I didn’t mention that I had my first MRI during my recent hospitalization. At least I think I did. When my physician told me that he had ordered the study for me I laid out a scenario for him that included my going completely out of my mind with an attack of acute psycho-killer claustrophobia. This is an as yet undescribed medical condition of which I would have been the first example in the universe.
I told the good doctor that if he put me in that tube without medication of some kind that I wouldn’t be responsible for what transpired, but I sensed that it would not be pretty, and that there would be a need for some significant cleaning up of the MRI room after whatever happened had happened.
Dr. Thompson paled, recoiled, and then scribbled “Versed” on the order sheet. As a result, I recall being rolled onto the elevator as we were heading for the radiology department, but I have no memory at all of being rolled off the elevator. What happened during my drug-induced blackout … I have to take people’s word that I actually had the study done.
I’m not particularly afraid of pain, although I will avoid it when I can, but try to confine me in a small space and you will find yourself looking at a different man indeed. My transformation from Dr. Jon to full-bore Mr. Hyde can occur in an eyeblink.
I dimly recall an episode when I was very young where I was rolled up in a small rug, as a joke. I can’t remember who did it or any other particulars, but the absolute sense of helplessness and of not being able to breathe properly were powerful enough to still affect me today. The recent horror stories in the news of the “I Can’t Breathe” variety … I am unable to read them without rousing that deep fear, down there in the sub-basement of my psyche.
Oh, the MRI itself? It showed a tiny area of injury which may slightly impair my ability to order from menus in Albanian restaurants. I can live with that.
The Science section of the Times of New York had something interesting to say this morning. It’s about a virus – don’t worry, this is a good one – that causes a very destructive plant fungus to become a very nicely behaved fungus indeed. Botanists are trying to figure out why it does this at the same time as they study how.
We do live in the most interesting world, don’t we? It’s pretty obvious that while our knowledge is impressive, our ignorance is on a much larger scale. But hey, don’t let it get you down. It means that there will always be something new to learn. Like today.
From The New Yorker
Memento Mori Department
As my own memory process becomes gradually more creative over time, quite possibly making up stuff when it can’t come up with the true facts, there are interesting little blips here and there that I know, positively know, are true. Maybe.
Johnny Nash (1940-2020)
One of those blips is the attachment of a piece of music to a particular event in my life. It happens all on its own, and those attachments are indelible. In 1974 I packed up my family in Buffalo NY and went west, driving across a good-sized chunk of Canada on our way to the Upper Peninsula of Michigan. On one of those travel days the song “I Can See Clearly Now” came over the car radio. The song was not new but was still getting a bit of airplay at the time. Johnny Nash sang it and it was my introduction to reggae music. Nash passed away yesterday, but each time I hear the tune I can vividly revisit a Canadian morning, zipping through what seemed like endless forests in Ontario.
Eddie Van Halen (1955-2020)
When Mr. Van Halen ran up against the limits of what he’d learned about guitar playing, why, he’d invent new ways to do it. His superpower was fingers that could move faster than those of mere mortals, almost too fast to see. What came out of his art and leadership was a passel of very memorable songs over a career that spanned nearly thirty years. One of my favorites was “Dance The Night Away,” which came out in 1979, as I was preparing to pull up roots and haul that same family to South Dakota. Here is a video of the boys doing their rock and roll thing, with all the excess and theatricality we came to expect of them.
Well, the world is certainly going to hell in a handbasket, whatever a handbasket is. Here is a pic of two women who shared the Nobel Prize for chemistry for using something called Crispr to engineer DNA. (Bravo, I say, and is there any possibility that I might have some of my genetic code re-engineered to make me taller and better-looking? Or has my Crispr moment come and gone?)
And last night a female candidate for vice-president who is also a person of color did a number on her opponent, who is male and as white as white can be. Women have forgotten their place entirely and the world is upside down as a result.
And finally, there is the matter of the recent editorial of the New England Journal of Medicine, which all of the journal’s editors signed, and which damns the present administration’s job performance re: the novel coronavirus.
Now, the NEJM almost never takes political positions, which makes this so very unusual. Its attack is based on the fact that our Covid response, as a nation, has been a colossal public health failure. I republish the editorial here:
Covid-19 has created a crisis throughout the world. This crisis has produced a test of leadership. With no good options to combat a novel pathogen, countries were forced to make hard choices about how to respond. Here in the United States, our leaders have failed that test. They have taken a crisis and turned it into a tragedy.
