It’s time for a frame-shift

There has been a lot of talk lately about the fact that we seem to be in a post-fact society. I think we also could look at through the lens that we’re in a post-critical thought society. Facts are only facts to the extent that they hold up to critical thought, and this kind of thought appears to be completely absent from the current GOP ideology. I’ll just use the latest decision by the Trump administration supported by the majority of the GOP (politicians and voters) to illustrate this point.

Trump just lifted a federal mandate allowing transgender students to use the bathrooms best suited to their gender. Their argument is that allowing transgender women to access to the bathroom of their choice endangers cis-gender women and girls. This is not backed up by facts. Not one study. Nothing. Not to mention that it makes little intuitive sense, as trans people are far more often the victims than the perpetrators of sexual violence. This mandate and its support is  based simply on the fact that the GOP is now solidifying itself as the party of intolerance. They want to marginalize trans children and promote a culture that is homogeneously white, heterosexual, patriarchal, and Christian. I believe that it’s important to call it out for what it is, because if the GOP truly wanted to reduce sexual violence against women, there are plenty of evidence based steps they could take. They could start by changing their language regarding reproductive rights, investing in sexual education programs in schools and universities, and supporting the many organizations that fight against this abomination. If they really gave a shit, they would end NCAA sports until each university put as much money fighting sexual violence as they do propping up their good-ol-boy bullshit glorification of gladiators, or cancel the Super Bowl until it stopped being a Mecca for sex-trafficking.

I’ve been working over these ideas of what it means to be a civically engaged American while trying to live in the moment up here in Ely. It might seem ridiculous, but being recognized as the local med student by the guy who stamps my card at the dump was affirmation enough to get through an entire day of CNN updates. My mom has these moments where she throws her arms up in the air and screams “I’m having a moment!” My moments are usually a little more reserved, but I experienced something close last weekend. The black and freezing cold water rolled off me as I pulled myself out of a hole in the ice. I quickly stood up on the wooden dock and felt the warm winter air as it brushed my skin. I was alone on the dock and the sky had cleared above me revealing a patchwork of stars. There was no moon, so the stars glittered down like diamonds on velvet. I stood alone as steam slowly faded from my skin, and the only sound I could hear was my heart beating in my chest. My whole body buzzed with each beat as my eyes traced the stars. I felt solid and at peace in space and time.

I didn’t think that I’d have to run so much while dog sledding. A couple weeks ago I suited up to go mushing in my Kazakh parka, cross country ski pants, and beat-up Timberlands. My friend picked me up in her little red car with a dogsled strapped on top and we drove out into the woods. It was a cold night with light snow falling and obscuring the full moon. I sat in the sled for the outbound trip. The snow crunched underneath the runners and the dogs plowed through the thick snow that was falling faster by the minute. After six miles of hard running, we swung the sleds around and pointed them back toward where we’d come from. We were in the middle of a massive lake. The real musher then gave me the reins of the smaller sled and a second later I was jerked to attention by a team of dogs ready to head home. Hovering over the wooden handles of the sled, I had to squint my eyes to try to make out the team in front of me. The lake shore was beginning to fade as the snow fell faster and faster. I spent most of the trip running next to the sled as the dogs struggled through the thick snow. Once we hit a plowed section of the road, I sat back on the runners and felt the tips rise underneath the sled as the dogs flew across the snow in front of me.

Most days I cannot believe how lucky I am to be up here working in the clinic and hospital. I wake up every morning and get to spend the rest of my day thinking about what it means to be human, talking intimately with strangers about their lives, and using my whole brain in complex problem solving. Almost all of the patients I see struggle with one or more of the following: weight, back pain, diabetes, hypertension, hyperlipidemia, and dysthymia. These are challenging illnesses that are caused by a variety of intrinsic and extrinsic factors. We have medications to treat each of these illnesses, and usually in clinic visits we mention that it’s important to make lifestyle changes to diet and exercise as well. However, since I have a little more flexibility with my time, I’ve been spending more and more time discussing the importance of exercise. Evidence based medicine has demonstrated through study after study that exercise is a magic bullet that improves every one of these health conditions as well has a separate beneficial effect on all-cause mortality. That being said, I completely understand why it would be difficult for doctors to keep prescribing and advocating for behavior change that they rarely see patients make. I also see the problematic nature of a young, healthy, privileged medical student telling people how they should live their lives.

I am far from perfecting this conversation, or even from being effective at it. However, I’ve also spent the past 4 months trying to learn how to have these conversations with people who humble me daily with their frankness. I try as hard as I can to listen to what patients tell me while affirming that their struggles and success are normal and human. I don’t mean this in the bullshit way that it’s important to affirm someone. I mean that it’s logical to remind people that the struggles they have daily (exercise, diet, smoking, stress) are universal. At some point it’s more helpful and logical as a society to look at the structural problems setting people up for failure instead of solely ascribing agency to their behavior. Every good conversation has give and take so I’ve found that in certain contexts it can be helpful to admit to my own failures as a human. I love nicotine, I’m insanely lazy when I get home from work, and I eat like a stoned pregnant woman.

  • I got up at 7:10 Thursday morning and was out the door by 7:45. However, in the 35 minutes that I had between rolling and of bed and walking out my door, I actually made time to bake and eat 6 chocolate chip cookies from dough that I’d made the night before.

