As Records Go Digital, Cultures Clash - Part 2

At "As Records Go Digital, Cultures Clash, Bringing to Life Secrets the Health IT Companies Don't Want You to Know" I wrote of the used-car nature of the healthcare IT market, where lemon laws do not seem to exist and "physician buyer beware" seems a defining characteristic.

The Huffington Post Investigative Fund now has a report of their own on this phenomenon:

Shopping for Health Software, Some Doctors Get Buyer’s Remorse

By Emma Schwartz
Huffington Post Investigative Fund
Jan. 29, 2010

Computerizing American medical records within five years is a key goal of federal health policymakers, but disputes between some doctors and their technology vendors highlight the many challenges for individual medical practices making the conversion.

Bankrupt vendors leaving orphan software and inaccessible data, vendors misappropriating others' software for their own products, fights over source code, and "doctors left holding the bag" are just a few of the factors that clinicians have to face.

A nightmare scenario:

Robert Cameron wasn’t much of a technology buff, but the orthopedic surgeon knew he wanted to get rid of all the paper in his nine-physician practice in Pensacola, Fla. So he bought an electronic medical records system from a California-based company called Acermed.

Cameron’s group spent more than $400,000 on the software, but the system still never fully worked and even confused patients’ scheduled visits, according to a lawsuit the doctors filed against the technology company in 2006. Acermed filed for bankruptcy in September 2007, complicating the doctors’ attempts to recover their expenses.

The effort to go digital “was a disaster,” Cameron says now.

... Cameron’s Florida doctors group, Gulf Coast Orthopaedic Specialists, looked at half a dozen companies before signing with Acermed in April 2005. After installing the first part of the system, they alleged in their lawsuit, the scheduling software “malfunctioned causing patient appointment[s] to disappear.” Also, the billing system was not feeding claims back to insurers, which over the next six months nearly ran the practice into bankruptcy itself, the complaint alleged.

[Perhaps an ancient TRS-80 programmed by a medical student in Microsoft BASIC would have done better? - ed.]

Gulf Coast doctors continued to alert Acermed to the problems, but the company was unable to fix them, the lawsuit stated. They weren’t the only ones having trouble. Two other doctor groups—one in Florida, another in Tennessee—had also filed suit against Acermed, alleging similar problems. Gulf Coast filed its suit in October 2006. Acermed stated in court documents that the doctors had no basis for their claim.

[In other words, disappearing appointments and failed billing never happened and it was all in the doctors' imagination - ed.]

As it turned out, Acermed had been dealing with problems of its own. In July 2006, a federal judge ordered Acermed to pay more than $750,000 for using some of the source code from another vendor it had once worked with to develop its own electronic medical record software in 2004.

[In other words, the company misappropriated part of its computer program from elsewhere - ed.]

Gulf Coast’s lawsuit was still pending when, in September 2007, Acermed filed for bankruptcy. Company officials at the time said that the reason for their bankruptcy was the financial impact of legal bills, not problems with their software.

In January 2008, Ophthalmic Imaging Systems of Sacramento, Calif., bought Acermed and renamed it Abraxas Medical Solutions with Acermed’s former chief executive Michael Bina as president.

In an email, Bina said he does not “represent AcerMed any more and would not like to comment on its behalf.” He said that one of his conditions for joining Abraxas had been that it continued to service Acermed customers, and that “many clients” of AcerMed have stayed with the new company.

[A musical chairs question - who, then, does represent the old company if not the president of the company that now supports the old company's products? - ed.]

One of those clients, Tony Cattone, general manager of a 70-doctor medical practice in New Jersey, said in an interview, “they have lived up to their commitments and it’s working fine.”

[Until the new company does the same as the old, that is - ed.]

Several other doctors said they were left with loan payments for a system they never received.

And today, the Gulf Coast group still hasn’t entirely gotten rid of paper. In December 2008, the doctors settled their lawsuit with Acermed for an undisclosed amount. They invested in a different electronic system, but the doctors aren’t entirely happy with the new one either, said Alan Trest, the group’s technology manager. With the current system, doctors have to type rather than dictate notes. Some aren’t willing to make that transition because they say it takes them more time. So the group still pays for transcriptions.

“They haven’t really completely bought into the idea,” Trest said.

See the full story at the above link.

I note that "revolutionizing medicine" via IT still seems somewhat unlikely when the IT industry conducts itself more poorly than the used car industry.

-- SS

What Happens When "We'll Manage it the Way We Damn Well Want"

Back in the early days of Health Care Renewal (2005, to be exact), we first wrote about some very strange actions by the management of Phoebe Putney Health System.  At first, we noted that the Phoebe Putney responded to a reporter's inquiry about lavish travel expenses pertaining to the system's Cayman Islands health insurance subsidiary by saying, "We own it. We'll manage it the way we damn well want."

Then the story got far more convoluted.  In 2006, we wrote about the over the top response to anonymous faxes challenged hospital management's commitment to the institution's mission.  The system CEO compared the fax senders to "terrorists."  After the local district attorney handed over his investigative records to hospital system private investigators, the investigators allegedly threatened a local accountant whom they accused of sending the faxes.  Allegations that the district attorney received campaign funding from and may have had other financial ties to the hospital system surfaced.  The district attorney indicted the accountant and a physician colleague on charges of burglary and assault in the absence of any police report of such crimes.  We commented that regardless of the outcomes of the legal case, the hospital system's management's actions seemed at variance with its stated mission.

Now, in 2010, the case is in the news again.  Since our last post, according to the Atlanta Journal-Constitution, the prosecution of the accountant, Mr Charles Rehberg, and physician, Dr John Bagnato, failed.  The district attorney, Ken Hodges,
provided the information gathered through the subpoenas to Phoebe Putney, which the hospital system used to file a civil suit against Rehberg and Bagnato -- a suit that was ultimately dropped. Rehberg then countersued Phoebe Putney, and that case was settled out of court for an undisclosed sum.
Meanwhile, more ties between Hodges and the Pheobe Putney system turned up:
Hodges' decision to run for attorney general elevated the case from a localized matter to one of statewide import. While still a prosecutor in Albany, Hodges received political contributions from Phoebe Putney executives and individuals connected to the hospital system, and his wife was hired as public affairs manager at Phoebe Putney's hospital in Albany.

Since leaving the prosecutor's office in Dougherty County, Hodges has gone to work for the Baudino Law Group, which represents Phoebe Putney. According to records Phoebe Putney must file with the Internal Revenue Service, the hospital system paid Baudino more than $8 million for the fiscal year ending July 31, 2008, the most recent data available.

Now, it is Rehberg who is suing Hodges, for abuse of power. "Charles Rehberg's suuit essentially accuses him and another prosecutor of filing criminal chargest that they knew to be based on fabricated information." A preliminary hearing took place yesterday.

So, in summary, two individuals sent anonymous faxes that charged that the Phoebe Putney system failed "to fulfill its charitable obligations as tax-exempt entity."  Hospital system executives accused them of terrorism, and hospital system investigators allegedly threatened them.  However, a criminal investigation by a district attorney with alleged financial ties to the hospital system ended without any convictions.  A lawsuit by the system against the individuals was dropped.  A suit by the indviduals against the hospital system was settled by the system.  A suit by the individuals charging that the then district attorney abused his power by basing criminal charges on false information is pending. 

So what did the hospital system's management's actions in this case have to do with the system's stated values? -
Phoebe pursues its mission through a patient-centered environment of care reflecting high standards and promoting a balance of professional preparation and service, continuous improvement and based on core values where:

* PEOPLE come first, are treated with dignity and respect, and diversity of culture and thought is respected.
* RELATIONSHIPS are built on honesty and integrity.
* REPUTATION is built on trust and pride.

In fact, the Phoebe Putney management's pursuit of Mr Rehberg and Dr Bagnato seems diametrically opposed to these values, intended to crush all criticism of management by any means. Once again, we see leaders of once-respected not-for-profit health care institutions whose main goal seems to be consolidating their power and thwarting criticism.

I say again, to truly reform health care, our health care organizations must be lead by those who put the institutions' missions ahead of their self-interest, who manage according to the mission rather than "the way we damn well want."

Why The Apple iPad Will Not Revolutionize, Change the Game, Transform or Create New Paradigms in Medicine Anytime Soon

The announcement of the Apple iPad has been accompanied by the usual irrationally exuberant, buzzword-laden statements and bellicose grandiosity from the IT punditry about how it will "revolutionize" or "transform" medicine.

However, this will not occur anytime soon, for in medicine, the device may help solve a portability and visibility problem (compared to PDA's), but it will not solve this problem: the mission hostile user experience.

The solution to that problem will require significant human magic.

-- SS

Boris Vian - Woman dies of the lily growing in her lung; because the people they loved are gone, mice persuade diffident cats to kill them

Boris Vian, Foam Of The Daze, Trans. by Brian Harper (Tam Tam Books, 2003)

"L'Ecume des jours (Foam of the Daze) is a jazz fueled Science Fiction story that is both romantic and nihilistic! Vian's novel is an assortment of bittersweet romance, absurdity and the frailty of life. Foam of the Daze is a nimble-fingered masterpiece that is both witty and incredibly moving. It is a story of a wealthy young man Colin and the love of his life Chloe, who develops a water lily in her lung.
The supporting cast includes Chick, an obsessive collector of noted philosopher Jean-Sol Partre's books and stained pants, and Nicolas who is a combination of P.G. Wodehouse's fictional butler Jeeves and the Green Hornet's Kato. The soul of the book is about the nature of life disappearing and loving things intensely as if one was making love on a live grenade!"

