Search Results for: Medicine

How Much is Too Much to Save a Dying Cat?

Max Oppenheim/Getty

s.e. smith | Longreads | November 2017 | 17 minutes (4,363 words)

The veterinarian looks anxious as she enters the room, clearly dreading the conversation she must have many times a night on the late shift at the emergency clinic.

Yes, your pet is dying. No, I’m afraid there’s not much we can do, she is bracing herself to say.

Her scrubs are a rich maroon, coordinating with the jewel-toned surroundings of the hushed exam room in the swanky clinic. Thick doors block the sound from outside, the interstitial space where they’ve left me alone in an echoing silence with a grim steel table and a box of tissues after the technician rushed my cat to the back, somewhere in the bowels of the hospital. The last time I saw her she was gasping for air, eyes huge, expression: betrayed.

I wonder if I will see her again.

It’s the largest veterinary clinic I’ve ever been in and it feels more like a spa, down to the powder blue polo shirts the receptionists all wear. The stack of euthanasia authorizations left out on the counter are the only sign this place is perhaps not what it seems. I have driven a long way to come here, because it is Easter weekend and my vet isn’t in the office, but this cannot wait.

Oddly, I find myself wanting to reassure the vet, to tuck her loose strand of hair behind her ear and offer her a cup of tea from the space-age machine out in the horrifically depressing lobby, filled with people sitting in little clumps with strained faces.

“I know,” I say as she sits opposite me, searching for words, and her shoulders slump in relief. “I knew the cancer would spread eventually, but is there anything we can do to make her comfortable?”

On my way in, struggling with the weight of my cat’s carrier and my bag, I passed a couple carrying one of those cardboard boxes they use to send cats home from the shelter, the takeout container that is supposed to presage many years of happy life together, cartoon kittens and puppies stenciled along the sides. It swung with a peculiar, empty lightness, bouncing in an almost sprightly way that felt at odds with the stricken looks on their faces.

There is a stark finality in the empty cat carrier.

You can take this, your cat won’t be needing it anymore.

Read more…

What Makes a Disability Undesirable?

(Ton Koene / VWPics via AP Images)

Who gets to decide if a disability is bad? This is one of the fundamental questions raised by a recent STAT feature on the genetic testing of embryos, which also looks at how that decision is reached. Andrew Joseph follows two women who knowingly pursue a pregnancy with an embryo that has a mutation that would put their child at a higher risk for certain cancers. It was the only viable embryo the couple had, so if they wanted a baby they didn’t have much of a choice.

Read more…

“No Fatties”: When Health Care Hurts

Illustration by Hannah Perry

Carey Purcell  |  Longreads  |  October 2017  | 4280 words (16 minutes)

Kasey Smith began gaining weight as a teenager. The numbers on the scale started increasing overnight, and no matter how few calories she consumed, they continued to go up. “It will even out,” she thought, crediting the change to puberty and hormones. But it didn’t, and her hair and skin began changing as well. “Something was definitely wrong.”

Each medical appointment, and there were many, concluded with doctors telling her to go on a diet. Smith (not her real name) remembers telling the endocrinologist about her frustrations with burning off the 900 calories she consumed each day and still gaining weight. “He looked at me and said, ‘Maybe you can cut back your McDonald’s to twice a week.’ I was stunned silent, and I went into the bathroom and broke down. ‘He doesn’t believe me. He thinks I’m just fucking with him.’”

As Smith’s weight went up, her food intake went down. Her mother signed her up for Nutrisystem, and her diet hung on the fridge for everyone in her family to see. Shame and humiliation narrowed her life down to three questions: what to eat, what not to eat, and how to burn more calories. She began to form dangerous habits, sometimes eating little more than lettuce.

Smith ultimately received a diagnosis of polycystic ovary syndrome, a hormonal disorder that can lead to excess male hormones, irregular menstrual cycles, and weight gain. She was prescribed Metformin and quickly began to lose weight, but the damage had been done. The 18-year-old developed anorexia, leaving for college at 130 pounds and coming back four months later and 30 pounds lighter, her hair falling out in clumps.

No one thought anything was wrong.

“I would go to the doctor, and there were no red flags. It was ‘You look fantastic!’ Not ‘This is alarming.’” Smith continued starving herself for another year until she ended up in the hospital, undergoing a colectomy to remove a foot and a half of her intestines, which had twisted as a result of her severe calorie restriction.

One year after the surgery, her worst nightmare returned: She was gaining weight. Celiac disease was the cause this time, but it wasn’t diagnosed until after Smith was in the habit of purging the little food she ate every day. She would regularly run in the park and pass out afterward. “I would starve all day, then I’d eat something at night, then I would purge it. In my head, I’m thinking, ‘I’m literally not consuming anything. The weight has to fall off.’”

She realized she needed professional help, and Smith found a therapist who specialized in eating disorders and began treatment at The Renfrew Center, a residential facility in Pennsylvania. She continues to struggle with discussing her weight at medical appointments. After she told her endocrinologist about her treatment at Renfrew, his reply was “I see you need to lose some weight.”

* * *

According to the National Association to Advance Fat Acceptance, one out of three doctors responds to obesity negatively and associates it with poor hygiene, hostility, dishonesty, and noncompliance, viewing fat patients as “lazy, lacking in self-control, non-compliant, unintelligent, weak-willed and dishonest.”

