January 21, 2017
Yesterday an international joke was inaugurated as the president of a super power, our country, the United States of America. The country that boasts of freedom is barreling down a highway of restriction, rigidity and governmental control. The political party that preaches soundbites of small government has an agenda filled with denial of personal freedom and implementation of social control. Its only allowances for relief slated for the already wealthy and powerful.
Today, we marched.
Actually, I did not march. But so many of you did and you brought tears to my eyes. I saw friends join millions, here in Minnesota, in DC, LA, Jackson (Mississippi), St. Louis, Oakland (California), Austin (Texas), New York City and Atlanta.
With great conflict I went to my daughter’s basketball game instead. It is not like I never miss my kids’ events. Actually, I do so quite often. Part of me wanted to march, and drag my other two children along so they could experience that historic event first hand. Part of me wanted to just be on the sideline watching my daughter compete in the sport she loves.
I felt guilty not going to the march. I felt sad to miss out on the experience. Had I gone, I would have felt the same about my daughter’s game.
And that’s how, I think, we women miss out on a lot. We second guess our choices. We let guilt stand in the forefront of our thinking. Both choices had value. A “right” choice is not always clear, and does not always need to be defined.
But as is often the case, my daughter taught me today.
Her team trailed behind the opposing team for most of the game, finally tying it in the last two minutes, and pulling ahead in the last 30 seconds to win the game. Effort, errors, effort. Twisting. Committing fouls. Getting fouled on. Tripping. Colliding. Missed shots, and surprising steals.
27-25. That doesn’t even begin to quantify the complexity of effort, practice and heart, from all the girls on that court.
I saw my daughter get a free throw opportunity, then miss both shots. The first miss gave way to a sign I know so well. Shoulders collapsed, game face disintegrated… self-recrimination. A flood of teammates surrounded her for a second, reminding her to stay in the game, just take the next shot.
This is how we feel when we are dejected. And this is what we need. Stay in the game. Get up and try again. And I know after years of watching my kids play sports, this is an education on how to fight the good fight. This is one way the skills of fortitude and determination are built.
But what do we do tomorrow?
We work. Marching is only the beginning.
Today the focus was not just about women’s rights, but about inclusion, well-being, freedom and, above all, love. LOVE, not hate. To make sure these values rise to the top, we have to work. We have to speak up.
Not long before the presidential election, I saw Billy Bragg and Joe Henry perform here in Minneapolis. Billy said, and it has stayed with me since:
“The enemy of cynicism is empathy. And the antidote to cynicism is activism.”
And in that spirit, I believe great leaps forward still lie ahead. But we have to make them happen.
January 14, 2017
I’m worried. I am fearful.
I am worried about women losing more control of their lives by losing control of their own reproductive and healthcare options. I am worried we are following the choices of Texas, with systemic STD issues and high childbirth mortality rates. Planned Parenthood is a Public Health Service. Texas is what happens when you remove such quality, inexpensive women’s (and men’s) healthcare and sex education.
I am worried we are going to spend money we can’t afford dismantling the ACA, temporarily or permanently removing coverage, or sufficiency of coverage, for many. I worry about such an effort’s impact on any number of public health initiatives able to launch and incubate under this law. Many such programs within the Medicaid population are making strides to reduce expensive healthcare services by increasing access to preventive care and educating patients and families on how to navigate the healthcare system. These programs also collect valuable data as to ways to reduce cost and illness escalation. And they are just getting started.
I am worried we have hundreds of thousands of people laying waste in prisons that don’t belong there. These lives are wasted at great social cost to communities, and great financial cost to tax payers. Many of those locked away and disregarded will one day rejoin society, with little to no support in their reentry, or in making sense of their incarceration experiences.
We expect them to shake off that traumatic environment, be industrious, find jobs and pay taxes. But too many policies make employment unlikely. If they overcome all the obstacles, find a legitimate job and pay taxes, they are still not restored their right to vote. In many states, felons are permanently ineligible to have a voice in the government which they help fund.
I am disturbed that the trend of climate denial is an excuse to make bad energy policy choices that would be better for us all, even if climate change wasn’t real. (Though it is, of course, real.) Hmmmm. Why is that?
Oil and money. That’s why.
Renewable energy would reduce foreign oil dependence, domestic oil harvesting, and wasteful byproducts which do far more than contribute to greenhouse gases. Why on earth wouldn’t we want to move to those more renewable sources?!? I was raised by parents who survived the Great Depression and WWII, and a mother who washes and reuses her tin foil. Why are we, and so many of our leaders, so determined to be wasteful?
I am worried that two months later, I am at a loss as to how to respond to this comment from someone I know to be kind and well-meaning. But this reads as someone who cannot differentiate between an experienced political candidate and a mentally ill narcissit.
I want to have and encourage dialogue with people of opposing viewpoints. But the normalizing language here is deeply disturbing. Trump had no candidacy record before. He had a strong record of lifetime wealth, unethical business dealings, predatory behavior in professional and personal life, shameless attention seeking and belittling of others.
“Liberal agenda.” Which of the statistically validated issues I’ve listed above are so unpalatable?
Trust in God? There’s a great joke about this. It has a boat and a helicopter and pragmatism, a parable about using the resources you’ve been given.
