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Archive for December, 2019

We May Disagree. We Are Not Enemies.

I wrote the essay below some 7 years ago. If you substitute “disagree” for “different” or “other” everywhere it turns up this very much applies to our present day world where single issue differences threaten to divide people who should actually be joining together.

 

“The original “word” for this thought was to be “enemy”, but the more I thought about it the less that seemed to apply. You see, “enemy” is really a very simple concept, one that is just too black-and-white in this world of grey in which we live. An enemy is nothing more or less than someone who has openly declared intent to do you harm. Nothing too very ambiguous about that.

This is very different from a person who dislikes you, or someone you dislike. It’s fundamentally different from someone who is angry at you. These folks can simply be ignored; they can be consigned to the trash heap of indifference. I’ve been known to say that it’s perfectly OK to make an enemy as long as you’ve done it on purpose so that you can assess the ramifications beforehand. Re-thinking this in light of a more accurate definition of “enemy” probably changes my tactical advise to “it’s OK to make someone angry at you.”

This is important today as we traverse our lives with our “situational awareness goggles” on high, important when we identify someone who is better described as “other” as “enemy” or “possible enemy”. By any measure we actually live in a world which is incredibly safe. We are not surrounded by legions of enemies but rather by “others”, people who stand apart for one reason or another as different. Maybe even odd.

If we view our world as one which is inhabited by only friends or enemies we are at risk to categorize these “standouts” as dangerous until proven otherwise, all data to the contrary. We are at risk to extrapolate the actions of one “other” to all, even those who share nothing with those villains besides their “otherness”. Is this really necessary?

Frankly, my worldview as a young man was very narrow, my willingness to even let the “others” be “something” less than zero. No, “others” were to be feared or ridiculed; they were certainly not meant to be ignored, let alone accepted. Now? Most of the “others” are just varying degrees of different, nothing more. Pick a number…99point whatever % are just that and will never be anything more diabolical or dangerous than a friend might be. They will never be an enemy, no matter how much their “otherness” sets us apart.

For most of us the world is filled with friends and others. We just don’t have that many enemies known or yet to be discovered. I do not advocate replacing our “situational awareness goggles” with “pollyanna specs”, but we really don’t need to have the setting on “high alert”. The risk of the false positive, the risk of identifying an “other” as an enemy is very, very high because there really are very, very few real enemies. Very few people who mean you, or anyone, true harm.

Don’t let the cacophony resulting from the rare sighting of an enemy, of evil, blind you to the fact that those who will not be your friends are almost always just “others.”"

 

We may disagree. In and of itself this does not make us enemies.

“Up By Your Bootstraps”: An American Success Story. Sunday musings 12/22/19

While fooling around on Twitter the other day I stumbled upon the latest beauty from Robert Reich, the Nobel Prize winning economist who has been making a mockery of his earlier achievements as a present day pop-culture economist: 60% of wealth in the U.S. is inherited. Now if that is even true it is at best brutally misleading, verging on dishonest. If even 60% of the dollar value of wealth was inherited the reality is that over the last 30 years whatever the original value was of that inheritance it  has increased many, many times over, falsely elevating its percentage level. What is much more misleading though is the purposeful effort to let readers assume that 60% of the people who would be considered wealthy (pretty low bar to be wealthy but that’s a topic for another post) got that way by inheriting their money. That’s just not true; a super-majority of the global value of wealth in the U.S. is actually concentrated in a very small cohort of super-rich.

What makes Reich’s clickbait headline and lede even more galling is that he uses his little bit of data sleight of hand to dismiss the cherished “up by your bootstraps” (EBYB) story line that underlies the success of literally countless narratives told by American families about their rise from poverty. Indeed, the possibility of EBYB success is a large part of what continues to drive people from all over the world to seek a new beginning by emigrating to America. Reich is calling BS on the entire EBYB path to success and in doing so saying that to seek an EBYB success is a sucker’s game.

Reich is just the latest and most famous non-practicing celebrity economist to let his fascination by, and revulsion at the super-rich blind him to the day-to-day reality of middle class success.

It is the rise from poverty, the elevation from being among the working poor and taking an UBYB approach to leaving both of those states that matters. The creation of super wealth, even the creation of entry-level wealth, is little more than a pipe dream for almost everyone who desires to  rise from whatever financial straights exist at the beginning of their journey. What matters, and what Reich casually nullifies, is not the immigrant who amasses a billion dollar fortune by becoming the owner of the largest yogurt company in America, but the thousands of immigrants who scrimp and save and buy a retail outlet that sells yogurt and at which they will toil for endless hours in order to support their families. It’s not the second generation that takes over the family-owned car dealership but the hundreds of tiny entrepreneurs who buy a NAPA franchise in order to create a little nest egg that can’t be formed as a line worker at Ford. In that 40% of wealth lies a super majority of small “fortunes” consisting of the fruits born from UBYB success stories.

