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Archive for January, 2010

On Wednesday, my six-year-old son, the Tiger, “lost a battle with gravity,” as my friend who witnessed the situation described it. He fell from the monkey bars on the school playground, to the great detriment of his left elbow. You could see that there was an actual bend in his arm just above the elbow.

We transferred up to Columbus after our local ER determined he’d probably need surgery. His dad deposited us at Children’s Hospital, then went home to take care of the Bear. The Tiger was almost heartbreakingly brave through all of this, even when he got an IV in his uninjured arm.

The good news is that the orthopedic resident at Children’s determined that the Tiger’s fracture could probably be treated without surgery. She set it under deep sedation and we were discharged before the night was over. There’s a lot more to that part of the story, which I’ll write about as I’m able. Right now, I’m still dizzy with exhaustion from the past few days, busy pampering the Tiger, and reeling from the night’s emotional trauma.

The Tiger is feeling pretty good today following a miserable first 36 hours. He’s off pain meds, which is a mixed blessing because he was extremely charming while on Vicodin, and now he’s rather cranky – but his pain is blessedly subsiding. He’s learning how to maneuver in the world with his left arm in a sling. Unfortunately, he’s a lefty, so eating is tricky, and schoolwork will be well-nigh impossible.

We’ll return for a recheck on Wednesday, at which time we’ll learn if the Tiger still needs surgery. He has a supracondylar fracture – a break in the humerus just above the elbow. It’s a common injury for kids his age. It’s also “serious,” if the intertubes are to be believed, with the short-term potential for harming arteries and nerves. The Tiger appears to be fine on that score, but the main possible long-term complication is failure of the bone to grow properly, since the fracture runs through a growth plate. His odds of unimpaired growth are pretty good if the bone is positioned properly. If not, well, that’s why he might still require surgery. Supracondylar fractures are rated on a 1 to 3 scale, with 1 meaning the bone is still in alignment, and 3 always needing surgery. The Tiger’s break is between a 2 and a 3, which basically means the bone was substantially displaced but still hanging together by a thread.

Oddly, his cousin – my sister’s daughter – who’s two months older had a very similar fracture just two months ago. She did end up with surgery (and a pin – ugh), and she broke her left radius just below the elbow. Like the Tiger, she too faces a risk of impaired growth. My sister has been a wonderful source of support and advice. The whole family is stunned that the cousins would go through such similar experiences – at the same age, almost to the day.

Ever since my niece’s accident I’ve been ruminating on how impossible it is for us to perfectly protect our kids. Throughout most of human history, it was common for parents to bury one or more of their babies. Gustav Mahler’s Kindertotenlieder have been echoing through my head – especially the fifth one, where the protagonist regrets letting his child go out in a storm. The text (by Friedrich Rückert) begins:

In diesem Wetter, in diesem Braus,
Nie hätt’ ich gesendet die Kinder hinaus

In this weather, in this windy storm,
I would never have sent the children outside

Four years after Mahler finished these songs, one of his daughters died at age four of scarlet fever. He later wrote:

I placed myself in the situation that a child of mine had died. When I really lost my daughter, I could not have written these songs any more.

These days, we don’t often face the specter of child death, and as a society we repress the fact that it still occurs. As a society, we try to convince ourselves we can always keep our kids safe, if only we buy the right products and hover over them incessantly. Moments like this – when a child’s little body suffers damage that could be permanent – break through our thick carapace of denial.

The storm never subsides completely. It ebbs and whispers, only to rage anew. We can’t always keep our children inside, nor should we. Therein lies our kids’ vulnerability – and our own.

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A few weeks ago I floated the proposal – which I swiped from Cenk Uyger – of using reconciliation to pass meaningful health care by vastly expanding Medicare. Now it seems that Ezra Klein is warming up to the idea:

My preference is that House Democrats pass the Senate bill and then run their fixes through the reconciliation process. But I think there is an argument that the current health-care bill has been terribly compromised by the months of controversy, the shady deal with Ben Nelson, the ambivalence of key legislators, the endless meetings with industry players, the wasted time, and the collective freak-out of congressional Democrats in the aftermath of Scott Brown’s election.

There is another option.

