Advising Mitt

 
I sort of feel sorry for Mitt Romney. He did what most of us have done, or I have anyway, and wished almost immediately we hadn't. Opened our mouths and watched as the unspeakable came out seemingly of its own accord. Maybe we were angry or afraid or eager to be viewed as acceptable and be embraced by others. At the time, it might have seemed innocent enough -- we thought we were in a protected environment -- and of course, we weren't, as demonstrated by the fallout we're unable to duck no matter how deep we dive into the shelter. Now, we're left, picking up the scattered remnants of our self-esteem, detritus from stepping on one of our own land mines.

Have you ever noticed how easily, on such occasions, a person  says, "But that wasn't me"? Well, if it wasn't, then who was it? It sure looked like me, it sounded like me, people say it was me. I haven't been cloned lately, so far as I know. It sure wasn't Robin Williams doing his best Beggar imitation. I "inhaled" in high school but my sensibilities have long since moved in other directions. I can't blame alcohol -- with my limited tolerance, slurred words are far more likely than misspoken ones. True, at least this way I'll never have to explain how "what made Milwaukee famous, made a loser out of me." (Thanks, Jerry Lee Lewis -- wish I'd written that line.)

So, basically, it was me, or you, or in this case, Mitt. Now, in retrospect, I'm sure he wishes he'd never said anything about the 47%, but it was caught on tape and splattered onto the news, so there's no denying it. The problem is, he's attempting to do what anyone would under similar circumstances, i.e. try to dissociate himself from the image he just created. That's normal -- we don't want people to think of us in terms of what we say or do when we wish we'd said or done something else -- and would if, please God, just this once, is it okay if we turn back the clock?

On the other hand, I sometimes wonder if a better strategy might be to simply own up and admit the truth. Instead of trying to convince us that he really is empathetic, state for the record, "Yes, I'm an elitist. I have a strong preference for associating with wealth, I don't relate well to the working class, I disapprove of welfare and those who depend on it, I'm opposed to government restrictions on business and given the opportunity, I'll lower taxes on people like me and if you want to see my tax returns, watch how fast hell freezes over."

You don't think that's going to get him elected. Well, you're probably right, I suppose it is asking a bit much. But trying to pretend he's someone he's not is even worse. The unconscious has a nasty way of making itself known and frequently does when least expected or welcomed. We all have an inner trickster who absolutely delights in making us appear foolish and the harder we try to keep her/him locked in the closet, the more determined s/he becomes to make us regret it. So, Mitt, if you still aspire to the presidency and you don't mind my unsolicited advice, admit you need to change. Trust me, it won't hurt. Okay, it will, but only your pride and most of us can use a little bit of that now and then.  


(Creative commons image, "Trickster Tales Sketch" by Amanda Schutz via Flickr)

Trickle-Down Economics

 
It used to be referred to as the horse and sparrow theory, i.e. if a horse was given enough oats, sooner or later some "ended up" in fields or along the road where sparrows could feed on them -- doesn't that sound lovely. But that's basically what trickle-down economics comes down to. Provide the wealthy with enough tax breaks or economic benefits and eventually the effect will trickle down to those on the lower rungs of the social ladder. As one who's worked his entire life for a living, as did my father (we were both business owners, by the way), you'll have to pardon me if I find that offensive.

For one thing, it's just too much like saying, if I devote myself to the care and feeding of a narcissistic parent, some day I'll be glad I did. Oh, please. For another, it's insulting to presume a "trickle" is all those who compose the majority of the American populace are deserving of. Who's making the rules here, anyway? Who decided a person born into a blue-collar family was less worthy of a seat at the socio-economic table than someone else born to wealth or privilege? It's not a good idea to forget history, you know.    

It was Paris, the summer of 1789, probably a warm and humid one like we had in Maine this year, when the so-called "benevolent aristocracy" came face to face with destiny.  Taxes were inequitable; merchants, tradesmen, and the poor bore the burden while the wealthy lived a life of the rich and famous. The court of Louis XVI had virtually spent the country into bankruptcy and reform was slow in coming. Food was scare and a revolution had taken place in America. The time was ripe for storming the Bastille.

