In which I am a Literal Buzzkill

Catching up this blog on some things I’ve been writing elsewhere, here is a link to a post I wrote for UW’s pediatrics blog about marijuana and teens. It’s called “Is Marijuana Really a Big Deal?” (Spoiler alert: Yeah, it can be!)

Click here to read the original blog post.

Image description: Josef Albers’ “Homage to the Square,” aka my self-portrait

Advertisements

Wisconsin Senator Ron Johnson Hates Talking to Wisconsinites

Fellow Wisconsinites, our senior US senator has a big problem: he’s virtually impossible to get ahold of. Yesterday Senator Ron Johnson reversed the position he took during his reelection campaign, and came out in support of the Executive Order banning refugees and certain immigrants (from countries carefully selected to not make certain members of the executive branch less rich) (and intentionally selectively applied to Muslims). The senator then encouraged opponents to “Tell me what you disagree with.” Well I’d love to if I could ever get ahold of someone who could pass that on. I’ve been calling his offices a LOT since November, and I finally got through to an actual person at the Milwaukee office last week–a slightly rude one. If not for that encounter I couldn’t be 100% sure his office is not staffed by six cats that are paid to occasionally walk across his phone keys.

It’s a good day when I get through to his voicemail. For a while there his office just wasn’t emptying their voicemail. Yesterday I got a bunch of rings followed by a busy signal. It’s been a while since I’ve owned a land line, but I’m pretty sure that’s not how they work. I am so not alone in this, everyone I know here is having the same experience. My friend Cabell Gathman, an associate lecturer in Gender and Women’s Studies here at UW, has suggested that whoever runs against Senator Johnson in 2022 should use as a campaign slogan, “Joe Schlobotnik: I’ll actually take your call.”

ETA: Another friend told me they called 25 times yesterday without getting through. Today was a good day because it only took six calls.

Video from Senator Johnson's most recent Town Hall

Video from Senator Johnson’s recent Town Hall

Senator Johnson does not want to hear what you disagree with. He doesn’t even want to hear if you agree. Based on my rough back-of-the-envelope calculations, this is a list of things you are more likely to do than get through to a staffer at Ron Johnson’s office:

  • Win the lottery twice in one week
  • Make out with Samira Wiley
  • Crack an egg with two yolks on the day your future mother-in-law is visiting, and go on to poach it perfectly for her Eggs Florentine
  • Wake up to find out you’ve metamorphosed into a rhinoceros beetle
  • Wake up to find Dustin Diamond in bed next to you and immediately tell all your friends
  • Pee your pants on live TV while auditioning for The Voice
  • Survive a shark attack
  • Be murdered by poisoned bikini wax
  • Succeed in your attempt to reanimate Bea Arthur’s corpse
  • Be a Latina paid the same as the average white man doing your job

So, Senator Johnson and staff, if you’re reading, please fix this problem. The senator’s constituents have a lot to say. Everybody else, keep trying. Democratically elected representatives should hear from the people they represent.

Eulogy for my Father

My beloved father, Arthur H. Cash, died peacefully over the winter holidays this year after a long and well-lived life. These are the remarks I prepared for his memorial service this past Saturday. They differ slightly from what I read at the service because I skipped a bit by accident. In order to preserve this blog’s PG rating while honoring my father’s most cherished values, I will once again be making use of the french word for seal

Everyone who gets a good dad loves their dad, and I’m no exception. But I also really liked my dad. His company was always a pleasure, from my childhood, through my not-annadadapplerehabunturbulent adolescence, to my adulthood. He parented me through all these shifts, allowing our relationship to change and me to set the pace. I always knew I could call him, for advice, or a chance to vent, some cheering up, or because I had been rear-ended and was facing the wrong way on the shoulder of the freeway. He was, in short, there for me. His demands in return were few, and never more than I could bear. Nothing worse than help with his computer and occasionally removing blackheads from the part of his back he couldn’t reach. He made mistakes—bad ones—as all parents do. But unlike most parents, or most people for that matter, he apologized for them, and learned from them, thus laying the groundwork for our adult friendship.

