Brick By Brick

 

             Image source: anntelnaes.com

After an exhausting week of stamping out human decency in his government, Trump spent the weekend taking the Miami golf cure. I spent it getting over not being confirmed as Secretary of Defense. I thought I had a shot; my resumé is on a par with Pete Hegseth’s, if not greater. We both served in the military in war zones, but, unlike me, he didn’t receive a Purple Heart. We both provide weekend opination via public media; and whereas mine is mine only, he shares his platform as a mere co-host. In managing huge bureaucracies, we’re identical. What put me out of the running, I think, is that I’m not a problem drinker or a sexual miscreant, both of which are touchstones in the upper echelons of today’s Republican Party.

Choosing Hegseth over me made Trump the only president who’s had two cabinet nominees requiring a Vice-Presidential tiebreak after a 50–50 vote. No other president has had even one. Which says everything about the quality of his choices. 

For those who believe Democrats’ unanimity in voting no was purely political, votes for the previous SecDef nominees, Democrats and Republicans, were as follows: Lloyd Austin, 93–2; Mark Esper 90–8; James Mattis 98–1. Ashton Carter 93–5; Leon Panetta 100–0. Robert Gates 95–2. The difference: credentials. If not all R senators are stupid enough to think Hegseth is qualified (?), only 3 had the guts to vote no, one of whose cynical hypocrisy put us where we are. It’s shameful and cowardly.

Arriving at the Pentagon, Pete went to work implementing Project Trump 2025: his first communiqué was about ending DEI, because any military member not straight, male, white, and Christian is inferior. Then, calling them “dishonorable” and “liars,” he banned trans people who, because they had the courage to be public about who they are, are braver than most; and about whom there’ve been fewer deportment issues than non-trans members. And he announced plans to interview top general officers to see which will kowtow and which won’t. Shoot protestors in the legs. 

Beyond turning the military into his domestic enforcers, Trump is eliminating people and programs that would keep him in check. He fired inspectors general of virtually all government agencies. His Department of “Justice” ousted every prosecutor who worked with Jack Smith and will subject them to “investigations,” and it just ended further pursuit of Trump’s crimes. The firing of the IGs was clearly illegal because the law requires thirty days’ notice. The message: Whatcha gonna do about it?

Same with the TikTok law passed by Congress, signed by President Biden, and approved in a rare 9–0 ruling by the Supreme Court. Trump ignored it. Likewise, his demented attempt to rewrite the Constitution by executive order. He’s convinced he’s above the law, which, thanks to congressional pusillanimity and judicial corruption, it turns out he is. Then, because they’d get in his way, he rescinded the ethics rules ordered by President Biden. 

In a silent coup, our country has been captured by a group of very wealthy men, Christian nationalists who are anything but Christian, whose aim is to remove from government all institutions that have, till now, protected us from people like them; that stand in the way of unchecked power and unregulated self-enrichment; that let people not like them retain the power of the vote. And they’ve put in place enough judges and justices to clear their path.

It’s been a concerted effort for years. In Trump, they recognized the perfect stooge, one they could convince he’s in charge because he so desperately needs to be; a frontman willing, for his needy gratification, to keep public eyes off what’s happening; to cede the agenda to Project 2025. It’s not Greenland or Panama or Canada. It’s in the backrooms of the White House, into which they’ve charmed and threatened unimaginably rich oligarchs to bankroll their efforts. Trump gives them what they want because they give him what he needs.

Trump was elected by a minority of voters, strategically convinced it was about eggs and immigrants. People who look worshipfully at his self-pity and rejoice as he strikes at the vulnerable, who will include, before long, themselves. When they realize that, it’ll be too late.

It’s hard to accept, to know whether to tune out or scream into the night. Trump has the limelight. For him, vengeance is the goal; that, and validating his neediness. He’s president of people who see the cruelty and love it. And of the string-pullers. The more distracting outrage he engenders, the more he lies and pounds his chest, the more he fools the media into focusing on the hole rather than the donut, the more easily the Project-iles can take down our democracy, all but unreported, brick by brick.

For those who still believe in democracy and kindness, it’s hard to watch and harder to know what to do.

