The Can Do/Can't Do Ratio

Hello from Manistique, Michigan! Today (I'm writing this on Saturday July 26) was the last day of the MUP Shoreline bike ride, and the riders had a terrific tail wind most of the day, which was gloriously sunny. The ride ended where it started, in St. Ignace. We spent some time at the annual whitefish festival, which happened to be today, and then started to drive south, taking a brief detour to drive across the Mackinac Bridge, which connects Upper and Lower Michigan, and then back again.

I'm taking advantage of the Internet access and computer at the Comfort Inn where we're staying because I will be computerless when I get home Monday. I should be able to pick up my new computer Monday, but who knows how long it will take for me to set up the Internet connection. Better to write the blog today and set it to publish on Monday, I think.

Which I suppose is another instance of the can do/can't do ratio I've been thinking about today. This has not been the most wonderful vacation I ever took (in any event it would have a hard time competing with Mozambique and South Africa, the Galapagos, Hawaii, Japan, Egypt....). But I think the problem was the almost constant reminder of what I can no longer do, compared with what I can. I generally try to focus on what I can do, not what I can't, but that proved to be pretty hard, when everyone else was riding and talking about rides past, present, and future. Although my friends were very willing to ride slowly with me, the weather conditions, the nature of the beginning and ending of each day's route, and a mild virus that laid me low on Wednesday evening, combined to ensure that, other than the spectacular circumnavigation of Mackinac Island last Sunday, I only rode yesterday morning.

That was just 11 miles, into a headwind, and I was actually very lucky to do it between rain showers. Later in the day, the bikers were drenched by rain so heavy that the car windshield wipers couldn't keep up with it. I was thrilled not to be on a bike right then (and also on an earlier day, when my friends arrived at our B&B bedraggled and soaked, having just biked through an hour or two of storms).

Well, live and learn. It was good to be with my friends, and to revisit some sights (like Tahquamenon Falls) that I haven't seen in more than 20 years. But I don't think I'd do this kind of trip again. Makes me too sad because of the can do/can't do ratio.

On the other hand, I did finish proofing the galleys for Facing Fear, sitting in a variety of coffee shops, parks, and restaurants. So at least I accomplished something!

Finally, a reminder to all of you who send me personal comments through the blog and clearly want me to respond. I will not publish personal comments for everyone to read; I will not respond to personal comments on the blog; and I will only respond to you directly if you send me email. My email address is jlstrass@wisc.edu.

See you in August, from my new laptop!

Bittersweet

Greetings from St. Ignace (pronounced, by the locals, IG-niss) on the beautiful Upper Peninsula of Michigan! It's 8:30 AM, and I've just seen off my five bike-riding friends on the first day (56 miles) of their ride and have returned to the Econo-Lodge where we spent the night, and which has an Internet-connected computer in its lobby for use by guests. I never imagined it would be so easy to blog today!

Of course, I'd rather be riding my bike, though the weather right now (cloudy, chilly, misting a bit) is not so tempting. But I admit to being a little teary as I drove away from the ride start. That's the "bitter" part of "bittersweet."

Still, as alway, I try to focus on what I can do, not what I can't. So here's the "sweet" part: Yesterday, five of us took our bikes on the ferry from St. Ignace to Mackinac (pron. Mackinaw) Island, and rode the eight-mile circumferance road that hugs the shoreline. It was a gorgeous day, the scenery was magnificent, the route was flat, and my friends tell me I was grinning from ear to ear. I was thrilled to be on my bike, having a fine and easy time of it, somewhere other than the Soiuthwest Bike Trail in Madison, which is a half-block from my house. The only slightly difficult part of the ride was near the end when we turned into a fairly stiff headwind, and I no longer had the breath to chat with Janet.

Highlights of the ride: Lake Huron and a great view of the Mackinac Bridge, a very long suspension bridge that connects Upper and Lower Michigan; lots of flowers, both wild and cultivated; the breccia outcroppings high above the shore, including a lovely natural arch that we climbed quite a lot of steps to see. (And I didn't find the climb difficult....) Also, the sense that the world could be a much calmer place if cars were banned everywhere, as they are (and have been since the late 1800s) on Mackinac Island. The only modes of transportation are bikes and horse-drawn vehicles. There are a lot of really gorgeous, big, old, and I'm sure expensive houses on the island, and it was amazing to think of how the materials arrived at the building sites, which are by no means all close to the shore. But there were, after all, thousands of years of human experience with large-scale construction projects before the invention of the internal combustion engine. It did remind me, though, of the abandoned Model T Ford on Sand Island in the Apostles, which Gertrude Wellish, a Minneapolis school teacher had used in the early 20th century to haul materials to build the summer "cottage" where I stayed for three weeks in 1998 when I was Artist-in-Residence at the National Lakeshore.

