Needs and wants

There seems to be a lot of discussion right now about what defines need and want. Both are categories of desire.  Need is most clearly defined by the bottom of Maslow’s hierarchy: food, shelter, safety. Included above this is some vestige of social connection, a form of intimacy akin to love- that thing without which babies die (see the studies regarding this from mid-twentieth century), old folks slip into afflictions and die, and the rest of us suffer depression and a variety of illnesses.  Abraham Maslow (1943) developed a pyramid of levels to represent a complete individual that has been revised from time to time, but the basic ideas have stayed the same.  There is a line on the pyramid, below it are needs and above it are what we might call wants.  Above the line categories include respect, achievement, creativity, self-determination.  Our founding folks might have seen these as the basis of the “pursuit of happiness”.  So are they really wants- or another form of needs?  I suppose it depends on whom you talk to. 

Many wealthy people in this country think cutting back on their monthly liquor orders constitutes privation.  They will also tell anyone who listens that everyone else, those making below 50k a year especially, ought to just suck it up and cut back.  They shake fingers and cluck, some massaging their conscience with a few dollars thrown at a charity (for which, as Blago of Chicago made clear, they expect a return in money, big parties, and other benefits).  No health insurance?  Too bad you are not “talented” enough to find a good job with benefits.  Need extra tutoring for your kids?  Daycare?  Too bad.  You should not have had children you can’t afford.  The list goes on and on. They strut around at cocktail hour, palms open, telling their friends “what do they expect?  Of course our companies/banks/businesses need the bailout.  We are the ones who keep this country going.”  The unquestioned assumption that big salaries, and big compensation packages are also necessary, needful things; this fun-house mirror of self regard and privilege is horrifying.  Finding out recently that a high percentage of the businesses getting bailout money operate core off-shore tax havens and that much of that money is being funneled away to these havens is also scary.  It all points out that the modus operandi for too long has been nothing more than greed driven to the extreme, and instead of being the foundation for a healthy, complex economy– undermined it entirely.  Like over-mined ground in West Virginia, the ground is collapsing and everything that rested on top is caving in and becoming toxic.  The fires that burn below in the mines of Pennsylvania will burn for thousands of years (http://www.offroaders.com/album/centralia/centralia.htm).  Let’s hope this metaphor for our financial system is a little less long term. 

Maslow had it right I think.  In a very pragmatic way, we know if people don’t have basic needs met their lives spin out of control, and even worse, they die.  I don’t think the vast majority of people in this country are confused about the difference between needs and wants, and they don’t need daytime talk show hosts to wag fingers and wax poetic about the uplifting opportunities for self improvement by learning to live with less.   What most people seem to need is parity between those who want to believe they are the caretakers of our systems, and those who have little control over them. Business journalists held hands over their collective mouths until the holidays had passed, and now are starting to blather forth all the bad news they held in.  It’s gonna get a lot worse, and no one is really sure how much worse.  Where have you gone Nancy Reagan; ketchup never was a vegetable and a full belly is a basic need.  We can’t wish or talk away the realities of what is happening.  The time for blame seems to have passed when the government is giving life boats to the very wealthy while yelling into the megaphone to look the other way, these are not life boats, they are some thing else, um, yeah, bailouts that will make everything better.  Just keep your noses to those rapidly sinking grindstones, and we’ll give you a couple hundred bucks at tax time (and take it back in the now $17,000 per wage earner that will be needed in taxes to fund the bailout).  When the ship is going down, those scions of business and culture will be off to their private islands stocked with alcohol and say it was everyone else’s’ fault. The nut-bags plan to hole up in Idaho, and as one blogger put it, “I’ll have the guns to come take your organic gardens, liberals”.  No, we have no time to blame.  

What do I need today?  I need a laugh.  I need to clean my house.  But more importantly, I need to know I can feed my kids, get them adequate medical care, and keep a roof over our heads and clothes on their rapidly growing bodies.  A solid elementary and secondary education is essential as well.  For myself, I’ll skip a meal or two but I can’t live without the laughs. It is way too dark for me, and many others, right now.  We have to find a way to laugh without sticking our heads in the sand as many conservatives would have us do.   We have to find a way to channel our anger productively, and act.  When we suggest a state-wide schools strike involving students, parents and staffers in the local newspaper comments section (in response to the announcement of deep cuts in public schools as the first place to plunder now that the state is broke) it is rapidly removed.  There was no foul language; it was a short, thoughtful, polite comment.  Do we need or want to speak out?  How about both? Perhaps it is doubly necessary, this need to speak, to form consensus, then act– no matter how scary it seems to those in control.  The ship is sinking.  What do you need as it does?  What are you going to do about it?

