When the Plague Came to New York

Jakob Schiller for The New York Times

Survivors Lucinda Marker and John Tull at home a decade after having the plague.

It was November 2002, little more than a year after planes had been flown into the World Trade Center and anthrax mailings had killed five Americans. New York City was still in a state of high alert for suspected terrorists.

Suddenly all eyes were on a middle-aged married couple from Santa Fe, N.M., on a brief vacation to New York, who had the remarkably ill luck to come down with the city’s first case of bubonic plague in more than a century. Television news trucks surrounded Beth Israel Medical Center North, where they had dragged themselves after being stricken in their hotel room with rampaging fevers, headaches, extreme exhaustion and mysterious balloonlike swellings.

It took just over a day for public health officials to dispel fears about bioterrorism; there had been no unusual rise in the number of very high fevers that could have suggested an attack.

It turned out that the couple, Lucinda Marker and John Tull, had been bitten by fleas infected with Yersinia pestis, the bacterium that causes plague. Their home state, New Mexico, accounts for more than half of the average seven cases of plague in the country every year. (In 2012, just one case was reported in the state.)

“It was an absolute fluke,” Ms. Marker, now 57, said during a recent visit to New York. “Just rotten luck.”

Like most people who contract the disease and are quickly treated with antibiotics, she recovered in a few days. But 10 years later, her husband is still badly scarred.

In the days after they were bitten, Mr. Tull, a burly, athletic lawyer — a former prosecutor who volunteered with search-and-rescue teams — developed septicemic plague, as the infection spread throughout his body.

His temperature rose to 104.4, his blood pressure plummeted to 78/50. His kidneys were failing, and so much clotted blood collected in his hands and feet that they turned black.

Mr. Tull was put into a medically induced coma. When he was brought out of it, nearly three months later, he found out that both his legs had been amputated below the knee to drain the deadly infection. The surgery that saved his life radically changed it, but did not dampen his resilient spirit.

Even before he was released from the hospital to begin a long rehabilitation, he vowed he would once again be hiking on the rustic trails above his home.

Today Mr. Tull, 63, drives his own car, sometimes takes over the controls of a private plane, and goes on an annual trout-fishing trip to Colorado with friends. But he has not been able to hike that trail.

“That is one of the things I miss most,” Mr. Tull, now retired and receiving a disability pension, said in a telephone interview from his home. “Every single hour of every single day, the plague affects our lives, but about the only time I really get angry these days is when, because of my physical condition, there is something I want to do but can’t.”

He has appeared in several television documentaries, speaking to medical researchers around the world and dealing with a posse of journalists as his very private ordeal has been played out in public.

“Basically Lucinda and I surrendered our privacy to the press and the people who make documentaries,” Mr. Tull said. “But you know what? That didn’t bother us a bit. Lucinda had been an actress and I had been a trial lawyer. We were used to it.”

Ms. Marker, who has started to write about their ordeal, says that after 10 years she is coming to terms with it emotionally and psychologically. Yet many aspects of their case still puzzle medical experts.

In particular, no one knows why she was so easily cured while he nearly died.

Bubonic plague is transmitted by fleas that feed off pack rats, ground squirrels and prairie dogs in the mountains of New Mexico and several other states. According to the Centers for Disease Control and Prevention, the disease probably came to the United States around 1900, in Asian rats that escaped from ships in the port of San Francisco.

Initially, plague was restricted to cities. The worst outbreak came in 1907, after the San Francisco earthquake. Vermin control programs prevented further outbreaks, but fleas hitched onto other animals in the wild.

Dr. Paul Ettestad, public health veterinarian for the New Mexico Department of Health, said prairie dogs became an “amplification host,” carrying the disease to their burrows and spreading it throughout their territory. Today, the easternmost limit of the plague roughly corresponds to the 100th meridian, which passes through central Texas. Known as the plague line, is it also the extent of the prairie dog population.

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U.S. to Require Electric Cars to Make Noise

DETROIT (AP) — A government safety agency wants electric and hybrid vehicles to make more noise when traveling at low speeds so pedestrians can hear them coming.

The cars and trucks, which are far quieter than conventional gasoline or diesel-powered vehicles, don't make enough noise at low speeds to warn walkers, bicyclists and the visually impaired, the National Highway Traffic Safety Administration said Monday in a statement.

The proposed rule would require the cars to make additional noise at speeds under 18 miles per hour. NHTSA says the cars make enough noise to be heard at higher speeds.

Automakers would be able to pick the sounds that the cars make from a range of choices. Similar vehicles would have to make the same sounds. And the government says pedestrians must be able to hear the sounds over background noises.

