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.