The Tyranny of Health

OK—if I’m alive today and writing this, it’s all because of a legend, though a legend who has escaped the fate of most of us: Having our first mention in a Google search be “Helen Whitman is on Facebook!”

Or was her first name Helen? Because I had it in my mind that her name was “Ernestine,” but that Whitman appears to have been a flutist whom I knew in the music school, not the Mrs. Whitman I knew as a head nurse at UW Hospital and Clinics.

It’s fitting, really, that I don’t know—did I ever?—her first name, since she was very much not on informal bases with anybody, much less her nurses. She was Mrs. Whitman, and everybody else was Miss or Mr. or Doctor whomever, and she applied the rule as rigidly as she applied her white nursing cap.

She ran her ward in a way that made Mrs. Thatcher look like a slacker, and no, it’s not true that she applied starch to her uniform. Rather, any uniform that Mrs. Whitman chose to wear was expected to comply with her own high standards: No creases or wrinkles ever appeared. Nor was it the case that her name was ever spoken: Rather, it was whispered.

She appeared one spring day with serious scratches on her legs: Obviously I couldn’t ask her what had happened, but a senior nurse whispered the news to me. Mrs. Whitman had “awoken” her rose bed for the season, and was I surprised? Of course not: I was gardening myself at the time, and passionately involved with heritage roses: Wonderful shrubs with tremendous French names—Madame Alfred Carriere or Souvenir de Malmaison. True, they tended to bloom only once, and they could be unruly. But Mrs. Whitman? No, she strode into the world of modern roses, much as she strode onto the unit each morning, with an appetite for errant medical students, one or two of which she would consume for breakfast (she munched steadily through the day on anyone at hand….) So of course she would have tackled the reigning hypochondriacs of the garden, with all their wilts and rots and mildews and mites. Had she been an animal lover, she would have had Siamese cats, and had them lining up in order of seniority for roll call each morning and night.

Nor was it true that no patient ever dared die on Mrs. Whitman’s unit. What can be said is that they all—terrified into obedience—waited until after Mrs. Whitman had relinquished her ward to the PM or night shifts.

Detour—my mother had three children. After the eldest child was born, in 1945, my mother spent a month in the hospital, on strict bed rest, with a long, wonderful backrub at the end on the day, and plenty of rejuvenating rest, since look—the lady had just had a baby, for God’s sakes! Anybody could see that she’d been through a hell of an ordeal!

There was a problem, of course, since after a month of lying in bed? Well, those ladies were weak, and then being sent home to care for a newborn. So for the second child—born in 1950—the month got chopped down to two weeks. And for me, born in 1956?

“Dr. Thornton strode into the room and said, ‘get up, Mrs. Newhouse, and walk!’ just hours after you were born. And I never did get a decent back rub….”

I tell you this because I had a second—and last—cataract surgery on Tuesday, and now, three days later, what has my doctor told me?

“You can do anything but bungee jumping!”

Yeah?

The surgery was not without a wrinkle or two, since it appears that the operation can be rough on the cornea. And what that meant was that the eye was swollen, painful, and mightily inflamed.

“Soak your eye in prednisone,” said the doctor, so I did. And what else did I do?

“I’ll be OK to give class on Thursday morning,” I told my newest student, who looked skeptical. Right so then I cancelled on Wednesday afternoon, and then cancelled Friday’s class as well. Why? Because it wasn’t the pain or the inflammation that was the problem: I was utterly exhausted.

I went to bed and felt guilty: I should be up and doing something about the weed trees growing in the back balcony. But wait—did I really want to be out there sweating, with my hands in the dirt, and wiping my brow? Look, I wasn’t supposed even to be reading!

I twitched, I jittered—I fell asleep and woke to guilt / shame staring me relentlessly in the face. And then I had the revelation….

Mrs. Whitman!

