Abraham Verghese in Texas Monthly:
I was taught to tap and thump my patients and listen for the sounds of sickness and health. But this is fast becoming a lost art, and that’s bad for everyone.
When I travel as a visiting professor to teaching hospitals, I have the distinct feeling that the patient in America is becoming invisible. She is unseen and unheard. She is “presented” to me by the intern and resident team in a conference room far away from where she lies. Her illness has been translated into binary signals stored in the computer. When I ask a question about her, the intern’s head instinctively turns to the computer screen, like a pitcher checking first base. I gently insist we go to the bedside, but that is often a place where the team is no longer at ease. I realize what has happened: The patient in the bed is merely an icon for the real patient, who exists in the computer. How strange this is! When one knows how to look, the patient’s body is an illuminated manuscript. Indeed, in an elderly patient with a double-digit “problem list” that scrolls off the screen, only at the bedside does one understand which problem is most important. As my brother-in-law would put it, “You have to kick the tires.”
I am no economist, but even a landlubber on a sinking ship is entitled to make observations about the rent in the hull that is about to alter his fate: The present crisis in American health care is only secondarily a fiscal one; the real crisis is that the “art” of bedside diagnosis at which a previous generation excelled has died with the next. Personal-injury lawyers allow us the wonderful excuse that we order batteries of tests because we are practicing “defensive” medicine. The truth is that even without the threat of malpractice, we would still need just as many CAT scans and echocardiograms as we do now. We know no other way. Take away our stud finders and we can’t hang a picture. We are like owners of playerless pianos asked to entertain during a blackout: Our fingers and ears may be intact, but we can no longer play or percuss.
Link to The Center for Medical Humnaities and Ethics started in 2002 by Dr.Verghese.
Thanks to Vimala Mohammed.
No one resembles a poet so much as another poet, which is a mixed blessing for American poetry. On the one hand, this kinship helps explain why writers with divergent sensibilities often read one another’s work with surprising compassion and skill; on the other, it also explains why certain factions in the poetry world loathe each other nearly as much as “Star Wars” fanatics despise people who have a working knowledge of Klingon. Sometimes this acrimony stems from a genuine aesthetic disagreement that is serious and important and (as one might say in Poetryland) worthy of a Panel Discussion, Followed by a Short Reception. Other times, though, it’s just a matter of writers carping at each other because they realize that if they didn’t, people would have a hard time telling them apart.
The longest-running feud is probably the low-intensity border war between so-called experimental poets and their “mainstream” brethren. Since the distinctions can be hard to parse (to most people, saying “mainstream poetry” is like saying “mainstream tapestry-weaving”), it’s helpful to turn to the experts.
more from the NY Times Book Review here.
I take a cassette out of a cupboard and go to the only machine I have left that can still play it. The technology feels old, for the cassette is a copy of a tape-recording made in 1968, of WH Auden reading his poems from a pulpit in Great St Mary’s Church, Cambridge. Auden’s reputation at that time was by no means at its height, but the church was packed with 2,000 attentive listeners. People were turned away, and the doors, alarmingly, were locked against them. The priest introducing Auden was Hugh Montefiore, and it was he who made the excellent recording, astonished at the amount of gin Auden had drunk before the reading (it doesn’t show at all) and astonished that he recited all his poems from memory, something Auden liked to do.
more from The Guardian here.
Also in the LRB, James Meek reviews The Looming Tower: Al-Qaida’s Road to 9/11 by Lawrence Wright.
In 1995, in Sudan, Dr Ayman al-Zawahiri put two teenage boys on trial for treason, sodomy and attempted murder, in a Sharia court of his own devising. Of the two boys, one, Ahmed, was only 13. Zawahiri, the partner in terror of Osama bin Laden, had them stripped naked; he showed that they had reached puberty, and therefore counted as adults. The court found the boys guilty. Zawahiri had them shot, filmed their confessions and executions, and put video copies out to warn other potential traitors. His Sudanese hosts were so outraged that they expelled Zawahiri and his group immediately.
It does not exonerate Zawahiri that the boys really had, as Lawrence Wright explains, tried to kill him: Ahmed by telling Egyptian spies exactly when Zawahiri was going to come to treat him for malaria; the other boy, Musab, by twice trying to plant a bomb. The assassination attempts were part of the Egyptian government’s ruthless efforts to destroy Zawahiri and his organisation, al-Jihad, after al-Jihad came close to killing the Egyptian president, Hosni Mubarak. ‘Ruthless’, in this instance, is a merited adjective. The way Egyptian intelligence recruited the boys – both were sons of senior al-Jihad members, and Musab’s father was the al-Qaida treasurer – was to drug them, anally rape them, then show them photos of the abuse and blackmail them. The boys were trapped; the photos could have led to their execution by al-Jihad as surely as their subsequent betrayal.