How many doctors does it take. . .

The head of our pediatric practice has lamented the current state of incoming MD’s more than once.  An old-school, military trained man with a quick wit, excellent problem solving skills, and more passion for his patients well-being than any physician I have ever met, he can also be cantankerous and short-tempered when it comes to the incredible bureaucracy, greed, and policy regulated ignorance that often runs pharmaceutical as well as insurance matters.

That said, my son and I have been taking tours through the world of diagnosing.  More than two years ago, I developed what I call “pencil pain” on my upper left side.  It feels like someone is taking the rubber eraser end of a pencil and slowly sticking it at an angle up into my body cavity, to about a third of the length of the pencil.  It comes and goes in intensity, and can be accompanied by tightness and uncomfortableness across my upper back and matching right side.  After some of the preliminary tests (MRI, upper GI, Gallbladder processing test) my gallbladder- that is on the RIGHT side- was determined to only operate at 10% at best, and needed to come out.  It went.  The surgeon later said he was glad it got pulled, because it would have gone necrotic (organ death and subsequent infection).  So far so good.  But the left side pain went on as usual.

I was told nothing showed up regarding the pancreas or liver (other than my liver being slightly compromised-fatty- from my lack of exercise, age, and persistently high triglycerides).  So, given the lack of gallbladder (that lovely mediator of all things spicy and fatty), I needed to go on a low fat diet and small portions the rest of my life.  Not news, really.

A visit to a GI man said, after a short conversation, “It’s probably musculo-skeletal”.  Co-payment please, and here is a free sample of the most expensive acid reflux med on the market (I do not get acid reflux as a rule, and when I do Maalox works just fine).  This was a complete waste of my time.  I threw the sample away.

My exasperated and often inattentive GP (general practitioner, your first defense against illness) ordered a stress test.  Normal.  Good to know, I thought, given my family history of heart disease. 

I have started to avoid eating.  I find myself hungry, but don’t eat.  I subsequently feel proud of becoming stricter with myself (and losing weight), but most importantly don’t have surges of pain.  GP says it could still be gastro-intestinal (duh), but unusual to be that high on the body.  All the MD’s I have seen told me, as if I were a mentally defective ten-year old, that “there isn’t really much on your left side”.  Funny, I always thought there was because I have to clothe that part of my body, but what do I know. 

As of yet, we have not changed GP offices (that’s a whole other story) but intend to do so soon for all the adults in our family.  The pain lingers on, waking me up occasionally just to say “Hello. Not going away!”.  Yeah, I know.

As for my son, he developed a growth that actually looks like it has a hold of his neck skin just to the left of center, and slightly above the fold.  As if something, starting to look slightly purple underneath, grabbed the skin and pulled in at that point, like you might do when sewing and making a pucker.  But there is an inch round creature making the pucker, not just the pucker itself.  It came to visit in early November, and never left. 

First Ped (young woman new to the practice):  infected lymph node.  It will go away.  It didn’t.

Second Ped (one of the founders and a good pragmatist):  Not a lymph node.  They don’t present this way.  Here’s a referral to see a great ENT (ears, nose and throat surgeon).  We did.

ENT:  Get a CT.  It’s probably a thyroglossal cyst (congenital problem, complicated surgery required; hey- I’m a mom.  I read about it until I was blind).

In the hospital once we were in the room for CT appt.:  Oh, he’s four.  I’m not sticking him more than once.  You really should come back for a sedated CT (he was busy watching a video quietly; and ENT said he didn’t like to do general anesthesia on people so young).  It got worse from there, the techs having decided they would not do the CT and all the skilled phlebotomists snoozing I guess (he was stuck a total of four times, by two people, and they were dubious the IV  would hold).  We left, after being told they “didn’t have time to really work with children”.  Well, we really don’t have time to waste our child’s life or money. 

After playing phone games with everyone affiliated with our insurance, we get approved for a CT at Johns Hopkins.  My son gets pneumonia over the holidays.  The CT will have to be rescheduled.  I email the ENT at Hopkins and call her staff about the appointment and CT.  In sum, I get told they are too busy for us and to go elsewhere.  Fine. 

Play phone games with the insurance and Peds office again.  Feel stupid.

We scheduled another CT at university-affiliated hospital an hour and a half away.  It went smoothly, the pediatric sedation team gave him an oral (not the general anesthesia the previous hospital wanted to use), he only was stuck once, and it all went well.

