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Opening Statement (Newer Opinions Follow after this one)

Introduction       "Think about it", my father would say as I worked to reason out a solution as a young man growing up in Lubbock. My father has always been a practical man who worked hard to understand something before he acted. As a young child I remember the interruption of my cartoons when President Kennedy was assassinated. I campaigned as a youthful volunteer for my uncle Waggoner Carr as he won the position of Texas Attorney General in the early 1960s. Reason paired with compassion for others in service to what was right served as the example in my family.

     Since those first days I have remained committed to the idea that we all experience greater success as individuals and communities when we host a reasoned debate. This does not always imply agreement for a democracy is an ever-growing and evolving entity. However, our ability to describe a concern, elicit information about its form and function, and arrive at some form of consensus serves us well.

     Earning my undergraduate degree from Texas Tech University in 1980 I went on to complete my Master's degree at St. Mary's University in San Antonio and later my Ph.D. from Indiana State University in 1988. I lived for two years in Dallas, serving on the faculty at UT Southwestern Medical Center, before returning to my hometown and family. After a term as Director of Bio-Behavioral Medicine at St. Mary of the Plains Hospital I entered private practice in 1991. I work with the full spectrum of people including difficult teenagers and individuals and families suffering with severe health problems.

     In 1996 I approached the Lubbock Democratic Party about developing their Internet presence and established their first web site that year. Over the years I revised the site many times in an effort to keep the message contemporary. In 2009 I felt it best to resign my position as web master for the local Democratic Party. LubbockProgressives.com was created to offer a more dynamic and exciting medium then had previously been supported.

     Am I a Democrat? I would consider myself as being more closely aligned with the Democratic Party however I do not blindly abide by their leadership's commands. I look at my tendencies toward one political group or another as similar to my being a member of the Methodist church. Raised up at First United Methodist in downtown Lubbock I have always enjoyed the music and messages that are given however my relationship with Jesus Christ is personal and my church serves as a guide but not a master. I believe that a diversity of views can be explored in any church as we strive to understand ourselves spiritually.

     I remember when there seemed to be a true distinction between Democrats and Republicans. When a debate remained civil and the focus remained on the issue and not a smear campaign against the person. I started this web site with the intention of working toward a restoration of a plain spoken conversation about how best we as a city, a state, and a nation can provide for our citizens and give each of us a chance at the American Dream.

     If you believe in a return to common sense join this organization by completing the Personal Profile Submission. If you believe that reason and civility can guide the discussion of problems we face then join with me. If you remember the joys of a childhood where you were challenged to "Think About It" then join with me.

Brian D. Carr, Ph.D.

June 28, 2010

Well Doctor, I’ve tried smart and I would rather be pleasant.

Last week we traveled down to the double-wide trailer on the Llano River in the Hill Country of Texas. Perched on a bluff overlooking the river it is a place of solitude and peace. The television doesn’t pick up any digital channels, no Internet is available, and quiet resounds across the brushy countryside.

When not dipping into the cool water of the river or enticing channel catfish or river trout to bite the hooks we watch movies. Classics as well as contemporary dramas and stories. My wife might read a book on the deck while my granddaughter and I enjoy a musical.

The pause from my professional life gives me time to reflect and consider life. While watching the classic Jimmy Stewart movie “Harvey” (1950) it occurred to me that the main character Elwood P Dowd, had a clear grasp on an important concept for governing one’s self.

For those not familiar with the story Jimmy Stewart performs in the character of Elwood and he has as his companion a 6 foot 3 inch “Pooka” a creature unseen by others that takes the form of a giant rabbit. A description of the movie is taken from the “Internet Movie Database” web site as follows:

“Harvey is a very gentle spirit who is always helping people out and can make everybody around him feel relaxed and in a good mood. Now Dowd needs all the help he can get. He likes to take a nip once in a while and is always talking to that danged rabbit to the chagrin of his sister Veta Louise (Josephine Hull) whose social life takes a nosedive when brother Elwood is around. Elwood's shenanigans also interfere with her plans to marry off her daughter Myrtle Mae (Victoria Home). When Veta decides that she has had enough and tries to commit Elwood to a psychiatric institution, the tables are turned and she ends up being committed in a hilarious case of mistaken identity. When Elwood leaves the hospital after being released, the medical staff in the hospital (a bit eccentric themselves) realize their mistake and all try to find him.

The madcap beginning soon turns into a gentle and moving drama. Jimmy Stewart is flawless as the decent man who never loses his temper and always has a smile on his face, giving everyone his card and inviting strangers home for dinner. The supporting cast is top notch as well including the unpleasant Dr. Chumley (Cecil Kellaway), the egotistical psychiatrist Dr. Sanderson (Charles Drake), his love struck assistant Miss Kelley (Peggy Dow) and the overwrought orderly (Jesse White, later known as the Maytag repairman).

Eventually some that ridiculed Elwood and his rabbit privately admit that they could see Harvey themselves and by the end we are gradually convinced that the so-called normal people may be stranger than Mr. Dowd. Harvey is considered a classic and with good reason. It works because of its good-natured humor and its gentle slap at those who automatically condemn ideas that are outside socially acceptable norms without thinking for themselves.”

In a scene with Dr. Sanderson Elwood is asked how he can accept such craziness as seeing giant rabbits since he seemed to be an intelligent man. Elwood replies, “Doctor, I’ve been smart but after I met Harvey I decided to be pleasant instead”.

The movie captures the essence of what I see as a contemporary problem in our society…we are all trying to outsmart the other. If we cannot outsmart them then we gravitate to a position of shouting and insulting those who we disagree with. We allow for no quarter, no offer of coming over to our house for dinner as Elwood frequently did. We act the role of Veta and attempt to put others away and see that they are silenced if they do not conform with our thinking.

George Wills, conservative columnist, decried this attempt to remove “the oddness of everything”. He defended the notion of how uniqueness is a treasured resource. Mr. Wills noted that the growing movement of “certitude” where there is no room for differences is a sad departure from the foundation of our country.

After 12 years of public education followed by 10 years of college and extended with 22 years of clinical practice as a psychologist I believe that being smart has its place, however being pleasant is greatly underutilized in our society.

In view of this lack of attention to such a powerful attitude I believe it is important that news of this choice between smart and pleasant be better publicized. Helping people to return to a time of gentleness and polite disagreement is greatly needed.

A curious thing about being pleasant is how the roots of this attitude are easily found in Christian teaching and in Scripture but seem to be brushed aside. You rarely find an offer to “break bread together” and treat others as you would hope to be treated. Instead those most virulent in the so-called religious right draw more from the Old Testament where rules and “smart” abound and judgments can be applied.

Being pleasant (otherwise known as loving and caring for others) is a trump card over being smart. Smart has lead us to create wonderful inventions and to develop tremendous skills but the Bible tells us that “the greatest of these is love”. That people don’t love when being tormented is logical and in keeping with our human condition. The intriguing situation is where someone decides to extend love where it is not expected, where it may be denied, but nevertheless it flourishes given freely from one person to the other.

So, I will continue to work toward being “smart” but I believe that Elwood has the more powerful choice. I’ll let others be smarter, be louder and be demanding. I think I’ll just invite people over for dinner or have them out for a drink. To quote Elwood “I’ve been smart but decided to be pleasant instead”.

A better choice.

January 31, 2010

Sunny or Approaching Storms: An Optimist’s View

Life is often in the flip of a coin. Probability moves across our daily life as we pounder “will it rain?”, “should I move my money now?”, “is he/she the right one?”.  Making a guess remains just that, a guess.

Everyday in my clinic office I share perspectives with people. The philosopher Aristotle say, “It is not reality that troubles us but our view of reality”. I believe that optimism is not so much genetic as it is learned.

In our country now are many concerns, many fears and I believe that there is a movement of pessimism that is fanned by our sensationalistic media and political and social leaders who ride such attitudes for personal fame, fortune and power. This negativity must be countered and attacked at its base. Failing to check this purposeful social corruption will result in further personal depression, disrupt families and other support ties, and consolidate power in the hands of those with little morality or true sense of humanity.

The best attack for those who are optimistic is to simply look out the window. What is the weather outside? What did the radio or television weathermen predict? Living in West Texas is to understand how much the weather is a guess. Even with advanced degrees and sophisticated equipment one moves only towards a position of an “educated guess”. A significant portion of the weather outside remains uncertain and this is where optimism can be grown.

If one looks out the window the accuracy of any statement about the weather will be dead-on in the moment. You can see the rain, feel the bite of the wind, hear the thunder of the storm and know that it is happening in real-time. However, if asked about the weather as time pushes into the future one is left to see their prediction soften and drain away.

One can state with certainty if it is raining outside this moment, but what about one hour from now…one day from now…a month from now? It is in this prediction that one makes a choice of optimism or pessimism as you label what the future holds. You don’t really know past a certain point but you “decide” what the unknown factor will be, without any really proof until you get there.

One cannot remove the unknown portion of what the future holds. No amount of computer power, collective “think tanks”, or massing of resources will provide for coverage of all possible contingencies. In this sphere of unknown operates what some call faith, a belief without proof.

So, when I consider this unknown that exists past what I know I prefer to think optimistically. As time moves forward I will make adjustments and take into account information that becomes available that may change my course of action. Lacking knowledge of the future past that point of evidence I simply choose the optimistic positive view.

Twenty-five years of working with people as they confront physical illness and, in some cases, approaching death has taught me the power of optimism. Unfortunately we receive care in a system that is not so much about healthcare as it is about sickcare. Doctors often assume the presence of something bad and then go out to find evidence of it. A young female client of mine recently was told that she might have tumors in her brain and needed further workup. Her physician told her that she wasn’t a radiologist but in looking at the CT scan it looked like there were unusual masses in her brain. She referred her to a neurologist who couldn’t see her for two weeks. In the meanwhile she was left to reflect on her mother’s bout with cancer and the fear of a young life crippled or cut short by disease.

She shared her story with me and we talked about her mounting fear as she waited for the appointment with the neurologist. We talked about her hopes for the future and the life story that she was mapping out in her college studies and friendships. We talked about the “unknown” in her circumstance and how she “didn’t know until she knew”. I repeatedly pointed out to her that her physician had stated that she wasn’t sure and that there were several factors that make it unlikely that she had such tumors.

As it turned out she did not have any tumors and the neurologist pronounced the findings as merely artifacts in the imaging process. We talked further about how her “negative” energy expelled in worrying had been for nothing. We talked about her future and how there were other “unknowns” that she could now better release herself from worrying about because “she didn’t know until she knew”.

Another point for optimism can be found in the predictions of our world being in the “end times” with our extinction being foretold. History has taught us that such predictions are usually used as a social force to create tension or seek support for a cause. Even within the halls of science we find predictions that strike fear while attempting to be factual.

Watching the Discovery channel one night the show featured the news of an approaching asteroid that might intersect with the course of our Earth in 2024. Information about the size of the asteroid, the speed it was traveling and the nightmarish outcome if it impacted our planet were all detailed. Then the scientists related that this was still not a certainty due to our not being able to yet plot the true course of the asteroid. The lead researcher stated that the course could be plotted with accuracy by the year 2022 when the distance was greatly reduced by the approaching asteroid.

My first thought was “I gotta stop watching the Discovery channel” while my second thought was “they really don’t know yet”. I then considered the question of how to spend my time waiting for the announcement in 2022 as to whether we were going to all die or not.

I broke it down this way:

1.      1. Starting now I will worry about it now in 2010 and stretch this out to the announcement in 2022. Then the scientists tell us the asteroid will impact and I will intensify my fear from that point until the end in 2024. Total time spent worrying 14 years.

2.      2. I will start worrying now in 2010 and the scientists trot out in 2022 and tell us the asteroid will miss the Earth. I relax at that point. Total time spent worrying 12 years.

3.      3. I decide the asteroid will not hit the Earth and don’t worry about it until the scientists tell us in 2022 that we are doomed. Worry from that point until the asteroid hits in 2024. Total time spent worrying 2 years.

4.      4. I decide the asteroid will not hit the Earth and don’t give it much of a passing thought until the scientists announce that the asteroid will miss the planet. Total time spent worrying is zero.

Deciding that “I don’t know until I know” helps me to pick #4 as the most efficient action I can take. This frees me up to worry about the more mundane things in my life such as the dog chewing up the sofa and how to keep the bills paid.

This optimism doesn’t always come easy as the more personal the potential problem the more that one assigns the negative to the outcome. However it is essential to draw from the Serenity Prayer and the wisdom contained there with ownership of what we can do and release of what we cannot.

As is often the case the wisdom of life can be stated simply but the execution is where the difficulty is. I prefer to think that this all will work out until I find out different. I think that justice will prevail, good people will succeed, and happiness will move into our lives. I like stories with happy endings and, when I don’t yet know the ending, I think that all stories end happy. There will be time enough to deal with pain and suffering when it arrives, I just don’t go down to the station and wait for it.

Life is good and that is what I believe.

January 2, 2010

In the Dash of Life

     The advent of 2010 finds me in the “dash” of life. You know this dash, you’ve seen it. It appears on the headstones at the cemetery. Between the year of one’s birth and the year they die. A tiny, insignificant dash that separates the two dates. Within this small moment is the essence of life.

Connections

     Life is not really captured in the dates on either side of the dash, but rather between. Here we find the story…what I did…who I knew…my adventures. Passion, cowardice, bravery, love all contribute to the flavor of the story. Most of all, the connection one has with the people and the world around them. My life is intertwined amongst those who came before and those who enter behind me.

       Jesse G. Carr was my great-great grandfather. I know of my family for two generations before him but he is the first to have a photograph made. Born in 1804 he was a farmer and physician who lived near Rome, Georgia. In a 1986 visit to the remains of his homestead we spoke with a woman who recalled the remedies that her grandmother had used that “Dr. Carr” had provided.

 

     His son, Zachary Taylor Carr was born in Georgia in 1848 and, as a young boy, served as a drummer in the Confederate army. With the family farm looted and in ruin he moved with his wife to east Texas where he served as a judge. He died on Halloween in 1944 and I’ve often reflected on the changes that he witnessed in his 96 years.

My grandfather Vincent Carr lost his bank in Fairlie, Texas in 1932 and with his wife Ruth and three sons moved to Lubbock where his brother Marvin helped him to find work. The family lived without indoor plumbing and my grandmother raised chickens and had a plentiful garden that provided during those lean days.

My father had two brothers and a sister. The oldest son, Waggoner, rose to prominence in politics and served as state representative, speaker of the house, and finally as attorney general for the state of Texas in the 1950s and 60s. My uncle Warlick was a well-respected attorney who served on the state bar for many years. Aunt Virgina was a refined social host and worked in state politics for many years as a professional staffer.

     My parents married in 1947 and spent their first years washing dishes in the bathtub as their apartment in Dallas near the medical school didn’t have a sink. Opening his pediatric practice in Lubbock in 1952 my father recalled that an office visit was priced at $3. I remember waiting with the family in our station wagon while father would stop by a patient’s home for a quick visit. He closed the clinic in 1992 but continued to practice until 2006. Now officially retired he and mother are active in historical preservation and research.

     My older brother Bobby served in the Army after medical school and returned to Lubbock to practice as an orthopedic surgeon in 1986. My sister completed her education and earned her Registered Nurse license. Married with two great kids she is also back in Lubbock and works at University Medical Center.

     My life expanded with the marriage to Valeri in 1984. Our two children are now adults and out into their own lives. We are blessed with two granddaughters and life remains very active. Not always easy but rich in details I find that these connections are what makes the story.

My Regrets

      With the start of another new year I find amble cause for celebration but am saddened by other aspects of contemporary life.  We have lost the commitment to polite disagreement and our communications are marked by a civility gap where rude and demeaning messages are aimed at those with whom one disagrees. Our impulsiveness and inability to be tolerant of others has led to a high divorce rate which leaves our children as victims in the aftermath. Finally, we ascribe self-responsibility while seeking ways to be absolved and released from our own obligations.

      To a large measure I believe that these modern maladies that are destructive forces in our lives are the result of a lack of the “connectedness” that I have enjoyed in my own family. A key aspect of my work as a psychologist involves the development of rapport with my clients. If one has a good “connection” with another person it is possible to achieve many goals but, if no such connection exists, then it really doesn’t matter how many books one has memorized. Carl Rogers spoke of “unconditional positive regard” for the other person as being central to the therapeutic process and I am in agreement that this is the principle aspect of good counseling.

     Learning to do what one doesn’t like is what leads to life success; however we have done a disservice to our children in teaching them that they shouldn’t have to perform a task that is difficult or unpleasant. As a result our children enter their adult years unprepared for the demands and sacrifices that are required for the betterment of one’s self and their loved ones. Instead we see the hard work of learning a skill such as playing a music instrument replaced with the “guitar hero” instant mastery portrayed on the video screen. Much like the cotton candy at the county fair the enjoyment is quick but lacking in any substance.

     There are ways back to the “connection” that I speak of, but the path may be a painful one. Our society continues to operate without a regard to the finite nature of life. America has become a country of credit, financed with international dollars and situated atop a “bubble” of false prosperity that cannot be maintained. While our country suffered a recession in 2009 that was unmatched since the Great Depression there is still a greater wave of upheaval in our future. We are approaching a time of “resource allocation” when decisions will have to be made about who gets what because we cannot sustain an “all for all” mentality.

     This approaching age of resource limitation will likely prove hard on many but I am optimistic that such a time will be manageable. Much like the limitations imposed by the war effort of World War II we will learn to live on limited energy, supplies, and food. To achieve an acceptance of these limits we must know why we are engaged. This is where the “connection” is restored and people and families are drawn together again. Seeing that we all share in the burden and that a common good is achieved is what will sustain us. Failing to share the burden and to equally suffer for the good of all I fear our society will devolve into a caste system where a few at the top of the economic chain fare well while the majority toll with little hope.

     A second, and less painful, way that we restore the “connection” is by a dedicated effort to raise the awareness among people of the importance of being “nice”, of being respectful again. One can start by participating in charitable giving and volunteering of one’s time. Reaching out and encountering relationships with others in need, seeing the appreciation when help is provided, and coming to understand the bond that exists between a people. Start by committing to standards of honesty, of obligation of giving one’s word in trust, and in setting straight-forward communication that “means what one says”.

      Confronting others with love and accountability is the next step after a self-inventory and self-commitment. This does not mean that we attack others for their opinions but seek to establish rapport that shows respect for diversity. We will need to appreciate the right to self-determination that others have even if we disagree. Seeking clarity as to what the other person means and then striving to ensure that they understand what you mean are the essential aspects of negotiation. We don’t back down just because the other person disagrees and yet, we don’t become insulting in response to the other person’s attacks on us. We recognize that life has many different chapters and that we all grow and change in our attitudes and beliefs.  We “agree to disagree without being disagreeable”.

