Hitchhiking past Lucas

Episode III is nigh, which means the time comes to find who among us has the fortitude to not reward George Lucas. After the manure-splattered wreck that was Episode One, I was through with paying full movie ticket price, and there was no way I was going to buy a DVD for what boiled down to three minutes of decent fight choreography. So I took my sweet time in getting around to seeing Episode II -- paying matinee price -- and despite those measures I'm still pretty sure I overpaid again.

You can tell that my relationship with Star Wars is one that evolved from interest, to passion, to restraining orders: nowadays there are a lot of rules involved. So let's be clear about my rules regarding Episode III. As before, I will not pay full ticket price. I will not wait in line to see it. I will not suffer a crowded showing. I will not inconvenience myself in any significant way to see this film. In this way, I might possibly get some small measure of satisfaction from the last installment of a once-admirable franchise.

Oh sure, the preview looked good. But they always look good. Obviously, the editors who splice the previews together remember some things about what made Star Wars so impressive. The previews focus on action and imagery, which are Star Wars' strong suits. Then eventually you see the actual film and find yourself wincing at tortured dialog and glancing at your watch, wondering when the characters will wind up hitting the inevitable plot milestones that everybody knows are coming, and which will arrive with no attendant surprises whatsoever. Perhaps you even reflexively turn away from the screen once or twice out of a vague notion that actually being visually engaged with a story so ineptly executed could be chipping away at your soul.

There are as many fan theories on Where It All Went Wrong as there are dunes on Tatooine, but my sense is that at some point Lucas became more interested in marketing to the viewer than in telling the viewer a story. How can I stay enthralled to a film if every twenty minutes I'm roused by unmistakable cues signaling "that last sequence will be packaged into a video game," or, "that character is a transparent hook to sell children's toys"? Characters both major and minor are afflicted with names that seem inspired by playground taunts or nursery school banter: Dooku, Jar Jar, Watto, Yaddle, Poof, etc.

I'm sure that hope springs eternal in some fans' hearts, and more than a few have convinced themselves that Lucas has managed to escape from his grandiose hackery for one final hurrah. There's just so little evidence to warrant optimism that positive outlooks like this sound like Battered Fan Syndrome. "Of course George still loves me. It's just that sometimes he has difficulty showing it." Consider for example the ultimate transformation of Anakin into Vader. We've known for years that Anakin gets horribly disfigured by falling into a volcano, molten pit, or some such. I have no idea where that plot item originated and how it was disseminated, but that's been the skinny for some time. Ask yourself though: how will Lucas choose to frame Anakin's fall? Will it be on a world (or a moon) that happens to have some lava on it? Or, rather, will it be a lava planet?

"Oh, Jujj!" you chortle. "A lava planet indeed!" But let us review Lucas' track record of constructing subtle, nuanced worlds blessed with depth and complexity. Tatooine (desert planet). Endor (forest moon). Dagobah (swamp planet). Coruscant (urban planet). If we're lucky, the name of the inevitable lava planet might avoid sounding like it was transcribed from the wall tile in a bathroom stall.

Ah, but it's all part of a grand vision, worked out flawlessly years in advance. Only when we see the totality of the completed project can we then appreciate the perfection of the individual episodes. Of course, nobody with any sense still believes this, with Episodes I & II having torn storyline holes big enough to drive a Star Destroyer through. True believers have tied themselves in knots trying to explain why the principal droid characters are in Episode I and yet lurch around the very same planet in Episode IV like they've never seen it before, with everyone professing to not recognize them either. Far more sensible to pick up Occam's razor and conclude, "Lucas doesn't care, and he certainly doesn't respect us."

My own pet counterpoint to the Grand Vision theory is the Queen Amidala character. In Episode I, she's quite simply a Queen. Fine. But in Episode II, Lucas suddenly remembers that he wanted the devolution from Republic to Empire to have some import, so the characters and their offices must be retrofit to fetishize representative government. Thus the position of Queen for the first time ever in reality or literature is transformed into elected office, albeit one with a spectacular wardrobe and staff allowance that seems to persist even after the supposed elective term is over. The scripts positively ooze with this ad hoc slapdashery.

It's not that there aren't directors who can tell a story. Heck, Sin City managed three good stories in two hours. And I'd wager fifty bucks that Hitchhiker's Guide to the Galaxy delivers strong imagery while still respecting the intelligence of its audience. Surely that puts both these films head and shoulders above Episode III, and more deserving of your entertainment dollar.

