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RAR reviews LPs from Michael ONeill (Ain't Leavin' Your Love), Sarah Stanley (Tuesday Girl), Hilary York (In The Dark), Tom Corwin and Tim Hockenberry (Mostly Dylan), The Boxmasters (Modbilly), Mad Buffalo (Wilderness), and others. Also read reviews from RARWRITER contributors Doug Strobel and Diana Olson.

BOOK REVIEWS AND MORE (click here): This edition, RAR takes a long look at Philip K. Dick, Edgar Allan Poe, Samuel Clemens and The Iowa Writer's Workshop. Read earlier RAR reviews, including a look back at David Halberstam's The Reckoning, and Alan Greenspan's book "The Age of Turbulence."

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RARWRITER.com Annual "State of the Union" Report 2008-2009.

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CONTRIBUTOR PROSPECTUS

RARWRITER.com is exploding with new readers, new artist profiles, and new business opportunities. Would you like to become involved as an editorial contributor? If you are a great writer or photographer with particular knowledge of your creative community, and you are looking for publishing credits, contact us at Rick@RARWRITER.com for a copy of the RARWRITER Contributor Prospectus to learn what involvement can mean for you.-RAR

The RARWRITER essay pages have been one of the most vibrant aspects of this site, to the point where we have archived previous pieces to manage the volume. Below is the current stuff. Read and weep. Comments are welcome. - RAR

The Undeniable Heaviness of Mendacious Demise

I wasn't particularly affected when Michael Jackson died suddenly (unexpectedly?) last week. While an admirer of his talent, he wasn't really of my generation, though born in 1958, Michael was a "50s" child like myself. Let that sink in for a moment and you start to get a sense for the disconnections that characterized his claustrophobic, shortened existence. I think it is captured, to tragic effect, in the shot above (uncredited from shamelesshype.com). In many respects it is among the more flattering of the last photographs taken of Michael Jackson, and yet it makes me sad to look at it. Those are the eyes of an old man, a sad one, and it makes me feel empathy for the person whose soul they are windows into. That they are the eyes of a prematurely old individual brings into sharp contrast MIchael Jackson's fantastical worldview and his own experience with living. He seemed to me to be stark raving mad, in a largely, not completely, benign way, like "The Hatter" in Wonderland. It is the back story that makes it all unsettling, the probability that this weird, intensely talented person was created out of love and abuse, every step along the way.

Remember B.F. Skinner's "air crib"? When I was in college it was often called his "baby box". It was a chamber intended as a controlled environment to make the process of raising a baby cleaner and easier for the caretaker.

Michael Jackson was famously and figuratively raised in such a box, created by his driven, domineering father and his Jehovah's Witness mother. Like a controlled experiment, it met its objectives while producing unexpected outputs. I think you could consider establishing your children as a work unit an objective reached. The unexpected would be the level of fame that came to the Jackson 5, and then the hyperbolic levels it reached in the solo manifestation of Michael Jackson. The sweet little boy who grew up in isolation, denied the social interactions that tend to calibrate people to behavioral norms, was finally and irrevocably isolated by the fanatical devotions of strangers. Is it any wonder he was known, in the 1980s, to sleep in a hyperbaric chamber?

As investigations into Jackson's death reveal the role that AEG Live, the concert promoter for Jackson's planned 50-show run at London's 02 Arena, were playing in his life, one is struck by the patterns of abuse that are repeated in Michael Jackson's story. Handlers can rationalize a lot of things when the reasons all have to do with producing money. People get paid, families get fed. People holding contracts get rich. Michael Jackson was reported to have been nearly a half billion dollars in debt at the time of his death, but there was a plan for him. He would just have to rehearse every day to recapture the old magic, get and remain energized and healthy. He just had to stay focused on being the money machine that he had been since he was a child. He just had to disconnect from time and the reality of his own mortal limitations, and just be Michael Jackson 50 more times. Or maybe more. There was talk of extending the engagement into a worldwide tour, to just keep going, to just keep cashing checks.

It was going to be Michael Jackson's way out. - RAR

From May 9, 2009

From May 7, 2009

Making Things Remain Possible...

On A Busy Artist's Time

When I was a kid, I was gripped with fear at the prospect of committing to a "regular" job. Like those storied tribes of the Amazon rainforest who blanch at the idea of having their images taken from them by a camera, I suspected that life lived regular would steal what feels like the very essence of me, which is my artistic spirit. (Yeah, you laugh, but I feel that way.) I haven't really changed over the decades, which makes me sound like a vampire, but so be it. I have been fighting the good fight against what we in the '60s used to call "conformity" - a loaded descriptive - for 43 years. I count that from the first summer job my parents got for me, which was in a pit under a Kansas grain elevator, where I worked 48 hours a week in the sweltering summer of 1966, most in respirator mask and goggles, shoveling wheat into a broken, dust-belching auger. I got $1.25 an hour and a bad taste in my mouth regarding the mis-marriage of fruits and labor.

That lowly beginning was all it took to convince me that hard work was not only not its own reward, but was something that, left un-managed, could steal your enthusiasm for each new day. And so I have marshaled through the years, doing my best to exist at the fringes of commonality, but in a manner comfortable enough to accomodate my ironic need for the normalcy of domestic life, including family and mortgage.