Democrats could scrap the legislation and start over in the reconciliation process. But not to re-create the whole bill. If you go that route, you admit the whole thing seemed too opaque and complex and compromised. You also admit the limitations of the reconciliation process. So you make it real simple: Medicare buy-in between 50 and 65. Medicaid expands up to 200 percent of poverty with the federal government funding the whole of the expansion. Revenue comes from a surtax on the wealthy.

And that’s it. No cost controls. No delivery-system reforms. Nothing that makes the bill long or complex or unfamiliar. Medicare buy-in had more than 51 votes as recently as a month ago. The Medicaid change is simply a larger version of what’s already passed both chambers. This bill would be shorter than a Danielle Steel novel. It could take effect before the 2012 election.

(The rest of his column is here.)

I realize that reconciliation is tricky, and it can’t do things like eliminate discrimination based on preexisting conditions. It can only deal with budgetary items. Also, Medicaid is no panacea. It’s second-class health insurance in some pretty major ways. Many doctors won’t accept it.

Still, a massive expansion of Medicare would also be a massive step toward affordable health care for all. It would establish the principle of universal coverage without making millions of Americans essentially captive to private insurers. It could set the stage for further expansions of Medicare.

Regulatory reform could still be achieved, though probably in a more piecemeal way. How many congresscritters would come out in favor of preserving the insurance industry’s right to discriminate on preexisting conditions, if that were the centerpiece of a bill? (This would obviously assume the prior existence of an individual mandate, because otherwise people would try to game the system, only buying insurance after they needed it.)

Anyway, just ’cause Ezra Klein likes it doesn’t mean it will happen. But his suggestion does mean that the policy wonks who have a voice in the debate haven’t declared “game over.” It means that we could accomplish meaningful reform without the likes of Ben Nelson and Scott Brown and (shudder) Joe Lieberman. It could mean thousands of lives saved.

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Okay, I have to fess up: there are no cats whatsoever in this clip. It’s goats all the way. I found this clip recently while helping my younger son, the Tiger, with a school assignment on the “Three Billy Goats Gruff,” and it just tickled me.

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In a couple of my previous posts on Mary Daly, I mentioned that her secularized notion of “idolatry” – which she saw in first-wave feminists’ singleminded focus on suffrage – can be applied to modern-day feminism as well. Today, on the 37th anniversary of Roe v. Wade, I’d like to dwell on how “choice” has served as an idol – as a foundational concept that can’t bear the weight it’s been given.

“Choice” was an attractive term to the defenders of abortion rights in the 1970s because it provided a way to counter a growing “pro-life” movement without having to say that they were “pro-abortion.” Even today, defending “abortion” is a politically dodgy proposition. My Democratic ?? !! @*&$# congresscritter, Charlie Wilson, D-Bluedognia, proudly claims at every opportunity that he’s pro-life. He and his cronies are sure not going to come out in favor of abortion.

By now, though, we need a more flexible strategy, as lots of folks – especially radical women of color – have argued before me. What about access to abortion, birth control, sex education, prenatal care, and fertility treatments? How about reproductive rights and justice? What about bodily autonomy and self-determination?

Yes, it’s important that women have choices. It’s even more crucial that we have the material, social, and cultural wherewithal to exercise them.

Denying the means to exercise choice shows that we, as a society, just don’t trust women – especially those women who don’t already enjoy a panoply of privileges. Conversely, “trusting women” doesn’t matter a whit as long as their choices are highly constrained.

And while we’re at it, let’s remember than no one –  female or male, fertile or not – has real bodily autonomy without access to health care. Reproductive autonomy isn’t just a women’s rights issue. It’s a matter of human rights.

Addendum, 1/24/10, 3 p.m.: Based on the comments to this post, it looks as though I haven’t fully clarified why I think feminists would be wise to walk back from our overreliance on “choice.” From the get-go in the 1970s, “choice” referred to narrowly to the formal legality of abortion. It was a product of liberal feminism, which framed abortion in terms of negative liberty – or freedom from interference. However, that wasn’t nearly enough to secure reproductive rights for women, broadly conceived, including a right to birth control, sex ed, etc. This would have required the issued to be reframed in terms of positive liberty, which includes the resources and means to act and exercise one’s liberties. (I’ve written about these disparate concepts of liberty here.) “Choice” also failed to highlight even the violations of negative liberty perpetrated on women who were poor or non-white, such as coerced sterilizations and pressure to use abortion or long-term birth control.