     We are in control of our thoughts and our feelings and no one can control our attitudes. If others could “make us mad” then my job as a psychologist would be a lot easier because I would just employ this external control to my sessions and people would be happy. This is not the case and yet, within this knowledge of who directs ourselves is the greatest gift that God gave us…Free Will!

     Free Will states that I can love you because I don’t have to. God loves us despite our many flaws and Christ died on the cross for our sins, not because we deserved it but because he loves us. Love is indeed “the greatest of these all” and the power contained in this love is the spirit of the “connection” that I wish so much could be a greater part of our current world. I do not always agree with my wife, my children, my siblings, my family, or the greater world…but I do not have to harbor hatred toward others no matter what happens. Hatred only consumes, love in the face of such hate or anger is much softer but it triumphs in the end. Hatred is strong in the form of a sword while love is muted, yet within our connection with others we move beyond “an eye for an eye” and achieve a measure of the Grace that Jesus showed us.

     May you find “connections” in 2010 and be restored in yourself and sense of the relationships that surround you. I challenge you to create or restore those “connections” with the people in your life if you do not have such now. Engage with those who would be rude and demeaning by first displaying your ability to not give back what they hurl at you. Be patience as you point out the alternatives to hatred and violence.

Make your 2010 resolution to be nicer and respectful to others. Work to create the most optimistic story within the simple dash that will one day adore your headstone. Create the relationships that link us together and help us to be better than where we started. Within these links are the story of your life, the “dash” between the dates.

Love is patient; love is kind
and envies no one.
Love is never boastful, nor conceited, nor rude;
never selfish, not quick to take offense.
There is nothing love cannot face;
there is no limit to its faith,
its hope, and endurance.
In a word, there are three things
that last forever: faith, hope, and love;
but the greatest of them all is love.

-- 1 Corinthians 13

December 20, 2009

Stories are life and everyone shares them equally. I listen to stories every day and all have value. In this season honoring our savior’s birth it is good to reflect on the humility found among us in the most simple of places.

I’ve been privileged to hear stories that demonstrate the best in people as they struggle in the most ordinary of ways. Stories not of fame and fortune, but merely of small joys and pleasures captured beneath the towering pain and “realities” of life.  I want to share the stories of three with you so that they may live on in this moment and bring reflection to your own life. I’ve changed some of the identifying information in order to preserve the identity of each, however the stories remain true to the circumstances.

Bruce the Loving Father

I met Bruce after he had been significantly “reduced” by his surgeon. A Type I diabetic since the age of seven he had not been attentive to taking care of his disease and so he was ravished by the complications while still a young man. When first consulted in the hospital to review his case I found a man of 29 years who had lost both of his legs below the knee to amputation. His hands had the opposing thumbs but only one finger each. His vision was severely limited by diabetic retinopathy. He had major cardiac problems and gastro-paresis that left him skinny and brittle. His social history was little better. He had been married but was now divorced. He lived in a small house that his parents had purchased for him and he managed with only a small disability check from the government. He had few friends as it was difficult to get out and his interests were limited by his physical status.

The consult read “evaluate for depression” and, after reviewing his chart and history, I thought that this was one referral question that I knew the answer to before even seeing the patient and like all good stories when they first start out…I couldn’t have been more wrong!

From that first occasion of meeting Bruce through his death five years later I could never make the case that Bruce was clinically depressed.  Yes, he was stressed and frustrated as he dealt with the tough choices he faced across almost every minute of his day. He would regularly have to return to the hospital and face further surgical revisions as his tissue would die from poor circulation. This was not what we talked about. He would cycle in and out of contact with me and he always seemed to enjoy the conversations. We would talk about his wayward youth mis-spent and the sadness that he felt for being apart from his young daughter. After a marriage of a few years they divorced and his wife moved back to the Midwest to be closer to her family, taking their daughter with her. The daughter would travel down to Lubbock in the summer and stay with Bruce with his parents helping. His parents would help them to take short times to New Mexico or around the region in West Texas. She was a central figure in his otherwise marginal life.

The day came when I was called to the hospital to see Bruce and it was the final chapter. An infection had developed in his knee joint and he had undergone repeated infusions of high powered antibiotics to combat the problem, with no avail. The surgeons told him that he was going to die if he did not undergo an amputation above the knee. Such a procedure would likely leave him unable to walk again. He refused to consent to the operation and, lacking any other medical intervention, I was consulted for guidance.

I thought to myself, “At last, he is going to be depressed because this is the end” as I walked down the corridors of the hospital to his room. I had always marveled at his cheerful attitude and did not see a way that he could maintain such in the face of what was now in front of him. He had been asking to see me and this gave me a sense of purpose to provide him assistance and compassion.

“Hello Brian”, Bruce said as I came in and sat down next to his hospital bed. Expecting him to be tired and in a sad mood I was unprepared for what followed, “Remember my daughter up in Illinois”, Bruce asked me, “I needed to talk with you about her”. He told me about how she was now old enough to decide where she wanted to live and the plan was for her to come down to Lubbock and live with his parents. His ex-wife was in agreement even knowing what was soon to happen to Bruce and the grandparents had worked out the details so that his daughter could live with them.

“I wanted to ask you some questions about schools in Lubbock since you were raised here”, Bruce said. We talked about the schools in Lubbock and which programs might be of interest to his daughter. He wanted to make the best arrangements he could for her and that was the reason he had asked me to come in.

He had made his peace about his impending death, much as he had accepted responsibility for the consequences of his disease. He had followed all directives of his health care team for all the years that I knew him but it was too late. His life was the living example of the serenity prayer as he did what he could do and let go of that which was beyond him.

Bruce died about a month after our talk about the best schools for his daughter. She did come down and got to spend time with her father before he died. As far as I know she did well in school and was a good granddaughter with his parents.

There won’t be any books written about Bruce. His situation will not be featured in People magazine or retold on the Oprah show. He slid through life with barely a sound or any marker to his memory however he was most impressive as a loving father.

Debo the Card Lady

Debbie grew up in difficult times. Adopted by parents with strict standards her memories of childhood were bittersweet. Molested by a family member the experience was hushed up and hidden away. The few photos she had of herself as a child captured a sad smile and softness.  Despite the pain of her youth Debbie did well in school and graduated high school. College was not a part of her future and she married. After so many years of strict rules she and her husband gravitated to a casual lifestyle and both gained massive amounts of weight.

I met Debbie in one of the diabetes education classes that I taught through the hospital. She was inviting and immediately enjoyable. She laughed at my bad jokes and was a favorite of the class during the four weeks we were together. She was accepting of the responsibility of her disease while at the same time not doing much about it. She was often involved in helping others and attended support groups that I led. She and her husband moved back in with her mother after she began to have significant health problems. She was diligent in caring for her husband as she would pack his lunch and see him off to work. For a time she operated a small sports card comic book shop and gave me small tokens of appreciation telling me, “Don’t take the plastic wrap off” in order to preserve the value of the comic book.

Acceptance was the core of what was the story for Debbie. I never heard her complain or place blame on someone else. She was upbeat even when tired, humorous even when sad. I always looked forward to my visits with Debbie as she showed me how one chooses their reality no matter what the reality otherwise might be.

Debbie would make attempts to improve her health yet, like so many that are morbidly obese, had progressed past the point where any diet would help. She couldn’t afford the more invasive bariatric surgery and was trapped inside her weight. She took the medication as prescribed and showed up for all of her appointments. Her diet improved but it was the years of excessive consumption and exercise neglect that trumped all of her efforts.

Related to her weight she had developed diabetes and the, because of the diabetes, her kidneys began to fail. Faced with End Stage Renal Disease she underwent placement of a fistula in order to be able to undergo hemodialysis. This procedure required her to go to the center three days a week for four hours a session. She sat in a recliner and a machine filtered all of her blood. She had problems in maintaining the venous access and underwent several more surgeries in seeking new places to perform the transfusions.

I met with her as a function of listing her on the transplant program at the hospital. While still cheerful and joking her skin was ashen and her eyes were sunk into her face. She had developed serious cardiovascular problems associated with the dialysis and unless a transplant was completed her chances of survival were minimal. Besides the problem of her obesity she was O positive blood type, the most common blood type and the longest wait time on the list. Each day in the United States 16 people die waiting for transplants. Debbie had read extensively on transplant and we talked about the long wait that she was going to have. She knew that the chances were that she would die before coming up on the list.

She was presented to the transplant selection committee at the hospital but was turned down because of her obesity related to the known problems that came with her condition. I recall sitting down with Debbie and sharing the bad news. “You did what you could doc”, she said. We talked about some short-term goals that might move her in the right direction but we both knew that the ultimate reality was that she was going to die. Even with this clear knowledge Debbie remained engaging. For the next few months she would come to the support groups always with a funny joke and a cheerful smile. One day I received a call from the dialysis center informing me that Debbie had died suddenly the night before. I remembered the black and white photograph of a little girl, hair brushed and a smile looking into the camera. I thought about how accepting she had been with herself and all around her.

My Buddy Timothy

Tim is my buddy. He only says one or two word phrases and these are usually angry. He uses simple sign language but most of his communication is action. Life may not hold much for Tim in terms of vocational productivity but it is what surrounds him that draws one closer.

Tim’s parents brought him to me for behavioral problems. Tim suffers from Down Syndrome and at nine years of age he possesses the intellect of a much younger child. He has the noticeable characteristics and appearance of an individual who is mentally retarded.  When frustrated he would become quickly aggressive, grabbing and shoving while yelling.  Tim’s father also had intellectual limitations and his mother was a loving but simple woman. The family managed with some assistance from an aunt that lived with them as well as the father working as a pizza delivery man.

I worked with the parents in establishing a behavioral modification program to better manage Tim’s aggression with time-out. We talked about different situations that would come up as they were at home or in public and how to react to Tim. We practiced various techniques in the office and, over time, Tim began to be responsive. Every session the parents listened attentively and they practiced what we talked about between sessions.

Tim was a real challenge but never once did I hear the mother or father wish that he was not a part of their family. We talked about a 23 hour road trip to North Carolina and how disruptive Tim was at times. We talked about his pushing the aunt and the fear that he was becoming stronger. We tried a variety of methods to secure his medication patches so that he would not be able to take them off. Tim was a challenge across every hour.

What Tim has taught me is that love doesn’t care about such small details as graduations or being polite. While we can enjoy such things it doesn’t really matter what one is able to do, but only who they are. Tim will now lift up his hand and motion his fist up and down signaling “yes” to me. He likes getting a piece of candy at the end of our family sessions (although he will still squirm on the sofa as we talk as a family). I doubt that Tim will ever be free of supervision or know what it is like to be independent but I also know that the most important thing in life is not a thing…it is the love felt for another.

Tim is my Buddy.

My Christmas Gift

My professional work places me into the lives of individuals and families where I have a front row seat as to the joys and tragedies there. I wish that I had the ability to stop the terrible events that occur but then I wonder if perhaps they exist to give us meaning and appreciation of the soaring heights of triumph and celebration.

These three people were just common folks that I met on my own pilgrimage toward another place. A “Canterbury Tales” where each day brings a new story. These stories are not impressive in terms of polling numbers or wealth obtained but they demonstrate what is the best in ourselves, of what we can be. We are not obligated to be better, to be nice or loving to one another. Yet, it is comforting to know that we can rise to that point to be beyond ourselves and our pettiness.

I hope that this Christmas season finds you and yours well. My hope is that no disease or disability is limiting or cutting your life short. Take a moment and enjoy that which is all around you in the most ordinary of places. Life is wonderful even within what is the reality we face. Merry Christmas!

November 29, 2009

Let me tell you about my death…

I could have lived longer. However, I enjoyed deviled eggs and real butter. Valeri shared a secret potato recipe this holiday that included a full carton of French onion dip. I shaved several hours off of my life with this tasty morsel.

You might be invited to my funeral. I’ve told my friends down at Sander’s Funeral Home to make it right. Sam, Loyd, Ray, and Dwight will see me off and I appreciate it. Flowers will be accepted but preference will be given to gifts to charity and your attending the open bar party with the Tejano band.  

It has been a ride let me told you. Born in 1957 I’ve seen a thing or two. President Kennedy’s head explode…Jim Jones set up an open bar… elephants replacing donkeys and now threatened to be replaced by China. ! I’ve experienced the depth of joy with my family and witnessed the best in people as they acted to help make our world better.

I loved life! 15 cents got you into Chapp Park to enjoy the slide. Older brother Bobby, manning the booth at the Village Theater, looked the other way as my band of friends got in to see “The Blog”.

Saturday nights were special. Would she or wouldn’t she? Passion shared and enjoyed. Memories of fond pleasures pursued with wonderful partners in those youthful days.

I’ve been married 25 years. We spent wonderful days in a tent outside of Las Alamos, enjoying the afternoon showers and love in the afternoon. Time has proved challenging but the adventure extends with the strength of partnership.

Two children are intertwined in my life. We will extend into the future. What was initially important to bestow into our children seems to melt away as we come to understand that love in the essential of life. Grandchildren are much more enjoyable as the need to teach rules falls to the wayside, captured instead in the moments of fun and novelty.

I am but a link in the chain. I enjoy genealogy and tracing my family. CARR is a surname in American’s history. SULLIVAN from my mother has an interesting road.

I like a fight. People don’t think much as a general rule and this troubled me. Neurons are too valuable to just let sit there. A good debate sharpens the soul and wit of a person and should be encouraged. To be insulting no…to be challenging and provocative yes. Respect given and received.

I’ve enjoyed good talks. My family lives long and their recollections are enjoyable. My father celebrated his 84^th birthday in August. My mother turns 82 this Christmas season. My father’s father lived to be 92. His father lived to be 98. His father lived to be 88. His father lived to be 80. My great-great-great grandfather was murdered by Indians in Georgia in 1779 at the age of 47. Our informal chats flush out the rich history of my family.

America has changed as I have lived. I recall the first 7-11 in Lubbock in the 1960s. It gave me a place to ride my bike to. The “Blue Laws” restricted my purchasing on Sundays. Apparently God didn’t want me to buy nails but it was acceptable to buy a hammer.

People have become rude. My uncle Warlick was described as the “ultimate diplomat” at a gathering of fellow attorneys following his death in the fall of 2008. He could tell you to “go to hell and you looked forward to the trip”. I wish that people would ascribe to this principle of respect as he did. Ugliness gets too much air time today as people vie for the attention of the camera.

I remain optimistic for the future. While there is a conflict in our country over the basic issue of caring for others or trimming expense I remain convinced that we will strike a balance. We just need to be honest about it and acknowledge that there are consequences to either choice.

Christmas is a wonderful time and I will not relent to the naysayers who bring negative karma to the holiday. I believe that one can enjoy the splendor of the holiday while honoring the birth of our savior, Jesus Christ. I sang in the living Christmas tree at the First Methodist Church and later served in the role of Joseph with Loraine Ross my 6^th grade counter-part in the role of Mary. No talking lines just trying to look spiritual as best as twelve year olds can.

I recommend that one strive for a life defined by extremes. Living on the edge keeps one aware of the chasm that exists and the danger there. It also brings a freshening breeze that allows one to take in the view of life. You like me or not, and I hope that rarely do I leave you in the middle about your opinion about me.  For or against we know where we each stand and, if we have conflict, then I hope you will allow me to buy you a beer at the bar afterwards. We are but passing strangers in life and finding friendship within disagreement helps the journey.

I establish my views as primarily applying only to myself. As I extend outside of that core I appreciate those who are supportive but understand that individual differences take precedence. The key is whether  the cause you believe in can achieve 51% of the vote as issues are defined and decided.  America evolves and I have a faith that we can find an answer about the social issues of our day. Those who incite violence by their words, either direct or by implication, are an unfortunate caste who deface themselves (and others) for glory or power. Our technology has made them a noisy standard of our day and we must learn to think apart from the “talking heads” that want to establish authority over us.

Now, I’m not planning for any immediate departure from this earthly plain I just find it helpful to consider if today was my last day. It is important to write down some of these thoughts so that I might feel resolved in expressing myself through the course of my life. Christmas comes too soon, and moves too fast, to give us pause to know that one Christmas in the future will be our last. I just didn’t want to miss the chance to offer a piece of this one to my family, my friends, my enemies, and those who just happen-by.

Take a moment and reflect on your life’s path. Define yourself and share with others so your life is marked. In only a few more moments your next chapter starts…

Happy Holidays.

November 16, 2009

Please to meet you, let me introduce myself. I’m a man of…

I am Satan! I’m fun at dinner parties. I flirt with your wife. I entertain your kids.

I’m not serious. I don’t “get the issues”. Am I “court jester” or “village idiot”?

I don’t appreciate the serious state of our country. I’m not yet convinced of the total governmental takeover and how Obama represents the end. Although I have lots of weapons I’m not convinced that they need to be taken up in arms to save our people.

I’m tired. I’m frightened. The man on Fox News tells me that the nation is sliding into destruction.

Dedication is good. Loyalty to cause and Espirit de Corp are tremendous forces in helping our country focus and advance. The difficulty is that we have been victimized by forces in the media, don’t exercise our reasoning skills, and enjoy the sensationalism of the moment.  Like adolescent boys we “can’t wait” to achieve a climatic state where it all makes sense. Bad is bad. Good is good. If you can quote Thomas Jefferson then all is well.

Here is my plan, I’ve got the fix. It is time to purify the country. Hey, come on, we all know a guy who is a bit off center. We are at war. No room for dissonance. If you are against torture then you are for the terrorists? These guys are gonna rape your sister for Christ sake?

Ok, so now you have the picture. There is this one bad guy, he is the leader. He bows to other world leaders like no other president (ignore history here), he crawled in under the wire with the other illegal immigrants and is taking an important U.S. job. He is selling off the country in a front yard sale. Be careful because his wife just might pound your ass with her sleeveless dress.

This man represents everything that you stand against. He wastes your money and insults your decency. America will slip away under his leadership. He is the problem. He is the problem. He is the problem.

In 1963 my uncle Waggoner Carr was Attorney General for the state of Texas. I was young (born in 1957) but recall a few moments from those earliest times. I proudly wore his lapel pin featuring a golden sedan with CARR imprinted as we did block walks with my family. Waggoner advanced from State Legislator in the 1950s to the office of Attorney General in 1962.

