Wednesday, November 29, 2006

Living Will

Personal Health

Medical Due Diligence: A Living Will Should Spell Out the Specifics

Published: November 28, 2006

When I ask people whether and how they have made preparations for the ends of their lives, the most frequent response is, “Well, I have a living will.” But chances are they are unaware of the serious limitations inherent in such a document and how it is likely to be interpreted by medical personnel should a life-threatening crisis arise.

A living will is an advance directive, a document that states your wishes about how you should be cared for at the end of your life. It is meant to be activated when you are unable to say what you do or do not want to be done medically — if, for example, you are in a terminal condition, your heart and breathing cease, you are in a persistent vegetative state because of severe brain damage or you are too demented to understand the situation.

A living will lists your general preferences for or against life-prolonging treatment like cardiopulmonary resuscitation if your heart suddenly stops, or mechanical respiration if you cannot breathe well enough on your own. But the simple statements contained in most living wills, more often than not, are hard to apply to the great variety of medical situations that can arise.

For example, let’s say you’re a 70-year-old active retiree with congestive heart failure who develops pneumonia and has trouble breathing. You go to the emergency room, living will in hand, stating that if you become terminally ill, you do not want to be treated with antibiotics or placed on a ventilator.

Open to Misinterpretation

The admitting physician reading your living will may interpret it as a “do not resuscitate,” or D.N.R., statement, meaning you want no treatment for your life-threatening infection, in which case you would probably die. Yet a course of antibiotics and a week or so with assisted breathing could restore you to your previously active state.

Dr. Ferdinando L. Mirarchi, chairman of emergency medicine at Hamot Medical Center in Erie, Pa., tells of a very active 64-year-old woman who nearly died because a nurse read her living will as a D.N.R. statement. The woman had slipped on ice and broken a leg, which was reset surgically. On the second postoperative day she began bleeding in her abdomen, and excreted and vomited blood. But the nurse saw her living will and told the physician on call that she was D.N.R. and thus did not warrant admission to the intensive care unit. Fortunately, another physician overrode the nurse’s interpretation and resuscitated the woman, who successfully underwent emergency surgery to stop the bleeding.

Living wills became popular — and were established as legally binding documents in all states except New York, Massachusetts and Michigan — after personal experiences and highly publicized cases like that of Terri Schiavo demonstrated the futility of prolonging lives that met few people’s definition of living.

Countless billions of dollars have been spent to support the hearts and lungs of people who will never leave the hospital alive. Many people, appalled by these torturously medicalized deaths, completed a notarized document to prevent this when they neared the end of their lives. About 20 percent of the population has a living will. But will it really help, or might it harm?

An Improved Document

Dr. Mirarchi (pronounced mir-AR-ki) has studied how health professionals interpret living wills and found that the overwhelming majority think they mean that the patient wants to be treated as D.N.R., when in fact aggressive life-saving interventions could restore some patients to their previous state of health.

Accordingly, he has devised a more comprehensive living will — an advance directive he calls a medical living will with “code status” — that people can fill out in consultation with their physicians and perhaps an attorney to help assure they get the kind of care they would want if they could ask for it. The “code status” tells medical personnel exactly how someone wants to be treated in a life-threatening medical emergency, removing the guesswork.

If, for example, you choose “full code,” the directive would say: “I would like to receive all lifesaving and supportive measures should an emergency arise. Should my condition fail to improve and I am no longer able to make my own decisions, then I would like my advance directive to be active and followed.”

Only at that point, then, would individually stated requests be honored, such as not being resuscitated, defibrillated, ventilated, fed by tube, transfused, given antibiotics or placed on a dialysis machine.

You could also choose “full code except cardiac arrest,” meaning that all measures short of restarting your stopped heart should be tried. Or let’s say you are a terminally ill cancer patient and recognize the futility of continued treatment. You could choose “comfort care, hospice care” and have only your symptoms treated to ease your departure from this life. Dr. Mirarchi’s reasons for the revised living will are spelled out in his forthcoming book, “Understanding Your Living Will: What You Need to Know Before a Medical Emergency” (Addicus Books).

Dr. Mirarchi strongly recommends that people periodically review and update their living wills as needs and medical conditions change. He points out that if you choose to be an organ donor, your living will should state that and give permission to temporarily suspend the document to preserve the viability of your organs.

Medical consultants writing in Patient Care (Nov. 15, 2000) noted that “the less inclusive a living will is, the more trouble it can cause.” Doctors may be uncomfortable following vague directives. The consultants suggested that living wills could be more useful if the directives were disease specific. For example, if you have emphysema, you may want to accept antibiotics and mechanical ventilation if you develop pneumonia, but you may not want such treatment if you are near death from cancer.

Your living will should also state that you (or your heirs) will not sue health care workers or facilities for following your stated wishes. The document can also call for a two-physician conference before life-prolonging treatments are withdrawn. The final document should be notarized.

Make several copies of your completed living will. File them with your personal physician or local medical center, your next of kin and attorney, and include a copy with your medical records and your last will and testament. You might also carry a wallet-size card stating your chosen “status code,” emergency information and name and phone number of your health care proxy.

Have a Health Care Proxy, Too

As may already be apparent, it is not enough to have a living will. You should also assign someone you trust to voice your medical wishes when you cannot speak for yourself. That person should first have a detailed conversation with you about how you want to be treated under various circumstances and also have a copy of your living will.

