Writing at the end of the world

The end of the Mayan Calendar has come and gone. As tsunamis and firestorms have not yet entirely engulfed the world, the onward march of days tempts us to pat ourselves on the back and conclude that everything will be right as rain.

If only that were so.

While I was on the board of Real Change, editor Tim Harris was accused of using his column to write the same rant over and over. I couldn’t agree more. And I thank Tim for doing so.

Real Change challenges a vision we hear expressed so universally that we never think to question it. Author Daniel Quinn pointedly identifies this vision in his novel Ishmael: man exists to take from an Earth made just for him. Always will the crops grow, the fish multiply, and the rains fall. Every billboard, TV ad, political speech serves this one idea: you deserve more, and there is more to take. The voice of our shared world culture, says Quinn, lulls us to sleep with such false reassurance. Harris challenges us to wake up and see the truth.

Why must we challenge this vision? Because is not viable. Whether with a bang or a whisper, a world built on such a vision will end. Not only is limitless consumption impossible on our finite planet, but in the meantime it guarantees two things: growth and inequality. Excess food results in population growth. Growth supplies labor well beyond that needed to grow food, and said labor is exploited to produce goods hoarded by the few. The two are inextricably linked. Unchecked, this vision has played out in a population that has grown from one billion to seven billion in the last 200 years, compared to the 10,000 years it took to grow from a mere 10 million, to that first billion. And it has produced the greatest gap between rich and poor in human history, in which the world’s three richest men have greater wealth than the 48 poorest countries.

Once again: the world’s three richest men own more than the 48 poorest countries.

If growth and inequality are the predicted consequences of unbridled consumption, then healthy relationships are its first casualties. Taking more than necessary establishes the unavoidable hierarchy that some beings are worth more than others. This hierarchy is easier to maintain the farther apart are those taking and those being taken from. We avert our eyes from the homeless; we willfully ignore the children who sew our shoes and the rainforest cut to raise beef for our burgers. Real Change erases that distance. It forces us to consider the disastrous human and environmental consequences of our actions—which can occur even with the best of intentions.

As an example, consider the Grand Coulee Dam, touted as a pinnacle of both green energy and equitable wealth distribution. When my wife and I moved to the town of Omak two years ago, this concrete monolith 40 miles away fascinated me. Completed in 1942, it was supposed to not only light up the West with clean electricity, but also provide over a million acres of land to small family farms. It was the crowning achievement of FDR’s New Deal and it promised the dream of more to all.

Welcome to the desert of the real. People created loopholes such that the 40-acre family farms disappeared into parcels of 80, then 320, then 960-acre factory farms. The electricity is discounted preferentially to distant corporations while local power and infrastructure rot. The seventy-plus dams across the Columbia and its tributaries have brought one of the world’s largest salmon runs to the brink of extinction. In doing so, they have decimated a tribal nation built on these fish. Blaine Harden’s A River Lost documents how Native rates of suicide and homelessness soared after Grand Coulee’s completion. Downstream of this “clean energy” machine, the Puget Sound orca population is dwindling. And yet it gets worse: even if all the dams were removed, the salmon and those that depend on them may not survive this century. In a 2006 New Yorker article titled The Darkening Sea, Elizabeth Kolbert explains the new threat of ocean acidification. Even if we had ceased all industrial carbon dioxide production seven years ago (we haven’t), the resulting drop in pH as the oceans absorb what is already in the air could cause the extinction of all shell life (shells dissolve in acid). If shells die, coral reefs die, as does half of the phytoplankton that is the base of the entire marine ecosystem.

Imagine a world without salmon, orcas, sea turtles, penguins, dolphins. Without fish. Without fishermen.

We need voices such as Real Change to demand that we pursue a different vision, and not merely because the consequences of growth and inequality are becoming ever more horrific.

In challenging a vision built on endless consumption, we must also demand a vision built specifically on what we’ve lost: the healthy relationships whose sum is a community. Humans are one part of the web of life we call Earth. Using an approach of education, empowerment and love, organizations such as Real Change transform a commerce of taking and being taken from into a mutually beneficial exchange between equals. In a community, every relationship counts. For millions of years the basis of sustainable hunter-gatherer societies was that all members of a tribe—and of their environment—were valued, precisely because they all were needed. A UW physician, Stephen Bezruchka, has shown in numerous studies that the more egalitarian a society is the healthier it is, in every outcome that can be measured. A vision of community will serve us well in the future as it did in the past.

If Tim Harris’s editorial repeats itself, it repeatedly challenges an untenable vision of taking until there’s nothing left to take. It challenges this unfolding nihilism with the only viable alternative: a society built on community, on a love for the world, for all the world.

