Bringing a Child Into a World Like This

April 26, 2022 By David Griesing Leave a Comment

_{(photo by Issac Quesade/Unsplash)}

Is having a child today—or a grandchild—an expression of fervent hope or an involuntary invitation that you’re handing down to someone who’s unable to refuse it?

It’s a fair question, relating to what are (perhaps) our first jobs: as parents, as caregivers, as either believers or non-believers in the world to come.

Because every newborn is an embodiment of hope, our answers make us grapple with the future as we see it today.

These days, Tomorrowland is no longer the Jetsons flying cars from their open-to-the-sky houses with friendly robots inside, impossibly dressed as maids. Today, it seems closer to Cormac McCarthy’s survivalist The Road or last year’s best picture contender, the farcical Don’t Look Up–harsh and cruel on the one hand, shallow and in-denial on the other.

I’d briefly thrown this question out to you before. That post was in the summer of 2017, years before a pandemic disrupted daily life, environmental collapse was something other than science fiction, or we had a 24/7 view of annihilation in a peace-loving country that often looked surprisingly like our own.

Even if you keep shutting off the news for the sake of your sanity, the brain still completes its gloomy pictures. But then we’re reminded, there have been victories too: those nurses in the terrible breach, that rebound in the numbers of whales plying our oceans, those Ukrainians serenading their fleeing breathern with folk songs and accordions in train stations. Bleak with shafts of sunlight I’d call it, but as the tribulation (a biblical word) piles on, still bleaker than it seemed only five years ago when people were already asking: “What if you decide to bring a child into this world? What do you owe her?”

Before reaching for the bottle, perspective helps. This is neither the first nor will it be the last time that the future looks bleak. In 1891, almost 25 years before the catastrophe of World War I, Oscar Wilde did what great artists always do. He looked out and realized that something was tragically missing in a world that was already marching off to war amidst destructive new technologies and social upheavals, with callow leaders and millions of oblivious bystanders along for the ride. As far as Wilde could tell, no one seemed to be envisioning a better world any more, even though that’s the only world any sane person should want to be heading towards. As he said at the time:

A map of the world that does not include Utopia is not worth even glancing at, for it leaves out the one country at which humanity is always heading.

Isn’t utopia the future that we want for our children? Not some nostalgic past that never really existed but a sustainable place with wiser leaders, where humanity is enhanced by its technologies instead of subjugated by them, where we flourish by celebrating our common humanity instead of preying on one another. But none of us will ever reach such of place unless we can imagine it first.

One of my favorite writers is Michael Chabon (check out his marvelous Moonglow if you’ve somehow missed it) and I happened upon an essay of his this week where he (like Wilde before him) looked around, shortly after the turn of a different century, and noticed that something was terribly missing. His queries around “what that was exactly” were prompted by his discovery of an audaciously hopeful scheme that had been launched some time before. It was called the Clock of the Long Now. A tee-up to Chabon’s essay on Longreads described the powerful response that a few visionaries had made to “a disappearing future”:

One of the grandest gestures toward imagining the future is the Clock of the Long Now. Originally conceived by inventor, computer scientist, and Disney Imagineering fellow Danny Hillis, and expected to cost in the tens of millions of dollars, the clock is designed to keep time for 10,000 years. Besides being a tremendous feat of engineering, it’s also a tremendous statement of faith — building it is a bet that there will be humans around over the next 10 millennia to hear its bells ring.

To Chabon, the Clock of the Long Now seemed a utopian commitment, not to a destination on a map but to something that feels just as bold today: that we, our children and our children’s children actually have “a Long Now” stretching before us.

As Chabon quickly understood, the point of this invention was not to measure our passage of time into an unknown future or to celebrate the strange race of creatures that built it. No, it had little to do with our time-keeping or technical wizzardry. “The point of the Clock,” he writes, “is to revive and restore the whole idea of the Future.”

‘The Future,’ whether you capitalize it or not, is always just an idea, a proposal, a scenario, a sketch for a mad contraption that may or may not work. ‘The Future’ is a story we tell, a narrative of hope, dread or wonder. And it’s a story that, for a while now, we’ve been pretty much living without….
Can you extend the horizon of your expectations for our world, for our complex of civilizations and cultures, beyond the lifetime of your own children, of the next two or three generations? Can you even imagine the survival of the world beyond the present presidential administration?

No, we probably can’t—or think we can’t. But the Clock of the Long Now wants to recover that loss, quite literally, as an emblem of belief in horizons that extend beyond the screens that we’re holding in our hands and their always-in-the-present diversions.

Chabon laments that Americans (as a culture and a country) are no longer caught between the poles of “the bright promise and the bleak menace.” Now (and he wrote this 15 years ago) we seem to have mostly the latter and little of the former. I think it’s one reason why we’ve been so gobsmacked by the nobility of Ukraine’s resistance in the face of barbarism—all of these people (where did they come from?) so full of “the promise” in spite of “the menace.”

