The Past Eight Years

A nice op-ed by Paul Krugman of the NYTimes.

http://www.nytimes.com/2009/01/16/opinion/16krugman.html?ref=opinion

Family and Friends

My last post was long ago; just life getting in the way, I assume. My New Year's resolution is to be more consistent. This post, like my first, will involve a topic that we rarely want to discuss - loss. The Christmas holidays have become bitter sweet for me these past few years. Essentially, over the course of the 12 days of Christmas, an uncle (colon cancer), my best friend's mother (uterine cancer), and my grandfather all passed away in the winter of 2001 just after the 9/11 attacks. It had been a somber fall and it only got worse. I had only 4 uncles, and 3 have now had cancer, two of whom have passed away. I would have to say that the few adult men in my life growing up were an exceptional group. Maybe this is just the haze of a happier youth. Everyone has his/her issues, and my uncles were no different. But, they provided me, along with my father, the basis for how I approach my life in so many respects today. My friend's mother might as well have been my second mother. I spent virtually every day at his house in high school. She never, ever in my memory, had a cross word to say about anyone or anything. She very much enjoyed a creative spirit. She was one of the most beautiful people I have ever known. My grandfather lived a long life, but his death was actually somewhat unexpected. These people hang with me in the background, for the most part, with the occasional event that reminds me how strongly embedded within each other we all are. This year, however, they have been with me all too clearly.

A patient of mine died just before Christmas. He was 5 years old and had many medical problems. He had had an infection as an infant and so he was very developmentally delayed. He could not see or talk or walk. He also had a seizure disorder and more than one endocrine issue. One would think that his death was inevitable. That may have been true, but at this point it was very unexpected. I went to his wake. I have been to the wakes or funerals of all of the patients who have died in my clinic since I became an attending. This is, happily, not as big a task as one might think. My clinic is small and very specialized, and there have only been three deaths since I started almost 8 years ago. The first two were very much expected.

The funeral home was full. It was like any other, reminding me of scenes from David Lynch's 'Twin Peaks'. It was of some comfort to me that there were so many people there to help his mother. Despite the fact that he could not communicate or interact as most of us do, he had shaped her life for the past five years. She was distraught. There was no indication that he would die at this point, but I also detected that feeling of guilty relief, that only someone who has taken care of a person with a chronic, debilitating illness would understand. The service was largely in Spanish, and the Priest spoke so quickly that I understood very little. My mind wandered through the years and the time that I had spent in such places. What emerged was a reaffirmation of a principle that I had become fond of long ago in a different context - interdependence.

Our connections are strong. Call it love, call it the God within, call it whatever is comfortable, but the truth is, we need human contact and relationships to thrive. That is interdependence. I used to enjoy the books of Carlos Castaneda, but there came a moment when he advocated removing oneself entirely from the world. I found this proposition uncomfortable, for no matter how much time I need to spend on my own, I always go back to others. Maybe I took his premise too literally at the time. He could have meant that one needed to shut out the distractions to truly experience the divine, but this is not how the prose was written. So, my patient reminded me not of the inevitability of death, but of the enduring nature of our connections and the need to foster them. Maybe, in this time of 'change', we should renew our relationships and re-invest in the people who have helped make us who we are.

World Events And The UN

It has been awhile. I guess that you could say that I am a recreational blogger. World events should remain an important focus of any US administration. Nothing seems more timely than the results of the independent commission formed by Kofi Annan to address changes to the structure of the United Nations. While I have not read the report yet, it is an extremely important document. I believe that a truly strong and effective UN would act as a gatekeeper to a globally based set of foreign policy initiatives. Let's hope that their recommendations are taken seriously.

Ukraine - This is just such an unbelievable story! Who would have thought that there would be a return to 19th century intrigue with the poisoning of Yuschenko prior to the runoff election. Despite this attempt to emasculate him, he will win the election on the 26th.

Africa - Let's hope that the movie Hotel Rwanda will focus some attention on the atrocities that are occurring daily in Darfur and the Congo.