“Doctors may think they are doing their jobs by focusing on patients’ weights,” said Dr. Rebecca Puhl, deputy director of the Rudd Center for Food Policy and Obesity. But the effects of weight discrimination, both physical and mental, can be harmful to patients. “I do see this in health providers just as much as the general population, which is that maybe stigma isn’t such a bad thing. Maybe it will motivate people to lose weight. Maybe it will provide incentives for weight loss. But that is not what we see in research. We see the opposite — that in fact, stigmatizing people about their weight actually reinforces behaviors in health that increase body weight and obesity.”

The doctor looked at me and said, ‘Maybe you can cut back your McDonald’s to twice a week.’

As weight discrimination has increased in recent years — roughly 40 percent of adults report having experienced some form of weight stigma — so have obesity rates. A positive correlation between experiencing weight bias and developing eating disorders has been documented, and two studies have reported that overweight children are more likely to binge after being teased about their weight. Nor do these habits change as we age. In a 2006 study of more than 2,000 overweight and obese women who were part of a weight loss support group, 79 percent said they turned to food after experiencing weight stigma. Another common response: refusing to diet.

Johanna Tan encountered that stigma when she gained 80 pounds in three months after beginning the hormonal birth control Depo-Provera. Her doctor suggested weight loss, and she chose a weight loss clinic. In the weeks after undergoing her doctor-mediated diet of 500 to 800 calories a day, Tan began experiencing episodes of chest pain so severe she made more than one trip to the emergency room. Her general practitioner blamed her symptoms on her large breasts. “Never mind that my boobs have always been this big, and this was a new symptom,” Tan said, laughing wryly as she explained she had been performing special exercises and getting massage treatments to help ease the symptoms. But it wasn’t her breasts that were causing the pain, it was her gallbladder. Gallstones had blocked her common bile duct, and if left untreated it could cause acute liver failure. The cause of the gallstones? Rapid weight loss. Neither Tan’s weight gain nor her loss had been correctly assessed by her doctors. (Depo-Provera lists weight gain as a common side effect. When Tan voiced concerns to one doctor, she was told, “Everyone gets more hungry. You just need to not eat more.”)

The assumption that any health issues a fat person experiences can be chalked up to weight has not gone unnoticed by the fat community. Marilyn Wann was motivated to pursue fat activism after what she describes as her Really Bad Day, when a man she was dating told her he was embarrassed to introduce her to his friends because of her weight, and she was denied health insurance because Blue Shield of California deemed her morbidly obese.

“This double whammy of social and institutional exclusion based on my weight woke me up,” she said. “Until then, I had hoped to avoid the impact of anti-fat attitudes by avoiding the whole topic. But hiding and silence and avoidance didn’t keep the yuck from finding me. So I recognized that I had to come out as a fat person. The next day, I went to a copy store and made up business cards for my new print zine, which I decided to call FAT!SO? — ‘For People Who Don’t Apologize for Their Size!’ Immediately, my life became less stressful. Of course, I still encounter anti-fat attitudes and weight-based exclusions, but I have drawn a line between me and the hatefulness. It makes a huge difference.”

Wann still experiences bias, especially at the doctor. “I know before I enter the door that the whole system prioritizes its prejudice over my well-being,” she said. “The prejudice is what’s necessary to the institution as it stands. The medical establishment, the insurance agencies, public health agencies that are government-based have always advanced their agenda on the back of fat people. … The institutions of our supposed health systems — in the government agencies, in the insurance companies, in all of the medical practices — are saturated or have deeply ingrained anti-fat bigotry.”

Establishing the balance of information and compassion while discussing a patient’s weight is constantly on Rebecca Zuckerman’s mind. “It puts medical professionals in a weird catch-22,” said Zuckerman, a fourth-year medical student at the Pritzker School of Medicine at the University of Chicago, who understands the motivation of fat activists but whose education includes the negative medical impacts of obesity. “It’s something I’ve struggled with personally. You can only explain it and tell people their options. You can ask if it’s OK to talk about weight loss or give more information. If they say, ‘No, I don’t want to hear it,’ you have to respect that.”

Still, the intense schedule of medical professionals, who are often allotted only 15 to 20 minutes per patient, often results in less-than-ideal communication. It’s easier to reach for the quickest conclusion: telling the patient to lose weight. Says Zuckerman, “A lot of doctors and nurses experience burnout, and they start losing empathy and don’t view the patients as people anymore. Your hands are tied to stay within those 20 minutes. Everyone’s trying to make more money, and the doctors are a cog in the wheel.”

That’s along with pervasive stereotyping about fat people in the medical community. In a study of 318 family physicians, two-thirds reported that their obese patients lacked self-control, and 39 percent stated that their obese patients were lazy. Even health care professionals specializing in nutrition thought poorly of their obese patients: “Attitudes toward obesity and the obese among professionals,” a study in the Journal of the American Dietetic Association, reports that 87 percent of health care professionals specializing in nutrition believe that obese persons are indulgent, 74 percent believe that they have family problems, and 32 percent believe that they lack willpower. In 2013, the American Medical Association labeled obesity a disease.

