The Death of Grace, The Rise of the Offended


Nike stepped in it this week with the recall of patriotic sneakers emblazoned with the Betsy Ross flag. The red, white and blue sneakers with the flag of the original 13 colonies had already been shipped to retailers when the company decided that the flag design was potentially offensive, as the flag is from an era during which slavery still existed in America.

I was taken aback by the story. The flag has been around for 243 years. No new information has recently come to light about the founders or their slave owning ways, and nothing new has been discovered about our nation’s history. Why are people offended now?

Thomas Jefferson was born in Charlottesville, Virginia. The city has long honored the birthday of the author of the Declaration of Independence and our third president as a paid public holiday. This last week the city council of Charlottesville voted to end the holiday, citing Jefferson’s history of slave ownership. As with the Betsy Ross flag, the decision was not based on any new information. Almost overnight the city of Charlottesville transitioned from pride to shame in their native son.

I have read much condemning these decisions, but little about the changes in thought that led to them. What has happened in America that has so quickly led to the condemnation of the previously celebrated?

I wonder if the answer is the death of grace. There was a time when it was universally understood that all men are broken, that there is brokenness, even evil, in all hearts. This realization of personal brokenness is a protection against judging others, it allows us to see the failures of others and say, “There but for the grace of God go I.”  It helps us remember that all men tend to share the sins of the time in which they live, and to see our forefathers in the context of the culture into which they were born. It keeps us from judging the past by modern standards, to realize that we would likely have made the same mistakes as our ancestors if we had lived in a similar time.

It is this historical grace that allows us to praise the accomplishments of slave owners such as George Washington, James Madison and Jefferson. It gives us room to overlook the adulterous failings of Martin Luther King, Albert Einstein, and Benjamin Franklin and instead focus on their contributions to society. It helps us see the good works of fallen men like Martin Luther, who was an anti-Semite, the murderous apostle Paul, and the beloved Franklin Roosevelt, who as president put Americans of Japanese descent into relocation camps.

When we cease to see the world through the eyes of grace, condemnation and judgment will take the place of forgiveness and acceptance in our society. As grace dies we will see more retrospective judgmentalism and more relentless searches for the flaws of our past heroes. The problem is that there are no perfect heroes. No historical figure will be able to withstand the inquisitions of the offended.

I think we will all be better served if we remember a simple truth. The grace of God has always allowed fallen men to achieve great things. Over 200 years ago in His grace He allowed rebellious, flawed men to form the greatest nation in the history of the world.

I think that is something to celebrate.


PS: I would have bought the shoes.

Broken Promises, Broken Marriages


He was shocked and depressed. The divorce papers served came as a total surprise. He had no idea his wife was that unhappy, which was a big part of the problem. He seemed to be the only person that didn’t know.

I knew, as she had been telling me for years how unhappy she was, how disconnected from the family he was, how uninvolved he was in her and their kids lives. They didn’t talk because he didn’t talk. When he had free time he either did nothing or he went out biking with his friends. He had asked his wife to bike with him, but she was not the biking kind. In his mind his invitation showed he cared and wanted her to do something with him, in her mind it was just another indication that he was not interested in what she wanted to do.

She told me that she was “done”. In her mind love was gone and he needed to be gone too. She was not interested in counseling or saving the marriage. Like CPR on a corpse, she felt all attempts to resurrect their relationship would be pointless. He took the opposite view. Finally acknowledging he could have and should have done more, he was ready to go to counseling to do what needed to be done to save his marriage. It was too late.

As I dialogued with each of them, I was saddened by the familiarity of their tale. Two people who were once in love, who had once looked forward to growing old together, had seen their relationship devolve into discussions of visitation rights and community property. In talking with them they each had their opinions on what had brought them to this point, places and times where each of them had gone wrong. As they shared their feelings I noticed something missing from each of their stories.

Neither one of them talked about the promises they had made to one another. 20 years ago, they stood before friends and family and made promises to one another, the promises couples make when they marry. They promised to love one another- in sickness and in health, for richer and for poorer, for better or worse, til death parted them.

They aren’t rich, not are they poor. They are both in reasonable health, and neither of them is dead, but things have definitely taken a turn for the worse, so much so the marriage was being abandoned. Apparently the promises they made to one another weren’t really promises at all. They were more like political promises, the kind that disappear at the first signs of conflict or opposition.

They are sadly normal in this regard. Marital promises don’t seem to carry much weight anymore. I have seen marriages end over finances, family conflicts, cigarettes and even obesity. Every divorcing couple I have encountered shares their sad reality, they have all failed to keep the most important promises they ever made.

This is the problem. People who keep their promises don’t get divorced.

Several years ago I heard the well-known Christian Pastor share his secret for he and his wife’s over 60 marriage- “Keep your promises and live a long time.”

It really is that simple. Lisa and I have learned this. When we are hurt and disappointed we have learned to focus on the promises we have made and how we can keep them instead of the hurts we feel and how we have been let down.

As of this morning, we have been doing that for 13,488 days. I think it’s working.



