Monthly Archives: July 2010

Samuel Mark, Bedbug Artist

This snapshot I took of a bedbug-adorned mattress on St. Mark’s St. has an artist: Samuel Mark, who has apparently done several bedbug-inspired pieces. He was profiled in a Wall Street Journal blog:

M: You scavenge materials on the street. Are you concerned they have bedbugs?

M: I actually look at pieces before I touch them. I know what bedbugs look like. I had bedbugs in Brooklyn and I was in a place where they were in the whole building. They congregate in different places and come out at certain times. The times of night I write on these things is the time they are out. I look at all the creases. If I see any evidence of bedbugs on the thing, I do not touch it. And I wear rubber gloves.

h/t EV Grieve

“Letting Go” – The New Yorker’s Atul Gawande, on giving up life to live

Trinity Church Cemetery

Trinity Church Cemetery

Dr. Atul Gawande’s latest New Yorker piece is described as another examination on on what’s behind the cost of health care, but it serves more as a lesson on how to both cope with the finality of death and to appreciate life.

It took me several times to get through it, and luckily I wore my sunglasses in the subway so I wouldn’t look like some snob getting teary-eyed over his iPad.

The opening (and ultimately, closing anecdote) is about an ill-fated patient of Dr. Gawande’s, a Sara Thomas Monopoli, who discovers she has incurable cancer 39 weeks into her first pregnancy. Dr. Gawande describes Monopoli’s long struggle to stay alive, with taking a series of experimental drugs with harsh side effects; at one point, she hides the fact that she’s lost feeling in her hands and had double vision for two months, for fear her treatment would be stopped.

Gawande’s sprawling piece ends up being kind of a travelogue of his journey of accepting death for his patients. He believes, as do most people, that hospice care is meant to hasten death, even though at least one survey of terminal cancer patients found that those who elected for intensive care had similar survived no longer than those who entered hospice care.

As Gawande puts it:

Curiously, hospice care seemed to extend survival for some patients; those with pancreatic cancer gained an average of three weeks, those with lung cancer gained six weeks, and those with congestive heart failure gained three months. The lesson seems almost Zen: you live longer only when you stop trying to live longer.

Gawande relates this to the current health care crisis by pointing out a 2004 Aetna study in which policyholders expected to die within a year could choose hospice services and have all the other treatments. The hospice care was so appealing, apparently, that these patients spent far less time in hospitals and ICUs, even though they didn’t have to give up any options. Costs fell by nearly 25%

The benefits of accepting fate are not just monetary. Gawande writes that by many objective metrics, patients who seriously discussed end-of-life care ended up suffering less:

Two-thirds of the terminal-cancer patients in the Coping with Cancer study reported having had no discussion with their doctors about their goals for end-of-life care, despite being, on average, just four months from death. But the third who did were far less likely to undergo cardiopulmonary resuscitation or be put on a ventilator or end up in an intensive-care unit. Two-thirds enrolled in hospice. These patients suffered less, were physically more capable, and were better able, for a longer period, to interact with others. Moreover, six months after the patients died their family members were much less likely to experience persistent major depression.

In other words, people who had substantive discussions with their doctor about their end-of-life preferences were far more likely to die at peace and in control of their situation, and to spare their family anguish.

I can’t think of many other journalists who I respect more than Dr. Gawande. Besides having incredible eloquence as a writer, he’s a respected professional in the field he covers. His book “Complications,” nearly made me quit journalism to try med school – it was that fascinating of a look into how terrifying, yet intellectually challenging, it would be to be an ER surgeon – until I realized it would be a long, uphill slog for someone who never took a college level biology class.

Atul Gawande

Atul Gawande

Gawande has had at least two other notable pieces. One, related to the subject of “Complications,” was how a checklist consisting of steps as simple as reminding doctors to wash their hands was saving a staggering number of patients from post-surgical infections. And the second, about how one town in Texas managed to have the highest, by far, health care costs per capita. The article reportedly caught President Obama’s eye during the health care overhaul.

Both are instructive essays on the complexity of health care. “Letting Go” is less so, perhaps because there are no cost-benefit studies that would convince either death-panel-fearing-Tea-partiers or an insurance-company-demonizers that the health care system would ever be right to compel a patient to give up treatment.

But as a collection of tragic anecdotes, “Letting Go” really shook me and at least made me remember to appreciate what’s good in life. Maybe that’s Gawande’s ulterior strategy all along, to convince the reader to place enjoying life over prolonging it, and by doing so, maybe, get both.

