Glen Beck, Sean Hannity, Rush Limbaugh: Are the Lights Out Upstairs?

I know, there are multiple types of intelligence. And I am also aware one of the greatest writers of the nineteenth century, Abraham Lincoln, had very little in the way of formal education. And I am painfully aware how thoroughly unimpressive people sporting Ivy League credentials can be.

And anyone living in New England knows there is a clear distinction between uneducated and stupid.

But, really, is it too politically incorrect to point out that among the leading lights of the Republican right, Sean Hannity, Rush Limbaugh and Glen Beck, none of them managed to stay in any college for more than two semesters? Limbaugh flunked out. Beck left a special program after a few classes.

Were all these guys simply too incandescentally brilliant to be able to tolerate the suffocating halls of academe? Were they simply so smart, they were unable to tolerate the stiffling effect of the classroom?

Or do the individual failures of each of these men add up to something, in the aggregate?

Yes, I understand, Anne Coulter graduated from Cornell.

And I understand, if I'm so smart how come I'm not making the tens of millions of dollars a year each of this fearsome trio is pulling in?

But sometimes, it's a head clearing experience to simply state the obvious: These men, individually and as a collection are simply not very bright. Each is, judged on listening to each one on multiple occasions, really pretty stupid.

Now, I know, H.L. Menkin's famous remark--you'll never go broke underestimating the intelligence of the American public--but really, is this not a case of the Emperor's new clothes?

Does it take a humble country doctor from New Hampshire to point out the plainly evident truth, these guys are simply not bright enough to chew gum and watch TV at the same time.

They are angry, and entertaining, and they voice the rage of the loser who failed in school and still isn't sure why, but he's been scarred (and quite possibly, scared) by the experience.

But should we listen to them?

It's not that we shouldn't listen to them because they are school drop outs and we only listen to people with the proper merit badges. It's just that when you listen to what these guys say, and then you look at what their own personal histories are...doesn't it make you wonder? I mean, is the reason for their appeal arising from their shared history of failure, their connection to rejection and being told they were inadequate and so now they know how to tap into that experience to connect with others who have had the same experience.

So is right wing talk radio simply a support group for losers?

I've frequently had the experience of listening to Rush and thinking--that sentence does not show the logical connection he thinks it does, and he is often so self satisfied and clearly thinks he has just trumped his imaginary opponent with a sequence like, "Well, if the liberals are so critical of our country, of our holding prisoners at Gitmo, then why don't they just leave the country and go find some place better?"

Not an "A" paper, that.

I can see the appeal of this sort of gleeful strutting of non sequitors to guys who showed up outside Obama rallies with their big guns strapped to their waists and backs. That's a sort of naked revellation of psychopathology. They were saying, "Okay, I'm a brain dead loser, but as long as I have this big gun, I'm just as important and potent and exciting as the guy you all came to see, the guy who went to Columbia and Harvard Law." He thinks he's so smart, but I've got this gun!

I don't know, this is probably not a very original insight, but nobody ever seems to talk about it, and I guess I had just missed it until now.

Gail Collins, Jon Stewart and the Bright Light of Clarity

Brains, you know, are suspect in the Republican Party.

--Walter Lippmann


For my parents, Walter Lippmann's column in the Washington Post was essential reading. He helped crystallize their thoughts, often presented an alternative way of looking at a problem and because his political perspective aligned with theirs, he was like a warm cup of milk, comforting and healthy. Walter Cronkite served that same role as a source of television news, although he was wonderfully inscrutable, never revealing his own opinion about what he was reporting, even as he help select the nightly video images of the carnage, the futility and the frustration of the War in Vietnam.

DeGaulle once commented the graveyards are filled with indispensable men, and neither Lippmann nor Cronkite are alive today and yet the nation seems to muddle on.

But there are people who have, for me at least, replaced these icons. I look forward to a column from Gail Collins of the New York Times every bit as much as my parents opened their paper to Lippmann. For me, it's Jon Stewart, not Walter Cronkite.

My parents might shake their heads and mutter about the regression to the mean--my tastes are simply not as high brow.

But, no. While Gail Collins may not turn a phrase like, "Ideals are an imaginative understanding of that which is desirable in that which is possible," she gets to truth and illumination just as quickly and deeply as Lippmann. She comes from a more proletarian road. While Lippmann was Harvard, Harvard, Harvard and not disposed to conceal it, Collins was educated in the Midwest and in Amherst, Massachusetts, and not at the expensive private college there, but at the state institution down the road which helped create Sesame Street.

She trusts the intellect of her readers every bit as much as Lippmann did--knowing the reader has to be bright enough to get the joke--and she usually begins with the joke, with the report of the really absurd stuff our leaders do and say. While Lippmann intoned, "It requires wisdom to understand wisdom: The music is nothing if the audience is deaf," Collins knows this without saying it and trusts we can hear the music and respond.

So her column today about the upcoming vote on health care is quintessential Collins, beginning with some stories about Nancy Pelosi invoking saints as she pushes the health care bill forward and the story about Harry Reid having become so weary he voted against the very bill he was sponsoring by mistake. But then she gets to the real point--Obama is pushing this health care bill and if it passes, some day we'll all look back on this time and be amazed we allowed Americans to go bankrupt with such regularity over health care bills, that we did not care for our own. We might then be looking back as we do today and wonder what life was like and would have been like without Medicare.