"The most heartbreakingly poignant modern love story ever written." - Raymond Queneau

"For the last thirty years L'Ecume des jours has been the author's best-known and most widely-discussed work: blending as it does the most light-hearted and playful fantasy with a sense of doom and tragedy that many readers across a wide range of ages and cultural backgrounds have found irresistibly moving, it is a novel that has paradox at its heart." - David Meakin

"L'Ecume des jours is full of good things - from farcical religious rites to the obsessions of a bibliophile which turn to fetishism and wreck his life. The set pieces are marvelous, rumbustious, and macabre. This is a tragic love story, a morbid and even a pathological farce. It is a book of failures and closures, and wonderfully destructive." - Adrian Searle

"I can't think of another writer who can move me as surreptitiously as Vian does" - Julio Cortazar

"Foam of the Daze is a novel like no other, a sexy, innocent, smart and sweet cartoon of a world which then begins, little by little, to bleed real blood until, in the end, the blood turns out to be our own... it's still one of my favorite books in the whole world." - Jim Krusoe

"Who wouldn't want to immerse themselves in THE greatest love story? With pages that drip with passion, cries, laughter, tears and so forth. Among the more sober, but magnificent just the same, I recommend L'Ecume des jours by Boris Vian. It begins like a fairy tale but don't panic, you will see that it won't take long to become something else indeed... First there is the young, rich and carefree Colin. He, above all, "longs to be in love". One immediately identifies with this fragile anti-hero yearning for love. The most important thing for him is his small circle of friends: Chick, Alise, Nicolas, Isis ...and Chloe. During a party of close friends, he falls madly in love with her. Everything is great. Colin and Chloe get married and the world belongs to them. But then this beautiful fury of life is broken clean. Chloe becomes sick with a poetic disease (even though Boris Vian doesn't want it). A water lily grows in the lungs of the beauty and pushes out all the oxygen. Colin becomes responsible and works but Chloe wilts away incurably. On their side, Chick and Alise had everything to be happy... if Chick didn't have the filthy mania of bankrupting himself by buying the works and clothes of a certain Jean Sol Partre, (a little dig from Vian to the famous existentialist of Saint-Germain-des-Près). This "partrophagy" pushes Alise to kill Partre. Only Nicolas and Isis escape a tragic destiny and accompany their friends to the end. The character's purity and carefree attitude... it's superb!" - Catherine Combet

"Boris Vian writes like a dapper, dilettantish dandy, which is appropriate because that's what he was. His 1947 novel perfectly reflects this breezy social agenda of elegant aperitifs, whimsical obsessions, and love, love, love. But Vian's very much a descendent of his dour and decadent French forefathers, learning from the life of leisure that beauty reaps the blood of solitude and pretty girls do, in fact, make graves, so even the book's blithest banter betrays an echo of the memento mori that is to come. And yet, for all its subtle sadness, Foam is fun and cleverly combats life's fragility with nimble wit and a sardonically deadpan appraisal that's as unassailable as it is hilarious. Nothing captures Vian's post-ironic genius as lucidly as his rendering of the fog-shrouded funeral procession for the protagonist's lovely wife: "it was very sad looking." You'll laugh. You'll cry. You'll smirk." - Britt Brown

"Rays of sunlight stream through windows and congeal into honey-golden droplets on a tile floor, which are gathered like jewels by a friendly house mouse. A "pianocktail" concocts wild libations inspired by the jazz song played on it. Rifle barrels are grown like flowers in coffin-shaped planters, which have to be warmed by naked human flesh. Metal-frog-powered Rube Goldberg machines crank out a pharmacy's medications. Cops tool around in skin-tight, bulletproof black leather and heavy metal boots. A weapon kills by attaching to the torso and ripping out the heart. Welcome to the wonderfully alive and terrifyingly human world of Boris Vian.
Born in Ville-d'Avray, France, in 1920 and passing away a short 39 years later, the fearsomely talented Vian crammed nearly a dozen careers into his brief life. Educated as a engineer, Vian abandoned the steady life to pursue his other interests, turning himself into a novelist, playwright, journalist, poet, writer of pornography and sci-fi, translator, actor, musician, jazz critic, instrument inventor, and, because that wasn't quite enough, opera librettist.
Most baffling, Vian miraculously squeezed out his original, imposing output during a life that sounds lifted from a bohemian fantasy. He was a member of the College of Pataphysicians, a parody of an intellectual society dedicated to imaginary solutions. A habitué of Paris' post-war St. Germain-de-Pres, Vian befriended Simone de Beauvoir and Jean-Paul Sartre, writing a column in Sartre's Les Temps Modernes under the name "the Liar." A jazz fanatic, Vian introduced a young Miles Davis to his friend Louis Malle, and the American jazz giant eventually scored the French filmmaker's debut, Ascenseur pour l'échafaud. Vian wrote Le Deserteur, the scathingly sardonic make love/not war song during France's Algiers troubles. He famously drank for sport; women liked him, and he liked them right back. His "debut" novel - a pulp dashed off in a fortnight called J'irai cracher sur vos tombes (I Shall Spit on Your Graves), published under the pseudonym Vernon Sullivan - became the American Psycho controversy of late-'40s Paris. When his congenital heart condition took his life - since Vian couldn't even die mundanely, he passed during a screening of the unauthorized film adaptation of his J'irai - Vian's acclaim was on the rise, and by the spring of 1968 he was a revered French cult figure.
...A mash note to pretty girls and the music of Duke Ellington, the book follows the fabulous misadventures of two young couples, Colin and Chloe and Chick and Alise, through an imaginatively bustling and otherworldly Paris. The independently affluent Colin lies with his manservant Nicolas and a mouse, and after marrying Chloe gives his friend Chick 25,000 doublezons (the novel's monetary unit) so that he can marry Alise - which Chick blows on the publications and collectibles of his favorite writer/philosopher, "Jean-Sol Partre."
Vian vibrantly paints this quartet's good life in colorful gestures - ice-skating where valets come and broom-sweep the fallen from the ice, dancing the oglemee at bawdy parties, and Colin and Chloe's magical wedding. Yet just as Colin and Chloe become gaga newlyweds, life turns bleak. Chloe becomes mortally afflicted with a water lily growing in her lung, and Colin spends his entire fortune, sells his belongings, and finally submits to the ultimate indignity – employment - to fill their bedroom with flowers, the only medication comforting her condition. Their radiant apartment begins to shrink, until the jovial mouse has to flee. From the crucifix above an altar, Jesus mocks Colin at Chloe's funeral, wondering why Colin didn't spend as much money as he did on the wedding. The cops come after Chick, and the cast-off Alise goes after the vendors of Partre paraphernalia with the heart-snatcher.
That weapon's made-up French word – "l'arrache-coeur" - plays on the euphemism for "heartbreaker" ("crève-coeur"), and Vian's final novel carries the heartbroken's heavy weight. Heartsnatcher, though less playfully animated, is Vian's most mature work, the shadow of his lifelong knowledge that his heart could stop at any moment cast over every page. Set in a phantasmagoric small town where the old are auctioned off and the congregation assaults the priest, Heartsnatcher follows the mounting obsessions of Clementine, a mother of three--twins Noel and Joel and a third, Alfa Romeo - who loathes her husband for putting her through the rigors of birth. Clementine grows more and more overly protective as her children age, and though town psychiatrist Timortis tries to assuage her neurosis, she ends up going to extremes to shield her offspring like animals eating their young - to put them back - eventually imprisoning them in cages.
Disarmingly funny and catastrophically tragic, Vian's novels take place in parallel worlds much removed from this one, yet their emotional landscape couldn't feel more familiar: love and art and sex and life and music and everything can be great, but things can always go horribly, monumentally wrong. Vian confronted his own unknown by injecting his ceaseless talents and infectious humor into everything he did, leaving behind a body of work that inspires by example: that it's what people choose to do with their life, however troubled and brief, that makes it the intoxicating folly worth caring about." - Bret McCabe

"This is a great novel, mind you. Though on its surface, the simplest of stories - Vian summed it up as "a man loves a woman, she falls ill, she dies" - beneath are a host of ambiguities, digressions, levels of meaning. Not quite beneath actually, for subtexts keep erupting to the surface. It is in many ways a novel built of eruptions.
Simply, then, this is a tale of two couples: Colin, a rich and rather superfluous man, and Chloe, a woman dying from a lily growing in her lung; Chick, whose life is ruined by his collecting of Jean-Sol Partre's books and memorabilia, and Alise, who tries to save Chick from himself by murdering Partre. As the lily grows in Chloe's lung, Colin does all he can to keep her alive. But her bed sinks closer to the ground and the room grows ever smaller. Because Colin has no money left to pay for burial, Chloe's coffin is simply thrown out the window.
In Vian's world, nothing is simple, nothing may be taken for granted. Because people they love have died, mice persuade diffident cats to kill them; bells detach themselves from doors to come and announce visitors; neckties rebel against being knotted; some broken windowpanes grow back overnight while others darken from breathing difficulties; a piano mixes cocktails to match the music being played upon it; armchairs and sausages must be calmed before use. When Colin puts Duke Ellington's "The Mood to Be Wooed" on the phonograph, the O's on the record label cause the corners of the room to become round.
In Vian's books, the world becomes ineluctably strange, the world as a child or a madman might see it. And that's the recipe for Foam of the Daze, a novel with paradox at its heart, as critic David Meakin has observed: one part light-hearted fantasy, one part tragedy. Add wordplay and romance to taste. Your heart will be broken. You will be confused and confounded. You will laugh aloud. And at least for a time, however hard you try, your own world will refuse to be what you think it is.
Here is Colin in church after Chloe's death:
'Why did you have her die?' asked Colin.
Oh... said Jesus, drop the subject.
He looked for a more comfortable position on his nails.
She was so sweet, said Colin. Never was she bad, neither in thought, nor in action.
That has nothing to do with religion, mumbled Jesus, yawning. He shook his head a little to change the slant of his crown of thorns.
I don't see what we've done, said Colin, we don't deserve this.
He lowered his eyes... Jesus's chest was rising softly and regularly, his features breathed calm, his eyes had closed and Colin could hear a light purr of satisfaction coming from his nostrils, like a sated cat.'
" - James Sallis

