I thought I’d try the new WordPress app for the iPhone. I’m at the Shambhala Center almost a half hour before class, and no one else is around, so why not? The app is simple to use, and it allows me to write, tag, categorize, and post entries, as well as allowing me to edit already posted entries. It even allows to post pictures taken with or otherwise on the phone. Except for the frustrations of typing on a phone, especially the near impossibility of entering HTML, this seems to work pretty well.

I went back to the ear doctor yesterday. This was a follow up from last week’s appointment, at which we discovered a setback. About a quarter of the tissue in the ear has become mucosa. The rest is becoming healthy, mature skin–that’s the good news. The bad news is that ultimately, all of the tissue in the ear (including the eardrum) will be either mucosa or dry skin. If we can’t win the battle for this quarter of the tissue, we’ll lose the war for the whole ear canal.

Thus far, we haven’t had any success getting mucosa in my ear to turn into dry skin, probably, my doctor speculates, because of an underlying case of eczema. Sort of at my suggestion, we decided last week to put wicking in the ear and use steroid and antibiotic drops. When we checked back yesterday, things looked better–the same tissue was mucosa, but it was a much thinner layer of it. We have managed to get to this point in the past, at which the normal course would be to stop treaemt, and after which things would be expected to heal normally. But that’s never been what’s happened. My doctor actually looked at me yesterday, palms up, and asked, “What do you think we should do?” I suggested continuing with the wicking and the drops and checking back next week, which is what we’re going to do.

I’m ambivalent about having such a significant say in my ongoing treatment. [And that's as much as I can type on a phone in half an hour. Now I'm on the subway home.] On the one hand I like having real influence over what happens, and it does really seem that the critical thinking and problem solving that I use in the various facets of software development are broadly applicable. On the other hand, I’d really like to be taken care of. But given the situation, I think this is evolving as well as I could hope. I’m mildly optimistic. We’re trying something new in extending this treatment further than we have in the past, and because three quarters of the tissue healed properly this time, more air can get into the ear, giving it a better chance of healing properly. We’ll find out next week if my optimism is justified.

Today was a good day. The horrible heat let up some overnight, and we were spared the worst of the severe weather that accompanied the transition. I was actually able to take a pleasant bus ride down Fifth Avenue and stroll over to the ear doctor’s office off of Park Avenue without getting uncomfortable. This was a significant improvement over Monday afternoon’s quixotic test of endurance that we successfully undertook in the upper deck of Yankee Stadium (though the linked story exaggerates–the passing cloud was cheered much more loudly than the sun’s return was booed, if it was booed at all, however justified the booing would have been).

The doctor had very good news for me. He looked in my ear and nearly got giddy. He said not only that it looked “terrific,” but that already, just under three weeks after the surgery, it looks better than it did at any point in the ten months that followed the previous surgery. He said it made his day, and got so excited that he let slip that he wasn’t even sure this would work. His excitement confirms my experience so far. Though there’s still some pain (my ear was all but cut off and gutted, after all) and ringing, the ear just feels and sounds more solid–there’s nothing moving around or squishing no matter how I move my jaw–and the hearing seems to be coming back more quickly than the last time. There’s one small spot near the entrance to the ear canal that’s not healing quite the way he’d like, but he assures me that’s just superficial. I don’t know how long it will be before this can be pronounced a complete success and I no longer have to worry about some sort of relapse or complications, but things seem to be going as well as they could so far.

So I’m in a pretty buoyant mood. But I’m trying not to lose sight of the fact that this run of good fortune will end–not out of some depressive impulse, but to try to clearly see how ephemeral all of that on which my happiness (and sadness) depends truly is. I want to remind myself that the refuge from the severe storms that accompany the movements back and forth from bliss to misery that constitute human experience is an equanimity that won’t be found anywhere on that continuum. The point isn’t to get to and stay at that blissful end of that continuum–it’s to abide in the equanimous space from which that continuum arises. That emptiness is easier to release into when I’m happy than it is to aspire to when I’m depressed or anxious. And as I become familiar with the release of happiness that gives rise to equanimity, perhaps I’ll come to know that the path from depression or anxiety to equanimity isn’t an aspiration, but rather that it’s the same release.