The story does more than illuminate the sheer vileness of the conflict that has been underway for decades between the death-loving hardcore of Islamic revolutionaries and the allies of European and American governments in the Islamic world. It underlines the centrality of Egypt to the origins and perpetuation of the conflict. One of the darker choruses of this excellent work of journalism is the success that three of those allied governments, the Saudi Arabian, Pakistani and Egyptian, have had in diverting the fundamentalist warriors away from their original prime target – them – and towards the West.
And in the LRB, Jenny Diski has a whole piece on Second Life.
Second Life is a virtual online world that exists on a vast computer somewhere in California. It has a detailed landscape, a mainland, many islands and more than one million simulated inhabitants whose actual bodies are distributed around every part of the physical world. It’s called a game though there is no goal and no end point at which a clear winner emerges and takes the prize. In this it is no different from real life (RL, as it’s referred to in SL). And it’s free up to a point, which is the entrance price of real life, though just like the here and now, if you want to own any part of the world in Second Life, you need money to buy it. There are of course differences between RL and SL. You have to opt in to SL, which is a degree of volition you don’t get in reality. This does give it a certain negative charm: at least there is one possible life to which you can just say no. It also has the edge on the real thing (for me, at least, as an über-indolent person), because being a virtual world, you don’t have to go out to get to it. I used to weep envious buckets watching whatshisname in Close Encounters of the Third Kind being taken off-world to the absolutely not here anymore by those delightful doe-eyed creatures, and Second Life seemed to offer a way of doing this without the hassle of the striving, making mountains out of mashed potato, quest thing. So I signed up.
The problem turned out to be (as it must) that Second Life is organised and inhabited by beings from the real world who have by definition very little experience of being anywhere or any way else. Being virtual is not very different from being real because the virtual place and its beings are controlled by the same old us as always. I heard the Tory politician Bill Cash on the radio the other day explaining that we needed to repeal the Human Rights Act because it was formulated and operated by idealists. I suppose it was my idealist tendencies which caused my difficulty with Second Life.
Second Life first established a news bureau to report on the virtual world. Karen Ballentine now points me to this in the BBC:
Sweden is opening an embassy in the internet fantasy world called Second Life – the first country to do so.
The project is being run by the Swedish Institute – a promotional body which works alongside the foreign ministry.
Institute director Olle Waestberg said the virtual embassy would reach many young people and provide information about Sweden.
Second Life has about three million users worldwide, who create and develop virtual characters – called “avatars”.
(I’m waiting for an embassy on Azeroth.)
Via Phineas Baxandall, Les Picker has a non-technical summary of Raymond Fisman and Edward Miguel’s “Cultures of Corruption: Evidence From Diplomatic Parking Tickets” (NBER Working Paper No. 12312), in the current NBER digest. (You can also find the July 2006 version of the paper at Ray Fishman’ page, here. Table 1 ranks countries by parking violations per diplomat.)
Approximately 1700 consular personnel and their families from 146 countries benefit from diplomatic immunity, a privilege that allowed them to avoid paying parking fines prior to November 2002. The authors examine differences in the behavior of government employees from different countries, all living and working in the same city, and all of whom can act with impunity in illegally parking their cars.
The act of parking illegally fits well with a standard definition of corruption, that is, “the abuse of entrusted power for private gain.” That definition suggests that the comparison of parking violations by diplomats from different societies serves as a plausible measure of the extent of corruption social norms or a corruption “culture.”
The authors point out that their chosen setting has a number of advantages. Most importantly, their approach avoids the problem of differential legal enforcement levels across countries, and more generally strips out enforcement effects, since there was essentially no enforcement of parking violations for diplomats during the main study period. They therefore interpret diplomats’ behavior as reflecting their underlying propensity to break rules for private gain when enforcement is not a consideration. Additionally, because U.N. diplomats are largely co-located in midtown Manhattan, the study avoids concerns of unobserved differences in parking availability across geographic settings.
The authors find that there is a strong correlation between illegal parking and existing measures of home country corruption. This finding suggests that cultural or social norms related to corruption are quite persistent: even when stationed thousands of miles away, diplomats behave in a manner highly reminiscent of officials in the home country. Norms related to corruption are apparently deeply engrained, and factors other than legal enforcement are important determinants of corruption behavior.
