CALL THE MIDWIFE by Jennifer Worth

"Call the Midwife," a BBC miniseries about intrepid nuns and nurses in London's East End in the 1950s, was the UK's most popular TV show in 2012, with even more viewers than last year's wildly popular "Downton Abbey."

I had not heard of the TV show three weeks ago when, browsing in a Chicago bookstore, I noticed Jennifer Worth's memoir by the same name. Always on the lookout for cheerful stories, I jotted down its title so I'd remember to look for it at my public library.

The book did not disappoint.

In 1965, my parents and I spent a summer in Bracknell, a middle-class suburb about 35 miles west of central London. Some 10 years earlier, Jennifer Worth had been working as a midwife in the London Docklands, about 6 miles east of central London. Only 10 years and 40 miles separated my comfortable (even though it lacked central heating and had altogether too much cabbage) world from the world Jennifer served:

I often wondered how these women managed, with a family of up to thirteen or fourteen children in a small house, containing only two or three bedrooms. Some families of that size lived in the tenements, which often consisted of only two rooms and a tiny kitchen.... Washing machines were virtually unknown and tumble driers had not been invented.... Most houses had running cold water and a flushing lavatory in the yard outside.

It was an area of bombed-out ruins from World War II air raids. "Knifings were common. Street fights were common. Pub fights and brawls were an everyday event. In the small, overcrowded houses, domestic violence was expected." Certain streets were well known as centers of prostitution.

So why am I calling this book cheerful?

Because Jennifer tells so many stories about people who work hard, who love one another, who survive against incredible odds, who welcome new life, who do their best.

Because even her heart-breaking stories--the teen-aged Irish prostitute, the weird old crone who hangs around when babies are due--reveal sensitive humanity under the off-putting exteriors.

Because her nuns, from bawdy Sister Evangelina to spacey Sister Monica Joan, are a hoot.

Because she's so good at describing all her characters, most notably Camilla Fortescue-Cholmeley-Brown ("just call me Chummy"), drolly played by Miranda Hart in the TV series.

Because she included a 13-page appendix "On the difficulties of writing the Cockney dialect."

Because Jennifer's storytelling shows her living by the philosophy she says she learned from a dying nun: Accept life, the world, Spirit, God, call it what you will, and all else will follow.
_______________________________

 "Call the Midwife" is being shown on PBS stations Sunday evenings from September 30 to November 4, 2012. If you've missed some episodes, you can get them online until December 3. Here's a link to Episode 1.

Hormone replacement - will it kill you or make you healthier? What the reports aren't telling you about HRT

"Hormone Therapy Whiplash: Say No to HRT! Say Yes to HRT! Which Is It?"

That's the headline of an article by Melanie Haiken on today's Forbes website. Haiken is  frustrated by conflicting recommendations about hormone replacement based on European and American medical studies.

In the new European study, women began using hormone replacement therapy at about the time of menopause and lowered their likelihood of getting a number of dread diseases. Take HRT, say European doctors.

In the 10-year-old American study, women began taking hormones some ten years after menopause and raised their chances of succumbing to heart disease, breast cancer, blood clots, gall bladder dysfunction, dementia ... well, you get the picture. Don't take HRT, say American doctors.

Aha! say some experts, examining both studies. Timing makes all the difference. Take those pills when you're relatively young. Don't wait until you're over 60 to start them. "If you’re within a five to ten-year window of menopause," Haiken concludes, think carefully about your own circumstances and then "see your doctor for a frank discussion."

Well okay. But somehow I'm still confused. Or would be, if I hadn't noticed something else about the studies.

Unfortunately, Haiken and Hwang - along with just about everybody else discussing conflicting studies on HRT - pay no attention to what may turn out to be the most important difference between the two studies: they used different types of estrogen. 

Participants in the American study took Prempro (a tablet containing conjugated estrogens made from horse urine along with a progestin) or Premarin (just the conjugated estrogens).

Participants in the European study took estradiol (a synthetic form of the principal and most potent human estrogen) plus a progestin if they still had a uterus.

The conjugated estrogen group had bad results. The estradiol group had good results.

Now, I'm not saying that the difference in formula is the reason for the difference in results. It may indeed have more to do with timing, or with some other element in the study. I'm just saying that I can't imagine how responsible scientists and journalists could ignore the fact that these studies were looking at different medications. All estrogens are not alike.

What happens to younger women who take Prempro? Or to women who wait until they're 60 and then start taking estradiol? We don't know, because those questions haven't been addressed.

And why haven't they been addressed? I'm not into conspiracy theories, but I do think that "follow the money" can be good advice. Prempro and its sister medication, Premarin (conjugated estrogens without a progestin), are among the top selling medications in the United States. Estradiol, by contrast, is available in a generic version.

