January 8, 2021

Dear Interested Readers,

 

I Am Trying To Hold On For Twelve More Days While Everything Seems To Be Spinning Out of Control

 

 

Do you remember where you were and what you were doing when you heard that John Kennedy had been shot in Dallas? If you remember November 1963, you probably have a Medicare card. I was in an English literature class on the campus of the University of South Carolina. Do you remember where you were when you heard that Martin Luther King, Jr. had been shot in Memphis or that Bobby Kennedy had been shot in LA? If you do remember the spring of 1968, you are likely to be a grandparent and you are either retired or asking yourself how long you can hold on. I heard of the assignations while I was in medical school. If you are in mid-career you are likely to remember where you were when Christa McAuliffe and her Challenger crewmembers died in 1986 less than two minutes after “blast off” because of the failure of an “O-ring.” I was returning to my office from a lunch hour jog around Jamaica Pond with some colleagues when we heard the news. If you are at least thirty I am sure you can tell me exactly where you were when the Twin Towers went down in 2001. On that beautiful fall morning almost twenty years ago, I was seeing my cardiology patients at the West Roxbury office of Harvard Vanguard when my medical assistant knocked on the exam room door and invited me and my patient into the “break room” to see what was on the television. 

 

We know that startling events get burned into our long term memory by a rush of catecholamines. Most of us can’t remember what we were doing three weeks ago, or three days ago, or what we had for supper yesterday. We all remember where we were when these history-changing events occurred. 

 

Where were you at about 2:30 on Wednesday afternoon when our Capitol was invaded by a mob that had been incited by the president’s rally on the Ellipse? I was squeezing my daily walk into a busy day. I needed to be home and showered in time to “Zoom in” for a 4 PM meeting of the combined boards of the Boston Medical Center. The meeting agenda was a financial update and budget approval and to hear a status report on the process of giving COVID vaccine to the essential workers and staff of the system. 

 

The picture in today’s header was taken from exactly where I was. The spot is on the return leg of a four-mile out and back route from my house with about a mile and a half to go. It is my favorite spot on the route.  When the sky is clear, as it was yesterday when I took the picture, you can easily see Mount Sunapee across a wide expanse of either water or snow. My home lies on the other side of the lake. In the picture, you can’t see the house, but it is just behind the last little patch of white shoreline under the ski run on the mountain that is furthest to the left. 

 

On most walks, I stop here and soak in the view. It is always a good day to be walking if I can see the mountain. On bright winter days, the wide expanse of snow and ice between where I stand and my home across the lake is a beautiful sight. On many days I marvel at some new and unexpected element of beauty in a view I have enjoyed several thousand times. There is a continuously renewing lesson in the unexpected variation in the same scene. It is my own personal “inspiration point.” 

 

Wednesday had already been an unusual day. I needed my walk to help wake me up and get me through the rest of the day. On Tuesday night my wife and I had stayed up until after 1 AM watching election returns from Georgia. We finally went to bed when there was evidence on CNN and in the New York Times that Raphael Warnock had beaten Kelly Loeffler and that Jon Ossoff was creeping ahead of David Purdue with most of the uncounted votes expected to come from Democratic-leaning venues like Fulton County. My excitement about the likelihood of the Democratic control of the Senate and the possibilities for real improvement in healthcare created by making Chuck Schumer the Senate Majority Leader thrilled me. Now there was also reason to hope for real progress on the environmental struggle against global warming, real improvement in economic inequality, and concerted efforts to improve the social determinants of health. I was so revved up that it was hard for me to get to sleep. 

 

Allow me a brief aside to talk about an excellent medical experience. I needed to be up early on Wednesday despite my lack of sleep to get to a medical appointment for a ruptured extensor tendon at the DIP joint of my right fifth finger which I had sustained when I tripped over my shoe strings on Christmas Day. It was an unforced error from a dumb old man who was too lazy to tie his shoes. I have always been accident-prone. I was pretty upset when I saw my new mallet finger. My self-splinted right pinky matched the poorly repaired extensor tendon rupture on the pinky of my left hand that was a trophy from a football injury in college. I had initially splinted the finger myself, but after exercising poor judgment for over a week, I called for an appointment on Monday. I was offered an appointment for the next day but asked if they had one for Wednesday which was more convenient for me. The answer was “sure.” 

