Wednesday, November 30, 2022

Rocky Mountain Low

If, in a few hundred years, historians (assuming humans still exist) seek to understand the fall of the Republican party, followed closely by the fall of the United States, they’d find it perfectly encapsulated in the murders, a couple of weeks ago, in a Colorado LGBT nightclub. It’s all there.

Increasingly desperate for a hook on which to reel in voters for whom they’ve had nothing to offer, legislatively, ever since electing Ronald Reagan, leaders and media mouthpieces of that once-respectable party have turned to denigration. Aimed at the LGBT community, immigrants, people of color, and, just reaffirmed down Mar-a-Lago way, Jews. Except in a couple of states, Trump’s voter fraud lie is losing appeal, so attacking non-straight, non-white, non-Christian, non-native-born people it is.

Whenever hate crimes are committed against those groups, the flame-fanners deny responsibility. Tucker Carlson makes millions pushing lies about “grooming” children. Screaming Marjorie Taylor Greene and gun-slinging Coloradan Lauren Boebert get elected on it. Ron DeSantis hopes to become president on it. Rightwing media marinate in it. But when someone takes their hideous mendacity seriously and does some murdering about it, the well-rehearsed response from the purveyors is “Who, me?” Followed, when culpability is suggested, by cries of “politicizing a tragedy.”

How deeply embedded is their incendiary, malevolent anti-LGBT rhetoric? The father of the murderer, himself a former porn star, said this on hearing what his son had done: “… I go on to find out it’s a gay bar. I got scared, 'S#!t, is he gay?' And he’s not gay, so I said, phew… I’m a conservative Republican and we don’t do gay.” Phew, indeed. Just an assassin. To a Foxified “conservative Republican,” there’s worse, evidently. Data for historians.

A war veteran, and Hispanic, the man who took down the shooter was there with his wife, adult daughter, and daughter’s boyfriend (who was among those murdered). After what he’d seen and done in combat, he’d sworn off guns; took the guy down bare-handed.

This embarrassed the good-guy-with-a-gun (and white-supremacist) crowd, who, rather than praising him as they did delusional, self-righteous killer Kyle Rittenhouse, attacked him for bringing his family to a drag show. Because, you know, something-something drag shows. Had he stopped the massacre with a gun, he’d have been all over rightwing media; offered jobs, encouraged to run for office. Like Rittenhouse.

Colorado has “red flag” laws. The shooter had previously exhibited numerous red-flag behaviors. But, having declared his county a “Second Amendment sanctuary,” the local sheriff, along with several others in other Colorado counties (and now, sadly, some in neighboring Oregon) had pledged not to enforce those laws. And didn’t. Historians take note.

Adding to the historical record came the aftermath. Uber-monger Tucker had on his show a woman with this to say: “… the tragedy that happened in Colorado Springs the other night, it was expected and predictable.” Was she referring to Tucker’s previous tirades? Of course not. “I don’t think it’s going to stop until we end this evil agenda that is attacking children,” she added, referring to helping trans children, all but excusing the motives of the criminal.

Former Trump attorney, Jenna Ellis, chimed in with this about the victims: “… There is no evidence that they were Christians… They are now reaping the consequences of eternal damnation.” God sides with murderers, evidently. Historians may find that informative

Which returns us to Mar-a-Lago, where Trump dined last week with outspoken antisemite Kanye West, along with white supremacist, holocaust denier, attendee of the Charlottesville “Jews will not replace us” rally, Nick Fuentes. Trump claims he had no idea who Fuentes was. He did, however, know Kanye’s antisemitic views, and invited him. By now he knows all about Fuentes, too. Has he disavowed him? Nope. Praised him. "He gets me."

At this point, some readers are composing letters accusing me of characterizing all Republicans as racist, homophobic, antisemitic, xenophobes. Rather than addressing their unacknowledged projection, let’s celebrate this week’s passage of the imperfect but important Respect for Marriage Act. Whereas seventy percent of senate Republicans voted no, around thirty percent said yes. Non-hateful Republicans do exist, and when they’re willing to partner with Democrats, it doesn’t require a majority of them to make good things happen.

