Presidents, Patriotism & the Blue Angels

The Blue Angels were in town for San Francisco’s Fleet Week in recent days, along with assorted presidents for the President’s Cup golf tournament and planners for the 20th anniversary of the Loma Prieta earthquake, all of which made for a patriotic sort of time. Not to give away the punch line, but two out of the three fell victim to the famous San Francisco fog, which little factoid offers too many metaphors even to think about.

The Blue Angels bring with them, it has to be noted, a lot of ambivalence. Something about all that military might, ear-shattering noise and expensive fuel, plus the radar that lets them know when anyone is considering a quick nap… but then, they are incredibly good at what they do, and strangely beautiful streaking around up there.

Letters to the editor, however, poured in. Against the warrior culture, the display of power, the celebration of aggression and militarism, pollutants in the air. In favor of flyover celebrations and tradition. Nobody mentioned interruption of naps. I remain ambivalent.

A flag-waver to the core, I find myself resentful that flag waving has been hijacked by those who mean God Bless America and the hell with everybody else. I’m even resentful of the hijacking of God Bless America, which is a beautiful song and shouldn’t mean please don’t bless anyone else, Ma’am.

By the end of the weekend, Tiger Woods had come off a hero again, the skies had cleared just enough for a few aerobatics, the spectators had spent a lot of money on extra San Francisco sweatshirts and foot warmers to get them through the festivities and the planners were still planning for the impending earthquake celebration, all proving that Nature bats last. And a few flags of all sorts were out.

Patriotism used to feel good. I yearn for the day when it can feel good again, and we patriots are too busy promoting peace and goodwill around the globe for other stuff. And earthquakes and tsunamis and hurricanes are more to be feared than somebody else’s nuclear missiles. It could happen. Nature, sports and celebrations notwithstanding, does bat last.

Bluegrass for World Peace

A million or so music fans and sun seekers found themselves in Golden Gate Park this weekend listening to the likes of Emmylou Harris, Steve Martin, Hazel Dickens, Earl Scruggs, Boz Skaggs & the Blue Velvet Band, and a long list of other music makers you will recognize if your bluegrass credentials are up to date. There were about 75 bands in all, on six stages scattered around several meadows. I missed The Brothers Comatose, and Booker T & the Drive-by Truckers, and I worried a little about The Flatlanders tooling around these San Francisco hills, but for sheer exuberant free entertainment, Hardly Strictly Bluegrass 9 could hardly have been beat.

The free part is thanks to local billionaire Warren Hellman, a banjo-picker, bluegrass enthusiast extraordinaire and one-man stimulus package — he does a little investment banking on the side — who has thrown this party for the past nine years and has now endowed it so it will be around in perpetuity. The fact that much of the music sung by these musicians is pure anti-billionaire dampens no spirits, Hellman’s least of all.

(The top ticket, of course, was our weekend houseguest Don Betts, faithfully YouTube’d by his wife Annie as he performed that great American classic “I just don’t look good naked any more.” Betts was introduced by Hellman, whose  group The Wronglers kicked off Saturday on Porch Stage. In addition to making money and playing banjo, Hellman is an an avid champion of the sport of Ride & Tie, and Betts is current R&T Association president… but that’s probably another blog. )

A little bluegrass celebration has never been needed more. What with the world having pretty much gone to hell, there is something immensely comforting in hanging out with a few thousand fellow sufferers grooving to songs about bad whiskey and love gone wrong — problems you can identify with and get your mind around. Not to mention damning corporate greed and evil rich guys, pausing every now and then for a standing ovation for one of Them who just dropped a few million in household change on your glorious weekend out. It all somehow fits right in with a tanked job market and universal political comedy.

A few decades back this music — or what sounded exactly like this music — was called Country. It was rousing and redneck and not cool. Bluegrass is cool. Hellman’s buddies came in every race, creed, color and national origin, ranged from in utero to way-80s, recycled everything and smiled whiled jostling for dancing space. I submit bluegrass as palliative care for the world.

How's your brain fitness today?

Pick five random numbers, say them out loud. Now say them backward. No fair using props. You have now exercised your brain, and your brain appreciates it.

