Katrina Blog Project

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.

Now Reading

Peter Matthiessen, Shadow Country

T. Harry Williams, Huey Long

Seyyed Hossien Nasr, The Heart of Islam

The Catechism of the Catholic Church


Things You Can Do to Make This a Better World

We usually think of improving the world as being something dramatic -- saving the rain forests, feeding the poor, stopping climate change. But there are many very small things we can do to improve our world.

Most of the things on my list artistic or participatory. That is because I believe that art increases our shared experience and binds people together. And participation is important for the same reason, because it improves our sense of shared experience and unity.

One could easily read this list and dismiss it as a "smell the flowers" argument. It is not. Instead I see this as a systematic way to redirect a few pennies of a person's funds and attention to chronically underfunded or under attended civic efforts. To save civilization, we first have to have a civilization we care about enough to save. That is my point.

1. Buy a book of poetry once a year. We are only talking about once a year here! Maybe owning a book of poetry will open your mind to something entirely new, and get you thinking along new lines. It also keeps to poets in business, and I think poets have important things to say.

2. Subscribe to one magazine, preferably one with intellectual aims. If you really want to do the world a service, find one that has a low circulation. The Southern Review, The Virigina Quarterly Review, or The American Scholar come to mind. Or maybe a professional rag: Guitar Player, Science.

3. Learn a foreign language. Ok, I admit this is a hard one. But the mistake most people make in approaching foreign languages is to rush it. How long do you have to learn Mandarin? Your entire life, of course. Just stick to it. If you are like me and have long lapses, go back to it. Every little bit you learn broadens your understanding of the world. This isn't necessarily about fluency, although that would be a happy result. It is about understanding other people better.

4. Go to the symphony. I have found this to be a great learning experience. You sit there, and some of the finest artistic achievements of all time unfold in front of you. Music directors spend a lot of time mixing old standards (Beethoven's Fifth) less well-known pieces that are equally great (Shostakovich's Cello Concerto No. 1). Everybody talks about Mozart but few people really know him. Learn. You don't have to go to the Met either -- most cities have some kind of symphony that costs much less than New York, and is almost as educational.

5. Vote. Goddammit, DO IT. Politicians behave the way they do because they know no more than 50% of the public will show up to vote. They know they will never be held accountable. The angriest people are the ones who never vote. And they wonder why nothing ever changes. Even if you vote for the losing candidate, the winner is aware that you showed up and told him to drop dead. The more people who do that, the more politicians have to adjust their attitudes.

6. Go to church. Believing in something and sitting at home is no different from believing in nothing at all. People draw strength from one another in church. You look around and say, he believes what I believe, I am not alone. When you go to church you are voting for your faith. Just as with voting in politics, if you don't show up, no one accounts for you. Whatever belief you have, it is nothing unless you practice it.

7. Turn the TV off. I don't think there is a more destructive device in modern society. It encourages laziness, sensationalism, and discourages rational thinking. Every minute the TV is off is a good minute.

8. Learn a musical instrument. Ok, this one sounds like another high difficulty suggestion. Not necessarily. How about the harmonica, or the ukelele, or djembe drum? Or voice? The point is not to become expert, but to learn a little bit about the theory and dynamics of music so you can appreciate it better. We live in a culture saturated with music, but most people have no idea what goes into creating a simple song.


Gun Control, Anyone? Anyone?

Yep, morning in America. Another day, another public shooting. So now we're ready to have a serious talk about gun control, right?

No? You want to have a talk about mental health instead, since a lot of these shooters have psychological problems?

Ok, fine, I'm in. Let's talk about mental health. You are aware, I'm sure, that the best way to provide mental health services is through universal health care, right? Because the truly mentally ill are usually disabled, and can't often hold down jobs, or lose the jobs they have because of emotional instability. Along with that, they lose their health insurance, which is where things tend to go off the rails.

If you want to beef up mental health services in America so there will be fewer public shootings, then you have to provide health care for everyone. A lot of mental health treatment, and most mental health screening, is done by primary care physicians. As a primary care physician, I can tell you that at least a third of the care I provide is related to mental health, especially substance addiction and depression, but the range goes way beyond that. You can't just pick out the future killers and treat them. We don't know who the future killers are. That means we have to treat everyone.

So, to sum up, if you want improved mental health services in this country, you have to get behind universal health care. What do you think?

That's what I thought. Ok, back to gun control....


Fr. Flannery's Fiftieth Jubiliee

On Tuesday the pastor of my parish celebrated the 50th anniversary of his ordination, and I was fortunate enough to attend. Three bishops attended as well, at least thirty priests, and a few hundred parishioners. It was a grand and glorious event.

There must be something bittersweet about celebrating 50 years of anything. Fifty years is a great accomplishment, but it is also a very long time, and anyone who celebrates 50 years put into anything knows that the fifty years has to be the bulk of what anyone can give, and that the commitment is in its twilight. During the Mass Father mentioned all of his immediate family members who had died before he reached this landmark -- I counted both parents, two brothers, and a sister. No doubt there were others, friends, more distant relatives, many priests. To make it so far, and to leave so many behind, this is what the sacrifice of fifty years really means.

