Sometimes when my mind is wandering around with no particular place to go I like to think about all the things that have changed in my lifetime. For example, our first telephone number that I can remember was just three digits. My grandmother was on a “party line” which meant that her neighbor, and not Google, was eavesdropping on her conversations.
I once enjoyed thinking about all the medicines that had been introduced since I graduated from medical school. The list got so long, even in cardiology, that it became easier to think about the few medicines we did have in 1971. We could use propranolol, off label, for angina and hypertension because it had been approved for the treatment of thyroid storm. For hypertension we still used a lot of Aldomet and occasionally used reserpine or guanethidine. I was once prescribed reserpine for my blood pressure and had nightmares that were certainly a “bad trip.” We had furosemide and ethacrynic acid, but we still would occasionally talk about mercuhydrine and all the tricks associated with its use. We were confused about whether we could use nitroglycerin after an MI was diagnosed, but used it a lot for angina. Our only anticoagulants were heparin and Coumadin. There were no ACE inhibitors, ARBs, calcium channel blockers, H2 blockers, or proton pump inhibitors, not to mention the hundreds of immunologically active injectables with names that end in “ab” that I can never pronounce.
Back in 1969 when Neil Armstrong and “Buzz” Aldrin were walking on the moon with Michael Collins circling above no one had heard of helicobacter pylori, AIDS, or Lyme disease. Spicy food and stress were still thought to cause most peptic ulcers, and ulcers, especially after they caused an upper GI bleed, were often treated by removing most of your stomach, a procedure now more often employed for gastric cancer. Also popular was a Bilroth II, or a really enlightened surgeon might suggest a vagotomy and pyloroplasty. Since we had no proton pump inhibitors or H2 blockers, it was milk and Maalox, a bland diet, and when those treatments failed, surgery. Things do change.
Medicine is not the only thing that has evolved. The nerds who were in computer science when I was in college in the mid sixties wore slide rules on their belts, and carried around huge boxes of punch cards that they spent months working on before they got a few minutes to try out what they had created late at night when their turn came on a “mainframe” that was located on a distant part of the campus I never visited.
I attended public schools that acted like they had not gotten the memo about Brown v. Board of Education. My first heartthrob was a junior high cheerleader. I don’t know if she could have played soccer, volleyball, or basketball because those options were not offered to her. It was band or cheerleading for girls. I think that the girls played some games in their physical ed classes, but the general opinion was who would want to watch them play a game? The “Friday night lights” were for guys.”
There are several reasons to remember the fifties and the early sixties before the Beatles, the birth control pill, Vatican II, and Vietnam. Those years played out against the background of the continuing struggle for civil rights for African Americans, a generalized fear of a nuclear holocaust, and the persistent threat of communism. Those were times that were an inflection point in our society. There were many new wrinkles in our social fabric, and it was the beginning of an accelerated harvest of technologies that would send us to the moon as it loosened the grip of small town scrutiny on our behavior and obliterated much of the pressures to conform with the values of the previous generations. In the wake of those accelerating technologies and the changes in social norms that we acquired, we now spend many hours a day staring at small screens and have a strange need to continuously check on how we are doing compared to everyone else we know. Many of us can’t put our phones down even when we are sitting across the table from a spouse or date at an expensive restaurant. I recently got quite anxious when I realized that I had left my iPhone at home, and it would be four hours before I could see how the world was doing without me.
This week we will be celebrating the fiftieth anniversary of the success of Apollo 11. I do not believe it was fake news. Although I do know that there are some on the fringe of rational thought who still contend that the moon landing was filmed by Stanley Kubrick or somebody like him on a sound stage at a Hollywood movie lot. One of my most cherished memories of fifty years ago is of my wife, our small son, and me being invited into the apartment of a neighbor in Highgate Village outside London where we were living while I worked for the summer in a surgical lab at the University College Hospital of the University of London. The invitation was to join others to watch the telecast of the moon landing on a small grainy black and white screen.
There must have been at least fifteen people, all British except for us, who marveled at the scene. There was a sense of shared awe for the great accomplishment on behalf of all people everywhere. Then the others in the room began to congratulate us because we were Americans. It was as if we had had a personal hand in the success and deserved some sort of special recognition because of what America had done for everyone. I have a cognitive disconnect when I ponder what our president means when he asks us to Make America Great Again as he creates divisions between us at home, and separates us from our traditional allies abroad. Is he directing us to live in an aparthied like environment as we did in the fifties? Perhaps he means that we should try to lead like we did with Apollo11? Does he have some different type of greatness in mind?
