ginandtacos.com

I need you to set aside about 30-40 minutes and read this. When I first saw it back in August I felt like I'd been punched in the stomach by the end. A second reading months later, inspired by the chaos in Haiti, had much the same effect. If you're in a hurry it is a lengthy New York Times piece about Memorial Hospital in New Orleans in the wake of Hurricane Katrina. It raises ethical issues complex enough to make abortion and the death penalty look like kindergarten topics in comparison.

Several hospital employees, particularly one doctor named Anna Pou, were charged with second-degree murder (and conspiracy to) for allegedly causing the death of a number of non-ambulatory patients with morphine and other sedatives after everyone involved had been trapped in the hospital for four days. A grand jury chosen from a community sympathetic to the doctor ("They did what they had to do! It was a tough situation!") refused to indict, and as the story stands it appears unlikely that any of them will be convicted of a crime. The reality of what happened appears to be a lot more troubling.

Triage is a pretty basic concept in emergency medicine and it originated on Europe's battlefields more than two centuries ago. It is necessary whenever the means to provide care are overwhelmed by the number of people who need it. We see that problem today in Haiti and four years ago in New Orleans. It seems like a very basic concept – do the most good with the limited resources available. But what does that mean? Does it mean treating the most severely injured, who may have little hope for survival? Treating the greatest possible number of patients? The ones with the best chance to survive? (and in whose judgment?) The youngest? The first to arrive? It's not so simple.

After the Hurricane, Memorial Hospital was without electricity or water, filling with backed-up sewage, and in a neighborhood in which gunshots were ringing out with alarming frequency. With dwindling resources (and the need to manually respire patients on ventilators) the doctors did an unorganized triage – there was no official policy in place – to make everything last until the government rescue that they soon learned was not coming. Evacuating patients to a helipad required carrying them down 7 or 8 flights of stairs in the dark, passing them through a 3'x3' hole in a concrete wall, and then carrying them up 5 more to the roof of the parking deck. This presented an obvious challenge to a staff – many of whom were older people who could add little to the manual labor effort – working on no sleep in appalling conditions. Compounding the problem was the apparent hopelessness of several of the patients; it is not hard to see how a 92 year old cancer patient with less than a week to live would seem like a wasted effort under such circumstances.

What resulted was a decision by a few doctors, given that no one seemed to be in charge, to euthanize several patients who were either nearly dead or simply too large to move. In one case that directly led to the second-degree murder charge, an otherwise healthy 350 pound patient who could not walk was euthanized for no reason other than that the doctors did not think he could be moved. Not all of the physicians agreed with these actions; several protested and others left rather than be involved.

That is the best I can do for a brief summary. Two things.

It is easy for us to revel in hindsight bias – we know that they were rescued after the fourth day – and make judgments based on information unavailable to the participants at the time. It's also easy to neglect the context. Before you come to a decision about the morality of their actions, close up the windows, turn the heat up to 90, and stay awake for three days manually pumping a ventilator bag, running from floor to floor in the dark, and caring for 100 dying people. To say that the doctors and nurses involved were not of a mindset to make good decisions is an understatement, especially in light of the paucity of information and outside help coming in.

Then again, their argument falls flat on my ears. It is essentially this: The hospital was being evacuated after several days in horrendous conditions. We could not leave these patients and we could not feasibly move them. What else could we do? It is easy for me to say, not having been present, but my answer is simple: suck it up. That's what you do. You have a moral obligation to provide health care to people regardless of the circumstances. If you have to stand there and manually ventilate people for days on end, do it. If it takes 15 people a full day to get a 350 pound man down the stairs in the dark, so be it. Spend that time suffering and thinking of the six-figure book deal and White House photo op you'll get for telling your heroic story.

