Sunday, December 28, 2014

Thoughts about reducing medical malpractice costs

I am concerned that medical malpractice costs are a significant contributing factor in the overall cost of healthcare.  I would like to propose some possible approaches to this issue.

First, I favor a Workman’s Comp model for medical malpractice.  

In the 19th century, litigation against employers for workplace injuries was endangering the existence of private enterprise.  It was recognized that on the job accidents were unavoidable, but that private enterprise was also a model that this country wanted to go forward with.  

As a result, the Workman’s Comp system was established. This is a system that allows some recovery for such injuries, but limits that recovery.  In particular, there are not punitive damages — and other amounts may be limited, as well.  Also, there is a universal, single provider system of insurance for employers in states, where employers pay in to protect themselves.

I would like to see us do something similar with respect to medical malpractice.  

We need to recognize that humans make errors.  In the case of doctors, those errors are going to cause medical problems and death.  Obviously, we need to work to reduce those errors, but the current solution is not working.  First, it unjustly penalizes a few doctors to the tunes of millions of dollars, but also unjustly penalizes all doctors every year, many of whom have to pay hundreds of thousands of dollars in malpractice insurance.

Second, tho, given the low amounts that Medicaid and Medicare are willing to reimburse, it is becoming increasingly difficult for doctors to take those patients.  I would like to propose that doctors be exempt from malpractice litigation for causes arising out of treatment of Medicaid and Medicare patients.  In this way, doctors who only take such patients would be able to forego malpractice insurance and reduce their costs.  This might be particularly attractive to new doctors, right out of medical school.

I don’t think that such doctors are necessarily going to be any worse than any other doctors, just less interested in making huge amounts of money, and more concerned about treating those who are low income.


Third, and most important, truly incompetent or corrupt doctors should have their licenses suspended or revoked, and possibly be subject to criminal prosecution.  Malpractice litigation is too capricious and random to be an effective tool in policing the medical profession.  

Monday, December 1, 2014

ical errors interfacing with Yahoo! and gmail calendars


I am getting various errors interfacing between ical on my mac mini and gmail and Yahoo.

The image above is an example of the kind of error message I get.

Also, tho, notifications do not transfer properly between my Android phone and ical.  The appointments transfer, but the notifications do not.  This makes the calendar substantially less useful, even dysfunctional.

I am very dissatisfied here. I thought Apple was a good company with long lasting products.

Now I'm finding the compatibility issues unmanageable.

Also I feel that google does not do enough to ensure compatibility with different platforms. I am also finding problems interfacing with Yahoo! mail using the chrome browser and the Yahoo! app for Android.  I suspect that this is partly due to google not working hard enough to be compatible.

Sunday, November 23, 2014

Christmas Stories

I went to a show at UCB the other day where people gathered to tell holiday stories.  Now, actually, not all the stories were holiday stories, but some were.

And I was thinking, well, I can’t consider participating in a show like that, because nothing interesting ever happened at Christmas in my house.

But then I thought, well, even if it wasn’t interesting I could still tell Christmas stories.  I’m sort of doing this with the idea that it might be interesting for my kids some day, if I’m not around to tell them.

The Tree & decorations
————————————

The first thing that happened for Christmas, as I recall, was the selection of the Christmas tree.  

Our living room was about 8 feet high.  My father was 6’ 2 1/2”.  He figured out that, if he raised his arm up over his head, the tips of his fingers should reach the top of the tree.  If the tree was just this high it would be the right size for our living room.

We kids would go out with him and select the tree from a lot where there were many trees.  It was cold in Wisconsin — making speed of the essence — and my father wasn’t much of one for discussion, so he pretty much picked the tree himself. He would measure the height with his fingers and then he would spin it around to make sure there were no gaps in the branches that would be unsightly.

Then we would put it in the station wagon and bring it home.

We didn’t put it up immediately after purchasing it.  We put it out on the screen porch in a tub of water that typically froze solid around the base.  Then we would bring it in only a couple of days before Christmas.  I think this process was supposed to minimize the period of time during which the tree would be dropping needles on the carpet.

My mom seemed to disapprove, also, of the idea of having the tree up for all of advent. Somehow I got the feeling that there was something socially inferior in that practice. Yet, we did not either follow the practice of having the tree brought by Santa on Christmas eve.  It went up 2 or 3 days before Christmas.

