Saturday, April 25, 2020
WHO Recommends Restricting Alcohol
Alcohol does not protect against COVID-19; access should be restricted during lockdown (WHO)
Image: Bojack Horseman
"Alcohol is known to be harmful to health in general, and is well understood to increase the risk of injury and violence, including intimate partner violence, and can cause alcohol poisoning. At times of lockdown during the COVID-19 pandemic, alcohol consumption can exacerbate health vulnerability, risk-taking behaviours, mental health issues and violence. WHO/Europe reminds people that drinking alcohol does not protect them from COVID-19, and encourages governments to enforce measures which limit alcohol consumption. (...)
Existing rules and regulations to protect health and reduce harm caused by alcohol, such as restricting access, should be upheld and even reinforced during the COVID-19 pandemic and emergency situations; while any relaxation of regulations or their enforcement should be avoided."
[ed. Good advice if you're looking to incite a world-wide riot. See also: Why Cocktail Hour is Back (NY Times).]
Existing rules and regulations to protect health and reduce harm caused by alcohol, such as restricting access, should be upheld and even reinforced during the COVID-19 pandemic and emergency situations; while any relaxation of regulations or their enforcement should be avoided."
[ed. Good advice if you're looking to incite a world-wide riot. See also: Why Cocktail Hour is Back (NY Times).]
March, April, May: Mood Darkens as Crisis Feels Endless
A walk in the park brings tense flare-ups: Back off, you’re too close. Oh really? Then stay home. A loud neighbor, once a fleeting annoyance of urban life, is cause for complaint to the city. Wake at noon, still tired. The city’s can-do resilience has given way to resignation and random tears.
In Queens, Nicole Roderka, 28, knows she must wear a mask outside, fears the anxiety it might bring, and sets it aside. In Brooklyn, Lauren Sellers grinds her teeth at night; there are sores in her mouth from the stress. When a 3-year-old boy in Manhattan’s Inwood section, Eli McKay, looked around and declared, “The virus is gone today, we can go see my friends,” his mother replied as if from one of his picture-book fantasies: “Maybe tomorrow.”
A feeling of sadness shot through with frayed nerves could be felt in conversations in and around the city as the coronavirus outbreak in the world’s epicenter dragged toward its sixth week, its end still too far off to see.
“This is the week where I feel like I have accepted this, and given up,” Euna Chi of Brooklyn wrote in an email. “My daily commute to the couch feels ‘normal.’”
The journey that began in March with an us-against-it unity, with homemade masks and do-it-yourself haircuts and Zoom happy hours, has turned into a grim slog for many. It felt as if the city had cautiously approached a promising bend in the road, a new page on the calendar, only to find nothing, and beyond that, ever more of the same. (...)
The most recent weekly survey of 1,000 New York State residents, about half of them from the city, by the CUNY Graduate School of Public Health and Health Policy asked how socially connected people have felt. Just over two in five said “not at all.” That was about double the number that answered that way four weeks earlier.
Forty percent of the latest poll’s respondents said they had felt anxious more than half of the time in the past two weeks; 32 percent said they had felt depressed.
“There is this grieving of life as we once knew it that wasn’t there before, as we try to come to terms with the new reality,” said Greg Kushnick, a psychologist in Manhattan. “I’m seeing it much more in my practice. People are really starting to get more depressed. And people who are prone to depression, it’s now kicking in.” (...)
“I think my ‘wall’ earlier this week was me finally dropping out of the ‘denial’ phase … it’s no longer ‘a fun change of pace,’” one of them, Annalisa Loeffler, wrote in an email to friends that she shared with The New York Times. “Things that are super important to me and make the rest of life bearable may not be physically possible for a very long time. I’m trying not to ‘borrow trouble,’ but there is definitely validity to accepting grief for what has been lost.”
In Queens, Nicole Roderka, 28, knows she must wear a mask outside, fears the anxiety it might bring, and sets it aside. In Brooklyn, Lauren Sellers grinds her teeth at night; there are sores in her mouth from the stress. When a 3-year-old boy in Manhattan’s Inwood section, Eli McKay, looked around and declared, “The virus is gone today, we can go see my friends,” his mother replied as if from one of his picture-book fantasies: “Maybe tomorrow.”
A feeling of sadness shot through with frayed nerves could be felt in conversations in and around the city as the coronavirus outbreak in the world’s epicenter dragged toward its sixth week, its end still too far off to see.“This is the week where I feel like I have accepted this, and given up,” Euna Chi of Brooklyn wrote in an email. “My daily commute to the couch feels ‘normal.’”
The journey that began in March with an us-against-it unity, with homemade masks and do-it-yourself haircuts and Zoom happy hours, has turned into a grim slog for many. It felt as if the city had cautiously approached a promising bend in the road, a new page on the calendar, only to find nothing, and beyond that, ever more of the same. (...)
The most recent weekly survey of 1,000 New York State residents, about half of them from the city, by the CUNY Graduate School of Public Health and Health Policy asked how socially connected people have felt. Just over two in five said “not at all.” That was about double the number that answered that way four weeks earlier.
Forty percent of the latest poll’s respondents said they had felt anxious more than half of the time in the past two weeks; 32 percent said they had felt depressed.
“There is this grieving of life as we once knew it that wasn’t there before, as we try to come to terms with the new reality,” said Greg Kushnick, a psychologist in Manhattan. “I’m seeing it much more in my practice. People are really starting to get more depressed. And people who are prone to depression, it’s now kicking in.” (...)
“I think my ‘wall’ earlier this week was me finally dropping out of the ‘denial’ phase … it’s no longer ‘a fun change of pace,’” one of them, Annalisa Loeffler, wrote in an email to friends that she shared with The New York Times. “Things that are super important to me and make the rest of life bearable may not be physically possible for a very long time. I’m trying not to ‘borrow trouble,’ but there is definitely validity to accepting grief for what has been lost.”
by Michael Wilson, NY Times | Read more:
Image: Marian Carrasquero for The New York Times
[ed. I feel it too, a growing sense of resignation and defeat. The uncertainty and open-endedness of it all, a dawning realization that life as we know it will probably never be the same again. So many unresolved issues: possible mutations, a seasonal reappearance in the fall, no imminent vaccine, even the possibility that once you contract the disease you still might get reinfected. Then there's the economy, poised on a knife's edge. It's like no one will escape without some measure of personal tragedy. In the mean time we live in isolated little silos, like mole people. For a worst case scenario (as if more depressing news is needed), see: The Scariest Pandemic Timeline (The Atlantic).]
Friday, April 24, 2020
Rise of Insomnia and Vivid Dreaming
Zyma Islam noticed her sleep began to change soon after the lockdown began.
Islam is in Dhaka, Bangladesh, which has been under a strict lockdown for over three weeks. All forms of public transport are suspended. That means scores of daily wage earners—domestic helpers, rickshaw pullers, construction workers, and garment workers—have lost wages, and are now battling hunger.
Islam is typically an early riser, but she had to adapt to a new routine of working during the night. “All day long there are queues of hungry people outside my house begging and crying for food,” Islam said. The streets get quieter after 11pm, which is when Islam now gets most of her office work done. She gets to bed around 7am—and most days, she’s barely able to sleep for four hours.
“I don’t have control over whether these people actually end up getting food or relief,” says Islam, which has left her in a constant state of anxiety. “As a result of this, I’m aways sleep-deprived in spite of constantly actually being home.”
Islam isn’t alone. “Everything about this situation is dreadful. It’s full of dread all the time,” says Orfeu M. Buxton, who directs the Sleep, Health, and Society Collaboratory at Pennsylvania State University. All around the world, people’s lives are being impacted by the Covid-19 pandemic—along with their typical sleep patterns.
Whether it’s insomnia, strange dreams, or even sleeping too much, sleep disturbances are part of our body’s response to trauma and anxiety. Everyone will react to these situations differently—but experts have helpful information to share about ways to improve your rest.
Insomnia
“We are in the midst of collective trauma,” says Christy Beck, a therapist based in State College, Pennsylvania. “Something none of us have experienced in our lifetime. And sleep disturbance is a common trauma response, along with anxiety and depression.” Beck says that stress can cause a variety of sleep disorders, including insomnia—not being able to fall asleep—and its opposite, hypersomnia.
Anecdotal evidence seems to agree. Google searches for the term “insomnia” hit an all-time high recently. Hailey Meaklim, a psychologist and research scientist who is investigating the impact of the pandemic on insomnia symptoms, says that it is the most common sleep problem.
The pandemic is an invisible threat, Meaklim explains, “one that we can’t fight or run away from like we would from a sabre-tooth tiger.” But it still puts our bodies on high alert. “When you can’t actively do anything about these concerns, that still elicits a stress response. You want to sleep, but the rest of your physiology is actually telling you to mobilize, and that can put you at odds,” says Tony Cunningham, a postdoctoral research fellow at the Harvard Medical School.
“This may be due to the physiological arousal of the “fight or flight” system that accompanies anxiety that is in opposition with the “rest and digest” system needed to sleep,” says Courtney Bolstad, a doctoral student at the Mississippi State University. “This arousal may also cause difficulty returning to sleep in the middle of the night.”
There’s one more reason for trouble sleeping: People may also be staying up later to be on their phones, as they don’t have to get up early for work. “The light emitted from phones signals to our “clocks” that it is still daytime,” says Meaklim, which can lead to disruptions to our circadian rhythms and ultimately our sleep.
by Amanat Khullar, Quartz | Read more:
Image: Nuca Lomadze/EyeEm via Getty Images
[ed. I know my sleep patterns have seriously gone to hell. See also: Insomnia and Vivid Dreams on the Rise With COVID-19 Anxiety (Smithsonian). Also indications of dangerously escalating mental health issues: A high-risk perfect storm': loneliness and financial despair take toll on US mental health (The Guardian).]