As the millennium drew to its dismal close, George Steiner was asked to choose the best book of the past thousand years. He named the Commedia, saying: “Dante’s totality of poetic form and philosophic thought, of ‘local universality’ and language, remains unrivaled. At a time when the notion of culture and of European culture, in particular, is in doubt, Dante is the sovereign underwriter.”
Steiner is perhaps the last of them: the grand masters of erudition who brought illumination to, and brought to the service of illumination, the histories of words, languages, and literatures, the confluences of their streams and rivers, living and dead, which led to the sea of our vast babble, the low and high of it, the poetry and cadences of it, the hidden bloodlines of it, the all of it.
more from Bookforum here.
Irène Némirovsky recently shot to fame with the posthumous publication of her unfinished novel, Suite Française (published in the UK in 2006). The circumstances of the book’s recovery attracted as much notice as its literary merits. The Jewish author had been arrested in the village where she and her family had taken refuge during the German occupation of Paris, and she died a few weeks later, in August 1942, in the infirmary at Auschwitz. The notebook manuscript of Suite Française, which she had been working on during the last months of her life, mouldered for decades in an old suitcase until discovered by her daughter.
Suite Française was not Némirovsky’s first book. During the 1930s she was one of France’s most prestigious writers, publishing ten novels before she was silenced by new laws stigmatising Jews. David Golder, her second novel, published in 1929 when she was only twenty-six, quickly established her credentials as a gifted storyteller and stylist. This book also has an intriguing back story. It seems that Némirovsky sent the manuscript anonymously to the French publisher Bernard Grasset, who was astonished, when he finally tracked down the author, to meet a fashionable, level-headed young woman, an émigrée from Yiddish Kiev. Grasset’s surprise is understandable. David Golder is bold, unsentimental and accomplished, a remarkable achievement for so young a writer.
more from Literary Review here.
Modern identity politics springs from a hole in the political theory underlying liberal democracy. That hole is liberalism’s silence about the place and significance of groups. The line of modern political theory that begins with Machiavelli and continues through Hobbes, Locke, Rousseau and the American founding fathers understands the issue of political freedom as one that pits the state against individuals rather than groups. Hobbes and Locke, for example, argue that human beings possess natural rights as individuals in the state of nature—rights that can only be secured through a social contract that prevents one individual’s pursuit of self-interest from harming others.
more from Prospect Magazine here.
From The Sunday Telegraph:
At gunpoint she was taken into a stable. Her clothes were ripped off and she was violated by four village elders. The ordeal lasted about half an hour and, when it was over, she was dragged out, semi-naked, in front of all the village men. Her father covered her with a shawl and carried her home. Mukhtar, who is also known as Mukhtaran Bibi, should then have killed herself. That was the custom. But such was her sense of outrage and injustice that she refused to commit suicide; and that act of defiance started a sequence of events that turned her into an international cause cilhbre, who was first praised and then condemned by Pakistan’s president, Gen Pervez Musharraf.
Mukhtar, an illiterate peasant, is an unlikely heroine. The crime committed against her is not uncommon in an area benighted by poverty, acts of brutality against women and the rule of thuggish overlords. But she has refused to be cowed by the pressure put upon her, by local officials right up to the president, to end her campaign against the men who raped her. She wants them to be hanged. “I will never forgive them,” she said yesterday. “They must be punished according to the law.”
This week, she publishes the autobiography she dictated, In the Name of Honour, which will again stir up the controversy over all that has happened to her. It took some persuading to get her to tell her story, and for the slight, shy 35-year-old with a lazy eye and a rare but wheezy laugh, recounting the events of that night, five years ago, is still painful.
Tad Friend in The New Yorker:
Hostility may be the engine of humor, but the broadcast networks dread its snarl. Whenever they air a truly mean sitcom, such as the long-gone “Buffalo Bill” or “Action,” the audience flees, so TV executives have learned to muffle their comedies’ barbs in “Only kidding” smirks and “You’re the greatest” hugs. Even on “Seinfeld,” which forbade hugs and learning, the core foursome reserved their mockery for outsiders, for the close-talkers and re-gifters. They were there for one another—the network made sure that we saw the love beneath.
