Urban Healing

Cleveland's famed clinic (formally CCF, for Cleveland Clinic Foundation) is a city within a city.  The ever-expanding non-profit institution owns miles of buildings downtown (a total 43,000 employes worldwide) and is the second largest private employer in Ohio after Walmart. The 167 acre property includes three hotels, subsidized transport, and  a system of regional healthcare centers that reach to Florida, Nevada, and a new billion-dollar outpost rising in Abu Dhabi. The latest planned expansion is a new medical education center on 11 acres carved out of the middle of its main urban campus, a cooperative effort with Case Western - the separate medical institution nearby - being designed by  London architect Norman Foster.

 This 4th largest medical center in the US ranked first in cardiology by US News & World Report  operates in military mode, doing battle with morbidity and mortality along with  shifting local and national political priorities. No more than 16 people are in charge atop a descending pyramid of responsible others. Doctors are paid salaries, just like generals. No wonder an efficiency-minded President Obama  endorsed the place as a model of the future in an early visit trumpeting the Affordable Care Act, now the law of the land. They really do seem to be trying to implement cost controls and "change the culture" to emphasize teamwork i.e. improve cooperation and reduce redundancies in patient care, the major contributor at present to US escalating healthcare costs. (Upward of 18 percent of the country's annual budget at present.)

"We don't use human assets as well as we could," confesses one of the staff  orthopedic surgeon. "Everyone can improve." Physicians will find their jobs changed, he warns.

 Among many innovations to be found at this empire of healing is the existence of a second CEO known as Chief Experience Officer. The experienced guide on a recent tour titled him "chief empathy officer," a job currently held by a staff surgeon. As in patients' experience, emphasizing - upping the ante on relationships while on hospital grounds.  A nice trick since surgeons not famously empathic professionals. Alas, we had no chance to meet either this sanctified leader nor any patients, though one experienced staff surgeon spoke hopefully of "patients having their own ownership in the outcome." Of what exactly? Their health, yes. Also - timely note - of implementation of the ACA that is going to find thousands, if not millions, more patients at their door. 

 Though as an aside, I must add an anecdote passed on to me that shows the outreach effort can be catching on many levels: a grateful royal personage in residence at the swank VIP rooms for months, having various organs transplanted  would have free pizza delivered weekly to CCF employes. (Probably not all 43,000.) Apocryphal? Perhaps, but that is just the sort of story suited to the institution's legend.  It helps to report that my source (then visiting a friend's hospitalized sister) was Cleveland-born and announced herself as a staffer for a key member of the US Senate. CFF President and heart surgeon Toby Cosgrove himself turned up to offer her a tour of robotics in use.

Surprise # 2: anyone ailing is welcome at CCF. Whoever you are or wherever you live, you are guaranteed to be given an appointment to be seen the day you call. (No further detail supplied by clinic's public relations professionals but it's likely that follow-through will be a little more complicated, depending on your gripe and your location.) All part of the much-touted empathic program no doubt. Try it - and see for yourself. Call 1-888-223-CARE.

Facts and figures and VIP names roll on in great numbers about the place on Wikipedia, a virtual honor roll of celebrity. Those lucky - wealthy - folks can claim a top drawer suite with commanding views and enough electronics to run a business from their bed.  On the other hand, the clinic says it had 150 million charity cases in 2012.

Part of the healing process includes visual therapy, to judge by what is on all the walls: a fulltime PhD art curator on staff takes care of acquisitions that enhance pristine soft blue-gray opaque glass paneling on the halls. Would that military quarters -see CCF's origins 91 years ago - 

Big Brother or Big Daddy definitely is in charge here: an anesthesiologist who confessed at the recent Chautauqua Institution's theme week on healthcare that he is a reformed soda pop (Dr. Pepper) addict manages the institution's wellness program seeking to improve the health of every employe. Anyone not coming up to speed doesn't last long at CCF.  Smokers and fatties don't get hired. Get with the program or else. Try meditation, leaner diets, and exercise  (10,000 steps a day) according to Dr. Mike Roizen, known fondly and familiarly as the clinic's energizer bunny. (He got  his friend, TV's Dr. Oz, to help  cure him.)

