Should I Help My Patients Die?

I was leafing through a patient’s chart last year when a colleague tapped me on the shoulder. “I have a patient who is asking about the End of Life Option Act,” he said in a low voice. “Can we even do that here?”

I practice both critical and palliative care medicine at a public hospital in Oakland. In June 2016, our state became the fourth in the nation to allow medical aid in dying for patients suffering from terminal illness. Oregon was the pioneer 20 years ago. Washington and Vermont followed suit more recently. (Colorado voters passed a similar law in November.) Now, five months after the law took effect here in California, I was facing my first request for assistance to shorten the life of a patient.

That week, I was the attending physician on the palliative care service. Since palliative care medicine focuses on the treatment of all forms of suffering in serious illness, my colleague assumed that I would know what to do with this request. I didn’t.

I could see my own discomfort mirrored in his face. “Can you help us with it?” he asked me. “Of course,” I said. Then I felt my stomach lurch.

California’s law permits physicians to prescribe a lethal cocktail to patients who request it and meet certain criteria: They must be adults expected to die within six months who are able to self-administer the drug and retain the mental capacity to make a decision like this.

But that is where the law leaves off. The details of patient selection and protocol, even the composition of the lethal compound, are left to the individual doctor or hospital policy. Our hospital, like many others at that time, was still in the early stages of creating a policy and procedure. To me and many of my colleagues in California, it felt as if the law had passed so quickly that we weren’t fully prepared to deal with it.

That aside, the idea of hastening death is uncomfortable for many doctors. In its original version, the Hippocratic oath states, “I will not administer poison to anyone when asked to do so, nor suggest such a course.” The American Medical Association, the nation’s largest association of doctors, has been formally opposed to the practice for 23 years. Its ethical and judicial council has recently begun to study the issue further.

At a dinner shortly after the law went into effect, I polled 10 palliative care colleagues on their impressions of it. There was a chorus of groans. Like me, they were being asked about it with increasing frequency, yet hadn’t found an answer that felt right. It wasn’t necessarily that we disapproved, but we didn’t want to automatically become the go-to people on this very complex issue, either.

This first patient of mine was not a simple case. When I walked into his room, he glared at me. “Are you here to help me with this aid-in-dying thing?” he asked. He was in his early 60s, thin and tired, but in no obvious distress. From my read of his chart, he met all criteria to qualify. Terminal illness, decision-making capacity, ability to self-administer the medications. And he had made the requisite first request for the drugs two weeks earlier, as procedure dictates.

When I asked why he wanted to end his life early, he shrugged. “I’m just sick of living.” I asked about any symptoms that might lie behind his request: unrelenting pain, nausea, shortness of breath. He denied them all. In palliative care, we are taught that suffering can take many forms besides the physical. I probed further and the floodgates opened.

He felt abandoned by his sister. She cared only about his Social Security payments, he said, and had gone AWOL now that the checks were being mailed to her house. Their love-hate relationship spanned decades, and they were now on the outs. His despair had given way to rage.

“Let’s just end this,” he said. “I’m fed up with my lousy life.” He really didn’t care, he added, that his sister opposed his decision.

His request appeared to stem from a deep family wound, not his terminal illness. I felt he wanted to punish his sister, and he had found a way to do it.

At our second meeting, with more trust established, he issued a sob, almost a keening. He felt terrified and powerless, he said. He didn’t want to live this way anymore.

I understood. I could imagine my own distress in his condition — being shuttled like a bag of bones between the nursing home and the hospital. It was his legal right to request this intervention from me. But given how uncomfortable I was feeling, was it my right to say no?

In the end, he gave me an out. He agreed to a trial of antidepressants. “I’ll give you four weeks,” he said. He would follow up with his primary care doctor. I couldn’t help feeling relieved.

The patient died in a nursing home, of natural causes, three months later. And I haven’t had another request since. But the case left me worried. What if he had insisted on going through with it?

I’ll admit it: I want this option available to me and my family. I have seen much suffering around death. In my experience, most of the pain can be managed by expert care teams focusing on symptom management and family support. But not all. My mother is profoundly claustrophobic. I can imagine her terror if she were to develop Lou Gehrig’s disease, which progressively immobilizes patients while their cognitive faculties remain largely intact. For my mother, this would be a fate worse than death.

But still. I didn’t feel comfortable with the idea of helping to shorten the life of a patient because of depression and resentment. In truth, I’m not sure I am comfortable with helping to intentionally hasten anyone’s death for any reason. Does that make me a hypocrite?

I realized it was past time to sort out my thinking and turned to the de facto specialist in our area on this issue for counsel. Dr. Lonny Shavelson, an emergency medicine and primary care physician in Northern California, has been grappling with the subject for many years.

Given his interest in the topic, Dr. Shavelson felt a personal obligation to ensure that this new practice would be carried out responsibly after the law was passed. He founded Bay Area End of Life Options, a consulting group that educates physicians, advocates on patients’ behalf and prescribes the lethal concoction for some patients who meet the criteria for participation.

He has devised a process for his patients that not only adheres to the letter of the law, but goes far beyond it. His patient intake procedures are time-consuming and include a thorough history and physical, extensive home visits, a review of medical records and discussions with the patients’ doctors. He assesses the medical illness, the patient’s mental and emotional state and family dynamics.

He does not offer the medications to most of the patients who request them, sometimes because he deems them more than six months away from death or because he is worried that they have been coerced or because he believes that severe depression is interfering with their judgment. Since starting his practice, he has been approached by 398 patients. He has accepted 79 of those into his program and overseen ingestion and death for 48.

Dr. Shavelson’s careful observations have made him something of a bedside pharmacologist. In his experience, both the medications used and their dosages should be tailored to individual patients. While all patients enter a coma within minutes of ingesting the lethal cocktail, some deaths take longer, which can be distressing for the family and everyone else involved. One of his patients, a serious athlete, experienced a protracted death that Dr. Shavelson attributes to the patient’s high cardiac function. After that experience, Dr. Shavelson began to obtain an athletic history on every patient, and to add stronger medications if indicated.

