Tuesday, June 4, 2024



I am reminded of what seemed so impossible in 1986: The end of apartheid in South Africa. Perhaps that is why only we young people were out protesting at the time. We had not yet grown old enough to restrict our activities to the realm of the reasonable, or our ideas only to the possible. Lydia Polgren from the New York Times gets this:

"In his 2020 book 'Neither Settler Nor Native,' the political theorist Mahmood Mamdani offered the idea that South Africa’s transition was possible because of an extraordinary act of creativity and imagination in which the holders of what were once seen as fixed, eternal and opposed identities — settler and native — mutually surrendered those identities and took on new ones, as fellow survivors of a brutal colonial project who would try to build something new from its ruins. It is hard to imagine such a project in Israel and Palestine in these dark days. But what was possible once can be possible again."   (Quote from Lydia Polgren, 'South Africa is Not a Metaphor,' NYT, 6/1/24)

Friday, May 17, 2024

Couples Need to Breathe

Just as you need both inhaling and exhaling, couples function best when--according to God's design--we are able to enjoy both bonding (inhaling) and being separate (exhaling). The healthiest marriages are those that are in a rhythmic routine of bonding and being separate, and each spouse is comfortable with both. Partners need a sense of security in order to view separation as something to be encouraged, valued, and promoted.

                                                                                 - Milan & Kay Yerkovich

Friday, May 10, 2024


 Many lives have a mystical sense, but not everyone reads it aright. More often than not it is given to us in cryptic form, and when we fail to decipher that, we despair because our lives seem meaningless. The secret of a great life is often a man's success in deciphering the mysterious symbols vouchsafed to him, understanding them and so learning to walk in the true path.

                                                                            -Vyacheslav Ivanov

Tuesday, May 7, 2024

There is not a physician shortage in the US



"The physician shortage as a significant driver of poor health outcomes is a red herring."

                                                                  -Corso et al

If anything, the poor state of affairs in American health has to do with too many doctors, not too few. Authors Corso, Dorrance, and LeRochelle make a good argument that simply blaming poor healthcare on the lack of primary care is insufficient (see their article in Military Medicine).

Thursday, May 2, 2024

To Protest

I remember waking up on the ground late on a Saturday night in the quad. Or was it early Sunday morning? It was my turn to sleep in the protest shanty we had built at Washington University in St Louis. I heard voices and guessed school security had picked the darkness to dismantle our little shack. Graduation was coming up, and they sure didn’t want this eyesore in the middle of the parents’ seating area. But as my consciousness cleared, and the voices turned to words, I realized it was a group of late-night partiers who were daring each other to pee into my bedroom. I said a few words to let them know someone was there and awake, and they scurried off, fortunately before letting loose with a yellow stream. The protest had survived another night.

Many campuses in 1986 had primitive encampments, as student groups protested against and hoped to pressure the South African government into dismantling the apartheid system, which officially and very broadly restricted the rights of non-white persons. On campuses across the US, these shanty towns were extensive, and battles between students and administration sometimes led to violence and arrests. Ours was a small shack, which we kept going for the whole semester. Nobody was arrested as far as I know. The school did not divest from businesses active in South Africa, which was our request. Campus groundskeepers were able to haul the shed off during exam week and quickly get some sod in there prior to parents showing up.

I considered that phase a failure at the time, but our group was involved in many other ways: marches, gatherings, education events, and the like. We were a small part of the pressure that did contribute to freedom in South Africa. I was amazed to hear during medical school in 1994 that Nelson Mandela was elected president. When we were marching, he was still in jail: a total of 27 years. From my involvement and observations from that time, I have some thoughts and pieces of advice I would like to pass on to the campus protesters of today. I was not, and I am not a professional protester, nor am I extensively involved politically overall. I am sure you have heard from people like that--I sure did. I appreciate them, but you may not want to follow them too closely. That is my first point. Not everyone should become a professional protestor, spend time in jail, and give up their career. Those three things don’t always go hand in hand, but they often do. Think very carefully before you get hauled off by the police. Sometimes that is the right thing, and sometimes it is unavoidable, but sometimes you may have more influence and say if you keep your student ID, avoid the jail record, and show up for school next semester.

Related to the professional protestor, is the problem of thinking-as-a-package. You do not need to agree on every single point to gather with others in protest. The world does not need more echo chambers. Read books. Think. Have opinions and say them. Respect and listen to people with differing opinions. It makes the world and your life much more interesting. Unfortunately, the press and the campuses seem to love to quote the student in the midst of his or her opinion formation, and then label them forever for what is really a journey, so be careful what you say in public or online. Or turn your thought into a question instead so you won’t be tagged.

Choose non-violence. If you are like me, you will want to throw something, break something, hurt somebody. There is so much evil out there, and you want to tackle it now! But the best message, that lasts the longest, is the one that is packaged in humility, with all violence and coercion removed. If you do get arrested or you are about to be arrested, do not fight. Don’t put the police person at risk or yourself. Look up quotes from Dr Martin Luther King. Read Gandhi’s autobiography. Consider Jesus on the cross. Leaders whose message persists even after they’re gone, who very intentionally and purposefully planned to reject violence. There will be people who are ok with violence, who consider power the primary goal. In fact, current university education and polarized news emphasize power politics so much, I am surprised there is not more violence than there is. This is why you must be very purposeful about non-violence as a philosophy and a practice. A non-violent path enhances your credibility and chances of lasting success.