After having attended a breakfast with President Kennedy that November morning in 1963 Waggoner left the event and departed on a private plane scheduled to return to the Panhandle. As his plane flew west the events in Dallas unfolded in the downtown Dealey Plaza.

Upon news of the shooting of President Kennedy Waggoner returned to Dallas and assumed the responsibility of investigating the assassination attempt as was his charge as Attorney General. He poured over the police reports, photos, and physical evidence. He directly interviewed witnesses to that day. He offered testimony to the Warren Commission. All of this can be reviewed by doing an Internet search on his name.

His conclusion…? One man, one rifle, one belief. Oswald acted alone, with no external directive from any governmental or criminal bodies. He placed three well-positioned shots into our President and Governor Connelly . He was well-trained as an expert rifleman in the United States Marines. Copies of his field exams reflected an excellent marksman who could hit his target.

Coinciding with the President’s visit to Dallas the local newspaper, the Dallas Morning News, featured a full page ad that attacked President Kennedy as being left-wing and soft on communists. Such newspaper “attack” ads were not uncommon to Kennedy and forces against him were very vocal and accusatory.  

The entire page 14 of the Dallas Morning News, November 22nd, 1963, was devoted to an advertisement, ominously bordered in black like an announcement of mourning. Under the sardonic heading, "WELCOME MR KENNEDY TO DALLAS," an organization styling itself as "The American Fact-Finding Committee" -- a local coordinator of the John Birch Society and Nelson Bunker Hunt, the son of H. L. Hunt, it later developed, were the committee's most prominent members -- asked the President twelve rhetorical questions. He was accused of responsibility for the imprisonment, starvation, and persecution of 'thousands of Cubans.' The ad declared that he was selling food to the Communist party, and asked, among other things, 'Why have you ordered or permitted your brother Bobby, the Attorney General, to go soft on Communists, fellow-travelers, and ultra-leftists in America, while permitting him to persecute loyal Americans who criticize you, your administration, and your leadership?'..."'Mr Kennedy', the ad concluded, 'we DEMAND answers to these questions, and we want them NOW.'

While the ad did not go as far as handbills that were passed out on the streets of Dallas that day that declared Kennedy a Communist and a danger the difference here was that the ad was featured so prominently in a major newspaper and involved major political figures as backers.

One is left to wonder if Oswald, frustrated by his inability to find a place in society, working in a dead-end job with no friends, felt “called” to make a difference for the first time in his life. Did he view himself as a champion for the cause spurred on by the harsh words condemning the president? Was he fortified by what he thought were the legitimate charges made against Kennedy?

Today, I can watch a multitude of television shows that decry President Obama. I can read newspaper articles, visit Internet sites, and talk to people on Facebook who appear to have much in common with those same attitudes that were prevalent in November 1963. The anger, the hatred, the “call for action” are the same across the two times, the only difference is that you substitute “Obama” for the word “Kennedy”.

We must challenge this hate speech! Our first amendment rights protect unpopular speech and, unless such comments incite violence, there is little that can be done from a legal standpoint.  However we would do well to appreciate the inflammatory nature of such comments. While such comments can get you on the evening news and talk circuit it is irresponsible and dangerous.

In my practice as a psychologist I work with unbalanced individuals every day. Most are simply neurotic, distressed by the events in their lives. Across my 25 years of practice however I have encountered some individuals who posed a danger to others. Most were focused on their family or the authorities that forced them into treatment. Others though were delusional about larger issues and were easily influenced by their surroundings. These individuals, paranoid as a function of their disorder, would become convinced that there were serious dangers and forces at work in our society. With the smallest of prompting they could be pressed into action.

The proof that my uncle offered that Oswald acted alone was very simple. He told me “if there were a conspiracy don’t you think that there would have been at least one person step forward in the years since with clear undeniable evidence implicating others”. We don’t keep secrets worth a damn in our society and this explanation is compelling.

So you who want to scream and charge President Obama with a host of offenses, understand what you are sending out to others. If such inflammatory speech continues to flood our airwaves, Internet, and print media I fear that we will revisit the same events that took place that cool November morning in Dallas. If you were alive during those years of Camelot remember the sorrow that poured against our nation as a young president’s head exploded in the freeze frame of the grainy camera footage.

When you hear hate speech confront the person! Challenge them to return to a more respectful debate that can contain all the essentials of point and counter-point without the personal insult and implied threats. Remind them of the terrible cost that was paid that day in the plaza and the shame that Texas felt for years after. I pray that those in our society who feel disconnected, feel weak, do not heed the call to take action.

As Waggoner would say…it only took one man!

November 8, 2009

We are Saved! We are Doomed! The Future of Healthcare is Upon Us

Yesterday I spent the afternoon engaged in the vigorous debate on healthcare on Randy Neugebauer’s  Facebook page. I was called a Maxist, a Communist, a Socialist, and several variations on the theme of being anti-American. Some of the people posting in opposition to me exclaimed their desire to not help anyone but themselves or their loved ones while encouraging me to lend support to those who needed help if I thought it important. When I offered to match donations to a charity of their choosing in order to help the government stay out of helping the poor I was rebuffed. When I asked people to volunteer with me in community health screenings I was refused. When I pointed out that the most vocal opponents to my comments refused to disclose their own charitable giving, religious affiliation, or community outreach service (after I had disclosed my own) I was told that this was private information.

While I do not think that all of the people who support Rep. Neugebauer on his Facebook page are similar to those who actively post their comments I do believe that those who shout the loudest are the most radical, more extreme in the political right. It is these extremes on both sides of the debate in healthcare that have made it difficult to advance on solving the problems in providing care to our citizens. Their self-righteousness combined with a self-centeredness represents a true threat to the political process that is already hampered by the taint of lobbyist money and corporate sponsorship.

Buried on page six in section A of the Lubbock AJ was the news this morning that the House passed the landmark health care legislation. I wonder if the placement of the story might have been different (on page one maybe?) if the legislation had failed to pass. The 220-215 found only one Republican crossing party lines and this morning the conversation on Facebook is trending toward the end of civilization as we know it.

One side shouts, “We are Saved” while the other side yells, “We are Doomed”. I’m not so sure that the end times are upon us. Nothing happens quickly but emotions won’t wait. While I remain convinced that there is a reasonable, middle of the road majority of Americans that are muted it is primarily the extremists that are bleeding from the mouth this morning.

I have never been a big fan of the government getting more involved in healthcare and I hope that the principle benefit that will ultimately come out of Washington will be more about regulating the insurance industry than replacing it. I do like that the legislation that just passed will force insurance companies to not deny coverage on the basis of pre-existing medical conditions or that higher premiums based on gender or medical history will be removed. I particularly like that the insurance industry would lose their exemption from federal antitrust restrictions. This will impact their past behavior of price gouging, rigging bids for contracts, and market allocation.

With passage of this bill I hope (but I have little expectation) that we might be able to have a productive discussion as the senate considers their version. Last Thursday night Dr. Mark Scioli and myself hosted a discussion about healthcare reform with a panel that held diverse views on the subject. Robert Ricketts, Endowed Chair of Taxation at Texas Tech University; Beth Ashmore, Licensed Insurance Agent and; Chris Winn, Chair, Republican County Party participated in a respectful conversation that attempted to find common ground. The discussion was recorded and uploaded to youtube.com where you can view it by searching the term “Lubbock roundtable”. Dr. Scioli and I are trying to demonstrate that it is possible to discuss this most complex topic without having to resort to personal insult or shouting.

I challenge all who read this blog to join with me in confronting those whose primary agenda is to disrupt any discussion on healthcare. These individuals seek to put forth a political ideology that is not broadly supported and is cloaked behind patriotic themes. This is found as you press past the popular slogans that are shouted and you persist in teasing out the details of what they want. These “patriots” not only oppose any change in healthcare their intent is to get the government out of all social programs without regard to the natural consequence of that action.

None of us want to offer “handouts” to a person who is healthy and able to function in life, however these agitators go beyond that point in not wanting to provide for anyone other than themselves or their loved ones. They will type in capitals NO CARE TO ILLEGALS but will attempt to change the conversation when asked about the specific instructions to follow when asked how to handle a young undocumented mother with a child suffering a high fever. A few will be honest enough to acknowledge that they don’t care what happens to that child or their suffering. Some are so disconnected with their humanity that they don’t even see how they have grown so cold and indifferent. Nathan Lusk, an announced candidate for state senate and in active opposition to my comments on Facebook, noted that the government should stay out of providing for the poor and let the private sector make such services “affordable to the poor”.

“Affordable to the poor” is as close to a delusion as one can get. The very definition of the poor is that they don’t have money, they don’t have choices. It isn’t that they need more choices of what to purchase it is that they cannot purchase anything in the first place. In another place and another time a person was said to have commented “Let them eat cake” which is apparently finding new traction in defining the separation that is occurring in our society.

To lump those who cannot with those who would not is criminal and yet quickly glossed over by those talking heads that suggest that we need only do nothing and everything will work out. The current internal bloodletting in the Republican party is likely to only highlight this growing disconnect from reason as their candidates seek to be ever more pure in ideology. This is an ugly comment about how far our country has moved from the founding principles that we need to care for one another.

In the next few weeks I suspect we will see even more agitation from these extremists on both sides of the issue and I hope that we can find a way to turn the volume down on their rants. We need conversation not grandstanding but I don’t expect to find much respect granted to others during this time. Do what you can to help further the effort to resolve this serious problem.  

November 1, 2009

"Use It" but better know why

Have you ever killed anything? I don’t necessarily mean people but just ordinary stuff.

I like to fish. I’ve enjoyed many times at my uncle Wag’s ranch on the Llano River. His double-wide home perched on a buff above the Llano is a retreat away from the day. My family and I have drawn from the ranch and sought moments of reflection there.

Fish die easy with a good thump! You take a hammer or other blunt instrument and give them a good blow to the head and it’s all over. I have not fished in a number of years so I consulted youtube.com as to the essential components of cleaning.  A natural cycle of life.  We eat what I caught and were respectful of the river in throwing back smaller fish so to maintain the ecosystem.

I’ve shot a few animals to dead. I’m not really the gun person in the family…my wife is. Valeri and I have been married for 25 years. Her father was a knife and gun maker and engraver. He died in 1988 from a heart attack.

Growing up I enjoyed the lifestyle of my family spending vacations in spirited spots such as South Padre or Florida. Valeri inhaled the gunpowder fumes of Brady, Texas at the annual pistol matches where her father competed. He was five time pistol expert winner for the State of Texas in the 1960s.

I knew Frank Clark only a few years. I met Valeri in 1980 and we married in 1984. Frank had a history of heart disease stemming from a bout with rheumatic fever as a child. He suffered his first heart attack in 1986 and died from his second episode in 1988.

In those few years that I knew my father-in-law I discovered many new avenues of life. I learned that drinking a lot of coffee at the IHOP was an essential aspect of hunting. You show up around 4 a.m. and shared a breakfast with the game warden. Then you piled into his Chevy Blazer and drove the back roads around Muleshoe or Levelland. You shot sandhill crane and stopped by and gave the birds to some local folks that appreciated them. You ended up back at the IHOP to drink more coffee and seek the virtue of the moment.

Those moments with Frank taught me important lessons. Don’t waste your talent or your ammo. Don’t joke about firearms. Meet people and be friendly.

Frank accepted me despite my having married his daughter. He was always welcoming and engaging in our talks. After his death I gathered genealogy on his family and reviewed a rich history of adventure. I wonder now what his views might have been on current issues before us.

I think that he would have wanted people to visit. Drinking coffee at 4 a.m. at the IHOP involved a lot of visiting. Our current communication between political ideologies seems to be polarizing and crippling. To be on one side or the other has rendered us unable to be polite. Frank had a talent to match up with everyone. I suspect he was a good poker player, able to befriend others and enjoy their company.

Frank would, I think, have stressed tolerance of other views. He was supportive even while in disagreement. At the same time, however, he was decisive as action needed to occur. His comments on firearms and their use was a demonstration of this.

His training in the use of firearms was well-established in his two daughters. My wife recalled that she thought little of her father laying his loaded 45 model 1911 pistol on the kitchen counter at night. “You just didn’t touch daddy’s gun” she recalled. After Frank’s (and later Francys’) death we inherited a cache of firearms. I remember looking through the collection of pistols, rifles, shotguns, and other weapons with interest and “dry-firing” a pistol. This provoked a strong message from my wife about firearms that I believe is the central message that Frank might have given.

“Use It” if you commit to picking up the weapon and if you are not committed then DON’T PICK IT UP! I believe that Frank would agree with this premise about some aspects of life (and death). I see so much ugliness, so much insult in almost any discussion about how to advance our county. I think that our citizens have lowered their standards so that we make light of how ugly we might become to one another without a full appreciate of what we are saying.

So, if you are so filled with hate about the opposition to your opinion than “Use It”.  I learned from my wife and Frank that you don’t pick up a weapon unless you have already decided to carry through. Don’t warn the person that you MAY shot them if they don’t comply because you are already passed that point. Just point, pull the trigger, and put lethal force into action and kill them. Some things in life are just too important to take a risk of mistake.

On the other hand, know the finality of the decision and give thought to what you are about to do. It seems that in today’s blogs and other discussions we are quickly side-tracked with talking heads that seem to wave around destruction much as one might “play” with firearms. Such behavior gets the attention of the media and broadcast into the “reality television” of the day. People are ugly for "effect".

So, I ask the opposing parties in whatever is the current debate in America, are you serious about your intention? Are you willing to stand behind the witch hunt that is so often found in your leader’s televised comments? Are you willing to “Use It” and do whatever it takes to win…to kill? I understand that we are (hopefully) not talking about actual murder but rather the manufacturing of partial truths, of personal insult, that lessen our humanity and encourage a rudeness and distaste that is poorly suited to useful conversation.

A good wack to the head does a fish in. A 9 mm round produces a smaller hole but a 45 caliber is a sure-bet. Frank shared with me the importance of a committed desire and appropriate equipment. He also was a living example of respect, of politeness, and of tolerance.

By the news reports we are moving into a “noisy” time in the debate over healthcare reform. This next Thursday Dr. Mark Scioli and myself will be hosting the next Lubbock Roundtable on healthcare which will be on youtube.com by this weekend. I hope that we can be civil in the discussion as we host a panel that is diverse in their thinking.

I believe that Frank understood America. He showed me the way to live with many different viewpoints and how to establish discipline with the use of deadly force. He also taught me the importance of carrying through with one’s intentions after a decision and how not to take this lightly. We could all do well to remember that lesson.

October 25, 2009

The Tragedy of Death

I saw in the news today that more people died. They died in cars, in fires, in foreign lands. In the obituary I read about the span of a person’s life, how they were born, grew up, married, had kids and a job. Others I know only how they spent their last moments and the cause of their death.

For some death is a blessing, a release from pain and suffering. For others, death is unexpected and sudden. For all of us death is the end to our physical being. We continue to live for a time in memory and, for those who believe, our story transforms into a spiritual passage.

When my grandparents died I was sad but felt that they were free of their aged bodies and tired minds. When I have encountered the loss of life in others I am torn by grief and a sense of question. Why did the God that I know take this person away? Why do babies die? Why do good people suffer?

For a time I facilitated a support group for parents who had experienced the loss of their pregnancy or the infant was stillborn or died shortly after birth. It was the most difficult group that I had every worked with. These men and women held great hope and anticipation that was stripped from them. They were often angry and yet lacked a target for their feelings. A rage might be directed toward God or others in a quest to understand. I shared in that moment of uncertainty and lack of answers. Each life, no matter where in the passage of time, is important and essential.

Everything is born and everything dies, living is in between. I understand death and the laying down of one’s life can symbolize the depth of commitment one can have for another or for a cause. Many have died in the process of creating and maintaining the freedom of our country. Our blood is what feeds the greatness of our country and gives purpose to our struggle.

While I appreciate the sacrifice that is necessary to support freedom and justice I am unsure how to accept the tragedies of what seems to be senseless death of so many of my countrymen. 

Coming of age at the end of the Vietnam conflict I recognize that I may be jaded as the voices out of Washington announce victory. In the years since American forces invaded Iraq and Afghanistan we have seen the following body count.

 Iraq Coalition Military Fatalities By Year

Afghanistan Coalition Military Fatalities By Year

Taken together America has lost 5237 sons and daughters, husbands and wives, fathers and mothers. I read the local news accounts of West Texans who have been killed and will be no more and I wonder what we have won for their blood.

As I reflect and pray that my country will find a way out of these far-away lands I turn to what is an even more tragic death story. This story is playing out right here on our home soil and at its core there is an even greater evil and injustice than anything we face abroad.

There is profit in death here in America. We already have the death panels spoken about at protest rallies. They are United Healthcare; Cigna, Blue Cross/Blue Shield, First Care, and many others. Each day 123 people die because of no insurance coverage. Over 47 million Americans have no health insurance. Contrast this number with the losses in our military campaigns and one finds that:

                *5237 died in military service

                *359,760 died during that same time period for lack of    

                 health insurance

I’ve heard Congressman Neugebauer talk about how anyone can get medical care in Lubbock but, with apology to Joe Wilson…he lies! Yes one can present to the local emergency rooms and be treated in crisis but tried to obtain non-critical routine care and you will need your wallet before any services are provided. More and more of us are finding out that we can only afford “bankruptcy” health insurance coverage with a $15,000 deductible because otherwise the premiums are more than we can afford.

I can understand a young man or woman putting themselves in harm’s way to support a belief in what we stand for but who among us wants to lay down our lives defending the astronomical profits enjoyed by corporate insurance? Who believes that the CEO of United Healthcare deserves his $57,000 per hour salary? How comfortable are you in knowing that little children are dying because health care is unavailable due to MONEY!

In the last few weeks the support for a public option has been growing. I believe that this is because of the increasing awareness in the common person of the excesses in corporate profits, money that is covered in the blood of our people. Profits at 10 of the country’s largest publicly traded health insurance companies rose 428 percent from 2000 to 2007, while consumers paid more for less coverage. One of the major reasons is the growing lack of competition in the private health insurance industry that has led to near monopoly conditions in many markets.

According to the recently released HCAN report, “Premiums Soaring in Consolidated Health Insurance Market“:

“In the past 13 years, more than 400 corporate mergers have involved health insurers, and a small number of companies now dominate local markets but haven’t delivered on promises of increased efficiency. According to the American Medical Association, 94 percent of insurance markets in the United States are now highly concentrated, and insurers are thriving in the anti-competitive marketplace, raking in enormous profits and paying out huge CEO salaries.”

