Thursday, December 1, 2016

The Five Senses, Plus At Least One


The day of the amateur scientist is gone. Everything is professionalized, even sports! Bigger and better, everything!

So, when I start to think I have something in mind that is new, I know that can't be correct. It isn't correct, it can't be.

But anyway, I thought I'd check it out. Here's the thing: traditionally, we recognize five senses: vision, hearing, smell, taste and touch. Fair enough, but this is a small and restrictive list. There is always talk about a Sixth Sense, often in sci-fi mode. It's mystical. ESP – like a ghost sense. I don't believe in that – even though I've thought from time to time that I've had something, like the time I played 20 questions and got to “German composer starting with the letter 'h'” without missing one question (it turned out to be Hindemith). But I don't believe in voices of the dead or ghosts or crap like that. Or the vague sense that he's no longer there.

It's true that other animals have senses we don't have – like radar or magnetism. We might have some of that that we're not quite conscious of. Certainly other animals perceive the world around them differently from the way we do because of their different balancing of their senses – imagine how a sense of smell orients a fish, for instance, think what their world is like. Our book club read a book that sought to explore that – what would it be like to be an otter, or a swift? (Being a Beast: Adventures Across the Species Divide by Charles Foster – my advice, do not read.) We are primarily vision and hands, and then big forebrain, I think.

But what struck me was something that we use all the time but somehow has not been described as a sense. That is this: the Sense of Time. We have it, we all know that, but somehow it may not have been described as a sense. It's kind of mysterious because it is one of those things that pops up, that isn't under our conscious control or even our conscious supervision. And time itself is always mysterious.

There is the straightforward sense of “How long has it been? It seems like it's been 20 minutes, doesn't it?” Check on your watch and it's been 19 minutes. Somewhere we have a sense of time, click click click.

It's also somehow different because it gets distorted, depending on what we're doing. If I'm on the computer writing something, time passes “quickly,” and it's time to go before I know it. So, there is some lack of precision depending on circumstances. But that variability also shows that it's there.

Then there's time at night – how do we know how long we have been asleep? Somehow, I tend to know, but I don't know how I know.

Also, what about the phenomenon of awakening just before the alarm goes off? Who hasn't that happened to? How does that work, exactly? I sure don't know, but I know it does. There is the same wonder as when something pops into our head we've been looking for, or even what we weren't looking for. Pop, pop, click, click.

So, as I say, this is not the time for us to simply appear at the Royal Academy of Science and make a short address to the learned ones in attendance and have observations and thoughts recorded in the Proceedings of the Royal Academy by the secretary, to be noted years later when the functional MRI depicts exactly where and how such calculations are made in the brain, and how they come not to be sensed directly by the executive function. If one wants to establish precedence, one can't be an amateur off the street. One needs to be established to be famous.

So, time as a sense must have been thought of before, right? Of course it has been! Of course.

So I looked it up on Google and found this: The Five Senses -- http://udel.edu/~bcarey/ART307/project1_4b/. Great little discussion. Talks about some other senses that might be described, which I had thought about myself. The interoceptive senses that perceive states within the body – you feel hot. What about feeling thirsty? The author says: “Humans have other senses that they are aware of, outside of the Traditional Senses. Senses like Balance, Temperature, Kinesthetic sense, and Pain.” GREAT! No sense of time listed!

So, I'm not looking any further. I figure, it's now in the Proceedings of Budd's Blog, as of today. Forget being first to the pole, that's so passé.

Actually, to be serious, I bet that functional MRI's are going to chart a whole bunch of neuron complexes firing off, and they'll chart what set them off, and where the firing went, and get all our known senses charted, and then some we don't know about will be discovered – what was it that set that firing off? Ah-hah, it was … what? Something. And they'll trace to where the firing landed, and maybe even see unconscious adjustments made by the human being. And some will remain a mystery for a long time. They will also compare species, and see just how different we all are. The problem of the brain will go on for a long time.

What a great mystery.

Budd Shenkin

Thursday, November 24, 2016

Shock Election -- The Perfect Storm



Poor Hillary! She wanted it so much, for herself, and for women. Poor us! We wanted it so much for ourselves, for women, for not Trump. Poor us, into the morass, where we will need every ounce of determined optimism we can muster.

This is an election that takes some getting used to. They all do, but this one especially. A decent woman lost to a man who has said terrible things repeatedly, a man with heinous associates. I'm confident of the basic strength of our democratic institutions and our culture – Hitler rose because of German weakness, not necessarily because of the strength of his own thugs – but it is scary, no question. And who knows, maybe Trump will grow in office. It's possible, and believe it or not, I'm hopeful.

It's tempting to be mad at Hillary. She brought on so much of it on herself. But then, so do we all. It is hard to escape oneself. She waged a deficient campaign in 2008, and voilá! – here we were again, misreading, mishearing herself and others with a tin ear. For a pro, you have to wonder – missing the importance of the caucuses in 2008, and not foreseeing the fenestrations of her Blue Wall in 2016. Reproducing the Romney 47% phenomenon with her own Basket of Deplorables, thus cementing the impression of her bubble existence. But as I say, she clearly couldn't help herself. If she coulda, she woulda. Her effort was unrelenting, and she surely got better and better. She did, after all, win a strong plurality of the popular vote.

Of course the explanation for her loss is multifactorial, from misogyny to the Electoral College to Comey to poor messaging to fake news from Macedonian teenagers, etc. I think it could be called a Political Perfect Storm, with every break going the wrong way. And Trump in his way was surprisingly effective.

Now, two weeks out from the Shock Election, the interesting question for me is not not only why it broke for Trump, why the perfect storm happened, but why it got to be so close that it could break for him. I'm look at two things here – technical analysis of our electoral process, and psychological analysis of the Democratic candidate.