It may be best if that person has no vested interest in your estate and is younger than you. In most states, the health care proxy is recognized as acting for the patient, compelling medical personnel to follow the proxy’s instructions.

Finally, it should also be obvious that both a living will and a health care proxy should be in place as soon as a person turns 18 and becomes an adult in the eyes of the law. You never know how old or healthy you may be when its instructions are needed. Ms. Schiavo was only 26 when she suffered a brain-damaging cardiac arrest.



Check Out My Other Blogs (click on blog name to go there) = / 1.3rd Eye Blog / 2. Favorites Blog/ 3. Vita Excolatur (Living Well ...) Blog/ 4. Humor Me Blog/ 5. News and Current Events Blog/ 6. Consider This ... Blog/ 7. Consumer Warnings Blog/ 8. New Orleans Pentimento Blog/ 9. We Constant Gardeners Blog/ 10. Chaillot Family Blog/

Asthma

Second Opinion

An Epidemic No One Understands

Published: November 28, 2006

When our first son developed asthma as a 3-year-old, my husband and I felt pretty much blindsided. We were only a little less shocked when the same thing happened to our second son, at the same age.

The disease turned out to be tenacious, and for years both boys needed inhalers or a nebulizer machine several times a day to prevent asthma attacks that could keep them up half the night, coughing and wheezing.

Both had eczema, too, and the kind of food allergies — to nuts, peanuts and shellfish — that can lead to fatal reactions.

What caused all this? My husband and I were mystified, because neither of us had asthma or life-threatening allergies, nor did our parents or siblings. I do have hay fever and allergies to cats and dogs, but I had always considered my symptoms just a nuisance — not a bad omen for the next generation. My husband isn’t allergic to anything.

But we seem to have been caught on a rising tide that no one fully understands. Our sons were born in 1984 and 1987, and we encountered an awful lot of children their ages who had the same illnesses, far more than we remembered from our own generation.

Statistics suggest that something strange was occurring in those years. From 1980 to 2003, the prevalence of asthma in children rose to 5.8 percent from 3.6 percent, an increase of about 60 percent, according to the Centers for Disease Control and Prevention.

Other estimates from the disease centers show an even bigger increase in the asthmas rates for younger children: a 160 percent jump in those younger than 5 from 1980 to 1994. But changes in data collection starting in 1997 make it hard to compare the figures before and after that year. More recently, the rates seem to have leveled off in the United States and in other Western countries. In any case, about 20 million people in the United States have asthma today, including at least 6 million children, and 5,000 people a year die from it. Children in the inner cities seem to be especially hard hit, with exposure to cockroaches and diesel fumes suspected as the culprits. But the cause is not known for sure.

Worldwide, the disease has also increased. From 1985 to 2001, the prevalence rose 100 percent. About 300 million people have asthma, 255,000 die from it, and deaths could increase by 20 percent over the next 10 years, according to the World Health Organization. The problem is especially severe in developing countries, which are least able to provide the long-term intensive treatment that asthma requires.

Some of the apparent increases may not be real, but may have occurred because doctors got better at making the diagnosis. But increased reporting seems unlikely to account for all the new cases. Theories come and go, and when you come right down to it, no one really knows why some people develop asthma and others don’t.

In “The Asthma Epidemic,” an article published last week in The New England Journal of Medicine, doctors tried to sort out various theories about the causes of asthma and explain why rates have risen. But there are no clear-cut answers.

Like other chronic diseases, asthma is probably caused by multiple genes and environmental exposures, and it can have quite different causes in different people. About half the cases are thought to stem from allergies and the rest from other problems that can irritate and inflame the airways, causing them to close.

Genetic changes in the population cannot explain the increasing rates, though, because such changes occur too slowly to account for the rapid increases in asthma, the authors said, suggesting that environmental factors are more likely candidates. But what has changed enough in the environment to explain spiking asthma rates?

The authors of the article, from University Children’s Hospital in Munich, review many study findings. They report that one clear risk factor is secondhand tobacco smoke. Exposure to it does increase asthma risk in infants and small children. But how would that explain the increases, when over all, parents today smoke less than previous generations?

People frequently blame air pollution for causing asthma, but its role is not entirely clear. Pollution does makes asthma worse in people who already have the disease, but it’s not known whether pollution also makes asthma develop in the first place. And in any case, air pollution in the United States has decreased in the last few decades. Living in a place with high vehicle exhaust may make asthma worse, but the evidence is “relatively weak,” the researchers report.

Dust mites, microscopic insects that live in bedding and furniture, were long blamed for causing asthma to develop in infants and small children and have led to a booming industry of mattress covers, air filters and guilt-ridden parents tethered to dust mops and vacuum cleaners. But recent studies have questioned the connection. Once children have asthma, though, the mites and their droppings may make the symptoms worse.

Cat dander has become a complete puzzle, with some studies finding that exposure early in life leads to asthma, and others saying it protects against asthma. At this point, nobody knows which study to believe, but most experts agree that when people already have asthma, being around cats can make it worse.

Under some of the theories, I should have had the world’s worst asthma. Clearly, I had allergic tendencies, and the experts would have shuddered at my environment. I grew up in New York in a small apartment with parents who were heavy smokers, on a busy street with trucks rumbling by and a bus stop in front of the door. Buildings all around us burned coal. At times, we had a dog, a cat, parakeets and, briefly, a duck. It’s amazing that the pets survived the smoke. My mother was a decent housekeeper, but she wouldn’t have won any prizes. I never wheezed. Go figure.

