Dysfunctional is the New 'Normal'

Michael Grief's 'Next to Normal,' winner of 3 Tony awards and a Pulitzer, provides consumers of New York with a pleasantly refreshing alternative to Les Miserables, Phantom of the Opera, and the other traditional lions of Broadway. This reviewer was advised NOT to read a review or a synopsis of the play (someone must have told him that I 'cheat' by reading the synopses of Operas beforehand), and I would in turn advise the same.

Wow! Is this play shocking! Next to Normal is not your run-of-the-mill "boy-gets-girl," "girl-falls-in-love-with-monster,' 'girl-escapes-poverty-and-overcomes-social-barriers-to-fall-in-love-with-student-in-pre-revolutionary-France,' 'American-soldier-gets-Vietnamese-peasant-pregnant' love story that historically defines Broadway musicals in the past. In fact, its not really much of a story. It's a scathing indictment of the traditional "looks good on the surface" family structure--the type of family that we all used to know or still do. You know, the Cleaver-ish family who lived three houses down who seemingly had it all figured out, but beneath the surface, les démons du sommeil!!!

Next to Normal begins with quotidian travails of a family of four: a detached father who cannot emotive, a hysterical mother toiling to keep the house together, a teenage son crashing the gates of manhood, and an awkward daughter struggling to fend off her pot-smoking suitors with her AP chemistry textbook. Sure, the mother goes to a little therapy. Sure, her shrink gives her few pills. Sure, the father takes just enough care of her in between conference calls at the office. But something is terribly amiss here. The audience discovers that this family is more than just long overdue for a family vacation.

Next to Normal has one of the most innovative sets I have seen in my nascent theater-going career. Rather than having the orchestra play in between the crowd and the action--an arrangement that only adds to the distance between the two--this set places the band IN THE SET. The Set resembles a stainless steel house cut in half, kinda like taking a chainsaw to your little sister's dollhouse so you can see whats going on. Each band member occupies a separate 'room' in the house, and while I am not sure what this does for the acoustics of the play (since this reviewer will be getting cochlear implants in a few short years), it allows the crowd to be closer to the action. Plus the set designer gets muchas felicitaciones for ingenuity.

Tom Kitt's world-class musical score does not disappoint. the music is more modern and contemporary (duh.....the band has an electric bass, electric guitar, a synthesizer, and drum-machine). The music haunts and depresses when the play turns dark. It vivifies when the story ascends. I would not describe the music as "catchy" or "gripping," for they don't necessarily stick in your head for days, as some of the Les Miz songs might be. But the score compliments the acting and the screenplay in the same way that Garden State's soundtrack did with the movie: accentuating and catalyzing without overtaking the actors and drowning the crowd.

This reviewer has a soft spot for the supporting role, and predictably this reviewer enjoyed the actor who portrays the multiple psychiatrists who the mother consults. He slips seamlessly between the boring, prescription-wielding shrink to the faith-healing, almost-evangelical hipster therapist. His singing voice was easily the best of the bunch.

On the contrary, the teenage son was slightly off-key. And while the story is meant to highlight the complex and intimate relationship between himself and his mother, the Oedipus -like infatuation seems a bit creepy and repulsive. As the artist intends, they say.

The Passing Scene Cafe urges its patrons to see Next to Normal before the sputtering Broadway
economy claims yet another victim. But BUYER BEWARE!!! Come to the cafe and have an extra strong latte, a tasty danish, and make sure you are in a good before you see it. You won't be disappointed!

Note to M.D's: Your Labor/Leisure Calculus is Wrong!!!

So says Peter Orszag, the left-leaning economist who served most recently as the head economist for the Congressional Budget Office and as Obama's director of the White House's Office of Management and Budget.

I would prefer not to get into Mr. Orszag's record at his two posts. As the head of O.M.B, his job was decidedly more political and mostly consisted of selling--or spinning---the health care reform efforts by Obama and the Democrats and its putative effects on the long-term fiscal picture of the US economy. He ended up being the first member of Obama's cerebral economic team to leave his job, and he was last seen on the pages of the New York Times arguing for an extension of George Bush's tax rates.

Being a newly minted hospital administrator, I decided to give Mr. Orszag's columns a look this evening. He writes an article entitled "Health Care's Lost Weekend," a cheerful overture to doctors and how they need to about their work schedules and consent to some oversight of their work.

The article mentions New York University's Langone Medical Center as a case study for the first idea.

"First, weekends. It’s never good to be hospitalized, but you really don’t want to be hospitalized on a weekend. There are fewer doctors around, and people admitted on Saturdays and Sundays fare relatively poorly.

One study in 2007 found, for example, that for every 1,000 patients suffering heart attacks who were admitted to a hospital on a weekend, there were 9 to 10 more deaths than in a comparable group of patients admitted on a weekday. The weekend patients were less likely to quickly receive the invasive procedures they needed — like coronary artery bypass grafts or cardiac catheterization"

I can't really quarrel with the numbers in the study. I would like to see these numbers replicated a few more times in other hospitals, but let's assume they are right.

"And then there are the economics of a $750 billion-a-year industry letting its capacity sit idle a quarter or more of the time. If hospitals were in constant use, costs would fall as expensive assets like operating rooms and imaging equipment were used more fully. And if the workflow at existing hospitals was spread more evenly over the entire week, patients could more often enjoy the privacy of single-bed rooms"

The first response I have to this article is: how much is the hospital really closed on weekends? After reading this article I had the impression that hospitals would have a big "CLOSED" sign on the front with the doors locked, the lights out, and no one but the weekend security guard on the premises. That was not my impression of hospitals growing up in the home of a neurosurgeon, whose weekend rounds and emergency cases seemed to have no discernible monday-thru-friday regimen.

But why would a $750 billion/yr sit idle on the sidelines on weekends if it could be put to better use 7 days a week? Why have decades worth of hospital CEOs, administrators, and department chiefs not thought of this idea before.

Hospital resources sit idle on weekends because its a cost-effective way of keeping the hospital services flowing. Mr. Orszag does not say how much more it would cost to keep the hospital open on weekends. He makes the incorrect assumption that the marginal cost of hospitals being open on weekend would be zero, or negative. Wouldn't you have to pay for people to work there? Nurses? Scrub nurses? back office staff? electricity? Pathology? Maintenance for instruments?

Or do all those employees work for free on weekends?

Also, Mr. Orszag discusses the reduce health outcomes for patients admitted on weekends, a fact which may be true. But what about having doctors work 6 or seven days a week? Same thing with PAs and nurses?

What effect would keeping the hospitals open on weekends have on the staffs' family lives? Social lives? Morale. Mr. Orszag does not say. Having doctors, residents, and physician assistants on call while spending time at home is a great way to use their leisure time wisely.

My point is not to hand down a harsh verdict on this column. I think his analysis is incomplete, yet the Passing Scene Cafe anxiously awaits a follow-up to this.