the artist came to paint her brightly colored mural on the brick wall of the warehouse by the derelict park. Around noon an old man would arrive and take his customary seat beneath a great elm tree. He enjoyed watching the artist work.

On the day the mural was finished the artist approached the old man and extended her paint-splattered hand. Hello, she said. I hope you like the mural.

It’s been wonderful to see it go up, the old man said with a smile. The girl you painted looking out the window reminds me of my daughter. I miss her. She’s far, far away from these ruined streets.

The artist sat down next to the old man, her silent companion for the past three months. They both admired the vibrant mural. They talked about art, life, and the dangerous neighborhood. The old man shared a photo of his daughter. The artist agreed there was a slight resemblance as she studied the tattered, wallet-sized portrait. She then packed up her paint cans, brushes, and ladder.

The next day the old man sat beneath the great elm tree. He fed a mangy squirrel. He missed watching the artist paint. Looking up at the mural he suddenly realized that the artist had changed the face of the girl in the window overnight.

He wept with joy as he looked upon his daughter’s smiling likeness, knowing that each day he would now be able to see her lovely face in the park they once visited together.

I’d like to propose a new condition into the medical lexicon:

Cellphonophobia – the fear that using a cell phone causes bodily harm, usually associated with avoidant behaviors that equate electromagnetic radiation with contagion.

Cellphonophobia is related to the obsessive-compulsive spectrum of disorders rather than those of the anxiety classification. Sufferers worry about being tainted with cancer-causing radiation emitted from their cell phone transmitters in much the same way that those with OCD worry about germs. Instead of compulsive hand washing, cellphonophobics use hands-free earpieces and speaker phones to achieve maximum separation from the cell phone. They prefer texting to talking, and turn off their cell phones when not in use. They may even give up the technology entirely and revert to landline use in all but emergencies.

Unlike telephonophobia, in which there is a social phobia about picking up the phone or making a phone call because of the other person on the line, cellphonobia is all about contamination.

I know this because I have a mild form of this condition. But as Nirvana sang: just because you’re paranoid doesn’t mean they’re not after you. Or something like that.
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I’m sure you’ve read through top doctor rankings and online physician ratings. It is only human to seek perceived leaders. But as sometimes seen in politics, those who have reached the pinnacles are often motivated by ambition, charisma, and gamesmanship instead of altruism, sincerity, and merit.

Beware the top doctors issues found in magazines and newspapers. Some of these doctors are excellent, but many are simply “notable.” They may be well-connected, in leadership positions, or presidents of this or that society. Many are excellent self-promoters, branding themselves through the name brand institutions they work for and the billboards that increasingly advertise their faces. Many are simply well-known or popular among their peers. But many are unavailable, aloof, or consumed with administrative duties for the institutions through which they’ve risen in the ranks. Others stand apart from the rest due to their strong entrepreneurial efforts. I know of a “Top Doc” who prescribes dangerous medicines for conditions I’ve never heard of. Many of the medications cause weight loss as a convenient side effect. He’s considered “cutting edge” or “popular among patients” simply because he fills a niche that’s in demand. Last I heard, he’s being investigated, but still graces the “top docs” magazine.

Be cautious about your own feelings about a doctor’s competence. A good bedside manner and a kind heart are important, and thinking of your doctor as a friend may lessen anxiety. But a certain distance is needed for objectivity, clear thinking, and a person’s best interest. For example, consider the doctor who pleases all his patients by agreeing to prescribe whatever medications requested. Before long the medication list bores a hole into some Wonderland, with pain pills, sleeping pills, anxiety pills, and weight loss pills whirling together in a mind-altering, life-threatening existence. Consider the doctor who agrees to order every test you can think of, including full body CT scans that find little-nothings in your spleen, liver, lungs, and bowel that now require monitoring with more CT scans, soaking your body with cancer causing radiation and worry. You want a doctor who is not your best friend, who shoulders the uncomfortable task of telling you “no” when he believes it is in your best interest.

Beware the insurance company rankings of doctors based on quality measures. I just received a survey from a big insurance company. They picked one single patient from my practice and asked me if that patient had received colon cancer screening in the past ten years. I pulled the chart and looked over our notes from the past ten years. We had reminded, cajoled, educated, and tried to convince the patient of the benefits of colon cancer screening over twenty times, yet he refused or declined each time. But to the insurance company quality rankings, this means I have failed, and I will be penalized both in terms of my “quality” as a doctor and most likely my diminished compensation from that insurance company. Shall physicians also be ranked based upon how many of their patients ride motorcycles, drink soda, or eat Baconaise? Other quality measures include stratifying doctors based upon how many of their diabetic patients’ blood sugar readings fall below a certain goal. Yet there is overwhelming evidence that excessively tight glucose control does more to harm patients than help. In this case, the best numerical results for quality only correlate with higher mortality for patients.

