Archive for June, 2013

CONTEXT

June 29, 2013

“A fanatic won’t change his mind and won’t change the subject”  

Winston Churchill

Twenty-seven years ago, I went to trial for malpractice and was not convicted.  Many people say, “You can’t be convicted in a civil suit.”  My reply: “When you have been sued and have gone to trial, then come back and tell me what word you would choose.”

During the pre-trial deposition, quotations from a textbook of neurology came from the prosecutor, and I did not question them.  I learned something that day:  people quote out of context.  At the trial, the prosecutor grilled me on the stand: “Is it not true, doctor, that Adams’ Textbook of Neurology says, “a brain tumor is not likely to be missed.”?

I looked at the prosecutor and quietly said, “May I see the book, please?”  He handed me the book.  I read the paragraph before and after the quotation the prosecutor had used, which stated essentially that with classic symptoms and signs and good imaging techniques, yes, certain kinds of brain tumors were not likely  (italics mine) to be missed.  That is a lot different.

A little later, the prosecutor quoted the textbook again, and again I read the pertinent passages before and after the quotation, politely handing the book back to him.  A third time, this happened, and again I asked for the book.  The prosecutor literally threw the book at me from four feet away.  I never have forgotten that.  At least one juror gasped at the rudeness.  I stayed calm, again reading the passages before and after.  I wasn’t sure what the jury was going to do, but after I stepped off the stand, the bailiff came up to me and said, “You’re a hell of a witness, doc.”

Of course, not losing didn’t mean I won, and I was never the same again.  A few years later, I left medicine.  I still feel like I was a bad doctor, nearly three decades later.

Out of context quotations are dangerous, and one recently surfaced when an Austrian woman came and spoke in Boston about the lack of free speech given to those who speak out against Islam. She spoke at a synagogue, and a person I know in Germany sent me the article.  This individual and I have very different political beliefs, although we share a concern about young women–often girls–who are forced into marriages with older men, have limited rights in their society, and can be killed by family members for not agreeing to these marriages.  These are well documented facts.

The woman who sent me the article is to me quite typical of those who are politically far right of me.  They have several common approaches.  One is to write comments with questions, rather than making statements.  A second is to send me articles, the implication (to me) that if I only would read this article I would come around to their way of thinking.  Third, they have never–that is true, the number is zero– read anything I have sent, so I no longer send articles.  A fourth characteristic is they take things out of context and often use words I don’t.  That’s how I know they are talking out of context. At a medical meeting once, I quietly asked one of my detractors  and the rest of the group if I had used a word she just had.  The room remained quiet.  The point was made.

The first article I got from the woman in Germany, a non-scientist, was that climate change wasn’t occurring.  The article, written by a non-climate scientist, good looking woman, paid by ExxonMobil, quickly stated, “Don’t let them fool you.”  Those words are not scientific, and it violated the first rule I have in dealing with those who disagree with me on science–personalization of the issue.  To a high level of confidence, we are causing climate change.  The confidence is not 100% (meaning we could be wrong), because climate is complex; but to disagree, one must offer high confidence limits that include 0, no change.  I have not seen any such articles.  I won’t discuss my other rules here.

The article about the Boston speech mentioned several men who allegedly had their rights infringed upon for speaking out.  I researched  the first man and found disturbing parts of his past behavior.  I wondered why he was used as an example.  Then the woman mentioned what “Barack Hussein Obama” had said, and my hackles rose.  Obviously, she knew Hussein is a charged word in today’s society, and she used the President’s name in a way that I consider rude, especially from a foreigner in my country.  I realize others might not agree, but to me, she was playing “loose” with Mr. Obama’s name.  I doubt Mr. Obama would care, but I did.

The quotation was “The future must not belong to those who slander the prophet of Islam,” and this was meant to imply that Mr. Obama supported those who were offended by complaints against Mohammed.

Personally, there is no love lost between me and fundamentalists of any breed, including Christianity.  Others feel differently. But I thought that Mr. Obama had said more than what was quoted, and I found the rest of the paragraph quite easily.  First, one had to recognize that the President spoke at the UN about the infamous video insulting Mohammed was circulating on YouTube, inciting violence.  That context was crucial, because it meant that Mr. Obama was criticizing the video maker, not everybody who criticized Mohammed. He continued:

“Yet to be credible, those who condemn that slander must also condemn the hate we see when the image of Jesus Christ is desecrated, churches are destroyed, or the Holocaust is denied. Let us condemn incitement against Sufi Muslims, and Shiite pilgrims. It is time to heed the words of Gandhi: “Intolerance is itself a form of violence and an obstacle to the growth of a true democratic spirit.” Together, we must work towards a world where we are strengthened by our differences, and not defined by them. That is what America embodies, and that is the vision we will support.”

