Wednesday, January 16, 2013

Brave New World of Medical Technology

Lucky me, I have a pacemaker.  Actually, very lucky as when I was fifty four I was running around the office one day, feeling a little dizzy, but going about my business, preparing to get on an overseas flight to the Frankfurt Bookfair, and my wise wife forced me to see my doctor before we departed (she was going with me). My doctor took an EKG and looked startled, saying that my heart was beating at only 30 BPM.  I should have passed out long ago and he wondered how I was able to get through the day.  So I said, isn't there a pill I can take, I have to be in Frankfurt tomorrow. He replied, the only place you're going is to the ER.  Had I gotten on that plane, ignoring the symptom, I was told I would have died.  So, lucky me, indeed.

After ER, I was admitted to the cardiac unit and they thought I had an advanced form of Lyme Disease, which can attack the heart's electrical conduction system. I was put on heavy duty antibiotics and meanwhile they warned me that if my heartbeat dropped below 30, I'd have to have a temporary pacemaker wired through my neck.  That evening a team of medical personal came bursting into my room, monitors beeping, indicating my heartbeat had dropped to 28-29.  Look, I said, I'm conscious.  Please don't put a temporary pacemaker in unless it drops further.  So they watched me that night and I was at least stable.

After almost a week of medical treatment, and no improvement of my condition, a cardiologist informed me they would be prepping me for a permanent pacemaker the following day.  They had no idea why, at my age, my electrical system was failing.  Lousy genes they speculated (a favorite explanation offered by medical personal when they have no clue). So, into the operating theater I was wheeled and was told I'd be sedated but hazily conscious as the surgeon would have to ask me questions as he placed the leads into the heart.  A representative of the pacemaker manufacturer was present and I remember he and the surgeon joking during the procedure.  The surgeon said this is a piece of cake as he's relatively young and in good shape so I piped up, I ought to qualify for a discount then!  Fat chance he replied.

In any case, I have lived with a pacemaker, now, for sixteen years.  Actually, I'm now on my third such device as when the battery runs low, it's not like replacing a couple of double A's.  A new pacemaker has to be inserted in my chest. 

I know, it's an awful looking picture, but that's what my chest looked like five days after getting the last one.  It actually looks worse than it felt.

My third generation pacemaker is high tech.  The older devices needed monitoring, usually in the cardiologist's office.  But now the monitoring is done remotely, as the pacemaker transmits the information wirelessly to a receiver that sits by our bed, one that is plugged into our phone system, and it dials out the data as I sleep.  Every three months if does a "pacemaker interrogation" the same one I had in the office and transmits the data (it will also send data immediately if it detects any serious irregularity such as a ventricular tachycardia).  Our phone system is now digital, so the information goes out via our cable company's broadband.

But wait, more high tech.  Our telephone answering service is provided by the cable company as well; not only are messages recorded, they are transcribed using voice recognition, and then sent to me via email.

And yesterday I received the following email:

From: Voice
Sent: Tuesday, January 15, 2013 1:04 PM
Subject: You have a new Voicemail

    "Hello this is your implanted cardiac device clinic calling to let you know we received your follow up data and it looks normal. We look forward to your next appointment. Thank you and goodbye."

Thus, from an implanted pacemaker with a computer chip transmitting on a proprietary band, to a receiver that dials out via broadband to a computer that analyzes the data and, if normal, then places an automated call which is recorded and then transcribed via voice recognition, finally being emailed back to me.  A full circle without human interaction!

Any sufficiently advanced technology is indistinguishable from magic.....Arthur C. Clarke

But there are serious issues with all this technology, both positive and negative.  My pacemaker is transmitting at all times.  Anyone within 10 feet knowing the frequency and having the right equipment, in a public place, can have access to the data which raises privacy issues.  I have no problem with that but it also means that same person would have the ability to reset or even disable the pacemaker.  Pacemaker (and implantable cardioverter-defibrillator) manufactures say that is nearly impossible, but it seems to me that almost any "techno-magic" is feasible today.

Thinking more macro-medical technology, we have the ability to build a national database of medical information, at least for Medicare recipients, that would obviate the endless duplication of medical record keeping for the same patient at multiple health care facilities and doctors' offices.  Again, privacy issues have been a stumbling block, but imagine the significant cost savings (and improvement of data accuracy).  I have less concern about the privacy issues than I do about rising health costs and the burden it puts on taxpayers.  Surely there is a techno-magic means of satisfactorily addressing the matter.

