Camping in the Woods

My First Russian

April 7, 2025 / David / 0 Comments

In 1972 I was twenty-five, and living in France. I was supporting myself for a year by teaching English is a business school in Rouen, but the job left me free to spend most of the week roaming. Often I ended up in Paris, where I knew people and had a place to stay.

One of my Parisian friends was Philippe, a medical student from Martinique. He had the easygoing ways one associates with a lifetime on a sunny island, and the intellectually active mind one would desire in one’s doctor. He thought it would be a good idea for me, an American, and Serge, a Russian, to meet. I felt underqualified to represent the country, even in a dormitory bull session, but it sounded like a good adventure.

When I arrived at the appointed time Philippe, several mutual French friends, and Serge were already there. Serge leapt up from his chair, and shook my hand enthusiastically. He was a good four inches taller (6’1” to 5’9’), built like a linebacker, yellow-haired, and movie-star handsome, with a thousand-watt smile. He was wearing a Russian sailor’s uniform; I was wearing whatever. He delivered several polite conversational formulas in perfect British English; I had yet to learn my first word of Russian.

Philippe served us all tea that had been brewing on a freestanding Campingaz stove, and we all settled into an amiable conversation in French. Serge and I conducted the main dialog with occasional prompts from Philippe. I bent over backwards to avoid anything remotely controversial, and sensed that Serge was doing the same. After an hour he said he had to go, and the meeting ended. I thought he was a little stiff but a thoroughly good-hearted person. I felt like a rube, and imagined he left thinking, “We can take these guys.”

My American friend Jack, in whose room I stayed, met him later, and spent more time with him. Later in the spring, when the Russians’ supersonic Tupolev airplane crashed at the Paris air show, Jack said Serge was devastated. I remembered him, and felt bad for him.

Teaching Physics

March 31, 2025 / David / 0 Comments

The best way to learn something thoroughly is to teach it. After returning to college to get a teaching certificate, at age twenty-nine I began teaching high school physics. I had taken physics in high school, studied it as part of the engineering curriculum, and taken it a third time as required by the college of education. The physics professor who taught this last class recommended me to a college-preparatory Catholic school.

The administrators, teachers, and parents were united in the goal of providing the best possible education to the students, who were highly self-motivated. I prepared carefully and presented my lessons enthusiastically; the kids gave back the energy through their participation in class. Teaching was a joyful experience.

Students take physics at age 16-17, after the upheaval of puberty, which includes rapid cognitive development. Physics is an ideal vehicle for teaching them to think, because they are regularly presented with challenging concepts like acceleration, gravity, inertia, and centripetal force. They had previously depended on memorization to get good grades, but with physics the rules had changed. Thinking is difficult. I tried to help them by asking the questions they needed to learn to ask themselves.

To shift the effort away from memorization I passed out 3×5 cards before the tests, and told them they could write on them anything they thought they would need for their work. Preparing this official “cheat sheet” was itself a learning activity.

Experiments and demonstrations are the hallmark of science courses. I looked for activities that provided adventure. We dropped apples out of our second-story window into a bucket of water, and pushed my Volkswagen Beetle down an empty street, measuring acceleration. As we returned from one of these excursions, the Science chairman pulled me aside. “Be careful,” he warned. “You thought the students were learning. They thought they were having a good time.”

Students’ attention to a demonstration increases if it appears the teacher may get hurt. To demonstrate conservation of energy, I used an 8lb iron ball as a pendulum. Backing away to take out the slack in its tether, I held it against my face and let it go. It went hurtling down toward the floor, rose up on the opposite side of the room, and came hurtling back toward me. As it approached my face, I shut my eyes to keep from flinching. When the murmur in the room subsided, I knew I had survived. Then every kid who wanted took a turn.

The physics curriculum builds on itself. The teacher must cover the prescribed set of concepts in a certain order. Students must master one concept before proceeding to the next. Every physics course I have either taken or taught began with kinematics, which is a description of motion. Next you consider the forces causing motion, and kinematics becomes dynamics. This general study of motion and force leads to specialized forms of motion. Wave motion is followed by sound, electromagnetism, and light. Finally the course arrives at modern physics—relativity and quantum mechanics. This is the weird stuff that appeals to adolescent imagination, and starts kids thinking about a career in science.

The physics teacher must prepare the students step-by-step, paying attention that no one falls behind. Sometimes they’re ashamed to ask for help in the presence of their friends.

An education professor told us, “You have to decide whether you’re here to teach a subject, or to teach kids.” Obviously it’s important to do both. But when you have to choose, I think you teach the kid. The difficulty is figuring out in individual cases how to do that.