In another patient, a mesh stent had been deployed to keep his intestines from collapsing. This stent prevented absorption in key areas, slowing the effect of the drugs and prolonging his death. Dr. Shavelson now routinely asks about such stents, something that a doctor less experienced in this process might miss.

Dr. Shavelson strives to mitigate all symptoms and suffering before agreeing to assist any patient in dying. He recounted many cases where patients no longer requested the medications once their quality of life improved. He counts these cases among his greatest successes. This demonstrates that his commitment is to the patient, not the principle.

When I asked Dr. Shavelson how he might have proceeded with my patient, he said he would have tried everything to relieve his distress without using the lethal medication. But if in the end the patient still wanted to proceed, he would have obliged, presuming his depression was not so severe as to impair his judgment. “I don’t have to agree with a patient’s reasoning or conclusions,” he said. “Those are hers to make, just as much as turning down chemotherapy or opting not to be intubated would be.”

by Jessica Nutik Zitter, NY Times | Read more:

Image: Chris Silas Neal

[ed. See also: Death as a social privilege?]

Free Alaskan Salmon: Just Bring a Net and Expect a Crowd

Wenceslous Fru, a physician assistant from Anchorage, stood on the sandy shore of the Kenai River and imagined the dinner he would put together once he felt the jostle of a salmon in his long-handled dip net. He would make it the way they do back home in Cameroon, splitting it down the belly and opening it like a book, rubbing it with ginger, garlic and spices, and then slipping it under the broiler.

Fishing nearby, Raviwan Dougherty, an Anchorage restaurant worker from Thailand, envisioned steaming hers and bathing it in fish sauce, lime juice and chiles.

Lyubov Miroshnick, who works in a dental office in Wasilla, planned to smoke her catch after a soak in her Ukrainian grandparents’ brine recipe.

“Mainly, we fish for the winter,” said Ms. Miroshnick, who had a dozen family members with her. “That’s how most people survive here. It’s the cheaper way.”

There is no more popular fishery in Alaska than the Kenai (KEEN-eye), a three-hour drive southwest of Anchorage, where millions of sockeye salmon ripple through the silty turquoise water each summer to spawn.

And there is most likely no more democratic fishing spot in America — a place where any Alaska resident, from an oil company executive to a carwash attendant, can fill a freezer with premium salmon for only the cost of gas and gear.

Most of the Kenai’s fish are caught by commercial boats and sold around the world. The rest go to sport fishermen, who catch them with a rod and reel, and, increasingly, a wildly diverse group of mostly urban dip-netters, who crowd the river’s mouth for three weeks in July, hoping to score a winter’s supply of wild salmon that most can’t afford to buy. In the roughly 20 years since the state started regulating dip-net fishing in the region, the number of permits it issues has doubled, to more than 30,000.

Now, when the dip-netters descend, the beach takes on the motley, slightly claustrophobic feel of a music festival. Whole families set up camp in the sand, hauling tents, chairs, dogs, children and nets by four-wheelers from the packed parking lot.

This year, a church group brought in a bouncy house and grilled hot dogs. A cart sold espresso. People on the beach spoke Hmong, Korean, Tagalog, Spanish and Thai. They played Christian rock, reggaeton and Pacific Island R&B.

July’s dip-net army lifts the economy in the town of Kenai, but it also clogs the highway and litters the beach with fish heads and guts that have to be raked to the water at night by special tractors. Hundreds of gulls cry overhead, diving to feast on entrails. On weekends, when crowding is at its worst, there are dust-ups over fishing territory, tangled gear, pilfered bags of ice and stolen coolers. Differences in culture, language and notions of personal space sometimes fuel the conflicts.

“It used to be 200 people — now it’s 5,000” on a given day, said Scott Turney, an Anchorage telecommunications engineer who has been fishing on the beach for more than 30 years. “There never used to be any conflicts, but the newcomers don’t have the same courtesy. As soon as you drag a fish out, one or two people will come take your place.”

Even with the crowds, he said, landing a big haul of fish is worth the hassle: “l still love it. I’ll never stop.”

To fish, most people stand elbow to elbow along the shoreline, wearing waders, chest-high in the cold river. Each holds a long steel pole with a five-foot-wide net basket on the end. When a fish hits the net, the fisher drags it onto the beach and bonks it on the head with a short bat. Some people also fish by boat to avoid the crowd, holding their nets overboard as they drift with the current.

Occasionally, a commercial boat putters by. There’s always a little tension.

Commercial fishermen catch salmon by stretching large nets in the inlet near the mouth of the river. When things are slow, dip-netters grumble that the larger boats take too many fish.

The commercial fishermen, on the other hand, must sometimes stop work for a few days at the direction of state biologists who monitor the number of fish in the river for conservation purposes. They don’t love watching the dip-netters filling their coolers.

“It’s always hard to not be catching fish,” said Hannah Heimbuch, who runs a 32-foot aluminum commercial boat, Salmon Slut, in the inlet. “I feel like our harvest is pretty responsible and pretty moderate.”

A single dip-netter is allowed to take home 25 sockeye, or red, salmon, and an additional 10 for each family member per season — limits enforced by state officers who patrol the beach.

The average dip-net fisher in the Cook Inlet — the 180-mile finger of ocean that runs along the Kenai Peninsula from Anchorage to the Gulf of Alaska — brings home 60 to 70 pounds of salmon each summer, said Ricky Gease, the executive director of the Kenai River Sportfishing Association. Even in Alaska, this is a bargain: Although wild salmon can sell for more than $25 a pound in the lower 48, here it will still cost $10 or more at the grocery.

An estimated 90,000 people, fishers and their families, share about 400,000 sockeye annually, Mr. Gease said, which breaks down to 2.4 million meals, the majority of fish coming from the Kenai. Food-bank workers in Anchorage say salmon has also become a supplemental source of protein for the city’s hungry.

