See Cruz

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In yesterday's Sunday column I mentioned Ted Cruz spending twenty-one hours lying about the Affordable Care Act. Guess I'm not the only one who noticed.

Not Bad, For An America-Hater

Well, I suppose you can posit all sorts of theories about screw-ups, stumbling and bumbling his way through foreign policy; or you can be convinced our president has had nothing to do with it at all. But the fact is, things might be looking up. It appears there's world-wide agreement about handling Syria's chemical weapons, and willingness on their part to cooperate. Meanwhile, the sort-of leader of Iran is making noises like a guy interested in meaningful negotiations over nuclear weapons. Even, sorta kinda maybe admitting, contra his predecessor, that something called the Holocaust actually happened.

Some will claim it's dumb luck, as do I regarding Saint Ronnie and the Cold War: he had the good fortune to preside (to the extent that he was aware of where he was) at the exact time when Michael Gorbachev appeared on the scene, and during the inevitable collapse of the Soviet system, which had been running on the fairy dust of propagandizing its people (a model for Fox "news") for decades. Some will say there've been back-room machinations and behind-the-scenes overtures since Obama first took office and they're finally paying off. We may never know. But it seems pretty unlikely this stuff is happening without the US being involved, somehow, to some extent, somewhere under the radar. Maybe it's even possible the current president is more interested in results than in who gets the credit; content to work off-screen, rather than flyboy his codpiece to an aircraft carrier and hang a self-aggrandizing (if entirely false) banner.

For whatever reason, we're in a moment where a certain level of optimism appears warranted; and where, despite desperate attempts to prevent it by Republicans, a few things seem to be coming together for President Obama. Which means, also, that they're coming together for all of us. Peace-ish posturing in the Middle East? Improved health care coverage at home? No wonder teabaggRs in Congress are so desperately trying to screw things up, by whatever means, no matter the consequences; or, more accurately, no matter the extent to which it perverts the fundamental political system of that country for which they claim such unique love.

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Sunday Column

Here's my penultimate column for our local newspaper, about meeting with one of my more vocal detractors, letter-to-the-editor-wise:

I’d been looking forward to publishing the column I’d queued up as my penultimate one. Started right after Michele Bachmann announced she wasn’t running again, it described how perfectly she personifies the ignominious intellectual descent of her party, wondered if she actually believed the crazy stuff she said, or if she just sluiced it out there for the attention. (During her mind-devouring appearance in Egypt recently, straddled by two other avatars of emptiness, it became clear she really is imperviously clueless.) The column also referred to her skittering to the land of nyctophobic fantasy in which the Republican Party has lately pitched its doorless tent. I enjoyed writing that. It ended by saying I’d love to believe her exit foretold a return to reality by her party, but I can’t. For, as Yoda said to Obi-Wan, “There is another.” And another. (Star Wars references: reportedly now passé.) 

I won’t indulge myself. Instead, I’ll tell you of meeting the other day with Ed, the man to whose letter I referred in my “bagging it” announcement; who pointed out I was no Charles Krauthammer, while making his preference clear. After my column, he emailed me. Following a pleasant conversation in cyberspace, we met in person, over coffee. What a good guy he is. Charming, funny, engaging, and, despite being ten years older than me, looking ten years younger. Or five. Good handshake, too: right in the palm, and firm. 

For about two hours, we talked and easily could have gone on much longer. This was no corny sitcom where we ended up agreeing on everything or found out we’d been separated at birth. Fact is, we didn’t agree on much. But in those areas of opposition we contended without a lot of heat, and with recognition that neither of us was entirely right, or entirely wrong; that there was always wiggle-room. (Okay, there were issues about which I was entirely right: he thinks the stimulus accomplished nothing and I think it made a big difference. I agreed it fell short, though. Wasn’t enough, ended too soon, included too much tax cut and not enough job programs. Also, he’s skeptical about climate change, but listened when I talked about ocean acidification.)
Ed thought I shouldn’t quit writing the column. He said he mostly disagreed with me, but not always. (I’ll not embarrass him by revealing with what he agreed.) He said if I toned it down a little, it’d be more effective. On that point, we agreed entirely: I’d sort of acknowledged it in my column. I get outraged at the outrageous, too loudly to be persuasive, I know. But sometimes you just have to run into the street and scream until you can’t anymore, especially when it feels like your brains will squirt out your ears if you don’t. 

We didn’t talk only politics. Each having a few years on us, there were tales to tell about where we’d been. As human beings, as Americans, we could disagree on everything political and still have more in common than not. Kids. Family. Things we like, and stuff we worry about. So it makes you wonder, doesn’t it: how have our politics gotten so unrecoverably nasty, when people are still people? If it’s been going on for a long time (I’d argue it detonated when Speaker Newt Gingrich decided his only purpose was to destroy Democrats, for perpetual power. Ed and I didn’t discuss that, and I doubt he’d agree), it’s gotten exponentially worse since Barack Hussein Obama was elected.  

And if both parties have had representatives in Congress who are embarrassments to themselves and should be to those that elected them, there’s only one, currently, with legislators babbling insane conspiracies, who reject science while populating the majority of the House Science Committee. People categorically unwilling to compromise (Ed thinks the Affordable Care Act was a no-compromise railroaded deal, since no Republicans voted for it. I think it was the ultimate compromise: an idea born of conservatives that let down liberals who wanted single-payer); itching to crash the economy, uncaring whom it hurts, unconcerned about worldwide repercussions; hissy-fitting if they don’t get their way in yanking health care coverage from tens of millions of people, just as they’ve voted to do with food for the hungry. 

So we don’t agree. But we talked respectfully and enjoyed each other’s company, and I’d bet that if people like us were in charge, we could find that workable, elusive middle ground. Too bad we’re not. Right, Ed?
  

