Saturday afternoon

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When I left the hospital today, black storm clouds framed the Minneapolis skyline, perfect running weather. Early this week when I went running with similarly threatening skies, the rumbling thunder gave way to sheets of rain and marble sized hail. It made for an exhilarating return trip and a meditation on the  power of nature. Today the weather held, so instead of meditating on life and death, I thought back on an incident that happened one week before.

Last Saturday afternoon was gorgeous, I hit the jackpot and got an early admit, so I was walking out of the hospital at 3 pm, at least 2 hours before I expected to. I snapped my pannier to my bike, rolled up my scrubs, and kicked off downhill towards the hospital entrance. As my bike lazily rolled towards the street, I heard yelling on my left and turned my head to see what was going on. Four security guards were standing around a young black woman who was crying and staggering towards the street, catching herself intermittently on the brick wall of the hospital or the concrete pillars holding up the parking garage. She was wearing shorts, a grey t-shirt, and hospital socks. She had spittle running down her shirt and foam in her mouth. She looked unwell.

So I turned my handlebars and pedaled up towards the scene, leaning my bike up against the hospital wall and slipping on on my t-shirt shirt as I walked towards security. The girl was now sitting on the ground with her back to a post, crying and banging her head against the concrete. I could hear one of the guards angrily telling her that she needed to leave the premises as the others stood next to him and watched. As I approached he turned to me and aggressively told me that I needed to “walk away.”

Now I’m a white man in scrubs, and I shamelessly used that social capital, ignoring his command, and continued to walk toward them. I said that I was a student doctor who worked at the hospital, and asked what was going on. One of the other guards quickly stepped between us and told me that the girl was admitted for a seizure disorder, but that her ED workup was negative. He said she tried to leave the hospital on her own, and was eventually discharged AMA (against medical advice). He then handed me a plastic bag full of her medications, grateful for the chance to be relieved of responsibility. I took the bag and sat down on the sidewalk in front of the girl as the four guards walked away.

The girl didn’t like me. She didn’t like the fact that I was sitting with her. She didn’t like the fact that I put my hand between her skull and the concrete. She didn’t want to be in the hospital. She didn’t want me to call a cab to take her home. She didn’t know why her boyfriend wasn’t there. Every few minutes she stood up and staggered a couple feet only to sink back to the ground, sometimes spilling onto her back, shaking and spitting, her eyes rolling to the back of her head. These spells only lasted a few seconds, during which I tried to keep her from biting her tongue. She would then sit back up and start crying again, unable to articulate much beyond her emotions.

After 20 minutes or so of cyclical conversation and behavior, I was only able to elicit her name, her age, that she was close to her family but that they were on a camping trip, and that she just graduated from high school. When I started to feel like I wanted to pull out my own hair, I knew I had to check myself, so I sat back on my heels as she cried in front of me and ran through what I knew:

The patient was harming herself
She was vulnerable (18 year old girl, alone, no wallet, shoes, ID or phone)
She was either having seizures or some sort of conversation disorder
She was not behaving like a competent adult
She has family she’s close to
I did not have the skills, words, or knowledge base to resolve the situation on my own

She had stopped banging her head, and she didn’t look like she was going to be moving anywhere quickly, so I walked into the ED and asked the admitting nurse what was going on. She told me the same story I heard from the security guard, and when I said that I thought the girl was unsafe and should be readmitted, she asked me if I’d like to talk to the ER Doctor. I said yes, and he came out a few moments later with an irritated look on his face. When he asked me what I wanted, I told him that I was a medical student working at the hospital and that I became concerned when I saw the recently discharged patient outside the ED. As I began to tell him what I saw, he interrupted me.

He told me I had “no idea” about the patient or her history, and that what I was seeing was nothing more than an attention-seeking behavior problem. Stifling my reaction to the heavily race-coded phrase “behavioral problem,” I replied that I agreed with him that I didn’t know anything about the patient’s history and that he likely had a much better idea of the patient than I did. That being said, I followed, there’s a girl outside with no ID, no phone, no shoes, foaming at the mouth and harming herself by banging her head against the wall. “Stay away from her and get out of my face,” he snarled and walked back into the ED.

I think I might have stood for 10 seconds in disbelief with my hands pressed down against the admission desk. As I turned to leave, another bearded young white man, either a scribe or nursing assistant, I couldn’t tell by his scrubs, turned to me and said “we see these people all the time.” I let my frustration get ahold of me as I angrily asked what he meant by that and whether she would have been treated the same if she were white. His eyes immediately widened as he said “You can’t say that. You shouldn’t be saying that,” but I was already walking toward the door, trying to figure out where to go from there.