Asking similar questions, he ends up thinking about his young son, with a tremendous sadness, given how different Chabon’s own speculations about The Future had been when he was that age:

If you ask my eight-year-old about the Future, he pretty much thinks the world is going to end, and that’s it. Most likely global warming, he says—floods, storms, desertification—but the possibility of viral pandemic, meteor impact, or some kind of nuclear exchange is not alien to his view of the days to come. Maybe not tomorrow, or a year from now. The kid is more than capable of generating a full head of optimistic steam about next week, next vacation, his tenth birthday. It’s only the world a hundred years on that leaves his hopes a blank. My son seems to take the end of everything, of all human endeavor and creation, for granted. He sees himself as living on the last page, if not in the last paragraph, of a long, strange and bewildering book. If you had told me, when I was eight, that a little kid of the future would feel that way—and that what’s more, he would see a certain justice in our eventual extinction, would think the world was better off without human beings in it—that would have been even worse than hearing that in 2006 there are no hydroponic megafarms, no human colonies on Mars, no personal jetpacks for everyone. That would truly have broken my heart.

So in response, Chabon tells his son about the Clock of the Long Now, and while he did so his son “listened very carefully” before asking, “Will there really be people then, Dad,” ten thousand years from now? “’Yes,’ I told him without hesitation, ‘there will,” [although, to himself] I don’t know if that’s true.” Chabon confirmed this Truth to his boy because he felt that he didn’t really have a choice in the matter. “[I]n having children—in engendering them, in loving them, in teaching them to love and care about the world—parents are betting, whether they know it or not, on the Clock of the Long Now.”

Just think about that for a minute. What you believe, what you hope, and how you’d answer that child, who embodies “a far longer now” than you do, when she begins to wonder about what lies ahead.

Doomsday scenarios around climate catastrophe have lent a powerful sense of urgency to questions around giving birth or refusing to do so. If what’s ahead are more devastating floods, wildfires, famines, mass migrations, ferocious competitions over scarce resources, and increasing strife among nations, it sometimes appears that all we have to look forward to is an even more Hobbsian world of tooth and claw–and no place for children.

In my own travels through this quandary, I couldn’t help but notice that there are hundreds of articles out there trying to find the “fairness” to future children in our having them today, with most concluding that we should forego childbearing altogether. In particular, these debates have been catnip for philosophers, with one in The New Republic (“Is It Cruel To Have Kids In the Era of Climate Change”) beginning his take on it this way:

In one of his early works, the nineteenth-century German philosopher Friedrich Nietzsche relayed an Ancient Greek legend about King Midas pursuing the satyr Silenus, a wise companion of the god Dionysus. When Midas finally captures Silenus, he asks him what ‘the best thing of all for men’ is. ‘The very best thing for you is totally unreachable,’ Silenus replies: ‘not to have been born, not to exist, to be nothing.’

If that were in fact true it would simplify matters enormously, not only for those of us who are here now but for all the rest who might be coming. But is it really this black and white?

In a different essay, another philosopher (who specializes in the “ethics and metaphysical issues regarding birth, death and meaning”) invites us to weigh the plausible (as opposed to existential) risks that are facing both us and that future child.

Against “the near-certain” threat of a “global warming apocalypse” today, she recalls the failed predictions of Thomas Malthus in 1798 that a human population boom would outstrip the world’s food supply (“Imagine if everyone decided to stop having children back then to avoid the ‘inevitable’ famine?), and somewhat more humorously, The London Times’ prediction in 1890 that by 1940 there would be so much manure piling up after the horse drawn carriages that “every street in London would be buried in nine feet of manure.” (“Imagine if people had decided it was wrong to create a child to wade through the muck?”).  As a result, her analysis concludes more equivocally than Silenus’s. Her “tipping point” for the question ‘Is life a worthwhile risk?” is whether or not you happen to believe the climate-related forecasts.

And I suppose to some extent that’s true.  But it leaves us (unhelpfully) in the middle of the climate believer/denier debates, when I think what we need is a sign post that will get us to a more enabling place, to help us decide the matter “in our hearts” (if you will), that brings us to a stand that’s more embedded in human nature than in risk analysis as we consider whether “bringing a child into a world like this” is justifiable.

Which brings us back to Nietzche.  Because, as the New Republic essayist eventually tell us, the great German philosopher didn’t agree with the answer that the satyr Silenus gave to King Midas. In Nietzche’s worldview, you should never wish that you hadn’t been born, nor should you refuse to bring children into the world because of the miserable state in which you currently find it.

To some extent, this is because living has always involved both tragedy and triumph. Only today, amidst the cosseting and complacency of a society as rich as ours do we seem to have forgotten this basic tension in our existence. (Before Nietzche and long before Amazon and the Metaverse believing people called these deeply human realities “sin” and “grace.”)

So the Nietzche readers among you will also recall his “Will to Life,” his “triumphant Yes” to the question of human existence, his “affirmation of life even in its strangest and sternest of problems.” To be human is always to struggle to find ways to affirm the force of our lives in the full knowledge that death is also roaming among us.

That’s maturity. That’s what every parent who should be a parent understands.

As they make it “their own work” to fight against what’s unfair and unacceptable, these parents teach their children by their examples, standing right there alongside of them as their kids learn how to do the same thing.

These parents believe in The Future, which is why they answer “Yes” (without hesitating) when they’re asked, “Will there be a future ten thousand years from now?” even though we can never be sure. That hope is always tentative, contingent, and we’re big enough to handle its uncertainties.