“You’re not to leave this bed under any circumstances,” she said, “and I’m sending Miss Porter in to attend to those hospital corners.” She sniffed, and then paused at the door. “I’ll be right outside, at the nursing station.”

Bliss!

Well, I mused about her, since I had been reading a book by Robert Whittaker: Here’s what one writer had to say:

Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America (Crown 2010), by the journalist Robert Whitaker, is one of the most disturbing, consequential works of investigative journalism I’ve read in a long time. Perhaps ever. Whitaker has persuaded me that American psychiatry, in collusion with the pharmaceutical industry, may be perpetrating the biggest case of iatrogenesis—harmful medical treatment–in history.

Well, my brother had recommended it to me, and my brother—unlike me—does not suffer depression. Shouldn’t it be “suffer from?” No, I meant that my brother, along with so many others, thinks that if I just got myself together, took a good long walk, and thought positive thoughts, all would be well. Am I being fair to my brother? No, of course not. But until you’ve been seriously depressed, it’s hard to imagine the peculiar hell of the noonday demon.

Well, I had read enough of the book to overcome my initial irritation. Then I had had my surgery. Then I pondered the fact that, with all our wonderful treatments for depression, the incidence of the disease is soaring, not dropping. So what gives?

It’s the tyranny of good health, I concluded. Because at no time in history have we been more healthy, and isn’t it time to speculate that sickness has a place in our evolutionary history? Even the most dreaded disease—cancer—is no excuse to take to your bed for extended periods of time: You have your chemotherapy one day, are sick as a kitten the next day, and are back peering at your computer screen at the office the next day. Repeat week after week until remission.

Consider the cancer of the 19^th century: Tuberculosis. Anybody reading Thomas Mann’s Magic Mountain will know the story. Here’s Wikipedia’s telling sentence:

In the opening chapter, Hans is symbolically transported away from the familiar life and mundane obligations he has known, in what he later learns to call "the flatlands", to the rarefied mountain air and introspective little world of the sanatorium.       

Well, a serious blogger would look into it, would see if anybody has proposed the theory: Robbed of the illnesses that would take us to our beds, isolate us, force us to look inward, put us in darkness, we have created depression, and are suffering vast amounts of it. Man spent most of his existence working outside during the day, and sleeping during the night. Now we are chained to our devices, and outside, for most of us, is the walk from office to car. So I should look into all this, except…

…Mrs. Whitman is ordering me back to bed!

Attention, Wal-Mart!

Let me tell you a story, a very familiar story. You are awakened at 3 in the morning by your three-year old, who announces, as best he can, that he has diarrhea. You sigh, get up, go to the bathroom, and yes—there it is. You wash the child, put him to bed, and wait for the inevitable. Sure enough, two days later, again at 3 AM, you’re at your local hospital. You wonder how much, if any, sleep you can get before you drag off to work….

Let me tell you a story, a very familiar story. You are awakened at 3 in the morning by your three-year old, who announces, as best he can, that he has diarrhea. You sigh, get up, go to the bathroom, and yes—there it is. You wash the child, put him to bed, and wait for the inevitable. Sure enough, two days later, again at 3 AM, you’re at your local clinic in a small town in rural Zambia, where there are no medicines. Your gut wrenches: your child may very well die. You trudge home, passing as you go small shops, all of which have Coca-Cola for sale.

There are people who have the word “why” wrapped tightly around every strand of their DNA, and my guess is that Simon and Jane Berry—two retired people who had a little to go off and save humanity—are two such people. And their question, as you can guess, is “why can a town have Coca-Cola but not have medicines? If the Coca-Cola can get there, why can’t a simple, cheap diarrhea kit that could save a kid’s life get there? Why do one in five kids in parts of Africa die of diarrhea before they reach the age of five?”

The nice thing about the why people is that they keep on asking questions, frequently driving everybody else who is just trying through the day, dammit, nuts. So Mr. and Mrs. Berry—they’re British, so no “Simon” or “Jane” here—asked, “why don’t we use the extra space in the crates of Coke to get the diarrhea kits up to the stores that sell the Coca-Cola? 

