Text Patterns - by Alan Jacobs

Friday, April 30, 2010

parents and children

Michael Norris, “an American publishing expert,” says, “Parents have too much of a role in deciding which books their child is going to read. It is turning children off. They should let them choose.” This is plausible. Let’s look into this some more.

First, he argues, reading should never be described with "work words" which make it seem like a chore. Too many families, Norris suggests, have fallen into the trap of stereotyping reading as a "good" activity and digital or online game playing as "bad". Instead, it is important to let reading become associated with pleasure and achievement, just as game playing is.

I like that thought. But then Norris goes on to say,

"The average child consumes a ridiculous amount of media in any given day, from television, videogame content and audio content, so new reading devices, such as the iPad, are not going to have as great an impact on the younger market as people hope. When they are not playing games or listening to music, the majority of a young adult's time is spent on the phone, talking or receiving and sending text messages. Books don't even factor into their thinking."

Seems generally true. But how can parents cause books to factor in to their children’s thinking without affirming that books are “good”?

Make sure children talk directly to a librarian or a bookseller, while parents stand well back. Looming over a child takes all the fun out of their discoveries, he says. Parents should allow children to choose their own reading material.

"Even if a mother or father is just standing with the child when the bookseller asks them what they like to read, we have found that the child will give an answer they think their parent wants to hear. It will not be the same answer they would give alone," said Norris. . . .

It is also important, he added, for parents not to enthuse about books that they loved as children: "Parents often say, 'When when I was your age...', and it tends to put off children too."

This seems to presume an oddly, strongly oppositional relationship between parents and children. Should parents really be forbidden to introduce books to their children that they themselves loved? Isn't it at least possible that one bond between parent and child can be shared love of a book? It seems rather closed-minded for a “publishing expert” not to take that option into account. My son Wes was indifferent to some of the books I recommended to him — or, earlier, read to him — but rather than ceasing to recommend books, I simply made sure he knew that his response was just fine and that he was not expected to like something just because I did. And then there are other books I asked Wes to read that we both love and have talked about often over the years, to our mutual delight. Should I really have refused to recommend those books to him because of the chance that he wouldn't care for them?

Maybe we can understand Norris’s attitude better when we read this:

"My father forced me to read The Hunt for Red October by Tom Clancy when I was much too young and I have never read another Clancy since," said Norris.

Ah, well, there’s your problem.

Thursday, April 29, 2010

commonplace copying

I’m not going to try to summarize this provocative talk by Steven Johnson — just go read it. I am also not going to mention that I have had a few things to say about commonplace books myself. (See what I did there?) But just two comments:

1) I think Johnson pushes a point way too far when he runs a Google search for “journalism” and then writes, “What I want to suggest to you is that, in some improbable way, this page is as much of an heir to the structure of a commonplace book as the most avant-garde textual collage. Who is the ‘author’ of this page? There are, in all likelihood, thousands of them. It has been constructed, algorithmically, by remixing small snippets of text from diverse sources, with diverse goals, and transformed into something categorically different and genuinely valuable.” Genuinely valuable, maybe, but almost the opposite of the commonplace book. The key point about my commonplace book is that it is mine, culled from my reading, full of selections made by me according to my beliefs, commitments, and interests. A Google search has value, but none of that kind of value — even when Google is reminding me of my search history.

2) Later in the talk Johnson makes a very, very good point about what’s happening to the text as certain digital architectures — I’m looking at you, iPad — become more closed. He provides a screenshot and then says,

This, as you all probably know, is Apple’s new iBook application for the iPad. What I’ve done here is shown you what happens when you try to copy a paragraph of text. You get the familiar iPhone-style clipping handles, and you get two options “Highlight” and “Bookmark.” But you can’t actually copy the text, to paste it into your own private commonplace book, or email it to a friend, or blog about it. And of course there’s no way to link to it. What’s worse: the book in question is Penguin's edition of Darwin’s Descent of Man, which is in the public domain. Those are our words on that screen. We have a right to them.