Islam is in Dhaka, Bangladesh, which has been under a strict lockdown for over three weeks. All forms of public transport are suspended. That means scores of daily wage earners—domestic helpers, rickshaw pullers, construction workers, and garment workers—have lost wages, and are now battling hunger.
Islam is typically an early riser, but she had to adapt to a new routine of working during the night. “All day long there are queues of hungry people outside my house begging and crying for food,” Islam said. The streets get quieter after 11pm, which is when Islam now gets most of her office work done. She gets to bed around 7am—and most days, she’s barely able to sleep for four hours.“I don’t have control over whether these people actually end up getting food or relief,” says Islam, which has left her in a constant state of anxiety. “As a result of this, I’m aways sleep-deprived in spite of constantly actually being home.”
Islam isn’t alone. “Everything about this situation is dreadful. It’s full of dread all the time,” says Orfeu M. Buxton, who directs the Sleep, Health, and Society Collaboratory at Pennsylvania State University. All around the world, people’s lives are being impacted by the Covid-19 pandemic—along with their typical sleep patterns.
Whether it’s insomnia, strange dreams, or even sleeping too much, sleep disturbances are part of our body’s response to trauma and anxiety. Everyone will react to these situations differently—but experts have helpful information to share about ways to improve your rest.
Insomnia
“We are in the midst of collective trauma,” says Christy Beck, a therapist based in State College, Pennsylvania. “Something none of us have experienced in our lifetime. And sleep disturbance is a common trauma response, along with anxiety and depression.” Beck says that stress can cause a variety of sleep disorders, including insomnia—not being able to fall asleep—and its opposite, hypersomnia.
Anecdotal evidence seems to agree. Google searches for the term “insomnia” hit an all-time high recently. Hailey Meaklim, a psychologist and research scientist who is investigating the impact of the pandemic on insomnia symptoms, says that it is the most common sleep problem.
The pandemic is an invisible threat, Meaklim explains, “one that we can’t fight or run away from like we would from a sabre-tooth tiger.” But it still puts our bodies on high alert. “When you can’t actively do anything about these concerns, that still elicits a stress response. You want to sleep, but the rest of your physiology is actually telling you to mobilize, and that can put you at odds,” says Tony Cunningham, a postdoctoral research fellow at the Harvard Medical School.
“This may be due to the physiological arousal of the “fight or flight” system that accompanies anxiety that is in opposition with the “rest and digest” system needed to sleep,” says Courtney Bolstad, a doctoral student at the Mississippi State University. “This arousal may also cause difficulty returning to sleep in the middle of the night.”
There’s one more reason for trouble sleeping: People may also be staying up later to be on their phones, as they don’t have to get up early for work. “The light emitted from phones signals to our “clocks” that it is still daytime,” says Meaklim, which can lead to disruptions to our circadian rhythms and ultimately our sleep.
by Amanat Khullar, Quartz | Read more:
Image: Nuca Lomadze/EyeEm via Getty Images
[ed. I know my sleep patterns have seriously gone to hell. See also: Insomnia and Vivid Dreams on the Rise With COVID-19 Anxiety (Smithsonian). Also indications of dangerously escalating mental health issues: A high-risk perfect storm': loneliness and financial despair take toll on US mental health (The Guardian).]
U.S. Blowjobless Rate At All-Time High
In the wake of a recent drop in the sexual-interest rate, Labor Secretary Elaine Chao announced Tuesday that blowjoblessness in America has reached a record high.
According to Labor Department statistics, the overall blowjobless rate swelled to 37.4 percent in July, causing widespread deflation of egos.
"Cutbacks in oral services have left 55 million Americans unsatisfied," Chao said. "Although June saw a promising jump in the age 15-19 demographic, with many teenagers finding summer blowjobs, almost 82 percent of married men are completely blowjobless."
The historically fluid blowjob market reached its climax in 1996, when millions of wives and girlfriends vigorously stimulated the privates sector. But while demand has remained extremely high, supply could not, or would not, keep up. As a result, the blowjobless rate has climbed steadily, and today's limp market shows few signs of immediate expansion.
According to Chao, long-term relationships are responsible for the loss of many of this year's blowjobs.
"Over time, traditional blowjob providers prioritize other services, eventually eliminating those blowjobs that they deem unnecessary," Chao said.
"Blowjobs are not as plentiful as some Internet sites would lead you to believe," said blowjob-market analyst Tom Cochran. "Overall, it's an extremely dry market. I myself haven't had a blowjob in years."
"And it's not from a lack of trying," Cochran added.
Some professional men who once had a steady source of outcome have begun looking for freelance blowjobs. Fairfax, VA resident Dave Abbott said if he can't find a blowjob in his field, he'll move to a throbbing market such as Las Vegas.
"I heard they'll offer a part-time blowjob to just about anyone in Vegas," Abbott said.
According to Labor Department statistics, almost half of blowjobless Americans are living below the oral-poverty line, and benefits packages that include sexual intercourse are not enough to sustain them.
"For many of these orally disenfranchised men, a hand-to-mouth existence is but a dream," Cochran said.
According to Labor Department statistics, the overall blowjobless rate swelled to 37.4 percent in July, causing widespread deflation of egos.
"Cutbacks in oral services have left 55 million Americans unsatisfied," Chao said. "Although June saw a promising jump in the age 15-19 demographic, with many teenagers finding summer blowjobs, almost 82 percent of married men are completely blowjobless."
The historically fluid blowjob market reached its climax in 1996, when millions of wives and girlfriends vigorously stimulated the privates sector. But while demand has remained extremely high, supply could not, or would not, keep up. As a result, the blowjobless rate has climbed steadily, and today's limp market shows few signs of immediate expansion.According to Chao, long-term relationships are responsible for the loss of many of this year's blowjobs.
"Over time, traditional blowjob providers prioritize other services, eventually eliminating those blowjobs that they deem unnecessary," Chao said.
"Blowjobs are not as plentiful as some Internet sites would lead you to believe," said blowjob-market analyst Tom Cochran. "Overall, it's an extremely dry market. I myself haven't had a blowjob in years."
"And it's not from a lack of trying," Cochran added.
Some professional men who once had a steady source of outcome have begun looking for freelance blowjobs. Fairfax, VA resident Dave Abbott said if he can't find a blowjob in his field, he'll move to a throbbing market such as Las Vegas.
"I heard they'll offer a part-time blowjob to just about anyone in Vegas," Abbott said.
According to Labor Department statistics, almost half of blowjobless Americans are living below the oral-poverty line, and benefits packages that include sexual intercourse are not enough to sustain them.
"For many of these orally disenfranchised men, a hand-to-mouth existence is but a dream," Cochran said.
by The Onion | Read more:
Image: uncredited
Saliva is More Sensitive for SARS-CoV-2 Detection in COVID-19 Patients Than Nasopharyngeal Swabs
Abstract
Rapid and accurate SARS-CoV-2 diagnostic testing is essential for controlling the ongoing COVID-19 pandemic. The current gold standard for COVID-19 diagnosis is real-time RT-PCR detection of SARS-CoV-2 from nasopharyngeal swabs. Low sensitivity, exposure risks to healthcare workers, and global shortages of swabs and personal protective equipment, however, necessitate the validation of new diagnostic approaches. Saliva is a promising candidate for SARS-CoV-2 diagnostics because (1) collection is minimally invasive and can reliably be self-administered and (2) saliva has exhibited comparable sensitivity to nasopharyngeal swabs in detection of other respiratory pathogens, including endemic human coronaviruses, in previous studies. To validate the use of saliva for SARS-CoV-2 detection, we tested nasopharyngeal and saliva samples from confirmed COVID-19 patients and self-collected samples from healthcare workers on COVID-19 wards. When we compared SARS-CoV-2 detection from patient-matched nasopharyngeal and saliva samples, we found that saliva yielded greater detection sensitivity and consistency throughout the course of infection. Furthermore, we report less variability in self-sample collection of saliva. Taken together, our findings demonstrate that saliva is a viable and more sensitive alternative to nasopharyngeal swabs and could enable at-home self-administered sample collection for accurate large-scale SARS-CoV-2 testing.
by: Anne Louise Wyllie, John Fournier, Arnau Casanovas-Massana, Melissa Campbell, Maria Tokuyama, Pavithra Vijayakumar, Bertie Geng, M. Catherine Muenker, Adam J. Moore, Chantal B. F. Vogels, Mary E. Petrone, Isabel M. Ott, Peiwen Lu, Alice Lu-Culligan, Jonathan Klein, Arvind Venkataraman, Rebecca Earnest, Michael Simonov, Rupak Datta, Ryan Handoko, Nida Naushad, Lorenzo R. Sewanan, Jordan Valdez, Elizabeth B. White, Sarah Lapidus, Chaney C. Kalinich, Xiaodong Jiang, Daniel J. Kim, Eriko Kudo, Melissa Linehan, Tianyang Mao, Miyu Moriyama, Ji Eun Oh, Annsea Park, Julio Silva, Eric Song, Takehiro Takahashi, Manabu Taura, Orr-El Weizman, Patrick Wong, Yexin Yang, Santos Bermejo, Camila Odio, Saad B. Omer, Charles S. Dela Cruz, Shelli Farhadian, Richard A. Martinello, Akiko Iwasaki, Nathan D. Grubaugh, Albert I. Ko, medRxiv | Read more:
Rapid and accurate SARS-CoV-2 diagnostic testing is essential for controlling the ongoing COVID-19 pandemic. The current gold standard for COVID-19 diagnosis is real-time RT-PCR detection of SARS-CoV-2 from nasopharyngeal swabs. Low sensitivity, exposure risks to healthcare workers, and global shortages of swabs and personal protective equipment, however, necessitate the validation of new diagnostic approaches. Saliva is a promising candidate for SARS-CoV-2 diagnostics because (1) collection is minimally invasive and can reliably be self-administered and (2) saliva has exhibited comparable sensitivity to nasopharyngeal swabs in detection of other respiratory pathogens, including endemic human coronaviruses, in previous studies. To validate the use of saliva for SARS-CoV-2 detection, we tested nasopharyngeal and saliva samples from confirmed COVID-19 patients and self-collected samples from healthcare workers on COVID-19 wards. When we compared SARS-CoV-2 detection from patient-matched nasopharyngeal and saliva samples, we found that saliva yielded greater detection sensitivity and consistency throughout the course of infection. Furthermore, we report less variability in self-sample collection of saliva. Taken together, our findings demonstrate that saliva is a viable and more sensitive alternative to nasopharyngeal swabs and could enable at-home self-administered sample collection for accurate large-scale SARS-CoV-2 testing.
