"The time has come," the Walrus said...

And so, we must speak of many things.

We here at the Bleakonomy Northern Office are moving southward. After five years in the greater Augusta area, Yours Truly has accepted a new position at a practice in Massachusetts. It's an exciting opportunity, of the kind that probably come very rarely. I'm too superstitious to kvell about it, as there are still a few administrative Is to dot and Ts to cross, but the new job means I'll get to work at a couple of nifty hospitals and have a minor academic appointment to a medical school of good reputation.

Anyhow, I mention this because the move will probably mean a big change in my ability to post here. While our Wee Little Blog hasn't quite taken the Internet by storm, we do have a steady stream of regular readers, for which I am genuinely grateful. I've had a lot of fun, and have enjoyed the ongoing conversation that has sprung up here. I hope I'll be able to continue to post with some frequency, but over the next couple of weeks it will probably get pretty spotty. Once I'm at the new office, we'll see if there are gaps in my day that afford time to write for the blog.

Thanks for reading, and for your comments. Thanks to my other authors, who I hope will continue to post. And for now, wish me luck.

Reassuring news, paranoid parents!

One of the deeply humbling things about having the Critter around is realizing how incredibly ignorant I have been when it comes to the actual business of parenting. You'd think with all the fancy book-larnin' and Board certification and such, I'd stride through the experience of child-rearing with the wind in my hair and a smile on my lips.

No.

When Critter was brand spanking new, he made (in the manner of all newborns) a variety of horrible strangulating, squeaking or gurgling noises while he slept. Even worse was when I couldn't hear him breathing, and would stand over his bassinet fighting the urge to poke him to make sure his lungs were working. While I had attempted to be reassuring during nights on call when panicked parents would call with similar worries, it was an entirely different experience to live through when it's your own kid.

In that vein, friends with young children (you know who you are) have done far more for my sanity than any pediatric text ever could. More recently, Critter has been a little bit slow to crawl. While I was deeply proud of his early development when it came to certain skills (he was transferring objects from hand to hand like a champ a couple of months early, and currently delights in his new-found page-turning skill to confound my attempts to read to him), I was convinced that his lack of crawling by nine months meant something dire about his long-term cognitive prospects. He would reach toward objects, get annoyed, and commence self-soothing thumb sucking. (Now that he is crawling tentatively, I can move on to other areas of paranoid craziness.)

But at least all of this monitoring is useful, right? It gives me a glimpse of his general intelligence and overall developmental potention, yes?

No. So says Nicholas Day in Slate:

[B]ut when parents today worry about their child not meeting developmental norms, especially for motor skills, they're too often worrying needlessly. The typical child, it turns out, is a myth. But someone forgot to tell the parents.

Arnold Gesell, a pioneering developmental scientist at Yale, came up with the theory of developmental norms—the idea that there is a normal way for humans to develop—a little less than a century ago. Gesell believed that motor development was a question of neuromuscular maturation: Motor skills developed as the brain matured. It followed that all infants had to pass through the same series of developmental steps, in the same order, at the same times. Gesell just had to map what those steps were and when exactly they occurred.

He did so in astonishing, migraine-inducing detail. Using cameras to record the tiniest details of infant behavior, Gesell described the appearance of 40 different motor skills and the developmental stages of each of those skills: 23 stages of crawling, 58 stages of grasping, 53 stages of rattling. His work was rigorous, seemingly authoritative, and the basis for the first charts depicting how infants should develop. These showed babies as they moved in a strict, perfectly timed procession from lying to rolling over to sitting to crawling, and so on. Gesell's work was hugely influential: It cemented the concept of developmental norms, and the separation of normal and abnormal, into the popular consciousness. Gesell's books and the movies of infants produced by his laboratory made him famous, an early child-rearing expert. This video offers a sense of his patient, painstaking style and the quiet grandeur of his pursuit.

Yet Gesell himself knew that his norms weren't set in stone. As Ann Hulbert writes in Raising America, her magisterial history of modern American childrearing advice, he warned that norms " 'are readily misued if too much absolutist status is ascribed to them,' as he knew from having arrived at them by observing countless deviations."

