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Archive for the ‘Medicine’ Category

He worked himself to death

In behavior, business, Health, journalism, Medicine, men, news, travel, work on April 13, 2014 at 1:25 pm

By Caitlin Kelly

The world of journalism is full of competitive, ambitious, driven people. I’m one of them.

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But a recent death — that of 39-year-old New York writer Matthew Power — raises questions for me that remain troubling and unanswered. He died in Uganda while on assignment of heatstroke.

On Facebook I read, and joined, a discussion with other journalists why his decisions seemed normal. Not to me.

From Bloomberg Businessweek:

And yet there was something else, too. Matt may have been a free spirit, but he paid a New York mortgage and worked hard to afford it. Reviewing Matt’s itinerary—red-eye, trans-Atlantic flight followed by a seven-hour drive to the trailhead the day of his arrival, then joining the expedition on his second day in country—I got a shiver of recognition. I’d have made the same mistake. Not just failing to give heat the respect I do altitude. Failing to give it more time. Departing from New York, where there is never a moment to lose, there’s no way I’d think to schedule an extra couple of days—much less the week Casa recommends to top athletes—to let my body adjust. No one has that kind of time….

It took Wood, Beka, Florio, and the rest several hours to get Matt’s body to the village of Arua. They lost most of Tuesday trying unsuccessfully to secure a helicopter to transfer his body to Kampala. By the time of his postmortem exam on Wednesday morning—36 hours since he’d passed away early on Monday afternoon—his body had begun to decompose badly, making it difficult to determine whether a preexisting condition or other factors had contributed to his collapse. To Florio, at least, his death poses no great mystery. Matt, he says, failed to acclimate to Uganda. The temperature as his flight departed New York was roughly 20F—had been, it seemed, for months.

“No one has that kind of time.”

This was not a breaking news story. He was not covering a war or conflict or election, nor competing head to head against dozens of other reporters on deadline.

If you’re working for so little money or on so tight a budget or feel so frenzied that you can’t afford even an extra day or two so take care of your body’s very real needs, what purpose does this faux frenzy actually serve?

To save your editor’s magazine $100 or $200?

I didn’t know Power or his work or the person who wrote this story about him. Power seems to have been universally loved and admired, so my comment is not meant to disrespect him or his skill. Let’s be clear about that.

But his judgment — and the encomiums of others mourning this set of decisions to race ahead at all costs — is not something I wish to emulate.

In the vastly diminished world of journalism, in which pay rates are lower than a decade ago and well-paid assignments rare for many, pushing back to defend your needs is now seen as suspect, grabby and weird; I was recently offered a contract that would only pay me 25 percent of the original $4,000 fee if it didn’t work out as we all hoped.

It didn’t, after two full revisions.

But, knowing this can happen on certain sorts of stories especially, when I asked for a better deal, I was called “difficult.”

I hate this.

Freelancers live in a state of perpetual professional and economic vulnerability. Caving immediately to editors’ “needs” — typically for more profit — is considered normal behavior.

Power died a few days before I left for Nicaragua to work in a five-person team, interviewing locals in 95-degree heat in 12-hour days, sometimes in the remote countryside. We often worked in full sun, drenched in sweat, frantically seeking whatever shade we could find; there was little to be had.

One morning, after walking and climbing in full sun for a few hours, I told our group leader I needed to soak myself at the well to cool down even though we were supposed to leave right then. I refused, politely but firmly, and told him I needed to lower my body temperature. We left 30 minutes later, and didn’t miss anything we had planned to do.

Of course I felt embarrassed being so demanding — no one else asked for this. But I’d almost gotten heatstroke when I was Power’s age, while hiking alone in the Grand Canyon. I’d written about it and knew how serious it is.

It killed Matthew Power, a young, healthy man who had done many tough overseas assignments before.

We are human beings — not machines. We are fragile. We get ill.

We can die from making the wrong choices.

Pretending otherwise, that we are somehow invulnerable — that an extra few hours of rest or an additional night in even the most basic hotel to acclimate — is an undeserved or greedy sort of luxury is madness.

His death appalls me.

But reinforcing the idea that ignoring your own needs is the wisest and most admirable choice is even worse.

 

When blogging about illness, what’s TMI? The NYT wades in — and angers many

In behavior, blogging, culture, domestic life, Health, journalism, Media, Medicine, women on January 16, 2014 at 12:49 am

By Caitlin Kelly

Maybe you’ve been following this recent firestorm?

The one in which Salon, a popular American website, called The New York Times’  former executive editor Bill Keller, and his wife, Gilbey’s gin heiress Emma Gilbey, despicable?

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Both of them wrote about cancer patient Lisa Adams, who has advanced breast cancer.

From Salon:

Lisa Bonchek Adams is a mother of three living with Stage 4 breast cancer. She blogs and tweets about what she is undergoing and the decisions she is making about her health; she does so frequently and to a large audience that’s rooting for her. And to a prominent husband-wife pair of journalists, she’s somehow offensive.

Bill Keller, the former executive editor of the New York Times, published an Op-Ed in that paper today indicating that Adams, in spite of the image of positivity and strength she generally broadcasts on her social media platforms, is dying and doing so in a manner somehow undignified; Keller draws a comparison between Adams and his late father-in-law. “His death seemed to me a humane and honorable alternative to the frantic medical trench warfare that often makes an expensive misery of death in America.”

That “trench warfare” has, for Adams, included a variety of medical studies; Keller indicates that Adams’ personal decisions about her health, and her expressing herself online, somehow detracts from people who choose not to undergo experimental treatments or who choose to slip under with less of what is traditionally known as “fighting.” He even finds a Stanford associate dean who is willing to say that Adams “shouldn’t be unduly praised. Equal praise is due to those who accept an inevitable fate with grace and courage.”