Obesity and asthma have also been linked in some studies, but the link, if it exists, is not understood. Researchers say it is simply not a matter of asthmatic children growing fat because they cannot exercise. The weight gain can be first.

Nutrition is another mystery. Studies of fruits, vegetables, cereals, fatty acids, vitamins, minerals and antioxidants have been inconclusive, and little is known about the effects from what pregnant women eat. Experiments in which pregnant women avoided cow’s milk and eggs in hopes of preventing asthma in their infants did not work, and breast-feeding doesn’t prevent the disease, either.

One theory that has received attention recently is the “hygiene hypothesis,” the idea that children today are raised in homes that are too clean and that asthma is somehow caused by the lack of exposure to infections and bits of microbes early in life. Under this theory, germs are supposed to help the immune system develop normally, and without them the system may overreact to other substances in the environment, producing allergies and asthma.

There is some evidence to support the idea. Studies find that children raised on farms are less prone than others to asthma, maybe because they are exposed to plenty of microbes in barns and stables. But the connection is still not fully understood, and some viral infections clearly make asthma worse.

A related idea is that the increased use of antibiotics in recent decades contributes to asthma by changing the type of the bacteria that live in the gut. But that has not been proved. Some researchers have suggested that acetaminophen, used to treat pain and fever, may be linked to asthma. Its use increased in the 1980s, after pediatricians declared aspirin unsafe for children. But that theory has not been proved, either.

Ultimately, this new list of the usual suspects still doesn’t solve the mystery.

Gradually, my sons’ asthma diminished. Both became track and cross-country runners in high school, and now, as they have gone on to college and graduate school, the disease is rarely a problem. But it was a worry that hung over us for a long time.

As for the food allergies, we choose to assume that they last for life. The only way to find out for sure is called a “challenge,” in which you eat the risky food with doctors standing by to revive you in case it turns out that, gee, you’re still allergic to it after all. Somehow, I don’t think we’ll be signing up for that.

My sons have adrenaline kits to treat a severe reaction. Neither has ever needed it, and I know they don’t carry it around the way they’re supposed to when they go to restaurants.

Needless to say, I wish none of this had ever happened. But, based on what’s now known, could I have done anything to prevent it? Was it bad that we had cats when our children were born or that we later gave them away? Asthma transformed me and my husband from rather casual housekeepers into mop-wielding fanatics. I’m not sure it helped.

Suppose I had recognized that my own allergies meant that my children would be at risk. Would it have helped if I had then avoided eating nuts, peanuts and shellfish while I was pregnant and breast-feeding? I don’t think the answer is clear.

Similarly, I’m not convinced that it would have made a difference if I had been more cautious and methodical about introducing new foods in their first few years, though allergy groups recommend it. The only thing that seemed to do them any good was asthma medicine, and lots of it.

Because children who have even one parent with allergies and asthma have an increased risk of developing the same problems, it would be great if somebody could figure out a way to lower that risk in time to help my sons and the millions of other young people who were also caught in the asthma wave, when they decide to become parents. I am hoping, but I know it may be a problem with many solutions — or none.



Check Out My Other Blogs (click on blog name to go there) = / 1.3rd Eye Blog / 2. Favorites Blog/ 3. Vita Excolatur (Living Well ...) Blog/ 4. Humor Me Blog/ 5. News and Current Events Blog/ 6. Consider This ... Blog/ 7. Consumer Warnings Blog/ 8. New Orleans Pentimento Blog/ 9. We Constant Gardeners Blog/ 10. Chaillot Family Blog/

Saturday, November 25, 2006

go to New Orleans

Frugal Traveler

Back to New Orleans, Gently

Lori Waselchuck for The New York Times

The New Orleans Jazz Vipers play at the Spotted Cat, a nightclub on Frenchmen Street. The stricken city’s legendary night life is far from silenced, and restaurants and bars stay open into the early hours of the morning.

Published: November 26, 2006

IT was a Friday afternoon in late October, and the narrow lanes of the French Quarter were quiet. Fresh paint — pale green, robin’s egg blue, canary yellow — adorned the low, tidy Creole cottages, and the wrought-iron railings of town-house balconies shone blackly in the sunlight. The streets were free of litter, the air unpolluted by the musky odor of all-night parties. But as I wandered the beautiful Quarter, one question stuck in my mind: Where was everybody?

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Lori Waselchuck for The New York Times

A house washed off its foundation in the Ninth Ward.

Lori Waselchuck for The New York Times

Royal Street in the French Quarter.

I suppose I already knew the answer. Since Hurricane Katrina struck in 2005, wreaking havoc across Louisiana and Mississippi, fewer than half the 485,000 residents of New Orleans Parish had returned to pick up the pieces of their shattered lives, according to the city’s Convention and Visitors Bureau. Even in the French Quarter, which was mostly spared the devastation visited upon neighborhoods like the Ninth Ward, “For Sale” signs hung from porch brackets, and on one street, a pickup truck had been abandoned, its hood open, its bed piled high with garbage.

This emptiness, disturbing and depressing as it was, turns out to be perversely beneficial for visitors — the city of exuberant indulgence has, almost overnight, become even more affordable. It’s a strange kind of affordability, though: Because tourists have yet to return en masse, the budget options sit wide out in the open, just waiting to be picked. Although rates have actually risen slightly, hotel deals still abound, last-minute reservations at hot restaurants are a phone call away and curbside parking actually exists. The Big Easy may no longer feel big, but it’s easier than ever.