Tropical storm Bullcrap

My homeowner's insurance comes due every spring. If I were to take the increases in recent years and project them backward, I would conclude that my parents must have been paying annual premiums of thirteen dollars in 1976.

What's driving the surge? Increasing property values and construction costs must factor in of course, but otherwise, who are the people that are racking up billions in insured losses that the rest of us are covering? And how am I in any way associated with their risk pool? If I had my own insurance company, here would be my top questions for a prospective policyholder:

Do you live in an area where storms are given names?
Do you live on a floodplain, or less than ten feet above sea level?
Do you live within 30 miles of an intersection between tectonic plates?
Is your county on fire, or has it been on fire in the last 24 months?

As a corollary on the last one, one could ask "When it actually rains three inches in your state, is it national news?" And it should go without saying that if you can actually see an active volcano from any point on your property, my office won't be taking your calls.

Anyway, it seems to me that when a homeowner can answer "no" to all the questions above, he shouldn't have to put up with fifteen percent annual increases in his insurance premiums.

Steroid season opener

I am neither a big baseball fan, nor a big fan of Congressional hearings on baseball, but I still got a dollop of amusement from the Sanchez suspension:

Outfielder Alex Sanchez of the Tampa Bay Devil Rays was suspended 10 days for violating baseball's new policy on performance-enhancing drugs, the first player publicly identified under the major leagues' tougher rules.

Sanchez says he committed no violation:

"I'm going to fight it, because I've never taken steroids or anything like that," said Sanchez, who was released by Detroit in mid-March and signed by the Devil Rays. "I never take any steroids because I don't need them."

Sanchez continues:

"I know I did nothing incorrect," he said."I take stuff I buy over the counter. Multivitamins, protein shakes, muscle relaxants."

[...]

Sanchez did not identify any of the products he purchased over the counter, but described them as "something to give me energy, put a little muscle on my body. That's it."

First off, if Sanchez never takes any steroids because he "doesn't need them," an enterprising reporter should ask whether Sanchez "needs" the protein shakes and muscle relaxants. If yes, why? If no, then that would seem to contradict Sanchez' "I never take because I don't need" philosophy.

Secondly, where is Sanchez shopping such that he buys muscle relaxants over-the-counter? Is he talking about the Dominican Republic, or the back of a gym?

And lastly, if Sanchez is so sure that he hasn't been using banned performance-enhancing substances, why does he not identify the products he used? Quite possibly it is because he is not sure, and would prefer not to know.

My response

The following was my email response to the email reproduced in the post below. The original email's snippets are blockquoted.

This was done in voice recognition

So... very... cool... (Despite the inherent wrongness in the physician having cooler tech toys than the engineer).

One of the greatest vagaries that I know of is medical ethics. Here you have medical experts, who present factual information, and this factual information gets contorted by the legal system and by the emotions of the general public, and then the know-it-all government gets involved and mucks things up even further.

See, there's gonna' be a divergence here. The stuff I was writing was mainly concerned with what the courts owed the case. I did not comment on the various legislative acts, nor did I take exception to official medical findings.

Ninety-nine times out of a hundred (or more, for all I know), stuff of this type never gets waved under the nose of any magistrate or arbiter. That's perfectly okay. It means that there was no disagreement about what should happen, or that any disagreement which existed was resolved. But this particular case got into the justice system, and I find the case remarkable for what happened therein.

T. Shiavo has been in a persistent vegetative state for 15 years.

I agree with [the writer's] appraisal of Schiavo's medical condition. I have not disputed this.

All we have is the verbal request, as stated by her husband and friends, that she did not want to have any extraordinary measures (tubes, etc.) and that she essentially declared herself as a do not resuscitate.

Well, that is what the courts have. The courts have the hearsay of the husband, and those that the husband chose to bring forward. Anybody with hearsay that contradicts this was not invited. My major criticism of the Florida courts is procedural.

This case was disputed. It went to court. There were no documents indicating T Schiavo's preferences. At that point, is it too much to ask to have an uninterested party appointed by the court to do factfinding, and verify that M Schiavo's (very sketchy) evidence is the only evidence extant? I don't see that as onerous or a high threshold, especially considering all the fighting and hair-pulling that has since unfolded.