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Oh, The Sun Shines Bright...

Gotta admit, despite thinking I was pretty politically aware, I had no idea Kentucky, home of Senators Mitch "The reptile" McConnell and Rand "It's pronounced eye-n" Paul, had a Democratic governor. As one would expect from a person of such affiliation, he seems a man of good sense:

... So why then is Kentucky — more quickly than almost any other state — moving to implement the Affordable Care Act? 

Because there’s a huge disconnect between the rank partisanship of national politics and the outlook of governors whose job it is to help beleaguered families, strengthen work forces, attract companies and create a balanced budget... 

The state ranks among the worst, if not the worst, in almost every major health category, including smoking, cancer deaths, preventable hospitalizations, premature death, heart disease and diabetes... 

The Affordable Care Act is one of those solutions.... 

Lack of health coverage puts their health and financial security at risk.
They roll the dice and pray they don’t get sick. They choose between food and medicine... 

Furthermore, their children go long periods without checkups that focus on immunizations, preventive care and vision and hearing tests. If they have diabetes, asthma or infected gums, their conditions remain untreated and unchecked... 

The Affordable Care Act will address these weaknesses... 

In short, we couldn’t afford not to do it... 

As for naysayers, I’m offended by their partisan gamesmanship, as they continue to pour time, money and energy into overturning or defunding the Affordable Care Act. It’s shameful that these critics haven’t invested that same level of energy into trying to improve the health of our citizens...

So, to those more worried about political power than Kentucky’s families, I say, “Get over it.” 

... and get out of the way so I can help my people. Here in Kentucky, we cannot afford to waste another day or another life.

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Nightmare

It could be teabaggRs worst nightmare: the cost of insurance premiums under the Affordable Care Act look to be lower than projected for 96% of Americans.

As they do everything they can to prevent tens of millions of Americans from, for the first time ever, having access to affordable health insurance, Republicans must be getting pretty worried. What if it works? What if that 96% of Americans discover that they've been lied to by the right-wing fear machine? It's coming down to the wire. Not long before we find out.

Meanwhile, I have no doubt that there will be problems -- probably significant ones -- with implementation; and issues that'll need fixing. Worse, the solutions will need to be found and legislated against the tide of disinformation and lack of assistance from the right, who'd rather see people suffer than pitch in and do the job of legislating for the good of the country. Led by such nihilist egotists as Ted Cruz, if they have their way, we're ruined.

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See The Ceiling

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On Further Review...

Yeah. From the guy who started it: McCain's campaign manager when they chose Sarah Palin, leader of the pack.

Cruz Control

I've read some interesting stuff about Ted Cruz, lately. Some of it was first person accounts of classmates, nearly all of whom agreed on two things: he's very, very smart; and he's an arrogant prick. I guess it changes my opinion somewhat. I'd known he'd attended Princeton and Harvard, but, given his legislative idiocy, I reminded myself that George Bush followed a similar path, and he's proudly a C student, and was a D- president. But, okay, I accept that Ted Cruz is a smart guy. So what's he up to?

He was elected on his promise to "shake up Washington," and he's certainly doing that. In the way that Gary Ridgway shook up the area around Green River in our other Washington. Plus, it's Texas. There's no amount of crazy that could hurt his reelection chances there. So it seems to me it can only be about building a base for what some consider higher office. And if that base consists of people like Iowa teabaggers, then the crazier the better. And here's an article that would seem to confirm that:

Simply put: When you’ve reduced your entire movement to saying “no” to Barack Obama and Nancy Pelosi, is it any surprise that whoever shouts “NO” the loudest will wind up defining what counts as “conservative”? 

Indeed, if you happen to be a demagogue running for president on the platform that you are the only True Conservative and everyone else is a squish or a RINO or a secret liberal, then the best plan is to find the most convoluted, self-destructive, but nevertheless very loud way of saying “no.” Which is basically what Ted Cruz and his allies have done with the demand that Republicans tie keeping the government open to defunding the ACA.

One wonders: does there remain any hope at all that the Republican Party will return to the playing field instead of hanging in the locker room welding everyone's doors shut? Will things get so bad that voters finally reject such tactics, or will they recede into the former Confederacy and seethe forever, dealing with their fears and hates and sense of inadequacy by ruining things for everyone else? Is Ted Cruz smart and crazy, smart and cynical, or does he really think what he's doing serves any purposes but his own?

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Haves, Having

One of the better screeds on the dishonesty spewing from the right about The Affordable Care Act was written yesterday by, once again, my favorite political columnist. He said, in part,

The administration hasn't handled the sales job as well as it could have. (Massachusetts governor Deval Patrick, one of the president's earliest supporters and the man to whom fell the job of selling Willard Romney's health-care reform in Massachusetts, told me as much last year.) But I think we can all agree that, for example, if you're trying to sell ice cream, and the people across the street start screaming that you're selling the kids frozen chocolate botulism, the sales job gets a bit harder. 

The motives of the political opposition to health-care have been allowed deliberately to remain murky. The fact is that the opposition is funded by people who do not believe that the benefits of the country's wealth should be shared by all of its people. The fact is that the politicians funded by those people believe, implicitly and explicitly, that there are people in this country who deserve good health, and people who don't, and that they can be distinguished by what they can afford. To leave these motives shadowy and implied is a choice that the courtier press has made.

If it's true -- and it is -- that the ACA is far from perfect (mainly because it was an total copout to conservatives in hopes they'd help make it work), there's no doubt about the cynicism with which Rs are dealing with it. I agree with the preceding sentiments; but I think it's also pretty clear that the main thing Rs fear is the distinct possibility that, given time, people will see the good to be had in the act; and that when they do, Rs will have been shown to be duplicitous liars, and it'll become clear as the space between Michele Bachmann's ears that R ideas, such as they are, are proven yet again to be utterly wrong.

