Some dear friends of mine, at Busy Community Hospital, are having a momentous day. Today is the ‘Go-Live’ for their brand new, shiny EPIC EMR.
For those of you outside the hallowed, creaky halls of medicine, EPIC is one of the most widely used electronic medical records systems in America. It’s big, it’s expensive, it captures lots of data, integrates ER’s, hospitals, clinics, labs and everything else. (Probably your cat’s shot records too.)
EPIC is also a company highly connected to the current administration; big donors to the President. FYI.
The problem isn’t what you get out of it, it’s the cumbersome way you have to put it in. In my opinion, for what that’s worth, EPIC is not intuitive. It takes a long time to learn to use it well. I have never used it in a situation where it could be fully customized, but I’m told that makes it easier. And admittedly, some docs and nurses truly love EPIC and are at peace with it. I suspect they have implanted brain chips or have undergone some brain-washing.
Typically EPIC instruction occurs over weeks, as it has for my friends. The first time I used it was in a busy urgent care, which was part of a large medical system. And I learned it over one hour. On the Go-Live day. So I’m sympathetic.
Thus, I have a prayer for those in the belly of the beast right now:
A Go-Live Prayer for those with new EMR systems.
Lord, maker of electrons and human brains, help us as we use this computer system, which You, Sovereign over the Universe, clearly saw coming and didn’t stop.
Thank you that suffering draws us to you.
Thank you for jobs, even on bad days.
Forgive us for the unnecessarily profane things we have said, or will say, about this process.
As we go forward, we implore you:
Let our tech support fly to us on wings of eagles and know what to do.
May our passwords and logons be up to date.
Protect us from the dreaded ‘Ticket’ submitted to help us.
May our data be saved, not lost.
Let the things we order be the things we have.
Shield us from power loss, power surge, virus and idiots tinkering with the system.
Give our patients patience to understand why everything takes three hours longer.
And may our prescriptions actually go to the pharmacy.
Keep us from rage and tirades.
Protect the screens from our angry fists.
May everyone go home no more than two or three hours late.
And keep our patients, and sanity, intact.
Great physician, great programmer, heal our computers.
The first presidential debate is over, and all I can say is that these are interesting times.
The fact remains that whichever candidate wins the presidency, the nation’s polarity will not be suddenly reversed. We are spinning further and further from one another all the time, divided by many issues, by race, gender, religion, accusation and insult. Are we one nation anymore? Hardly. We’re many nations trying to control all the others.
The election itself cannot change that. Whether Donald Trump or Hillary Clinton wins, they are unlikely to do so by a wide margin. And they will make policies that nearly half of the country will find objectionable. Maybe both parties need to strive to bring unity more passionately than they strive for electoral, legal and legislative victory.
We live in South Carolina. Thus, we live in what amounts to a tropical rain forest. Starting about April and ending about, say, November, you can almost hear the trees, bushes, brambles and vines growing. The many layers of green can be overwhelming. Trails we cut in the winter, fields we mow down, erupt as soon as the weather is right; verdant invaders who overtake all. I have fought the battle of the weeds; and recently, I have surrendered. We had a huge DR brand brush cutter. It was great at cutting thick stuff until it ran into Mountain Laurel. The bushes simply forced the great 17 HP machine to climb the front and try to run vertically.
We have been through an assortment of weed-trimmers and lawn-mowers, most of which appear to be in league with the lawns and weeds, given their tendency to early obsolescence within one season of battle.
Our porch and utility building are the resting place of all too many devices. The electric ones are anemic and raised the white flag early after their first uses. (Even small weeds and grass scoffed.) The gas powered devices are systematically destroyed by ethanol in the gasoline, which dissolves the plastic fuel lines and priming pumps. I have used some herbicide, but from what I can see it’s more like a vitamin cocktail for my green attackers. I suspect that for our needs, a plane-full of Agent Orange might come close. But I wouldn’t count on it.
We have chain-sawed and machete’d and axed our way through many trees and larger bushes. I had a beautiful European brush scythe (bought by my wife as a Christmas gift), which the weeds found laughable and ultimately broke in two pieces.
This yearly war with nature is something that those in more urban settings may not get. I’m speaking of those who love the manicured beauty of their local parks, or the well-maintained paths of national forests and mountain-biking trails. Those things, my dear reader, are false advertising. They’re ‘nature porn.’ Because nature is ‘in it to win it.’ And so far, may be winning despite our national obsession with the belief that humanity is destroying the environment. Sure, we can harm the natural world with oil spills and air pollution, with deforestation and other grave errors. And we should be good stewards. But nature is still, well, nature. And often as not, Mother nature laughs at us dismissively.