Now, trust me, I'm not sounding the trumpet for revolution and I'm definitely not a member of the Tea Party. Nor, by the way, am I saying there's something wrong with having money. However, I do think it's time to take a look at the underpinnings of trickle-down aka supply-side economics, especially since one of the major presidential candidates seems to think it's the solution to what ails this country. As I see it, trickle-down economics is an outgrowth of an outmoded and substantially mistaken belief that wealth is a sign of moral, intellectual, and cultural superiority. Put another way, personal worth is what distinguishes saints from sinners. Not only is that theologically bogus, it's factually baseless. Crimes are committed by both rich and poor; Louis XVI lost his head making that clear. 

Of all the things we need in this country and God knows, we need a lot, a repeat performance of trickle-down economics isn't one of them. I don't know if anyone's noticed lately, but there are a great many of us out there who are first-generation college, graduate school, and medical school graduates. Like our parents, we've clawed our way through public education and worked like demons to establish ourselves as persons of social, if not yet economic, value. Not because we think that makes us "better" than anyone else or because we think it qualifies us to stand in judgement of those who've made different choices. We've done so because we believe our efforts create opportunities we and our children might not have had otherwise. Opportunities to be of service, opportunities to improve the lives of those around us, opportunities to establish justice and build a world where no one goes hungry or lives in fear of annihilation. It's not wealth that makes us do this, it's our humanity, and thank God for it.      

 (Creative Commons image by David Shankbone via Wikipedia)

His Failing Heart

JVD is an anachronym for jugular venous distention, a phenomenon I observed Friday for the very first time outside a classroom. It's one sign of a failing heart, a heart that has virtually worn itself out pumping against the unrelenting resistance of untreated high blood pressure. Besides the accumulation of fluid in the lungs -- pulmonary edema -- which leads to shortness of breath, with heart failure the jugular vein becomes distended and you can literally see the pulse throbbing away, driving the rhythm of circulation like a drummer's foot on the bass pedal. Boom, boom, boom.

For clarity's sake, we aren't talking oxygenated blood here, the bright purplish juice of life that shoots out the left ventricle into the aorta. Nor is JVD the same thing as an aortic aneurysm. You've heard of those, I'm sure. An expansion of the artery in all directions forming a cul-de-sac typically (though not exclusively) in the gut with two openings, an entrance and an exit, instead of just one. As long as it stays intact, blood can make its way from the heart to the toes and back again. If it begins to leak or worse, if it blows, you get a STAT ticket to the surgical suite.  

The blood carried by the jugular vein is deoxygenated -- it's already given up its cargo of oxygen molecules in the name of everything that constitutes daily life. On its way to the lungs for more, however, it runs into a problem. Heart failure starts out with an overworked left ventricle but as it progresses, the right ventricle slowly turns into an anatomic approximation of a child's balloon that has been inflated a few times too many. Having lost much of its elasticity, the right ventricle can't pump as well and back pressure builds in the veins above it; naturally, they distend with the volume of blood waiting in the queue.

I'd read about JVD, but reading is one thing, seeing it up close, is another. I watched my resident turn our patient's neck to the left in order to tighten the skin on the right, then watched wide-eyed as his neck bulged outward every half-second. I'd been talking with him for fifteen minutes -- how could I have missed seeing it before? As must have been the case with my entering classmates when they were in my shoes, my mind raced through a litany of possible explanations, while I waited for the end of the day when we'd finally have a free moment to recap. I was glad my first best guess was the correct one.

Yesterday, going over material for board exams, I thought about my patient's physiology, why he was short of breath, why he gained excess weight in water only to lose it when he took his diuretic medication, why just sitting there talking with me was an effort. He was a good teacher who taught his lessons well. But I also thought about him, his experience, what it meant for him to retain his driver's license, why he was so determined to hold tight to his independence and live like there was no tomorrow. Why he continued to have heart. Despite his failing heart.

