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Homelessness in America has been a socially scandalous epidemic for some decades now.  And, of course, not just for the current generation of immigrants.  My spouse and I dined recently at a cheap joint a few blocks from our city home.  As we exited into the cold January night of the northern Midwest, we ran into one of her former co-workers who had just been laid off from his pressman’s job at a regional newspaper.  We stood between our two cars in the dimly lit parking lot while the two of them chatted about their former work lives.   My wife had been one of the newspaper’s long time photographers until her retirement a few years ago.

Stealing a glance now and again at the man’s old Chrysler mini van, I could see sheets, a sleeping bag rolled out, and personal belongings filling the automobile’s interior up to the windows.  He had not been very many paychecks away from homelessness, and was attempting survival in the North Country winter in his van.  Unfortunately, he was only the most recent in a series of persons rendered homeless in our area of the world.  When I wrote THE COST OF DREAMS, I had ample images readily at hand regards human beings kicked out of their residences by the landlords and the banks.

One summer as I worked on the book, I walked out into my local bank’s parking lot to spot a young man on an early Saturday morning stretched out in the back of a small Ford station wagon.  I drove home and described the scene for my family, and a friend visiting that morning knew the young fellow, who worked for a sub-survival wage at a local restaurant.

In my novel, the Latin American occupants of an old rusted sedan know all of the associated problems occasioned by living in a car.  The young children have no consistent access to proper schooling and education, which positions them for a continuance of a life of dire poverty.  And they’ve nothing for decent and dignified access to proper hygiene, to toilets, or to laundry facilities.  Moreover, my characters know no peace, living in fear night and day of deportation and/or jail for the simple earthly crime of hunger, and of having crossed a border to eat.

In THE COST OF DREAMS, immigrants from Mexico haul a terribly wounded adult woman, who has been shot by her husband, from the southwestern US to the northern Midwest in an old automobile.  By the time and occasion of her medical attention in the North Country, the dreadfully injured woman has crossed the mid continent paralyzed and filthy.  Her gunshot wounds are seriously infected, and a craterous pressure sore into the fat of one buttock has achieved a diameter of over six inches from lying in the car in one position for weeks.  These events, by the way, reflect a back-story of a homeless person I cared for at my hospital over fifteen years ago.

Social problems always and forever have social roots.  The social wealth created by working persons has been stripped out and handed to the largest banks in America, in an utter and contemptible gluttony of the financial aristocracy.

It is a social disgrace.

I traveled to Central America during the dirty little wars of the 1980’s, when mercenaries (today they are called “private contractors”) were maiming and killing impoverished workers, farmers, and Indians to protect local dictators and their wealthiest cronies and families that held virtual all of the society’s assets.   One mid day I sat on a café veranda in a small city with several co-workers when I noticed that one of the women at my table was very studiously wiping the rim of her drinking glass with a handkerchief.  Marta (real person, fictional name) was from Mexico City, and was attending graduate school at the University of Wisconsin in Madison for her doctorate when she decided to travel with us.

“What are you doing, Marta?” I asked.  I was taken with the peculiarity of such a gesture.

“I am trying to not get sick,” she replied.

Being the medical officer for our little band of co-workers and visitors, I pointed out the futility of her efforts.   “You are just moving germs around the glass, Marta.  Plus our beverages and food will be hopelessly contaminated.”  We were also guests in workers’ homes, and not residing in multi-starred hotels with clean food and water provided for other tourists.  I had dispensed anti-biotic pills to my troupe, to be taken each day “preventively,” of undetermined effectiveness.

We both recalled having sat with a writer from Boston on the flight to San Jose, who informed us of her nearly dying at a local hospital from food poisoning on a previous trip to the region.

Marta had elaborated, “When I moved to Madison, I could not believe it.  Within a week, I was well.  In Mexico City, I was sick all the time.  All my life, my parents, my siblings, none of us really well a single day of our lives.”

Marta was pointing to vital societal differences between North America and Central America and Mexico.  At that time, US taxpayers were still adequately funding a very critical segment of public health for citizens to “be well (most) all the time.”   The municipal provisions and laws and money guaranteeing clean water, with its consistent and reliable separation from sewage, will always constitute one of the most important measures of a modern and healthy standard of living.  If coli-form water flows out of a residential or commercial faucet, no one can clean his own hands, or properly cleanse fresh fruits and vegetables.  For a very long while, that has been an assumed basic social provision in the United States.

On a Sunday some weeks ago, the New York Times published a long article about the defunding of this feature of our modern lives, and the resulting breakdown of public health.  Over forty large cities were sighted in the article, including New York, with profoundly antiquated water and sewer systems.  Public health officials have been tracking the flooding of sewer facilities during heavy rains, and the visits to emergency rooms for gastrointestinal illnesses by the city’s residents.   It turns out there is a surge in use of health facilities, coincident with the rains, occurring in NYC at least once a month.

With the breakdown of funding for infrastructure in America, I have been wondering if I will see other “Marta’s” making the futile gestures of trying to wipe away the source of illnesses in the era of a shredded social contract.


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A book reviewer asked me yesterday if the title of my first novel had always been THE COST OF DREAMS.   I answered, “no.”  I had called an earlier, much longer, and terribly flawed draft THE DISAPPEARED ONE.  A potent and intriguing enough title I think, and not at all a bad fit for the later manuscript.  But I made the change because I wanted to reach a little deeper into the suggestion of what the story, or several stories interwoven, might offer to the interested reader.  Rather than the single and narrower event of a person vanishing, and leaving the reader and the characters in the tale simply wondering if the “disappeared one” would ever be found.

