Sunday, April 30, 2017

Climate Change and Health

NOTE: At the time I drew these pictures a year ago, to accompany a Resolution presented to the Washington Academy of Family Physicians House of Delegates, the focus was on climate change and the family physician. The lessons apply to us all--and we are, or can be, healers, in the broadest sense.

Hopefully the pictures mostly speak for themselves. A few points of clarification and intent:

First, on the “less-busy” side: On a finite planet, any species must eventually reach equilibrium with its environment. In a traditional graph it’s difficult to appreciate that this holds true for humans. To capture our growth in the last 200 years from 1 billion to 7 billion, everything prior to 1800 looks pretty flat. Yet it’s anything but. As the log-log scale shows, we’ve had one series of exponential leaps after another, and every time the curve gets close to flattening, a new “advance” results in another order-of-magnitude population growth. The great hazard is that our last two (or more) leaps have likely been unsustainable. Oil provides both the energy, through mechanized harvesting, as well as literally the substance, through petro-fertilizers, of our food growing. And biotechnology, while it has delayed the crashes predicted by Paul Ehrlich’s 1968 “The Population Bomb”, has resulted in further dramatic growth while increasing our reliance on mono-crops, which could prove susceptible to massive failures of disease, drought, or heat. The larger question is, even if we could produce vastly more food, would this result in improved quality of life, or even less worldwide hunger? To date it hasn’t.

The bottom of the page shows atmospheric CO2 in the last several hundred thousand years. Though we don’t have one continuous, unbroken record dating back to Earth’s formation, we do have, from ice cores looking at different carbon and oxygen isotopes, excellent data. What this graph can’t show, because of scale, is a comparison to the last known major warming period post-dinosaur extinction (65M years ago). But we know a lot about this period, called the Paleocene-Eocene Thermal Maximum or PETM, which occurred 55M years ago. At that time, massive release of carbon dioxide led to a period of global warming. Geologists have often used the PETM as the best recent analogy to today’s warming and CO2 levels. It has been offered in the lay press as a reassuring comparison, because while certain ocean species suffered extinction rates of at least 50%, most land animals did well. However, as described in geologist Robert Hazen’s 2013 book “The Story of Earth”, recent ice-core evidence has shaken scientists by revealing that The PETM’s 5 degree Celsius warming occurred over a time period of 10,000 to 20,000 years, and the CO2 release was also slow. Today’s rise in CO2 levels is at least 10x as fast, and the projected temperature increase—currently we are on track for 5-6C by 2100, the non-binding Paris agreement doing nothing concrete to slow this—is thus occurring at a rate 100 to 200x as fast.

This brings us to the “busy” side and the heart of the matter starting with Wile E. Coyote in the upper left: we are stepping off a cliff. What that cliff represents is a huge number of positive feedback loops, processes we’re setting in motion that will likely continue even if all emissions stopped tomorrow. This in combination with our population growth makes our current history frighteningly akin, as journalist Elizabeth Kolbert argues in “The Sixth Extinction”, to the K-T boundary (dinosaurs) or one of Earth’s other 5 mass extinctions. I call your attention to three of those: in the far upper right, as the permafrost melts, it will release huge sinks of methane, which is 20 to 80 times more potent than CO2 at trapping heat. Near the bottom left, as the ocean acidifies, we’re facing the loss of the very phytoplankton that both absorb CO2 and provide half of our breathable oxygen. And back to the upper right: Severe weather, such as multi-year droughts that Syria and other places are already in the midst of, are causing or exacerbating civil unrest while simultaneously stripping the resultant climate refugees of land to which they might otherwise relocate.

Thus in the center of the page: We are, already, in a crisis of the health of the public. Here and abroad the entire public sector is being slashed and/or privatized even as the wealth of the very very richest increases. This phenomenon is well-described by Naomi Klein in “The Shock Doctrine” (one example being New Orleans during and since Hurricane Katrina), and in her latest book, “This Changes Everything” she makes the compelling case that climate change could push public infrastructure past its breaking point.

