Smoking Cessation Down Under

It's not that often that one can say this, but here goes: The Australians have it right, at least regarding a ruling by their High Court that cigarettes be sold in plain packages. The law was passed by Parliament last year and requires cigarettes no longer be peddled in bright and cheerful, logo-infested packs. Instead, they're to be marketed in drab and dark packaging with graphic images of cancerous lungs and the comeuppance of other smoking-related diseases.

The major tobacco companies, up in arms, naturally enough challenged the new law, arguing that the plain packaging was unconstitutional, since it amounted "to an acquisition of intellectual property without adequate compensation," according to the Washington Post.  Nuts to you, said the High Court, perhaps having secretly read various reports issued by health authorities in Europe and the US that claim that cigarettes--and not the oft-maligned marijuana--are, along with alcohol, the real gateway drug.

The studies argue that drug consumption among the very young is often peer-related and that the use of cigarettes provides such users with various incentives. The youth get to act illegally by purchasing cigarettes while underage, or stealing them from parents. This is a cheap thrill--breaking the law with no or minimal consequences--but it prepares them for the more seriously illegal act of later buying drugs. Since consuming tobacco products is also illegal for young people, the adventure surrounding illegal acquisition is compounded by the act of using. Again, this is good preparation for graduating to more serious drugs. 

That, though heavily taxed, cigarettes remain cheap is another impetus. Even at five or more dollars a pack, they are within reach of most kids who can recoup their initial investments by going Asian and selling their surplus butts individually to their friends.  Sound like Dealing 101 to you? Hmmm.

Cigarettes are also highly branded, which kids respond to with gusto, just as they do branding in shoes, clothes, sunglasses and hair gel. Removing the Camel, or the bright red and white motif from a pack of Marlboros or Winstons, is likely to make the product less attractive. Big Tobacco, having spent billions in creating and marketing their brands in the first place, is fully aware of this.

According to NIDA, the National Institute on Drug Abuse, "the experience of smoking can teach youngsters to use a psychoactive drug to influence mood and alertness, as nicotine does, and then reinforce that behavior. Smoking cigarettes prepares young people for the relevant mode of ingestion for one of the next drugs in the sequence namely marijuana."  NIDA points out that drawing a foreign substance into the lungs is not a normal behavior for humans or other animals - it is a behavior which "has to be learned and rewarded enough to overcome the aversive experiences which usually result."

Additionally, says the 1994 Surgeon General's report, 12- to 17-year-olds who reported having smoked in the past 30 days were three times more likely to use alcohol, eight times more likely to smoke marijuana, and 22 times more likely to use cocaine, within those past 30 days than those 12- to 17-year-olds who had not smoked during that time.

Still not persuaded? Here's a handy chart put out by the National Center for Health Statistics relating to problem behavior among youth.  The first percentage figure is for kids who don't smoke. The second figure is for kids who do.

You can put it on your refrigerator door.

Alcohol use in past month                  23%                /                       74%

Five or more drinks in a row                9.5%             /                       50%

Marijuana use in past month                1.5%              /                       50%

Carried a weapon                                  9.5%              /                       25.6%

Physical fight in past year                  29%                /                       55%

Smokeless tobacco use

  in past month (boys)                          4%                 /                   28%                                        

So yeah. Go Aussies!

Writers Past

A few decades ago, I was convinced being a writer was largely a matter of appearance and attitude. Tweed jackets, briar pipes, alcohol--a lot of alcohol and occasionally some other drugs--a vaguely supercilious manner that barely dissimulated my great pain and anguish. I worked on an aged Royal manual typewriter bought at a pawnshop, was convinced of my genius and talent, and, best of all, owned a complete set of Harvard Classics. Back then (I've since sold them) the books, trimmed with gold leaf and bound in leather, were my proudest possessions.
The Harvard Classics, 51 volumes in all, were known as Dr. Eliot's Five Foot Shelf. Eliot was the President of Harvard University when the collection was first published in 1909, and he believed a well-bred gentleman could achieve a respectable education by reading this compendium of every major literary figure, philosophy, religion, folklore, and historical subject through the twentieth century. A few years later, Eliot created a separate 20-volume selection entitled the Harvard Classics Shelf of Fiction. I owned that as well.
What's interesting about Eliot's 51-volumes of disparate selections is that many of them, exactly a century later, have sunken into whatever Stygian obscurity ill-fated writing goes to when it dies. Who nowadays has read Volume 18, Modern English Drama, featuring Sheridan's School for Scandal, and All For Love by Dryden? Personally, I never got through Three Dialogues Between Hylas and Philonous in Opposition to Skeptics and Atheists by George Berkeley. Nor did I read the second volume of Elizabethan Drama, which includes The Shoemaker's Holiday (Thomas Dekker), Philaster (Beaumont and Fletcher), The Alchemist (Ben Jonson), or A New Way to Pay Old Debts (Philip Massinger).

