Month: May 2010

Apoptosis of the Species

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A CHILD WALKED on the beach near Gualala, Calaifornia,  on a clear moonless summer night. The sea breeze had let up and she gazed at the rising  starry darkness, disordered by an occasional satellite mirroring the sun below the horizon. A strange figure approached her, a diminutive man costumed in a mail coat and carrying a plumed steel helmet under one  arm. He could not be ignored as they were completely alone.

“Who are you, anyway?”

“My Welch name is Gwalchemei, but the Brits call me Sir Gawain, and the Cthix call me… something you’d find unpronounceable. I have a message for Merlin. Could you please direct me to him?”

“I doubt it. Merlin lived hundreds of years ago on the other side of the world.”

“I detest the autocratic, bureaucratic, incompetence of the CPGW. You’d think they could pay more attention to simple details. I had hoped to alert your world earlier. I suppose I shall have to make do with you, with here, with now.” He looked into his helmet while rotating it slightly. “I see; this is 2007 your time, in America, right?”

“Very good. Pacific Standard Time.”

“I’m only allowed one contact. No touching.”

“Not to worry.My Granny says dwarfs give you warts. What’s the CPG…what you said?”

” Warts!?  Well, it’s true so keep your distance.  The  Inter Galactic Commission to Promote Galactic Warming. CPGW for short.”

“Wow! Where are you from?” asked the Child.

“I am from Infinity. I suppose in your world, from Time.

“Time! There is really only one time. Now.”

“Ah, no. There is time, and there is Time.  Your Mr. Augustine, was it,  said, there is knowledge, and there is Knowledge. They are different.

“You are as weird as you look. Short and confused.The old time, the past is gone. the time to come isn’t here. So…”

“Knights were all short by your standards. I think my representation is very good indeed. By a knight’s standards Americans are blubbery giants. But enough pleasantries.  I’ll just ignore your error in logic. I’m in a hurry.  But curious…what are you doing here alone at night?”

“I’m looking at the stars. In West Sacramento, there are only a few.”

“Stars? What do you know about them?”

” They are just stars. More here than at home.”

“Just stars! We are all made of stars; but what are they, really?”

“OK, I’ll bite. What are all those stars?” said the Child. ”

“Well” said Gwalchemei hesitantly, it’s a long story. They are created by the apoptosis of species; of worlds. ”

“A pop-what?”

“I’m not sure you are old enough to understand. I shouldn’t have mentioned it.”

“I’m fifteen! My teacher said stars are Suns.”

“Help me ye gods! A huge teenager!  With a Big Mouth! Well, yes; they are like suns, some of them; why are you out here looking at them?”

“Well, I guess… I wonder…” the Child hesitated. “How did they get there? Who made them?”

“People something like you made them.”

“No way!”

“They didn’t plan to make them. It just turned out that way.”

“That’s dumb.”

The Knight sighed deeply, shivered, and sank to his knees. “Do you mind if I lie back here on the sand? It’s still warm from the day and my mail is cold in the sea air. I’ll tell you about Sun, your closest star, and you will know about all the rest.” He threw a heavy faded woolen garment over himself, rested the nape of his neck on his palms, looked fixedly at the starred darkness, and continued without shifting his gaze.

“Once Sun was a planet. Not an ordinary planet. Life developed there. Beings appeared, but of a different shape and size than yours. They evolved. The most aggressive and lethal flourished. They became Creators of Tools, Language, Gods, and Writing, much like humans. They seized Dominion of their planet and all life there. They learned the secrets of Things. They gathered and accumulated Knowledge without the capability to understand it.”

“But God created everything, knows everything, loves everything.”

“Oh yes indeed. But the beings who lived on that long ago planet created God; many Gods. Some Gods feared one another.”

“Which Creator was First?”

“There was no First. First implies that Time has meaning. That is why this story is so hard to tell. It has to do with Infinity.”

“Why, I know what that is!” said the Child eagerly. It’s when you divide a number by zero. It’s when something has no end and no beginning like numbers or fractions; like i.”