All that good parents can be sure of is that they’ll be standing next to that child while he or she begins to claim his or her part of it, that no child in this family will ever have to face The Future alone. Likewise, it’s a standing-on-shoulders legacy that can continue as long as the young and their nurturers are giving a “triumphant Yes” to whatever tomorrow holds in the overlapping work of their lives.

Yes!, even when our streets are clogged with nine feet of sh*t and the warm sun of springtime has just come out.

This post was adapted from my April 24, 2022 newsletter. Newsletters are delivered to subscribers’ in-boxes every Sunday morning and sometimes (but not always) I post the content from one of them here. You can subscribe and not miss any of them by leaving your email address in the column to the right.

The Giving Part of Taking Other People’s Pictures

June 14, 2021 By David Griesing Leave a Comment

It’s harder than ever to maintain, and then safeguard, our zones of privacy.

I’ve been thinking about it in terms of pictures that other people take of us or that we take of them—sometimes when those other people are friends, sometimes when they’re strangers, and sometimes when its companies or authorities who are taking them for their own purposes.

In these photographs, what is the line between a fair exchange (with mutual benefits) and an unwelcomed intrusion?

What exactly are we “taking” when we take a picture of somebody?

(When shown their photographs, tribal people often complain that the camera has somehow stolen their souls.)

Is there, or should there be, a “give” as well as a “take” with photography?

Two encounters this week sharpened that last question for me.

A close colleague of mine in counseling work stopped by unannounced with some cookies to end our just concluded school year on a celebratory note. We’d been meeting with our kids on Zoom and hadn’t seen one another in person for months. She was so glad to see me that she wanted to take my picture before leaving, but I waved her gesture off. I’d stopped mowing the lawn when I saw her heading my way and felt that my sweaty appearance would have made a poor souvenir (even though she clearly felt otherwise). “What just happened?” I wondered afterwards.

My second encounter came by way of reminiscence.

Three years ago this week, I had been in New Orleans and was remembering that unbelievably rich and flavorful time, eager to go back and dig in even deeper. Part of my return trip would be taking in a “second line” street parade, because every week of the year at least one of them takes place somewhere in the City.

*_{A “second line” street parade photo by Aeisha Palmer, May 20, 2007}*

As you can imagine, these parades (which are sponsored by New Orlean’s “social aid and pleasure clubs”) are a kind of paradise for professional and amateur photographers. While following a random NOLA thread last week, I came across a story about “the etiquette of making photos” of the performers at these parades. This story also speculated about the “taking and giving” boundaries of photographing other people. For example:

Are there different rules for friends than there are for strangers?

Several years ago, Susan Sontag explored these boundaries and expectations in a series of essays for the New York Review of Books, later published in her own book, On Photography. Sontag focused on the “acquisitive” nature of cameras, how they “take something” from whoever or whatever is being photographed, a sentiment that’s similar to those tribal member fears about having their essences stolen. She wrote:

To photograph is to appropriate the thing photographed.

Sontag also commented on the vicarious nature of picture taking.

Photography has become one of the principal devices for experiencing something, [or at least] for giving the appearance of participation.

The way she saw it, we may not be marching in (or even watching) the parade, “but somehow we feel that we are” if we can capture a picture of it for savoring now and later on. Instead of “being in the moment,” we’re counting on the triggering nature of these pictures to approximate the real experience we’ve missed by “capturing enough of it” to still feel satisfied.

Of course, there are consequences on both sides to this kind of “taking.” A drive to accumulate photographic experiences can not only rob us of more direct engagement with other people and places (say, the actual smells and sounds of the parade, or the conversations we might otherwise be having with spectators and participants), it also raises questions about the boundaries that can be crossed when we’re driven by a kind of hunger to “take” more and more of them without ever realizing the impacts that we’re having by doing so. To our camera’s subjects, it can feel like violation.

As I’ve become more thoughtful about these impacts, it’s meant thinking through my picture-taking drive in advance.

What is gained and what can be lost when I’m taking somebody’s picture? What is (or should be) the etiquette around photographing others? These are questions that seem impossible to ignore since cameras are literally everywhere today, devouring what they see through their lenses. As a result, going through some Q&A with myself by way of preparation—whether I’m likely to be the photographer or the photographed—increasingly seems like a good idea.

For instance, what if strangers “who would make me a great picture” are performing in public or, even more commonly, just being themselves in a public place when I happen upon them with my camera?

My most indelible experience of the latter happened at the Damascus Gate, which leads to the “Arab Quarter” in Jerusalem’s Old City. In arcs along the honey-colored steps that sweep down to that massive archway, Palestinian women, many in traditional clothes, were gathering and talking in a highly animated fashion against the backdrop of ancient battlements, but as soon as I pointed my camera in their direction to take “my perfect shot,” they raised their hands, almost as one, and shielded their faces from me. Was that ever sobering! I didn’t know whether they were protecting their souls or simply their modesty and privacy from another invasive tourist.

In the story about picture taking at parades in New Orleans, one photographer who is drawn by their similarly incredible visuals observed:

You really have to be present and aware and know when the right time is to take a photo. Photography can be an extractive thing, exploitative, especially now when so many people have cameras.

To her, knowing when to shoot and when to refrain from picture taking is about reading the situation,

a vibe. You know when somebody wants you to take their photo, and you know when somebody doesn’t.

Another regular parade photographer elaborated on her comments:

If you carry yourself the right way . . . people putting on that parade see you know how to handle yourself and will give you a beautiful shot.

