Archive for October 2009

Health Care Reform, Quick!

October 30, 2009

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This is an open letter to everyone who has ever been sick, and to everyone who will ever be sick.  It’s a letter to everyone with cancer, past, present, and future. It’s a letter to Ron Williams, CEO of Aetna, our insurance provider, and a letter to your insurer too.  A letter to Jay Inslee, our Congressman, and to your Congressperson as well.  A letter to Barack Obama, my President and yours.

It’s  a letter that’s too much about brutality and too little about redemption.  It’s a letter about our life.

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As many of you know, we’ve been living with Shel’s cancer for 15 years. Like everyone who loves someone with cancer, I’ve felt alternately hopeful and hopeless countless times over the years since his diagnosis.  With each new treatment he’s tried there’s been hope and fear and relief and disappointment, and then, finally, settling for the new thing that has become our life, taking into account whatever part of it has been lost to the ravages of the disease.  We’ve been lucky enough to have health insurance through it all, although the amounts we’ve had to pay out of pocket have been staggering.

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Cancer is a savage beast, eating away at one’s strength and vitality every day.  Doctors and patients take their best shot at it, but sometimes the guns are just not big enough.  New surgeries, new drugs, all have taken their toll on our life.  And as Shel has moved through all the conventional treatments, and some unconventional ones, worries about what our insurance will and won’t cover have increasingly come to dominate our health care horizons.

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Sometimes it seems like all we can do is huddle together in silence, awaiting our fate.  That’s what my son Jordan has to do, huddle and hope.  He had leukemia as a small child, and lived to tell the tale about how a cancer survivor with no health insurance goes without any sort of  follow up, having no other choice.

At other times, resignation and a “there are lots of good things about America, too bad health care coverage isn’t one of them” attitude just don’t cut it anymore, and we’re desperate to fight back.  This is one of those moments.

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When what you have is thyroid cancer, and conventional treatments fail you, there aren’t a whole lot of choices.  It’s not a sexy form of cancer, and research dollars don’t often find their way into the thyroid cancer research labs.  But still, after 40 years of sticking with the same old same old, treatment-wise, new drugs are finally being developed, often drugs that have been used successfully to treat other forms of cancer.  There’s always some bright spot of hope down the road, even though it often tarnishes before you even get close enough to name it.  The treatment system is a patchwork of old and new, and  it doesn’t hold together too well.

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It’s time to confess, to share the nasty little secret that we’ve been guarding these past few weeks.  Shel’s been taking one of those experimental drugs for more then three years, and now, it seems to have stopped working.  The tumor that almost cost him his voice last year has been growing again. Sylvie’s healing hands seem powerless this time.

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For a long time it seemed that the drug worked, and we were fierce with hope.  We tried to live as if cancer weren’t perched on our shoulders, came back to France, settled in, planned a new life.  But now all that’s water over the dam, our hopes and dreams washing under cancer’s cruel bridge in the blink of an eye.  One minute you’re lying in the scanner thinking the radiologist will give you good news, the next you’re reeling with the shock of hearing the unhearable.

Every cancer patient has faced these moments, some of them many times.  And for some reason no one ever holds your hand when pronouncing the terrible words.  For the French, the words are no less terrible, but cancer treatment is free, because it’s understood that the disease itself is brutal enough without having to worry about money at the same time.

If you’ve been unfortunate enough to hear the words “it’s cancer” or “your cancer has come back,” hasn’t one of your first coherent thoughts after emerging from the fog of despair been “is this going to bankrupt me because my insurance company won’t cover the care I need?”

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We heard those words recently.  “Your tumor has grown.  There aren’t a lot of good options.”  In fact, there aren’t any good options.  There are just more or less bad options, and the prospect of dire financial consequences, because most of the options aren’t approved by our insurance company.   The dark door has opened, and no matter how faithfully we’ve guarded out hearts against too much hope, the cold truth is sucking us in.

In Shel’s case, he could still have that surgery they offered him last year, the one that might leave him without a voice, or without being able to swallow, or both.  Aetna would pay for that.  Or he could try one of the new drugs.  Could.  If the world were different.

