Independence Day 2020

This Independence Day is different from all others that I have experienced.

We are so bitterly divided.

We face the fury of a resurgent pandemic.

We cannot even agree if wearing a face mask is the right thing to do.

Tens of millions of Americans have been thrown out of work.

Our politics is increasingly poisonous. 

Anger and frustration over racial injustice has erupted.

How do we move forward?

Will we be able to celebrate the day with the 'bonfires and illuminations' that John Adams forecast?

The Whistleblower

”I am apt to believe that it will be celebrated, by succeeding Generations, as the great anniversary Festival. It ought to be commemorated, as the Day of Deliverance by solemn Acts of Devotion to God Almighty. It ought to be solemnized with Pomp and Parade, with Shews, Games, Sports, Guns, Bells, Bonfires and Illuminations from one End of this Continent to the other from this Time forward forever more.”

John Adams

'Face Masks Violate my Rights!

Several decades ago, Thomas ‘Tip’ O’Neill, who was Speaker of the House is associated with the adage, all politics is local.  In other words, caring for the needs of one’s constituents is the best strategy to preserve one’s political viability.  Of course, those were also the days when Democrats and Republicans – despite their philosophical differences – could argue and thrash out a deal.  Indeed, it has become political lore how Speaker O’Neill and President Ronald Reagan could capitalize on their personal chemistry to make progress for the nation.

Those were the days.

There is a different type of chemistry today that exists between Speaker Pelosi and President Donald Trump.  When they are mixed together, they form an unstable compound that is highly volatile and may explode.

Instead of all politics is local, we now have all things are politics, a sad bastardization of O’Neill’s principle.  Now, as we are all so painfully aware, anything can be politicized, which serves only to frustrate and divide us. 

We all know that many issues are highly political, as expected.  For example, if 2 congressmen argue if income taxes for certain Americans should be raised, this falls well within the realm of politics.  If the president proposes a change in our immigration policy, then we expect that various constituents will do their best to exploit the issue to serve their political interests.  In a perfect world, of course, there would be no political tainting of the issues as all good people would strive to serve the greater good and not their parochial interests.  Have you noticed that our world is slightly less than perfect?

Yet, one might have thought that certain issues transcend politics.  But, that naive notion is pure fantasy.  There is no issue today that can escape the predatory tentacles of the political machine.

Is this guy making a political statement?

Readers might be aware that we are in the midst of a pandemic and that our nation’s progress has been halting.  As I write this, nearly 30 states report that their COVID-19 cases are on the rise.  Every public health expert has advised us to wear masks, among other sensible recommendations.   Wearing a mask, as I do, is not a political statement; it is a public health measure.  I do it to protect those around me in case I am unknowingly infected.  And, it is possible that it might also afford me some protection.

Yet, there is a vocal movement of anti-maskers out there who vociferously argue that a mask infringes on their rights.  I reject this.  Their right to mingle near others barefaced is outweighed by the community’s right to avoid infection.  How such a simple act could become a political issue may seem baffling, but it is standard operating procedure today.  Earlier this week I watched citizens in Palm Beach County Florida decrying the mask and those who advocate its use.   One watching this venomous display might have thought that the government was poised to seize their homes.  Alas, it was only about a cloth mask to protect their neighbors, not quite a 'grab your pitchfork' moment.  

I challenge you to identify any issue that is immune to politics.  Apple pie, baseball, Mother’s Day, Sesame Street, stuffed animals,  petting zoos, Halloween, Thanksgiving…  

Stumped yet?

Ohio City to Remove Christopher Columbus Statue

Progress is a messy business.  The pathways that have led, and are leading, and will lead to societal change have not been straight shots.  The nation is now tightly focused on pursuing racial justice, which has entered the 401^st year of a journey that has yet to meet its destination.  You can site your own examples of necessary reforms that were the result of years or decades of struggles that have been wrenching, frustrating and even violent.  None of these successes and ongoing works in progress are easily accomplished.  It’s hard for folks to feel they must give up something, particularly if they do not feel personally responsible for the injustice that is being legitimately targeted. 

The reform process is not clean and many friendly fire casualties often result.  We saw this when the nation become revolted after learning about the horrible and pervasive culture of sexual harassment that permeated many businesses and industries.  I felt that in this instance, and elsewhere, that the net being wielded to snatch up the perpetrators became too wide in another example of zero tolerance.  Whenever zero tolerance is invoked, brace yourself for unfair and absurd outcomes. Do we really think, for example, that Al Franken had to be thrown out of the U.S. Senate for irreverent actions and speech he committed prior to public service when he was a comedian?  And, in our zeal to come to the assistance of harassed women, we were counseled to ‘believe the women’, as if any allegation should be assumed to be true. These examples of overshoot make me uncomfortable.    I endorse our current system when the accused is presumed innocent and the burden of proof is on the accuser.

