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Thomas Jefferson said that given the choice between government without newspapers and newspapers without government, he would choose to have newspapers.

In medicine we have government without newspapers. Patients cannot find out what they need to know to make informed choices. No one in medicine records or reports the information patients need to know the most. So patients will have to.


Rough Draft / Under Construction

Growing up with Ted for a brother enabled Aaron in later years to understand himself and other injured patients that he might not have otherwise. When he first recognized it in himself, he assumed it must be a family thing. But when he saw it in others, he realized that something he had assumed to be rare if not idiosyncratic to his brother is latent in many people. It just takes a tragedy of great enough proportions, possibly along with the possibility of its happening again, to bring it out.

When Aaron had been born, the first thing his mother worried about when she discovered he was a boy was how she could be a better mother-in-law than her mother-in-law was. When he was four she had begun a hope chest for him to begin paving the way for his future family. By the time Ted was four years old, her concerns for Ted were different. She was worried about how any woman would be able to live with him. He was not people oriented. He was object oriented to the exclusion of people. His father didn't see that. His father was too busy being amazed at how mechanical and imaginative his youngest son was.

Being mechanical wasn't something of which one would be especially proud in their circles. Showing leadership potential and management skills elicited smiles among a wider group of adults. A child who knew the ticker symbols of a few stocks is what made people nod approvingly. Being able to fix a lawnmower was nice, but did you want your child to grow up to be a mechanic?

Ted's parents smiled at his mechanical abilities because his interest was not in the mechanical things except in so far as they were useful to achieving some a goal. When Ted was eleven he turned their wagon into a piece of earth moving equipment not because he was interested in creating machines. He did it because he wanted to move earth. On a class field trip he had visited Fort Ancient and seen the work of the mound builders. After that, when their Dad came home from work but could not get his car in the garage because Ted was working building yet another project in it, it was nothing new. When their Dad saw his lawnmower engine mounted on his children's wagon, he did not worry about how he was going to mow the lawn. He laughed. He was so amazed that a child of his could do that. When he asked Ted what he was going to do with it and heard the explanation, his only question was, "Where are you going to do that?"

"On the other side of the tomatoes."

This was a story he would tell to people at work who would not know how to take it. They would not entirely believe it was true, not just because it seemed a stretch for an eleven-year-old to be able to do that, but also because they did not understand how a father would not be more concerned about the safety aspects. But he wasn't. His sons had never had a serious mishap. They had never made an emergency run to Children's Hospital and it did not occur to him that they ever would (and did not occur to him that part of the reason they never had was his wife's disinclination to expose their children to healthcare even when a normal person would have). He had faith in them to be smart enough not to get hurt.

Actually, in their experience, Aaron was more likely to get hurt playing soccer with the other kids. Ted by himself in their garage didn't complain and didn't stop even when he was bleeding. Drilling holes in their wagon and doing test digs in the field next door he was too absorbed in his project to care about discomfort. During the test digs he discovered how little structural rigidity there was in the steel of the wagon, and returned to the garage to remedy that by bracing it with angle iron. His mother wondered if there ever would be room for people in his life.

His father said, "So you're building a steam shovel?" Ted was surprised that his father didn't know what a backhoe was and explained that this was more like that than a steam shovel. What used to be the family spade was scooping back toward the wagon.

It took about a week and a half for Ted finally to get it working. When he did, he got a neighborhood friend to sit on the front of it with him to help weigh it down so that it would not lift itself off the ground when its scoop met hard Ohio clay. A twenty-year old with a shovel could have moved earth faster, but Ted wasn't twenty and couldn't. Besides, Ted would have found that boring. Even the friend enlisted merely to sit to add weight to it found this interesting. In a day they managed to lay out about of third of Ted's plan for the field. He was going to take over the entire field except for the tomatoes. They had moved very little earth, but had scored the surface where they were going to dig and left a dusting of earth on the places where there were going to be mounds. When his parents saw it, they were faced with a dilemma.

Ted never needed to learn what his parents referred to as stick-to-it-iveness as long as no one told him what to do. But you could not tell him what to do. It was almost impossible to steer his interests. When he got interested in something, it seemed there was nothing else in the world for him other than the focus of his interest. He had showed an interest in music. They got him piano lessons, but they could not get him to practice the lessons. They told him to sit at the piano with the music in front of him, which he did without argument, but he would not work on the assigned music. He would look at it and play a few notes from it and then go off pounding out notes that were not assigned. It frustrated his teacher to the point that she would have refused to teach him anymore if she hadn't had empty spots in her schedule, and if he weren't getting better. It's not that he did not learn. And not that he would not sit at the piano for as long as he had been told to. But he could not be channeled to the assignments. As long as you let him play what he wanted, he would sit at that piano for hours. The problem was not getting him to stick to something. The problem was what he would stick to.

