From: Choosing a Specialty: A Letter to a Medical Student

Society punishes those who improve it. Emerson observed this fact when he gave up a promising Christian ministry career to instead minister to all of mankind. Don’t expect awards and accolades from the psychiatric profession for bettering it. The awards go to those who maintain the status quo, not to those who change it. Freud never won a Nobel prize; they gave it to the fellow who introduced frontal lobotomy.

Nassir Ghaemi, MD, MPH

You Drive Like a Sodding Slugfuck

This post was to be entitled, “You Drive Like a Dick,” but hey–it’s the holidays.  And in case you haven’t noticed, people drive even more dickishly (copyright, ERG) now than at other times of the year.  Hence, the new title.

Angry Cat Driver

In keeping with the holiday spirit, it is my considered opinion that people are now driving worse than ever.  Both of the regular followers of this blog know that I have a bit of a petulant streak when it comes to my fellow drivers, e.g.., “Overcourteous Assholes Like Me.”  Last year, I was irritated.  This year, I fear for my life.  This year, a new classless class of drivers has appeared, a class that adheres to the following three point credo:

I.  The rules of driving apply to you, not to me. 

II.  Get out of my way.  

III.  My car/truck is a two ton steel weapon on wheels which I am willing to use to injure, maim, or kill if you slow me down or generally do anything that pisses me off.

I refer to this new class of driver as “sodding slugfucks.”  But not to their face.  This is why I don’t refer to these people as “sodding slugfucks” to their face:  Detroit Driver Shot in Face in Road Rage Incident.  If you have ever been tempted to get out of your car to discuss driving etiquette with someone, this article will surely disabuse you of that silly notion.  Please don’t.

It has come to my attention that otherwise reasonable people can and do behave like sodding slugfucks when they drive.  I know this, because I live on an island.  When you live on an island, you occasionally find yourself in a situation of being assaulted by a sodding slugfuck while driving, only to subsequently realize that both of you are driving to the same destination.  On one occasion, that destination turned out to be our mutual place of employment.  We parked next to each other.  Somewhat awkward. On another occasion, the sodding slugfuck cut me off, tried to hit me, then screamed at me through my window before we both ended up in my neighborhood, only to realize that we live on the same block.  Even awkwarder.

With the foregoing in mind, perhaps it would be a holiday mitzvah to point out the type of activity that may lead to the realization that even you may be acting like a sodding slugfuck.  So you can stop.  As kind of a public service, I offer the following:

–Over the last six months, I have witnessed several guys who, in the middle of the day and at a busy intersection, decided that waiting for a traffic light to turn green was for losers, so they proceeded to just sprint across the intersection against the light. This causes every other driver to screech to a halt, wondering what the hell just happened and whether civilization as we know it has come to an end and nobody told us.  If you were one of these guys, and you didn’t jump the light because your wife was in active labor at a nearby hospital, then you, sir, are a sodding slugfuck.  Don’t do that anymore.

–I still pull over when I see an ambulance, lights flashing, come racing up behind me.  Call me old-fashioned, I know.  Other drivers may just drive faster to try to stay ahead of the ambulance, but last I checked that was kind of against the law.  What I’ve noticed now with frightening regularity, however, is that once the ambulance has passed, some sodding slugfuck (sometimes a whole string of sodding slugfucks) is chasing so closely behind the ambulance that I’m nearly killed when I try to pull back into my lane.  Unless you are related to the poor sap in the back of the ambulance, if you don’t let me back into my lane because you’re speeding behind the ambulance, you are a sodding slugfuck.  Or an ambulance-chasing lawyer, in which case you are also a sodding slugfuck.

