Tuesday, January 26, 2010

A child in the 60's

A Trip to the City

When I was a boy I was fortunate to have a life that seemed unquestioningly safe and happy.  I lived with both of my parents and was part of an exciting time, the 1960's, even for a kid who was too young to truly understand what was happening.  The emotion of the times was hopeful and powerful, something I could grasp.  The intensity was unavoidable.  Musicians dying almost weekly.  A march on Washington protesting the war that I didn't understand but knew to be a bad thing.  I knew enough to realize that there were two sides but I couldn't always tell which side someone was on.  A bus driver had a poster with a peace sign-good.  But why did it say it was the footprint of the American chicken?

During the long bus ride to the peace march, I saw my art teacher from school go by in another car and I always wondered if she saw me.  I knew she was going to the march and it reassured me.  She never said anything about it and neither did I.

My parents would often take me to the city, driving from our home in Long Island.  Sometimes these were "culture" trips during which we would visit museums.  About these I remember sore feet and boredom.  Then there were the trips to Greenwich Village.  I fantasized about moving there.  I wanted to be a hippie.  The scene reached inside of me and grabbed me by my guts.  The guys looked cool, the girls were pretty, the music was wonderful, and it had a simplicity to it.  I don't think we understood that politics was so corrupt yet.  The world did not seem so corrupt yet.  We just wanted the war to end.  There were good guys and bad guys, plain and simple, it seemed to me.  Now we accept corruption and try to find a comfortable place in its spectrum.  We don't expect it to stop.

I told my best friend that if I moved to the city, he wouldn't be able to write to me because he wouldn't be able to spell the town where I lived.  I thought it was cool that Greenwich Village was pronounced "Grenidge Village".  As I told him this he quietly pointed at my bellbottom pants with a pleading look on his face.  His mother's clear response was no.  You can't have those.  I didn't understand that what was cool to me and OK with my family was not the same with everyone else.  I always assumed I was on the side of the good guys.

Our trips to the city were magical to a little boy with long hair.  I was old enough to want to be a part of the scene, but young enough that I wasn't yet embarrassed to be with my parents.  A favorite memory is one that fills me with security even now.  Each of my hands held by one of my parents as we walked through the excitement, they would swing me over the curbs.  Happy and Safe.  My father is gone and I hold my mother's hand to help keep her from falling.  I don't have long hair.  I don't have much hair at all.

We would get pizza, mixed twist ice cream cones, shop at Azuma and Brentano's and Larry Schaefer's record store where albums were 2 for six dollars.  Everything seemed aimed at the senses, particularly visually, with psychedelic posters, lava lamps, and colorful liquid crystal toys.

On one trip a young black boy approached me and asked if I wanted to hang out.  I was tempted but afraid.  Did he recognize me for the Long Island boy that I was?  Did he plan to hurt me or did he really just want to walk around and check out the cool stores together?  Was he lonely or a predator? Although tempted, I stayed with my parents, wanting to go but afraid.  It was not consistent with the safety I knew and needed.  I wasn't one to take chances.

We would drive home, me in the front seat, my mom sleeping in the back.  I stayed awake, knowing that my father was tired and wanting to make sure he stayed awake too.  He would open the window to blow cold air on his face and play loud jazz music.  I would sit, thinking about the new poster I bought, or what would have happened had I played with that kid.

Saturday, December 26, 2009


Sometimes it seems that I have been around more death than most people I know.  It has touched me again.   I learned she was sick in June and I called her then.  She had been a nurse when I was an intern.

I had a lot of fun when I was an intern and I have lost a good friend who was part of that fun.  She died, went through pain, operations, loss of modesty, while I went on with my life.

When I was an intern I organized adventures, usually just me and my nurse friends.  We went white water rafting during a low water period.  We pushed our raft for much of the way and the only rapid water we encountered was when one of the nurses peed in the raft.

We went ice fishing together and I lost my Willie Nelson tape into the hole.  We didn't catch anything but we had fun, ice skating, waltzing on the ice.  I chopped the holes with a crowbar.

She got married before the rest of us.  She had a baby before any of us.  I visited her during the height of my bachelor years and remember her yelling at cars to slow down in the parking lot because she had a baby with her.  I didn't understand that yet.  She was happy with her life in a way that made me happy.

She was a poet.

For me, divorce has been painful and the pain of it doesn't end.  Each week I re-live the loss of my children, but it is temporary, even if it is painful.