The new drugs are out there, but they’re mostly not approved for thyroid cancer.  There is one promising drug that’s approved in the Netherlands. Perhaps we need to move there?  Because while there’s a chance that it might be made available to Shel off-label here in France, it would cost 4000 Euros a month, which is $6000.  Then there’s another drug he might be able to try in the US,  but it costs, you guessed it, $6000 a month.  And we already pay $1000 a month for our health insurance.  But since the drugs are off-label, aren’t “approved” by insurers, even though oncologists say they might work, might spare Shel the terrible operation, our insurance won’t pay for them.

We’ve completely lost touch with the idea that “doctor knows best.”  In fact, the doctors’ hands are tied by the insurance companies and they no longer have the right to provide the drugs and care they think are necessary.  No wonder the doctors don’t hold our hands when delivering the bad news.  They’re handcuffed.

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Aetna is happy to take our $1000 per month, but then they leave us high and dry, alone to contemplate a terrible future.  Oh, it’s probably not just Aetna.  Almost certainly your own insurance company would treat you exactly the same way, were you in the same trouble we are. And not because they’re all just a bunch of heartless baby-killers and father-rapers, either.  It’s pretty much a sure thing that every single person at those insurance companies has loved ones, plays games with their children, pays taxes, relaxes in the sunshine, and sometimes wakes up in a cold sweat after a nightmare.

As well they might, because they know that their loved ones too will be touched by cancer, because one in three Americans is.  And the nightmare is that their insurance company won’t treat them any better than ours treats us.  We’re all in the black hole together.

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So here’s my message in a bottle to senators, congressmen, insurance company CEOs, Mr. Obama, and all of you.  Every one of us will be touched by cancer in this lifetime, one in four of us will die of it.  Perhaps one of them will be my husband.  Perhaps one of them will be you.

And while it’s true that everyone must die of something, is it equally true that Ron Williams, CEO of Aetna, while he might be a heck of a nice guy, deserves to earn $3.4 million per year with an additional $10 million worth of benefits, while Aetna refuses to pay its fair share of the $6000 per month that might save Shel’s voice, or life?  That $3.4 million that Williams pocketed last year in base pay alone would buy 47 years worth of the drug Shel needs.  And at his age, Shel won’t be needing the drug for 47 years, so he’ll be happy to share it with some other thyroid cancer sufferer who has no better options.  Come on Mr. Williams, don’t you feel like sharing too?

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It’s cruel, it’s unfair, it’s regressive and shameful, but what can we do, besides weep and gnash our teeth?  Changing our citizenship to that of a country that actually takes good care of its most vulnerable citizens isn’t an option for most of us.  All that’s left is to stand up and fight.  Scream and yell  until someone listens.  Make America as good as it should be.

I’m not asking you to do this for me, or for Shel.  Be a ray of hope for someone you love who has cancer, or someone who will get cancer.  That someone might even be you.  Send the link to this post to your congressmen and women, to your doctor,  to anyone you know who might lift his or her voice in outrage against a system that perpetuates such shameful discrepancies.  Write letters, make phone calls, sign petitions, march in the streets.  In standing up for a fair and responsible health care system, the life you’re saving might be your own.

As The Swallow Flies

October 26, 2009

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In the practically invisible little hamlet of St. Cirq, in the Tarn et Garonne, is a wonderful restaurant called L’Hirondelle, like the swallows that swoop over nearby fields.  The first time we drove through St. Cirq, after hearing about L’Hirondelle, we thought there was no way the tiny town had any sort of restaurant, let alone an excellent one.  And indeed, we couldn’t even find it until I called for reservations and got directions.

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To get there you drive through a rolling pastoral countryside full of the beautiful blondes d’Aquitaine, as these lovely cows are called.  No blonde jokes now, these cows are so ubiquitous they’re like the symbol of the region.

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When you arrive at L’Hirondelle, you’re greeted by a freestanding fireplace in the middle of the room and this truly unique bar made of colombage.  There’s colombage all over the area, but usually on the exterior of houses, where beams and bricks are more normally found.  So we were quite enchanted by seeing them used in this unexpected fashion, and could tell that we were in for something special.

