April 24, 2020

Dear Interested Readers,

 

A Fear Of Slip Slidin’ Away 

 

The changing character of the native population, brought about through unremarked pressures on porous borders; the creation of an increasingly unwieldy and rigid bureaucracy, whose own survival becomes its overriding goal; the despising of the military and the avoidance of its service by established families, while its offices present unprecedented opportunities for marginal men to whom its ranks had once been closed; the lip service paid to values long dead; the pretense that we still are what we once were; the increasing concentration of the populace into richer and poorer by way of a corrupt tax system, and the desperation that inevitably follows; the aggrandizement of executive power at the expense of the legislature; ineffectual legislation promulgated with great show; the moral vocation of the man at the top to maintain order at all costs, while growing blind to the cruel dilemmas of ordinary life–

 

There is something here for the right, and something for the left. The right focuses on borders and a puffed up military. The left eschews the military and unfair taxes. Both sides wrap themselves in the flag and offer insincere homage to the founding values and the heroism of previous generations. The legislature accomplishes little, and the executive branch consolidates power. The outcome of the dysfunction is inequality. 

 

The description in italics is not a description of our “current state.” I lifted it from the end of the first chapter of Thomas Cahill’s delightfully readable and perhaps academically disparaged as “pop” history, 1995 best seller, How The Irish Saved Civilization. I was one of its readers who kept it on the New York Times best sellers list for two years. The quote comes from the end of Chapter 1, “The End of the World: How Rome Fell–and Why.” When I first read that paragraph over twenty years ago I had the creepy feeling that it was a contemporary statement. My next thought, or perhaps at some time between then and now, was to connect the idea to Paul Simon’s sadly lyrical masterpiece of 1977, “Slip Slidin’ Away.” 

 

Simon describes some very human situations, but the recurrent theme is vaguely applicable to many moments and situations; large and small; global or personal:

 

Slip slidin’ away

Slip slidin’ away

You know the nearer your destination

The more you’re slip slidin’ away

 

Cahill was not describing America in the mid nineties, nor was he prescient and describing America during the Trump presidency. He was describing Rome as it fell to the Visigoths without a fight. The Romans had become so dysfunctional and so corrupt that the barbarians just walked in without a fight, and Europe was propelled into more than seven hundred years of “dark ages.” Cahill suggests that the glory and power of Rome morphed into the long winter of medieval times through a process of self interested social decline. 

 

Cahill is quick to reassure us that his objective is not to write a thesis about how the fall of Rome should be taken as a sermon for our times. He knows that we will draw our own conclusions about the eerie match between the fall of Rome and these times of deep political division, and economic inequality.

 

He finishes the paragraph:

 

–these are all themes with which our world is familiar, nor are they the God-given property of any party or political point of view, even though we often act as if they were. At least, the emperor could not heap his economic burdens on posterity by creating long term debt, for floating capital had not yet been conceptualized.

 

That may be true, but I would counter his statement that seven hundred years of intellectual darkness, recurrent wars, pandemics that wiped out half the population, and the general miseries for most of the people living a feudal existence, may be as burdensome as twenty or thirty trillion dollars of debt. We are living in a stressful time, and I hope that you will forgive me for not being upbeat. We all have our own ways of dealing with difficult times. I have always tried to get my head around the facts. Looking into the abyss, or the fog, or whatever metaphor you like to use to describe the uncertainty that may be associated with painful problems has always been my natural choice. Denial is the choice of many others. Our president dances back and forth between an appearance of understanding and accepting the reality of our challenge, and then acting so irresponsibly that he seems to have gone back to his denials of February and early March. 

