Category Archives: General Thoughts

It Happens

Spent a big chunk of the afternoon cleaning up shit.

No, this is not a metaphor. We have a dog, and although most of the year we make it a point to clean up the yard daily, it’s been really cold and snowy and rainy and cold and snowy and muddy and cold and rainy and did I mention cold? and I just haven’t been in the mood to do it for a while. And today it’s in the 40’s and dry and actually (I think) supposed to stay warm for many days in a row, and so it was time to get out there and clean up the mess. And today is garbage pick-up day, and although the recycle truck comes early, the garbage truck comes late in the afternoon, so if I got out there and did the turd pick-up quickly enough, I could get it to the curb in time to be taken away from my house today.

So out I went.

The process involves significant risk of stepping on poop land mines, so, wisely, I wore Doug’s shoes (sorry, Dougie, but you weren’t home and your shoes were conveniently located at the back door and I love you!).

In my “reduce/reuse” effort to decrease our plastic impact on the planet, I save produce bags and newspaper delivery bags to pick up after our pooch, and I filled up quite a few.

So here come the metaphors (you knew they were coming):

Health? Life? Politics? Let’s throw in a little of all of the above.

We’ll start with the produce bags: onions, broccoli, and zucchini in, poop out. So the produce bags can be a metaphor for intestines. And we’re discussing chores we don’t necessarily want to do. Perfect segue for an update on the American Cancer Society’s colon cancer screening recommendations. They now recommend that people of average risk for colon cancer begin screening at age 45 (the old recommendation was 50). Gold standard for screening is colonoscopy (starting age 45 and then every 10 years for the average-risk folks). Those at higher-than-average risk likely need to start earlier and do it more frequently. The prep isn’t overly pleasant, but it’s way better than late-stage colon cancer. So talk to your doc about it. This public service announcement brought to you by a bunch of canine backyard bowel movements.

Moving on:

It’s fairly easy to be methodical in the collection endeavor, as our pup is quite consistent in his tendency to defecate along the periphery of our property – he’s an edge-pooper. For the most part, I knew where to look: within a foot of the fence. This is true for most of us. We learn when and where to expect crap. Yes, every once in a while, there’s a big steaming pile in the middle of the lawn where you don’t expect it, but by and large, in the day-to-day, it’s where it usually is. There’s a lot of traffic at rush hour. There are long lines at Trader Joe’s the day before the Super Bowl. You don’t get as much sleep as you’d like when you have exams or when you’re on call. Your spouse is snippy when he/she is under stress. You expect it. You plan for it. You deal with it. It might not be pleasant, but it’s not surprising.

Along the perimeter of our fence we have all sorts of perennials – day lilies, crocuses, hydrangeas, peonies, various other pretty green and/or flowery things that I don’t know the names of. And under the piles of fecal matter I found a plethora of green shoots. The icky and the good are right up next to each other. The fertilizer feeds the flowers.

Much of the excrement has been through multiple freeze-thaw-get-rained-on-and-snowed-on-and-frozen-again-and-thawed-again cycles, and although you can certainly tell that it’s shit, it’s not fresh shit – a lot of it is really dried out and actually somewhat easy to scoop up and most of it doesn’t really even have much of a smell. When life throws general crap at us is can seem pretty awful at first. The fresh stuff stinks – we should pick it up right then and get rid of it, because if you step in it, it embeds in every crevice of your shoe and you have to do the twist on the grass to get the big chunks off and then bring the shoe straight to the utility sink and scrub the rest out of the treads. But if you’ve just stayed away from the crap for a good part of the winter, it might not be so bad when you come back to deal with it later. Works for some things, not necessarily others. Breast lump? Deal with it now. But some things that seem like a big deal right now turn out not to be such a big deal through the lens of time.

Of course, we’d never leave our dog’s waste on the ground when out walking – you don’t leave that for someone else to step in or have to clean up. But we don’t always afford ourselves the same courtesies we give to others. Maybe we should.

I seem to recall I said I’d find a way to tie this to politics as well. I used a bunch of newspaper bags. Need I say more?

Truth be told, I only got around 40% or so of our property’s perimeter-o-poop (there was only so much I wanted to deal with at one time), so will head back out later today or maybe tomorrow. My shoes (well, Doug’s shoes) are clean for now.

It Could Have Been Worse

Well, I just had a relatively shitty morning. But it could have been a lot worse.

I have a lot in my head these days – plenty that’s good (like starting a new business venture with another doctor), but quite a bit that’s not so good (relatives with health concerns, multiple friends with significant health crises in their families, a friend who just lost a sibling), and I’m a little tired. My brain is doing a lot of multitasking.

Our dog’s annual checkup/vaccine visit was scheduled for 9 o’clock this morning, and he gets very stressed out at the vet’s office (read: “wont-even-step-on-the-scale-so-I-have-to-lift-and-hold-my-60-ish-pound-dog-while-I-weigh-us-both-together-and-then-weigh-myself-and-subtract-my-weight-and-then-heaven-forbid-the-vet-should-try-to-look-in-his-ears”). So I started to think about how much I hoped he wouldn’t stress too much, took him for a walk, and seat belted him into the car for the 20-minute drive. Perfect timing, since it was 8:35 when I left the house.

Except it wasn’t perfect timing, because the freeway is under construction and they closed the exit ramp that I needed to take to get there. Not a huge deal – I’d have to take a later exit and wiggle back to get there from another direction – GPS would get me there just fine. I called the vet’s office to explain what happened and tell them we’d be a few minutes late – they said “no problem.”

Thought about friends’ family members. A few miles later, there was an open exit ramp. I took it, and started using my internal sense of magnetic north to navigate until the GPS recalculated.

Again, no problem. Cell signal was strong. Map was on the screen. The little blue circle representing my car was on the blue preferred route. I glanced down occasionally at the navigation as we made our way to the vet’s office. Thought about the condolence call we’d be making this evening. Thought about the website copy I needed to complete today. Thought about the talk I’d be giving tomorrow to the Science National Honors Society at the high school my boys graduated from. I had a lot to do.

And then the map shrunk down to a tiny little box in the bottom corner of the screen. No clue why it did that. Glanced down and tapped the little box with my thumb. Eyes back on the road. Thought about my friend’s father.Glanced back at the phone – map still tiny. Crud. Eyes back on road. Tapped at the tiny map square again. Eyes back on the road. Thought about the new business bank account I needed to open. Glanced down – map still tiny.

Of course, what I should have done was pull into a parking lot and figure out what my phone map was doing, but what I did instead was continue to repeat my same action while expecting a different result. I didn’t have time.

Eyes on the road. Glance down. Tap. Eyes on the road. Glance down. Tap. Eyes on the road – oh SHIT. The pickup truck in front of me was stopping because there was a bus stopping in front of him.

Slammed on my brakes. Hit him anyway.

We pulled immediately into the driveway/parking lot of a bank. It took all my strength to turn the wheel – the power steering was dead. I jumped out of the car as he exited his and asked immediately, “Are you OK?” “Yes, are you?” “Yes. I’m so sorry.”

The front of my 14-year-old minivan was hemorrhaging red liquid onto the ground. I started to smell something burning and realized I hadn’t turned off the engine, so I immediately turned it off. Our dog was sitting calmly in his seat.

Called the police. Stared at my bleeding car. Looked at the hole that was punched in my front bumper by the trailer hitch (now slightly bent) on the back of the other guy’s pickup truck.

And now there were no other thoughts intruding on the issue at hand. Nice timing, brain.

Police officer showed up, took our info, and was just generally really nice, as was the guy whose truck I hit. Called my husband, told him what happened, and asked him to call the vet’s office for me.

Called our car guy (when your family’s “fleet” consists of vehicles that range in age from 6 to 22, you have a car guy), who told me where to have it towed. Called AAA, who told me a tow truck would be there within an hour.

The police officer stayed until I knew the tow truck was on its way. He offered to drive us up to the vet’s office (about a mile away), but I needed to stay with the car until the tow truck arrived. The officer gave me his card and told me to call if I needed any help with anything.