So “The Sarah Silverman Program,” much the meanest sitcom in years—and one of the funniest—premières this week, perforce, on Comedy Central. Silverman, the telescope-necked comedienne, has had trouble finding the right showcase for the contrary elements of her persona: the post-feminist tomboy who’s sexually cocky and emotionally frigid, the eerily alert counterpuncher who’s totally self-involved. (In her 2005 concert movie, “Sarah Silverman: Jesus Is Magic,” Silverman makes out with her own mirrored image.) She is best known for jarring “The Aristocrats,” the documentary about a legendary joke, with her deadpan claim that “Joe Franklin raped me,” and for dropping the epithet “chinks” into a joke on “Late Night with Conan O’Brien.” Unlike many comedians, Silverman excavates prejudice less by digging into her own background (though in one episode she insincerely promises “full-frontal Jew-dity”) than by strip-mining the turf of other minorities, particularly blacks and gays. Her game is to throw out stereotypes in a little-girl voice and with a winsome look that suggests no offense can legitimately be taken. You might admire Silverman’s boldness, or you might feel that there’s something sneaky in her appropriation of slurs that never wounded her—that it’s the standup equivalent of the person who cuts in line and then can’t believe you object.
Over at Adventures in Science and Ethics, Janet Stemwedel is hosting an interesting discussion about the ethics of the new PETA ad (nudity warning).
As hard as it may be, please put aside your pre-existing view of PETA for the moment and consider this strategy:
You’re running a group that is committed to bringing people over to position X. For various reasons, there’s a big population that is quite accustomed to not even thinking about the issues around position X.
Do you try to grab them with a reasoned argument in favor of position X? That might work for the part of the population who pay attention to reasoned arguments. But there are many people who have gotten surprisingly proficient at tuning out reasoned arguments. (Remote controls and computer mouses make it so easy for them to drift off to something less tiring.)
So you have to get their attention with something they don’t see every day — perhaps a young woman taking off her clothes. Then, once you have their attention, you can try to engage them on position X (and that may involve a bit of shock and/or emotional appeal, too).
As the head of this group trying to bring as many people as possible over to position X, should you be at all concerned that your attention-grabbing strategy is likely to alienate a good number of the people who came over to position X on the basis of reasoned arguments (say, because the attention-grabber runs deeply counter to position Y, which many of the folks who were rationally persuaded of the goodness of position X also hold)?
Or, is it fine to count on the reasoned arguments to keep the people who also hold position Y firmly in support of position X as well?
In 1955, after completing my studies at Warsaw University, I began working at a newspaper called Sztandar Mlodych (The Banner of Youth). I was a novice reporter, and my beat was to follow letters to the editor back to their point of origin. The writers complained about injustice and poverty, about the fact that the state had taken their last cow or that their village was still without electricity. Censorship had eased—Stalin had been dead for two years—and one could write, for example, that in the village of Chodów there was a store but its shelves were always bare. While Stalin was alive, one could not write that a store was empty: all stores had to be excellently stocked, bursting with wares. So this was progress.
more from The New Yorker here.
In bitterlemons.org, a debate about “Future vision of the Palestinian Arabs in Israel”, a document by National Committee of the Heads of Arab Local Councils and endorsed by the Supreme Follow-up Committee of the Arabs in Israel. A Palestinian view, Ghassan Khatib:
This document is inspired not only by the inequality Palestinian citizens of Israel face, but also by the Israeli Jewish insistence–an insistence that came to the surface most clearly during the years of the peace process–that Israel should be recognized as a Jewish state.
How can this be, leaders of the Palestinian community in Israel asked, when one-fifth of the population is non-Jewish? Would it not be more democratic and civilized if Israel considered itself a state of all its citizens?
But the document, which has created a lot of controversy in Israel with often shrill reactions, is significant for more than one reason.
And an Israeli view, Yossi Alper:
For nearly all Israeli Jews it is also a profoundly disturbing document. Yet this should not come as a surprise. After nearly 60 years of neglect, prejudice and poor treatment on the part of the Israeli establishment, and despite repeated violent incidents and policy-oriented research efforts that sounded a sharp warning, the Arabs of Israel are declaring their demand for a full-fledged bi-national state (“consociational democracy”) that would give Arabs a veto over Israel’s Jewish content and symbols.
That Israel’s Arabs demand equal land and education rights is of course fully justified. But this document goes much further. Most disturbing of all–and here the years of neglect cannot be blamed–the document can be understood to bring its authors into line with those in the Arab and Islamic world who refuse to accept the existence of a Jewish people at all, much less one with legitimate roots in the Middle East.