Tuesday, March 17, 2015

Anthony Doerr responds

On the advice of my friend Bob, who said that he thought the author would like to read my reflections on his book, I sent my last post on to Simon and Schuster to forward to Anthony Doerr.  And here is what he wrote back:

Dear Budd Shenkin,

Thanks much for spending some hours with one of my books and for your gracious and lovely blog post. I’m so grateful that you enjoyed the book. And your post spurred me to revisit the parable of the blind men and the elephant, too. 

Wishing you a lovely and bright springtime,
Anthony Doerr

I was so pleased to get this!  Isn't that nice?  He seems to be a nice man, and actually, that's what you would expect from All The Light You Cannot See.  When we were discussing the book at our book club last night, I realized how much caring for one another there is in the book.  Everyone cares for Marie-Laure, and you the reader are grateful for each one.  Werner cares for his classmate Frederick.  Werner regrets it when he can't care for his sister Jutta, but he thinks about it.  It's the villains who don't care for anyone, and who don't have anyone to care for them.

I guess I'm still thinking about the book.  A good sign.

budd shenkin

Sunday, March 15, 2015

All The Light You Cannot See

I have always been fearful of being blind. I thought, what would I do if I went blind? I might kill myself. It's so important that I haven't even wanted to think about being blind, for fear of bringing it on. Just as Natalie Wood, a Russian – that irrational people – drowned when that was her biggest fear. Just as I for years bought more expensive PPO rather than HMO insurance because I explained, using an example, what if I had a brain tumor, I would sure want to go to the best place for it, wouldn't I? So sure enough what was it I got, a pituitary tumor. Close enough. And I was going blind with it before the operation. So blindness, not that I'm superstitious, I'm not, but still, just don't think about it.

So I didn't want to read “All The Light We Cannot See,” by Anthony Doerr, even though Sara my stepdaughter gave it to me for Christmas and Sara's choice of books is always, always excellent; and even though my friend Larry pushed it as a read for our book club. I just didn't want to read it. I didn't want to read about some blind girl and what she goes through. But when the book club chose it, and I even found myself putting my hand in the air voting for it somewhat unaccountably, I had to.

I loved it. I cried at the end, even though it's not a tragic ending, it's just time going on and people living in it. OK, the guy's a great writer. He can write sentences, he can set a scene, he used a modern form with short chapters following two main stories simultaneously, and a third smaller story coming in a bit later, and the stories shifting from pre-WWII to 1944 and 1945, back and forth, in a way that really works to build affection for the characters and tension in the story and the three strands all intersect at the climax, as you know they will, so I'm not giving anything away. And as I say, I guess I cried at the end, tears came to my eyes and even though I'm allergic and it's flower season and all my bulbs are coming out in the front yard and the window was open and it was near dawn as I finished it, I think it was the story and not my allergies.

For me, this book was an eye opener, especially with my fear and dread. (Don't think about it.) Marie-Laure (love the name, especially since Laure is the name of the female principal in Spiral – see Netflix) loses her sight to congenital cataracts at the age of 5 or so in pre-war Paris. Her mother died in childbirth and her father is a saintly dad as he raises her and loves her. He cares for her, he is tender, he makes wooden scale models of the neighborhood so she can feel them and orient herself for moving around, and he is a genius in constructing the wooden models with secret ways to access the insides that sometimes contain presents for her. She feels her way by touching his pants, she feels and hears – I know we've heard this about blind people, how the brain expands in the areas that function to compensate for the loss of sight, but Doerr brings us to exactly how it feels. Later on, when she is at St. Malo – which by coincidence Ann and I visited just last year, so I know it, even Place Chateaubriand http://www.trekearth.com/gallery/Europe/France/West/Bretagne/Saint-Malo/photo1392483.htm – she can tell all the snails and other molluscs by feel; she is a natural biologist taught by her father and colleague at the museum where he works. People are so kind to her. Her world is not like seeing, but it's her world and it's a tender, exquisite world all by itself.