Radiologists report:  Not a thyroglossal cyst.  Other possibilities:  bronchial abnormality (fancy way of saying another class of congenital problem, from our old evolutionary genes and gills surfacing during fourth to fifth week of pregnancy, then having to dissipate), infected lymph node, and others.

Look at CT picts at home.  See the size and shape of the growth, and changes in density.  See the thin, worm-like thread attached to it that seems to go back.  See the other thin like thread with two ends that goes down and forward.  Wonder why no one has ordered baseline blood tests.  Get reinforcement from family (one whom is a surgeon) that being persistent as a parent is a good thing.

See original ENT, look at CT with him:  It’s a thyroglossal cyst.  98% of what it probably is:  the thyroglossal cyst (requiring the removal of approx. a third of the hyoid bone and restricted lower facial and upper neck muscle use for life, and diminished vocal expression) or bronchial abnormality.  Rest lymphatic.  Small probability of cancer, benign or malignant.

Still no ordering of blood tests.

Second opinion recommended by ENT.  Appt. made by office staff at Peds for two and a half months out with ENT an hour an a half away.  Parental outrage.  Going on eleven weeks at this point.  Try to get appointment moved up, or put on a wait list.  Rude office staff.  Appeal to original ENT.  No help.  Get a call from head of Peds practice, which has not even read the ENT opinion.  Tell him.  He gets into instant action, and orders baseline blood work.  Next day, first portion normal, no infection indicated.  Great!  Day after, no thyroid disruption evident in blood work.  Good!  Also, the man went straight to the second ENT and got the appt. moved up to thirty-two days from today, not several months.  Spoke to us with kindness, knowledge, and support.  I want to hug this man- make him cookies or something, but he just had heart surgery himself so I can’t bake for him, and chicken giving in addition to co-pays went out about seventy years ago.

Now, we wait.

I read more.  I realize both major probabilities of congenital defects are a bit like saying schizophrenia.  A class of cause, with many attendant problems possible.  Also, that other than the blood work there is no “in-between” tests to give more information.  The growth needs to be removed intact (no biopsies), and pathology done.  Even so, causal issues may lack clarity.  As the original ENT said, if you don’t take the hyoid portion out then, you’ll have to do another surgery because growths will continue to form from the malformed system.  Great.  Step A to step Q with no stops in between.  We are on the express train in medicine, driven by a series of revolving, conflicting diagnoses.

My son was a twin.  The other died, and was miscarried a little after the fourth month.  I believe they were fraternal, but no one is sure.  We didn’t even know we were having twins, so the miscarriage was a shock- and the worst day of my life when we thought it was the baby we knew we had.  When he was shown dancing around on the monitor, we were flooded with relief.  Rest, watchfulness for a few weeks as the cervix closed fully again, and all was fine.  Did the twin die because of something that happened in those first four to five weeks?  Did I do it?  Did it also cause this abnormality in my son?  I will never know.  More to the point, is there anything else wrong with my son I do not know about (the radiologists report evaluated the whole series of CT picts and said the rest looked normal)?  What else can I do?

I wait.  We wait.  My son has seen the CT scan photos and thinks the pictures of his “skeleton” are cool.  He knows he’ll have surgery.  He hates being stuck, but knows he’ll have to do it again.  He’s being great about it all, in only the way a soon-to-be five year old can.  He knows he can’t sign up for soccer this spring because of his surgery, but that he’ll be eligible for summer T ball and that’s great.  He also knows we do the kindergarten visit this spring, his “new” school for the fall. 

We struggle to pay all our bills, budget for the repairs the house needs, and cut back where we can.  We are not unlike millions of other people in this country, and very grateful to have health insurance (which Husband pays for in big premiums every month through work, like everyone else we know).  Who knows what the future brings?  We wait, and wonder how many physicians we’ll see, and how the joke will end.

Mental space

“Gimme some space damn it!”

This is a thought I have often around my kids and my husband.  I have been thinking about what this means.  On the surface, it means “pick up the toys, clothes, dirty dishes and detritus of daily living that clutter our shared physical space and make for constant random picking up in the effort to make space” (or at least orderly space).   This constant demand to clean is a distraction and irritant, making anything else productive difficult.  Just walking, as anyone who has stepped bare footed upon a lego can tell you, can be interrupted.  If I had several hours alone to crank the tunes and clean, that would be different.  I could organize my time, react to unexpected issues (needing to pretreat a shirt here, address the bill that was found in the Dr. Seuss book), and Get Things Done (capitals intended).  Usually though, it’s a constant barrage in which one small gain here or there gets accomplished, and the macro level of the problem remains a mystery. 

