Month: April 2014

HOTEL DU LAC: SHOULD EDITH HAVE MARRIED PHILIP?

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Edith Hope is the main character (I hesitate to call her the heroine) of Anita Brookner’s “Hotel du Lac,” a book which one of my book groups decided to read during the time I was sick last month.  I was unable to attend the discussion, so don’t know what the other group members thought of it.  I will therefore put it to you!

But let’s start with Brookner.  Now in her mid-eighties, she was an international authority on eighteenth and nineteenth century painting, in 1968 became the first female Slade Professor at Cambridge University, and then for twenty-five years taught at the Courtauld Institute of Arts in London.  She is reported by her students as having been a superlative and dedicated teacher.  In one of her rare interviews, she herself declared that she loved art and loved teaching students how to look at it.

However, at some point in her early fifties, she began to write a short novel during each of her summer breaks from teaching, and after retirement continued with the novel writing.  She has now written, I believe, close to thirty of these shortish novels, although none for the past couple of years.  “Hotel du Lac” was the third, and probably the most successful in sales; there was also a movie, starring Anna Massey, based on the book.

For quite a few years, I used to read Brookner’s books as they came out, but eventually stopped because after “Hotel du Lac,”  they began with very few exceptions to seem essentially more or less the same, except that the protagonists grew older as the years went by. They were almost always about a lonely woman (although sometimes a man), living in London on somewhat limited but not uncomfortably limited means, often with ties to an elderly and dreary European relative (or relatives) still alive or recently dead. This protagonist took long solitary walks in all weathers in London’s parks while considering her (or his) situation, which never seemed to resolve in any way that seemed to me satisfactory, much less happy. The books were certainly instructive about how to pass time if you were lonely, which I often was when I first began to read them. But after a while, enough was enough for me.  I also used to wonder what Brookner’s own life must have been like for her to focus so exclusively on short fiction about lonely single people growing older from book to book.

However, since I had to read “Hotel du Lac” again last month at the behest of the reading group, afterwards I went online — a resource not available to me back in the days when it won the 1984 Booker Prize and I first read it. That is how I found the most recent of her rare interviews, given when she was eighty — in which, among other topics, she considers the ending of “Hotel du Lac,” written so many years before, when she was considerably younger.

Here is the book’s plot, in brief.  Edith Hope, a thirty-nine year old unmarried writer of very romantic novels with names like “Beneath the Visiting Moon” and “The Sun at Midnight,”  has come to spend two weeks out of season at an out-of-the-way old-fashioned hotel in Switzerland, just before it closes for winter, because she is in disgrace for having decided not to show up at the church for her wedding to Geoffrey, a dullish sort of bachelor recently bereft of his mother. She had been “fixed up” with Geoffrey by her one female friend, Penelope — a flirtatious sort who doesn’t marry but has plenty of fun.  Edith has not had plenty of fun.  Instead, she has a secret:  David, a married lover who has been the delight of her life during twice-a-month visits for the past five years.  David has children and will not divorce.  For all Edith knows, he may be unfaithful to his wife elsewhere than with her.  But it is apparently glorious to be in bed with him when he is there, and he adores her cooking of fattening comfort foods denied to him by his wife.  She gives him up for social standing as the wife of Geoffrey — “Are you sure?” David sobs into her neck during his final visit — but then cannot go through with the wedding.  She is sent off to exile in Switzerland while the oprobrium dies down.  (Even her cleaning lady leaves her because of the scandal!)

At the Hotel du Lac, there are very few other guests:  an old French lady parked there by her son and daughter-in-law to get her out of the way; a very slender and beautiful Englishwoman with a little dog and an eating problem who has been sent there by her husband to get in shape to have children (or he will divorce her); a lovely older woman (who turns out to be 79) and plump pretty daughter (who turns out to be 39) with plenty of money; they apparently come to Switzerland once a year to shop extravagantly and eat pastries.  There is also an immaculately dressed and somewhat mysterious Englishman in his fifties named Philip Neville who arrives for a few days.  Edith spends her time observing the others, trying to engage them in polite conversation, going for long walks around the lake and to the village, trying to finish writing “Beneath the Visiting Moon” for her publisher, and composing long, coyly amusing letters to “darling David,” who never once during the time she is there writes back.

About halfway through her intended stay, Edith accepts an invitation to lunch across the lake from Mr. Neville (Philip), during which he proposes to her. He has been watching her during his time at the hotel, and it is an extraordinary and (I think) intriguing proposal.  [I’ve shortened it somewhat, in the interests of blog-post length.]  He makes it on the boat that takes them back from the lunch:

Tilted back in his chair, Mr Neville watched her face. ‘Let me see,’ he said mildly. ‘Let me see if I can imagine what your life is like.  You live in London.  You have a comfortable income. You go to drinks parties and dinner parties and publishers’ parties. You do not really enjoy any of this. Although people are glad to see you, you lack companions of first resort. You come home alone.  You are fussy about your house.You have had lovers, but not half as many as your friends have had; they, of course, credit you with none at all and worry about you rather ostentatiously. You are aware of this.  And yet you have a secret life, Edith.  Although only too obviously incorruptible, you are not what you seem.’

Edith sat very still.

…’Of course you would say that this is none of my business. I would say, simply, that it does not concern me. Any more than my diversions need concern you. Whatever arrangements we may come to must leave these considerations scrupulously unexamined.’

‘Arrangements?’ echoed Edith.

…’I think you should marry me, Edith,’ he said….’I am not a romantic youth.  I am in fact extremely discriminating.  I have a small estate and a very fine house, Regency Gothic, a really beautiful example….I have a lot of business overseas,’ he went on…’And I like to entertain.  I am away a certain amount of the time.  But I dislike having to come back to a house only occupied by the couple who live in it when I am not there.  You would fit perfectly into that setting.’

A terrible silence installed itself between them. ‘You make it sound like a job specification,’ she said. ‘And I have not applied for the job.’

‘Edith, what else will you do?  Will you too go back to an empty house?…You see,’ he went on, ‘I cannot afford another scandal.  My wife’s adventure made me look a laughing stock.  I thought I could sit it out with dignity, but dignity doesn’t help. Rather the opposite.  People seem to want you to break down.  However, that’s all in the past.  I need a wife, and I need a wife whom I can trust. It has not been easy for me.’

‘And you are not making it easy for me,’ she said.

‘I am making it easier for you.  I have watched you, trying to talk to those women.  You are desolate.  And without the sort of self-love which I have been urging on you, you are never going to learn the rules, or you are going to learn them too late and become bitter.  And when you think you are alone, your expression is full of sorrow.  You face a life of exile of one sort or another.’

‘But why should you think me such a hopeless case?’

‘You are a lady, Edith.  They are rather out of fashion these days, as you may have noticed.  As my wife, you will do very well.  Unmarried, I’m afraid you will soon look a bit of a fool.’

‘And what will I do in your fine house, when you are away?’ she asked.  And when you are not away, she thought, but kept the thought to herself.

‘Whatever you do now, only better. You may write, if you want to.  In fact, you may begin to write rather better than you ever thought you could.  Edith Neville is a fine name for an author.  You will have a social position, which you need. You will gain confidence, sophistication. And you will have the satisfaction of knowing that you are doing me credit….’

‘Again you are paying me the tremendous compliment of assuming that no one else will want me, ever.’

‘I am paying you the compliment of assuming that you know the difference between flirtation and fidelity.  I am paying you the compliment of assuming that you will never indulge in the sort of gossipy indiscretions that so discredit a man.  I am paying you the compliment of believing that you will not shame me, will not ridicule me, will not hurt my feelings.  Do you realize how hard it is for a man to own up to being hurt in that way?…. I am not asking you to lose all for love.  I am asking you to recognize your own true self-interest.  I am simply telling you what you may already have begun to suspect: that modesty and merit are very poor cards to hold.  I am proposing a partnership of the most enlightened kind.  A partnership based on esteem, if you like.  Also out of fashion, by the way.  If you wish to take a lover, that is your concern, so long as you arrange it in a civilized manner.’

‘And if you…’

‘The same applies, of course. For me, now, that would always be a trivial matter. You would not hear of it nor need you care about it. The union between us would be one of shared interests, of truthful discourse.  Of companionship. To me, now, those are the important things. And for you they should be important. Think, Edith.  Have you not, at some time in your well-behaved life, desired vindication?  Are you not tired of being polite to rude people?’

Edith bowed her head.

‘You will be able to entertain your friends, of course.  And you will find that they treat you quite differently.  This comes back to what I was saying before.  You will find that you can behave as badly as you like.  As badly as everybody else likes, too.  That is the way of the world.  And you will be respected for it. People will at last feel comfortable with you. You are lonely, Edith.’…..

‘I don’t love you.  Does that bother you?’

‘No, it reassures me. I do not want the burden of your feelings.  All this can be managed without romantic expectations.”….

‘And you don’t love me?’

He smiled, this time sadly and without ambiguity. ‘No, I don’t love you.  But you have got under my guard.  You have moved and touched me, in a way in which I no longer care to be moved and touched.  You are like a nerve that I had managed to deaden, and I am annoyed to find it coming to life….

‘I may have to think about this,’ she said eventually.

‘Not too long, I hope.  I do not intend to make a habit of proposing to you.  You will have to get your skates on, if we are to leave by the weekend.’..

‘May I ask one more question?’ she said.

‘Of course.’

‘Why me?’

This time his smile was ambiguous again, ironic, courteous.

‘Perhaps because you are harder to catch than the others,’ he replied.

Edith gets back to her room, has her bath, thinks, sits, thinks some more, then writes a letter to “dearest David,” telling him she is going to marry Philip Neville, a man she met at the hotel, and does not think she will ever see him (David) again.  She tells him (David) he is the breath of life to her, that she doesn’t love Mr. Neville nor he her, but that he has made her see what she will become if she persists in loving him (David) as she does. She says there is no point in giving him her new address.  She recognizes she was always more willing than he was, and sends him her love, always.

She awakens in the middle of the night after a bad dream and decides to go down to the desk to get a stamp for her letter.  As she opens her door, she sees Philip Neville making a discreet exit, in his dressing gown, from the room of the plump rich thirty-nine year old daughter of the rich seventy-nine year old lovely mother.  She then retreats to her room again, tears her letter in half, drops it in the wastebasket, goes downstairs, tells the night porter to get her a ticket on the next plane to London and sends a telegram to London.  First, she writes, “Coming home.”  Then she realizes that is not entirely accurate.  She crosses out “Coming home” and writes simply, “Returning.”

When I first read this book, I thought the ending felt warm and brave.  Now I think Edith was a damn fool.  Perhaps she need not have married Neville — although the older I get, the less objectionable his proposition begins to appear — but she certainly should not have “returned” to the life she had had.

This is what Anita Brookner had to say at eighty when asked by an interviewer about marriage and the ending of “Hotel du Lac.”  First she observed that she herself had never married not because there had been no opportunity, but because she had always been interested in the wrong sort of man and the wrong sort of man had been interested in her. She then remarked that her books had always seemed to write themselves, and that this book had been no different:  at the time she wrote it, the ending simply came out of her.  But after it had been published (when she was well into her fifties, and not thirty-nine as Edith Hope had been), she began to think she had been wrong.  And now, living alone at eighty, she was certain that if she were to do it again, Edith would have married Neville.

It isn’t good to be alone, she said, when you grow old.

So I ask you, friends:  What do you think?  If you were in my book group, what would you have said?

AGGRAVATION!

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[I know I should be glad I have adequate health insurance and am a smart cookie and can figure out when someone else is trying to pass on their stupid coverage mistakes to me.  But I’m not glad.  I’m Type A, and quick to anger, and also eager to put everyone else on the qui vive.  [Look, look!  Look what happened to me! ]

Life is full of relatively small things that aggravate and take up precious time to rectify. You can be philosophical (although I’ve never found that approach really soothing) when, for instance, a box of paper clips falls from your fingers, opens, and scatters its contents all over the floor — or worse, the rug. But do you leave the mess there, for the cats to play with? And for you to re-discover when you return from whatever you were rushing off to with those papers that needed a paper clip?  Or do you take the time to vacuum up, possibly clogging the vacuum hose and certainly losing a boxful of clips?  Or — an even more time-consuming option — do you laboriously pick them up one by one, even the ones that scooted under the desk, fuming all the while — and be really late to wherever?