A woman pulled into the bank parking lot to use the ATM. She saw me and asked if I was OK. I said yes and thanked her.

I called the vet again, and they said they’d fit our dog in whenever we got there.

After just a couple minutes, someone from the towing company called and said he had a truck nearby that would arrive within five minutes. It arrived within three. The driver was also extremely nice – offered to drop us at the vet’s office, but my dog did not want anything to do with going up the steps into the truck (and I was NOT about to attempt to carry him, struggling, up them – picture, if you will, a 60-pound bucking bronco with nails that need to be trimmed). So I paid the tow truck driver for the miles-beyond-which-AAA-covers and started the walk to the vet’s office.

I may not have mentioned that it was about 25 degrees. My hands were frozen. I stopped at a store along the way, where the employee kindly allowed me to bring the pup inside for a moment to warm up.

I may also not have mentioned that one of our other cars (the 1997 model) is in the shop, so My husband didn’t have a car at work. One of his colleagues lent him his car so he could meet me at the vet’s office and bring me home. His colleagues also changed the location of their afternoon meeting to be near where we live so that Doug could get there easily.

I still had to pick my dog up and weigh the two of us together and then subtract me, but he is fully vaccinated and healthy.

The collision shop has managed to find used parts for the bumper replacement. The red liquid was not coolant – I had just squashed and punctured the power steering fluid line. I should have a functional car back by Monday.

It could have been a lot worse. I could have caused an injury. The repairs could have ended up costing a lot more. Any of the people mentioned in this story could have been unkind.

So it allows for perspective. Because of my line of work, and because I and people around me are all getting older, I am frequently exposed to people’s sadness, worry, pain, and frustration. It can really get stuck in my head, because my drive is to fix it. And when it can’t be “fixed,” I still want to make it better. So sometimes I think about it more than is helpful. Sometimes, like last night, I lose sleep. Sometimes I think about it when I should be getting other things done, so I end up thinking about getting those things done when I should be thinking about the smart thing to do when my GPS screen shrinks.

Perspective. Priorities. I can’t let thinking about the big things get in the way of thinking about the little things, because a little thing, like driving to the vet, has the potential to become a big thing. Perspective. Priorities. Even when you can’t change what’s happened, you can change the experience of those it’s happening to by being kind. I called the towing company to tell them how helpful their towing guy was. I called the police chief to tell him how helpful and kind his officer had been. Perspective. Priorities. Allowing the stress of being late and of having things to do cloud my judgement so much that I thought it was reasonable to try to fix a GPS issue while driving caused worse issues than just being a little behind schedule and could have caused much worse still.

I’ll consider this a wake up call. And I hope that, if you need it, my morning can serve as a wake up call to you as well, so that you don’t need your own.

It’s Complicated. That Cannot Stop Us.

I am a medical doctor. I was trained to look at a whole person, to evaluate and assess every human system – renal, cardiac, digestive, circulatory, hormonal, neurological, psychiatric, social, immunologic, and many others – and to keep my eyes and brain open to systems I might not think of at first. I was trained to think clinically, empathetically, and ethically. I was trained to advocate for my patients, to serve in their best interests at all times. I was trained that “hoof beats mean horses,” but to look for the zebras. I was trained to ameliorate symptoms while working to correct underlying disease and to look for ways to prevent disease from occurring in the first place. I was trained to recognize that causes of illness are multiple – that there is an interplay of genetics and environment, of biology and social factors, of pathogens and immune responses. I was trained to attack each of the underlying causes while looking at the whole person and keep his/her overall well-being in mind at all times. I have been trained to look for cause and effect, to understand human processes from the molecular to the sociological, to weigh risks versus benefits, to use scientific knowledge combined with psychological understanding and empathy to work to relieve suffering, and to work to provide the conditions that will be most conducive to health. It’s complicated as hell.

I am a parent. I was trained to distinguish my children’s hungry cries from their “I’m in pain” cries from their tired cries and many others – and to keep my eyes, ears, hands, and brain open to cry causes I might not think of at first. As my children grew, I was trained to listen not only to their cries and their words but also to what they did not say. I was trained to control my emotional thinking and combine it with my rational thinking while at all times keeping my children’s long-term well-being in mind. I was trained to recognize that there is an interplay of genetics and environment, of personality and friends, of strengths and stress. I was trained to combine my scientist’s mind with my mama bear instinct with my understanding of risks and benefits to work to provide the environment that would be most conducive to my children’s healthy, adjusted progression to adulthood. It’s complicated as hell.

I am a human. I have been trained to look at society globally and locally. I have been trained to rejoice in the goodness of humanity and to balk at the evil. I have been trained to recognize the interplay of psychology, sociology, religion, economics, philosophy, politics, technology, and more in how they promote good and how they promote evil. I have been trained to consider the risks and benefits of the manipulation and modification of all of the above. It’s complicated as hell.

I watched the footage two days ago of the high school in Florida with a lump in my throat, a rock in my stomach, and tears in my eyes. I watched and listened to the video taken by a hiding student and heard the gunfire that went on and on and on and on and on and on and on while children screamed. I now read the words and hear the voices and watch the faces of those grieving, of those lamenting, of those judging, of those blaming, of those who are sure they have the answers even though those with completely opposite views also are sure they have the answers. I listen to people discounting the arguments they don’t believe and discounting the people who hold the differing views. I look at this shooting and the ones that came before and the ones that will come after as an interplay of psychopathology, of sociology, of religion, of philosophy, of history, of politics, of ethics, of ineffective laws, of imperfect systems, and more. There are risks and benefits to the ways in which we address different aspects of all of the above. It’s complicated as hell.

I listen to very smart people for whom I have the utmost respect espouse combinations of diametrically opposed and surprisingly in-synch opinions. But during the discussions, the subject of which is so emotionally charged, the defensiveness kicks in, the self-righteousness kicks in, the name-calling kicks in, and these very smart people’s thoughts are almost immediately drowned out by the sounds of heels digging in and minds shutting down to ideas not already firmly entrenched in those minds. Unless the discussion is taking place in a venue only open to one opinion – then the discussion is infinitely more amicable but really not productive, since you cannot understand something and figure out how to deal with it if you only consider it from one vantage point. It’s complicated as hell.

What seems logical and obvious, what is taken as truth, is not infrequently wrong. This is nowhere more demonstrable than in the field of medicine. As medicine has evolved, we have looked at the theories, the treatments, the outcomes, and we have refined our methods continually. We delve into the basic sciences – the biology, the pathology, the physiology, and we figure out what the cause of an illness is and how to cure it and prevent it. We run trials. And we are frequently wrong. And when we are wrong, which we discover because we look at outcomes, we change what we do. We have come so very far by doing this. And we have done this not by dividing up into our own little labs or offices, but by listening to what the other smart minds have found. We don’t approach a patient with cancer just from a surgical angle, nor just from a chemotherapeutic angle, nor just from a radiotherapy or immunotherapy angle. We look at the disease from all the sides we can think of, we talk to one another, and we listen when someone thinks of another angle we hadn’t thought of before. And we think about the potential risks and benefits of each approach – there is nothing in medicine (including the option of doing nothing) that is without risk. It’s complicated as hell.

We need to hear the thoughts of people who approach the problem of gun violence from different angles. We need to look at the numbers. We need to verify the numbers. We need to evaluate risks and benefits to every approach. We need the minds of people who look at the problem differently than we do – we need a holistic approach to an enormous problem that is complicated as hell.

