Health Care Rationing and Death Panels

Sarah Palin got a lot of attention when she claimed that the Affordable Care Act would result in “death panels.” Like many partisan issues, liberals immediately defended the ACA, while conservatives flocked to Ms. Palin’s side. As in many cases, both sides missed the mark—and an opportunity for having a productive discussion. “Death panels” have recently been resurrected from the political grave now that Republicans are beginning the ACA rollback. We shouldn’t miss the opportunity this time to discuss the realities of the healthcare system.

Ms. Palin was right, in a sense, when she said that the ACA would set up “death panels.” She was right in that there would be a government mechanism—perhaps a panel, perhaps regulations, which would ration health care and would inevitably end in people living or dying. She was wrong to insinuate that this didn’t already exist in some form and that there was some way to organize health care so that rationing care wouldn’t exist.

All health care systems ration care in one way or another. They must. No system can afford to pay for all treatments for all people. So there has to be a mechanism for deciding who gets what—which patients will receive which treatments. This is an uncomfortable reality for most people, but it’s a reality nonetheless.

We already do this with organ transplantation. There are medical criteria for being placed on an organ transplant list and certain criteria which can prioritize one case over another. This is because there are more people who need transplants than organs available to transplant.

We do this at the insurer or payer level with specific medications or treatments. In 2014 Gilead Sciences released Sofosbuvir, a breakthrough medication which effectively cured Hepatitis C (HCV) faster and with fewer side effects than any other therapy. The aggregate cost of a Sofosbuvir treatment, however, often exceeds $100,000[1]. Due to the high price point, insurance providers and public health-care systems (Medicare, Medicare, and the VA) are reluctant to pay for it if there’s any other option. Due to this, Sofosbuvir was placed in a special category of medications which required “Prior Authorization,” meaning that before this medication could be prescribed, it needed to be approved by the insurer.

Three of the largest healthcare providers—Humana, Anthem, and Aetna–all have published requirements that state that patients must be in an advanced state of liver disease before treatment with Sofosbuvir can be approved. Advocate groups say that requirements which do not to allow patients to receive the newest, best treatment available (there are other treatments available for HCV) are cruel. Insurers say that they are trying to prioritize their spending on the most critical patients. Both of these are legitimate concerns.

The question we should ask as a country is not: “Should care should be rationed?”; because care has to be rationed in one way or another. Rather, the questions we should ask are: “Who should be making these decisions?”—and—“By what criteria should they be made?” In a single-payer health system, the government does the rationing. Government boards, panels, and regulatory bodies decide which patients will receive priority spending. In a pure free-market system, the rationing is done by the market, based on whether someone can afford the care they need or want.

Currently, in the United States, we have evolved a complex economic and financial apparatus to handle this fundamental problem of health care. This system, which certainly has downsides, does have its benefits, mainly that (a) no individual is forced to solely bear the cost of their care; and (b) no single organization has total control over the market. It’s an interaction between insurance companies, government agencies, hospital systems, and vendors (such as pharmaceutical companies).

This discussion, however, makes many people uncomfortable, because the idea of telling someone who is sick, “No, you can’t have that care,” is distasteful and uncomfortable. The priorities of the society and the individual are often not the same. As an individual, my life has infinite worth, and I would be willing to spend any amount of resources to preserve or extend it. To society, however, my life has finite worth, and society is not willing to spend unlimited resources on my health care.

This friction between society and the individual is at the heart of our society and is nowhere better embodied than in the health care debate. An ideal policy should balance the interests of the individual and the collective, with clear boundaries to which everyone understands and agrees. The only way we can reach that balance is a frank and honest discussion of the realities involved. Using emotionally charged terms like “death panels” doesn’t help, but neither does pretending that any one policy is a panacea which will provide all things to all people.

[1] Gilead priced Sovaldi at $1000 per 400 mg pill, which as part of a 12-week treatment course costs $84,000 and as part of a 24 week, treatment course costs $186,000. Sovaldi is most commonly prescribed as part of a treatment plan including other drugs such as Peginterferon-alfa, or Simeprevir (Olysio) which cost, $9,250, and $66,360 per treatment course respectively. When the price of Sovaldi is considered alongside the costs of medicines it is prescribed with, the aggregate treatment cost will often exceed $100,000 per patient.

Note: This was originally published by Wine With Cheetos on March 25th 2017 under the title “The Unavoidable Realities of Health Care”

Original Link: https://winewithcheetos.com/2017/03/25/health-care/

Lies, Damn Lies, and Statistics: Refugees and Terrorism

When President Trump issued his executive order on immigration, it reignited the issue of Syrian refugees, and the popular statistic “you only have a one in 3.64 billion chance of being killed by a refugee”[1] began circulating widely on social media.

This statistic, while factually correct, is severely misleading when used out of context. Advocating using it as a driving force behind public policy grossly misunderstands both probability and how probability is used in security policy.

It is important to look at this in its wider context: “you have a one in 3.64 billion chance of being killed by a refugee.” There is a significantly higher chance that any given refugee is a terrorist (one in 162,625). These are reached by calculating together that out of 3,252,493 refugees admitted to the US, 20 were terrorists. Between those 20, they succeeded in killing three Americans. The total deaths were divided by America’s population since 1975 to reach one in 3.64 billion[2].

It is misleading to rely on historical data alone for determining the probability of a future event. FEMA training and guidance warns directly against this practice.

“Communities should take care to not over-rely on historical averages or patterns that may give a false sense of likelihood,”[3] the Department of Homeland Security warns.

Historical data is remarkably bad at predicting the future, especially aberrations like terrorist attacks. Prior to 9/11, the “likelihood” that 19 foreigners would be able to destroy the World Trade Center and directly attack the Pentagon would have been effectively zero. It happened nonetheless.

Estimating probability (or likelihood) is also only one part of the process for determining risk and creating policy. Other values are weighed, including consequence and vulnerability. If something is highly unlikely but would have a catastrophic consequence, then it’s assigned a high-risk value despite being very unlikely.

The part of the discussion that always gets glossed over is that there is a risk inherent in the refugee system (or letting any foreign nationals into the country for that matter), and there always will be. We know that terrorist organizations are attempting to embed their members in refugee and migrant groups to get them across western borders[4]. No amount of extreme vetting as the President advocates will eliminate that risk, better processes can decrease it, but not eliminate it.

The conversation Americans should be having is how much risk is acceptable. Policy and law are not made in a vacuum. Homeland security wonks are not appointed philosopher kings, allowed to create national policy at will because there are other things Americans value alongside safety and security.

Americans need to have a continuing national conversation about those values, and about how much risk we’re willing to tolerate towards humanitarian ends. Using statistics like “one in 3.64 billion” as “empirical” proof that refugees pose little risk to Americans is misleading and a tool for shutting down the conversation. It serves no purpose other than leaving the brandisher of the statistic self-satisfied in their own intelligence, and the person on the receiving end silently indignant having not changed their mind. Ideally, leadership would come from our elected representatives on honest discussions of national values and acceptable risk- but it doesn’t seem likely that that will happen.

[1] http://www.politifact.com/california/statements/2017/feb/01/ted-lieu/odds-youll-be-killed-terror-attack-america-refugee/
[2] https://www.cato.org/publications/policy-analysis/terrorism-immigration-risk-analysis
[3] https://www.fema.gov/media-library-data/8ca0a9e54dc8b037a55b402b2a269e94/CPG201_htirag_2nd_edition.pdf
[4] https://www.washingtontimes.com/news/2017/jan/29/isis-finds-success-infiltrating-terrorists-into-re/

Note: This was originally published by Red Alert Politics on March 3rd 2017 under the title “1-in-3.64 billion chance of being killed by a refugee? Believe that at your own risk”

Original Link: http://redalertpolitics.com/2017/03/03/1-3-64-billion-chance-killed-refugee-believe-risk/

Barroom Conversations: Reflection on 3.5 Years

Yesterday I was sitting at a bar with four of my best friends since my very first semester at DeSales. This morning I took my last undergraduate final. This afternoon I had dinner with two of my best friends who I’d only become close with over the past six or so months. This evening I moved out of my college dorm for good and drove back to NJ. Life comes at you fast, and sometimes you need to step back and let it unravel. This is a reflection on my time at DeSales. It’s overly long and self-indulgent, and there isn’t really a point to it per say- just to put some things down on paper at a milestone in my life. I am sure there are typos here, I’m fixing them as I find them, grammar is not one of my strong suits

It’s often said: the worst thing about DeSales is that it’s so small, everyone knows everyone and everything. But I’ve come to realize, that the best thing about DeSales is that it’s so small, everyone knows everyone and everything.

It’s a significant cultural adjustment starting your Freshman year at any college, let alone DeSales. Not only are you all of a sudden on your own, no parental supervision, but you’re also thrown into a community of a couple thousand, which for most of us is a small fraction of the size of towns and cities where we grew up. We all came to college, with a vague idea of what it was going to be like, something like a fresh start than a four-year party.

I never so much got that “fresh start” after high school, I came to DeSales with five other people from my (small) high school. I couldn’t really reinvent myself overnight because I was around people who knew me. I was frustrated by this for a while, it felt like I had been cheated of a “quintessential college experience” by having stories from high school follow me to college, and not being able to become a new person on freshman move-in. These people from high school, especially my friend Gerry, kept me accountable when it may have been tempting to embellish or gloss over bits of high school.

Beyond just the “fresh start” part of that college mystique the high school students buy into is not just that college is one big party, but that there are no strings attached. The way college is portrayed in pop culture is that it’s a libertine “find yourself” and “experiment with everything” environment. I was quickly disabused of this notion my freshman and sophomore year. You don’t get to go around willy-nilly doing and saying whatever you want with no social consequences. You will, and I did, get a particular reputation around campus. People will know what happened last weekend. People will know you and your girlfriend are fighting. People will know who hooked up with who. There are no real secrets. People swap stories like social capital especially at a school this small. You can’t just “disappear” into a crowd.

