Communion Of Dreams

Well, we all will, unless there’s some sort of miracle breakthrough in medicine or technology. But that’s not what I’m talking about. Rather, I’m talking about something anyone who has thought about it much has probably already assumed is true: that in the event of a large-scale pandemic, procedures will be put into effect by medical authorities to determine who will be treated and who will be allowed to die.

This is called triage. And to the best of my knowledge, for the first time such procedures are being publicly put forth as being applicable for all hospitals in the US, in recognition that it is better to have consistent and uniform criteria already in place before a disaster hits. The May issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians (ACCP), today carried a supplement titled Definitive Care for the Critically Ill During a Disaster. From the press release on the ACCP website:

(NORTHBROOK, IL, May 5, 2008)—In an unprecedented initiative, US and Canadian experts have developed a comprehensive framework to optimize and manage critical care resources during times of pandemic outbreaks or other mass critical care disasters. The new proposal suggests legally protecting clinicians who follow accepted protocols for the allocation of scarce resources when providing care during mass critical care events. The framework represents a major step forward to uniformly deliver sufficient critical care during catastrophes and maximize the number of victims who have access to potential life-saving interventions.

“Most countries, including the United States, have insufficient critical care resources to provide timely, usual care for a surge of critically ill and injured victims,” said Asha Devereaux, MD, FCCP, Task Force for Mass Critical Care. “If a mass casualty critical care event occurred tomorrow, many people with clinical conditions that are survivable under usual health-care system circumstances may have to forgo life-sustaining interventions due to deficiencies in supply, staffing, or space.” As a result, the Task Force for Mass Critical Care developed an emergency mass critical care (EMCC) framework for hospitals and public health authorities aimed to maximize effective critical care surge capacity.

So, is this just good public health planning? Well, yes. But it is also very sobering to read the following:

The proposed guidelines are designed to be a blueprint for hospitals “so that everybody will be thinking in the same way” when pandemic flu or another widespread health care disaster hits, said Dr. Asha Devereaux. She is a critical care specialist in San Diego and lead writer of the task force report.

“When”. Emphasis mine. Not “if”. The news report goes further:

Bentley said it’s not the first time this type of approach has been recommended for a catastrophic pandemic, but that “this is the most detailed one I have seen from a professional group.”

While the notion of rationing health care is unpleasant, the report could help the public understand that it will be necessary, Bentley said.

Devereaux said compiling the list “was emotionally difficult for everyone.”

That’s partly because members believe it’s just a matter of time before such a health care disaster hits, she said.

“You never know,” Devereaux said. “SARS took a lot of folks by surprise. We didn’t even know it existed.”

Again, emphasis mine.

I’ve written many times about the possibility of widespread flu or some other kind of pandemic. Partly this is just because such a catastrophe sets the stage for Communion of Dreams. But more importantly - and this is even part of the reason *why* I wrote Communion of Dreams - is that I don’t think that people give this matter nearly enough thought.

It is good to see that the public health authorities are taking this step. And I was heartened to hear about it on NPR as I started to compose this post. Maybe it will prompt people to stop and think for a moment about what they themselves should be doing to prepare for some kind of pandemic or other disruption. Because I bet that almost no one you know is actually ready to ride out such an event - and by the time you hear of a pandemic starting, it will be too late to get everything you will need to increase the chances of you and your loved ones surviving. This is not fear-mongering; this is taking some reasonable precautions - the same sorts of precautions that have lead to the development of this new triage plan. If you want to know more, check out the Flu Wiki (where they also link to this resource).

Yeah, we’re all gonna die. And I can easily imagine disaster scenarios where I would not want to live. But I sure as hell don’t want to die needlessly from something I can avoid, or ride out with a little advance prep.

Jim Downey

Communion of Dreams is set in a post-pandemic world, some 40 years after a new flu strain has caused massive death and global disruption.