The misdiagnoses that occur lead directly to poor health outcomes. Johanna Tan ultimately spent three years in pain, leading to four weeks of hospitalization, a series of invasive surgical procedures, and lengthy rehab — procedures that wouldn’t have been necessary had the gallstones been caught earlier. While she was enduring severe pain following her first surgery and struggling to complete her postsurgical rehab, the hospital staff accused her of being lazy. “I spent two weeks in hospital post-surgery,” she said, “copping abuse for being lazy and not participating in my own rehab, before they realized they fucked up.” Tan said the nurses were condescending, saying, “I know it hurts. It’s major surgery. You still have to get up.” The pain didn’t ease until her doctors realized they had missed some gallstones and had to perform a second surgery. Tan wasn’t able to walk more than 10 feet at a time for the first month following her surgeries. It took six months for her to be able to walk further than a block.

* * *

Fat patients also often find themselves facing off with doctors who refuse to write prescriptions or referrals until patients lose an arbitrary amount of weight, a common scenario for those seeking joint replacement surgery. Despite being in “crazy amounts of pain,” Melinda Belles-Preston was required to lose 30 pounds before receiving an operation on her hips. Losing between one and two pounds a week, a healthy pace according to the Centers for Disease Control, would delay her surgery by several months. Heavier patients see longer lags. A required loss of 50 to 100 pounds can postpone a procedure for months or even years unless the patient undergoes weight loss surgery. Without surgery, the time spent in pain is prolonged, opening the door to painkiller dependence. It took Belles-Preston roughly six months to lose the weight, and she was in pain the entire time.

“Going in nutrient-deprived and starved is probably not a good way to send someone into heart surgery or major any surgery,” Wann said; her tone made it clear she was stating what she thought should be obvious. “Someone who’s been losing weight may have worse outcomes than someone who’s stayed the same weight. … It’s amazing how someone can just look at you and decide how a random number of pounds can shift you from someone who doesn’t deserve care to someone who does.”

Pain management was barely discussed when Virgie Tovar, activist and author of Hot & Heavy: Fierce Fat Girls on Life, Love & Fashion, went to the doctor after being injured on an amusement park ride. Suffering what she described as “debilitating back spasms” that made movement “electrifyingly painful,” she was told she had to lose weight before anything could be done for her. “It was like this dogged commitment to not helping me until I was at a different weight,” she recalled. “Let’s say I lose weight at what is considered a normal pace that doesn’t endanger a person’s life. For me to get to the weight you’re talking about is like 10 years. So I just get to be in pain until I’m at that weight. And if I’m still in pain after a decade of weight loss, then you’ll think about taking care of this?”

Ideally, preventive care helps patients avoid catastrophic health problems, but it’s not always accessible to fat patients, whether because of issues with doctors, issues with technology, or both. Fat patients have been refused medical screenings, such as Pap smears, mammograms, and colonoscopies, that are considered routine and vital for thin patients. The American Cancer Society advises women to get mammograms yearly beginning at age 45 and colonoscopies every 10 years beginning at age 50, but fat people often struggle to find facilities that will perform the screenings and are told they cannot fit in the machines.

A required loss of 50 to 100 pounds can postpone a procedure for months or even years… It took Belles-Preston roughly six months to lose the weight, and she was in pain the entire time.

The importance of an MRI comes from its ability to provide higher-quality images. But the machines that provide those images are small, and other options, like CAT scans or ultrasound, don’t provide a comparable alternative. “All those scans need to penetrate the body to create an image. If a body is larger and has more fat tissue to penetrate, the image quality is poorer and blurrier, and it’s harder to make out structures,” Zuckerman explained. “It’s harder for skilled radiologists to diagnose things in patients who are larger for that reason. … The fact is, MRI machines are tiny. Some people literally cannot fit in them. So we do something else like an ultrasound or CT that is not quite as good. It’s better than nothing, but it doesn’t give us the image quality that an MRI does. You run the risk of missing something because the picture that you’re getting is not clear.”

The need for hospital equipment that can accommodate fat people has grown, and imaging devices are now available. This equipment is not available everywhere, however, and sometimes patients are referred to their local zoos. When Wann called the San Francisco Zoo’s medical department to ask about accessing its technology, the person on the phone sighed and said, “I wish people would stop saying that,” referring to requests to use the department’s CT and MRI scanners. While vet schools and zoos have larger-capacity devices, they can’t allow human subjects, and scanning humans in machines intended for animal subjects is banned by formal policies in most facilities. “That’s really beyond their certification,” explained Wann. They’re not licensed as an institution to practice medicine on people. Their entire institutional certification is being put on the line because our human medical system refuses to accommodate people above a certain size. It draws an arbitrary line and says, ‘Go beyond this line, and they’re monsters.’”

Without being properly screened, patients can’t be diagnosed. A 2008 review of previously published studies, 32 in total, reported that white, female, obese patients were less likely to be screened for breast and cervical cancer. A study from 2006 reported that only 68 percent of women with a BMI of greater than 55 were given Pap tests, while 86 percent of other women were tested.

In some cases, this is a result of fat patients opting out of health care entirely, even if they otherwise have the ability to access health care facilities and are insured: According to the International Journal of Obesity, 19 percent of participants reported that if they felt stigmatized about their weight by their doctor, they would avoid future medical appointments, and 21 percent said they would seek a new doctor.

