May 10, 2024
Dear Interested Readers,
A Flash Back To Tense Times
The biggest stories in the news over the past few weeks have been Donald Trump’s trial in New York, the continuing efforts to end the war in Gaza, and the police reactions to the demonstrations, encampments, and building takeovers on the campuses of many of our colleges and universities. I keep hearing that it is déjà vu for the late 60s when students across the country organized to express their opposition to the war in Vietnam. I was a student at Harvard Medical School at the time. In the spring of 1969, I lived in Peabody Terrace, the married student housing on the Cambridge bank of the Charles River just across the river from the Harvard Business School and Harvard’s football stadium and only a few blocks from the epicenter of the demonstrations in Harvard Yard.
The antiwar demonstrations came to Harvard in April 1969, Many members of my class quickly became involved. Our class had demonstrated a sense of social consciousness the year before when we piled up for return in the “Quadrangle” all the “black bags” and stethoscopes that Eli Lily had given us. It seemed to me that the leaders of these movements in our class were primarily the Ivy League and West Coast college grads among us. They were more politically active than I was. I was still in a state of cultural uncertainty because everything around me was so vastly different than the very conservative environment of South Carolina.
I had a close view of what was happening in Harvard Square because to get to my classes at the Medical School which was in the Longwood Area of Boston I had to walk to Harvard Square and take the “Red Line” subway to Park Street Station where I would transfer to a “Arborway car of the Green Line” trolley to ride out past Symphony Hall, Northeastern University, and the Museum of Fine Arts before arriving at Brigham Circle and the Harvard Medical School. As I made that trip each day, I learned a lot about the surprisingly racist attitudes that existed in Boston in the late 60s. My classmates seemed to me to be more “progressive” than the commuters I rubbed shoulders with on the MTA.
On April 9, 1969, about 500 students occupied University Hall in Harvard Yard. On April 10, police and the National Guard were called to clear the building. There were injuries. It is noteworthy that Dr. Ebert, our dean, went to the scene to assist in the medical care of the injured. Dr. Ebert’s official Harvard obituary confirms the story:
His concern for the human problems of those around him was palpable and deeply ingrained. There were many times when this aspect of him, perhaps the perspective of a caring physician, governed his actions. One such event occurred during the anxious days when some of Harvard’s undergraduate students had occupied a major building in the Yard. The story was that, against the advice of many present, he left a meeting of deans in Cambridge to go over to the scene of trouble out of real concern for the physical welfare of the students. He was heard to declare something to the effect that, “After all, I’m a doctor, you know.”
After University Hall was cleared, the organizers of the Harvard “strike” proposed a huge meeting of the university to occur in Harvard Stadium on April 11, 1969, where a “vote” would be taken about whether to extend the “strike.” At the medical school, we seemed to be a distant planet in the solar system of the university. Someone decided we would march together the three and a half miles from the Medical School Quadrangle to the stadium. I remember, and I may be wrong, that there was a banner announcing who we were and many people showed up wearing their white jackets. When the march began, and this also may be a false memory, I was surprised to see our dean, Dr. Ebert, and some other faculty members at the front of the march. Harvard Stadium seats about 40,000 people. When we finally arrived I was amazed to see it was over half full. I don’t remember the speeches, but the link from where I lifted the picture below of the stadium crowd that day does state that there was a vote to extend the strike until demands were met. Eventually, many of the demands like the discontinuation of the ROTC program were agreed to by the Harvard leadership.
My apartment was just a few blocks toward the river from Harvard Yard. On the night the police and National Guard removed the students from University Hall, I could see smoke and hear the noise from what sounded like an invasion. When I walked up to Harvard Square the next day to catch the “T” to school, the square was covered with the detritus of the previous night. It looked like there had been a battle.