Maybe my choices haven't exactly been strictly bohemian, as I might have preferred. I make my living doing technical writing projects on a "consultant" basis now, but in the past have worked in staff writing and editing positions at architecture and engineering, information technology, and training firms. I have worked as a writer on various weekly and daily publications. It has been pretty standard stuff, largely mundane, and I have been rigid about keeping it balanced, as best I've been able, with my off-the-clock interests.

Like most right-brained people, and I mean that in the technical rather than the judgmental sense, I was more or less convinced as a young person that my life would end if somehow I lost the time required to write my masterpieces - I have always been a plural thinker - and follow my bliss. I don't think I thought even then that there was some big reward coming my way in the end, I just felt strongly compelled to spew everything I could think of out onto the page. Why? Who knows. People sometimes demand explanations, particularly when it becomes apparent that few are those who give one twinky about one's produce.

What one discovers, after years of trying to explain one's self to others who will never understand, is that it is all a waste of gas. One's own creative output may be a waste, but certainly trying to defend one's approach to life is utterly hopeless. Speaking as a writer, if you can't inspire the interest of a reader, it is unlikely that you will personally inspire anyone's empathy with your woeful relationship to life's demands, barring an on-air session with Oprah, and the new-found admiration that comes with income, particularly in amounts obscene.

Offering a defense for one's artistic bent also misses the point. This life ultimately belongs to each of us personally and what is right for another may not be right for you; in fact, will almost certainly not be right for you. The answer is not in crafting clever and insurmountable defenses, but in letting it be. Amend that. Letting it be with these rules:

• You must function as an independent person who causes no inconvenience to others
• You must earn your independence through good works
• You must do what you say you are going to do
• You must produce works of authentic value

My Mother has always stated, somewhat maddeningly, that people find the time for the things they really want to do. I have found that to be true, now that I am old, and I wish I had absorbed this wisdom when I was younger, because it would have saved me a great deal of angst.

EFFICIENCY: I am sometimes amazed, these days, by my own efficiency. This feels weird because I don't think that people perceive me as a particularly efficient person, but I write constantly, roughly 7,500 to 10,000 words per day over a range of vehicles, some profit-earning, others not. I publish this website, which takes no small amount of production labor. I market my consultant business, which adds a good 10 hours of time to each "work" week. I grab moments to compose song lyrics and melodies and experiment with arrangements. I use my digital audio workstation to record parts and compose in midi instrumentation. I write fiction, essays and reviews. I research topics. I do the grocery shopping, take the kids to and from school, cook, read, travel to meetings around the Bay Area, play in the park. I catch a little television. I usually find myself in bed by 10:30 p.m. and often start my day between 3:30 and 4:30 a.m. My best hours are before 7 a.m., before the family wakes up, when I am electric by my own standards.

It has occurred to me that outside of the activities referenced in that paragraph, I don't have much of a life. I have no idea how to vacation and rarely attempt such. My social life is non-existent. I rarely "go out" to a movie or a restaurant. But I find time for the things I really want to do.

SHORT-CUTS: I have learned that part of using time efficiently is to get smart about the short paths from A to E, which is about as deep into the alphabet as I ever have time to go. Accepting what is do-able is a part of the maturation process. Knowing that you must make each stroke count tends to fine tune one's efforts and over time you get good at it, whatever it is you are doing. I do a lot of things and, quite apart from my earliest inclinations, I think that being busy helps.

In my writer's life, I have learned that the best way for me to work is to explode my thoughts onto paper before getting too crazy with thinking about what it should all be. Rule 1: move the project forward. Once you have something started you can make further progress by moving elements around and editing. This second phase of work often springs new ideas to my mind and I find myself creating yet another draft that will require further molding. Using this approach, I typically have developed something by the end of my available time. It may not be a finished something, but there is a tangible output that didn't exist before, and I always seem to learn something in the process, even if the product falls short of what I had hoped for it to be, as they most always do.

Technology has done wonders for my musician's life, such as it is. Here again, I can't budget the time to develop an interest in the social side of my musical inclinations. I don't really want to go out and play with and for others. What I do budget time for is songwriting and the design of sonic expression, which I typically do in one of the following ways:

• Develop a figure on the guitar that will become the musical center of an idea, one that I can quickly record and capture as something I can use as a "loop" around which to build (I use Cakewalk's Sonar Producer software on a PC); or,
• Chart out chord changes that form a melodic infrastructure to be developed using import tracks and available midi technology

RISKY MEASURES: The revolution in digital recording and sampling and in midi instrumentation has gone through a curious arc. The advent of midi instrumentation launched Techno House music, which has been bane to some and life blood to others, and it was an immense presence in popular music in the 1980s and '90s. Then there came a push back, a desire to move back toward the sounds of real instruments, though the days of pure acoustics are largely a memory now at any (sampling) rate. Synthetic, digitally representative sounds have become omnipresent in music production, in part because they lower costs and afford extreme ranges of flexibility to the greatest number of users.

Among the earliest off the shelf software to aid with musical production was the Canadian import "Band-In-A-Box", which is a nifty concept that allows the user to apply a wide variety of musical styles to chord changes of one's own choosing. I was introduced to the product years ago by a top L.A. musician who suggested that "it would be perfect for you". I took that as an insult, at the time, but not so much after I became familiar with the product. BIAB, as the software is called to pejorative effect, recognizes that music is performed as a string of repetitive actions, the standardization of which produces a "style" of play. There are obviously styles by the truckload, taking into account the interpretations of individual players who come to stamp their particular brand on musical types. The clever folks who contribute interpretations of playing styles to BIAB are good at parsing the nuances of players known for their distinctive styles, so the off the shelf offerings are immense. BIAB also allows the user to design his or her own style sets, which requires a significant commitment of time, and a significant flexibility in one's thinking regarding musical notation. All BIAB styles are written in a single key, so your notation is indicating variations in steps, which become translated by the program into the chord changes you write for each of five instrument voices.