The public has 60 days to comment on the proposed rule. The agency will use public input to craft a final rule.

NHTSA estimates that the new noise would prevent 2,800 pedestrian and cyclist injuries during the life of each model year of electric and hybrid vans, trucks and cars.

The rule is required by the Pedestrian Safety Enhancement Act that was passed by Congress in 2010.

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Assad Says Syria ‘Accepts Advice but Not Orders’

BEIRUT, Lebanon — President Bashar al-Assad of Syria, sounding defiant, confident and, to critics, out of touch with the magnitude of his people’s grievances, proposed Sunday what he called a plan to resolve the country’s 21-month uprising with a new constitution and cabinet.

But he offered no new acknowledgment of the gains by the rebels fighting against him, the excesses of his government or the aspirations of the Syrian people. Mr. Assad also ruled out talks with the armed opposition and pointedly ignored its central demand that he step down, instead using much of a nearly hourlong speech to justify his harsh military crackdown.

Mr. Assad waved to a cheering, chanting crowd as he strode to the stage of the Damascus Opera House in the central Umayyad Square — where residents said security forces had been deployed heavily the night before. In his first public speech since June 2012, he repeated his longstanding assertions that the movement against him was driven by “murderous criminals” and terrorists receiving financing from abroad, and he appeared to push back hard against recent international efforts to broker a compromise.

“Everyone who comes to Syria knows that Syria accepts advice but not orders,” he said.

His speech came a week after the United Nations and Arab League envoy on Syria, the senior Algerian diplomat Lakhdar Brahimi, visited Damascus, the capital, in a push for a negotiated solution.

“Who should we negotiate with? Terrorists?” Mr. Assad asked. “We will negotiate with their masters.”

Mr. Assad’s speech was a disappointment for international mediators and many Syrians who say they believe that without a negotiated settlement, Syria’s conflict will descend into an even bloodier stage. The United Nations estimates that more than 60,000 people have died in what began as a peaceful protest movement and transformed into armed struggle after security forces fired on demonstrators.

Rebels have made gains in the north and east of Syria and in the Damascus suburbs, but Mr. Assad’s government has pushed back with devastating airstrikes and artillery bombardments and appears confident that it can hold the capital. Neither side appears ready to give up the prospect of a military victory.

The tenor of Mr. Assad’s speech is likely to raise the question of whether Mr. Brahimi’s mission serves any purpose; there was no immediate comment from him or his staff.

Mr. Assad’s opponents rejected the proposal as meaningless, sticking to their longstanding demand that the president resign as a precondition to negotiations.

“We can’t deal with this murderous regime at all,” George Sabra, a member of the opposition Syrian National Council, said in a brief interview. “This regime has killed 60,000 people, so no one could possibly think that working with this regime is a possibility. It is out of the question.”

Mr. Assad, whose family has ruled Syria for 42 years, said Sunday that he was open to dialogue with “those who have not betrayed Syria,” apparently a reference to tolerated opposition groups that reject armed revolution, like the National Coordination Body for Democratic Change, whose members have been floated by Syria’s allies China and Russia as possible compromise brokers.

Yet Mr. Assad’s speech appeared unlikely to satisfy even those among his opponents who reject the armed rebellion, since it made no apology for the arrests of peaceful activists or for airstrikes that have destroyed neighborhoods. Mr. Assad gave no sign of acknowledging that the movement against him was anything more than a foreign plot or had any goals other than to inflict suffering and destroy the country.

“They killed the intellectuals in order to afflict ignorance on us,” Mr. Assad said. “They attacked the infrastructure in order to make our life difficult, they deprived children from school in order to bring the country backward.”

He added, “The enemies of the people are the enemies of God, and the enemies of God will burn in hell.”

Mr. Assad has framed the uprising as an attack by the West and its allies, and the members of the exile opposition leadership as puppets of their foreign supporters, including Turkey, Qatar, Saudi Arabia and the United States, which has offered what it calls nonlethal support and recognized the main opposition body, now known as the National Coalition of Syrian Revolutionary and Opposition Forces.

Some armed rebel groups have used techniques that randomly target civilians, like car bombs, and there are foreign fighters among the rebels. But most of the armed movement is made up of Syrians who took up arms during the uprising or defected from the armed forces.

In his speech, Mr. Assad thanked officers and conscripts and vowed that he would stay by their side, apparently seeking to dispel speculation that he will flee the country. He spoke against a backdrop of snapshots that was reminiscent of montages that the opposition shows of people killed by the government.

When he finished the crowd chanted, “With our souls, with our blood, we defend you, Assad,” and vowed to be his “shabiha,” the term that has come to designate pro-government militias that have attacked demonstrators.

