Monthly Archive for August, 2008

Being a patient

Published
by
Susan Greenberg
on August 29, 2008
in Arts and culture and Health and medicine
. 7 Comments

This is the second in a series related to my cancer treatment. The aim is to talk about the personal experience of illness in a broadly analytical way. The first posting looked at blood, and how its condition affects our mental state.

This time I am focusing on patienthood. When you have a serious illness, being a patient is a major occupation, and not just because of the time taken up by medical matters – although, god knows your diary commitments, all of them once Very Important, go through a rapid reclassification after diagnosis. Patienthood also involves, potentially, a change in one’s entire take on life.

One reason is that you receive massive exposure to the way doctors think, and they think in a very particular way. This is partly because of their training and specialist knowledge, but it is also simply because medicine is what they do for a living.

The things that make doctors happy are not always the things that the patient thinks of. When I was first diagnosed, doctors were happy that my tumour tested strongly for hormone receptors, because that meant they could throw an extra treatment at it. I was not happy, because I had a freaking tumour.

Doctors think in general categories rather than individual narratives. Naturally they wish the patient well, but other things are driving them. They want a good outcome – as measured against others in their field – so that their own reputation, and that of their hospital, is enhanced. They value skill and craftsmanship. I do not begrudge this. When the ultrasound specialist first spotted my tumour, after another hospital had missed it entirely, a flash of professional pride passed across her face. At one level, she was pleased. And why wouldn’t she be?

It is not just doctors who think a certain way, but medical establishments in general. When you become a patient, you submit to the system with both your mind and body. There has to be a system, of course, or nothing would get done, but when the system is deficient you end up being there for their benefit, rather than the other way around. It is a fine judgment to make, when to submit and when to challenge the system.

The everyday meaning of patient is ‘a person receiving medical treatment’ but as one person commented in a previous posting, its roots are in the Latin pati, to suffer.  A patient is therefore also defined as someone who ’suffers and endures the actions of others’. If you are a patient patient, you do it without complaint. 

The suffering results not just from surgery and medication, but from all kinds of smaller, regular invasions. My own bugbear is the canula: a piece of plumbing inserted into the vein which provides a port into the body’s interior. The insertion is painful and if the first attempt does not succeed, results in multiple bruises. It has an effect on the mind as well as body: the canula harpoons the patient’s private space and signals clearly to the world that one is enduring the actions of others.

There is a lot of information that medical people don’t think to volunteer, and if you don’t ask the right question, you may not get the answer. But you need information to know what questions to ask. So you become informed, using terms unimagined a short time ago. You start to make the same distinctions and comparisons as specialists.

The main change in outlook as a patient is the attitude to risk. I will look at this in the next posting of the series. Meanwhile, feedback is very welcome.

Denver Dispatches - Erik Tarloff - 29 August

Published
by
Erik Tarloff
on August 29, 2008
in United States
. 4 Comments

       This will be my final post, and it will, of necessity, be short, since I have to leave for the airport soon.

        My wife and I watched Obama’s acceptance speech in Al Gore’s sky box.  The atmosphere, like the atmosphere in the other sky boxes Laura and I visited last night, was festive and congenial.  Nevertheless, one had to wonder what Gore was thinking and feeling.  His own speech had I thought, been excellent — it was one of the most serious and principled of the convention — and the love that welled up in that mammoth crowd (said to be 84,000 strong) when he made his entrance, and the approval that greeted his every salient point, must have been gratifying to him.  But bitter-sweet as well.  History has been capricious and sometimes downright nasty to Al Gore.  However, although the Democratic Party can be tough on its also-rans, subjecting them to scorn and recrimination, Al Gore, after a season in Purgatory, has seen his reputation redeemed.  He seemed to be a better speaker, too, partly, no doubt, as at the last convention, because he was forced to go faster than usual by the short amount of time he had been allotted.  As my friend Chris Caldwell observed in 2004, Gore “had to speak at the speed of his intelligence.”  Which meant stepping on applause lines time after time, but also avoiding the syrupy sanctimoniousness that sometimes mars his standard speaking style.