–It appears that many drivers incur physical pain if they are required to use the brake while driving.  This must be some type of new epidemic, because I witness this ailment at least a half dozen times a day.  The symptoms are evident when a car slows to make a right hand turn and the car behind, instead of braking slightly to let the guy turn, swerves around him into the left turn lane.  Or in my recent experience, across the double yellow line to nearly hit me head-on, requiring me to veer off the road and almost hit a tree.  Main Street in my little hamlet is not the Nouvelle Chicane in Monaco, okay?  If you do this, please stop being a sogging slugfuck.   You’re going to kill someone.  Maybe me.

I could go on, but it’s the holidays.  I’ll save the rest for next year–like how your horn doesn’t make all the cars stuck in traffic ahead of you magically disappear.  Really.

Happy Holidays.  Don’t Drive Angry!

 

Mammographic Misery and the Plight of the Perpetual Patient

Mammograms save lives.  Despite several controversial studies over the last couple of years, there is no question in my mind or that of most other health care professionals that annual screening mammography for women over age forty has completely revolutionized the treatment of breast cancer.  Those studies can’t claim that people regularly receiving mammograms don’t have better rates of survival or cure from their disease–they claim, with mixed success, that providing a large population of women with mammographic screening is not cost effective.  What price a life, you ask?download

When I began performing surgery for patients with breast cancer in 1982, the typical patient presented with a mass she had felt herself.  By the time she came to me for surgery, her cancer was often in a relatively advanced stage.  Surgery involved complete mastectomy, usually with the removal of large numbers of her underarm lymph nodes, too often leading to disability and disfigurement.  This was followed by chemotherapy and radiation therapy. Worst of all, survival rates in this group of patients rarely reached 80% for the five years following surgery.

Fast-forward to my current practice.  Over 90% of women referred to me for surgical treatment of newly discovered breast cancer are now presenting with a lesion found on their annual screening mammogram.  Almost all of these lesions are about the size of a pea or smaller, having been discovered years before they grew to a size that could be felt on examination.  These early cancers have not spread to the patient’s lymph nodes or anywhere else in her body. There is no need for mastectomy to achieve a complete cure from this early stage of cancer.  Indeed, I can reassure patients that equivalent cure rates for such small cancers can be achieved by a small lumpectomy and a sampling of one or two lymph nodes, a procedure that takes less than an hour.  The patient is home later that morning and experiences minimal discomfort.  Newer forms of radiation therapy permitted by such early diagnosis expose only the localized tissue and can be achieved in five days, rather  than the whole breast radiation therapy over 4 to 6 weeks required in the past.  Most significant of all, this minimal therapy now provides cure rates well over 90% in these early stage patients.

All of this revolutionary success in the treatment of breast cancer has been made possible by earlier diagnosis due to routine screening mammography.  So don’t buy the hype–there is no controversy amongst practitioners over mammography:   A mammogram once a year can save your life.

But that’s not what this post is about.

Let’s talk about what happens after:  After that excruciating moment when I tell you that the biopsy showed cancer.  After the discussion of what we need to do, how soon we can do it (“Sorry, not yesterday”), what happens after the surgery.  Surgery for the treatment of breast cancer is safe, straight-forward, and relatively painless.  To be honest, surgery for breast cancer is the easiest operation I do.  Patients usually are surprised by their rapid recovery.  They come back to my office a couple of weeks after surgery feeling great.  Over the next several months, I see the patient as she completes her recovery and any additional therapy that’s recommended, usually a short course of radiation therapy and a daily estrogen-blocking pill.  By six months after her diagnosis, she’s feeling great and has her life back.   And then reality sets in:

The reality being that you are not really convinced you’re cured of cancer until the moment you die of something else.

We’ve moved from a paradigm of the valiant patient bravely battling her cancer to the successful breast cancer survivor–who now must live forever with her diagnosis.  It’s not a battle with cancer.  Battles are fought and won, and then we can move on. You don’t just fight cancer–you survive cancer, and then you live with having had cancer. This is a burden that few who have not experienced the diagnosis, or lived with someone who has survived cancer, can appreciate.  It doesn’t matter how great you feel, or how many times the doctors say that you’re doing great, or how great your spouse or friends say you look–you worry.  You worry every day.  Because you remember feeling pretty darn great just before the doctor told you that you had cancer.