My two years in private school were the best experience I could have had as a beginning teacher. I have never worked so hard, or enjoyed it more, or been paid so little. I left to teach science, including one class of physics, in a public school in another state. It was a step back from enlightenment into the dark ages, and I resigned at the first opportune moment.

I know why people go into teaching, and I know why they burn out and quit.

If you have a good education and an abiding interest in your major subject, you might considerer teaching high school for two years. In addition to tradition public and private schools, there are now a variety of charter schools, and home-school cooperatives where children gather several days per week, usually in churches, for group lessons. It takes a year of diligent work to become a good teacher; taking a methods course in a college of education would hasten your progress.

By the time you begin your second year, you should be enjoying your subject and your students.

Fifty years later, the intangible rewards of my brief teaching career persist. I look back on it as my time of national service.

Water Is Life

March 24, 2025 / David / 0 Comments

From earliest times, abundant water has been the first requirement for human societies. Our need for clean water is second only to our need for clean air. To be healthy we need to drink about a gallon a day to flush out the waste products from our cellular processes.

The first villages and cities sprang up along river banks and sea coasts, both for the availability of drinking water and for transportation. As population increased and the technology of aqueducts and lifting/pumping machines developed, people moved inland. In modern times, our discovery of how to remove salt from sea water has increased our supply of drinkable water. But all over the world, the greatest concentrations of people continue to live near water.

Local populations in California and Colorado, arid regions of Saharan Africa, the southern tip of Africa, and elsewhere have increased to the extent that demand for water exceeds the capacity of delivery systems, and there are shortages. Agriculture and cities compete for water. Cities restrict the timing and type of water use. People who stay the same location come to believe they have a right to use as much water as they want.

During prolonged droughts, Austin limits lawn watering and car washing. When I reminded an elderly neighbor of the rules, he responded unapologetically, “As long as I can afford it, supplying the water is someone else’s problem.” Law enforcement seems to follow an 80/20 rule: if they can get roughly 80 percent voluntary compliance – and in my neighborhood they can – they don’t expend any effort to sanction the noncompliant 20 percent. I commented on this situation to a friend across the country; he said it was the same where he lived. In my childhood in the fifties in a different Texas town, the police patrolled the neighborhood at night, shining a flashlight out of the window of their patrol car, looking for illegal watering. That was a simpler time.

In arid climates, there are villages where women and girls spend a large part of every day trekking to the nearest well to get water for their families and livestock. For over 750 million people worldwide, the only water they have to drink is not clean. When wells dry up, animals die, and families are forced to migrate long distances to camps where they get barely enough food and water to survive. Their young people make long, perilous journeys to other countries, other continents, seeking better living conditions.

People living on small islands have the opposite problem. The gradual, unrelenting rise of the sea as polar ice melts is flooding them out. Both extremes, too little water and too much, will get worse as global warming progresses. The number of climate migrants coming to North America and Europe will increase, unless we improve conditions in their home countries.

We are now conscious of world food scarcity and the inequality of distribution. We are aware of how much resources are required to produce a unit of animal protein (notably beef) compared to a unit of plant protein. Agriculture accounts for 92 percent of water use, compared to roughly 4 percent each for industry and personal use. The increasing scarcity of drinkable water makes eating lower on the food chain ever more important. Replacing part of the beef in our diet with beans and rice helps our water supply go farther.

America uses twice as much water per capita as any other country, and twenty times as much as the poorest countries. Saving an acre-foot of water in one part of an American river system makes it available in another part of the same river system. But we cannot help other countries poor in water by exporting it to them directly. If we want to help, we can reduce our personal use of water and our consumption of animal protein, and use the water saved to produce protein-rich plant products like rice and soybeans, and send water to them indirectly.

If we have sufficient compassion, we can bring thirsty people to where the water is. Because our burning of fossil fuels is largely responsible for their predicament, it’s only fair.

I think water will soon replace oil as the world’s most crucial natural resource.

Cutting My Own Hair

March 17, 2025 / David / 0 Comments

After tramping Europe one summer, a week before settling down to teach in France, I crossed the Channel into England and hitched rides up to Edinburgh. I have Scots ancestors on both sides, and so wanted to visit my “old country.”

That first night I showered and washed my shaggy hair at the hostel, and midway through my wanderings the following day, found a likely barber shop. I walked in, leaned my pack against the wall, and sat down to wait my turn as if I’d lived there all my life. The regulars eased me into the conversation as if I were a returning son. That early September haircut lasted well into the chilly days of winter in Normandy.

I was there for the job; early on I met Jack, a fellow Southerner who was there for a girl. Our hair grew longer and longer; he succumbed to a French barber before I did.

