of us. So the politicians have had theirnsay, and through them, the people.nBut what is it that we have said? Thenmessage is that we are cheap andncowardly. A more generous or merelynmore intelligent expenditure of medicalnresources would provide some ofnthe things that aren’t necessarily reimbursednby third-party payers (or at leastnnot under the present operating rules)nbut that save lives. Pap smears for allnthe women in the hospital’s cachementnarea and sigmoidoscopies for all mennover 50 would cost comparatively littlenand would produce enormously greaternbenefits than these fortunes that arenbeing spent in the MICU’s. The advantagesnare not merely economic butnmedical — in the early diagnosis ofndisease (which is critical if there is to bena cure). But we’re too cheap for that.nAnd yet when we are faced with death,nwhen it’s right there at the door, huffingnand puffing like the big bad wolf,nour tight-fistedness relaxes, and wenbecome suddenly generous and evennprofligate, throwing vast sums aroundnas if we could buy immortality andnrevise the human condition, or at leastnsnatch one or another poor sufferernback from the yawning of the grave.nWell, who can be against that? Howncan one question the motives andnpractices of an institution that dedicatesnitself to such an enterprise? We are allnin favor of life and against death, aren’tnwe? But we see that the realities arenbeing ignored, and the death of reasonnis also something to worry about. Thenagonizing exchanges between the doctorsnand the family members thatnWiseman shows us with searing intimacynand poignancy are unimaginablyncomplicated as the doctors cajole ornbully or just wait for the poor wife ornhusband to realize how there isn’tnanything more to be gained by thesengrotesque and invasive methodologies.nThere are now hard decisions to benmade about whether to continue tonstrive for a cure or to bow to theninevitable and supply only palliativencare, and although the families now getnto collaborate in these decisions, therenis something terribly unfair about hownunprepared they are and how the collaborativenprocess results in their feelingna much greater degree of complicitynand guilt.nThe doctors do what they do; thenfamilies and the patients do what theyndo; and then there is the ultimatengarbage-bag scene, in which a team ofnnurses runs a corpse down to thenmorgue and (one, two, three, heave!)ngets it from the guerney onto the slab.nAnd later on, the hearse comes fromnthe mortuary to take away the remains.nThis isn’t what always happens, but thensurvival rate of the MICU’s is notngood, is in fact much less good than thenrate of survival of Wiseman’s group ofnpatients. The question then suggestsnitself as to what these people supposenthemselves to be doing.nThe answer is not spelled out. Wisemanndoesn’t do that. But anyone whonknows anything about medical trainingncan see that there are teams of internsnand residents who are passing through,nlearning how from the patients nonmatter what the outcome. There arenattending physicians who are competentnand decent but who can’t worknmiracles, and one of them admits thatnthis one month a year in the MICU isnabout all he can stand. The steadynplayers are the nurses who work herenyear-round, and the hospital itself, anhuge machine that has contrived a waynof converting the suffering of the doctorsnand the patients and their familiesnto reimbursement from insurancencompanies and agencies of the government.nWiseman’s first documentary filmnwas Titicut Follies, about the BridgewaternState Hospital for the CriminallynInsane, and he found in that film thatnthe doctors were crazier than the patients.nThe guards were the only humannand helpfvil people around, andntheir efforts were more or less eclipsednby a system that was at once grotesquenand pleased with itself Wiseman hasnsince aimed his camera at other institutions,nall of which to one degree ornanother resemble hospitals for thencriminally insane. That the doctors andnnurses are performing admirably,ndoing their best in a hopeless andnabsurd situation, only makes it morenpainful to watch. Near Death isn’t justnabout Beth Israel’s MICU but about allnof American society, or even life itself,nfor another way to describe life is to saynthat it isn’t death but only — andnalways — near it.nDavid R. Slavitt is a poet and novelistnliving in Philadelphia. His latest novelnis Lives of the Saints (Atheneum).nMORESnnnLemonsnby Janet Scott BarlownWhen he was younger, my sonnwould pipe up from time tontime with what he called “Scott’s rulesnto live by,” his distinctly personal littlenlife guides. My all-time favorite, arrivednat when he was seven, was “Never getnyour hair cut by a man named Buster.”nBut the tidbit I would ponder most overnthe years was this: “Don’t hire repairmennon Mondays.” I have no idea hownmy son arrived at the haircut rule (hendidn’t know anyone, much less a barber,nby the name of Buster), but the norepairmen-on-Mondaysnidea addressedna specific problem. Strange things werengoing on in his household, and the boynwas just trying to help.nMy husband and I happen to bencompletely devoid of skills in the area ofnhome improvement and repair, andnutterly lacking in desire to acquire thosenskills. While we would prefer that thisnsituation were different, we have comento accept what is, the way you eventuallynaccept flat feet or the inability toncarry a tune — regretfully but philosophically.nIn the great genetic roulettengame of life, you win some and you losensome, and why fight it? (I prefer to thinknof our ineptitude as genetic and thereforenunalterable because it removes thenpossibility, and thus the responsibility, ofnlearning awfiil things like wiring — or,nworse yet, rewiring.)nI’m not sure we’re missing muchnanyway. We have friends who can takenan old house, a mere shack, and turn itninto a showplace, complete with guestnJUNE 1990/53n