"Foam of the Daze is influenced heavily by music, namely jazz... a song ["Mood Indigo"] by Duke Ellington surfaces in the novel several times... when the protagonist, Colin, first meets the love of his life, Chloe, he asks her impulsively if she's "arranged by Duke Ellington." It's clear that Vian intends Chloe to embody the bittersweet music, which promises her and Colin a less than happy fate. The lovers have dinner with friends, take walks, get married, and Chloe becomes sick as a water lily grows inside her lungs. The novel meanders in a way that's indeed reminiscent of jazz, though it may remind non-jazz lovers of a Quentin Tarantino film, with its surreal dialogue, obscure cultural references, and improbable occurrences.
From the beginning, the novel feels like a mixture of fairy tale and journalism. Realistic narrative alternates when fantasies in which inanimate objects come alive and mice act like people: "The kitchen mice loved dancing to the sound of the shock from the sunbeams on the faucets, and they ran after the little balls that the beams formed upon pulverizing themselves on the floor, like spurts of yellow mercury." Many writers have tried to pull off passages like that but few have succeeded. Lewis Carroll created a convincing universe with cartoonish characters in Alice's Adventures in Wonderland, and a white rabbit wearing a waistcoat would fit in among Vian's creations. In its first half, Vian's novel is actually more exultant and luminous than anything Carroll wrote - yet Foam of the Daze is not a children's book. In its second half, the story turns a few shades darker than any of Alice's adventures when one of the delightful, dancing mice commits suicide by convincing a cat to eat her: "She shut her little black eyes and put her head back (in the cat's mouth). The cat carefully placed his razor sharp canines on her thin, soft, gray neck. Their two mustaches mingled together. The cat unrolled his furry tail and let it lie out on the sidewalk."
This moving scene lingers in the mind, like many of Vian's images." - Doug Pond

"This offbeat, surrealist novel has been popular in France for the last half-century... The novel's plot follows the rise and fall of two youthful romances. One romance involves the wealthy and idle Colin, who falls in love with Chloe. The other involves Colin's friend Chick, who falls in love with Chloe's friend Alise. The narrative opens with cheerful whimsicality, but it takes on a darker tone when troubles arise for both relationships. Chloe falls ill with "a water lily in her lungs; as a result Colin must sell his possessions and work at pointless and degrading jobs to pay for doctors who can't cure her. Chick, on the other hand, suffers a different ailment when he becomes so obsessed with the philosopher Jean-Sol Partre that he neglects Alise and reduces her to murderous desperation. A notable feature of Vian's style is his tendency to highlight impossible environmental conditions as oblique counterpoints to his characters' understated emotions. For example, after Colin is forced to sell one of his prized possessions, "The green-blue sky was hanging practically down to the pavement and large white spots marked where clouds had just smashed down." Such fantastical elements also permeate Vian's social world: e.g., an invention called a "pianocktail," currency known as "doublezons," and weapons referred to as "heart-snatchers" and "cop-killers." The novel reads like a combination of Lewis Carroll and Thomas Pynchon, and sometimes Vian's absurdist style creates an emotionally distant effect. But its final chapters sustained a powerful note of sadness for two young loves ruined by mortality, rival intellectual obsessions, and a repressive work ethic." - Thomas Hove

"The love of Colin and Chloe may end tragically, but the novel is filled with wordplay (one character collects Jean-Sol Partre memorabilia) and such imaginative notions as the "pianocktail" - a drink blended by playing a keyboard to release different combinations of liqueurs and flavorings. Vian himself remains a legend in France; imagine a James Dean who played jazz trumpet, wrote innovative novels and poems, and died young from a bad heart." - Michael Dirda

"When I was a film-school student in Beijing in the early 1990s, I had randomly picked a French novel in a bookshop – the Chinese translation of Foam of the Daze. I was 20; I had never left China, I had never met any Westerner, and I had never tasted red wine either.
So I was reading that novel in those barbecue stalls in the streets of Beijing - no cafes around at that time, no Starbucks either - and I got the impression that the book was about melancholy French youth in the 1940s. The translation was not bad.
What I understood was that the author tried to paint a picture of youth. It starts childishly and beautifully, but then youth becomes ravaged and swallowed by time and society.
I loved the water lily that grows in the girl's chest in the novel. She is dying, but the doctor can only diagnose a flower growing in her chest, and can do nothing to help her suffering. The boy starts to lose his smiles and grows poor because his girl is losing her life, and the society is demanding that he be a "man".
After reading the novel, I thought, "I must go to Paris, and I would like to meet those beautiful sad young men in France. One day!" I indeed left China, only 10 years later. I came to Europe, trying to escape all my problems with the city of Beijing: dusty dry weather, noisy industrial buildings, a government work-unit job; basically, a rusty youth - a youth without much imagination or distance towards my reality in concrete Beijing. Coming to Europe was a second chapter of my life.
Then, in London, I bought the English translation of Foam of the Daze – 15 years after first reading it in Chinese, after drinking thousands of cups of coffee, tasting hundreds of glasses of wine, after travelling through the whole of Europe, after seeing my own youth fading away from working too much and thinking too hard.
In a foreign bed, I reread the novel, and it killed me. My tears flew when I tried to read the ending as slowly as possible – the little mouse puts his head into the cat's mouth, in order to die with the briefest pain.
The world of Boris Vian: the prince of Saint Germain – a great novelist, a jazz singer, a party drinker and, essentially, a great child who refuses to grow up in a ugly and complicated society. He died before he hit 40.
Foam of the Daze is perhaps Vian's most innocent work. The innocence of youth is drawn in such an elegant way, and its darkness and profound melancholy when the human innocence fades away, and gets lost in a blur of the political world." - Xiaolu Guo

"Upon opening this book, the reader is directly confronted with the game of inversions which sustains the global perspective: in an absurd, very strange world, the narrator presents us a character that is particularly ordinary and indefinite.
Thus, Colin is a very easy-going young man who loves jazz music, girls and who hates work and violence. He finds the love of his life in the person of Chloé, a crazy love which will make him lose everything he holds dear. Chloé’s illness will force him to work for the very first time in his life: his first job would be that of manufacturing weapons and his second job, that of guarding a goldmine and crying out loud when he sees a thief.
Chloé is the epitome of beauty and womanhood. She’s the perfect woman for Colin: young, pretty, sweet and attractive, but fragile. Her name comes from a piece played by Duke Ellington called "Chloé."
Chick is Colin’s best friend. He is mad about Jean-Sol Partre’s philosophy even if he doesn’t understand it at all. Because of this obsession with Partre he sometimes acts selfishly. Unlike Colin, he has to work in order to survive. He is also Alise’s boyfriend, but he loves Partre more than her.
Alise is a sentimental, friendly young lady. She is madly in love with Chick and full of compassion towards Chloé, but she sometimes thinks her life would have been much easier if she had married Colin.
Nicolas is Alise’s uncle, and Colin’s cook. He doesn’t belong to the same social class as the other characters. He is at the same time a loyal friend of Colin’s and Isis’s lover.
Isis is part of the high society and is the only one who has a family; she is in love with Nicolas, and she knows how to enjoy life’s pleasures.
Another character in this novel is the funny, adorable grey mouse with dark mustache.
As far as the friendship between Colin and Chick is concerned, we can notice its development all through the novel. They admit at the beginning of the book that they see each other as unique persons. Colin is aware of his friend’s poor financial situation, and therefore invites him to dine with him every Monday evening. Chick also regards Colin as a very kind, true friend, who can help him get all the books from Partre’s collection.
In fact, Jean-Sol Partre’s books are the only passion Chick has. It’s a very popular author, and Chick is simply obsessed with acquiring all of his books. But his engineer wages and the money he gets from his uncle are not enough for him to enrich his collection. Because of that, he constantly borrows money from his generous and rich friend Colin.
Nonetheless, Chick seems to take advantage of Colin’s hospitality and generosity. He never hesitates to ask him for money. In fact, he doesn’t even ask "could you lend me some money?" but instead he uses the imperative: "lend me some money." Colin accepts, of course. Apart from that, he also gives Chick 25 000 doublezons in order for him to marry Alise. But Chick uses that money amount to complete his Partre book collection. So Chick does not honestly take advantage of the money Colin had given him. So he is left with only one doublezon. He also misses to pay his taxes. In addition to that, all through the novel, Chick does not have a single moment for Colin, he doesn’t help him when Chloé is sick, when Colin is also short of money.
Therefore, Chick is nothing but a very superficial person, who does not get attached to anyone but a single obsessive thing: Jean-Sol Partre, and his successful books. This will lead him to the road of perdition. He does not, under any form or circumstance, share Colin’s friendship and warm feelings of sympathy towards him.
Apart from all these, the novel charms the reader through its fantastic imagery and descriptions, through its strange, sometimes adorable, sometimes cruel humor. It is an absurd world where the inanimate tends to replace the animate, where humans tend to be replaced by objects and machines, or to transform themselves in machinery. In all, it’s a book worth reading." - Claudia Miclaus

