Taking a break

Heading north to Michigan after lunch today. Posting will be sporadic for awhile.

The Pulitzer Project: So Big

This one's a keeper. That didn't come as a surprise -- anyone who could crank out as many best sellers as Edna Ferber did had to be capable of at least telling a decent story. She could do more that, though. Danielle Steele tells stories; Edna Ferber could actually write. I was vaguely familiar with Ferber's work before I started So Big, the novel that won her the Pulitzer in 1925. I doubt there's a person on the planet who hasn't seen Showboat (there have been four movie adaptations to date) or Giant (Elizabeth Taylor, James Dean!), and I'd felt obligated to read Come and Get It because I graduated from high school in the town (Hurley, Wisconsin) that allegedly served as the model for the rowdy brothels and bars community Ferber so colorfully describes. I'd never gotten around to reading So Big, though.

So Big is set on the outskirts of Chicago at the end of the 19th century. Ferber takes some familiar conventions and twists them in intriguing ways. She has the plucky heroine, so well-loved in fiction for generations, who is suddenly orphaned, finds herself almost penniless, and is forced to make her own way in the world. She goes off to teach at a country school, and then is swept off her feet by a handsome Dutch farmer. This is the point where most stories would end -- the traditional happy ending.

Except it's not a happy ending, of course. The handsome Dutch farmer turns out to be both stubborn and stupid, totally oblivious to the fact his schoolteacher wife isn't just more literate than he is, she's also a heck of a lot smarter. He really loves his wife, but the bottom line is he's basically an unimaginative lout, a good-natured idiot totally incapable of entertaining any new ideas. Still, Selina perseveres and manages to find beauty and happiness despite the frustrations, and eventually Pervus DeJong has the good grace to die. Widowed and with a young son to raise, Selina turns it into one of the most profitable truck farms supplying high quality vegetables to the Chicago markets.

When a person looks at the plot outline -- gambler's daughter marries farmer, waits for him to die, and then lives reasonably contentedly ever after -- it really doesn't look like the book would be worth reading. But it is. Ferber had a true gift both for descriptions and for characters. There is nothing flat in the book. You can almost feel the muck rising up around Selina's ankles in the farmyard, and see the bafflement in her son's eyes when she's trying to explain to him the difference between actually living and merely existing. Dirk doesn't get it, but at least when the book ends you get the impression he wants to understand, so maybe eventually he will.

In the introduction to the book, Maria K. Mootry (whoever she might be; I don't have a clue) speculates that one reason Ferber tends to be overlooked and/or forgotten today is she was too successful. Her books don't count as "literature" because they sold too well. I'm not sure they are forgotten or overlooked -- this was the first book in this "project" that was easy to get. The DeKalb library system has multiple copies, and the one I checked out looks to be extremely well-read. It's been rebound at least once already, and it's a 1995 edition.

I was amused to discover as the book progressed that young Dirk DeJong lived on the same street in Chicago that I did briefly. He rented rooms in a boarding house on Deming Place. Ferber doesn't do much neighborhood description, but it was a great place to be during the summer I spent there as a mother's helper, spitting distance from the North Pond in Lincoln Park and an easy walk to the Fullerton Avenue Beach.

Purely rhetorical question

Are there any married Republicans left out there who aren't screwing around on their wives?

I want this guy's job

I came home for lunch and saw this van. My first thought, naturally, was gas or plumbing? I was wrong. This is what's getting checked:

I heard the dude say it's going to probably take him "another 3 or 4 hours" to do a really thorough check. Any job where the "uniform" consists of swim trunks and flip flops can't be too shabby. And for sure I can think of far worse ways to spend a hot summer day in Atlanta than being paid to dip in and out of a swimming pool.

One for Ranger Bob

Check out the postmark. Is this or is this not really cool railroading ephemera?

Trip down Nostalgia Lane

It's that time of year when people are heading to reunions. I have no desire to attend one myself, but after reading Lisa's pre-reunion posts and her mention of Cindy Lauper, I started thinking about oldies. . . and this is what was number one on the Billboard charts the week I graduated from high school.



I really am older than dirt.

More health care musings

I've been reading the article about health care costs in the New Yorker that's been referenced a number of times in various discussions, both in the MSM and in the blogosphere, and it's pretty interesting. The author, a surgeon, went to McAllen, Texas, an area with the highest per capita medical expenses in the country. He wanted to find out what was going on there that made it different from a place like Rochester, Minnesota, home of the world-famous Mayo Clinic. Per capita costs in Rochester average about 60% what they do in McAllen.

It's an intriguing article. The first thing the author discovers is that the clinicians and health care administrators in the area had no idea they ranked first in the country for patient costs. As far as they all could tell, no one was going out of his or her way to push treatments that weren't needed. So they posit that perhaps the problem is that McAllen just has a higher than average percentage of unhealthy people. It is, after all, a poor area with an extremely low average household income, which in turn suggests lousy diets, obesity, and clogged arteries.

Well, that theory gets blown out of the water pretty quickly. Turns out that the while the local populace looks like they'd be key candidates for things like heart disease and its attendant high dollar procedures (echocardiograms, angioplasties, by-passes, etc.) the average number of procedures done in McAllen isn't noticeably higher than any some parts of the country and is actually lower than cardiac procedure rates in regions that have lower overall costs.

