Al Qeida Infiltrates Local Safeway

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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


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

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

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

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

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

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

A Series of Unfortunate Events

No one wants to hear good news.

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

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

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

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

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

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

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

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

On writing

This is going to be a short blog.

A survival blog.

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

An essential blog.

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

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

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

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

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

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

it is Henry David Thorea in a Massachusetts jail;

it is Arundhati Roy unwriting a dam with her pen.

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

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

Forgive us our trespasses

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

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

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

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

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

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

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

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

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

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

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

Separation

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

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

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

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

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

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

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

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

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

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

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

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

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

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

God's country

It is Wednesday morning. This is my day off from work.

I drive in to work and work until noon. When I leave I am headed for a funeral, but instead turn my car around on Highway 97 and take a left up Cameron Lake Road. As I climb the hill the snow deepens and the sagebrush is joined by the occasional ponderosa pine. The small fragments of light offered by mid-December are gathered up carefully by the new snow and amplified, reflected, a thousand million tiny suns making the short day bright. At the top of the hill I pull over and climb out to take in the view.

The air is colder here and I haven't brought my hat or jacket; I can only stand outside for a few moments before returning to the valley, to the funeral, to people and community and the warmth offered by the shared experience of living and dying. But for this instant I am alone with the indifferent and utterly beautiful landscape.

Directly below me a small lake is identifiable as a flat expanse of uninterrupted snow, which in this rocky terrain can only be explained by water. Below that a bluff blocks my view of the Okanogan River, and in the places where I can see further, the river itself is mostly hidden by trees. Wherever there are trees there are houses, at least in the valley floor, and from here the towns of Okanogan and Omak appear to be only slightly dense accumulations of the the farm buildings that dot the river's path to the north and south. But for the most part what I am looking at is wide-open space. It is rugged country writ large, basalt cliffs rising to timbered slopes and painfully white peaks, and all human endeavors look small and transient by comparison.

I think of the writer Ed Abbey, describing the desert southwest he so loved, God's country, Abbey's country. The same wide-open beauty.

In a few minutes I will drive down and cross the river and go into a church. I will hear about how wonderful God is to have given us this time here on earth, and I will find it hard to argue. The pastor will tell me that we are here to glorify God and be thankful, and who am I to argue? I will hear this message, spoken perhaps in different words than I would use, but expressing the same idea. We are here to love one another. We are here to be a part of this beautiful world, and if given the opportunity, to leave it a better place than when we entered it.

In a few minutes I will hear all of this, and be grateful for the human companionship, the hugs, the offers of pie and coffee, the warmth. In a few minutes.

Right now I am happy to just be here on the ridgeline with my thoughts.