I’ve told prospective students more times than I can count: DeSales is what you make of it. If you want to party, there is certainly a nightlife. If you want to have a chaste, temperate, college experience, there’s ministry community at a lot of folks who come here for that kind of lifestyle. If you want something else, or a mix of the two, there’s just about every imaginable lifestyle in between. I certainly made a choice my freshman year, and freshman year was one long party for me. To paraphrase Clint Eastwood’s character from Heartbreak Ridge “I’ve drunk more beer… and pissed more blood and stomped more ass that all of you numbnuts put together… You men do not impress me!” I thought I was quite the swinging Richard my freshman and sophomore years, so it was only fair that over my junior and senior years life would knock me down a few pegs.

In a lot of ways, I think I peaked my sophomore year. Sophomore year is what I reminisce about when I think “college”. I was a sophomore who thought I ran the damn school. I was in a relationship with a beautiful, fun, woman, a relationship I found fulfilling. I had two part-time jobs and more money than I knew what to do with. I went out almost every weekend, some of my best party stories are from sophomore year. I thought I was going to go to law school. Things made sense, but what I realize, looking back, is that it was just an illusion. I thought I had everything together because I was faking it. The plans I had weren’t realistic, and the life I was living wasn’t sustainable. I broke up with my girlfriend. I quit my job. I lost my focus academically. I fell away from my friends a little, I spent my first summer since middle school largely unemployed. While everything was in reality crumbling, from the outside it looked like I had it all together. I was taking over as the Captain of DeSales EMS, I had been officially hired as an RA, my grades were great. I learned that having direction and purpose was more important than having a title. Leaving sophomore year, I’d collected a lot of titles, resume boosters, but I’d lost my purpose, and I felt very alone.

Junior year is, I like to think, the year I really grew up. It had its ups and downs. At first, I loved being an RA, I met lots of new people, made new friends, turned 21 in December. By the winter the bloom had come off the rose. I had fallen into some old habits, being an RA had crushed my spirit, I had a surgery, and did some things I wasn’t proud of. I was very unsure of who I was or what I was doing. I realized I didn’t really have a good reason for a lot of the things I did, I just acted on impulse a lot.

The second semester Junior year made me the person I am today, I think. It taught me the influence of randomness, of “black swans” on my life. We like to think that we’re in control, and the modern world gives us that illusion. But we’re not, “No matter how sophisticated our choices, how good we are at dominating the odds, randomness will have the last word”. Sometimes in life, a person, or event, comes through like a wrecking ball, shattering that illusion of control, reminding us that we’re all victims of chance.

At the risk of sounding cliché, I met a girl. We met in February 2016, and over the next six months give me the highest highs and lowest lows. It was very much an on again off again relationship, and like most relationships existing in the real world, doesn’t really fit into any of the standard molds of relationships, so I’m going to decline to try to describe it in too much detail. I could draw parallels to songs, movies, and literature, to try and explain it, but I’ll spare you being that vomiting inducing. Suffice it to say, it was a relationship that simultaneously made me feel like a kid again, and like the man I didn’t know I wanted to be. The relationship ended, but like most things, its lessons endured. I walked out of my Junior year with everything together- and a different outlook on life. The summer of 2016 was probably one of the best of my life- I didn’t work, but I was seriously happy for the first time in a long time.

What I mean when I say I was happy is this, that I didn’t just have momentary blips of not being unhappy, but I was just in a pleasant state most of the time. I’ve found that the best measure of my own happiness is where my mind goes when left unsupervised. If when left to wander my mind goes to happy memories and positive aspects of my future, then I consider myself happy. However, when my mind goes to unhappy memories and an uncertain future I consider myself unhappy. For the summer, I was happy, I reached a kind of zen for a few short months.

Most of my time at DeSales, I hated that I had picked a school this insular, with this much gossip. There are only a handful of undergrads, walking into senior year, I could give you the nickel version of pretty much anyone, my characterization of them very well may be inaccurate, but there aren’t a huge number of people about whom I could say “yeah I have no idea who that is”.

People will often lament “DeSales is just like high school”. One of my friends recently said after getting her first internship in a “real” workplace, “the world is just one big DeSales!”. So it seems, just like in the Bowling for Soup song, High School really doesn’t ever end. Many of the things people criticize DeSales for really aren’t DeSales specific problems, they’re just part of life. I often wished I could get away from my problems, get away from my reputation, get away from my past. By the time I was a senior I had two failed relationships with DeSales students under my belt, along with a line longer than I’d like to admit of dates, courtships, hookups, or as college students would put it: people I had a “thing” with or had at one point “talked to”. Add on top of that three years of baggage, arguments, rumors (true and false), and people I had met in a negative way, either through my role as an RA or an EMT on campus. Being at DeSales just seemed frustratingly complicated at by the beginning of my senior year.

At DeSales, as in life, you can’t just run away from the things you’ve done. I’m only coming now to realize how valuable that is. If I was at a school where I could easily escape any of the stupid or questionable things I’ve done, I would be nowhere near the person I am today. Just learning how to be around people you don’t like or don’t want to be around is an incredibly important life skill.

Being constantly surrounded by people you know forces an intense self-awareness. When someone has a poor opinion of you, you don’t have the luxury of brushing is off and avoiding them. The luxury of saying off the bat “well… that’s just like… your opinion man”. You have to confront and seriously consider what other people think of you. This is at times a painful process but real self-examination always is. You may decide at times that a person’s opinion is junk and they’re just being an ass (these people do exist, surprising I know), but it’s important to consider what they’re saying because it will follow you. You may refute what they say, you may think they’re wrong, but you can’t just stick you head in the sand and pretend they’re not saying it. I can say I am without a doubt a better person because of that self-awareness I’ve gotten from DeSales. I hated it for a long time. I hated that certain people on campus looked at me as an irresponsible, womanizing, typical college guy. I hated that some people looked at me as a self-important know it all. I hated the opinion my ex(s) and their friends had of me. For a long time, I stuck my head in the sand. But to paraphrase a comedian whose name I don’t remember, “when somebody says you’re an asshole, you don’t get to decide they’re wrong, it’s not up to you”. I hated it because a lot of people had limited interactions with me, and I felt were drawing unfair conclusions from incomplete data. I really thought I was more than all that, that I was a good person.

This eventually (after too many years) forced me to confront two things. First, that while I thought I was a good, decent, personable guy, the way I was presenting myself sometimes didn’t reflect that. Second, I wanted everyone to reserve judgment on me until they had really gotten to know me, meanwhile, I was the king of making snap judgments about someone after hearing something about them or having one interaction. I wanted everyone else to give me the benefit of the doubt, however, believed that my gut judgments on people’s character were always accurate.

I realized all this, and then realized how many “enemies” I had made by simply refusing the recognize that other people may… actually be humans who have bad days or complicated lives like me. I remember saying to one of my friends a few months ago in the midst of extreme frustration with this school that “there’s nothing left for me here, I just need to get out of this place, move on to what’s next”. I wanted a clean slate. I wanted to leave all of the baggage behind. It was only late in this semester, my last semester, that I realized far from there being nothing for me here, everything for me is here.

My last semester I started to consciously be friendlier and approachable to everyone, including those I thought I disliked. I reconnected with people who I had falling outs of varying varieties with. I met people and interacted with social circles I had previously dismissed as “too this” or “too that”, or people I had just decided I wasn’t going to like. I took ownership, really for the first time, of ways I had mistreated people around me, and I let go of grudges I had been holding for years. Granted “taking ownership” of having not treated people with the dignity they deserve, or “letting go” of a feud doesn’t excuse anything or make that history go away. I don’t get to decide “well I’ve forgiven myself on your behalf for acting like an ass”. But it is a step in the right direction. These things did me no good to cling on to (yeah I know I’m starting to sound like a pop self-help book you bought at a thrift shop, trying to bring it around).

I was amazed by how quickly these interpersonal conflicts I had built up into mountains in my head reverted to the molehills they were once I stopped playing into them. Why I was still ignoring and avoiding people who I had some kind of argument with 3 years ago is really beyond me. Ok, actually I do know why. I was playing into these conflicts because it was fun, well, maybe not fun, but it was something to do. Acting like I was some Game of Thrones character, playing interpersonal politics gave me something to do. There’s something addicting about having “enemies”. About being able to say; “Oh that height/ sports team/ group of friends/ major doesn’t like me, and I don’t like them”. Having “enemies” makes you feel like kind of a badass, makes you feel good in a weird way. None of this is good, or healthy, or productive, but it is, that’s the way I am, or people are. Once I stopped pretending I had enemies around every corner, the way this campus looked to me changed. It revealed the great diversity and tremendous amount of human beauty at a place people complain about being homogenous and tiny.

It took me years of being the awkward loner in the corner, a surly introvert to realize that I like people, being a part of something, a community. The worst things about DeSales are also its best things. The reasons for hating it are also reasons for loving it. To quote Chesterton;

“The point is not that this world is too sad to love or too glad not to love; the point is that when you do love a thing, its gladness is a reason for loving it, and its sadness a reason for loving it more. All optimistic thoughts about England and all pessimistic thoughts about her are alike reasons for the English patriot.”

We say we hate this school. We bitch and moan constantly. We all say we wish we had gone somewhere else, and most of us at one point had serious thoughts about transferring. But there’s something that keeps us here, there’s a part of us that loves it here. I know what kept me here, and it wasn’t the academics, the athletics, or the sunsets, it was the people.

I realized that this terrible little school, with its terrible people, represents the best parts of humanity. I realized all this, just in time to leave it. I was the guy for years who would act like an angsty nihilist teen, say, quoting Bukowski, “I don’t hate people I just prefer when they’re not around”. I realize now, I didn’t like people, or community because it’s hard. People are difficult, and instead of trying I would just withdraw inside myself and segregate myself. I realized years late, that I love people. I love the diversity of thought, I love connecting with other human beings,

I want to love my neighbor not because he is I, but precisely because he is not I. I want to adore the world, not as one likes a looking-glass, because it is one’s self, but as one loves a woman because she is entirely different. If souls are separate love is possible. If souls are united love is obviously impossible. A man may be said loosely to love himself, but he can hardly fall in love with himself, or, if he does, it must be a monotonous courtship. If the world is full of real selves, they can be really unselfish selves.

I got the clean slate I wanted. I didn’t get it by moving somewhere new where nobody knows me. I got it by a change in attitude. I love this community, and leaving it now, having just realized that, is one of the hardest things I’ve ever done.

