September 23, 2022
Dear Interested Readers,
What We Say, What We Do, and a Doctor Whose Actions Speak For Her
My wife and I have been watching the latest Ken Burns PBS production, ”The U.S. and The Holocaust”. For over forty years, Burns has educated us on subjects that range from baseball and jazz to a tour of our national parks and most of our wars, with a storytelling talent that grabs you in a way that will not let you look away. He has celebrated our accomplishments and held up a mirror that forces those who watch his presentation to examine our inconsistencies, self-centeredness, and frequent cruelties that we conveniently forget when we celebrate our “exceptionalism.” Burns has a knack for showing us that there is a difference between what we say and what we do.
Joseph Berger of the New York Times previewed the presentation of the Burns production. In the first two paragraphs of his review, he orients us to what makes this six-hour documentary different from previous presentations of the Holocaust.
A new documentary about the Holocaust opens with photos of perhaps the most familiar faces from that dark chapter of history: those of Anne Frank and her family, whose story has been read or seen by millions around the world.
So why would a six-hour film that offers fresh illuminations about America’s response to the Holocaust begin with such well-worn images? The answer is likely to surprise even those who know all about the arrest and eventual deaths of Anne, her sister and their mother. Their deaths, the documentary argues, were also a stain on the United States and the foundational myth of its benevolent open door for “huddled masses” of immigrants and refugees.
As recounted in “The U.S. and the Holocaust,” Ken Burns’s latest deep dive into America’s past, Otto Frank tried desperately to seek sanctuary in the U.S. for his family “only to find,” the narration says, “like countless others fleeing Nazism, that Americans did not want to let them in.” Seeing no other recourse, he arranged for the construction of the Franks’ ill-fated hide-out in Amsterdam.
Many of our current controversies have roots that are over a hundred years old. The Statue of Liberty was dedicated in 1886, but even then we had already begun to close the door to “the huddled masses” of the world with the Chinese Exclusion Act of 1882. The door was open only a crack after The Immigration Act of 1924, The Johnson-Reed Act, which set small quotas and created huge bureaucratic barriers for immigration from each country in response to the millions of immigrants that had come to America in the late 19th and early 20th centuries from southern and eastern Europe. These immigrants usually did not speak English and practiced religions that seemed so foreign to America’s dominant protestant population with roots in the British Isles and western Europe.
Burns spends some time reviewing the pseudo-scientific concept of eugenics that was advocated by prominent politicians, academics at major universities including Harvard and Stanford, and celebrities and business leaders like Charles Lindberg and Henry Ford. Ford was almost as prolific in his propagation of racist and antisemitic propaganda as he was in producing “tin lizzies.” Eugenics was intertwined with antisemitism and racist organizations like the Klu Klux Klan. One measurement of its prevalence is that the sterilization of those deemed feeble-minded or defective was ruled to be constitutional by the Supreme Court in 1927. As a result, over thirty states had laws that caused over 70,000 people, many of whom were from minorities, to be forcibly sterilized. It makes you shudder to realize in the wake of the recent Dobbs decision of the court that most Americans are ignorant of just how cruel our institutions can be. Burns proves the chilling fact that America’s antisemitism and its Jim Crow laws and oppressive treatment of Black Americans had a formative influence on Hitler and the evolution of his “final solution.”
Burns makes the point that we could have done much, much more, but as always there were some heroes who did try to make a difference, and because of their efforts about 200,000 Jews did survive by coming to America before Hitler fired his furnaces and made leaving impossible, but millions of people died because they were systematically turned away, literally by the boat load. A very sad example of our official refusal to help those in distress that echoes in our immigration controversies today was the refusal to let the St. Louis, a German oceanliner with over 900 Jewish passengers fleeing Hiter’s oppression, dock in New York in 1939. Then, as now, there were many people who recognized the inhumanity of our policies and tried to help including Eleanor Roosevelt. Berger writes:
The filmmakers sought to emphasize the story’s ambiguities and complications, Burns said. For one thing, the U.S. let in more Jewish refugees than any other country — roughly 200,000 between 1933 and 1945 — the result partly of efforts by rule-benders like the journalist Varian Fry and the Swedish diplomat Raoul Wallenberg, whose clandestine dealings were financed by the War Refugee Board, under the direction of John W. Pehle.