Around our place, she wins all the time. I now have a hayfield where a yard used to stand. Why have I ceded the yard, you may ask? Because nature has stinging insects on her side. After a long summer of assorted attacks, with resulting pain, itching and swelling, I admit it. The bugs can have the yard until the first freeze. We have been stung by wasps in our bed, wasps on our carpet, wasps on the porch and in the utility building. My son was stung mowing. So the last assault, when his mother was mowing and sustained seven yellow-jacket stings at once, well that was it. ‘I give,’ I told my swollen, itchy bride. ‘They can have it until it gets cold.’ I sounded retreat and never looked back. Quitters may never win, but they do avoid painful stings and potential allergic reactions.
The weeds and wasps are an annual reminder that nature has a way. Whether by freezing or melting, by stinging or biting, by erosion or earthquake, by lightning, flood or hurricane, she will have her way. It’s a charming human affectation, the belief that we can ultimately deal her a serious body-blow. Nature may fall down, but she’ll be right back up in no time, erasing careless humans from the surface of the world they thought they ruled.
So don’t judge me please. I’m biding my time. I’ll take the yard back, I really will; even if it means a grass-fire. But I’m not ashamed to say that for now, the Green Flag of nature waves in victory, fluttering in the breeze around my house.
But once that flying, stinging, irascible security detail is dying or sleeping off the winter, I’ll be back. And then we’ll see who’s more evolved!
Until October of course; we have an understanding.
The Gospel in a Lost Bracelet
My wife lost a charm bracelet about a month ago. She was shopping in Easley, and she thinks it came unhooked and fell to the ground. We haven’t found it, despite her asking at the stores and restaurant she visited.
If someone picked it up, they would have seen charms of various sizes and shapes. Some from distant places, some representing times in the lives of our children. It’s a lovely bracelet that she has had for decades. However, it’s a bit worn with time. It hasn’t been polished in a while. It’s still precious to my bride, but for reasons a stranger could never fully appreciate in what appears a trinket.
I was thinking about this at work one day; about how easily we miss the value of others. I have seen this demonstrated as I have watched married couples, late in life, come to the hospital. They attend as closely as they can to their cherished partners. They hold hands, they stroke hair, they speak in sweet tones and say things like, ‘there’s my beautiful girl!’ Or ‘hey handsome!’ Even in the midst of their mate’s profound dementia, they are gentle and loving. Even though the ravages of time and illness have left their spouse with babbling speech, or a body twisted from stroke.
It may not even be the aged, but the young; with scars, burns, amputations, infections. The families of wounded service-members understand this well. When we come to them, as strangers, we sometimes fail to see the truth. What we see as shattered and unlovely is only a dim reflection. Who they are, their value, is perceived through the loving eyes of those who ‘see them as they are.’ We strangers certainly have no concept of the treasure trove of stories and wisdom, memory and meaning in the people we often see only in terms of illness and injury.
I have also seen this in the adult parents of addicts. Worried fathers and mothers who come to the hospital from across the town, or across the country. They hover over their children despite the emotional pain, the fortunes spent on rehab and legal fees. They are so happy to see that wayward, prodigal child that they ignore the lies, the violence, the profanity and derision hurled at them as they try to help. Many times I’ve wanted these patients to simply go to jail and stay there. Their manipulation and narcissism being more than I can tolerate.
Ah, but I cannot see them as they are seen by those who love. I cannot know them before the drugs and alcohol, when they had joy, when they were charming or kind. Even if they were always hard to handle, I cannot know the innate, irrevocable love, the hopes and dreams their parents (spouses, siblings) have carried for decades, through trial after trial. The remembrance of school days, vacations, triumphs, romance and dreams.
My vision is sometimes clouded because these people appear worn. They have cirrhosis, hepatitis, HIV, chronic wounds. They have handcuffs and warrants; they have lived hard lives. But that’s not how they look to those who continually lose them, and find them again, hoping at last to see the cycle broken. They are precious gems, covered in dust and dirt, lying in life’s sediment, as families try to find them and polish them. It’s easy to ask ‘why do their parents keep helping?’ To which they answer, ‘how could I stop? This is my child.’