When their parents saw the field, his parents knew that if it took till Christmas, this is where their son would be every hour that he was allowed to be until this was completed. That was the problem. If he were like a normal eleven-year-old and could be counted on to lose interest or meet an obstacle that was discouraging, they would have had to do nothing but wait until this phase passed. Ted's phases passed when his visions were brought to fruition. Since they did not own this field this was a problem. This was a scale of alteration that owner of the field and the neighbors and perhaps even the zoning commission could care about.

He took it hard when they explained that to him. During the next days he had many questions about just what this zoning commission was. He dismantled his backhoe, for the most part anyway, with sections of it getting thrown on a scrap heap no adult had yet seen on the other side of a privacy fence. He called the library and talked to friends and asked his parents. He was looking for a loophole. The neighbors and the owner of the field were entities with which he believed an arrangement could be made, but this zoning commission was an anomaly. The only thing he knew about it was that it had let Dr. Smith have an antenna.

So a few weeks later their youngest son was welding a tower in their backyard. If Dr. Smith could have one, why couldn't he? "But where did that steel come from?" his father asked. Other than the rebar that had been delivered by a building supply? His parents were shown the scrap heap for the first time. He did not call it a scrap heap. It was raw materials to him. Angle iron and sheet metal and pieces of pipe scavenged from dumpsters at building sites. He had read about welding and figured he could do it. He had visited an equipment rental company and discovered they wouldn't rent to a child, but that they did deliver. He called them up and, when they arrived to drop off the welding equipment and asked if his father was home, he said No, but that he had the money and could sign for it.

When his father came home from work, his eleven year old son was 30 feet in the air welding a joint. During the preceding days he had witnessed the preparations for this project without imagining it would turn into this. He had seen what he thought were stakes in the ground, like stakes marking a construction site, without understanding that they were seven feet long with only one foot showing above ground. He had asked Ted what the stepladder was for and had been told that it was for driving the stakes and thought only that he didn't understand why a stepladder was needed for that, but he often didn't understand at first what Ted tried to explain. He assumed that in time he might understand.

A neighbor who came to see the tower pointed that out. Ted explained how deep into the ground the rebar was pounded. He'd walked down the step ladder as the rebar got further in the ground until there was only a foot of sticking up. So each of the twelve legs of the tower was welded to a piece of rebar that was driven six feet into the ground. Since it was nine feet in diameter, and since Ted had read in their encyclopedia that the base of something freestanding should be a third of its height, he knew that with no foundation this would be safe to a height of twenty-seven feet. In order to go higher, he had driven the rebar in the ground and thought that this could be at least as high as Dr. Smith's antenna. He didn't know why ninety feet would not be okay. The neighbor was skeptical. Ted's father smiled and worried and half laughed simultaneously, but agreed that it probably would need better foundations. He admired the energy and the research, but was looking for a way out of Ted's proceeding. Work halted for several days as Ted went to the branch library to read about foundations. It was a library more tuned to fiction and didn't have much written on foundations. Although they did have architectural magazines which became a new passion for him.

Watching him doggedly try to learn what he needed to know about foundations worried his mother. Even if he figured out the foundations, the idea of her eleven-year-old hauling an acetylene tank thirty feet in the air with a block and tackle tied to a steel contraption he'd built himself was something she could not watch. She persuaded him that the structure just wasn't in keeping with this neighborhood. Eventually he took it down.

But word of it traveled to church and to school. The eleven-year-old who knew how to get an equipment company to rent him a torch, and then whose innate understanding of engineering was good enough that his tower was stable enough to hold his weight as he climbed it and hauled tools up it while working on it. And now his fascination with architectural magazines. Everyone assumed he was going to be an important architect. He might have too if, at the age of twenty, mentally he still had been in the same place that he had been when he was eleven. But he wasn't.

By the time he was in college, the Southern California Institute of Architecture, studying to be an architect, he longer was interested in structures that could be built. He had gone to SCI-Arc in part because Charles Moore was there, but soon Ted had moved on from the philosophical underpinnings that brought him there. He still got into discussions with Moore, but he was not doing the assignments. Assignments were departure points, like sheet music had been. Perhaps his designs could be built someday, but not now, not with current materials and current engineering. Perplexed at his professors lack of appreciation for, or interest in, what he tried to explain, he resorted to building models of his work. They were works of art that should have been collected as such, but he didn't care about them once they were finished and did not take care of them.

When his professors saw his models, they offered him a position teaching model building to their architecture students. They believed their school could distinguish itself by graduating architects with model building skills that separated them from the rest of the field. They would give him faculty status. That would mean free tuition as he finished his degree. Excitedly he called his parents to tell them about the accolade. Since hope springs eternal, his parents thought that at long last he might have plugged into something stabile with a future in it, but he never signed on the dotted line. He was on to another idea. The job offer was left in limbo where it was forgotten. When you have enough money, offers like that are flattering, but they are limiting. Someone without enough money would find it the reverse as they no longer would have to deliver pizzas, but instead could work in the field they were studying. Ted wasn't delivering pizzas. He did not have money problems to bring him back to earth. He lived in a conceptual world imagining the way buildings should be. Teaching model building would have been dealing with the way things are, not the way they could be, and it just did not get his attention.