Hemorrhages and Homelessness


My instructor in inpatient medicine seemed to be obsessed with anemia. Whenever a patient in the hospital had a low red blood cell count, he would write in his notes, “w/u anemia” (for “work-up anemia”) It was such a common occurrence that one year the residents bought him a rubber stamp with “w/u anemia” on it so he wouldn’t have to write it anymore!

Anemia does require a medical work-up. The single abnormality of a low red blood cell count can have many different causes, each with a different treatment. Sometimes anemia is due to a single episode of blood loss and a transfusion is all that is needed. Other times, such as with bleeding ulcers, the bleeding must be stopped so the anemia can be treated, repeated transfusions make no sense. Other times anemia is a sign of another disease that needs to be treated. Alcoholism, vitamin deficiencies, kidney disease, cancers and infections can all suppress blood cell production in the bone marrow and lead to anemia. Fixing the blood count requires the physician to address the underlying cause.

Given the long list of possible causes, the word “anemia” used in isolation, is near meaningless. More information is needed to understand the word and devise treatment. There is no single solution to the problem. A doctor who orders iron tablets for every anemia is a very bad doctor.

Homelessness and anemia have this in common. All homelessness involves people living on the streets, but not all homelessness is the same. There are many different causes of homelessness, and treating the problem will require varied approaches

Some homeless people want to participate in society and have the ability to work, but need some help rejoining the workforce. Others are so damaged mentally and emotionally that participation in society is impossible. They lack the personal and mental skills needed to hold a job, handle money and relate to others. Many, perhaps the majority, could participate in society if they wanted to, but don’t want to. The causes are varied, and the solutions must vary as well.

The “capable homeless”, those who want to work and provide for themselves are perhaps the easiest to help. These unfortunate souls often find themselves on the street due to a combination of poor planning and bad luck and on occasion, burned bridges. They may be hardworking people who were barely getting by, living paycheck to paycheck until a health crisis, loss of transportation, or lost job left them with no place to go. Whether due to pride or social isolation, they have no friends or family to turn to. For these people a homeless shelter, some free meals and some financial assistance (perhaps affordable housing) could turn their lives around. When it comes to the problem of homelessness, these people seem to be in the minority.

The mentally ill pose a unique problem. People who suffer from psychotic disorders may never be able to participate in society. Delusional thinking, hallucinations, lack of interpersonal skills and inability to handle complex tasks may render them incapable of holding down a job or managing their finances. Mental illness can also make it impossible for them to comply with medication regimens, trapping them in a cycle of isolation. Our society decades ago decided it was immoral to force these individuals into institutions, is so doing ignoring the reality that a life on the streets trapped in delusions is an even crueler existence. Temporary shelters may provide a brief respite for those suffering from severe mental illness, but like blood transfusions for a bleeding man they do nothing to solve the underlying problem.

The most numerous and most troubling segment of the homeless population are those who have (or had) the ability to work and participate in society but choose not to. The stress of normal life, of waking up on time, going to a boring job, answering to a boss, and paying bills is more than they care to handle. Some escape from the stresses of life via needle or bottle, living from one high to the next. There are others who are simply antisocial. They do not care at all about other people or how their actions impact others. They want what they want, when they want, how they want, refusing to answer to anyone. Paradoxically, these people act as if the world owes them everything and that they owe the world nothing.

This last category may be the largest. They know help is available, know there is a way they could rejoin society, but have no interest in such help. They prefer a life on the streets to a life of responsibility. They will take food and financial assistance when offered but will intentionally avoid such help if it requires them to change their behavior. It is difficult for others to understand, but to these people a life of “freedom” on the streets is superior to a life of responsibility.

Just as the treatment of anemia is dependent on the underlying cause, the treatment of homelessness must also take root causes into consideration. There is no single response to the homeless problem that will work for all. If the problem of homelessness is to be addressed multiple solutions will need to be pursued. As obvious as this truth is, it seems to not be understood by the judges who hand down rulings demanding more shelters or the politicians who make our laws. Our government leaders seem to think the solution is to provide everyone with a place to live and food to eat. While this may work for the small subset of unfortunate individuals who want to work and rejoin society, it will do nothing to address the root causes for the majority of those living on the street.

The mentally ill are often unable to access help on their own and thus will need hospitalization, institutionalization, or ongoing supervised care. They need to be in settings where there are people to make sure they take their medications appropriately, counselors to help them understand the world, and structure to keep them safe from their bad judgment and destructive behaviors. Our society needs to let go of the belief that such arrangements violate the rights of the insane. If we do not change our approach, there plight will not change. They will remain on the streets.

The anti-social, drug addicted and alcoholic homeless present a different problem. As long as they are given the option of living outside of the rules of society, most will choose it. They will refuse shelter and services when offered. Those that accept shelter will not typically stay long, leaving when they realize they cannot use drugs or drink. Getting these people off of the streets will require a firm and decisive response from society. Instead of building shelters with swinging doors and no obligations, we will need to develop a path to reenter society. We will need programs, camps or facilities to provide these people with opportunities to get sober, receive psychiatric care, life counseling and job training. These able bodied homeless will need to be given a clear choice, enroll in a reentry program and become someone who contributes to society, or go to jail and contribute to society via a supervised work problem. Returning to the streets cannot be an option. If it is, they will choose it.