“Fat people don’t go to the doctor often. They tend to avoid it,” writer and activist Kitty Stryker said. “A lot of fat people are ashamed of being naked. They don’t want to be touched. When I say I have a lower-back problem, I know they’re going to say, ‘Lose some weight, and that will go away.’ So what’s the point? Why bother continuing to try to get to the root of my health problems when I know the only thing they will ever tell me is ‘Lose weight’?”


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Patients often face added risk beyond concerns of being dismissed or the necessary treatment being denied: the possibility of weight loss treatments and procedures being strenuously suggested at inopportune or irrelevant moments. While the American Academy of Family Physicians recommends screening for obesity along with monthly sessions of counseling and behavioral interventions, the timing of these suggestions is crucial to the impact of motivational interviewing — and execution is often poor. Tan was mid-Pap smear when her doctor asked if she wanted a Weight Watchers pamphlet.

“The speculum’s already in and open. And she says, ‘I can tell you’re getting upset. Do you want me to continue?’” Tan recalled in disbelief. “I said yes because I didn’t want to have to make another appointment for my Pap smear. I was so mad, I was crying at this point. I couldn’t move. I couldn’t yell. She said, ‘I can tell I’ve made you upset, but weight is a serious issue.’”

Although familiar with the prejudice that came with her weight, Belles-Preston was still shocked when her general practitioner recommended weight loss surgery — while she was pregnant. “I walked out of the room. It was so incredibly offensive to me. I’m coming to you for medical advice about my pregnancy, and you’re talking to me about weight loss surgery, which is the furthest thing from my mind.”

“I have tons of resources and attitudes for confronting this kind of stuff, and it can still kill me,” Wann said as I marveled at her calm approach to discussing prejudice so severe it can result in death. “I understand not going [to the doctor]. I think it’s self-protective to some extent.… Every time I go to any kind of medical appointment I anticipate facing weight bias. I anticipate being denied the sort of services thin people would receive with no problem or being targeted for weight-based treatments that I don’t want and could harm me. I’m not interested in stomach amputation or stomach squeezing. I don’t think those are therapeutic practices in any sense. Every time I go see a doctor I’m aware they may casually say the only thing they want me to do is have my stomach cut off.”

* * *

The effects of that bias were traumatizing and long-lasting for Tan. Triggered by her uncomfortable experiences in hospital environments, Tan’s first job as an audiologist after graduate school provoked frequent panic attacks because of its location at a hospital. “I used to have to go to work early so that I could tamp down the panic associated with being in a hospital at all,” she said. “This fear of hospitals hasn’t quite gone away. Most recently, a few months ago, we had to spend a few days in ICU as my partner’s dad passed, and just being back in ICU rattled me so badly it was a month before I could stop popping several Valium a day.”

It was the adversarial relationship she had developed with doctors and nurses that contributed to Tan’s panic. And she’s not alone. For many, thin means healthy and fat means unhealthy. So small and slender equates with good health and is encouraged by medical providers, often resulting in strained relationships with their patients.

The idea that the lower the weight, the healthier the person, escalated into life-threatening conditions for Smith, who was frequently complimented on how healthy she looked while she was starving herself. “When you’re restricting [calories] you can brag about it,” she said, recalling her preparation for the colectomy. “[Doctors] asked, ‘Are you eating well and exercising?’ I said, ‘I’m very healthy. I exercise all the time. I only eat vegetables.’ It’s a funny dichotomy. Just because the scale is low does not mean that you’re healthy. A lot of doctors forget to be careful of that.”

But as the number on the scale climbs, the less flattering characteristics — greed, lack of control, messiness, lack of self-care, laziness, automatic unhealthiness — are associated with fat people, only to be furthered by the media’s portrayal of fat characters, who are typically the butt of jokes or seen as slovenly and undesirable. Women are often the punch lines, much more than men. BMI standards also are more harsh for women than for men, which is apparent in the statistics regarding weight loss surgery: Obesity rates in America are split fifty-fifty between genders, but 80 percent of bariatric surgeries are performed on women. In a 2014 study from Kansas State University, 72.8 percent to 94 percent of overweight and obese men were satisfied with their health as compared with 56.7 percent to 85 percent of overweight and obese women. There’s a reason all the stories and sources here are about and told by women.

“The truth is that there are reasons why fit people live longer, better lives,” Tovar said. “It’s because the entire culture is constructed to benefit them.” Weight discrimination is associated with an increase in mortality risk of nearly 60 percent for both women and men.

Fat activists are working to provide recourse at the community level; patients share the names of fat-friendly doctors or establishments, and Wann uses her social networks to help people get referrals for doctors and other medical providers. She also assists people with planning responses to doctors and providers who inflict weight bias. Fat activist Stef Maruch maintains a list of doctors who do not inflict bias or are fat positive, and Wann encourages people to update it whenever they can. NAAFA also publishes brochures and tool kits to assist fat people in navigating bias and fighting anti-fat legislation. A monthly newsletter updates recipients with the latest research and provides referrals to practical tools like products made for people of size. After Hurricane Harvey devastated Texas, NAAFA released a special-edition newsletter and sent plus-size clothing and supplies.

Obesity rates in America are split fifty-fifty between genders, but 80 percent of bariatric surgeries are performed on women.

