I got to go to a workshop on poetry with the best teacher I have ever had the privilege of working with--- Rodger Kamenetz. He came to town for a reading, and had a circle of local poets for this workshop-- and it was an unbelievable "mitzvah" or blessing, that I was off, and able to go, and be in that space!
He started out by saying "Let's set aside both pride and shame." The idea of doing so, as the preliminary to a workshop, was breathtaking. Then he spoke about the difference between a word and an image--- how much richer and more meaningful an image is, than a word. I had not read his book yet, called "The History of Last Night's Dream". He explained that the way he wanted to approach the subject of our poems was to speak about what is on the horizontal axis, the daily life stuff of the poem, and then the vertical axis--- the place in a poem where we get an image, a really rich soul-work piece of the puzzle, which is where the strength of the poem would be. As each person read their poem, he handled the commentary in that way--- avoiding tinkering with the horizontal or the structural issues, and just trying to discuss the importance of the image itself--- the "where's the beef?" of the poem. I read a poem from the set I have been working on, about the Camino. Since he had asked for dreams, I read a poem called "Dreaming the Journey". Rodger was intrigued by the line "I carry the tribes with me." I was writing about bringing the "new world tribes" back to Spain, in my own person. He inscribed the copy of his book about dreams to me, "to the one carrying the tribes". I was excited to think about this line more deeply, as an image, and also the one about the "gold on those altars" in Spain. After the workshop, I read Rodger's book "The Jew in the Lotus" about a group of rabbis going to meet the Dalai Lama in Dharamsala, and sharing issues about soul-work, across the two traditions. I was fascinated and interested in his command of the subject, of rabbinical thinking-- of Torah and the mishnah of reflections on the scriptures. And also, because he is a well-educated and sensitive Jew, his appreciation for the traditions, the mores of the Jewish people. I had grown more interested in Jewish faith and traditions when I was trained at Maimonides hospital in Brooklyn. Also, I have read a lot about the soul-journey, and so his way of looking at the question of "where's the beef?" in the tradition moved me and kept me very keenly interested, in his book. So when I got to the new book about dreams, I was overjoyed to see that question about yearning to see the face of God. I am still very interested in that question, and in anyone who asks it, from any tradition. I have pored over stories about the Baal Shem Tov, and the reflections in the 13-petalled Rose. I loved Rabbi David Cooper's book "God is a Verb" which I read about 20 years ago. I am also very much a fan of Martin Buber, and the "I/Thou" conversation. So each page was just getting more and more interesting, as I read about Rodger's soul work, and his going to Jerusalem to work with Colette, a dream-work person who was highly intuitive and aimed at healing through dreams, and the great-granddaughter of important rabbis in both of the lines of her genetics. In the book, Rodger finds a dream-work person in Vermont, named Bregman, who is very adept, and who sees the real soul image in a child, rather than the animus/anima of Jung. I was completely taken with and in agreement with this way of seeing things, because for me the deepest question is still that yearning to be in the "I/Thou" which is only possible if one acts as a little child. Jesus said "unless you are like a child, you shall not enter the kingdom of heaven". The other thing I really love about his work with this mentor, Bregman, is that there is an adversary or a predicament, and there is really important work to do, to get to that deep interaction with the divine. And that the way he characterizes that work is to say it requires the discipline of obedience. This fits with every spiritual tradition, and to me it is an ongoing invitation to what is really real, and really true. When one recognizes that one is being directed or guided, and that one must humbly do the work, we are at the depth of being on the journey. I am really excited to be thinking about this. It has been a long time since I have had a vivid dream. But like his teacher, I feel that I am being clearly directed in my work, and that my job is to humbly DO it. And that many times, I am working from instinct, and that voice, not from some intellectual grasp by my own capacity. I feel like I am working like a blind man, feeling carefully along the narrow path, using my white cane, and listening for that voice. There is a word I did not know before, "metonymy"--- which is when one is referring to an image, not using a comparison (like or as)--- which Rodger says is more true of modern poetry. I have stayed with that idea for a couple of weeks now, as I have read through this book. I feel like he gave me a whole new way of writing the poems for the book about the Camino. I am really grateful. I sent him a note and told him that I think he is the person for whom I wrote the poem "The Key to the House in Toledo". I was so excited when he mentioned that in Spain at around the time of Maimonides, there were Jews and Moslems, writing in Arabic, and sharing mystical understanding. It gives me tremendous hope that we could maybe recover that matrix of understanding, and interfaith sharing, and that somehow Spain is the crossroads, where it is possible. My feeling about being able to add this new sense to the understanding of the Camino is thrilling.
Sunday, June 22, 2014
Thursday, May 15, 2014
The Lightness of Being
Last night we had a discussion about "light" in medicine. Not just the feeling of enlightenment, or going toward the light, or light shining in a particular way on the subject at hand, but the way one is light on one's feet, the way Milan Kundera called "the unbearable lightness of being". Which to me is not unbearable, but actually the most desired way to move in the world; that is to be fitting in to the molecules of the situation in such a way that one is both coherent and graceful, and can do what is needed with the least friction, the "lightest" touch.
I haven't read the book by Milan Kundera in a long time, but I think I remember that the most important thing is that he cannot sleep unless he is holding her hand-- he begins to know love in that fact. He wants to stay connected, to touch, to be held by this particular woman. He who went through women like water before, suddenly finds a particular woman necessary-- and it is because he cannot sleep without holding her hand.
When we are going to surgery, I hold the patient's hand. I know that there is a primal fear, that the person is conscious of the reason the surgery is needed; but that they are frightened, as a child looking over the edge of an abyss is frightened. Holding the hand of someone trying to go to sleep without terror is a very important thing. Surgeons need to do it, sharing that moment with the patient in our care. It is a wordless reminder that we will be "attending" them through this experience, and that we have their life in our attention and care, and yes, love.
Another thing we talked about is the shared feeling of meaning. One of the great young women docs in our group, Neha, told us that she asks 5 questions when a person is in the hospital. The patient in the hospital always feels the terror of the child looking into the abyss. I call it "walking through the valley of the shadow of death". She feels that in between the daily rounds, there is a lot of time for the patient to find answers to these questions.