Yes. And here’s a related point: “Interestingly, the Kindle – even the Kindle app for the iPad – does allow you to clip passages and automatically store them on a file that can be downloaded to your computer, where you can post, archive, forward, tweet to your heart’s content.” This is true, but a little misleading. As far as I know, the only way to access your “Clippings” file is to connect your Kindle to your computer via USB. Using the Kindle apps for Mac, PC, iPhone, or iPad you can't copy text — on the Kindle for Mac app (at least right now) you can't even select text and highlight it. So Amazon and Apple alike aren't doing much to facilitate copying for the purpose of quotation, or even commonplace-book-style selection.

Which I guess is okay — after all, one of the guiding ideas of the original commonplace book was that the reader, by laboriously copying out the wisdom of some learned author, was assuming some of that author’s wisdom. Maybe we shouldn't be copying and pasting but rather writing our quotations by hand. If it was good enough for John Milton. . . .

Wednesday, April 28, 2010

is this a dagger I see before me?

Jennifer McDonald writes about Ander Monson’s Vanishing Point:

“This is a book,” Monson writes on his first page. “It is fixed in time, in space, in print, an artifact.” His brain, however, represents “flux, motion, … thinking exploding everywhere.” So he is not satisfied with the book’s limitations, with the way its “fixed” nature implies that here, in the book, is where the thinking ends. He seeks to find a way to take the reader beyond the book. And so he has employed daggers (†).

“OK,” he writes. “Each dagger indicates an instance of redirect, a bubbling-over instance, where, for one of many reasons, I have more information, a further reflection, more thinking on the subject that has either gone on past the boundaries of the object, the fixity of the book. … The daggers sometimes lead to things that exceed the capacity of footnotes. Some of them have video. Some images. Some evolving text.” The daggers lead to Monson’s Web site.

As you read, then, you find daggers appended to words and phrases like “the memory of vanilla” (as in ice cream), “mother” (as in Monson’s), or “diversity of the city” (as in Grand Rapids, Mich.). I happened to be reading his book while riding subway, and I have to say, it was an odd feeling. Each time I saw a dagger, I had the impulse to go explore; I found myself wishing I were reading with my laptop at the ready, so I could stop and see where these daggers wanted me to go. I imagined a picture of Monson’s mother, a chart showing the racial breakdown of Grand Rapids. And “the memory of vanilla”? I wasn’t sure. Would it be a poem? A photograph? A video of Monson enjoying an ice cream cone? (In the future, would the technology exist in which an e-reader might shoot a whiff of vanilla at my face, like some shopping-mall perfume spritzer?)

This makes me wonder what would be the best way to experience Monson’s book. Should it be read online, so that the daggers become real followable links? Should the reader hold the book next to a laptop, so that the page and the screen can be consulted in rapid sequence? Or is McDonald’s experience — knowing that there are links, but being unable to follow them while reading — really the best one? After all, as the poet says, hyperlinks clicked are sweet, but those unclicked are sweeter.

Tuesday, April 27, 2010

the wheel of time

I'd love to put this photo on the cover of my book on reading.

Monday, April 26, 2010

the wisdom of Sydney Smith

If you ever suffer from low spirits or melancholy, you might consider the wise advice of Sydney Smith:

  1. Get into the shower bath with a small quantity of water at a temperature low enough to give you a slight sensation of cold, 75° or 80°.
  2. Short views of human life — not further than dinner or tea.
  3. Be as busy as you can.
  4. See as much as you can of those friends who respect and like you, and of those acquaintances who amuse you.
  5. Attend to the effects tea and coffee produce upon you.
  6. Avoid poetry, dramatic representations except comedy, music, serious novels, sentimental people, and everything likely to excite feeling and emotion, not ending in active benevolence.
  7. Keep good blazing fires.
  8. Be firm and constant in the exercise of rational religion.