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In our corner of the pretty room there were just three tables of elegant couples, or two, if you subtract Shel and me.  Behind us was one long table of boisterous hunters in camouflage, even many of the women.  Serious hunters one and all, intent on having a seriously good time.  It made for a great atmosphere.

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It was lunchtime on Sunday, our absolutely favorite meal of the week in France, so we ordered the menu at 30 Euros.  They immediately brought us this huge tureen of pumpkin soup, as silky and ephemeral as a dream.  I actually thought about just having soup, since they’d brought us enough for 6-8 people, but I managed to restrain myself after the second bowl.

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Shel’s first course was all seafood

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mine was all duck   My salad was one I had versions of several times while in the southwest, and I fell in love with it.  In this incarnation it’s topped with foie gras, over slices of duck breast, surrounded by sliced duck gizzards and bits of walnut.  It was superb.

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As our main course we’d ordered the côte de veau for two, a huge roasted veal chop served on a slice of tree trunk, which is what you should order too when you go there.  But make sure they don’t think you’re English, or if you are, pretend you’re not.  Because when we saw that the veal was barely pink, and remembered that we hadn’t been asked how we’d like it cooked,  we said to ourselves “they must think we’re English or something.”  In the event, the veal was delicious, but we both would have preferred it rarer.  So when the owner came by to check on us and asked “it is well-cooked enough?” at first I murmured politely “perhaps a bit too cooked, but then I didn’t mention that we’d like it pink.”  When he looked surprised, I proceeded boldly, asking him if he thought we were English.  He was very taken aback when he discovered that we were Americans and that he’d just assumed that we wanted the meat well done, since evidently many of his English clients have sent theirs back to be re-cooked.  We shuddered delicately and ate every scrap anyway.

But I knew he owed me one, and he knew it too.  The elegant couples had departed, leaving us in the company of 25 camo-clad hunters.  I approached the colombage bar and asked assertively “est-ce qu’on a le droit de ronger les os ici ?”  Is it ok if we gnaw on the bones in your restaurant?

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Faites comme chez vous, Madame,” he replied, make your self at home.  And so, showing no restraint whatsoever,  I did.  And I’m here to testify that it was one of the best bones ever.

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Shel’s mouth-watering chocolate dessert made him want to lick his plate, but really, that would have been going too far.  My dessert was a plate of excellent cheeses, but honestly, if I showed you every cheese plate I’ve eaten since we got to France it would be a huge yawn.  Instead, let me show you the dessert the hunters had,

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a gateau à la broche, which is a cake cooked on a special spit over an open fire.  You can see a picture of one being made here.  It looked so good that Shel had to buy himself a little one we found along the road on the way home, and although he hasn’t eaten it yet, it’s bound to be a treat.

As was our whole afternoon at L’Hirondelle.  I’d move to St. Cirq just to be able to eat there often.  It’s the kind of place where you want to have a regular table, know the menu inside out, and have the chef slip you something special now and then.  The kind of place where they don’t (normally) think you’re English, where all the food is perfectly delicious, and where you can gnaw your bones with pleasure.  That’s my kind of place.

Birthday Cake Au Chocolat

October 22, 2009

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Last night we hosted a birthday party for 20 people.  It was a very American party, in that it was a total surprise, complete with the guests hiding behind a curtain, and then, on the count of three, shouting “SURPRISE !” which, amazingly, is the same word in French as in English.  It was also very American in that it was a potluck, with each guest bringing something delicious to share with the group.  My job, as hostess, was the birthday cake.

Since I currently don’t eat cake, this was an interesting exercise.  I swear, I never realized how many times I would have licked my fingers in times past, when making a cake and frosting.  But this time I just washed my hands until they were chapped, and served up this beauty to general acclaim.

This cake, which comes from the Cafe Beaujolais cookbook, is absolutely foolproof, and guaranteed to please all of your guests.  It’s very festive, very American, and finger-licking good, everything a birthday cake should be.