During the second World War President Roosevelt announced strong action against any company that engaged in war profiteering, earning excessive profits from the blood sacrificed by our soldiers. Today in America we see these large corporate engaging in a systematic “bleeding” of our countrymen that is rapidly approaching a breaking point.

Without relief I believe that America will join our neighbor to the south Mexico in having a social system where there are 5% rich and 95% poor and no real middle class. Our citizens will be viewed as no more than domesticated beasts of burden designed to serve their corporate masters. Upton Sinclair, in his seminal work The Jungle published in 1906, decried the indifference to the plight of the worker in the slaughterhouses in the mid-west. He wrote of the unfortunate worker who fell into a huge vat of bubbling animal fat where he was transformed along with the cattle into soap and sold.

Death is always sad as we lose our loved ones however death for profit is anti-American and anti-Christian and must be challenged and fought against. For those that want to talk of balance sheets I point to the silent image of those who died in the night for lack of MONEY and nothing else.

Each of us need to ask our leaders…have you no shame?...no compassion? We need reform with a public option not more meaningless deaths.

October 11, 2009

Action Now: We are Talking About Life and Death

Sometimes I think that an argument drifts into the abstract, a concern only for intellectuals and analysts. Pundits describe their position in technical terms and respond emotionally when challenged. We lose focus on what we are talking about.

What are we talking about in the central construct of health care reform? What can bring a unifying force to bring us together in understanding the issue?

The central issue is that we all have a role in the issue as we are all going to die. The issue is how our health care can preserve our health, lessen our disabilities, and extend our lives. I would like to think that we do not have a primary focus on the costs of health care as this then creates a system of distinction between those with money and those without and creates a different America from the one that I was born into.

In a recent study conducted by Harvard University and the Cambridge Health Alliance it was found that 45,000 Americans are dying, each year, because they don’t have health insurance. 123 of our fathers, mothers, brothers, sisters, sons and daughters will die today and every day for simple lack of money.

Keith Olbermann on the MSNBC show “Countdown” described how our system of modern medical care has achieved a return to the year of 1843. In that year the author Charles Dickens wrote the beloved tale “A Christmas Carol”. A central character in the story, Tiny Tim, was a little boy who couldn’t get sufficient medical care for his illness because of lack of funds.

The Harvard study found that the risk of death for the uninsured is only getting worse, growing at a rate of about 1 percent a year. The morality rate among Americans under the age of 65 who are uninsured is 40% higher than among those with insurance. It was reported that your change of dying because you used to smoke tobacco, compared to those who never smoked, was only 42% higher. At the predicted rate this means that, by 2012, you will be more fortunate and live longer if you used to smoke than if you don’t have insurance.

At the time of the writing of “A Christmas Carol” the city of Manchester in England commissioned a study of morality among its citizens. The city where the story of Tiny Tim was set was divided into three classes. The morality rate in the worse class was 53% higher then the first class. Using the projected growth in the uninsured the Harvard study would suggest that, by 2022, we will be living in the insurance-driven version of the Dickensian England of 1843!

I see the problem first hand everyday at our clinic where I practice with two family medicine physicians. I see people wondering if they can afford to see the doctor, afford to buy the medication, afford to live. As Olbermann noted we have a new fear to confront-the fear not of disease but of Deductibles. It is no longer that one fears the bell that tolls for thee but rather the envelope from the insurance company that leaves yourself and your family in ruin.

The enemy is not the physician, the pharmacist, the nurse…it is the insurance company. Like the Scrooge of Dicken’s story these corporate entities are attempting to protect and vastly extend their authority over us to further create their own cash cow that bleeds us dry and then uses the premiums to buy the politician, the judge, the press and media.

It is sickening to me to think that the greatness of our country can be subverted into a cartoon character that shouts of freedom while enslaving us to the insurance pocket. I am fearful of the day when the poor are simply dismissed to their plights because those of means move silently through their day while paying taxes for “programs” that don’t really help prevent disease or death.

I believe in a country that offers the same care to everyone without regard to the financial status of the consumer. The $20 for a flu vaccination should not be an obstacle so that the person doesn’t get it and ends up with a $20,000 hospital bill that throws them into bankruptcy. I don’t want to know that someone’s daughter died while mine lived because I had money and they did not.

I applaud the action announced by Mr. Olbermann of the staging of mass health care free clinics offered by the National Association of Free Clinics in the home districts of the six senators that are key to defeating a filibuster against health care reform in the Senate. I want to see that they witness first-hand the need of our contemporary “Tiny Tims” in what health care poverty is really like.  Each day that the leadership in Washington delays action I want the blood of the 123 who die each day to spread across their hands in memory of their loss.

God is just and merciful and for that I am thankful. I know that his love for us will outweigh the tragedy of our actions against our fellow man. I do not understand how the men and women who lead our country can bear witness to such despair without becoming enraged. I don’t understand how health insurance and the corporate medical profiteers can live with themselves as they profit through the death of so many. May God have mercy on their souls but don’t ask me to do the same.

October 4, 2009

A Story of Never-Never Land: The “Rules” of Healthcare”

A door opens. You step through. A new world unfolds before you. Logic and sensibility appear to have been suspended. Common sense is noticeably absent as you attempt to predict your future.

Welcome to the contemporary world of health insurance. Much like Alice you find yourself in a strange place where time is distorted and you are confronted by an endless parade of odd characters. Have a seat, the show is about to begin.

If you call my office and want to pay for your session using good old greenbacks I can tell you what the cost will be. However, if you want to use your health insurance I have to disclose to you that I’m not sure what your portion will be. My office will provide you with the information that we obtain from your insurance carrier but, just as the insurance carrier tells my office, the coverage may change based on several different factors. Having been in practice for almost twenty years I can give you a reasonably close estimate of what your co-pay will be but we really don’t know until the EOB (“explanation of benefits”) is received.

Like the Monopoly game that we played as children the insurance “game” is very similar. You must know the rules to effectively function even if the rules don’t seem fair or may change in a moment’s notice. The prime directive that governs health insurance carrier’s behavior seems to follow the rule that “one takes in as much premium as possible and pay out as little as possible in claims”. If one references this rule then the resulting actions are understandable.

Rates of reimbursement are developed based on market analyses coupled with fear mongering and “splitting” of professional alliance. Take the following description provided by Medicare:

     For our patients who are eligible to receive Medicare benefits, we do accept assignment. Medicare defines assignment as:

"An agreement by a provider (physician or supplier) to accept Medicare beneficiary's rights to benefits under the supplemental medical insurance (Part B), to bill the Medicare carrier rather than the patient, and to accept Medicare's approved charge paid by the carrier as payment in full (excluding the beneficiary's 20 to 50% coinsurance and the deductible). The provider may then bill the beneficiary only for the coinsurance and any applicable deductible.

     We would also like for our Medicare patients to be aware of the Outpatient Mental Health Services Limitation. All covered therapeutic services are subject to the outpatient mental health services limitation (i.e., only 62.5 percent of expenses of these services is considered incurred expenses of Medicare purposes). The limitation does not apply to diagnostic services.

EXAMPLE OF ABOVE: A beneficiary who has met his annual deductible begins receiving psychotherapy. He visits the psychologist's office once weekly and the charge for each session is $75. The fee schedule amount for the psychologist is set at 72. This fee schedule amount is lower than the actual charge and effectively represents the reasonable charge for the psychologist's service. Multiple $72 by the outpatient mental health limitation of 62.5 percent to obtain the net Medicare allowed amount of $45. Since the annual deductible has previously been satisfied, no further subtraction needs to be made from the net allowed amount. Multiply $45 by 80 percent to calculate the Medicare amount payable to the psychologist. The difference between the Medicare payment of $36 and the fee schedule amount of $72 is the financial responsibility of the beneficiary.*

     Simply stated, the above example means that Medicare will pay 50% of the fee schedule amount instead of the usual 80%. You, the patient, are responsible for the other half. We will gladly file any secondary insurances which are presented at the time of your initial appointment; however, most secondary insurances do not cover the full co-payment. If, when you receive your Medicare Explanation of Benefits, you still have questions, Medicare's toll-free beneficiary inquiry number is 1-800-442-2620. Please be aware that any amounts not covered by Medicare or secondary insurances are your responsibility and every effort will be made to collect these amounts.

While the explanation above might seem to ramble I actually find dealing with Medicare to be very simple compared to private corporate insurance companies. I submit a claim and within about one month get paid.

Corporate health insurance companies such as BC-BS, Cigna, United Health Care and locally owned First Care are the real challenge in my practice. Some of these carriers manage their own mental health benefits while others will outsource these benefits to be managed by a fourth party vendor (i.e., BC-BS contracts with Magellan, First Care used Compcare until 2008). This means that a provider has two levels of insurance to deal with in obtaining coverage information and ultimately payment.

The “insurance dance” has a typical stepwise progression. The individual calls my office asking about services and whether insurance will pay. We obtain their insurance information and contact the carrier about the need for pre-authorization, types of mental health coverage, and rates of reimbursement and co-pays. The person may have no mental health coverage, coverage restricted to severe mental illness, or unlimited sessions. They may have deductibles that have not yet been met or separate deductibles for mental health services. There may be coverage for services such as testing for learning disability or attention deficit disorder but there are only reimbursable if “medical necessity” can be established (a particular problem if your child is only having problems in school as this is an academic and not a medical problem).

The individual then is advised of the information obtained from their insurance carrier and told what we believe will be their co-pay amount. In the case where there is a request for psychological testing (such as for ADHD) we advise them that we will seek pre-authorization from the carrier but that it may not be deemed medically necessary and they will have to pay the entire amount.

The individual or family are seen for the first appointment. Release forms are signed and other records generated. A record is created in our clinical and billing software and a claim submitted to the clearinghouse that forwards it to the appropriate insurance company.

This is where one enters Never-Never Land. Most carriers will respond back within the contracted time limit with the news that the claim is denied for lack of preauthorization, the person is not found in their system, the claim form lacks a certain number, or the wrong office received the claim submission. The interesting point of this is that most of the time all of these reasons are bogus and only serve the goal outlined above in the prime directive. In some cases my office will follow up on a claim that just never got paid and we are told that we must re-file without any explanation for how the claim was lost (particularly note-worthy when we have other claims before and after a date that are paid).

Given the time it takes to follow up on and re-file claims it is not uncommon that a claim may be denied simply because too much time has elapsed since the service was provided. Of course, the reason that so much time had elapsed was because of the delays in getting the claim processed.

Of course, don’t forget that one is usually only pre-authorized for 6 to 10 sessions at a time (even if you have unlimited sessions as a benefit). This means that my office must be ever mindful about not running out of sessions or going past the point where the authorization was allowed. It is also required that I complete a summary report at the end of each block of sessions and, in some cases, have the client complete an assessment form to accompany my request for more sessions. I also have to participate in telephone staffing with an agent of the insurance carrier who usually doesn’t have any professional qualifications but they must be responded to or, you guessed it, no more sessions.

I wonder how those of you in other businesses outside of healthcare would manage using the rules of Never-Never Land. I track the claim payments in my billing software and know that my best payment return is with Medicare and Medicaid. My worse is with First Care, who in 2008 paid me 43% of the time. To understand this statistic one starts with my hourly rate and reduce this to the contracted rate that is 72% of that. However, instead of being paid 100% of that 72% I am ultimately reimbursed at 43% which means that 29% of what I billed is simply not paid.

Here is the core idea in the present health insurance system as it would play out in other businesses. Say your boss promises to pay you $100 dollars a day for your labor. However, you must check in with his secretary ever third day and submit a form and receive clearance to continue. Failure to do so means you don’t get paid. Even then, your paycheck will be delayed anywhere from one month to one year and, in then, you receive only $45 to $75 a day. Can you plan your life with that arrangement?

Why do we need health insurance reform? Because the amount of time and money spent in dealing with the Never-Never Land rules is mind-boggling and a source of great waste. We must bring health insurance carriers to a level playing field so that providers such as myself can spend our day doing what we were trained to do and not being buried under a mound of paperwork. The current proposals in Washington are moving us all toward a mandatory purchase of coverage from the very companies that don’t do a very good job already. This will be a bottomless well of money to these corporations and will doom our country to a continued spiral down toward the collapse of our healthcare system.

I just want to live my life and enjoy the rewards of my education and hard-work. Since going into private practice in 1991 I have only increased my charges approximately 8% while the insurance carriers have enjoyed billions in profit. I ask that each of you “follow the money” in understanding the present system and the need for reform. Be active in your communication with our leadership so that they understand that we need to escape from Never-Never Land.

September 27, 2009

Coming Out of the Closet: I’m Straight

I don’t know what is wrong with me. I really have tried to fit in, to be a productive member of society. I pay my taxes, exercise my right to vote, and keep my lawn mowed. I just can’t continue to live a lie.

I think I was born this way. Even as a small child I knew. My friends and I would be playing, having fun. My friend Patti lived down the street. Her ponytails and friendly smile let me know that she and I were buddies. We laughed and joked. I liked her very much. From deep inside myself I began to know that there was an attraction to girls.

I tried to push these feelings down. After all, I didn’t want trouble, didn’t want to get labeled. I hide behind my GI Joe and tinker toys. I found ways to mask my feelings, my hidden desires.

Puberty washed over me in junior high and the passion grew. Along with body odor and geeky hair I found myself looking more and more at girls. I fantasized about how Kim, Denise, and Karen might return my affection. I started to drift into hanging out next to girls, enjoying their scent and laughter.

I wasn’t able to contain my feelings anymore and my feelings took flight into action. Holding hands, kissing, and being held close fueled my life like nothing else had. I knew from Sunday School that such things might doom me to eternal hell fire but yet, I discovered such joy in those early moments.

Going steady met a refinement of my obsession, a promise of stability and a mutual pledge to be together. I learned to accept the rejection of those who didn’t understand who I was. Being different in my sexual orientation was just another way to define myself as unique.

The freedom of college and young adulthood brought a new chapter of openness about my heterosexuality. I openly pursued women and learned all the “moves” that were to be used in the disco club. These dens of dishonor were many in Lubbock. “Faces”, “Crystal Pistol”, and “Freeman’s” on Broadway were places where I found others who shared my intensity for meeting the opposite sex. I had no shame in trying out new pick-up lines.

I became to have opposite sex live-in relationships. My male roommates were open-minded and enabled my carnal desires. I learned to look the other way with their “hook-ups” bringing into our house their female companions. College was a time of experimentation and Randy, Tom, Joel, Greg and I were a decadent bunch in pursuing our sick desires.

After college I would visit my old roommate Joel who lived in Austin. After college he left behind our shared experience and decided to give up on women. I tried to deny who I was and would go with him to gay bars in Austin but only because it was a place where lots of straight women would hang out and I could hit on them. Oh, I could flirt with the men there but just never got the “zing” that told me that it was what I wanted.

Joel and I parted ways after a time. I think he was saddened by his inability to get me to make the right choice. I moved in with Valeri and we married, further confirmation of my long-standing faithfulness to who I thought I was. We raised two children and I established my career back in my home town of Lubbock.

I’ve worked to deal with my straightness and to try to be ok with it. I know that I’m more than just my sexual orientation but it is humbling to be so powerless against my desires. I wish that people would just leave me alone about it. I think that there are a lot more important issues that the government needs to get involved with. My family and friends are pretty much accepting of my heterosexuality now. My children accept and love me. My patients don’t seem to make much of a deal about it.

Now, take my story above and simply change the underlying premise about sexual orientation and think about how it shifts. Do we gain as a nation to pursue an agenda against people who are just like us with the exception of who they like to be intimate with? Do our political leaders really think that dictating morality in our behavior changes who we are inside?

I believe that sexual orientation is primarily a matter of genetics. People are “born” with the innate desire as to sexual orientation. Some small percentage of people may be traumatized by life experiences so as to pursue a particular sexual orientation because of its usefulness in obtaining benefit of authority or finance. My own professional association (American Psychological Association) does not support a view that homosexuality is a mental disorder. Of all the things that might be "wrong" with someone who they like to make out with is not big on my list.

My friends are my friends. Some of my friends are gay. I like my friends for who they are and I don’t worry about being overwhelmed by what they do and losing myself in their choices. Some of my friends like country music. I can listen to country music but just don’t feel a desire to do it because it is not what I like. I could engage in intimacy with another man but just don’t feel any desire to do so. I don’t fear it I just don't want to.

So, please enjoy your friendships and do not stand passive as those in authority push hate speech about those who are “different” for we are all “different” in some way. That is what is great about our country.

September 20, 2009

Chasing Ghosts: If We Do It Right, We Can’t Count It

Tomorrow morning I’ll start my work week with my first appointment at 8 a.m. I’ll take a lunch break at noon and resume my counseling work at 1 o’clock. Most days I’ll work until 7 p.m. Catching a moment here and there I’ll return phone calls, write client notes, and see if anyone is posting anything of interest on Facebook.

About a third of my practice involves children under the age of 12. For the last twenty years parents or grandparents dutifully arrive for the appointment bringing in the young boy or girl. They usually voice the same complaint of poor performance in school, challenging behavior in the home, or concerns about peers.

Typically I offer handouts on understanding how children learn and the importance of consistency, persistency, and a quickness to respond. I emphasize the need for a united front among all the adults in the children’s environment and how communication is vital to success. I point out that commitment is the essential component to the program and that involvement by the parents with the children is the single most important factor as to how successful the intervention will be.

The parents and other adults will listen attentively to my presentation of how to be good parents and the role we all have in preparing our children for life. They take the handouts and preliminary goals tailored to their child and they schedule the next appointment.

About 1/3 don’t show up for the next appointment. About a total of one half of those referred fail to complete more than five sessions. While I’m not happy about this failure to follow through my performance numbers are actually better than the national averages.

Why do the parents and children not return? I suspect that, for many, the pressure of multiple demands from other sources (i.e., job, other family) inhibit their follow through. A second feature is the sense of fatigue they expect in carrying out the various aspects of parenting. Being able to provide a response each time to an inappropriate behavior may be viewed as too much effort. It may also be that one parent views the other adults as unwilling to follow through and they may feel inadequate to do it alone.

Another, more insidious, reason may be the portrayal by pharmaceutical companies of the “pathology” of what was once considered to be simply growing up. The desire to sell our nation endless anti-depressants, stimulants, and other “management” drugs promises exhausted parents a quick fix for their problem. Coupled with this profit driven campaign by Big Pharma are the strained resources of our schools. Faced with 24 to 1 student to teacher ratios it may be impossible to realistically address student behavior one-on-one. Children are naturally active, exuberant, easily distracted and, at times, very uncooperative. Unfortunately, we may not understand and honor the truly amazing exuberance of a remarkable child. Our public schools are not designed to embrace these qualities in children. One cannot argue but that medications can be effective in gaining control over a child, getting them to sit still or otherwise be passive.