For the most part, people never really think about the flu or any other virus presenting much of a threat. Partially, this is due to not wanting to think about such things as death. Partially, it is because there really isn’t much in the way of treatment for most viral diseases. As a result, sometimes it is difficult to get much information in the news, unless you really work at it. A good example of this is the recent outbreak of EV71 in China - my wife caught a brief mention of it on the BBC news, told me. I had to really hunt around to find this:

Mass intestinal virus infection up to 1,520, kills 20

HEFEI — A lethal outbreak of intestinal virus in Fuyang City in east China’s Anhui Province has killed 20 children and befallen 1,500 others, the provincial health department said on Tuesday.

Du Changzhi, Anhui Provincial Health Department deputy chief, said the virus, known as enterovirus 71, or EV71, had altogether sickened 1,520 children, claiming 20 lives by Tuesday morning.

Of the sick, 585 had recovered thus far. At present, 412 sick children have remained in hospital for further medical observation. Of the total, 26 are seriously ill.

The Wall Street Journal did have this:

China Suffers HFMD Outbreak
Common Illness Catches Attention Of Global Officials

HONG KONG — A deadly outbreak in eastern China of a common childhood illness that rarely kills people has caught the attention of international health officials.

The outbreak of hand, foot and mouth disease, or HFMD, has killed 20 children in Fuyang, a city in eastern Anhui province, and has affected some 1,200 children altogether, according to the Anhui provincial health department. Of those cases, 341 children are still in the hospital.

A report by the state-run Xinhua news agency late Sunday evening said the outbreak began in early March and cited the city’s health department as confirming that the disease was caused by enterovirus-71, one of several viruses that can cause HFMD.

* * *

China’s Health Minister Chen Zhu visited Fuyang on Saturday, according to the Xinhua report. Chinese health officials at the local level in the past have sometimes played down disease outbreaks early on, only to be caught off guard later.

Indeed. There have been a number of such problems with reporting outbreaks in China, as we saw with the SARS virus in 2003. What this means is that a new virus can get established before anyone really knows what is going on. And that could be really catastrophic in terms of implementing public-health plans to limit the spread of any major new disease.

[Major Spoilers Ahead.]

At the end of Communion, I reveal that the new engineered flu virus which has been released comes from China. I did this for this reason - to draw attention to this very real problem. It’s bad enough that some virus could pop up just about anywhere where there is very little public health infrastructure, and so be missed. That a threat could come, and be intentionally ignored, is really dangerous. You really gotta wonder just what people are thinking when they do this.

Just as you really gotta wonder why such things are not covered in the news, rather than the latest celebrity gossip or outrage.

Jim Downey

A discussion over on UTI about a post I made there took a bit of an odd turn, engendering some interesting discussion about polygamy. This morning I made a comment that I thought I would share here, since it does relate directly to some of the things I do in Communion of Dreams. You’ll see what I mean.

Heinlein’s use . . . of non-standard family structures got me thinking about many of these issues when I was very young, and helped me form my opinions intellectually before getting into emotional commitments.

I tend to think that the serial monogamy that we see as a default in Western countries reflects the differences between societal conventions and evolutionary inclinations, with a big helping of “we live a whole lot longer now than early humans did” thrown in for good measure. It is rare to see a marriage last more than ten or fifteen years these days, and I think that makes a lot of sense - when most humans lived until 30 or so, it would make sense that pair-bonding would be a good strategy to raising and protecting children into early adulthood. That would mean a “marriage” of about the length I mention above.

But we live a lot longer now, and people grow and change throughout their lives. So it is unsurprising to me that divorce is common (something like half of all marriages end in divorce) as a way of dealing with these changes. Some people find a way to grow in tandem with their partner, and some find ways of allowing a certain freedom of definition for each partner within the structure of an ostensibly conventional marriage (some, of course, do both). Different cultures have found different strategies to accommodate these stresses - some allow for polygamy of the ‘conventional’ sort (think the Mormon or Islamic variety), some make divorce easy, some de-emphasize marriage itself, some ‘look the other way’ when one or the other partner in a marriage cheats or has a formal concubine system.