“You do know, don’t you! You are a good student. But I doubt you really understand infinity. One thing is to know; another very different order of things is to understand. People know the concept of infinity; not what that implies. You talk of life eternal, or infinity squared, and ‘orders of infinity’ as if you understood. You know some things that big numbers can do. As when a baby takes its first breath, it breathes in so many molecules of gas that in its whole life it will never breathe them all out of its own lungs. So you know that. But not the implications of Infinity or Time. Both are beyond the ignorance of reason.”

“You say there’s no First? Do you mean like the Chicken and the Egg?”

“I do mean something like that. Because the question has no meaning. The question about the ultimate or beginning or ending has no meaning.”

“Well, laughed the child. “You lost me.”

“Of course. We are all lost in Time and Infinity.”

“OK OK OK!” said the Child, with an impatient look. “Get back to the stars.”

“OK OK OK!” replied Gawain with a shudder. “The Stars. Sun was once merely a planet, but Life lived there, and evolved into Beings, who gained more and more knowledge of Things, of the Universe, of Universals. And one day one of these intelligent clueless creatures discovered how to unlock the power of dark matter or energy some call it; and, inevitably, some smart creature did it. All that energy that was trapped in the Stuff of this galactic region was unleashed and self destructed. Ultimatlely… a long long long time, it became what you call a Super Nova. Every one of the stars you see overhead began that same way. Can you imagine all those intelligent beings,  all those worlds, brilliant discoveries, achievements, insights, atrocities, vanities? No one can. It is in the nature of Life that this happens: all life forms are born and develop. To review, one species succeeds beyond reason, and ultimately self-destructs. Round and round in infinity, where all time is OneTime and all places One Place. Apoptosis on a grand scale;  apoptosos. Sorry; google it. “On Earth that process started with religion, proceeded to magic, alchemy and onward. I had hoped to convince Merlin to slow down the process of apoptosis for humanity. Now thanks to the bunglers at CPGW, I must rely on you, although it’s very late, and I must leave. It’s up to you.”

“Go on!” cried the child, turning away.

“It’s Gawain, not Gowon.” Said the Knight with a sad smile.

“Whatever.” said the child. “I too have to go on. Good night, good Knight, you crazy dwarf.”

Yes.You must go on; that is truer than you suspect.  But Ppease think seriously about what I’ve said. This is my job you see,  to warn you here on earth. Even though I fully expect nothing will come of it I have to do it. Your granny may have told you about warts. My granny told me this was all a big waste of effort. But there it is.  Mission Accomplished. Adios.”

“Ah! Dios! “, said the Child, smiling archly.

They walked away in opposite directions, occasionally looking back to see if the other were real, while the distance between them kept its pace with infinity.

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Anthrax Exposure?

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“I think I May Have Been Exposed to Anthrax”

What happens when someone suspects an exposure to Anthrax? This is a first person fictional account based on a real event. The time, the web sites, and their contents, are very real.

Oct 17, 2001 – At 5:00 p.m., as the office was closing, the secretary to a local judge appeared requesting to be seen for an urgent matter. I knew her to be a very capable person not given to exaggeration, who had always been in good health. Her problem was one I had thought about, but had never expected to face in my own practice. She had opened a suspicious letter and was concerned about anthrax exposure because she now had a sore throat and general aching.

“What did the letter look like?”

“It was hand addressed to the ‘County Court.’ I opened it and some gray dust fell out.

Inside was a weird note.”

“Weird? You mean threatening?”

“Well, I’m not really sure. Yes and no. I couldn’t say. It seemed like a prank,  but a senseless one. It was only about ten words, written in block letters. It was so strange; I just laughed at it and showed it to the law clerk, then threw it out. But as I reflected, it wasn’t exactly funny, and I washed my hands and dusted my desk. That was six weeks ago; I never gave it a thought ’til now. There’s the anthrax thing.”