She has that kind of clarity.

Jon Stewart, in his own way, can illuminate. Using all the high tech tools, he shows what the mindless Right is saying and just in case you can't see through it, he helps. Playing clips of Glen Beck giving a lecture on a blackboard, Jon Stewart is able to parody a performance so outrageous it ought to be a parody of itself and thus beyond parody. Beck is literally so stupid, he defies criticism. But Stewart manages to get past that. He can usually demolish Rush Limbaugh by simply playing a Limbaugh clip and rephrasing what Limbaugh says.

This is not always easy, when you have a man capable of saying, "If you commit a crime, you're guilty." Or, "If Thomas Jefferson thought taxation without representation was bad, he should see how it is with representation."

And Stewart would look into the camera and say, "That, actually, is what we call, 'Democracy.'"

Limbaugh at least has a sort of harebrained clarity of his own: "Nationalizing businesses, nationalizing banks, is not a solution for the democratic party, it's the objective." Of course, that is an interesting comment coming in light of our understanding of the failure of regulators which led to the nationalizing Limbaugh is railing against. And what do you think Mr. Limbaugh thinks of regulators, government regulators, the heavy hand of government restraining the horses of free trade?

Limbaugh, of course performs an ongoing service with lines like, "None of what Barack Obama is doing or wants to do to this country is anything the rest of the world hasn't seen before and already failed at."

Like providing health care to your citizens. Oh, yes, England, Germany, Spain, Italy, you name it--they are all just roiling over the failure of their own health care systems. You want to really see popular revolt--just try imposing what we've got for health care on Western Europe.

And then there's one of my favorites, "You know why there's a Second Amendment? In case the government fails to follow the first one."

That's a good line. Now as I read the First Amendment it says, "Congress shall make no law respecting an establishment of religion or prohibiting the free exercise thereof."

And when it comes to the War on Christmas, Rush is front and center: "My friends, I am not going to participate in this killing of Christmas. They can try but they can't take it away from us."
Which means, of course, don't take my Christmas tree away from your public school yard or your courthouse.

The other part of the First Amendent prohibits Congress from making laws "Abridging the freedom of speech, or of the press, or the right of the people peaceably to assemble."

I must have missed the story about Rush organizing a militia with guns drawn, to protect that teenager who was suspended from school for holding up his Bong Hits for Jesus sign.

The blogosphere can post, but there are only a few people who can step up to the microphone. If the dark forces can muster Limbaugh, Beck, O'Reilly, who can muster the forces of light to bring them to the radio, the newspaper and the television?

We are lucky to have Gail Collins and Jon Stewart. And don't forget Rachael Madow, if anyone would actually tune in to watch her.

Fear of Flying Up In the Air: Connectedness and the Unbearable Light ness of Being Alone

When I was about ten years old I had a recurrent dream, which is to say I had it more than once. It was a dream about flying. I would be running along Bannockburn Drive, a long step hill, running along the sidewalk and flapping my arms like wings, and I could feel the air beneath my scrawny wings lift me firmly, and within moments, I was soaring above the tall trees which bordered the road.

As a ten year old, I had a fair number of anxieties and phobias, more than most ten year olds I suspect, and they did not do me a lot of good, but when I took flight on these occasions I was not afraid of crashing--in fact my only anxiety was someone might see me and I'd get into trouble and they'd point at me and talk about me.

But nobody ever did see me. I would just fly around above the trees and it was exhilatrating and joyful and wonderful, but I knew I could not risk staying up there and judiciously brought my most wonderful adventure to a close.

I kept telling myself, "You're going to wake up and think this didn't really happen. But believe it. It did happen. Don't let yourself talk you into believing it didn't, because it really did."

Then I'd wake up and tell myself it really hadn't happened.

Later, I saw men jump off cliffs in New Mexico and do hang gliding and I wanted to try it, but so far, I haven't, in part because if I broke my back doing it who would take care of my family? My kids were young then. Now, I'm back to thinking about it again.


I thought about all this recently thinking about Up In the Air which is a male fantasy about, among other things, freedom, adventure, breaking the surly bonds and the perfectly unencumbered sexual relationship, a relationship untethered, without bonds.

Billy Crystal once said something to effect a woman needs a reason to have sex; a man needs only a place to have sex.

In Up In the Air, Ryan Bingham lucks into a woman who is looking only for a place to have sex. She wants nothing more. He is, of course, delighted. He crashes only when he starts to value bonds more than freedom.

Oddly, this ideal relationship was described decades earlier by a woman, Erica Jung, in a book with another airport motiff: Fear of Flying .

What Ryan Bingham's woman calls, "An escape, " or "A parenthesis," Erica Jung calls a "Zipless fuck." But it's all the same thing. Sex without the ecumbrances. Just frolic. A one night stand, a roll in the hay.

It has to do with freedom, with joy. Like flying.


But it may be, like the dream of flying, illusory.

It's a case, maybe, of "I was so much older then. I'm younger than that now."