Of course, we all worry about getting some disease or another.  We worry about that dark mole on our arm that might be a little bigger, particularly after we hear of a young friend recently diagnosed with melanoma.  We worry about heart attacks, because we get chest pain every time we eat Taco Bell or palpitations at the gym.  It’s not the same. It’s not the same because you’ve never been told by the doctor that the biopsy is positive, that your worst fear when you walked into the office was true.  You’ve heard of Post-Traumatic Stress Disorder?  This is Post-The Test Was Bad And You’re Totally Screwed But Now You’re Finally Better Stress Disorder.  And it’s every bit as bad. Maybe you didn’t experience faceless bad guys shooting bullets at you in Iraq, but you experienced some pretty heartless machines shooting xrays at you every day for a couple of months, or smiling nurses apologizing as they stabbed the needle in your vein for the third or fourth time, or watched the strange colored fluid dripping into your body knowing that in 24 hours you’d be doubled over the toilet vomiting because that’s just how this stuff works.  Cancer sucks, and it doesn’t stop sucking just because everyone tells you that you’re cured.

Sure, they say you’re cured.  But you don’t really believe it.  You don’t believe it because we keep sending you for more tests and more mammograms and more CAT scans and more PET scans.  If there were a PUPPY scan or a CUTE FUZZY BEAR scan, we’d send you for that, too.  If I’m cured, you keep wondering, why do we keep looking for it?  And every time you have to go for the test, it’s an opportunity to relive that special feeling you had that time when the test came back bad.  You relive that feeling for the week before you take the test, while you’re in the machine trying to breathe during the test, and for every single second until the doctor calls to tell you that it’s okay. This time, you think.  It’s okay this time.  The elephant steps off your chest–but he doesn’t leave the room, he just steps behind you for awhile.  Until the doctor says that it’s time to do another test.  And there is always another test.  If I’m cured, you think, why do we have to keep looking?

So here we are:  Surviving today.  The test was good.  Enjoy it.  You can run faster than any old elephant.

 

 

 

Magnificently Overrated: Whale Watching

My wife and I spent the day “whale watching” last weekend.  She had been anxious to pursue the great, wild whale ever since our last outing two years ago.  During that previous high seas adventure, we failed to spot the elusive, majestic whale.  This despite many, many hours tossing about the Atlantic Ocean, accompanied by seasick shipmates and an entourage of dolphins that made fun of us for even caring about whales.  No whales that day, alas.whale

On this sunny Sunday, however, we were successful.  We spotted a dozen whales!  Which was surprisingly similar to not seeing any whales at all the last time, just with more whales.

It became all too evident as we bobbed about the wide Atlantic Ocean, chasing from one sighting to another for hours, that these are not professional whales.  These guys are the ones that just happen to be lying about when the boat pulls up.  It’s as if you took your friends visiting from the Midwest into the city by driving for hours in hot, rush-hour traffic in your car with no air conditioning and four broken windows, but when you finally got into the city you decided not to take them to see Les Miserable or The Book of Mormon like you promised, but instead took them to a karaoke bar that was popular with taxi drivers recently emigrated from Eastern Europe.  Lack of stage presence is being kind.  Forget jumping over the boat in an arcing trail of crystalline spray.  No tail pirouettes or lunging jetes, either.  Those are the actions of the elite, highly-talented whales, it seems.  These guys were more circumspect.  More “log-like.”