I have little hope that these approaches will ever be implemented, for they will require us to accept hard truths about human nature and to change our way of thinking. Simple solutions, though destined to fail, are more politically and socially palatable.


Trans Before Trans Was Cool


He was not what I expected. I had met his wife his wife that morning, an attractive woman in her 40’s and when she told me that I would be seeing her husband in the afternoon I pictured a man who would look manly, masculinity to match her femininity.

He looked to be in his early 50’s, and was quite effeminate. He was darkly tanned, almost bronze. His perfectly coiffed blond hair was long enough to cover his collar and parted on the side, with a layered cut that was popular in the 70’s. His clothes, a khaki shirt, khaki pants, khaki belt and khaki shoes, matched perfectly, so perfectly as to merit the term “ensemble”. His speech and mannerisms were distinctively feminine.

I shrugged off his appearance and greeted him in my usual fashion. His wife had told me he was in to have a mole checked so I asked him to remove his shirt. Without a word he unbuttoned it and set it over the chair. As he did I was suddenly aware of the reasons for his feminine appearance. He had breasts.

They were not the “man boobs” of an obese man, nor were they gynecomastia, the slightly prominent breast tissue sometimes seen as a side effect of medications. He had female breasts. Any doubts I may have entertained as to the nature of his bosoms, any thought that he was not striving to be a women disappeared when I saw the tan lines outlining his pale breasts. He had been tanning in a bikini top!

Wondering what to say, I quickly took a look in his chart. The medication list told the story. He was taking estrogen pills. He was in the process of a sex change.

The first thought that passed through my mind was, “Why didn’t his wife warn me about this?” Some form of heads-up would have been appropriate, something along the lines of “My husband is coming in to see you this afternoon for a mole on his chest, and by the way, he has boobs,” would have been nice. I struggled to come up with an appropriate response. (“Nice boobs, are they new?” did not seem appropriate…)

It was one of the rare times in my life that I had no idea what to say. I decided to say nothing at all. I examined the mole as if there was nothing at all out of the ordinary. I diagnosed the skin lesion, recommended a course of action and sent him on his way.

I never saw either one of them again. I have no idea if they stayed married or if he completed his transition. I do know that I will never forget him, and that I never know what I will find behind each exam room door!

At that when in doubt, the best response is to simply do my job.


Broken Windows Parenting


“It was an accident!”

My son’s explanation was the same as millions of others little boys throughout history who found themselves in trouble. On this day and in my son’s case the explanation was true.

He was playing across the street in the neighbor’s yard. His friend had a new boomerang which he had eagerly shown to our 6-year-old son. Like any self-respecting little boy, he threw it, hard. He and his friend watched as it flew in a graceful arc, spinning majestically through the air until it came to a sudden stop against the window of the neighbor’s garage. The boomerang remained in one piece, the window did not.

“It was an accident!” my son repeated his defense, obviously fearful of my paternal wrath. To his surprise, I was not angry.

“I know it was an accident, and you are not in trouble,” I said. I saw the fear begin to leave his eyes, slowly being replaced by hope. “You are not in trouble, but the window is still your responsibility. You are going to have to pay for the window.” The hope faded.

“But I don’t have hardly any money!” he replied.

“How much do you have?” I asked

“Seven dollars”

“Okay, you can give me the seven dollars and I will pay for the rest.”

“But it was an accident!”

“I know it was an accident. But the window is broken and it has to be fixed, and that costs money. Someone has to pay for it, and because you broke it, you have to pay for it. Even though it was an accident, you are still responsible.”

My son was unconvinced but obedient. We went home and gathered all of his change and took it back across the street. The neighbor reluctantly accepted our payment. He felt badly for my son and quietly told me that we did not need to pay. I told him that we had to, because my son needed to learn the meaning of responsibility.

I thought of this story this last week when my dog was attacked by another dog. The dog’s owner offered the same defense as my 6-year old had proclaiming, “It was an accident!” It was obvious that to him the lack of intention absolved him of any obligation to remedy the situation. Because it was “an accident” he owed me nothing.

It was clear to me that his father had not taught him the meaning of responsibility (or the he had had failed to learn the lesson when his father tried to teach it). He truly believed in his "accident defense.”

He is not alone in this belief. It is clearly shared by the person who did not leave a note when he dented by car 6 months ago and by the vast majority of people who bounce checks in my office. Most people do not think of the consequences of their actions or the impact on others. Their primary goal is to avoid responsibility.

What can be done? How do we get people to accept responsibility for their actions?

I do not know how I can get other adults to take responsibility for what they do, but I do now how to get future adults to take responsibility for their actions.

One window at a time.

  • Bart