Sunday, November 22, 2009

Review: When Everything Changed

In the first year of Gail Collins's survey of "the amazing journey of American women from 1960 to the present," I turned 12. Not long after that, I told my father I was thinking of becoming a lawyer. "That's not a good job for a woman," he said.

Some 25 years later, when my daughter Molly was a teenager, she told my father she was thinking of going to law school. "Good idea," he said. "You would make a fine lawyer."

"Dad!" I howled, reminding him of what he had told me. He smiled benignly. "Times have changed," he said.

I didn't know how much until I read When Everything Changed. "In 1960 women accounted for ... 3 percent of lawyers," Collins writes. Sylvia Roberts, a law-school grad in the late 50s, could not find "any firms in New Orleans that would allow a woman to apply." She finally found a secretarial job with a small law firm. A few years earlier, Sandra Day O'Connor, though third in her class at Stanford University's law school, could find only one California law firm willing to hire her--as a legal secretary. By the time Molly was thinking of law school, however, Ms O'Connor was a Supreme Court justice.

I was eager to read When Everything Changed because I love Collins's witty op-ed pieces in the New York Times. This book, though, is straight journalism--well researched, well written, intended to inform rather than entertain. Collins, who turned 15 in 1960, became "the first woman ever appointed editor of the Times’s editorial page" in 2001, a job she held until 2007. When the book was published last month, Forbes interviewed Collins and introduced the book thus:
In the course of the five decades that Collins charts, Nora Ephron applies to a job at Newsweek, is told that "women don't become writers here" and becomes, well, Nora Ephron. A postwar survey that finds fewer than 10% of those interviewed believe an unmarried woman could be happy evolves into the era of Sex and the City, which sculpted single women into enviable icons. A 1961 medical school dean who says, "We do keep women out, when we can. We don't want them here" is relegated to history's trash heap: Female students now claim 50% of the spots in medical schools.

When Everything Changed also includes a long, informative chapter about African-American women in the civil rights movement, as well as fascinating information about women in politics, changes in abortion and divorce law, feminism and the backlash against it, the political careers of Hillary Clinton and Sarah Palin, and the personal journeys of a variety of women from all ethnicities and social classes.

Having lived through those tumultuous 50 years, I was at least dimly aware of most of the people and events and circumstances Collins describes. At the same time, I was continually surprised to realize how much societal change I've experienced. Five decades of daily life look so different when the bits and pieces are gathered into one place and viewed as a whole. I would like my daughters to read this book and tell me how it strikes them, though I expect they will tell me they don't have time. Heidi is immersed in her career as an artist and college professor. Molly, who decided to get an MBA instead of a law degree, discovered that her husband could, more easily than she, find an adequately paid, family-friendly job. So she spends her days supervising their three kids, cooking, volunteering at church and school, handling family financial and travel arrangements ...

Hey, wait. That sounds a lot like what I did. Before everything changed. And yet there is a difference, and it's huge. American women may not have achieved equality yet, and a lot of changes remain to be made. But my daughters and granddaughters have choices that were not even considered 50 years ago, and we enjoy a lot more respect. If ever you doubt that, listen to the lyrics of popular songs from the 50s and 60s, or watch a few old movies. Or read When Everything Changed.

Thursday, November 19, 2009

The mammogram panic: or, false positives are no picnic

Inhale through your nose (be sure your abdomen moves, not just your chest). Exhale through your mouth. Slowly, now ...

OK, let's talk about the U.S. Preventive Services Task Force's recommendation that women begin getting mammograms at age 50 instead of 40, and that we space them two years instead of one year apart.

I'm not going to argue that the USPSTF is right or wrong about this. I'll probably keep on getting my annual mammogram, and the HHS secretary assures me that this should be no problem. But I do understand the Task Force's wish to cut back on unnecessary procedures. As satirical columnist Gail Collins wrote this morning, "Whatever happens, we do not want the government conducting any studies on whether current health practices actually do any good. Let this continue and soon you will not be able to get your hands on a good leech when you need one."