Of course, the message of Up In The Air is such freedom from bonds is, in the end, an empty thing.

As the end of life seems less distant, however, you begin to wonder. We each of us come into this life alone and we most certainly go out alone.

You can argue this is not true. We are delivered into the arms of our mothers, and embraced, if we are lucky, by the rest of the family. And every hospice pamphlet pictures a family gathered around the dying relative, comforting the dying and the living with each other's presence.

But I'm not so sure, having seen death often enough, the dying actually feel embraced. They seem to slip away, very alone, removed.

Which brings me back to that wonderful dream, of flying. I was always alone. Ryan Bingham asks his brother in law to think of the happiest moments in his life and he asks, "Were you alone?"

The answer is no. The happiest moments were always with other people.

Certainly, I would have answered that among the happiest moments in my life were moments which involved the presence of other people. Especially when those people were my sons, or in some cases teammates on a baseball team, or a swimming team or a wrestling team.

But then I think of flying alone.

And I think one time, after I saved a life during a long, lonely night in the hospital, working alone and not giving into fear or lto ack of confidence, but just pushing ahead and after I was relieved by the next shift, once the patient was out of danger, I walked out into the bright sunshine of a New York morning knowing I had just done something I could never have imagined myself capable of--when I was a teenager or even a college student, I could never have believed I would have been capable of doing what I had just done--and I knew I had reached a new level of existence in life. I had actually managed to surprise myself.

You can value both, of course, the solitary joy and the joy of connectedness.

Maybe you have to have both to really have life.

Up In The Air and 9/11 and Live Free Or Die

If you have not seen the movie, Up In the Air, you can stop reading now. I would not want to ruin that experience for you. Fair warning, I'm going to give away at least one crucial surprise in a movie which contains significant surprises, which does not offer up any of the typical Hollywood solutions or Hollywood moments and which is certainly the best I've seen in years.

But this is not about the movie so much as about what it says about the choices we make. Like many rich acts of fiction, this story reveals more truth than a documentary, with all the constraints imposed by efforts to document "facts" and truth impose.

Ryan Bingham leads the perfect life, a dream life, in a sense an Ayn Rand life, lived for himself, divorced from any responsibility for others, from the burden of having to do things for others, including, as he lists those burdens, the burdens of obligations to blood relatives, a spouse, children. He is free like a bird, freer actually than most birds, who do after all tend to fly in flocks, or at least to raise young.

The ecstatic thrills of this life are gradually introduced as the initial credits and titles roll, and you are among those heavenly clouds, looking down on vast landscapes of the gorgeous North American continent, with its fascinating plowed fields, wild streams, lakes, coastlines and rivers. Who has not fantasized about being able to take wing and see all this, and to swoop down whenever you see something really attractive?

This is Ryan's life, and the only catch is when he swoops down it is to kill. He is a bird of prey, doing the killing, relentlessly, remorselessly, although not without sensitivity and inclination to make the best of a terrible act. He actually works harder than he has to--in one case he reads the file on a man who always wanted to be a gourmet cook and is now being fired from a job which really never inspired him, and despite his desperate fall, Ryan extends to him a branch from the crevasse, which may or may not support his weight, but it helps both of them get past the moment.

Ryan is as ruthless as any hired gunslinger, executing his quarry without any hesitation. He reminds me of the hired killers in McCabe in Mrs. Miller who arrive to execute McCabe and McCabe wants to negotiate and the killer says, "I'm not here to negotiate. I'm here to kill you." How different is this attitude from what Lieutenant Spiers says in Band of Brothers, "You have to killl without pity, without remorse. All war depends on it" ?

Ryan is not completely amoral. He recoils from the even more heartless but more efficient and less expensive alternative to firing people in person. When a young comer suggests you can fire people over the internet, using a video, and save on the cost of flying the hit men out to personally deliver the news. In Dylan's words, "The executioner's face is always well hidden." But not in Ryan's world, where he offers precisely the opposite: What his company sells is the face. The act of firing an employee can be so wrenching and emotionally draining managers shrink from the task and being cowards and gutless, they hire Ryan to do the dirty work. Ryan has nothing but contempt for these spineless bosses, but he has some sympathy for his quarry. How different is his ritual from that of Chingachgook in the wonderful Daniel Day Lewis version of Last of the Mohicans who, just before delivering the coup de grace to the deer he has brought to the ground, "I am sorry to have to kill you. You have run well through the woods and you are strong and worthy. But I have to eat"?

But, as Ryan observes during one of his paid inspirational talks, human beings are more like sharks than nesting birds, they have to keep moving or they die. So Ryan keeps moving and like most extremists, he has taken his philosophy to its logical conclusion. He owns no car, no home, no condo. He lives in a rented room without pictures on the walls, without much of anything. The twenty odd days he spends at "home" in Omaha in this barren place are the worst of his year. He is happy only at airports, in airplanes, hotels, rented cars.

