Why Can’t We All Just Get Along?

I have read a lot these last few weeks about the division and hatred that now characterize political debate in the United States. There appears to be no room left for simple disagreement. Sides have been chosen, battle lines have been drawn and enemies clearly identified. Winning is no longer enough, for many it seems that destruction of others is the goal. The questions arise, “Is there any hope for us? How can I make a difference?”

I stumbled across the answer a few weeks ago in my men’s Bible study group. We had just finished a several month’s long review of the Sermon on the Mount, Jesus’ remarkable discourse on the nature of a godly life. To the Jewish people living under Roman rule, people looking to overthrow their oppressors and restore their freedom, Jesus taught sacrificial love for their enemies. He told people to bless those who persecuted them, to pray for those who would do them harm.

His words were challenging then and they are challenging now. Even more, they seem nice and sweet on the page but impractical in reality. There are some people who seem out of reach, some people with whom no peace seems possible. There are cultures too different, beliefs too contradictory, for common ground to be found.

While this is a natural assumption the gospel writer made it clear that Jesus did not intend his teaching to be merely theoretical. He demonstrated this immediately following his discourse. In two successive interactions with outcast and despised individuals he showed how it is we can go about breaking down barriers with those who are different from us.

The first encounter was with a leper. Lepers were social outcasts, banned from societal contact and interactions. Their disease was viewed as more than a contagious illness, it was a sign of condemnation and separation from God. When the man approached Jesus in search of healing Jesus did not scorn him or reject him (the standard responses of the day). He saw him as a man in need of physical and spiritual healing. Against all societal conventions and norms, Jesus reached out and touched the man, healing him.

The second encounter was with a Roman soldier, a representative of the hated empire. The centurion came to Jesus on behalf of a paralyzed servant. Jesus’ response to news of the Roman servant’s plight had to stun all those who heard it, “I will come.” He was willing to enter the home of someone considered by others to be the enemy, to go where no one else would go.

In each of these cases I believe Jesus was motivated by perception. Where others saw ethnicity and illness he saw men in need. He did not see a leper or a Roman he saw men created by God, in God’s image. He did not see them as outcasts or enemies but as children of God. It was not that the men were not different from Jesus, it was that the differences were not as important to Jesus as was their humanity.

A powerful example for all of us. Peace can only be found when people choose to focus on our common humanity, common desires to be loved, understood and known, and on the value that comes from being people created in the image of God. When we focus on anything else we lose sight of our shared condition and division is inevitable.

• Bart

Success Defined. Differently

When I was in elementary school I loved classroom competitions. I looked forward to spelling bees, timed tests and word puzzles. One of my favorite educational games was “around the world.” The desks were arranged in a circle, with one student standing. The standing student would be paired with a sitting student and the teacher would hold up a flash card with a math calculation. The student who answered correctly first “won” and moved on to the next desk. The goal, for me, was to go “around the world”, to defeat every other student in the class. I loved the game, as I rarely lost.

Looking back now, I see the game was stupid. As fun and as challenging as it was to me, it had to have been demoralizing for those in the class for whom math was a struggle. I am sure many of them felt like not trying at all, seeing the “game” as just one more opportunity to be humiliated.

It had a negative impact on me as well. The game fed a warped sense of self, the idea that it was my academic performance that gave me value, that good grades made me special. Educational success, being smart, was a major component of my self-esteem. It left me with a precarious view of self that failure could easily destroy. 

It took me decades to realize that academic successes were nothing to brag about. My school acheivements were primarily due to genetics, not effort. I was the son of a brilliant man who passed his genes on to me. For me, being proud of my GPA would be like a 7 foot tall person being proud of their height. While intelligence and height can be advantageous and beneficial, they are not something anyone earns or works for.

I have finally reached the point in my life where I have learned to measure success differently. What is important to me are the things that I work for the things that do not come naturally, even in my medical practice. While making a correct diagnosis is important, even crucial, I am realizing this is not the best way for me to measure the success of a visit. I now measure success of a patient interaction on the things that take effort, the things that are challenging for me, such as the clarity of my communication and the patient’s comfort and understanding with what I say. If the patient is not satisfied with their care, I have not succeeded.

I need to do this in every area of my life. It is the successes I work for, the changes brought by diligent effort, of which I should be most proud.  When my worth comes from the things that I strive for and not just on the things I am born with, I know I am on the road to being a better person.

 - bart

Friend, Patient, Candidate

 “I’m running for city council!” KC’s words caught me off guard. Although I have lived in Huntington Beach since 1993 I have never been involved in city politics. My interactions with elected officials have been pretty much limited to waving at them as they passed by during the 4th of July parade. My experience with city hall is equally limited, centered around construction permits and business licenses.  It was surprising to realize that a friend of mine might soon be a part of city government. Yet as I thought about the man I know KC to be, it made sense.