I had the second ear surgery last Thursday, and I went back to work today, though I’m still not fully functional. This surgery has proven much more difficult for me than the first one, and because the doctor took a skin graft from my hip this time, I have that added pain. More positively, given that I’m now fairly used to all that this surgery entails, I’ve been much less disoriented this time. I’m not having the trouble locating sounds that I did after the previous surgery. I’m getting quite used to having only one working ear. And the pain, on my hip (where it looks like he used a cheese grater to take a three inch long strip of skin) and around my ear, is subsiding as it should.

As planned, the doctor did the surgery differently this time, taking advantage of all that he’s learned since the previous surgery. As I’ve mentioned before, he’s using the one large skin graft, rather than several smaller pieces, and he’s also tried to more effectively address the issues caused by my previously unidentified TMJ. He didn’t discover that until more than two months after the previous surgery, so he didn’t take it into account the first time. It’s not clear to what extent that contributed to the replaced tissue becoming mucosa, the ultimate reason the surgery had to be done over, but the more he addresses up front, the better our chances are. This time, he tried to address it in the surgery. He tried various things, and opened and closed my jaw like a ventriloquist’s dummy’s during the surgery to see how they worked. He tried putting some cartilage between the jaw and the ear canal, but the bone pushed through that. What he finally settled on was replacing almost all of the skin with a single graft, and then replacing the skin directly over the bone protrusion (only a few square millimeters) with a separate graft. He’ll then keep the ear well-packed to ensure that the protrusion is scarred over as it should be (and as it was eventually last time). If there are any problems with that, the rest of the graft should still heal correctly, and that specific problem can be addressed by an oral surgeon. I hope that doesn’t prove necessary.

But the real difficulty this time has been emotional. I don’t know how much that’s related to the surgery and how much it’s just an accident of timing. Certainly any surgery is traumatic, as is the related starting and stopping of very powerful medications, no matter how much less I dread it than most people do. And the prospect of having to wait weeks, possibly months, before we know whether or not this will even work isn’t conducive to peace of mind. But I think the larger problem is a coincidence. All of this is happening while I’m still trying to recover from having been, for lack of a better term, emotionally overwhelmed. I stopped taking the clonazepam about a week before the surgery, in part because I felt better and didn’t think I’d need it any longer and in part because I thought it would be best not to have to account for that among all of the other medications I would taking. And for the first three nights, I felt fine. But the Monday before the surgery, the anxiety returned. I thought it might just be a symptom of withdrawal and figured I’d tough it out, but it kept getting worse. By the day before the surgery, it was clear that this wasn’t from withdrawal and I was just anxious, but at that point it didn’t make sense to re-start the clonazepam.

I didn’t sleep the night before the surgery. Even the night after the surgery, with no sleep the night before, the general anesthesia, the intravenous painkiller, the Percocet, and a few hydrocodone, I didn’t so much sleep as nod on and off. And that’s the way my sleep remained into this week. On Saturday, when it seemed I was no longer in pain, I stopped the hydrocodone, and gradually the pain emerged all over the place–stiffness in my jaw and neck, soreness in my hip, and a general feeling of being beaten with a stick–but worse was the depression. I just felt hopeless, and I couldn’t think of anything I’d even want to hope for. After the recent return of my anxiety, this marked the return of crushing depression, the other half of the cyclothymic experience. I started back with the hydrocodone, which helped, but not enough. Finally yesterday, I pretty much stopped with the hydrocodone and started again with the clonazepam, and finally, I slept well. Today, I could even imagine hoping for things.