NRA members are as equally horrified as Moms Demand Action members by what happened two days ago. Republicans and Democrats feel equally as sick to their stomachs. And as long as no one trusts “the other side,” we will continue not to evolve, not to refine, not to fix this horror. I am currently gathering a select group to set a course of action. It will include Democrats, Republicans, centrists, NRA members, Moms Demand Action members, gun owners, gun haters, gun tolerators, people with backgrounds in mental health, people with backgrounds in education, people with backgrounds in the military, people with backgrounds in law enforcement, Christians, Jews, Muslims, people of other religions, atheists, agnostics, Blacks, Caucasians, people of other races, people from urban, suburban, and rural areas, and other areas of representation. We will develop a core set of goals and a core set of questions that need to be answered, numbers that need to be found. We will consider physical safety, civil liberties, societal factors, public health factors, racial factors, religious factors, physiologic factors, psychological factors, ethics, politics, and whatever else we come up with. It’s complicated as hell.

We will listen. We will discuss and argue with respect. We will find research that is objective and unbiased, and where that doesn’t yet exist we will outline the next steps for creating it. We will do this because there is no other choice. And it’s complicated as hell.

Small Snapshots of a Big Picture

Early yesterday morning, a 16-year-old child went missing. Early yesterday morning, a woman, in desperate anguish, put out a Facebook post with pictures of her child and asked for help. By late this morning, through the power of social media, the child was found safe.

Two days ago, a Big Ten university football team played a national military academy’s football team.  There was an amazing pre-game military tribute, and the half-time show culminated with the university’s marching band and the military academy’s drum and bugle corps combining to perform an inspiring armed forces medley.

Three days ago, a hungry, homeless man was given a bag of food by a volunteer who shows up daily to distribute food to the hungry. Three days ago, a wealthy woman wrote a large check to the organization that supplies the bags of food.

Every day, a parent brings a sick baby into the pediatrician’s office. A pediatrician sees how sick a baby is, and sends the child to be admitted to the hospital. Every day, a hospitalist assumes care for a sick child and sees to it that appropriate care is given.

A mother is on the far end of the political spectrum. She holds her beliefs firmly and is outspoken in her opinions and stances. Many are right there with her. Many are on the far other end of that political spectrum, and they argue. They argue intensely. Sometimes there are insults. Sometimes there is name-calling.

Every Saturday, a Big Ten football team’s fans dress in audaciously colored and outlandish garb, and cheer wildly. They boo the opposing team’s successful drives and boo the referees when a call is not in their team’s favor. Sometimes they trash-talk the opposing team’s fans.

A volunteer in a food delivery truck believes very strongly the SNAP program and government assistance disincentivizes working. He believes taxes are too high, that raising taxes disincentivizes working and being productive. He believes no one should go hungry, and that private or faith-based organizations do the best job of caring for those who cannot care for themselves. A woman who wrote a check to an organization running food delivery trucks believes that the government is not doing nearly enough to feed the hungry. She believes that taxes need to be higher, that the SNAP program is too small, and that the government should be funding the food delivery truck. The two argue on Facebook and on Twitter. When speaking with like-minded friends, they ridicule the other. There is name-calling and disdain.

A pediatrician believes strongly that we need government to get out of health care. He spends his days jumping through hoops to get needed care approved for his patients. He spends hours clicking boxes and filling out government-mandated forms that takes time away from his patients. He is sick of the bureaucracy that is inefficient and that he feels costs patients their health and at times their lives and makes practicing medicine near impossible. A hospitalist cannot understand why we haven’t yet gone to single-payer government-sponsored health care. She rolls her eyes at the arbitrariness of the admission criteria used by the various insurance companies and can’t believe the time she wastes jumping through the seemingly random and wildly diverging hoops of each coverage provider. She sees so many people without insurance who leave the hospital with bills that will cost the patients their homes. The two argue all the time. Each cannot understand how the other can be so stupid and naive, and they say so.

Early yesterday morning, women on extreme opposite ends of the political spectrum, who argue with one another and are at times unkind to one another came together in the blink of an eye when they heard that one of their children was lost. They posted the child’s picture. They asked for updates. They rejoiced when the child was found safe.

In the week preceding Saturday’s game, the big political discussion on campus was, “wait – so do we boo the military?” The consensus was an overwhelming, “of course not.” Although there were a few scattered boos early in the game (which stood out sorely), and an occasional loud disagreement with a referee’s call, not a single person trash-talked the visiting team’s fans.

A man in a food truck who hates big government and a woman with a checkbook who wants bigger government programs, who have used some very ugly words towards each other, together enabled a hungry group of people to eat.

Two doctors who have polar opposite views of how healthcare should be paid for and administered, who frequently are angry at and resent each other, worked together to heal a sick baby.

There are some absolutes. We look for one another’s lost children. We respect the people who dedicate their lives to protecting our country. We feed the hungry. We work together to save a life.

Yes, some people are assholes. But most people aren’t. We pretty much all have the same end-goals, but disagree on how to reach them. When people have real people in distress in front of them, most people will do the right thing.

The answers to our problems are complex. They’re nuanced. There are no perfect solutions.

But when push comes to shove, with all the bitter division and partisanship and “other”ifying so prominent in our country’s current landscape, in so many instances we’re doing what needs to be done. We are able, at times, to forget the name-calling and trash-talking. We’re able to put aside the insults. We can see one another’s humanity. We notice the few jerks and glare them down.

I have not lost hope. A child is found. There is respect in a college town’s stadium full of rabid fans. A hungry person is fed. A sick child is cared for. And so it will be.

Pinball, Ping Pong, and Personality

The “big ones” are home from college, and our house sings – the music of the three boys, the laughter, the banter – nothing is better. If you know me, you know that nothing makes me happier, more content, more whole, than when the five of us are together, and it is only enhanced when we get to throw in the presence of more family and friends. I love my people.

I hate being alone. I’m perfectly capable of being alone – I can get things done, I can entertain myself – but I generally have a deep desire to be in the presence of others. I’ve always been this way, and it’s been a little bit complicated by the fact that, by nature, I’m quite shy. Those who knew me as a child will certainly nod their heads in recognition of my shyness. Those who met me later, even in my teens or young-adulthood, will likely say, “What the hell is she talking about? That woman is not shy.” Those who met me later are wrong.

I gain strength connecting with others. I hate being alone. The underlying shyness is a fundamental fear of rejection by others, and hence a fear of being alone. But that fear of rejection leads to an avoidance of potential rejection, which leads to an avoidance of people, which leads to being alone, which sucks, which led me to learn to force myself to defy my shyness and put myself in positions in which no sane shy person would put herself. For example, my second year of medical school found me on stage at a full Fox Theater in Detroit, solo-ing at the top of my lungs for our annual Lampoon show, about pubic lice. This illustrates the extent to which I’ll go to fight my innate personality traits so that I can connect with people.

So why am I thinking about being alone? Today is Sunday – Doug is not at work, Andrew is not at school, Zachary and Ryan are home from college, I don’t have any particular pressing things to get done – and I chose to stay home alone while my men are at an annual pinball expo all day today. This wasn’t a last-minute decision – I made the choice weeks ago, when tickets to the event needed to be purchased – and I still stand by my decision. Which doesn’t make any sense – kind of like it doesn’t make sense for a shy person to sing in public about crabs.

Doug and the boys argued with me when I made the decision not to go. “It’ll be fun, Mom!” “You don’t hate pinball – I see you smiling when you play!” “They’ve got so many great games!” “C’mon, all the cool people are doing it!” (I made up the last one). They’re correct – I don’t hate pinball, it’s fun, the collection of machines is incredible – and I still didn’t want to go. How do I reconcile my deepest drive to be with people, and especially to be with people I love, and my decision to spend today on my own? It’s the machines.

The pinball machines. It’s specifically the pinball machines.

The machines stand in rows, one next to the other, filled with people staring into them and hitting flipper buttons. And while someone is staring into the machine and flipping the flippers, for the duration of the time each ball is in play, he is fully connected with the machine and disconnected from the people around him. And when you’re good at it, each ball’s play time is significant. It is fundamentally isolating. While I enjoy a reasonable amount of time playing, I don’t like the feeling of that isolation for a whole day.