Fox “news” and the rest of rightwing media are all in on grooming haters. So is Trump. Nothing will get those democracy-rejecting sheriffs and other no-regulation absolutists to listen to reason. But if actual conservatives would spend less time being offended by critics and more time working to change their unconservative party from within, Republican leadership might rejoin our democracy. And, in time, rid us of their traffickers in performative hate, ready to waste the next two years doing nothing but “sticking it to the libs.” Historians could study that happier phenomenon.

Monday, November 21, 2022

A Dusty Trunk And A Cardboard Box

This column was sent in the day before Thanksgiving, appearing now the day after. I trust everyone remains in a pleasant tryptophan buzz. Because we’ll have spent it on the Oregon coast with our son’s family, including two much-loved grandkids, I’ll assume we had a wonderful time. So, rather than harshing the mallows on the sweet potatoes, by addressing the approaching hellscape coming into view as Republicans take control of the House of Representatives, I’ll revisit something I wrote on another Thanksgiving, from our former family home at Cannon Beach. The politics can wait. Here’s what I wrote: 

Ten days before I was born, my father died. Three years earlier, my mom had been a twenty-one-year-old bride, excited and optimistic, proud of marrying the brilliant young physician whose given name I bear, and whose family name is my middle. I know he was brilliant because over the years I've heard it from many of his former colleagues and patients, and because when he married he'd just finished his term as Chief Medical Resident at Johns Hopkins Hospital. At that time, the position was highly selective and much sought: the plumbest of prestigious plumbs.

We're at our family home on the Oregon coast, where my wife and I have been rummaging through the contents of a trunk hiding in plain sight for many years. In it we found my mom's first bridal book (she married my adoptive dad when I was young enough that I have no real recollection of being fatherless. Their marriage lasted sixty years, till death did they part.) 

Seeing these mementos for the first time is haunting, knowing the ending: all the happiness, the smiling people, the florid and joy-filled notes vouching their certainty of the couple's future. Lists of gifts, with checkmarks after each, denoting timely acknowledgment. Dozens of telegrams: congratulations and love. Stop. A dime-store booth photo of the happy couple; a picture from the "society section" of the paper, showing Mom in a flowing gown, wearing a bonnet made from her mother-in-law's wedding dress.

Perfectly preserved, there's an announcement of the opening of my father's office in the Medical Arts Building -- still standing in downtown Portland -- for the practice of "Internal Medicine and diagnosis," under which, in my mom's hand, is the breathless exclamation "the first of these went to me!!" It's easy to relate to the nervous excitement of opening a medical office after all those years of study. But I know how the story turns out.

When I applied to college I indicated "pre-law" as my probable direction, but when I got to Amherst I took all the pre-med courses I'd need, just in case.

During my first summer back home, my mom brought out a box of letters and cards she'd gotten when my father died. They were from friends, colleagues, and patients, all with the same sentiments: a tragic loss, a brilliant career cut short, a young widow with two babies (my brother, a year-and-a-half old at the time). And the continuity of life: his death, my birth. That box, I think, had much to do with my eventual decision in favor of a career in medicine. The outlier in a family of lawyers: dad, brother, aunt, uncle.

My father died after an operation for hyperthyroidism. Feared and frequently fatal in those days, it was postoperative “thyroid storm,” virtually unknown now with the advent of greater understanding and better drugs. I've done that operation many times. Here's how I described my first, in a book I wrote about my training days: 

I’d given no thought to the factors that made me choose medicine, and then surgery, and then the kind that did thyroid operations, until I found myself doing the very operation that had killed my father, having made the simple preparations that would have saved him. As I entered the OR, I wondered: would it be a B-movie moment, a zoom-in on my sweaty brow as I froze up, the nurse asking, “Is something wrong, doctor?”

It didn’t happen. The operation flowed. Had it been a way of meeting the man I never knew, who never knew me? Of symbolically saving his life, while the quest saved my own? A meeting of souls in the ether, as it were? I’ve thought about it since then. I like the idea, but I’m pretty sure the answer is no.

It's possible, it turns out, to miss someone you’ve never known. I wish I had. I wish he’d seen me as a doctor; I miss talking with him about it. The last thing my mom remembers hearing from him, as he went off to surgery, is "You look really cute. I think I'll keep you pregnant all the time."

Still and all, and notwithstanding MTG’s ascent, I have much to be thankful for.