The girl was still sitting on the ground with her back against the wall. I squatted down in front of her trying to collect my thoughts when two other nurses, both men, came outside beside me. One of them sat down beside her and restrained her from banging her head against the wall, which she had started doing again as they walked up. The other had a wheelchair and spun it around so that it was in front of the girl. I asked them if they would take her back inside, and the one holding onto her head nodded. He said that was why they came outside, and that he thought she wasn’t safe and needed to be re-admitted. She initially struggled when they tried to get her up, but seemed to collapse into the chair once she was in it. As they wheeled her into the ED, I walked back inside to talk to the senior resident on call. The resident was going over notes with another medical student in the lounge when I walked in. I quickly explained what had happened, including what I thought went wrong.

I understand that dealing with patients who are that difficult must be frustrating, because they are the people who require the most complicated physical, mental, and emotional care.  I am also aware that I knew less about the patient’s story than the ER Doctor did, and I can imagine how frustrating it is to deal with a complicated patient and then have a 3rd year medical student question your decisions.

However, what I saw was a  scared, sick, 18 year old girl 2 months out of graduating from high school. She was harming herself, unable to articulate her needs, and extremely vulnerable. There are always options if we take the time to figure them out, even though this kind of problem solving isn’t as sexy as diagnosing something rare like Pheochromocytoma. We could contact social work and psychiatry, bringing them in to to lay eyes on the patient and lend a different perspective. We could send an aid or sitter outside with the patient to make sure she didn’t hurt herself. We could place the patient on a hold in order to do a further workup and contact her family. Or at the very least we could tell security that it is their job to make sure the patient stays safe and has a ride home.

I also know that there’s a good chance that the ED team went over all of those options and maybe more. However, I refuse to believe that with all of the options and brain power available, that there was nothing more that we could have done. Maybe I’m naive but I still think hospitals should strive to be a place of healing and caring for the whole person, not just their lab numbers. And I know I’m still learning, but from what I can tell, the line between mental health and behavioral decision-making is a fine one and probably not a line at all.

I spent a lot of time reflecting on this incident, and am still not sure whether or not writing about it is a good thing, because it’s hard not to make the story about ‘me,’ when the story really should be from the perspective of those who suffer the most. Because I’m so lucky, I biked home, went swimming, got drinks and dinner on a patio, woke up to a feast of a breakfast made for me because I had a long day, just in time to drive over so we could watch my mom win her age group in yet another triathlon.

I knew I wanted to write though, because I spent the following afternoon eating good food by the creek in my family’s backyard, holding my cousins new babies, and playing with their toddlers.  This afternoon reminded me that my generation has an obligation to fight to make their world into a better one.  I want them, as well as my future children, to grow up in a society that does all it can to hold up those in need. And I guess the first step for me is rattling the cage when I have the opportunity to, and taking on the responsibility of my profession by working to contextualize and humanize every person I work with,  striving to serve my community, and staying hungry for change.

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Judgement

On Friday afternoon my 94 year old patient I’ll call “Betty” kissed me on the cheek as I said goodbye to her for the day. She winked at me as I left the room, her elvish eyebrows arching high on her wrinkled forehead. We had just finished a care conference in which she had elected to discontinue BiPAP and supplemental oxygen. This meant that in a few hours her oxygen saturation would begin to fall as carbon dioxide built up in her blood. When I quietly stepped into her room early the next morning she was already unconscious and unresponsive, facing the ceiling with her eyes closed and her mouth frozen open in a small “o”. After checking her pulse I slipped out of the room, only to immediately turn back around and sit on her bed for another minute or so to hold her hand. It’s cliche as hell, but I had to tell her how much she meant to me and let her know that she wasn’t alone. Her mind had already turned internally, but I needed that moment for me. Thirty minutes later I was sitting in the residents lounge writing up my notes for the morning, and I got a page telling me that Betty had died.

I had spent the past two weeks following Betty and getting to know her. From her admission, when I found her unconscious and struggling to breathe, my first real doctor moment as a med student, to checking in on her on the floor and eventually the ICU, where she would wake up with a smile that lit up the room. It was easy to love someone like her. I didn’t stand a chance in the face of her razor sharp mind, radiant smile, and squeaky voice that piped up from the bed to ask me how I was doing every morning before I got a chance to ask her how she was doing. What I didn’t anticipate however, was how difficult it would be to stay objective and medical with her at the end. As a medical student, my responsibilities consist mostly of knowing my patients, figuring out what’s going on, checking up on them, and offering suggestions or ideas. Being a part of a conference in which someone who is one 100% cogent and deciding whether or not she wants to continue a treatment that, if withdrawn, will ensure her death in the next day or so, isn’t something I’m used to. Struggling to keep back tears as I kissed her goodbye, I felt a faint whisper of the power and importance of this kind of decision making. Talking about death is possibly one of the most important human moments we can have, especially in an era in which we can prolong life longer than ever before.

