Acrobaticalists

NANDA: A Review

“Nothing touches a work of art so little as words of criticism: they always result in more or less fortunate misunderstandings. Things aren't all so tangible and sayable as people would usually have us believe; most experiences are unsayable, they happen in a space that no word has ever entered, and more unsayable than all other things are works of art, those mysterious existences, whose life endures beside our own small, transitory life.”
—Rainer Maria Rilke

Twisp, Saturday night, December 10. The 15-degree air snatches away breath and shutters doors. The sun is a distant memory. To attempt movement, much less “unbounded imagination and creative agility”, seems an absurdity.

But in the Community Center gymnasium the absurd is about to take form. The air hums with energy as in the front, on mats, a tousle of kids is instructed to stay there: What is about to happen could be dangerous. Keep your head down. Don’t stick out any limbs. NANDA is about to begin.

As the lights fade to black and a screen rolls with dramatic opening credits (NANDA presents a NANDA production starring NANDA…), I am once again 7 years old and the world is magic. The music builds, the curtains part, the stage explodes into action, and the next 3600 seconds are measured in pure joy. When it is all over and my entire torso aches, I realize I have scarcely stopped laughing the entire time.

What is NANDA? Trying to touch NANDA with words is truly to take the unsayable and try to pin it down. From an opening scene of kung-fu fighting to a medley of air guitar and swaying hips, from a daring heist involving invincible robots to a comic radio-surfing lunch break, from one impossible juggling feat to the next, NANDA defies. Expectations, conventions, stereotypes, propriety, and most of all the laws of gravity are utterly ignored. For 3600 seconds this “four-man acrobaticalist performing arts troupe” demands my attention and it is theirs.

According to their website (nandatown.com), “Nanda” is a colloquial Japanese expletive for “What!?!” This is an apt name for a group with enough testosterone to fuel an F16 and enough whimsy to make Bambi blush. In a time when so many role models—male and female alike—espouse a pseudo-Darwinian view of conquest through superior strength, NANDA turns this all on its head.

It’s not just that the winner of a ninja fight scene may be the guy who gets to put on the silver spandex. It’s that winning may involve everyone doing a musical number à la the Rockettes.

To say more would only be to go further down the path that Rilke cautions against. The show will live on far beyond these meager words. NANDA is what??!, and what!?? is NANDA. Don’t miss it.

Olympia, Nov. 29th, Ways & Means Commitee

My name is Ned Hammar. I am a family doctor working at a community clinic in Okanogan. I drove six and a half hours to be here.

I am here today on behalf of those who have no voice.

I am here today to speak for my 38-year-old patient with pelvic cramping. She had light spotting of blood and found that her IUD was coming out. We tried to get another IUD to replace it but could not because she had no insurance. We tried to offer her condoms but she declined them because her husband beats her up if she uses them. We tried to offer help but she said she couldn’t leave the situation because of her children.

This woman faces an unplanned child born into an abusive relationship in a family already struggling to get by, because she can not afford safe and effective contraception.

I am here to speak for my 47-year-old patient who just wants to get back to working as a short-order cook, but can’t because the voices in his head tell him to kill himself. He’s been into our clinic five times in the last year in suicidal crisis. Each of those times we’ve tried to get him admitted to emergency psychiatric care but each time this has been denied because he can’t pay. He can’t afford a medicine that keeps the voices at bay and costs $17 a month.

I am waiting for the phone call to tell me that he is dead, because we couldn’t help him find $17 a month.

I am here today to speak for my 9-month-old patient. This little girl was born to a mom who had just one prenatal visit. She appeared normal at birth but at her 1-week check-up she stopped breathing and turned blue. In the hospital she started seizing, and she was sent by air to Spokane. There she had a massive stroke and lost 90% of the temporal lobes of her brain. Somehow she lived. But she will never walk. She will never talk. She will never play patty-cake, or read a book, or sing a song.

This girl had a herpes infection that reached her brain, which could have been prevented if her mom had received adequate prenatal care.

I am here to tell you that our system is failing, and it is failing those who have very little left to lose. If these budget cuts go through, you are asking them to let go of one final thing. It may seem like a small thing but in my experience as a family doctor it seems to be the only thing some folks have left.

You are asking them to let go of hope.

I have heard that one of the accusations leveled against the Occupy movement is that they don’t have an “ask.” So I’ve thought very carefully about what my “ask” is, if I’m going to come here and take up your time.

My “ask” is very simple. My “ask” is that you tax the wealthiest individuals and corporations in order to pay for basic healthcare and education for all.

You might say, “Well, that failed. I-1098 last fall put that exact choice to the people and it was voted down.” To which I would point out that for 6 of the 7 months that polls were conducted, I-1098 was supported, initially by a margin of 66% for to 27% against. Only an aggressive and highly-funded campaign which played to baseless fears was able to convince people to vote against their own best interest.

More to the point, I would remind you that Washington State has the most regressive tax structure in the nation. The poorest fifth pay 17% of their income in taxes, while the richest 1% pay only 2.6% percent. From 1979 until now, the income percentage of almost everyone has dropped, but the richest fifth have increased their share 6 points from 43 to 49%—and the wealth disparity is far greater.

