Down the Trump Rabbit Hole 9 April 2019

Today for me is more than another day, more than an ordinary day.  Tomorrow is Day One for the person replacing me in managing our department’s surgery clerkship by which all WUSM 3^rd-year students spend twelve weeks being introduced to the surgical care of patients.  Tomorrow I move into the driving instructor’s seat, into the relay runner’s baton passing.  We have four overlapping weeks together to make this transition as seamless as possible.  As I walked reflectively to the medical school campus early this morning, I recalled a Ralph Waldo Emerson quote I came across more than twenty-five years ago when I was still new to the experience of being embedded inside the healthcare sphere filling positions that – to use Dr. Elkins’ interpretation – put me “on the field” or “in the arena”.  In the early 1990s, I joined a team being led by a University of Miami neonatologist with the aim to find a sustainable intervention for breaking the downward spiral of cocaine-abusing women who were delivering prematurely cocaine-exposed babies.  My primary responsibilities were to optimize the field results of the case managers and to develop the project’s internal evaluation process (including a nuanced approach to defining ‘success’).  My secondary opportunity was to encourage the neonatologist whose spirit was sagging and whose vision was dimming.  I had an idea new for me as well as for her – i.e., I offered to assist her in building a ‘to be’ list.  Every couple of weeks, I would send her a new entry for the growing list.  The Emerson quote below was one of the first entries.  The quote remains centering for me and clarifies where/how as a family you and I continue to meet.

[Ralph Waldo Emerson quote]

To laugh often and much, to win the respect of intelligent people and the affection of children; to earn the appreciation of honest critics and endure the betrayal of false friends; to appreciate beauty; to find the best in others; to leave the world a bit better, whether by a healthy child, a garden patch or a redeemed social condition; to know even one life has breathed easier because you have lived -- this is to have succeeded. 

Down the Trump Rabbit Hole 23 March 2019

Yesterday the number of days before my retirement from full-time work in the medical education/practice sphere dropped below 50 days.  In seven weeks, I will close 30+ years of implementing the still somewhat novel challenge and invitation I began receiving shortly after finishing my doctoral studies in 1981 from my close friend and first collaborative partner Dr. Elkins in the early years of his Ob/Gyn academic career – “Brown, we need humanities specialists on the field with us, in the arena with us, in the trenches with us . . . but it won’t/can’t be primarily as an ethicist . . . there are no such positions and no funds for such . . . no, you will have to fill some weightbearing role we recognize by which you can establish credibility and in addition to which you can then be an ethics educator among/with us . . . Are you interested?”  From UT Memphis School of Medicine to the University of Michigan Ob/Gyn Department to the University of Miami program for mothers and infants compromised at birth by cocaine abuse to the LSU New Orleans Ob/Gyn Department to the East Tennessee Appalachia community health center to Barnes-Jewish Hospital to the Washington University in St. Louis Surgery Department – each move/location has had in common the intent to embed in a teaching hospital, a medical school department, a federally funded research project, or a medical practice and as an ‘insider’ to contribute additionally as an ethics educator and a qualitative data researcher.  After May 10, I will no longer be embedding in this way.  I do plan to continue encouraging the careful and radical (i.e., ‘to the root’) self-examination so crucial for living life well to the end and am very grateful to the WashU Surgery Department for carving out a part-time position by which I can continue nurturing the department’s longstanding efforts to draw attention to the ethical challenges unique to surgery.

With ‘tip of the iceberg’ news headlines just in the last few days such as the university admissions scandal highlighting systemic inequities underneath, with the completion of the Mueller investigation capping the shockingly pervasive corruption overloading our efforts to grasp and understand, with the harrowing Mozambique cyclone devastating yet another vulnerable population, . . . – how can firm footing be (re)set?  I most often return to two core/centering resolves. 

First, as prompted by the affluent author of Ecclesiastes, I return to the resolve to face my affluence, to keep my mind’s eye open indiscriminately to the full range of human experiences, to resist the easy opportunities to look away that are within reach for those who are healthy and socio-economically advantaged.  I agree that to do otherwise results in a shallow, inauthentic, haunted existence.  The more difficult alternative -- to stand with those who sacrificially contest inequalities by living an answer to such questions as -- Should those more advantaged give disproportionate attention to those less advantaged?  Can complacency (or resignation) about inequalities be overcome?  Should the interests, rights, and/or liberties of a few to whom resources flow freely override the interests, rights, and/or liberties of the many to whom meager resources flow?  How far beyond those immediately affected should consequences be tracked in assessing the fairness of a decision?