The organization has also updated the brochure it gives health care providers treating fat patients. It was last updated in 2011, and per the recommendation of one of NAAFA’s advisers, its language is being revised to be much more aggressive when discussing weight bias with medical professionals. “Up until this point we’ve been trying to inform and be a little bit gentle,” explained Peggy Howell, NAAFA’s vice chairman and public relations director, citing the research scientists, Ph.D.s, and professors in medicine, law, nutrition, social work and more who serve on NAAFA’s advisory board. “The advisers came back and said, ‘I think we need to take a different approach. I think we need to be more assertive about this. There are lots of studies that support that this bias does more harm than good to the patients.’” The nonprofit’s 2011 brochure states, “NAAFA is working to help ensure that health care providers provide the best possible care by keeping in mind the special needs of their fat patients.” The new brochure reads, “We currently live in an environment that stigmatizes anyone who does not meet the aesthetic or medically defined categories of an ‘attractive’ or ‘healthy’ weight… [it] creates and sustains fat phobia and oppression, which includes weight bias, prejudice, stigma, discrimination, bullying, violence, and cultural imperialism. … Sometimes the internalized biases of health care providers directly contribute to further stigmatization of fat people.”

There is some movement on the medical end as well, driven by health care providers seeking training and resources. The Rudd Center has developed educational videos, which have been tested and found to reduce weight bias. Viewing the two 17-minute films — “Weight Prejudice: Myths and Facts” and “Weight Bias in Health Care” — resulted in improvement in attitudes toward obese people. The Rudd Center has also created a media repository of 400-plus photos and more than 80 B-roll videos that portray children and adults with obesity in non-stigmatizing ways, intended as a resource of respectful, rather than stereotypical, images for the media as well as scientists and health professionals to use when making educational presentations.

“We’ve created online courses and all different kinds of resources to use to try to increase awareness about this issue and educate providers that this is more than a social justice issue,” Puhl said. “This is a full public health issue. The stigma is making their patients’ health worse.”

For many fat people, the response is too little, too late. “I would rather doctors have signs on their door saying, ‘I don’t treat fat people,’” Wann said. “It would save everyone time and money if they had a sign on their door that said, ‘No fatties.’ At least they would be honest and own their bias.”

***

Carey Purcell is a New-York based writer who covers culture, politics and current events from a feminist perspective. She has been published in The New York Times, Vanity Fair, Politico and other publications. She has been a featured guest on AM Joy and Good Morning America, and her writing can be read at CareyPurcell.com.

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Editor: Michelle Weber
Illustrator: Hannah Perry
Fact checker: Matt Giles
Copy-editor: Sylvia Tan

Reflections of a Lifelong Metalhead

Axel Heimken/AP Images

There are scores of pressing issues in our turbulent world, but that doesn’t mean we can’t take a moment to discuss things that might seem superfluous. For instance, heavy metal. If you grew up in the late 1980s like I did, you encountered a certain tribe of people wearing torn faded jeans and black band t-shirts who either listened to operatic bands like W.A.S.P. or truly heavy bands like Slayer. Whether it’s the Reagan era or the Trump era, death metal or grindcore, metalheads’ passion has remained undiluted across the decades, even as the music evolves. For many people, all these metal subgenres are confusing and repellent. To fans, they’re exactly the strong medicine that’s needed to get through tough times.

At March Shredness, part of an annual, themed music project, Andy Segedi looks back at his youth as a headbanger. Examining metal’s history and intertwined subgenres, Segedi reflects on what drew him to loud, dark music in the first place, looks at how the debt serious metal owes to lame “hair metal,” and makes a case for all metal.
It’s my opinion that, if you’re one of those people who maybe looks at the dark side of things, has what proudly normal people might consider a socially unacceptable sense of humor, and whose favorite songs tend to be in minor keys, then listening to Sabbath or any of the myriad styles and crossover genres it inspired is an ideal way to safely release (not cause) the accumulated angst and frustration that comes from living in this increasingly self-destructing world.
Best of all, by celebrating the broad metal category, Segedi goes beyond it: even if you don’t like Sabbath or Pantera, loving music is always essential, and bonding with strangers over your chosen tunes is one of the most powerful, joyous aspects of the human experience. Even if it involves a flaming pentagram.

A person’s discovery of music of any kind is a journey, and while for some pop music fads these journeys are relatively brief and uncomplicated (see: disco; fuck: disco), metal is not. It’s been around for almost 50 years now, its mainstream popularity fluctuating like a sine wave but never quite disappearing, just slinking away into the stygian underground to mutate as new hybrid sub-genres and styles emerge. After 50 years of this, things get messy. So unless you were lucky enough to be there at the beginning, your discovery of metal and its offshoots is bound to be just as non-linear and complicated as a particular sub-genre’s influences. Complicated, but still traceable for those who are more forensically inclined, as metal scholar Fenriz of Norwegian black metal pioneers Darkthrone shows in this earnest reconstruction of that particular genre’s lineage.

This complexity might be one reason why metal shows are so… friendly. There’s a sense of community, of comfort and relief in the air. Here, many fans whose backwards employers don’t allow them to wear rock shirts, or display piercings, or grow their hair, or otherwise express themselves in the Holy Workplace are finally among their own kind. Everyone’s there for the same reason, but they each got there a different way, and therefore offer new perspectives on the genre. While waiting in the beer line, complete strangers compare notes on whatever bands they’re repping on our t-shirts. I’m sure this happens at other types of shows, too, but it always happens at metal shows (and I’ve been to more than a few “other” shows where nobody talked to anyone outside their social circles). Anyway, these beer-line conversations almost always include “Dude, if you like [Band A], you’ve got to check out [Band B]” moments, which often lead to momentous discoveries. And momentous metal discoveries are important to explorers like me.

