Back to work

    For some months now, I felt that I had nothing to say here.  The political turmoil has left me speechless.   So much hatred on display.  We just returned from a trip to London between two graduations on the east coast. The  Brits are debating whether to leave the EU, with plenty of vitriol leading up to the referendum in June.   Everyone asked us about Trump.  I think it made them feel better about their own problems.

        In February,  I received a letter that it was time for my "annual mammogram". The letter distorted the  American Cancer Society guidelines in order  to drum up business.  I felt ashamed for the hospital where I used to practice.  When I protested to the radiologist in charge, she admitted that the letter was inaccurate ( even the ACS now recommends mammograms every other year for my age group) but said that it didn't matter, because radiologists still recommend yearly tests.  She doesn't want any part of  empowering us to make our own choice if that choice could jeopardize her income.  

      At my daughter's  graduation from medical school, one of the speakers pointed out that we would never have been able to eliminate polio if that vaccine had been priced equal to the cost of caring for someone with polio, the way the pharmaceutical companies claim that hepatitis C drugs are priced.  Of course, internal memoranda suggest that there was no such calculation, just a decision to charge as much as the market could  bear.  Meanwhile, other pharmaceutical companies raise the prices on drugs decades past their patents to outrageous levels, so that even people with insurance can't afford them.   For the first time, the percentage of patients without insurance has dropped to single digits but doctors still have to "explain" to patients why they can't access the treatment they need. 

       When my son received his masters in education a few weeks later, one of the student speakers spoke of how he hoped to bring the benefits of modern medicine to his  home village in China.   Not "precision medicine", the  expensive individualized genetic treatment that has seduced the medical profession with its potential profits (at the expense of public health) just basic health care.  At both graduations, speakers focused on the inequities of the current system, which are strikingly similar, in education and health care.  It was good for me to hear their academic perspective, because it made me realize that whoever is elected, my job remains the same.       

Mindful Flossing

One of my problems as a writer is that I can't confine myself to one genre.  Ideas occur to me and I write them down, with no concept of what to do with them.  One of my resolutions for the new year is to experiment with posting short pieces here, starting today.  Mindful Flossing  is a silly little story that came to me after an encounter with a new dental hygienist.   For some reason, it fits my holiday mood.  Happy New Year!

MINDFUL FLOSSING

After my divorce, the only woman in my life who withheld her approval was my dental hygienist.  At a tender age, she had already perfected the slight head tilt and sad eyes that asked the question, “Is this the best you can do?”

            For years, I wanted to scream, “Yes! I have a life! A life I don’t want to waste flossing!”  My wife and I never agreed about my career goals and I despaired of reaching an accord with this freckle-faced hygienist either.  There were days when I didn’t floss at all, refusing to cede authority to someone named Tulip.

            Then I discovered Mindful Flossing™.  The concept is simple: teeth are sentient beings.  Everyone recognizes that teeth feel pain.  It only stands to reason that they can also feel clean.  Not all teeth are equally attractive; they are as variable as people are. But like us, they want to display their best selves to the world.

            The Mindful Flossing™ technique helps me to focus on the needs of my teeth.  I start by holding a generous length of floss at eye level in front of me and give thanks for all the events in my life that have led to this moment, for the opportunity to floss another day.  I take ten deep breaths, in and out, to calm my monkey mind.   Then slowly and deliberately, I pull the floss down one tooth to the gum on the inbreath and up the adjacent tooth on the outbreath.  I visualize a continuous “u” between the teeth, down, across and up.  

            I know that it sounds like it would take forever to floss all my teeth.  And it does take somewhat longer in real time.  But here’s the magic of the technique: the time feels shorter.  My relationship is directly with my teeth, not with a wife/dental hygienist figure.   By flossing, I release the life force in my mouth.   In other words, it is all about the teeth, here and now, rather than the threat of periodontal disease in the future.  It is a way to center myself, a dental meditation.  After flossing, I rinse with pure, cool tap water and rest in total acceptance of my mouth.

