The quiz everyone (I know) will fail

Not as much fun as a cosmo quiz perhaps (unless you're Sheryl Crow or
Al Gore, then it's nirvana), but it will make you feel the same way
after you take it (namely guilty: for lying on something nobody knows
about but you and scoring badly anyway). If anyone gets only one
earth, let me know. You won't win a prize, but you may be able to
write an eco-stunt book/blog.

http://www.myfootprint.org/en/

Elegy for the North Woods

Last Wednesday around eight thirty in the morning, I went for my typical weekly self-flagellation (also known as running the loop in Central Park). Leaves, twigs, and even large tree branches littered the drive, turning the road's black pitch into something like the rain forest floor. The scene was almost beautiful. I thought to myself, "That was some storm." Then as I rounded Lasker Pool, the weight of the storm literally revealed itself in century-old oak barring the way. Crews were already trying to clear the felled tree and signaled me to turn around. I shrugged and turned, warning oncoming cyclists and runners about the obstacle.

As I headed around the bend at 110th street, near the entrance of the great hill, I realized the full import, the catastrophic devastation that the lightning, rain, and wind of the night before had wrought. Trees of enormous girth and height had fallen all over the North Woods and in the glades on the northern sides of the Park; an entire canopy had seemingly collapsed. My heart seized and I felt like crying. Trees are not people--this I know--but at that moment, they felt like family. When one has so little green space, trees become sacred. I had just lost some essential part of myself.

Some of the more than two hundred trees that came down last week date back to the original construction of the park. Olmstead himself planted one fallen giant, a chestnut tree, near a favorite new playground that is now closed. Some trees managed to stay upright but their branches deserted them, giving them the appearance of charred apocalyptic ruins.

Wood chippers and log rollers hum and buzz all over the park now, a logger's paradise. For the rest of us, the northern end of Central Park is like the scene of a gruesome battle, a painful reminder of life violently torn from us, without yet the hopeful signs of life born anew. Maybe next spring we will see the sprouts of the seedlings and each green bud will fill us both with the promise of grand elms, pines, and sycamores to come and the memory of those grand stanchions from which these new trees will rise. For now, there is empty space where once was our shade, our history, and maybe even a little bit of our soul as a city.

Please help Central Park clean up from the storm and plant new trees by donating online. Also, see my central park photo album for pictures of Central Park in the fall, spring, and winter.

On the Nexus of Health and Care

Gawande, et al, just wrote an op-ed piece in the New York Times about the health care situation where he is trying to re-introduce the data and analysis that he so excellently laid out in his New Yorker article, The Cost Conundrum. While I agree with his point about finding new efficiencies and eliminating inflated and ineffective care, I have my doubts still that we can accomplish an overhaul of our medical system without some more rational rationing of care than we currently have. Let's face it - there is rationing right now. Doctors, hospitals, and insurance companies are doing the rationing, and generally not on the basis of what will benefit society as a whole, what is fair, or even what will benefit those who do receive health care. Apportioning of health care services is based on some combination of first come/first serve, ability to pay, proximity to health care centers, and severity of condition. The "system" prefers crisis to prevention, focuses on the cash-rich end-of-life phase, and does not always take into account the longevity of the patient or quality of life when providing expensive services.

Recently a doctor friend of mine complained that he was performing million-dollar work-ups on immigrants who have come to New York explicitly for our health care. As I think one can extrapolate from this article, we should not provide million-dollar workups to anyone, regardless of their immigration status. We should also not use hospitals and emergency rooms to deliver palliative or remedial care. I'm not a doctor but I have been to many doctors (who generally ask few questions, order a battery of tests, and frequently have no or the wrong diagnosis), had many (often useless) tests and numerous procedures (of questionable value), and visited the ER more times than I liked (when an after-hours clinic would have been more appropriate). I'm only 37 and relatively healthy, so what gives?

We need better primary physicians who listen to patients and their bodies instead of relying on technology to implement their art, and work with specialists to deliver total health care to a patient before illnesses spiral out of control and require crisis (expensive) medicine. We need to be able to stay with a physician we like regardless of health plan changes. We need to have information automatically transferred when we do change primary care providers or are sent to specialists. We need to be able to speak to our doctors on the phone after hours or be able to visit an after-hours clinic if we have urgent but not emergent medical problems (for instance, my daughter had what appeared to be an allergic reaction late one night and we had gotten Benadryl into her before the EMS arrived but they insisted we take her all the way up to Columbia Pres - by ambulance - for a workup). Most of all, as Gawande et al also demand, we all deserve a medical culture that works to make people as healthy as possible, rather than making rich those few who are gaming the system. Because health is not a bigger house, an iphone, or a meal at Per Se - health, like justice, is a basic human value so essential to the proper functioning of our society that we cannot subject it to the vagaries of the marketplace.