I don’t believe in deities. But no religion I’ve seen paints a greedy, defensive, reactionary, prideful man as a vessel for holy work. I am horrified that so many people of faith believe he is the answer.
But I am still hopeful.
I saw Hidden Figures with my kids tonight. A new story to me, and one of many reminders that we overcame some of our stupidity back then. We can open our eyes and see our different (and same) stupidities now. There will always be some, even many, who refuse to seen it. We need work and humility and diligence to keep that moral arc bending in the right direction.
Recently I read The Road to Character, and now am reading The Social Animal, both by David Brooks. His bias sometimes makes my skin itch, and reading his books pushes my argumentative buttons.
A conservative-leaning thinker, he has an insatiable curiosity toward human nature, and love for humanity, community and individual well being. He is not afraid to dig deep into personal stories and character studies, and lay them out for us to better understand each other. He is not afraid to dissect the role we as a community play in the well being of each other. We cannot have enough voices like this.
I have hope in the contributions of writers and story tellers and journalists and lawyers and volunteers and healthcare workers and public servants and citizens and the power to change hearts and minds. I have hope that however misguided we are, however ridiculous the lies we swallow, we slowly, stubbornly, begrudgingly learn to be more decent to each other than not.
November 6, 2016
I’m saddened by this election and who we have become. Regardless of its outcome, a large percentage of this country is willing to elect a candidate running on fear, divisiveness and hate. And his message is selling better in the Christian community than anywhere.
I know there is a huge volume of Christians who not only oppose Trump, but are vocal in their expression of his failure to align with Christian faith. But there are still many who do not see that disconnect, or don’t believe it to be relevant.
I asked friends of Christian faith to share the verses of the Bible that most bring them comfort. As an atheist without emotional connection to that text, I had to ask others to gain that perspective. I have listed them below, in the order they came to me. I don’t necessarily know the political leanings of those who shared them.
If somehow you are reading this and are considering casting your vote for Trump, I ask this. How do these words of comfort align with the leader you may elect? If the ones that promise God will take care of everything bring you the most comfort, remember there are many more verses that give specific direction to your own choices. There is a time for everything, yes, but never a good time for arrogance or cruelty. “But the fruit of the Spirit is love, joy, peace, forbearance, kindness, goodness, faithfulness…”
I listed one passage at the bottom below that wasn’t shared, but stumbled upon when I accidentally typed in the wrong chapter number. I don’t believe in divine intervention, but many of you do, and it seemed relevant.
Lastly, if you need a glimpse into a man who runs on a platform of racism and fear, capitalizing on the attention of the poor and uneducated, look here and here. This man, who successfully ran on such ideas, was short lived in his political success. Later, no longer a politician but a community leader, he helped organize the false imprisonment of blacks into forced labor to manage the crisis of the 1927 flood. That choice created abuse, enormous suffering, and even murder. As his great granddaughter, I can’t help but see the similarities. I benefit from the wisdom of a father who fought in WWII and was shown the detriment of such ideas. Please don’t dismiss the collateral damage of electing a man who would campaign as Trump has, and all the reasons we have to know better.
The Lord is my shepherd, I lack nothing.
2 He makes me lie down in green pastures,
he leads me beside quiet waters,
3 he refreshes my soul.
He guides me along the right paths
for his name’s sake.
4 Even though I walk
through the darkest valley,
I will fear no evil,
for you are with me;
your rod and your staff,
they comfort me.
5 You prepare a table before me
in the presence of my enemies.
You anoint my head with oil;
my cup overflows.
6 Surely your goodness and love will follow me
all the days of my life,
and I will dwell in the house of the Lord
13 I can do all this through him who gives me strength.
16 For God so loved the world that he gave his one and only Son, that whoever believes in him shall not perish but have eternal life.
I Peter 5:7
7 Cast all your anxiety on him because he cares for you.
22 But the fruit of the Spirit is love, joy, peace, forbearance, kindness, goodness, faithfulness,
1 The Lord is my light and my salvation—
whom shall I fear?
The Lord is the stronghold of my life—
of whom shall I be afraid?
16 See, I have engraved you on the palms of my hands;
your walls are ever before me.
5 Trust in the Lord with all your heart
and lean not on your own understanding;
6 in all your ways submit to him,
and he will make your paths straight.
9 Have I not commanded you? Be strong and courageous. Do not be afraid; do not be discouraged, for the Lord your God will be with you wherever you go.”
7 And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus.
10 He says, “Be still, and know that I am God;
I will be exalted among the nations,
I will be exalted in the earth.”
There is a time for everything,
and a season for every activity under the heavens:
2 a time to be born and a time to die,
a time to plant and a time to uproot,
3 a time to kill and a time to heal,
a time to tear down and a time to build,
4 a time to weep and a time to laugh,
a time to mourn and a time to dance,
5 a time to scatter stones and a time to gather them,
a time to embrace and a time to refrain from embracing,
6 a time to search and a time to give up,
a time to keep and a time to throw away,
7 a time to tear and a time to mend,
a time to be silent and a time to speak,
8 a time to love and a time to hate,
a time for war and a time for peace.
