Managed by Care

Sun, 01 Apr 2001 00:00:00 -0500

The year was 1962. My sister was eagerly preparing for the brave new world of junior high. To ready herself for this great event, she began to buy Teen magazine. Since I read whatever was lying around, I picked it up and, at the age of ten, discovered the world of managed care.

No one told us how to be kids. We just were, and it was a lot of fun. But while boys seemed to be able to go on growing and doing whatever came naturally, girls needed help. Nature couldn’t just take its course, and parents were too old-fashioned to be of any service. Fortunately, there were “experts” ready to help, for the small fee of fifty cents. So I began to read Teen magazine, and discovered how desperately I needed someone to manage my adolescence for me.

My first discovery was that I was ugly. This came as quite a shock. But I soon realized that I had company. Everyone else was ugly, too. We couldn’t just walk around afflicting the world with our ugliness. Fortunately, Dear Beauty Editor was there to help. In fact, every paragraph in her column seemed to begin with the word “help.” “Help! My nose is too wide!” “Help! My ears stick out!” “Help! My waist is too thick!” Dear Beauty Editor would comfort the afflicted with specific remedies—dark makeup on the sides and light makeup on top of the nose, a bouffant hairdo to hide the ears, vertical lines to disguise the waist. Over the next few years I read articles dealing with every part of the body not covered by a G-string, all flawed, all needing “help.” I soon learned that clothes, shoes, and hair styles could not be chosen simply because they were pretty or comfortable. Style was essential, but the main goal was to hide all the flaws.

After sensitizing us and raising our consciousness about our inadequate bodies, the magazine went on to manage our personalities. There were two advice columns, Dear Jack and Dear Jill, full of pleas from shy and desperate teens also needing “help.” “Help! I broke up with my boyfriend but I’d really like to date him again.” “Help! This really cute guy asked me out. I thought we had a great time, but he never called back.” “Help! I really like this boy in my science class. How can I get things started?”

Dear Jack and Dear Jill soothed these unfortunates with advice which always seemed to end with the words, “Be yourself,” as if all those neat boys in science class never rejected a girl who was herself. To forestall this possibility, the magazine told us just what kind of self we were supposed to be. First and foremost, we were told to be good listeners. This sounds easy, but a listener cannot listen unless someone is talking. Expecting a shy girl to engage an awkward boy in conversation is like expecting a terrier pup to bark at foes and not at friends.

We were also told to have lots of interests and participate in many activities. It was taken for granted that these would be the popular things—sports, current TV shows, movies, and pop music. I was interested in almost everything that crawled or happened on the face of the earth except sports, current TV shows, movies, and pop music.

But I faithfully read the magazine, never doubting that the advice would come in handy some day. Then it happened. In ninth grade, a boy smiled at me. A cute boy. I smiled back. We walked to class. The next day it happened again. And again. The boy was not in sports or school activities. He was too shy to do more than smile. What could I say? Do you like canoes? Victor Hugo? Dennis Brain? I didn’t even try. None of the advice I’d read over the years seemed to apply. My first romance fizzled out.

When my sister went to college, my Teen supply dried up since I was too cheap to buy it for myself. I lost touch with the world of managed care until the day, years later, when I got a letter in my mailbox at school.

As a French teacher in a small town school, I was safe from the “experts” who knew nothing about French. No one told me how to teach but myself, for the most part. So it was a new sensation to receive in my mailbox a list of suggestions for helping kids with attention deficit disorder. The list was in everyone’s box. It was one of those things the special services director had to do. ADD kids often have trouble organizing their space. The list told teachers exactly how to help.

The teacher has to remain in the hall between classes, or she will get in trouble with the Principal. The final bell rings. The kids are in the room, standing around talking. The teacher rushes in. She shoves two desks together for Matthew; she pushes two desks together for Mark; she hurls two desks together for Luke. (She regrets that John, Paul, and Barnabas must sit on the floor.) Meanwhile, her students are talking, but she can’t start class yet. She must get tape recorders for the three boys. She must set the recorders on the desks, insert the tapes, and connect the headphones. (ADD students often need taped lessons.) She welcomes the boys and guides them to their desks. She helps them set out their books, paper, pencils, and notebooks, helps them turn to the right chapter, adjusts their headphones, and starts their tapes. Now she can start class, but she must check back every six or seven minutes—ADD students need help to stay on task. There were many more suggestions, all useful in a classroom with four or five kids, all ridiculous in a class of thirty students who also need attention.

I began to read about classroom management techniques, and I saw that most of them were quite sensible, as long as the teacher didn’t have to teach and manage at the same time. But managed care does not stop with advice on how to do our jobs. We can find advice on how to manage every detail of our lives, from the correct way to wash our faces in the morning to the proper way to curl up in bed at night. The St. Louis Post Dispatch once published an article on the best way to set out photos on the desk at work, telling us what size photos to display, who should be pictured, how many photos we should use, where to place them, and how they should be grouped.

I once knew a man who was leaving his first pastorate for bigger things. He actually bought a book on how to leave a church. Leaving a church does, in fact, have its difficulties. Most of us want a pastor we know and love to preside at our daughter’s wedding or our mother’s funeral, even when he’s no longer our pastor. There are only two perfect solutions to this problem. One is for the pastor to be such a pain that everyone is glad to see the back of him; the other is to move so far away that no one can possibly expect a return. Our friend took the second route: he moved from mid-Missouri to a church four blocks from the Atlantic Ocean.

