Dear Life – a doctor on grief, love and the NHS

Gavin Francis in The Guardian:

Part-way through this memoir of hospice medicine and living with loss, Rachel Clarke lists a few troubling ideas she prefers to avoid thinking about: global warming, far-right populism, email overload, menopause, declining numbers of bees and, of course, mortality. It’s become a truism that western societies have difficulties accepting death, but Clarke, whose daily work is to ease the suffering of the dying, has a different view. She sees sense in avoiding the contemplation of death, and often applauds her patients for it – right up until they no longer have any choice.

It’s a kindness to see death as belonging on the same list as brown envelopes from the government: “Maybe, more prosaically, dying is on a par with tax returns and pensions. We know we should address them all proactively, it is just that the admin involved is, frankly, tiresome.” Only 4% of the population have had the foresight to prepare an “advanced directive” detailing how they’d like to be treated or left in peace should they become critically ill; Clarke would like to see that number increase. Her book has an appendix of websites and organisations that can help. But Dear Life is not a manual for dying, or an orthodox medical memoir – it’s a very personal autobiography. It charts one woman’s trajectory from a happy childhood in rural Wiltshire as the daughter of a local GP, through university, then into a successful career making TV documentaries in London. There’s a Damascus moment in her late 20s when she decides to retrain as a doctor, first in acute and emergency medicine, then finally as a consultant in palliative care.

More here.

Malcolm X: The Ballot or the Bullet

From American Radio Works:

Whenever the Negroes keep the Democrats in power they’re keeping the Dixiecrats in power. This is true! A vote for a Democrat is nothing but a vote for a Dixiecrat. I know you don’t like me saying that. I’m not the kind of person who come here to say what you like. I’m going to tell you the truth whether you like it or not. [applause] Up here in the North you have the same thing. The Democratic Party don’t – they don’t do it that way. They got a thing they call gerrymandering. They maneuver you out of power. Even though you can vote they fix it so you’re voting for nobody. They got you going and coming. In the South they’re outright political wolves, in the North they’re political foxes. A fox and a wolf are both canine, both belong to the dog family. [laughter, applause] Now, you take your choice. You going to choose a northern dog or a southern dog? Because either dog you choose, I guarantee you, you’ll still be in the doghouse.

This is why I say it’s the ballot or the bullet. It’s liberty or it’s death. It’s freedom for everybody or freedom for nobody. [applause] America today finds herself in a unique situation. Historically, revolutions are bloody, oh yes they are. They have never had a bloodless revolution. Or a non-violent revolution. That don’t happen even in Hollywood [laughter] You don’t have a revolution in which you love your enemy. And you don’t have a revolution in which you are begging the system of exploitation to integrate you into it. Revolutions overturn systems. Revolutions destroy systems.

A revolution is bloody, but America is in a unique position. She’s the only country in history, in the position actually to become involved in a bloodless revolution. The Russian Revolution was bloody, Chinese Revolution was bloody, French Revolution was bloody, Cuban Revolution was bloody. And there was nothing more bloody than the American Revolution. But today, this country can become involved in a revolution that won’t take bloodshed. All she’s got to do is give the black man in this country everything that’s due him, everything. [applause]

More here. (Note: Throughout February, at least one post will honor The Black History Month. This year’s theme is “African Americans and the Vote.” Readers are encouraged to send in their suggestions)

Wednesday Poem

“Many American men…do not have enough awakened or living warriors
inside to defend their soul houses.” —Robert Bly

Old Self

I chanced across my old self
today. He was sitting in the second
floor office where I used to work —
at the typewriter, young, thin guy,
in his late twenties, white shirt, narrow
dark tie, serious demeanor, writing
an essay against the Viet Nam war.

I came up the stairs and saw him —
a decent human being, diligent,
not remotely aware of the ambush
life had waiting — not knowing
he’d permit himself to be taken
prisoner and then, in confusion,
do desperate things, betray
what he loved — and that nothing
would enable him to survive
as he was.

I passed the open door
and wanted to cry out — warn him,
force the warriors to raise
their spears. But even hearing
my shout, he would have only
hesitated, then turned back to
his devoted, lonely and interminable
work.

by Lou Lipsitz
from
Seeking the Hook
Signal Books, 1997

Is Democracy Compatible with Extreme Inequality?