The USPSTF's recommendations are not exactly outlandish. Beginning mammography at age 50 and thereafter at two- (or even three-) year intervals is already the standard in the European Union and Japan. Breast cancer, however, is one of the few diseases with higher survival rates in the United States (especially for white women) than anywhere else. Is this due to early detection, better treatment, fewer smokers, or a different approach to statistics? People have theories, but no one knows for sure. So, until they figure this out, I imagine I'll opt for the annual mammogram.

Still, there are good reasons to be concerned about false positives. I've had two false positives, and here's what happened to me.

I had a worrisome mammogram on July 25, 1999. The doctor didn't like what he saw, so he sent me for a second mammogram on July 29. It did not make him any happier, so I went immediately for an ultrasound. On August 18--after nearly three weeks of what the USPSTF, with classic understatement, calls "anxiety"--I went to the hospital for one-day surgery.

First, however, I had yet another mammogram to mark the tiny mass through needle localization. While the breast is compressed, a needle bearing a small wire is inserted. This does not feel good. Also, it somehow affects the vagus nerve, and some women pass out while it is being done. I came very close to being one of them. Fortunately, the technicians started hollering and someone brought a bed to catch me. Eventually they found what they wanted, and I was taken to the operating room for a surgical biopsy. It left me very sore for several weeks and slightly disfigured forever. Nothing whatsoever was wrong with my breast.

Two years later I had another false positive. This time I went directly to an oncologist, whom I will bless forever. She did not ask for a second mammogram, and she did not do a needle biopsy. Instead, in her office, she did an ultrasound followed by a fine needle aspiration. Again, nothing was wrong.

A number of my friends have been sent for breast biopsies too. Most of them had stereotactic biopsies (if you're in a grisly mood, see Mayo Clinic's descriptions of different kinds of biopsies). None of them had anything wrong either. They had a lot of anxiety, discomfort, and expense, though.

I'm not saying mammograms should be done later, or less frequently. I don't know. I'm just saying that false positives are nothing to sneer at. If yearly mammograms really do provide better results, then false positives may be an unpleasant, expensive, but necessary side effect. If yearly mammograms make little or no difference, then we need to consider that false positives carry their own risks, not the least of which is infection.

I suppose I'm going to carry on with yearly mammograms. Maybe they contribute to the U.S.'s good survival statistics. Maybe I'm superstitious: if I skip a year, I will surely be punished. But if Blue Cross or Medicare someday decides not to fund annual mammograms, or if I move from Wheaton to Paris or Geneva, I won't panic. At least not as much as I did when I had the false positive mammogram results.

Wednesday, November 18, 2009

Review: The Migraine Brain

If ever you find yourself thinking that spirit is stronger than flesh, or ought to be, try getting a migraine.

I'm lucky: I've been to the ER only three times with headaches. Once I forgot to open the window while stripping paint from a door. Once I was coming down with the flu. And once, earlier this year, I had a classic migraine. Tip: if you want to be ushered quickly to a private exam room, try sitting in the communal waiting room barfing into a bowl.

Some of my friends have that sort of migraine several times a month. Fortunately, after years of misery, they have found medications that help. To them--and to less seriously affected migraineurs like me (with frequent but comparatively mild migraines)--I recommend The Migraine Brain by Carolyn Bernstein, MD, and Elaine McArdle.

The authors give lots of good advice for diagnosing, preventing, treating, and living with migraines. A migraine is not a headache, they say, but "a neurological illness caused by an abnormality in your brain chemistry." Headache is one of its most frequent symptoms, but there are many other symptoms as well, and not just the familiar accompaniments such as nausea and flashing lights. Thanks to this book, Mr Neff now understands why I insist on putting a towel over our glow-in-the-dark alarm clock, why the smell of baking bread wakes me up at night, and why I can't wear turtlenecks or hairstyles with bangs. Hey, I have an abnormal brain! Who knew?

The solution? Alas, there isn't one: migraine is a chronic condition. But migraines can be aborted, reduced in number, and made less severe. The authors discuss drugs and doctors as well as complementary and alternative treatments (they like triptans, magnesium, and acupuncture but are nervous about some herbal supplements). Equally important, they suggest a lifestyle overhaul: a migraineur needs to eat right, sleep enough, take breaks, and have fun.

Or, if that's too tall an order, she can at least try drinking eight glasses of water a day while wearing a V-neck T-shirt and sitting in a darkened, odor-free room.

