Saturday, March 9, 2019

Creativity Abounds in Las Vegas

“Because the world is round it turns me on . . .”

So begins the Cirque du Soleil The Beatles – Love extravaganza.

Last month, my kids whisked me away to Las Vegas as a Christmas/birthday surprise overnighter. Wow!! What a transformation from my previous trip in 1970 when all small-town Vegas sported was a quaint strip.

I was blown away by the creative explosion that is Las Vegas today, and not just with the Cirque du Soleil show, though that exuded a wealth of creativity in and of itself.

My kids were seasoned tour guides and delighted in showing me the sites along the strip. The hotel architecture astonished me, my head spinning from the glitz and glamor: The Bellagio with its intricate classic mosaic floors, and its stunning fountain, the water swirls like harps—tugging at my heart strings; The Venetian with its canals, bridges, and singing gondoliers; The Paris replete with its Eiffel Tower; and The New York Hotel boasting skyscrapers, a Statue of Liberty, and a Coney Island roller coaster. And yes, my son persuaded me to ride on it – the up-and-down as well as the sideways 360 rolls – the whole deal. I never thought I would ever dare go on one of those crazy rides – but heck, in Vegas I felt like a kid again.

Our two days in the city fell during the Chinese New Year, and every hotel lobby was festooned with elaborate oriental decorations illustrating the year of the pig. Creativity abounded in the designs and the ornate flower arrangements – it looked like a miniature Rose Parade!

We even rode in a Lyft driverless car – yet another example of creativity – this time technologic – at its finest!

Ah, but the The Beatles – Love show! I had a continuous grin on my face during the entire performance!

What depths and cascading layers of creativity! It all began with the songs originally dreamed up and orchestrated by the genius Fab Four. Then came the sparks of ideas emanating from the Cirque creators that connected the Beatles music to the Cirque du Soleil format.

What followed was a fantasmagorical waterfall of expression: the music arrangements that connected the Beatles original tracks with segue orchestration; the script that connected the acts with the songs; the fabulous sound, projection and light systems that dazzled; the artists that dreamed up, the sets, the costumes, the makeup; the impressive infrastructure that raised, tipped and rotated the stage and platforms, that moved a van and a VW bug, suspended performers with ropes and cords; the machines that spewed red-white-and-blue confetti and floated a sheer, humungous filmy curtain over the audience. That’s not to mention all the behind the scenes managers, stage hands, all creative in their own right.

And what about the people that managed the copyrights, releases and contracts? One might think these individuals to be less creative, and more practical, but then again this production introduced a new concept merging a world renowned group with the Cirque organization, and there were surely elements of creativity involved in the legal fashioning of contracts, agreements and copyrights, all needing to be finalized and fool-proofed to the last detail.

Our culture abounds with creativity and it’s up front and I found it visually mind-blowing in Vegas: over the top, elegant, sensual, sumptuous, voluptuous, and decadent.

That’s all fine and good – or not fine and wasteful, depending on how you see it – but how can we channel creativity into helping humanity and the earth? How can we use our creative talents to equalize the economic extremes: to balance the haves and the have-nots? How can we create ways to solve global warming, develop clean energy, clean up our bespoiled environment?

Is the problem that our creativity has gone amuck in the world? Or does it merely flow where it will? If creativity comes from the Divine as Julia Cameron in The Artist’s Way suggests – is Las Vegas and all its excesses a reflection of the Divine?

“What happens in Vegas stays in Vegas,” so the saying goes, but I want the creativity that happens in Vegas to NOT remain in Vegas. My deep desire is that creativity be channeled into helping humanity and the earth, and I believe that this is already happening. Creativity knows no bounds and I think it is spilling into all areas of life, and into every corner of the world. I am reassured by that belief. Many are creating and implementing solutions to our serious humanitarian and environmental issues, and they are fueled and heartened by the notion that:

“All you need is love, love
  Love is all you need . . .”

Sunday, January 6, 2019


- Getting in Tune With My Selves in 2019
 *A quote by Krishnamurti to convey that with his meditation and awareness practices, he was constantly and joyously entertained. I use his quote here with some irony . . .

With an all-star cast of my inner selves.

In the car in the gym parking lot.

Everyday self: I found a parking spot. The lot’s not too empty, not too full. Oops, I forgot my glasses, but then I did pass the driving vision test, so that’s okay. I’ll only be in hot water if I have to read something.

Complaining self: oh, I’m aching to begin with. Why am I doing this? I’m not making any progress with my workouts.

In the gym.

Judge self: just do the work, whiner. Get on the damn rowing machine and don’t stop till you do 200 calories and 4,000 meters.

Zoned out self: doing the work. Getting through it. Football on the telly.

Vacillating self: should I weigh myself, or should I not?

