Wednesday, February 23, 2022

Of Mice And Men

Since we don’t know the outcome in Ukraine, or when Merrick Garland will get around to prosecuting our criminal ex-“president” (who just called Putin’s invasion “genius”), let’s talk about something possibly even more impactful.

Lately, people are raising alarms about negative population growth. In the US, it’s only slowing, so far; but in dozens of countries there’s actually a net decline. Japan, for one. It bodes ill, say the ill-boders. In fact, it’s a glimmer of hope for humanity. Admittedly, though, it’s a threat to capitalism; which explains the concern.

Before certain readers poke their pre-programmed “COMMIE” buttons and hit “send,” I like capitalism. I believe for-profit competition is good. I spent my career in just such an institution. Capitalism fuels innovation. In college, traveling the Soviet Union on a Russian language study program, even as a politically-na├»ve biology major I saw the failings of its opposite.

Shoddy products, disinterested and disincentivized workers, antiquated, crumbling factories, drab, cramped housing in huge, gray apartment buildings; block after block of them. Even to me, and well before Saint Ronnie demanded Mr. Gorbachev “tear down this wall,” inevitable collapse was obvious. Nonstop, ubiquitous propaganda about the American enemy seemed designed to distract from their dictatorial leadership’s inadequacies. (A Foxian parallel for Trumpists.)

Except for a few evanescent, wishful enclaves, pure communism has never existed. Where it has, it failed, because human nature isn’t as altruistic as the system requires. Nor does unregulated capitalism, like that in the age of the robber barons, work for long, for similar failings of human nature: greed; exploitation of the powerless; disregard for collateral damage to the planet.

But even properly-regulated capitalism has an inherent and ominous flaw: dependence on consumption, requiring an ever-expanding consumer base. Which, in a closed-system – Earth, for example – is unsustainable. Sooner or later, substrate runs out. Which, it’s apparent, is happening very much closer to the sooner side. Some say it’s the real reason for Putin’s aggression: Water. If so, it won’t be the last war over it. 

Businesses exist by and for making stuff. When people have most of the stuff they need, businesses find ways to convince them they need more, or they fail. We’ve been taught to value stuff over substance, so we consume. And reproduce. More and more. We pollute, we poison, we gas the wind, while producers, fearing an end to profit, and politicians, fearing an end to cashflow therefrom, convince us to deny.

As oceans warm, coral reefs die, icecaps melt and the sea rises; as species go extinct, daily, because they can’t adjust; as floods and droughts, wildfires, hurricanes and heatwaves break record after record, counter-reality warnings are heard from those who see population decrease as a threat. Go forth and multiply. Add to the population. Subtract from available resources. Divide the country with lies about the peril we face. Weapons of math destruction.

Forests, the lungs of the planet, disappear, to be replaced with housing. Roads, once at least occasionally passable, are becoming increasingly gridlocked. Ours are among the worst in the US. It can’t continue like this. Clearly, there’s a breaking point. In the long run, how can having more humans be a good thing for the planet? Or, in fact, for humans?

In medical school I read of an experiment done with mice. Placed in increasingly close quarters with a limited amount of food, reproduction stopped and they began eating each other. We haven’t yet taken up cannibalism – not, at least, to the extent that the Qanon-convinced would have us believe about Hillary Clinton and liberals. But data are showing we’re heading down the other road.

Which proves, participants in a particularly propagandized political party excepted, we’re at least as smart as mice. Republicans not only deny climate change and push pollution, they’ll create more and desperate people. Intentionally forcing unwanted and unaffordable births, some members are angling to end access to contraceptives. That’s ideological, self-destructive – if typical -- madness. The last thing we need is increasing population. 

If we’re not yet eating each other, we sure are murdering. States with newly-enacted “stand your ground” laws have seen an eleven-percent increase in killings. A maddened believer in Foxotrumpian lies about Antifa and BLM just assassinated an unarmed woman and shot five others directing traffic in a peaceful protest in Portland. Examples abound. Is overpopulation part of the reason for the growing violence we’re seeing? Do we sense the walls closing in?

