Glass Shallot by Adam Baer | Adambaer.com

il dottore a roma

I am having a lovely time in Rome. But I can't help but feel that the trip is somewhat marred so far by a persistent cold, sore throat, and fever-like sensation that worsens at night. Until yesterday we thought I just picked up something nasty on the plane. But as it continued to worsen over a week's time, I figured it would be wise to get it checked out. First I went to a farmacia, where things are a little different than they are in America. For one thing, as my local farmacia dottore pointed out, in America, you never get to to speak to the pharmacist: That isn't entirely true, but I know what he means having spent lots of time in inpersonal Rite Aids run by uneducated fools. But then the farmacia dottore continued: Here, we are doctors, he said. And there are four of us all the time in this place. Of course, they only have one form of sudafed that doesn't make you drowsy (Vicks -ah"FLu-ah Action-ah"), and they decide what it is you need, but it is nice to speak to someone who knows a little something about medicine. You like-a this system better than America's, he asked, ah? No, I said. They are both good, but I wish I had the choice over my medication. Ah, he said. But we are doctors. Lina then perked up: But you are doctors of phramacy the same way I am a doctor of psychology, just like our pharmacists. Yes! he said. Clearly we weren't communicating very well. At any rate, I then ran into my Zia on the street looking for peaches at the fruit stand. It so happened she had just returned from her doctor. What type of doctor is he if you don't mind me asking, I said in Italian. Allora, she said. Ancora, sentai male? Si, I replied. Allora. She took my hand and we walked one block from the apartment where she rung up her local doctor's office. We entered and the doctor took me right away, checked my throat and gave me a full exam. I see no sign of bacterial infection, she said; drink water and lemon. And don't let water come from your body (sweat!). Then she OK'ed the phamacist's Sudafed and the new throat spray. Then, when it was time to pay, she refused money. Instead she kissed the both of us, tolf my aunt to feel well and tousled my hair. Then she sent us home and told us to bring her lemons from Amalfi. Now, think of even the nicest doctor in the U.S. Would he or she see you for free, and instantly? Would he or she care enough to put you ahead of her other patients? That is what I miss about the American system. I don't care if I have to pay for my Sudafed (my Zia will get reimbursed by her government-fortified insurance company for my over-the-counter cold meds). But it would be nice if I had a doctor who cared even 30% as much as this fine Roman doctor. Oh, and by the way: She went to Harvard but she grew up in Rome.  Va bene, indeed.

huffpo'ing immigrant health reform

And the fight rages on:

http://www.huffingtonpost.com/adam-baer/keep-kids-covered----espe_b_99213.html

the springtime harvest: food stories

Recently, a 40-year-old friend e-mailed me a thanks for telling him what he should be eating at his ripe old age. About nine years younger than him, I couldn't claim to be a true expert and had a good laugh at his note. But the other cool thing about some of the facts I uncovered in reporting this recent Best Life food-for-health story is that you don't have to be a man to get benefits from these ingredients. Have a look at the piece, featuring actual experts (including a look at celebrity nutritionist culture), and if you see me at the local French bakery, I give you permission to smack me in the gut.

p.s. I also admit that I did send into the universe this cocktail story for Angeleno as well as this artisanal hot dog roundup for Lexus's newly retooled lifestyle and culture magazine--but hey, one of the dogs is made from organic, grass-fed beef, and let's not forget about the medicinal uses of ginger, which appear in one of Katsuya Hollywood's most transporting sips.

keeping coverage--no matter how you got here

Yesterday's article in the LA Times about young immigrant liver-transplant survivors who hit 21 and lose state coverage, often causing a lapse in their post-transplant care without chances for re-transplantation, raises issues so important, it should spark questions in a forthcoming presidential debate. Not only does it shine a light on whether or not young, illegal immigrants should receive taxpayer-supported medical treatment; it is powerful enough to illuminate a candidate's sheer humanity, regardless of his or her opinion on immigration reform.

In reporter Anna Gorman's story, a young woman circumvented near-certain death and won her way back to state-supported care at UCLA, which could offer her another transplant if necessary as opposed to care provided by the county. Her strategy? Admitting that she lives in this nation illegally. Bold.

