A Defeat


Welcome back to Poetry Monday, Hope you had a good woo weekend. Here is another poem for you to start your week.

a defeat

pulling into a new city,

cloud-muted dawn

thin as patience

after sleepless train night.

collapsed into a single blurred

blunt old pocket knife,

brain-fuzzed eye-skuzzed,

blind to perspective.

the albatross pack,

drizzle working into clothes,

map-defying tangle of streets,

voices masked in foreign tongues.

and it’s on me

like an old flame

once wisely extinguished

dropping by the apartment

on a solitary drunken night:

a sweet welling hopelessness

(a twinge of disgust)

but it comes on, comes on,

and I yield to it.

p. ferenczi

Posted in friendship, Loneliness, Poetry, Travel | 3 Comments

Decline and Fall


There was a time, not so long ago that it no longer exists in my memory, when it was expected that family members of wealthier, educated people would enter public service, and do their part in maintaining the integrity of our country. These acts of noblesse oblige, along with universal military service, ensured that those in government and politics had contact with, and understanding of those who they served.

If you visit an older cemetery where veterans of our prior wars are buried, you will see on the tombstones the names of those powerful families who ran the factories mixed in with the names of the bakers, electricians, and grocery clerks. Furthermore, those who made decisions about deploying troops for wars outside of our borders had experienced war and military service themselves, and clearly understood the sacrifices to which they were subjecting those asked to serve.

Edward Gibbon in his opus, The Decline and Fall of the Roman Empire, traced as a root cause the lack of military service by Roman citizens, and the increased reliance on mercenary soldiers to fight the wars of the Empire. We now have a professional military, most of whose members are drawn from the poorest segment of our population, and a legislature where almost all who serve never experienced military service.

There are merits to having a professional military, and I’m not suggesting it should be abolished, though it also carries risk, as has been experienced in other countries. However, the concept of universal service to the country for a couple of years (as currently espoused by President Macron in France) is one which would help heal at least some of the divisions we currently experience. People who work alongside one another cannot help but get to know each other. While I am now  a physician, the time I spent working in the steel industry as a laborer, and as an electrician’s apprentice has given me both great respect for blue collar workers, as well as a better ability to communicate with my patients and understand their needs.

We need to change the image of the politician and the government worker from the negative portrayals of today to an image our children can aspire to. In order to do this, we need to offer better pay for these important posts on which the country depends, require personal integrity as an essential qualification, and encourage our best and brightest to once again look on public service not as an option for those unable to get better jobs, nor as an opportunity to use such service as a means to line their own pockets, but as vital part of our democracy. Failure to do so will result in America’s continued decline and eventual fall.

Posted in America, Family, News and politics, Organizations, Politics, Thoughts & Musings | Tagged , , , | 2 Comments

Within and Without


Welcome back to Poetry Monday. Hope you enjoy today’s offering.

within and without

I feel my unity,

imperfect, gaps and cracks,

holding together

for now.

I wonder to her,

conjure her of memory.

her being in me fills me out-

swells cracks tight.

I feel taught, complete,

armed and armored.

but with steel or smoked glass?

hard to discern

in the projected mirror

of self-reflection,

perception rippling its fluid surface

like birds drinking on the wing

or

fish stirring in the depths.

p. ferenczi

Posted in Dating, friendship, Happiness, Poetry, Thoughts & Musings, Travel, Uncategorized | Tagged , | Leave a comment

The Role Of Luck In Our Lives


It’s interesting to see how people view the role of luck in their lives, and how these perceptions reflect on their own views of themselves. Recent research has shown that chance plays a far larger role in our lives than most people realize. Not everyone appreciates or is willing to admit to this fact. According to Pew Research Center, people in the highest income bracket are much more likely to say that individuals get rich primarily because they work harder than those who are poorer. People with a lot of money almost uniformly attribute their financial success to their own hard work rather than luck or being in the right place at the right time.

The problem with this view is that results of research has shown that looking at ourselves as self-made, rather than talented, hardworking and lucky, leads us to be less generous and public minded. It even makes the successful less likely to support such things as high quality public education and infrastructure that made their own success possible. It isn’t until these people are prompted to reflect on their good fortune that they are willing to contribute to the common good.

Successful people don’t like to be told how much their success is due to fortuitous circumstances. It’s not that hard work and talent don’t play a role; they clearly do. But how successful would you have been if you had been born in war-torn Sudan? Or your educational opportunities were limited by significant poverty, or lack of role models? And what would have happened to your success if you had been born unattractive, or didn’t happen to meet the individual who opened doors for your career at that dinner you almost didn’t attend? If you read about people blessed with high achievement, it’s not uncommon to find an element of serendipity contributing to their success.