He has dispensed with "stuff." His wonderful canned speech with it's knapsack prop, presents his philosphy better than we at first understand. He really means it. All that stuff, the physical and the familial and the emotional weighs one down. It is, ultimately a burden. I could not help but think of George Carlin's bitter routine about "stuff." Carlin developed this particular rant during his grumpy old man period, toward the end of his life. He was railing against the soul damaging consumer economy, the whole life of shopping to acquire things we already have, more shoes, more shirts, more gizmos and then to acquire a place to keep them. But Ryan has gone beyond anything Carlin imagined.

Ryan wants no people, beyond the temporary connection of a fling in the hotel room with an attractive woman. He wants no dogs (and Carlin loved dogs) because dogs are a huge burden. For him burdens are suffocating. He is the ultimate in Live Free or Die. He lives truly "Off the Grid," far more than those non taxpayers who want to generate their own electricity and do their own plumbing so as not to have to be connected to the rest of humanity, to a country which might tax them for providing an infrastructure. The off the grid types in Idaho have a home base, and own stuff and have families. They just don't want to be connected to a larger world. Ryan doesn't want connection even to the smallest unit, to a family.

What makes him so appealing is he is not heartless. He tries to be kind when it costs him nothing. He tries to save his sister's marriage. Ironically, of course, his pitch is every man is happier if he has a co pilot. Not that he believes this, of course, at least not as he is saying it. But his little talk to the hesitant bridegroom is one of those delightful suprises, when he asks, "Think of the happiest moments of your life? Were they what happened when you were alone?" Coming from Ryan, that's quite a question. Here is a man who has absented himself from his only living relatives. Who lives in an apartment so alone he knows only one neighbor, a woman he obviously bedded and then left the next day on a flight.

Ryan does not hate people, he simply does not want the burden of people.

But things begin to change for Ryan and that change is brought to him by two women. The younger woman makes him face the fact he is getting older and some day he's not going to be able to count on the warm body in the hotel bed because he won't be attractive enough. He deflates her callow idea of what life should include in terms of marriage, committment and others. But she gets off a volley of her own, calling him an eternal adolescent who cannot grow up because he cannot commit to anyone but himself.

At that moment I thought of Terry Rodgers, the artist. Go google Terry Rodgers and look at those gorgeous, erotic, dreamlike paintings of young, hard bodied, rich, revelers. The scenes are riveting, mesmerizing visions of a completely erotic life, and the people although physically wrapped up in one another are emotionally remote, untouched. The effect, at first is sexually arousing, but after a few minutes of looking at one of his paintings one gets more and more depressed. Entering a Terry Rodgers painting is a very bleak and depressing experience. My first response was a little buzz running through my brain, "These are the hollow men." I don't know where that came from. Is that T.S. Eliot? Auden? I don't know, but I knew that line just welled up, looking at those paintings.

I don't know whether or not Terry Rodgers lived that life and got past it, or is still living the life of a Ryan Bingham. But his paintings are the world of Ryan Bingham on the wall.

Another one of the wonderful surprises in Up In the Air occurs when the young Cornell grad pries out of him his great goal in life: To achieve the exalted status of a 10 million mile flyer status. What connects Ryan to his older paramour, initially, is a shared love for the empty perks of frequent flyers and travelers, the Admiral lounge memberships, where they can sit in plush leather chairs, the upgrades to bigger rental cards, the better hotel rooms and all the toys and bright shiney things airlines, rental car companies tangle as if they were something really desirable when in fact most people would rather be home in their own chairs, driving their own cars, surrounded by people in whom they actually have an abiding interest.

Ryan is someone I know. As Pogo once said, "We have met the enemy and he is us." Or words to that effect. I did not want kids. I did not want a dog. I was free and happy to be free and shuttered whenever one of my friends got married and I felt very sorry for both of the people who had been suckered into all that. But kids, now there is the ultimate burden.

Funny thing happened, though. Kids were a burden, but they were the best thing that ever happened to me.

My British secretary put it as perfectly as it could be put, in her perfect Oxford vowels, "Children? Oh, yes you must do children. They enrich life." She also had a dog. The burdens are burdens, but without them, life is impoverished. She learned something at Oxford.

Eventually, this is what Ryan learns. He gets his fabulous metal card, presented by the captain of the ship and he cannot remember what it was that was so important about it. By the time he gets the card, he has already learned from the one woman who really captivated him that he was simply what she told him all along he was, an escape, an escape for her from the routine of family life, a life she actually felt enriched by and would protect and certainly prefer to romps in hotel rooms with him. He was a parenthesis, not a main clause. He thought he was special to her. And he was, as any splash of color is to an otherwise muted painting. But it's all the muted shades that gives the bright color its effect.

And while this woman was scrupulously honest with Ryan, she lied about one thing. She tells him she is simply Ryan with a vagina, but she was far from this. Ryan lives a life which for all its emptiness is scrupulously honest. He has made no commitments and he has broken no promises. He accepts the loss of paintings on the wall, and he says he can do without that sort of pleasure and enrichment to keep his backpack light. The woman has not. She leads a double life. Ryan leads a fanatically single life.

If this woman commits a foul, it is when she accepts Ryan's invitation to go to his sister's wedding. She tacitly accepts the proposition Ryan may be more than a hotel room sensation. She provides him with reason to believe he might find a different life with her. If she is simply a female Ryan, he has every right to expect she might come to the same enlightenment he has, and he can bring her to a different place in life.