This is a very different view from the first line, and the quoting out of context meant that the speaker was deliberately choosing what she wanted to choose.  This is done by many, including the man who prosecuted me for malpractice, but it is wrong, and violators need to be called out on it.  To me, the speaker had lost credibility, and I wanted to call my German contact out on it.

How I did that was difficult, but I know exactly how I must do it.   I am incapable of writing what I feel and sending it immediately.  I am an emotional person, and if I am not careful, my emotions will hijack me into using sarcasm and hurtful, non-factual comments.  In short, I become the person they often are.  I thought about the comments for three days, then I sat down and suddenly, opened the computer and wrote 1200 words–in English.  I then let the writing sit for a day, removed the anger, the sarcasm, the nastiness, stayed factual where there were facts, and translated it to German.

Eventually, she wrote me back, and I sent the article.  I was disappointed in the response, not because she disagreed, but because she did not even acknowledge my comments about context, which are as basic to arguing what people believe as statistics is to arguing whether a trend exists. My last paragraph discusses the words I use–probably, possibly, I think, I once thought, I am 95% confident, and “I could be wrong.”  These are words of science, of probability and uncertainty, of openness, of being human.

My letter to her in German is not good German, but I am self taught, and it was important to write her in her language.

Es ist nicht einfach, diesen Brief zu schreiben.  Ich bin absichtlich verschwunden, um Deinen Artikel zu denken und endlich darüber zu schreiben.  Ich war enttäuscht und ein bisschen wütend.  Wahrscheinlich würde es besser verschwinden, weil diese kürzlichen Tage sehr schwierig für mich gewesen sind.  Ich will schreiben, ohne Sarkasmus, ohne wütend, und mit allen Tatsachen.  Ich werde in meinem Brief nur zwei Fragen stellen, weil viele Radikalemenschen mir die Frage stellen mögen, wenn sie mir schreiben, und das gefällt mir nicht.  Ich schreibe, ich stelle oft keine Fragen, die ich die Antwort schon wissen.

Vor mehrere Tagen hast Du mir eine Frage gestellt (vide infra).  [Übringens habe ich gesagt: Seit 20 Jahren gab es keinen Krieg in den Balkan, nicht die Welt.  Achttausend Muslimen sind in Srebrinica gestorben.  Ich erinnere mich daran.  Dieser Krieg hat in Dayton, Ohio, mein Land beendet.  Unser Präsident war Clinton, ein Demokrat.  Es war das erste Mal, dass einen Krieg beendet wurde, mit nur den Luftverbomben.  Die Republikaner hatten gesagt, dass es unmöglich sein würde.]

 1. “Syrien?”  Es ist eine Tragödie des Menschens.  Mein Land können nicht mehr die Welt retten. Ich frage mich, ob diese Frau und Europa wollen, dass Amerika in Syrien mit unseren Soldaten, mit unserem Geld kämpfen sollen.  Wenn es viele Probleme stattfinden werden, und vertraut mir, es wird viele Probleme geben, wird man sagen, “Verdammten Amerikaner.”  Plötzlich wird niemand sagen: “Vielen Dank.”  Es hat immer stattgefunden.  Immer.  Ich bin alt, und ich habe es oft erlebt.

 2. Deine zwei Artikel haben mich beleidigt.  Ja, beleidigt. Das letzte Mal, dass ich so beleidigt war, eine muslimiche Frau, die Dagestan auskam, hat mir geschrieben, dass meine Regierung 9/11 verursacht hat.  Wieder bin ich sehr enttäuscht, und ein bisschen wütend. 

Die Wahrheit macht uns Frei.  Aber sie ist die ganze Wahrheit, nicht ein bisschen Wahrheit. Es ist sehr wichtig, der Unterschied zu erkennen. 

Sie hat “Barack Hussein Obama” gesagt.  Das ist unglaublich unanständig für eine Ausländeringaste in meinem Land zu sagen. Ja, wir haben unsere First Amendment.  Sie können sagen, was sie willst.  Wir bedürfen nicht, höflich zu sein.  Er ist President oder Mr. Obama.  Sie hat absichtlich “Hussein” gesagt, um ihre Zielgruppe zu beeinflussen.  Ich bin voll überzeugt.  Ich werde alle Opfer nicht hier diskutieren.  Ich habe ein paar schon erforscht, und ich war nicht beeindruckt, besonders der erste Mann. 

