permanent damage to my kidneys.   I was hung up on the fact that the disease was idiopathic, she said.  She tried to convince me that it was not idiopathic, because they knew so much about its progression and how to cure it.  She described the cure again, in great detail.  

At the end of her long presentation about her hammer I told her that since science doesn’t know what causes this membrane to grow on the filters of the kidney that, whatever they knew about a way to cure it sometimes, by definition the disease was still idiopathic.  She didn’t like the way I’d seemingly ignored her presentation of the cure.    

The doctor retested me, five or six weeks after our first meeting.  The test would confirm what the January and April tests had– I have a blood marker, some kind of antigen or something that comes up 99.9% in patients with my kidney disease, and only in the blood work of such patients.  

Still, though the test might well show that the disease was still progressing (and the retest would show it was),  I hesitated to commit to six months of immunosuppressive therapy, which she was urging me to start immediately. We had another discussion during that second visit, virtually identical to the first.   She dismissed the idea that diet, exercise, life-style changes could have any effect on the disease or improve my chances of remission without the chemotherapy.  She told me I’d be wasting time and money going to see a nutritionist or naturopath.   She had no studies to point me to.   At this point, realizing this was all she knew, and that my many questions could never be answered by her,  I probably should have thanked her and gone to see another doctor.  

Instead, I allowed her to convince me to have a kidney biopsy.   She explained to me in detail that a biopsy is the only way to know how long I’ve had the disease.  In an early stage, the tissue sample will show tiny dots, like pinpricks, of membrane.  As the disease progresses these dots become larger and larger and begin to grow on top of each other.  Eventually, toward the stage where you begin to have serious decrease in kidney function and are headed toward dialysis or a kidney transplant, the membrane is a thick coating over the nephrons.  By staging the disease, she told me, we would know exactly how urgent it was for me to begin immunosuppressive therapy, medical science’s only present treatment.  She sent me downstairs to the lab to retest my blood and urine.

A few days before the biopsy I had a call from the lab.  The doctor had neglected to check the box to have the coagulation of my blood tested, along with the other tests.  This coagulation test was needed before any biopsy.  I made an appointment and went back to the lab I’d been to a few days earlier.  A few days after that I managed to avoid a $2,100 charge to my credit card, demanded of me the afternoon before the biopsy,  prior to the biopsy.  I avoided this charge, though my final “out of pocket” responsibility for the biopsy is well over a thousand dollars.  

It turns out the biopsy cannot tell you how long you’ve had the disease, not with any precision at all.  The biopsy is, however, necessary protocol before the immunosuppressive therapy can begin.   The doctor told me I’d misunderstood, had unreasonable expectations, was very smart but had too many questions.  I resisted telling her she was acting like a fucking bitch, but we did argue.  We argued again the next time we spoke.  She told me again that I was being unreasonable.  

Being a lawyer, by training, I began to make a record.  I sent her a message that laid out part of my case, her repeated failure to return calls to give me test results, promises she simply didn’t keep.  She called me and struck a very defensive pose, which is to be expected.  She explained that she works at four different sites and rarely has a chance to check email or messages.  For my part, I was frightened and angry and not acting like a mensch, though my words in the text were very measured and I mostly kept my patience as she justified herself and explained why I was wrong.  I made my points.  The relationship between doctor and patient was now toxic and adversarial.  

She began to offer the conditional apologies Harry Shearer has helpfully styled “if-pologies”.  If you feel that I misled you about the biopsy, then I am sorry.  If you were hurt that I never responded to multiple messages and calls to my office to give you test results and that increased your anxiety, then I am sorry.  If your anxiety was increased by misunderstandings or miscommunications, then I am sorry.  I corrected her each time as to the form of these non-apologies, but it was a very wearying exercise.

After a few more defensive, blame-shifting ifpologies, I felt ready to punch her out.  I managed to summon the last of my cool, thanked her for calling, told her I was sure she was a very nice person but that I had to get off the phone.  My head was ready to explode, but I felt I had done pretty well under the circumstances.    