A fairly recent development in all of this has come to be known as polyamory - defining relationships as being more open and less “possessive”. There are some fairly well-known practices and practitioners, such as Penn Jillette. This attitude pretty well covers most of Heinlein’s alternative marriage structures and can work for some people, though it would understandably require a different sort of approach and mindset than what is commonly considered about marriage/love/relationships. In an homage to Heinlein I had originally used alternative family structures as the “norm” in my SF novel set about 50 years from now (a survival-strategy response to environmental conditions), but early readers of the book got too hung up on that so I changed it. Perhaps if/when I am an established author I can get away with it, as RAH did.

Children? I dunno - don’t have any, by choice. Not an issue for me, in several senses of the term.

[Mild spoilers ahead.]

To me, the novel actually does work better the way I had the family relationships defined before, with a group marriage built around a small number of adults who have just a couple of fertile people at the core.  This would allow for those precious few who are able to have children (remember, the fire-flu plague had not just killed vast numbers - it also left most people who survived it sterile) to do so with minimal stress, the rest of the family caring for them and the children born into the family.  Think how it would be otherwise: the few fertile couples trying to have and raise children in a society desperate for kids, maybe even willing to steal them or force child-baring couple to give their children to others.

But this change was just too hard for some people to wrap their heads around comfortably - they wanted to turn it into something about sex rather than about children.  Maybe they felt threatened by the idea, since the time-frame of the novel was so close to our own.  I dunno - my head doesn’t work that way.  So I made the change, and tried to work in enough explanation for the type of ‘family’ that exists in the book, while removing the polyamory element.  So far no one has commented on the current version as being a problem for them, and that is likely how it will stay.

Jim Downey

(Again, if you didn’t recognize the quote used in the title, shame on you.  It’s from this.)

A good friend and I have a running joke about getting our six chickens and a goat, and retiring from the world to farm while things fall slowly into ruin.

But the thing is, it’s not a joke. Not really.

I’m not saying that everyone should fall into a paranoid spiral, become some kind of survivalist nut. I’m not ready to do that. But when you read something like this, it does make you wonder. An excerpt (please note, I added the embedded links in the following):

For decades, his [James Lovelock's] advocacy of nuclear power appalled fellow environmentalists - but recently increasing numbers of them have come around to his way of thinking. His latest book, The Revenge of Gaia, predicts that by 2020 extreme weather will be the norm, causing global devastation; that by 2040 much of Europe will be Saharan; and parts of London will be underwater. The most recent Intergovernmental Panel on Climate Change (IPCC) report deploys less dramatic language - but its calculations aren’t a million miles away from his.

* * *

On the day we meet, the Daily Mail has launched a campaign to rid Britain of plastic shopping bags. The initiative sits comfortably within the current canon of eco ideas, next to ethical consumption, carbon offsetting, recycling and so on - all of which are premised on the calculation that individual lifestyle adjustments can still save the planet. This is, Lovelock says, a deluded fantasy. Most of the things we have been told to do might make us feel better, but they won’t make any difference. Global warming has passed the tipping point, and catastrophe is unstoppable.

“It’s just too late for it,” he says. “Perhaps if we’d gone along routes like that in 1967, it might have helped. But we don’t have time. All these standard green things, like sustainable development, I think these are just words that mean nothing. I get an awful lot of people coming to me saying you can’t say that, because it gives us nothing to do. I say on the contrary, it gives us an immense amount to do. Just not the kinds of things you want to do.”

Too late? Yeah, maybe so:

I opened the email to find an article about the most recent “comments and projections” by James Hansen. Hansen, you may know, is perhaps the most famous NASA climate change scientist. He’s the man who testified before Congress twenty years ago that the planet was warming and that people were the source of that warming. He’s the man who was pressured by senior officials at NASA, at the behest of the current administration, to tone down his reports about the impacts of climate change. Thankfully he seems to have resisted that pressure.

I read the article and then I read a related article by Bill McKibben. Hansen says, and McKibben underscores, that there is a critical maximum number of parts per million of carbon dioxide in the atmosphere to heed to prevent climatic catastrophe. That number, he says, is between 300 and 350.

* * *

Can you guess how many ppm of CO2 are in the atmosphere now? Slightly below 350? Slightly above?

