OVERHEARD LINES: Welcome To Church, or, Kleptomaniacs Anonymous

In the foyer at Church:

Guy: I heard the woven cable bike locks are the hardest to get through.

Dude: Eh - they're not so tough.

Last Time That Will Happen, or, Keeping The Sabbath Day Holy, or, Sacrament Talk

Clearly I haven't been writing much lately. This past month I was all over interviewing for residency, but I just got back home. I have had a few ideas for upcoming posts, including The Adventures of a Mormon Sommelier, and the Best TV Opening Credits Ever. But, most recently I wrote a talk for my church services, where the homilies or sermons are typically given by a couple members of the congregation. I was the concluding speaker and went until the normal time, but the Bishop stood and took about 7 minutes after me. I am not sure whether I am proud of this or embarrassed -- or maybe it was completely unrelated. While he did not clearly recant any of my words for me, he may have been trying to. It was difficult for me to write this talk, so I thought I would share it here. By way of preface, please remember this was written to be spoken, not read, and intended it to be humorous frequently. Some Most of those jokes fell flat. Surprise, surprise.

Why I Hated Sundays

Brothers and Sisters, I hate Sundays. Or at least, I used to hate them. Now I just don’t look forward to them very much. Why? Well, first and foremost, background. The Sabbath, by Hebrew definition, means “day of rest.” When the Lord gave the command to Moses to “Remember the Sabbath day and keep it holy” he also added, “Six days you shall labor and do all your work.” Josephus, the First Century historian, wrote that the Sabbath day was “set apart from labor and dedicated to learning our customs and laws.” This teaching nicely dovetails with D&C 59:10 where the Lord instructs that the “Sabbath Day is appointed unto you to rest from your labors and to pay thy devotions unto the Most High.” (Incidentally, we have the Jewish labor unions of the 19^th century to thank for the 5 day workweek and 2 day weekend. Since a large portion of workers were Jewish and wanted Saturday off to worship the labor bosses capitulated. But since an even greater portion of workers wanted Sunday, “the Lord’s Day” to worship, we got both days off, and road trips became possible.) And what do we do as Mormons do with that two day weekend? I believe it is summarized well in the 14^th Article of Faith:

We believe in meetings, all that have been scheduled, all that are now scheduled, and we believe that there will yet be many great and important meetings scheduled. We have endured many meetings and hope to be able to endure all meetings. Indeed, we may say that if there is a meeting or anything that resembles a meeting or anything that we may possibly turn into a meeting, we seek after these things. (Robert Kirby, SL Tribune)

On a more serious note, part of the reason I have not always looked forward to Sundays is epitomized in an experience I had in Elder’s Quorum last week. Before the Bishop or President Moody have conniptions, this experience was in my parents’ ward in Utah. Priesthood opening exercises were good – great even. A boldly sung hymn. Warm welcomes. Elder’s quorum started out with the usual announcements and invitations to do service in the middle of the workday. With about 30 minutes left of the block, a teacher came to the front of the room and an iPod was turned on. For the remainder of the time, Elder Holland’s talk from this past session of conference was played. En toto. That was the lesson. Approximately 3 minutes of comments were made at the end of the lesson. Then we dismissed. While Elder Holland’s is a good talk – some may even say an instant classic – I will confess I took little from the class other than a sense of bewilderment that I had to listen to the same material a second time, and that the opportunity to discuss and explore these inspired words in a more personal setting was being completely ignored.

But remember, I don’t hate Sundays anymore, even though this stellar EQ lesson was just last week. Why don’t I hate them anymore? Let me turn to one of my favorite passages from the Epistles: Paul wrote: (1Cor13:11 NRSV)

“When I was a child, I spoke like a child, I thought like a child, I reasoned like a child; when I became a man, I put an end to childish ways.”

When I was a little younger, I expected to come to church and be, served plugged in and recharged. I expected to come and have others take care of my spiritual needs. I came to church expecting not only to be fed, but to be spoon-fed.

Brothers and sisters, this is obviously the wrong attitude. Church is not here to let us sit back and become better people. Now please do not misunderstand me. I am not trying to say that I have "put away all my childish ways" and am now a "man" in all gospel-senses. I am only trying to say that I think I have moved past this one childish thought. Let me use another favorite scripture. Moroni, near the end of his life, wrote (Mormon 9:27) “. . . hearken unto the words of the Lord, and ask the Father in the name of Jesus for what things soever ye shall stand in need. Doubt not, but be believing, . . . and come unto the Lord . . . and work out your own salvation with fear and trembling before him.” Moroni here tells us that the purpose of the gospel, including the Sabbath day, is to learn. He also says that it is our responsibility to learn it. We need to figure it out individually. Sometimes that means 9 hours of meetings on Sunday. It almost always means that the Sabbath is not a day of rest anymore, like I wanted it to be as a child. The Sabbath may not be the most restful day anymore, but that is okay. To quote Eugene England, “If we constantly approach the Church as consumers, we will never partake of its sweet and filling fruit. Only if we can lose our lives [in church service] will we find ourselves.” “If we only ask ‘What has the Church done for me?’ we will not think to ask the much more important question, ‘What am I doing with the opportunities for service and self-challenge with which the Church provides me?’” (England, Why the Church is as True as the Gospel.)

No church talk about keeping the Sabbath Day Holy would be complete without a discussion of “do’s and don’ts.” Guidelines certainly exist for keeping the Sabbath day holy, but they are inadequate. The only appropriate set of guidelines that I have found for appropriate Sabbath day activity is this: you should be doing things on Sunday to help yourself and others become better people. For a professional cyclist, he or she may not feel it appropriate to go for a bike ride on Sunday. For the rest of us who do not get to ride bikes much, Sunday may be a wonderful day to take that opportunity to enjoy God’s Green Earth from a bike saddle. Indulge me for a moment on this topic; while preparing for this talk, I came across a blog that had a posting regarding Sabbath day activity lists, asking for commenters to add their own insights into what they, and their typically young families did or did not do on Sundays. It seemed to quickly devolve into something of keeping-up-with-the-Joneses. One commenter would say they didn’t watch team sports on Sundays. The next would say they only watched Discovery Channel, and that as a family. The next said that they never watched TV on Sundays. The next said that they sold their TVs and were forging ahead with a plan to feed the world. Not only did these comments not seem helpful, they started creating a sense of anxiety in me. I watch TV. I have not been working for world peace enough, and so on. Am I not doing what is right? I want to share a word of caution that my grandfather once gave to my sweet mother, who was an accomplished violinist. When mom was about 14, she was asked to perform a piece in church. She practiced and practiced, but she choked when the time came and did not do so well. She of course was devastated. But Grandpa Kirton came to the rescue, taking her into the front room, sitting her down, and saying, “My sweet Collie, you are good enough.” He went on to say that by comparing herself to others, she was setting herself up to either be puffed up in pride or racked with self-doubt and feelings of inadequacy. Comparing yourself to others is a good way of setting yourself up to fail, because you will always come up short in some aspect. So it is with Sabbath Day observance. I hope we can remember that, while there are basic guidelines, each individual and each family’s path, is, ultimately, their own path. Do not let anyone tell you otherwise. Your best is good enough.

Allow me to discuss another reason why attending church and keeping the Sabbath day holy are important. Martin Luther wrote that “Marriage is the school of love.” Note that he did not say that marriage is the product or result or home or goal of love. Marriage is the school. Marriage is what teaches someone how to love. I think part of the reasoning behind this is because at times, I have heard, you want to murder your companion. But marriage does not just teach you how to not kill your companion; rather, marriage teaches you how to deal with and love and cherish your companion. Church, similarly, is the school of godliness. At least half of you, if you had the choice, would choose to never associate with me. At least half. Yet here you are. Forced to associate with me. Typically, we see each other at least once a week. And by that forced association, you are made better people. Not by associating with me, necessarily (though that is often the case – eg Chris Sorensen). But in learning to deal with and work alongside and worship together with people that you would otherwise choose to avoid. By doing this we all become a little more, well, Godlike. Is there anything more Godlike than learning to care for and take responsibility “for the personal and marital, the physical and spiritual welfare of people we may not already love [or] (may even heartily dislike)[?], and thus we learn to love them. It stretches and challenges us, even when we are disappointed and exasperated in ways we would not otherwise choose to be stretched and challenged. . . [church] gives us a chance to be made better than we may have chosen to be – but ultimately want to be.” (E. England, Why the Church is as True as the Gospel –edited with brackets). Is it any wonder that attending church meetings is such an important part of keeping the Sabbath day holy?