“Outside the revenues generated from oil,” Mr. Gease said, “this is the largest single shared natural resource in Alaska for residents.”

by Julia O'Malley, NY Times |  Read more:

Image: Joshua Corbett

Annalynn Hammond, Back to the River
via:

No One Should Have Sole Authority to Launch a Nuclear Attack

In just five minutes an American president could put all of humanity in jeopardy. Most nuclear security experts believe that's how long it would take for as many as 400 land-based nuclear weapons in the U.S. arsenal to be loosed on enemy targets after an initial “go” order. Ten minutes later a battalion of underwater nukes could join them.

That unbridled power is a frightening prospect no matter who is president. Donald Trump, the current occupant of the Oval Office, highlights this point. He said he aspires to be “unpredictable” in how he might use nuclear weapons. There is no way to recall these missiles when they have launched, and there is no self-destruct switch. The act would likely set off a lethal cascade of retaliatory attacks, which is why strategists call this scenario mutually assured destruction.

With the exception of the president, every link in the U.S. nuclear decision chain has protections against poor judgments, deliberate misuse or accidental deployment. The “two-person rule,” in place since World War II, requires that the actual order to launch be sent to two separate people. Each one has to decode and authenticate the message before taking action. In addition, anyone with nuclear weapons duties, in any branch of service, must routinely pass a Pentagon-mandated evaluation called the Personnel Reliability Program—a battery of tests that assess several areas, including mental fitness, financial history, and physical and emotional well-being.

There is no comparable restraint on the president. He or she can decide to trigger a thermonuclear Armageddon without consulting anyone at all and never has to demonstrate mental fitness. This must change. We need to ensure at least some deliberation before the chief executive can act. And there are ways to do this without weakening our military responses or national security.

This is not just a reaction to current politics. Calls for a bulwark against unilateral action go back more than 30 years. During the Reagan administration, the late Jeremy Stone, then president of the Federation of American Scientists, proposed that the president should not be able to order a first nuclear strike without consulting with high-ranking members of Congress. Such a buffer would ensure that actions that could escalate into world-destroying counterattacks would not be taken lightly. Democratic legislators recently introduced a law that would require not just consultation but congressional support for a preemptive nuclear attack. Whether or not that seems like the best check on presidential nuclear power is a matter for Congress.

We already know that second-check plans would not compromise American safety. Security experts used to worry that a hair-trigger launch was needed to deter a first strike by an enemy: our instant reactions would ensure that our opponent would feel catastrophic consequences of aggression. In the modern world, that is no longer the case. The U.S. has enough nukes in enough locations—including, crucially, our roving, nuclear-armed submarines—that nuclear strategists now agree it would not be possible to take out all of the nation's weapons with a first strike. The Pentagon, in a 2012 security assessment, said the same thing. It noted that even in the unlikely event that Russia launched a preemptive attack on the U.S.—and had more nuclear capability than current international agreements allow for—it “would have little to no effect on the U.S. assured second-strike capabilities.” That conclusion suggests that we will have ample firepower even if two or more people discuss how to use it.

by The Editors, Scientific American |  Read more:

Image: Ross MacDonald

Error 404: A Look At Digital Decay

Digital Decay

The internet is stitched together by an incalculable number of hyperlinks, but much like cells in an organism, the sources and destinations have a finite lifespan. Essentially, links can and do die.

Most “link rot” is the result of website restructuring, or entities going out of business and pulling their website offline.

A high-impact example of this is when Yahoo! pulled the plug on GeoCities, one of the first popular web hosting services. In one fell swoop, roughly 7 million websites (containing a plethora of animated gifs, auto-playing midi files, and traffic counters) went dark forever.

Links can also die because of more deliberate reasons, as well. In 2015, the editor-in-chief of Buzzfeed, Ben Smith, came under fire for deleting thousands of posts from the site (including content that was critical of Buzzfeed advertisers). Journalism has traditionally acted as a public record, so this type of “decay” has serious implications on the credibility of media brands.

Who Cares?

The idea of a public record is at the heart of why digital decay is an issue worth addressing. Once millions of links simply burn out, what will people in the future know about society in the early-ish days of the internet? What record will remain of people’s thoughts and feelings in that era?

Perhaps more urgent are public records that live in the digital realm. Supreme Court decisions and academia lean heavily on citations to build their arguments. What happens when those citations simply vanish? A Harvard study found that 49% of the hyperlinks in Supreme Court decisions are now broken.

Even that ubiquitous resource, Wikipedia, has serious issues caused by digital decay. Over 130,000 entries link to dead pages – a troubling development, as linked citations are what lend entries their credibility.

by Nick Routley, Visual Capitalist |  Read more:

Image: uncredited

Hillsong United

[ed. Repost. Not all music sucks these days.] 

Breaking Bad Ended the Anti-Hero Genre by Introducing Good and Evil

Taking what you want is not glamorous. It is not sexy. Giving in to your own worst impulses does not somehow make you more of a “badass,” more of a figure to be respected. It makes you awful. In some circumstances, it makes you evil. It is not the sort of thing most people do lightly, unless they’re sociopaths. Stepping off the path—breaking bad, if you will—requires extreme circumstances, usually, just the right combination of elements that results in a cataclysmic transformation and flowering into something new.

Yet you wouldn’t know this to look at most stories about anti-heroes, about gangsters and crime lords and men (it’s almost always men) who do the wrong things. There’s something dark and mysterious and sexy to this idea, particularly on television, where even someone as unlikely as James Gandolfini can become a sex symbol because of the role he plays. There’s nothing more alluring than power, and the modern anti-hero drama has played off this association all the way to the bank.

Except for Breaking Bad. There is very little about Walter White that is alluring. There is very little about him that is, God forbid, sexy. When he threatens his wife or emotionally abuses her, it’s treated as a gross violation of who she is. Even if the series finale seemed to push too far toward redeeming the character in the eyes of the audience—more about that in a bit—that may have been because the preceding 61 episodes had stripped away so much of the myth that surrounds the great American cable-drama anti-hero. Walter wasn’t some icon to look up to; he was a man who made excuses to indulge his own worst impulses, then selfishly insisted everybody else get on board with what he was doing. Creator Vince Gilligan and his writers set up several opportunities for Walter to back off his plan of cooking crystal meth—even as early as season one—and he always said no. Walter is the ne plus ultra of anti-heroes. There is no further to go. He is the logical conclusion of the whole movement, the point beyond which only bleak nihilism exists.