And finally, the lower right, the family doctor! Why the family doctor? Because no one is talking about this. Because we give voice to our most vulnerable patients and communities. Because we have an opportunity to build something better. It would be easy to say, “If the door to 2 degrees C closes next year, does it really matter what we do?” Yet we really do have a unique chance to both slow down emissions and, in the process, mitigate the effects of climate change by building a more just, equitable, and sustainable society.

For a moment, and it is likely a brief moment, there is more than enough wealth in the world to bring about enormous good. The challenge is that wealth is concentrated, as per the extreme lower right corner, in the hands of a very very few individuals. Over a decade ago a study found that the world’s 3 richest men controlled assets greater than the world poorest 48 countries. The statistics have only worsened since then. In America today top CEOs make more in a year than their employees could make in 350 years, or 7 generations each working 50 years. Nearly everyone in the world would benefit in the short- and long-term by investing some of this wealth in the strategies proven to increase world peace and stability, namely, improving the educational status, economic status, and reproductive rights of women and children. And even the super-rich would benefit from this approach in the long-term, because no ultimately no one wins, if we all lose a livable planet.

This, I believe, is what we must stand up for. If not us, who, if not now, when?

Tuesday, April 18, 2017


For anyone who has read The Hitchhiker’s Guide to the Galaxy series: I have arrived at the answer.

For anyone who hasn’t: The answer (only, of course, the answer to life, the universe, and everything) is 42.

The question, of course, is what is the question?

Recently I’ve started my second attempt at reading BrenĂ© Brown’s Daring Greatly, this time as an audiobook that I can digest while working out or driving. LL had suggested I read it a while ago. Maybe a year or more ago. To my credit, I did start. It’s just that I don’t actually get far with reading books these days, unless it’s Moomin, Mymble and Little My, or perhaps Madeline, or Monster Trucks—our 2-year-old’s current favorite, featuring trucks that are actually monsters (I’m embarrassed to admit it’s actually growing on me). So right before a recent trip to Seattle I purchased the recorded version of Daring Greatly and started listening, again, as it were.

The truth is, I wasn’t quite ready to hear what I was reading, the first time around. I thought that I really “didn’t do shame.” I feel more ready now. The ready-ness journey has not been an easy one, and it is very much a journey that is ongoing, but I will say that it received a bolt and a jolt, a bump and a thump (to borrow from another favorite, the Meg and Mog series) from last fall’s election. Daring Greatly, for those of you who haven’t wandered into BrenĂ© Brown territory, is about shame, vulnerability, and the excruciating, exquisite transformation that happens when we “show up and let ourselves be seen.” It is not that I suffered from a terrible back-log of shame that needed to be worked through. It was and is more that I’ve become more aware of the small moments when I’m either turning towards life, as painful and awkward as it can be, or turning away. And I’m trying to turn towards.

So I’ve finally posted the essay I wrote, well, about a year ago. See my last posting prior to this. At the time I wrote it I knew it was premature. I knew that were I to post it at that time…well, it just didn’t seem right. It was “laying it all out there,” but I hadn’t yet put in any of the real work of relationship-building that I recognized I needed to do. Now, I think, I have embarked on that path. I am doing my best to put in the time and effort. It is exhausting, at times terrifying, and so, so liberating. I am also coming to grips with a basic truth that I already knew years and years ago; in fact I wrote and illustrated my own children’s book on the subject. The opposite of scarcity is not abundance. The opposite of scarcity is enough.

What does any of this have to do with the recent election and with the number 42? And, what is the question?

For me it is this:
We live on a dying planet, by which I mean that we are in the midst of the greatest life extinction event since the K-T (end of dinosaurs) boundary. We are living under a fascist regime that all of us bear some responsibility for allowing to happen, and all of us bear some responsibility for dismantling. Am I willing to speak up about this?