In all fairness, there were truly important works in both collections, books every one should read, or at least skim--Aristotle to Dickens, Maupassant to Herodotus. Thousands of non-Harvard students read the Classics in their entirety and were the better for it. In time, Eliot's idea spawned other collections. After the Classics came Great Books of the Western World in 1952, and since then a host of other tomes have promised instant erudition for the common man.

I remember trying my luck with the 20 volumes of fiction, where I found--among other works--such deathless titles as Pepita Jimenez by Juan Valera, A Happy Boy by Bjornstjerne Bjornson and Skipper Worse by Alexander Kielland.
I mention all this because it's my belief that the majority of writing, like any other endeavor, is merely the product of its time. Some may survive, most does not.
Not that long ago a young man by the name of David Foster Wallace committed suicide at his home in California. Wallace, 46 at the time of his death, was the Great White Hope of modern American Lit. His work found its way into the New Yorker, Harpers, Atlantic and a host of other publications. Reporting on his death, the New York Times said, "the world of contemporary American fiction [has] lost its most intellectually ambitious writer."
When it first came out in 1996, I remember picking up what would become his best known work, Infinite Jest, with both hands--literally. It is a very heavy volume, 1,079 pages, footnote-filled, complex and, to me, eminently unreadable. Proust by way of Joyce with here and there some Kerouac and ee cummings; a touch of Howl and a whiff of Hunter Thompson.
Following Wallace's death, The New Yorker published a ludicrously over-long article on his career, followed by one of his short stories, Wiggle Room. The piece opens with a 400-line-long paragraph. For the second time, I gave up trying to read Wallace's prose.
So I wondered, who decided this guy was great? I canvassed my friends. Some had heard of Wallace, most had not. One had gotten to page 27 of Infinite Jest and dropped the book back into the library bin. Not one person I spoke with had actually read the work in its entirety.
So it stands to reason that one of two things is true, and both possibilities are frightening: the New York publishing world is putting one over on us. Either that, or all my friends are dolts.

Bring in the Legion

“You’re not gonna like this,” said The Good Doctor, TGD from here on. No surprises there, I haven’t liked much of anything TGD has done to and for me in the past year. Three surgeries, five or six bladder exams, enough drawn blood to make a good-sized boudin sausage, hours in the waiting room, the pre-op room, the post-op room and an entire collection of dehumanizing moments as various people handle various parts of my body, that. in my estimation should be handled only by someone near and dear. Now TGD is telling me I have to undergo six weeks of something called Bacillus Calmette-Guérin therapy to eradicate the cancer in my bladder. The treatment, he says, was invented in France, which of course makes me feel better, but, he adds, no one really knows how the therapy works, it simply does, most of the time, just like a lot of things do in France.

So I do my research.  What I have is a condition called low grade noninvasive papillary urothelial carcinoma (LGNPUC), a not particularly sexy type of cancer with a really bad acronym. There doesn’t seem to be a lot written about this particular malady, so here’s my take on it:  Imagine you have a nice home and you go on vacation and when you come back, an extended family of truly malicious squatters has taken over the place; there are a few dozen of them and they inhabit every nook and cranny of your house, using the pool without showering first and not flushing as often as they should. They cook really nasty smelling food on a campfire in the middle of your living room, don’t mow the lawn and never separate the recyclables. Basically, these are not the people you invite to the country club. Instead, you call the sheriff (TGD) who, after a brief tussles, evicts them (surgery). The sheriff is justifiably proud of his work and declares you squatter-free, but wait! He’s wrong! He returns a second time, performs another eviction, but it’s pretty obvious that these squatters are resilient and sneaky; they practice guerrilla warfare.  So the sheriff (TGD) calls in Bacillus Calmette-Guérin, the French S.W.A.T. team. Or maybe it’s the French Foreign Legion, I’m not sure.