by: Anne Louise Wyllie, John Fournier, Arnau Casanovas-Massana, Melissa Campbell, Maria Tokuyama, Pavithra Vijayakumar, Bertie Geng, M. Catherine Muenker, Adam J. Moore, Chantal B. F. Vogels, Mary E. Petrone, Isabel M. Ott, Peiwen Lu, Alice Lu-Culligan, Jonathan Klein, Arvind Venkataraman, Rebecca Earnest, Michael Simonov, Rupak Datta, Ryan Handoko, Nida Naushad, Lorenzo R. Sewanan, Jordan Valdez, Elizabeth B. White, Sarah Lapidus, Chaney C. Kalinich, Xiaodong Jiang, Daniel J. Kim, Eriko Kudo, Melissa Linehan, Tianyang Mao, Miyu Moriyama, Ji Eun Oh, Annsea Park, Julio Silva, Eric Song, Takehiro Takahashi, Manabu Taura, Orr-El Weizman, Patrick Wong, Yexin Yang, Santos Bermejo, Camila Odio, Saad B. Omer, Charles S. Dela Cruz, Shelli Farhadian, Richard A. Martinello, Akiko Iwasaki, Nathan D. Grubaugh, Albert I. Ko, medRxiv | Read more:
[ed. Pre-print and not certified for peer review at this time. From the Yale School of Medicine and Yale School of Public Health. See also: Contact-Tracing Technology: A Key to Reopening (Johns Hopkins).]
The Great Distractor/Schrodinger’s Trump
One of the many things Donald Trump has done badly for the country in recent months is focus this debate – largely around himself – about whether to ‘open up’ or not. This argument is good for generating intractable arguments. But it’s not terribly productive. Jeremy Konyndyk, a former Obama administration official involved in the US ebola response and other international aid efforts, suggests this analogy. Your house is on fire. You can shut the windows to deprive the fire of oxygen. That will slow it down. But eventually you’ll suffocate. We’ve now got a public debate which amounts to whether to be incinerated or suffocate. What we need is the fire brigade to show up and hose down the house. The fire brigade, as Konyndyk explains, is a system of widespread testing, contact tracing, isolation for the infected and beefed up hospital capacity to make an interim new normal possible.
This is very hard work to do.
It would be too much to say that’s not happening. Various states are groping toward a version of that. Some is happening at the federal level. But it’s not happening anywhere fast enough. Nor is it being done on an organized national basis. We’re largely distracted by this open vs don’t open food fight in which the President is on one side or another each day depending on his mood and who he’s talked to in the previous few hours. Different parts of the country will require different approaches. But having each state devise their own strategy is as ridiculous as leaving it to individuals to make their public health decisions. Life in general is a constant mix of cases in which we are either individuals or parts of a much larger social organism. In a time of epidemic disease we are emphatically in the latter category.
TPM Reader TB flagged another key point for me. Georgia Gov. Brian Kemp (R) has now become that comic figure, the dutiful party lickspittle who in his eagerness to ingratiate gets just slightly out ahead of a mercurial paramount leader and then gets cut off at the knees for having zigged when he was supposed to zag. (Read more: The Great Distractor - TPM)
Six weeks ago I mentioned that it was now conceivable that for the second time in a generation a Democratic President – and perhaps a Democratic Congress – could come to power in January 2021 charged with picking up the pieces for a financial collapse on the GOP watch. Suddenly deficits which haven’t mattered for three years will matter again with a vengeance when it’s Democrats doing the spending.
We don’t know what the result of the November election will be. But what is remarkable is how Republicans and actually Trump himself haven’t even waited for Trump to be driven from office. Trump is now both the head of state saving the country from the global pandemic and the hidden leader of the resistance to pandemic overreach and the forces which destroyed the best economy in the history of the universe. He is both fearless leader and embodiment of the state and rebel commander goading supporters to ‘liberate’ their country. [ed. Emphasis added. Maybe this is why everything seems so surreal?]
The Trump administration has always had similar features: Trump both leads the government but often remains out of sync with or rebelling against many of the people he has appointed to run the government. (...)
Governors who are holding the line against a premature reopening of society are sometimes pointing out that they are actually operating in line with the guidelines President Trump himself has at least nominally promulgated. But Trump’s partisans know instinctively, if only because he says so so often, that Trump doesn’t support them at all. Or rather, that he supports them when he does and not when he doesn’t, whenever it is situationally convenient to do so. (Read more: Schrodinger’s Trump - TPM)
[ed. See also: We Are Living in a Failed State (The Atlantic). Recommended. And: The President is Unwell (The Week)]
This is very hard work to do.
It would be too much to say that’s not happening. Various states are groping toward a version of that. Some is happening at the federal level. But it’s not happening anywhere fast enough. Nor is it being done on an organized national basis. We’re largely distracted by this open vs don’t open food fight in which the President is on one side or another each day depending on his mood and who he’s talked to in the previous few hours. Different parts of the country will require different approaches. But having each state devise their own strategy is as ridiculous as leaving it to individuals to make their public health decisions. Life in general is a constant mix of cases in which we are either individuals or parts of a much larger social organism. In a time of epidemic disease we are emphatically in the latter category.
TPM Reader TB flagged another key point for me. Georgia Gov. Brian Kemp (R) has now become that comic figure, the dutiful party lickspittle who in his eagerness to ingratiate gets just slightly out ahead of a mercurial paramount leader and then gets cut off at the knees for having zigged when he was supposed to zag. (Read more: The Great Distractor - TPM)
***
One of the enduring features of the early Obama administration and the 2008/2009 global financial crisis was how quickly the Republican party pivoted to being the chief critic of efforts to clean up the mess their incumbent President and party had in many respects created. Suddenly the GOP barely knew George W. Bush and the 43rd President was retrospectively rebranded as the exponent of something called ‘big government conservatism’ that the GOP absolutely had nothing to do with and had never truly supported. Months into office Barack Obama was the spendthrift leading the country toward hyperinflation, decadence and ruin.Six weeks ago I mentioned that it was now conceivable that for the second time in a generation a Democratic President – and perhaps a Democratic Congress – could come to power in January 2021 charged with picking up the pieces for a financial collapse on the GOP watch. Suddenly deficits which haven’t mattered for three years will matter again with a vengeance when it’s Democrats doing the spending.
We don’t know what the result of the November election will be. But what is remarkable is how Republicans and actually Trump himself haven’t even waited for Trump to be driven from office. Trump is now both the head of state saving the country from the global pandemic and the hidden leader of the resistance to pandemic overreach and the forces which destroyed the best economy in the history of the universe. He is both fearless leader and embodiment of the state and rebel commander goading supporters to ‘liberate’ their country. [ed. Emphasis added. Maybe this is why everything seems so surreal?]
The Trump administration has always had similar features: Trump both leads the government but often remains out of sync with or rebelling against many of the people he has appointed to run the government. (...)
Governors who are holding the line against a premature reopening of society are sometimes pointing out that they are actually operating in line with the guidelines President Trump himself has at least nominally promulgated. But Trump’s partisans know instinctively, if only because he says so so often, that Trump doesn’t support them at all. Or rather, that he supports them when he does and not when he doesn’t, whenever it is situationally convenient to do so. (Read more: Schrodinger’s Trump - TPM)
[ed. See also: We Are Living in a Failed State (The Atlantic). Recommended. And: The President is Unwell (The Week)]
Thursday, April 23, 2020
Five Threats to US Food Supply Chains
The coronavirus pandemic has upended food supply chains, led to closures of meat producing plants and left Americans with the unsettling experience of seeing empty shelves at supermarkets.
Coupled with the run on toilet paper that led to severe shortages, recent events are leading Americans to wonder if the nation's food supply is secure.
Experts say that by and large, Americans don’t need to worry about food running out, but that does not mean all food will be readily available.
“I think we have a strong food supply system, and it’s diversified enough to provide the products to consumers,” said Olga Isengildina Massa, an associate professor of agriculture and applied economics at Virginia Tech.
“Obviously it has a lot of hiccups right now, but we’re working through the system,” she added.
Here are five of the major challenges facing food supply chains.
Virus outbreaks at food plants (...)
Agricultural reliance on guest workers (...)
Supply chain mismatches (...)
Increased food insecurity (...)
Crunch on delivery capacity (...)
[ed. Important. See also: Here's why you can't find frozen fries, while U.S. farmers are sitting on tons of potatoes (Reuters); and Severe coronavirus outbreaks stagger some meat-packing plants in Washington (Seattle Times):]
"So far, Corral has maintained his health, and has stayed on the job even as many co-workers opted to stay home. The facility, during normal operations, processes enough beef each day to feed 4 million people, according to the company. And Corral takes pride in his support of that effort."