Her 5 questions:
"What is the meaning of the part of you that is ill? Why this part of your body?"
"What else needs to be healed?"
"Why now, in your life?"
"What else might you have missed?"
"What would you say if you could speak from your heart?"
I find this profound and helpful. It helps the patients find meaning and context for the illness, and for the way their life has been wending. It usually helps people come to terms with whatever other issues may need to be addressed, besides the illness. For most people, the logjam is in the relationships around them, and these questions help them to find the way to open up and deal with the dilemmas. The wonderful fact is that we are all having these dilemmas, and none of us is only a "patient". Our own "cloud of unknowning" is part of trying to work with our patients in helping to find coherence, in befriending their lives. We work toward our own coherence, as we confront these questions together, and find the answers.
One of our wonderful docs, Bruce, has become a chaplain. He spoke about the personal way we have been given some time. From the first breath to the last, we have a "complete" circle. He spoke of the way that each day, each breath, in whatever time we have-- another hour or another decade, is precious. We recognize the gift of it-- even when we are most profoundly affected by the loss of loved ones. This too, is a great gift. It lightens our suffering, to see "completeness"-- even when a life seems broken-off.
Energy is very like light. Vivekan Flint was a wonderful soul who helped Rachel Remen MD set up the program at Commonweal, and ISHI. He wrote poems. Abby read a poem of his, which speaks of a meteor. At the end, it turned into a streak of light. Light is a complex of mass and energy.
I wrote a poem called "Prayer for the Blue bird"-- it is in the first book of poems, called "My throat is full of Songbirds". It ends this way:
"Even death cannot stop
The true singing,
The real joy.
The air will fill with light,
The joy will be like light,
When light is speeding and blending with mass,
Becoming the bluebird singing."
I haven't read the book by Milan Kundera in a long time, but I think I remember that the most important thing is that he cannot sleep unless he is holding her hand-- he begins to know love in that fact. He wants to stay connected, to touch, to be held by this particular woman. He who went through women like water before, suddenly finds a particular woman necessary-- and it is because he cannot sleep without holding her hand.
When we are going to surgery, I hold the patient's hand. I know that there is a primal fear, that the person is conscious of the reason the surgery is needed; but that they are frightened, as a child looking over the edge of an abyss is frightened. Holding the hand of someone trying to go to sleep without terror is a very important thing. Surgeons need to do it, sharing that moment with the patient in our care. It is a wordless reminder that we will be "attending" them through this experience, and that we have their life in our attention and care, and yes, love.
Another thing we talked about is the shared feeling of meaning. One of the great young women docs in our group, Neha, told us that she asks 5 questions when a person is in the hospital. The patient in the hospital always feels the terror of the child looking into the abyss. I call it "walking through the valley of the shadow of death". She feels that in between the daily rounds, there is a lot of time for the patient to find answers to these questions.
Her 5 questions:
"What is the meaning of the part of you that is ill? Why this part of your body?"
"What else needs to be healed?"
"Why now, in your life?"
"What else might you have missed?"
"What would you say if you could speak from your heart?"
I find this profound and helpful. It helps the patients find meaning and context for the illness, and for the way their life has been wending. It usually helps people come to terms with whatever other issues may need to be addressed, besides the illness. For most people, the logjam is in the relationships around them, and these questions help them to find the way to open up and deal with the dilemmas. The wonderful fact is that we are all having these dilemmas, and none of us is only a "patient". Our own "cloud of unknowning" is part of trying to work with our patients in helping to find coherence, in befriending their lives. We work toward our own coherence, as we confront these questions together, and find the answers.
One of our wonderful docs, Bruce, has become a chaplain. He spoke about the personal way we have been given some time. From the first breath to the last, we have a "complete" circle. He spoke of the way that each day, each breath, in whatever time we have-- another hour or another decade, is precious. We recognize the gift of it-- even when we are most profoundly affected by the loss of loved ones. This too, is a great gift. It lightens our suffering, to see "completeness"-- even when a life seems broken-off.
Energy is very like light. Vivekan Flint was a wonderful soul who helped Rachel Remen MD set up the program at Commonweal, and ISHI. He wrote poems. Abby read a poem of his, which speaks of a meteor. At the end, it turned into a streak of light. Light is a complex of mass and energy.
I wrote a poem called "Prayer for the Blue bird"-- it is in the first book of poems, called "My throat is full of Songbirds". It ends this way:
"Even death cannot stop
The true singing,
The real joy.
The air will fill with light,
The joy will be like light,
When light is speeding and blending with mass,
Becoming the bluebird singing."
Saturday, March 29, 2014
Wednesday, March 26, 2014
Hope and Time; corollary to E=MC_2
Hope and Time
Hope is something all of us need, to be able to look forward to the future, in spite of our own inexorable path toward death. I have been so lucky to be able to hold babies, which is the deepest and most organic way I know to get hope for the future.
The equation of Einstein's, which teaches us that there is mass and energy, and that they become equal when mass is moving at the speed of light, actually inherently tells us that there is such a thing as time, and it is measurable, and because of it, the universe is moving onward, and as they say, expanding. So we do not just go over and over the same territory, and life is not static or circular. There is process, and there is evolution. Teilhard de Chardin spoke of God the creator as the alpha and the omega, both initiating the universe, and calling it home; and Christ as the central turning point in history. God grows green grass through the asphalt. No one steps in the same river twice, everything is actually new, and today is the first day of the rest of your life. SO time is the river of history, and each of us in it is unique, with our own particular past, and our own unique path into the future. The progress may be hard to see, from our vantage point, but it is there. This is a huge difference from 200 years ago, when some people thought life was just going over the same ground, over and over.