One more bittersweet moment from the past week: On Friday, I had my last cello lesson with my fabulous teacher, Carina Voly. Carina has accepted a great job with the New World Symphony (that's the sweet part), which means she will be moving from Madison to Miami next month. I'm really happy for her, and for the New World Symphony and its young musicians, whom Carina will help make the transition from conservatory students to professional teachers and orchestra members. But for me, I'm kind of devastated. Carina helped me make the transition from 55-year-old non-string-player to 63-year-old intermediate-level cellist who enjoys participating in easy (and non-auditioned) orchestral performance. Along the way, she's put up with my extreme performance anxiety and my unreasonable expectations of myself as a musician, and--most recently--has helped me figure out how to work around the chemo-induced neuropathy in my fingers. She's irreplacable as a teacher, and I'm not quite sure what comes next. I managed to control myself when we hugged goodbye, but as soon as her condo door closed behind me, I burst into tears....

Ah, well. Time to move on with the day. As usual, not sure what it will bring: maybe sitting on the shore of Lake Huron, proofreading Facing Fear. Or proofreading in a coffee shop somewhere, if the weather doesn't improve. And if it does improve, perhaps riding my bike back from De Tour Village (tonight's stopover) to meet my friends as they end their ride.

Health Care Reform (and more personal matters)

(Note: I may not be able to post blog entries of much substance between now and about August 1. To learn why, see end of this entry.)

I know, I know-- you're probably more interested in my health and activities than in the arcane political jockeying among progressives on issues of health care reform. So I'm not going to go into detail on the politics, but just give you a heads-up on what apparently is going on. It's the old debate about different means to an agreed-on end, applied to a "new" old issue. To be specific: do we insist on pushing for a single-payer plan, or do we assume that's not going to happen in the near future, so we support incremental change that somehow mixes existing private insurance plans with some sort of subsidized insurance for people who can't afford or aren't eligible for private coverage?

Here's how the debate seems to be shaping up:

Rep. John Conyers has sponsored single payer legislation in Congress. HR 676, the U.S. National Health Insurance Act (also sometimes referred to as "Medicare for all") was endorsed in late June by the U.S. Conference of Mayors, and has received more media attention than one might expect for a "radical" proposal.

And you may have heard about the HCAN campaign that's ramping up. HCAN is an acronym for Health Care for America Now, a $40 million organizing and media campaign sponsored by a fairly broad coalition including unions, Move On, Planned Parenthood, and others. Maybe AARP? I haven't checked on that. According to a Move On fundraising plea, the campaign will fund 100 organizers "on the ground" (which doesn't seem like very many, considering the size of the country), plus TV and radio ads, etc. HCAN advocates an incremental, "any reform is better than what we have" approach.

You can find out more about both these approaches by Googling HR 676 and HCAN. I'd be interested in knowing which strategy you favor.

And now a few things about me: I've been home for a week now, and am getting ready for my next trip, a week plus a couple of days on Michigan's Upper Peninsula. I'm going with five friends who are signed up for a bike tour sponsored by the League of Michigan Bicyclists; they'll do a 6-day loop, including one rest day, starting at St. Ignace (near the famous Mackinac Bridge) and heading first north and a little east, and then west and south. I'm signed up as a "non-rider," since there's no way I can ride 60 miles a day, and will spend time entertaining myself while the others are riding, but eating breakfasts and dinners with them and also hanging out with them in the evenings and on the rest day and the day before the ride starts, when I think we'll go to Mackinac Island.

I'm planning to do some sight-seeing (the tour organizers promise a special sight-filled route for non-riders) and also, I think, will be proof-reading Facing Fear, which is supposed to go to the printer in early August. And I'm taking my bike; I hope that I will be able to ride a little of the route in reverse from the end each day, and meet my friends as they're coming into town.

As I said above, my blog posting may be a little spotty, or even non-existent, between now and late July or early August. Next Monday (7/21) I will be traveling between St. Ignace and De Tour Village, Michigan. If there's a library with internet connection for non-natives in the Village, and if I have time, I'll post something Monday, but it might be more likely to find both time and internet on Tuesday or Wednesday, when we'll be in Sault Ste. Marie.