We have seen a massive increase in the diagnosis of Attention Deficit Disorder (ADHD) in the last ten years. The vast majority of ADHD diagnoses are given in the United States, and within this country, according to a 1999 survey, the rates vary from 1.6% of school-age children in San Juan, Puerto Rico, to 9.4% in Atlanta. The United States contains about 15% of the world’s population (6.6 billion compared to 300 million in the U.S.) but consumes over 80% of all legally manufactured stimulant medications.

I do believe that ADHD is a legitimate disorder and the medications intended for its management are useful and effective. However, I do take issue with the choice to medicate a child over the use of a behavioral program that should be a part of any parenting program. It is time that our nation come to terms with the importance of primary prevention in addressing problems before they occur and result in life-long damage.

Lubbock is an excellent example of what is available in most communities in America for assistance with our youth. Within our health care system one can see first hand the lack of awareness of resources, the difficulty of finding and accessing care, and the “band-aid” approach that puts profit before people.

For those programs that are implemented to target developmental and behavioral problems we have the difficulty of counting “ghosts”.  A successful program may result in fewer hospital visits, fewer episodes of abuse, or fewer suicides but how to count what does not happen? What we see are the costs associated with providing the service which remain “soft” in the minds of taxpayers and boards. Competing demands for funding to fight crime, to pave roads, and to keep the lights on often win out. Fighting crime is a better rallying cry for our politicians than demanding daycare for our children.

Texas has the HIGHEST dropout rate from public schools in the United States. Over 450,000 sons and daughters dropped out from Texas schools in 2005. Lacking this education these young people cycle into poverty and crime. We respond by building a prison in every small West Texas town where the jobs are welcome and the inmates are valuable assets for funding other needs. People who have to scramble to make ends meet are less likely to be politically active or to go vote. Being a single mother increases the chance for poverty six-fold but you don’t expect to see this demographic group being courted by our politicians. After all, they have no money to contribute, don’t tend to vote, and are invisible in our society.

How many hospital beds does Lubbock county have for the mental health needs of anyone under the age of 18? With over 218,000 citizens the surprising answer is 0. An emergency situation where a teenager has attempted suicide or is otherwise a danger to themselves or others means an ambulance ride to Amarillo or San Angelo where treatment units are available. Even when a transfer is possible the problem of paying for treatment can be challenging. If you think getting medical care paid for by your insurance carrier is difficult just wait until you try to get them to pay for mental health services.

Our present health care system is organized around short-term interventions that chase after the problem. We wait until the condition is out of control before anything is done and, even then, we tend to emphasize treatments that fail to offer systematic interventions that are sustained over time.

In the 1990s I served as the psychologist for the Heart Transplant Program at Methodist Hospital in Lubbock. Before the sudden tragic death of Dr. Vince Rittman, the program’s surgeon, we completed 45 heart transplants. Only about 10 of these patients were actually able to pay for their care, the rest of the cost was “shifted” (meaning that the other hospital patients made up the loss by being charged $20 for a box of tissues). It was estimated that the first month cost for the treatment was around $250,000 a person. That means that the program incurred a cost of over 11 million dollars helping those 45 people. I don’t begrudge those 45 people for this expense but I wonder how many we might have helped in Lubbock if we had 11 million dollars to set up prevention programs?

Health, however, is not profitable under the current system. Children who behave, who do their homework and care for their siblings, are lost in the shuffle. We talk a good game about mentoring youth or “being an adult” but don’t really support it with meaningful programs. We are moving toward a “have and have not” society where doing what is cheap triumphs over doing what is morally right.

For almost twenty years I have served as a volunteer for the National Kidney Foundation of Texas. This past Saturday I was providing assistance at the 3^rd annual Kidney Walk held in Lubbock. My wife’s agency provides professional staff at no-cost for kidney disease screening events. About 10% of my practice involves free counseling services to those who otherwise could not pay. For over thirty years I have attempted to mentor young college men through alumni associations. I donate clothes and other personal items to charity. I write my political leadership demanding that they be pro-active in addressing the needs of our children and families.

I’m not telling you this to impress you. I do hope that, if you are not active in addressing these issues, you might feel appropriate shame and use this energy to get involved. I would prefer that such problems not exist but I see a shadow moving across our great country robbing us of a future for our children. It is not spending money that will burden our children and grandchildren it is the indifference and lack of commitment to action that will be our legacy.

What will you do tomorrow when you get up?

September 18, 2009

True Evil

Come along children, get on the train. David, take your sister’s hand and stay close.

Papa, where are they taking us? I’ve heard terrible things and I’m afraid. Yes, I know that people exaggerate but our neighbor Maggie said she heard that the Nazis were lining Jews up and shooting them for no reason.

The guards have opened the doors to the freight car. Step up children. Stay together now. Papa pick up Joseph he is too small and might get separated. Everyone stay together.

I wish that we could have kept our luggage. I marked our name on the bags but I don’t see how they will get the bags to us later. Inside were all our clothes. I did save your mother’s ring here in my pocket.

So many people crammed into the car. I can hardly move. Yes Judith I know you are thirsty but we have nothing for you to drink. People coughing. I hope we don’t get sick.

The train is leaving the station. We are headed east I think. Auschwitz is east. Those stories I heard cannot be true. Even Nazis are still people.

Oh, please be quiet. The moans are frightening the children. That poor woman over there. Her husband, I think he might be dead. Hard to tell without any light. Everything must turn out all right.

I can see out the small crack in the wall. We’re passing through a village. Look at the people. Why did that little girl drag her finger across her throat? Must not tell anyone about that.

Here are some crackers children. Eat them slowly it is all I have. I’m sure we will stop soon and we will get food and water then. Stop crying David. It will be alright. Here let me wipe your face. That’s better.

The train, I think it is slowing. Thank god maybe we will be able to get out of this awful car. The smell of urine, feces, and filth is overwhelming. I am so thirsty.

Yes, yes the train is coming into some sort of station. I see guards, dogs. Look there, those people look like they might be Jewish. See, this is just some sort of work camp. There are people here.

The doors are open. Guards are screaming at us to get out quickly. This way Papa. Come children we must stay together.

I’m so frightened but must remain strong for my children. Here is the line. Everyone stay together. There are so many people in this building. Listen to that man talking. He is telling everyone not to be worried. This is a work camp and shortly we will all be taken to our new living quarters. Thank God. The stories were not true.

Papa looks worried. The guards dragged off those men. They were shouting “you lie”. The speaker continues to tell us not to worry. We must be processed and deloused.

Take off my clothes? Yes, do this quickly so as to avoid any trouble. Here Judith let me help with your buttons. We all have to be cleaned. Don’t want to get sick when we have just arrived do we? That’s my girl. You are so sweet I love you so much. Papa, help the boys.

I’m cold. The guards are so mean. So many of us being moved so quickly. What is this room we are going into. The sign says “Delousing Showers”. How can we get proper cleaning with so many? I’m so cold.

Oh my god, that woman just cried out that we are going to die. I can’t see anything. The small electric light is swinging back and forth and what I can see I don’t want to. All of us naked, shivering. Look at me children. Don’t be frightened. We are all together.

I hear something. Look there in the ceiling vent. That powder falling. Vapors steaming up from below. This is the end. People are fighting, struggling to crawl near the ceiling while the gas filters across the room like a deadly fog. Oh, my children, my babies how did this happen?

I must live, I must live, I must

Die...

The Final Solution ordered by Adolph Hitler and carried out by his henchmen resulted in the death of over 6 million people during World War II. The extermination camps operated by the Nazis “processed” over 2.7 million people. In a single day at Auschwitz over 29,000 men, women, and children were received from the incoming trains, stripped, murdered, and their bodies burned. Murder on such a massive skill outpaced conventional methods of execution such as by shooting or carbon monoxide poisoning and so Zyklon B gas was developed which quickly paralyzed the lungs and suffocated the victims.

After the gassings had been carried out, the Special Detachment men from the camps would remove the bodies, extract the gold teeth and shave the hair of the corpses before bringing them to the crematoria or the pits. In either case, the bodies would be cremated, with the men of the Special Detachment responsible for stoking the fires, draining off the surplus fat, and turning over the “mountain of burning corpses” so that the flames would constantly be fanned.

 The railway entrance to Auschwitz

Other deaths in the camp were caused by systematic starvation, forced labor, lack of disease control, individual executions, and purported "medical experiments".

Imagine the horror that reached out and enveloped those men, women and children. Families forced at gunpoint to board freight cars bound for unknown destinations. Unrelenting thirst and hunger in the blackest of nights as the train rolled across the countryside. Pulling into a station, being lured by speakers telling you of the good life in the camp. Stripped of your possessions, your clothing. Crammed into a dark, smelly room where your final moments are spent fighting for air. All of this masterminded by those who represent true evil. You had done nothing but existed. No one had charged you with any crime. Your only wrong was in being born.

So the next time you hear someone call someone a Nazi I hope you will think about what they are saying. When you see a sign labeling someone as being like Hitler I hope you will feel outraged. I can’t imagine what turned inside of those who “processed” those helpless victims so that it was acceptable. We must not accept that the association of what happened then is to be integrated into our present debate. To do so is only shameful and lessens each of us whether we say it or simply allow it to be said.

It deflates and minimizes the true evil of Adolph Hitler and the Nazis to use their images or those labels in the midst of our national debates about where America is or might be headed. You might disagree with our President but to suggest that he is ANYTHING like the Nazis is disgraceful. I can only believe that those who make such charges are really not aware of the horrors of the Third Reich. They are only aware of the way that such a charge is electrifying because of the hint of what is contained there.

Shame on those who betray the memory of Auschwitz, who have not “looked through the eyes of those who died”.

September 15, 2009

I've Always Liked Lubbock

Lubbock, I'm a professional and you are not crazy. While there are elements of crazy among us it was reassuring Monday night at the called “Town Hall on Healthcare” to see that we can be sensible.

I attended the meeting sponsored by “Americans for Integrity in Government” held Monday night at the Lubbock Auditorium. The advanced billing heralded the message that America was on the brink of disaster, that socialists were gathering at the gate, and that soon we would all be enslaved by Obama and his minions. From what I had seen at such meetings from television I expected a fiery crowd with anger in their bellies to attend.

Instead, I found an informative moment in this national debate.  The panelists were, in general, informative and tempered in their comments. Even Dr. Donald May, usually advocating a position just short of lighting torches and marching to war, was relatively muted (I think the presence of two reasonable physicians on the stage may have help his reluctance to appear so inflammatory).

The plan outlined by Dr. Mark Scioli was endorsed by the other panelists. He suggested that we press the national leadership to adopt a model where each of us is mandated to invest in a health savings account (HSA) of several thousand dollars. We control where this money goes as we access healthcare and, because it is our money, we require transparency as to what services cost. Above that amount we draw from that individual account we then shift to a private health insurance carrier who provides coverage if there is a major event requiring significant cost. The government helps to cover the cost to both the HSA and insurance by tax breaks and direct funding if the person is unable to fund the account or insurance purchase.

A point somewhat glossed over was the importance of looking at regulation for insurance carriers so that they don’t drive the market seeking excessive profits. Dr. Scioli and Dr. Buesller put noted that for-profit models have yielded the insurance carriers billions in profit while encouraging questionable practices in delaying (or flat denying) care or terminating coverage if you file a major claim. I would have liked to have seen more of a development of this aspect of the discussion but that will have to wait for another day.

There were some moments of energy, both positive and negative. Dr. Scioli is an excellent presenter and he won the crowd’s approval as he noted that our poor ranking in health as a people is related to factors outside of healthcare and associated with damaging lifestyle choices. Again it would have been nice to have developed the question of how much we as a people are willing to “give up our chicken fried steak” and seek a healthy lifestyle as I think that might have provoked more of a challenge.

An elderly man took to the microphone and stated, “Obamacare is not going to unplug Grandma, they are just not going to plug her in”. This was greeted with a laugh and cheers. During Dr. Scioli’s early remarks a single voice shouted out “illegal aliens” but no others rose to support the comment. Dr. May provided several brief tirades on how America is losing all control to the socialists but, again, surprisingly, there was little carry of these comments with those in the room.

I left pleased and reassured. Having been born in Lubbock and spending most of my 50+ years here I was beginning to wonder about the people in our community. I have always felt that there was a sensible, large, but reserved and quiet, majority here in Lubbock who could still think and reason together to find solutions. I know that these are very conservative waters surrounding us but that doesn’t mean that we have to be rude, mean-spirited, or insulting. At the town hall I visited with several other people who were willing to “agree to disagree” without being ugly and disagreeable.

I suspect that Dr. May and his AIIG supporters may have been somewhat disappointed that the crowd was not more rabid. There was no collective call to bury anyone and no signs with pictures of Hitler or Stalin. While I have no doubt that there is an active local extremist group that believes and offers such views I don’t think that the broader support is found in Lubbock.  I believe that my hometown knows what is right and wrong, knows what is proper and respectful, and we will not support the excesses of those who act inappropriately.

Having practiced as a psychologist for almost twenty years in Lubbock I am an expert in mental disorders. I’m pleased to find that, while my hometown has some unusual (if not outright bizarre) individuals the vast majority of our citizens are nice people who can coexist with differing opinions. We are not crazy by and large, just people who want to take care of our family and loved ones and try to do what is right. I’ve always liked Lubbock.

September 13, 2009

Civil Protest is not the same as Temper Tantrums

It is good that Congressman Joe Wilson from South Carolina didn’t have to submit to review from Grandmother Sullivan. Grandmother was born in 1900 and lived to be 95 years of age. She knew the hard work of the Great Depression and the importance of being respectful. Although a petite and mannered woman I know where I would bet my money in a debate between Representative Wilson and Grandmother.

Respect was taught to me at an early age. While there were many opinions among my family I don’t recall that our conversations involved interruption, name-calling, or frenzied shouting. Growing up we would on occasion stay with Grandmother Sullivan and I learned first-hand that we grandchildren were to be polite, to ask permission, and to respect others. Grandmother Sullivan was a “Matron of the Eastern Star” and quite the social planner, which required that we be quiet during her activities.

At the same time however Grandmother Sullivan did not conform just because someone said we should. She would drive up from McAllen in the 1970s in her big yellow Buick Electra and she would be the life of any party. She taught me how to play many variations of poker and “Go to Mexico” with six decks of cards. She spoke her mind about events of the day and I enjoyed our talks during my years in San Antonio when I would visit her in a retirement home. Once during a Saturday night card game where I was the only male and the youngest player by 50 years she advised me to “watch out” when one of her friends was flitting with me with serious intent. She reminded me that age is merely a matter of outlook and I better not be steered into trouble with her seductive 80 year old friend.

I learned from Grandmother Sullivan that having an opinion was important and how you expressed it was just as meaningful. It reflected on your character and showed the world what type of person you were. She allowed for changes of opinion without feeling the need to be locked in. During my college days she spoke negatively about how young people were living together but then several years later, while living in the retirement home, she noted that several of her friends were living together without benefit of marriage. “It would mess up their Social Security if they married”, she commented. Grandmother was very pragmatic.

I agree with a recent article written by Bill Moyers that we should not decry that there are extremists in America for they are an outstanding example of what is unique about our country. I suspect that any assembly of my countrymen has always included people with strong opinions and loud voices heralding views that are filled with conspiracies and dislike. The distinction that is made that troubled him (and I) is the acceptance of the disrespect that is hurled at others. It seems not enough that there is noted to be disagreement but that a personal grudge seems to be promoted where the other side must be evil and dangerous and should be eradicated.

I believe we are beginning to bear witness to the result of such baiting of this extremist group in our midst by those in the media and leadership. There have always been individuals who feel disenfranchised and lacking in authority, and these shouts of “fascist”, “bury Obama”, and “overthrow” fuel their anger and give a direction. People are already carrying weapons to town hall meetings, how long before they are used?

Representative Wilson did make a half-hearted apology but then quickly promoted the correctness of his action. Locally, Chris Winn (Republican Party Chair) and other conservative leaders have championed the interruption of the President’s address to Congress. The view promoted is that such actions are appropriate given the seriousness of the situations facing our country.

I know what Grandmother Sullivan would say about Representative Wilson. I suspect that he would have to sit on the couch at her house and wait for her to finish her meeting of the Eastern Star in the other room. She would then come into the room and sit down with him. She would ask him what happened. Her voice would not raise, she would not interrupt anything that he had to say in explaining himself. After he finished I can envision her telling him in a direct tone of voice that he was wrong. Her words would serve as a tutoring session on proper conduct and how he was out of line and should have known better. She would have drilled him on proper etiquette and the importance of respecting others and the offices they hold even if you disagreed with their policies. It would not be an easy session for Joe.

While we are all Americans we seem to be moving toward a distinction that is fueling a hatred between political factions. To appreciate the violence in the Middle East is to understand the a similar distinction made between Sunnis and Shiites. The Islam religion was founded by Mohammed in the seventh century. In 622 he founded the first Islamic state, a theocracy in Medina, a city in western Saudi Arabia located north of Mecca.

There arose two branches of the religion he founded after his death. The Sunni branch believes that the first four caliphs—Mohammed’s successors—rightfully took his place as the leaders of Muslims. They recognize the heirs of the four caliphs as legitimate religious leaders. These heirs ruled continuously in the Arab world until the break-up of the Ottoman Empire following the end of the First World War.

Shiites, in contrast, believe that only the heirs of the fourth caliph, Ali, are the legitimate successors of Mohammed. In 931 the Twelfth Imam disappeared. This was a seminal event in the history of the Shiite Muslims. It was not until the ascendancy of Ayatollah Ruhollah Khomeini in 1978 that they believe that they had once again begun to live under the authority of a legitimate religious figure.

Shittes represent only about 15% of the total membership of Islam and their numbers are concentrated in Iran, Iraq, and Lebanon. Treated with indifference at times and with violence at the hands of Sunnis such as Suddam Hussin it is within their ranks that extremists grew. Death and destruction are created, and suffered, by both Sunnis and Shittes on the streets of Bagdad and other Iraq cities.

Replace the terms "Democrat" and "Republican" for those of Shittes and Sunnis and one can see what happens with the stereotyping of liberal and conservative and the negative feelings that can be whipped up. One group viewing the other one as "less" and needing to be "dealt with".

