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Evelyn Waugh, A Handful of Dust

Dante, The Divine Comedy

Fyodor Dostoevsky, Crime and Punishment

Tara Westover, Educated

The Teaching Company, The Great Minds of the Western Tradition



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

Donald Trump and Southern Values

As someone who has lived his entire life in the Deep South, I find the most perplexing thing about Trump supporters is the casual way they dismiss his rude, bullying behavior. The South, despite its ugly underbelly (I’m thinking of its history of segregation and racism), has always prided itself on decorum, on the appearance of propriety and morality, even if the deeper reality is something different. One may insult or harm to another person in many ways, but to show them disrespect in public, to flout the rules of public decency, was always socially unacceptable. And yet here we are.

The ways that Trump’s behavior has been excused hasn’t only been hypocritical — that seems like such a mild crime these days — it has been a virtual instruction manual on how not to apply ethical principles. Any vestige of the Southern code of conduct, that venerated set of family values the Southerner claims to have learned at his mother’s knee, is undermined by Southern Trump supporters, who will forgive their Chosen One for almost any sin.

Consider the argument Trump gives for pressuring the President of the Ukraine to dig up dirt on his political opponent. Ordinarily the act of using the resources of a foreign country against the interests of citizens of your own nation is called treason. The response from Trump’s defenders is that Joe Biden’s son may have been doing something wrong, and so Trump was justified in violating ethical principles to find out.

But where in criminal law does it say that a person can commit a crime as long as he can supply a good reason for doing so? A bank robber has a good reason for robbing a bank. He needs the money. A murderer has a good reason for killing someone. He is very, very angry. Excuses can sometimes mitigate the severity of a crime — stealing bread because you are hungry is different from mugging an elderly woman for drug money, for example — but it is not a measure of guilt or innocence. Stealing is stealing, no matter what the reason is. One might get a lighter sentence for a crime with a good excuse, but that does not make the perpetrator innocent.

The idea that the President of the United States can commit treason as long as he has a good reason is absurd. Further, his “good reason” was that he wanted to hurt a political opponent. If he has another plausible reason he has yet to give it. He says he wants to prove the Democrats interfered with the 2016 election, but the Mueller report showed that it was the Russians who did this. That two year investigation never turned up Ukrainian involvement. Mueller was not able to prove Trump cooperated with this election interference, but that does not change the fact that the Russians, not the Ukrainians, were behind the 2016 election meddling.
Since Biden’s primary relevance right now is that he is running against Trump in the next presidential election, there is a huge personal motive here, one so massive that if Trump had any sense of what the term conflict of interest meant, he would turn the matter over to an independent investigator and take his hands off. Instead, he has done exactly the opposite, not only trying to handle the investigation himself but trying to hide what he was doing from other government entities that could have helped him investigate.

Which brings us back to the Trump excusers who plan on letting him off the hook on this, just as they have on everything else. When I ask them why, they say because “we are doing well.” Which I take to mean the economy is doing well, the borders are tightening, and abortions are becoming harder and harder to get.
If you excuse Trump because the economy is good, you are saying that you can be bought. That a little more money in your bank account is all you ask for to write out a pass for treason. There you are.

If you are giving Trump a pass because of immigration or gay rights or abortion, what I want to know is: Do you think the best way to handle our border problems or prevent abortion is to find a leader who has no ethical boundaries? Think about this for a moment. You argue that you will support Trump for moral reasons. Abortion is so wrong that you will sacrifice every other ethical value to see it banned. This not only makes no moral sense, it makes no logical sense. If you cede absolute power to a leader for the purpose of banning abortion, that person can easily turn around and legalize abortion again. A person without moral compass is the absolute worst type to entrust an ethical mandate to.

Does Trump have dictatorial power? Well, has he been held accountable in any way for his behavior? If not, then he has dictatorial power.