The main entrance is a curving wall of windows behind a round constantly moving water feature that is said to promote a feeling of security. The doors open onto white and off=white public areas - a strategically designed welcoming space. The lighting is worthy of theater,  carefully executed to emphasize the grandeur of CCF's calling.  Pedestrian skyways link various parts of the immediate campus - with institutes organized into "diseases and body parts" -  show videos in constant motion. Little if anything is stagnant here; a piece of stray paper dropped on the ground would probably disappear on the spot out of sheer shame. Dr. Toby would almost certainly be on it, if not.

Summer Road Tripping

 A friend and I make our way mid-July  from Washington, D.C., to Bridgewater, New Hampshire, stopping in a pre-Revolutionary War home outside Philadelphia and going on to multi-faceted Poughkeepsie, N.Y., headed for two nights in Stockbridge, MA., around the corner from Tanglewood, and finally reaching tiny Bridgewater (outside Bristol) on the sixth day. A total of 689 miles and no protest at all from the four-year-old MiniCooper. Philip Caputo did an even longer trip (Florida to Alaska),  creating a book out of it (see 'The Longest Road'), with homage to the wanderings of predecessor William Least Heat Moon.
 We had no vision in mind beyond a chance to drop in on familiar terrain that would remind us of the distinctly different demographic and geographic contours of the Northeast. Nothing to prove beyond the pleasure of the changing scenery, though in hindsight, Berkshire country and New Hampshire terrain (both coniferous and deciduous, ticks and mosquitoes) aren't really so different. Go with the flow and come back with new memories. Swim in a clear cool lakes and gamble on good weather (70 to 100 degrees) with history as an aside. The Philadelphia origins of our country, alongside Franklin Roosevelt's 20th century legacy laid out in the modest splendor of Hyde Park. N.Y. before coursing onto the sublimely elite Tanglewood festival scene, second home for many of New York's Upper West Side denizens .
Road trips may well be an American invention. A person doesn't think of the Silk Road in those terms. That fabled journey was meant to get you from one place to another in record time doing some commerce along the way. Modern tripping implies rambling, discovery,  escape.
It's possible, of course,  to take a road trip by foot through the city, looking up and around and poking in and out, learning as you go. There is a certain conspiratorial sense among city residents who choose to - or are forced to - stay home in the middle of summer. No better demographic view can be had of them than the barely-dressed patrons of the Olympic-size outdoor pool at Hains Point in the Southwest. Swimmers and dabblers are a mix of brown and white, sleek and slow, awkward and athletic. A cozy cross-section cheerfully engaged.

Street Scene Summer '13

The report was alarming: neighbors at dinner report elders/seniors/whoever watch the weather channel more than any other channel on TV.  (They also stated that no one reads an entire email anybody, that bullets are a necessity.) That  was enough to send me the next day out into the street again, to engage the world. First, to line up for a free preview of a new movie about STeven Jobs. Alas, all seats taken but a promise of another showing if we give the young lady our email contact. She writes it down laboriously with pencil and paper. Jobs is in the poster as a technicolor hippie guy. (The friend with me reports that her granddaughter was introduced to her first black and white movie only recently - Heidi, an old version apparently - and loved it. A touching note about generational bonding.)
So we amble the Georgetown Waterfront streets and run into a young woman introducing herself at our behest as ' Jackie', who is wearing the Google Glass and looking something like a grasshopper on patrol. She is some sort of inspector general overseeing software functioning, testing it out. This comely well-spoken friendly 30-something lass then allows us - at our suggestion - to do some testing ourselves. Glass is one-up on Jobs for sure but hardly ready for prime time. Audio is key I guess. (See Gary Shteyngart's tryout with the thing in this week's New Yorker magazine (www.newyorker.com).) I only could see strange visions in my upper right eyeball, maybe real-time looking back at me. "You have matching iPhone," Jackie notes with satisfying chirpiness. Tangerine! Yes, but what good is an iPhone when I can't figure out to take a picture of myself wearing the tangerine Glass. Jackie can do that and more when I fumble around with this old-fashioned device that uses keys...

Miami Miasma

Surely everything about Miami is a contradiction, beginning with its very existence. (I leave you to check Wikipedia or elsewhere for that great story.) But who would expect modern day restaurant codes to follow suit? Namely, a new high-end and literally sky-high eatery called Juvia, atop a parking garage on famed Lincoln Road, requires 'gentlemen' clients to wear only 'closed' shoe styles. An elegant leather sandal is entirely off limits, as my party found recently. Women, however, can come in almost naked in whatever shoe they wish and it sometimes seems that is about all they wear to show off their bodies. Shorts for men seem ok as well. Keeping off the riff-raff of the streets may be the reason but it's also reasonable to think a law suit could be in order here (as litigious action seems to be the rule everywhere these days).