We had ornaments and lights in the basement that we used over and over every year.  We used tinsel also.  I wonder if it contained lead. I don’t use tinsel any more now.  I have sparkly garlands that seem to be of some kind of plastic.  I wonder if that isn't just as toxic in its own way.

There was a particular star that we put on top of the tree every year, and we used the same stand every year as well.  Crawling under the tree to fill the water in the stand was a child task, made trickier by the presence of lots of presents.

We had to get the tree down by 12th night, according to my mother, because her Irish nanny had told her when she was a child that Christmas decorations (especially berries) could turn to gremlins if left up after 12th night.

There were lights on the bushes out front.  

One time, when I was older, maybe college age, my father sent me out after sunset on an especially cold night to put up lights.  Now my father was one of those “When I say jump, you say ‘How high?’” type of men, so I was not about to say no — totally unlike my kids.  So I went out even though it was very cold out.  My mittens were too bulky to manipulate the lights over the little nails around the door frame, so I took them off. But then my fingers when numb, so I still couldn’t manipulate the lights.  I did get them up, more or less, tho a number of bulbs were broken in the process.

I’ve never liked to put up outdoor decorations since then, even tho it’s often much warmer here in New York than it was in Wisconsin when I was a kid.

It might have been easier to wait until noon of the next day, when it would have been warmer and easier to see, but like I said I always felt compelled to do things immediately when my father asked.

My parents' wedding anniversary
—————————————————————
My parents were married two days before Christmas.  Therefore their anniversary became part of Christmas.  Every year, after my brother and I were old enough to be presentable at restaurants, we went out as a family to eat.

There was one year, when we went to a place called the Jamison House outside of Madison, WI.  It was an old Victorian mansion that had been converted into a restaurant.  It felt very elegant.

The waitress came out and started playing with my father’s hair, while we were all sitting there at the table.  it was an odd thing for a waitress to do, especially with my father, who was a very standoffish, severe person who tended not to like to be touched.  He did have nice hair, though, still fairly thick in advanced age, wavy, and white.  

She said “I love curly hair.”

He replied “My whole family has curly hair.”

She looked around the table, and saw that, in fact, we all had curly hair.

“I hate you,” she exclaimed.  And rushed off.

I guess that was the weirdest thing that happened around Christmas time for us.

We did somehow manage to get food, though, so she must have come back.

I remember wandering around and looking at interesting antique furniture there, including a player piano.

Religious services
———————————
My mother was raised Protestant.  She had us baptized Presbyterian, but then we moved to the Episcopal Church, when the church we had been going to was converted into a parking lot and moved father away.  The Presbyterian Church that was only two blocks from our house had a preacher who was too conservative for my mother’s taste.

My father’s ancestry was Jewish, but he had been raised as Lutheran in Germany, before being forced to flee.  I don’t know what his beliefs were exactly, because he generally forbade the discussion of religion, philosophy, or politics in his presence.  I think he was probably an agnostic.

My mother sang in the church choir. She took us kids to church every week.  

My father would only come on Christmas and Easter, when the church put on a special show.  The Christmas service was in the evening of Christmas eve.  The church was generally full those evenings.  

The priest always made some comment about that, how he wished so many people would show up every Sunday, but that never happened.  I guess there were a lot of people like my father that way.


Opening presents
———————————
We were fortunate.  There were always a lot of Christmas presents.  My mom’s siblings, who lived on the east coast, sent presents to all of us in Wisconsin every year, which added to the pile. And each of use gave each other person at least one present.  My parents generally got my brother and me each several presents.  So there was quite a pile.

We were wrapping and putting presents under the tree for a couple of days before Christmas.  The wrapping paper was kept in the upstairs closet, below the linens.  My mom was careful to save large pieces to use over year after year, just as we saved ornaments.  I don’t think people do that much any more, but we did then.

There were also stockings.  

I know, in some families, the tree and all the presents are brought by Santa.  In my family, only the stockings were brought by Santa, after we children went to bed.  

On Christmas morning we were only allowed to open the stockings before my parents got up.  This was because my mom wanted to keep a record of who gave what to whom, so that we could write thank you notes to the more distant relatives.