Trump’s election, and continued support in many sectors, looks to me like a kind of despair. It suggests that people who say they want a more ethical world do not trust that there are enough moral politicians to deliver one, and so instead they will support someone who will break every rule in the book to achieve a “moral” end.
This is akin to a man who, because he is having ongoing financial problems, signs over all of his money to someone who runs a brothel. Since the brothel is making a lot of money, the man reasons that the pimp will properly manage his money.

Maybe he will, maybe he won’t. (I would put my money on won’t.) But either way, the assumption that an immoral person will do the right thing and return your money in the end is a ridiculous risk to take.

It is good to have a moral code. But if you have one, you must believe in it all the way. You can’t believe that half your moral code should be sacrificed for the other half. That is almost certain to lead to the loss of it all.
While I think what Donald Trump is doing is indefensible, I think even less of people who have such little faith in their ethical system that they will sacrifice most of their values for the survival of a handful of principles they think are more important than the rest.  Value systems don’t work like that. They aren’t a collection of baseball cards that can be traded one for another. An ethical system is a web of related principles. Truthfulness relates to respect, which is related to love, which is related to the family, which is related to faith, and so on. You can’t tear out part of the web and expect the rest of it to hold.

It doesn’t. It won’t.


A Few Lines Written After Spending Four Hours at the DMV

The service at the Mississippi Motor Vehicles offices has been deteriorating. For two reasons: First, one of the offices here in Jackson closed and was not replaced, and second, new Federal ID requirements have led to more complicated licenses that are harder to print.

So I waited fo four hours this past week. I couldn’t renew online because I accidentally allowed my old license to expire.

Some thoughts about the experience:

  • The employees at the office were not to blame. It is chic to call government employees lazy, but the fact is that once my name was called the service was quick and efficient. The employees were working. There just weren't enough of them.
  • I brought a copy of George Eliot’s Middlemarch with me and read it while I waited. I don’t think I would do that again. Middlemarch is a wonderful book, but it is a notoriously complex novel. After three hours, my mind was mush.
  • Renewing my license required me to stand for a photo and verify my address. No vision test, no written test, no review of my driving qualifications at all. It is hard to see the point of getting a license in Mississippi except that it is a way to collect money. No concern about safety.
  • I am not at all angry about the experience. I knew it would be a pain from the beginning — my expectations were low. I had the day off and was prepared to spend all of it there. Low expectations do wonders for the mood.
  • The state gave me the option of paying double the fee and getting an eight year license. This was a fantastic deal and almost made the four hours worth it. I was able to condense eight years of interactions with the DMV into one day and get it over with.
  • What kind of a person will I be in eight years when I have to come back? Long stretch of life between now and then.
  • Everyone in statewide elective office should have to renew his or her license in person at the DMV once a year. If our political leaders had to sit for four hours each year in the DMV, I am betting the number of clerks would increase and the wait times would fall dramatically. Politicians these days tend to be wealthy and therefore rarely have to use public services. They know nothing about the systems they create. 
  • Come to think of it, every politician should have to spend one day a year off health insurance for each percent of citizens who are uninsured.


Recently, while clicking around in this website, I realized that the links to my orginal series of posts about Hurricane Katrina, entitled The Katrina Blog Project, were all broken. This was greatly disturbing, since these posts were the reason I started writing this blog 14 years ago. I have fixed them all, and access to the entire project and an explanatory post have been restored.

I suspect the links all broke one or two years ago when I upgraded my Squarespace account.

Anyway, I am still here and posting after 14 years, and this must be one of the oldest continually updated blogs on the internet. I know of none that have kept going for so long, even for such a small audience. To the few who still come here, I thank you from the bottom of my heart.

Speaking of hearts, this past week I had the honor of taking my daughter to college. She is now installed at Millsaps College in Jackson, Mississippi, a wonderful little school that deserves a lot more credit and attention from potential college students than it gets.

