Democracy Rules

Since my knee surgery two weeks ago, I’ve had a really hard time sleeping through the night. It’s either pain, muscle cramping or simply because I can’t get comfortable, but if I start out in bed, I end up in the recliner before morning. Last night, finally, I made it through eight hours with only a single walker-assisted trip to the bathroom. At some point, I managed to lay on the TV remote resulting in MTV being my wake-up call. I was listening to Janet Jackson around 8:15 AM, when minutes later I learned school children in Minneapolis were dodging death and longing for the safety of home.

I know, this occurred at a church, but does it really make any difference? School, church, one isn’t any safer than the other any more. The point is, our children were the target. I don’t know about you, but the thought of the children running for their lives makes me want to take up arms and stand a post. Right or wrong, my reaction is visceral. Put me in harms way, not them. 

And, of course, the public response has become predictable. Thoughts and prayers, ad nauseum. Democrats call for more regulation of assault weapons, Republicans call for arming teachers, both blame the mentally ill because only the mentally ill would “do such a thing.”  When it comes to identifying shooters before they pull the trigger none of us is worth more than a bucket of warm spit. 

Oh, and by the way, today’s shooter used a rifle, shotgun, and pistol, all purchased legally, so there’s no blaming illegal possession or boohooing about illegal aliens. Which brings me to another point: guns that find their way into the hands of those who misuse them generally don’t fire bullets that fly straight. That is to say, they don’t use  weapons designed to preserve the integrity of the target (meat), whether deer, elk, you name it. Instead, they tend to use assault-type weapons that fire bullets that tumble, end on end, once they leave the barrel of the gun. As a result, they don’t simply enter the body, spinning neatly left or right, they’re designed to rip and tear their way through tissues that are helpless to maintain their integrity in the presence of such violence. They’re designed to kill an enemy or render them helpless.

Now, here’s the rub. If we’re hunting for food and we actually know what we’re doing, we’re not going to pack an assault weapon because it does too much damage to valuable venison. If we simply want to take the Ruger or Springfield to the range and work on accuracy, that’s fine. Go for it. My point is, responsible gun ownership does not have anything to do with playing with guns. It entails using gun locks, obtaining professional training, and bending over backwards to ensure our shooting is safe and exemplary of sound common sense. 

So, back to the beginning: what do we do with those among us who seem to think gun ownership can be divorced from thoughtful and mature gun ownership? We begin with education and training involving appeals to those who don’t think, who don’t like complexity or complications, who like to believe problems were simpler way back when. They’ve got to learn sometime.

You see, the circumstances that contrived to make things easier back when, no longer exist. Our populations are larger, we live in bigger spaces and work in more complex situations. All the political blathering in the world can’t change the fact that no single person can know everything and no single concept can encompass all that we know. In other words, like it or not, complexity and diversity are here to stay. The sooner we embrace them, the sooner we can begin to figure out how to prevent one of us from trying to kill too many of the rest of us.

In the meantime, blowhards claiming to have the only answer have no answers. Our problems are too much for any one person. I repeat, they are too much for any one person to understand, solve or otherwise make explicable, and only a huckster or a fool would claim to try. Knowledge is too much of everything for one mind, one school of thought, one anything to have all the answers. If you doubt me, go read the late Karl Rahner on intellectual concupiscence; it’s all there in black and white. 

In the meantime, let’s keep on talking, keep on asking hard questions, keep on refusing to let the blowhards speak for us, and keep on trying to find our truth together. Democracy rules; it’s the only rule.

Life & COVID-19: Ain't No Fairy Tales

I have to feel sorry for Donald Trump. I mean it, he is so wrapped up in himself he'll never know the simple pleasure of people being nice to each other. 

He can't experience the pleasure I felt this afternoon when, idling in line at the recycling center, the person ahead noticed I'd arrived and pulled away. He was done, apparently, and since no one was behind him, was probably texting. I caught his attention as he passed, waved and smiled in thanks, he smiled and waved back. 

