Another Story Entirely

She rose waning in her majesty, as pure as silver, before the dawn of passing into early Spring, after Eastertide, the moon to regulate the clock, twentynine, twentynine.

As small the silver pendant about grandmother's collar, above her rich low breasts, darkness through crescent her skin.  Crescent?  Is it the waxing moon that sets, or in waning, rises?

A theory, to her.  Their moons were orderly and dull, about the ecliptic of their planet, no declination; staid and ordered, far.  There was no eclipse at her home, but a brief dimmingnowagain, on the equinoxes - only around the equinoxes, staid as rain, placid.

It was only The! Moon! that rare celestial orb, that ran impudently on the solar plane, the Ancients might have riddled out her secrets, were She tame and docile.  Not!

So northers the Sun, so southers the Moon in ripeness when in full; and the ancient solariums, and lunariums thus, saw their oppositeness in course.  How much of humans' nascent thoughts drew towards natural duality, for so did the Moon in her slightness rival the Sun in his thermonuclear might?

Grandmother's mark was hers only.  The Learned had their ranks, numbers; she did not know how rare was a Solitary Mark - it was like a name, a cognomen of which few had and none the same - that mark was not Grandfather's.

"Tell me Grandmother," came back the distant whisper on the predawn wind and rain, "how came it to be that we are Dark?"

"Of the time, the Awakening, of course you know, several hundred years ago, much is held in secret.  What is your rank, then, three?  Little can I tell you."

She blurted out to Grandmother, "Of course I am Three!  You know that!" a bit impudently; for a young girl her age, she was bold; Grandmother smiled.

"Sometimes the decisions during the Awakening were wise, or sometimes foolish.  Nevermind.  We do not change what was in error; they were often fools to us; but we may be fools to the next generation, and the next and next - so when the die is cast, we let it settle."

She frowned, unsatisfied.  There WAS more.

Gemeinsamschact, morgens früh um sechs

Morningtide

Caleb awoke refreshed - !scrubbed! - after the night's mental laundry.  He could remember that the detectives had deduced some great truth about magnets.  He stood by the refrigerator, idly pulling a small magnet off the door, and letting it pop back on.  It made him snicker.  "Boum!  Boum! Boum!" chuckling like a toddler.

Syra called out to him from the monitor in the breakfast nook, "Do you want your day's schedule?"

"Shut up and leave me the hell alone.  Turn off while you're at it."

Nag.  Nag, nag, nag, nag, nag.   He didn't give a damn what trivial crisis 'o' the day would be today and unfold to ruin his Thursday.  Syra, thank God, did NOT follow him to work; he had another CGI assistant there.  She didn't have a name.  He liked it that way.  He fired them every couple of weeks, anyhow.  A new face, a new voice would come in, just like the old one.  Bla, bla, bla at the home office.

No chatter from Syra about calling Kathryn -or was it Karen?  Better goddamn NOT!  He buttoned his collar on the way, clenching a piece of toast between his teeth.  Chuckled.  Magnets aren't real!  See what you get for puddling around in the old ways of thought - cogitating, and getting nowhere!  Without a roadmap, it's all hiking through Swampville.

AfterThought.  AfterThought, AfterThought.

Gemeinschaftspraxistraum

As the leaden rain spattered mournfully on the windowglass, the two gentlemen sat in the study, a glass of amber, a glass of burgundy in the hand, fire stoked against the winter's chill.

"I am in the occasional habit of corresponding with a telegrapher, Watson - a fellow of a most keen and inquiring mind.  Late in Denmark, but originally of Camden, he came up with some most cunning inventions in telegraphy.  Heaviside is his name.  Have you heard a bit about him?"

"Yes, a reclusive gent, I hear.  Nephew of Wheatstone, is he not?"

"Indeed, a bit eccentric fellow indeed.  He became intrigued with some writings of James Maxwell about the conductance of electricity, and seemed to become a bit unglued with it, Watson.  At first, in conversation, I could not be certain whether his postulates were adherent in some way to reality, or merely the wanderings of an overly-brilliant mind into whimsy. 

As I understand his meaning, he offers four postulates of Maxwell's thought, as firmly enraptured by them as any new convert to a religion.  The first two postulates, as I understand, involve the inclosures of charges of electricity and magnetism.  These do not intrigue me as much as the latter two,  which involve the whirling of the various fields electric and magnetistic.

