I Wanted the Government to Buy Kidneys: Why I Changed My Mind (2.0)

Here’s a new draft brought to you by the blizzard currently striking NYC. Same caveats as the previous one. Thanks to everyone who’s provided comments so far.

Please let me know any ideas for how to make it better. In particular, it got even lengthier, so if you have ideas for how to shorten it, I’m in great need.

Four years ago, when I became a kidney donor, I passionately believed that the government should pay people for their kidneys, save a great deal of money, and rescue tens of thousands from a grueling death. So in 2013, I left my job at a corporate law firm (and my home in Boston), moved to Toledo, and joined the transplant field in order to enact this change.

A year after that, I co-authored a letter in favor of incentives signed by hundreds. By that June, I’d received a grant from a major foundation to plan a nonprofit to bring incentives to the transplant field. But then I changed my mind.

I didn’t change it all at once or entirely. I still think donors should be treated better than they are. A lot better. But what’s different is where I used to think kidneys could be an item to be purchased by a government monopoly, now I think it’s a bad idea to treat organs as just another commodity up for exchange. Instead, for kidney donation to be respected, our society needs to treat it like an act of public service and to honor donors accordingly.

Here’s how I got there.

Why I Liked Incentives

The kidney transplant shortage might be the most underrated public health problem in America. The current waiting list is a hundred thousand names long. Each year, twenty thousand more people go on the list than receive a transplant. That number represents 50% more than all the homicides committed in the nation last year. Year after year, this shortage crisis represents a truly massive number of lives lost.

<infographic comparing mortality of car accidents, gun related homicides and suicides, kidney failure, war deaths>

Kidney donation is a safe, laparoscopic procedure. Most donors are out of the hospital after a couple nights and off prescription painkillers after a week. Donors lead normal, healthy lives.

As with any surgery, there are risks: about 1% of donors will develop kidney failure over their lifetime, compared to 0.1% if they hadn’t donated. By contrast, the lifetime risk in the general population is 3.2% (kidney donors are healthier to start with). Like any surgery, donation can have complications, but the chance of dying is just 3 in 10,000.

<risk infographic>

And there is uncertainty; the real risks may be higher than our estimate. People have been donating kidneys for sixty years, but ascertaining exact health effects decades down the line for an unrepresentative population is an epidemiological struggle– one that with necessarily imperfect results.

But what is clear is that kidney donors remain as healthy or healthier than the general population after they donate.

Moreover, kidney donation saves the government a great deal of money: Medicare guarantees coverage for patients with kidney failure regardless of age, and over their first five years, transplants cost $60K less per year than dialysis. Since a living donor kidney lasts for fourteen years on average, saving $300K per transplant is conservative.

That means the government could easily afford to pay $50K or $100K for donors to undergo a surgery that is safe and saves another person’s life. If you persuaded one in two thousand Americans to take that deal, you’d end the shortage tomorrow. No more waitlist: a hundred thousand lives saved; a hundred thousand families rescued from tragedy.

Back when I donated, it seemed like a no-brainer.

And while it’s reasonable to worry that most kidney sellers would be poor, the shortage is itself extremely discriminatory. Minorities make up 38% of the American population but 63% of its waiting list. African Americans get kidney failure more often, are less likely to be listed for transplant when eligible, wait longer for an organ once listed, and are less likely to find a living donor. An incentive system could correct vast inequities in access to life-saving care.

The Problem with Incentives

When I moved to Toledo, Ohio to join the Alliance for Paired Donation, I didn’t know anyone that lived in the Midwest. I had a lot of free time.

Much of that was spent gorging on Netflix and text messaging with my ex-girlfriend, but some was spent on kidneys and some smaller portion of that was spent trying to understand why people disagreed with me about incentives. Since I’m a philosophy geek, that meant reading authors like Elizabeth Anderson, Margaret Radin, Lewis Hyde, and Michael Sandel to better understand commodification and the philosophy of market exchange. That led me to reconsider my views.
To vastly simplify, commodification is when you take something that’s sacred and sell it like it’s scrap. But sacred how? A bible is sacred, but selling bibles does nothing to tarnish them.