He was a great teacher. Disciple that he was of the Enlightenment, he taught me how to evaluate evidence, how to reason empirically, and how to express my understanding. He dadbrotherratused to say, “Thinking without writing is as bad as writing without thinking.” The root cause of my somewhat impulsive decision to get a degree in biostatistics is that my dad played math games with me as a little girl, ensuring that numbers would always be fun. He planted the seeds of my interest in medicine every time I got a paper cut or a splinter, talking me through the pain by explaining the science. And of course he told me his stories of serving with the 108th General Hospital. I’ve agreed to remember the names Myron Fertig and Teddy Gomalek, because they belonged to patients that were particularly important to Dad before they died.

He was also, as you know, highly eccentric. He had strong likes and dislikes. He liked Willie Nelson, Judge Judy, and every cop movie ever filmed. He abominated chapstick, polar bears, and Mickey Rooney. He believed the most handsome man in the world was Harry Belafonte. Left to his own devices he could subsist indefinitely on a diet of peanut butter sandwiches, sardines, stoned wheat thins, hot dogs, and bananas. He would hide a banana every time a bunch came home because he didn’t trust us to leave him his breakfast, so one might open a drawer looking for needle-nose pliers and happen upon a banana instead. He owned a navy blue undershirt that he believed made him look Puerto Rican. He would corner people at parties and demand that they explain to him what the Internet was. Equally dissatisfied with explanations and with metaphors, he would listen, shake his head and triumphantly declare, “You see? No one really knows.”

He and my mom both could behave quite scandalously, leaving me no choice but to rebel by becoming a square. He felt we should be fluent in profanity, and made sure it was spoken in the home. When bantering with my brother as a teenager, I once said, “Oh Phoque3 you, David,” and Dad corrected me, “Mind your manners. It’s Phoque3 off.”  Once at a gathering I teased him for behaving sluttishly with the ladies, and Dad demurred, “No, no. I’m not a slut. I just have catholic tastes, and a universal sympathy.”

He was capable of some shocking lies, and would shamelessly play the adorable grandad card. Back in the days of Blockbuster, Mom once left town for work, forgetting to return her VHS tapes. When she realized she owed three weeks in overdue fees, Dad called Blockbuster and wove a most pathetic tale of his wife having to leave town suddenly to care for a sick and nonexistent aunt. The clerk was utterly charmed by him, and when Dad returned the tapes—for which he was not charged—the clerk said, “I hope your wife’s aunt is feeling better.” Dad looked at the young man solemnly and said, “She isn’t. She died.”

I had 36 years with him; that’s 24 more years than we were expecting to have together after he was diagnosed with metastatic prostate cancer, the first of several times he survived a grim prognosis. But, what can I say? I’m greedy. It wasn’t enough. My dad was irreplaceable, and I’ll miss him every day that I have left.

The person I’ve been thinking about most these past few days in my grandmother Dess. She gave birth to my dad at home, and family legend has it that the doctor that was supposed to deliver him was out at a poker game and couldn’t be located in time. So I believe she was alone with him when he came into the world. Maybe it’s because of the frightening times we live in, but I find myself going back to a scene Dad described of the last family dinner they had before he left for Basic Training. His oldest brother, Mitch, was already in the Navy. The middle brother, Web, was kept from serving by his disability, his health a constant worry to his mother. So they sat around the table, this family of people who are all gone now: the mother, the father who had been in love with her since they were seven years old, and the three beloved sons, all believing this might be the last time they were together, and no one sure that they world they knew would endure. I want to go back to my grandmother on that night and tell her, “It will all be ok. We win the war. They make it home. They survive with bodies and minds intact. All three of your children live past 85, and so do you. You meet eight of your nine grandchildren, and your great grandchildren run to double digits. You are all of you blessed.”

And so are we.

And Carry On

I hate the Keep Calm memes. It isn’t just that I don’t like the choices, flippant or worse, of words used to finish that sentence–although I won’t soon forget eating dinner with my family at our local pub about a week after Sandy Hook and finding ourselves at a table next to a couple sporting matching tees that read “Keep Calm and Carry Guns.” It frustrates me that people can’t be bothered to google a little bit of history. If you aren’t aware of its origins, the now iconic Keep Calm and Carry On poster is what the British Ministry of Information was secretly holding in reserve to be used for morale-boosting after its people were conquered by the Nazis. You know, after Hitler had bummed everyone out by executing his plans to do things like publicly hang the royal family, and kill off British children with disabilities, and punish non-whiteness and non-Christianity and homosexuality with life sentences to be served at concentration camps. Thinking about the intent of that poster still has the ability to hurt my heart a little, knowing how frightening that time was, when it wasn’t clear that right would prevail, or that anyone would ever be safe again. I wish it commanded more respect.