At the same time, the frugal New Orleans experience can weigh heavily on your mind: How can you enjoy yourself when ravaged buildings (and lives) lurk around every corner? In seeking out discounts, are you exploiting the crippled city’s economic straits? And can mere tourism really help improve New Orleans’s fortunes?

I was determined to find out. Joined by my friend Tracy Jo, a punky redheaded poet from Houston, we planned an indulgent, affordable and, yes, ethical weekend in the Crescent City. We began by checking into the Hotel St. Pierre, a compound of former slaves’ quarters that had, in the 1960s, housed the New Orleans Jazz Museum. Our second-floor room was clean and basic (except for an elaborate gilded mirror), with a creaky balcony that overlooked a small swimming pool. At $99 a night, it was also the cheapest French Quarter hotel I could find.

Not that the other options were that much more expensive. For $20 or $30 more, we could have stayed at any of the half-dozen other slave-quarters-turned-hotels, or indeed almost any hotel in the metropolitan area — the average daily rate was $125.25 in July.

That’s actually $12 higher than pre-Katrina levels, a rise that the New Orleans Convention and Visitors Bureau attributes to a 25 percent reduction in the number of rooms and the presence of so many government contractors. Unlike New York City after Sept. 11, there has been no concerted campaign to woo back tourists with discounts. Still, virtually all the hotels had specials starting under $200, even Le Pavillon, the 99-year-old bastion of New Orleans luxury, and the designer W New Orleans.

No data yet exist on whether tourists are taking advantage of these bargains, but judging from my experience that gorgeous weekend in October, I’d have to guess not.

NIGHTS at the St. Pierre were ghostly silent, with few, if any guests, moving through the lobby. At times, the only sign of life in the French Quarter was a lone dog-walker or a television flickering behind French doors. More visitors congregated around Jackson Square, the boardwalk along the Mississippi River, and, of course, the bars of Bourbon Street. But the only time I felt crowded in the French Quarter was in front of St. Louis Cathedral, where about 10 people had gathered to listen to a jazz trio. I instinctively fled, realizing too late that the audience was tiny, the music was good and that, in the new New Orleans, my tourist-trap alarm needed recalibration.

My escape route took me down Pirate’s Alley to Faulkner House Books, so named because William Faulkner had lived in the yellow town house while writing his first novel, “Soldier’s Pay.” Several of his first editions sat on the ceiling-high shelves, including “Absalom! Absalom!” for $1,750. I asked the employees if they’d lost much stock to Katrina and was met with dismissive smiles — nothing, they said, had been damaged. I got the feeling I wasn’t the first to ask.

It was eerie, this sense that nothing out of the ordinary had occurred in the French Quarter. But I felt a similar absence of Katrina in other tourist areas. The Garden District, an easy-to-stroll neighborhood of million-dollar Victorians, was in near-perfect shape, and the iron fence surrounding Rosegate, the Greek Revival mansion where Anne Rice once lived, was festooned with fake cobwebs in anticipation of Halloween.

Magazine Street, meanwhile, looked like yuppie-bohemian paradise, its six miles lined with po’ boy emporiums, makeup shops that looked like art galleries and art galleries that looked like po’ boy emporiums. The only signs of Katrina were, well, signs. “Stumps Removed,” said one nailed to a telephone pole. “Houses Gutted,” read another. “Road Closed,” warned a white-and-orange barrier, with “No Exceptions!” written in by hand.

But otherwise, the streets were empty. Magazine Street was positively sleepy on Friday and Saturday nights, though it was obvious why. Every store closed at 6 p.m. While no one could say for certain whether this was a post-Katrina phenomenon, it was clear that stores were not about to extend their hours for a customer base that did not exist. It’s a tragic feedback loop that makes it ever more difficult for visitors to return to New Orleans.

Luckily, the early closing afflicts mostly stores: the restaurants, cafes and bars still stay open into the wee hours, and it was at these establishments that Tracy Jo and I began to find our missing New Orleanians.

We started at Casamento’s, an oyster bar on Magazine Street with fluorescent lights and yellowish tiles that scream no-frills. Maybe it was the neighborhood vibe or the cheap oysters (a dozen raw were $7.80), but the restaurant was completely full and buzzing. We must have arrived early, because while I was powering through beautifully briny oysters, the line grew to reach the door. There appeared to be few tourists among them, and I was guiltily grateful that we had the city to ourselves.

After dinner, we headed to Le Bon Temps Roulé, a down-to-earth bar. In the back, a piano player was jamming modern Dixieland on an upright, accompanied by a percussionist who made use of everything around him: a bucket, a stool, a cardboard Budweiser box. Better yet, an oyster shucker was slicing open shells and doling them out free of charge. Was this, I wondered, a post-Katrina deal to lure back customers? Nope, the manager Laura Vidacovich told me later, free-oyster Fridays have been a Bon Temps tradition for years. In fact, she said, the Bon Temps was operating just as it had before the storm.

“We still have no cover for shows, we still have free oysters,” she said. “New Orleanians do not like change. They can barely get away with cleaning up the corrupt court system, let alone changing the prices at bars.”

New restaurants, too, are coming to life. Saturday night, we went to Cochon, a casual restaurant in the warehouse district that Donald Link and Stephen Stryjewski opened last April, after a six-month Katrina delay. In line with the blond wood and picnic-chic décor, the menu, offers haute renditions of Cajun and Southern classics — none of which cost more than $19.

