July 30, 2021
Dear Interested Readers,
Is “Normal” A Concept That Is Over?
This summer has been a very strange season with some very violent weather. Some days feel eerily spooky with a dangerous heavy haze from the West Coast fires hanging over my lake. After a heavy day of haze like last Monday, the next day can be crystal clear. That is a relief. Was the clearing due to the heavy rain that fell on Monday night? Tuesday was a beautiful day until high winds and driving rains darkened the sky late in the afternoon while I was chairing a committee meeting on Zoom from the comfort of my new screened porch. Suddenly there were multiple bursts of lightning and my screen froze. It took a minute or two to realize that I no longer had an Internet connection. We also had lost our television and telephone service. The good news was that I was able to rejoin the meeting via the “Hot Spot” function of my iPhone, but we did not get the Internet, phone, or television back for five hours. Apparently, the lightning had hit a telephone pole down the road. There were lines down and a fire. I guess it has been similar events that have sparked many of the West Coast fires. Our fire did not spread through the adjacent woods because everything is soggy from the downpours we seem to get almost every day. All of these events could occur individually as part of “normal variation in the weather” but the regular occurrence of unusual events and the fact that the term “once in a hundred-year event” is now in almost daily usage convince me that there has been a real change in our atmosphere and that global warming is a reality that has destroyed “normal.”
There are other strange events to observe. Today’s header shows part of the mushroom crop that is covering much of my yard. I see a few mushrooms every summer, but I have never felt that we were at risk of a mushroom invasion. Will 2021 be the year of the “attack of the mushrooms?” I enjoy nature and I know that there is a year to year variations in the weather and in other associated events like the number of mushrooms to be seen, but it just seems that we are living in a new era where what was “the expected” is now past history and a new rhythm or a new normal has yet to evolve. At times my fear is that the new normal will be “no normal,” and that we will live in a world of continuous events that are crescendoing to levels of “extreme” that have never been seen before.
NASA suggests that it is too late to return to our old expectations from the weather. In an article entitled “Is it too late to prevent climate change?” they write:
Humans have caused major climate changes to happen already, and we have set in motion more changes still. Even if we stopped emitting greenhouse gases today, global warming would continue to happen for at least several more decades, if not centuries. That’s because it takes a while for the planet (for example, the oceans) to respond, and because carbon dioxide – the predominant heat-trapping gas – lingers in the atmosphere for hundreds of years. There is a time lag between what we do and when we feel it.
NASA goes on to say that the inevitable continuous rise in temperature that we have brought on ourselves is no reason to give up trying to lower the carbon dioxide levels in our atmosphere that continue to rise because of our dependence on fossil fuels and is much of the reason that we see climate change, but it is time to begin to try to learn to live with what we have brought on ourselves. If we can’t stop the rise, we might bend the curve and learn to live the losses and change we can’t avoid. It is a sad outlook, but it is probably a realistic assessment that suggests our best strategy. They continue:
But it may not be too late to avoid or limit some of the worst effects of climate change. Responding to climate change will involve a two-tier approach: 1) “mitigation” – reducing the flow of greenhouse gases into the atmosphere; and 2) “adaptation” – learning to live with, and adapt to, the climate change that has already been set in motion. The key question is: what will our emissions of carbon dioxide and other pollutants be in the years to come?
I think that NASA is giving us good advice. We must have a dual strategy of stopping further damage and developing strategies for living with the consequences of the damage we have brought on ourselves and the generations to follow that we will have no chance of avoiding. In healthcare, we are already seeing the exacerbation of chronic conditions and untimely and essentially avoidable deaths from the climate. With last week’s haze, the chronically ill were well-advised to avoid going into the muck.
I know that the readers of these notes care about healthcare. More importantly, you care about the overall health of the community. Most of us even care about the well-being of every member of the community. I have never met a doctor or nurse who would not respond when presented with the individual pain and distress of another human being. We spend much of our time advising people to exercise, eat well, avoid tobacco and limit alcohol because we know that our advice will protect them. The catastrophic events that occur randomly around the country and world also grab our attention and sympathies and should be factored into our desire to protect our patients from unnecessary harm.