And in considering all of this, from bracelets to drug abuse, I understand better than ever what this kind of love actually is. This kind of profound worth and care of the beloved, do you know what it is? This is the Gospel of Jesus. It’s a love that will live and die for the objects of its affection. It knows the value of everyone, for it created them, and imbued them with it. It’s a love that knows all of their stories of sorrow and pain. And never, ever, stops pursuing them until the end of time.
If we want to stop struggling with ‘isms’ and ‘phobias’ and all the rest, if we want to stop the endless, exhausting arguments of political parties, all the attempts to assert control, all of the ‘othering’ based on ideology, science, faith, race, education, geography or anything else, this Gospel is the best place to start.
Because everyone is a treasure. If only to God. May He open our eyes.
These days, I work most of my shifts about 45 minutes from my ‘house on the hill.’ At one of those jobs, the day shift starts at 06:30. Which means I’m rising from my bed at 04:30 in order to get on the road in time. I’ve started waking up at four, spontaneously, as if it were the most natural thing in the world.
I lay out my clothes the night before, so as not to awake my darling wife in her sleep. Sometimes I am able slip out without her knowledge. Others she wakes to kiss me goodbye. Then I go downstairs and put together some lunch, get the backpack and make my way out the door. I know that my wife and children are safe upstairs, as I lock the door behind me.
The door creeks a little, or did until my son Elijah oiled it. (One always wonders why a teenage boy oils a front door…) Occasionally I lock it as I realize I left my keys inside, and poor, tired Jan opens the door for me patiently. On the front porch, by the soft yellow of porch-light or the shock of flashlight, I step over dogs freshly awakened from sleep, who look at me with gentle annoyance. The sharp-eyed cats sleep in more secret places, so are seldom seen in the morning. Other dogs (we have five), sleep on the gravel drive in the summer and seem confused as to how to react when my Tundra rolls towards them, slowly, and I roll down the window. ‘Get up, you silly dog!’ Heads and tails down they amble away.
Up the long drive and down the road, I am suddenly all but alone on the two lane roads that lead me to Tiny Memorial Hospital. Despite the early hour, I am ‘awake, alert and oriented.’ The sky is dark, and in winter stars shine down when clouds don’t lay low against the earth. I scan the roadside for deer, their eyes reflecting the truck’s headlamps. Opossums sometimes shuffle across, along with squirrels and rabbits. (One day I saw a big, black bear on a hill by the road. He ran away as I stopped for a photo.)
I drive through forests, past sleeping houses and across a dark, still lake where sometimes, the light from a bass-boat shines across the emptiness where someone has fished all night…or started very early. Or a campfire on the shore still burns as their line rests untroubled in the water.
It is so early that I drive past gas-stations and convenience stores still dark and locked, the ‘closed’ sign reminding me to keep on moving. The air, even in summer, is cooler and in winter, positively cold. Winter is my favorite, I think, with the heat of the truck turned out, and the chill wind blowing past.
I think as I drive. And I pray. And I listen to the news, a recorded sermon, a pod-cast. Many mornings I turn on an oldies station from the North Carolina mountains; in the loneliness of the drive the music of Sinatra, Johnny Cash and others, make me feel I’ve gone back in time.
I cannot talk on the phone (hands free or otherwise). I pass through places where cell-signals are only a dream, and often even radio reception is poor. Remote areas, mountainous places, lonely and beautiful places defy cell signals and seem to say ‘look around! What else do you need!’ Even at 5 am, I agree.
Eventually I am near, and I find a fast-food joint for the obligatory chicken biscuit and tea, because, well, the South and all. And then I roll into the ER parking lot, lock things up and head to work.
Because this is no urban trauma center, the early morning is sometimes very slow and relaxed. A few patients may be waiting for turnover, but often none. I can sit and think, I can ask about the previous night. I can ease into work. My drive has already prepared me, but it’s nice to have a few minutes peace in the department before the chaos of the day begins. I text Jan. ‘Here safe, love you,’ and she answers. ‘Love you back, have a great day.’
There are those who don’t have to drive long distances. For most of my career it was about 15 minutes to work. And there are those who have long commutes through traffic, and through the waking body of a large city, people and cars just starting to fill its veins and arteries. Sometimes I am jealous. It can be lonely where I am.
But I think I’ll keep it for now. There is a solemnity, a serenity to my mountain and lake commute, with animals heading to bed and people not yet rising, with my own thoughts and prayers to myself.