I checked prices at my online pharmacy, Prime Mail, and here's what I found.

• A 30-day supply of Prempro (0.625mg conjugated estrogens plus 2.5mg medroxyprogesterone acetate) costs $94.34.
• By contrast, a 30-day supply of estradiol (1.0mg) plus generic micronized progesterone (100mg a day for 10 days) costs $23.91.
• For women who have had hysterectomies, the progestin/progesterone is unnecessary. A 30-day supply of Premarin (0.625 conjugated estrogens) costs $74.74.
• By contrast, a 30-day supply of estradiol (1.0mg) costs $4.96.

For some reason American doctors don't prescribe estradiol nearly as often as they prescribe Prempro and Premarin. For some reason American researchers pay little attention to estradiol and none, as far as I can tell, to micronized progesterone. For some reason American journalists write as if all estrogens were alike.

And yet the difference between a healthy old age and years of debilitating illness could lie in the difference between an expensive patented medication and its inexpensive generic counterpart. We simply won't know until extensive studies have been completed and analyzed. And since that's not likely to happen during my lifetime, I plan to stick with the medication that costs less and yet appears to give far better results.

The foreign policy debate, the four horsemen of the Apocalypse, and four candidates

Albrecht Dürer, ca 1497-98
The Four Horsemen
of the Apocalypse

Tonight's debate between President Obama and Governor Romney is about foreign policy. This may be the most important topic of the entire [interminable] election season, both to America's future and to the future of the whole world.

If our leaders get foreign policy wrong, we may suffer more than a severe recession. Think world economic collapse. Rampant terrorism. All-out nuclear destruction. Conquest, war, famine, death (the four horsemen of Revelation 6).

Unfortunately, tonight's debate is likely to have fewer viewers than the first two presidential debates: it will be competing against Monday night football. We Americans have priorities.

And, as writers for Forbes magazine recently pointed out, learning foreign languages--perhaps the most important tool for understanding other cultures--is not high on our priority list. Though demand for foreign language learning is increasing, "schools at every level are balancing their budgets and offsetting reductions in government allocations by cutting their offerings and/or eliminating foreign language requirements."

In 2001, before the latest round of language cuts took place, only about one in four Americans could carry on a conversation in a second language (Gallup poll). Half of these were native Spanish speakers. By contrast, "just over half of Europeans (54%) are able to hold a conversation in at least one additional language, a quarter (25%) are able to speak at least two additional languages and one in ten (10%) are conversant in at least three" (Europabarometer survey, 2012).

President Obama agrees about the importance of speaking foreign languages and has apologized for not speaking any himself (though he apparently knows some Indonesian from his childhood).

Governor Romney claims to speak French. After listening to him read a speech at the Salt Lake City Olympics, I'm guessing that he's far from fluent without a script.

Vice-President Biden and Congressman Ryan, as far as I know, speak no foreign languages at all.

OK then, what about the foreign affairs knowledge and experience of these men who want to lead the world?

President Obama lived in Indonesia from 1967 to 1971, between the ages of 6 and 10; for part of that time he attended local schools. His undergraduate major at Columbia University was political science with a subspecialty in international relations. Between 1981 and 2006 he traveled to Indonesia, Pakistan, India, Kenya (three times), and Europe.

Governor Romney lived in France from 1966 to 1968, between the ages of 19 and 21, working as a Mormon missionary. I was unable to find evidence of other overseas trips before this summer's tour of Europe and Israel--a trip that may have contributed to the fact that "the reputation of the US in Europe risks sinking back to Bush-era levels of unpopularity if Mitt Romney becomes president, according to new international polling published on Tuesday" (The Guardian, September 11).

Vice-President Biden was for many years a member of the Senate Committee on Foreign Relations and chaired that committee three times. Over the years Biden has met with dozens of heads of state. The Council on Foreign Relations summarized his positions and achievements (up until 2008) here.

As far as I can tell, Congressman Ryan has had no particular education or experience in foreign policy.

Not so long ago the United States had an administration that understood so little about the world, they really believed they could overthrow the Iraqi regime without giving Iran a license to do their worst--and they really thought that if they did this, Iraqis would fall to their knees in gratitude. We don't need another administration with that kind of dangerous naïveté.