This section (left) shows a pattern to be played on the guitar in the "New Waltz" style, which works well with songs like Marty Robbins' "El Paso". The default key for BIAB is C, so while in the music for this song the first chords are written as "D", they appear in the patterns per the example at left, which shows the C, E and G notes of the C major triad. The key is the pattern, in which you (or with midi, the computer) play the 1st-5th-3rd-5th-3rd notes in the key as written. So in this song, the sounds you hear are D, F# and A, the notes of the D major triad.

This two-measure pattern is one of 162 patterns of play spread out over five instruments to create the complete arrangement for each of five instrument voices. This pattern is the first played by the guitar in the A section of the arrangement, highlighted in blue in the screenshot below. As shown in that screenshot, BIAB styles map out into A and B sections, with multiple subparts for each, including measures in various time signatures.

This next screenshot below shows the second two-measure guitar pattern of the A section, which offers subtle variations on the theme established with the first pattern. The quarter note on the third beat of the first measure is played as a "D" rather than an "E" as it is in the first pattern. In the second measure, the quarter note on the third beat is also played as a "D". Or, more precisely, it is played as flat thirds, or minor triads.

Professional musicians largely recoil at such breakdowns of musical performance, calibrated to be played by your "robot computer", their disparagements ranging from the shortcomings of midi sounds (largely dependent upon the quality of one's sound card) to the fact that they are not being produced through the blood, sweat and tears of real people.

While I am largely in agreement with those attitudes, I am also of the opinion that this BIAB program, and others like it, should be a part of every public school music program because they brilliantly deconstruct musical composition into comprehensible bites. There is much to be learned from this, which is my reason for guiding you through this tutorial. Optimize your possibilities by using the available options. Move your projects forward.

PROCESSING IDEAS: While I wouldn't argue that the midi revolution has helped the overall quality of sound - once you have attuned your ear to its characteristics, you realize that you hear it everywhere in the media, which must be deteriorating our sense of what pure acoustic sound is - it is an extraordinary boon to compositional creativity. It allows the average bloke, like myself, to create a demo version of a tune in a short amount of time that is light years better than could have been achieved a quarter century ago by a talented multi-instrumentalist with a home 4-track recorder.

BIAB has limitations that are too great for me to accept, but that doesn't mean it isn't valuable. I sometimes use the software to capture a basic arrangement of a chord progression, with something close to the feel I hope to achieve. As clever as BIAB's style producers are, I can never quite fit their work to the feel I want for my own compositions. If it is a country, jazz or pop tune, I can usually come close enough that I can save a version as a midi file that I will then import into Cakewalk's Sonar Producer. Sonar allows me to edit all five tracks that are imported from the basic BIAB arrangement, and usually with some minor tweaks in the notation editor of Sonar I will get the song dialed in closer to how I want it. I often just use the bass, drum and piano tracks, saving the guitar work for myself to balance the midi instrumentation with "real" strings.

Sometimes there just aren't any short cuts one can take. I can't gain any benefit from BIAB with pure rock feels, which I typically build from scratch using Sonar's notation tools. Drums are always the hardest for me, as I am a non-drummer, and I never seem to find "canned" beats (which Sonar offers) that do what I want. I end up creating my own "loops", which takes me right back to the BIAB model shown above, i.e., set repetitions that add up to play the style of the song.

WORKING FAST: My whole point in starting this piece was that I am focused on efficient use of the little time I have available for any one of my multiple projects. This little intro to BIAB and Sonar Producer's midi notation capabilities is offered as one example of tools I use to make the best use of my time, though some may argue that I might find more valuable things to do.

Doubter voices aside, my focus with music production is on developing instrument parts quickly, and where the guitar parts are concerned, which I typically record "live", I have endeavored to become adequate to the task of quickly writing and recording a song at least well enough that I can stand to hear it back. I never consider my guitar parts more than "sketches". This may not seem a high standard to shoot for, but it is like I said earlier, I do what I can with the time I have. The toughest challenge for me is that I am usually recording my guitar parts the one and only time I will ever play most of them. That gives me kind of a rush, like a captured moment that one hopes is inspired. It isn't always, but working that way keeps projects moving forward.

I do the vocals the same way, doing most in not more than a few takes. Sometimes I'll keep a handful of full performances and then cut and snip the best parts and put them together in Sonar, which is where I do all my recording.

I usually don't put more than a few hours in to any of the originals I produce as demos, and yet they have gotten better over the years. Some weeks are tougher than others, but on average and using the available technology I write and record, to various degrees of completion, two or three new originals each week, year around. And yet it can't account for more than 10 percent of my waking hours.

I may not be great as an artist, but I have done the one thing that I never believed was possible back in my youth. I have learned, in large part, to master my own time. The hub-bub of life does not own me anymore, which means my spirit is still alive. And that remaining the case, anything remains possible. - RAR

From April 24, 2009

The Sorry State of U.S. Healthcare Personified

Oh Kaiser! You Are Killing Us!