Chang Che in Quillette:

In 1831, Alexis de Tocqueville took a 10-month trip to the United States to study the American penal system. In the resulting book—Democracy in Americahe singled out one noteworthy feature: “Amongst the novel objects that attracted my attention during my stay in the United States, nothing struck me more forcibly than the general equality of conditions.” Although he ignored the fact of slavery, his reference to economic equality among white Americans was, at the time, accurate. According to economic historians Peter H. Lindert and Jeffrey G. Williamson, the share of national income going to the top one percent was less than 10 percent.

Today, the share of national income going to the top one percent has doubled, while median wages have remained largely stagnant. In the last 40 years, CEO wages have grown nearly 100 times the rate of wages for average workers. The popularity of left-wing candidates like Elizabeth Warren and Bernie Sanders—both with significant redistributive policies at the core of their platform—reflects the moral concerns many have about high levels of income inequality.

But no moral case for economic equality will convince those on the Right. What is at stake is an idea of fairness. It is unfair, so the thought goes, for others to live off one’s labor without making an equally productive contribution to society. This appeal to fairness trumps any moral case for income redistribution. There is, however, another case for relative equality of conditions that appeals to the same idea of fairness that’s appealed to by the opponents of redistribution.

More here.

Sean Carroll’s Mindscape Podcast: Kwame Anthony Appiah on Identity, Stories, and Cosmopolitanism

Sean Carroll in Preposterous Universe:

The Greek statesman Demosthenes is credited with saying “I am a citizen of the world,” and the idea that we should take a cosmopolitan view of our common humanity is a compelling one. Not everyone agrees, however; in the words of former British Prime Minister Theresa May, “If you are a citizen of the world, you are a citizen of nowhere.” On the other side of the political spectrum, groups who share a feature of identity — race, ethnicity, gender, sexuality, and others — find it useful to band together to make political progress. Kwame Anthony Appiah is a leading philosopher and cultural theorist who has thought carefully about the tricky issues of cosmopolitanism and identity. We talk about how identities form, why they matter, and how to negotiate the difficult balance between being human and being your particular self.

More here.

Lingering at the Edges of Experience

Morgan Meis in The Porch Magazine:

You should sit low, not on a chair or a stool or a couch. A small crate will do the job. Or anything that is lower than 9.5 inches from the ground. You can’t shave or cut your hair. You can’t have sex. You shouldn’t take a shower, though you may do some light swabbing of your especially funky bits, as well as dousing your feet and hands in cold water now and again. You can’t greet people in the normal way. You definitely cannot work. No freshly laundered clothes. The list of things you cannot do is long.

What you can do is mourn. You can weep and wail, and you are encouraged to talk about the loved one who has recently died. You aren’t to take care of yourself, but to allow everyone else– family, the community–take care of you. You are to throw yourself helplessly upon other people, and you are to confront the feelings of sorrow and loss, to bring them to the surface and let those intense feelings have their place.

This is sitting shiva. It’s how observant Jews have been dealing with grief since ancient times.

In Ari Aster’s recent film Midsommar, a terrible thing happens. A young woman named Dani (Florence Pugh) loses her sister and parents in a ghoulish suicide/homicide. Hellish stuff, the stuff of nightmares. If anyone has ever needed help grieving, it is Dani. If anyone has ever needed a community to fall back upon, it is Dani. Does she get it? Of course not. She is, like many people living in the contemporary, globalized, post-modern world, more or less without a community in any functional sense of the word.

More here.

An Evening With George Steiner (1929–2020)

Kinton Ford at n+1:

GEORGE STEINER IS A CHARMING but monstrous narcissist. In November 2001, I spent an amazing evening with him and the Celebrated Poet at the Professor of Poetry’s house. Things got started when another Professor, the Poet, and an Artist (the Poet’s spouse), complained laughingly about the xerox machine in the University English Department. This led to an interesting and moving story of Steiner’s about his Czech students copying out Middlemarch by hand since access to copying was extremely difficult in Prague: the Czech xerox machines were controlled by the state, lest any samizdat activities got going.

more here.

Why Women Read Fiction: The Stories of Our Lives

Sophie Duncan at Literary Review:

Men not reading women’s writing is widespread, and they begin not reading early. In the university applications that cross my desk, it’s common for male candidates not to mention a single female author, despite otherwise showing evidence of wide and ambitious reading. The opposite is rare.

As it turns out, though, without women, men wouldn’t have much to read at all. Women are responsible for fiction’s survival, as Helen Taylor details in Why Women Read Fiction. We buy, borrow, download and lend the majority of fiction books, from classic literature to romance, erotica and saga writing. Taylor has surveyed more than four hundred female readers, documenting their responses to fiction and their urgent, frequently furtive efforts to scrape out space for reading. Most movingly, a number of Taylor’s respondents stress the conflict between reading and domestic labour: a former library development manager confessed she can only read ‘when I’ve done everything else (washing, Hoovering etc)’, while others recall having faced accusations of ‘sneaking off’ or rudeness for choosing reading over angelic housewifery.

more here.