Wednesday, November 16, 2022

Hopeful Signs

Last week’s election results, some of which are still pending, turned my unrelenting pessimism into chary optimism. Nearly all Trump-touted terribles were defeated, including, importantly, every one of his election-denying, would-be secretaries of state, who’d have been able to decertify future elections if the wrong people won. The truly awful, prevaricating but nice-looking election-denier, Kari Lake, also lost. Like Trump, she’ll claim fraud forever.

Nevertheless, many Trumpian losers’ races were disturbingly close. Belief in The Big Lie and in Trump’s innocence of obvious crimes is wounded, but, like heavy breathing on a midnight phone call, still panting. Exposing their nationwide, vote-suppression agenda, the R candidate for Wisconsin governor promised that if he won, no Republican would ever lose again. He lost, but not hugely. Vigilance remains essential. The work of democracy isn’t term-limited. 

Ohioan Tim Ryan’s graceful concession speech reminds us what it means to accept the requirements of democracy. “I have the privilege to concede this race to J.D. Vance,” he said; a touchstone for all Americans. By contrast, several Trumpists, including a notable downstate Washingtonian, some of whom lost by huge margins, have refused to concede. This time, though, decent, undeceived Republicans showed up. By enough Republicans to have made a difference in some places, democracy is still considered worth preserving. Maybe MAGAs will give it some thought. 

Also hopeful is that younger voters showed up, too, in unprecedented numbers. They’re the future, and it’s clear their values align more with today’s Democrats than Republicans: Equality, voting rights, climate change, women’s reproductive freedom, democracy itself. “Values voters,” let’s call them.

In Pennsylvania, for example, about seventy percent of young voters voted for John Fetterman. And whereas they turned out in record numbers, it was still only thirty-percent of those eligible. Which means there remains a large reservoir of educable people, within which, presumably, future votes would favor Democrats. Puzzlingly, older white women still largely favored Republicans. Hard to figure. For what are they voting? Pollution? Bad schools?

Conceding their lack of positive ideas for attracting those upcoming generations, many Republican electeds are proposing raising the voting age to anywhere between twenty-one and twenty-eight. It’s laughable, but definitely on brand. Their dearth of helpful plans couldn’t be made clearer. 

Nothing schadens my freude more than Trump’s increasingly desperate, detached, and widely-reported meltdown, as many of his formerly reliable excusers are blaming him for the fizzled “Red Tsunami.” In the nascent war between him and DeSantis, I’d welcome either as the Republican nominee for 2024. Notwithstanding the media fawning over Reactionary Ron, this election made it doubtful either could win. To enough voters, Trump is manifestly poison. After attendees were prevented from leaving his (indictment-escaping?), lie-filled,  disturbingly authoritarian announcement, previous megadonors are bailing. Even Ivanka.

Outside Florida, DeSantis’ radical and cruel policies are poisonous, too. As a believer in the two-party system, I’d hope Rs have someone better. But maybe not till Democrats finish re-greating America.   

Close races confirm that Trumpism still lurks. Plenty of money will be spent on future dishonest, inflammatory, Tiffanoid ads, intended to keep MAGA Republicans in line and misinformed. But the fact that Lauren Boebert might have lost in a heavily-gerrymandered district, created as a lock for any R candidate, suggests there are many Republican voters who’ve had it with performative nastiness. MTG, Matt Gaetz, et awful, won easily, though. America needs conservatives who voted against such people to spread the word.

I’ve pleaded, many times, for those actual conservatives to pitch in and speak out. Based on these election results, some Republican voters are waking up to the dangers of Trumpism. That’s encouraging.

The runoff election between Rafael Warnock and Herschel Walker will be instructive. If Warnock wins decisively, it’ll be confirmatory. If he loses, or wins in a squeaker, well, optimism will take a bit of a hit. Because the fact that R leaders looked to Walker in the first place, knowing how dishonest and clueless he is, how unable to form a coherent, not-weird sentence, how disturbing his past, confirms the depth of their disregard for competent government: it’s only about gaining power on behalf of their biggest donors, by whatever means necessary. Imagine Walker, having nothing but a Heisman Trophy to recommend him, as one of a hundred senators responsible for our future. It doesn’t get more cynical than that. 