Scores of people then rushed toward him with an almost aggressive frenzy. Bodyguards pushed them back to form a phalanx that slowly escorted Mr. Assad through the crowd.

Many observers wryly noted on social media that the opera house was a fitting setting for the speech.

“It was operatic in its otherworldly fantasy, unrelated to realities outside the building,” Rami G. Khouri, of the Beirut-based newspaper The Daily Star, wrote on Twitter.

Mr. Assad said the first step in his plan would be for foreign countries to stop financing the rebels; then his government would put down its weapons, he said — although he reserved the right to continue to fight terrorism, which his government has defined as nearly any opponent.

Next would come national dialogue, but only with groups Mr. Assad termed acceptable; then a constitution approved by referendum; then a coalition government. There was no mention of holding elections before Mr. Assad’s term expires in 2014.

Hania Mourtada contributed reporting.

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Design: Who Made That Universal Product Code?

On a Sunday afternoon in 1971, an I.B.M. engineer stepped out of his house in Raleigh, N.C., to consult his boss, who lived across the street. “I didn’t do what you asked,” George Laurer confessed.

Laurer had been instructed to design a code that could be printed on food labels and that would be compatible with the scanners then in development for supermarket checkout counters. He was told to model it on the bull’s-eye-shaped optical scanning code designed in the 1940s by N. Joseph Woodland, who died last month. But Laurer saw a problem with the shape: “When you run a circle through a high-speed press, there are parts that are going to get smeared,” he says, “so I came up with my own code.” His system, a pattern of stripes, would be readable even if it was poorly printed.

That pattern became the basis for the Universal Product Code, which was adopted by a consortium of grocery companies in 1973, when cashiers were still punching in all prices by hand. Within a decade, the U.P.C. — and optical scanners — brought supermarkets into the digital age. Now an employee could ring up a cereal box with a flick of the wrist. “When people find out that I invented the U.P.C., they think I’m rich,” Laurer says. But he received no royalties for this invention, and I.B.M. did not patent it.

As the U.P.C. symbol proliferated, so, too, did paranoia about it. For decades, Laurer has been hounded by people convinced that he has hidden the number 666 inside the lines of his code. “I didn’t get the meat,” Laurer said ruefully, “but I did get the nuts.”

CODE BREAKER
Bill Selmeier runs the ID History Museum, an online archive dedicated to the bar code.

You worked at I.B.M. in the 1970s and then helped promote the U.P.C.?
Yes, I started the seminars where we invited people from the grocery and labeling industry into I.B.M. We were there to reduce their fear.

What were they afraid of?
They were afraid that anything that didn’t work right would reflect badly on them — particularly if it was only their own package that wouldn’t scan. The guy from Birds Eye said, “My stuff always has ice on it when it goes through the checkout.” So we put his package in the freezer and took it out and showed him how it scanned perfectly.

Why are you still so interested in the history of the U.P.C.?
Let me put it this way: What bigger impact can you have on the world than to change the way everyone shops?

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Despite New Health Law, Some See Sharp Rise in Premiums

Health insurance companies across the country are seeking and winning double-digit increases in premiums for some customers, even though one of the biggest objectives of the Obama administration’s health care law was to stem the rapid rise in insurance costs for consumers.

Bob Chamberlin/Los Angeles Times

Dave Jones, the California insurance commissioner, said some insurance companies could raise rates as much as they did before the law was enacted.

Particularly vulnerable to the high rates are small businesses and people who do not have employer-provided insurance and must buy it on their own.

In California, Aetna is proposing rate increases of as much as 22 percent, Anthem Blue Cross 26 percent and Blue Shield of California 20 percent for some of those policy holders, according to the insurers’ filings with the state for 2013. These rate requests are all the more striking after a 39 percent rise sought by Anthem Blue Cross in 2010 helped give impetus to the law, known as the Affordable Care Act, which was passed the same year and will not be fully in effect until 2014.

 In other states, like Florida and Ohio, insurers have been able to raise rates by at least 20 percent for some policy holders. The rate increases can amount to several hundred dollars a month.

The proposed increases compare with about 4 percent for families with employer-based policies.

Under the health care law, regulators are now required to review any request for a rate increase of 10 percent or more; the requests are posted on a federal Web site, healthcare.gov, along with regulators’ evaluations.

The review process not only reveals the sharp disparity in the rates themselves, it also demonstrates the striking difference between places like New York, one of the 37 states where legislatures have given regulators some authority to deny or roll back rates deemed excessive, and California, which is among the states that do not have that ability.