Presto, mágico! (And I’m sure it wasn’t that easy….)

Tremendous idea, right? The Berrys had designed the kit to fit between the bottles of Coca-Cola. And the kit—which contains basic salts, soap, and a towel—is relatively cheap; as I recall, it costs about a dollar to produce the kit, and it’s a nice little moneymaker for the shopkeeper, with a good margin.

Unbelievably, the Berrys succeeded in getting the attention of Coca-Cola, and they met with them and learned about their distribution chain. That frequently looks like this:

Well, the whole thing seemed like a great idea, when I was pondering the problem of what to write about last July, and also wondering what to do about my brother John and his wife Jeanne, who have:

1.     everything

2.     birthdays in early July

So it seemed like a good idea—why not donate 10 dollars every month? What’s ten bucks to me? So I called John and Jeanne up on vacation and told them about it, and then I forgot that I / they were making the donation. (Just as an aside, isn’t it criminal that we are living in a world where ten dollars is nothing for some, and everything for others?)

Well, among the people for whom the ten dollars is nothing are Bill and Melinda Gates—I’m presuming no introductions needed—who, so says the email the Berrys sent me, agreed to screen a documentary of the project in Seattle last month. Nice!

In fact, I also have a fair amount of “why” bred in the marrow of my bones, and I spent seven years at a company even bigger than Coca-Cola making everybody completely crazy. And when Wal-Mart could bear it no more, they showed me the door; there are, however no hard feelings.

So here are my questions, presented in good business English as a bulleted list:

·     Why doesn’t Wal-Mart partner with ColaLife (the Berrys’ organization)?

·     Why not sell the kit in Wal-Mart (the cost of Pedialyte at Walgreens—sorry, but it’s closer—is six bucks, so what a Volume Producing Item! Wow—better than those Moon Pies!)?

·     Why not donate one dollar for every kit sold to Colalife, thus letting the developed world help the undeveloped world?

There’s something about the Internet that makes people go nuts, and a good example I draw from the comments section of the “About ColaLife” page:

The third world government should tax coca cola and other multi nation corporations at proper rates according to their level of profits. This tax then should be use to supply medicine and infrastructure for the maufacture and distribution of medicines,

These half ass aid program does very little to truly alleviate underdevelopment or promote progress. These programs only continue the dependency and underdevelopment of Africa.

Tax coca cola and other multinational like they do in the west and use the money for medicines and infrastructure.

Ouch—as much for the grammatical errors and typos, as for the content. Fortunately, Mr. Berry is a more temperate soul, and does a neat job of first agreeing with him, and then—gently—demolishing him.

In fact, I think the Berrys’ ideas are a breakthrough on several levels—not the least of which is to combine the private sector with public health.

Now then, Wal-Mart, you guys in?

Scrambling to Keep Up

“I can be the president of the United States or I can control Alice, but I cannot possibly do both,” famously said Teddy Roosevelt about his hellion daughter. And every father in America knew just what he meant.

And that’s the way I feel about Wisconsin governor Scott Walker. Consider—I emailed myself an article my friend Gary posted on Facebook; here’s the headline: 
    

Wisconsin Prepares to Hand Half-Million in Taxpayer Funds to Koch-Tied GOP Lobby Shop

OK—that was something I had to check out. But it was late, my brain was tired; I sent it off to my inbox to be dealt with in the morning. Well, it’s 11:50, and where have I spent the morning? Right up there in Wisconsin—virtually—looking at, among other things, a map of frac sand mines and production centers.

Sorry, I couldn’t copy / paste the map, but here’s the link.