My daughter is now there, and I am amazed at how profound an experience it was for me. I always knew I loved my little girl, but the intensity of that love never showed through the way it did when she moved out. I didn't think I could love another so much, but I was mistaken.

Have sympathy for those parents taking their children to college for the first time. It is a triumphant time, it is a lucky time, but for parents it is also a sad time. I will miss her, and can't wait to see her beautiful face again.


Toni Morrison (1931-2019)

At the time of her death this past week, Toni Morrison was arguably the most famous American literary author. While there are a few writers who were better known to the U.S. public, Morrison’s international reputation as put her above almost any other American writer on the world stage.

I first encountered Morrison in college. Song of Solomon was assigned reading in one of my literature classes, and I was impressed enough to read Beloved during the following school break. I emerged from Beloved changed. I am still changed now.

Morrison is usually encumbered with the descriptor African-American. This is unfortunate, because more than any other writer of color that I can think of, except possibly Ralph Ellison (who was far less prolific), Morrison was larger than any label. Though she certainly wrote about the African-American experience, it was clear from page one of each of her books that her goal was not to be the best of her genre, but simply the best. She didn’t chase after James Baldwin or Ralph Ellison, her peers in the African American community; she chased after the all time greats — Melville and Twain and Faulkner. This ambition was plain in book after book.

Her books all had one thing in common — a singular devotion to craft and perfection. Unlike most writers, Morrison never wrote a bad book. Her writing style, while relatively conventional, bore the hallmark of high quality. Some of her books were better than others, but all displayed craftsmanship and polish. Even as a Nobel laureate, her reputation permanently secure, Morrison never let up, never let a crack show.

More importantly, she left a permanent mark on American literature, if not all American art. This is not something even some of the greatest of the greats can claim. Her contribution was the historical sensibility she brought to American racial history. Before Morrison, almost all African-American writers focused on contemporary racial conflict. Writers like Ralph Ellison, James Baldwin, Alice Walker, and Zora Neale Hurston wrote about the problems of their own generation, sometimes reaching back to the world of their parents. But Morrison looked further back, into the days of slavery and the slave trade for literary material. By doing so, she was reminding the world that the racial problems we see today are not new. They are rooted in the past, even the distant past.

To be fair, Morrison’s historical approach wasn’t entirely original. She was never an altogether original writer, preferring instead to weave together threads begun elsewhere. Decades earlier, William Faulkner explored the roots of racism, going back to the days before Civil War, but from the white prospective. Alex Haley, in Roots , looked at the African-American story before emancipation. Unlike Faulkner, Morrison wrote her stories from the viewpoint of the slave; unlike Alex Haley, who was interested in proving his family descended from African royalty, Morrison looked at the life of the common slave. She understood that the history of slavery lay in the experience of ordinary black people, with names wiped off the historical books. Her accomplishment was to take Faulkner’s and Haley’s approach to history and to stake a new claim for people who had been forgotten. She took up the threads created by other writers and wove them into something entirely new.

Morrison was old school in her racial thinking, as am I, which is why I admire her so much. Before the modern racial debate about identity and emotional triggers and white privilege, there was a concept in race discussion called multiculturalism. This idea was the rainbow concept — that all races would live together in harmony, side by side, not exactly blending, but learning from one another and complementing one another. Multiculturalists recognize that our histories are different, but that our futures are together. In recent years, multiculturalism has fallen out of favor, replaced with a harder-edged discussion about rights and access, about social justice that not only respects social differences, but insists that ethnic heritage is more important than the things we have in common. The new idea is that I am me and you are you, and I can never understand your experience and you can never understand mine.

Morrison was not against this. Nor am I. But she understood (as I think I do) that social justice begins with mutual respect and acceptance. It begins not with emphasizing how my experience is different from yours, but how it is the same. Human. To read Morrison is not to be struck by how different people of other races are (a hallmark of more recent fiction), but how similar we all are. In Beloved, Morrison’s artistic achievement is make the reader to ache for the loss of a child of color just as much as we would for any child anywhere. Her gift was not to make us see race, but to teach us how not to see it.