I am but one small scared white privileged straight male 42-year-old homo sapiens. Only through collective action will any of the above (regarding the planet) change. Am I willing to, not from a place of guilt, or despair, but from a place of love, hope, and possibility, reach out to those not like me, to make the world a better place?

Of the qualities I listed above (regarding myself), there is only one that I can change.
There is only one I can let go of.

Am I willing to let go of my fear?


Thursday, April 6, 2017

Why I’ve always hated the term “At a Crossroads”

-NJH, APRIL 2017

When I was a kid growing up, my family didn’t own a television. But once a year we would make the epic drive from Halfway, OR, to Toppenish, WA, where we’d stay with family friends, go to the State Fair up in Yakima, and, most significantly, wake up at the crack of dawn to watch all the Saturday morning cartoons we could stomach. So while I have no idea what people are talking about when they mention past (or current—I’ve never owned a TV) shows, I at least have a basic cultural reference point when it comes to, say, Wile E. Coyote and Roadrunner.

One iconic image has been replaying itself over and over in my head of late: that combined suspension of disbelief, and gravity, where Wiley has run off the edge of a cliff but not yet accepted the fact of his fall.

“Hate” is a strong word (see “Cars”, 8/31/13). So I’ll just say I’ve always found the term “at a crossroads” woefully inadequate to describe situations such as less than half of Earth’s current species surviving into the 22nd century, where we humans are driving this cataclysm. The reversal needed to give our planet better odds is just not captured by the image of a bucolic
footpath on which stands a culturally neutral forest critter—a squirrel comes to mind—calming choosing between the left and right arrows hand-painted on a quaint wooden sign. The action needed is not a leisurely choice between two paths both rooted on solid ground. The action needed is an emergency pair of (solar-powered, of course) rocket thrusters to be turned on full throttle in reverse, in hopes of crashing backwards into the side of the cliff rather than continuing to plummet into thin air.

I’ve long favored (and recently employed) the image of Wile E. Coyote to describe humanity’s race through the next 50-100 years. I never imagined that such a picture would describe the state of my own future as a husband and a father.

As a spouse and a dad right now I’m in that very thin air. I’m trying to activate my emergency rocket boosters and catch the edge of the cliff instead of plummeting to the rocks far below.

Right now I’m writing this blog on a scrap of paper. I’m sitting in my parked car listening to a marimba CD for the 11th time straight through. In the back seat my 3-year-old son is finally starting to stir, having slept the last 30 minutes here in the parking lot of our hotel near Stanley Park. The hour before that he passed out and slept for a fossil-fuel-consuming driving tour of Vancouver, BC, that eventually, and thankfully, included 30 minutes parked in a quiet residential neighborhood on the north side of the Lion’s Gate Bridge. Prior to that, the epic, screaming, kicking meltdown in the Japanese restaurant, and before that, last night’s head-turning, child-protective-services-call-eliciting (had anyone had a conscience), absolute meltdown in Stanley Park itself. A couple days before that, my own loud, cursing meltdown on a public street in Victoria. My frustration had been in part at having waited half an hour in the cold for a bus that came only minutes after we’d abandoned the bus stop. It was part at being back in a walking orthotic boot as another chapter in a saga of chronic foot injuries. And it was in no small part at the dawning recognition that I am not being the parent nor the person I aspire to be.

It’s been quite the Canadian vacation.

On our ferry ride up from Port Angeles, we found ourselves engaged in a warm exchange with two men. Amusingly, I mistook them for father and son. The “son”, it turned out, was working to put up signs advising motorists of the planetary health effects of our fuel emissions, akin to how cigarette packages carry a human health warning label. The “dad”—they were, in fact, travelling together—was working at similar if less-direct action at Victoria’s Environmental Law Center.

He had written a book, he told us, that at one time was a Canadian best-seller, “Becoming the Kind Father.”