I could play ski-ball for hours. Each throw requires focus, but you can chat with others between every throw. I can play ping pong for hours – it requires focus, but when you’re in the middle of a really good rally, even if you’re not making small talk nor engrossed in deep philosophical conversation, you’re very much in connection with the person across the table, anticipating her moves, reacting to her spins, adjusting your actions and reactions to interact with her as she adjusts hers to interact with you. I love ping pong.

I’ve spent my life making calculated decisions to increase my ability to be close to people. I chose to major in psychology as an undergraduate so I could understand people. I chose to power through my pre-med classes and medical school years of intense basic sciences (which did not come easily to me) because I had the ultimate goal of being a physician and helping people. I spent the clinical years of medical school, years of residency, and even some time as a hospitalist in a rural area, working 80 to over 100 hours per week, away from the people I was closest to, caring for people who were sick, injured, worried, grieving, and scared. That’s some pretty good interpersonal connection material.

The vasst amount of time I’ve spent alone, studying for exams, was done with the goal in mind of the ultimate connection of the doctor-patient relationship. The time I spent singing about sexually transmitted parasites and other things I’m unlikely to tell my children about, despite significant stage-fright, was done with the goal of connecting with my classmates in creativity and stress release. The times I stand and give talks in front of large groups of people (remember the aforementioned stage fright?) are done with the goal of sharing information and promoting discussion with others. The times I swallow down my shyness and chat with a random person at a conference, or on an elevator, or at my kid’s track meet, or at one of the boys’ jazz concerts, my drive to connect wins. When I walk in and stand in front of a class of medical students, my shyness is defeated by the pull of the teacher-student connection.

Today, the pull of the day-with-my-family was outdone by the aversion to the prolonged isolation of the pinball machines, which produced enough loneliness and self-pity to pull me into this self-reflection, which pushed me into sitting in front of my DocThoughts keyboard and reconnecting with you.

The men have returned home, happy and a bit glassy-eyed. I’m going to suggest some family ping-pong.

Through the Haze

I drove out this morning into a thick fog. It wasn’t a surprise – my smartphone had alerted me ahead of time that it would be there – but it was still slightly disconcerting. I had to get to the clinic, so I didn’t really have a choice to sit home and wait for the fog to clear. People needed me. I could see a short distance ahead, but not far. The route to the clinic is one I have navigated countless times, but although the general path was clear in my mind, the realities of the current traffic and road hazards were not something I could know. I had to slow down a bit and prepare to react to what emerged from the fog as I proceeded.

Today is the day after the inauguration of the 45th president of our country. There are many citizens who are hopeful and looking forward to what the new administration brings. There are many others who are in a fog – scared, unsure of what hazards they will encounter in the days ahead, not sure what the path ahead will be, and not sure that their vision of a destination is the same as that of those in political power.

The red of brake lights broke through the haze before I could see the red of the traffic light. I took my cue from those ahead of me and slowed down, gliding to a safe, albeit mildly abrupt, stop.

Fear. We all feel it at varying times and to varying degrees. It’s a primal thing, the feelings caused by a release of epinephrine in our bodies evoking physiologic reactions of a quickening heart rate, increased blood pressure, increased blood flow to our muscles so that we can fight or flee. It widens our pupils to let in more light, just as an exposure to darkness does. But that pupillary dilation can make things blurry. Foggy. Unclear.

I continued on my way, nervously negotiating lane changes and turns, knowing that my risk of being hit by a truck that didn’t see me or of hitting a pedestrian that I did not see was significantly higher than normal. Not everyone was headed to the clinic this morning. Some were heading to the grocery store. Some were heading to the gym, to a movie, to work, to a pharmacy, to a friend’s house, to visit a family member. Different paths to different destinations, crossing, merging, and diverging with the paths of others.

People are afraid when they sense a threat. A threat to their lives or to the lives of those they care about. A threat to their ability to eat. A threat to their physical safety. A threat to their ability to care for and provide for themselves and those that depend on them. A threat to their dignity as human beings or they’ve only just recently attained through generations of people fighting for those rights, rights which are still tenuous and are still not fully achieved. Many are afraid for their physical safety because they fear violence from outside, and many are afraid for their physical safety because they fear violence from those who perceive them to be from outside.

Again, brake lights alerted me to an approaching red light. Those ahead of me provided guidance through the fog.

For generations, people have marched for their rights. They have marched when they’ve been afraid for themselves and for others. We have seen the effects of their efforts. We are guided by their experience. Today, people are marching. They are marching in Washington D.C. and in cities across the country and around the world. It is a women’s march, but the women are joined in solidarity by plenty of men. They fear different things, they have different priorities in what they are marching for, but they are all motivated by a desire to protect what each considers a fundamental right under threat. Marching and speaking out has worked before.

I arrived at the clinic, a place staffed entirely by volunteers to provide medical care to those without medical insurance – those who cannot afford to go to an urgent care center, to visit a doctor’s office, to purchase medications, but who do not make little enough to qualify for Medicaid. These patients work as seasonal laborers, as nurses’ aides, as caregivers for their elderly relatives or their young grandchildren. They can keep food on the table and a roof over their heads most of the time, but healthcare is a luxury they cannot afford. This clinic provides basic care while it partners with other organizations and some individual specialists to provide some of what we are not able to provide. Many of our previous patients at the clinic had been able to obtain insurance through the Affordable Care Act and were able to move into the general medical system, getting the comprehensive care they needed and freeing up our clinic resources for others in need. There is a real fear that these people will soon find themselves once again needing our help. Rolling up sleeves and staffing this clinic and soliciting the funds to keep it operational has worked thus far. I saw clearly in the clinic. The fog was safely outside. The work of each one of us there today continues, and we have many miles ahead of us in this particular march towards health.

Some march literally and physically, but we all march figuratively – in our support of those marching and of their causes, in our denunciation of those marching and of their causes, and in the words we speak and the actions we take.

When I left the clinic and headed home, the fog had lifted. I had a clear view of the roads ahead of me, of the cars changing lanes around me, of the brown bag blowing into the street, of the cyclist to my right. Our paths cross and coincide and intermingle as we head towards our intended destinations, some of us on roads that some others of us will never travel. May our head-on collisions be minimal. May the lights of others on the roads help guide us as our lights help show others the way. May the fog be kept at bay. May we all reach home safely.

Our Home – a play

Setting: A large, multi-level mansion inhabited by multiple members and branches of an extended family. They are looking for a new house manager.

Main Characters: Bob (current house manager), Grandpa, Grandma, Dad, Mom, Stepdad, Oldest Sister, Brother-in-law, Youngest Sister, Oldest Brother, Youngest Brother, several middle siblings, Uncle Crazy, House Manager applicants: Heather and Darrin

Act One

(Living room)

Grandpa: Damn, it’s hot in here!

Grandma: I know, Dear. The air conditioner still isn’t working right.

Bob: I hear you. I’ve been working with the guys on this problem the whole time I’ve been working here. It’s definitely better than it was before!

Oldest Brother: No, it’s not.

Youngest Brother: Yes it most certainly is!

Oldest Brother: You’re just saying that because it’s working in your room. In my room –

Youngest Brother: Yeah, it’s working great in my room. Bob’s done such a super job! And everyone’s totally happy!

Mom: You’re so right! I’m happy! Dad’s happy!

Dad: Actually, I’ve been really hot recently. The A/C isn’t working in my office or in the –

Mom: And Step Dad is happy, and –

Grandpa: Will someone fix the goddamn air conditioner already? I’m gonna pass out from this heat! Bob’s retiring next month and we need someone to run this place and fix the air conditioning. And the coffee maker. It’s broken, too. And the –

(Doorbell rings)

Youngest Sister: I’ll get it. It’s probably the new house manager applicants. (exits)

Grandpa: Thank god. We need the air conditioning fixed.

Youngest Sister, entering with two people: Here are Darrin and Heather, the applicants for our house manager position.

Heather: Pleased to meet you.