Alvaro Fernandez, co-founder and CEO of SharpBrains, author of The SharpBrains Guide to Brain Fitness, enthusiastic speaker on healthy brains and how to keep them, addressed a group at the New York Library — great spot for exercising brains — recently and another in San Francisco a few days later. If you’ve ever despaired over forgetfulness or worried about some day getting Alzheimer’s, Mr. Fernandez will brighten your day. Much as the gym trainers promise you your muscles can be strengthened, Alvaro Fernandez can convince you those neurons can multiply and prosper. With an energy and demeanor to match his several degrees, he may one day be the Jack Lalanne of brain fitness.

The San Francisco audience was made up of members of San Francisco Village, the second such aging-in-place organization in California. (Other village-concept communities are springing up across the country, preferred options for many seniors who want to stay in their homes.) Most of them highly active and engaged, they were receptive to Fernandez’ proposals about how to stay that way.

Fernandez began by offering facts to debunk a few popular myths about brain function: Lifelong neuroplasticity means we can always help our brains evolve through lifestyle and activities; brain function can be affected by a variety of things, from yoga to cognitive therapy; and nothing is carved in stone that says brains deteriorate with age. In short, you might not be able to avoid Alzheimer’s completely if it’s in your genes and your karma, but you might well be able to forestall it with vigorous exercise.

Four “pillars of maintenance” will keep the brain fit, Fernandez says: good nutrition, stress managment, physical exercise and brain exercise. Potato chips and TV are not on the pillars list. The best comment of the event, in fact, probably came from author/healthy aging expert and SF Village advisory board member Walter Bortz, MD, who quoted a Harvard study that revealed “watching TV is like staring at a brick wall.”

Your brain is, when you come right down to it, not interested in the TV.

Pelosi's Plea for Calm

However you feel about Nancy Pelosi’s performance as Speaker of the House so far, or however much you agree or disagree with her views, yesterday’s comment (as reported by San Francisco Chronicle Washington staffer Carolyn Lochhead) is worth both consideration and support.

For the first time anyone can remember, House Speaker Nancy Pelosi teared up at a news conference Thursday morning in response to a question about the current state of political discourse.

Visibly struggling to retain her composure, Pelosi recalled a time in San Francisco when emotions ran out of control, referring to the 1978 assassination of Mayor George Moscone and Supervisor Harvey Milk by former Supervisor Dan White.

“We are a free country, and this balance between freedom and safety is one that we have to carefully balance,” Pelosi began. She then became emotional as she recalled the events, startling the reporters gathered for the weekly news conference.

“I saw this, myself, in the late ’70s in San Francisco,” she said. “This kind of rhetoric was very frightening and it created a climate in which violence took place.”

I was not it San Francisco at the time, but those who were affirm that the intensity of anger, fear and hostility abroad in the community at large offered the ground out of which such an appalling act could grow. Many say the movie Milk accurately caught that mood, and watching the movie made my heart rate accelerate. I don’t think we need any more heart rate acceleration in the U.S. right now.

Regaining control, (Pelosi) expressed a wish that “we would all, again, curb our enthusiasm in some of the statements that are made” and “take responsibility” for what is said.

Those of us who have lived through other periods of polarization in this country — the McCarthy witch hunts, the Vietnam war, the battles for civil rights — retain vivid memories of too many brutalities, assassinations and cruelties. Pelosi is right about the need to retain a balance between freedom and safety. Unless we return to some semblance of civility in the public discourse we stand the chance of losing either, or both.

via Emotional Pelosi urges civility in discourse.

An Immigrant, Undocumented, Uninsured

I have a friend I’ll call Maria. She lives in San Francisco, but her story is very probably the same as any number of Marias in Atlanta, New York, Chicago and elsewhere. You may not know her, but I’ll bet your paths have crossed.

Maria came here from Mexico 22 years ago. She has never applied for citizenship, largely because for the first few years she was in the country her English skills were so limited it would not have been remotely possible. Recently she has been afraid to try. Maria has a 20-year-old undocumented daughter, an extraordinarily smart illegal immigrant/recent college graduate niece and a large, extended family of mostly undocumented immigrant adults and American citizen children. The niece, tired of living in a very rough part of town, went online a few years ago and found them some minimally affordable rental housing toward the ocean. They have a strong sense of belonging.

Maria and the other women clean houses for a living; the men work for landscaping companies. They drive cars without licenses because they can’t get licenses. But they are little threat due to the fact that one minor brush with the law and (Maria’s daughter explained to me in some detail) you’re out $1,000 including towing charges and fines.

