June 5, 2020
Dear Interested Readers,
It’s Never Been This Late Before
Many times during my practice life I would try to have a conversation with a patient about some change in lifestyle or a choice that they might make to avoid some future problem or complication. These conversations were an attempt to “market” a positive change in behavior and would always make me feel like I was a salesman. I would make a suggestion about giving up smoking, or suggest that more sleep or getting more exercise might be beneficial. The reluctant patient might then counter with something like, “I don’t see why I need to do that because I have never had a problem before.” My snarky come back would be, “I’m sure that until now it’s never been a problem, but it’s never been this late before.” That statement was usually a conversation stopper. The patient would pause in mid sentence of their comeback defense, and looked puzzled for a few seconds before asking, “What do you mean?”
The only thing that I ever said when talking with a patient that caused more consternation and confusion than “it’s never been this late before…” was to ask an adult what they did for fun. Virtually no one over thirty can answer that question without more explanation or coaching. Fun does not compute for most of us. “Do you play golf” gets a quick yes or no response. The same is true if you ask someone if they have been to a movie in the last month. Either of those and many other direct “do you” questions get a quick response. “What do you do for fun” gets a blank face followed by the same “What do you mean?” that “It’s never been this late before…” elicits.
I admit that “It’s never been this late before” is a strange declarative statement. After the patient’s pause and subsequent question, I would try to explain that “It’s never been this late before” could have many meanings, but what I meant was just because they had never had a problem with their smoking, diet, or lack of exercise, that was no assurance that what had not happened yet could not happen in the future.
Stability is usually an allusion. We know change occurs, but none of us expect it, and we are usually surprised and confused when it does occur. We rarely see it coming. In truth, we all know from personal experience that things (systems) fall apart (deteriorate) unless effort (work) is applied. Going from a state of disorder to a higher state of order requires energy. That’s a fact I cooroborate everyday as I stack wood, wash dishes, do my laundry, and pick up after myself. I buy other people’s time and energy to bring order to other key systems in my life.
I’ve mentioned “Stein’s Law” before. Herbert Stein, Nixon’s chief economic adviser, said, “If something cannot go on forever, it will stop.” Stein’s Law comes off as a half joke, but it is totally true, and describes reality. Does it apply to this moment?
We know that the COVID-19 pandemic won’t go on forever. Sooner or later we will reach herd immunity, find a cure, develop a vaccine, or it will just go away for reasons we do not understand. It’s also true that at some moment the last vigil for George Floyd will occur. As difficult as it may seem for some to believe, it is also true that some how, some way, we will move on past Donald Trump. It is also true that someday we will have recovered from losing over 40 million jobs, and probably tens of thousands of businesses, large and small. Most importantly, we will someday move past the racism and exploitation that has seemed to be such a resistent problem for so long. Are we finally beginning that process? Are most of us tired of the contradiction between what we say America offers to everyone and the reality of what a large number of people actually experience? Are we tired of having to turn away from the ugliness that we know exists, but can avoid seeing if we stay on the right side of the tracks? Are we finally realizing that it has never been this late before, and finally, at this late hour, the beginning of change has finally come?
Public opinion turned against our presence in Vietnam when we got tired of watching atrocities on the evening news as we ate supper. A majority of us finally realized that we needed a Civil Rights Act and a Voters Rights Act after watching Bull Connors and his police sick dogs on protesters, tear gas them, turn water cannons on them, and then beat them with billy clubs. Did we need to see George Floyd die before we realized that morally most of us could be held to account for the complicity of looking the other way? How long can we walk away while leaving the work of fixing the most obvious defects in our society to those who have the least resources and have suffered the most? Where is the enlightenment and honor in our well practiced facades of empathy and concern? We see and mock the shallowness of the president’s responses. Why can’t we see how superficial our own expressions of solidarity against racism have been?
My father would occasionally joke with me and suggest that I had adopted the philosophy expressed by the idiom “let George do it” when I was confronted by a difficult or messy task that I just did not want to do. When I heard “let George do it” I knew that it was time for Gene to get to work. Now George has done all that he can do. Since it’s never been this late before, what comes next? Is it finally time to realize that something as ugly as racism and its shameful corollary of white privilege can’t go on forever, and is now the time for all of to get to the task of bringing it to an end? Perhaps those of us who are white should give more thought to the reality that by 2045, the year I become a centurion, caucasians of all origins will be a minority in America.