The article goes on to describe how pervasive the idea of developmental milestones has become in pediatric training and care. The certification exam of the American Board of Pediatrics is full of questions about subtle differences in milestones between, say, month 3 and month 4. You're expected to know them backward and forward. Delays of any kind are meant to be monitored closely, and intervening early is frequently recommended to shore up skills that seem to be lagging.

I think Day overstates things when he dismisses developmental monitoring out of hand. Keeping track of general progression is useful, and patients who show delays in numerous domains really do warrant further investigation. However, the attention we pay to every single milestone is excessive, and only leads to anxiety and frustration.

The funny thing is that this is my philosophy as a pediatrician. As often as seems prudent, I reassure worried parents that their kid who isn't babbling quite on time or who still hasn't taken that first step is almost certainly normal. (I take as non-alarmist an approach as I can, generally speaking.) Unless something is clearly wrong, I tend to avoid over-investigating and take a "wait and see" stance. So far, this has worked out quite well.

But when it's my own kid? OHMYGOD HE'S NOT CRAWLING YET??!?! It's depressing how human a parent I remain. But, in the long run, I know he's going to be just fine.

Sue Lowden really needs better health care advisors

Hoo, boy. First chickens, now this:

The good news for Sue Lowden's Republican Senate campaign in Nevada is that it's no longer talking about bartering, bargaining, and chickens. The bad news is, Lowden's campaign is still struggling with health care policy.

This week, the candidate's campaign manager, Robert Uithoven, was asked a straightforward question: does the campaign believe all Americans should have access to health care. He replied:

"They do. If I have a bullet hole in my chest, I can go down to UMC and I'm gonna get health care."

You know what you'll get after you "get health care"? A bill.

As the Political Animal link at the top of this post makes clear, this whole GOP "we have universal health care, it's called the emergency room" meme is as forehead-slappingly idiotic as it is common.

First of all, care delivered in the emergency department is not free. Somebody has to pay for it. Doctors and nurses don't work there gratis, and all the tests and treatments still cost something. Patching that bullet hole will involve a trip to the operating room, with a whole other set of nurses and doctors and medications and stitches and bandages and anesthesia, not to mention the care Lowden's moronic campaign manager would need as he recovered.

Further, not only does someone have to pay for all that "universal health care" people supposedly can access through the ED, but you can only get acute care there. What if, during the course of his bullet wound treatment, a chest x-ray discovers a suspicious mass that turns out to be lymphoma? Will Uithoven go to the ED for chemo or radiation? What about vaccines for his kids? EDs don't stock them.

It astounds me that so many prominent members of one of our two major parties seem to think EDs are a catch-all solution to health care problems. Quibble with the health care reform bill all you want, but don't suggest galactically stupid alternatives.

Proof that I am no longer young at heart

As God is my witness, when I saw this picture, which accompanied an article about the White House Correspondents Dinner,



my first thought was "that kid looks just like Tatum O'Neal."

2666 : thank God that's over

"An oasis of horror in a desert of boredom."

-- Baudelaire

"You said it, buddy."

-- Dan

I will say this for Roberto Bolaño -- he has helped me accomplish what I once thought impossible. I have now found an author I enjoy less than Thomas Pynchon. I would rather read V. ten more times than 2666 even once more. (That's not much by way of praise, nor is it exactly fair. I rather liked V. [Gravity's Rainbow and Against the Day? Not so much.] And if given a choice between the phone book and 2666 to take to a desert island, at this point I think I'd opt for the former.)

What a wearying, wearying book that was.

Many (most?) of the people who participated in this group read (and one could see the attrition in the precipitous drop in posts and comments) came to it on the heels of the Infinite Summer project. While I didn't participate in that group read other than to follow along and comment on occasion, I am very familiar with Infinite Jest. It has seemed that readers occasionally cropped up to compare 2666 (negatively) with Infinite Jest, despite the very different tone of the two books. Using IJ as a counter is as good a method as I can think of to discuss why I simply did not like 2666, and am so very glad to be done with it forever. (I agree with commenter Joan at Infinite Zombies that I will probably never pick it up again.)

