Friday, November 14, 2014

Gedy Barnes Returns

It wouldn’t be entirely inappropriate to title this interview, “The Talented Mr. Barnes”. With a career spanning thirty years of entertainment, art, and medicine, Mr. Barnes’s life truly defines the idea of the complete man. I’m honored to know him as a colleague, and dare I say, a friend.

Q: Mr. Barnes, welcome and thank you for this, our second interview.

GB: It is certainly good to see you again Quatro… Quarto… however you’ve styled yourself. And may I say, you’ve outdone yourself with this room-- your quaint reel to reel recorder and SM57’s. It’s perfect!

Barnes has correctly observed that this room is perfect. It’s a small meeting room on the mezzanine of a medieval castle themed hotel. The hotel, however, is never used for meetings of this kind, and the rental of this room, with its mosaic glass windows and Anglican stilt, has been occasioned only five times since the commencement of its business, and only by me. – Q

Q: I have to share this with you. Your first interview drew dozens of visitors to my website.

GB: Dozens, you said? 

Q: Yes, 26, to be exact-- two dozen, dozens, two baker’s dozen? 

GB: That’s a little overwhelming. Of course I’m flattered by the attention, 26, you said.  

Barnes turns a contemplative eye toward a glint of light in a glass mosaic that crowns an arched window in the far corner of the room and smiles almost imperceptibly. 

Q: I think that the Creative Medical Advisory Office at Our Lady of Rejected Saints is a fascinating project, but you’re currently on sabbatical from OLoRS. What prompted the change?

GB: There comes a point in every endeavor when I simply run out of ideas to keep the thing, whatever it is, moving. The key idea is movement. It’s a cornerstone of the perception of life—movement that is. When a thing can’t be quickened again, it’s dead. And dead things aren’t much fun.

Q: Do you consider resurrection?

GB: No, No, No… but I maintain the plasticity of death. 

Q: If I told you that people say, “I don’t know how to act when I’m around Gedy Barnes”, what would your reaction be? 

GB: I’m very glad you asked, because you’ve raised a point I’ve tried to demonstrate many times, and that’s this; if you presume to know how to act around a person, you’re doing just that—acting. I cannot abide an act. But I find people are true to themselves in those moments, when they don’t know how to act—caught off guard, as it were. 

Q: I’d like to put a finer point on that. Do you make a distinction between?

Before I can finish my sentence, Barnes stands and commences a fierce attack on the stone hearth in the North corner of the room using a spare roll of audio tape that I’ve left adjacent to my recorder. He stops and returns to the table as if nothing unusual has occurred. I’m initially stunned, but a wave of understanding passes over me. 

GB: How did you feel just then? 

Q: Speechless, really. I didn’t know what to say or do. We were taking as we had, then you were, the next moment, attacking the fireplace. 

GB: Precisely, Mr. Barto. All your affectations, the sycophantic presumptions of my dispositions, were obliterated in that very moment—thus fell the fa├žade. But as the spinning slowed, the pieces were drawn back by the sinewy threads of expectation; and as the last chink was closed, you remembered how to act around Gedy Barnes. 

Q: I do remember how to act around Gedy Barnes. 

GB: [laughs] If you’d been lucky enough to slip into a coma during a routine medical procedure at OLoRS, you’d be remembering how to act around Gedy Barnes with a full set of porcelain veneers!  

Q: I’m glad you brought us back to the CMAO. I had a few questions from readers about the project, which you mentioned is now closed, on the ethics of performing medical procedures in situations where patient consent would be impossible to obtain. The cosmetic dental work on dying or unconscious patients, Smiles for the Terminal Miles, it was called, raised a few eyebrows.

GB: That doesn’t surprise me in the slightest. First, let me address the patient consent question in very simple terms; insurance pays, patient stays. Second, all these definitions, dying, dead, comatose, etcetera, are plastic to a point. I can remember a few cases where we were able to work double knee replacements into an embalming—saved a ton on surgical aftercare.
Take a look at the alternative, if we’d simply relied on the traditional definition of death, that patient would never have had the opportunity to walk without pain, the surgeon would missed out on a lucrative operation, surgical suite rental fees for the hospital—gone, and our staff mortician, Barry, he just never gets to talk to anybody during the day. 

Q: Wouldn’t the patient be dead if he were being embalmed?

GB: Of course, I should clarify that point. We were pioneers in the field of pre-embalming. That’s what I was referring to—of course we couldn’t perform surgery on a completely dead patient, or embalm a live one for that matter. Remember though, death is a continuum. 