My friend knew that she would be leaving her children for good.  I don't know what she believed about an afterlife so I can only imagine how I would feel.  I would feel sad knowing that I would not be there for so many things.  I would feel sad knowing that I would not be there to comfort them when they needed it.  I would feel good knowing that my husband was solid and would be there for them.  I would feel good knowing that he would tell them stories about me, keeping me alive for them.

It would break my heart knowing that they would miss me and that I would be gone forever, that they would want to talk to me and wouldn't be able to.  I would not meet their boyfriends or girlfriends.

I'm an older parent.  I sometimes think about the likelihood that I will not be around for much of my children's lives.  I no longer have a spouse to keep me alive.  I can leave a video to tell my story.

I spoke with my friend's husband today and he told me she had died.  I knew she was sick.  I'm glad I spoke with her back in June while she was sick before she died.

She will always be a part of me.  I'm sad that friends drift so far apart.  I'll miss her.

Friday, December 25, 2009

Competitive Parenting

A father arrives at the home of his children's mother to pick up his kids.  They've been with their mom for three days, celebrating chanukah, cooking, playing, and having fun.  They don't want to leave. 

The dad and his new trophy wife are at the front door, eager to take the children to their respective families' homes for christmas.  Lot's to do, let's get going.  This will be fun.

The kids are clinging to their mom, crying, "I don't want to go with daddy, I want to stay with mommy".  The mom, teary eyed, hands them over, telling them to have fun with their dad.  "I'll miss you but I'll see you soon". 

The dad asks her if she has somehow sabotaged his time with the kids.  She says of course not.  The dad feels terrible, the kids feel terrible, the mom feels terrible.

What would be the right thing to do?  Is it best that the kids learn that they have to do what adults ask of them, or do they have the right to dictate what they want?  They can choose their friends, whether they want to eat their Brussels sprouts.  Why ignore their preferences when they clearly don't want to be with a certain parent at a certain time? Because that is a much bigger decision than they are able to make.  Their input should be considered but it is a decision with repercussions they are not aware of.  A decision that only their family should be able to make.  I shudder when I think that decisions are made by authority figures, other than family, who know the children for days at best, yet the family is unable to do it. 

I shudder to think that people need a license to fish but not to have children.  I cringe to think that in anything other than completely dysfunctional families, the parents can't work things out in the best interests of the children.  I break into a cold sweat thinking about what goes on in homes that are not under scrutiny.  Homes that don't have a gay couple for parents, homes where the parents are not divorced.  Homes where kids are spanked, loaded guns are left unlocked, second-hand smoke wafts through the home, accidents wait to happen, and do. Homes where the standards aren't so high because they are not considered high risk.  When half of all families divorce, when half of all households have guns, I think they are all high risk.

The mom closes the door and is shaking.  It is a scene that reminds her of nazi films where children are taken from parents. 

The dad feels angry and hurt.  What did my ex do to make my kids not want to be with me? 

The dad and mom don't sit down together to discuss what happened, to try to come up with a way to make transitions easier.  At least one of them is too consumed by his or her own feelings that they can't work as a couple to understand the children's feelings.  This is what I call competitive parenting and it does not attempt to do what is right for the children.  It does not attempt to teach children how to deal with difficult situations by setting a mature example.  It's all about winning.  The children will be bribed with special treats by the dad to show that he is really great and they should be happy to be with him.  Even young children lose respect for adults who behave like this.  They take the gifts and learn that acting out brings rewards.

Parenting plans of divorced couples often speak of the need to be "flexible" but there is no concrete description of what this means.  When children are with one parent, the absent parent is allowed to speak with the children at "reasonable times".  Who defines that?  These are the weapons used to wage competitive parenting, and it takes both parents to end the war.  The casualties are always children, no matter how the parents justify their actions.  If an action doesn't begin with "It would be best for the children if...", then it is likely not in their interest.  It is good practice to start each sentence that way when making decisions that involve the children.

I see parallels between drug addiction and divorce.  Each is highly prevalent.  Each  can be prevented but each is only dealt with after it happens.  Each is a disease of our culture and neither has a cure.  We pay lip service to each but continue to take the easy path on two diseases that are eroding our society.  They are too complex to deal with so we develop a one size fits all approach that does not work at either preventing the disease or treating it.

A mother comes to the home of her children's father to pick them up.  The two children, aged 4 and 6 are crying, clinging to their dad, screaming "we don't want to go with mommy". 