That, to me, sounds like a new beginning.

The place where love shines through

Arguably the most self-injurious act I commit on a semi-regular basis is to give myself a haircut.

Semi-regular, because when I have the time, I don’t mind patronizing a barbershop. Sometimes my schedule just makes it difficult. Not precludes but delays it long enough that my exasperation outgrows the hair itself, especially on the back and the sides—we won’t speak of the thinning top and front—and out come the scissors. I look forward, albeit with some trepidation, to the time when the hair doesn’t grow back at all and I can save myself the trouble.

Self-injurious, not because I draw blood, but simply because the results are, well, patchy. Sometimes a loving family member insists on a bit of clean-up. While this is never refused it should be noted that I and I alone take full responsibility for an end that is occasionally beyond rescue.

And arguably, because I have gotten myself into enough tight situations that outside inspection might suggest not only a will to self-destruction but a pattern thereof. From jumping off of a 100-foot cliff into water at age 17, to being rescued by helicopter from a 1000-foot cliff above water at age 32, there has been an irregular but spectacular incident log. In college, for no reason that I can recall other than to prove to myself that I could do it, I swam across the Connecticut River and back at 3AM. In the Peace Corps, I very nearly spent the night alone in the middle of the (South African) woods after taking a few detours on a bicycle and then getting a flat just as the sun set. And more recently than I would care to recall I did spend the night in the woods—unplanned though not alone, on top of a mountain in the dead of winter, with new snow falling to cover any ski tracks.

If any such pattern existed then I am happy to report that it is over.

In a deeper way than even marriage confers, becoming a parent has bestowed on me a sense of caution. Not a timid or constricting caution but a joyous and life-affirming caution. An awareness of world beyond self in a way that celebrates the physically small but emotionally staggering risks of raising a child.

This may seem a truth so obvious as to be trivial. Yet until recently, when an unexpected event led me to realize it, I think I had been unconsciously mourning the loss of—what? A secret swagger of invincibility? A false sense of spontaneity?
The event, thankfully, was nothing life-threatening. Rather, it was a moment of clarity in the middle of a conference on mind-body-medicine in which I recalled the words that the most amazing dance teacher blessed me with at age 18: “you are the place where love shines through.”

In that moment of recall I saw the swagger and the spontaneity for what they were: a carefully and secretly nurtured feeling of superiority. Nothing overt. Plenty of moments of self-deprecating laughter along the path. But there nonetheless. A feeling of, “it’s up to you to save the world! You are the one! If you can’t do it no one can!”, coupled, irrationally, to “you can do whatever the heck you want to.” And I think until I acknowledged that, that there was a part of me, which, recognizing that I could no longer be physically reckless (never mind that I was falling short of world-saving), felt cooped up inside.

And just like that the naming of it caused it to fall away. To fall away and allow me, hopefully, to continue on the journey of being the parent, partner and person that I want to be. In that moment, in the midst of a hundred strangers going through the same conference, I felt confident enough to stand up and share my story. I do not have to be the strong one, the consistent one, the family doctor who stands up for his community and for the world—not that these are things I couldn’t and can’t strive for. But I don’t have to prove anything, least of all to myself. There are no more physical cliffs to ascend; the real cliffs, after all, are just beginning.

In that moment I could be comfortable with who I have been, who I am. I could just breathe in and out and be the place where the love shines through.

Granted, there may always be a streak of recklessness alive and well in me. Hopefully one that at its worst will only be cosmetically injurious—my apologies in advance if the love shining through is a bit patchy.

Yay!!!!!

Yes Obama!!!

Up

Climbing to 30,000 feet appears to be the only means I have to escape, long enough to write, the earthly concerns that have so occupied me this month. So it would seem appropriate to write about matters less terrestrial than I otherwise might. Plainly put: when awake with both feet on the ground I’ve been overwhelmed, and my mind has no desire now to dwell there when my body doesn’t have to. As Morpheus advised Neo, “Free the mind!”

This is easier said than done. Maybe the conference that LL and I are flying to, a conference on Mind-Body Medicine, will help. But letting go—allowing my thoughts to rise above such matters as upcoming patient visits, our baby’s sleep poop laughter growth and development schedule, or the forest fires consuming eastern Washington, to name but a few items—is as difficult as it is necessary.

When I advise patients to meditate I give them something to focus on: I have them breathe slowly in and out and say the number “one” on every out-breath. So perchance I must give myself a focus. Something not of the earth. Something up.

