fogo demas (too much fire)

I just finished the brief wondrous life of oscar wao by junot diaz - pick it up from the library from the bookstore whatever. you have to read it. I haven't been so sucked to the core of a novel since I read the power of one (by bryce courtnay and probably my favorite book) for the first time, and that was all sorts of different. or maybe not, come to think of it. more on that later.

I always get crazy thoughts at the end of a great novel and because it's so difficult to share that kind of moment with another person who hasn't just emerged from the soul of that particular novel, many of these thoughts are lost. but I'm curious about these ones and I want to process them more - later. so I wanted to share them with you and let them simmer a bit before thinking through them more.

sometimes, maybe too often, I find myself envying the educated oppressed - I know that's not remotely a politically correct or perhaps even linguistically correct term, and even just writing it out makes me feel like an asshole, but I'm resting on the hope that you understand a bit of what I mean and won't hate me. It's not envy of their suffering or their un-freedoms (as Amartya Sen, the author of Development as Freedom, the other book I'm reading right now, would call them) - but for their anger. Anger that's directed, focused - at those who created the Diaspora, who benefited from slavery (I always wonder if this is my family and then I think it must be, and if it wasn't, it is now); anger at a loss of place, a confusion of identity, at a language that narrates the western world but still can't figure out the words to articulate their past and story to define them now (African-Americans, Black, Latinos, Hispanics, Caribbean-American, Bi-racial?)

In Brazil everyone would talk of having African heritage as having a fire in your soul (literally "fogo d'alma") - and they say it as the cause of all the trouble that Afro-Brazileiros get into in Brazil is because of this fire in their souls (the social forces that provoke it and the racial context of the country's role in creating it aside), but it's also seen as something to be proud of - because as much as its a source of trouble and temper, it's a source of anger and passion -- of a kind that us lame ass white people just cannot comprehend even if we do learn to speak la lingua.

and it was true - and is true - I'm mostly just in awe of such passion, but what's more striking is that when I think about it, I'm more in awe of the anger. because while I've felt passion - serious passion - for serious - I've only felt anything close to that kind of anger once, maybe twice and only for fleeting situations, just a taste of what anger at being wronged feels like.

and while I understand conceptually the unbreakable link between this anger and oppression, my desire to feel the former, to empathize to the point where I can feel the start of a burn - carries me too close to actually feeling like I could accept the latter with it.

Maybe that's part of why I want to be a doctor - or at least a fear of mine about why I want to be a doctor - because a physician is rarely an object of this anger, and is most logically aligned with the oppressed, to the point where she can actually feel the anger because of their oppression. which I know is at least partly problematic, but what I can't sort out is how much.

I'm exhausted and slowly coming back into the world I'm in instead of the world of Junot Diaz and going to try to slip off to sleep before I try to work through these thoughts too much more. But I'd love to hear any thoughts, on this or the book (when/if you read it) or both or neither.

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I don’t want words to sever me from reality.
I don’t want to need them. I want nothing
To reveal feeling but feeling – as in freedom,
Or the knowledge of peace in a realm beyond,
Or the sound of water poured in a bowl.
-Henri Cole

how to have a difficult conversation

(courtesy of my mother, who has lots of sources of her own)

Questions to ask yourself when you're considering having a difficult conversations:
1)What keeps me from having this conversation?
2) Where do I want to end up at the end of the conversation?
3) Is this the right time/right place

-Focus on the Positive. "I want to have this difficult conversation because I respect you and our relationship/friendship and I am afraid if I wait or don't have this conversation, resentments will build and harm our relationship"
-Beware of strong feelings. Confront them in yourself before you start the conversation with another person
-Ask for feedback from the other person as you go along - have a dialog not a lecture

Most "minefields" in conversations are because one person or both feels one or more of the following:
(1) I am not competent
(2) I am not a good person
(3) I am not loved
When you think someone is overreacting or taking something too personally - consider which of the minefields you're touching on with the current topic and either address it or drop it.

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"relationships are so important - and a whole lot of work"
-the one and only comment I've ever appreciated from a therapist

in fast forward (or "running with feathers")

For the past month or more I've had the sensation that my life is in fast forward and I'm always running behind trying in vain to catch up.

A. put it best when she described it as running with an armful of feathers: Every time you reach to grab a feather that's falling out of the pile, even more fall out - so that it actually becomes impossible to hold onto everything.

mathematicians and mentors

Over cocktails the other night and again while walking along the river with a few friends, I'm struck by the power of brilliant women - and although I know and love many brilliant men, keep wondering why the vibe of a group of brilliant women is so different.

I think some of it has to do with how unique it is to be with a group of women when no one is being self-deprecating. I know that may be harsh, but we are socialized from a young age to be apologetic for our talents, maintaining the stability of a group because no one feels threatened (some of this I'm getting from The Female Brain but it resonates with my own experiences with group dynamics). But at the same time women know how to be so passive aggressively cruel, especially if they feel threatened. So any time I'm with a group of women who are unabashedly and unapologetically brilliant AND are intrigued in each other's different takes on an idea - it gets wild, with ideas and thoughts and questions all buzzing around the table as we order another round.

One woman at the table was expressing that it's such an important skill, particularly for a woman in a field of men, to know when to get her bullshit on (because according to her, men are much better trained at this) and front like you know slightly more than you actually do. It's true - the successful women I know do know how to "turn their bullshit on" - but, and perhaps this is actually more important, they know when to turn it off, too.