The universe works in funny ways. Sometimes clues are subtle and other times (as when, for example, one chooses to ignore the subtle ones) they are more direct. Here we were, journeying through Victoria on our way to Vancouver to see Naomi Klein speak on climate change and capitalism, and we run into a man offering a possible path to better parenthood. At the time I thought, “that sounds kind of interesting.” Now, several collapses of serenity later, I am feeling more and more that I, like Wile E. Coyote, am not at a crossroads. I’m about to crash and burn.

Friday, March 3, 2017


Once a month LL spends her Friday evening at a women’s dance gathering. The boys and I stay home and watch part of a movie. The boys are 2 and 4. As a family physician I’m well aware of the recommendation to limit screen time, along with the solid evidence between all the other things one could be doing with that time—reading, playing outside, making music, engaging with friends—and better health. Probably more importantly, my own parents raised me without a TV, and we don’t own one. For the occasional movie we set up a projector and screen.

So up until tonight (not counting the Winnie-the-Pooh movies that their Nana and Papa allow them) our boys had seen a total of two movies, both by director Hayao Miyazaki: Kiki’s Delivery Service and My Neighbor Totoro. Watching a little over half an hour at a time, we’ve seen each film now twice all the way through.

Tonight we decided to branch out and try something different: 2014’s highly acclaimed Song of The Sea.

We made it about 20 minutes in.

At that point we had to stop. Our 4-year-old was terrified. My good friend (not coincidentally, a pediatrician), who lent me the movie and whose 2-year-old loves it, had warned us that there were scary parts. I do not believe we made it to any of the scary parts. My son was crying because the main character and her older brother were being taken away from their father to live with their unsmiling grandmother. Again and again I was asked, “Why was she so mean?”…“Why was she making them do things they didn’t want to?”…and most of all, “Why was she not listening to them?”

Over an hour later—after reassuring, coming up with no less than seventeen possible explanations for why she was so mean, reassuring, watching some of the familiar Totoro, reassuring, brushing teeth, reassuring, pee in the potty, reassuring, reading a story, reassuring, carrying upstairs, reassuring, lights out, reassuring, a long giraffe family story, our repertoire of eight songs, hugs, kisses and gobbles, love sparkles, and more reassuring—I was able to reflect on why this movie had evoked such a strong fear response.

In our family we value listening, empathy, explanation, and love. Equally, we value responsibility, natural limits, community, and helping others. Looking back at the short clip of the movie we saw, the whole thing was terrifying. The little girl who is the central figure is mute. She cannot be heard because she has no voice. Her older brother, to whom she clings, is clearly antagonistic towards her. Her father loves them both, but takes no responsibility in protecting them from a figure who is a caricature of evil. There was no community because they lived alone on an island. I was terrified too! In reading, afterwards, Wikipedia’s plotline, the obvious was stated: of course things get better. Her brother sticks up for her. Her muteness is explained. The family is reunited. Even the grandmother isn’t so bad. I’m familiar with the elements of the Hero’s Journey, and I don’t doubt that the rest of the movie lives up to its reviews. At the same time I understand why it was so scary. Up to the part where we hit “STOP”, there was very little that was not a direct threat to everything we’ve tried to instill in our little guys.

This is not to say that we will never again venture beyond our same safe two Miyazaki films…though I did promise our 4-year-old we’d shelve Song of the Sea for now.

Yet neither is it in any way a cautionary note to self that we’re over-sheltering our kids. There is so much fear and actual horror in the world right now that the last thing I want is to try to numb our boys by exposing them to any significant fraction of the 200,000 acts of onscreen violence the average American child sees by age 18. There is also so much incredible beauty, kindness, selfless heroism, creativity, collaboration and community in this world, and these things tend to get an ever-shrinking amount of our focus, much less media time, beyond the walls of preschool. If our son experienced genuine fear at the depiction of a separation of family, that is a very natural and healthy fear. I feel grateful that he has the vocabulary and courage to express his feelings and ask for what he needed in that moment.

And of the seventeen explanations that I came up with for why the grandmother was so mean, the one my boys liked the best was, “maybe she just didn’t get enough ice cream!” Think I’ll go have some myself so that I never turn into a mean dad.