No matter how advanced medical technology has evolved, we still don’t understand what it is to live and die. It’s the ultimate fear of the unknown, and this fear can easily tempt us into simplistic and reductionist thinking. What happens when we die, what does it mean to pass time on this earth, what’s important, do we have free will, can we really live in the moment, what does it mean to lose your mind, how much responsibility can we shoulder, how much responsibility can we assign to someone else? We reflexively pass judgements daily based on our own unconscious answers to these questions, often without stopping to reflect on them.

Two weeks ago I was on an early morning on-call team that rushed up to the ICU to admit a patient, an elderly native woman who presented to the hospital for septic shock due to suspected pneumonia. Her blood pressure was tanking, she had a fever, and she was drifting in and out of consciousness. Her chart indicated that she was an uncontrolled type II diabetic with a history of alcohol abuse who was living in an assisted care facility. Looking down at this sick woman who had sky high blood sugars and bacteria coursing through her veins, I couldn’t shake the feeling that she had been poisoned. She had been poisoned by a capitalist colonial system that eviscerated her culture, impoverished her, and then enticed her with liquor and cheap fake food. That’s how I saw it through my unexamined lens. Then as we were walking to round on our other patients, one of the residents coolly commented that I was just witness to what happens when people don’t give a shit about their health. That’s how he saw it through his unexamined lens.

These moments happen every day. Today a diabetic Somali man on dialysis who was taken off the renal transplant list because he ran off to Mcdonalds while NPO (nothing per oral) for a scheduled procedure, or last week a 60 year old anorexic smoker with a history of alcoholism who refused to have her labs drawn. Judgement is quick, easy, and laid down with force behind closed doors. And I get it, I get how frustrating it must be to devote your life to prolonging the lives of others only to watch in disbelief as they seemingly throw theirs away. The thing is though, we have no fucking idea. We have no idea what it is to walk in their shoes, to live in their skin, and to wake up every day in their sick and increasingly obese bodies. I think we’re frustrated in part because we’re frightened of our own mortality, and it’s easier to assign blame and get angry than face the reality that our control is a facade.

This past Memorial Day weekend was perfect, 60s-70s and not a cloud in the sky Saturday through Monday. I had just taken my boards on Friday, so Saturday morning I decided to go out for a run, and I just kept running. By the time I got home I had run 12 miles, probably around 4 miles longer than I had run in over a year. I felt fantastic and that night I slept on marshmallows. So Sunday I did it again, and like a drug seeker I wanted more. Sixteen miles later I stumbled onto my front porch, but this time it was all I could do to keep my eyes open for the rest of the day. The next morning I discovered a sore knee that ended up taking 8 weeks to right itself. In the intervening months, I’ve kept running hard, rolling cigarettes, drinking whiskey on my porch, staying up late, and waking up bleary eyed to spend 12 hour days at the hospital. Self-destructive behavior takes all shapes and sizes, but it paints different pictures on different bodies.

My sore knee, chronic exhaustion, and the scar on my leg from taking a motorcycle down to avoid being broadsided are all symptoms of my own discomfort with mortality, and my own ways of dealing with it. Hopefully however, reflecting on the reality of death and learning from people like Betty, will allow me to better empathize with the decisions of others. I’m also hoping, as icing on the cake, it will allow me to continue to wrest every moment from this beautiful existence without destroying myself in the process. That’s why I love Minnesota; this state forces us to be alive. Give me the bike rides to work in dress pants and no shirt because of the impossibly hot and humid summers. Give me the contemplative fall where air is crisp and the leaves paint the city and country both with brilliant hues, only to lose those hues to a gray and impending cold. And give me the cold north winter where the black night burns your lungs and deafens your ears with its silence.

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The Myth of The Persecuted White Man

I am not a white man. I am a man who believes himself to be white, and there are many people who believe it as well. I stole this language from Ta-Nehisi Coates, a writer far more articulate than me, but the idea has been tumbling around in my head for a while now. I am not rejecting my white male privilege, my white male experience, nor the experience of others who’ve benefitted or suffered from this malignant idea that is race. I am however rejecting its intrinsic reality because it dehumanizes our species.

I was seven maybe eight years old when I stood with my mom at the edge of human horror, the Guatemala City dump. Tin and cardboard houses rimmed the edge of a steaming garbage pit. Packs of dogs, spiraling vultures, and starving people all fought each other for the shit that others had thrown away. I remember wondering why my mom didn’t want me to touch the ground with my bare hands when I saw kids my own age living on that ground. Her expression told me she didn’t have a good answer. Why are we born to whom we’re born isn’t a question that has an answer, it’s purely random. We do nothing to deserve the privilege that our parent’s wealth, our statehood, or our genes happen to give us; that was my first lesson. My second lesson was simpler: just because I don’t see something happening in front of me doesn’t mean that it’s not happening somewhere. And as long as my lungs draw breath, my humanity is intrinsically tied to the humanity of those on whose backs my privilege rests.