I was not radicalized by the Harvard Strike of 1969, but I do think it was a moment of change for me. It opened my eyes to things I had never seen and opened my mind to new perspectives that I am sure had an impact on the way I think about the problems we face today in our complex world and in the increasingly dysfunctional world of healthcare. Thinking about those events of the late sixties makes me nervous for these times. As a student, I was greatly impressed by the social activism of Dean Ebert. As a septuagenarian looking back on events from long ago, it feels as if there may be transferable lessons to the present as we look back on the resistance to the war in Vietnam. We should take advantage of all we have experienced in the past and the lessons we have learned as we struggle to find balance and a way forward in these troubled times.Â
In many ways, the issues around Vietnam may have been easier than the issues on campuses today where the conflict includes charges of antisemitism, colonialism, and repression. The immediate driving realities are the unjustifiable events of October 7 on one side and the horrendous toll on human life in Gaza on the other which some believe are necessary to protect the right of Israel to exist.Â
Tom Friedman of The New York Times has possibly spent more time in the Middle East in the last forty-five years than any other American journalist. I appreciated the perspective that he brought to the conflict in Gaza and the future of the Israeli and Palestinian people in a column that he published this week entitled “Why the Campus Protests Are So Troubling.” In the article, he explores the complexity of the issues and the necessary changes in perspective on both sides that will be required before there is a return to the search for a long-term solution to this problem that has resisted the best efforts of many of our leaders for the past 75 years.
Friedman begins by confirming that his greatest sympathies lie with Israel in the aftermath of the horrendous violations of decency by Hamas on October 7, 2023. As for so many of us, the events on the ground in Gaza and the campus demonstrations calling for an end to the war raise conflicting feelings for Freidman. He begins:
Readers have been asking me, and I have been asking myself of late, how I feel about the campus demonstrations to stop the war in Gaza. Anyone reading this column since Oct. 7 knows that my focus has been on events on the ground in the Middle East, but this phenomenon has become too big to ignore. In short: I find the whole thing very troubling, because the dominant messages from the loudest voices and many placards reject important truths about how this latest Gaza war started and what will be required to bring it to a fair and sustainable conclusion.
He quickly clarifies that his problem is not that many of the demonstrations raise questions of “antisemitism.” What is and isn’t antisemitism? He thinks the term has been overused and is not his chief concern. Â
I should clarify that although I am not Jewish, three of my four grandchildren are Jewish by custom and rabbinical law because their mothers are Jewish. Had they lived in Germany in the nineteen thirties and forties their mixed heritage would not have protected them from the horrors of the Holocaust. Despite that fact, I can’t claim to understand the moment from a Jewish perspective. Freidman is primarily focused on what will happen when the conflict is over. He continues:
My problem is not that the protests in general are “antisemitic” — I would not use that word to describe them, and indeed, I am deeply uncomfortable as a Jew with how the charge of antisemitism is thrown about on the Israel-Palestine issue. My problem is that I am a hardheaded pragmatist who lived in Beirut and Jerusalem, cares about people on all sides and knows one thing above all from my decades in the region: The only just and workable solution to this issue is two nation-states for two indigenous peoples.
His next statement resonates with me and is a departure from the current thinking of Prime Minister Netanyahou’s far-right political coalition that is controlling the events in the air and on the ground in Gaza.Â
If you are for that [the two-state solution], whatever your religion, nationality or politics, you’re part of the solution. If you are not for that, you’re part of the problem.
He continues by reminding us of the horrific acts of Hamas on October 7, but he balances that reality with the “disproportionate” reality of the thousands of Palestinian children who have been orphaned, maimed, or killed in the subsequent conflict.Â
Friedman boils the situation down to a crisp thought of what happens when we forget what Hamas has done and focus only on the Israeli response.Â
By giving Hamas a pass, the protests have put the onus on Israel to such a degree that its very existence is a target for some students, while Hamas’s murderous behavior is passed off as a praiseworthy adventure in decolonization.
Friedman continues to try to sort out the dilemma of the moment by posing a question to himself:
Hey, Friedman, but what about all the violence that Israeli settlers perpetrated against Palestinians and how Bibi Netanyahu deliberately built up Hamas and undermined the Palestinian Authority, which embraced Oslo?
His answer to the question he has posed to himself, best describes where I am on this complicated subject.