Well, the fall of the clips was probably your own fault.  (Clumsy you.) So is discovering you’re practically out of gas when you’re hurrying somewhere, and then having to get yourself to the nearest gas station as fast as possible before moving on to your destination — only to find a long line at each of the pumps.  And if something’s not your own fault, you probably can find a loved one to blame.  The cats for the box of clips, Bill for the near-empty state of the gas tank.

But what do you do when someone, or several someones, who you don’t know at all, and never even knew existed, is just plain sloppy or dumb on the job, and you wind up losing much of your afternoon — plus some of the next day, and possibly more time to come — trying to keep your blood pressure down while you extricate yourself from unsought and unmerited liability and expense?  If you’re smart (or used to be a lawyer) — you eat the time, choke down the bile, and deal with it, so that, hopefully, it will get been resolved once and for all. Even though it should never have arisen in the first place.

And what if you’re less smart, or don’t think fast when you get stupid explanations for why strange things are happening, or are too inexperienced to ask the right questions in the first place?  Well, that’s some unfortunate other person’s blog post, involving even more aggravation and grief.  This one is mine — and while it’s true that my aggravation has been of limited duration, and cost me only parts of two days I was planning to devote to something else, plus $6.49 in unforeseen postage charges — it was more than I should have been subjected to. After all, I was the entirely innocent party in the transaction.  But perhaps it may serve as a sort of Aesop’s fable about tiptoeing through the computerized minefields of the American health insurance system, complete with a short “moral” at the end.

Okay, up with the curtain.  Here’s what happened.  I don’t know if something of the sort could occur under a single-payer insurance system.  But here in the States ours is far from single-payer, as anyone who’s been paying attention to the history of Obama’s struggles in Congress to provide nearly everyone with affordable health insurance coverage can attest.  However, leaving that aside, the closest we have to single-payer coverage is Medicare, which kicks in when you turn sixty-five.  If you have a social security card, or are eligible to apply for one and do, you will automatically receive some hospital coverage, and are able to apply part of your monthly social security benefit to the premium for covering some of your out-of-hospital medical costs.

Original Medicare was therefore entirely single-payer, even though the insured was paying the government a small premium for part of it.  Subsequently, private insurance companies were legislatively enabled to offer insureds Medicare “plans” which monkey with the original concept, and of which I disapprove, so I can’t tell you much about them.  I have the original Medicare coverage, which is, in the “service provider” trade, known as my primary coverage.

I also buy what is known as “Medigap” coverage from a private insurer (in my case Medex, the Medigap coverage sold by Blue Cross, Blue Shield of Massachusetts, the state in which I was living when I turned 65), for which I pay a hefty annual premium.  I buy it because not only does Medicare not pay the entire “service provider” charge for a hospital stay or a doctor’s visit or a “procedure” or whatever; it also approves only a certain amount of the charge, and does not pay all of what it approves.  The Medigap coverage you choose (if you choose it) then pays the remainder of the approved amount, up to 50% of it, usually more than enough to take care of it.  And what of the difference between what the doctor or hospital or other service provider initially charged and what it received as an “approved amount” from the primary and secondary insurers?  They have to say bye-bye to that overly demanding part of its bill.  Any provider which accepts Medicare payments must accept the “approved” amount as payment in full.  (That part is important to this piece, which is why it’s in bold italics.)

When Medicare pays a service provider, it sends you a “Claim Summary” which tells you the name of the service provider, the date of the service, the amount charged, the amount Medicare approved, and the amount Medicare paid.  When your Medigap insurer pays a service provider (after Medicare has identified the “approved amount” and made its payment), it too sends you a “Claim Summary,” telling you most of the above, plus what Medigap paid, plus what’s left over for you to pay (except a service provider that accepts Medicare can’t collect this part from you).  On the former-lawyer principle that if you throw away a piece of paper (a “document”) you will probably need it in future, I keep all mine stashed away in reverse chronological order in a big black box that moves from my office to the basement every year, to be replaced by a new big black box.  I almost never look at the Claim Summaries before I put them in the currently open big black box, and have never had a reason to hunt up a Claim Summary to prove anything afterwards.  Still….   After four or five years, I do throw them away, though.

You may remember a piece I posted in March which was captioned “The Ugh Factor in Getting Old.”  It was about preparing for and having a CAT scan after a prior ultrasound showed something obscure but questionable.  All ended well medically.  But that was just the beginning of the paperwork.  About ten days ago, a Medex Claim Summary arrived for the ultrasound.

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A day after that another one arrived for the CAT scan.  

IMG_0528 I’ve shown you only the top parts, because that’s all that’s relevant here.  Actually though, the Claim Summaries are on  8 1/2″ x 11″ paper, and are always mailed folded in half.  So blasé am I that I didn’t even unfold these two until it was time to stuff them in the currently operative black box.  (Nor did I remember whether they had each been preceded by a similar claim summary from Medicare, as should have been the case. As it turned out, they hadn’t been.)  But when I did unfold them — surprise surprise!  Each had a check made out to me attached on its bottom half.  The first check (in connection with the ultrasound, for which $733 was alleged to have been charged by Princeton Radiology, the “service provider”) was for $715.00.  The second (in connection for the CAT scan, for which $3,258 was alleged to have been charged by the same “service provider”) was for $2,576.00.

$3,291.00 for me?  This had never happened before.  I have never seen the money that passes, probably electronically, between my insurers and providers of medical services.  Reluctant though I am to turn away cash in any form, especially in such an especially welcome large amount, I knew — just knew — I wasn’t supposed to put nearly 3,300 unexplained dollars in the bank or go on a spending spree.

“Call Princeton Radiology,” said Bill.

“What good will that do?” I said.  “They’ll just take the money before I know why I’m suddenly in the middle here.  No, no: it’s Medex which should explain.”  So I looked up the phone number for insureds on the back of my Medex card, kissed the rest of the afternoon goodbye, and waited through about ten minutes of “All of our customer representatives are busy, but your call is important to us; please stay on the line” interspersed with music deemed “popular” by someone but not popular with me.  Finally, when I was already chewing the inside of my mouth, “Danielle” took my call.  (Why are perfect strangers in Customer Relations always on a first-name basis with you — making you sound stuffy or stuck-up if you insist on being addressed as Ms. Mishkin or Nina Mishkin?) Did she want to know why I was calling?  No.  First she had to be sure I was me. (Come on! Who else but me would be complaining about receiving an unexpected $3,291.00?)  We first reviewed my account number followed by the pound sign, my address, my home phone number, the county I live in, my mother’s maiden name, and my social security number before she asked how she could help and I was allowed to tell my story.

Danielle didn’t know why I had suddenly received two checks from Medex, and in such substantial amounts, for the first time in the more than seventeen years it had been my secondary insurer.  She asked if she could put me on hold while she consulted a claims “specialist.” (Would I say no?)

She must have asked because I was on hold for quite some time.  All the claims specialists must have been busy helping other insureds.  Danielle came back on the line every five minutes or so to assure me that it would only be a little longer. Ha!  Finally, she was ready to transfer me to “Mark.”

Mark, thank God, didn’t need my mother’s maiden name.  Just the number on my card, followed by the pound sign.  We went through my story again.  Mark listened attentively, but in the end didn’t know any more than Danielle about why I had received those checks.  He went off to find out, after asking if it was all right with me to hold while he consulted Accounting.  At least Mark had no ability to ease my waiting time with  popular music; this time I did my holding in silence.  I suppose if I were a crossword puzzle aficionado, as many of my contemporaries seem to be, I could have put all that time on a silent telephone to good use. But I’m not, and I didn’t, and eventually Mark came back from Accounting with the “good news” that I’m supposed to pay Princeton Radiology myself.  That’s what the checks were for.

We had by then chewed up nearly an hour of my time.  “Why now, after seventeen years of coverage, am I suddenly in the middle?” I demanded.  “I don’t want to be in the middle.  I want Medex to take care of it. That’s why I’m paying you those obscene amounts of premium money!”

“Accounting says we can’t,” said Mark peaceably.  “Princeton Radiology is a provider that doesn’t take Medicare. And we only pay service providers after Medicare does.”

“That’s ridiculous,” I said, beginning to sound — as well as feel — angry.  “Excuse the language, Mark, but that is absolute crap!  Princeton Radiology has been happy to take Medicare, and Medicare’s payments for the services it provided to me, during the whole eight years I’ve been in Princeton.  They took it for mammograms every three years, for ultrasounds of the abdomen every year or so, even for a CAT scan of the lungs four years ago.”  Memories of signing papers in which I assumed liability for any “service” Medicare refused to approve began to come back to me.  I told Mark about that, too.

“And look, ” I added, really wound up now.  “If neither of these so-called “procedures” is covered by Medicare, I will have to pay an additional $660.94 for the CAT scan, as well as $17.02 for the ultrasound, over and above the amount of the checks.  I would NEVER have agreed to submit to the scan if I’d been informed it would cost me anything, much less an amount as large as that!”

Mark mumbled something.

“What’s more,” I threw in, “your very own Claim Summaries state that Medicare allowed $431.79 for the CAT scan and $157.68 for the ultrasound — both of which sound low to me. But if Medicare “allowed” anything at all, however low, Princeton Radiology must have submitted its bills to Medicare for these numbers to appear on your Claim Summaries.”

He caved.  “Let me call Princeton Radiology.  Do you have the number?”

With Bill’s help, I found the number for him. (It took us another ten minutes.  Mark didn’t seem to mind.  Time is nothing to those guys in Customer Relations.)  Then he put me on hold again.  For what seemed a very long time, even though by then I was getting used to long “hold”s.  After which he came back and said he would have to speak to Accounting again. After which it was almost the end of the afternoon, and I hadn’t written my blog post for next day, or paid some legitimate bills, or gone for a walk on a (finally) glorious Spring day.

When Mark finally returned with some answers, you’ll never guess what he had to say!  Someone had made a billing mistake.  No kidding!  But was it Medex?  No siree! It was Princeton Radiology.  They had billed Medex as the primary insurer, not the secondary.  That’s why I had received the checks.  Hmmmm.  But not to worry.  Princeton Radiology, possibly contrite (although I doubt it), was putting a “hold” on my account and rebilling everything properly.  I wouldn’t be liable for anything.

“Who did you speak to over there?” I asked, pen in hand.  He told me.  At this point I was writing everything down:  the transaction number for my multiple conversations with Danielle and Mark, plus the fact that Mark had obtained his information at Princeton Radiology from one Mary Jean. (No last name, of course.)

“And what am I to do about the checks?  Can you void them? Can I just tear them up?”

Apparently neither of these options was available.  I would have to send them back.  Mark gave me the mailing address.

“Tell me,” I asked.  “Why do the Claim Summaries state that Medicare allowed certain amounts for these two procedures if Medicare never received the Princeton Radiology invoices?”

Mark really didn’t want to go there.  “Well, Accounting just had to put something,” he said evasively.  “There’s a place on the form, you see? But never mind that.  It’s all being rebilled anyway.”

A place on the form?  That sure wouldn’t hold up in any court I knew of. But since it was nearly five o’clock, I decided not to mind, despite the fact I really did.  However, I did not take Mark’s advice to just drop the checks in the mailbox.  The next day I invested forty-five additional minutes in driving to the closest post office at which I can easily park and in waiting on line to pay a certified fee and return receipt fee, totaling $6.49 — so that I should have proof I sent both checks back.  Because having lived as long as I have, I don’t trust anything to go right if it can possibly go wrong.