Now, I am not in support of every immigrant having to take such a leap in our current immigration-reform environment; but that isn't the issue. When terminal or chronic and progressive illnesses strike, certain compromises need to be made.

And surprise: For as many citizens who don't want an illegal immigrant on a liver-transplant waiting list in a country where supplies are low and costs are high, there are humanitarians in medicine and the field of medical ethics who believe that a hospital should not drop a pediatric immigrant transplant case--or any other type of chronic case--just because the patient has reached legal drinking age.

It is a terribly imperfect system, to be sure. But I don't just feel for these patients as a chronic disease sufferer who received a transplant during the pediatric period of my life. I see and hear about what these patients deal with firsthand as the husband of a cross-cultural health-psychology researcher who, among other things, assesses quality of life and depression in monolingual immigrant patients with similar circumstances.

The facts: These patients are under tremendous stress outside of their medical predicaments--as if they need anything else to worry about. Other cultures also sometimes view chronic illness differently than Americans—it's not just "bad luck" or something that can be "fixed." Some patients from other countires, for instance, may consider one disease a curse or punishment. Some may never tell family members. Some may not seek treatment consistently enough without strong reminders. These factors need to be considered when rendering a decision about medical care for non-citizens.

In fact, it's even harder to be a sick young adult as an illegal resident, and I say that knowing how terribly difficult it is to weather multiple conditions of this severity as an American citizen. When these 21-year-old immigrants received livers as children under state-supported insurance plans, they didn't ask for American care. They didn't ask to be here at all, most likely. We cannot hold them responsible for a choice they didn't make, and to ignore them on this count would show some of the lowest regard for human life I can imagine. While these patients may not pay the same taxes as other American residents, notifying the government of their status is not as simple as it sounds. It is a brave and risky measure. One with potentially harsh repercussions for their families that should be rewarded with at least the same care that would be given to any other American child.

For the record, oncologists consider patients "pediatric" up to and sometimes beyond 20 years of age. But the public has caught on to this labeling due to powerful cancer survivorship networks like that of Lance Armstrong's (love him or hate him). Liver disease and other ailments that strike patients up to this age, and perhaps beyond, should also be considered pediatric. And pediatric patients--for starters, at least—should have a reliable medical support system in this country regardless of how or when they arrived on these shores. As Dr. Michael Shapiro, the vice chairman of the ethics committee for the liver network, said in Gorman's LA Times piece: there's probably a better chance that more illegal immigrants donate organs in America than those who receive them.

So let's pose the question to all candidates, regardless of political party. The results could tell us not who is ultra-conservative or ultra-liberal but who really values human life. They could give us a true sense of a candidate's character. And wouldn't that be a little more interesting than getting nitpicky about whose national health plan will do exactly what before it's even put into place.

 

docs with a (literary) dream

In today's Huffington Post, I have a piece on some issues a well-known doctor missed in his recent national newspaper essay. It discusses the trend of doctors writing books and articles about the behind-the-scenes medical world. But I just wanted to expand here on one small point in the piece: a) Of course, I agree that anyone with a specialty problem should see a specialist (I wasn't advocating that someone with hormonal imbalances shouldn't see an endocrinologist), and b) I know plenty of docs, super-specialists included, who are to be lauded for their work as scientists and humanitarians. Still, this piece had to be written. Could it have been more concise? Sure, but then I wouldn't have done the blog op-ed justice, right?

Obama's Concern for Chronics

[Cross-published at The Huffington Post]

NOTE: See addendum below this piece to as a response to HuffPo commenters.

IN A RECENT New York Times piece, Paul Krugman, one of my favorite columnists, explains how the numbers can't deny that Hillary's health plan is better than Obama's. But what "better" means here is relative even when stats and dollars are an issue. The idea is that Hillary's plan calls for a mandate and will result in more coverage dollars per person. You can't argue the logic of strong economic research. But what excites me about Obama is his less-than-bright-lining look at things. He's got a realistic hold on the healthcare crisis even if his plan is less likely to insure everyone immediately.