And I suppose that if there were a better way to prepare for the madness, badness and sadness of the ER, I don’t know what it is.
Ah, EMTALA! The revered ‘Emergency Medical Treatment and Active Labor Act!’ It’s one of those things which is like a nursery rhyme to emergency medicine folks like me. We’ve heard about it from the infancy of our training. ‘And then the bad doctor sent the poor lady to another hospital because she couldn’t pay! And the King came and crucified him for doing it!’ The end.
EMTALA, for the uninitiated, is a federal law which ensures that we don’t turn people away from the ER because of finances, and also keeps us from transferring people to other hospitals without that hospital’s agreement. It also exists to guarantee that we stabilize them as much as possible before they go.
I’ve said before, and always will, it was a good idea. But like many laws, it was subject to the law of unintended consequences. For instance, being forced to see lots and lots of people (who may not really be that sick), and do it for free, has huffed, and puffed and blown the hospital and trauma center down on too many occasions. But that’s not my point here.
My point is that when EMTALA forms meet electronic medical records, chaos can ensue.
Allow me to illustrate: This is a standard EMTALA form. Check, check, check, sign. It takes a busy physician less than a minute, and the nurses a few more since they have to call the other hospital and record times, etc. This has worked well for a very, very long time.
Enter EMR. This is the procedure for doing an EMTALA form at Tiny Memorial Hospital, which has been enchanted by the dark Lord Cerner. Mind you, I’m sure the ‘powers that be’ feel that this is a perfectly wonderful way to do the form. Indeed, it captures lots of information and stores it in the system. But two facts remain: first, the people who designed the system generally work at Large Urban Hospital, which owns Tiny Memorial. They don’t transfer things out very often. They receive things. Second, most of the patients being transferred are going within the system. All the data is on the EMR, and it isn’t as if they’re going to some strange facility far, far away.
This, children, is the EMR based procedure (on a cheat sheet developed by a frustrated and confused provider):
Not long ago my team worked a cardiac arrest at Tiny Memorial, with a successful return of cardiac activity. Given our size and staffing, it took pretty much all of the staff available and nothing moved for a while. A helicopter whisked our patient away.
Of all the things we did; drag her out of the car, do CPR, start IV’s, intubate, talk with family, chart, arrange transfer, nothing was as complicated or frustrating as this process to complete the EMTALA form. In the end, I still got it wrong somehow.
Mind you, I never violated the spirit of the law in any way. She was treated, stabilized (to the extent of our ability) and sent away to a receiving hospital with the capacity to care for her.
I don’t want to impugn the motives of those who developed this. I’m sure they were trying their best. But if you don’t use it, you can’t see how hard it is. And you also can’t see how much time it takes in a place with limited resources and staff.
So please, folks, let’s use technology to simplify, not make things more complicated! And let’s remember that charting isn’t the same as doing the right thing. And sometimes, doing the right thing isn’t perfectly reflected in the chart.
But paper or electrons, it’s still the right thing. And that’s what EMTALA is about.
Emergency departments come in all shapes and sizes. I recently visited one that treats about 350 patients per day, which comes in around 127,000 per year. That’s a lot of sick people. Some departments see more than that.
Other emergency departments where I have worked in my locums journey see fifteen patients a day, which is about 5,000 patients per year. Some see less that that.
But one thing is certain. All of them are dangerous. And I don’t mean because of medical error or malpractice. They’re dangerous because they are frequently overcrowded and understaffed, to be sure. But what I’m really talking about is the dangerous people who use them.
In addition to the incredible work done in so many ER’s around the country, in addition to the lives saved the suffering alleviated, many of our patients are suffering from mental illness (some violent), many are seeking drugs (and dangerously angry when denied) and others are simply criminals. ER patients are sometimes victims of other ER patients. ER visitors can be as dangerous as the patients, and sometimes claim to be family in order to exact vengeance on the sick and injured.
Many nurses and physicians are assaulted every year in US emergency rooms. This is a well documented phenomenon, as the following links demonstrate.
(This ACEP information is a good overview but suspect, as it oddly attributes ER violence to citizen concealed carry of firearms; I challenge them to produce anything that supports that assertion. Like most medical organizations ACEP is left-leaning, so no surprise. The piece also expresses concern about liability if armed officers took their weapons home. Blah, blah, blah. In the South, most of the cars in the parking lot have firearms…owned by nurses…who take them home quite safely.)