But, even tho we only owed notes to the relatives on the east coast, she wrote out a huge spread sheet with all the presents under the tree so she would have a record.  I’m not sure what she did with those spread sheets. I don't recall finding them when I went through her stuff after she died.  Maybe they were in the papers that had to be thrown out after the basement flooded, because they got moldy.

This record keeping meant, tho, that we couldn’t open presents too fast, because she wouldn’t be able to write it all down.  

The stockings generally had several toys to play with, to keep us busy.  When we were smaller, we were up an hour or two before my parents.  They insisted on having breakfast before opening the rest of the presents.

As we got older, it was more likely that they were impatiently waiting for us, because we wanted to sleep in.

Visitors
———
When I was in law school, I lived in a dorm with students from all the graduate schools of Columbia.  Across the hall from me was Mika, who was a student from Japan who I was very fond of.  

While her family could afford to send her to graduate school in New York City, apparently flying home over Christmas break was too much, so she was expected to spend the whole month in the dorm, with most of the other students gone. 

I asked my parents if I could bring her home to Wisconsin.  

Disappointingly, my mom said “No.”  Asians were too neat and clean, she opined, and she couldn’t have an Asian scrutinizing her housekeeping before Christmas.  It would be too stressful.  

This was an inaccurate stereotype in Mika’s case, I thought.  Mika kept dirty sanitary napkins under her bed and drank orange juice directly out of half gallon cartons. 

Eventually, my mom relented partially and said that Mika could come the day after Christmas.  The week after Christmas was the week when my father made his annual pilgrimage to a warm climate before the semester started up and he had to teach again.

My father hated the cold.  He generally refused to get proper winter clothing.  He seemed to refuse to believe that it wouldn’t matter what clothing he wore.  He would always be cold. This was not very logical for a physicist, who should have appreciated the benefits of insulation.  

The boots he wore were just the rubber types that you pull over shoes.  One winter I got him Sorel boots for Christmas.  After that he was forced to admit that it did matter what types of winter clothing one wore.

Eventually, my mom convinced him to wear a coat with a hood.  Hoods are much warmer than hats, because they insulate all around the neck and ears, but it was a long time before he was sort of dragged into that kind of warmer clothing, despite his constant complains about the cold.

My mom went along on these pilgrimages, so Mika and I had the house to ourselves. I’m not sure where my brother was.

I remember driving her out to the countryside around Madison.  She was amazed at the open space, which she considered wasteful.  Perhaps it looked so in winter, tho I think it was used by dairy cattle in summer.

My parents did let me bring home my two serious boyfriends, Andy, and Alan (who I eventually married), for Christmas.

My mom was concerned about having premarital sex going on in her house when I brought Andy home.  I wasn't one to challenge this sort of thing.  I thought she had the right to decide what would happen in her house.

I was surprised that my father turned out to be the more liberal one.  He said we would use the English system, which he said consisted in putting unmarried couples to bed in separate rooms, but not checking afterwards to see where they ended up.

Generally, tho, visitors were not in order on Christmas Day.  My mother, in general, and a hard time with visitors.  She had been raised in a house with servants, and entertaining, in general was very stressful for her.  She could never relax about food preparation and cleaning, because she had to learn all that stuff as an adult.  I was told that her mother, my grandmother, only learned to boil an egg at age 45.  That was an issue with her throughout my mother’s life, feeling inadequate to entertain.

Linzertorte

My father's mother was from Vienna, Austria. She had many fine recipes, which she would happily have shared with my mother, but my mom wasn't in to cooking, so she only took one, the Linzertorte, which was my father's favorite. It took quite a bit of time to prepare, so my mom made it only on Christmas and on my father's birthday.

My brother and I both loved this recipe.  I've posted it on this blog before.

Oma's linzertorte recipe

I don't eat highly sweetened foods any more and the recipe contains nuts, so I seldom have an opportunity to make this recipe, which I'm sad about. My kids also don't like nuts, which is in the dough.  In that respect, they are like my ex husband, who also does not like nuts.  Therefore I can never make the recipe for them either.

Most Americans have never had this wonderful desert, and eat things that I believe are far inferior.


Saturday, October 18, 2014

Open letter to Tom Steyer, billionaire environmentalist

I just put this up on twitlonger, but thought I would copy it here

@TomSteyer My particular bugaboo is that private automobiles should be eliminated, at least in urban areas where there is public transit.