Amazon Cake With Mocha Buttercream Frosting 

For the cake:
3 cups flour
1/3 cup unsweetened cocoa
2 tsp baking powder
2 cups sugar
1 tsp salt
2 cups water
1/2 cup plus 2 T canola oil
1 T vanilla
2 T white vinegar

For the frosting:
2 ounces unsweetened chocolate
1 T instant coffee
2 T espresso
1 cup unsalted butter, softened
2 cups powdered sugar
1 egg yolk

Mix dry ingredients together.  In another bowl, mix wet ingredients.  Whisk together until smooth, strain if necessary.  Pour into two greased 9″ round pans, or a 9×13″ pan.  Drop on the counter several times to eliminate air bubbles.  Bake at 350° for 25-30 minutes. Cool.

Melt chocolate in espresso and powdered coffee.  Let cool slightly.  In food processor, place butter, sugar, and egg yolk, and blend thoroughly.  Add chocolate mixture and blend again.  Chill to spreading consistency, about 15 minutes, and frost cake.

I made the layers two days before the party and froze them, well-wrapped. This makes your life a lot easier, since you can just frost and decorate the cake a couple of hours before the party.  I doubled the recipe and baked it in two rectangular pans, which made 24 big American-style servings.

La Nuit Des Temps

October 19, 2009

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Back in la nuit des temps, which I think occurred slightly before our “dawn of time” but was definitely “when dinosaurs roamed the earth,” humans lived on the site of what is now the Château de Bruniquel.

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A nearby grotto houses the original of this Paleolithic cave painting

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and the “lady of Bruniquel” rests here for all time.  She’s not the real lady to which Bruniquel owes its existence, for that lady lived much later, in the 6th century.  She was Queen Brunehaut, or Brunhilda, and she was a Visigoth.  She had a long and complicated life, which you can read more about here if you wish.  I’ll just say here that although her life ended badly, she evidently had vision and power long before women’s lib held sway.

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Today she’s mainly remembered for the château she’s said to have built on a steep hilltop overlooking the Aveyron River.  There are actually two châteaux on the site today, one old, and one very old, but a series of restorations has resulted in the curious fact that the older of the two actually seems to be newer.

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From the outside it’s an imposing fortress, built to repel the invaders that have besieged the south of France since la nuit des temps.

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Inside it’s startlingly beautiful

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and tranquil, evoking the days when the ladies of Bruniquel dallied here, dresses trailing softly over the polished stone.

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Although, if truth be told, they probably spent a lot of time here too, sanitation being what it was.  It’s an image of the times that’s not nearly as picturesque, but one that’s infinitely more atractive than similar arrangements must have been at the time of Queen Brunehaut.  If the Visigoths had plumbing, its legacy has long since vanished, even though Queen Brunehaut’s remains.

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Like a lot of history, this is a place of shadows and mirrors.  Here in what is now a lovely high-ceilinged room we were surprised to discover that there were fireplaces up in the air, where there used to be a second floor.

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Here in a little “truth window” one can see the original stone wall, covered at some time long after by plain wood paneling, and then even later by this elaborately carved surface.   It’s a graphic reminder that history is much more like an onion that a heap of stones.  Time after time, era after era, people came, they saw, and they redecorated.

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Some of the early features were built to last forever, like this spiral staircase carved long before power tools were even a gleam in a stonecutter’s eye.

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Others might have been transitory, offhand, even at the time of their creation.  This little sketch might have been a cherished bit of art, or might have been quickly covered over.  Its creator might be bowled over to think that hundreds of years later the vase of flowers has become part of the legacy of Bruniquel, through an accident of preservation.   We’ll never know.

History is like that, more random than we’d like to think, at the whims of wind and weather, and of the storytellers, and of the intention of those who come after to guard what came before, even when they don’t understand it.

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At least some things don’t change much.  The château’s old wine press isn’t that different from what we use today, and in fact it’s still used at least once a year when Bruniquel does a harvest à l’ancienne, just to remind everyone that some things vanish and some things hold fast, and raising a glass to both is often the best thing we can do.

How The Internet Works

October 17, 2009

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So un beau jour, one fine day, I got this comment from an unknown reader who’d just discovered French Letters.  In her comment, Robin made an unusual request: she asked me to take a photograph and send it to her.  A photograph of a specific cat door in Saint Antonin Noble Val, where we were at the time, and where she’d been recently.  Since it’s a really cute cat door, and such a quirky request, I couldn’t resist.