In Michael Moore's documentary on the U.S. healthcare system, Sicko (click here to read a review on RARWRITER.com), there is a section in which President Richard M. Nixon is captured on one of the notorious Nixon White House tapes talking with his domestic advisor John Ehrlichman about how impressed he is with Henry J. Kaiser, the steel baron and founder of Kaiser Permanente, whom Nixon admires for finding a way to turn provision of health care into a profit-making enterprise. That audio clip itself is enough to make you sick, and most certainly it is the personification of the film's title.

Kaiser Permanente came into existence in 1952 as an extension of a health care model developed for Kaiser shipyard and steel workers in the 1930s and '40s, and which opened its enrollment to the public (non-Kaiser employees) in 1945. Today, Kaiser Permanente is, according to the company website, "a working partnership of two organizations: the not-for-profit Kaiser Foundation Health Plan and Hospitals, and the Permanente Medical Groups."

Kaiser Permanente was the first of the Health Maintenance Organizations (HMO). The Nixon administration championed the HMO concept as a fix to rising health care costs and the Health Maintenance Organization Act of 1973 created a special, protected category of health services. The act established the HMO as a mechanism within which subscribers paid fees (premiums) to gain access to a network of doctors and hospital facilities. In return, the HMO received mandated market access and federal development funds (taxpayer money). The corporate welfare wasn't the only advantage afforded to the crafty Kaiser. Under the 1974 ERISA Act, Kaiser and his band of lawyers established a protection against state common law tort lawsuits, putting in place a Federal law that protected HMOs from malpractice litigation on the grounds that the decisions regarding patient care are administrative rather than medical in nature.

That is worth repeating for emphasis: Under ERISA, HMOs like Kaiser Permanente were protected from malpractice litigation because decisions regarding patient care were defined as administrative rather than medical decisions. Here you have the smoking gun that for the last 35 years has taken decisions on your health out of the hands of your physician and put them in the lap of bean counters and faceless corporate administrators. This was the beginning of the end of quality health care in the United States, accounting for why the U.S. is now viewed as having the 37th best health care system in the world (according to the World Health Organization).

That's right, the "richest" nation on the planet delivers poorer health care to its citizens than do many eastern European, formerly Soviet-block underdeveloped nations.

The story below puts a face on what this means for real people, in this case the Rice Family of Benicia, California.

* * * * *

MANAGED CARE: Two weeks ago, my wife became ill and for days she stayed in bed at home, growing sicker and sicker. She felt poisoned. She couldn't go to the bathroom, couldn't eat. Then she started to vomit.

We contacted Kaiser to request an appointment with her doctor. That could not be arranged the day we called, but we were told a Nurse Practitioner - a strange locution - could see her, so an appointment was made for that. Joanne's color drained from her usual Olive complexion to a weird grey.

When we arrived for the appointment, we got right in but my wife was seen for less than 5 minutes and was sent away suggesting that she double the dose of over the counter stool softener that she was taking. Kaiser's pre-printed instruction called for the commercial product Dulcolax, which carries a warning label that the product not be used if the patient is experiencing nausea or fever. She returned home to bed.

EMERGENCY: On the following day, a Saturday, she began to run a fever and experienced sharp stomach pains. We rushed to the Emergency Room at Kaiser Vallejo (CA).

When we arrived, there were a handful of people in the waiting room. Joanne registered at the window, where a receptionist sat behind a thick glass partition and spoke to us through a little vent, instructing us to speak loudly so we could be heard. Security personnel were stationed in the waiting room, where we were instructed to wait until a physician could see her.

We sat there for 4 hours, during which time Joanne's condition grew worse. She doubled in pain and began to cry.

We repeatedly went to the protected reception area and pleaded for someone to see her, but were instructed to wait.

Eventually her pain became so great that I complained to the receptionist that we needed immediate attention. Apparently uncomfortable at the pressure we were putting on her, she disappeared from her station and remained absent, even while we stood at the window, unwilling and unable to simply sit any longer in the waiting room waiting for medical attention. When she finally returned to her station, I told her that it didn't feel to us like the ER staff was doing anything to respond to what was obviously an emergency situation.

She asked if I would like to speak with the Assignment Nurse, who soon enough came out to talk to us in the hallway. She told us there was nothing they could do because there was no bed available. I told her that we didn't need a bed, we needed a doctor! She replied that they had to get a bed for patients before a doctor could examine them. (Really? Doctors Without Borders examine people where they find them in Africa: in a hut, outside, lying on the ground, etc.)

I pleaded with the Assignment Nurse, asking if Joanne could be put on a gurney in the hallway - anything to get her seen by a doctor - but she said no.

I asked if we called an ambulance - there were two of them parked not more than 50 feet away from us, just outside the door to the ER - if we could be seen immediately. There were people being carted in from arriving ambulance units.

The Assignment Nurse seemed to find this funny and again refused us service.

I asked, in all sincerity, if she could tell us if there was some alternative to the Kaiser ER where we could get immediate help for this situation that was deteriorating rapidly and had been for more than 4 hours. I asked "Is there anyplace else we can go to get help?"

"You can go wherever you want," she replied with a smarmy, baited smile.