A few hours later, early Friday evening, when I’d finally calmed down, I had another call from the doctor.  She told me how upset our previous call had made her, how much I’d hurt her feelings by calling her a malicious person, etc.  I suppose one could call this playing the woman card.  It worked a little bit, I explained quietly that I had never called her malicious nor did I believe she was a malicious person.  Overworked, defensive, a bit dismissive and argumentative perhaps, but not malicious.  I told her I believe she is a good doctor.  It was truly a pointless call, although hopefully it made her feel a little better.  Her “unconditional apology” at the end was meaningless.

I went online and cancelled the appointment the doctor had made for me, without consulting me, on the Friday before my birthday.   During this appointment we would presumably discuss the biopsy and set up the immunosuppressive therapy. I’d already told her I was unavailable that day, but it was, in her words, another misunderstanding.  

I sent a message asking her to send my biopsy report to my general practitioner.  When I heard nothing back I followed up 24 hours later with a call to the Patient Advocate and was promised they would send it right away.   My doctor read the biopsy report and confirmed there was nothing conclusive about staging, though it did show very little scarring to the nephrons, indicating it had not yet progressed to the point it was doing any permanent kidney damage.  

Sekhnet got me a referral to a very experienced nephrologist from her beloved doctor of more than 40 years.  We highly value this wonderful doctor’s advice and I was looking forward to a second opinion from a nephrologist who could answer some of my questions and refer me to recent research on the efficacy of the treatment I was being pressured into beginning right away.  I want to make a fully informed decision before allowing them to pump steroids into my veins the first three days of every other month, while I sit with other chemotherapy patients.  

My bills for two visits to this nephrologist, blood and urine tests, and the biopsy are close to $2,000.  Good news for me, in a way, because once I rack up $2,000 out-of-pocket my insurance will kick in and begin to pay part of my future medical bills.  When I mentioned the expense to the nephrologist she told me she had nothing to do with the billing, had no idea an initial visit to her was billed at $860.  I made some snide comment about corporate medicine and she promised to look into getting me some reduction on my bill.  It was a promise made in good faith, and, naturally, never followed up.

Anyway, to the issue of menschlichkeit I promised at the top.   When I called to make an appointment with the new, highly recommended nephrologist I was told that, since he was, as luck would have it, in the same practice group as the first nephrologist, that the two doctors would have to agree that I could see the highly recommended one, since I’d already been a patient of the first.  The mentor, I was told, had to have permission from his protégé and would have to agree to see me.   I wrote to the first nephrologist asking her to expedite the switch so that I could continue my treatment.  The following day she wrote back:  I have instructed my front desk staff.  That was on June 22, almost a month after the kidney biopsy.   

Each time I called after that to make the appointment I was told I’d need to be called back.  Each time I received no call back.  On July 13 I finally had a call from the office manager, only two days after the most recently promised call back.  She told me it was an apparently inviolable office policy, that no doctor in the practice group would see anyone who had seen another doctor in the group, under any circumstances.  

She brushed off my comments about the unethical three week wait to deliver this news, if the policy was indeed inviolable the first time I called, while I’d been trying in the meantime to make an appointment and being told each time that the doctors hadn’t yet discussed it.  She offered to refer me to other nephrologists outside the group, and wished me the best of luck.  I resisted telling her to fuck herself as I said goodbye.

My reaction was rage.  I wrote a letter accusing the doctor I’d been referred to of being unethical.  I figured to run it up the food chain at the corporation he worked at, pressure him into doing the right thing.  It was a stupid idea, although my doctor endorsed it, in fact, recommended it.  I was talked out of  sending the letter.  

I thought of the belligerent retarded man I’d represented years earlier in Housing Court.  He stood on his right to smoke crack, play loud music and bring prostitutes to the room in the nursing home he’d inherited a right to when his mother, who he apparently helped care for, died.   He was angry every time we were in court, left me angry phone messages, sometimes several in a row, between court appearances.  When I finally settled his case, with no admission of wrongdoing on his part, and preventing his eviction, the judge congratulated me.  