(GNU Free Documentation Image via Wikipedia)

Repeating History

Those who cannot remember the past are condemned to repeat it. ~ George Santayana

I don't know that remembering has much to do with it. Human nature being what it is, we seem bent on some things whether they've worked at all, worked only a little, or ended up in disaster. Knowing they've been tried before doesn't appear to prevent their being tried again with similar results. Mr. Hughes hid in Dylan's shoes and wearin' his disguise, as the late Rick Nelson put it.

I'm thinking about Germany in the early 20th century, in case you're wondering. High unemployment (30% in 1932), deficit spending, economic depression overlaid with inflation from the printing of large amounts of paper money, unable to meet foreign debt payments, national pride in the gutter. Whenever I watch something about the rise of Adolf Hitler, as did yesterday afternoon, I can't help thinking about the social conditions that made him possible. 

And then I start thinking about Santayana's quote.

I know, I know, Germany didn't have 1776 and the aftermath of two hundred years of democracy. Then again, she didn't have slavery and the subjugation of the western frontier. Let's play fair. I'm not one of those writers who makes a living telling you what's wrong with America, but neither do I want to ignore the obvious for the sake of good feelings. When something stinks, there's usually a reason.

What Hitler accomplished was masterful -- demonic, but masterful. Instead of taking reality on its own terms and leading Germany to do likewise, he fled into a delusional fantasy and created a massive marketing machine to sell it like Volkswagens. There are at least two ways to offer hope to those in need of it. One entails accepting responsibility for yourself, your successes and flat out, falling down failures, and by so doing, show others how to survive doing the same. Another is to imagine there's nothing wrong with you or wouldn't be if it wasn't for someone else. Say it often enough, sooner or later people will start believing. Say it long enough, maybe you'll win, and then you get to rewrite history so no one remembers the way it really was.

For instance, an editorial in an upcoming Southern Baptist theological journal, in complete ignorance of the wider social issues involved, described the fundamentalist takeover -- some have suggested "highjacking" is more apt -- of the Southern Baptist Convention a few years ago in terms of a restoration of biblical Christianity. The subsequent split with social-theological moderates, the virtual purging of non-strictly-doctrinaire seminary faculty, and the smear campaign against those who stood up to be counted, were conveniently overlooked. When the ends are used to justify the means, whether we're talking about theology, the search for weapons of mass destruction, or the virtues and vices of universal health care, a lot of things get overlooked.

Trouble is, this is precisely how we end up repeating history. And isn't that a hell of a thing.

(Creative Commons image of singer Rick Nelson via Wikipedia)

Graduation: Catching Up at Last

If the road to hell is lined with good intentions, I was well on my way yesterday, having fully intended to write and yet finding my brain utterly exhausted from the events of Saturday. To say graduation was memorable is so far from the truth as to almost be a lie: it was more like a dream and I was living it. Truthfully, though, Sunday morning I was almost certain it had been precisely that. It wasn't until I took the dogs out for their walk and looked in the car for my sunglasses, that I noticed the box my robes had come in. "Well, guys," I said, "I guess I wasn't dreaming, after all."

It sure felt like it and I'm sure it stems from the fact that I've never had any absolute assurance I'd make it this far. Not that I was a doubter, like Hero Boy in The Polar Express, who wanted proof of the existence of Santa Claus before committing himself to believing. I knew in my "heart of hearts," as my mother used to say, the obstacles and difficulties I'd encountered along the way would only make graduation sweeter. But still in all, our demons have a tendency to haunt us in the darkness of night, especially before exams, whispering wickedly, You're a fraud -- you're in over your head -- if you were meant to do this, it would be easier. 

Martin Luther, the 15th century church reformer, said the Devil was exquisitely sensitive to humor and the trick to banishing him lay in laughing in his face. I've wondered if that's a skill we must learn to employ and if so, medical school has given me a lot of practice.I was definitely laughing Saturday, along with my classmates, when my best friend placed my doctoral hood round my neck backwards. It wasn't intentional; he'd been handed it backwards and the rest will go down in Hooding Ceremony history. But what better way to thumb my nose at all those demons?