This is an outrage. There are people dying on our streets and in our clinics, in my clinic, every day, while the richest of the rich linger over the choice between a new yacht and a private airplane. This is an outrage.
The argument against raising taxes on the wealthy is that we will no longer attract the best and the brightest minds to our State to be the innovators and doers of tomorrow. I ask you, what about the minds we have here? Are we willing to write off 80% of our population as worthless? Are we willing to pin our hopes on the richest 1-2% of individuals and corporations, hoping that somehow they will smile on the rest of us? If we are, then the last 30 years should give us some idea of what to expect. Do we have better schools? Better clinic? Better health? Safer neighborhoods? Cleaner air? Better transportation? A secure economic future?

Study after study shows that the health of a community can be best predicted by one single measure: a lower income gap between rich and poor. Over the past 30 years our income gap has widened, and our schools, neighborhoods, clinics, our health, our future, our hope have suffered as a result.

I can’t pretend that reversing this trend will be easy. The defeat of I-1098, a measure which would have directly benefitted 98% of our people while asking a nominal tithe of the remaining 2%, illustrates the power of the wealthiest individuals and corporations.

Nonetheless I ask you to try. John Burbank and the Economic Opportunity Institute offer some specific measures which would close corporate tax loopholes and protect social services, while both protecting the environment and stimulating economic growth. I ask you to look at these and other measures which more equally share the responsibility for our current crisis. We the people need you to try. Our future, which is to say the future of Washington itself, depends upon it.

I ask you to give us hope. Not the gaunt, stretched, thin hope that my patients barely survive and sometimes perish on, but a real hope, a robust hope, a hope nourished by true investment in our future. Thank you.

a jump in the lake

This blog was headed for disaster.

When I was a kid—when I was a little kid—when I was 5 years old I would tell my mom stories. She would write them down, I would draw in the pictures, and we would create little books together about an 8-year-old boy who sailed the high seas in a 3-masted wooden sailboat saving princesses from pirates and seeking buried treasure. Not incidentally, this boy was named Ned. My name, at the time, was not Ned, but that’s another story…

Throughout grade school my authorly aspirations grew and blossomed, and up until a short time before college my intention was to be a writer. In high school, however, this goal was supplanted by the belief that I would be most effective at saving the world (princesses being recruited to help) though a career in science, perhaps the development of a good 5-cent contraceptive or a renewable source of energy.

This belief collapsed.

The further I went in science and eventually medicine, the less I believed that progress in these areas correlated to that of humanity or the world. Instead, and nowhere more vividly than in the time I spent in the Peace Corps in South Africa, I saw the overwhelming effect of a world divided between the haves and the have-nots. Divided, and inextricably linked, as the labor of the poor provided the wealth of the rich. It was not so much that technological progress was the enemy as that it was too often used as another tool of the powerful to consolidate their power.

Along the way I was fortunate to meet the real Dr. Hunter “Patch” Adams. Here was a human being who had dedicated his life to the betterment of life on the planet. But his message to me was so much more important, so much more meaningful, than one of responsibility. His message was one of joy.

“If you need a break,” Patch says, “I want you to take one that day. I don’t want you working under stress. We look at teachers, nurses, doctors, social workers, and we say, ‘Why would I ever want to do that?’” Patch wants us to make a life of revolution the most attractive, fun life imaginable.

Which is why, when the inspiration struck me at age 30 to create a children’s book, I was excited. Here was a chance to have loads of fun doing something meaningful, and something that took me full-circle back to my childhood dreams of authorship.

The other part of this was that I worried that if I ever sat down and tried to write prose, what would come out wouldn’t be joyful. It wouldn’t be fun, or funny. It would be yet another painful, wordy, semi-autobiographical first novel that might, if you were lucky, leave you pissed off at the state of the world.

What I hadn’t realized is that this blog was becoming that novel.

Today, my day off from work and best chance to write, I struggled to feel creative, to create. The bitter cold outside didn’t help. At the end of the day I had a painful, wordy novel, and I felt pissed off at the state of the world.

And then I remembered Patch Adams, and my commitment to not take any of this so seriously, and I decided to go jump in the lake.

Omak Lake on a 43-degree day is no bath. The freezing jolt to the system was exactly what I needed. After jumping in, getting out, and jumping back in twice more, breathing was painful and my skin tingled from head to toe: I was alive. This blog, and the life it reflects, were averted from disaster, despair, and all the rest of the melancholy I’ve been dwelling in recently.

If this becomes more that an occasional trip, of course, it could start getting really cold…but hey, there’s always snow rolling!

The International Association for the Advancement of Creative Maladjustment

~
It is Monday night and I am parousing around the internet when I come across a rare find: information that borders on knowledge, even wisdom.

Having just suffered through James Gleick’s The Information on cd in my car, this is not a trivial distinction. According to formal information theory as developed by Claude Shannon, information is a quantifiable property of anything worth looking at—an NPR news broadcast, a poem, a storefront, or for that matter, a face, a flower, a bark beetle—that is independent of meaning, which we assign to such information.