Constitutional Minority Protections

One of the known evils of democracy that the Constitution was careful to avoid is the Tyranny of the Majority (TOM). While we worry currently about minority rights according to identity, the Founders worried about the size of states: Delaware and Rhode Island didn't want to be bullied by larger Virginia and Massachusetts. We are all familiar with the solution of two Senators from every state, the Electoral College, and voting by state if the Presidential election gets to the House of Representatives.

But there is another protection against TOM built into the Constitution which I don't think the Founders thought about. That protection derives from the fact that voting is voluntary and not compelled, as it is today in Australia, for instance. This protection works against a well recognized flaw in straight democracy, the Problem of Intensity. The POI is this: what if 51% of an electorate is kind of against something, but 49% is strongly for it? Wouldn't it be fair for the intense minority to prevail over the shrugging majority? With non-mandatory voting, enthusiasm and turnout is a partial answer to the Problem of Intensity.

Both these protections worked to Trump's advantage in this election; both minorities – small rural states and intense and aggrieved believers – exerted their protections fully. Without them, Trump would not have come close, for as we know, Hillary outpolled Trump by over 2 million, or 1.5% of the popular vote. Hillary piled up votes where they didn't make a difference, and just barely lost in swing states. Trump's combined margin of victory in Wisconsin, Michigan and Pennsylvania appears to be about 107,000, giving him the Electoral College win. Vanity candidate Jill Stein received 131,000 votes in those same states. What a wonderful result for the virtuous ultra-left, delivering the election to Trump. As I say, it really was a perfect storm.

When the EC was formed, Virginia was 11 times as populous as Delaware. Today, California is 65 times as populous as Wyoming. Unfortunately, it was a couple of bridges too far for the framers to propose a sliding scale for the future, and now it is unrealistic to foresee small states voting themselves less power. If that were indeed possible, however, I would propose a rebalance by stealing a Republican idea for tax simplification and establishing three levels of states depending on population: one Senator, two Senators, or three Senators, which would reform the Senate. For the EC I'd propose a formula that would put a lid at 5 to 1 as the maximum difference allowable in population represented by an Elector. Yes, Wyoming would still be over-represented and California under-represented, but it would be closer. Nice idea. Let's move on.

Non-mandatory voting will also be with us forever. In political theory, voting is the final verdict on policy conflicts, and voting settles who gets what. In fact, though that might be the result, voters hardly think through their votes on that basis. Instead, they vote for visions, hopes, dreams, fears, resentments, delusions, and their own projections and hopes of being taken care of. Or you could say, they vote a feeling of “who gets you,” and “who do you get.”

Because of non-mandatory voting, the key to a Presidential election is turnout, and a key component of turnout is enthusiasm. There are other factors that weight the scales – political machines turn out votes, voter suppression laws are often judged to be legal and are effective, untrammeled political contributions favor the moneyed interests, and older and wealthier citizens are more reliable voters. In effect, non-mandatory voting also helps to protect the interests of the moneyed minority.

But it sure ain't simple. It is by now an American tradition to vote (or choose not to vote) against your economic interest – as in What's the Matter with Kansas (Thomas Frank), where socially conservative voters consistently deny themselves their economic interests in favor of some half-thought out ideology. On the other side, more educated voters vote in favor of raising their taxes (although a case can be made that this is in their enlightened interest.)

In this election, however, the difference of enthusiasm between supporters of each candidate was large, possibly decisive, and enthusiasm turns on the irrational factors cited above. Trump voters in key close states and some key counties decided to come out and vote this time because of the intensity of their feelings, largely that they were being systematically overlooked by the Establishment, and that Trump “got them.” Trump was a hot-button candidate, while Hillary, who would have governed well in prose, could not mount a campaign with sufficient poetry (and a smart enough economic message) to bring out her voters enough in key states and key counties.

Technically, then, this election went to Trump because of minority protections – for smaller states, and for more intense voters. If these minorities were not protected, Hillary would have won handily. Unfortunately, among other characteristics, the protected minority areas that elected Trump have a view of the rightful place for women that would be endorsed by Archie Bunker.


The Election and Hillary's Psychology

It might seem churlish to criticize the campaign of a candidate who won the popular vote handily. Achieving this was no mean task, given the difficulty of any party retaining the Presidency after two terms, and a problematic economy that was poorly explained by Obama – fireside chats would have helped a lot, and would have provided a platform for Hillary to expand on economic efforts, and pivot to rustbelt solutions.

On the other hand, a Democratic victory was there for the taking. Trump certainly seemed to be a weak candidate in so many respects – a boor with very bad manners and hateful things to say, uncivil, with awful taste, unread, self-obsessed, someone who would probably fail a test on basic American government. Who couldn't beat him??

Well, Hillary couldn't, apparently. Trump identified her core weakness and dubbed her “crooked Hillary.” She just didn't have it in her to make a good enough counter-case. Why she couldn't is very interesting to look at, I think.

Besides the Clinton team's obvious campaign malpractice – 2008 redux – I think two personal factors hold the key. The first one is congenital – her personality type. In Myers-Briggs typology, she would probably test out as ISTJ (introverted, sensation, thinking, judging – as opposed to extroverted, intuitive, feeling, perceptive.) The second personal factor is an acquired trait – her apparent cupidity. These long-standing factors were elements of the perfect storm.

ISTJ

Yes, she is not a natural politician, as Bill is, for instance. Natural politicians are generally extroverted feeling types rather than her introverted thinking type. That was probably Al Gore's downfall, too; he came home from parties exhausted from all the people and feelings, while Bill came home energized (and got on the horn to Monica, but that's another story.) Why was it that Hillary, at the exemplary Democratic Convention, gave the weakest speech? She couldn't do otherwise, it was her best effort, but unfortunately voters do not vote for teammates, they vote for the captain. Alas.

She did as well as she did because she is hella smart and works her butt off. In private they say she is nice, even warm, and has a refreshingly ribald sense of humor. But Carl Bernstein sketched cogently in Woman in Charge how she puts up the barricades and protects herself in Hillaryland, just as an introvert tends to do, even one who hadn't been attacked and vilified through the years, producing a protected territory where it seems Cheryl Mills advised her on the email server without outside advice. Insulation breeds trouble.