"Foam Of The Daze is a light-weight work filled with puns, bittersweet romance, elements of science fiction and jokes about Vian’s friend Jean-Paul Sartre who appears in fictional form as Jean-Pol Partre. The plot, an inconsequential love story exists only as a vehicle for Vian's literary riffing. With its many jazz references this novel appears to be an attempt to translate the Afro-American art of signifying into something that could be found acceptable within Anglo-French literary discourse. Tam Tam’s edition reproduces the copious annotations from the ten year old French critical edition of Foam Of The Daze put together by Gilbert Pestureau and Michel Rybalka. Since these two critics don’t appear to realise that Vian is attempting to dumb up Afro-American street traditions of tall tale telling, they fail to provide clued up readers with any insights into the book and it isn’t long before the mute literalism of their annotations becomes grating. Indeed, had I not been reviewing the book I certainly wouldn’t have bothered with their notes, and skipping such unnecessary froth can only add to one’s enjoyment of the text.
Foam Of The Daze is an interesting if ultimately faulty experiment which pales in comparison to the work of real masters of the art of signifying such as Rudy Ray Moore. Moore’s comedy sketches are often obscenely extended and he is perhaps best known for the routine and subsequent film Dolemite both derived from a tale he’d first heard acted out by an alcoholic street bum. Although familiarity with the movie Dolemite (1975) would be preferable by a long chalk, for readers unfamiliar with Moore the following short joke will provide an almost adequate flavour of his humour: ‘What did the whirlwind say to the palm tree? Hold onto your nuts because you’re about to get one hell of a blow job’. Returning to Foam Of The Daze, it is inferior to Vian’s slice and dice hack work I Spit On Your Graves precisely because it is more literary, and by the time this was written in the wake of James Joyce bourgeois fiction was already dead."- Stewart Home
Boris Vian, Heartsnatcher (Dalkey Archive Press, 2003)

"Set in a bizarre and slightly sinister town where the elderly are auctioned off at an Old Folks Fair, the townspeople assail the priest in hopes of making it rain, and the official town scapegoat bears the shame of the citizens by fishing junk out of the river with his teeth. Heartsnatcher is Boris Vian's most playful and most serious work.
The main character is Clementine, a mother who punishes her husband for causing her the excruciating pain of giving birth to three babies. As they age, she becomes increasingly obsessed with protecting them, going so far as to build an invisible wall around their property."

"The last novel Vian completed before his death in 1959, this whimsical, absurdist sendup of human foible takes place in a village where old people are auctioned off like slaves, villagers stone the vicar to produce rain and stallions are crucified for "falling into sin." The novel opens with willful Clementine deep in the throes of labor and furious about it. With her husband, Angel, locked in his room (from the outside), Clementine is rescued by Timortis, a traveling psychoanalyst, who helps her deliver triplets. Timortis befriends the browbeaten Angel (Clementine vows never to have sex with him again) and decides to stay on at the house. As a stranger to the country, he provides a window onto its bizarre customs-it is possible to pay someone to take on another person's shame, for example-even as he trolls the village looking for people to psychoanalyze. As the "heartsnatcher" of the title, Timortis has no feelings or desires of his own and embarks on a futile, hysterical quest for patients so he can "steal their feelings." His sole subject is a maid who thinks psychoanalysis is a euphemism for sex; she's happy to take off her clothes, but she refuses to talk about her feelings. The episodic, meandering narrative wanders from incident to incident, until Angel leaves Clementine, and she takes up child-rearing with unbridled abandon. Vian's sharp, playful humor makes for an entertaining read, although there are extended flat stretches. While the allegorical conceits may be something of an acquired taste, Vian's prose is surprisingly accessible, and his fascinating take on the strange logic of human cruelty and inconsistency makes this a worthwhile read." - Publishers Weekly

"An impish satire on regimentation-as seen in the delicious particulars of this fetching 1953 novel, previously, unforgivably unavailable in English translation... Heartsnatcher's arresting title alludes directly to the devious practices of its protagonist Timortis, a morose psychiatrist who attempts to enrich his own life by entering, then possessing his patients' dreams, fears, and fantasies (the scene in which he sets forth to "analyze" a bored housecat is beyond praise). His counterpart is the other protagonist, Clementine, an insanely overprotective mother who locks up her baffled husband, safely away from their progeny (a set of triplets), over whose lives she hovers with paramilitary paranoid rapture. These two characters (and several others scarcely less grotesquely absurd) coexist unpeacefully in a provincial town bedeviled by impossible occurrences, and itself a fount of hilarious eccentricity and misrule. For example, an indigent fisherman is hired to retrieve garbage from a nearby river with his teeth. And elderly people are sold as toys. What's so captivating about Vian's mad inventions is their perfectly logical relation to recognizable societal folly (e.g.,maternal "smothering," exploitation of poor people, indifference to the rights of the aged). Though Vian matured in the time of Sartre and Camus (and knew both), he's really an antiexistentialist. His people are indeed responsible for their actions: it's they, not the universe, who are absurd. A major rediscovery. Don't miss it." - Kirkus Reviews

" 'Novembruary, the cold, spitgrey, drizzleridden, fogeared month. Novembruary rain can cause all sorts of damage in all sorts of places. It can furrow through the fields, flaunch the furrows into ravines, and carry off the enraptured ravens. Or it can suddenly freeze.'
In descriptions so richly imagined that he sometimes has to invent new words, Boris Vian brings to life the strange world discovered by a wandering traveler, Timortis, a psychiatrist who wants to "psychiatrize." Timortis has been born an adult and has no memories of his own. An "empty vessel," he believes that if he can learn everything there is to know about someone, he can bring about a transference of identity and make his own life more complete. He is wandering in search of people who will bare their souls and all their memories.
When he hears the cries of Clementine, a village woman giving birth to triplets, he stops to give aid and ends up delivering her sons - Noel, Joel, and Alfa Romeo. He is soon banished from the room, however, along with the woman's husband, Angel, as Clementine decides that she, and she alone, knows what is best for her babies - she will raise the little prodigies herself.
Though much of the birthing scene is humorous, the full satirical flavor and the allegorical construction of this novel do not unfold until Timortis and Angel, sent out of the house, go into the village. There, Timortis discovers that he has arrived just in time for the Old Folks Fair, at which old people are auctioned off, and he observes a man, Ezekiel, buying an "old folk" for his kids to abuse-"Here you are, kids. Have fun with him." The auctioneer, Gerry Mander, hits one of the old folks in the mouth and kicks another in the behind, while the others sit patiently waiting for their turn to be auctioned. Later Timortis visits a shop, where he sees a child being worked to the point of death, then splashed with icewater to revive him when he passes out. Farm animals are well treated, however, being given days off when they behave themselves and allowed to hitchhike when they need rides. Few readers will have any questions about the meaning of these early scenes, though some later scenes are more ambiguous.
A scarlet stream winds through the village, "pale red and opaque. Like poster paint." Into this stream people throw their trash, including all dead bodies, and it is the job of a scapegoat, named Glory Hallelujah, to retrieve decaying things from the stream with his teeth. "I've got a house and I've got loads of gold-but I have to swallow the shame of the whole village for them. Remorse for everything wicked and evil they do. For every one of their vices." He goes on to explain that "the first person to be more ashamed than I am takes my place. That's the village tradition. They're very religious here. They've got their consciences for themselves. But never any remorse." When Timortis visits the egg-shaped church and meets the vicar, he discovers that the vicar does not want people to think of applying religion to everyday life. "God is not utilitarian. God is a birthday present..a luxury, a tasseled cushion made of beaten gold."
Vian's satire and offbeat humor continue unabated throughout the novel. A horse is crucified for his sexual depravity, women take off their clothes so they can be "psychoanalyzed," Angel builds a boat and tells Timortis that it is "not a Maytree Ark," and Noel, Joel, and Alfa Romeo grow quickly, looking for blue slugs so they can learn to fly. Additional bizarre episodes abound, leaving the reader to ponder the meaning of the non-stop action, at the same time that s/he is whisked along by the speed of Vian's prose to new and still more surprising events. Puns, word play, and literary inventions fill the novel, even as Vian's often lyrical sentences and vibrant descriptions set the scenes. One sentence, more than a page long, is a testament at least as much to Vian's enthusiasm for his story as it is to his prodigious creativity.
Vian creates a whole new world here, satirizing the existing world for some of its most obvious faults, and presenting a remarkably open-ended allegory, which makes the reader think, at the same time that s/he often laughs at the absurdities and winces at the truths. But this is no full-blown alternative universe created to illustrate a serious and specific political or social agenda. Here Vian symbolically smiles at the reader as he leads Timortis through this strange community from episode to episode, illustrating his own opinions in a more or less random way, having fun all the time, while making some serious points. Not scholarly, though highly literate, this is a book for which one must buckle up, sit back, and just enjoy the ride." - Mary Whipple
Boris Vian, Autumn In Peking (Tam Tam Books, 2006)

"The story takes place in the imaginary desert called Exopotamie where all the leading characters take part in the building of a train station with tracks that go nowhere. Houses and buildings are destroyed to build this unnecessary structure - and in Vian's world waste not, make not. In Alistair Rolls' pioneering study of Vian's novels, The Flight of the Angels, he expresses that Exopotamie is a thinly disguised version of Paris, where after the war the city started changing its previous centuries of architecture to something more modern. Yes, something dull to take the place of what was exciting and mysterious.
Vian, in a mixture of great humor and unequal amount of disgust, introduces various 'eccentric' characters in this 'desert' adventure, such as Anne and Angel who are best friends; and Rochelle who is in love and sleeps with Anne, while Angel is madly in love with her.
Besides the trio there is also Doctor Mangemanche; the archeologist Athanagore Porphyroginite, his aide, Cuivre; and Pipo - all of them in a locality similar to Lewis Carroll's Alice in Wonderland, where there is a tinge of darkness and anything is possible, except for happiness."