Monday, January 14, 2013

Dock Life -- and Loss

I've written before about living on a boat, something we've done now for the past 13 summers in their entirety and before that, on weekends and summer vacations.  In spite of traveling on the boat, much of the time has been spent at the dock, either getting ready to go out, returning and cleaning up, or in bad weather, just staying there, rain, wind, lightning and all.  How many days of our lives have been at the dock? Probably, in the aggregate, it measures several years.  A brief video of awaiting a storm at the dock is here:

Dock life is unlike any other.  It's close living and on weekends, when we were younger, it was a party atmosphere, someone was always hosting cocktails or sometimes there would be a dock party, everyone putting out something and dock mates strolling past, and filling up on finger food, libations. and good cheer. When we were younger, it was a family affair, the kids running up and down the dock under the watchful eye of the community. 

Of course, our boating life has been defined by the fact that we are "Long Island Sounders," berthed in Norwalk, CT. Over the years, we have cruised to most of the ports in Connecticut, to the north shore of Long Island and as far east as Newport, Block Island, Martha's Vineyard, and Nantucket.  As we grew older, the amount of cruising and distances traveled diminished to the point of now spending most of our time at the dock or the occasional short cruise to the Norwalk Islands. 

Our boating is also different because we live in Florida, and our boat in Connecticut is now our home up north.  That changes everything.

When we had a home in Connecticut, jumping on and off the boat was easier and the boat was less cluttered.  Taking the boat out now means stowing much more and unplugging all of the umbilical cords to the dock for power and water.  Easy when younger, but more challenging now.
We also have a small boat in Florida. Boating is different here, primarily because many in Florida have their boats, as we do, behind their homes.  There frequently is no marina or dock life.  Of course, there are people from up north who bring their boats to Florida for the winter.  I see lots of Canadian flags coming down the Intracoastal.  Many of those boats, though, wait out cold fronts to make a crossing to the Bahamas.

So, my comments are more "northern boat" centric, not Florida or Bahamas focused.  I could divide the boaters at the two docks we've lived at into several categories: fishermen (rarely saw much of them, they were up early and off to Montauk), cruisers (we fell into that category until I retired), liveaboards or people who rarely took their boats out (that's us now), and, strangely, people who have boats but never seem to use them.

For a long time we thought we wanted to live on a boat 24 x 7 x 365, selling our house and ties to land.  Our good friends Ray and Sue felt the same way and when towards the end of the 1990s it looked like, coincidentally, both Ray and I would be out of jobs, we fantasized about pooling our resources and buying a big yacht, something that would be comfortable for all, a ship that four experienced boaters could handle.  We looked at large Hatteras motor yachts, and some high maintenance ships such as the welded aluminum Burgers.

In our mutual excitement, we went to boat shows searching,  thinking up names for our fabled new home such as 'Moments to Remember,' 'Four Happy Hoboes,' Four Seasons,' Summer of our Lives, 'As Time Goes By,' and the overly cutesy 'Home Sea Home.'  But things have a way of taking care of themselves.  Ray and Sue were gravitating toward a sport fish style boat and we were also looking at homes in Florida.  It seems we both came upon our own individual dream places for our next phase of life simultaneously, wisely abandoning the idea of sharing a yacht, they buying a 56' Ocean sport-fish and we our current Florida home.  It worked out better this way, and we remain close friends.

They are still to this day true liveaboards on 'Last Dance,' having no other home, spending part of the year in Norwalk and the other part in the Abacos, Bahamas (usually stopping at our dock in Florida before heading out to the Abacos, and we've joined them a couple of times, stayed for awhile and then flying home from Marsh Harbor to West Palm).  Thus, we still have our own independent boating lives in Norwalk during the summers on our 'Swept Away' and that is when we try to catch up with all of our former boating friends.

Our dock life has changed as we ourselves have become summer liveaboards. Aside from Ray and Sue, we know few people who are year-round liveaboards.  But one such person was our friend, Lindy, who I referred to a couple of entries ago when he was entering a hospice.  Lindy succumbed to cancer shortly after I wrote that entry.

It occurred to me that we shared the same dock for 26 years, first at Norwalk Cove Marina, and then at the South Norwalk Boat Club.  We knew each other well and relied upon one another, checking the other's boat if one of us was away, picking up something at the store if we were going there, having a quick bite at the Club and sharing the same table at regularly scheduled boat meetings.  Lindy was somewhat of an enigma, typical though for a man who lived alone on a boat, even through the harsh winters in Connecticut, shoveling snow off the dock to get to his car. 