Things are commodified when selling them reduces them from a rich, multi-dimensional source of value down to just their worth as a dollar figure. Picture prostitution. Whether or not it should be legal, whether or not it can be empowering for workers who perform it, there is some change in meaning of a sex act when it includes a transaction for money. If this were the only the type of sex we had access to, we would justifiably feel diminished.

The commodifying effect of organ selling isn’t purely hypothetical. While organ trafficking is a scourge throughout the developing world, Iran is the only country where it’s legal to buy and sell an organ. Not coincidentally, it’s reported to be the only nation without a shortage.

But in many parts of the country, kidney donation is a source of shame and signal of desperation. Rather than feeling honored to have saved a life, donors may hide their good deed for fear of being treated as a lesser person who sold off a part of themselves.

That does not mean the decision can’t be a rational one—the going rate is more than the average annual income. But a decision can leave us worse off in some dimensions that cannot simply be converted to money or aggregate welfare

Somewhat embarrassingly, the example that best illuminated this for me was my time as a corporate lawyer. Like many such, I was all at once unreasonably well-paid, extraordinarily lucky to have the job, and absolutely miserable. Though it may have been completely rational to sell years of my life for money, in some real way it left me diminished.

So how to weigh this risk of commodification against the benefits? I’m honestly not sure, but I do know the lives saved by incentives don’t just erase the problem. A society that looks down on kidney donors as desperate and unclean – as mere human vending machines – would be unspeakable no matter how much healthier it was than our own.

Moreover, diminishing the value of donation could also have bad consequences. Living donors currently give 5,500 kidneys a year; deceased donors 11,500 more: will people still be so generous if the status of organ donation were to decline?

And then there’s the risk. What would the price of organs even be? How much would it cost to buy up enough organs, even the ones that were now given for free? Would donors lie about their health history to be able to donate? How would we avoid trying to save on cost by neglecting safety standards? Market incentives would represent a drastic change with consequences that aren’t totally knowable.

The national regime of organ donation took hard effort to build and relies on only the public’s good will to survive. Jeopardizing that system through drastic change could sacrifice people who definitely receive transplants today for the mere potential of lives saved tomorrow. We should avoid that risk if at all possible.

Transplant Support

When my co-founder Thomas Kelly and I started the planning of Waitlist Zero in 2014, we conducted a listening tour of the transplant field. We saw great respect for this 2006 paper arguing for lifetime health insurance for kidney donors. The leading professional societies published a paper in favor of incentives, but were fearful of brooking controversy: to many in the field, cash incentives would never be acceptable.

On the other hand, free health insurance for donors just make sense. Donors risk their lives in ways that are limited but real and not perfectly known. They do it to help others, and their gift helps not just the recipient but the broader community as a whole. Public servants like teachers, firefighters, police officers, and soldiers all receive special benefits that are not reducible to cash (e.g. health insurance, early retirement, free education). Why can’t we think of donors the same way?

A GI Bill for kidney donation wouldn’t be stingy, but it would avoid the worst problems of incentives. Transplant support would treat kidney donors like public servants. Far from commodifying donors, transplant support would honor them. Instead of crowding out generosity, support would nourish it. It builds from the current system and sets an example that we would want the rest of the world to follow.

In practice, respecting donors as public servants could mean things like:

I admit that the idea isn’t perfect and the details need to be worked out. But the kidney shortage is a crisis, and these measures have broad support today. We need to move beyond the old debate about incentives and forge a new path.

If you told me there was a button I could push tomorrow that would install incentives and end the shortage, I’d still have a hard time saying no. The lives saved would weigh too heavily for me to honestly prefer the status quo. But that’s not the best system we can create. It would leave donors worse off and risk failing entirely.