One point of history that remains ambiguous was whether President Roosevelt was politically able to have done more. Roosevelt had his explanations and excuses, but his immigration decisions were a continuous source of disappointment for his wife Eleanor who wanted him to do more. Berger’s defense of Roosevelt was brief:
Despite pleas from his wife, Eleanor, and from Jewish leaders, Roosevelt chose to devote his attention to defeating the Axis.
It has often been said that the average American was unaware of what was happening in Europe. Burns destroys the myth that most Americans were unaware of what Hitler was doing. The pictures, film clips, and documents that Burns presents undeniably establish that Americans did know that people were suffering and wanted to escape to America and were comfortable with America’s closed door to immigrants and its isolation policy. Roosevelt had a very difficult time even organizing aid for Britain as they were attacked by Hitler. Jews had been terrorized, ostracized, beaten, isolated, and deported for several years before Hitler fired up the crematorium and began in earnest to implement his “final solution” in 1941. It is hard to deny that we hid from our humanitarian responsibility to welcome Jewish refugees for at least seven years after Hitler came to power with his message of antisemitism. We failed to do much about the fascist menace to the future of humanity before Pearl Harbor was bombed in December of 1941 and we finally shed our policy of isolation and entered the war. It is painful to imagine how many lives might have been saved if Lady Liberty had been able to welcome as many refugees between 1934 and 1941 as she did in 1907 when hundreds of thousands of immigrants passed her torch on the way to Ellis Island.
Neat the end of the last segment, during the wrap up which is an obvious bridge to our moment in time, Eleanor Roosevelt is quoted from a speech she gave in 1946. Michael Abramowitz, the current president of Freedom House writes:
Eleanor Roosevelt is memorably quoted as the film closes. Reflecting on the consequences of American inaction in a 1946 speech, she said, “I have the feeling that we let our consciences realize too late the need of standing up against something that we knew was wrong. We have therefore had to avenge it, but we did nothing to prevent it. I hope that in the future, we are going to remember that there can be no compromise at any point with the things that we know are wrong.”
Let’s muse on that wisdom and see if it fits with what is occurring at home and abroad in places like Ukraine, China, and across the Middle East, as well as at our Southern border. Mrs. Roosevelt knew from her own experience that when we fail to confront injustice innocent people die.
Samuel Clemons (Mark Twain) is credited for the insight that, “History doesn’t repeat, but it often rhymes.” The rhyme of history seems to be the message of Burns’ story. The facts in this moment are not the same as they were in the late thirties and the early forties but the rhyme, rhythm, and I might add the smell, are similar. There certainly does seem to be some rhyming going on when we hear about the reprehensible political use of refugees by the governors of Texas, Florida, and Arizona. On Wednesday “The Daily,” a podcast of current events from the New York Times, was entitled How Border Politics Landed In Martha’s Vineyard. You have probably heard about the cute trick of Florida’s governor, Ron DeSantis. He conned over fifty Venezuelan immigrants in Texas to get aboard planes that would fly them to a better life. His behavior isn’t an exact replica of the American behavior that Burns pictures in his documentary, but it rhymes in its lack of concern for individuals in desperate circumstances. Even worse the governor’s cruelty is performed with the smirk of a creative political trick. What impressed me most in the podcast was not the strategic brilliance of the jerk governors, but rather the responsiveness to human needs demonstrated by the people of Martha’s Vineyard and Massachusetts. I wish that Governor DeSantis would use his strategic skills and ability to influence conservative voters to improve the social determinants of health for the twelve percent of Floridians without health insurance and the even larger number who have inadequate care.