I find myself thinking about the sentiment behind the original Keep Calm posters the morning after the shock of this presidential election. Let me stop you there, I’m aware that Donald Trump has not, to date, perpetuated a genocide, and I am not comparing him to Hitler. Among other reasons I don’t care for argument by analogy. But do I listen to my elders, who were there for the Second World War, when they tell me they’ve seen this before? You bet I do.

There is an elderly man who lives in my neighborhood, and with whom I sometimes chat at the bus stop. I don’t know his story, only that he appears to be in his 90s and speaks with a German accent. I imagine he has seen a lot. So it chilled me when, several months ago after violent conflict at a Trump rally in another state, my neighbor told me in tones of deep resignation, “That is the end of democracy.”

Being American doesn’t mean the same thing to me today that it meant yesterday. I am disappointed, and I am afraid. I am afraid for democracy, and for peace, and for myself, and for my countrymen, and for my country. I’m pretty sure Donald Trump and his supporters have no plans to hang the first family…but I’m not that sure. I don’t think the president elect cares one fig what happens to children with disabilities, queer Americans, immigrants, Muslims, or Jews. If he doesn’t actually want to kill the people he despises, well, he doesn’t care enough to defend our lives either.

And I’m angry at myself. I’m angry that I didn’t realize that I was living in the middle of a battleground state. I should have been the last to underestimate the racism of Wisconsin’s white people. They are my patients, and they tell me all about it. From the mom wearing confederate flag nail art in her child’s hospital room, to the man who confides in me why he won’t rent to Mexicans, to the granny that tells me she isn’t racist she just doesn’t care for black people because she can’t stand laziness. Mostly I am angry that I vanished up my own behind worrying about getting into a residency and I let that and the other stresses in my life distract me from the work that needed to be done. I owe amends.

Today, as we grieve, there is nothing else to do but carry on.  I think Jay Smooth puts it best when he says, “We come from a tradition of resistance. Just as surely as America’s history is the story of…hate, it is also the story of our resistance.”

Though it’s not sufficient, as a future pediatrician I’m responsible for carrying on with the training that will allow me some small power to protect children. Children with disabilities, children who survive abuse and neglect and violence, children living in poverty, children in danger of being separated from their families by deportation, children traumatized by discrimination of all kinds.

I’ll leave  you with a different British propaganda poster, one that was printed and circulated during the worst violence visited on the British people:

freedom_is_in_peril_defend_it_with_all_your_might-svg

That Time Prostitution was Decriminalized in Wisconsin

In his unpublished autobiography, David S. Rose recalled that one of his first orders of business on being elected mayor of Milwaukee in 1898 was to set up an official red light district. “I started to make an investigation,” he wrote, “And ascertain what would be the best and safest policy for society, for the rising youth, for the suppression of crime.” Mayor “All the Time Rosy” was a Democrat and a machine politician, more or less Wisconsin’s analog to Tammany Hall, and arch enemy of Progressive “Fighting Bob” LaFollette, who is more or less Wisconsin’s patron saint.  Rose instructed the chief of police to pursue a policy of containment: sex commerce inside the boundaries of the River Street district would be ignored, and outside it would be fiercely prosecuted. The city flourished, Rose remained popular for decades, and Milwaukee grew its reputation as an “open town.”

davidsrose

Milwaukee Mayor David S. Rose (source: Milwaukee Historical Society)

Milwaukee was just one of many U.S. cities that decriminalized prostitution in the late 19th century, usually in the name of two things: preventing venereal disease, and protecting children. I say decriminalized rather than legalized, because it was not, in fact, ever legal to exchange sex for money. Rather enforcement became selective and strategic, to keep the sex trade regulated and geographically isolated, not necessarily in that order. Towns and cities all over Wisconsin tried some version of the decriminalization experiment until the rise of the Progressive movement turned the tide of public opinion against the regulation approach and toward a policy of abolition. Today we know about the “segregated vice” system mostly through the work of the Progressive reformers that dismantled it. In May of 1913, the Wisconsin State Senate passed bill, “to provide for the appointment of a committee to investigate and report on the subject of white slave traffic, and kindred subjects.” The committee would come to be known by the name of the State Senator who chaired it as the Teasdale Vice Committee. From 1913-1914 the Vice Committee deployed undercover private investigators throughout the state, to report on the true status of the segregated districts in Wisconsin.