       Obama’s speech ws a triumph.  It wasn’t as eloquent or as elevated as the one he delivered in Boston four years ago, the one that thrust him onto the world’s stage.  This one had a different purpose, setting out to say three simple things:  1) I’m like you, I’ve had the same problems you’ve had, I know what you’re going through;  2) Despite my elegant appearance and demeanour, I’m one tough son of a bitch, and if John McCain doesn’t know that yet, he will before this campaign is over;  and 3) I may be untraditional, but a president can look like me, and I can look and feel just like a president.  And he conveyed all three things magnificently.  I don’t imagine there’s much happiness in Republican circles this morning.  Whatever displays of bravado they’ve been managing for the benefit of the press and their own supporters, they know there’s only one way for them to beat this guy, and win or lose, it won’t be pretty.

       Because at this stage, there’s only one genuinely unresolved issue in the campaign.  And that issue is race.  The country despises Bush, both the man and his policies.  Over the last two years, polling results consistently confirm this.  The Democrats enjoy a large majority in terms of public support.  Obama’s gifts are manifest, his youth and energy compelling, his rise phenomenal.  Meanwhile, John McCain has run a campaign that has bordered on the incompetent, has policy prescriptions that veer toward the incoherent, and seems to have aged visibly and alarmingly in the eight years since his gallant first campaign for the presidency.  If Obama were a white man — a white southern governor, say — this contest would already be over.  So the only question remaining is whether Americans are ready to make what Norman Mailer would have called an existential choice, to risk an outcome without precedent that will redefine the country and the world.  I don’t know the answer.  But I do know that if we wake up on 5 November to learn that John McCain is the president-elect, the depression that follows will be abiding;  something noble and courageous and large-spirited in the United States will be gone, hopelessly lost for a generation.

Denver Dispatches - James Crabtree - The Main Event

Published
by
James Crabtree
on August 28, 2008
in United States
. 0 Comments

I can’t add much to Erik’s thoughts about last night here in Denver. After two days of kvetching and other nervous anxiety, it really did feel as if the convention blew off the cobwebs. Bill Clinton was superb. The crowd’s outpouring of affection was extraordinary;  a five-minute standing ovation holding up the start of his speech as if to remind him, and themselves, how he is adored. Biden also was stirring, if not quite as good. His attacks on McCain were forceful, his life story compelling, and his aged mother charming. Walking out you could feel the sense of relief in the crowd.

That said, anxiety still remains. This morning much of the papers discuss whether the seemingly enlightened decision to move Obama’s speech to a giant stadium will actually work. Steps are being taken, says the New York Times, to try and make the stadium look less stadium-like, better to play down Republican attacks on Obama’s glitzy star quality. Meanwhile, people are beginning to think about what happens after tomorrow, when McCain will announce his Vice Presidential pick in the morning, and the much feared Republican attack machine will limber up for a week of gleeful Obama bashing. (This piece in the Politico, in passing, gives a deeply intriguing overview of how McCain’s choice, thought most likely to be Mitt Romney, has been made more difficult in recent days.)

Maureen Dowd wrote an unusually measured column in the last few days, claiming that the tension felt in Denver was all down to the remaining, dormant enmity between the Clinton people and the rest. My sense is different. The delegates gather here care less about the Clintons, and more about how the Republicans can steal a seemingly unstealable election. Bill Clinton wowed them last night because he looks like, and is, a winner. Democrats don’t have many like him. Losing twice to George Bush has left an almost psychological doubt about whether the party can win. They desperately want Obama to join the winner’s list, but still aren’t sure he can. And, as this cartoon from yesterday’s Washington Post nailed, as the week goes on, the reality dawns that the election it isn’t just about Obama, his wow factor, and 70,000 fans in a stadium. Even if this evening goes well - and, i predict, it will  - it is next week in St Paul that provides the true test of this week’s success.