Here’s an analysis piece from NPR’s blog:

the piece enraged a lot of Times readers, according to public editor Margaret Sullivan, that she heard a great deal of negative feedback, and who herself said “there are issues here of tone and sensitivity.”

Boy … you can say that again. By closing the piece with a piece about a dean who “cringes” at Adams’ alleged embrace of a “combat metaphor” (unsupported by any quotes from her own writing) and salutes those who show grace and courage, Keller implicitly suggests that to handle your disease as Adams has is one way to go. The other way to go is with grace and courage. And that’s very unfortunate.

Adams herself says that Keller, along with his wife Emma Gilbey Keller, who also wrote a controversial column critiquing Adams’ handling of her cancer (that was in The Guardian and has since ), have misrepresented the basic facts of her medical status, and Keller has already admitted he got the number of kids she has wrong. These disputes have been pretty thoroughly inventoried in a . And writers at outlets including and have been sharply critical of the need to explain to a cancer patient how to handle (and discuss) having cancer.

This is an issue I’ve thought a lot about — how much to write or blog about one’s illness or surgery or medical issues — and how much to never share beyond one’s circle of intimates. People, in my view, who are the ones who are most likely to have actually visited you and your family in the hospital or come with you to the chemo suite, perhaps.

One woman I know, barely, professionally, shared a lot of detail on Facebook about the effects of chemo as she was treated (so far, successfully) for breast cancer. But there was a lot I wish she had simply kept to herself.

She got a lot of emotional support, which I understand — why she craved it and why people offered it.

My mother had a radical mastectomy in 2003. She is alive. She has survived multiple cancers, including thyroid and a meningioma, a form of brain tumor.

In other words, I already live in daily fear of my genetic heritage and have little appetite to read anything about cancer.

That is not a judgment of people who do, but the effect of knowing too much firsthand already.

I get my medical tests and keep a careful eye on my own body and that of my husband.

I’ve already stared down plenty of doctors and Xrays and seen too much and heard too much. I saw my mothers’ very large brain tumor on the Xray and had to give informed consent for her; here’s the piece I wrote about it for Chatelaine, Canada’s largest women’s magazine.

Who am I to complain when I, too, have written these sorts of stories? They can, I know, be helpful to others and provide comfort to the ill and to their families.

A friend my age died of cancer in January 2006 and several men in my apartment building are currently fighting cancer.

It’s not that I don’t care about people who are ill. It’s the reverse. Instead, I find myself worrying about people I do not even know.

For me, that’s not the best choice.

I have really mixed feelings about this sort of thing — none of which suggests I’m right.

How do you feel about someone sharing a lot of very graphic detail on-line about their illness?

Writers, beware: 10 caveats before you publish your book

In art, behavior, blogging, books, business, culture, journalism, Medicine, work on November 25, 2013 at 1:20 am

By Caitlin Kelly

English: Logo of french publisher Léon Vanier

English: Logo of french publisher Léon Vanier (Photo credit: Wikipedia)

Here’s a wise/sorrowful reflection on publishing, by former lecturer in French at Cambridge, blogger Victoria Best:

Nowadays you could be forgiven for thinking that everyone in the world writes and harbours some secret dream of superstardom. And publishers seem (and this may be an illusion) to have become more and more cagey and restrictive about what they will put out…And paradoxically, the more platforms that appear for writers to publish on, the more problematic it all becomes. There are people out there drawing flow charts now to account for all the different choices that can be made. And still the question remains: who will actually read us?

It seems to me that the basic problem is that publishing is way too emotive a subject for writers to be allowed near…Many writers talk about publishing before they have actually experienced it. In the same way that newly-formed partnerships fantasise romantically about having children, and university students imagine being rich, writers think about publication as a joyous event, and quite possibly one that will solve all their problems – financial, moral, existential. Whereas most of us who have published limp bloodied from the arena, humiliated by having failed to make the crowd go wild. My premise in this post is that – like so many modern phenomena – publishing is an awful experience and yet still we want it beyond all reason.

Here’s the inside dope from NYC career editor, Daniel Menaker, in the blog Vulture, an excerpt from his new book:

Approximately four out of every five books published lose money. Or five out of six, or six out of seven. Estimates vary, depending on how gloomy the CFO is the day you ask him and what kinds of shell games are being played in Accounting….

To make matters worse, financial success in frontlist publishing is very often random, but the media conglomerates that run most publishing houses act as if it were not. Yes, you may be able to count on a new novel by Surething Jones becoming a big best seller. But the best-­seller lists paint nothing remotely like the full financial picture of any publication, because that picture’s most important color is the size of the advance. But let’s say you publish a fluky blockbuster one year, the corporation will see a spike in your profits and sort of autistically, or at least automatically, raise the profit goal for your division by some corporately predetermined amount for the following year. This is close to clinically insane institutional behavior.

The entire blog post is a must-read for anyone who really wants to hear what goes in inside publishers’ hallowed halls. Not for the naive or foolish. It’s funny, sad, bitter — and true!

And, from The Nation:

the work of writers is traded in three currencies: money, meaning book sales and author advances; status, meaning reviews, awards, fellowships and general cachet, which are not strictly quantifiable but pay dividends nonetheless; and a third, which I can only describe as the actual life of a book, which is its movement through the world after it is published. Sales do contribute to this third currency, but only so much, because it is intangible, uncountable and ultimately unknowable, and yet still entirely, wonderfully real.

What do authors hope for with publication of their work?

Fame

Defined how? Ten people beyond your immediate family? A cover story in People magazine?