I have also always been partial to the advice Smith gave to a young girl of his acquaintance:

Lucy, dear child, mind your arithmetic. You know, in the first sum of yours I ever saw, there was a mistake. You had carried two (as a cab is li­censed to do) and you ought, dear Lucy, to have carried but one. Is this a trifle? What would life be without arithmetic but a scene of hor­rors?

You are going to Boulogne, the city of debts, peopled by men who never understood arithmetic; by the time you return, I shall probably have received my first paralytic stroke, and shall have lost all recollection of you; therefore I now give you my parting advice. Don’t marry any body who has not a tolerable understanding and a thousand a year, and God bless you, dear child.

Friday, April 23, 2010

those pathetic youngsters

From Yahoo News:

Researchers at the University of Maryland who asked 200 students to give up all media for one full day found that after 24 hours many showed signs of withdrawal, craving and anxiety along with an inability to function well without their media and social links.

Susan Moeller, the study's project director and a journalism professor at the university, said many students wrote about how they hated losing their media connections, which some equated to going without friends and family.

"I clearly am addicted and the dependency is sickening," said one student. "Between having a Blackberry, a laptop, a television, and an iPod, people have become unable to shed their media skin."

Moeller said students complained most about their need to use text messages, instant messages, e-mail and Facebook.

"Texting and IM-ing my friends gives me a constant feeling of comfort," wrote one of the students, who blogged about their reactions. "When I did not have those two luxuries, I felt quite alone and secluded from my life."

Thank God that I — an educated, thoughtful, mature person — need never worry about such addictions.

But seriously: there is a tradition of human reflection in which being in the midst of busyness is to be "secluded from your life," and to be alone is to find that life. Just in case we've forgotten.

dubious assertions, thoughtful reflections

Craig Mod says:

Previously, reading was an act of solitude by design, with most residue of the process locked in a book's physicality. This is no longer true.

Why do people say things like this? (I know, I always ask that question. But really: Why do people say things like this?) The overwhelming majority of readers read paper codexes. Maybe someday they won't, but today they do, and simply asserting that Everything Is Different Now doesn't change any of the facts. Sigh.

Fortunately, Mod goes on to say many other things that are interesting and valuable, and his essay has a number of illuminating links. He concludes,

I'm excited about digital books for a number of reasons. Their proclivity towards multimedia is not one of them. I’m excited about digital books for their meta potential. The illumination of, in the words of Richard Nash, that commonality between two people who have read the same book.

We need to step back for a moment and stop acting purely on style. There is no style store. Retire those half-realized metaphors while they're still young.

Instead, let’s focus on the fundamentals. Improve e-reader typography and page balance. Integrate well considered networked (social) features. Respect the rights of the reader and then — only then — will we be in a position to further explore our new canvas.

Very much worth a read.

Thursday, April 22, 2010

the desire of the Sybil

It’s generally understood that books are read differently in different generations: cultural changes bring themes and images to the forefront that might have been invisible, or wholly subdued, to a previous generation of readers. It took the rise of Romanticism and its associated revolutions to cast Milton’s Satan in a heroic light; existentialism made King Lear seem to be, not some strange figure from an obscure past, but our contemporary.

This can happen to lesser works as well. Recently I was re-reading The Lord of the Rings and began to wonder how it might be read fifty years from now, assuming that our scientists are able to extend the human lifespan significantly. Might it not be that Bilbo and Gollum will become more significant figures in the minds of future readers? And might not the Ring itself take on a different aura of meanings?

Think of Bilbo, in appearance “unchanged” in his eleventy-first year, who nevertheless confesses, “I am old, Gandalf. I don't look it, but I am beginning to feel it in my heart of hearts. . . Why, I feel all thin, sort of stretched, if you know what I mean: like butter that has been scraped over too much bread. That can't be right.” And think of Gollum, to whom the Ring has given “unnaturally long life”: in the end, “He hated it and he loved it, as he hated and loved himself.” In the lives of these two characters the One Ring does not appear as a Ring of Power so much as a Ring of Immortality, a ring that gives biological life without the means to enjoy it or profit from it. How many people in the future will identify in a particularly strong way with Bilbo and Gollum in this respect? — and maybe especially with Gollum, who unlike Bilbo is unable to relinquish the Ring, unable to escape or even lessen its power over him. Will biological life become all the more precious to people as they enjoy it less, according to the implacable law of diminishing returns?