But she is already in a different place and that she has not shared with him. That is her lie.

She has a wonderful scene, which was probably not written by a woman, unfortunately, in which she tells the younger woman what a woman can hope for in a man. Someone who makes more money than you do, the most important thing. Other non essentials, but nice upgrades: a nice smile, scalp hair. So she tells Ryan, who is listening, she is just Ryan with a vagina. But she has another life she's not talking about which, in a sense makes her the villain in a film without villains. She is not mean spirited or intentionally venal or even willfully wrong; she simply commits a sin of omission.

And once Ryan learns this, his world starts to disentegrate. All along, I was looking for the typical Hollywood comeupance--Ryan would one day get the same thing he gave others. He would learn how terrible being fired is. They were setting that up with the heartless video firing scheme.

But no, the film makers were going after a more devastating blow for Ryan. He can keep his job, and his flying and his 10 million mile card and all the things he has come to value, but he will find them worthless. Like King Midas, he will find the gold is not the point.

Now what does this have to do with 9/11?

Those maniacs used airplanes.

You may say, yes and they would have used an atomic bomb if they could get their hairy hands on one. Airplanes were just what was available. But, in some existential sense, which those twisted terrorists may or may not have understood, the six thousand airplanes in the air over American skies daily are what really makes this country what it is.

You don't see those airplanes, are only rarely even conscious of them. They are just forms in the sky. If you have a life which does not require travel, they may seem irrelevant to every day life. But they are what make us different from the vast seething underdeveloped populations on the planet and they are what makes our generation different from our parents. It's the energy in the airplane which drives this country, its economy, its psyche, its connectedness.

Your kid can go to school on the West Coast, in Nashville or in Boston, if you live in Washington, DC, it's all the same. It's a plane ride away. Once you get beyond a three hour car trip, you are going to get on an airplane and so California is as close to Washington,DC as Atlanta, Boston, or Chicago.

And you have to admire or at least be impressed by the energy. Go to the Seattle Airport at 4:30 AM and look around. The place is whirring. People are awake, dressed, pulling suitcases. Flight crews are assembled, getting of buses headed to their aircraft.

And the majesty of those great aluminum birds. They are commonplace, but they are what gets our juices flowing.

The British Empire was sustained by their ships. The American Empire, and the global empire of Western "advanced" economies are sustained, connected, driven and juiced by airplanes. If you were going to bring down the British empire, you needed to attack it's shipping. Bring down the modern global economy, bring down the airplane network.

Of course, the other target was the financial nerve center. But hitting the financial icon, the World Trade Center with airplanes, how obvious.

If you want to return to the fourteenth century, if you want to rekindle the crusades and bring east and west into mortal conflict, fly airplanes into Wall Street, or given how small a target the New York Stock Exchange is physically, go get the World Trade Center.

One reason it may be difficult to get people interested in reoccupying a couple of big towers is they would present such an easy target. The whole idea of the internet, as I understand its conception, was to scatter the targets so no one hit could disrupt communications. Spread those eggs out of a single basket into many.

I cannot imagine anyone has had the fortitude or interest to have read this far, but if you have, you know there is some value in watching movies. Once in a great while, people show the capacity to amaze.

For me, it has been Up In the Air. The economy of it's delivery is astonishing. The Wire delivers a different sort of enlightenment, but to really soak that message up, you need five seasons of shows and hours and hours of time. Up In the Air does its task in under two hours. It brings you from the greater economy down to the personal. It takes you from the skies and the eagle's eye view to the worm's eye view.

It shows us a glimpse of an answer to the question Jim Lehrer asked a number of pundits, none of whom had a clue. After 9/11, Lehrer kept asking, "Why do they hate us?" Watch Up in the Air and you'll see how "they" see us. Of course, you won't be able to see us exactly as they see us, because you are not warped by their peculiar psychopathology. But you'll see something different.

Tea Party and other anti government psychopathology

Here's an email I got from a coworker, who obviously expected from me a sympathetic, "So true, so true."

I'll cut to the chase by saying the bufoon depicted here turns out to be a government bureaucrat intent on using his high tech toys to scam this cowboy out of a calf, although why this Gucci shoed bureaucrat would want a calf in the trunk of his BMW is never expalined.

                         A cowboy named Bud was overseeing his herd in a remote mountainous pasture in California when suddenly a brand-new BMW advanced toward him out of a cloud of dust.. The driver, a young man in a Brioni suit, Gucci shoes, RayBan sunglasses and YSL tie, leaned out of the window and asked the cowboy, "If I tell you exactly how many cows and calves you have in your herd, Will you give me a calf?" Bud looks at the man, obviously a yuppie, then looks at his peacefully grazing herd and calmly answers, "Sure, Why not?"

                          There ensues a lengthy description of all the high tech satellite based technology this wimp is able to bring to bear on the problem of counting how many head of cattle Bob owns.

                         "That's right. Well, I guess you can take one of my calves," says Bud.

He watches the young man select one of the animals and looks on with amusement as the young man stuffs it into the trunk of his car.

Then Bud says to the young man, "Hey, if I can tell you exactly what your business is, will you give me back my calf?" The young man thinks about it for a second and then says, "Okay, why not?"