A few days later I had a complaint forwarded to me by the First Department’s Attorney Disciplinary Committee.  The letter gave me two weeks to respond in full to the charges or face a disciplinary hearing and possible sanctions including the suspension of my license to practice law.   I read the complaint thoroughly.   It had my name spelled right.  My office address was given as the Bronx Housing Court.  The box for the complaint was entirely blank.  I spent four hours composing the letter defending my professional name against a blank complaint.  I eventually had a letter back from the First Department dismissing the blank complaint against me.  

I figured there has to be a similar procedure to make a complaint against an unethical doctor.  I have no idea if there is.  And anyway, I was urged, more important for me, as a man with a serious kidney disease, to find a new nephrologist in the phonebook than to fight these unaccountable, defensive, reflexively united, never at fault pricks.  

Here’s where somebody being a mensch comes in.  If the original nephrologist was a mensch she could easily have reached out to me by phone or message.  She could acknowledge that things were not going smoothly between us and persuade her colleague to see me, even if only for a single second opinion visit. To her mind, this would be an admission of defeat, of having proceeded badly with a patient.  She has established that she is not much of a mensch.   Like I say, the mensch is a rarity.

What of the doctor highly recommended by his older, highly respected mensch colleague?  How difficult would it have been for him, out of respect for this colleague, if for no other reason, to have contacted me and asked me what the problem was?  

Too much trouble, much easier to have the office manager call me back, after weeks of misleading delay, and wish me luck with some new doctors.  I researched this senior nephrologist online and found only one comment about him from a patient.  According to the comment he did not return calls, did not provide answers to patient questions, was abrupt and dismissive.  How well he has trained his protégé!  

It is rare to find a mensch.   For years doctors routinely removed the breasts of countless women who came to them with early signs of breast cancer.  It was standard procedure at the best cancer hospitals at one time, a radical mastectomy.   It is no longer standard procedure, thankfully, as advances in science, more women in the medical field and a greater recognition of the importance of treating the entire patient, feelings included, emerge.  

In the meantime, I’m determined to have a very nice day, and to go fuck off for a while, before I compose the original letter I should have written to this apparent douchebag of a senior nephrologist.  On the off-chance, you know, that he was recommended to me by a mensch because he himself, in some hidden region of his non-reptile brain, has the repressed spark of acting like a mensch.  In any case, that unanswered letter will be a better one to send to the medical ethics committee, if such a thing exists, than either of the two previous attempts at a letter.

Take it like a man, Madam

Years ago, as a disaffected undergrad at City College in Harlem, I enrolled in a course in the Women’s Studies department.   This was around 1979 and I was the only male in the small seminar course.  The professor was a brilliant woman named Joan Kelly-Gadol.   I remember her referring to a movie or a book by the title above.  The clever and evocative phrase stuck with me, apparently.  

As a side note, Joan Kelly (who, Wikipedia informs us, began teaching at CCNY in 1956, the year of my birth) died young, of cancer while I was still a student at City College.  She was a historian and the college instituted a prize named for her, to be given annually for best research paper by an undergrad in an elective history course.  I may have been the school’s first Joan Kelly Prize recipient when my history professor, the equally brilliant Walter Struve, submitted my paper on The Nazis vs. Degenerate Art on my behalf.  I realize now I was probably the first winner, since the prize was awarded in 1982, the year of her untimely death, and my last year at City College.

“Take it like a man, Madam,” says the overbearing person doing something that should not be done.    

Should is not a word one should use,” stresses the overbearing person. “What you should do instead of sanctimoniously invoking morals and ethics, those two amorphous, infinitely flexible man-made constructs, is shut the fuck up and take it like a man, Madam.”  

Words to the wise:  take it like a man, madam, whatever it is.  Whimpering only makes it more humiliating.  If you have lived in this world any significant length of time, you will know exactly what I’m talking about.