"L'Automne à Pékin could well become one of the classics of a literature which, after having exhausted with a uniformly accelerated movement all the nuances of the sinister, from Romanticism to Naturalism and from Socialism to Mysticism, notes all of a sudden that it winds up in the desert of Exopotamie; a literature where one is finally permitted to laugh!" - Alain Robbe-Grillet

"Let the entire College pay attention to this work, let it uncover its riches: they are incalculable. A great lesson that Satrap Boris Vian gives us in L'Automne à Pékin, using, moreover, a sacred language. L'Automne à Pékin is one of the rare novels of our time which renders words their literal sense without suffering from the prejudice furnished by other possible means." - Noel Arnaud

"Ostensibly about the expedition to build a railway in the desert of Exopotamie, populated with engineers, randy priests and hermits, lovelorn couples, and a physician obsessed with model airplanes, as well as by buses that feed on catfish bones, typewriters that shiver when uncovered, and bedclothes that climb affectionately back into place when thrown back, even a chair that falls ill and must be hospitalized, this is the strangest of many strange Vian novels, like the others part science fiction, part love story, part surrealist farce - and wholly, unforgettably readable." - James Sallis

"From my freshman world lit. survey I can distinctly remember one session. The reading to be discussed was Franz Kafka's THE METAMORPHOSIS, a book that I had read at least three times during high school. As it turned out, so had the rest of the class, because, quite uncharacteristically, they had endless comments of a supposed "literary" nature to offer, all of which bore the unmistakable mark of high school English class mediocrity.
Admittedly, THE METAMORPHOSIS isn't a simple book. From the first line, in which Gregor Samsa awakes to discover he has turned into a large bug, the novel presents precisely the sort of problem that students, inundated with the worst reductive tendencies school can shove down their throats, can't quite make sense of. So, lacking any capacity for original thinking, they glibly repeat the banalities of their high school English teachers.
One person suggested that maybe Samsa's transformation was a reference to the Holocaust, as the Nazis had referred to Jews as "vermin," Unfortunately, Kafka had been dead for a couple decades by the time Hitler came to power. Another student claimed that the apartment the novel takes place in represented the Trinity, and that Samsa's transformation had something to do with transubstantiation (the belief that the bread and wine actually turn into Christ's flesh and blood upon touching one's tongue). Kafka being a Jew, though, it seems a bit of stretch to claim his work is filled with Catholic dogma. A third student simply thought it was "Freudian," as though that was, in itself, elucidating.
Of course, in reality Samsa's transformation means nothing. It's not a symbol, a metaphor, an allusion or thematic device. It's just kind of funny, and, by interjecting a radical change into the Samsa household, allows for growth and change amongst Samsa's family. But, led to believe that everything in "great literature" (or at least the books they make you read in school) has to be filled with "meaning," my classmates simply couldn't grasp that it was all an absurd joke. And what's more, that it was supposed to be funny.
Reading Boris Vian's AUTUMN IN PEKING, and desperately trying to figure out what I was going to write about it, that episode kept coming to mind. Vian, like Kafka, is full of strange absurdities. At the beginning of AUTUMN IN PEKING, Amadis Dudu can't seem to catch his bus to work, the 975. There's no room on the first one. The second one is over-full because of a fat woman. The third one runs him down. A bunch of priests with slings keep him off yet another, and so on.
Or there's Dr. Petereater's intern, who's driven to murder by a sickly Louis XV chair that keeps farting and mocking him from its hospital bed. When he poisons it with strychnine, it stiffens back up and becomes a Louis XVI.
Such absurdities (or inanities if you're some sort of tiresome bore who only loves Tolstoy) are par for the course when it comes to Vian. As noted in the reviews of both FOAM OF THE DAZE and HEARTSNATCHER which appeared in these pages over the last year and a half, Vian's work is filled with a humorous sort of surrealism, and AUTUMN IN PEKING is no different. But fortunately, Vian seldom if ever uses them as tiresome philosophical metaphors (like, say, the abysmal contemporary novelist Jonathan Safran Foer). Instead, in the aggregate they serve to invite the reader into a strange, alien world that intersects-in classic Surrealist fashion-with our own in odd ways. As Vian said of his novel in the foreword to FOAM OF THE DAZE, "Strictly speaking, its material realization consists essentially of a projection of reality, in a biased and heater atmosphere, onto an irregularly undulating reference plane, resulting in some distortion."
However, FOAM tends to cast a long shadow over the rest of Vian's work. Most readers fall in love with Vian's quirky love story, and see him as a hopeless romantic with a dark streak. Beauty and horror are thoroughly entwined. Chloe dies, after all, of a water lily growing in her lung.
But Vian is first and foremost dark. The quirk, the charm and the whimsy are mere accoutrements. Other novels-particularly those he wrote under the name "Vernon Sullivan," like I SPIT ON YOUR GRAVES-have plenty of violence and horror and none of the cute tidbits of FOAM. As I noted in my review of HEARTSNATCHER, Vian's last novel, his work grew progressively darker over his short career.
AUTUMN IN PEKING, written between FOAM and HEARTSNATCHER, is somewhere between the two. Like FOAM, it's primarily a love story, but unlike in FOAM, the love story is remarkably lacking in sentiment.
Amadis Dudu, after finally catching the 975, dozes off and awakes hours later to find himself cruising through the desert. The bus conductor, it turns out, won't stop unless someone dings the bell or he runs out of gas. Dudu, however, finds his unexpected detour to the "Exopotamie" desert to be advantageous. An executive with the railroad company, he proceeds to begin a project to build a line through the desert for, more or less, no reason.
Back in the city, an engineer, none too eager for the job, is hired to design the rail line. He is overjoyed, then, to be run over by Anne, a (male) engineer driving erratically to impress his girlfriend Rochelle and his (also male) friend Angel.
The love triangle between Anne, Angel and Rochelle forms the backbone of the plot. Anne, a pretty-boy with a well-paying job, is a bit of a playboy to boot. Rochelle is, however, devoted to him, much to Angel's chagrin.
As in FOAM, the young relationship eats away at Rochelle. She begins to fade away and shrivel up, consumed by her passion for Anne. But unlike FOAM, there's none of the tepid sentimentalism regarding youthful romance. For Anne, the relationship is nothing but sex, quite the opposite of the lovesick Colin.
Although theirs is the central story, there are far more characters in AUTUMN IN PEKING. Vian, decidedly anti-clerical and atheistic, takes aim at the clergy in the form of Littlejohn, a Falstaffian cleric who recites dirty limericks as liturgy and imbibes a great deal of alcohol. Claude Leon, an office-worker who accidentally commits a murder à la Albert Camus' THE STRANGER, becomes a re-born Catholic in prison and is sent by Littlejohn to be a hermit in the Exopotamian desert, with his penance to be having sex with a gorgeous Nubian princess. Then there's Athanagore, an archaeologist looking for sarcophagi in the sands, his gay assistant (who vies with Dudu for the affections of the cook), and Copper, one of his students who spends much of the novel nude.
Trying to reduce Vian's work is a painful task destined to failure. Like Kafka, Vian creates fantastically complex, surreal worlds in his fiction, which deserve to be savored rather than paraphrased by critics. Just over 50 years old, AUTUMN IN PEKING is still as fresh and hip as it was in Vian's day, if not more so (he was, in many ways, ahead of his time). In a new translation from Tam Tam Books, an LA micropress that is struggling to make Vian available to American readers, AUTUMN IN PEKING is a book that should be required reading, and serves as an antidote to the tired, self-obsession and gimmicky cleverness of most hip contemporary fiction." - Jeremy M. Barker

"Contrary to what the title indicates, it takes place in an imaginary desert land called Exopotamie, where the sun emits black rays and an ill-matched collection of eccentric characters is trying to build a railroad. Whether this project is eventually accomplished is a matter of indifference to both the novel's characters and its narrator. As in his third novel Foam of the Daze, Vian's absurdist humor highlights the pointless and demoralizing effects of modern work. It also serves as a tonal counterpoint to the tragic love triangle that comprises the other main plot thread. What's most characteristic of this novel are its nonsensical events, its unpredictable dialogues and interactions, and the random and careless acts of violence that its characters both suffer and commit. Neither shocking nor even darkly humorous, Vian's scenes of violence have a hilarious effect. It's not unusual for a character who has had his hip broken in five places to exclaim, "If you only knew how happy I am!..." Although these characters certainly feel pain, they don't seem to resent being poisoned, or getting maimed by uncooperative vehicles, or having their limbs sawn off. With a slapstick exuberance reminiscent of the Marx Brothers, this novel is much more fun to read than countless other modern experiments in narrative form. At its end, all that's left are ruined romances, several dead or vanished characters, and a renewed plan to start up the railroad project again with a different set of workers. It's all completely devoid of purpose, but Vian provides exactly the kind of pleasurable and surprising purposelessness that art is supposed to offer." - Thomas Hove
Boris Vian, Blues for a Black Cat and Other Stories (Bison Books, 2001)