The cruise was  narrated by a marine biologist with bubbling enthusiasm for all things whale.  This loud, incessant narration was piped over a battery of tinny, scratchy speakers set next to all available seating areas.  Some adjectives used by the marine biologist to describe the whales:  majestic, enormous, magnificent, playful, friendly, endangered.  Adjectives that crossed my mind as I stared at the same whales the biologist was pointing at:  grey, might-be-dead, abandoned-car-ish, and, again, grey.  Dr. Marine Biologist had names for all the regular whales, cute names like Susie and Eddie.  On this exciting cruise, however, two new whale friends were found and needed names, which the good doctor solicited from our ranks.  Sadly, he did not select my recommendations of “Roadkill” and “Old Rubber Boot,” preferring the much less apt “Pete” and “Pauline.”  He also did not invite me to become a volunteer marine biologist, though he seemed to encourage pretty much everyone else on board to do so.

The pedestrian whales such as we encountered were fairly limited in their entertainment skills.  The occasional sneeze, dramatized by the appearance of sneeze vapor wafting across the boat.  Sometimes, they slowly sink.  Every one of them totally ignored the  potato chips I threw their way.  Pretty aloof, actually.  A glaring lack of people skills.  Majestic?  Is a half-submerged Volkswagen beetle majestic?  Then, no.

Next week:  We go to a Mets game.  Woo-hoo!

DRONES ATTACK IN CENTRAL PARK!

We have seen the future:

A1a-1SQ-Quadcopter

Drones Mug Tourists in NYC

“My buddy and I were walking across the park, you know, and two of those drone copter things just came down right in front of us while we’re walking.  You know, those quad-copter things you see on Youtube.  So, we’re just walking but these two copter things keep buzzing right in front of us, so Steve kinda swats at one but it just dances away and gets right back up in our face and says, ‘Hey, asshole, don’t do that.’  Yeah, it called Steve an asshole, which we thought was pretty funny until the things stop right in front of our face and it says, ‘Give over your money and wallets.’  We didn’t even know what it was talking about, but every time we try to get away the things get in our face, you know?  Steve told the thing to fuck off, we’re not giving you anything and then, bam, the copter in front of Steve hits him square in the chest with a TASER!  Yeah, fuckin’ crazy, right?  Steve goes down and is screaming and the drone thing in front of me says I should take his wallet and his money and his phone and put it in the basket thing hanging under the copter that just TASER’d him.  I mean, the things menacing, you know what I mean?  So I did it.  Then I had to give it my phone and shit, too, and then they both just zoomed up over the trees and were gone, man.  Crazy, right?  That’s what the cops said.  They thought we were high.”

Anniversary of a Tragedy

In memory of those lost one year ago today, I reprise my earlier post:

Superman is a Myth

It was a classic Superman moment. A train of seventy-two railroad cars filled with highly flammable liquid was poised precariously on a hill above a sleepy town filled with innocent Canadians. It was dark. There was no driver or attendant to witness that the airbrakes preventing the train from slipping are slowly draining pressure. The train begins to slowly roll downhill, picking up momentum as it ponderously but inevitably begins to roll faster and faster towards the center of town, disaster looming–but wait! Here he comes, streaking out of sky! A red and blue caped blur, a powerful hand braced against the lead locomotive, a grimace and then, with a squeal–all is saved, disaster averted.Minolta DSC

Only it didn’t happen. No Superman. Instead, disaster, death, and destruction. Innocent lives lost. The classic Superman moment, one I had witnessed in comics and onscreen since my wide-eyed youth, went horribly wrong. No Superman.Minolta DSC

At first, I hoped and believed that Superman could not save the day because he was otherwise occupied achieving even greater goodliness, saving even larger populations of threatened innocents. But I checked–it seems that North Korea had not simultaneously launched a nuclear tipped missile aimed at a New York museum at the exact moment that Lois Lane was visiting with her little nephew’s fourth grade class. The only other possible explanation, that Lex Luthor had Superman incapacitated under a geodesic dome made of Kryptonite, was also disproved by a quick Google search. No Superman.

How could it be that Evil had triumphed? How could the sinister forces of darkness and malevolence succeed, unchecked by our heroes? Such a situation is contrary to the workings of a moral universe, would require the balance beam of justice to be bent beyond all reasonable fairness. Not possible; the Fates are not so cruel.