What is up? Trees, of course, though these are bound to the earth, and immediately I think of Gandalf, Bilbo and the dwarves awaiting treetop rescue by eagle from the goblins lighting fires underneath, and from there I go to the aforementioned fires scouring the arid West in which I live, while pumps siphon off snowmelt to feed neon lights and artificial fountains from Spokane to Phoenix, and then I think that we must be the goblins in this story. This will never do! What is above trees?

Sky. Wind. Clouds. Ahhh…forest-fire smoke. Radio towers interrupting sandpiper migration patterns and jet-fuel trails from unmanned drones marking dubious targets. Higher, higher!

The stratosphere. Ozone depletion and satellite junkyards falling into the Pacific, even as ever more machinery is commissioned by multinational corporations to zero in on the untapped niche market of left-handed preschoolers who don’t yet own iPhones. Higher yet!

The moon…1969 landing, one small step, American flag. No good. Mars. Land Rover. Pluto. Voyager, Carl Sagan, whales singing ad infinitum into the void.

It seems that even leaving the solar system I struggle to be free of the tedium of human preoccupations. Is there anything else out there?

Closing my eyes and breathing for a few minutes in the noisy, crowded airplane, I am transported, not to nirvana, but to a place of focus amidst similar chatter. I am in college again, in the café on the top floor of the Wesleyan Student Center, my nose pressed into texts on Chemistry and Physics. At the other extreme of the scale, I burrow into molecules and atoms and the even smaller bits that make them up.

The parallels to the cosmic are actually striking. For starters, everything we can see or smell or touch is made up of particles that are themselves 99.9% empty space. The more we try to zero in on the actual “stuff”, the less it looks like matter and the more it looks like energy. Predicting the outcome when bits of these energies collide is expressed in matters of probability. The ability of such interactions to coalesce into clusters of existence that taste sweet on our tongues or bounce off our soccer cleats into a goal or grow from a seedling into a sequoia is no less amazing than the ability of clouds of dust and gases to coalesce into a green and blue planet.

Seen from this level, the idea of something as complex as life itself is absolutely, mind-blowingly staggering. And retracing my journey into space in the face of this miracle, humans and our concerns seem no more and no less important than the named types of the smallest subatomic particle, the quark. We can be quite strange, and we can be all charm. We can be top or bottom, or just plain down. And we can be up.

Flood, part 2

It is, predictably, 17:32 on the 31st of August, i.e., there are six and a half hours remaining in which to write the monthly blog I set out to write and which I have neglected for the past two months.

Beside me on the bed, cradled in his mother’s arms and sleeping soundly, is the cause for the neglect as well as the inspiration to write further.

Three months ago I described a flood. If we humans are not merely the cause of the flood but the water itself, I asked, how might we direct our energy—our love, to which can be traced our abundance—to include all life on earth? And implicit in this question: might we in so doing construct the lifeboat of our own salvation?

In other words: the human species, through our prolific love, through, one might say, our parousing, has brought itself in a short ten thousand years (the time since the dawn of what Daniel Quinn would call totalitarian agriculture) to the distinct possibility within the next 100 years of an ecological collapse not seen since the fall of the dinosaurs. The extent to which this occurs, and the degree to which humans survive it, will depend in large part to the degree in which we can broaden our perspective. The degree to which we can recognize that our own well-being is inextricably linked with that of other species one earth.

In the last couple of months I’ve given myself the luxury of some non-medical reading. Three seemingly disparate stories stand out in particular as relevant to the above question.

The second story distracted me from the first: while visiting my dad in Oregon, I commandeered LL’s book-club selection, Ender’s Game, and didn’t really put it down until I’d finished. In crisp prose Orson Scott Card tells the story of a civilization so bent on total annihilation of an alien species that it is willing to risk its own end in one final war. What struck me about the novel was not as much the terrible outcome as the degree to which the soldiers—who are children—are inculcated from day one with the sense that they are utterly alone. That, ultimately, they must destroy or be destroyed.
The third story I’m in the middle of reading. It is the tale, in two books which LL’s dad has compelled me to read, of the “death of the Snake and Columbia rivers”. Apart from his urging I might have read these on my own. I used to guide on the Snake River where it still flows wild through Hell’s Canyon. For a while I’ve been aware of the direct link between declining orca populations in the Puget Sound and the dam system on the Snake-Columbia watershed that has reduced salmon populations to 1% of their pre-dam numbers. The blatant disregard for salmon and the Native Americans who depended on them was sad but not surprising. What did shock me was the degree of collusion between government and corporations. We taxpayers pay $870 million a year for dam upkeep and such “unforeseen” but totally predictable costs as dredging, to keep shipping channels open as silt piles up in dam-induced slackwater—while rivers die and the electric prosperity that was supposed to go to all citizens is awarded, by means of preferentially discounted rates, to giant corporations.