With all of the things that have happened over the last month or so, it’s hard to tell what’s causing what, but it’s reassuring to know that I can feel better. I’m going to see the psychopharmacologist tomorrow morning, and we’ll discuss what the long term plan will be, but I suspect I’m going to be on an SSRI for a while. The clonazepam isn’t a long term solution, but I think I’m going to need something for a while. Though I’m not entirely pleased with this situation, I have to do something, for myself and my wife–it’s not fun being around me right now. We probably won’t be able to make any final decisions tomorrow, given how up in the air my condition is, but we’ll start formulating a plan. The other thing that’s reassuring (perhaps) is to learn that however bad (or good) I feel, it’s temporary and it’s caused. I know that in a cognitive sense, but I still haven’t fully absorbed it experientially–I don’t yet have faith in that truth. Once I do, I suspect I’ll suffer less. Perhaps the worst aspect of depression is the inability to remember ever having felt differently or to imagine ever feeling differently again. I suspect that once I’ve genuinely absorbed the truth about that, depression (or anxiety) will be less overwhelming, but until then medication is likely to be an intermittent reality.

The Four Noble Truths, the teaching of the Buddha’s first sutra and perhaps the closest thing Buddhism has to a Genesis, establish Buddhism as a fundamentally pragmatic religion. Where the Abrahamic religions begin with God creating the universe and then humanity within that, implying particular relationships among humanity, its environment, and its creator, Buddhism begins with a man sitting under a tree contemplating existence until he determines the causes, and thus cure, of suffering, implying a very different relationship between humanity and its environment, and excluding any creator. Rather than the theological or the metaphysical, Buddhism begins with a focus on the practical. Rather than handing down rules to govern our behavior, Buddhism encourages us to investigate the truths discovered by the practitioners who have gone before us and to embrace only that which we find to be valid. This pragmatism can help to keep practitioners from becoming attached to particular views (though it’s by no means foolproof in that regard), and to keep them focused on the path of practice.

The Four Noble Truths are modeled after the medical approach then in use, which suggested that illness be understood in terms of symptom, cause, relief, and cure, and suffering is the first symptom that the Buddha chose to address through his spiritual approach. He stated that suffering is a universal experience, that suffering is caused by our view of existence, that the cessation of suffering is possible, and that the Noble Eightfold Path leads to that cessation. In this context, it’s important that suffering is caused. If it weren’t caused, if it simply existed, then it couldn’t be cured. And from the Buddhist perspective, the causes of suffering fall into two categories: Things that happen to us (karma) and how we react to them (klesha). Karma is what yields an effect for every cause, and klesha is what informs and motivates our participation in karma. Or put slightly differently, klesha is what informs how we feel about what happens to us (causing our immediate suffering), and it’s what causes us to react to what happens to us (propagating that suffering through karma). The distinction between karma and klesha gets harder to locate the closer we look, like the distinction between self and other, subject and object, mind and matter, or any other dualism. Increasing precision brings us closer to the realization that they are interdependent phenomena, two aspects of the same truth. Without either, there would be no suffering. If nothing happened to us, we wouldn’t suffer, and if we didn’t feel compelled to react to what happened to us we wouldn’t suffer.

Buddhism suggests that klesha is the more important of the two causes of our suffering, which is the reverse of how most of us see things. We tend to think that what happens to us is the more significant contributor to our suffering, but Buddhism teaches us that how we view and then react to what happens to us (klesha) is actually the more significant contributor. Enlightenment ultimately frees us of both karma and klesha, but in the short term, klesha is generally the more available to us as an object of investigation and practice. From our dualistic perspective, it’s the subject side of the interplay of karma and klesha in the propagation of suffering. This may be seen as analogous to the realization of the selflessness of persons (or egolessness of self) being achieved prior to the realization of the selflessness of phenomena (or egolessness of other) in Mahayana Buddhism. This also has has practical implications. Just as it’s important that suffering is caused, it’s important that one of the interdependent causes of suffering can be at least partially understood and controlled by those of mundane achievement–it provides a reachable first step on the path. If karma alone caused suffering, the cessation of suffering and the path leading to it would be immeasurably more difficult–the first rung of the ladder would be out of reach.