I'm not taking my computer with me; in fact, my current laptop will spend my time in Michigan with the people who are selling me a new laptop, so they can move stuff from this hard drive to the new one. I'll probably pick up the new computer on Monday 7/28, and it should be ready to go--except for my wireless connection, which I'll have to re-install. So maybe I'll be able to post on 7/28, and maybe not. You know how it is with new technology.... No promises! Except that my sons, who lobbied heavily for replacing this admittedly cranky four-year-old beast, and who even made the initial phone calls to the vendor, assure me that I will be thrilled with the new laptop. Even though it will be a PC, not a Mac.

Now a word about my health: it's terrific to be off chemo! I can tell the neuropathy is getting better because my balance is much improved. And so's my digestion. Not to mention my mood. And I think so far the tumors are behaving themselves.

One more thing-- for those of you in Chicago, or inclined to visit Chicago for a day, I will be reading at the Peggy Notebaert Nature Museum in Lincoln Park on Tuesday, August 5, at 6:30 PM. The reading is part of the Chicago Public Library's Read Green, Live Green program; I and other contributors will be reading from the anthology Fresh Water: Women Writing on the Great Lakes.

Rationing Health Care

I'm back from a lovely weekend, visiting my sister Susie and her husband Bob in Takoma Park, Maryland, and taking in the fireworks display in our nation's capital--a little muted by low-lying clouds (aka light rain), but maybe that's some sort of metaphor for our times.

Susie and I spent much of my visit viewing reels and reels of 8 mm movies, taken by our father, Alex, between about 1950 and 1966. So many birthday parties (there are four of us Strasser girls) and miniature train rides and pony rides at the Pittsburgh Children's Zoo and children (including some totally unrelated Dutch kids in Amsterdam) on swings! And a lot of really, really bad photography. This is not art; more a kind of obligatory "this is what fathers do" documentation of mid-twentieth-century family life.

But thinking about Alex, combined with reading a long article about the high--perhaps socially indefensible--cost of a new cancer drug in Sunday's New York Times, led me to muse, once again, about the cost of health care. More specifically, on the question of how much extension of whose life is worth how much money.

When my dad was in the hospital in Madison in the fall of 2002, being treated (unsuccessfully) for a staph infection that he contracted after hip surgery, he was quite adamant that I should read a particular book that presented the argument for rationing health care, spending more on pregnant woman, infants, and toddlers and less--much less--on the elderly. The book pointed out that, in our present system, by far the lion's share of expenditures goes toward keeping old people alive for the last six to twelve months of their lives.

My father, who was 84 at the time, was quite explicit about his belief that the focus on keeping old people alive was an abomination. He, himself, had a living will and a healthcare power of attorney, and made it clear to his wife and his daughters that he did not want any extraordinary measures taken to prolong his life. When he was trying to refuse a diagnostic CT scan on the grounds that it was too expensive a procedure for a man his age, I remember saying, "That may be good social policy, but we're not talking policy reform here. We're talking about you." He finally gave in.

(Despite his resistance to extreme--or even not so extreme--medical treatments, and his careful advance directives, he was subjected to resuscitation efforts that left him severely disabled after his heart stopped and his brain was deprived of oxygen for more than fifteen minutes. We had to argue with the hospital to withdraw life support--an argument that, ironically, we won only after I described to the chair of the ethics board how intensely my father insisted that I read the book about rationing health care. But that's another story.)

The Times article reminded me of that argument about the CT scan, and about the different perspectives that even a single person (like me) might have about rationing health care. The article raised the question of whether it makes sense to spend as much as $50,000 or $100,000 for a cancer treatment that may only extend a patient's survival by four months. In the scheme of things, four months is a tiny amount of time, a tiny fraction of a normal life span. Like Alex, I really do think it makes much more sense to invest that kind of money in prenatal and early childhood care--and even on young adults who can expect many more years of productive life--than on terminal cancer patients. But as a cancer patient who has now outlived her prognosis by four months thanks to very, very expensive treatments paid for by insurance and by the American taxpayers who fund Medicare, I can tell you that every good month--heck, every good day--is precious. (So thanks, you taxpayers out there.) And even if I didn't have cancer, I and many of my friends have already passed the arbitrary magic number--60, or 62, or 65--that in many rationing proposals would make us ineligible for open heart surgery or other very expensive treatments. That's a much more sobering reminder of mortality than becoming eligible for Social Security or Medicare.