My life has been blessed, as I am in the vanguard of the women who got to train in and practice medicine. We have actually made great strides, in understanding both intelligence and healing love, not as a gender-limited thing. We can understand what it means to be a healer, and a professional person, independent of one's gender. I think a lot about the nuns, and the ordination of women. I think about what Jesus said and did, and how long it has taken to undo the problems of patriarchy. I am glad that when the Buddhist nuns told the Dalai Lama how hard it was for them to get the training, to become experts in their tradition, he cried. They were kept down-- treated as cleaning women, and refused admission to the sessions for the enlightenment of the male monks, just as women in the West have been. Everywhere on the earth, there has been a blossoming in this time; although in some places quite modest, there is a recognition that women are fully human, not just beasts of burden, or "hysterical" animals whose only task is to carry pregnancy and nurture the young.
We have been able to help hold the space, as more women come into medicine as the decades pass. We can see that bringing ourselves to work, as sisters, friends, daughters, wives, mothers, helps us to connect with our patients emotionally, and to be better at nurturing and compassion, without losing the ability to be good diagnosticians and surgeons. We can continue in our work as obstetricians and gynecologists, to help push for better and more maternal and infant care all over the globe, and we can try to push for better parenting, and better stewardship of the earth at the same time. We can help our patients to only have as many children as they think they can raise well. We can help them avoid having their children too close together, so they cannot recover physically from pregnancy. We can try to help them not get pregnant before they are ready to be mothers, both physically and emotionally. We can help get the children to grow up healthy, get more vaccines and better nutrition, partly through the working of public health care systems. It is unlikely that we will sink back into patriarchal societies where half the population could not get educated or be able to give their talents to the needs of the society. It is unlikely that women will continue to have to put up with abusive or alcoholic or violent spouses, just to be able to feed the children.
When I was a child, there were a lot of stories which had to do with being "odd"-- such as the Ugly Duckling, and Goldilocks and the 3 Bears. For those of us girls who got into medicine, and felt like Goldilocks, one might say that we are now able to sit in the right chair, and eat the porridge which is just the right temperature. We do not have to hide in Bear clothing, or pretend to be something we aren't. We are ok, being women in this place and time.
One of the things we can see as a benefit is that gay people are more safe, now that women are also in the field. Couples can choose to love each other, and are not routinely being stoned to death. Fathers are getting paternity leave, and men are able to give more love and attention to their children, as couples work cooperatively on family life, as well as economic security. Many couples who might have been unable to have children in the past are getting medical help to make that possible, so that they can have healthy families.
We are making headway against the laws which protected pedophiles from exposure, and we are making it more likely that the true bogey-men get caught, and prosecuted. The world is becoming safer for children-- less chance of incest and rape, less chance of under-age pregnancy, and less chance of abusive power over moms and children going unchecked. Although it is not true everywhere, as more brave women fight for respect and healthy behaviors, all over the world the laws will become better at supporting individual rights. We are working to reduce and end sex-trafficking, and prostitution. We are also working to increase job security, better worksite safety, and job protections, including healthcare and benefits for retirement and disability.
Although the trade agreements go against this human rights advocacy, we are building an informed citizenry, and it is not so easy to do things in the dark, to destroy human rights, as in the past. It is very likely that as we educate women, we will be able to help protect the environment, because women are raising children, and do not want toxic waste causing illness in our families.
I remember the song in "My Fair Lady" which is sung by Professor Higgins--- "why can't a woman be more like a man?"--- in which he says "… their brains are filled with cotton, hay and rags;" which was something I really wondered at, when I was young. I know now, that the problem was simply that women were not being educated. When they ARE educated, they still make mistakes as often as men, but the sheer necessity of raising children makes most women really work hard to get the best answers for themselves and their families that they can.
For this reason, I have tremendous hope, that we are moving into a much better future, where there will be even less abuse, less ignorance, less cruelty than now. I have great hope that family planning is going to be as great a force as war, famine and plague, at keeping humanity's numbers to a more bearable presence on the earth. I think we may actually become the good stewards we were intended to become!
Hope is something all of us need, to be able to look forward to the future, in spite of our own inexorable path toward death. I have been so lucky to be able to hold babies, which is the deepest and most organic way I know to get hope for the future.
The equation of Einstein's, which teaches us that there is mass and energy, and that they become equal when mass is moving at the speed of light, actually inherently tells us that there is such a thing as time, and it is measurable, and because of it, the universe is moving onward, and as they say, expanding. So we do not just go over and over the same territory, and life is not static or circular. There is process, and there is evolution. Teilhard de Chardin spoke of God the creator as the alpha and the omega, both initiating the universe, and calling it home; and Christ as the central turning point in history. God grows green grass through the asphalt. No one steps in the same river twice, everything is actually new, and today is the first day of the rest of your life. SO time is the river of history, and each of us in it is unique, with our own particular past, and our own unique path into the future. The progress may be hard to see, from our vantage point, but it is there. This is a huge difference from 200 years ago, when some people thought life was just going over the same ground, over and over.
My life has been blessed, as I am in the vanguard of the women who got to train in and practice medicine. We have actually made great strides, in understanding both intelligence and healing love, not as a gender-limited thing. We can understand what it means to be a healer, and a professional person, independent of one's gender. I think a lot about the nuns, and the ordination of women. I think about what Jesus said and did, and how long it has taken to undo the problems of patriarchy. I am glad that when the Buddhist nuns told the Dalai Lama how hard it was for them to get the training, to become experts in their tradition, he cried. They were kept down-- treated as cleaning women, and refused admission to the sessions for the enlightenment of the male monks, just as women in the West have been. Everywhere on the earth, there has been a blossoming in this time; although in some places quite modest, there is a recognition that women are fully human, not just beasts of burden, or "hysterical" animals whose only task is to carry pregnancy and nurture the young.