I’ve also found that performers want you to portray them in the best light and will help you “to light the scene” when you make eye contact and invite them to do so. On the other hand, they will also tell you (if you’re paying attention) when the lighting is off and you should just back off.

*_{Here’s one where I got it right, at least about “working the scene together.”}*

Because everybody wants to look their best while being photographed, the same rules usually apply when the subjects aren’t part of a performance but simply out in public, being interesting by being themselves. For the would-be photographer, it’s about initiating a conversation and establishing at least a brief connection before asking: can I take your picture? If they don’t feel “looked down upon” by your interest, they’ll often agree. But as with those “on stage,” these preliminaries can also result in: “No, I’d rather that you didn’t right now,” a phrase that’s hard to hear when “a great picture” is right there in front of you if only you could “take it.”

Whenever you know in advance that taking pictures could be uncomfortable for those being photographed, one New Orleans parade regular talked about the need to deepen his relationship with those he wants to photograph before showing up with his camera. Because he takes pictures at NOLA’s legendary funeral parades, he brings club members photos that he’s taken of the deceased on prior occasions so that colleagues and family “have a record of that person’s street style.” It’s his sign of respect at what is, after all, a time for grieving a loss as well as celebrating a life.

We go and we shoot funerals and [then] it’s not a voyeuristic thing. You’re doing what you do within the context of the community

—a community that you’ve already made yourself at least “an honorary member of” through your empathy and generosity.

Then, what you’re giving tends to balance what you’ll be taking.

_{Here’s a gentleman I’d just purchased something from at the annual flea market.}

So what about my cookie-bearing friend who showed up unannounced this week?

Should I have relaxed “my best foot forward” enough to permit one sweaty shot when she so clearly wanted a memento of our reunion after so many months apart?

Yes, probably.

But I’ve become so defensive about cameras taking my picture on every city street, whenever I ring somebody’s doorbell or face my laptop screen that sometimes it’s hard to recognize when “putting down my guard” is actually relationship building and for my own good instead of some kind of robbery.

Where zones of personal privacy are concerned, this is a tricky time to navigate either taking pictures of somebody or being captured by one.

It’s one more reason to try and rehearse my camera-related transactions before I find myself, once again, in the middle of one.

+ + +

(If you’re interested in a photo essay I posted after my last visit to New Orleans, here it is, from May, 2018. Another post, with photos taken at the Mummers Parade in January, 2019, can be found here. Taking pictures has always been a way that I recharge for work, although I’m still in the process of learning its complicated rules.)

This post was adapted from my May 30, 2021 newsletter. Newsletters are delivered to subscribers’ in-boxes every Sunday morning and occasionally I post the content from one of them here. You can subscribe by leaving your email address in the column to the right.

A Movie’s Gorgeous Take on Time, Place, Loss & Gain

February 9, 2021 By David Griesing Leave a Comment

As a kid, I was a digger. Always outside in the meadow that ran the back of my house, in the woods that huddled behind the half-circle of homes down the hill, or even in the less visited recesses of my yard, I was always looking for something “down there.” But I never found anything like the spines of the Anglo-Saxon long ship that were unearthed in the picture above.

In a post from December called Digging for a Sense of Place, I described how I didn’t really find anything you’d call “archeological” until I got to Philadelphia and came upon what might have been an 18^th century kitchen dump beneath our magnolia tree out back. (My home is a block and a half from an historical marker that tells of British troops camping here before the Battle of Germantown, so I suppose the pottery shards I found there could also have been left behind when these very soldiers moved to their next encampment.) Anyway, while thinking about my relationship to the places where I’ve lived, I also saw some of the roots of my commitment to and indifference about the ravages of climate change—and how I might get that wavering to settle down into something more like steady resolve.

Because our plots of land are relative strangers to us, we don’t embrace them with the same protective bonds that draw us, to say, a child under threat. Instead, they are… little more than addresses, places to arrive at or depart from but not necessarily learn more about, even while we’re spending most of our time there.

Maybe because I’d written this post so recently, I couldn’t believe the coincidence when a British filmmaker presented his movie, called The Dig, on Netflix this week. Told with unsettling beauty, it’s a story about the quixotic excavation of an ancient burial mound on a manor estate in southeast England. With remarkable restraint, it uses its Dark Age discoveries to throw the early bombing raids over Britain during World War II (whenThe Dig takes place) into bold relief.

These bombers, like heavy, lumbering cows, crisscross the skies above the excavation site, falling down to earth on one occasion while simultaneously calling more young Englishmen up into the clouds to risk their lives. Much like them, we also need the memories of our place in the world to anchor an uncertain future. With new viral strains announced almost daily and the need to inoculate an entire planet before “normal” or “safe” can return, it still remains unnervingly unclear how any of us will come out the other end. As with the pilots and diggers of rural England in the 1940s, it might get us thinking about what we’d most like to carry with us–what we’d most like to preserve–as we too face the unknown.

This trailer for The Dig will give you the flavor of its juxtapositions on time, place, loss as well as the kind of gain that becomes possible when you seize the day.

Among many other things, this is an actors’ movie, particularly for Mulligan, Barnes and Fiennes.