One of the gauntlets facing our youth is the challenge of getting accepted at a prestigious school. The pressure starts early, and intensifies as you approach college. Driven by parents convinced that the key to success in life is having their son or daughter attend a top ranked school, and fueled by the competitive atmosphere among their peers, the stress and anxiety associated with college admissions is huge. Some parents are now in jail for trying to game the system, while those who didn’t succeed in getting accepted to the schools of their choice are faced with a sense of failure, shame, and loss of self-worth, driving some so far as to commit suicide.

There have been numerous books and articles on the college admission process, from what are the best study aids to passing entrance exams to how to write the best essay or make the best impression on the personal interviews. While these provide information on the mechanics and the processes of admission, they omit a very key and very large portion of that process – the role of luck.

My wife and I have been mentoring high school students for many years, and have attended a number of sessions with them where college admission officers try to describe how the admission process works, and the many factors that selective schools use in their choice of prospective students. Yes, there is an extensive attempt to create a holistic impression of each applicant. What is not made clear, and what my wife and I both know (she served on the admission committee of one of the most selective Ivy League schools, and I did the same at one of the top ranked West Coast schools) is that after reaching a selection threshold based on grades and requirements for each school, you are left with a large pool of candidates who are all qualified, and almost any one of which would make excellent students for the given school. Decisions for admittance are then based on luck, and minor factors which capture the fancy of the individuals making the choices. This randomness can be illustrated by the fate of a young man, who happened to be the son of one of the people with whom I worked. He finished with top grades in engineering from Cornell, a tier 1 institution, yet failed to get admitted to any of the 30 some medical schools to which he applied. This was a huge shock (and embarrassment) to both him and his family. Yet the following year, with the same credentials, he was admitted to several excellent schools, graduated from a most challenging MD/Ph.D. program, and is now a member of academia.

We understand that when we buy a lottery ticket, luck determines the winner. If we lose, we don’t experience a loss of self-esteem. Instead, we buy another ticket. If parents and students understood, that as long as applicants meet the baseline requirements of a school who gets in is often a matter of luck, they would not have this large sense of rejection and sense of profound failure. They would try again. (The topic of being able to obtain a good education outside of a prestigious institution is a matter for another blog.)

Posted in America, Beauty, Family, Medicine, Organizations, School, Thoughts & Musings | Tagged , , , | Leave a comment

Why Do We Do Good?


Why do we choose to do good? What motivates us to sacrifice ourselves for others, even people we don’t know? Psychologists and philosophers have offered a number of suggestions. Sonya Lyubomirsky, a notable psychology professor who has published extensively on the subject of happiness, suggests we do good because it increases our personal happiness. She believes that we are all working towards becoming our “best possible self” and that positive action and kindness towards others is the way to increase well-being. It is part of our innate moral responsibility. Despite the impetus to do good, the distractions and selfish nature of our modern society cause many of us to drift away from the impulse to be kind. (Nobody is completely good – or bad.)

She posits that we choose to be kind because it feels good. It increases our sense of self-esteem and self-worth. And whether or not you believe in karma, whatever you put out into the world  is what you get back. You reap what you sow! This is the underpinning of the Golden Rule.

Being generous and kind also increases your social network. How many do you know who are generous and kind that are lacking in friends? Doing good helps you grow as a person. It gives you reasons to be grateful, appreciating the needs of others at the same time being appreciative of all the gifts you have been given in your life. As mentioned in my earlier blog on happiness, gratitude is one the four necessary pillars needed to achieve this state.

From an evolutionary standpoint, altruism doesn’t seem to make any sense. Modern neo-Darwinian theory states that humans are basically selfish. Some psychologists claim that there is no such thing as pure altruism. When we help someone, it makes us feel better about ourselves, makes other people respect us more, perhaps increase our chances of getting into heaven. Or perhaps it’s just an investment strategy; we do good so someday others will return the favor. Finally, evolutionary psychologists have suggested that altruism is a kind of a mistake, a leftover trait from when we lived in small groups with people who were genetically closely related. We helped each other because our survival depended on the safety of the whole group, and would ensure indirectly the survival of our genes. All these explanations try to explain away altruism, to make excuses for it.