9 What do workers gain from their toil? 10 I have seen the burden God has laid on the human race. 11 He has made everything beautiful in its time. He has also set eternity in the human heart; yet no one can fathom what God has done from beginning to end. 12 I know that there is nothing better for people than to be happy and to do good while they live. 13 That each of them may eat and drink, and find satisfaction in all their toil—this is the gift of God. 14 I know that everything God does will endure forever; nothing can be added to it and nothing taken from it. God does it so that people will fear him.
15 Whatever is has already been,
and what will be has been before;
and God will call the past to account.
16 And I saw something else under the sun:
In the place of judgment—wickedness was there,
in the place of justice—wickedness was there.
17 I said to myself,
“God will bring into judgment
both the righteous and the wicked,
for there will be a time for every activity,
a time to judge every deed.”
18 I also said to myself, “As for humans, God tests them so that they may see that they are like the animals. 19 Surely the fate of human beings is like that of the animals; the same fate awaits them both: As one dies, so dies the other. All have the same breath[c]; humans have no advantage over animals. Everything is meaningless. 20 All go to the same place; all come from dust, and to dust all return. 21 Who knows if the human spirit rises upward and if the spirit of the animal goes down into the earth?”
22 So I saw that there is nothing better for a person than to enjoy their work, because that is their lot. For who can bring them to see what will happen after them?
5 If any of you lacks wisdom, you should ask God, who gives generously to all without finding fault, and it will be given to you.
19 My dear brothers and sisters, take note of this: Everyone should be quick to listen, slow to speak and slow to become angry,
17 For the law was given through Moses; grace and truth came through Jesus Christ.
Now listen, you rich people, weep and wail because of the misery that is coming on you. 2 Your wealth has rotted, and moths have eaten your clothes. 3 Your gold and silver are corroded. Their corrosion will testify against you and eat your flesh like fire. You have hoarded wealth in the last days. 4 Look! The wages you failed to pay the workers who mowed your fields are crying out against you. The cries of the harvesters have reached the ears of the Lord Almighty. 5 You have lived on earth in luxury and self-indulgence. You have fattened yourselves in the day of slaughter. 6 You have condemned and murdered the innocent one, who was not opposing you.
September 20, 2015
We have become so comfortable with this term. We hate on stuff for sport. It is the label we slap on judgment, disregard and general scoffing to make it socially acceptable. It is such common practice, we pretend we celebrate something other than arrogance. We brand it in that acceptable package of “hatin’.” Then we continually spend our energy pulling more of it off the shelf.
Have you ever created something from your heart and put it out in the world to be loved, liked, hated, or worst of all, simply not heard? It is an inherently vulnerable endeavor.
I have a friend whom we’ll call Andy, because that’s his name. He is such an intelligent, thoughtful and big hearted person. Because I have so much regard for him and these qualities of his, I just can’t let this post, and his public disdain for Taylor Swift, go unchallenged.
The enemy of art is not Taylor Swift. It’s your arrogant snobbery.
Having almost no musical training myself, I can’t speak to the quality of Taylor Swift as an artist. Her PR savvy is impressive. Her track record of supporting and encouraging lesser known artists is well-documented.
Her message is consistently positive. Not sugary sweet positive. Real life positive. She coaches her gazillion young fans that they don’t have to be perfect and they should be kind to themselves. It is a good message, and few people convey that in a way that sticks in the psyches of children. She will be the Free to Be You and Me for this young generation.
Art elevates humanity, not just technique.
But even if that wasn’t the case, I often wonder why Taylor Swift draws such ire in a way that Train, Maroon 5 and any number of other financially successful artists do not. Is it because she is so young? Is it because her wealth is so enormous? Is it because she is a woman? We wouldn’t debate her legitimacy if she wasn’t raking in the big bucks. But there are plenty of artists in her league that do not garner such negative commentary.
Who are we to say she doesn’t take risks? And what do we know about the risks on her journey here? Who are we to judge the legitimacy of her art? Or anyone else’s?
Even if the judgment is spot on, when we sit around opining about who is legitimate and who is not, we foster a culture of critique, not creation. Our kids hear us. Timid artists of all ages hear us. We learn at a young age that we are not cool enough, special enough. We learn to debase creative production through the most bullshit lens there is: coolness.
We frame our critique as prizing authenticity, but we only build a bigger fraud complex in our collective psyche. We applaud ourselves for setting high standards, but only fuel self-doubt. By judging so harshly the art we don’t like, we elevate nothing but egos. We embrace the armchair critic, rather than encourage the man in the arena.
If you want our future artists to elevate genius, let them create without your judgment. The world will give them plenty of that. Teach them to practice what they love. Teach them to respect technique. Teach them to experiment. Teach them to resist giving a damn about the opinions of others – even yours.
You want to see genius succeed and get recognized? Go find the artists that speak to you, and shine your spotlight on them. Share their talent with others. Buy their music, support the proliferation of that which you claim to love. There are thousands of talented people schlepping their instruments and their souls from town to town just trying to make ends meet doing what they love. Go find them.
“Art resides in the quality of doing; process is not magic.” – Charles Eames
Be a lover, not a hater.