A Good Convent Should Have No History

Francesca Wade at the Paris Review:

“I would venture to guess that Anon, who wrote so many poems without signing them, was often a woman,” wrote Virginia Woolf in A Room of One’s Own (1929). In that essay, commenting on the fact that women’s lives are “all but absent from history,” she argues that this is not only a consequence of the ways women have been deprived of the material conditions under which their talents can prosper but also reveals the sort of events and lives historians have traditionally considered worth remembering—primarily, the public activities of “great men.” Perusing the index of G. M. Trevelyan’s History of England, Woolf looks up “position of women” and is dismayed to find only a smattering of references, mostly to customs of arranged marriage, wife-beating, and the fictional heroines of Shakespeare. Flicking through chapters on wars and kings, she wonders why so little room is left for women’s activities in the events that “constitute this historian’s view of the past.” It was clear to Woolf that new histories were needed, which would examine the reality of women’s lives, their relationships and activities, and the forces that thwarted their ambitions.

more here.

Tuesday Poem

What It’s Like

And once, for no special reason,
I rode in the back of the pickup.
leaning against the cab.
Everything familiar was receding
fast—the mountain,
the motel, Huldah Currier’s
house. And two stately maples. . . .

Mr. Perkins was having a barn sale,
and cars from New Jersey and Ohio
were parked along the sandy shoulder
of Route 4. Whatever I saw
I had already passed. . . .
(This must be what life is like
at the moment of leaving it.}

Jane Kenyon
from
Collected Poems
Greywolf Press, 2005

Researchers Find Cell-Free Mitochondria Floating in Human Blood

Katarina Zimmer in The Scientist:

Sometime around 2 billion years ago, a bacterium slipped inside a larger cell, started producing energy there, and became the indispensable powerhouse we know today as the mitochondrion, so the working theory goes. But that old story now has a new twist. Scientists have detected the organelles outside of cells, apparently functioning perfectly well while drifting around the blood of healthy people, according to findings published recently (January 19) in The FASEB Journal. The researchers who made the discovery propose that the independent mitochondria may be released by cells for signaling purposes, although more work is needed to validate that hypothesis. “It’s very exciting. . . . I think altogether the combined evidence is pretty strong that they definitely are whole mitochondria,” remarks Martin Picard, a physiologist at Columbia University who wasn’t involved in the new research. “I think there’s a lot more work to be done to know . . . whether they have a functional role to play,” he adds.

The findings were the result of a multi-year project led by Alain Thierry, an oncologist who researches the development of cancer biomarkers at the French National Institute of Health and Medical Research. About seven years ago, he and his colleagues were studying cell-free mitochondrial DNA—long known to circulate in human blood—as a potential diagnostic marker for cancer.

More here.

Overlooked No More: Homer Plessy, Who Sat on a Train and Stood Up for Civil Rights

Glenn Rifkin in The New York Times:

When Homer Plessy boarded the East Louisiana Railway’s No. 8 train in New Orleans on June 7, 1892, he knew his journey to Covington, La., would be brief. He also knew it could have historic implications. Plessy was a racially mixed shoemaker who had agreed to take part in an act of civil disobedience orchestrated by a New Orleans civil rights organization. On that hot, sticky afternoon he walked into the Press Street Depot, purchased a first-class ticket and took a seat in the whites-only car. The civil rights group had chosen Plessy because he could pass for a white man. It was asserted later in a legal brief that he was seven-eighths white. But a conductor, who was also part of the scheme, stopped him and asked if he was “colored.” Plessy responded that he was. “Then you will have to retire to the colored car,” the conductor ordered.

Plessy refused.

Before he knew it a private detective, with the help of several passengers, had dragged him off the train, put him in handcuffs and charged him with violating the 1890 Louisiana Separate Car Act, one of many new segregationist laws that were cropping up throughout the post-Reconstruction South. For much of Plessy’s young life, New Orleans, with its large population of former slaves and so-called “free people of color,” had enjoyed at least a semblance of societal integration and equality. Black residents could attend the same schools as whites, marry anybody they chose and sit in any streetcar. French-speaking, mixed-race Creoles — a significant percentage of the city’s population — had acquired education, achieved wealth and found a sense of freedom since before the Civil War. But as the century drew to a close, white supremacy movements gained traction and pushed hard to quash any notion that people of color might ever attain equal status in white America. The Separate Car Act spurred vigorous resistance in New Orleans. Plessy, himself an activist, volunteered to be a test case for the local civil rights group, Comite’ des Citoyens (Citizens Committee), which hoped eventually to put Plessy’s case before the United States Supreme Court. The group posted his bail after his arrest.