Considering how many Americans had died so near and so recently to liberate their country, I was surprised how deeply the French who disliked us, disliked us. There weren’t that many, but when you met one, there was no doubt. Jack’s barber could not have cut his hair so badly by inexperience; he had to work at it. Patches of hair cut close to the skin, adjacent patches not cut at all.

I had a pair of folding scissors in my repair kit; the blades were an inch long. Taking Jack’s barber as my standard of quality, I was confident that my first self-haircut would be acceptable. Cutting by feel, I took my hair from 4 inches to 1 ½ inches long, all over. Washed it to remove the cut pieces. Later that night, Mary from Nottingham used her sewing scissors to even it up across the back.

Among my students, only the ones who were friends teased me. When I told them what had driven me to do it, they smiled sympathetically.

Before my next haircut, I went to a barber-supply shop and got proper scissors. The basic technique I started with – pull out each lock a standard length and cut underneath the fingers – I have now used for fifty years.

The tactile sensations of cutting hair are pleasant. Your hair slides gently through your fingers, and the shearing action is half auditory and half tactile. You move your measuring hand all over your scalp, lifting the hair between your fingers, pulling and cutting, pulling and cutting. Eventually you pull the hair out the proper length and it slips free. Nothing to cut. You’re done.

I joke that every time I cut my hair, I wear a hat for three days. It’s really only one day. But over the past 50 years I have become a hat person. When I buy a hat, I tell myself I’ve already saved the money to pay for it.

When you cut your own hair, you’re never completely done. For a week after, when I feel like procrastinating, I stand in front of a mirror and trim stray hairs that stick out. It’s more for fun than necessity.

I think my hair looks best just before I decide to cut it, which is about once a month. It’s not a big deal. Usually I get tired of drying it and cut it short.

Farewell

March 16, 2025 / David / 0 Comments

In mid-April 2024 I took out a one-year subscription with a web-hosting service, and with less help from their technical support than I would have liked, produced an amateurish website for posting the essays I had been writing. I have been reasonably happy with the WordPress publishing software and the Hemingway theme I used, but if you are contemplating a similar project, I recommend looking beyond the obvious choice for a hosting service.

Look for someone local, who can communicate with you on your level, who has a broad understanding of the technical issues you need to solve. Once I understood the jargon well enough to define what I needed to know, I could usually go online and get the answer. I spent two months struggling to get a week’s worth of web-design skills.

I have written over 80 essays and published about 40 of them on randomdave.net. When the subscription runs out in mid April 2025, I won’t renew or keep the domain name, RandomDave.net. I may possibly resume writing and publishing in the future, in which case I will pick a different domain name incorporating the words “random dave.”

If I resume the blog, I will publicize it on social media and make a deliberate effort to get more participation from readers. Getting noticed is a hard problem for a new blog. Even your longtime friends have many demands on their time. I don’t want to make money, but I do think it takes being able to stimulate an exchange of opinions and ideas to justify the effort. Producing a blog is like peeing in a dark suit — you briefly get a warm feeling but nobody notices.

There are so many other sources of news and entertainment in the modern world that in retrospect, I shouldn’t be surprised that this blog failed to attract a large number of readers, or any active participants.

If you’re reading this, thank you for staying with me. I hope you feel well repaid for your time. I have no idea how many of you are out there. The email dedicated to randomdave.net is :

[email protected]

If you are starting a new blog yourself and would like to republish one of my essays, ask me.

And now I shall put my time into something else. I have a month left on my subscription to the hosting service, and a month of weekly essays scheduled.

March 10, 2025 / David

The guys in my group of friends started camping together at sixteen, when we had been driving for a year, and our parents let us drive fifty miles north, to an undeveloped region called the Tunica Hills. In early spring we camped in the same hardwood forest where we hunted squirrels in late fall. We cooked meat from home on campfires, slept under the stars in sleeping bags, and drank water from the bottom of a 20-foot waterfall. Once I brought out family’s cocker spaniel; she roamed the hills exploring, and fetched sticks we threw into the pool below the waterfall. When we took her home, my mother said she slept for three days.

Eventually our group dispersed. I moved away, and camped in less familiar places with people I barely knew. On one such trip I teamed up with a running buddy who was a fellow blues enthusiast. I considered him a good camping prospect because during his freshman year at a Canadian university, his dorm room had been a tent in the snow.

Our third companion was a college friend who grew up in the city, who was also our driver.

The three of us drove to a flat, swampy lowland outside of New Orleans. The Canadian and I brought rolled up sleeping bags and packs with gear to spend the night outside. Our friend carried a bedsheet under one arm and a jug of wine in his other hand.