The magnitude of this failure is astonishing. According to the Johns Hopkins Center for Systems Science and Engineering, the United States leads the world in Covid-19 cases and in deaths due to the disease, far exceeding the numbers in much larger countries, such as China. The death rate in this country is more than double that of Canada, exceeds that of Japan, a country with a vulnerable and elderly population, by a factor of almost 50, and even dwarfs the rates in lower-middle-income countries, such as Vietnam, by a factor of almost 2000. Covid-19 is an overwhelming challenge, and many factors contribute to its severity. But the one we can control is how we behave. And in the United States we have consistently behaved poorly.
We know that we could have done better. China, faced with the first outbreak, chose strict quarantine and isolation after an initial delay. These measures were severe but effective, essentially eliminating transmission at the point where the outbreak began and reducing the death rate to a reported 3 per million, as compared with more than 500 per million in the United States. Countries that had far more exchange with China, such as Singapore and South Korea, began intensive testing early, along with aggressive contact tracing and appropriate isolation, and have had relatively small outbreaks. And New Zealand has used these same measures, together with its geographic advantages, to come close to eliminating the disease, something that has allowed that country to limit the time of closure and to largely reopen society to a prepandemic level. In general, not only have many democracies done better than the United States, but they have also outperformed us by orders of magnitude.
Why has the United States handled this pandemic so badly? We have failed at almost every step. We had ample warning, but when the disease first arrived, we were incapable of testing effectively and couldn’t provide even the most basic personal protective equipment to health care workers and the general public. And we continue to be way behind the curve in testing. While the absolute numbers of tests have increased substantially, the more useful metric is the number of tests performed per infected person, a rate that puts us far down the international list, below such places as Kazakhstan, Zimbabwe, and Ethiopia, countries that cannot boast the biomedical infrastructure or the manufacturing capacity that we have. Moreover, a lack of emphasis on developing capacity has meant that U.S. test results are often long delayed, rendering the results useless for disease control.
Although we tend to focus on technology, most of the interventions that have large effects are not complicated. The United States instituted quarantine and isolation measures late and inconsistently, often without any effort to enforce them, after the disease had spread substantially in many communities. Our rules on social distancing have in many places been lackadaisical at best, with loosening of restrictions long before adequate disease control had been achieved. And in much of the country, people simply don’t wear masks, largely because our leaders have stated outright that masks are political tools rather than effective infection control measures. The government has appropriately invested heavily in vaccine development, but its rhetoric has politicized the development process and led to growing public distrust.
The United States came into this crisis with enormous advantages. Along with tremendous manufacturing capacity, we have a biomedical research system that is the envy of the world. We have enormous expertise in public health, health policy, and basic biology and have consistently been able to turn that expertise into new therapies and preventive measures. And much of that national expertise resides in government institutions. Yet our leaders have largely chosen to ignore and even denigrate experts.
The response of our nation’s leaders has been consistently inadequate. The federal government has largely abandoned disease control to the states. Governors have varied in their responses, not so much by party as by competence. But whatever their competence, governors do not have the tools that Washington controls. Instead of using those tools, the federal government has undermined them. The Centers for Disease Control and Prevention, which was the world’s leading disease response organization, has been eviscerated and has suffered dramatic testing and policy failures. The National Institutes of Health have played a key role in vaccine development but have been excluded from much crucial government decision making. And the Food and Drug Administration has been shamefully politicized, appearing to respond to pressure from the administration rather than scientific evidence. Our current leaders have undercut trust in science and in government, causing damage that will certainly outlast them. Instead of relying on expertise, the administration has turned to uninformed “opinion leaders” and charlatans who obscure the truth and facilitate the promulgation of outright lies.
Let’s be clear about the cost of not taking even simple measures. An outbreak that has disproportionately affected communities of color has exacerbated the tensions associated with inequality. Many of our children are missing school at critical times in their social and intellectual development. The hard work of health care professionals, who have put their lives on the line, has not been used wisely. Our current leadership takes pride in the economy, but while most of the world has opened up to some extent, the United States still suffers from disease rates that have prevented many businesses from reopening, with a resultant loss of hundreds of billions of dollars and millions of jobs. And more than 200,000 Americans have died. Some deaths from Covid-19 were unavoidable. But, although it is impossible to project the precise number of additional American lives lost because of weak and inappropriate government policies, it is at least in the tens of thousands in a pandemic that has already killed more Americans than any conflict since World War II.
Anyone else who recklessly squandered lives and money in this way would be suffering legal consequences. Our leaders have largely claimed immunity for their actions. But this election gives us the power to render judgment. Reasonable people will certainly disagree about the many political positions taken by candidates. But truth is neither liberal nor conservative. When it comes to the response to the largest public health crisis of our time, our current political leaders have demonstrated that they are dangerously incompetent. We should not abet them and enable the deaths of thousands more Americans by allowing them to keep their jobs.