We have been able to help hold the space, as more women come into medicine as the decades pass. We can see that bringing ourselves to work, as sisters, friends, daughters, wives, mothers, helps us to connect with our patients emotionally, and to be better at nurturing and compassion, without losing the ability to be good diagnosticians and surgeons. We can continue in our work as obstetricians and gynecologists, to help push for better and more maternal and infant care all over the globe, and we can try to push for better parenting, and better stewardship of the earth at the same time. We can help our patients to only have as many children as they think they can raise well. We can help them avoid having their children too close together, so they cannot recover physically from pregnancy. We can try to help them not get pregnant before they are ready to be mothers, both physically and emotionally. We can help get the children to grow up healthy, get more vaccines and better nutrition, partly through the working of public health care systems. It is unlikely that we will sink back into patriarchal societies where half the population could not get educated or be able to give their talents to the needs of the society. It is unlikely that women will continue to have to put up with abusive or alcoholic or violent spouses, just to be able to feed the children.
When I was a child, there were a lot of stories which had to do with being "odd"-- such as the Ugly Duckling, and Goldilocks and the 3 Bears. For those of us girls who got into medicine, and felt like Goldilocks, one might say that we are now able to sit in the right chair, and eat the porridge which is just the right temperature. We do not have to hide in Bear clothing, or pretend to be something we aren't. We are ok, being women in this place and time.
One of the things we can see as a benefit is that gay people are more safe, now that women are also in the field. Couples can choose to love each other, and are not routinely being stoned to death. Fathers are getting paternity leave, and men are able to give more love and attention to their children, as couples work cooperatively on family life, as well as economic security. Many couples who might have been unable to have children in the past are getting medical help to make that possible, so that they can have healthy families.
We are making headway against the laws which protected pedophiles from exposure, and we are making it more likely that the true bogey-men get caught, and prosecuted. The world is becoming safer for children-- less chance of incest and rape, less chance of under-age pregnancy, and less chance of abusive power over moms and children going unchecked. Although it is not true everywhere, as more brave women fight for respect and healthy behaviors, all over the world the laws will become better at supporting individual rights. We are working to reduce and end sex-trafficking, and prostitution. We are also working to increase job security, better worksite safety, and job protections, including healthcare and benefits for retirement and disability.
Although the trade agreements go against this human rights advocacy, we are building an informed citizenry, and it is not so easy to do things in the dark, to destroy human rights, as in the past. It is very likely that as we educate women, we will be able to help protect the environment, because women are raising children, and do not want toxic waste causing illness in our families.
I remember the song in "My Fair Lady" which is sung by Professor Higgins--- "why can't a woman be more like a man?"--- in which he says "… their brains are filled with cotton, hay and rags;" which was something I really wondered at, when I was young. I know now, that the problem was simply that women were not being educated. When they ARE educated, they still make mistakes as often as men, but the sheer necessity of raising children makes most women really work hard to get the best answers for themselves and their families that they can.
For this reason, I have tremendous hope, that we are moving into a much better future, where there will be even less abuse, less ignorance, less cruelty than now. I have great hope that family planning is going to be as great a force as war, famine and plague, at keeping humanity's numbers to a more bearable presence on the earth. I think we may actually become the good stewards we were intended to become!
Sunday, February 9, 2014
Gratitude
I have been reading the book by Ann Voskamp, called "One Thousand Gifts." It is a great book, with some slightly difficult phrases, but also some very sharply pungent metaphors, which aim at deepening her own spirituality and consciousness, as she reflects on her life as a busy farmer's wife, a mother of 6 children, and a person of faith, who is trying to go deeper. She uses the tool of writing down gifts. Her lists-- the few things on it which she actually tells us, and her thoughts are intense and poetic, and well-educated and well-informed. She is the kind of person one wants to be. She is able to slow herself down, in times of intense emotions and busyness, by going into deep and true gratitude for gifts given-- the slant of light on the walls and floors of her farmhouse, the way the soap bubbles look iridescent on her hands as she does dishes. The book centers on several thoughts which are the ballast of Christian theology, the idea of Eucharisteo-- taking bread, giving thanks, being present to the great presence of God as the beloved who fills our longing with plentiful grace and perfect joy. But she has such clarity about the ways we forget to be open to that love, open to that way of seeing.
I started my own list, which this week, (early February) contains chiefly the gift of rain. We are in the 3rd year of drought in California, and we need buckets and buckets of rain; enough rain to replenish the aquifers, to help the salmon have enough water to get downstream to the sea, and back again; enough water to help the crops. The redwood trees seem to be standing taller, more gracefully green, more openly embracing the drizzle which is letting them breathe and unfurl their beauty. We have the Soquel cherry trees blooming on Old San Jose Rd, right on schedule. Their frilly pink blooms always seem to come too early, but then I realize it is February, and they know better than I when it is time for them to go onstage! I am also watching the bridal plum tree open its dazzling white blossoms, now covered with diamond-bright raindrops. And this week, in my family, our German exchange student/son came to visit, cementing now 19 years of friendship with us. He has always been like an older brother to my boys; and he loves Point Lobos like I do, so we were able to rejoice that we got to make it down there--- and even though the day was blustery, the beauty of it has not been lost on us. We stopped at the beach at Marina, which was not being rained on, although we could see storm clouds over both ends of the bay, and Jan was so glad to get to dip his toes in the Pacific ocean, and walk a bit on the strand. To appreciate the seasons, the way the rain has come finally, the way we have had to tuck ourselves into winter again, to be waiting for the harbingers of spring, and to start working on this gratitude list, trying to pay attention with more grace, more patience, more humility, and yes, more love, is my hope.
I started my own list, which this week, (early February) contains chiefly the gift of rain. We are in the 3rd year of drought in California, and we need buckets and buckets of rain; enough rain to replenish the aquifers, to help the salmon have enough water to get downstream to the sea, and back again; enough water to help the crops. The redwood trees seem to be standing taller, more gracefully green, more openly embracing the drizzle which is letting them breathe and unfurl their beauty. We have the Soquel cherry trees blooming on Old San Jose Rd, right on schedule. Their frilly pink blooms always seem to come too early, but then I realize it is February, and they know better than I when it is time for them to go onstage! I am also watching the bridal plum tree open its dazzling white blossoms, now covered with diamond-bright raindrops. And this week, in my family, our German exchange student/son came to visit, cementing now 19 years of friendship with us. He has always been like an older brother to my boys; and he loves Point Lobos like I do, so we were able to rejoice that we got to make it down there--- and even though the day was blustery, the beauty of it has not been lost on us. We stopped at the beach at Marina, which was not being rained on, although we could see storm clouds over both ends of the bay, and Jan was so glad to get to dip his toes in the Pacific ocean, and walk a bit on the strand. To appreciate the seasons, the way the rain has come finally, the way we have had to tuck ourselves into winter again, to be waiting for the harbingers of spring, and to start working on this gratitude list, trying to pay attention with more grace, more patience, more humility, and yes, more love, is my hope.
