Now Reading

Shelby Foote, The Civil War

Herman Melville, Moby-Dick, or the Whale

Michael Punke, The Revenant

Bill Bryson, Notes from a Small Island



The contents of this website are for contemplative purposes only. No medical advice will be given, and emails asking for medical advice will be ignored.

Although patient vignettes are based on my experiences with real individuals, I liberally change details to maintain patient confidentiality.

I also reserve the right to change old postings to correct errors, and to delete comments that include obscene language or that I deem abusive to me or other commentators.  If you are looking for a open mind, I suggest you consult a neurosurgeon.

Katrina Blog Project

What You Can't Take Defines You

A priest, a rabbi, and an pink polka-dotted elephant went into a bar. The bartender was a Republican.

After a few minutes, someone noticed that the pink polka-dotted elephant was gone. People looked everywhere, but the elephant was nowhere to be seen.

The rabbi said, "I think the bartender took him."

"Oh, no, that's impossible," the priest said. "The pink elephant was a joke. Republicans can't take a joke."


There Are Two Beings

A time will come
When you will erase my birthday from your calendar.
You will swipe from your electronic memories
My address, my links, my breath.

I have two kinds of being.
The one I know, the one you know.
Mine could be shorter, and is linked indirectly
To the stars that wobble in the night,
To the moon that arcs its sometime passage,
To the sweeping sun, to the variable tides.

Yours is an impression
Chalking on a first rate stone by the sea
Eaten by lichen.


Katrina at 13 Years: NOLA vs. Puerto Rico; King Lear

This week marks the thirteenth anniversary of Hurricane Katrina’s landfall in New Orleans. Since it was the original reason for this blog back in October of 2005, it always stands as a moment to reflect. A long time has passed, and there has been a great deal of healing, but the past is always worth remembering.

And oddly enough, Katrina has come up in the news lately. Revised estimates of the death toll of Hurricane Maria, which struck Puerto Rico last year, now nears 3,000. Besides the pure tragedy of 3,000 deaths, there is the unfortunate fact that our President, when he toured Puerto Rico after the storm last year and was told that there were only 16 deaths, said:

If you look at a real catastrophe like Katrina, and you look at the tremendous — hundred and hundred and hundreds of people that died. And you look at what happened here with really a storm that was totally overpowering. Nobody's ever seen anything like this. And what is your death count at this point, 17? …. You can be very proud of all of your people, all of our people working together. Sixteen versus literally thousands of people.

Now that the Puerto Rico death toll has far surpassed the 1,800 deaths attributed to Katrina, the press is revisiting this statement.

It was a stupid statement then, and it is a stupid statement now. Something in the hard wiring of human brains tempts us to make comparisons. Nothing is ever taken as an absolute, which a bad thing in and of itself. For something to register in our national consciousness, it has to be better or worse than something else. No one is interested in the ninth-worst hurricane in U.S history, let alone the the fiftieth. We decide if something is worthy of our attention based on how much worse it was that the worst we know of. “Sure, there was a flood in Houston, but was it worse than Katrina? Rita? Sandy?” If not, then why worry?

What made the President’s statement so damaging is that it allowed millions of Americans to dismiss a disaster in their minds because there were only a few deaths. Once dismissed, as the disaster in Puerto Rico worsened, few people gave it another thought. When something is dismissed, resurrecting it is hard.

This dismissal might have happened anyway, but it was certainly made easier by lazy comparison. The President, who brags daily about how much money he has (and many things besides), is very prone to comparing things and dismissing those that seem to him to come in second, but really, in this case he is simply an exemplar of American culture at large. In America, everything is a race, everything a contest. TV and movie award shows get higher ratings than the shows they honor, because no one wants to watch a TV show that isn’t the best. (Once the show gets wins the Best category, then people can be bothered to go back and watch it.)

A restaurant can’t be good, it has to be a four star. A book can’t be good, it has to be a prize winner. And from my own experience: A doctor can’t be good, he must be a to Top Doctor. The best in his field, or nobody.

On a number of occasions, while telling other people a personal story, I have been shut down, expected to give ground to someone who had it worse; or, if I told about something lucky that happened to me, I had to yield to a story that was luckier. It is bad enough when the person says, “Oh, you think that’s bad? Let me tell you what happened to me!” Even worse is when the person says, “You think that’s bad? I have a cousin who…” In such cases, you aren’t just competing with the other people present, you are competing with people not there who got the shaft worse than you did.

So if you happen to be in a disaster, remember that you have to go for it. You have to be the worst disaster, you have to be the most destitute, you have to lose the most neighbors to drowning. Otherwise, you are just second rate. And second rate misery loses out in the great competition that we call the American Way.