Second, as prompted by the last paragraph of Bonhoeffer’s December 1942 After Ten Years reflections he shared with his family and with his fellow Abwehr conspirators who had all been courageously resisting Hitler and the Nazis for a decade, I return to the resolve to confront the ironic but serious risk of being damaged/victimized by daring to be near enough long enough to resist the current divisive, destructive, demeaning darkness enveloping our country and the international community.  As Bonhoeffer framed the question – “Are we still useful?”  He explained the question this way (my translation) --

“We have become silent witnesses of evil actions.  We have been drenched by many storms.  We have learned the art of disguise (counterfeiting) and ambiguous speech.  We have through experience become suspicious of people and remain often culpable (at fault) regarding truthfulness and free speech.  We have been mellowed (made brittle) or perhaps even become cynical through intolerable conflicts.  To be useful, what we need to be is unpretentious (without artificiality), modest, straightforward individuals – not geniuses, cynics, despisers of humanity, cunning (clever) tacticians.  Will our strength to stand against being unnaturally shaped be strong enough and will our genuineness (sincerity, honesty) with ourselves remain relentless enough that we can find our way back again to simplicity and straightforwardness?”

Firm footing is key for living meaningfully in these turbulent times.

Down the Trump Rabbit Hole 21 January 2019

For this Martin Luther King, Jr. Day, I have inserted below a couple of photos.  The first one I took a few years ago when in Washington, DC, attending a professional meeting.  I remember having to search for the statue, which seemed metaphorically appropriate.

The second photo I took when my family and I were walking to the 1991 opening of the Civil Rights Museum in Memphis.

 

It is simple enough to say “I am for justice”.  I have yet to come across someone who says, “I am for injustice”.  Trump and his lockstep constituency – so hostile to immigrants, LGBTQQs, Muslims, ethnic minorities, women, the disabled, et al – routinely assert “We are for justice”.  It is much more complicated to be just and to seek justice – beginning with the question, “Justice for whom?”  One reason for the complexity is the reality that no single definition of what is just in the access to and distribution of limited resources is equally compelling and clarifying for all situations.  But the reason for the complexity on my mind this Martin Luther King, Jr. Day is the degree of sacrifice and risk the privileged/advantaged must embrace in order to act seriously on a claimed commitment to justice.  I have inserted below the current draft of a spectrum I first created several decades ago as a tool for differentiating the differences – in some cases, very subtle differences – among those who say “I am for justice”, a spectrum designed to avoid an easy/relieved conscience or a hesitancy to probe to the core.   The spectrum is organized around a few key terms or phrases – e.g., ‘affluent’ (to flow to/toward), ‘respect’ (to look back/again), ‘hunger and thirst’ (an incomparable or unparalleled value – yes, with echoes of Jesus and Bonhoeffer), ‘radical’ (to the root), ‘genuinely present’ (with integrity). 

“But what does it mean for the affluent to ‘hunger and thirst for justice’?”

(-3)               (-2)               (-1)               (0)               (1)               (2)               (3)

DISPOSITION -3: The protected/advantaged who demonstrate a complete lack of respect for neighbors, colleagues, and the widening circle they represent of the many without basic civil rights by noticing them only for the purpose of exploiting them. 

DISPOSITION -2: The protected/advantaged who demonstrate a complete lack of respect for neighbors, colleagues, and the widening circle they represent without basic civil rights by noticing them only for the purpose of shunning/avoiding them.

DISPOSITION -1: The protected/advantaged who routinely disregard neighbors, colleagues, and the widening circle they represent of the many without basic civil rights, but who are latently predisposed to purposefully shun/avoid them if significantly disturbed by them.

DISPOSITION 0: The protected/advantaged who are not predisposed to purposefully shun/avoid neighbors, colleagues, and the widening circle they represent of the many without basic civil rights, but who do not respect them deeply enough to make a serious effort to be genuinely present with them (i.e., to ‘welcome’ them).

DISPOSITION 1: The protected/advantaged who express an interest in being genuinely present with neighbors, colleagues, and the widening circle they represent of the many without basic civil rights (i.e., to ‘welcome’ them), but who do not respect them enough to make substantial lifestyle changes for such to happen.

DISPOSITION 2: The protected/advantaged who respect neighbors, colleagues, and the widening circle they represent of the many without basic civil rights deeply enough to make radical (i.e., ‘to the root’) lifestyle changes necessary to be genuinely present with them (i.e., to ‘welcome’ them).

DISPOSITION 3: The protected/advantaged whose respect for neighbors, colleagues, and the widening circle they represent of the many without basic civil rights leads them to put their lifestyle privileges and even their lives at risk in their effort to be genuinely present with them (i.e., to be ‘welcomed’ by them).