Monday, October 28, 2013
Justice, Charity, Healthcare and the U.S. Constitution
Justice, Charity Healthcare and the U.S. Constitution
I promised my friend Danielle, that I would try to write something which I think is not being very clearly stated in the public dialogue around the politics of the Affordable Care Act (which should perhaps have been called National Health Care). The Constitution of the United States is a very supple document; a blue-print, establishing the way our government is supposed to run. It has this nice balance between the Houses of Congress, and the Judiciary and the Administrative branches. I am pretty rueful that most high schools no longer offer civics classes, or American government. In my school years, it was mandatory that students begin to learn and try to understand their role in our government. This became even more urgent to me, when we were going through the Watergate scandal and the impeachment of President Nixon, while I was in the Peace Corps. It was inconceivable to the Paraguayans, and the strongest possible argument that we actually ARE a democracy, when we told them that none of us had voted for him, and almost all of us were opposed to our role in Viet Nam. They could hardly believe it would be possible to get a job for a government when you voted for the other party.
The United States Constitution starts out "We the people, in order to form a more perfect union" and goes on to list other vital parts of the functions of government, including "provide for the general welfare".
When conservatives say they uphold the Constitution, I think they are actually LYING-- in so far as they do not want to "provide for the general welfare" through the establishment of national health care. The idea of forming a "more perfect union" is that the society over time should be improved. We the people want to have a seamless interaction as much as possible, in getting the most out of the social interactions as citizens. We understand that some of what we want may take time, and needs to be worked toward. When the Emancipation proclamation happened, President Lincoln knew that it was the most important legal thing that had happened to the country since the beginning of the nation, and that it had to be ratified to keep the country together, and for the nation to function. They had to pound it out, in the blood, sweat and tears of the Civil War.
Lately we have had the evidence that the taxpayers had to bail out the banks, in the 2008 crash, to the tune of something like 80 billion dollars, because that is how the whole banking world worked, and no one wanted to watch the financial ruin of the country and possibly the whole world. We also have seen that companies like Walmart are paying their workers sub-standard wages, which force the workers to need food stamps and Medicaid--- effectively putting them into needing to be SUBSIDIZED by the taxpayers for the basic necessities of life.
The other thing that we know is that Social Security has been a great boon to the elders in our country. Prior to Social Security, a few people had enough income saved up for their retirement years, but most people either died soon after retiring, or became dependent on their children-- needing them to earn the means of continuing to provide for the elders as they aged. Many were living in penury. The Bible speaks often of the duty of providing for the widows and the orphans. The widows are the elder women, who were dependent for food, housing, healthcare-- and often were so self-effacing that they would die of anemia due to eating only tea and toast. No sweet granny would want to take the food from the mouths of her grandchildren, and food scarcity persists in being one of the very difficult things for people in poverty. As Americans have stayed healthy into their 70's and 80's, their needs for adequate food, medical care and housing have also expanded past the time of natural retirement.
When the ACA was proposed, the conservatives refused to let the idea of a Single Payer medical system even come to a vote. The kind of system that Medicare is, which had an overhead of 2% administrative costs, is the most efficient and cost-effective--- FOR the taxpayers, who are THE PEOPLE, who are trying to form a more perfect union. The insurance mega-business forced the Congress to keep them in the loop, instead of cutting them out. Many insurance companies take 40, 50 or 60% profits from the dollars paid for the healthcare policies people buy. The problem also was made worse because some of the cost was offset by businesses, on behalf of employees, for SOME of the employees, in SOME of the companies.
Health care costs rose for many reasons-- the aging of the population, the increase in effective and sophisticated medications which could save lives, more expensive healthcare in hospitals and nursing homes; and ALSO, the increased administrative overhead-- which profits led many people to have good returns on investments in the healthcare sector of the stock market.
There were doctors and many people from many walks of life benefitting in each part of this system, and so it was difficult to tease out what the truth is, for the WHOLE society to see.
Still, many doctors believed and fought for the ACCESS to care--- because poor patients would not even come to see a doctor if they couldn't pay for the visit, or the medications. Different states had different rules and variable strength of their Medicaid programs. Also, about 40 years ago, in order to lower costs, the mental healthcare needs were SEPARATED from the total healthcare needs of patients, so most mentally ill people had NO care, as most of them were poor, due to their diseases; and many doctors who would otherwise have treated these patients, could not afford to take care of them, in their dire poverty.
So to me, the answer had to come from that first sentence in the Constitution, that WE THE PEOPLE, in order to FORM A MORE PERFECT UNION, would endeavor to provide more reasonable healthcare to the WHOLE population. As the ACA gained momentum, the insurance giants wanted to keep their power and money, so they gave a little, in order to gain a lot--- the law would force everyone to purchase insurance. The doctors in every medical society and in every specialty tried to see how to help themselves stay solvent, and still be able to see the patients they needed to see, with rules which are medically sound. In states where there are more progressive doctors, like California, and where systems like Kaiser Permanente had already built a program with "economies-of-scale" to help keep costs down, it was reasonable to use their data as the benchmarks for the new rules of engagement. At least for the beginning, it would allow a predictable assessment of costs, and a way to tell people how to compare "apples-to-apples" in what they were being promised in the healthcare exchanges. Finally there would be transparency, and at least some real competition between the big insurers.