Opening the back window on my CRV I reflected on the simple kindness people seem inclined to show each other lately. We smile more easily, we're more considerate, we're more thoughtful. I wondered if it's because we don't know which of us is going to get COVID-19 next. Which one of us will go into the hospital and never go home again.

Not knowing who's next, we want to be kind to everyone, just in case. It's tragic it's taken a pandemic to get our attention, but at least it did. Not that we're all going around thinking about dying and asking, "What's it all about, Alfie?" 

I do think most of us are aware life has become more tenuous the past few months, though. A new microbe has ridden into town, gunning for all of us and the best we can do is try to stay out of its way. You can take my word for it, coronavirus is not one bit intimidated by liberal gun laws. Smith & Wesson can't protect anything from this outlaw.

But we don't need Smith & Wesson, anyway. If we can keep our heads long enough to smile and joke with strangers about being mistaken for robbers because we're wearing masks into Walmart, that's a good sign. If we can batten down the hatches on our pride, use some good sense and wear masks, wash our hands, and practice the pure human decency of social distancing, it's an even better sign we might help each other have half a chance.

It may not seem like a lot but at the moment it's what we've got, so let's use it with impunity. We're not talking about snake oil or something Trump has pulled out of his backside and tried to pass off as a miracle. 

The true fact is, we don't need a miracle. What we need is a healthy dose of reality. Take a spoonful every hour until this is all over and then keep taking it. Don't let some reality TV character sell you a story about a handful of magic beans and a goose and a golden egg. That only works in fairy tales and life and COVID-19 ain't no fairy tales, no matter who says they are.

(Creative Commons Image)

Virus Like Confetti

It is alarming, if not downright frightening, that in the midst of a crisis affecting the nation and the world, listening to the White House is not such a good idea.

I say that because the White House has developed the nasty habit lately of being less than reliable about passing along the best that medical science has to say about COVID-19. As a matter of fact, the daily White House briefs often as not reveal the President and his chief coronavirus expert at odds with one another. Of all the times to make sure you listened to your scientists and followed their advice, now would be the time, but it's not happening. 

I'm a psychiatrist, not an epidemiologist or politician, but I know enough about all three to know it's wise to recognize your limitations. If Dr. Fauci advised me to be cautious when it came to "opening up" the country, you can bet your life I'm going to be cautious. The last thing I'm going to do is play "guess who's smarter" games while your life is on the line.

The coronavirus health crisis is not make believe. It is not a conspiracy theory. It is not the flu. It is a virus-borne illness that has resulted in the deaths of over 40,458 Americans as of this moment. Over 762,690 cases have been confirmed, by the way, as of this moment. To those who dismiss it and insist on going to church or crowding around protesting, when you get sick, when you need an ICU bed, when you're  desperate for a ventilator, when you'd sell your soul for a doctor and nurse, just remember:  You were warned. 

A flattening of the bell curve as we've started seeing in New York doesn't mean we've got coronavirus on the run. It means what we've been doing to try and reduce its extent appears to be working. That's all it means. 

The good news is, we can still screw this up. All we have to do is lie. Close our minds and lie like our lives depended on it because they just might. Distort reality, deny the truth, and brag about being invincible. See? We still have time. We can still screw this up. 

When COVID-19 reruns hit the theaters this fall, tell you what, let's all go. It's all a hoax, right? Nobody at the White House wears a mask (at least in public) why should we? Forget social distancing. Let's cozy up and cough, sneeze in each other's faces, splattering virus like it was confetti at New Year's. Let's all get sick this time. Maybe even die.

Won't that be fun?


(Image by Mark Waugh and www.cartridgesave.co.uk)

Pink Hats 27: Deju Vu

 
Christmas parties in the first two years of medical school tend to be few and far between, or so it was in Jessie's experience. There just wasn't the time. The last week before the holidays was dedicated to exams and if you had time to party, you slept instead. It's tough and everyone knows it.