Fortune

Most writers receive an advance, from a commercial publisher, of $5,000 to $50,000 for their first book — maybe even their seventh or twelfth. The advance is typically paid out in thirds, at best, more often in quarterly payments: upon signing of the contract; upon delivery of the first few chapters or full manuscript; upon publication, (typically at least a year after signing), and — yes, really! — a year after publication.

Which somewhat re-defines the word “advance.”

Every payment is sent through your agent who claims their 15 percent fee for representing you before they forward the rest to you. Most mid-list authors, (i.e. not best-sellers), will never “earn out”, i.e. repay the publisher their advance and thereby receive any additional payment for their work. This is because we receive a tiny fraction of the cover price and because publishers make sure to claim their profits before we see ours.

Foreign sales

Pleasant, but rarely lucrative. Citic Press bought the rights to publish my book “Malled: My Unintentional Career in Retail” in China, paying $3,000. It simply went to pay down my advance. They re-named the book for their market, (“The Greatest Saleswoman in the World” — hardly!) and gave it a crisp new cover, with a photo wholly different from the American version.  I’ve received no reply from them to my repeated emails asking for information about how it’s doing there.

Thousands of passionate readers

Many books find fewer than 1,000 buyers, in any format. Ever. A book selling 10,000 or more copies has done well. (My second book, “Malled”, did. Whew!)

A movie deal

I know someone whose book — published in 2001 — is now in production as a major motion picture. Many books are optioned, (which usually means you get a nice five-figure check), but few make it through the process to become a finished film. Here’s an interview with Orson Scott Card in the current issue of Wired magazine, author of the award-winning 1985 book Ender’s Game — now in theaters after more than a dozen scripts were rejected over the decades.

A television series (with residuals!)

Sweet! My book Malled was optioned by CBS as a sitcom and I was swooning with excitement. I was paid $5,000 — but lost $1,000 to the two agents who repped it. Many emails went back and forth between me and the script-writer, a Hollywood veteran. But CBS’ top executive said no to the final version and CBS now owns the script.

A job offer

Maybe. Certainly not a sure thing.

For posterity

Everyone’s dream.

Rave reviews

OK, these days, any reviews! While many online sites review books, and you can read dozens on amazon.com, it’s difficult to win an inch of serious reviewers’ space. The competition is ferocious.

Awards

Oh, the gnashing of teeth and the rending of garments! We’d all like that “XYZ-award-winner” on the cover of our book, but only a tiny fraction of us will ever get it. I was really honored when Malled was nominated for the prestigious Hillman Award, given to “those who pursue deep storytelling and investigative reporting in the service of the common good.” (A professor won it.)

So…why the desperate compulsion to publish a book?

For some people, it’s the pure satisfaction of having done it, knowing they can.

For others, it’s a strategic move, to build or bolster their brand or authority.

For academics, it’s a must, without which they can’t win tenure.

And yet, despite all of the above, I’m glad I’ve done my two books, and am now working on a proposal for another, fully aware of the pitfalls (and pleasures) if someone does make an offer on it.

I enjoy writing non-fiction books because journalism today offers few places in which to deeply explore serious ideas at length. A book gives you 80,000-100,000 words to plumb the depths of a complicated story. For me, that’s the draw.

Will anyone review it or buy it after a year or more of consistent effort to produce it? No idea!

Here’s a brilliant bit of writing advice, (there’s more if you follow the link, from Pulitzer Prize winner for fiction Paul Harding, in the one publication every ambitious writer must read, Publisher’s Weekly:

Get your art written any way you can. It’s tempting as a teacher to present your own method as normative. It’s maybe even more tempting as a student to look for a method that sounds good and austere and disciplined, with a dash of charming self-deprecation thrown in, and conform to it in the hopes that it will work for you, because writing is hard, after all, and it’s nice to think that if you follow a prefabricated set of rules you’ll get a story or a poem or a novel out of it.

But a huge part of being a writer is discovering your own intellectual and aesthetic autonomy, and how you best get the best words onto the page. The musician Tom Petty tells a great anecdote about working with the producer Jeff Lynne. Petty was in the studio making an album and being very doctrinaire about some recording method or another, much to Lynne’s exasperation, and so Lynne finally said to him, “Tom, no one gives a shit about how you make your records. They only care if the record sounds good.”

Outside of writing workshops and seminars, no one cares if you sit facing the blank page for six hours every day beginning at sunrise, or if you loaf around frittering away most days like a bum, or if you write your book one line at a time on the sly in between typing your boss’s business letters at the office. What’s important is that your reader holds a thrilling, amazing work of art in her hands.

How about you?

What would it mean to you to finally publish your book?

Those who have self-published, is it what you hoped for or expected?

THIS WEEK’S WEBINAR IS “CRAFTING THE PERSONAL ESSAY”; 4:00 p.m. EST Nov. 30. I HOPE YOU’LL JOIN US!

DETAILS AND SIGN-UP HERE.

Get that needle away from my face!

In aging, beauty, business, culture, domestic life, History, life, Medicine, Style, women on October 5, 2013 at 2:14 am

By Caitlin Kelly

Having had four orthopedic surgeries in 12 years is enough to put you off needles for a long, long time, between pre-op blood tests, IVs and anesthesia.

So I’m not going to be reaching for the Restylane or Botox — face freezers or fillers that make you look calmer and younger — any time soon.

No needles in my face, kids!

Pretty Face

Pretty Face (Photo credit: Wikipedia)

Here’s a recent column from The New York Times about how to age gracefully, without all the paraphernalia:

Some days it seems everyone I meet is afraid of getting old — or at least of looking as old as they are. Occasionally, I see women who have had so many face lifts that they can barely move their lips when they talk, let alone smile.

Business is booming in the anti-aging market. Plastic surgeons who specialize in lifts, tucks and fillers barely noticed the recent recession. Cosmetics with anti-aging properties fly off the shelf, and new concoctions appear almost weekly.