She and the clerk couldn’t recall exactly what the note said, even after thinking back as hard as they could. It was something like, ‘Cocaine for infidels and harlots. Enjoy.  In Shah Alla.’  There had been no other symptoms, no fever, no other people ill at work, or at home.

“So why are you concerned now?”

“Yesterday I felt tired, and had a slight pressure in my chest., a little cough.  I had some Cipro and started it. It was the prescription they gave dad before he died. I know I shouldn’t have, but I heard that by the time you get symptoms of pulmonary infection it’s too late.”

I’d planned to play poker that night, a game with friends that had been a regular thing with us for years.  My wife suggested I  ‘Bond’ more with Buddies.  And actually i have enjoyed that. But now I, in my own myopic way, was another victim of terror,  and  I sat down, resigned to my fate. At this time of day, the local Health Department was on phone tree answering machine mode. But with this scenario they wouldn’t have done anything at this point anyway. Nor would the police.

Then I remembered the mythic e.net. I excused myself, went to my office, and mounted Browser, my net-horse, settling easily into my Windows saddle for a pixel ride. I would go until I reached a place where a clear decision tree was laid out. I knew that there was some sort of CDC national plan such that local police and health departments were terrorism first-responders. But here there was no longer a crime scene, so I urged Browser on expectantly to What Next.

The local health department did have an electronic information tree. But after a few minutes it became clear that it didn’t yet include bioterror. Employment opportunities. Women’s rights, Babies, Rabies and Scabies were the best there was. “Hell,” I thought, “Why couldn’t it be itsy bitsy mites jumping from the mail? I’ll just  ride on to headquarters, to the top: CDC. “There it is! bt.cdc.gov; bt for bio terror! Maybe I’ll get to poker before the beer is gone.” There was a page of links. And links to links in an elegant chain to… where? I began to click on likely ones. ‘Facts and FAQs about Anthrax. Botulism, Plague, Smallpox.’ Seven pages of them. But it was boilerplate, nothing about what to tell my patient at 5:20 p.m., PDST.’

‘Preparedness; Training; Laboratory issues; Info. Technology; National Pharmaceutical Stockpile.’ There was a phone number for Public Inquiries, another for Emergency Contacts and still others for CDC itself. But this wasn’t an emergency after six weeks. ‘Protocols’ That should do it! I linked to: ‘Interim Recommended Notification Procedures for Local and State Public Health Department Leaders in the Event of a Biochemical Incident.’“Well,” I thought, “at this point I’ll take anything I can get.” But it was actually what it claimed: “Health officer notifies local law enforcement and FBI, then State Health and other response partners per pre-established notification list,” which of course I didn’t have and wasn’t pertinent to a 6-week-old unlikely exposure anyway.

I pushed Browser on to the Morbidity and Mortality Weekly Report where there was a ‘Continuing Education Activity’ based on vol. 49, RR-4, expiring April 21, 2001’. But itdidn’t seem reasonable to take an obsolete e.course at the moment. Besides, the test questions were there, and in large part seemed clearly designed to help justify course perpetuation. But wait! There at bt.cdc.gov/documents/Anthrax etc was:

‘How to handle anthrax and other biological agent threats’. “Whoa, Browser!” After the Do Not Panic section were several scenarios starring powder – containing letters/packages all leading to police or 911. But they didn’t apply after six weeks, no envelope, degraded site. Reluctantly, I headed Browser to the 26-page April 21, 2001 MMWR report entitled ‘Biological and Chemical Terrorism: Strategic Plan for Preparedness and Response.’ No help despite the fancy title.

Then a 15-page ‘National Bioterrorism Preparedness and Response Initiative Report’ of May 8, 2000. Then a 15-page ‘Public Health Preparedness and Response for Bioterrorism’ in which the last entry on a list of upcoming events, ironically, was a Sept 10-11 2001 meeting in Orlando, Florida. By the time I read all that my patient would have died from old age or from anthrax right in my office.

It was clear that the answer to my question – what to do next or where to find the proper advice for this patient tonight – was not addressed. I would have to base a decision on the least wrong thing, most right thing. But isn’t that what every doc does, with every patient, every day?