Abraham Flexner, who is best remembered for importing the European system of medical education to the U.S. (and let me tell you it’s been slow going trying to get U.S. medical education to relinquish Flexner’s curriculum), was also an anti-vice reformer. He wrote in 1918, “Regulationist and abolitionist are absolutely agreed that prostitution exists and on a vast scale; that it is infinitely damaging; that something must be done about it. They disagree only as to what that something must be.” Those in favor of segregated vice districts and those opposed to it were equally vehement in their condemnation of commercial sex and their dire warnings that prostitution was a threat to decent citizens everywhere. They used the language of infectious disease to describe the sex trade, and they addressed it with policies that used the tactics of the burgeoning field of public health. “Regulationists” tried to quarantine prostitution, while “abolitionists” tried to eradicate it with both treatment (prosecution) and prevention (sex education). Continue reading

On the Virtues of Whining about your Illness

Feeling sick is hard. File this one under Things you Don’t Need a Medical Degree to Know. Or file it under Things of which Everyone in this Culture Needs Constant Reminders. No argument from me either way, they’re both true. A few days after Hillary Clinton took her politically disastrous header into a limo I came down with my own respiratory illness that, if it didn’t actually make me pass out, that was probably only because my attending sent me home to lie down. Actually the same attending sent me home three separate times.

I don’t know for sure what I had, but it sucked, both in the absolute sense and the life out of me. First it was just a cough. Then it was a really unpleasant cough productive of truly disgusting sputum. Then I got winded walking a very normal 1.5 miles home from clinic. Then I felt like I had swallowed a hot poker then stuck it down my trachea for good measure. Then came headaches and fevers. Then the malaise, by which I mean I was not up to doing ANYTHING. Like, not even typing in bed. Not even mousing. Although between the cough and the fever I couldn’t actually sleep, I wanted very badly to remain horizontal. Rather than raise my head off the pillow I watched eight episodes of this feculent series in which the only actor of color plays a servant with almost no lines, and the principal female character’s main thing is that she is possessed by Satan every time she has intercourse (oh and somehow the plot just somehow leads to her repeatedly getting put in four-point restraints but not clothing). Just when I thought I was getting better I lost my voice completely.

notgood

Point is, I felt like a dog’s armpit. So it was easy to empathize with the Democratic candidate for president while everyone was debating whether a) getting pneumonia is a sign of weakness b) not staying home when you have pneumonia is reckless c) coming to work with pneumonia is for tough guys d) not mentioning your pneumonia is fishy e) whether Hillary Clinton is being actually being slowly poisoned. It was such a pure distillation of our culture’s perverse relationship to sickness.  I mean, for the record I agree with item b, but most people really have no choice about whether or not to go to work sick. Next year, if all goes according to plan, I will be one of those people.

As a person with the good fortune to expect general physical wellness on a typical day, I usually try to be stoic about illness out of respect for everyone I know that’s living with chronic disease and probably has limited sympathy for my temporary discomforts. I don’t know if it was the fever making me a little loopy, or my frustration at having made it through all of third year without getting sick only to get knocked on my behind in the middle of an elective I’d been looking forward to for months. And also in the middle of residency applications, did I mention that? At the moment I submitted mine my temp was 102.8. I’m certain that I uploaded a picture of myself with my application and not this picture of the kid that dressed as a fart for Halloween, but only because I double checked in the morning. So yeah, I was in a weird mood, and for whatever the reason, this time I threw myself a big, public, pity party.

epicwhine

Really everyone was very sympathetic, even people who endure significant pain on a regular basis. I have great friends and colleagues. But here’s where I’m going with this. I think it is actually good to whine about being sick, or injured, or otherwise uncomfortable in your body. We’re all under a lot of pressure to perform good health. Sometimes for concrete reasons, like fear of discrimination, sometimes for more nebulous reasons, like fear of seeming weak. It’s the worst for people with chronic disease, who paradoxically can expect less sympathy from their support network the longer their disease goes on. When that’s your new normal, everyone expects you to suck it up and accept what’s happening to your body. I see this even in the hospital, a place that exists only so that people can go there when they’re sick. I’ve had numerous patients apologize for complaining about their symptoms, or for feeling upset about them, even though it is literally my job to find out in great detail how they are feeling. But who can blame them? They live in the same world that considers it a personal failing on Hillary Clinton’s part that a bacterium (afaik) colonized her respiratory system.

