I stand with Israel

I’ve never wanted to write about the Israeli-Palestinian conflict. It’s easy to come off sounding like a brainless partisan or a Friedmanesque utopian. And no matter what you write, someone is going to hate you. But the current conflict is making me crawl out of my little comfy North American hole.

The conflict itself is a painful, violent remnant of European colonialism, fed by hatred of Jews, apathy about Arabs, ignorance of complexity, and continued geopolitical gaming. It’s senseless to argue about which land “originally” belonged to whom—the entire region has been a battle ground since Biblical times. What matters most is the current reality on the ground.

The current reality: The region that makes up Israel and the¬†putative Palestinian state will eventually become two independent states, one majority Arab, one majority Jewish. Utopian visions of a single state are also a colonial pipe dream as can be seen with nearly every other state in the Mideast. When this will happen though is anyone’s guess, as the parties continue to play out their zero-sum game of futile militarism.

To “take sides” in this conflict as is shown in the media is also a fool’s errand. The people of both states have an absolute right to live safely and govern themselves. But they are in each others’ way and the world has made a decision: Israel, the stronger state-entity is the bad guy.

This is true. And it’s not. Israel has done some horrible things. That’s not surprising given that it is in a perpetual state of war, surrounded by countries that wish it dead and by non-state actors doing the actual killing. No one “wins” wars. It’s always the so-called non-combatants who suffer the most. But to paint this as a simple “Big Bad Israel” against the poor Palestinian refugees is incorrect at best, anti-Semitic at worst.

The classic “tu quoque” fallacy—“I know I did, but you did it too!”—is easy to fall into here, but there is truth to the complaint that while Israel has killed civilians in defending its citizens, its neighbors are slaughtering their each other in numbers unimaginable in Israel and Palestine. It is good and proper to hold nations accountable for their actions, but why this special focus on Israel’s misdeeds?

The origins of the State of Israel lie in Europe. While there has always been a Jewish presence in Israel, the greatest number of Jews until the mid-20th century lived in Europe. Mostly-secular Jewish intellectuals saw that Europe, with its endless pogroms and laws limiting Jews’ freedoms would not be a permanent home for the Jewish people, no matter how much they might wish it. They came up with a plan to form a state where all Jews would be welcome, and would survive by their own hands, live by their strengths, and fail by their own faults. The dissolution of colonialism along with the Holocaust gave birth to the Jewish state, and several kinds of hatred and prejudice gave rise to what will become a Palestinian state. Many Arabs were forced out of Israel during the War of Independence, many more fled, and those that did flee did not find welcoming homes in other Arab countries. Jews however continued to find relative safety in Israel, a safety they fought for daily.

In many ways the greatest tragedy of the conflict is the de facto partition that tore Jewish and Arab neighbors apart, and that exiled Jews from Arab lands, forcing them into the new Jewish state and creating more hostility between Jew and Arab.

But that’s history. The now is not so different for the people of the region. Violence flares often. The killing in Israel and the Territories, the limits on freedom, the daily humiliations are not nearly of the scale in Syria, Iraq, Iran, and Egypt. But the killing is real. And so is the hate that drives the world to focus on Israel’s culpability. Israel and the Territories fill a small bit of geography, and it’s a bad neighborhood. Distances are small. Hamas, a terrorist organization dedicated to preventing a two-state solution can easily attack Israeli civilians, keeping Israelis scared and alert. And wakening their military might. Hamas is also embedded in a very crowded strip of land, one that makes any fighting deadly to non-combatants. The problem here isn’t that Israel is killing civilians in its fight for survival but that there is fighting at all.

The only way to stop the violence in Israel/Palestine is to continue good-faith negotiations, but this is difficult when Israelis build settlements in traditionally-Palestinian lands and when those who claim to represent the Palestinians dedicate themselves to murder. And it’s not just terrorism used as a negotiating tool. Hamas’ goal is the complete annihilation of Israel and its Jews. This is why there is an “asymmetric” war, why Israel must maintain a powerful military, why Israel’s right manages to garner so many votes. Jews don’t want to lose their country, and they don’t want to be murdered.

And the pro-Palestinian demonstrations cropping up around Europe and the US, and the BDS movement, reveal the real feelings of the rest of the world. The greater world isn’t out to “save” the Palestinians but to destroy the Jews. To non-Jews this inevitably sounds paranoid, but we have a little bit of experience here. And look at the demonstrations around the world–they are not pro-Palestinian, not anti-Israeli, but anti-Jewish.

If the world is serious about helping bring peace they will give up their hypocrisy and recognize that as horrible as the situation is, the violence is minimal compared to the rest of the region. The violence in the Mideast is not a “Jew thing”. It is regional. It is horrible. It may be unforgivable. But it is not Jewish. There is a war, a war in which one side is divided as to how to live in peace with its impoverished neighbors living in unjust conditions. The other side simply wants to kill all the Jews. And it has found easy allies throughout Europe and the Mideast.