STUCK IN PURGATORY:  The problem, of course, is that we can't go wherever we want, though there are other hospitals in the area. Our health coverage, through my wife's employment with the Benicia, California school district, is with Kaiser. It is, in fact, one of the primary reasons she works for the school district, outside of being in love with teaching. The amount of money taken from her pay to cover the Kaiser monthly premium takes all but $500 a month from her paycheck. (In the U.S., we don't value teachers much either.) Like many Americans, she works for almost no pay, just coverage.

And the Kaiser ER wouldn't provide service for the money we pay.

I reminded the smarmy Assignment Nurse - and I'll try to get her name for the benefit of us all, so she can be watched - that we were asking to receive services for which we pay dearly and routinely. This was not charity or a favor we were asking. We were needing the health care we had purchased with hard work. It didn't mean a thing to her.

"What if she dies in your waiting room?" I asked.

The Assignment Nurse just smiled, as if it was offered as a funny aside.

We refused to return to the waiting room, as instructed. We just stayed at the little window, staring in at the staff. People came and went and we waited, my wife crying, looking terrible and doubled over in pain.

It seemed we finally pressured our way in. They allowed Joanne to lay on a gurney in the hallway and I sat on a chair next to her, waiting for someone to help.

Suddenly the doors of the ER burst open and a woman, who apparently had experience with this ER, pushed a man in a wheel chair to another empty gurney next to us, and helped him up on the contraption. He was moaning loudly and doubled in pain. This woman, who was a civilian, maybe a wife, and certainly not a Kaiser employee, had apparently driven into the emergency, commandeered a wheel chair near the entrance, and simply blasted her way in without waiting for the rigmarole we experienced at the reception window. The nursing staff looked at them warily.

The Assignment Nurse was in the area, joking with co-workers. Eventually someone went to the man and checked his vital signs.

Some other hospital worker told us that we would be taken into a room as soon as it was readied. More than 4 hours into this nightmare, Joanne was wheeled away to someplace I wasn't allowed to follow.

FACE OF DEATH: Tests immediately revealed that Joanne had a blockage in her colon, an emergency situation that required "immediate surgery" - another 14 hours later. She was prepped and went into the surgical suite around 2 p.m. on Sunday, now 24 hours after we had arrived at the ER. She was in surgery for 6 hours as they removed a section of her colon that was badly distended. Just after 8 p.m. that night the surgeon spoke with me as I sat in the surgery waiting room, the only person there.

He told me that at the point her colon was blocked, the tissues were swelled to many times their natural size and he could see that the tissues had already started to rip open. She was experiencing an intestinal infarction (intestinal necrosis), a life threatening situation in which Peritonitis is a common outfall. She was not more than hours or possibly even minutes, from sepsis, a spread of infection to the blood stream.

* * * * *

PREVENTIVE CARE: Kaiser Permanente is big on preventive health care. Live Well and Thrive is the message that is broadcast constantly in television and radio ads in California as they spend huge money on advertising budgets to try to lure potential victims...I mean, patients...away from the rival Blue Cross/Blue Shield and other HMO providers.

Several months ago, our Kaiser general practitioner insisted that Joanne have a colonoscopy, advising that it was something that people over 50 years of age should have done to head off problems in the bowels before they develop. The procedure had not gone well. The doctor who performed the procedure was unable to complete the colonoscopy because he believed Joanne had a "twisted colon". They tried repeatedly, though Joanne experienced great pain and discomfort, to perform this procedure that has been promoted by the likes of CBS anchor woman Katie Couric, who had one done on herself for the benefit of television viewers. (Couric's husband died of colon cancer and she was on a crusade to promote the "life-saving" procedure.)

Most people do fine with a colonoscopy, but not Joanne (or, as it turns out, her brother, who also had the procedure and found it excruciatingly painful). Joanne was in bed sick for days following the colonoscopy, then for additional days as Kaiser doctors tried other less invasive means of examining her colon. They came away with nothing, but Joanne lost a week of work.

The surgeon who removed part of her colon in the emergency operation determined that the colonoscopy had aggravated a condition of diverticulitis.

diverticulitis: A common digestive disease particularly found in the colon (the large intestine). Diverticulitis develops from diverticulosis, which involves the formation of pouches (diverticula) on the outside of the colon. Diverticulitis results if one of these diverticula becomes inflamed or infected. The colon can become infected with craters of food stuck inside, which causes abdominal pain. In complicated diverticulitis, bacteria may subsequently infect the outside of the colon if an inflamed diverticulum bursts open. If the infection spreads to the lining of the abdominal cavity, (peritoneum), this can cause a potentially fatal peritonitis. Sometimes inflamed diverticula can cause narrowing of the bowel, leading to an obstruction. Also, the affected part of the colon could adhere to the bladder or other organ in the pelvic cavity, causing a fistula, or abnormal connection between an organ and adjacent structure or organ.

THRIVE MY ASS: As I write this, Joanne is in a "step-down unit" - halfway between an Intensive Care and a regular hospital unit - which she was moved to after spending a day in a regular hospital room. Supposedly she would get more attentive care in the step-down, where there are more nurses. At least that's what we were told, but I have seen no indication that they do anything more for her there than they did in the previous post-operative unit. The proximity of the nursing station to her room is much nearer than in a normal hospital unit, but that only seems to mean that the racket is louder and the nurses don't have to walk as far.