We’re at 383 parts per million and counting, well past the number Hansen suggests is critical. We are past it by a lot. We were at 325 parts per million in 1970! Um, I don’t think we can just suck all that carbon back out, ask billions of people not to have been born, tear down all of those new suburban developments, return to non-fossil-based agriculture, and innocently pretend it’s thirty years ago.

So, what to do?

Well, that’s the problem. Lovelock says that you might as well enjoy life while you can, as much as you can, before the shit hits the fan. The second passage, from a very long blog entry evidently by Sally Erickson, explores some options but focuses on the need to convince people that the shit has essentially already hit the fan, in order to radically change behavior sufficient to have a hope to save the world.

I am not sanguine about the prospects of making radical change, nor what that would really mean for our civil liberties. I think, unfortunately, that the mass of humanity just cannot deal with a problem until it becomes an actual, in-your-face emergency, but that once in it, we usually do a fairly decent job of slogging our way out.

This is one of the reasons that I decided to choose a pandemic flu as the cataclysm behind the ‘history’ of Communion of Dreams. As I have discussed previously, I made that decision for reasons of plotting, but also because I actually believe that we’ll likely experience some kind of mass die-off of humanity sometime in the next century, whether due to war, asteroid impact, plague, global warming or some other disaster. We’ve just been too lucky, too long.

But in a way, it is an odd sort of optimism, as reflected in the book, and as shared by James Lovelock (from the same Guardian article):

“There have been seven disasters since humans came on the earth, very similar to the one that’s just about to happen. I think these events keep separating the wheat from the chaff. And eventually we’ll have a human on the planet that really does understand it and can live with it properly. That’s the source of my optimism.”

And not to end it there, here’s a little something for counterpoint, I suppose:

Jim Downey

(Via MeFi here and here.) 

Last night we settled down with some dinner to watch a bit of Firefly, settling on Serenity (the episode, not the movie). At one point fairly early on, when plans have gone south at several junctures, the captain of the ship (Mal) is considering options, trying to make the best of a not-great situation. There’s this little bit of dialog:

MAL: We don’t get paid for this, we won’t have enough money to fuel the ship,
let alone keep her in repair. She’ll be dead in the water anyhow.
(Mal turns to the others)
We just gotta keep our heads down and do the job. Pray there ain’t no more surprises.

I looked at my wife, and we just nodded to one another.

* * * * * * *

We did a hard thing. And we did it well.

Caring for my MIL for years somewhat warped my perspective. First and foremost in our consideration was always what her needs were and how best to meet them. I’ve often talked about what that meant in terms of rewards and sacrifices, and I don’t intend to rehash that now.

But a couple of things have changed with her passing. First off, is the odd sense of disorientation. I’ve compared it in discussion with friends with almost having a sense of agoraphobia - a nervousness when out in the world I’ve never felt before. It’s really just a conditioned reflex, and will fade as I adjust to the lack of need to always being worried about Martha Sr.

Another thing which has changed is the need to return to something resembling a ‘normal’ life, with the usual requirements of work. I don’t mind work, never have. My life has never been easy (though it certainly could have been harder), and I’ve never expected it to be otherwise.

But sometimes you wonder if maybe it couldn’t be just a little bit easier.

Caring for Martha Sr those last weeks was more demanding, and lasted longer than anyone expected. Getting hit with the flu so hard following seemed a bit gratuitous, in the sense of the universe having fun at our expense. Both my wife and I are behind on our work, and while our clients understand, that doesn’t help the cash flow situation. I knew these days would come, and things would be a little rough for a while until we got settled again. But we’ll manage.

* * * * * * *

We did a hard thing, and we did it well.

What has come of a bit of surprise has been how some people have responded to that. There’s been some discord in the family about the disposition of Martha Sr’s possessions, borne mostly out of a misguided sense of guilt, from what I can tell. It’s really unfortunate, but everyone has their own way of reacting to death. If we’re lucky, with time the matter will sort itself out with a minimal amount of damage.

I’ve also seen others in different forums who have almost felt like they had to defend their own decisions regarding a loved one who has Alzheimer’s or some other debilitating illness leading to hospice care. I’ve witnessed those who almost seem resentful that we did what we did, because it somehow implies that they did less - that they cared less.

