Leopards and medicine

I’m a word person. Words are my love language. Words are how I turn ethereal planet-sized phantasms into bite sized monsters one can stab with a fork and dip in a bit of sauce before digesting. Words are my jam. But I’ve been short on them this past year. I haven’t been on social media much, and have shortchanged many a friendship in the real world to boot.

It’s been a hard year. I write this after a hard day. Yesterday was full of death. Full of did-I-do-enough. Full of not enough oxygen, in a year when the sanctity of breath has been so brutally underscored. Full of trying to stay clear headed in the face of 13 concurrent decisions to make, all of which involve ambiguity and complexity and impossible ethical choices. The current COVID surge looks much worse up close than it looks on the news and maybe someday I will write about it more publicly but for now I just send late night angsty texts to people I love telling them they should really stay home and order grocery delivery and tip the hell out of everyone delivering, because it’s everywhere and there are orders of magnitude more death in our faces than there ever were in any point of our careers in healthcare. I, and 1 in 6 Americans, chose healthcare as our vocation — a field that acknowledges and tries to mediate mortality on the daily. But it’s never been like this.

It’s been a hard year. Not much time in the margins, nor much sanity and energy left for scribbles there. But this week has writ large some questions — spelled out in mountainous font, letters scraping the sky — demanding some words and reflection be offered to them.

There’s the question of how to frame and process the dual looming menaces: of this deadly virus, and of the deadly force of white supremacy highlighted in this week’s domestic terrorist attack on the capital. Those monstrosities share some similarities, which I find helps to define their edges. They are dangerous to everyone, but considerably more deadly to the oppressed. They are insidious and pervasive — whether in the air around us or in our laws, policies, norms, and institutions. They are contagious, with an efficient instinct toward self-survival, adaptation, and proliferation. They are complex and misunderstood, but they are not magical: good research can in fact make them both more knowable (1). They lack personhood: neither has a namable enemy general one can campaign against, and yet…

…They can be fought.

The question that arises next is how one defines one’s scope of control to do something about these specters. The answer to this, by the nature of the question, is going to be different for you than for me. But there are some principles that I come back to when trying to answer this for myself.

It’s important to me that I spend more than a tithing of my precious few hours in life on activities that will help design, strengthen or launch better policies and better systems that serve humans more equitably. And on dismantling systems and policies that do not meet that aim. If there’s an 80/20 here, my particular resources and skills give me more bang for the buck on the “build” side than the “tear down” side. We need both. However I worry that history points to the need for building often being neglected, whether as a mitigation to, or following, a tear down phase.

I don’t know about you, but for me this week sparked the need to re-read Frantz Fanon and a few other thinkers with perspectives relevant to our own little post-colonial nation (2). What I come back to after that is this: that building things is harder than breaking. It takes longer. It often requires compromise, and always requires monitoring whether you’ve compromised too much or not enough. It can feel less morally righteous or satisfying than busting things down. But more just, effective, equitable, inclusive institutions and social programs are a potent antidote to many things. Working towards building them is certainly an antidote for me — to the feelings of futility, cynicism, and fear that reared up this week as we were yet again faced with the reality of injustice and white supremacy as foundational currents in America’s policies, norms, power structures, and laws.

As I come back to this second question this week, I believe the answer is always that more is in our scope of control than initially appears to be. The imperative to invest time and resources in building the kind of institutions and communities we want to live in, the imperative to continue to question and adjust our approach to building to make sure it works for the people and by the people, is an imperative we can all contribute to (3).

The third question is prioritizing where to start, or what to continue, and how. Here again, the answer to this question for you will be yours alone. But as I re-ask this of myself, some things come to mind. I don’t always agree with David Brooks (which is to some extent the same caveat for all writers cited here), but a speech he gave in 2016 really stuck with me (4). He talks about that part of everyone’s soul that sits, like “a reclusive leopard,” in the shadows. The part of ourselves that stares us down in the middle of the night, in moments of self awareness, demanding our attention to “one’s place in the cosmic order”; demanding a connection of our life to meaning, to “unconditional love, truth, justice, beauty and home.” So this third question is really the question of what the leopard asks of you. It is the question of what problems and questions of the world you are positioned to address. It is a question of: how can I serve the work, in this one lifetime that I have?

Four years and change ago, I spent a night crying over an election, spent a morning nursing an otherworldly hangover, and I pledged to find a way to contribute more to the bastions of defense against America’s demons. I was, and am, ashamed by how surprised I was by the outcome of that election. I was ashamed to find how blind I’d been to the kicking-screaming-thriving white supremacy, and the ley lines of caste, in this nation. Well, maybe not blind but I sure didn’t have my contacts in. Salty-eyed and squinting at outlines is no kind of way to face the day, or American history.

The small, quiet commitment I made to the universe four years ago, while fumbling for water and some aspirin, led me to the work I have the privilege of doing today. I got there by spending a few months asking the question above of an army of people I respected and was intrigued by: what problems are out there in my specific circumstances that I am well positioned to address? Second- and third-degree connections volunteered their time, their contacts, and their guardian-angel-ship, and I will forever be grateful (Chitra, Bob, Graham, Melora, Arnie and so many more folks — if you ever spot this, you know who you are. I hope you know how much your wisdom meant to me).

Today, working at a county-organized health system, I get to help strengthen the healthcare safety net for my community, making sure it’s there when we need it most. I get to constantly tackle the question of how we make high-quality, more equitable healthcare accessible to everyone. The constraints of limited resources and heavy regulation are oftentimes frustrating, but they push me constantly to try harder and to be more creative. It’s an organization with its normal allotment of imperfections, but one that puts its money where its mouth is to close equity gaps and stay true to its mission. It’s an organization that actively seeks critique and input on how it can do better to correct injustices. It’s an organization with a wallet full of receipts for real impact. And at the end of the day, after days like yesterday? I am often exhausted, but I sleep hard, knowing that I may have made mistakes but I left it all on the floor; that today, I served the work.