Sie hat seine Ansprache nicht im Zusammenhang zitiert.  Das war völlig falsch, und sie soll sich schämen.  Mit diesem großen Fehler kann ich ihre ganze Ansprache nicht glauben. 

Hier ist der volle Absatz.  Meine letzte Frage: hast Du dieser Absatz gelesen? Wenn ein Zitat merkwürdig erscheint, lese ich immer den Zuhammenhang.  “Ich liebe die Muslimen, die nicht zu Europa kommt” kann “Ich liebe die Muslimen” werden, und nicht mehr. Leider habe ich mehrmals gesehen.  Hier: 

“The future must not belong to those who slander the prophet of Islam (Es war sehr wichtig zu verstehen, was passiert ist, wenn Mr. Obama darüber gesprochen habe.  Es gab ein schlechtes Video auf YouTube, das von den USA auskam.  Es gab nichts mit Sabatina oder mit anderen muslimischen Kritiker(in) zu tun.  Es geht ein Video.  Du mußt  in diesem Rahmen erkennen, darüber Mr. Obama gesprochen hat). Yet to be credible, those who condemn that slander must also condemn the hate we see when the image of Jesus Christ is desecrated, churches are destroyed, or the Holocaust is denied. Let us condemn incitement against Sufi Muslims, and Shiite pilgrims. It is time to heed the words of Gandhi: “Intolerance is itself a form of violence and an obstacle to the growth of a true democratic spirit.” Together, we must work towards a world where we are strengthened by our differences, and not defined by them. That is what America embodies, and that is the vision we will support.” 

Das war der ganze Absatz.  Das ist die ganze Wahrheit.  Sie hat absichtlich das Zitat nicht im Rahmen, um die Menschen zu beeinflussen.  Ich kann ihre Ansprache nicht vertrauen.  Es gibt keinen Grund zu tun.  Meine Frau konnte es auch nicht glauben.  Man muss immer im Rahmen zitieren.  Es ist traurig, weil die Tatsachen sich sprechen können.  Sie hatte genug Tatsachen, ohne diesen Fehler zu machen. 

Ich kann verschwinden.  Wenn Du etwas diskutieren wollst, kann ich bleiben.  Du kannst entscheiden, ob ich ein wertvoller, aufgeschlossener Mann bin, mit wem Du schreiben willst.  Ich kann Dir sagen, dass ein Fundi hier gesagt hat:  Weil ein LGBT Umzug in New Orleans geplant war, ist warum Hurricane Katrina kam.  Der Gott hat New Orleans bestraft.  Ja, hat gesagt.  Oder eine Frau, die ist vergewaltigt, wird nicht Schwanger werden, weil ihr Körper eine Verwaltigung erkennen, und kann eine Schwangerschaft verhüten.  Jedoch muss die Frau das Baby haben. (32K Babys gebären nach den Vergewaltigen hier jedes Jahr).  Vielleicht wird Sabatina diese Tatsachen wissen wollen.  Oder nicht.  Ich weiß nicht, aber ich denke, dass es hier ein “Republikanerkrieg gegen Frauen” gibt, ein Missbrauch der Frauen.   

Wenn Du über Deinem Garten, über der Erde, über deine Familie, uber dem Leben, schreibst, würde es gut sein.  Alles Artikel gefällt mir nicht.  Ich habe Dir keinen Artikel geschickt.  Es ist für mich höflich nicht zu tun.  Du wirst ihn wahrschinlich weder wollen noch lesen.   Ich werde ein Artikel lesen, aber wenn ich etwas voll Unrecht finde, würde ich den ganzen Artikel wegwerfen.  Jetzt bist Du null für zwei.  Mein Brief über Syrien wird diese Woche  in The New Yorker Zeitschrift erscheinen.   TNY ist sehr wohlbekannt hier, und einen Brief ist sehr schwierig in diesem Zeitschrift zu haben.  Ich bin ein guter Wissenschaftler, Arzt und Stastiker.  Ich bin sehr neugierig.  Ich kann gut schreiben, und ich lese sehr vorsichtig.   