At any rate, Monday in a week, noxious chemicals will be injected into my bladder. Then I will pretend I am a chicken on a rotisserie spit and spin horizontally for a while so said bladder is coated with the poisonous substance. After that,, more than likely, I will get sick, puke, and go home. I’ll do this six times over the next six weeks. Since I do not want to puke good food, I plan to stock up on raisin bran, Twinkies and Slim Jims.

All this is unpleasant but the alternatives could have been far worse.  At one time, TGD thought I had Carcinoma in Situ, and combating that is the chemotherapy equivalent of World War One trench warfare.

By comparison, LGNPUC is small pommes frites.

Book Sale

The librarian who works weekends and whom I'm slightly scared of wasn't at the book sale on Sunday.  She's a largish woman with a port wine stain on her forehead, and in a decade of going to the library, I have never seen her smile. Children do not run, shout or cry in her library. In fact, they barely breathe. When she's on the job, the loudest sound is the thin hum of  computers that have replaced the index cards, and the faint rustling of turning pages.  I suspect she's not a fan of the tri-annual sale, when the library rids itself of surplus books.  For seven dollars, you get a grocery bagful of fiction, reference, photo books, children's classics and as many back issues of National Geographic's as one family could  sanely handle.

It's as raucous a scene as can be found in any library, and I suppose it's not the weekend librarian's cup of tea. I go there even though I don't need more things to read, indeed, I donate books three or four times a year, and this time around found some items for sale that came directly from my shelves.  I was tempted to buy back my Doonesbury collection--I had donated it in a moment of weakness--but resisted the impulse. 

Still, I bought a few things. The complete works to date of  David Guterson, a writer whose Snow Falling on Cedars I admire. A replacement King Rat because the middle 60 pages of my copy vanished some years ago during a move. Two *** for Idiots that need no explanation, nor does a mint Pocket Book edition of Harold Robbins The Piranhas.

Pawing through the stacks and boxes, I found myself in competition with immigrant families that, while their command of English might have been limited, displayed unbridled enthusiasm for the treasures offered. Asians and Latino children raced through the hallways while their parents filled grocery bags with everything from romances to Readers' Digest collections. An ancient man who might have been Vietnamese had appropriated a grocery store cart and filled to the brim with travel and computer books; the library volunteer at the checkout table had to call a staffer to decide how many bags equaled a shopping cart.

One stack caught my attention--twenty-or-so volumes of the Encyclopedia Britannica, circa 1999. A sign wedged between two tomes read, "Complete Set, $10." Someone had scratched out the ten and replaced it with a five. Twenty-three years ago, I bought a complete set of the  EB for almost $1,000. It still presides over my small collection of reference works. I was tempted to buy this one too, so I'd have a separate set in my basement office. While I pondered, a brown-skinned little girl took the top volume, opened it randomly and started reading aloud, one small index finger tracing the line of print. Her mother, wearing a burnt-orange and green sari stood behind her.

"Did you want to buy these?" the mother asked me. I said no, I already had a set at home.

Did I use it much?  I had to admit that I didn't any more. Like almost everyone, I relied on computers now.

"They are no longer printing them, you know," the woman told me and I answered that yes, I had read a few months ago that the Britannica people had decided to forego printed editions in favor of digital ones.

"Very sad," she said. "In my home in Delhi, we had these books and my father made us read 10 pages every day."  I told her that when my family first came to the United States, my father had decided that, pound for pound, the World Book Encyclopedia was a better bargain, so we'd gotten that instead, one volume at a time from the Giant Food store that sold the set at a discount.

Soon the woman's husband appeared, a whip-thin man with a white short buttoned all the way to the neck. The family spoke a minute or two, and the father nodded. "I will purchase these if you do not." He and I found cardboard boxes to stack the books in; he paid for them and I volunteered to help carry the Britannicas to his car.

The weekend librarian of whom I am a little scared would have been proud.

Gérard and Me

There are only two French people in the world, me and Gérard Depardieu.

