9/11 Before and After

These are two pieces written before and after 9/11. It is not often that we are able to see our own darkest imaginings take place in the real world:

3/11/01 (Before)

I am sick of the TV, of the internet, of the radio, of the people I meet. I am sick of constantly being solicited for one thing or another. I am sick of the wealth-generating, mass-marketing juggernaut that has taken over our culture. I am sick of being reminded that working at the homeless clinic is advantageous because it will look good to residencies and make me feel proud of myself. I am sick of the idea that every interaction must boost my pleasure / entertainment / self-esteem / net-worth / sex-appeal / market value. Is there anything genuine left without a dollar amount attached?

Life / Love / Freedom / Faith / Sex / Anger / Fear / Happiness: all bought and sold like grade-D meat these days. Sure there are "some things money can't buy," we used to believe that. We told ourselves the world wouldn't affect us, but look at us now. Everybody's got their soul for sale to the highest bidder of money / pleasure / love / whatever. Nothing is genuine. Nothing is honest. Nothing is selfless.

I fear the best thing for us would be a humiliation and destruction. Perhaps a people as ruthless and narcissistic as ourselves will attack us... kill us by the thousands and rob us blind. As horrible as it sounds it may be the only way to save us from ourselves. We will never repair things ourselves (although we often say we will--and sell the idea for cheap thrills and votes) because we have become addicted to our own decay.

November 2001 (After)
*Written in the same page of my gribook as the above:

Exactly six months later to the day was one of the bloodiest days in our history. Ruthless people leveled our towers... and we watched on TV for shock entertainment. Then we created a war for an even bigger television event. Watching someone else's sons in the special forces risk their lives is even more exciting than seeing 3000 bankers and MBAs go down in a towering inferno!

We took the fact that evil men had targeted us as a sure sign of God's blessing on us. "God must approve of our selfishness. Gluttony and greed are now sure signs of freedom and virtue. Suddenly it is heroic to rescue our sacred economic prosperity by consuming even more luxuries. Send the special forces overseas to fight on television, and I'll do my duty by doing the Christmas shopping in my gas-guzzling SUV!"

We are not capable of justice or even sustained hatred. We only redouble our relentless pursuit of wealth and entertainment. We didn't even stop to think about examining our own souls. We seem to have forgotten that the terrorists only did what we had been longing to do in our own self-loathing. No instead we are now quite certain that divine justice has spoken in favor of our greedy pleasures.

If these last few months were unable to constrain us... I fear we are beyond saving. May God have mercy on our souls.

Playing the Part

The way doctors are created has always fascinated me. It addition to the mastery of information we expect young physicians to create a role of "doctor" and play it perfectly. I wrote this piece when I was an intern:

It is strange to watch myself from inside myself while at the hospital. It is like watching an actor play a part. The element of acting is thrust upon me. There isn't supposed to be such a thing as a fearful, unknowing doctor so interns first learn the art of taking on a persona cool confidence while panicking inside. "Dr Whittemore, your patient is having trouble breathing." I think, "Oh shit, this man needs someone better than me!" but I never say it. I stay in character. "Get an ABG! I'm on my way," I say calmly. I always arrive smiling and keep smiling no matter what happens. Patients don't like it when doctors show fear. Never let them realize this is the first time you've taken care of this.

In addition to the general requirement that young doctors be actors, I have written a particular flare into my character. He is the gentle, happy healer. I play him quite convincingly. I like this character and so do my patients. The nurses too seem quite charmed. I can keep cool in a crisis and then hug all the nurses and thank them quite naturally. Then I hold the patient's hand until she is laughing and chatting like she doesn't have lines and catheters all over her body. No matter how sleepy, terrified, or angry I become I never break character.

It is strange to watch this character. He must have been stolen from the kindly old "Doc" in some movie or TV show. Overall I like him: somewhat simplistic, but overall good-hearted and humanistic. He may resemble what I might want to become, but he is most definitely not me. He comes out of a script; he is not an expression of who I am today.

I am realizing I act a lot these days. At home I sometimes even play the part of the "good husband," a character not too different from the "good doctor." I suppose I have less acting to do here at home because I really do love and admire this woman. But there are the unavoidable times when love and admiration are not as strong and the best thing to do is stay in character. I know the part well because this character is actually based on myself on my better days. I remember all the lines because I wrote them.