Today the New Yorker magazine, in a long and thoughtful article dated October 29, endorsed President Obama. Here is what they said about Governor Romney's approach to foreign policy:

Holding foreign bank accounts is not a substitute for experience in foreign policy. In that area, he has outsourced his views to mediocre, ideologically driven advisers like Dan Senor and John Bolton. He speaks in Cold War jingoism. On a brief foray abroad this summer, he managed, in rapid order, to insult the British, to pander crudely to Benjamin Netanyahu in order to win the votes and contributions of his conservative Jewish and Evangelical supporters, and to dodge ordinary questions from the press in Poland. On the thorniest of foreign-policy problems—from Pakistan to Syria—his campaign has offered no alternatives except a set of tough-guy slogans and an oft-repeated faith in “American exceptionalism.”

I am posting this four hours before tonight's debate begins. I sincerely hope both candidates show broad knowledge and deep wisdom about questions of foreign policy, because one of them is going to win this election. I also hope that voters have enough wisdom and understanding to be able to tell when they are speaking truth and when they are blowing smoke.

A lot depends on the winner's understanding of and ability to work with other nations. A lot.

P.S. None of the four candidates served in the military. None of Governor Romney's five sons served in the military. One of Vice-President Biden's sons joined the National Guard and has done a one-year tour of duty in Iraq.

Death with Dignity

Seneca the Younger committing
suicide with the help of his friends,
A.D. 65 (Luca Giordano, 1684)

Next month Massachusetts voters will decide whether to allow "Death with Dignity," aka physician-assisted suicide. If a majority vote yes, Massachusetts will become the fourth state (after Oregon, Washington, and Montana) to allow a licensed physician "to prescribe medication, at the request of a terminally-ill patient meeting certain conditions, to end that person’s life."

Father Tadeusz Pacholczyk, a Catholic priest and fierce right-to-lifer who weighed in on the issue in yesterday's Wall Street Journal, plans to vote no.

In "Please Step Back from the Assisted Suicide Ledge," Pacholczyk argues that physicians who provided lethal medications would destroy public trust as surely as policemen who provided guns or lifeguards who provided millstones (millstones?) to despondent people. He then offers two anecdotes: one about a woman who felt betrayed by her grandparents' joint suicide (they did not have a terminal illness, and their deaths were not physician assisted, so her story does not apply), and the other about a friend with multiple sclerosis who is glad he's still alive to enjoy his grandchildren (nobody is suggesting that PAS be mandatory, for Pete's sake, so this story doesn't apply either).

Father Pacholczyk makes me embarrassed to admit that I too would vote No.

I'm not going to make an argument here. I'll just point out that, when it comes to dying, there are more than two or three choices. Some people believe dying people should be kept alive for as long as medically possible, no matter how they or their families feel about it, no matter how much suffering is involved. Other people believe that, in extreme cases, doctors should have the right to administer lethal drugs to dying patients (euthanasia). Physician-assisted suicide lies between these two positions. So do hospice care, palliative care, and other dignified alternatives to either prolonging suffering, on the one hand, or causing death, on the other.

I believe that a lot of people support physician-assisted suicide or euthanasia because they fear they have only one alternative--to be kept alive for days, weeks, months, or even years of misery through painful interventions. Extremism breeds extremism. There are other approaches to terminal illness, however, as Bill Keller's excellent article in Sunday's New York Times points out. Last month Keller's father-in-law, Anthony Gilbey, died in a U.K. hospital of inoperable cancer. In "How to Die," Keller describes the older man's six-day dying process and the decisions--personal, medical, and political--that made his death dignified, loving, and peaceful. "We should all die so well," Keller concludes.

The approach used with Mr Gilbey, the Liverpool Care Pathway, doesn't appeal to extremists on either side, says Keller. "'Pro-life' lobbyists ... portray it as a back-door form of euthanasia.... Euthanasia advocates ... say it isn’t euthanasia-like enough." It is, however, realistic, compassionate, family oriented, spiritually sensitive, and sensible. It allowed Mr Gilbey to die at peace with God and his family, knowing he was loved.

The Liverpool Care Pathway is the standard approach "in most British hospitals and in several other countries [where, by the way, assisted suicide is illegal] — but not ours," writes Keller. "When I asked one American end-of-life specialist what chance he saw that something of the kind could be replicated here, the answer was immediate: 'Zero.'"

Learn more about how we Americans could choose to die with dignity, if only we were willing to give up our politically exacerbated extremism. Read Bill Keller's moving (and short) article. Click here.

THE CASUAL VACANCY by J.K. Rowling

J.K. Rowling's first novel for adults was released a week ago, and a lot of reviewers have weighed in since then (Google them, if you care: some of the best are from U.K. newspapers). The professional reviews mostly range from "OK" to "Oh dear," and Amazon customer reviews stand (right now) at 2.7/5.0 in the U.S., 2.9/5.0 in the U.K. Maybe the higher U.K. score is because more U.K. readers know what Ms. Rowling means when she says things like "the rubber soared right across the room."