A few weeks ago, in the wake of the tremendous, towering episode “Ozymandias,” NPR’s Linda Holmes argued that Breaking Bad had become a series about watching evil. Although some subset of the show’s audience always viewed it as the tale of Walter White vanquishing all his foes—actual and perceived—for the most part, Breaking Bad depicted with very clear vision just how dark this man had become in his pursuit of power. In Holmes’ estimation, this transcended badness, past even wickedness, and into the full belly of Walter’s own evil. The blackness in his soul seeped out until he was ranting at his wife over the phone, a ploy to get the police off her back that conveniently also let him yell about how everyone around him had failed to recognize his greatness. That darkness manifested itself as a band of neo-Nazis who could break into homes at will, simply because it’s impossible for the police to stop evil. Evil isn’t a thing that can be shot with a gun. It simply is.

There was a good reason for Breaking Bad to be able to do this: It is, fundamentally, a religious show. I don’t mean that Walter White needs to find Jesus or Buddha or Allah (though he probably would have been better off if he turned to anything that wasn’t his own hubris). I mean that this show occupies a world with the concepts of good and evil, where “the right thing” and “the wrong thing” exist. When David Chase put The Sopranos on the air, he famously argued that Tony Soprano should be allowed to kill a former mob snitch in episode five because if he didn’t, the audience would never respect him again. He would have broken his code and would be uninteresting as a protagonist forever after. There were things like “the right thing” and “the wrong thing” on The Sopranos, but they more often broke down as “the hard thing” and “the easy thing.” The series’ argument was always that the vast majority of us choose “the easy thing” every day of our lives, even if that’s as basic as eating a burger instead of a salad for lunch. Tony Soprano’s easy things may have been many degrees of latitude worse than our own, but we were at least somewhat in concert with who he was. In contrast, choosing the hard thing is ultimately rewarding but rarely so in the moment. The only way a human being can truly change is to do so, but few of us want to engage with the work necessary.

For the most part, the anti-hero TV shows that followed in The Sopranos’ wake engaged on this playing field. There were twists here and there; The Shield had some of Breaking Bad’s weird, Biblical morality, but it also suggested that Vic Mackey might be worth having on the streets, protecting the citizenry. But for the most part, these series played out in worlds where “right” and “wrong” were determined via a kind of moral relativity, where a sliding scale suggested that these people were just like you, only with much, much larger problems. Even Breaking Bad’s closest cousin, Matt Weiner’s brilliant Mad Men, in the midst of planning its own ending, mostly plays on The Sopranos’ turf, with cycles of misbehavior and the need for true disruption to ever make a positive change.

Gilligan took this framework and tossed in an element of the Pentecostal preacher. When Breaking Bad began, it sometimes seemed to push too hard to suggest that everybody was a sinner, where the difference between Marie’s kleptomania and Walt’s meth cooking and murder was largely a matter of degree. Yet the show quickly disabused itself of this notion. Everybody’s a sinner, yes, but that matter of degree is important. Walter White isn’t just a sinner. He’s a man who pushes further and further into his dark heart, who unleashes all manner of destruction upon the world, both at large and in his own home. He is a murderer, many times over; he is a man who abuses his wife; and he is a force of fear for everyone who sees his true face. He is, for lack of a better word, Satan.

There have been shows about Satan before, where the devil consorts with humanity and reveals how similar he is to us. (The Sopranos could be one of these, coding its read of Lucifer in a very Catholic notion of what is unseen.) Most of these series separate the devil from those he interacts with, whether through dream imagery or arch sensibility or just putting him in a sphere most of us wouldn’t enter. But Gilligan didn’t do this with Walter. He started out as a weak-willed science teacher, beaten down at home and at his job. He had a banal life-threatening illness, lung cancer. He dressed in earth tones and lived in a sort of nice house that had clearly faded from the one he bought. He was, in other words, every Breaking Bad viewer: a normal person who wanted to live out what life he had left and still be happy.

The genius of the series, then, is that Walter White is at once every viewer and the Prince Of Darkness. When the series begins to reveal that he’s carried deep reservoirs of anger and resentment for years prior to the pilot, it not only suggests that this is true of Walter, it suggests it’s true of anyone watching. Given the chance, aren’t there old slights you would viciously repay, money or power you would grab? Recognize me, Walter cries at every turn, with every brazen action he takes, and it might as well be the cry of a modern American, ground down by a system that seems designed to keep things rigged. Breaking Bad first aired in 2008, on the cusp of the Great Recession, and its story progressed very little beyond that point. It is steeped in a world where some people were getting lots and lots and lots, and other people were continually getting stiffed. And in those circumstances, is it any wonder that somebody might reach out and take what he felt was rightfully his?

The problem that Breaking Bad recognized is that once you start taking, it’s difficult to stop. Even Skyler, who so loathed her husband and what he’d become, started to get used to the trappings of luxury, to the comfort of wealth. This made the final season—both halves of it—at times punishingly difficult to watch. Sure, there were highs—like that train robbery in episode five—but they were always balanced out with ever-deeper lows, with moments that existed seemingly just to gut-punch the audience whenever it might start rooting for Walt again. The final season asked viewers to locate the place in themselves where they once connected to Walt, then realize just how far he had fallen, then realize that every person has this sort of darkness within them. In practice, it resembled the concept of original sin. All fall short, not just of the glory of God, but of a better, more loving world.

by Todd VanDerWerff, A.V. Club | Read more:
Image: AMC

How to Drive a Motorcycle

When Steve McQueen got away from the Nazis in The Great Escape, he did it on a motorcycle. When Evil Knievel roared over the top of the fountains at Caesar’s Palace, it was on a motorcycle. And when Chris Pratt sped through the jungles of a fictional dinosaur-filled island, he did it on a motorcycle, being chased by velociraptors. In other words, when a man has to get somewhere and make sure that he looks cool along the way, a motorcycle is the way to go. But in an age when manual transmission cars are all but relics of another time, it’s rare to find people who know how to operate gears, shift, and use a clutch; which is too bad, since motorcycles are a great way to get around, even when you’re not surrounded by velociraptors. Whether you want to find a more economical way to commute in the city or race down dusty roads in search of big adventures in far off places, a motorcycle opens up a world of opportunities that you just can’t get in a car. So strap on a helmet and grab a leather jacket — it’s time to learn how to ride.

by Patrick Hutchison, The Art of Manliness | Read more:
Image: Ted Slampyak

[ed. I got my license at age 59 (after completing a basic MSF course - highly recommended). It's never too late. Sold my beloved Kawasaki KLX 250 before my recent move, but, first chance: a Yamaha XT250 or FZ-07.]

via:
[ed. See following post.]