Now as we go forward, the smaller frictions are going to have to be ironed out, also depending for vitality on that urge to "form a more perfect union" and to "provide for the general welfare". For the last 4 years, we have been waiting with baited breath for January 2014, hoping people will not die while waiting for the exchanges to open up, and hoping that families will not go into bankruptcy as someone becomes significantly ill.
Those of us in gynecology and obstetrics were adamant that women's health be covered--- pregnancy and miscarriages, and pediatric care of premature babies can be super-expensive. Family planning is expensive, as the pharmaceutical industry got HUGE concessions, which allow them to charge top dollar for things which should have been under "economies-of-scale" bargaining.
As we go forward, the new science of "Health Care Delivery"--- as defined by Paul Farmer MD and Jim Kim MD at Partners in Health and for the World Bank will help change the economics to make sense of the concepts of economies of scale. I believe this will bring in a whole new era of cost-reduction, and that PUBLIC HEALTH will again be the queen of the sciences. Our attempts during the past 20 years to get to this moment, looking at the future of healthcare FOR ALL, will seem like bumbling around in the wilderness, like the journey in the desert in the Book of Exodus.
I rejoice, that of all the unfairness of the last 100 years, the failure to address the needs of patients for mental healthcare are finally about to be addressed: to become part of their total healthcare. We are not going to act like people are jigsaw puzzles, and only certain parts are worthy of our medical attention.
Physicians are also scrambling to avoid bankruptcy, as many of the older ways of practicing medicine are dying. We are fearful and anxious. But the doctor-patient relationships will come back, stronger than ever, when we actually ARE COVERING the WHOLE patient! As a woman in medicine, I am glad to have lived long enough to see some of the changes which will help doctors to also be healthier and more sane, and to have healthier families.
I do believe we will have to hold onto our hopes and dreams, as the new system is tried, and as new problems, which will not have been anticipated, need to be ironed out. The whole thing is do-able, as long as WE THE PEOPLE, intend to FORM "a more perfect union". The intentionality is paramount. We cannot assume that people who are fighting for their own piece of the jigsaw puzzle actually SEE the whole picture. So I believe it is a good idea to keep that sentence in mind. It is a good idea to remind ourselves and each other, that NO other government in history has accomplished so much for its citizens, in such a short time. We MUST continue to cooperate, in order to live up to the promise our founding fathers could barely begin to see.
The United States' Constitution gives us a mandate, and a framework. We have work to do; and the work we do will help us be a light to the nations.
I promised my friend Danielle, that I would try to write something which I think is not being very clearly stated in the public dialogue around the politics of the Affordable Care Act (which should perhaps have been called National Health Care). The Constitution of the United States is a very supple document; a blue-print, establishing the way our government is supposed to run. It has this nice balance between the Houses of Congress, and the Judiciary and the Administrative branches. I am pretty rueful that most high schools no longer offer civics classes, or American government. In my school years, it was mandatory that students begin to learn and try to understand their role in our government. This became even more urgent to me, when we were going through the Watergate scandal and the impeachment of President Nixon, while I was in the Peace Corps. It was inconceivable to the Paraguayans, and the strongest possible argument that we actually ARE a democracy, when we told them that none of us had voted for him, and almost all of us were opposed to our role in Viet Nam. They could hardly believe it would be possible to get a job for a government when you voted for the other party.
The United States Constitution starts out "We the people, in order to form a more perfect union" and goes on to list other vital parts of the functions of government, including "provide for the general welfare".
When conservatives say they uphold the Constitution, I think they are actually LYING-- in so far as they do not want to "provide for the general welfare" through the establishment of national health care. The idea of forming a "more perfect union" is that the society over time should be improved. We the people want to have a seamless interaction as much as possible, in getting the most out of the social interactions as citizens. We understand that some of what we want may take time, and needs to be worked toward. When the Emancipation proclamation happened, President Lincoln knew that it was the most important legal thing that had happened to the country since the beginning of the nation, and that it had to be ratified to keep the country together, and for the nation to function. They had to pound it out, in the blood, sweat and tears of the Civil War.
Lately we have had the evidence that the taxpayers had to bail out the banks, in the 2008 crash, to the tune of something like 80 billion dollars, because that is how the whole banking world worked, and no one wanted to watch the financial ruin of the country and possibly the whole world. We also have seen that companies like Walmart are paying their workers sub-standard wages, which force the workers to need food stamps and Medicaid--- effectively putting them into needing to be SUBSIDIZED by the taxpayers for the basic necessities of life.
The other thing that we know is that Social Security has been a great boon to the elders in our country. Prior to Social Security, a few people had enough income saved up for their retirement years, but most people either died soon after retiring, or became dependent on their children-- needing them to earn the means of continuing to provide for the elders as they aged. Many were living in penury. The Bible speaks often of the duty of providing for the widows and the orphans. The widows are the elder women, who were dependent for food, housing, healthcare-- and often were so self-effacing that they would die of anemia due to eating only tea and toast. No sweet granny would want to take the food from the mouths of her grandchildren, and food scarcity persists in being one of the very difficult things for people in poverty. As Americans have stayed healthy into their 70's and 80's, their needs for adequate food, medical care and housing have also expanded past the time of natural retirement.
When the ACA was proposed, the conservatives refused to let the idea of a Single Payer medical system even come to a vote. The kind of system that Medicare is, which had an overhead of 2% administrative costs, is the most efficient and cost-effective--- FOR the taxpayers, who are THE PEOPLE, who are trying to form a more perfect union. The insurance mega-business forced the Congress to keep them in the loop, instead of cutting them out. Many insurance companies take 40, 50 or 60% profits from the dollars paid for the healthcare policies people buy. The problem also was made worse because some of the cost was offset by businesses, on behalf of employees, for SOME of the employees, in SOME of the companies.
Health care costs rose for many reasons-- the aging of the population, the increase in effective and sophisticated medications which could save lives, more expensive healthcare in hospitals and nursing homes; and ALSO, the increased administrative overhead-- which profits led many people to have good returns on investments in the healthcare sector of the stock market.
There were doctors and many people from many walks of life benefitting in each part of this system, and so it was difficult to tease out what the truth is, for the WHOLE society to see.