Beware the websites upon which patients can submit reviews and rate different doctors. Just because a doctor is well-received does not make him a good doctor. As I’ve written in the preceding paragraph, pleasing people is easy. Disappointing them out of a sense of beneficence is actually quite hard. A perceived bad experience by a patient may provoke a negative review online, but improving people’s health and satisfying their needs and wishes don’t necessarily overlap. A doctor could see thousands of patients and do a good job with them all, but never be rated by anyone except the three disgruntled patients she did not please. And staying on time is every doctor’s goal, but sometimes a 92 year-old woman with multiple needs shouldn’t be dispatched of in 20 minutes, and patience is a community responsibility.

I understand the need to measure quality in any system as a means to figure out how things can be done better. But the crowning of top doctors, the bureaucratic measuring of imperfect health quality markers, and the compulsive clicking of online reviews are not the solution.

Unfortunately I don’t have the answers. Perhaps we as patients should be ranked, too? I already see signs that insurance companies are doing this in subtle ways.

Plastics? Robots? Nanotubes? Some combination of cold fusion and artificial intelligence? Or just old-fashioned word of mouth.

“Will you grab that spider web?” my grandmother said abruptly. We were sitting on an old bench overlooking the river. It was September. I had sprung her from the assisted living home earlier that day.

“Which spider web are you talking about, Gram?” I asked her. My eyes were sleepily watching the timeless flow of the big river, the eddies and swirls along the banks, and the gracefully bending boughs of the old oak trees as they waltzed with the wind.

“There to the left!” she said with certainty, reaching her bony hand into the sky and grasping at thin air. “Get it, will you?”

I looked again but there was nothing. I knew that my grandmother’s mind had developed a little static among the signals, a few crackling wires in the electric grid of her brain, and I figured that her eyes were playing tricks on her.

“I don’t see it, Gram. What does it look like?”

She seemed a little disappointed that I did not share her perception. “It’s feathery, and it’s drifting just over the river. It’s actually quite pretty.”

I let my eyes lose their strict focus. There was muddy blue from the river, majestic green and brown from the weeds, a smattering of orange and red from the leaves about to change in fall, and slate gray from the worn stones and pebbles along the riverbank. But still I couldn’t see the spider web.

“I think your eyes are playing tricks on you, Gram,” I finally confessed.

She frowned ever so slightly, embarrassed by the loosened reins she held over her body and the cloudy lenses through which she saw the world. She was a proud woman. She used to take me fishing along a tributary of the big river. It disgusted her that she could no longer drive a car safely.

“Well, the river sure is beautiful.”

“It is, Gram.”

“Shouldn’t we be heading back to the nursing home?”

“Only if you want.”

“You should get going, I don’t want you staying too long. You must be bored.”

“No Gram, I’m quite happy. Do you remember that summer the river was so low we could walk across it?”

She smiled. “I sure do.” She turned her head away from the spider web. I watched her ancient eyes gazing across the flow to the far banks of the mighty river. “It’s such a beautiful day here in the sun.”

“It is, Gram.”

Years have passed since that day. I wish I could take her down to the banks of the river and just sit there again. I wish I could hear her voice on the phone. I wish I could feel the knobby bones of her fingers in mine and marvel at how different our skins look.

It took me some years, but finally I can see the spider web. It floats off to the left side, just like she said it did. When I walk through the snow or look to the sky it is quite prominent. Sometimes it angers me that I’ve lost that perfect clarity of youthful vision I once had. Will I travel the rest of my life with this gray web they call a floater? Will I be an old grandfather someday and forget that the hovering filaments are only visible to my own retina? Unaware, will I ask my own grandson to catch the web on a beautiful fall day, before he takes me back to the nursing home?

The spider web is pretty, Gram. I’ll remember to watch for it out of the corner of my eye. I’m glad you saw it, too.

Mmmm. I just discovered non-homogenized milk – the kind with the thick layer of cream on top and more watery milk below. You have to shake it up before each serving, and the little flecks of buttery cream never quite disappear. Non-homogenized milk can look alien at first, with tiny chunks of floating cream fooling the mind into thinking the stuff’s gone rancid. But the taste is far superior to homogenized milk. Think milk with a hint of butter.

This is the old-fashioned kind, available to humans for 10,000 years until the 1930’s when homogenized milk became widespread. Homogenization of milk is accomplished by a series of filtration steps under high pressure that squeeze milk and its relatively large fat globules through tiny tubes, breaking the globules into microscopic pieces which are then prevented from coalescing by the casein already in the milk. This process makes milk look… homogenous, uniform in consistency and tasting evenly creamy.

There was great controversy over whether homogenized milk was responsible for the brisk uptick in coronary artery disease beginning in the 1940’s. Dr. Kurt Oster proposed a mechanism by which homogenization of milk might enable an enzyme called xanthine oxidase to initiate the formation of harmful plaque in arterial walls. In general, scientific study and peer review have consistently disproved his theories.