Woman On a Metro Train

 The color, pattern and texture of a jacket  worn by a woman seated on the Metro train is similar to a garment I wore on my wedding day long ago.
I have a sudden shock of recognition and a memory still  clear about a peripatetic day in Athens when I spotted a long-sleeved top and long skirt designed with wonderful simplicity and appeal. A waffle weave, exquisitely made - possibly unique. Possibly silk.  Straight lines. Classic. Even tiny Chanel-like buttons down the front and a small shirt-style collar. No label name. It hung in a boutique on a side street in a fashionable part of town at a time when tourists were few. (The junta had just come into power.) I had no premonition of a ceremony; no groom in mind. But I knew then that having found the dress I would find the man. And so it happened..
 I wore the dress once on a hot July day. No jewelry and no veil. I carried red roses from a bush on the lawn of the very great old house where assorted guests had gathered. The dress turned yellowish with age and ended its wearable life in a collection of wedding dresses being assembled by a costume curator at Vassar College who intends one day to display them, with a history of each dress attached. Stay tuned.

Slick City Touts

An accomplished urban man of distinction,  who likes to answer to the description of 'flaneur' (which Webster's translates miserably as 'an idle man about town'), can be easily engaged in a name game about cities he has known and loved. He fancies ranking them in terms of the 'it-ness' of the moment - their individual allure based on what might in other people's minds be simply subjective impressions from a recent visit. He appears very firm in his judgments and by no means volunteers them to gain effect. He has traveled the world, lived at separate times in a number of celebrated places, and feels justified in his conclusions.
Take heed then: Paris is 'over.' The city stifles creativity chiefly because government policies and regulations discourage innovation. The talented young especially are all going to London. He says a friend reports recently that the language she heard most often in London was French. Berlin has replaced Paris as a continental city worth inhabiting. More verve and excitement. Sydney has it in spades over Melbourne, the latter being "tired" and mainly a refuge for - well, he can't exactly say but it isn't really alive. Forget Rome, Lisbon, Madrid, Moscow, Tokyo - though he might give the latter some praise.
 His own choice is New York - and the upper East Side of Manhattan, which has lost its allure for the luxe crowd  (Fifth Avenue and Park Avenue excluded). Rents are cheaper, live is easier since small service businesses still exist in the neighborhood. He can close his small apartment at any time and leave without regret for any wanderings he fancies. He is giving away most of his possessions and relying on digital devices to make his way. "Seven bus lines between New York and Washington," he exclaims - a lark for the last minute unencumbered traveler, even one on a day trip. 

BRAIN WAVES: Minding What Matters

• Neuroscience minds talking June 5/13 at an AAAS (www.aaas.org) Capitol Hill luncheon forum titled "Mapping the Brain" provided more details on efforts to decode that  three pound complicated mass of gray matter - those 186 billions of neurons, synapses, circuitry, what have you. Projections call for a 15 year target date to understand more than the rudiments of brain behavior, thanks in large part to the developing world of nanotechnology. (A nanometer, the customary measure in the field, is 50,000th of a hair width, if you dare to imagine it.) There's much to learn, with humility the guide, since isn't the task really the mind studying itself?  The search involves the invention of new tools - even new terms - well beyond very advanced MRI now providing  impressive insights into  the organ's functioning.
•  We need to learn about the "electrical, chemical, mechanical" elements - "what happens at every moment," in the words of Dr. Michael Lee Roukes, founding director of Caltech's Kavli Nanoscience Institute. He uses the word connectome  for understanding regional processes, spoke of connectivity gates (wiring), and said currently scientists have charted some 1000 out of a possible 50,000 channels. It's new worlds and worlds out there...
• Curiously, on the humble front, what we might begin to learn at the outset is why anesthesia works. We know how - patients and doctors know the effects - without understanding the intricacies within the brain that allow a person to lose consciousness and withstand pain. Further studies could lead to new treatments for relieving pain and depression. One study has focused on the after effects at different ages of  propofol, according to Dr. Emery Brown, of MIT, and a member of the NIH BRAIN Working Group. In what was almost an aside, he noted work done by Dr. Terri Monk of Duke University showing that up to 13 percent of the elderly (60 and over) have some mild cognitive impairment as long as six months after receiving such drugs in non-cardiac surgery.