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“That Was the Final Straw”: On Reporting From Venezuela as It Spiraled Downward

diego looking at Caracas landscape.
Diego, who's on the verge of leaving Venezuela, was followed by reporter Christian Borys during the July protests. (Daniel Blanco)

On July 30, Venezuela’s anti-government movement quickly collapsed after a controversial, and possibly fraudulent, vote radically extended Nicolás Maduro’s presidential powers. On the ground in Caracas during those fateful days was Canadian journalist Christian Borys, whose Longreads Exclsuive about the unraveling of Venezuela’s Resistencia movement, “You Can See the Battle Scars,” came out last week. I recently chatted with Christian over email about the protests’ sobering aftermath, and the experience of reporting from a country caught in a dramatic downward spiral.

* * *

It’s been almost two months since you returned from Caracas. Have you been in touch with some of the people you met there? What are they telling you about the current state of things?

Yes, I’m in touch with someone almost every day. The weirdest part about what’s happening now is that nothing is happening. The movement against the government died the day after the big vote on July 30. It was as if everyone either gave up the fight, resigned themselves to a future under a dictatorship, and returned back to their work-life routine or got out of the country. A lot of people told me that their friends just left afterward. That was the final straw.

You’ve reported about protests and civil strife before, in places like Poland and Ukraine. How was the experience in Venezuela different for you as a journalist, and as an observer?

Venezuela is in a far more difficult situation than any other place I’ve been to. It’s devolved into one of the worst places in the world to live, and although they’ve managed to avoid any sort of massive internal armed conflict, people are struggling just to get basics. You have people picking through trash to find food, which you can certainly find in any country, but everyone we spoke to said that they’d never, ever seen that in Venezuela before. The food shortage and poverty had grown so extreme that people were forced to pick from scraps. We heard stories about women turning to prostitution to make a dollar, about how insanely difficult it is to acquire medicine if you can’t afford it, and even about the trouble of acquiring something as basic as a T-shirt if you want a new one. The prices have just gone to such extremes in relation to the wages that nothing is remotely affordable anymore.

People with access to U.S. currency can live like kings in Venezuela because the currency has fallen off a cliff, but not everyone has relatives in the U.S. who can send them dollars. It’s this slow descent into the abyss. I think it was Diego — a young man featured in the story — who said to me, while we were at a market, something like, “Man, this is such bullshit, nothing is affordable anymore.” And I asked him about when he began to notice the changes. He said it was slow, so slow that you just got used to it each time it happened. Each time there was a spike, you thought it can’t get worse, but then it did. For reference, when I got there, the currency was below 8,000 bolívars per one U.S. dollar. When I left, it’d dropped to 20,000 to one dollar amid the chaos. Now it’s gone all the way to 30,000. People’s real earnings have just gone up in flames.

One of the most striking things in your piece is the way it conveys the normalcy of danger. How did it feel on the ground while you were reporting? Was there a sense of imminent violence, whether from the authorities or from random crime? Has it affected the way you went about reporting this story?

The dangerous part about Venezuela — and why it was so different than Ukraine, for example — is that when you cover war, you generally know which direction the threat could be coming from, you know who could be out to cause you harm. In Venezuela you had no idea, and the options were limitless as to who might put you in danger. There was SEBIN (The Bolivarian National Intelligence Service), robbery, kidnapping, National Guardsmen, Venezuelan officers, and random murder. It was an especially difficult place to work during that time because there were checkpoints, even casual ones, all around. Authorities were looking for suspicious groupings of people in cars to figure out which ones could be protesters. There was a lot of paranoia on our part about who was watching us — and it was definitely justified. One day, on July 30 actually, the day of the Constituyente vote, a middle-aged man came up and snapped my picture, then rushed away. My colleagues and I were concerned we’d be picked up.

Your reporting took you to very different areas in Caracas — from affluent enclaves to some of the poorest barrios. Does the despair, and the reactions to it, transcend these divisions, or did you see it play out differently across socioeconomic fault lines?

Yes, we went all over the city. I wanted to make sure we saw the whole spectrum of opinions, and frankly, everyone young, without exception, was against the government. It didn’t matter if they were ultra-poor, like Gaucho, or wealthy, like Federica — who are both are featured in the story — the young people were universally against their government. It makes sense when you look at the statistics and realize that they no longer see any future for themselves in their own country. I think people sometimes discount or can’t empathize with how difficult it is to have to pack up and move to a different country, even if you speak the same language. I mean, moving apartments can be enough of a pain in the ass, but fleeing a country, finding a new place to live, building a new social and professional network, restarting school, finding a new job, starting a career from scratch, learning a new culture, establishing new routines. Those are all emotionally exhausting.

Bringing this back to a North American perspective, the concept of political “resistance” has seen a major resurgence this past year. And it’s almost always framed in optimistic terms. Your story shows the moment where a resistance movement very clearly hit a major, perhaps fatal, dead end. Is there anything that can be learned from the Resistencia activists you’ve witnessed in Caracas in the days before the July 30 vote? What’s in store for this now much-weakened movement?