But while Mr. Stryjewski and Mr. Link had expected most of their clientele to come from the many nearby hotels, the city’s sagging tourism has turned Cochon into a haven for locals. When we arrived around at 7:15 p.m., having easily made a reservation that afternoon, every table was occupied by couples and families.

And no wonder: the food was excellent. I started off with a plate of fried boudin, the ubiquitous blood sausage, as well as fried chicken livers served with a spicy-sweet pepper jelly and refreshing shock of mint leaves. I followed it with the juicy Louisiana cochon (a pan-seared pulled-pork patty) and a perfect slice of lemon-buttermilk pie. Tracy Jo, a vegetarian, ordered a slew of non-meat sides but had to shush our waitress when she tried to explain that the lima beans and collard greens might contain, um, meat. She gobbled them up in blissful ignorance. Along with a couple of Sazerac cocktails, a potent New Orleans special, dinner for two came out to $107 — not bad for such a memorable feast.

Afterward, we drove to the nearby Circle Bar, which occupies a Victorian house that even pre-Katrina was said to have looked run-down. Now, in the shadow of the multicolored Hotel Le Cirque, it appeared ready to topple, though not before Tracy Jo and I sipped cheap bourbon, listened to 1960s garage rock and discovered that our waitress from Cochon had sat down next to us.

She was, we learned, Adrienne Lamb, a poet and — big surprise — blogger who’d been chronicling her post-hurricane travails on afterkatrina.blogspot.com. As she told us about her ups and downs — her flight to Florida, her anger and depression, her sudden divorce — I was reminded of the way New Yorkers like myself still find ourselves recounting our Sept. 11 experiences to total strangers. Now, though, I was on the receiving end, feeling conflictedly creepy for my curiosity.

There is, however, an antidote to feeling such guilt: volunteering — it’s like Lenten repentance after Mardi Gras. Tracy Jo and I woke up early Saturday morning and drove through the upper Ninth Ward, which, although it escaped the wreckage of the lower Ninth, was in abysmal shape. Everywhere we looked were caved-in roofs, houses ready to collapse and porches spray-painted with codes like “TFW,” short for Toxic Flood Water.

We arrived at 4000 North Roman Street, where a compound of small houses in cheery blues, yellows, greens, reds and browns rose from a wide field of grass. This was the Musicians’ Village, a Habitat for Humanity project where we’d arranged to volunteer for the day, figuring that our labor would help as much as the dollars we were spending elsewhere.

We were not alone in our thinking: the village had 250 volunteers that morning — less, the organizers said, than they’d typically gotten on summer weekends. They split everyone into groups; I chose one where we’d be hammering nails, which is about the extent of my carpentry skills.

Twelve of us hopped in the back of a pickup and drove across the field to the worksite, a bare foundation of sand and cinderblocks reinforced by 35-foot pilings driven into the soft, damp soil. Under the direction of Ken Francois, the crew boss, we got to work building a floor system. First we laid a frame of 6-by-6’s atop the cinderblocks, and then filled it in with load-bearing joists.

By half-past ten, my hammer-bearing right hand was blistering, but I didn’t really care. It was a beautiful day and I got to meet my fellow volunteers. Some, like me, had come from New York City to tour Katrina-affected regions and were doing what they could to help. Others, like Kevin, a burly, bearded pediatrician, lived in New Orleans and were intent on resurrecting their city. Then there was Debra, a young woman with a sweet smile and 6-year-old son, who was hoping to live in this very house.

We banged and banged all day, and my aim and technique slowly improved. At one point, no-nonsense Ken came over, inspected my work and said, “That’s a nice, tight join.” I’d never felt so proud. When we finally broke for lunch — provided free by Loaves and Fishes — I devoured my peanut-butter-and-jelly sandwich, hard-boiled egg and packet of Fritos with a hunger that comes from satisfying hard labor.

The workday ended at 2:30 p.m., and we returned to the St. Pierre with not only a sense of accomplishment but also a music tip: Kevin said that Frenchmen Street, just outside the Quarter, was his favorite spot for bands, and was livelier and less touristy than spots along Bourbon Street.

AND so that night, we headed to Frenchman Street, where there was easy parking and a bona fide crowd of revelers. They flowed up and down the street, some in scanty pre-Halloween costumes, others in jeans and T-shirt. A fair number were spilling from yuppie-free, charmingly grimy bars like the Spotted Cat and d.b.a. We paid a $5 cover at Kevin’s pick, d.b.a., bellied up to the bar, ordered a pair of Dead Guy ales and turned our attention to the small stage.

A local band called the Tin Men were playing a vaguely familiar cover of Led Zeppelin’s “Immigrant Song.” The trio was comprised of a singer-guitarist, tuba player and Washboard Chaz, named after the instrument hanging on his chest. The version rocked, but when their set was over, we realized we’d been up 18 hours straight, finished our too-sweet ales and called it a night.

We awoke Sunday morning at the reasonably late hour of 9, had a nice brunch of eggs Dauphine (eggs Benedict with country ham and fried green tomatoes) at a sunny nearby cafe, Eat, and set off in search of the grave of Marie Laveau, the fabled voodoo queen. A beautiful, powerful black woman in pre-Civil War New Orleans, Laveau remains a figure of legend and mystery today — she’s appeared as a character in everything from blues tunes to Marvel Comics. Her tomb is a pilgrimage site. (Her reputed tomb, anyway: A new Laveau biography disputes many of the myths of her life — and death.)