In addition to their always-reliable culture wars, Republicans are campaigning on “preventing socialism.” But if we can’t find a way for capitalism to function without ceaseless population growth, what’s already happening won’t end well. 

Thursday, February 17, 2022

To Kill A Conversation

Because one of our local school districts just made the national news over it, let’s talk about book-banning. Well, actually, what the Mukilteo School District did was the opposite of banning, but you wouldn’t know that if you listened to only right-wing media or, sadly, even occasionally credible ones.

Full disclosure: I’ve been sleeping with an MSD school board member.

After being on the required ninth-grade reading list without objection for years, a request was made to end the teaching of “To Kill A Mockingbird.” Published in 1960, winner of a Pulitzer Prize, chosen several times as the best American novel, TKAM is considered by many to have been a factor in the Civil Rights awakening of that decade.

But, if not yet enough, much has changed since then. It’s doubtful there are many school districts that have never updated their required reading. Unlike assumptions and false claims of some people, here and across the land, the book was neither banned nor “pulled;” nor was the decision about white students’ discomfort or imaginary “critical race theory.” The complaint was that, because of language and characterizations, some students of color found it offensive. Not “uncomfortable.” There’s a difference.

This newspaper carried letters and opinions on both sides of the issue. Those that weren’t based on misinformation presented credible arguments. Example: It’s a seminal (a word that could become banned in Florida) book and should be taught, in historical context. Making students uncomfortable is the point. Or: There are more recent books that address racism from the point of view of its victims, rather than of “white saviors,” and in more current context.

Following district policy, a committee was convened to address the complaint. Consisting of teachers, administrators, and community members, it gathered input from all sides. Some insisted on keeping it as is; others demanded it not only be removed from required reading but also banned from libraries. The committee’s decision “split the baby,” and the board, respecting the process, accepted it.

There’s another question, which has received less attention: what’s the pedagogic goal of required books in English classes, as opposed to social studies or history? It’s understandable that not all English teachers feel equipped to tread the hot coals of racism. The decision by MSD allows those who do, to continue doing so, and those who don’t, to teach other books.

No decision would have made everyone happy; this one surely didn’t. But last Saturday’s opinion piece by our local NAACP’s Mr. Glazer, stating, “The decision to remove it as “required” reading at the same time to list it as an “approved” book is absolutely contradictory” makes no sense at all. I approve of lava cake for dessert, but I don’t require it. For example.

So, what’s the difference between un-requiring TKAM here and what’s happening in states like Florida, Tennessee, Texas, Virginia, and others? Isn’t it just a matter of which race is being protected? If one, why not the other? Well, The MSD decision was made in consideration of minority students’ and some teachers’ finding a particular book offensive, not an attack on teaching about racism itself. The latter are attempts to erase America’s history of racism altogether. Likewise, banning “Maus” wasn’t about words or images: it was about wiping memory of the Holocaust. 

It’s being taken even further. No sexuality. No gender issues. No discussions that could make a student "feel discomfort, guilt, anguish, or any other form of psychological distress on account of his or her race.” (Define that, if you can.) And worse: Virginia’s new governor established a “tip line” for parents to report “inherently divisive practices in their schools.” (Define that, too.) There are proposals to put cameras in classrooms, so parents can spy on what teachers are teaching and report whatever they dislike.

At the center of it all is this: Who decides what’s taught in our schools? Who gets to object? What number of objections becomes dispositive? Is there a national interest in our children having a common body of knowledge? If it should be left to states, would it matter if half our students know realistic American history and half know only what red-state politicians want them to?

If it’s one thing to make TKAM optional, it’s quite another to muzzle teachers legislatively, or to allow any parent to veto lessons they don’t like. We’re already stacking up poorly, internationally. How bad would it be if all our students are “protected” from thinking critically? And OMG: evolution!

We could also discuss that when President Biden talked about protecting school board members from death threats, right-wing screamers called it attempting to “silence parents.” But let's not. It’s too disturbing. 

