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.

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.