But, hold on a second. Deep investigation reveals no Fates, cruel or otherwise, in the immediate vicinity at the time of the accident. Reviews of salient radar logs show a sky clear of evil, flying monkeys. Overhead satellite imaging clearly indicates that a demonic miasma did not dissolve the critical feedlines to the airbrakes. Not at all. No Evil, either, it seems.

No, upon further investigation it appears that a well-meaning crew of volunteer firemen, responding to a fire on the train, skillfully extinguished the blaze. They did their best, including following the protocol which required them to shut down the engine to the burning train. The engine that provided the pressure necessary to maintain the airbrakes. And then they went home.

No evil. Not even an absence of good intent. But no Superman.

It makes me sad.

My heartfelt sympathy to the families of the victims of the Canadian railway tragedy.

Requiem en pace

The Alternate Reality We Live In

In light of this past week’s incomprehensible ruling by the Supreme Court of the United States, and since I am still intellectually stuttering in my attempts at a reasoned response, I instead present a very old essay that pays tribute to another of our Supreme Court’s auspicious decisions.  Hindsight is easy, I know, so please take this with the sense of irony with which it was conceived.  Have a happy and safe Fourth of July holiday.

BROUGHT TO YOU BY THE THOSE FINE FOLKS AT  THE SUPREME COURT OF THE UNITED STATES OF AMERICA

REALITY  (JANUARY 22, 2001):

“Gee, Dick, is this the first damn meeting in this office?  The tags are still on the chairs.”

“You know, Bill, now that you mention it, I think it is.”

“Well, Dick, I want to just say how great it is to finally have a couple of real Americans running this country.  And Texans, to boot!”

“Not just Texans, Bobby, Texas oil men!”

“Gentlemen, thank you.  And I know you know how much me and George deeply appreciate all you’ve done to make this a reality.  Now you know why you’re all here–our country needs an energy policy, and we’re here to write it.  This is our first and highest priority.”

“We appreciate the opportunity to participate at such an early stage.”

“Hey, Dick.  Since we’re talking about oil–you and George ever notice how Iraq is just about the same size as Texas?”

“Yeah–we could call it East Texas, Dick!  Way East Texas–I think Jeb’s gonna need a new state to run soon.  Term limits, you know.”

“Whoa, whoa.  This would be a prudent time to point out that this meeting is being transcribed and will be subject to discovery under the rules of the Freedom of Information Act.”

“Yeah, Dick.  Like you’d let that happen in this century…”

ALTERNATE REALITY (January 22, 2001):IMG_1114

“Mr. President, I appreciate you seeing me so early on in your Presidency.  I know you’re very busy.”

“I certainly am, Mr. Pickens. My staff tells me you’ve been calling nonstop since I finished my acceptance speech. You’re my token meeting with Big Oil.  Talk fast.”

“Yes, thank you Mr. President.  Please call me Boone.  Mr. President, our country’s highest priority is a new energy policy.  I believe our very survival as a nation will depend on what we do in the next decade.”

“I couldn’t agree more, Boone.  I said as much at my inauguration.  But drilling for more oil all over ANWAR is not the approach this administration is going to take.”

“I’m not here to talk about oil, Mr. President.  I’m here to talk about natural gas.”

“Gas?  I was hoping for something a little more imaginative from you, Boone.  Nothing renewable about gas. At least pretend you listened to my speech.”

“Mr. President, the technology does not yet exist to obtain any meaningful relief from our nation’s energy crisis from renewable resources.  That’s just reality, Mr. President.  What we do have, sir, is a breakthrough in our ability to tap our nation’s reserves of natural gas.  I believe that my plan will make our country independent of foreign sources of oil by 2020.”

“You have a plan?  Do your buddies in Texas know about this plan?”

“Mr. President, I think it would be best not to involve too many oil execs during these early critical months.”