I get why people have a hard time dieting. Normalizing destructive behavior while accompanying it with spare facts and a prescription for how to move forward is a tricky dance. We all do things that we wish we didn’t, but for some of us, the stories of these decisions are written on our bodies and in our laboratory reports.

It was almost 50 degrees out last weekend in Ely…. in February. Because I have no shame I went skiing shirtless and in spandex bottoms I won at a race this year in Duluth. I decided to embrace the hot sun because no matter how foreboding the weather felt, there was nothing that I could do that day to change it. The sun beat hot on my skin and water dripped down from branches thick with old snow. I slipped through the woods on wet snow that was just barely able to stay formed and icy. I try to use these long Saturday skis as a time to reflect on different problems or ideas that bounce around my head during the week. Usually this is the perfect time to do so as my body stays in cruise control and my mind floats along on its own. It didn’t work on Saturday. I was cruising down a shaded and icy hill that opened up to the hot sun baking a sticky bog. When I hit the bog, my body shot forward off the trail as my skis stayed firmly rooted in the wet snow. It was painful lesson in living in the present moment that tore me from the question I was working on.

The question in question was how to bridge the gap between small town values and small town politics. I work and hang out with good people, actually some of the best people I’ve ever met. Part of the charm of living in a small town is that it is harder for people to retreat into their own private lives due to the fact that you’re forced to interact with the same limited number of people for all of your mundane daily interactions. This closeness builds a sense of responsibility and brotherhood different than what we have in metro areas. For example, when I asked my friend, a full-time dad and RN at the clinic, why he goes out on every single odd-hour EMT call that brings in a minimum wage salary, the answer was simple: “This is my town.” There are problems here, some startling in their viciousness, but there are problems everywhere that people gather and live. However, the average interaction that I personally have in the street is much warmer than I’m used to while living in the city. People constantly open themselves up to me, invite me into their homes, and go out of their way to make sure that I feel welcome. That’s why I’m still having trouble understanding why the good and decent people I know here are so quick to malign our culture of political correctness.

The conversation eventually veered towards politics at our Valentine’s Day taco party the other week. After hearing yet another complaint about our “current state of censorship,” I shared my thoughts through a mouthful of guacamole and ground beef. To me it’s simple, I see political correctness as an extension of common decency. If I have to limit my vocabulary in order to make sure that those around me feel safe, accepted, welcomed and non-threatened, then that’s an easy way to make the world a little bit better. It’s no skin off my nose to be a little more careful in how I speak in order to create an accepting and loving space around me. When people here talk about small town values, they talk about helping your neighbors, investing in your community, and caring for your children. That’s why it’s so confusing to hear political comments that are so contrary to these values. I think I’m beginning to understand it a little though. Change is hard and no one likes being told what to think or how to behave. Besides the underlying current of white fear that has been fomenting in our country for generations, people have a legitimate desire not to be told how to be.

To this point however, I want to propose a mental frame shift, similar to the way in which I mansplained my concept of feminism to my friend’s girlfriend who asked me about my bumper stickers. She told me she didn’t see herself as a feminist because she enjoyed conventional gender norms, and responded that I saw feminism as her right to choose to live however she wants, be it conventional or not. I see feminism, trans-acceptance, religious tolerance, and racial equity as deeply American ideals consistent with small town values. America is a community that has come together around the idea that people should be free to live their own lives in the way they see fit. That oppositional dynamic of a community built on individualism is precisely what makes this country so unique. This is a complicated foundation for a democracy and requires that its citizens strive continuously to maintain these values while fending off attempts by fear mongers and bullies who wish to warp America into their own neo-fascist autocracy. The very nature of America demands that its citizens use moral fiber and critical thought to defend it. The Trump administration and those who support it actively and passively should be afraid. They should be afraid because they have given the citizens of this country a worthy cause to fight for.

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To feel important

What’s happening right now in America is unconscionable. Muslim ban, border wall, avowed white nationalist on the US security council, DAPL, Keystone, and assault on reproductive rights all in the the first week. This isn’t just going to be another political rant, there are enough out there already. That being said, as staying silent is tacit approval, I would consider myself remiss if I didn’t say off the bat that I will continue to stand with those who are marginalized in our current (and past) culture of racist sexist xenophobic fascism. Just today I connected with two men who I consider brothers, men from predominantly Muslim countries who are not only two of the kindest people I know, but who have graduate degrees in engineering and economics. These brilliant, kind, and fully americanized professionals are no longer sure that they feel like they can make this country their home. I’m far from perfect and am constantly face to face with my own humanity and shortcomings. However, I am also sick and tired of hearing well-intentioned liberals discuss the need to further explore the flaws of the leftist ideology and hear out rural America to better understand this conservative/reactionary/impotent white male perspective. I don’t buy it. We’ve been living that perspective for the past two thousand years and it’s time we stood up and fought to broaden our fucking horizons.

 

Selfishly living in Ely allows me to escape our current political horror show whenever I want to and think about smaller problems. First on my list is that I have yet to see a wolf. I’ve wanted to see wolves since I moved up here, but the closest I’ve come is a ragged coyote that looked like it had mange. For the first few months I was here, almost every time I closed my eyes  wolves would come to me in my dreams. They were always powerful and wild, looking me in the eyes at a distance just too far to smell them. There hasn’t been a fatal wolf attack in the wilds of the lower forty eight since 1893, and I tried to keep that in mind when I was putting on my skis the other week. The sun had long since gone down and I was alone in the pitch black parking area in front of the Hidden Valley ski trails. My long day working with Schwinghamer, the on-call doctor, had given me a lot to think about. Dr. Schwinghamer is built more like an offensive lineman than an academic. He thunders in and out of clinic rooms too quickly for me to catch him but that’s a small price to pay for what I’m learning. In addition to the doctoring, he’s showed me power of putting your hands on patients, of being unafraid to say you don’t know, and letting down your guard to show your patients that you care for them. 