I say this with a degree of certainty because every time I turn on the French channel on cable, there he is—Gérard jeune, Gérard vieux,  Gérard in his 30s mince come un fil (thin as a thread), Gérard in his 40s balaise (hefty), Gérard now abolument gigantesque, (absolutely gigantic), Gérard en Francais, en Anglais and for all I know Gérard en Farsi.
Personally, I like Gérard. No one will mistake him for Maurice Chevalier and start singing "Sank 'eaven fur leetle gurls." Looks-wise, he’s no Alain Delon, though he might give Jean-Paul Belmondo a run for his Euro.  He has become, somehow, so quintessentially French that the whole image of the average Frenchman has changed from the baguette-carrying, beret-wearing, and Gauloise-smoking rotund little guy to the frighteningly overweight cro-magnon-lout-in-a-cheap-leather-jacket-who-likes-to-punch-people. I think this is a positive development. Enough of Pepé Le Pew, I say.

 
I like Gérard as an actor, too. He mumbles like Brando, postures like Newman and has the kind of grin that made Cruise famous. Also, he's pretty wide-ranging—from Cyrano de Bergerac to Georges in Green Card, and I suspect his nose needs its own visa when they both travel.

Gérard and I share a few similarities.

• He was in Les Miserables. I have read the book.
• He was born in France in 1948. I was born in France two years earlier.
• We are both males.
• He starred in Green Card. I had a Green Card.
• He owns an island in the South Pacific. I own some worthless snake-infested land in South Virginia.
• He speaks English. I do too, and better than he does.
• He likes saucisson, smelly cheeses, and boudin. I do too.
• He once spent $5,000 in a trendy New York club.  I once got lost in New York.
• He's gained a lot of weight. So have I (but to be fair, he has gained way more than I have.)
• He smokes Gauloise cigarettes. I stopped smoking Gauloise cigarettes 13 years ago.
• He once drank a $1,000 bottle of Scotch whiskey in three hours. I once drank a $5 plastic liter-and-a-half of Popov vodka (from New Jersey) in an evening.
• We both have large jaws. I got mine from my grandmother. I don't know about Gérard.
• His mother told Depardieu that she had tried to abort him with knitting needles. My mother almost aborted me when she fell off her bicycle at seven months pregnant.
• We both like Johnny Haliday a lot.
• We both wish we could have starred opposite Catherine Deneuve (actually, Gerard did, but it was in Potiche, possibly the worst French movie ever made. And I include Last Year in Marienbad in that statement.)
• He studied dancing under Jean-Laurent Cochet. I have danced once in the last 15 years.
• He is scheduled to play disgraced International Monetary Fund chief Dominique Strauss Kahn. I worked at the World Bank, which is across the street from the IMF.
• He peed in the aisle of an airplane when the bathroom was occupied.
• I.... No, I never did anything like that.

But anyway, Gérard and me, we're almost twins.

Blinders, Part I

There were still horse-drawn carts when I grew up in Paris. The hooves made clopping sounds on the cobblestones, and the horses were not the sleek and shiny beasts of movies and race tracks. Instead, they were weary animals bedeviled by flies; they pulled loads of coal or cement or junk, and they wore blinders. I was told in school this was so they could only look straight ahead and not be overly concerned with what happened to their right or their left.

Recently, I’ve come to think the same thing is happening here to the leadership and population at large. We have blinders on; we do not want to be distracted from what lies directly before us, and because of this we’ve allowed a host of truly important issues to be merely discussed—endlessly—and not acted upon. 

Five overwhelming concerns leap to mind: gun control, infrastructure, the war on drugs, the financial rape of the average citizen, and the biggest bugaboo of them all, serious and effective political reform that would prod our openly somnolent public servants to action.

Gun control:  According to the Washington Post, mass murder by definition involves the killing of at least four victims in one incident. From 1976 to 2010, there were 645 mass murders—the overwhelming majority involving firearms—leaving behind the bodies of 2,949 men, women and children. 

That’s a lot of folks, folks. Our legislators have taken the easy way out, typified by a statement from Senator Jon Tester, a Democrat from Montana, who told the press, “You can’t stop crazy people from doing crazy stuff.”  It’s interesting how such a figurative shrug-off works. By blaming crazy people, we can absolve ourselves of any responsibility for follow-up action. I’m reminded that World War I was set off by the murder of Archduke Franz Ferdinand and his wife. I suppose Tester would have called the assassin, Gavrilo Princip, just another gun-totting crazy guy over whom we were powerless.
Thirty-four years of mass murders, of course, are a drop in the bucket compared to the everyday mass-killing perpetrated by gun wielders. Eighty-four people are shot dead daily in this country. Think of that. Think of your children and family and friends and workmates all dying violently in one day… It amazes me that there are no permanent demonstrations against gun violence, and that we have accepted such damning statistics as a suitable cost of living in the USA.