“I don’t want to have a shortage of food later,” he said. “That’s my motivation. I feel like my job produces something that benefits the community.”
Coupled with the run on toilet paper that led to severe shortages, recent events are leading Americans to wonder if the nation's food supply is secure.
Experts say that by and large, Americans don’t need to worry about food running out, but that does not mean all food will be readily available.“I think we have a strong food supply system, and it’s diversified enough to provide the products to consumers,” said Olga Isengildina Massa, an associate professor of agriculture and applied economics at Virginia Tech.
“Obviously it has a lot of hiccups right now, but we’re working through the system,” she added.
Here are five of the major challenges facing food supply chains.
Virus outbreaks at food plants (...)
Agricultural reliance on guest workers (...)
Supply chain mismatches (...)
Increased food insecurity (...)
Crunch on delivery capacity (...)
by Niv Elis, The Hill | Read more:
Image: Dave Sanders for The New York Times[ed. Important. See also: Here's why you can't find frozen fries, while U.S. farmers are sitting on tons of potatoes (Reuters); and Severe coronavirus outbreaks stagger some meat-packing plants in Washington (Seattle Times):]
"So far, Corral has maintained his health, and has stayed on the job even as many co-workers opted to stay home. The facility, during normal operations, processes enough beef each day to feed 4 million people, according to the company. And Corral takes pride in his support of that effort."
“I don’t want to have a shortage of food later,” he said. “That’s my motivation. I feel like my job produces something that benefits the community.”
Smoking and Virus Protection
French Researchers to Test Nicotine Patches on Coronavirus Patients
French researchers are planning to test nicotine patches on coronavirus patients and frontline health workers after a study suggested smokers may be much less at risk of contracting the virus.
The study at a major Paris hospital suggests a substance in tobacco – possibly nicotine – may be stopping patients who smoke from catching Covid-19. Clinical trials of nicotine patches are awaiting the approval of the country’s health authorities.
However, the researchers insisted they were not encouraging the population to take up smoking, which carries other potentially fatal health risks and kills 50% of those who take it up. While nicotine may protect those from the virus, smokers who have caught it often develop more serious symptoms because of the toxic effect of tobacco smoke on the lungs, they say. (...)
The renowned French neurobiologist Jean-Pierre Changeux, who reviewed the study, suggested the nicotine might stop the virus from reaching cells in the body preventing its spread. Nicotine may also lessen the overreaction of the body’s immune system that has been found in the most severe cases of Covid-19 infection.
The findings are to be verified in a clinical study in which frontline health workers, hospital patients with the Covid-19 virus and those in intensive care will be given nicotine patches.
The results confirm a Chinese study published at the end of March in the New England Journal of Medicine that suggested only 12.6% of 1,000 people infected with the virus were smokers while the number of smokers in China is around 28%.
In France, figures from Paris hospitals showed that of 11,000 patients admitted to hospital with Covid-19, 8.5% were smokers. The total number of smokers in France is estimated at around 25.4%.
“Our cross-sectional study strongly suggests that those who smoke every day are much less likely to develop a symptomatic or severe infection with Sars-CoV-2 compared with the general population,” the Pitié-Salpêtrière report authors wrote.
[ed. Hard to believe but maybe smoking (at least at low to moderate levels) stresses the immune system enough to make it a little more robust, or, as the authors suggest, that nicotine somehow affects virus receptors. Wierd. (But not as wierd as waking up this morning and seeing the President suggesting people should try swallowing disinfectants in the sun or something. It's like living in an insane asylum). Anyway, here's the study: Low incidence of daily active tobacco smoking in patients with symptomatic COVID-19 (Qeios):]
There are however, sufficient scientific data to suggest that smoking protection is likely to be mediated by nicotine. SARS-CoV2 is known to use the angiotensin converting enzyme 2 (ACE2) receptor for cell entry[14-16], and there is evidence that nicotine modulates ACE2 expression[17]which could in turn modulate the nicotinic acetyl choline receptor (manuscript submitted). We hypothesize that SARS-CoV2 might alter the control of the nicotine receptor by acetylcholine. This hypothesis may also explain why previous studies have found an association between smoking and Covid-19 severity[1, 9, 10]. As hospitals generally impose smoking cessation and nicotine withdrawal at the time of hospitalization, tobacco (nicotine) cessation could lead to the release of nicotine receptors, that are increased in smokers, and to a “rebound effect” responsible for the worsening of disease observed in hospitalized smokers.
French researchers are planning to test nicotine patches on coronavirus patients and frontline health workers after a study suggested smokers may be much less at risk of contracting the virus.
The study at a major Paris hospital suggests a substance in tobacco – possibly nicotine – may be stopping patients who smoke from catching Covid-19. Clinical trials of nicotine patches are awaiting the approval of the country’s health authorities.
However, the researchers insisted they were not encouraging the population to take up smoking, which carries other potentially fatal health risks and kills 50% of those who take it up. While nicotine may protect those from the virus, smokers who have caught it often develop more serious symptoms because of the toxic effect of tobacco smoke on the lungs, they say. (...)
The renowned French neurobiologist Jean-Pierre Changeux, who reviewed the study, suggested the nicotine might stop the virus from reaching cells in the body preventing its spread. Nicotine may also lessen the overreaction of the body’s immune system that has been found in the most severe cases of Covid-19 infection.The findings are to be verified in a clinical study in which frontline health workers, hospital patients with the Covid-19 virus and those in intensive care will be given nicotine patches.
The results confirm a Chinese study published at the end of March in the New England Journal of Medicine that suggested only 12.6% of 1,000 people infected with the virus were smokers while the number of smokers in China is around 28%.
In France, figures from Paris hospitals showed that of 11,000 patients admitted to hospital with Covid-19, 8.5% were smokers. The total number of smokers in France is estimated at around 25.4%.
“Our cross-sectional study strongly suggests that those who smoke every day are much less likely to develop a symptomatic or severe infection with Sars-CoV-2 compared with the general population,” the Pitié-Salpêtrière report authors wrote.
by Kim Willsher, The Guardian | Read more:
Image: Joel Saget/AFP/Getty Images[ed. Hard to believe but maybe smoking (at least at low to moderate levels) stresses the immune system enough to make it a little more robust, or, as the authors suggest, that nicotine somehow affects virus receptors. Wierd. (But not as wierd as waking up this morning and seeing the President suggesting people should try swallowing disinfectants in the sun or something. It's like living in an insane asylum). Anyway, here's the study: Low incidence of daily active tobacco smoking in patients with symptomatic COVID-19 (Qeios):]
There are however, sufficient scientific data to suggest that smoking protection is likely to be mediated by nicotine. SARS-CoV2 is known to use the angiotensin converting enzyme 2 (ACE2) receptor for cell entry[14-16], and there is evidence that nicotine modulates ACE2 expression[17]which could in turn modulate the nicotinic acetyl choline receptor (manuscript submitted). We hypothesize that SARS-CoV2 might alter the control of the nicotine receptor by acetylcholine. This hypothesis may also explain why previous studies have found an association between smoking and Covid-19 severity[1, 9, 10]. As hospitals generally impose smoking cessation and nicotine withdrawal at the time of hospitalization, tobacco (nicotine) cessation could lead to the release of nicotine receptors, that are increased in smokers, and to a “rebound effect” responsible for the worsening of disease observed in hospitalized smokers.
Wednesday, April 22, 2020
Cold Calculations
The Cold Calculations America’s Leaders Will Have to Make Before Reopening (NY Times)
Image: Desiree Rios for The New York Times
[ed. Businesses can re-open if they want, but if people don't feel safe they're not going to expose themselves or their loved ones to unnecessary risk, no matter what politicians and agitators want (and it leaves employees in a very conflicted position). The economy will get going again when everyone feels the problem's finally under control (or at least risks have been reduced to acceptable levels). Unfortunately, many innocent bystanders could be affected/infected in the process.]
Emergency Room Notebook, 1977
You never hear sirens in the emergency room — the drivers turn them off on Webster Street. I see the red backup lights of ACE or United Ambulance out of the corner of my eye. Usually we are expecting them, alerted by the MED NET radio, just like on TV. “City One: This is ACE, Code Two. Forty-two-year-old male, head injury, BP 190 over 110. Conscious. ETA three minutes.” “City One … 76542 Clear.”
I like my job in Emergency. Blood, bones, tendons seem like affirmations to me. I am awed by the human body, by its endurance. Thank God — because it’ll be hours before X-ray or Demerol. Maybe I’m morbid. I am fascinated by two fingers in a baggie, a glittering switchblade all the way out of a lean pimp’s back. I like the fact that, in Emergency, everything is reparable, or not.
Code Blues. Well, everybody loves Code Blues. That’s when somebody dies — their heart stops beating, they stop breathing — but the Emergency team can, and often does, bring them back to life. Even if the patient is a tired eighty-year-old you can’t help but get caught up in the drama of resuscitation, if only for a while. Many lives, young fruitful ones, are saved.
The pace and excitement of ten or fifteen people, performers … it’s like opening night at the theater. The patients, if they are conscious, take part too, if just by looking interested in all the goings-on. They never look afraid.
If the family is with the patient it is my job to get information from them, to keep them informed about what’s going on. Reassure them, mostly.
While the staff members think in terms of good or bad codes — how well everyone did what they were supposed to do, whether the patient responded or not — I think in terms of good or bad deaths.
Bad deaths are ones with the manager of a hotel as next of kin, or the cleaning woman who found the stroke victim two weeks later, dying of dehydration. Really bad deaths are when there are several children and in-laws I have called in from somewhere inconvenient and none of them seem to know each other or the dying parent at all. There is nothing to say. They keep talking about making arrangements, about having to make arrangements, about who will make arrangements.