Mulligan’s Edith Pretty is weighed down by the emotional and physical ailments that have increasingly burdened her since her husband, a soldier himself, died shortly after they married and their son was born. It is her estate that houses the ancient burial mounds, she’s always wondered what secrets they might hold, and perhaps because of her own dwindling, she finally resolves to find out. Mulligan’s startling performance pushes Edith to the boundaries of her fragile condition and to small bursts of vitality beyond it.

Edith finds the complement she needs “for a dig” in Basil Brown, “a self-taught excavator” who knows “everything there is to know” about the ground and soil of Suffolk since, as he takes pains to explain, his hands have been combing through it for over sixty years. A hard-working man, he learns how to find common ground with Edith across the gapping class divides of rural England in a dance of blunt and sometimes comical exchanges. Basil Brown is played by Ralph Fiennes, who has inhabited everyone from Voldermort to Jonathan Steed (the TV Avengers protagonist) and the English Patient in his years playing leading men on the big-screen. Given those marquee roles, his understated Basil is a departure.

When interviewed about it, Fiennes (himself a Suffolk native) said he spent weeks riding an old bike along the country roads of southeast England to refresh his feelings for the place and its rhythms before filming began. In other interviews The Dig’s creative force, Simon Stone, said he encouraged his actors to ad-lib the script when it felt right to them. For the character of Basil in particular, deep knowledge of the land and the freedom to be spontaneous produce a kind of honest power that is evident throughout this performance, which is the best of his that I’ve seen in his long career.

The eight (or so)-year-old actor Archie Brown plays Edith’s son Robert. A dazzling counterpoint to the mumbling Basil and his frail mother, Robert brings the fireworks of childish excitement and gushing enthusiasm to this dig for buried treasure. In their small community quest, he also discovers a father figure, awakening in Basil the best kind of paternalism when the old codger least expects it. A sequence where Robert takes off from home on his bike in search of Basil is gorgeously realized and almost unbearably sad in its desperate longing. But while the buried treasures here are frequently emotional, there are also splendid discoveries to be made as this ragtag band carves its way beneath the ground.

What The Dig’s spirited amateurs discover became known as the Sutton Hoo Treasure, stored in the buried hull of a sixth-century Anglo-Saxon ship to honor a Dark Age king. As a long-time believer in buried treasure, if I have a complaint about this movie it’s that we get to see too little of this magnificent horde—mostly as it temporarily rests on the mossy beds of wooden crates that are placed, one after another, under Edith’s bed, near a suitcase that had been her husband’s.

She ultimately gives the Sutton Hoo Treasure to the British Museum despite sniveling among the “professional” archeologists and museum curators that provide the film’s suspense (“What will become of this magical discovery at a time when we all need to feel the joy of it?”) Representing an almost entirely unknown chapter of the nation’s memory, there is never really any doubt where it’s headed. The Sutton Hoo Treasure will go to the place where the greatest number of Edith’s and Basil’s countrymen and women can gather around its campfire and face whatever tomorrow holds together.

Well into The Dig, Basil’s bedrock of a wife wonders at his conviction and tenacity, over “just how he is,” not really asking as much as telling him: “Why else would you be playing around in the dirt while the rest of the country prepares for war?”

So it’s fitting that his and Edith’s quiet obsessions play out not in a “post-card pretty England” but in more of a dreamscape of grays and ochers during the day or in a nightmare when it’s dark and raining and Basil is trying to pull reluctant tarps over the excavation site despite being blinded by the spattering mud. What’s at stake here is not the rose-colored surfaces of England’s countryside but what supports that splendor underneath: its long buried past and the quiet furnaces that animate the men and women who have lived for centuries “closest to its ground.”

In an echo of the Anglo-Saxon ship that’s being unearthed, my favorite scene in the movie is of a contemporary sailboat drifting along the same nearby river that carried the burial chamber of an ancient king to what might have been his final resting place 1500 years before. It was like a message-in-a-bottle or maybe a promise of things to come. Like Basil for a moment, I could almost hear the past reverberating into the present and maybe even the future.

When you see The Dig, you’ll know what I mean about “how Basil is,” the silent quest that drives Edith, and how valuable spirit voices like theirs might be in each of us too as we worry and wonder about what’s worth preserving in our fragile world today so we can take it into the future.

This post was adapted from my February 7, 2021 newsletter. Newsletters are delivered to subscribers’ in-boxes every Sunday morning and occasionally I post the content from one of them here. You can subscribe too by leaving your email address in the column to the right.

The Roles of Doctor and Patient Are Changing

November 11, 2019 By David Griesing Leave a Comment

On a train to New York City, I found myself sitting next to a doctor from Johns Hopkins. Mid-career. Confident. As it turned out, he was also from a family of doctors.

In his career, he said he’d alternated between research and seeing patients and I asked him if he was getting what he’d hoped out of it. He said he had at the beginning, when he could practice more the way his dad had, like taking the time he needed to treat his patients. But more recently, demands from the government and insurance providers were requiring him to spend more and more patient time gathering information and creating medical records about their visits.

It gave him “an awful choice,” he said. “I can either spend much of my patient time looking down at my pad or tablet and taking notes or I can look them in the eye. I went into medicine to establish healing relationships, it’s how I saw my dad practice, but now this beast has to be fed every day.”