It was early summer, and the spongy ground was covered with a thin, cracked crust of dried mud. The vegetation included sparse 15-foot willows, scrub brush, and waist-high dried grass.

The Canadian and I spent our last hour of daylight gathering grass to make pads to sleep on. Our friend built a fire, because he said that’s what one did on camping trips. As darkness came on, the mosquitoes came out. After drinking a fair amount of his wine, our friend stood up, and announced he’d be back for us in the morning.

The mosquitoes were somewhat deterred by our repellent-soaked bandannas. We two agreed that we should let the fire die down before going to sleep. We occupied ourselves with incidental tasks and prepared to retire early.

By the time we were aware, the fire had escaped its bounds. It had burned into the dry grass on the side opposite our beds, and the flames generated enough wind to push the fire farther out into the woods. We were in good condition from our evening runs, and began stamping it out with our feet. The fire was getting away from us, and we stamped more frantically, trying to keep from setting the whole woods on fire. After a hectic five minutes we gained control; exhausted, we spent another fifteen minutes making sure it was completely contained.

I have never gotten a better night’s sleep in more wretched conditions.

True to his word, our friend came wading through brush the next morning while we were still breaking camp.

Learning to Carry the Load

March 3, 2025 / David

This is the third guest essay by Toby Campbell, M.D.

Dr. Campbell is a pulmonary oncologist and pain management consultant who teaches at the University of Wisconsin.

In this series of essays, he shares his experience helping patients and their families going through the process of dying from terminal illness.

Here’s Dr. Campbell:

If you can think of one hundred ways for a person to die, then I have seen at least as many reactions from patients who learn they are dying. As an oncologist, I have the responsibility of identifying and delivering the worst possible news to people, and I have witnessed an awesome range of reactions, from whispered regret to outrage. It is my job to prepare myself with the most accurate information and then lead all of us through this life-altering conversation, making certain that all voices are heard.

It must be an awful experience, being the unfortunate subject of this “it’s not curable” conversation. Sometimes I see rationalization (“at least I…”) and sometimes resignation (“everyone has to die someday…”) and commonly rejection (“there must be something you can do”). Whatever the verbal response, there is always an emotional response–often the strongest emotion of that patient’s entire life (“Who the fuck are you to tell me that?”).

Quite naturally, a patient’s first reaction is to ask about treatment options: “What are we going to do?” The patient is usually hoping, often desperately, to discover that I have a way out of this situation, in spite of what I just said. Our patients may even implore us to “give me some hope”–“hope” usually means “treatment”–even before they have a firm grasp on the goals for treatment. The concept of life-prolonging or palliative therapy may be so clear and familiar to oncologists, yet it is easily misunderstood by a patient desperate for a clear path to a long future. The temptation, of course, is to accept their suggestion and follow them into the routine dialogue about the standard of care, chemotherapy, or the current clinical trial, but this often obscures the prognostic implications. The rotten “this is incurable” bit gets washed away like so much water under the bridge. I think allowing the conversation to proceed in this order is a big part of the reason patients and caregivers routinely misunderstand their prognosis and the goals of therapy1. So I have learned to slow down and to ask permission to wait for a moment before we talk about treatment. “We will definitely talk about treatment,” I tell them, “But before we do, can I check in on you? How are doing with this news?”

I have come to believe that my responsibility to my patient in this daily (for me) and once-in-a-lifetime (for them) conversation requires me to carefully transfer a piece of completely unwelcome knowledge about disease and mortality. Only then can we honestly consider, and plan for, their future. In this moment we create, we have to spend some time processing, and beginning to cope, with the news. We have to jump into the river together. My goal is for them to fully understand what I am telling them. They may not be able to take it in unless I create and hold an emotional space for the patient and family to process, to grieve, or weep, or thrash.

When you have this conversation as frequently as I do, you see all these reactions in their most raw and honest and fresh form. I see the moment someone truly registers the mortal implications of what I am telling them. I see them break, as I gently apply the pressure, like a pretzel popping in my hands. If I press steadily, and slowly, with just enough force, the pretzel pops into pieces but doesn’t crumble. If I do my job well, my patients can still see me as a caring, even loving, presence rather than an aggressor. With my patient Jake, I found it difficult to tell in the moment if I had succeeded. But ultimately he demonstrated his understanding, incorporated his impending mortality, and proceeded to live in the face of it.

When I told Jake, a 65-year-old veteran with rough hands and relapsed mesothelioma, he sat stock still and silent. For a long time, the only sound was his sandpaper hands rubbing slowly together as he shook his head no. Then, hands now rubbing and then tapping his thighs, he began to nod. His wife, Carol, sat by his side but never touched him and never spoke. It occurred to me they had coped with difficult things before and she knew what he needed from her. Neither of them cried. The tension was so thick I may have held my breath as I took Carol’s cue and held the silence.