We white men can’t help but be on the spectrum of narcissistic personality disorder. It’s hard not to feel in your bones that the privilege and power that comes with your every step isn’t god-given. When confronted with the painful reality that the world might not exist simply to serve our desires, we lash out. Poor uneducated white men who make up the vast majority of the voting block supporting the racist, misogynist, and xenophobic policies of Donald Trump are not intrinsically bad people. However, they are more viscerally confronted with the reality of their ordinariness than men of the educated and wealthy intelligentsia. Furthermore, they often lack an emotional and social toolbox to deal with this new reality. This impotent male rage played out in horrifying fashion recently in Cologne, Germany where immigrant men gathered in mass and sexually assaulted groups of women. These men are scum deserving prosecution to the fullest extent of the law, but they are also symptomatic of something more universal. They’re men who have held power over women their whole lives due to global misogyny, and suddenly they’re thrust out of their positions of power and forced to assume the role of refugees. When confronted by this new reality, they lash out like animals.

Men who believe themselves to be white in America are suffering another delusion about our whiteness: the myth that we are being persecuted. Talk radio, tv, country music, and political rhetoric all tell the same story: that traditional values are under assault, freedoms are being taken away, family values are disappearing, and that there is a culture of political correctness. This reaction shouldn’t be a surprise to anyone; white men have been running rampant over the world since time immemorial and just as society has evolved to legitimately push back against this injustice, there comes a man in Donald Trump who harnesses the impotent rage that has been building among those who are losing their power.

Fighting against oppression in language and structure isn’t political correctness or repression, it’s an acknowledgement of injustice and an important step to bettering the human race. There hasn’t been a legitimate debate in American politics since I’ve been alive, but up until now, through vague racism, half-truths, and remarkable leveraging of religious beliefs, the Republican party has been able to pass themselves off as more than greedy xenophobic evangelists manipulating uneducated whites to vote against their own interests. Today however, Donald Trump has wiped off the spit shine that has covered the pile of shit that is Republican politics. In one way, the anti-immigrant, anti-muslim, anti-women rhetoric spewing out of the republican primaries has led to possibly one of the most honest conversations our country has ever had.

When our country was founded, slavery was the law of the land. Then on May 9th 1865 the confederacy lost the civil war. Soon thereafter, Jim Crow laws were enacted and lasted one hundred years until 1965. Since the civil rights movement in the sixties, we’ve continued to have disparities in justice, incarceration, education, and housing policy, not to mention the vast inequalities and discrimination in regards to gender, sexuality, and religion. America was never “great,” but it’s always had the potential to be the very best. We have the potential to be great not because of some bullshit idea of American exceptionalism, but due to the fact that although our country was founded on slavery and the genocide of Native Americans, we are also a nation of immigrants who were given one of the most brilliant constitutions and forms of government the world had ever seen.

That brilliant government however, will only work if it’s held up by an educated and healthy populace that’s free from discrimination on the basis of gender, race sexuality, and religion. Lofty thoughts from from an armchair philosopher though, because on an individual level I’m not sure where to go from here. Starting tomorrow I’ll be working 12 hour days 5 days/week with a 24 hour shift on Saturday, work being an easy excuse to slide into the power and wealth that can seem natural and god-given to men like me. I’m under no illusion that I’m anything but fortunate however, because I’m finally out of the classroom and training in possibly the most interesting job in the world. However, it means that if I’m not intentional about staying engaged in the world around me, I’m going to find myself gliding along on that moving sidewalk without a thought to breaking it. Fortunately though, I have incredible examples in both my brother and mom who work for social justice with self-reflection and passion that feed off the energy their work creates. Furthermore, I have a father who reminds me through examples and words how important it is to carry myself with integrity and treat those around me with respect.

I’m writing today at the very real risk of mansplaining, so I can begin to formulate this conversation, a conversation I want to keep having as long as I can and as long as it’s necessary. I’m writing in honor of the people around me to whom this conversation and these values come without thinking.

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I had to put this in here because she somehow stays ageless while I can’t even zip my fly consistently.

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American Healthcare

 

 

As a medical student at The University of Minnesota I’m learning that patient’s stories are not only a privilege to hear, but probably my best guide for being a good physician. I’m also learning that that these stories have as much to do with our broken healthcare system as the physical ailments themselves. I believe in my country, but I believe we can do better and that we as a nation must ask ourselves if this is the world we want to live in.

This past summer, while volunteering at a free clinic run by medical students from the University of Minnesota, I was walking a young mother through the process of applying for health insurance for her 4 year-old daughter. She is a child and citizen of the richest country in the world, yet she is not automatically enrolled in healthcare. Mother and daughter had to wait in a dank church basement, at night for over two hours, in order to have a first year medical student listen to her cough. This past year I often found myself providing first-line healthcare to men, women, and children without health insurance. This is an opportunity for me to practice clinical skills, and learn about both medicine and healthcare policy. This opportunity for privileged students like me to provide subpar care as a stopgap measure for our nation’s most vulnerable people is not only problematic, but shameful.