At the risk of being accused of substituting anecdote for analysis (albeit looking at the flip side of Reich’s own story coin) let me tell a couple of stories to illustrate that UBYB is much more than myth. My Dad was born into a family of the working poor during the teeth of the Depression. One of six children his family expanded (to 10? 12?) when his mom died and my grandfather remarried. Dad was a “cardboard in the shoes kid”; when your shoes got a hole in them you neither got new shoes nor a new sole, you stuck a piece of cardboard inside the shoe to cover the hole. Family lore has it that Dad was plucked out of the trade path in high school by a teacher who saw in him the potential to rise. Upon graduation he went to UNH on a football half scholarship, whereupon he promptly starved for lack of money. Like so many young men of the time he joined the Army. During his enlistment and his years fighting in Korea he rose to the rank of Sergeant First Class. After mustering out he went to UVM where a combination of another half-scholarship and the GI Bill got him through school. Dad graduated with a degree in what we would now call industrial engineering, the only member of his family to get a degree.

Our life in the early days of Dad’s career (Mom stayed home after I was born) was one of “enough”. We had risen above the level of working poor, but the most charitable description of our status would be to say that we clinged to the lowest rung of middle class. But my Dad was a true believer in the UBYB dream. He put himself through Business School as he slowly rose among the ranks of middle management at the company where he began his career. When that company was sold and much of the lower and middle managers were let go Dad caught on with a much smaller, older, family owned enterprise. After quadrupling sales at the new company he and two other senior mangers bought out the founding family. For 15 years of so our family was comfortably in what at the time would be the upper middle class. Mom and Dad prepared a wealth starter kit in the hopes that their good fortune would continue on the same upward trajectory.

Did we become wealthy? Did my siblings and I enjoy the fruits of my Dad’s success with a big inheritance or a big infusion of start-up capital at the beginning of our own journeys? Sadly, this was not to be. For all of my father’s brilliance at running a small company he was not equally adept at divining the effects of large macroeconomic trends. The 80′s brought crushing interest rates, inflation, and an artificially inflated dollar, all of which conspired to destroy not only my Dad’s company but the entire domestic industry of which he was a part (there are no manufacturing companies in the U.S. remaining in his industry). There will be no generational transfer of wealth; Mom just sold the family home and hopes that the sale will support her for the rest of her life. Was Dad’s UBYB story a failure? Of course not. My parents sent four kids to college, all four of us debt free on graduation. We are all economically independent and have been since graduation. We would all be counted among that 40% Reich dismisses.

Cynical readers, especially the young, would say that my parents’ story has nothing but historical relevance. Such an UBYB story was little but a historical footnote by the time my Dad bought his company. Nothing could be further from the truth. I have two very close friends, men I’ve know since school days. My oldest close friend grew up in a family that was devastated by mental illness. He and his father shared a one bedroom apartment, taking turns between the single bed and a couch, floating just above the poverty level of the 70′s. Mother and Father were high school grads; there was little familiarity with college as a goal. Like my Dad my friend was raised up by teachers and the parents of a couple of classmates and put on a straight shot to a college degree. He got some scholarship aid and took out a bunch of loans and graduated from a highly selective college. My friend has taken himself UBYB to where he now has generational wealth. None of it was inherited. There was no wealth to disburse when his Dad died a couple of years ago. Indeed, I think he paid for the funeral.

As an aside, as this is the Christmas Holiday season, my friend is the most grateful human being I know. His Birthday is on Christmas Eve. You know how some Christmas babies always resent the fact that they have to “share” their day with Christmas, complaining that they get shorted because of the overlap? Not my friend. There wasn’t anything under the tree or wrapped up in a “Happy Birthday” package; there wasn’t anything at all. To this day I have never heard a single word of resentment from my friend. He is grateful for every tiny blessing that comes his way, even if it has come because he bought himself up by his bootstraps. My Dad was like that. They are both inspirations.

So you see Mr. Reich, even if your data is accurate and tells the story you’d like us to think it does, it still doesn’t render moot the power of UBYB wealth. Wealth, it turns out, is sometimes better measured in smaller ways than those that catch the attention of starry eyed celebrity economists. Sometimes it is something as small as being able to resole a shoe or order a new pair of sneakers without worrying about the rent. UBYB might mean the next generation goes to college. Maybe they even graduate without debt. Where once there may have been inherited wealth for my siblings and me to look forward to perhaps there will be that kind of wealth for our children and/or grandchildren.