New York, for example, recently used its sweeping powers to hold rate increases for 2013 in the individual and small group markets to under 10 percent. California can review rate requests for technical errors but cannot deny rate increases.

The double-digit requests in some states are being made despite evidence that overall health care costs appear to have slowed in recent years, increasing in the single digits annually as many people put off treatment because of the weak economy. PricewaterhouseCoopers estimates that costs may increase just 7.5 percent next year, well below the rate increases being sought by some insurers. But the companies counter that medical costs for some policy holders are rising much faster than the average, suggesting they are in a sicker population. Federal regulators contend that premiums would be higher still without the law, which also sets limits on profits and administrative costs and provides for rebates if insurers exceed those limits.

Critics, like Dave Jones, the California insurance commissioner and one of two health plan regulators in that state, said that without a federal provision giving all regulators the ability to deny excessive rate increases, some insurance companies can raise rates as much as they did before the law was enacted.

“This is business as usual,” Mr. Jones said. “It’s a huge loophole in the Affordable Care Act,” he said.

While Mr. Jones has not yet weighed in on the insurers’ most recent requests, he is pushing for a state law that will give him that authority. Without legislative action, the state can only question the basis for the high rates, sometimes resulting in the insurer withdrawing or modifying the proposed rate increase.

The California insurers say they have no choice but to raise premiums if their underlying medical costs have increased. “We need these rates to even come reasonably close to covering the expenses of this population,” said Tom Epstein, a spokesman for Blue Shield of California. The insurer is requesting a range of increases, which average about 12 percent for 2013.

Although rates paid by employers are more closely tracked than rates for individuals and small businesses, policy experts say the law has probably kept at least some rates lower than they otherwise would have been.

“There’s no question that review of rates makes a difference, that it results in lower rates paid by consumers and small businesses,” said Larry Levitt, an executive at the Kaiser Family Foundation, which estimated in an October report that rate review was responsible for lowering premiums for one out of every five filings.

Federal officials say the law has resulted in significant savings. “The health care law includes new tools to hold insurers accountable for premium hikes and give rebates to consumers,” said Brian Cook, a spokesman for Medicare, which is helping to oversee the insurance reforms.

“Insurers have already paid $1.1 billion in rebates, and rate review programs have helped save consumers an additional $1 billion in lower premiums,” he said. If insurers collect premiums and do not spend at least 80 cents out of every dollar on care for their customers, the law requires them to refund the excess.

As a result of the review process, federal officials say, rates were reduced, on average, by nearly three percentage points, according to a report issued last September.

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Despite New Health Law, Some See Sharp Rise in Premiums

Health insurance companies across the country are seeking and winning double-digit increases in premiums for some customers, even though one of the biggest objectives of the Obama administration’s health care law was to stem the rapid rise in insurance costs for consumers.

Bob Chamberlin/Los Angeles Times

Dave Jones, the California insurance commissioner, said some insurance companies could raise rates as much as they did before the law was enacted.

Particularly vulnerable to the high rates are small businesses and people who do not have employer-provided insurance and must buy it on their own.

In California, Aetna is proposing rate increases of as much as 22 percent, Anthem Blue Cross 26 percent and Blue Shield of California 20 percent for some of those policy holders, according to the insurers’ filings with the state for 2013. These rate requests are all the more striking after a 39 percent rise sought by Anthem Blue Cross in 2010 helped give impetus to the law, known as the Affordable Care Act, which was passed the same year and will not be fully in effect until 2014.

 In other states, like Florida and Ohio, insurers have been able to raise rates by at least 20 percent for some policy holders. The rate increases can amount to several hundred dollars a month.

The proposed increases compare with about 4 percent for families with employer-based policies.

Under the health care law, regulators are now required to review any request for a rate increase of 10 percent or more; the requests are posted on a federal Web site, healthcare.gov, along with regulators’ evaluations.

The review process not only reveals the sharp disparity in the rates themselves, it also demonstrates the striking difference between places like New York, one of the 37 states where legislatures have given regulators some authority to deny or roll back rates deemed excessive, and California, which is among the states that do not have that ability.

New York, for example, recently used its sweeping powers to hold rate increases for 2013 in the individual and small group markets to under 10 percent. California can review rate requests for technical errors but cannot deny rate increases.

The double-digit requests in some states are being made despite evidence that overall health care costs appear to have slowed in recent years, increasing in the single digits annually as many people put off treatment because of the weak economy. PricewaterhouseCoopers estimates that costs may increase just 7.5 percent next year, well below the rate increases being sought by some insurers. But the companies counter that medical costs for some policy holders are rising much faster than the average, suggesting they are in a sicker population. Federal regulators contend that premiums would be higher still without the law, which also sets limits on profits and administrative costs and provides for rebates if insurers exceed those limits.