Suddenly this week I am aware of myself as an actor, because I suddenly find myself off stage and out of the heat of the spotlight. Joy is out of town so I have time alone.

I have forgotten how it feels to be alone. The actor is at a loss for who to be with no audience present.

Years ago when I never acted. I was myself. The man you saw or spoke to was more-or-less a true representation of my inner self. There was the freedom to not be good, or wise, or stable. Any desire for goodness, wisdom, or stability naturally required me to examine and improve my mind and character.

Now I find myself having taken on so much responsibility. With responsibilities come expectations. People trust me with their lives when they are ill and far more experienced professionals must obey my orders. These people expect us to behave in a certain way. This job demands acting. I cannot "just be myself" on a bad day. I have to be what those who depend on me need me to be. As an intern the character you must play wears a confidence and knowledge that hides abilities still lacking. As a family practitioner the role also calls for a level of warmth and trustworthiness.

I have become quite an actor out of necessity. I will act out the good doctor in order to become one. The funny thing I have found is that it is much easier to act than to be. So on the days I come home too tired to be a loving husband I still have the strength to play him convincingly. Acting is not wrong –everyone has to occasionally act the part to live up to our responsibilities. However, when you act as much as an intern you replace personal growth with improving your acting. Now to improve myself –my confidence, my goodness, my stability– I just adjust the character I play. No internal changes are needed because the internal never reveals itself.

And then comes a week of solitude. I spend nights of silence and feel suddenly at a loss without a part to play. I used to love to be alone with my thoughts. I used to read and think through my emotions, beliefs, and actions. But I find myself devoid of any emotions, beliefs, or actions at all.

I have been acting so long that I have forgotten how to speak without a script. I have forgotten how to play myself.

-8/26/04

"Died of Renal Failure"

I worked in a hospital in rural Haiti during the summer of 1999 as a college student. I recently found some old folders from back then, and saw faces of patients long dead. Since in Haiti there are not the same privacy laws we have here, I can share the faces of the people I saw there. I still wish to portray people with the utmost respect. (Often patients asked me to take their pictures or draw them.) There are some things you can see in the face of dying patients that it is impossible to describe. This is a woman who came to our hospital from a tiny village. She was found to be in renal failure. There was no dialysis for poor Hatians, so there was nothing that could be done for her. She went home to die with her family. Before putting her in the truck to carry her home, I made this picture. She asked me not to forget her. I haven't.

I first experienced medicine in Haiti. I still think of the people I cared for there, as I now study medicine here in Tennessee. I have another woman (whose name or story I would not be permitted to tell) who will die very soon, perhaps even tonight. I sometimes wonder if I get “too involved” with my patients. In specialties other than Family Medicine loving your patients is often looked down upon. I think, however, that for those who are suffering, kindness is often much better than medicines.

The Pragmatic Use of Embryonic Stem Cells

Embryonic stem cell research was in the news today. (New York Times Article) I doubt the veto will last. Polls say 75% of Americans want embryonic stem cell research so there is little doubt they will eventually get it. I don't think I am being too incendiary to make the comparison to the crimes of my ancestors against the slaves they bought and sold:

Stem Cells and Slavery:

America has always been a pragmatic, business-minded culture. Most of our genocides have been done in name of sober well-doing. We have a history of inventing entities that we call humans but not persons (human things rather than human beings). Then we kill, maim, enslave, banish these “things” in the name of charity or good business.

We tend to invent these “human things” when our fellow humans can be conveniently used to further our goals, and then with clear consciences we go about our violent business. History will always judge us as murderers. We are, but we are not viscous murderers—just practical well-meaning murderers.

Florida

Just came back from trip to Florida. I wrote this a few years ago when I was down there. I don't think I would state it in such a negative way were I to write it today. Mountains are no more virtuous that beaches. I hope my relatives who retired to Florida don't take this literally. I think, however, the dangers of consuming the world for our own pleasure is quite real.

Florida is a lie. The warm sun, the ocean breezes, the year-round flowers: all lies. They are the forgetful lotus, the siren song lulling the unaware to poisoned sleep. This is not real. Were it real life in the tropics you would be malnourished and riddled with parasites, rather than fat and relaxed. Give me the dark grandeur of mountains. They might keep my soul alive. The tropics have been tamed, their wildness subjected to air conditioning and lawn mowers. Buy up beach front property and be lulled into the life of pleasure and ease.