The tomb was a few blocks away from our hotel, near the center of St. Louis No. 1 Cemetery, the oldest in the city. But we took our time, since wandering the cemeteries of New Orleans is such a pleasant (and cheap) way to spend a Sunday morning. The aboveground crypts are marvelous reminders of the city’s past, topped with marble statues, the brass plates etched with names like Joachim A. Bermudez and Onesiphore St. Amand.

Laveau’s supposed crypt, however, is just a simple white block covered with triple X’s inscribed by devotees. Before the crypt were gifts they’d left: a candle, a guitar pick, Mardi Gras beads, a hollow tin cat, a scattering of small change and a slip of paper. Tracy Jo picked up the paper, unfolded it and showed it to me. Written in a child’s shaky hand was this request: “Please help me at school.” I added a quarter to the pile and hoped that the voodoo queen — or someone, anyone — was listening.

VISITOR INFORMATION

WHERE TO STAY

Hotel St. Pierre, 911 Burgundy Street, (800) 225-4040; www.hotelsaintpierre.com.

WHERE TO EAT & DRINK

Café du Monde, the frill-free standby for café au lait and fresh-from-the-fryer beignets, open 24 hours; 1039 Decatur Street, (504) 525-4544; www.cafedumonde.com.

Casamento’s, 4330 Magazine Street, (504) 895-9761; www.casamentosrestaurant.com.

Circle Bar, 1032 St. Charles Street, (504) 588-2616; www.members.cox.net/circlebarnola.

Cochon, 930 Tchoupitoulas Street, (504) 588-2123; www.cochonrestaurant.com.

d.b.a., 618 Frenchmen Street, (504) 942-3731; www.drinkgoodstuff.com.

Eat, 900 Dumaine Street, (504) 522-7222.

Le Bon Temps Roulé, 4801 Magazine Street, (504) 895-8117.

The Spotted Cat, 623 Frenchmen Street, (504) 943-3887.

WHERE TO SHOP

Faulkner House Books, 624 Pirate’s Alley, (504) 524-2940; www.faulknerhousebooks.net.

The New Orleans School of Cooking, 524 St. Louis Street, (504) 525-2665, www.nosoc.com, carries everything you need to replicate Creole cooking at home, including the hard-to-find line of Cajun Power hot sauces.

WHAT TO DO

Habitat for Humanity, 7100 St. Charles Avenue, (504) 861-2077, www.habitat-nola.org, takes volunteers Tuesday through Saturday, and can arrange discounts on hotel stays and rental cars.

St. Louis No. 1 Cemetery, corner of North Rampart Street and St. Louis Street.

MATT GROSS writes the Frugal Traveler column for the Travel section.



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Wednesday, November 22, 2006

Cell Phone Freebies

State of the Art

Free Services to Inspire Your Cellphone

Published: November 23, 2006

Thanksgiving, is it? Well, despite occasional headaches, technology has also brought us plenty to be thankful for: safety, convenience and entertainment on the go. Next time you’re running late, lost or lonely, ask yourself: aren’t you grateful for your cellphone?

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Illustration by Stuart Goldenberg

A message from Pinger alerts a user that a voice mail message has been received.

Google allows for simplified Internet searches for weather, movie times and other information over cellphones.

Actually, don’t answer yet. With every passing month, cellphones are becoming even more useful. Sure, it’s nice that they let you call people from the road. But lately, their reach has grown, thanks to clever programmers making links between the cellular world and the Internet.

Here, for your gratitude-generating pleasure, is a rundown of some of the most exciting and powerful services awaiting your cellphone at this very moment. Better yet, at the moment, they’re all free.

FREE DIRECTORY ASSISTANCE By this time, it’s quite clear that nobody with a “$50 a month” calling plan actually pays only $50 a month. The cellphone companies will do anything to puff up your bill — like charging you $1.50 or $2 every time you dial 411 to find a phone number.

Try 800-FREE-411 (800-373-3411) instead. A computer or human being looks up a number for you at no charge, once you’ve listened to a 20-second ad. It’s a classic time-for-money swap.

Or, for an ad-free option, there is a little-known Google service. Send a text message to 46645 (that’s “Google”; leave off the last E for efficiency). In the body of the message, type what you’re looking for, like “Roger McBride 10025” or “chiropractor dallas tx.” Seconds later, you get a return message from Google, complete with the name, address, and phone number.

FREE ANSWERS Google’s 46645 text-messaging service can fetch much more than phone numbers. It can also send you the weather report (in the body, type, for example, “weather sacramento”), stock quotes (“amzn”), where a movie is showing nearby (type “flushed away 44120”), what a word means (“define schadenfreude”), driving directions (“miami fl to 60609”), unit conversions (“liters in 5 gallons”), currency conversions (“25 usd in euros”), and so on.

Every cell carrier charges for text messages — about 10 cents each, unless you have a plan that includes them. But Google itself doesn’t charge for any of this. It’s not only ad-free, it’s free free.

If you prefer conducting your research missions by voice, call 800-555-TELL (800-555-8355). A cheerful recorded voice invites you to say “Travel,” “Traffic,” “News Center,” “Stock Quotes,” and so on. The system is smart enough to know your location, which pays off when you say “Movies,” “Restaurants,” “Driving directions” or “Taxi.” (This service, run by Tellme Networks as a showcase for its corporate voice-recognition technology, also lets you say “Time” when you’re setting your watch — a blast from phone companies past.)