Monday, November 16, 2009

Vegetarians vs carnivores--a personal choice?

I’m a cradle vegetarian. Didn’t have even a bite of meat—red or white, fish or fowl—until I was maybe eleven years old, and then I lost my dietary virginity to a hot dog. Go ahead and snicker.

I’m not a vegetarian anymore. I had some chicken when I was fourteen right after I dissected a frog in biology lab; I almost threw up. Tried lamb chops a couple of years later: gross. By my mid thirties, I was able to enjoy the occasional beef or chicken in restaurants, and a decade later I discovered how to broil salmon at home. I’m sixty-one now, and I still can’t prepare a decent beef steak or roast. I’ve never roasted a whole chicken, and I don’t know how to bone a fish. Last Thanksgiving my turkey tasted fine, but our guests had to read instructions out of a cookbook while Mr Neff manfully carved it. He was pretty much raised vegetarian too.

So it’s no wonder that he sent me a link to James E. McWilliams’s article “Bellying Up to Environmentalism” in today’s Washington Post. McWilliams, author of Just Food:Where Locavores Get It Wrong and How We Can Truly Eat Responsibly, argues that what we eat--whether we are vegetarians or meat eaters--is more than just a personal choice:
Here's why: The livestock industry as a result of its reliance on corn and soy-based feed accounts for over half the synthetic fertilizer used in the United States, contributing more than any other sector to marine dead zones. It consumes 70 percent of the water in the American West -- water so heavily subsidized that if irrigation supports were removed, ground beef would cost $35 a pound. Livestock accounts for at least 21 percent of greenhouse-gas emissions globally -- more than all forms of transportation combined. Domestic animals -- most of them healthy -- consume about 70 percent of all the antibiotics produced. Undigested antibiotics leach from manure into freshwater systems and impair the sex organs of fish.

It takes a gallon of gasoline to produce a pound of conventional beef. If all the grain fed to animals went to people, you could feed China and India. That's just a start.

Most alternatively produced meat is little better, McWilliams says. (Did you know that grass-fed cows produce four times the methane of grain-fed cows? eeeeeeeeew.) The label may say "free range," but that doesn't mean the chickens have been frolicking in the grass. Well, maybe a few of them have been. A farmer who sells pork, chicken, and eggs at Wheaton's outdoor market displays a notebook full of pictures of his contented animals enjoying their short but happy lives. But his food is awfully expensive, and very few people have access to it.

McWilliams raises a troubling question:

If someone told you that a particular corporation was trashing the air, water and soil; causing more global warming than the transportation industry; consuming massive amounts of fossil fuel; unleashing the cruelest sort of suffering on innocent and sentient beings; failing to recycle its waste; and clogging our arteries in the process, how would you react? Would you say, "Hey, that's personal?"

Well, no. And I don't think America's consumption of vast quantities of corn syrup is personal either. Nor is our addiction to fast food. In my vision of the Peaceable Kingdom, all 308 million of us would have access to a steady supply of fresh, organically grown vegetables and fruits. We'd eat meat, but considerably less of it, and all of our meat would come from brilliantly run small farms like Polyface Farm in Virginia's Shenandoah Valley, described in Michael Pollan's The Omnivore's Dilemma. Polyface's meat animals do not damage the earth. Their website notes that "pastured livestock and poultry, moved frequently to new 'salad bars,' offer landscape healing and nutritional superiority." (The website does not discuss the methane problem.)

But in the meantime, and given what is generally available in the suburbs and cities where most of us live, how do we eat for our own health--and for the common good?

Friday, November 13, 2009

Review: The Matthew Shardlake Mysteries by CJ Sansom

2009 has been a good year for Tudor fiction. Hilary Mantel's hefty Wolf Hall, a portrayal of Henry VIII's strongman Thomas Cromwell, won the Man Booker prize for fiction. Best-selling novelist Philippa Gregory added a back story to her seven Tudor novels with The White Queen, about Henry VIII's maternal grandmother Elizabeth Woodville. And C.J. Sansom, whose first novel about the fictional hunchback lawyer Matthew Shardlake was blurbed by P.D. James, added a fourth book to the series, Revelation.