"A cocky black cat that drinks cognac and can't stay out of holes, a hyperactive plumber who pulls out all the stops, an expiring jazzman who sells his sweat, a green soldier who moves into a terribly serious position - these are a few of the outrageous and poignant creations of Boris Vian in Blues for a Black Cat and Other Stories. Julia Older makes available for the first time in English this collection of his short fiction, which was originally published as Les Fourmis in 1949. It is a delightful introduction to the work of a much-admired French poet, playwright, and song-writer whose celebrity has continued to grow since his untimely death in 1959. These early stories, written in 1944 and 1945, reveal that Vian was already a master of black humor, wordplay, elegant understatement, and leaps of fancy. Blues for a Black Cat, bubbling with Vian's sense of mischief and evocative of his love for jazz, shows the seamier side of postwar Parisian night life. "The Plumber" is the nightmare of every citizen who has been incommoded by expensive repairmen. "Pins and Needles" conveys Vian's daring opposition to World War II (his song "The Deserter" later would be censored by the government for inciting sentiment against the French-Algerian conflict). The other stories - "Cancer," "Dead Fish," "Journey to Khonostrov," "Blue Fairy Tale," "Fog," "Good Students," and "One-Way Street" - are marked by the same verbal Niagaras, zany sexual encounters, and absurd situations. But, as Julia Older points out, parody only heightens the masked terrors of war, poverty, ill health, and unemployment that hound the bizarre protagonists of Vian's fablelike narratives."
"Ten avant-garde fables of serious whimsy, ushered in by Older's useful introduction, bibliography and discography, are culled here from Vian's rich output. During his brief life author and musician Vian wrote novels, plays, poetry, songs and libretti, contributed essays to Jazz Hot in Paris, and translated American works (by Raymond Chandler and James M. Cain) that shaped his own writing. Playful and tough, fresh and zany, Vian generally speaks from a moral stance. "Pins and Needles'' treats the horrifying absurdity of war and the Allied rescue of 1944 with wacky grisliness. In "The Plumber'' a fast-talking workman browbeats a tenant and wreaks chaos with needless repairs. The title of "Good Students'' refers to young police cadets who study the rule book on how to control and brutalize an innocent populace. "Blue Fairy Tale'' is a tale of betrayal during a motor jaunt, a format evoking the fictional popularity of the automobile in the period. The title story features an articulate, garrulous cat stuck in a sewer, while drinkers turn out of a nearby bar to save it. The collection displays Vian's range from gallows humor to verbal fireworks, and happily serves to give visibility to this important writer." - Publishers Weekly
Boris Vian, I Spit On Your Graves, Trans. by Boris Vian and Milton Rosenthal (Tam Tam Books, 1998).

"I Spit on Your Graves, a sensational bestseller in France in 1947 that reportedly sold more than half a million copies by 1950, was presented as a translation (by Boris Vian) of a novel written in English by a 'Vernon Sullivan'. The idea that it was unpublishable in the United States seems entirely plausible; it is a very graphic pulp thriller, and Europeans might very well have believed that the racial element made it impossible to release it in the US.
The novel is narrated, for the most part, by an angry young man, Lee Anderson. Lee can - and does - pass for white, but is apparently black; one of his brothers was killed - lynched -, and he's out for revenge. He takes a job running a bookstore in a small town and befriends the local youths, teens bored by small-town life and willing to have fun the only way they can around here - drinking and having sex. Lee provides both.
Eventually, Lee sets his sights on two sisters who live a few towns away, the wealthy Lou and Jean Asquith. Jean has at least hit twenty, but Lou is only fifteen. Lee's style of seduction is pretty rough and tumble, but in these parts it seems to work, and despite taking advantage of a completely drunk Jean he soon has both sisters wrapped around his finger.
When Jean finds herself pregnant, things come to a head faster than he had hoped, but he figures he can take them both out. Naturally, things spin further out of control and don't go quite as planned or hoped for, with an ending of Greek-tragedy proportions. Vian allows the book to a come to a desperate, rushed end, which somewhat diminishes its power and effect, but the conclusion was, of course, inevitable.
One reason the way Vian ties things up does not work that well is because the book is so shocking from the start. There's not that much violence (except as part of the sex-play that goes on), but there's a lot of loose and graphic sex going on (even as Vian maintains that Sullivan (i.e. he): "thinks more of suggesting by a turn of expression and construction of a sentence than by the crude word. In this respect he comes nearer to a more Latin erotic tradition" ...). There's some simmering racial tension, too, though Vian does not make as much of this as he might have, only bringing things to a head when one of the local youths takes Lee to have sex with some very underage girls ("two little girls about eleven or twelve years old"), one of whom is coloured (though at least that one, which Lee is paired up with, has a body that "had already taken the shape of a woman").
I Spit on Your Graves is genuinely shocking in its display of the loose ways of 40s youths, but only works because Vian has a good ear for dialogue and a good sense of pace. Much of the story, including Lee's various seductions, seem very implausible, but there's a confident air to the whole presentation that prevents it from seeming entirely ridiculous. It reads well, and is an excellent example of the pulp-thriller, even if Vian can't completely hold it together. It also has held up very well, perhaps because it is so much a work of the imagination (as opposed to being based on any real experience of the American South, since Vian had none at that time).
Disturbing, but a solid, sex-drenched piece of pulp." - The Complete Review

"In the tradition of Karl May and Franz Kafka, Boris Vian imagines an America even more amazing than the land he has never visited. I Spit on Your Graves is the first novel to put quotation marks around the 'hardboiled' - a vivid and startling performance." - J. Hoberman

"In I Spit on Your Graves, Vian wrote an utterly untypical work, a blast from his Id that may well have killed him. Even now, with misogyny disguised as racial justice, its venom remains potent and disturbing, in equal parts appalling and riveting. It is a singular book, not for the squeamish, and not to be passed by." - Jim Krusoe

"The book's protagonist is Lee Anderson, a white-skinned mulatto seeking retribution for the racially-motivated murder of his kid brother. His somewhat curious method: to sleep with as many white woman as possible-and if they prove worthy enough (which would seem to mean "white" enough), murder them. There are no heroes, but-less common for the "noir" genre- there are almost no victims, with the exception of the barely mentioned dead brother, and a particularly disturbing chapter involving two pubescent prostitutes. To read this book as an outrage against racism, however (which has been done), would be a misreading. Although the issue is obviously present, it makes for more of an off-kilter vehicle for the narrative. This might perhaps be due to the fact that Vian had never been to America; in the existential jazz atmosphere of postwar Paris, the lynching of a black man was perhaps as exotically "American" as the gumshoe. But the book, for all its terse prose and crafted crudity, is actually more complex than that, and ends better as a reflection (or perhaps celebration) of the misogyny and sadism so endemic to postwar pulp fiction. These were qualities that George Orwell addressed in an essay on the enormous success of James Hadley Chase's No Orchids for Miss Blandish - qualities that Queneau, Vian's pataphysical colleague, attempted to parody in his own puzzling effort at pseudonymous pulp: We Always Treat Women Too Well. Vian, though, proved to be more successful at casting a troubling light on this peculiar period in French literature. The fact that it took this long for its translation to see print in the U.S. is puzzling, to say the least." - Marc Lowenthal

"It opens innocuously enough with Lee establishing himself in small town America, but soon you are embroiled in a maelstrom of violence, pornography and nihilism. Blacker than noir, this Molotov cocktail of race, sex and hatred burns off the page." - Jim Healy

"The book is interesting from a historical standpoint because of its publishing history and Vian’s authorship hoax. It’s also a good example of an artful thriller that plays with the pulp conventions and uses the genre to satiric effect—while reading the lurid story, readers are encouraged to conflate social criticism of race relations with sheer titillation, and the reception of the work dramatizes the way people can behave, as though reading a sensational novel about racial violence is the same as doing something about it. Unlike many pulp novels, Vian’s holds up as a strange and shocking read today, no small feat in a gratuitous age." - Monique Dufour
Boris Vian, The Dead All Have the Same Skin (Tam Tam Books, 2008)

"Written one year after the controversial (putting it mildly) I Spit on Your Graves, you think Vian would have known better. But no, he decided to do another violent shocker that is ripped out of today's (or was it all in my head?) headlines. This surreal masterpiece of 'dark' writing is about Daniel Parker who is a bouncer in a drink hell bar hole somewhere in New York City (Vian, a French man never been to the States) who is blackmailed by his long lost brother who is black and threatens him to tell the truth about his brother's racial blood. Parker is not going to take that. His life, by that admission, becomes a tipsy topsey one-way ticket to hell.
If that is not enough it also includes a short story by Vian "Dogs, Desire, and Death" which is an erotic tale of a bad girl, a helpless driver, and the need for destruction and sexual release.
And no even that is not enough; we have a small essay or more like a rant by Vian regarding the history of his first controversial shocker I Spit on Your Graves. And not only that, but also a thoughtful and informative introduction by Marc Lapprand."

"Vian pulps noir by running it through the blender of his rancid post-avant-garde imagination. This book is a brilliant, brutal, page-turner, and every bit as nasty as the most depraved prose of the Marquis de Sade or Jim Thompson; simultaneously, it is one of the most intelligent novels dealing with race and racism in the United States penned by a white European writer." - Stewart Home

