Saturday, June 21, 2008


Summer lies over the meadow crest
of the longest day --
generation, heat, and green --
and I wink back.

The keen eye knows
how to read the strata,
the intercalations of blood and black,
against which ghost weeds
like pilgrims
strain at their roots.

The unctuous dead
well and gush
through the least fissure.
They are our treasure,
our memento, boiling
in the noonday sun,

as in the heavy air
birdsong queers --

parasol parapluie

parasol parapluie

and rain snakes down from heaven
in disguise.

Stanzas, filaments --
wind through the grass field
an ocean, a breathing
beast or breast,

and there are births
that seem to fast
forward into a last
feast, you know the one,

you scan the linen length
and, as far as you can see,
is the presence of enemies.

Oh, Christ,
you mutter, Mother,
prayer and curse,

into the ear of the world,
waiting for the te

that never comes.

Here, tiny as bedstraw --


incarn -

and, for the sport of it,
the meadow's working celebrations

from which, Dear God, your Christ can't be deduced,
in which He wanders, nonetheless,


in the din and dust of the world's
original sin and original blessing,

graceful, in a loud boy,

graceful, in a burned-out boat,

graceful in the thing that clutches at my throat,
the that I am
and its unkind obverse,

once nausea,

now You, Dear Three-in-One.

Wednesday, June 11, 2008

I Would Prefer Not To

The big envelope from the Gigantatron Pharmaceutical Managing company was emblazoned with "May Contained Protected Health Information," a HIPAA-engendered bit of jargon that means "there's stuff about a patient inside," so, rather than chuck it unread in the circular file along with all the other medical marketing junk mail, I opened it.

It was packed full of papers. I scanned the the "Dear Doctor" boilerplate and, on page 2, found the patient and drug in question, "Mr X.," to whom, a few months ago, I had prescribed "prednisone 10mg," a standard treatment for asthma-gone-wild. I pulled him up in the EMR and reviewed the case, fretting inwardly about the pile of new Mr X's queued up in walk-in clutching their Gigantatron cards and their chests. I remembered Mr X. His doc, also in the EMR, had been treating him for a respiratory infection with an antibiotic Mercedesbenzafloxacin, and he had showed up in walk-in wheezing. Hence the prednisone. And a standard inhaler, which I shall call PuffGrand

I turned back to the massive offering from Gigatatron. They began by informing me there were two Gigantatron "preferred" inhalers , PuffGrand (GlaxoSmithKline) and PuffSupreme (AstraZeneca.) This puzzled me because, as I said, I had given a prescription to Mr X for his own, personal PuffGrand inhaler ! Gigantatron didn't seem to be acknowledging this. How could it not be aware ? Gigantatron knows all, after all. It knew about the (generic) prednisone ! If I had tried to prescribe PuffOther, not on their "preferred" list, I would have heard right at the point of Mr X. hitting the pharmacy and being asked for $350 in exchange for the right to breathe. So what was up ?

I read on. After the puzzling Dear Doctor boilerplate letter about Mr X, prednisone and "our 2 preferred inhalers" was a massive packet of glossy info about "PuffSupreme." Nothing about PuffGrand, no head-to-head studies comparing PuffGrand and PuffSupreme, just reams of glossy text about PuffSupreme. I was growing increasingly annoyed.

What was Gigantatron trying to tell me ? That some preferred drugs are more preferred than others ? Was it even aware that I had given Mr X. his prednisone with a side of PuffGrand and, on a second visit, I discovered that he'd done great ?

I turned back to the EMR and scrolled upward. Looks like Mr X had visited his PCP after his two visits to me. I read Dr. PCP's progress note. "Patient went to walk in and got antibiotics. I think he has a virus and antibiotics will not help."

WHAT ! WHAT !!! Wait a minute, Mr. Dr. PCP, if that's really your name, YOU, sir, are the one who prescribed Mercedesbenzafloxacin in the first place !!!!! I gave no freaking antibiotics ! I prescribed prednisone and PuffGrand and now I am being doggedd by the hellhounds of Gigantatron ! And you, sir, are vilifying ME in the medical record as an overprescriber of the ridiculously strong and expensive and unnecessary antibiotics that you, yourself prescribed ???

Now I had a double annoyance roiling me and, probably, even more patients queuing up.

I glanced back at the mailing. There was some
very small print
on the bottom of the first page that I had missed. I squinted at it.

All became clear.

Funding for this communication was provided by AstraZeneca LP -- the purveyors of of PuffSupreme, the "preferred" inhaler I did NOT prescribe to Mr. X..

I slumped in my chair. I had fallen for it. It was the oldest trick in the book. It was a drug ad dressed up in Protected Health Information clothing. It was a trojan horse, and the marketing armies were swarming, triumphant, all over me.