In Iguanas, I reported that South Western Wisconsin is known as the Drift-less Area, so called because the glaciers never rolled into the area. So it’s hillier, and there are curious rocks, the Niagara dolomite limestone, or some such thing. And that’s precisely the area where there were a few sand mines, because Wisconsin is one of the few, or at least one of the richest, places to produce this:

OK—that’s frac sand, or “silica sand: smooth, round grains of almost pure quartz that can be found in lower Wisconsin’s sandstone bluffs.”

A couple years ago, Wisconsin had fewer than ten sand mines; today, it has over one hundred. And here’s what they look like:

And what’s the big deal with frac sand? Well, it’s the only sand you can use for fracking, a process which involves drilling extremely deep vertically, then drilling horizontally several lines, and then forcing a water mixed with frac sand at extremely high pressure. The water / sand mixture fractures (hence the name, get it?) the shale and natural gas is released.

Those fussy environmentalists, of course, have various quibbles. The process requires enormous amounts of water, and thus lowers the water tables, and makes irrigation all the more difficult. Oh, and it also produces some really gunky byproducts—water and sand and a lot of toxic petrochemicals. And where do you put that? Into the river? Dump it on the ground, or in ponds?

Never mind—says the industry. It produces natural gas, and that’s a clean fuel, and don’t we want to be energy independent?

OK—to get at all this sand, the Koch brothers, owners of Koch Industries (a huge petrochemical concern), had to run up to Wisconsin and find someone they could work with. And they certainly did—Scott Walker, who promised to relax Wisconsin’s fussy environmental regulations. How fussy were they? Quite a bit like Minnesota’s, which also has the frac sand deposits. And how many mines / processing plants does Minnesota have today? A handful.

Which tells you how effectively Walker made a “business-friendly” environment in Wisconsin.

So what’s the problem, you say. We create all this sand, ship it off to North Dakota or Texas. That’s their problem, right?

Well, beyond being just a bit callous…no.

“It was clanging railroad cars at night, underground blasting that put cracks in the walls of peoples’ kitchens,” she said. “I had emails that said, ‘I don’t know what they’re doing, but there’s sand all over the inside of my house.’” 

That’s what Kathleen Vinehout, a Wisconsin state senator, said.

Right—sand all over your house is an annoyance. But what about sand in your lungs?

These particles are associated with an increased risk of a battery of illnesses that Crispin Pierce, a professor of environmental public health at the University of Wisconsin–Eau Claire, ticked off for me: “Silicosis, bronchitis, tuberculosis, chronic pulmonary diseases—it’s a really nasty, toxic substance.”

Well, there are emission standards for each mine—but they measure the emissions from one mine only. And what happens when there are three mines, one processing plant, and trucks filled with the stuff—all in one area? Sadly, because this industry is so new—no one knows. So we’ll find out in a generation or so, when Wisconsinites all start wheezing (in the Drift-less Area, of course).

(Added value to Wisconsinites in that area—definitely consider taking up smoking, because guess what? Your lungs are fucked, anyway….)

Oh, and there are social costs, too. The mining companies are coming along waving huge checks at people who will either sell or lease their land. Here’s one account:

She was offered more than $100,000 from the mining company EOG Resources Inc. to move but declined, citing high moving costs and a connection with the area. Since then, she said, her home value has dropped by about half, to around $60,000. The mine provides subsidies for lower property values, but Sonnentag said her property is too far away to qualify.

What happened? Reading further on in the story, it’s clear. She said “no,” her neighbor said “yes.” So she saw the value of her property fall, due to the mine, which was too far away to qualify for the mine subsidy program.

From the same story:

As the mines have been built, a chasm between some neighbors has widened.

"Why should I have to move because my neighbor wants to be selfish?" said Sonnentag. "If I had trouble, I always used to know I could count on my neighbors.

"Not anymore. Now, it's the sand people versus the anti-sand people."

Remember how I was going to tell you about the half million the State is going to give a Koch brother lobbying group?

And remember Teddy Roosevelt and his daughter—Alice ?

See what I mean?

Wraiths Wrapped in Blankets

Who knows why I had to watch it? I had, after all, lived it.