Another New Yorker piece (h/t/ longform.org), written in 2001 by Gary Greenberg, also examines the moving line between life and death, and in particular, how where the line is drawn has been influenced by the demand for organs. With the concept of “brain death”, organs can be retrieved in a more viable state, as opposed to waiting until the heart stops beating. But doctors and ethicists (I assume today, as well as in 2001) are still arguing about the different kinds of brain death, and even those who accept it, they still have to train themselves to think of a warm, breathing body as “dead”:

“It took us years to get the public to understand what brain death was,” [Howard M. Nathan, who heads an organ-procurement group] said. “We had to train people in how to talk about it. Not that they’re brain dead, but they’re dead: ‘What you see is the machine artificially keeping the body alive . . .’ “ He stopped and pointed to my notebook. “No, don’t even use that. Say ‘keeping the organs functioning.’ “

And if you’ve got even more time to spend reading life-or-death longform pieces, I’ll pitch this 13,000-word Pulitzer-winning piece by my ProPublica colleague, Sheri Fink. The subject is how doctors at a New Orleans hospital may have been to quick to euthanize a group of patients while desperately waiting for rescue after Katrina.

The overarching theme, as it is in the New Yorker articles mentioned here, is what makes a life worth living/saving, and can doctors make that decision when patients can’t?

Gawande:

“Is she dying?” one of the sisters asked me. I didn’t know how to answer the question. I wasn’t even sure what the word “dying” meant anymore. In the past few decades, medical science has rendered obsolete centuries of experience, tradition, and language about our mortality, and created a new difficulty for mankind: how to die.

Greenberg:

He wanted to show that the higher-brain rationale, which holds that living without consciousness is not really living—and which the President’s commission rejected because it raised questions about quality of life which science can never settle—was the sub-rosa justification for deciding to call a brain-dead person dead. He wanted to make it clear that these doctors were not making a straightforward medical judgment but, rather, a moral judgment that people like Matthew were so devastated that they had lost their claim on existence.

Fink:

According to Memorial workers on the second floor, about a dozen patients who were designated as “3’s” [a triage category for patients thought to be close to death] remained in the lobby by the A.T.M. Other Memorial patients were being evacuated with help from volunteers and medical staff, including Bryant King. Around noon, King told me, he saw Anna Pou holding a handful of syringes and telling a patient near the A.T.M., “I’m going to give you something to make you feel better.” King remembered an earlier conversation with a colleague who, after speaking with Mulderick and Pou, asked him what he thought of hastening patients’ deaths. That was not a doctor’s job, he replied. Patients were hot and uncomfortable, and a few might be terminally ill, but he didn’t think they were in the kind of pain that calls for sedation, let alone mercy killing. When he saw Pou with the syringes, he assumed she was doing just that and said to anyone within earshot: “I’m getting out of here. This is crazy!” King grabbed his bag and stormed downstairs to get on a boat.

Xi’an Famous Foods, Savory Cumin Lamb Noodles

The best $6.00 meal ever: Savory Cumin Lamb Noodles, or just “D1″. Xi’an Famous Foods just opened in the East Village to much fanfare. I guess they have a few spots throughout the city and have been featured on the Food Network and Anthony Bourdain’s show.

I’m no noodle expert, but their hand pulled liang pi noodles are the best noodles in the entire world, and conveniently located in the East Village on St. Marks. Well, they must be pretty good if they’re the number 2 result for liang pi in Google.

Here’s a picture of the tiny interior. Go to the Flickr full size version to zoom into the actual menu items and prices.

Xi'an Famous Foods

Khmer Rouge’s Duch’s Duck

Inmate photographs from www.tuolsleng.com

Inmate photographs from www.tuolsleng.com


Kaing Guek Eav, also known as Duch (or Deuch), was the first of Khmer Rouge officials to be put on trial for crimes of humanity. The Khmer Rouge is estimated to have killed as many as 1.7 million people from 1975-1979. The former schoolteacher was charged with overseeing Tuol Sleng prison, where at least 14,000 people were tortured, with such heinous methods as “live autopsies” or starved to death, according to Duch’s confession:

From the Guardian:

Mey recounts the tortures used to extract false confessions from prisoners and force them into implicating others as CIA spies. He was beaten with bamboo rods, forced to eat faeces, given electric shocks to his ears, and had his toenails ripped out with pliers. Others were waterboarded, hung upside down, and had their hands crushed in clamps. Children were thrown from third-storey balconies to their deaths. Prisoners were presumed guilty, effectively already dead, Duch has said.

Notes found in the Tuol Sleng prison he oversaw:

The notes record the results of 11 “experiments” with 17 prisoners, living and dead. They begin:”1. A 17-year-old girl, with her throat cut and stomach slashed, put in water from 7.55 p.m. until 9.20 a.m., when the body begins to float slowly to the top, which it reaches by 11.00 a.m. “2. A 17-year-old-girl bashed to death, then put in water as before, for the same period, but the body rises to the top at 1.17 p.m.”Similar details were recorded for “a big woman, stabbed in the throat, her stomach slashed and removed,” and “a young male bashed to death,” then “four young girls stabbed in the throat,” and “a young girl, still alive, hands tied, placed in water..”If Deuch didn’t write these lines, he knows who did. Someone should ask him.