More powerful, he's also clearly interested in eliminating waste that contributes to hard-to-explain hardships for sick people. And from the standpoint of someone somewhat young with chronic health problems in the wake of serious cancer, it was damn-near J.F.K.-inspiring to hear him discuss healthcare in the past by leading with talks about insured Americans who had survived cancer but now face secondary problems and an endless onslaught of salary-zapping bills.

To be sure, getting everyone insured is of paramount importance. But so is realistically looking at how one can make that happen over a span of time so that it happens correctly in the nuanced way that it should. Does Obama have specific ideas for how to stop hospital and doctor billing fraud? For how to get cancer survivors better quality of life as they age and new bizarre conditions come their ways because of the toxic chemicals and treatments they were forced to endure to be able to vote in this election? I haven't exactly heard them. But if there's one thing that keeps people going after they've been very sick and now have uncertain futures, it's hope. And Obama gives me, a survivor of an autologous stem-cell transplant for pediatric lymphoma, hope.

Hillary? I just wouldn't trust her looking out for me at the infusion center if there was another chance for her to win some more powerful support from someone across the street. I wouldn't look to her for thoughtful looks at the small problems facing patients double-billed by hospitals, giant corporations, in fact, who often charge $150 facility (or in some cases, emergency room) fees in addition to outrageous doctor fees just because a physician chooses to practice inside a hospital-owned professional building a few blocks from the actual hospital building--what I call the branding-inspired Mayo Clinic model.

What's become evident, however, is that the sufferers and survivors of chronic diseases in America should band together to endorse a candidate based on the specific issues of getting and keeping not-just-OK-but-excellent insurance after a war has been waged against our bodies. Medicare, for instance, recently stopped paying out for some instances of immune deficiency treatments like intravenous immunoglobulins (which is also used to treat auto-immune diseases affecting the nerves, muscles, and joints, to say nothing of its promise for Alzheimer's and other conditions). Someone needs to ask the candidates about this.

Universal health care is vital. But if some of us devoted to it aren't alive—or well enough—to fight for it as the years pass, voting for someone's broad promise of more coverage dollars for everyone when they may not really care about the details for those sick people lucky enough to already have insurance isn't going to help. If there's one thing sick people know, it's that there are a hundred questions to be answered and solved after deciding on a treatment plan.

There's a way to live more healthfully on the left side with insurance – and that doesn't mean just swallowing our severe insurance and medical care issues because the rest of the country isn't insured. Let's look at the problem in a complex, multi-angled manner, and not jump to the flashiest, sexiest solution just yet.

When flight attendants tell you to make sure your air mask is secured before you help others with theirs in the event of an emergency, it's about not being self-interested or conservative. It's about being smart. And while Obama's thoughts about healthcare may seem like an immediately smaller and less comprehensive band-aid for the country's uninsured, they may also be the most realistic and nuanced on the ticket because they come from someone who sees that this problem is a lot larger and more intricate than it seems.

---

Response to HuffPo commenters:

Don't teach me about the value of hope vs. the value of insurance. I know it all too well. But I also know it matters who's holding the cards. And it's never you as the patient. So in this case hope matters. Because I simply wouldn't trust Hillary holding the cards that concern my medical treatments--what's allowed, what procedures, what payouts, when. Obama has shown concern not just for universal health coverage but for a growing population in America: the chronically ill, the survivors who now face mysterious secondary conditions (and secondary can mean 5 or 6 or 12 of them). So to anyone who doesn't understand the above piece, let me say it clearly: More coverage dollars and an immediate quick-fix mandate doesn't mean jack if it means that the person in control won't necessarily grasp or care about the nuances involved in high-level medical treatments once plans are put into place. Obama has shown the most important quality here: human concern. My biggest nightmare is waking up to find Hillary with her hands around some patient's IV, discussing the economic worth and political value of his or her treatment with an insurance company.