In retirement, my wife and I listen to a lot of news programs. After the last drug company ad, and the feel good story that usually comes before the sign off by the “anchor,” we usually ask each other: “Why did we do that? Why did we waste the time watching?” The return on investment in time and energy watching the news on TV is very small, because there are so many better ways these days to get the news, and there are no Walter Cronkites on the tube who can make it feel like legitimate journalism. This week has been different.
I am not talking about the riots, or the continuous replays of the video of Derek Chauvin crushing the neck of George Floyd with his knee. The moment of epiphany this week for me came when I heard an interview on the CBS Evening News between the anchor, Norah O’Donnell, and a black minister. In the interview he said, “It will take more than you being nice to me, and me being nice to you to fix what is wrong with this country.”
How do we fix this country? Where would we start if we really did want to do what Dr. King asked for in his “I Have A Dream Speech?” Remember, he said
“Five score years ago, a great American, in whose symbolic shadow we stand signed the Emancipation Proclamation. This momentous decree came as a great beacon light of hope to millions of Negro slaves who had been seared in the flames of withering injustice. It came as a joyous daybreak to end the long night of captivity.
“But one hundred years later, we must face the tragic fact that the Negro is still not free. One hundred years later, the life of the Negro is still sadly crippled by the manacles of segregation and the chains of discrimination. One hundred years later, the Negro lives on a lonely island of poverty in the midst of a vast ocean of material prosperity. One hundred years later, the Negro is still languishing in the corners of American society and finds himself an exile in his own land. So we have come here today to dramatize an appalling condition.”
We can add to Dr. KIng’s list of injustices by saying that black Americans still die at younger ages than their white neighbors in upscale zip codes. We can add that for reasons that we don’t fully understand, they are more likely to become infected with the coronavirus and die. We are puzzled to learn that the care that they receive when they are theoretically covered falls short of the experience that white patients receive. We can see the nation respond with the swift infusion of trillions of dollars of support if our large banks or manufacturers are on the brink of disaster, but we can’t find the resources anywhere to repair the situations that we neatly label the “healthcare inequities” or “healthcare disparities” that we know are associated with inadequate repair and maintenance of the “social determinants of health” in the communities where the black, brown, and poorer white Americans live in increasing despair. Many of us blame the people who suffer for the problems they can not solve, and contend that their misery is the “just desert” of their sloth and lack of character.
Dr. King was describing the state of things 50 years ago, 150 years ago and four hundred years ago. We have had dramatic evidence over the last ten days that a growing number of people have finally been shocked into considering what Dr. King asked us to ponder a half century ago. He had much more to say in the speech. He articulated a path that his dream might follow.
In a sense we have come to our nation’s capital to cash a check. When the architects of our republic wrote the magnificent words of the Constitution and the Declaration of Independence, they were signing a promissory note to which every American was to fall heir. This note was a promise that all men, yes, black men as well as white men, would be guaranteed the unalienable rights of life, liberty, and the pursuit of happiness.
He continues with the metaphor of a promissory note that has not been paid, a bad check. Fifty years later the debt has accumulated a lot more interest.
It is obvious today that America has defaulted on this promissory note insofar as her citizens of color are concerned. Instead of honoring this sacred obligation, America has given the Negro people a bad check, a check which has come back marked “insufficient funds.” But we refuse to believe that the bank of justice is bankrupt. We refuse to believe that there are insufficient funds in the great vaults of opportunity of this nation. So we have come to cash this check — a check that will give us upon demand the riches of freedom and the security of justice.
In every way, metaphorically, and in hard cash, the debt has never been paid. Lynchings, police violence against unarmed people stopped or detained for no real cause at all other than the color of their skin, and now a death by the slow crush of an airway are the sort of responses that increase the debt. Perhaps the worst part of the “failure to pay” has been that those who are asking for a “fair share” have been marginalized even more for having asked for that opportunity that should be a birthright expectation of every American.
Dr. King was speaking to people who had come from all over America to ask for the debt to be paid. After telling them to take the high road of non violent protest as they traveled back to their homes, he gives them his dream:
I say to you today, my friends, so even though we face the difficulties of today and tomorrow, I still have a dream. It is a dream deeply rooted in the American dream.
I have a dream that one day this nation will rise up and live out the true meaning of its creed: “We hold these truths to be self-evident: that all men are created equal.”
