Catcher in the Rye and Streetcar Named Desire

 

To Love Without Knowing

I always find it kind of amazing to find out how little I know.

I can go through life loving something, being attracted to something, recommending something to others, and then I realize that I really didn't understand it in the first place. I am saved only by the fact that others have been in the same state. We might have liked something, been attracted to something, been able to talk about it, but then something happens and I realize that we reallydidn't understand it, not really. In fact, the more I think about it, the more I think we like (or dislike) much more than we understand.

I'm thinking about books and movies, two pastimes, sometimes obsessions, and sometimes loves. When something grabs me, – that's the word, when something grabs me, I just grab it back. Eventually we let go of each other, but even then, the memory stays. Even if it was a youthful attraction – the Hardy Boys, say – and you realize you were an immature appreciator of a work aimed at the immature, still, the good feeling remains. Or even before that, A. A. Milne and Christopher Robin and Pooh. And then in my mid-teen years, when I felt so good about having become a good reader, and I reveled in being able to just go through books, I briefly read science fiction. Lester Del Ray – what a name! He had to have been born to write science fiction, Lester Del Ray. It was a brief infatuation, but the good feelings remain, and some of the memories – exploring around the place of your birth to discover you lived in a sphere in space that had been expelled from Earth. Can't forget that one.

But some books are loves that haunt, and stay, and you love, but maybe you don't really understand. Like that old trusty book now become a standard, so standard that current young people can say to my surprise, “I hated that book they made us read!” They made you read that book, the one my mother gave me, recommended to me, only five or six years after it was written, that was even somewhat subversive – my mother liked somewhat subversive books. Or at least intelligent books, which some people suspect of being subversive just because of that quality. Catcher in the Rye. I read it when it didn't have the disadvantage of having been recommended and assigned, so it had the air of discovery. It's not secret now, but when I first read it, I think I was the only one of my friends who did. My mother was responsible for so much of my discoveries of books. I myself discovered Word Power Made Easy, which I still love, but that's such a minor discovery compared to all the books my mother gave me to read.

Holden was haunting, who couldn't root for him, identify with him? I sided with his denouncing phonies even though when I read the book I had not yet met a real preppie. That came several years later, when I was a freshman at Harvard, and I guess I saw then what he was talking about. The accents, the attitudes, even the nice ones, John Erdman who was a nice boy my age but came from Hotchkiss Academy and affected a tweed jacket and, wait for it, a pipe. Eighteen years old in a tweed jacket and with a pipe. Ivan Light tried the same shit, a pipe. And John was taking advanced French literature as a freshman, he said with his deprecating and experienced voice, and he was only eighteen, and I was envious. He was nice, actually, he just had these affectations, which maybe affected him more than others. They said he was depressive, afterwards they said that, anyway, after we went to medical school together and he became a heart surgeon – why did you do that, John? – and I guess he was good enough to go to the Mass General but long after I had left Boston, while he was still in training, he was ready to fly on his own and he opened up a chest to do an operation but, for some reason that was only described to me as fear, he didn't follow through with doing the operation and he just closed the chest back up, without doing anything, and hooked himself up to an IV and lay down, I imagine on a gurney, and killed himself. He was a nice person, he was smart, although affected, but nice, somewhat less than average size, pursed lips it seemed, formal, preppie. I wouldn't have known he was Jewish if someone hadn't told me. I don't know if he had pimples, probably not, but I tend to think of him as having had pimples because that's the way Holden Caulfield described The Makeout King, I think it was, although John was nothing like The Makeout King. Phonies, Holden hated that. That's what I guess I thought the book was about, even though Holden wound up in a mental hospital at the end of the book, which I didn't understand, and his closest friend was probably his little sister Phoebe. That's an unusual name these days, but when you meet a Phoebe, or you hear of one, do you think of Holden's sister? I do, even when I don't consciously do it. It's a name I pay attention to.

But what I was saying before I got diverted, or at least I think I got diverted, was that you can love something and be influenced by it, or seduced by it for reasons you might not be able to describe, or even haunted by it, and not understand it, or maybe understand it and not know that you do, because you can't express it, or maybe it's an unconscious understanding, a non-verbal understanding of a purely verbal medium, books. So when Catcher in the Rye was fifty years old Louis Menand wrote in the New Yorker Holden at Fifty. The book is so famous you can just use the first name of the protagonist. Louis Menand is so very smart, he's one of those writers that if you see his name, just read it.

So I read the review and I realized, for all my love of the book, for the attention I had paid to it, even writing a tiresome paper about it in David Riesman's class at Harvard, I realized that I didn't understand the first thing about it. Because the first thing about it is his brother Allie died, and Holden just couldn't come to terms with it. “Come to terms.” That's quite an expression, isn't it? “Get over it.” “Wrap his arms around it.” Instead, he goes nuts. He tries to work it out with Phoebe, but he goes nuts, although he does emerge eventually. And where are the parents? Parents – they never get over a death of a child, do they? Or not nowadays, maybe. More kids died than survived originally, some societies didn't even name kids until they were two years old. Lincoln lost Willie, his favorite, right in the middle of the Civil War, and he was depressive to begin with, they say. And I couldn't even realize that, as Menand says, that's what it's all about. I just don't understand literature, I think. Although I did, for reasons that I never really understood, name my firstborn child Alexander, to be called Allie. Allie – why choose that? I always said that I named him after Holden Caulfield's older brother who died, and the Yankee righthander Allie Reynolds, although that must have just popped into my mind, because if anyone knows me, they know I'm a born and bred and nurtured Yankee hater, from Philadelphia. So Reynolds was just an afterthought. I think maybe I did understand more than I knew, because choosing that name is like repairing Holden's sanity. But what did I know?

I've also always loved my favorite playwright's best movie, Tennessee Williams's Streetcar Named Desire, which I watched the other night. I'm pretty sure I never really understood it, maybe don't understand it now. I'm pretty sure I've watched it more than I've read Catcher in the Rye. Movies are short, but so concentrated. It doesn't take long to describe an atmosphere, it just appears. You choose black and white sometimes even when color is available. Eddie Muller on TCM quotes someone who says, color is more realistic, but black and white is more truthful, or something like that. Black and white is so intense, especially when there are lots of shadows and streaks of sunlight, like a Tintoretto. Somehow black and white concentrates the feelings, I think.

I've always felt Streetcar was one of the very great movies, a true movie, even though it deals with so much invention and pretension. I think if you're not in a class and you don't have to think about it and talk about it, maybe you don't come to terms with it. So I guess I didn't. I liked Marlon Brando, I could sense all the tension, I heard people remark on his brutality, and everyone yells “Stella” when you start to talk about it. Why is that? It's so startling, is that it, striking? Or is it embarrassing, it's so stark. And you think about Blanche, played by Vivian Leigh, and her feeble pretensions and her sordid past about which she lies. And you think about Mitch, played by Karl Malden, his frustrations living with his mother, seeing a chance to break through his limits with Blanche, and then finding out about her lies. Finding out because Stanley (Brando) makes it his business to find out that she had turned to whoring, that she had seduced the wrong young man and had gotten thrown out of her town. I had to tell him, Stanley tells Stella, he was with me in the war! What was he going to do, sit on it? But why did he inquire, because he hated her, or because her seductiveness caused him so much confusion?