God Help Us

 

We’ve just returned from visiting my brother and his family in NYC, which we hadn’t done for several years. Between getting up at 4:30 a.m. for both flights, long and sleepless, staying in one of the smallest hotel rooms anywhere, I’m still uncombobbled. This offering, therefore, will lack my usual cohesive brilliance.

Even if back to “normal” it’d be hard to process Trump’s inaugural speech and its sequelae. I still haven’t, dark as it was and dully delivered. Bravado and bull. Claiming a mandate where none exists, but joyously received by the select crowd.

Sidebar: why is the Vice-Presidential Oath so much longer than the Presidential? Perhaps the Founders anticipated the current short attention span and difficulty reading. But he managed to articulate the lies and contradictions. 

Trump swore that he would faithfully execute the office of president of the United States and would, to the best of his ability, preserve, protect, and defend the Constitution of the United States. It might not have been a lie. “To the best of my ability” is the escape clause. He’s made it clear he has no inclination to preserve, protect, and defend. But ability? Based on the last eight years, four in, four out, not much. So, no matter how bad, it’ll be the best he can do. Plus, he’s been granted immunity by the SCOTUS Five.

His speech was surprisingly listless, even when he described the past four years, in which a pandemic ended, employment and markets soared, businesses were created at a record pace, infrastructure finally began long overdue rebuilding, as the most bleak in all of history. And took credit for the (three) Israeli hostages being released.

As soon as circumstances were unpomped, he headed downstairs, where he unloosed a more typical tirade, the usual disproved untruths, the self-pity, the threats. It was far more nefandous and much more in character. 

Later, sitting behind the Resolute Desk, he signed out of the Paris Climate Accords, benefitting fossil fuelers and harming everyone else, especially those alive in twenty years or so. Same with abandoning the World Health Organization, saving a few nickels, potentially costing many lives. Also, making JD Vance look like an idiot for saying he wouldn’t, he pardoned or commuted all of the anti-constitutional actors of J6, including the most violent and those convicted of seditious conspiracy. There’s no clearer evidence of his disdain for the law and love of those who share that disdain in his favor. Has any Congressional R criticized the pardons? Does a bear fly in the sky? 

This is the lesson to be learned from his pardons and commutations of the J6 criminals: the rule of law no longer applies. It impedes his agenda and he has no intention of following it. Now he has 1,500 grateful foot soldiers ready to be the core he’ll call upon, to threaten lawmakers, federal and local. Scare them into falling into line. Fear worked during his two impeachments, even without an army of directed mobsters.

This time, the Proud Boys and their ilk, the “militias,” the racists and anti-Semites know they’ll not have prosecutions to worry about, whatever they do. They’ll be the core of Trump’s Gestapo, his SS, and he’ll use them to cow every Republican in office. Am I over the top? No. I got the message, is all. He made it clear: The era of Constitutional government is over. It had a good run, though. Will any of those who voted for him care? Before the election, he couldn’t have made it clearer. They saw it and voted him in. 

15,000 trans people are serving in the military, honorably. Trump has banned them. As usual, cruelty, not the best interests of anyone but himself, is the point. Same with his banning of further refugee admissions, which includes Afghan citizens and their families who aided Americans during the Afghanistan war.

Nor can I ignore the “my-chance-in-the-spotlight,” hyperbolic praise of Trump, the least religious, most un-Christian man ever to occupy the White House, by the inaugural clergy, including the Rabbi, virtually anointing him God’s avatar on Earth. To any but the most besotted, Franklin Graham’s elegiac effusiveness and prayerful praise, barely short of equating Trump with God, was borborygmic.

Next day, in his presence, a brave lady bishop preached love and charity. He’s demanding an apology. Too Christ-like, evidently. I can’t define “evil,” but I know it when I see it.

So let’s end happier: Importantly, people speculated about Melania’s hat. Some pointed to the similarity to the Pizza Hut logo; or the Hamburgler; or Spy vs Spy. Clearly, though, the purpose was to fend off any attempt by Trump to kiss her. It mostly worked. So there’s that.

Also, far as I can tell, day one has passed. Did the war in Ukraine end?