The parallel story is about a short German boy with white hair named Werner, a little older than Marie-Laure, who lives in an orphanage near Essen, who has a mechanical ability. He makes a radio and he and his precious little sister Jutta listen to it and hear a Frenchman broadcasting stories about science and physics in a warm and cuddly voice. Because of his emergent ability Werner is chosen to escape the mines and become brutally trained in a Hitler youth school, where he befriends a gentle soul, Frederick, who identifies birds by the songs he hears, not needing to see them. Werner helps invent the technology that triangulates radio signals to find hidden broadcasters. So, I realized, Werner is like Marie-Laure, because he uses radio with his ears and not the eyes. When his hearing is translated into sight, his friend the giant soldier strides into small, primitive cottages that are broadcasting and kills the partisans as they transmit.

As I was reading and realized this, it hit me – what I am doing is a blind activity, too! I'm reading and making up pictures in my mind. Reading is like a blind activity, so I'm part of it, in it with them, doing a similar thing.

And then I thought even more – “Keep thinking, Butch, that's what you're good at!” – we are all so often looking (note, “looking,” maybe it would be better to say “listening for the future”) but we really can't see it. We imagine what it might be, we seek indicators to project what it might be, but we are really essentially blind to the future. Sometimes if somebody thinks he has it, he'll say: “I can see it clear as day!” Maybe. It sure is great when you can.

And then, Doerr is constantly referring to what is happening in nature as events unfold. St. Malo is about to be besieged, the populace is being herded into areas, airplanes are dropping bomb loads, food and water are missing – and what is happening in nature? The birds are doing what they always do, chirping, finding food here and there whatever it is they eat, I think Doerr knows what that food is but I don't. The snails are doing what they always do, creeping and filtering the calcium from the water to build up their shells. They are blind to what is going on around them with the people and the larger landscape, just as the people are blind to what is happening with the birds and the snails.

Then there is the long term working of nature, the evolving crustaceans and molluscs that Marie-Laure orders in her bedroom, so she can feel them as they have evolved, see the long term trends and changes maybe you could say. No one planned it but it happened and afterwards we see the results, but never before. We can see the past, which we can't affect, but we only intuit the future, we only hear it coming but we don't know exactly what it is.

Marie-Laure's favorite book is Jules Verne's 20,000 Leagues Under The Sea. She learns to read it in Braille, and later she reads it on the radio. Captain Nemo explores, but he often can't see much. He is under icecaps and he is picked up by a giant squid, which he can't actually see. The sea is dark and inky, and he and the sub are tossed about, hoping for the safety of chance. Listening to Marie-Laure read it on the radio, Werner is just like her, because neither of them can actually see what it is, they are picturing in their minds.

I think it's just coincidence, but just in the last few months before reading All the Light, I have been thinking more and more about the parable of the blind men and the elephant. http://www.buddhisma2z.com/content.php?id=471. We really see so little of what there is in life, we understand so little. It is best to be humble and listen, but it is also important to try to understand, to try to put things together, and to try things even though you know that your vision is limited and many of the things you try to do will fail.

What a book!