The quietest of the group, the one with the least screen time, the least demonstrative, is Stella herself, played by Kim Hunter. When I saw it this time, her dilemma is what hit me hardest for the first time. What would anyone do in her situation? You love your husband, you are having a baby for the first time, a huge event, and your older sister comes to visit, as a last resort in saving her life. Sisters can't turn each other away. Stella is caught in a vise. She can't deny her sister, she can't deny her husband, and she's having a baby. You see your household falling apart, but what can you do?

Stanley has been called a brute, but he's not. What is he going to do? He loves his wife, he needs his wife, and he can't stand her sister's invasion, he can't stand her, and she's there for months with no signs of leaving. He could let Mitch take her, but that would be craven – poor Mitch, how can he let that happen? His wife's crazy, lying, seductive sister. And Mitch is caught, too – why does the truth have to raise it's ugly head? If it didn't, he could solve his own problem, no woman and home with Mama. Can you imagine what would happen to Mitch with his friends if he ignored Blanche's lies?

And what is Blanche to do? She wound up at her last resort. She has run out of options. Her dilemma is that she can't do anything, she has to rely on others, and she must hope that they will be kind.

In Streetcar, everyone has impossible choices.

Sometimes the only solution is to bulldoze things through, and Stanley is the bulldozer. Don't ignore the truth, don't wait for “things to work themselves out,” don't wait for others to act, it takes a bull. But to be the solver, he will also be the heavy. To solve these problems, someone must suffer. Or maybe everyone will suffer, because that's what happens with dilemmas, especially with quadruple dilemmas. But then, everyone hates you for it. Mitch is left with his problem, Blanche has to go with all her pretensions. Stella has failed her sister and hates her husband for it. And Stanley is left hoping that he will be forgiven and his marriage will be restored. Because the central truth of the movie is the love between Stanley and Stella. It's why it's so appropriate that everyone remembers “Stella!” What is it about those cries, repeated throughout the movie? Brando's cries are a mixture of insistence and plea, with his aggression, yes, but with his insistent need. Mitch knows they love each other desperately – everyone knows. She says she'll never be with Stanley again, but whenever she says it, even at the end, you know it's not true, it can't be.

So in the end, faced with all the dilemmas, the brutal insistence of love puts itself forward. But you get the feeling, and this is Tennessee's genius, you can't imagine anyone doing anything else. It's all as insistent as a Greek play, the insistence of fate and destiny which lies in ourselves and where we come from and, if you'd like to believe it, the insistence of what the gods will. Are there some of us the gods will to be crazy? Insoluble dilemmas, not brain chemistry, were posited to be the core of schizophrenia, said R. D. Laing, back in the 1970's. Seems right for Blanche.

How much control do we have? Any? We all struggle through and do the best we can. People help us along the way. The kindness of strangers, the kindness of those we know and love, the best we can do.

The gods are cruel. Our dilemmas are often hopeless.

But, on the other hand, they are also kind. For instance, how come we have been granted to right to love something, or someone, and we don't even know what it is or who it is we are loving? Why do I love Catcher in the Rye and Streetcar? I really can't tell you. But I really do love them.

Budd Shenkin

Medical Education Is A Patchy Thing

 

I've been asked a lot, first, why do you want to be a doctor, and then, why did you want to become a doctor. I've always been too concrete to say, “destiny,” which is a more positive word than “fate.” Nowadays, now that my doctoring is through – or is it? – I tend to think it was destiny, what with my father being a neurosurgeon, and with my temperament harboring kindness and with my being smart. But back then, when I was a medical student, it might have felt more like fate, although I never regretted it. Even when I felt I might not belong to the Harvard Medical School milieu, even when I was a malprepared and maladapted second year student appearing on the wards of the Beth Israel Hospital with a formal and unwelcoming Benjamin Banks as my first attending, even when the house staff were the insiders who hazed me and I was the outsider, I never thought that I didn't belong. I might not have known how to play their game yet, but it was I who belonged, because my father was a great and devoted doctor and I was a chosen and respected son, and if I perceived the BI crew as formidable and ingrown and somewhat bleak, it wasn't me who didn't fit in medicine, I figured, because one thing that I had been given by my family was self-respect, and that was never leaving me.

But that isn't to say I was ready, because I wasn't. I didn't picture myself saving anyone, or serving anyone, although being nice and essentially beneficent by nature, my brother and my sisters thought I was and family friends thought I was and I guess they mentally matched me up with their daughters, they all probably projected my being nice onto my role as a prospective doctor. But I was coddled, there is no better word for it, I guess. Not that I wasn't held to rigorous standards, I was, and I had internalized that, but it was all academics, although it was also sports. But classroom study was my thing, I excelled, my father said I could pass an exam in any subject, even if I hadn't studied it, as long as it was a multiple-choice test. Classrooms – let me at them. Tests – not a problem. Laboratories – well, not so much the hands on stuff, to tell you the truth, I was a theory guy, a words guy. Except for sports, there I was rock'em sock'em. But classroom studies, chess, my turf. My medical destiny? Maybe public health, my father drummed into me – they had a good deal going, he thought, practice was so high-tension, such a grind. Public health – all that time off, the academic postings in foreign lands, that was the greener grass to my father, and I accepted it faute de mieux.

And then, all of a sudden, there I was on the wards, real doctors and real patients and long hours. The patients were welcoming. In those days the BI had open wards, a big room with probably eight or ten beds arrayed around the periphery. When the sun came up we were there to take the daily blood tests, syringes, needles, tourniquets, test tubes in hand. One really nice black guy on the left as you came in had giant veins, and he knew he was the med student's gift. I came in and he said, “Hey, doc!” and beckoned me over and offered up his antecubital fossa – that is, the reverse side of the elbow – where giant veins stuck out like giant worms. He offered his veins as a return gift for all the care he was getting in these pre-Medicaid pre-Medicare days. Me - “doc.” Jesus, what a new world.

And then on the far wall was Mr. Marcuse, a spare and very thin little man who lived not far from the Mass General, but had wound up here at the BI. When he had appeared at Mass Eye and Ear, his chief complaint had been wax in the ears. Assigned to a medical student, a full history and physical had uncovered stomach pains in the review of systems. The doctors worked him up and determined he needed an operation for cancer of the stomach or intestines, or something, so they had operated and there had been post-op adhesions – fibrous bands had strangled his small intestines after the operation, probably performed by house staff, I guess – and he had lost pretty much all of his intestines and couldn't absorb anything and was wasting away on this ward of the BI, because he had sought help for excessive wax in the ears. No one said much about him, there was silent indications of a cautionary tale, but caution for what? Was the patient at fault for seeking care, the med student for doing a complete history, the decision to operate for what turned out to be non-cancer, the operation itself? Or a system that used human beings of the lower socioeconomic order to train doctors? No one said, but there was Mr. Marcuse stoically – or, rather, with anger suppressed – wasting away in his bed on the far wall, ready to give his history to one and all.

Looking back on it, maybe that was the shocking introduction. Or maybe it was the formal rounds where I was expected to know how to present a case, never have been taught to do so, just having seen an example or two, I guess, and only at the end adding to my succinct history, after Dr. Banks, with his little gray mustache and suit and tie bent over the patient with stethoscope in hand and in ears, only at the end did I add, Oh, and he is a diabetic. The look of disdain and offense and disgust that I was shot by Dr. Banks as he straightened himself up and snapped at me for only adding a crucial piece of “the case” as an afterthought. The look of glee from Lee Younger, one of my residents with a cruel streak, as he contemplated my dismemberment. I wasn't in Philadelphia anymore, I wasn't in a classroom anymore, I was no one in particular's son in the eyes of Dr. Benjamin Banks and Lee Younger, I was just an ill-prepared second year student at the med school that had just decided that waiting for the third year to send the students onto the wards was a waste of time, let's just send them in second year, ready or not here they come, and Dr. Benjamin Banks had probably been one of those in opposition and here was the proof of the pudding, ill-prepared me, fresh meat. Maybe thin-skinned me, entitled me, reluctant me, not ready for prime time me. I guess.