I decided: Do Nothing.

Back with my patient I reviewed the situation. I advised her again about the extremely favorable position she was in, statistically speaking, without confessing that what happens to a single person can be different from what happens to numbers.  I allowed that she might as well continue the Cipro until I was able to review the case with our local public health officer. I suggested that if asked by people at work, or by her family or friends about risk to them, it was now a moot matter; no one actually had anthrax after six weeks, and the suspect mail was not available. I planned to see her again in a week, mainly to decide about stopping Cipro. Lastly I again explained why testing was not advisable.

She left. I corralled Browser and went to my poker game. I lost.

Oct 18, 2001 – End of story? No. As I had feared, the next morning the chief administrator for the court called about an anthrax test. I was aware that his daughter was a veterinarian, and wondered if he had spoken to her about the advisability of doing expensive and inaccurate tests requiring a number of days to perform, then in the end arriving back where you started, with a decision based on clinical evidence.  After all, vets are far more knowlegable about herd medicine than physicians. We have much to learn. He had talked with her. He understood. She had explained it perfectly. But…

“But doctor, isn’t it possible to just do the test anyway? You know. To allay fears here. And your patient states she isn’t sleeping well; she, too, feels a test would relieve her mind.” There are times, actually more than a few, when it is right to do the wrong thing. I realized this was probably one.

“Of course. Please send her right over. The results will take a few days”.

“But I read in the news that they do them in a few minutes.”

“Well, that is true and not true. There is a test to find anthrax spores in the environment. Or in an envelope, places where contamination is very high. Then there are cultures. First, one looks for organisms like anthrax. If suspect organisms are seen, one must re-culture requiring more time. Then finally a capsular test can be used and may confirm that anthrax is even more likely, but still not certain. And ultimately a DNA test can be done, though that’s not available except, I think, at CDC.”

“But isn’t there a blood test?”

“Yes, but that relies on the presence of antibodies. It requires that actual infection be present for at least a few days, and even so it is not diagnostic; as in the capsular test, other non-anthrax organisms can lead to a positive blood test.”

“Well  shit! It seems to me the news media has been great on sensationalism, the modern standard for professional journalism, and terrible on informing the public!”

” Tell me about it!” I said. “They do best what pays best.  And they are not alone. It is the law of the land,  primum dollarum. Res Upsa Loquitor and al that stuff.   Sorry, Judge!  But maybe, in large part, contradictions result because the best course is truly unclear yet. The solution, or solutions, are complex. We are all learning. A relatively  qualified expert may never have personally seen a case of pulmonic anthrax, and read about less than a hundred in recent years, most all in foreign countries, and some 85 or so downwind from a Russian biological warfare facility in the former USSR. How does one decide, for example, what antibiotic is best? Only the makers of Cipro, an expensive proprietary antibiotic, did the research; it didn’t pay to research the low cost antibiotics. But even then there was no work on real people.”

“ If I were cynical, which I’m not, I’d wonder if Bayer sent the envelopes! Sorry for the bad joke! This has me wierded out. I’ll send her down. Thank you. I really do think doing a test will help.”

So here we are; all waiting for the results of the nasal swabs. Today I spent more time on Browser, and rode him through the National Library of Medicine, at nlm.nih.gov. We galloped through dozens of article summaries, and nothing changed so far as my patient is concerned. I know a little more about vaccines, which, so far, are monumentally impractical for general use. I also spoke with the local health officer, who confirmed that until I had an actual case, or credible evidence of high risk, neither they nor the police would get involved.

“But,” I objected, “if the case is pulmonic, actually mediastinal, the first patient dies.”

“That’s right. Like the index case in Florida. The rest usually live.”

“Cool,” I said dryly. But that’s state of the art, until we learn more. To paraphrase Pogo, “We have met the  unqualified and unprepared Leaders, and they is us.”