Oh, The Inhumanity

 

Upon learning of the horrific fires in Los Angeles, death, destruction and suffering by his fellow human beings, President-elect Trump wrote, “What’s happening in Southern California is an indescribable tragedy. When in office, I will continue President Biden’s skillful efforts at guiding federal resources to their aid. My government will do everything possible to succor the suffering and rebuild that great city.”

This was in a parallel universe in which Donald Trump and his political party are known for their generosity and concern for those in need, and in which Schrodinger’s cats roam free while Newton’s apples rise into trees.

In ours, as is well-known, if under-repulsed, he and his sycophantic similars chose to attack and blame Gavin Newsom, DEI, liberals, Joe Biden, and Ukraine, expressing zero sympathy, affording no comfort. It’s consistent with previously withholding aid for places where he thought people hadn’t satisfactorily kissed an anatomic ring, the location of which we care not to mention.

Across America, decent people are offering help and sympathy. Not Trump. Because it’s who he is: nasty, brutish, and short. On humanity. For which MAGA loves him all the more.

Trump’s nastiness has been accompanied by his signature disinterest in facts, and lies. Falling in line, avoiding any mention of climate change as a factor, his team piled lies upon lies. It’s worth noting how many Republicans offering effortless thoughts and prayers for LA residents and meaningless praise for the firefighters voted against a bill addressing wildfire prevention just months ago. 

Except for providing help or not, Trump’s lies are of little importance to people affected by the fires. But they reveal what’s to come for the next four years. People suffering from the true “Trump Derangement Syndrome,” MAGAs who believe that, like Jesus, he can do no wrong, will forever fail to see that, for Trump, it’s never about the people he’s sworn to serve: it’s about him, always and only. And his fragile ego, need for praise, resentment of those who fail to provide it, and his desire for vengeance against them. If his reaction to the fires hasn’t convinced his supporters, nothing will. Assuming they care.

And why is that? A tsunami of bad information and outright lies consumed online have made it impossible for reality to find a way in. Even someone with resources the rest of us don’t have has given up trying: outgoing HHS Secretary, Xavier Becerra, said, in describing the impossible task of providing accurate information and having it accepted, “I can’t go toe to toe with social media.” In addition to which, Republican leaders like Holy Mike Johnson and hole-y Ron Johnson threaten to withhold aid until California Democrats change those policies about which R Congress-dwellers, holding their Johnsons dear, continue to lie.

Social media misinformation targets voters ill-equipped to recognize lies and uninterested in dispelling them. It’s unlikely, though, that Mike and Ron and their fellow spouters are too dull to know the facts. (Hannity, Waters, Ingraham, et al., on the other hand, do seem too dumb to know, and definitely don’t care.) Which makes the battle against willfully dishonest social media and rightwing propagandists even more difficult, as they force their knowing untruths into their listeners like an un-lubed colonoscope.

And so it is that MAGAs soak up Trump’s lies ever more eagerly, even as he breaks one promise after another. He’d build an impenetrable wall and Mexico will pay for it; balance the budget; wipe out the national debt. Promises forgotten or denied. This time it was ending the war in Ukraine within 24 hours of inauguration. Now it’s “try for 100 days.” Bringing down prices will be easy and immediate, he said. Now it’s “very difficult.” "Temper your expectations," said his incoming border czar, about "mass deportation of millions." But it got him elected.

Elon Musk said trimming “at least two trillion dollars” from the annual budget would be no problem. Now, “there might be a good shot at one trillion.” He’s lying about the LA fires, too. Steve Bannon hates him and, for once, is right. Poor Elon had no idea how the federal budget works and he’s beginning to realize it. Expect he’ll find a few billion; then see how he manages to get it through Congress.

Trump, though, deserves no such deference. He never fulfilled his false promises, but, because his acolytes have no memory and will believe anything, keeps making them. Annexing Canada and Greenland is purely performative (though many MAGAs are taking it seriously), distracting from the impact of tariffs and deportations, assuming he follows through. Retaking the Panama Canal, though, is about revenge for refusing his planned hotel there, accusing him of money laundering and fraud. Business as usual, in other words.

Comments on Jack Smith’s report just released and, more importantly, the one not, wait for another time. And the hearings. The ridiculous, embarrassing hearings.