“Hell, couldn’t agree with you more.  Let’s ask the Secretary of Energy to come in and listen to your plan.  I think we can find some extra time in the schedule–I only pencilled you in for five minutes.  Not wind power, huh?”

“Not in our lifetime, Mr. President.”

~~~~~

REALITY (September 12, 2001 AM)

“Bill, you’re my goddamn head of CIA.  How in God’s name could you let this happen?

“I’m sorry, sir.  We screwed up.  We had these guys on the radar.  FBI, too.  We didn’t know they were this close.”

“Close?  There’s a goddam smoking hole in the ground where the Trade Center used to be!  Over three thousand people dead, probably more by the time this is over.  On my watch!”

“Yes, Mr. President.  Let me just say that the CIA feels devastated by this.  I’ve got senior analysts in tears at their desks.  But we are all over this.  Nobody has gone home since this happened. We’re working our assets and configuring our response–”

“That’s just bull and you know it.  After the fact.  Hell, they should be in tears.  They failed.  They let down America.”

“Mr. President, it’s not that simple.  But if that’s how you feel, sir, you will have my resignation on your desk in the next hour.”

“It is that simple and that is how I feel.  But Dick and Karl and I have been talking and now isn’t the time to change horses.  No resignations, not right now–that would just send the message that we screwed up.  No–you stay.  But, Bill, I want a good old-fashioned house cleaning.  I want everybody who failed our country out!”

“Mr. President, it’s not like that.  These people are professionals, they are the best in the world.  I stand by my–”

“House cleaning!  Or I’ll put somebody over CIA who’ll do it.  And Bill–”

“Yes, Mr. President?”

“Don’t go signing any long-term leases in this town, you hear me?”

ALTERNATE REALITY (September 12, 2001 AM)

“What happened, Bill?  We’ve been talking about this coming for over a year.”

“Yes, Mr. President.  We knew.  We knew these guys–we just didn’t know enough.  And CIA didn’t know they were in country.”

“What are you saying?”

“FBI knew they were in the country.  But they didn’t know who they were.  We blew it–we all blew it.  Three thousand dead.  My God.”

“Mueller told me the same thing just now.  My God.”

“It’s not the people, Mr. President.  We’ve got the best.  Mueller’s got the best.  It’s the system–the system failed.  It’s gotta be fixed.”

“Can you do it?”

“I’m not your man–you need a systems guy.  Somebody younger–I’ve got a couple of names.”

“Thank you for not making me  say it.  Mueller’s getting me his letter in the morning.”

“You’ll have mine in the morning as well.  I’m sorry, Mr. President.  We let down the country.”

“I know it wasn’t your fault, Bill.”

“Three thousand people dead–you tell me whose fault it is, Mr. President.”

~~~~~

REALITY (September 12, 2001 PM)

“Gentlemen, America has been attacked.  I know it’s soon, but I want to go around this table and have your thoughts.  Please speak freely.”

“Mr. President, as you say, America has been attacked.  This is our generation’s Pearl Harbor.  We are at war.  We must respond.”

“That’s easy to say.  But at war with who?  How do we respond?  Dick?”

“SecDef is right, Mr. President.  We’ve pussyfooted around this too long and this is the result.  Clinton wouldn’t do it, last time around.  Hell, the last guys who tried to knock down the Trade Towers are eating three squares in San Quentin.  This changes the game.  We take it to the next level–no more police actions, no more trials.  They wanted a war–let’s give it to them.”

“You mean bomb those bases you showed me pictures of?”

“No, Mr. President.  That’s not enough.   That’s what the last administration did. This is a game changer.”

“Yeah–a game changer.  I get that.”

“Mr. President, we need a new policy on terrorism.  The Bush policy–we bring the full force of the world’s most powerful military to bear on any country contributing to terrorism.”

“Dick, that’s half the countries in the Middle East.”

“We know where these guys came from–we hold the state responsible for the actions of its citizens.  Providing safe harbors, that sort of thing.  And we don’t stop there–we take the offensive.  We go after them before they do this again.”