 

As I kicked off into the trails, I thought about the second patient of the day. He was a guy in his early 20s with a left below the knee amputation from a job site accident. I looked down to hide my emotion in the clinic when he started talking about his service dog as his “little lover.”He had no bitterness, no callousness, and no anger. He was just trying to do the best he could with the cards he’d been dealt and wasn’t ashamed to tell us that it was hard. It was all I could do to keep myself from giving him a hug when we finished talking. The next patient was a woman in her early 30s who had an infection s/p mastectomy for breast cancer. She had three young children, one of whom is completely dependent. When she told me about her children, I remembered that I’d met her husband a few months earlier when he brought in their daughter due to an episode of her recurrent aspiration pneumonia. I will never forget that ER visit. The love and care emanating from that man towards his daughter was palpable. We were worried that we couldn’t give her appropriate care in Ely, but he told us that if we would just let him care for his daughter at the hospital instead of sending her down to Duluth, he would take care of everything on his own. I was telling this story to his wife and before I knew it I had another lump in my throat and she needed my box of tissues. Medicine so often seems to rob people of all that is good, but almost daily it can reveal these brilliant moments of pure love.  

 

So I had a lot to think about as I stepped out of my car into the dark night the other week. My skis were sticking to the wet snow, and the air was warm and murky with patches of fog that were so dense you could only see three or four feet in front of you. My headlamp did little more than create a dim outline of the trail in front of me. I streaked down hills virtually blind, more than a few times veering off the trail into the pines. For the first time since coming to Ely, the woods unnerved me. Something about the fog and the dark made it feel like every glint I saw in the trees were eyes staring back at me. I finished up my workout and was going to take the outer loop for a cool down lap mostly because my instincts told me not to take the trail going into the heart of the forest. Fighting my craven gut I plunged back into the trees. Then I was going to take the meandering loop back to the chalet in order to avoid “The Screamer” in the now total darkness . The next thing I knew I had pushed off into the darkness. A moment later I felt my skis leave the ground for a few glorious and terrifying seconds before reconnecting with and skidding across the icy hill. I’ve night-skied since and have yet to feel again that same sense of uneasiness that I did the other week. It might have just been the fog, but I’d like to think that as I skied through the woods I was flanked by silent canines running beside me.

 

Last weekend I joined the Ely Women’s March before heading out to explore the North Arm ski trails by Camp DuNord. There were only about 40-50 of us out there, maybe 4-5 depending on White House estimates, but it felt good to be involved in something as our maniac in chief took office. Plus I scored a dinner invite from an incredible couple in their 80s. Reflecting on the past few weeks though I realized that Trump and his cronies might hold office today, but there’s so much that they’ll never have. Fame doesn’t matter, if humans survive another 10,000 years no one will remember our names no matter how famous we are. Wealth doesn’t matter because past a certain point (~70,000/year) it does nothing to improve our life. Power doesn’t matter for the same reasons that fame and wealth don’t matter. At the end of the day, all that matters are the individual moments where we are good to people. Being kind, loving someone, working for justice and equality, etc are infinitely priceless moments because unlike fame and power, goodness stands on its own. Thousands of years after the dust from our bones settles on the ocean floor of what was once the coast of Florida, those moments of kindness and love will still have happened. Those moments will be all that mattered.

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Ely Women’s March

I was thinking about this in light of our current president and the lengths for which he is willing to go in order to feel important. Unfortunately I think that his mind is too twisted to ever understand that none of the wealth, fame, or power he has matters. He is a little man and he will live the rest of his miserable life a little man no matter how powerful he becomes. What I do hope however is that the republican politicians in this country can wake up and realize that power isn’t worth the almost unpayable moral debt they have incurred. As many others have mentioned, one of the only silver linings in this abomination has been watching so many people in our country turn out for one another, showing us that maybe we do still have the potential to be the greatest country on earth. I’m proud watching my countrywomen and men march on cities and airports. I’m proud to be a part of a family where my mom was just hired to be the executive director of Mediation Services for Anoka County and my brother was just hired to be a 10th grade English teacher at Cottageview High School. They turn out every single day and I look up to both of them as examples of how to live and work with purpose.

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Professionalism

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20 below and walking into my clinic at sunrise

I leaned over a bed in the ER and stared into the opioid epidemic. The patient was a late sixties Vietnam veteran who looked up at me from sunken eyes, his body shaking on the small bed. He was going through withdrawals after trying to quit prescription Dilaudid that he was supplementing with Heroin. Fighting back tears, he told me he was prescribed narcotics for neuropathy in his right leg. My mind, already struggling against ever strengthening biases and heuristics, didn’t have to work hard to see that this man was in pain. Distinguishing real versus feigned suffering is an instinctual judgement call whether we like it or not. Pain is complex and it forces us to ask philosophical questions for which we don’t have answers. Whether we have fibromyalgia or necrotizing fasciitis, pain is all in our heads. It doesn’t exist without our brains and it only matters to us because of the neural connections running between the primary somatosensory cortex and the amygdala. Even though this brain tissue is as biological as our fingers, we cannot help but ascribe agency to it. To do differently would be to alter the very idea of what it means to be human and how we see ourselves in the universe.