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While driving there, I also figured out why Princeton Radiology suddenly began billing Medex as my primary insurer after seventeen years of billing it correctly as the secondary.  I remembered that just before the ultrasound that was eventually the cause of the CAT scan, Princeton Radiology presented me with a whole sheaf of new forms to fill out.  Why?  When they had all this information already?  Because they were changing over to a new and more sophisticated computer system!  And you know what that means?  Before the new sophisticated system is up and running, someone has to enter into it, with old-fashioned ten-finger technology, all the handwritten information I put down on the sheaf of paper as well as everything every other radiology client has written down on similar sheafs of paper.  Data entry!  Boring, boring, boring.  Room for error?  Oh boy, is there!  I picture some young thing, thanking God it’s Friday and dreaming of her weekend plans as she tediously transfers my insurer information into Princeton Radiology’s new data bank. She makes, and fails to catch, a teeny weeny little mistake.  She’s only human.

As for the mysterious appearance on my Medex Claim Summaries of amounts “allowed” by Medicare (when Medicare had never received the invoices for services involved) — that was, I think, worse than a young thing daydreaming her way through a data entry job. Someone had made up a figure to fill in a blank because the form required it, which was easier than inquiring why an insured always before covered by Medicare for services provided by Princeton Radiology suddenly wasn’t.  Or than going to get another form, to be used for non-Medicare-covered invoices. If anyone had done either of those things, it would have alerted me — even if I had not remembered to ask the right questions — not to follow Mark’s advice to pay Princeton Radiology with the two checks;   I would have known that if I had done that, I would also have been liable for the amount remaining: $697.02.

So what is the moral here?  Setting aside the problem of boring jobs, which is no longer my problem,  perhaps the moral for those of us no longer needing to thank God it’s Friday is not to assume it’s all going to be smooth sailing from here on in.  Don’t think you left paperwork aggravation behind you in the work force.  It pursues you into the grave.  So if you’re a Type A like I am, you might consider investing in a meditation tape.

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Like I just did.

WHY I DON’T CHECK A BOX

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People sometimes ask me — or ask us, but usually it’s some other woman asking just me — why Bill and I don’t get married.  We’ve lived under the same roof and shared all expenses for the past thirteen years.  So what’s holding us back?

There are several answers to this question.

  • Rude:  “None of your damn business.”
  • Smartass:  “If it ain’t broke, don’t fix it.”
  • Legal:  Since neither of us will leave an estate substantial enough to benefit from the tax code if we were married when the first of us dies, marriage offers no financial advantage over not being married.
  • Religious:  Bill considers himself a Secular Humanist.  I consider myself a-religious, although if it makes anyone more comfortable to classify people ethnically or religiously, I suppose you could call me a white Caucasian woman of Jewish parentage with no particular sense of obligation to be married before living with a man.
  • Societal:  We are too old to have children together, and therefore the legitimacy or illegitimacy of offspring — if anyone cares about that anymore — is a non-issue.
  • Truthful:  Having both been married twice before, with notable lack of success, we are probably each somewhat gun-shy.  Of what?  We live like man and wife.  We say we’re married.  We register at hospitals and doctors’ offices as husband and wife.  As far as other people are concerned, only our lawyer, accountant, children, grandchildren and a few close friends know for sure to the contrary.  Although we will in all likelihood be together when the first of us dies, not being married gives me, at least, a sense that I could fly the coop if I ever wanted to, that I am not a “wife” in all the unpleasant senses I have experienced in my two previous marriages, that I still have free choice, every day — even if I never exercise it.

Of course, that is all quite foolish.  Every other year or so, one or the other of us raises the issue again.  The one who might possibly be leaning in favor, of course.  Which is always the time when the other would prefer not to.  And so we are never, even hypothetically, in sync.

Nonetheless, Bill did once give me a Valentine’s Day card that asked, in French, if I would marry him.  It had the two boxes you see above, one of which the recipient was to check.  If I tell you the French word for “no” is “non,” you can see that the card didn’t offer much choice.  I keep the card — unchecked — on our mantel, though.  Because it’s nice to know you’re wanted.  And also to remind him the question’s still out there, and not yet answered, and that there’s only one way to answer it, short of throwing the card away — just in case he were to change his mind.

Equally pertinent to this loopy discourse is a copy of a statuette from The Art Institute of Chicago  which is also on our mantel. We gave it to ourselves as a present one Christmas. (Even though we’re both “Jewish.”)  It looks good from every angle, no matter which way you turn it, which may suggest to you what I’m getting at.

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I happen to like best the top and bottom versions (which are similar), perhaps because I think the female figure shows best from that angle and you can best see the alignment of the bodies.  But it doesn’t really matter how they stand on the mantel.  As long as we feel like that about each other, at least most of the time — and can also make each other laugh — who cares whether or not I check a box on the card?

WHY BLACK IS ALWAYS THE NEW BLACK: A FRIVOLOUS PIECE FOR LADIES

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[Note:  Male orchestra conductors and classical musicians also seem to be going down this road more and more frequently, although almost certainly for reasons to which I am not privy.  Could it be that black looks more artistic?  If so, consider that the twelfth reason to wear black, as set forth below.  I could only come up with eleven on my own.]

Is it true that you can never go wrong with black?  I have been reading this ever since I first opened a copy of my mother’s Vogue, some sixty-five or more years ago. That’s not to say you should believe even a very small part of what you see in Vogue. But about black — as I have come to realize after considerable trial and error over all the intervening decades between then and now — those crazy fashion editors have pretty much got it right. At least for all purposes where jeans won’t really do.  (And by the way, well-polished black leather boots and a good black turtleneck cashmere sweater really do dress up a pair of narrow jeans beyond belief.)

These are some of the reasons I have concluded that black is always “in”:

1.  Black is appropriate for all ages.  If you think you look too young (haha), it will make you look more sophisticated.  If you’re feeling dowdy, it will make you feel more urban.  If you’re feeling middle-aged, it will make you feel sexier.  If you feel you’re looking old, it will help you feel you’re still in the game.

2. Black is slenderizing. Yes, more so than navy, which tends to look prim, institutional, or nun-like.  If you’re already slim, it will make you look even more svelte and seductive than you already do.  If you’re the opposite of slim, and you don’t buy your black too tight, it will seem to smooth out the lumps and bumps and bulges.

3.  Most things that come in black, other than shrouds, are chic.  Yes, they are.  A black sweater is more chic than one in lime green or pale blue (no matter how green or blue your eyes).  A black dress looks a hundred times better than a print one. On everybody.  Including the model in Vogue.

4.  Men appreciate women wearing black.  They will be proud to be out with you, or — if they’re not yet in position to be able to do that — will certainly be more likely to be eyeing you than that other woman across the room wearing a yellowish tunic over brown pants.  Men also like black lingerie very much, but that was never the subject of a piece in Vogue when I was growing up and therefore not strictly speaking the subject of this piece, which is limited to why Vogue has been right about black all these years (despite being wrong, or eventually wrong, about so much else).

5.  You need fewer clothes if most of them are black.  You can only wear that dress in fuchsia, or the one with red roses or big polka dots all over it, once or twice; after that, you’ll be tired of it, and even if you’re not, other people will begin thinking “Hm. Hasn’t she got anything else in her closet?”  Whereas you can wear a well cut black dress over and over  — with a different scarf, or different jewelry, or different footwear — and no one will be counting.  They will be overcome with the overall glamour of You.

6.  Black tops and black bottoms go with each other even if not bought together. They also go with almost everything else you may own. This means you can travel light.  (One week’s worth of wardrobe changes in a carry-on bag if it’s not the dead of winter, and maybe even if it is!)  It also means you don’t have a lot of stuff cluttering up your closet that only goes with one other thing.

7.  Black goes out of style much more slowly than other “hot this year” looks and colors.  You can adjust hemlines if need be.  Put your money in a great new handbag.  Or a new laptop.  Or the bank!

8. Black looks good on nearly everybody.  You just need the right neckline.  (Decolletage, anyone?)  Or the right accessory.  Pearls perhaps. (If real pearls are beyond you, as they are for me, get fake ones with knots between each fake pearl. That will make them look more real.) Or a good silk scarf in a color that’s “you.” (White or cream or ivory is always good.)  Interesting earrings.

9.  Black doesn’t show dirt.  You can’t see what accumulates at the neckline or at the edges of sleeves.  And most other spots, such as those acquired elsewhere on the garment from sloppy eating, can be made undetectable by sponging off, which cannot be said for spots on lighter-colored clothing.  It’s true that hairs from affectionate family pets, unless the pet is black, will be visible, but these can easily be removed by several swipes of a Scotch Pet Roller, the outer layer of which then gets discarded in the nearest wastebasket.  I keep one of these Rollers in my closet, another downstairs near the front door, and a third in the car.  Far cheaper than dry-cleaning, far less labor-intensive than laundering (or worse, hand-washing) and subsequent ironing of non-black garments.

10.  Clothing in an inexpensive or synthetic fabric looks less cheap in black than in color.  If it’s not cotton, silk or wool, it usually doesn’t take dye well; the colors will be too bright, or too dull, or slightly shiny.  Black  — or, in all candor, white — is the better choice. Unless you don’t care about whether your inexpensive purchases look it.  But that’s not you, of course.  If it were, you wouldn’t be reading this trifle of a piece, but looking for something more meaningful on WordPress — about the state of the economy, or what’s happening with campaign finance, or how to write a truly readable novel in just thirty days.

11.  Black tends not to show wrinkles, even when it’s cotton.   I have a black cotton shirtdress, straight up and down, with a black cotton string-tie belt, that I can wear throughout the summer (with a straw hat, straw bag and black ballet slippers) — and I don’t have to press it, even though I sit in it, and perspire gently in it, and don’t give it any special treatment until fall, when it gets washed and ironed and put away for another year.  I have another version of exactly the same dress in lavender cotton, which I don’t wear nearly as often (see point 5 above), yet its backside looks much more wrinkled after a wearing or so than the black one’s does.  Go figure.  I say black conceals more than any other color, including wrinkles made by sitting.  You can say whatever you want, including that I may be stretching the truth.

But I won’t be listening.  Now that I’ve provided some lightness and mirth to balance all that heavy stuff about proactive defense of the immune system, I’m out of here, to look for something on the economy, or campaign finance.  But not something about writing a truly readable novel in just thirty days.  That I do not believe!

VANITY AND THE OLDER WOMAN

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A year ago last November I had a phone call from an acquaintance who’s ten younger than I am.  Which means she was about seventy-one when she called.  It was a peculiar conversation. You may not even believe two mature, extremely well educated women would actually be discussing what we discussed.  But it’s true: Charming, intelligent older ladies can be reading Lydia Davis or War and Peace one minute — as a matter of fact, this acquaintance and I met in a James Joyce class — and still have a seemingly nonsensical exchange the next.

The purpose of her call was ostensibly to “touch base,” since it had been a while since we’d met or talked.  However, it soon appeared there was something more on her mind.  Although we were then heading into winter, she and her husband were going to Florida for three or four weeks while he recovered from surgery.  Florida in winter may offer cool evenings, but the days are usually not bundle-up weather. (Unless you spend your time in overly air-conditioned restaurants.)  “May I ask you a personal question?” she suddenly blurted out, a propos of nothing at all.

Well, sure.

She seemed almost embarrassed.  “It’s, um, about your arms,”  she said. “Mine aren’t looking so good any more.  The upper part. How do you deal with that?”

Actually, I was surprised she hadn’t brought this up before.  Although she was a fiend for exercise — the gym at least four times a week, a personal trainer once a week, bike-riding along the Jersey shore every weekend when weather permitted, golf all summer long — she was short and not thin.  And the last time I had seen her upper arms sleeveless, I had privately thought that perhaps there was rather too much of them to be shown so openly to all the world, especially as they had curious cellulite-like indentations in their probably softening flesh that I have never seen on the arms of a young woman, no matter how plump.

Wow!  Didn’t think I could be so judgmental?  Then you sure thought wrong.  I make judgments all the time (including about myself).  However, I mostly keep mum about them.  As I had with respect to the acquaintance’s upper arms. Didn’t even mention it to Bill.  Of course, I had also privately admired her for displaying an age-related cosmetic flaw without a trace of self-consciousness. Especially as she’s still a pretty woman, if somewhat round, who could usually pass for sixty, and therefore might be expected to be vain about presenting herself in the best light possible.