Thursday, February 10, 2022

The Revelations Keep Coming

American Nazis in Florida, upchucking anti-Semitic hate from their suppurating ids. Delusional QAnon supporters parading at the border, defaming immigrants; shutting down the National Butterfly Center, of all things, having pushed Qrazy conspiracies to the point of endangering its employees. Fraudulent Electoral College electors. These are people Republican leaders won’t criticize. So pardon my cacoethes for purple prose. It’s called for.

Election workers quitting in fear. Rally-addicted Trump, suborning mob rule against guardians of our laws as they investigate his personal and “presidential” crimes. Interminably pushing his election fabrications. Dangling pardons for the January 6 insurrectionists, video of whose criminality he replayed repeatedly that day, pleased. Making plans to confiscate voting machines. Urging replacement of honest election officials with ones who perpetuate his lies.

Feloniously destroying or absconding with White House records throughout his “presidency.” Flushing them and clogging toilets, reportedly. That’s the man to whom “law and order,” “family values,” “patriotic” most Republicans pledge fealty; to whose reelection they’re committed. This is only the most recent news.

He’s now admitted he wanted Mike Pence to “overturn” the election, something Pence had authority to do only in Trumpically infirm minds. But his Freudian use of “overturn” is telling: you can’t overturn something that’s not upright. Somewhere unreachable, he knows the election was lawful and decisive. (Or he’s clinically insane.) He just hopes his idolators stay stupefied. It’s never been about righting a fraudulent election. It’s about nullifying a legitimate one, then, now, forever.

Ironically, their un-American, anti-democratic behavior is acceptable only because our country isn’t yet the authoritarian, illiterate, history-denying black hole of their dreams. But they’re getting disturbingly close. They couldn’t have made more clear what’s at stake: If today’s Republican Party, enthusiastically embracing lawlessness and ignorance, gains majority power, fair elections are over. The voice of the public will be rendered irrelevant. Lies will become truth; truth, lies. Not pretending otherwise, they are, in fact, running on it

Oh, and murder will be legalized. Not kidding

Trading principle for power, elected Republicans delight in millions of Americidal followers still convinced the election was stolen. For which, other than Trump’s repetitive lies and Pillow-man’s daily proclamations that tomorrow’s tomorrow is when he’ll reveal history-making proof, there’s not a molecule of evidence. To the contrary, through manifold recounts and investigations, legitimacy is indisputable. But undead Trumpists believe. Even as revealed fraud is almost entirely on behalf of Republicans

Waving its love of lawlessness like swastikas outside a synagogue, the Republican National Committee just censured Representatives Cheney and Kinzinger for participating in the January 6 investigation. Said its chairperson, Ronna “Ignore-my-uncle” McDaniel, “We’ve had two members engage in a Democrat-led persecution of ordinary citizens who engaged in legitimate political discourse…” Defilers of our capitol, bearers of Nazi regalia, spreaders of urine and feces and lies within and on its walls, breakers-down of doors. Threateners of hangings and beheadings; beaters and draggers of cops; precursors to five deaths: “Legitimate political discourse!” “Persecution!” Right. And Antifa?

Confident of Trumpists’ artisanal credulity, it was an official statement, bearing the imprimatur of the party of Lincoln. How can anyone who professes love for America not be appalled? Feel insulted? How can claimants of conservatism call themselves Republicans anymore?

No-middle-name McDaniel confirmed it: Republican leadership is all in. Decades of disinformation and fomentation, culminating in nominating a lifelong liar, a cheating, amoral “businessman” and gameshow host has left them only one way out, and they’re not taking it. Currying and capitalizing on the worst human instincts for decades, offering nothing but one-sided tax cuts and pollution-positive deregulation, they own the fleas of the dogs with whom they lie.

As long as they “stick it to the libs,” they’ll defend the deplorables they’ve elected to Congress (need we list them, again?), whether or not they accomplish anything. Promising investigation, not legislation. The silence of lambs who know better. How much lower?

McDaniel’s inquisition also convicted Cheney and Kinzinger of supporting “… Democrat efforts to destroy President Trump more than they support winning back a Republican majority...” If that party and its supporters retained an ounce of Lincolnian integrity, rejecting Trump and Trumpism would be a bedrock requirement for running.