“Up by your bootstraps” wealth is about people, and there are many, many more people in that 40% you deride than those fortunate few who have assembled the 60%. The opportunity to raise yourself “up by your bootstraps” within sight of that 40% is still the American Dream. It is still the hope of a nation, the antidote to the pithy observations of economists enthralled by the super rich, the engine that lifts countless families out of poverty. “Up by your bootstraps” is no myth.

 

 

A Lesson About Customer Care: Sunday musings…12/15/19

As hard as it may seem to believe this, I learned a valuable lesson about taking care of patients from an airline. Granted, this occurred because I had an unpleasant (for me) interaction on a rather long flight because a flight attendant had an unpleasant interaction (because of me) at the very beginning of that flight. My lesson can be applied any time one finds oneself on either side of the service continuum.

We should give a patient who may be having a hard day the benefit of the doubt.

This weekend I was in Las Vegas for a meeting with my very favorite people, fellow members of the small professional group called CEDARS/ASPENS. It’s a lousy time of year to be traveling, to be away from home. At my best I am a reluctant traveler when I am away from Beth, and at this time of year I’m also a little tired and cranky. Couple all of that with a late night prior to a very early morning flight (and a 3 hour time change to boot) and I was pretty much one big exposed nerve getting on the plane.

Knowing this would be the case Beth had helped me out by booking a bit of extra leg room, purchasing a carry on slot, as well as early boarding. On the outbound leg I had all of this too; I arrived at the gate a bit tardy and ended up with my roller bag 7 or 8 rows behind my seat. My bad, since I was a bit too casual getting to the gate. But on my return flight I was chilling in the gate area for area for an hour; when I got trampled by folks rushing to get on board first in that early boarding group my mood started to darken. Naturally all of the overhead bins around my seat were filled. My attempt to jam my bag in was unsuccessful. Once again I ended up with my bag several rows behind my seat. The flight attendant asked if that was OK and my instant, out loud response was: “nope. Not OK. Not even a little OK.”

I instantly regretted it.

You see, my tiny moment of petulance, during which I was admittedly behaving like an entitled brat, resulted in that flight attendant punishing me for the rest of the flight. For the next 4 hours she effectively ignored me. Not subtly, either. I sat with a credit card out to buy a drink and a snack while my row mate got a coffee. She failed to acknowledge this obvious cue that would otherwise have had her jumping to sell me something (and garner a tip). Newspapers piled up around me as she scooted by with the trash bag, and the beverage cart glided past my row during each trip down the aisle. Thankfully one row mate was sound asleep for the whole trip and the other only had that one coffee request. They did not suffer for my transgression.

Was I badly treated? Yes, of course I was. But I knew in a nanosecond after my micro-tantrum that it was going to happen. The flight attendant was not having any of it, and she was either unaware of the downstream risk she might be creating, or was willing to use her position of power while in flight to deal with any reaction I might have had to being “shunned”. Why didn’t I assert myself and request the same service offered to those around me? After all I was hungry, thirsty, and under-caffeinated. Looking back I am sure that I did not “raise my hand” because it was  obvious that my flippancy had created an enemy. I have spent so many years evaluating the micro details of the customer care experience from both sides that my reaction was to observe and analyze.

Which of course leads us to the question of where does the lesson lie and for whom is it meant? There is certainly a lesson for the young flight attendant but it is not for me to provide. I will tag the airline when I link this on Twitter in the hope that the lesson I learned might be shared with all of their flight attendants. I will not identify my flight; after all, the “original sin” was mine. Rather, I will look at this for an insight into how we as physicians and our staff might be better able to serve our patients when circumstances may not be optimal. Realizing how hard it is to be always “on” for passengers I am almost always solicitous and bring minimal demands to flight attendants. Most of our patients behave like this when they come to see us.

It is where a patient, the “served” individual in the service continuum, behaves less than perfectly that the lesson for me lies. An edgy or unhappy person should be given the benefit of the doubt as long as they do not persist in angry or unhappy behavior.  The young flight attendant whose job it is to provide a service did not give me the benefit of the doubt. My behavior after being seated was impeccable. I neither pouted nor complained. How often do we see a patient who comes into the office and instantly pops off to the reception staff about something trivial like filling out a form? You know, the equivalent of having to place your carry on a few rows behind your seat. Or in the exam room is a little aggressive with the first question? Do we as healthcare providers, doctor and staff, treat them from that point on as if they are the passenger who won’t hang up their phone, put their seat back up, or stay out of the aisle for the entire flight?