 Heaviside postulates that a magnetic field will whirl about a changing current.  This is merely Faraday's law of induction, you may recall.  In a proportionate sense, an electric field will be generated to whirl about a changing magnetic field.  This is only Ampére's circuity law; but with a change that incldues Maxwell's stipulations."

"Holmes, I fear that you have lost me in the whirl of these things.  What is  interesting about this fellow who reformulates what is known?"

"Merely this.   Let us purport that we have a cannon which fires an electrically charged object.  It can be easily designed by the coiling of wires in a clever manner, to fire off the object at a very great velocity."

"Clever, that.  What of it?"

"Well, as any inventor of an impressive and clever invention might have it, our inventor replicates the device, and now has two of them."

"Good show for him.  And now what?"

"He has interconnected each, to fire off two identical charged particles at an extremely great velocity, comparable to the speed of light. Relative to each other, of course, the two have no difference in velocity; therefore, they seem to each other to be at rest.

From the perspective of the objects, being similarly and equally charged, they repel each other with great force.  However, from the perspective of the inventor, the burst of velocity imports a terrific magnetismal whirl around each object.  the whirl acts upon the other to restrain its flight from the other, so much so as they nearly fail to move apart whatsoever!  That's the paradox.  Do they act on each other electrically, or not?"

 I fear, Holmes, that I question the substance of reality itself.  How can one thing happen to one observer, but to another might be absent?

"Here's the interesting part, Watson.  A Dutchman Lorentz, and a certain Swiss physicist have postulated that things that are in motion and things that are at rest, have a different perception of time itself.  Their postulate would claim that the difference in perception can solely be attributed to different time-pieces, as it were, on the observer that is moving, and the inventor's timepiece."

"Clever, then.  A continental explanation, and a good British explanation.  But mutually exclusive.  Good for inquiry, that - keeps the mind sharp."

The man with the pipe jumped out of his chair, energetically.

"Don't you see, Watson - don't you see?  The deuce is, each theory - each explanation is absolutely and incontrovertibly correct!  Both must be occurring - at the same time!  The only credible way to wed the two is that magnetism - that simple movement of the compass, the pull of the magnetite against iron - magnetism  itself is completely and utterly fictional - unreal!" 

,   

.

die Gemeinschaftspraxis, zwei

Brainfart

Brainfarts would sear across the night sky like shooting stars - brilliant, meaningless to the knowledgeable scientist, portending nothing.  The ancients looked for wisdom in their fiery trail - there was none.  You could measure the ionization spectra of atmospheric gases.  If you wanted to. Not phaeton, not phoenix, nor haephestus' rock, brainfarts were simply the stiff wire brushing of the mental dendrites, shaking off the debris of the day. Lift yourselves by your own boobstraps, comrades!

BF-Ekphron

Ekphron, ekphron, the poet of old.

Used to think things so his brain wouldn't mold.

It would dull up the bite of the cruel winter cold,

Sa-something, sa something.  Ba-diddy-dold.  

 Reality

Screw the date, screw the thinking, stop it.  Caleb walked away from the computer screen.  The delight of dealing with Robinsons is never having to say you're sorry.  He went to bed. 

die Gemeinschaftspraxis

Clinic.

Caleb was crabbed.  The Goddamn Little Boss had come in from Corporate, breezing in without announcement, and bitching as usual about the work and production and such.
She hated the coffee.  That was unexpected, but since she didn't have a goddamn clue about what she was talking about, ever, she usually bitched about some witless triviality, just to make him feel cramped and irrelevant.  She fumed about the coffee and made him miserable.  She whined about Dr. Lucius, and carped about Dr. whats'er name, Peggy.

He ran a good clinic.  Screw her!  He had a degree in automated business management, and was certified, and did all the lousy things that the corporate idiots came up with.  It was fifteen more years until retirement; a slow and dense creep of the years, through the seasons, day-by-day.  And was a physician.

CGI had been a fun part of this horrid job, though.  The first halfway deployable CGI clinic heads had come out about five years ago.  Really, they had started during the medical melt-down at the end of the decade.  Everyone was scrambling to do something, and CGI had pretty much saved the day.