Finally, barely-eked Republican control of the House will showcase their distaste for responsible governance, as they focus entirely on shrunken-base-appeasing, lib-sticking investigations into law-abiding and competent people, which, unlike Trump’s two impeachments and the January 6 Committee’s findings, will be demonstrably vaporous. If 2022’s enlightened Republican voters have any second thoughts, that should end them.

Wednesday, November 9, 2022

The Calling Of Surgery

Despite being mostly pleased, I find myself uninterested in commenting on Tuesday’s elections. Maybe next week. So here’s something corny I wrote, years ago, for an obscure medical publication: 

Being a surgeon, having the lives of fellow humans literally in your hands, is intimacy that only surgeons can fully grasp; it never stopped stopping my breath, never dulled me to its privilege. I never stopped saying to others in the operating room, “Look, at this. Isn’t it beautiful?”

How do you explain enveloping a living liver in your hand, its firm, slippery smoothness; or the pleasure of sewing bowel segments together in a way passed down by pioneering surgeons, laying it back in place, knowing no one else will see or appreciate the – dare I say -- artistry of it?

I was taught by great and generous surgeons. I learned well. But I never considered myself special: Electricians learn, too. Lawyers. Teachers. The difference, perhaps, is intensity. And immediacy: dozens of big and small decisions need making during an operation, instantly; there are no hiding places in the OR.

Receiving that trust is a daunting honor. As I wrote in my memoir of surgical residency, “A surgeon can kill you, and you’d sleep right through it.” I should have said “An inadequately trained surgeon.” Surgical residency gets bad press: too hard; cruel, even. But, at least in my long-ago time, it inculcated the most fundamental requirements of a surgeon: knowing your limits and accepting responsibility. Doctors who don't know when they’re in over their head are dangerous. Ones who avoid responsibility for outcomes aren’t to be trusted.

My career straddled very different eras. In training, the easy rotations were those in which I spent all days and every other night in the hospital; on the rest, it was twelve days and nights out of fourteen. Entering San Francisco General Hospital as Chief Resident on the trauma service, I didn’t leave for sixty days. I won't argue it was sensible (actually, I might), but I came out well-trained, comprehensively experienced, tempered by fire. Now, with working hour restrictions (based on a mischaracterized incident in NYC), it’s less true. Feeling unready, graduates increasingly seek subspecialty fellowships. More and more, we general surgeons are relics of times past.

I finished residency committed to being there for my patients, always. In my practice I made hospital rounds at least twice daily, more for the sick ones; whether on or off call, I felt better seeing my post-ops every day. My mentors wouldn’t have accepted anything less. Looking back, was it an overblown sense of irreplaceability, that no one could care for my patients as well as I? Whatever it was, I felt bad if I didn’t. And yet, when I retired, people did fine.

So I burned out. This era of reduced hours isn't all bad. I imagine newly-trained surgeons aren't as likely to bail out early. The pleasures of surgery remain: the marvels of the human body, knowing its anatomical secrets, the nooks and crannies, the hidden spaces into which you're allowed entry, knowing what to do. It’s still a binary world, though: you succeed (mostly) or you fail (sometimes). But the exhaustion? Maybe not so much. These days, surgeons might have a life, as they did during training.

Many hospitals now have both medical and surgical hospitalists, 24/7. Calls from the emergency department, the bane of my existence, no longer interrupt schedules of office-based surgeons, or their sleep. The hospital-based have predictable work hours and freedom from much of the administrative hassles that drove me nuts.

After retiring, I spent several months as the first and only surgical hospitalist in town, working ten-hour days (sometimes more) five days a week. Other than the lack of long-term connection to my patients, I liked it. Later, I spent several relatively stress-free years assisting on complex cancer operations, able to continue to be useful, yet sleep through the night.

In many ways, a general surgeon is like a family doctor who can operate. I'd argue there's no specialty that demands the same breadth of knowledge and range of skills. Surgery encompasses the pleasure of accomplishment and, occasionally, a heart-rending feeling of failure; the ability to do much good while balancing on the scalpel-edge of the potential for harm. I felt it every time I entered the OR, or left it to talk to waiting families, with good news or bad. I felt it in every office consultation where I tried to instill hope and confidence, to allay fears, to map a path from where we were to where we wanted to be.

Connecting. Able to help. That was always the best part.