The first story I come to last because it was the most immediately relevant: an article in the Atlantic, by Anne-Marie Slaughter (former Director of Policy Planning for the U.S. State Department) titled “Why Women Still Can’t Have It All.” Slaughter highlights the very real differences that still exist between men and women in social and economic worlds. Without in any way trying to downplay these important differences, I thought in many respects her title could have had “Families” in place of “Women”. The article discussed how the higher one went in a career the more difficult it was to maintain a healthy balance with a family life.

Put another way, as it was in a parenting book that asked me to ask myself why my child isn’t sleeping: “Look at your own life first. Are you too busy?”

The common thread in these three readings was for me the unquestioned first priority to self, progress, career. What is lost—somewhat ironically, because it is the fire driving population growth and thus ultimately all economic development—is time for love and family.

In a science-fiction novel a little boy is the pawn for destroying another world, only after which is he allowed to try and understand it. In the very real and ongoing history of the American West, in author Steven Hawley’s words, “dams are performing their usual dirty work: transferring wealth for the profit of far-off interests,” and wiping out entire ecosystems in the process. In a lament for the impossible double task of raising a family while functioning in a patriarchal career, a State Department official comes to understand that the forward progress of nations somehow does not include the health of the families that comprise them.

Were I to end this here, “this” being this particular entry as well as the larger effort of continuing to reflect and write, I would be doing a dis-service to the authors I reference above. For each in their own way puts forth ideas, solutions, seeds of dissent from the status quo. But in the interest of preventing this from becoming an even longer ramble, allow me to grossly over-condense the advise I took away from my reading into a single word which I have failed to apply to this very writing: simplify.

The tired phrase that one “must love oneself in order to love others” rings true. If we hope to expand our flood of love to include not just our immediate selves but our larger human community and the ecosystems we are part of, we must first simplify to the family level and take the time to nurture our children.

Thank goodness that this job is made easier by the fact that LL and I have, as do all new parents, the most beautiful baby in the world.

*see May’s entry, Flood

June and July...

...were underwater.

Hopefully back soon in August!

Flood

My new favorite expression in English comes, perhaps not surprisingly, from someone to whom English is at least a second language—after Gujarati—and on a good night of the telling, a third or fourth or fifth, behind French, Spanish, and Farsi. This is the same friend who didn’t so much coin, as call into existence for its obvious need, the word “parouse”, to peruse while carousing. One of the many delightful things about Neville is the casual conviction with which he invents language, and it was with nothing less that I first heard him say, “Don’t worry about that. It’s just water over the bridge.”

Like the phrase “heels over head” (for is not one’s head almost always over one’s heels under normal circumstances?), this expression packs much more weight than the original and/or intended statement. Water under the bridge carries with it the reassuring familiarity of the hydrologic cycle: the moment may have passed, but just wait for the river to become the ocean to become the cloud to become the snowflake to become the stream, and it will return again. History is a circle. Have a cookie, and by the time you finish it you’ll feel right as rain.

Water over the bridge implies a linearly rising tide, infrastructure swept away, a calamity, a natural disaster, poodles on rooftops, get out the lifeboats. A flood.

Growing up I heard over and over again that history comes in cycles. Water under the bridge. The Egyptians, the Mayans, the Romans, the Anasazi, civilizations rising and falling, the regularity a lullaby. If there was a thread pulling anything forward, it was that of progress. Yes, thousands might die in a tribal conflict, but now we have…the wheel! Yes, millions might die in a world conflagration, but now we have…toaster ovens! morality! iPhones!

Lest you think I thumb my nose at progress: I love my iPhone, aspire to lead a moral life, and am eyeing a toaster oven (less electricity than a conventional, less nukes than a microwave). Neither progress, nor, for that matter, cycles, are bad ideas.

But what gets lost in this representation is the fact that almost everything we as humans have meted out upon the earth—most notably, ourselves—follows the mathematical model of water over the bridge. We and our phones and our ideas and our infrastructure are a flood. We are a natural disaster actively happening.