To Lindy, his boat was a sacred refuge and as much as he talked about leaving it behind for the winter, staying with one of his sons, or renting a place in Florida, he stuck with his boats, in the northeast, through blizzards and ice, awaiting the thaw of summer, until the following Fall when he would talk about not living another winter on the boat and then just do it again.

Lindy was an optometrist during his working years.  His boats were appropriately named 'The Optimist,' and if a sign of optimism is to have a joke du jour, he was the supreme optimist.  He always had me laughing and for most of the time I knew him as a live aboard, he had but two boats, a 42' Post, a beamy boat which I think he later regretted selling, and then a 42' Bertram. Both are classic sport fishes and, indeed, in the earlier years that I knew him, he would plan one big trip to Montauk each summer with some friends or his sons to "fish the canyon." But as he aged, his boating stayed more local until he rarely took the boat out as well.

His social life on the dock was spent visiting us and a few other couples, but mostly with a couple of guys who no longer married, ones who were on their boats a lot, particularly Harold, who remarkably boated into his 90s, having a 42' Bertram as well.  Harold predeceased Lindy by only a little more than a month.  I think it was one of the final straws for Lindy, who had been struggling with esophageal cancer during the last year.

Lindy's closest companion for many happy years was his beloved black Labrador, Charlie, a large dog to have in the confines of a boat.  I am convinced that no one knew the man better than Charlie, an exceptional dog, keenly intelligent, and extraordinarily well trained by Lindy.  That dog would sit in the cockpit of the boat and NEVER leave it until commanded by Lindy.  There could be a litter of cats parading by and Charlie would stay fast.  If Lindy was walking down the dock, Charlie would follow him with his eyes. He did not pace or whine like so many dogs missing their owners. He waited patiently as the photograph below attests (ironically, I have no photos of Lindy as he usually vanished when he saw my camera out).

Once Lindy said watch this:  he walked down the dock, Charlie keeping his eyes on him.  At the end of the dock, Lindy turned and just stood there, looking at Charlie.  He raised a finger and his eye brows, and Charlie came bounding out of the boat towards his master.  That was the sign.  Otherwise, Charlie would have stayed put.

It is strange, all those years on the same dock, knowing the man well, but not closely, and having to acknowledge that his dog knew him best.  But that is the way Lindy wanted it.  During the last few years I urged him to spend more time with his son, John, and family during the winters rather than the hard life on the dock in the winter.  He was the ultimate maverick, though, and felt that would be an imposition.  This summer, when we saw him for the last time in early September, we had a prescient feeling that that would be the last time, even though, as the perpetual optimist, he felt he would get better. 

But the operation to remove the cancerous tumor from his esophagus had taken its toll.  He wasn't able to eat, and had lost a lot of weight.  He was unsteady on his feet and we worried.  Ann had sent over quite a few meals and we had been shopping for him, but we were then going back to Florida.  Lindy, I said, why don't you make arrangements to go to New Hampshire to your son, establish doctors up there, the winter here will be impossible for you.  We'll see he said.  I spoke to him in early December and he said he was going to go to his son's for Christmas.  Great, I said, you are staying there, right?  Make arrangements with local Doctors?  He said that he'd like to get back to the boat. 

I called him on Christmas Day and I could tell he was in bad shape.  The cancer had metastasized in his lungs and the plan was for him to start chemotherapy after he had hoped to put some weight on. He said he would like to see the boat one more time.  On Dec 26, though, John had to call an ambulance, over Lindy's protestations.  He had pneumonia and it was then, according to his son, that he "realized that to continue to try to fight the cancer would only extend his life a short while but at the cost of his dignity and his quality of life. He decided to discontinue nutrition and enter hospice." And so finally at the end he was with family for a compassionate, comfortable passing. 

I remember getting up on Jan. 4 and looking at the clock.  It was 6.00 am.  I didn't think anything of it -- about 15 minutes earlier than I normally wake up now. Later that day I got an email from John, about Lindy's passing at approximately 6.00 am. Indeed, Bon Voyage, Lindy.

His death has had a big impact on us, not only because of the years we spent on the dock together but because it reminds me, and anyone connected with him, of our own mortality.  I wish I was a religious person and could say with conviction that there is some sort of heaven, but I believe in the here and now and, when dead, especially after such a horrible disease, one is indeed in another better place.  As Susan Jacoby quoted 19th century Robert Green Ingersoll in her article in last week's New York Times on atheism -- when Ingersoll had delivered the eulogy for a child who had died -- “they who stand with breaking hearts around this little grave, need have no fear. The larger and the nobler faith in all that is, and is to be, tells us that death, even at its worst, is only perfect rest ... The dead do not suffer.”