Bummed out self: My weight’ll be up, I’m sure of it.

I weigh myself.

Judge self: 145 lbs. Christ almighty. You are hopeless, absolutely hopeless. All your striving over the past few weeks has been for naught. You will be a beached whale in Hawaii. Well done you nutter! You can’t keep on a program worth toffee.

Persistent self: do the work, just do the work.

Ring pulls

Sadist self: do more of them

Persistent self: do the work,

Push ups.

Sadist self: do more of them.

Persistent self: do the work, then do one-legged sit stands

Sadist self: do more of them

Judge self: even though you’re doing more of them, it’s not enough. It won’t make a difference.

Bummed out self: my hip is hurting today. Over the long haul, it hasn’t improved. Damn!

Persistant self: band pulls, just do it. And do the floor exercises. And now the stretches. Ouch! 

Encouraging self: you did it. You did a good workout.

Pessimistic self: you’ve done it before, and it hasn’t really helped. Why are you even bothering?

Bummed out self: and you are still limping.

In the car

Persistent self: go home. Eat light cause you are going out to dinner tonight.

Judge self: you need to do your laundry. You need to do your bills. You need to keep moving – do more exercise. You are not doing enough. You are not motivated enough. You are the same old, same old.

Analytic self: take a naproxen. You don’t have to have this much pain

In the shower

Judge self: you are in the shower too long

Nurturing self: stay in the shower, feel the heat on your back.

Creative self: Ah-ha! Write a play about your different parts. Use the Krishnamurti quote.

Monday, November 5, 2018

Healthcare Coverage -- Easeful or Aggravating?

I recently read The Nordic Theory of Everything and was amazed and heartened by what the author, Anu Partanen, revealed about the Nordic and American systems. More importantly, her theories resonated with my own experiences in medical practice.

Partanen’s perspective, backed by several annotated and well documented studies, is that when populations in the Nordic countries pay taxes, and a streamlined government administers those taxes into healthcare, disability, retirement, and primary, secondary and tertiary education – for everyone – the population then has, in fact, more independence and more freedom. People aren’t tied to jobs because of the need for health insurance; parents don’t mortgage their houses to pay for their children’s education; people don’t go into hock and get stressed out when they have to pay and care for their aging parents; and school quality isn’t dictated by the neighborhood where people live. When these core needs are taken care of, people are free to base their relationships on what Partanen terms “the Nordic theory love”, and not on dependency and obligation.

And, by the time you figure the American out of pocket costs for healthcare, tuition, disability etc. etc. added to the taxes paid, the amount Nordic populations pay in taxes to pay for every one of these services is quite comparable – and equitable. That sounds pretty intelligent to me.

With respect to healthcare, it’s universal and uniform, and therefore the administration costs are streamlined. There is no privatization, no advertising, no competition, and no convoluted calculations for what’s covered and what isn’t.

I wrote about my experience as a physician with the misdirected explosive growth of administrative complexity in my memoir Lonely Refugee. Here is an excerpt:

When I began to work at Group Health [in 1984] there were no treatment record forms (TRFs) or billing forms to fill out. All I had to do was see patients and write good chart notes – good by peer review standards. My practice kept me jumping for sure, especially on days that I saw up to thirty patients in eight hours, but I spent most of my time coordinating patient care and leaving clear tracks in the charts. Back then there were no copays, no deductibles, no exclusions that patients were obligated to cover. All patients paid for were their monthly dues. That is all they paid for! And there was pretty much one single coverage plan – no deluge of coverage options from which to choose, and through which to navigate. One basic healthcare plan served practically all. At the time, I didn’t realize how lucky I was.

Twenty years later, myriad levels of administrative complexity had seeped into my practice. I had treatment record forms I had to fill out to document the level of care I provided, and to account for every procedure I performed, from paring corns to performing endometrial biopsies and suturing lacerations. A plethora of billing codes for every possible diagnosis and procedure inundated my work life. I could only charge higher diagnostic billing code levels if I followed the required documentation guidelines. I had to write my clinic notes in minute detail, using the exact mandated language. If I failed to follow the strict rules, I risked Medicare fraud charges: billing for work there was no evidence for in the chart . . .  

Hundreds of administrative non-patient care positions and system “upgrades” surfaced to cope with the tsunami brought about by the new changes. I was astonished at the magnitude of the upheavals: clinics were remodeled to create registration areas where newly hired clerks collected copays and determined insurance coverage; business departments exploded with coding technicians, billing clerks, and computer programmers; huge infrastructures materialized to develop, monitor, update, and maximize data capture and optimize reimbursements. And to keep up with and compete with the nationwide healthcare chaos, Group Health expanded its insurance coverage options and now offered literally hundreds of plans – so confusing, that I no longer knew how or whether the tests, medications, referrals, and procedures I ordered would be paid for by my patient’s coverage plan.
When patients asked me, “Is that lab test covered, doc?” I could only shake my head. “I don’t know. You’ll have to check at the business office.” . . .