M-B element two is sensation – a preference for details, the trees – as opposed to intuition – the patterns, the forest. Hillary loves lists – it's just too bad she forgot to add “whites” to her list of the oppressed whom she would “fight for,” a terrible image for a President who needs to be comforting to everyone, by the way. But overall images don't emerge well from lists. Images come from topic sentences, and from feelings, too. But there she was with her “check my website” for her list of thought-through programs. She needed a quick two minute economic plan as well as the policy papers, but she could never trot one out. She needed forest rather than trees, or weeds.

She did her best, and improved steadily, but there is only so much anyone can do with oneself. I'm very impressed by her details and her lethally lawyerly skewering of Trump in the debates, which was delightful, but I don't think I'm typical. People look for image, the overall, and Trump did a better job of this to people who would come out for him, even if the image was at base a Potemkin Village.

Not to put too fine a point on it, but “Stronger Together,” in addition to be clunky, was such a misnomer. By listing all those who she thought were left out and pledging unending battle, she was inadvertently emphasizing divisions. “Fighting for” implies an opponent. Who was the excluded opponent, the inhabitants of Iowa, Ohio, Lakawanna County? It just didn't work. It would have been better to emphasize the better angels of our nature in everyone – and list some ways that white working class people could find some outdoor work, and not be retrained to sit behind a computer, and find some reason to believe in it this time. That's the pivot from the Obama economy she couldn't make.

Hillary is stronger with thinking than feeling. Since both extroversion and feelings are her inferior functions, she finds it hard to convey feelings to crowds. Her tendency is to shout and to urge on rather than to persuade. What she needed to convey to her listeners was,“She gets me.” If only she had read my blog! I suggested a Ron Burgundy strategy, where after or before she hung out with rich donors, she would have dropped in on local news anchors the way Stephen Colbert did in Minnesota. While Trump was tweeting – his feelings rather than his thoughts – she could have taken a new format to connect, and excited people in the process – where will she turn up next? Shoulda coulda woulda. 


Hillary and her crew never really got Trump. They saw crudeness and impudence, but Trump voters thought – I get him! He sounds like us, he's Queens, he's construction yard, he's borscht belt. Doesn't read? Neither do we. Makes stuff up? Creative! Marries a sexy lady? Why not? Grabs pussy – hey, someone in his place can do that. We women in Lakawanna County don't worry about that – if he grabbed my pussy, it wouldn't bother me so much. I know how to protect myself if I have to, and I know what men are like. I'm not highty-tighty like those fancy college ladies who think they're above all that and demand protection. Big shots. They want to compete, we just want to get along. Melania moves up from Slovenia and translates her good looks and big breasts into wealth? Well, I don't resent that – she uses what she's got. If I had what she's got, I'd do the same. I mean, look at her! We can't aspire to what Trump has, but we don't resent it, we are where we are, we just want not to lose ground and to do a little better, and not have those Ivy League tech twits and finance twits flit around and fuck us over. They are assholes; we want people who sound like us. We want our work back.

I wish Hillary had gone back to the Pennsylvania bars where she traded shots with locals during the 2008 campaign – probably would have done her a world of good. Maybe cooling down from that shot session with the local news anchor. Good press! Would have been fun. A little joie de vivre never hurt, did it?

Cupidity

Personality is something we're born with. We can work hard to improve, but we work with what we were born with. On the other hand, there are characteristics we acquire. What Hillary seems to have acquired, with Bill's help perhaps, is cupidity.

On a public policy basis, Hillary did not sell out. She was a reasonable politician seeking a reasonable way to achieve better equality and fairness, and she meant it. She wasn't really hypocritical, I don't think, although it's arguable, and certainly arguable about her supporting cast, all the hangers-on in DC and NYC. But you can't keep going back to what you did in your 20's to prove it. After all, when he was young Joe Lieberman went to Mississippi.

When I was in high school back in the 50's, I used to hang out after school with my friend John at his house and talk to him and his mother over the kitchen table. Née Anna Kleinfelder, his mom grew up in Pennsylvania Dutch country – which would now be Trump country. A nice lady, with the point of view that reflected her girlhood. She told me once that she thought was OK to be a Communist, but if you were one, then you ought to live like a Communist. I guess she meant to live modestly. My thought, although I was too young to express it properly, was that it's not really a moral issue, is it, but a conviction of a just form of government? But that's the way people think. From Anna's point of view, Hillary would have looked like a hypocrite. I always liked Anna.

It's hard to deny Hillary's cupidity, and I wouldn't be surprised to find out that some of it was connected to Slick Willy, the rascal too smart and too undisciplined for his own good, or ours. Or maybe not – I've read about her money worries in Arkansas, worries that he didn't seem to share. But wherever it comes from, people see it, and Republicans make sure that people see it. People understand if in the post-presidency period, they will want to make some money. Not a problem, make some money, make $10 or even $30 million from books and talks and some directorships, and no one will object. But we're talking hundreds of millions with the Clintons. We're talking “that's what they offered” as an excuse, a $17 million sinecure for Bill on some for-profit education company, grabbing money from the King of Morocco, and the Foundation's employing Doug Band the money man (who was a friend of my stepson Brian, who was a White House intern with Doug and Monica.) We're talking about a $650,000 salary for Chelsea at NBC, and a $9.5 million condo for her in New York City. Over the line, gang, over the line. Or if not over, right up there within a couple of millimeters. Hanging out with the like-minded gang in gilded New York charity balls, pictures of hanging out with Trump at his third wedding. And then for the campaign flying from fund raiser to fund raiser with rich people cordoned off from the public. C'mon, Man! Nothing says “You don't get me!” as much as these private actions. Pretty far away from the Obama standard.