 I used to floss in the car to save time, swallowing the food stuck between my teeth.  How vile.  It pains me now, to think how disconnected I was from my teeth, dividing my attention between them and the road. No wonder my gums bled.  Teeth know when we’re distracted, just as children do. 

            Since I began to practice Mindful Flossing ™ five months ago, I have not missed a day.  Typically, I floss morning and evening and sometimes indulge at noon as well.  I find myself longing to floss when my stress level rises. My teeth offer me unconditional love, despite hard use. I can hear a chorus of little voices, “Thank you, thank you” after I rinse.

            Mindful Flossing ™ encourages experimentation with different kinds of floss and other dental stimulants to keep the flossing experience new and vital. Changing from waxed to extra slippery or mint may revitalize your practice. Dental tape, toothpicks, tiny wire brushes, rubber tips, all have their place in a rich dental life. The frank display of edgy products in the dental aisle reflects the new image of flossing, which transcends hygiene: on Breaking Bad, Anna Gunn flossed through a conversation with her psychopath husband.

  As my flossing practice deepened, I gradually understood that it is the process itself, my relationship with my teeth and gums,that is the goal, not the approval of the dental hygienist.   Yet as so often happens, once I was fully present for my teeth and let go of the outcome of my flossing, my gums rebounded to health.

At my next dental visit, when Tulip probed, my deepest gum pocket measured two millimeters, instead of the threes and fours she expected.  I could see her smile at the corners of her eyes, before she pulled down the paper mask and her perfect teeth greeted mine.  At that moment, I knew that I had found my soul mate.  She immediately embraced the precepts of Mindful Flossing™ in her life and work and encouraged me to share my discovery with the world.

            Reader, I married her.

Fall Reading

        In the course of reading Negroland,  a recent memoir by Margo Jefferson,  I followed a trail back through James Baldwin to James Weldon Johnson, who not only wrote  The Autobiography of an Ex-Colored Man, which is fiction, but a true autobiography, Along This Way, which is even more interesting.   Johnson not only trained as a lawyer, founded and served as principal of the first colored high school in his hometown, Jacksonville FL, wrote songs for New York musical theater  with his brother and other friends but was fluent in Spanish and served as a  U.S. Consul in Venezuela and Nicaragua in the early years of the twentieth century after a stint at the fledgling NAACP.  A fascinating life,  written in a conversational style that seems entirely modern. I only knew him as the author of the poem that became the "Negro National Anthem",   "Lift Every Voice and Sing".  His brother set the poem to music.   The autobiography  also gives some context for the recent furor about Woodrow Wilson.  Johnson talks about how Teddy Roosevelt, (before Taft, before Wilson)  appointed many blacks to prominent government posts, so many that they were called his "Negro Cabinet".    The NY Times headline, "Wilson legacy gets complicated" is misleading.   Wilson's legacy has always been complicated.  

Summer's End

Here in California, we have been praying for the end of summer for months.  Even in the city, the drought has been a constant low-level irritation.   I am trying to water my garden just enough so that the plants survive until the promised El Niño.  It feels cruel, to withhold the full measure of water they need to flourish.  My rose bushes are so old, about twenty years now, that they have held up pretty well with the minimum water, even though they are thirsty .  The rhododendrons, on the other hand, are shallow rooted and disease-prone  when water is scarce.  When plants die, I leave bare spots.  The front lawn, about 100 square feet, is mottled brown and green.  We are allowed to use the sprinkler twice a week, which is sufficient  to sustain the grass when we sleep under our fog blanket but last week's heat wave was additional stress.  There's little air conditioning here and none of us do well with more than two ninety degree days in a row.    I make everyone collect a bucket of water while they are waiting for the water in the shower to warm up and I carefully rotate which plants get the bonus water.  Carrying water daily makes me more conscious of its value.  We save water from boiling corn and blanching vegetables, too.   After cooking, I set the pots outside to cool down.   More mulch, less fertilizer...every trick I know.   The water bill in August said that we had used 30% less water than in 2013, so we're on track.  And there have been no major fires near us, although we flinch every time we hear a fire engine.   Could be worse.