FREE INTERNATIONAL CALLS You can now call any of 50 countries from the United States, free. Talk as long as you like. You pay only for a call to the access number in Iowa, which is 712-858-8883; if you use your cellphone on nights or weekends, even that’s a free call.

There’s no contract, no ads, nothing to sign up for. At the prompt, press 1 for English. Then punch in 011, the country code and the phone number. The call rings through immediately.

Fine print: In some countries, you can reach only landlines, not cellphones. And in part because FuturePhone’s lines have been flooded, its success at placing calls is not, ahem, 100 percent.

But it’s hard to argue with “free,” which, according to the company, it will be until at least 2010.

FREE ‘PINGS’ Pinger is a new way to reach someone: a method that combines the immediacy of a text message with the personality of voice mail. (You can sign up at Pinger.com.) You call one of Pinger’s access numbers, say the name of the person you’re calling, and then speak a message.

Suppose you’ve just pinged your sister. She receives a text message to let her know. With one keystroke, she can hear your message — and with another, send a voice reply. There’s no waiting to roll over to voice mail, no listening to instructions, no outbound greetings.

Because Pinger is much faster and more direct than voice mail, it’s great for sending quick voice notes when you’re driving or walking between meetings. It’s also ideal when you can’t risk being stuck in a 20-minute conversation with no polite way out.

Bonus features: You can broadcast a message to a whole group at once (“Baby girl, seven pounds — mom doing well!”), forward a message to a third party (any cellphone carrier), or retrieve and manage your messages on the Web.

Pinger is free until the new year. Even then, you’ll get 10 or 20 free pings a month (details aren’t complete); additional pings will cost a few cents each. Pinger says it’s working to fix the biggest downside, which is that you can’t ping someone’s phone (only the person’s e-mail address) until they’ve signed up for a free account.

FREE FUN YouMail, also in beta testing, is also dissatisfied with traditional voice mail. Its solution, though, is a complete surgical replacement of your carrier’s voice mail system. When you sign up at youmail.com, you’re instructed to reprogram your cellphone by typing in a series of codes. When it’s over, YouMail is your voice-mail service — not your cell carrier.

Why bother? First, because you can record a separate greeting for everyone you know. Your boss will hear you say: “This is Casey Robin, systems manager at Globodyne Technology. I’ll get back to you promptly. After all — your business is our business.”

Your love interest, however, will hear: “Hey there, huggalump. Miss you. Leave me a massage.”

(Hint: Don’t mix them up.)

You can even treat certain callers to something called Ditchmail. That’s when they hear, “This user is currently not accepting new messages. Goodbye!” (Disgruntled exes come to mind.)

For everyone else, you just record a generic greeting. You can also check your messages from the Web or any phone, save memorable ones to your computer, and forward messages to other people.

The Web site is still glitchy — for starters, a fix for Macs is in the works — and switching back to your old voice mail if you don’t care for YouMail isn’t exactly a one-click operation. But over all, YouMail is fun, and it has real uses; for example, you can let your friends know that you’re away on vacation, but not people who don’t need to know.

YouMail, too, is free during its testing phase; after the new year, it will be free if you’re willing to endure ads, and a few dollars a month otherwise. Note that YouMail isn’t ideal if you have Sprint, which charges you for “conditional forwarding” — a feature that YouMail requires.

Frankly, it is worth a few dollars to escape the minutes-burning, recorded instructions of cellular voice mail systems: “To leave a message, speak at the tone. When you’re finished, you may hang up ... .”

FREE PRICE COMPARISONS As you head out to the seething malls for holiday shopping, your cellphone can do more than tell your family you’re stuck in traffic. It can also save you money.

As you inspect something you’re tempted to buy, dial 888-Do-Frucall (888-363-7822; leave off the last two L’s for — well, for now). When prompted, plug in the bar code on the package. After a 10-second ad, a voice is usually successful in identifying the item by name (“Luv’s Diapers Value Pack, 208 Diapers Variation — not available used”), and provides the prices from three sample online stores.

It’s a disruptive little technology — doomsday, really, to a “we’ll beat any price” retailer. Frankly, the whole comparison concept seems a little unfair: How is a physical store supposed to match the prices of online outfits with much lower expenses for rent, clerks, taxes and so on?

Still, Frucall may let you know when you’re about to make an expensive mistake, and occasionally provide ammo for negotiating.

All right, it’s a stretch to think that you’ll be making free services like these part of your official, solemn, dinnertime thanksgiving. But it’s entirely possible that they may one day get you out of a pinch or save you a little time or money. Surely that will merit at least a little “Hey, thanks!” in your head.

E-mail: pogue@nytimes.com

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Tuesday, November 21, 2006

Thanksgiving Meal Manners


Pass a Drumstick, and an Olive Branch

Bettmann/Corbis

Published: November 22, 2006

COOKS can control the Thanksgiving menu, but when the dishes leave the kitchen, things can unravel fast.

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Family grudges buried by time and distance resurface. New girlfriends meet ex-husbands. Prius drivers make small talk with S.U.V. owners. And vegans spend the meal defending themselves.

It’s enough to break a cook’s heart. We seek the culture of the table as much as a well-made stuffing. We want the pace of the meal to be dreamy, the conversation indelible. Nirvana is a table trimmed with our best platters and a room brimming with friends, family and warm feelings.

The problem: Americans, as a whole, have lost touch with the ritual of the shared homemade meal. Although we eat at home a lot, the food often is from restaurants or the prepared foods section of the grocery store. Families eat in shifts and leave the television on. The sandwich has become the most popular dinner entree.