Patients would then have to decide what they could pay for and what they couldn’t afford. I had to let them know the risks of not getting the tests done, or I had to scramble to find less expensive care options. All this required extra time, and inconvenienced both my patients and me. Care was occasionally compromised when patients didn’t check back after heading to the business office, or if they waited until they could come up with funds to pay for the medications and tests that I ordered. Many times patients became disgruntled with the costs they had to bear, and some became irate when the drugs or tests to treat their particular illness weren’t covered. I resented having to spend more of my clinic time documenting widgets of care and acting as the gatekeeper and mediator with my patients.

I was sickened to see how, with all the new changes, the focus had shifted away from patient care. Our medical staff meetings that once provided educational case reviews and clinical lectures, were now replaced by coding and charting classes to train providers on how to comply with the Medicare standards and maximize reimbursements from the government and insurance companies. The coding specialist frequently showed up at our meetings, giving us the latest code changes. For diabetes alone, hundreds of coding options were created – and they were updated almost weekly. The administrators had to make sure that we were entering the newest and most complete classifications. Learning these codes, taking the time to make sure all the parameters needed for the appropriate level of service were included in my charting, keeping up with the frequent updates and “corrections,” consumed more and more of my time. It drove me nuts.

When the codes were first introduced, the office billing clerks corrected the ones that I had flubbed and added codes that I couldn’t figure out. These employees were godsends! But when electronic charting was initiated, my backup system went poof! I had to enter every darn diagnostic code myself. To my chagrin, the computer wouldn’t allow me to order any labs, prescriptions, X-rays, treatments, or referrals unless I entered the exact diagnostic code.

Many a time I would flounder when with a patient. “Just a moment, Mrs. Smith. I’ll have to go find the right code number so I can order your X-ray . . . I’m so sorry for the delay, Mrs. Smith. Let me quickly finish up here and get you on your way.” But by now, I would be ten or fifteen minutes farther behind in my schedule. “Crap,” I would think to myself. “I’m going to be here until all hours tonight!”

I didn’t question that the electronic charting system improved access to medical records and therefore served patients and clinicians well. What I was at odds with was how most of us docs were staying at least an hour or two later to finish up with our charting and paper work. I had to ask myself if the high complexity level of billing, coding, coverage, and reimbursement systems also served to create better health, and I knew the answer to that – I didn’t think it did! And that made my extra work harder to accept. My disillusionment with the medical system grew.

What do you think?

I highly recommend The Nordic Theory of Everything, and I dearly hope that the U.S. will come to its senses and institute more effective and efficient medical care – and education – and retirement – and disability – coverage.

Tuesday, September 25, 2018

The Traveling Dress Photo Shoot

I was up before four a.m. to help with a photo shoot. Stephanie had been awarded the honor, along with seven other professional photographers, of showcasing a layout taken with a “traveling dress” that was mailed from photographer to photographer, over several weeks. We drove to her chosen locale: a solitary dock jutting into Lake Washington. My inspired, on fire daughter began shooting well before sunrise.

I was her assistant, tasked with guarding the camera and tripod that she carefully positioned before running out onto the dock, swaying, prancing, dancing, her layers of tulle skirts swirling, flowing, and glowing in the backlight. She set the camera to take one hundred shots at a time, reset the hundred over and over, moving the camera here and there, checking the angles, the exposures, scrunching her face when not pleased with the results, grinning with an I like that one . . . pretty! with ones that captured her creative spirit.

In the flow, she braved splinters and gravel on her bare feet; her legs seized with charley horses as she crouched and squatted; she gazed into the searing sunrise for that look-directly-into-the-camera picture. She chuckled when the voluminous layers of tulle snagged on weathered planks, and dipped into the water. The “holy-water” drops on the gown served as grace-filled glitter, a blessing on her project.

At one point, a policeman drove by and motioned to Stephanie. He was concerned when he saw her dashing toward the edge of the pier, thinking she would jump. She and I later mused at the vivid image of “doing a Virginia Wolf exit from the world”.

My heart clenched to hear Steph’s response to the officer: I’m just playing.

My hard working and relationship challenged daughter could so use more lightness, more playtime in her life. She deserved beauty, pleasure, and amusement. She deserved to be admired, cherished and loved.

Stephanie shot for over two hours, taking thousands of images. Self-portraits galore, each showing a different aspect of the glory of the woman she is: beautiful, regal, talented, sensitive, vulnerable, strong.

I glow in her glory.

Here’s the link to her website post The Traveling Dress