“The Bush policy?”

“Yes, Mr. President.  Pre-emption.  Offense, not defense.”

“There’s still the problem of which state to hold responsible–hell, you told me half these guys were from Saudi Arabia.  You’re not saying we bomb Riyadh, are you?”

“No, Mr. President, not at all.  But there are targets worth considering.  I’d like you listen to Mr. Wolfowitz, from the Pentagon.  I asked him to prepare a short presentation.”

“Thank you, Mr. Vice President.  Mr. President, gentlemen.  While the events we are discussing this morning are truly tragic, I believe we are now presented with the opportunity to directly confront the greatest danger currently facing our country–I am referring to Saddam Hussein and Iraq.  Could I have the lights down, please?”

“Did he say Iraq?”

ALTERNATE REALITY (September 12, 2001 PM)

“Mr. President, the people of the United States demand a response.”

“I know that, Mike.  But I’m the President and I’ll tell you something–this is not Pearl Harbor.  We are not going to treat these guys like the Imperial Empire of Japan.  This was horrible, I know.  But we’re not the first country to be attacked.  I’m going to weigh our options.”

“We have very few options, Mr. President.  I believe it is imperative that we immediately respond with overwhelming force.”

“Where?  Against whom do we respond with overwhelming force?”

“To start, Afghanistan.  We know Bin Laden was behind this.  We know he’s there.”

“So we bomb the whole country?”

“Not just bomb, Mr. President.  It will take a major land force to take out Al Queda.  Not to mention toppling their government–the Taliban have been supporting them all along.”

“Invade Afghanistan?  Are you nuts?  My Secretary of Defense is recommending I recreate the biggest military fiasco of the twentieth century?”

“No sir, I’m just saying…”

“Is that what you’re saying, Joint Chief?”

“Absolutely not, Mr. President.”

“Well, maybe you could share your thoughts, then.”

“As the Secretary said, we know who’s behind this, Mr. President.  We know where they live.  Al Queda isn’t an army–it won’t take an army to take them out.  We know how to do this.  I need additional assets, additional funding–and time.  We’ll take them out, completely and permanently.  But there won’t be any headlines.  It’ll take six months, maybe a year.”

“A year?  The American people won’t wait a year for revenge for yesterday.”

“Revenge, Mr. President?  Revenge I can do in six weeks–very loud, lots of explosions.  It’ll look great on the evening news–shock and awe, the whole works.  But if you want us to really take care of this–six months, at least.  A doubling of funds for special forces.  Creation of a new special forces command, complete international integration–the Israelis, the Brits, the French, the Saudis.  And no headlines–completely dark.”

“Can we sell this, Mike?”