Critics, like Dave Jones, the California insurance commissioner and one of two health plan regulators in that state, said that without a federal provision giving all regulators the ability to deny excessive rate increases, some insurance companies can raise rates as much as they did before the law was enacted.

“This is business as usual,” Mr. Jones said. “It’s a huge loophole in the Affordable Care Act,” he said.

While Mr. Jones has not yet weighed in on the insurers’ most recent requests, he is pushing for a state law that will give him that authority. Without legislative action, the state can only question the basis for the high rates, sometimes resulting in the insurer withdrawing or modifying the proposed rate increase.

The California insurers say they have no choice but to raise premiums if their underlying medical costs have increased. “We need these rates to even come reasonably close to covering the expenses of this population,” said Tom Epstein, a spokesman for Blue Shield of California. The insurer is requesting a range of increases, which average about 12 percent for 2013.

Although rates paid by employers are more closely tracked than rates for individuals and small businesses, policy experts say the law has probably kept at least some rates lower than they otherwise would have been.

“There’s no question that review of rates makes a difference, that it results in lower rates paid by consumers and small businesses,” said Larry Levitt, an executive at the Kaiser Family Foundation, which estimated in an October report that rate review was responsible for lowering premiums for one out of every five filings.

Federal officials say the law has resulted in significant savings. “The health care law includes new tools to hold insurers accountable for premium hikes and give rebates to consumers,” said Brian Cook, a spokesman for Medicare, which is helping to oversee the insurance reforms.

“Insurers have already paid $1.1 billion in rebates, and rate review programs have helped save consumers an additional $1 billion in lower premiums,” he said. If insurers collect premiums and do not spend at least 80 cents out of every dollar on care for their customers, the law requires them to refund the excess.

As a result of the review process, federal officials say, rates were reduced, on average, by nearly three percentage points, according to a report issued last September.

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Economic View: Pigovian Taxes May Offer Economic Hope

NO one enjoys paying taxes — and no politician relishes raising them. Yet some taxes actually make us better off, even apart from the revenue they provide for public services.

Taxes on activities with harmful side effects are a case in point. Strongly favored even by many conservative Republican economists, these levies are known as Pigovian taxes, after the British economist Arthur C. Pigou, who advocated them in his 1920 book, “The Economics of Welfare.” In today’s deeply polarized political climate, they offer one of the few realistic hopes for progress.

To see how Pigovian taxes work, consider a driver checking out the offerings at his local auto dealership. He is trying to decide between two vehicles, one weighing 6,000 pounds and the other, 4,000 pounds. After comparing sticker prices, mileage estimates and other features, he views the choice as roughly a tossup. But because he has a slight preference for the larger vehicle, he buys it. His decision, however, could be viewed as a bad choice for society as a whole, because of the side effects. The laws of physics tell us that heavier vehicles tend to cause more damage in crashes. They also spew more emissions into the air and cause more wear and tear on roads.

By providing an incentive to take those external costs into account, taxing vehicles by weight would make the total economic pie larger. Those who don’t really need heavier vehicles could buy lighter ones and pay less tax. Others could pay the extra tax as fair compensation for their heavier vehicles’ negative side effects.

But the mere fact that Pigovian taxes produce greater benefits than costs doesn’t make them an easy sell politically. Like other changes in public policy, a Pigovian tax produces winners and losers. And it’s an iron law of politics that prospective losers lobby harder to block change than prospective winners do for its adoption. That asymmetry creates a powerful status-quo bias that makes even broadly beneficial policy changes hard to achieve.

Yet, in principle, any change that makes the economic pie larger makes it possible for everyone to enjoy a bigger slice than before. The practical challenge is to slice the larger pie so that everyone comes out ahead. A first step toward a vehicle-weight tax would be to make it revenue-neutral — for example, by returning its revenue in the form of lump-sum rebates to each buyer. That would soften the blow, while preserving the incentive to buy lighter vehicles.

For example, if the tax were 20 cents a pound, a 6,000-pound vehicle would be taxed at $1,200, as opposed to $800 for a 4,000-pound one. If an equal number of vehicles of each weight were sold, all buyers would get a $1,000 rebate when the total tax income was redistributed. The buyer in our example would thus be making a net payment of $200 because of the tax, but his total outlay would have been $400 lower if he’d bought the smaller vehicle instead.