 

David Hume, the 18th century Scottish philosopher, is credited with the thought that “reason is slave to the passions.” I was reminded of that wisdom this week when I either heard or read the idea applied to the president’s hilarious performance in the now daily press conferences that he offers as we endure our COVID-19 tribulations. It is clear that the president’s greatest passion is himself. His long answers in sixth grade English with the overtones of a playground bully are his attempts at some sort of reasoning process that separates himself from the daily demonstration of organizational confusion. He can not stand being wrong. He can not gracefully tolerate questions about his performance or his authority. His reasoning is convoluted, but it has a predictable outcome. It is always a convoluted pathway toward underlining the perfect nature of his performance. 

 

The president would have us believe that anything that is not right is the concern or failure of someone else. Anyone who but Dr. Fauci who attempts to disagree is shamed or has a short half life. From time to time Dr. Fauci can tactfully suggest an alternative interpretation of reality. Fauci seems to survive by virtue of his long and brilliant career, and his amazing ability to thread the needle between politely offering the wisdom of experience and science and being greased in the oil leaking from the sycophants that crowd the stage with the president. I offer Michael Specter’s excellent presentation of Dr. Fauci in the New Yorker entitled “How Anthony Fauci Became America’s Doctor: An infectious-disease expert’s long crusade against some of humanity’s most virulent threats.” The online article has a different name than the article in the print version of the magazine which I like better, “The Good Doctor: How Anthony Fauci became the face of a nation’s crisis response.”

 

Dr. Rick Bright is the latest example of the fact that if no one knows who you are, you won’t last long if you disagree with a statement from your leader. If you are loyal to this president, you must be willing to discard your own reason and science based facts. If you express an alternative opinion or point out a flaw in his reasoning you will be the recipient of his scorn. As the governor of Georgia learned this week, if you are a sycophant, and get out in front of him in an attempt to demonstrate fealty, and it becomes obvious to others that there are flaws in your reasoning, he will abandon you to the scorn he deserves as he continues to try to build the case that any success is his doing while contending that the whole problem and all of its mismanagement are attributable to someone else.

 

An event that leads to the unemployment of 20% of the workforce, will not not be soon forgotten, and will be studied for decades even if in the end we only lose sixty thousand old, black, and Latinex Americans. I agree with the president when he contends that the pandemic is not his fault, but the response to the virus is his responsibility to manage. He has a responsibility to speak to the real fake news, and not be the author of even more confusion. I don’t think the virus came from a Chinese lab or a 5G cell phone tower. I don’t think hot saunas or hydroxychloroquine will be game changers. I do believe that we have so much yet to learn about this virus that we will be living with uncertainty for a long time. What I also believe is that no matter how many people have died so far and how much economic pain has already occurred, it is far from over and the president’s inconsistent behavior and his political need to make it all go away makes us vulnerable to even greater losses of life and longer delays to the return of economic stability.

 

The road ahead of us will be a process of continuing revelation and learning. Successfully traveling that road will require collective patience and continuing sacrifices sustained by leadership with wisdom and character. I also know that like the fall of Rome did not occur just because Alaric, king of the Visigoths, showed up at the gates of Rome one day, and our problems dealing with this pandemic are not all the fault of Donald Trump.  There is a long prequel to this story. Illnesses reveal the vulnerability of patients, and it appears that pandemics can show us what has not been optimal about a nation or a population. The pandemic has shown that America’s greatness has been thin in many places. The wealth and the comfort of a controlling minority has been sustained by the stagnation of opportunity for the middle class and the suffering of the underclasses. Our eyes turn toward the glitter of wealth, and we look away from the hardships that are so easy to see if we turn down rural roads or venture into the shabbier neighborhoods of our cities where many of our “essential workers” live. It is hard for me to imagine how I would ever be able to tolerate the day to day misery of working in the fields or standing inches from another worker processing chickens or pork in one of our agricultural sweatshops where the virus is finding new victims.

 

There are two manifestations of the pandemic, the medical and the economic. They are inseparable. It is becoming clear as the process evolves that those who were suffering the most  from economic inequality and had the most challenging social determinants of health before COVID-19, are at greater risk during the pandemic.  As the numbers roll in from New York, Detroit, Chicago, and other crowded urban areas, it is becoming increasingly obvious that  minorities and low income populations are more vulnerable. Is it because they have had less effective treatment of their hypertension, diabetes, obesity, and asthma? Is it because they perform more of the “essential jobs” that allow others to remain at home? There is good evidence that they also suffer more from climate change. 