Darrin (scowling): It’s hot in here. Someone needs to fix the air conditioner. I can fix it. I’m a very successful radio salesman so I’ll be really good at fixing air conditioners. The air conditioning industry is totally fixed, you know. They make it impossible for anyone’s air conditioner to work. I’m gonna make the air conditioners work in every room of the house. I’m gonna get rid of the whole air conditioning industry.

Heather: Well, I’ve been working with house managers for a long time, and I understand what this job entails. I see that some rooms are getting pretty good circulation, but a lot of the rooms are just stifling. We’ll have to redirect some of the air from the high-flow rooms to reach some of the lower-flow –

Darrin: Wrong! You’re part of the problem. You’ve been in the house manager business so long that you have no idea what it’s really like to live without properly functioning air conditioning. Your people have had plenty of time to fix this already. We have a problem and I’m here to fix it. And you know what makes this air conditioning problem really horrible? The cousins living in the guest wing. They’re only second cousins once removed. I don’t know why they’re here. They use way too much of the air conditioning.

Cousin: Um, actually, we only have a window fan, and we’re chipping in on the electricity bill each month and we help with –

Darrin: Cousins are like that. They’re not good people. They use all the air conditioning so there’s none left for anyone else and it’s always the worst of the cousins who show up.

Mom (horrified): What did you say?

Darrin: Well, I’m sure some cousins are ok, but most aren’t. As house manager, I’ll make sure any uninvited cousins or cousins who were invited but stayed longer than they were supposed to are sent right back where they came from.

Heather: Most cousins are hardworking people. When I manage this house, I’ll make sure there’s a path for cousins who have been here a long time and are helping around the house and raising their kids here to make it their permanent, legal address.

Darrin: I’m gonna build a big wall around the house so that no more cousins get in.

Dad: That’s ridiculous. No one’s building a wall. But can you really get the air conditioning to run better?

Uncle Crazy: I hate cousins. They’re all stupid and inferior. And so are adopted kids.

Oldest Sister: Hey, I’m adopted!

Darrin: Well, that was a legal process, so it’s ok for you to be here.

Uncle Crazy: Nope. Not ok. Can’t stand any of those cousins or adopted folk. I say we hire Darrin. He’ll get rid of all the cousins and adopted kids.

Darrin: Just the uninvited cousins or the ones that’ve stayed too long.

Oldest Sister (to the room at large): How can you let him say that? How can you let him say that he’ll get rid of me? I’m part of this family!

Mom: Of course you are, Sweetie. Darrin never said he’d get rid of you – that was crazy Uncle Crazy.

Oldest Sister: But he said those awful things about our cousins!

Youngest Sister: He did. He’s disgusting. I don’t know why we’re still interviewing him.

Youngest Brother: I say we send Darrin back to wherever he crawled out of and let Heather take over.

Grandpa: But Darrin sounds like he can really overhaul this air conditioning system and give us some relief from this –

Youngest Sister: Yes! Totally we should go with Heather! You agree, right Mom? Right, Youngest Brother? Right, Cousins? Right, Oldest Sister? Yeah! Everyone agrees! This is great! And we’ve never had a short person as a house manager before, either – what a perfect step for our family to take!

Darrin: Heather steals.

Youngest Sister: What?

Darrin: Heather steals. And she lies.

Uncle Crazy: Fucking thief. Fucking liar. Thinking she can do a tall person’s job. Adopted person lover. Cousin lover. All of them should hang from trees. Darrin all the way. Darrin’s our man!

Darrin (tipping his hat to Uncle Crazy): (wink, wink)

Mom: Uh, Darrin, shouldn’t you maybe distance yourself a bit from crazy Uncle Crazy here?

Darrin: Who’s Uncle Crazy? Don’t think I’ve ever heard of him.

Youngest Sister: Oh my god! Darrin’s like Uncle Crazy! How can anyone still let Darrin stay in this house? Why haven’t you kicked him out? What’s wrong with all of you? Why do you all hate Oldest Sister and Cousins and all short people? You always do this! All of you! You always –

Grandpa: Isn’t anyone listening? I’m gonna pass out! I’m too hot! Please, someone fix the damn air conditioner!

Grandma: I really am hot, too. Will someone –

Darrin: The whole house manager system is corrupt. I know this. I used to buy them all off in my radio business dealings. I did whatever I wanted because I was the best in the radio business. I know these people. They’re all corrupt. I bribed them all the time to get exactly what I wanted, so I know that they’re all corrupt. And if Heather could fix an air conditioner she’d have done it already while her friend Bob was house manager. She was head of laundry while Bob was house manager, so she had plenty of time to fix the air conditioning. We need to build that wall and get rid of the air-hogging cousins now! Make this house cool again!

Grandpa: I remember when the house used to be cool! Oh, it was so much more comfortable then!

Brother-in-law: But back then, kids and short people weren’t allowed to use the air conditioning, only the –

Uncle Crazy: Yeah! Make the house cool again! Get rid of the cousins! Get rid of the adopted people! And the short people sleep in the garage where they belong! Darrin! Darrin! Darrin! Cool house! Cool House! Cool house!

Darrin (smiling at Uncle Crazy): (wink, wink)

Oldest Sister: Dad, do you hear what Uncle Crazy is saying? Do you see how Darrin is goading him?

Dad: How dare you call me anti-cousin! How dare you call me anti-adoption! I adopted you! I’m as pro-adoption and pro-cousin as they get! I paid for college for you and Youngest Sister and all your cousins, several of whom are short people! How dare you say I’m misoshortpeopleistic!

Oldest Sister: Where the hell did that come from? All I said was –

Youngest Sister: How can you support this guy? You care nothing about me! You hate me! You have no respect for me!

Middle Sister One (walking through the room): Hey, has anyone noticed how hot it is in –

Dad: This guy wouldn’t kick anyone out, no one hates anyone, it’s just talk to get attention so he’ll get hired and everyone’ll be totally safe and –

Darrin: I’m really rich, you know. It’s because I’m so good at everything I do. Everyone loves me. In fact, they love me so much that I can do whatever I want. Heather’s a thief and a liar.  Let’s make the house cool again! House! House! House! House!

Uncle Crazy: House! House! House! House!

Darrin: Liar and thief! Liar and thief! Liar and thief! Remember the laundry? She put red socks in with the white dress shirts. A disaster. A total disaster!

Uncle Crazy: Jail her! Jail her! Jail her!

Heather: I was never convicted of stealing or lying. They’ve investigated me 64 times so far and the charges have never stuck. I may have used some bad judgment with the laundry, for which I take full responsibility, but –

Darrin: Liar!

Uncle Crazy: Thief!

Mom: Heather has been investigated an awful lot times, do we really think that she would be the best alternative to Darrin?

Oldest Sister: Nothing’s been proven! If you look for someone else, Darrin will end up with the job, and he’s a vile, disrespectful –

Darrin (to Oldest Sister): You’re fat.

Middle Brother One (walking through room): Hey, don’t know if you all know this, but the A/C is out again in my –

Oldest Sister: What does my weight have to do with –

Darrin: I’ll make the house cool again!

Heather: Darrin knows nothing about air conditioning. He has no experience, and he doesn’t have the temperament to manage this house. There’s the driving to think about, the dry cleaning, the yard work, the cooking –

Darrin: I’m the only one that can make the air conditioning work. I’m the best at driving. I have the best laundry skills. I’m the best at food –

Mom: Darrin, who would you hire to help with meals? You’ve never cooked before and –

Darrin: I would hire myself first because I’m the best with meals and I’m really good at everything and I know way more than the career chefs.

Youngest Sister: You would put this in charge of our house?

Grandma: He was really successful selling radios.

Heather: I have significant experience with meal preparation. I was sous chef here for years and –

Dad: Yeah, and we had that kichen fire when you were here.

Heather: Wasn’t my fault.

Darrin: Yes it was. Liar. Pyromaniac.

Uncle Crazy: Pyromaniac! Thief! Jail her! Jail the cousins! Make the girls sleep in the garage! Laundry!