June 27, 2015
In a short time a sweeping change has taken place in the Deep South. Sentiment for removing the Confederate flag as a present day representation has never been so strong. But detractors remain. The ones I know personally are also people I have known to be deeply compassionate and kind. This is my letter to them.
When one flies this image, what does it celebrate? The only defense I hear is that it does not represent racism. But what meaningful value worthy of our pride does it symbolize? I’ve asked and gotten no response. How can we cling to a symbol by shouting only what we claim it ISN’T?
It’s time to let it go.
I am thankful to be from the Deep South. Living in the Midwest for 14 years has only strengthened my understanding of my heritage. There are beautiful parts of Southern culture few people see because the negative are so awful and well documented.
How do people know I’m from the South? My ass carries the legacy of vegetables laced with bacon fat. When I holler at my kids in public, my southern accent immediately kicks in. I tell stories.
Where I come from, we hold out our hand to a wounded sister. We hand her a linen handkerchief to dab her tears, and pour her a sweet tea with fresh mint. Or bourbon. We sit with each other and bear witness. We share our crazy ass stories to normalize our experiences and assure each other we are not alone.
These are the things I think of when I consider my heritage. We commune over good food and drink and music and stories and our humanity. We know our history. We have seen messy change and ugly resistance up close. We are proud of how far we have come, and saddened by resistance that remains.
Where I come from, we do not flaunt our privilege in the face of suffering. We do not act entitled to our good fortune. To do so is to commit the sin of gettin’ above your raisin’. It is just bad manners. Such arrogant behavior is a social felony and carries the sentence of exclusion from gatherings where good food and drink are served.
I would have thought the racist connotation of this image was indisputable. Yet you can find an argument for or against anything on the internet, dressed up with pretty graphics and feel good sayings.
But ultimately the long history of this image doesn’t matter. Just like the words in our vocabulary gain meaning from how they are used, so this flag has come to represent white supremacy. Whatever positive and legitimate association you maintain for this image, there are too many radically hateful people who fly it with their cruelty.
You will not reform it. You cannot make it mean something else. Let it go.
My education began in the late 1970s in the post-integration Jackson, Mississippi public school system on the heels of the Civil Rights Movement. African Americans of my generation in Mississippi likely knew terror from racism first hand, or at least through their parents and extended family. Imagine looking at this image with that deeply painful context of personal grief and anxiety. Imagine fearing for your personal and economic safety because there were people in your community who believed they had the right to harm or even kill you just because of the color of your skin.
Offense at this image is not a personal attack on you. Whatever meaning you grasp when you hold on to this flag pales in comparison to that kind of pain. To be a Southerner is to have a moral obligation to reach out to each other in kindness and acknowledge that painful past. Where I come from, we hold out our hand to those in pain. We can’t do that if our hands are busy clutching this image.
Let it go.
Relinquish it to the history books and let those folks sort out what it does and did, doesn’t and didn’t mean.
A flag is a symbol of our identity, what we treasure and what we celebrate. It is time to craft new images that reflect who we are today, and who we hope to become. It is time to find symbols of which we can be indisputably proud.
Let go of defending this symbol. You do not have to fear relinquishing your heritage. You only need to honor the good parts of it in the way you live your life and how you treat others. Show that the good in your history is not as fragile as a flag. Show that you have the capacity to imagine another’s suffering that you have not experienced. Show that you are capable of caring about that hurt, and willing to help heal it.
April 19, 2015
Several years ago a fleeting question entered my mind as I wrote a check to the American Cancer Society for a neighborhood block campaign. Most of my donations until that moment were reactionary – an unwillingness to say no when asked, and the fact that cancer research is important.
If I took an intentional approach to donation, rather than wait to be asked, where would I choose to give my money?
I immediately thought of the The Algebra Project in my hometown of Jackson, Mississippi. Its founder, Robert Moses, was an activist in Jackson during the Civil Rights movement. Harvard educated, he returned many years later as a teacher committed to closing the economic mobility gap that remained. This program focuses on improving high school achievement in advanced mathematics in low income communities, putting its students on a more successful path to college and / or higher paying technical careers. The program has been so successful its model is being implemented in several other communities.
Years later, I learned about Baby’s Space here in Minneapolis, an early childhood intervention program which runs high quality daycare and charter schools. Baby’s Space is neighborhood based and largely neighborhood staffed. Their primary focus is on social emotional health of children and families exposed to poverty and violence. Its design engages the family and the community to recognize how community behavior effects a child’s development. Its founder, Terri Rose, believes that change comes when the community learns to see their behavior from the “baby’s point-of-view.”
I slowly grew into that initial fleeting thought, and over the years have focused what donations I make to non-profits like these, aimed at relieving poverty and inequality. I don’t give enough, and I don’t do enough, but continue to move in this direction.
A few months ago, I heard a speech by Bryan Stevenson he had given in town the day before. Stevenson founded and runs the Equal Justice Initiative, devoting his career as a lawyer to fighting the failures of our justice system and its disproportionate impact on those of color and in poverty.
His focus is on the death penalty, wrongful convictions, inappropriate sentencing, and adjudication of children as adults. His focus is also on compassion, reconciliation and hope. At the time I made a note to get his book, Just Mercy, and finally finished it a few days ago.