 You matter, your life matters, and what you make of it. But you can only make something of your life if you realize others matter more -Roger Scruton

I often wonder, what my legacy will be at this school once I’ve gone. Everyone has a legacy after they leave. Everyone leaves an imprint on the people they’ve interacted with. I wish I was naïve enough to say I’ve had a uniformly positive impact on those around me, but I’m more self-aware than that. I know what it feels like to have your heart ripped out of your chest by someone you trust, and I know what it feels like to do that to someone. Even in the last couple months having taken a less cavalier attitude with other people’s feelings, there are a couple relationships with (now former) friends that I seriously f’ed up. At the same time, I’ve met so many great people in the last two semesters who I wish I had met years ago, people who I feel like I didn’t get enough time with. But I don’t know if more time is it, I could probably spend a lifetime with these people and still want more. Leaving friends who I’ve known since freshman orientation, who I’ve spent most of my college career with, felt like it was too soon.

One of the more enduring quips from JRR Tolkein’s Fellowship of the Ring is Bilbo Baggins speaking to his neighbors at a party, saying “I don’t know half of you half as well as I should like; and I like less than half of you half as well as you deserve”. This is how I feel leaving DeSales, leaving all my friends, classmates, coworkers, associates, whatever words I should use to describe my relationship with the people here. Having said a lot of goodbyes in the past week I began to acutely feel the passage of time. It was only when it was coming to an end that I realized how much more I wish I had done.

[H]e does not belong to it, or to any place; and the proof of it is this, that he thinks of [it] as a place. The moment we are rooted in a place, the place vanishes. We live like a tree with the whole strength of the universe.

I am rooted to DeSales, and it was only in my last semester that I came to appreciate it for what it is. I am rooted here, and just I am rooted, I vanish.

I’ll leave you with this; Father O’Conner said to me regarding our respective future paths-” I guess you and I are in the same boat right now, I’m sure we’ll get it all figured out. I have faith there are great things still to come”

As always- It’s a great day to be a Bulldog.

12 Days To Christmas: A Reading List

Sarah posted about some books she’s been reading- you can check out here post here. I’ve read some of the same ones, but I’ll avoid doubling up. You can read her post here.

The cool thing about just blatantly copying my sister is that I get to borrow her topic and format, which saves me quite a bit of mental energy. I will, however, take a slightly different tact with this post, I’m going to discuss five books that have impacted my way of thinking.

 

Orthodoxy- G.K. Chesterton (Amazon Link

Orthodoxy is one of the great Catholic apologetics of the 20th century, and Chesterton one of the most prolific, if underappreciated writers. He’s named as a primary influence by the likes of Tolkien and Lewis later in the 20th century. When reading Chesterton I have to resist the impulse to underline or highlight every other line, his style is eminently quotable, there is no doubt had he lived to see it, he would have had a very successful twitter account. Even if you are not interested in Christianity, Chesterton is still an incredibly enjoyable read, all of his writing is peppered with thought-provoking ideas and paradoxes.

My acceptance of the universe is not optimism, it is more like patriotism. It is a matter of primary loyalty. The world is not a lodging-house at Brighton, which we are to leave because it is miserable. It is the fortress of our family, with the flag flying on the turret, and the more miserable it is the less we should leave it. The point is not that this world is too sad to love or too glad not to love; the point is that when you do love a thing, its gladness is a reason for loving it, and its sadness a reason for loving it more. All optimistic thoughts about England and all pessimistic thoughts about her are alike reasons for the English patriot. Similarly, optimism and pessimism are alike arguments for the cosmic patriot.

(Bonus Quote from Heretics) (Amazon Link)

It is true enough, of course, that a pungent happiness comes chiefly in certain passing moments; but it is not true that we should think of them as passing, or enjoy them simply “for those moments’ sake.” To do this is to rationalize the happiness, and therefore to destroy it. Happiness is a mystery like religion, and should never be rationalized. Suppose a man experiences a really splendid moment of pleasure. I do not mean something connected with a bit of enamel, I mean something with a violent happiness in it–an almost painful happiness. A man may have, for instance, a moment of ecstasy in first love, or a moment of victory in battle. The lover enjoys the moment, but precisely not for the moment’s sake. He enjoys it for the woman’s sake or his own sake. The warrior enjoys the moment, but not for the sake of the moment; he enjoys it for the sake of the flag. The cause which the flag stands for may be foolish and fleeting; the love may be calf-love, and last a week. But the patriot thinks of the flag as eternal; the lover thinks of his love as something that cannot end. These moments are filled with eternity; these moments are joyful because they do not seem momentary. Once look at them as moments after Pater’s manner, and they become as cold as Pater and his style. Man cannot love mortal things. He can only love immortal things for an instant.

 

Tribe- Sebastian Junger (Amazon Link)

Sebastian Junger is a veteran war correspondent and wrote Tribe, which is I think is one of the most important books of the past couple years. Junger explores how modern society has bred a profound disconnect between members of American society, and how humans were not designed to live in extreme individualism. It’s a short read, less than 200 pages, and very well written, you should pick up a copy and read it today. This is, I think, one of the books that explain Trump. It’s not explicitly political, but then again neither is the Trump phenomenon.

Soldiers experience this tribal way of thinking at war, but when they come home they realize that the tribe they were actually fighting for wasn’t their country, it was their unit. It makes absolutely no sense to make sacrifices for a group that, itself, isn’t willing to make sacrifices for you.

That is the position American soldiers have been in for the past decade and a half. There was a period during the run-up to the Iraq War in 2003 when a bumper sticker that read NO BLOOD FOR OIL started appearing on American cars. Implicit in the slogan was the assumption that the Iraq War was over oil, but the central irony of putting such a message on a machine that runs on oil seemed lost on most people.

The public is often accused of being disconnected from its military, but frankly it’s disconnected from just about everything. Farming, mineral extraction, gas and oil production, bulk cargo transport, logging, fishing, infrastructure construction— all the industries that keep the nation going are mostly unacknowledged by the people who depend on them most.

 

How to Be a Conservative- Roger Scruton (Amazon Link)

Despite the title, this book is not an ideological tract by a Fox News commentator. Roger Scruton is for my money one of the greatest living philosophers. I’m sure philosophy folks will argue with me about that- but that’s my view and I’m sticking to it. Scruton has made perhaps the greatest contribution to conservative political philosophy since Burke. How to Be a Conservative is a blistering defense of classically conservative principles. I think that in modern politics we are to a policy focused as opposed to principle focused. People do a lot of arguing about policies, and very rarely drill down to the principles underlying those policies. Scruton brings us back to the fundamental principles of conservatism. As an added bonus (and rarity in the field of political philosophy) he’s eminently readable, even funny in a dry British sort of way. Scruton and Chesterton are two of the larger influences on my political and religious development as an adult.

Conservatism starts from a sentiment that all mature people can readily share: the sentiment that good things are easily destroyed, but not easily created. This is especially true of the good things that come to us as collective assets: peace, freedom, law, civility, public spirit, the security of property and family life, in all of which we depend on the cooperation of others while having no means singlehandedly to obtain it. In respect of such things, the work of destruction is quick, easy and exhilarating; the work of creation slow, laborious and dull. That is one of the lessons of the twentieth century. It is also one reason why conservatives suffer such a disadvantage when it comes to public opinion. Their position is true but boring, that of their opponents exciting but false.

Because of this rhetorical disadvantage, conservatives often present their case in the language of mourning. Lamentations can sweep everything before them, like the Lamentations of Jeremiah, in just the way that the literature of revolution sweeps away the world of our frail achievements. And mourning is sometimes necessary; without ‘the work of mourning’, as Freud described it, the heart cannot move on from the thing that is lost to the thing that will replace it. Nevertheless, the case for conservatism does not have to be presented in elegiac accents. It is not about what we have lost, but about what we have retained, and how to hold on to it. Such is the case that I present in this book. I therefore end on a more personal note, with a valediction forbidding mourning.

 

On Thermonuclear War- Herman Kahn (Amazon Link)

Published in 1959- Reading OTW is like stepping into another world. One of the foundational texts on nuclear strategy, Kahn found himself living during the dawn of a new age- the nuclear age. Mankind had within its reach the power to destroy all life on earth, and nobody was quite sure how to utilize this new power. As Eisenhower said in ’56 “[T]he the United States is piling up armaments which it well knows will never provide for its ultimate safety. We are piling up these armaments because we do not know what else to do to provide for our security.”

OTW was one of the first serious attempts to devise a coherent nuclear strategy. Its 600 pages explore nearly every corner of the nuclear problem and act now as a sobering reminder of how close man was to an enormous cataclysm. Kahn also gives a warning which is still prescient today, against the type of lazy thinking which seems to prevail in many areas of the modern world. One only needs to replace “nuclear” with “terrorism” or “cyber” in some passages of OTW to recognize the same patterns of simultaneously hyperbolic and lackadaisical thinking on the part of politicians and policy makers.

I have a firm belief that unless we have more serious and sober thought on various facets of the strategic program than seems to be typical of most discussion today, both classified and unclassified, we are not going to reach the year 2000- and maybe not even the year 1965- without a cataclysm of some sort, and that this cataclysm will prove a lot more cataclysmic than it needs to be. It is with the hope of decreasing the probability of catastrophe and alleviating the consequences of thermonuclear war if it comes that I offer these pages to all with the interest- and the courage- to read them.

 

War is a Force that Gives Us Meaning- Chris Hedges (Amazon Link)

Chris Hedges is, like Junger, a war correspondent and spent much of his career in the Balkans during the 1990’s. The quote below I one of the most enduring from the book, and has haunted me ever since I read it. “The poison that is war does not free us from the ethics of responsibility.” This book is an enduring reminder that we, as the United States, as the leader of the Western World, bear a heavy burden. We do not have the luxury of withdrawing from the world- because when we do people die. Intervening- with force of arms if necessary- in humanitarian crises is our absolute duty and one we have neglected as of late. This book is especially important now, given the abject failure of the Obama administration in Syria & Libya, and our failure as the American people to demand action from our elected officials. That blood is on our hands because we did nothing. War is a Force that Gives Us Meaning is an enduring reminder of the possibility for the western world be a great power for good, or evil, in the world, and that the choice is ours.

