Sunday, June 16, 2019


Of You

Dear love
dear you
my love.
dear my undying unfounded
devoted you,
my you.
I miss you a lot and I am thinking of you
all of the time
I am thinking of you all the time
all the time I am thinking of you
I am thinking as I am thinking of you
all of
the time.
I am thinking
and I am thinking
and thinking
of you
all of the one I am thinking of
I am.
I am thinking
not all of the time
not all of the you
not all
of the you
not all
the time
I am not thinking.  
of you
this time


ACS surgery thread reply

ACS Surgery Discussion Forum regarding recent AMA statement on health care as a human right.  The objectivism trolls had hijacked the thread.  This was my poorly received response:

Dear Dr X(and those of similar vein)-

I must respond to your impassioned excoriation of the idea that healthcare is a "human right" (scare quotes rendered as a show of respect to you) in the name of the dignity of surgeon labor.

Your initial salvo is an interesting mashup/admixture of both the Declaration of Independence (We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness) with the US Constitution (i.e. 5th and 14th Amendments prohibiting deprivation of property without due process).  Your inclusion of "property" (my scare quotes, my turn) is interesting, to say the least. Similar arguments were made in the infamous Lochner vs New York case of 1905 that upheld the "right" of a bakery to violate employment laws that limited the number of hours a baker could work in a week, under the auspices of honoring the sacredness of the contract.  Similar arguments were made, most infamously, and perhaps more familiarly, in the Dred Scott decision of 1857, using the same due process, right to property arguments. Dred Scott was merely the "possession" of John Emerson (an army surgeon, imagine that!) and therefore had no recourse to the noble, high fidelity rhetoric contained within the holy writ of the US constitution.  John C Calhoun made similar arguments during the nullification debates decades earlier.

But let's not spend too much time nosing around in Supreme Court history.  Your argument mounts an army of straw men to fight a battle you will never see.  No one is dragging Dr X out of bed at 7 am to operate all day long on an endless list of self pay patients.  No one is mandating uncompensated labor. This has never happened in your life. And if it has (bad call draw, bad weekend ER luck) then universal healthcare would have made such future events impossible.  Which begs the question: what is it you are going on about again? What is your point? Universal health care would guarantee that you are compensated for every operation you do. Do you just not like the idea of people getting "free care"?  Do you turn away Medicare patients? Did you know that most people on Medicaid work? Your diatribe about free care and uncompensated physician labor only seems applicable to the current status quo, i.e when self pay patients show up with appendicitis.   A world of universal health care would obviate the existential pain you seem to be suffering from regarding the dignity of physician labor. Your gnawing angst about a future world of…...too many patients being covered by insurance seems to be..….at odds with what you originally purport to fear. As someone said earlier in this thread, 50% of healthcare is provided by that horrible, totalitarian "government" you demonize.  Ask recipients of medicare, of VA benefits, of Tricare how they feel about the care they receive. You may receive a higher reimbursement from private insurance but that's only after the population at large has had their paychecks and wallets picked over by marauding bands of parasitical insurance companies and third party administrators.

Yuval Harari has a fascinating new book out called Sapiens, a historical review of our human species.  One of his themes is this idea of there being "imaginary orders" that humans collectively agree upon. Think of all organized religion, the divine mandate of kings, feudalism, master/slave relationships, race hierarchies, and then, post Enlightenment, the idea of individual human rights and government of the people and by the people.  None of these ideas has any basis in empirical or mathematical reality. They are all necessary figments of the human imagination that we have at one time or another collectively internalized as truth. Thus, there is order and structure to our lives at certain points in history. The ideas derive their power not from some transcendent unassailable Truth but simply from the collective societal decision to assent to their tenets.