The facts regarding healthcare management are unambiguous, it would be cheaper and more effective to have single payer healthcare: a universal healthcare system in which every American would pay into a single government-run plan. Single payer universal healthcare is the American thing to do.

Single payer health care is the American thing to do because it frees employers from being mandated to pay for their employee’s health insurance and allows them to invest that money back into their businesses. It’s American because it insures that every man, woman, and child in the United States doesn’t have to worry about delaying care, being bankrupted by healthcare costs, and losing health insurance if they lose their jobs. The US spends twice as much per capita on healthcare as the average developed nation that provides universal coverage, and we rank dead last out of the top 19 highest income countries in preventing deaths amenable to healthcare (Nolte et al, 2008) (Woolhandler, 2002).

This summer I also interned at a rural hospital in northern Wisconsin where many patients had chronic diseases that couldn’t be fixed by a single procedure or pill, but required long-term health maintenance. One patient was a 67-year-old woman with uncontrolled diabetes. Before becoming eligible for medicare, she hadn’t seen a doctor for her diabetes because she couldn’t afford to buy good, low-deductible low-copay insurance. She is one more American paying the physical costs of our broken system, as our nations economic costs are rising as she begins to receive care to deal with her worsening chronic illness.

Single payer healthcare is American because it reduces unnecessary costs. The overhead of Medicare is around 2%, compared to an average of 13% for private insurance (Sullivan, 2013). The US would save an estimated 380 billion dollars anually if we instituted as single payer system (Woolhandler, 2011) (Lewin Analysis, 2012). Medicare is our grossly overburdened and inefficient government system that doesn’t have the benefit of young, rich, healthy patients, yet it is far more efficient than the private healthcare system. Single payer healthcare removes the middleman from between the consumer (the patients) and the providers (healthcare professionals). The middleman—the insurance industry—produces nothing, skims revenue off of this transaction, and disrupts the flow of the market. Furthermore, this middleman is currently telling the consumer what they can and cannot buy, as well as telling the provider what they can and cannot sell.

While at this hospital in rural Wisconsin, I also shadowed an internal medicine physician at the Bad River Indian Reservation. One of our patients came in with 3rd degree burns covering his hands that were so severe he couldn’t hold a cup of coffee. He had delayed coming into the clinic due to fears of high costs, and refused to seek further treatment at the burn clinic—after the doctor suggested it—due to high copays. He had insurance, but he was underinsured and suffering from it.

Most of all, single payer healthcare is the American solution because we live in a land of opportunity with the rights to Life, Liberty, and the Pursuit of Happiness guaranteed to us in our Declaration of Independence. Neither life, liberty, nor the pursuit of happiness is possible when we don’t have access to healthcare without the fear of being bankrupted and billed into poverty and ruin.

We are a nation that rewards innovators and fighters, those who strive to be the best that they can be. But how many young men and women are stopped from achieving their potential and bettering their country due to barriers to healthcare affecting themselves and their families? America can easily create the best healthcare system in the world because we already have what it takes. We have the top healthcare centers in the world—many of them here in Minnesota—and we already spend the money that would allow us fantastic coverage and care without the wait lines. What we don’t have however, are enough people in power that are courageous enough to fight for those who don’t have a voice and who suffer under our current system. We need to come together as a society to make this kind of change, because it’s the American—and the right—thing to do.

 

 

  1. Nolte E, Ph.D., and McKee CM, M.D., “Measuring the Health of Nations: Updating an Earlier Analysis,” Health Affairs, January/February 2008.
  1. Woolhandler S, M.D., et al. “Paying for National Health Insurance – And Not Getting It,” Health Affairs 21(4); July/August 2002.
  1. Sullivan K, J.D., “How to Think Clearly about Medicare Administrative Costs: Data Sources and Measurement,” Journal of Health Politics, Policy and Law, Feb.15, 2013.
  1. Woolhandler S. “Cutting Health Costs by Reducing the Bureaucracy,” New York Times, Nov. 20, 2011.
  1. Lewin 2012 Analysis: Beyond the Affordable Care Act: An analyis of a Unified System of Health Care for all Minnesota , Growth and Jestice http://www.growthandjustice.org/publications/P10
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It’s good to write again

I’m sitting across from an old man at the Seward Coop. It’s gray and cold outside and the old man is wearing my watch and a sweater that looks like one in my dresser. I can’t type well because my finger is still healing but if I go slow it’s not so bad. Obliterating my finger was a gift, pain medicine and stasis all at the cost of a fourth digit. Cheap lesson in empathy and I found I’m well suited to doing nothing. Running today was drinking with a friend I enjoy but don’t need anymore.