"Imagine an intellectual, astutely French, who hangs out with the likes of Jean-Paul Sartre, has a child's sense of humor and of the world's newness, writes radically perverse novels and spends his evenings playing trumpet with jazz bands 'round about the Left Bank. There you pretty much have Boris Vian.
Life on its own, however fervently and furiously embraced, was never enough for him. It needed the seasoning of imagination: rhetorical figures, filigrees of language, slapstick, turns of phrase and radical shifts of perspective, a touch of the mythic, a pinch of the mystic. He'd walk by front doors left ajar, squeeze his way in through a basement window propped half open.
In an early story about the Normandy invasion Vian wrote: 'We arrived this morning and weren't well received. No one was on the beach but a lot of dead guys (or pieces of dead guys), tanks, and demolished trucks. Bullets flew from almost everywhere... The boy just behind me had three-quarters of his face removed by a whizzing bullet. I put the pieces in my helmet and gave them to him.'
Of the dead-unserious group in which he was central, he remarked, 'Only the College of Pataphysicians does not undertake to save the world.' Asked to fill out a form in triplicate, Vian said, the Pataphysician will remove the carbons and enter different information on each sheet. That playfulness and refusal to be pinned down peeks out, Kilroy-like, from all that Vian wrote.
... Vian wrote two further Vernon Sullivan novels, in which he kicked out all the stops and skidded toward parody; neither has the authority or purchase of the first two. Reminiscent of Chester Himes' sadly neglected Run Man Run in its intensity and its protagonist's needless headlong rush to oblivion, The Dead All Have the Same Skin also verges - with its fierce energy, candor and matter-of-fact savagery - on Jim Thompson territory: "I liked it. I got a kick out of pummeling the heads of those pigs. But after five years I've started to lose my taste for this particular sport. Five years and not a soul suspects it. No one has the slightest idea that a man of mixed blood, a colored man, has been the one pounding on their heads each and every night."
Dan Parker works as a bouncer in a New York club. It's all gone stale: drunken clients, available women, the buzz of violence, the hard-and-easy sex. Living as white in a white world, he has always felt out of place and vaguely afraid, but he has his home, his white wife and kid, his job. And when braced by Richard, a black man claiming to be his brother, Dan fears it will all come undone. From that moment, we are securely in the jaws of classic noir, as, driven by circumstance, careening from one dreadful act to another, Dan becomes his own chatty tour guide to damnation.
If only. . . .
But character is destiny and writes the script of our lives.
'I killed Richard for nothing. His bones snapped under the force of my hands. I killed the girl with one punch. And now the pawnbroker is dead, again for no reason... I killed them all for absolutely no reason. And now I've lost Sheila and the hotel is being surrounded.'
The Dead All Have the Same Skin came out in 1947, at the peak of success for I Spit on Your Graves... Certainly, Vian is not to every taste. As is said of pulp fiction, there's much silliness mixed in with the driven, hard-edged storytelling. Ever the iconoclast and reconstructed adolescent, Vian continually pushes boundaries and crawls under barricades, seeing how much he can get away with. Yet like other great arealist writers, he had a way of dipping into the pools of archetypes and primal emotions we all share - very much, in fact, like Jacquemort, of L'Arrache-coeur, condemned to fish the refuse of an entire village, all of its guilt, from the river with his teeth." - James Sallis
Boris Vian, Manual of Sant-Germain-des-Prés (Tam Tam Books, 2005)

"After World War Two, the Parisian neighborhood of Saint-Germain-des-Prés became a Mecca for intellectual life and innovative social thought. This first English translation of French author Boris Vian's Manual of St-Germain-des-Prés is a walking tour of the Left Bank cafés, galleries, underground jazz clubs, theatres, and apartment salons that were the center of existentialist and post-surrealistic circles.
Provocateur, novelist, playwright, jazz musician and singer, Boris Vian ran with luminaries including Simone de Beauvoir, Albert Camus, Jean Cocteau, Jean Genet, Alberto Giacometti, Juliette Greco, Raymond Queneau, Jacques Prévert, and Jean-Paul Sartre. Manual of St-Germain-des-Prés is a mosaic of their memories and anecdotes, as much as it is a collection of Vian's impressions. 200 sumptuous black-and-white photographs by Georges Dudognon capture the exciting and provocative spirit of post-war Paris.
Manual of St-Germain-des-Prés documents the first time legendary African-American jazz musicians rubbed shoulders with French writers, artists, musicians, and intellectuals who wanted to shake the conservative grip and dance. The interactions amongst a cast of characters who lived exuberantly active and diverse lives make for a captivating read, and vividly illustrate the irresistible, anything-is-possible spirit that made the Left Bank the place to be in the 1950s."
"In this priceless mock Baedeker, the 20th century's coolest Frenchman, novelist/jazzman/boho bon vivant Boris Vian, explains the Commandments of Cellar Club Existentialism and how to distinguish between the various dancing, strident, inert, misunderstood, panhandling, brawling, and megalomaniac "troglodytes" inhabiting the jazz-club catacombs. The Manual is passionately introduced by Tosh Berman (who has single-handedly restored Vian's American rep), charmingly translated by Paul Knobloch, and rich with Georges Dudognon's photographs of visiting celebs-Garbo, Faulkner, Monsieur Orson Welles-come to swill Sperm of Flamant Rose and faire un boeuf with Miss Vice, Hot d'Dee, Timsy Pimsy, and the other Rats de Cave at Le Tabou. It looks like one helluva party and I treasure the image of existential chanteuse Juliette Gréco waking up damp and tousled in her dumpy Hotel Louisiana room. It must be four in the afternoon and, even before lighting a Pall Mall, she extends a bare arm to drop the needle on the little phonograph that waits to wail some Coleman Hawkins amid the detritus of half-empty bottles and stale coffees beside her bed." - J. Hoberman

"Go to the place where the Big Bang of Bohemianism took place and you'll find chichi cafés and an Emporio Armani. It's a funny business, evolution. But 40 years ago, in post-Occupation Paris, when French philosophy and high literature met American jazz, movies and popular fiction, and started shagging each other senseless, the Rive Gauche was a cauldron of new, artistic-intellectual thought. Vian was one of its prime movers: a singer, songwriter, jazz musician, record producer and novelist (yes he did influence Serge Gainsbourg) who also translated Raymond Chandler and arranged Paris gigs for previously-banned black American jazzmen. Understandably he was a bit busy to take detailed notes. So this is not much of a travel guide, more a collection of smart, caustic, entertaining observations for his fellow insiders. There's particular venom for the press, drawn by the scene's decadence and celebrities. And there are plenty of both in the excellent black and white photos." - Sylvie Simmons

"...while he was alive Vian was known less for his work than for being the epitome of Left Bank bohemia, standing at the center of its postwar rehabilitation after the trauma of the German Occupation. He was the presiding spirit of intellectual café society, and a close conspirator with Sartre and Simone de Beauvoir. He had no allegiance to existentialism, however. Instead, he offered a single absurd voice, dedicated to pleasure and provocation, to dreams and pure subjectivity. While Albert Camus and Maurice Merleau-Ponty spent their time worrying about choosing the right sort of authentic freedom or struggling against world-historical forces, Vian was more interested in amusing himself. “I am not an existentialist,” he wrote. “For an existentialist, existence precedes essence. For me, there isn’t any such thing as essence.”
“I was born, by chance, on March 10, 1920, at the door of a maternity ward, which was closed due to a strike,” Vian wrote by way of autobiography. “My mother, pregnant by the works of Paul Claudel (whom, to this day, I cannot stand), was in her thirteenth month and could not wait for a legal settlement to the issue.” In fact, he was born, on that day, into a well-to-do bourgeois family living in Ville-d’Avray, a suburb of Paris. The Vians lost most of their money in the crash of 1929, but by the time he was a teen-ager Boris was already committed to not letting anything get in the way of fun: he organized legendary parties in his family garden, with guests dancing into the night.
As a child, Vian was given a diagnosis of a heart problem, and he battled various ailments throughout childhood and adolescence. He often predicted that he would die before he was forty. An early death, and a long-foretold one, became an essential element of his personal mythology: he had no time to waste. He liked to say that one should be a specialist in everything, and he did his best to live up to this dictum.
In his late teens, Vian began listening to Duke Ellington and took up the trumpet. In 1941, his heart condition having kept him out of the war, he began performing with the clarinettist Claude Abadie’s jazz band, which soon was renamed the Abadie-Vian Orchestra. Meanwhile, he did his best to avoid any sort of regular work, though he did spend four years as a civil engineer, employed in the glassworks division of the French standards bureau. (His first assignment there was to find the perfect bottle, appropriately enough: one of his more famous songs is called “I Drink,” and runs, “I drink / the worst cheap wines./It’s disgusting / but it passes the time.”) After the war, he formed his own group, which he called the Little Choir of Saint-Germain of the Feet, and helped transform the underground club Le Tabou into one of the hottest spots in the city. As he wrote in The Manual of Saint-Germain-des-Prés, “Rather quickly Le Tabou evolved into a center of organized madness.”
When Vian was twenty-one, he married Michelle Léglise, the daughter of an inventor, and his first attempts at writing were done to amuse her. He began with poetry—a book of sonnets—and finished two novels before writing Foam of the Days. He dedicated it to her—“Pour mon bibi”—and the book has the quality of an absurd love letter, a fairy tale for grownups. Colin, a young man possessed of a fortune large enough to avoid any sort of work, and Chick, a young man without fortune who avoids work nonetheless, meet two girls, Chloe and Alise. Colin has a factotum, Nicolas, a sort of Surrealist Jeeves, who serves pâté made out of eels that he finds in the plumbing, carries on conversations with mice, sleeps with teen-age girls, and is Alise’s uncle. When Chick remarks on the resemblance between uncle and niece, noting a particular difference in the general area of the chest, Nicolas answers that, indeed, “she is more developed perpendicularly, if I may be permitted this precision.” Colin and Chloe fall in love, and marry.
But this simple tale is only the canvas onto which Vian’s hyperactive imagination splashes a rich variety of bizarre effects and contemporary allusions. He misses no opportunity to invent new words, or to play with the ambiguities of already existing ones. The book is peppered with pianos that mix cocktails according to which notes are played, rifles that require being fed by human warmth to grow regularly, a philosopher named Jean-Sol Partre, who arrives at his lectures on the back of an elephant, and a visit from a noncommittal Jesus, who refuses to take responsibility for any of it. The book is half a satirical picture of sleek postwar culture—gadgets, car trips, parties—and half a blooming forest of surreal effusions. Here is Colin, off to meet his friends, seeing the world as only he sees it and drawing his own conclusions:
Colin got out of the metro and went up the stairs. He came out on the wrong side and went round the station to orient himself. He took the direction of the wind with a yellow silk handkerchief and the color of the handkerchief, carried away by the wind, landed on a large and irregularly formed building, which then took on the air of the Molitor skating-rink-pool complex. . . . A man in a white sweater opened a changing room for him, accepted a tip for his work that he would use for his leisure because he looked like a liar, and abandoned him in this forgotten dungeon after haphazardly scrawling his initials on a blackened rectangle placed for that purpose inside the cabin. Colin noticed that the man did not have the head of a man, but of a pigeon, and did not understand why he was put to work at the skating rink rather than at the pool.
That a pigeon-headed man is better suited to water than to ice is hardly something that most readers will feel requires no explanation, but Vian isn’t interested in explaining what he sees. He deploys his effects with deadpan bravado, as if they were nothing out of the ordinary. He works in a universe of pure lightness, rising up against what Italo Calvino once called “the weight, the inertia, the opacity of the world,” lifting himself above all laws of gravity out of a certainty that they do not apply to him.
Until, suddenly, they do. For most of the book, Colin and Chick live in a childish world, of girls and jazz and fun, but around them Vian’s surreal sketchbook starts to display an almost giddy cruelty. Vian evokes a mechanized world in which human lives, apart from those of the main characters, seem utterly expendable. At Partre’s lecture, his fans are so crazy to see him that some try to parachute in (a team of firefighters drown them with hoses) and others try to enter the hall through the sewers (security stomps them, and rats eat the survivors).
...Indeed, from the end of the war, Vian was everywhere you looked—“the Prince of a subterranean kingdom,” his biographer Noël Arnaud called him, “a prince in shirtsleeves with a trumpet for his scepter.” The Manual of Saint-Germain-des-Prés portrays a scene filled with poets and painters, movie stars, singers, and philosophers—Jean Cocteau, Jean Genet, Alberto Giacometti, Tristan Tzara, Juliette Gréco, Simone Signoret. De Beauvoir, describing a party at the Vians’, recalled:
When I arrived, everyone had already drunk too much; his wife, Michelle, her long white silk hair falling on her shoulders, was smiling to the angels; Astruc . . . was sleeping on the sofa, shoeless; I also drank valiantly while listening to records imported from America. Around two in the morning Boris offered me a cup of coffee; we sat in the kitchen and until dawn we talked: about his novel, on jazz, on literature, about his profession as an engineer. I found no affectation in his long, white and smooth face, only an extreme gentleness and a kind of stubborn candor. . . . We spoke, and dawn arrived only too quickly. I had the highest appreciation, when I had the chance of enjoying them, for these fleeting moments of eternal friendship.
...Vian remains difficult to categorize, in part because he both was and wasn’t a creature of his time. For all his cultural centrality in postwar Paris, his books have much less in common with anything his contemporaries were up to than with the linguistic playfulness of writers who preceded him, from Mallarmé to the Surrealists, or, for that matter, with literature that came just after—the practitioners of the nouveau roman who emerged in the late fifties, or the game-playing Oulipo crowd of the sixties. “He lived ahead,” Arnaud wrote. “He was, and remains, on the arc of the future.” Foam of the Days was largely ignored on its publication, but it became a totemic book to the revolutionary generation of 1968: by 1962, it had sold only three thousand copies; by 1975, the figure had reached a million.
But by then Vian was long dead. In 1959, as he sat in a movie theatre, watching an adaptation of I Spit on Your Graves — a French production that he had wanted nothing to do with and had tried to prevent from being made — his weak heart finally gave out. He was thirty-nine. According to Vian legend, he was able to bear only ten minutes of the movie before collapsing, and his last words were “These guys are supposed to be American? My ass!” Evidently, the Americans in the film were not the Americans Vian had seen in his head, and, for Vian, what he saw in his head was all that counted. In the preface to Foam of the Days he wrote, “There are only two things: love in all its forms with pretty girls and the music of New Orleans or Duke Ellington, it’s the same. The rest should disappear, for the rest is ugly, and the brief demonstration that follows gathers all its energy from the fact that the story is entirely true, because I imagined it from one end to the other.” - Dan Halpern