 

My appointment was a delight. Dartmouth Health sends hand surgery clinicians to the New London Hospital. The whole system is now on Epic. It would be hard to imagine a better medical encounter. After an x-ray, I was seen by a very experienced and engaging PA with decades of experience treating hand injuries. He reviewed everything and reassured me that conservative management was now considered the way to go. If I was faithful with the splint for about two months I could expect a better outcome than I had gotten with surgery on my left hand. Along with reassurance, I was given several much better splints than my own “popsicle stick splint” and detailed instructions about how to care for my injury. There was an after-visit summary note waiting for me on my “My Dartmouth” app before I got home. My visit was such a positive and efficient experience I was left to wonder why in a country as wealthy as ours every person could not always count on having such a patient-centered, safe, efficient, and timely medical experience. Maybe, Joe working with a Democratic-controlled Senate might make some progress toward such a goal.

 

I had decided to take my walk while listening to the joint meeting of the House and Senate for the purpose of certifying the election of Joe Biden as the next president. Mike Pence was presiding and it had been announced that he was resisting the unconstitutional pressure that the president was putting on him to defy the will of the voters and negate the votes of millions of Americans. Over a hundred Republican members of the House and thirteen Republican Senators led by Ted Cruz and Josh Hawley were planning to challenge the votes of the electors from eight states. What is usually only a ceremonial event was going to become an extended political showdown. Before I had started my walk I had tried to find a telecast of Donald Trump’s rally of his supporters on the Ellipse but found that it was a Twitter broadcast. I don’t do Twitter. I have now learned that YouTube has apparently taken down the recording of Trump’s speech, although by now almost everyone has heard the inflammatory and seditious charge that he gave to his assembled troops. 

 

As I started my walk I discovered to my disappointment that NPR was not broadcasting the joint session, so I downloaded the radio version of C-Span and headed out after watching the objection to the Arizona vote that split the session and sent members of both houses back to their chambers to debate the merits of the objection for two hours. C-Span offered me the broadcast from the House. Some congressman was spouting lies about how the election was being stolen when there was an interruption. I could hear shouts and strange sounds that suggested confusion. The announcer said that the session was to be briefly delayed. They offered Ted Cruz’s eloquent bundle of lies from the Senate while the House session was paused. I offer you the YouTube link because I believe it represents Cruz’s audition to be the inheritor of Trump’s base. This man is more dangerous than our current führer because his lies are distortions that often seem to make sense.

 

By the time I arrived at my “inspiration point” on the turnaround leg of my walk, C-Span was announcing that the Capital was under siege and that the legislators were on their way under armed guard to an undisclosed place of safety. Could this be true in America?

 

I attended my Zoom meeting on mute while simultaneously watching CNN with one eye while trying to pay attention to a lot of spreadsheets and explanations for the financial uncertainties that face a DSH Hosptial System in the era of COVID with my other eye and half of my brain. The last 36 hours of continuous news coverage and commentary have reminded me of the way I felt as we watched the several days of continuous news coverage after 9/11 or the assassination of JFK followed by the murder of Lee Harvey Oswald by Jack Ruby working for we don’t know who. 

 

The positive events in the aftermath of the last 24 hours have been the speeches of Joe Biden and the fact that Congress returned to their chambers after the Capitol was cleared of the rioters. Well after 3 AM they completed the process of confirming the election of Joe Biden. Some of the 13 dissenting Senators changed their minds, but despite all that had happened more than one hundred House members and a shameful six senators continued to do the bidding of the president and oppose the certification of the election.  