Why Do You Discriminate Against Boats?

For all of his adult life, Donald Trump has been telling people that he’s a brilliant businessman, a habit he continued, to great effect, on the campaign trail. So you’ll have to forgive Australian Prime Minister Malcolm Turnbull,who may have been laboring under a similar assumption when he got on the phone last January with the newly sworn-in president. One of the primary purposes of the call was to discuss a deal that had been struck by Barack Obama to take in 1,250 refugees who had been detained by Australia, which Turnbull was worried would not be honored in light of the travel ban Trump had ordered the day before. But as Turnbull quickly realized, as revealed Thursday by a leaked transcript of their conversation, Trump is completely incapable of grasping even basic facts about foreign policy—and is too ignorant to negotiate even the most basic deals. In fact, it seems highly possible Turnbull came away from the conversation not confident the president of the United States knows what Australia is.

The details of said deal were fairly straightforward: in order to deter human smuggling, as well as to prevent people from drowning at sea, Australia has a policy of not allowing refugees who arrive by boat to enter the country. That means you could be the second coming of Mother Teresa, Mr. Rogers, and Albert Einstein all rolled into one, but if you arrive by boat, you’re not coming into the country. Because Australia did not want to compromise this policy, when a significant number of refugees did arrive by boat, rather than deporting them, Turnbull’s government placed them in detention centers on the Pacific Islands of Nauru and Manus. Human-rights groups have condemned the conditions of these camps, the latter of which is set to close on October 31. Australia reached an agreement with the Obama administration for the U.S. to vet 1,250 of these refugees and then take as many of them as deemed acceptable to enter the country. If the U.S. decided none of them were safe, then it would be under no obligation to take any of them in. In exchange, Australia agreed to take in people the Obama administration wanted to get out of the United States. See? Simple. Really, it's not that difficult.

That is, unless you’re Donald Trump, president of the United States, who apparently can't follow a simple train of thought, based on the transcript of his mind-boggling conversation with Turnbull.

by Bess Levin, Vanity Fair |  Read more:

Image: Nathan Edwards/Newspix/Getty Images

Rich SF Residents Get a Shock: Someone Bought Their Street

Thanks to a little-noticed auction sale, a South Bay couple are the proud owners of one of the most exclusive streets in San Francisco — and they’re looking for ways to make their purchase pay.

Tina Lam and Michael Cheng snatched up Presidio Terrace — the block-long, private oval street lined by 35 megamillion-dollar mansions — for $90,000 and change in a city-run auction stemming from an unpaid tax bill. They outlasted several other bidders.

Now they’re looking to cash in — maybe by charging the residents of those mansions to park on their own private street.

Those residents value their privacy — and their exclusivity. Past homeowners have included Sen. Dianne Feinstein and her financier husband, Richard Blum; House Democratic leader Nancy Pelosi; and the late Mayor Joseph Alioto. A guard is stationed round the clock at the stone-gate entrance to the street to keep the curious away.

So imagine the residents’ surprise when San Jose residents Cheng and Lam wound up with the street, its sidewalks and every other bit of “common ground” in the private development that has been managed by the homeowners since at least 1905. That includes a string of well-coiffed garden islands, palm trees and other greenery that enhance the gated and guarded community at the end of Washington Street, just off Arguello Boulevard and down the hill from the Presidio.

“We just got lucky,”said Cheng, a real estate investor.

The homeowners, however, are crying foul and want the Board of Supervisors to negate the sale.

The couple’s purchase appears to be the culmination of a comedy of errors involving a $14-a-year property tax bill that the homeowners association failed to pay for three decades. It’s something that the owners of all 181 private streets in San Francisco are obliged to do.

In a letter to the city last month, Scott Emblidge, the attorney for the Presidio Homeowners Association, said the group had failed to pay up because its tax bill was being mailed to the Kearny Street address used by an accountant who hadn’t worked for the homeowners since the 1980s.

Two years ago, the city’s tax office put the property up for sale in an online auction, seeking to recover $994 in unpaid back taxes, penalties and interest. Cheng and Lam, trawling for real estate opportunities in the city, pounced on the offer — snatching up the parcel with a $90,100 bid, sight unseen.

Since the purchase in April 2015, the couple have been quietly sitting on the property, talking to a number of land-use attorneys to explore their options.

“We were looking to get title insurance so it could be marketable,” Cheng said.

He and his wife see plenty of financial opportunity — especially from the 120 parking spaces on the street that they now control.

“We could charge a reasonable rent on it,” Cheng said.

And if the Presidio Terrace residents aren’t interested in paying for parking privileges, perhaps some of their neighbors outside the gates — in a city where parking is at a premium — would be.

by Phillip Matier and Andrew Ross, SF Chronicle | Read more:
Image: Nicole Boliaux, The Chronicle
[ed. Sometimes you read a story that just makes your day.]

Rock On

On Stephen Stills and Tom Petty

Several years ago an academic colleague and I embarked on what we called a “Stills-off”: we would listen to our record collections and narrow the musician Stephen Stills’s oeuvre down to its top five songs. Then we’d see whose list was better. I assumed our choices would overlap, and that high among them would be “4 + 20,” whose piercing Appalachian melancholy seems to belong more to the ages than to the moody twenty-four-year-old who wrote it, as well as “Find the Cost of Freedom” with its sea shanty cry of grief and endurance. We would both surely include his Buffalo Springfield resistance anthem “For What It’s Worth,” with Stills’s calm, urgent baritone and rhythmic stops; originally released to protest a Los Angeles curfew—its composition probably began earlier when Stills was still nineteen—it has endured long past its original occasion. According to Tim Rice it is “one of the best songs ever written with just two chords.” (Rice is a lyricist: the song has more than two chords.)