Heather: The laundry was thoroughly checked – the white shirts are fine. Yes it was a mistake, but I’ve learned from it and the shirts are ok. Most of the shirts were polyester.

Darrin: She threw out the socks! She threw out the shirts! She didn’t want to be caught!

Heather: The socks were all worn out – big holes in the heels and toes. The shirts were looked at and they’re ok, none of the good white shirts turned pink.

Darrin: Laundry! Laundry! Laundry!

Uncle Crazy: Kill the bitch! Kill all cousins!

Brother-in-law: Hey! I found this Youtube video of Darrin! Watch this!

(Video Darrin: I’m rich! I can do whatever I want to short people! I don’t even ask! I just steal their laptops!)

Mom: What the hell, Darrin?

Darrin: That was a long time ago. That was just hangin’ with the tall people talk. Heather’s a pyromaniac. Kitchen fire. Laundry incident.

Heather: The kitchen fire and laundry incident were looked into repeatedly. How many times do we have to revisit the same –

Mom: Potentially ruining the white dress shirts is a big deal. How could someone be so careless with something so important? Maybe she was getting paid by someone from another house who wanted a pink shirt.

Heather: The shirts have been thoroughly examined. It was poor judgement. Let’s move on and –

Darrin: Laundry.

Uncle Crazy: Hang her! House! House! House! House!

Darrin (smiling at Uncle Crazy): (wink, wink)

Middle Brother Two (walking through living room): Hey, guys. How’s everyone doing? I’m totally sweating here. The air conditioning is still –

Darrin: I’ll make the house cool again! I’m the only one who can do this!

Heather: The house is slowly getting cooler. Two bedrooms are averaging two degrees cooler than they were before Bob was house manager. It’s a slow process, but I know how to tweak it and get –

Darrin: Laundry!

Uncle Crazy: Make the house cool again! Kill the bitch! Build the wall! Build the cousin wall!

Darrin: It’ll be a tremendous wall. Just tremendous, really. And the cousins will pay for it.

Middle Brother Three (walking through living room): Man, it’s hot in here! I think we need to –

Youngest Sister: Look, we need to pick someone now to take over as house manager. Obviously Heather is the only reasonable choice. Only Uncle Crazy wants Darrin.

Middle Brother One (walking back into room): Darrin sounds like he could really fix the air conditioning in a meaningful way, and I think –

Youngest Sister: The Middle Siblings haven’t been in the living room enough to know what’s going on. They’re uninformed. Anyone who wants to hire Darrin is either Uncle Crazy or an uninformed Middle Sibling. Everyone knows that. Everyone agrees with me. Right, Oldest Brother? You wouldn’t choose Darrin, right? You’re not a crazy uncle or an uninformed middle sibling, right?

Oldest Brother (averting her gaze and mumbling quietly): Uh, right…

Youngest Sister: See? Everyone agrees with me.

Mom: Look, we’ve gotta decide who to hire. Let’s call everyone in and take a vote.

People yell and call everyone to the living room. All the family members squeeze in. Pieces of paper and pens are handed around for people to write in their choice for house manager. People fill out their papers and put them on the coffee table.

Grandpa and Grandma count the votes.

Grandma: Well, I’ll be damned. Darrin will be our new house manager.

(Close curtain)


Youngest Sister is sobbing in the middle of the living room. Cousins are shaking in the corner of the room. Darrin has gathered his sons and closest relatives, all of whom are in his family business, to advise him and help in his transition to house manager.

Grandpa: Finally the air conditioning will get fixed!

Uncle Crazy: Kill the cousins!

Oldest Brother: No one’s killing anyone. We’re gonna get a new air conditioning system.

Middle Brother Four (to Oldest Sister): Dirty adopted person. Go back where you came from. With Darrin here, we won’t take your kind anymore.

Darrin: Gonna get rid of those uninvited cousins! This is the best! House! House! House! I’ll be the best house manager for everyone in the house! You’re all gonna love me!

Middle Brother Four (to cousins and Oldest Sister): Fuck you, Cousins. You’re outta here. All of you. No one was invited. And fuck you, adopted person. This is Darrin’s house, now. (Pushes Cousins and Oldest Sister)

Uncle Crazy: Damn straight!

Darrin (observes and says nothing)

Youngest Sister: Fuck you, Middle Brother Four! Fuck you, Uncle Crazy! Fuck you, anyone who voted for Darrin!

Brother-in-Law: Don’t worry. There are enough of us to protect cousins and adopted siblings and short people. We’ll work together and everything will be ok.

Mom: I hope so….

Act Two

We shall see.


Election Reflection

I took a long walk with my dog today, and then I took a shower.

I like showers. I’ve always found them soothing and comforting. I can think in there. I can relax. I can’t hear the phone ring. I can’t see a television. Generally, no one bugs me while I’m in there.  I come out clean, refreshed, and smelling and feeling good.

A shower can relieve aching muscles while removing the dirt and sweat from a long hike or a hard work-out or a stint fighting weeds, raking leaves, or shoveling snow. Showers are powerful for me, so much so that the combination of just a single 200mg ibuprofen with a long hot shower will knock out even my worst, sick-to-my-stomach headache.

So although my shower was not able to negate the outcome of yesterday’s election, it helped me to gather my thoughts and to process them a bit.

Here’s what I’ve got:

People really suck at communicating. And people are hurting, which tends to decrease their communication skills.

People are hurting. And they are not hearing what is being said. Which leads to more hurt. Which leads to more closing off and even less ability to hear what is being said.

People are hurting. And they feel that they are not being heard. So they yell. And other people don’t like being yelled at, so they don’t listen and they yell back. Which leads to more hurt and more feelings of not being heard. Which leads to more yelling.

With full recognition of the fact that my children will see it as quite ironic that these words are coming from my mouth, although a yell or scream is at times necessary to grab attention, yelling tends to lose its at first attention-grabbing power when it is done too frequently. And although there are circumstances under which someone must continue to scream because their life depends on it, in most situations there are far more effective means of communication.

It has been a long election season. I am a heavy user of social media in that I am a heavy lurker – I listen. And I listen. And I listen more.

There are countless posts about how people have deleted people from their social media circles over politics. There are myriad political discussions which devolve into name-calling spats. There is vilification and dehumanization of those affiliating with a particular political party or supporting a particular candidate. On both sides. And within both sides.

So I listen. And I think. And I don’t un-friend or un-follow, because I want to know what other people are thinking.

And I occasionally say something, in a blog post, or in a private message, or in conversation with others.

What I hear in these personal conversations and in my lurking observations continues to affirm my initial assertion that people suck at communicating. And the reason is that they don’t listen – they don’t listen to what others are saying, neither on their own side nor on the other side, nor at times do they listen to what they themselves are saying.

I have many people whom I am close to on both sides of the political aisle. During this particular election cycle, most of the folks close to me, even those who generally vote conservative, voted for Hillary Clinton. But a few voted for Donald Trump.

The people I know well who voted for the president-elect are not racists. They are not xenophobic. They are not homophobic. Not even in a closeted-but-belying-underlying-prejudice-with-behind-closed-doors-remarks kind of way. Every person is by nature subject to carrying some bias, but beyond this basic condition of being human, these particular people are not –ists or –phobics. They happen to be smart, kind, highly educated, giving people. They support their local schools, they help feed the hungry, and one has given substantial financial support to LGBTQ causes. Their arguments tend towards the economic in general, and they allude not infrequently to frustration with the “political elite” and stifling bureaucracy. They uniformly decry unfair labeling by the general media and “liberal elite.”

The labeling hurts them. And they hear it even when it is not there. A statement about the white supremacist groups that support the president-elect evokes not an immediate repudiation of the white supremacist group but a defensive response of “I’m not a racist and the fact that I am fed up with career politicians doesn’t mean you and all the liberal elite have a right to cast me as a xenophobe.” I hear plenty of people lump all President-Elect Trump supporters together as xenophobes, but plenty of people don’t lump them all together, and it’s not fair to assume that everyone does lump. Anyone else see the parallel to what our Muslim citizens deal with? And does anyone see the parallel of what many of our president-elect’s supporters deride as “political correctness” (if it involves not offending a minority or disenfranchised group member) to the defensive response to the perceived offense in the example here?