And by this I do not mean that what we have, that who we are and what we have created and are yet capable of creating, is anything short of wonderful. I simply mean that it is unsustainable. A river rises and falls with the seasons, but a flood by definition rises and rises and keeps on rising. Eventually, on a finite planet with a finite amount of water, it too must fall. My concern is the destruction that a flood leaves in its wake. In the process of converting as much as possible of Earth’s arable land to human food production, we drive other species to extinction. In the process of building the Grand Coulee and Hoover and Three Gorges dams to light our casinos and fill our swimming pools, we condemn salmon runs to oblivion and sanctuaries to wastelands. In devouring our fossil fuels we have already put enough C02 into the air that the ocean, in absorbing it over the next century, will become so acidic that up to 90% of all shell life—including half of the phytoplankton that is the base of the entire marine food chain—will simply dissolve. From the number of new McDonalds in developing countries to the obesity rates that follow to the health care costs of that obesity, from the inequality and abject poverty our unfettered capitalism ensures to the violence that that inequality promotes to the wars we wage in the name of combatting that violence (and, tacitly, to ensure unfettered capitalism), we have removed ourselves temporarily from a cycle of giving back to the earth at a rate equal to that we are taking from it.

Wow. This posting itself has become a flood, a tirade.

Someone recently asked me if I would ever again be able to write about anything other than my new baby. In some ways the answer is that I never have, even from long before he was born. All of the above, this torrent of words, concerns the world that we have created and that our children will inherit.

In wanting to make sense of this world, I also choose to believe that everything that we humans have brought about derives from a parallel flood. This other flood is that of a deep animal desire to take care of each other, to love and protect and provide for our young, our families. Bringing a child into the world is water under the bridge. There is no turning back. There is no return policy. There is nothing but a rising tide, at times overwhelming in the face of the trials of daily living, of love.

We do not invent toaster ovens and dam the rivers to power them out of malice, but out of desire to feed and house ourselves. When we wage war and plunder the earth’s resources, almost always it can be traced back to an urge to provide for our immediate needs, albeit at often-overwhelming cost to other humans, to other life, or to our future selves.

The question then seems to change. From, how can we stem the flood?, to how can we embrace the flood, expand our scope of the flood, to include the entire planet? Can we expand our love for our babies to include all babies, including those born today on the other side of the world, including those born right here 100 years from now?

That seems like a good subject to explore in next month’s blog. This bridge is long since underwater.

Infinite Time

It is early on Saturday morning. LL is sleeping. Outside the world is quiet, sunny, new. A couple of days ago it rained, heavily for eastern Washington, and now everything is ablaze in a green fire of tree buds and birdsong. The corkscrew willow, Russian olive, and catalpa trees we planted last fall have all pushed out new leaves, and under the carport a pair of swallows has built a nest.

On my chest, making occasional squeaks and grunts as he breathes against the Moby wrap holding him in place, is our new baby, our new world.

Shortly before this new world arrived, one of the PA's I work with told me to enjoy the infinite time that I had as a not-yet-parent. I smiled and nodded, as if I knew what he was talking about. I thought I did know. I thought that yes, becoming a parent would be a big, even huge adjustment. But infinite time? I did not have infinite time!

Sorry for the interruption. Be right back. Spit-up, need new burp rag.

The truth was I couldn't imagine being a whole lot busier than I already was. Now, looking back, I appreciate the small moments of time that I did have. Time for things like an evening game of Bananagrams with LL in which we'd make words like "discombobulate" and "scintillating". Time that I had but somehow failed to use to keep up on emails. Time to use the bathroom without--

Sorry, abnormal breathing pattern. Moby adjustment needed. Back in a minute.

Where was I? Oh yes, infinite time. I remember having a conversation about time, a scintillating conversation about time, in my residency training. It was during the taking of one of those Rorschach tests of the pysche, and the woman administering it explained that those of us like myself who were ENFP's tended to view time more loosely, and thus have a greater likelihood to, for example, be late for--

Excuse me. Fussing. Bordering dangerously close to squawking, which is usually followed shortly by squalling, then outright screaming. Intervention: a walking bounce while singing "Do-Re-Mi."

Actually, we feel blessed to have a generally very un-fussy baby. He seems to be a pretty happy little guy most of the time. As long as he's being held. And fed at regular intervals. And sung to. (He's a big fan of James Taylor, Greg Brown, and Stephen Merritt.) And as long as he has a clean--

Oops. Good news. Everything is working in the GI and GU departments. Change starts with your underwear; I'll be right back.

So yes, as I was saying, I'm starting to appreciate the time that I had in my former life. Not that I would trade this new life, this new world, for anything. And these things are pretty irreversible anyway. It does make me think, though, about the myriad ways in which I was wasting away all the--

Uh-oh. New pattern. ("The word 'pattern'", as the parenting book a friend lent me, "can only be used if one invokes chaos theory.") He's trying to eat my shoulder.

free time I had before having to wake up at 3am to burp someone. If I think about...

Serious rooting behavior now. This is the kind of thing that even the Creole lullaby that my mom used to sing to me, and which she's now taught me so that I can sing it to our baby, can't soothe.