But my colleague and I could not stay away from Stills’s rocking guitar solos—“Crossroads,” for instance, or “Ain’t It Always,” pieces that got Stills labeled “Guitar God” on YouTube. Then there is “The Love Gangster,” from his double album, Manassas, on which Bill Wyman of the Rolling Stones plays bass. Wyman wanted at the time to leave the Stones and join Stills’s band; the instruments on Manassas are all in the hands of virtuosos. Stills has put out recordings in which, like Prince, he has played all the instruments and sung all the parts. (“Do for the Others,” a song from his first solo album, is aptly named.) But Manassas did not require that.

And so our lists began to burst at the seams and soon the Stills-off seemed an increasingly stupid exercise. Stills, now seventy-two, has often been named one of the top rock guitarists of all time and is the only musician to have recorded with both Jimi Hendrix and Eric Clapton on the same album—his first solo LP (1970). His work has sprung from every stripe of American music—blues, folk, rock, “songs with roots,” as he has put it; he was “Americana” and “singer-songwriter” before those terms were used. And although as a child he began as a drummer and tap dancer, the only percussion one is likely to hear from him now might be when he knocks rhythmically against an acoustic guitar. Once, on a 2006 tour that was being filmed, he tripped over some electrical cords and fell to the stage with a certain percussive flair. “We’ve got more lights than we’re used to,” he said. “We usually don’t care if they can see us because we’re old.”

A year after my misbegotten Stills-off I attended a sold-out concert in Nashville by the Long Players, a tribute band that performs one single album from start to finish at each of its concerts. This time they had chosen Déjà Vu (witty!), which is the first and best (and for a long while was the only) album by Crosby, Stills, Nash & Young. (Ampersand and no Oxford comma for Young: when he needs to get out of a band he flees quickly.) No sooner had the Long Players begun with Stills’s “Carry On” than the capacity crowd was standing—this cannot always be counted on with members of the AARP—and singing along at the top of their lungs. Jubilant, revelatory, the evening was more than a geezer-pleaser: it was baby boomer church, late-middle-aged ecstasy, a generation stating that it had not just yet entirely surrendered to the next. I started to suspect that no American demographic had so thoroughly memorized an album—not even one by the Beatles or Bob Dylan or Joni Mitchell—as this generation of baby boomers had Déjà Vu.

by Lorrie Moore, NY Review of Books |  Read more: (Ain't It Always Stephen Stills)

***

In 1979, I was an undersized FM-generation high-school junior with a voice that wouldn’t change, a stressed single mom, and a bedroom in a rented gray two-family house in which I had to play my stereo low so I wouldn’t disturb all the people living close around me. And then my daily affront at this complete lack of agency found validation when some skinny blond dude calling his album “Damn the Torpedoes” uplifted my evenings with a simple phrase about being cut down to size on a regular basis: “Don’t do me like that.” He wasn’t celebrating humiliation—he understood the condition, which is, foremost, the inability to make the humiliation stop. There was nothing to do except to say to hell with annoying Mom and the neighbors and, in my alarmingly pitched treble that sounded like a radio veering between frequencies, to sing out that ambrosial phrase right along with Petty: “Don’t do me like that.”

Tom Petty and the Heartbreakers have been filling the air with pop masterpieces for forty years now. Their hits have spent so much time in cars, in grocery aisles, in offices, and on beaches, and have such aural clarity that they are instantly individuating—you can be immersed in your own business, busy with tasks, and within three bright chords you are sure to recognize “American Girl” or “Runnin’ Down a Dream” or “I Won’t Back Down.” That kind of cultural endurance is sufficiently unusual that this summer, during what Petty has said is the band’s final big tour, I have found myself circling back and wondering what it is about Petty that’s kept him so much around. Certainly, Petty’s early embattled lyrical world view wouldn’t have promised such resilience; and the days and nights seemed to press hard on his gaunt, underfed pallor.

But protecting Petty against the inimical forces through the years have been his many admirable qualities: wry detachment, a bitter-green sense of humor, understated layers of musical ingenuity, and a completely original delivery. That voice! The incomparably distinct Petty vocal is thin, top-register, nasal, and yet cured in oak barrels. No white man in America works his septum through a vowel as distinctively as Petty, except maybe Jack Nicholson on a very good day. The voice is so seductive that it’s possible to listen to Petty describe the absolute mundane quotidian and feel completely ecstatic: “It was a beautiful day, the sun beat down, I had the radio on, I was drivin’.” Most advantageous of all, the voice communicates Petty’s great subject, which is strain.

As I grew older, Petty became for me a classic-rock fave; I was always glad when the songs appeared, but didn’t habitually seek them out. And that’s why it took me a long time to notice that, over the years, Petty’s alluring vocals, plugged into the beautiful, purring engine of his band, contrasted in their bright-sized vitality with what Petty was actually saying—which was pretty near the same thing that first brought me to him as a kid. Even twenty years into his career, on his 1994 solo hit “You Don’t Know How It Feels,” the message still seemed caught in that aggrieved adolescent moment. There were, in fact, so many songs of grievance, so many songs casting unhappily inward, so many songs expressing the perpetually injured and afflicted American male. That man’s wounds are inevitably some woman’s fault. She leads him on. She keeps him waiting. She wrecks him. He knows her heart’s beyond wicked, but he can’t kick it. Yes, there’s the occasional bluesman brag: “You got lucky, babe, when I found you.” But even then, it’s all about him—and that glint of grievance. He’s sticking around to take it because taking it is what he does.