Still, many doctors believed and fought for the ACCESS to care--- because poor patients would not even come to see a doctor if they couldn't pay for the visit, or the medications. Different states had different rules and variable strength of their Medicaid programs. Also, about 40 years ago, in order to lower costs, the mental healthcare needs were SEPARATED from the total healthcare needs of patients, so most mentally ill people had NO care, as most of them were poor, due to their diseases; and many doctors who would otherwise have treated these patients, could not afford to take care of them, in their dire poverty.
So to me, the answer had to come from that first sentence in the Constitution, that WE THE PEOPLE, in order to FORM A MORE PERFECT UNION, would endeavor to provide more reasonable healthcare to the WHOLE population. As the ACA gained momentum, the insurance giants wanted to keep their power and money, so they gave a little, in order to gain a lot--- the law would force everyone to purchase insurance. The doctors in every medical society and in every specialty tried to see how to help themselves stay solvent, and still be able to see the patients they needed to see, with rules which are medically sound. In states where there are more progressive doctors, like California, and where systems like Kaiser Permanente had already built a program with "economies-of-scale" to help keep costs down, it was reasonable to use their data as the benchmarks for the new rules of engagement. At least for the beginning, it would allow a predictable assessment of costs, and a way to tell people how to compare "apples-to-apples" in what they were being promised in the healthcare exchanges. Finally there would be transparency, and at least some real competition between the big insurers.
Now as we go forward, the smaller frictions are going to have to be ironed out, also depending for vitality on that urge to "form a more perfect union" and to "provide for the general welfare". For the last 4 years, we have been waiting with baited breath for January 2014, hoping people will not die while waiting for the exchanges to open up, and hoping that families will not go into bankruptcy as someone becomes significantly ill.
Those of us in gynecology and obstetrics were adamant that women's health be covered--- pregnancy and miscarriages, and pediatric care of premature babies can be super-expensive. Family planning is expensive, as the pharmaceutical industry got HUGE concessions, which allow them to charge top dollar for things which should have been under "economies-of-scale" bargaining.
As we go forward, the new science of "Health Care Delivery"--- as defined by Paul Farmer MD and Jim Kim MD at Partners in Health and for the World Bank will help change the economics to make sense of the concepts of economies of scale. I believe this will bring in a whole new era of cost-reduction, and that PUBLIC HEALTH will again be the queen of the sciences. Our attempts during the past 20 years to get to this moment, looking at the future of healthcare FOR ALL, will seem like bumbling around in the wilderness, like the journey in the desert in the Book of Exodus.
I rejoice, that of all the unfairness of the last 100 years, the failure to address the needs of patients for mental healthcare are finally about to be addressed: to become part of their total healthcare. We are not going to act like people are jigsaw puzzles, and only certain parts are worthy of our medical attention.
Physicians are also scrambling to avoid bankruptcy, as many of the older ways of practicing medicine are dying. We are fearful and anxious. But the doctor-patient relationships will come back, stronger than ever, when we actually ARE COVERING the WHOLE patient! As a woman in medicine, I am glad to have lived long enough to see some of the changes which will help doctors to also be healthier and more sane, and to have healthier families.
I do believe we will have to hold onto our hopes and dreams, as the new system is tried, and as new problems, which will not have been anticipated, need to be ironed out. The whole thing is do-able, as long as WE THE PEOPLE, intend to FORM "a more perfect union". The intentionality is paramount. We cannot assume that people who are fighting for their own piece of the jigsaw puzzle actually SEE the whole picture. So I believe it is a good idea to keep that sentence in mind. It is a good idea to remind ourselves and each other, that NO other government in history has accomplished so much for its citizens, in such a short time. We MUST continue to cooperate, in order to live up to the promise our founding fathers could barely begin to see.
The United States' Constitution gives us a mandate, and a framework. We have work to do; and the work we do will help us be a light to the nations.
Tuesday, June 25, 2013
Thinking about the book "A Constellation of Vital Phenomena" by Anthony Marra
One of the great things about a brand-new fresh book from a young author is that no one has said much about it yet. One can consider what it means, without overlays of other people's interpretations already coloring the landscape. This book is extremely rich, luminous, full-bodied. It is a once-in-a-great while achievement. I am still compelled to think about it, all the parts of it, as well as the whole. It has not faded, but is like the glowing embers of a fire, which was a bonfire of sumptuous proportions.
I must say that I love to read. I have re-read Anna Karenina 4 times, and War and Peace twice. I have read Checkhov's stories at least 3 times, Doestoevsky (the Brothers K) twice. So the potential connections to Russian literature, which were what drove Anthony Marra to visit St. Petersburg in school, and possibly to writing in the first place, are not completely lost on me. And I will also say that I love children's books, and am a big fan of the Harry Potter books by J.K. Rowling. What I love about the best books is how they help hone one's consciousness about what it is to be a human being. Tolstoy is the greatest writer, still, because of his ability to show so many textures and colors to any scene that it comes "alive"-- his cinematography shows us when a smile is enigmatic, when it is delighted, when it is ironic. And he is able to follow the thoughts of so many persons, of so many psychological bents, so amazingly well! But the depth charge is always to ring the bell of the conscience, to hone recognition of the soul, the needs of the soul, the peculiar growth of the soul.
The big theme in this book, for me, is the story of Abraham and Isaac. It is all the more interesting because the culture he writes about in Chechnya is Islamic. The people are Abrahamic. He is writing about the way humans behave in a time of war, in a fringe area of a terrible devastation, with a huge sense of defeat, and invasion, and bullying. There is no victory, there are no victors, there is no "rightness' to the geopolitical landscape in which the story is set. One could call it a wilderness, with brambles. It is very post-modern; the landmines, the urban orphans scavenging, the hopeless question of whether it is federal troops or guerrilla warfare-revolutionaries doing the bullying, and how in so many ways, it doesn't matter. It is also very post-modern in that the main character for "stability" is a woman surgeon, trying to keep a hospital going, and who has calluses on her hands, from using the bone saw to amputate all the victims whose legs have been blown to smithereens.