Disneyland, A Small World Lost

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In honor Small World Order Day, Disneyland provided each child with a black cardboard placard-pendant in the familiar shape of a Disney character’s head. Each child’s home town was writ large on the front in phosphorescent chartreuse with the parent or responsible adult’s name on the back. The entrance fee was 75 percent off and a huge crowd was expected so that Security wanted bar codes and portable scanners to keep track of lost kids, but Publicity objected; they felt it lacked the personal touch. That was the end of the bar code proposal because the Disney personal touch is sacred. And of course P comes before S, so both alphabetically and practically, Publicity ruled.

It was a cool morning and we hadn’t seen “It’s a Small World VII” the last time,  so joined that line first.

My son was a Pluto Venice Beach and my daughter a Minnie. Venice Beach, too, of course. Things didn’t look so bad. There were only about 200 people back from the covered part of the line. I felt sure we’d be in the shade before long even though we were still so far from the front that I couldn’t hear  the Small World music. Music? Speaking relatively.  Since I wasn’t sure it was the right line I asked the Donald Brooklin’s adult in front of me, in my most cheerful voice.

“Hi! I’m Don Nocere.” He turned his head slightly but not his trunk. “Do you know if this is the Small World line?”

“How should I know, I’m from the East. We don’t do this kind of line thing there. My curiosity got the better of my reason. ”

I turned to the Belle Bogota’s lady behind me and asked again, but she looked puzzled, and fired off  some machinegun Spanish. I couldn’t tell if she was angry or trying to be  helpful. At last she looked down at the Belle herself, who said:

“She don’ know.”

Well, no one in voice range was actually sure. I got on top of a bench to look and still couldn’t tell. Finally the Minnie Minneapolis’ mother, two places back, went to look. Her brother was with her and would watch the Minnie. Curiously, they hugged and kissed and looked teary-eyed, like she was going on a long trip. As it turned out, they were right. In about 20 minutes the Minnie’s uncle asked to take Minnie to the bathroom; would I save his place? The Huey Stockholm behind her seemed OK with that. Life goes on, even in line.

People began to interact, usually with tolerance, sometimes with humor, occasionally with irritation. Mickey San Jose’s man (there were quite a few Mickeys and Minnies) was constantly on a cell phone, and he wasn’t the only e.type; soon we could overhear stock trading, game playing and even hushed tones of phone sex. We inched along at times, and at others seemed to stagnate. People in adjacent rows sometimes became quite involved with one another, and as the line snaked back and forth tried to maintain contact. An Aladdin agreed to move back, so as not to be separated from a Snow White. People from Brazil moved to be with their countrymen. Communities formed.

There were problems, too. Some people, probably strangers unaccustomed to lines, became restless, and complained to an attendant, who reassured them that the park would stay open until all in line had completed the ride. By nightfall the management brought out cots and bedding. In their opinion, they said, this was the line for ‘It’s a Small World VII’.  We were advised that by using a charge card we could rent laptops with movie CDs. Of course, they were all Disney, but one has to admire genius for organization and the human touch.

At 11 pm the Minnie Minneapolis had still not returned. Her brother was worried. Some felt we should send out a search party, others that it was too risky. A Somethingorother Sacramento insisted loudly:

“What the hell, when she comes back, we’ll have to send somebody else out to search for the searchers. I say wait. She’s got a sign on!” Everyone started speaking at once. “If she was your own sister, you’d not say that!”

“We still don’t know if this is the right line! They only said they thought we were in the right line.”

“I say we need to get organized here.”

The California locals were dominant of course, and had much experience with both Disney and lines. They controlled the resulting Committee, and elected as Chair  a Mickey San Jose. A lot of other Mickeys voted for him too. They acted like their Mickey sign made them upper class. The Committee issued numbers so we could go and come without losing place in line – to the bathroom, or to get food, whatever.  In time the Committee grew unreasonably  because it was necessary to make it reflect the diversity of color, sex, age, weight, height,  language,  income quartile, hair color, and so on. So the committee selected a Supreme Administrative Council, SAC, made up of a Mogli Mexicali, a Flower Singapore, a Lion King LA, a Moulan SanDiego, and a Minnie… Auckland, I think, I can’t recall her last name.