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Two Good Ones

[I think I got them both off Facebook.]

The Price We Pay

Read this and weep. For the kid, his family, and for our society, which as horrible as this sort of stuff is, considers it, if not exactly okay, then just the expected collateral damage, an unpleasant side-effect of our preferred status as the most heavily armed "civilized" nation; not desirable, necessarily, but whatchya gonna do?

A 24-year-old man was arrested in the shooting death of a 3-year-old Michigan City-area boy in what an official said was a game the man played with a gun... 

... The child, Lance Wilson, was found dead from a gunshot to the head inside the trailer where Grisham lived with the boy and his mother and at least one other child. 

... Grisham and the boy often played a game where the boy pointed his finger at Grisham and said, "bang, bang." Grisham would respond by pointing his gun at the boy and pulling the trigger.  

... the investigation shows Grisham "this time forgot the chamber was loaded."

There's no excuse for letting that guy walk the planet any longer. He should be strung up in Wayne LaPierre's front yard.

I don't think our society would suffer much were all guns to disappear. It'll never happen, of course, particularly as long as it's possible another black guy could become president. But I have no problem with recreational guns. I have a friend, NRA member, gun safety instructor, hunter who only shoots when he has a clear shot, and has never needed more than one shot to kill the animal. I've gone shooting with him (at a range.) I've eaten his delicious elk sausage, too.

Absent any other options, I'd like it if guns in the US were rounded up and put in Larry's safe-keeping. I'm pretty sure he'd demur: his garage is already pretty full. But if all gun owners were like him, we'd have nothing to talk about. When it comes to guns, anyhow.

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Yep, That'd Do It

Wedding delayed as man chops off testicles, storms church

And he used scissors!

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Blame To Go Around

Trouble, albeit with obvious solutions, coming soon. It's always been clear that budgetary sanity requires spending control in "entitlements" as well as tax increases. Will we ever elect enough people to act on it? People who aren't as dishonest or dumb or both as Paul Ryan? And if so (unlikely), will it already be too late?

WASHINGTON — As the White House and Congress careen toward another fiscal showdown, the nonpartisan Congressional Budget Office warned on Tuesday that President Obama and lawmakers have been cutting the wrong kind of federal spending as they try to avoid unsustainable levels of debt in coming decades... 

... The accumulated federal debt ... would reach 100 percent of the G.D.P. in 2038. But that probably understates the potential crisis, the budget office said, because it does not account for “the harmful effects that growing debt would have on the economy.”... 

... Republicans have supported keeping the sequestration cuts in place rather than accepting Mr. Obama’s proposal for a mix of higher taxes on wealthy people and some corporations and cuts in future entitlement spending. And he will not accept their alternative for deeper reductions in Medicare and Medicaid without new taxes... 

... Budgets proposed by House Republicans would replace Medicare with federal subsidies to buy private insurance, although at limited amounts, and would transform Medicaid into much-reduced block grants to states.

...  Mr. Obama refuses to consider those far-reaching changes and has proposed savings for the existing Medicare, Medicaid and Social Security programs. But Republicans refuse to accept the higher taxes he also demands. 

In the current budget debate, Republicans propose to repeal or delay Mr. Obama’s health insurance program. Representative Paul D. Ryan of Wisconsin, a Republican who leads the House Budget Committee, responded to the budget office’s report with a statement suggesting that eliminating or delaying the program, called the Affordable Care Act, would address the nation’s fiscal woes. 

But the Congressional Budget Office has reported that the Affordable Care Act would reduce deficits and that repealing it would increase them, largely because its costs would be offset by taxes and savings from care providers who benefit from an increase in insured patients.

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Sunday Column

Here's my pen-penultimate column in our local newspaper. Two more to go, and then I bail out.

Among the many baffling bogglements of American politics is the derisive disregard held by most Republicans – lovers of liberty, of small government, of “Don’t tread on me,” of our constitution (which, inconveniently, includes The Bill of Rights) – for the ACLU. The “American Civil Liberties Union.” Not the “Big Government Union;” not “Americans for Ignoring Your Rights, “or the “Let Government Run Rampant Coalition.” It’s an outfit concerned about preservation of the freedom of individuals caught in the clutches of governmental or private attempts at overreach, and guarding against illegal discrimination. 

So why the reflexive rejection of that organization by the very people who claim to have a virtual monopoly on its central concerns? It’s liberals, their leaders and media idols love to declaim, who hate the Constitution. 

Not that it’s a unique disconnect. The Tea Party, created and financed by the most wealthy and powerful, mendaciously manipulated by their wholly-owned and propagandistic “news” outlets, and designed specifically to foment resentment among regular folks for the very things that regular folks actually need, while ignoring the fact that they’re obligingly facilitating the takeover of government by the most regressive and oligarchical and un-regular-folks elements, is proof of how easy it can be to manipulate people into working against their own interests. (Phew. What a sentence! Passed it like a kidney stone.) The point: lots of people seem unable to recognize when they’re being deceived by those who absolutely do not have their best interests at heart. The ACLU, on the contrary, does. 

Not known for his sense of irony, Rush Limbaugh, who considered the ACLU some lefty-commie-America-destroyer, happily accepted their help in asserting that his privacy had been violated when his illegal trafficking in prescription drugs was revealed. And why not? Protecting the individual, no matter who, is precisely their mission. 