Before this turns into too long of an I-love-my-job recruiting pitch (although I do, and it kind of is…come work with me!), or before this careens off into some kind of problematic virtue-signaling, the reason I share this is that I needed to hear about others’ experiences before I made the jump to the work I do today. Maybe I can be an entry in your catalog of other people’s experiences. Mine wasn’t an entirely intuitive next step. It wasn’t on the menu of things that a lot of people I knew professionally expected of me. It’s not like I ran off to join the circus (not ruling that option out yet), but I wouldn’t have landed where I am if I hadn’t continued to ask the question of what problems I was positioned to tackle. I wouldn’t have gotten there if I didn’t continue to keep my own counsel, when the answers that resonated with me weren’t what other folks quite expected. I’m just here to say that listening to the leopard is possible, and that the leopard’s approval is infinitely more filling a dish than likes on a LinkedIn update.

All this to say: in times of darkness, I know I need to remind myself that building things is possible. I need to remind myself to continue to ask the question of what work is mine to do, and how I can serve that work. I need the reminder that the many-handed work of building better, stronger, more just and equitable systems is some of the best ballast we’ve got to keep this ship upright and adjust its course. These words are that reminder to myself, and to you if they serve you.

References:

(1a): Some sources that have been helpful to me in better understanding white supremacy:

• America’s Enduring Caste System, Isabel Wilkerson: https://www.nytimes.com/2020/07/01/magazine/isabel-wilkerson-caste.html.
• For a deeper dive on caste in America, and the great migration of the 20th century, Isabel Wilkerson’s Caste: The Origins of Our Discontents and The Warmth of Other Suns are masterworks.
• James Baldwin — I mean, everything
• Homegoing by Yaa Gyasi — if you learn history better through well-researched fiction than non-fiction, this is an astounding book.
• I’m still working through these, but I’m sharing these due to the strengths of their recommendations to me by others: Stamped from the Beginning and The Color of Law
• Relevant to this week: “The Police’s Tepid Response To The Capitol Breach Wasn’t An Aberration”, FiveThirtyEight: https://fivethirtyeight.com/features/the-polices-tepid-response-to-the-capitol-breach-wasnt-an-aberration/

“Between May 1 and November 28, 2020, authorities were more than twice as likely to attempt to break up and disperse a left-wing protest1 than a right-wing2 one. And in those situations when law enforcement chose to intervene, they were more likely to use force — 34 percent of the time with right-wing protests compared with 51 percent of the time for the left. Given when this data was collected, it predominantly reflects a difference in how police respond to Black Lives Matter, compared with how they respond to anti-mask demonstrations, pro-Trump extremists, QAnon rallies, and militia groups.”

(1b) In terms of staying on top of evolving information about COVID, I rely on my public health colleagues, our physician community and associations, The Lancet, NEJM, JAMA and checking multiple sources for everything, because imperfect information + conclusions needed ASAP to inform action + intentional obfuscation of information by Trump, particularly in the critical first months of the epidemic = higher margin of error (see: “large droplet precautions only” at the onset of this pandemic; the implications and death toll from that withheld information will haunt me forever).

(2) Frantz Fanon, The Wretched of the Earth. Chapter 3, The Pitfalls of National Consciousness, is particularly worth a read. Providing just excerpts here misrepresents the whole of the idea, and I’m a little rusty on his full body of work, but two bits I’m mulling over:

“…(t)he unpreparedness of the educated classes, the lack of practical links between them and the mass of the people, their laziness, and, let it be said, their cowardice at the decisive moment of the struggle will give rise to tragic mishaps.

(…)

The collective building up of a destiny is the assumption of responsibility on the historical scale. Otherwise there is anarchy, repression and the resurgence of tribal parties and federalism. The national government, if it wants to be national, ought to govern by the people and for the people, for the outcasts and by the outcasts. No leader, however valuable he may be, can substitute himself for the popular will; and the national government, before concerning itself about international prestige, ought first to give back their dignity to all citizens, fill their minds and feast their eyes with human things, and create a prospect that is human because conscious and sovereign men dwell therein.”

(3) Some resources with more specific recommendations for things that everyone can do:

• How to be an Antiracist by Ibram X Kendi. Works as advertised.
• So You Want to Talk About Race by Ijeoma Oluo — concrete advice and concise summaries of important considerations for conversations about race. I’ve found this book very useful for discussions with groups at work and elsewhere who have varying degrees of understanding and experience talking about racial injustice. It’s also a book I’ve revisited after those conversations, to question where I can do better when I mess up.
• Unrig: How to Fix our Broken Democracy by Daniel G. Newman. Has an angle but one I found informative. Bonus: it has pictures!

(4) David Brooks’ Baccalaureate address to the University of Pennsylvania class of 2016: https://www.macleans.ca/education/university/david-brooks-to-have-a-fulfilling-life-you-have-to-make-promises/. If you prefer to skip the dad jokes, jump to the paragraph that starts: “It’s like this: There is a part in each of our souls that is like a reclusive leopard…”

• In a similar vein, I’m also putting in a plug for Man’s Search for Meaning by Victor Frankl, and Being Mortal by Atul Gawande as books that may be worth reading/re-reading in a year full of this many questions and shadows. Those are not light reads — sharing if they are helpful, and if you’re in a space where it feels productive to do this kind of reflection. If you’re not, that’s very okay too. I have zero judgements to make on anyone’s content consumption. No matter what, I hope you’re finding ways to take care of yourself this year, and refill your wells so that you have the strength to go out and serve whatever work is yours to do.