Friday, December 27, 2019

Pees On Earth

My upcoming column/poem in The Everett Herald:

This weekend betwixt I should try to be nice,
Refrain from complaining or giving advice.
Until Twenty-twenty, of rants I’ll steer clear,
Maintain equilibrium, spread naught but good cheer.
Perhaps we can find things on which we agree,

If nothing else happens, as friends we can see,
Such pleasures as sitting before a nice fire.

Americans all, we do share the desire,

For grandkids to thrive in a land that is fair,
Relying on reason to clear up the air.
And when it comes down to it, who can deny,
Under stripes and bright stars do our colors still fly.
Deciding to shout less, to look for the best,

And be a good person: can we pass the test?

Let’s not forget this while looking around,
It’s lucky we live by the grand Puget Sound.
And that’s reason enough to be taking a pause,
Refraining from ranting (though for a good cause).

As Christmas has passed and left kids a few gifts,
No better time now to be healing our rifts.
Do join me in wishing to everyone here,

A pleasurable start to another new year.

To emailers past who have pieced me their mind,
Restraining my tongue, I’ll not answer in kind.
And to those who have liked what I’ve offered to say,
I pass on my thanks for oft making my day.
To everyone, though, since we all share a heart,
Or when we do differ we’re not far apart,
Rely on my words when I say most sincerely,
Our differences can’t stop what to me are most clearly,
United States values we all want to hold,
Since we were all made from the same sort of mold.

From common ground sprang we not far in the past,
And whatever our future, we want it to last.
Kindness, therefore, could be just the solution,
Each one of us makes as our next resolution.

(Read carefully, or you'll miss it.)
[Image source]

Tuesday, December 24, 2019

A Winter's Tale

This is from years ago, my surgery blog. Because why not?

Tending toward the heavy myself (losing it when I get back into cycling, periodically), I have sympathy with those who are overweight. Nevertheless, it's a fact that the obese present a broad spectrum of problems for surgeons: higher risk of wound infections or hernias, slippery hands when tying knots, harder to find the proper tissue planes for dissection. Difficult anesthetic management, blood sugar issues, blood pressure, too. Lots of things make it less than pleasant to have patients who are significantly overweight. So when the guy showed up in the ER and I was called, I wasn't thrilled. On the other hand, his problem was one I'd not seen before. I like a challenge, most of the time. Not necessarily in the middle of the night, in the middle of winter.

It being late when I got the call, and cold outside, my first thought was that I could punt the case to the plastic surgeon. But they'd already tried him, and he was having none of it. So with my usual expletives and foul wee-hour mood, I got out of bed and headed to the hospital. "Circumferential pressure sore," they'd said. Fat necrosis, risk of a necrotizing infection. Gonna have to take him to the OR, cut away a huge amount of tissue, maybe a few times. Dressing changes for weeks. Skin grafts. Royal pain in the ass. Such were my thoughts on the dark drive, watching out for black ice, sliding on snow.

In the ER, reading his chart before going into the room, I could hear the man referring, it seemed, to every nurse within shouting distance as a "ho'." So I was primed for an unpleasant encounter when I walked in, and I must admit I was a little rude to him. Didn't ask how he'd gotten the injury, didn't exchange pleasantries. Just lifted up his garish shirt and had a look (what was this guy, a pimp? He called me a "ho," too. Several times.) Occupying the entire circumference of his enormous belly (the kind that transmits waves across it, like Jello -- not a good prognostic sign, in terms of pleasant surgery) was a band of mottled skin, maybe five or six inches in width, pocked here and there with open sores; oozing, and dirty.

Mixed in a disgusting brew, with what looked like a bunch of tiny hairs, was a fine black powder, like pencil-filings without the wood. Like uniformly ground dirt. Like soot. And despite wearing gloves and boots and the most ridiculous pants I'd seen in a while, the man had cold skin, without the erythema you'd expect in someone successfully being re-warmed. Clearly, he'd been out in the cold for a long time, raising all sorts of other possible untoward scenarios. Given the potential for rapidly progressing infection I reluctantly opted for immediate surgical debridement, put in a page for the anesthesiologist, and called the OR.

Uncharitably, as I contemplated the problems this guy was going to entail, possibly for weeks, I noted he was a "John Doe," from out of town, no local contacts, no insurance. Of course not: if he'd been insured, they'd have called one of the fancier docs.