The final issue, and the one most commonly ignored, is the prevalence of this kind of "passive euthanasia" in palliative care. All of the opiates they pump into terminal and elderly patients when they are near death…come on. Who is naive enough to see that as anything but what it really is? It is ostensibly about patient comfort, and to some extent it is. But it is really about convenience – about getting on with the inevitable so time and resources can be devoted to patients with some chance to survive. Even in non-emergency situations this mentality prevails. And who can blame medical professionals for that? The staff of Memorial Hospital were right to wonder why in the hell the hospital had a floor full of people in their nineties hooked up to ventilators and heart-lung machines. That is, to all but the bleedingest of hearts, a complete waste.

We comfort ourselves with advanced care directives, living wills, powers of attorney, and codes of medical ethics, believing strongly that these things will govern our end-of-life decisions. And they do, except when reality intervenes and removes us from the world in which resources are limited only by what we and our insurer will bear financially. When the capacity to provide care becomes a zero-sum game it is only natural that "turkeys" with no long-term prospects for survival will go to the bottom of the priority list. But whether triage decisions should account for doctors' convenience or their impressions, made under duress, of what is feasible is a much more troubling question.

I have a terribly small family. My four grandparents are dead. My parents have one living sibling between them, and she has no children. This leaves me with two parents, a childless aunt/uncle pair, and a married sister with three kids. That's it.

Unlike most Americans, then, I don't have a giant extended family full of knuckleheads with whom I must interact for the holidays. I feel cheated, deprived of the borderline insane Uncle burying silver in his yard and ranting about the coloreds; the Garfield- and Touched By an Angel-loving Aunt who incessantly forwards email after email laden with Bible verses, Teabagger crap, and some non-existent little white girl with leukemia who needs our prayers; the high school dropout cousins hurling child after illiterate child at the world while bravely waging a losing battle against the horrors of paint huffing. Worse yet, what family I have are normal. This perennially deprives me of good anecdotes about the insane people to whom I am related.

So on this most Thankful of holidays, regale me with your best tales – quotes from Uncle Larry, your dad's conspiracy theories, redneck cousins who knock out one another's teeth in billiard hall scuffles, Aunts straight out of a Cathy comic, etc. – of your extended families. I look at Teabagger footage and realize that every one of those people is related to someone normal. If you're lucky enough to be that person, feel free to share with the rest of us. It will be cathartic. Mean, I guess, but also cathartic. And funny.

I drive a 2000 Nissan Sentra which I purchased new. It has 132,000 miles on it. It's gray. The exterior is a topographic maze of dents, streaks of paint from other vehicles, chips, and rust spots. It is, in the truest sense of the term, basic transportation. But it runs like a tank and excepting an alternator which gave up the ghost at 118,000 miles it has had no mechanical failures. I get up every morning and it takes me where I need to go. I win no style or cool points in the process, but cheap, durable, and reliable are all that I need.

Despite my bland choice of conveyance, I like cars. They're neat. I read blogs like AutoBlog, The Truth About Cars, and Motor Trend. But I also like reading about the space program, and that has never made me consider purchasing a space shuttle. Hence I can enjoy reading about exotic sports cars and new technology without feeling the need to spend. My car will do until it falls apart.

The preceding two paragraphs, assuming that my opinions on this matter are not rare, say everything one needs to know about why the American auto industry has become a joke, a collection of free market ideologues sucking the public teat and utterly unable, after 30 years of being spanked by the Japanese, to make a car anyone wants to buy.

Cars like mine – actually, Japanese cars as a whole – are derisively referred to on automotive blogs as "appliances." Boring, not "fun" to drive, and unlikely to make one's acquaintances green with envy. In contrast, partisans of American autos tout Detroit's proclivity for turning out cars for "enthusiasts," big hey-look-at-me cars with huge engines that go VROOOOOM! This point is not entirely invalid. Companies like Honda and Toyota make cars that blend into the background and last forever without the need for repairs every 5,000 miles. Driving a Toyota Camry is about the farthest one can get from automotive thrills without bringing mopeds into the conversation. Detroit titillates the 12 year-old boy in American males with their go-fast Mustangs, Camaros, Corvettes, and retro-everything muscle cars. Vroom.