The poison that is war does not free us from the ethics of responsibility. There are times when we must take this poison – just as a person with cancer accepts chemotherapy to live. We can not succumb to despair. Force is and I suspect always will be part of the human condition. There are times when the force wielded by one immoral faction must be countered by a faction that, while never moral, is perhaps less immoral.

We in the industrialized world bear responsibility for the world’s genocides because we had the power to intervene and did not. We stood by and watched the slaughter in Chechnya, Sri Lanka, Sierra Leone, Liberia, and Rwanda where a million people died. The blood for the victims of Srebrenica- a designated UN safe area in Bosnia- is on our hands. The generation before mine watched, with much the same passivity, the genocides of Germany, Poland, Hungary, Greece, and the Ukraine. These slaughters were, as in, Gabriel Garcia Marquez’s book Chronical of a Death Foretold, often announced in advance

My Expirence with Privilege and Healthcare

Over the past 18 months, I’ve had my first real foray into the American medical system as an adult. Throughout my life, I’ve been healthy, nothing much outside of yearly checkups, one broken bone, and a sports injury. But over the past year and a half I’ve seen my general practitioner and three specialists. I received two misdiagnoses, a full battery of increasingly obscure tests, culminating in a surgery from which I am almost recovered as of writing this. I handled most of this on my own (you know you’re an adult when you start making your own doctor’s appointments). What I’m going to talk about today is “privilege” in the healthcare system.

The term “privilege” is bandied about quite a bit in modern American discourse. If you’re my age and you haven’t at least seen an argument over “white privilege” you must have been living under a rock. But the “privilege” I’m talking about today has nothing to do with my skin color. Rather my (my parent’s) economic status, but I’ll circle back around to that in a minute.

Some background: Without going into too much detail, I had what turned out to be a rare condition in people my age. It was not life threatening, just something I had lived with for my entire life, but finally asked my doctor about, and got fixed. This started with my general practitioner, who misdiagnosed me and referred me to a specialist. This first specialist who is located in my town, took a step in the right direction towards a correct diagnosis. He told me that my best option was surgery, but that he was “not comfortable operating on me” because he was “unfamiliar with this condition in individuals my age”. He told me he would do some research, make some calls, and find someone in the area more experienced.

This if I’m being honest, scared the living hell out of me. I had grown up looking up at physicians as people who always knew what to do. Now I had a respected specialist sitting in front of me telling me in the same breath that “you need surgery” (which I had never had before) and that “he wasn’t comfortable operating on me”. I am, beyond happy, that he had enough humility to admit to me that he was not experienced enough to give me the best treatment. Never the less, I left that office concerned, since I now needed to track down a specialist’s specialist. I spent the next week doing my own research. I found, the guy on the east coast for what I had. He published many papers on my condition, and sat on advisory board for the patient’s association for this condition. He practiced out of Memorial Sloan Kettering in New York City, which is by any measure, one of the best hospitals in the world, and was a department head. I decided, this was my guy, this is the physician I wanted. So I called and made an appointment.

After a series of appointments, it turned out that the first specialist had also misdiagnosed me. He had gotten the symptoms right, but misunderstood the cause. This was in fairness to him understandable given his experience and the symptoms I presented as a patient. Surgery was still my best option. I decided to go ahead with the surgery, which I received at the beginning of January. I took a full week off school, since the surgery required a few days of bed rest. After I returned to school, I was on painkillers and light duty for 4 weeks. After 4 weeks, I went back to NYC for the post-op. I was cleared to return to all normal activities, and told my scar should heal in 3-6 months.

I made the trip from Center Valley PA to New York City (2-3 hours each way), a half dozen times through the course of my treatment. Initial appointment, tests, followup to review test results, consultation with the surgeon, pre-operative tests, the operation itself, post-op followup. I took a full day off classes / work each time. I paid for parking in the city, which in one case was $60 for an hour. Gas, food, lost earnings, opportunity cost. This was all before you even touch the costs of the appointments themselves.

I am covered under my parents insurance, which is generous. Initially, we weren’t sure if this physician at MSK was going to be covered by insurance, but I went anyway. This, in my mind, is the real privilege in the healthcare system. I’d gone to two doctors, wasn’t happy with the care I received. So I in my free time, researched, and found one of the top guys in the US (and extension the world) to operate on me. I decided that that was where I wanted to receive care, and I went. If it wasn’t covered by insurance (which it was), my parents would pay out of pocket, but MSK was going to be where I went. This cut out quite a bit of waiting and delays in me receiving care. I never had to wait to schedule an appointment until the hospital sorted out the billing with the insurance company. I just scheduled the appointment and if it had be paid out of pocket, it’d be paid out of pocket.

A family without the financial resources to pay out of pocket, or without private insurance, would have waited. This was, at the end of the day, an elective procedure, and could have been delayed indefinitely. Patients on public assistance can access this level of care. There were Medicare and Medicaid patients in the MSK waiting room who I spoke too. But would they have been able to google the office number, call, and make an appointment, just like that? Probably not. That’s not the way Medicare works. What I had done, in retrospect, is bought my way to the top. I wanted the best care, and my family had the financial resources to pay for it either way, so I got the best care.

Further, privilege allowed me to be in a situation where I could take off from all my responsibilities for days at a time. I wasn’t working full time, and nobody was relying on my pay. So I could take a week off from school for the surgery and recovery without too much trouble. I was concerned about a lot of things. Surgeries can go wrong, I had been two times misdiagnosed, how much was the recovery going to hurt. But never at any step, was I concerned about money.

I said above that I handled this on my own, which was, to be frank, a lie. I scheduled all my appointments, and made the decisions about my care, but my parents did a lot on the backend. Paid for everything, handled any extraneous paperwork, argued with the insurance company. They figured out how everything was actually getting paid for, they got me to and from the surgery when I was all drugged up. They made sure I ate when I was lying in bed high as a kite after the procedure. I could not imagine having handled that by myself. Healthcare is complicated, both of my parents, and myself are familiar with the system, through both professional and personal experience. We know how it works. We know at least enough to in the case of things like “is the insurance company going to pay for x” or “this bill is incorrect” where to start. I can’t imagine going into this process as someone without experience with the healthcare and insurance industries.

It’s important to note that, despite having every possible advantage, I was still waiting 2-3 months inbetween each appointment, that’s how far ahead they were booked. My condition wasn’t life threatening, so the waiting was annoying, but not terrible, or detrimental to my health. Further, it was a simple procedure. In the category of surgeries, having an outpatient elective procedure requiring very little followup, is a minor deal. It can be easy for cancer patients to rack up bills from a half dozen hospitals and private practice physicians. In the grand scheme of things, my experience as a patient in the healthcare system was minor and simple. Despite that however, and my parents helping, and my insurance company, one bill still slipped through the cracks and got sent to collections. We paid it, but if we lost track of the bills for such a minor procedure, I can’t imagine what it’s like for patients who are in and out of the hospital for months.

I’ve spent two pages, laying out a problem description. I for a variety of economic, social, and institutional factors, received some of the best healthcare available in the modern world. This same care, for a variety of factors, would have likely been inaccessible to someone poorer than me. The reasons this care would have been inaccessible extend beyond just financial means. Mechanisms exist for Medicare and Medicaid patients to receive healthcare like this. However, healthcare extends past the “health”, the care component is also important. The support I received from my family was invaluable from handling paperwork to ensuring I ate while I was recovering. Likewise, not having to have ever stress about money, wait on hold with the insurance company, or confusing paperwork, was important to my overall positive experience. The presence or lack of that kind of stress can have real impacts on health outcomes.

I don’t know what the solution is to this. It’s complicated, and no policy can exist in a vacuum. Medicare was a program designed to alleviate some of the problems relating to financial access. As someone who worked in the healthcare industry, Medicare has had unintended consequences, and introduced an additional level of complexity into certain areas of the system. That’s not saying it’s a bad program, or didn’t result in a net positive, but it did complicate the system in ways that were not foreseen.

My only thoughts on possible policy solutions are that we should be careful to not throw the baby out with the bathwater. As many problems with the health system as this experience opened my eyes to, I still consider this a blistering success for the healthcare system in my life. I say, without fear of contradiction, that I could not have received this level of care anywhere else. Despite all the benefits of universal healthcare, the rich and powerful from other countries travel here, to America, to get care. We shouldn’t throw out the baby of exceptionalism, with the bathwater of unequal access. I see a lot of politicians, calling for complete overhauls of the system, without ever considering “what is it that makes the best American hospitals, and the best American doctors, some of the best in the world?”. We don’t need to tear down our health system and build a new one. We need to find ways to make our health system work for more people. In an ideal world, I would like everyone to have access to the kind of care I received. What I do not want to see is a future where all Americans are equal in receiving mediocre healthcare because of well-intended, but poorly considered policies.

Id like to thank my doctor at MSK, and the rest of his team. The man was a raging Scotsman, and managed to make jokes during discussions of complicated medical topics, and as an added bonus, one hell of a surgeon. 

(Cover Image: Wesley Wilson)

Ode to Éire

I suppose before I start, I should disclose the following: I’m not actually that Irish, I’m pretty Irish, but not very, anyone familiar with etymology could tell you “Illis” is not an Irish surname. While I’m not sure exactly how the percentages break down, I know I hail from three main areas, Hungary, Ireland, and Scotland. My maternal family’s presence on this continent predates the United States by a half-century or more. My paternal family was early 20th century immigrants for the most part. Understandably, my exact ancestry is a bit muddled underneath 300+ years of war, immigration, migration, and relocation. My skin tone and freckles alone however should attest the fact that I’ve got a little more than a touch of Irish blood in me. Regardless, today is St. Patrick’s Day, a day in which even full-blooded Italians feel a particular connection to the Emerald Isle, and I am no exception.