So too with mental space.  In order to be creative, I have learned I not only need to be self-disciplined (that’s where procrastination guilt occurs- when I know I could have been self-disciplined but have not), but also need “head time” to let ideas “cook”.  Head time can even come when I am Getting Things Done- because the mental is uninterrupted.   Then there is the creative need for “doing” time.   This is most pointedly putting down thoughts and ideas into the computer without interruption (writing).  It can also be creating objects, or seeking out and taking in stimuli without interruption (“feeding the head”).  All of which I rarely get, and the consequential outcome is depression and irritation. When I have time in a span of a week to create, I am a much happier and a nicer person to be around.  Husband has noticed this about himself as well.  I also believe there is a long-term additive effect.  We are also more productive people if we can create on a regular basis. These observations are also borne out in creativity research.  

I recently stumbled across Jonah Lehrer’s book “Proust was a Neuroscientist” (2007) and the accompanying book reviews.  I agree that he over-reaches a bit; with many underlying assumptions about the shared positions his readers must have to imagine where he is going with his ideas.  He also blogged about the use of Modafinil, wondering if it’s use and established ability to help concentration and focus was a deterrent to creativity.  I wrote him a response to that blog.  What I found most useful about him is he is a good example of a new breed of thinkers.  Young, smart people who are continually learning, from every experience be it academic or something as plebian as a line cook.  They are taking in what they experience and try to create a framework for understanding that works better than the overly specialized units we currently know.  They want to bridge the macro and the micro, and synthesize areas of philosophy that have been said for hundreds of years to be completely incompatible.  They do not postulate any dogma, and seem to have extremely open, mature minds- and are willing to acknowledge when they are wrong, or need to reframe something they have conjured.  I like the things I read from this new wave of thinkers, even if I don’t always agree (Steven Pinker is not one of them, his framework of reference and definition being clearly and unapologetically hierarchically organized according to scientific principles and the culture of high science). 

To do the things Lehrer and similar writers are doing requires a high degree of creativity. I hear myself shouting “ARRGGHH”, knowing I will never be free of the research subject area I started investigating a long, long time ago. The areas I was synthesizing formally as a graduate student were seen as arcane; when people were being kind, they would say rather esoteric.  But I know them as red-blooded, living ideas.  It is good to know people smarter and younger than me think so too.  When I mentioned all of this to Husband, an accomplished artist in a complex culture, he replied ” A lot of what I do requires creativity.  Not just my art.”  I nodded.  Sometimes the partnering in a marriage is to remind us of what we already know, and even have already discussed in a different time or place.

Note to Lehrer:  mental crowding can also come from too much immersion into a culture and topic.  Me? I gasped for air and got out for a while.  Now I get back in from time to time, and make much better use of the knowledge and information I find.  Virginia Woolf had it right– in order to do that, I have to shout “gimme some space damn it!”; and pick up those sharp little legos.  

Fly on the wall

There are two old guys I would like to know have met: Stephen King and Garrison Keillor.  They are almost the same age, and are talented, funny, grounded writers.  Someone buy these two lunch! Seriously, what a broadcast that would make: have them go to lunch together, record the whole thing, and let them edit it as they please.  Sort of “Dinner with Andre” for the audio set.  Then do it again with other folks. Instead of celebrity death match entertainment (remember the claymation series?),  a series for those of us who would love to be flies on the wall when specific famous folks meet.  

 Fill in the blanks:  Madeleine Albright and ___.    Buddy Guy and ____.   The interest is generated by an overlap of some similarities, some differences, but generally two people who in meeting would generate some interesting conversation.  Steve Jobs and  ______ (Say, somebody get that guy on tape in a non-Apple environment before it’s too late).  Brad Bird and ______.   Isn’t this a project for NPR?  It would certainly generate revenue for the cash strapped radio company.  Who would you like to hear talk about life, themselves, all that rot and face the challenge of being introduced to someone new?   