Actually being able to put on a dress or at least something other than scrubs and spend a social evening -- unless she was on-call -- with her "working family" was one of the perks Jessie loved about Maine Med. She'd gone through residency with several of her classmates and established friendships among the medical staff that she cherished. A rumor circulating about an attending position opening up once her fellowship was complete had been confirmed by the departmental director, and she was considered a shoe-in for the job. Christmas parties at Maine Med promised to be a feature in her life for years to come.

This year was going to be special for a lot of reasons, not the least of which was an occasion to formally announce her engagement to Bob. The truth is, there was scarcely a soul who didn't know already, thanks to the hospital grapevine. Good news travels like wildfire, especially when Halley Henry is the one with a match. Jessie and Bob spent the afternoon following his proposal with the twins and gave Halley the "Go" command she'd been waiting for. By the following Monday, neither one could walk the hospital hallways without running a gauntlet of congratulatory handshakes and hugs.

Fresh powder had fallen in the White Mountains off and on the week before the Saturday evening event, so Bob and Jessie drove up to Pleasant Mountain ski area near Fryeburg. Jessie skied while Bob spent the morning learning the ins and outs of snow boarding. After a few runs alone, she joined him on the beginner's slope.

"Why, if it isn't Shawn White!" she said, teasingly. "Can I have your autograph, pretty please?"

"Baby, you can have my autograph and anything else you want. I am footloose, fancy free, and all yours!"

She laughed and said, winking, "I can think of a lot of ways to take that."

"I'm sure you can, but this is the bunny slope and that means G rated. With the twins around, you better start getting used to that, Dr. and almost Mrs." he said, winking back.

"Only during the early evening hours -- after they're asleep, anything goes." she said, sidling close and raising her eyebrows.

"I think...I've created...a monster," he said, eyes wide.

"You have no idea. Now come on, you hot snow rider you, show me your stuff!"

Yogi Berra said it, this is like deja-vu all over again.

(Creative Commons image of Shawnee Peak by bobtravis via Flickr)

My Last Night in Bethlehem

The following is an unpublished essay from medical school I've always liked. I don't know why I never made it public before, but here it is. I hope you like it.

To my final evening of night shift, I say hasta la vista, baby, with mixed feelings. I'm looking forward to walking my dog at sunset and I'm sure he is, too, but all the same, I'll miss a few things. For one, there's nothing like a hospital at night. I've always loved walking the hallways when lights have dimmed and patients gone to sleep. The entire place feels like a warm blanket. Even the obstetrics unit can be like that, though not so much lately. Certainly not this morning around 4.00 AM when all the unborn babies suddenly woke up in their respective wombs and cried with a single voice, "Let me outta here!"

Yeah. It got kinda busy. Fast. The doctors were in surgery and I was on the unit keeping watch over my flock of one, a shepherd mimicking a memorable night in Bethlehem. I was on my way to her room, checking in once again, when the head nurse raced past, calling back over her shoulder, "20 is giving birth -- now -- and I have no doctors!" I waved the cloud of dust she left behind away from my face and tried to quell the wave of panic rising in my gut. A medical student who's only assisted in vaginal births is more hindrance than help at a time like this, so if s/he has a lick of sense, they attend to their patient. And that's what I did. One of the residents scrubbed out and came to the rescue.

A baby's cry and a few minutes later, she was finished in one birthing suite in time to join us in another. My patient was at ten centimeters and it was time to push. She and I held hands and breathed through the contractions together. When her baby finally slipped out, we smiled wearily and gave each other a thumbs-up. Heading back to the residents' lounge, I had the feeling I imagine all doctors must have at times like this: no matter how numerous are my faults, once in my life I did something good.

Mother and daughter will be gone by the time I show up Monday morning, like all the parents and newborns I've gotten to know this week. It's a privilege -- being allowed to share in a dream come true. The woman with whom I held hands through labor and delivery was a stranger when I walked onto the unit. She was alone with the exception of her mother who was in and out of the room. By the time the night was over, we were much more than strangers.

All on my last night in Bethlehem.