                         "You're a bureaucrat with the U.S. Government", says Bud.

                         "Wow! That's correct," says the yuppie, "but how did you guess that?"

                          "No guessing required." answered the cowboy. "You showed up here even though nobody called you; you want to get paid for an answer I already knew, to a question I never asked. You used millions of dollars worth of equipment trying to show me how much smarter than me you think you are; and you don't know a thing about how working people make a living - or about cows, for that matter. This is a herd of sheep... Now give me back my dog.

This vignette encapsulates much of the mentality which animates the sort of visceral, reflexive anti-government vitriol which finds voice in the Tea Party movement, a sort of up to date What's The Matter with Kansas?

Thinking back on my decades in private practice in a suburb of Washington, DC, where many of my patients were "government bureaucrats," I was struck by the disparity between the reality of government workers, civil servants, the people vilified in this story and the reality of what these people are really like.

I had a patient, a fifty year old lady who arrived in my office with her maroon attache case and she was wearing a blue suit, but certainly not a designer outfit--she worked for the Department of Agriculture and they don't pay civil servants enough for designer labels. She worked on Mad Cow disease and her job was to go out and inspect herds and sometimes she had to tell farmers the bad news they had to kill off a lot of cattle. I asked her how she was received by these guys in overalls when she stepped out of her government K car--they don't drive BMW's when the government is paying.

She told me she grew up on a dairy farm. One night, when she was about nine, her brother was killed driving his truck back to the farm at night and at midnight they woke her up along with her sisters and younger brother and told them about their older brother. Then they all went back to bed and got awakened again at 4 AM to milk the cows.

I asked, "They didn't even let you sleep in that day? After your brother was killed?"

She said, "The cows didn't know that. They wouldn't have cared either. We did our chores, as always."

So when she arrived at a farm and started talking with the farmers, they very quickly learned who they were dealing with and that was pretty typical of the government workers I knew. They knew their stuff and they knew the impact they were having on the people they regulated and they knew how they were perceived.

That story with all it's focus on the foppish twit in his expensive car and clothes is someone's imaging of what the government is all about, not the reality. It's an image which evokes class resentment and the idea of the salt of the earth cowboy, who is actually more intelligent and competant than the privileged dingbat who has all the power and technology of the US government at his disposal. It's the Rush Limbaugh delusional state of what he'd like his enemies in the "Power elite" to be like.

But who are the government people you actually know?

When was the last time you saw the postman drive away from work in his BMW, wearing a Brioni suit?

Do the soldiers, even the officers, who are humping off to Afghanistan strike you as being overpaid?

Are the airport security people arrogant twits?

Do the air traffic controllers do such a terrible job they'd be likely to mistake a dog for a piper cub?

When was the last time you saw a government employee dressed in really expensive clothes--outside of the Congressmen and Senators?

Of all the government workers you might hate just because of the glossy finish, it's the very people we put there with our votes who are the most officious.  Can you see John Boehner in that BMW?  I know I can.

Even the Supreme Court Justices, who are a pretty sanctimonious lot, at least four of them are, do not make anything close to what the private lawyers who appear before them make.

SEC workers are daily faced with regulating people who make so much money, driving a BMW would look like slumming to them.

The federal prosecutor draws a salary; the defense attorney will demand everything the defendant in a capital case has--on the premise he's saving that man's life, if he gets an acquittal.

And the doctors at the National Institutes of Health, at the Veterans Administration Hospital are not in it for the money. Generally speaking, they are federal government employees because they got hooked on the job.

But that's not what Rush and Glen and Cowboy Bob want to hear.  The real government worker is just not that much fun to skewer.





      

Peter Pronovost Saves the World

Okay, I admit it. I see his picture in the NY Times and I am immediately envious of his great shirt and tie, his blond good looks and as I read on, his MacArthur genius grant and the life which allows him to  "travel  the country, advising hospitals on innovative safety measures." (Italics mine.)

It gets worse--or better, depending on how green you are turning with envy-- when you look him up on Wiki and discover Atul Gawande has said his work "Has already saved more lives than that of any laboratory scientist in the past decade."

Now that got me thinking. What lab scientist has saved lives over the past decade? Let's see, there were the guys who identified the HIV virus, but that wasn't in the last decade. I'll have to think about this.

And there was that guy in Pakistan who did microlending and those people in Africa who brought cheap water pumps for clean water to African villages and there were those guys who came up with a new malaria drug...but why quibble over a statement like, "Has saved more lives than..."?

So, okay, what did this designated genius do?

Seems he came up with a checklist, similar to the ones used by airplane pilots, but for doctors and nurses, to be used in intensive care units which is:
1/ Wash hands with soap
2/ Clean the patient's skin with antiseptic
3/ Put sterile drapes over the entire patient
4/ Wear a sterile mask, hat, gown, gloves
5/ Put a sterile dressing over the catheter site

Check, washed my hands, got that. Check, wiped off the patient's skin. All these things, actually, I used to do with some part of my brain which hangs out way below the cerebral hemispheres, in those automatic part of the brain which gets you from your house to your office in the car and you cannot remember how.
Nothing new here. These are all things we were doing thirty years ago. But maybe people forgot, or forget.