I honestly have no idea what can be learned. I was shocked to see the movement die off the day after the vote. I expected some massive uprising to take place, as did many people, except for the veteran correspondents who’d spent years in Venezuela. Several people told me to expect nothing much, but it seemed like such an intense moment that I discounted that theory a bit. But that’s exactly what happened.

Some people tried to explain it to me afterward as the failure of the opposition politicians to actually keep the trust of the movement. Their message changed so often, from “Let’s march on the Presidential Palace!” to “Pull over and turn your cars off in protest.” People were disheartened by their leadership, especially when they saw their leaders willing to cooperate with the regime in the wake of the vote. I mean, people on the street were screaming “dictatorship!”, and yet the politicians who’d asked them to give their lives for this movement suddenly changed views and began to negotiate. I guess the people felt betrayed. The only way you can ensure that doesn’t happen is if you make the resistance movement apolitical, meaning you don’t let a political party co-opt it and lead the charge. You’d have to let civil society lead it, and do it for the betterment of society, not for the political goals of any party. How you can ensure that a politician doesn’t step in and take over is beyond me.

As far as what’s in store for this movement, I honestly have no idea. I feel like the country is just going to lose a ton of its young, talented people and devolve further into a shadow of what it once was economically and culturally. I don’t know if there will be a big challenge to Maduro’s regime anytime soon.

Read “You Can See the Battle Scars”

The Examination of a Playboy Bunny

The photographer Weegee sets up his equipment to photograph a Playboy Bunny in the 1950s (International Center of Photography/Getty Images)

Her nom de bunny was Marie Catherine Ochs, an old family name that Gloria Steinem thought sounded “much too square to be phony.” Marie went to high school and college, but “wasn’t a slave to academics,” dropping out after her first year of college to fly to Europe and work as a waitress in London and a hostess-dancer in Paris. After returning to New York to work as a secretary, she saw an ad in the newspaper looking for women who were “pretty and personable, between 21 and 24, married or single” who wanted to make between $200 and $300 a week — about the same salary as a Madison Avenue ad executive. When Steinem handed over Marie’s detailed personal history to the Sheralee, the Bunny Mother at Playboy’s New York Club, the hostess handed it back without looking at it.

“We don’t like our girls to have any background,” she told Steinem, who was going undercover as a Playboy Bunny for Show magazine, “we just want you to fit the Bunny image.” Steinem kept meticulous notes as she completed each stage of the interview, as well as the job itself, and she collected these notes in a day-to-day account that was published in May 1963 as a two-part series “A Bunny’s Tale” which was later collected in her 1985 book Outrageous Acts and Everyday Rebellions.

Part of Steinem’s training involved the fitting of a skin-tight uniform in two colors, the application of false eyelashes, and a physical examination with a doctor, which she recounted in detail.

Read more…

You Can See the Battle Scars

In east-central Caracas, an improvised memorial for Neomar Lander, a protester killed in June.

Christian Borys | Longreads | September 2017 | 20 minutes (4,916 words)

Diego

Recklessly driving through the sloping streets of Caracas, Diego blares “Bonita,” the bass-heavy reggaeton hit of the summer. The stock speakers of his tiny sedan pulsate as we pass block after block of buildings, each cloaked with layers of razor wire and electrified fencing. Diego (whose name, as well as others’, have been changed to protect their identity) laughs and looks at me, smiling cynically, when I ask why it seems like no one bothers to stop at red lights.

“Do you want to be kidnapped or something?”

It’s the night of Thursday, July 27. In less than three days, Venezuelans will live through one of the most defining days in their country’s modern history — and one of the bloodiest. A vote nicknamed the Constituyente is scheduled for July 30. If successful, it would be a major step in president Nicolás Maduro’s march toward dictatorship.

Tonight, the sidewalks are empty and the roads nearly barren. For the few brave enough to be out, traffic laws go by the wayside. Even the sunlight brings little comfort. Just the day before we met, Diego was driving home after making a late-afternoon withdrawal at a nearby bank. En route, three men on motorbikes surrounded his car and tried to steer him off the road. “I always knew it was dangerous here,” he explains, “and you get used to it. But in my whole life, that never happened to me before.”

Read more…

Camping with Kids: A Non-Primer

Per Mattisson/The Image Bank/Getty

Reid Doughten | Longreads | September 2017 | 12 minutes (3,073 words)

 

It’s dark and I’m sitting beside the smoldering remnants of sausage fat and cocoa powder. My kids roll around noisily in a tent behind me. I can hear my son try to reason with his younger sister, a bedtime dialogue marked by grunts and half-English. She cries out every now and again, fighting the sleepiness which, by god, must surely win out.

I’ve ventured into Virginia’s George Washington National Forest to go camping with my kids — ages 1 and 3 — and I elect to do this without the help of my wife. She’d started working full time as a nurse several months before, including back-to-back 12-hour shifts every other weekend, while I was working a standard Monday-to-Friday schedule. And so for the first time since my children were born, I was left to solo parent for two days every other week. How hard could it be?