I ran and I started by breathing but when the breath got long and my mind wandered I moved to feeling and when that was more than I wanted to do I began to listen which lasted until I smelled the decaying river so I stayed in my nose and memories until I hit the bridge where I opened my eyes.

This running sensory deprivation test is borderline bourgoise on a Thursday at noon, but it served its purpose. My mind was quiet and I what I experienced was beautiful. It felt like sliding through an old memory. I wonder if that’s what art is, just existing in a -sense- for a moment. Birds cars and the wind blowing a leaf across the sidewalk becomes an orchestra, and the salt line running down the asphalt is a painting that only I am looking at. Dog shit still smells like dog shit, but reading and writing is like painting my thoughts.

I degloved and broke my finger off two days after skiing the City of Lakes Loppet and two weeks before I was going to ski the Birkibeiner. I started the race well and was skiing easy in the top pack of five until my body broke down. No exogenous source or reason, I simply hadn’t trained enough. I looked at the 35 kilometers ahead of me and I thought about giving up. I kept skiing because I wanted the lesson.

I’m still processing the lesson and I’m ready to drink so I was going to tie this off with a quip about Donald Trump, man buns and our worst selves. But he doesn’t deserve a quip and neither do man buns. He is the embodiment of the worst in every one of us and therefore shouldn’t be mocked dismissed or endorsed. He needs to be observed cauterized and pathologized so that we can become a better nation and a better people. I just passed my finals though so I’m taking the day off from training to be a doctor. Instead I’ll drink and stew and create a differential tomorrow.

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3rd Week of October

Last Friday night, I stumbled into my apartment sweaty, tired, and mostly sober from the bus ride home from a downtown bar. Actually it was an old American Legion that moonlights as a music venue. It was the first time I’ve ever had my name on a list to get in anywhere, so it didn’t matter that it was an American Legion. My roommate Christyn and I picked a bad night to go out, the bus to the bar was hot, packed, and filled with men going to drink and see Mexico play Panama. The return trip was stuffed with the same guys coming home, sweatier, stinkier, and more boozed.  Christyn stood against the window while I braced myself in front of her with both hands pressed against the wall. It wasn’t fun but there was a little breeze from the window and my mouth was still smoky from the house mescal.

Running the next morning I felt like I was breathing fire. I ran early because we were supposed to be picked up at ten to go to our boss’s mandatory all-day birthday party. I struggled running through the wooded trails and glared at running groups who thundered past me smelling fresh and liquor-free. I took a shower when I got home and shoved eggs down my throat ignorant that Mexican time meant I had three more hours of free time ahead of me. I started into Notes from Underground and just when I was getting into it I got a text that our ride was outside.

We left around one and wound our way to the family mansion/farm a couple hours away. It was a hot day with scattered rain that turned the backyard into a jungle, and I made good on my promise to Christyn to sweat and eat until they took the food away. After the food was inevitably taken from me, I helped bring chairs up to the porch where the remaining guests reconvened and ate more dessert washed down with steaming hot coffee.  It was a good day and the car ride home left me with a lot of time to think.

I’ve noticed lately how people congregate and talk to people of similar social standing, class, education etc, and that for the same reasons some people’s words and conversation are given more or less weight than others. To be more specific, it seems like people are always trying to talk up, forgetting that up is an illusion that we create. This mentality shouldn’t bind us, and if the technological revolution had any potential for positive change, it should have blown apart this smokescreen. Instead we continue to erode our relationships and humanity through iphones instagram facebook and twitter while maintaining the social stratifications this technology should bring crashing down. We obviously want to talk to other people that stimulate us, but to assume that prestige, education, wealth, or culture could limit the infinite complexity of a human being is absurd.  This isn’t just a feel-good abstraction on life, it’s insane and limiting to deny the complexity and interest of another human being.

I thought hard on judgment again as I swam through a thick poisonous smog for my Tuesday afternoon run. After dodging in and out of traffic for the fifteen minutes it takes to get to the park, I snaked around the track and ran straight up the backside of the mountain. It’s on a path that I’ve been beating myself up on the past few weeks. The trail is a steep dirt incline for about four minutes, then it turns left and keeps climbing on an even steeper incline for 2 more minutes, then it reaches a ridge and turns to the right to continue up an even steeper and rockier incline for the final push, another minute and a half. It doesn’t matter how slow I go, I shred my lungs just going up without stopping.

As I was making the final ascent I ran past an enormously overweight older man who was walking slowly up the hill. I didn’t think much about it and kept running out into the forest, winding my way in and out of the woods until my stomach told me it was time to turn around. I looped back through the trails but found myself running down the same steep dirt path I came up on and past the same old man who I ran past on my way up. I saw that he was walking laps of one of the steepest trails I’d ever run on. Not only was I impressed by his training technique, which is probably the most effective way of man of his build could get a cardio workout, but I was reminded of the madness that it takes to judge one another, which I most certainly did as I ran up the hill for the first time.