Let me close with the words of President Spencer W. Kimball, “We do not go to Sabbath meetings to be entertained or even solely to be instructed. We go to worship the Lord. It is an individual responsibility, and regardless of what is said from the pulpit, if one wishes to worship the Lord in spirit and truth, he may do so by attending his meetings, partaking of the sacrament, and contemplating the beauties of the gospel. If the service is a failure to you, you have failed. No one can worship for you. (Ensign, Jan 1978, p4-5, emphasis mine).

What beautiful opportunities the Sabbath presents us with. A chance to mingle and serve people we do not always want to be around, a chance to actively pursue our spiritual needs, and a chance, as Josephus said, to take a day “set apart from labor and dedicated to learning our customs and laws” and finally, the Sabbath presents us with a chance, to practice true religion which James, the brother of Jesus, wrote that (James 1:27) “Religion (and I might add Sabbath observance) that is pure and undefiled before God, the Father, is this: to care for orphans and widows in their distress, and to keep oneself unstained by the world.” That is the only “do’s and don’t’s” list I will give. And that is why I don’t hate Sundays anymore.

So What If It Was On A Treadmill?

5 miles. Barefoot. Felt great.

OVERHEARD LINES; or, Relaxed Fruits, or, Enlightened Culinary Styles

Dude, to dude: "Hey, I left my banana hammock in your kitchen. Can you bring that to the restaurant?"

Looney Tunes Lied To Me!, or, Midnight Snacks

Have you ever had a fundamental, foundational portion of your world-view removed, suddenly? Right before you crawl into bed? Well, I did, just now.

I turned out my light, began crossing the room, and stepped squarely on a banana. Not only did I not slip, the banana still tasted great. Footy, but great. Turns out having your cornerstones removed isn't such a big deal after all.

Poem-ish type writing of the time period

Dark and cold we may be, but this
Is no winter now. The frozen misery
Of centuries breaks, cracks, begins to move,
The thunder is the thunder of the floes,
The thaw, the flood, the upstart Spring
Thank God our time is now when wrong
Comes up to face us everwhere
Never to leave us till we take
The longest stride of soul men ever took.
-Christopher Fry

Supreme Snark, or, People Eating Tasty Animals

A lot of stuff comes into my Google Reader. Lots of lame stuff. Some not lame stuff. Medical blogs, photography blogs, friends' blogs, sports blogs. Well, you get the picture. One of my favorite posts, that I have kept "unread" for a month so I can laugh at it every time I open up Google Reader, is simply the below Bulletin Board WIN.

Modern Medicine At Its Finest, or, Good Thing Dad Does Not Wear Hats

I recently came across this article, from the Journal of the American Medical Association. I found it interesting. I think you will too.

PROPHYLAXIS OF BALDNESS.

If anyone had insisted 25 years ago that tuberculosis was only slightly hereditary, but distinctly communicable, they would have been laughed at. The germ theory has now become a doctrine of ever-widening scope, and we realize that many affections are directly communicable and only a few hereditary. At the present moment it seems that even for so old-fashioned an affection as baldness a complete change of opinion as regards etiology is taking place. As with tuberculosis, so it has long been noted that baldness is likely to run in families. The sons of bald fathers are all the more likely to become bald young, and it is not the rule to find a single bald brother where there are a number in a family. On the other hand, daughters seldom become bald, but then the women folk rarely use the combs and brushes of the male members of the family, while boys not only use such articles in common, but often exchange hats, have their hair cut frequently at barbers, and in general are not rarely in circumstances in which they are likely to contract the disease, if it is communicable.

It is nearly ten years now since Sabouraud at the Pasteur Institute pointed out that premature baldness is practically always associated with the presence of certain bacteria. The seborrheic condition causing what is known as dandruff, on which early baldness probably often depends, he demonstrated to be a very probable result of the presence of these micro-organisms. Bacteriologic investigations made since have tended to confirm this opinion, and while they have failed to show the existence of any specific germs, they have made it appear probable that microbes play an important roˆ le in causing the increased desquamation of the epithelium which chokes up hair bulbs and finally leads to their obliteration. Undoubtedly the ordinary conditions of scalp hygiene among men are favorable to the development of these germs. The circulation to the scalp all comes from the vessels of the neck and finds its way over the bony skull to be distributed to the hair bulbs. It is especially likely to be interfered with by the pressure of the hat band, and that this is an important factor in the etiology of alopecia can be seen from the fact that baldness always begins just above the occipital prominence at the back or above the frontal bosses anteriorly, that is, just where the pressure of the hat band on the blood vessels is most likely to be occlusive. This interference with the circulation lowers the resistive vitality of these parts of the scalp and consequently provides opportunities for the growth of micro-organisms. It must not be forgotten, moreover, that these three points mentioned are especially liable to infection. The comb and brush are used particularly in arranging the whorl of hair in the occipital region and in parting the hair and brushing it back over the frontal bosses anteriorly. If infection plays an important role, then, in the production of baldness, these are just the parts that, theoretically, should be first affected, and from which infection should spread to the other parts of the head. As a matter of fact this is what occurs in practice.

Greater care should be taken with regard to brushes and combs, especially in families in which early baldness is the rule. The hair brush should be dipped in an antiseptic solution several times a week. Combs should be boiled regularly and frequently, and under no circumstances should

members of precociously bald families use other combs or brushes than their own, or allow them to be used on them, in barber shops, unless they are assured of their sterilization beforehand. These precautions may seem a high price to pay for the prophylaxis of premature baldness, and many will prefer to take the chance of becoming bald, but some have such a horror of the affliction that they will willingly put themselves to much trouble to prevent it.

JANUARY 14, 1903

JAMA. 1903;40:249 as quoted in JAMA. 2003;289(4):494 (doi:10.1001/jama.289.4.494)

This all just begs the question, why were bald men using combs 100 years ago?

Skip to 1:17 in the clip. Worth it.

The Difficult Truth, or, Health Care Reform

After President Obama's address last night, this seems like a good time to talk health-care reform. Two large issues come to mind when I think about the need for reform.

1. The elimination of "just to be sure" medicine. Defensive driving is a very good thing. Defensive medicine is sometimes a good thing, but it is almost always a very expensive thing.

2. The second is an issue about the need to apply cost-benefit ideas to medical care, is covered better in an article posted below. I realize this a horrible idea, but the world is a horrible place. I'm not ecstatic about this, believe me, but please, read the article. I know it's long. (Click on the title for the link to the original article).

July 19, 2009

Why We Must Ration Health Care

By PETER SINGER

You have advanced kidney cancer. It will kill you, probably in the next year or two. A drug called Sutent slows the spread of the cancer and may give you an extra six months, but at a cost of $54,000. Is a few more months worth that much?

If you can afford it, you probably would pay that much, or more, to live longer, even if your quality of life wasn’t going to be good. But suppose it’s not you with the cancer but a stranger covered by your health-insurance fund. If the insurer provides this man — and everyone else like him — with Sutent, your premiums will increase. Do you still think the drug is a good value? Suppose the treatment cost a million dollars. Would it be worth it then? Ten million? Is there any limit to how much you would want your insurer to pay for a drug that adds six months to someone’s life? If there is any point at which you say, “No, an extra six months isn’t worth that much,” then you think that health care should be rationed.

In the current U.S. debate over health care reform, “rationing” has become a dirty word. Meeting last month with five governors, President Obama urged them to avoid using the term, apparently for fear of evoking the hostile response that sank the Clintons’ attempt to achieve reform. In a Wall Street Journal op-ed published at the end of last year with the headline “Obama Will Ration Your Health Care,” Sally Pipes, C.E.O. of the conservative Pacific Research Institute, described how in Britain the national health service does not pay for drugs that are regarded as not offering good value for money, and added, “Americans will not put up with such limits, nor will our elected representatives.” And the Democratic chair of the Senate Finance Committee, Senator Max Baucus, told CNSNews in April, “There is no rationing of health care at all” in the proposed reform.

Remember the joke about the man who asks a woman if she would have sex with him for a million dollars? She reflects for a few moments and then answers that she would. “So,” he says, “would you have sex with me for $50?” Indignantly, she exclaims, “What kind of a woman do you think I am?” He replies: “We’ve already established that. Now we’re just haggling about the price.” The man’s response implies that if a woman will sell herself at any price, she is a prostitute. The way we regard rationing in health care seems to rest on a similar assumption, that it’s immoral to apply monetary considerations to saving lives — but is that stance tenable?