Similarly, what will future generations make of that terrifying epigraph to Eliot’s poem The Waste Land, taken from Petronius’s Satyricon? The epigraph concerns the Cumaean Sybil, who made the mistake of asking the gods for extraordinarily long life without also asking for youth, so that her body wthered and shrank almost to nothingness. One of the main characters of the Satyricon, the ludicrous Trimalchio, says, “For I myself once saw with my own eyes the Sibyl hanging in a cage, and when the boys asked her, ‘Sibyl, what do you want?’ she answered ‘I want to die.’”

Tuesday, April 20, 2010


A simple but useful suggestion about e-reading from Russell Jones:

There's a difference between linked information (where links can become obsolete) and embedded information, which is persistent. I'm sure you've all had the frustrating experience of clicking on a link only to find that the information is no longer available. In contrast, footnotes or endnotes in a book are always available. Ebook publishers can use both, as needed. If the information is critical (and small), embed it; otherwise, link to it.

The UI problem of all the ancillary material getting in the way of a clean reading experience can be solved easily, by simply making the links/extra info invisible until the user reveals them. That can be done through a gesture, a Ctrl+Click or some other unused-in-ebook-reading action. The reveal would be a toggle, so users could turn it off equally easily. That lets publishers include as much ancillary information as they wish without interfering with the reading experience.

Other reflections in the article are useful too, but I especially like this suggestion. Of course, one's dedication to the reading experience will be constantly tested by the presence of the toggle.

Monday, April 19, 2010

I wuz robbed

Ken Auletta writes:

Publishers maintain that digital companies don’t understand the creative process of books. A major publisher said of Amazon, “They don’t know how authors think. It’s not in their DNA.” Neither Amazon, Apple, nor Google has experience in recruiting, nurturing, editing, and marketing writers. The acknowledgments pages of books are an efficiency expert’s nightmare; authors routinely thank editors and publishers for granting an extra year to complete a manuscript, for taking late-night phone calls, for the loan of a summer house. These kinds of gestures are unlikely to be welcomed in cultures built around engineering efficiencies.

Really? These things “routinely” happen in the print publishing world? Wow. All these years I’ve just worked hard to meet deadlines, almost always with success; I have never called my editors late at night — I have never even had any of their home or mobile phone numbers; and it never once occurred to me that any of them might have access to summer houses that they could lend me. What a sucker I’ve been.

iPad vs. Kindle

Sara Peyton compares reading on a Kindle and reading on an iPad:

I've owned a Kindle for about 6 months and it's my trusty companion whenever I travel. The Kindle, my headlamp, and my iPhone sit on my bedside table. I've always got at least five or six new novels on the Kindle. I like the Kindle's e-ink, the easy-on-the-eyes screen, compact size, and comfortable weight. When I have trouble sleeping at night, I grab the Kindle, strap on my headset, read a few pages or so, and drift back to sleep.

Enter the iPad. For my weekend reading test on the iPad I purchased Next by James Hynes. The novel, depicting the day in the life of a man who has flown to Austin, TX, at the height of a terrorism scare, has garnered rave reviews. Much to my surprise I enjoyed the iBook interface. I quickly settled into the book and enjoyed advancing the pages with a swipe of a finger and watching the animated page roll up. I didn't think the iPad was too heavy. I set the screen to the lowest brightness setting. But, compelling as Hynes' book is — and it's a fast paced romp — I grew distracted. I interrupted my reading to check Facebook, my email, and Twitter several times. Plus, reading on the iPad made me want to write on the iPad. I wanted to write notes on my iPad books. Worst of all for me, once I set the iPad down and turned off the light, I couldn't go to sleep for hours. Was the light from the iPad too stimulating?