I miss that. I miss her. And it hasn’t been that long since she’s been gone.


July 1

Supposedly, July 1 is the worst day of the year to be admitted to the hospital. The first of July is the day everyone in the doctors’ world moves up the ladder: It is the first day of work for interns (brand-new MDs), the first day for residents (just completed intern year), and it is the first day doctors who have just completed residency training begin practicing medicine without supervision.

On July 1 there are more inexperienced doctors at every level than at any other day of the year.

All of that inexperience deserves some advice, and now that I am almost twenty years in, I would like a try.

Dear New Doctors of All Kinds:

Doctors like to complain. They complain about long hours, insurance companies, difficult patients, school debt, and hospital management. They complain about work stress, burnout, and physician suicide. Some of the complaining is legitimate. Some of it is doctors feeling, out of their own sense of self-importance, that the misery of medical work is unique, not understanding that all jobs everywhere have their own griefs.

None of this is to belittle the hardness of the work doctors do. But it is to remind us of two things. First, unhappiness is not limited to physicians. Everyone who has a job has to put up with many of the same problems doctors do, and a lot of them don’t have nearly as much power to fight back. And most do it for a lot less money.

Second, most people in non-medical jobs don’t have a secret resource that doctors do: patients. Unlike other professionals, doctors have human beings in their work lives who will appreciate what they do — if, that is, they do their jobs with care. This is true no matter what the medical malpractice system is like, no matter how badly the insurance companies treat doctors, no matter how unreasonable hospital managers choose to be. The patient is the doctor’s friend.

The doctors I know who get burned out all have one thing in common. They stop caring about their patients. As long as a doctor sees that his patients need him, medicine will never be intolerable. I could quote psychological research but common sense suffices: the happiest people are those who think themselves useful to others. As doctors lose touch and empathy with their patients, seeing patients feels less like usefulness and more like drudge work. Patients become problems, obstacles between now and the trip home, the afternoon off, or the three day weekend. The patient becomes the enemy. The moment a doctor thinks of patients as enemies, as a drain on time and energy he or she would rather spend elsewhere, all is lost. I have, in my time, known many lost doctors.

This doesn’t mean doctors don’t have a right to personal time. They do. A physician has a right to a private life as much as any patient has, and ought to protect it jealously from the stresses of work. But that, of course, applies to any job in any profession. But it does mean that the patients a doctor sees deserves complete attention. In the exam room, a patient should be the complete focus of work. If we give that to our patients, if we listen to them instead of listening to our own worries, we will always find enough inside us to get up in the morning.

Giving is a gift that mitigates many sorrows. Medicine is one of the few careers in which giving to others is built into the job, every day. Not just serving, as a waiter serves a person a meal or a banker serves a the finanical needs of a client, but true giving -- healing illness, according support and dignity to the suffering, walking with the dying in their final days, providing life-saving advice and counsel. True gifts. The doctor who fails to take advantage of that giving is on the path to depression and burnout.

The Second Book of Kings tells the story of how the prophet Ellijah was inspired by God to go out into the wilderness to seek divine guidance. He saw a powerful wind blow, but God was not in the wind. An earthquake came, but God was not in the earthquake. Next there was a great fire, and God was not in the fire. Finally, after the fire, there was a stillness. God was in the stillness.

Even someone not religious can see the value in this wonderful parable. God is an ethical force. God is truth. Ethics and truth cannot be found in the fire-and-earthquake drama of the doctor’s life. Truth is a gentle voice in the stillness, and it speaks only to those who stop and listen. That voice can be found in the words of patients. The voice of a patient can bring a doctor back to the purpose of work, no matter how miserable and unfair the rest of it may seem to be.

The doctor who remembers this will never go too far astray. I say that from experience.