Endlich schlage ich die Leute vor,  diese Wörter zu lernen, dass ich oft benutzte:  “Vielleicht,”  “Wahrscheinlich,” “Ich denke,” “Ich dachte einmal, aber jetzt denke ich nicht”, Ich habe 95% Zuversicht” und am wichtigsten:  ICH KONNTE UNRECHT HABEN. Man würde gut tun, diese zu lernen. 

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THE NEW YORKER LETTER

June 23, 2013

One has to be a writer to appreciate fully how we want to get our work accepted by the top publications in the world.  The New Yorker has a circulation of over a million.  The articles are extremely well written; I have long been jealous at the medical writers, who put me to shame.  But I read every word they write.  A very good friend, writer, and neurologist helped me write A Wise Owl, which won me the Creative Expression Award for Human Values in Neurology 10 years ago.  His goal was to get a letter published in the magazine.  Sadly, he died before that could happen.

I don’t set out to write letters to get published.  I read something, and if it connects with me in some fashion, I write.  It is difficult for me to do so, because I am under a time pressure, which adversely affects my writing.  I am under a word pressure, too, but I have learned to cut words.  Some will say, “You should have said such and such.”  Maybe, but if the letter is too long, it will never appear, so all the wisdom is lost.

The current letter had to do with an article about Syria.  I thought Senator McCain, who represents me in the Senate, was allowed too much space and did not see the same picture I did.  I thought maybe I had something to impart on the debate, so I wrote.  I never expected anything to come of my letter, but last week, I was told it was a “finalist,” which gives one some idea of how difficult it is to get writing into the magazine.  I said to my wife that I got lucky, but both of us realized it wasn’t just luck.  I get a high percentage of my letters to the local newspaper published, because I pick my battles carefully and keep the letters short.

 

Filkins reports that Senator John McCain has pushed for military intervention in Syria. But I doubt Republicans in 2013 will tolerate “emergency authorizations,” even if they raised no objections to these off-budget costs a decade ago. Indeed, overruling a national security team might show more wisdom than McCain might think. President Obama overruled his Secretary of Defense in 2011, when he authorized the raid that killed Osama bin Laden. Obama is weighing morality, costs, and unintended consequences of another conflict after learning the hard lessons of exiting the military morass in Iraq and Afghanistan. Perhaps he is heeding the proverb, “The more we sweat during peace, the less we bleed in war.” 

Michael S. Smith

Tucson, AZ

 

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BELIEVING IS SEEING

June 14, 2013

My wife read a CT Scan of the heart recently, done to check coronary artery calcification, and told the referring physician the patient had breast cancer.

Whoa!  What does that have to do with heart disease?  The answer: nothing, and that is the point: we need radiologists to read films formally and not clinicians, and I say that as a former clinician who read CT head scans really well.  It’s fine for a medical group to have its own X-Ray facility and for clinicians to read the images.  But every image must have a formal reading by a radiologist, for that individual is both unbiased and trained to look at everything on the image, every corner, every part.  There is no law in nature that says a person will have one thing wrong.  It is entirely possible for a neurologist to look at an MRI of the spine and miss a large abdominal aortic aneurysm.  We see what we expect to see.  Seeing isn’t believing.  Believing is seeing.  We believe something, and we tend to look for it.

On a CT scan, there is a side view, which shows the skin.  This isn’t a mammogram, but it certainly is capable of showing a breast cancer.  In addition to the breast cancer, there was a “ground glass” area in the lung suggesting there might be an early lung cancer, too.  Wow. A CT scan of the heart is done for coronary disease, and two other systems have primary cancers.  Maybe the cardiologist would have found those, but I doubt it.  I doubt when I read CT scans of the head that I would have found a throat cancer, even though the throat was scanned and on the film.

In my defense, I was once sent a patient with leg pain, with a concern that this was due to pinched nerve in the back.  The lady had pain near the knee, but it was point tender, and I obtained a bone scan, looking for a fracture.  I found a hairline fracture of the proximal  tibia.  I got a lot of pleasure diagnosing something correctly out of my field.  Most specialists do.  There is a cardiologist in town, whom I met 31 years ago when he was new here.  I had seen a man in the emergency department who had driven 2500 km to Arizona and presented with sudden, brief unconsciousness.  I saw him and noted he seemed to be breathing a little faster than normal.  I obtained an arterial blood gas and found pronounced hypoxia.  Thinking that a cardiac arrhythmia would cause unconsciousness (strokes seldom do), and thinking of pulmonary emboli as a cause of both that and hypoxia, I did a lung scan, since that is what we did back then, and there were pulmonary emboli, because of leg clots that occurred during prolonged sitting on his drive to Arizona from Minnesota.  The cardiologist happened to be present, and I referred the patient to him.