Transplant support would end the shortage by treating donors with respect. It is the best way I could come up with to simultaneously save tens of thousands of lives and improve our society’s sense of dignity and self-respect. It is what I am working to achieve today.

 

I Wanted the Government to Buy Kidneys: Then I Changed My Mind (DRAFT)

Here’s a draft of a piece I’m working on. Would love any suggestions for improvement or other thoughts. The more critical the better!

Also note that it’s just a draft, so I may make dumb points or say things in stupid ways. Wait till it’s final to hold it against me.

I Wanted the Government to Buy Kidneys: Then I Changed My Mind

Four years ago, when I donated my kidney, I was a passionate believer that the government could pay people for their kidneys, save a great deal of money and rescue tens of thousands from a grueling death. So in 2013, I left my job at a corporate law firm (and my home in Boston), moved to Toledo, and joined the transplant field so that I could enact this change.

A year after that, I co-authored a letter in favor of incentives signed by hundreds. By that June, I’d received a grant from a major foundation to plan a nonprofit to bring incentives to the transplant field. But then I changed my mind.

I didn’t change it all at once or entirely. I still think donors should be treated better than they are. A lot better. But what’s different is where I used to think kidneys could be an item to be purchased by the government, now I think it’s a bad idea to treat them as just another commodity up for exchange. Instead, for kidney donation to be respected, our society needs to treat it like an act of public service and honor donors accordingly.

Here’s how I got there.

Why I Liked Incentives

The kidney transplant shortage might be the most underrated public health problem in America. The current waiting list is a hundred thousand names long. Each year, twenty thousand more people go on the list than receive a transplant. That number represents 50% more than all the homicides committed in the nation last year. Each living donor transplant saves a decade or more of life. Year after year, this shortage crisis represents a truly massive number of lives lost.

Kidney donation is a safe, laparoscopic procedure. Most donors are out of the hospital after a couple nights and off prescription painkillers after a week. Donors lead normal, healthy lives. As with any surgery, there are risks: about 1% of donors will develop kidney failure over their lifetime, which is 0.9% higher than if they hadn’t donated. By comparison, the lifetime risk in the general population is 3.2% (kidney donors need to be healthier to start with). Like any surgery, donation can have complications, but the chance of dying is just 3 in 10,000. And there is uncertainty—people have been donating kidneys for sixty years, but ascertaining exact health effects decades down the line for an unrepresentative population is an epidemiological struggle– one that is necessarily imperfect.

But what is clear is that kidney donors remain as healthy or healthier than the general population after they donate.

Moreover, kidney donation saves the government a great deal of money: Medicare guarantees coverage for patients with kidney failure regardless of age, and averaged over the first five years, transplants costs $60K per year less than dialysis. Since live donor kidneys last for fourteen years on average, a cost savings of $300K is conservative.

That means the government could easily afford to pay $50K or $100K to donors to undergo a surgery that is safe and saves another person’s life. If you persuaded one in two thousand Americans to take that deal, you’d end the shortage tomorrow. No more waitlist: a hundred thousand lives saved; a hundred thousand families rescued from tragedy. Seemed like a no-brainer.

And while we may reasonably worry that the people incentivized to donate would be disproportionately poor, the shortage itself primarily affects people of color and the impoverished. The primary causes of kidney failure are obesity, diabetes, and hypertension, which each share a racial bias. Minorities make up 38% of the American population but 63% of the kidney waiting list. Access to living donation is also racially skewed. Only 29% of living kidney donation comes from minorities, and a white person in the top income quintile is three times more likely to donate than an African American in the bottom quintile, despite African Americans needing kidneys at three times the rate of whites.

Whatever negative racial pattern incentives might have for donors would be dwarfed by the extraordinary health improvement it would achieve for vulnerable communities.