Mayo Dispatch 10: Medical Tourism and Bad Eats

[Note: Please scroll down to Mayo Dispatch 1, and then scroll up for each new dispatch, if you're interested in reading this account of my time a the Mayo Clinic in a chronological way. Otherwise it will just run in retrograde. Herewith, dispatch 10. ]

I have to prepare a last Mayo Dispatch, as I'll be kicked out of my Hilton in less than an hour, forced to roam Rochester's tunnels and skyways until the last shuttle of the day(!) can get me to my plane four hours early. Yes, there's no shuttle to the airport here after 4:15 p.m. on Saturdays. I don't get it either. But one of the nice things about being stuck in the tunnels--or rather one of the decent things I found do to in the tunnels--was traipse about a bookstore the way I once did as a young New Yorker. There's a large one adjacent to one of these tunnels, and I've spent time there, inside its "cafe," drinking subpar mochas while I page through 10 mags  and a few new notable books in each sitting--an activity that once made me want to be a writer and eventually led to me meeting my wife. Still, I haven't really done this since moving to Los Angeles--maybe it's the fact that you have to drive everywhere there. In New York, you just often have to kill time on foot--so where do you go? Bookstores and coffee shops. At any rate, it was at the Rochester superbookshop where I noticed a great and large "official" tome celebrating the Sopranos, written by Brett Martin with the cooperation of the cast and producers. Martin, a writer whose works have appeared in some of the same mags as mine (although let it be said, that he has truly outdone the author of this here Shallot with a hilarious and moving output of articles and essays for GQ, among others for This American Life, Vanity Fair, and beyond), seems to have won (hell, earned) the ultimate score here for Sopranos fans, of which I consider myself one. The book is extremely entertaining and does feature some information that has escaped even some of the show's scholars, but I also must admit that I had so much time to kill in the bookstore, that I read the whole thing. The point of all this? That sometimes you need a little distraction, and if your favorite TV show of all time is over, you didn't bring your DVDs, and you're stuck in a bookstore, well, by all means look for the official book celebrating your favorite show and see if it isn't great. Martin's book, for its part, deserves to be purchased wildly as a holiday gift, not just read in a store by word-mooching latte drinkers, so maybe get this one for your brother, dad, mob-crazed sister, or cousin--and certainly get it for anyone needing to dissolve from scary real life into pop culture references and diversions. It's fun to read about how Robert Iler basically got his role as A.J. just by repeating "What? No fucking ziti now?" 30 times in a tiny room on 72nd Street. But Martin has also elevated his book's genre with spot-on cultural criticism and articulate (but fun to read!) spotlights on issues in the show you may have never explored. Kudos.

How has the Mayo portion of my life ended? Well, last night we attempted to give Rochester's one tapas restaurant a try, and ended up with some seriously mediocre and overpriced food, one example of which had to be sent back. (I hate doing this, but honestly the food tasted like dirt, and I cook with sihtake mushrooms all the time, so I love the flavor that was supposed to permeate this risotto.) But Rochester being what it is--you mean my expensive plate of crap isn't great simply for being expensive?--the chef then sent the waitress back to tell us that he thinks the food tastes great and that we're wrong, but that he'll gladly do us the favor of removing the plate from our tab. How kind, I thought. After we just spent $12 on individual drinks (in Rochester!) with perhaps a quarter of an ounce of alcohol and endured your terrible pizza--excuse me, "Neopolitan pie"--as well as picked lemon aside one tiny piece of chicken that tasted like Ajax. One thing that appears certain about downtown Rochester is that while it remains podunk, some uppity entrepreneurs are attempting to upscalify the place and rob monied or simple less podunk Mayo travelers while flauting faux-sophistication. 

Have you ever heard of medical tourism? As medical charges increase in the U.S. and people don't necessarily want their procedures done at the nearest facility, it appears that a large group of travelers are hitting new cities and even leaving the country to receive medical treatment. And when these people aren't being cracked open like lobsters, sometimes they want to eat some. It seems like Rochester may be on the verge of turning into a medical tourism hotspot--it already has the built-in traveler base. But as it does, Mayo patients and even those traveling here for business need to be careful. Eating at one of these faux-gourmet restaurants is sort of like asking for psychotherapy from a schizo locked in an asylum. Other restaurants in town have been similarly Emeril-ized, but they aren't as offensive in their attempts to swindle. They either serve over-complicated food or bad attempts at the classics. This is much more acceptable to me. Nonetheless, read your Chowhound, and then still open your mouth with caution.

