Taking Note

Pain and Palliative Care

“His heart filled virtually his whole chest,” recalls Dr. Diane Meier describing her very first patient, an 89-year-old suffering from end-stage congestive heart failure. 

It was the first day of Meier’s internship at a hospital in Portland Oregon, and after being assigned 23 patients, she was suddenly told that one of her patients, who had been in the Intensive Care Unit for months, was “coding.” She raced to the ICU where the resident told her to put in a “central line.”

“I didn’t know how,” Meier admits.  “I felt overwhelmed and inadequate. Then, the patient died. . .

“Everyone just walked out of the room,” she remembers.  I stood there. I still sometimes flash back on that scene: the patient, naked, lying on the table, strips of paper everywhere, the room empty. This was my patient. I felt I was supposed to do something—but I didn’t know what.”

Meier left the room and, in the hallway, saw the patient’s wife. “I walked right past her,” she recalls, nearly shuddering at her own cowardice.  I didn’t know what to say. I didn’t even say ‘I’m sorry.’ As a physician, I didn’t think that I was supposed to do that. “

I heard Dr. Diane Meier tell this story at a conference for medical students at  Manhattan’s Mt. Sinai School of Medicine last week. When she finished, she asked her audience, “What is the hidden curriculum here? What does this story tell you?’

Approve Your Own Message

    Another technical milestone in the democratization of political communication has been passed, just in time for the general election campaigns.  Two new web sites make it Amazon-easy for citizens to enter the heretofore exclusive club of political advertisers on television. 

    Suppose you are a concerned citizen who wants to build and sail your own Swift Boat, as it were.  Until now, your best option entailed posting a web video in the hope that it would please the news business (or, as an interim step, bloggers) enough to get free air time.  VoterVoter and SpotRunner Political provide you with software and support that streamlines administrative procedures, assures legal compliance, and shrinks agent fees.  VoterVoter labels the steps, somewhat out of logical order, as “Sponsor.  Create.  Browse.”   You can choose a pre-fab spot starting at $499, or insert your own material, or hire a crew and then upload your own ad.  You can place ads by your wits, or contract for geo-targeting.

An Idea Whose Time Has Gone

Greg Anrig's recent Washington Monthly piece argues that school vouchers are  an idea whose time has gone.  In the video below, Anrig, Vice President of  Programs at The Century Foundation and author of The  Conservatives Have No Clothes: Why  Right-Wing Ideas Keep Failing, explains how and why one of the conservative movement's most cherished ideas hasn't worked out in practice. 

To view shorter clips of this video please visit The Century Foundation's YouTube page.

Only a Minority of Americans Now Expect a Comfortable Retirement

As the U.S. economy slides into a recession, the economic insecurity that has afflicted so many Americans during the Bush administration is likely to get even worse. Consider what has happened to Americans’ belief that they will be able to live comfortably in retirement. Back in early 2002, 59 percent of non-retirees said they expected to have enough money to live in retirement. That figure has now fallen to just 46 percent.

Robert Kennedy, Barack Obama and Affirmative Action

As Democrats unite behind a presidential nominee, the challenge will be to find policies that attract both Barack Obama's following among African Americans and educated whites and Hillary Clinton's support among white working class women and men and Latinos.  In a new article in Inside Higher Education, I discuss the way that Robert Kennedy united working class whites and blacks in the Indiana primary in 1968 by emphasizing common economic interests and discuss Senator Obama's potential to do so with his tantalizing suggestion that affirmative action policies benefit low income and working class people of all races.

A Dispatch from the Green Zone

Amid the din of incoming-fire sirens that have punctuated life in the Green Zone, news of political developments has largely been absent.  My current stay in Baghdad has coincided with continuous large-scale military operations and an almost complete lack of movement on political issues. This is not particularly surprising when judged against the dismal track record of the Iraqi government in working towards a sustainable political accommodation since the dissolution of the Coalition Provisional Authority in 2004 and the transfer of sovereignty. However, the focus on the Sadr City offensive and the long-anticipated launch of a major military offensive in Mosul targeting al-Qaeda in Iraq and other Sunni extremists has clouded understanding of the precariousness of the current state of affairs.

