Every year there is a convention of American Booksellers. When I published my first book, years ago, my publisher ushered me in, and I was stunned. The Washington Convention Center covered a full city block, and the floor I was surveying covered that entire expanse with 50,000 books, all published that year.
And I thought, how is my book ever going to get anyone's attention in all this?
The answer was, it wasn't. Mine was a voice, unamplified, lost in that ocean of voices all straining to be heard.
I understood that old story about a child who grew up in a family with ten children. He never spoke a word and nobody noticed because everyone was always talking, at him, over him, for him.
And there is the questioin asked by Samuel Johnson, "Why is it there is so much writing in the world, and so little listening?"
Somewhere, in most human beings, is a desire to be heard, to express one's outrage or observation. In Treme John Goodman plays a character in post Katrina New Orleans, a professor of English at Tulane, who records a UTube rant about how he and everyone in New Orleans is being ignored, not being heard, and he is outraged by what has happened to the city he loves. Oddly, he has writer's block and cannot get going on his novel about New Orleans, even though he's got the advance in the bank, or maybe because he's got the advance in the bank.
Beneath all this is an idea somewhere, that talking, writing a blog, is a wasted effort.
If a tree falls in the wood and there is no ear to hear it, does it make a sound?
I would have to say, yes, but it doesn't matter.
The same may not be true of writing a blog. If nobody reads it, it is still a message sent, like those probes sent into outer space for intelligent beings who may never hear it. At least there is a reaching out, just in case, some day, someone will hear.
Or, even if nobody ever hears, you have had a conversation with yourself, and that, in the end, may be the most important audience.
NB: I first published this as The Road Taken, in a hospital newsletter, some years ago, but I've had occasion to remember these events recently.
When I was fourteen, my good friend suggested the worst thing about being a doctor would be that all my friends would be doctors, or at the very least, I’d have to spend a lot of time hanging out with doctors.
Actually, in retrospect, that has proved to be one of the best things about medicine—not that all my friends are doctors, but the doctors I met along the way turned out to be one of the best things about medicine.
Take the neurologist, Kathleen F. , for example. When I was a third year medical student, I was lucky enough to draw Dr. Kathleen as my resident for the six week neurology rotation. She had been one of the four women in her medical school class of one hundred and she was the only woman I ever heard of who landed a neurology residency in a department headed by a very famous chief of Neurology who thought women would always be mothers first and doctors second, and never as committed to the profession as men, and so he refused to appoint a woman to his faculty.
But even he had to give Kathleen a spot in his residency program--not because there was any political force in those days which would have motivated him, but he gave her a residency spot because she was a stellar medical student. He was the co-author of the classic textbook, Stupor and Coma, the Chief of Neurology, but if he believed in the idea of meritocracy, he had to give Kathleen a residency, even if he would ultimately refuse her a faculty position.
The first thing which struck me about her was how fragile she looked: Five feet five, no more than one hundred pounds, very blonde hair and skin and eyes so light blue they were almost white. I could well imagine her in her plaid Catholic school skirt and patent leather shoes, but she wore a white skirt and short white jacket, pockets stuffed with reflux hammer, tuning fork, ophthalmoscope, packets of coffee for testing the olfactory nerve--Kathleen tested each and every cranial nerve in every patient—stethoscope, and the notebook in which she kept the names and numbers of patients she would call in for admission to the neurology ward.
She was all business, but she was a hummingbird among the bears on that ward.
Life on the neurology ward was rigidly punctual: The four medical students arrived at six a.m. to draw bloods on the forty patients; Kathleen arrived at six-fifteen and did teaching rounds from six-thirty until seven fifteen; then the students fanned out on the ward to do patient chores until ten a.m. when the Chief arrived to do his harrowing, teach-by-humiliation rounds. The rest of the day went downhill from there.
On the days she was on call, I shadowed her doing consults on the wards, in the emergency room, wherever her beeper took us. One night, well after midnight, we were called to the ER to see a seventy year old man who had become demented over the prior three weeks, started falling a lot and taken to bed.
It was a pro forma consult: Nobody expected Kathleen to do more than take a quick look and reject him for the neurology ward, which was for neurologically interesting cases, not for garden variety cases of dementia, which went to the general medical wards. But Kathleen kept jerking his foot with her hand and kept looking at his tongue, wriggling in his mouth. I was leaning with my back against the wall, nodding off, when I heard her say, “Do you know what this is?”