I could add link after link. You can search for yourself if you’re interested. This is the sort of thing that endless committees meet over. Heaven only knows the untold amount of coffee and pastries consumed at meetings where ‘violence working groups,’ etc. discussed the latest assault of a nurse, physician or other hospital worker. I sat in on some of these once. Among the more inane comments, when we suggested having armed, off-duty police officers patrol, was this gem from an administrator who never wrestles drunks or tells addicts no:
‘I’m not sure I’m comfortable with them having weapons!’ (To which officers rightly said, ‘then we won’t be there.’
Another: ‘Why don’t we just have more cameras?’ My retort: ‘why? So we can see the murder from more angles?’
Everyone knows this is a problem. Sometimes, good ideas emerge. We did, after all, have those off-duty (armed) officers. Bad behavior dropped significantly when they were present. But that’s not the case in all too many hospitals.
In fact, I’d say that as dangerous as large hospitals are, given that they’re typically in big urban centers with more drugs, gang activity and free-roaming mentally ill patients, the problem may be worse in small facilities. Big centers often have their own internal security (which can be quite good), or have a police station co-located. Further, there are lots and lots of officers patrolling at all hours, and they usually aren’t that far away. (Not to suggest their work isn’t perilous and difficult by any means.)
The thing is, in smaller departments, in rural areas, the dangers are just as real. I think of my native Appalachia (where, in fact, I still reside but further south). Heroin, Meth, Oxycontin, Methadone, all this is epidemic. And often, the little hospital on the hill, or in the valley, waiting to treat the sick and injured, is the place where the addicted go. Rural areas also lack mental health care. Where do the mentally ill go when they decompensate? The ER, which typically has very little in the way of resources…especially at night. Medicate and transfer, that’s all there is. In the mean time, it can be touch and go, with violent outbursts only seconds away.
But in these places, security is often lacking. It may be a senior citizen who checks the locks. It may be a relatively untrained young man who has no real idea how to deescalate a situation, or disarm a violent attacker. It may, thanks to our equality society, by a small women with little physical strength. I applaud her courage, but she’s putting herself, and the rest of us, in danger in that role. Especially if she’s unarmed. (And even if she is armed but is in poor condition or is poorly trained. All fights, firearms or empty hand, are exhausting affairs that require explosive bursts of energy to survive.)
Yes, we can call the police. But in large, rural ares, they’re often far away. I worked one facility in rural Kentucky where the only security available was the regional highway patrol, who likely covered either the whole county or several counties alone. City police? Home at 1900.
What about giving us a Taser? Or pepper spray? Nope, too dangerous. A common suggestion is that we give the violent patient a sedative. But that requires wrestling him or her down and using a needle. Not a safe exercise. Here’s a fun video to illustrate. Note the apparently drug addled individual was Tased multiple times, as well as being hit with a baton. Anybody want their 140 pound daughter, the nurse, to try and give him an injection?
It isn’t that we aren’t willing to take our chances. We work through ice-storms, hurricanes, SARS and Ebola outbreaks, Anthrax scares, disasters and terrorist attacks. But there’s increasing pressure on America’s emergency departments (and I’m sure, those around the world). Everything, everyone, that is difficult, sick or dangerous in any way, ends up in the ED. Which is, to some degree, what we do. But we need the resources to do it safely.
What can be done? I mean, there are armies of consultants and training courses, video cameras and panic buttons. But death and injury can come swiftly. And unless security is present, on site, we’re really rolling the dice; or counting on our guardian angels to keep us from harm.
And God forbid any person in the hospital arm themselves against life-threatening attack! They’d be fired. Alive after the event perhaps, but fired most likely. And maybe criminally charged, depending on the state where it happened. Better a dead physician or nurse than a wounded or killed ‘customer,’ however dangerous that customer might have been. At least that’s how it seems.
What should we do? We who work in locations with poorly controlled entry points, who work at all hours of the day and night? We who walk into rooms with the victims, and the perpetrators, of violence? We who are seen as holding all the cards in the world of drug addiction? We who are out on the ‘frontier’ of medicine, but without so much as a tomahawk?
I’ve thought about this for a long time. I have engaged in martial arts training for a lot of years in my life. I’ve studied Tae Kwon Do and Aikido. I’m in reasonable shape. But wrestling and fighting the violent and impaired is not going to be easy. A few moves in a four hour class won’t cut it. And those who try to do it will probably be injured unless they work as a group and have trained and practiced a lot.