Infrastructure: Over the coming decade, deteriorating infrastructure will pick $7000 from the pockets of each and every American household.  That, of course, is an abstract and symbolic number representing costs of lost wages because of time spent in congestion or in poor transit systems, and the wear-and-tear on cars by rough roads. In reality, this number from a recently released report by the American Society of Civil Engineers, attempts to illustrate a micro level. Thinking macro, we get 870,000 jobs or “a $3.1 trillion suppression of the GDP” before the decade is out.

A few simple examples:

• There are almost 600,000 bridges in the US. More than 150,000 of these are deficient. 
• We are spending $42 billion each year on highway maintenance.  We should be spending $146 to $310 billions annually over the next decade.
• Four-thousand-four-hundred of our 84,000 dams are deficient.
• Only 11 cities in the US have subway systems, some dating from the 1900s. All of them are in dire need of repairs.
• The 94,000 public schools in the country account for some $20 billion in annual spending. To work efficiently they need $254 billion.
• The 360 seaports in the US get $850 million annually but more than twice that is required for routine maintenance. 
• The pipes that deliver drinking water are mostly underground and falling apart. It will cost $335 billion to updates all the systems. Currently, less than a tenth of that sum is budgeted.
• A massive blackout could cripple the nation and its economy.  The country’s 157,000 miles of power line comprising the electrical grid need an infusion of $338 billion to pay for modernization and stave off almost certain failure.

More to come… 

Surgery, etc.

On Thursday at 9:15 in the morning an anesthesiologist will insert an IV into a largish vein in the crook of my left elbow and pump into me an elegant mélange of chemicals that will knock me out. I will be under long enough for the surgeon to excise whatever cancerous nastiness has taken occupancy in my bladder, and then I will come out of it feeling nasty, peevish, soiled and angry. The last time I went under and then came to, I insisted on having a bacon-cheeseburger. I don’t remember if I actually ate one, but I wanted it badly.

Since I will be non compo mentis when I awake, the surgeon will tell my friend Paul, who took me to surgery and will remain in the area, what the operation entailed, if it was successful, and what I should be doing for the next few hours and days.  Paul, in turn, will tell me.

I don’t like going under. Thursday will mark the fourth time I’ll have been anesthetized in a 12-months period, and I’m convinced no good can come of this sort of unconsciousness. I understand the necessity of the procedure—where I to twitch, the surgeon might accidentally puncture my bladder, which would be, to quote him, “a not good thing.” Still, I worry about a massive brain cell die-off, which I understand is not uncommon in people who go under too often. I have no brain cells to spare, and even though modern science has demonstrated that the cells repair themselves, I think mine are very, very slow to do almost anything, and the repairs are likely to be as swift and effective as a those done by a Washington, DC, road crew.

I have noticed that medical website minimize the dangers of full-body anesthesia, telling me that serious side effects are uncommon in people who are otherwise healthy and can be easily managed. The side effects, not the people.

Here’s what I know: General anesthesia suppresses the normal throat reflexes that prevent aspiration, such as swallowing, coughing, or gagging. To help prevent aspiration, a tube is inserted down the throat, in order to protect the lungs from stuff coming up from the stomach, hence the usual instructions to patients not to eat or drink anything for a certain number of hours before anesthesia.

Insertion or removal of the tube may cause respiratory problems such as coughing or gagging, as well as an increase in blood pressure and heart rate. There’s also the possibility of damaging the teeth and lips, swelling in the larynx and attendant sore throat and hoarseness. After the first operation, I found I couldn’t swallow without pain for about three hours.  

I’ll probably have nausea and vomiting after the procedure—that happened with the first two surgeries—but that will go away after I take antiemetics.

Actually, here’s my main concern: waking up during the surgery. That has happened to me twice before many years ago when the anesthesiologist poo-pooed my worries that my once-addicted liver has a tendency to assimilate anesthetics a lot quicker than the same organ in normal people. I make it a point to tell my history to the person administrating the drugs, but I do remember not that long ago having an attending nurse argue with me on the subject.

Now I simply hope that the anesthesia specialist will pay attention and prevent a premature awakening. After all, this ain’t brain surgery.