Maria’s family does not do in-home care; however, there is another large, mostly undocumented community of Pacific Islanders who are highly recommended and routinely called upon when seniors (and others) here require but cannot afford extended nursing care. Not nurses by a long shot, they are nevertheless highly skilled.

Whenever Maria or other members of these communities need medical care they go to the county hospital. If the need is sudden or extreme, they go to the emergency room. Either way, they pay small amounts and they get excellent care. I’m grateful for that. They are all truly good people, honest, hard-working and contributing members of the larger community. They don’t pay income taxes (and have no Social Security accruing) but they buy local, pay their rents on time and add to the economy.

I do not support illegal immigration and am SURELY not advocating health insurance coverage for the undocumented, the very mention of which is enough to sink any reform in a New York minute. But it is a subject of contention constantly just below the national surface — or sometimes above the surface, as with the ill-mannered Joe Wilson.  As reported last week in the San Francisco Chronicle (and widely elsewhere), the current policy is clear:

Under long-standing federal policy, people who are in the United States illegally don’t qualify for federal health programs, and the current proposals for reform in Congress hold to that. With the exception of limited emergency Medicaid primarily for pregnant women and children, and some hospital funding, federal dollars do not pay for the care of people who are in the country illegally.

The health care reform bill in the House explicitly bars “undocumented aliens” from receiving federally subsidized health benefits. A Senate version doesn’t address the issue, suggesting that current policy would remain unchanged. A second Senate bill has yet to be released.

Some would have us go farther, requiring a system verifying immigrant status to be incorporated in the final health bill.

“If you don’t have a provision that clearly requires applicants’ immigration status to be verified, just to state that illegals won’t be covered is misleading,” said Yeh Ling-Ling, executive director of the Alliance for a Sustainable USA in Oakland.

Opponents argue that such verification systems would add a layer of bureaucracy and cost, and unintentionally screen out U.S. citizens who lack proper documentation. They also contend that denying a segment of people access to health care, even if they are illegal residents, could increase costs for emergency care as well as the risk for contagious disease in the general population.

However angry those are who are raising their voices about “illegal aliens,” that last sentence is worth consideration. If you cannot bring yourself to care much about the health of uninvited fellow residents of our corner of the planet, you may still want to look at this reality: treating colds in emergency rooms is an expensive folly; colds left untreated for want of an option breed more colds.

A lot of the anger is easy to understand. The economy has tanked, times are tough, you gotta blame somebody. But until all we documented citizens are ready to quit eating strawberries and drinking wine, and to forgo such niceties as in-home care and mopped kitchens, we would probably do well to care about the lives of our undocumented neighbors.

Via: http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/09/11/MN4A19GI9I.DTL#ixzz0R040rESh

Hospital Safety 101: Didn't Mom Teach You to Wash Your Hands?

San Francisco Chronicle Washington Bureau writer Carolyn Lochhead reported today on a new idea somebody had about making hospitals safer: get folks to wash their hands. Hello?

The president of a leading medical standards organization announced a new program Thursday that is designed to improve health care safety practices, starting with a rigorous approach toward hand-washing by hospital staffers.

And this is serious business.

Hand-washing failures contribute to infections linked to health care that kill almost 100,000 Americans a year and cost U.S. hospitals $4 billion to $29 billion a year to combat, said Dr. Mark Chassin, who leads the Joint Commission, which sets standards and accredits hospitals and health care organizations.

Chassin’s announcement came after Hearst Newspapers published the results of an investigation, “Dead by Mistake,” which reported that 247 people die every day in the United States from infections contracted in hospitals.

Anyone who has ever come home from surgery with an infection, or more specifically anyone whose spouse has come home from surgery with an infection (nasty-wound-tending not having been fully explained in those for-better-or-for-worse lines) will applaud the new program, but it’s hard not to wonder what has taken the medical profession so long. Hospitals have found, Lochhead reports, that “caregivers washed their hands less than 50 percent of the time when they should.”

If there’s ever been a good example of potential savings to pay for universal health care, this is one to top the list. Consumers, we who would do well to wash our own hands when visiting or inhabiting hospitals, owe a debt of gratitude to the Joint Commission (and to Hearst Newspapers for the excellent ‘Dead by Mistake’ series.)

Maybe more sinks will be adorned with the sign that gave my husband and me a healthy chuckle during a recent visit to the Kaiser emergency room:

“Hand-wash unto others” it read, “as you would have them hand-wash unto you.”