My trail went something like this: James Gleick --> the library of Babel --> Jorge Luis Borges --> magical realism and The Attack of the Killer Tomatoes --> the real Patch Adams, who was recently named the honorary chair of… --> the IAACM --> the originator of the idea for the IAACM, namely Martin Luther King Jr.

As it is impossible to overstate the wisdom (that is to say, the meaning I assign to the work) of Martin Luther King Jr., here simply is the link to the speech in which he says, “I'm about convinced now that there is need for a new organization in our world. The International Association for the Advancement of Creative Maladjustment…”

Martin Luther King Jr.'s speech at WMU:
http://www.wmich.edu/library/archives/mlk/transcription.html

Among the reasons these words speak to me is my own never-ending struggle to adjust to life and work at a community health center. Confronted with the daily injustices that I view as being in no small part the direct health outcomes of poverty, it is inspiring to reflect on these thoughts from King.

“Modern psychology has a word that is probably used more than any other word in modern psychology. It is the word "maladjusted." This word is the ringing cry to modern child psychology. Certainly, we all want to avoid the maladjusted life. In order to have real adjustment within our personalities, we all want the well-adjusted life in order to avoid neurosis, schizophrenic personalities.

“But I say to you, my friends, as I move to my conclusion, there are certain things in our nation and in the world which I am proud to be maladjusted [to] and which I hope all men of good-will will be maladjusted until the good societies realize.

“I say very honestly that I never intend to become adjusted to segregation and discrimination.
“I never intend to become adjusted to religious bigotry.
“I never intend to adjust myself to economic conditions that will take necessities from the many to give luxuries to the few. (my highlight)
“I never intend to adjust myself to the madness of militarism, to self-defeating effects of physical violence."

~ ~ ~ ~ ~

I never intend to adjust to a segregated health care system.
I never intend to adjust to the idea that the norm, for those who do the important work of social justice, is to burn out. (Patch Adams has some great thoughts on this).
I never intend to become adjusted to waiting for justice to come with time.

"We must always help time and realize that the time is always right to do right.”

The time is right to do right. Be creatively maladjusted!

~ ~ ~ ~ ~

Some great commentary on King’s words in our modern context:

"Informed Comment", Juan Cole:
http://www.juancole.com/2010/01/mlk-international-association-for.html

Guns & Mosquitoes

It is Friday evening, LL is gone for the weekend, and all the external factors mentioned a month ago—i.e., the affairs of the world—haven’t exactly improved. The internal front is equally bleak. Staff shortages have led to work being even busier than before. I’ve been struggling valiantly to reach out and ask for help, but help right now is swamped, flooded, snowed in, choose your aqueous metaphor. And while I have no illusions of fostering any grand social movements in the next couple of hours, it would have been nice at least to talk with someone; at this hour it’s looking less and less likely.

Which is why, when I get the invitation to a barbecue, I almost stay home and work on my nascent (nearly non-existent) guitar skills. It would be so easy to hunker down: it is the path of familiarity.

But I’m interested in change! Right? Surely the pits of despair haven’t been for naught? So I assemble a mixed six-pack of beer, slice some avocados for a food offering, and go.

And that is how, these odd hours later, I come to be writing about mosquito spraying and gun control.

The mosquitoes had been on my mind for a while. The train of thought went something like this:
1) There’s a great quote from activist Bernice Johnson Reagon which I first encountered in a Real Change newspaper, “If you're in a coalition and you're comfortable, you know it's not a broad enough coalition”.
2) How broadly does this idea of an alliance for a common goal extend? If the common goal is a healthier planet, then surely it has to reach not just to all humans, but to all life interconnected—all species.
3) “All species” includes…mosquitoes.
4) How uncomfortable are we willing to be in order to get along with each other? Are we willing to tolerate a few more mosquitoes instead of aerial bombing our own neighborhoods with the biotoxin malathion?
5) What about the agricultural watering that is feeding the mosquito population in the first place? Are we willing to grow less food? Never once, in the history of humans and food production, has increased food led to a net decrease in human hunger, never mind suffering…

Not one among this sequence of thoughts is a topic of discussion at the barbecue. There is, however, much discussion of something that makes me quite uncomfortable: guns. Guns, in the hands of people, kill people. The night before, a woman had shot and killed herself and another woman in a struggle and wounded a third. This happened just down the street from our clinic, and just next door to one of the potluck-goers. In a town this size everyone is connected to someone. It would have been impossible not to discuss.

In the course of talking various opinions come out on gun control. Being new to the group I mostly listen. It isn’t surprising in rural eastern Washington that there are staunch gun rights advocates, even among what I assume to be a relatively liberal subset of folks. Having grown up in rural eastern Oregon this is familiar territory.

It does, though, make me question my own tolerance of difference—how willing am I to sit down and try to reason with people of polar opposite opinions? Is there some common ground here? The discussion eventually turns to “the worst movie you’ve ever seen,” and no one really pushes the envelope on guns. I’m left to ponder this for the time being on my own.