Capitulants

 

The above cartoon was created by Pulitzer Prize-winning Ann Telnaes, then spiked by Jeff Bezos' Washington Post. So she resigned. The worst is yet to come.

Last time round, Trump lost the popular vote by millions, but the antiquated Electoral College, disinformation from Russia and others, and a rightwing media conglomerate devoted to replacing truth with fiction put him in the White House. He proceeded to run up massive debt, mishandle the pandemic to the tune of hundreds of thousands of unnecessary deaths, and gift world leadership to our adversaries. Then, at the end, he lied about losing a free, fair, multiply-adjudicated election and instigated an attempt to overthrow it. The lie lives on.

This time, all memory erased, Americans gave him more votes than Vice President Kamala Harris; though, as in both prior elections, more voted against than for him. Baseless claims of receiving a “mandate” notwithstanding, it was one of the narrowest margins of victory in history. But they gave him both houses of Congress, too, Republican members of which are more MAGAfied than ever. The Supreme Court was already his. It’s a four-fecta. How quickly we forget.

Well, not forget, so much as succumb to four years of concentrated whitewashing. Because they know their agenda depends on obsequious acquiescence by Congress and voters, along with the press and social media, it’s been an all-out effort by Project Trump 2025. Who remembers Trump’s words on January 7, 2021, when he said that “the demonstrators who infiltrated the Capitol have defiled the seat of American democracy”? He doesn’t. He never meant it in the first place. Now he agrees with Rep Mike Collins (R-GA), who said this week, evidently without irony, “On this day in history in 2021, thousands of peaceful grandmothers gathered in Washington, D.C., to take a self-guided, albeit unauthorized, tour of the U.S. Capitol building.” And if he was being ironic, his colleagues and voters nevertheless buy the rewrite like Trump Bibles.

This Olympic-level gaslighting has been furthered by relentless attacks on big- and small- “ell” liberalism as hatred of America. Holy Mike Johnson, whose ear, by his own report, God has, just referred to Democrats as “the enemy.” Newly-elected MAGA Congressmen Brandon Gill of Texas and Riley Moore of West Virginia, on the occasion of their swearing-in, unlimbered themselves of their demagogic Trumpist bona-fides:

Gill: “We want to end the woke chaos that they have unleashed on this country, that boys can become girls and girls can become boys, and that boys should be in girls’ sports and boys should be in girls’ locker rooms.”

Moore: “My constituents have sent me here to this town not to work with Democrats but to destroy their agenda over the last four years that has crushed the American Dream and the American worker.”

After Vice-President Harris swore in three-time Senator Deb Fischer (R-NE), the senator’s husband shook off Harris’ proffered hand. Placing themselves on the side of the lawbreakers and against its defenders, Republican leaders have refused to install an authorized plaque in the capitol honoring the police who fought to stave off the riot. Thus is the division and hate Trump has stoked within his party and among his voters.

There are consequences to accepting this totalitarian repetition of lies and rejection of legitimate dissent. Before blowing up himself and a rented Tesla in front of Trump’s Las Vegas hotel, the deceased had written: “Try peaceful means first, but be prepared to fight to get the Dems out of the fed government and military by any means necessary. They all must go and a hard reset must occur for our country to avoid collapse.” It’s all but a direct quote from Trump at every one of his rallies.

The perpetrator of the terrorist attack in New Orleans was immediately hyped on Fox “news” and the rest of rightwing dissemblers as an illegal immigrant rather than the US-born Texan he was. The truth hasn’t stopped Trump from continuing to blame it on President Biden’s so-called “open borders.”

The political inversion of America is nearly complete: an incoming administration promises to lie to us, suppress truth, and punish those who dare tell it. While claiming to be protectors of free speech. Rather than taking a principled stand, self-serving media oligarchs are pre-capitulating, donating millions to Trump’s inauguration, which, for lack of regulation, may as well have been slipped directly into his pocket. Because they knew President Biden and Democrats weren’t a threat, those same moguls gave nothing, or next to it, to his. 