The Big Three and their loyal fans simply don't understand that "appliances" are exactly what most American consumers want. We want a car that starts when it's cold out, doesn't require extraordinary maintenance, and runs for a decade or more. When Detroit monopolized domestic auto sales prior to 1970, the nation was experiencing a period of unparalleled prosperity. Not only did middle class Americans have the means to replace cars frequently but ample 1950s-style social pressures to keep up with (or preferably one-up) the neighbors. GM, Ford, and Chrysler responded accordingly. They made big, garish pieces of shit with V8s and attention-getting bodies. Why spend money on making a durable car? Everyone buys a new one every two years anyway!

New models were never really new. They were the same basic cars, year after year, which the manufacturers "updated" with their familiar bag of cheap gimmicks: chrome strips, tail fins, trunk spoilers, and "pizazz." When the Japanese finally figured things out in the seventies (Japanese imports were few and universally terrible before that) they marketed value, reliability, durability, and attention to detail. And when the American economy stopped growing like gangbusters many consumers realized that buying something that fell apart, rusted out, or exploded at 20,000 miles wasn't very appealing. The proportion of Americans whose self-esteem was tied up in the kind of car they drive was vastly overestimated in corporate boardrooms around Detroit. We happily drove the bland, pizazz-free cars if it kept us away from the repair shop.

Thirty years later and facing (or in the midst of) bankruptcy, Detroit is still trying to sell American cars with tail fins, racing stripes, and silly interior trinkets. If they could have a monopoly over domestic sales once again or if all American car buyers were guided by the impulses of a teenage boy, perhaps the recovery plans would work. Since reality precludes either, the prospect of seeing the American industry picked over and auctioned off to foreign manufacturers appears unavoidable. Of everyone and everything that will be blamed in the post-mortem (unions, unions, the UAW, and unions) the fact that the Big Three are still operating like it's 1957 will conveniently escape mention.

The wording of the following post has flummoxed me for the better part of the weekend. There is news I must share with you, news which simultaneously feels very important yet represents no significant change from your perspective.

The Blogocracy, the world council of which meets in a hardened bunker deep underneath the Alps, has called me into higher service; as of today I am a regular contributor to Instaputz, the internet's foremost site for pointing out what a bag of wet dicks Glenn Reynolds is. What was once a tag team effort by Blue Texan (of Firedoglake) and TS (origins unknown) is now a mighty troika. We who so savor mocking right wing pundits recognize our own kind and tend to congregate.

I am thrilled by this opportunity, not because it carries with it any tangible rewards but because it will give me the opportunity to swear about David Brooks in front of a much wider audience. We're talking like ten or fifteen times wider. Technically audience size is irrelevant, but those of us who spend copious amounts of time writing without compensation take comfort in knowing that someone is reading. Maybe it's malignant narcissism or maybe it's an easy rationalization, but: If this brings information or pleasure to other people, then it's worth it to me.

So what does this mean for ginandtacos? Nothing. Absolutely nothing. Same format, same content, same frequency. Wild, incontinent horses couldn't drag me away from this thing. Maybe there will be a few more names popping up in the comments, but rest assured that I won't soon forget the people who have been here all along.

This represents a challenge for me because the prospect of contributing to another blog made me confront the fact that…well, I'm not really a blogger. I have never considered this to be a blog, a format I associate with short, frequent, and truculent posting. I think I'm more of an essayist, and that's not because I'm pretentious and the term makes me feel more important. What I mean is that my posts are less frequent (daily, although lately I've tried to do a late-afternoon quickie too) and exceptionally long-winded by blogging standards. I'm more of a shitty, prodigious imitation of Mencken or Twain than a true blogger, so it will be a learning experience for me to adapt to that format.

Thanks to everyone who has followed along thus far. I'll stick around if you will. Back to business as usual later today.