I admit to supporting the multibillion-dollar skin care industry with my long use of night creams, as well as a slew of daytime facial and body lotions that purport to “smooth out” aging skin while protecting it with sunscreen. I also color my hair, which in its natural state is now about 80 percent gray.

But I draw the line at injectable fillers and muscle relaxants, face lifts and tummy tucks. I’ll do everything I can to stay out of an operating room.

I’m with her on that. I also really like her emphasis on who you are are as you age, not just the shape, size and condition of our bodies and faces:

Youthfulness is not just a question of biology. People are perceived to be younger than their years if they smile and laugh a lot (be proud of those laugh lines!) and are generally cheerful and upbeat, the kind of people who smile at strangers and wish them a good day.

People often guess me as 10 to 15 years younger than my true age, which is pleasant. This week, a NYC cabbie guessed me 13 years younger, and young people looking at me in broad daylight (i.e. their eyesight is fine!) do so as well.

If people perceive me a decade younger than some of my peers, it’s likely a combination of things:

– I’ve never smoked

– I get a lot of sleep

– I disconnect, often, from technology to meet people in person, read books in print, get into the real world

– I minimize my use of social media (however hip) to recharge and reflect

– I enjoy my life, and have a wide network of supportive friends

– I only drink moderately

– I exercise 3-4 times a week, often outdoors in nature

– Genetic good fortune – my aunt, who died at 82, looked amazing (she might, having been a well-known actress in England,) have had “some work done” along the way.

– I have much younger friends, some even in their early 20s, and love being part of their lives

– I’ve never hit rock-bottom, terrifying poverty, the kind where you have no idea where your next dollar, or dime, is coming from. Terror and 24/7 anxiety will age anyone quickly.

Here’s a great post from Emma Johnson, aka Wealthy Single Mommy, a fellow New York journalist, who is 36, about accepting and enjoying how our bodies change with age:

In the past year or so I’ve noticed other first, albeit subtle signs of aging: The large pores. A second glass of pinot grigio at night and I wake to extra-dark circles and creping under my eyes. The cellulite that has hugged the back of my thighs since I was 12 has spawned and now also covers the front of my thighs. After two babies and four decades, I don’t expect to see a flat tummy again. Everyone knows bodies age, yet are surprised when it happens to theirs. Here I am.

And yet.

And yet for the first time in my life, I see something else that wasn’t there before. When I see pictures of myself smiling I notice the fine laugh lines, yes. There is something else in my whole face that is new. The same thing when I catch a reflection of my eyes in the rear-view mirror as I glance at my children sleeping in the backseat. I see the crow’s feet at the same moment and I see a pretty face. I did not see pretty before. It may have never been there, I’m not sure.

For the gentlemen in the audience, here’s a smart/funny column from Details magazine on the subject:

We now have a small army of male archetypes suffering sartorial midlife crises.

There’s the man still padding around dressed like the 28-year-old Silver Lake hipster—Vans, Daft Punk tee, thigh-hugging jeans—he was a decade ago. His proliferation is easy to understand, because his style requires no effort. Change nothing. No wonder he has numerous stuck-in-time siblings, like his urban-styled brethren.

Women, certainly in the U.S., are judged harshly when we’re not deemed sufficiently  thin, perky and unwrinkled — which rules out plenty of us over 40, let alone 50.

It also focuses way too much attention on the size of our hips or ass when we really need to focus attention on the size of our paychecks and investments for retirement.

Active, curious,open minds and generous hearts are every bit as important — and generally far more within our control — as the inevitable ravages, and sometimes really lousy luck, faced by an aging body.

Some of the coolest women I know live in my apartment building, like M. who’s 80 — and feels about 60 — with fab clothes and a pompadour, a booming laugh and a spirit that still kicks ass.

I want to be her.

When you look in the mirror — especially those of you over 30 — are you happy with what you see?

“Her Best-Kept Secret”: American women and alcohol: Q & A with author Gabrielle Glaser

In aging, behavior, books, culture, domestic life, Health, History, journalism, life, Medicine, news, US, women on July 2, 2013 at 12:18 pm

By Caitlin Kelly

One of the pleasures of being a non-fiction writer is knowing others who write well-written, well-reviewed serious non-fiction.

Glaser jacket

I met Gabrielle a few months ago at a social event and immediately loved her energy and sense of humor.

Her new book, her third, examines a key change in how American women are relating to alcohol use. Says Kirkus Reviews, famously stingy with praise: “an important addition to feminist literature.”

It is — but it’s also a lively read as well. As someone with female alcoholism in my own family, I read this one with specific interest.

Here’s an excerpt that ran in The Wall Street Journal and a WSJ video interview with her.

download

Here’s my Q and A with Gabrielle:

Tell us a bit about you: where you live, how you got into writing/journalism and what sorts of things you typically cover.

 I’ve been a journalist for 26 years, ever since graduating from college. I had hoped to get a Ph.D. in Brazilian history, but a friend who worked as the assistant to the late, great New York Times writer Johnny Apple invited me to a dinner party at Apple’s house. My friend was going to law school, and Apple needed a new assistant. I didn’t  even know who he was — I’m from the West Coast and just happened to be in Washington for a brief stay. But we started talking, and he offered me the job. He told me my nice Oregon parents would be happier if I took a “real job” instead of worrying about me living on ramen for the next four years. (He definitely had a point!)

I loved the newsroom, the energy there, and just didn’t look back.

 Since then I’ve covered a lot of things – crime in Baltimore in the late 1980s; the shift from communism to capitalism in Poland in the early 1990s; and basically since then, how health and health trends intersect with our particular culture. I’ve written two other books, including one that examines how our noses and scent affect our lives.

 Where did you get the idea for this book and when?