Nobody is going to give us a weapon; in some places they won’t give a security guard. Physicians and nurses are trusted to give life altering drugs like thrombolytics for stroke and heart attack (clot-busters), trusted to take away the patient’s drive to breath in order to insert a tube and breath for them, trusted to keep them from killing themselves. But we can’t be trusted to defend ourselves in extremis when no protection is available.
I don’t know the answer to this. Well, I do. It’s going to require money and physical security. But there’s often little money (so much having already been spent on expensive EMRs). And there’s sometimes no will to increase security staffing or physical plant issues like tightly controlled entry points.
I’ve contemplated my own response. Run from danger? I hope not. Fight? I hope I can, but I know that I’ll probably get injured. Call for help, scream, run around in circles?
And for the shooter? What do I do then? I’ve thought about having a sling-shot with steel balls in my back pack. I mean, a steel ball to the head might have some effect. (Mass shooters tend to stop when confronted.)
Or do I get a bottle of Wasp and Hornet Spray? You know, the foam variety that’s sticky and noxious? It sprays 20 feet. I’ve used it dozens of times around the house. What if I hosed the attacker’s face with that until we could run? Or do something else?
So here’s the crazy thing. It’s 2016. I have worked in ER’s of many sizes, large and small. There are resources and security experts, consultants and safety technologies. And there are ER’s vulnerable all day and night, while policy makers and hand-wringing attorneys work and sleep in relative safety.
And I’m thinking: ‘hey, maybe a can of hornet spray would help!’
Does anyone else think that’s a little ridiculous?
I have written very little about this election cycle. It’s contentious and causes unnecessary divisions between everyone; strangers, friends, spouses, parents…probably even house-cats.
And I’m not here to sing the praises of Donald Trump. I have said, and continue to say, that I understand those who have passionate objections to him. But on the other hand, many of us find many reasons to object to Hillary Clinton. And we aren’t stupid. We have our own ideas, ideologies and desires for the future of the Republic, such as it is. I don’t want to insult anyone. But I’m getting a little weary of being insulted. I am a middle-aged, white, male, conservative Christian of Appalachian heritage, who lives in Appalachia. And I’m so tired of hearing people like me, especially men like me, insulted for the beliefs that are important to us, some of which come from the fabric of our faith and culture, not from perceived hatefulness in the minds of our political opponents.
So I have to say, I’m very saddened by the dismissiveness of top Democrats. Just this week Bill Clinton mocked people in WV (my home) and KY for not supporting his wife. He called them ‘the coal people.’ Follow the link and see it for yourself. He points out that he won those states and they prospered. Yes, but times have changed and that prosperity, such as it was, doesn’t remain. KY and WV face crushing poverty and addiction. Any ideas on how to fix that? Probably not.
Not to be outdone, Mrs. Clinton (ever the uniter) says that half of GOP candidate Trumps supporters are deplorable and are racist, sexist and homophobic. Seems like a bad idea to me, but I’ve never been a presidential candidate. Go figure. I thought we weren’t supposed to stereotype people? Oh, I forgot, you can be intolerant of those you consider intolerant. You can judge people for judging or something like that. More likely, when you’ve lived your entire adult life in a political and ideological echo-chamber, when you are buffered on all sides by boot-lickers and sycophants, you can dare to insult and ‘other’ huge portions of the country.
This reminds me, of course, of former Secretary of State Clinton’s clear disdain for an entire region of the US when she said she was going to put a lot of mines and miners out of business. (Admittedly, she was just echoingPres. Obama’s former plans.) Whatever you feel about coal and renewables, there was probably a better way to put it. If I were running I’d say, ‘we honor your contribution to the greatness of this amazing country, and we respect the deep, proud traditions of Appalachia, but we want to move you in a new direction, toward even greater economic opportunity and security! And we’ll find a way to do it without putting you on welfare!’ What do I know. I’m a doctor. But then, I give bad news all the time so maybe I’m used to it.