I’m no celebrity, but I happened to meet a woman my age with two daughters my sons age yesterday at a local auto repair/dealership.  She came into the “crying room” as I think of it (like the sound proofed room in my childhood church, where parents with unruly or bored kids could go to the back of the church and peer out, ostensibly still participating in mass), while my son and I sat on the floor watching PBS kids on the ceiling mounted TV monitor.   When the repair clerk came in to give me the standard lies (I was only there for a state inspection, a yearly scam I have written about before) and tell me what the routine tax was this year (wiper blades and a rear light bulb I KNOW was not out), and try to manipulate me into more charges (an alternator belt, when only 5 weeks ago they went over the whole car and we dropped a bundle getting anything that needed fixing done- but the auto industry being what it is, there is a push on to make cash from claiming things need to be done that don’t, especially when they pick a mark they see as a “stupid woman”).  I was instantaneously furious, and firmly told the man I expected the usual petty “taxes”– items for getting an inspection done, but NOT egregious inflation with other items.  He asked me to come see the belt.  When I got out to the repair bays, the tech was a very young man that I told right away I resented being manipulated and I did NOT think the car needed the new belt, and if it had they should have caught it five weeks ago.  He backed off, and told me it didn’t really need it, it was just a recommended thing.  Sure, for $100 extra bucks you make your quota and I get skinned, I thought.  No thanks.  So I said do the blades and bulb.  Fine.  But do not touch that belt and if I have any problems with it in the next month, I will assume you deliberately monkeyed with it.  The belt is not part of the inspection either, I have lived here long enough to know that- so I better get the sticker on this only 30,000 miles two and a half year old van.  I did not know what to expect, but boy was I pissed.  

When I went back to the play room, the other mom whispered, “How did it go?”  I told her what I said and vented about how much I hate the bureaucracy and corruption at all levels in this state.  I also laughed.  She was sympathetic, having brought her Prius in that day for a repair and having just moved from Washington State.  We talked for a long time, and we found a wonderful set over overlapping interests.  I gave her my email and phone number as I left, thinking I wish I had recorded that conversation.  

I thought about meeting new people as I drove away.  Making new friends is always difficult, no matter what your age and I find it useful to have many friends at many degrees of intimacy.  The model I have been shown is a bulls-eye, as in playing darts.  A very few people in the center with which we have extreme intimacy, the more people and less intimacy as the circles fan out.  Since moving here, I have felt a profound loss of some good friends, and have not made many new ones.  Randomly meeting someone and feeling camaraderie is a rare and good thing.  It’s a lot like dating.  I tell this to my father, who has always been awkward about trying to meet people, especially since mom died.  Try and try again I suppose, and those wonderful conversations will happen.  I hope.  No one else may want to listen to them, but they make life better none the less.  And it sure would be nice to know those intellectually gifted celebrities go through much the same thing too.

Romance?

I was surfing today when I saw an ad for a contest, promoting the film Last Chance Harvey.  On the site Divine Caroline, the contest asked in very few words to describe one of the most romantic things that had ever happened to you.  Most of the responses were, well, sad or pretty standard.  I could think of many, and added what I think was certainly the most random.

I was in my early 20’s living in Chicago.  It was a warm day.  I wore one of my favorite long cotton skirts, white sleeveless shirt, and wide brown belt.  I needed a tube of red paint.  I stopped in an art supply store.  The clerk, a cute bearded young man came round to help.  At the register, he flirted.  I was down the street to the corner of Michigan Ave.  when I heard him yelling.  I turned around and he was running towards me, apron in hand.  He had cut work to follow me.  He asked where I was off to, and if he could walk me there.  I told him fine, and that I was on my way to a matinee down the street.  At another corner further on, he popped into a convenience store and bought us both bottles of juice – apple — without prompting.  We sat on the grass across from the theater, talking, and drank them.  I asked him why he had followed me.  He shrugged and told me quite simply, “because I thought you were beautiful”.  No one had ever said that to me before.  I laughed, eyeing him sideways, wondering if he was as sincere as he seemed, or playing a good come-on.  He asked for my number.  I said no.  He gave me his.  We parted, I went to the movies.  He went back to work.  I never saw him again.

I can still recall many details of that event.  Everyone should have a random stranger tell him or her they are beautiful.

I look back at photos of myself from that time and shake my head.  Do we ever know who we are when we are young?  I see the fit, long haired young woman who was worrying everyday about what she was going to do with herself.  I knew I was not as pretty, smart, funny, or worldly as so many of my friends and acquaintances.  What I failed to see was what I was, instead of all the things I was not.

Romantic events should, I think, be those unexpected times when we are raised above the mundane routines of our lives.  Those times when life becomes crystallized, even for only a moment, and we feel truly alive.  We associate the sexual so closely with the notion of romance, to the detriment of romance.  They are not interchangeable themes, but do often overlap. 

One of my greatest fears is succumbing in old age to dementia of some sort.  I do not ever want to forget so many things, especially the romantic events of my life.  Just recalling them helps me have perspective, and laugh. 

2009 has started as the year not many of us can seem to catch a break.  In times like these, I think knowing we have well and truly lived with hope and honorability matters.  May you remember random moments of romance.   May we all have more someday.