Now Reading

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

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.


EtOH Goggles

"I have found," the old man said, "through long experience, trial and error, that when I drink, I gain weight. When I don't drink, I am able to maintain my weight.

"The writing is clearly on the wall, and as soon as I am sober I will be able to read it.'


The Fox's Secret

[The fox said,] "Here is my secret. It's quite simple: One sees clearly only with the heart. Anything essential is invisible to the eyes."

-- Antoine De Saint-Expuery, The Little Prince, Richard Howard tranlation.


Book Catechism: The Bullet Journal Method, by Ryan Carroll


Track the Past, Order the Present, Design the Future.

How did you come upon this book?

I am a Lifehack dabbler, always looking for something to make life easier. One of my interests is time organization methods. I have tried many of them, to little effect, because they are too complicated. During an internet search I found a video about the Bullet Journal method, and from there arrived at Ryan Carroll’s website. His organization method is simpler than most, and it can expand in complexity as needed. I liked that about it, and that got me started with Bullet Journaling.

I bought the book to have a paper reference for the method, and to see if there were any tips or tricks that would improve my game.

Also, I felt a tad guilty that I was using his method and he wasn’t getting a dime. All my money was going to the Moleskine and Traveler’s Notebook companies.

So what is the Bullet Journal Method?

It isn’t complicated, but I don’t want to completely explain it here. There are enough websites doing that already. A Bullet Journal centers around a daily list of todo items (called the Daily Log) and a system of symbols that either mark the items as to-be-done or direct them to another list where they wait to be done. It is a hierarchy of lists, starting at long-term and drilling down to daily. An item can be migrated to the Daily Log if it is to be done today. If it can wait, you can move it to the monthly list, or even a longer-term list called the Future Log. The key to the system is the migration, which keeps items moving from one list to another until it gets done or is archived somewhere for later reference.

And for things that aren’t strictly todos, or for special todos like grocery lists or things to buy for a camping trip, you can assign them to special lists called Collections. Collections are indexed for easy reference later.

The point is that there is a Daily Log that allows you to organize your day, and other lists that allow for everything else. You index these lists as you go, so they are easy to find when you need them.

Sounds like sliced bread just got displaced from the greatest thing list.

Sure. It’s not everything and it isn’t for everyone. But I like its flexibility. You pick up a notebook, any notebook, and you start on page one. When you need a new list you turn the page and continue. Unlike most systems, where you create a set of cubby holes to sift data into (such as tabbed sections of a notebook or separate files for different subjects), with a Bullet Journal you just keep adding to the end. You keep track of what you add by maintaining the index.

But the whole thing is free form. Some months I don’t have a lot to do and I may only generate a few bullet lists. Other months will be very busy and I will have pages and pages. That’s what is nice about it. It expands to fit the project rather than the other way around.

Ok, fine. It's a good system. How is the book?

The first 100 pages or so lays out the system, and were fine. The last 200 pages Carroll jumps into the Zen of Bullet Journaling, about how it will change your life.

First of all, I don’t need a personal organizer that changes my life. I need a personal organizer that reminds me to take out the garbage on the right day. My view of personal organization is purely utilitarian. When Carroll starts getting into the Zen of it, it wears on me quickly.

You have something against Zen?

Oh, no. I like Zen. But Zen is a practice all in itself that does not need Bullet Journals to make it complete. Carroll is trying to make a todo list into something more than it is. This is a common ploy in self-help books. How tidying your house will cure your problems. How running will wipe away your depression. How getting your finances in order will perfect your life. 

It’s all hogwash. Religion and philosophy perfect your life. Keeping a todo list is a tool to free you up to find personal peace, but it is not inner peace itself.

Since you brought it up, what is inner peace?

It may be different for different people. But inner peace is a profound experience, rooted in the transcendental. It is an end in itself, not a means. Personal organization is not an end, it is only a means. You organize so you can move on to inner peace. 

Organization is not the goal that provides joy. It is only a step on the path, and nowhere near the end. When Carroll starts spewing advice about how to solve life’s problems, he loses me. Nothing about the Bullet Journal is important enough to bring me to a state of joy. 

Can you give us an example of taking it too far?

“We can’t always control what fate drops in our lap. In the moments where we do have a choice, we must be vigilant about what we let into our days because we don’t have life to spare...We ask ‘what is vital’ and ‘what matters’ to help us filter our distractions from our lives....Adding this lens of impermanence to your Reflection can provide clarity by reminding you of what’s at stake. We remember death so we don’t forget to make the most of our time alive” (p.182).

Wow. Pretty heavy for a book about managing your todo list.

Exactly. What he says isn't wrong. I just prefer my grocery list not be delivered with a dose of Henry David Thoreau.

Gotcha. So you don’t like the book.

I like the book fine. The pages about how to organize a Bullet Journal are good. But the attraction of the Bullet Journal is its simplicity, not its function as the doorway to nirvana. I suppose if you had never heard any of this mindfulness/carpe diem stuff before, if you had never listened to a Sunday sermon or a graduation address, it might be a place to start. But if you are looking for a philosophy of life, there are better places to look.