I am 40 pages into Wolf Hall, and I'm not sure if I will continue: it is a literary novel that is heavy on character and light on plot, and it is very long. I have read only one Philippa Gregory (The Queen's Fool), and I enjoyed it: as I recall, it was a page-turner of a romance in a well-researched historical setting. Sansom's books fall in the middle of the literary-to-popular continuum. They are mysteries, but (like most P.D. James books) they are also fully developed novels with well-developed characters, intricate plots, and serious concerns that go well beyond whodunit.

Sansom tells his stories in chronological order, so it's a good idea to begin with his first book, Dissolution (read my review here), whose events take place in 1537 when Henry VIII and Thomas Cromwell are breaking up monasteries. The second book, Dark Fire (reviewed here), involves Thomas Cromwell's demise in 1540.

In book three, Sovereign, Shardlake accompanies Henry VIII's 1541 "progress" (massive displacement of the entire court designed to overawe the populace) to York. Major players include Thomas Cranmer, Archbishop of Canterbury; and Catherine Howard, Henry's foolish child bride. Book four, Revelation, finds Shardlake back in London in 1543, desperately trying to steer clear of political intrigues--but of course falling headlong into one involving Cranmer, Henry VIII's former brother-in-law Thomas Seymour, and Catherine Parr, whom Henry wishes to make his sixth wife.

I've been reading Sansom as distraction from twenty-first-century politics--I'm weary of furious accusations hurled back and forth between liberals and conservatives in politics and religion over topics ranging from abortion to Afghanistan--and I find Tudor England strangely comforting: clearly, we are not living in the worst of times. As Sansom describes it, some of the sixteenth-century problems sound familiar. Religious conservatives battle religious innovators. The rich take the property of the poor. The poor find themselves without health care. Rumor has it that weapons of mass destruction are being developed. Rulers bypass courts of law and illegally torture people without formal accusations or trials. The Book of Revelation becomes popular, and people expect the last days. Religious fanatics turn into killers.

Perhaps Sansom means for me to think, Whoa... look where we're going, look what could happen here. I'm afraid that my response is more shallow (I may be in denial). For example, as I read about what happened to prisoners in the Tower of London, I thought, Whew... I'm glad I live now and not in Tudor England. But Sansom is looking at how power operates, especially when there are no counter-powers restraining it, and what he sees is worth pondering.

Fortunately, Sansom also looks at goodness. As a skilled novelist, he gives us well-rounded central characters with flaws and virtues inextricably mixed. Still, Shardlake is reassuringly kind most of the time, and he unflaggingly pursues justice to the best of his ability. His physician friend, Guy Malton, is compassionate; Shardlake's young assistant Jack Barak is loyal and courageous. Even as you fear that one or another of the characters is about to make a huge mistake, you trust their intentions. They will not turn on you. Perhaps they will make their tumultuous world a better place.

The Shardlake mysteries are long, ranging from 400 to nearly 600 pages. Fortunately, they do not drag. Sansom follows the good novelist's dictum: Show, don't tell. He keeps his characters on stage--these books are all written in the first person--and moves the plot largely through fast-paced dialogue. It's nice for a reader to have some prior acquaintance with Tudor England, but extensive knowledge of the period isn't required. A quick romp through the PBS series "The Six Wives of Henry VIII" would suffice, or an even quicker viewing of "A Man for All Seasons" (a film you should review if you plan to read Mantel's Wolf Hall, since the book completely reverses the film's portrayal of Sir Thomas More and Cromwell).

And if you've heretofore paid no attention to the sixteenth century, let Sansom initiate you. He's only up to July 1543, but I'm guessing Matthew Shardlake will be back. Archbishop Cranmer will sorely need his services during the brief, chaotic reign of Edward VI (1547-53).

Monday, November 9, 2009

Pro-choice people: Get a grip

OK, pro-choice people, get a grip.

Yes, the House passed a health-care bill that clearly excludes abortion from public funding. Yes, a spokesman for the United States Conference of Catholic Bishops said, “We think that providing health care is itself a pro-life thing, and we think that, by and large, providing better health coverage to women could reduce abortions. But we don’t make these decisions statistically, and to get to that good we cannot do something seriously evil.”