Gypsies are good deaths. I think so … the nurses don’t and security guards don’t. There are always dozens of them, demanding to be with the dying person, to kiss them and hug them, unplugging and screwing up the TVs and monitors and assorted apparatus. The best thing about Gypsy deaths is they never make their kids keep quiet. The adults wail and cry and sob but all the children continue to run around, playing and laughing, without being told they should be sad or respectful.
Good deaths seem to be coincidentally good Codes — the patient responds miraculously to all this life-giving treatment and then just quietly passes away. (...)
“It simply won’t help the situation, Mr. Adderly.”
“Nothing will help. It’s all I can do. Let me alone.”
When he heard McCoy had left, to make arrangements, he told me that he had never cried before. It scared him, because of his eyes.
I put her wedding band on his little finger. Over a thousand dollars in grimy cash had been in her bra, and I put it in his wallet. I told him that the denominations were fifties, twenties, and hundreds and he would need to find somebody to sort it all out.
When I saw him later on a bus he must have remembered my walk or smell. I didn’t see him at all — just climbed on the bus and slumped into the nearest seat. He even got up from the front seat near the driver to sit by me.
“Hello, Lucia,” he said.
He was very funny, describing his new, messy roommate at the Hilltop House for the Blind. I couldn’t imagine how he could know his roommate was messy, but then I could and told him my Marx Brothers idea of two blind roommates — shaving cream on the spaghetti, slipping on spilled stuffaroni, etc. We laughed and were silent, holding hands … from Pleasant Valley to Alcatraz Avenue. He cried, softly. My tears were for my own loneliness, my own blindness.
The first night I worked in Emergency, an ACE ambulance brought in a Jane Doe. Staff was short that night so the ambulance drivers and I undressed her, pulled the shredded panty hose off of varicose veins, toenails curling like parrots’. We unstuck her papers, not from her gray flesh-colored bra but from her clammy breasts. A picture of a young man in a marine uniform: George 1944. Three wet coupons for Purina cat chow and a blurred red, white, and blue Medicare card. Her name was Jane. Jane Daugherty. We tried the phone book. No Jane, no George.
If their purses haven’t already been stolen old women never seem to have anything in them but bottom dentures, a 51 bus schedule, and an address book with no last names.
The drivers and I worked together with pieces of information, calling the California Hotel for Annie, underlined, the Five-Spot cleaners. Sometimes we just have to wait until a relative calls, looking for them. Emergency phones ring all day long. “Have you seen a — ?” Old people. I get mixed up about old people. It seems a shame to do a total hip replacement or a coronary bypass on some ninety-five-year-old who whispers, “Please let me go.”
It doesn’t seem old people should fall down so much, take so many baths. But maybe it’s important for them to walk alone, stand on their own two feet. Sometimes it seems they fall on purpose, like the woman who ate all those Ex-Lax — to get away from the nursing home.
There is a great deal of flirty banter among the nurses and the ambulance crews. “So long — seizure later.” It used to shock me, all the jokes while they’re in the middle of a tracheotomy or shaving a patient for monitors. An eighty-year-old woman, fractured pelvis, sobbing, “Hold my hand! Please hold my hand!” Ambulance drivers rattling on about the Oakland Stompers.
“Hold her bloody hand, man!” He looked at me like I was crazy. I don’t hold many hands anymore and I joke a lot, too, if not around patients. There is a great deal of tension and pressure. It’s draining — being involved in life-and-death situations all the time.
Even more draining, and the real cause of tension and cynicism, is that so many of the patients we get in Emergency are not only not emergencies, there is nothing the matter with them at all. It gets so you yearn for a good cut-and-dried stabbing or a gunshot wound. All day long, all night long, people come in because they don’t have much appetite, have irregular BMs, stiff necks, red or green urine (which invariably means they had beets or spinach for lunch).
Can you hear all those sirens in the background, in the middle of the night? More than one of them is going to pick up some old guy who ran out of Gallo port.
Chart after chart. Anxiety reaction. Tension headaches. Hyperventilation. Intoxication. Depression. (These are the diagnoses — the patients’ complaints are cancer, heart attack, blood clots, suffocation.) Each of these patients costs hundreds of dollars including ambulance, X-ray, lab work, EKG. The ambulances get a Medi-Cal sticker, we get a Medi-Cal sticker, the doctor gets a Medi-Cal sticker, and the patient dozes off for a while until a taxi comes to take him home, paid for with a voucher. God, have I become as inhuman as Nurse McCoy? Fear, poverty, alcoholism, loneliness are terminal illnesses. Emergencies, in fact.
We do get critical trauma or cardiac patients, and they are treated and stabilized with awesome skill and efficiency in a matter of minutes and rushed to surgery or ICU, CCU.
Drunks and suicides take hours of time holding up needed rooms and nurses. Four or five people waiting at my desk to sign in. Ankle fractures, strep throat, whiplash, etc.
Maude, beery, bleary, is sprawled on a gurney, kneading my arm like a neurotic cat.
“You’re so kind … so charming … it’s this vertigo, dear.”
“What is your last name and your address? What happened to your Medi-Cal card?”
“Gone, everything is gone … I’m so miserable and so alone. Will they keep me here? There must be something the matter with my inner ear. My son Willie never calls. Of course, it’s Daly City and a toll call. Do you have children?”
“Sign here.”
I have found a minimum of information among the rest of the mess in her purse. She uses Zig-Zag papers to blot her lipstick. Big smeary kisses, billowing like popcorn all over her purse.
“What’s Willie’s last name and phone number?”
She begins to cry, reaching both arms for my neck.
“Don’t call him. He says I’m disgusting. You think I’m disgusting. Hold me!”
“I’ll see you later, Maude. Let go of my neck and sign this paper. Let go.”
Drunks are invariably alone. Suicides come in with at least one other person, usually many more. Which is probably the general idea. At least two Oakland police officers. I have finally understood why suicide is considered a crime.
Overdoses are the worst. Time again. Nurses usually too busy. They give them some medication but then the patient has to drink ten glasses of water. (These are not the stomach-pump critical overdoses.) I’m tempted to stick my finger down their throat. Hiccups and tears. “Here, one more cup.”
There are “good” suicides. “Good reasons” many times like terminal illness, pain. But I’m more impressed with good technique. Bullets through the brain, properly slashed wrists, decent barbiturates. Such people, even if they don’t succeed, seem to emanate a peace, a strength, which may have come from having made a thoughtful decision.
It’s the repeats that get to me — the forty penicillin capsules, the twenty Valium and a bottle of Dristan. Yes, I am aware that, statistically, people who threaten or attempt suicide eventually succeed. I am convinced that this is always an accident. John, usually home by five, had a flat tire and could not rescue his wife in time. I suspect a form of manslaughter sometimes, the husband or some other regular rescuer having at last finally tired of showing up just in the guilty nick of time.
“Where’s Marvin? Must be worried sick.”
“He’s phoning.”
I hate to tell her he’s in the cafeteria, has gotten to like their Reuben sandwiches.
Exam week at Cal. Many suicides, some succeeding, mostly Oriental. Dumbest suicide of the week was Otis.
Otis’s wife, Lou-Bertha, had left him for another man. Otis took two bottles of Sominex, but was wide awake. Peppy, even.
“Get Lou-Bertha before it’s too late!”
He kept hollering instructions to me from the trauma room. “My mother … Mary Brochard 849-0917 … Try the Adam and Eve Bar for Lou-Bertha.”
Lou-Bertha has just left the Adam and Eve for the Shalimar. It was busy for a long time, then an answer, and Stevie Wonder for a whole record of “Don’t You Worry ’Bout a Thing.”
“Run that by me one more time, honey … He OD’d on what?”
I told her.
“Shit. You go tell that toothless worthless nigger he better be taking a lot more of something a lot stronger if’n he expects to get me outta here.”
I went in to tell him … what? She was glad he was okay, maybe. But he was on the telephone in room 6. Had his pants on, still wore a polka-dot gown on top. He had located the half-pint of Royal Gate in his jacket pocket. Was just sort of lounging around, like an executive.
“Johnnie? Yeah. Otis here. I’m up here at City Emergency Room. You know, off Broadway. What’s happening? Fine, fine. That bitch Lou-Bertha messing ’round with Darryl … [Silence.] No shit.”
The charge nurse came in. “He still here? Get him out! We have four Codes coming in. Auto accident, all Code Three, ETA ten minutes.”
I try to sign as many patients as possible before the ambulances arrive. The people will just have to wait later, about half of them will leave, but meanwhile all are restless and angry.
Oh, hell … there were three here before this one but better just sign her in. It’s Marlene the Migraine, an Emergency habituée. She is so beautiful, young. She stops talking with two Laney College basketball players, one with an injured right knee, and stumbles to my desk to go into her act.
Her howls are like Ornette Coleman in early “Lonely Woman” days. Mostly what she does is first, bang her head against the wall near my desk, dump everything off my desk with a swoop.
Then she starts her cries. Whooping, anguished yelps, reminiscent of Mexican corridas, Texan love songs, “Aiee, Vi, Yi!”
“Ah-hah, San Antone!”
She has slumped to the floor and all I can see is an elegantly manicured hand, extending her Medi-Cal card above the desk.
“Can’t you see I’m dying? I’m going blind, for crissakes!”
“Come on, Marlene — how’d you get those false eyelashes on?”
“Nasty whore.”
“Marlene, sit up and sign in. Ambulances are coming, so you’ll have to wait. Sit up!”
She sits up, starts to light a Kool. “Don’t light that, sign here,” I say. She signs and Zeff comes to put her into a room.