I have been caring for Joanne through the night. The nursing staff has provided two foot stools that I line up with a chair so I can lay down from time to time. Occasionally someone will come in and take her blood, usually flipping on the light in the room around 4 a.m.. Sometimes a nurse shows up to change an I-V bag or empty a bed pan, but it feels like most of the nursing is being done by me. I reposition her in the bed, help her go to the bathroom using a portable commode, refit the cuffs that keep the blood circulating in her legs, and fetch ice chips, which is all she can have. I empty bed pans myself when the staff isn't around, and there don't seem to be enough of them to pay much attention to the patients filling every room.

I haven't seen the surgeon since just after the surgery, though I leave messages for him to call.

Joanne's recovery is painful and slow. It may be par for such a difficult surgery - or "complicated" as the surgeon called it - but not being a medical practitioner myself, I don't know what to expect. No one tells us anything. As long as I am in the room, the Kaiser nursing staff seems happy to let me do the work. I am afraid to leave because I lack confidence that they would respond to her needs.

She has been largely incoherent since coming out of surgery, hallucinating and talking to dead relatives. One nurse asked me if she was always this way. No, not normally, I assure them.

I wish someone would assure us.

I am exhausted, as is my wife. She has been able to take liquids, including broth. She asked for milk yesterday. What they brought had gone bad and had to be thrown out, and no replacement was provided.

We don't know when this will end, but the expectation is a follow-up surgery in two months.

I have lost a full week of work without pay. We wonder what part of this medical expense will be picked up by our Kaiser coverage, and what humongous bill we will be left to pay out of pocket. We know that most people in the U.S. who go bankrupt do so because of overwhelming medical expenses. Such prospects don't help the healing process.

SICK OF US: Joanne was moved to a room one floor up, where she will receive a lower level of attention from nurses, were such possible. The nurse who processed her in to her new room noticed that her dressing had never been changed. It was filthy because her colostomy bag had not been emptied and had broken open.

I finally got a call from our primary doctor, who had been unaware of any of what was going on. Her response, as she read through her chart as we talked on the phone: "This sounds like a nightmare."

FINAL WORD: In this country, we citizens seem split on whether health care should be guaranteed universally, as it is in every other industrialized nation but ours, or whether it should be left to free market enterprise, as Henry Kaiser envisioned it. It is really only "Republicans" who look at it that way.

I am angry and sad. People argue that "socialized" medicine, like that in Canada and Britain, is a terrible thing because people have to wait for delivery of health care services. I personally know European natives who live and work in the United States but return to their home countries once a year to receive medical treatment, covered under their home countries' universal health care systems. None of them say anything about long waits for treatments and procedures.

Fair warning: the next person who, in my presence, says that they don't want the government running the health care system in the U.S. is going to experience such a beating... It will be interesting to see how well their health care system cares for their suffering.

Our "health care provider", Kaiser Permanente, doesn't seem to give a damn about ours. - RAR

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From March 6, 2009

From the Annals of Home Ownership in a Small Town:

Design-Build with Dufus and Gomer

That photograph above captures part of the rustic appeal of the street on which my family lives in Benicia, California. In the old part of town, six blocks east of First Street, near the historic military warehouse district that is now the arts community, and near the pier where the new Saturns get driven on to outbound ships, our neighborhood lacks all the accoutrement of a modern development. We have sidewalks that lack the will to make the entire length of our block. We have a mixture of housing types, nice but small for the most part, because this is California where square footage remains dear: $210-$240 per in our neighborhood, depending upon the builder and the complexity of the project. We have a palm tree in our front yard with palms growing straight up, like a weed topping a humongous totem, cut weird to prevent the showers of electrical sparks that occur when the fronds are allowed to grow into the passing power lines. We have huge eucalyptus trees that are roosts to red-headed turkey vultures, and just a block to the north we have a trailer park where some of our best friends live. We have a neighbor with a wonderful chocolate lab named Boomer, and now a new puppy who is the mirror-image of Boomer, who plays merrily with anyone who will have him. His master blares blues music, when he's home, so the neighborhood has a "feel". But it's not blue at all. Are you kidding me? It's the best damned street in America, because it's our street!

When I say "our" street, I'm talking about "our" as meaning more than just my immediate family. This is a neighborhood and the street that is "ours" is also our neighbors'. It's not that we know all of our neighbors, though we know the ones near at hand, and they are all friendly folks who don't do a thing to get in anybody's business or personal way. Benicia is a small town that often puts me to mind of the setting of "To Kill A Mockingbird." We are out on the edge, not too far from Boo Radley's Mom's place, but it's all good.

But wait...

For the last many weeks we have had a new presence in the neighborhood. That is his portable potty, his sign (he paints far better than the smudges would indicate, but I wanted to give him the courtesy he would never give to us), and his trucks shown in the picture above. It is only some of the equipment he has on site.

He is a contractor by the name of Dufus Jones, and the proprietor of Dufus Construction (names changed to protect the guilty). He is a well-established Benicia builder who has a daughter who goes to school with mine, and she is by all reports a great kid, the product of strict parenting. My daughter has spent the night at the Dufus' home, and she speaks well of Dufus who helped her get down games so she and her friend could play. "He's really nice," she tells me, but then she says that about everybody.