How on earth does this relate to mosquitoes? Well, long after the fact, I have a brilliant idea. Why not let all those in favor of unlimited gun rights, and those in favor of mosquito eradication, find common cause in a mosquito hunting season? It could run from April through October, no limits, anything suspected of being or being near a mosquito is fair game.

Just to keep things interesting, though: Arm the mosquitoes.

Despair

“Despair is the only cure for illusion. Without despair, we cannot transfer our allegiance to reality…it’s a kind of mourning period for our fantasies. Some people do not survive this despair, but no major change within a person can occur without it.” —Philip Slater, Earthwalk

In March, in response to an email I’d written about feeling overwhelmed, a figure whom I see as a mentor wrote back, “Despair is not a useful option.” I am sad to say that until now I had not responded to this email.

The past year has held ample cause for despair. The movies "Collapse", "Inside Job", and "The End of Poverty(?)" offer glimpses of the problem. In Washington State last fall voters failed to pass an initiative that would have taxed only the wealthiest 1% and very specifically used that money for public healthcare and education. In Washington D.C. this week a group of freshmen lawmakers, for the sake of upholding tax cuts for the nation’s wealthiest individuals and corporations, is failing to compromise on legislation that will allow the U.S. government to pay its bills. And every day in my clinic I see the human consequences of this failure. The 51-year-old man who has to choose between paying for his medicines and his rent, having already cut back on food. The 63-year-old woman who was evicted from her home and is living in a motel with her daughter and grand-daughter. The 47-year-old patient who begs me to be hospitalized. He cannot buy the medicines that stave off the voices telling him to kill himself.

In my head I am trying to balance these two approaches to despair—despair as a non-option, and despair as the only cure for illusion. The one says, “If you give in to your despair, then who will do the work? Who will fight on behalf of your patients?” The other says, “By continuing to work at the level you are working, what are you actually changing? A life here, a life there, but the system is collapsing around you.”

Which brings me closer to the heart of the matter, which is to say: “On what level am I most useful?” And this causes a lump to form in my throat. Because I know the answer to that question. I know it, and I have been unwilling to face it. I have been unwilling to allow myself the despair that will actually allow me to change.

The truth is: I need you. The answer to that question, the question of how I can work for change on a deeper level than individual patient care, is that I need to reach out to others. Patch Adams says: “We need each other, more deeply than we ever dare to admit, even to ourselves.”

The question then becomes, what am I willing to give up in order to ask for that help? Asking for help, working with others—in a meaningful way—takes time and energy. Where has my time and energy been going? It would be easy to say, “Well, duh! You’ve been taking care of patients...you haven’t had time to stay in touch with friends and family.” And that is part of the story. The easy part. The harder part, the part that takes me into despair, is that I have clung tenaciously to an idea, a fairly simple idea, an idea that has kept me from making positive change in my life.

The idea is this: “I am the hero of the story.”

That is it. It is simple, and pernicious. I am the hero of the story. It is the idea that has kept me from reaching out to friends and family (“I’m tough, I can get through this on your own, I always have!”), from fully engaging patients as partners in their own health (“You’re not ready for the whole truth—that our world is collapsing—so let’s keep this at a superficial level”), from admitting to myself when I’m NOT the positive and healthy person that I strive to be. And in this denial, in this denial of despair, I’ve ironically allowed myself to be the victim. To say, “It’s the overwhelming daily work that’s keeping me from doing the things I want to be doing.” In trying to maintain my hero status, my self-image as the can-do cowboy, I’ve put on hold the essential work of self-reflection and dialogue with others.

And this is not trivial work, not a luxury to be afforded only when things are going well. In fact it is probably most important at the very moment when it seems that there isn’t time to do it. It is not that despair is not a useful option. It is that despair needs to be discussed in bars and shouted from the rooftops.

At the same time I must caution myself against the ebullient joy I feel welling up as I write that last sentence. I have a tendency to flip too easily between self-despair and self-resolution, to think I’m back in the saddle again when I haven’t actually addressed the underlying issue that threw me off. And in this case, as identified above, I need to get rid of the horse and saddle all together, and start the more demanding—and ultimately, ojalla, rewarding—work of coalition.

Al Qeida Infiltrates Local Safeway

Omak (AP)—A man of Middle Eastern origin was observed walking into a rural Washington grocery store, according to several cashiers and a shelf stocker. The man, whose club card number identified him as one “Rani Hasan,” walked in, bought two cartons of soymilk, a package of organic strawberries, a can of black beans, then walked out and hasn’t been seen since. “He walked in, bought two cartons of soymilk, a package of organic strawberries, a can of black beans, and then BAM! He just walked out, and hasn’t been seen since,” said one cashier, who declined to be named for safety reasons. “Al Queida, for sure.”

I apologize to the real Rani Hasan (Doctor Rani Hasan, I presume) wherever he may be, and I apologize doubly to the hardworking employees of Safeway, who, I’m sure, are thinking no such thing as the above. I can’t resist, however, playing out this fantasy in my head every time I make a purchase under Rani’s name. Let me explain.