Although revenue neutrality would help, buyers who really need large vehicles might feel aggrieved. Paradoxically, the key to mollifying them is to propose Pigovian taxes not just on vehicle weight but also on a swath of other activities that cause undue harm to others. We could tax drivers contributing to traffic congestion, for example, on the grounds that entering a crowded roadway causes delays to others. We could tax noise, carbon emissions and other specific forms of air and water pollution. Although some people would end up as losers under any single one of these measures, virtually everyone would come out ahead under a broad suite of Pigovian taxes.

That’s because adopting a large number of them is like repeated flips of a coin whose odds are stacked heavily in your favor. If someone offered a chance to flip a coin that paid $10 for heads and lost $1 for tails, would you take it? It’s an attractive gamble, obviously, but if there is only a single flip, there’s a 50 percent chance that you’ll be a loser. After many flips, however, you’d almost certainly be a net winner.

Likewise, any single Pigovian tax is an attractive gamble for the average taxpayer, who would get a rebate equal to the amount she’d paid in tax and would benefit from the resulting reduction in harm. Under a collection of such taxes, the odds of being a net winner go up sharply. Only the minuscule minority who cause much more than average amounts of harm in almost every category might end up paying more total tax than before. And even those few would still be net winners, because of the corresponding reductions in harm.

A BROAD slate of Pigovian taxes would thus meet the challenge of how to divide the larger pie so everyone comes out ahead. And because the prospect of a continued divided government makes short-run legislative progress unlikely on other fronts, why not pick this low-hanging fruit right now?

The case for Pigovian taxes isn’t easily reduced to bumper-sticker slogans. Still, the basic ideas are not complicated, and President Obama has the biggest megaphone on the planet. It should be easy for him to persuade rational voters to embrace policies that would make virtually everyone better off.

But he must also persuade House Republicans. Getting their votes will be the real test of his celebrated rhetorical skills.

Robert H. Frank is an economics professor at the Johnson Graduate School of Management at Cornell University.

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McChrystal Book Details Tensions With Obama

WASHINGTON — In a memoir, Gen. Stanley A. McChrystal, the former American commander in Afghanistan, writes that tensions between the White House and the Pentagon were evident in the Obama administration from its opening months in office.

The beginning of President Obama’s first term “saw the emergence of an unfortunate deficit of trust between the White House and the Department of Defense, largely arising from the decision-making process on Afghanistan,” General McChrystal writes. “The effects were costly.”

The book by General McChrystal, who was fired from his post in 2010 after an article in Rolling Stone quoted him and his staff making dismissive comments about the White House, is likely to disappoint readers who are looking for a vivid blow-by-blow account of infighting within the administration.

The book, titled “My Share of the Task: A Memoir,” does not provide an account of the White House meeting at which Mr. Obama accepted the general’s resignation. General McChrystal’s tone toward Mr. Obama is respectful, and he notes that his wife, Annie, joined the crowd at Mr. Obama’s inauguration. The book is to be released on Monday.

An advance copy of the book provides revealing glimpses of the friction over military planning and comes as Mr. Obama is weighing, and perhaps preparing to overrule, the troop requests that have been presented by the current American commander in Afghanistan, Gen. John R. Allen.

The account is all the more noteworthy since General McChrystal, who retired from the Army, remains a respected voice within the military and teaches a course on leadership at Yale.

According to the book, the tensions began before General McChrystal took command in Kabul, Afghanistan, and were set off by a request from his predecessor, General David D. McKiernan, for 30,000 additional troops at the end of the Bush administration.

Instead of approving the entire request, in February 2009, Mr. Obama decided that 17,000 would be sent, adding that decisions on additional deployments would be based on further analysis.

From the White House perspective, General McChrystal writes, “this partial decision was logical.” After less than a month, the president had increased American forces in Afghanistan by 50 percent. Though Mr. Obama had cast the conflict in Afghanistan as a “war of necessity,” as a candidate he was nonetheless wary about a prolonged American military involvement there.

But the Pentagon pressed for an additional 4,000 troops, fearing that there was little time to reverse the Taliban’s gains before the August elections in Afghanistan.

“The military felt a sense of urgency, seeing little remaining time if any forces approved were to reach Afghanistan in time to improve security in advance of the elections,” he wrote.

The White House later approved the 4,000 troops, but the dispute pointed to a deeper clash of cultures over the use of force that continued after General McChrystal took command.

“Military leaders, many of whom were students of counterinsurgency, recognized the dangers of an incremental escalation, and the historical lesson that ‘trailing’ an insurgency typically condemned counterinsurgents to failure,” he writes.

In May 2009, soon before he assumed command in Kabul, General McChrystal had a “short, but cordial” meeting with Mr. Obama at which the president “offered no specific guidance,” he notes.