Wednesday, November 30, 2016

Post-election world

My head is reeling from all the various links people have sent me and I want to share some quick thoughts-to-myself as I try to process it all:

Staying positive. A lot of negative post-election analysis out there, important for understanding perhaps; also a lot of positive organizing/momentum to focus energy on.

Staying connected. For me one smile, hug, or phone call is worth a million internet articles.

Remembering human goodness. A lot of good and suffering people on both sides cast their ballots in hopes of a better future, and we are all in this together.

Remembering the big picture. I keep coming back to “350”…we’ve surged past 350ppm CO2 and only concerted action will slow climate change, and climate change will exacerbate the fate of the less fortunate in a world where CEOs currently make (on average for Fortune-500 Co’s) 350x the salaries of their lowest-paid workers.


Here are some links I’ve found helpful:

“House of Straw: How Washington’s tax system undermines our economic future—and how to fix it”—a very readable primer on WA’s highly regressive tax structure (worst in the 50 States!)

The L-curve: a graphic representation of wealth distribution in the US:,

The Spiritual Grandmothers on a helpful framework in which to place our president-elect

An article I found OUTSTANDING, from a friend, understanding the reasons why many Trump voters cast their ballot for him:
(and the first link therein explains the “deplorables” comment Clinton made…)

And this much, much longer article really gets to the heart of value-based voting (and what we can do)-- has some good articles on neoliberalism and its endorsement of a winner/loser world, and a related article (sent to me by the same site) stresses the need for reaching out across ideologic lines:

Finally, for anyone interested in supporting what I characterize as a “climate-and-how-it-hurts-the-most-vulnerable” group,, which is very active in the Standing Rock movement, here’s their link:

Monday, October 31, 2016

Vote Hillary Clinton

It's been 6 months since I wrote. But this posting isn't about me.

In the madhouse that American politics has become, it's easy to lose sight of the fact that critically important issues hang in the balance. Hillary Clinton stands on the right side of every one of those issues compared to her rival. And while Obama wasn't my first choice in 2008 (Dennis Kucinich was) and I would be voting for Bernie Sanders if he were still in the race, he isn't. In fact, it's harder to find a stronger endorsement of Clinton than from Sanders: "Any objective observer will conclude that--based on her ideas and her leadership--Hillary Clinton must become the next president of the United States."

What are these critically important stances, for which Clinton must, must, must be elected?

First is a livable planet. I don't just mean "the environment" as some bucolic ideal removed from everyday life, but rather, the fact that our carbon emissions are altering the Earth's climate so rapidly that we are already in the midst of a mass extinction event. For further reading I'd direct you to Elizabeth Kolbert's "The Sixth Extinction", or, for a shorter starting read, her 2006 New Yorker article, "The Darkening Seas". The latter outlines how even if we had stopped all carbon emissions tomorrow--10 years ago!--we've already released enough CO2 into the atmosphere to radically acidify the oceans and cause massive die-offs, die-offs we're already starting to see, for example, in oyster beds here in the waters of Puget Sound. While the ability of any one President to halt or slow this process, much less reverse it, is limited, at least Clinton acknowledges that climate change is real. And, she has a cerebral cortex that can be engaged.

Second is a livable planet. I don't mean a peaceful, hand-holding lovefest where we all sing Kumbaya and drink hot cocoa made with vegan coconut milk and fair-trade organic chocolate. I simply mean a world where we don't shoot each other, lock each other up, and build walls between each other, just because we don't all have the same skin color or speak the same language or share the same religion. Somehow, soon, we've got to figure out how to live together, all of us, or we might die together, all of us. Check out "Countdown: Our Last, Best Hope for a Future on Earth?" by Alan Weisman. Clinton is far from a peace-wager. But she is less likely to accidentally, or intentionally, nuke Iran, or Mexico, or New Hampshire...wait, isn't that one of ours? the first 5 minutes of her time in office. And, she has a cerebral cortex that can be engaged.