Advocating civil rights isn’t for the easily cowed. Pretty much by definition, an organization willing to stick its neck out the way the ACLU does is asking for controversy. For one important thing, goring is in the eye of the begored. If you never much liked gays, for example, you’re not going to be all that enthusiastic when the ACLU stands up for them. Nor, if you’re for biblical theocracy, are you likely to be thrilled when they argue for the right to build mosques. But if we are indeed a nation of laws, and if we do indeed give more than lip service to the other nine amendments (the second, of course, goes without saying. Did you know the ACLU has expressed reservations about recently proposed Democratic gun restrictions?) and if we acknowledge that government has a tendency to abuse its power (what is the Tea Party if not a proclaimer of that?) then having people willing to take heat from all sides in the name of the law and of fairness is something for which we should all be grateful. In a nation that places its constitution deservedly highest among documents, it’s the last thing you’d expect to break along party lines. But like so many things in America nowadays – even science! – it does. 

Some may recall that, in the 1970s, the ACLU supported the right of American Nazis to march in Skokie, Illinois, a town with a large Jewish population, many of whom were Holocaust survivors. In doing so, the ACLU lost many of its Jewish supporters; but because civil liberties are civil liberties, even when disagreeing with the exercisers thereof, they did it anyway. Growing up in a Jewish family, I recall heated discussions among my parents and their friends at the time; and I remember being proud that my mom and dad argued, strongly, much as they hated the very idea of American Nazis, that the ACLU was right. 

The fact is, Republican animus isn’t much of a mystery: the current leaders of that formerly honorable conservative party don’t actually believe in democracy anymore. Thus the widespread suppression of those voters with whom they disagree, and the impenetrable, conspiracy-based refusal to accept election results. Twice. Nor do they value civil rights or religious freedom, except as they apply to themselves. Thus, their transcontinental efforts to embed biblical law and homophobia into our legal codes; their attempts to expunge science from classrooms; their claims of religious persecution despite overwhelming evidence to the contrary, not the least of which is the radical fundamentalism of nearly all their recent presidential candidates. The ACLU demands consistency in following the law. Isn’t it weird that today’s Republicans don’t like that?
  

Special bonus for blog readers: watch this and know why we need the ACLU.

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The Scandal

I've expressed, ah, mixed feelings about Alan Grayson in the past. But his to-the-point questions here make it pretty clear that teabaggRs are beating a dead horse that never lived. Of course it was a tragedy. Of course there are always things that, in hindsight, could have been done differently in a tragic situation. Like, for example, having laws that would prevent a known insane person with a history of gun violence from legally purchasing a shotgun.

There's also this report, just released.

And yet. CongressRs persist, and their mindless followers eat it like hummus on fresh and warm pita. Our politics have gone irretrievably over the edge.

Credit Where It's Due (Or Not)

John McCain wrote a commentary in response to Vlad Putin's now infamous one in the NYT. McCain's appeared in "Pravda," the Communist answer to Fox "news" in Russia; although I gather this organ, while named "Pravda" (which, as we Russian language speakers know, means "truth" and, at least when I traveled in the Soviet Union at the height of the Cold War was to truth as Fox is to news) isn't the same "Pravda" that's more well-known.

At any rate, kudos for "Pravda" for printing it, and even more to John McCain whose straight talk was impressive:

... President Putin claims his purpose is to restore Russia to greatness at home and among the nations of the world. But by what measure has he restored your greatness? ... He has given you a political system that is sustained by corruption and repression and isn't strong enough to tolerate dissent. 

How has he strengthened Russia's international stature? By allying Russia with some of the world's most offensive and threatening tyrannies. By supporting a Syrian regime that is murdering tens of thousands of its own people to remain in power and by blocking the United Nations from even condemning its atrocities. ... He is not enhancing Russia's global reputation. He is destroying it. He has made her a friend to tyrants and an enemy to the oppressed, and untrusted by nations that seek to build a safer, more peaceful and prosperous world. 

President Putin doesn't believe in these values because he doesn't believe in you. He doesn't believe that human nature at liberty can rise above its weaknesses and build just, peaceful, prosperous societies. Or, at least, he doesn't believe Russians can. ... 

I do believe in you. ... When I criticize your government, it is not because I am anti-Russian. It is because I believe you deserve a government that believes in you and answers to you. And, I long for the day when you have it.

So, good for him. It's said that that version of Pravda doesn't get read much; but I'd bet the piece will go viralskii pretty fast over there. If there is such a thing.

On the other hand there are those who see it very differently; from the fact that it's in the "wrong" Pravda, to the fact that it's a provocation at exactly the wrong time, and suspecting that what McCain is really up to is kiboshing the Syria WMD agreement so we can have another war, which is way past due, in his view.

The man who crashed in the 2000 primaries, the man who acquiesced to CIA torture (the same methods once used on him) in 2006, the man who claimed to put country first in 2008 and then impetuously picked an unstable half-wit as a veep candidate, the man who wanted to launch a war with Russia over Georgia, and the man who has spent the last five years actively trying to undermine the president’s foreign policy when visiting Israel … well, we should expect stupid amateurish displays of ego like an op-ed in the wrong Pravda. 

Yes, it was the wrong Pravda, one founded online in 1999 and not connected to the other Pravda founded in 1912. But McCain is not exactly known for his precision, is he? And at a moment when the US needs to keep relations with Russia stable – because Russia is critical to controlling and destroying Assad’s chemical weapons – McCain lobs a rhetorical hand-grenade at the Kremlin... 

... But this pointlessly provocative op-ed is also obviously serving a purpose. McCain wants the US to go to war in Syria in order to achieve regime change. For him, remember, Iraq was a huge success. Now that he has been stymied in this effort – stymied by the president and the Congress and a huge majority of the American people, 79 percent of whom back the US-Russia agreement – he has decided to try and sabotage it. 