 

The man in the bed in front of me was suffering. It’s so fucking hard, so fucking hard he stuttered again and again. He was brought to the ER by the sheriff who had heard from a friend that he might harm himself. When and where to ascribe blame is always complicated, but this patient was unfortunately a perfect example of someone whose brain had hijacked their life. Narcotic abuse, like any other drug abuse, is an complex problem that challenges our ideas of free will. If we control our own actions, why would we do something that makes us suffer? What do you do when patients demand narcotics, when patients appear to be in real pain, and when you have that power at your fingertips? I deleted and stopped listening to the podcast “Reveal” after their episode on Opiod Abuse. It frightened me to hear people so convincingly simplify a staggeringly complex issue in order to make it more palatable and give it more zing.

 

Pounding up the final ascent of my last hill repeat I wondered why the hell I was doing hill repeats. I was up on the Birkie trail with my family after Christmas. After finishing eight meaningless repeats I skated off deeper into the woods. Tall pines graced the sides of the trail as I skated alone through the trees. The trails around Telemark snake through a rugged undulating forrest and every so often you can turn a corner and find yourself in a magical grove of old-growth trees. It’s enchanting to look up at the towering pines sheltering carpets of soft white snow. Floating through the trees stirs the same feeling as when you look at someone you love and she smiles back at you. That jump in your chest that tells you the world is an endless maze of possibilities ready to be conquered. I stayed on the trails till the sun went down.

 

On Monday afternoon I met “John,” an obese white male in his late 60s. He had shaggy gray hair, a shaggy gray beard, and red suspenders just barely holding onto a massive belly contained within a stained white t-shirt. He was in the clinic to have a cyst removed. The cyst removal was important, but so was his “oh by the way.” My hand was on the doorknob ready to escort him to our procedure room when he started to talk about his depression. In a flat voice he began to me tell his story. I was transfixed, placed momentarily in a world I’ve never known and would never want to.

 

You’re from another state but have been living in Ely for ten years now. Never making friends besides those of us you see in clinic, you believe that someone once diagnosed you as a hermit. You don’t get out much, maybe to the grocery store twice a week. You live off disability and spend your days in your small apartment watching tv, sitting, staring, watching the world go by without you. You had a dog that a friend gave you. He wasn’t house trained but he loved you. You both loved it when he sat on your lap and you scratched behind his ears. He made you happier than you’d been in years, but your apartment complex took him away because made messes inside. You don’t want another dog because you’re afraid he’d get taken away too. Sometimes you get confused about things.

 

I eventually had to take him into the procedure room to incise and drain his cyst with the help of another doctor. The cyst was scarred over the top and diffuse under the tissue after it had been squeezed multiple times. We had to use two different scalpels to cut through it. I’m not sure that I’ll ever get used to that smell. Every day since, he’s come in for wound care at 11 am. Usually the nurses take care of wound management, but in the interest of learning functional skills and not being an asshole who makes people do things I can do just as easily, I asked if I could take over. Every day, one of the nurses lets me know when he’s roomed and I then proceed to unpack, irrigate, pack and dress his wound. We talk as I carefully shove centimeter after centimeter of packing tape into the hole in his back. He gets by with his life and I selfishly get to peel back deeper layers of a wounded humanity. Whereas he makes me confront my own biases about dog owners and white male suffering, I also can’t help but marvel at the adaptability of the human spirit.

 

On New Years Eve I watched Jesse Diggins race on TV in a bar in Northern Wisconsin. She was amazing, racing fearlessly against the top skiers in the world. It shouldn’t have, but it made me proud to be in a bar where a group of people watched women perform feats of unthinkable athletic achievement. I bombed back to Ely the next morning to coach middle school skiers. I co-coach with one of the doctors in the clinic. When Dr. Bianco and I told the skiers they could head back in, I noticed that there were 3 girls who seemed like they wanted to stay out longer. So I volunteered to take them on one more loop and teach them V2 alternate, a simple technique we hadn’t worked on yet. As we took off our skis in front of the chalet, the girls turned to me for what I took to be a final word on the day. After telling each one of them what I thought they rocked at and what I wanted them to work on next time, I mentioned that I thought that each of them could grow up to be as strong as Jesse Diggins. Seeing the smiles on their faces reinforced just how powerful it is for young women to have role models like her.

 

I’ve had my own trouble with smiling recently. Yesterday I lost my composure with a patient for the first time in medical school. Twice actually in one day. The first time was early Friday morning when I was seeing a patient for stomach pain. As he told me about his one-day bout of ten to fifteen loose non-bloody stools, it seemed to be a pretty clear case of a limited diarrheal illness. I was comfortable with my diagnoses and therefore caught of guard when he finished in a thick Minnesota accent, “I decided to come in yet because last night I was talking to my friend on the phone and I farted and shit myself.” I lost it. Not being able to get ahold of my laughing, the next thing I knew I was telling him that I was only laughing because I had recently done the same (which isn’t inconceivable but not true either). I felt terrible but it was all I could do to keep a straight face through the rest of the visit.