"You're going to hate me for this," I confessed to Larry, who happened to be one of my favorite anesthesiologists. "He's huge, I'm going to have to reposition him two or three times during the case, and he has an enormous beard [anesthesia guys hate beards: they make it hard to fit a mask while inducing anesthesia, obscure the view while intubating, and resist taping to secure the tube] which he refuses to let anyone near. Dirty as hell, too. Soot or some crap like that." Trying to be candid up front, letting the man know what he was in for. "Great," said Larry, as he hung up the phone. "I'll be there when I get there."

By the time I next saw my patient, in the pre-op holding room, they'd removed his clothes and put them in a couple of bags. Boots, gloves, heavy coat with fur-crested sleeves (who wears crap like that? Heard of PETA?); and now, in the warmth of the room the stuff smelled like a barn. So did he, for that matter. Looked like cow-shit on his boots, too. I don't mean to denigrate the man -- he was a human being, after all -- but a fat smelly guy at three a.m. or whatever it was by then: I like to think of myself as more empathetic than your typical surgeon, but it was just a bad situation, getting worse at every turn. Larry was much more mellow than I, probably getting a laugh over my obvious displeasure. He gave the man the usual once-over and piloted the gurney to the OR.

It took six of us to move him onto the OR table. He'd told us he was two-eighty, two-ninety pounds, but he was three-fifty if he was an ounce. I work with bariatric surgeons of late, and we have these very ingenious Hovermats for moving the patients: they literally float on cushion of air, and glide so easily you have to worry about zooming the patient off the other side. No such thing this night, in this OR. My back hurt, to make a bad situation still worse.

I won't belabor the surgical details. Suffice it to say it was as depressing as I'd imagined it would be: fat upon fat, greasy, slippery, smelly. Rolling the man from side to side, to Larry's grumbling (he'd crossed over to my mood half way through trying to intubate), I cut away a belt of skin and subcutaneous crud which, had I been able to do it all in one piece, could have wrapped twice around a telephone pole. It had taken the poor nurse fifteen minutes to scrub clean the man's stomach: ground-in dirt, intertriginous gooey grime. What had he been doing that he couldn't stop for a shower once in a while? No running water where he lives? Everyone had his or her own reason to be repulsed by the whole thing.

Having written post-op orders and assured myself it looked like he'd wake up OK, I went to take a shower. Unlike the description in my recent post I wasn't covered in blood. It was just the stink of the whole situation that needed cleansing, I guess. When I came back to the recovery room, the man was gone.

Gone!! Kathy, the world's best recovery nurse, seemed uncharacteristically befuddled. "What the hell happened?" I inquired (you might call it). "Where's my patient? What's going on around here???" I was pissed: I hadn't yet decided whether to send him to the floor or the ICU. Who'd made that decision without me??

"He checked out," Kathy said.

"Checked out?! What are you talking about?? He died??"

"No. I mean he checked out. He said he felt fine, and had to leave. Pulled out his IV, insisted I take off his bandages. Said he had important work to do that absolutely couldn't wait. He said he'd been so cold in the ER he couldn't even remember who he was, could barely talk."

"You gotta be kidding. There's no way he... How could you let him..."

"I don't know. Really, I don't. I know he couldn't, shouldn't... he just talked me into it, like I was a child. I know it's wrong, but it's like I couldn't argue. I didn't even think to call you, or security, or anyone. I don't know, I just went blank, like he..."

"Oh, man! This is really bad. We gotta call the cops or something. He's gonna die out there..."

"I know you won't believe this, but he looked great. And the wound? Either you did an amazing job or, or, I don't know what. It looked like it was healing already. Almost like it never happened."

"Jeez, Kathy! What have you been drinking? I don't believe this. This is.... I'm calling the supervisor. We gotta..." I was as flummoxed as I've ever been; didn't know what to do. Finally, I just decided to go home. It was the most screwed up thing I'd ever heard of, and I just wanted to pretend it hadn't happened.

"Sid?" Kathy asked as I tried to storm out the recovery room door.

"What!!??" I responded, with zero patience.

"How about his story? About how he got the injury?"

"What story? I didn't even hear the story. What story?"

"Getting stuck trying to get into someone's chimney, being pulled out by some animals. The way he said it, he seemed serious. Oh, and he left these for you," Kathy grinned, tentatively, as she handed me half a dozen wrapped boxes.

"Yeah, right. Keep 'em. Guy's a liar, some sort of sociopath. I gotta get home and get Danny's presents under the tree before he wakes up. Merry frickin' Christmas."