Well, now that I think about it, and given McCain's penchant for self-serving glory-seeking and the fact that he loves him some war, I might have been wrong, and Sullivan right. After all, McCain has been nothing but an Obama-pricking asshole since the American people rejected him and his "half-wit."

Another chimes in as well. So, I take it back. He's still an embarrassment to himself and, now, to the rest of us, too.


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Missing From The News

Not a lot of coverage of this, from any media source I know of (note the date of publication):

Conclusions. We observed a robust correlation between higher levels of gun ownership and higher firearm homicide rates. Although we could not determine causation, we found that states with higher rates of gun ownership had disproportionately large numbers of deaths from firearm-related homicides. (Am J Public Health. Published online ahead of print September 12, 2013: e1–e8. doi:10.2105/AJPH.2013.301409)

Not that one would expect anything different. Guess that's why it was ignored.

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Don't Get Sick!

This is really scary, frustrating, disappointing, and totally in synch with what I've been predicting, and observing first-hand. I don't think there's public access to the article, so here's the summary, with no link. It was from an article on Medscape, and refers to a study published in the Annals of Surgery (Annals of Surgery. 2013;258(3):440-449). The title of the paper is "General Surgery Residency Inadequately Prepares Trainees For Fellowship." That really says it all. And if they ain't prepared for fellowship, they ain't prepared for you. I added the bolding:

Abstract

Objective: To assess readiness of general surgery graduate trainees entering accredited surgical subspecialty fellowships in North America. 

Methods: A multidomain, global assessment survey designed by the Fellowship Council research committee was electronically sent to all subspecialty program directors. Respondents spanned minimally invasive surgery, bariatric, colorectal, hepatobiliary, and thoracic specialties. There were 46 quantitative questions distributed across 5 domains and 1 or more reflective qualitative questions/domains. 

Results: There was a 63% response rate (n = 91/145). Of respondent program directors, 21% felt that new fellows arrived unprepared for the operating room, 38% demonstrated lack of patient ownership, 30% could not independently perform a laparoscopic cholecystectomy, and 66% were deemed unable to operate for 30 unsupervised minutes of a major procedure. With regard to laparoscopic skills, 30% could not atraumatically manipulate tissue, 26% could not recognize anatomical planes, and 56% could not suture. Furthermore, 28% of fellows were not familiar with therapeutic options and 24% were unable to recognize early signs of complications. Finally, it was felt that the majority of new fellows were unable to conceive, design, and conduct research/academic projects. 

Thematic clustering of qualitative data revealed deficits in domains of operative autonomy, progressive responsibility, longitudinal follow-up, and scholarly focus after general surgery education.

Back in my Surgeonsblog days, when I'd write about this I'd always get some pushback from med students: surgeons like you think you have to torture people to teach them; you're inhumane; you're locked in the dark ages. Well, maybe so. Maybe you don't have to treat residents like animals; but if you limit their hours the way it is now, this is the price you pay.

There's no way I could now live through even a couple of weeks of the kind of training I had back then; but back then, even when I was tired, I never doubted that the hours I was spending were necessary. As a resident, the easy rotations were the ones where I got out of the hospital every other night for maybe eight hours. On the rest, it was every other weekend, starting sometime Saturday afternoon and ending around 4 or 5 am Monday. As chief resident on the trauma service, I left the hospital for one night in sixty days; and that was because my attending was a good enough guy to cover for a few hours on my anniversary.

In my view, the number one thing that makes a good surgeon is commitment. Well, of course, and having a certain level of skill and knowledge. And judgement. And maybe even empathy. (Yes, believe it or not: empathy.) You don't get a sense of commitment by bugging out when your shift is over. And if your teachers don't pound you once in a while if you were sloppy, or didn't think things through, or didn't follow up when you should have; if, when you screwed up like that they didn't hang you out to bleed in front of your peers, maybe you might not ever fully internalize the implications of the trust your patients place in you.

It's just the way it is: surgery is different. There are no hiding places in the operating room; no way to have the patient come back next week after you've had time to think, or look stuff up, or just hope it'll all will go away. Which it might, if it's not surgical.

Surgeons who trained in my day -- and there's no way to say it without sounding self-serving and self-congratulatory -- are different, too. I fully acknowledge I let myself burn out too young, because I hardly took time off, I made rounds several times a day, day on or day off; I came in early and stayed late, worked over lunch to fit a woman in who was worried about a mammogram report, even though it really wasn't a true emergency. My younger partners didn't. I'd see a woman with a breast lump, take a needle sample, drive it to the pathology lab over the "lunch hour," look at it with the pathologist, and call the lady back the same day. Have her come in at the end of the day if it showed cancer, so we could talk about it right away. I don't think you'll find many -- or any -- who'll do that nowadays. Not bragging; just making the point that there's old-style commitment, and there's today.

I'll hasten to add: I know young surgeons who are very committed to their patients and to providing high-quality care. Nor do I claim that the newly-minted surgeons are satisfied with or happy about the inadequate training they've received. But I've also seen many a good young surgeon bail out of the rigors of a general surgery practice because it's too hard. Take a job as a hospitalist with regular hours; limit their practice to, say, breast care only, or bariatarics. Their training didn't require the hours that practice does. Us old guys, well, it was easier in practice than in training.

On the other hand, they will probably stay in the game longer than I did, because they won't be exhausted all the time. If they ever learn how to take out a gallbladder, or operate on a tough case, it should be fine.

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Expert

Only slightly under the radar is the fact that a Syria "expert" on whom both Johns Kerry and McCain relied in their claims of moderation among the "rebels" turns out to be a liar. She falsely claimed a PhD; then, when found out, claimed it was only a misunderstanding: she'd defended her thesis but hadn't yet been granted the degree.