No wonder we have no idea how to behave at Thanksgiving.

I have a friend whose Thanksgiving meal went south just after her grandmother called her brother a cowardly Communist. Another friend’s nightmare began when her mother’s new boyfriend started talking about breasts, and he wasn’t referencing the turkey.

“There are a lot of impossible, unspoken rules on Thanksgiving,” said JoAnn Loulan, an author and family therapist who practices in the San Francisco Bay Area. “We’re supposed to be thankful and eat a lot and drink a lot and be nice to each other. Teenagers are supposed to stop being sullen. Matriarchs are supposed to make a perfect turkey and some man is supposed to know how to carve it.”

The day is so emotionally charged that Ms. Loulan is only half-joking when she suggests a potentially lucrative line for her practice: the dysfunctional family Thanksgiving chat room, an online marathon therapy session. Or, we could all save a little money and learn a few simple rules of etiquette instead. We’re not talking about the rules that make everyone nervous, like where to put your napkin and which fork to use, but the rules that make the day soft and smooth and comfortable. Kind of like Valium, without the side effects.

“The meaning of manners is really about being kind to people, about being nice,” said Nicole DeVault, a New York etiquette instructor who for years served as the manners consultant for the Plaza Hotel in Manhattan.

At the Emily Post Institute in Burlington, Vt., plenty of pre-Thanksgiving queries come in from people who hope to brush up on manners at the last minute. That kind of panic only adds to the pressure, said Peggy Post. She married into the family of Emily Post and recently published “Excuse Me, but I Was Next ...: How to Handle the Top 100 Manners Dilemmas” (HarperCollins, 2006).

A better approach is simply to make sure every action takes into consideration how another may feel, Mrs. Post said. It’s just what our parents told us all along: do unto others.

“The whole point is to make people feel comfortable, but to do what makes sense,” she said. “Etiquette is about applying consideration and respect and common sense.”

Susan Phillips Cohen, a social worker who lives in Brooklyn, relies on ritual and tradition to establish the tenor of her table. This year she will be one of a dozen or so people at her sister-in-law’s house in Staten Island. They will use the family china and make beloved dishes from childhood. That way guests can be reminded of the rules that go along with the holiday.

“Rituals are what help you get over difficult times, and they keep a lid on things, if you’re that kind of family,” she said. “There’s a code. We understand that we should try, that we should make the effort. Even if we haven’t been formally taught, we pick them up through the years.”

That’s why, before you know it, you find yourself reassuring the worried host that the turkey is most certainly not dry and leaping up to do the dishes.

One of Ms. Phillips Cohen’s favorite tricks for creating harmony is to give people something to do. It’s an axiom a professor of social work taught her years ago: action absorbs anxiety.

Just make sure it is a task someone can do well, advises Serena Bass, the Manhattan caterer. With nearly 25 years of experience catering events that included AOL’s holiday party and the actress Claire Danes’s birthday party, Ms. Bass has learned a little something about making parties work.

“People like to be told what to do, but they also like to feel successful at it,” she said. “So give them something they can do well. And remember that if you don’t assign a job to every person, they’ll amble off and get into trouble.”

And what if the conversation starts to turn sour? A host should know how to steer a conversation away from political implosions, personal attacks and off-color jokes.

“You have to use humor and think on your feet,” Mrs. DeVault said. If someone says something that seems designed to anger people, acknowledge the guest’s opinion, then make a joke about it and ease the conversation in another direction.

Mrs. Post is a little more proactive. She suggests polite but pointed private discussions ahead of time with potential troublemakers. And while it is not necessarily impolite to discuss politics or religion, a host should be prepared to defend a guest who falls under attack or appears uncomfortable.

Mrs. Post suggests language like this: “I really feel like this discussion is going nowhere and I’m sure poor Harry didn’t expect this.”

Then follow a time-honored custom: change the subject.

A good host must also handle with aplomb the guests who drift away from the table before dinner is over. Younger children can be dismissed to watch a special DVD or do an art project, but adults tempted away by the football game “must know they have to sit-stay,” Ms. Bass said. “Once they go out for a cigarette or they start texting, it’s all over.”

Clarity is key, she said. Announce ahead of time what the plan for the meal is. For example, say that appetizers will be served while the game is on, but the TV will be turned off for the meal. Better yet, offer to record the game and show it later.

Then, when the main part of the meal is over, ask one or two people by name to help clear, and ask the rest of the group to ready themselves for dessert.

So much for the hosts. But what about the guests? Ms. Loulan, the therapist, suggests bringing your boundaries to dinner. Make a plan for how you are going to handle uncomfortable situations. Give yourself permission to leave the room or to leave dinner early — as long as you prepare a thoughtful, polite excuse.

“If you can’t stay, call a friend to come and get you at a set time,” she said. “You know what’s going to happen, so act like it and make a plan to take care of yourself.”

For all of us, whether guest or host, the best tip of all might be one from Gregory McNamee, who has written dozens of books, including works on the folklore of South Africa and the natural history of an Arizona river. His latest is “Moveable Feasts: The History, Science and Lore of Food” (Praeger Publishers, 2006).

For thousands of years communal meals have been a key to building cultures. So relax and take the long view, he advises. Thanksgiving is just one more meal, and a bad one isn’t going to make or break civilization.

Besides, historians have recently concluded that the premise of Thanksgiving might be a lie.

“It turns out,” he said, “that the Indians were not so forthcoming, and the Pilgrims were not so grateful.”

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