In the long run, I suspect that rationing health care may be necessary. (In fact, one can and probably should argue that rationing exists now, determined by the market: poor and uninsured people don't get treated; wealthy and insured people do.) But "official" rationing, and the difficult decisions and heartache it will necessitate, can at least be delayed if we take a hard look at cutting health care costs. I recommend the Times article (available here), which explains some of the reasons for the outrageous cost of cancer drugs, as one place to start educating yourself on this issue. And then you might investigate the cost-saving advantages of a single-payer insurance system. They're considerable.

Better Late Than....

Well, so far two people have remarked on the fact that I didn't post my regular Monday blog entry yesterday. It's great, really, to know that you're out there reading! And, some of you, even commenting--though I do wish more of you would do that.

I could say that I was just preparing you for the fact that next week, the blog post will appear on Tuesday, not Monday. (On Monday I'll be returning to Madison after a glorious Fourth of visiting my sister and watching fireworks in DC.) But the truth is, I was just too busy yesterday to get to the blog. In addition to spending most of the morning working out at the gym and then having brunch with Jed and our friend Jim, I was doing a bunch of desk work, picking up copies of th Facing Fear manuscript and delivering them to people who've agreed to write blurbs for the cover, meeting with the book designer to talk about interior and cover designs, and then spending several hours looking at fearful images on various web sites for potential use on the cover. I discovered, in that search, an amazing collection of Arthur Rackham illustrations for Wagner's Ring cycle. None at all appropriate for the cover, but if you're a Rackham afficianado, or just curious, go to the Wikimedia site and search for Rackham.

In the past week, I've run across a couple of articles that provoked me to file them away to share with you. One is an interesting piece in the June 23 issue of The New Yorker addressing the question of whether a computer can ever actually have an intelligent conversation with a person. Two things in the article ("Hello, Hal" by John Seabrook) struck me as especially pertinent to my situation. First, I discovered that there's actually a scientific explanation-- complete with a name, the Lombard effect--for why I find it tiring to talk against loud background noise. We humans unconsciously raise our voices to compensate for ambient sound. Of course, I'm often aware that I won't be heard against, say, the passing bus or truck, or (at a recent party) a salsa band, and I just shut up. (At the party, I whispered a response into a friend's ear when he asked, in the middle of a lively piece, how I was. "I can't talk," I said. Which he already knew.) But often, I'm not even aware that I'm trying to compete. I just know that talking is tiring.

The other salient point in that article really irritated me. After some comments about how dissatisfied many customers are with the speech recognition programs that many companies use ontheir customer service lines in place of touch-tone menus, Seabrook refers to Leopard, Apple's new operating system which responds to voice commands. This, he point out, "is wonderful for people with handicaps and disabilities...." Which I'm sure it is. But I wish he'd been as sensitive to the needs of people who have trouble speaking when he was writing about those speech recognition programs. Last fall, when I needed to call some company (I think it was Northwest Airlines) that offered only this option, the friendly computer could not understand a word I said, and I was so frustrated I came close to crying. Eventually, the computer got frustrated, too, and turned me over to a real person, who also had trouble understanding me. Even though my voice has gotten a lot stronger, I still quail at the thought of conducting business on the phone. Recently, I had to call both a credit card company about a questionable charge, and the UWHealth business office about an invoice question, in the same day-- and when I was able to successfully complete both calls, I felt like I'd accomplished an amazing feat. Two amazing feats, in fact.

On a more positive note, here's some interesting information from a post that appeared recently in the Topeka (KS) Capital-Journal blog (http://blogs.cjonline.com/index.php?entry=7452). The blogger, Bill Roy, a retired physician and former member of Congress, was reporting on a talk by the senior vp and chief medical officer of a Kansas medical center to an audience of retired physicians. The vp, Dr. Kent Palmberg, said he thought eventually the U.S. would "end up with something like Medicare for all." And then he added, "I'm not sure that's all bad. They pay promptly, predictably and adequately, with a minimum of paperwork. That beats costly fighting with scores of insurance companies, plus caring for the many uninsured."

Dr. Roy notes that this attitude is growing among physicians. He writes that "a 2007 study published in the Annals of Internal Medicine...found that 59 percent of physicians in the U.S. support 'government legislation to establish national health insurance,' up 10 percent in five years." Last December, the American College of Physicians endorsed single-payer as "one pathway" to universal coverage. And Dr. Marcia Angell, former editor of the New England Journal of Medicine, says, "There's only one choice for universal health care at a cost we can afford, and that's single payer, Medicare for all."

Please tell this to your Senators and Representatives, and to both Presidential candidates, too! And to every Harry and Louise you meet.

See you next Tuesday. And have a brilliant Fourth....