I was eating a cheese sandwich and grapes on the top of a small pyramid in the middle of a park near my apartment a few nights ago, and when I looked out over the city I saw smog in the distance rolling into the mountains like low hanging clouds. When I looked in front of me, the air seemed crystal clear. It reminded me how easy it is to forget that I live in a fishbowl of my own experience. The fundamental beauty of living in a foreign land is in this opportunity to climb outside my fishbowl and look back in at the world.

Sometimes though, the world pulls you back in, like the other day when I noticed a boy playing hide and seek with me while I was working out.  He was good so for a while I didn’t notice we were playing. I think I was doing some stupid looking jumping thing I recently invented when I saw a shadow fall behind a tree. After 10 or 15 minutes, I caught him sneaking around the tree and grinned when he saw me; he smiled back and I thought that was it. As it turns out, Jose Martin had more social grace than me, so he walked up  and introduced himself while I was panting with my hands on my knees. We went through the normal pleasantries of exchanging names, birthdays, and birthplaces, and then both went back to working out. He made a fast friend when he commented on how tall I was, that I could reach the pull up bar without jumping, I told him I get that all the time. He even had the decency to pretend not to see when I stepped in dog poop.

If I want to live my life with my eyes open, I will often have to dig deep and forgive myself my own humanity and if I can forgive my own shortcomings while being privy to every reason I could possibly have for my own actions, how is it that I find myself so easily judging the behavior of others? Barring actions which humanity has for centuries held as violations of what it means to be a person, withholding judgment as much as possible seems to be much more rational. Unlike the sharp pain that I get in my lower back signaling dehydration when I’ve been running for more than a few hours without any water, the evolutionary advantage conveyed by judgment of others is twisted by our migration from caves to the 21st century.  Making time to be with people gives me more than anything else in the world and judgment impedes this. I got choked up today saying goodbye to Rosa and Raquel, two of the women who work at my boss’s house/the office. They gave me hugs and promises that they’ll save me homemade Dia de Los Muertos mole for when I come back. Those to women are not only my two best friends in Mexico, but they keep me healthy by sneaking me food when I come into the kitchen to heat up my cheese sandwiches.

After work I jogged back down to the dilapidated park where I do push ups and pull ups, set my watch and keys down, and commenced my meditation on pain. I was shortly joined by two tatted-up guys my age who sat down a few feet from where I was working out and immediately started doing drugs. My whole reduced judgment philosophy fell into flux as I noticed that they were literally just doing drugs and staring at me. After a few more minutes of awkwardness I walked up to them, said hey, and continued my workout. They seemed chill enough, so besides making sure they were never at my back, I continued like I would have. However, as I jogged back home I thought about how judgment was one of the most confused remnants of my caveman brain. I’m trying to deal with this confusion by separating judgment from the necessary and important act of observation. That being said, living in Mexico City constantly reminds me of the staggering advance of civilization, and living in my brain constantly reminds me of the monumental sluggishness of human evolution.

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Subway Brutality and Supermarket Friendship

I spent another weekend walking the city; something in the air makes me do it. I forgot how stimulating it is to explore someplace alone and quietly, to be completely lost, to stop and rest when I’m tired, and to eat when I’m hungry. It reminds me of when I did nothing but explore new places while backpacking alone through Venezuela and Colombia. I made friends asking for directions, uncomfortably posing for pictures with a group of high school girls, and with the waiter who brought me a cappuccino on restaurant porch overlooking a lake while the sun was setting. I took the subway downtown around noon on Sunday and walked to Parque Chapultapec. The park was filled with crowds of people, tall trees, lakes, paddleboats, and food tents. I walked up a curving road to the Castillo, a relic of an older time sitting in the center of the madness. The castle is now a National History museum, and unfortunately I got there forty minutes before it closed. After I spent a half an hour awed by murals, I stepped outside and leaned against the castle’s stone balcony looking out over the sprawling city. The storm clouds were high and threatening over the green sky, and the dark mountains seemed to hold the metropolis at bay.

My heart pounded as I stared at the harsh beauty of the immense city. It’s hard not to feel something while looking at the enormity, greatness, and folly of human civilization. In moments like this I feel like there is a thread of meaning connecting human experiences. It’s hard for me to shake this feeling because I want to believe that there is an enduring place for us in existence, a place in the beyond. After listening to This American Life last night, I wonder if this feeling is just a manifestation of the delusions of grandeur (Cue Rick Cousins on Collin Cousins). However, the concept that we classify anything as a disorder is problematic for me, especially in regards to someone else’s consciousness. As scientists burrow down the rabbit hole of discovering the biology of our brains, I find myself more and more confused about basic human concepts like holding people responsible for their actions and how we can change our own behaviors. If behavior is genetics and biology, and the desire to change behavior is also genetics and biology, then how have humans developed the cognitive dissonance associated with self-improvement. Maybe this is where we are unique from other animals, the blessing and curse of humanity in our ability to desire to change ourselves. Or maybe I just need to change how I’m looking at this whole idea, because possibly due to the impossibility of changing ourselves, what we actually want to change is our actions, leaving dissonance tied only to the feeling of regret.