But now, apparently, she was concerned. So what was it, if not merely over-dimpled buttery flesh?  Awnings of loose skin hanging below when the arms are raised?  A generally wrinkled surface?   “What do you do?” she repeated.

Well, that was an easy question.  ” I cover them up,” I said.

“Really?  Even in summer?”

“Have you ever seen my upper arms?” I asked.

“Come to think of it, no,” she replied.

“There you go.  You have no idea what they look like.”

“That’s true,” she observed, thoughtfully.  “So what do you wear?”

“Three-quarter or long-sleeved tee shirts with the sleeves pushed up. Or else linen or cotton shirts with the sleeves slightly rolled up.  Or if it’s a sleeveless dress  — and it’s hard to find great summer dresses that aren’t, although there are some — always a light jacket or shirt-jacket over it.”

“Oh,” she said.

“You’d have figured it out for yourself,” I said, encouragingly.  “You just have to start thinking a little differently than you used to.  You can still look good.  A different sort of good.  And you’ll have so much fun stocking up on new summer tops!”

She didn’t exactly say, “Gee, thanks.”  But I did feel I had been as helpful as I could.  I don’t know what her other older friends told her, if she asked them, but I don’t know what they look like, either. And it was my sense she called me first. So that tells you something, doesn’t it?

We did not discuss beachwear in this particular conversation because she didn’t bring it up. That’s just as well; what to wear at the beach is a difficult topic at any age unless you look like Barbie.  Obviously you have to swim sleevelessly.  My rule would be to get in fast if you’re getting on in years, do what you have to do, get out, and cover up.  Old skin shouldn’t have too much sun, anyway. I personally never really liked big salty waves, and stopped liking generous displays of self on sand and shore somewhere around forty — after the second baby.  But then I never did my post-partum exercises.  Others may have a somewhat longer beach shelf life. However, there comes a time for all of us ladies — and gentlemen, too, but that’s an entirely different subject — to bow to the inevitable.

There’s an ethical component to how you comport yourself when that time comes.  You can spare other people too intimate a look at the inroads time is making on your body, or proudly let it all hang out.  I suppose the second path is the one that leads to righteousness.  Indeed, there are quite a few older-woman blogs which declaim that we should be proud of our wrinkles, our receding hairlines (if that’s how age afflicts us), and all the other visual signs that our bodies are slowly shutting down and giving up, now that we’ve done our reproducing and finished raising our young.  Even Diane Keeton, who at 67 still looks great, has just come out with a new book that declares the beauty of the wisdom that shines from the aging face. (Although, come to think of it, I haven’t seen her prancing around sleevelessly in movies for quite some time.)

The thing is, though, most other, younger, people don’t have eyes for that kind of “beauty.”  Although the very very young make no judgments about what they see, people who are no longer children but are still quite far from getting “old” themselves, do make judgments.  If you look too much older than they are, they may disregard and/or discount what you say, and be impatient for you to finish. You may be invisible on crowded streets; people — busy men, especially — may walk right into you. You begin to feel no longer entirely a full-fledged member of the human race.

So you can take the high ground, let what happens just happen,  go on dressing the way you always dressed, doing your hair and face the way you always did, and spend the years and energy you have left trying to change group-think about what “getting old” means — hoping someone will listen to you as you look older, and older and older.

Or you can forget about trying to change how the world thinks about “old” (especially if you were somewhat impatient with “old” people yourself in days gone by) and instead try to look as attractive as your years permit. Which, by the way, does not mean face lifts. They fool nobody, and also expose your aging body to the real risk of general anesthesia for four hours or so, for entirely elective and frivolous reasons.  It does mean considering how to adapt to what you now have to work with in order to present a pleasantly acceptable self to the world.

Which is why I still go to the best hairdresser I can afford, for a good haircut and color for my hair. It’s why I watch my weight, and wear some makeup, and throw away clothing that shouts “I am twenty years out of date and nobody wears pants like this anymore.”  It’s why when I’m not in jeans or black yoga pants, I wear very classic well-cut pieces that fit perfectly (even if they need tailoring to get there), in black and grey and brown and white and ivory, with a few punches of red (or sometimes pink or violet), and once in a while something with edge, but not too much.  All of this costs, which means I buy less and wear it more often — and that’s good, too.

Call me superficial or vain if you like. I don’t expect anyone to fall to his knees anymore, clasp my ankles and beg me to be his.  But I also don’t expect to be walked into on the street when I go to New York, and nobody does. I do expect that when I smile at strangers, they will smile back, and most of them do. I expect to feel like a somewhat older, but not too-old, member of the human race until I have to pack it in — and I will do whatever I can do to ensure that that happens.

Anyone inclined to argue that this is the wrong approach for a woman with both feet in her eighties, go right ahead.  If you want any cred, though, you’d better have really flabby upper arms!

PROACTIVE DEFENSE STRATEGIES FOR YOUR IMMUNE SYSTEM

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[This is the last in a series of four pieces arising from my recent, and in some ways still ongoing, experience with an obscure and distressing skin affliction apparently extremely rare in adults. They haven’t been only about skin, though. Is anything ever really just about what it first appears to be?]

I never thought I would ever be filing a Getting Old Blog post under a caption that would turn me off and on to something else in a blink of an eye if someone else had written it.

I am also entirely aware that no one, including me, wants to be told what to do, and that advice about what to do about your health and general well being is particularly unwelcome. Until you’re plagued with unwellness.  For most people, that tends to happen more as you get older. Which may be why the caption above sounds like something you might find in a publication from AARP [American Association of Retired People], all of which go straight into the recyclable paper bin at our house. [They go there because AARP’s advice is always conventional. It’s also nothing Bill and I don’t already either know or don’t find too simplistic.]

So if you’re in what used to be known as “the prime of life,” you should probably move on for now, while you still feel pretty good — knock wood!– and full of pep and vigor. Unless you’re curious. Or tend to take the long view. Or for some other personal reason have begun to ask questions about the effects of a first world market-driven economy on human well being which are not the usual economic, or political, or even environmentally concerned questions.

As for those of you who are no longer young, or youngish, and don’t feel quite as good as you used to, if you ever did feel really good, you may not like what’s coming, either.  It’s very hard to swim against the tide, to begin doing things other people aren’t doing, to investigate aspects of health your doctor may not know about or may shrug off, to risk being thought a crank.  It’s easier and pleasanter to be like the other guys, go with the flow, enjoy doughnuts (or on a more upscale level, pain au chocolat, foie gras, Sacher torte), and avoid striking out on your own.

No, I don’t think we can live forever if we eat only the right things and use non-toxic personal care and cosmetic products, and if we try to rid our indoor environments of most of the sources of the minuscule amounts of contaminants that slowly build up inside us and force our immune systems into an ongoing battle which they will eventually lose as we, and they, age.

What I do think is that each of us can live somewhat better for somewhat longer.  I believe there’s a certain satisfaction in being master of your ship, in having some control over what happens to you — however hard it may seem at first. I believe in fighting the good fight. As the worthy Rabbi Hillel is said to have said:  “If I am not for myself, who is for me?”

He is also said to have said: “If am only for myself, what am I?” And then, “If not now, when?”  That’s why this last, and possibly distasteful, post of the series.  Take what you wish, or don’t wish, from it.  I guess the point is that to a considerable degree your well being can be up to you, whatever the odds and whatever age you are.

A.  Food and drink.

It’s axiomatic that we are what we eat.  But what are we eating?  What is “food?”  Not everything the Food and Drug Administration says is safe to put in your mouth and swallow, and that can make its way through your digestive system (with more or less difficulty) and out the other end (with more or less difficulty) is “food” in the basic sense of the word, however tasty you may find it.  In first world countries, it is much more likely to be an edible non-food substance. Or else what looks like food — but is so impregnated with toxins and (in the case of factory farming) antibiotics as to be worse than useless as nourishment.

I begin with the assumption that “food” — as human beings and all other forms of animal life have consumed it for millennia — is organic material caught, gathered, or grown and then ingested for two purposes:  (a) to provide fuel/energy for life to continue at optimum levels — in other words, to provide sufficient, but not overly sufficient, calories; and also (b) to provide all the macronutrients and micronutrients — the vitamins, minerals, amino acids, anti-oxidants, etcetera — that enable every cell of your body to repair itself and function properly, as it was designed to do.  These, of course, include not only every cell of your heart, lungs,  brain, liver, kidneys, digestive system, bones, joints, skin, blood but also the cells that provide you with immunity from the perils of the biological universe in which we all live.

A great deal of what almost all of us eat today in prosperous first world countries isn’t that, even if we pay more for it under the assumption that more expensive always means “better.”  I can only speak specifically of the United States here, but I am going to assume that matters in Canada and Great Britain are similar, and from what I’ve seen of the new supermarkets in France, that  that allegedly gastronomically elite country is moving in our direction as well.  Except for the very poor, who may not qualify for or avail themselves of food stamps, we all get enough calories — more than enough, if the obesity rates are to be believed.

It’s the other, equally important, element in food as our great-grandparents knew it that is now in danger of vanishing from our food supply.  Our advertising and packaging skills are magnificent. Our ability to keep manufactured food from spoiling practically forever is extraordinary.  [What is the shelf life of a Twinkie or a Cheez Doodle?  And why do you suppose that is?]  Our laboratory knowledge of how to enhance taste appeal to the destruction of nutritional value is put to fullest use, so that you will eat more and buy more.  We know how to get the most profit out of livestock through factory farming that is both cruel to the animal  or bird or fish and detrimental to the health of the consumer. We know how to protect crops from every kind of infestation by saturating the earth they grow in with toxic pesticides that go into the root system and thereby also saturate the developing cells of the very foodstuffs they are designed to “protect,” so that you can’t “wash it off” no matter how hard you scrub.  [And how do you scrub a strawberry or a blueberry, anyway?]

These areas of discourse are beyond the scope of any blog post. Let me say only that I have never been, and still am not, a saint here.  Until about thirteen years ago, my principal concern with the food I ate was its calorie count coupled with a lingering awareness that one should get enough “vitamins” (available through a supplemental tablet, I thought) and “protein,” which I assumed was available only from animal sources, defined loosely to include eggs, milk products and cheese.  As I grew older, however, and felt lousier, I began to read more about what I was eating and what I perhaps should have been eating.  Then I met Bill, a vegan at the time.  (Now more of a modified and knowledgeable vegetarian with lapses. We’ve changed each other.)  So by the time I encountered the virus that just laid me low for over three weeks, I was pretty far along in knowing what was going into my mouth and making reasonably wise choices about it — as far along as I thought I could get without being a self-sufficient organic farmer.  And without being entirely ascetic.   I already wanted the most nutritional bang for my buck, even if it cost more.  And I already wanted the least amount of toxins and chemical additives (with known or unknown harmful qualities) in my food.

These are now my assumptions:

1.  I stick with the outside aisles of big modern supermarkets, where the produce, meat, fish, dairy are.  I avoid almost all of the middle, a fairyland of processing and packaging.

2.  Organic is better than non-organic, because you can’t wash off the toxic pesticides.  Yes, it costs more. But then I think of all the money I’m not spending on the stuff I’m now not buying.

3.  Less animal-sourced “protein” is better than more, but if I’m going to have it once in a while, I make sure the eggs come from organically pasture-raised chickens and that the beef comes from grass-fed cows (even if it is harder to chew) and is also hormone free.

4. If I must, once in a while, buy something edible that has been processed and packaged, I choose glass containers over cans because almost all can linings made in the United States contain a coating of epoxy resin made from BPA (bisphenol A), which disrupts the endocrine system as well as helping preserve the contents of the can.

I am also aware, in an almost entirely unscientific way, that in general: (a) raw is more healthful than cooked; (b) microwave heat changes the molecular structure of food and thereby presumably destroys all its nutritive value other than its calories;  and (c) no-stick pans, however easy to clean, are bad for you because something harmful in the no-stick surface gets into the food you prepare on it.  I should also now add awareness that: (d) no matter how carefully I tread through the quagmire of American food production, my aging digestive system will no longer fully benefit from what I ingest and requires careful supplementation from trusted sources. (Not the drugstore.)