I have a feeling I’d have the same experience. As I have written on several occasions, one of my favorite things about the Kindle is the way it limits distractions.

Friday, April 16, 2010

chose any two

Ars Technica summarizes a new report in Science:

Humans are capable of pursuing multiple goals at once—for example, I am pursuing writing an article and eating a bowl of Froot Loops—but how those activities get divided by the brain is still somewhat of a mystery. A new study, published in Science this week, imaged human brains and watched them try to multitask as subjects performed a set of variously interrupted tasks. They saw that our brains can divide resources fairly easily for two tasks, but have a much harder time juggling three or more.

Here’s a link to the original article, but it’s subscription-only.

Thursday, April 15, 2010

Who wrote Shakespeare?

While I was recuperating last week I read and enjoyed James Shapiro’s new book Contested Will: Who Wrote Shakespeare? It’s an excellent history of the debates over the authorship of the plays attributed to William Shakespeare — and it’s primarily that, a history. Shapiro wants to understand how and why, at some point in the 19th century, people began to suspect that someone other than Shakespeare wrote the plays, and why they chose the alternative candidates they did. For the first hundred years of doubt, the preferred candidate was Francis Bacon; when that hypothesis became entangled in a dense web of ludicrous theories about cryptography and hidden acrostics, Edward de Vere, the Earl of Oxford, was put forward — and is today the preferred candidate of most anti-Stratfordians.

The case against William Shakespeare’s authorship of the plays is based almost wholly on what Richard Dawkins calls, in a very different context, the argument from personal incredulity. People think that it’s just not possible for a poorly educated glover’s son from a provincial town to have written those plays, with their wealth of knowledge, wisdom, and even technical detail in a range of fields (from law to sailing). Leaving aside the question of whether Oxford or Bacon had more direct experience, across the whole range of Shakespearean reference, than the man from Stratford, we can note that this incredulity is based on a very low opinion of the learning that can be acquired from reading, even by a person of genius. The possibility that the glover’s son could have had the intellectual resources to draw more from books than most people draw from direct experience is never considered, even though the plays show unmistakeable signs of extraordinarily deep and broad reading.

Shapiro knows, and mentions at the outset of the book, that his fellow professional Shakespeareans have tended to be contemptuous of the hypotheses of alternative authorship, and is determined to be more respectful, even though he is convinced that William Shakespeare did indeed write the plays (and poems). He may succeed in this too well. In his last chapter, in which he lays out the case for Shakespearean authorship, he noticeably pulls his punches. The case for alternative authorship, especially that of the Earl of Oxford, simply cannot survive an encounter with what scholars now know about the composition and performance of the plays, especially the later ones, and I wish Shapiro had been more assertive in making this point.

But he does make it all the same, and the book is very much worth reading not only for its history — which is fascinating in its own right — but for that case. Is it likely that a man from the provinces with a limited education and a head for business wrote the plays of Shakespeare? In one sense, no — in the sense that it’s not likely that anyone could have written those plays, since they constitute some of the most amazing productions of the human mind. That they exist at all is a miracle. But if you go through the records of the theatrical companies of the era, and you listen to the testimony of people like Ben Jonson who knew Shakespeare as man and poet, and you scrutinize the surviving versions of the plays, I don't see how you could come to any other conclusion than this: Shakespeare wrote Shakespeare.

Wednesday, April 14, 2010

personal liking

The critical judgment “This book is good or bad” implies good or bad at all times, but in relation to the readers future a book is good now if its future effect is good, and, since the future is unknown, no judgment can be made. The safest guide therefore is the naive uncritical principle of personal liking. A person at least knows one thing about his future, that however different it may be from his present, it will be his. However he may have changed he will still be himself, not somebody else. What he likes now, therefore, whether an impersonal judgment approve or disapprove, has the best chance of becoming useful to him later.
— W. H. Auden, from “Making, Knowing, and Judging”

Tuesday, April 13, 2010

the length of texts

Charlie Stross asks an interesting question: “Why are novels (the prevailing form of fictional entertainment on retail sale today) generally the length that they are?”