“Your’re the president, Mr. President.  You tell me.”

~~~~~

REALITY (August 25, 2005)

“Mr. President, I’m sorry, I know you’re very busy.”

“Not at all.  Just getting ready to head to the ranch for a couple weeks of R and R, you know.  Gawd, I hate this town in the summer.  Feels like we’re living in a swamp.”

“Yes it does, Mr. President.  I wanted to just quickly mention one thing.  I’ve got a guy over at the National Weather Center who’s called about a hundred times about this hurricane in the gulf.  He’s bending everybody’s ear about a real disaster scenario.”

“Really?  Did you know about this, Karl?  Does this mean the weather’s gonna suck down in Texas?”

“Yes, Mr. President, I heard about it.  He’s called about every department in the government.  He thinks New Orleans could be hit hard.  It’s just one possibility–he’s a weatherman.  Twenty percent probability sort of thing.

“What do you think, Karl?  Get a task force together like we did in Texas?  Let’s get FEMA on it–who is FEMA, anyway, Karl?

“Michael Brown, Mr. President.”

“You’re kidding!  Brownie?  That Michael Brown?  Couldn’t find his office for the first six weeks when he was head of the racing commission?  Head of FEMA?  You have got to be kidding.”

“No Mr. President.”

“Karl, this is bad.  You’ve got to get Brownie some help.  Hell, he probably couldn’t find New Orleans on a map.  Put together an emergency task force, mobilize the Guard.  Let’s get on this!”

“Of course, Mr. President.  But could we discuss some of the other aspects of this, Mr. President?”

“Other aspects?  Karl, it’s a hurricane.  We’ve seen our share while I was governor.  We know how to do this.”

“This isn’t Austin, Mr. President.  There are bigger ramifications to how we handle this.  A big difference between state and federal authority.  This is a problem to be handled at the state level.  If we go charging up at the federal level, what kind of message does that send?

“Your losing me, Karl.  The man said this could be really bad for New Orleans.  What if they can’t handle this at their level?”

“Of course, Mr. President.  But we’re talking only possibilities.  Nothing’s definite.  Do we want to send a message that the federal government is willing to charge in, take care of all your problems?  That’s not us, Mr. President.  Remember, smaller government.  Compassionate conservatism.  Responsibility to the states.   Let’s see how this plays out.  If things look bad, we can always have Brownie come to the rescue.”

“Gee, Karl, you’re always seeing the political side.  It’s just a hurricane, for crissakes.”

“That’s what you pay me for, Mr. President.”

ALTERNATE REALITY (August 25, 2005)

“Mr. President, one more thing.”

“If I had a buck for every time somebody said that…”

“Yes, Mr. President.  It seems the Chief Meteorologist at the National Weather Service is having a conniption over this storm in the Gulf.  He’s called everybody with a phone, telling  a doom and gloom scenario about New Orleans.”

“When?  I haven’t heard about this.  What’s he saying?

“Evidently, this guy’s an authority on New Orleans.  He says there’s about a twenty percent chance that this is the big one–broken levees, massive flooding, hundreds of thousands homeless.”

“Holy cow!  When?  How come I’m just hearing about this now?”

“It’s not definite, Mr. President, just a possibility.  Nobody really thinks it’s gonna happen.”

“You don’t think so?  This is just the kind of thing I’ve been talking about for twenty years, dammit.  This is global warming taking a swing at us.”

“I’m sorry, sir, you’re losing me.  Global what?”

“Are you kidding me?  You’re my Chief of Staff?  What are you doing about this?”

“Well, nothing yet, sir.  I wanted to get your take on how you’d like to proceed.  As I see it, there are two approaches.  Traditionally, this sort of thing falls to the states.  We could let them handle it.”

“Have you ever been to Louisiana, Elliot?”

“Uh, no sir.”

“What’s your other approach?”

“Well, just the opposite, I guess.  Full court press.  Activate FEMA, call out the Guard.  Though, of course, we’d have to do that in cooperation with the governor and all.  Don’t want to offend–”

“Offend?  Don’t you think the sight of a few hundred bloated bodies floating in the bayou on the six o’clock news might offend?  Listen, Elliot.  This is what you’re going to do–who’s at FEMA, anyway?”

“Actually, I don’t know, sir.”

“Oh for crissakes!  Remind me to look for a new Chief of Staff.  Find FEMA and light a fire under his ass.  I want bigger than full court press–you put together a damn federal emergency task force.  I’m talking the army, not just the reserves.  Put somebody you know in charge–don’t screw this up.  Get a general, somebody in uniform.  I want helicopters and those big Starlifters we use when there’s a disaster in Somalia or whatever.  If we can send them to India every time there’s a goddam monsoon, we can sure as shit send them to Louisiana.  Use less gas, too.  And I want press notified–get them on this hard.”

“But, Mr. President–he’s a weatherman.  What if he’s wrong?”

“Then we’ll call it a damn training exercise for when the big one really does come.  You’re kidding about not knowing about global warming, right?  And Elliot–”

“Yes, Mr. President?”

“If this guy’s right, I’m gonna give him a medal in the Rose Garden.”

END