“Well, well, if it isn’t our old angry pal, Marlene.”
“Don’t you humor me, you dumb nurse.”
The ambulances arrive, and for sure they are emergencies. Two die. For an hour all the nurses, doctors, on-call doctors, surgeons, everybody is tied up in room 6 with the two surviving young patients.
One of Marlene’s hands is struggling into a velvet coat sleeve, the other is applying magenta lipstick.
“Holy Christ — I can’t hang around this joint all night, right? Seeya, honey!”
“See ya, Marlene.”
by Lucia Berlin, Maxima-Library | Read more:
Image: A Manual for Cleaning Women: Selected Stories
[ed. I'm currently reading Lucia Berlin's "A Manual For Cleaning Women: Selected Stories, and am so impressed (like discovering Raymond Carver for the first time). She's not well known (and died in 2004) so I Googled some reviews to learn more about her work and background. Guess what? I found this website with the entire book reproduced! I'm sure there must be some copyright issues involved, but I don't know. Anyway, here's one (lightly) excerpted story (while the link still exists) for readers who want to get acquainted with her. Purchase the book. Only half way through so far, but also recommend: the title story (AMFCW), Detox, and Tiger Bites.]
If it is Code Three, where life is in critical danger, the doctor and nurses wait outside, chatting in anticipation. Inside, in room 6, the trauma room, is the Code Blue team. EKG, X-ray technicians, respiratory therapists, cardiac nurses. In most Code Blues, though, the EMT drivers or firemen are too busy to call in. Piedmont Fire Department never does, and they have the worst. Rich massive coronaries, matronly phenobarbital suicides, children in swimming pools. (...)
I like my job in Emergency. Blood, bones, tendons seem like affirmations to me. I am awed by the human body, by its endurance. Thank God — because it’ll be hours before X-ray or Demerol. Maybe I’m morbid. I am fascinated by two fingers in a baggie, a glittering switchblade all the way out of a lean pimp’s back. I like the fact that, in Emergency, everything is reparable, or not.
Code Blues. Well, everybody loves Code Blues. That’s when somebody dies — their heart stops beating, they stop breathing — but the Emergency team can, and often does, bring them back to life. Even if the patient is a tired eighty-year-old you can’t help but get caught up in the drama of resuscitation, if only for a while. Many lives, young fruitful ones, are saved.The pace and excitement of ten or fifteen people, performers … it’s like opening night at the theater. The patients, if they are conscious, take part too, if just by looking interested in all the goings-on. They never look afraid.
If the family is with the patient it is my job to get information from them, to keep them informed about what’s going on. Reassure them, mostly.
While the staff members think in terms of good or bad codes — how well everyone did what they were supposed to do, whether the patient responded or not — I think in terms of good or bad deaths.
Bad deaths are ones with the manager of a hotel as next of kin, or the cleaning woman who found the stroke victim two weeks later, dying of dehydration. Really bad deaths are when there are several children and in-laws I have called in from somewhere inconvenient and none of them seem to know each other or the dying parent at all. There is nothing to say. They keep talking about making arrangements, about having to make arrangements, about who will make arrangements.
Gypsies are good deaths. I think so … the nurses don’t and security guards don’t. There are always dozens of them, demanding to be with the dying person, to kiss them and hug them, unplugging and screwing up the TVs and monitors and assorted apparatus. The best thing about Gypsy deaths is they never make their kids keep quiet. The adults wail and cry and sob but all the children continue to run around, playing and laughing, without being told they should be sad or respectful.
Good deaths seem to be coincidentally good Codes — the patient responds miraculously to all this life-giving treatment and then just quietly passes away. (...)
I saw blind Mr. Adderly on the 51 bus the other night. His wife, Diane Adderly, came in DOA a few months ago. He had found her body at the foot of the stairs, with his cane.
Ratshit Nurse McCoy kept telling him to stop crying.
Ratshit Nurse McCoy kept telling him to stop crying.
“It simply won’t help the situation, Mr. Adderly.”
“Nothing will help. It’s all I can do. Let me alone.”
When he heard McCoy had left, to make arrangements, he told me that he had never cried before. It scared him, because of his eyes.
I put her wedding band on his little finger. Over a thousand dollars in grimy cash had been in her bra, and I put it in his wallet. I told him that the denominations were fifties, twenties, and hundreds and he would need to find somebody to sort it all out.
When I saw him later on a bus he must have remembered my walk or smell. I didn’t see him at all — just climbed on the bus and slumped into the nearest seat. He even got up from the front seat near the driver to sit by me.
“Hello, Lucia,” he said.
He was very funny, describing his new, messy roommate at the Hilltop House for the Blind. I couldn’t imagine how he could know his roommate was messy, but then I could and told him my Marx Brothers idea of two blind roommates — shaving cream on the spaghetti, slipping on spilled stuffaroni, etc. We laughed and were silent, holding hands … from Pleasant Valley to Alcatraz Avenue. He cried, softly. My tears were for my own loneliness, my own blindness.
The first night I worked in Emergency, an ACE ambulance brought in a Jane Doe. Staff was short that night so the ambulance drivers and I undressed her, pulled the shredded panty hose off of varicose veins, toenails curling like parrots’. We unstuck her papers, not from her gray flesh-colored bra but from her clammy breasts. A picture of a young man in a marine uniform: George 1944. Three wet coupons for Purina cat chow and a blurred red, white, and blue Medicare card. Her name was Jane. Jane Daugherty. We tried the phone book. No Jane, no George.
If their purses haven’t already been stolen old women never seem to have anything in them but bottom dentures, a 51 bus schedule, and an address book with no last names.
The drivers and I worked together with pieces of information, calling the California Hotel for Annie, underlined, the Five-Spot cleaners. Sometimes we just have to wait until a relative calls, looking for them. Emergency phones ring all day long. “Have you seen a — ?” Old people. I get mixed up about old people. It seems a shame to do a total hip replacement or a coronary bypass on some ninety-five-year-old who whispers, “Please let me go.”
It doesn’t seem old people should fall down so much, take so many baths. But maybe it’s important for them to walk alone, stand on their own two feet. Sometimes it seems they fall on purpose, like the woman who ate all those Ex-Lax — to get away from the nursing home.
There is a great deal of flirty banter among the nurses and the ambulance crews. “So long — seizure later.” It used to shock me, all the jokes while they’re in the middle of a tracheotomy or shaving a patient for monitors. An eighty-year-old woman, fractured pelvis, sobbing, “Hold my hand! Please hold my hand!” Ambulance drivers rattling on about the Oakland Stompers.
“Hold her bloody hand, man!” He looked at me like I was crazy. I don’t hold many hands anymore and I joke a lot, too, if not around patients. There is a great deal of tension and pressure. It’s draining — being involved in life-and-death situations all the time.
Even more draining, and the real cause of tension and cynicism, is that so many of the patients we get in Emergency are not only not emergencies, there is nothing the matter with them at all. It gets so you yearn for a good cut-and-dried stabbing or a gunshot wound. All day long, all night long, people come in because they don’t have much appetite, have irregular BMs, stiff necks, red or green urine (which invariably means they had beets or spinach for lunch).
Can you hear all those sirens in the background, in the middle of the night? More than one of them is going to pick up some old guy who ran out of Gallo port.
Chart after chart. Anxiety reaction. Tension headaches. Hyperventilation. Intoxication. Depression. (These are the diagnoses — the patients’ complaints are cancer, heart attack, blood clots, suffocation.) Each of these patients costs hundreds of dollars including ambulance, X-ray, lab work, EKG. The ambulances get a Medi-Cal sticker, we get a Medi-Cal sticker, the doctor gets a Medi-Cal sticker, and the patient dozes off for a while until a taxi comes to take him home, paid for with a voucher. God, have I become as inhuman as Nurse McCoy? Fear, poverty, alcoholism, loneliness are terminal illnesses. Emergencies, in fact.
We do get critical trauma or cardiac patients, and they are treated and stabilized with awesome skill and efficiency in a matter of minutes and rushed to surgery or ICU, CCU.
Drunks and suicides take hours of time holding up needed rooms and nurses. Four or five people waiting at my desk to sign in. Ankle fractures, strep throat, whiplash, etc.
Maude, beery, bleary, is sprawled on a gurney, kneading my arm like a neurotic cat.
“You’re so kind … so charming … it’s this vertigo, dear.”
“What is your last name and your address? What happened to your Medi-Cal card?”
“Gone, everything is gone … I’m so miserable and so alone. Will they keep me here? There must be something the matter with my inner ear. My son Willie never calls. Of course, it’s Daly City and a toll call. Do you have children?”
“Sign here.”
I have found a minimum of information among the rest of the mess in her purse. She uses Zig-Zag papers to blot her lipstick. Big smeary kisses, billowing like popcorn all over her purse.
“What’s Willie’s last name and phone number?”
She begins to cry, reaching both arms for my neck.
“Don’t call him. He says I’m disgusting. You think I’m disgusting. Hold me!”
“I’ll see you later, Maude. Let go of my neck and sign this paper. Let go.”
Drunks are invariably alone. Suicides come in with at least one other person, usually many more. Which is probably the general idea. At least two Oakland police officers. I have finally understood why suicide is considered a crime.
Overdoses are the worst. Time again. Nurses usually too busy. They give them some medication but then the patient has to drink ten glasses of water. (These are not the stomach-pump critical overdoses.) I’m tempted to stick my finger down their throat. Hiccups and tears. “Here, one more cup.”
There are “good” suicides. “Good reasons” many times like terminal illness, pain. But I’m more impressed with good technique. Bullets through the brain, properly slashed wrists, decent barbiturates. Such people, even if they don’t succeed, seem to emanate a peace, a strength, which may have come from having made a thoughtful decision.