Weeks later in the rotation we made rounds on the semi-private rooms at the BI. Little groups of housestaff, short white coats, “Boys In White” was the title of a sociological study of medical school, senior residents and junior residents and interns and students on what seemed like a traveling team huddled together going from room to room, like a platoon. We visited patients, reviewed their tests and studies and vital signs and reviewed the chart notes and performed for one another. We were there most of the day while the attending physicians came and went. One lady was in her late 40's, I guess, petite and dark haired and wiry and very yellow and very concerned about something as she approached us to find out when something was going to happen or something, but almost frantic. The head of our team, maybe it was Bruce Chabner who went on to excel at the NIH, dealt with her formally but not unkindly, she scurried back to her bed, somewhat unsatisfied, and we moved on. That afternoon I guess we were going to go back to see her but we heard that she had died. She had been so alive. No one said anything.

I was sent by a chortling Lee Younger to evacuate manually the bowels of Mrs. Naruscewicz, who suffered from some apparently terminal illness, was bed-ridden, who couldn't speak English, and who objected to this necessary but invasive assault on her body with groans and grunts. I said, there there, I have to do this, and she resisted but I was finally successful. It was quite unpleasant, which pleased Younger no end.

Of all the Harvard hospitals I had chosen BI for my internal medicine because I had heard they were the most humanistic in their approach, a hospital with a heart. Maybe so. But it must have been there that I was introduced to the gallows humor of house staff, a psychological defense against the trials of dealing with people with serious diseases. Most memorable were the series of signs of the dying patient – the O Sign when the mouth of the patient formed that perfectly round letter, the Q Sign when the tongue protruded out of the edge of the mouth, and the Fly Sign when an actual fly buzzed round and round the patient's face awaiting death. I guess we laughed when we first heard it. It was there that I heard the expressed intellectual fascination with the pathophysiology of the patient, the distancing from the individual in anguish and distress, those feelings that went unremarked, or frowned upon as unseemly and uncontrolled. This was the foreign territory of clinical medicine I hadn't experienced at home, where my father suffered along with his patients, usually nonverbally. He never made fun of a patient, he never discussed a patient's physiology with relish, although he did manage to publish over 130 papers, even though he was not in a university hospital. He most relished the two bottles of wine he received each year from a patient who never forgot, and he would have relished the short speech of a person I didn't know, who came to his memorial service at The Quadrangle, his last home, when this man stood up at the front and told the story of how my Dad had made a diagnosis of his own dad that no one else could make, and operated on him, and gave him decades more of life. No one talked about things like that at the BI.

But of course my Dad had his own defenses. His telephone number was BA6-5050, which he said was appropriate, since when you came to him, that was about your odds, 50-50.

I also did my obstetrics rotation at the BI. I “delivered,” that is, I sat at the foot of the delivery table when a Catholic mother pushed out her eighth baby. I guess someone congratulated me at my first delivery. I don't even remember clamping the cord, but I certainly remember the other-worldly feeling of a newly formed baby, a little human being, coming out of another human being and landing in my lap. No one said much.

Finally, I did my pediatrics rotation at Children's Hospital. Since it was my last rotation I got the most out of it, I had been acculturated, I knew about coming in early, I knew how to present a case, I sat quietly and cooperatively with the neonatology team helping them do a double volume exchange transfusion of babies with Rh factor incompatibility, erythroblastosis fetalis, all that. One day I was taken into the neurology ward. All the little kids were on the floor playing with toys, little toy cars to pedal around, in their hospital clothes. And they all had football helmets on their heads. I wondered what that was all about, and either I figured it out or someone told me it was because on neurology, kids had seizures, and their heads had to be protected as they fell. It was shocking to me, these poor kids, the parents. But no one said anything.

There was one very nice attending there, an active, extroverted somewhat pudgy, bouncy, and kindly man, and I posed a question for him. Why are the internists such stuffed shirts, and pediatricians are so nice? He said, it's very hard to be a stuffed shirt when your patient is peeing on your leg. Question asked and answered. I went into pediatrics.

We were taught and questioned and quizzed and tested and coached and examined and rated on all our scientific and clinical knowledge and skills and performance. Our emotional reaction to all that we were exposed to and experienced remained, throughout my training as a medical student and later as house staff and as clinician treating thousands of patients through decades, as patients experienced severe illnesses and deaths, as well as wonderful cures, unexamined and unexplored, private territory to work out on our own.

Budd Shenkin

Medical Student Medical Event Debriefing Service - A Proposal

 

Medical Student Medical Event Debriefing Service

MSMEDS

Inevitably, in the course of medical school training, medical events will occur which are striking. Sometimes they are destabilizing – being present at a death, seeing a patient happy one minute and dead the next, seeing a patient raving crazy, seeing a patient and family receiving a dire diagnosis, seeing the controlled chaos around a code blue, tending to a severely ill patient day after day with no end in sight, seeing children suffer and families coming apart. Sometimes, happily, there are uplifting events – an amazing life-saving, life-changing event, a great diagnosis and treatment, an operation that seems magical, a recovery to health, seeing the devotion of a spouse, a birth. Whether positive or negative, seeing the human condition unfold before you, where you are a participant, where the context is medical, is a deeply emotional experience.

How do medical students deal with these experiences? Variably. All students are different, the circumstances in which they find themselves with each event are different, the input they get from those around them are different. Usually, most of what happens to students is internal, often solitary. They absorb it. Sometimes there is the counsel of a wise and experienced clinician, someone who handles it in their own way, who can give advice, someone who can offer concern and solace. Occasionally, such a person can elicit the students feelings and reactions in a way that not only consoles, but deepens their appreciation. But in most medical schools, I think, this is usually a matter of chance, of who is available when, of who has time and inclination, of who is equipped.

Sometimes, unfortunately, the surrounding atmosphere is not so positive, and reactions are psychological defenses. The gallows humor that develops in medical trainees has been well documented, as senior students and house staff ironically make light of a dying patient. Iconic sarcasm on medical lingo is typified by evocation of the progression from the O sign to the Q sign, and to the Fly sign. The O sign is when the dying patient's mouth forms a circle; the Q sign occurs when the tongue protrudes in the corner of the mouth, and finally the Fly sign is when a fly hovers circling the patient and awaits his or her death. House staff observes the process of dying by asking, how far along is he, and reference made to O, Q, and Fly. Sometimes there is just a flip comment, “That's the way it goes, on to the next.” House staff laugh as they assign the student to evacuating the bowels manually of a terminal patient. Often there is intellectualization as in, “What a fascinoma! Wasn't that an amazing EKG?” It's not so different from soldiers, or police, as they gird themselves against the rigors of their profession and life itself. Defenses against the stark realities of life, disease, and death abound.