Or because we don’t know anything about what else is going on for them do we instead give them the benefit of the doubt? Allow them a few moments to demonstrate that their first little outburst was just that, a trivial anomaly, and not an indication that they are going to be an ongoing problem?

That’s the lesson I learned from the 4 hour punishment for my tiny, brief moment of pique. When presented with a patient who is on edge, who may be less than cuddly on first blush, we should offer them the benefit of the doubt. At least until they demonstrate that they are going to double down on their petulance rather than move beyond it. While I was pretty hungry by the time we landed, in the end I am thankful for the tiny lesson in customer care I received while flying home from Las Vegas.

 

 

Memories and Remembering: Sunday musings…12/1/19

Not gonna lie, Thanksgiving this year has been a tough go for me. As you know Thanksgiving is far and away my favorite holiday. The coming together of family and friends for nothing but the joy of coming together as family and friends has always touched my soul. That we would or could continue to do so year after year has been a bit of a touchstone for a kid (and a couple) who moved away. For more than 30 years we have alternated in some way between extended families. Where once we needed only manage two generations there are now four in the mix. 2019 was an “off” year for us, a year when children would prioritize in-laws (if even that was possible). Beth and I neither hosted nor traveled to be hosted by family for Thanksgiving dinner (hugs and infinite thanks to the Taylors for folding us into theirs and to Randy and his little family for joining us for brunch).

I missed everybody.

Seriously, I was a mess. Just a great big blubbering mess. I missed everyone, those both simply away and those who are gone. This longing was occasionally just below the surface, and to my wife’s great amusement bubbled through at pretty much every tiny little emotional prompt. It goes without saying that I sprung a leak watching “Mary Poppins” and “A Beautiful Day in the Neighborhood ” (the Mister Rogers movie), but come on, I cried at the end of “Downton Abbey”. Everybody lived! Everybody was happy! And I still cried. Don’t even get me started about that new “E.T.” commercial. Sheesh.

For whatever reason, well, probably because we wouldn’t have a typical family Thanksgiving, I’ve been thinking quite a bit about family members who are no longer with us. It’s been a tough few years for the White and Hurst families, and for the families of our sibling’s spouses for that matter. I’ve found myself thinking of my Dad and my Father-in-Law, wishing I could chat about any number of things. We stumbled upon a lovely picture of Sandy, my Mother-in-Law, making Christmas cookies. So vibrant, so alive in that picture. My memories of those holiday moments came alive, too, a rush of color and smiles and scents and laughter. Bob’s puns. My Dad’s terrible palate that could nonetheless parse the provenance and price point of Chateauneuf de Pape. They are here with me as if we’d had dinner yesterday.

If I had the guts I would re-watch “Coco”, that lovely little Disney movie about the Mexican day of remembrance Dio de los Muertos. I don’t, and I won’t, at least not now while I seem to be just one raw exposed nerve, but if I did it would probably help a bit. Remembering, that is. Harold Bloom, the Yale professor of literature and societal scold, has given this some thought: “Our beloved dead live only as long as we absorb them into our daily thoughts and feelings. When we die, our own survival will be the extent to which we have changed the lives of those who come after us.” Very Mexican, that. Still, both Bloom and Coco are right; Beth’s folks and my Dad have been here with us this Thanksgiving.

Are they in Heaven? Boy, for as much thinking as I’ve done about that over the years I still don’t know where that is. Heaven, that is. Is it a place like what Disney depicted in “Coco”, where our dead live for as long as they are remembered by the living? Does the Heaven of my upbringing exist as a place of eternal joy for those whose lives were deemed worthy? Or is there some other, more rational explanation like the one that my genius brother-in-law and I have explored through quantum physics? The multiverse of infinite time going both forward and backward?

Or perhaps it is not our beloved dead who are in Heaven but us. Maybe it is we who are in Heaven. Mr. Rogers: “The connections we make here in the course of a life–maybe that’s what Heaven is.” Maybe Heaven is here, now, and those we’ve lost in the flesh are nonetheless here with us in Heaven for as long as they are remembered. Make no mistake it is easier and far more satisfying to be warmed by a hug than a memory. But still, the connections persist. That’s likely the important lesson for me this Thanksgiving. The rituals help us to remember, and the remembering keeps those we love and have loved close by. My beloved Thanksgiving, in every version, may be as close as I will ever come to understanding Heaven.

And that it’s OK for me, for anyone, to want a little more of Heaven.

 

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