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“It Tastes Like a Memory”: Sunday musings…11/8/2020

Sunday musings…11/8/2020

1 Consilience. Knitting together of sciences and humanities.

Actually a word. 

2 Polymath. No, not many maths. A person who is knowledgeable or accomplished in many fields or across many disciplines. 

Good at consilience.

3 Single. As in single-payer healthcare. Prepare to hear a whole lot about this. Yesterday on Twitter I was taken to task by someone who works in the NHS system in the UK (not sure if they are a doctor as they did not say, nor does their handle give any indication). As we begin 4 years of the Biden presidency with at least 2 years of a Democratic-led House I predict that financing healthcare will be among the first 5 issues tackled. 

For the record I’m OK with addressing healthcare financing. 

What I won’t be OK with is the condescension leveled at me yesterday by the NHS employee. Their position is basically that as a private practice specialist who has worked under a pure fee for service system, I have no standing in the discussion. I am not a voice to be heard, pre-cancelled, nullified. For two reasons this individual could not be more wrong. As a taker of the Hippocratic Oath I am honor bound to advocate for that which is best for my patients. Every doctor has a seat at this table. 

The second reason my voice should be heard is because of the length of my tenure working in our present system. No, simply being an old guy doesn’t get me a seat. Being old enough to have worked in the system during HMO v1.0 in the 90’s does. You see, HMO’s as constituted in the 1990’s were a very good experiment in how a single-payer system a la the NHS or the Canadian system might work in the U.S. Top-down administration. Financial decisions rather than clinical decisions with regard to covering entire segments of disease, entire classes of medications. Patients and physicians quickly came to loathe how these HMO’s functioned; we actually have data to examine that should allow us to see how NOT to do it if it is to be done. On the positive side we could look to the highly successful Kaiser systems in place in Colorado and California, American models in which there appears to be much more satisfaction on both sides of the care relationship. 

This is a conversation that is worth having based on data that is available. It can be had without resorting to ad hominem and broad-stroke nullification. I intend to participate. 

4 Gizmo. “It tastes like a memory.” Beth, after her first sip of our family version of the Gimlet. 

Memory is a funny thing. We don’t really remember details all that well, we humans. Oh sure, some of us are blessed to be able to remember certain things better than others (I remember most of what I have read; Beth remembers most of what she does with her hands), but the details fade for even those so blessed if we look back over a long enough period of time. What we do remember, and what actually is likely to help us remember more details, is how we felt during a memory. Our emotions are like a kind of glue that secures at least some of the objective details of an event. 

As I walk my little dog Sasha I find that we are joined on our tiny journeys by memories of all sorts. As an aside I don’t really know why it is that memories come while we are walking rather than times of quiet repose. In any event, how I felt at the time of any particular event is what comes to me first. Be it happy or sad, triumphant or despondent, each memory is carried to me on a wave of emotion. I have lived–indeed I am living–a lovely little life; most of my memories are quite nice. Sasha and I are most often borne ahead under a rainbow festooned sky. 

The Gizmo is just such a memory. One evening Beth had a yen, but just couldn’t place the name of our drink. “Gimlet” insisted on hovering just outside her conscious memory. “Could you make we one of those Gizmo’s we like so much?” Equal parts hilarious and precious, our house Gimlet had a new name. It became a standing part of Friday night family meals, the first course in countless evenings that I now remember only by how I felt. Warm. Happy. Home. For a long time, I would order a Gimlet in any restaurant I visited, trying to start a meal out with those same feelings of a meal in. No one made a drink quite like a Gizmo; each meal out was fodder for new memories only. 

Last night we lingered over our Gizmo’s, awash not so much in the details of those long-ago dinners but in the emotions. Each sip bringing back to us the laughter and the love as we savored our memories. 

I’ll see you next week…

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