You would think that medicine, with its history of beneficence, would have evolved ways of passing on wisdom in the face of these events, and in many ways it certainly has. But in many ways it hasn't. When airline pilots have traumatic events, accidents or near-misses, guidelines call for them to be grounded and counseled for a period of time. When that happens to a surgeon, he or she is expected to proceed to the next case as though nothing had happened, schedule comes first, tough it out. And students and trainees, when faced with these events, are often left to fend on their own. Scientific knowledge is presented and judged and tested constantly, but humanistic knowledge almost never.

If students are to be taught humanistic medicine, it would make sense to recognize the impact of these events, and to view them all as opportunities to deepen the humanity of the student, whatever the student's ultimate career objective. Students could profit enormously by discussing the events, and most importantly their reactions and their feelings and their reflections on the events, with someone wise and understanding and experienced. Doctors have a lot to give in their roles as physicians, but what they can give is predicated on what they have absorbed.

While departments and divisions throughout the university will have resources to provide this reflective counseling, and while there is something to be gained by having a variety of approaches that different disciplines might offer, some centralization would have advantages. A separate service would ensure that effort would not be diluted and derided by those who view humanization as somehow namby-pamby. A centralized service would allow faculty to best learn from each other, and to identify strengths. A centralized service could arrange for constant availability for processing events. A centralized service would bring more attention to the effort to all the students, perhaps even by conferences, classes, and publications. A centralized service would enable tracking of the student body to take place, papers to be written about the experience, statistics to be kept, and progress made in an organized fashion. If it's important, put it in one place, and staff it with those who are wedded to the task.

We propose, then that a MSMEDS be established. There are many ways that one can imagine that this service would be organized and operated. Wherever it is centered, the department of psychiatry should be involved. Senior clinicians noted for their humanity should be involved. Departments notoriously resistant to such considerations – one can think of orthopedics and urology, perhaps – should be involved. Students should be empowered to participate in the shaping of the efforts.

To support this important service, funding should be assured, and yearly reports should be made available on the efforts of MSMEDS. If it's important, give it money, give it personnel, and write about it.

Budd Shenkin

"Quando?" "Jamais!" Chapter 262 of my French novel

 I thought someone might be interested in this little story, which is a chapter of the book I am writing in French, as I study French with my teacher, Claude Convers, a native of Switzerland.  Here’s our process: Claude gives all her students the same title for whatever they are going to write for their lesson the next week, and it's up to us to work it into our writing.  Early on, I decided that I had always wanted to write a novel, so I would write another chapter each week, as our writing assignment, and that I would make the assigned word the title of that chapter.  I’m now up to chapter 262, although I skipped some numbers, so the total number isn't quite that high.  But still, it seems to have gotten significant.

This week’s title was "Jamais."  In this chapter, the three characters who are professors of sociology are at a southern France city (without a name so far, despite the fact that other locations do have names, and this is the central area where action takes place) where they will be meeting with most of the other characters to discuss what to do about this allegation that they are all just characters in a novel.  Originally, the two women, Laura and Juliette, colleagues  in the department and friends, had attended an annual party given by Morton, the older head of their department.  Morton was a notorious bore, and Laura discovered Morton and Juliette in rapt conversation during the party, and she was appalled that Juliette was the trapped victim.  But it turned out that this was the beginning of a passionate affair that led to their living together and being now engaged.  Laura, for her part, is single and notorious for being seductive and attracting all sorts of men, but not sticking with them.  There is a brief mention of Hortense, an older woman who was active in the May 1968 student revolt, who has her own history with men, which I won't bother you with.

Note that my translation is kind of awkward - as a translator, I don't give myself much freedom to be colloquial.


                                                                262 Jamais

In France, they say that the best strolls end in a cafe, especially when there is a threat of showers.  And in this season, in this town, there is a threat of showers almost every day, even with a clear sky.  As a result, the city’s cafes are prosperous, as are the boot stores and umbrella stores.  It was because of these two things, shelter from the storm, and to continue the conversation with a glass of wine, that the three colleagues from the Department of Sociology at the University of Lille found themselves at a table at the Café de la Chanteuse (the Café of the Singer.)

“Who is this singer that the cafe is named for?”  

Morton set the question to the waitress, a small young brunette with blue green eyes.  “She’s a beauty,” Morton told himself.  “What a body!”

“Oh, Monsieur, there is a special story here in our town.”  The voice of this small woman sounded like honey.

“Well, mademoiselle, we’re not from around here, so we’d like to hear the story.  Do you have the time?  I know the place is full, before the shower comes.”

“I doubt a storm, Monsieur,” said the waitress.  They say there is a threat of showers and everybody thinks is a good time for a glass of wine.  I think if there were too much sun they would say it’s a good time to have a drink to protect us from a sunburn.  It’s a good business, this cafe, don’t you think?”

“Is there a story?” said Laura.

“Oh, yes, the story,” said the waitress.  She sat herself down on the fourth chair at the table, very much at ease.  “Once upon a time, there was a small lady, no taller than I am, and she could sing like Edith Piaf.  Two real sparrows, those two.  And she and her boyfriend wrote songs, about the seasons, about the sea, and especially about love, of course, since they were young and French.  Anyway, at that time there was a very popular song, Quando Quando Quando.  You know, that means When When When in French.  And this one summer there were a load of Italian women here in town — there were courses in French for Italians, and many young Italian women needed to learn French for their work, I suppose.  After class, the Italian ladies usually here to have a drink and to eat something — too much pizza, actually, too much pizza, disgusting pizza, our town is well known for having pizza like a rubber tire.  But anyway, the cafe had its little band, and they were fed up with the requests to play Quando Quando Quando.  All the city residents, especially my mother, who was a waitress here just as I am today, all the French detested that terrible song.

“But what could you do?  The young customers request the song from their country, they pay for their drinks and their disgusting cardboard pizzas, and they wanted their song.”

“Yes, what could you do?” said Juliette.  The customer is always right, no?

“Here in France?  You speak French perfectly, Madame, is it possible that you could really be an American?  That’s an American myth, I think.  Here in France, the waiter are kings, certainly!

“Did the musicians refuse to play it?” asked Morton.

“More amusing than that, Monsieur.  Remember, the singer and her boyfriend were song writers.  So, they could find a creative solution.  In place of Quando Quando Quando, they wrote another song.  They declared that it was a love song, and indeed the words referred to love but the title was a clever answer to the students.  The song was called Jamais Jamais Jamais (Never Never Never).  You understand that?  When When When?  Never Never Never!”

“I remember that song,” said Laura.  “I loved it!  When am I going to get married?  Never Never Never!  A very romantic song.”

“Why is it romantic, Laura?” said Morton.  It says I’m never going to get married.  It’s anti-romantic, isn’t it?”

“Not at all, Morton, the song and the singer doth protest too much!  I will never be in love again, they say.  That’s something Hortense would say.  This is after an affair that had to end badly.  It was too painful at the end, to say see you later, or goodbye.  That doesn’t work, it’s never worth the pain.  Never again!  At least, never again for now.”

“Madam is right,” said the waitress.  It was very romantic.  The song and the singer were like Edith Piaf.  After the first performance, every one requested Jamais Jamais Jamais instead of Quando Quando Quando, even the Italian students, in fact the students more than anyone.  They planned to go back to Italy with their new discovery.  The cafe became famous.  So, they were going to rename the cafe Jamais Jamais Jamais.”

“But that didn’t happen that way?” said Laura.  “What happened?”

“Unfortunately, the singer and her boyfriend separated.”