Back in the mid to late Victorian period, when books were frequently printed and sold as weekly serials, in chapter-sized magazines that could be bound together, the length of a book was really dictated by the author's (and printer's) stamina. In contrast, as I mentioned in my last blog entry, I've got a book coming out this month which is actually not a stand-alone novel, although that's what it's listed as in the publisher's catalog — it's the sixth (and final) installment in a multi-book story, six volumes long. Why isn't that story coming out in a single binding?

It looks obvious at first — novels are the length they are because, well, they're novels — but in truth, the length of a novel varies depending on the prevailing publishing industry distribution model when it's written. . . .

Going forward, I speculate that if we make a successful transition to ebooks — that is: if ebooks become a major sales channel and authors are still writing professional quality work for money, and readers are finding some way to pay them — we may see a revival of other formats: novellas for one (they're undergoing a renaissance in SF publishing among the smaller publishers), the Dickensian serial for another, and the gigantic shoebox-sized monster for a third. The corsetting of the modern novel to fit between the tight constraints of binding costs and price elasticity of demand will be unstrung, or replaced by bras, or some other over-stressed metaphorical construct.

I find this scenario both plausible and exciting. The constraints Stross describes in book-publishing — the whole post is quite detailed on these matters — are matched by a similar set of constraints in the periodical world. For periodical fiction and nonfiction alike, there are a set of containers of more-or-less fixed sizes, and stories, essays, and reports need to fit into those containers. Some of the most celebrated moments in the history of the New Yorker, for instance, center on deviations from those norms: John Hersey’s Hiroshima), which took up a whole issue — and can you imagine the magazine today running a story the length of Salinger’s “Hapworth 16, 1924”, no matter who wrote it? (Well, maybe. But it would be a cause célèbre.) Digital environments could turn out to be ideal homes for the miniaturist and the super-expansive writer alike.

Monday, April 12, 2010

"a colossally elaborate manipulation"

Tim Burke is one of the most consistently thoughtful bloggers I know — and I’m choosing that word carefully: Burke doesn't blog very often because he actually takes time to think before posting. The problem with the web, of course — and especially with the world of blogs — is that not many people follow Burke’s example. In a recent post, he gives a good reason why this is so:

There’s really very little to be said for trying to carry on a conversation (online or otherwise) with people who have nothing but an instrumental view of conversation as a means to their own anti-pluralistic or illiberal ends, who concern-troll every debate in the hopes of getting someone to take the bait. There are a set of writers who work hard every day trying to create a framework where the only right answers can be some kind of dogma, who will never for one passing second acknowledge the legitimacy of evidence which contradicts their own pet doctrines, who are never even momentarily in any danger of being persuaded by any countervailing viewpoint. For these writers, all online discussion is a colossally elaborate manipulation. I spent too much time in developing this blog arguing for an indiscriminate openness to conversation. Pursuing conversation with the comprehensively dishonest is a fool’s errand, and I’ve sometimes been just such a fool.

This seems exactly right to me. In an environment dominated by “ideological amplification”, very few people have any interest at all in thoughtful conversation, and they are hard to find in the midst of all the shouting.

I have thought about this a lot, with no results. I have argued for years that the post-plus-comments model is fundamentally broken — it works fine for a blog with a readership the size of this one, but it simply doesn't scale — but I can't for the life of me come up with any alternative to it, except the famous Slashdot karma model, which has the opposite problem: it works only at a very large scale.

When I wrote for The American Scene, for a time we had a wonderful community of conversation and debate, but then the comboxes were overwhelmed by trolls and other unhelpful voices, and became unreadable. Sure, I could look for the remaining thoughtful commenters, but only at the cost of having to wade through a great deal of garbage to get to them. Increasingly that came to seem too much trouble; and commenting itself came to seem too much trouble for a number of the people I most valued. If a typical post had three hundred comments instead of thirty, a Slashdot-like system could have filtered out the crap and left me with a reliable body of interesting comments to read; but with just thirty comments, one thoughtless vote can have a disproportionately great effect.