So I will soon be launching a second website, BillKristol.net, after regular reader Evan called my bluff and registered the domain as a gift (at least I think it was, inasmuch as he did not demand sexual favors or money in return). I am loosely planning the site with a running "FJM" format to be updated with each newspaper column or cable news network appearance by the titular neocon. I would also like to devote some time to going through Billy's back catalog / greatest hits to highlight and showcase his stunning record of accuracy.

My long-term goal is to be unsuccessfully sued by Bill Kristol. Alright, kidding aside, it's a risk-free endeavor. He's a public figure and the site will make it abundantly clear that it is not a website authored or condoned by Mr. Kristol. The satire will be obvious. I have zero intention of passing it off as his blog.

Since I already spend far more time on ginandtacos than I should at the expense of my "paying" career (if it can be so called), I am looking for one or more people to chip in with BKnet. Now a lot of you are probably thinking "Hey, I hate Bill Kristol! Count me in!" This is appreciated. However, this does require a tiny bit of committment, i.e. a willingness to pay attention to Mr. Kristol's output and post somewhat regularly – not daily, but at least weekly. It also requires you to be funny and sort of a dick. Nothing kills a blog faster than long stretches of silence, and having four "authors" with only one person posting isn't much better.

There is unlikely to be any sort of reward for your labor beyond the smug satisfaction of being a dick to the king of smug satisfaction. If any of this sounds appealing, let me know.

Regarding the GovTard appointing herself to fill Ted Stevens' imminent vacancy: it can't happen, at least not in the traditional sense.

After Frank Murkowski resigned from the Senate in 2002 and appointed his vapid daughter to replace him, Alaska's state legislature passed a law requiring special elections within 90 days to fill Congressional vacancies. The Governor of Alaska does not have the power to appoint anyone, let alone herself, to "fill" such a seat. At most the Governor may be able to appoint a placeholder for a two months until the special election can be held. Even that is dubious, and doing so would prompt a resolution before the Alaska Supreme Court on the lack of clarity in the 2004 legislation (which notes that special elections must be held but does not clarify whether the Governor retains the power to appoint a short-term replacement – see State of Alaska v. Trust the People).

Whether Palin would resign the Governor's mansion to roll the dice on a crash-course Senate election is unclear. But she's a "maverick" so who knows what to expect! She could Go Rogue!

It took me about 45 seconds to vote. Good thing everybody freaked out and waited in line for 3 hours to vote early. Really cleared things out for me.

I am going to post an election chat-style thread. Too lazy to set it up as an actual chat, but if anyone wants to make this your election night HQ I'll be thrilled to use the thread comments as a faux-chat.

And the conservative firing squad shoulders its rifles and prepares to fire.

Former White House aid Peter Wehner insists that the ideology never fails but is often failed. "The GOP is in bad shape. Conservatism is not."

Kathryn Jean Lopez at NRO dares us to "Blame Palin at (our) Own Risk." She somewhat delusionally notes that "without her, all may have been lost for the Republicans weeks ago" in bold defiance of reality. Perhaps she missed the part where McCain threatened to inch ahead of Obama after the convention, and then Palin opened her mouth and turned the ticket into a joke.

Who would have thought that Victoria Jackson is mentally retarded.

A Canadian comedy duo crank called Sarah Palin and managed to convince her that she was speaking to Nicolas Sarkozy. Recording to be released immediately before the election for maximum damage, I'm sure.

John Ridley makes an excellent argument about how Palin could have been the GOP's Obama if, like the Democrat, she had been slowly introduced to the public over a four-year period rather than being taken from the shithouse to the penthouse in 12 hours.

Well, goodbye to the twenties. I feel about having lived for 30 years the way Mark Twain described a trip to the falls in "Niagara":

You can descend a staircase here a hundred and fifty feet down, and stand at the edge of the water. After you have done it, you will wonder why you did it; but you will then be too late.

Given my epic fail on the academic job market I am starting to wonder what, exactly, I have to show for the twenties. I mean, other than a profane blog.