Pastors, it turns out, get lots of advice. One came to see me in the hospital, and it was obvious that he had been listening to the hospital visitation “experts.” He didn’t sit in the chair; he positioned himself the correct number of inches from the edge. He tilted his body slightly forward, smiled, and established the proper eye contact. Occasionally he stopped smiling, looked serious, and intoned the recommended phrase—“I hear you.”

I wanted to dump the ice pitcher over his carefully sprayed gray hair and see if there was a person behind the façade, but I didn’t quite feel up to it. I was offended, as we all are at a bad performance. Perhaps we need an “expert” to tell the “experts” that acting is an art, requiring hard work and talent.

I had another hospital visit that same week. This pastor sat sideways in his chair. He squirmed and fidgeted. He looked at me and looked away. He was worried about me, not about whether he was correctly positioned to show sympathy. He was concerned, not occupied with seeming concerned. I was grateful for his visit.

“Managed” hospital visits are bad enough, but parenting advice can be even worse. When Rodney kicks Susie at the table, and Susie grabs Rodney’s hair and jerks his face into the mashed potatoes, mom doesn’t have time to recall all the “expert” advice on sibling rivalry and sort through various recommendations for an effective solution. And since she knows her children better than anyone else, she can probably find a better solution than any professional. Her remedy may not work, but the same is true for the “experts.”

For years, experts have been telling parents, “Respect your child’s privacy. Don’t pry, don’t snoop, give him space, don’t invade his territory.” Certain families in Colorado have probably wondered why such “expert” advice went so horribly wrong.

This is the problem with managed care. If I want to paint my deck or make potato salad, I can follow techniques that will guarantee success. But when I am dealing with people instead of potatoes, such is not the case. Once we have applied “love your neighbor as yourself” and “do as you would be done by,” the playing field is the same for everyone—rough and extremely bumpy.

I sometimes think our insatiable appetite for advice simply comes from our refusal to admit that no matter how much expert advice we swallow, our lives will never be even close to perfect. Not only will we lose our lives by continually worrying about the best way to live them, we will still say the wrong thing and do the wrong thing. And unless we are dealing with sin, saying and doing the “wrong thing” may be the best thing we can do.

One day, as I was waiting for a college class to start, a boy I had met in music theory came up and asked if I had been to any concerts lately. “No,” I said, “I’d really like to go, but I haven’t been able to drag anyone with me.” After I said those words, I could almost hear the thud as Dear Jack and Dear Jill fainted at their desks and slid to the floor. A girl could hardly say anything worse. The boy will think no one wants to date her. The boy will think she’s a desperate man-chaser. The boy will say, “That’s too bad. Well, gotta go, see ya,” and hide the next time he sees her.

But this boy took hope from my answer. He immediately asked me to go to a concert with him. That was almost thirty years ago. We are still together, probably because we have jealously guarded our marriage from the “experts” of managed care.

Nancy Harvey, now retired, taught French and English in the Missouri public schools.

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The Imitation of Mr. Starbuck

Sat, 01 Aug 1998 00:00:00 -0400

Imagine an enormous royal blue tick. If that seems too repulsive, imagine a large royal blue beachball. Let a little of the air out to soften the shape. Add six scrawny appendages-two arms with three-fingered hands, and four short legs, each one ending in a brown shoe. Put a large yellow star (five-pointed) on the stomach. Set a bright blue head about the size of a cantaloupe on top of a tiny neck, and let two stubby antennae sprout from the top. Finish the face with two large, pleading eyes, a yellow clown nose, and a hesitant, crooked grin.

This is Mr. Starbuck. This is our mascot for teaching character education in our public school.

Character education is fashionable these days. It comes, not at the request of parents, but in response to upper-level teachers and members of the business community tired of dealing with irresponsible young adults who arrive late or not at all, who are lazy, careless, and rude, and who expect grades or pay for doing almost nothing.

Mr. Starbuck is supposed to help remedy this. He promotes thirteen “responsibility skills”—be prepared, be on time, be here, be responsible, be a worker, be a listener, be a goal-setter, be a risk-taker, be polite, be friendly, be confident, be a doer, be healthy.

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Dying Like a Dog

Sat, 01 Apr 1995 00:00:00 -0500

Hunger and thirst, starvation and dehydration—ugly words to most of us, bringing images of tormenting weakness, agonizing muscle spasms, the ultimate cannibalism as the body devours itself to stay alive. But not everyone views such words with disgust. Last May, St. Louis University, a private Catholic school, held a conference on medical ethics that included a workshop entitled, “Dying of Dehydration—Does it Hurt?” Last April, some contributors to the symposium in First Things on medical ethics, “The Sanctity of Life Seduced,” recommended starvation and dehydration for certain terminal patients and those in a “persistent vegetative state” (PVS). Living wills list artificially administered food and water as things that may be taken away, and newspaper and magazine articles continue to suggest that modern technologies for continuing food and water cause the terminally ill to suffer long and agonizing “bad deaths,” or (if they are in PVS), “bad lives” without human capacities.

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Wishing People Dead

Mon, 01 Nov 1993 00:00:00 -0500

Christine Busalacchi, a Missouri woman suffering from serious brain damage, died on the 8th of March, 1993. The cause of death was starvation. Her case was not a nationally famous one, but it does serve to raise certain disturbing questions—questions that must confront the families of anyone who is helpless and unable to communicate effectively and that will also continue to confront not only medical care givers but judges and law enforcers as well. For Christine’s death followed the deliberate decision of the state’s attorney general to allow those involved in her medical treatment to withhold food and water on the grounds that life support was no longer beneficial to her.

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Managed by Care

The Imitation of Mr. Starbuck

Dying Like a Dog

Wishing People Dead