The point of this little digression is to say that imaginary orders, in general, are somewhat arbitrary and can be altered as time passes and circumstances of human existence change.  Human rights in the era of authoritarian monarchy, nascent democracy, and mercantilist empire were thought to include, at the very least, a guarantee toward life, liberty and the pursuit of happiness.  But that doesn't mean Thomas Jefferson stumbled upon some sort of special theory of relativity of political philosophy. In the context of his time, his writings rang true (and still do for the most part).  But that doesn't mean he had the ability to foresee the eternal unfolding of human history. Further, we do ourselves no favors by limiting our views on human rights to those of an 18th century American slave owner.  I have a more expansionary perspective on what ought to be deemed necessary and proper to all living souls. Human rights is a living, evolutionary concept.

In the context of a  21st century America, an America that is unquestionably the wealthiest, most powerful nation in the history of nation states, a nation that spends more on its military exploits every year than the next 10 countries combined,  where millions of men and women avoid basic health care due to high deductible private plans or go uninsured entirely, where medical bills represent the number one etiology of personal bankruptcy, where life expectancy has fallen vs the rest of the world, where the USA alone among advanced democracies remains the one nation that does not guarantee universal health care, in this particular context, I aver that health care belongs in the pantheon of human rights.

This is my imaginary order.  For what is liberty if you are afraid to take a new job or start a new business for fear of losing your employer based health care plan?  What is the pursuit of happiness without having the right to obtain the medicine and care needed to mitigate illness and pain? What is the right to life without having the ability to afford the necessary measures to amplify, maintain and heal the body in which you reside?

Too much of this thread is dominated by a juvenile Ayn Randian rhetoric that treats the modern world of resources in purely zero sum terms.  As if provision of food necessitates breaking into Dr Leonard's pantry in the middle of the night or armed bandits raiding the neighborhood grocery store.  (How about simply paying the populace----in the era of 3% unemployment--- a living wage so they can afford to buy their own groceries.) As if doctors are remanded by state police and forced to perform procedures on the unworthy, the lazy, unentitled. (How about instead legislating universal care, whether in the form of single payer or one of the hybrid systems used by Germany, France et al) This world of abundance and wealth is both a blessing and a curse.  Our lives are enriched and made comfortable by its spoils but it is also the dark mirror that reflects our basest, most selfish instincts.

I would urge many of you to break out of your cloistered intellectual dead ends.  Put down the Atlas Shrugged. Read about alternative solutions. Expand your minds.  Your hearts will follow.

Monday, April 15, 2019



Last lunches suck.
You had turned your head,
swollen eyes waterlogged red.

By then
we’d given up all hope.
To go on seemed dumb,
an effort entirely unreasonable.
But I noticed that your coffee cup, half full,
suddenly seemed
to be shrinking.
Miniaturized, like gazing
through the wrong end of a telescope,
a tiny dollhouse accessory
delicately pinched between finger and thumb.

But perspective is all relative.
Maybe it wasn’t even lunch.
No one was hungry.
The food remained untouched.
All the things were still the same old size

But the distorting effects of distance:
the way cars become toys
and people seem like ants
when the plane rises into the sky

Or a rocket blasting into orbit:
the moment when the seal on the airlock breaks
and everything I adore
into the void of space.
I can still see them, tiny specks,
soon to be indistinguishable from stars.
And I’m still here clinging to this iron bar
as hard as i can; it hurts.

(Smack the red button)

It’s just a reflex.
And the doors start to close.
Soon gravity will be restored.
Everything returns to its proper perspective.
But I have a few seconds:
time has started to go slow:
all I’d have to do is just let go


Tuesday, April 9, 2019



The great conundrums in life don’t
always come to a crossroads.
The big decisions rarely culminate
in a forked path that will render your fate.
We’re stressed by a world of binary divergences,
always ruing the roads left untraveled.

The toughest choices in life
are never about turning left or right,
then stumbling a little further ahead
until you come to the next split:
only to choose again and
choose again and
choose again.

I’ve learned to accept indecision
as a necessary distillation
of the tension between living
and its infinite series
of one-chance choosings.