Riding the subway home on Sunday night, I was leaning up against the track-facing door when a shirtless young man holding a bundle of cloth came into the car. He was skinny, covered in acne, and had bloodshot eyes. At first I thought he was just awkwardly trying to sell something or beg for money, but then he spread out the rag on the floor and I noticed it was filled with broken glass. He laid down on the floor, crunched his torso up, and slammed his back onto the glass, again and again. A boy sitting next to this brutality covered his little sister’s eyes, and most of the car turned to look away. The young man sat up, rolled up the glass, and walked the length of the car holding his hand out for money with pieces of glass still stuck to his back. Leaning up against the subway car in a clean white t-shirt with the whole world in front of me, I wondered where the meaning was in this kind of life. It’s moments like this, or when I see physically wrecked older people begging for money in the streets, that I cannot see or believe in a rhyme or reason.

Every two or three days when I pick up something at the grocery store near my apartment, I stop to talk to a man who sits outside next to the cubbies where people store backpacks and purses. He has some sort of disability that confines him to a wheelchair and appears to twist his body into tight knots. I give him money, set down my bags, and listen to him talk.  From what I can tell, he always begins by talking about his life and his philosophy. I often have trouble understanding the voice coming out from under his thick uneven mustache. I’m not sure he remembers who I am because ever day he looks at me with his bright dark eyes shining out from under his cowboy hat and asks me “So blondie, how long have you been in Mexico? Do you live close by blondie? Do you have time to see some tricks?” I say yes, and he reaches under the little blue towel that sits on his lap and pulls out a wooden paddle with a lamination on one side only. He shows me how he can spin it with his twisted fingers and his eyes closed and tell me which side is up.  Other times it’s magic tricks with strings or cloth. I used to try to talk to him, but now I just say ‘hi’ and listen because he talks for both of us. It’s the best part of my day, he speaks with joy and hope.

By no means am I trying to say that most people who seem like they’re suffering are always filled with hope and happiness. On the contrary, I imagine that most of the time people’s lives appear hellish, it is because they are hellish and because their bodies will only continue to fail them as they become poorer and more and more relegated to the shadows, there lives will get worse until the day they die. This idea rips the floor from under my feet, which I understand is a pale shadow of nothing compared to the the actual reality. It also makes me want to live and fight to better the lives of those around me until I’m gone or need care myself. This shouldn’t be the natural state of humans; if our intellectual evolution has done anything it should give us the empathy and respect to care for our brothers. If there is nothing more than this moment, then what can be more precious than to love people and care for them? I’m not a religious man, but seeing the hell that people go through on earth, I can see why people turn to God in hope of justice beyond this life.

Every day or so, I find myself closing my eyes and replaying one of two incidents, it’s one of those thought patterns that’s both self-directed and automatic, a delicate blend of the two. Sometimes I’m back in Silao, doing pullups in a park at 8 am. I hear something and look toward the bushes about a hundred yards away. I see her run out and get pushed to the ground. By the time I get to her, he’s already run away, the same asshole that looked me in the eyes while I was running. When his long blade flashed in the air, I stopped to grab a rock and I am still haunted by these seconds. Time doesn’t slow down like it does in the movies, in fact I don’t remember having any time to think, only to react. But I am haunted by the knowledge that those seconds could have meant her eternity. Luckily I didn’t have to call a hospital, only hold her and say it was going to be ok.

Other times when I close my eyes, I’m swimming as hard as I can away from the canoe and against the current, my head above the water as I pull it like I’m trying to tear it apart. Suddenly I see my mom’s head break the surface and I start bellowing at her. Later I swim to get the canoe before it crashes down the next set of rapids. It isn’t until I’m laying in the tent that night that water runs down my cheeks and in that moment I feel grateful for such my strong mother and the opportunity spend the rest of my life balancing the scales. I’ve come closer to death more times than I would like, but I never think about it much until afterwards. However, as my own mortality begins to flesh out, both life and death feel more significant to me. On one hand, I don’t want to be cavalier with the incredible and precious life I’ve been given, but on the other hand, I believe life is precious because of how I live it and who I am, and that having too tight a grip on my own existence could alter the man I want to be. Living in fear might not be a life worth living, and I’m believing more and more that living for others can be the best way of living for myself.

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