Health care is a scarce resource, and all scarce resources are rationed in one way or another. In the United States, most health care is privately financed, and so most rationing is by price: you get what you, or your employer, can afford to insure you for. But our current system of employer-financed health insurance exists only because the federal government encouraged it by making the premiums tax deductible. That is, in effect, a more than $200 billion government subsidy for health care. In the public sector, primarily Medicare, Medicaid and hospital emergency rooms, health care is rationed by long waits, high patient copayment requirements, low payments to doctors that discourage some from serving public patients and limits on payments to hospitals.

The case for explicit health care rationing in the United States starts with the difficulty of thinking of any other way in which we can continue to provide adequate health care to people on Medicaid and Medicare, let alone extend coverage to those who do not now have it. Health-insurance premiums have more than doubled in a decade, rising four times faster than wages. In May, Medicare’s trustees warned that the program’s biggest fund is heading for insolvency in just eight years. Health care now absorbs about one dollar in every six the nation spends, a figure that far exceeds the share spent by any other nation. According to the Congressional Budget Office, it is on track to double by 2035.

President Obama has said plainly that America’s health care system is broken. It is, he has said, by far the most significant driver of America’s long-term debt and deficits. It is hard to see how the nation as a whole can remain competitive if in 26 years we are spending nearly a third of what we earn on health care, while other industrialized nations are spending far less but achieving health outcomes as good as, or better than, ours.

Rationing health care means getting value for the billions we are spending by setting limits on which treatments should be paid for from the public purse. If we ration we won’t be writing blank checks to pharmaceutical companies for their patented drugs, nor paying for whatever procedures doctors choose to recommend. When public funds subsidize health care or provide it directly, it is crazy not to try to get value for money. The debate over health care reform in the United States should start from the premise that some form of health care rationing is both inescapable and desirable. Then we can ask, What is the best way to do it?

Last year Britain’s National Institute for Health and Clinical Excellence gave a preliminary recommendation that the National Health Service should not offer Sutent for advanced kidney cancer. The institute, generally known as NICE, is a government-financed but independently run organization set up to provide national guidance on promoting good health and treating illness. The decision on Sutent did not, at first glance, appear difficult. NICE had set a general limit of £30,000, or about $49,000, on the cost of extending life for a year. Sutent, when used for advanced kidney cancer, cost more than that, and research suggested it offered only about six months extra life. But the British media leapt on the theme of penny-pinching bureaucrats sentencing sick people to death. The issue was then picked up by the U.S. news media and by those lobbying against health care reform in the United States. An article in The New York Times last December featured Bruce Hardy, a kidney-cancer patient whose wife, Joy, said, “It’s hard to know that there is something out there that could help but they’re saying you can’t have it because of cost.” Then she asked the classic question: “What price is life?”

Last November, Bloomberg News focused on Jack Rosser, who was 57 at the time and whose doctor had told him that with Sutent he might live long enough to see his 1-year-old daughter, Emma, enter primary school. Rosser’s wife, Jenny, is quoted as saying: “It’s immoral. They are sentencing him to die.” In the conservative monthly The American Spectator, David Catron, a health care consultant, describes Rosser as “one of NICE’s many victims” and writes that NICE “regularly hands down death sentences to gravely ill patients.” Linking the British system with Democratic proposals for reforming health care in the United States, Catron asked whether we really deserve a health care system in which “soulless bureaucrats arbitrarily put a dollar value on our lives.” (In March, NICE issued a final ruling on Sutent. Because of how few patients need the drug and because of special end-of-life considerations, it recommended that the drug be provided by the National Health Service to patients with advanced kidney cancer.)

There’s no doubt that it’s tough — politically, emotionally and ethically — to make a decision that means that someone will die sooner than they would have if the decision had gone the other way. But if the stories of Bruce Hardy and Jack Rosser lead us to think badly of the British system of rationing health care, we should remind ourselves that the U.S. system also results in people going without life-saving treatment — it just does so less visibly. Pharmaceutical manufacturers often charge much more for drugs in the United States than they charge for the same drugs in Britain, where they know that a higher price would put the drug outside the cost-effectiveness limits set by NICE. American patients, even if they are covered by Medicare or Medicaid, often cannot afford the copayments for drugs. That’s rationing too, by ability to pay.

Dr. Art Kellermann, associate dean for public policy at Emory School of Medicine in Atlanta, recently wrote of a woman who came into his emergency room in critical condition because a blood vessel had burst in her brain. She was uninsured and had chosen to buy food for her children instead of spending money on her blood-pressure medicine. In the emergency room, she received excellent high-tech medical care, but by the time she got there, it was too late to save her.

A New York Times report on the high costs of some drugs illustrates the problem. Chuck Stauffer, an Oregon farmer, found that his prescription-drug insurance left him to pay $5,500 for his first 42 days of Temodar, a drug used to treat brain tumors, and $1,700 a month after that. For Medicare patients drug costs can be even higher, because Medicare can require a copayment of 25 percent of the cost of the drug. For Gleevec, a drug that is effective against some forms of leukemia and some gastrointestinal tumors, that one-quarter of the cost can run to $40,000 a year.

In Britain, everyone has health insurance. In the U.S., some 45 million do not, and nor are they entitled to any health care at all, unless they can get themselves to an emergency room. Hospitals are prohibited from turning away anyone who will be endangered by being refused treatment. But even in emergency rooms, people without health insurance may receive less health care than those with insurance. Joseph Doyle, a professor of economics at the Sloan School of Management at M.I.T., studied the records of people in Wisconsin who were injured in severe automobile accidents and had no choice but to go to the hospital. He estimated that those who had no health insurance received 20 percent less care and had a death rate 37 percent higher than those with health insurance. This difference held up even when those without health insurance were compared with those without automobile insurance, and with those on Medicaid — groups with whom they share some characteristics that might affect treatment. The lack of insurance seems to be what caused the greater number of deaths.

When the media feature someone like Bruce Hardy or Jack Rosser, we readily relate to individuals who are harmed by a government agency’s decision to limit the cost of health care. But we tend not to hear about — and thus don’t identify with — the particular individuals who die in emergency rooms because they have no health insurance. This “identifiable victim” effect, well documented by psychologists, creates a dangerous bias in our thinking. Doyle’s figures suggest that if those Wisconsin accident victims without health insurance had received equivalent care to those with it, the additional health care would have cost about $220,000 for each life saved. Those who died were on average around 30 years old and could have been expected to live for at least another 40 years; this means that had they survived their accidents, the cost per extra year of life would have been no more than $5,500 — a small fraction of the $49,000 that NICE recommends the British National Health Service should be ready to pay to give a patient an extra year of life. If the U.S. system spent less on expensive treatments for those who, with or without the drugs, have at most a few months to live, it would be better able to save the lives of more people who, if they get the treatment they need, might live for several decades.

Estimates of the number of U.S. deaths caused annually by the absence of universal health insurance go as high as 20,000. One study concluded that in the age group 55 to 64 alone, more than 13,000 extra deaths a year may be attributed to the lack of insurance coverage. But the estimates vary because Americans without health insurance are more likely, for example, to smoke than Americans with health insurance, and sorting out the role that the lack of insurance plays is difficult. Richard Kronick, a professor at the School of Medicine at theUniversity of California, San Diego, cautiously concludes from his own study that there is little evidence to suggest that extending health insurance to all Americans would have a large effect on the number of deaths in the United States. That doesn’t mean that it wouldn’t; we simply don’t know if it would.

In any case, it isn’t only uninsured Americans who can’t afford treatment. President Obama has spoken about his mother, who died from ovarian cancer in 1995. The president said that in the last weeks of her life, his mother “was spending too much time worrying about whether her health insurance would cover her bills” — an experience, the president went on to say, that his mother shared with millions of other Americans. It is also an experience more common in the United States than in other developed countries. A recent Commonwealth Fund study led by Cathy Schoen and Robin Osborn surveyed adults with chronic illness in Australia, Canada, France, Germany, the Netherlands, New Zealand, the United Kingdom and the United States. Far more Americans reported forgoing health care because of cost. More than half (54 percent) reported not filling a prescription, not visiting a doctor when sick or not getting recommended care. In comparison, in the United Kingdom the figure was 13 percent, and in the Netherlands, only 7 percent. Even among Americans with insurance, 43 percent reported that cost was a problem that had limited the treatment they received. According to a 2007 study led by David Himmelstein, more than 60 percent of all bankruptcies are related to illness, with many of these specifically caused by medical bills, even among those who have health insurance. In Canada the incidence of bankruptcy related to illness is much lower.