The Irish are in fact a quite remarkable people. British writer GK Chesterton says of the Irish,

The Irish are not only practical, but quite painfully successful. The poverty of their country, the minority of their members are simply the conditions under which they were asked to work; but no other group in the British Empire has done so much with such little. [Irish] Nationalists were the only minority that ever succeeded in twisting the whole British Parliament sharply out of its path. The Irish peasants are the only poor men in these islands who have forced their masters to disgorge. These people, whom we call priest-ridden, are the only Britons who will not be squire-ridden.

No other group has done so much with so little”. The Irish took a rocky, damp, island, and created a culture, producing individuals who have in a very real way, dominated world events for the past 200 years. Irish-American’s have played a disproportionate role in the creation of America[1], as we know it today. From military leaders to politicians to writers, the Irish can be found to have at least one finger in anything quintessentially American. The Irish are as American as America is American, the two peoples are quite inseparable. It was said of Irish-American settlers in the American west that: “[The Irish] settlers were described as a fun loving, kindly people, who would give someone the shirt off their backs, but were also known for shooting anyone who meant them harm.“[2]

I have since I was a child, loved Ireland. I love Ireland much as I love my native country, that is, I love it for reasons I cannot articulate. Ireland, more than any other place I have traveled to outside of The States, feels like home. Chesterton says this type of love is the highest form for, “The man who is most likely to ruin the place he loves is exactly the man who loves it with a reason.”, and as he goes on to say,

My acceptance … is not optimism, it is more like patriotism. It is a matter of primary loyalty. The world is not a lodging-house …, which we are to leave because it is miserable. It is the fortress of our family, with the flag flying on the turret, and the more miserable it is the less we should leave it. The point is not that this world is too sad to love or too glad not to love; the point is that when you do love a thing, its gladness is a reason for loving it, and its sadness a reason for loving it more.

I love the Irish like I love my family. Often when I am faced with adversity or a bout of depression, I’ll return to the one place the has always felt like home no matter where I am. There are no higher highs, or lower lows, then can be expressed by the Irish. Folklore, music, literature, this is my security blanket against a world of adversity and uncertainty. As the blessing goes;

I believe in the sun when it’s not shining, I believe in love even when I feel it not, I believe in God even when he is silent.

The Irish practice of melancholy acceptance of the world as it stands is one which I have tried to imitate throughout my life, and a trait I have always much admired. A humorous Irish toast goes “Here’s to a long life and a merry one. A quick death and an easy one. A pretty girl and an honest one. A cold pint– and another one!”. The Irish themselves are a contradiction in terms. At once friendly yet pugnacious, melancholy yet cheery, pious yet fickle. The Irish culture reflects the variety of life, the struggle within all of us, and the tenacious resiliency that makes the Irish Irish.

The great Gaels of Ireland,
are the men that God made mad
For all their wars are merry,
and all their songs are sad.[3]

Australian writer Beau Taplin said of the concept of home, “Home is not where you are from, it is where you belong. Some of us travel the whole world to find it. Others, find it in a person.” Éire is a place that lives in the heart of any man with a drop of Irish blood in his veins. I am forever blessed to carry a piece of home with me, something that no matter how dark my surroundings can never be taken from me. Even if the island itself fell off the face of the earth tomorrow, Ireland would live on. In every Irish Pub, in every glass of whiskey, in every folk song, in every green field, in every Irishman, there lives a piece of that island, and the ideals that sprung from it. I wish everyone, especially those of us with some Irish ancestry, a safe and merry St. Patrick’s Day.

May the road rise up to meet you,
May the wind be ever at your back.
May the sun shine warm upon your face
And the rain fall softly on your fields.
And until we meet again,
May God hold you in the hollow of his hand.

[1] For further reading on this I’d recommend The Other Irish and How the Irish Saved Civilization
[2] Quote from The Other Irish
[3] Quote from GK Chesterton, The Ballad of the White Horse

The copyright for the image in this post is fully owned by the author.

On Mice, Mules, and Swans

“No matter how sophisticated our choices, how good we are at dominating the odds, randomness will have the last word”
-Taleb[1]

Wherever you are right now, look around yourself and consider.

“How did I end up here?”

“What choices let me to this point?”

Chances are, if you look back relatively recently there will be an act of chance, randomness, which sent you spiraling off in a new direction. The further you think back, the more events, little and big, you think of, these bits of randomness, will compound exponentially. You may come to the realization that your life as it stands today is less of a culmination of careful planning, and more of one big sick accident.

The first half of this semester represents the peak and trough of my own attempt to wrest control of where I was going from the hands of chance. I had never before in my life done such careful planning, and I had never before in my life watched such carefully laid plans, fall into such tiny pieces. There is a certain security in plans, to do lists, and deadlines, having a clear idea of where you are and where you are going. There is also a certain sickness unique to watching deadlines pass, to do lists left undone, and the very foundational assumptions that your plans were built upon crumble underneath you. To paraphrase the Scottish poem “The best-laid plans of mice and men, often go awry”[2]. But why? Why do plans fail and foundations crack, and why can’t we see it coming?

In noted science fiction series, The Foundation by the prolific writer Isaac Asimov, the universe is ruled by a scientific discipline called psychohistory[3], which is a combination of statistical reasoning and sociology by which psychohistorians are able to predict the future course of societies within very good margins of error. Since a universe where everything is predictable would make for a poor science fiction series, enter the Mule[4], an individual who represents the statistical error in the psychohistorian’s calculations. Even with their god like powers of prediction, Asimov’s psychohistorians are still at the mercy of chance. The emergence of one extraordinary individual changes the timeline in way’s unpredictable.

Mules are people who come into your life like a whirlwind, and have an effect that you never could have predicted. They are accidents, which come to in one way or another redefine your world. A Mule can be good or bad, or a mix of both, but whatever their effect on the trajectory of your life, it was unexpected, and unpredictable before it happened.

Noted Philosopher Nassim Nicholas Taleb, writes of Black Swan Events[5]. A Black Swan, is an event which there is or was no real way to predict, has an extraordinary effect, and is often incorrectly rationalized in hindsight. Black Swans, like Asimov’s Mule, represent the far end of statistical chance. Taleb, like Asimov, focuses on the “big picture” the way chance pushes whole societies in one direction or another. On a macro-level, Black Swans are the assassination of Archduke Ferdinand, which sparked World War I, the discovery of Penicillin which saved on the upwards of 100 million lives, or the invention of the internet, which would come to revolutionize the modern economy. However, I find a more compelling case for randomness to be found in looking at these Swans and Mules in the frame of the individual. In our lives Black Swans are events like the death of a friend, a robbery, or winning the lottery.

Black Swans and Mules, are the randomness inherent to the human condition. You go to a bar one night drinking, you’ve done this many times before, but tonight is different, you get in a fight outside the bar and get arrested. That is a Black Swan. You had no way of knowing that that would happen, based on all previous experience in bars, you expected to have a good time and wake up in bed. If you could go back in time and have decided not to go to that specific bar on that specific night, you almost certainly would. However, there was no way of knowing that that specific trip to a bar would have a radically different outcome from every other trip to the bar you’ve ever taken.

But let us also take the opposite proposition. You go to a bar one night drinking, you’ve done this a thousand times before, but tonight is different, you meet someone. Fast forward three months you’re happily dating, fast forward three years you’re married, fast forward three decades you’re happily retired. Had you not gone to that bar, on that night, you almost certainly never would have crossed paths with this person. You had no way of knowing that the choice of going there then, would ripple for decades, and effect every aspect of your life.

The reality is that every decision we make can be unwound like this. We never know when we will be hit by a bus, or meet someone who will change us forever. This is randomness. We make too many choices whose effects will ripple outwards in unpredictable ways to ever fully be in control. This realization can paralyze people accustomed to the allusion of control. The thought that by every action or inaction, we may be courting disaster or salvation, is, terrifying. Everything becomes a terrible mistake, or a missed opportunity.

In response to a loss of control to randomness, the religious and secular alike will often fall into the mental trap of “fate”. The idea that what happened or didn’t happen was fate, and would (or wouldn’t) have happened, in one way or another, regardless of choice. That even if you hadn’t gone to the bar that night, you would have met that person somewhere, sometime, if it was “meant to be”, it’ll be. Through the mechanism of fate, individuals remove the burden of choice from themselves, and place it in the hands of God, a muse, or some strange cosmic trajectory whereby things that are supposed to happen just happen.

People however are funny this way. Good things that happen are fate. Meet a pretty girl, get the promotion, win the lotto, that’s fate. That was meant to be, that would have happened come hell or high water, at one time or another. However, bad things, people often assume, are things of chance or choice. Car crash, bar fight, DUI, these are avoidable results of decisions by yourself, others, or a combination thereof. These events are your fault, someone else’s fault, or cosmic accident, but rarely will people call them fate.

Many will fall into self-blame, taking on their shoulders the entire responsibility of the effects of a given decision. The simple fact is, to get into a bar fight, there needs to be at least two people involved. While every individual choice can be unwound to show far reaching effects, every effect has more than one choice made by more than one person associated with it. For you to get into that bar fight, you needed to be in that bar, on that night, at that time, having drank exactly as much as you did, as did the other person. Yes, you could have prevented something bad from happening by breaking one link in that chain of choices, but so could someone else, so could the weather, so could any number of other people. The weight of the effect of randomness cannot be laid solely at your feet.

Humans are bad at being able to foresee the effects of our individual choices, let alone series of choices. Entering into the equation the choices of everyone else shows the pure randomness of the world we reside in. Black Swans are the product of an infinite number of choices made by disparate individuals, resulting in an effect, which could not have been foreseen. Mules are the product of individual personalities, with all their complexities and subtleties, combining and reacting in a way that cannot have been foreseen. The truth is, we are all a Mule to someone, and whether known or not, choices we have all made have contributed to someone’s Black Swan.

This is the part where I admit, I don’t have an answer. Are Mules and Black Swans a product of fate, chance, or choice? Are we being played for fools by a celestial puppet master or are we just helpless blind men in a world of too many unknowns?

I don’t know.