Safeway, like many other national grocers, claims to reward customer loyalty by giving club card discounts to those of us willing to register our information with them. Now, as there’s no penalty for being part of multiple clubs, I’ve always had the suspicion that this club discount system is being used to some far more nefarious end. Maybe they are keeping track of how much soymilk I drink and have been steadily decreasing their supply accordingly to try and get me to drink, I don’t know, coconut milk. Maybe once my lifetime purchase of black beans reaches a thousand dollars then men in dark suits and sunglasses will show up on my doorstep. Who knows?

You want to know how many pounds of spaghetti squash I bought last month, Safeway? Well, two can play this game. This is where Rani Hasan comes in.

Because Safeway allows me to identify myself by phone number alone, I still use the phone number assigned to Reed Hall, Apartment 4, Room A, Johns Hopkins University School of Medicine, Baltimore, Maryland. This was where I was living when I registered for Safeway’s glorious club, and I’ve seen no reason to update my information. The fun part, of course, is that the information attached to this phone number has been updated with the change of tenants. For about a year I purchased my strawberries under another boring Caucasian name, Ben Smith or the like. But since 2005—and I assume the reason it hasn’t changed again is that smartphones have replaced all landlines in the lives of incoming freshmen to the School of Medicine—I’ve been going to Safeway as the very suspicious, clearly foreign Rani Hasan.

In Seattle this was not such a big deal. Cashiers would barely look twice at me. “Thank you, Mr. Hassen,” they’d say, probably wondering why Ronnie was spelled so oddly.

But in the tiny fishbowl of Omak, Washington, I’m sure it’s only a matter of time before some well-meaning soul reports me to the authorities. I can’t go into Safeway anonymously. On my last trip I ran into three patients, one of my MA’s, our local radiologist, and one of our dentists. People know my face. They know my name. It is not Rani Hasan.

Not that that stops me from wishing, more and more, that I could become Rani Hasan for these brief trips. Not just in name but in appearance. I have no idea what you look like, Rani, but my guess is you’re not gangly, blonde-haired or blue-eyed. Just once I’d like to purchase a six-pack of Negra Modelo without worrying who’s behind me in the checkout line.

I’d even be willing to trade. Wherever you are, Dr. Hasan, if you’d like to go to Safeway as Ned Hammar, just let me know. If you can’t find me, just get yourself a subscription to the Omak-Okanogan Chronicle. I’m sure that, in between the ads for free chicks and the results of the Stampede, I—as you—will be appearing there soon.

“Saving the World” as an Emergent Theme in the K-12 Doodle for Google Competition

Introduction
In a world with seven billion people, numerous ongoing wars, and the well-documented and widespread destruction of natural ecosystems, one might well ask, “Does the health of the planet concern today’s children?” One interesting way to answer this question is to look at the results of an art contest for grades K-12 hosted by the world’s most popular search engine, Google. The “Doodle 4 Google” competition asked children to submit artwork in response to the open-ended question, “What I’d like to do someday…” The theme that emerged in the #2 position, second only to “Animals”, was “Saving the World.”

Materials, Methods, Limitations, Biases
The 400 winning entries (two per state for each of four grade divisions, or eight per state, for each of the 50 states) of the “Doodle 4 Google 2011” competition were reviewed, with evaluation of both title and visual content. Each entry was then tallied according to categories. A category had to have at least two entries in order to be listed. Any one entry might be tallied in more than one category; for example, a picture depicting space exploration with the title “I Want to Be an Astronaut” might be tallied in the categories “Career”, “Space”, and “Explore”; however, no entry was tallied more than once in any single category.

In categorizing each entry, every effort was made to consider the title and symbolic content and to avoid allowing tone, artistic style, or ability to influence placement. For example, a picture clearly depicting a heart might be placed in the category of “Peace” based on the symbolic content, whereas a picture of butterflies painted in soft pastels might be placed in the category of “Animals” alone even if the tone was peaceful, unless a title such as “World Peace” clearly affirmed the artist’s intention for peace.

Despite this attempt at objectivity, of course, viewer bias remains one of the primary limitations of this study, and it would be informative to have multiple independent viewers perform the same categorization. Categorization of all 400 images was done twice, with a time lapse of one week in between viewing, yielding almost identical results between the two efforts.

Another limitation is that only the 400 winning entries immediately available online were reviewed, whereas approximately 100,000 entries were submitted. While a priori selection of these 400 winning entries may have been influenced by unpublished biases by the judges, the only published criteria had no mention of content. The four selection criteria were as follows:
• Artistic merit: based on grade group and artistic skill
• Creativity: based on the representation of the theme and use of the Google logo
• Theme communication: how well the theme is expressed
• Appropriateness of the supporting statement
As “Saving the World” is a broad category, a bias of this study is the inclusion of any major ecosystem, such as “rainforest”, in “the world”—however, an entry depicting a rainforest or rainforest animals would only be included in the “Saving the World” category only if the title said something like “Save the Rainforest.” Furthermore, in each age group, a distinctive category of “World” emerged without explicit words or symbolism to suggest “Saving the World” (if an entry was tallied in one of these, it was excluded from the other). A broader interpretation of “Saving the World” might have including these entries (32 in total) because of the implicit tone of most of them.