All the same, there is a tender, albeit bitter sweetness to graduation, that comes from having to hold off being called "doctor" a bit longer. I've gone through the exercises and taken my Osteopathic Medical Oath, but with rotations yet to complete, I won't hold my degree in hand until later this year. Like a teenager who is neither child nor adult, I'm in a liminal space. I'm no longer entirely a student, but then again, I'm not entirely a doctor. Thankfully, however, I'm closer to one than the other and the confidence I've gained from standing shoulder to shoulder with my graduating classmates, pledging my life, loyalty, and sacred honor to the practice of medicine and the care of patients, will see me through.  

To my beloved entering classmates, nearly all of whom preceded my graduation in 2010, I can truly say, look behind you, the footsteps you've been hearing are mine. I'm catching up at last.        

(Photo of the author and graduating classmate and friend Dr. Joseph Scott, copyright 2012, all rights reserved) 

Off to Graduation!

Since I can scarcely remember when, Brahms Academic Festival Overture has been synonymous for me with the fulfillment of dreams. I first encountered it as the sound track for the film People Will Talk, the movie that got me thinking of becoming a doctor when I must have been about nine or ten. I'm listening to it now, the version by Maron Allsop and the London Symphony -- my favorite -- because today is graduation day. 

I'm not done yet -- I still have boards to take, rotations to complete, but by the grace of my university I'm walking across the stage at 3.00 pm EDT to receive my doctoral hood and a few moments later, will raise my right hand and speak the words of the Osteopathic Oath, choking back tears, and joining friends from my incoming class at long last. 

Actually, I've got to leave in about 30 minutes, so forgive me for making this brief -- more to come tomorrow. In the meantime, please also forgive my absence these past months while preparing for boards. I've wanted to write but whenever I've begun, my conscience has spoken up, telling me to get back to studying or else. Thanks to all who've come by in the meantime, I appreciate it so very, very much.  Now, off to graduation!

The Liebster Blog Award

Applications for medical school and residency usually contain a space where applicants may list the awards they've received for academic or professional achievement and it's usually at this point my hard-earned self-esteem takes a nose dive. Apart from a couple of work-related "pats on the back" and Scouting's Order of the Arrow, I don't have a lot to report. I'm just guessing, but it's doubtful committees are interested in my horse and I having taken third place in Western and English Equitation at Denver's National Western Stock Show when I was 13.

One never knows, perhaps I ought to list some of those accomplishments for good measure. But, in general, I'm assuming they'd prefer to know whether I managed a summa cum or summa cum laude or was recognized for an outstanding something or other. The truth is, I must have been out, literally standing in a field when they were handed over, because I ain't got any of 'em.

I'm not complaining, though, because the sparsity of awards has made me appreciate those I've been given all that much more -- rather like the one appended below. I'm deeply grateful to everyone who's visited this website over the past three years, validating my desire to write and have what I've written, be read. That in itself really is recognition enough; when someone decides it deserves an award, I'm blown away -- so much so that it takes me a week to get up the nerve to make it public. Pride goeth before a fall, says the writer of Proverbs, and the last thing I want to do is fall flat on my face, tooting my own horn. That said, I'd like to express my sincere thanks to rosewiththorns, author of but I'm beautiful, for her kindness in nominating my blog for The Liebster Award.

I'd also like to thank my mother, my father, my make-up artist, my fellow actors, my dogs and cat, and last, but not least, the Academy of Motion Pictures...oops, sorry, wrong speech. Seriously, please visit rose's blog as well as the others I've listed below as worthy of receiving a Liebster Award. And, as always, thanks for reading.

Trust Me, I'm a...Resident, written by one of my classmates who is currently a resident in Family Medicine in Pennsylvania.

Surviving Medical School and Motherhood, by another of my classmates, sharing her experiences juggling children and husband with one hand and medical school with the other.

Cafe of the Cosmic Dance, by Paul Sunstone. Although Liebster Awards typically go to blogs with less than 20 followers, I'd like to pass on the link anyway in the hope you'll find his writing as enjoyable as I do.

Garnet's Virtual Salon, by a pharmacist and fellow Mainer who lives in the mountains near the Maine-New Hampshire border and drives a Camaro -- wow.

The Student Epicure, written by a Massachusetts med student who has a way with food that I hope translates into medical magic once she's graduated and joined the work force of resident physicians.

The Liebster Blog Award