The Problem with Incentives

When I joined the transplant field, I wanted to understand the best case against incentives (so I could beat it). Since I’m a philosophy geek, that meant reading authors like Elizabeth Anderson, Margaret Radin, Lewis Hyde, and Michael Sandel to better understand commodification and the philosophy of market exchange.

To vastly simplify, commodification is when you take something that’s sacred and sell it like it’s scrap. Prostitution takes something intimate and reduces it to something more empty. Selling organs could turn our very bodies into a mere repository for parts (“Kidney Depot”). Even though the seller can rationally consent, she might not be able to avoid being in some way worse off.

Mortifyingly, the example that best illuminated this for me was my time as a corporate lawyer. Like many such, I was all at once unreasonably well-paid, extraordinarily lucky to have the job, and absolutely miserable. Though it may have been completely rational to sell years of my life for money, in some real way it left me diminished.

So how to weigh this risk of commodification against the benefits? I’m honestly not sure, but I do know the lives saved by incentives don’t just erase the problem. A society that looks down on kidney donors as desperate and unclean – as mere human vending machines – would be unspeakable no matter how much healthier it was than our own.

Moreover, diminishing the value of donation could also have bad consequences. Living donors currently give 5,500 kidneys a year; deceased donors 11,500 more: will people still be so generous if the status of organ donation were to decline?

And then there’s the risk. Market incentives would be a drastic change to a national regime of organ donation whose creation was hard-fought and which relies on only the public’s good will to survive. Jeopardizing that system through drastic change could sacrifice people who definitely receive transplants today for the mere potential of lives saved tomorrow. We should avoid that risk if at all possible.

Transplant Support

Transplant support was my way of trying to get the benefits of incentives while avoiding their pitfalls. Transplant support treats kidney donation as a public service: making donation an act of community support rather than individual heroism.

In practice, respecting donors as public servants means offering them lifetime health insurance to alleviate and offset the risks of donation; it means providing annual research stipends to donors to encourage participation in follow-up study and care; and it means removing disincentives to donation by paying donor expenses like lost wages and making the experience of donating as convenient and easy as possible.

This GI Bill for kidney donation isn’t stingy, but it also avoids the problems inherent to incentives. Far from commodifying donors, transplant support honors them. Instead of crowding out generosity, support nourishes it. It builds from the current system and sets an example that we would want the rest of the world to follow.

I admit that the idea isn’t perfect and the details need to be worked out. If you told me there was a button I could push that would immediately install incentives and end the shortage, I’d still have a hard time saying no. The lives saved would weigh too heavily for me to honestly prefer the status quo.

But that’s not the best system we can create. Transplant support can end the shortage by treating donors with respect—by transforming a system that demands a patient beg for her life to one where transplant is supported by the community.

 

crimes

I’m Not Here to Tell You About Jesus

Do you think that God exists? If you had to choose, would you describe yourself as a believer, an atheist, or an agnostic? Now, the first thing I should flag about this question is that for most people it yields a firm answer. For thousands of years, erudite scholars have made argument after  argument on all sides of this question, but I bet that, whichever one of these options you choose, your choice is an unreserved one: you don’t tend to qualify it with “well, I could be totally wrong: there’s a lot on each side.”

Now maybe I’m looking at this the wrong way, and actually agnosticism is just the box to check for “there’s a lot on both sides.” But I think agnostic means a bit more than that: it’s a term that describes a range of people running from atheists-in-sheep’s-clothing to those who think it is truly an unknowable question and either side could be equally right. In my personal experience I tend to find more of the former than the latter, but your mileage may vary.