In theory, of course, “choice” could embrace both notions of liberty and and could include issues beyond abortion. Despite some feminists’ efforts to expand the term, however, it continues to carry historical baggage. The popular understanding of “choice” is that it’s shorthand for legal abortion. Its meaning has constricted and frozen. I hear this from my students in women’s studies classes, as well as from critics within feminism. That’s why I’d prefer we stop privileging “choice” in favor of “reproductive rights” and “reproductive justice.” These concepts highlight the importance of positive liberties and challenge us to think about the whole spectrum of gendered health issues.

Thanks to figleaf and kb for pointing out that I didn’t connect all the dots – a hazard of writing when I probably ought to have been sleeping instead. :-)

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While I’m stewing a couple of longer posts, here’s a medical breakthrough. And for once, I don’t have anything critical to say about it. I’m all gee-whiz-isn’t-science-awesome!

Science Daily announces that a team headed by Dr. William Dooley of the University of Oklahoma has developed a technique to radically shrink large breast tumors. The study is not out yet (it’ll appear in the Annals of Surgical Oncology), so here’s what Science Daily reports:

They are working on a treatment called Focused Microwave Thermotherapy. The technique, which was approved by the U.S. Food and Drug Administration, uses a modified version of the microwave technology behind the “Star Wars” defense system.

In the most recent study, researchers tested the therapy on tumors that were an inch to an inch and a half in size. These large tumors usually require mastectomies. When researchers used the heating therapy within two hours of patients receiving chemotherapy, the tumor was more susceptible to the chemotherapy and shrunk rapidly. The percentage of patients needing mastectomies was reduced from 75 percent to 7 percent.

(More here.)

In other words, only a tenth of the women who would’ve needed a mastectomy ended up having one.

In their next step, the researchers will zap tumors as large as five inches. (I cringe at the idea that a tumor could grow that large without detection. We’re talking about the size of a small melons. My entire breast isn’t five inches in diameter.) In theory, the therapy could be applied to any organ that can be immobilized.

So this is really, really cool. It’s also making me rue my role in the Star Wars program – Reagan’s, that is, not Darth Vader’s. Back in the summer of 1984, I worked as a lab assistant at Hewlett-Packard in Palo Alto. I was supposed to grow laser crystals. The specifications were tight. The equipment was old. Control of the reactor was all manual. I grew a lot of crystals, measured them, tested them, watched them fail. This went on all summer. Donuts were served daily, and they were scrumptious. Only at the end of the summer did I learn that those useless wafers were all intended for Reagan’s Star Wars initiative.

I felt much better.

But now I wonder. What if our failed research could have fed into a great peacetime medical application, as this thermotherapy process promises to be? How many other projects funded by the DoD, Department of Energy, etc. might spawn brilliant but overlooked civilian applications? I mean, I know we’ve got computers and the Internet thanks to DoD, but what other wonders might be hiding in their junk closets?

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One Good Thing …

… about the Senate Democrats losing their filibuster-proof 60-vote majority?

At least Joe Lieberman won’t be able to kick us around any more.

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Tuesday Recipe: Little Raspberry Tarts

These are a variation on the pecan tassies that I make at Christmas. The raspberry/almond combo might even be better than the original.

Tart dough:

1/2 cup butter, softened
1 3-ounce package cream cheese, softened
1 cup all-purpose flour
Filling (see below)

In a small mixer bowl, beat together butter and cream cheese. Stir in flour. Cover and chill about one hour or till easy to handle. Cut into 24 pieces. Shape into one-inch balls. Press onto bottom and up sides of ungreased 1 3/4-inch muffin cups. Fill each with one rounded teaspoon filling. Bake in a 325 F oven for 20 to 25 minutes or till done. Cool slightly in pan. Remove and cool well. Makes 24.

Almond-Raspberry Filling:

Divide 1/4 cup red raspberry preserves among pastries (about 1/2 teaspoon each). Beat together 1 egg, 1/2 cup sugar, 1/2 teaspoon real almond extract, and 1/2 cup  ground almonds. (I used Trader Joe’s almond meal, plus a handful of chopped almonds that I first blanched and popped out of their skin.) Spoon one level teaspoon of the mixture over preserves. Sprinkle with coarsely chopped sliced almonds or a whole almond. If desired, drizzle cooled baked tarts with additional red raspberry preserves (I didn’t bother).

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