My knowledge of Dufus and his construction outfit is that he is known for his ability to transform any dwelling into something resembling a Century 21 office. Don't be confused, this is residential construction, so his reputation as a "Design-Build" guy is narrowly defined. I don't happen to like Century 21 offices, for the most part, but I must say that Dufus is doing a nice job on the ramshackle property next door to our house. He replaced all the windows, the roof including rafters rotten with dry rot, the stucco exterior (which he painted the same color as our house), and he gutted and is redoing the entire interior. He built a large covered front porch, which seems almost a fourth the size of the entire house, which is small.

This aspect of having the portable potty parked on the street for the last 10 weeks has been well worth the discomfiting eyesore. Dufus is taking a "tear down" and turning it into a pleasant little property, or so was the thinking of us and our neighbors. Dufus is improving property values for us all.

Then, one day several weeks ago, the worm began to turn...

My wife, who is about as helplessly controlled by her innate curiosity as a domestic cat, but who is as controlling and territorial as a tiger in the wild, decided to ask the guy working next door just what was going on there. Was it being fixed to sell? Was it going to be a rental?

"I hope my boss is going to give it to me," the man told her. To which she replied, "Wow, you must have a nice boss!"

With that introduction, she took the next opportunity to meet the man himself, Dufus Jones.

There is something fishy about a guy who comes into a deeply routed neighborhood and plants his potty and starts tearing things down using little front loaders and power tools, but who never says boo to his new neighbors. That's just not the way its done in polite society. "Professionals" introduce themselves to the adjacent land owners and talk about what they hope to do with the property, and they take the appropriate steps to service the concerns of affected parties. They put up "site poles" to clearly indicate the height of what they intend to build, in case it interferes with any of the neighbors' view lines. None of this was happening next door. Under certain circumstances, the City Planning office should insist on such mechanics, but they may not be required in this case. We just don't know and no one is telling the neighbors anything.

My wife, who is pretty good at coaxing conversation, introduced herself to Dufus Jones and started making small talk, leading to questions about what he is building. "We are doing a facelift to the house," he said, and talked a bit about that. When she offered that she was always interested in knowing what was going on in the neighborhood, Dufus for some reason volunteered that he had experienced rough going with some previous neighbors. "I had one lady tell me that I was just a mean-spirited person," he told the wife, which struck her as an odd boast, almost threatening. Then Dufus mentioned the garage he was building out back.

Interesting that a guy would build a garage on a house that already has one. "How big?" the wife asked. "It will be 30' by 30' and 15' feet tall." Otherwise, a building at least as big as the house he is renovating. "And what are you going to put in there?" she asked. "A boat and a couple motorcycles," Dufus said.

Mrs. RAR, it should be said, is not stupid. Besides, it hardly took advanced intelligence to deduce that one could put a boat and two motorcycles in the existing garage.

Dufus picked up on her skepticism and, by her account, flared at her. "I'll put whatever the fuck I want to put in there!" he reportedly snapped. She read this as innate disdain for "questioning women".

Oh-oh. Boy, did he mess with the wrong person. I know, I've been messing with this "wrong person" for years.

She immediately called the Benicia City Planning Office to inquire about Dufus Jones and what he was building. In fact, he had requested and received permits to renovate the house and to build a garage on the property. He was granted the permits in December and had started demolition within days of receipt. "Oh, Dufus will probably move in there for a couple of years," said the planning office guy. "He does that." It seemed like our planning official, whom we will call Gomer, knew Dufus. The Planning official's response, when my wife voiced concern that Dufus was misrepresenting his intentions for the property was, "Well, one day if you want a permit to build I'll give you one."

It didn't take long to get a picture of what Dufus was up to. He had a dump truck, filled with the rubble from the demolition of the house, that had been parked out on the street in front of the construction site for weeks. It scared our kids to get into our car, parked behind it along the curb, because there were thin sheets of metal that flapped in the wind and threatened to fly off the pile like whirling heli-blades. Dufus obviously had no place to park this truck, any more than he had a place to park the mini-front loader sitting in the front yard, or the large box truck in the driveway, or any other of his vehicles. Dufus is clearly setting up to run Dufus Construction out of the 900 square foot building, complete with running water, that he is building off our alley. He even had the audacity to tell my wife he wanted to widen the alley - as if this city property were his - so he could "get my trucks in there."

A quick check of the City of Benicia zoning map showed that Dufus is planning to do this on property zoned for residential use, not commercial. One might think the duped City Planners would want to know about this!

On a Friday, I fired off emails to the City offices and got a nice lady from Community Development that confirmed that Dufus could not legally pull this stunt, however willing the permitting office to allow Dufus' deceptions. She instructed that Dufus was allowed to park one vehicle in that 900 square foot garage, and that if he did more, and certainly if he used the building to run his business, that he would be out of compliance with city ordinances. As for the dump truck parked on the street, she set up a call for the truck to begin being ticketed on a daily basis starting on Monday. On Saturday, the truck disappeared. Was this just coincidence? Had Dufus just finally gotten around to getting rid of the rubble? Or had he been tipped off by someone in the city that tickets and fines were being prepared? I found the Dufus Construction truck by accident on that following Monday, parked in a vacant lot next to my son's karate dojo. The truck was still filled with the "dangerous" rubble. That rubble has finally been disposed of, but the dump truck is still sitting on that vacant lot, no doubt until the day it can be moved in doors over by our house. (I drove by the lot this week and saw a disgruntled looking fellow staring at Dufus' dump truck while talking in an agitated way on a cell phone, no doubt lodging a complaint to the City. The words Dufus Construction, along with a phone number, are prominently displayed on the doors of the heap. )

Benicia is a small town of only 28,000, and the old town community we live in comprises only a fourth of that population. It is the more "intimate" Benicia, different by nature from the bedroom community of commuters who live on the north side of I-780. People in "old Benicia" talk, and a torrent of stories have poured forth about Dufus and his operation. "He's part of the good old boys network with the City Planning office," one business associate told my wife. "My husband and I had a terrible time with him at another place we lived. We documented the whole thing. We had photographs, even video, of Dufus and the good old boys from the City drinking beers after work on the lawn next to our house. It didn't do us any good at all. He got away with whatever he wanted."