The emotions Petty describes are, of course, emotions most people experience, and to Petty’s credit, they aren’t what most people like to advertise about their inner lives. If for some the songs were awash in self-pity, many others heard the adversity in them and located something hopeful and persevering—they listened and thought, That’s me. (This was, perhaps, especially the case during breakups.) And Petty could also write excellent songs in a more romantic key, such as “Wildflowers.” Yet, in the end, so many of his memorable compositions work a path beginning with pain and leading to resentment. This is even true of “Here Comes My Girl,” in which a primary benefit of enduring love is that it enables a man feeling stuck and discouraged to “tell the whole wide world to shove it!” That thick and affirming carapace of injustice suggests that a man can subsist a long time on nothing more than his favorite grudge. As Petty writes of a man in “Rebels,” his characters are “a little rough around the edges, inside a little hollow.”

by Nicholas Dawidoff, New Yorker |  Read more: (The Proud Pain of Tom Petty)

Harold Harvey, Marazion Marsh
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The Average NFL Fan Will Watch 23.5 Hours Of Commercials This Season

The Average NFL Fan Will Watch 23.5 Hours Of Commercials This Season

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We're Screwed

These tiny screw cameras are about $20 on Amazon (or $15 on eBay), with versions that plug into CCTV systems, composite inputs, and USB ports. There's also the bare camera, minus the fake screwhead. [via OPSEC]

The Amazon listing includes a photo of it installed in a public toilet door.

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The Strangers Nextdoor

Gone, mostly, are the days of asking your neighbor to borrow a cup of sugar. When I was growing up, my mother viewed our neighbors with irritation — their principal crimes were overdoing their Christmas decorations, and on one occasion, drunk-driving through our fence. I can count on one hand the pleasant neighborly interactions I’ve had as an adult. Once, in my upscale urban neighborhood in Atlanta, my fiancé asked another neighbor for an egg — he eyed us with suspicion, as if blueberry muffins were a pretext for some sort of political scam or a multi-level marketing scheme. Now, irritation generally characterizes my relationship with my neighbors. Why would you wear heels when you have hardwood floors and a downstairs neighbor? Who still listens to the Barenaked Ladies, much less on repeat? But I also have intense curiosity, and in the absence of peeking through my neighbors’ windows as I walk by, which is hard to do in a high-rise, I have Nextdoor.

Nextdoor, for the sane and detached among you, is a social media platform that’s locality-driven, an alternative to meetings you actually have to show up for, neighborhood Facebook groups that might give away a little too much information about you, or listservs that clog your inbox. When you sign up, you give your address, which the company verifies by credit card billing address, phone billing address, or postcard. You have access only to your neighborhood and a few surrounding hoods. It’s a place to post about a lost dog or found kittens, advertise an estate sale, or ask for recommendations for a handyman from fellow residents.

My neighborhood’s Nextdoor includes a space for officials to communicate with residents, like the Atlanta Police Department and the Department of Watershed Management. The categories for posts from residents include classifieds, crime and safety, documents (almost never used), free items, general, lost and found, pet directory, recommendations, events calendar, real estate. More than 150,000 neighborhoods in the U.S., U.K., and Netherlands are on Nextdoor, according to Fortune. It was valued at about $1 billion in 2015.

“Community building” is usually more of a buzzword or phrase on social media, but in this case, it’s quite literal. The idea is that Nextdoor promotes community engagement with the people in your actual, geographic community, and that it would build social capital and better citizens. Instead, it’s been heavily criticized for contributing to fear, distrust, and racist behavior. There are also coyote sightings, warnings about the Starbucks Unicorn drink, and requests to borrow someone’s kombucha scoby.

The Crime category is where the ugliness of Nextdoor is most obvious. The coded language of “hip-hop types” and “thugs” (translation: black or brown), “suspicious” people and the homeless. In 2016, due largely to the efforts of advocacy groups in Oakland, California, the company changed how crimes and suspicious activity are reported in an attempt to crack down on racist language and incidents, forcing residents to describe a person’s clothing, for example, rather than just being able to say “a black man.”

It didn’t used to be like this, neighbors say; “this” being break-ins and rude language and panhandling and litter. Back in my day, we left our doors unlocked, they say. But they also say, be smart. See something, say something. You have second amendment rights. Take no chances.

“I wish we had a death penalty for stealing,” wrote my young, white, female neighbor. “Go to the range and hone in on your shooting ability and drop someone that shows total lack of regard for your personal property,” said a young white man, who explained that “castle doctrine” would protect you from prosecution if you killed someone for breaking your car windows. (No, it wouldn’t, commented a lawyer.)

My former neighbor Heather* exemplifies the worst of Nextdoor. She saw a Dodge Charger with tinted windows and rims parked on her street and posted several times over the course of a few days, with photos and video. “Suspicious Dodge Charger is here around again!!!” “I am getting angry because I don’t see a patrol neighbor drive around to check all of neighbors for their safety plus cop NEED to go his place to take him to jail for stalker often. (I gave him a tag number) there is nothing cop can do bc this suspicious didn’t break a law!”

Someone’s brother ran the plates. Other neighbors posted surveillance photos. Then, Daniel*, another neighbor, chimed in about “this suspicious.” Daniel, whose nanny has never been late, not once in 2 years. In fact, she arrives early every day, so she parks around the corner from the house before her shift.

She didn’t pull into the driveway to get away from you, she pulled into the driveway to bring our kids home. She drives by your house frequently, well, because you are my neighbor. If you want to know, she has a clean driving and criminal record, and the respect of a lot people in our neighborhood. I trust her with the safety of my family and we love her like a member of our family. It breaks my heart to see her arrive in tears, which was the case this morning. I understand why you might approach someone outside your house if you do not recognize the car. Three separate people approached her this morning, each interaction was a bit different, but thematically there was clear message sent “that she didn’t belong”. How can I say that you might ask? Well, one person told her explicitly that she need to go even after she tried to explain who she is, and another approach her with a gun holstered on his hip. You can’t tell me, that as a woman sitting in a car alone you wouldn’t find that scary. Hell, I know I would be scared in that situation.

Not that there isn’t crime, though — there are carjackings, the burglaries, the stolen tires and cold cases. Police departments post about criminals they’ve caught. Neighbors warn each other about rashes of car break-ins.

