The Ownership of Things

Returning to the present day:

I bought a new car, the first new car I have ever owned. The old white rattle-trap was becoming unreliable. With so much long-distance driving these days I decided to buy a cheap, reliable, fuel-efficient new car. It is all those things, and it is also fun to drive.

The fact that I like my new black car is concerning. I never really liked the old white car; it was just a functional thing that got me from place to place. During this phase of my life in which I am often alone I find myself becoming attached to things. The fact that my new car fits my values of thrift and environmentalism only increases my sense of attachment.

I was told when I was younger, "Always care about people and use things, not vice-versa." I recall the Sisters of Charity I admired in Haiti. Their cheap flip-flops were the only things they owned in the entire world. They walked freely and joyfully in places where someone with a nice car and a wallet full of credit cards could never have been. Similarly there are places the old white junker could take me that my new black car doesn't go so comfortably. The beat up white car could be left in front of a homeless shelter or driven up these winding Tennessee hollers without the awkwardness that a shiny new car creates.

The fact is that the ownership of nice things isolates one from others. There are certain considerations you must take for your property, that makes you lonelier than before. It seems to me that extreme wealth must be the saddest place a person can be.

As a young and idealistic student, poverty was easy to achieve. Now an idealist with a family and responsibilities I find certain nice things seem unavoidable. I tell myself that these things are still tools I will use to do what I am called to do. But I cannot help but wonder if years from now I might find myself safe behind locked doors fretting over protecting my property from the very ones I had hoped to serve.

How to Live When the World Falls Apart

This is the last in a series of three posts from the months surrounding 9/11 five years ago. I wrote it in a gridbook after Thanksgiving. Every year for the last 5 years a group of my friends has met to celebrate that holiday together. The first Thanksgiving was in a secluded cabin in the mountains:

It was the day after Thanksgiving. We were all together beside a waterfall in West Virginia. The sky was gray and overcast. We were close enough that we could feel the thundering of the water beneath us. I was talking to Scharlie and Chris. We had been talking about living in community. I was telling them about the old electrical plant beside the river in Georgia. I telling them about the group of people I had known who were planning for Y2K and had considered buying the abandoned plant. “It was such a strong building in a secluded place; they thought it would be a good place to go if the world falls apart.”

Chris never moved except for stroking his beard with his long, thin fingers. His eyes never left the torrents beneath us. He said, “Everyone keeps looking for the world to fall apart. What no one seems to realize is that it already has.”

I thought about the recent death of David, about the bombing in New York and the war in Afghanistan, about the obnoxiously sentimental advertisements for Christmas shopping, about my love Joya and my hope for a life with her, about my beloved new niece Hadley who would grow up in front of a television, about my parents who had done nothing but fight recently, about that Thanksgiving in a tiny cabin with friends who I loved. I watched John and Brian jump from rock to rock over the roaring falls, calculating where I would have to jump into the water beneath me to save them if they slipped, wondering if it was possible to survive in those freezing rapids under the best circumstances. I was sure Chris was right. The world has fallen apart and no amount of hopefulness or flag-waving can undo what has already gone too far.

So what should one do when he lives in the waning of a great civilization? I am studying medicine. I hope to marry Joy someday. I hope to be a doctor for the poor in some rural town. I think I need to write –exactly what I should be writing I’m not sure. I need to pray and read the scriptures more. I need to eat less and get my large body more physical exertion. I need to visit my family more, before Joel and Emily’s daughter grows up. I need to tell my friends that I love them. I need to somehow keep myself from quitting medical school. I am growing old. I feel older than I really am. I think about all these things and wonder… Is this the right way to live at the end of the world? I don’t have the answers. I don’t even think I am up to the few tasks I have given myself.

Loss, 9/11, and David

David died of metastatic bone cancer just a few days after the September 11^th bombings. All the grief over the killings will always be bound in my mind to the loss of David. I wrote this the day he died:

Dear David,

You died today at 6 am. I was planning to write you. I have always been planning to write you –ever since you gave me your address when you left. I hope you didn’t mind. We were never very close, but I wish I had a chance to tell you that I admired you. I remember that afternoon when I asked how the doctor’s visit had been. You told me that it was cancer. “Oh,” I said, “but not a serious cancer is it?"