I returned from the vacation that wasn’t quite a vacation, and had four days of much needed rest before returning to work. Actually, it was four and a half days before returning to work, because I spent Monday morning at my internist’s office getting my annual physical (everything looks good) combined with a pre-operative check-up. And when I finally did get back into the office, I found that my management had addressed just about everything that had overwhelmed me. I’m impressed to the point of awe by how progressively and pragmatically the whole situation was handled. And aside from the disorientation of things going so well and having to adjust to an abrupt shift in my responsibilities (and feeling more than a little guilty about how much people have inconvenienced themselves on my behalf), I’ve been recovering. I’ve been tapering off of the Clonazepam and, if nothing comes up in the meantime, will complete that process this weekend.

This will allow me to prepare for the next disruption, which is next Thursday’s encore tympanomastiodectomy. The ear hasn’t healed itself, so that’s still going to be necessary. I saw the ear doctor right before I went away, and he outlined the things he would do differently (use a larger, thicker graft of skin from my hip, and try to open the ear canal wider to get more air onto the skin as it heals) in hopes that it will heal differently. He continues to be irked that this hasn’t gone better, and that’s promising. I think he wants this fixed more than I do.

Lately, I’ve been reading Tsong-Kha-Pa’s The Great Treatise on the Stages of the Path to Enlightenment. It’s difficult to describe. It’s sort of the complete text and practice manual for Gelukpa Buddhism, though it’s probably only going to make sense to someone who’s already studied a fair amount. I’m finding it very helpful, even though I’m a Kagyu Buddhist, in pulling together the disparate threads of texts, practices, and wisdom, and laying them out in a practical, straightforward way. In Chapter 3, “How to Listen to and Explain the Teachings,” I came across this:

2. Think of the instructor as a doctor. For example, when you are stricken by a severe illness…, you seek a skilled doctor. Upon consulting your doctor, you are greatly delighted and listen to whatever your doctor says, revering him or her respectfully. Likewise, seek in this way a teacher who imparts the teachings…

It struck me that this isn’t the way we consult doctors any more. I’ve mentioned before the fact that expertise, especially doctors’ expertise, has come to be less valued, but more than that, the idea of faith that consulting a doctor (or a teacher) in that way depends on is increasingly rare. Though it’s important that we take responsibility for ourselves, we cannot separate ourselves from those on whom we might rely. This is the paradox that most of us would see around the notion of the guru in Tibetan Buddhism. The American tradition, starting perhaps with Emerson, seems to be to jealously guard the right to make our own choices. However, though I believe Emerson would have also urged us to take responsibility for the results of those choices, that seems to be a vanishing aspect of the American tradition. To make a sweeping generalization, people expect to decide for themselves whether or not they’ll follow their doctors’ instructions (or, as they’re more likely to be referred to now, advice), but the responsibility for whether or not they get well lies entirely with their doctors.

The Tibetan guru seems to turn that arrangement around: Someone else is given the right to make our choices for us, but we must accept full karmic responsibility for the results of those choices. I haven’t yet reached, and may never reach, the point in my practice where I have a guru, but I find contemplating the possibility instructive. We have fairly limited influence over what happens to us, especially if we believe ourselves to be separate from reality, and as we practice accepting responsibility for what happens to us nonetheless, we experience more fully the truth that we aren’t separate from reality. In this way, we finally learn to have faith in reality and not hold ourselves apart from it. If my doctor cannot fix my ear, that’s an outcome with which I’ll have to live, and holding someone else responsible for that won’t make it any easier. And my management has already rewarded my faith in the reality that I’m not currently able to make my professional experience bearable on my own.