 

The second visit was different. I spent a half hour or so talking with a seventy year old man about his insomnia. The trouble sleeping turned out to be secondary to a depression and anxiety brought on by a multitude of stressors. He told me that he’d called his son the other day, and that his son must have thought he was crazy. Why? I asked. Because I told him I was just callin to visit. But you know it felt good to talk to him eh. His eyes watered and mine welled up. I put my hand on his shoulder and told him that I was sure that his son would like to hear that. I told him how much it means to me to be able to talk to my dad.

 

I’m coming up on four months now in Ely and I’m still snorting at farts, gagging at cysts, and tearing up in exam rooms. Yesterday wasn’t a win for professionalism but who am I kidding? I’m loving it up here but can’t help counting down the days until I get to fly to NYC to stand next to one of my best friends as he gets married. Almost as importantly however, I’m counting down the days until I get to reunite with the other two members of the greatest dancing trio of all time.

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Rainy Christmas

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All I hear are the soft sounds my skis and poles make in the fresh snow. Driving one leg forward and then the other, I slowly find my rhythm. I’ve never been a graceful classic skier. I glided through Sunday lost in my stride and my thoughts while my face stayed hot against the twenty below. The trees lining the trail were thick and weighed down by fairytale goops of snow. Arctic air only made it more striking.

My high beams cut into the black highway at 3:30 am. It only took a few hours of public radio and guzzling coffee before I had to pull off the road to relieve myself in the woods. I wanted to get to Standing Rock by noon. The dark woods soon gave way to the open plains of North Dakota as the sun crept over the horizon behind me. I stopped for fuel in Mandan and then sped across more plains towards the camp. I didn’t expect it to be so beautiful. The clear blue  sky was framed by snow-capped hills which opened up into the Cannonball river valley as I reached my destination. Flags whipped in the wind as I rolled up the road toward the entrance. The camp spread out on both sides of the river, Oceti to the East and Rosebud/Sacred Stone to the West. Tepees, yurts, tents, woodsmoke, colors, people, mud, snow, and dogs all blended into one feeling as I pulled my car in and found a place to park and set up my tent.

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Snow hangs heavy again on the pine trees today. The forest is becoming my midday meditation. I keep driving my feet forward trying to get kick as I stride up the back trails. It feels unfair that I’m allowed to ski like this. I wasn’t sure if my car would make it up the steep quarter mile hill to the ski trails over lunch. The snow was 3 inches deep and falling fast. I hit the bottom of the hill at 40 mph and crawled across the top bottoming out at 7 mph. Once in the woods, I pushed forward hard, gamely slipping and sliding as my ski tips cut through the thick layer on the tracks.

Woodsmoke formed a thick and continuous haze in camp. After completing my instinctive and almost animal hike through the entire settlement to get my bearings, I walked over to the main medic tent. There I met another third year medical student who told me she’d been at Standing Rock for over a month. For some reason she decided I was legit, and gave me an informal orientation to camp. Spending the afternoon with her and the other long term activists gave me a flashbang insight into the place. Emotions seemed to be a mix of love, pride, passion, resolve, and frustration with each other and newcomers. I worked in both Oceti and Sacred Stone on the day I arrived. It didn’t take me long to find a stethoscope, figure out where supplies were stored, and get to work. I stopped at a massive woodpile in Rosebud as I hiked between from Sacred Stone back to Oceti. Using my body for an hour helped steady my nerves and gave me time to think about the place and my role in it. I was taken aback by the legitimacy that I was immediately imbued with in a place that was so questioning of motives. It’s hard to tell why you’re accepted or not, but it was sobering to reflect that my profession, gender, and race all seemed to advantage me even in a community of activists. As the first day faded into night, I took a break from the medic tent to make dinner in the back of my car and walk around the tent city at sunset. Long underwear was key as the temperature fell into the teens.

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My friend shared her birthday with the coldest day of winter thus far. At 6:00 pm it was dark, fifteen below and getting colder. She asked me if I wanted to go night skiing before we met up with people at the bar. How could I say no? Besides her inexcusable lack of quality ear protection (so my ears suffered), it was pure magic. We didn’t turn on our headlamps, so the trails were like ghostly streams weaving front of us.

Over the next two days I split my time between the two different medic tents, stopping to split wood for a couple hours each day at lunch. The medicine itself was everything from asthma and URIs to extreme agitation and head lacerations. The positive energy was palpable as we all seemed to get a thrill from being a part of something bigger than ourselves. It was hard to keep a clear head and avoid being seduced by the sense of purpose and feeling of being needed. Everyone came for their own reasons, and questions of privilege, appropriation, respect, and space were present all the time. There seemed to be an ongoing argument/discussion regarding who was up at the protest, how long they were there for, and their motivations for being there. I had thought a lot about why and whether to go before I left, and decided that I would rather go and risk being problematic than not go at all. I did my research and I believe that the Standing Rock tribe’s claim to the land is just. Either way however, I felt uncomfortable  that the government and local police have been using force against peaceful protesters. It was powerful to be a part of something so strong yet rooted in non-violence. Things seemed to be coming to a head when the Veterans for Standing Rock decided to come on the weekend that the government had given the protesters an ultimatum to leave. I figured if there was any weekend I could be of some use, that was it.

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Rain hit my face like cold little pebbles as I sat in the hot tub looking up at the trees on Christmas night. Strange winds howled and whipped the naked tree branches back and forth. The sky was beautiful. Icy rain made our house feel even more cozy and welcoming as family, friends, and neighbors poured in. Sitting in the living room with Niko, Brad, and Nate it felt like we were in a time capsule circa 2005 in Brad’s basement.