The father invites the mother in for a cup of tea, immediately defusing the situation and bringing calm.  The likelihood of this happening is strictly a product of how the two parents have behaved towards each other in the past.  A vicious divorce is unlikely to result in cooperative co-parenting and the result is damaged children.  Why are they damaged?  Because the parents are putting themselves ahead of the children's needs.   Children should not run the show, but that is not what cooperative co-parenting requires.  It requires the ability of parents to put their own egos aside and understand what it is like to be a child in a given situation.  We are more likely to trust a therapist to do that for us, when nobody is better suited than the parents who have known the children all their lives.

Once the ink is dry and the divorce is final, the parents are pretty free to screw up their kids.  Perhaps there is room for a skillful counselor to meet with the parents periodically, in a non judgmental way without the risk of punishment, so that the parents could be honest about how things are going, and maybe even come up with creative solutions to the recurring problems, without the fear that any imperfection will later be held against them.  Maybe our society could throw some money at this.  Or we can keep producing maladapted kids and try to fix them after they're broken.

The parents drink tea together and the children see the parents getting along.  This might be very painful for the father, seeing all the nice stuff in the home that reminds him of the money he considers stolen from him in the divorce.  Anger rises along with the desire to throw the fucking cup of tea in her face and walk out.

If he resists that urge, and the parents recognize that they can help their children by behaving better, in a few months the kids will be less angry, less scared, and better adjusted.  The lifelong benefits are staggering.

Divorce is not fair to children or adults.  We have very few wise people to settle the financial and parenting aspects of the failed marriage, and the wise people that exist do not have the time to spend on something so important.  I can think of nothing more important.

Once the money has been handed over, their is nothing to do but be a good parent in the new reality.  Resentment and anger won't help.  There's no getting even.  As painful as it is, if one cares about one's children, the only right thing to do is be a good parent and learn to cooperate with the other parent.  That means that each parent has to be able to get out of his or her own head and truly try to understand what the other parent is experiencing.  Only true compassion, the lack of narcissism, and a sincere desire to do what is best for the children will allow the children to grow strong, healthy, and happy in a world that is already difficult.  This is a delayed gratification job in a world where we want immediate results.  It's not easy.

But it's a better gift than a new video game.

Sunday, December 13, 2009

The good and bad of internet shopping

Buying on the internet is great, right?  We find wonderful prices, we can do all kinds of research on items, and even share experiences with other people.

The prices sure can be good, although sometimes the shipping costs more than compensate for any savings.  We also assume that we are purchasing the exact item we want.  Many times companies have their own model number with slightly different features.  This can make comparison shopping difficult.

Reading other peoples' opinions can even be misleading.  People might be paid to write "reviews" of products or companies that are not based on reality, but based on deception.  Yes, you can be paid to write good reviews of a product, and cynical me is sure that it is common for online companies to have employees write good reviews on popular review sites.

Amazon sells many products and often has great prices.  They offer free shipping on many items, but they also sell many items through their website that they do not take any responsibility for.  These items are sold through "Amazon Marketplace" and you may not even notice that you are not really buying from Amazon, except for the fact that you probably won't get free shipping.  Amazon makes a profit on these sales and the seller get exposure on Amazon.

I recently purchased a headphone from Vibecellular, advertised as the Skullcandy Proletariat noise canceling headphone.  What arrived was a product made by Amp'd instead of what I had ordered.  The Amp'd headphones may be wonderful, but I was shocked that a company could advertise a product on Amazon and then deliver something completely different. Skullcandy has a great reputation for honoring warranties, which is why I really wanted their product.

I read further on the Amazon Reviews and found that MANY people had experienced the same thing with Vibecellular and were very angry.

I went through the usual channels and Amazon told me that they take customer service very seriously (they claim to be "obsessed" with it), but they continue to let bait and switch companies sell products on their website.  In my opinion, a company that has so consistently misrepresented what they sell should be dropped by Amazon.

Vibecellular offered me $5.  This would not bring my final price to the regular price of the Amp'd headphones, which were selling at the time for $18, although strangely they are no longer selling for only $18.  I suspect that's because it made Vibecellular look bad to sell the same headphone for both $18 and $25.  I asked for either $15 or a refund, including my shipping costs.  I have not heard back from them yet.  If I do, I will post it on this site.

On the other end of the spectrum, I  recently had a very positive experience with internet shopping.  I was in New York City and wanted to buy my kids some authentic Chinese outfits.  The shops all had the same tired items and nothing really seemed special.  It was cold and dirty and we were tired.  On the internet I found a company called Chinese Moods.  I researched the company as well as I could and didn't find anything very reassuring, but I decided to go ahead and roll the dice.  In about a week I received my items and they are beautiful, well-made, and even included a couple of gift wooden combs.  It was very nice to be so pleasantly surprised. 