 

I frequently hear the phrase, “It is what it is.” Unfortunately, we are not going to be able to immediately fix the issues that have caused the increased risk of coronavirus complications among vulnerable populations. It is very likely that we will have a vaccine long before we have healthcare equity. The issues that we can’t avoid seeing today have been with us for decades. In truth they have been with us since the first Europeans came to this continent, and certainly since 1619 when the first black slaves arrived in chains. These issues have been under active political discussion since Lyndon Johnson facilitated the passage of the Civil Rights Act of 1964, the Voters Rights Act of 1965, Medicare, Medicaid, and all of the associated legislation of the War on Poverty that was passed in the mid 60s. The progress has been slow. We have to admit our failing to be able to fix them. The pendulum swings toward progress, and then it drifts back toward a preference for some mythical time when America was flawlessly great. America’s greatness is real. Our greatness does not come from perfection, but from our intermittent desire to extend the hope of a better life to everyone. There have always been those among us who have known that we have the possibility of doing better. Our greatness arises from the generally shared commitment to move toward “these truths” rather the fact that we have arrived at a destination. That movement has always been a process of going forward, falling back, and going forward again with the knowledge acquired from the most recent failure.

 

It seems that the dream for a good life for all made famous by Martin Luther King, Jr. in August of 1963 has been slowly “slip slidin’ away over the last 57 years. We’ve been stuck since the late seventies. The war in Vietnam left us weary and bruised. We make some progress and then we drift back. That’s been the same story in healthcare. We described what needed to be done in 2001 in Crossing the Quality Chasm and like the song says:

 

You know the nearer your destination

The more you’re slip slidin’ away

 

We make progress like we did when we passed the ACA for all the right reasons, and over the next decade we have watched much of its gains slip away. The Supreme Court gave women control of their reproductive decisions in 1973, and that accomplishment has been slipping and slidin’ ever since under continuous challenges in multiple states where usually it’s OK for the state to take a life. We give every adult a vote, and then try to undermine the voting process. 

 

The “Old Testament” contains many warnings from prophets of the consequences of ignoring the needs of others. In our day the “prophets” have been scientists, physicians, social scientists, compassionate caregivers, social activists, environmental activists, and a “new silent majority” that knows that perpetuating social injustice, economic inequality, and environmental abuse for short term gains will lead us all into a modern equivalent of a “Babylonian Exile.” We should have known that a situation that is oppressive and unhealthy for some would eventually impact us all. The perpetual “social distancing” that has marginalized so many for so many decades has come back to bite us all in ways that are having devastating economic consequences for all of us, and physical death for many. 

 

They say, “Never waste a crisis.” When we get past this challenge will we remember the unity and spirit that we lavished on one another and the prayers we offered as we asked for protection during the time when we felt so vulnerable? I hope that we will. Will our new normal include renewed efforts to improve the social determinants of health and grant universal access to care? Will we address the deficiencies in our housing policies and make sure that everyone has the dignity of an address? Will young people have access to higher education without acquiring decades of debt that thwart their future possibilities? Will we be sure to give everyone access to a healthy diet? Will we fund research and program development to more effectively address the “diseases of despair?” In time we will know. 

 

For the near future, we have work to do. Perhaps the hardest job will be maintaining the gains that have been made with great sacrifice. Several polls suggest that at least two thirds of the country is willing to wait a little longer before proceeding very carefully in the relaxation of social distancing and a return to “normal” economic activity. They do not want to rush to another demonstration of the potency of this virus. We must also broaden our concerns. How can we return to normal without taking care of the rest of the world? Will we limit commerce just to domestic trade? When we return to the wider world we will be vulnerable to its continuing problems. We will share the viruses of the world just like we share the climate concerns of the world. If we ever do produce a treatment or a vaccine, we will need to treat the world as we have done with vaccines for smallpox and polio. 