Mayo Dispatches likely to end now, though I may return with more info and commentary. But I have some nice newspaper articles to run on the west coast tomorrow, and I'd love to get back to some of the day-to-day. Keep your eyes open, however, for a large piece about this experience. It's definitely going to be a part of a forthcoming book as well as a script being developed with a partner right this very second. And yes, we can do this, even during the strike. (Thanks to all of you for writing, too.)

And now I walk out of hell and into the urban. Well, I fly, and it will take more than half a day to get there, but you get the drift. --Alexander Superpatient, Dec. 15, 2007 

Mayo Dispatch 9: Clinically Photogenic

Enlarge the above picture to learn about how Mayo has "one of the oldest and largest programs of medical photography in the world." Next draft pic? Mario Testino. Tell me you can't see it: "America's Next Top Model," Mayo Clinic Edition.

As Charles Mayo would have it (click on and enlarge the above pic to read his thoughts on how to tech people to stay well), this young man looks beautifully preserved.

"A surgical procedure should be planned so that the patient, with the least possible risk and loss of time, will receive the greatest possible benefit." Charles Mayo offered these words, seen in this exhibit of surgical tools, on display for anyone en route through the main building's subway level walkway. Did he have thoughts in 1930 on whether or not people would ever want to see the tools--even the historic versions of what we now employ--used to open up their body cavities for life-threatening procedures? America needs to know.

In the aforementioned subway level mall that takes many people to their hotels or healthy fast food establishments (we all eat the lowest cal sandwich at Subway, right?), there's an actual store run by the Mayo Clinic for sufferers of sleep apnea. This is both extremely useful and extremely hilarious.  'No more sleepless nights' is not what I think of when I see that Darth Vadaresque mask in the bottom right corner. But if it will stop the snoring that keeps Lina painfully watching Carson Daly as I sleep with the remote tucked under a leg or head or something else, I say, let's get into the holiday spirit and patronize the joint

Mayo Dispatch 8: The Penultimate

We were comfortably shocked with our final MMD meeting yesterday. He was a lot more openminded and seemingly more concerned than we had anticipated--understandable given our experience, but it craved noting. And, drumroll!, he also provided what might be an answer to the problem--but it is, to be fair, the easiest of answers and may not have popped up until now due to time as opposed to proprietary Mayo technology or insight.  If it's not the answer, we're only a little further beyond square one and must move on. We'll move on anyway, leaving Rochester tomorrow at last for the Big Pomegranate I still call home. But it should be chronicled that if I hadn't asked yesterday's skin-sensation technician to test the right foot instead of the left, where I have permanent nerve damage from ankle surgery, she would have followed her orders to test the left, even though this information had been conveyed to MMD on Day One.

MMD also asked me if there were any other tests that I felt needed to be done. I appreciated the question--a doc who respects his patient's education about his own condition?--but I also didn't really feel that a doc should be asking a patient this sort of question and wondered if it wasn't just patronizing ego-candy. We want to believe in you, MMD--just do everything if you doubt yourself. Nonetheless, the man may have come through (or rather, my system may have made things more obvious, finally), and we'll find out more through the mail in the coming weeks.

So: Don't think you always come to Mayo for one (extended) visit and return with a cure, or even an end to your medical journey. That's sort of a misconception, and it should be known more widely that this place is much more like a major city university hospital than it is some super-unusual rare disease "let's get everything figured out immediately" kind of place. That said, some of its tests have been unusual and helpful, and it does figure out mysteries in one-week periods for others, I'm told. That's just not the majority. Too many people have told me that they return here frequently--not for treatment but for more chances to discover the culprit.

Another interesting Mayo fact: the docs don't trust pathology from outside labs. They believe their techs and docs do everything best. Which may be true but seems impossible in all regards on every day of the week. So they often hold onto biopsies from you longer than other places, and they also want to redo much of the testing themselves and then take their answers over anything else. It's less-than-curious in that creepy George W. Bush kind of way, and I worry about that sort of over-confidence and narrow-mindedness in every respect. But yes, they are good here. Retractions aren't necessary. But contractions of criticism about this place are. It's both less special and unusual than it wants to be, but it's also a fine, praise-worthy medical center. Let's just stop referring to it with religious devotion. In my case, it is helping me move in the right direction; it's not putting a stop to the trip.