In the second week a big fight broke out between a Louie Portland and a Dopey Miami. Both had been drinking and Louie accused Dopy of  using a racial slur, Obamacare.  People joined the argument,  leading to  shouting, shoving, cussing, bird flipping and Jerry Springer finger whipping.  Finally Disney Security appeared and Dopey and Louie were thrown out.

The SAC allowed adults to let their children stay with other adults, provided they were of the same type: That is, for example a Hewey with a  Louie  or a Daisy but not an Alladin. It was deemed as  abusive to allow a Porky to care for a Belle , as it would  be to for a child of color to be adopted by a white, even though in both cases no one  could reasonably say why.  After that big row, the council named a Sergeant at Arms; a Pittsburgh Little Mermaid who was a defensive lineman for the Steelers.

Disney management took care of the trash, but other services were lacking, and only gradually became available, as provided by entrepreneurs in the line: like clothes washing, tent rentals, sundry sales and psychological counseling. I was in danger of having to provide medical services after my son let it out that I was Doctor Don Nocere; but I pretended to be a pathologist, and was deferred from the doctor draft.  Someone confessed to being a pediatrician, typically the most community minded of all physicians.

Religious services  of  various traditional or opportunistic stripes began to be held regularly. Pocahontas Beirut set up a tent massage parlor, but some folks found the presence, or should I say the noises, irritating. The  SAC resolved that crisis by taxing the massage artists- owners and moving the business tent to some distance, where the operation could be better ‘regulated’. Naturally the  SAC members spent a lot of time there. Alcohol, bookmaking,  money changing, banking, and drug trade were not allowed by Disney, and were therefore hugely popular and profitable.

We never heard from Minnie Minneapolis again. Her memorial service, after she had been gone for six months, was moving. We set a little cross with a Madonna by the Women’s Rest Room flower bed, next to two other little shrines. In the Fall, Snow White and Aladdin were married; she was obviously pregnant. To most people’s distress they were not of the same character, like both being from the same Disney movie or cartoon. That sort of miscegenation was  originally revolting, but we gradually got over it. It goes to show you that society can change, grow.  To a point.  It was unproven but widely known that a  Shia’s  Alice Manhattan daughter was stoned to death one night after consorting with a Sleepy Stockton boy.

Yet violence was quite rare.  People adjusted to Line Life, which often seemed more orderly, less uncertain, more  predictable than elsewhere. Life took on a rhythm, an ordered and civil certainty.  Not everyone was happy of course, but overall, life went on as well as possible. under the circumstances.

No one  seemed to suspect it might end one day. That  happened suddenly, as unannounced as an earthquake.   We reached the  string of Small World boats. My cell phone became perceptibly heavier and hotter in its holster, as though insisting I activate it.  The plastic voice of a Disney Gabriel sounded:

“As you board, please move to the end of your row. Remain seated and keep your arms inside. Have a Safe Ride, and a Good Day.” We were herded with strangers from unknown regions of the line into those dreary little plastic boats, like cattle loaded for slaughter.  The song now seemed ridiculous, mocking, cloying. ‘It’s a world of Laughter, A world of Peace’… I became physically ill and vomited into the crystal clear chemical blue moat.

I missed my friends, the daily activities we shared, like the Japanese classes where I was beginning to learn some of the characters. The worst for me is that I lost my best friend, Don Brookline, the guy in line ahead us, the very same  Easterner who was rather stiff and  unfriendly at first. He was an ornithologist, and held regular classes on birding.  I wanted desperately to go back and get in line again, on the remote chance we could find one another. But  i realized that even if we did it would never be the same. The soothing Small World lyrics and music that used to wash over me like soft surf became  a mockery,  an ominous, insupportable, cynical curse.  then Gabriel spoke again.

“Please be careful as you step from the boat. Have a nice day, and we hope you will come back to Disneyland and our Small World soon! ”

Not me. My world  had ended.