 

Experience can create learning and sometimes wisdom. Self interest can blunt accepting the truth. We see frustration, impatience, and “magical thinking” in every presidential news conference and with every demonstration of those who are frustrated with the social restrictions that have “flattened the curve.” As we move into May and then into the summer, my hope is that we will continue to see adherence to the general good sense that has enabled us to flatten the curve. I hope that our courageous healthcare providers begin to see a break in the personal demands that so many have courageously carried. Some people are beginning to document the magnitude of their sacrifices. I hope that we will begin to plan for a new normal where we take up the work to correct the deficiencies that have made us all so vulnerable. It does not have to be true that we slip slide away as we approach our destination. If Martin Luther King Jr.’s dream were to ever come true we would be living in a world that would be much less vulnerable to pandemics and any other collective horror that might come our way. It is hard to learn that caring for one another before the fact of a disaster will always be better than coming together after the onset of the horror. 

 

Slowly It’s Becoming Spring, Sort Of…

 

Our Springs days have been a fifty fifty experience. I don’t mean fifty in terms of the temp. The percentage of the days when the high temp has reached fifty degrees has hardly been in the double digits. I haven’t seen a crocus. There are some green shoots that I hope will soon be daffodils. We have awakened on several days over the last few weeks to a light cover of snow that is usually gone by noon. I mean fifty fifty in that about fifty percent of days are raw with clouds, wind, and some rain. Just nasty weather. The other fifty percent of days are very bright with almost no clouds. Those days are a promise that spring is trying hard to gain a foothold in the middle of New Hampshire.

 

My usual walk takes me around the lake to near where Colby Point sticks out like a long finger from the northern shore. That makes sense since the lake is a glacial lake and the glaciers that gave origin to our lake flowed down from the north. I am told Colby Point is part eskar and part drumlin. If you look at the picture of Colby Point that is the header, and then click on the link to eskar you will see a drawing of an eskar that looks just like Colby Point if there was water on both sides of the eskar in the drawing. 

 

No one lives on Colby Point. It is privately owned and is a summer time beach club for members only. I have enjoyed being invited to walk the Point. I fish along its shores. It’s almost a half mile long. It divides our lake into almost equally sized but very different bodies of water. I have seen pictures that show that most of the giant white pines that once covered it were flattened like broken match sticks by the high winds of the great New England hurricane of 1938. Two things followed that event. The wood was salvaged, and much of it was used to make munitions crates in World War II, and it was replanted with red pines from upper Michigan. Those immigrant trees have never been happy here. They don’t like the soil and many are diseased. 

 

The picture was lifted from a beautiful spring video. The video was taken a few years ago by my neighbor, Peter Bloch, using his drone. It’s a few minutes of beautiful footage that shows buds and a few blossoms on trees. I am hoping that this next week will play out as predicted. Tomorrow will be 60 and sunny! Every other day except for Monday and Tuesday is advertised as over 50! The call for Monday is for snow! Monday is the 27th of April. Snow on April 27 feels like salt in a wound. I am definitely fishing on Saturday when the sun is out. I have been out once on one of those rare fifty degree days, and introduced myself to the first rainbow of the year. It was small but pretty as you can see. He is resting in the floor of my kayak. I released him quickly after giving him a lecture about impulsive behavior. I hope to meet him again in the summer after he has put on a little weight.

 

 

Be well! Practice social distancing. Wash your hands frequently. Don’t touch your face. Cover your cough. Stay home unless you are an essential provider. Follow the advice of our experts. Assist your neighbor when there is a need you can meet. Demand leadership that is thoughtful, truthful, capable, and inclusive. Let me hear from you often, and don’t let anything keep you from doing the good that you can do every day,  

Gene