This is our American Heaven, live your life well and you get to come here when you retire. But it is not heaven. It is anesthesia for the heart. Put you down quietly, forget the evils of your world, forget your obligations to the needy, forget the needs of your soul, sit in a comfortable chair under a palm tree and forget it all. But Florida is a lie. Even this world is not tamed. The Hurricanes and heart attacks will come like thieves in the night. The fountain of warm-climate youthful sensation will dry up. Give me the dark grandeur of the mountains where the sight of immensity or the shroud of fog will remind me of my death daily. I hope that I may consume fewer pre-packaged comforts and perhaps pay some attention to the state of my soul.

Generation X and Revolution

This is something I wrote a few years ago. It still strikes me as applicable to our society.

A commercial I have seen on TV recently: A shoe commercial with a loud and chaotic stream of angry, physically-absurd images with pictures of running shoes and the word DEFY over and over again:

Defy gravity!

Defy limitations!

Defy electricity!

Defy anything!

What a ridiculous lot of furious fools my generation is! And now they are using our fury to advertise shoes. We always want to raise a fist of angry revolt in the air. One must revolt in order to establish one's identity (a tradition we learned from our parent's generation). But we can't find much worth rebelling against. We are a nation of rich and unrestricted people, but still we must defy something. We must loose control of our passions and strike out against anyone who dares oppress us, but no one cares about us enough to oppress us, which infuriates us even more.

The ideal young revolutionary of our generation is like an uncaged animal that unleashes blind lust or fury at anything that nears it. What other kind of revolutionary could we expect in a world with nothing worth believing in? It is only the insightful revolutionaries who truly identify that hateful oppression they riot against. They recognize the oppressor within themselves, in their own unrestrained passions. What else to do but turn that limitless fury in on itself? So they unleash all fury on their own angry selves, often killing a schoolyard full of random classmates with them, creating a horror so beautiful and rebellious that the rest of us can only watch with awe and envy.

The school shooter is not an isolated phenomenon, he is the final product of the Revolution. But alas, most revolutionaries sell out too soon. Not many are willing to become martyrs for the cause. Instead we fade away into hedonism and self-loathing narcissism. Corporations harness the sentimentality of our fading revolution to sell us running shoes.

What a miserable generation of old people we will become! Not only did we sell out like past generations, but we didn't even know what we were trying to do. Our grandparents tried to create an orderly and decent society, and failed. Our parents were revolutionaries for peace and love, but they all sold out. And what about us? We gave ourselves over to every desire. We shook a defiant fist at everything and nothing. What was our revolution? What was our struggle? Perhaps we wanted to end up empty inside. If so, we may have been the first American generation ever to succeed in its struggle.

Death and The Doctor

I had a lot of patients die recently and it was weighing heavily on my mind. It is interesting where your thoughts go when you sit down and start writing:

In the hospital again. Lots of death is always here. Watched a 2 year old girl whom I had delivered, slowly die. Nothing I tried worked. She faded right in front of me while her mother cried. For a while I had dreams about her. I would wake up frantically trying to save her only to realize the child had died a week before. Later on call, I ran a code on a woman for almost an hour. All her ribs broke. We shocked her again and again but nothing worked. Then the other day I sent a gentleman I have cared for several years to hospice. I always liked him, although he never cared for doctors. He said he was tired of treatments and check-ups and was ready to die.

Working in medicine is an odd job. I can think of no other role that brings one so close to death without any real danger involved. Soldiers or law enforcement put their own lives in danger in their jobs that involve for life and death, but the doctor or nurse almost never fears harm. Other than the occasional cold caught from a patient and being kicked by a drunk patient I have never experienced any physical harm or danger in medicine. Doctors are like the television-watchers who absorb violence after violence from the safety of a living room. We may struggle to save our patients or mourn them when they die, but in the end we are observers and not participants in the suffering we see. I wonder if it is healthy for the mind to see death so often and have no immediate threat of it to force fear in us?

I have often noticed that soldiers and police officers I encounter seem cool and distant, but their experience with death is different. They have known their own lives to be in danger. The modern hospital may be a unique place in society where those who intimately interact with life and death are immune to being harmed. (In some ways even literally immune; I get more vaccinations than the average person.)

I wonder if there are threads of voyeurism in our desire to help the suffering? It is a job that must be done, and we are proud of our opportunity to "help people," but we are not the ones who would be just as contented helping people from a distance or even helping those we might never see. We want to help from up close where the blood and crying is.