As the nation state elites the world over recklessly and irresponsibly rattle sabers at one another ceaselessly, their respective working citizens (and employers) aspire to a secure future, probably without exception.  And depending on their local circumstances and living conditions, they may strive to work life out where they live.  Or they may feel the urgent need to move to another country or part of the world to work and eat.  Or they may need to flee emergently for their lives, such as our characters in the opening scenes of THE COST OF DREAMS.

The characters in my tale are wracked by their dreams:  by their aspirations for a secure future with proper nutrition, decent shelter, absence of violence (to which so many are subjected in Latin America and Asia and Africa), education, quality public health and the fruits of a modern existence.  All too frequently, their dreams are ground to dust by nightmare recollections of what they’ve been through in their struggles for survival in their countries of origin, and in their migrations.  Recollections that torment them night and day, shaping and scarring them, sometimes to the point of living dysfunction and drug addiction.  An equivalent of posttraumatic stress disorder can threaten the working poor to pandemic proportions, most especially with parts of families injured, sick, and dying while on the move and striving to stay together.   A strain that can bring them to sanity’s breaking point.

Such circumstances bring the main character of my novel to a point of quite extreme desperation.  Flora Enriquez perceives herself in dire straits, and risking the lives of her most reliable companions on earth, enters the most remote wilderness of northern Mexico in search of a shaman and the healing realm of his dream making.  This being her personal attempt at mending the wounds of her suffering travels.

Though I am thoroughly a modernist and not given to religious practices of any sort, I found very interesting (and I certainly respect) the aboriginal concepts for sleep and dreams that are deemed essential for healing and for sorting out the meanings and problems of living.


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My publicist asked me recently, “Why do so many doctors turn to writing?”   Which gave me pause.   Until I saw that my life, my brain, had become so packed with “back stories,” enough of them exceedingly dramatic and interesting, that I could almost do no other than struggle to deal with them, to assimilate them, in some productive and creative manner.  Otherwise, I think the “subtexts” of my existence were going to script themselves into my day-to-day living in some unhealthy and dysfunctional manner.  The more vital past events were looming larger and pushing to the foreground in my life, demanding an accounting.  This reality, and no other that I can see, is the origin for THE COST OF DREAMS.

William Faulkner said it best, “The past is not dead.  It’s not even passed!”

The following two subtexts demanded an especial mental and emotional reckoning in working up my first novel:

Firstly, I attended a young foreign-born woman in my hospital’s emergency department a number of years ago.  She had been shot and dreadfully wounded in her neck and face by her cocaine-dealing brother-in-law in southern Arizona.  Her husband had driven her and their two small children to the northern Midwest some months later, where I found her to be very ill from her inadequately treated, infected and unhealed injuries.  She was totally disabled.  After several surgeries and sufficient treatment, she required placement in a skilled nursing facility, while her husband dropped the children off at another relative’s home.   He then drove away and abandoned them all.

I directed her care for a protracted time, until she drifted away to another nursing facility in another city, I know not where.  I always felt very badly for her and the fate she suffered.

Secondly, I had traveled to Central America on a medical education trip many years ago, and came home to read that a young engineer from California had been murdered not so far from the region where I’d resided.  Travel mates of mine in San Francisco attended his memorial service at a large public auditorium, which I was informed was filled to standing room only by well-wishers, his friends, and his family.  He had been working on a project to bring electricity to a remote village, only to be brutally murdered by that country’s military.  A US national news magazine published all the horrifying and gruesome details.

Some had said to me, “well, he just threw his life away,” or “what a waste.”  To which I could only reply, “Complete nonsense!!  That young person’s wonderful life was stolen, unlawfully taken from him, while he attempted to elevate the standard of living for highland villagers.”  I could not permit the notion that the young man was to be blamed for his own murder.

These two aforementioned “back stories,” and the genuine human beings living them, I have never forgotten.  And now, everywhere I go, I have begun to see stories that I want to write.

I worked as a doctor in a small city of the northern Midwest for almost thirty years.   As most of my former colleagues will attest, it’s a very interesting and very intense line of work.  I finished my first novel, titled THE COST OF DREAMS, about a year and a half before my retirement.   Anticipating that I would have a difficult first winter psychologically after I quit (and I certainly did), I wanted a job waiting for me off-stage, wary of just winging it after I walked out the door.   Almost no matter the reception the book receives, I am very happy to have the work.  It is also very interesting, but not so intense as my former job.

If I may quote Jane Smiley from 13 WAYS OF LOOKING AT THE NOVEL, “What is difficult is not to write something new but to write something interesting and true.  As any piece becomes interesting and true, it becomes original.”

I attempted keeping to that little dictum as I assembled THE COST OF DREAMS, a tale about a family living in the downtrodden strata of humankind, about half of the planet’s inhabitants of whom are striving to survive on $2 a day.  Not infrequently, I would see such persons in my former job, from the USA and from around the world, much in need of healthcare attention, and little or no means of obtaining it.  The dignity with which so many strove for a decent life forever moved and impressed me.

We do not live in a just or healthy social order.  And believing as I do that social problems have social roots (as opposed to say religious roots or stemming exclusively from individual personal failings), I decided to tell tales in that context, as “interesting and true” as I am capable.

I want to do four more novels.  The next will be set in New Orleans at the time of Katrina, a human cataclysm of such immense historical importance and consequence, we are incapable of measuring it today.  By rights, the events of that summer should produce a few hundred “interesting and true” tales.  I will attempt to find the thread of one of them, peopled with persons and families striving with their measure of dignity for survival and a better life, with their federal onlookers flying over and standing by.

The third book will be set in Detroit, the epicenter of America’s industrial collapse.  Formerly, it was a city in which workers had the highest standard of living anywhere in the US.  This October, fifty thousand souls showed up at a housing agency, seeking assistance available for three thousand.

As to novels that will follow, I must keep my options open and remain attentive to the events in the human community.