Funny Rochester fact: We can't seem to find any movies to see here that don't have something to do with Christmas or fantasy or disease except for "I'm Not There," which we've seen.  I said to Lina: "That's an awfully artsy movie to be playing in a town obsessed with Fred Claus, I Am Legend, and the Chipmunks" (Could we combine both movies and pit Will Smith together with his cheeky friend Tom Cruise Hubbard?) But then I remembered where Bob Dylan grew up: Minnesota. It's also the place he eventually escaped, though. Thank J.C.--and Alvin--for that.

P.S. Some more fun facts about Rochester:

1. "Fine dining" establishments--and I use that term loosely--are open at 4:30 p.m. for dinner! Who's racing me to the early bird special? You don't ever need reservations here.

2. Hotel housekeeping employees *will* knock on your door at 8 a.m. if you don't have your Do Not Disturb door-hanger in full view on the outside of your temporary home.

3. The one store in the mall that sells mod home accessories--think Eames chairs and Alessi kitchen accessories--serves free chocolate toffee straight from a kitchen in Minneapolis! (That's how bad they need business...)

4. If I had gone to grad school in Minnesota--their MFA in creative writing dept once offered this here syntactically challenged blogger a fellowship that would have included having me teach a class on Hemingway--I might have had to come here pretty often for checkups.

5. Every time you have an test at the Mayo Clinic, the tech who comes to get you from the waiting room asks you to repeat your name and birthdate. I have tried variations on Alexander Supertramp just to see if I might get a smile or a scowl. I usually just get a  straight-faced: "Whatcha say?"

6. Lots of older folk here use the term "You bet" to say "anytime" or "you're welcome." Where does this habit come from? Was Minnesota a gambling hotspot at one time? Tell us in your next convoluted series, David Milch!

Mayo Dispatch 7: Digital Nature Interlude

There's probably nothing better for your spirit when you're foxholed up in a medical society--and this *is one contained medical community; everyone here has something to do with Mayo--than to escape it as thoroughly as you can. That proved physically impossible for us over the past few days. But thankfully we arrived with an academy screener of Sean Penn's "Into the Wild." I don't know that the movie was the best I've seen. But I do think Penn outdid himself in terms of visual and visceral scope. The film transports you (and in my case, reminds me why I've avoided a fulltime corporate job since the year following my undergraduate degree). I also don't believe like others that the flick necessarily glorified its protagonist: it showed him in frequent states of potheaded smuchkification for all his innate intelligence, ascetism, and Emory degree. Some people are just goofballs, and the film seemed to be honest about that. That Supertramp died so closely to supplies, a highway, and help seems only to enforce that notion. Maybe Penn could have made that more explicit about those facts. And maybe there could have been less original Vedder in the soundtrack. But locking up in a dark hotel room with a laptop DVD viewing session of this film after spending a day grappling with the unique blend of Mayo invasiveness and impersonality really brought Lina and I back home. L.A. may have the worst air in the country but it provides a lot more access to nature than Hell's Kitchen. After the flick, I put myself to bed re-reading Krakauer's Outside article, and thought yet again: This man is an extremely clear writer, but I don't know what his prose legacy will be. Which is not to say that every writer needs to be a great stylist. I love my plain sentences, my purist storytellers, my adventurers who return with tales that defy linguistic elan. But it seems to me that Krakauer's greatest feats have been finding (or living) content and packaging material with his pen. No pun intended. Still, "Into the Wild," the film, was about the best thing I could have watched last night, and Penn deserves some serious recognition for his work. Perhaps Krakauer or the new gen of Krak-type writers should look into the young pioneers who venture into the depths of the elite medical world as patients; these extended trips and transfixing diagnosis procedures should be viewed as intensely as wilderness. There are certainly more ways out of Denali--if you're smart.