What is lost in all this is empathy. Pure, common empathy, and its noble cousin compassion.  The ability to give other people the dignity of telling their own stories. It is, of course, horrible to know that 3,000 people died in Puerto Rico, but what is much worse is the thought that we would not have cared as much if it had not surpassed the Katrina total. As if that matters.

Everyone has misfortunes. Some are worse than others. But better or worse, every human being has the same dignity, the dignity of being heard, not in comparison to others but on his or her own terms. The misfortune of another is always worth paying attention to, whether it is worse than someone else’s suffering or not. It is the nature of human concern not to compare people and their suffering. All suffering has meaning, small or great, or else human beings have no intrinsic worth. This is what John Donne meant when he said, “any man’s death diminishes me, because I am involved in mankind, therefore never send to know for whom the bell tolls; it tolls for thee.”

When I think of this foolish game of comparisons, I also think of what I consider to be one of great moments in literature, a scene from Shakespeare’s King Lear. By scene three of Act III, King Lear has lost everything; his children have abandoned him, friends have been tortured and imprisoned, and his kingdom has been taken away. He is turned loose from his castle by his own daughters to wander alone on the heath and die of exposure. His only companion is the Fool, his court jester. Standing on the heath, abandoned, unloved, ruined, and in agony, he nonetheless turns to the Fool, the only friend he has left, and says:

My wits begin to turn.
Come on, my boy: how dost, my boy? art cold?
I am cold myself. Where is this straw, my fellow?
The art of our necessities is strange,
That can make vile things precious. Come,
your hovel.
Poor fool and knave, I have one part in my heart
That's sorry yet for thee. (Act III, Scene 2)

Despite all he has suffered, Lear can still find a part of himself to be concerned for the welfare of his last friend.

Real human greatness is concern for another, no matter what your own plight. This isn’t a competition. We are all dignified human beings, and it makes all of us greater when we are concerned for one another.


Facebook No More.

Here are the circumstances surrounding my recent separation from social media:

I was friends with a woman I don’t know. In ordinary (analog) life that statement makes no sense, but in the strange logic of Facebook, it does. She was someone who occasionally posted on the same pages as I did, worked in my profession, and generally had opinions similar to mine (although she was a tad more liberally tinted than I).

That wasn’t abnormal. It also wasn’t abnormal that she posted a great deal of negative comments about Donald Trump. This was fine with me, since I am no fan.

But she had a troll. Some guy who would reply to every post critical of Trump with some kind of defense. Sometimes his comments seemed reasonable, but often they were annoying. He would reflexively defend Trump, every single time. He was so predictable and reliable a naysayer that I could practically write his answers for him. If Trump wanted Muslims out he was arguing that Muslims are behind most terrorism. If Trump wanted a wall he talked about Mexicans taking farm jobs. If Trump dumped on African countries, he argued that African countries were asking for it.  If Trump did it, it must be right.

It went on and on. I would refute him. He would try to refute me back. He wasn’t always nice. I guess I wasn’t always nice.

Then came the mothers and children being separated at the border. This, I thought, was such an obvious wrong that I couldn’t see him trolling about the issue. What could be more evil than taking an innocent child away from his or her parent? But I was wrong — he argued that the immigrants were breaking the law, and the law must be enforced, the age of the child punished be damned. He argued that if someone breaks the law, the government is justified in meting out whatever punishment it is in the mood to prescribe, no matter how heinous the punishment may be. Should the punishment fit the crime? Nope. The punishment should be so brutal that no one will ever think about repeating it again. The chopping-off-hands for stealing bread argument.

I was fed up. I wrote, “So how are you getting paid, in rubles or bitcoin? Just curious.”

It wasn’t the worst retort I ever made on Facebook. Nor was it the angriest. But I was angry. And after I posted it, I thought, why? Why am I angry? Who is this troll to me? Why do I care what an ignoramus thinks? What is the point in arguing with a fool?

So I deactivated my account.

I did it because I realize being angry is not entertainment. It is easy to make that mistake these days. While anger doesn’t entertain, it does stimulate, which is an antidote for boredom. For people who live dull, empty lives, devoid of love or compassion, anger is the antidote to boredom. It is easy to conjure up, and when anger arrives, it banishes fear and anxiety. Anger is an emotion that does not allow other emotions to co-exist with it, and so people who have no happiness in their lives tend to gravitate towards it, subconsciously preferring outrage is to fear, depression, emptiness, anxiety, or boredom.

This is what most social media clicking is about — not making people happier, but staving off that unpleasant feeling of boredom.  And anger is social media’s secret weapon — it makes boredom disappear. The average internet surfer is too mindless to realize that not being bored is not the same as being happy.

Happiness is a hard emotion to evoke. It requires art, intelligence, honesty, and the ability to generate empathy to make someone else happy. Anger, on the other hand, is easy. Just say something somebody else doesn’t want to hear. Be a troll. So if you want to attract eyeballs online, you can be artful, intelligent, and compassionate, or you can just piss people off. Either way generates clicks, and makes money. One is for the hardworking and concerned, the other for the ignorant and lazy. Anger is the perfect emotion for those too lazy to cultivate anything else.