“Did success spoil their relationship?”

“No, I don’t think so.  I think that at bottom they were first of all partners, and that their love relationship was secondary.  They were together, so why not be a couple, I suppose.  Anyway, the boyfriend left the relationship, the singer stayed, and it seemed that it would be unlucky to name the cafe after a relationship that ended.  So, they gave it the name of the singer, Café de la Chanteuse.”

“And your mother was a waitress here then?”  The young waitress nodded her head.  “And she stayed here after the guy left?”

“Well, in fact, she left at the same time as he did.”

“She did?”

“Yes.  In fact, the two of them became my parents.  But now that the singer is long gone, I took the old place of my mother.”

“Oh, yes.  And what do you do?  Are you a student?”


“Nope, I’m a waitress.  And I’m waiting for my prince someday.”

“Yes?”

“Yes.  That’s my family history, that’s what we do.”

And at that, Laura exclaimed, “Me too!  Someday!”

And with that, the two women, one a little tall and a little bit redheaded and a little older, and the other a little short and a little brown haired and a little younger, kissed each other and looked at each other warmly, and them they turned around and scrutinized the crowd to find their prince.

Meanwhile, distractedly. Morton was whistling the melody of Jamais Jamais Jamais, and over the loudspeaker came the sound of Miles’ Davis’s trumpet, One Day My Prince Will Come.  A small shower started.

—————————————————————————————————————————-

Et en français, la version originale:

                                     262 Jamais (corrections by Claude Convers)

En France, on dit que les meilleures promenades se terminent dans un café, surtout lorsqu’il y a une menace d’averse.  Et en cette saison, dans cette ville, il y a presque tous les jours une menace d’averse, même lorsque le ciel est clair.  En conséquence, les cafés de la ville sont prospères, comme aussi les magasins de parapluies et de bottes.  C’était donc à cause de ces deux choses, l’abri d’une averse, et pour continuer la conversation avec un verre, que les trois camarades du Département de Sociologie à l’Université de Lille se trouvèrent à table au Café De La Chanteuse.

— Qui est cette chanteuse après qui ce café est nommé ?  Morton posa la question à la serveuse, une petite jeune femme avec des cheveux brun foncé et des yeux bleus-verts.  C’était une beauté, observa-t-il à lui-même.  Quelle silhouette !

— Ohhh, monsieur, il y a une histoire particulière de notre ville.  La voix de cette petite femme résonnait comme du miel.

— Ah, bon, mademoiselle, nous ne sommes pas d’ici, alors on aimerait bien [] entendre l’histoire.  Vous avez le temps ?  Je sais qu’il y a du monde ici, avant [] l’averse.

— Je doute d’une averse, Monsieur ! dit la serveuse.  On dit qu’il y a une menace d’averse et tout le monde pense que c’est un bon moment pour prendre un verre.  Je pense que s’il y avait trop de soleil on dirait que c’est un bon moment pour prendre un verre pour se protéger d’un coup de soleil.  C’est une bonne entreprise, ce café, n’est-ce pas ?

— Il y a une histoire ? dit Laura.

— Ah, oui, l’histoire, dit la serveuse.  Elle s’assit sur la quatrième chaise, à table, très à l’aise. Une fois, il y avait une petite dame/femme, pas plus grande que moi, assez petite, et elle pouvait chanter comme Edith Piaf.  Des vrais moineaux, les deux.  Et elle et son copain écrivaient beaucoup de chansons, sur les saisons, sur la mer, et surtout sur l’amour, bien sûr.  Ils étaient jeunes et ils étaient français.  En tout cas, à l’époque, il y avait une chanson italienne très populaire, [] Quando Quando Quando !  Vous savez, ça veut dire Quand Quand Quand en français.  Et [] cet été il y avait beaucoup d’italiennes, ici dans la ville — il y avait des cours de français ici pour les italiennes, beaucoup de jeunes femmes italiennes [] avaient besoin d’apprendre le français pour le travail, j’imagine.  Après les cours, d’habitude les italiennes venaient ici pour prendre des verres et manger - trop de pizza, en fait, trop de pizza, de pizza dégoutante, notre ville est bien connue pour la pizza qui ressemble à du pneu.  Mais, en tout cas, le café avait son petit groupe qui jouait ici, et ils en avaient marre des demandes pour cette chanson, Quando Quando Quando.  Tous les habitants, surtout ma mère, qui était serveuse ici comme moi aujourd’hui, tous les français détestaient cette chanson épouvantable.

— Mais quoi faire ?  Les jeunes clientes demandaient la chanson de leur pays, elles payaient leurs verres et leurs pizzas en carton dégoutantes, et elles voulaient leur chanson.

— Qu’est-ce qu’on [] fait ? dit Juliette.  Le client a toujours raison, n’est-ce pas ?

— Ici en France ?  Vous parlez le français parfaitement, madame, mais est-ce [] possible que vous puissiez être, en réalité, américaine ?  C’est un mythe américain, je pense.  Ici en France, les serveurs sont les rois, certainement !

— Les musiciens ont refusé de la jouer ? dit Morton.

— Plus drôle que ça, Monsieur.  Rappelez-vous que la chanteuse et son petit ami étaient [] chansonniers.  Donc, ils pouvaient trouver une solution créative.  Au lieu de Quando Quando Quando, ils ont écrit une autre chanson.  Ils ont affirmé que c’était une chanson d’amour, et en effet les mots parlaient d’amour, mais le titre était une réponse maline aux étudiantes.  La chanson s’appelait, Jamais Jamais Jamais.  Vous comprenez ça ?  Quando Quando Quando ?  Jamais Jamais Jamais !

— Je me souviens de cette chanson ! dit Laura.  Je l’aimais beaucoup !  Quand est-ce que je vais me marier ?  Jamais Jamais Jamais !  Une chanson très romantique.

— Pourquoi c’est romantique, Laura ? dit Morton.  Il dit, je ne me marierai jamais, c’est antiromantique, n’est-ce pas ?

— Pas du tout, Morton, la chanson et la chanteuse protestent trop !  Je ne serai jamais plus [] amoureuse, elles disent.  C’est quelque chose qu’Hortense dirait.  C’est après une aventure qui a dû mal se terminer.  C’était trop pénible à la fin, de dire au revoir, ou plutôt adieu.  Ça n’a pas marché.  Ça n’en vaut jamais la peine.  Jamais plus !  Au moins, jamais plus pour le moment.

— Madame a raison, dit la serveuse.  C’était très romantique.  La chanson et la chanteuse ressemblaient à Edith Piaf.  Après la première présentation, tout le monde demandait, Jamais Jamais Jamais au lieu de Quando Quando Quando, même les étudiantes italiennes, en fait, surtout ces étudiantes.  Elles avaient l’intention de rentrer en Italie avec leur nouvelle découverte.  Le café est devenu très connu.  Alors, on a eu l’intention de renommer le café, Jamais Jamais Jamais.

— Mais ça ne s’est pas passé comme ça ? dit Laura.  Qu’est-ce qui s’est passé ?

— Malheureusement, la chanteuse et son copain se sont séparés.

— Le succès a gâché leur relation ?

— Non, je ne [] pense pas.  Je pense qu’ils étaient au fond, en premier, des collègues, et que leur relation amoureuse était en effet secondaire.  Ils étaient ensemble, pourquoi ne pas être un couple, j’imagine.  Quand même, le copain a quitté la relation, la chanteuse est restée, et il semblait que ce serait de la malchance de nommer le café après une relation finie.  Alors, ils ont donné le nom à la chanteuse, Café de la Chanteuse.