Okay, these things happen. In med school, I always pointed out to patients who called me "doctor" that I really wasn't one yet. But honesty only takes you so far... Needed to do that rectal exam.

Anyhow, it turns out the "misunderstanding" went a little further. She wasn't actually in an advanced degree program at all. I have no idea whether her opinions on Syria are valid or not, although it seems pretty clear that characterizing some of the rebels, anyway, the ones that tear hearts out and eat them, or the ones that line up prisoners and shoot them in the back of the head and send around the videos, as "moderate" might be based on criteria that differ from mine.

But what really gets me is this:

“There is little I can do to assuage the lack of credibility this misrepresentation has created, as well as the confidence my colleagues and others who have relied on me may have lost the past several weeks. Their anger and distrust is understandable, however, I never intended to willfully deceive anyone,” O’Bagy said.

What sort of person can say that with a straight face? Only a pathological liar. "Never intended to willfully deceive." Really? What did you intend?

Also, it's a split infinitive.

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Question

If Wayne LaPierre is right, and the only solution to a bad guy with a gun is a good guy with a gun, then how is it that mass murders can happen on military bases?

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Join!!

I chipped in on another Kickstarter campaign, and helped put it over the top. Now we all can. Together, we can change the world. Not saying how, though...

The System Works

So yesterday I spent the morning at the county courthouse, having responded, like a good boy, to a jury summons. (They took pains to tell us our county is among the highest in the country in terms of percentage of people showing up when called. You mean people don't? Who knew? Coulda stayed in bed.) After passing through security, not unlike TSA stuff, and being shooed away when I got too close in picking up my watch) I joined about 140 other people awaiting their fate, in a large room with extremely uncomfortable chairs and extremely bad coffee. I was pleased,  for no particular reason, to note that my peers were all dressed non-sloppily. Not a tube top among them. Of course, it had been raining.

I'd been called a few times before; when I was working I always wiggled out, because serving would have meant canceling operations which would have been unpleasant for my patients. I reported one prior time, sat there for a few hours, and was excused without much really happening. This time I got as far as being named to a group of 40 people destined to a certain courtroom. After being told we'd be called upstairs in ten minutes, several times, extending it to nearly an hour, they announced we were excused. Case continued, as they say. In total I spent about four hours, peed a couple of times, emailed my wife, surfed the net, read a book, exchanged a couple of pleasantries. They had free wi-fi in the jury containment area, and I had my laptop.

Not sure if I'm disappointed or not. I'm pretty sure I'd not have been selected to sit, although I have no idea. I hear they don't much like doctors on juries; and the fact that I write (or have been) a ranty-liberal column in the local newspaper might have been exclusionary, too. It might have been fun to announce that stuff and see the reaction. As to sitting for untold hours while lawyers did their thing, and then, perhaps, to hear other jurors say what they though, well, I think I can do without it; although there's a certain unsatisfied curiosity.

On the other hand, I'd really hoped to make it into the courtroom, had it been a particular judge with whom I have a little history. When our kids were in pre-Little League baseball, I had to umpire a game because the actual ump didn't show up. The now-judge, then half-ass lawyer, was coaching the other team, and kept yelling about rules. Like when our pitcher walked in a few runs and started to cry, and our coach went to the mound to put a consoling arm around his shoulder, the asshole objected, announced he was playing the game under protest, because the rule says the kid was supposed to come to the sidelines.

He raised more objections to other insignificant infractions meant to help kids but, evidently, from the wrong place on the field, and I finally said to him, hey, man, this isn't the World Series. These kids are third graders. Some of them are fourth graders!! he yelled, external jugulars flopping like docked fish, as if he'd just announced the most important truth since something something.

Another time, the asshole pulled a U-turn in front of me, heading the other way on a semi-main drag, causing me to slam on my brakes. Then he pulled back out in front of me, causing me to slam them again. Then he turned into what turned out to be his driveway, stopping first without signaling, causing me to slam on the brakes yet again. So I honked the horn as I drove off, teaching him a thing or two. At which point he jumped out of his car and ran into the street, flipping me off as I disappeared. Or he did. Anyhow, it was a dick move.

So I was hoping to be able to ask, all innocent, if personal issues with the judge were something I should report; and, if questioned for specifics, telling those stories. Particularly the finger wave. In front of him, the lawyers and other participants, and the rest of the potential jurors. Or, better yet, in chambers, just him and me and the lawyers and Della Street.

Didn't happen. I discharged my duty, and can expect a check for ten bucks to arrive in about three weeks. They pay a mileage allowance, too, based on zip code.

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Ain't That The Truth!

Mongers, Denied

So, just to be sure I understand: if, by some means, we are able to accomplish the goal of ridding Syria of its chemical weapons without the need to drop bombs, with the attendant collateral killing of innocents, that's a humiliation. HUMILIATING, I tell you!!

If Vladimir Putin, whose hypocritical column in the NYT has the crazies going crazy, gets some credit, brought into the mix by whatever means (which, horror, might even include deliberate and on-going behind the scenes negotiating by Obama), that somehow instantly erases the obvious imbalance between our two countries in terms of economic and military strength and of round-the-world credibility? Just because Putin can, with a straight face, lecture us about equality and democracy while demonstrating the opposite in terms of gay rights, free press, political protest, it means he'll be taken seriously as a standard of decency?