He shows how comfortable we have become with the failures of our justice system. Often it traps those who are either innocent or able to be rehabilitated. But instead of helping to salvage these lives, we spend a great deal of money to lock them away and forget about them. Too often we put the victim in the cell with the criminal. Too often we release inmates back into the world in far worse emotional and economic shape than when they left it.
But why do I choose these causes over cancer research?
For fiscal year ended in August 2010, the American Cancer Society received over $300 million in donations. This is just one example, and doesn’t include the Komen Foundation (net public support in 2013 also over $300 million) and other organizations focused on specific types of cancer.
When a new therapy is successful, there are for-profit businesses for which its success is lucrative. Despite the issues we have in healthcare funding, these businesses are profitable because the market is filled with reliable payers. Financial incentives to cure and manage disease are common.
But poverty and inequality don’t entice entrepreneurship in this manner. The most privately lucrative endeavor which draws investment dollars is our prison system. Not only is it not working, in many cases it is the source of our greatest injustices. Non-profits like the ones I have listed do not have a return for profit seeking investors. And yet these non-profits have the potential to change lives, and reduce many of the costs to society related to poverty.
Behavioral economists have long recognized that we pull out our wallets when we connect personally with a tale of suffering.
Do you know anyone personally who has been deeply impacted by poverty? Do you know anyone personally whose life has been formed around his experience of violence? Do you know someone who has spent years of her life in prison? We all know someone effected by cancer. But poverty and violence and imprisonment are far more centered around class and race.
We are insulated from this suffering by virtue of class. We readily talk about the cyclical nature of poverty, but rarely acknowledge the cyclical nature of success. If our good fortune was only a function of hard work, the line between classes would be far more fluid.
So we have to choose to see these issues. We have to choose to hear the stories of people suffering in this way. We have to believe these efforts are worth our resources.
Poverty and inequality are cancerous to the human spirit. So is our disregard for our fellow human beings. If you do nothing else different, I hope you will take a moment to listen to Bryan Stevenson’s talk. Because he’s right. We are not talking about injustice enough, and we need to be.
February 8, 2015
Why do so many people deny science? This is the question of the hour.
I became a mother in early 2004, when murmurings of vaccines and autism were getting loud, but before they were definitively refuted. My father survived a long bout with polio in the 1950s, and I grew up on tales of its brutality and longevity. My personal history easily leads me to favor vaccination.
About a year ago a friend of mine took her child in for a check-up. She was wary of the messages going around and simply asked the pediatrician for more information before the shots were administered. She received a lecture and was derided like a naughty kindergartner for asking the question.
She wanted information and reassurance. New parents, by the way, need a lot of that. And for the dumbest reasons you could imagine because we are exhausted, sleep deprived, and overwhelmed.
I have no sympathy for the likes of celebrities who abuse their vast access to uneducated masses by spreading ideas they are not qualified to present, especially when they profit from doing so. But I am concerned over new parents not having a safe place to voice their fears and talk through them (no matter how stupid they may seem today).
In the vitriol spewing from either side, are new or uncertain parents going to get the support they need? The bedrock of critical thinking is inquisitiveness, an inherently imperfect practice. The only stupid question really is the one not asked.
Whenever we as a society gather a group together, string them up, and label them the enemy, I can’t help but be suspicious. Are we sure the criminals are so different from us? Are we missing important parts of the picture by laying the blame so squarely at the feet of one group?
We want to identify the enemy and annihilate her. But denial of science is a more vast landscape than today’s dialogue frames. While those who refuse to vaccinate are extreme, their failure to recognize flawed thinking and its consequences are far from unique. As we vilify science deniers in the media, our list of criminals may be too narrow.
Consider the slow beginnings of anesthesia, first used in human medical operation in 1846. Methods had been tested with that goal in mind for more than 300 years, and the general chemicals and protocol used in that first surgery had been around for over 40 years. The medical community resisted for so long this practice we now consider indispensable.
“…anesthesia itself was hardly new in the 19th century, but that a moral objection prevented its use. Why? Because pain was considered an integral and necessary part of life, and the removal of pain was the work of either a charlatan or a Satan…”
Could you imagine such an innovative technique sitting on the shelf unused for four decades? Fortunately we know the benefits of reducing patient suffering. We even sedate or anesthetize for routine invasions whether the discomfort is pain or just anxiety.
But there have been holdouts to this line of thinking among some caregivers. It is well documented that Mother Theresa withheld pain medication from suffering patients because she believed pain was God’s Will. And what did we do? We set her on the path to sainthood. Her name is synonymous with selflessness, and the pedestal we have her on is high.
Only a year after that first anesthetized medical procedure a clinician succeeded in proving how vital hand washing is to the quality of patient care during child delivery. But the overwhelming evidence had a rocky path to the light of day. (See On Washing Hands, by Atul Gawande.)