First of all, and perhaps most damning for me, the characters in 2666 were exactly that. They were plainly, unmistakably characters in a literary novel, whose behaviors and motivations resembled those of actual human beings only in so far that the same verbs could be used to describe both. At no point did I pause in my reading and say "yes, real people really are like that. I understand why [character] did [action] for [reason]." They remained oddly stitled, unnatural and removed at all times and in all situations.

Contrast that with any of the characters in Infinite Jest. Both Wallace and Bolaño seem to have a passion for telling every single character's story, no matter how closely related to the action of the novel itself. The difference is that Wallace cared about his characters, to the point that they are as real as a fictional person can possibly be. Hell, even though he patently loathed them, Jonathan Franzen at least cared about the various protagonists in The Corrections. I've read short stories about ants with more relatable characters than anyone in 2666.

Further, I haven't the faintest foggiest clue why Bolaño wrote a word of this book. It seems an extended meditation on the phrase "shit happens." Given that the characters are neither sympathetic nor unsympathetic but merely there, and the action of the various Parts fit together in no discernable way, by the time we find ourselves confronted by grisly murder after grisly murder, what possible reason do we have to continue? Bolaño apparently expects us to invest in further reading for its own sake, despite no hope for any possible understanding of why he has chosen to exhume and thinly fictionalize these real-life murders.

Infinite Jest leaves many questions unanswered, and ends in a similarly abrupt manner. But it's obvious that Wallace had something to say that mattered. He honestly cared (probably [tragically] too much) what you, the reader, would experience and take away from his book. If Bolaño cared a whit for the reader's experience, he leaves no evidence that I can perceive. Perhaps I, a Mere Reader, should be grateful to have experienced the ineffable brilliance of the Great Author, but this Mere Reader is inexpressibly hostile to that particular attitude.

Finally, I simply reject the worldview that seems to pervade 2666. Infinite Jest is, in many ways, a heartbreakingly, achingly sad book. For all its humor and humanity, it is very, very sad. But Wallace admits the possibility that, hard as it may be, a person can still be happy. I can think of at least four characters that are either described as happy, or at least have a decent shot at redemption. (Some of them minor and surprising, but there nonetheless.) There was not one moment of genuine joy in the entire span of 2666, this arid, godforsaken book. (Please, tell me if I missed it.) Apparently Bolaño's world is either boring (and worthy of scorn) or horrible (and worthy of cold fascination). And that's an attitude I find loathsome.

So, call me pedestrian or small-minded. I really don't think that the faintest whisper of an actual narrative (dare I say "story"?) is too much to ask. I don't think that believable characters are an unreasonable expectation. And I certainly don't think any author can write a book without either that is also largely fixated on unmitigated brutality. The critics all seemed to love 2666. They can keep it.

Anyone desperate for a dose of loveliness (an oasis, if you will) after this blighted expanse of a book, written in the most beautiful way about people so real they could walk off the page, might I suggest the exquisite novels of Marilynne Robinson? Or maybe the phone book. Anything besides more of the same.

The value of a New Yorker

Matt Yglesias wonders why the bomb in Times Square is inciting less freaking out than did the Christmas underpants bomber (what an odd epithet to have attached to oneself!). I suspect three things:

1) The Times Square bombing is in New York. People kind of expect New York to get bombed, and it doesn't make them feel uncomfortable in Tupelo.

2) Americans, in general, lack a kinship with New Yorkers. All those jibes about Real America speak to a real disconnect between many Americans and New Yorkers. I think part of the reason why everyone went on and on about the firefighters after 9/11 was not only because their actions were heroic, but because people across the country found firefighters relatable, far more so than a worker for Cantor Fitzgerald.

3) The guy who did it seems to have been white. Therefore, while less relatable than even a New Yorker, he is more relatable than a Muslim Arab. It will be interesting to see how people react if it's a Tea Party type who did it.

Who knew?

I am, it seems, a conservative left-wing progressive. (Hat tip Ordinary Gents.)