But what I think is this: we are masters of our own fate. Our day-to-day lives are ruled by randomness. We have no way of predicting how going to Starbucks vs. Dunkin Donuts for coffee, or being stuck in traffic for an extra five minutes, will cascade throughout our lives. Everyone can think back to a seemingly insignificant choice, which had far-reaching and unprecedented consequences. Worrying about the “coulda shoulda woulda” of mundane decisions will do nothing but drive us to madness. The way we react to randomness is what truly defines us. Similar decisions made consistently, deliberately, and repeatedly over the course of time will in the end mute randomness. In a world where plans fall apart and we are seemingly at the mercy of chance; resilience in the face of adversity is the ultimate virtue.

We are, in the end, the sum of the choices we make and the people who have touched us. A Mule or Black Swan can shift that total in one direction or another, but they cannot overcome the sheer mass of choices we make and interactions we have.

 

[1] Fooled By Randomness Nassim Nicholas Taleb
[2] To A Mouse Robert Burns
[3] Psychohistory
[4] The Mule
[5] Black Swan Theory

To This Beautiful Life​

My unit had been sent to bring a discharge from the hospital back to his house. There was much grumbling by myself and my partner leading up to this job because the patient weighed 250 pounds and his home had 15 steps, which meant that we would need to physically carry the patient up the two flights of stairs to his bedroom. My partner and I roll into the hospital, and of course, the nursing staff is nowhere near ready to discharge our patient (they never are), so we drop our stretcher to an appropriate height, take a seat, and wait.

When the nurse has decided that the patient can indeed leave, I walk into the room with her to introduce myself and meet the patient. I’m confronted with four women standing around a man sitting in a chair. One of the women introduces herself as the patient’s wife, but before she can finish the man in the chair interrupts with the air of someone who has spent a lifetime being in charge. He points at me and says “I know you!” I having never seen this man before in my life respond “Oh you do?” “Yes yes,” he says “you helped me out last week!” as I’m forming the word “No…” in my mouth, I look at the wife who gives me the motion indicating “just roll with it”. Yes, I say, I remember you, how are you doing? “Well, I’m doing just fine”. I step outside of the room to speak with the nurse and the wife, who tells me that my patient is 97 and has advanced dementia. She adds in that I should just humor him and make him feel important and he’d be happy.

So I do all my paperwork, speak to the wife about her house, and the best angle of approach to get the commander (my patient had been a commander in the Navy) home and in bed. During all of this, the commander is perfectly happy to sit back in his chair and observe the scene. “You know” he chimes in “this place is really run like shit. There’s no organization whatsoever. Everyone is always running around, they have no idea who comes and goes. This would not have passed in the Navy.” I couldn’t help but chuckle. His floor was very busy with discharges and new patients that night, and there were people everywhere.

We get the commander loaded and into his house. We have him seated on a piece of equipment called a stairchair, which is essentially just a metal chair with handles that’s used for carrying people up and down stairs. Before we can lift him up procedure says we need to strap him in with a strap over each shoulder and across his chest to keep him secured in the chair. “When you were in the Navy did you ever wear a jump harness?” “Of course, I did son” “Alright well I’m going to strap you into our chair here, and it’s going to be just like a jump harness, nice and tight to keep you attached to the equipment” “Well get on with it son”. He made a quip which I won’t repeat for the sake of decency about the straps being “looser than a…” compared to a jump harness.

Having strapped him into the chair we carry him upstairs. His wife who is watching from behind gets nervous as many people do, and the commander shouts “Now honey calm down and let these men work, this ain’t the most dangerous thing I’ve ever done”. Once we had him upstairs and settled in bed, his wife brought everyone a glass of water since it was a hot summer day and me and my partner were sweating. Before we could take a sip, the commander piped up:

“Now first I want to do a toast. I know toasting with water is bad luck, but to hell with it, never believed in luck anyway. Here’s to this beautiful life, the little bit I’ve got left, and what you guys have got in front of you.”

My job is not a fun one. Being a Transport EMT is the kind of job people do on their way to somewhere else. It takes a herculean effort for me to drag myself to work, especially those early morning shifts. There’s something devastating about working for a company that is at best ambivalent about your existence, for pay that’s hardly adequate, doing a job that requires you to take nice people to a facility they’re probably going to die in, and being pleasant and reasonable with people who will yell, scream, spit, and throw things at you.

Every time I step into an ambulance at work, I know that today I’m going to meet someone who want’s to live and is going to die. I’m going to meet someone who wants to die but is going to wither in a nursing home for years. I’ll deal with the ass-end of the healthcare profession and a lot of people who I’m not sure how they still have a job. This is the part of our healthcare system that doesn’t look like Grey’s Anatomy. The walls are dirty, the doctors are nowhere to be found, the nurses are at best burnt out and at worst apathetic, and nothing works the way it’s supposed to. Most people, doctors, nurses, EMTs, who are stuck in this part of the system are overworked, underpaid, and fighting a losing battle against things they cannot fix.

Sometimes, however, a glimmer of light shines through my days of lukewarm coffee and stuffy ambulance cabs. There’s a moment, just a moment, where I don’t hate myself for what happens at work. I meet people who give me perspective. I meet people who show me how not to be. I meet people who give me a funny anecdote. I meet people or find myself in situations that teach me a lesson. It’s these patients, family members, medical practitioners, who can make a twelve hour shift with mandatory OT worth is.

Towards the end of my shift, my dispatcher hops on the radio and tells my partner and I, we’re going to have one more job. Shit. Of course, because 12 hours isn’t enough. The job is a psych discharge from an ER going to an inpatient psychiatric facility an hour away. Just wonderful. Psych patients, especially the ones requiring in-patient care who need to travel by ambulance, are not typically the kind of people you want to spend an hour in an enclosed box with going on the 13th hour of your shift. That may sound harsh, but it’s true. I’ve had psych patients attempt to jump out of moving ambulances, swing at me, spit on me, and talk my ear off about government mind control chips. But it is what it is, this is my job, at least I’ll pick up an hour of time and a half.

We roll up to the ER, wander inside. The nurse hands me a stack of papers, which I absent-mindedly flip through while she signs my transfer sheet. The patient is a middle-aged male with a history of substance abuse, depression, and violence. Internally I groan at “history of violence”, I really don’t want to restrain anyone tonight. We head over to the room where our patient is, my partner and I introduce ourselves, and have the patient get himself situated on our stretcher. Seems like a mellow enough guy, kind of looks like one of my friend’s dad. A little bit of hope grows inside me, maybe this guy isn’t that bad.

We get in the truck, and I do my normal “do you want the lights on or off; do you want the AC on; do you want to sit up or lay back? Please keep your arms and legs inside the ambulance at all times, the Captain has turned on the no-smoking light” shtick. The patient is quiet, just stares out the back window for the first 15 minutes of the trip. All of a sudden he turns to me and asks “What kind of music do you listen to?” Caught off guard I say “Rock and country mostly”

“How about Johnny Cash?”
“I’ve been known to listen to Cash”
“Do you know the cover he did of 9 Inch Nails?”
“Yeah, Hurt”
“If you wouldn’t mind could you play it for me?”
“Uh… sure”

I pull out my phone, dial up “Hurt by Johnny Cash” on YouTube. As he listens to the song, I see tears roll down his eyes. After the song ends, he apologized and started explaining how he ended up in the back of an ambulance being committed to a psych ward. He had dropped out of college, got married, and ended up owning a plumbing company with a friend of his, where he made ‘good money’. He had two kids. He told me his whole life story. His wife left him, and he hadn’t seen his kids in years. What was obvious to me, but what he was still in denial about was that he was an alcoholic. He maintained that he would just have a few drinks after work and his (ex)wife would always overreact, and they just had some fights that got “out of hand”. I’ve seen substance abuse before, but not this side of it. Never what happens after I drop off that drunk guy at the ER.

Alcohol has destroyed this man’s life. His wife lost a husband, his children lost a father, and he lost his family. Standing in the wreckage that used to be his life in a last attempt to take control, he tried to take his life. Now he was sitting in an ambulance crying to a 19-year-old EMT who was trying to pretend like he knew what to do. Choices have consequences, and before you know it you may hardly recognize yourself. Since that night I’ve never been able to listen to Hurt without thinking of him and his family. When we dropped him off, he shook my hand, wished me luck, and told me he’d look me up if he ever got better.

There’s one facility everyone hates, and my company, bless them, has a contract with this facility so we are in and out of there on a regular basis. This facility is a “Skilled Nursing Facility”, and I use “Skilled” in the loosest sense of the word. If you’ve ever seen a horror movie set in an old medical facility, this is basically that. The scent that hits you when you walk in is overwhelming, feces, disinfectant, and something I still can’t place that only exists in places like this. There are patients left in the hallways, moaning grabbing at us as we pass. The nursing staff is typically nowhere to be found, and when you finally track one down, they’re less than helpful. Many of them clearly do not care about their patients. This is just a job for them, they show up, do enough to get by, and leave. Others are just incompetent. I cannot imagine working in a place like this, let alone receiving “care” and living here. Neither can most people, so the long term residents at this facility are people who have nobody left to advocate for them, or people with no other option.

There are a few patients at this facility who are regulars for our company, meaning we take them to and from treatments (typically) dialysis three times a week. One such patient is a male with a host of problems, but he’s nice enough. I’d been taking him regularly for a few weeks, he’s typically quiet and looks sad, so I would leave him be during the transport. But today was different. It was a beautiful sunny day, and we took him outside. The sun hit his face, and I’d never seen him smile the way he did that day. On the drive back to this facility, he asked me if I liked NCIS the TV-Show. I don’t watch it regularly, but I know enough to hold up a conversation about it, so I said yes. We talked about NCIS the whole ride back (apparently, it was his favorite show), this was a man who I don’t think had ever said two words to me before.

When we pulled up to his Nursing Facility he asked ever so sheepishly if we could stay outside for a minute so he could enjoy the sun. We told him that we technically weren’t supposed to, and he could have his family or one of the nurses bring him outside. He quietly told us that his family didn’t come to visit anymore, and the nurses always told him no. Sounded completely plausible, so we sat outside with him for a few minutes. After that, we brought him inside and put him in bed. On our way out I asked him if he was going to be watching NCIS, he said he wanted to, but his TV wasn’t working. I did what I was supposed to do and I let the nurse know, who rolled his eyes, and said he would get around to that “someday”. So, I lied to my dispatcher to stall him, and I went back to the patient’s room. After some digging around, I found that his cable connection had fallen out the back of his TV. I popped it back in and just like that everything worked. I left him in his room beaming with the NCIS title sequence playing.