...if I think about...what was I thinking about?

Now we've progressed to head-banging. Those little neck muscles are so strong!

Ok, I give up. We've managed to hold off the inevitable for a couple hours, at least, giving LL some well-deserved sleep. But now we're into realm in which dads simply have nothing to offer.

Which makes me realize, with an overwhelming wave of gratitude for LL: whatever else I may be doing, I am not breastfeeding for thirty to sixty minutes every two hours. I may have infinitely less time than I had before--but time being the relative thing that it is, I still have an infinite amount.

Parenthood

It is Sunday afternoon, April 1st. I started this yesterday and didn’t make it very far. My goal has been to post monthly, and March’s post is now officially late, despite the entry time listed. I think I’ve been too scared to write.

I am standing on the edge of fatherhood, and to paraphrase my friend Erik, it scares the pants off me.

Don’t misunderstand me. This has been something I’ve looked forward to for as long as I can remember. Literally. Since I was a kid and old enough to form memories, I have wanted to have kids of my own. My brothers and sister and I would turn the garden cart over onto the picnic table in the front lawn of the Olsen house, where we lived before we moved onto the land where my dad was building a house, and we would play Pirate Ship, and I would think, someday I want to have my own kids, and watch them invent worlds in the front lawn.

Now that someday is upon me.

In fact I wanted about a dozen kids. Mind you, I didn’t want to contribute my own genetic material to a dozen kids. Maybe one or at most two given the world’s population growth: two children from two parents is a sustainable number. But I wanted to adopt another ten or so and raise a dozen. I was blessed with good parents and a happy childhood, and at age seven I could imagine nothing more fun or rewarding than being a parent myself, to as many little ones as I could.

It was my older brother who recently reminded me of this childhood dream, I think sometime shortly before or after LL became pregnant.

“How many kids are you guys planning on having?”

“Oh, I think one, or two at the most.”

“Not a dozen?”

“A dozen!?”

“Yeah, when we were little, you used to say that you wanted to adopt a whole bunch of kids. Do you remember that?”

I did, and when we talked about it, I remembered that scene in the front lawn of the Olsen house: waves crashing over the deck, the ship tossing in a South Seas gale, the cargo full of richly plundered loot, and lo! off the port bow, a dark shape looming through the salt spray: a desert island? a sea monster? Ahoy, mates!

It strikes me in these memories of childhood that our parents were so often in the background. They loved and supported and encouraged us in every way to become whoever it was we would turn out to be with very little demands of what that might look like. In retrospect one of the ways they did this was by continuing to be who they were. My mom served for twenty years on the local school board, worked as a home health nurse, and in the same year that I graduated from high school, completed her outreach degree as a Family Nurse Practitioner. My dad worked as an ER doctor 60 miles away in order to put four kids through college, and in his free time built a mortise-and-tenon house from floor to ceiling with essentially his own two hands. And between the two of them they read stories to us every night, put a hot home-cooked meal on the table every morning and every evening (pancakes every Sunday), took us on overnight backpacking trips into the Eagle Cap wilderness and on road trips to Albuquerque to visit Granddad (with plenty of stops to run amok over the red-rock canyons en route), patched up the scraped knees of bike wrecks and the bruised emotions of junior high crushes, and listened and listened and listened to us. Without being overbearing they were always close by, always there.

Now, as I contemplate the birth and raising of a single child—never mind twelve—it scares the pants off of me.

I know that very soon our days and nights will become a joyous and exhausting marathon dictated by our baby’s cycles of crying, feeding and pooping, and I will not have time to be terrified. But at the moment my fears are irrationally focused on the distant future of what our baby will grow up to be, and all the myriad pitfalls that I might step into as that baby’s father. I will want to comfort and caress, instruct and inspire, protect my child from everything the world might throw at it, and ultimately the best I may hope for will be simply to be there.

Perhaps I might take a morsel of comfort in observing that my siblings and I did not grow up to be pirates or pillagers. Turned loose but always able to count on the sturdy mast of our parents’ love, we instead became the opposite: each in our own way striving to bring more healing, joy and understanding into the world.

In this recognition comes a clarity of purpose for today’s writing. Not to somehow pretend that with words I can set a lifetime’s course as a good parent, but to take a moment and give thanks to my own parents.