It’s the repeats that get to me — the forty penicillin capsules, the twenty Valium and a bottle of Dristan. Yes, I am aware that, statistically, people who threaten or attempt suicide eventually succeed. I am convinced that this is always an accident. John, usually home by five, had a flat tire and could not rescue his wife in time. I suspect a form of manslaughter sometimes, the husband or some other regular rescuer having at last finally tired of showing up just in the guilty nick of time.
“Where’s Marvin? Must be worried sick.”
“He’s phoning.”
I hate to tell her he’s in the cafeteria, has gotten to like their Reuben sandwiches.
Exam week at Cal. Many suicides, some succeeding, mostly Oriental. Dumbest suicide of the week was Otis.
Otis’s wife, Lou-Bertha, had left him for another man. Otis took two bottles of Sominex, but was wide awake. Peppy, even.
“Get Lou-Bertha before it’s too late!”
He kept hollering instructions to me from the trauma room. “My mother … Mary Brochard 849-0917 … Try the Adam and Eve Bar for Lou-Bertha.”
Lou-Bertha has just left the Adam and Eve for the Shalimar. It was busy for a long time, then an answer, and Stevie Wonder for a whole record of “Don’t You Worry ’Bout a Thing.”
“Run that by me one more time, honey … He OD’d on what?”
I told her.
“Shit. You go tell that toothless worthless nigger he better be taking a lot more of something a lot stronger if’n he expects to get me outta here.”
I went in to tell him … what? She was glad he was okay, maybe. But he was on the telephone in room 6. Had his pants on, still wore a polka-dot gown on top. He had located the half-pint of Royal Gate in his jacket pocket. Was just sort of lounging around, like an executive.
“Johnnie? Yeah. Otis here. I’m up here at City Emergency Room. You know, off Broadway. What’s happening? Fine, fine. That bitch Lou-Bertha messing ’round with Darryl … [Silence.] No shit.”
The charge nurse came in. “He still here? Get him out! We have four Codes coming in. Auto accident, all Code Three, ETA ten minutes.”
I try to sign as many patients as possible before the ambulances arrive. The people will just have to wait later, about half of them will leave, but meanwhile all are restless and angry.
Oh, hell … there were three here before this one but better just sign her in. It’s Marlene the Migraine, an Emergency habituée. She is so beautiful, young. She stops talking with two Laney College basketball players, one with an injured right knee, and stumbles to my desk to go into her act.
Her howls are like Ornette Coleman in early “Lonely Woman” days. Mostly what she does is first, bang her head against the wall near my desk, dump everything off my desk with a swoop.
Then she starts her cries. Whooping, anguished yelps, reminiscent of Mexican corridas, Texan love songs, “Aiee, Vi, Yi!”
“Ah-hah, San Antone!”
She has slumped to the floor and all I can see is an elegantly manicured hand, extending her Medi-Cal card above the desk.
“Can’t you see I’m dying? I’m going blind, for crissakes!”
“Come on, Marlene — how’d you get those false eyelashes on?”
“Nasty whore.”
“Marlene, sit up and sign in. Ambulances are coming, so you’ll have to wait. Sit up!”
She sits up, starts to light a Kool. “Don’t light that, sign here,” I say. She signs and Zeff comes to put her into a room.
“Well, well, if it isn’t our old angry pal, Marlene.”
“Don’t you humor me, you dumb nurse.”
The ambulances arrive, and for sure they are emergencies. Two die. For an hour all the nurses, doctors, on-call doctors, surgeons, everybody is tied up in room 6 with the two surviving young patients.
One of Marlene’s hands is struggling into a velvet coat sleeve, the other is applying magenta lipstick.
“Holy Christ — I can’t hang around this joint all night, right? Seeya, honey!”
“See ya, Marlene.”
by Lucia Berlin, Maxima-Library | Read more:
Image: A Manual for Cleaning Women: Selected Stories
[ed. I'm currently reading Lucia Berlin's "A Manual For Cleaning Women: Selected Stories, and am so impressed (like discovering Raymond Carver for the first time). She's not well known (and died in 2004) so I Googled some reviews to learn more about her work and background. Guess what? I found this website with the entire book reproduced! I'm sure there must be some copyright issues involved, but I don't know. Anyway, here's one (lightly) excerpted story (while the link still exists) for readers who want to get acquainted with her. Purchase the book. Only half way through so far, but also recommend: the title story (AMFCW), Detox, and Tiger Bites.]
Tuesday, April 21, 2020
Oil Industry Braces for Devastation
‘I’m Just Living a Nightmare’: Oil Industry Braces for Devastation (NY Times)
Image: Bing Guan/Bloomberg
[ed. Not just the oil industry. See also: An Extinction Level Event for the News (TPM)]
[ed. Not just the oil industry. See also: An Extinction Level Event for the News (TPM)]
America Is About to Witness the Biggest Labor Movement It’s Seen in Decades
In September 1945, a little-remembered frenzy erupted in the United States. Japan had surrendered, ending World War II, but American meat packers, steelworkers, telephone installers, telegraph operators, and auto assemblers had something different from partying in mind. In rolling actions, they went on strike. After years of patriotic silence on the home front, these workers, along with unhappy roughnecks, lumberjacks, railroad engineers, and elevator operators — some 6 million workers in all — shut down their industries and some entire cities. Mainly they were seeking higher pay — and they got it, averaging 18% increases.
The era of raucous labor is long past, and worker chutzpah along with it. That is, it was — until now. Desperately needed to staff the basic economy while the rest of us remain secluded from Covid-19, ordinarily little-noticed workers are wielding unusual leverage. Across the country, cashiers, truckers, nurses, burger flippers, stock replenishers, meat plant workers, and warehouse hands are suddenly seen as heroic, and they are successfully protesting. For the previous generation of labor, the goal post was the 40-hour week. New labor’s immediate aims are much more prosaic: a sensible face mask, a bottle of sanitizer, and some sick days.
The question is what happens next. Are we watching a startling but fleeting moment for newly muscular labor? Or, once the coronavirus is beaten, do companies face a future of vocal workers aiming to rebuild lost decades of wage increases and regained influence in boardrooms and the halls of power?
For now at least, some of the country’s most powerful CEOs are clearly nervous. Late last month, Apple, faced with reporters asking about a company decision to furlough hundreds of contract workers without pay, did a quick about-face. Those employees, Apple now said, would receive their hourly wages. A few weeks earlier, after Amazon warehouse workers demanded better benefits during the virus pandemic, that company also reversed course, offering paid sick days and unlimited unpaid time off.
The backdrop is a country at a standstill and uncertain over which businesses will survive the current economic shakeout, and in what form. With some notable exceptions, very few companies seem prepared to risk riling their employees, especially given broad popular support for workers at their grocery stores, nurses at their hospitals, and drivers who are keeping supply arteries open.
But if companies are responding to those who are protesting, they might also think ahead and preempt festering trouble down the road. “I like to believe people will say, ‘We treat these people as disposable, but they are pretty indispensable. Maybe we should do what we can to recognize their contribution,’” says David Autor, a labor economist at MIT and co-director of the school’s Work of the Future Task Force.
Until the 1980s, layoffs were barely a thing, writes Louis Uchitelle in The Disposable American: Layoffs and Their Consequences. Companies tended to avoid large-scale dismissals, because they violated a red line of publicly accepted practice and also could finger the company for blame. The United States was still in the age of company as community and societal patron, and even when workers went on strike, they were generally not replaced, because the optics would be bad.
But in 1981, President Ronald Reagan changed all that. [ed. emphasis added] Some 12,000 air traffic controllers went on strike, demanding higher pay and a shorter workweek. In a breathtaking decision, Reagan fired all but a few hundred of them. The Federal Labor Relations Authority decertified the controllers’ union entirely. The era of strong labor was over.
In the subsequent age of the no-excuses layoff, the number of major strikes has plunged. Starting in 1947, when the government began keeping such data, there were almost always anywhere from 200 to more than 400 big strikes every year. But in 1982, the year after the air traffic controllers debacle, the number for the first time fell below 100. In 2017, there were just seven. “There was damage to self-esteem every time there was a layoff. It took the militancy out of organized labor, and I don’t think it ever recovered,” Uchitelle says.
The past four decades have been perhaps labor’s weakest since the Industrial Age. For a half century, those working for hourly wages have won almost no real gains. The real average hourly wage in 2018 dollars adjusted for inflation was $22.65 in 2018, compared with $20.27 in 1964 — just an 11.7% gain, according to Pew Research. Real median hourly wages rose by only another 0.6% last year despite the sharp tightening of the job market and an increase in the minimum wage across the country, according to the Bureau of Labor Statistics.
The current revival of worker activism precedes Covid-19 in the unlikeliest of places. In 2018, West Virginia teachers, among the lowest paid in the nation and four years without a raise, went on strike for nine days in a demand for higher pay. That they won a 5% increase was one astonishing thing. But the walkout itself was stunning, specifically because of the state where it occurred — a former bedrock of ultramilitant coal miners who had repeatedly gone to actual war for better pay and safety but more recently were a bastion of worker passivity.
Last year, the West Virginia teachers were on the picket lines again. This time, they stopped the state legislature from funding private schools in what they saw as an attempt to weaken their newly revived strength. Officials buckled after just a day. The strikes meanwhile spread to a dozen red and blue cities and states. Often wearing red shirts as the symbol of the strikes, the teachers were demanding more money — from 2000 to 2017, teachers’ real salaries actually shrunk by 1.6% nationally, according to the National Center for Health Statistics — as well as more supplies and help in the classroom. In Arizona, teachers won a 20% raise, and Los Angeles teachers won a 6% raise. That triggered more strikes through much of 2019, with Chicago teachers, for one, winning a 16% pay raise. Strikes seemed likely this year, too, in Detroit and Philadelphia, for starters.