Duch

Duch (Reuters)

Duch, now 67, was sentenced to 30 years in prison, only 19 of which he has to still serve. He could still be alive at the end of his prison term, which isn’t too bad of a situation to be in, as one victim bitterly complained to the New York Times: “His prison is comfortable, with air-conditioning, food three times a day, fans and everything,” he said. “I sat on the floor with filth and excrement all around.”

Not satisfied with that lenient sentence, Duch and his legal team are reportedly seeking an appeal. Earlier in the process, Duch’s French and Cambodian lawyers argued about whether to seek leniency or acquittal. It’s hard to decide who had the more execrable argument: Duch’s Cambodian lawyer, Kar Savuth, who argued that Duch should be freed because Duch wasn’t the only mass murderer and Tuol Sleng wasn’t even the worst of the prisons: “It would be better not to try anyone than to try some and leave others at large.”

Or the French lawyer, Francois Roux, ( later fired by Duch), who combined both the Nuremberg defense and Jesus’s ‘Let he who is without sin cast the first stone” dictum:

From the NYT:

Duch’s second lawyer, François Roux, said Duch was part of a hierarchy of terror in which all the actors were in effect victims as well as perpetrators.

“It was because of the terror that every link in the chain of command acted zealously to please superiors,” Roux said.

Taking his argument of moral equivalence a step further, Mr. Roux said that just as Duch had dehumanized his victims, his accusers and victims were guilty of dehumanizing him.

“Duch remains a human being,” he said, addressing prosecutors. “Maybe there are certain points at which he has a bit of trouble admitting certain things. But maybe you as well have trouble admitting certain things.”

Is there a Guinness World Record in a man’s ability to dodge responsibility? It makes you wish international standards and decorum could be set aside, as in a Jerry Bruckheimer movie or South Park episode, so that we could hear the judge respond justly and firmly with a simple, Fuck. You.

Bedbugs Mattress Art on St. Marks Place

Saw this a few days ago on St. Marks and sent it out to EV Grieve, who was kind enough to link to the Flickr. Curbed NY and ScoutMob (who didn’t credit EVG or me, but I’ll let it pass, because of their yummy deals) also posted the photo. You can’t underestimate our fascination with bedbugs…New York has been under terror alert with the news that some of our greatest American icons, Victoria Secret and Abercrombie & Fitch, have succumbed to the evil bugs.

I blame the heightened fear on this well-written, terrifying New York magazine piece by Marshall Sella…I didn’t even know bedbugs were that bad until I read this. Now I will never sleep outside of my hyperbaric chamber again.

Update: The WSJ profiles the artist, a “Samuel Mark

There are 854,000 people with “Top Secret” Clearance. Who the hell are they? (WaPo’s Top Secret America series)

So the Washington Post’s 2-years-in-the-making series on the crazy house that is our intelligence operations was launched yesterday. Lots of interesting facts, including the estimate that there are 854,000 people with Top Secret clearance, the highest of the three standard categories of classified intelligence:

Every day across the United States, 854,000 [nearly 1.5 times as many people as live in Washington, D.C.] civil servants, military personnel and private contractors with top-secret security clearances are scanned into offices protected by electromagnetic locks, retinal cameras and fortified walls that eavesdropping equipment cannot penetrate.

A standard definition of Top Secret: “Top Secret” shall be applied to information, the unauthorized disclosure of which reasonably could be expected to cause exceptionally grave damage to the national security.

Sounds like a pretty exclusive club, or should be right? If you were to take all of the government employees who might be within a football’s field distance from a piece of “Top Secret” paper…including everyone who works at the Pentagon, CIA, NSA, all active duty military officers, etc. from lowest ranking clerk to top chief, that’d equal to about that 800K number, right (*see footnote)?

Here’s some numbers, taken from Wikipedia and other similarly take-with-a-grain-of-salt sources (some agencies have their payrolls classified):

Total854,000
Central Intelligence Agency20,000
National Security Agency30,000
Defense Intelligence Agency16,500
Army Military Intelligence31,800
Office of the Director of National Intelligence1,500
Every active military officers224,144
All Pentagon personnel26,000
All State Dept. personnel20,000
All of Congress, White House, WH Office~1000
Department of Homeland Security216,000
WTF267,056

So, if Excel is correct, subtracting the usual suspects and then some, there are still more than 260,000 people out there with access to secrets that could cause “grave damage” to our country. But I guess if we’ve got solid security standards applied across all the bureaucracies, it’s not like some barely-old-enough-to-legally-drink-maybe-emotionally-insecure-kid, who happened to be given top secret clearance, could waltz into a classified network system by pretending to listen to Lady Gaga and download anything critical, right?

* Footnote: My count doesn’t include private contractors, some of which do legitimately need top secret clearance. But I believe that’s the point of the WaPo piece, that our intelligence infrastructure has become so bloated and convulutedthat even if you were to wildly overestimate the number of government employees who need top secret clearance, you’d still have hundreds of thousands of other people, including contractors, if the WaPo estimate is on the mark. Read their Top Secret America series for even more disturbing implications.