More importantly, though, is that the agnostic is not someone who is half a religious believer and half an atheist, she doesn’t just sit astride the midpoint of that spectrum. There is an entire type of religious experience the believer has access to that the agnostic forsakes. She doesn’t worship in temple on Monday, Wednesday and Friday and then stay home in disbelief the rest of the time*[1]: the act of worship is totally cut off by her self-designation. This is not because she has doubt – the religious believer also has doubt (indeed it’s the very crucible of faith). The agnostic’s doubt is different because it leads her to rationally designate herself as removed from the concept of God. And that is something a believer can never truly do. Continue reading

Rabbit, Run

Rabbits are stupid creatures. They’re grazers, chewing on pasture; their huge eyes scan the sky for danger (just about any predator is bigger than them and far more imposing).  They run fast but not far, dashing away when threatened yet incapable of aiming at any lasting end: they don’t roam far. Rabbits don’t just run; they breed incessantly, fucking furiously is their path to immortality. Maybe it’s this oblivious helplessness, the gentle hedonism, that makes them so appealing. Maybe it’s that they’re just puffs of white fur with cute ears. Either way, they’re just so darn cute and we can’t help but love them.

The rabbit is a rather unheroic beast, yet that’s the spirit animal John Updike chose for Harry “Rabbit” Angstrom, the main character of Rabbit, Run. Harry was once a high school basketball star. He set his school’s scoring record as a junior and then broke it again as a senior. It took four years for someone else to break it in turn. Now (as of 1960 in Rabbit, Run) he’s a twenty-five year old father of one and husband to a pregnant wife. He’s a salesman of the Magi-Peeler kitchen appliance. He’s also basically a rabbit.

Ok, not really. This isn’t Watership Down (or Redwall: funny, the continued anthropomorphism of rodents in fiction). Harry’s just a person with strangely-rabbit like qualities. Updike revels in the sheer wit ofmatching Harry’s characteristics to his rodent namesake’s special traits, delighting in rabbit-like mannerisms (“Now, Harry, don’t wrinkle your nose.”) as well as his rabbit’s soul. Harry, you see, shares all of those qualities I wrote about above. He’s obsessed with sex; he instinctively runs from adversity. He shares the rabbit’s wide-eyed appreciation of nature, is a grazer rather than a predator, his inner gaze somehow always half-turned towards the sky, towards finding the deeper meaning in the brutal ordinariness of life around him. He’s a sensitive creature but not a strong or imaginative one. When he feels the oppressive ordinariness hemming him in, the only thing he can think to do is run away. Ignorant of destination, he never wanders far. He’s a domestic animal at heart. Continue reading

Tiny Furniture

            Is Lena Dunham an exhibitionist by nature or does she just play one on TV (and in her movie and on YouTube)? By this, I mean, does Lena Dunham just like showing herself off or does she think boldly putting her self in self-expression is the best way of achieving her artist’s vision? Weirdo or a hero? You decide, but all appearances point to the latter.

            Not that it matters, I suppose. Her work is her work, no matter its motivation (great fiction is not created just by the pure of heart). Nevertheless, it’s tough not to speculate when, in her first movie, Tiny Furniture, Lena casts her mother as her mother and her sister as her sister. Lena herself plays, of course, the star, Aura, a wannabe film-major daughter of an artist (guess what Lena’s mom does for a living).

            This seeming autobiographical mode poses a problem: How do you play yourself sympathetically if you’re staggeringly successful at an extremely young age, if you know you’re absurdly privileged, if your subject is “how hard and weird it is to be alive even if you’re middle class and your parents were pretty loving”*? By being absolutely vicious to yourself, Dunham answers. Dunham the director portrays Dunham the actress in the least attractive manner possible: without makeup, in various stages of unattractive undress, having sex doggie-style in a metal tube on the streets of New York, etc.. Dunham’s not really fat but, flouting actorly norms, she consistently makes herself look fat by broadcast standard. She makes Aura in Tiny Furniture as unappealing as possible: she’s whiny, entitled, dishonest, and unwise. One would say Aura’s unlucky in love but that would imply some possibility that her choices might work out better than they do. An audience could be forgiven for giving up hope in her, but she seems too immature to even be a lost cause.