Q: Some people might say that CMAO looked for ethical loopholes to allow unnecessary medical procedures, on the dead or dying, for the purpose of bilking patients and insurers.   

GB: I have heard that criticism, but I think that’s the narrow view. I’ve heard some bizarre accusations, believe me! The toe nail incident comes to mind. I can assure you it was patently false. Some things were just misunderstood. Our cardiopulmonary sharing program that matched cardiac intensive care patients with a “lung buddy” from the coma ward, it was a huge success. 

Q: It seems that you’re still piqued by the perceived ingratitude. 

Barnes pauses and removes his glasses. He rubs his temples gently with the tips of his ring fingers. 

GB: They’re your cleanest fingers, generally speaking; the ring fingers, I mean. They’re protected by the little finger medially, laterally by the middle ones, and insulated from vulgarity by the natural proclivity to prefer the index finger and thumb. 

Q: I don’t even have the words. 

GB: Well, what’s to say? A style for digital interaction? The manipulative fashion? 

Q: Witty as ever! Should we break today? These interviews always run the risk of turning into conversations, meandering as they do.

Barnes chooses not respond, but stands and walks from the room. As he reaches the door, with its black iron hardware and thick coats of lacquer, he mutters a single word. It was almost inaudible and I believe it was intended only for my ears. As it was not intended to be transcribed, it shall remain unknown but to Gedy and me. I suspect they will not be the final words between us.

Monday, December 2, 2013

Part One of an interview series with Gedy Barnes

July 2013

An interview with Gedy Barnes, Director, Creative Medical Advisory Office, Our Lady of Rejected Saints Hospital

It’s cooler today than it has been the past few. The respite is palpable. This afternoon I’m interviewing Gedy Barnes, the Director of the Creative Medical Advisory Office (CMAO) at Our Lady of Rejected Saints Hospital in Northcrest, Texas.