There was more, but we all know that he did not live to see his dream come true. He had a great faith, and he seemed to know that somehow and in some way that if something should not go on forever then someday something would happen to end it. Dr. King did not claim to be the author of the statement that “The arc of history (the moral universe) is long, but it bends toward justice,” but he used the concept so often that it became a truth for him and many who have followed in his footsteps. Barack Obama had the words woven into a rug in the Oval office.
What bends the moral arc of the universe? Is this the moment in history when the arc bends? There has been much more than peaceful marches of African Americans in big cities asking for the end of the police killing African Amercians. Demonstrations have occurred in every state and many unlikely places like the one in my little town on Tuesday evening. I know of only two black men in our town, both are immigrants from Africa, but since it’s never been this late before many residents of our town stood with the hundreds of thousands of other Americans of all races in all 50 states who showed up to demonstrations to try to be a small part of the reason that something that should not go on forever will finally stop. If you follow the link above, you will see a map of the country with dots showing where more than 430 demonstrations have occurred. It’s an undercall. My little town is not on the map, and I am sure there are many more that did not make the news.
The youth group at the local Episcopal Church in my town was responsible for the gathering on our green. On Tuesday the kids started a chain of emails inviting everyone to come to the green with a sign just before 7 PM. Over 200 people showed up wearing masks and carrying signs. There were no speeches. A young man with a microphone announced that when the clock in the Baptist Church struck seven everyone was to stand in silence for nine minutes to reproduce the time that a knee was pressed against the neck of George Floyd. We were told that another bell would chime nine times when the nine minutes had passed. Nine minutes is a long time. When the time had passed there were a few quiet conversations, much like the ones that might occur as people exit a funeral, and then we went home with the hope that in some small way we had contributed to a growing awareness that the time had come to end all manifestations of racism and white privilege in our country. My hope is that perhaps it is, since it’s never been this late before.
As I was standing in silence, I wondered how many or us had ever participated in some sort of public demonstration. It was my third effort. I stood holding a candle on a street corner in the center of Wellesley on Sunday evening March 16, 2003 with several hundred other people who were demonstrating to ask George Bush to not have us invade Iraq. We did anyway on March 19, 2003. I attended one other event organized bt high school students in our state in front of the state capital in Concord, New Hampshire in 2018 to ask the governor to sign a bill to increase gun control in the wake of the Marjory Stoneman High School shooting in Parkland, Florida. Governor Sununu vetoed the bill. So far, I am 0-2 in effectiveness at demonstrations. I hope that “the third time’s the charm.”
I think that even with the associated episodes of regrettable violence the demonstrations have been effective because they have involved so many people who see their own rights and safety diminished when they see an African American die under the knee of a very determined white police officer. Dr. King warned us that it was not the “bad people” who had prevented the debt from being paid. He implied that it was the silence of those of us who wanted to be seen as “good” that had perpetuated the swamps of racial hatred and injustice. It was those of us who looked the other way. Those of us who benefit every day from a class of people who are doomed by their poverty to do the dirty and dangerous jobs that in the COVID era we call “essential.” Dr. KIng said:
History will have to record that the greatest tragedy of this period of social transition was not the strident clamor of the bad people, but the appalling silence of the good people.
Perhaps when enough time has passed, history will record that the most effective thing this week’s demonstrations accomplished was to provoke the behavior from the president, a racist who gives cover to other racists, that was so egregious that the bastions of the status quo were shaken enough that many men and women of prominence finally spoke out. The words of General Mattis, our former Secretary of Defense and a much decorated general, may become the equivalent of the words of Joseph Welch when he famously spoke directly to Senator Joe McCarthy and asked, “At long last, have you left no sense of decency?”
The Atlantic published an analysis of General Mattis’ break of his self imposed silence along with his powerful statement. The power of his statement is multiplied by the reality that no one questions his patriotism or his leadership. He was respected by the forces he led in war because of the balance between his professionalism as a soldier and his empathy as a human being. He is a man that other people will follow. Is it too much to hope that his example will give others the courage to confront the president, denounce his divisiveness, and announce that we can no longer tolerate the perpetuation of the inequities of our collective racism? In case you missed his words that prove it’s never been this late before in the struggle to be a better America, here is his statement.
IN UNION THERE IS STRENGTH
I have watched this week’s unfolding events, angry and appalled. The words “Equal Justice Under Law” are carved in the pediment of the United States Supreme Court. This is precisely what protesters are rightly demanding. It is a wholesome and unifying demand—one that all of us should be able to get behind. We must not be distracted by a small number of lawbreakers. The protests are defined by tens of thousands of people of conscience who are insisting that we live up to our values—our values as people and our values as a nation.