Jake took in a huge breath and let out a long sigh. Then he abruptly stood and offered me his outstretched hand for a shake.

“Well, Doc, I’d better be going.”

Shocked, I said with a little chuckle, “What? Jake, this is a different reaction than I was expecting.” He just looked at me, so I added, “How are you doing with this?”

“Oh, okay, I guess. I need to get out of here. I need to buy a Corvette. I’m going to get a brand new one. Red. It is the one thing I always wanted to do, own a Corvette. I want to thank you for helping me realize it’s time to buy a new car.” Carol, with a half-smile, shook her head, gazing at her lap.

Over the next couple years as we treated his mesothelioma, Jake proved to be a man of few words. He lived his remaining time with conviction and a clear sense of purpose and he often thanked me for being honest. “I appreciate that I could drive my corvette a lot longer than I ever imagined.”

I carry these conversations with me, and the older I get, the more stories I have to carry. Now, in my fifteenth year as an attending oncologist, I am feeling the accumulated weight of tragedy and my strategies to lighten my load seem limited to playing basketball and family time and eating out. It all makes me wonder: is my part in this work a privilege? An opportunity? A burden?

The moment prognostic awareness dawns on someone is a scary and tenuous point, in both the conversation and our relationship. I expect strong emotions so much that their absence is how I realize I haven’t yet done my job. Because breaking people is, in a way, my job. I know from experience they will pick up the pieces and reform, both in the moment and over the duration, into something new and different–usually something stronger, but not always. Sometimes I fail to navigate this moment just right for a particular person. If so, I usually discover I’ve broken not only the patient but our relationship—but I only learn this later, when the patient asks me never to return or goes to see a different doctor for follow-up.

With Rhonda, I think I went too far on the first visit. While I treated her with chemotherapy and she lived nearly two years, I was never able to regain the trust to broach the subject of mortality again. Even when she was approaching the very end of her life and I tried, in vain, to discuss the help a hospice agency could provide, I managed only to push Rhonda and her family away.

Rhonda was a 58-year-old elementary school cafeteria worker with purple hair and a love for dancing. When I told her, she stared at me, then looked at her family: she had brought at least ten family members to the visit today, including a 2-year-old grandchild who was currently scooting around the hallway outside the room in a toy car. The family’s eyes were darting between each other and back to me, silently registering the information.

“You all are going to be okay,” Rhonda pronounced.

And with that, like a wave they all rose and surrounded her. Her sisters were at each shoulder, leaning down to hold her. A daughter was on her knees in front of her, crawling up into her lap, sobbing and wailing uncontrollably. Others were in the chairs next to her. With no room to reach her, a daughter fell to her knees on the floor in front of me, arms wrapped tight around my legs and her head in my lap. She was shaking her head between my legs as she screamed over and over “No, Jesus. No, Jesus. NO JESUS NO JESUS NO JESUS.”

Typically, my emotional and physical needs in these crucible moments are minimal to absent. But right then, in this compromised position with an unknown woman’s head in my lap, I had a moment of terror all my own: what if someone walked in here right now? And how did I comfort her? Was there any safe place to touch her right now? Certainly not her head, but if I leaned forward to touch her shoulder…

Rhonda saved the day. “Tamara, you get up,” she said. “Tamara: get off the doctor. Come over here and give me a hug.” Rhonda looked at me as if to say, “What can you do?”

Rhonda, her eyes shiny but not flowing, looked like a person who wanted to break down, to embrace her sadness, but who worried about the effect it would have on this roomful of crushed souls. In future visits, Rhonda would bring a sister and a daughter, her strongest protectors. They would remind me as soon as I entered the room that they were there to “talk only about good news.” Even after all chemotherapy was exhausted and I was seeing her at home on video visits, we never captured another moment of intimate conversation. Her family was shocked when she died. “I’m sure you’re an excellent oncologist with the technical stuff,” they scolded me, “but you really need to work on your bedside manner.”

Even as I do my very best, I have cases like Rhonda’s that gouge into the core of my identity as a physician and send me reeling. I felt doubt about my oncologic and communication skills, drank too much, and wondered if continuing as a clinician was pointless. I could recognize the symptoms of fatigue and burnout. Since the pandemic, and some chronic knee pain, has limited my basketball playing, I decided to try another method.

I have been writing for 25 years informally as a mechanism to process and explore events that happen in my life. I decided to partner with a local author, editor, and writing instructor (MW2) to create a narrative workshop for myself, trainees, and colleagues as a tool for coping with being an oncologist. We worked collaboratively to develop a curriculum and agreed to include four core components to our workshop: writing, sharing with peers, editing, and a public reading.