What it comes down in the end turns out to be pretty predictable: physicians, hospitals, and other providers who have come to see patients as a revenue stream. No one thought that he or she individually was pushing unnecessary procedures, but it turned out the overall culture with its emphasis on profits and revenue streams encouraged doctors to do just that. McAllen has high medical costs per capita because the system, both private insurance and public programs like Medicare, incentivize high dollar procedures. The more procedures that get done, the more patients that cycle in and out of waiting rooms, the more money the doctors make. (In contrast, the Mayo Clinic in Rochester removes the financial incentive by putting physicians on straight salary; there's no linkage between number of patients seen and the size of their paychecks.) In McAllen no one is seeing the system as a whole -- they're just viewing each patient, each procedure, as a unique cash transaction in itself. Ironically, despite having all this high dollar medicine available, the overall morbidity and mortality rates for McAllen aren't so hot. Turns out that as clinicians focus on revenue streams, they lose sight of prevention. So the elderly in McAllen get a lot of colonoscopies (over $3000 a pop) and echocardiograms ($1400) and not enough flu shots ($20 at the local Walgreen's?).

Plus, of course, the fact that a procedure can be done doesn't necessarily mean it should be done. Every invasive procedure introduces the risk of infection or other complications, every "routine" surgery carries with it the possibility of an allergic reaction to anesthesia, wounds that refuse to heal, blood clots, you name it. So between the de-emphasis on preventive health and the excessive ordering of various procedures, the folks in McAllens end up dying sooner than the American average.

I must say that conclusion floored me. At the very least, one would expect that if clinicians are ordering all sorts of tests and things there'd be a pay-off of some sort for the patient: better quality of life, increased longevity, whatever. Nope. No such luck.

The author basically comes to the conclusion that what the American health care system needs isn't a change in who's paying for what because switching who signs the checks isn't going to address many of the fundamental problems in the system now. What the system needs is to go back to being patient-centered. Unfortunately, in a culture that prizes profits above all else, that isn't likely to happen any time soon.

I did learn one interesting thing. In addition to the Rochester, Minnesota, area, there are some other parts of the country that stand out for putting patients first in the health care equation. One is Grand Junction, Colorado. It ranks really high in terms of both quality of care and patient satisfaction. That's were my mom lives. No wonder she never has anything bad to say about her doctors or Medicare.

First they came for the peanut butter. . .

And now this:

Food maker Nestle USA on Friday voluntarily recalled its Toll House refrigerated cookie dough products after a number of illnesses were reported by those who ate the dough raw.

The company said the Food and Drug Administration and the Centers for Disease Control are investigating reported E. coli illnesses that might be related to the ingestion of raw cookie dough.

[Photo of e. coli bacterium from the CDC's Public Health Images Library.]

Another reason to miss the S.O.

Since the S.O. left for the tundra, I've been planning meals and doing the grocery shopping with all the intelligence of a slightly brain-damaged teenage boy. When the S.O. is around, I may have an occasional odd craving but I have the good sense not to indulge it. But today I found myself at Target on my lunch break, and this actually jumped into the cart. Along with a Dr. Pepper, a bag of Cheetos, and a package of Australian licorice. Even worse, I'm sitting here actually eating the stuff.

Maybe I should just take comfort in helping to support the economy of northern Wisconsin* and not think too hard about the way jerky looks like road kill. (I also think their Sasquatch ads go so far beyond stupid the only possible explanation is that everyone at the ad agency grew up huffing Aqua Net hair spray, but that's a topic for another time.)

(*I've actually been to Minong, but did not dine at Grandma Link's Restaurant, although I hear the food's not bad, nor did I browse the cars on the lot at Link's Ford, or look at campers at Link's RV Sales -- who'd a thunk that Link was an actual family name and not something made up by a corporate shill?)

Pultizer Project: The Able McLaughlins

Well, I'm up to 1924. Margaret Wilson's The Able McLaughlins marks the seventh one* I've read since starting this project, and I'm beginning to think that Pulitzer winners are like Star Trek movies -- only every other one is actually worth spending time with.

The Able McLaughlins is a post-Civil War novel, sort of. The war doesn't actually enter into the story much beyond the fact one of the main characters serves in the Union army. The hero, Wully McLaughlin, is a hard-working Iowa farm boy, one of the older sons of a humongous family of Scottish immigrants who are establishing farms on the prairie, and grows up surrounded by a zillion aunts, uncles, and cousins. Apparently where one McLaughlin went, several hundred soon followed, so when one McLaughlin left Scotland to start farming in the midwest, he wasn't alone very long. The McLauglins are a lot of things -- honest, devout, incredibly fertile -- but communicative doesn't make the list. They do a lot of thinking and brooding, but actual conversations don't seem to happen very often.

Wully, for example, comes home from the war briefly, on an unofficial leave (he was captured by Confederates and escaped, and decided to come home to rest up for awhile before reporting back to the Union army), and while at home falls in love with the girl next door. As far as I could tell from the book, their interpersonal communications consist basically of them staring at each other, being instantly smitten by love at first sight when they both suddenly realize they're no longer children, and then Wully goes back to the military having decided that Chirstie (and, yes, I know all the names look like typos; I think it was part of the author's misguided attempts to add some folksy and/or ethnic charm to the tale) is his One True Love. A few months later the war is over, Wully comes home for good, and is dismayed to find Chirstie giving him the cold shoulder.

There are Reasons, of course, and a low-life villainous cousin lurking in the shadows. Once Wully blunders upon the truth he insists that Chirstie marry him immediately. His parents are puzzled and shamed by the sudden marriage (they believe Wully has been less than honorable), but eventually the facts emerge and his mother is able to be quietly proud of him again. Long before that point, though, the Reader finds herself losing patience with the incapable-of-speech McLaughlins and thinking dark thoughts about authors who persist in creating characters whose only function seems to be inspiring irritation in the audience.

Good points about The Able McLaughlins: it's easy reading, definitely much, much lighter than the first five winners were, and one of the minor characters (Chirstie's stepmother) does add some comic relief.

Negatives? It's not very good.

*I read Gilead (2004 winner) way out of order; otherwise I'm working my way up the list from oldest to most recent.