“…the Viennese obstetrician Ignac Semmelweis famously deduced that, by not washing their hands consistently or well enough, doctors were themselves to blame for childbed fever. Childbed fever, also known as puerperal fever, was the leading cause of maternal death in childbirth in the era before antibiotics (and before the recognition that germs are the agents of infectious disease). It is a bacterial infection — most commonly caused by Streptococcus, the same bacteria that causes strep throat — that ascends through the vagina to the uterus after childbirth. Out of three thousand mothers who delivered babies at the hospital where Semmelweis worked, six hundred or more died of the disease each year — a horrifying 20 percent maternal death rate. Of mothers delivering at home, only 1 percent died. Semmelweis concluded that doctors themselves were carrying the disease between patients, and he mandated that every doctor and nurse on his ward scrub with a nail brush and chlorine between patients. The puerperal death rate immediately fell to 1 percent — incontrovertible proof, it would seem, that he was right. Yet elsewhere, doctors’ practices did not change. Some colleagues were even offended by his claims; it was impossible to them that doctors could be killing their patients. Far from being hailed, Semmelweis was ultimately dismissed from his job.
Semmelweis’s story has come down to us as Exhibit A in the case for the obstinacy and blindness of physicians. But the story was more complicated. The trouble was partly that nineteenth-century physicians faced multiple, seemingly equally powerful explanations for puerperal fever. There was, for example, a strong belief that miasmas of the air in hospitals were the cause. And Semmelweis strangely refused to either publish an explanation of the logic behind his theory or prove it with a convincing experiment in animals. Instead, he took the calls for proof as a personal insult and attacked his detractors viciously.”
But despite all that ego and personal dysfunction, the lesson was learned. Handwashing is a cornerstone of surgical practice.
“But such enthusiastic devotion to hand hygiene does not exist outside the operating room. And again and again in discussions about quality and safety and the terrible infections that can ensue, one issue continues to bedevil the patient-doctor relationship yet defies all reason: why don’t doctors wash their hands more?
Over the last 30 years, despite countless efforts at change, poor hand hygiene has continued to contribute to the high rates of infections acquired in hospitals, clinics and other health care settings. According to the World Health Organization, these infections affect as many as 1.7 million patients in the United States each year, racking up an annual cost of $6.5 billion and contributing to more than 90,000 deaths annually.”
Christopher Hitchens, the journalist who published the story about Mother Theresa I mention above, died of one of the illnesses we fear most. Cancer. Well, actually, he was battling cancer. But he died of pneumonia caused by a hospital infection, as his wife was quick to point out in several interviews. We spend billions of dollars fighting this disease, and still can’t comply with the simplest and least expensive strategy in favor of surviving it.
Science denial is a symptom of the worst part of our humanity – our incessant notion that our judgment is enough, our priorities are right, and we are not the problem. Our god complex. We then systematically scramble evidence to the contrary in our brains to give us a worldview palatable to our psyches. Then we point the finger at someone else.
When Gawande refers to his hospital and details its compliance statistics, he is referring to Brigham & Women’s in Boston, staffed by Harvard physicians and one of the finest hospitals in the world.
“With the (alcohol) gel finally in wide use, the compliance rates for proper hand hygiene improved substantially: from around 40 percent to 70 percent. But — and this is the troubling finding — hospital infection rates did not drop one iota. Our 70 percent compliance just wasn’t good enough. If 30 percent of the time people didn’t wash their hands, that still left plenty of opportunity to keep transmitting infections. Indeed, the rates of resistant Staphylococcus and Enterococcus infections continued to rise. Yokoe receives the daily tabulations. I checked with her one day not long ago, and sixty-three of our seven hundred hospital patients were colonized or infected with MRSA (the shorthand for methicillin-resistant Staphylococcus aureus) and another twenty-two had acquired VRE (vancomycin-resistant Enterococcus) — unfortunately, typical rates of infection for American hospitals.”
Quality public health is not simply a battle with a small community of nutjobs. It is a complex system that needs us to fight against the foolishness in us all.
As I watched the polarization over immunization grow, I asked other parents what they thought. One friend reminded me that her son has had a suppressed immune system most of his life to help him battle an ongoing medical condition. I had forgotten, because he is a healthy and vibrant kid now. His immune system can’t tolerate a live vaccine, and many of the conditions we avoid through vaccination could kill him. He doesn’t have the luxury of immunization. Parents who choose not to vaccinate do so because they don’t believe their own child is at risk. Well, this kid is.
So I asked her, what do you do?
She makes sure the school nurse knows her son’s face and his story. She gets to know the other parents and sometimes which kids haven’t been immunized. She tells them her son’s story. She encourages her school community to tell her if they get so much as a whiff of concerning symptoms.
“I build relationships,” she told me. She knows firsthand that some minds simply will not be swayed, and that their ignorance could deliver her worst fear to her doorstep.
New vaccines will come, thankfully. Despite the amazing advancement of pharmaceuticals, there is no perfect science. If a new vaccine starts to show evidence of unacceptable risk, I worry we will be so weary of this issue, and so defensive on behalf of vaccines as a category, that even the most pro-science among us will be unable to consider it.
We can never be too certain we know the answer. I don’t share the sentiment that Big Pharma is evil, but pharmaceutical companies don’t have a pristine track record either. Not because they are evil, but because companies are made up of human beings.
As you shake your head at the idiots of the world, take the time to make sure your own vaccinations are up to date. And when you are or someone you care about is being treated in a health care facility, make damn sure your caregivers wash their hands.