We care about more than just the patients who come to us for care. We donate to disaster relief. After the fact of a disaster, after the last moment when there might have been something to do that would avoid or mitigate the harm, we spring into action and show that we care about the victims and their families when a building collapses in Florida or there is a devastating landslide on clear-cut hillsides that kills hundreds in some third-world country. We have good reflexes after acute events. “Coulda, woulda, shoulda” is our confession, and we promise to carry our new insight into a future where we behave differently. If I am making an unacceptable generalization, I apologize. Another gross generalization for which I prospectively apologize is that many of us do not seem to care enough about the less dramatic creeping disasters from chronic exposer to the toxins in our environment that many of our neighbors endure. We respond to the acute disasters in our neighborhood and abroad, but we do not respond as well to the chronic collective distress of the disadvantaged in our neighborhoods that lie near toxic manufacturing sites or have a water supply with elevated lead levels. We can be equally unmoved by the harsh living conditions endured by many people in underdeveloped places in our world where we have a long history of extracting wealth. It is hard for us to see beyond what appear to be immediate costs of remediation to us with little or no possibility for our personal benefit if we were to attempt to meaningfully address the chronic problems that damage the lives of the less fortunate in our society or to address the huge oceans of need that exist in places that seem so far away. We reason and imagine that what happens in those places we do not see is not our concern, or that the people experiencing the harm in some way brought the disaster down on themselves because of some personal deficiency. Is it enough to say, “Except for the grace of God there go I” or to attempt to mitigate the pain of the unfortunate by saying, “You are in our thoughts and prayers”? I am guilty of both.
Richard Branson and Jeff Bezos say that their world views have been transformed by seeing our home from the edge of space. That is good, but we must find some way to transform the hearts and minds of a majority of earth’s inhabitants, or at least those responsible for national and global policy, without needing to send them to space so they can appreciate what a small and delicate planet we share.
Our interconnectedness is not a new idea although it seems that many among us have not caught on to the reality of how one person’s vulnerability is a threat to all. The English poet and cleric, John Donne, wrote that “No Man Is An Island” four hundred years ago.
No Man is an Island
No man is an island entire of itself; every man
is a piece of the continent, a part of the main;
if a clod be washed away by the sea, Europe
is the less, as well as if a promontory were, as
well as any manner of thy friends or of thine
own were; any man’s death diminishes me,
because I am involved in mankind.
And therefore never send to know for whom
the bell tolls; it tolls for thee.
Two inescapable lessons from the pandemic are that no one is immune from the danger and that the poorer you are the more vulnerable you are to the dire consequences of the virus. My local paper frequently publishes editorials from The Washington Post editorial board. Tuesday’s editorial was entitled “We don’t know the half of it.” The piece addressed the concern that the infection and death counts associated with COVID-19 are gross underestimates of the actual reality. Underestimates of the impact of COVID are especially true in places like India and the entire continent of Africa, but is also true that the estimates are also low for developed countries like ours. A proven reality from business is that you manage what you measure. We are neither measuring well or managing well the facts of the pandemic, and our neglect will surely prolong the pain and suffering.
There are many things to concern us about COVID, but one thing that seems certain to me is that at no moment since March 11, 2020, have we had a universal understanding or acceptance of the challenge that we face together. I know for certain that there are unvaccinated adults in my community who don’t wear a mask. Some of them are acquaintances. It should not be a surprise that even though our vaccination rates are high we are not protected from rising rates of infection and the complications of COVID. Sometimes we are smug and we take pride in the fact that we are doing much better than places like Florida, Texas, Missouri, and Alabama, but despite our efforts, COVID infections are on the rise in Merrimack County, New Hampshire. Can we imagine any other reason than the fact that there are among us people who are considering what they do solely from the perspective of their own comfort? I accept that they can choose not to get vaccinated. I can’t accept that they can choose to not be vaccinated and not wear a mask and avoid close contact with other people and children who may be vulnerable.
On Tuesday I sat through the hearings of the House committee that is investigating the insurrection at the Capital. I was moved by the stories given by the four police officers who had put their own lives at risk to defend the members of Congress as they met to do their constitutional duty of certifying the November election for president. I was distressed by the events of January 6 beginning with the speeches full of lies that were delivered on the Eclipse and the attack on the Capital that followed. My distress was only partly related to those events and the associated suffering of the four gallant officers. I was most distressed by the knowledge that there were many members of Congress who believe that what happened does not deserve their attention and by the fact that they must believe that their lack of concern is in line with the desires of their constituents back home.