Ethically/legally, the husband is the guardian. It makes no difference what her parents ask to be done or anyone else other than her husband.

Legally, what the Florida courts professed to matter were the wishes of Terri Schiavo herself. And if that is what mattered, the courts were remiss in only availing themselves of one side's evidence.

In case there's some misunderstanding here, I am not all broken up that T Schiavo has died. What spurred me to write was what I viewed to be remarkable procedural shortcomings in a life-and-death matter before the courts. If procedural short-shrift is allowed to become precedent, we pave the way for undesirable outcomes in the future.

If she had a mere stroke, but still had some cognitive function to provide quality of life this would be a more difficult case. One would expect a true guardian to do everything possible to provide quality care and treatments to maximize her quality of life and one would think there were ulterior motives if the guardian did not fulfill the obligation on behalf of the patient.

And when the "more difficult case" comes to court, I would have vastly preferred that in the Schiavo case they had set the precedent of permitting independent fact-finding.

Removing the feeding tube is not killing someone (medical ethics 101), and until society understands the medical profession with both its extraordinary capabilities of extending natural life and shortcomings of failing to provide immortality we will continue to have discussions like these.

I was talking about a court case. You are talking about medical ethics. Correct me if I'm wrong, but the reason that removing a feeding tube is not killing (from the medical ethics standpoint) is that there is an a priori assumption at work that you have discharged your duty of care and you have no further obligations. We would say the same thing about a patient on a ventilator, would we not? When the necessary obligations of care have been satisfied and the responsible parties have agreed to termination of life support, you turn off the ventilator. This is not an ethical violation, because your duty of care was terminated.

At the same time, I think we all understand that turning off the ventilator can be murder if, for example, some nurse unilaterally decides to pull the plug in the dead of night. Duty of care was still in place and was intentionally violated. Big difference.

So in referring to a court case in which it was to be decided whether a duty of care did in fact still exist, I do not think it hyperbole to say that if the court gets it wrong that they would be "killing" unjustly. And please recognize that this language does have different implications in court as compared to medicine. After all, if state court X were to decree that food should be denied death-row inmate Y, the court would never get away with claiming that they weren't killing Y.

Thus I believe I was using language appropriate to the venue.

Schiavo died 15 years ago.

Personally, I agree. From what I can tell, the characteristics that made T Schiavo a person perished when her brain perished.

But legally she did not die. And yes, the laws can be changed for the better or for the worse, and will probably say something different about this sort of thing in 25 years. That's a different discussion.

If she is truly alive then she needs to feed herself, communicate needs, experience happiness, sorrow, grief, anger, interact and show awareness to the world.

All of the above, to be alive? That's a little stricter than I'd like, but again, a different discussion.

Society is very quick to say that doctors are killing their loved ones.

Society is jerky -- which is why I prefer law, which is merely an ass.

Imagine the cases similar to this nationwide and the amount of funds spent in futility.

Whole 'nother topic!

No hard feelings.

Not at all. I'm just sorry it wasn't convenient for you to post your reply. Thanks for emailing.

An M.D.'s perspective

I received an email response to my Schiavo's End post from an M.D. in northern Wisconsin. I liked it a lot, because I'm not often privy to the professional irritants manifest in medicine, which apparently extend past the "does this look infected?" standard query. (Engineers get that question too, but only in the context of personal computers).

So I'm happy to have obtained permission to post the email here (with minor changes for readability and to obscure identities). My email response will be reproduced in a subsequent post.

First of all, no offense to any of you or the beliefs of others; but as a physician, I see this case as cut and dried.

I was about to write a commentary in that blog-whatever forum but I changed my mind for now. I will write to all of you on a medical point of view. This was done in voice recognition, so there may be a few typos:

One of the greatest vagaries that I know of is medical ethics. Here you have medical experts, who present factual information, and this factual information gets contorted by the legal system and by the emotions of the general public, and then the know-it-all government gets involved and mucks things up even further.

T. Schiavo has been in a persistent vegetative state for 15 years. The persistent vegetative state means that the patient is in a coma but has active sleep-wake cycles. The sleep-wake cycles are non-cognitive and represent the most primitive portions of the brain.

Fact: a coma is a state of unarousable unresponsiveness. It can be caused by diffuse insults to the cerebral hemispheres (the cognitve higher functioning parts of the brain which separates humans from bacteria) or damage to the reticular activating system in the brainstem, which is necessary to maintain cortical operations.