America must not continue in this gravitation to extremism and the acceptance of disrespect as a first step toward the violence we see elsewhere. We need the spirits of our Grandmothers to visit us in our living rooms and remind us that we were “raised better”. Each of us is responsible to respond to intimidating and disruptive behavior. We should help to remedy this frustration through conversation and organization and may the better message pass the test at the voting booth. I do not want to live in a country where one lives in fear from those who are screaming.  Freedom of Speech is the cornerstone of our country but this standard only serves to show the outer marker of what should govern our common ground. We need to step up and show that we respect each other within that larger standard and can engage in a positive way with each other.

I hope that Grandmother Sullivan is listening because I’m sure she knows what is needed. Don’t mess with my Grandmother.

September 6, 2009

Profound Clarity Moments: What Matters!

I remember where I was when the World Trade Center Towers fell. Just a regular day, seeing clients in the office, taking phone calls, being engaged in managing the stress of life. Casual glimpses of the TV in the waiting room that grew into captive attention as the events unfolded. As the second plane crashed into the building it became clear that I was watching an unprovoked planned attack by the enemies of my country.

There have been several moments like that one in my life. A slow drift into jarring awareness of what is happening. A judgment made, a lesson learned about myself, others, or life in general. Not uncommonly these moments of profound clarity occur as a function of the consequence of a bad decision. Most life lessons are painfully learned.

In the course of one’s life we are enlightened by such profound moments. In a similar sense America has experienced such pivotal moments where our course is altered and a new understanding is achieved. I believe that our country is presently in the midst of such a profound clarifying experience and we will be the better for it.

The present conversation about the role of government reflects a deeper question. Questions of payment, financial concerns, and access to service are featured. What is not so directly considered is the moral imperative of our responsibility to our fellow man. This is not the first time that America has considered this question.

Slavery was a fundamental part of the founding of our country. Deemed necessary to fuel the agricultural operations of the young nation it was tolerated. As the country expanded westward the question of slavery was bitterly debated. Compromises were made by the leaders of the time but ultimately the division of opinion became too great to be contained in legal documents.

The Civil War consumed more of our countrymen than any other military conflict in our history. Over 620,000 casualties came from that conflict with 51,000 men dying in the single battle of Gettysburg. Passion ran great within both grey and blue ranks as the issue of freedom for slaves was decided with deadly intent. In the end, we as a nation declared that all people had the right to freedom.

I recall that Monterey High School had about 2,000 students during the years I attended (1973-75). The vast majority of the students were white, with few Hispanics and even fewer Blacks. My years at Texas Tech University continued to reflect a white majority. In my all-white fraternity I recall the outspoken racism that was championed as we refused membership to those who were not white.

Attending St. Mary’s University in San Antonio introduced me to reverse discrimination as I became the “token white guy”. Almost all of my peers were minority, either Hispanic from Mexico, Central or South America, or Black from the local Air Force bases. I discovered the uneasiness of being the only “one” in a crowd.

Out of this came a moment of profound clarity about racism and my tolerance for it. I felt ashamed that I had not spoken up and I decided that I would be silent no more when I witnessed such mistreatment of people. I came to understand that all of us are people with little real difference except for what we create through ignorance and inaction.

Another instance of profound clarity came as I first came into contact with a person with AIDS. Living in Indiana we had not yet heard the story of Ryan White, the young hemophiliac who contracted HIV through a blood transfusion. During those early days of AIDS it was not uncommon to hear the blatant condemnation of HIV as being a “gay disease” with pronouncement from God as punishment for those who engaged in such perversions.

After the death of my client from toxoplasmosis that ate his brain away from infection I heard of how the hospital staff stripped his room clean and burned every item. Critical comments about his lifestyle overshadowed the fact that a person, a husband, a son, had died horribly. In that moment I experienced a clarity about how such ugliness was not to be allowed to become even worse by the cruelness of those who don’t see the person behind the disease.

Now, after twenty-five years of professional practice as a psychologist working with children, adults, families and larger society I have experienced another moment of profound clarity. I will not accept the plight of those who are less financially able as something that should simply be dismissed. It will not be a part of me that I put profits before people. I will not be coerced by an argument that says we cannot afford to ensure that all of us are tended to in our illnesses.

Much like the argument against ending slavery was based on economic issues I will not waver as to the more basic question that is posed…who am I in my view of self when it comes to reaching out to others. I want my country to be open to all even if it means that we are all in the same boat and will suffer the same fate.

Health care is a right just as freedom can only be offered to all without exception. We cannot establish levels of freedom must as we cannot offer conditional love. Either I love you or I don’t. This does not mean that we cannot have accountability or standards. Once we accept the right of each to health care then we can proceed to the question of how to deliver and manage it. However, as long as we disagree about this central point there can be no progress. The present insurance model has allowed us to accept the standard acknowledged in “Animal Farm” where “all animals are equal and some are more equal than others”. The poor without insurance are the slaves of our day, lacking the essentials that the more affluent take for granted.

Even for those with insurance we are subjected to levels of care based on money. The process of pre-authorization delays and denies care. Sarah Palin doesn’t have to wait for the establishment of death panels, they already exist in the form of endless review, lost documentation, and mind-boggling phone trees before ever speaking to a living person.

We are witnessing what can be described as another civil war. There have been several profound clarity moments in our country since the cannons fell silent at Appomattox in 1865. The stock market collapse of 1929 gave us a display of unrestrained capitalism. The news of attack that came on December 7, 1941 slapped America with the reality of evil that had to be confronted. The unleashing of police dogs and water cannons on the peaceful protesters in Selma in the early 1960s alerted us to the unfinished business of civil rights. Within such profound clarity comes a clear question with a clear answer.

I hope that our country can marshal the strength to remain civil in these troubled times. I am concerned about the whipped frenzy of media “entertainers” who press their audience to take action while skirting the direct language of violence. I believe that the “muted majority” among our country will be stirred by the debate and become more outspoken in their belief.

I have in my book collection one entitled “The Negro: Beast of Burden or Son of God” written around 1900. Freedom of speech means that such books must be available however it is important to reference them in order to return to those moments of profound clarity about what is right or what is a right. I might not stand with some on the issue of health care as a right but I know that I stand with conviction and certainty.

There is not middle ground as regards slavery. There is also no middle ground when it comes to health care.

August 31, 2009

America: Can We Move Beyond Ourselves?

Our country faces many contemporary challenges. Across the land we witness a diversity of opinion about how we can manage difficult and costly social issues. What are the rights of our citizens? What are our shared obligations? Are we attempting to return to the foundations of our country’s philosophy or carve out new directions in how we as a nation define our moment?

For the last twenty years I have worked in the health care system as a psychologist. Unlike most therapists I provide service in a primary medical environment. I have served on the faculty of two medical schools as well as taught medical and graduate students about my role with physicians and other health care providers. I’ve worked in free clinics in downtown San Antonio as well as sat down with some of the most affluent members of my community.

In the final analysis we are all the same under the thin hospital gown. All of us will require health care as we move through our lives. We share this bond of need and I would hope all of us are participants in this on-going debate about what needs to happen to provide this care.

The problem in health care is not socialism it is capitalism! Much as with our schools it is not appropriate to utilize a for-profit model in how care is delivered. Early in our country’s history we undertook to provide education for all as such intention allowed for the betterment of our country. All attempts to bring business management into schools has met with failure as our children are not manufactured on an assembly line and we cannot discard those who “don’t measure up”.

United Behavioral Health, Inc. has posted over five billion in profits over the last six years while their CEO earned over 700 million in salary during that time. As long as profits must be generated to return dividends to investors then there is the strong potential that care will suffer. While there are concerns about interference between a doctor and their patients this is not something that will happen but rather something that has already happened. Claims managers, insurance auditors, and “pre-authorization” agents already intrude and serve to impede care. “Please listen carefully as our options have changed” is burned into the office manager’s mind as they navigate through the maze of choices to gain approval.

It is essential that we define what the issue is in this current town hall meeting about a service we will all use. This is a moral issue that defines the character of our country. Much like the debate among the founding fathers of our country concerning education we are at a defining moment. How we respond to this issue of health care offers evidence of who we are by what we do in the care of us other.

It has been said that we need the leadership of someone like Franklin Roosevelt in this troubled time. I would much prefer the call to action from an earlier Roosevelt, as in Theodore. “Teddy” Roosevelt helped to bring our country into a more just society as he rallied against monopolies in business, established our National Park System, and sought to regulate sweatshops and outlaw child labor. That President Roosevelt talked to his countrymen in simple, powerful, moral language. He understood that to argue that “half a loaf” and partial goal-attainment was better than nothing was still an empty promise that left our most vulnerable at-risk and our morality meaningless.

Bill Moyers, the long-standing commentator and White House aide under President Johnson, stated that America is “A crippled giant suffering from self-inflicted wounds”. He noted that great leaders in our country have often led us to “think beyond yourself”. His words and experience remind us of the terrible costs we have suffered in our denial of what is needed. Can someone explain to me what our objectives are in the Middle East? What am I getting for $500,000 a minute in the financing of our military operations there?

Money has great influence in the current debate in health reform? Insurance companies are spending 1.5 million dollars A DAY in lobbying efforts to delay or stop any reform. It is significant to note that the six “Blue Dog Democrats” that are delaying any action in the Senate all come from small districts and each has thousands and thousands of dollars being poured into their reelection coffers by Big Pharma, insurance carriers, and others who stand to be disrupted by any attempt to regulate or impose compassionate standards on their practices.

I agree that we would do well to be distrustful of the forces in the government that would impact our health care. I do not agree however that we cannot afford to provide care, to grant access, to seek to be better about our care for each other. It is important that any massive new program address the fact that people know what is healthy but go right out and pick unhealthy lifestyles. We eat too much, smoke and drink, and postpone any change until next year. Just paying for and providing health care doesn’t fix our problem anymore than when the government set up Medicare Part D to pay for medications without addressing the issue of the cost of such pills and potions.

Benjamin Franklin understood the importance of education and vigorously debated Thomas Jefferson about what emphasis was to be placed on this by the government’s involvement and funding. Jefferson believed that education should be provided to the “few diamonds in the coal” while Franklin pressed for vocational education for all our citizens. America responded to their debate and today our universities and research institutions are some of the best in the world.

My parent’s generation has been called “the Greatest Generation” as they fought against those regimes that suppressed freedoms and allowed the worse of human torture. I believe that my generation, the crest of the Baby Boomers, has a similar opportunity to define what is right about our country and ourselves.

Education is costly and I don’t care. I do want efficiency and reason to govern the provision of services to educate our children but we have to commit to what is “beyond ourselves”. Just as I advocate a commitment to our children because it is RIGHT and MORAL I hope that my fellow citizens will also view health care as something that cannot be put on a balance sheet. I believe that doctors can attend to the needs of their patients with a sensitivity to expense without having to outsource reviews of their decisions.

We need Teddy Roosevelt to lead the charge up San Juan Hill and take back our health from the grips of those who only look at the bottom line. America is the only one of the industrialized nations on the planet that does not provide for the health of her citizens. There is no room for compromise as we consider what is right, what is moral. The “crippled giant” can heal from her wounds but we have to recognize that the issue before us is a defining moral one. It is time that we show the world that we are the beacon for all other countries as we display our action behind the inscription on The Statue of Liberty,

"Give me your tired, your poor,
Your huddled masses yearning to breathe free,
The wretched refuse of your teeming shore.
Send these, the homeless, tempest-tossed to me.
I lift my lamp beside the golden door."

Or for those who follow the teachings of Jesus

"Therefore all things whatsoever ye would that men should do to you," Jesus said, "do ye even so to them…" (Matt. 7: 12).

I wonder if Jesus would have purchased health insurance?

August 24, 2009

Helping America Succeed: Why I Use Drugs

I am a True American…I like drugs. Before me on the television screen or via email I am told how inadequate I am. My penis is too small. I’m at risk for explosive diarrhea. My bones are melting. My depression is clear.

The only hope is if I can obtain the proper drugs. Everything will balance out if I can restore my liver functions or cleanse my colon. Offices full of people in white lab coats reassure me that happiness is only a gulp away and can be obtained with only twelve easy payments of $29.95.

In my youth I was introduced to illegal drugs. In the ninth grade I went with my Methodist youth group to a ski retreat in New Mexico. Wanting to fit in I wandered in the woods around the church camp and learned to smoke marijuana. I felt acceptance while stoned (or, at least, didn’t notice the rejection as much) and enjoyed a sense of pushing back on a society that didn’t seem to care to much for me. My class grades were marginal and pot helped me to find a definition of counter-culture where I fit in with my curly hair and lack of athletic ability.

Alcohol and I started up a friendship in high school. I learned the rules of obtaining booze in Lubbock. You could get beer or wine from one place as long as you didn’t have a girl in the car. Diversion of alcohol from parent’s liquor cabinets was common among my group of friends. Everclear and cheap wine were quick but often left one sick. Listening to Cheech and Chong on the 8 track in my first van we enjoyed a life in the shadows in our conservative community.

Starting at Texas Tech in the fall of 1975 I continued to refine my drug use. Much like today’s college student I was challenged if I didn’t partake of alcohol. Marijuana was more hidden but not unexpected at any party. Parties started on Thursday and intensified on Friday and Saturday. Being in the marching band I never drank before or during the football games on Saturday but once out of the band uniform it was time to PARTY!

Disco stormed on the scene during my undergraduate days and the bass beat pumping on the dance floor was matched by the continued exploration into drugs. Drinkers and stoners shared space together and millions of brain cells were damaged. Those who couldn’t manage some degree of balance were lost and disappeared. I managed to finally understand that study before party worked much better than party before study.

Excess in drug use reached new heights in college and my organizational skills became apparent. I was in charge of membership drives for my fraternity for four semesters. Each semester featuring two full weekends of themed parties with drinking being the primary activity. Whether it was “Pimp and Prostitute”, “Cowboy Roundup”, or “Drink and Go Naked” one was sure to find lots of trashcan punch. The drinking age at the time was 18 so no problem getting cases and cases of booze. Tobacco use was supported and even desired as tobacco and alcohol companies gave out lots of free gear and snuff.

Alcohol and drugs began to move away from my life as I relocated to San Antonio and started graduate school. I re-invented myself and put a new spin on my life as I told my new friends that I didn’t party much and mainly just studied. This lack of intoxication on the weekends left me plenty of time to study and with that effort I started to make excellent marks in school.

I married in 1984 and we didn’t even serve any alcohol at the wedding because it was held on the campus of Texas Tech which prohibited any such substance. Moving to Indiana to complete my doctorate I helped with the chapter of my fraternity located at Indiana State University but my role was more to organize the party and not so much to drink.

Finally I just found myself unable to be comfortable with the illegal aspect of marijuana and stopped in my early 40s. I had too much at stake in my professional practice to be arrested and I also didn’t want to ask my children to help me score some weed. After years of my parents (and the government) telling me I needed to behave and not use drugs I finally relented.

The problem was that, about the same time that I gave up illegal drugs, I started into a much stronger habit of using legal drugs sometimes referred to as “medications”. Following a familial pattern I developed Type II diabetes as well as the usual lifestyle issues of elevated blood pressure, cholesterol issues, and common aches and pains.

Now, at 52, I take 15 pills every morning and administer myself an injection in the a.m. and p.m. I travel with my “stash” of pills and worry about being questioned by homeland security. Before a major project in the home I warm-up with Motrin and proper back support. While visiting my uncle Bill I had to bum some Actos from him for my diabetes as I ran out.

There was never a time that I was really persuaded to not use drugs, either legal or illegal. I think that I reacted to the negative and what were outright lies when told that marijuana was an automatic gateway to harder drugs. The reason I never embraced cocaine and other powder drugs was more about the cost (I could get way more alcohol and pot for my money than that little vial of cocaine) and my distrust that a jungle chemist knew what they were doing in the processing.

I’m amazed that America continues to fight its longest war…the war on drugs. Our justice system is overwhelmed with simple possession cases and our prisons house thousands who are sentenced for harsh long terms. I don’t understand how we as a society so completely miss the point about which drugs are dangerous. On average in a year’s time we suffer

                *10,000 deaths from heroin and other narcotics

                *150,000 deaths from alcohol-related conditions

                *400,000 deaths from tobacco

I marvel at the hypocrisy that the two primary corporate sponsors for the “Partnership for a Drug-Free America” are Phillip-Morris and Seagram. I note that there is no evidence-based research that has documented deaths due to marijuana overdose while each weekend carries the news of another alcohol-related crash and deaths.

Even more alarming is the clear trend in explosive growth for legal drugs to control our children or otherwise medicate ourselves. The United States has about 15% of the world’s population but we consume over 85% of the legally manufactured stimulants, commonly used for those diagnosed with Attention Deficit Disorder. Pharmaceutical companies are making massive profits on medications that target our children and we seem to have decided that evidence of a child acting like a child calls for intervention.

Drugs are neither good or bad but rather this value is found in how they are used. Recently New Mexico joined the ranks of 13 other states in allowing for the legal use of marijuana for the relief of pain and nausea among the medically ill. A host of university presidents and administrators have called for a return to a lower drinking age citing the evidence that prohibiting a substance has only served to increase the desire for it. Some might feel better in passing mandatory sentencing laws for those who use various substances but the end result is only a sub-class in our country of people who are not able to function because of the stigma attached to being a felon.

I used drugs, and continue to use drugs, because they help me. I no longer use those drugs classified as illegal however I am now on a daily timeline for medication. As a youth the drugs I used held a hidden toll but left me feeling like I have friends and could succeed. As an adult other drugs hold the hope that I might be able to maintain my health and enjoy my friends and life. We need to help form communication with other members of our society to learn about these drugs and the consequences of choice in which ones we take. People of all ages are going to drink too much, smoke, and take substances that promise adventure and pleasure. We must not treat them as outcasts but rather should work to understand why these needs are present and what healthy routes are available to achieve these.

Choices are a part of life and I appreciate knowing that my parents, family and friends tolerated and cared for me even in the worse of times. I never found a drug that made me smarter, it was life that taught me that.

August 17, 2009

“I’m not Cheating on my Wife and other Tales from the Muted Majority”

I have some confessions to make. There are things I need to get off my chest and come clean about. It may be difficult for my family and friends as I reveal these troubling details but it is time that I make amends.

My wife of twenty-five years went out of town this past weekend and I thought about what mischief I could get into. Maybe call up a group of misfits and host a big party? Perhaps approach that alluring woman I know and gauge her interest in something tawdry? Reflective for a moment I considered all the possibilities and, in the end, mowed the lawn and cooked a steak which I shared with our three rat terriers.