When a Washington Post journalist asked Daniel Zemel, a Washington rabbi, what he thought about federal agencies putting a dollar value on human life, the rabbi cited a Jewish teaching explaining that if you put one human life on one side of a scale, and you put the rest of the world on the other side, the scale is balanced equally. Perhaps that is how those who resist health care rationing think. But we already put a dollar value on human life. If the Department of Transportation, for example, followed rabbinical teachings it would exhaust its entire budget on road safety. Fortunately the department sets a limit on how much it is willing to pay to save one human life. In 2008 that limit was $5.8 million. Other government agencies do the same. Last year the Consumer Product Safety Commission considered a proposal to make mattresses less likely to catch fire. Information from the industry suggested that the new standard would cost $343 million to implement, but the Consumer Product Safety Commission calculated that it would save 270 lives a year — and since it valued a human life at around $5 million, that made the new standard a good value. If we are going to have consumer-safety regulation at all, we need some idea of how much safety is worth buying. Like health care bureaucrats, consumer-safety bureaucrats sometimes decide that saving a human life is not worth the expense. Twenty years ago, the National Research Council, an arm of the National Academy of Sciences, examined a proposal for installing seat belts in all school buses. It estimated that doing so would save, on average, one life per year, at a cost of $40 million. After that, support for the proposal faded away. So why is it that those who accept that we put a price on life when it comes to consumer safety refuse to accept it when it comes to health care?

Of course, it’s one thing to accept that there’s a limit to how much we should spend to save a human life, and another to set that limit. The dollar value that bureaucrats place on a generic human life is intended to reflect social values, as revealed in our behavior. It is the answer to the question “How much are you willing to pay to save your life?” — except that, of course, if you asked that question of people who were facing death, they would be prepared to pay almost anything to save their lives. So instead, economists note how much people are prepared to pay to reduce the risk that they will die. How much will people pay for air bags in a car, for instance? Once you know how much they will pay for a specified reduction in risk, you multiply the amount that people are willing to pay by how much the risk has been reduced, and then you know, or so the theory goes, what value people place on their lives. Suppose that there is a 1 in 100,000 chance that an air bag in my car will save my life, and that I would pay $50 — but no more than that — for an air bag. Then it looks as if I value my life at $50 x 100,000, or $5 million.

The theory sounds good, but in practice it has problems. We are not good at taking account of differences between very small risks, so if we are asked how much we would pay to reduce a risk of dying from 1 in 1,000,000 to 1 in 10,000,000, we may give the same answer as we would if asked how much we would pay to reduce the risk from 1 in 500,000 to 1 in 10,000,000. Hence multiplying what we would pay to reduce the risk of death by the reduction in risk lends an apparent mathematical precision to the outcome of the calculation — the supposed value of a human life — that our intuitive responses to the questions cannot support. Nevertheless this approach to setting a value on a human life is at least closer to what we really believe — and to what we should believe — than dramatic pronouncements about the infinite value of every human life, or the suggestion that we cannot distinguish between the value of a single human life and the value of a million human lives, or even of the rest of the world. Though such feel-good claims may have some symbolic value in particular circumstances, to take them seriously and apply them — for instance, by leaving it to chance whether we save one life or a billion — would be deeply unethical.

Governments implicitly place a dollar value on a human life when they decide how much is to be spent on health care programs and how much on other public goods that are not directed toward saving lives. The task of health care bureaucrats is then to get the best value for the resources they have been allocated. It is the familiar comparative exercise of getting the most bang for your buck. Sometimes that can be relatively easy to decide. If two drugs offer the same benefits and have similar risks of side effects, but one is much more expensive than the other, only the cheaper one should be provided by the public health care program. That the benefits and the risks of side effects are similar is a scientific matter for experts to decide after calling for submissions and examining them. That is the bread-and-butter work of units like NICE. But the benefits may vary in ways that defy straightforward comparison. We need a common unit for measuring the goods achieved by health care. Since we are talking about comparing different goods, the choice of unit is not merely a scientific or economic question but an ethical one.

As a first take, we might say that the good achieved by health care is the number of lives saved. But that is too crude. The death of a teenager is a greater tragedy than the death of an 85-year-old, and this should be reflected in our priorities. We can accommodate that difference by calculating the number of life-years saved, rather than simply the number of lives saved. If a teenager can be expected to live another 70 years, saving her life counts as a gain of 70 life-years, whereas if a person of 85 can be expected to live another 5 years, then saving the 85-year-old will count as a gain of only 5 life-years. That suggests that saving one teenager is equivalent to saving 14 85-year-olds. These are, of course, generic teenagers and generic 85-year-olds. It’s easy to say, “What if the teenager is a violent criminal and the 85-year-old is still working productively?” But just as emergency rooms should leave criminal justice to the courts and treat assailants and victims alike, so decisions about the allocation of health care resources should be kept separate from judgments about the moral character or social value of individuals.

Health care does more than save lives: it also reduces pain and suffering. How can we compare saving a person’s life with, say, making it possible for someone who was confined to bed to return to an active life? We can elicit people’s values on that too. One common method is to describe medical conditions to people — let’s say being a quadriplegic — and tell them that they can choose between 10 years in that condition or some smaller number of years without it. If most would prefer, say, 10 years as a quadriplegic to 4 years of nondisabled life, but would choose 6 years of nondisabled life over 10 with quadriplegia, but have difficulty deciding between 5 years of nondisabled life or 10 years with quadriplegia, then they are, in effect, assessing life with quadriplegia as half as good as nondisabled life. (These are hypothetical figures, chosen to keep the math simple, and not based on any actual surveys.) If that judgment represents a rough average across the population, we might conclude that restoring to nondisabled life two people who would otherwise be quadriplegics is equivalent in value to saving the life of one person, provided the life expectancies of all involved are similar.

This is the basis of the quality-adjusted life-year, or QALY, a unit designed to enable us to compare the benefits achieved by different forms of health care. The QALY has been used by economists working in health care for more than 30 years to compare the cost-effectiveness of a wide variety of medical procedures and, in some countries, as part of the process of deciding which medical treatments will be paid for with public money. If a reformed U.S. health care system explicitly accepted rationing, as I have argued it should, QALYs could play a similar role in the U.S.

Some will object that this discriminates against people with disabilities. If we return to the hypothetical assumption that a year with quadriplegia is valued at only half as much as a year without it, then a treatment that extends the lives of people without disabilities will be seen as providing twice the value of one that extends, for a similar period, the lives of quadriplegics. That clashes with the idea that all human lives are of equal value. The problem, however, does not lie with the concept of the quality-adjusted life-year, but with the judgment that, if faced with 10 years as a quadriplegic, one would prefer a shorter lifespan without a disability. Disability advocates might argue that such judgments, made by people without disabilities, merely reflect the ignorance and prejudice of people without disabilities when they think about people with disabilities. We should, they will very reasonably say, ask quadriplegics themselves to evaluate life with quadriplegia. If we do that, and we find that quadriplegics would not give up even one year of life as a quadriplegic in order to have their disability cured, then the QALY method does not justify giving preference to procedures that extend the lives of people without disabilities over procedures that extend the lives of people with disabilities.

This method of preserving our belief that everyone has an equal right to life is, however, a double-edged sword. If life with quadriplegia is as good as life without it, there is no health benefit to be gained by curing it. That implication, no doubt, would have been vigorously rejected by someone like Christopher Reeve, who, after being paralyzed in an accident, campaigned for more research into ways of overcoming spinal-cord injuries. Disability advocates, it seems, are forced to choose between insisting that extending their lives is just as important as extending the lives of people without disabilities, and seeking public support for research into a cure for their condition.

The QALY tells us to do what brings about the greatest health benefit, irrespective of where that benefit falls. Usually, for a given quantity of resources, we will do more good if we help those who are worst off, because they have the greatest unmet needs. But occasionally some conditions will be both very severe and very expensive to treat. A QALY approach may then lead us to give priority to helping others who are not so badly off and whose conditions are less expensive to treat. I don’t find it unfair to give the same weight to the interests of those who are well off as we give to those who are much worse off, but if there is a social consensus that we should give priority to those who are worse off, we can modify the QALY approach so that it gives greater weight to benefits that accrue to those who are, on the QALY scale, worse off than others.

The QALY approach does not even try to measure the benefits that health care brings in addition to the improvement in health itself. Emotionally, we feel that the fact that Jack Rosser is the father of a young child makes a difference to the importance of extending his life, but his parental status is irrelevant to a QALY assessment of the health care gains that Sutent would bring him. Whether decisions about allocating health care resources should take such personal circumstances into account isn’t easy to decide. Not to do so makes the standard inflexible, but taking personal factors into account increases the scope for subjective — and prejudiced — judgments.