* * *

In a very real way, this story is representative of so many of the basic ills of our community life. It seems that at the root of every turmoil we experience is some Dufus who is determined to act in a self-interested way, reinforced by a corrupt system of public administration. That's the micro view of what has happened to the U.S. financial system, which was fraught with self-indulgent bullies screened by regulators who for some reason looked the other way. Dufus Construction and the City of Benicia Planning Department bring it down to a neighborhood level, where the biggest assets people hold are their homes. It is a quality of life issue on that plane. You would like to think that people would behave respectfully "in your home", but some don't. Some are Dufus's.

That house next door has vexed me since I spoke with our former neighbor last year and learned that he was having to sell his home, which he couldn't afford to maintain, to cover medical expenses left by his recently deceased mother. He and his sister - senior adult children - had lived there with her until she died, inheriting $60,000 in medical bills that insurance wouldn't pay.

But there it is. We can't commit to be careful with others. We allow people and property to be ruined, or debased, because there are Dufus's who will sweep in like those vultures who haunt the tall eucalyptus across the way, to take advantage. And our systems, riddled with the kind of good old boys that gave us "Brownie" and the systemic breakdowns along the Gulf Coast following Hurricane Katrina, don't really do to protect our communities what we would like to trust that they would. That's not a new development in this country, just one that eventually works against us all.- RAR

"It's the poor that get the blame..."

The Renewed Spirit of "Meanness"

It's the same the whole world over,
It's the poor that get the blame,
It's the rich that get the pleasure,
Ain't it all a bloody shame.

The words of that old pub favorite kept coming back to me all week.

There is a rising sense of ill-feeling in the U.S. coming from those of us - myself not included - who are miffed at having to ante up taxpayer funds to bail-out new homeowners who took advantage of the liberal mortgage lending policies of this decade to buy houses that they would never be eligible to gain financing for in any other time or environment.

The pitch went like this: we will loan you money based on your stated income, no tax returns or financial statement required as long as you have a job and are reasonably honest in your claims of income. We will set you up with an interest-only, Adjustable Rate Mortgage (ARM). You will have five years to refinance into a regular fixed-rate mortgage, and you can begin that process at any time. This first ARM you are getting gets you into the game. You won't be paying on the principle of your loan under this interest-only arrangement, but even with a fixed-rate mortgage you wouldn't be paying on anything but the interest in the first five years anyway. Lenders always take their cut off the top.

To a population that has seen wages stagnate for better than three decades now, and who had begun to doubt that their "American Dream" - symbolized by home ownership - would ever come true, the offer was way too good to pass up. Especially in California, where the vast majority of working people make nowhere near enough money to buy a home at the inflated values the state saw for the past 25 years, the prospect of getting a piece of the pie was too good to pass up. Especially in California, where the class system is partitioned around who owns and who just rents. And especially in California, where everyone knew people for whom the purchase of real estate had been a huge financial boon. It just didn't make any sense to rent if there was any way you could "get in the game".

The aggressive lenders at Bank of America and Washington Mutual and other "local" institutions got into bidding wars with online brokers like Countryside to write ARMs that they then packaged and sold off to other financial institutions as mortgage-backed securities.

It all rolled along pretty well, like a Ponzi Scheme, until the ARMs started coming due and people found they couldn't refinance, as promised. And they couldn't afford the ballooning payments, so home foreclosures skyrocketed, dragging property values down all across the board, devaluing portfolios and rendering mortgage-backed securities as debits, weighing down bank balance sheets. That caused contraction in the lending markets, including the overnight swaps that keep the whole rickety banking system upright, and the dominoes began to fall.

Probably no statistic points out the frailty of the now defunct housing boom more tellingly than the fact that something like 85 percent of the people who are forfeiting on their mortgage loans never contact their lender to tell them they are having a problem and to ask for help. Why? Because they were scared and ashamed and probably completely uneducated to the process of dealing with such financial arrangements. They were first-time home buyers, inexperienced at dealing with banks. Some were speculators who were rolling the dice on flipping a property before it ate them alive, and those people who never intended to live in the homes they bought had little stomach for arguing their piracies to lenders. They just walked on the whole mess and took the loss.

A certain segment of our population - usually the people who are generally opposed to government entitlement programs - are sounding off about how the people who bought homes they couldn't afford are largely responsible for the mortgage crisis. The meanness of people who have had the good fortune to turn their hard work into honest money with which they made sound investments is understandable, but dispiriting.

We have reasonable people talking about the benefits of stable communities, arguing that helping those marginal buyers maintain their homes is a far better investment for everyone in the long run than is having houses lost to foreclosure and becoming vacant magnets for societies ills, as they tend to do, dragging down property values for everyone in the area.

Mean is mean though, and it never makes sense. - RAR

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