Ah, yes, the doctor tells the Times, he discovered doctors don't always do these things when things get hairy in the ICU, so his big bright idea was putting all this stuff in a handy cart and making these carts available and close at hand. Voila, MacArthur foundation calling.

Meanwhile, he somehow measured outcomes. He showed, somehow, how many infections occurred because of lapses in sterile technique in the ICU and how many fewer infections occurred as a result of being more meticuluous by using the checklists. (Ergo, Dr. Gawande's assertion about how many lives his innovation of using handy sterile supply carts resulted.)

I guess there are some infections you can be pretty sure came from catheter sites, because of the nature of the bug (staph) which is a known skin (or nose) contaminant, but whether or not there was an actual lapse in technique would be harder to say, but if you see a reduction in local IV site infections and in bloodstream infections with skin contaminants, you could track that.

So maybe, if you get everyone's attention by doing a study, you can improve performance, at least for a brief time--the way worker's productivity improves every time you paint the factory walls a new color--the so called "Hawthorne effect." The problem is, how do you keep up the improvement, once it becomes routine?


It's not like this guy is Semmelweis, the Hungarian physician who had to convince his colleagues handwashing was a good idea, especially when you were going from the autopsy room to the delivery room and transmitting these invisible things, we now call bacteria,  doctors did not believe in at the time. So in Semmelweis's time, childbed fever killed a lot of patients because doctors were obtuse and he was nearly hounded out of the profession because doctors don't like to be told they are doing something wrong.

I agree, doctors still do not like being told they are doing something wrong, but there are mechanisms in place to change behavior (vidre infra.)

And the good Dr. Pronovost is reviving that role of the crusading, courageous physician. He tells a story about the time he was the anesthesiologist and the surgeon was wearing latex gloves--at least he was wearing gloves, give the poor surgeon some credit--and Dr. Pronovost knew those latex gloves were killing the patient because somehow Dr. Pronovost knew the anaphylactic reaction he was seeing in the patient was caused by the latex and so he got the nurse to call the Dean of the medical school to make the surgeon take those gloves off. That's what a crusader Dr. Provonost is!

The surgeon cursed Dr. Provonost, which is to say, the crusader was doing what was right for the patient even though it was at a cost to the crusader, he will have you know.

But Dr. Provonost would do it again, You can bet on that.

That's the kind of guy he is.

He told the nurses at the hospital, "They could page me day or night, and I'd support them," if they saw any of those arrogant doctors failing to wash hands or step out of line.  "Well, in four year's time we've gotten infection rates down to almost zero in the I.C.U."

And so he's save more lives than any lab rat, test tube rattler in any lab in this country.

Or so they say. Or so Dr. Gawande says.

Dr. Pronovost says he got the infection rate at Johns Hopkins Hospital from being among the worst 10 percent of the country to among the best.  Of course, this assumes the other hospitals really know what their infection rate actually is--not always so simple a proposition.

There are certain numbers which get floated around, like there are "Over 90,000 deaths in American hospitals every year from medical errors." That particular bogus number which was supposedly extracted from a review of hospital charts (as if you can tell anything like that from a hospital chart) has been the only number out there. And any time you see a number that large about what happens with patients the only thing you can be sure of is it's a fantasy and pretty surely bogus.
Dr. Pronovost says his biggest opponents are the doctors who form a hierarchy and will not admit their mistakes. So he has written a book, Safe Patients, Smart Hospitals: How One Doctor's Checklist can Help Us Change Healthcare from the Inside Out.

Apparently, Dr. Gawande has a copy.

An appearance on Ophra cannot be far behind.

Who am I to denigrate antisepsis or Dr. Pronovost?

I do not have a PhD in "hospital safety" from the Johns Hopkins School of Public Health. As far as I know, they were not giving out PhD's for stuff like that back in the days of the dinosaurs. And a doctoral thesis with the core tenet being a five item checklist every medical and nursing student learns the first day on clinical service--well, who woulda thunk?

Do I pick up the very strong aroma of a self promoter?

I mean, doing what we were all taught to do in medical school, reminding others to do this, and parlaying that into a genius grant and a professorship and such a great looking shirt with a white collar and stripes, just gets all my olfactory senses in an uproar.

I remember, now admittedly this is long ago, when I was a medical student in the OR and I was standing there holding retractors for some very intimidating surgeon, an eminence grise who had invented the procedure we were doing,  who wrote the textbooks, who could turn a medical student's blood into ice by simply looking over this scrub mask at you, and the scrub nurse or some circulating nurse tells  that surgeon, "Uh-uh. Broke field, Re glove."

And this titan of surgery  sqwaked like some ten year old caught with his finger up his own nose, and the nurse shook  her head and everything stopped while the surgeon regloved. I had not noticed what he had done, but the nurse had caught it.

And the surgeon laughed , once he got back, shook his head and said, "She's a tough cookie, that one. But that's why we keep her around."

So, I'm asking, since when does the nursing profession need a champion who nurses can call day and night, as if there is only one doctor who has ever empowered nurses?