The only thing that I see as a guarantee is that things will change, and I’d rather ride that wave than fight it. I left Standing Rock after the easement was denied and the tribal elders asked people to decamp for the winter, but I didn’t feel any sense of accomplishment as I drove home. What I felt was an energy pushing me to keep fighting for a better world. Trump’s election was so devastating because I think for the privileged among us, it had felt like we were on a moving sidewalk on the way towards that better world. I think this gives us the opportunity to see that this world won’t come easy and that there are millions of people who didn’t feel like they were riding that wave of progress. It takes small steps, like my cousin Megan explaining to her husband how he doesn’t see his white male privilege. Or my brother, throwing his life and energy into social justice and teaching. I have no answers, so I guess that just means I’ll have to go on that 10th Mountain Division Hut ski trip in March. Even if we don’t come up with answers, it seems better to ask the questions in a log cabin surrounded by snow capped peaks in the Rockies.

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Civic Engagement

A few miles outside of Virginia I pulled my Prius into a snowy gas station to refuel on coffee and gasoline.There was a paper sign taped to the coffee maker that read Please pay for the coffee whether you like it or not. Too many people are dumping it out without paying. I felt uneasy but the coffee was cheap. After forking over ninety cents, I eased the Prius back onto the highway. Seven hours earlier I had opened my eyes to the inside of a cold and frosty tent. I tried to pack up as much as I could while staying in my sleeping bag, but eventually had to unwrap myself and tumble into the black morning air. It was 6:30 am Monday morning, the day after the Army Corps of Engineers  denied the easement on the Dakota Access Pipeline. I took down my tent, packed up my bags, and bombed out of camp without stopping until I was past Fargo. The bad coffee was the second stop on my nine hour drive back home from working as a medic at the Standing Rock Native American Reservation. I’m still figuring out how and whether to write about that experience.

Now I’m back home in Ely  and continuing to humble myself. Three days ago I was sitting in an exam room with a congenial patient afflicted by the ever more common metabolic syndrome. While scanning through his charts and discussing diabetes, weight, hypertension, and hyperlipidemia, I asked him if there was anything else that he’d like to follow up on. He nodded and said that his knee had been bothering him lately, especially early in the morning. Thinking nothing of it, I absentmindedly reached down to palpate the knee while simultaneously checking his labs for his latest hemoglobin A1C. My fingers ran over a kneecap that was hard, boxy, and unlike any I had ever felt. Can you tell me a little more about your knee? Anything precipitate the pain? I hadn’t gotten to his past surgical history in my chart review. He pulled up his pant leg with a smirk. I just had a little surgery, no big deal or nothin. I found myself staring down at a 2,000$ prosthetic holding up a right BKA.

I’m dead serious about what I do, but I’ve given up on taking myself serious. The nurses and patients seem to have given up on that too. Sometimes I think the patients can smell it on me.Last week I walked into an exam room and was met by a bleach blonde 65 year old woman who was a retired long-haul trucker. I usually don’t have much trouble guiding patient interviews, but her stories blitzed me and I found myself trapped in her musings about her “36 inch all American stems.” When I finally corralled the conversation back to the HPI, she told me she woke up with chest pain. My stomach dropped as my mind flitted through a vast differential and images of her dropping dead on the floor in front of me. Yeah, the chest pain was bad but then I looked down and realized I was standin on my nipples! I groaned as she grinned up at me.

Whether it’s the nurses changing my contact picture to an anal speculum or the doctors feeling comfortable enough to have me close up hernia repairs, I feel like I’m integrating and getting in the swing of things here. I might have put that all in jeopardy on Tuesday night after I got a phone call from my mom. I was making a snowy trek to the grocery store and the laundromat when she called to ask about my weekend in North Dakota. After I talked for a bit about the camp, she told me about a comment that was posted on Facebook by a newly elected member of the Ely City Council. She’d read about it in the Star Tribune and saw that the next Ely City Council meeting was scheduled for that night to discuss it. Councilman Forsman’s post read as follows: Do you suffer from Trump Acceptance Rejection Disorder (TARD)? Ask your doctor if suicide is right for you. I was furious. Not only is this a disgusting statement that uses a slur for people with different abilities and makes light of suicide, but the writer is an elected official who insinuated that if you’re upset with the election, you should go kill yourself.

I googled the when and where and found out that the council meeting was 3 blocks away and started 5 minutes before I got my mom’s call. I paid my grocery bill and jogged over. Once inside City Hall, I pushed my way through a packed room and found a spot along the side wall of the chamber just in time to hear Mayor Chuck Novak address the assembly. The mayor was seated at the center of the council in order to facilitate the meeting. Before the conversation started however, the mayor made a few things clear. First, he argued that people need to understand that there’s a difference between private and public life.  And I’ve known Danny since he was a boy, and he’s not a hateful guy. He finished by turning up the folksy accent and saying Some people are even calling for me to resign. Well I ain’t going nowhere! Dan Forsman then made a brief apology and that was that.