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He wasn’t like some other men who moan and protest the very idea of shopping with their wives. He wouldn’t throw small tantrums at the idea of spending money on beauty, belts, and blouses. He enjoyed strolling around the city streets, feeling the sun warm the concrete, watching the wild array of people and their interactions with the world. But as soon as he would step into a small boutique and close the door behind him, the tinkling of little bells on the door handle was like a Pavlovian cue to feel a different sort of anxiety beyond spending money. For the walls seemed to close in on both him and those sad, tragic characters looking up from their registers, smiling and greeting him with: Hello, is there anything I can help you with today?

It was a lovely Saturday in the spring, and hope was budding on every tree limb as he found himself walking from store to store with his wife. They must have been to at least thirty stores already and he had not spent a dollar. A pair of jeans hanging in the display window of a small store caught his wife’s eye, and she tugged his elbow towards the door. As they entered the small shop a thin, middle-aged man with a receding hairline emerged from the back. There was no one else in the store. Eerie pop music emanated from speakers perched near the ceiling. Everything is fifty percent off this week, he said with a desperate grin.

They walked around the store, his wife pulling on shirtsleeves and holding up jeans for imagining. “Do you like this?” she asked him, while both she and the expectant shopkeeper awaited his inevitable shoulder shrug.

“Looks good,” he answered, but somehow his wife knew the many inflections of those two words and put the jeans back on the rack. The shopkeeper quickly procured three alternative pairs of jeans to evaluate. He looked sincere in his quest to please. Did he have a family? Three kids in college? A mortgage and a sick mother? Had this dream of running his own store turned into an imprisonment? Would his front window be shuttered within a week as the vultures of bankruptcy fed on his store’s fetid collapse? Were they as shoppers vultures too, making him dance for their disinterested fancy, juggling his blue jeans on sale for fifty percent off?

Yet he knew it was a conceit to pity the entrepreneurial shop owner. Undoubtedly some were doing quite well, supporting themselves or their families, even planning expansions and expensive trips on the money they were making. Yet the hundreds of small rejections that accumulate during a day of shopping were enough to dishearten him. He wished he could buy each small store’s entire inventory, delighting the shopkeeper if just for a day. If only his wallet were a fountain of milk and honey that flowed to all those who struggled, from this store to the artists in the park, to the coffeehouse on the corner, to the rare bookstore down the street, onwards and into the mouths and souls of every struggling being in the world.

“No thank you,” he heard his wife say. “They are very nice, but not quite what I’m looking for.” The shopkeeper pursed his lips and thanked her. They left the store without buying anything, never to see the middle-aged man with the receding hairline again.

Thank you for stopping in. Have a great day.

The heartache was becoming unbearable. “How much more shopping are we doing today?” he asked his wife. She feigned not hearing him as she pushed on to the next store, this one selling shoes and as empty as the last. The familiar bells on the door handle jingled, and a fresh wave of dread ushered him into the space. There were three women staffing the store, one straightening the shoes to perfection, another typing something into a computer, and the last one simply watching the door. All three chimed in to say hello and welcome.

His wife quickly ran through the inventory and found nothing of interest. He meanwhile was standing awkwardly in the middle of the store, his arms crossed behind his back, with morbid fantasies of single motherhood and a sad awareness of scarcity and human frailty overcoming him. He was about to excuse himself to wait outside the store when his wife pointed out a pair of leather sandals. “Do you like these?” she asked. He did. Sincerely.

He touched the leather and found himself admiring the construction. Before he could start pitying all the menial labor that had brought these shoes from the skin of a cow through some southeast Asian factory to this urban showroom one of the saleswomen was bringing him several sizes to try on. He felt terrible about life’s necessary consumption. He felt embarrassed about his own arrogance, the conceit that he should pity others or himself for our common struggles. But these sandals were feeling damn good on his feet. The saleswoman was smiling upon seeing his satisfaction.

Shall I ring them up for you? she asked.

“Yes. In fact I’ll wear them out of the store if that’s okay,” he replied. There was an exchange of money, with human hands touching and pleasant smiles traded as a scrap of manna from heaven flowed through the store. The bells on the door rang lightly, sounding both distant and near as they exited.

He was exhausted, and his heart could take no more.

He and his wife headed off towards home. She bought a few books at the bookstore and a bottle of wine along the way. She thought his brooding about the heartache of shopping was a little bizarre, which it was. As he walked down the concrete streets he marveled at how the earth felt padded in soft leather. The sandals were good things.

Perhaps the shopkeeper was a kind of artist – performing, taking risks, displaying the necessary truth of our consumptive existence, and capturing something human, unspeakable, pleasurable, and timeless in the art of the exchange.

Or maybe it was just finiteness that broke his heart, and shopping laid it bare.

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