Most of my patients are elderly; I do however occasionally get the opportunity to work with life after it has just begun. I sometimes get kids, and occasionally even infants. The catch is none of these children are healthy by the time I interact with them. Their parents are going through what all parents dread: spending time in a NICU, PICU, or specialized children’s hospital. Some of these children have been abandoned by their parents, left as wards of the state. It’s a harrowing experience, in a lot of ways harder than dealing with adults.

Dispatched to a pediatric long-term care facility, to take a patient for evaluation by an outside physician. Get to the facility and start doing my paperwork and talking to the nurse, this patient as it turns out is on the upswing, and may be able to be discharged. I knew it was going to be a good day when I walk up to my patient’s bed to introduce myself and I get a high-five and a “hey dude”. This kid, bless his heart, was the most energetic ladies’ man I’ve ever met. The patient was 9 years old and a character. On the ride to his doctor’s appointment, he was picking my brain the way only 9-year old’s do. He’s particularly interested in how I do with the ladies. Asked if I have a girlfriend, and I showed him a picture of my girlfriend at the time. I get a “Nice dude! She’s a score!” and another high-five. He asked me all about my job, and how much training it took, and how much I get paid, and what’s the furthest I’ve gone in the ambulance, and what the buttons on the ambulance do, and what I’m writing on my paperwork, and everything else under the sun.

Dispatched to one of the hospitals my company has a contract with, to the NICU (Neonatal Intensive Care Unit), to bring an infant to a procedure at another hospital, parents would meet us at the destination. This baby was on her way to being discharged and sent home with her parents. In the back of the ambulance, the baby started crying. I really didn’t know what to do, I couldn’t remember the last time I’d interacted with a baby. I would assume sitting in a car seat next to some random guy in the back of a loud box probably wasn’t the most soothing experience for a newborn. I tried to “pet” her I guess? Calm her with my hand? Anyway, as soon as I touched her, she grasped onto my finger. I started humming amazing grace, I don’t know why really, I just did. She stopped crying and smiled. I’m almost certainly assigning too much significance to the acts of an infant, but that was a good day.

Folks reading this have probably caught on to the fact that I do not have the highest opinion of my sisters in scrubs, the collective nursing staff’s of the facilities I work with. I should clarify, I don’t hate nurses, I just feel strongly about bad nurses. That, I do run into a lot of great nurses, and one of the best pressure releases during a long can be joking with a nurse about our shared lot as unappreciated cogs in the machinery of modern medicine.

Nurse: Damn it, I forgot room 32 was going out today
Me: Don’t sweat it, I’m paid by the hour, don’t cost me nothing to sit here for a few minutes
Nurse: Ain’t that the truth, in that case, I think I’ll go on break, reconvene here in 30 minutes?
Me: Sounds good to me! I’ll go catch some shuteye

Or embracing the suck of the industry we’ve found ourselves in. This is an excerpt from a report I gave to an ER Nurse.

Nurse: What’ve you got?
Me: Fall victim, possible AMS from such and such nursing home
Nurse: AMS? When was the last time he was seen normal?
Me: Sometime in the past 72 hours
Nurse: *gives me an “are you f**king kidding me” look* [which is the only appropriate response to that statement]
Me: The nursing staff at the facility said someone may have seen him normal on Tuesday, but they’re not sure
Nurse: Great… I love that facility
Me: Oh yes it’s one of my favorites!
Nurse: So in what way is he altered?
Me: Well, he has a history of dementia, and I couldn’t get a straight story on what his baseline is… but he’s pretty in an out in terms of having a grasp on what’s happening
Nurse: *exasperated sigh* alright, thanks
Me: No problem

Little moments of professional humor can always make a shift go faster.

A common question that people ask me when they find out I’m an EMT is “What’s the worst thing you’ve ever seen?” It’s the public safety version of the infamous “Did you kill anyone?” question civilians ask of veterans. I don’t understand why people ask this question. If I walked up and asked “what’s the most terrible haunting thing you’ve ever seen?” to people I had just met, people would think I was a sociopath. But for certain professions, this is an acceptable conversation starter. I know what they want, some crazy story about a 10-car pileup, or a chemical spill, or anything involving drugs or alcohol. I’ve got a few of those, and I usually give the crowd what they want. Lay people lap that up for some reason. I don’t know why someone being really drunk and going to the hospital qualifies as an interesting story, but whatever. These things don’t bother me anymore, trauma’s, car accidents, OD’s, death, they don’t get my blood pumping the way they did when I first started. The honest answer to the question “what’s the worst thing you’ve ever seen” is despair. I don’t talk about it because that’s not what people want to hear, that’s not what they’re interested in. What keeps me up at night, what twists knots in my guts is the patient’s I’ve had who have given up. They’re alive, but they just don’t care anymore. People who are waiting to die. That’s the worst thing I’ve ever seen, and I see it regularly.

That’s my conclusion from all of this. You need something to live for. I realized at a point when I was nearing the end of my rope at work that I had more in common with a patient I was taking to hospice who had visibly given up on life than many of my peers. All of the patient’s who I admire, the ones I talk about above all had something in their life worth caring about, a reason for them to still be alive. The commander loved his wife and enjoyed telling his old war stories even if they’re the same ones over and over. My depressed patient still cared about his family more than himself, even if he hadn’t yet come to terms with his alcoholism and depression. My regular dialysis patient just wanted a few minutes of sunshine and to watch NCIS. If a man with no family left, living in an awful nursing home can be made that happy by a few minutes of sunshine, then me, an able-bodied college kid with a lot going for him can certainly find something worth caring about no matter how much I may dislike my job sometimes. Sometimes it’s something silly like taking a quality Instagram picture or getting an Oreo Frosty on my way home from work. Sometimes it’s something more wholesome like going far beyond what is expected of me for a patient or advocating for them when nobody else will. Either way, I’m trying to learn from these moments. I try to find the beauty in life, even if that means embracing the suck of wiping feces off my stretcher. I’ve found over the past years, that more than anything else (including coffee) I need those moments that remind me of the good in people, I need those moments that make me feel like me again.

From my Instagram (https://instagram.com/ninthhostage/)
From my Instagram (https://instagram.com/ninthhostage/)

Continue reading

In Remembrance: My Memories of Ken Stiefel

I remember the first time I met Ken Stiefel. It was my first week of high school in 2008, I was 13 years old. I was still adjusting to being in high school. They had said in the morning announcements that the signups for something called “TV Crew” was in the back of the library during lunch. I thought that sounded interesting, I figured I’d go and sign up to see what it was all about. I went to the library, and after asking a few people, I found what I was looking for, a door in the very back of the library labeled “TV Studio”. I went in to find two men, one older and one younger. The older man had a big smile on his face and was wearing jeans, suspenders, and a flannel. This was Ken, I didn’t know it at the time but the two men I had just met and the club I had just signed up for would be a defining factor in my high school career and the man I am today.

996829_319138394885801_852132386_n
Ken, Joe, myself, and a bunch of the rest of the crew during our senior year

Last week was filled with memories at every turn for me. Last Wednesday, Joe Voorhees, Jeff Stiefel, myself, and many other students, alumni, friends and family, attended a Board of Education meeting. The reason we were all there was to petition the Board to change the name of Davis Hall (The Governor Livingston Theater) in order to honor Ken and his contributions to the theater program. On Friday I was back working in the theater for a Dance Show, which Ken used to work with us, and his presence is sorely missed. Saturday morning I was up at 6 am to go back to the theater for another dance show, and I was greeted with a notification on my phones saying It’s Ken Stiefel’s birthday! Wish him a happy birthday. After the dance show on Saturday was the Berkeley Heights Relay for Life. Two years ago after Ken was first diagnosed I helped organize and fundraise for a relay team in Ken’s honor, called Daddy’s Crew. Two years later the current students continued that team.

Ken, or Daddy as we called him, has undoubtedly been one of the largest influences on my life to date. He was the most stubbornly optimistic person I’ve ever met. If you listened to him during one of the many crises in the theater, everything was going to be fine, even if he had to make a square peg fit in a round hole to make it fine. He was the kind of person who knew something about everything. I remember countless brainstorming sessions and experiments trying to make all manner of things do something they weren’t quite designed to do.

I remember while working on sets for the shows the little bits of life advice he sprinkled into work. During my junior year, I was dating another member of the crew. I was 16. In the way that things do when you’re 16, it seemed like this relationship was the most important thing in the history of mankind. When we broke up, once again, it seemed like a tragedy that would echo through the ages. High School relationships can be funny that way. Ken’s favorite quip while we were dating was some variation of : “You know, you’re a lucky guy, she’s too good for you. Just remember, whenever you get in a fight, she’s right. When she asks for something, give it to her, but that’s not going to be enough alone, you’ve got to surprise her, show her why you deserve her”. He would lovingly refer to his wife as “she who must be obeyed”. After we broke up, I took it very poorly, and making some highly questionable decisions, Ken’s response in classic form was “Well that was a pretty stupid thing to do, but at least you learned something, bet you won’t do that again.” Over the years Ken gave me more advice on school, relationships, and life than I can even remember at this point. He was the kind of person who you could go to with any sort of problem, personal, professional, technical, and he would find a solution.

There was a running joke among GLTV Crew and GL Theater, that Ken who was old enough to be Joe Voorhees’ (the TV Teacher’s) father, and old enough to be my grandfather, wasn’t allowed to leave GL until Joe had retired as a teacher. One of them being separated from the other was inconceivable to us. My fellow students and I used to joke that after we had finished with college and all had lives, we would come back to GL to visit. We would find that the administration had canceled the TV and Theater programs. But us being the few, the proud, the Crew, would obviously have to go investigate what had come of the TV Studio. So we would find some way to break in, and we would find it dark and covered in dust, but otherwise exactly how we left it. To our surprise, we would also find that Ken and Joe hadn’t left at all, and had been stowing away in the abandoned studio for years. We would find them exactly how we left them, constantly re-writing, and building all sorts of things that shouldn’t work but did. We thought that Ken and Joe, running the TV Studio and Theater, would just go on forever.