While these motivations likely exist in some, or even in many situations, I believe that pure altruism is a real thing that exists based on our empathy, our ability to recognize all life as being bound together, and an unselfish desire to relieve suffering in someone (or some animal) simply because we share the same life force on this same planet. All living beings are interconnected. We can sense another’s suffering, because in a sense, we are them. In the words of German philosopher Schopenhauer, “My own true inner being actually exists in every living creature, as truly and immediately known as my consciousness in myself…This is the ground of compassion upon which all true, that is to say unselfish, virtue rests, and whose expression is in every good deed.”

Posted in America, Family, friendship, Happiness, Health and wellness, Religion, Science, Thoughts & Musings | Tagged | 2 Comments

Enforced Economy


It’s Monday, so it must be time for poetry. Here is another selection from my favorite poet written while he was on his grand tour.

the road strips you down.

or rather,

the road lets you do it-

just hands you the knife.

you abandon 99%

before you start

and don’t notice.

a bit more goes

after the first long day

with an obese pack,

the white rind shaved off.

with pack balanced,

you turn the blade on yourself,

begin whittling at the edges,

probing for bits of flab

to excise with a flick.

the blade ducks behind the eyes,

a selective lobotomy:

weak thoughts culled,

half-formed notions

sculpted complete

or pared completely.

what’s left

is

the stone of you.

p. ferenczi

Posted in Happiness, Loneliness, Poetry, Thoughts & Musings, Travel | Tagged , , | 2 Comments

The Robot Will See You Now


Yesterday, the Wall Street Journal had a special section regarding some of the structural changes that have occurred in the practice of medicine in the United States, and projections for what will come in the future. They talk about the rise in the number of nurse practitioners and physician assistants, of health care teams instead of doctors treating your ailments, of robots and AI computers who may perform operations now done by surgeons, and the rise of medical care in drug stores like Walmart and CVS competing directly with primary care. They mention the use of Big Data in health care decisions, and the rapid erosion of privacy of your personal medical information. They don’t mention anything about the increasing corporate control of medicine, with large insurance companies and hospital systems buying up physician practices, and how this might impact you in the future.

As someone who has been practicing medicine in the private sector for over forty years (both solo and in group practice), teaching house staff and medical students at a major university, and with an MBA background serving on the board of trustees of a three hospital medical system, allow me to share my perspectives on some of these changes and their likely impact on you in the future. There is no questioning that the single most important driver of the changes we are now seeing are economic.  The United States has the most expensive health care in the world, and not the best in terms of the over-all population. Medicine has become a highly profitable business for the pharmaceutical industry, the medical equipment manufacturers, the insurance companies, and the makers of information technologies. It has also become a lucrative field for the hospital administrators and consultants, but not necessarily for the hospitals themselves. It has become a business of progressively declining profitability for most physicians, who have to contend with rapid increases in regulation and business complexities (for which none have any training in medical school), increased work load, decreased autonomy, and marked increased in the costs of acquiring and maintaining medical education. Most new graduates now choose an employment model for practice, being unable and untrained to deal with the requirements of running a private practice. These changes are occurring as physicians have not been able to organize to effectively state and defend their roles in medicine. It’s not an accident that we are no longer referred to as doctors or physicians, but rather “health care providers” in public discourse, lumping us together with nurses, physician assistants, nurse practitioners, nutritionists, acupuncturists, optometrists, psychologists and the host of other people whose training is shorter, less rigorous, and without the same degree of oversight given to physicians.

A lot of the difficulty from the patient’s perspective comes from being unable to effectively discern which doctor is likely to provide the best care. Even as a physician, I am faced with a similar problem when I have to recommend a doctor to a friend or relative in a location where I personally do not know the individuals in practice. Board certification is a minimum criterion, but we all know a number of board certified doctors to whom we would not refer our patients. Looking at where the person did their training is partially helpful to someone familiar with the better training programs. Looking at patient ratings on Yelp or similar consumer sites only reflects on the social skills of the doctor and his office, not on the quality of care that is provided. Why is it so difficult to define good quality in medicine? It’s because the formal criterion currently used for defining quality comes from process measurements, rather than outcome measurements. It’s relatively easy to measure process; did diabetics get the appropriate tests to monitor their disease, are patient with heart disease receiving cholesterol lowering medicines? Measuring outcomes is a great more difficult, as current EHRs (electronic health records) do not provide the data. (The disasters which the EHR has and continues to cause in medicine are a topic too large to discuss here.) 