So I think everyone should whine. People who are acutely ill should whine. People who are chronically ill should feel especially entitled to whine. Because feeling sick is really hard. And when everyone tries to act healthy all the time, it makes it easier to pretend that being sick is an aberration. And it makes it easy to deny how profoundly it affects people’s lives. Maybe being honest about your own experience will make it safe for the next person open up about theirs.

Wisconsin’s Strange History of State-Sponsored Sterilization

“It would be a rare phenomenon if the progeny of two mentally deficient parents were not likewise deficient. Yet in every state there are hundreds such in the pauper class free to bear children of whom a large percentage are certain to have criminal tendencies, murderous proclivities or vicious social traits. The public expense and private property loss they cause is beyond computation, and their presence at large is a menace that grows with the spreading branches of their family tree. What’s to be done?  ‘Well’, says Mr. John Average Public, ‘Why not try a safe and sane compulsory human sterilization law conservatively administered as in Wisconsin?’”

Frank C. Richmond, State Director of Psychiatric Field Services, 1934

The Law

People tend to be shocked when I tell them that the last state-sponsored sterilization in Wisconsin took place in 1963. It gives one a lot of cognitive dissonance imaging that some surgeon could have performed a coerced salpingectomy one afternoon and then popped over to the cinema to watch The Birds.  But so it was, and the law that permitted such operations actually stayed on the books until 1978. Although estimating the exact number has proven difficult, between 1,500 and 2,000 people were sterilized by the state under the Wisconsin Sterilization Act.

The passage of the act in 1913 was a victory long in the making for proponents of the practice of eugenics.  Wisconsin prided itself on using science to guide state policy, and eugenics was endorsed as science by representatives from the University and beyond. Writing a half-century later, Rudolph J. Vecoli documented in fascinating detail how “the congruity between  the eugenic doctrines and  certain aspects of the Progressive mentality,” including the Wisconsin Idea of connecting university and government, folded neatly into the creation of a law to restrict the freedom of its citizens to reproduce. Nonetheless in the early years of the 20th Century sterilization remained controversial and politically risky.  A law preventing the unfit from marrying had been passed in 1907, but it was unpopular and fated to be overturned in the courts the following year.  In the intervening years, two bills that would have codified state-sponsored sterilization had been defeated in the legislature. The 1913 bill succeeded in part because it was promoted as a conservative approach that would not take the extreme measures that had been seen in other states (then as now, a lot could be achieved in Wisconsin politics with by rallying around shared distaste for Illinois).

EugenicsPoster1926

Education poster from 1926 (source)

Wisconsin was the eleventh state to legalize compulsory sterilization, but it was not the last.  Thirty-two states passed sterilization laws in the 20th century, and five more generated a historical record of involuntary sterilizations without the blessing of the legislature. Wisconsin is an instructive case precisely because it kept the scope of its sterilizations narrow.  While other states defined the unfit broadly or loosely, and some used sterilization as a punishment for criminals and sex offenders (in Oregon men could be castrated for having sex with other men), Wisconsin separated the concept of sterilization from punishment.  The law outlined only three conditions that justified it: epilepsy, insanity, and “mental deficiency.”

Wisconsin’s law represents one of the least extreme cases of government regulation of fertility, and as such it is among the most instructive. In his book Breeding Contempt: The History of Coerced Sterilization in the United States, Mark Largent notes that in historical debates surrounding sterilization, “Even the most aggressive opponents of coerced sterilization often set aside some particularly problematic group for the procedures,” and the same might be said to be true today. People with cognitive disabilities are often made to occupy that role of the particularly problematic group for whom an exception might be made to the concepts of autonomy and the right to reproduce, opening a back door to legitimization of coerced sterilization.  Of the three medical conditions made explicit in the law, mental deficiency provided the rationale for surgery in the overwhelming majority of cases, perhaps because it was the most acceptable.  As it was put by one prominent supporter of the law, University of Wisconsin professor of sociology E.A. Ross, “The wedge should have a very thin end indeed. Sterilization should at first be applied only to extreme cases…As the public become accustomed to it, and it is seen to be salutary and humane, it will be possible gradually to extend its scope until it fills its legitimate sphere of application.” Continue reading