Actually, I hadn’t. By in my years as a nurse, I had seen a lot of bulimics and anorectics; as well, I had worked on the eating disorder unit at University of Wisconsin Hospital.

And the documentary Thin, by Lauren Greenfield, brought it all back, from the moment I saw the first wraith wrapped in her blanket coming down the hall. Nor does Greenfield hold back—at times it’s unbearable, almost too painful. A fifteen-year old girl is confronted in group therapy, and breaks down shrieking, “I just want to be thin!” Another patient is kicked out of the institution, and has to call her mother, who spits out her rage at the staff. You can hear the desperation behind the fury, and it’s well justified: the patient later killed herself.

And it made me remember: this is nursing in which you never really know what you’re doing. Can you believe the patient when she breaks down and swears she really, really wants to get better? Should you trust your gut, which is telling you, “nah, bullshit?” And what’s better—to tell the truth, and say, “I don’t believe you?” Or do you say nothing at all?

The really dangerous nurses were the ones who thought they knew what they were doing. For them, it was simple—believe the least of what the patient says, set limits, and then follow up with consequences. On psych wards, that often meant seclusion or restraints; sadly, there were times when I thought the staff had egged the patient on.

In the film, Greenfield captures the uncertainty and the anguish of the staff, as they struggle to understand what’s going on on their ward, who the players are, and what to do about the situation.

One of the most telling moments of the film is the patient who sketches a life-size outline of what she thinks she looks like—she produces a chubby figure. The art therapist the puts the patient against the sketch are draws the patient. But that’s not enough to convince the patient—who then writes “fat,” “chubby,” and a host of other epitaphs on different parts of the sketch. At the end, she writes, “help me.”

There’s the frustration of the insurance running out—the patient is nowhere near ready, you know you’ll see her again. At least, you hope you’ll see her again—if not, she’ll be dead.

There are the relatives, who are almost more anguished than the patients. The patients, after all, are very often in denial, but mothers know perfectly well how sick their kids are. One patient reports her boyfriend saying, “I want to be with you for the rest of my life, but the way you’re going, I’m gonna bury you in five years.”

It’s possible—the mortality rate is between 10% and 20%.

To make the documentary, Greenfield spent six months living in the facility.

It’s a remarkable achievement.  

  

Right—Got That Taken Care Of....

It’s such a good idea, why didn’t I think about it?

I spent seven years working for Wal-Mart, ostensibly as an English teacher. A good part of that time, in fact, I was busy dreaming up great ideas that absolutely no one liked. The sustainable shopping bag that we were pushing all the customers to use was a great idea, but there’s one little problem: you have to remember to take them with you every time you go shopping. And what if you decide on the spur of the moment to drop into a store? Your bags are at home.

Enter the Newhouse KeyChainShoppingBag!

OK—the problem of keeping meats separate from vegetables and fruits? Easy—redesign the shopping cart!

So I’m totally impressed with two like-minded people, Simon and Jane Berry, who looked around them one day in Northeast Zambia, and realized: Coca-Cola was everywhere.

The Berry’s also put together that fact with another two. First, one in five children in developing countries will die of dehydration before their fifth birthday. Second, though a simple solution of salts and sugar will cure the diarrhea, most public health clinics are too far away, or may not have the formula.

Right—so we can get Coca-Cola to kids, but not life-saving kits?

Then they looked at the Coca-Cola crates and realized—hey, there’s a lot of space wasted there. What if we made a kit of a bar of soap (prevention, as well as cure), the oral salts and sugar formula, zinc pills, and put it all in a container that would wedge in between the necks of the Coca-Cola bottles? So the Berrys created an organization, ColaLife, which produced a product called Kit Yamoyo. Here’s what it looked like:

That way, you could simply piggyback on to Coca-Cola’s distribution system, and not have to invest all that energy on reinventing the wheel.