Friday, December 20, 2019

Counting (On) Sheep

My next column in The Everett Herald:
Read the transcript, he said. Don’t be sheep. Think for yourself. Do your own research.  
Have you read the transcript? 
But it’s important to read it, and decide for yourself? 
But, to be clear, you haven’t read it. 
Don’t need to.
It was a real interview, of him and other rally-going Trumpists.  
Housing within his skull so many contradictory beliefs that he can’t see the irony, he’s the archetypal Trumpist. And now that impeachment is upon us, he’s the exact supporter Trump and his enablers are counting on: proudly, aggressively, uninformed. Inside a bubble so perfectly designed that he thinks he’s on the outside, he’s done with thinking. 
As only the third impeachment in our history, it’s serious business. Those who think Democrats aren’t giving it the gravity it deserves, like that prototypical Trumpist (let’s call him PT), accept, unquestioned, Republican screaming and dissembling and outright Foxotrumpian lies. 
Democrats presented dedicated, respected public servants (many of whom were Republicans), along with experts in Constitutional law. Republican committee-members responded with mockery, character assassination, and attempts to convince PT he didn’t hear what he heard.  
“This is an assault on America,” says the man who called the press “the enemy of the people,” the FBI “scum,” who declared, “liberals want to destroy you,” and who claims absolute power. Impeachment is, in fact, a counterattack on Trump’s assault on America. The articles leave out more of his corruption than they name.  
Senators Collins and Ernst, a pair of perfectly emblematic Republican hypocrites, will be among the jurors. During the Clinton impeachment, Collins demanded more witnesses before making up her allegedly open but predictably docile mind. Now she finds it unnecessary. Senator Ernst is counting even more on PT- style credulity: there’s no need to call new witnesses, because if Democrats didn’t call them, it’s their screw-up. Yep, that’s her position. Invited to send his lawyers, Trump refused. Democrats subpoenaed key witnesses, Trump blocked them. Therefore, it’s on Democrats. One assumes PT buys it.  
But none of these is as destructive, if entirely expected, as Moscow Mitch and Lilly-liver Lindsey admitting outright they have no intention of following the oath they’ll be taking as jurors in the Senate trial. Which means they hold our Constitution in even greater contempt than does Trump, who has regularly demonstrated he has no clue what’s in it, and doesn’t care to find out. 
For those who haven’t inquired, the oath pledges the following: 
"I solemnly swear that in all things appertaining to the trial of the impeachment of Donald John Trump, now pending, I will do impartial justice according to the Constitution and laws: So help me God." 
On government TV dba Fox “news,” Moscow Mitch proudly announced he’ll be taking orders from the White House. Lilly-liver Lindsey crowed, “… I’m not trying to pretend to be a fair juror here.” Let’s recall his words last time ‘round, when he stated, correctly, about White House refusal of subpoenas, “It is not your job to tell us what we need, it is your job to comply with the things we need to provide oversight over you.” That was when elected Republicans at least faked it. 
These raised middle fingers to the rule of law reflect their confidence that the likes of PT won’t care, or even notice, how dangerously un-American this is. Nor will it occur to PT et ilk how clearly it confirms that Trump has plenty to hide, and that Republicans are happy to help. 
Hook, line, and sinking citizenship, their voters have gobbled the shouted lies and curated ignorance we saw in the House hearings. Then, they claimed the process was a kangaroo court. Now their Senators would make it exactly that: conclusion forgone, new witnesses and new facts forbidden, “presidential” malfeasance ignored, corruption approved and encouraged.  
Because of Moscow Mitch, the Senate trial will be a sham, while the citizens’ right to know will be tossed aside like the Constitution itself. It’s increasingly persuasive that the House should refuse to send impeachment to the Senate unless Mitch remembers his job, or until after the election, when he might be minority leader. Or gone.  
In a court of law, McConnell and Graham would be dismissed preemptively. Instead, they’re facilitating the end of democracy, confident that the ubiquity of PTs within their party allows ignoring the few remaining honorable Republicans, like former CIA and FBI director William Webster, and these actual Christians. 
[Image source]

Friday, December 13, 2019

Snow? What Snow?