Short of being able to actually come into your living room, one hand out for donations and the other hand setting up a slide projector, I figure this entry is about as pushy as I can get. It’s time to raise money again for AIDS Walk New York. Please, if you can, donate here. And as in years past, I’ll match every dollar donated up to $500, so make it hurt. And thanks for your support–it’s deeply appreciated.

One of the many places your donation will be appreciated is Provincetown, one of the American communities hardest hit by the AIDS epidemic. Which brings us to my other hand. Here are my vacation snaps from this past week’s visit to Provincetown. Think of it as a reward for your donation, or think of it as yet another burden imposed upon you by this entry, but in either case, please give if you can.

I’ve been ambivalent about Provincetown for as long as I can remember. It was about thirty-five years ago that I first camped with my family in North Truro and visited Provincetown, which we did every summer for several years. Then, after my parents divorced, my father, my brother, and I stayed in a hotel on the beach in Provincetown itself for a few summers. One of those summers, my father met a woman who happened to have just built a house in the woods on the east end of town on a whale watch (I have no idea what she, as a local, was doing on a whale watch). A few years later, she and my father split up, and we didn’t come up here again for years. I came up with friends in college a couple of times and camped back in North Truro again, and then didn’t come up again until the trip on which my wife and I got engaged.

Since then, she and I have come back pretty much every year, a couple of times twice a year, and stayed in a series of better and better inns. We’ve come on our own, we’ve had friends up at the same time, and we’ve had family up. This is where, five years after his passing, we finally had my father’s memorial service. It’s a beautiful place, with everything that anyone (or anyone I would want to know) could want, from high-end shops and restaurants lining the aptly named Commercial Street, to art galleries and theaters with pedigrees decades and even centuries long, and all of it set in the vast unspoiled beauty of dunes and ocean as far as the eye can see. You can be as entertained, as active, or as relaxed as you’d like. I long for it; I dream of it when I’m not here; I listen to the local radio station and look at the Web cams; and yet when I’m here, it never offers the solace I hope it will. And it’s more than the simple disappointment that follows the failure to realize any unreasonable expectation.

As long I’ve been coming here, there’s always been something besides the joy of it. In fact, despite the continuing improvement in the accommodations and resources at my disposal, the joy hasn’t really increased. And behind the joy, there has always been this desperate sadness, a sadness that is probably best captured by Edward Hopper, often in paintings of Cape Cod landscapes. The light in those paintings flirts with warmth, but settles on an emptiness that ultimately feels harsh and hopeless. It’s the light of a photograph being overexposed, all the detail standing out sharply and then fading, showing how everything will dissolve into void. It’s the primordial impermanence of everything to which I’ve attached myself showing through. In Freud’s terms, it’s the uncanny. It’s the emptiness I’ve known since beginningless time appearing undeniably before me in the form of everything that I want. In Buddhist terms, it’s the samsara I’m coming to understand as the delusion that I cling to as the root of all of my suffering. And in both Freudian and Buddhist terms, these would be excellent realizations for me to achieve, were I better equipped psychically and spiritually to integrate them. Alas, I’m not.

Instead, I spiral into my suffering. I can neither renounce the attachments that drag me into this pain, nor can I simply enjoy them. I grab them and hold them fervently, wringing out and then discarding whatever they might offer me. And I wonder: Is this the collapse of my futile project of ego, the surrender of which will lead to some attainment and perhaps some bliss; or is it just the onset of some sort of psychotic breakdown? I suppose it depends on whether I believe the Freudians or the Buddhists. This started with being a little overwhelmed at work, but it has begun to engulf everything around me. Something’s going to happen.