The facilities of the university had been too limiting for the models he wanted to build. He had rented warehouse space off campus and filled it with tools. Professors had visited him there when his creations were too big to move. He spent less time at school. They admired his work but didn't know what to make of him. They gave him longer and longer extensions. Finally he took leaves of absence. His mother felt sadness at his isolation and disconnection from the people and things here in this world.

And then he met a woman. And then he married her. And then she turned out to be a woman who understood him. He married a woman who, without complaining, brought sandwiches to the floor of his shop when she gave up trying to get him to come home to dinner. She understood his devotion to his work. She did not expect him to come home at six each night for dinner, or at bedtime to sleep. If he still had not rolled in by the time she was waking up the next morning, she did not worry. She took breakfast to him because she knew he wasn't going to take a break to get food for himself. She put together something for him to eat and then watched him eat it, sometimes as he stood on his shop floor, not even willing to stop working long enough to walk to where there was a chair in which to sit while eating. She would stand with him as he ate without eating herself. He never thought about that. Although his mother did.

"So she eats with you at your shop?"

"Yeah. Er, no. I mean, she brings food."

"She doesn't eat it with you?"

"Yes. I think so. Sometimes. Well, maybe not."

"Does she eat at home?"

"I guess so. Why?"

"She's so thin."

"She's a model."

Worried though she might be, his mom had to be happy for how his wife connected him to other human beings. They lived in a community that understood creative talent. It was a community that contained many people working at artistic things in the hope that those things would change the world or make them famous or make them rich someday. Like their composer friend who constantly was writing scores for the pilots for new television shows. It took getting only one on the air to make you financially secure. But there were lots of talented people competing for that work. When they got it, the pilot had to get on the air and succeed. The odds were very poor. But they were talented and passionate and understood other people like that. Their community not only recognized Ted's genius, but also had a special respect for his absence of thoughts about financial gain. Aaron's parent's secretly were dismayed about it, but they knew that eventually Ted would inherit enough to survive, and he probably had enough to keep afloat until then. They inferred that they would help him if at anytime he wanted to have children. They would not let him starve. They especially would not let their grandchildren starve.

They had begun telling him that before he even had met his wife. He too wanted to be married and to have children, but he didn't have a normal social life. He did have girlfriends a few times and did have a few other friends, friends who tended to be like him, absorbed in some creative endeavor that probably was going to be the end of them someday. But not being focused on people didn't work for his girlfriends. When they would want him to pay attention to them, for instance out at dinner in a restaurant on a Friday night, they once again would find that he wasn't listening to them. As they were speaking he would interrupt to ask the server for a pencil, and perhaps an old receipt to write on the back of, and then sketch something he had thought of. He would apologize and say he wasn't ignoring her, but he'd just thought of something he had to put down on paper. It did not work for girlfriends that he was not focused on people even when he was in love with them and they were sitting across the table from him.

There was only one time in Ted's life that he looked at a human being really saw her. Tellingly, it had been when he was looking through an equipment catalogue. He saw Miss Porter Cable holding a pipe threading tool and stared at that page for a long time.

A friend of his, Alan, was a starving filmmaker who was trying to get Ted to build sets for him. That's why Alan was Ted's friend. He made short films that he entered in festivals where no one understood them. His next film was to be set in a fairytale land. He wanted Ted to build the sets. He believed Ted could make sets that would be unrivaled in the no-budget world. Alan could make films with no-budget because he knew how to persuade people. He invited Ted over to a party with members of the cast and crew most of whom were regulars on his films. There was a cast member who was new to the group and just meeting everyone, a model who infrequently got work but who had been persuaded that this might help her career. When Ted saw her on the other side of the room he said, "That's Miss Porter Cable." His friend said, "Sunny. Come here," and introduced them knowing how to get Ted to build the sets.

"Are you constantly approached by people who ask you to come back to their place so they can photograph you?"
"That happens."
"Has anyone ever asked you to come back to his place so he could sculpt you?"