Wednesday, March 11, 2015


On our SOAPM pediatrics listserve we have had a conversation about treating strep throat. The options are: (1) take oral antibiotics once or twice a day for seven or ten days, or (2) get one shot of penicillin at the time of the visit. Factors include the fact that a shot hurts (briefly); and that it is hard to fulfill the oral medicine instructions for a week or more even if it is yourself, let alone a kid, so that “lack of compliance” becomes an issue with oral medication.
Myself, I've always been a shot guy. Over and out, I figure.
But many of the doctors wrote that they hesitate to give the shot because they themselves remember the pain when they were kids. For instance, my friend Iris Snider from Tennessee writes: “Kim, like you I had my share of Bicillin shots as a child and am loathe to give them. I average about one every 10 years and apologize to the 'victim' every time I do.”
Here's my response:
When I was probably about 6 or so - I was born in 1941 - it was summer and we were at the New Jersey shore, in Beach Haven.  Somehow I got an infection in my foot.  It was bad enough that I had to go back to Philadelphia and was hospitalized, probably at Graduate Hospital.  Penicillin wasn't that old a drug and we were lucky to have it.  At that time there was probably only crystalline penicillin.  I don't know if it was every four or every six hours that the nurse came into the room with a big hypodermic needle and I cried at the prospect and my mother helped to hold me down.
Then after a while my mother reasoned with me.  She said, “Look, it's going to be done, so why don't you stop resisting and just accept it and make the best of it, and after all it is fixing you all up,” or who knows what words she used. 
The next time the nurse came into the room I smiled and turned over and offered my cute little butt to her ministrations.  She said, “Well, what got into him?”
And you guys are complaining about a one time shot, with pain-killer as one of the components, when the kid can walk out of the office and not think about it again?
You should have been in Philadelphia right after the war and seen a little kid with a foot infection in the hospital bed and offered him that choice!
Budd Shenkin

Monday, March 2, 2015

Vaccines, Anti-Vaxers, SOAPM, and Jimmy Kimmel

Pediatricians have been hot! Ever since measles spread out from Disneyland, what we have been dealing with internally in pediatricianland, how to deal with the anti-vaxers, has gone mainstream.
For me the heart of pediatricianland is SOAPM, the Section on Administration and Practice Management of the American Academy of Pediatrics. There are over 1,100 of us in this section, and on the SOAPM listserve 50 messages a day is a slow day. If you are lonely and have little to do, joining SOAPM can fill up your day real fast. And truthfully, SOAPM has become a real home for me, and my admiration for SOAPM denizens fills my heart. It makes me so pleased and proud to be a pediatrician. Practical people, assertive people, inventive people, imaginative people, people with great hearts and minds and values, people who are not ashamed to say, “No margin, no mission!” And then they go out and do the right thing.
So when measles got hot, SOAPM got hotter. Some of our energy has been going into how do we convince anti-vaxers to vaccinate? Some energy into, what does our American Academy of Pediatrics do with the rogue pediatricians who capitalize on the anti-vax movement to sell books and get publicity? Shouldn't they be drummed out of the AAP and lose their imprimatur as Fellows of the AAP? Some of our energy has gone into how the AAP should respond publicly, especially after they issued a somewhat tedious statement once again reaffirming the value of vaccination with zero pizzazz. Some of our energy has gone into trying to get the AAP to revise its statement that practices should not dismiss patients who delay or deny vaccination, but should work with them.
Truth to tell, my practice was always counted among those who accepted anti-vaxers and worked with them. But now, if I ran the zoo, I'd change that. For one thing, the public tide has turned and there is value in putting up a common front. For another, there is now evidence that shutting out antivaxers convinces more patients to vaccinate than “working with them.” But of course I know longer run the Bayside zoo – thank goodness!
But then, while all the sturm und drang of SOAPM dialogue was proceeding, up came a message on the Listserve from James Weidman of Los Angeles – “Watch the Jimmy Kimmel show,” he said. And then came this clip:
This clip made me so, so proud to be a pediatrician and a SOAPMite.
OK, the AAP was too reserved and stodgy. But, is this a great country, or what? In liberal democracies there is a multiplicity of channels and freedom of expression. Enter popular media! Enter emotion, enter sarcasm, enter dirty words! Enter great intelligence and communication and presentation skills, and enter great directorial skills that enabled these real life pediatricians to be such great performers! To me, these pediatricians perfectly bridged the profession's rectitude with being able to relate as lovable human beings, which to my mind is the essence of being a pediatrician.
I am just so proud!
Sometimes, the best politics is great entertainment.

Budd Shenkin