The QALY is not a perfect measure of the good obtained by health care, but its defenders can support it in the same way that Winston Churchill defended democracy as a form of government: it is the worst method of allocating health care, except for all the others. If it isn’t possible to provide everyone with all beneficial treatments, what better way do we have of deciding what treatments people should get than by comparing the QALYs gained with the expense of the treatments?

Will Americans allow their government, either directly or through an independent agency like NICE, to decide which treatments are sufficiently cost-effective to be provided at public expense and which are not? They might, under two conditions: first, that the option of private health insurance remains available, and second, that they are able to see, in their own pocket, the full cost of not rationing health care.

Rationing public health care limits free choice if private health insurance is prohibited. But many countries combine free national health insurance with optional private insurance. Australia, where I’ve spent most of my life and raised a family, is one. The U.S. could do something similar. This would mean extending Medicare to the entire population, irrespective of age, but without Medicare’s current policy that allows doctors wide latitude in prescribing treatments for eligible patients. Instead, Medicare for All, as we might call it, should refuse to pay where the cost per QALY is extremely high. (On the other hand, Medicare for All would not require more than a token copayment for drugs that are cost-effective.) The extension of Medicare could be financed by a small income-tax levy, for those who pay income tax — in Australia the levy is 1.5 percent of taxable income. (There’s an extra 1 percent surcharge for those with high incomes and no private insurance. Those who earn too little to pay income tax would be carried at no cost to themselves.) Those who want to be sure of receiving every treatment that their own privately chosen physicians recommend, regardless of cost, would be free to opt out of Medicare for All as long as they can demonstrate that they have sufficient private health insurance to avoid becoming a burden on the community if they fall ill. Alternatively, they might remain in Medicare for All but take out supplementary insurance for health care that Medicare for All does not cover. Every American will have a right to a good standard of health care, but no one will have a right to unrationed health care. Those who opt for unrationed health care will know exactly how much it costs them.

One final comment. It is common for opponents of health care rationing to point to Canada and Britain as examples of where we might end up if we get “socialized medicine.” On a blog on Fox News earlier this year, the conservative writer John Lott wrote, “Americans should ask Canadians and Brits — people who have long suffered from rationing — how happy they are with central government decisions on eliminating ‘unnecessary’ health care.” There is no particular reason that the United States should copy the British or Canadian forms of universal coverage, rather than one of the different arrangements that have developed in other industrialized nations, some of which may be better. But as it happens, last year the Gallup organization did ask Canadians and Brits, and people in many different countries, if they have confidence in “health care or medical systems” in their country. In Canada, 73 percent answered this question affirmatively. Coincidentally, an identical percentage of Britons gave the same answer. In the United States, despite spending much more, per person, on health care, the figure was only 56 percent.

Peter Singer is professor of bioethics at Princeton University. He is also laureate professor at the University of Melbourne, in Australia. His most recent book is “The Life You Can Save: Acting Now to End World Poverty.”

This article has been revised to reflect the following correction:

Correction: July 19, 2009
An article in The Times Magazine this weekend about the argument for rationing health care in the United States misstates the number of years it would take under the current system for the country to spend nearly a third of what it earns on health care. It is 26 years from now, or 2035, not 15 years.

Guided by teh Spirit, or, If Only

On Awesmeness, or, (Possible) Best Music Ever

This is an attempt to list what I consider the ultimate music in several different categories. Clearly, this is my opinion, and limited at that to the few categories below. As always, I'd be interested in your own lists, or the critiques you have of mine.

THE LIST:

Baroque: Bach’s Air on G String. I realize most would put Pachelbel’s Canon in D here, and it is a beautiful piece. I was torn and almost put Bach’s “Little” Fugue in G minor for Organ here instead, but the simple elegance of the wining piece made the difference.

Classical Piano: Beethoveen’s Waldestein Piano Sonata; this may be the greatest piece of solo music ever written. I will stand by that statement. I will even put it on my blog.

Romantic Orchestral: Tchaikovsky’s Violin Concerto with close second place tie Romeo and Juliet vs 1812 Overture. I do like most of the Russian composers. So angry and passionate.

Rock: Pearl Jam’s Better Man. My friends scoff at me for this. One asked, repeatedly, when I told her we were listening to this song if I meant Dave Mathews. She is not my friend anymore.

Alternative: The Decemberists The Crane Wife 3. Practically perfect.

Opening: Nirvana’s Smell’s Like Teen Spirit vs Guns ‘n’ Roses Sweet Child o’ Mine

Bluegrass: Nicklecreek Ode To A Butterfly

Country: Johnny Cash I Walk The Line – but his covers, notably on American IV & V albums, with such songs as the remake of NIN’s Hurt (absolutely unbelievable) and God’s Gunna Cut You Down, are some of the best songs I’ve ever heard. That’s right. Ever.

Punk-ish: The Get Up Kids Mass Pike

This band was my staple for about five or six years, until a few years after they broke up. I missed their show in SLC during their alleged last tour during college, and I still cry myself to sleep about it. The fungus growing in my pillow from the constant damp is really starting to cause problems, too. And they’re coming to town at the Newport 11/8 of this year. So tell all your friends, and come to the sweet show.

Hardcore: Taking Back Sunday There is no “I” in Team. This song just makes me want to explode. It’s awesome.

New Country: Toby Keith, Beer for my Horses. This surprised me. I don’t really like Toby Keith’s newer music, but since Willie Nelson sang in this song, too, it really mellowed Toby out. “New Country” is such a broad genre, too, that to pick a single artist that can represent Chris LeDoux and Alabama as well as Brad Paisley and The Dixie Chicks just does not seem possible. I think this song works well in that sense, a melding of the older, more traditional backbone of the genre with the newer, more popular style as well. Incidentally, the music video for this song is one of the most laughable things I have ever seen. Probably a close second to the Journey music videos I used as research for my mullet.

Bluegrass/Country: Alison Krauss & Union Station’s Forget About It. For some reason I really love the drum in this song. This song probably stands second only to the last song on my list, and not far behind.

The Beatles Blackbird. What is there to say? The song is perfect.

Clearly, this list is flawed as Neil Diamond, Journey, Led Zepplin, and the Greatful Dead are all absent, but, I suppose you could write your own list. And tell me your favorites.

Music of the Year (2008), or, Still On a Physician's Timetable

Without much introduction, let's just talk the best music of last year.

7. Alison Krauss & Union Station – Live. This is #7 only b/c it is not new this year; it came out in 2002. However, it is deservedly on the list because I discovered it this year. Ms. Krauss & Co. have been on my many years, but I am embarrassed that I’d never listened to this album before. It is chock-full of awesome. Just listen to “Everytime You Say Goodbye,” even with the crappy Youtube sound, it’s still awesome.

6. Mates of State – Re-Arrange Us. I was turned on to this awesome group by the awesome radio program, This American Life, (which you should all be into). The band has a really fun up-beat sound in nearly all of their songs, but manage to not get repetitious. I think you will like them too.

5. Bishop Allen – Rain. Actually, if you want an album you can listen to start to finish, This Broken String is one of the best on this list. The songs cover the spectrum from just up-beat pop-fun in “Middle Management” to the more eclectic sound of “Like Castinets.”

4. Mike Doughty – Here's another one not discovered in 2008. Mike Doughty is the former singer of Soul Coughing. It's not often you get a real bass singer, and this guy pulls it off really well.

3. Band of Horses – Cease to Begin. This band has a great ephemeral sound to them, as well as some great harmony.

2. Ingrid Michaelson – You’ll all recogonize “Unbreakable,” and justly so. It’s a fun pop song. But the rest of this album is great too. The last half of “December Baby” for example, is great in its point, counter-point architecture.

1. The Mountain Goats –Heretic Pride. From start to finish, this album is ridiculous. I mean, who names their band after those shaggy animals? Have you ever seen one live? They are ridiculous looking. The band also has a ridiculous number of albums released. And they make ridiculously awesome remakes.

As for my favorites from this album, it’s difficult. The first song, Sax Rohmer #1 is really difficult to improve upon. The nasal vocals even work with everything else. Can you see it coming RIDICULOUS.

The title track is equally awesome. The simple piano background just pops out, the song grooves along, and you can’t help but love this song.

How to Embrace a Swamp Creature – besides an awesome title, this song also brings out a sweet piano theme in the bridge sections. The slow crescendo through the entire song is also great.

The quiet serenity of Marduk T-Shirt Men’s Room Incident is also great. There aren’t any videos with even marginal enough sound quality to post here. But I think you get the point. This album is awesome. Get it now.

And as a sneak peek of next year’s entry here is The National. Can you get a more plaintive, melancholy song than this?