Israel has no real friends. The Jews never have. America is the closest thing, but politics are fickle. Europe made its feelings clear for centuries. Terrorists with a stated purpose to kill ALL the Jews are lobbing rockets at Israeli civilians. Any Israeli government that did not respond militarily would rightly fall. What else is Israel to do? If they were to suddenly lay down arms and recognize the pre-67 borders, recognize a Palestinian state, and pull out of the West Bank, what would happen? Would they suddenly have a valuable trading partner across the border? Would the two states suddenly become the economic powerhouse they could be together?

Clearly not. Palestinian politicians aren’t ready to keep peace with Israel, no matter the conditions. They probably couldn’t if they wanted to as one radical army or another would move in and set up bases to attack Israel. And as long as Israelis feel this threat, and see that they have no one in the world who will say, “Israel has the right to live in peace,” it will be politically impossible, and perhaps literal suicide to treat with the other side.

Those who are not intimately tied to this conflict, who are not Palestinian, Jewish, or Israeli, can have opinions but they cannot understand what we feel. Palestinians and Jews legitimately feel we are fighting for our survival, our very right to live. To judge us harshly is to participate in the colonialism that got us into this mess in the first place.

Want to help? Then help support Palestinians who aren’t anti-Israel. Support Israeli organizations that are pro-Peace. But don’t tell us to lay down our arms just because of ridiculous concepts of “asymmetry” or what have you. In war, people die, usually innocents. The way to prevent it is to support peace, not to demonize one side or the other.

 

On this day, a great battle

Once again, I ready for battle with an implacable foe. I prepare for the latest foray as best I can: cotton armor, leather gloves, boots of Spanish leather. My weapons are sharp though I know this will be a close quarters fight, main a main.

I approach the champs du bataille warily, my step slow. Had I a true squire, he would wipe the sweat from my brow; instead, i must be content to blink it away. I cannot raise my hand because the Foe is most unforgiving. His wounds seem light but the misery does come, if days after the encounter.

At the last moment I’ve brought my fickle friend Mont-de-Santo. He has failed me so many times, but he is the only one mad enough to join this folie a deux.

I pick my way through the hedge, my weapon lowered at first. And then I see the advance line: trefoil, edged by rubor of spite. And this is a warning, a shaking of spears, for its poisoned edge is a harbinger of erythematous misery.

I can delay no longer. I begin to hack my way through his ranks, but he seems unfazed. He bobs up and down, perhaps thinking me risible. He isn’t wrong. I look down, his line unfazed by my attack, no breach to sally through. I check my leather and cloth and bend down to do the work of a true knight. I grasp the enemy one or two at a time, by the neck, and pull, hoping to unseat him.

Have I found a weakness? Why does he seem to give way so easily? Oh! Woe! He has struck! I have unseated him, yes, but his hind has flown forward striking my wrist below the gauntlet. I should retire from the field and tend to this as I know it will inflame at a later time, but the heat of battle is upon me. I tear at him, no longer careful of his strikes but amok with rage. For each I unseat, more take their place to unleash their insidious poisons (not poissons for that is a different story altogether).

Finally, nearly surrounded, I retire and find my sometimes-friend Monte-de-Santo at the edge of the champs with that same look he always has, the one that says, “you may not want to but you will always return for my help and in return I will ask you for a favor.”

And it is done. The outcome unsure. Monte-de-Santo has returned to his place up high, my edged steel has been sheathed, my armor soaked in sweat. I strip it off carefully, not knowing where the Foe may have struck.

“A bathrobe?? Are you naked? In the laundry room? What the hell is wrong with you? You know the poison ivy is just going to grow back!”

Ah, a maid who cares more for my welfare than her gardens. I may just live to fight another day.

Flu???

Every fall I bring flu shots home for my family. My wife has a hard time getting to the doctor, and my child uses wild, sadistic gestures to explain how it’s done at the pediatrician’s office. She reminds me every day to bring home the shots, and when I have it, she dutifully drops trou and takes her mediicne. My wife not so much—she requires a bit more wrangling.

Still, it has served us well. I haven’t had the flu in recent memory despite multiple exposures and the Pal Family has steered clear as well. But as of last week, I’m the captain of a plague ship.

MrsPal started coughing last week, then wheezing. Later my phone rang and she told me that her body was aching and she had a fever of 102. It was obviously flu, but I still had her come to the office for a test. Influenza b. Yuck.

So we sent PalKid to a friend’s house for the weekend to keep her away from the bug. This morning at 4am she came into the guest room (where I was isolating myself) to say, “Daddy, I’m shivering worse than when I get out of Lake Michigan.” Shit.