Automobiles are horribly dangerous. Tens of thousands of people are killed in them every year in the USA alone. Hundreds of thousands are wounded and maimed. 

This is an inherently defective technology. It turns a moment of inattention into fatality. Moments of inattention are part of the human condition. We are humans, not robots. Yes we drink. Yes we look around in the car for things. Yes we carry distracting passengers. That's human.

Also, of course, automobiles cause pollution.

Public transportation has not succeeded in competing with automobiles in the area of time in many places. For instance, I live in Tarrytown, NY. While there is good hub and spoke transportation into NYC, there is not good peripheral transportation. I once interviewed for a job in Murray Hill, NJ. It was an hour and a quarter by car to get there in good traffic. It was THREE hours by public transit through NYC. An hour and a quarter was difficult, but three hours each way was completely impossible. 

I would like to see the institution of an artificial intelligence based public transit system. Currently, you can go on google maps and ask for them to plan a public transit route from one point to another. But why not go a step further? 

Why not deploy public transit in response to a user request? A system of vans, taxis, and carpools, buses, trains, and airplanes directed by an artificial intelligence system, could take passengers door-to-door in an efficient manner. 

The user should be able to access the system via the Internet or via telephone, be presented with trip choices, pay for a chosen route, and then be picked up at the door of his or her home and delivered to the door of the desired destination.

By reducing the number of cars on the road, we could also reduce road construction costs. For instance, New York State is currently constructing the world's widest bridge from Tarrytown, NY to Nyack, NY, three miles across the tidal estuary known as the Tappan Zee. This behemoth is incredibly expensive. Tolls are expected to be $14. 

AND the problems of peripheral transport in this corridor are still not resolved. There has been discussion of a light rail system, but that has not been pursued.

An artificial intelligence based system would reduce accidents, reduce expenses of road construction/expansion, AND protect the environment. Modern artificial intelligence techniques are well adapted to solving this type of problem.

Friday, October 17, 2014

Obamacare

I am becoming one of those people who is angry about Obamacare.

I am a sole practitioner, so all of my health insurance is paid for by ME.

First, right after Obamacare, my premiums went up by $150/month because the lifetime limits on benefits were removed.  I didn't mind that so much, because I sort of understood it, but it was distressing, nevertheless.

Now, I find out that my insurance is going away entirely.  I was in a group sponsored by the New York State Bar Association.  Apparently, under Obamacare, the New York State Bar Association can't be a group.  The only groups can be partnerships or employers with W-2 employees.  This implies that the firm that I am of counsel with can also not list me as part of their group, even if I wanted to pay premiums.

How is this helping more people get insurance, by limiting what constitutes a group and destroying a group that's been providing insurance to hundreds or even thousands of people for years?




Tuesday, September 30, 2014

On visiting Sterling Hall 6/29/2007

I wrote this poem back in 2007 when visiting Madison, Wisconsin.  My father was a physics professor who taught in Sterling Hall.  Sterling Hall was bombed in 1971 and a student was killed.  There is more about this in the book Rads


On Visiting Sterling Hall June 29, 2007
By Anne Barschall (daughter of late emeritus professor H.H. Barschall)

There is something about that door
That old and dingy looking door
Its concrete ornamentation grayed
By years of not so gentle weathering
Something dingy like the old photos
Of physicists, years ago
Photos I grew up looking at.

I thought the photos merely old
When I looked at them as a girl,
But I see now that, no,
Those scenes were always a bit dull
To the eye.

The fire that burned there
In corridors vilely beige and green
Was the fire of the mind
The lightening of genius within
Not without.

Sandaled feet,
A crop of disheveled hair,
Awkward glasses,
Baggy shirt and pants
Of indeterminate color,
Covering a slender form --
The archetypal physicist --

I saw him again today
Walking through the overpass
Between Sterling and Chamberlain,
No apparent difference having arisen
In 80 years of fashion
For the seekers of the watchworks
Of the cosmos,
His dedication to that same search
Showing in his external sameness,
A grayed and dingy sameness;

And a tracing of new brickwork,
On the building’s façade,
Still tells a story of a different type of fire
That I remember from my childhood
A silent memory of a loud noise
In the night.