Yesterday, I took a walk out west along Commercial Street and then back east along Bradfrod Street. When I first starting coming here, those were the two streets that defined the town, the whole of which seemed to lie between Bradford Street and the harbor. Over the last thirty-five years, contemporary houses that don’t fit at all architecturally with the unspeakably charming houses crowded into the older part of town and, worse, row after row of tacky condominiums have been crowded into what used to be the woods and swamp between Bradford Street and Route 6 (and beyond that, the blessedly still protected Cape Cod National Seashore). It occurred to me as I walked along the edge of this development, that little tiny Provincetown has developed suburbs with all of the ecological and aesthetic disadvantages that suggests. Where you once used to be able to walk anywhere you wanted to go in Provincetown, the people living, or at least staying, over there will need to drive everywhere. They’re not near any commerce, recreational activities, or entertainment. Whatever they’re in Provincetown for will require that they drive to it. And I can’t imagine the water, sewage, and electrical demands this places on the very narrow and delicate infrastructure that’s been stretched out here to support this little fishing village and artists’ community. As I had started my walk, I passed the Unitarian Universalist Meeting House, which was advertising a presentation of how global warming and rising sea levels would affect Provincetown (most of which is a couple of feet above sea level). Something’s going to happen.

I started back in therapy, and a few weeks, maybe two months, after that, I started back on medication. I’m starting with Clonazepam, just as I did last time. I hope this is temporary and brief; that it doesn’t drag on and then lead to months or years on an SSRI. In some ways, I’m better off than the last time. I can see more clearly what’s happening, even at just about the worst of it; I’m still able to tell myself that whatever is bothering me will pass; and the pain doesn’t get too deep or intractable. And this does seem to have a more specific proximate cause, though it is still growing out of the same dark, twisted suffering that I’ll be addressing for the rest of my life. It seems that I’ll move from shielding myself from one unpleasantness or another.

The first time around, the unbearable proximate cause of all of my suffering was the noise of our apartment–the drummer upstairs, the summer parties on the decks all down the block, and the screaming unsupervised children in front of the adjacent community garden at 2:00, 3:00, and 4:00 in the morning in the summer. I went through all sorts of treatment and did all sorts of work, but we also moved. We found an astonishingly quiet apartment–not just quiet by New York standards, but quiet by any standards. It’s only when we travel that noise is a problem anymore. And the only price I seem to have paid for this is the ongoing suffering in one of my ears, likely caused by the over-vigorous insertion of an earplug at some point in the battle against noise.

The time around, the problems stem from work, though not in the usual way. Over the last couple of years, my responsibilities have escalated fairly quickly, and I’ve been struggling with what seems to me to be an exceedingly complex and ambitious project. The details are too tedious and subtle to try to lay out here, and some of them are probably confidential anyway, but the point is that I became overwhelmed. My coping mechanisms failed more and more often and more and more seriously. I started therapy, and the decline slowed. At my therapist’s suggestion, I started working out more and taking calcium and melatonin to ensure that I at at least sleep regularly, but still my coping mechanisms weren’t working well enough often enough.

The situation was, if not exacerbated, then at least made more difficult to get a handle on by my Buddhist practice. Though my practice has been invaluable in so many ways, and I do believe that it offers the ultimate means to address my suffering, the mundane walking of that can be painful at times. It offers the insight that allows me to see the impermanent nature of my suffering, and it gives me access to the perspective to witness all of this without actually being it and access to the indestructible awareness that can transcend. But in the worst moments, I find myself asking myself why I’m suffering so horribly from something that’s not real and becoming impatient with myself for not simply not doing this anymore. I lean too heavy on the wisdom it offers, and lose the ability to be compassionate with myself.

And so, with the therapy and the medication, I’ve found again the ability to be compassionate with myself, to allow my coping mechanisms to work and to stop thinking less of myself for needing them. I’ve spoken to my management and told them that I can’t quite handle what I’ve undertaken, and, not surprisingly, they were more compassionate with me than I’ve been with myself. They made sure the project with which I’ve been struggling will be completed successfully, they told me that they will discuss whatever needs to be discussed so I can continue to contribute as much as I have been without it being a threat to my emotional well-being, and they sent me off on this vacation I’m now on with nothing but their best wishes, the admonition not to give work a thought while I’m away, and the promise that everything will be taken care of. I admit to checking my e-mail once, and they’ve been as good as their word. This touches my to the point of tears.