Your Dream vs. Demons

In your dream you can get to a place in your life where you are mostly content. Everything is good, the sky, the water, the music, the company, the smell of cooking.  You are doing something you like, take pride in, have mastered, get paid a fair wage to do.   You are no longer subject to childish hurt and rage.  You have arrived in your mature form at last, relaxed, present and ready to enjoy the final chapters of your life.

It is not a crazy dream, although the individual iterations of the dream can be eccentric.  There are a hundred ways this dream can be twisted by the workings of the world, by our own spirits, by luck, by accident, by fate. There are many factors in this irrational world that are beyond our control: the constant maddening reality that things that make perfect sense are often impossible to put into practice.   This aggravating feeling pervades human affairs.  Commies wonder why everyone can’t share in the world as equals without exploitation, Reactionaries wonder why there is any controversy about the justice of the superior few exploiting their superiority to own everything.  People feel entitled to things and their bitterness when these things are denied can be without end.

I have a friend who wakes up tormented from time to time.  There is a voice in her head carping at her, a merciless voice familiar to many of us who were raised with some kind of cruelty instead of what children need.  I have another friend who recently woke up shuddering over horrors he’d seen in his sleep.   We discuss these things with each other because it gives some small measure of comfort to speak of these demons out loud to someone who listens with sympathy.

It is a great blessing to have a real friend.  Many people have not mastered the art of friendship.  Being a good friend requires a certain amount of diligence and work.  Friendship, at times, is not for the faint-hearted.  Look around at the challenges we are all up against in this brief curtain call before death.   I have friends who are in constant despair, looking at America in the age of the impulsive Twitter President, energetically serving himself and powerful, inhumane forces.  The solution of several of my friends to life’s challenges is to work hard and run pretty much non-stop, to pause is to have time to ponder, and pondering can lead to terrible thoughts.  As long as they stay productively busy they feel they are not sitting ducks to be confronted by life’s torments.  Busy, active people tend to go to sleep early, worn out and snoring hard by the time the late night comics come on.  I’m not really one to opine on this particular subject, almost everybody goes to sleep early compared to Nosferatus like me.

This world is a struggle.  It is a miracle, full of indescribable beauty, grace, kindness, collaboration.   It is also a curse, plundered by the greediest, those who have no hesitation to kill in order to control it all.   There are Howard Zinn’s fugitive moments of heroic group action, and we must remember these rare, inspiring episodes.  These times of unity are human beings at our greatest, standing together to confront a monster and sometimes forcing the monster to back down.  It is not possible to be brave all of the time, but it is always possible to be brave.  We have moments when our puny species rises to do heroic things.

I was thinking of a brief chat an old friend and I had in passing the other day.  She decided to visit her therapist to get help figuring out why she is not advocating for herself, selling her best, brightest idea and having the pay day she deserves.  In this dream, it is her inability to fight for and achieve recognition that is the defining failure of her life.  If she fought successfully and got recognition for her talents, she would have conquered her demons and could live a happy life, unvisited by them.  I imagine that is the theory, we didn’t discuss it for more than a few seconds.  

I was thinking some more just now about that dream, fixing unhappiness by achieving a goal that measures one’s accomplishments against the pros,  in contrast to the simpler dream of living a demon-free life day to day, independent of the judgments of the world of commerce.   I often feel the gnawing of writing every day for no pay, sometimes writing things I feel could be helpful, or contribute positively to the public discussion, and regret they will never reach more than a few people.  I would be happier getting paid, reaching more people, certainly.  I can relate to the feeling that this would be a major life change for the better.  I am, on some level, working toward that goal.  I should probably see a therapist about my slower than snail-like progress.  I just wonder how much it would really solve on the deepest level. 

There is nothing objectively bad about my old friend’s life.  She leads a good life, helps many people, has a wonderful family and a comfortable home at the service of their many friends and their extended family.   Yet, because childhood pain has no expiration date, nor any adult explanation that can neutralize it, she sometimes wakes with an evil spirit casting a cold shadow across her soul.