The process of writing is often as significant as the finished work. Only as I wrote this essay did I realize my patients and I are in a similar fragile condition. They are dealing with the acute shock of facing mortality; I am carrying the accumulated burden of stories of loss. I sometimes feel dejected, even hopeless, in the face of my five new patient visits every week. Yet our patients expect us to be tireless crusaders, invulnerable to the slings and arrows of fortune. And I want to be, if not tireless, at least able to maintain my energy and enthusiasm for the day-to-day practice of oncology. So, like my patients, I have to create space to process and to grieve.

For me, writing and sharing stories with my colleagues is the safe space we create together in order for us to do what we must: allow ourselves to break. We write from prompts and learn writing techniques to help us explore and express ourselves. We edit to refine and retell the story to others but also to discover the elements in the story that are central to us. Finally, we read aloud one of our pieces publicly which, while anxiety provoking for all, feels like a critical step, for me, to ultimately letting a story go. By doing all of it together, we give our stories away and lighten the load. We have the opportunity to learn from one another, support one another, and re-form into something stronger and more resilient.

Sharing my written work publicly, as in this essay, is another step in admitting my own vulnerability and my desire to grieve and celebrate and heal. The partnership with a writing professional elevates the quality of the writing and of our experience. It also fosters our ties to the local community. For example, our public reading is at a locally owned bookstore where many graduates of the course now buy their books.

As an unanticipated side benefit, I think the writing class helps me be a better clinician: in learning more about story development, I find myself interviewing my patients with more attention to details about character and setting and story.

Each of these components of our process is important. Each contributes meaningfully to the end result of a more resilient community of clinicians.

Judy, a 74-year-old retired executive making a second career as an organic farmer, simply looked at me. She looked at me for a long time. Then her brow furrowed and head started shaking, a slight rhythmic oscillation, more like a tremor than a gesture.

Her husband reached out to take her hand and she looked at him, eyes wide and blank. And then back to me, her expression lost, eyes imploring.

“I don’t understand,” she said.

“Shocking, I know,” I replied.

“I’ve lived a good life. I’ve always eaten all the right things.” She had a yellow legal pad in front of her with what appeared to be pages of questions she’d been prepared to ask me, with spaces for writing my answers. She flipped through the pages, front to back and back again, looking for something to ask me. From what I could see as she flipped, I guessed her prepared questions were no longer relevant: How long might I expect the recovery to be after surgery? Do you have a wig salon? How soon after we finish treatment can we travel internationally?

She scratched her pencil on the paper as if taking notes but, from my vantage point, I could see it was just wordless jottings.

Here, in the sterile quiet of my office, it feels clear that what I do is, of course, both a privilege and a burden. Oncologists and palliative care clinicians are at high risk for burning out, doing this day in and day out, and I certainly feel the despair at times. It is through writing that I have come to an understanding that I have a choice to make: I can decide to consider this part of my job not the “dirty work” but a chance to have once-in-a-lifetime conversations every day. I have decided to accept responsibility for this messy task in order to skillfully and compassionately show my love for my patients. I realize “love” is a loaded word, but I chose it deliberately because love is messy and resilient; love accepts and trusts; love feels big enough to hold the weight of these special relationships. Those patients are fully aware and engaged when they choose to grant me access to their secret desires and sacred family spaces. We unite to plot against our common enemy. And we celebrate victories, large and small, along the way.

References:

1. Weeks JC, Catalano PJ, Cronin A, et al. Patients’ expectations about effects of chemotherapy for advanced cancer. N Engl J Med 2012;367:1616-25.

2. Madison Writers Studio Homepage. (Accessed 3/17/2022, at https://madisonwriters.com/our-team/michelle-wildgen.)

3. Komlos-Hrobsky E. Narrative Medicine for Doctors. Poets & Writers 2019:October 9, 2019.

Suicide

February 24, 2025 / David

Here in America, the phone number for the National Suicide Hotline is 988. There is someone you can talk to 24/7.

Suicide is a permanent solution to a temporary problem. Most people who survive an attempt to kill themselves never try it again. It’s a horrible thing to do to yourself, and to all the people who love you.

The Eastern religions which believe in reincarnation teach that when you commit suicide in your present life, you are condemned to repeat it in five hundred future lives.

One night when I was in college, I received a phone call from a friend’s mother a hundred miles away. Her son’s girlfriend just broken up with him, and his mom thought he was considering suicide. We knew he had a handgun.