I didn't consciously recognize this in myself when I chose medicine as a career. However, I cannot deny that when I run to a code it is not only altruism that drives me. I want to be where the action is. I suppose this is the same instinct that keeps us glued to news broadcasts of wars and plane crashes.

There is something in us that seeks to watch death and suffering. Perhaps we seek catharsis—to somehow improve our souls by empathizing with the suffering of others. At least I hope it is reflection and improvement we seek.

"The New World"

I don't plan to make it a common occurrence to put my movie reviews on this blog. I want this blog to be about interesting ideas, and not just some random conglomeration of my personal tastes. That being said, however, I find this particular film so thought-provoking and such a powerful work of art that I feel comfortable discussing it here.

If you haven't seen "The New World" you really should watch it as soon as is possible. It is one of the most fascinating films I have ever seen, and perhaps the most beautifully filmed. I have seen it twice now. Like most films by Terrence Malick (director of “The Thin Red Line”) its depth and meaning grows with each viewing. This movie seems to have unfortunately suffered from its own advertising. Many people who went expecting a historical romance along the lines of "Braveheart," encountered a film so subtle and profound it didn't make sense to them. Reviews were mediocre. It floundered in theaters. (Most people expecting a comic strip might find a painting by Rembrandt disappointing.) And yet I would have to say this is the best film I have ever seen.

It has a subtle beauty and profound way of watching its characters that is unlike any film you have likely ever seen. There are only about 100 lines of dialog in the entire film. The rest is simply watching. Never has watching interactions or gestures of the characters reenacting history been so engrossing. The film only briefly plays with myths like the “noble savage” or the “welcoming Pocahontas” only to show its characters to be deeper and more complex imaginations that the audience must interpret themselves. It is always watching… watching the complex interplay of new cultures… watching the years pass… watching people rise and fall then rise again. Most of it has no words at all. (Not in the dull independent film way of watching people doing nothing and calling it art, but in a way that is obviously meaningful and understandable in spite of its depth.) It is told less like a narrative and more like the way someone might remember the events of their life. “The New World” is about people in the midst of great change. It will resound with tragedy and beauty long after the petty political dramas of this year’s Oscars are forgotten.

Watch this film with an open mind and you will find an artistic treasure well worth watching again and again.

On Altruism

In medicine I have met some incredible humanitarians. I even try to be one myself, which brings up some interesting thoughts on human goodness. It is odd that doing good would inspire anxiety, but I believe it does. I work with some incredibly caring people, but I can't help but wonder if this applies to them too. I wrote this originally in 2001 while in medical school:

Each human role has its inherent fears. The rich fear poverty, the strong fear weakness, the independent fear impotence. But the greatest of fears must be the unspoken fears of the good person. He fears himself.

He fears that he will suddenly be exposed as the opposite of all he does. So he works even harder. His dread that he might someday be caught doing something cruel or selfish makes him into a saint. He is driven to goodness by his phantoms. He wants to see himself as someone else, someone like Mother Teresa, Martin Luther King, or Ghandi, assuming that these people never had that frightening sense of rottenness inside. So the good person becomes good at such a price. He sacrifices himself. He becomes a fiction, a shadow. Ah, but it is a beautiful shadow, something good, something he loves, something worthwhile, a puppet in an imaginary story. And despite all he does for others he dreams at night that they will turn on him and point their fingers saying, "Ha, you are not the good man you seem to be. You are a fraud!" He wakes afraid and tries to comfort himself with better thoughts.

He even tries to still do good while abdicating his claim to the title of goodness. He speaks openly of his flaws to all who praise him as good. But this only makes it worse. They praise him more because he does his good with humility. And so his isolation grows.

The good person is always out of place. Because he always does good he cannot even describe his strange feeling of inadequacy. He is most alone among other good people. “Perhaps something is wrong with me? They cannot possible feel like this.” Of course they are all uncomfortable around him for the same reason, but he doesn't know this.

Such an odd group of good people! These are the ones that really do give all. They change the world. And we admire them, because our own fears drive us to such baser things.

In the Hospital

Sorry I haven't posted much of late. I have been on the hospital service this month. I'm sure I'll have some interesting things to say later. Right now I am working too much to think. There seems to be a lot more death and suffering in here than I remember when I am off service. I spent all day taking care of someone who probably won't make it another 24 hours. It sometimes makes this place seem futile.