Wednesday, November 2, 2022

Last Chance To Choose

Far be it from me to blame the attack on Paul Pelosi by a guy who posts typical Qanon/ Trumpofoxian blather, on people like Marjorie Taylor Green, who called Speaker Pelosi a traitor who should be executed; or Tucker Carlson, et Fox, who demonize her in the most inflammatory language; or Junior Trump comparing her to Satan.

Near be it to me to point out the despicable responses to the attack from fellow Americans on the right: False flag. Staged. A gay liaison gone wrong. Nancy’s fault. What about Steve Scalise? (About whom the satanic Speaker said at the time: "It's an injury in the family. For the staff and for our colleague and for his leadership. We cannot let that be a victory for the assailant or anyone who would think that way.”) The right-wing Pelosi response also featured gleeful mockery and what they consider hilarity, including from Trump spawn.  

As it happens, the would-be kidnapper and torturer’s confessional isn’t hard to find. And the break-in was caught on camera; they debunk all the Trumpistry. But MAGARs prefer conspiratorial cruelty. Retractions? Apologies? Not who they are. Not who their leader is.

Our politics have become too toxic. It’s incumbent upon us all to tone down the rhetoric.

Is what people say. Extend a hand, readers advise. Seek common ground. I don’t dispute the premise, but where? Does Hawaiian ground seek commonality with Mauna Loa’s lava? In these, the times that gave us Trump, common ground has become scorched earth.

What more can be said to MAGA Republican election deniers, after all this time with zero evidence of fraud, that would change their minds? The outreaching of which hand might convince them that climate change is real, even as glaciers melt, fires rage, oceans warm and acidify, and storms and heat waves bring death worldwide? That there aren’t 87,000 new IRS agents coming for their middle-class money; that Democrats aren’t for “open borders”? That the transgressions of January Six weren’t patriotic?

If there’s been political violence on “both sides,” there’s no equivalence, no comparable approval or fomenting from the left. In the past twenty years, there have been 122 political murders by right-wing American terrorists; by the left, one. Two-hundred sixty-seven right-wing plots or attacks since 2015; 66 by lefty extremists. Nor is there equivalence in the lies coming from each side, including from the very top; or asking crowds to beat up protestors, promising to pay legal fees. Or in whose media conspiracy theories and other falsehoods spread like herpes. Only Trump has called America “Rigged, Crooked, and Evil.”  

The explanation isn’t difficult: in Trumpistan, democracy is the ultimate foe. Also, it’s too hard. Autocracy is easy.

For democracies to endure, citizens must accept two most basic requirements: first, that voters make the effort to educate themselves about their political world. Which, in today’s calamitous climate, means ceaseless effort to extricate singular truths from multitudinous lies.

Second, the lifeblood of functioning democracies – no longer of interest to MAGA Republicans and their propagandistic progenitors – is willingness to accept electoral, legislative, and judicial outcomes with which one disagrees. Including support for the peaceful, post-election transfer of power. Which is not to suggest remaining silent or forgoing working to effect change.

Because that’s the thing about democracies: not everyone agrees with you, and sometimes they win. MAGA is code for “return all power to white Christian males.” As that goal is threatened by our Constitutionally-mandated democratic processes, Trumpists are attempting to end them. Election denial is democracy rejection. It’s not mysterious.

The hard work of democracy affords little time off, whereas submitting to authoritarianism is a full-time vacation from responsibilities of citizenship. Go to rallies, thrill to the stoking. Trust your deified leader to tell you what to think, who’s your enemy, whom to blame for your failures; who’s your inferior, trying to take what you have. Or had, before that voting thing. Which must be repudiated, along with the undesirables it empowers. It’s history, in repetition mode.

And it’s Trump’s greatest con. And R leaders’. And every right-wing media star’s. Convincing millions who think they love this country to reject its indispensable Constitutional principles, while believing they’re upholding them. Accepting intentional destruction of democracy-preserving public education and fair elections. Persuaded to extinguish democracy, assured that, in doing so, they’re saving themselves. Ceding power (and riches) to Trumpic clones, who’ll protect them from not-them.

It's ironic. Once their preferred autocracy is established, they’ll have no more power than the ones from whom they think they regained it. Democracy, they’ll discover, is what kept them safe. It’s a lesson too late for the learning, made of lies, made of lies.

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