            Yet Aura comes wrapped in a nice, earnest, Lena-Dunham-shaped bow meant to maintain a hold on our good graces, and as you watch the movie you don’t notice the unlikeable details piling up. This triumph, such as it is, is perhaps enabled by a reversal of typical indie-movie structure.  Usually, such movies start by making their protagonist unlikeable as possible and then steadily softening them up throughout the film. Tiny Furniture flips the script, backlogging Aura’s self-destruction mostly till the end. We grant our love at first sight; it’s only later events that force us to question our sympathies.

            This unconventional plot structure slots Tiny Furniture into the category of character-centric mood piece in the vein of Jack Nicholson in Five Easy Pieces or Ryan Gosling in Half Nelson. Like those movies, Furniture denies us the opiate of conclusion delivered by the climax of more conventional works. Here there is no climax. Such dramatic satisfaction as we receive must be awkwardly tantric: a prolonged awareness of mood and character that fades only as we move on from the movie to other things. I find this feeling unpleasant, and I suspect many audience-members will enjoy Furniture’s beginning more than its end, the pleasures of its initial uber-realistic dialogue over its finale’s quiet, contemplative emptiness.

            But are we being fair to decry this a weakness? Isn’t the demand for conventional dramatic structure a sacrifice of art for entertainment’s sake? After all, real life doesn’t always provide resolutions, and certain experiences may require a wider palette to be successfully painted. The condition of being no longer a girl but not yet a woman** doesn’t need to be one that ends triumphantly. This of course begs the obvious question of why Dunham couldn’t have pushed her character a little further, couldn’t have ended her movie with Aura achieving for herself some steps towards the successful adulthood where she seems to be heading?

            We could look at stopping short as a weakness on Dunham’s part, but I prefer to project a little, use my imagination, and take it as an occasion to admire her honesty as an artist: She was 22 when she made this work; she may just not have felt ready to successfully portray her character’s successful ascent to responsibility. Now, many directors in that situation would have just shrugged and jammed a happy ending in anyway. It’d be easy enough to write: you just switch a few plot details towards the finale to put the movie on an upbeat trend rather than an ambiguous one; problem solved. Who’d know the difference?

            Dunham would, for one. She’d know that some of the movie was good and reflected her best expression of what she felt was true about the world and some of it was just meant to make other people like it. And maybe the audience wouldn’t know per se; maybe, in fact, they’d enjoy the movie a little more, but the ideas they’d get from the film, what they’d perceive about their own lives as a result, would be hopelessly tarnished: the message of post-college adolescent angst muffled by a smiley-face of everything’s-always-going-to-be-ok.

            I remember watching the James Bond movie, GoldenEye, when I was thirteen. Spoiler alert, James gets the girl in the end. As I watched he and Natalya rolling idyllically through the grass, so in love after the world (or a football-sized-satellite dish) had exploded around them, I wondered what her fate would be after the movie was over. Did they remain in love and get married? Even then, I knew better, but one of the reasons that GoldenEye, while a tremendously fun movie, wasn’t exactly a serious contender to win Best Picture in the 1995 Academy Awards is that it was fundamentally a fantasy, its romances imitating real romance with an aim not to reveal something true but to obscure something fake. We never see James drunkenly stopping by Natalya’s Moscow apartment a few times and then failing to return her calls. The movie wouldn’t be better for doing so, but that’s just because it’s not exactly all that deep.

            Even for very good movies that aim to do more than pleasantly imitate, the temptation to cut corners and succumb to easy sentimentalism is often too strong to resist. Dunham deserves credit for abstaining from this easy satisfaction, praise for the maturity to tell the best story she was capable of, admiration for making something not as satisfying as we would have wanted her to create.   

 

* a quote from another HBO show, not Girls. Two points to any reader who got the reference.