The next month, General McChrystal was surprised when James L. Jones, Mr. Obama’s first national security adviser, told him that the Obama administration would not consider sending more forces until the effect of arriving units could be fully evaluated.

That contradicted the guidance that General McChrystal had received from Defense Secretary Robert M. Gates that he should submit an assessment in August of the additional forces that might be required, he writes.

At an Oct. 8, 2009, video conference with Mr. Obama’s National Security Council, differences again emerged when General McChrystal outlined his goals: “Defeat the Taliban. Secure the population.”

That prompted a challenge by a Washington-based official, whom General McChrystal does not name, that the goal of defeating the Taliban seemed too ambitious and that the command in Kabul should settle instead for an effort to “degrade” the Taliban.

At the next video conference, General McChrystal presented a slide showing that his objectives had been derived from Mr. Obama’s own speeches and a White House strategy review. “But it was clear to me that the mission itself was now on the table for review and adjustment,” he wrote.

After General McChrystal determined that at least 40,000 additional forces were needed to reverse the deteriorating situation in Afghanistan, Mr. Obama provided 30,000 and said he would ask allied nations to contribute the rest.

General McChrystal acknowledges that he had concerns that Mr. Obama’s decision to announce a date for beginning the withdrawal of the additional “surge” forces might embolden the Taliban. But the general writes that he did not challenge the decision.

“If I felt like the decision to set a withdrawal date would have been fatal to the success of our mission, I’d have said so,” he writes.

General McChrystal has little to say about the episode that led to the article in Rolling Stone. He writes that the comments attributed to his team were “unacceptable” but adds that he was surprised by the tone of the article, which he had expected would show the camaraderie among the American, British, French and Afghan officers.

As the controversy over the article grew, General McChrystal did not seek advice before offering his resignation. The book does not say if he was disappointed when Mr. Obama accepted it at a brief White House meeting.

Returning to his quarters at Fort McNair after that White House meeting, he broke the news to his wife: “I told her that our life in the Army was over.”

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App City: Taking Stock of Mobile Apps

Testing apps from week to week, it’s easy to fill my phone with a seemingly endless number of theoretically helpful programs. But how many of them do I actually use? To start off 2013, I decided to take stock of my apps, with a focus on those that relate to my life as a New Yorker. Here are my favorites, many — but not all — of which I reviewed for App City. — JOSHUA BRUSTEIN

Christoph Hitz

Embark NYC

Free for iOS and Android

For directions, the default is Google Maps. But Embark, which helps you chart a trip on the New York City subway, is the other transportation app I use regularly, largely because it can generate directions without a data connection. After all, plans can change while you are underground. Offline, you can get only directions between stations, not for street addresses, but it’s a start.

Instapaper

$3.99 for iOS; $2.99 for Android

Instapaper is not new, but the idea of setting aside articles that I see online so that I can read them when I get stuck on the subway never gets old.

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Seamless

Free for iOS and Android

This tool for placing orders for delivery or takeout food through a smartphone app has drastically increased the likelihood that I will order in on any given day. I do not know if this is a good thing, but it is certainly a testament to its effectiveness.

Christoph Hitz

Immaculate Infatuation

Free for iOS

Apps for finding restaurants are plentiful, but most of them leave me feeling overwhelmed. I want someone to choose for me, and I trust the authors of this app to do that. Their taste has never led me astray — although unlike them, I have no problem with the immense popularity of brussels sprouts.

Christoph Hitz

Taskrabbit

Free for iOS

One of the neatest things to come from the current generation of tech companies are informal communities where strangers do things for one another, like share a ride or a spare room. Taskrabbit allows people to hire one another for odd jobs. These jobs can be pretty much anything, but for tasks like taking in clothing for donation, I would much rather give $20 to a neighbor with a car than figure it out myself. Getting tasks done may be easy, but becoming someone who does the tasks isn’t: there are 1,500 people on the waiting list in New York City.

Songkick

Free for iOS and Android

It analyzes the music you listen to and tells you when bands you may like are playing nearby. It has successfully kept me away from Seamless on a number of nights. But being constantly reminded of great shows has the potential to be somewhat expensive.

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Nike+ Fuelband

Wristband $149, app free for iOS and Android

This setup serves as a pedometer for the digital age, keeping track of your physical activity 24 hours a day. The app’s graphical representations of miles walked and calories burned are addictive. While the Fuelband does not do a good job of measuring exercise in a gym, it is a great way to keep a tally of all the walking you do. And if I’m going to spend my life wandering around the city, I might as well get credit for it.