Truth is, most patients get better or die, depending on the nature and severity of their illness. It’s only in a relatively small percentage, maybe 10-20%, where physician knowledge and skill truly makes the difference between life and death. Given these numbers, and the inherent variations in the number and severity of sick patients any one doctor sees, accounts for the difficulty in separating the wheat from the chafe. The body has a limited vocabulary in illness presentation. You can have pain, fever, nausea, rash, headache, weight loss, bleeding, shortness of breath, blurring of your vision. Since most people coming to a doctor’s office have fairly straightforward problems that tend be seen again and again, a person with limited training can well diagnose and manage these ilnesses. The problem arises when the presenting symptoms are caused by rarer diseases or more complex problems, such as a cold in the setting of someone who has underlying heart or kidney disease. This is the scenario where all those extra years of training and experience are required. We can only diagnose and the treat the diseases we know. This is why, if you have something that falls out of the usual pattern of knowledge of your non-physician health care provider, your diagnosis will likely be missed, or at least significantly delayed.

From an economic model, which is the one used by insurance companies and the government, using non-physicians to provide health care is unquestionably cheaper. It would also be unquestionably cheaper for airlines to use only computers to fly all their planes, instead of having highly trained human pilots to step in should there be a rare emergency. The question is which kind of plane would you choose to fly if the cost of your ticket could be lowered by 10-20%? As for hospitals and insurance companies controlling physician practice, some types of illness and patient demographic is a lot more lucrative to treat than others. How comfortable are you in ceding the decisions regarding what type of care will be available to you to these entities?

I come from the era when medicine was still considered a profession and a calling, rather than primarily a business enterprise. I was trained to place the needs of my patients before all others. Judging by the number of my colleagues who are still willing to risk their lives caring for those who may bring lethal disease to themselves and their families, we still have many who believe in that creed. Given the increasing corporatization of American medicine, how long will our ideals still be here when you need us?

Posted in America, Computers and Internet, Health and wellness, Medicine, Mental Health, News and politics, Organizations, Science, Thoughts & Musings | Tagged , , , , , | 4 Comments

What You Don’t Believe Can Still Kill You


During World War II, Churchill warned: “There are vast numbers…in every land, who will render faithful service in this war, but whose names will never be known.” Much has changed since WW II, but our fears have not. Needing to protect our families, becoming sick, losing one’s life,– these are our Covid-19 concerns during this protracted war with a pandemic whose end is still too far away.

I work in a hospital that has seen its share of Covid patients, most eventually discharged, but some who have died. Not all the victims were elderly or had co-existing diseases. Recently, we lost a 22 year old, previously healthy young man whose ignorance of needing to avoid parties sadly cost him his life. The toll is not just on those who are sick. It’s also on those who provide their care, on their families, on the hospitals who face serious financial hardships (some will end up closing), as well as the millions who have lost jobs as well businesses.

I go to work because that is my professional responsibility. I wear scrubs, double mask, double glove, put on protective gowns and a face shield when doing procedures, wash my hands innumerable times, avoid eating with my colleagues, change my clothes in the garage before coming into the house, and wash up again. Despite these precautions, I worry about bringing the virus home to my wife, and she worries as well. We don’t see our friends, restricting contact to phone and Zoom conversations, and despite itching to get out and go somewhere, we don’t travel. The nurses and other hospital workers live similar restricted lives. I don’t consider myself a hero, as I don’t feel that doing the job you have chosen and love to be a heroic act. These days, it comes with a price higher than some expected to pay, yet we are there, doing our best. However, I admit to feeling anger and frustration when I have patients ask, “Do you think all this real? Don’t you think this is all part of a conspiracy to damage our president and our country?”

Admittedly, I can see how the public has been confused by apparent mixed messages coming from both health care and government sources. I can only tell them that I personally haven’t verified the numbers of sick and dead from Covid, by I have first-hand knowledge of how many patients we have in our hospital system, how any have died, and how many have come close to dying. I know that washing your hands frequently, wearing a mask, maintaining social distancing, and avoiding unnecessary human contact helps to keep the disease from spreading. I know that I will get my annual flu shot, because it helps to save lives from a disease that last year resulted in 60,000 deaths. And when the Covid-19 vaccine becomes available, I will take it, as will other members of my family.

You have the right to believe whatever you want. Unfortunately, even if you don’t believe in the infectious theory of disease or in Covid-19 being a real threat to you and those you love, the virus doesn’t care. It will kill you just the same!