In ranking the categories, the first consideration was total number of entries, followed by the number of entries in grades K-3, and then by grades 7 through 9. One category (“Fashion”, with 6 entries) was moved down in rank below those with only 5 entries because it was not represented by entries in at least two non-contiguous grade divisions. This yield an arbitrary but useful division into 31 “major” (i.e., those with at least 5 entries AND representation by entries in at least two non-contiguous grade divisions) and 20 “minor” categories or themes.


Results
The categorization of the 400 entries into the top 51 categories (all those with at least 2 entries) is shown in Table 1.

As Table 1 shows, the top theme is “Animals” when considering all four age groups totaled together, with 57 entries. However, the 23 “Animal” entries from grades K-3 constitute the largest proportion of these 57 entries. “Saving the World” was second only to “Animals” in grades K-3 and “Art” in grades 4-6, and emerged in first place in both of the two upper grade divisions.

If one tallies together the categories of “Clean Energy”, “Clean Water”, “Pollution”, “Green/Recycling”, “Local/Organic”, “Hunger” and “Climate Change” into a “Planet” category, there are 54 total entries. Only 16 of these were tallied in “Saving the World”, meaning that there were 38 unique entries within these categories. This would put it in 3rd place just behind “Saving the World” and above “Art”.

Table 2 displays representative titles for some of the top categories.


Discussion
“Animals” and “Saving the World” emerge by a substantial margin as the top two themes. If one considers the aggregate “Planet” category mentioned above, this comes in at number three; summing the entries for “Saving the World” and “Planet” yields a total that is far and away the number one theme, well above even “Animals”.

As described above, the entries in number three “World” were not tallied in “Saving the World”; a broader interpretation of including these would again—independent of the “Planet” entries—put “Saving the World” well above “Animals”.

The other two most populated categories in the top five, “Art” and “Imagine/Dream”, might suggest that children who submit artwork are more inclined towards art and idealism than their non-submitting peers, and that we might get a different result if we were to require that every child in a population submit artwork and tally the results.

At the same time, even within this perhaps-more-idealistic cohort, themes that one might expect to have more numbers simply don’t. “Space” and “Sports” come in at #10 and #17, with 16 and 11 entries respectively, less than a third of the number in “Saving the World.” “Peace” (#18; 11 entries) has as many entries as “Sports”. If one adds the 8 entries of “Cooperation”, these 19 entries would rise above “Space.”

It is interesting to see that within “Learning/Teaching” (#6; 22 entries) and “Science” (#14, 13 entries), the highest number of entries is in grades K-3. These categories both reach a nadir of two entries apiece in grades 7-9. One explanation is the probable transference of some of these entries into more concrete ambitions, as evidenced by the growing numbers in “Invent/Build” between K-3 and 7-9.

Overall, this study might give encouragement to anyone interested in a healthier planet and a more hopeful future. Regardless of the above-mentioned limitations and biases, the clearly dominant themes all had to do with preservation of our natural world. The biggest limitation of this paper, in attempting to categorize and define trends in this sample of children’s artwork, is that one cannot here see the art itself. One can go to the internet and search “Doodle 4 Google” in order to more fully appreciate the intentions, not to mention creativity and expressiveness, of these K-12 schoolchildren.

A Series of Unfortunate Events

No one wants to hear good news.

Take the wild popularity of Daniel Handler’s A Series of Unfortunate Events, the commercial and critical success of Modest Mouse’s Good News for People Who Love Bad News, or the voracity with which we consume any television or newspaper reporting of tragedy—which is to say, most of the reporting. It might seem that we are genetically encoded to seek out suffering.

If such is the case, I’m happy to recount that this past week was Miserable with a capital M. On Monday I am in the hospital until 11 PM after transferring one critically ill patient. Her O2 sat drops from 98% to 60% and her systolic blood pressure goes from the110’s to the 60’s. We rush to give fluids and maintain oxygenation. Tuesday I stay again until 10 PM to help with a second emergency transfer, a man whose blood refuses to clot and we cannot wake up from breathing assistance. On the occasions I am able to make it to my own outpatient clinic, I feel overwhelmed trying to manage medically what I so often see as failures of society: failure to prioritize grade-school education over tax breaks for the super-rich, failure to protect local farmers from having to compete with an influx of cheap packaged food products, failure of insurance to cover basic, proven therapies that would not only improve health but also save money by keeping people out of the hospital.

Yet if tragedy is our daily bread, we also seek out humor, hope, good-ness. We marvel at the story of the 4-month old baby pulled from the wreckage, alive, a full 96 hours after the tsunami hit the coast of Japan. We celebrate the pilot and crew who manage to land a plane with 259 people on board after both engines fail (LL and I just finished listening to Atul Gawande’s The Checklist Manifesto on CD.) We laugh with relief when Jackie Chan uses a chair and a ping-pong net to defeat an attacker twice his size.