With discussion and coverage of military actions overshadowing the pressing political questions that will shape the future of Iraq, it is easy to forget that tactical military gains cannot form the basis of national reconciliation without corresponding political achievements. This truism has been voiced rightfully since it became clear that the U.S. troop surge, in conjunction with the Jaysh al-Mahdi ceasefire and the turning of key Sunni Arab tribes in al-Anbar province and former insurgent groups, known as Sons of Iraq, resulted in significant security gains. Yet it is worth repeating in light of the focus on current military events in Iraq.

While the long-term prospects of the tentative ceasefire between Jaysh al-Mahdi and the al-Maliki government are still unclear, for someone in the Green Zone, the absence of incoming fire sirens for two days is a welcome change. But a ceasefire, even if it is advantageous to the al-Maliki government, which is far from clear based on the discrepancies in public interpretation of the terms of the agreement, is not a significant achievement in and of itself. This is heightened by the fact that the one benchmark that is currently being discussed, namely, the provincial elections law, which had its first reading in parliament last week, is intimately bound up with the issues presented by the government of Iraq’s struggle with Muqtada al-Sadr and the Jaysh al-Mahdi.

Counting West Bank Checkpoints

I have written before about the seemingly unstoppable proliferation of checkpoints and obstacles to movement in the West Bank, but I thought an update was in order. After all, Secretary Rice has just devoted another round of relatively fruitless Mid-East shuttling on primarily this issue. Here is the situation, how it has come to be, and why it makes America look Lilliputian....

The Economy Can Still Tank

On Tuesday, Treasury chief Henry Paulson announced that the president would veto the Democrat’s proposal to staunch the rising number of defaults.  The Bush administration didn’t offer a better plan. But in today’s Financial Times, even Martin Feldstein, the former Reagan chief economist and long-time Harvard conservative, argued the economy is not out of the woods yet. There has, of course, been some heartening news. For example, retail sales look better today, companies are making profits, and unemployment hasn’t soared.   Thank the lower dollar, government fiscal and, especially, Federal Reserve policies for all that.

But, in fact, new evidence shows that credit is still tight in America and Europe, Fannie Mae just lost a bundle on mortgages, oil keeps rising in price, and individuals just have no money to keep demand up. Most important, house prices are falling.  The last is the key.  The Case-Shiller index of house prices keeps tumbling.  That means the bad mortgage debt will keep climbing, and there will be more big losses at the financial institutions.

Government has to drop the other shoe.  The nation needs a partial rescue of the mortgage market.  It is costly and not easy to save only those who deserve it.  But if the bleeding in housing is not slowed, the economy could seriously deteriorate. Paulson’s disturbing insensitivity to reality reflects the prevailing laissez faire ideology of the last generation. And it is still reflected in quiet conversations among Washington’s policy making crowd.

 

New Highs for Economic Worries

A new Gallup poll conducted between April 6 and April 9 shows that the public’s worries about maintaining living standards and paying monthly bills have hit new highs. At the same time, the public’s belief that money and wealth in this country are fairly distributed has hit a new low.

The poll found that 55 percent now report they are very or moderately worried about “not being able to maintain the standard of living you enjoy.” And 44 percent say they are now worried about “not being able to pay normal monthly bills.” Both of these are the highest figures Gallup has recorded since it first started asking these questions in 2001.

Alt-Debate: Coming This Fall From YouTube and New Orleans

Last year, the Commission on Presidential Debates (CPD) rejected New Orleans as one of its three host cities for the 2008 debates. In a demonstration of technology trumping tradition, New Orleans announced last week that it would be partnering with YouTube and Google to host its own presidential forum on September 18. Louisiana Governor Bobby Jindal and New Orleans Mayor Ray Nagin made the announcement in a video post on YouTube that also featured the CEO of YouTube, Chad Hurley, and Senior Vice President of Google, David Drummond.

The forum’s format has not been explicitly outlined but with YouTube as one of the partners, video participation is likely and by adding Google into the mix of collaborators, the forum will offer a new toolset so far unused in this election’s other interactive debates. Hurley and Drummond describe the forum as an extended opportunity for voters to learn about the candidates and the issues with Google's expansive technology while having an ongoing discussion that will be combined with the real-time forum in New Orleans and continue on after the forum.