As always, I’d love to hear your suggestions or thoughts on music. Is my list to pop-centric? Not enough feeling? However, if you point out any flaws, please bring a new/better song or artist to the table.

Medical Condescension of the Time Period , or, Primum Non Nocere, or, the Future of American Healthcare

Bryce’s Best of 2008 (Part 1), or, On Physicians’ Timetables, or, Sorry I’m Running Late

As my year drew to a close last week (one year of school left. Sort of.), I am reminded that I never put forward my Best of 2008 post. I had intended to write it, and even thought about it once or twice. However, doing “research” for the Best of 2009 article I plan to write always seemed more interesting. So, my selections for favorites that I discovered in 2008 are below. As always, I’m open to suggestions in all areas. Just make them good suggestions.

Without any further ado, here are my Best Reads of 2008.

Best Books of 2008

1. The Name of the Wind, by Patrick Rothfuss. This book ruled with incredible awesomeness. Undoubtedly one of the best fantasy books I have ever read, and it actually came out in 2008. It takes the very traditional, oft-repeated approach to fantasy novels of a young man, orphaned, who later turns out to kick ass. This one does it with some incredible flair, great prose, amazing puns (if you think I’m kidding, read the book and then tell me I’m wrong), and clever twists. This book definitely stands out, head and shoulders, as the single best book of the year.

2. The Backslider, by Levi Peterson. Long-hailed as one of the standard works of Mormon fiction, this was another very well-constructed story, with some powerful themes in it. I do not believe a comparison between the protagonist, Frank Windham and the main character of Catcher in the Rye , Holden Caulfield, is out of order. Clearly a “coming of age” type of story, told as Frank struggles to deal with his Mormonism, parents, neighbors, and love. It really is a great read, with tight plot lines. While the book does have a bit of an abrupt climax without much resolution, this is clearly intentional. The focus of the book is on Frank’s struggles, not on his life after the resolution of those struggles. While some of the story lines may seem bizarre to those familiar with Mormonism, I think they are fairly representative of Peterson’s experience with his religion as he was raised with it, and gives a fascinating peek into his experiences as a young man.

Incidentally, I took the opportunity to also read Canyons of Grace, a collection of short stories by the same author, and have come away very impressed with this English professor of Weber State University. I would definitely recommend this collection as well.

3. Dune, by Frank Herbert. I grew up consuming fantasy novels whole, to hear Mother tell it. How did I never read this book until this year? I played the video game on my 386 running DOS 6.0. I’m not totally sure where I got the game, but I do know it was from one of the pre-internet “BBS”s that I used. That game was fun, but it just didn’t make sense. It had these Stormtrooper knock-offs that were fun to play with though.

I made the unfortunate mistake of renting the movie Dune as a senior in high school. This should come as no shock to anyone who might be reading this, but Satruday nights, after 10PM, Top Hat Video would let any video still in the store be rented for $0.25. My dad had this sweet dual deck VCR ideal for copying videos, and I could squeeze three movies onto one blank cassette. Hence, logically, I would rent 10 movies for $2.50, copy them over the weekend, and watch them at my leisure. In this way I stumbled on Dune, the movie. And such things as Sting in a plastic pair of pants speedo.

But there is also some other actor in the film who looks just like him, and that really helped the plot make sense. Especially since I had no exposure to the story before the film. To sum my experience with Dune in my youth, I was always completely confused.

But I did pick up the book eventually. And the book was great. I was pretty disappointed when my roommate told me that all the subsequent entries in the series stink. And any book that can stand the test of time and desecration dressed in dark blue vinyl clearly deserves a spot on this list.

4. Honorable mention goes to Joe Abercrombie, for cranking out (quickly!) his trilogy that took the traditional Tolkien quest, told it exceptionally well, all while turning it on its head. The most believable characters – the most flawed characters – that I think I’ve ever read about.

5. Another Honorable Mention to Scott Lynch, whose first two books of the “Gentleman Bastard” series have been enjoyable, believable, and completely different from each other.

Well, that is it. My Top 5 for 2008. If you have read any of them, I would like to hear your opinion; if you have your own list of Best Books of '08, I would also like to hear that. I promise I don't only read fantasy.

So far there has not been anything notable produced by my research for 2009, but I have hope for some promising releases later this year. Suggestions are always welcome.

3 Simple Rules, or, Medicial Theory, or, Eww

1. Assume nothing. Every priest has syphilis until proven otherwise.
2. Believe nothing. Your patients will lie to you for who knows what reason.
3. Read like hell. And never stop.

These were passed along on rounds Friday afternoon. They rang true to me. But as someone with an insider's view of medicine, I'm curious, though, how are these perceived by the non-medical world?

As the same instructor pointed out, patients value their physician for, 1st, Availability, 2nd Affability, and a very distant 3rd, their Ability. Conversely, physicians judge other physicians in basically the reverse order. The ability to properly diagnose and then treat is far more important than friendliness in the care of a patient. While I agree bedside manner is important, I think I agree with my instructor here, too. Again, I ask the same question: which doctor would you want - the available, friendly one; or the smart one who figures out the disease and treats it properly?

On Synergy; or, Diversions

I've played Rockband once. I think the Beatles are okay. Put them together, though, and you get pure unadulterated awesomeness.



http://www.thebeatlesrockband.com/cinematic.php

Recipes of the Time Period, or, Corn Chowder, or, Say it Frenchie!

Corn Chowder
Makes 8 servings.

4 oz bacon, chopped into 1 inch squares
2 Tbs butter/olive oil
2 cups chopped onions
3 ribs celery, chopped
2 Tbs flour
2 cups chicken stock
2 cups milk
2 large red potatoes, diced
4 cups frozen corn kernels
2-3 Tbs sugar
1 Cup half-and-half
Salt/pepper to taste (read: tons and tons of pepper
2 bell peppers (red and green for color)
3 scallions, trimmed/chopped
1 Tbs fresh cilantro, chopped

1. In large stock pot, cook bacon ~5 min until almost crispy over med-high heat.
2. Reduce heat to medium-low. Add butter/oil, onions, and celery. Cook ~10 min. Stir occasionally.
3. Sprinkle with flour and cook ~3 minutes. Stir.
4. Add chicken stock, milk, and potatoes. Bring to simmer over medium-high heat. Reduce heat to medium low and cook until potatoes are just tender.
5. Stir in corn and sugar.
6. Remove 2 cups and puree. Add back to pot.
7. Stir in half-and-half. Salt and pepper to taste.
8. Bring back to simmer over medium heat. Add red pepper and scallions. Cook ~5 min.
9. Garnish with cilantro.

This seemed to be a major hit. I did use a bit more flour to thicken it some, and while I cooked the bacon in the pot, I didn't put any of the bacon in the soup until after serving it for my friends with vegetarianism, as bizarre disease if ever there was one. I also neglected the cilantro, mostly due to my poor ability to multi-task in the kitchen. I would be very sparing with it, though. It might work as a light accent.

Happy Mothers' Day! or, Happy Overworked-underappreciated Day!

To my Mother, my three dear Sisters, and to the Lighter Half of the human race,

Please read these two articles and give yourselves a pat on the back. I realize the first is in specific reference to Christmas, but work with me. It's still a good article.

Merry and Martha, by Kristine, at bycommonconsent.com

There is one story from the scriptural account of Jesus’ life that haunts and troubles me, like a Zen koan–the story of Mary and Martha hosting Jesus. It is a good story and a useful corrective to (Mormon) women’s tendency to privilege the meeting of others’ physical needs (real or imagined) over the sating of their own spiritual hunger. And yet I find myself wanting to defend Martha from the Savior’s gentle rebuke. Particularly at Christmas, I’m inclined to assert the value of hustling and bustling and busy-ness.

If our church services hadn’t been snowed out Sunday, it’s likely there would have been talks decrying the commercialization of Christmas, urging more thought about the reason for the season, pleading for a return to the simplicity and wonder of Christmases past. “Keep Christ in Christmas,” pundits urge, fearing, perhaps, that God might be outmuscled by Santa Claus. To all of this well-intentioned sermonizing, I say bah! humbug.