You can tell that I like to dis companies that I feel are bad eggs, but I also like to bring attention to companies that are good eggs.  Shipping isn't cheap with Chinese Moods, but it's coming all the way from China, after all, and the prices are great.  The selection of items is extensive and I would recommend them highly.  Some of the English on the website is poorly translated, especially regarding the materials.  I'll post a picture of my kids wearing their outfits when they get them.

I guess my point is that we like to save money when shopping and we also like good service.  Often, we get only one of the two, sometimes neither, and on occasion we get both.  I think we should speak up angrily when we get neither and we should let people know when we get both.  We are supposed to control the marketplace.  And, remember to read the reviews before you buy!

When is a will not a will?

Is something unclear about this sentence?

All personal effects and property which I may own at the time of my death, either real, personal, tangible, intangible, or mixed, of whatsoever nature and wheresoever situated, including all property which I may acquire or become entitled to after the execution of this well, including all lapsed legacies and devises or other gifts made by this will, I leave to my wife.

There are lots of legal terms, but it seems pretty clear that my dad left everything he owned to my mom.  Including the bond in his name which matured several years ago, years after his death.

I called the financial company that holds the bond to negotiate the transfer of funds for my mother.  I was prepared with a copy of my father's will and death certificate, documents which I assumed they would require.

Much to my surprise, that was not enough.  An attorney would have to read my father's will and determine that he really meant to leave everything to my mother.  The attorney would then need to create an affidavit to that effect.

Maybe I'm dense, but this bit of news astonished me.  What is the point of a will, if not to indicate who gets what?  And what could be more clear than a will that leaves everything to one person?

I began to wonder if my will could be questioned after my death.  Was it not clear enough that I was leaving everything I own to my two children, to be shared evenly?  Was that not clear?

If an attorney helps me write a will to dictate who gets my stuff after I die, why does an attorney have to interpret what the first attorney said?

These absurd bureaucratic pie grabbing actions seem to be nothing but greed created by instilling a fear of lawsuits.  Common sense goes out the window.

I have a hard time with things that clearly just don't make sense.  During my divorce I had to have my house appraised.  I requested the appraisal and paid for it, but the appraisal company would not give me a copy of the appraisal.  They said that their client was my attorney and they were not very polite about it.  Huh?

I went to a gym in New York City, where I spend a few days every month or two, to see if I they offered a trial membership.  If I liked the gym I hoped to find a type of membership that might be geared towards people who are not in the city full time.
First I had to fill out a card with lots of personal information such as address, marital status, whether I have children, phone numbers, email address.  I left most of it blank but still managed to qualify for a meeting with a membership representative.

His first words were "What's your phone number?".  I replied that I don't give out my phone number and all I wanted was to find out if they offered a trial membership".
"We don't give free trials", he replied gruffly.  Clearly he was done with me.  I explained that I had not used the word "free" and that I would be happy to pay to try the gym for a few days before committing to membership.  He became more friendly but I had seen all I needed to see.  I found another gym where the representative actually listened to me.  I even was offered a T shirt and use of the gym for free that day, and I still hadn't used the word "free"

Both gyms were practically empty at the time I went.  The first one, Crunch Gym, had a bad attitude.  The second gym realized that they lose nothing in letting me try the gym for free, and may gain a member.  I walked out wanting to tell everyone.  Kindness and sanity exist in at least one place!  The nice gym is New York Sports Club

I like it when the world makes sense.  I like it when people communicate, rather than work on their agenda.

Friday, November 20, 2009

Screening guidelines in healthcare

If you lived in Maine and told the local animal control group that you were concerned about cobras in the area, it would be foolish and a waste of money to begin a program to search for cobras.

If, on the other hand, the local zoo had reported that their snake exhibit had escaped in the middle of summer, you reported seeing a large snake that reared up and displayed a hood, and you had small children playing in the area, then money spent on a program to find and remove cobras in your area of Maine would be a good idea.

This example illustrates how decisions on health care screening should be made, although with more simplicity.  If a disease is extremely rare in your area and you have not had symptoms of that disease without another good explanation, it doesn't really make a lot of sense to screen you for that disease.

Remember that any screening test may give a false result.  In other words, that polyp they took a biopsy of from your colon may come back with a result of cancer.  You may undergo surgery and you may even suffer complications such as infection, or scarring that blocks your intestines, among others.  It would then be frustrating to find out that the original biopsy result was incorrect and that you do not have colon cancer.