Q: Gedy Barnes, author, administrator, and father of what is considered in many circles to be the future of medical service delivery, welcome!
GB: It’s good to be here, Quatro.
Q: So nice to see you again. One note, my name is Quarto, not quatro.
GB: Did you change it?
Q: Do you remember that kid named Quarto that you insisted on calling “quatro” all through junior high?
GB: Of course, I wonder what came of that fellow-- so dour.
Q: So, Mr. Barnes: Creative Medical Advisory, what is it?
GB: It’s an experiment, first and foremost. I've always had a keen interest in hospital administration. Yes, the hospital provides health care, but it’s also a business. My intent in this project was to bring a synergy to the two. I was thrilled when, three years ago, OLoRS accepted my proposal and I opened the Creative Medical Advisory Office on campus. 
Q: What does the synergy of business and medicine mean to you?
GB: It’s easy to see the institution, brick and mortar, monolithic. A person gets sick, is admitted, gets well, or not, then receives a bill for experience; but it’s more nuanced than all that. 
Q: Sure, looking at the bill I received from the hospital after my daughter was born, it’s obviously more nuanced that that, but where’s the synergy?
GB: Okay, there’s a tendency to think of it as a revenue generating, profit creating machine. Let me correct that perception and say this, and it’s very important, the CMAO was never about maximizing profits for the business concerns of the hospital. The CMAO was about looking at individual cases, patients if you will, and maximizing their opportunity for care through the CMAO programs.
Q: Okay, can you walk me through a case?
GB: There are certain patient confidentiality issues that preclude those specific discussions, but let’s take one of our programs, “Smiles for the Terminal Miles”. Through “Smiles” as we liked to call it, the hospital was able to offer orthodontic and cosmetic dental procedures to a range of non-traditional patients.
Imagine for a moment, you wake from a ten year coma to find your children grown, your wife remarried, and your body an atrophied wreck. But hold on a minute! As you’re being rolled onto your side by an orderly for yet another humiliating sponge bath, you catch your reflection in the mirror, and BAM!, two rows of gleaming pearly whites, straightened and veneered, just waiting to share your next adventure.
A simple example, but before CMAO, it was an impossible example. You can see the win-win right there. Of course we aren't advocating a coma for a stubborn bicuspid that just won’t turn-- but if the opportunity is there?
Q: I want to move on a little and explore your role as director of the CMAO. Can you give us a snapshot?
GB: When you really drill down on the point, I’m an idea guy. My degrees are in social science, not medicine, but I always saw that as an advantage. The hospital is filled with physicians, what I do is bring that outside perspective to maximize those opportunities for patients to receive the care they deserve. My pen cuts on a different angle from a surgeon’s scalpel.
More to your point though, my day usually begins with a review of the previous night’s developments… intakes, evolution of current cases. I like to get ahead of things, so I’m always thinking down-line, which gets us back to the core of what I do anyway.  On Mondays and Fridays, I buy coffee for my staff and we just relax and talk about anything except work. It’s gotten to be something of a tradition and one of those little things we all look forward to. 
Q: A few times you mentioned that you see yourself as an idea guy. What does that look like in practice?
GB: So often it’s the convergence of circumstances that creates new doors. I’m the one who recognizes those and tries the knob.
Q: Can you elaborate on that a little bit? Maybe take us through a particular, inception to implementation?
GB: Of course! Let’s step back a few years to the beginning of the project. Like many older facilities, OLoRS was designed to house two patients per room, with these assignments generally made ad hoc. Well, prima facie, it seemed that we could put a finer point on that and add some value to the operation, but we were all stymied and put it aside.
Well, a year later, I was out on rounds supervising a group of foreign interns when we walked through the doorway of room 638. That was the first act in a revolution in the way we delivered patient care.
[Barnes pauses for a moment and looks out of the window. There’s a mockingbird frolicking in a concrete birdbath. Even though the heat has abated, the freshly coated asphalt is too warm for the tiny bird’s delicate feet]
GB: That sums it up, right there!
[Barnes nods toward the window]
GB: In room 638 I found a patient, let’s call him Ted. Ted was suffering from some sort of kidney failure. A few feet away lay a man recovering, as nearly as I could discern, from some type of head injury-- recovering with a complete set of veneers I’ll add. The staff had nicknamed him “Chompers” because he kept biting his feeding tube in half. No one could get near his head without risking a finger, so they finally came up with the idea to… I’m getting off point here.
So there I was, standing between a rapidly yellowing Ted and old Chompers, when it hit me. Ted needs some dialysis and Chompers could use some company. Boom! The “Gemini Healing” concept was born.
Q: How did that work out exactly?
GB: Well, the medical esotery would bore, and frankly, it’s none of my business, but in this case, old Chompers had a skull full of mush and some spare capacity in the old renal system, so I said, “Let’s get these two together on something.”
Like I said earlier, it’s a convergence of circumstances and taking that brave step. All the rest is just tubes and wires to me.  I don’t practice medicine; I just provide creative advisement to our health care system.
Q: Looking back, what’s been CMAO’s biggest challenge?
GB: Tough question! You know, in the moment, everything new carries that “most” quality, especially when you take the temporality out of things and look at them on a plane. I think when I first proposed the idea that we take a more plastic view of death than what was traditionally accepted, it took us right to the brink. It’s a tough concept to embrace medically, but from a business perspective, it’s just right there. There’s that synergy I mentioned earlier.
Q: Let’s flesh that out a little bit. I’m familiar with your work and I know you've refused to name this program out respect for its gravitas, but I wonder if you could…
[I know I’m walking a fine line here. Asking Barnes to explain here could set the wrong tone, so I use the hum of vagary and a begging gesture to elicit a response.]
GB: I want to be precise in the concept but vague in the details. What I’m about to describe is the foundation of our institutional practice. But first, let me ask you this, “What is death?” Did you imagine a clinical sort of death, cessation of breathing, heartbeat, brain activity? What if you were running a business? If a person stopped doing business with your company, wouldn't you consider that relationship dead? If the business collapsed, bankrupt, isn't it dead?
I’m asking you to consider these questions because their answers are essential to understanding this point. The synergy between medicine and business lies directly in the intersections of your answers to these questions. We've taken the brave step and applied those answers.
We have both a doctor/patient relationship and business/client relationship with each case in our facility. Each side of that relationship supports the other. There’s a balance there, of course, we explore the limits of that balance. That’s what I mean by a plastic definition of death-- how far can one side lean to support the other. I think to carry that out further would be flirting with vulgarity.
Q: Well… the hour grows late. I hope your schedule doesn't preclude another meeting. I've read your journal article, “Abbreviated Digestion, a Solution for Institutional Foodservice”. It would make a fascinating roundtable discussion.

[Barnes is clearly exhausted. He nods, and we stand to shake hands. I stood for several minutes after he left studying the little mockingbird bathing outside the window. If it doesn't rain soon, even that water will be too hot for its delicate feet.]