After the past two weeks, the sickness of today’s Republicanism can be denied only by the infected. In the face of undoing centuries of American values and, soon, the Republic itself, silence is collusion. For love of country, true conservatives must reappear from the shadows of denial and reject the party that has rejected them. If not now, it won’t matter.

If Trump is nominated again, Republicans’ ruination will be permanent, and, like darkness after sunset, America’s will follow.

“Legitimate political discourse.” God help us.

Wednesday, February 2, 2022

God Of The Operating Room

Allowing time for minds to unblow after Trump’s latest sedition and incitement red-state rallies, here’s something from my “Surgeonsblog” days, shortened:

Doctors play God, is what they say. By some measures, it’s true: in my surgical life, I’ve had to make life-or-death decisions, choosing to render help when the outcome might be regrettable, or concluding it’s best to let things go. It weighs heavily. But I signed up for it. 

Called in past midnight, now opening a belly, you encounter a large amount of dead intestine. (Usually due to a blood clot.) You must decide whether there’s enough left to support life: go ahead or close up, deliver the news to the family. No universal guidelines exist, nor certainty of the result. Wrongful death? Wrongful life? Victims show up in the ER deathly ill, in no position to philosophize. Having little time to establish trust, likely never having met before, and only because you happened to be on call, their lives are in your hands.

She’s been in a nursing home for a couple of years. Ninety years old, no longer recognizing family, she began complaining of abdominal pain and now presents with all the signs of an abdominal catastrophe. "We need to get her to surgery right away," you can say, "or she'll die." Which stacks the deck toward going ahead, and, frankly, it's the easiest way out -- for the surgeon. It avoids the moral wrestling.

"Something very serious is going on, something that likely requires a complex operation to fix. It might not be fixable. She might not recover from what we'd be putting her through. I want you to know it's possible to make her comfortable, to be sure she doesn't suffer, and to let her go. You know her better than I do. I'm comfortable with either approach. What do you think?"

And sometimes, when there’s no consensus, or when even before I've said such a thing I see a family in turmoil, I'll ask, "Would you like to know how I see it?" That's when it’s hardest of all. "We can take a look. I can see what's going on and make a judgment: if I think it's solvable with a reasonable chance of recovering, I'll do what I can. If you’d like, I can come out and talk to you before making that decision." Or "I think whatever is going on in there is too much for her, given her condition, and I think making her comfortable would be a kindness." 

I've said each of those, or something like them, on several occasions. Some people say if there's a one in a million chance of recovery, it should be taken. I don't share that idea, but I can't say it's objectively wrong. If, purely by chance, a patient with one-in-a-million odds for survival got me as their surgeon, more than likely they’d die without an operation. If another surgeon, probably they’d die with one. Should such a heavy decision be a matter of happenstance? Shouldn’t there be a rule book?

In the example of our elderly, demented lady, if most of her gut is dead, it’s not difficult: take a look, close up. (“Peek and shriek,” we call it, morbidly.) But if there’s plenty of viable bowel, then what? And what about a much younger person with nearly all of it dead? I’ve seen it. Most likely you'd remove the bowel and do everything you could to get the person through the crisis, knowing they'd be facing a very abnormal existence.

Having the whole gut gone is rare. Having most of it gone, though, less so; enough that you could hook a foot or two of small intestine to a few feet of colon. It's unlikely I'd do it with an elderly, sickly person; but I’ve done it with a young one. In both cases, it was entirely up to me; lacking a crystal ball, I made the decisions. Hearing nothing from God, playing Him by default.

If not ninety, but yes thirty, where's the line? Sixty-seven? What about co-morbidities? Heart disease? Diabetes? What parameters am I bringing to bear from within myself? Experience, knowledge of what I can (or can't) do; my personal definition of futility; what decision I'd want if it were me? Should those play a role? It’s impossible that they wouldn’t.

Having no universal guidelines, it's understandable that some surgeons choose always to operate, always do what's technically possible, leave it to the patient, family, and medical doctors to deal with the consequences. Not me. Which led to many sleepless nights.

Primum non nocere, we’re told at graduation. “First, do no harm.” Sounds simple, doesn’t it? I wish I could say I never have.

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