This might not even be a case of malpractice.  Sometimes it is not clear what the result of a test or biopsy is, and an informed "best decision" has to be made, often with the consultation of several experts and hopefully inclusion of the patient.  Complications of treatment can occur even when nothing is done wrong.  Infections occur.  Scarring occurs. 

I think that the public reads about disease screening recommendations and fears that health care is being taken away.  It is important to understand the difference between routing screening and good health care.

So, if you are young, and colon cancer is rare, screening for it may not be a great idea.  On the other hand, even if you are young and it is a rare disease, if you describe symptoms such as a change in bowel habits, blood in your stool and weight loss, then screening would be a good idea, even though you might not fit into the group of people that should receive "routine" screening.

That is called the good practice (or the art) of medicine, not dictated by the base of evidence guidelines, but by the patient's symptoms and the doctor's judgment.

Evidence based guidelines can be helpful to make broad decisions that might save a population money that would otherwise be wasted, and allow it to be used for more fruitful endeavors, but they are not laws.  Part of what makes all those years of  a physician's training valuable is the ability to think without a rule book, and to use judgment that may go against what is traditionally thought.

Guidelines are just suggestions for groups of patients.  I would hope that they are never used to deny care that is proposed by a physician based on a patient's symptoms.  Guidelines are not intended to be used as such.  This is further reason why it is important that patients have relationships with their physicians and the ability to be seen without a long wait when necessary.  A physician who knows you can deliver better care because he or she knows your history and the way you have presented symptoms of disease in the past. 

Systems that apply to everyone are not interchangeable.  For instance, pain scales are OK for following the course of pain in an individual, but do not give an absolute measure of pain.  One patient may have a hangnail and call the pain 8 out of 10.  Another patient may have broken a finger and call the pain 3 out of 10.  That's because a 10 is the worst pain "imaginable" by that patient and is affected by personality and experience.  A physician who knows you is better able to take your personality and experience into account when treating you.

As guidelines for health care screening evolve and recommendations are changed, it is important to remember that all bets are off when a  patient has symptoms consistent with a disease.  Sometimes adults get "children's" diseases, and children get "adult" diseases.  We need to maintain the autonomy of physicians as well as their relationships with patients to provide the best health care, if that's what we want.  Otherwise patients will need "health care providers", insurance, and "health care advocates" to help them understand the decisions and make sure the correct ones are made.

In a recent New York Times article  Louse B. Russell, a research professor at the Rutgers University Institute of Health who has studied whether prevention necessarily saves money (and found that it does not always do so) said  "It's going to take time in part because too many people in this country have had a health insurer say no, and it's not for a good reason.  So they're not used to having a group come out and say that we ought to do less, and it's because it's best for you."

Sunday, November 1, 2009


Six months ago I was married.  Tonight I went trick-or-treating with my ex-wife, her new husband, and our two children.  Life changes quickly.

In past years we had Halloween parties that the children still remember although they are only four and six years old.  No party this year that I know of.  Of the three of us, I was the only adult in costume.

I joined the kids and greeted my ex and her husband pleasantly.  The things we'll do for our children.  For the rest of the evening I just pretended that my ex and her husband were casual acquaintances, easy to do as I have no feelings of lost love.

I focused on the kids and joined them as they approached each house eagerly.  I made small talk with the people who had decorated their homes.  My son wanted to give me all of his candy.  My ex-wife made sure to call from the curb for the kids to say thank you at each house.  I wondered where the Unicef boxes were.

My ex-wife and her husband walked along together and I heard a familiar tone and pattern of conversation that I found artificial and an unpleasant reminder of what I had once bought into.  I worried that she doesn't have what it takes to find herself.  I worried for the kids.

It was raining hard and my daughter became cold and I gave her my Marlon Brando jacket, part of my biker costume.  She looked cute in her fancy dress and too-large motorcycle jacket.

How strange it must be for a child to have two homes.  Not uncommon, but strange, especially to someone like me who grew up confident in his family's unity. 

As we walked my son mostly stayed with me, his current alliance.  My daughter is having a harder time and went back and forth, telling her mom and me both that she loved us.  Reciting the mantra, "I love daddy and I also love mommy".  A seemingly unnecessary burden for a small child to carry.

We arrived back at my ex-wife's home.  I was not invited inside, and I got my jacket back from my daughter and dripped my way to my truck.  I drove home in rain blown horizontal by the wind. 

I had a feeling of sadness.  I wanted to be there to review the loot.  To sort out the good candy from the undesirable stuff.

I took a candy bar that my son had given me and ate it.  I hope they had fun tonight.