Of course, there’s more.  There’s always more.  So perhaps I hadn’t been quite ascetic enough when I encountered the triumphant virus four weeks ago. I have since begun to monitor what we consume much more carefully. We gave away the microwave two years ago, but  since the arrival and eventual departure of the general viral exanthem with which I’ve been contending while I was away from the blog, I’ve also rid the kitchen of the two no-stick pans remaining, and augmented the supplements I take with S-acetyl glutathione, a powerful antioxidant now newly formulated in nutritionally available form.

Given my up-front acknowledgement that nobody really welcomes advice about how to eat from anyone else, I will stop here — but with a reading list.  If anyone wants to explore any of the ideas set forth above and is an absolute novice in this kind of thinking about what to feed yourself, I guess that person should begin with Michael Pollan’s “Food Rules: An Eater’s Manual.” It’s short and very easy to read.  If Pollan seems too difficult to put in place in your own life, Andrew Weil is a gentler, kinder guide. “8 Weeks to Optimum Health” might be a good one of his books to start with.  A more recent book of his is “Healthy Aging: A Lifelong Guide to Your Physical and Spiritual Well-being.” I eventually found him too permissive in certain ways, and his recipes not always to my liking.  But I would trust him.

On the subject of protein from animal sources, you might want to check out T. Colin Campbell’s “The China Study” (subtitled, “Startling Implications for Diet, Weight Loss and Long-Term Health”) and Jonathan Safran Foer’s “Eating Animals,” a compelling and extremely well-written book even if you have no concerns whatsoever about the current state of your well being.  For hard-core pursuit of health, there’s Joel Fuhrman’s “Eat to Live.”  Everything he says seems to me to be right; to try to do everything he says is beyond me.  (And we did try, twice!) Fuhrman has subsequently written many other books and “nutritarian” handbooks.  I consider them inspirational rather than directive, but well worth reading.  It’s also worth incorporating into your life as much of what he has to say about health as you can.  Weil and Fuhrman are both M.D.s.  So is William Davis, author of “Wheat Belly,” the somewhat excitable style of which I disliked, but whose book seems essentially reliable and deserving of attention, even if you decide not to act on what you discover in it.  (He’s not alone in condemning what has happened to wheat in the last 100 years and what eventually happens to you when you eat it regularly; other nutritional authorities have reached the same conclusions.)

If weight is also an issue, you may find “Fat, Sick and Nearly Dead” both amusing and a good kick in the pants to get going and do something about it. It’s an awkwardly made film by an Australian amateur named Joe Cross about his own successful pursuit of a very great weight loss, supervised by Joel Fuhrman, and the even greater successful weight loss of someone he encountered while in in the United States who was inspired by his example to do likewise.  I am certain no one reading this blog can possibly be as fat as either of those two men, but it’s encouraging to think that if they can do it, anyone can!    Less entertaining but a book I found helpful with weight loss issues even before I embarked on the quest for healthier food thirteen years ago is “The Philosopher’s Diet: How to Lose Weight and Change the World,” by Richard Watson.  It may be out of print, but is probably still available in libraries and on the used book market.  Watson was a professional philosopher, and his slender book embraces more that “mere” weight loss.  I have read it four or five times.  It begins with two quotations, not entirely irrelevant to this post and its three predecessors in the series.

War Came.

Bodies lined the roadside.

Their fat sizzled in the sun.

— Lamentation for the Destruction of Ur.  Third Millennium B.C.

And:

Diet … Course of life: way of living or thinking …To regulate oneself.

— Oxford English Dictionary

Finally, in case anyone is interested in where reading all this has led me, I suppose I should conclude by saying that my present nutritional guru, to the extent I have one, is Frank Lipman, an M.D. trained in South Africa who has been practicing what he calls integrative and functional medicine in New York at the Eleven Eleven Wellness Center for some time.  He has incorporated into his practice of the traditional allopathic medicine taught in Western medical schools many of the insights and practices of other treatment modalities and therapies, including herbal medicine, Eastern medicine, nutritional counseling, biofeedback, meditation, yoga and acupuncture.  He has also become the go-to doctor for certain celebrities, which is in a way too bad, but is also how I discovered him, so I shouldn’t complain.  [He was recommended in her blog “goop” by Gwyneth Paltrow, owner of what is said to be the cleanest intestinal tract in show business — a blog I used to follow for fun before she became such a brand, and an expensive one, at that.]  Celebrities aside, Lipman offers what seems to me sane, balanced nutritional and other counsel to address sub-optimal functioning; he can help with becoming less unwell and on the path to feeling better.

I have never met him, and don’t expect to.  He has certainly never heard of me. But if you’re interested, you can find him online where I did:  at www.drfranklipman.com  [In the interests of full disclosure, I should add that I don’t blindly buy many of the products offered there, but I do buy, and use, a few of them.]  Most of the useful stuff is in his Blog, which can be explored at leisure from the website. You can also sign up for his newsletter, which will bring the most recent blog pieces into your email inbox once a week.

Well, that should keep you busy, if you haven’t already gone away and left me until I go back to pieces of memoir and photos of cats.  Onward!

B.  Personal care products, makeup and cleaning products.

When I was growing up, there was an advertising slogan for something or other used in the home that proclaimed:  “Better Living Through Chemistry!”  Yes, indeed!  It has certainly happened!  Our laundry is now whiter and brighter and can smell like a summer breeze.  [Haven’t you seen all those smiling ladies in television commercials rapturously embracing what emerges from their washers and dryers after little Tommy has got mud and jam and chocolate syrup all over everything?]   Our non-washable clothes come back from the dry-cleaner safe from moth and encased in plastic that keeps them that way. Our dishes sparkle, our windowpanes are absolutely transparent, our homes are dust-and-bacteria-free and gleaming.  On a more personal note, our hair shines, but remains manageable, our teeth are whiter than white.  Underarm deodorants and antiperspirants prevent our body odors, if any, from offending others — and even deter us from perspiring and ruining our cashmere sweaters!   Our faces, if we choose, can be a canvas for a whole palette of treatment and cosmetic products to keep us young looking, and visually competitive, and attractive to the other sex. (Some of these are unbelievably expensive, but others can be acquired at your neighborhood drugstore.) I understand men too have a cornucopia of available shaving and after-shave products from which to choose the perfect solution to whatever problems they seek to eradicate along with their daily stubble.  And then there’s hair color, and straightening (aka “relaxing”), and “highlighting.” With regard to these, only the price and the tipping are non-toxic, except perhaps to your credit card.

All this, and more, has come at a price in personal harm which until now I didn’t really think about much. Thanks to such better living through chemistry, plus air-conditioning behind closed windows in summer, which are also closed in winter to keep the heat in — the domestic interiors in which we live are today apparently far more toxic than even an urban outdoors polluted by vehicle and industrial exhaust. We inhale these toxins from our indoor air; we absorb them from our clothes and furniture through our skins; we apply them directly to ourselves in the personal care products we use.  And our seemingly indomitable immune systems take them all on, and try to subdue them as best they can, so that we don’t get as sick as we might.

But all these things are “safe,” you may protest, or else they couldn’t be sold!  Federal agencies judge safety by the application.  The minuscule amount of toxicity in one spritz of Pledge is “safe.”  But go on spritzing, and sudsing, and purifying, and deodorizing — and it gradually builds up in you, and builds up, and builds up; after a while the amount you harbor inside of you isn’t quite so minuscule or safe anymore.  General malaise, poor digestion, dry and itchy skin, undue fatigue, unexplained aches and pains too minor for medical help but not quite minor enough to ignore?  And then something more identifiable, about which a dermatologist or other medical specialist may remark when asked:  “It happens.”

In a very few ways, Bill and I had begun to address this huge problem earlier.  I have never had wall-to-wall-carpeting because I like wood floors — which is fortunate, because no matter how clean you are, tacked-down wall-to-wall carpet harbors mold and mites and things that are very bad for your lungs.  Thanks to Bill, who does have lung issues, we had already installed a large air purifier in the bedroom and another downstairs.  We also have a water purifier installed in the kitchen for the water we drink and cook with.  But the products with which we, and our cleaning ladies, filled the bathrooms and the under-the-sink kitchen cabinet and the laundry room and the utility closet?  We have a big job ahead of us there!  Not to mention my personal bathroom clutter of Bobbi Brown and Laura Mercier and Lancome and Chanel cosmetics, makeup removers, plus Crest toothpaste, and the shampoo and conditioners from France promoted and sold by the hairdresser.

It will involve study, elimination, and trial and error.  I’ve already replaced the shampoo, got rid of the conditioner, thrown out all aerosol sprays, eliminated any cleaning product or personal care item with “natural fragrance” (unless from an entirely natural source like lemon oil or lavender), chucked the Tide, the Clorox, the fabric softener, the handy laundry “pods” I wrote so happily about in a post a few months back.  No more plastic bags in the closet, entrapping the PERC (tetracholorethylene) with which my dry-cleaned clothes were saturated.  No more conventional dry-cleaning at all, because PERC is a known neurotoxin. The way to go seems to be either wet-cleaning and air drying, or else dry cleaning with carbon dioxide.  There are cleaners who have installed the special equipment required for these two processes.  They charge more.  There’s one in Princeton, and I am about to find out how the five oldish sweaters I brought them last week for a trial run will look when I pick them up.  As for everything else, I am in transition.

The two authoritative sources for how to proceed are the Environmental Working Group (EWG) and its sub-division Skin Deep (for cosmetics and personal care items).  If you have the interest and can invest the time, you can find out everything you need to know about safely cleaning yourself, your clothes, your hair and your indoor environment from their websites.  The EWG site is http://www.ewg.org  The Skin Deep one is http://www/ewg/org/skindeep/  If you have young children, you may also be interested in reading about the effects of toxicity on child development (and on the development of children’s brains and neurological systems) by subscribing to the newsletter of the Children’s Environmental Health Center of Mount Sinai Hospital in New York, which can be obtained on the Center’s website: http://www.cehcenter.org  You can go a little crazy, as I have.  (But then, I have just been through a crazy-awful time, and if somewhat detoxifying the place where I spend most of my life these days will help prevent its recurrence, or help prevent something equally unpleasant, I am hyper-motivated to try.)  Alternatively, you can take it slowly, one piece at a time.  Or you can forget the whole thing, and rest assured that this post is almost over.

I will not give up everything in favor of castile soap, white vinegar, baking soda, washing soda, hydrogen peroxide (for disinfecting) and tea tree oil — the six substances apparently sufficient for cleaning, disinfecting and deodorizing everything in one’s home and laundering one’s clothing. I know I will not give up Keratin treatments twice a year at the hairdresser, because really straight hair has changed my life for the better to a degree you would not believe unless you had spent most of your life, as I did, wildly curly-haired in a straight-hair culture.  I will not entirely give up my indulgence in several costly French fragrances (in eau de parfum or eau de toilette form), although I may not apply them as frequently as I used to. I will not abandon the light application of cosmetics that enhance my face and the look of my eyes, although I will try to find alternatives to what I am currently using on the Skin Deep website.  But I will be moving, product by product, towards less toxic ways of living (irrespective of the loss to the manufacturers of these unnecessary products of my tiny contribution to their financial health). And that’s probably more than enough from me on this subject, although I will be glad to answer any specific question about it raised in the comment section below, to the extent that I can.

Finally, as I step down from the podium, let me add that If this excessively long piece has been in any way helpful, or has made you think about things you take for granted in new ways, then it was worth writing.  And if not? Well, I guess we can’t win ’em all. Now that I’ve stopped scratching, I’ll be back to my usual sort of thing next time.

 

 

 

 

 

WHY ME, WHY THIS, WHY NOW?

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[This is the third in a series of four pieces arising from my recent, and in some ways still ongoing, experience with an obscure and distressing skin affliction apparently extremely rare in adults.  They’re not only about skin, though.  Is anything ever really just about what it first appears to be?]