“What beast,” I asked. “Because I’ve chosen to keep talking to my patients,” he responded, “I still have to record all their medical information before I forget what we talked about, so almost every night I spend between 9 p.m. and midnight ‘feeding the data beast’ because, of course, my wife and kids get to see me for an hour or so once I get home.” “The volume of it is grinding me down,” he continued, “but our insurance system requires it. What I looked forward to as a doctor every day is getting harder to come by.”

I’ve noticed this from the other side too. When I go to a specialist or for my regular check-ups I’m faced by my doctor as well as “a record keeper” with a touch screen. I’m always asked whether “I mind” having record keepers there and can always ask them to leave if I want to talk “one-on-one,” but it changes the entire dynamic in the room. Is this visit about me or my medical information?

It’s not whether electronic record keeping is working as intended, or is actually helping to manage medical costs that caught my eye this week. Instead, it’s how the generation and use of patient data is placing more obligations (with fairly profound ethical implications) on the so-called healing arts, and how far those obligations extend beyond data privacy and confidentiality. Among other things, it got me wondering whether even our best doctors and medical caregivers are treating us as collections of data points instead of “as whole patients” in the grind of it all.

For centuries, a doctor’s ethical obligations have been set forth in the Hippocratic Oath, with its standards being tailored to current understandings about health and healing. For example, to reflect our growing environmental awareness, a current version of the Oath widens the focus of care from the individual patient to the health of the community and the planet itself:

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.

I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability.

My responsibility [also] includes these related problems, if I am to care adequately for the sick:

I will prevent disease whenever I can, for prevention is preferable to cure.

I will protect the environment which sustains us, in the knowledge that the continuing health of ourselves and our societies is dependent on a healthy planet.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those [who are] sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

In the light of today’s Hippocratic Oath, it was easy to find several of its shadows.

Can our doctors provide “warmth, sympathy and understanding” while they are also filling in the blanks in their paperwork during the few minutes they are allotted to spend with us?

When it comes to my data, how is it being used, who is using it, and how exactly is “my privacy” being protected?

Is this data collection primarily designed to make “the business of medicine’” more cost effective and efficient, or does it also promote my health and healing?

What is my responsibility as a patient, not only as a collaborator in my medical outcomes but also regarding “the multiple lives” of the data I’m providing?

In these regards, some food for thought this week came in the form of a new Hippocratic Oath that has been proposed by West Coast doctor Jordan Shlain. I think you’ll agree that in some ways his proposed Oath makes our jobs as patients and our doctors’ (and other medical professionals’) jobs as healers even more fraught than they were already.

Here’s Dr. Shlain’s proposed Oath, with my initial impressions [in brackets] following each of its statements.

1. I shall endeavor to understand what matters to the patient and actively engage them in shared decision making. I do not ‘own’ the patient nor their data. I am a trusted custodian.

[Instead of doctors doing and patients receiving, the emphasis on joint decision-making shares the health and healing burden more equitably. Unanswered is whether patients should own their medical data.]

2. I shall focus on good patient care and experience to make my profits. If I can’t do well by doing good and prove it, I don’t belong in the field of the healing arts.

3. I shall be transparent and interoperable. I shall allow my outcomes to be peer-reviewed.

[Both 2 and 3 confront “the business of medicine” squarely in the Oath, acknowledging that care should be delivered with greater transparency around a doctor’s outcomes for patients, which the data now allows. As the business of medicine publically proves its worth, patients will become more like shoppers in a marketplace. What this new reality means in terms of accessibility or quality of care is, of course, uncertain.]

4. I shall enable my patients the opportunity to opt in and opt out of all data sharing with non-essential medical providers at every instance.

[Recognizing a patient’s interest in his/her data, information will need to be disclosed about essential and non-essential users of that data and about each patient’s ability to limit how it is shared.]

5. I shall endeavor to change the language I use to make healthcare more understandable; less Latin, less paternal language; I shall cease using acronyms.

6. I shall make all decisions as though the patient was in the room with me and I had to justify my decision to them.

7. I shall make technology, including artificial intelligence algorithms that assist clinicians in medical decision-making, peer-reviewable.

[As AI and augmented intelligence programs become more common in medicine, protecting proprietary business information should not inhibit validation of the tools a doctor is using to treat us by his or her professional peers.]

8. I believe that health is affected by social determinants. I shall incorporate them into my strategy.

[This one goes further into the community behind the patient. As Dr. Shlain argues: “Someone’s zip code can tell you more about their health than their genetic code.”]

9. I shall deputize everyone in my organization to surface any violations of this oath without penalty. I shall use open-source artificial intelligence as the transparency tool to monitor this oath.

[With doctors working until midnight to feed the data beast and stressed about market competition from other practice groups, their willingness to open themselves to these kinds of ethical challenges from within their organizations seems almost utopian, but at the same time, this part of the proposed Oath acknowledges that patient/consumers alone won’t be able to police this rapidly evolving profession.]

Increasing reliance on data collection and algorithm-driven automation is changing the medical profession into a business. It also changes our jobs as patients, Where once we were passive recipients of “the healing arts,” we are now being called upon to become more engaged consumers, with rights to more information about our care and additional options in the marketplace. Moreover, we should be as concerned about the uses of our medical information as we are about how our other personal data is being used (or misused) by Google, Facebook or governmental bodies like the police and IRS.