Here is the CT scan of a healthy brain, left, and T. Schiavo's brain, right [image not posted]:

The entire parenchyma (brain tissue) is gone as the low oxygen (anoxic) insult caused permanent cortical cell death. Cerebral spinal fluid has replaced the void where brain tissue once was.

Fact: "Patients in a vegetative state have complete unawareness of self and the environment and show no evidence of purposeful responses to stimuli, but continued to have sleep wake cycles and preserved brainstem function" - MKSAP 13 American College of Physicians.

To see a summary of the Shiavo case, here is a web link, but I am sure you know the case details better than I.

Therefore:

All we have is the verbal request, as stated by her husband and friends, that she did not want to have any extraordinary measures (tubes, etc.) and that she essentially declared herself as a do not resuscitate.

The parents of T. Schiavo somehow were able to get tube feedings started and apparently there's been an ongoing battle for the last 15 years to have these tube feedings withdrawn.

Ethically/legally, the husband is the guardian. It makes no difference what her parents ask to be done or anyone else other than her husband. Ethical law, our medical teachings, provide a hierarchy for decision making and responsibilities in situations such as these. If the patient is not autonomous then the husband is next in line, then parents, siblings, close friends, etc.

One might argue that T. Schiavo's husband has things to gain by her death. If she had a mere stroke, but still had some cognitive function to provide quality of life this would be a more difficult case. One would expect a true guardian to do everything possible to provide quality care and treatments to maximize her quality of life and one would think there were ulterior motives if the guardian did not fulfill the obligation on behalf of the patient.

This is not the case here: this person is one fraction away from pure brain death and has been so for 15 years. She will never wake up, never hear, see, smell, taste, feel, or even have the ability to acknowledge existence as the entire cortical area of her brain is irreversibly destroyed.

[Kwik2Jujj], your statement I feel is incorrect: "Such painstaking agency for the disabled is not usually necessary, but this is not a 'normal' case like siblings quibbling over grandma's intravenous drip during her last month of Alzheimer's. What is being discussed is authorization to kill someone who was not dying, and in such extraordinary circumstances the lack of independent consideration on behalf of the person to be killed is bewildering."

Removing the feeding tube is not killing someone (medical ethics 101), and until society understands the medical profession with both its extraordinary capabilities of extending natural life and shortcomings of failing to provide immortality, we will continue to have discussions like these.

I therefore would be a murderer because I have removed tube feeds, ventilatory support, and IV fluids many times -- and in circumstances that were more "gray" than this one.

Schiavo died 15 years ago. Modern medicine has given her nutrition to sustain a few brainstem (not brain) cells that govern respiration and non-cognitive function, with no hope of her ever reaching consciousness. Withdrawal of the feeding tube is allowing her to truly die peacefully. If she is truly alive then she needs to feed herself, communicate needs, experience happiness, sorrow, grief, anger, interact and show awareness to the world. Medicine provided prolonged unnatural existence, so removing the unnatural means of existence is not killing.

Society is very quick to say that doctors are killing their loved ones.

I have been there. I have coded people back to life and I have failed at bringing people back to life. Families were thrilled that I saved their loved one's life -- treating me like God -- and a week later were threatening to sue my ass because their loved one was cognitively impaired or like Schiavo. I have coded persons where I did not have a directive, only to find the family barging into the room at the end of the code stating that their loved one is a DNR and they are going to call their attorneys. "Gee I'm really sorry that I tried to save your loved one's life, and I really would have tried to call; but if I did take an extra ten seconds to contact you he would have surely died and then you-all would have told me he was to be resuscitated and my ass still would be sued!"

Physicians play God because society wants it and we extend life by unnatural means -- so to take away extraordinary measures such as tube feeds is not killing, but merely allowing the patient to pass on. Which is what would have happened 15 years ago.

By the way... who was paying the tens of thousands of dollars per day for Schiavo to receive her care when there is no hope of her ever regaining consciousness or meaning of self?

Imagine the cases similar to this nationwide and the amount of funds spent in futility. Society needs to change its values. We need to provide the appropriate care to those in need, where there is reasonable chance of obtaining cognitive function. Millions of dollars are wasted on futile cases, and this money could provide care for hundreds or thousands of individuals who either don't have insurance or the finances to treat curable illnesses. We need a multifaceted team approach to allocate resources. Imagine funneling this money into Medicare... problem solved!