 I moved back to the East Coast from a six-year stay in Oregon in late 2008, just as the economy was tanking. Newspapers and magazines were laying people off, and it was really hard to find work. I had lunch with an acquaintance who is an editor at Simon & Schuster and all around us, women were drinking.

 I drink, too, but drinking at lunch puts me out for the day. We started talking about women’s drinking habits, (and our own), and the cultural shift we’d seen around us.  She suggested I look into it. The proposal hit her desk the same day as the news of a terrible accident in which a suburban mom killed herself and seven others when she had the equivalent of 10 shots of vodka in her system.

Was it a difficult book to sell to an agent or publisher?

 No, because I was lucky to have already had her interest. I had written other books so already had an agent.

 What were the most challenging aspects of reporting or researching the book?

 At first I thought the book would be a straightforward trend book, about women drinking more than in previous generations, and why. But then I started researching how they got better if they got into trouble, and I found some really interesting new options. I hadn’t had exposure to harmful drinking in my life, and I assumed that the traditional 12-step methods we rely on in this country were effective. I was stunned to learn that they had a very low success rate and were designed by men, for men at a time when the knowledge of brain chemistry was at its infancy – and that it was used by the courts, employee assistance programs, and the medical establishment as a gold standard.

 So digging into that was challenging – but fun. It’s always exciting to shift your thinking about something you’ve accepted, or taken for granted -– sort of like you did with “Malled.”

 How did you research the book? Tell us where you went, who you spoke to, how you found sources.

 At first I started looking into statistics, which as a reporter is the easiest starting place. Drunk driving among women was up; hospitalizations for alcohol overdosing were up among women; the number of older women who checked into rehab had spiked. The number of women who said they were regular drinkers was up.

 Once I had those figures, I could sort of move backwards – contacting the researchers and interviewing them. Researchers typically know the others in their areas of expertise, and a lot of them are really generous. One man told me, “Oh, I’m nothing in this field – you should talk to so-and-so and so-and-so.”  Those so-and-sos turned out to be amazing sources who were patient and funny and helpful, and pointed out where I had holes.

I also did a lot of searching online for women who would be willing to talk to me about their issues. It is a dicey thing to ask people to discuss a topic that is shameful or embarrassing to them, but I’m a good listener and sometimes that’s what people need. Talking helps a lot of us process our “stuff.”

 How long did it take you, from signed contract to delivered manuscript?

 Three years.

 Was this faster or slower than you anticipated?

 Much slower. I thought it would take me a year! That’s crazy.

 What did you enjoy most about working on the book?

I loved learning about our history with alcohol, and how our habits have shifted so dramatically over the years. I loved meeting people, and making new friends, but I also loved diving into the history of why we treat alcohol so oddly in this country. We went from Martha Washington, whose collection of 500 recipes included 50 for boozy drinks, (plus some hangover cures), to wild-eyed prohibitionists to Girls Gone Wild.

 What was the least fun part?

Some chapters were torture. Reducing the history was particularly hard for me, because I found it so fascinating. At one point, I had about six pages on how the women who crossed the Oregon Trail drank whiskey and wrote about how it helped calm their nerves and sadness in their diaries. My editor, God love her, wrote, “I know this is fascinating, but I think we could carve this down to a sentence or two.” What? All those diaries I read to a sentence? Sometimes you need cold water on your face to knock you to your senses.

Who do you see as readers for this book?

 I think any woman who has ever thought twice about their drinking would be interested in this book, and anyone who has ever thought twice about the drinking of a woman they love would be interested in this book. I tried to bust a lot of myths. I also think it would be a good read for anyone interested in women’s history and women’s studies. It traces the arc of female power through our relationship to alcohol in ways that are quite surprising.

 If you have written other books, how is this one different – in tone, content, approach?

This was much better conceived and executed than my other books, because it had a tighter focus. I used history as a guide, and medical research as a foundation, whereas my nose book was a sort of kooky history – cool stuff you didn’t know about your sense of smell, the history of Kleenex, nose jobs. My first book was a starter book, on interfaith marriage. It was too long and not focused enough.

What advice would you offer a would-be non-fiction author?

 Develop a good working relationship with your editor. That is absolutely key. If you don’t see eye-to-eye from the beginning, you aren’t going to see eye-to-eye at the end. I’ve had a great experience this time with a patient, wise, and incredibly generous editor who helped reel me back in when I needed to be. I haven’t always had that experience. Chemistry matters. My best working relationships have always been with editors I really admire and love. In other words, don’t try to force something that isn’t there. And also: don’t be afraid to lose your good material in order to save your great material. Nobody wants to read six pages about something only you find amazing.

 

What do we owe to those for whom we labor?

In behavior, business, design, journalism, Medicine, science, Technology, work on May 29, 2013 at 5:35 am

By Caitlin Kelly

Loved this recent piece in The Wall Street Journal, a profile of a Canadian engineer, (now there’s a doubly invisible category!) who designs bridges:

If his work didn’t keep him up so late, he would probably wake up in the middle of the night worrying about it. He points out that the catastrophic 2007 collapse of a bridge in Minneapolis—which he wasn’t involved in—happened during construction work.

Mr. Johnson shows off a gray ring on his right pinkie: “It’s called the iron ring,” he says. In Canada, civil engineers wear the iron ring on their drawing hand as a symbol of their oath to protect life and limb. “We have to make sure everything we do is infallible,” he says.

I love the physical reminder, worn every day after graduation, that a civil engineer has chosen to create things that millions of us rely on every day to be functional and safe.

English: A Canadian Engineer's Iron Ring, Stai...

English: A Canadian Engineer’s Iron Ring, Stainless Steel Version. This is a picture of the author’s personal iron ring, received at the University of Waterloo, Camp 15, on February 17, 2004 (Photo credit: Wikipedia)

I really like this tradition of making a public (and/or) physical vow of responsibility.