So Berry went running around—trying to get Coca-Cola’s attention, which proved at first difficult. Finally, he got an interview with the BBC, and the door cracked open. They met to discuss Berry’s great idea.

And like all great ideas, it had to be tweaked. The peak period for diarrhea is in rainy season, which is when Coke sells the least. As well, there may be times when Coca-Cola may prefer not to distribute to a remote location—it simply isn’t worth it. But the kids still need the medicine.

So, in the end, they decided not to distribute through Coca-Cola, but rather to use the company to learn about Coca-Cola’s distribution chain. Consider this photo:

For Coca-Cola to get its products into a small shop in a tiny town in a remote area, they have to work with a lot of people, from the local producer to the regional suppliers to smaller supplier to individuals who have a horse and cart. And many times, the break in the chain was the guy with a horse and cart; therefore, Coca-Cola started their Last Mile program. (Nice name, guys!)

So the Berrys worked with Coca-Cola, often tagging along with them and meeting the people who delivered the Coke. And they soon discovered—it would be better if the shopkeepers simply ordered the Kit Yamoyo as a regular item, like laundry detergent.

The ColaLife began its pilot project in September 2012, and so far, the results are encouraging. Here’s what Berry has to say, as quoted in The New York Times:

Thus far, ColaLife has received mostly positive feedback from customers regarding Kit Yamoyo. “People are convinced it cures diarrhea,” said Simon Berry. “They say it’s much stronger than the medicine you get at the health center. And there’s some evidence that we’re stopping chronic diarrhea.” (While conclusive data has not yet been published, Berry’s assessment is based on more than 20, 000 kits sold and surveys of more than 1000 households.) The team also found that shops that sell Kit Yamoyo are, on average, two-thirds closer than health centers — making it much easier for a mother to obtain O.R.S. (oral rehydrating salts) when a child is sick.

There’s a little problem, for which, of course, I have the answer. And that is, you say?

The kit costs one dollar, unaffordable to many people. Sales have slumped by 60 percent from when the kit was introduced free.

My answer?

I think the genius of the Berrys was to see that the Kit Yamoyo was a product and could be treated like one, not a medicine or a health care issue. So we have a product, a nice product with a terrific potential and an un-mined gold field in public relations. A nice product that Wal-Mart (ASDA in Britain) can sell for $2.49—a steal. Wal-Mart pockets 74 cents, pays ColaLife $1.75. ColaLife, in turn, can use that money to lower their price substantially. They then employ an unemployed blogger in Puerto Rico to write terrific press releases, which I will.

Yes?

Sorry, guys—gotta go. Gonna call some friends at Wal-Mart….

Navigation by Burger Kings

Nobody who knows him would ever employ the word “conventional” in describing Mr. Fernández. We could start with the mustache, of which only Salvador Dalí’s was more extreme. Then there are the muttonchops, which make him look like a great-uncle out of Galsworthy. He also, once a decade, does something completely crazy—the most notable of which, in the nineties, was to join Amway.

“Get ready,” he informed me solemnly, “in just a few months, we're gonna have masses of merchandise in this place.” This was right after he had listened to a motivational tape—the message of which was believe, visualize, SEE the success and...bam! You’re rich.

Well, he has just embarked on a course of a zillion chiropractic treatments—the purpose of which is unknown to anyone but Mr. Fernández and (one hopes) the chiropractor. There are now little blue foam devices all over the house. There are special vitamins in large containers marked “Maximized Living,” as well as Daily Detox pills that apparently need to live in the refrigerator.

Even more extreme is the diet. No alcohol, no gluten, no pork, no rice, no…it goes on endlessly and gets added to daily. Of course he cannot have lactose—what, MILK!—horrors! So yesterday I was busy tracking down almond milk, unsweetened, because sugar, or god forbid high-fructose syrup, is absolutely, completely, totally and thoroughly bad and banned.

And guess what?

His health has absolutely dive-bombed!