I don’t know what is wrong with me. I see our leaders coming forth to confess their sins and I’m not able to compete. In my younger days I was somewhat of an expert in creative disruption and leading others into temptation. There was that small gathering of 300 people at my parent’s home (they were on a cruise) during my high school years or the time the marching band from Texas Tech had a fun-filled evening at my fraternity house of Broadway. Something happened to me as I moved into my older years…I lost my touch.

I believe that there is a “muted majority” of Americans who have been struck by the same affliction. Something happened so that we developed a sense of moral perspective and dislike for choices that complicated our lives. We are the citizens who wake up around 6 a.m. and read our newspapers while listening to “The Today Show”. We are at work by 7:30 and busily engage our day’s duties. We respond to our phone message, answer our mail, and pay our bills. Then we go home, visit with our spouses and children, and enjoy a favorite television show or two before retiring. Life is stable, organized, and understandable.

I confess the following:

1.       I met my wife in 1981, we married in 1984, and we are still together. We don’t always agree and sometimes I know we think about how it would be easier to be single but we still find common ground. What was hot romantic love has evolved into deep companionship love and I don’t want to change it. Easier would not be better I think.

2.       Despite the development of an intimate knowledge of both legal and illegal drugs during my formative years I now limit such usage because it just makes me feel null and void. I don’t drink and drive. I don’t think drugs are bad or good but it is how they are used.

3.       I don’t stay out late. Where once I thought the party didn’t start until after 1 a.m. I now am tucked away in bed in time for “The Cobert Report”.

4.       I believe that I am a spiritual person but not a particularly religious one. I attended regularly throughout my childhood and played trumpet at Lakeridge Methodist for several years but I don’t attend now. I felt that the church came between myself and God and the more prominent leaders were often the furthest from what I believe Jesus was trying to teach us. I continue to struggle with this.

5.       It is important to me that people are helped and, while I support making a profit, I harbor great disdain for the outrageous dividends and salaries that I read about in the news.

There it is, the ugly truth. I love my family, pay my taxes, volunteer my time for social causes, and don’t abuse my body.

From what others say I guess that makes me a socialist, tree-hugging, druggie, goofball that is un-American and should be “dealt with” by those who would question my lifestyle and choices.

Meanwhile I want to understand and offer Grace to those leaders who stand before the camera and offer explanations for their poor choices. Love, alcohol, drugs, money, too much sugar, are all offered as reasons for what happened. The problem is that our “muted majority” doesn’t make the same types of mistakes, we just follow our sense of what is best and strive to lead a life that is valued.

I appreciate that everyone makes mistakes and I seek forgiveness for my own action however I grow tired of the hypocrisy that has become common among those who are assigned the task of promoting the best interests of our country. I believe that people know what is sensible and reasonable but why bother with those when you can simply do whatever you want and, if caught, just apologize and go into rehab.

I hope that others with my same disease of sensibility will step forward and become involved. We need reasonable men and women in these trying times to set the goals that help us to all be better in our humanity.

But, don’t think that this means I don’t keep my imagination.

August 10, 2009

Watching People Die

I read in the newspaper and see on television the concerns about our healthcare system. How we are 37^th in world rank and have a higher infant mortality rate that is greater than some third world countries. We are frightened by our media and political leaders about “death squads” and moving to a time when we will discard people if their balance sheets don’t show a positive.

I don’t know what the end point will be in this debate about your healthcare system. I remain optimistic because that is the preferred place to be until one knows for sure. What I do ponder is how our society has broken off the final chapter of a person’s life and lessened the quality of our existence by doing so.

A hundred years ago we died at home, usually attended by family and friends. Today most of us will die in a hospital or nursing home, with paid attendants providing for our last needs. We keep death behind a set of automatic doors or down the hall from the nurse’s station. We scrub down the counters and floor and pull the sheets up to hide the view. We fear death more than we ever had.

Having provided psychological services in a general medical setting for over twenty-five years I have witnessed the dying process and death. I’ve sat with spouses, children, and others as the clock ticked down. I’ve struggled to understand how the end comes about fair or unfair. I am angered by the use of this final moment in our lives as a scare tactic employed in the political process.

Because we don’t talk about death or seek to include an understanding of it when we are raising our children there is a misery when it approaches. When faced with a loved one dying we remain in an active curative mode offering advice on what might still be done rather than being comfortable with just sitting with them.

With today’s technology in medicine I wonder if people realize that dying is what is hard and death is the liberation. I recall the sadness I felt as a women with a generalized staph infection inside of her abdomen died slowly over three months in an ICU cubicle, her belly open exposing her organs. Her husband faithfully standing by her bedside while both were fed empty hopes of recovery.

I once interviewed my father (pediatrician) and brother (orthopedic surgeon) about their views on death and their role in the dying process. My brother, relatively young in his practice at that point in the 1980s voiced a sense that death was a challenger to be responded to. My father, after forty years of practice offered a perspective of death as a colleague with a place in the process of life. When he started his practice in Lubbock in the early 1950s he related making difficult choices with his patients knowing that there was little to be done and not wanting to prolong their pain or the pain of their parents. However, by the time that he retired he was afraid not to muster all the technology at his command for fear of litigation despite his personal feelings that it contributed only to the tragedy. I have a sense of dread with all of this technology knowing that, should an accident or illness strike me and I can get to a hospital within the “golden hour” I stand a good chance of surviving, even if I wouldn’t want to.

It is emphasized in the news that America must address its citizen’s lifestyle or any healthcare costs will continue to spiral out of control. We don’t think about the future, only this moment. Obesity, diabetes, and heart disease don’t kill quickly they only cripple by degrees. Much like our death, we don’t think about what today might mean and why we would be better to acknowledge that death will happen to each of us and motivate ourselves to plan out this final stage exit.

Two of my four college roommates from Texas Tech days in the 1970s are dead. During those wild times of my youth I don’t recall that any of us thought that the end would come so early. Not really unexpected for Joel. After graduation he “came out” about being gay and moved to Austin. I maintained contact with him and would visit when in town. One day he mentioned being in the high risk group for contracting the newly described AIDS syndrome. He was casual about his sexual encounters and it ended his life.

I’m not sure what happened to Greg. We drifted apart after college and I recall seeing him a few times for the alumni activities with the Goin’ Band from Raiderland during homecoming. He wasn’t much for healthy lifestyle and I suspect that is what happened to him with a chronic illness that wore him down.

It is strange that with death so common we don’t do a better job of incorporating it into our lives. Sometimes it seems we care more for people after than are deceased than we did when they were alive. We harbor regrets for what we failed to say or for not releasing old grudges that strangled our connections with others.

We don’t have to worry about dying or death becoming uglier as it has always possessed the greatest sadness and tragedy. Easter is a strange event with churches usually focusing on the great transformation that occurred after the horrible death as this is preferred. Mel Gibson’s “Passion of the Christ” was a strong visual of what the death of our savior was actually like. It was not sanitized for our protection and the movie left people with uneasy feelings about its “value”.

Cancer has a statistical likelihood of touching us and remains very difficult to treat. Mary suffered from multiple myeloma and I visited with her as she wasted away over two months. She had been a wife, mother, Sunday School teacher and all around good person and her cancer didn’t care. I sat with her as she moved into shallower and shallower respirations with a death rattle gasp followed by long silence and then another gasp and finally death. Her emaciated body with ashened skin tone stood as testament to her final moment. After offering my shared grief with her husband I found myself having lunch fifteen minutes after leaving her room. While listening to a conversation about how the Cowboys were doing in the season it occurred to me to ask myself what kind of cold-hearted bastard was I that I could eat lunch after what just happened.

But, in answering that question, I considered that I have participated with Mary in her final chapter of life. I could have done more, I could have done less, but I did what I did it was now in the past. Her death was the natural course of life. Everything is born, everything dies, and living is in between. I don’t believe that she had a good death but that she did have a less bad death and that was what was important.

If there were not a Heaven I would have to invent one as the world is too cold of a place without it.  Years of encountering the unfairness of life I still raise my hand to the sky and ask “why” but I’ve perhaps gotten a little better about not having to have the answer. I’m left with many unanswered questions that I look forward to getting answers for. I think that maybe God lets us experience pain so that we might know and appreciate pleasure but I am unable to reconcile this to a young mother after the still-birth of her child. I am left angry.

So, when our leaders toss about the term “death” and they prance about telling us that something must be done I agree. I agree that we need to turn to our parents, to our companions, to our children and talk about what is the future for all of us. I agree that we need to prepare and formalize our wishes through Advanced Directives and Power of Attorneys so the fate of Terry Schivo doesn’t happen to compound our final moments. I agree that we should school our media and politicians to speak completely and respectfully about these difficult moments.

And mostly, I hope that I might be able to slip away without a protracted draining struggle, leaving a few good stories to be remembered by. Goodbye Joel. Goodbye Greg, Goodbye Mary.

August 8, 2009

We Must Never Forget: We are Not Nazis!

Language and the ability to communicate are essential foundations for civilization and a democracy. Without a method of expression that facilitates a common understanding we would be unable to form cooperative ventures or social pairings. As a person is born and matures we strive to equip them with the ability to communicate through verbal and written means. Whether we are enjoying a good movie or seeking knowledge in print or electronic media we need to have strong communication skills.

Growing up our mother would champion proper English. She would correct us when using double negatives such as “ain’t no”. I remember sitting and listening to my father making presentations in church or at civic organizations. Correct usage of words required knowledge development and practice. While slogans or catch phrases might be used to emphasize a point it was important to fact check and to possess an understanding of the historical nature of certain words or phrases.

Across the television screen of late we see our fellow citizens protesting as they exercise their first amendment rights. We see signs reflective of the, at times, painful discourse as our country works to come to a course of action in dealing with our problems. Some comments and displays are quite provocative and their attack personal. At recent town hall meetings there have been signs with the Nazi Swastika and the implication that President Obama or other national leaders are displaying fascist tendencies or desires.

I am saddened that such symbols are displayed during this time of national debate as they only serve to inflame the situation. We seem to have become so desensitized (or possibly just misinformed or ignorant of history) to the true horror found in those days of World War II and now throw out the label of what Hitler and his henchmen were without a true regard for what happened. All this seemingly only to hurt and limit debate rather than open up a national conversation.

If we might take a moment and consider the words and phrases we use it might afford us the chance to actually understand what it means to be American. We might find ourselves ashamed that we toss around such terms of “SS” or “Nazi” for their emotional jarring without a sense of how these terms came about.

The protesters who hold up such signs associating President Obama with the Nazis should be willing to acknowledge the details that they say are binding. If they are unable (or uncomfortable) in standing on what the assumptions are then they must admit that the words are used merely to insult without a true connection.

It is understandable that differences of opinion are noted regarding President Obama and his ideas on how to manage through the many problems that are affecting our country.  His ideas on healthcare reform, the economic, and our foreign wars can be polarizing. However, to suggest that he is liken to Hitler or other despots only serves to lessen the evil that was found in those men while not providing any improvement in our contemporary efforts to solve our problems.

By associating Nazi Germany and Adolph Hitler with President Obama one is suggesting that Obama:

1.       Is seeking a “final solution” that will liquidate several million people through a systematic highly efficient program. Now before one states that the healthcare reform bill includes counseling for end of life decisions I would hope that you would consider the 6 million men, women, and children that were rounded up, transported to large death camps, stripped of their possessions, murdered with Zygon gas, and then burned like so much trash. In those children’s eyes are you willing to trivialize what happened to so many by suggesting that this is what is going to happen in our country.

2.       Will push for the adoption of only one political party and will use the tools of murder and oppression against any who oppose him. Again, before you respond, are you mindful of the thousands who were purged, murdered or forced to relocate at the point of a pistol in Germany under Hitler?

3.       Will seek to develop a “super race” reflective of his own sense of perfection and then invade other countries to gain supremacy over inferior beings so that they can be used in labor camps.

It has been estimated that World War Two resulted in the death of almost 70 million human beings. Approximately 418,500 Americans were killed in the conflict. While the horror of the battlefront was unimaginable the true evil of this moment in our history was found in the absence of any humanity and complete dedication to the mass murder of so many.

This disdain by one human being toward another is what is the essence of the evil found in the Nazi regime and its symbols. To be able to round up innocents, dig a pit lining them up on the edge, and then with no sense of emotion go down the line and shoot them in the back of the head men, women, and children, is too horrible to be treated lightly or used to “make a point”.

Shame on those who place those symbols on public display and suggest that our fellow Americans are similar. Shame on those who make a mockery of the deep, disturbing evil that was the Nazi party. I can only hope that these people don’t fully understand or they simply lack the historical facts of the Holocaust. If they want to make a point in their disagreement with the country’s leaders than I pray that they will develop a argument of substance and not just ignore that they are more closely aligned with the Nazis they speak of, as their words display the evidence of lack of compassion and humanity.

August 2, 2009

Does Lubbock need a Beer Summit?

Lubbock doesn’t have race relations problems…so long as everyone stays in their proper place. While our community’s first priority is commerce we take note of concerns that we might judge people for some other reason than the amount of money they have. We want to make it clear that all are welcome so long as it is understood that order must be maintained.

At the recent “Presidential Gala” held in January celebrating the election victory of President Obama the divide was clear. My wife, daughter and myself walked into the Civic Center that evening and assumed the role of the minority race attending that event.

We sat and befriended a couple and started conversation. As it turned out the husband and wife were contemporaries of mine in time if not space. While I graduated from Monterey High School in 1975 they had completed their education across town at Dunbar High School that same year.  Now 34 years later we compared stories about growing up in Lubbock and events in our community (or I might say communities).

Growing up I don’t recall any attempt to segregate minorities but I also fail to have any strong memories of a mixing of ethnicity. My Sunday school class at First Methodist-White. My classrooms at Bayless, Parsons and Evans Junior High-White.  In my graduating class at Monterey I recall only a single young black man and woman. I had a few Hispanic friends but primarily my friends were White.

I knew that Lubbock had many minorities, it was just that none of them lived in my neighborhood. In high school I remember getting up early on Christmas day in order to drive down to the Fair grounds and pick up paper sacks of gifts that we would deliver to houses in central and east Lubbock.

One evening in April 1968 when I was eleven years old I remember sitting at my desk in my bedroom when the news came across the radio that Martin Luther King had been assassinated. My father drove down to his medical clinic on Avenue Q fearing that there might be violence. I didn’t have an appreciation of Dr. King at that point but knew that a national leader had been senselessly murdered for reasons I didn’t understand.

Starting at Texas Tech in 1975 I found friendships among a variety of people that I had not had much contact with previously. Black, Hispanic, Asian, gay, various faiths (or none at all) might have been found at our hangouts. My college fraternity pledged the first Black man in the Greek system but he dropped out due to pressure from both the all white fraternity system as well as from other Black students.

Graduating from Texas Tech in 1980 I proceeded to start my Master’s studies at St. Mary’s University in San Antonio where I was confronted by my limited upbringing in terms of race relations.  St. Mary’s University has a student body that is primarily Hispanic and international with the exception of the fine law school. During my two years there I was usually the “token white guy” and lived on the west side of San Antonio where the billboards were more likely to be in Spanish than English. I dated several Hispanic women and suffered at times from veiled hostility from their mothers who didn’t like their daughters being with an “Anglo”.

Over the next two decades I married (a white girl) and we welcomed a nice white son and daughter. In Indiana I learned more about people of the Jewish faith when I mentored an incoming doctoral student from the East Coast. As he was driving over for our first dinner together I recalled saying to my wife, “Rudman, do you suppose he might not want to have pork chops?”. We managed through the embarrassment of that evening (finding a different entrée at the last minute) and I learned to check on such things.

Now in my 19^th year of practice as a psychologist in Lubbock my day is spent with clients of all ethnicities, age, social status, religion, and a diversity of other unique qualities. While my office reflects this changing landscape of our country my neighborhood in Southwest Lubbock continues to be primarily White. My daughter recently graduated from Lubbock High and her social contacts are quite varied and open.

So, in looking back across my 52 years, Lubbock has changed in some ways and yet in other ways it is still a community that is separated by race. A recent 2008 report prepared by the Economic Council for Lubbock showed that 30.6% of our citizens are Hispanic and 69.4% are white. I’m not sure what happened so that those Black citizens who were not counted. The 2000 census did find this group as provided in the following data for Lubbock:

Population - 213,305

Latino

 29.9%

White

 59.7%

Black

 7.8%

Asian

 1.8%

I conducted an Internet search attempting to find information on where various ethnicities live in Lubbock but had no luck. By experience I believe that there is little doubt about the major concentrations of different races in our city.

A white man or woman driving down Bates Avenue would appear out of place while a young black man driving an older car in the Lakeridge subdivision would likely attract attention. Every Saturday you can find crowds of minorities chasing good deals at garage sales in Southwest Lubbock but they don’t live there. Outside of university events the sight of a mixed race couple would still draw hushed comments. Young white teenagers are implicated in criminal activities including negligent death and are well-represented by attorneys. Young black and Hispanic teenagers are simply arrested, tried, convicted and sentenced.

I believe that Lubbock needs a “beer summit” but there are major obstacles. I doubt that anyone would argue that there is a diversity of ethnicities across the city however our history has been one where “like finds like” and our neighborhoods become self-selected as people feel comfortable.

Our community has long accepted that lower standards are acceptable for our minority groups. Substandard housing, roads, and utilities are allowed to continue as the representatives from the central and eastern parts of our city are voted down. Civic leaders were concerned when Monterey High School was found to be unacceptable and action was taken. Just released by the State Board of Education were the findings that Dunbar and Alderson Junior High schools were found lacking in standards. Where is the public outcry and monies to improve those schools?

The biggest problem facing Lubbock in terms of race relations is that white people don’t think there is a problem and minorities don’t believe anything can be done about the situation. Much like the college students in town we like their money but would like to be rid of them except for that benefit. We stand idle while our drop-out rates spin off the chart, leaving Texas number one in the country for dropouts. As long as we can build prisons which boost the economics of small towns across West Texas then we remain uncommitted as to needing to do something about our uneducated, unskilled, and throwaway children who are headed to our prison cells.

If a beer summit could be arranged I wonder what would happen. The whites attending would likely be calculating the profit margins while watching out for the Texas Department of Alcohol Beverage Control. The Blacks might circle the block to see if any police are watching while Hispanics would be present but off to themselves. Local churches would decry that beer was served and loose morals exhibited for such.

However, I remain optimistic about what our community can achieve. I believe that the more people can encounter each other and learn their life stories the better our country will be for it. For myself as a white person I do not have any experience as being profiled for my race or harassed for simply “being”.  We must challenge any such actions that result in a person being treated a certain way simply because of their skin color. We would do well to remember the legacy of Dr. King in seeking to bring our country together.