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I emailed her the picture, and after a while I got a note from her saying that she’d figured out that when she was in Saint Antonin she had stayed in the same house we were staying in, where she sunned on the same terrace, and dined at the same table.  This she evidently worked out by looking at Beppo and Zazou’s  view from our window. The house, by the way, is Maison Fleurie, where you too should definitely stay if you get to Saint Antonin and don’t mind stairs.

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In a subsequent email Robin and I discovered that we had rather a lot of time-space continuum occurrences in common, so when she recommended that we visit Castres, we got in the car that same day and set off for a town we’d barely heard of.  And just look how lovely it is.  Before heading out, of course, I looked online for a good restaurant in Castres and came across some reviews for La Mandragore.

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It sounded lovely, and according to Google maps it would be easy to find. Yet Mandy, our GPS mistress, couldn’t manage to get us there. Castres has a typically French and infernally complex inner-city road arrangement, for which you really can’t blame it since the town began growing in about the year 650, and we just couldn’t get to the restaurant from anywhere.  Mandy consulted her satellites obsessively and had us driving in circles, until we finally ditched the car and relied on Shel’s superior low tech masculine internal compass.

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When we finally stumbled in La Mandragore’s back door we found the warmest possible welcome by some of the friendliest restaurateurs anywhere, and a homey three course lunch, each course accompanied by a glass of wine, for 13 Euros.

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Were we happy campers?  You betcha!

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Robin had also piqued our interest about a phenomenon we’d never hitherto understood, why every town in France has a Boulevard Jean Jaurès.  As it turns out he was born in Castres in the mid-19th century, was a Socialist firebrand of a politician, and was assassinated in Paris on the night before World War I broke out.  There’s a museum dedicated to his life, and we marveled at how neither of us had ever heard of someone so important in French history.  What the heck did they teach us in school anyway?

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Google had also informed me that Castres houses the Goya Museum, home to the largest collection of Spanish art in France and one of the largest in Europe.  Ranging from medieval pieces to Picasso, it’s a fabulous collection, with three Goya pieces on permanent display, and while we were there, an exposition of Goya gravures,  pointed and often hilarious political cartoons about the events of  his time.  There’s also a lovely garden behind the museum, designed by Le Nôtre, who did the gardens at Versailles.

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Then, on the way back to the car, with no help from the Internet whatsoever, we happened upon this lovely church, notable for its majestic width and tranquil colors.

And so we thank you Robin, whoever you are, for sending us on this journey into one of the nicest days we spent in the Tarn et Garonne.  And we thank you Internet, whatever you are, for making all of this possible.  But no matter how high tech a goodly portion of this excellent day was, I’ll never forget that we owe it all to a cute little French cat door.

La Rentrée

October 12, 2009

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In Saint Antonin Noble Val the Fall has fallen.  Leaves are everywhere, crunching underfoot like they do in some mythic childhood, the fog hangs low over the morning valley, children have reluctantly returned to school.  In France la rentrée signals the time when it’s all work and no play, everyone heads back from vacation at the same time, and life gets serious again after the summer’s respite.  It’s the time of the return, the return to life as we knew it before the careless summer swept us off our feet.

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The last of the walnuts are ripening on the trees

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and the chestnuts are falling freely, sometimes into unexpected shapes. This is a spontaneous chestnut heart we happened upon, a kind of I Love Fall installation that says “eat me” and “love me” all at once.

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The chestnut is, in fact, an excellent metaphor for life and love and autumn, at once prickly and sweet, in free fall yet ephemeral.  It’s the staff of life in the countryside, a gourmet treat in the city.  Living in Saint Antonin made us think a lot about the differences between the country and the city, made me decide that I’m neither a country mouse nor a city mouse. Henceforth, I’m proud to declare myself to be a village mouse.  I love the village life, a thing that I don’t think exists in America.  I didn’t want to leave Saint Antonin, and I’m already thinking about going back.  That village captured my heart, in only a few short weeks.

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Zazou almost finished growing up there, turning from a scrawny kitten when we picked her up from kitty camp into a wild and crazy young lady cat a short five weeks later.  We met her in the street one day when we were out for a walk, racing through Saint Antonin like she owned it, and who’s to say she didn’t.