No. We were able to make this work out. Barely. Everyone has a different situation, and each family, each person, must come to their own conclusions, their own solutions. None is better or worse than another. Because my wife and I don’t have kids, we didn’t have to juggle that aspect of life at the same time. Because we live here in the same town as Martha Sr, and have professions which allow a considerable flexibility in terms of work hours, we were better able to adapt to providing care at home than most. Our solution worked for our situation - barely. Those final months were very demanding, and I will admit that I was pushed further than I would have thought was possible, and failed and succeeded in ways I never expected.

I will not judge another - this experience has taught me humility.

Jim Downey

(I’m still fighting this stubborn flu, so forgive the light content quality. But I just had to pass on this brilliant item found on BoingBoing.)

I’ve recently been going through all the old Star Trek: The Original Series episodes and movies, and being amused at just how well the stuff holds up after so many years. But that has nothing to do with this, which I offer for your amusement: Jefferson Airplane’s White Rabbit with TOS crew.

Bloody well brilliant.

Jim Downey

I was going to title this “I’m sick and tired . . . of being sick and tired.” After yet another night of coughing jags, tossing and turning, getting up to take OTC meds every couple of hours, and generally being miserable in this tenth day of this flu.

But then I popped that phrase into Google, to see why it echoed so from my childhood. And a couple of clicks later I found this, and was humbled.

My tendency to feel sorry for myself is not one of my most attractive traits. I can only say that it usually is a sign that I am bottoming out, and before long I will be climbing back out of my own personal pit of despair (whether it is caused by health problems, my mild bi-polar condition, or some other source). It’s that Emerson quote, again.

So, sorry about that, Fanny Lou. Didn’t mean no offense.

Jim Downey

Wow. It’s been a while since I was this sick, this long. Nothing life-threatening, just the flu that’s going around. Of course, I was completely worn out by the last few weeks of caring for Martha Sr, with no reserves to draw upon to fight this virus, so it comes as very little surprise that I haven’t been able to just shrug off the bug and get better.

It is this sort of experience that drives home the statistics pertaining to how many soldiers over the ages died due to disease rather than battle - I don’t have the numbers right at hand, but generally it has been concluded that at least as many soldiers have died due to illness than from battle related injuries, at least up until the last century. Why? Because soldiers are frequently pushed past the point of physical exhaustion, denied adequate sleep, with poor quality or inadequate food, and under conditions which foster rapid transmission of disease from soldier to soldier.

And that’s one of the things that I always chuckle about when I read about TEOTWAWKI scenarios on this or that forum. Often, particularly when such threads come up on a firearms-related forum, people will get way too preoccupied with guns and ammo, and lose track of the fact that those tools are completely useless if you are too sick or too tired or too hungry to employ them. Get sick, and your superior collection of guns or other tech mean nothing. H.G. Wells knew this, while most of us have forgotten it.

I’ll write more when I am up to it.

Jim Downey

My aches and pains from this cold/flu have reached the point where it is tempting to go sit in a doctor’s office just in order to get some antibiotics. Not that they would do any good, mind, as it is almost certain that what I have is a viral bug rather than a bacterial infection. All the symptoms are in place: cough, watery eyes, runny nose, lack of any real fever. Yet when you are miserable enough, long enough, you get a little desperate. You want antibiotics, just so you feel like you’re “doing something” to beat the disease.

And that, actually, was where Communion of Dreams had its origin: in the over-prescribing of antibiotics and the routine use of same in factory farming of livestock. I started playing around with what would happen if misuse of antibiotics lead to a bacterial ’superbug’ which we couldn’t treat. Eventually, I went a different direction with the idea, and decided that a viral agent was more appropriate, and for different reasons (which I won’t go into here.)

But at times like this I sure do identify with all those who want antibiotics for every viral beastie to come down the pike. Even if they don’t really do anything.

Jim Downey

. . . I’m not the only one miserable and sick, as noted in this post.

How misery loves company.

Jim Downey