I hear they will renovate you,
Monument to vanished memories,
Infusing an aura of newness.
Will they try to make the sandaled gentleman
Wear something spiffier as well?

Monday, September 22, 2014

Ongoing updates

Links to my profiles

upcoming performances
  • tba

News from 2017

recent performances & other acting

ongoing or upcoming courses
  • Musical Theater with Jeffrey Saver
  • drop-in dance classes with James T. Lane of "Chicago." He's amazing. I'm not.

completed courses

  • Stage Combat with Joe DiNozzi, Producer's Club 5/11/17
  • Improv 412 UCB, NYC with Frank Garcia-Hejl 3/22/17-4/19/17
  • Monoscene Magnet Theater 1/8/2017-3/19/201 with Michael Lutton
  • Character 101 UCB 1/7/2017- 3/5/2017 with Chrissy Shakelford
  • volunteering as a coaching subject in Armando Diaz's improv Coaching class 1/20/17- 2/18/17

law related courses

  • JPPCLE 4/27/17, Crowne Plaza Times Square, NYC
  • "Insights from Practitioners in the Nation's Busiest Patent Courts" sponsored by http://www.nyipla.org/nyipla/default.asp 1/11/17


Calligraphy examples and more calligraphy examples (some from earlier)
Here's a photo taken by Brad Benson of me performing with Lauren Stripling at The Magnet Theater in November of 2014.



Earlier updates, deleted from this blog and moved to separate blogs:

2016 updates
2015 updates
2014 updates
          *********

          How this page started:


          I made my very first attempt to post updates on linkedin with some of the above.

          This was one of those hard knocks things.

          First, they have rather small limits on the lengths of updates.

          Second, they remove carriage returns, so that bulleted lists become garbled.

          Third, There doesn't seem to be a way to edit a post once you get it up there.

          Fourth, it's really hard to enter text in there, because they automatically substitute miscellaneous links, while you're typing, and you have to hit "escape" while typing to avoid getting this miscellaneous, unrelated garbage in your post.

          So I deleted my post, put a link to this blog on linkedin, and am maintaining this for recent updates.  I also have a link to this update page on my website and on my profile at Paul Michael's The Network. I am grateful to this website for allowing me to be verbose and format and reformat my posts.

          Sunday, August 3, 2014

          Making my bed

          I was making my bed yesterday. I don't do it often enough. I used to do it every week. Now I've gotten lazy and do it maybe once a month.

          I do try to take a shower before I get in there, so I won't be sleeping with a lot of germs, and they'll only be my internal germs, I guess, since I sleep alone. 

          When I had a cat, I wouldn't let him sleep with me. Maybe I avoided toxoplasmosis infection that way. 
          More recently I read an article that explained that this disease causes a particular type of brain damage that makes you want more cats, a curious type of symbiosis.

          So I was making my bed, and I noticed how easily I pop pillows into pillow cases, and flip covers onto the bed. I've developed all sorts of conditioned reflexes that make this almost effortless, which makes it hard to understand why I do it so seldom.

          I'm better than my kids in this respect. The only times their sheets get changed are if I have a house guest when they're away and I put clean sheets on the beds for the guest, or if I really nag a lot.

          So, I'm doing this task, and I'm hit with the memory of when I was five and my mom first started teaching me to make a bed.

          It was very hard then. I was a lot shorter, so to reach the side near the wall I had to crawl over there on the bed, which them messed up the covers. I hadn't yet developed a strategy for dealing with these issues, but I had listened to my mom read Mrs. Piggle Wiggle. That book had a story about teaching kids to make a bed. In that story, it was emphasized that the bed should have no wrinkles. Probably, my mom told me the same thing.  As a result, the problem of getting rid of wrinkles while crawling about was distressing to me.

          Then the thought of the likely recurrence of cancer came to mind, along with the consciousness of the limit on the number of times that I can use this skill that I've acquired over the course of many years, and how all the effort that I've put into learning these little skills may soon just disintegrate.


          I find that the prospect of loss of other knowledge, like loss of knowledge of patent law, doesn't disturb me as much as the loss of something so basic as making my bed.  Perhaps, because I was such a small child when I first learned, this simple task seems more fundamental to my character, to me as a person, despite the fact that it is not at all unique or distinctive, seeing as most people in our culture know how to make a bed.

