The Palimpsest

James Cantwell with his sister Chloe

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My paternal grandfather, James Harold Cantwell, in his last years, between about 1969 and 1972, his mind and body in sharp decline with chronic illness, wanted to write a book. In the one, single instance he writes about his health it is with panic—“I haven’t any time to spare.” And he did run out of time, dying at age sixty-seven with the book unfinished. It was not for lack of effort. He worked on it for years, writing almost every day, isolated in his own bedroom/study, scribbling away for hours in dozens of spiral notebooks that piled up around him. As a child of nine or ten, I remember seeing him hard at it, bent over his desk in a kind of trance. Though I knew not to disturb him, I peeked in a couple times anyway, my curiosity aroused by a sense that my family didn’t approve. I wondered why.

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The Broken-down Bus

Mexican poet Alberto Blanco wrote a singular poem called, “The Broken-down Bus,” which is set in the winter of 1965. The narrator is riding a bus from Mexico to Los Angeles—his first journey across the border into the United States. But on the second day of the journey, at midnight, the bus breaks down in the middle of nowhere. All the people—first the teenagers, then the children and grown-ups—get off the bus. They are exhausted from the long journey, anxious to escape the wailing of a baby, impatient with the delay, and angry with the bus driver—blaming him for the mechanical breakdown.

Once the passengers are out under the night sky, their collective mood begins to change. The mother nurses the now quiet baby “under the soft stars,” “bajo las suaves estrellas.” A blind woman starts playing an accordion. The open air outside the bus is cool and smells sweet. Someone sings the first Beatles song the narrator has ever heard. The passengers light a small fire and gather around it. 

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Unprecedented collaboration brings hope in a harsh time

Emi the mighty dog

COVID-19 will have a profound and permanent impact on how we interact with other people and with the world at large. This really hit home to me a month ago. My son and I were walking our dog Emi—a docile, lab-border collie—when two very large dogs (mastiff/Irish wolfhounds, I learn later) rushed out of nowhere and attacked her—biting and snarling, literally at her throat. I clutched her leash, feeling the weight of all three dogs, and scrambled to stay on my feet and get my dog to safety. The owner of the two large dogs soon joined the fray and pulled his dogs back, but he didn’t offer so much as an apologetic glance.

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Everything Under the Sun

In March 2018, my Uncle Clair had been visiting his son, Jim, in Phoenix and was ready to return to Utah. I offered to fly down to drive back with him so he wouldn’t have to travel alone. My aunt Linda (Clair’s sister) was concerned. He was, after all, in his late eighties. I jumped at the chance to spend time with him, though I knew he was fully capable of making the trip on his own. So, you see, there was a little self interest in my offer. My father, Lee, one of Clair’s younger brothers, had passed away just a few years before. What I had missed more than anything since my father’s death was the chance to talk freely about everything under the sun. Not small talk. But vast conversation with no limits. I knew with my cousin Jim and Uncle Clair that was exactly what would happen. I was desperately hungry for such talk.

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On Being Down in the Weeds

In a photograph circa 1967 my cousin Jim and I endure an interminable family portrait session—I still remember itching in my Sunday clothes. While my sister and I sit passively smiling, my cousin Jim can’t hide his contempt for the amateur photographer’s incompetence. It looks like he’s about to lunge from his seat and knock the camera off its tripod. Continue reading

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Annie Dillard’s Fierce Arithmetic

Annie Dillard 1.jpgIn 1999 Annie Dillard published For the Time Being, her most enigmatic book to date, where she layers statistics in a chilling attempt to pierce the mystery of who we are, as individuals, as humans, and about what matters and what does not.

Using turn-of-the-millennium demographics, she estimates the human population at 5.9 billion (we’re now at 7.7 billion). When I was born in 1959, the earth’s population was 2.97 billion. The number of living humans has now more than doubled. Dillard describes these billions of living beings as “unique shades of consciousness,” and would say no different of the 70 and 100 billion people who have lived and died on earth—half of the dead being babies and children. “We who are alive now make up about 6.8 percent of all people who have entered the world to date,” Dillard notes. “This is not a meaningful figure.” The dead outnumber the living by at least 14 to 1, though this could be as high as 20 to 1. Continue reading

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The long shadow of mental illness and substance abuse comorbidities

tall face sculpture (cropped)My physician neighbor works in several urban emergency departments where mental illness and substance abuse cases run rampant. When I ask him about the impact on readmissions, he lights up: “Are you kidding? It’s off the charts!”

He tells me of a man who shows up at one inner-city ER so often the stitches in previous head wounds have yet to heal. “And there’s this hideous trend to self-medicate these disorders with methamphetamines, as if opioids and alcohol weren’t bad enough.” He shakes his head. Continue reading

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Why you can’t win without teamwork

colin at regionals (cropped)You’ve probably noticed it’s been a bumpy regulatory ride for bundled payments of late. On November 30, 2017, CMS cancelled two “mandatory” bundled payment programs that targeted cardiac and joint replacement care episodes. Then, on January 9, 2018, they announced a new “voluntary” bundled-payment model for 32 clinical-care episodes. What are we to make of this? Will a voluntary approach work? And what does this have to do with teamwork? Continue reading

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When hospital-acquired infections hit close to home

healthcare associated infectionsLate one night in April 2018, my good friend and work associate finds it so difficult to breathe she wakes her husband to drive her to Emergency. One day she’s on her feet at work, the next she’s in the ICU, diagnosed with Streptococcus Pneumonia, on oxygen, intravenous antibiotics and pain medication. Continue reading

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Artificial Intelligence and Clinical Data: Finding Patterns Now to Shape Our Future

scantwell_scan2My oldest son is on the autism spectrum which brings him both challenges and unique skills, such as perfect pitch and encyclopedic memory. One of his gifts is an ability to see patterns that most of us miss. At least I do.

When my son is not doing homework, I often find him with a calculator and his red notebook. He experiments with graphs that create visual representations of words or names. This began with a simple formula he learned at school, but then he started to experiment with colors, rhythms, musical notes, random numbers and equations tapped out on the calculator. Continue reading

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