Several years later, one of that cardiologist’s partners referred a patient to me on whom he had diagnosed an occipital lobe infarct.  For a neurologist, that is not difficult, but I was impressed the cardiologist had picked it up.  Most non-neurologists miss it.

So when the MRI of my neck was unchanged from 9 years ago, that was good news, I was a bit chagrined, however, when the radiologist told me that I had a significant thyroid nodule.  It never occurred to me look for thyroid disease on my MRI.  It is sort of like people’s being surprised when I tell them the Moon is visible in broad daylight.  “It is?” they say.

“It’s there, isn’t it?”  I reply.  The thyroid nodule was quite present.  Once I looked, there it was, plain as can be, like the first quarter Moon in the southeastern sky in the afternoon.  Try finding the Moon in daylight, sometime, if you haven’t seen it.  You will discover a whole new world–literally., and wonder why you never noticed it before.  That’s the problem.  We notice only what we are willing to notice.  Once we are willing to notice many things, a brand new world opens up to us.  Like the Moon, or even Venus, which you can often see in broad daylight, if you know where to look.

Look around you.  See, smell, touch, hear, and taste the world.  Notice things.  Life becomes very interesting when you do.

Even when you have an “interesting” thyroid nodule.  By the way, it was benign.

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“THIS CAN’T BE HAPPENING TO ME”

June 8, 2013

Last week, an elderly couple, experienced canoeists, capsized in Upper Basswood Falls, which straddle the Canadian border, and the 78 year-old man drowned.  His 75 year-old wife made it to the Canadian side.  She heard him say, “I can’t move,” but was unable to help.  I can imagine that.  Ice out was 3 weeks ago, and she probably was hypothermic.

I don’t like Upper Basswood Falls.  Never have.  A couple once left their young daughter at the end of a portage, while they returned to get the remainder of their gear.  She fell in the river, and that was the last time they saw her alive.  I was there on September 12, 2001, and that’s where I first heard the news that the world had changed forever.  In 1991, I did one of the most stupid things I have ever done in the woods.  Solo, I was coming upstream, on the Canadian side, and moved forward in the canoe to deal with the current.  I later learned that there are three things that a solo canoeist cannot manage:  wind, muck, and current.  I was  thrown out of the canoe, without its capsizing.  I found myself suddenly underwater thinking “This can’t be happening,”  usually the first thought people have in these circumstances.  It isn’t a good one. Quetico maps often don’t show portages, and when I went ashore, there was a short carry.  Fortunately, the water was warm, and all that was hurt was my pride.  I could have drowned, because back then I didn’t wear a PFD (Personal Flotation Device), either.  I know that, because I was underwater, which wouldn’t happen with a PFD.  I made two bad decisions and got away with them.  In 40 years of canoeing, it is the only time I dumped.  I’ve worn a zipped up PFD since, for it cannot come off.  The victim was found without one.

Upper Basswood Falls is not a waterfall but a series of falls, and there is a long portage around them.  The Horse Portage, as it is called, is 340 rods (1700 m).   It is longer, should one choose to set in downstream a little further, which I have also done.  The trail is not good, and the put in spot isn’t, either.  But in high water, it is safer.

The couple had reportedly discovered they could paddle Upper Basswood Falls and avoid the Horse Portage. The thought of bypassing the Horse Portage has never crossed my mind, and I’ve paddled 5 miles (8 km) of Class III rapids in the Far North on the Nahanni, a week’s travel from civilization and no way out other than on the river. This information shocked me.  A solid rule in the Boundary Waters-Quetico is never to paddle rapids if a portage exists.  In known high water, with 3 feet of snow on the lakes a month earlier, probable water temperatures of 45-55 F., Upper Basswood is a killer.  The widow isn’t sure whether he scouted the rapids; that means that both of them did not decide together whether to continue.  In any case, he took a different channel from usual, and that was that.