When I arrived at his apartment, he was lower than I had ever seen him. He asked me if his mother had called me and I said Yes. “I just don’t see any point in living,” he told me. I had no training for this; I was 19 or 20 years old. We talked. I just encouraged him to get it all out. I knew the girl fairly well from having been around the two of them. Gradually he got over the worst of the sadness; when he said he was going to fix something to eat and asked was I hungry, I relaxed a little, and then he relaxed. In those days we were both lousy cooks, and we laughed for the first time that night over the food. We called his mom around 3 am and I went home.

Intellectuals see suicide as a philosophical problem — do we have a right to kill ourselves? Under what circumstances? Legally it’s a crime, in which the victim and the perpetrator are the same person.

At our 40-year high school reunion I learned that one of our girls had recently killed herself. She had an inoperable brain tumor and was in unrelenting pain. I knew the girl slightly. She was quiet, thoughtful, and accepted the responsibilities of life. Since we are unable to inhabit each other’s bodies and share their experiences, I accept her self-death on her terms, as an act of courage. And yet…

In Harper Lee’s To Kill a Mockingbird, the hero Atticus Finch tells his young daughter, “You never really understand a person until you climb into his skin and walk around in it.” As much as I abhor the idea of suicide, I refrain from condemning anyone who commits it– I can’t fully comprehend the situation that drove them to it. I deeply regret whatever circumstances made them feel it was necessary.

There are so many possibilities in life I have been spared so far. I am grateful to have lived to be elderly, and still be in good health. When I talk with a lifelong friend who has been less fortunate, we occasionally speculate on the end of life, on the desirability of a quick, easy death. “A nice, clean heart attack” are his words.

The Roman statesman-philosopher Seneca (4 BC- 65 AD), in his essay on old age (De Senectetude), compared life to a banquet. Eventually the time comes for each of us to leave the table, and give up our seat to the next person. To extend the metaphor, it seems to me that suicide is analogous to skipping out on the bill.

I believe that all animals, including people, are biased toward survival. Regardless of whether we have religion, we don’t know what follows death. I embrace Christian ethics as the guiding principle of my life, despite an abiding, reverent agnosticism about the existence of God. He may well exist, and be testing, developing our character through adversity.

Part of my personal faith is that He will give each of us strength to withstand all the suffering that befalls us, including the circumstances of our death.

We need to stay and take the final exam.

Bird Flu

February 17, 2025 / David

Note 2/17/25, 11a.m: An alert reader just pointed out that H1N1 is swine flu, and H5N1 is bird flu. As explained below, the H_N_ designations refer to the structure of these influenza viruses.

The President has decided he can shut down Federal science programs and their websites on his own authority. Unless Congress and the courts stop him, America will reenter the Dark Ages.

In medieval times, plagues remained local because people were limited in their travels. Today someone can fly anywhere in the world in 24 hours, carrying an infection with them.

The H5N1 “bird flu” virus is in the earth’s biosphere to stay. It can lie dormant in a small population of its host species for years, then emerge and spread. The H5N1 designation refers to the location of two spike proteins on the surface of its particles, which it uses to attach itself (H) to the cell walls of a new host, and then release (N) to go infect other cells.

Every organism has to survive and reproduce. In the conflict between a virus and its host, the host seeks and destroys viral particles, while the virus tries to avoid detection. Randomly, parts of the virus’s genetic material mutate. Some mutations resist detection, enabling the new forms of the virus to survive.

H5N1 mutates rapidly. These mutations are infecting more and more species of animals, including cows, cats, and people. Within the past few weeks, dozens of people have come down with H5N1 infections, and a few have died. One of the traits of a successful virus is that many of the individuals it infects have no symptoms, and in most cases its symptoms are mild. A crucial requirement of a parasite is to not kill its host until it has reproduced itself.

Until you become infected, you don’t know how your body will respond to a viral attack. Feeling lucky today? Maybe you can skip wearing a mask when you go shopping. Everyone alive today survived the first six months of COVID by luck.

Our experience with COVID suggests that it’s time to resume health precautions against H5N1: hand washing, careful handling of food, social distancing, and wearing a KN95 mask in crowded indoor spaces. Masking is particularly advisable during air plane travel.

In addition to breathing it, you can potentially get H5N1 from the bodies or excretions of infected animals.

Vaccinations are safe and effective. For over two hundred years they have reduced the incidence and severity of common diseases. We still have a small amount of earlier flu vaccine, but don’t know its effectiveness against the H5N1 strain currently circulating.

The mRNA biotechnology used to make the COVID vaccine began development in 1989. Technicians start with a harmless virus, and graft onto it a piece of the virus we want our body’s immune system to detect. The success of the COVID vaccine has been spectacular. When we make a new H5N1 vaccine, we will use the same process. But it will require experimentation to learn which snippet of H5N1 produces the best results. Then we’ll need human volunteers to take the vaccine to prove it’s safe and effective for our entire population. Finally, it will take large resources to make enough vaccine for the entire world.