          My friend T.J. Mannix posted this link on FB


          Which sort of captures my feelings about my newly made bed and wondering about what will happen to it when I can't make it any more.

          Monday, June 9, 2014

          Remembering Nora Solmssen

          Edits:

          The good thing about posting something like this is that it can help you get in touch with lost family members.  Nora's daughter Mimi contacted me and offered some corrections

          1) Nora had ovarian rather than breast cancer
          2) Nora was tested for BRCA mutations.  The first test was inconclusive and the second test was negative.  This makes me wonder how accurate these tests are.
          3) Nora was diagnosed in 2001 and died in 2005.  My father died in 1997, so he couldn't have been the one who told me she had cancer or that she had died.
          4) A second cousin on my *mother's* side says that her mother, who would have been my mother's cousin, used to play music with Mimi, and that Mimi was a violinist, not a pianist.  Small world.

          ---------------------
          The original post:

          Recently, I've been remembering my second cousin, Nora. 

          I only met her once or twice when I was a child. Her family lived in New Jersey. We lived in Wisconsin. 

          Her father was eight years older than my father, and my father had kids late. He was 41 when I was born. As a result, she was probably twenty years older than I. 

          I remember her as very beautiful. She had long, thick, shiny jet-black hair. She was slender and graceful. 

          She had an aquiline nose. Some people don't like that type of nose, but I always liked them, because several people in my family had them. 

          I dated a guy briefly who had a hooked nose, like Nora, and like my grandfather. Later I saw him and he had had his nose bobbed. I was horrified. I loved that nose. Good thing he dumped me before he bobbed his nose. He was Iranian, but he reminded me of that part of my family that was of Jewish ancestry.  He considered himself Aryan, though. 

          Nora was a Solmssen. The Solmssens and the Mendelsohns were the great Jewish banking families of Germany. 

          When I was twelve, my father took me to Germany, including to Berlin, where he was born. 

          My grandfather was a successful patent attorney before the Holocaust. My dad took me to the building where he was born. His family had lived on the top floor.  They had the whole floor. It was a large building. The whole top floor would have been a huge apartment. They had servants. There were stone sculptures, maybe of lions, on the railing of the balcony along the front of the top floor. Even with the holes in the walls left over from the WWII bombing, which were still visible, it was an impressive place. I think it was on Linden Street.

          Yet my father's family were the poor cousins. He also took me to Schwanverde. I hope I have that name right. Schwanverde was the complex where my father visited his Solmssen cousins, when he was a child. The Solmssens had a different name then.  They were called Salomonson.  I hope I have name spelled right also.  

          When we went, Schwanverde had been made into a children's camp, but it was still impressive.  It was a huge house, on a lake. Later I was told that it was actually an island. My father told me that every tree had been imported, that they were all exotic. 

          My father also told me that Hitler later confiscated that complex and lived there himself during WWII. 

          My father's cousin, Kurt, Nora's uncle, later told me he had had to fight with the neighbors to keep it a children's camp. They felt that a children's camp did not belong in their fancy neighborhood. 

          Nora's mother, Mimi, was from the Mendelsohn family, which also included the famous composer, Felix Mendelsohn. Mimi was an accomplished pianist herself. I seem to recall that Nora was a musician as well and that she may have sung with Don Ho. 

          When I knew them, Nora's parents, Mimi and Max, lived in an elegant mansion, in Summit, NJ. They had impressive pieces of antique furniture that, at least as I understood, they had managed to get out of Germany.

          As an adult, Nora moved to Hawaii. That seemed to me a very romantic place to live.  

          All in all, the Solmssens seemed to me to be rather like royalty. I was very impressed with them. 

          Of course, too, my second cousin, Nora's first cousin, Arthur Solmssen, wrote a historical novel called A Princess in Berlin, based on Solmssen and Mendelsohn family stories. In the novel, one of the family members was a legal princess. In reality, there was no one who was legally a princess, but they lived that life. 

          The Solmssens also tended to be tall. I think that increased sense of awe with respect to them.  In any case, children tend to be easily impressed by adults. 

          And yet, despited all this, my cousin Nora died fairly young of breast cancer. I remember my father telling me and being disconcerted. How could this beautiful, graceful, vibrant person die so young? I thought she must have had incompetent doctors. 