In my series of unfortunate events this past week, there is a moment that I hold on to for hope. It is not the phone call I receive on Thursday that the man we transferred is awake and doing quite well, though that is unbelievably good news. It is not the patient who presents with a stroke and recovers quickly. Nor is it the small times when I get to go home and sleep.

Rather it is the moment of calm in the middle of Tuesday’s transfer when, with the indispensable help of our anesthesiologist, we have stabilized the patient enough to wait for the flight crew. For a few minutes, I get to talk with the son about his dad. I get to hear about his move out to this tiny town and his years working as a diesel mechanic. I get to hear about the time up in Alaska when he pulled in five halibut—and then that night couldn’t lift a drink up to his lips because his arms were shaking. How he was a simple, hard worker who spent too much of his life standing on hard concrete lifting heavy objects.

Then the flight crew arrives and it is all medical again: how much fresh frozen plasma was given over what time frame, the exact lab values measuring bleeding time, the results of the chest xray.

But for those few minutes, waiting there with the patient’s son and my colleagues, we are able to know that we have done everything that we can do, that there is nothing else that we can do, except talk to each other, connect, as humans.

That is good news indeed. Even for people who love bad news.

On writing

This is going to be a short blog.

A survival blog.

An I'm-overwhelmed-and-don't-have-time-to-write-right-now blog.
This is an after-the-fact blog, a take-a-deep-breath blog, a there-is-so-much-going-on-in-the-world-blog, a how-could-I-possibly-sit-still-for-even-a-moment blog...

An essential blog.

This blog, this writing, this act of creation, needs to take place. For me. For my own sanity, for my own survival. This act I must do. This moment I must take.

There have been so so many others who have said the same thing much better. Under much more trying circumstances. Why create? Why write? Why think?

It is Nelson Mandela writing for 30 years in the prison of Apartheid.

It is Georgia O'Keefe noticing, really noticing, a flower. The skull of a cow.

It is Paulo Freire engaging, teaching, revising, communicating.

It is Martin Luther King, Jr., in an Alabama jail;

it is Henry David Thorea in a Massachusetts jail;

it is Arundhati Roy unwriting a dam with her pen.

It is Andrea Gibson, tiny as the universe, standing up on a lit stage in a darkened room:

"we have to create
it is the only thing louder than destruction
it is the only chance the bars are going to break,
our hands full of color
reaching towards the sky
a brushstroke in the dark
it is not too late
that starry night
is not yet dry"

Forgive us our trespasses

According to my 1966 Reader's Digest Great Encyclopedic Dictionary, the word trespass derives from the Latin trans, beyond, + passare, to go. Similar combinations yield transgress, from gradi (to step), transcend, from scandere (to climb), and the related exceed, excel, surpass, surmount, outdo.

Of these "go beyond" words, only trespass and transgress have taken on negative connotations, and these mostly in the context of law and religion. But what if the law or the religion is unjust? Then is to trespass not to excel, to transcend?

Disclaimer: Even as my heart races with excitement and my mind jumps to Thoreau's principles of civil disobedience, I have a confession to make. This entry was not inspired by causes any greater than skiing and parkour. A couple months ago LL and I committed a barbed-wire trespass in the pursuit of telemark ski turns—further confession, I committed the trespass and dragged LL along with me. Then a few weeks ago, inspired by a Sports Medicine CME at which I was introduced to the label "parkour" for the brilliant environment-interactive free-running highlighted in the French action movie District B-13, I scaled a 30-foot concrete wall using the overgrown spillover branches of a tree only to find myself in one of Seattle's gated communities giving an impromptu parkour explanation to one of Seattle's gated community watchmen.

But even as I make this disclaimer I cannot help but think of what is happening in Egypt and Libya, not to mention Wisconsin, of the protest against unjust governance, the trespassing and transcendence happening with each voice raised. One of Thoreau's central points in Civil Disobedience is the connection between the small, daily, unexamined allegiances most of us contribute to the status quo at home, and the actions that that same status quo achieves remotely. With our wages we condone harm. By our taxes, by our purchases of household items, by our silence, we enable the violence that our government and our corporations commit.

"I quarrel not with far-off foes, but with those who, near at home, cooperate with, and do the bidding of those far away, and without whom the latter would be harmless. ...It is not so important that many should be as good as you, as that there be some absolute goodness somewhere; for that will leaven the whole lump."

Before writing this today I had not read Thoreau’s essay. I would not have been able to articulate any of his ideas, beyond this: “Unjust laws exist: shall we be content to obey them, or shall we endeavor to amend them, and obey them until we have succeeded, or shall we transgress them at once?” But there is so much more here! Set in opposition to slavery and to America’s imperialism in invading Mexico, Civil Disobedience questions the nature of a government that promotes stagnation over reform.

“Men generally, under such a government as this, think that they ought to wait until they have persuaded the majority to alter them. They think that, if they should resist, the remedy would be worse than the evil. But it is the fault of the government itself that the remedy is worse than the evil. It makes it worse. Why is it not more apt to anticipate and provide for reform? Why does it not cherish its wise minority? Why does it cry and resist before it is hurt? Why does it not encourage its citizens to be on the alert to point out its faults, and do better than it would have them?”