Gimme a break! This Syria episode has been a circus in all ways from all sides; but the obvious disappointment among wingnuts that we didn't (so far) get to bomb another bunch of Muslims may be the most instructive of all. Their certainty in American "exceptionalism," whatever that is, is so ephemeral that it melts like a gallium spoon if we can't put on a war once in a while, or if we don't act unilaterally like bullies around the planet. Because it's worked out so well whenever we have. If this is patriotism, then it's weak tea, indeed. If their only measure of strength is in kilotons, if their only view of America's strength is borne of military might, then they don't have a clue of what this country is (or has been, anyway) and don't deserve a seat at the table. Especially if food is served.

What a pathetic bunch of insecure losers today's "conservatives" have become. Walk stupidly and carry a big dick. (To make up for their small ones, one must assume. Not that I've ever seen one.)

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Sunday Column

My latest column in our local newspaper. Sort of a pre-swan song.

A recent letter writer has a point: I’m no Charles Krauthammer. Ever since I started doing this column thing, I’ve asked myself why, and who am I to be doing it? Krauthammer, despite his hyper-partisanship and blinding contempt for our president, has a national forum and a Pulitzer. Me, I’m just some guy who reads too much, thinks too much, and gets upset. 

I’d argue the writer misses an important point, though: he’s correct when he says I’m, shall we say, unkind to today’s Republicans. But he overlooks the “today’s” part. If there’s been a consistent message in my writing, it’s lamenting the insanity that’s officially overtaken that party, nationally. As many ways as I can, I’ve said we need two opposing parties to make our democracy work. But when one has gone galloping over the edge, electing people like Bachmann, Gohmert, Braun, and so many others, science-rejectionists all, spinners of conspiracies, uncaring obstructers who offer no alternatives except defunding everything our future requires, well, there’s a problem. And Sarah Palin! Proudly simplistic, hard work averse, slogan-slinging and hypocritical self-promoter. Still considered credible. Seriously? 

So I’ve cried out. Clearly, though, the message doesn’t get through. Maybe it’s because I lack persuasive eloquence; or maybe it’s because of the insanity itself: the writer says Krauthammer calls the facts “as he sees them.” That, in a nutshell, is the problem. I state the facts as they are. Then offer my opinion. There’s a difference. 

I’ll argue until my last breath that there’s no comparison between our current political parties in terms of seriousness, of trying to do what’s most right for the most people. Among Democrats there’s no equivalent to Louis Gohmert, who just said he thinks liberals might be trying to “cull the population” using vaccines. That’s insanity of galactic proportions: if his words were fog, there’d be thousand-car pileups on interstates across the land. I mean, vaccines have wiped out polio and smallpox, right? Worst culling ever. Republicans elected that guy; his wild-eyed pronouncements are countenanced by his peers, and greeted with enthusiasm by his voters, who’ll surely reelect him. We’ve always had raving lunatics, and always will. But how is it that one party’s solution is to send them all to Congress? When has one party so unwaveringly refused to rise above petty politics? 

Absent Democrats, nothing George Bush proposed would have become law. Literally nothing. TARP, No Child Left Behind, Medicare part D, the awful authorization to invade Iraq. Without Democrats, the flaws in NCLB and Medicare part D would have been left to fester; instead, they joined the battle to help fix them. It’s how good stuff happens. Compare and contrast: The Affordable Care Act. Balancing the budget. 

I wish today’s Republicans would come to their senses and engage the process with sincerity, because actual conservative ideas, long since abandoned by the people in control of their party today, need to be part of the mix. Snohomish County hasn’t elected Gohmert/Bachmann equivalents. Yet. Maybe we have enough thoughtful voters that if they were to speak out and not reflexively defend the indefensible, it could help bring our political process back to workable. I’m not optimistic. 

But here’s the real point of today’s column: I’m gonna bag it. I agree with that writer: I have no business doing this, even though the facts are on my side. Maybe if I weren’t so troubled by comparing today’s decidedly not conservative party to what once was, I could write with less exasperation. But, so help me, I can’t help it. I might have a grandkid one day, and I’d like her to be born into a world where there’s hope. But today’s Republican party, with its denial of science, its attacks on public education, its hidebound refusal to spend money where it’s needed for our posterity, makes me think there is none, and won’t ever be. 

I could write more about our community, I guess; but the fact is, I’m not concerned about it: our worst local Republican is better than the best national one. (Admittedly a low bar.) Washington will hang in, until Congressional Republicans ruin everything for everyone. 

It isn’t the criticism. That’s been the fun part. One writer said I brought his fish back to life when he wrapped it with my column. Great line! But I agree: I’m not the one to be producing a column like this. I have three more pieces I’ve already written. After that, as they say in the business: -30-

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Pedophilia For God's Sake

How many instances does it take to make a pattern? Why is it that those who rail most loudly against whatever particular sin they rail against most loudly are most likely to be committers thereof? At what point might people who prefer religion decide to do their praying and communing with their gods away from the hallowed halls where roam the pedophiles and hypocrites? "Youth pastor." Based on countless episodes, there oughta be a special term for it, similar to "oxymoron." Something like "immiscible," maybe. Take a pastor, definitionally suspect for reaction-formation anyway, put him with yoots, as Joe Peschi so famously called them, and what do you get?

... have you heard of the Iowa youth pastor who is walking free after confessing to raping boys to “cure” them of homosexuality? 

Well, that’s precisely what happened in Council Bluffs, Iowa. Brent Girouex, 31, was arrested on 60 counts of suspicion of sexual exploitation by a counselor or therapist... 

... Girouex told detectives that his actions were meant to “help with homosexual urges by praying while he had sexual contact with [them]” in order to keep them “sexually pure” for God. He then allegedly told police that “when they would ejaculate, they would be getting rid of the evil thoughts in their mind.”  (ed note: haven't had an evil thought in years.)

Victims say Girouex took them to his own home to violate them. It’s the same home Girouex’s wife and four children resided in. 