It is not entirely different from graduation, another event of this season; proud of what you have accomplished, nostalgic for what has passed. Nonetheless, to put 50 years into anything is a monumental accomplishment in any age, let alone our own, where we throw out anything that is more than five years old.

At the reception after the Mass, when I congratulated Fr. Flannery, his response was to ask me how long I had been practicing medicine. I had to think about it, since when you are in the thick of things you tend to lose track of wins and losses. Including my four years of residency -- a fair thing to include because I really was practicing medicine as a resident, in the strictest sense a student no more -- it has been 17 years this spring.

"That's great," he said.

Yes, great. Seventeen years gone. I doubt I will ever make fifty in this business. But that's the sign of a great teacher and minister. You intend to remind him of what he has accomplished, and instead he turns it around and gets you to account for what you have done.


Happy Birthday to the Bard!

I have been busy in the last few weeks and unable to post, but it would be terribly remiss for me to let slip by William Shakespeare's 450th birthday.

Little William presented for baptism at Holy Trinity Church in Stratford-upon-Avon on April 26, 1564. Tradition has it that children are baptized on the third day of life, and therefore his birthday has always been assumed to be three days earlier, on April 23. But like so many things about this shadowy genius, this birthday is only an assumption based on scant facts. The truth is, no one knows the precise date. But it is enough to know that about 450 years ago, Shakespeare was born. I can drink to that.

As someone with more than a passing interest in writing and literature, I have often been thankful that English is my native tongue. One can easily argue that English, the language of the internet, is the most important language in the world today, and maybe the most important language that has ever been.

And it has been writers like William Shakespeare that have made it so great. Sometimes I have thought how nice it would be to learn Latin to read Virgil, or Spanish to read Cervantes, or German to know Goethe. Yes, but I know English, and I know Shakespeare, and I wouldn't trade a native understanding of any other language for knowing Shakespeare as a native English speaker. To know the 37 plays, the 154 sonnets in translation would be an irreplaceable loss.

How sweet the moonlight sleeps upon this bank!
Here will we sit, and let the sounds of music 
Creep in our ears: soft stillness and the night
Become the touches of sweet harmony. 
(The Merchant of Venice, 5.1.63-66)


The Real Politics of Envy

New York Times columnist Paul Krugman, in a March 24 piece, makes the argument that America is slipping into an oligarchy. I would argue that he uses the wrong word; oligarchy means "rule of the few." A better word would be plutocracy, or "rule of the wealthy."

It is nonetheless an interesting article, and I largely agree with him that America is moving towards being controlled by a rich elite. But I think he is a little too harsh and simplistic in setting up the rich vs. poor contest in America as a power struggle the rich is winning.

The truth is, in the United States the public could shatter the political power of the wealthy in one election. If every American who wasn't rich refused to vote for a candidate who was, or for any candidate who supports policies that favor the top 1%, the rule of the wealthy would be over in one day. Theoretically, there is nothing preventing it.

So why doesn't it happen? Why doesn't the middle class simply vote its interests, instead of, election after election, voting the interests of the elite? Krugman argues that it is because the rich control the media and the organs of government, but I don't think that is the whole story. As I said, if it was, the whole thing would end on Election Day.

America is an aspirational culture. There is an old saying in business: Don't dress like your job, dress like your aspirations. And many sayings like it, all amounting to the belief that if you want something badly enough and work hard enough for it, you will achieve it. The Horatio Alger ethic, if anyone remembers who Horatio Alger was. Even though his book series is long forgotten, the ethics embodied in it are still with us: Work hard and you will succeed (which usually means get rich).

The reason the middle class and poor won't vote their interests is because too many of them want to be rich. And they fear, in that odd calculus that human beings have when it comes to emotional thinking, that if they stop wishing to get rich, they never can be. So they vote like the rich because they want to believe that voting rich will make them rich one day. They support elimination of the estate tax because they dream of leaving a fortune to their heirs. They frown on luxury taxes, anticipating the day that they will once live in luxury. They support capital gains tax cuts, without really understanding what capital gains are, because they dream of one day having capital.

And they somehow think, in their heart of hearts, that if they oppose such things God will deny them an estate, yachts to be taxed, or capital to gain.

Consider for a moment that in America's most prosperous time, right after World War II and up to the early 70s, Americans aspired to be middle class, and that was enough for them. People didn't think it was necessary to back an agenda that supported wealth accumulation, mainly because they didn't necessarily think wealth was the only thing worth aspiring to. And America did quite well at that time, thank you.

Liberals are accused of engaging in "politics of envy" when they pursue plans to redistribute money from the rich to the poor. But this is hardly envy; no liberal plan has as its goal making the rich poor and making the poor rich. The goal is to make the poor less destitute and the middle class more self-sufficient. Expanding the middle class is not politics of envy. It is politics of self-sufficiency.

The real politics of envy is allowing the poor and middle class to give up more of what they have because they aspire to be rich. It is starving our schools for the sake of low taxes. It is refusing to address the problems of hourly wage earners because it would take investment opportunities from Wall Street. It is using the envy the poor have for the rich as a weapon against them, by making them feel guilty for having the gall to vote their own interests instead of for the interests of the wealthy.

Envy is not turning our country to socialism. It is turning our country into a plutocracy.