Until things go wrong, most of us fail to appreciate the ability of our bodies to protect us from the innumerable, frequently unseen enemies outside our skins that would invade and take us down if they could.  That ability is lodged in our immune system, and when it’s doing the job it was intended to do we never even know what we’re escaping.  Our bodies may provide an ideal environment for viruses, bacteria, fungi, parasites, but our immune systems prevent or limit their entry.  Without going much further into how immunity works, which I am insufficiently knowledgeable to be able to do anyway, let’s just observe that it is provided by a network of cells, tissues, and organs that collaborate to protect us from invasion and infection.  We get some of this protection from our mothers at birth; we develop the rest of it from adaptation to the dangers with which we are threatened as we grow.

However, even in a healthy adult, the fully functioning immune system is not impervious to breakdown and failure to defend.  Major stress can eventually compromise it or shut it down and render you vulnerable.  So can an external “enemy” too powerful for the immune system to overcome on its own without external help.  (Vaccinations are one kind of such “help.”)  At these times, each of us has a body that seems predisposed to go its separate way in response.  Perhaps this predisposition is genetic, perhaps not.  We just don’t know.

Some people are most vulnerable internally. Those are the ones who develop digestive problems, irritable bowel syndrome (IBS), ulcerative colitis.  Others respond with a lung crisis, such as asthma. In still others, the immune system fails to operate properly by going crazy; in the course of trying to defend you it attacks you instead:  those are the unfortunate sufferers of auto-immune diseases, such as lupus, Crohn’s disease, rheumatoid arthritis.  Looking back now at my own medical history, such as it has been — and up until now I’ve been very lucky, in that it has been relatively minimal — I must conclude that my own particular vulnerability has been skin.

It first manifested itself when I was very young, with a still immature and only partially developed immune system. I am told that by the age of one, I was breaking out in hives from what was then considered healthful exposure to the sun. I certainly remember the hives of subsequent summers, until I was about five or six, when the summer sun miraculously seemed to cease to stimulate their arrival.  Those were the years of endless maternal daubing with pink calamine lotion, which dried white and flaked off, and didn’t help the itch at all after the first wet cooling minutes.  Also the years of, “Nina, don’t scratch!  It will make it worse.”  It did make it worse.  Always.  But how can you not scratch an itch?  Even if your mother tells you not to.

Then came the mosquito bites.  As an aside, I will permit myself to note that while I was doing all this research during my recent long and dreary convalescence, I discovered mosquitos only bite human beings.  They’re not interested in the blood of house pets, or elephants or any other kind of animal because there’s something to be found only in human blood which is necessary to the mosquito reproductive process.  In addition, some people seem to have more of this mysterious “something” in their blood than others.  Count me in the appetizing group.  If I’m sitting on the grass with six other people, they will escape unbitten while mosquitos feast on me.

However, that’s neither here nor there with regard to my immune system.  The point is that I appear to be extraordinarily hypersensitive to whatever hostile substance mosquitos release into the human bloodstream when they sip their mosquito Viagra (or whatever it is). The mast cells in my skin (the outer Maginot line of the immune system) rush to defend me by releasing what I consider inappropriately vast amounts of inflammatory chemicals, like histamine, to combat this antagonist substance at the point of entry and mediate my allergic reaction to it.  My parents, the first persons I observed, and later many others — including both husbands and Bill — did not have this problem, and therefore did not need to scratch a bite.  If a mosquito deigned, rarely, to sip their blood, it left a tiny red pinprick which faded without fuss or bother. No inflamed and unsightly red circles of histamines rushing to over-protect against the invader and its venom.  No swelling. No irresistible need to scrape away at the spot until it was raw. No endless itch-scratch-itch cycle leaving scabs for sometimes as long as a month after the initial bite — or, more likely, many bites. Nothing like that for them.  Only for me.

Well, now there’s air-conditioning. That has pretty much taken care of the mosquito problem for me, even though I’ve lived most of my life in the hot damp stretches of the American mid-Atlantic seaboard.  So I can move right along to the next skin-related immune system failure of my past.

The stress and unhappiness of my first marriage eventually produced — not colitis, to which the first husband succumbed (he was unhappy too) — but a boil, a bacterial infection of a hair follicle on my neck so large and virulent it had to be cut out at Roosevelt Hospital.  (I didn’t even know there were hair follicles on the neck!)  Skin again.  After the incision and removal, penicillin was prescribed.  Allergic reaction?  You bet.  Rash here, rash there, rash just about everywhere.  Those mast cells were really working overtime.

Actually, I’m not a particularly substance-allergic person.  Besides the penicillin, which no one has ever dared again prescribe, my only other known allergy is to erythromycin.  Two tablets by mouth when I was thirty-six, and rash again, almost instantaneously — all over me (plus, in this case, ominous swelling of the joints).

Okay, enough of that.  I’ve been well enough for most of my life to have had almost no experience of other later-generation antibiotics and drugs, and therefore have no more drug-induced rashes to tell you about.  Whatever was administered during a right hip replacement four years ago caused no problems whatsoever.  And I’ve already told you in a previous post about the one-time mysterious appearance of an “eczema” or “atopic dermatitis” that arrived to plague me in my early sixties during a period of extraordinary economic, emotional and professional stress.

So I will mention just one more thing.  In August 2008, when I was seventy-seven, under the blazing sun on a tiny Greek island in the Dodecanese, I came down with a severe case of shingles on the upper right quadrant of my face. [Shingles is the disease officially known as herpes zoster.] You don’t get shingles unless at one time in your life you’ve had chicken pox.  And yes, I had had chicken pox — the summer I was nineteen.  [I thought I looked so awful I wouldn’t let my entirely sympathetic boyfriend come see me.  Fortunately, my vanity also kept the need to scratch in check.  If you don’t scratch, you don’t get pock marks.  It was the one time in my life I managed to keep my fingers away from a nearly intolerable itch.]

But you don’t necessarily get shingles because of a chicken pox history.  Chicken pox is caused by the varicella virus.  Unfortunately, after it’s been defeated, this virus doesn’t die.  Weakened, it retires to your spinal cord, or someplace like that, and lurks there harmlessly, perhaps for all of your life, kept down by your ever-vigilant immune system.  But should extreme stress or very hot sun combine with a weakened immune system, the virus will arise to attack again from within, and this time it’s savage.

It is relevant here that shingles tends to strike only the aged.  There’s a very expensive shingles vaccine which American insurance doesn’t cover but which does appear to offer some protection some of the time; it’s intended to boost the aging immune system against this particular virus.  However, as I didn’t even know shingles existed until I fell victim to it (and neither did the only doctor on the island, who failed to diagnose it properly),  I certainly didn’t know about the vaccine.  But yes, we got off the island and back to America, and again I was lucky:  it didn’t go into my right eye and blind me, as it might have done, and eventually it went away.

And now we come to my recent bout of “general viral exanthem” at the age of eighty-two, pushing eighty-three — and to the three-pronged question with which I began:  “Why me, why this, why now?”  I’ve already provided a possible, and to me plausible, answer to part of this question:  I succumbed to this particular virus because it attacks the skin and because my Achilles heel has been, throughout my life, my skin.  The real thrust of the question, however, is why now?

One of the interesting things I learned about “general viral exanthem” is that it manifests itself almost exclusively in very young children. Rarely, if at all, in adults.  There are pictures of a four-year old boy online whose face and skin looked exactly like mine (except that he, poor little thing, had it inside his mouth, too).  Very young children have not-yet fully developed immune systems.

That observation seems to me related to why, as a person whose immune system functioned extraordinarily well throughout much of my adult life  — almost too well in the zeal with which it released inflammatory histamines to annihilate invaders of my skin once its outer barrier had been breached — I succumbed to stress-induced eczema in my early sixties and shingles at seventy-seven.  Research has shown,  although it’s evident anyway, even without the data produced by “research,” that the aging process reduces immune response capability.  The elderly succumb to more infections, more inflammatory diseases, more cancer.  Just by way of example, the thymus — which produces T cells to fight off infection — begins to atrophy with age and produces fewer T cells.  Glutathione, the body’s most powerful antioxidant and detoxifying agent, is at its optimal level when you’re 20.  After that, natural production (in the liver) drops by roughly 10% per decade.  By the time you’re 60, you’re producing only a bit over half the amount you had when you went to college.  By my age, less than that.  A compromised liver (like mine) will generate even less.

So a virus to which I might have been impervious at forty or fifty was able to lay me, and my skin, painfully and annoyingly low for three weeks.  Yes, the mast cells still did a great histamine-and-itch production job in trying to burn out the invader, but I still wish the virus had been unable to gain a foothold in the first place, so they hadn’t had to.

I concede, reluctantly, that aging is inevitable. Nonetheless, it seems to me that there are still things one can do to slow down its inroads on one’s immune system so as to keep from feeling really crappy — in whatever special way “crap” manifests itself in you — for as long as possible.  One is evidently to optimize the workings of the immune system in every way one can.  The other is to reduce the number of adversaries in one’s immediate environment with which the aging immune system has to contend on a day-to-day basis, thereby reducing the strain and burden on its overtaxed resources so that some reserve power remains for halting both minor and major health problems before they make themselves at home in your body.  A very large subject, which I will touch on briefly next time.

 

A ONE-OFF RIFF ON THE USE OF CORTICOSTEROIDS IN A RECENT BOUT OF SKIN DISEASE

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[This is the second in a series of four pieces arising from my recent, and in some ways still ongoing, experience with an obscure and distressing skin affliction apparently extremely rare in adults.  They’re not just about skin, though. Is anything ever really only about what it first appears to be?]

I have no medical expertise whatsoever, and throughout a long educational career avoided science whenever I could.  Moreover, I’ve been extraordinarily lucky, compared to many other people my age, in the relative infrequency with which I have needed to consult internists and other medical specialists.  So you could say I am somewhat inexperienced when it comes to medical and pharmaceutical matters.  I’m emphasizing this up front because nothing that follows should be construed as medical advice.  However, my own recent experience with a very particular kind of non-fatal disease raises certain questions you may want to think about yourself, in whatever way seems applicable, at present or in the future, to your own health situation.

That said, I am observant.  And sentient.  And now there’s the internet, a resource not available thirty years ago, where one can look up matters of interest to oneself.   Which is not to say I don’t respect doctors.  It seems to me that most medical professionals I’ve met really do want to help those who come to them, and do the best they can with the training they’ve received in medical school.  Much of which is remarkable.  The ability to identify and name medical problems, even those coming down the pike but not yet arrived, is extraordinary — thanks to the armament of sophisticated testing equipment which has been developed in the past fifty or sixty years.  Surgeons have also become highly skilled at repairing and replacing broken and worn-out parts of the body. Valve replacements, joint replacements, cataract removal and replacement with artificial lenses.  In addition, they know how to cut bad things out of you — such as many cancers, parts of colons so inflamed that they will kill you if not removed.  And like that.

But when we reach pharmaceutical treatment, we’re on somewhat shakier ground.  There are clearly successes. Some cancers in remission for ten or more years.  Hypertension held in check, without perceptible side effect, by a combination of medications reached after trial and error.  HIV-positive no longer necessarily a death sentence.  But as Bill, my resident now-retired medical guru, used to tell his patients:  medicine is not rocket science.  Meaning — doctors don’t know everything.  Or, in some cases, very much.

Nonetheless, when you feel truly awful, who do you go to?  It’s almost instinctive: if you don’t know what’s wrong with you, go to someone who knows more.  And so, when nearly four weeks ago, I felt weak and listless, and began ceaselessly to scratch first my scalp and then my chest and back, which both soon turned hot and dotted with bumpy itchy eruptions, I betook myself to the local dermatologist, who had a look, asked a few questions, and concluded, “eczema,” or possibly an “atopic dermatitis,” and wrote out a couple of prescriptions.  To make me feel better, until it passes, he said.  Why this, and why now?  He shrugged.  “It happens.”

The prescriptions were for fifteen days of oral prednisone (to be tapered off gradually, in five day increments), for another form of steroid in topical form (to be rubbed over the afflicted parts), and for an oral anti-histamine to take at night.  He also mentioned Claritin, an over-the-counter anti-itch tablet, for daytime, because it’s not sleep inducing.