Alisha was the first.  Looking at her nowadays was pretty painful, of course.  Artificial something-something.  Around the time that broadscale DNA sequencing was deployed, the amount of information skyrocketed.  Nobody could even find anything in the goddamn medical chart, there was so much obligatory documentation and crap - oh yes, and then!  The videotaping of all encounters, God!  That was supposed to be easy and smooth like every other god-damn adventure, and transcribing!  All that transcript for every encounter was a mandatory part of the medical chart, along with the god-damn videotape as well.  That pretty much started the crisis.

Artificial lexical instruction something-something.  She was initially designed to carp at the meats, instruct them about their followup and their stupid lives.  They could take home the video instructions - so few meats these days could read, at least read anything they could remember.  They were much happier with this setup, than getting some piece of paper they would lose on the bus.

AlishaMD was just a mock-up head with Integrated Best-Practices access capacity, supposedly in real-time; she stuttered and paused, and looked like the Max Headroom videos of fifty years ago.

The meats loved her.  They flocked to her, they bonded, they talked, they wouldn't get out of the goddamn room.  The CGIMD project was nearly canned, until the Big Light Bulb went off - who gives a god-damn how ling the patients take in the room chattering with the electronic head?  Screw them!  Build more rooms - buy more monitors!  The stupid meats can sit in there all day and chat with the talking head!

And they would.  You needed special flow engineering to get the meat out of the seat.  It wasn't like the spin-cycle ten-minute get'em'out of the old days, but they had to be prompted to move along.  The CGIMD was set up to regulate meatflow; prompts to moove on, during the busy days and chatter-on all you want, if it's slow!  Flap that meat!

Caleb stormed into the break room.  The employee meat scattered like quail.  God, that place used to be packed with whining employees and the smell of sour milk and hopelessness.  Only Phyllis remained.  Phyllis would never miss a break, or lunch either.  Something was slowly heating up in the microwave - it smelled like peppermint sauerkraut, with some sort of revolting knuckle spinning slowly on top.  10:15 and that's gonna be the Smell of the Day in the break room.

It used to be jammed; now, even during lunch, it was cavernously empty.  Phyllis sat reading some paper book that was tattered, and looked unclean. 

Phyllis was the Last Problem Doctor.  She was the last doctor left on the staff.  She was aging in a spectacularly unattractive way, with orange hair, thinning on the crown, you could see skin.  She had flabby, fleshy earlobes, and a drab and slow demeanor.  She was from someplace out West.  She trained out West someplace, eons ago.

He said hello, but she did not move, and the peppermint stench continued to build slowly. 

"Your DFP's were down last cycle," he offered, "good job."

 She looked at him like a cow looks at a wet gate.

"Keep up the good work!" he repeated, cheerily.

"I was out sick for two days," she replied.  "Probably that was why."

Deviations From Procedure.  Mistakes from the past, bound to become a long-forgotten nuisance in a few years.  With Phyllis, it was always DFP's at least.  Best Practice clearly stated what to do for every class of patients.  For the Robinsons, it was easy.   They could simply crossmatch the patient's DNA sequence and Integrated Best Practices, and tell the patient what they were doing.  It was always correct according to the best practices.

But Phyllis, she went off in every which way and did what she felt like doing.  She must have had a guardian angel - it was always DFP's and not Practice Deficiencies - that was what they called it when a DFP went awry.

DFP's were still a problem; they damaged the database by doing nonstandard procedures, and couldn't be used to bootstrap up the revisions of the IBP.  Phyllis was lucky.  Maybe it was her bovine dullness that made her lucky.  Her DFP's didn't seem to produce bad results.

Her feedback ratings were the worst.  Sometimes, she didn't brush after lunch.  She had a cadre of loyal patients, as happened - but so did the Robinsons, The meats belonging to a Robinson were usually much more sympathetic and worshipful.  The Robinsons were like rock stars to their patients, sometimes.  He forgot why they were called Robinsons, the CGIMD's.  It didn't matter.

 Brainfart.  

Axillary ozochrotia.  Osmidrosis.  ABCC11polymorphism.  The Diné say that Bilga'ana smell like dead people.  Humans stink.  Lamb smells like lamb - you have to eat it with mint to cover up the smell.  Goat meat smells like goats.  And human meat smells like humans - a secret that some doctors learn in the autopsy rooms, if they're paying attention.  It's as classic as the lamb smell of lamb.  Bacon is bacon.  Meat is meat.  Once you learn the smell, it's everywhere.  The Diné must've choked on it.