When Ken was diagnosed with cancer, it came as a shock, at least to me. This man who had become such a big part of my life, built a theater and a TV Studio, this wise man, father, husband, and friend, had cancer. But Ken didn’t let it slow him down. He was still in the theater every day doing what he always had. He would go to his treatments and then come right to the theater. He would insist we not worry about him and just let him be. For the two years after he was diagnosed, Ken was still the man I had always known and kept doing what he loved.

After Ken passed, there was a memorial service held at the GL Theater. I along with most of the other GL Theater Alumni, stood up by the booth, where we were most comfortable. Most of us rarely if ever sat in the seats in the theater, we were always in the booth, the TV Studio, or backstage. In the Stage Manager’s seat, where Ken would sit we put a coffee, milk, no sugar (because he’s already sweet enough), and a spotlight, in his honor. The memorial service was surreal. Hundreds of people turned out, from all walks of life, and not just theater alumni or GL Students, Ken’s extended family, members of a model train club he was active in, members of his church, friends of his from far back. I was amazed by just how many people Ken had touched during his life. He was always a humble man, of modest means, but had influenced the lives of hundreds of people who all came out to honor him. It was for me, a watershed moment in how I looked at what a successful life is. Ken hadn’t “made it big”, he wasn’t a wildly successful businessman, he was someone who I’ve never seen not wearing flannel and suspenders, and drove a Minivan with a ladder strapped to the roof everywhere. But he had during his life, been a positive, formative influence in the lives of so many others, a had a loving family, and a strong network of people who came out to support him.

I remember the last time I saw Ken. It was October 2015, I was 19 years old. After getting a call saying that Ken was in the hospital, I drove to Overlook Medical Center straight from school. I let myself in the Emergency Department entrance and went down to the Oncology Floor. I went to Ken’s room, and there he was, hooked up to all the machines, for the first time, he looked like a terminal cancer patient. I didn’t know how to process what I was seeing. I’m an EMT, and at work, I work with cancer patients and the chronically ill regularly, I know what this looks like, I know what the equipment does. But none of that experience could have prepared me for seeing one of the most stubbornly independent men I’ve ever known, dying in a hospital bed. I remember sitting on the floor next up against the nurse’s station trying to pull myself together. I had known conceptually what was happening and what this was going to look like, but seeing it was different. The drive back to school was long and quiet.

This is not how Ken would have wanted to be remembered. Those last days at the end never defined him, and he would have wanted to be remembered as the man he was. I remember the last time I saw Ken. It was September 2015, I was 19 years old. Joe had sent out an email asking if any alumni could come out to a football game the TV Crew was shooting. Joe couldn’t be there, and Ken was going to be running it by himself. Ken being Ken was going to try to do the whole thing himself instead of just sitting back and supervising the rest of the crew. I had a free Saturday, so I drove out. I stopped to pick up coffee, medium black for me and medium with milk for Ken, and I drove to the high school. I was supervising the supervisor if you will, doing the heavy lifting so he didn’t try too. We ended up sitting on the bumper of the bus and bullshitting for most of the day. We talked about my experiences at school, new plans for the Theater, the TV Studio, my ex-girlfriend from high school, everything. Everything except his cancer, which is the one thing he never had any interest in talking about.

To say that a man like Ken “lost his battle with cancer” is a fallacy. Ken never lost his battle, he won. He never let his disease define him, he flatly refused to step back from the theater or TV Crew, despite our urgings he wouldn’t slow down at all if he could help it. I remember working a dance show in 2014, and there was a light on stage with a blown lamp. Ken, grabbed a ladder and climbed up to change it himself before I could stop him or offer to do it myself. Joe called down on the radio asking, “Why is Ken climbing a ladder?” But he was going to do it, no matter how much everyone insisted that we have the young expendable one (me), do it. Ken lived the way he wanted to all the way to the end, and he left behind a legacy that will live on in the heart and minds of generations of students, family, and friends. If that’s losing, I don’t know what winning looks like. I am proud to have been able to count Ken among one of my friends.

2013-07-11 09.06.572013-07-11 09.07.30
Ken saying goodbye to our old bus which we used as a remote truck

1043848_319143488218625_1604297987_n
Ken, Joe, and myself at my high school graduation

1300 Miles, 13 Cups Of Coffee, and a Few Thoughts

This past weekend I went on a short 1300-mile road trip with two of my friends. One of my friends had a college visit at the University of Southern Carolina scheduled on Friday afternoon. The plan was to leave at 7 pm on Thursday, drive through the night, arriving at 5 am. We would sleep for ~6 hours at a hotel, Shane would go to his visit, and then we would drive back to PA. Estimated travel time from Center Valley PA to Columbia SC was about 9 hours. We took my car, and I ended up doing all the driving. 

By the time we got back to PA at 3am Saturday morning, we had covered 1300 miles, 9 state lines, and I had spent 21 of the past 48 hours driving. We had burned through almost 100 gallons of gas, almost 400 songs, and I’d consumed 13 cups of coffee. This was the longest I had ever spent behind the wheel of a car. I regularly make relativity long drives, 1 hour from school to home, 2 hours from home to NYC, 2 hours from school to Philly, 3 hours from home to the beach, 4 hours from home to Albany. I’ve even made a few trips to Connecticut and Massachusetts for work, but 2 back to back 10 hour drives was more then I’d ever done before. 

20 hours behind the wheel of a car driving on interstates gave me a lot of time to think. While driving especially towards the end of both of the drives, I began to consider how adept yet awful people are at driving. According the NHTSA in 2013, 32,719 people died in motor vehicle collisions, and motor vehicle collisions are the leading cause of death for every age group from 3 to 34. Humanity has shown that we are terrible at operating motor vehicles. My own driving habits show this. When I’m driving long distances, I drive one of two ways: with the cruise control on, or with the cruise control off. Regardless of which I’m using, I have little “games” that I play while driving, which while they keep me fully engaged in the act of driving, I fully admit are not the safest way to drive. With the cruise control off, I keep myself engaged by continuously moving up and passing vehicles in front of me. Not to say I’m speed racer doing 95 in the left lane, I’ll often pass the person in front of me over the course of 15 minutes by going 1-2 mph faster than they are. With the cruise control on, I do the opposite, I keep myself engaged by trying to go as long as possible without altering my speed. I switch lanes to allow people moving faster than I am pass, or to allow people to pass who going slower than I am, but I try to avoid altering my speed, for no better reason than it’s something to do.

Neither of these are the optimal way to drive. The best way to drive would be to drive in the right lane, going to speed limit. However, I need these little games to keep me fully focused on the act of driving. My driving is goal orientated, “Im going to pass this guy in the left lane”, “Im going to get around this truck”, “Im going to drive another 30 miles before I stop for food”, “Im going to wait until I get to mile marker x to open my bag of chips”. I always need a short to midterm goal to focus on, and that fact alone makes me, and all people incredibly poor drivers. My singular focus while driving should be getting to my destination safely, but it’s not, I should never drive when Im tired, hungry, etc, but I do, I should always go the speed limit but I don’t, I shouldn’t get mad when someone else on the road is driving exceeding slow, fast, or generally not paying attention, but I do. A computer driving my vehicle would only focus on driving safely, avoiding wreaks with other vehicles, and navigating to its destination. Computers would not lose focus and start thinking about it has due next week, a computer would not dose off, a computer would not be thinking about what kind of food it wants to get.

That being said, it is frankly amazing that we humans are as good at driving as we are. Despite everything I talked about above, I’ve been driving since I was 17, put over 30,000 miles on my car in the last 2 years, and I’ve been in one motor vehicle collision since I began driving, a fender bender on a local road. When you think about what I actually did this weekend, it is astounding that driving is as safe as it is. I navigated a 4,000 lb metal enclosure at 70 mph for 20 hours across 6 states. I did this by keeping my piece of metal in between two lines with less than 1 foot on each side, while avoiding thousands of other people one the road. It amazes me that this system works as well as it does. If we were to propose the system we have today to someone living in the 1880’s, it would sound like a death trap. 

I’ve spend the majority of my life driving in Central Jersey/ the NYC Metro-area, places known for their aggressive driving. Around my home driving often seems like a competition with everyone else on the road, given the general unwillingness by drivers to do things like let others merge, move out of the way for fast moving vehicles, use turn signals, etc. I think this attitude is largely a product of the way NJ is structured. NJ has a very high population density, and being communing distance from Manhattan, during 7-9 am and 4-6 pm, it is very difficult to get anywhere. Where I grew up in Jersey is right around the intersection of almost every major highway in Central Jersey, Rt.s 78, 22, 287, 24, 95, as well as the Garden State Parkway and the Turnpike. Traffic patterns are a mess, and constantly changing. Once you get past my town and closer to Manhattan, if you miss one off ramp you just added 45 minutes to your commute. It is these crowed highway systems that lead to the driving style found in this area of the country.

Having grown up driving on roads where you have to constantly be on the look out for guys in sports cars weaving in an out of traffic, as well as being fully willing to force your way on to an off ramp, giving other drivers the “You can let me merge, or you can hit my car, your choice” look, driving below the Mason/ Dixon was refreshing. The other drivers on the road in the south were almost suspiciously courteous, driving on 81 through Charlotte NC during rush hour I was cut off twice, to put that in perspective, making my 25 minute commute on Rt. 78 and the GSP I can expect to be cut off 4-5 times. I was amazed by the level of cooperation between drivers. When I needed to switch lanes, I put my blinker on and almost immediately, a space would open for me to merge into. The cooperation between normal drivers and truckers I also found interesting. In Jersey, trucks are regarded typically as annoyances to be passed as soon as possible, and if a truck is trying to merge into your lane, you should make sure you get past them and let someone behind you let them in. Driving down 81 however, drivers worked with truckers to make driving an easy experience for all. When a truck would want to switch lanes, the car behind them would slow down to make room for the truck. When there was enough space for the truck to fit, the car would flash its brights, the truck would move over and flash it’s brake lights as a thanks. First time I saw this I thought it was a coincidence, the second time I thought it was just a particularly nice driver. By the fourth and fifth time, I finally decided that was just a thing people do down there.