(Public Domain image of Bethlehem, 1882, via Wikipedia)

Paranoia

"Paranoia strikes deep.
into your life it will creep..."
~ Stephen Stills

Of all we could say about paranoia, one thing is pretty clear: it's a symptom of something gone wrong. When we're coping well with life, we aren't generally suspicious or mistrusting without reasonable cause. Even under stress, when we are compensating, as we say in "shrink lingo," we're able to distinguish between real and imagined threats. True, we may not be able to cover every single solitary possibility imaginable -- no one's perfect -- but we do our best. And most days, in most situations, that's good enough.

In extraordinary situations, however, things can change rapidly. With good coping skills and a healthy ego, we're okay, maybe even better than okay. With poor skills or a weak ego, it's not so good. It may even get scary once in a while. Especially to those of us who are on the outside looking in. 

I'm referring specifically to the rash of paranoid ideations that have found their way into video and print in response to the terrorist attack in Paris. Don't let those Syrian refugees into America, they say, you can't tell the good guys from the bad guys. Well, maybe not, but haven't bad guys been able to enter the United States for a long time? What self-respecting, evil, scheming bad guy is so stupid that he'd masquerade as a refugee and expose himself to serious scrutiny, when he could simply walk through customs with a legal passport on any other day?

That's the problem with paranoia, especially the socially-acceptable kind. It checks its brains at the door and starts shouting about the sky falling when the issue is actually much closer to the ground. It becomes irrational even when couching its rhetoric in rational terms. It is true, America has endured terrorist attack before and it only makes sense to be prepared. Once burned, twice cautious. To become obsessed with the possibility to the point we abandon our leadership role on the world stage isn't caution. It's more like crazy.

These are times for brave, sensible people. People like the Parisian father who explained to his young son that memorial flowers and candles were there to protect them from bad people with guns. He's too young to grasp the concept that flowers and candles represent the collective will of good, solid, brave people who refuse to give in to terror. Someday he will, though. When he does I hope he also understands that paranoia is a warning, not a watchman to be heeded.


Creative Commons image by Katlew via Flickr.com.

The White Coat Brigade

Although I wasn't running late, it still felt that way. It was my second day of residency and a meeting with the psychiatry training director had me intent on arriving early. At my hospital, residents have access to a parking garage, unlike lowly medical students. Having been one of them for so long, the garage looks to me like the Taj Mahal. Anyway, after driving round a couple of minutes and coming up empty-handed, I spied an empty space marked, "Physician Parking Only." Wouldn't you know it? I thought, may as well have Dirty Harry guarding it. I started to drive past when the lights came on. 

"Wait a minute, that means me."

If there was a single thing typifying the impact of residency thus far, this incident depicts it. Over and over something happens -- entering the resident's lounge for the first time, hearing my name called with the title "doctor" appended to it, having other residents smile in greeting -- something happens to remind me I'm not in Kansas anymore. Medical school really is finished, I really did graduate, and I really am here, at long last.

It's kind of funny, when you think of it, the way reality creeps up and sinks in. I don't know if it affects other people like this, but I can't help thinking about how everything feels. Maybe that's why I'm in psychiatry: just being here isn't enough; I have to take it in and digest it. And unlike some third year rotations I was glad to bid farewell to, I want these first six months of inpatient psychiatry to poke along at pace that would make a snail impatient.

It's weird, though.  I feel like a buck private who's been given a battlefield commission. Only a few years ago I was an enlisted man, now I'm at the opposite end of the food chain -- or chain of command, as the case may be. Sort of. As a first year resident, I'm little more than a medical student with a title. But the people I work with didn't know me back then or in my life before that, on the front lines of mental health care. They only know me as I am now, a member of the White Coat Brigade. It's up to me to let my behavior spell out what I learned while serving on their side of the coin. 

Nothing is automatic, but it's all as pleasurable as it is satisfying. Especially sitting down with patients for therapy knowing it's partly what I'm getting paid for. I'm here to learn everything I can, but I'm also here to work and at this point, psychotherapy is something I can do quite legitimately. It's one of the tools I've had rattling around in my backpack the past few years, waiting for its time to come.

(Creative Commons image by Kids_Safari2 via Flickr)