A few people die annually in the Boundary Waters-Quetico from falls or drowning; lightning is another cause.  Rapids must be avoided; further downstream I once tried to dissuade a pair not to run Wheelbarrow Falls.  They asked me to take pictures.  I have some good ones, which first show the pair with no helmets and bare feet.  Not wise.  Then the pictures show the canoe tipping, going broadside, and two guys in the water being taken downstream.  They survived, unscathed.  The canoe was perpendicular to the rapids, full of water.  They said they could handle it, although a canoe full of water weighs about 600 kg.  I later learned they did get the canoe out, before the keel bent and the Grumman became scrap metal.

I told my wife last night I would never stay on shore if I heard her say in the middle of the river, “I can’t move.”

“I’d get you out, or we’d both go together.”  I really meant that.  She reminded me that we have animals.  I reminded her that we have each other.  I wouldn’t live with myself if I did anything less.  But, I said, “I wouldn’t put us in that situation.”  I won’t, and I haven’t.  I hope to be 78 and still canoeing, although I would be exceptionally careful in rivers, high winds, rain, and thunderstorms.   I insist she speak up any time something doesn’t seem right.  That took a while to get her to do, and for me to listen, but we’re better off for it. The man’s widow didn’t know if he had a life jacket on.  If I forgot to put mine on, my wife would tell me.  These are little things, perhaps, but in the woods, as in so many other places, it is the concatenation of little things that produces the disaster.  Was the reason the victim couldn’t move was that he was pinned down?  Would a PFD had prevented it?  We will never know.

Bad things happen.  Some are simply not preventable.  Lightning strikes kill, although if one pitches a tent where there are no tree roots and uses a pad, there is a good chance of avoiding ground currents.  Trees fall;  high winds are frightening, because healthy trees can be suddenly splintered like matchsticks.  I’ve seen it.   I will sleep during a thunderstorm; during high winds, I stay awake listening for the first loud “CRACK,” for once I hear it, we are out of the tent, until the wind dies down.  The BW had a derecho in 1999, wiping out 30 million trees.  Incredibly, nobody was killed.

Fire is another concern, and even small “distant” fires can blow up into monsters, which almost killed a pair in 2011, when the Pagami Creek fire ran 12 miles in a day, and the couple had to turn their canoe over in a river, stay underneath it, breathing the air that was there.  Getting caught in a fire that day was nothing anybody could have foreseen.  The couple survived a freak occurrence by doing the right thing.

I am not afraid to solo.  I did that in April in snow into Angleworm Lake.  Or almost.  The snow got too deep, the trail difficult to find, and the map showed more distance left than I had hoped for.  I didn’t spend time analyzing; I automatically turned around to return to a known dry spot on the trail that I had noted on the way in.  I was fine.  What I told my wife after the trip was simple:  “I think this was the smartest I’ve ever behaved in the woods.”  But being smart just makes the stupid things less likely to occur; freak occurrences and unexpected illnesses are wild cards.

I’m sure some might say that dying in the woods is not the worst way to go.  Maybe.  The problem with dying “doing what you loved,” is that people who love you are left behind, and others often have to put their lives at risk to recover your body.  It is clear if I am ever in the position where death is a real possibility, there is a good chance I did something wrong.  I’d like to think if I got on a river that was unusually high, a lake with huge waves, or a thunderstorm that looked really bad, I would tell my wife we were going to stop to think about our options.  Nature isn’t out to kill us.  Nature just is.  We decide whether we run rapids, deal with waves, lightning, bears, and falling trees.

It’s a real shame what happened.  I never dreamed an elderly couple would shoot the beginning of Upper Basswood in spring.  I’m just filled with sadness, hoping some learning will come from this.

If there is one, only one rule I would tell people in the woods, it is this:  if you aren’t certain what to do, stop immediately and think of your options, remembering the best one likely is to turn back or change what you are doing.  It may be inconvenient and annoying, but you will survive to have those emotions.

If you allowed me a second rule, it would be this:  “Nobody ever drowned on a portage.”

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DRESSING UP A PIG

June 1, 2013

In 1967, when we began heavily bombing North Vietnam, we called it a “protective reaction.”  Doonesbury asked “what are the casualties?”  The answer, in the same cartoon, was, “On language, very great.”  The following year, we heard, “We had to destroy the village in order to save it.”  We use derogatory terms I won’t write here to de-humanize an enemy, since it is easier to kill somebody one doesn’t think is human.

In many instances those somebodies are women and children.  Let’s start with circumcising women, which I will call by a proper name: “Genital mutilation.” This has no medical reason, unlike male circumcision, which completely prevents penile cancer and makes HIV less prone to be transmitted.  I don’t remember mine, and I don’t believe it caused lasting harm, but I am open to evidence on the latter, just not the former.