More California Medical Centers Plagued by Quality Problems While Their Executives Get Bonuses for "Improved Patient Care"

Earlier this week, we noted that while executives at one University of California medical center were getting large bonuses supposedly for "improved patient health," the hospital was being cited for serious health care quality deficiencies.  Now, more stories have appeared that raise questions about the rationale for the generous bonuses handed out to multiple top hospital executives at University of California hospitals. 

University of California - San Diego

First, in alphabetical order by city, the San Diego Union-Tribune reported on penalties for poor quality care announced by the California Department of Public Health:
UCSD Medical Center in San Diego was fined $50,000.... The state said the hospital staff failed to follow its surgical policies and procedures, which resulted in a patient having to have a second surgery to remove a foreign object — a guide wire that was left in the patient when a central venous catheter was inserted into the patient’s right femoral vein in the groin area in January 2009. The wire migrated into a chamber of the patient’s heart.

The procedure was done by a first-year intern and supervised by a third-year resident.

This marks the third time the state has penalized UCSD, with the first penalty issued in May 2008 and the second in May 2009.

However, a few days earlier, the Union-Tribune had reported:
Despite criticism from union leaders and rank-and-file employees, University of California regents yesterday overwhelmingly approved $3.1 million in incentive payouts to 38 medical center executives.

The payouts mean, for instance, that former UC San Diego Medical Center CEO Richard Liekweg will receive $136,174 in performance pay for the last fiscal year, added to his base of $660,500.

Regents justified the payments by noting that incentive programs are common in the health care industry, and necessary to compete for top talent.

'It’s the way this industry works,' said Regent William De La Pena, an ophthalmologist and medical director of eye clinics throughout Southern California.

At UCSD Medical Center, 10 senior managers will receive a combined $754,650 for surpassing goals set in areas ranging from improved patient safety to increased revenue. The bonuses amount to 14 to 23 percent added to executives’ salaries.

University of California - San Francisco
Meanwhile, the San Francisco Chronicle reported that a major University of California - San Francisco teaching hospital was also cited by the state Department of Public Health for quality problems:
San Francisco General was fined $25,000 for leaving a piece of surgical gauze in a patient who underwent an eight-hour operation for two types of cancer in September 2008. The foreign object was discovered about three months later and was removed without surgery during an office visit.

The Chronicle also reported a possibly major breach in the confidentiality of patient records at the UCSF Medical Center:
Medical records for about 4,400 UCSF patients are at risk after thieves stole a laptop from a medical school employee in November, UCSF officials said Wednesday.

The laptop, which was stolen on or about Nov. 30 from a plane as the employee was traveling, was found in Southern California on Jan. 8.

There is no indication that unauthorized access to the files or the laptop actually took place, UCSF officials said, but patients' names, medical record numbers, ages and clinical information were potentially exposed.

The security breach is UCSF's second in recent months. Last month, UCSF officials revealed that a faculty physician responding to an Internet 'phishing' scam potentially exposed the personal information of about 600 patients.

However, despite these obvious quality problems, the San Francisco Business Times reported
University of California regents approved $500,000 in bonuses to six top officials at the UC San Francisco Medical Center, part of a package of $3.1 million in payments to 38 hospital executives across the UC system.

In an interview last week with UCSF Chancellor Susan Desmond-Hellman, she said that the executive bonuses were tied to meeting specific performance goals, such as reducing clinical infections and increasing satisfaction ratings by patients. She also pointed out that additional payments of $14.3 million to the UCSF Medical Center’s 6,600-strong workforce were approved earlier.

The UCSF officials awarded bonuses were:

* Mark Laret, chief executive officer, $181,227;
* Ken Jones, chief financial officer, interim chief operating officer, $89,162;
* Larry Lotenero, chief information officer, $66,045;
* John Harris, chief strategy and business development officer, $63,196;
* Susan Moore, finance director and interim chief financial officer, $53,261; and
* Sheila Antrum, chief nursing/patient care services officer, $49,280.

Summary

So, in summary, multiple executives at three major University of California medical centers received generous bonuses.  The rationale for these bonuses, given out at a time when the university system was under major financial constraints, was that they were incentives for exemplary performance and patient care. 

Yet almost simultaneous with announcement of the bonuses were news reports indicating serious patient care problems at the same medical centers.  The point I am NOT trying to make is that the care at any of these medical centers is bad.  The examples of quality problems were limited.  I am sure that many other major medical centers hae had such quality problems as well.  However, the cases cited above were sufficient to argue that the care at these medical centers was not outstanding, not exemplary.  Yet, the bonuses were awarded not for acceptable performance or average quality.  Their rationale was exceptional performance and quality.  Thus, the rationale for the performance bonuses seems at best naive, if not foolish. 

I would suggest, instead, that the sorts of bonuses given out at the University of California are a product of the current management culture that has been infused into nearly every health care organization in the US.  That culture holds that managers are different from you and me.  They are entitled to a special share of other people's money.  Because of their innate and self-evident brilliance, they are entitled to become rich.  This entitlement exists even when the economy, or the financial performance of the specific organization prevents other people from making any economic progress.  This entitlement exists even if those other poeple actually do the work, and ultimately provide the money that sustains the organization. 

Although the executives of not-for-profit health care organizations generally make far less than executives of for-profit health care corporations, collectively, hired managers of even not-for-profit health care organizations have become richer and richer at a time when most Americans, including many health professionals, and most primary care physicians, have seen their incomes stagnate or fall.  They are less and less restrainted by passive, if not crony boards, and more and more unaccountable.  In a kind of multi-centric coup d'etat of the hired managers, they have become our new de facto aristocracy. 

Or as we wrote in our previous post, executive compensation in health care seems best described as Prof Mintzberg described compensation for finance CEOs, "All this compensation madness is not about markets or talents or incentives, but rather about insiders hijacking established institutions for their personal benefit." As it did in finance, compensation madness is likely to keep the health care bubble inflating until it bursts, with the expected adverse consequences. Meanwhile, I say again, if health care reformers really care about improving access and controlling costs, they will have to have the courage to confront the powerful and self-interested leaders who benefit so well from their previously mission-driven organizations.  It is time to reverse the coup d'etat of the hired managers.

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