Writer for a week

Most of the time I juggle my roles as a writer and a doctor without thinking about it.  But once a year, I try to attend a writing conference where I can feel like a writer among my peers.  This year I chose the Santa Barbara Writers Conference, in its 43rd year.  It was a heady experience, with a myriad of workshops, speeches and panels, almost around the clock, with "pirate" workshops starting at 9 pm.  It is always fun to talk to other people who are passionate about prose, especially since the Electronic Health Record has reduced day-to -day medical writing to stilted computer-speak stitched together from templates.  It was striking, when I returned to my doctor work, reviewing disability applications, how difficult it was to extract the story from the claimant's frequently confusing allegations and the  medical jargon of the health care team.  The clarity we writers strive for in fiction is elusive in medical files.  I thought about the importance of establishing an authoritative voice in a  file, just as in fiction.  There can be a thousand pages of evidence, but if there is no note that tells the story in a logical, coherent manner, from the beginning,  supplies a careful, comprehensive exam and bases the diagnosis on a synthesis of all the pertinent testing, I must stitch  the narrative together from  patches of isolated facts.  I face backwards, trying to figure out what happened, rather than writing a story forward. Most of the time the claimant is stuck in the middle of the catastrophe, with no resolution in sight.   I can only offer my best guess as to an ending, disabled or not disabled.

At the theater

This week I finally saw the mega-hit show Book of Mormon.  I knew that the musical was set in Africa.   But my friends assured me that it “was equally offensive to everyone”.   I don’t think so. Why does it matter?  It’s only a show.  It matters because the same stereotypes that we accept in the theater endanger black men on the street.

As a public service, I offer below the questions I ask myself to measure offensiveness.

      1. Are the targets equal?

The Church of Latter Day Saints, 95% white, has assets between 30 and 40 billion dollars, according to reporting by Time Magazine and Reuters.  Per Wikipedia, the estimated 2013 GDP of Uganda was 23 billion.  Insofar as money is power, it is less offensive to poke fun at rich people than at poor people.

      2. Are negative historical stereotypes equally emphasized?

The musical reinforces the negative stereotypes of blacks as ignorant, violent and hypersexual while glancing over the negative stereotype of Mormons as polygamous.

 In the airport scene, there are not an unusual number of siblings seeing off the missionaries.  The authors refer to the stereotype of the Mormons as polygamous by putting long fake penises on the Africans, in a play within the play, rather than on the Mormons.

     3. How far do the authors deviate from reality to make the joke?

By and large, the recitation of the history of the Mormons is factual, funny because it is out of context.  Even the line “I am Christ” earned a big laugh because of the campy delivery.  The missionaries are portrayed as zealous and naïve, not stupid.  Much of the white humor is mild “odd couple” gags, between Elders Price and Cunningham.

By contrast, the Ugandan village is unrecognizable as modern Africa. The female lead “texts” using a typewriter, although according to Wikipedia, Uganda ranks 68th among nations in terms of cell phones in use.   The character who loudly proclaims and repeats that he has maggots in his scrotum is the doctor.  Even after graduate school, a black person is an idiot.

     4. Who carries the obscene humor?

A black character is called “General Butt-Fucking Naked” (only “General” in the Playbill) There is no comparably named white character. There is no white person with an infection in an indelicate area.

 If it’s vulgar, it comes from the blacks: the song with which they greet the missionaries or Elder Price’s preposterous comeuppance.

5.     Whose Happy Ending is it?

The Africans are portrayed as overjoyed that the missionaries are going to stay.   