My first husband was a physician. I attended his graduation from McGill medical school and watched his class, aloud, recite together the Hippocratic Oath, which begins with “First, do no harm.” It was powerful, moving and unforgettable. Every graduating physician says these words.

Even if they do do harm, and it happens to many of them in the course of a career, they all know they made a vow now to.

We seem to live now in an era of the deke, the dodge, the “I have no knowledge”, the denial, the shrug. We’re left to watch, in New York, the miserable, unending parade of elected officials being charged with fraud, theft, deception, bribery and corruption.

Wall Street? Don’t get me started.

I wish — how I wish! — there were similar public, shared, hallowed rituals for every profession and field of endeavor. Especially finance, politics and journalism, three fields whose decisions can profoundly alter the lives and fortunes of millions of others, people who depend on them for wisdom, good faith and honesty.

Here’s blogger/author Seth Godin on the need for great public design.

What do you think of this tradition?

Every 20 minutes an American dies for lack of health insurance: one man’s story

In behavior, culture, Health, journalism, life, Media, Medicine, Money, politics, US on October 19, 2012 at 12:11 am
Prostate cancer

Prostate cancer (Photo credit: Wikipedia)

This, from The New York Times:

So why didn’t I get physicals? Why didn’t I get P.S.A. tests? Why didn’t I get examined when I started having trouble urinating? Partly because of the traditional male delinquency about seeing doctors. I had no regular family doctor; typical bachelor guy behavior.

I had plenty of warning signs, and that’s why I feel like a damned fool. I would give anything to have gone to a doctor in, say, October 2011. It fills me with regret. Now I’m struggling with all my might to walk 30 feet down the hallway with the physical therapists holding on to me so I don’t fall. I’ve got all my chips bet on the hope that the radiation treatments that I’m getting daily are going to shrink the tumors that are pressing on my spinal cord so that someday soon I can be back out on the sidewalk enjoying a walk in my neighborhood. That would be the height of joy for me.

The writer of those words, Scott Androes, is now dead. He did not have health insurance so he did not see a doctor when he first noticed the signs of prostate cancer.

When Times’ columnist Nick Kristof yesterday wrote about his friend’s death, he got replies like this one:

“I take care of myself and mine, and I am not responsible for anyone else.”

Here’s some of Kristof’s column:

I wrote in my last column about my uninsured college roommate, Scott Androes, and his battle with Stage 4 prostate cancer — and a dysfunctional American health care system. I was taken aback by how many readers were savagely unsympathetic.

Readers’ Comments

Readers shared their thoughts on this article.

“Your friend made a foolish choice, and actions have consequences,” one reader said in a Twitter message.

As my column noted, Scott had a midlife crisis and left his job in the pension industry to read books and play poker, surviving on part-time work (last year, he earned $13,000). To save money, he skipped health insurance.

The United States, whose own Declaration of Independence vows “life, liberty and the pursuit of happiness”, has become a shockingly divided place, where far too many of those who have inherited, cheated, conned, off-shored — or yes, fairly earned — their good fortune — are now hammering the oars of their lifeboats against the desperate, clutching, frozen hands of those now dying and drowning in the icy waters of an ongoing recession.

Too many of of those now driving gleaming new luxury vehicles see people like Androes, if they acknowledge them at all, as mere bugs on the windshield, something small and annoying to be ignored or dismissed.

Androes screwed up. He, God forbid, decided to step off the hamster wheel for a while and take life a little easier, something many of us long to do at mid-life. With no wife or kids to support, he was able to do that. But he was not able to afford health insurance, which is sold here like any other consumer product — and which can be brutally expensive. When I was able to get onto my husband’s health plan at work, even unmarried, in 2003, I was then, as a single, healthy woman in my 40s, paying $700 a month.

That meant an overhead, every year, of $8,400 just to avoid medical bankruptcy. Given that my mother has survived five kinds of cancer, I went without many other amusing choices (new clothes, travel, eating out) for years just to be sure I could, and did, get annual mammograms and Pap smears and all the preventive medicine possible to stay healthy.

Many people in the United States now earn $7 to 12/hour, since the two largest sources of new jobs in this country are foodservice and retail, which pay badly, offer only part-time work and no benefits (i.e. employer-subsidized health insurance). They might as well make out their will now. Because they can’t afford regular medical checkups, nor medication nor ongoing counseling to manage their diabetes or heart disease, even if it’s been diagnosed.

A young friend  — sober — fell on a slippery sidewalk, on a steep hill in the rain, and severely damaged one of his knees. He needs surgery that will cost $22,000. His employer, a Christian-based organization, the YMCA, refuses to help.

Yet another writer to Kristof said that people who are destitute medically have all created their own hells, and that’s where they belong:

“Smoking, obesity, drugs, alcohol, noncompliance with medical advice. Extreme age and debility, patients so sick, old, demented, weak, that if families had to pay one-tenth the cost of keeping the poor souls alive, they would instantly see that it was money wasted.”

I am ashamed to live in a country where selfishness is considered normal behavior.

I am appalled by such vicious callousness.

I am sickened by a growing lack of compassion from those who have never known, and utterly dismiss in others, the sting, shame, fear and misery of poverty and desperation.

And you?

How does this make you feel?

Why getting sick in America is a really bad idea

In aging, behavior, business, family, Health, life, Medicine, politics, US, work on June 28, 2012 at 2:42 am
May_30_Health_Care_Rally_NP (641)

May_30_Health_Care_Rally_NP (641) (Photo credit: seiuhealthcare775nw)

One element of living in the United States sickens me to my core — the persistent inequality of access to affordable quality health care, something citizens of virtually every other developed nation take for granted.

