A Common Farewell

When all is said and done, the greatest failure is the loss of a friend.
Someone you cared for, someone you liked.
Gone, just passed on like a ghost, never again materializing,
but there to haunt you with the question, "Why?"
There's no certainty, sometimes, just a sinking suspicion that
things are out of whack.
Someone reliable starts getting flaky.
Someone friendly grows distant.
That is as great to me as a loss of love.
Unwritten on a tombstone,
not mentioned in our eulogies,
but nevertheless they are the cores of our lives.
Some we know for years, others for months, others for less.
What will happen when our worlds cease to collide?
Sadder because nothing can replace you.
Gladder because someone else can try.

When flu flies over the coop

There is a risk, with a reemergence of a new strain of flu, that the weaknesses in how we provide health care in the United States will be exposed to the breaking point. While the CBO does not consider the short term value of preventing illness through providing universal preventive and primary care, the CBO and everyone familiar with an overburdened emergency department understands how costly it is to everyone, patients, hospitals, insurers, and the insured, when people without access to a primary care physician become ill and require emergency care. The price this year for not already having these measures in place could be tremendous.
The H1N1(2009-A) virus has characteristics that indicate a propensity for the lower respiratory tract, or the lungs. Accounts from Australia suggest that artificial ventilation is often required when the disease progresses beyond its early stages. Countering this concerning news is the rapid development of vaccines and the success had in treating this disease with anti-virals that are already in large scale production. Unfortunately for the U.S., versus most other industrially developed nations, tens of millions of our citizens will not have a provider to see to get a vaccination before being infected or treatment with anti-virals within the first forty-eight hours of initial symptoms. For those who do not get better with rest and fluids, intensive care will be common to an extent not seen in our lifetime. A shortage of ventilators could leave people dying in hospitals across the nation. Use of ventilators will cost hospitals dearly, and these costs will be passed along to the rest of us. With all due respect to the CBO, it is obvious to almost all close to the issue that preventive and primary care provided to all will save a great deal in terms of finances and lives.
I sometimes wonder how bad it has to get before the status quo in health care will be fundamentally reworked. This fall, the emergence of this new flu will give us another chance to compare our system to our peers in Canada, Europe, Japan and elsewhere. We will see, if we care to look, how well we stack up when our emergency departments fill up and there are no more vents available to keep people alive. What Churchill would call an “Era of Consequences” appears to be coming over the horizon. This time the costs may be too great to continue doing business as usual.

Underneath it all

Living in a small town makes me appreciate riding a subway in a big city.
A walk down Main Street in my hometown usually results in a random encounter with an acquaintance. Normally that is a welcome occasion; generally speaking, I enjoy meeting someone I know. Kind of like a surprise party, but without all the wrapping between you and the present.

This almost never happens on the subway. In the big city you trade in familiar faces for complete anonymity. And it is liberating. There is no one else there to remind you of who you were, so who you are is up to you. And sometimes that is just what you need. A break from the past just long enough to let you live in the moment. Sitting on a platform in Queens, after a full night of drinking and a half night of sleep; that is when an early morning flock of pigeons can be heard between trains. And your soul takes flight with them. You have no one to answer to, and no one to listen to. A rare chance to listen to the sound of your own wings flapping in the stillness and unencumbered backdrop of a city of millions completely unconcerned with where you are going or where you have been, but still willing to offer good directions if you decide to move from where you are.

Murder on Broad Street, Middletown

A Wesleyan junior was murdered on the street where my daughter goes to school.
How often have we seen a single impulsive act born of anger bring lifetimes of suffering? There is a sickness in our culture that turns heart-sick men into monsters.My daughter's school walked by this place on the way to the Y minutes before this happened. My wife was called to pick her up at the Y when the return route was blocked by a police perimeter. She was told a bad crime had taken place, and she asked "Was something stolen?" When she was told no,she asked "Was someone killed?" How will this eight-year-old feel next week when she walks past this place? And when she is eighteen, I will worry for her safety at the hands of some young man too blind with passion to know what it is to truly love a woman.
Somehow we must teach our young men the horror and destruction that will follow should they lose faith in the goodness of life in the face of emotional pain from life's many disappointments. We need to build circuit breakers into their thought process so that they never choose to destroy what they can not possess. That is the difference between seeing a woman as an object of desire and truly caring for her.