To me, the trust issue is right there upfront with cupidity. I'm for the downtrodden, but don't ask me where my money is coming from. Who can trust that? What she could have done, what she should have done, was to head it all off, by taking my advice. She should have given a big speech on her and money, the way Kennedy did with Catholicism in Houston. Bob Reich on the Left thought it was a good idea, and Dan Henninger of the WSJ on the Right thought it was a good idea, but also that she couldn't do it. He was probably right, she is too self-protective. But she should have tried. It really beats me why she didn't read my blog and act on it.


When I bring this up, people object that “Trump is worse.” Of course he is, he is execrable. His business practices are exploitative, he wouldn't show his tax returns, etc. Couldn't be worse. But no one could say he was a hypocrite. He just said, I did it for me, and now I'll do it for you. People don't think deeper than that, many of them. It's the image. And don't forget, a lot of people are trying to decide not between them, but whether or not to vote at all.

Finale

In the end, it was very close, could have gone either way. Trump benefitted from enthusiasm, Hillary had trouble ginning it up. I was surprised that in the final days she continued to run the ads that were supposed to be embarrassing for Trump, rather than ads about her vision for the country – but then what was it? As a splitter rather than a lumper, she didn't have the message. She didn't have a two minute economic plan, only long position papers. And so many voters didn't see the Trump crudity as so embarrassing after all.

Maybe the arguably treasonous act of Comey was responsible for the last week, but her whole campaign had given up on much of her upside. I thought she was becoming more and more likable, but maybe that's just me. I always thought that although poetry escaped her, she would govern very well in prose.

I feel so bad for the women. I had dismissed so many women's pleas for Hillary in 2008, preferring Obama. But this year I got it more. My little granddaughter Lola cried on Wednesday morning when she heard. I urged my friend Lynn Sherr, news correspondent, author and long time women's advocate, to write a book called “Tomorrow Is Still Coming, It's Just Going To Be A Little Longer Than We Thought.” But she didn't think it would sell. It's too soon to reignite hope, I guess.

Where do we go from here? Well, let's hope the USA doesn't implode. Among other worries, I'm concerned that Trump's business background will work against him as W's did. If you take risks in business, you just move on, sometimes after declaring bankruptcy. Can't do that with the USA so easily. The experiment in Iraq has proved pretty hard to walk away from.

Other than that, it's goodbye, Clintons, goodbye. I for one will not miss you – too much rubbish with the goods. I hear that the Clintons suppressed the emergence of a viable bench for the Democrats, so the next people in line are still around the corner. All one can say, here's hoping. Maybe the new crop will make common cause with reasonable Republicans (or former Republicans) and form the long sought middle party of America.

So we plunge forward – time runs only one way. Let's hope it is kind to us, if we do our part - which is watching, defending, proposing, and most importantly, learning. Learn, people – don't complain about the lack of solemnity as he builds suspense by parading possibilities into Trump Tower – it's showbiz, people, learn. And new people who rise to the top, please, live nice, but let's keep it within reason. People Magazine will be watching. And so will we, the voters.

Budd Shenkin


Saturday, November 19, 2016

Doing Business On Maui, Philly Style


Doing business in Hawaii can be difficult. Not showing up at the house happens all the time, even calling about the cancellation is spotty. Personally, I don't find it charming, I find it lazy, unorganized, and disrespectful. Call me a hardass – I am, I admit it. When people talk about preserving Hawaiian culture, that's a good thing, to a point. Not working to educate yourself and not giving a shit, not so charming.

Not that it's just Hawaii – after all, this is the fight of business, isn't it? I was in the business of pediatrics, and I tried to run an office with customer service. That meant fighting the instincts of staff and managers in many cases. I remember I arrived early one day to our Walnut Creek office and I found our patients sitting on the steps in the hall outside the office waiting room because the staff had kept the front door locked until the first appointment at 9 AM. They thought they were working at Macy's, I guess, with shoppers waiting for the doors to open.

Hey, I said, let them in! If they're early, treat them well, get them in chairs, get them registered, etc. Seemed like a new idea for the staff. You mean we have to be nice to people? Jesus.

I remember an OB whose receptionist resigned and was working for a few weeks until her last day. Max noticed that his schedule started to get lighter. He inquired and found that the soon to be ex-staffer was giving everyone appointments for after she would be gone, to lighten her load. Jesus.

So here we are on Maui and we had to get a document notarized. The Kihei UPS store where we have a mailbox did well by us last time, so yesterday we went there again. The staff seemed to have changed. “Sorry,” said the clerk, “we do notarization by appointment.” I'm not sure she actually said sorry. I think she just went straight to you don't have an appointment.

“Appointment?” I said. This was new. “We're here now, can't you do it now? It takes five minutes.”

“We have an appointment coming in in ten minutes,” she said.

“Come on,” I said. “It doesn't take very long.” I knew that if this happened in our pediatrics office, and if I were there or our best staffers were there, we would please the customer, not a problem.

“I'll check,” she said, and reluctantly looked around the curtain to the cubby hole where the notary was hanging out. She came back and said, “You'll have to make an appointment.” The next one was an hour later. Couldn't interfere with the notary's nails, I guess.

“You people run a great business here,” I said. I wasn't nice. We got our mail and left. I observed to Ann that you could tell they didn't own the business. I don't think I said it to the clerk. Should have.

We went across the street to Bank of Hawaii where we have an account. It was hard to find someone to talk to, but I went up to someone at a desk and said, “Do you have a notary here?”

“You'll have to make and appointment. The next one is in three hours.” Could have looked around to see what they could do, but officiousness won the day. Hawaii. We put it off for a day.