When I joined the military, some 50 years ago, I swore an oath to support and defend the Constitution. Never did I dream that troops taking that same oath would be ordered under any circumstance to violate the Constitutional rights of their fellow citizens—much less to provide a bizarre photo op for the elected commander-in-chief, with military leadership standing alongside.
We must reject any thinking of our cities as a “battlespace” that our uniformed military is called upon to “dominate.” At home, we should use our military only when requested to do so, on very rare occasions, by state governors. Militarizing our response, as we witnessed in Washington, D.C., sets up a conflict—a false conflict—between the military and civilian society. It erodes the moral ground that ensures a trusted bond between men and women in uniform and the society they are sworn to protect, and of which they themselves are a part. Keeping public order rests with civilian state and local leaders who best understand their communities and are answerable to them.
James Madison wrote in Federalist 14 that “America united with a handful of troops, or without a single soldier, exhibits a more forbidding posture to foreign ambition than America disunited, with a hundred thousand veterans ready for combat.” We do not need to militarize our response to protests. We need to unite around a common purpose. And it starts by guaranteeing that all of us are equal before the law.
Instructions given by the military departments to our troops before the Normandy invasion reminded soldiers that “The Nazi slogan for destroying us…was ‘Divide and Conquer.’ Our American answer is ‘In Union there is Strength.’” We must summon that unity to surmount this crisis—confident that we are better than our politics.
Donald Trump is the first president in my lifetime who does not try to unite the American people—does not even pretend to try. Instead he tries to divide us. We are witnessing the consequences of three years of this deliberate effort. We are witnessing the consequences of three years without mature leadership. We can unite without him, drawing on the strengths inherent in our civil society. This will not be easy, as the past few days have shown, but we owe it to our fellow citizens; to past generations that bled to defend our promise; and to our children.
We can come through this trying time stronger, and with a renewed sense of purpose and respect for one another. The pandemic has shown us that it is not only our troops who are willing to offer the ultimate sacrifice for the safety of the community. Americans in hospitals, grocery stores, post offices, and elsewhere have put their lives on the line in order to serve their fellow citizens and their country. We know that we are better than the abuse of executive authority that we witnessed in Lafayette Square. We must reject and hold accountable those in office who would make a mockery of our Constitution. At the same time, we must remember Lincoln’s “better angels,” and listen to them, as we work to unite.
Only by adopting a new path—which means, in truth, returning to the original path of our founding ideals—will we again be a country admired and respected at home and abroad.
This president will not let such a rebuke go unanswered. He immediately blasted back on Twitter:
“Probably the only thing Barack Obama and I have in common is that we both had the honor of firing Jim Mattis, the world’s most overrated General. I asked for his letter of resignation, & felt great about. His nickname was ‘Chaos’, which I didn’t like, & changed it to ‘Mad Dog’,” Trump tweeted. “His primary strength was not military, but rather personal public relations. I gave him a new life, things to do, and battles to win, but he seldom ‘brought home the bacon’. I didn’t like his ‘leadership’ style or much else about him, and many others agree. Glad he is gone!”
Dan Lamothe of the Washington Post set the record straight because there were several lies in the president’s Tweet. He did not fire Mattis. Mattis resigned over the president’s policies in Syria. The president did not give the general the nickname “Mad Dog.” That title was given to him years ago by other members of the military who recognized his intense commitment. But, what did we expect? What’s two more lies when you have already made more than 18,000 false or misleading claims in a little more than three years?
There is so much more to say. As one of my colleagues in Kearsarge Neighborhood Partners told me just today, “Racism is a huge problem, but it is not the whole problem.” Racism multiplies all of the inequities of laissez faire, unregulated capitalism, in an era of widespread economic inequity. Dr. King knew that poverty enhanced racism and racism made the burden of poverty even heavier. Consider the wisdom in the following quotes:
“God never intended for one group of people to live in superfluous inordinate wealth, while others live in abject deadening poverty.”
Dr. King, “Strength to Love”, 1963
“A second evil which plagues the modern world is that of poverty. Like a monstrous octopus, it projects its nagging, prehensile tentacles in lands and villages all over the world. Almost two-thirds of the peoples of the world go to bed hungry at night. They are undernourished, ill-housed, and shabbily clad. Many of them have no houses or beds to sleep in. Their only beds are the sidewalks of the cities and the dusty roads of the villages. Most of these poverty-stricken children of God have never seen a physician or a dentist.”