— Et votre mère était serveuse ici à l’époque ?  La serveuse hocha la tête.  Est-ce qu’elle est restée ici après que l’homme soit parti ?

— Non, en fait, elle est partie au même temps que l’homme.

— Oui ?

— Oui.  En fait, les deux sont mes parents.  Mais maintenant la chanteuse est partie depuis longtemps, et j’ai pris l’ancienne place de ma mère.

— Oui.  Et que faites-vous ?  Vous êtes étudiante ?

— Non, je suis serveuse.  Et j’attends mon prince d’un jour à l’autre.

— Oui ?

— Oui.  C’est l’histoire de ma famille, c’est ce que nous faisons.

Et avec ça, Laura s’exclama — Moi aussi !  D’un jour à l’autre !

Et avec ça, les deux femmes, une un peu grande et un peu rousse et un peu plus âgée, l’autre un peu petite et un peu brune et un peu moins âgée, s’embrassèrent et se regardèrent chaleureusement, et puis elles se retournèrent et scrutèrent la foule pour trouver leur prince.

Entre-temps, distraitement, Morton sifflait la mélodie de Jamais Jamais Jamais, et par les haut-parleurs arrivait le son de la trompette de Miles Davis, Un Jour Mon Prince Viendra.  Une petite averse commença.


Humanistic Medicine Defined, and Why We Need To Teach It

Humanistic Medicine, and Why We Need To Support Teaching It

I

This is the age of amazing medical advances – I personally have had my own share of medical gifts of life and limb that former generations could only dream of, and the odds are that you, the reader, have had your own. The touch of modern medicine is everywhere. But in this age of scientific advance, there are unforeseen consequences. Just as the scientific doctor has advanced, so has the role of traditional healer, the practitioner of humanistic medicine, been partially eclipsed.

That is a shame. Because as much as we welcome the newly empowered doctor as scientist with miracle cures in the pocket, we still need the doctor as humanist, a tradition that goes back for millennia in human history. Scientific and humanistic medicine are both necessary; one does not go without the other.

Let's be more specific about what Humanistic Medicine is. “Humanistic medicine” encompasses a lot. It can mean interviewing patients to find out where they're at, how best to reach them, how to be empathetic. It can be befriending patients, even while being a professional. It can refer to adopting the proper stance according to the problem, as indicated by the classic article on the doctor-patient relationship by Szasz and Hollender, a relationship that can go from (a) active-passivity, to (b) guidance-co-operation, and to (c) mutual participation. It is part of the art of medicine to determine which situations and which patients require (a), (b), or (c).

It can mean becoming wise, as old time doctors were reputed to be, rabbi-like. It can be becoming attuned to the cycles of life, from birth to death, knowing when and how to intervene and when to let nature take its course, to acquiesce. It can be giving advice that is not strictly medical. It can be being able to call upon literature, philosophy, art and other forms of wisdom to help patients and give them perspective.

It can mean being part of a team that works with patients when curing is not an option. It can be helping patients navigate so they can do things they really want to do, when it becomes very hard. It can be giving patients and families bad news in a sensitive manner, different for each practitioner and each family. It can be caring for the bedridden, turning and cleaning, cheering up, relating, simply being there. It can be tending sensitively to the dying patient, and the families of the sick and dying patient, in all their variety.

Humanistic Medicine is that part of medicine, the softer side.

II

If you look at the medical miracles of modern life, it's understandable that an unintended consequence of its rise would be to put the traditional role of caring in the shade. The new possibilities of curing are so exciting as well as demanding. There is so much more science to master. It can be overwhelming in its difficulty and obvious importance. The time for learning to care can be crowded out.

In addition, it's not clear that medical schools and large research institutions were ever very good at teaching the softer side of medicine, the feeling side, the relational side, the empathetic side, the long term supportive side. The role of the scientist has taken over the medical turf, and the humanistic doctors are not the top recruits for medical schools, which think of themselves as research institutions. Curing has crowded out caring.

And that is a shame, because caring for and caring about the patient, and relating intimately to the patient and the family, and caring for the chronically ill, is as important as it ever was. Even when doctors could do very little to cure patients, they still rendered important services by being there. They always coordinated care for patients with ongoing illnesses, and for patients who were dying.

Caring for people, moreover, is not only important for patients, but for the doctors as well. It's hard to be a doctor. It's hard work to tend to patients, it's hard to prepare and learn so much and to keep learning all your life, it's hard just physically to work all that time including nights, and nowadays, of course, it's hard to cope with the corporations that run medicine. It's a very hard job.

But more than in most jobs, medicine can have so much meaning. You are doing so much, you have all the expectations on you, and when you meet them, when you actually do your job and help people in this most important aspect of people's lives, their health – talk about satisfaction in your work, few things match medicine, at least when things go right. So for all the difficulty of the job, there is a lot of upside.

Humanistic medicine is not a frill. Most doctors who have been in practice know how fulfilling it is to both patient and doctor when the softer requirements of medical care are fulfilled. And most doctors who have been practicing for a while realize how hard it has been to achieve that status of the wise and sensitive and caring physician. When you have been at it a while, you realize how important it is that humanistic medicine be taught and emphasized, perhaps more consciously than ever.

III

And, on a personal note, this all came home to me in spades over the last few years as my wife was afflicted with Alzheimer's. I had tried as best I could in a long career in primary care pediatrics to be that practitioner of humanistic medicine that I've advocated here. It was a long slog, I had a lot to learn, although I tend naturally towards being empathetic, which was a help. In pediatrics, I did have some bad diagnoses to deliver, and I did better at that as time went on. I tended to people's personal lives. I tended to try to put things in perspective. I wasn't a “Just the facts, ma'am” practitioner. But still, it wasn't easy.

And then I sat with my wife as our neurologist delivered the diagnosis, "I'm afraid it's Alzheimer's," a direct and caring face to face encounter, a heartfelt “I'm sorry.” She didn't at all shy away from the direct, personal connection while giving bad news. I was able to tell her, our neurologist, that we liked her very much as a doctor and ask her if she could schedule us for periodic visits a few times a year even if there was little she could do, because she was our doctor. She said yes, and told me later she had learned something from me and that she was scheduling her patients more frequently, just to give them care, if not prescriptions.

I cared for my wife as she needed more and more care, as I had to drive her everywhere, to the hairdresser, to take her shopping for clothes she would never wear and books she would never read, help her in showers, I had to help her in the bathroom, I had to prepare meals on an ever more restricted menu of things she would eat. I had to get care for her, thank God I found our Angelicare agency with professional caregivers, wonderful giving people, based in nearby Vallejo, all from the Philippines, eventually 24/7 care when Ann couldn't get out of bed and they had to keep her clean, which wasn't easy, but they did it so well in a way that I never could have. She never had a bedsore. The nurses came from hospice, as did the aide who washed her body and her hair twice a week as she was in the hospice-supplied hospital bed. We had to give her more and more medicines to control her neurological symptoms, especially when the seizures came. What I didn't see in pediatrics was professionals who take over when they know their patient is going to die, prepared to see that happen and move on to the next dying patient.

And then the final days, the kids assembled, sitting with her when she couldn't eat or drink anymore, I sat by her side and held her arm as she took her last breaths and gradually her heart stopped.