Another aspect that is unique to groups of brilliant women (versus a group of brilliant people that includes men) is that everyone asks more questions. And when everyone is brilliant and confident, the questions aren't clarifying an already known answer, but actually make everyone reach a little bit further into what they know to be true. Questions, my female friends and I have learned, can really make or break whether women feel like you're connecting with them or just talking at them. In our experiences, men don't really feel the same way. I wonder if this continues to be true as we all get less self-absorbed. I guess I probably have enough questions to go around.

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"It's spring fever...you don't quite know what it is you DO want but it just fairly makes your heart ache you want it so"
- Mark Twain

copayments rise: bearing a double burden

The basic idea of health insurance is spreading the burden - this is why everyone (healthy and sick) pays into a pool of money when they are well and able to work so that when they are sidelined by an illness or caring for an ill loved one, they can have the resources they need to get better. According to my grandfather, it's a lot like in the old days, you'd pass a hat amongst all the Italian workmen to pay for the hospital (or funeral) expenses for someone who needed them - and by giving your contribution, you're also assuring that if you needed it, the hat would be passed for you.

A NYT article this morning reports that in a new system, called Tier 4, health insurance companies have decided that system could be EVEN MORE profitable for them - and have decided that for some drugs, mostly the ones for life-threatening and chronic diseases, including cancer - people should have to be really sick (hence the "life threatening or CANCER" part) AND pay more for medication. Under this system, people are charged for a percentage of the total actual cost of the medication. This is extremely expensive (eg. $13,500 for a 90-day supply of a medication to treat a type of cancer called CML) and because most of these meds are for long-term illnesses, people have to pay for a continuous supply.

Apparently this isn't a totally new idea, as this 2005 article from the WSJ discusses new ideas for plans using "reference pricing" and "coinsurance" that would charge the user a percentage based on the actual price of the medication. In the WSJ Health Blog, they quote Dan Mendelson of Avalere Health saying “This is an erosion of the traditional concept of insurance...those beneficiaries who bear the burden of illness are also bearing the burden of cost.”

It makes me wonder how all these companies who aren't concerned with health are running our healthcare system...yikes. Maybe it would be better to go back to passing a hat?

Re-Vamping Primary Care in the US?

there's been a huge amount of press lately (by this I mean at least the last five years) about how our medical system is set up so that it rewards expensive treatments with big machines and not preventative medicine, like lifestyle changes, screening techniques, and other early interventions to diseases and disorders that later become difficult if not impossible to cure (eg diabetes, breast cancer, heart disease, MIs). The US Medicare Advising Committee (Medpac) just released a brief discussing this problem - emphasizing that less medical graduates are going into primary care careers because their work in other fields is viewed as more important and rewarded accordingly. However, the action recommended for this critical problem is only: "The Commission should review and discuss draft recommendations".

And what about the recommendations by physicians in this article in the Journal of the American Medical Association a few weeks ago? They included emphasizing more collaboration by an entire health care team - including Nurse Practitioners and Case Workers. Whatever the recommendations the Commission comes up with, I hope they include both collaboration and a reward system that allows doctors to keep people healthy and focuses on screening, education, and early intervention.

And, American Medical Association, doesn't it also make sense to decrease the price of medical schools, so new doctors don't graduate in so much debt that it's impossible for them to ignore the financial incentives of specialty fields.

intentional happiness

Last night I went out with some friends I hadn't seen in a while and we talked a lot about the life/work balance that we're all trying to figure out. More proof that even though we're in our early twenties, we have so little energy (and time and money) right now for fun. Because unlike college, there's not unlimited, effortless fun in a three block radius at all times.

Because this is apparently happening to everyone, my three best friends and I have been compiling a list of "intentional happiness building" ie things that one can do to increase one's happiness right now at any time.

Here are a few gems:
(1) drink a glass (just one) of whiskey/wine/your preferred relaxation beverage of choice, while listening to the sexiest music you own (I'd recommend Billie Holiday) while painting your toenails and wearing bright colored underwear so as not to feel too overwhelmed with how sexy you are
(2) haul your hiney to the hardware store and buy some new materials. So many hot craft possibilities. For example, I adore chicken wire - perfect for push-pinning to the wall and hanging earrings, necklaces, etc.
(3) browse a used book store for an old classic novel to read. Not only will you feel kind of awesome for plopping down with folks like Tolstoy, you will remember that reading is an unparalleled way to explore another world and reflect on/distance yourself from your own experience.
(4) strut/Model walk. break it out anywhere, anytime - it's sometimes more fun in some fiiine heels, but a little more baller if you do it in sweats and running shoes. Extra points if you're walking down a crowded street.
(5) reach out to a friend crush. Do something active with them--hike, ice skate, bowl, contra dance, bike--somewhere you haven't been before
(6) create (and keep) standing dates, whether its for lunch every week, a TV show, drinks after work - something you CAN count on amidst all this instability and ephemeral-ness

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"She is a friend of mind. She gather me, man. The pieces I am, she gather them and give them back to me in all the right order. It's good, you know, when you got a woman who is a friend of your mind."
~Toni Morrison, Beloved

directing traffic

Every day on my commute, I see this man in a blue hoodie who stands at the merge point of the highway and the other main road into the city and "directs traffic". For a while I thought that perhaps he was a cop or hired to do it, but it's become increasingly clear that it's just something he does. When the cars stop (there's a light up ahead) he asks the cars around him for money, in a sort of half-hearted-just-passing-the-time-before-I-can-direct-traffic-again sort of way.

I guess we all just want to feel like we have a purpose.

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"Francisco, what is the most depraved type of man?"
"The one with no purpose"
-Atlas Shrugged (don't get me started)