Interview.

He had to interview one of the Robinsons, Dr. Karen Lucius.  Central reported that she was not polling well with older female patients, and Caleb had to have a talk with her.

He went down the hall to her examination room.  Actually, he could have gone to any examination room - it didn't matter, as he could call up any Robinson to any room.  They had their "own rooms," with suites, so that the help could "assist" if needed with any physical examination details.

The patients seemed to be stubbornly attached to their own Robinsons and their own waiting rooms, soothed by the ritual of care as much as anything else.  The schedulers, in fact, found that the patients gave better ratings if the doctors were ever so slightly late in their visits; it gave them some sense of familiarity, somehow.

Talking Heads, CGI's were everywhere now - they took the unpredictable and unpleasantness out of necessary encounters.  Obsequiousness was the norm - everyone had their own home assistant CGI to handle the details of their lives.

Caleb brought out the controller and pressed in.  He walked into the examination room and sat down.  Dr. Lucius was writing at her desk, the motions and the human movements - the breathing and eyeblinks - showing concentration and alertness.  She did not "know" he was there, as he had entered on observation-only mode.

The desks all had "family pictures," of course - especially for the female doctors with female patients.  This touch improved image management, as did all the other props; an old-fashioned coat rack for the white coats and stethoscope - the whole thing.

He pressed "instruct" and she looked up blankly, awaiting orders.  He smiled slightly, feeling a sense of order and importance wash over him that had fled ever since Little Boss had thrown off his groove.

"New patient visit, 63 year old female with well-controlled hypertension."

Dr. Lucius looked up with a gentle smile.  "Well, hello!" she said.  "I'm Dr. Karen Lucius, and I'll be your primary care doctor.  It's wonderful to meet you!"

Bang.  There it was.

"Before we get started, Dr. Lucius, tell me a little bit about yourself."

She smiled.  "Mrs. Smith, please call me Karen.  Well, I'm a full-time doctor here in this clinic, and I'm also a mom.  I'm thirty-five years old, married with two wonderful children., Ken and Adele...."

He hit the pause button.  It was her cleavage.  Her tits were too high for a thirty-five year old mom, and her cleavage was showing - very pleasant - but too much for an interview with an older female patient. Paydirt and just right for an old codger; but a little too showy for older female patients.  He pressed the instruct button; Lucius halted, stood and rested, breathing subtly.

Caleb watched her breasts gently rise and fall.  Very nice.

"Appearance and movement change.  Demographic, older female.  Let's take the breasts down about an inch or two.  Leave the cleavage alone but soften the highlights.  Mole to the upper left chest about two inches from base of cleavage; more sun damage on upper chest."

 That did it.  A little less noticeable for Granny.

"Save that.  Interview, Dr. Coflin.  Performance rating."  then as an afterthought, "revert changes temporarily during interview."  He really enjoyed looking at her cleavage.

Her face grew more serious, a bit pensive, still smiling.

"Karen, I've got to talk with you about your performance rating with older female patients.  Do you know any reason that you might not be keeping up with their expectations?"

She looked worried.  Perfect method acting, these Robinsons.  Her smile dropped.

"I don't know, sir.  Perhaps I've been showing a little strain recently.  I promise that I'll try harder to engage and support my older female patients."

"Well, you just do that.  I don't want to come back here one more time to deal with this problem."  He scowled and leaned across the desk."

That was perfect.  It got all of the bad feelings that the Little Boss left behind, out of his head.

"I'm sorry, sir.  I'll try to perform a little better."  Smile gone, crestfallen downward gaze.

He pressed the instruct button.  "Interview over. Resume.  Observation-only."  Karen returned to her imaginary note-taking.  Caleb sat and watched her.

One benefit of having Robinsons in your clinic was that you could do absolutely anything you want with them.  No employees with hurt feelings sobbing in the break room; no bad days, no dysmenorrhea, no back-talk.  No bitching.

Keeping a distance is one of the big matters in working with the meat.  The heads didn't need to be handled with kid gloves - go ahead, yell at them!  Belittle them!  Insult them!  They're Robinsons, it's therapeutic!

Hitting on the Robinsons was not a big deal - you can get fired for doing that with the meat.  In fact, the leadership encouraged having "relationships" with the staff, if you wished.  Anything!