Nurses, good nurses, have been invested with certain policing powers for decades.  It was the thing which struck me most vividly when I was a mere third year student, the power of the OR nurse. They didn't use the power to show how important they were. They knew they were extending anesthesia time for the patient. But everyone knew the OR and its rules were organized to protect the patient.

Primum non nocere. First do no harm.

Actually, for most medical students, the phrase they heard most often, ad nauseaum, from every nurse, from every resident, from everybody right down to the unit cleark, was "Put the patient first."  You want to go to the bathroom before you help that patient out of his wheel chair? You want to go eat lunch before you get that unit of blood for the patient? You want to go to sleep before you look at that patient's X Ray. Fine, but it's the patient who'll suffer. You have to put the patient first. It's the patient who'll suffer. I got really sick of that phrase. Out and out appeal to your guilty conscience. But doctors used to be selected for a well developed guilty conscience. I guess that's why we had so many kids from Holy Cross at my medical school and the ones who didn't go to Holy Cross would have felt right at home in any Catholic school. We all had the internal nun, not far below the surface.

But maybe things have changed.

Apparently, if you cleave to all that  now, you are a media star, and get to wear shirts with white collars and stripes.

Damn, isn't the modern world something?

Obama and the RI school firings

 It's so much easier to suggest solutions when you don't know too much about the problem.
  - Malcolm Forbes


One good rule about essays is you should not express an opinoin until you know sufficient details about the event you are talking about. Talking about a situation you don't know much about is a great way to be a fool.

On the other hand, I have achieved fool status often enough to be now uninhibited.

So with respect to the school board in Central Falls,  Rhode Island firing the entire faculty of the high school, I have an uninformed opinion. As I understand it from the entirely inadequate news reports, which answer none of the essential questions about this school, its teachers, the students and, most importantly, the families of the students, the school was failing to educate its students by any measure you care to propose.

The question is, whose fault is that failure? If you fire someone, presumably, you are saying, it's your fault. Or, if you are afraid to use the phrase, it's your fault or you are to blame, then you say, you cannot do this job. And, this is important, we will replace you with someone who can do the job of educating these students in this school, that is, in this setting. If you fire all the teachers and close the school down,

I'm with you. I have no objections to firing everyone, closing the school, if you then have the honesty to say, "Nobody can succeed in educating these students in a public school here."

I lived once in Montgomery County, Maryland. In the southern part of the county, the wealthy suburbs bordering Washington, DC there were two high schools which graduated virtually one hundred percent of their students and over ninety percent went on to college and not just to college but nearly 100 of every 400 in every graduating class went to the Ivy League or equally competitive and selective colleges.

Up county, the story was different, and the story was different in parts of the county where the kids came from families which were struggling economically.  Fifty years ago, the only economically stressed families in Montgomery County were farm families, but now the county has immigrant communities, broken families, communities with drug problems, crime. It's not exactly the desperation of The Wire--you knew I was going to allude to The Wire eventually--but county developed pockets of poverty and things changed.


When the new superintendent of schools arrived,  he looked over this landscape of the haves and the have nots and he announced he was going to improve the failing  schools by transferring the teachers from the successful schools to the failing high schools.

This brilliant solution came from a man who was being paid over three hundred thousand dollars a year to be brilliant.

Of course, after the parents in the successful schools stopped laughing, when they realized he was serious, they simply pointed out to the superintendent the success of those schools had little to do with the teachers.

Those kids came from families of Ivy Leaguers. Those kids had violin lessons, tutors, travel, enrichment camps and most importantly, immense pressure to succeed. Their parents drove them crazy. They drove each other crazy telling themselves if they didn't get into Harvard, their lives were ruined. You could send any teachers into those two schools and those kids would score perfect scores on the SATs and get straight A's and build computers, organize soup kitchens, win equestrian team and polo competitions and nothing would change, except all the teachers you sent from those good schools to the bad ones would quit and look for work across the river in Fairfax County, where they knew how to treat good teachers.

Laying the success of the students at the feet of the teachers was just as absurd as laying the failure of students at the feet of the teachers.  What makes kids succeed (notice I did not say "Learn," is the family structure.

So when President Obama supports the school board in scape goating the teachers at Central Falls High School, he is being just as obtuse as that superintendent. Likely, that school was failing those kids because families had been failing those kids and the community failed those kids and those families and the place where the tests were administered which revealed those failures--inability to read at grade level, inability to do math, resistance to learning--all this happened in the school.

It's like firing all the doctors and nurses at the hospital when you discover patients are dying from drug over doses, gunshot wounds,  AIDs, untreated diabetes and strokes from untreated hypertension. Those failures are happening on your watch, right in front of your eyes and you haven't prevented them. So we fire you.

President Obama is said to be a fan of The Wire.  He must not have watched the fourth season, which is about the schools, about how hopeless the task of teachers in those inner city schools is. He ought to take the time to watch that season. Then he'll apologize to those teachers.

On the other hand, maybe he'll realize he was wrong and not apologize. There is a wonderful bar scene in The Wire where an assistant to the mayor is shaking his head at how disappointing the mayor he helped elect has been. Another political type commiserates: "They always disappoint you. I don't care how great they were, getting elected. They always disappoint."