The American budget for disease control rises and falls at the pleasure of our elected officials. Right now, our dominant politicians believe that at least 51% of the public care only about the price of groceries and gasoline.

At the start of the COVID pandemic, researchers learned that the virus spread by airborne transmission, and that masking was effective. Soon masking or not became a political statement. Then came the vaccine, and whether to get it also became politicized. Hospitals kept records; the majority of COVID patients who died, died unvaccinated.

Given the President’s disdain for science, America may be on the verge of a “natural experiment” in public health. Our Secretary of Health and Human Services is openly skeptical of vaccines; Louisiana and other Republican-led states are canceling vaccination campaigns. Without public encouragement, ordinary families have little motivation to take off work to get their shots.

In a natural experiment, the subjects being studied are exposed to conditions determined by nature or other factors outside the control of investigators. Many times a natural experiment comes about inadvertently, as a result of unforeseen, usually adverse consequences of a government policy.

The Chinese Communists’ One-Child Policy, in effect from 1966-76, was a natural experiment. Many parents responded by killing their first-born baby girls, hoping the next child would be a more desirable male. The resulting gender imbalance has been a lingering demographic catastrophe.

Without high levels of vaccine-conferred immunity, this new outbreak of H5N1 will sicken and kill Americans at higher rates than in other countries having proactive health policies. The greater tragedy is that all we needed to do was to continue what we have done for decades.

Trump’s impulsive policies will likely spawn other natural experiments. The American people would be wise to remember that his genius-level promotional efforts have seldom produced successful business outcomes. [reference: “Trump Revealed: An American Journey of Ambition, Ego, Money, and Power,” Washington Post writing team headed by Michael Kranish and Marc Fisher, Simon and Schuster, c2016. The work analyzes Trump’s business career beginning as an assistant to his father.]

There may also be a larger natural experiment developing across national boundaries, concerning the role of science in guiding the public health policies of nations. The World Health Organization (WHO) has facilitated communication between nations since its founding in 1948 as a UN agency. When Trump’s withdrawal of the US from WHO takes effect, the few public health officials who remain on the job in America will be isolated from their colleagues abroad. We will have delays in getting medicines, materials, and information.

Despite America’s primacy in many areas of world affairs, we depend on international supply chains for crucial materials, products, and services.

Disease knows no boundaries. Competition for scarce resources favors entities that work well together. Progress at the frontiers of knowledge depends on international collaboration.

Americans across the political spectrum will share the consequences of Trump’s rash decisions.

My Father’s Fables

February 10, 2025 / David

I think it possible that my father heard these little stories from his father, an uneducated man who made a living with a team of mules, hauling and plowing. All I know of my grandfather comes from one black and white photograph of a man old before his time, who wore faded overalls and whose face was deeply lined and weathered by a lifetime of labor. The personalities of my father and his two brothers point back toward a man who would have told such stories.

“Once upon a time, there was a young clock. One day he happened to think about all the ticks he had to make during his lifetime, and it made him sit down and cry. While he was crying, a wise old clock came along and asked him what was the matter. The little clock told him. ‘Oh, don’t worry,’ said the old clock. ‘You only have to make one tick at a time.’ “

“Once upon a time, a man was walking down a road. He was young and strong, and when he came upon an old man struggling under a heavy burden, he stopped and took up the burden for him. When they reached the old man’s destination, he set it down. The old man thanked him and said, ‘I don’t have any money to pay you,’ he told him, ‘But if you pick up a handful of rocks from this road, tomorrow morning you will be both glad and sad.’

“To humor the old man the young man did as he was told. The next morning when he put on his trousers, he remembered the rocks and took them out. They had become precious gems. He was glad he had picked up a few, and sad he had not picked up more.”

My brother told me this last story. I should perhaps explain that my father was the youngest child, and grew up during the Depression helping his father with the mules. When Daddy graduated from high school he took all his money and used it to buy a Harley-Davidson motorcycle, intending to ride north from Texas with his best friend, working the wheat harvest as they went. But at the last minute, he sold the bike, bought the house his parents were living in, and went off to college. He studied Agricultural Economics at Texas A &M, and eventually completed a PhD at Cornell after the war.

My brother went to medical school to become a doctor. Just before he graduated, Daddy sat him down and told him, “When you started medical school, you were a pig. When you graduate from medical school you’ll be a pig with a curly tail, but you’ll still be a pig. Remember that, and when someone comes to you needing care and can’t pay, I hope you’ll treat him just like he had the money.”