Here I am, on vacation in the place I love most (though a bit before the weather’s quite ready) in gorgeous accommodations, with nearly a week and nothing to do. First, I was just so pleased to be here and to have Provincetown still be here. It’s just so wonderful. I went out and wandered the shops, picked up a used copy of Young Törless to read while I’m here, checked the restaurants to see what would be open, and went to Spiritus Pizza to pick up a MOP for dinner and watched someone from WOMR pick up a stack of pizzas for their fund-raising drive. When I got back to our room to eat, I listened to WOMR, and heard them thank Spiritus for the pizzas. I’m back in the small town I know well, though I noticed that my mind was still running much faster than the context demands. I’m not ready to be quiet and with myself yet.

The room we’re staying in this year is not nearly as private as others we’ve stayed in, and it’s in a newly renovated building that lacks the sound insulation that we’re used to at home. The neighbors upstairs have at least one child, and they’re not very still. The water from the tub, the sink, the toilet, sounds as though it’s running down our walls, and, once again, lying here trying to read Robert Musil, I felt my coping mechanisms going under one more time and the anxiety rising through the core of my body. And so it was back to the Clonazepam (which will require a gradual withdrawal anyway) and all this writing. In that hour, things seem to have unwound some, and I’m going to meditate. But I’m left with these questions: Will I ever be able to be happy unless everything around me is exactly as I want it to be? Do other people feel this way and just deal with it? Will I ever get away from all of the distractions and difficulties that I feel plague me so that I can just be present and with my wife now, not in some future ideal situation?

I just read through Nicholson Baker’s Human Smoke. It’s an unlikely page-turner, but it is a page-turner. It is, as its subtitle claims, an account of the beginnings of World War II and, Baker feels, the end of civilization. Many writers have assumed that civilization ended at some point in the twentieth century, and each has advanced his or her candidate moment or event. In Against the Day, Thomas Pynchon (or one of his characters) suggests the beginning of World War I. But Baker seems to mean something specific by the phrase “the end of civilization.” What he draws attention to over and over again throughout the book is the way in which World War II was significantly, perhaps even primarily, fought by armed forces against civilians, starting with Great Britain’s blockade of much of continental Europe and terror bombing of German cities, continuing through Germany’s Blitz of British cities and, of course, the Holocaust, and culminating in the United States’ firebombing of Tokyo and atomic bombing of Hiroshima and Nagasaki.

Baker clearly means this book to be a provocation, and he arranges his material to make his point, yet he manages to maintain an even, almost flat tone while marshaling his ultimately persuasive argument. His method is a sort of factual pointillism, stringing together short entries (most about a paragraph long, with none more than two pages) in strict chronological order, starting at the end of the nineteenth century and ending at the end of 1941. It proves addictive, pulling the reader along entry after entry. And as dry as it might sound, it conveys a disconcerting sense of immediacy and intimacy. On finishing the book, I felt sort of like I’d lived through that time (admittedly at some remove) and knew many of the central players as people I’d met, rather than as icons or historical figures. And by and large, they’re not the historical figures I expected. This is a deliberately, patiently, and persistently revisionist book. Herbert Hoover is a tireless, faintly heroic advocate for the welfare of the starving masses of Europe; Franklin Roosevelt is a Machiavellian anti-Semite; Winston Churchill is a dangerously charismatic sociopath; and Hitler, well, Hitler is still Hitler, but somehow more plausible. Having recently finished Dante’s Inferno, I couldn’t help but picture Churchill and Hitler below us now in the ninth circle, in the ice up to their necks next to Ugolino and Ruggieri, with Churchill gnawing Hitler’s head for all eternity.