After several weekends, the answer was clear enough — it can be incredibly hard. Set aside the notion of treating time off of work as time “off.” Understand that your days are no longer your own, that time is marked not by numerals on the clock face but by bouts of wakefulness and sleep, of meals, snacks, playdates, shitty diapers, baths, and bedtime stories. Of course, anyone who spends their day as the lone supervisor of small children knows this instinctively, and should probably be awarded a fucking medal. This includes my wife.

So in my naiveté, I decide hastily that on this Saturday in early September, while my wife spends her “days off” from watching the kids working the telemetry floor at the hospital, that the children and I will do something that I enjoy and that perhaps they might get a kick out of as well.

Later that night beside the fire, while we haven’t technically been out of the car for more than five or six hours I realize this is not the purposeful experience I’d imagined. I’ve spent the majority of those hours in a state of frustration as I roll back the tape in my head. I lie in the dirt, push my sleeves down, and stew on all of this — my misguided preparation, my skewed expectations, how little sound is muffled by tent walls. I wonder, What the hell was I thinking?

Read more…

America’s First Addiction Epidemic

The Time of Trouble at Cornplanter's Village, by Jesse Cornplanter. Via Wikimedia

Christopher Finan| Drunks: An American History | Beacon Press | June 2017 | 28 minutes (7,526 words) 

The following is an excerpt from Drunks, by Christopher Finan. This story is recommended by Longreads contributing editor Dana Snitzky.

* * *

The men full of strong drink have trodden in the fireplaces.

In spring of 1799, Handsome Lake, a Native American, joined members of his hunting party in making the long journey from western Pennsylvania to their home in New York. Handsome Lake was a member of the Seneca Nation, one of the six nations in the Haudenosaunee (Iroquois Confederacy). He had once been renowned for his fighting skill. But the Iroquois had been stripped of almost all their lands after the American Revolution. Now fifty years old, Handsome Lake, too, was a shadow of what he had been. He would later say that heavy drinking had reduced him to “but yellow skin and dried bones.” After stopping in Pittsburgh to trade furs for several barrels of whiskey, the hunters lashed their canoes together and began to paddle up the Allegheny River. Only those in the outer canoes had to work. The rest of the party drank whiskey, yelling and singing “like demented people,” Handsome Lake said. The good times didn’t stop after they picked up their wives and children, who had accompanied them on the hunting trip and were waiting at a rendezvous. Everyone looked forward to being home in Cornplanter’s Town, named for its Seneca Leader.

The joy of their homecoming did not last long. There was enough whiskey to keep the men drunk for several weeks. Handsome Lake described the horror of that time:

Now that the party is home the men revel in strong drink and are very quarrelsome. Because of this the families become frightened and move away for safety. So from many places in the bushlands camp fires send up their smoke.

Now the drunken men run yelling through the village and there is no one there except the drunken men. Now they are beastlike and run about without clothing and all have weapons to injure those whom they meet.

Now there are no doors in the houses for they have all been kicked off. So, also, there are no fires in the village and have not been for many days. Now the men full of strong drink have trodden in the fireplaces. They alone track there and there are no fires and their footprints are in all the fireplaces.

Now the Dogs yelp and cry in all the houses for they are hungry.

Henry Simmons, one of three Quakers who had recently come to the village and had been contracted by the US War Department to “civilize” the Indians, said that some natives died. “One old Woman perrished out of doors in the night season with a bottle at her side,” he wrote. In a community meeting later, Simmons denounced “the great Evil of Strong Drink.” But the Indians did not need much persuading. After several days of deliberation, a council of Seneca elders announced that they were banning whiskey from the village. Read more…

Pregnant, then Ruptured

Thomas Northcut/Getty Images

Joanna Petrone | Longreads | August 2017 | 28 minutes (7,729 words)

 

It comes on suddenly as a gas main explosion, the feeling of being grabbed tightly from within and twisted. I am standing at the front of my classroom, at one, almost, with its beige institutional carpeting and faint but pervasive smell of damp paper. I’m instructing sixth-graders — sleepy and vaguely conspiratorial-looking, the way they often are on Fridays in January just after lunch — when that blue flash of pain rips through me. I stop talking. I freeze, hand on belly, and wait to find out if I’ll vomit.

Inside me everything is lightening bolts and banshee wails and chaos. Outside, obedient, slightly bored students print in marble composition notebooks. Not one of my charges says anything — no one has noticed — so I steady my breathing and shuffle next door to find another teacher to cover for me.

On the toilet, I check my underpants. There is no new red blood — only ­ the same smear of tacky rust-colored discharge that’s been soiling my pads for weeks. The bathroom light, set to a motion-sensitive timer, blinks out into darkness while I sit stock still, afraid and in pain, replaying the highlights of the last two weeks: positive pee sticks, phone calls and doctor’s offices, a sequence of blood tests, an ultrasound confirming a mass in my right adnexa (a uterine appendage), and, last night, a duo of cheerful ER nurses sheathed in full-body, bright orange hazmat suits injecting an abortifacient into my backside.

To turn the light back on, I need to move, but I am immobilized by pain so intense I can no longer tell where in my body it is coming from. After a time, the pain quiets enough for me to think over it and will my body into action. I flail my hands to trigger the light, stand up, wash. Maybe this is cramps from the methotrexate working, I think, just very bad cramps, signaling the welcome end of a doomed, rogue pregnancy.

Read more…