I walked out of the chamber as my blood boiled. The mayor had just delegitimized the concerns of roughly half the people in attendance through faulty logic and a blatant appeal to nativism. Not only that, but the hall itself felt threatening as a group of six or seven young white men stood cheering in the back clad in red “Make Ely Great” hats, Trump paraphernalia, and American flag cutoff t-shirts. I stood off to the side and watched the crowd, waiting like everyone else for the open forum at the end of the meeting. The group of guys in the back kept looking over at me, eyeing me and trying to decide whether or not I was part of their in-group. I leaned back against the wall hoping they could sense that I wasn’t. Finally, the people who had signed up beforehand were called up to speak. In the interest of time, I’ll just leave it at this: the (mostly women) who spoke out against the hate speech all thanked Forsman for his apology and argued that this was a moment to learn from, while the (all men) who spoke up in his support told him to stay strong against the bullies in the room and questioned as to how we got so politically sensitive and serious about a joke. I’m sure that Forsman received some horrible hate mail, but I didn’t see any bullies in the room that night and I didn’t hear anyone tearing him down. I did however see people asking the mayor and the council to hold a man responsible for his actions.

When it was my turn to speak, I tried to keep it simple. I introduced myself as a new Ely resident and thanked the town for welcoming me in. I then talked about how I’d taught 5th-11th grade in the peace corps before starting medical school. I said that both in our country and abroad, we teach children that they will be held accountable for hurtful things they say in class or post online. When a child punches another child on the playground, we don’t pass it off as I’ve known this kid since he was in 1st grade, or she’s not a hateful 5th grader. We hold them accountable for their actions so they can learn from their mistakes and so that we set a precedent in the school community. If we hold our children to this standard, we should hold ourselves to it as well, let alone our public officials.

Insinuating that people should commit suicide and making fun of people with differing abilities isn’t about being overly serious and politically correct, it’s about having the bare minimum of decency and social graces. The people who I most often hear malign our culture of political correctness are usually those with no idea what it means to have a politically correct conversation that stifles intellectual thought. They’re immature individuals who want to continue to get away with saying shitty things that hurt and frighten our marginalized communities. I looked at Mayor Novak when said I that I specifically disagreed with his distinction for elected officials differentiating public and private life in regards to social media. I thanked Forsman for his apology, thanked Ely for welcoming me to town, and stepped back from the mike.

I looked towards the group of men in the back as I made my way back to where I’d left my coat and groceries. They didn’t look friendly. I’m not sure why it struck me as funny, but I couldn’t stop smiling when I thought about them as I walked back to the laundromat. I think the idea of white men feeling disenfranchised is just too ridiculous for me to handle anymore. I want people to be straight up and say what they really mean. White men (myself included) have always had all the seats at the table, and now many of us are pissed as hell that we have to give some of them up to brown people and women. We’re pissed that we can’t just say whatever we want to anybody we want without incurring consequences. These angry white men don’t get it, they don’t feel disenfranchised, they’re pissed that brown people, immigrants, and women are being enfranchised. Yes, poverty in rural America is real, but that doesn’t mean that we need to keep using false pretenses to cover up fear, misogyny and racism.

 

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Rebellion

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View from the top of the fire tower

Her wheels spun next to me as my feet pounded cold pavement, arms pumping at my sides. I could no longer talk. Our conversation had gradually faded into this moment as my lungs sucked air. Rounding the final bend we burst out of the woods and strangers stared as she screamed at me to run faster. I was murdering myself to cauterize an old injury with fresh tissue. I’m lucky to have my mom as a one woman cheering section to spur me on.

 

Our country needs a rebellion, an open resistance against the established authority. We must rebel against white supremacy, male supremacy, hetero/cis supremacy, and nationalistic bullshit. We must rebel for love, acceptance, tolerance, progress, and the future of our species. Pigment, gender, and sexuality place me in the dead center in the establishment, but I’m okay being problematic and learning to be okay with being checked when not properly woke.

 

On Thanksgiving morning my brother, parents and I found ourselves scattered around our kitchen drinking coffee and grazing on breakfast food. Discussing. Whether or not. To discuss. Politics. But life is politics. This idea that there’s normal life and then there’s political life is a fantasy concocted by white people, those settled comfortably into the dominant culture. Like myself. Besides, it’s way more fun to experience life in all it’s grime and awkwardness instead of settling for bland, meaningless, and good enough relationships with the people who will be with us from birth to death.

 

Thanksgiving was good. Grease dripped from a piece of Turkey meat my cousin dangled in front of me as has become our holiday tradition. He cooks and I steal food. Eyes glazed over and stomach distended with pie and stuffing, I leaned back on my parents couch with my newest infant cousin falling asleep on my chest. River honored me with some namesake drool and we might both still be napping on that couch if I didn’t have to drive back north to learn more about doctoring.

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Helping me eat birthday cake

Because we’re the Cousins, Thanksgiving got political, it wasn’t all babies. Sometimes it’s good to talk to a likeminded friend under the northern stars. And sometimes it’s even better to have a bellyful of whiskey and a cigarette between your lips as you talk with your conservative cousin in his 4-door pickup. Listening was my first step. I was told by one relative that my intensity was overwhelming, so I listened as much as my mouth would allow. What I heard was fascinating.

 

Perpetuating the fear and racism driving our descent towards authoritarianism is an assault on information. We don’t get the same information. We don’t talk the same discourse. Our facts are not the other’s facts. Too many of us believe that institutions of learning and science are inherently biased and therefor untrustworthy. We have no common source of facts and information to depend on. The first step towards destroying a democracy is to undermine the institutions that pursue knowledge and speak truth to power. The white nationalists/Trump campaign did an excellent job of this during the election.