Answer: That violence and those Netanyahu actions are awful and harmful to a two-state solution as well. That is why I am intensely both anti-Hamas and anti-Netanyahu. And if you oppose just one and not also the other, you should reflect a little more on what you are shouting at your protest or your anti-protest. Because no one has done more to harm the prospects of a two-state solution than the codependent Hamas and Netanyahu factions.
I am not sure that I completely accept Friedman’s explanation for the campus demonstrations that comes next, but his position is worth considering:
My view: Hamas was ready to sacrifice thousands of Gazan civilians to win the support of the next global generation on TikTok. And it worked. But one reason it worked was a lack of critical thinking by too many in that generation — the result of a campus culture that has become way too much about what to think and not how to think.
As the critical thinker that he is, Friedman makes other points that are a good reason for you to read his piece and begin to apply your critical thinking to this dreadful moment and what is likely to follow. I appreciate his final statement.Â
This is not a time for exclusionary thinking. It is a time for complexity thinking and pragmatic thinking: How do we get to two nation-states for two indigenous peoples? If you want to make a difference and not just make a point, stand for that, work for that, reject anyone who rejects it and give a hug to anyone who embraces it.
You might be thinking, “Isn’t this a healthcare letter? Why is he writing about campus demonstrations over complex questions like the conflict in Gaza? What does Gaza have to do with the future of healthcare?”
My answer is that in the political world of today, everything is connected. We are in an election year, and although improving healthcare seems to be way down the list of top priorities for debate and consideration over the next six months before the election, the outcome of the election will determine whether there is any chance at all for much improvement in our system of care over the next four years and perhaps much longer. I don’t have much sympathy for those who would threaten to use their disgust for the Israeli actions in Gaza and the West Bank as an indirect way to help usher in a more authoritarian and irresponsible American president. Like it or not, every political subject this year from inflation to concerns about our Southern border to Gaza is connected to the future of healthcare.
It is very likely that on many coming Fridays between now and November 5th I will be discussing issues that may on the surface seem to have no connection to the future of healthcare. Freidman challenges us to be critical thinkers in complex times. Based on my brief experience with a campus protest in 1969, and all that has happened in the intervening half-century, I agree with him. We must be critical thinkers as we face complex interconnected issues.
Great Expectations! A Fisherman’s Tale
As I mentioned at the end of last week’s letter, my dock has never been in place before the first of May. As you may have noticed, when things go without a glitch, this letter hits the Internet at 3 PM Eastern time every Friday. If you are a subscriber, you get an email around 3:05 that tells you that the letter is out and facilitates your access. Occasionally, that email gets delayed, some error I have made is usually the explanation for the delay. When that happens, I send a desperate text to my trusty IT guru and champion, Russ Morgan, who usually quickly discovers where I made my error, and all things are set right. So, if it’s after 3 PM on a Friday and you haven’t gotten the notice that the letter is out, just go to strategyhealthcare.com and it will be there.Â
If I am not otherwise occupied, I watch my own email around 3 PM to make sure the letter goes out to you. Once I am sure that the letter is out, my weekend begins. Last Friday afternoon was beautiful here, as I mentioned in the letter, I was eager to get down to the dock and begin the fishing season. Fishing in fast-moving rocky rivers has been a challenge for me since I developed a foot drop in my left foot after a fall on an icy downslope in February 2021. Over the last three summers, my fishing has been limited to tossing flies from my dock, or “trolling” a fly behind my pedal kayak as I tool around my lake listening to the Red Sox or an audiobook.Â
My left foot drop has been improving; so, before my right leg became a disaster, I was anticipating a return this spring and summer to several well-stocked trout streams within a half hour of my home. Sadly, that is unlikely to occur because, during the delay in my surgery, I developed a foot drop in my right foot. I still hope that as time passes from the surgery the neurological deficit will gradually improve, but I am trying to prepare myself for the possibility that it may be another three years, if ever, before I can return to the “catch and release, fly fish only” stretch on the Sugar River that has given me so much satisfaction over the last fifteen years.Â