          Her father Max has breast cancer as well, but he managed to live to be ninety one. He outlived my father who was eight years younger, but then my father was in a radiation accident in Los Alamos. 

          But it was the story of Nora and Max's cancers that made me seek Ashkenazi Jewish type BRCA mutation testing. 

          My mother's family didn't have breast cancer at all. They are all WASPs. There were more of them and more closely related. I always thought that I would be like them. I was surprised that the genetic counselor didn't even know that WASP meant English ancestry. Perhaps she never even sees WASPs. 

          I never thought of myself as really connected with the more distant relatives on my father's side, but, sure enough, I have a typical Ashkenazi Jewish BRCA 2 mutation that caused my recent Ovarian cancer.  Despite the apparent distance of our relationship, Nora and I apparently share this mutatino.

          So I'm thinking of beautiful Nora now. 


          Last I saw Arthur he was writing a real history of the Solmssen and Mendelsohn families, but I don't know if he ever finished it.  I hope he does finish it.  I think it would be fascinating.

          Tuesday, May 6, 2014

          Fantasies of being an Amazon

          I tend to fantasize a lot: really a lot.

          Not all of these fantasies are positive. For instance, if I have a crush on someone, I might spend just as much time imagining what it would be like to have a fight with him, as I would spend imagining romantic love scenes.

          A big fantasy that's been occupying me recently has to do with having BRCA gene mutations. I heard about Angelina Jolie, about how she was told that she had an 87% chance of developing breast cancer, so she had a preventive double mastectomy. I knew that these mutations were associated with ovarian cancer as well as breast cancer. Two women in my gyn cancer support group who have these gene mutations have had ovarian cancer and not breast cancer, but are being followed for both breast cancer as well as recurrence of their ovarian cancer.  One of them takes tamoxifen.

          I became convinced that I had these genes as well. My father's side of the family is all Ashkenazi Jewish, which is a risk factor.

          My paternal grandmother had breast cancer, albeit with onset at age 68. I never knew her family. They may have all died in the Holocaust, or they may have been estranged somehow. My mother said that she thought that since that family had converted to Catholicism they did not like my grandmother marrying my grandfather. He wad officially Lutheran, but his sister married Georg Solmssen who was a prominent Jewish banker, so the Barschalls seemed more Jewish, our at least weren't Catholic. My Fahey later cast some doubt about the estrangement theory, as he says he remembered having some contact with members of his mother's family when he was a child. In any case, for whatever reason, my grandmother's family is a big question mark for me.

          My father was an only child so there was limited information about genetics there also. Still, he had a male first cousin on his father's side, inner of the sons of the famous Georg Solmssen. That cousin had breast cancer in advanced age, though nevertheless lived to be ninety one. That cousin had a daughter who died of breast cancer fairly young, in her forties or fifties.

          My mother's side of the family was fairly clear of cancer. They were WASPs. Women in my mother's family tend to die slow, lingering deaths with multiple strokes and/or Alzheimer's, making them into vegetables or childlike, before they went.

          My father died of kidney cancer. He was 81 and it had metastasized all over his organs by the time it was discovered. He refused treatment and died three months later. He had been in a radiation accident in Los Alamos. His urine was radioactive after that accident. I attributed the cancer to the accident. He also had huge black, hairy lesions all over his back that he had refused to get treated for years, which were likely cancer. I suspected those were from alpha radiation to his skin. He claimed never to have had a tan or sunburn on his back.

          He didn't think his cancer was from Los Alamos. Other physicists who got cancer had gotten it much earlier. He thought this was too much later. I attributed that opinion to denial. Los Alamos was the most wonderful, exciting thing that had ever happened to him. It gave his life meaning that, after being a refugee from the Holocaust, he could participate significantly in the war effort against Hitler; even though he was an enemy alien and even though,  ultimately,  the bomb was used against Japan instead. Many other physicists had gotten beryllium poisoning, and he hadn't. He couldn't stand to imagine that his work there had ultimately killed him.

          In any case, I could have all sorts of strange mutations due to my father being in a radiation accident. I grew up with my mother being very nervous about xrays. "Your genes have been irradiated enough," she would say. I thought about that when I was having a catscan yesterday. I had the catscan anyway, but it worried me.