January 19, 2015
This past year was one of great professional stress, and I determined not to carry it into 2015. When I did find resolution in October, it came in a better manner than I could have imagined. While I made some contributions to the outcome, I assure you luck was the prevailing factor.
When the dust settled, I was stunned to find my life relatively drama free for the first time in years. My kids are at great ages in which they are relatively dependable, responsible and communicative, but haven’t begun to hate me. Life still has plenty of stress, but a bit less overwhelming.
So I have been thinking to myself often, I really need to enjoy this. Really. And I dare not feel entitled to its continuation. Sometimes we get to a good place and assume it to be a part of a long and steady trajectory. We are certain it can only go up from here. Enough continuous rise, and descent is certain.
In my case, I have three children heading for puberty. Rough terrain is surely ahead.
I wouldn’t change most of the challenges of the last four years if I could, because I have learned so much. (In case you don’t know me, they involved divorce, going back to work, and a great deal of constant professional change as I regained my working legs.) Those stresses paved the way both to goodness, and my ability to appreciate and savor it.
When I had to fight mighty battles, I discovered I had it in me. There is no easy path to that discovery. When I needed to let battles go, I found I could. When I stepped out on a tenuous limb, people who loved me cheered me on, but never with the platitude that the limb won’t break. At 42 I’m learning to let go of false assurances, and those who love me seem to know not to give them. I know they’ll be there if I come crashing down, and that I will find a way to recover. This is what security means to me now.
A few days ago I rushed out of work late to get home to my kids. I started my car and began to back up, but stopped when I saw in the rearview mirror what had to be the oddest formation of ice I’d ever seen. That wasn’t ice, I quickly realized. It was shattered glass. My back windshield, it seemed, had been smashed leaving a big hole and sparkling web of shattered glass.
I took the time to confer with the security staff at my office building in the hopes this mystery would be solved via video recording. No such luck. I had to get home. Fortunately it was above 0 on that January Minnesota evening. It had snowed a good bit that day, so between the window and traffic, I was an hour and a half late getting to my kids. Since they are not always with me, the loss of that time matters.
I was mad about the lost time, the damage, the inconvenience of the repair, and so forth. Once home I needed to cook dinner, tend to my kids, figure out a temporary fix to the gaping hole in the dark, and shovel snow. I was also upset at the idea someone could have done it intentionally. There was nothing missing and nothing of value in sight anyway. Maybe it was the temperature swings, an accident, or vandalism. Who knows?
As I drove I remembered what I’ve been saying to myself. Things are pretty good right now, don’t forget that. Don’t let this minor inconvenience derail you. It calmed me, this inner dialogue. I believed it.
I was plenty calm by the time I got home. I visited with my kids a bit, explained what happened, and began to make dinner. My kids commented on how surprisingly well I was handling it. They have far more experience seeing me freak out. I assured them it was an inconvenience that needed fixing and not worth being upset over. We are so lucky, I tell them all the time. The wind was bitter that night, and the day before so cold Minneapolis schools were closed for the day. We had dinner cooking, a warm home, and each other.
After dinner one of my girls helped me cover the gaping hole in our van and shovel the sidewalk while the other two worked on a project inside. As I struggled to tape the cardboard to the van (adhesive and cold don’t go well together), I got really frustrated, but tried to maintain my calm. Again, she commented on how well I was handling it. She said it was like we were having a really good evening in spite of this bad thing that happened. I laughed and agreed.
“You know, Mom, at times like this I really admire you.”
She went on to say she didn’t think she’d ever forget this night. I was stunned. I think this is the only time in over a decade of parenting that I felt like I got it right when it mattered. I will never forget that night either.
For better or worse, no one knows you better than your children. They see you at your very best and worst. Despite the many pieces of parenting that make you feel helpless, we have power over them. Holding power is the greatest test of character.
My kid’s response is largely her surprise because of how many times I had not handled stress well. At 9, she can now reflect on her own moments of freaking out, and learn to talk herself down. With my recently calmed professional waters, I would not have appreciated my new situation so well had I not experienced the preceding struggle. The same is true for my kids. I just hate that “the struggle” is sometimes me.
It is heart wrenching to fail in front of your kid. But we all mess up sometimes, and so will our children. There is never a bad time to improve or try to get it right. And when our children see us fail, get back up and try again, we are telling them the absolute truth that this is how life is, and they can do it too.
June 30, 2013
When someone I love leaves this world, it is the conversations I miss most. I can imagine facial expressions, the sound of a voice, the cadence of laughter. But no matter how good my guess, I cannot perfectly conjure the response of a person who is no longer here to give it.
With each of my friends, there is something specific and unique we share, be it a love, an experience, a hope. I have many friends with whom I can always share a book I’ve just read or a movie I’ve seen.
And since I can’t have that with one particular sweet and dear friend, sometimes I need to express it to others. Maybe because I hope some response will approximate the one I miss. Or maybe because I just want to put it out there.
So here goes…
You should see this movie. It’s beautiful, and you would get how perfect its imperfection is.
You should read this. It speaks to your observation of human nature and desire for global understanding, and most of all to your love of travel.
You should watch these. I haven’t, actually, but saw a review of it and knew you would love it.