Late last Friday afternoon was gorgeous. I donned my fishing vest which held most of my critical gear and headed for the dock. My laziness includes the fact that I don’t obsessively maintain my fly rods. I own several rods of various lengths and flexibilities, and they spend the winter fully assembled in a stand on my screened porch that overlooks the lake. My favorite rod is a gift given to me by the practice when I retired. It is a light 4-weight Sage rod that feels like an extension of my left arm. Since I am primarily fishing in the still water of a lake, I have my best luck with “green cone-head wooly buggers.” The fly that I had left on the Sage over the winter was a more purplish variation of the cone-head wooly bugger. It was a good place to start. I guess that in the water it mimics a minnow. I must have cast thirty or forty times from my dock without any action. I was even ignored by the ubiquitous sunfish that are usually hanging out under the dock. The bigger ones can be fun to catch on a fly rod. When my grandchildren fish off the dock they are guaranteed success. One summer my granddaughter caught forty-five sunfish in less than an hour. I was busy just taking the little fellows off her hook and throwing them back in the water.Â
When I am fishing, I always resist changing flies. It’s just a lot of trouble to tie a new fly onto the thin line. As my vision has deteriorated, it has become an even greater challenge. I doubt that I could do it at all standing waist-deep in a fast-moving current which is a good reason for me to stay on my dock or in my kayak and out of the river. My second choice, and probably a better choice for this time of the year, is a Prince nymph. The Prince nymph, created by a man named Prince, has been a favorite of the fly fishing public since the 1930s. Reluctantly, I went through the ordeal of changing my fly. I often carry several rods with different flies that are already tied on which means to change flies all I need do is switch rods. I had carried only the 4-weight Sage down to the dock so to fish with the “Prince” I had to tie it onto the wispy filament at the end of the line. It was a challenge.Â
Every spring, the New Hampshire Fish and Game Department stocks the ponds, lakes, and rivers of the state with trout. My lake gets only rainbow trout. For reasons I don’t understand they put brown trout and eastern brook trout in other lakes and streams. Most years, Little Lake Sunapee gets “1500 newbies” fresh from the hatchery. I was disturbed when I read in the “stocking report” that this year on April 26, we were given only 500 fish.
These hatchery grads are usually at least ten inches long. Trout like cold water. The water temp in the lake is in the fifties now. Later in the summer when the surface water gets into the seventies and the water feels great for swimming, the trout will go deep. This time of year trout are catchable from my dock where the depth is five to six feet.Â
I should inform you of my “moral” fishing code. I ascribe to the philosophy of “catch and release.” I usually remember to flatten the barb on the hook which diminishes the trauma to the fish and gives it a little chance of jumping off the fly if my technique is flawed and I fail to keep a “tight line.” Finally, I have a ritual. I take a picture or have someone like my wife take a picture of me and the fish. I give the fish a little advice about limiting impulsive behavior and warn it that the next time it may be caught by someone who wants to eat it. I then gently return it to the water while it is still able to swim away with only a light case of PTSD at the worst.
After tying on the “Prince,” I had cast my fly only two or three times before I got a hit. The fish was not the most ferocious fighter I ever caught, but it was early in the season for both of us and it was likely that the little fellow was a recent grad from the hatchery and had been in the lake only four days. I was its first encounter.
The biggest problem I had was getting the attention of my wife. She was in the house, and I wanted her to come down to the dock to see my accomplishment because she was convinced that it was more likely in my post-op state that I would fall into the lake than catch a fish. I let the fish tread water on a tight line until she heard my cries and came down to the dock. The picture in today’s header is proof that my story is mostly true. Look closely to see the prince nymph in the fish’s lip.Â
Since last Friday, the weather has been off and on miserable with just a few brief moments of dock-worthy weather. After the great start last Friday, I was convinced that it would be a great summer of fishing. Not so. Since last Friday, I have caught only one three-inch sunfish. I always cast my fly with high hopes, but I accept the uncertainty that is always a part of fishing.
I hope that spring is showing up most days for you and that you have plans for a great Mother’s Day weekend. We are headed to Maine to celebrate the most recent mother in our family, and to check out the progress of our most recent grandson while we celebrate his father’s 39th birthday.
Be well,
Gene