And then there’s Rep. Pelosi. Ah yes, the lady who so eloquently told us that white men vote for Trump because of Guns, Gays and God (‘God being a woman’s right to choose’…I could write for a while on that little bit of unintentional idolatry!) She says they’re you know, not ‘college educated.’ (The horror!) Careful Rep. Pelosi, it looks as if lots of those college educated men are making less than the troglodytes you are referring to who dared not to have a degree, but instead went to work in labor, trades, industry, private businesses or the armed forces. The morons you disdain might actually have money to give to campaigns, compared with the kids who have diplomas in ‘Gender Studies with an emphasis on the effects of global warming on gender pronouns.’ Granted, when you get your coffee or need some yard-work, they’ll be happy to oblige. Of note, she also says those monstrous uneducated white men actually vote against their economic interest. I hear that a lot. What she’s saying, along with all the other big players on the left, is this: ‘I always legislate with my economic interest in mind. Why doesn’t everyone?’ Of course, Rep. Pelosi is extraordinarily wealthy, so the plan worked. But what happened to ‘money isn’t everything,’ or ‘keep money out of politics,’ or ‘follow your beliefs?’ To the left, respecting one’s beliefs is only valuable if it means voting the right way. And if money can change that, and make a conservative, blue-collar white man into a state dependent, then he should follow the money into servitude.
All of this is tiresome. The ‘you’re so stupid because you disagree with me’ meme is un-American and is, itself, deplorable. We all believe things for different reasons. Some good, some bad, but insults don’t change any of that.
And when you insult men like me, who work hard to be good citizens, to be good at our jobs, to care for our families and obey the laws of God and man, you only drive the political, cultural and geographic wedges deeper and deeper.
Worse, when you insult an entire region of the United States, which has provided power and resources, workers and soldiers to the nation for hundreds of years, and treat them as irrelevant and expendable, as beneath your elite contempt, you only confirm their suspicions and make the election that much clearer to them.
This is my column in today’s Greenville News. I wasn’t sure if it was the right column for this week, but I’d been thinking about it for a while. Ironically, I really lost track of the date and wasn’t thinking about the anniversary of the 9-11 attacks. But maybe it was appropriate as we consider what evils were inflicted that day. Anyway, here it is. May God deliver you and yours from temptation and evil.
‘And lead us not into temptation, but deliver us from evil.’ So goes the last sentence of the Lord’s Prayer. (Well, unless you count the later addition, ‘For thine is the Kingdom and the Power and the Glory, forever and ever, amen.’)
The more I think about it as I get older, the more important the ideas of temptation and evil seem. As a husband, as a father, as a physician, I am fully convinced of the moral and spiritual dangers of this world. And yet, those words,’temptation’ and ‘evil’ fall on skeptical ears in a modern, scientific world. Do we believe in such a thing as temptation? Do we believe in evil? And how do we learn about these things in a time when virtue itself seems all too relative? And are they really relative as we search everywhere for virtuous leaders?
The word ‘temptation’ is dismissed as laughable. Rather than seeing it as a thing to be resisted, an assault on our character, a fork in the road of life, (or worst of all, the actions of Temptation should be embraced, as it invariably leads to fun and to liberty.
And ‘evil’ is even worse. Evil is only evil in the eye of those condemning it. One man’s junk is another man’s treasure; one man’s terrorist is another man’s freedom fighter. One man’s campaign contribution is another man’s bribe. Evil is passe’. It’s a yawn, a hoax passed down from an irrelevant church through silly preachers and uptight believers. Evil isn’t a thing for modern, educated people. Right?
Personally, I hold with the stark reality of temptation and evil. Reflecting on my own life I realize that I have experienced any number of temptations. Some of which I regrettably embraced.
Media and popular culture, being the principal moral guide-posts of generations, teach us that it’s funny to laugh about temptation, especially when it occurs in youth, and relates to sex, drugs and alcohol. But it quickly turns serious when we realize that temptation also eads people to use ever more powerful, ever more addictive and lethal drugs. Temptation leads men and women to cheat on their spouses, abuse children, embezzle, lie, engage in shady business deals, abuse public office, commit acts of terror, oppress, torment, rape or murder. It causes coups and wars, genocides and crushing poverty, loneliness, broken homes, broken hearts.
It’s common to suggest that such activities are merely the result of mental illness or caused by the frustrations of poverty or oppression. While sometimes true, the news doesn’t bear that out. Many very sane, very capable, very educated and financially sound people fall prey to temptation, a thing which ruins their own lives and those of others.Temptation, then, is the trail-head down evil paths. Evil, that old church bugaboo, that joke perpetuated on children, by ignorant religious folks, in order to manipulate them! But we all, every man, woman and child, believe fully in evil. We just have different words for it. We may disagree about the source. Is it something spiritual? Is it mental, financial or social? But without doubt, we know that there are dangerous forces and wrong things in the world.