At Christmastime, we long for the kind of simplicity Thoreau achieved at Walden Pond with his mother dropping in daily to bring him food and clean laundry (!) (!!) Those Norman Rockwell scenes of contented, well-scrubbed families at church or around the table–the pictures we invoke to remind us of the “real” meaning of Christmas–they require a great deal of behind-the-scenes work by someone! (Even the paintings of the stable where Jesus was born suggest that a great deal of cleaning had occurred before the poses were struck). My least favorite part of the season is the well-intentioned (often male) voices urging us to keep our celebration simple, to not “overdo”, to slow down. This message creates yet another impossible double bind for women, who now feel pressure to make a magic, wonder-filled holiday for their families AND make it look easy. It is not easy, and there’s no sense pretending that it could be. Ordinary housekeeping and cooking and childcare are plenty of work; the imperative of extra-special homey-ness and glitter for the holidays inevitably makes more work. But, as Kahlil Gibran says so perfectly, “work is love made visible.”

The spirit of Martha broods over the holidays, a troubled ghost yearning for Jesus as much as her contemplative sister, pouring her love into cookies and trinkets and overwrought centerpieces. Her work is unnecessary only when it is unappreciated, redeemed when it is received with the gratitude due all lovingly intended gifts. Work joyfully undertaken and happily received is among the deepest satisfactions of human existence. Loving those around us will, of necessity, entail being “careful and troubled” about some things, at least. Perhaps Jesus’ words to Martha were less rebuke than acknowledgment. Perhaps we would have seen, if we had been there when he spoke those words, his great love and tender gratitude for her fussy gifts, and his yearning to give her that which he had to give which could only be received after the hustle and bustle were through.

I would like to think it was so. Part of the wonder of the scene at the creche is the image of the baby patiently receiving the wise men’s ridiculous gifts. Surely they were no good to him, but they were good for the givers.

. . . [edited for length]

And second, Not-so-great-expectations by Judith Warner, New York Times 5/9/2007

The father of one of Emilie’s friends stopped by last Sunday morning to pick up his daughter from a sleepover.

His phone rang. He spoke for a moment, then hung up, looking peeved. His wife was mad at him, he said.

“What did you do?” I asked.

“Nothing!” He threw up his hands. “I offered her pancakes!”

“You must have done something else,” I said, settling eagerly into a chair. There is nothing more enjoyable than listening in on other people’s marital squabbles.

“I did not!” he protested. Then conceded: “I offered her pancakes, when she’s on a diet.”

“Ah,” I said, sympathetically.

I am on a diet, too. Every time I move the scale from the tiled bathroom floor to the rug in the hallway, I lose two pounds. The same two.

“At our age, it’s really hard to lose weight,” I said, peace-makingly.

“At our age,” he replied sharply, “maybe we just have to adjust our expectations.”

This was a very radical idea.

I mulled it over all week. I realized that this very same not-so-great expectations theme had also come up, not long before, in a conversation I’d had with my father-in-law.

We were talking about sleep. I was ruing the fact that I need it – nine hours’ worth sometimes.

I was telling him about a woman I know who gets up at 3:30 a.m. every day to do yoga. She’s on her computer at 4:30 and on a train to work at 7:30.

At 7:30 I am usually spilling my first cup of coffee down the front of my bathrobe and screaming at my children that if they don’t get out of bed they’ll never again eat anything sweet or watch any TV or have anything they want in the world for the rest of their lives.

“I wish I could get up early,” I said, explaining all the gracious, relaxed, self-improved Simply Being I would do, if I had an extra hour or two in the day.

I was saying I wished I needed to sleep only six hours a night. Or five, or four – like the really successful people you read about.

I would wake up my children, showered, teeth-brushed and smiling, the way the magazines tell you to do. I would exercise and garden and pay bills and reorganize the kitchen cabinets and make photo albums and …

My father-in-law looked at me with genuine befuddlement.

“Why,” he said, “would you want to do anything more than you already do?”

What a question! What a mind-bend! What a culture-clashing, anachronistic, out-of-this-world concept this had seemed: Know your limits. Acknowledge them. Deal with them. It had struck me as a revelation.

But upon reflection, I’ve come to think that perhaps this is what it’s all about. “It,” of course, being this experience of life-on-the-cusp-of-middle-age to which I keep returning, rather obsessively, week after week.

If one were to be highbrow about it, one could see the desire for self-surpassing – the refusal to accept, for example, a muffin top, or a greater need for sleep – as a refusal to accept mortality, which is of course the ultimate self-limit.

I never had any sense of my own mortality until I was pregnant with Emilie, my younger child, now nine. It was just a twinge then. But it accelerated when Emilie started school, and suddenly – as my waist thickened and hair thinned – it dawned on me that someday all too soon both my kids would be gone from home for good.

(“What is it like to have older kids?” a mom of toddlers I’d just met asked me outside a moon bounce, at a birthday party recently.

“You realize that your time with them is limited. That soon it’s all coming to an end,” I answered.

A moment later, as I stood there suddenly alone, I wondered why people always seem to run away from me at parties.)

The timor mortis explanation is really the only way to account for all the lowbrow concerns that have increasingly crowded out my higher thoughts as I advance in my forties. The weeds choking the garden. The hundreds of digital photos that no one has ever seen. The kid-art that hasn’t been hung. All these undone things, all these instances in which I Fail to Meet Expectations (according to the imaginary report card I update every day), derive their urgency for me from the sense that, if did meet performance standards, then I would be living my life to the fullest. If the photos could be put in albums, if I could sit down with the girls to look at them, then time would somehow slow down, perhaps even freeze, like the images on the page.

Every night, for as long as I can remember now, I’ve been swearing I’ll wake up early the next day.

Now, though, I am thinking of giving myself a reprieve.

For on another Sunday recently I had yet another important conversation, this time with the mother of one of my best friends. She was telling me about how her mother had kept all kinds of family memorabilia. It was wonderful, she said, to have bits of personal history going back for generations.

“I’ve been meaning for so long to make photo albums,” I said guiltily. “At least for five years.”

“Oh, that’s nothing,” she said, folding her hands. “I’ve been waiting 50 years.”

And then she laughed. She had her husband and children and grandchildren all around her.

“Nobody makes photo albums,” she said.

There are far more important things than photo albums - your sanity included. And roast beef for Sunday dinner. But maybe we can pull that off.

With a little help.

OVERHEARD LINES: Study group for the SAT, or, She really gets it!

At a restaurant.
Him: The Lion King is to The Little Mermaid as . . .
Her: Doctors are to dentists.

OVERHEARD LINES: Taking Nicodemus Too Literally, or, Worst Hot Tub Ever

Woman, after finishing Easter Breakfast: I just want to crawl back in a womb.

Why I Love My Friends, or, Puns are Awesome

I was reminded tonight of how much I like some of my friends. I had the following conversation the other night. I bet you can't tell which one is me and which is my friend.

We're going to Fast & Furious tonight at 740.

You’re not serious.

I’m fast and serious.

Hope I’m wrong and it’s awesome. I just don’t see how that’s possible without Sam Jackson, snakes, and mother effing planes.

Dude, it’s the fourth movie of a series that should never have started. You know it’s gonna be awesomely bad. What have you got going tonight that could compete?

Anything.
Anything could compete.

Not true and deep down you know it.

But I’m living pretty superficially right now, so deep down doesn’t matter.

Here’s a chance for change

If I’ve learned one thing from the Republican party, it’s that Obama has shown that change is both impossible and dangerous.

Receipes of the Year, or, Vincent's Favorite

I've been planning several "Year In Review" posts for two or three months now. Best Books of 2008. Best Movies of 2008. Best New Albums of 2008. Best "Your Mom" jokes of 2008. Best Moment of 2009 (which is undoubtedly going to be January 2nd at the Sugar Bowl). Anyway, you get the picture. Like I said, I've been planning these for a while now. Yet with the few free moments I have, writing blog posts just is not a priority. Best Night's Sleep of 2009 keeps getting priority. Sorry you two. I'm sure you've survived without a new update.

So, without further ado, here are a couple of the best recipes cooked in 2009. Tthe first two are new to me this year. Odd, I think, that all three are desserts. While all three of these qualify as my favorite dessert, a friend told me that this first one was his favorite bar-none. Restaurants included. I hope you like it too.


Ameree's Mtn. Dew Apple Turnovers

2 cans Crescent rolls
2 Granny apples, peeled and cut into eighths

2 sticks melted butter
1 1/2 Cup sugar
1 Tablespoon Vanilla

1 can Mtn. Dew

Wrap apple pieces in crescent roll pieces and lay in 9x13 pan.
In medium sauce pan, melt butter and stir in sugar until just mixed. Add vanilla. Pour over rolls. Pour most of a can of Mountain Dew all over into dish. (I do all but about two swallows. Otherwise they aren't quite flaky enough).
Bake 350 F for 40 minutes. Remove from oven.
Sprinkle with cinnamon.

These things are awesome, and they go really quickly, so be sure to get one early.