 

I am sure that what I have written is not news to you. I do believe that each of us must examine closely how we feel about what transpired and what it means for the future of our country. It is the culmination of more than five years of real effort to drive our nation to the far right to sustain the economic advantages of a frightened minority that can’t accept the equal rights that should be the experience of everyone in our increasingly diverse nation. Those equal rights should include equal access to healthcare that is of equal quality for everyone.

 

Every election, including this one, that has ever been held in America has been flawed by efforts to control the process in a way that denies or diminishes the vote of someone. We have had poll taxes, unfair literacy tests, limited voting hours, and a host of other unethical and unfair tactics applied by the politicians of the dominant class to restrict the voting rights of minorities. This election was the fairest one we have ever had and that has motivated demagogues like Trump, Cruz, Hawley, and a hundred members of the House to try to convince their followers that the election was stolen because the outcome returned some of the power that they have held to those they have tried to suppress. 

 

This problem did not go away when order was restored in the Capitol. Five people are dead. Most of the perpetrators of this heinous plot are still walking around and thinking about what they will do in the future. I am not naive. Efforts to gain political advantage by the distortion of facts, the manipulation of the courts, the erection of barriers to the ballot box for minorities, and the gerrymandering of political districts for electoral advantage will continue for a long time to come. Progress is slow, but “the arc of history does bend toward justice.”

 

We will never be able to use laws or penalties to change what is in the hearts and minds of people who feel entitled to the advantages to which they were born, but we can hold those who incite violence or enable those who do accountable for crossing an obvious line. The responsibility to defend the Constitution and not use lies and misinformation should be a minimal moral requirement of any elected official. 

 

We have seen responsible Republican officeholders during these difficult past two months. Brad Raffensperger, the Secretary of State of Georgia is probably the best example, but there are many others. I was pleasantly surprised by the position on the validity of the election taken by former Attorney General William Barr. We need political diversity and we can expect that it is within the norm for them to seek any “legal” advantage. The best way to manage the future will be efforts to vote out of office those who have enabled the president as we hold the president accountable for the crimes he has committed in office. 

 

Trump is not the first president to violate his oath of office, but he could be the first president held accountable through a judicial process for his crimes. Nixon was pardoned because Gerald Ford reasoned that the country needed to move on from Watergate. Nixon’s crimes did not include inciting violence in an attempt to subvert the outcome of a fair election. There was no obvious loss of life associated with Nixon’s actions. Five people are dead because of what Trump encouraged. 

 

In our society, it is easy to send someone who tries to hold up a convenience store to jail for a long time, but it is almost impossible to hold accountable people who steal billions. In his memoir, A Promised Land, Barack Obama discusses the difficulties that were encountered when those who led the financial institutions that precipitated the Great Recession of 2007-2008 received billions of dollars of income rather than jail time. Joe Biden and Merrick Garland should carefully consider the sense of justice that will be violated if the president is not held accountable for his crimes. Trump should not walk away with as much as 250 million dollars that he has gleaned by “fighting” the outcome of the election and to continue to lead his base toward another run at the presidency in 2024. At a minimum, he deserves a second impeachment and a trial in a criminal court. The healing that will lead to a more secure future for our country will be better served by holding President Trump accountable for all of his crimes. We still have 12  days to survive under the leadership of a man who is either insane or is a criminal. Our short term focus should be on being safe from the potential actions of a man who is still a threat and a worldwide liability. Our long term focus should be on justice that is a deterrence for those who would willingly assume his mantel and not on political expediency that attempts to prematurely close a deep wound.  

 

We joke about how bad 2020 was as if the calendar was our enemy. The enemies of social equity and justice and those who expose all of us to the dangers associated with a planet we have violated by the tolerance of widespread denial of facts and science for their own financial gain are still with us. Things won’t get better and selfish people won’t go away just because we moved into a new year. Things will only improve when we take our circumstances seriously and make the changes that will mitigate our shared threats and problems. 

 

May we all be well, and may we move closer together, as we move past a difficult time,

Gene