So today we were going to the airport to pick up Sara and Lola. I figured that even though it was Saturday and good ol' Kihei UPS didn't have weekend notary service – I wouldn't have gone there anyway, I remain pissed – somebody in Kahalui would, and I remembered hearing a good thing about Maui Pack and Ship at the corner of Hana Highway and Dairy Road. We had needed something at FedEx across the street some months ago, maybe a notary, and they referred us to Maui Pack and Ship with some respect in their voice. Also, they got five stars on Yelp with a note about great service. I called to see what they could do for us. The lady who answered told me that they had notary service today open from 10 to 4. Great, I said, we'll be there. Then I turned to Ann and said, “I think this lady is from Philadelphia.” There was that accent. Maybe not Philly, but somewhere nearby.

We got to Maui Pack and Ship and there she was manning the store. She took us right away, got the document ready, did the business in nothing flat, and was super friendly. I said, “Where are you from?”

She said, “Philadelphia!”

“I thought so,” I said. “Where in Philadelphia?”

“Ardmore,” she said.

“Did you go to Lower Merion High?” I asked.

“No, we were military and I was away by then. I went to Penn Valley Elementary.”

“So did my sisters,” I said. “I went to Ardmore Junior High and then to Lower Merion.”

“That was the progression,” she said. “So did my older sister.”

Some more talk, introductions, she took the document and our envelope and stamp, weighed it and said she'd send it out. I hadn't asked anything, she just saw the envelope and stamps in the folder.

We left with smiles all around. In the car I said, “I forgot to pay her! I better go back.” Which I did.

“I forgot to pay you,” I said. In that short time that we had gone to our car, she had finished with someone else and was helping the next person. With such efficiency no lines were forming.

“Why?” she said. “You already had your stamp.”

I said, “Well, you notarized it. I owe you.”

She reached out and touched my arm and said, “It's on me. You're a homey.”

Philly service on Maui. That's just what the doctor ordered.



Budd Shenkin

Friday, November 18, 2016

Reflections 50 (!) Years Out


I have a medical school anniversary coming up – 50th! Never thought this would come. I specialize in denial; it's my primary defense, and I'm sticking to it. As my classmate Bob Ruberg observed many moons ago, walking around the old school, “We have now become the old farts!” Indeed, now we are the even older farts.

Looking forward to our reunion next June, perhaps, the old question has arisen on the class listserve: do you honor or regret your choice of medicine as a career? One of our classmates observed:

We have lived through the end of medicine's conversion from an art to a science. We are now seeing the conversion to a business. … I've been asking older physicians (65 yo and greater) whether they would become physicians in this time setting. Less than 1/4 of them would.  What say you, HMS 67?  What career would you select if you were in college today?”

So far, everyone has responded that he or she would choose medicine again, what a great profession it is, and that their careers have been fulfilling. Here is my response, amended by some reflection since I jotted it down, more discursive than most responses, not unexpectedly.

Why all this talk about medicine losing its luster? It's not a simple question, I think. The most disappointed and even bitter critics come generally from the private practice realm, often rugged individualists, people who didn't want bosses, people who wanted to do what they wanted to do, people who enjoyed being king of the hill in their towns, often people who made a fair amount of money. Or some subset of those. Or from doctors who ruled the roost in their hospitals and have been taken down by corporatization.

Academics, on the other hand, usually don't bemoan the older days. In academia things haven't changed a great deal. There always was some bureaucracy, there always were groups, there always was the three-legged stool, and academics aren't making any less money. At least that's what I understand; I may be wrong.

For practitioners, there has been a great deal of change, starting with insurance and government and pressure to conform one way or another and then yet another, the need to form groups, pressure from hospitals, Medicare crap, pressure on fees, etc. And the rising tide of administrators, fueled by hospital consolidation, governmental mandates, etc. If you just wanted to practice medicine and do the right thing and be true to yourself and do well by doing good, it became harder. A lot of nonsense came into existence, having to listen to “marketers,” prove that what you were doing was the right thing when it always was the right thing to begin with, and other kinds of crap. Last year I read Henry Marsh's book Do No Harm – he's an English neurosurgeon – really good book. What he has had to put up with in the NHS! Well, a lot of it has come here.

For myself, I wound up being an entrepreneurial pediatrician who built a big group, and instead of feeling oppressed by the new forces, I found happiness in fighting them and going with the flow of emerging larger groups and doing well by doing good in building the group, taking care of my people, and as an owner-administrator building systems of care and helping to direct people so that the docs in my group could “just practice medicine.” Mostly, my docs were very happy, and I was happy for that. The practice staff also appreciated being in a place that treated them with respect, and most importantly, consistently put the patient first. Staff join a medical practice with some respect for the place of medicine in people's lives, and when they find their mission honored, they feel some fulfillment. I myself have found it all very fulfilling and interesting. I was also able to publish along the way, so I did my own academic stuff without academia. I've always done a lot of stuff alone.

Medicine is a great profession and always will be. The great advances in what we can do for people, and being able to do good for people off the street from all walks of life, is all very fulfilling. It's true that when you help others you are helping yourself even more. I didn't know that before I did it. Yes, there is lots of crap. I wish docs would get together better and fight the crap, and make sure the administrators and business people, whose ethics often don't match ours, don't call the shots. My view might be influenced here by our local conditions, but when I talk with colleagues across the country, there is some agreement.

My stepdaughter worked for me, then became a pediatrician, worked for me again, and is now Associate Professor at UCSF, head of the eating disorders program, and unlike so many of her academic colleagues, knows how to see patients and not mess around. She is a wonderful doctor and the most productive in the department and a great teacher. Her 6 and 1/2 old daughter, with whom I have an ongoing love affair, was going to be a doctor until she started taking a course on animals and now wants to be a vet. We'll see.

It was hard for me to become a doctor, ironically, because my dad was a doctor, and I found it hard to follow in his footsteps. But with every passing year I am more grateful that I became one, and even now when I just see patients a half day a week, and very few patients at that, I still hope that I'm becoming a better doctor every year. Frankly, I've always found it hard to measure up, to really be good enough. But I guess there's nothing wrong with having high ideals. In freshman year in college a guy in our dorm was so excited about his paper, “The Relevance of an Impossible Ethical Ideal.” I struggled to think about it as he raved on. That was in 1959. I think I'm seeing what he meant.