It so happens that this week I was listening to the recording of a sermon that my father preached in Darien, Georgia in February of 1995. Lately, I have been digitizing some of his taped sermons that I have let rest in a box for over twenty-five years. My parents are on my mind frequently, and it is wonderful to hear his voice even when I did not always agree with his politics or his theology. He died this week four years ago less than two months short of his 98th birthday. In January it will be ten years since my mother died 2 months short of her 94th birthday. The point of my dad’s sermon was that the world can only measure us by two objective determinants: what we say, and what we do. Obviously, there is confusion when it appears to others that there is no harmony between our words and actions. Talk is easy. Actions take effort. I think there is a corollary that when we talk about the past we often misrepresent what we did. It is wonderful when the words and actions in the moment and the memories and the history are consistent. It is not good when words and promises are not followed by action, or when the actions are a surprise because they are not aligned with the words and the promises.
The words/actions analysis works for individuals, it works for professions, and it works for nations. I grew up in an America that wanted to talk about its virtues, generosity, concern for the oppressed, universal opportunity, and devotion to democracy. There was some truth in that those words described our best intentions, but evidence produced by Burns and actions that are taken now by men of authority like the governor of Florida reveals that what we do often is inconsistent with who we tell ourselves we are. It seems increasingly obvious that we are not fooling the rest of the world. The free world seems to judge us as inconsistent leaders, and our enemies consistently think they see opportunity in our self-delusions.
One advantage of having spent decades helping people with chronic diseases is the realization that for years and years there is still opportunity for improvement in each new day. Sure, there comes a day when the only option is “care and comfort,” but for longer than we sometimes realize, improvement is a choice. Previous mistakes can be learning experiences. Grace is possible.
The last few years have been very difficult for all of us, but much more difficult for those who were previously suffering from the inequities that are so prevalent within our lower-income neighborhoods and communities. I was inspired this week by reading the story of Dr. Kimberly Becher who is a family practice physician in Clay, West Virginia. Clay, population 396, is the county seat of Clay County, West Virginia. Dr. Becher has practiced for eight years at the Clay office of Community Care of West Virginia, a federally qualified health center. Dr. Becher grew up in a poor family in another small town in West Virginia, but she was an excellent student, the valedictorian in her high school class, and went to Dennison University in Ohio. It was the first step in her plan to “leave West Virginia and never come back.” She did come back as a young mother attending the Joan C. Edwards School of Medicine at Marshall University. She changed her mind when she finished her residency in 2014 and immediately began to practice in Clay under a mountain of debt for her medical education.
Her experience in Clay has included a flood that wiped out the only grocery store. People now travel more than an hour for groceries. Her focus has been split between providing very personalized individual care for individuals, and public health efforts to improve the most essential elements of life that constitute the most fundamental social determinants of health for the needy population in Clay County who suffer from substantial poverty but are apprehensive about the government in a food desert during a pandemic. In the article written by Oliver Whang we read:
Dr. Becher spent her first years in Clay building up what she called “patient equity.” She slowed down in her characteristic way when talking to her patients and learning about their lives and health issues, which could stem from causes as varied as diabetes, opioid addiction, anxiety, loss of electricity or an old car that had recently broken down. But outside of these interpersonal relationships, she continued apace. She began blogging for the American Academy of Family Physicians, took on advisory roles in local government, increased the number of patients she saw and made more home visits to people unable to drive to the clinic.
She was working endless hours when the pandemic increased her stress. Mr. Whang describes a visit to her in February 2021:
Dr. Becher had been working in the clinic seven days a week most weeks, and often stayed up late at her kitchen counter, writing notes on patients’ charts and grant applications for food vouchers. She had begun encountering resistance to Covid science, which added to the strain on her, she said; patients she had seen for years were suddenly questioning her judgment.
Against that background, it is not a surprise that in April 2021 she collapsed. She had what appeared to be a heart attack, and it was, sort of. She had an unusual stress-related cardiac injury as Whang described:
Tests soon revealed that she had a rare disease called takotsubo cardiomyopathy, which forces the tip of the heart’s left ventricle to stretch. Most cases occur in older women who have recently experienced some type of intense physical or emotional distress, like the loss of a loved one or a serious accident. It has gained a catchy moniker — broken heart syndrome — but its causes remain unknown.
