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Rebecca Miller Reads from The Private Lives of Pippa Lee

Topic: Rebecca Miller reads from the Private Lives of Pippa Lee

Rebecca Miller: Okay.  So Pippa is having lunch with her friend Moira [Dallas].  Moira is a friend of hers and her husband Herb’s.  Herb is Pippa’s husband.  Pippa is 50, her husband Herb is 80 and they’ve recently moved to Marigold Village Retirement Community at Herb’s urging.  And they’re meeting at at a, Moira and Pippa are meeting for lunch at a restaurant in the little town near Marigold Village.  And Moira is younger, she’s about 35 and she’s been going out, living with a writer friend of Pippa and Herb’s for quite a long time.  And Herb’s a sort of legendary publisher.  So, here’s Moira and Pippa’s lunch.  Moira was late.  Pippa leaned back in the aqua leatherette banquette and scrutinized the small oil paintings that were hung at regular intervals on the walls of the restaurant.  They were all dutifully painted humorless landscapes.  She thought about her old artist friend, Jim.  How he would’ve looked up at them, his head slightly bowed, he would’ve nodded slowly.  “Oh, yes,” he would’ve said, smiling grimly.  She wondered if Jim was still alive.  Moira appeared out of breath, kissed Pippa, strands of black hair escaping from her ponytail.  She smelled pleasantly of milk.  “I’m so sorry, I’m late.  I was writing and I looked at the clock and…”  “Don’t worry,” said Pippa.  “I was just relaxing, enjoying the art.  That’s a great buckle,” she said, fingering at sheriff star, a silver sheriff star below Moira’s bellybutton.  “Thanks,” said Moira, covering it with her hand and sliding into the opposite bench, her large suede handbag clutched to her side.  An effeminate waiter appeared.  “Oh, hi.  Can I please have ahmm… an ice tea, the one with a melon in it?” Moira said to him with involuntary flirtatiousness.  Then she looked back at Pippa, tucked a strand of hair behind her ear girlishly, and smiled, a dimple indenting her left cheek.  “No wonder she’d been her father’s favorite of seven kids,” Pippa thought, she must have been a magical child with that heart-shaped face, those enormous Indian orphan eyes, and that imagination, and her messy, breathless, self-obsessed way.  Moira was adorable.  There was no getting around it.  You could think her sincerity was ridiculous.  You could lampoon her overblown sexuality, her exaggerated appreciation of life.  But, finally, you just had to throw up your hands and love the absolute purity of her confusion.  Disarming, that was the word for Moira.  “You look so beautiful,” Moira said scrutinizing Pippa’s face.  “What are you doing different?”  “It’s the indolence,” said Pippa, “I wish I could be peaceful and good like you.”  “Good?  You seem so beatific.”  Pippa laughed, “If only you knew.”  “Knew what?”  “Oh, variety of things.  I’m like one of those used cars that have been in a terrible accident.  They look perfectly fine on the outside but the axel is bent.”  Moira smiled, puzzled, “You were so mysterious about the past.”  “You think?”  “You never say anything about your life before.”  “There are things that happened that I don’t dwell on,” said Pippa.  “What?  Like what happened to Herb’s first wife?”  “Second.”  “Second.  He said she was already crazy.”  “Not that crazy.”  Moira sighed, put her head in her hands and sniffed.  “What?” Pippa put her palm on Moira’s shoulder.  “I’m just a rotten apple,” said Moira wiping the tears off her cheeks, “I’ll never have a normal life.”  Pippa was used to her friend’s sudden episodes of self-flagellation.  She always used humor to bring her out of her maudlin spirals.  “Oh, come on,” said Pippa, “What’s normal?  You mean marriage?”  Moira nodded, blowing her nose.  “It’s over between Sam and me.  Oh, Pippa, it’s also completely fucked up.  I’ve got myself into…  I’m going to be 40 with no man, 50, not that it matters but it does.  I just wish I knew how to recognize the right man.”  “Oh, pish-tosh,” said Pippa, “You can’t be…  You can be married to anybody if that’s what you’re worried about.”  “What do you mean?”  “Pick any man in this room with the right age range I could be married to.”  Cheered up by the game, Moira surveyed the room then point to a thin man wearing glasses, looking at the menu with distaste.  “He just needs his routines, that’s all,” Pippa said, “I bet if you anticipate his needs before he knows he has them, he’ll be dazzle as a lamb.”  “What about that one?”  “As long as you stick your finger up his ass when his coming, he won’t give you any trouble at all.”  “Pippa!”  “Sorry, it just slipped out.”  “You make it seem so unromantic.”  “Courtship is romantic.  Marriage is an act of will,” said Pippa, taking a sip of water. “I mean, I adore Herb but the marriage functions because we will it to.  If you leave love to hold everything together, you can forget it.  Love comes and goes with the breeze, minute by minute.”  Moira shook her head, smiling, baffled.  “I can’t get my head around that one,” she said.  “You’ll see,” said Pippa amazed that this active complacent cynicism she was playing.  When in God’s name had she started saying pish-tosh?  When did she even hear of it?  Did she really believe what she was saying about marriage being an act of will?  Yes, she realized sadly.  She did.  After all she and Herb had been through together, after what they had lost to be with each other, their very souls perhaps, being married, ended up being an act of will, it made her want to tear through the dull present.  Claw the vivid past back into herself, devour it like a bear busting into a [camp or stores].  She wanted to run out of the restaurant to find Herb and kiss him violently on the mouth.  She could imagine his surprise, bemused expression as she crushed herself on him, to burst into tears, [screaming] then lose control at last.  Instead, she waited smiling for her lobster sandwich and wondered if she might be on the brink of a very quiet nervous breakdown.