For more optimistic thoughts on death you can read this post from last month.

-Jonathan

Spiritual but Not Religious

The other day I saw a classmate of mine carrying a book named “The Wisdom of the Buddha.” I doubt he is a Buddhist. I also doubt he is an Atheist. I barely know him, but it would be safe to guess that he is not a true believer of any religion, nor does he intend to be. I am also sure he would describe himself as "spiritual."

The rise of "Spirituality" in our culture is a very interesting phenomenon. The hospital here has a questionnaire that they gave to all the patients. There was a question that asked the patients to identify their religion. The question listed the 70 religions most prominent in the US. Even with so many to choose from over 60% identified themselves as "other." Since 90% of Americans say they believe in God, it would be quite an anomaly to have a hospital in the “Bible Belt” with that many Atheists. No, instead they want to communicate "Yes, I am spiritual, but it is something that is my very own. It is not like anyone else and not like a religious system."

My classmate was reading Buddha to seek “spirituality.” Spirituality encourages exploration. Everyone's spirituality is different. Spirituality is a freer way to reach that which is transcendent. It is a way to believe without having to disagree with anyone else's belief.

It seems that "Spirituality" is a backlash against the cold, empty universe of Existentialism. Once it was popular to be a proud Atheist, but that was just a passing fad. Human beings need myth and transcendence to bring meaning to their existence. So now everyone is very excited about their rediscovered status as spiritual beings.

But we still hold to so much of Existentialism. Existentialism embraced the emptiness of a world without God, because without the weight of divine purpose human beings were truly free. We were free to define ourselves as we pleased and live and die in an existence that was ours alone. And the Western world loved autonomy, even at the price of a dead God. Since then, the idea of a cold and purposeless universe has lost its appeal. Westerners are flocking back to what was lost. We are ready for spiritual meaning in our lives. But we Americans love our individual liberty. We love our autonomy. So we run headlong back into transcendence as if it were a shopping mall. We enter with a new attitude, an attitude unique to our free, unstructured, and post-Atheist culture.

We have a strange view of transcendent things! We see the spiritual as if it were some raw material of the invisible world. Like wood, stone, or steel, we imagine we can take transcendence and build it into any form that suits us. New Spirituality is ours to use. We do not belong to the spirit, the spirit belongs to us. We trust it to give our lives meaning, but only because we give it meaning first. We have taken the infinity of the spirit and reduced it to a piece of ourselves. “We are Americans, we are free, and we will not be dictated to by anyone or anything. We create our own reality, so the spiritual world had better be pliable enough to fit our needs.”

The New Spirituality theoretically embraces all religious traditions, and yet is opposed to the basic spiritual premise underlying almost every religious tradition. Religious traditions believe that we did not create the spiritual world; it created us. Religions acknowledge that the spiritual world is beyond our understanding and we must approach it on its own terms. Although the many religions differ greatly in their approaches, they all approach humbly, believing that that which is transcendent sets the rules we are to follow. As far as I know the New Spirituality is the only religion on earth that claims that we can all just step into the spiritual and tell it how it should configure itself to fit our needs. We Westerners are so arrogant! We are highly offended by the idea that the spiritual world or God might be so rude as to possess specific eternal qualities without asking our approval first. How ridiculous we must look, approaching that which is immense and eternal and telling it that it must conform to our tastes and desires!

"The Almighty sits in the heavens and laughs" -Psalm 2

Pascal on Happiness

"All men seek happiness. There are no exceptions. However different the means they employ, they all strive towards this goal. The reason why some go to war and some do not is the same desire in both, but interpreted in different ways. The will never takes the least step except to that end. This is the motive of every act of every man, including those who go and hang themselves…"

"All men complain: princes, subjects, nobles, commoners, old, young, strong, weak, learned, ignorant, healthy, sick, in every country, at every time, of all ages, and all conditions… What else does this craving, and this helplessness, proclaim but that there was once in man a true happiness, of which all that now remains is the empty print and trace? This he tries in vain to fill with everything around him, seeking in things that are not there the help he cannot find in those that are, though none can help, since this infinite abyss can be filled only with an infinite and immutable object; in other words by God himself."

"God alone is man's true good, and since man abandoned him it is a strange fact that nothing in nature has been found to take his place… Since loosing his true good, man is capable of finding it in anything even his own destruction."

-Blaise Pascal (1623 -1662)