I have known KC Fockler for over 20 years. Our kids played youth sports together and his son was on a baseball team I coached. I had a lot to learn about coaching and on one occasion my inexperience resulted in me being less than fair to his son. KC pulled me aside to talk it over. I do not remember the specific words he spoke but I have never forgotten the grace and kindness he displayed. He was right and I was wrong but he did not approach me with anger or condescension. He gave me the benefit of the doubt and treated me with respect. He had class.

A few years later KC showed up as a patient in my office. The fact that he trusted me as his doctor was further evidence that he had chosen to see the best in me. Over the years that followed I saw him for physicals and routine health care, with plenty of time for us to catch up on life and family. We talked about his job and our kids. It was clear to me that he was a good dad, a good teacher and a good man. He cares about people and he cares about our city.

In the few months since he told me about his candidacy we have talked more about his heart for Huntington Beach. One Saturday we met for breakfast so we could talk in depth about what he hoped to accomplish. I should not have been surprised, but he seemed more interested in my thoughts about Huntington Beach than he was in sharing his own. He came with a note pad and made notes of my questions and concerns.

When I asked about his plans his answers were straightforward and sincere. He wants to serve. He wants to help people get involved, to participate, to be invested. He wants Huntington Beach to be a city that feels more like a small town, where ideas are welcomed and citizens are served. He showed remarkable insight into the issues our city faces, from pension liabilities to homelessness, with a willingness to consider any solution.

A few weeks ago KC impressed me even more. I sat in his living room in a meeting he hosted with people interested in his campaign. He was once again in listening mode. I later learned exactly how intently he had been listening. Someone had brought up issues of trash in the local parks. It was a little thing, something that could be easily dismissed, but not by KC. The next day he made a call to Republic Services, the trash collection agency that serves Huntington Beach, and came up with a possible solution!

I am not informed enough to know how to solve the problems of my city. The issues are complex and challenging. I am nonetheless comforted in the knowledge that there is at least one good man with integrity who is willing to serve, a man I am proud to call a friend.

- Bart

Huntington Beach residents who want to know more about KC can call him at 714-722-1710, or visit his website at https://www.surfcitycouncil.org/about.html

Let Them Not Eat Cake

Why won’t the government let Jack be wrong?

This question has repeatedly run through my mind over the last few years as I have followed the story of Jack Phillips. Jack is the owner of Masterpiece Cakeshop in Lakewood, Colorado. He is a man of deep religious convictions who believes that marriage was created by God to be the union of one man and one woman. His beliefs are so strong that they preclude him from supporting gay marriage in his work. As a matter of policy he does not design wedding cakes for gay weddings. For this position he was disciplined by the Colorado civil rights commission which mandated he not only make cakes for same sex weddings but that he and his staff undergo sensitivity training. Convinced that complying with the commission would require him to compromise his beliefs he stopped wedding cakes (which were 40% of his business) and decided to fight the ruling in court. He appealed the decision of the commission all the way to the United States Supreme Court, which ruled narrowly in his favor.

The ink was barely dry on the Supreme Court decision before the Colorado commission again came after Mr. Phillips. His offense this time was a refusal to back a custom cake celebrating the male to female  “transition” of a transgender individual. It does not appear to matter to the commission that there are dozens of other bakeries who are willing to bake the types of cakes requested, nor that Mr. Phillips is being targeted by activists opposed to his views. In the eyes of the commissioners, Jack Phillips is a bad man who must be punished.

In understand why people disagree with Mr. Phillips, but I confess I do not understand why he is being singled out by a government agency. The question comes to mind, “Why won’t the commissioners let Jack be wrong?”

This question brings clarity to the debate. Countless columns, opinions and articles have been written about the Masterpiece Cakeshop case, each setting forth arguments as to the rightness or wrongness of Mr. Phillips’ position. I think they all miss the point.

The question is not whether or not Mr. Phillips is wrong in his position. The question is, why does the government care? People do wrong things all of the time. One might even argue that the freedom to do wrong and stupid things is at the heart of what it means to be free.

We can find stupid decisions almost anywhere. I recently went to visit a dermatologist who as a matter of policy refuses to see any patient who arrives at the office more than 7 minutes after their scheduled appointment time. The policy is rude, arbitrary, and unkind. No allowances are made for traffic or weather or forgetfulness. If you’re late, you’re not being seen. His policy has cost him patients and resulted in negative Yelp reviews yet he believes he is doing the right thing for his business.

I visited a church recently that has a flier in the pew that reads, “PLEASE, NO CHILDREN IN THE SANCTUARY DURING SERVICES… the age limit for children is 12 years and older…” I imagined how that might feel to a visiting parent of a shy 11 year old who wanted to sit in the service. While I understood the intention, the wording caught me off guard and I considered it offensive.