          So, you see, I have been persuaded that I must have BRCA gene mutations, whether from my ancestry, or from the radiation accident.

          And, I've been persuaded that, like Angelina Jolie, I was going to have to have a preventive double mastectomy.

          Therefore, I've been fantasizing about life without breasts.

          I've never liked wearing a bra. They hurt my back. They itch.

          I don't like the idea of plastic implants. I've read that they have to be replaced every ten years. I don't relish the idea of more surgery in ten years, if it can be avoided.

          I used to have long hair, which I cut off in 2004, after hair blowing in my eyes was a significant contributing factor in a serious auto accident. When my hair was long, I used to keep my barrettes, elastic bands,  and combs in a large glass jar. I noticed a vile, chemical smell every time I opened that jar, so I surmised that the plastic gadgets in there were outgassing something.

          I read an article in Science News about a museum that held plastic artefacts. The museum noticed that, when the objects were about fifty years old, they disintegrated into toxic chemicals. The suspicion was that they had been slowly disintegrating for years, but had only been visibly affected at the end.

          In my family cottage, we had some very old plastic plates that also started breaking spontaneously. I had a very old bottle brush in my kitchen. The plastic handle of that brush started breaking and I had to get an new one.

          I already have two plastic devices surgically implanted in my body. I fear that the first one may have contributed to my cancer, though my doctor emphatically denies that this is possible. It's probably more likely that the low level hormone replacement I was doing was responsible, that and my chronic refusal to allocate enough time for sleep.

          Still, the idea of more plastic devices in my body, for purely cosmetic purposes, struck me as scary.

          Also, from a psychological perspective, the idea of being a breastless Amazon had a certain appeal. I've long had a lamentable tendency to get crushes on gay men. Maybe they would like me better with no breasts? Also I'm trying to become a performer. Maybe I would attract the attention of casting directors better if there were something really odd about me like that?

          I had this whole scenario worked out in my brain. I had a long time to work on it. I was waiting five months to see a genetic counselor at Sloan Kettering. The Angelina Jolie effect has created quite a run on these folks recently.

          I went to see her yesterday. She agreed that there was cause to test me. Also the new laws preventing discrimination based on the results of genetic testing, and preventing genetic testing results from being a preexisting condition for insurance purposes, would protect me from adverse effects.

          Then we video conferenced with the doctor in New York City. That's an interesting twist in medicine now. I can get treatment in the suburbs here and video conference with a doctor who is elsewhere.

          This is where reality intervened. He told me that my chemo for ovarian cancer will have killed cells that might tend to become cancerous in my breasts. Therefore, even if I have BRCA gene mutations, my risk of getting breast cancer, at least in the next five years, is now similar to that of the general population.

          Moreover, they would not recommend any elective major surgery in the next year, as my body is already weakened, and my chances of recurrence of ovarian cancer are much higher than my chances of getting breast cancer. The weakening effect of surgery could make the treatment of any recurrence more problematic.

          Therefore no preventive mastectomy.


          Tempest in a teapot.

          ----------------------

          Addendum 6/5/14

          Genetic testing reveals that I do indeed have a mutation on my BRCA2 gene which is typically found in Ashkenazi Jews.

          -------------------

          Addendum February 2016

          Now they're saying that maybe I should have the surgery if I'm still in remission 5 years out, so this may be reopened.  I've been thinking about it a lot, because one of my friends is having a mastectomy because they're gender fluid.

          My breasts have been useful. I nursed my first son for 22 months and my second son for 36 months.  I found nursing to be an extraordinary experience. I was riveted by it.  I pumped at work. I was in La Leche League. 

          Even I came to feel that breastfeeding explained my childhood obsession with vampires, that I had subliminally wanted to nurse a child all that time, hence the feeling that vampires were so fascinating.  I used to think, particularly of my older son, when he was still nursing, affectionately as my little vampire.

          Of course, they're no longer useful in that way.  

          I did read this article about a woman who developed a genetic treatment that would lengthen the telomeres in human cells.  This would in some sense, theoretically, make the treated person 20 years younger.  If I were suddenly 20 years younger maybe I would still want to nurse a child, even though I can no longer bear one, due to surgery for cancer.  But that all seems very unlikely.

          So, back to the amazon fantasies, if I can resurrect them.  I just bought 4 bras recently.