CGI sex had improved so much that it was getting blurry to tell what was real and what was virtual.  Some clinic leaders had relations with all their staff; who cared?!  It just evoked the same "bonding" feelings with the Robinsons as though they were somehow real humans - and that trick was the secret of running a CGI clinic.

Caleb hadn't slept with a Robinson since his divorce, a year ago.  He'd mixed it up a little afterwards with one of his Robinsons, a feisty little Mexicana doctor named Lupe.  Anger issues got the best of him, though.  He'd gotten in an argument with her - yest, you can even argue with them, if you have a relationship!  But he 'beat her to death with a hammer', which surprised him.

Central doesn't mind, of course - the Robinson shows up right as rain the next morning at work.  Domestic violence doesn't lead to absenteeism, another benefit of employing heads.  But everything you do is watched, and Corporate figured out he was pretty stressed from his divorce.  Lupe 'went to another clinic,' Caleb got some treatment for depression - which really helped! And he had sworn off sex for a while, with meats or Robinsons, not having any sex drive for a long time anyhow.

Dr. Lucius' cleavage brought up a long-forgotten tickle, and he was bored, so he thought he'd flirt with her a little.

"Instruct.  Resume discussion.  Private."  Not part of the performance interview.

She looked up from her paperwork, and then back down, suddenly crestfallen.

"Karen.  I hope I didn't hurt your feelings.  I hope you know that was just business.  I really like the way you do your job."

She responded with a smile.  "I'm sorry, Caleb.  I've just had a lot on my mind."

"Do you have some time free after work?  I thought we could maybe get a drink."

 "Sure.  My family's out of town for a week, visiting the in-laws."

"That sounds great, Karen."  He got up to leave.  "See you after work."

Brainfart

 

Turing's tensor is simple.  T=⟨Q,Γ,b,Σ,δ,q0,F⟩ in the archaic formulation, or ⟨Λn⟩ in an ordered septuple.  Λ1 is topologically intransitive after the space is defined.  Neither manifold nor diffeomorphism, Turing space cannot be mapped smoothly onto realspace-seven.

 Apartment

 Of course, one doesn't take a Robinson from work to a bar, or dinner, or home - they're CGI's after all.  But a clinic supervisor has all the freedom he wants to play with them at home.

He could do all sorts of things, even more than one can with a meat - change them down, make them talk dirty, make them dress up - whatever!  What happens on the home computer, stays on the home computer!

He once gave a CGI date a 'breast growth medicine' only known to CGI world.  Her breasts grew slowly, to the size of softballs, bursting her blouse and bra - the size of soccer balls, and firm!  The look of astonishment on her face was priceless!

He called up Karen on his home computer.

......

Campesino Medicine

Of my patients

I am a physician.  Most of my patients are Mexican.

Of course, we stop and scrutinize everything that mentions another culture or country, and parse the phrases for their political correctness, so let’s, for a second.  It is politically alright to call my patients Mexicans, I’d say, for they are from Mexico.  Most are not in any sense not Mexican-Americans; excepting a brief continuation of their stay in the United States, they are here illegally, awaiting deportation to Mexico.  The few I see who have lived since childhood in the US are a whole different sort.  I treat them in English; they are completely from a different universe.  My patients are from Sonora, and Durango; from Baja California Norte, and Oaxaca.  Mostly, their “business enterprises” have brought them here; I do not discuss their “business” background.

They come from a broad range of cultures, abilities, education and origins.  Here, in the US bubble, we sketch our pictures of Mexicans with the broadest strokes.  Our image of Mexicans is really a cartoon; our amigo bueno, Gustavo Arellano will tell you that in “Ask a Mexican^®” in the Orange County Register, and in the local Alibi.   For those bothered by the logo on his column (right), one can click on it and take it up with Mr. Arellano and Mark Dancey.

I shall not dwell overmuch on political correctness in terms.  Political correctness is often called upon to fill up time in the absence of real thought, and to generate purposeless dispute and bickering, in the empty echo-chamber of modern thought.

We think of the campesino – the fieldworker – most of the time when we speak of Mexicans.  We do not think of the Museo Soumaya, a museum which contains a preponderance of the works of Rodin and other Impressionist artists in a boldly modernistic structure in Mexico City.  The picture is an actual photograph of the museum, although it appears so crisp and stylized as to seem like an artist’s sketch.