July 25, 2009

Doing What is Right Will Cost You: Is Profit and Pleasure Always the Goal?

I believe that the people of America possess good common sense and a philosophy that wants to bring justice and equality to our society. Looking back at our history our country has come together in the face of threats and we have willingly sacrificed to advance our efforts. With the financial crisis in our midst and faced with the changing nature of our position as the world’s superpower we need to go back to our founding principles in order to make the transition to our new identity for our citizens and on the world stage.

In my work as a psychologist I am often called on to help young people (and sometimes older ones) cope with the reality of “unfairness” in life. It seems so often that young people today possess a sense of entitlement. Having never been thwarted or denied they are surprised and upset when they finally meet a person or institution that tells them “no”. Families struggle with what Time magazine called the “betwixt-and-between” generation that moves out for college only to return home in their mid-twenties in order to enjoy the financial benefit of no rent or other monetary demands. Several times a week I meet with parents and their adult children who have “failed to launch” and someone is needed to force the situation and get the young adult out in the world.

No individual wants to be the “bad guy” in setting limits and acknowledging that one has to deal with what there is in front of them. Our society has become attention-deficit disordered with a short-term perspective that damages and destroys us as we yield to pleasures and profits that set the stage for long-term destruction.

We suggest savings for long-term planning while bombarded by marketing solicitations that tell us to “play now, pay later”. Diseases such as diabetes and high blood pressure are clinically understood but difficult to manage as people fail to be concerned unless there are symptoms. We snicker as we label consumer and environmental advocates as “tree huggers”, “greenies”, and “socialists”.

In working toward a new definition of our country it has been suggested that we will have to “live within our means”. At the same time we witness large corporations hike interest and service rates while awarding large bonuses to their leadership. Goldman-Sachs recently announced their largest profits ever with over a million dollars earned for each employee of that company. Profit at the corporate level is supported and lobbyists fight off any lessening of their ability to make money. A informative web site to visit is www.followthemoney.org to observe how money changes votes in our leadership.

I wonder if our country could have fought and won the second world war if profits and pleasure were as required as they are in today’s society? Would people have sacrificed by accepting meat and gas rations or would there be the expectation that others would “do the right thing”? War profittering could result in criminal prosecution and we understood that success required all to participate. Today such calls would likely result in accusations of socialism and liberalism.

Some activities in our society may never generate a profit and are costly when done correctly. In “A Nation At Risk” published in 1984 by the National Committee on Excellence in Education the statement was made that, “If a foreign country came in and did to our country’s educational system what we did to it we would likely declare total war”. Efforts to make schools perform within a business model have consistently failed. We share the burden of school property taxes in order to finance a better future for our country.

Jails also require a massive expense but somehow we feel better about it. Candidates for office are always seeking to be “tough on crime” and we agree as we watch Willie Horton being released only to engage again in heinous crimes. In West Texas prisons are big business as small communities are able to tap into a revenue stream that doesn’t go away or is affected by budgets. Unlike education, where it is inherently difficult to judge effectiveness other than passing a test or graduating, we can count the inmates and review their crimes, giving us solace that we are somehow safer.

Healthcare, at least until business models took over in the 1980s, was also a “service” that sought to do what was right over what made a profit. The heady days of HMO, PPO, and other managed care that started in the 1980s convinced us that costs could be contained while still offering excellent care. Looking around us today I do not think that this was achieved and, in fact, our care suffers as “care managers” from the insurance carriers define what we need and how much they will pay.

To do what is right in life will likely call on each of us to sacrifice much as our country has had to do across time. The problem in healthcare is not socialism it is capitalism.  Taking the concept of not seeking a profit but focusing instead on good care will take us back to a time in our history when what mattered was that we “did it right”.  Establishing the long-term benefit will mean a reduction in the short-term pleasure (and profit). We will not like it but by considering a reasoned and debated course of action we will advance and yet return to a place and time that was the core of our country.

July 24, 2009

Talking around the Dinner Table

In watching the “talking heads” on television I’m left to wonder if anyone actually communicates anymore. There seems to be no common grounds where people can find agreement. Even being polite and listening to those who you disagree with appears to be rarely displayed. If the other person is not in complete agreement with your position then the only option is to aggressively challenge and debase their view with personal attacks and insinuations that they are not “true Americans”.

Growing up in Lubbock our Sundays were distinct from the rest of the week. After attending First Methodist Church services we would pick up a bucket of fried chicken and enjoy lunch around our dinner table. After lunch the children were pressed to take naps in their rooms or at least keep the house quiet. Dad would retire to his study and read medical journals. Mother usually enjoyed her own nap.

Even as we matured there was always the Sunday lunch. After moving out with college friends most Sundays still found me pulling up to the homestead and setting down for chicken and mashed potatoes. The after-dinner conversations actually grew in importance as time went on as it was a moment for us to offer comments on events, both big and small.

We didn’t (and still don’t) agree on all subjects and these lazy conversations might note disagreement. Point and counter-point would be offered and, at times, a simple agreement to “agree to disagree”. Liberals and conservative views sat at our table and issues were vigorously debated.

As I wander through my life now I wonder if such cooperative exchanges are even possible anymore. The media, in need of round-the-clock material, fans the flame of extremism. The more accusatory and libelous the charge made the more prominently it is featured.

Just as I can still sit with my elderly parents around the Sunday dinner table and talk still I believe that there exists a large proportion of our citizens who are also able to speak, discuss, exchange, and accept divergent opinions. I would like to think that we can consider the position of the other person and celebrate that our country was founded on free speech and the ability to voice one’s opinion.

Forgiveness and acceptance are key components in my work with individuals and families in counseling. Looking back at some of my views as a teenager and young adult I marvel at my parent’s ability to be even tempered at the Sunday table. Now in my 50s I appreciate that others can forgive me for my mistakes (although I feel you get partial credit if you make a brand new mistake). Grace as I embrace it through my Christian beliefs enables me to forgive others who don’t deserve it and I humbly seek the same for my transgressions.

We have to find a way back to “the dinner table” in our country as the divide between us is only growing worse and threatens to tear our country apart. Whether it be the “race card” or “class warfare” we are so polarized on issues that our interactions are marred by bitterness and insult. Much like our Constitution our country is a “living” entity, changing and transforming as new challenges appear.

Around our table we challenged each other to take a position and explain and support it. We refrained from simple labels that took away from the point. Liberal and conservative, socialist or capitalist, Democrat or Republican labeling does little to further the conversation. I fear that we are moving toward a pattern of desensitization toward others who oppose our view with the outcome being that mistreatment, neglect, and even direct abuse becomes acceptable.

So if the local blogger “Mr. Conservative” (Donald May), or Robert Pratt (KFYO Pratt on Texas) wants to denigrate or label me as a left-wing, liberal, idiot socialist I would hope my reaction back is not drawn from the same vein. Reacting in kind only deepens the divide between us and suggests that such behavior is appropriate when it IS NOT!

We might have to get a bigger table at my parent’s house for everyone to sit around but that is what America needs. I hope that each of us can reflect on our memories of such sharing and begin to heal our country and move forward.

July 20, 2009

The Final Solution: How to Stop Worrying About Healthcare and Die Happy

     With a tip of the hat to Jonathan Swift of “Modest Proposal” fame it is possible to identify clear cost-containment strategies that propel our nation out of the healthcare crisis we face. By accepting a dialogue where all options are considered we stimulate thought and move forward to a better tomorrow. A solution that recognizes an individual’s right to choose combined with the marketing media's spin machine can lead us into a technology driven service that is good for the economy. I propose that we aggressively develop and market the “why wait and suffer” service that encourages self-selected euthanasia for whoever wants it, whenever they want it.

     The debate over an individual’s right to choose, even as relates to orchestrating their own demise, has ranged over the last thirty years and across the globe. Whether by slow suicide through chronic ingestion of toxic substances (i.e., tobacco, alcohol, hot dogs) or by assisted suicide attended by medical professionals the argument has many definitions and aspects. I do not believe that anyone is for needless suffering and pain however how each of us define our own reality creates a problem as to what exceeds our tolerance. Traditionally our country has taken a parental approach as to whether someone can end their life. A general consensus has been that one cannot voice a desire to die or take steps to complete the task without being labeled as “psychiatric” and needing to be restrained and possibly hospitalized.

     As technology and medicine has evolved we are now equipped to end a life relatively painlessly. Dead by lethal injection is the standard in capital punishment and leaves us more comfortable with a criminal just “slipping away”. This quiet separation from the living to the dead is often missing among those, more law abiding citizens, who are left to experience agony and purposelessness while warehoused apart from those who “contribute”. Others in life are faced with a personally derived reality that their lives are empty and the forecast is only more of the same. What can be done to help?

     The primary driving force in the need to deal with our healthcare system involves cost. Who is to pay and for what? What services are to be offered? Much of the expense in the system involves end of life care issues with spiraling expense associated with the final few months of life. Procedures and medications are provided which may be ineffective and contribute to the dysfunction of the patient. Taking a tip from Hollywood we can and must do better!

    In place of arguing about the need for services the system needs to develop a service arm that specializes in “self-snuffing”. When faced with the diagnosis of a statistically likely terminal disease the treatment plan will include extensive information on euthanasia services. Highly trained counselors paired with emotionally charged videos produced by Tom Hanks and Dreamworks will be shared with the patient and family. Excel spreadsheets will be used in Powerpoint presentations that contrast what the expense of treatment will be versus spending those funds for the person’s children or grandchildren's education. No stone will be left unturned as even the spiritual side of life is addressed by engaging in a “What would Jesus Do?” conversation with highlights of the great things waiting beyond in Heaven.

     For those electing to pursue the “self-snuffing” option a menu will be presented from which they can pick their “final progression”. Framed beneath the stirring words of Sarah Palin, “We are not retreating but only going in another direction”, the individual and family are assured of the correctness of their choice as they sign a binding legal contract.

     Looking over their options some will look forward to the resort vacation at one of several destination spots around the country. Whether a cool mountain overlook in New Mexico, a sunny beach front in San Diego, or the quick traffic and great shows on Broadway there will be a perfect locale for their swan song. The one-week event will feature unlimited everything at absolutely no cost to the person (and still much less than would have been paid for their medical care). Aging media stars will be assigned from the endless reality shows to the resort where they will hang out with the soon-to-be-departed for casual conversation. Alcohol and all other drugs will be available without oversight for the guests to enjoy and, if an accidental overdose occurs, then the savings are passed on to the government.

     If someone should have a desire to reconsider their decision each resort will feature an American Idol competition where they can perform in front of Simon Cowl and other judges to see if they can escape their faith. Guests who are disqualified will be immediately executed (painlessly of course) in front of a national viewing audience on a pay-per-view channel (raising more money for the program).

     Some will defer on the resort option, choosing instead the “martyr” option. Designed to further feelings of guilt onto others that has already taken place for years the individual is flown to Alaska where they are placed on an ice floe and pushed out to sea. Family and friends are invited to witness the event while a banner is dragged across the sky with the title “All for you”.

     Still others will be excited about the “lottery winnings” option where their name is entered into a giant hopper with others choosing that avenue. A winner is pulled out and their healthcare is 100% paid for with every technology known being made available. Given how poorly most of us understand statistics this may attract significant interest even through the actual probability of winning is very low. Those who are not chosen are then (painlessly) extinguished on PPV.

     Sadly, some of those who face terminal, and expensive, healthcare costs may refuse to accept any of these options. This recalcitrant group will be referred to the “special compassion team”. Although details are not yet completely translated out of the original German it would be anticipated that these individuals would be transferred to a lovely country setting and greeted with the camp slogan “Arbeit Macht Frei” as was popularized by other such camps. AIG or other large corporate management firms would be used to ensure efficiency and timely service delivery. Any concerns that might be expressed by the citizens would be managed by pointing out the commitment our nation has to provide only the best for her people.

     Movies such as “Logan’s Run” and “Soylent Green” were not just great entertainment but harbingers of the common-sense world that we can all embrace (although obesity has likely made ourselves as diet too fatty). We should not turn away from the opportunity to tap our great BS manufacturing industry to solve this problem by giving it the correct spin it needs. Much like cattle headed down that final chute at the processing plant we can all be happy again…right before the bolt hits us in the eyes.

July 18, 2009

What is Healthcare?

     With the swirling debate over healthcare reform I’m left to give thought as to the core components to the problem. I hopefully understand the limits of my expertise and will, for the moment, not delve into the economic concerns of how services will be paid for or who pays. Rather, it stood out in my mind that the issue of what is this activity termed “healthcare” and what expectations are present and may have to be changed.

     My father Robert L. Carr, M.D. set up the first pediatric clinic outside of the local hospitals in Lubbock in 1953. Located at 2602 Ave Q the Children’s Clinic hosted three physicians and each day the waiting room greeted dozens of sick children and their anxious parents. Examining 30-40 children and teenagers a day in the clinic my father would go to the hospital in the morning and evening to conduct rounds on his patients. He held clinic on Saturday mornings for those unable to be seen during the work week.

     I remember going with him on occasion to Methodist Hospital (now Covenant) and enjoying a special dessert in the dining room. Out for a family evening our car might be parked for a moment in front of a family’s home as dad “needed to stop by and check”.  

     For his dedication to medicine our family prospered. We lived in a nice home off of 59^th and College (now University) Avenue. Although usually in his study at night dad would always attend band or choir concerts and we faithfully were found at First Methodist Church each Sunday.

     The clinic closed in 1992 and my father worked several years as a traveling physician. He concluded his medical practice with several years at the Children’s Clinic located in the Community Health Center of Lubbock on Broadway Avenue. He and my mother are today engaged in historical work for the county society and are both in good health.

     As I reflect on my experience growing up in the family of a physician during the 1960s and 1970s I believe that healthcare has changed dramatically since that time. Our relationship with our doctors and other providers is often superficial and unsatisfying. We are unhappy about our insurance premiums and resent the protracted battle with carriers over deductibles, coverage, and payment. Distrust from all sides leaves both doctor and patient ill-at-ease as concerns over money and profit cloud the picture of our health.

     Out of the many factors to consider in where we as a people are trying to get I believe that three need to be considered by each of us in defining what we want and what we are prepared to do.

     First, we must address the issue of access to care. A central portion of this involves securing the professions that provide the service and placing them where they are available to the consumer.  To draw people into health careers I do not believe that it is a requirement that outrageous salaries be offered. My father enjoyed a good income (although low in comparison to most other medical specialties) but his motivation was to serve others and he enjoyed the challenge of medicine.

     I suspect that healthcare careers will evolve into well-paid vocations that will remain relatively high in salary but not at the same level as has been the case for the last forty years. Individuals who explore their career options based primarily on income generation will be less likely to enter healthcare as other job opportunities will be more promising in that respect. Somewhat similar to careers in education we will see practitioners who find other benefits or rewards that lead them into healthcare.  This trend may result in instances where care is not optimal just as in our schools where education may be poorly provided. I believe however that this possibility is not a reason to investigate such a change as our present system is already engaged in providing poor service.

     Indirect benefits to attract young men and women to pursue careers in healthcare might include financial support for college and training programs. Opportunities for educational achievement would open doors for our youth and strengthen our public and private school systems. Options to repay sponsored expenses could include service in rural or inner city clinics. Tax deferments for those who practice in such settings or who are oriented towards a family practice (as opposed to specialist) could be offered.

     Second, we will need to “take a step back” and engage in primary prevention services in place of waiting for something bad to happen and then taking action. A $30 immunization is much preferred over a $75,000 hospital admission. What has to happen is to break out of the “save it today” way of thinking. This will require a major change in our insurance carrier system.

     In the present insurance model the “save it today” mentality takes the view that money not spent today saves money. Deep in the bowels of the insurance company organization are the adjusters who vigorously scan each claim and attempt to preauthorize service. Any claim denied or authorization refused is “money saved”.  At the base of the current insurance model is a loyalty to shareholders and desire to make as much profit as possible.

     A recent trend among insurance carriers is the development of “health coaches” who review the claim history of covered individuals who fall into a high risk for health problems such as people with diabetes, aggressive cardiac disease, and high blood pressure. These coaches will regularly contact the patient and advise them of the importance of taking care of their disease states and what services are available. While I welcome this in one sense it seems a sad comment that the present care system is not able to provide for this in the clinic office instead of over the telephone with the insurance company.

     Removing the profit motive and restoring the decision-making authority to the doctor will significantly transform the existing insurance industry. Medicare operates with approximately an 8 % operational overhead while private insurance carriers such as BC-BS operate at significantly higher overheads. I do not support replacing one master with another in terms of a shift from business to government oversight in an effort to control cost. I believe that doctors can be returned to a position of authority in determining care and costs can still be maintained. Models of care, developed by scientific research and deployed in a cooperative manner with professional organizations will lessen the fear that concerns for cost will restrict care.

     Parallel to changes in the insurance industry there will need to be changes in the pharmaceutical industry. My father remarked that, when he picked up his and my mother’s three month medication supply, the cost was almost $2,000. The Medicare Part D plan was unnecessary and needs to be reformulated.  Solving the cost in healthcare cannot be done without controlling the cost of medication. While nationalizing the drug companies has appeal it will be critical to the solution that research and development of new compounds not be reduced.

     Lastly, we as a people must understand our own personal role in healthcare. As a psychologist who specializes in health psychology I understand that you cannot cure as well as you can prevent and this responsibility needs to be focused on each of us. As obesity has moved into prominence the United States now represents a people who are grossly overweight. As with most social issues the best approach to reduce this problem is to start early. Funds will need to be spent in community outreach, school programming, and in-home services to educate and support individuals as they adopt or change health behaviors.

     I do not support going to the point where we deny services to individuals who, because of poor choices (for example, smoking, drinking, over-eating), have disease as a result. There will always be those who make such poor choices so our goal is to reduce this group as much as is reasonably possible through individually-centered healthcare.

     Coupled with this emphasize on individual responsibility must be the capacity to decide how much we as a society support services being provided versus unlimited care for unlimited problems. Understanding that a great portion of Medicare expenses are incurred in the last few months of life we will need to discuss the significant ethical problems associated with attempting to balance expense over quality of life. I don’t see a “good” answer to this ethical quandary and this may become the core issue that rules the conversation of the day.

     While there are disagreement in how to change our healthcare system there is a clear consensus that it must be changed. In its simplest form in my mind I think of my father and how he practiced medicine for over fifty years. I remember that he worked hard, was paid fairly, and yet it was about being a doctor and the care that came with that service that he valued. I believe that America will negotiate through this difficult issue and those of us still in the healthcare system can return to caring for others.

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