Posted in America, Covid-19, Death and Dying, Health and wellness, Lies, Medicine, Mental Health, News and politics, Politics, Science, Thoughts & Musings | 2 Comments

Couples


It’s Poetry Monday, and time to be on the road again with my favorite poet. For those of you in the USA, happy Labor Day!

couples

rigid postures like cats facing off,

words in bursts,

glances lancing in and away,

a whip-lash negation.

the stream of discussion

perhaps innocuous to start,

the plan for tomorrow,

where to have lunch,

now a foaming rapids,

wills clashing.

I turn from the couple

pulling against each other

in angry mitosis.

I think of my other.

a desire to be with her,

and

needles of relief

at her absence.

p. ferenczi

Posted in Dating, friendship, Happiness, Loneliness, Marriage, Poetry, Thoughts & Musings, Travel | Tagged | Leave a comment

Forgive us our trespasses…


I recently wrote a post about the four requirements in life for happiness: friends and family, doing for others, forgiveness and gratitude. Of these four, the one that seems the hardest for me (and many others) is the one involving forgiveness. How is it possible to forgive those who have hurt us deeply and grievously?

Occasionally, you turn on the news (something I tend to avoid these days in order to preserve my sanity), and you see a story about a person whose family member was killed by a drunk driver, or died during the commission of a violent crime, and the person comes forth to publicly forgive the perpetrator. You wonder; how can these people find it within themselves to forgive someone who caused them so much pain?

I mentioned earlier how Nelson Mandela forgave those who held him unjustly in horrific conditions for 27 years because he realized that was the only way he could be free of the prison his life had become. In doing so, he also became instrumental in avoiding the mass genocide of millions of white South Afrikaners. I recall a few years ago on a visit to Johannesburg staying with such a family, and having them share this remarkable story with us. In 1990, when De Klerk announced he would release Mandela and fully dismantle apartheid, ceding rule of South Africa to its predominately black population, everyone expected a blood bath to follow. The couple we were staying with, in their mid-fifties, told us that every white person was armed to the teeth, carrying cell phones, and waiting for the start of the violence in which they all fully expected to die based on how outnumbered they were by all those they had oppressed through generations. Their first sign of hope in the truth of Mandela’s promise to avoid retribution came when Mandela as the newly elected president attended the rugby match between South Africa’s all white Springboks and the powerful New Zealand All Blacks. Rugby and their Springbok team had an almost religious following among the Afrikaners, and this pivotal, history changing event is the center of the movie Invictus with Matt Damon and Morgan Freeman.

Those brought up in the Christian faith are all familiar with the Lord’s Prayer, recited innumerable times in our lives, often with little attention to the true meaning of “forgive us our trespasses as we forgive those who trespass against us…” Yes, we all desire forgiveness for our sins, for the wrongs we have caused. But do we really forgive those who have wronged us? The history of the human race is interlaced with conflict, war, violence, hate – all because we do not see the need to forgive those who have wronged us, feeling our grievance is just and our enmity equitable for the wrongs against us. We not only hold anger against those who have harmed us, but against those whose family members have hurt our family members, against those whose race have caused harm to our race, our people. Be it the Hatfields and the McCoys, the Irish and the British, the Jews and the Arabs, the white and the black races, we do not forgive. As the song from the musical South Pacific says, “You have to be taught early to hate, before you are six, seven or eight…”

I remember someone I once considered a close friend. We spent a lot of time together, worked and traveled together, enjoyed many of the same passions in life. I was the best man at his wedding. One day, as someone who had ownership in a building, he came to me and told me that if I didn’t rent space from him and his partners, they would send all their business to a competitor. I was shocked and angry, asking him how he could do this to someone who was his friend. His reply was, “This is nothing personal. It’s only business.” Though we still talk occasionally, that interaction ended our relationship. I was not able to forgive him for what I felt was a callous choice of money over friendship or the willingness to use what I felt was blackmail for financial benefit. I’m older now, and while I still feel his actions were wrong, I perhaps didn’t consider what pressures were placed upon him to come to me with his offer, or to accept him as a flawed person with other redeeming characteristics. None of us are perfect, and we all view the flaws of others as greater than our own. I reached out to him a few times, but our lives have followed different paths, and he has not seen a need to expand effort in trying to revive a relationship from the past. At least now, I feel I can forgive him, and perhaps ask if there is anything from him for which I need to ask forgiveness.

What is there in your life for which you need to give forgiveness? And what is there for which you need to ask to be forgiven? Don’t wait too long. Not if you want to be happy.

Posted in America, Family, friendship, Happiness, Mental Health, Politics, Religion, Thoughts & Musings | Tagged , | 5 Comments