This past week, I came across an example of overshoot that merited Whistleblower attention.  A city in my own state of Ohio plans to remove a statue of Christopher Columbus, a figure who many  believe to be a dishonorable person who should be removed from the public square.  The city has taken this act to promote diversity and tolerance.   The statue has stood watch over the City Hall since 1955.

The Flag of the City of Columbus Still Waves

There are many Americans who oppose efforts to scrub out Columbus Day and to dismantle statues honoring him.  However, I can understand why a city, particularly in the current political and social climate we are now in, might feel that a Columbus statue is improper.  Here’s what I don’t understand.  Explain to me how a city named Columbus takes down a statue of Columbus but still keeps its name?

If the leadership and citizenry of Columbus aim to remove a statue of the explorer because it is deemed too offensive for public display, then shouldn’t they enthusiastically jettison the city’s name for the same reason?  And if they opt to keep the city’s name, what is their explanation?

Breaking News! Black Lives Matter vs COVID19 vs Election 2020!

Protests for racial justice continued throughout the country.

Businesses are racing to announce their corporate policies for justice and equality.

New polling reports that a majority of American support the protests and the Black Lives Matter movement.

Even military brass support renaming military installations named after Confederate generals. 

New York City opened up showing bold determination to aim toward normalcy

Over a dozen states are reporting increased cases of COVID-19.

President Trump expressed that policy brutality is committed by a few bad apples.

Attorney General William Barr and others denied that systemic racism exists in law enforcement. 

Over 40 million Americans have lost their jobs. 

Over 150 COVID-19 vaccine efforts are underway.

Major League Baseball still has no agreement between owners and players because of the usual obstacle.

HBO Max pulled Gone with the Wind because of its sanitized portrayal of slavery in the antebellum south.

Polling shows that presumed Democratic presidential candidate Joe Biden continues to gain strength.

Gone!

All of these items occurred just within the past week.  The news cycle is exploding.  Every item is a Page 1 ‘above the fold’ story, but only 1 or 2 can be accommodated. There is simply an avalanche of real breaking news these days.  This is in contrast to CNN, where Breaking News, with it’s bold red font, is used to introduce every newscast, and is often sprinkled throughout their programs.  Of course, if every report is Breaking News or is a Crisis or is Unprecedented then these terms have no meaning.  Fox News has it’s own Fox News Alert designation, but in their defense it is utilized much more sparingly.

But, in the past week and months, we are all struggling to follow so many truly monumental and evolving stories simultaneously.  And we and the media may not have the bandwidth or the attention span to absorb them all.  Since the George Floyd murder and the subsequent protests, the coronavirus pandemic was pushed aside, even though it is still a page 1 story here and abroad. And soon I expect that the protests, even if still present, will be edged out by an event or a controversy that hasn’t yet occurred. 

There’s a whirlwind of information bombarding us in real time   How do we prioritize the news?  How closely should we follow the stories?  How do we know that our news sources are trustworthy?  Do we have the skill and the desire to separate out the static and the noise?  (One man’s static is another man's...)  

When every story is ‘breaking news’ does it mean that the news business itself might be broken?

A Nation Reels from Police Brutality

In medical terms, the nation has been in status epilepticus – an unrelenting seizure - since the cruel and cowardly killing of George Floyd, an act of evil that we have all witnessed on tape repeatedly.

First, there was the brazen killing of an unarmed man who was already lying face down in handcuffs while a police officer pressed his neck into the pavement.  All the while the officer’s hand was comfortably planted in his pocket, a casual pose that one might expect from an officer ambling down the street greeting folks passing by.  Three of the officer’s confederates hovered over the scene.  Was Mr. Floyd a flight risk?  While I am not a law enforcement professional, Mr. Floyd did not appear to be combative or resisting?

This violence was perpetrated by one who was sworn to protect and serve all of us, including Mr. Floyd.

Protests erupted throughout the nation and beyond our borders.  While Mr. Floyd's passing may have been the spark, the story started hundreds of years ago.

And, there was also violence and looting.

And, there was a reaction to the violence and looting.

And, yes, there was a reaction to the reaction to the violence and looting.

And, so it goes.

How will we find a way out?