Hospitals urged to strictly enforce hand-washing.

Public Option: the Single Payer Salve

Single payer proponents are still stung by the loss of their big issue to other big issues — or big players, if you will — but the prospect of a strong public option is the balm that may still salve that wound. This was one of the messages delivered by Giorgio Piccagli, President of the California Public Health Association, North and member of the Executive Board of the American Public Health Association at a panel discussion tonight sponsored jointly by OWL of San Francisco (The Voice of Midlife and Older Women) and the League of Women Voters of San Francisco. Audience members were urged to fight, among other things, for retention of the provision which would allow states to have single payer. (A California single payer bill passed the Senate Health Committee this spring and will be heard by the full Senate in 2010.)

Fellow panelist Debbie LeVeen echoed the call, saying a “robust public plan” must be national, to insure it’s large enough, must have authority to set prices and to bargain on drugs, and use the Medicare provider network.

Backing his call for reform with increasingly heard data such as sobering figures about uninsured Americans (45 million uninsured and another 50 million under-insured, for a total of about 1 in 3 of us) Piccagli said the lessons of the past 40 years include the fact that classical economics of supply and demand do not apply to health care: increasing the number of doctors, or competition among hospitals, only results in rising costs.

If the energies formerly tied to single payer can be channeled into a push for a public option some feel a viable reform bill will emerge. The San Francisco audience, many of whom were fervent proponents of single payer (which was endorsed by both OWL and the League of Women Voters) and most of whom are seasoned activists, left the room armed with cards to send appropriate legislators and plenty of ammunition to support their call now for a public option.

Said the third panelist, Co-Director of the Center for Policy Analysis Ellen Shaffer, about prospects for a robust public plan, “I think it’s up to us.”

The Public Option Death Panel

Here’s a death panel even Sarah Palin could love — but maybe we’d better not tell her. You, however, will probably understand its value and possibly want to put it to work for your own benefit. It centers around a form called POLST, for Physician Order for Life Sustaining Treatment (in New York it’s MOLST, for Medical Orders) fast catching on across the country. The panel consists, essentially, of your doctor and yourself.

Initially developed in Oregon in 1991, POLST programs are underway in a handfull of states including Washington, California, New York and North Carolina, and are being developed in over a dozen others.

Erin Henke, POLST Program Manager for the California Coalition for Compassionate Care, outlined the program for a group of healthcare professionals this week in San Francisco, part of CCCC’s efforts to get it efficiently established across the state. The key, she emphasized, is the conversation between individual patient and medical professionals. You don’t get the form signed, in other words, unless and until patient and physician have discussed what the former wants: CPR if you’re not breathing? Feeding tube? Comfort care only, if you’re in bad shape, but you’ve got a pulse and are breathing? Or perhaps every intervention possible — tubes, wires, ventilators, the works, including transfer to a hospital intensive care unit. But the point is, you make your own decisions. Once the form is completed and signed, it follows you as part of your medical record. In California it’s printed on Pulsar Pink card stock, and not easy to overlook.

Rollout of the program, Henke explained, is an ongoing process; it will only work when it is widely known and understood not only by individual patients and physicians but also by the many other members of the profession — nurses, caregivers, ER personnel and others. CCCC’s focus right now is on skilled nursing facilities and hospitals, though Henke and the teams of POLST program advocates around the state are working toward a broad educational spectrum.

The basic POLST approach, as explained in a Journal of Palliative Medicine article by Diane E. Meier, M.D. and health care journalist Larry Beresford published earlier this year, is to provide “actionable information on how to honor the wishes of a patient with a life-threatening condition” on a variety of issues. It goes farther than an Advance Directive (though if there’s a discrepancy, the Advance Directive takes precedence) and it differs from an out-of-hospital DNR (Do Not Resusitate) form because it lets you choose treatment.

I asked Henke if the patient/doctor conversation which is necessary in order for this extraordinarily useful document to be completed is covered by most insurance companies. She says that to her knowledge there is no specific code for such a conversation, although she understands there are other codes under which physicians can bill. Let’s hope Betsy McCaughey and Sarah Palin don’t find out. Or Chuck Grassley.

Though I am only terminal just now in the same sense that all of us mortals are, I talked about the POLST form with my Kaiser primary care physician just to be sure we remain on the same page. Wouldn’t it be nice if everyone had that same opportunity.