Christoph Hitz

Craft Beer New York

$1.99 for iOS

This app is great when deciding which bars to visit. Of course, it works only for beer drinkers; good bars without good beer selections do not make the cut. There is a nice coffee app designed by the same team, and I use it in essentially the same way, although a bit earlier in the day.

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The New Old Age: Murray Span, 1922-2012

One consequence of our elders’ extended lifespans is that we half expect them to keep chugging along forever. My father, a busy yoga practitioner and blackjack player, celebrated his 90th birthday in September in reasonably good health.

So when I had the sad task of letting people know that Murray Span died on Dec. 8, after just a few days’ illness, the primary response was disbelief. “No! I just talked to him Tuesday! He was fine!”

And he was. We’d gone out for lunch on Saturday, our usual routine, and he demolished a whole stack of blueberry pancakes.

But on Wednesday, he called to say he had bad abdominal pain and had hardly slept. The nurses at his facility were on the case; his geriatrician prescribed a clear liquid diet.

Like many in his generation, my dad tended towards stoicism. When he said, the following morning, “the pain is terrible,” that meant agony. I drove over.

His doctor shared our preference for conservative treatment. For patients at advanced ages, hospitals and emergency rooms can become perilous places. My dad had come through a July heart attack in good shape, but he had also signed a do-not-resuscitate order. He saw evidence all around him that eventually the body fails and life can become a torturous series of health crises and hospitalizations from which one never truly rebounds.

So over the next two days we tried to relieve his pain at home. He had abdominal x-rays that showed some kind of obstruction. He tried laxatives and enemas and Tylenol, to no effect. He couldn’t sleep.

On Friday, we agreed to go to the emergency room for a CT scan. Maybe, I thought, there’s a simple fix, even for a 90-year-old with diabetes and heart disease. But I carried his advance directives in my bag, because you never know.

When it is someone else’s narrative, it’s easier to see where things go off the rails, where a loving family authorizes procedures whose risks outweigh their benefits.

But when it’s your father groaning on the gurney, the conveyor belt of contemporary medicine can sweep you along, one incremental decision at a time.

All I wanted was for him to stop hurting, so it seemed reasonable to permit an IV for hydration and pain relief and a thin oxygen tube tucked beneath his nose.

Then, after Dad drank the first of two big containers of contrast liquid needed for his scan, his breathing grew phlegmy and labored. His geriatrician arrived and urged the insertion of a nasogastric tube to suck out all the liquid Dad had just downed.

His blood oxygen levels dropped, so there were soon two doctors and two nurses suctioning his throat until he gagged and fastening an oxygen mask over his nose and mouth.

At one point, I looked at my poor father, still in pain despite all the apparatus, and thought, “This is what suffering looks like.” I despaired, convinced I had failed in my most basic responsibility.

“I’m just so tired,” Dad told me, more than once. “There are too many things going wrong.”

Let me abridge this long story. The scan showed evidence of a perforation of some sort, among other abnormalities. A chest X-ray indicated pneumonia in both lungs. I spoke with Dad’s doctor, with the E.R. doc, with a friend who is a prominent geriatrician.

These are always profound decisions, and I’m sure that, given the number of unknowns, other people might have made other choices. Fortunately, I didn’t have to decide; I could ask my still-lucid father.

I leaned close to his good ear, the one with the hearing aid, and told him about the pneumonia, about the second CT scan the radiologist wanted, about antibiotics. “Or, we can stop all this and go home and call hospice,” I said.

He had seen my daughter earlier that day (and asked her about the hockey strike), and my sister and her son were en route. The important hands had been clasped, or soon would be.

He knew what hospice meant; its nurses and aides helped us care for my mother as she died. “Call hospice,” he said. We tiffed a bit about whether to have hospice care in his apartment or mine. I told his doctors we wanted comfort care only.

As in a film run backwards, the tubes came out, the oxygen mask came off. Then we settled in for a night in a hospital room while I called hospices — and a handyman to move the furniture out of my dining room, so I could install his hospital bed there.

In between, I assured my father that I was there, that we were taking care of him, that he didn’t have to worry. For the first few hours after the morphine began, finally seeming to ease his pain, he could respond, “OK.” Then, he couldn’t.

The next morning, as I awaited the hospital case manager to arrange the hospice transfer, my father stopped breathing.

We held his funeral at the South Jersey synagogue where he’d had his belated bar mitzvah at age 88, and buried him next to my mother in a small Jewish cemetery in the countryside. I’d written a fair amount about him here, so I thought readers might want to know.

We weren’t ready, if anyone ever really is, but in our sorrow, my sister and I recite this mantra: 90 good years, four bad days. That’s a ratio any of us might choose.

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Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

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