It would be easy and not untrue to say that we are living in both scary and exciting times. Even as the few work to consolidate power—a rabid dictator in the Middle East, a no-less rabid governor in the Midwest—there is a recognition from the many that this is unjust.

What would be untrue is to call the situation novel. It is the struggle between the propertied and the property-less. It has been going on ever since men began to lay claim to particular pieces of earth and extract everything possible, rather than living in equilibrium with ourselves and our world. What Thoreau does is to call our attention to how much our wealth comes at cost to others, in a way that has always been true but has become much less transparent. It is simple (and requires no change in behavior) to look backwards and see that the slavery of the 19th century was wrong. It requires more work to make the connection between a Coke I might drink or a shirt I might wear or a computer I might type on, and the often unjust (not to mention environmentally unsustainable) conditions under which those items were produced.

"It is not a man's duty, as a matter of course, to devote himself to the eradication of any, even the most enormous, wrong; he may still properly have other concerns to engage him; but it is his duty, at least, to wash his hands of it, and, if he gives it no thought longer, not to give it practically his support. If I devote myself to other pursuits and contemplations, I must first see, at least, that I do not pursue them sitting upon another man's shoulders."

If the injustice of our world requires our daily support to continue, then it is time for us to practice parkour. It is time to trespass, to transgress, to excel.

Separation

How do I begin to write? How do I, a mid-thirties white male physician who is happily married to the love of my life, begin to write about a 20-year-old Native American woman, incarcerated as a bystander to a violent crime, who gave birth 40 hours ago and must now give up her baby?

The first thing to say is how very little I know about this woman.

I don’t know the story of her family, other than that there is a history of substance abuse. I don’t know the details of her own birth, whether there was alcohol involved in her mother’s pregnancy, if she was born early, if she was breastfed. I don’t know if she was wanted or loved or ignored or abused or some of all of these things.

Our electronic medical record could be called comically inadequate, except in this case the inadequacies are anything but amusing. Her chart lacks a Y/N checkmark beside “Less than 8th grade education”, and the checks for “Alcohol” (N), “Drugs” (Y) and “Tobacco” (N) are the opposite of what she has told me—she admits to alcohol and tobacco around the time of and possibly after getting pregnant, but denies drug use. There are negative checks next to “Abusive relationship” and “Cats” (cat feces being a risk for a parasite called Toxoplasmosis, although in developed countries a more common source of this infection is from consumption of undercooked or cured meat or meat products).

There are affirmative checks next to “No family support,” “Poor living environment,” and “Significant social problems.”

What I can speak to is what woman has been through. When I assumed her care late in the second half of her pregnancy, she had just had preterm contractions and been told that she was a bad mother to the fetus for not taking a medicine that was making her sick and for which there is no evidence of improved outcomes. For every clinic visit, she would be escorted into the exam room shackled at the ankles and wrists. Not one but two generously-proportioned guards would stand outside while we talked. For her delivery, she was allowed to have no family or other support present.

To their credit, all of the wardens and nursing staff always treated her kindly and courteously.

At our first visit this young woman was very guarded. As the number of visits increased both in number and frequency—she had several more scares for early labor—she seemed to open up little by little. Occasionally she even smiled. Whether she grew to look forward to our prenatal visits, I’ll never know.

Because of horror stories she’d heard about epidurals, she wanted to “go naturally” when it came time, without medicine in her spinal fluid to numb her pain. LL and I had just watched The Business of Being Born and I supported her decision; at the same time I did my best to dispel the myths regarding epidurals.

2 days after she’d made it to term, having had several previous visits to the hospital for which she was “ruled out” for labor, her bag of water broke and her cervix began the often-tortuous dilation to 10 centimeters. She stuck with her decision to not have an epidural. Throughout the labor she remained quiet, stoic, and polite. Every time I came in to talk with her she asked appropriate questions. Mostly she would be looking down with her face a blank slate, but on rare occasions she would let a smile escape, and even more rarely let her pain show. As I would be walking out of the room, she would invariably look up and quietly say, “Thank you for everything.”

17 hours, several bags of Pitocin, 5 doses of GBS-prophylaxis antibiotics, a last-minute epidural, internal monitoring, and 20 minutes of pushing later, she delivered a 5 pound 7 ounce beautiful crying baby girl.

For the next precious 40 hours she got to hold her baby. The baby was more consistent with being 2 weeks early than being term, and had difficulty latching onto her breast to feed. But it did not become febrile, lose more than the accepted 10% of its weight, or become jaundiced. Somehow through all that this woman had endured her baby was healthy. And in her eyes, for this baby, was something I had not seen. It was love. It was pure and simple love.

I again find it difficult to write. For me it was hard but easy this morning, when she had to go back to jail and her baby had to go to a grandmother somewhere to be taken care of: I am there, I cry with her, I leave. I carry on with my life. I cannot know, cannot imagine, what this woman went through. Is going through. Right now everything is up in the air. If all goes well for her in court, she and her baby could be re-united as early as the end of next week. If not it could be months, or years.

Ojala that it goes well. Ojala that it goes well.