If teachers are an indicator of what is coming, Amazon, fast food restaurants, hospitals, and gig companies have a long, hot few years ahead. On April 6 alone, the employees of a Los Angeles McDonald’s walked out when a co-worker was diagnosed positive for the coronavirus. For the second time in a month, workers at a Staten Island Amazon warehouse went on strike after 26 co-workers came down with the virus. And outside Chicago, employees of two plants walked out because management failed to immediately announce that co-workers had been diagnosed with Covid-19.
Across the country, workers are on the march over safety, pay, and sick days. The picture is jarring at a time when 16 million people are newly out of work. Companies and CEOs need to prepare for a new post-Covid-19 reality where workers will recognize their power — and use it.
The era of raucous labor is long past, and worker chutzpah along with it. That is, it was — until now. Desperately needed to staff the basic economy while the rest of us remain secluded from Covid-19, ordinarily little-noticed workers are wielding unusual leverage. Across the country, cashiers, truckers, nurses, burger flippers, stock replenishers, meat plant workers, and warehouse hands are suddenly seen as heroic, and they are successfully protesting. For the previous generation of labor, the goal post was the 40-hour week. New labor’s immediate aims are much more prosaic: a sensible face mask, a bottle of sanitizer, and some sick days.
The question is what happens next. Are we watching a startling but fleeting moment for newly muscular labor? Or, once the coronavirus is beaten, do companies face a future of vocal workers aiming to rebuild lost decades of wage increases and regained influence in boardrooms and the halls of power?
For now at least, some of the country’s most powerful CEOs are clearly nervous. Late last month, Apple, faced with reporters asking about a company decision to furlough hundreds of contract workers without pay, did a quick about-face. Those employees, Apple now said, would receive their hourly wages. A few weeks earlier, after Amazon warehouse workers demanded better benefits during the virus pandemic, that company also reversed course, offering paid sick days and unlimited unpaid time off.
The backdrop is a country at a standstill and uncertain over which businesses will survive the current economic shakeout, and in what form. With some notable exceptions, very few companies seem prepared to risk riling their employees, especially given broad popular support for workers at their grocery stores, nurses at their hospitals, and drivers who are keeping supply arteries open.
But if companies are responding to those who are protesting, they might also think ahead and preempt festering trouble down the road. “I like to believe people will say, ‘We treat these people as disposable, but they are pretty indispensable. Maybe we should do what we can to recognize their contribution,’” says David Autor, a labor economist at MIT and co-director of the school’s Work of the Future Task Force.
Until the 1980s, layoffs were barely a thing, writes Louis Uchitelle in The Disposable American: Layoffs and Their Consequences. Companies tended to avoid large-scale dismissals, because they violated a red line of publicly accepted practice and also could finger the company for blame. The United States was still in the age of company as community and societal patron, and even when workers went on strike, they were generally not replaced, because the optics would be bad.
But in 1981, President Ronald Reagan changed all that. [ed. emphasis added] Some 12,000 air traffic controllers went on strike, demanding higher pay and a shorter workweek. In a breathtaking decision, Reagan fired all but a few hundred of them. The Federal Labor Relations Authority decertified the controllers’ union entirely. The era of strong labor was over.
In the subsequent age of the no-excuses layoff, the number of major strikes has plunged. Starting in 1947, when the government began keeping such data, there were almost always anywhere from 200 to more than 400 big strikes every year. But in 1982, the year after the air traffic controllers debacle, the number for the first time fell below 100. In 2017, there were just seven. “There was damage to self-esteem every time there was a layoff. It took the militancy out of organized labor, and I don’t think it ever recovered,” Uchitelle says.
The past four decades have been perhaps labor’s weakest since the Industrial Age. For a half century, those working for hourly wages have won almost no real gains. The real average hourly wage in 2018 dollars adjusted for inflation was $22.65 in 2018, compared with $20.27 in 1964 — just an 11.7% gain, according to Pew Research. Real median hourly wages rose by only another 0.6% last year despite the sharp tightening of the job market and an increase in the minimum wage across the country, according to the Bureau of Labor Statistics.
The current revival of worker activism precedes Covid-19 in the unlikeliest of places. In 2018, West Virginia teachers, among the lowest paid in the nation and four years without a raise, went on strike for nine days in a demand for higher pay. That they won a 5% increase was one astonishing thing. But the walkout itself was stunning, specifically because of the state where it occurred — a former bedrock of ultramilitant coal miners who had repeatedly gone to actual war for better pay and safety but more recently were a bastion of worker passivity.
Last year, the West Virginia teachers were on the picket lines again. This time, they stopped the state legislature from funding private schools in what they saw as an attempt to weaken their newly revived strength. Officials buckled after just a day. The strikes meanwhile spread to a dozen red and blue cities and states. Often wearing red shirts as the symbol of the strikes, the teachers were demanding more money — from 2000 to 2017, teachers’ real salaries actually shrunk by 1.6% nationally, according to the National Center for Health Statistics — as well as more supplies and help in the classroom. In Arizona, teachers won a 20% raise, and Los Angeles teachers won a 6% raise. That triggered more strikes through much of 2019, with Chicago teachers, for one, winning a 16% pay raise. Strikes seemed likely this year, too, in Detroit and Philadelphia, for starters.
If teachers are an indicator of what is coming, Amazon, fast food restaurants, hospitals, and gig companies have a long, hot few years ahead. On April 6 alone, the employees of a Los Angeles McDonald’s walked out when a co-worker was diagnosed positive for the coronavirus. For the second time in a month, workers at a Staten Island Amazon warehouse went on strike after 26 co-workers came down with the virus. And outside Chicago, employees of two plants walked out because management failed to immediately announce that co-workers had been diagnosed with Covid-19.
Across the country, workers are on the march over safety, pay, and sick days. The picture is jarring at a time when 16 million people are newly out of work. Companies and CEOs need to prepare for a new post-Covid-19 reality where workers will recognize their power — and use it.
by Steve LeVine, Marker | Read more:
[ed. We can only hope. See also: Coronavirus Live Updates (4/21/2020): Trump Narrows Immigration Ban; Senate Passes Aid Package (NY Times).]
Monday, April 20, 2020
David Foster Wallace: The Nature of Fun
[ed. Excerpt from DFW's posthumously published collection Both Flesh and Not on a writer's motivation.]
This is the sort of parabolic straw you cling to as you struggle with the issue of fun, as a writer. In the beginning, when you first start out trying to write fiction, the whole endeavour's about fun. You don't expect anybody else to read it. You're writing almost wholly to get yourself off. To enable your own fantasies and deviant logics and to escape or transform parts of yourself you don't like. And it works – and it's terrific fun. Then, if you have good luck and people seem to like what you do, and you actually get to get paid for it, and get to see your stuff professionally typeset and bound and blurbed and reviewed and even (once) being read on the AM subway by a pretty girl you don't even know, it seems to make it even more fun. For a while. Then things start to get complicated and confusing, not to mention scary. Now you feel like you're writing for other people, or at least you hope so. You're no longer writing just to get yourself off, which – since any kind of masturbation is lonely and hollow – is probably good. But what replaces the onanistic motive? You've found you very much enjoy having your writing liked by people, and you find you're extremely keen to have people like the new stuff you're doing. The motive of pure personal fun starts to get supplanted by the motive of being liked, of having pretty people you don't know like you and admire you and think you're a good writer. Onanism gives way to attempted seduction, as a motive.Now, attempted seduction is hard work, and its fun is offset by a terrible fear of rejection. Whatever "ego" means, your ego has now gotten into the game. Or maybe "vanity" is a better word. Because you notice that a good deal of your writing has now become basically showing off, trying to get people to think you're good. This is understandable. You have a great deal of yourself on the line, now, writing – your vanity is at stake. You discover a tricky thing about fiction writing: a certain amount of vanity is necessary to be able to do it at all, but any vanity above that certain amount is lethal. At this point 90+% of the stuff you're writing is motivated and informed by an overwhelming need to be liked. This results in shitty fiction. And the shitty work must get fed to the wastebasket, less because of any sort of artistic integrity than simply because shitty work will make you disliked. At this point in the evolution of writerly fun, the very thing that's always motivated you to write is now also what's motivating you to feed your writing to the wastebasket. This is a paradox and a kind of double bind, and it can keep you stuck inside yourself for months or even years, during which you wail and gnash and rue your bad luck and wonder bitterly where all the fun of the thing could have gone.
The smart thing to say, I think, is that the way out of this bind is to work your way somehow back to your original motivation: fun. And, if you can find your way back to the fun, you will find that the hideously unfortunate double bind of the late vain period turns out really to have been good luck for you. Because the fun you work back to has been transfigured by the unpleasantness of vanity and fear, an unpleasantness you're now so anxious to avoid that the fun you rediscover is a way fuller and more large-hearted kind of fun. It has something to do with Work as Play. Or with the discovery that disciplined fun is more fun than impulsive or hedonistic fun. Or with figuring out that not all paradoxes have to be paralysing. Under fun's new administration, writing fiction becomes a way to go deep inside yourself and illuminate precisely the stuff you don't want to see or let anyone else see, and this stuff usually turns out (paradoxically) to be precisely the stuff all writers and readers share and respond to, feel. Fiction becomes a weird way to countenance yourself and to tell the truth instead of being a way to escape yourself or present yourself in a way you figure you will be maximally likeable. This process is complicated and confusing and scary, and also hard work, but it turns out to be the best fun there is.
by David Foster Wallace, Brain Pickings | Read more:
Photograph: © Gary Hannabarger/Corbis[ed. Repost.]
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