During more than forty years of practice, I saw two cases of Takotsubo Syndrome. It was first described in 1990 and is characterized by chest pain that suggests a myocardial infarction, but the coronaries are usually clean and there is an unusual pattern of left ventricular dysfunction and a decreased ejection fraction. Perhaps, her collapse was a physical manifestation of burnout that occurred because she did not give in to the emotional challenges of her work. You can read Dr. Becher’s story in her own words because she blogs on family practice websites. I would recommend her post on the website of the American Academy of Family Practice from last February, about a year after her collapse, entitled “Teetering on the Edge of the Moral Injury Cliff.” In the piece, she writes:
February 2, 2022, 8:00 a.m. — Looking back, I realize now I thought not only that I knew burnout, but also — naively — that I had beaten it. I thought I knew compassion fatigue and had overcome it. I even thought I had figured out a way to survive as a physician in a dysfunctional health care system during a pandemic. I honestly thought I was coping appropriately with the stress of early 2021 until it literally stopped me in my tracks.
Seven years is all it took to break me. I completed residency in 2014 and was fortunate enough to have a job I loved, in a community I enjoyed serving, working for an organization that actually valued me and my patients. I was meeting productivity goals while making measurable improvements in my patients’ health. I was not just exercising but training for another marathon. Life was great…
Dr. Becher’s deeds exceed her words. In recovery from her event, she is doing more administrative work and teaching than direct patient care, but she remains an example of positive works being more important than empty rhetoric. Remember:
“By their deeds you will know them. Does a man gather grapes from thorns or figs from briars?”
Matthew 7:16
Summer Departs After Another Double Rainbow
Fall officially began last night at 9:04, but it looked like fall and felt like fall all this last week. We enjoyed the coziness of our first fire of the season this week while watching Burns’ Holocaust documentary. While I was on my daily walk yesterday the sky suddenly went from bright sunshine to a rapidly moving dark ceiling, and I was caught in a soaking cold rain. The rain only lasted about fifteen minutes and then the sun returned in a bright sky adorned with a huge double rainbow. The temperature of the air was in the mid-fifties, and the water temperature of the lake was sixty-five. I decided it was time to don my wet suit if I was going to get in one last summertime swim.
My son is living with us for a month while waiting for his new home in Maine where his wife spends the work week with friends because she has just started working as a lawyer with the state’s legal aid practice, Pine Tree Legal, When the rainbow appeared he was working in our guest house. He was able to take a great picture of the rainbow from its deck. The picture proves that I am lucky enough to live “at the end of the rainbow.” I can report that there is no pot of gold, but it is a very pleasant place to be.,
My world is full of color which can be a balm to my soul if I spend too much time thinking about Donald Trump, Ron DeSantis, and Gregg Abbot. I am expecting more color soon. There are trees sporting bright colors popping up everywhere. In two or three weeks they will be a colorful majority. My drone-flying neighbor has recently surprised me with a new display of color–from under the surface of our lake. Today’s header is a colorful screenshot from a video he posted last week that was entitled “Below–Little Lake Sunapee” which was taken with his waterproof Apple 13 ProMax.
Now that summer is a memory, it’s time to have high hopes for the fall. I am absolutely certain that there will be colors that will stir my soul. Fall colors are a peaceful certainty that we will enjoy for a little while, but the midterm elections are a huge uncertainty that worries me. Some days I am encouraged that common sense will prevail and huge numbers of concerned citizens will show up and void all attempts by Republican state legislatures to deny the votes that will ensure the continued existence of our democracy for yet a little while. It feels like our democracy is like a family that is living paycheck to paycheck. We survive as a democracy by the “skin of our teeth” from election to election. The survival of our democracy is on the ballot at every election.
I can promise you that you will hear more from me about how this election, like all elections, is a chance to move from rhetoric to action. Colors and political concerns will be a dual focus for this fall. Enjoy the colors and do your part to prepare for an election that will make a big difference in efforts to improve the health of the nation.
Be well,
Gene