In my review for Books and Culture (online edition) I look at an aspect of The Casual Vacancy that other reviewers didn't mention, to my knowledge--its fairly obvious theological underpinnings. (Quite a few other underpinnings are fairly obvious in the book as well, but I decided not to mention them in the review.) It would make me and B&C editor John Wilson very happy if you'd click the link and read my review on the B&C website.

In the review, I argue that Rowling's village of Pagford is post-Christian. Indeed, it is post-moral: love of neighbor is sorely lacking. Instead, we see status seeking. Middle-class chauvinism. Decreasing funds for social services. Increasing poverty. Love of money. Selfishness. Bullying. Disdain for outsiders (gays, people of color, people on welfare, mentally ill people, ugly people). Abuse. Fractured relationships. Polarization. And on, and on. If you've been paying attention to U.S. or U.K. politics recently, the picture will look depressingly familiar.

In Pagford there's a shabby little street called Hope. Three of the book's characters have lived there. One moved out long ago and became one of the town's biggest (literally) hypocrites. One died. And by book's end, one is getting ready to leave. There are still plenty of people in Church Row, though. You just might not want to spend time with them.

A lot of readers have found A Casual Vacancy dull. I understand: it didn't grab me until I was past page 200 (I stuck with it because I had a review to write). Then I read it a second time, and found it interesting right from the beginning. I think that's because by then I knew all the characters and could just read the story without trying to sort out Colin and Gavin and Simon (why do Brits have so many five-letter names that end in "n"?). To make your reading more enjoyable right from the start, here's a list of the book's major characters. Print it out and use it as a bookmark:

• Barry and Mary Fairbrother and four children including the twins, Niamh and Siobhan. Barry, who was born in the Fields but became a banker, dies. The family lives in Church Row.
• Miles and Samantha Mollison and two daughters, Lexie and Libby. Miles practices law and Samantha owns a bra shop. They also live in Church Row.
• Howard and Shirley Mollison, parents of Miles and Patricia (who now lives in London). Howard owns the village deli and is president of the Parish Council (sort of like being mayor); Shirley is a hospital volunteer. They live around the corner from Church Row in Evertree Crescent.
• Colin and Tessa Wall and their son, Stuart ("Fats"). Colin is deputy headmaster at the comprehensive school (=high school vice principal); Tessa is a guidance counselor. Fats is in high school. They live in Church Row.
• Simon and Ruth Price and two sons, Andrew ("Arf") and Paul. Simon works at the printworks; Ruth is a nurse. Arf is in high school.
• Vikram and Parminder Jawanda and three children including Sukhvinder, the youngest, a high school student. Both parents are doctors. They live in the Old Vicarage.
• Gavin Hughes, divorced, a junior partner in the law firm where Miles Mollison is senior partner. He lives outside town at the Smithy.
• Kay Bawden and her daughter, Gaia. Kay is a social worker; Gaia is in high school. They  live in Hope Street. Kay and Gavin have a rocky relationship.
• Terri Weedon and her children Krystal and Robbie. Terrie is a junkie and a prostitute who lives in the Fields (a subsidized housing project). Krystal is a classmate of Fats, Arf, Sukhvinder, and Gaia. Robbie is three years old.
• Nana Cath, Terri's grandmother. At various times she has taken care of Terri and Krystal. She lives in Hope Street.

OK, now you're ready to read. Or to resume reading, if you gave up early. The Casual Vacancy, as everyone points out, is not Harry Potter. All the same, it's worth getting into if you want to think about what the Muggle world might look like without Hogwarts, without Dumbledore, and without Harry.

10 grumpy observations about the first debate

1. Mitt Romney is a bully. We knew that.
2. Barack Obama doesn't know how to stand up to bullies. We knew that too.
3. Jim Lehrer really doesn't know how to stand up to bullies. Jim, just cut the mike.

4. Neither candidate stuck to facts. We are not surprised.
5. This may be because neither candidate knows what is factual. This is worrisome.
6. Or it may be because neither candidate cares about facts. This is even more worrisome.

7. America's economy is in profound poop. No surprise there.
8. Neither candidate has a plan that will help very much. No surprise there either.
9. Only once was the word "sacrifice" uttered--after the debate was over, by commentator Mark Shields (click this link and listen to minutes 7:06-7:24), who pointed out that the concept was entirely missing from Romney's discourse. Shields may know more about how to fix the economy than either candidate does.

10. Will the presidential debates sway the undecided voter? This SNL clip says it all.

Alas, I can't get the actual clip to embed on my blog.
Click HERE to see it. It's less than 2 minutes long.