Dr. King, Nobel Peace Prize address, 1964
“There is nothing new about poverty. What is new, however, is that we have the resources to get rid of it.”
Dr. King, Nobel Peace Prize address, 1964
“The time has come for us to civilize ourselves by the total, direct and immediate abolition of poverty”
Dr. King, “Where do we go from Here: Chaos or Community”, 1967
“Where do we go from Here: Chaos or Community?” was Dr. King’s last book. His conclusion after the legislative victories of 1964 and 1965 was that all Amercians should unite to end the poverty that would continue to define the opportunity and health of all Americans. He planned the Poor People’s Campaign and March on Washington that occurred after his death and the riots and demonstrations that followed his death in April of 1968. My friend is right. There is much more than racism that threatens us. We face greater poverty in the aftermath of the pandemic. We have a growing threat of capitulation to an authoritarian government designed to defend the property and advantage of a powerful minority that is willing to rape the planet and keep its knee on the neck of those whom it considers “less than” and expendable. It’s never been this late before. We are at a crossroads. Things are changing. What could not go on forever won’t. What is to follow depends on how we treat one another and how we manage this moment. The black minister on the evening news was right when he said, “It will take more than you being nice to me, and me being nice to you to fix what is wrong with this country.”
Looking For Summertime Relief From Much Grief
Summer has finally arrived! Well, I am pretty sure it has. It did get down to the mid thirties last Sunday and Monday nights. My wife had to blanket her tomato plants. I have caught some nice fish as has my old friend, walking buddy, and former colleague, Tom Congoran. There is nothing better than discussing the woes of the world with him on a four mile walk and then forgetting all that worries us as we putter around the lake catching and releasing big fish with him on the bow of my old boat, and me more than six feet away in the stern. Have you ever seen a picture that shows a man more at peace with the world? What made it even better was that his four year old granddaughter called just before he caught this big one to ask what he was doing.
Whatever is in your plans for the weekend, try to imagine a better, more secure world for all of the children of the world. It could happen. Anything is possible even if the best things we might imagine are not likely to happen until we learn how to more generously live together. If we do decide to reach for Dr. KIng’s dream it will take much more than being nice to one another, but that is a good place to start.
Be well! Practice social distancing. Wash your hands frequently. Don’t touch your face. Cover your cough. Stay home as much as possible. Assist your neighbor when there is a need you can meet. Demand leadership that is empathetic, 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
Thanks, Gene. I appreciate the truthful, wise, inspiring words of others that you have shared, as well as those of your own, interwoven into a powerful message. I happen to know that now you can add a fourth protest to your resume. I believe there may need to be a few more for you and the rest of us, to continue to move leaders to change laws and protocols, and to soften more hearts toward true justice.
Hi Gene, of course, and thank you! Your letter is what prompted me to share my plan and to ask the questions I did in the first place. I’ve added a bit to my comment plus my contact information. No need for you to serve as a go-between, although you are kind of offer! If you could post this in response to today’s letter, that would be my preference. Here it is:
Hi Gene,
As I’ve told you privately, the disproportionate deaths from Covid-19 among blacks and the Navajo have prompted me to research and write my next book on racism in American healthcare. The thoughts you’ve expressed today echo many of my own.
I would like to hear from your readers of color, and those who are white, what they know about racial bias in medical school selection and healthcare education, the delivery process, differences in facilities serving persons of color, funding, the institutional culture, cultural training and sensitivity, aspects of the clinical encounter between white clinicians and patients/families of color (black, Navajo, Asian, Latinex, and immigrant populations and subgroups of these), and any subject I have not mentioned that bears on healthcare disparities. I’m now reading the IOM report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare, which was published in 2003. It is a good introduction to this complex subject but it is now 17 years old.
I imagine much remains unchanged in the intervening 17 years, but since I am just starting my research I would like to be sure to read about all aspects on the healthcare education and delivery side that lead to disparities in treatment and outcome. For the moment I want to put aside the role of the patient (e.g., lack of insurance, fear of care-seeking, lack of access to facilities, pre-existing conditions, and more) and focus on the role of the healthcare system itself.
I have contacted the National Medical Association for their thoughts and have spoken with a few people who are knowledgeable about this topic. I hope your readers will respond to share their suggestions for sources to read, what a book like this should include, and whom I should talk to. Readers can contact me directly at: eveshapiro912@gmail.com
Thanks, as always, my friend,
Eve