I am writing this after eating pizza and drinking generous amounts of wine last night. I visit the doctor, nowadays, only when the blood pressure pills run out and CVS declines to give me a refill. Mr. Fernández, however, has been sicker than a wet kitten for the last several days—the ENT guy told him yesterday that his sinuses were completely filled with…right, you don’t want to know. As proof of this, every five minutes or so, Mr. Fernández issues a foundation-shaking sneeze, almost but not quite blowing his mustache off….

I know about this because in the days when I was waiting for the axe at Wal-Mart I practically lived in my doctor’s waiting room. I was there so often that, in the last year, I helped put up the Christmas tree (at 6-foot three, I always have to put up the angel….) AND take it down three months later. That’s what stress does to you.

So I wasn’t surprised when Mr. Fernández told me, yesterday, that there was a problem. Actually, I wasn’t surprised because there is ALWAYS a problem, and guess who gets to fix it?

“So where is it?”

I needed to know where the doctor’s office was because I had to go and pick up another prescription because the prescription the doctor had written did not please the exacting eye of CVS. The doctor had prescribed just a touch of codeine, and that requires a physical address, not the post office box that the doctor had supplied.

“It’s on this little street behind Pavía Hospital that everyone calls Calle Asia but now it’s named after somebody or other….”

This did not sound promising.

“OK, so how do I get there?”

This is, in fact, the operative question in Puerto Rico. Let me explain—absolutely nobody operates on the address system. That, of course, seriously challenged me when I first arrived on the island. I remember it vividly—calling a government agency.

“Do you speak English,” I began. I was a monoglot (well, computer, polyglot exists!) at the time.

“MIRTA! MIRTA! UN GRINGO!!!!” She had not bothered to move the phone from her face.

Right—so it took 10 minutes to find someone who spoke English. Not well, but enough, and hey—how much Spanish could I speak at the time?

“Where are you located,” I asked.

“Stop 17 and a half.”

There was, it seems, a trolley thirty or forty years ago that went down the main drag of town. It had stops, or paradas, which absolutely everybody knew about and by which everybody navigated (though the trolley was long gone) so the world was perfect, see? Oh, and no—they had no idea about what street number they were at.

So we went around and around, and finally Mirta went off to get directions on how to orient a clueless gringo to the parada system.

Fortunately, she had the answer!

“Just go to stop 18 and walk half a stop down!”

There was a particular and minor torture about those days when the linear and logical gringo mind was exploring the depths of Latin exuberance and zest. I give you an example I am living right now: a group of schoolchildren are screaming under my balcony. In fact, they have been directed to scream by their teacher, who is beaming happily at them and smoking a cigarette.

“Aren’t teachers supposed to shut kids up?” I would ask Mr. Fernández at the end of the day.

You may ask—what about the rest of the island? Are they navigating under the parada system too?

Nope—Burger Kings.

Look, there are no street signs because we all—except you—know where exactly everything is and anyway if we had them the hurricane would just blow them away and anyway you shouldn’t rely on signs because the point is to go and talk to people and get the straight story and pass the time of day and have Fulana de Tal call you mi amor and kiss you after a pleasant 15 minutes of chatting about health problems and crooked politicians. That’s how you get to places!

So here’s how it plays: “Ay m’ijo, you go down three streets and turn left at the Burger King and then go for a little while to the Church’s Chicken and then you’ll see a big blue store—The Gatsby—and then turn right at the McDonalds.”

At this point they will note your glazed eyes, so what will the do?

Hop in their car and take you there!

Well, by a miracle I found the place, this morning. The first secretary didn’t know what I was talking about but the second did. I prepared to wait but unbelievably the doctor was there, a patient was just leaving, the secretary snagged him. Five minutes later, the prescription was filled out and in my pocket and CVS has grudgingly and administratively-correctly given me Mr. Fernández’s narcotics.

Thanks for asking—he’s already sounding better.