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Beppo too was reluctant to give up his favorite spot for watching the sunset. A village cat has a lot of freedom, in amongst the little streets where there are no cars to run from and everyone has time to say “minou, minou” to a passing cat.

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Living with stones that were cut six or eight hundred years ago does give one a sense of the passing of time, of how short our lives are.  The hands that cut those stones have been long forgotten by those they touched.  I try to remember them all, although I don’t know who they were. I want to remember them, because someone must, and because I want someone to remember me, after I too return to that place where even a village mouse is long forgotten.

Drive On, Dionysus

October 10, 2009

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Now tell the truth.  Would you go chasing all over the countryside for these two guys?   What’s that you say, either one of them?  Well then, we’re in synch.

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‘Twas a dark and stormy day when we embarked on our last road trip in this corner of France.  We were in search of the black wine of Cahors, and weren’t going to be deterred by a little rain and thunder.

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We crossed over the Lot river, leaving behind the Tarn et Garonne that’s been our home these past five weeks, and entering into a wild and wine-soaked part of France.

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The harvest is over here, and the vines are turning.  Cahors wines are made of mainly Malbec, known locally as Auxerrois or Côt, plus a little merlot and tannat.  You probably think of Malbec as a wine from Argentina, but they had it here first.  In fact, the Romans appreciated it, trade wars have simmered over it, it was exported to Russia in the time of Peter the Great, and it tastes not a whit like its South American cousin.

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We headed first to Clos de Gamot in Prayssac, hoping to buy some of the wine that accompanied this meal. After tasting through 5 years of their excellent wines, I was very happy to come away with a few cases of their delicious 2002 that’s 100% Malbec, although not actually black.  I was also happy to see that an ancient and venerable wine house

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retains a proper sense of perspective.  The poster rhymes nicely in French, although the translation doesn’t:  one glass opens the way, three glasses bring joy.  Their wines made me really wish I had a cellar, since they’ll only keep getting better over the next 10-15 years.  However, the 2002 is ready to start drinking now, and that’s just what I plan to do.

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The wines I wanted to compare with the Clos de Gamot were wines from Chateau de Gaudou in Vire-sur-Lot, also hundreds of years old and widely venerated.  I was interested because this domaine is represented in the US by our friend Michel Abood of Vinotas Selections, and if Michel likes it, I’m pretty sure to like it too.  These wines are made in a more modern style and are ready to drink earlier, but are still very carefully structured and complex.  And they’re more nearly black, but not inky like I was expecting.  I guess that actually black wine doesn’t exist anymore, with modern winemaking techniques.  Or maybe it was just poetry all along.

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Fabrice Durou took the time to let me taste through a large selection of their wines

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while his Dad Jean Durou undertook the less glamorous task of repairing the bottle labeling machine.

The low point of the day came when I found out that my two favorite wines weren’t available to buy, although I felt a little better when I learned that the 1994 that I totally loved would cost, if it were available, which it isn’t, about 200 Euros for a half bottle.  Oh well, at least I got to taste it, and if only all the wines that pass my lips were that good, I might have to give up food altogether and just stick to drink.  But although the ones we did bring home are pretty darn good indeed, it’s just that I’m permanently spoiled by that little half bottle of 15 year old magic potion.

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Leaving Chateau de Gaudou we admired the pastoral and peaceful view they have out over the valley,

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although just 40 minutes down the road we found ourselves in a sort of gravel dune desert.

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We crossed back across the Lot with a little sigh of regret.  It’s a remarkable countryside, deserted, wild, alternately forested and teeming  with vines as far as the eye can see.  There’s wine on every corner, and I wish we’d had time to taste more of them, although we really started at the top and so avoided disappointment.

And now our wine bounty is fighting for trunk space with other essentials like clothing, because tomorrow we leave here and head to our home in Uzès.  I have lots more to tell you and show you about this part of France, but that will have to wait for a day or two or three, until we get settled in and back in the swing of normal life.  In the morning we’ll stuff Beppo and Zazou in the car, in amongst the wine bottles, and head off into the east.  See you when we get there.