WAPO cartoon

Denver dispatches - Erik Tarloff - 28th August

Published
by
Erik Tarloff
on August 28, 2008
in United States
. 2 Comments

Before I begin in earnest, I do want to point out that my prediction in my first post in this series, about Hillary Clinton’s strategy for the Wednesday night rollcall (interrupting the vote to move the nomination be declared unanimous by acclamation), proved to be 100% accurate.  Forgive the self-advertisement, but having so spectacularly failed to anticipate the quality of her Tuesday night speech, I’m aware my bona fides need a little burnishing, and if I don’t do the burnishing, who will?

Up through yesterday afternoon, the general consensus was that this convention was mediocre or worse.  The Clintons, it was widely believed, and as I’ve reported in these blogs, were angry and disconsolate, Hillary’s supporters were stubbornly recalcitrant when it came to shifting their loyalties, the PUMAs were threatening trouble on the convention floor and off, and Obama’s candidacy was failing to connect with the American public.  Even Hillary’s terrific performance on Tuesday night was adduced as evidence of the convention’s inadequacy, although the logic of that position wasn’t clear to me;  some commentators actually said the speech was “too good,” that she had set the bar for Obama too high, that she had primarily once again shifted everyone’s attention to herself.  Maureen Dowd even wrote in The New York Times that the mood of the convention was dominated by raw hatred.

What a difference a day makes.

Continue reading ‘Denver dispatches - Erik Tarloff - 28th August’

Denver Dispatches - Biden’s Task

Published
by
James Crabtree
on August 27, 2008
in Uncategorized
. 0 Comments

With something approaching closure behind it, the Democratic Convention proper begins today. Hillary Clinton’s speech last night was simultaneously impressive and uninteresting. Not creating interest was its job, and it succeeded. No hint of being less than 100% loyal. No thinly or thickly veiled jibes about who the real choice should have been. No hostages to talk show talking points. As a result this morning’s front pages all speak of unity. Job Done.

And yet the sense that this convention hasn’t moved beyond third gear remains. On the one hand all of the speeches that matter - Teddy Kennedy, Michelle Obama, and Clinton herself - have been as good, or better, than could have been expected. On the other, none have managed properly to lay out either a vision for Obama’s presidency, or offer up a new critique of the Republicans. The latter point was especially evident in supporting speeches last night. Montana Governor Brian Schweitzer had the evening’s only good line - “we simply can’t drill our way to energy independence, even if you drilled in all of John McCain’s backyards, including the ones he can’t even remember”. But that apart, pickings were thin. Former Virgina Governor Mark Warner, once fancied as a potential presidential candidate himself, delivered a long-winded and often bafflingly incoherent speech, which i’d hazard a guess was meant to be about the economy. None of the other speakers managed to move their contributions beyond platitudes. All were ignored by a crowd more intent on talking with each other than listening to the stage. More worrying for the Democrats, none managed to come up with fresh or interesting way to biff their opponents. The lines seemed stale. “We can’t afford more of the same” and “John McCain is out of touch”, may well be the right messages, but they were delivered last night by politicians on autopilot. None shed the impression that something isn’t quite clicking.

Which brings us to Joe Biden’s speech, later tonight. After two days of throat clearing his delicate task is both to to drip foreign policy gravitas, and bring a new zing to lacklustre attempts to attack McCain. Including a hint of the campaign’s slightly mysterious economic message - again picked up in the New York Times this morning - would be an added bonus. Yet Biden’s position is trickier still. Given the option, my sense is that the campaign would rather not have picked a running mate at all. This campaign is fundamentally and personally about Obama - his charisma, his embodiment of a new future, his now familiar message off change. Biden was in many ways a deeply conservative choice of running mate, and as yet it isn’t clear how he fits. So, he must try to craft a role for himself too - as a gaffe-free mix of elder statesman and attack dog, who adds something to the ticket without distracting from a campaign whose strategy, for better or worse, is Obama-centred.