This amazing building was constructed by Mr. Carlos Slim, a Lebanese-Mexican businessman, in memory of his wife, Soumaya, who collected many of the artworks in her personal holdings that now reside in the museum.  She was a Mexican, like her husband.  Those artworks, like the museum, were paid for by the family out of their personal wealth.

Lest anyone cringe at the term “Mexican Businessman,” and consider the PRI and institutionalized corruption, this family’s wealth largely derived from introducing the digital age to Mexico and beyond.  One could call him the “Bill Gates of Mexico.”  However, his wealth exceeds that of Mr. Gates, so really Microsoft was founded by the “Carlos Slim of America.”

Of Campesinos that I have met

What we see here in America is largely the campesinos – the rural fieldworkers, who are simply the Okies of the Dust Bowl from a different place, from a different time.

America struggles to understand and handle the presence of illegal Mexicans.  I do not understand why, as they are the model residence in the eyes of government.  They work in an economic paradise, from the government’s perspective.  They often pay Social Security taxes through withholding, using bogus numbers; but they do not collect Social Security earnings, nor Medicare nor Medicaid.  They pay millions, but are not entitled to any benefits – any government’s ideal citizen.

In America, the campesinos do not annoy the government with entitled demands and expectations; they usually hide from any contact with authorities.  They flee.  They cannot argue for their Fourth Amendment rights, or other Bill-of-Rights stuff; that is not their America.

Unlike the farm and orchard, the Mexicans I see come from a broader swath of background and culture than the pickers and stoopers of the Central Valley in California. 

My interest is not in what makes pickers pick – our civilization has spent many millennia gathering food from the earth, and it is not a valuable enterprise, regarding wealth and prosperity.  It will keep you alive; the gleanings of windfall can be eaten from the orchards, the bruised apples and wormy pears.

In actuality, the term “Mexican” can mean picker, or entrepreneur, when applied to the whole spectrum of the country’s people.  Here in the US, we simply mean campesinos, and for some reason fear and despise them.  What Mexicans do to us does not concern me as much as what we are doing to ourselves.

Campesino Medicine

Somehow, the recruiters have gotten my email address.  I am offered a position in Virginia.  “Are you available in December to pick up hospitalist work?  We have a new facility in Virginia looking to fill their schedule and need your help!” And in California: “CA Puzzle Piece Solutions 1Hr to Bay Area, California - $300,000+ Real Potential - 100% Outpatient - No Call.”  Or Las Vegas (NV) “See a show or try your luck in Las Vegas for 6 months!~ ANY State License Gets You Here” And East Coast: “we have an opportunity just minutes form Philly and the Jersey Shore in our rehab facility.”

This is depressing.  How does a former profession go from providing care, to eMigrant labor in the 21^st century?  Of all the business models for healthcare in the future, why the campesino model?

I have no particular contempt for the campesinos from Mexico.  One side of my family came to the factory town of Lawrence, Massachusetts to work in the mills doing handwork; the other side fled north Texas to high water and survival in Magdalena, New Mexico.  I think no less of pieceworkers, or pickers and stoopers; I only ask why that means of producing things is still used beyond Neolithic agriculture.

Of ideas old and discarded.

Somehow, we have harvested the chaff in management planning, at least in medicine.  All of the terrible ideas in management that were energetically discarded years ago have gone underground, and survive still in the HR departments and general occupational consciousness in America.

Early in the Journal of the Harvard Business School, Whiting Williams criticized and scrutinized some of these terrible old ideas and suggested a reformation of them.

To-day the majority of us find ourselves in such contact with the general public that we are likely to accept as final for us-the measurement of the particular tape-line which that public, rather than any smaller and probably more discerning group, currently, employs.   Here in the United States, that is apt to mean the pursuit of one thing - wealth.  For, at the present time at least, the dollar furnishes ·the yardstick by which the great body our fellow citizens habitually endeavors to determine the exact degree of each member’s accomplishment.

…

Too long we have thought of work as a curse. The truth is that every one of us plays a part in making it whatever it is; it becomes a curse only when we withhold from the performer of any useful service our proportionate economic and social recognition. Because we have so long failed to see men's wish for worth through work, we have failed too often to keep our promises of reward. Indeed, we have too generally based our whole program of the management of our industrial personnel less upon the hope of reward than upon the fear of punishment. That fear is the fear of discharge the fear of joblessness and all of those attendant stigmas and miseries which not management but society has erected.[1]

No campesino would speak well of any of the current management ideas.  They would agree with Williams – for what other purpose would drive a family to uproot themselves in the old country and flee to a new land without any guarantee of success, other than the hopes that Williams writes about.