I just need to know to what moment in time we should turn back the clock. What previous attitude from what era of greatness should we resume? Should we go back to when we virtually eliminated the native population of North America under the theory of “manifest destiny?” We are in general agreement that we are really better than every other country, and that God is on our side, right? Have the lefties among us forgotten the concept of American exceptionalism?
It was silly of me to be thinking about the early sixties, moon landings, the exclusion of girls from sports, and American exceptionalism last Sunday while I was watching my grandaughter play volleyball with members of the Dartmouth Women’s Varsity Volleyball team at a volleyball camp on the campus of Dartmouth College. She is a great history student, but just as I never really understood the traumas my parents suffered in the Great Depression, there is really has no way of her understanding how different her life would be if Title IX had never been passed by a bipartisan coalition and signed into law by a Republican president, Richard Nixon, back in the early seventies. If the world had stayed as it was when her grandmothers were teen aged girls, she would never have had the fun and personal growth that has been associated with a high level of competition, and the excitement of seeing what she can achieve. Bills like Title IX, and like the ACA, do require a learning curve for the nation and those huge social changes of direction must overcome resistance from those who do not want to see change.
Just as there are huge challenges ahead for healthcare and legal barriers to the continuing existence of the ACA, there are plenty of challenges remaining for the exceptional young women of my granddaughter’s generation. When I look back over the road we have traveled in my lifetime, I feel good about the prospects for continuing growth in opportunity for her. The recent success of our Women’s Soccer team in the World Cup, followed by the demand for equal pay for the women compared to the men who have never been victorious, is an example of further impending change. There is still much to be done before we can say that women really have an equal opportunity to both play and be paid fairly in soccer and in life. Change, or the cry for change, will always create uncomfortable moments. It’s not clear yet whether the team will be invited to the White House, and if invited whether they would go.
As I was thinking about what has changed over the decades in national posture, medical practice, computer technology, civil rights, and even in women’s athletics, I also began to think about what hasn’t changed. I believe that we still have a deep sense of patriotism. I do believe that most of us have a desire for our country to be seen as a positive force in our world. I believe that we have a preserved ability to make sacrifices both for abstract causes and for people we do not even know. I believe that most people want a chance to do their best, and will not cheat to win. I also think that most of us believe that we are a great nation that still has the capacity to be greater yet than we have ever been before, if we do not lose our sense of caring for those who are less fortunate than us at home and abroad. I do believe that if we have proven that we can give every girl a chance to play a sport at school, we will also make sure that she has access to good healthcare. Even though we have not proven yet that we will treat her fairly when she enters the workforce, I do believe that day will come. I think we have proven that we have the capacity to give every child, and their parents, a chance to be healthy and continue to enjoy a world of expanding opportunity. We just have not agreed on the details of how to do it. There is ample evidence of our progress, as Stephen Pinker tells us in Enlightenment Now: The Case for Reason, Science, Humanism, and Progress, and there is reason to be hopeful that we will be able to parlay our advances into a better world for everyone even as there are glaring holes in the fabric of fairness and equal opportunity, if we just stay the course.
As I looked down from the spectators gallery at the young women demonstrating their volleyball skills in the Dartmouth gym, I was also delighted to see that there was an amazing ethnic and racial display of diversity among the participants. That scene led me to think that with persistence and a continuing conversation about what would be better, we have come a long long way against an incredible amount of resistance without adopting an authoritarian form of government or restricting anyone’s rights. We have further to go, and as we travel forward we should remember that have come this far because of a bilateral willingness to talk, and a raw persistence of purpose. The only safe way forward is to continue to demonstrate a willingness to continue to talk about the differences in opinion among us without resorting to the use of force, or attempts to curtail free speech. It is much talk and respect for the opinions of others reenforced by constitutional process that has brought us this far. An espoused shared American dream of a better world has been the common ground and bedrock upon which our accomplishments have been built. We must continue to use the norms and mutually accepted rules of democracy to evolve changes that stick like Title IX, even as we defend in the courts, and in our elections the accomplishments like the ACA that are stepping stones to the Triple Aim.