Prospect’s new issue - flirting with Stalin

Published
by
Tom Nuttall
on August 27, 2008
in Europe, In the news and Inside Prospect
. 10 Comments

Our cover story this month is an uncompromising attack on Russia’s intelligentsia, the liberals and intellectuals who after 1991, argues Arkady Ostrovsky, were presented with a one-off opportunity to drag their country into the modern world. Instead, they got mired in irony and bad art, and were all too easily seduced by Vladimir Putin’s neo-imperialist vision of Russia’s future and his exploitation of public nostalgia for Soviet greatness. Communism is dead, and will not return. But the absence of a liberal voice in Russia means that the most powerful force in that country, as the Georgians have just discovered to their cost, is likely to remain old-fashioned belligerent nationalism.

Let us know what you think in the comment boxes below.

We happy Danes, we band of brothers

Published
by
Tom Chatfield
on August 27, 2008
in Europe, Inside Prospect and Uncategorized
. 3 Comments

Hamlet, the most famous Dane of them all, was both fictional and glum. Yet, Sally Laird argues in her Opinion piece for the latest issue of Prospect, real Danes in modern Denmark are the happiest people in the world (according to the best recent investigations into such matters).

They’re not the most economically successful, or the cleanest-living, or the most demanding. But a national emphasis on shared experiences and a “gift for being properly ceremonious without being solemn” have created a society happier simply to be itself than anywhere else on earth.

It’s also a place that might, just, remind the rest of us that man can hand on more than misery to man—given half a chance and a properly assembled plate of herring sandwiches.

A noble death?

Published
by
Tom Chatfield
on August 27, 2008
in Inside Prospect
. 37 Comments

One piece in our latest issue that’s sure to provoke debate is Alexander Fiske-Harrison’s account of contemporary bullfighting in Spain. It’s a topic close to the author’s heart, and he eloquently defends the modern spectacle of the bull-ring as an art form while acknowledging the moral compromises inherent in a festival that has slaughter at its heart.

As Fiske-Harrison has explored in his previous postings on this blog, what it means to behave “well” towards animals is a very different business to what it means to behave well towards other people. Given, however, that our behaviour towards animals does not simply exist in an ethical vacuum, most modern societies find themselves in a peculiar position: horrified by bull-fights or fox hunts, yet economically predicated on the industrial rearing and slaughter of many millions of animals.

Can such contradictions be reconciled? Can we justify our pleasure in either the spectacle of a bullfight or the savour of a steak dinner? As ever, let us know your thoughts below.

Nuclear power? Not likely

Published
by
Tom Nuttall
on August 27, 2008
in Energy, Environment and Inside Prospect
. 7 Comments

Pressing ahead with its plans for the next generation of nuclear power stations, the government has repeatedly pledged that no taxpayers’ money will be spent on subsidising nuclear construction or bailing out debt-ridden energy companies. But, says Tom Burke in the new issue of Prospect, no one should be blinded to the fact that the economics behind nuclear power remain lousy—and the government’s plans will fail. If we are serious about climate change and want to ensure security of energy supply, we need to focus on carbon capture and storage technologies.

Why Africa needs a new democracy

Published
by
Tom Nuttall
on August 27, 2008
in Africa
. 7 Comments

Richard Dowden, writing in the new issue of Prospect, argues that the latest round of electoral failues in Nigeria, Kenya and now Zimbabwe shows that western-style “winner-takes-all” democracy is not suited to African states. Competing ethnic and linguistic groups, arbitrary borders—the legacy of colonial rule—and a lack of democratic tradition create an climate unsuited to electoral systems in which one group takes complete power at the expense of others. What is needed instead, suggestes Dowden, is a new, “African” democracy, perhaps one that approaches a form of proportional representation in which all groups are accorded a seat at the top table.

Let us know your thoughts below.

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