You should read Christopher Hitchens, especially Hitch-22 and Mortality. And if you wouldn’t have, which I doubt you would, then I would at least have insisted you read this piece of his in Vanity Fair, an excerpt from Hitch 22. They are so different from the Rogers book above, but you would love his command of the English language, wit, passion, and most of all his irreverence to all but the search for truth.
And there is more, but I will stop there. Must get back to work and not spend so much time hurling stuff into the empty space.
The wonderful thing about coming home when “home” is Mississippi is that, whatever else goes on, good stories will be told. Years ago I learned of the following piece printed in Playboy magazine some time in the 1970s, but never managed to lay my hands on a copy to read for myself until today. The witty and erudite judge quoted here is my late uncle.
Below is the Playboy write up in its entirety, which I modified only by splitting paragraphs for easier reading in my blog format:
Eloquent legal decisions rarely come out of municipal courts, but an interesting exception occurred in Jackson, Mississippi last year in the case of a night-club patron charged with failure to obey a police officer and resisting arrest, among other things. It seems the patron first endeared himself to the arriving officers by loudly proclaiming, “Here comes the fucking police!” They ordered him to leave the premises and later arrested him when he did not comply. In court, the issues became those of lawful arrest and of whether or not his language amounted to “fighting words” that under state law would constitute a criminal act. Judge Howard C. Ross, Jr., held (in part) as follows:
In some instances, it could be a matter of speculation or inference by the court as to whether the language attributed to the defendant is such that a disturbance of the public peace would occur. In the case at bar, no difficulty is experienced, since nothing happened.
The statement was made, apparent due note taken thereof by all the people in the night club and nothing approaching a civil commotion or disturbance of the peace transpired. The only portion of the remark, being the adjective (which the court believes to be a participle) describing the police, which was offensive lacks a good bit of being a “fighting word.” It undoubtedly was received by its auditors as an appropriate, although this court believes an inaccurate, description of a member of the Jackson Police Department.
Assuming the defendant uttered the remark, its net effect was to advise all within hearing distance that the defendant had reached that state of maturity at which he can publicize his unmitigated and unredeemed ignorance and repudiation of our mother tongue. If the defendant’s ability to express disrespect, scorn, ridicule or the like toward law enforcement finds its quintessence in the quoted remark, his educational progress must be somewhat akin to the dog scavenging its daily carrion from the city garbage dump, who, when approached by one of his fellow mongrels, growls but does not speak, for he cannot. Woe to that generation who masticates its own bile and vomits such filth as the epitome of its thought processes. If it is unthinkable that the defendant’s imagination could conjure up such a thought, that he gave voice to such a declarative English sentence is unbelievable. Whether the defendant is guilty of using profanity in public is not before the court, nor is his obvious lack of breeding, intelligence and vocabulary.
It is said patriotism is the last refuge of the scoundrel. To this may be added the last refuge of unregenerate man must surely be the retreat into the abyss of obscenity…Public utterances such as the one here under consideration are proof enough the evolution of man is not complete; for God help us all if it is. But the law gives man the right to search for truth and light and immortality on the one hand and the right to debase his very soul on the other; and these with equal zeal…The Constitution, as politics, makes strange bedfellows. One day the lady who has worn the blindfold for so long, to satisfy her curiosity is going to remove it and be horrified with the contents of her scales…What is before the court is whether the language of the statement constitutes “fighting words.” As a matter of law, they do not.
In discharging the defendant, Judge Ross also delivered himself of some kind and equally poetic words for the police:
Despite effluvium from the mouths of degenerates and malevolent future draft choices of the far reaches of hell itself, the badge of the cop on the beat is a shield of honor, integrity, honesty and courage. To those who say he’s not much, society responds, he’s all we have. Discredit him and you deny yourself protection from the criminal. Deny him and you deny your form of government. Defrock him and you have anarchy. To those who call him “pig,” he asks, how many murderers have you apprehended, how many rapists; how many vacant buildings have you entered at two o’clock in the morning, searching for a burglar; how many drunk drivers have you chased at 100 miles per hour?
Why an otherwise reasonably decent segment of our citizenry seems to see red when a policeman appears is an anomaly of our times. But the policeman, as the child, must only speak when spoken to, come when he is called, perform when his master raps the lectern with his baton, remaining at all other times, like Jim Crow, at the back of the bus. What is bad about police? Their most grievous sin appears, to this court, at least, to be that they protect our lives and property; they catch crooks; they keep rowdies under control; they patrol our streets, and this at hours and in weather conditions that keep the rest of us indoors; and all of this at a pay scale that makes one speculate why there are any honest cops left. Yet they are scorned, abused, ridiculed and denigrated to a degree that should be reserved for the criminal element.
This is truly one of the wonders of the modern world. Their job, dangerous as it is, must be accomplished in somewhat the contradictory manner of brandishing a Smith & Wesson in one hand, an olive branch in the other, one eye on the miscreant and the other on the Constitution. No easy task, methinks.
Gilbert and Sullivan perhaps said it best in The Pirates of Penzance:
Our feelings we with
When constabulary duty’s
to be done-
Ah, take one consideration
A policeman’s lot is not
a happy one.