I had to admit I did not and she informed me it was myoclonus and I should go home and read up on it for morning rounds, which were now only about five hours away. She admitted the patient to the neurology ward with Jacob-Creutzfield disease, which she had diagnosed at one a.m., in a dark ER stall, by physical exam and history alone, picked him out of all the other demented old “gomers,” filling the ER.
The next morning, the Chief of Neurology examined the patient on rounds and had to agree the patient had Jacob-Creutzfield and he moved on to the next patient, as if there were nothing remarkable about this. Of course, medical students came from all over the hospital to see the patient,--interns and residents, too. Her dark hours diagnosis added to Kathleen's local renown, but she never showed any sign of special pride about it. She treated her coup as casually as the Chief had.
Later that week I had to present a case to the Chief, a patient with a parietal lobe tumor. Kathleen prepared me rigorously, so I could point out all the findings and she warned me the one thing which was not explained by the tumor was the patient’s significant memory deficit and we went over how to handle that part of the case in the presentation. The Chief listened intently with the expression he reserved for student presentations, which made him look as if he was smelling something nasty, but he did not interrupt me, nor did he castigate me as being unworthy of taking up space in the highly select medical school, nor did he grunt or snort. I kept pausing, waiting for his slings and arrows, which never came.
Finally, he asked about the memory deficit, just as Kathleen had warned me he would and I answered exactly as she had prepared me to answer and the Chief turned to Kathleen and the other residents and said, “This presentation is just a little too perfect. Did any of you tell this student what to say? Did any of you prepare him for this?” He was looking directly at Kathleen.
She met his glare and said, simply and directly, “No, sir, we did not.”
Later I pulled her aside and said, “How many Hail Mary’s are you going to have to say this Sunday? I presume bearing false witness is still a sin.”
She said, “The Chief is not a normal person. The best thing to do is to do your work and stay away from him.”
Our next on call night, we got called down to the pediatric ward to see a fourteen month old in the pediatric ICU.
We were met by the Chief Resident in Pediatrics, the junior resident and two medical students and they all had a stricken look I hadn’t often seen among housestaff at that hospital. I understood, when they told the story: A twenty year old single mother had her child by one hand and a bag of groceries in the other, and she walked up the three flights of stairs to her apartment, holding the kid with one hand the groceries with the other. She lived in one of those apartment buildings with an Alfred Hitchcock type stairwell, where you could look down over the banisters four flights, right down to the cement landing in the basement. The mother had eggs in the grocery bag and rather than setting down that bag, she let go of her child’s hand, reached in her pocketbook for her keys, turned to unlock the door and in the time it took to get the key in the lock, her child managed to squirm through the banister rails and plunge four flights down, head first, to the cement landing.
We were being called to say if there was any brain activity or to pronounce him brain dead.
I watched over Kathleen's shoulder as she examined the rag doll child, as she went through all the tests with which I was now familiar, Babinski’s and so forth, but what I found myself looking at was not the child, but Kathleen's ears, which had gone quite crimson. She had her hair up that night, and you could see her ears. Kathleen was the mother of a child about this kid’s age. She went over him methodically, as she always did, but after about five minutes, she reached in her pocket and got out a tissue and wiped her eyes and blew her nose. Then she finished examining the baby.
I followed her out to meet the residents in the ICU and she told them she would see the mother in the conference room, alone. She dismissed the residents and the students and headed into the conference room and sensing I was still with her, she turned around and said, “I’ll do this alone. Hold my beeper. Answer any pages. Wait for me.”
This was the first and only time she did not allow me to stay with her. I was just a happy, but I also knew she was sparing me something nobody had much stomach for. And she was thinking of the mother. She was in there a long time. Then she came out, totally composed, and we got in an elevator and I handed her back her beeper and reported there were no more consults to see, for which I was grateful, because it was now approaching two a.m. So we stood in the elevator together staring at the overhead numbers and I said, “You okay?”
“Yes,” she said. “Don’t be late for rounds.”
I suppose I could have gone into some other sort of work, and there would have been rewards, and talented, intelligent people. But if I had, I never would have been instructed by Kathleen, never seen her grace under fire and tried to emulate it.
And I would not have met all those whom I met later, who sailed with her, guided by the same stars she followed, those people who combined toughness, rigor and kindness who call themselves doctor.
Reading Howard Zinn last night about the numbers of English males who volunteered for duty and were promptly slaughtered during World War I, I was struck by the idea that we tend to repeat the past, but, if there is any consolation, as bad as Viet Nam and Iraq and Afghanistan have been, they have been only pale reflections of what others have suffered through the marketing of the idea of "Patriotism" or the mass indoctrination of what you owe God and Country.