Today the U.S. Supreme Court will hand down its decision on the constitutionality of what’s been called Obamacare, a mandate requiring all Americans to purchase health insurance. A CNN/ORC International poll released this month showed 43% of Americans favor the law, 37% think it too liberal, and 13% oppose it because it is not liberal enough.

I grew up in Canada, where health care, paid for through taxes, is offered cradle-to-grave by the government. Yes, it has some deficits, but everyone can see a doctor and go to the hospital without fear of medical bankruptcy, common here.

From this week’s New York Times:

When Wendy Parris shattered her ankle, the emergency room put it in an air cast and sent her on her way. Because she had no insurance, doctors did not operate to fix it. A mother of six, Ms. Parris hobbled around for four years, pained by the foot, becoming less mobile and gaining weight.

But in 2008, Oregon opened its Medicaid rolls to some working-age adults living in poverty, like Ms. Parris. Lacking the money to cover everyone, the state established a lottery, and Ms. Parris was one of the 89,824 residents who entered in the hope of winning insurance.

And this, on how confusing and frightening it can be to receive a fistful of enormous medical bills:

With so little pricing information available, expecting people to shop around for quality care at the lowest cost — something that’s not always possible in emergency situations — is also asking a lot of consumers. “I have always found a bit cruel the much-mouthed suggestion that patients should have ‘more skin in the game’ and ‘shop around for cost-effective health care’ in the health care market,” said Uwe E. Reinhardt, a health policy expert and professor at Princeton University, “when patients have so little information easily available on prices and quality to those things.”

President Obama’s Affordable Care Act, the health care overhaul law passed in 2010, tries to make some improvements (though the Supreme Court is expected to rule whether all or some of the law is constitutional this month). But while the law’s changes help you shop around for insurance policies — specifically through its new HealthCare.gov Web site, a one-stop shop that lists all of your insurance options in one place — it’s still unclear how effective the law will be for anyone comparing medical services.

On February 6, 2012, I had my arthritic left hip replaced. Thanks to my husband’s job, we have excellent insurance coverage, but I knew enough to do plenty of questioning, and negotiating, long before that gurney wheeled me into the OR to avoid nasty and costly surprises later. For example, I needed to make sure the surgeon would accept whatever fee my insurance company offered — decisions and prices I have no control over — but which would come bite me on the ass if I didn’t plan ahead.

I also had to make multiple calls to find out:

1) what the anesthesiologist would charge (about $3,800);

2) what my insurance would pay (about $1,000);

3) who would be on the hook for the difference. Me. (I told the billing manager I’d send my tax return to prove my income; $2,800 is a very big number for me.)

Jose, my husband, offered to look at the medical bills as they arrived, as they would only freak me out, not helpful post-surgery. The hospital — for a three-day stay, with no complications, charged $90,000. No, that’s not a typo.

Did they collect it? Probably not, but they routinely try for whatever they can get.

Then my surgeon billed $25,000. (Our insurance covered it all. Thank God.)

But…what if, like millions of Americans, I had no insurance?

Like my friend R, who is young, broke and lives without it. He recently slipped and fell on a wet sidewalk, needed an ambulance and needs physical therapy then surgery. Worst case, he’ll be paying off a huge bill for years, maybe a decade.

In my 24 years in the U.S. I’ve never lived one minute without health insurance; my mother has survived four kinds of cancer and I live an active and athletic life that also puts me at greater risk of injury. How ironic that being active, (fighting the great American scourge of obesity), can put you at risk of losing your shirt financially…

The cost of buying my own insurance, as a freelancer, left me with few additional funds for fun stuff like travel or nice clothes or shoes or replacing things in my home — air conditioner, dishwasher, computer — I needed and relied on. By 2003, it cost me $700 a month.

Health care is a right, not a privilege. We will all get sick or fall down or suffer a complicated labor or discover a tumor or suffer a heart attack. None of us is immune.

Many Americans cannot even purchase health insurance because they have — in that exquisite euphemism — a “pre-existing condition.” If you’re already sick, tough shit!

Seriously?

Life is a pre-existing condition. Americans, and their elected officials, must deal with this reality more effectively.

I don’t (only) want to do more faster. Do you?

In behavior, business, culture, domestic life, life, Medicine, Money, urban life, US, work on June 1, 2012 at 12:16 am
productivity

productivity (Photo credit: Sean MacEntee)

Since my wedding in September 2011, (when we took a week off locally afterward), I haven’t taken more than four days off in a row. My last extended vacation was in May 2005, three weeks in Mexico.

I’m taking a month off, starting today — but will still blog here three times a week. I’ll also be working on a book proposal and one or two short articles, but only after the first 12 days of rest, relaxation, seeing friends and family, recharging my spent battery.

In the past 12 months, I’ve:

published my second book; done dozens of media interviews and speaking engagements to promote it; written a new afterword for the paperback, which is out July 31; hired an assistant to help me with all of this; negotiated more speaking engagements; addressed two retail conferences in Minneapolis and New Orleans; gotten married in Toronto; helped my husband deal with kidney stones; had my left hip replaced and done 3x week physical therapy for two months; served on two volunteer boards, and additionally visited Chicago and Toronto for work.

Oh, and blogging here three times a week, working with a screenwriter on the television pilot script for Malled (not picked up), and writing for a living.

Kids, I’m fried!

Time to not be productive, which leads me to this essay raises an important question, and one especially germane to any economy premised on “productivity”:

But there are sectors of the economy where chasing productivity growth doesn’t make sense at all. Certain kinds of tasks rely inherently on the allocation of people’s time and attention. The caring professions are a good example: medicine, social work, education. Expanding our economies in these directions has all sorts of advantages.