When you come to the crux
it’s best to retreat to the dark wood;
that rough undiscovered country
for which there are no printed maps
and the canopy of green blacks
out all guiding stars.

You cannot memorize this terrain.
Etch your marks on the tree bark in vain:
You cannot blaze a trail.
You won’t leave behind a trace.
You lack the skill to sketch your beloved’s face.
All efforts at capture are doomed to fail.

But all along the journey something is happening
as the vastness of unfamiliarity engulfs
(positional certainty unessential to the existential).
All those conjured mental maps de-materialize.
Your compass just spins
and spins
and spins.

Stopping to lean against some old gnarled oak
or this chipped gray boulder,
to rest in the sun….
the weeds and trees and wildflowers
oblivious to your passing presence.
All paths are doomed to impermanence;
the forest is always closing in.

There are destinations that cannot be named.
There are routes that are only traveled once.
This is the end of a journey.
This is where it all begins.
Stopping is not a surrender;
if you don’t pause
the old ways can never be sundered

You have found your long lost home;
it was always present in the heretofore
wide, unroofed frontier of alone.
You don’t need to know where you are anymore
or where you are going….
It’s not about finding or choosing
but the prospect of being found.

You’ve seen the tracks,
heard branches snap;
you know someone is out there searching,
probing every square inch
of this primeval hinterland,
becoming more and more lost
in your endless uncharted wilderness.

This is where you will start your fire.  
Send your plumes of smoke ever higher.

Thursday, January 3, 2019

Poem for Dad on 70th Birthday

Love, Dad

I thought I knew my father best on the handball court;
watching him down below from balconies as a boy,
his muscular body coiled to strike the hard black ball
as it wrapped around the white cement back wall.

I also knew my father in suits and ties.
The smell of his cologne.
The power of his hugs when he finally got home.

I knew my father by his sighs
and darting glances
that told me I’d lost his attention,
temporarily passed from his field of vision.

I knew him by his boxy squared off printed letters.
And his looping baroque cursive.
Love Dad, Love Dad, he always signed his notes and presents,
tracing my finger tip over the black ink.

I knew my father when his hair began to turn;
senatorial gray temples
and then a moon white silver.
I knew him by the slight limp
that deliberated into a mechanical lumbering
after he got his new knees.

I could write a paragraph on his golf swing.
His forehand slice down the line
The perfect way he parted his hair
His tiny razor teeth
His famous impatience
His unwavering self belief.  
I knew him by his strength
His courage
His indefatigable will.
But I also knew him by
his frauds and flaws and faults.
And I said to myself: these are the main things to know.

But now I know I knew him least of all.
These things I decided I knew
were both true and untrue,
real and imagined.
There is too much to know.
The mind must make decisions
which then become barriers
to the only knowns that matter.

Just as a child doesn’t choose the things he remembers,
all fathers and sons
just sort of end up with each other
without much say in the matter.
Over time they see only reflections
of themselves in each other
instead of the flickering glint of glorious light
that was there from the beginning.

All that he is, I am not.
And all that he’s not, I’m always claiming to be.
And so the stories they tell about dad and son
are just the stories they’ve been meaning to tell
about their own respective selves.
A conjured cloud of unknowing,
a long wasted prelude,
to an ending that was there all along.

A father just wants to be followed.
And the son just wants to be seen.
Why does it take so long
for them to see that this is just
two sides of the same old thing,
opposite faces of the truest,
most natural species of love?

Maybe I did know him best of all
down there on the courts, years ago
surrounded by four cement walls,
my eyes wide in wonder and awe.
And maybe that’s when he knew me best,
turning to point to his son in the balcony
after an ace or a hustling dig,
his face young and unhurried,
his own eyes wide in wonder and awe,
to have his boy, here, watching it all
right here between these four walls.

The father gives life
And the son receives.
And the father now sees that he is seen,
that he is known,
by a boy who carries the same fire
the same spark in his eye
that someday he will find
in a boy of his own.