Facebook and Twitter, and all their ilk, are designed to make people angry. To accomplish this, they deliver fast feedback — in Facebook, there is that little bell on the screen that shows a red number when somebody flames you back. You check the bell and find that some jackass answered you and it makes you want to answer back. This raises the temperature of your response, and your troll raises the temperature in return, and it spirals up from there.

Facebook and Twitter design their systems to promote fights. Just as reality TV producers figured out a long time ago that they could attract more viewers by encouraging people to argue with each other on camera, social media knows that it can get people coming back to a page if they can get people arguing with each other. And their algorithms encourage it —  If you get on a page and have a heated exchange with someone, the program offers you more feeds from that page or similar pages so you can get in more fights.

Social media companies will deny this, but the fact is, they make money from clicks. More clicks come from addictive behaviors. There isn’t a product on earth that its manufacturers wouldn’t want to be addictive if it could be, from Diet Coke to Call of Duty to Lucky Strikes to Game of Thrones. The holy grail of every marketing department is to create a product that is addictive, but can’t be proven to be addictive. Hook people without them knowing they are hooked. Think cigarettes in the 1950s.

For social media, the key to addiction is feedback. Social media sites provide immediate, continuous feedback, stimulating you to go back in, before you have had a chance to completely get out of the medium and depressurize. Most other products can’t do that. It is the feedback that makes you return and return.  Just when you think you are on your way out, it pulls you back in. Anger is the hook. Anger is addictive: it makes you feel self-righteous, feeds your fear of being publicly bested by someone else, encourages the impulse to get in the last word and therefore be recognized as having had the final say, and most of all, banishes anxiety and boredom, the scourges of our age.

I don’t like to be angry. I like to be in control of my emotions. I think happiness and compassion are out there to be found, and that they can’t be found in anonymous online encounters. Face to face time with real people is required. Avoiding anger is not always possible, but the least I can do is stop looking for opportunities to be obnoxious. Facebook tempts me to look for opportunities to be obnoxious, and so I shut it down.

Do I miss it? Sometimes. Sometimes I wish I could send friends far away pictures of what I am doing, or share my opinion about a book or movie, or political issue. But then I realize this has no effect on anybody. Lots of people sent me pictures of their kids or dogs and I ignored them, preferring instead to find out what the trolls were saying about the latest stupid thing Trump did

I don’t want to care about the latest stupid thing Trump did. That’s what Trump wants me to do, to be angry, and that’s what his legions of trolls want me to do. To be angry, and to be addicted to being angry.

So I’m out.

If my friends want to send me pictures of their dogs, cats, and kids, they can send me a Christmas card.


To the Graduate, Any Graduate, Who Might Happen Here

This year marks the twenty-first year since I received my medical doctorate. Since then, I have not for one day regretted my undergraduate major in English and American Literature. As the years have gone by, my knowledge of literature has given me a resource to hedge against the way medicine is practiced today — that is, data-driven dehumanization. A humanities degree offers me perspective, the ability to empathize with the plight of the ill, and most of all the ability to communicate the concepts of science in a way patients and other professionals can understand.

To any student who wants to major in the humanities, I say go for it. (Or if you already went for it, congratulations.) The world of technical knowledge will always be there for you. You may be a bit behind your more technically trained colleagues when you start your post-graduate career (I was), but while you can close that gap, most of your colleagues will never make up for the loss of wisdom and human understanding, of empathy for others, of the ability to discern the truth, and thus of the ability to sniff out a lie and render it harmless.

Knowledge of life and culture is knowledge, too. It doesn't fill the wallet directly, at least not at first, but over the years those who truly study and learn the humanities discover that others who lack that grounding often ask for advice, and usually respect the wisdom given. Insight and clarity of thinking is like being physically strong. It is something you can achieve when you are young, and if you care for it properly it can be with you always, but if you don't acquire it young you will find it much harder to learn when you are older. It is knowledge that lasts.

Practical knowledge, on the other hand, has the shelf-life of raw salmon.


ONE FINAL NOTE: Everyone thinks to get accepted to medical school that you have to major in biology or chemsitry. I have heard this one, and heard it, and heard it, and heard it. Every guidance counselor I have ever talked to will tell you the truth, that you can major in anything you want to and still go to medical school. Counselors and medical schools try, but nobody listens -- it is like the myth that cold weather gives you pneumonia; there is not an ounce of truth to it, never has been, but the belief cannot be stamped out.

But I tell you, as someone who majored in English and went to medical school -- medical schools don't care what you major in! And majoring in the humanities does not hinder your medical education. I swear it's true, and I am living proof.