But it’s the cases of paranoia that are the most fascinating. There’s the mother who saw a car slow down and decided it must be a child sex trafficker out to get her toddler (and the neighbors who backed her up, as a mother’s instinct is never, ever wrong, even when it is). There’s the woman whose neighbor smokes weed, and the commenter who informed her that they probably run a “drug lab.” The man who asked how we should prepare to combat the “Ferguson effect,” or the supposed phenomenon that police officers are now afraid to use force because of the riots over Michael Brown’s death.

by Katie Lambert, The Awl | Read more:
Image: uncredited

[ed. I'm generally a community-minded person and tried Nextdoor thinking it might be something useful (in the last town I lived in). It only took one pass through the site before I decided to unsubscribe (for reasons noted above).]   

Jim Plunkett's Painful Journey: 'My Life Sucks'

He rises from a chair next to his Heisman Trophy in a room stuffed with dozens of silver and gold keepsakes that recognize a remarkable sports legacy. At 6-foot-3, Jim Plunkett still commands a room.

But underneath the tanned exterior anxiety grows over an uncertain future.

“My life sucks,” said Plunkett, 69. “It’s no fun being in this body right now. Everything hurts.”

The years of daily pain pulsating from the neck, back, knees, shoulders, hips and head have taken a toll on a quarterback who played 15 NFL seasons and led the Raiders to two Super Bowl victories.

His body is a patchwork of medical magic: Artificial knees, an artificial shoulder and a surgically repaired back. After 18 operations, Plunkett’s activities have been reduced to golf and light workouts at home on a Crosstrainer.

A quiet figure during his quarterbacking days, Plunkett represents a generation of men who played football with a taste for violence while locking their emotions in safety deposit boxes. For decades, Sunday’s heroes have suffered in silence from degenerative brain disease, depression, opioid addiction, Parkinson’s and amyotrophic lateral sclerosis (ALS).

The price for playing football has come due.

“Think of getting in 50 car wrecks a week for 20 straight weeks a year,” said Hank Bauer, a former San Diego Chargers running back known for his reckless play on special teams. “Everybody hurts at our age. We just hurt more.”

Latest health problems

A year ago, Plunkett contracted Bell’s Palsy, a temporary facial paralysis that causes one side of the face to droop. No sooner had the disorder disappeared than the throbbing headaches began. The head pain has been diagnosed as a neurological disorder that his physician thinks is connected to Bell’s Palsy.

These are the latest in a series of health problems that began four years after Plunkett left the NFL in 1986. He takes six pills in the morning, seven at night for his heart, blood pressure and other problems. Plunkett usually takes an opioid to play a round of golf, but otherwise stays away from the addictive painkillers. In early summer, he even tried hemp oil for a month but stopped when he didn’t see any results.

“There are a couple other drugs I take — I can’t know them all,” he said. “I’ve got to take them every day to quote-unquote survive.”

Plunkett’s football career began in the 1960s at James Lick High School in East San Jose. Then he played four years at Stanford, appearing in 32 games. After winning the Heisman Trophy in 1970 — he remains the only Heisman recipient in Stanford history — Plunkett was the No. 1 pick in the NFL draft by the New England Patriots.

He weathered 380 sacks in a pro career from 1971-86, and that doesn’t begin to account for all the times he was hit after throwing.

A year after Plunkett retired, NFL officials began addressing ways to protect their most valuable asset as quarterbacks were getting injured at an alarming rate. They prohibited pass rushers from taking two steps before smashing into a signal caller after the ball had been thrown. Such tactics were legal in Plunkett’s era. So was slamming quarterbacks to the ground. 

by Elliot Almond, Mercury News |  Read more:

Image: Matt Slocum

[ed. How sad. I remember standing next to Jim when he came to practice at my high school football field before the 1971 Hula Bowl game. I was in awe - a Heisman trophy winner, throwing zingers right next to me! He was big, humble, an easy-going guy, signing autographs and joking around with everyone. Highly respected by all.]

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Lexington Lab Band

[ed. Best Cover Band Ever (BCBE). See also: New Kid in Town, Voodoo Child, Josie, Driven to Tears, Crazy on You (and more). Have a nice weekend.]

An Honest Business News Update

NEW YORK – The S&P 500 closed at a new high on Wednesday in what analysts hailed as the accumulated result of several hundred million people waking up every morning hoping to solve problems and improve their lives.

The index finished up 4 points. Goldman Sachs strategist Bill Blake said the move was the result of unidentified marginal buyers being a little bit more motivated than unidentified marginal sellers. “We’ve now had 241 years of people in daily competitive pursuits to do things a little better, and those benefits add up over time. Mix that with some good luck and where we happen to be in the business cycle, and here we are,” he said. “My job is to sound smart, but you can explain this stuff to a five year old,” he laughed.

Corporations earned $5.89 billion in after-tax profits. Financial advisors and middlemen took in $710 million in fees. The difference, Blake said, would accrue to investors over time.

Analysts warned of several metric tons of dopamine and cortisol careening through the global economy, which they said created a near certainty of poor financial decisions. At some point, Blake said, these bad decisions create social proof and feed on each other, leading to recessions. “When is the next recession?” he asked. “I don’t know. Whenever the second mortgage you took out to buy a boat to appease your insecurity convinces your brother in-law to do the same, and his boat gives the boat salesman enough misguided confidence to become a day trader, and then all three of you crack under a collective bout of geopolitical bad luck or something. But we’ll move on.”

About 9,000 new businesses formed on Wednesday. Another 8,200 dissolved. Analysts expect the trend to continue, calling it an “unmistakable example of basic capitalism.”

Fifty-five million American children went to school Wednesday morning, leveraging the compounded knowledge of all previous generations. Analysts expect this to lead to a new generation of doctors, engineers, and problem solvers more advanced than any other in history. “This just keeps happening over and over again,” one analyst said. “Progress for one group becomes a new baseline for the next, and it grows from there.”

Three dozen political pundits yelled at each other on TV in front of an audience of 75 million. Meanwhile, a couple hundred million people were reasonable and productive in front of an audience of zero. (...)

* Nothing, and yet everything, about this post is accurate.

by Morgan Housel, Collaborative Fund | Read more:
Image: Camila Demasio