In the first place, the time spent by these professions directly improves the quality of our lives. Making them more and more efficient is not, after a certain point, actually desirable. What sense does it make to ask our teachers to teach ever bigger classes? Our doctors to treat more and more patients per hour? The Royal College of Nursing in Britain warned recently that front-line staff members in the National Health Service are now being “stretched to breaking point,” in the wake of staffing cuts, while a study earlier this year in the Journal of Professional Nursing revealed a worrying decline in empathy among student nurses coping with time targets and efficiency pressures. Instead of imposing meaningless productivity targets, we should be aiming to enhance and protect not only the value of the care but also the experience of the caregiver.

The care and concern of one human being for another is a peculiar “commodity.” It can’t be stockpiled. It becomes degraded through trade. It isn’t delivered by machines. Its quality rests entirely on the attention paid by one person to another. Even to speak of reducing the time involved is to misunderstand its value.

The only thing this industrial mindset — speed the production line! -- produces in me is frustration and annoyance.

I also attach value to the production of:

deep friendships; a happy and thriving marriage, my own physical and mental health, daily, and weekly, periods of rest and reflection.

I recently asked a friend, who out-earns me by a factor of 2.5, how she does it. The answer was to quadruple my workload, and at a speed I think probably, for me, unmanageable.

My book “Malled”, which describes my 27 months working as a part-time retail sales associate — supplemented by dozens of original interviews with others in the industry — has brought me paid invitations to address several conferences of senior retail executives. I suggest to them every time that focusing solely on UPTs (units per transaction — i.e. why they try to sell you more shit unasked for, than you want) and sales per hour is not the best or only way to go.

But numbers are safe and comforting. When corporate players hit their numbers, they keep their jobs and get their promotions/bonuses. Metrics rule.

Except when they don’t.

I once spent an hour talking to a female shopper in our store. Turns out we had a lot in common. She spent $800, which remained the single largest sale I ever had there. She also asked if I knew a good local psychotherapist. Not many people would have asked that question of a minimum-wage clothing clerk, but she’d clearly decided to trust me. I did know one and recommended him.

A year later she returned, glowing, with one of her teenage daughters, to thank me for helping her survive a very tough transition in her life.

That “transaction” is completely meaningless in any economic sense.

Yet:

— it enriched the therapist, who well deserved a new client.

– it enriched my customer’s soul, which needed solace.

– it enriched her three daughters’ lives as their mother found help she needed.

– it enriched my heart to know I’d been able to make a good match and help her.

But these powerful emotional connections are routinely dismissed as valueless behavior on any corporate balance sheet — because they can’t be quantified, measured and compared to other metrics.

Which is why I have such a deeply conflicted relationship with capitalism.

How about you?

Do you think working harder and faster is our wisest  or only choice?

Ten warning signs you’re an adult

In aging, behavior, children, domestic life, family, life, Medicine, women on April 9, 2012 at 12:07 am
My Mortgage Docs to be Reviewed by an Expert

My Mortgage Docs to be Reviewed by an Expert (Photo credit: Casey Serin)

We all know the standard metrics: graduate college, grad school, marry, have kids, acquire property and a vehicle.

I never had kids, so that typical dividing line into Maturity escaped me.

But for many of us, different moments mark a definite end to innocence.

Here are ten that resonate for me:

Taxes!

I grew up in a family of freelancers whose approach to paying income tax — which is never deducted at source, for those of you who’ve never done it — was, hmmm, variable. One day my Dad said, “I have two pieces of advice for you about taxes.”

“Running and hiding?”

Suffice to say I now have a very good accountant and genuflect to him deeply.

A mortgage

In New York, getting a mortgage is like some bizarro obstacle course littered with lawyers with out-stretched hands. Check, check, check, check!

Knowing — and caring about — your FICO score

For those of you outside the U.S., this is your credit score whose quality determines whether life is pleasant (low interest rates on mortgages, car loans, credit cards) or a hell of slammed doors refusing you access to any sort of credit. Surprisingly few consumers realize what sort of leverage you have with a good score — a lot!

Giving informed consent for my mother’s brain surgery

That was very weird, given how deeply private she always was. I looked, literally, into her head, staring at the four-inch tumor on X-ray that soon, successfully, came out.

Putting my mother into a nursing home

Pretty much the hell you’d expect: having to sell 95 percent of her things and make consequential decisions quickly. Being an only child makes it both easier and harder.

Getting a colonoscopy

For those of you under 50, something to look forward to! (And those putting it off out of fear, it’s no big deal. You have one wearying day beforehand to cleanse you colon, go to sleep during the procedure. Done.)

Knowing your neighbors

When you’re young, single and often behaving badly, you may not want to know your neighbors. Who was that guy/girl skulking out of your apartment? What were those weird noises at 3 a.m.? Once you’re a bit older, maybe traveling for work, maybe with a place you own and/or value more than a dive shared with six roomies, having kind and watchful neighbors is a wonderful thing.

Regular mammograms/Pap smears/prostate exams

I’m always a little stunned when I hear of someone, (who has health insurance, which in the U.S. means these are no-brainers), who skips these essential tests. No one wants to hear bad news. My mother has survived breast cancer, so mammo day is always a little shaky for me. But seriously? Just do it!

Joining a faith community

No disrespect to atheists and agnostics. But for many of us, finding a congenial place to nurture your spiritual growth is a major step. It’s easy to focus solely on family/work/friends/fun — until the shit hits the fan.

Making a will/living will/power of attorney/health care proxy

So cheery! But if you have been fortunate enough to have accumulated anything of value, it’s worth deciding who to leave it to. And facing any sort of major surgery — even childbirth, my mom-pals tell me — means facing the scariest of fears about mortality or severe injury.

How about you?

What milestones have marked your path to adulthood?

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