But really, why would Cecile Richards, president of Planned Parenthood, accuse the bishops of “interceding to put their own ideology in the national health care plan”? Isn’t that exactly what Planned Parenthood is trying to do? Isn’t that what everybody tries to do in a democratic republic?

The thing is, as most of us have noticed, America is seriously divided about abortion. The most recent statistics from Pew Research indicate that 46% of us are in favor of legal abortion in all or most cases, 44% are against. You’re more likely to get a hotly debated health bill through Congress if it doesn’t force people who are strongly opposed to something to pay for it. When the Democrats in Congress excluded abortion funding, most of them weren’t making an ideological statement. They were just trying to get the bill to pass.

This bill isn’t the end of civilization as pro-choice people know it. Roe v. Wade wasn’t attacked. If Congress eventually passes a health-reform bill that, like the House bill, excludes abortion payments, there’s no reason pro-choice people can’t fund abortion themselves. It actually wouldn’t cost them all that much.

Look at the statistics: there are approximately 1.21 million abortions a year in the United States at an average cost of less than $500 each. So let’s say that the total cost of providing abortions is $605 million a year.
Personally, I’m glad the House voted in favor of health care and against public funding of abortion—I’m one of those politically liberal, pro-life Catholics. But pro-choicers, if you really want to make abortion easily available and totally free, stop whining and just do it. Really, you won't miss the ten cents. And by going private, you can keep your ideology from sinking the entire national health-care plan.

Monday, November 2, 2009

Farewell to a merry old soul

Saturday afternoon "Mom" Wilma Elliott's 17 descendants, 10 of the in-laws, and several dozen friends gathered to say farewell. The 95-year-old matriarch of the Elliott clan (into which our daughter Molly married) once explained to me why she survived so long beyond her husband and my parents, who died 15 years ago. "I was the one who was smoked and pickled," she said. (She stopped smoking when she was 90, but she continued to enjoy her afternoon glass of bourbon.)

At her memorial service we sang a few of Wilma's favorite hymns and listened to some readings from Scripture. Susan Elliott, our granddaughter and Wilma's great-granddaughter, played "Ashokan Farewell" on her violin. Then friends and family members stepped up to the mike and told stories. (Wilma's wedding-day message to her granddaughter-in-law: "The Elliott men are stubborn, but they can be finessed.") If the departed keep tabs on us or at least drop by now and then, I expect Wilma enjoyed the service as much as we did.

So I want to qualify my enthusiasm for a thought-provoking article that several of my Facebook friends have linked to: Thomas G. Long's New York Times op-ed piece, "Chronicle of a Death We Can't Accept." Long thinks that many of our contemporary memorial services miss the point: the body of the deceased should attend the funeral. He writes:
A corpse is a stark reminder that human beings are inescapably embodied creatures, and that a life is the sum of what has been performed and spoken by the body — a mixture of promises made and broken, deeds done and undone, joys evoked and pain inflicted. When we lift the heavy weight of the coffin and carry the dead over the tile floor of the crematory or across the muddy cemetery to the open grave, we bear public witness that this was a person with a whole and embodied life, one that, even in its ambiguity and brokenness, mattered and had substance. To carry the dead all the way to the place of farewell also acknowledges the reality that they are leaving us now, that they eventually will depart even from our frail communal memory as they travel on to whatever lies beyond.

I appreciate Long's insistence on embodiment. I like his emphasis on physical reality. I welcome his lack of sentimentality. His article was appropriate for All Hallows Eve and El Día de los Muertos, the days it was published online and in the print edition. There is a time for gathering around an open grave, for lowering the heavy casket (or small urn), and for scattering handfuls of dirt; and these rituals should not be skipped. Too often we Americans trade hard truths for reassuring illusions.

But today, All Souls Day, there are other truths to consider as well. There is also a time for "a soul cake: an apple, a pear, a plum, a cherry--any good thing to make us all merry" (not Sting's vapid new version, by the way: insist on Peter, Paul, and Mary's classic). Wilma's family said the hard good-byes in September, when she died. When we gathered on Saturday, it was to celebrate the love that is stronger than death."Weeping may endure for a night, but joy cometh in the morning" (Psalm 30:5). For those who believe in the resurrection of the body, the joy--even more than the corpse--is a sign of physical reality.