Nostalgia

     I just returned from a visit to Cambridge, MA where I visited two of the Harvard museums, the new combined Harvard Art Museums and the Harvard Museum of Natural History.  I don't remember spending much time at the art museums when I was an undergraduate, but my advisor's office was located in what was then called the Museum of Comparative Zoology.    In the evolution exhibit,  I watched a video that featured my advisor, Stephen Jay Gould, the most effortlessly erudite man I ever met, as well as E.O. Wilson, my first biology professor. Both of them became authorities in their fields.   When I met  Gould, he was not yet a full professor and co-taught the introductory geology course.   He was a scientist concerned with social justice at a time when many felt that it was wrong for scientists to express opinions outside of their academic pursuits.  And he was a writer, a wonderful, eclectic writer.  At my weekly tutorial,  I struggled to follow his discourse, darting about paleontology, biology, various languages  and baseball (that was hopeless).  I always left challenged and grateful.  He recognized how odd it was for a  black girl to major in geology  in those political times.   He laughed about being a Jew from New York City, who discovered rocks in museums, as I did, unlike many geologists who have rural roots.   It is his support to pursue my inner nerd that I remember most now, all these years later, not the geology.  When he died in 2002, I was surprised to find out that he was only ten years older than I was because he seemed so wise.  It was great to feel in his presence again.

Spring

It's been almost exactly a year since I  posted.  Last year was the year of my mother.  We celebrated her 100th birthday in April and mourned her death in December.   There is always a tension between actually writing and communicating about writing but when I am under stress, it is the communicating that suffers the most.  

Last fall,  The Threepenny Review published one of my medical essays,  "Faithful to the Corpse", which was inspired by a comment (from an artist)  that only artists think about death.   As a primary care physician and geriatrician, there were times where it felt like death clung to me, the way the smell of formaldehyde penetrated our clothes in anatomy lab.  Since my essay appeared, I read Atul Gawande's lovely book Being Mortal, which argues for a more thoughtful approach to end of life care.   I was surprised to find that he, too, discounted the current role of doctors, primary care doctors, in particular, in this realm.   Although an MD, he portrays himself as previously unaware of the work of geriatricians and looks to the new specialty of palliative care to fill what he perceives to be void in this area. The community hospital where my mother spent some of her last weeks didn't even have a palliative care team.  It's not clear how well the model that was developed in academic medical centers will function in other settings--that was the problem with geriatrics, too.  Fortunately, the primary care doctors in our family were able to reach out to my mother's outpatient primary care provider, a nurse practitioner, who helped the family in our mother's last illness. The NP engaged with us out of the goodness of her heart, since she couldn't bill for our conversations.   Dr. Gawande does not discuss finances in his book, but unless we as a society are willing to pay for end of life care, rather than depending on the goodness of the hearts of providers,  the impetus for palliative care will fizzle, like the geriatrics movement I joined  25 years ago.

Reading

"It takes wit and courage to make our way while our way is making us, with no consolation to count on but art and the summer lightning of personal happiness."

                                                                 Alexander Herzen, 1812-1870

Saw the Shotgun Players production of Salvage the third play in Tom Stoppard's trilogy The Coast of Utopia.  They produced all three plays over the past few years, a tremendously ambitious undertaking because  all of them are meaty and long and require many actors.  A theatrical feast.  A few months ago, prompted by the plays and a friend  who kept recommending them, I read the first two parts of Herzen's autobiography, about his early life in Russia and his six-year Siberian exile.  Also saw the American Masters portrait of James Baldwin on TV, which prompted me to return to his essays.   Both literary/political men who lived abroad, Herzen in exile, Baldwin by choice, and eventually found themselves displaced by younger revolutionaries.   Their chunks of history are easier to digest because they write so well.

"But in our time, as in every time, the impossible is the least that one can demand--and one is, after all, emboldened by the spectacle of human history in general, and American Negro history in particular, for it testifies to nothing less than the perpetual achievement of the impossible."

                                                                        James Baldwin, 1924-1987