Letters - October 7, 1998

"On machine"

I read Maureen D'Honau w'49's account of dealing with her husband's sickness with a combination of sympathy, sorrow, and not a little anger (First Person, April 8). She represents many of us who grew up with one style of medicine and now face the realities of today's medical system, which has wrought technological wonders while dehumanizing the doctor-patient relationship. We, the patients, must now step up and be responsible for our treatment to assure that our wishes are followed.

Over the past two years my family has dealt with a series of medical crises that started when my father, Eugene, Jr., of the Class of 1935, learned he had an esophageal tumor and would need surgery. About two weeks later, my wife's cardiologist found a problem that would eventually require surgery to implant an artificial heart valve. Two months after that, we learned that my sister had a rectal tumor, the first of two that would be discovered. About a year later, I suffered a severe concussion in a near-fatal cycling accident. Of the four people in this scenario, two have since died: my father in February 1997, at age 83, and my sister this past Easter Sun-day, at age 54.

The doctors who cared for all of us were among the best in their fields, and the hospitals were outstanding, and I thank them profusely. Still, dealing with these crises taught me more about the impersonal nature of our medical system than I ever wanted to know. Here are some lessons I learned:

Doctors today are for the most part mechanics. The doctors tending my father (an elderly man with a history of heart disease and strokes) wanted to remove his esophagus and stitch the top of his stomach to the bottom of his throat -- an operation that was fortunately overruled by the hospital's Tumor Committee. The doctors tending my wife, a middle-aged woman with known heart damage, put her through an arduous stress test that resulted in temporary heart failure. These physicians weren't stupid, careless, or uncaring people, but they focused more on what could be done than what should be done.

A patient has to ask questions -- and know what to ask. Most good doctors will tell you everything you want to know to the best of their knowledge, but you have to ask. My wife's heart surgeon explained the operating procedures, helped her select the type of valve, and told us what to expect on the day of surgery. But he revealed the mortality rate from the operation only when we asked about it. Information needed to ask informed questions is available from books, the Internet, and friends in the medical profession.

Know your family's medical history and your family's attitude toward illness. My sister was aware of a history of cancer in our family, yet she delayed seeking treatment until her pain became unbearable. Her denial was part of a family pattern of shaking off pain and discomfort and believing that, whatever the problem, taking two aspirin will make it go away.

Have the courage to act in the best interests of the patient. However difficult, it's important to muster the strength to make the best decision for a loved one who is terminally ill. Writing a living will (the patient's responsibility) is one thing, but executing it -- the relative's job -- is something else.

Know your rights. Most hospitals post a Patient's Bill of Rights. Find it and read it. And if you have a living will -- and everyone should -- don't check into a hospital without giving a copy of it to the person at the registration desk.

Eugene C. Worden III '64
Phoenix, Ariz.

Wilson and Madison

I read your March 11 interview with Virginia Postrel '82, the editor of Reason magazine, with interest. Although unenthusiastic about both liberalism and conservatism, I find libertarianism to be even less attractive. Its adherents have a tendency toward political libertinism rather than liberty.

Ms. Postrel gently criticizes Woodrow Wilson 1879 while preferring James Madison 1771. I wonder if Madison could have anticipated that laissez-faire capitalism in the late 19th century would lead to monopolies and abuses of workers' rights, neither of which promotes the public interest. Wilson's concept of the "administrative state" seems to have been a reaction to such excesses of the robber-baron era.

Just as the principle of filial piety tends historically to lead to nepotism and corruption, laissez-faire capitalism leads to pollution and other forms of environmental degradation; I would love to see any evidence to the contrary. I would also like to know how libertarians would end such devastating logging practices as the setting of massive brush fires in the tropical forests of Kalimantan and Sumatra.

Ms. Postrel describes the polarity between letting "the future evolve through trial and error" and trying "to plan it through some centralized approach," a dichotomy she glibly labels "dynamism versus stasis." However, it could just as easily be stated as "chaos versus order" or "ignorance versus knowledge." Such rephrasings show how easy it is to shift the bias to the position opposite of the one Ms. Postrel so clearly prefers.

In trying to understand how to balance this type of polarity, we might look to our beloved university's destiny and purpose. Managing a place as complex as Princeton involves the kind of long-range central planning that is anathema to libertarians. Yet, as a result of that planning, students and professors are given immense freedom to learn by trial and error. I encourage Ms. Postrel to contemplate this example as she discharges her responsibilities as an editor and opinion leader.

Martin Schell '74
Central Java

As both a visionary and an achiever in the intractable realm of politics, James Madison was not only the greatest Princetonian, but arguably the greatest American. I neither know nor care about the origins of libertarianism, but Virginia Postrel is right to point out how inadequately the fourth president has been remembered by his alma mater. It would be recompense of suitable magnitude to name the new stadium -- something of an orphan at present, since it still lacks a major donor -- after James Madison, one of the fathers of our country.

Devereux McClean '74
Brookline, Mass.

Sex and sexuality

Contrary to the assertions of several of your correspondents (Letters, April 22), courses on sex and sexuality such as the one described in the February 11 PAW are long overdue at Princeton. Recent discoveries in biology and genetics, the work of sociobiologists, and a century's worth of scholarship in history, sociology, psychology, and anthropology provide a substantial framework begging for synthesis. The point of such courses is not simply to provide a forum for the dispossessed, but to inform us about human nature.

Gary Walters '64 *75
Ontario, Canada

Blow pongers identified

Your July 8 From the Archives photo depicts the 1977-78 Cap and Gown Blow Pong All-Stars vanquishing the hapless Cottage Club team in the spring of 1978. I have not considered this particular episode of undergraduate fun in 20 years, but would like to thank you for this shot of insta-memory. The rest of that day is lost in a haze of Southern Comfort-induced amnesia. I was not a member of the Cap team, lacking the necessary lung power, but appreciated the efforts of my clubmates. Perhaps Cap won because, being coeducational (Cottage was still all male), it had more girls cheering for it.

Julian Heller '79
Toronto, Ontario

Editor's note: Heller and other corespondents have identified all the blow-pongers. From left, they are Chad Restum '78, Robin Johnson '79, John Brodsky '79, Haden Gerrish '79, Bob Bolling '79, Tim McNamara '78, and Cosmo Santullo '78. McNamara and Santullo huffed for the Cottage team.

"Old Nassau"

Now that we have both a new stadium and a new football season upon us, I would like to suggest that the band consider the playing of "Old Nassau" during half time, when everyone can enjoy it. In recent years it has been played at the end of the game, unheard by those many alumni who leave the stadium before the final whistle. Many universities play their alma maters at the half, and so should we.

William F. Haynes, Jr. '50
Princeton, N.J.