Even the most convinced and brilliant atheist (and there are many) will reasonably condemn certain actions and applaud others. We use words like ‘unfair.’ We say we ‘ought to’ or ‘ought not to’ do certain things. We believe ‘that’s just wrong’ about a host of behaviors. Slavery? Bad. Murder? Bad. Greed? Bad. Human trafficking? Bad. Environmental destruction? Bad. Intolerance? Oppression? Tyranny? Hatred? Abuse of political power? Bad, bad, bad. And, to those of us with a more theistic inclination, evil.
And yet we live out a strange duality, in which we reject the idea of temptation’s perils and the reality of evil, even as we want to see virtue blossom. We find ourselves surrounded by crime, war, racism and sexism. We rail against big business, misleading ministers and lying politicians. We desire that our leaders be ‘good’ and ‘just’ even as we vacillate over virtue for ourselves, and can’t help laughing at things like ‘temptation’ and ‘evil.’
We may have to find different words to speak a common language here. But suffice it to say, I still pray that God will lead me not into temptation, and will deliver me from evil. And all those I love. For in a dangerous world, temptation and evil are real. And I’m just too weak to face it alone.
Step away from the phone and learn something useful
Well it’s school-time again, and all over the land the kids are back at it. Little ones are surrounded by the non-toxic but highly addictive smell of crayons and the wonderful colors and textures of construction paper. The simple delight of a backpack, the joy of snack time with new friends, these are novelties sufficient to send the little ones into pediatric rapture. Or tearful fits. Either way, they’re learning useful things like shapes, numbers, the alphabet and how to get away with stuff when the teacher is looking the other way.
But even as the little ones are embarking on the long journey of education, I have a request for those in higher grades, all the way past college. You, also, should continue to learn useful things. And I don’t mean on electronic devices.
I say that because any visitor from another world would reasonably wonder about the strange relationship we have with our smart-phones, lap-tops and tablets. Are constant selfies evidence that humans worship themselves? Are the devices connected to some powerful leader who watches and guides us? (If an alien abducted humans to figure this out, would the humans look up from their phones and notice? Or simply post it to their Snapchat story?)
It seems to me that a lot of young people have decided that they needn’t actually know anything; they can just pull out their minor deity phone and ask it questions in a crisis. But here’s a dark secret: in many parts of America and the world, there isn’t a connection to the great Web. Furthermore, the Internet might not always be there! Don’t freak out, but our electronics can be compromised by solar flares. Or by Electromagnetic Pulse Weapons used by terrorists or other countries. Furthermore, in times of disaster our phone networks and the Internet could become hopelessly overwhelmed. At that point, you can’t look up: ‘what to do if Internet isn’t working,’ as you’ll be unable to use said Internet.
So dear young people, learn things that are practical and helpful. One of my children was proud to learn some basic plumbing on a mission trip. One cooks well. Another is in EMT school while going to college and is proud to know CPR and how to use a defibrillator. Still another prides himself on learning to pick locks and start fires while camping. (You never know.)
There are so many things I should have learned when I was younger! For instance, every summer my-weed eater consistently dies when I need it the most. Why didn’t I ask my grandfather or dad to teach me how to work on 2-cycle engines? I suppose I was too busy being a vacuous teenager who thought he knew everything. Like pretty much every teenager ever.
So even as you brilliant students are knocking out degrees and certificates in what are often highly specific areas of education, I’d suggest you all keep adding new skills. Learn first aid or become a first responder so you can help the injured who cross your path. Learn simple wiring, learn woodwork, learn how to fight a fire, build a shelter, find your way in the woods with a compass or raise an animal for meat.
Learn to operate a boat, rescue someone from water, grow your own vegetables, hunt, fish, fight off an attacker, cook a meal, use a generator, drive a piece of heavy equipment, dig a hole, cut down a tree or whatever other practical skill that interests you and is anchored in the unrelenting bounds of Internet-free reality. The place where food doesn’t just appear because you order it online, and help doesn’t always come just because you call for it.
The thing is, there are untold numbers of people, often older men and women, who would love to share their knowledge and experience with a new generation. Seek them out, talk to them and learn. You may not get a diploma or certificate, but you’ll never be sorry you have it. And you’ll always treasure your new knowledge.
Then one day, when your phone is broken and you have to cook a fish you caught to feed the wounded hiker you found and aided in the woods where you were wiring your cabin, I promise you’ll thank me.
Even if you can’t e-mail me to say it.