Slow Learner

"Truth is, I thought it mattered; I thought that music mattered. But does it? Bollocks! Not compared to how people matter." –Pete Postlethwaite in the 1996 film Brassed Off

I graduated from high school before learning to snap my fingers, and from college before learning to blow bubblegum. Only in the Peace Corps did I learn the proper way to cleanse oneself (with water), and in medical school proper squat mechanics (query Daniel Hsia’s The Asian Squat). Still in progress are such basics as how to shoot a left-hand lay-up, build a set of shelves, play a C chord on guitar: I’ve come to accept that while I may be a quick study, I’m definitely a slow learner.

Nowhere has this been more evident than in my approach to Getting Stuck in the Snow.

Getting Stuck in the Snow is a time-honored art form that at first glance can seem child’s play, yet has a depth and subtlety that can only be appreciated with years of experience. In my case, about 15 years.

Over the holidays I took LL home to my dad’s in Eastern Oregon and demonstrated for her my skill at Getting Stuck in the Snow. As with all worthy expeditions, this one began with great intentions. We wanted a few tele turns. The snow wasn’t there. A meager shadow clung to the north side of the house, whereas a typical year growing up had 3 to 4 feet at a time. To find snow one had to climb towards the 10,000-foot peaks above.

As luck would have it my dad’s ’93 Pathfinder wouldn’t start. At this point we should have a) abandoned our plan, or b) taken my little Civic, which at least has studded tires and front-wheel drive. Instead my dad (who is about the smartest person I know, and a physician), came up with the idea, and we, a pair of practicing physicians (albeit a pair containing one slow learner), went along with it, of taking the little black pickup. I think it was so we could bring Hugo.

Having learned many great lessons about Getting Stuck in the Snow on the narrow, winding, cliff-hanging road to Cornucopia 15 years earlier, I wisely chose the narrow, winding, cliff-hanging and much steeper Carson Grade instead.

We made it less than a mile.

The first couple turns were indicative. Early on the pickup began sliding backwards, and we retreated to a safe and rare patch of dry ground amidst what was otherwise packed ice: an excellent point to turn around. But by gunning the engine and getting a good run at it, we made it past that particular pitch and up around several more turns, each narrower, windier, and with more dropaway cliff. The road steepened. We slowed, stopped. The tires spun. The whole pickup began to slide slowly and inexorably downhill. LL hopped out of the front and watched and Hugo hopped out of the back and barked, while I tried turning, rocking, rocking, turning the sliding vehicle, until I managed to not quite get the back pointed uphill, and instead wedged it sideways on the narrow road on sheer ice.

This is the point were the learning opportunities really (in retrospect) opened up.

I’ve been thinking a lot since that day of two quotes from the real Patch Adams. “It has to be thrilling, or it will eat me up inside,” he says of his life’s work. And as to what’s important, “My god, it’s friendship, friendship, friendship.”

One would be justified in wandering what these things have to do with each other, not to mention with Getting Stuck in the Snow or my want for adroitness in learning from past mistakes.

The connection is simple and accessible, which is probably why even I can make it: there is little in my life more thrilling than the opportunity to connect with people, to lend a hand or as in this case receive one. Getting stuck is for me usually a solitary pursuit, and getting unstuck, communal. 15 years ago, when I got our little Sentra stuck on the road to Cornucopia in pursuit of ski-able snow, I first called up my friend Arthur Baker. After nearly getting his Blazer stuck just below the Sentra, I resorted to calling up Dave Mader, for whom I used to scrub out the inside of a dairy barn. Dave had a pair of Clydesdales and he graciously harnessed them up to his hay wagon, walked them the several miles to where my car was stuck, and pulled me out. In exchange I gave him a full day of bucking bales later that year in the heat of August. Not the ski adventure I’d planned, but ultimately more rewarding.

Now, older but apparently not much wiser, I again abandoned a vehicle to winter and set out in search of help from friends. LL and I walked down through the back forests and fields to our house. Dad did not seem surprised. After a proper Norwegian outburst (shaking his head a few times) he called up our friend Mike Higgins. Mike had employed me in a variety of jobs during my childhood in Halfway, and had pulled me out of more than one mishap. Like my dad, he didn’t seem surprised that I had, many years and a couple of degrees later, demonstrated an aptitude for Getting Stuck in the Snow.

The rescue was unremarkable. Mike drove us all up the hill. He, my brother Hans and I pushed the front of the pickup out of the ditch while Dad steered. Once pointed downhill, the pickup had no problems returning home. Mike nearly got his giant pickup stuck on the ice, but thankfully we did not require actual horse-power this time.

Until I get back to Halfway, this posting shall have to serve as my thanks for the help and for the friendship. And Mike, when I do return, if you need some rocks moved or trees pruned—I’m all yours. I might even be able to operate the riding lawnmower.

If, of course, you trust me to not get it stuck.