I realized that although primary care pediatrics had prepared me for some of all this, a lot actually, my training had left out a lot. I had never sat with a patient for a long time to see what it was like – I mean, it would take 12 hours of sitting there to really absorb it, and more than that, longitudinally. In med school and in residency I had never learned to give a dreadful diagnosis properly, and as a result I had botched some of those instances in practice. I had never sat with someone as they died – my only direct death encounters were after the fact, although one time at the Mass General ER a patient had coded in the radiology suite and the staff doc had taken me with him and as the patient wasn't responsive he opened the chest and massaged the heart manually and urged me to do the same, which I did. But that wasn't caring for a patient and then being there for the death, the way the movies of old-time doctors show that that's what used to happen.

So, it occurred to me that our training left out a bunch of stuff on the humanistic side. And that's why I'm writing this.

 

Budd Shenkin

My Day In Maui

 

 

I'm here in Maui, and on viewing a recipe from the NYT, I realized that, for some reason I cannot fathom, we did not have a Dutch oven.  My wife Ann was implacably well supplied with everything.  I set her up in our spare bedroom with a built in wrap around desk and shelves, and in going through them last year, I discovered pens and paper and folders etc. for roughly the next decade or two.   But no Dutch oven.

So I went onto Wirecutter to find the best Dutch oven for a good price, found one, ordered it from Amazon, and it was here in two days.  Then I was ready to make the NYT eggplant chili recipe.  I found the ingredients, had to replace one or two -- couldn't find canned fennel so I used pinto beans instead -- and cooked it up yesterday.  No salt -- I never add salt to recipes, it's unhealthy, maybe too much pepper, made the jalapeño to be added for each portion rather than in the mix.  And guess what -- it's great!  What a triumph of man over ability!

But then, the point.  Who did that make me feel like?  Was it Julia Child, Tony Bourdain?  Hardly.

It made me feel like Steve Kerr.

I often say that great managers and general managers are like landscape artists, who discover how each person, like a plant, fits in; which one needs light and water, which ones shade and sand, and which ones enhance the growth and beauty of the others.  But yesterday, I thought maybe they are also well thought of as great chefs, although in this case the creativity was only in recreating someone else's.

So, with that little snippet, we move on, perhaps to other pastures, perhaps to bramble bushes, but like the now un-PC Br'er Rabbit -- I had to go off-Amazon to get a DVD of Song of the South -- wherever we wind up, let it be a place of familiarity and ease.

 

 

But, oh, like Columbo, just one more thing.  After making the chili, I drove to Wailuku to have lunch at Cafe Saigon with two Maui friends, Ryan and Jess.  Ryan used to be my pool guy, now has moved up a bit in the company, but we used to see each other regularly and talk.  We became friends; I was able to encourage him in his give-up-smoking and live-better project.  An interesting, intelligent, introspective and very sweet guy, it turns out.  Then, what happened to him?  Far away in his native North Carolina, his friend of 20 years, Jess, traversing her own briar patch of a life, was in therapy, and discovered that what she wanted to do was to marry Ryan.  So she came to Maui and put it to him and said, we are going to get married.  Which they then did, and they are so happy, and she is so proud of herself, and he feels like he was given a gift.  They are going back to NC next week, after 3 years since she's been there, to get stuff settled, see her lawyer, sell her car, etc.  And, what did Jess want to know, what was eating at her?  She wanted me to narrate the further adventures of Hortense, one of my characters in my French novel, the grandmother-age who still has the hots for guys and doesn't hide it.  Somehow, Hortense tickles Jess, and she thinks she has some older friends at her gym up-country here in Maui who might fit the description of Hortense, I think.

And I was able to tell Ryan and Jess a little bit about my friend Big Bob's odyssey, his quest for and success in wooing Adele, and how I thought it was probably the greatest achievement of his life.  They nodded appreciatively, and recognized themselves in the story.

Anyway, onward and upward?  This is my son Peter's cat here in Maui, a feral cat whom he has befriended and made family, and who comes in and eats and rolls around several times a night.  I finished the day off petting him.  His name is Meatloaf.

Budd Shenkin

On Israel, And American Policy Toward Israel

I

Events clarify your positions, values, interests, opinions, points of view, and so on. Events.

Before getting to Israel, the subject of this post, let me first cite a preliminary example of how events provide clarity. What could be more clarifying than the Russian invasion of Ukraine? Russia was quiescent for years after the USSR breakup. But then, the invasions of Georgia and Crimea should have been clarifying. Three US administrations ignored them, essentially, out of what? Hope that it was not true, disbelief that Russia was changing, or perhaps better said, reverting? But with the Ukraine invasion, the picture became unavoidably clear – Russian aggression was back. And then, a year later, events have clarified another truth – Russia's conventional military strength is nothing like what was advertised. As these truths have become clear, in response, the US and NATO have changed their policies accordingly. Events clarify.

I think you can say the same thing about Israel, events have been clarifying, even if there has been a delay in recognizing the clarification. When I was a boy in the 1950's, the Israel myth was potent. A long-sought haven in a world that had experienced the Holocaust, which was just the latest and worst manifestation of anti-Semitism in a world long distinguished by its omnipresent existence in word and deed. The restrictions from employment and residence, the national expulsions, the pogroms, Dreyfus, the reluctance of the West to help the victims escape during WW II, the profound injustices against a people. And then, at last, a homeland.

And not just a homeland, a country of liberal Western values carried by Ashkenazi Jews, the only democracy in the Middle East, the industriousness of a people turning desert into farmlands, many educated and English speakers, underdogs, the original people of the book. The sturm und drang of its birth was tossed aside. The terrorism of the fight for existence, the pushing out of Arabs who had lived there, explained by the willingness of the more liberal Jews to live together with them, and explained by the war made by the Arab countries to destroy Israel, their expulsion of Jews who had lived in Arab countries for centuries, the confiscation of their property and goods. All in the throes of birth, we were told, and we accepted it.

And for decades, Israel held fast. Israelis were democratic, they were welcoming, they had a hell of an army and intelligence service, they became prosperous, they were smart. They held their own against outrageous anti-Israeli acts of savagery, like the Munich Olympics and Entebbe. After all, they were modern Jews, Jews at their best.

But then, as Israel matured, it changed. The swing to Likud was at first thought to be the quirk of an election or two, and attempts at peace with the Palestinians were hopeful and often sincere. But the turn to the Right turned out to be permanent, reinforced by the demographics of Russian immigration and increasing Sephardic/Ashkenazi ratio,and the increasing orthodox/secular ratio. Moreover, what immigration doesn't fully provide the religious right, a propensity to large families does. The religious parties and their rabbis show little hesitation in trying to bend all of society to their theological beliefs and practices. The favoritism shown to the ultra religious in policy, at first thought to be simply an artifact of a multiparty parliamentary system where the ultra religious were willing to go to either side simply because of favors granted, now appears to have become a deeply ingrained and accelerating fact of Israeli life. The question of “who is a Jew,” which originally seemed obviously inclusive, with implications of for whom Israel would be a haven of last resort, is at risk of being further narrowed with religious constraints. Israel can no longer be said to be a secular nation. The attitudes of many Israelis toward Arab land and rights, and the connivance of official decisions, are far from the original version. This swing to the theological and the right has proved enduring. The Labor Party is dead, and the Left looks to be a permanent minority.