At the same time that doctors should be anticipating more changes to the Hippocratic Oath, the job of being a patient and the responsibilities that come with it are also becoming more burdensome. It’s not doctor “up here” (with all the responsibility) and patient “down there” (with almost none of it) any more. We’re confronting an uncertain future together now.

This post was adapted from my November 10, 2019 newsletter. When you subscribe, a new newsletter/post will be delivered to your inbox every Sunday morning.

The Next Crisis Will Be a Terrible Thing to Waste

September 30, 2019 By David Griesing Leave a Comment

(photo by Markus Spiske temporausch.com @pixels)

We are moving into less settled times both here and in the rest of the world. Several different storms are gathering along the waterfront today:

– in politics, with gridlock both breaking down and intensifying over impeachment and the future course for America, in the UK over its relationship with the rest of Europe and what it wants for itself, in the battles between populists and traditionalists elsewhere;

– in economics, with weakening global prosperity and the likelihood of a financial pullback that will affect almost all of us as the fundamentals weaken;

– in the environment, with increasing alarm over the current effects of global warming, the longer-term outlook for the health of the planet, and state actors’ halting efforts to respond to the challenge;

– in the world order, with a rising China, a demoralized and divided West, and a handful of nations around the edges that are both willing and able to take advantage of the uncertainty; and

– in the prevailing spirit, perhaps the most impressionistic of these storms but potentially the most powerful, as pessimism, alarm, hysteria, backlash and hostility get reduced into urgency in their boiling cauldron—a drive to do something, anything to move off the dime.

The silver lining is that chaos, confusion and uncertainty also provide opportunities. When you’re clear about the priorities behind your work, your chances to advance them are always greatest when the storms finally break as long as you’re ready to rebuild the storm-tossed world in the ways that you want. Now is the time for getting ready, because the chances to address our most pressing problems–and the rewards for us and others that can flow from that–may never be greater.

When the work we do helps us realize our priorities, it becomes more purposeful and satisfying.  As I argued here last week, in many of our jobs it is both possible and desirable to align our priorities with that job’s broader objectives. Improved health. Greater fairness. A more sustainable way to live.

In other words, it’s tying what you want yourself to almost every job’s higher purposes. Not only does the alignment reduce friction between you and those impacted by your work, it can also produce an esprit de corps with your bosses, co-workers, customers, suppliers and members of the broader community as they support your efforts. You’re experiencing the shared benefits of a productive community while taking home both the pride and satisfaction that comes with it.

Of course, another essential of “good work” is its future focus: anticipating circumstances that might enable you to take bigger-than-usual strides towards realizing common priorities. It is being aware of the obstacles and opportunities today so you are ready to act when the storms break and the lay-of-the-land shifts, weakening those obstacles and providing those with a vision of the future a path for realizing it. That’s because everyone who has weathered the storm wants to put the pieces back together and is unusually receptive to putting it all back together in some better way.

Realizing your particular work ethic in times of crisis has almost nothing to do with luck but everything to do with your mindset and plans. It’s having a vision of the better future that you want, keeping your eye on that goal line as the game degenerates into chaos, and, when everyone is finally able to listen, inviting your fellow survivors to help in rebuilding something that you’re convinced will be more durable and sustainable than all of you had before. At such times, aligning your personal priorities with a higher, common purpose will not only be satisfying for you, it can also make changes that seem impossible today, possible tomorrow.

My priorities (in search of this broader resonance) would include the following:

Thriving workers, families and communities.  Most of us have jobs as citizens of democratic countries with capitalist economies. We regularly make our preferences known by choosing leaders who share our priorities. As citizens during unsettled times, what kinds of change would we support and priorities would we pursue?

In large part because “thriving workers” are the foundation for other kinds of positive change (such as reducing income inequality, gaining affordable health-care and safeguarding the environment in our communities), I’ll be looking for leaders with the courage to say they are foregoing other “hot button” reforms to invest in retraining today’s workforce for a more automated world; to support trade buffers so that workers here don’t lose their jobs to cheap foreign labor when they’re compensated more fairly or work under safer conditions; and to support new public policies like bolstering the economic security of low-wage workers by supplementing their incomes through payroll deposits, thereby encouraging their continued work and improving their chances to start building wealth for their families and communities.

We don’t hear politicians making hard choices between costly alternatives.  Or willing to make the engines of capitalism more democratically-driven by ensuring that working men and women have a larger seat at the table with business owners. In the wake of the economic storm that’s coming, there will be many citizen-driven opportunities to support leaders who are eager to rebuild the future on the backs of thriving workers, while admitting that to realize that goal means putting many other goals on a back burner. It should also be a bi-partisan issue. As citizens, our focus and support can help them to accomplish this one important thing as the political process bottoms out and it struggles to identify new, common goals.

Environmental stewardship. As Alain de Botton argues persuasively (and often amusingly) in The Pleasures & Sorrows of Work it can be difficult to understand the wide-ranging impacts of your paying job given the global supply chains that feed it and the distribution networks that bring your “goods or services” to consumers. Difficult yes, but hardly impossible.  Among many other things, De Botton invites us to learn more about the consequences of our work, both for better and for worse. I’d argue that when we do, we’ll be able to see “how we can work better in the future” in a common light that includes “greater environmental stewardship.”