No reason to keep mother and child apart any longer, so I plopped her in bed with mom, hopped in the shower, and skedadled.

PalKid likely has influenza b as well. This year there were two basic flu vaccine formulations: a trivalent and a quadrivalent. Both vaccines contain two types of “a” and one of “b”. The quadrivalent has an additional “b” strain.

The CDC didn’t recommend one over the other. Both matched the circulating flu strains well. So there are couple of reasonable hypotheses as to why my family is down for the count.

1) The flu vaccine covered their strain but it didn’t work well enough
2) They both got the “b” strain not covered by their shots
3) The vaccine covered the strain but has worn off

All of these are plausible and it doesn’t matter too much at this point. Next year’s shots are likely going to be identical to this year’s, but next time, I’m bringing home the quadrivalent.

Meanwhile, PalKid is eating ice cream and watching Minecraft videos. She may end up liking the flu a bit too much.

April, vernal and triumphant

Running season has finally risen from its wint’ry grave and the trails are crowded with celebrants. My running calendar pinpoints my sloth as beginning in mid-November, coincident with the start of the Worst Winter Ever.

Excuses melted away with the last of the snowbanks and my sneakers stiff with un-use are getting some fresh air. Unfortunately, this weekend’s lovely weather was accompanied by a miserable case of influenza b which has left my spouse bed-bound. The trail will just have to wait for her a few more days.

With the warm air (which is expected to take a quick break this week allowing a bit of last snowfall) comes tornado season marked by the whines and howls of my terrified child. Not that she’s ever seen a tornado but every time the sirens go off or the weather even looks threatening, she’s grabbing her favorite stuffed animals and heading for the basement.

At the moment though I’m at one of those trampoline places where pop music blares, whistles whistle, and kids scream as the leap from platform to platform. It’s a migraine-inducing hell, but the kids do seem to love it. It’s strictly a no-shoes affair and I just saw some adult walk out of the bathroom in bare feet. I’m not squeamish, but I can’t imagine what twisted circuitry would allow a grown man to stand at a urinal in bare feet. Yech.

I suppose I should just be grateful I’m not holed up in the plague-house. I’ve enjoyed serving up meals in bed and all, but if I want to escape unscathed I’d better keep myself anywhere but home.

Start spring out right. Go for a walk. Look down at the crocuses. Enjoy the rumble of spring storms. Shake off the long winter and get outside.

Thanks, Kid

I’m not gonna lie—I’m a fat, lazy slob. Last summer and fall I moved my sorry but motivated ass down the trail 4-5 days a week, doing my lame but effective intervals. I was all ready with my cold weather gear—and then a winter that would have frozen off the Stark’s cojones.

Like the parade of tired patients slouching into my exam room, I basically gave up, and as you know, once you give up, it’s hard to get out there again.

But the roads are finally back in their pot-holed glory. The lawns, yellowed and battered by unrelenting snow are looking, well, dead, but at least I can see them. And PalKid asked me to pull out her bike.

There are people out walking! Lots of them! And we took off tonight, she in her pjs on her bike, me in my muddy-weather running shoes. These were intervals, alright. I kept up with her on the flats, and lost her when I took a break to walk. I didn’t bring my Garmin, but we probably did a couple of miles and would have kept going but for the dark.

So, I think I’m back. Join me out on the trail and get your asses moving. The world won’t run out of cookies.

The yearly physical that isn’t

I realize that most of my readers are below Medicare age, but as goes Medicare, so goes the nation, so pay attention my friends.

Nearly all healthcare plans now include so-called preventative care, including some sort of yearly check-in visit. Medicare’s version of this is the “Annual Wellness Visit”. Most patients think this means they are getting a complete physical, and often they do, but this isn’t going to continue.

Medicare’s Annual Wellness Visit has a very limited set of requirements, including screening for depression and dementia, making a list of all the doctors someone is seeing, and calculating their body mass index. It’s really a brief visit, and doesn’t pay all that well.

Despite this, many of us have been including a more traditional physical. This adds on considerable uncompensated time to the visit. A time will come when AWVs are brief visits done by assistants, and the patient will have to come in for a physical on another day (which will not be covered at 100%, as the AWV is). I suspect many patients won’t like this.

The same may happen with non-Medicare plans. Doctors’ offices may have patients come in for a brief prevention visit with a physicians’ assistant, fill out any health screening forms, and make them come back at another time for a real physical.

It’s all better than being un-insured, but don’t be surprised when your doctor tells you that your yearly physical isn’t your yearly physical.

Pi day thoughts

Kids don’t get pi. Neither do most adults. For we non-mathematicians, it’s disturbing. Numbers are so concrete. You can hold two apples in your hands, but pi apples?