This book also suggests a different perspective from which to view our current misadventure in Iraq. From this perspective, the machinations that the Bush and Blair governments went through to get us into it, as ham-fisted as they undeniably were, were nowhere near as bloodthirsty or plainly Rube Goldbergesque as what the Churchill and Roosevelt governments went through to get us into war with Germany and Japan. The disadvantage under which our current leaders labor is the increased transparency allowed by advances in communications and related technologies. Ever since, say, Vietnam, it has been harder and harder to unify populations behind war efforts, and it has been harder and harder to conduct those efforts with the brutality that war seems to be require for success. And on the whole, that’s probably a good thing.

When last we left my ear, the left one that is, the lining of its outer canal and the ear drum had, after a tympanomastoidectomy and against all of the known laws of medicine and biology, turned themselves into mucosa. Odder still, all of the difficulties typical of this sort of surgery were averted. The cholesteotoma was successfully removed, all of the grafts took, and the hearing was returning as expected. But with the tissue stubbornly remaining mucosa, my hearing can’t get much better (at least not very quickly), I have to keep my ear dry at all times, and even then, it’s ridiculously susceptible to infection, meaning I get a regular diet of antibiotics that’s probably not a great idea in the long run.

Last week, I visited my doctor’s mentor, which put me three or four rungs up the specialist ladder, and I don’t think there are any rungs above this one. He looked into my ear, asked a few questions, and said there were really only two options available to me: leaving things as they are or doing the surgery again. He recommended doing the surgery again, with the slight change that a single large graft be taken from my hip (rather than the several small grafts taken from behind my ear). He also said, without my even having asked, that the hearing would never really recover in that ear, though he quickly qualified that by saying that he hadn’t seen the full history of my hearing tests (he’d only seen the most recent one). He then went on to assure me that my doctor is an excellent technical surgeon and, for good measure, he cauterized my ear.

I had a little over a week to think this over before going back to my doctor, during which Jeannie stopped by to share the story of how badly her cholesteotoma surgeries had gone. I admit to feeling lucky in comparison. Though my hearing hasn’t fully returned and there is some ringing in my ear, the situation is one I could live with without complaint if it were permanent. As annoying as some of this has been, I haven’t suffered in any meaningful way, and unlike any sane person, I actually don’t mind going through surgery. I find the whole process fascinating, especially when I trust everyone involved, and I love the idea that I don’t really have to do anything but be attended to for a few days. And it’s the only time I ever indulge in anything even remotely like recreational drug use.

I went back to my doctor this morning, and we discussed everything. I’m actually developing more of a rapport with him than is usual with a surgeon, and I find his prototypically geeky combination of expertise and childishness charming. He was so proud of his mentor, and he wanted me to be, too. After reviewing all of the background, options, and implications, I asked him what he would do if it was his ear. He said given my youth, he would have the surgery. He said I would have to live with this ear for a long time, and that being otherwise very healthy, I should heal quickly. (It’s nice, now that I’m forty and it feels a bit like I’m falling apart, to be told I’m young, hale, and hearty.) He couldn’t imagine that I’d end up any worse off than I am now, and I might very well end up better off. He admitted that he couldn’t tell me how likely this was to work, since what he’d already done should have worked. And then he let me think about it. I decided to go ahead, and now I’ll spend Memorial Day weekend recovering from surgery. I kind of wish I could get it done sooner.

There was an interesting aside in this discussion. I mentioned that the hearing isn’t bothering me, and if that were the only problem, I’d be relatively happy. It’s just the other implications of the mucosa that are bothering me. I told him that in reflecting on this over the last week, I wondered if there was a way they could just replace the tissue in question with vinyl or some other inorganic substance. I wouldn’t have any hearing, but I wouldn’t have the issues of moistness and infection. He said that there actually is such a procedure where they block the ear canal. He said that hearing is reduced, but not destroyed. Yet he wouldn’t recommend this for me except as a last resort because it’s destructive and he still has hopes that my ear can be fixed. I found this comforting first because such a thing would be possible and second because it’s not yet necessary. It’s nice to have options.