People want to be understood, but they don’t always want to understand. People want to be heard, but they don’t always want to listen. People don’t want to feel vilified, pigeonholed, and dehumanized, but they don’t always want to give that same consideration to others. And when people don’t understand, don’t listen, and instead vilify, pigeonhole, and dehumanize others, we get the cycle of viciousness that accompanies every election but that we’ve watched grow exceptionally heavy over this past year-and-a-half.

Our president-elect is a successful businessman. He has had business failures, but he certainly has grown his financial empire overall. He knows how to work a system, how to get what he needs or wants. He worked the country successfully to get the votes he needed. He did this with divisiveness, with name-calling, with insults, with threats, and with plenty of lies. I do think he is smart and knew very well what he was doing at all times. He knew his viciousness and his baiting would tear groups apart and drum up a certain base that he would need to get the numbers he needed and get them where he needed to get them in order to win.  He has his work cut out for him if, as he stated in his victory speech this morning, he intends to be a president for all Americans.

It’s funny – at the very beginning of his bid for the presidency, Donald Trump was so over-the-top and so much like a caricature that I seriously thought he was doing what he was doing to make the Republicans look ridiculous and boost up the Democrats. It seemed satirical. This whole experience has been surreal. And frightening.

Words have consequences. Words are powerful. And some of his words have caused pain and fear that will be very difficult to heal. And some of his words have emboldened those that are, truly, deplorable in their malice toward others, and the rest of the country will have to work together, all of us, to halt whatever momentum they’ve gained. I can only hope that the demagoguery will be kept in check now that the deal has been closed, so that those flames of animosity and malice will not be fanned.

I take hope in the fact that a significant portion of his votes were based on economics and frustration with bureaucracy, that the overwhelming majority of voters in the youngest demographic did not vote for him (as this group voted on social ideology as opposed to financial dissatisfaction – a luxury those in the older brackets are not necessarily afforded), and that it appears that he did not win the popular vote – it doesn’t keep him out of the office, but it makes the statement that there is significant work to be done, that support needs to be earned.

We will have to fight hard to keep our rights. We will have to fight hard to keep hatred at bay. We will have to work hard to listen, to understand, to see the humanity in one another. We have been shown that we cannot be complacent, that we must keep our eyes open and keep on our toes, that we have further to go than we may have thought.

I hope we have a big enough hot water tank.

Many Cannot Breathe

It was almost 14 years ago. Our three sons had gone to bed and Doug and I were getting ready to go to bed ourselves.

We heard a strange noise coming from the boys’ room. We turned on the light in the hallway and looked into their room – Zachary, our eldest, who was six years old at the time, was sitting up, holding his hands over his chest and upper abdomen, and crying softly and desperately, his face contorted in pain.

“What’s wrong, Zachary? Sweet baby boy, tell us what’s wrong!” we yelled as we turned on the light and ran to him.

It took a minute before he could get any words out. “I can’t breathe, it hurts,” he sobbed.

My mind raced. Is he having a pulmonary embolism (a blood clot in his lungs)? Is it cardiac?

“What hurts, Baby?” I begged as I pulled him to me and put my ear to his chest, hearing air move in and out, hearing no wheezing, and feeling his thorax expand fully between sobs.

“Right here. My heart. My heart hurts,” he said, as he held his hands over the center of his chest.

Doug was ready to call 911. I was ready to let him.

And then I asked my son, “Why? Why does your heart hurt?”

I don’t know why I asked him that. But he answered.

“Because I’m so sad.”

We held off on the 911 call, and now our parental distress went in another direction. What could have happened? Who had hurt our child? What had he seen? What had he heard? What on Earth was going on?

“Sweet baby, please, please tell us. Tell us why you’re so sad. Tell us what’s wrong.”

We sat on his bed and waited for him to be able to speak. It took quite some time.

“We saw a movie at school today,” he started, and dissolved into sobs again.

Again, our minds swirled. What could they have shown a class of first graders?

We held him and waited again for him for him to speak.

“We saw a movie,” he repeated. “It had very bad things. It was so sad and so scary and just really, really bad.”

“Please tell us what you saw, sweet Zachary. What happened in the movie? What made you so sad and scared?”

“It was about a person named Martin. Martin Luther King. And people were so mean. Some kids couldn’t play with other kids. They couldn’t play with their friends. The people couldn’t be with their friends because of their skin color. The people were just being so mean – even parents and teachers and the principal and some kids. And then, and then…..” We waited again for him to regain composure. “And someone shot Martin Luther King. Someone killed him. Why? Why? And Mommy, Daddy,” he continued as he started sobbing again, “there was something else, even worse….”

It took a few more minutes for him to be able to speak again. “The policemen. The policemen. They were hurting people. They’re supposed to help people. They were hurting people. They shot water on them from a hose and they hit them with sticks. Why? Why, Mommy? Why, Daddy? Why weren’t they helping people? Why were they hurting people? I don’t understand. How could that happen?”

And so began our family’s first discussion of racism.

We spoke of people’s fear of differences. We spoke about how fear and ignorance could lead to hatred, meanness, and even to violence. Our son had known that people were capable of doing bad things, that people hurt one another and sometimes even killed people. It was less than a year-and-a-half after 9/11, so this was not his first exposure to evil in our world.

But this was different. He was stuck on the police officers in the movie. He could not grasp how our protectors could harm someone. He could tell that it meant something very different that it wasn’t a few bad people that were hurting others – Doug and I could see that a foundational aspect of his understanding of the world was crumbling. He was seeing that evil could be systemic, that injustice – even violent and deadly injustice – could be in the fabric of a society. This realization shook him to his core.

At the time, we told him that the events in the movie had happened a long time ago. We told him that things had changed. We talked about the ways that our country was better now for everyone. We talked about the good that people did, how lucky we were to have the friends we had, how lucky we were to be living where we were and when we were, and how grateful we were to the people before us who fought for what was right so that everyone could live in a better world. We talked about how great a man Dr. King had been, and how he helped make our society kinder and more just. We talked about what we could do to make sure people are always treated right – that we needed to speak up and stand up for what is right, always to treat others with kindness, even if – especially if – people around us were not treating others kindly.

This is what we could think of at the time. This is how we comforted our child. And as we comforted our child, we comforted ourselves: the world had moved forward.

I went to the school the following morning to find out more about the movie so Doug and I could know better what exactly we needed to address with our son. I learned that it was an animated film that they showed to the whole elementary school annually around Martin Luther King Day – it was rated “G,” and the school had never before heard from a parent that a child had been disturbed by it. The teacher said  that Zachary must have a very strong imagination to have been so upset – she said that it was a cartoon about elementary school-aged kids and time travel, that there were some very brief news clips that went over the young students’ heads, and that the students had always enjoyed watching it. The principal lent me a copy of the video, and Doug and I watched the hour-long production, “Our Friend Martin,” that evening.

We saw that it was not Zachary’s imagination that had caused him such anguish.

At six years old, the time travel concepts had gone over his head, but not the interpersonal interactions nor the news clips. He saw and felt the inhumanity.

He was saddened and confused by friends’ turning on one another, by parental unkindness and school-sanctioned exclusion, by rules that made no sense, by the killing of a man who was helping others. And what caused the worst of his agony was what he saw in just a few seconds of film footage of the police yelling, turning fire hoses on people, and raising their sticks. He saw the hatred in their eyes and felt the cruelty in their actions, and he could not comprehend how that could exist in the people whose job was protecting others. He understood that this was extremely significant.

What a child of six registered was analogous to what a doctor sees when looking at blood cells that have gone awry.