Third is a livable planet. And I don't mean a U.N.-controlled socialism-faced wealth-redistributing egalitarian democracy, for heaven's sake. I just mean that if we're going to learn to live together--both as people, see point two, and as people with the planet that sustains us, see point one, all evidence points to the idea that healthier societies are more equal. Not equal. Just more equal. Less un-equal. Currently, in the US, the average CEO in a Fortune 500 company will earn more in a year than could be earned by 7 generations of his lowest-paid worker each working for 50 years. (yes, that's 350x as much.) That's a hard truth to reconcile with the idea that all individuals are created equal and are endowed with certain inalienable rights. See "The Spirit Level" by Picket and Wilkinson for more on this. It may be hard to endorse Clinton, who has received millions from large corporations in speaker fees, though it could be argued that this is the soul-selling necessary to play the game as it's currently played. But she at least pays lip service to policies aimed at reducing inequality, instead of boasting about the power that wealth buys her. And, she has a cerebral cortex that can be engaged.

Vote Hillary Clinton. Our lives depends on it. She's not perfect. But she's the only electable choice. And, she has a cerebral cortex that can be engaged.

Wednesday, March 30, 2016

Autonomous interdependent gratitude

Thank you to my mother. For the month of March, she made our little family a “March Advent”, and every day my boys (and LL & I) have delighted in opening a package wrapped in brown parcel paper. For my birthday I received a tribute poem to Nelson Mandela, written by Maya Angelou and brimming with images of Madiba, which brought tears to my eyes. On the package she’d affixed a horoscope for Aires that read, “You love autonomy. You specialize in getting the freedom and sovereignty you require. You are naturally skilled at securing your independence from influences that might constrain your imagination and limit your self-expression. But here’s a sticking point: If you want the power to help shape group processes, you must give up some of your autonomy. In order to motivate allies to work toward shared goals, you need to practice the art of interdependence. The next test of your ability to do this is coming right up.”

Thank you to It informs me that autonomy comes from the Greek root auto, self, plus nom, or law: self-governance, self-determination, independence (not to say self-control!) Consider how highly—in the U.S.—we hold those values, as compared to their opposites. Even “interdependence” and its synonyms “symbiosis” and “cooperation” can draw frowns in our radically go-it-alone culture, while from “dependence” it is a short slide to “addiction” and the double-edged sword of “faith”. (I once watched a TED talk whose thesis was that doubt is the essence of faith, an idea I have to think might benefit the devout in any radical belief sect. Even my own, of what I might call “Earthism”.) What I need is a radical shift towards recognition of the interconnectedness of all life, including the ripple effects of my everyday smallest actions.

Thank you to Tanmeet Sethi. Tanmeet was one of my mentors in residency. She has a son, Zubin, who was born with muscular dystrophy. Thank you, Tanmeet, for sharing your story with the world via your own TED talk on the power of gratitude. What a gift.

Thank you to Randall Battle for teaching me how to play guitar, or at least, to do the very best he could in the short space of several hour-long sessions every week or two for a few months in the time right before our family left the Okanogan.

Thank you to my friends, colleagues and most of all LL, who tolerated, encouraged, and even did their best to work with me on, submission of another resolution to this year’s Washington Academy of Family Physicians’ House of Delegates. This one is no less than a call to action for the preservation of our own species, a fate inseparably linked to that of so many other species. If this is what my horoscope is trying to tell me, that is, to let go of my attachment to the specifics in order to achieve any good at all, then I will do my best to listen.

Thank you to my boys for bearing with me as I learn to be a kinder and more patient father.

Thank you to Bill Manahan, whom I credit with teaching me the little song our family sings every night along with fun hand gestures: "Thank you for this food, this wonderful wonderful food, and the animals, the fruits and vegetables, and the human hands, that made it possible."

Thank you to all those I've thought of but have run out of time to record in this very very short list of thanks!