Let’s assume not all Trump voters are happy with what they’re seeing now, that they’re not as enthusiastically destructive as those legislators and people like these. But, having been willing to overlook the obvious and believe the lies, they’re complicit. If it’s not already too late, they should consider Abraham Lincoln’s 1862 message to Congress as Civil War approached: 

"The dogmas of the quiet past are inadequate to the stormy present. The occasion is piled high with difficulty, and we must rise with the occasion. As our case is new, so we must think anew, and act anew. We must disenthrall ourselves, and then we shall save our country."

Healers

 

To start 2025 on the right foot, and because America has rejected the left for now, I’ll begin the year with a non-political column. Also, in the waning days of a nasty, flu-like illness, I don’t have the psychic wherewithal to address the prospects of another Trump “presidency,” even as it seems to be self-destructing like a “Mission Impossible” tape, which deserves a fun-filled column. Too bad.

I will, however, mention the passing of Jimmy Carter, whose post-presidency, in terms of integrity and righteousness, compares to Trump’s as light does to darkness. No matter what one thinks of his years in the White House, few can disagree that the life President Carter lived for decades after was exemplary.

Nor, though it’s not original with me, can I resist pointing out what might be Carter’s most fitting legacy of all: after the death of a president, flags on federal buildings and locations, by tradition and executive order, fly at half-staff for thirty days. Which means that, during Trump’s inauguration, American flags we and the world will see will be in the mourning position. What could be more appropriate? Thanks for that and for so much more, Jimmy. Also, think how much better off we’d be today if Ronald Reagan hadn’t reversed all of Carter’s green energy initiatives forty-three years ago.

And now, apropos of nothing and of only particular significance, here’s something I wrote, long ago, in my “Surgeonsblog” days: 

In no way is it false modesty to say that physicians are not healers. At best, what we do is clear the way, making conditions as favorable as possible for the body to heal itself. For without the body's amazing powers of defense and repair, nothing we do -- especially we surgeons -- would be lasting at all. The most immediate and palpable evidence of this is watching what happens after an operation. If healing within the abdomen evolves in secret, the incision itself is a biology classroom available to all.

Wound healing is a complex process, and it would be folly for me to attempt explanation in detail; mainly because, so long after medical school, I've forgotten the pathways, the kinins and the prostaglandins involved, and I'm not inclined to look them up again.  Anyone who's had an operation, from minor to a big deal, has had the opportunity to witness it themselves.

Despite having explained it in advance, I’d often get calls of concern about redness of an incision. Of course, it's necessary to separate the natural from the infected (nowadays, digital photography and email can save an office visit); but all incisions get red for a small distance out from the cut. The process of bringing the building materials into the work site is a form of inflammation: capillaries dilate and proliferate, blood flow increases, making a visible Red Zone. Of millimeters, though, not twenty yards.

That, and much more, goes on under the surface as well. Attracted by "injury chemicals," various cell types arrive and unload their cargo, set up lattice work, induce structural changes. The result of this cellular influx is a gradual thickening and hardening of the area for an inch wide or more, and which carries the unofficial-official name "healing ridge." When the ridge isn't there, trouble lies ahead. In the chronically ill, in people on high-dose steroids, in the malnourished, a soft and non-pink incision is an unwelcome and unhappy harbinger.

As much as feeling the swelling and firmness of the healing ridge can alarm the unexpecting, it's a sign of health, indicating that help is on the way, that the work of healing is carrying on. I'd warn people to expect and welcome it. To hernia patients, I'd say, "In a few days it's going to feel like a sausage under there. You might think the hernia is back." Or, after removing a lump of some kind from some place, "In a couple of weeks, you'll think I didn't remove it at all."

It takes months for the ridge to disappear. While the zone of redness dims, the incision itself gets increasingly red, and doesn't simmer down for a year or more. It's a living monitor of how long healing is active. Recipients of an operation get a ridge-side seat from which to watch the body do its work.

A corollary is the tiredness that most everyone feels after surgery. There's lots of work going on, I'd tell them. While you're feeling lazy, your body is doing the equivalent of walking around all day. So, if you’re recovering from surgery, give yourself a break. Watch and feel your body do its amazing work, rising to the occasion and making us surgeons seem like the wizards we aren’t.