He saw that parents, friends, and teachers, society’s red blood cells that are supposed to deliver oxygen, were not providing the love that normally sustains us. And he saw that the police officers, our society’s white blood cells that are supposed to protect us from infection, were attacking society’s own cells. A hematologic and immunologic nightmare. And while it is possible, in an acute setting, to provide a transfusion of red blood cells when needed (although it does not work well as a long-term solution), it can be a bit trickier to deal with an immune system that has turned on its own body – since autoimmune conditions and allergies arise from erroneously triggered overactivity, rather than from deficiencies that can be replenished, they can be difficult to stop. When a white cell sees a threat in something not dangerous, the body can be in true peril – we know all too well that allergic and autoimmune reactions can kill.

A body, like a society, is indescribably complex. There are countless more questions than answers, and rarely are there easy, universally effective fixes. But we study, we experiment, and we learn. Sometimes slowly, sometimes in amazing spurts of advancement, we evolve and improve our understanding and ability to heal what is ailing.

Medicine has come remarkably far in its ability to treat and prevent illness and injury because the field has focused on finding and fixing the root causes of ailments. Yes, we have developed treatments for symptoms of disease and injury, but our greatest advances have been in addressing the processes rather than bandaging or putting a salve on the results. And this is because we look to see what lies beneath the symptoms. We look at the patients. We look at x-rays, CT scans, and MRIs. We look at blood and tissues under a microscope. We do autopsies. We search for the causes so that we may find the cures.

Medicine has come remarkably far, but we have a long way to go. Although our life expectancies have increased dramatically, people still die far too young, and far too frequently, not only from accidents or from intentional violence, but also from natural causes.

Our society, in terms of civil rights, has come remarkably far. Even 14 years ago, the concept of children not being allowed to play together or go to school together because of their skin color, of this injustice being enshrined in school policy and enforced with violence by the police, was unfathomable to a six-year-old. We have come a long way from the times of separate lunch counters and separate drinking fountains.

But we have a long way to go.

We have, with laws, with education, with evolving social norms, fixed some of the most egregious symptoms of systemic racism. We have not eliminated the racism. We are far from having even mitigated many of its effects. And its effects are still sometimes fatal.

We have to see it. We have to see it in order to fix it.

When we try to excuse the tragedy, by pointing to reports that he had used marijuana, of a child murdered for walking through a neighborhood with a bag of candy, when we justify, by pointing out that he had been selling loose cigarettes, the murder of a man who repeatedly told officers he couldn’t breathe as they compressed his airway and held him down, when someone in a helicopter, watching an unarmed man hundreds of feet below, says, “that looks like a bad dude,” as another officer shortly thereafter shoots the unarmed man, when we don’t hear universal outrage at how long these people lie dying before anyone tries to help them, we aren’t seeing it.

We aren’t looking. We need to not only open our eyes to see the videos right in front of us, but we need to use x-rays, CT scans, MRIs, and microscopes. We need to perform autopsies – not on the bodies of the unarmed victims, but on the underlying process. While it may appear that some of the white blood cells are malfunctioning, white cells do not function in a vacuum – they are getting signals, in so many cases, to attack when there is no danger, to turn on their own pancreatic cells like occurs in Type 1 Diabetes, to respond to a peanut with an anaphylactic reaction.

It seems that right now, our society has, in effect, a low-to-moderate level inflammatory malignancy which triggers these and other reactions. The raging cancer of systemic racism that was so obvious just a few decades ago has been treated, resulting in a partial and variable remission. The chemotherapy of judicial and legislative action has knocked out some of the largest areas of disease burden – the police are no longer tasked with and ordered to remove people from eating at the wrong lunch counter. The targeted radiation therapy of education has enabled individuals to work on surgically excising incidences of racism when they are recognized.

But something remains and we are not seeing enough. We are not recognizing. Our detection capabilities are not where they need to be. We are not seeing our misplaced fears, our faulty immune reactions which are fueling a cycle of anger and deadly violence. We are not detecting the inflammation or the tumors. And one of our biggest blocks in this area is that we are not willing to do self-exams.

What are the self-exams we have been advised by our doctors to do? Breast exams and testicular exams. They are at first awkward and uncomfortable. They’re done on parts of our bodies that we tend to cover in public. We are shy about these areas, and these areas are physically sensitive. We tend not to seriously discuss these parts of ourselves or their exams with people of the opposite gender – women may discuss breasts or breast exams with other women, men may discuss testicles or testicular exams with other men, but we don’t tend to discuss these at the family dinner table. And because we are reticent even to discuss self-exams, we are frequently reticent to do them. We hold on to the awkwardness and we miss finding information that could save our lives.

When we don’t talk openly, we miss out on learning information that could save not only our own lives, but the lives of others as well. We need to talk about the lumps we find on ourselves. We need to describe exactly how they feel, how they move, how deep they are. We need to talk about whether we found them by chance or by concerted effort to look for them, or if someone else noticed something that caused us to look. When women hear men’s stories and men hear women’s stories, they learn about symptoms or feelings that could be a warning sign to their opposite-gendered friends or relatives, or even analogous to things going on in their own bodies.

We need to look. We need to feel. We need to talk. It doesn’t matter if it feels awkward. It needs to be done. We need to find the lumps. We need to evaluate them further with ultrasounds, and sometimes with CT scans or MRIs, and sometimes we need to biopsy them and prepare the biopsy samples with different stains and fixative agents and look under microscopes. And we need to figure out which of the lumps are benign and which are harmful, and if they are harmful how best and most safely to remove them. And also when they are harmful, we need to look for metastases and try to clear those as well.

A properly functioning immune system will recognize and destroy the majority of pathogens – bacteria, viruses, parasites – and it should recognize and destroy an occasional malignant cell. It should recognize and not harm its body’s own cells. It should recognize as harmless a particle of pollen or a walnut and should not release poisons to attack which put its own body in mortal danger.

We are complex. We don’t always function properly. So we need to be ever vigilant. We cannot remain silent. We cannot be reserved. We cannot stop speaking out loudly when we hear something dangerous.

We must keep looking – checking ourselves from head to toe, noticing suspicious moles on our loved ones’ skin. And when we see an obvious problem – a tumor, a misdirected immune response, an inflamed area – in ourselves or in our society, we need to address it. We cannot let racist/sexist/xenophobic/homophobic/prejudiced statements nor exhortations stand without refutation or repudiation, for all of these are truly, in effect, misanthropy, and feed on one another to harm us all.

Sometimes we will overreact. Sometimes we will do an invasive biopsy and find out that the lump is benign. Sometimes we will do a cardiac catheterization and find that there are no blockages. But not to look when there exists the presence of such ominous symptoms in our society is gross malpractice.

We need to quell our society’s low-level, simmering inflammation.

Yes, our country has moved and continues to move forward from the inhumanity and injustice that so shook my child when he first learned of it while watching a cartoon in his first grade classroom. But we have a long way to go. I hope we get far enough that when our three sons have children, our grandchildren will react with similar shock and disbelief to the hatred, fear, and violence that was still present in 2016.

Ready to Speak Out About Race

My heart is heavy and I am afraid, yet I am not the one who must fear for the life of her husband and sons because of the color of their skin.

I am sad and I am angry, yet people who look like me are not the ones who are still experiencing the lethal effects of systemic racism.

My sons, ages 20, 18 and 15, are outraged and devastated, incredulous and indignant, questioning and searching, while they understand fully that they are in positions of privilege due to our societal advantage of having lower dermal melanin levels than others.

My husband is distressed and discouraged, though he knows that he and I and our sons could not have anywhere near the level of distress of those with darker skin.

We are not currently the targets here, but this is our fight. It is our fight because we are human. Because this is our country. Because we all need to be better than this. Because people are dying.

Because I am a doctor, this is specifically my fight. I chose to go into medicine because I want to help people. I want to help keep them from getting sick or injured, to help heal them when they do become sick or injured, and to help ease their pain and suffering whether or not they can be healed.

People are being hurt and I need to help.

The best way I know how to help here is to speak and to write. I have listened and read, and now I am ready to talk. In my next post, I have a story to tell.