Is the product I’m selling or helping to sell, is the service I’m providing and the ways I’m providing it, improving the health of the planet or reducing it? Raising consciousness in the workplace about an issue like environmental stewardship provides opportunities for alignment with others–including bosses and even owners—who may share your concerns. The accelerating storm of today’s climate debate and the quest to find our way out of it will likely present many opportunities to change business practices (and even nudge them in groundbreaking directions) where we work.

Righting the balance between people and profits. Connecting your paid work to its wider-world impacts is not just limited to environmental stewardship. As global economies get roiled and we begin to look beyond these upheavals, we can be thinking now about how our jobs can provide greater benefits to us and our communities and not simply about how we can assist business owners in becoming profitable again. To ensure that you and I are not merely helping to restore the profit-dominated status quo after the next recession, we could be learning now how to connect our labor to “more of its fruits” than higher corporate dividends.

As I argued last March, administrators of a global education test are using that test to assess independent thinking, collaborative problem-solving and building better communities. On the theory that we “treasure what we measure,” students globally are now building these aptitudes in their classrooms because they will ultimately be tested on them.

By the same token, employers could assess (and reward) their employees–and be assessed themselves–for “aptitudes” beyond profit-making, including their success at tying company productivity to greater community benefits. For example, workers could push their companies to retain them (even with reduced hours) instead of firing them during economic downturns because policies like this maintain stable communities, or to take less profit from a product or service if it will keep a job here instead of losing it to a foreign worker. Moreover, employees who can demonstrate that they have strengthened the company-community bond would be rewarded for doing so.

The groundswell for this broader focus needs to come from forward-looking employees as well as executives and owners, and the time to be thinking about more community-oriented work assessments and broader exercises of corporate responsibility is now.

After we’ve weathered the next downturn, are looking for better ways forward and desiring greater corporate accountability for common problems—that’s when you can stand up with your new way to determine economic success.

That’s when you can argue that what’s good for the company needs to be good for the community too, and that the economic fallout might be reduced next time if the broader community were part of the equation from the start.

That’s when you can gain even more pride and satisfaction than is usually available when you help to solve common, work-related problems, because now you’re helping to humanize the foundations of democratic capitialism itself.

+ + +

We are far enough today from the economic recession that began in 2008 to gain at least a measure of historical perspective. Two new books are arguing that Barrack Obama was so eager to restore economic stability and the health of the American banking industry that he failed to “use” this crisis (as FDR had used the Depression) to seek fundamental—and to these authors—necessary changes to the country’s economic policies.

For example, in the course of re-building America’s way out of the last recession, they observe that Obama (like Clinton before him) never challenged the economic imbalance between the corporations and ordinary working people that had been a hallmark of the Democratic Party from the 1930s through the 1980s. When it came to punishing wrongdoing, Obama refused to insist that the bankers who had profited from the bubble they had created in the housing market be held accountable. When it came to economic initiatives like the Affordable Care Act, he favored market solutions over government policies and direct interventions (unlike the alphabet soup of initiatives during the Thirties or The Great Society programs of the Sixties).

According to Reed Hundt’s Crisis Wasted (out last April) and Matt Stoller’s Goliath: The 100 Year War Between Monopoly Power and Democracy (coming in mid-October), Obama sought to preserve the pro-business status quo rather than rectify the economic imbalance that disadvantaged workers, families and communities while benefiting the American business owners who held (and continue to hold) a disproportionate share of the country’s wealth.

I agree with them that a crisis is a terrible thing to waste, and that the last one was a string of opportunities neither taken nor pursued. None of us should be willing to waste the next one.

+ + +

I’m defining a “crisis” here as a ground-deep unsettling of prior certainties. A political/economic/environmental/moral crisis tends to prove that “the ways we used to do it” are no longer working and, for a brief window of attention and opportunity, regular people are willing to explore (and even support) both different and better ways forward. It’s why from the perspective of our work, we need to be ready with arguments, data, plans, hope and visions for the better world that each of us wants when that window finally opens.

We don’t need to agree on the changes. (The bold-faced objectives above just happen to be some of mine). But I’d argue that all of us need to be active parts of the conversation, even when it’s full of anxiety and has a fevered pitch. Because it’s when your work really can “change the world” and when the personal satisfactions and sense of purpose that come with it can be similarly transformative.

In 2016, a group of forward thinkers who were clustered around the University of Sussex in the UK created educational materials for anyone who is interested in seizing the opportunities of a world in flux. Those materials begin with powerful examples from history where:

– radical changes occurred in disruptive times that would not have been possible otherwise;

– to nearly everyone’s surprise, immediate changes were accepted by the public fairly rapidly; and

– longer-term improvements followed, with some expected and others exceeding expectations.

The Sussex materials also describe how, in a host of practical ways, change-agents can capitalize on the opportunities crisis presents and maintain forward momentum.

There is a broader discussion of their approach and a link to additional materials here. If you’re interested in readying yourself to take full advantage of the opportunities after our gathering storms break and the re-building begins, I think you’ll find their approach empowering.

Our work can always be aligned with deep motivations and high purposes, but the rewards are never more satisfying than when you’re helping to build a better world out of one that may be ending.

This post was adapted from my September 29, 2019 newsletter. When you subscribe, a new newsletter/post will be delivered to your inbox every Sunday morning.