Many years ago when I used to go down to our boat to check on it during the winter, the boatyard which during the summer was such a bustling place, became one of stark desolation.  Most boats were up on land for storage and the early morning winter sun and wind made it an eerie place (I think of Emily's Dickinson's poem that begins, "There's a certain slant of light, / On winter afternoons, / That oppresses, like the weight. / Of cathedral tunes."). On one such day I felt compelled to write my own poem about the experience, not a very good one, I'm not a poet, but it expressed my feelings.  I include it here in memory of Lindy.

Wintry Moorings

Halyards slap
in the winter morning’s
northwest wind.

The boat yard
is a lonely place.

Hulls are awkward hulks
beached on parking lots,
stringers and fiberglass
settled on blocks and cradles.

Some boats still endure the water,
lines urging
finger slips to test pilings;
ice-eaters drone in the briny dark.

On land they are shrink-sealed in plastic
or framed under bulky tarpaulins,
riding out the wintry bombardment,
awaiting next summer’s voyages.

Others lay abandoned
by Captains who are no more

Friday, January 4, 2013

Getting Back to Reality

The extraordinary increase (as a percentage move) in the 10 Year T Note yield shows the artificiality and the fragility of market values, everything being propped up by the Federal Reserve in the absence of any sound fiscal policy.  The recent Fed minutes merely hinted at the possibility of reducing asset purchases before the end of this year, and bond investors were left without their bungee cord:

Bill Gross, the "bond king," persuasively writes about the problem in his January letter, a long discourse on why "helicopter money" rained down by the Fed to save the financial system has to end badly in some way.

The artificiality of it all hasn't escaped the notice of corporations, many of which have loaded up their balance sheets with cheap debt, while holding mounds of cash, even to the point of paying massive dividends to their shareholders with borrowed funds.  The poster child for this is Costco which paid its shareholders $3 billion and borrowing the funds to do it.  Of course that was before the laughable fiscal cliff deal, which raised taxes on dividends to 20% from its present 15% but only for high income taxpayers.  They were talking about taxing dividends as regular income which must have freaked out the five largest shareholders who are corporate officers or directors, their take on the special dividend with borrowed funds being almost $12 million.  What a country! Borrow the money to pay your top people a huge bonus that is taxed at only 15%.  It truly is the microcosm for the contrived and completely unpredictable financial landscape of today.

A few days ago Barry Ritholz suggested a positive way of using today's manipulated market -- that is to upgrade and repair our aging infrastructure. Many of our roads are atrociously maintained and bridges are crumbling, not to mention aging water systems, power plants, and a railroad transportation system which is truly 3rd world quality.  As Ritholz says: At some point in the future, your kids are going to ask — “Wait, you could have upgraded _______ and it only would have cost you 2.5% in borrowing costs?!?”
Isn't that where we should be putting borrowed money to work, creating jobs?

Tuesday, January 1, 2013

Time Happens

Some might go to Times Square or the virtual equivalent to celebrate the New Year, but the night before we celebrated by seeing, again, A Delicate Balance by Edward Albee at Dramaworks in West Palm Beach, taking our son Jonathan, and his friend, Anna.  We normally see the previews of Dramaworks' productions, but Bill Hayes, the Producing Artistic Director of the Theatre and the Director of this particular production challenged us to see the play later in its run.  One can indeed see its maturation as a drama, especially the complex dialogue and character interaction coming even more together. But as a philosophical statement, it had the same profound impact on me, about families and about life.  I shuttered when Agnes says, "Time happens, I suppose,... To people ... Everything becomes...too late, finally. You know it's going on ... up the hill; you can see the dust, and hear the cries, and the steel ... but you wait; and time happens. When you do go, sword, shield ... finally ... there's nothing there ... save rust; bones; and the wind."

Those words came flooding back to me as the New Year began on a heartbreaking note, learning that a friend is entering hospice.  Too upsetting to write about now, but this panoramic photograph sort of expresses my feeling, one I had remembered taking earlier in the year when a "Supermoon" was rising in May.  There are spectacular images of this event on the web, the moon truly dominating the landscape, but this one is the opposite, conveying the vastness of our world, and, ultimately, the solitary nature of our journey. Time happens....