It is hard for me to imagine that if such a blatant attack on our constitutional system of government does not initiate a bipartisan response of outrage and a determination to fully explore the event we have much chance of ever coming to a bipartisan resolution of the issues of climate change, our shared vulnerability to pandemics, and our need to give good healthcare, education, employment, and housing to every person. If we can’t answer the questions that are outstanding about why the Capital was attacked and who was behind the action, we have little possibility of ever assuring the stabilit¥ of our government in a way that will finally achieve the equality for all citizens that we say was the founding principle of our nearly 250-year experiment in self-governance.
What are we to do as we yearn for a return to the place and safety for the privileged or the dream that we will eventually create a place where we are equally privileged? Are haze, mushrooms, and masks the future that awaits us? Is universal access to care, improvements in housing, education, job security, and in the environment unachievable dreams? Are the full benefits of what we produce going to continue to accrue to a very small privileged ownership population? Heather McGhee has suggested in her book, The Sum of Us All, that we live in a non-zero world where we can choose policies that benefit us all. The flip of that assertion is that we can choose policies that have short-term benefits for some but are long-term losses for all of us. That outcome of that negative math is what we are seeing more and more as the climate changes.
In 1933 T S Eliot wrote “The Hollow Men.” It is a dismal poem that leads to an ironic conclusion:
This is the way the world ends
Not with a bang but a whimper.
I wonder if Eliot was alive and writing today whether or not he might change his last lines to read:
This is the way the world ends
Not with a bang but in a filibuster followed by a whimper
Earlier in this complaint, I implied that it was still possible to mitigate the multiple impending episodes of shared unpleasantness that await us, and even create some hope for improvement if our leaders could set aside immediate self-interest and agree on sound policies. I heard the four officers and several of the questioning members of the congressional committee, including the two brave self-described conservative Republican members of the committee who are now the target of their leader, plead for consensus about the importance of examining what happened on January 6 as the first step in a long process of ensuring a better future for the country. I also know that short of divine intervention or some mundane miracle Congress will go home next week for its August vacation with a lot of unfinished business. There is some slim hope that a bare-bones compromise infrastructure bill might pass the Senate. There is less hope that the House will accept it. If a miracle occurred and the bill was to become law it provides insufficient resources for the job that needs to be done. The bill would not come close to delivering the resources that are needed just to repair what is broken, and the funds it would provide would be far from enough resources to deliver the infrastructure that we need for a secure future. If it does pass, it will be like providing us with a teaspoon rather than a backhoe with the expectation that we will use our meager tool to dig a deep trench. I see no hope for any kind of really meaningful infrastructure bill, a voting rights bill, or any bill that might offer a step out of poverty or better health for every American. It is very likely that when Congress goes home the book of hope and opportunity will be closed once again. I am pessimistic about the possibility that the book will be reopened when business resumes after Congress returns in September. After December, all efforts will be directed toward the midterm elections when Republicans hope to regain the House and maybe the Senate by proclaiming that President Biden couldn’t deliver on his promise of bipartisan progress.
What could you do if you cared about the haze, the mushrooms, the deteriorating environment, and the lack of focus on our crumbling infrastructure, millions without healthcare, and a legacy of universal distress that we are preparing for our children? I am sorry to say that alone there is not much that you can do. Don Berwick famously advises us to think globally and act locally. I agree. Anything that you can do in your place of employment, hometown, or home state, may help a little. Your opportunity to vote in 2022 will be a chance to help to try to build a governing supermajority that might have the capacity to deliver the equity and opportunity that a majority of Americans have been saying that they need and want. We have the technical skills to make great progress. We have the wealth to include everyone in the promise of the possibility to do much better. How long will we be hobbled by the self-serving control of a decaying minority?
I think the mushrooms are interesting. They may even be edible, but I am taking no chances. I am thankful that there are a few cool, clear, and sunny days. I try to take maximum advantage of any that occur. If we refuse to believe that we are not helpless and say “no” firmly to those who think only of themselves then we are not hopeless, just endangered. At the end of the Constitutional Convention, Benjamin Franklin was asked, “What do we have?” His response is famous. It is quoted by politicians on both sides of the aisle in support of their own ideas. What he said when he answered the question was, “A republic if you can keep it.” We can think about an acceptable “new normal” in healthcare and in our whole world if we are willing to work for it and give up enough self-interest to the common pot of resources to keep it.
Be well,
Gene