Jenny's Bread Pudding

Pudding
2 loaves white bread, cut off crusts, cut in cubes
1 1/2 Cup sugar
4 eggs, beaten
1 1/4 cup heavy whipping cream
1 1/2 cup milk
1 stick butter


Caramel Sauce
1/2 cup sugar
1/2 cup brown sugar
1 stick butter
1 cup corn syrup
1 1/3 cup heavy cream

Caramel Sauce: combine sugars, corn syrup & butter in sauce pan over medium heat. Remove from heat and add cream.


Mix all the pudding ingredients except bread. Fold in bread. Put in non-stick 9x13 pan. Pour 1/2 cup of caramel sauce on top. Bake 350 F for 30 minutes. Rotate pan 180 degrees in oven. Bake 30 minutes more until golden brown on top. Pour remainder of carmel sauce on top. Serve with whipped cream or vanilla ice cream.

This is really tasty but super-rich. People can't usually handle too large a piece, so this will feed more people than you'd expect.



Mom's Strawberry Cream Cheese Cake

1/2 white box cake mix, bake ~15 minutes.

Whip 1 pint cream, add 1/2 cup powdered sugar.
Whip 8 oz cream cheese with 1 cup powdered sugar.
Fold cream and cream cheese together. Spread over cake.
1 pkg danish junket with 1 1/2 cup water. Put as many strawberry slices as will fit on top of cream. Pour junket over top while still hot. Chill and serve.

This has been my personal favorite for the last 10 years. The apple turnovers might be edging it out currently, but I don't know if they can hold on to the lead once the novelty wears off.

Sacrament of the Damned, or, Folgers in the Sacrament Cup, or, Gone Fishing

I was nine years old when I became a hardened sinner.

Grandpa wanted to teach me to fly fish, so we planned a weekend trip – just the two of us. I loved him, of course, but this particular grandparent was more intimidating than the mean-old-lady-substitute-Primary-teacher.

We rode up in Grandpa’s ancient diesel VW Vanagon – a vehicle never known for its stealth. Add to that the fact that, due to a childhood illness, Grandpa was deaf in his right ear, and it becomes clear why all our conversations sounded like a shouting match. But though these barriers to communication were high, they did not stop Grandpa from hollering a few jokes at me as we puttered north from Salt Lake. Jokes I would never repeat to my mother.

“What was the last thing to go through that bug’s brain?” he barked, pointing at a particularly large red-green splotch on his windshield.

“I don’t know,” I shouted. “What?”

“His anus.”

We got to the fishing hole before dark, time enough to pull in a few rainbows. Gramps did not have a pair of waders small enough for me. So I got to “cowboy up, kid.” Even in mid-summer, the water was icy, and numbed my skinny legs quickly. Grandpa had attached a billy club to his waders. He used it to crush the fish’s head as he pulled it out of the water. As for me, billy clubless, I was just supposed to break the fish’s back with my bare hands.

Fishing was rapidly losing its allure.

Finally, the sun sank below the horizon and I gratefully followed Grandpa to the van, shivering the whole way. We drove to a parking lot, warmed up a nice dinner of pork and beans, and retired for the night. I knew that a full day of fishing awaited us tomorrow. A day full of fire and brimstone, damnation and hellfire, because God had me in his scope, and was about to pull the trigger.

I woke as Gramps fried up some of the previous night’s catch. I still have no concept of his actual skill at cooking trout –I’ve never been able to bring myself to try one again. I picked at my fish for some time while he worked at the stove, fiddling with a strange, tall pot that had a transparent bubble on top. The clear bubble flashed brown occasionally, letting off strange gurgling noises, too. After a few minutes, Gramps finally poured me a mug of whatever it was. Pushing the mug across the breakfast table he muttered, “Here’s some sugar, if you want it.”

I was nine. Of course I wanted sugar! I wanted even more after I tried Grandpa’s new drink. Could he make nothing that tasted decent? A liberal dousing of sugar was the only thing that made the drink passable. I stopped pretending to eat the fish, and nursed this new breakfast drink instead. It soon became clear, however, that I had scrimped on the sugar. So I added more after every few sips and quickly found the point of diminishing returns: the sugar stopped helping. The drink became cold.

There I sat, longing for the pork and beans of the night before, picking at a mauled trout fillet, playing with a half-cup of brown swill swimming over a bed of undissolved sugar, when Grandpa’s harsh voice scolded me:

“What, you’re gunna be a damn Mormon brat and not drink your coffee, either?”

Suddenly the reality of Grandpa’s bitter brown liquid became horribly clear. I sat dumbstruck; my mouth suddenly glued shut. A flood of Primary lessons came rushing back to me. “The Lord has given us these bodies. They are holy temples. And cursed is he who defiles a Temple of the Lord,” I could hear Sister Purplehair declaring, “How would you feel if someone spray-painted graffiti all over the Salt Lake Temple? Well, that’s how Heavenly Father feels when we don’t respect our bodies!”

And here I was pouring filth straight into my temple!

My mind was racing. “Coffee! How could you be so blind, Bryce? Maybe you wanted to be blind. You wanted to be led away in sin. You wanted to walk close to the edge. Well, you’ve done it now. You’ve walked up to the edge and jumped right off. I sure hope Hell is nice this time of year. Hello, Brother Lucifer, long time no see.”

Plainly, I had become one of the vilest of sinners. But I did not want anyone else to know my shameful secret. The seriousness of my sin swirled in my mind as the water lapped around my legs that Saturday in the fishing hole. That my fallen, sinful, and horrifying state should be kept from my family, and especially my parents, was painfully clear to me. The first few years of my deception turned out to be easier than I had feared. I was not due for my next bishop’s interview until I was 12; and not having the priesthood meant no monthly PPI’s questioning my worthiness.

The Sacrament, however, was a challenge. My education in this area had been quite complete. You were NOT supposed to partake of the Sacrament if you were not worthy, unless you wanted to ensure your own damnation, of course. Woe unto him who eateth unworthily and what-not. I knew that I had already bought my ticket to the underworld, but I did not need any more flight insurance.

So I developed a strategy to hide my shameful status as a Sacrament non-partaker. When passed to me, I would pinch the bread between thumb and forefinger (right hand, of course!), bring it toward my mouth, and deftly palm the piece of bread. It could then be slipped inconspicuously into a pocket while a bit of artful misdirection on my part – pretending to chew and swallow – completed the illusion. That was the easy part. Smooth sailing to this point. I was a David Copperfield in training. I could make anything disappear. Until the next tray arrived.

Water. It was just an ounce or so, but it was a liquid ounce. I could not simply palm and pocket this. Nor could I merely pass the tray untouched. The whole ward would obviously see that. Neither could I just press the cup to my lips, as Pops would surely notice. I had no choice but to actually allow the water to enter into my mouth. Only then could I evade detection as the whited sepulcher that I had become. But once in my mouth, it was imperative that it not proceed down my throat to water the seed of damnation inside me.

I was a skinny, limber child and could easily double over on the pew. It seems only obvious that I would assume this reverent, contemplative pose after taking the water. Letting the water trickle out from my mouth onto my knee thus became child’s play. My father, who could detect whether or not water had been sipped from the small paper cup, would never notice the four inch wet spot on my knee. Or, if all else failed, I could wait until the Sacrament was over, go out into the foyer, run the drinking fountain, and place my lips into the stream of clean water . Only then would I allow the damning water to dribble out of my mouth and down the drain.

This continued for three years.

As I neared my twelfth birthday, I became aware of an upcoming event that could bring my house of cards crashing down around me: the required interview with the Bishop prior to my ordination to the Priesthood. I had the Articles of Faith down pat, but I had no idea what questions the Bishop would ask me or what the consequences would be for failing to answer one correctly. Public humiliation? Denial of the priesthood? I did not know, but my conscience was not completely seared by my wicked past. I resolved that I would not tell a lie to the Bishop. I knew I was already in deep enough.

The bulk of the interview passed without note—my worries were for naught—until that damning last question. The one designed to catch sinners like me.

Yes, there were things in my life that would keep me from receiving the Priesthood.

Lower-lip quivering, my mouth opened. And though the powers of hell conspired against me, making the walls close in around me, my throat dry up, and my stomach clench, I confessed.

I can still hear the Bishop laughing.

My Country, Tis of Thee, or, Go UTES!, or, Oh, Canada!

In true American style, as a self-declared patriot, I declare that if the nation does not vote The University of Utah Utes the National Champions of the National Collegiate Athletic Association Football Bowl Subdivision, I am moving to Canada.

Word of the Time Period

Koro.

Worth googling. I promise.