The Mail

Note: I attempted to place this in the "Comments" section of "Nov.30 Ways & Means", as it was written in response to a writer's commentary on that posting. I was unable to do so, initially because of technical difficulties, but ultimately due to length. And so here it is as a new post. To whoever posted their response to "NANDA" (which was really a response to "Nov.30 Ways & Means"), I did NOT delete your response, I just moved it to Nov. 30. Thanks! -N.H.

Dear writer,

Thank you for your response to my posting; I have relocated it from “NANDA” to this post, on which it comments. You raise a number of excellent points which I will try to address.

First, thank you for the reminder that I am writing, as a family physician, from a position of both power and responsibility. It is my hope and aim to never abuse either. I am, at the same time, human. I make mistakes. I do not always live up to my hopes and ideals; I nonetheless try, and I see your response as an opportunity for reflection. My path is always, I hope, one of learning. It should also be noted that the views and opinions expressed in my blog are mine alone and do not necessarily reflect those of my employer or of anyone else associated with me.

I am also aware that I am writing not in a vacuum but in the context of a small town. As such I am constantly reminded of the importance of relationships with all people. To this end my goal in interactions is no different than it has been my whole life, which is to say, to treat everyone with respect.

To whatever degree I have treated you in a way that you saw as disrespectful, I apologize. I do ask that if you would like to address this further with me, you do it in the context of our relationship as doctor and patient in the clinic, as this appears to be the source of your anger, and not in this blog. Out of respect for your comments I have left them as they stood, with the exception of the deletion of your use of profanity.

Secondly, thank you for the chance to point out something I should have stated explicitly: each patient example I gave represents a composite of multiple patient stories from my practice over the last five years in Seattle, Auburn, and here. As such, while any one patient might be based mostly on one person, there are always details that I have changed or borrowed from another patient to avoid identifying one person.

Thirdly I would like to address your question of why I and/or the clinic do not simply give our most needy patients the financial help they need. While I have and will continue to make individual donations to patients, the reasons that I cannot make this the mainstay of my efforts are many. One, I would go broke. Recognizing, again, that as a doctor I am in a position of great power, my resources are still finite. I have a family to support. With me already six years out of medical school, we still have over $100,000 of student loan debt. I rent a 2-bedroom house, drive a used car, and do not own a television. If I were to help out every patient who needs money—which is virtually everyone—I could not carry on what I hope to be a lifetime of service. Two, I would happily pay higher taxes to support a more just and moral healthcare system. As I pointed out in my blog, our current taxation system promotes gross inequality. Three, it is this system of inequality which I believe is doing our patients and our world the most harm, and which I have and will continue to devote my efforts to try and change. Not on behalf of one person, but for us all.

This brings me to the fourth point you raise, which is a very valid one: why on earth am I taking time away from clinic to go to Olympia and speak out?

You should know that my activist efforts are done on my own vacation time, at my own expense, and that every time I leave town for whatever reason I face a sizable stack of back-logged work when I return. So I do not do this lightly.

The reason that I still do it is that I believe in fighting for a more just system for everyone. Because I understand that I have power as a family doctor, I see part of my responsibility, as stated in my address to the legislators, as speaking out on behalf of those with no voice.

Is this effective? I cannot say. But I can tell you that one Senator on the Ways and Means Committee, to whom my efforts were addressed, found it compelling. Here is the link to her site:
http://blog.senatedemocrats.wa.gov/keiser/health-care-needs-exist-across-washington/

Finally, you might ask, if my efforts are addressed to the State Legislature, “why don’t you keep it to that, and not post in a public blog as a member of this small town?” The answer to that is that I hope to raise awareness amongst my own friends and contacts. While I do not promote my blog in any way to patients, I recognize that anyone can search my name and find my blog, as you did. I welcome that too. I aim to foster open discussion amongst anyone who takes these issues seriously.

As such, I also aim to enter into such discussion with an open mind, the awareness that I may be wrong on any issue, and always with respect. I ask that you do the same.

. . .

p.s. If your dissatisfaction with me had anything to do with me running late or not spending enough time with you (and if it was something else entirely, I again ask that you address this with me in clinic), first I apologize, and second I encourage you to speak up. I tend to run behind because I try to listen to patients; I would love to work in a system that allowed me to give you the time you deserve. Even before the budget cuts, we are under pressure to see more and more people in less time. Speak out! You as a patient have a voice—use it! Call your local representatives and let them know your concerns!

. . .

Final Note: To see the comments to which I was responding, please see "Comments" under "Nov.30 Ways & Means". Again, I moved the comments by "Little Cat" from its original location under "NANDA" to there, as this was the post it deals with.