World War I was fought for the flimsiest of reasons--people are still trying to figure out how that one started, who drove it, and who benefited, but clearly, whatever got that one going, it was not to make the world safe, or to make it safe for democracy or for whatever other reasons were given by the English government, the German government or the French or the American governments.
As Slim Charles tells Avon Barksdale in The Wire, "Don't matter who did what to who now. Fact is, we went to war. If it's a lie, then we fight on that lie, But we got to fight. That's what war is, you know."
Slim Charles is a street hood in Baltimore, He hasn't gone to school. He's been schooled on the streets. And, as if in testimony to Paul Simon's line, "When I think back on what I learned in high school, it's a wonder I can think at all." Which is to say, if you are living your life outside the mainstream, your mind is not distorted by all the marketing and indoctrination.
So it is the little child who can see clearly that the emperor has no clothes. He hasn't been schooled not to see the truth.
Zinn takes us through a month by month slog through WWI with the English general making some idiotic decision to send waves of soldiers across fields as Wellington once did, only to have them mowed down by modern machine guns. So 600,000 are lost in a month. Then another 500,000. Whole armies of Englishmen are mowed down. And on the home front people are told to not think they know as much as the general who is issuing these orders.
Know your place. Don't disrespect your betters.
And here we are listening to secretaries of defense, four star generals talking about "The Mission" in Iraq and "The Mission" in Afghanistan, as if there were a real mission in either place.
What is The Mission?
To deny Al Qaeda a "Safe Haven?" What idiot would believe you can deny a group of 19 men a safe haven? Groups so small they can live in an apartment in Germany or a hotel room in Florida, and you think you can destroy them by invading a country as big as Texas, where the people don't speak your language and they can hide in mountain caves?
So, if it's a lie, then we fight on that lie.
One of my favorite series is Band of Brothers. If The Wire is a dystopia about dysfunctional institutions, then Band of Brothers is a story about an institution which actually did work, or at least an institution which bumbled into success. Certainly, you see the American army making stupid mistakes--giving parachute troops a bag to carry their equipment which they were supposed to strap to their ankles and jump out of the plane--and popping this on them after two years of training, giving them this untested bag the night before their jump into Normandy. And the bags, containing weapons and ammo simply blew away, leaving troops landing without weapons. And the night jump leaving troops miles from their targets. But, somehow, the officers and men were trained well enough to overcome obstacles and they succeeded.
As is typical of a Stephen Spielberg production, there is a heavy lard of sentimentality which nearly destroys the story. In the episode titled, "Why we fight," the 101st airborne stumbles onto a concentration camp. This happens just after a scene where one of the soldiers has told his comrade he doesn't fight to win a war, but to simply survive and, at least, to be able to use toilet paper again and to sleep on a bed with real sheets rather than in a foxhole. This same soldier is stunned by what they find in the concentration camp. And the moral of the story, is that's what we were fighting for, to defeat a hugely evil entity--the Third Reich.
The problem is, how can you say the why you are fighting is for something you never knew existed until after you had defeated it.
You took on faith, you believed the marketing that you were fighting on the side of God. But the other side was told and believed they were fighting you because they were on the side of God. (The Germans wore belt buckles, Gott Mitt Uns.)
So it's not why you fought. You can't invent a motivation retrospectively. You fought because you wanted to for other reasons. Because you bought into the idea of heroism, of God and Country or for the adventure, or to escape boredom and a sense of meaninglessness. But you did not fight to free the victims of Nazi Germany who were buried in concentration camps you knew nothing about.
We were hoping to find weapons of mass destruction, mass graves, something in Iraq to justify our crusade, but we did not. So why did we fight there? Because we believed the line Saddam Hussein was evil. He probably was, but no more evil than a dozen other despots. Why him?
We fight on that lie.
As for Osama Bin Laden, well, I'll accept on faith he was a murderous man--or on the possibly tampered evidence of his Internet videos in which he spewed hatred toward America. He may or may not have had much to do with 9/11, but he was apparently a cheerleader, so I'm happy he's dead.
But what lies have we been sold about him?
You have to believe there are haters when you watch the evening news and see the random bombings of trains, subways, markets. There are haters out there for us to hate, hunt down and fight. But, how can we trust the people who say they know who the villains are and how to get at them?
I haven't figure out that part yet.