We humans like concrete answers, especially when they conform to our beliefs and worldviews. And this scares me.

Yesterday I was sitting at the cafe and the woman next to me struck up a conversation. Turns out her kid is autistic. “He got that stupid MMR shot, you know.”

Yeah, I do know, but what do I say to the irrational stranger about it? Do her friends also just sort of shut up when she goes off on the “MMR causes autism” thing?

There are plenty of nice people who believe destructive things. We don’t like pi. It doesn’t fit with how we see the world. Yet, it exists. So now what?

Let’s talk about your doctor’s office

Going to the doctor starts as a disconcerting experience: getting naked, physically and emotionally; talking about your weight, your smoking, your divorce. You count on your doctor’s ear and her discretion. Often enough, a patient will apologize for taking my time or for crying or whatever. I remind them that this is what the exam room is for, this is what they pay me for.

How far does this special relationship extend? Primary care doctors can’t bill for time with their patients unless it’s face-to-face. This is one of the reasons your doctor might not want to spend a lot of time on the phone or email with you. It’s also one of the reasons we may require you to come to the office to complete complex forms or change a prescription. These activities require work, and our main work is thought. Without you in my exam room, I’m not sure about that medication change or that disability form. And I can’t ignore the fact that I’m not paid for my time unless you’re in the office with me.

In my opinion, some doctors go too far, requiring monthly visits for simple prescription refills, but there are times when it’s necessary to drag someone in to make sure the drugs are working and not causing harm, or to make sure you are working on your dietary habits and exercise.

Saying ‘no’ to patients isn’t easy; we’re in this job to help. But it’s often the right thing both clinically and economically. This brings up another question, one we don’t often talk to patients about: how should we treat our time when the office is closed? The tradition has been to take patient calls after hours and on weekends, perhaps rotating this time on call between partners.

But there are murmurings out there about this uncompensated time. After all, what can I do for someone on a weekend? It’s not usually wise to diagnose someone over the phone. It’s also not so good to renew prescriptions on the weekend; it’s a poor use of time and for those of us with paper charts, it’s nearly impossible to know what’s appropriate.

For a primary care doctor, the answer to many phone calls is, “Call the office on Monday,” or, “Go to the ER.”¬†

As a patient I want to be able to reach my doctor on a weekend, but I would understand if he should decide to change his policy.

What say you? How can we maintain communication and deal with the problem of uncompensated care?

Helplessness

Many years ago, someone I loved was in the hospital and whenever I would visit, I would display my badge prominently. She wasn’t inmy hospital; my ID badge opened no doors; it didn’t get me free food in the cafeteria. It was a talisman, something to ward off the evil I would wade through, something that might have some magic—any magic—to help us through this hell.

Some people respond to this helplessness not with magic but with anger. It’s one of those things doctors have to learn to deal with. When families lash out, it’s not about you. Your white coat is the magic that wasn’t, the shield that let through the plague arrows.

Some get bossy—very bossy. They focus on the minutiae, the things that doctors and nurses know aren’t important. The shades aren’t drawn right, the medicine is ten minutes late, the meal tray is all wrong. What about that bandage, doesn’t anyone see it’s bunched up?

We are all at some point powerless in the face of disease, and we reach for what little power we have. We huddle together against the biting wind, cobbling together what shelter we can, and wait for the storm to pass.

Liberals: stop apologizing

If elections results are to be believed, about half of US voters are “conservative”. Why are liberals so apologetic? Why so willing to compromise beliefs?

Submitted as an example, abortion. Conservatives have no problem making it a dichotomous issue of good and evil. They are unapologetically against a woman’s rights over her own body. They continue to act as if humanity comprises two creatures: people, and women.

We liberals, as human beings, find this abhorrent, but we have diverse views. This diversity can sometimes lead to a willingness to compromise amongst ourselves, but that willingness sometimes bleeds into our interactions with conservatives.

“Abortion should be legal, safe, and rare,” is a common rallying cry on the left, and a stupid one. If you truly believe in a woman’s physical automony, then abortion should be “legal, safe, and none of my damned business.”

This wishy-washy bullshit opens us up to the bullying of the right. Many liberals may believe the “rare” part, but many of us see that as a related but separate reproductive rights issue. Access to contraception, something the right also abhors, does not guarantee fewer abortions; it is another layer of autonomy for women, one that shouldn’t have to be “added”.

If we really believe in human rights, in the right to work with dignity, equality of all people, freedom from hunger, access to healthcare—if we are to call these “rights”—then we cannot be apologetic. The Right succeeds with their base by being uncompromising in their defense of inequality and prejudice. We need to be equally unapologetic, unwilling to compromise on human rights.

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