Mid Winter's Dream

There is something incredibly soothing about snow falling on a busy day. Cars slow, and the world pauses to watch a new coat of white paint dry. Familiar landmarks are subdued as a dreamscape descends and buries not just the surface, but thoughts of the day, as well.
I do not think the the same way when I am watching the snow fill the air and cover the ground. It is as though the old world has come to an end, blanketed by a fine linen sheet drawn gently across the face of a recently expired patient. For a while time is frozen by the relentless piling of powder.
Old songs on the radio play like new. Worries and memories disappear in the face of the ancient threat of wind and cold tamed by a car heater set on hi. Driving through the cloud of flakes, the traffic proceeds slowly, carefully, red lights blazing a trail to the horizon until they disappear into a point. Brake lights call out in warning of ice on the road ahead.. The danger claims me from the cloud and I grip the wheel tight, ready to turn away from whatever might hurl itself in my way. Once past the frozen bridge the tail lights line up two y two and march into infinity bliss. My ride has cut a ribbon through heaven, but it closes behind me as soon as I pass. My ride is almost over, and with it a dream of oblivion to end a busy day.

Healthcare Nation - To be or not to be.

In these times when even our most dependable institutions are challenged to their breaking point, it is important to appreciate that it is the commitment of a community to provide for its members that is the bedrock of a society. Institutions come and go and are replaced with new ones as humanity tries and tries again to create systems and structures to achieve a defining mission.

All of these collective efforts include an identifiable membership with roles essential to the success of the mission. The roles played by various members change as an institution is forced to adapt to changing circumstances. An organization where roles are rigidly defined often neglects important feedback and fail to change with the times. Sometimes when a system is under stress it fails to fulfill the mission and contracts, decreasing the membership it benefits. Other times it is a change in the membership that forces a change in the system. More mouths to feed challenge nations and families, alike, to extend themselves to meet basic commitments. Priorities change. Values assert themselves at the expense of other values. A rising tide lifts all boats, except when it is a sea of red ink.

Returning to the theme that a society is defined the commitments it fulfills for its members; our nation’s identity is not just a matter of who we are, although that is a question that is the subject of great debate. Our nation is also defined by what it is we do for one another.

Other nations provide affordable healthcare to its members. In the United States today there co-exist two nations: one whose members have access to healthcare, and one whose members do not. The border between these two separate nations is not well guarded. With every pink-slip families slip across the porous border between Healthcare Nation and Healthcare-Not Nation. This is a border I wish our leaders would strive to secure. So long as we accept a sub-nation of people lacking access to healthcare there is going to be a risk that their numbers will swell, as their domain encompasses more and more Americans.

Lincoln spoke of how a house divided against itself will not stand. We must let our leaders know that we will not stand for our nation to endure the fate of a divided people.

John Kilian, RN

Bombings in Gaza: A Christmas present for Hamas?

In general, extremists seem to fear moderation more than they fear opposite extremists. Hamas may cry foul about these attacks, but maybe this sort of intervention is what keeps them relevant. A secure and lawful Palestine would have little place for the antics of Hamas's militant leadership. And the leaders who prosecuted the invasion of Lebanon to save Israel from Hizbullah are now pursuing the Hamas bogeyman with excellent zeal.

What both these sides may fear most is elections in Israel and U.S. leading to more constructive engagements that will, slowly but surely, leave them behind the way the IRA in Ireland succumbed to a reconciliation of former enemies through a political process.