I have returned to this topic many times over the past few years, because I can't find any answer to these problems. The person who figures out a new architecture for online communication that encourages real conversation and filters out the trolls will have performed a great service for humanity. Though of course the trolls are always with us.

Friday, April 9, 2010

and now we're done with the medical stuff

Regular Text-Patterns-style posting will resume on Monday.
But one note quickly: I find myself so overwhelmed with email that I've gone back to Gmail for a period. I just can't manage the volume in a regular email client that lacks all Gmail's organizational features. Will this mark a permanent regression? Will I be drawn back into the maw of the gBeast? Only time will tell. . . .

off-topic medi-blogging (slight return 2)

As Bryan says in a comment on my previous post, “you do get better care from such big institutions precisely because so many different people with such specialized expertise can be involved, but the more of those resources you have the harder it is coordinate and monitor them to ensure that they work properly.” With that point in mind, my own story, told at some length for a particular purpose:

Six or seven months of increasingly regular abdominal pain eventually led to the removal of my gall bladder — my “huge, completely dead gall bladder,” as the surgeon so neatly described it — in February. I thought my troubles were over, but after a few weeks my symptoms started to return. The days before Palm Sunday were increasingly bad. I called my excellent gastroenterologist, Stephen Chang, on Monday and he had me get some blood work done. By Wednesday morning jaundice was showing, which my bilirubin levels predicted. It was an obvious diagnosis: a stone from the gall bladder had worked its way into the common bile duct, something my surgeon had warned was possible, and was creating havoc. Dr. Chang asked me to come in to CDH the next day for an endoscopic procedure to have it out — then, an hour later, called back to ask if I could come in that afternoon. I did.

He said that 90% of the time ERCP is successful; he also said that in a very small number of cases the procedure itself can prompt an attack of pancreatitis. If the latter happened, he said, I would know: pancreatitis is “not subtle.” In my case the procedure was unsuccessful, so Dr. Chang immediately got on the phone with a major specialist at the University of Chicago, Irving Waxman — who, as should be obvious from his name, turns out to be from Mexico — to see when he could take over. Unfortunately, just a few hours later I discovered that I was among the lucky few to pick up the pancreatitis.

Rarely has there been an understatement to match the observation that pancreatitis is “not subtle.” My entire abdominal cavity throbbed as though Saruman had set up a supplemental Uruk-Hai-making facility within it; every muscle in my back went into spasm. My wife Teri drove me to the ER, where they rolled me into a wheelchair; when I finally got in to see the triage nurse, the convulsive vomiting began. I would have been white as a sheet had it not been for the bilirubin, but, Teri tells me, the absence of normal skin tone made my brilliant yellow stand out all the more.

On the other hand, to be a doubled-over, groaning, violently shivering, bright-yellow vomiting guy is an excellent way to get moved up in the triage rankings. So I got medicated and got into a room before too long.

I spent Thursday receiving antibiotics, saline solution, anti-nausea meds, and pain meds. I slept through much of that. On Good Friday an ambulance arrived to take me to the University of Chicago Medical Center for a more advanced form of ERCP with Dr. Waxman — which now seems to have been fully successful. About noon on Easter Sunday I was released, and I have been resting (mostly) since then. I am still pretty weak, but I’m not very yellow any more and a blood test done yesterday confirms that the various chemical levels are all moving in the right direction, though none of them are what they should be. Teri has been incredibly kind and attentive to me. I got great care from everyone involved.

But remember what I said in my last post about the absolute necessity, in this absurdly complicated system, of having an advocate? And remember what commenter Brian said about the difficulty of coordinating and monitoring such high-level services? Well, I had in Dr. Chang just such an advocate who did all the coordinating for me. Just look through the previous narrative and think about how things might have turned out had he not been assertive, persistent, and knowledgeable. So while I owe debts of gratitude to many right now, I think I owe my greatest debt to him. Thanks, Dr. Chang!