** Sorry, but no points for getting that reference, which I’m basically ashamed even to have made.

The Art of the Goon Squad

 This is the second of two posts about Jennifer Egan’s A Visit from the Goon Squad

            Yesterday I mentioned that Egan’s novel lacked moments of joy as if it were a critique. Now, of course, the experience of joy is just one of many emotions that come upon us in life, and it’s no artist’s obligation to depict every feeling in every work (“I don’t like Radiohead because they never just, like, chill out.”). So is it fair for me to (sort of) mark her down for failing at something she didn’t really attempt? Perhaps not, but while I’m here I might as well make another possibly unfair attack, which is the way she deals with the value of art. Goon Squad is a book about a constellation of people involved in punk rock written by someone who seems to despise punk and everything it stands for. Now, contempt is not always a barrier to understanding (see the poisonous attitude the Sopranos had towards its characters; unsurprisingly that show greatly influenced Egan’s work on Goon Squad), and in many ways Egan’s opposition to the “never-grow-old” theme of punk does a fantastic job of illuminating the essence of the genre. By setting the bulk of her story after the end of punk, she draws out the sterile echo of the electric Fuck-You punk screams at death. Who’s to judge hers as an unfair attitude to take towards such music?

            Indeed, Egan seems to lump music in nihilistically with the whole pile of vanities, trivialities, and general bad shit that her characters misguidedly cling to. For Bennie, music is just a way of reliving his mediocre high-school band (same with Scottie, I think). Lou likes it because it keeps him around young people. Rhea (a young person) mostly wants the excuse to hide because “how can anyone call me ‘the girl with freckles’ when my hair is green?”. When we see the much-talked about band Conduit (who made Bennie’s career) in concert, the character’s attention is elsewhere, Rob (chapter 10, 2nd person) simply notices the feel of lead-singer Bosco’s flinty, crowd-surfing back as the rest of his life crumples in around him.

            I can think of really just four moments in the book where we see art’s potency: in the first, the anger of the crowd at a Flaming Dildos concert feeds back into Scotty’s furious performance, creating an electric screech of disappointment and nihilism; years hence, a late-period, sagging Bosco explains his idea for a “Suicide Tour” to the dissatisfied housewife who doubles as his publicist (chapter 7). It’s a comeback where his on-stage antics will inevitably lead his cancerous body to collapse and kill him; – the novelty of the idea sends an unhappy charge through her as she recognizes its immediate appeal while struggling to be repulsed by it; my favorite potent moment describes a “slightly-autistic” thirteen year-old’s loving catalogue of the silences within different songs (“The pause makes you think the song will end. And then the song isn’t really over, so you’re relieved. But then the song does actually end, because every song ends, obviously, and THAT. TIME. THE. END. IS. FOR. REAL.”) – songs becoming just the beat that reminds us we’re still alive and that that’s something.

            The book ends with the final such moment: a concert that was conceived impurely, its audience summoned through corporate tricks to see music meant to appeal to infants. Nevertheless, the music, its artist shaky and in declining years (as if he ever had lofty years from which to fall), broadcasts a signal to which the audience is tuned: “And it may be that a crowd at a particular moment of history creates the object to justify its gathering…. Or it may be that two generations of war and surveillance had left people craving the embodiment of their own unease in the form of a lone, unsteady man on a slide guitar…. Gazing … with the rhapsodic joy of a generation finally descrying someone worthy of its veneration.”

            Here we see most clearly the meaning of art according to Egan the artist. Whereas writers so often romanticize art itself as hallowed, as providing meaning and beauty in a world with too little of it, to Egan, art simply extracts more purely ore from the world as it is. Purifying the essence of the world to make it visible fails to render it more pure, not truly: it’s just the same shit as life, this time in a more obvious shape. While most artists pride the quest for artistic success as inherently dignified, as more heroic than the pursuits of others, to Egan, it’s just another vanity, another way to forget the ticking clock you can’t ignore grinding away at the base of your spine. Art isn’t some universal end, some capital word Truth or Beauty. it’s just the same as everything else, only moreso.