More here. (Note: Throughout February, at least one post will honor The Black History Month. This year’s theme is “African Americans and the Vote.” Readers are encouraged to send in their suggestions)

The Feminist Case For Men’s Rights

by Thomas Wells

The case for men’s rights follows straightforwardly from the feminist critique of the structural injustice of gender rules and roles. Yes, these rules are wrong because they oppress women. But they are also wrong because they oppress men, whether by causing physical, emotional and moral suffering or callously neglecting them. Unfortunately the feminist movement has tended to neglect this, assuming that if women are the losers from a patriarchal social order, then men must be the winners.

While it is bad luck to be born a woman in our society, it is also bad luck to be born a man, in ways that relate directly and indirectly to gender norms and rules. For example, men die significantly earlier than women in just about every society and historical period known to us. The causes are manifold and interact in complex ways. They include physiological factors (notably the harmful effects of testosterone on the immune system) that make human males frailer than females at every stage of development, even before birth. Gender norms about the value of men’s lives aren’t directly responsible for this, but they nonetheless play an indirect role in deflecting away public concern and action. Other factors reducing men’s life-expectancy are more directly related to social context and upbringing, such as men’s propensity for risky behaviour (such as smoking) and violence. Not only are these intimately connected with gender roles and rules, they are also shielded from scrutiny by them: Men are supposed to be aggressive risk-takers, and we are also blamed for being so. Read more »

A Brecht Poem, On his Birthday

by Joseph Shieber

Bertolt Brecht, the German poet and playwright, was born on this day 122 years ago, February 10, 1898.

Fearing persecution by the Nazis for his writing and leftist political views, Brecht left Germany in February 1933, shortly after Hitler assumed the German Chancellorship.

At the time that he wrote the poem “Frühling 1938 / I”, Brecht was living in exile on the Danish island of Fyn.

Frühling 1938 / I (German)

Heute, Ostersonntag früh
Ging ein plötzlicher Schneesturm über die Insel.
Zwischen den grünenden Hecken lag Schnee. Mein junger Sohn
Holte mich zu einem Aprikosenbäumchen an der Hausmauer
Von einem Vers weg, in dem ich auf diejenigen mit dem Finger deutete
Die einen Krieg vorbereiteten, der
Den Kontinent, diese Insel, mein Volk, meine Familie und mich
Vertilgen mag. Schweigend
Legten wir einen Sack
Über den frierenden Baum.

Spring 1938 / I (English)

Today, early Easter Sunday
A sudden snowstorm came over the island.
Snow lay between the budding bushes. My young son
Brought me to an apricot sapling at the house wall,
Away from a verse in which I pointed with my finger at those
Who prepared a war that may well mean, for
The continent, the island, my people, my family and me,
Extermination. Silent
We placed a sack
Over the freezing tree.

Translation: Joseph Shieber

Disunity: the perennial problem that plagues progressives

by Emrys Westacott

“In unity is strength!” This is one of the foundational maxims repeated by progressive forces everywhere. As history has often demonstrated, though, unity is easier to affirm than to achieve. And the consequences of failing to achieve it can be dire.

Germany 1932

The direst of all dire examples of progressive disunity helping to bring about a horrendous outcome was that which allowed Hitler to attain power in Germany in 1933. Here are the results of the November 1932 general election:

Nazi Party  33.1%
Social Democrat Party 20.4%
Communist Party  16.9%
Catholic Centre Party 12.4%
German National People’s Party 8.3%
Bavarian People’s party 3%

The Social Democrats and Communists combined received more votes than Hitler’s Nazis. But in the early 1930s, even though the threat posed by the Nazis was becoming increasingly dangerous and apparent, those opposed to them could not form a united front. The Social Democrat leadership viewed communists and fascists as essentially the same, and they chose to support the right-wing Hindenburg government as a “lesser evil” to (and as a bulwark against) Hitler. The communists labelled the Social Democrats “social fascists” and also rejected the idea of collaboration against the Nazis. In January 1933, Hitler was appointed Chancellor. Less than eight weeks later, Germany was a dictatorship. Many of those who couldn’t work together to oppose Hitler would soon find themselves suffering and dying together in Nazi concentration camps. Twelve years later, more than seventy million people lay dead, victims of World War II, and much of Europe lay in ruins. Read more »