Through it all, the nation is headed by one who gives voice and space to the darker angels of our nature.

Astonishingly, for a week or so, COVID-19 was pushed to the back pages of our attention.

Much of the nation who are not black are accepting the existence of structural racism whose roots sprouted here over 400 years ago.  The issue is longer, wider and deeper than we can fathom. And, we have made real progress over the past several decades.  Let’s acknowledge this as we also accept the challenge to pursue fairness and justice.  Making progress will take strength, pain, perseverance, frustration, understanding, protests, compromise, reform, disappointment, fairness, tolerance and, perhaps most importantly,  the ability and willingness to consider an issue from another’s point of view. 

The task is beyond the abilities of any one person to accomplish.  And, we may not personally witness its completion.  

As written in the Jewish Talmud, it is not incumbent upon you to complete the work, but neither are you at liberty to desist from it.

 

Telemedicine Surges during the Coronavirus Pandemic

Not long ago, Telemedicine was something that I read about.  Now, it’s something I do.  Over the past weeks I have been evaluating patients over the phone from home.  It has been an adjustment, but it has been smoother than expected.  First, I have always thought that the physical examination is overrated.  Yes, I recognize that such a declaration constitutes medical blasphemy, but I stand by it.  Don’t extrapolate beyond my actual meaning.  I am not suggesting that the physical exam is superfluous.  Indeed, there are many circumstances when the exam is absolutely critical.  However, for a good bulk of the routine gastroenterology patients I see, particularly for those who are returning to my office for a follow up visit, the exam contributes little value.

Here is a sampling of patient visits where the history alone is largely sufficient.

• A patient with years of chronic constipation returns to see me for a 6 month follow up visit.
• A new patient sees me to evaluate frequent heartburn.
• A college student returning from a spring break camping trip in Central America sees me for diarrhea.
• A 35-year-old new patient is referred to me for abdominal cramps that occur after eating dairy products.
• A 65-year-old asymptomatic patient is sent to me with occult blood in the stool.

For cases similar to those I listed above, it is highly likely that I could obtain sufficient information simply from the patient interview – a hands free encounter.   This is why telemedicine can be a highly functional modality for treating patients.  And, while it is beyond the scope of this post, technology exists and will be further developed that will allow for many aspects of the physical examination to be performed remotely.  Even without futuristic technology, we can evaluate a patient’s appearance skin, pharynx, speech, joint mobility, respiratory effort and ambulation through the miracle of video transmission.  And, a patient can palpate their own abdomen and report if it is tender.

Do you think you could canoe up a waterfall?

My telemedicine encounters have been nearly all conducted by phone, and they have gone well.  At times,  patients have needed to have their expectations revised.  For example, if I have a phone visit with a patient whom I have never seen, who has years of unexplained abdominal distress and has seen digestive specialists and had emergency room visits, it would seem unlikely that a new physician will crack the case on the phone.  

As I have written throughout this blog, I lament how technology has exacted a cost on the doctor-patient relationship, much as it has eroded humanity and intimacy writ large.  To reclaim what has been lost would require canoeing up a steep waterfall.  It can’t be done.

After the pandemic has passed, I hope that I can return to my conventional office practice, which for me is the ideal setting to practice medicine.  But who knows what the new normal will be. 

Memorial Day 2020 - A Plea to Remember.

Tomorrow will be a Memorial Day worth remembering.  Of course, its core meaning – to remember and honor those we have lost in the service of this nation – remains paramount.  I have thought over the years that the day’s essence has become blurred as the day has become one of family picnics and barbecues.  I confess that I have not sufficiently paused and meditated on the day's meaning in year's past as I think I should have.  I placed a small American flag on our front lawn today, the smallest of gestures to honor a very solemn remembrance.   

But this Memorial Day is different.  To those of us like me who have never served, this may feel as close to a war atmosphere that we will hopefully ever know.  Lockdown.  Shelter in place.  Commerce shuttered.  Empty streets and concert halls.  Fear.  Desperation. Hope.  Propaganda.  Supply chain disruption. Heroes.  Victims.  Agony and death.  

We are battling an invisible and cunning enemy who knows no borders.  Thusfar, he is bulletproof.  Yes, we are winning, but it has a been a tortured grind leaving a staggering wake of destruction.  We are not even sure what winning will look like.  We will get to the other side, holding a collective fantasy that life as we knew it will await us. But that destination is yet unseen and unknown.

Let’s remember those we have lost in the current war, and the loved ones who still grieve, and the ordinary folks who became extraordinary heroes as they ran straight into the fire.