EU - Congratulations to the European Union for approving Turkey's application for membership despite widespread negative feelings by many of the Union's constituents. Only good can come from their full membership.

Middle East - I am almost afraid to say it, but there appears to be the possibility of fruitful negotiations occurring between Israel and Palestine. One can only hope for peaceful coexistence between these two peoples.

Chile - The supreme court of Chile has taken the extremely important step of holding Pinochet accountable for what has been termed state sponsored torture. The families of the victims during his time in power will be thankful for any justice they can receive.

Iran - The disturbing events in Iran relating to the production of fissile material needs the strongest possible diplomatic response not only form the United States but from the EU and Middle Eastern governments as well.

N. Korea - Let's hope that the stalled six party talks will resume soon so that this serious regional and potentially international threat can be addressed.

Well, that's all for now. There is so much more to mention, but it will have to wait for future postings. Enjoy the holidays, and don't forget to make a contribution to your favorite charity.

PEACE - M

Ukraine

This situation is so fascinating. I was watching This Week yesterday and it was noted that the old Eastern bloc countries had split down religious lines when it came to an affinity for European Union or Russia. Those countries with strong Roman Catholic roots have gone to the West and those with strong Eastern Orthodox roots have gone to the East. The Ukraine happens to be split down the middle, and it is interesting that there was a call for secession from the Eastern half of the country if the opposition candidate wins another run-off. The only other country with that kind of religious split was the former Yugoslavia - and we know what happened there. It is in many ways very heartening to see so many people out in the streets exercising a truly populist brand of democracy. The real test will be whether the region plunges into civil war or can work out its' differences peacefully.

Darfur

It's been awhile since my last post, but this is a topic that needs greater discussion. It is disgraceful that we, as a global community, are not doing more about the situation in Darfur. Have we not learned any lessons from the previous 30 or so years since the end of the Pol Pot regime in Cambodia, Idi Amin in Uganda, Milosevic in Kosovo, and the tragedy of Rwanda 10 years ago. A governments legitimacy is severely strained, to say the least, with the systematic murder of its own populace by proxy or otherwise. While we are praising the peace treaty that is ending a 20 year civil war between the North and the South, we should be putting pressure to bear on the African Union via a United Nations Security Council vote to send peace keepers to stabilize the area as well as to initiate sanctions against a regime that is currently less than responsive to the situation. Of course, negotiations should continue, because the conditions that have led to this crisis need to be addressed and corrected, but there should also be a stabilizing presence in the form of African military units who can safeguard the refugee camps. Time is of the essence.

Post Election Let Down

I must say that I am extremely disappointed in the outcome of the election. It was gratifying that so many people waited in long lines to cast their vote and that there were relatively few problems. Not that there weren't any, but they seemed manageable this time. President Bush can rightly claim a mandate for his political agenda, and from today's news conference and news reports, he is on his way to re-shaping American society in a 'neo-conservative' light. Just a few brief observations:

1. While there were no great election day voting issues, there could have been. We need to set a system in place that allows for maximal accountability. I think that a national voting scheme which requires electronic voting machines that have a paper trail for recount possibilities and evidence of tampering is necessary. A move in this direction may begin soon.

2. The liberal establishment and/or the Democrats can no longer allow the Conservative segment of society lament their minority status. They are no longer in the minority. A clear majority voted on conservative lines, and the Democratic Party is really now the minority party. We have to do a better job of putting forth our agenda and countering the 'morality' issue.

3. Since 1968, the Republicans have had 5 presidents whereas the Democrats have had 2.

Gay Marriage

This is the biggest non issue in this entire campaign. It threatens absolutely no one. If two committed individuals want to get married then so be it. I don't see that we have too much to say about it considering the dismal marriage performance of most heterosexuals with our 50% divorce rate. Spouses should be entitled to all of the benefits and visitation rights that are bestowed upon everyone else. End of story.