On Loss and Stains

by Abigail Akavia

A. E. Stallings’ long poem “Lost and Found” (from her 2018 collection Like) delivers a mesmerizing meditation on loss in its various and myriad forms. I first encountered it read out loud, like a true epic, and I was gripped, astonished at once by the breadth of the journey Stallings invites us on as by the intimacy of its landscapes. A journey from the prosaic, to a Virgilian terrain of shadows and truths, and back again. 

The protagonist of this journey is a poet-mother—can we just agree to call her Stallings?—who starts off on her hands and knees, crawling on the floor in search of a lost toy. In her dream that night, she is led by a woman—she later learns it is divine Mnemosyne herself, Memory, Mother of the Muses—on a guided tour through “the valley on the moon / Where everything misplaced on earth accrues, / And here all things are gathered that you lose.” I found it a delightfully feminist act on Stallings’ part, to cast herself as a hero who crosses the threshold between our world and the beyond, in order to come back to the land of bills and paperwork and lunches waiting to be packed for school, armed with wisdom. A journey that reveals and affirms her position in this mundane world as a poet, a “sieve” who lets the moments pass through her, an artist noticing and writing them down. Read more »

The Cancer Questions Project, Part 28: Jaroslaw Maciejewski

Jaroslaw Maciejewski, MD, PhD is a Chairman of Translational Hematology and Oncology Research at the Cleveland Clinic Taussig Cancer Institute, and a professor of medicine at Lerner College of Medicine at Case Western Reserve University. He is also Associate Director for Translational Research and Co-Leader, Hematopoietic and Immune Cancer Biology Program, Case Comprehensive Cancer Center. Dr. Maciejewski is recognized for his leadership in finding better treatments and a cure for bone marrow failure diseases.

Azra Raza, author of The First Cell: And the Human Costs of Pursuing Cancer to the Last, oncologist and professor of medicine at Columbia University, and 3QD editor, decided to speak to more than 20 leading cancer investigators and ask each of them the same five questions listed below. She videotaped the interviews and over the next months we will be posting them here one at a time each Monday. Please keep in mind that Azra and the rest of us at 3QD neither endorse nor oppose any of the answers given by the researchers as part of this project. Their views are their own. One can browse all previous interviews here.

1. We were treating acute myeloid leukemia (AML) with 7+3 (7 days of the drug cytosine arabinoside and 3 days of daunomycin) in 1977. We are still doing the same in 2019. What is the best way forward to change it by 2028?

2. There are 3.5 million papers on cancer, 135,000 in 2017 alone. There is a staggering disconnect between great scientific insights and translation to improved therapy. What are we doing wrong?

3. The fact that children respond to the same treatment better than adults seems to suggest that the cancer biology is different and also that the host is different. Since most cancers increase with age, even having good therapy may not matter as the host is decrepit. Solution?

4. You have great knowledge and experience in the field. If you were given limitless resources to plan a cure for cancer, what will you do?

5. Offering patients with advanced stage non-curable cancer, palliative but toxic treatments is a service or disservice in the current therapeutic landscape?

A Young Woman in Lahore

by Samia Altaf

Some months ago, on a sunny Sunday afternoon, I went to my bank’s ATM in the main market close to where I live in the Defence Housing Authority, Lahore’s latest fancy suburb, which is organized and managed by the military. 

The market, usually bustling, was quiet that day. There was barely anyone around, and no one at all where I was, at the end of the building. When I came out after withdrawing my cash, I saw a rickshaw parked between me and my car. The rickshaw driver was leaning out of his vehicle, his eyes red, hair dirty and uncombed, his clothes mismatched (a shirt of sorts, alternate buttons missing, and scruffy cloth trousers); he looked completely demented. He was looking intently at me. 

Oh no, I thought. This is a holdup. There is no one around except the two of us, and this fellow knows I have just taken money out of the ATM and have to go past him to get to my car. I tried to be brave, and, clutching my purse tight, said in a gruff voice, “I do not need a rickshaw, I have my car right here.” 

He stepped out in front of me, forcing me to stop, and said in Punjabi, “I am not offering you a ride, I need your help.”

“What kind of help?” I asked, stalling while contemplating a quick dash past his left side. 

“My wife is sick and I need money for the doctor.” Read more »