After this interview, Mr. Barnes contacted me with a request. He asked that I hold off on publishing the interview for a few months. The fact that he gave no reason for this request piqued my interest. I didn't make any further inquiries and indulged us both with the delay in publication.

Saturday, November 30, 2013

"Knots" a short story from the institution


“Step up, heels to the line.”
The smartly uniformed guard ordered through a broad mustache that vibrated in sync with his speech like baleen. His soft kind eyes made it hard for Billy to do anything but oblige him.  Billy stood in front of the lectern and waited for his next instruction. In the quiet, he remembered that he had been here, in this place, long enough to forget a different reality.  His canvas shoes lifted a fleck of paint from the yellow line drawn across the polished concrete as he did his best to appear compliant.
From behind the guard, Sergeant pushed open the double doors with the weight of his rank. A great blast of air sent the little yellow paint chip skittering across the floor. Sergeant glanced at Billy, and then dropped the weight of his thick hands onto the guard’s shoulders.  His mustache quivered as he recoiled from the unexpected blow. 
Billy reflexively winced at the sound, and both uniformed men raised their eyes to him in unison, appraising the nature of his breach. He shuffled inside his loose fitting elastic strapped shoes as the older convicts had taught him. Sensing the release of tension from the prisoner, Sergeant once again focused his attention to the guard. After muttering a few words, he left through the double doors behind him, deliberately avoiding Billy’s eyes. 
“Sergeant has informed me that your height and general physique has been spuriously recorded and that a correction must be made to the record.” 
The guard leaned closed to Billy and eyed him from top to bottom, as if he were trying to estimate his height. 
“Turn sideways.”  He ordered sharply, causing Billy to pivot ninety degrees.  “Hmm,” he considered the prisoner carefully.  “I see the nature of Sergeant’s dilemma.”  He chuckled a bit before bringing himself back into line, considering the gravity of the task. 
Billy turned back to face the guard.  “I've just been to the nurse this afternoon.” 
“Yes, that’s all right, but you see we've gotten into a bit of a scrape with the accounting department and well…”
“I don’t see what that has to do with me, considering I’m to be hanged today.” Billy replied.
“And hanged you will be!” the guard answered enthusiastically. 
The guard turned his attention to the ledger in front of him and made a few hesitant marks with his pencil.  He glanced up at the prisoner and back to the ledger.  Billy shuffled again inside his shoes. 
“I suppose there’s no harm in telling you now.”  The guard smiled broadly behind his rows of bristling whiskers. “We take your height and divide it by a figure, give or take a little for your vigor.”
Billy looked up at the guard quizzically. “I’m just here for the hanging, sir.”  He did his best to look small. 
“Of course you are. I’m sorry to bother you with all this clerical business; I should have known it’d be of no interest to you.” The guard closed the ledger and smiled.
Billy shuffled again and another fleck of paint skittered across the floor like a tiny haphazard point of sunlight cast through pinhole in the ceiling then cut off by a passing bird. 
Sergeant burst through the door again with a great flourish.  He opened the ledger and glanced at the last entry.  “He’s still too short.”
Billy cleared his throat, “Excuse me sirs?  Might I inquire as to the nature of your difficulty?”
Sergeant and the guard glanced at each other, and a brief discussion ensued in hushed voices.  The only sound Billy could hear was the bristling of the guard’s mustache.  Sergeant looked up and nodded to the guard who folded his hands in front of him before speaking.
“You see, we’re a long drop state, which means that instead of just pulling you up by your pretty little neck, then having a smoke while you dangle and strangle, we make every effort to see your suffering reduced by attempting to snap your neck with the correct fall, calculated by your height—which I’m afraid is wrong.”
“How do you mean it’s wrong?”
“For the calculation, don’t you see?”  Sergeant interjected. 
“I’m sorry sir, how could I be the wrong height for your calculation?”  Billy asked pleadingly.
 “What the guard means, is that we need to correct your height in the ledger, so our calculations are correct.”  Sergeant restated the point. 
            A wave of understanding washed over Billy as he suddenly understood the predicament.  Episodes from his life twinkled in his head, and he began to laugh, starting first as a chuckle, and then building into great heaves of laughter that shook his bones and echoed off the concrete block walls.
            “You only have one rope.  You bastards only have one rope.”  Billy spat through peals of laughter.  

Wednesday, October 23, 2013

The humidity has abated, the neck is true, and the tubes are warm-- off standby.