Recorded on: 10/16/2008

Rebecca Miller reads a passage from The Private Lives of Pippa Lee.

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The psychological scars a traumatic experience can leave behind may have a more profound effect on a person than the original traumatic experience. Long after an acute emergency is resolved, victims of post-traumatic stress disorder (PTSD) continue to suffer its consequences.

In the U.S. some 30 million patients are annually treated in emergency departments (EDs) for a range of traumatic injuries. Add to that urgent admissions to the ED with the onset of COVID-19 symptoms. Health experts predict that some 10 percent to 15 percent of these people will develop long-lasting PTSD within a year of the initial incident. While there are interventions that can help individuals avoid PTSD, there's been no reliable way to identify those most likely to need it.

That may now have changed. A multi-disciplinary team of researchers has developed a method for predicting who is most likely to develop PTSD after a traumatic emergency-room experience. Their study is published in the journal Nature Medicine.

70 data points and machine learning

nurse wrapping patient's arm

Image source: Creators Collective/Unsplash

Study lead author Katharina Schultebraucks of Columbia University's Department Vagelos College of Physicians and Surgeons says:

"For many trauma patients, the ED visit is often their sole contact with the health care system. The time immediately after a traumatic injury is a critical window for identifying people at risk for PTSD and arranging appropriate follow-up treatment. The earlier we can treat those at risk, the better the likely outcomes."

The new PTSD test uses machine learning and 70 clinical data points plus a clinical stress-level assessment to develop a PTSD score for an individual that identifies their risk of acquiring the condition.

Among the 70 data points are stress hormone levels, inflammatory signals, high blood pressure, and an anxiety-level assessment. Says Schultebraucks, "We selected measures that are routinely collected in the ED and logged in the electronic medical record, plus answers to a few short questions about the psychological stress response. The idea was to create a tool that would be universally available and would add little burden to ED personnel."

Researchers used data from adult trauma survivors in Atlanta, Georgia (377 individuals) and New York City (221 individuals) to test their system.

Of this cohort, 90 percent of those predicted to be at high risk developed long-lasting PTSD symptoms within a year of the initial traumatic event — just 5 percent of people who never developed PTSD symptoms had been erroneously identified as being at risk.

On the other side of the coin, 29 percent of individuals were 'false negatives," tagged by the algorithm as not being at risk of PTSD, but then developing symptoms.

Going forward

person leaning their head on another's shoulder

Image source: Külli Kittus/Unsplash

Schultebraucks looks forward to more testing as the researchers continue to refine their algorithm and to instill confidence in the approach among ED clinicians: "Because previous models for predicting PTSD risk have not been validated in independent samples like our model, they haven't been adopted in clinical practice." She expects that, "Testing and validation of our model in larger samples will be necessary for the algorithm to be ready-to-use in the general population."

"Currently only 7% of level-1 trauma centers routinely screen for PTSD," notes Schultebraucks. "We hope that the algorithm will provide ED clinicians with a rapid, automatic readout that they could use for discharge planning and the prevention of PTSD." She envisions the algorithm being implemented in the future as a feature of electronic medical records.

The researchers also plan to test their algorithm at predicting PTSD in people whose traumatic experiences come in the form of health events such as heart attacks and strokes, as opposed to visits to the emergency department.