The two stories of the child-parent bond, are Dokka and his daughter Havaa; and Khassan and his son Ramzan. They amplify and resonate and clash with each other. The amazing amazing thing, is that the ultimate question is whether to help a child live, or to destroy the child. It is this fundamental question, which I think is the underpinning of the JK Rowling books also. And the question is the soul's question. And I think for all of time, I will see that small piece of paper which Akhmed has left for Khassan, with the word "mercy".
We are absorbed, many of us, with the problems of PTSD, of torture and its sequelae. We are also absorbed with prostitution, drug-addiction and the hellish power of the procurers of whatever can be sold; guns, drugs and people. Against the backdrop of a time-immemorial landscape of the hills one heads for when there's political trouble (the Caucasus); where there are forests, snow, no electricity, minimal roads, and minimal access to modern conveniences, there are only the ballast of story-telling, hearsay, rumor, memories, and the ways we treat each other. The landscape helps throw the human behavior into stark relief.
There are severe mercies, in this book. There are immense beauties. The writing is like a summer field full of fireflies. The memory Khassan writes, of Dokka peeling plums is shimmeringly lovely. It is then even harder to bear the crippling of his hands. I love the description of Havaa's birth, and of how Natasha comes back to life as she helps mothers with birthing, with new babies. I love the way Akhmed gives his wife a bath. The soul lessons are about the simplicity of kindness, the costliness of compassion, and the gift of freedom from bullying, from becoming the thing you hate. And even at the landfill, dancing for joy, as we know that the child has been saved. There are things about friendship, and love, and the things we hold dear, even through immense suffering. And I think one of the great gifts of this book is to recognize that the ones who are tortured can still refuse to become the torturers. We can understand the reasons, and still say no. It is in this that Marra's book resembles the way Tolstoy wrote, to me. There is the old-fashioned kind of honor in it, which is durable, time-immemorial. When I went to the bookstore reading here in Santa Cruz, a lady said "I resent you for making me understand and care about the bully." I thought that was a great compliment. We cannot drop down into black-and-white thinking, and we need to pray for mercy, for humility, for help to reach for the better way to be.
I must say that I love to read. I have re-read Anna Karenina 4 times, and War and Peace twice. I have read Checkhov's stories at least 3 times, Doestoevsky (the Brothers K) twice. So the potential connections to Russian literature, which were what drove Anthony Marra to visit St. Petersburg in school, and possibly to writing in the first place, are not completely lost on me. And I will also say that I love children's books, and am a big fan of the Harry Potter books by J.K. Rowling. What I love about the best books is how they help hone one's consciousness about what it is to be a human being. Tolstoy is the greatest writer, still, because of his ability to show so many textures and colors to any scene that it comes "alive"-- his cinematography shows us when a smile is enigmatic, when it is delighted, when it is ironic. And he is able to follow the thoughts of so many persons, of so many psychological bents, so amazingly well! But the depth charge is always to ring the bell of the conscience, to hone recognition of the soul, the needs of the soul, the peculiar growth of the soul.
The big theme in this book, for me, is the story of Abraham and Isaac. It is all the more interesting because the culture he writes about in Chechnya is Islamic. The people are Abrahamic. He is writing about the way humans behave in a time of war, in a fringe area of a terrible devastation, with a huge sense of defeat, and invasion, and bullying. There is no victory, there are no victors, there is no "rightness' to the geopolitical landscape in which the story is set. One could call it a wilderness, with brambles. It is very post-modern; the landmines, the urban orphans scavenging, the hopeless question of whether it is federal troops or guerrilla warfare-revolutionaries doing the bullying, and how in so many ways, it doesn't matter. It is also very post-modern in that the main character for "stability" is a woman surgeon, trying to keep a hospital going, and who has calluses on her hands, from using the bone saw to amputate all the victims whose legs have been blown to smithereens.
The two stories of the child-parent bond, are Dokka and his daughter Havaa; and Khassan and his son Ramzan. They amplify and resonate and clash with each other. The amazing amazing thing, is that the ultimate question is whether to help a child live, or to destroy the child. It is this fundamental question, which I think is the underpinning of the JK Rowling books also. And the question is the soul's question. And I think for all of time, I will see that small piece of paper which Akhmed has left for Khassan, with the word "mercy".
We are absorbed, many of us, with the problems of PTSD, of torture and its sequelae. We are also absorbed with prostitution, drug-addiction and the hellish power of the procurers of whatever can be sold; guns, drugs and people. Against the backdrop of a time-immemorial landscape of the hills one heads for when there's political trouble (the Caucasus); where there are forests, snow, no electricity, minimal roads, and minimal access to modern conveniences, there are only the ballast of story-telling, hearsay, rumor, memories, and the ways we treat each other. The landscape helps throw the human behavior into stark relief.
There are severe mercies, in this book. There are immense beauties. The writing is like a summer field full of fireflies. The memory Khassan writes, of Dokka peeling plums is shimmeringly lovely. It is then even harder to bear the crippling of his hands. I love the description of Havaa's birth, and of how Natasha comes back to life as she helps mothers with birthing, with new babies. I love the way Akhmed gives his wife a bath. The soul lessons are about the simplicity of kindness, the costliness of compassion, and the gift of freedom from bullying, from becoming the thing you hate. And even at the landfill, dancing for joy, as we know that the child has been saved. There are things about friendship, and love, and the things we hold dear, even through immense suffering. And I think one of the great gifts of this book is to recognize that the ones who are tortured can still refuse to become the torturers. We can understand the reasons, and still say no. It is in this that Marra's book resembles the way Tolstoy wrote, to me. There is the old-fashioned kind of honor in it, which is durable, time-immemorial. When I went to the bookstore reading here in Santa Cruz, a lady said "I resent you for making me understand and care about the bully." I thought that was a great compliment. We cannot drop down into black-and-white thinking, and we need to pray for mercy, for humility, for help to reach for the better way to be.
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