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.

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.