Budd Shenkin

Thursday, November 10, 2016

Post-Election: The Moral Imperative of Optimism


In the wake of the election, here is what I posted on Facebook:

My friends: The election is a shock, the people we will be hearing from will not be congenial to us. What I will try to keep in mind is this: We have a moral imperative to be optimistic. No one knows what the future holds; it's too complex to offer predictions that will hold water. If we are optimistic, our chances for positive outcomes increase. We need to take joy and hope where we can find it, be it in little things or in big things. We need to take care of each other as best we can. I believe in the moral imperative of optimism!

By way of explanation, there are many. Hillary did get the popular majority – just – so the technical explanation of the skew of the Electoral College toward small, rural states is significant. It's the second time in five elections that this has happened, and the last time it happened prior to that was in 1888. This skew also biases the Senate, and is a major reason we have had gridlock for so many years, and why we have had consistent conservative politics as well. Even in the New Deal, FDR had to accept segregation as the price of progress. Let the working man (sic) advance – not so fast there, African-Americans.

Hillary also failed to turn out enough of the Obama coalition – Nelson Polsby, the great American political scientist at Cal once sat on the couch and told me, elections turn on turnout. She couldn't do it. She got youth, but not enough of them. My brother blames Bernie and Elizabeth Warren, and he has some truth there, they definitely damped Hillary enthusiasm. I blame Jill Stein, whom I revile as Ralph Nader without the charm (snark, in case you missed it.) Special place in Hell for her, she who prevented the first woman president this year, perhaps – I'd have to see where her turnout was, and if those voters would have gone for Hillary instead if Stein were not on the ticket. Or as my brother Bob says, self-righteousness might not be all it's cracked up to be. Or you could say, Hillary's lack of charisma took its toll.

But beyond all that, although there are many explanations, and this might just be me, I think the biggest thing that sunk Hillary was her taste for money, her cupidity.  I don't think she is a hypocrite, I think she is sincere, but the optics of making all that money makes her suspect.  The Obama's stayed far away from the ethical line, way inside it.  The Clinton's stood on the very edge.  I don't think they did illegal things.  But avidity for money is a funny thing.  When you're out of the White House, OK, make some money.  Make $10 million, $20 million, write books and give speeches.  Fair enough.  But hundreds of millions?  Goldman Sachs?  The King of Morocco??? Bill's $17 million deal for being Honorary Chairman of some for-profit education company? Hanging out with people you shouldn't be hanging out with?

To me, that conflict in word and deed could be the deepest explanation. It could have killed enthusiasm of the Hillary voters and fueled deep resentment among opponents. People don't look at policies, they don't think things through, they process images through the filter of their hopes and their resentments.  The image of the Clinton's just couldn't square with what their policies would be. They became super-rich while espousing the causes of the poor, and minorities.    Chelsea - what the hell has she ever done, although she was probably a competent member of the Foundation? - lives in a $9 million very large apartment in Manhattan.  She seems like a nice person in public, but living large and espousing the causes of the poor – well, I understand it, but it's bad optics. Or, as Obama would say, “C'mon, Man!”

I guess I should also mention Hillary's fractionating of the electorate, which I always found irritating as well. Even in her graceful – and for once persuasive concession speech with emotional closeness rather than distance, Hillary continued with her list of the put-upon, and still did not list the millions of the working class who were the ones she lost! The stitching together had a missed spot that wasn't small.

But, as I said, through it all, I cling to the moral imperative of optimism. Who knows what the future holds? I am deeply suspicious of the comfortable Establishment, I was very impressed by Gretchen Morganson's book on the housing bubble and how the Democrats fixed themselves a nice money stew over at Fanny Mae. I'm impressed also by my new Eisenhowerish depiction of health care would-be reformers as the academic-institutional-corporate-governmental faction, all of whose prescriptions for change incidentally benefit themselves. The mantra of Trumpism could be, away with all that!

Maybe something good will come of it all. If only.

Budd Shenkin

Tuesday, November 8, 2016

Love and the Single First Grader


I'm involved in a lot of important things. There's politics, there's the medical care system, there's the Warriors (think new team, not just updated old team), and this year I'm even following the Raiders with great interest (think easy schedule.) But above all of this, I'm tuned in to 6 ¾ (don't forget that “3/4,” we're micromanaging age these days) years old Lola. Lola. What a character is Lola. When she is introduced to someone new, she knows what's coming, so she has started to mutter, “Whatever Lola wants....” Ah, Lola.

Lola and I just hang out, totally at our ease. She can be on her iPad (Cookie Swirl C! Shopkins!) and I can be on my laptop (emails! SOAPM listserve!), or we can be walking down to Star Market together holding hands, or we can be driving home from her school together. I can put on my classical station while we drive and she can kind of listen and say, “That's like the Nutcracker.” Or I can put on the kids station and we can sing along with it. We tune in together.

One thing about Lola, “demure” does not and will never describe Lola. Lola is, in the immortal words of her grandmother Ann, a native born shitkicker. She is really so funny. We were driving home from school and I thought I'd put in some education. I said, “Lol, remember how we talked about the physical states of matter? (OK, big vocabulary there, but we had talked about this.) So, what's the solid state of water?”

She thought a minute and said, “Frozen water?”

“No, not quite. Think about it. You go into a cave, or you are in the mountains and it's cold, and you look around you, and what does water look like?”

“Ice!”

“Right! Now you got it. Now, what's liquid water?”

No pause at all, “Water!”

“Right. Now, what is water when it's a gas?”

Small pause. Then, “Fart!”

Giggle.

She's a shitkicker. How can you not laugh?

Typical for her age, in the last few years poop has been a recurrent source of raucous laughter. Nothing wrong with that, I figure. In fact, truthfully, I've heard more than once, “Stop encouraging her, Budd.” She's actually pretty funny, IMHO.