I read recently that Reuters refuses to use the term “Terrorists,” and the Associated Press now refuses to use “Islamic terrorists” or “illegal aliens.”  This is equally bad as dehumanizing an enemy.

I’m a liberal, but I am a strong believer in using the proper word to describe a situation or condition.  An improper word or phrase, used frequently, can become harmful if it becomes ingrained in the vocabulary.

Examples of the latter include “The Death Tax,” which is the estate tax.  There is a threshold over which the estate is be taxed at about 40%.  The threshold varies and is now $5.25 million. The proper term is “Estate Tax.”

“Death Panels” were used when during the debate on the Affordable Health Care Act (called Obama Care, another misuse of the language, since the Congress passed the law, and the Supreme Court upheld it).  One part of the bill was to have Medicare pay for counseling on End of Life planning.  As a neurologist who dealt with end of life issues, often when no other physician was willing to do so, I found that lack of advance directives was a significant impediment to decision making families had to make, when a member had irreversible brain injury.  I saw families torn apart over the issue.  Paying to have these discussions with competent people in advance seemed to me to be a good use of money, since the amount was 1-5% of the cost of one day in intensive care, and many of these people languished, and that is the proper word, in intensive care for days, weeks, or in some instances months. I saw this often.  Many elderly want their estate going to their offspring, not for futile, unwanted care. ICU beds are in short supply, so having them used to house patients who were going to die soon, when seriously ill people could benefit from those same beds, made no sense.  I made sure neither of my parents lingered.  They made me promise not to let it happen to them.

I practiced in a Catholic Hospital, and the Church had no problem with discontinuation of futile care.  Nor should anybody else.  I used terms like “die,” and “death”, hard words, but final in meaning.  “Expire” is too soft, and “pass on” implies something I don’t believe in.

Some of the terms we use would be funny if they weren’t so pernicious in their ability to dress up a pig in such a fashion that people forget it is still a pig.  “Pre-owned” means “Used”, half the letters and twice as easy to understand.  “Fastest growing” is another term for “smaller,” since large firms need proportionately more money to grow a given per cent. If my firm grosses $1 million a year, and next year it grosses $1.1 million, it has grown 10%.  If my competitor grosses $100 million a year and next year grosses $105 million, his has grown 5%, but his share of the market has increased nearly 4%, from 100/101  to 105/106.1.  The amount of new business in the market has increased $5.1 million, and nearly 98% of that increase went to my competitor.

We can say “undocumented immigrants,” and the term is correct.  But people who cross borders without going through customs and immigration are violating the law.  That is why we have the word “illegal.”  There may be all sorts of reasons for the person to do so, and there may be appropriate words for those reasons–fleeing a repressive regime, starvation, an epidemic of disease.  But the person is still performing an illegal act.  Whether the act is immoral is another matter altogether.  We saw during the last financial crisis that people did immoral acts that were not necessary illegal.  We should not confuse immoral and illegal.

Beheading a British soldier in broad daylight and saying that his country is responsible for killing millions of Muslims daily is a gross act of religious terror and exaggeration.  [Mathematical note:  “millions of people daily” would require about 5 years to have no Muslims on the planet, using a minimum number of “2” for the plural and 2 billion for the number of Muslims.  This error was not brought out in any article.]  Terror scares people, and that act scared the hell out of me.  Since this was a brutal act carried out in the name of religion, both the act and the modifier belong. I fail to see why Reuters won’t use the term.  Indeed, a mullah interviewed on British television refused to call the beheading an “abhorrence,” using only the word “shocking,” which is far milder and has many different meanings.  Abhor is very clear, and the man refused to use the word.

My liberalism has limits.  When I saw Corregidor, the American Cemetery in Manila, the prison where men drowned during high tide, I felt strongly that we had a place in the world that we had earned through the blood of men who fought and died in places not many people know of today, like Guadalcanal, Tarawa, Leyte and Lingayen Gulfs, Bataan, Kwajalein, Enewetak, and Saipan.

The issue we face as a country is how we deal with a very nasty world without compromising our values.  For if we become what our enemy is, then we have lost.  But if we allow the enemy to proceed without resistance, then we have lost as well.  The world is not black and white but a large shade of gray.  Any time the gray hides something evil, we need to shine a spotlight on that evil and address it.

With a carefully chosen word or phrase, because it is proper, regardless of who may be offended.

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