... The judge in the case sentenced Girouex to 17 years in prison last week, and then immediately suspended the sentence in favor of sex offender treatment and five years probation. All Girouex has to do is avoid violating his probation and he’ll NEVER spend a single minute in a prison cell.

And why not? After all, it's not as if he harmed anyone. And we all know how well sex-offender treatment works. Sounds like a thoughtful, god-fearing judge.

The louder a religionist rails, the further away you should run.

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Mindblown

At least they're making it easy to see: there's no longer even a pretense that Rs are about anything but rejecting whatever Obama is for, even if it's what they were demanding of him before he was for it. The Republican Party has completely abandoned seriousness, wholly endorsed assholery as modus operandi. I guess they're confident that their voters are like-minded: if Obama is for it, we're agin' it. No need for policy; and certainly not for coherence:

Brian Beutler raised a good point today. 

When the full story of the Obama administration's clumsy involvement in, and (possible) disengagement with, Syria is told, we'll have a clearer sense of whether it was bungled all the way, or whether a diplomatic resolution was actually the product of a credible military threat and clever negotiating. Or maybe a bit of both. 

But whoever tells that story should reserve a footnote for the handful of politicians and public figures who did a complete about-face from opposing President Obama's proposed military strikes to mocking -- and even rooting against -- an unexpected diplomatic alternative. 

If you took both of those positions you have some 'splainin' to do. 

Karl Rove offers a helpful example, having insisted a few weeks ago that Obama go to Congress because lawmakers would obviously approve a resolution to use force, only to then condemn Obama for having gone to Congress because there's no way lawmakers will approve a resolution to use force. 

But Senate Minority Whip John Cornyn (R-Texas) has been even more brazen. He demanded that the president answer his questions about Syria and then asked no questions when he met with the president; he supported military strikes until Obama endorsed the same idea; and as Brian noted, Cornyn is now questioning the value of a possible diplomatic solution. 

In other words, the #2 Republican in the Senate is, quite literally, against whatever President Obama is for -- even when the president changes course.

In a democracy that, heretofore, has succeeded because of the good that comes from serious conversations between people with differing approaches, one can only conclude the obvious: we're screwed. The Republican Party is no longer a serious player; and those that mindlessly support it are doing so, either blindly or willingly, with total disregard for addressing issues seriously. Having that black guy in that white house has, I must conclude, simply blown their minds. I can't think of anything else at this point. Because from the point of view of logic, of politics, of history, of humanity, it simply makes no sense in any other context.

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And With That, It's Over

So the NRA succeeded in recalling, in Colorado, home of the Aurora mass murder, two Democratic state legislators who voted for (puny) gun restrictions. And that's that. Or, as Charles Pierce says:

... A few feet away stood Steven Martin, 53, a recall supporter with a Beretta handgun holstered on his hip. "It's a deterrent," he said. "I love my country." 

A gun. Outside a polling place. I knew I missed something not growing up in Argentina. 

Guns have won. Period. The people who make them have won. The people who sell them have won. The people who want to use them to shoot up elementary schools have won. Iowa's arming the blind. The NRA's fighting state laws to reduce the amount of lead in the bullets used for hunting because there's evidence that the lead in abandoned carcasses is leaching into the environment, and lead does very bad things to the body. We have decided to be an armed nation. And the next time some lunatic opens fire in a movie theater, it really would be nice if we could dispense with the maudlin national mourning pageants on cable-TV and admit that these are the kind of things with which we have chosen to live. It at least would be honest.

So we've gone from "a well-regulated militia" to everyone packing, everywhere. And any politician foolish enough to think that trying to moderate that in order to lower the incidences of mass killings or, as is a practically every-day occurrence nowadays, little kids blowing themselves away because their idiot parents left loaded guns around, is toast.

Okay, then. Exceptional America, the only "civilized" country that has made gunplay part of daily life, accepts the fallout as simply the price of doing business. If it's sort of inexplicable, if there's no reality-based reason for it, we now know for sure: it ain't gonna change. So, let's live with it. And, hopefully, not die from it. Case closed.
 
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"Hypocrisy" Starts With "F"

Just in case there's anyone out there who still thinks Fox "news" is something other than a propaganda network (actually, there are tens of millions) whose sole mission is to bring down President Obama no matter what he says or doesn't, no matter what he does or doesn't, note what they were claiming after Obama's speech on Syria. Awash in people saying the same thing, the message was that, in finding a diplomatic approach which involved Russia, the US had been "humiliated."

Then consider what, months before the president actually did it, Fox president Roger Ailes said he'd have done:

In Zev Chafets’ 2012 book Roger Ailes Off Camera the president of Fox News is quoted saying if if he was in the Oval Office he would “open a new front” in Syria, and that he’d use use flattery and the promise of international prestige to convince Russian President Vladimir Putin to join the intervention.

From Ailes’ comments in the book:

“Putin is angry. He thinks the United States doesn’t take him seriously or treat Russia as a major player. Okay, fine, that’s how he feels. If I were president, I’d get in a room with him and say, ‘Look at the slaughter going on in Syria. You can stop it. Do it, and I’ll see to it that you can get all the credit. I’ll tell the world it was you who saved the innocent children of Syria from slaughter. You’ll be an international hero. You’ll go down in history.’ Hell, Putin would go to bed thinking, ‘That’s not a bad offer.’ There will still be plenty of other issues I’d have with Russia. But instead of looking for one huge deal that settles everything, you take a piece of the problem and solve it. Give an incentive for good behavior. Show the other guy his self-interest. Everybody has an ego. Everybody needs dignity. And what does it cost? You get what you want you give up nothing.”

Let us await, breath abated, for the interview with Ailes the Foxies will surely produce, shall we?

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