Within two days Sunny was modeling for him. As she saw him sculpting her, as she watched herself being recreated in art, as she felt the depth of his focus and vision, she felt the attention she always had wanted. She was an attention seeker. She liked being looked at. She liked getting a response from men. She liked seeing her photo in magazines. She liked that men would be looking at her there. But all of that was done out of a hunger for something that never was satisfied. It was like cooking without eating. Modeling for Ted was like eating. Before the sculpture was finished they got married. He never focused on a human being that way again, including her, but whereas Ted's mother mourned the end of the poetry when Ted's father stopped focusing on her like that, Miss Porter Cable knew she was the only one who ever had inspired Ted in this way. When she first had been at his shop and first had seen his sketches and seen his home, she saw no evidence of other human beings. She had asked if he still had the magazine with the picture of her. If it had been lying open on his desk, she might have worried that he was a stalker. But it was filed in order with other equipment magazines. When he sheepishly put his hand on it, knowing exactly where it was, and pulled the magazine out for her, she felt as though she had been loved at first site.

After having been the center of his creative attention for that project, she had an intimate knowledge of how his mind worked. After they were married, when she went to his shop to feed him and he didn't really see her anymore, she understood that his focus was on something abstract that he was not able to bring to physical reality to show other people. All she wanted to do was be part of his life until he worked it out. She knew that his world had been expanded by her.

They discussed when to have children. They wanted children like all people want children. And they had started trying to have them. But when children did not come, they did not visit fertility clinics for help. She talked to friends about it. She read about it some. When she brought food to him on the floor of his shop, and stood watching him eat without eating herself, she did not say that she had an inkling that she might be too anorexic to get pregnant. She steered the discussion away from solutions others had suggested. Like visiting a fertility clinic. That could result in someone questioning her eating habits. People in denial about addictions and disorders often steer around solutions that would make them face their problems. Ted's not focusing on her kept him from seeing this about her. So his not focusing on her worked for her. He was never going to make her face her problem. He was never going to find fault with her. His vision of her was frozen in the perfection he had seen while sculpting her.

Ted's mom saw that. She laid awake nights wondering what she could do to help. They lived so far away. Neither of them were likely to be influenced in a way that could solve this. She tried talking to Ted about it. He defended Sunny with a description of the feast she had brought to the shop so that for once he and Frank could have lunch where they could spread out and sketch and stand as they ate and talked. If not for this conversation with him his mother never would have learned that her son had lunch with Frank Gehry from time to time and that they talked for hours about architecture. Ted had not taken accepted the job as model-building-teaching at the university, but when the university was asked by Gehry if they knew of any model builders more creative than the ones he had been able to find, they said, "Yes." Ted took that work and built three models for him, not for the money, because no matter what they paid, he was going to put so many hours into it would not be worth it for the money. He took it because Frank Gehry had invited him to talk and look over plans with him in order to get the models he wanted. They had talked for hours. After that they began meeting to analyze a model or look over plans or sometimes just to go to lunch. Lunch always had been in restaurants until this last time. They were opposites in some respects. For Gehry architecture was about the activity, the work, the process, the interface between the workmen and their tools, the CAD drawings and the people. For Ted it was the next idea, the solution of which no one had thought, the advancement that would change the world. Gehry turned a profit on every project he built and always came in on budget and on time - rare among architects. Ted worked on projects that had not been commissioned and could not be built.

"In your shop? Did you stand?" asked his mother about the lunch.

No. Ted had built a table. "Of course," his mother thought. "What else would Ted have done? Nothing purchased would have crossed his mind." Previous lunches with "Frank" bumped into limits imposed by politeness in restaurants and settings designed for purposes other than nurturing thought. Two days before the lunch, Sunny told him the kinds of things from which she was going to extemporize the menu. Ted worked straight through to build a table to fit the menu and the conversation. It was birch and steel designed to bring the two into close proximity over food with expansive side boards wrapping around each of them to hold sketchpads, photographs, books, and whatever else they wanted to have within reach to augment their conversation. Scandinavian in profile but Picasso from an aerial view - six hours to design and twenty to build. Hooked straps hanging from rafters to hold architectural models in the air above them, models of structures that could not be built except as models. Zaha Hadid sketches hanging in the background.

Interestingly, the things that caught Gehry's eye were the hand tools laying around. They were ones Ted had built for himself based on the designs Aaron had come up with for the five-year-old. Gehry was knocked out by them and talked of nothing else. Ted told his mom that he had been completely off track with how he set up that lunch. Of course, Frank would be more interested in the tools than all the rest. Next time he was going to surround them with nothing but the tools already in the his shop, which, he explained, when you know Gehry, is probably why he wanted to eat in Ted's shop in the first place, to be immersed in the tools and the materials, not sketches and prototypes. -

His mother resigned herself to the fact that Aaron was her only hope for grandchildren.

Next Chapter

Medical Novel Table of Contents

Persons, places, events, and situations in this story are purely fictional.
Any resemblance to actual persons, living or dead, is coincidental.

Rough Draft / Under Construction


Home | Table of Contents | It's a Path
Silence versus Patient Safety
Loyalty versus Patient Safety
The White Wall of Silence versus Patient Safety
Blacklisting Patients
Freedom of Speech for Patients
Medical Complaints - How to

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It's a path

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