These are the events. This is not a phase, this is not a test, this is a longstanding trend that is still increasing in its power. In fact, it's clear that the events are accelerating. Abolition of judicial independence (now under serious consideration in the Knesset) is a well-known landmark on the way to illiberal democracy. Truculent and aggressive policies toward Arabs, both citizens and residents of the West Bank and Gaza, are increasing, not decreasing. Only the willfully blind think that all this is temporary. It's true that Arab aggressive extremism and incompetence and corruption in governing have contributed to making peace impossible, but still, by now, the Israeli policies have a momentum of their own.

II

Assimilated American Jews like me, reflexively supportive of a Jewish homeland, supportive of the important national right to defend yourself, proud of Jewish accomplishments, are put onto the horns of a dilemma by the clarifying events in Israel. How far do you go in defending a country that is becoming less like a Western social democracy, whose government seems on the brink of becoming more similar to Hungary or Turkey, rather than resembling the US?

Being assimilated and secular, I turn to thinking of American national interest. After all, the US is in a dilemma similar to my own. Do you adjust your views in light of clarifying events in Israel? Well, you have to. And as you readjust, you go back to the roots of the basis of your support to date. Why has the US supported Israel so fervently?

Our support is clearly not the result of the so-called Israel Lobby spotlighted by the misbegotten, unsupported, and discredited accusations of “realists” Mearsheimer and Walt 20 years ago. No, there have been firm, self-interested reasons for the US to support Israel.

As a matter of values, Israel is a home to Jews, who need and deserve a home, who have been discriminated and targeted for eons, and were able to achieve a home less than 75 years ago. The US itself bears its share of the guilt of neglect of European Jews as they were slaughtered and neither protected while they were in Europe nor welcomed here.

As a matter of principle, both for morality and for the practical reason of establishing order in the world, the United States supports the sanctity of borders and the preservation of identity of countries.

As a matter of geopolitics, having Israel as an ally in the Middle East is of immense help to the United States for exerting influence in that region.

As a matter of national interest, it is in the interest of the United States to support countries and movements that share the democratic form of government, and the general Western set of values. This has both a moral basis, of wanting all people to have human and political rights, and a self-interested basis, since the more agreement on values we have in the world, the safer are our own values.

As a matter of internal national politics, Jewish Americans and others who wish Jews and Israel well for various reasons, including Christian religious adherents, have formed for many decades a strong source of support for American support of Israel. It is important, valid, and practical for governments to represent the sentiments of significant parts of their population.

So, the question becomes, should the significant changes in Israel make a difference to our preferred policy?

The idea of “Jews should have a homeland” is still a good one, given the historical targeting of Jews, all of this obvious to Westerners. There are many other minorities who lack a homeland – the Kurds, the Rohingas, many others, but they are less visible to Westerners, and none of them have actually achieved the modern establishment of a homeland, so for them it is still a hope to be pursued, while for Jews, a homeland would be a takeaway. There's a difference between defending what is and hoping for what isn't. Don't go backwards.

But, this homeland argument is tarnished by the question, would all Jews be welcomed in this increasingly theological country? Would Jews now in the Diaspora really want to repair to a state that so constricts their freedom to believe and to act? Imagine – would the Iranian-Americans now living in Los Angeles really want to support Iran on the basis that they need a place to decamp to if things got hot for them in the US? It's not a fair argument, Israel is not Iran yet, but that comparison might help to clarify Israel's claim to support as a homeland. Not to mention that, with increasing orthodox power, even conservative and reform Jews could well be excluded from the right of return in the future. Home is where they have to take you in, but sometimes they won't recognize you as part of the family, and sometimes you really can't stomach the prospect yourself.

A more powerful argument for continued US support for Israel are the more prosaic geopolitical issues. Especially with Ukraine as the target of unbridled old-fashioned predation by a stronger power with duplicitous arguments, and as we remember what happened when Kuwait was overrun, we are strongly reminded of the value of recognition of borders for world peace. It is in the interest of international collective security that countries be supported. Israel has a right to exist, not only because it is a refuge for a people, but because it already exists. Israel also has every right to protect itself, and to receive aid from allies to protect itself. (The issue of the occupied territories leaps up at this point, and forms another reason for the US to be wary of undue support of an Israel that makes claims on international support to protect its own borders, yet violates the principle on various practical and Biblical grounds, all fairly bogus.)

Traditional geopolitics also attracts the US to ally itself with Israel. We need allies in the world everywhere, and the Middle East is a crucial area. We have always looked for allies abroad, allying even with states we view with various degrees of distaste. Famously, FDR said about Somoza in Nicaragua, he might be a son of a bitch, but he's our son of a bitch. Even in the Middle East itself, few regimes could be more distasteful than that of Saudi Arabia, but here we are. And, what are we going to do about increasingly extreme and recalcitrant Iran, which seeks not only to destroy Israel, but allies itself with Russia and will establish drone production in Russia for their offensive military use? Having a firm ally in the area is a value that speaks for itself.

We were used to supporting Israel as “the only democracy in the Middle East,” the only country there that shares a European-American sensibility. As we see Israel become illiberal in both governance and society, this reason for supporting Israel is increasingly severely attenuated.

Finally, is American sentiment within the country still attuned to supporting Israel? Yes, it seems so, although with the alliance between Netanyahu and the Republican, Trumpist right, liberal and Democratic sentiment has attenuated. Jews at large still support Israel, although many (probably most) would like to see a shift back to the middle in Israel. The BDS-supporting Left is a vocal minority that really hardly counts at present, given the predominant sentiment nationally.

So, as an American and as a very secularized Jew, what do I conclude? I conclude that holding one’s nose as one deals with an ally or votes for a candidate is an ordinary course of action. We make choices among possibilities, not among wishes. I have a sentimental attachment to Israel, although clearly not so strong as many of my more reverent American Jewish friends. But even as my personal ties to Israel attenuate, as an American, I see plenty of reasons to continue to ally with Israel. We will have only limited ability to affect their internal actions, much as with other countries. We can admonish, we can encourage, but our leverage will remain limited. Israel might make some policy alterations as we reduce aid to them considerably, and as we cease protecting them so consistently in the UN Security Council, or they might not. But the US will have to take these and other actions as it distances itself from Israel, according to the distancing that Israel is in the process of establishing with us.

Finally, there is another consideration, which is the widespread existence of anti-Semitism. Internationally and domestically, it's always there, either under the surface as a threat, or even more visible as it is now. Like it or not, Israel and Jews are tied together, and if we encourage anti-Israeli sentiment, we are also pushing the door a little bit open to anti-Semitism. We have to be very measured in our stances, no matter how despicable we find the particular Jews who are becoming predominant in Israel. We can't treat Israel as we would like to treat Hungary or Turkey, as foreign powers with little history of being a target of worldwide hate and repression. We have to be prudent.

So, in the end, we have to let events clarify our thinking. Israel is becoming more theocratic, significantly less liberal and on the brink of becoming an illiberal state, but remains strategically important to the US, and there are vestiges of morality that still accrue to Israel. We need increasingly to hold Israel at a distance, take steps to discourage Israeli alliances with the extreme right wingers in the US, and indicate to Israel that we will help them as a last resort, but the more their values and interests differ from ours, the more removed they will be from our inner circle of friends.

It's an unsatisfying conclusion, but at least it might be based on some clarity.

Budd Shenkin

I am once again indebted to David Levine for excellent suggestions and editing.