I had only once in my life broken out in what was either an “eczema” or “dermatitis” on my back and upper arms — in my early sixties, when I was enrobed in professional, emotional and practical stress of almost every kind you can think of, and my skin decided to protest.  That was twenty years ago, and the dermatologist I consulted at the time prescribed an earlier version of a topical steroid, plus an anti-histamine, plus immersion in some kind of colloidal substance that coated the bathtub as well as me, so as to soothe the irritated skin and make the tub nearly impossible to clean. In two or three months, the condition went away and never came back — whether because of the “treatment” or because the problems in my life began slowly to resolve themselves, I don’t know. (Interestingly, the dermatologist had predicted that it would return every winter from then on.) Without speculating further on an issue of the past long since resolved, what I conclude from this is that in twenty years, nothing much has changed:  steroids and anti-histamines for problems of the skin, about which little is apparently understood.

Except that now, twenty years later, the local dermatologist was wrong in his diagnosis. I began to turn boiled-lobster red as the hot, itchy eruptions ran together, and they also moved steadily downwards, in five or six days covering face, arms, tops of hands, lower torso front and back, legs and tops of feet (although I had already begun taking the oral prednisone, as well using the other stuff) — until all of me other than my palms and the soles of my feet were afflicted.  Bill consulted the head of dermatology at Cornell-Weill in New York. He recognized it at once from its symptoms as described. It wasn’t eczema at all.  It was apparently a “general viral exanthem.”  An attack on the skin by a virus. It would eventually go away on its own.  Should I continue with the prednisone?  Yes:  once you start, you shouldn’t stop until the prescribed course is finished.  And it might do some good.

So let us consider prednisone, and other corticosteroids (of which prednisone is one) — the dermatologist’s go-to medicine for problems of skin. [The specific information in this post about corticosteroids comes from the Mayo Clinic’s website section on steroids.]  Steroids are the kind of medication accompanied by the caution that “your doctor has determined the benefits of taking this medication outweigh the risks.”  I have known two people for whom the benefits certainly outweighed the risks, but what was at issue was not skin.  An old college friend was gasping for breath from asthma, and corticosteroids saved her life.  They also made her, a formerly slim attractive woman, blow up (as my mother would have said) like a balloon.  But if the choice is thin and dead or fat and alive, which would you choose?  Similarly, one of the two cleaning ladies who visit us twice a month to keep our condo nice and clean is suffering from rheumatoid arthritis.  She is in her early fifties and if it were not for steroids, she wouldn’t be able to function.  She too is quite plumped out, although her daughter says she used to be a tiny petite little thing.  There are also other future worse side effects of long-term continued use of whatever form of steroid she is taking, some of which she is aware of.  But does she have a choice?  I understand corticosteroids are further helpful in auto-immune diseases, such as lupus, where the immune system attacks the body’s own tissues.

But why is it prescribed for skin conditions? Because corticosteroids mimic the effects of hormones the body produces naturally in your adrenal glands.  When prescribed in doses that exceed the body’s usual levels, corticosteroids suppress inflammation, and thereby can reduce the signs and symptoms of inflammatory conditions.  Alas, they also suppress your immune system. Furthermore, after seven days of doses exceeding the body’s usual levels, the body shuts down its own production of anti-inflammatory hormones, so if you stop taking synthetic corticosteroids suddenly, you will be left without any protection at all against body invaders.   The synthetics have to be tapered off gradually, so that your body picks up the cue that it’s time to start functioning normally again.  Even when you’re no longer taking them, the Mayo Clinic warns that you may feel fatigue and lightheadedness for a while.  Yes, I did, for almost a week after the last pill.  And I’m not fully recovered yet, another week later.

Did it help at all?  Presumably, it was intended to shorten the duration of my affliction — my body’s reaction to the virus — and lessen the inflammation (and therefore the severity of the “discomfort.”).  A general viral exanthem is supposed to last ten to fourteen days.  My inflamed and burning redness faded on the eighteenth day. Today, twenty-eight days after the initial outbreak, my legs — the last to suffer — are still slightly blotchy, and the rest of my skin, although looking normal again, still hypersensitive to touch and hyper-responsive to any form of gentle scratching.  You could say that my age was a factor in delaying complete recovery within the predicted period.  But you could certainly also say that the oral prednisone — the form that affects the entire body — did nothing to shorten the recovery period.  Did it lessen the inflammation?  As I don’t see how it could possibly have been worse (other than to enter the inside of my mouth, which it didn’t do), I answer this question with a clear negative.  So much for the benefits.

Prednisone comes from the pharmacy accompanied by a multi-page printout of possible side effects.  These are the ones I experienced, at first without knowing what was causing them, as I was too tired and confused to start researching this subject until about ten days ago:  Confusion, dizziness, spinning sensation, dry mouth, dry lips, extreme thirst, extremely increased urination (up almost every hour at night), limp feeling, gradual weight gain (two and a half pounds in two weeks despite watching what I ate like a hawk), trouble thinking, trouble speaking — I was groping for words, me! — at times slightly blurred vision, cough, hoarseness, runny nose (without having a cold), shaky hands, chills. I paid less attention to all this than perhaps I should have because I was almost entirely focused instead on the misery of the burning skin, the rash and the itch.  However, I will note, gratefully, that the side effects I didn’t get, perhaps because the course of treatment was relatively short, are even scarier — and include, of all things, skin rash!  Again, I will concede that my reactions were likely exacerbated by age and my body’s inexperience with pharmaceutical substances that tinker with its chemistry.  That, however, was a question of degree, and does not alter the risk/benefit analysis.

[One word about the oral anti-histamine, to be taken at night:  It put me to sleep for about three hours until I woke myself up scratching, still groggy from medication.  So it didn’t really work, either.  As for the Claritin — ditto, and it didn’t take three hours to find out.  Perhaps it helps with something really mild.  Whatever that may be.]

As for the topical steroid ointment, to be applied at judicious intervals to the “afflicted” parts  — even if it had helped, it was a greasy mess to apply (all over!) and precluded the wearing of anything but a long loose nightgown for the four days I kept with it.  I did not keep with it after that because it soon became clear that applying it was counter-productive.  It cooled things down for about five minutes once I had anointed all of myself, and then everything flared up again worse than before.  I will not speculate as to why. Perhaps the inflammation was more determined than the ointment, and refused to be put down!  I have subsequently found some evidence online that this can happen; topical steroids can begin by suppressing inflammation and end by further encouraging it. But as I have now packed all that away in a box labeled “Itch Stuff” (which I suppose will get thrown out in due time, but not quite yet), I will not think about it again, because there are now other things to think about.

Such as: What should I have done when all this began?  My personal opinion is now that corticosteroids are bad news unless you are going to die without them.  They are certainly bad news for skin. And especially as you get older.  There are other ways of dealing with the extreme discomfort of skin rashes, whatever you call them and whatever caused them, that do not carry the heavy burden of side effects that accompany the questionable benefits of steroid application.  (Cold packs wrapped in a towel or washcloth at night, lukewarm showers with Dead Sea salt soap, oatmeal baths, liberal and frequent application of Aloe Vera lotion and — even better — Calendula lotion, which is said to have some healing properties. Wear cotton against your skin; avoid wool and synthetics while you’re inflamed. There’s more, but I won’t continue, unless someone asks.)  On the other hand, when you are truly afflicted in your skin,  or anything else that requires medical attention, do you meekly submit to the pharmaceuticals offered on prescription, or do you dare challenge authority?  Should you emulate Job’s wife, and disbelieve?  Do you curse steroids, and set off on your own, at the risk of metaphorical death (that is, increased suffering)?

At a minimum, if I were doing it again, I would ask Dr. Dermatologist hard questions I didn’t ask.  (Shame on me, the retired lawyer.) What would happen without the steroids?  What are their side effects?  Is this a good idea at my age?  What is the least amount of “treatment” possible? What else can I do to relieve myself?  And even — are you sure I have what you say I have, and how do you know that? And if it isn’t that, but something else entirely (such as a virus attacking the skin),  would the steroids be any use at all?

Then when I had got past all that, and come to whatever decision I had made about following the medical directives I had been given and not looking elsewhere for relief — the fact that I had made it being important here — I would feel better about the consequences, since I had knowingly chosen them and had not had them imposed upon me because “doctor knows best.”

I would also resolve that if I could possibly help it, my immune system would not again so easily yield to viruses and other unseen evils afloat in the world.  I would figure out what I could do to make whatever future I have left as safe and comfortable as possible. But that’s a subject for another day.

 

 

 

JOB’S WIFE

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[This is the first in a series of four pieces arising from my recent, and in some ways still ongoing, experience with an obscure and distressing skin affliction apparently extremely rare in adults. They will not be just about skin, though. Is anything ever really only about what it first appears to be?]

When I announced that I would be absent from The Getting Old Blog for a while because I had come down with what was initially diagnosed as eczema but then turned out to be something else entirely, I described it like this:  “It’s a scalp-to-toe proposition, front and back … and makes you feel like Job.  (In my case, female version.  Was there a Mrs. Job?)”

That last bit about Mrs. Job was a throwaway line, to lighten things up.  The only time I had looked at the Book of Job — and “looked” is the appropriate word here — was for a class in Classical and Christian Civilization sixty-five years ago.  And all I retained of that long-ago cursory flipping of the pages was that the God of the Old Testament had put good and pious Job through many painful trials, including boils, to test his faith.  I didn’t even remember how it came out in the end.

Fortunately, I have at least one better-informed reader, who stepped up to the plate at once.  ShimonZ replied:  “Yes, there was a Mrs. Job…and her story was what first turned me against the entire tale, though it is reputedly written by Moses himself.  She died just to make Job unhappy…and after he’d proven how faithful and innocent he was, she was replaced!”

However, by the time Shimon’s comment reached me, my head was spinning with medication side effects, and I was unable to process anything about this new information other than that the loss of his wife was simply one more punishment God imposed on Job to determine how steadfast was his faith. That didn’t seem exactly fair to the wife, but I had other more skin-specific things on my muddled mind just then, and if I had to think about fairness to anyone, what about me?  (It usually all comes down to that in the end, doesn’t it?)

But once my brain had cleared, I looked into the matter further  — online, of course — and see that there is much confusion and controversy concerning the significance of this wife, of whom I had not known, during the course of God’s testing of Job’s faith.  She shows up in the Book of Job only once, after her husband has lost his wealth, his flocks, his seven sons and three daughters (who were also her seven sons and three daughters), and has been afflicted with loathsome disease. At this point, she asks him a question. Then she tells him what to do, irrespective of the cost.  He remonstrates with her. (No, no, bad wife.) And then she disappears.  That’s all there is:  one sentence, over and out.

Where there’s so little textual data, there’s plenty of wiggle room to go where you will with the story, and both Christians and Jews have had at it with vigor over the intervening centuries.  But why would this interest me — a person freshly risen from her sickbed who is not religious in any formal, or even informal, sense and has never engaged in textual, much less Biblical, exegesis either professionally or in some search for inner truth?

Because, put simply, I ask questions too.  When unforeseeably bad things happen, I am not docile. In the end, I may have to accept them.  But not before trying to find out why. And so, without knowing more, I was at once on nameless Mrs. Job’s side.  In her circumstances, I would have done and said exactly the same thing.  More specifically, an unforeseeably bad thing had just happened to me, and I was asking some questions and trying to decide what to do about preventing the next unforeseen bad thing.  No more blind faith in Dr. Dermatologist for me!

Guess what?  Asking big questions about blind faith has been a big no-no for a long time, and even more so if you’re “just” a woman.  Here’s one relatively recent take on the matter — both misogynist and repugnant — from http://www.biblegateway.com.

Job’s Wife: The Woman Who Urged Her Husband to Commit Suicide

Strange, is it not, that … we do not have the name of [Job’s] wife who remained at his side all through his trials and tribulations?  She is identified by only ten words which she uttered to her husband as she saw him suffering from so much bodily pain and discomfort.  ‘Dost thou still retain thine integrity?  Curse God, and die,’ or ‘Curse God and die by your own hand.  End your suffering by taking your own life.’  She urged him to commit suicide and thus relieve himself of further anguish.