While I think that both the church and the dermatologist are “wrong”, I understand that they believe they are doing something right. They are free to make decisions in accordance with their beliefs and I have the right to choose to go elsewhere. If anyone forced the church or dermatologist to change their actions, they would no longer be free.

Living in a free society means that we will need to get along with people who disagree with us, people who do things differently than us and who believe differently than us. The day right and wrong are determined by majority rule, the day we are compelled to go along with the masses, will be the day freedom disappears for all of us.

Bart

PS- I don’t think Jack is wrong and I have donated to his cause. I am just wondering how we reached the point where our government is so hateful towards one man’s beliefs. 

A Diabetic on Parole, A Failing Healthcare System

Her blood sugars were terrible, more than three times the normal level. She was not a new diabetic, so to my thinking this was inexcusable. She should have known better. Frustrated, I told her she needed to get serious about her blood sugars and her diet. I told her to write down everything she ate into a log book along with the blood sugar levels I wanted her to check at least three times a day. I told her to follow up with the log book in a week.

A week later she was back in the office as requested,  the only part of my recommendations she had followed. Her log book was nearly empty, containing only four entries for the entire week. She told me that she had been “trying” but it was clear that our definitions of "trying" varied greatly. I reminded her that I could not manage her diabetes without information, that dosing her insulin depended on what her diet and sugars were. The displeasure in my voice was apparent as I told her again to write down everything she ate and all of her blood sugar measurements and to come back in a week. 

The next week's visit was not much better. There were a few more numbers but almost no dietary information entered. I repeated my previous admonitions and told I would need to see her every week until she had a better handle on things. Her response caught me off guard.

“I can’t afford to come back in a week,” she said.

“You can’t afford not to,” I replied, “you sugars are terrible and I can’t treat you without more information.”

“I know but I can’t afford the co-pay.”

“How much is it?” I asked

“It’s $10, but I can’t afford it. I just got out of jail and I don’t have a job and I can’t afford to keep coming in.”

I paused and looked at her, seeing her perhaps for the first time. Before me was a woman in her 40’s who looked as if she was in her 60’s. Some teeth were missing, her t-shirt was worn and had a few holes, and she wore no makeup. She was poor. As poor as she was materially I realized she was poor emotionally and intellectually as well. The stress of normal was almost more than she could handle. The added burden of checking blood sugars, of counting carbohydrates and adjusting medication levels, was beyond her reach. I realized that controlling her blood sugar would take a lot of time and effort and patience.

“Then I won’t charge you,” the words sounded right as they came out of my mouth, “I will see you in a week.”

The next week she returned, log book in hand. This time it was nearly half-filled with results. It was inadequate, but it was progress. Together we went over the log book as best as we could. As we did I pointed out how certain foods caused her blood sugar to rise and how the changes in sugar levels from one meal to the next helped me see that. I praised her progress and had her schedule another follow up appointment 7 days later.

Week after week she came, each time with more of the logbook completed and her sugars improving. After 2 months things clicked. She could analyze her results on her own, determine what she had done right or wrong, and come up with a plan for how she could do better. We started to space out her visits as he confidence increased.

Four months after our first interaction she went to the lab for blood work. To my great surprise it revealed that her diabetes was perfectly controlled. She had done it! At her next visit she was beaming with pride over her results. She was a failure no longer.

We scheduled a follow up visit for a month later. I was confident that she had turned a corner in her health and that her future was bright. I was wrong. She never came back.

She had lost her job and with it her health insurance. I offered to see her for free while she searched for another job but she did not come in. She never told me why, but I wondered if it was out of shame and embarrassment. Perhaps she was fearful in disappointing me. We had invested so much time, maybe she felt she was letting me down.

That was years ago. I never saw her again.

Her story illustrates much of what is wrong with medicine today. Our entire system is based on 15 minute visits spread out over time. While this works for many, there are those who need much, much more. People like my patient, for whom even small co-pays seem like mountains, whose health continually teeters on the edge of disaster, need more time and attention than out system is designed to provide.

People like her, whose life circumstances, educational background and emotional limitations make routine health decisions seem overwhelming, need more time, and time costs money.

There is no place for people like her in the American health system. Obamacare, with its $6500 deductibles and exorbitant premiums, provides no relief. Medicaid (MediCal in California) is a sham of a “solution”, paying a measly $24 for a routine 15 minute visit, forcing doctors to see a patient every 5 minutes in order to make a living and making good medical care impossible. Excessive regulation and documentation requirements make caring for the needy even more challenging.

I do not know what societal solution is needed. I only know what I can do, which is to make time when I can, invest time when I am able, care as much as possible, and fight off the sense of frustration and futility when my efforts prove inadequate. Every once in a while, I may be able to make a difference.

- Bart