“Very serious,” you replied. I was amazed that a 17-year-old could make such conversation without hesitation. You didn’t put on a false bravery either; you admitted to us that you were afraid. I would have been more afraid than you. I would have been angry if my future had withered just as I was reaching manhood.

I remember the last night you were at Covenant. You and the guys from the dorm came over to my house. We read poems. Your poem was beautiful. You wrote it long before you knew there was a cancer in your bones. You wrote about being lonely. You wrote about sitting alone when everyone else sat with friends. You wrote about being afraid to talk to girls. You wrote about your faith in God. I was amazed at you. I was amazed at the peace you found in loneliness, and how grateful you were. You were grateful that the guys at Catacombs had made you feel welcome and loved. You were grateful for the three months you got to spend with us here. You were even grateful for the cancer that you couldn’t understand. We all just sat around the fire and laughed and read each others poetry. Before you left we all took a picture together. You didn’t smile. You didn’t frown. You just looked right at the camera while the rest of us clamored and grinned.

You faded suddenly. For the last two years all I heard was good news. You were feeling strong. Your chemotherapy was going well. And then suddenly one day all the news changed. You were dying. You had perhaps a month left. Fernando told me about seeing you. He said you looked weak, but as always you were kind and resilient. You said that you take it one day at a time. I wish I could have gone to see you. I wish I could have put my arm around you and said, “Courage. Take courage.” I wish that I had written you a letter. I planned to write someday just to let you know that you were in my thoughts and prayers, but you died too quickly.

I know you are at peace. You see the face of God. But I cannot help but feel angry for you. Angry that you went so early… angry that you will never fall in love, graduate from college, make love to a woman, have children. All the things I have in life anger me right now because you will never have them. Your death came at the time everyone was mourning for thousands of people who died in New York. They died in falling buildings, and the whole world cried for them and vowed revenge. You were dying too but no one noticed. You had no woman who loved you, no children, no close friends to mourn you. Due to the timing, your family’s mourning is likely lost in the national paranoia. I wonder if any of us at all will be thinking of you 10 years from now when we all have wives, children, and lives of our own? I am angry at myself that I never wrote you. You gave us all your address when you left. I was never a close friend, but did you have many close friends? I thought of you often, up north in some lonely oncology ward. You would have taken comfort in letters from one of your friends from college. And you might have shared your wisdom with me. I would have known how to mourn you better because I would have known you. But I was always too busy, always planning to write you later. Now you have died, and I am mourning that I did not know you. I realized long ago that you were wise and lonely. I should have been a friend to you. I think you needed friends. I hope that when I die, that I have friends. But you died too young, and we who are young forget too quickly… too quickly to hold on to a friend over 2 years of chemotherapy.

I wonder if you died alone. Was everyone who should have been focused on you too absorbed in the news of bombings and war? I hope no one told you about it. I hope you slipped away without the thought of the whole world—the world that needed the wisdom and kindness that you would not live to bestow—mourning thousands of dead New Yorkers, never knowing that you were dying alone or that you even ever lived. But you are no longer lonely, you know the presence of Jesus our Savior. I am the one who is lonely. I am here thinking of you and crying. Did I tell you that I cried when I heard you were dying? I had not cried in many years. I didn’t even cry when I heard about the thousands of innocents killed last week, but I cried for you. I cried that you died so young. I cried that I could never know you as I had wished I could two years ago when we spoke at my house.

I know that heaven is a better than here. I know that death does not have the final victory, but it is a chasm between us. You know longer have the possibilities of this life, the books you hoped to write, the women you longed for, the friends you needed, the wisdom you wanted to share. I must live my life better. You give me wisdom even in death. I will join you in death someday, and it will be better there, but for now I will live my life better. I will live and love better for all the life and loves you missed.

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.