My next column in The Everett Herald:
It’s predicted this will be a hell of a winter. The PUD is gearing up, we’re told, for more outages than usual, lasting longer. Maybe it’s time to buy a generator. One thing is sure, though: if it hits as hard as expected, if we find ourselves suffering bone-chilling winds and frozen pipes, cars stuck in deep snow or spinning out on icy roads, we’ll see Trump supporters strutting in bathing suits and flip-flops, smelling like coconut oil, claiming it’s sunny and warm.  
So here we go. Democrats have produced their articles of impeachment, enumerating, in plain language, abuses of “presidential” power and obstruction of Congress. Much more could have been included; Mueller’s report was replete. That improper actions occurred is as obvious as a snowdrift; likewise, that Congressional Republicans will pretend it’s green grass and blue skies.  
But they’re in a tough spot. Given the evidence, their only rational defense would be to agree Trump did those things but they don’t amount to impeachable offenses. That’d make more sense than choosing to assert nothing happened. It’d suggest residua of integrity, while not requiring their current Pythonesque denial 
There’s a problem, though: they’d be saying they’re okay with a “president” – and, because they’re certainly not hypocrites, even a Democrat – unconstitutionally seeking election help from foreign countries, including those that undeniably wish us ill. And they’d be disavowing their oversight requirements, ceding to ANY president virtually unlimited power. Improbably, given the propagandophilia of their base, they seem to believe that’s an abridgement too far. Thus, the circus we saw at the impeachment hearings: screaming, insulting, ignoring, complaining about process.  
The impeachment articles arrived right after the DOJ Inspector General’s report, about which the expected disemboguement of boilerplate rightwing agitprop commenced immediately. While finding inexcusable errors and omissions, the report dismantled Trumpic claims of FBI “spying” or unjustified, politically-motivated investigations. Of course it did: had intelligence agencies ignored possible wrongdoing at that level, it would have been malpractice. 
Between the impeachment articles and the IG report, Republicans have a lot of dissembling to do. No worries: William Barr, full-time Trump defender, no-time Attorney General for Americans, is on it like white on Nazis. Fox “news” is doing its usual up-is-downism as if it was pre-scripted, and Trump’s rally-lies and language about it were deranged, even for him.  
If they’re not good at America, Congressional Republicans are peerless at distraction. Their tantrums at the hearings were low-aiming performance art. Claiming there was no “there” there, they resurrected Mueller-report-style, preemptive obfuscation. They should have been laughed off the dais: crime-us interruptus isn’t a crime; Trump, the embodiment of corruption, was only seeking to root it out, despite testimony that, knowing his base, all he wanted was the announcement of an investigation. Possibly because his conspiracy theories had already been debunked. 
It was hard to watch. Did they think their attempts at parliamentary interruptions would accomplish anything? Were Trumpists who viewed it on Fox “news” impressed? Had Republicans any compelling arguments, there might have been better tactics. They didn’t, so there weren’t. Hatred of Trump, they claim. Attempts to undo an election. But how hard can it be to understand that if a “duly” “elected” “president” is found to have committed crimes, undoing the election is exactly why impeachment was codified? Doesn’t national interest require finding out? Unlike most Republicans, true conservatives get it  
So now it’s real. Will Republican Senators, as FBI Director Wray just did, understand that their oath of office was to defend the Constitution, not a “president”? Will Trumpists acknowledge what’s at stake and relinquish Foxification long enough to decide for themselves? Take it seriously enough to read the articles of impeachment, which they didn’t with Mueller’s report, rather than accept Trump’s and Barr’s perversions? Would they apprehend the significance if they imagined the charges were against Hillary Clinton? 
Those who decry lack of bipartisanship ignore the unprecedented effectiveness of a 24/7 disinformation network and a ceaselessly lying “president,” and the fact that he prevented key witnesses from testifying. Truth was under siege.  
Today’s extraordinarily vicious divisiveness is on Trump, whose rantings and invective toward Americans and institutions who don’t kowtow have created such toxicity that “patriot” militias are threatening harm to senators who vote to convict. Fainthearted Congressional Republicans won’t stand up unless forced by an awakening among their voters: namely, remembering the highest obligations of American citizenship. 
Discouragingly, that part is on them.
[Image source

Friday, December 6, 2019

The Ball Is In The Court

My next column in The Everett Herald: 