She has now, however, evolved from poop. She is now not unlikely to come out with “butt crack.” Butt crack. Where did that come from? It's a little more personal than poop, I guess, in a way. A little more … what? Incisive, maybe, both literally and figuratively. We wince a little, chortle maybe, and let it go, and make sure she knows it's not for the public to hear.

So Lola and I, we hang out – two field trips last week! On Tuesday she had off and we drove into the California Academy of Sciences in SF – the aquarium, the rain forest. After we parked we went out a back exit and scurried up the earthen bank leading up to the aquarium as a short cut. Lola hauled herself up by clinging to a grate. Climbing up a slope in the middle of the city. Later, we agreed this was the most fun of a very fun day. Unfortunately, one of Lola's less desirable inheritances from her mother Sara is car sickness. So on this trip she puked going in, and she puked coming home. The last time she said observationally, not upset but a scientist, “It's brown.” She was soaked. She got out of the car at home, put her arms out like a scarecrow and said, near tearfully, “I don't want to touch me!” Into the house and Grandma's specialty, the bath. Fifteen minutes later I ventured into the bathroom to find her supine and at ease, body out and head back with mouth just under the surface, calmly blowing bubbles in the water, observing the results. She loves her bath, and clean clothes.

Then on Sunday we went to the Oakland Zoo. Ann passed – she said she's gone once this year, and that's her quota. So off we went a little late, because Lola wanted us to play school first, with all her stuffed animals lined up under the window on the stairs as students, with me – Baba – as teacher's assistant. We got the farthest parking place in the lot but it was a nice day, we scurried down an embankment, got our hands stamped for reentry, and settled in by the flamingos for a little. Lola stood back and looked around and said, “Grandma doesn't know what she's missing.” Actually, she did know what she was missing, but it's a good point.

When we go to the aquarium and the zoo, I just kind of hold back and follow what she wants to do. At the zoo she has it mapped out in her head. Actually, she has added something to her repertoire on Sunday, looking at the actual handout map of the zoo. She opens it up, looks at it closely, says “Where are we?” and looks closely again and charts our course confidently. Since the map seems a little impressionistic to me and it isn't rectilinear, I have trouble with it. I'm not sure she actually connects her assuredness to results, and she's been here a lot so she knows the territory, but off she goes according to her map and intuition and I follow enthusiastically, knowing there are no precipices over which to topple.

On Sunday she had a set agenda. She told me, four rides and five animals. She said, “I told Grandma two rides, but I'm going to do four.” When I'm out with Lola and she wants things, I remember my mother when she had terminal cancer, although devotee to denial that I am, I never called it that, and we took my brother's daughter Emily and my son Peter out to the toy store, where they trolled the aisles. My mother had always been vigilant with limits, but as they came back with their choices, instead of a limit, she looked at me askance and said, “What does it matter?” Right, a little strange, but I got it. Kind of, I've done what I can do, now I'm just letting it go for someone else to do, I'm going to just let it go. I was just there to support.

I'm older now than my Mom was then, and although I know that limits are important, but I invoke them judiciously. Excellent mother that she is, Sara has set them very well, so I really don't have anything to add, just make sure I don't undercut. If she wants four rides, why the hell not? What's so virtuous about making the animals come first? Let her call the tune, I figure. I did negotiate her down from a $18 long snake stuffed animal to two little plastic figures for a buck apiece that she could play with imaginatively in the back seat on the way home – she is very firm with them. I told her the prices of the toys were ridiculous, and she accepted that well. It was something we did together. But as many rides as she wanted.

We took the Sky Ride chair lift first, which is her favorite. We sit side by side and schmooze. One thing Lola doesn't excel at is nicknames. A stuffed bear is “beary.” “Pelicany” is another. The first animals we see on the Sky Ride are giraffes. “Look at the baby,' said Lola. “We should give him a name.”

“Spotty,” she said. Good enough! Then the tigers, and the camels – the grounds are big enough that you have to look for them and discover where they are. “What's a camel with three humps called?” she quizzed me.

“I don't know.” Strange question.

“Pregnant,” she answered herself.

Wow, I thought. That's new! Where did she hear that? Up to now her only joke was the one I taught her, the old “why did the moron tiptoe past the medicine cabinet,” every kid's proverbial first joke, which she struggles to remember but is very fond of, because the other kids don't have any joke at all. Except for the knock-knock jokes which is her friend Felix's specialty.

Then she said, “What are those animals up there? Where are they?” That's the buffalos, and she wanted the story, which I was happy to tell her, how they used to be in the millions and how the Native Americans (that's what we say, “Native Americans,” and she doesn't think about the term for one minute, except when I slip into “Indians”) took one or two for food and clothing and then how the European hunters shot them nearly to extinction. “Just for target practice?” she asked.

“Yup,” I answered. She knows the story, and wonders at it. Then we talked about extinction, and she posited a way that a species could be reborn. “Nope, “ I said, once they're gone, they're gone. Harsh reality.

Then we were on the way down, the same animals in reverse. “They're going to have new animals over there” she said. Right, they are, in 2018, the California Trail.

And then I saw a tree that had fallen with branches all akimbo. “Look,” I said. I remembered a book we read about Fancy Nancy who wanted to be the lead ballerina of her ballet class but was disappointed and became a tree, and the teacher assuaged her disappointment by urging her to be a very graceful weeping willow. It's a book about disappointment and how to handle it. I had asked Lola how she was going to handle disappointment. She said that her solution was that she wouldn't ever be disappointed, and when I said everyone got disappointed sometimes, she wouldn't discuss it further. Maybe that lesson wasn't fully absorbed.

So I said, “Look at those branches. They're just like the branches of the other trees, but they go out instead of up.” I was really going on it. “Maybe you could be a tree like Nancy. You could reach out and be a weeping willow.”

She hardly looked at me. She just was looking around and said out of the corner of her mouth, “And you could be a butt crack.”