Morals of the bit** session:

1. Today over lunchtime demand to meet immediately with your attorneys to get your living will/power of attorney stuff drafted. It doesn’t matter that they can’t see you on short notice! You are an American and the Constitution says you can see any doctor and any lawyer at any time and get whatever you want, because medical and legal counsel are your God Given Right -- and by the way demand they don’t dare charge you a fee for this God Given Right!

2. Support legislation which allocates monies in futile cases to other areas of need, like research for cancer, deadly-but-curable diseases, and the Medicare problem!

3. Society -- including government, the legal and medical professions -- need to collaborate to set guidelines as to how to handle these ethical dilemmas.

4. Whether you or I or anyone else hold differing opinions on this, it comes down to this: money!! And availability of resources. If this husband were Bill Gates, he could pay for the hospital bed and feeds and there’s no financial strain on the system. But a bed is being tied up that could be used to save someone’s life.

Well, I did get a little emotional near the end. But then again [colleague] (as chief of the northern Wisconsin medical ethics department) and I deal with this every day, and it is extremely frustrating.

No hard feelings.

Any of you... feel free to reply.

Election time

Somehow, 2 Minute Sidebar was nominated for this week's "best blog" runoff at MKE online. (This blog was notified via a comment written here). I have since petitioned acquaintances to vote on my behalf, and when pressed I have claimed that my blog is at least "okay" and "marginally readable." This alone should place it among the top thirty percentiles.

Voting is open until Thursday. Loyal reader 3XHAR opines:

I voted... but I'm not certain I voted for the right one. The holes on the left didn't match up with the verbiage on the right. So I voted for two different ones, hoping one of them was yours. Then I got some kind of error. I demand someone in charge determine who I voted for with subjective, ever-changing criteria! Only then will justice be done!

Thaa Reverend adds:

I like 2 Minute Sidebar so much, I voted twice! You think they'd log IP addresses and such to prevent ballot box stuffing, but this is Milwaukee we're talking about.

Admittedly, if I had time to burn I would engage in all manner of shenanigans to skew the vote in my favor. But I don't care to spend my time that way, and it isn't nearly important enough.

Not that there aren't any important elections going on today -- for it is an election Tuesday in Wisconsin, the first one since the big presidential one in November. I think that the biggest statewide race is for head of the Department of Public Instruction (i.e., the state school superintendent). Don't expect a large turnout.

Low turnouts though spell opportunity for the proponents of local school spending referenda. Since the direct beneficiaries of school spending increases always turn out to vote for the money, low turnout of the property tax paying rank and file tends to increase the chances for any given referendum's success. And in Wisconsin, it is not unheard of for essentially the same rejected school spending referendum to appear on the ballot for three or four elections in a two-year period, vying for a magic combination of stealth and voter apathy that will squeak it through. The process resembles the following:

"We would like an extra fifteen million dollars. Will you pay for it?"
"No."
"Now?"
"No."
"How about now?"
"No."
"But what about now?"
"... Oh, fine."

--- [pause one election cycle] ---

"Another eight million dollars?"
"No."

As school expenditures often constitute half or more of local property tax levies, they are primarily responsible for the property tax bills that non-Wisconsinites find astounding. It actually happens in this state that first-time homeowners who take out a 30-year mortgage may pay half that again in property taxes. Which is to say that if their mortgage payment is $1000, their property tax liability divided out monthly can be $500.

For example, let's consider a home purchase with a 30-year mortgage using 20% down at 5% (a rate that was obtainable in the last couple years). The monthly payment will be about $5.37 per thousand borrowed. Let us further assume that the tax assessment will be based on 90% of the fair market value. Therefore, to find the mill rate that will result in monthly property tax liability of $2.865 per thousand borrowed (half the mortgage payment), multiply by eight-ninths to get $2.387 per thousand valuation, and then by twelve to get an annual $28.64 per thousand valuation (a mill rate). Again, this is probably news to out-of-state readers, but a handful of Wisconsin communities do have property tax rates this high or even higher (e.g. West Allis in Milwaukee county, Fitchburg in Dane county). The overall average mill rate for Milwaukee County is about $26.

But by now I'm way off-topic. Vote for 2 Minute Sidebar. Thank you.