From Federal Judge Jackson’s ruling on Trump ordering White House personnel to ignore congressional subpoenas: 
“… However busy or essential a presidential aide might be … the President does not have the power to excuse him or her from taking an action that the law requires…  
Presidents are not kings. This means that they do not have subjects … whose destiny they are entitled to control. Rather, in this land of liberty, … current and former employees of the White House work for the People of the United States, and they take an oath to protect and defend the Constitution of the United States...”  
Your indefatigable columnist has previously asked on what basis any president could command current or former underlings to refuse congressional oversight. None, as it turns out. Not according to this judge, appointed for her competence rather than for past and future rightwing dogmatism. 
Which means the issue remains unsettled until we hear from the Supreme Court. It may well come down to Chief Justice Roberts, who once claimed that his job would be to “call balls and strikes.” If he believes that, it’ll be an easy call.  
After discarding truth and compromise in favor of Newt Gingrich’s scorched earth policies (leading presently to that literal thing) and catering only to the wealthy, everything the Republican Party has become has set the stage for an amoral, confabulating, autocratic “president.” And now, when it arrives in the Supreme Court, this far-reaching case will determine the future of our democratic republic. It’ll announce whether the Constitution still means anything; whether, notwithstanding Congressional Republicans’ subservience, having co-equal branches of government remains an American value. 
If the male Justices pledged allegiance to the law and not the Federalist Society, it’d be unanimous. Other than within today’s Republican Party, and possibly among its most tendentious judges, there’s nothing controversial about “original intent” regarding separation of powers, nor the requirement of Congress to oversee the executive. The Constitution was written by men familiar with monarchy and committed to the prevention of it footholding here. 
That presidential power is limited by and subject to congressional oversight is carved in parchment; that it’s indispensable to protecting Americans from autocracy is undeniable. No true conservative would contest that, nor would anyone who understands and believes in our form of government.  
And yet, here we are. After decades of Republicans tilling the soil for a lifelong miscreant like Trump, America’s future comes down to one court decision: may Trump obstruct Congressional oversight, or not. If Trump, “president” of the Electoral College of the United States, can compel members of the executive branch not to appear before or release documents to lawfully constituted oversight committees, and if it’s affirmed by the judges he’s appointed, mainlined for their partisan ideologies by Mitch McConnell’s hypocritical senate after blocking highly-qualified, widely-admired nominees of President Barack Obama, America as originally construed will have been erased. Which has been the aim since Newt’s “contract.”  
Trump couldn’t have happened to us, nor would he still be in office, without preceding decades of Gingrichian abandonment of principle, and Mitch McConnell’s cynical continuation of it. While Republicans cower, Trump has declared himself above the law. “I have an Article II, where I have the right to do whatever I want as president,” were his exact words. As his lifelong cheating and lying and his bragging about sexual assault should have ended his candidacy, that claim should have ended his presidency. No patriot could accept it, and none have. It’s only Trumpists, who don’t now and may never have had love for America as it was intended to be, and once was. 
This isn’t about the case for impeachment. It’s more fundamental than that; it goes to the very definition of the United States of America, and might be the most impactful court decision since Marbury v. Madison. 
You can call impeachment a witch hunt. You can rationalize mountains of evidence of presidential misconduct, or, as Congressional Republicans are doing, pretend it’s not there. You can convince yourself Ambassador Yovanovitch, et al., are liars. You can even love Trump because he “sticks it to liberals” and reinforces your enmities. These things you can do, albeit mistakenly, without abandoning the essence of American governance. 
But if you accept his refusal of Constitutional oversight, you must finally admit you prefer dictatorship over democracy. Unless it’s a Democrat. That applies equally to Republican Congress-people and voters.
[Image source]

Thursday, December 5, 2019

ICYM The Ellipses

Herewith, proof that Republicans have no real defense of Trump. They resort to replacing facts with conspiracies, evidence with obfuscation.

For those who might have missed the counsel for the R "Intelligence" members grilling one of the professors by quoting from former US Solicitor General Neal Katyal's book, "Impeach: The case against Donald Trump," here are his words, which were also displayed behind him on one of their nutty charts:
“Is what Hunter Biden did wrong? Absolutely. Hunter Biden had no real experience in the energy sector, which made him wholly unqualified to sit on the board of Burisma. The only logical reason the company could have had for appointing him was his ties to Vice President Biden. This kind of nepotism isn’t only wrong; it is a potential danger to our country, since it makes it easier for foreign powers to buy influence  No politician, from either party, should allow a foreign power to conduct this kind of influence peddling with their family members.”
Note the ellipses. Here's what the dishonest prick (no offense meant to pricks everywhere) left out:
. ..The thing is it is not illegal. That’s why Hunter Biden didn’t hide his involvement in Burisma. And it’s why President Trump’s children — Ivanka, Don Junior, and Eric — continue to conduct business around the world with impunity. As does President Trump’s son-in-law, Jared Kushner, who works in the White House... 
Still with the Hunter Biden distraction. And they can't even make it without, in effect, lying. 

They got nuthin'.

[Image source]

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