Actually, this alternative reading — ‘die by your own hand’ — appears to be the commentator’s interpretation of ‘and die.’  I myself would have assumed that cursing God in the Old Testament World would have brought a punitive death at God’s hand –which is, I suppose, a sort of suicide, but not exactly where the commentator seems to be going here:

There was also the diabolical suggestion that [Job] should relinquish his faith in God, seeing He was permitting him to endure such terrible physical torment and material loss.  It is because she allowed Satan to use her as an instrument to grieve rather than comfort her husband, that commentators have spoken ill of her character.  Augustine referred to her as ‘The Devil’s Accomplice’ and Calvin wrote of her as ‘An Instrument of Satan’ and as a ‘Diabolical Fury.’ The little she said to her husband whose heart was at breaking point was enough to crush him altogether.  The one closer to him than all others should have encouraged him and offered him human sympathy.  Job’s wife, however, was the female foe in his household and reminds us that ‘the worst trial of all is when those nearest us, instead of strengthening our hand in God and confirming our faith, conspire to destroy it.’ (Micah 7:6; Matthew 10:36)

What does biblegateway suggest that Mrs. J. should have said or done when confronted with the pitiable sufferings of her ravaged husband (not to mention what must have been her own)?

…..Job was determined not to sin with his lips as his thoughtless wife had done….Because God has given woman an affectionate heart, and a large capacity for sympathy and compassion, it is incumbent upon women…. to ….persist in encouraging [their husbands] in times of great trial and tragedy.  It is only thus that a woman functions as God meant her to, as an ‘helpmeet.’ © 1988 Zondervan. All Rights Reserved.

Woman as mindless helpmeet. Heavy stuff. Enough to turn the most ardent believer into a feminist.  If this was the male mindset in Job’s day, can you blame Mrs. J. for disappearing from the text?  Luckily, there is another way of construing the Job family situation:

Wife of Job: Bible  by Ilana Pardes

[from the Jewish Women’s Archive, http://jwa.org.]

In the well known biblical story dealing with the problem of undeserved suffering, Job loses his [ten] children, his possessions, and his health.  Job’s nameless wife turns up after the final blow, after Job has been struck with boils.  Seeing her husband sitting in the dust, scraping his sores silently, she bursts out, ‘Do you still persist in your integrity?  Curse God, and die.’ (2:9)  She cannot bear her husband’s blind acceptance of the tragedies that befall them.  Indeed, the attention to Job’s suffering usually ignores the fact that she too, after all, is a victim of these divine tests in addition to being pained by exposure to his afflictions. (19:17) To cling to a model of perfect devotion to a supposedly perfect God when reality is so far from perfection seems to Job’s wife to be not exemplary strength, but an act of cowardice.  Such ‘integrity,’ she seems to be saying, lacks a deeper value.  What Job must do is to challenge the God who has afflicted him so, even if the consequence is death.

Much has been written about the unusual challenge the Book of Job offers in its audacious questioning of the ways of God, but one never hears of the contribution of Job’s wife to the antidogmatic bent of the text. …She opens the possibility of suspending belief, of speaking against God.  Job’s initial response to his wife’s provocative suggestion is harsh: ‘You speak as any foolish woman would speak.  Shall we receive the good at the hand of God and not receive the bad?’ (2:10)  When the dialogues begin, however, Job comes close to doing what his wife had suggested.  He does not curse God directly, but by cursing his birth he implicitly curses the creator who gave him life.  Much like Eve, Job’s wife spurs her husband to doubt God’s use of divine powers.  In doing so she does him much good, for this turns out to be the royal road to deepening one’s knowledge, to opening one’s eyes.

Job’s wife disappears after her bold statement…. [She] is conspicuously absent from the happy ending in which Job’s world is restored. Job’s dead children spring back to life, as it were, because he ends up having, as in the beginning, seven sons and three daughters.  Yet his wife, who actually escaped death, is excluded from this scene of family bliss.

But that’s okay, because it’s the family bliss of an Old Testament world, where ten new children by a second wife [Dinah, daughter of Jacob] can replace ten dead children, and a wife, similarly replaceable, is a mere extension of her husband. Not really something you or I would want for ourselves or our families.  You see, there’s more, only it’s not in the Bible.  According to the apocryphal Testament of Job, Job’s wife did have a name.  It was Sitis, or Sitidos, and she was, in a way, an outsider:  a woman of Arab descent. So what I would like to think is that she went away and made a whole new life for herself as Sitidos, a woman with a mind — far from undeserved suffering inflicted on her to test her husband’s faith.

This piece may have seemed like a wandering through the wilderness.  It wasn’t.  What began as an idle posting reference to Job, or Mrs. Job if there was one, turned out to be useful and fortifying in thinking for myself about my own recent “ailment.”  Although my immediate response to unforeseen misfortune may be to hurl myself on the nearest mattress, sob, shake my fist at the plaster ceiling and cry out, “Why me, oh God? — eventually, as in the words of the song, I do pick myself up, dust myself off, and start all over again. Which is what I did when the worst of my recent affliction began to resolve itself.  But where and how to start?  Learning about Sitidos taught me something:  If the status quo fails you, curse it and look elsewhere.  You probably won’t die.  She didn’t.

 

 

 

SEARCHING FOR THE PAST

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[I’m almost back to speed from my recent, ah, ailment, and have begun to load the pipeline with some new pieces.  However, everything is taking me longer than it used to.  Perhaps because I’m out of harness.  Perhaps because real recovery is slower than what meets the eye.  So if you’ll bear with me for another four or five days, here’s one more post from the end of last calendar year to keep you going. Many of you may not have seen it.  If you have, perhaps you won’t mind reading once more.]

[Re-blogged from December 16, 2013]

SEARCHING FOR THE PAST

Proust says you can find it again only in art.  ”It” — lost time —  being the years of your life now behind you.

But what is the past? Is it still alive somewhere, in a separate universe — where every single moment that ever was goes on existing?

That was an idea that used to excite me.  While still in high school, I came across a play called “Berkeley Square” which was so sad!  The hero — a modern young American — found himself transported through time and space into an eighteenth- century English drawing room, where he fell in love, by candlelight, with the beautiful heroine.  By the end of the second act, she loved him too (despite his unusual clothing, manners and speech).

Alas, in act three he was unable to bring her back with him  – forward with him? — when he had to return home to electric lights and penicillin.  All they could share across the centuries was a lifetime of eternal love. (At the same time? That point was not made clear.)  He had her faded portrait.  She had her memories of a man not yet born. Thrilling!

Later, my college roommate and I developed this separate-universe concept of time over pints of coffee ice cream (delivered from town to campus as late as ten p.m).  On dateless weekend evenings, we asked ourselves the question: What if a time traveler could change the course of history?

There was even a scenario for the film:  Storm at sea.  Ocean liner traveling from New York to Southampton is thrown off course, collides with large iceberg, sinks before they can lower the lifeboats.  One passenger, knocked unconscious, floats ashore before freezing to death.  He’s a young academic, specializing in medieval English history. Wouldn’t you know?  He washes up near Tewksbury, England in 1471!  During the Wars of the Roses!

Our hero is discovered by bearded land-owning nobility on horseback. They wear heavy armor and carry lances and shields modeled on the exhibits in the armory section of the Metropolitan Museum of Art.  There is also a lovely young maiden with long golden tresses who tends to his minor bruises and helps him brush up on his spoken Middle English.

But the whole point — and we had to get there before the ice cream was all gone — is that our hero has been rescued by members of the House of York; in gratitude for the good care he’s been given, he volunteers to carry a message from one part of their army to another that will (1) prevent a significant battle from taking place; (2)  make peace between the two sides; and (3) thereby change everything we always thought came afterwards.

Change everything!   No more Tudors, no Henry VIII, no Church of England, no Virgin Queen, no Puritans, no Restoration…. I tell you, the ramifications would have been stunning!

But here’s the kicker:  this very important message is written on paper. Not even parchment.  Paper! And our hero falls off his horse in transit. (Horseback riding is not part of the Medieval English History Graduate Studies curriculum).  The concussion knocks him clear back to the twentieth century in America, where subsequent amnesia about his fifteenth-century adventure prevents him from telling anyone about it.

And the piece of paper in his hand? What of that?  It stays behind. (Probably because it didn’t come from the twentieth century in the first place.  We never really worked out that part.)

What do you think happens to a piece of paper lying on wet muddy ground over the course of five and a half centuries? You’re absolutely right.  That’s why the Wars of the Roses ended as it did.  And not our way.

Addendum:  There was an alternate scenario where the paper is in an oiled bag which somehow or other rolls into a dry cave and is eventually found by twentieth-century medieval historians, including the hero. This extraordinary discovery jogs his memory. He then snaps out of his amnesia so he can tell everyone what occurred while he was time-traveling.

The alternate version had the merit of leaving history as it was while also demonstrating that our hero might  have been able to alter the course of events if he had been a better horseback rider. But we rejected it as too complicated and philosophical for a movie.

There was also a book I read later, when I was almost grown up but not quite, about parallel dimensions of time:  Two Shakespeares writing separate Hamlets at the same moment — one entirely different from what the other Shakespeare was scribbling over there in hisdimension.  Two American revolutions, with different outcomes. Two World War I’s.  And like that. But suppose there were three dimensions of time? Or four? Or five?   You can go just so far with this kind of thing before you get dizzy.

So let us put childish things aside, and look at the real past.  The past that’s really past, and not quivering out there in some other dimension we will never know.  The one Proust was writing about. Where does that past reside?  In your memory?

Maybe.  Some of it.  Or you think it does. But how good is your memory?  Do you really remember your grandmother’s face (if you ever saw it)?

Or  – as we ask a recalcitrant witness in the courtroom — is there anything that would refresh your memory? (Like a photograph of your grandmother?)

I have plenty of such refreshers. They’re all down in the basement, in well-labeled files. (I’m a pack rat for paper.)  Let’s look, for instance, at my graduation album from Public School 99, Queens.  I was twelve and a half.  You’d think I’d remember something.  On one random page I see, in blue handwriting:  ”United States is your nation/ Kew Gardens is your station/ But you had to go to 99 to get your education.  Till nail polishes…Elliott Settle.”

Who is Elliott Settle?  Try as I might, I can’t remember.  We sat in the same classroom for at least ten months, I asked him to write a remembrance message in my album, and he has completely vanished from my recollections of my past.  If it weren’t for the album in the basement, I wouldn’t even know his name.

Another remembrance from an author I have no memory of whatsoever:  ”To Nina Raginsky, Love and kisses.  In getting 100 she never misses.  Robert Bier.”  Robert Who?

Kinder words from one William Konigsberg:  ”When Cupid shoots his arrow, I hope he ‘Mrs.’ you.”  Can’t remember him either.

I do remember William Weibel:  ”December 23, 1943. May your life be like arithmetic.  Joys — Added.  Sorrows — Subtracted. Friends — Multiplied. Love — Undivided.  Your friend, Bill W.”  But that’s only because, in a misguided demonstration of affection, he took a big bite out of my brand new pink rubber eraser in seventh grade.  What girl could forget that?

I also remember Georges Petipas, or at least what he looked like.  I’m not sure we ever spoke to each other, although if he’s still alive and wants to prove me wrong, I won’t argue.  He turns out to have been pretty wise, even before high school:  ”Yesterday is dead. Forget it.  Tomorrow is not yet come. Don’t worry. Today is here.  Use it.  Georges P.”

You may notice quite a few boys wrote in my album.  This did not escape the attention of Althea, who neglected to sign her last name and thereby also ensured my inability to recall who she was:  ”Dear Nina, If all the boys were across the sea/ What a good swimmer Nina would be.  Love, Althea”

I want to cry.  All those children gone from me as if they had never been.  Even Willie and Georges gone, except their names and faces.  And so too am I gone, little girl Nina with her perfect grades and an eye for the boys and no idea of tomorrow.  All that’s left is the album.

Better get out of the basement.  I can always come back another time.

Meanwhile, as I look for a Kleenex:

  • Proust was right.
  • Memory fails.
  • Better make art.  (Where you can make things up when you don’t remember.)

And if you can’t make art, blog about it.