 

Creating accepted and trustworthy sources of information is a tremendous task in our age of exploding information. More importantly however, we need to be honest with ourselves about the role that fear, racism, and complacency have all contributed to our current political climate. Trump won all white demographics: young, old, female, male, rich, and poor. Forget the fact that we need to push back on the racist implication that only white people are working class, we’re kidding ourselves if we think that this election was about economics as much as about white nationalist fear.

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Sunset at the firetower

Today I’m back up in the northcountry, leaning against exam tables with my head in my hands as I try to figure out how to best serve the men and women who come into our clinic. The sky is grey and the ground is wet, which is unusual for this time of year. Today in the Babbitt clinic I sat back while an elderly white couple in their late eighties railed against the racism, sexism, and economic insanity of Trump and what he stands for. It seems like it’s my fate now to let the wisdom of the elderly wash my soul clean when I find myself losing hope.

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Hope

I couldn’t smell the piss that I was told might be soaking the soft clinic chairs. The sun blazed in through the glass windows and I could see rows of single story houses marching down the street. I was working at the Babbitt community center and clinic, a retirement community for the rugged. A bead of sweat was beginning to form on the top of my nose when the old man roused himself.

 
Those things he said about women. Awful. Not sure what’s going on anymore here. D’ya watch it last night?

 
It was Wednesday morning and I was hunched over a clinic computer scanning through labs and hoping that the numbers would help me forget. The room was hot and my stomach hadn’t yet uncoiled from the night before.

 
For the first time since Ohio fell, a little pressure lifted from my shoulders.I looked up at the old man and nodded. Then I stood up, walked across the carpet and pulled on the metal latches to feel the cool air move into the room.

 
The next day I was back in Ely and I screamed at a patient that I was better looking than Dr. Montana. He was mostly deaf and mostly blind. During the physical I asked him to exhale as I pressed my fingers into the soft tissue of his abdomen to feel for his liver. He looked at me with sightless eyes.

 
My stomach don’t hurt nothing. Least I don’t think so. Might’ve shot myself in it votin for Trump. I dunno. Beard makes you look old ya know. Thought you were older than Montana. Beard makes em handsome.

 
He grinned as I sat him up. The history was taken, exam completed, and note written. We were shooting the shit waiting for labs to come back. I forgot that I was screaming into his left ear. Greg the triage nurse looked at me funny when I left the room. My beard was shaggy, I hadn’t slept well since Monday night, and I was pretty sure I was wearing the exact same clothes as the day before. I didn’t have it in me to deny my claim and explain myself.

 
I needed time to think in the woods. I don’t have the money for a good camp stove right now so I stopped by Shopko after work to pick up a hatchet and tarp. On my way home I dropped by the bar to grab a quick beer with some of my coworkers. It was cheap, but not knowing their politics allowed me a moment of respite.

 
The next day I sewed up a boy’s hand in between impromptu cardiology lectures by the visiting heart doctor. The hand owner wasn’t much younger than me and regaled me with wild stories after I put the local in and the pain went away. I felt competent cleaning, numbing, and sewing the hand, and frustrated when I realized how much I forgot about cardiology. I headed up to the woods on Sat night.

 

It was the day before the super moon, but it was still impressive as it floated higher and higher in the sky illuminating my camp with ghostly light. The night was cold and good for sleeping. The next morning I held black and boiling coffee in my hands as I sat on the rocks and watched the sun crawl over the treeline. This morning was good for thinking.
The election had no winners. Trump and those who stood by him lost because they fell prey to our basest, saddest, and most pathetic selves. History never smiles on those who act out of fear and hate. However, human civilization is but the blink of an eye in the cosmos, so this is about something bigger than history. America lost this election because love lost, decency lost, equality lost, and justice lost.

 
We aren’t lost because we lost the election. The struggle for love, decency, equality, and justice plays out from the micro to the macro level every single day in every single human interaction. I have hope that this election will teach us by opening up our eyes to our flaws and bringing people together to fight for love.

 
But words are nothing, especially these words which are only echos in the deafening chorus of pain and sadness. There are real people who are in fear and pain because of the results on Tuesday night. There is a generation of women, girls, immigrants, people of color, LGBTQ citizens, and muslims who all may feel unwelcome and less than. There are women, children, and men who will suffer because of the actions Trump has threatened and behaviors that he has legitimized. There are people suffering already today because of fear and hate that existed long before Trump entered the stage.

 
Therefore it is up to every one of us to make use of our own blink in time to fight for love and make the world a better place. I don’t need to lay out an argument for this philosophy because I know that it is embedded in our DNA. From the pro Trump diabetic overjoyed by the success of his CABG, to the six foot tall and devilishly flirtatious 87 year old Lady in Blue, each patient I meet has a goodness in them.

 

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So sitting in the sun and drinking coffee on a cold morning in the BWCA, I thought about how I needed to buy better cookware as well as how I personally will move forward without losing faith in the humanity of those around me. I guess it’s my own weaknesses that comfort me, because I know if I can be better then we all can be better. Although I voted for Hillary Clinton and not Donald Trump, I know that there are days in which I lose my own battles to fear and anger, as do we all.

 
I can count on one hand the moments and people which/who make me want to be a better man. It’s why I keep feeling drawn to them no matter how destructive they might be. I vow to keep coming back to this election to remind myself to use my time on this earth to stand up and fight for the wellbeing of all people no matter what their gender, color, culture, sexuality, or religious creed. I will work towards being brave enough to make the inevitable sacrifices that come with fighting injustice. And I won’t lose hope.

 

 

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