They may be proud of being campesinos – of working hard with dignity.  They are not proud to be campesinos.  Their children are intended to be Americans.  Every culture that has come to America has hoped to make their children Americans, not second-class Americans.  Although they may derive honor for feeding their children, they would be embarrassed if their children only follow in their footsteps.

The awful idea remaining is that if a certain enterprise is considered too expensive, one should fracture it into constituent elements, rote behavior and piecework; and measure the productivity of the “pieces” scientifically, in order to maximize profit and throughput.  Then one can offer “best practices” that maximize the productivity of the workers’ hands.

Nowadays, Williams sounds uncomfortably Euro-socialist, and Frederick Taylor more familiar, at least in the concepts currently used for management in medicine, in his assertion:

As has been pointed out, however, the underlying principles of the management of "initiative and incentive," that is, the underlying philosophy of this management, necessarily leaves the solution of all of these problems in the hands of each individual workman, while the philosophy of scientific management places their solution in the hands of the management… Under scientific management, on the other hand, it becomes the duty and also the pleasure of those who are engaged in the management not only to develop laws to replace rule of thumb, but also to teach impartially all of the workmen who are under them the quickest ways of working.

All that is needed is to include the assumption, in medicine, that management is the thing learned in a business school with an MBA, and that MBA’s should direct the business of medicine, and there you have it – the history of medicine over the last few decades.  Taylor long ago invented “management” as a class of people, as well as a duty; he implicitly accepts the division of the “management” class from the “proletariat,” as Marx sketched out decades before.  The inherent assumption is that those who ‘do’ cannot possibly see the forest for the trees, and it takes a special, remote class to govern the strategic interests of the enterprise.

We have decided that we no longer have the money to pay for medicine, and our response is to revert to Taylorism.  To make it work in America, we must denigrate the status of the ‘do-ers’ to pieceworkers, and the ‘leaders’ as the management class – a concept credible only to Marxists and scientific managers.

In order to dissolve the old model of healthcare, we have needed to disparage the professions, which we have done so admirably with nursing.  Now, it is the doctor’s profession that is being reconstructed as the shifting, migrant pieceworker, here in the Central California valley for a few months, then up to Oregon for a few more – the locum tenens and the campesino as all but the same principle.  As picking strawberries is easily measured and paid, why not the provision of medical care?  From a management perspective, they are all the same.

Where are we going?

 So, we continue to stagnate with management ideas that are a hundred years old and obsolete.  Meanwhile, Latin America is becoming digital.  The Mexican GDP exceeds that of Canada; it rivals and may soon exceed that of the UK and France.  Mexico did not really have a firm foundation for stability until 1929, when it became a stable autarchy of the PRI; it has only recently had a credible multi-party government in this millennium.  Within a much shorter time period of stability, Mexico is rapidly flourishing.

Like the Ottoman Empire and Roman Egypt, America might become the Amusing Old Man of the New World over the next few decades.

Do-ers and leaders.

Somehow, after starting with a powerful contempt towards nobility and class, we have settled into a culture riven with class and status; while Latin America struggles to jettison its old racism and discrimination.  They, like the Americans of old, are becoming more interested in those that can do, make and build, over the old aristocratic days of color and family. Perhaps the legacy of Jefferson and the founders has spread; it has not taken permanent root at home.  We persist in our Puritan certainty of this land as Divinely Chosen even after nothing recognizable persists from those days.

---

[1] A Theory of Industrial Conduct and Leadership, Whiting Williams, Harvard Business Review April 1923
Ref:  See also Chomsky interview on Taylorism, Here.

On the herd animals.

Mahan fiddled with the damp coaster on the scarred table, considering another draft.
Nah, he snarled, and don't think I'm being a softie with the vegetarian and all.  I don't eat the animals because I think humans oughtn' associate with such beasts.  They are dirty, and not in the flesh, but their lives in the herd corrupt human civilization.  We have had such animals and are changing to make us like them, and it is wicked.  They live on instinct, a we on adaptation, and such things as goats are a powerful wicked source for our lives...