The dream: if I accomplish this public success, my life will have meaning and I’ll be relieved of the grief of waking each day as a fungible drone, doing the meaningless yet demanding work of a million other fungible drones.   That is not really the best dream, I think, though it is certainly a large part of the American dream– to be recognized as the unique, important celebrity/culture creator/brand I actually already am.  

The dream is to wake up each day without ever being oppressed by life-sucking dread, I think.  The demon is not conquered by looking without, there is no extrinsic cure, it seems to me.  I think demons must be seen as intrinsic to our particular psyches — you have to corner them in your own soul and make them leave.  They are crafty, they are mean, manipulative bastards, that’s why they’re demons.  But at the same time, they are only demons.  With courage and the right help, as my friend and I have both learned, demons can be put back in their place.

 

(Thanks to an old friend for editorial input on this post)

Plain Language

When I went to law school, more than twenty years ago, there was a big emphasis on plain language.  Lawyers should write as plainly and clearly as possible.  In the old days, we were told, scriveners, who wrote legal papers for lawyers, were paid by the word and so they laid the words on with a trowel.  This practice led to unplain, exceedingly excessive language, writhing, modifier-laden legalese, language embellished, decorated, complicated and modified, as needed, or sometimes not, according to long custom, by a dozen redundant, recursive, tautologous synonyms encompassing a dozen finely calibrated shades of meaning, foreshadowing, portent, legal significance, modified ambiguity, standard boiler-plate ambiguity, ambiguousness intended and incidental, anything to the contrary notwithstanding.   Reading legalese is generally a huge pain in the ass– take a glance at our Constitution or any on-line contract you must accept before getting web-based services.   “Plain language!” we were told, “the law now requires anything a consumer will be bound by to be written in plain language.”

 That was some precatory, aspirational, academic shit, apparently.  We were also taught to use the female pronoun instead of him and his when speaking of general things.   It was a fairly liberal school, I suppose, even though it had its share of rigid sociopaths on the faculty.   There are, I need not point out, rigid sociopaths on every shade of the political spectrum.    

I am thinking about this because I just got a determination from the New York State of Health appeals unit.  It is seven pages of fairly spare legalese that concludes with the determination that NYSOH must rescind its notice of January 9, 2017 and reconsider my case in accordance with the law.   It does not say, anywhere in its learned pages, anything that someone without a background in the law can understand as a clear, five and a half month belated, reversal of NYSOH’s clear error.   An error, moreover (to use a word beloved of scriveners everywhere) that anyone on the NYSOH website can verify in less than five seconds.  

It was only a four and a half month wait for the appeal and then, a speedy 30 days for the determination to be written up and sent out.  I have only been required to loan a large corporation about $1,250 in that time and I am told it will come back to me some time next year when I file my taxes, since I was entitled to what the decision refers to as the APTC, payable on my behalf towards the monthly premium of the QHP.  The subsidy, in other words.    

Rigid sociopaths are currently dickering about the quickest way to dismantle the conservative think tank-born, health care industry-friendly health insurance plan that bears the hated secret Muslim president’s name.  These are some dangerous, cynical, amoral motherfuckers doing this dickering.   Obamacare is bad in many ways, very bad in some ways, but it is a step forward, although not necessarily in the absolutely right direction since it leaves ravenous foxes to supervise the hen house.  The plan these dickheads are trying to push through will be a disaster for millions.  It has a 12% approval rating among the citizens of this nation of poor bastards, which is why it was initially kept secret and why its advocates are refusing to allow public debate on the punitive details of the new bill.

The Republican plan, in fairness to them, while hurting the poor and lower middle class, will greatly benefit the rich.  Who can blame the rich for trying to get richer?  It’s only natural.  

Like trying to repeal the hated DEATH TAX, another long time dream of America’s greediest.  Check this number out– I don’t know why it is not more widely known.  The so-called DEATH TAX affects the top 0.2% of our great, gullible, lynch-mob republic.   For those of you not good in math, that’s 2 estates out of every 1,000.   I don’t know about you, but that number of people affected by the so-called DEATH TAX, the top 2% of the top 1%, gives me goose bumps.   

Have a groovy fucking day, y’all.