Thursday, April 8, 2010

off-topic medi-blogging (slight return)

So I spent some time in hospital last week — I’ll say a little more about the details later — and a slow recovery will mean that posting will continue to be limited around here for a while, and perhaps a little more link-heavy than usual. But I want to deviate from the topics of this blog, for a post or two, to comment on what I saw in the belly of the health-care beast. I think it will fit the general New Atlantis mandate, if not that of Text Patterns more specifically.

I was admitted to Central DuPage Hospital late on Wednesday night, March 30th, and sent to a room on the fourth floor. My roommate was an elderly man I’ll call Mr. H. I later learned that he is a retired teacher in the area who suffers from both Parkinson’s and some form of dementia, but who was in the hospital for some other reason. I think he may have had pneumonia. It soon became clear that his wife cared for him full-time, wholly, and without any substantial assistance, and whenever she wasn’t around he was quite simply a lost soul. He called our her name over and over, in a keening wail, throughout the night, and kept trying to get out of bed, which set off alarms. (In the meantime she, poor lady, was probably getting the first night of real sleep she had had in some time.)
It’s almost impossible to sleep in hospitals — the ceaseless rounds of nurses and techs ensure that — but this was worse than usual, so the next morning I asked to be moved, and was graciously accommodated. Before I went I was pleased to see that Mr. H.’s wife had returned, quite early, and was comforting him, playing cards with him, and gently making sure the nurses gave him his Parkinson’s meds on time.
For a wonderful sixteen hours or so I had a room to myself, but then in the middle of the next night the staff wheeled in a new patient — another elderly man whom I’ll call Mr. P., suffering from a range of difficulties: kidney disease, a concussion from a fall, dehydration from diarrhea. Mr. P. was not demented by any means, but was quite deaf and had malfunctioning hearing aids; plus his concussion had disoriented him. Helplessly, I listened as he told one story to a nurse, another to a gastroenterologist, still another to a neurologist, in response to questions that he only sometimes heard and still less often comprehended. It was almost impossible for anyone to penetrate the tangles and discover what his real complaints were, why he had come to the hospital, even how he had come to the hospital.
Mr. P. had three daughters, one of whom, I think, had simply dropped him off at the emergency room because she was too busy to care for him. Over the next couple of days two of them came by, visited briefly, complained about the poor care he was getting — in fact it was as good as it could have been in the circumstances — and then left. After their departure he tended to be even more confused than usual about why he was there and what was being done to him.
Eventually I decided that I needed to speak up for Mr. P. When things went awry — say, when he wet his bed — I called the nurse; during several interviews with doctors and nurses I spoke up across the curtain to correct his inadvertent misstatements or provide additional information; once I stopped a tech from giving him a cup of coffee because he was supposed to have nothing by mouth that morning. (He had an early endoscopy scheduled.) He said the doctors hadn’t told him that, but of course they had, and it was written on a writeboard in the room; the tech just hadn’t remembered to check. I had just met the doctor who was to give him the endoscopy — he looked in on me as a representative of my own gastroenterologist, since they worked in the same practice — and told Mr. P. he was in very good hands, which encouraged him.

Maybe I was butting in, though no one complained. I really didn't need to be dealing with Mr. P.’s problems — I was a pretty sick puppy myself — but it was clear that I was the only possible person to be an advocate for him in a tough situation.

All of our recent debates about the American health-care system, it occurred to me, had been about availability and cost — about getting into the system and getting out again. But when you’re in the midst of it, it’s an incredibly complex, convoluted, murky system to navigate. There are overlapping levels of responsibility among many different medical personnel, and it’s rarely clear who’s in charge. In his more seriously compromised condition, Mr. H. had an advocate: his wife; but Mr. P. had none at all. By the time I left I think his situation was clarifying — he was soon going to be transferred to some kind of rehabilitation center — but I still worry a bit when I think about him. Whoever pays for it, and however they do so, the health-care system remains a dark wood in which it is very easy to get lost.