We had a wonderful time hanging out at the zoo, petting the goats, eating slushies, enjoying the gibbons twice. Sara had to call us to see when we were coming home. We got to their house and Lola told me she didn't want me to come up the stairs with her, she could do it herself, which she did, knocking on the door just loud enough for Sara to hear her and come to the door. So grown up! Before I left I told Sara the butt crack story, and she almost couldn't believe it and then laughed wondrously. I remembered every part of the day so I could repeat it and savor it with Ann. I wrote my friend Lynn about her the other day and told her that Lola and I were in love. I'm not sure that's what you would call it, but my hope is she'll know what it is to be relaxed and have fun with a good friend who is a man, and she will look for this and not accept less.

I'd say we love each other. Butt crack notwithstanding.

Budd Shenkin

Saturday, November 5, 2016

So Close


I'm taking it for granted right now that Hillary will win, simply because Trump's winning is unthinkable. If it happens, we'll rethink it, but I don't think we'll have to.

So, let's do a prospective post mortem. What is the meaning of the election?

Clearly, we are in the era that so many have foreseen, where intermediate organizations, like parties, like establishments, have less power. Trump almost made it, a charlatan, a thief, a thoroughly disreputable reprobate. A real asshole. A dangerous demagogue, the kind of person who has arisen in the past – Huey Long – and in other places – Argentina – but who has come so much closer to the center of world power than any of them. He's clever, true; he's talented in a borsht belt kind of persona, content-free, truth-free, which frees him to do whatever he wants whenever he wants. The Republican party couldn't stop him, and they showed their moral hollowness through and through, so they may be through. The Democratic party did a better job, and it was the party that did it, with a very vulnerable candidate, with an organization that worked. My favorite sight was on Friday's edition of Chris Mathews' Hardball, where he visited a meeting of the Philadelphia Democratic party apparatus, the last of the big city political machines. It's just organization, that's all it is. They could run a hell of a medical practice, that's what I think. And it was Philly that was Hillary's keystone. Go, Philly!

The non-directly political Establishment did it's job also. Money flowed to the Dems. Major figures endorsed Hillary. They had some effect, they were important. But, it was still very close, very close. Very close.

So, what to learn from that? I'm not sure. But one thing, America and the world needs American stability. We all count on it. And achieving stability, by achieving the consent of the governed, need to be the overwhelming objective. Call me conservative. OK, I accept it. But progress comes from stability with the consent of the governed, which much be achieved.

Personally, I think we need super-delegates in both parties, even though the Dems are ready to jettison lots of theirs. It's not ideal, but we need intermediate institutions to avoid a caudillo. You can't outlaw social media, and even I can't watch network news – it's so boring, full of ads for intestinal disorders and constipation, which gives you a pretty good idea of the viewer demographics. Much of the media is trapped in false equivalents, although increasingly they started to take Trump's lies apart. Long term, education of the populace would be nice, but that's really long term, and a different society all together. We are dumbed down for a long time, I'm afraid. Let's just put it down as something to be worked on. In the meanwhile, we need some elements of indirect democracy.

Second point: substantive politicians need to be media personalities as a primary job, not just something that they may or may not have. It's a central part of the job, not an add-on. Hillary has done as good a job as she is capable of. I think she has gotten better, yelled less. She is still not great at persuasion – although she was terrific in the debates. But as I put it somewhere or other, she couldn't persuade a toad to jump; she'd be standing there giving orders instead, I think. I did get to like her better as the months went along, but I still won't look forward to hearing her speak. Take acting lessons, everyone, if you want to lead!

Also, given the power of the negative, major political figures need to eschew hugging the ethical line; they have to stand way back from it. Bill Clinton has made himself fairly disgusting in achieving megabuckdom. OK, he does good with the Foundation, but it leaves a bad taste, not to mention Hillary doing the same, and Chelsea in her $9 million penthouse. It's legal, and I'm not sure how many favors were done, and it's not altogether a bad thing to have a place for political figures to perch for a while, but it's too close to the line.

Contrast Obama. Part of his record breaking approval rating is his personal life and his standing far back from the line, as well as Michelle's persona and ethical ardor, and their family dinners every night. Plus Obama's sports interest – that's key to American life, I figure. OK, the ignorant fall for the idiocy of Rush Limbaugh, but that's far from a majority, and with time I think it will abate. We need people who realize that the public life is different from the private business life, and they will just make less.

Looking to substance as opposed to visuals, the white male non-college populace might be deceived – they ain't the smartest - but they have real grievances. As I mentioned a couple of posts ago, they and their children need attention. If I were Hillary, I would include in my victory speech something like this:

“I know it was a close election, which means that millions of people voted for someone other than me. But now that the election is over, I want to speak directly to them. Even though you didn't vote for me, I am going to take my responsibility seriously to be President of all the people, and that means you, too. You may not trust me, you may not agree with me, you may not like me – but that doesn't make any difference to what my responsibility is. I have to serve your interests just as much as everyone else, because we are all Americans. And I want to serve your real interests to make progress in your lives.

“We have to make sure that nobody is left behind, and that includes you. We need for you to have meaningful work. We need to have your children educated and trained and capable of contributing to society and fulfilling their inherent promise. I pledge myself to deliver not only for the people who voted for me, but to serve the welfare of those who didn't. Government can't do everything; we all know that. But you need education, health, and jobs, and I'm going to do all I can to get government to contribute to that end.”

And then that's what I would do as President. If she is successful, both in substance and in appearance – they have to see her trying, and they have to see some results – then maybe she can clip off enough of that demographic to make the Democrats the party of the center, a predominant party, while the Republicans complete their self-demolition. That will bring stability.

There is no dearth of challenges. But it's important not to underestimate the importance of the job. To make the world safe, government needs the endorsement and confidence of people at large. It's very scary to think that America is not stable. Everyone has relied on that stability and that strength. But to maintain that, a lot of work must be done.

Wake up call, ladies and gentlemen, wake up call.

Budd Shenkin