My last thought is: do something besides protest. I found that protesting racial injustice overseas was not enough for me, and I jumped into racial reconciliation and related work in St Louis both on and off campus. What can you do in your community to locally improve respect, dialogue, and understanding? Or to support those in need?

All the best to you in this fascinating time! I hope you don’t get peed on!

Wednesday, June 3, 2020

Thank You Spike Lee

Now I think I understand Spike Lee a little better. A man who can see things 30 years before others take them seriously is going to be an angry man. Watch “Do the Right Thing,” if you can stomach the profanity. Or at least see the clip that Lee has already noted is so similar to recent events (it's disturbing). You will see the complexity, the horror, the drama, the pain, the anger of today. The difference is, nobody marched for a strangled black man in 1989. The pain and the anger and the confusion of the violence and injustice around him, Lee carried by himself. Or carried it with a whole lot of other black men and women, most of whom did not have the focus or the understanding or the clarity or the charisma to make a movie to contain it. And so he was alone.


Thank you, Spike Lee. You were brave enough to focus that anger and that confusion into something real, disguised as something fictional. You were ahead of your time. But what you did perhaps planted a seed somewhere, so that when George Floyd breathed his last in real life, so much like your character Radio Raheem, people knew it was time to say something. Time to throw something. And so you woke the sleepers, made the blind see. Not enough to see clearly perhaps, to know the way forward. But enough to know there is light and a road.

Sunday, May 3, 2020

General Colin Powell on Politics

Neither of the two major parties fits me comfortably in its present state. Granted, politics is the art of compromise, but for now I prefer not to compromise just so that I can say I belong to this or that party. I am troubled by the political passion of those on the extreme right who seem to claim divine wisdom on political as well as spiritual matters. God provides us with guidance and inspiration, not a legislative agenda. I am disturbed by the class and racial undertones beneath the surface of their rhetoric. On the other side of the spectrum, I am put off by patronizing liberals who claim to know what is best for society but devote little thought to who will eventually pay the bills. I question the priorities of those liberals who lavish so much attention on individual license and entitlements that little concern is left for the good of the community at large. I distrust rigid ideology from any direction, and I am discovering that many Americans feel just as I do. The time may be at hand for a third major party to emerge to represent this sensible center of the American political spectrum.
                                                                  -General Colin Powell, 1995

Saturday, February 8, 2020


It appears that a good church upbringing will do many marvelous

things for you, but one of the unfortunate things it also does is

convince you that Jesus is to be worshiped but not followed.

                                                                                                - Frost/Hirsch

Tuesday, January 14, 2020


Facebook did not invent this problem but it does illustrate it quite well: having many friends can be a way of not having any friends.

Monday, December 16, 2019

Stateless Patients

A 30 y/o woman presented to a rural clinic for prenatal follow up: G2P1 at 25 weeks. As I used the ultrasound to check dates, look for anomalies, and measure amnionic fluid, I thought of the patient’s lack of sufficient identification in this country to allow her access to complex OB care. Instead, a volunteer internist was doing her ultrasound. The baby appeared healthy, but I later noted that she had not gained weight for several visits and that she was on prednisone. She had started having joint pains when she first got pregnant, was diagnosed with rheumatoid arthritis, started on steroids, and the labs that she could afford were sent off.
Through translators, the patient reported oral ulcers that were now healed, but no rash. Exam confirmed persistent pain and limited range of motion in the elbows, knees, wrists, MCP and PIP joints. Anemia down to a hemoglobin of 5 had improved to 8.5 with iron and steroids, but the WBC was still low at 2.7. She had negative rheumatoid factor, positive ANA and dsDNA, and negative anti-Smith. The creatinine was normal and urine protein was 3+. She met criteria for lupus.
I explained to the patient how a lupus diagnosis put her and her baby at risk, and the medications had risks as well. I increased the prednisone and asked her to come back in a week, hoping I could get some advice via email as to what to do. Thankfully, rheumatology friends overseas emailed back. We then developed a plan including medications that we could obtain and that were considered relatively safe during pregnancy, hoping to reduce the steroids at some point.
Three weeks after I first saw her, the patient had gained some weight and her joints were nearly normal, though she still had proteinuria. I outlined an ongoing plan for the staff as I left and prayed for her and the baby.
One wonders when helping people who are outside the “system” and its resources for whatever reason, at home or abroad: am I doing the right thing? Am I practicing beyond my scope if no one else will see them? How can I get better at doing this when medical progress seems to require more and more sub-specialization? And how can I protect these people’s privacy and security and still advocate for improved access to care?

Saturday, December 14, 2019

The Power of the News

The newspaper press is a great power, but just as an unchained torrent of water submerges whole countrysides and devastates crops, even so an uncontrolled pen serves but to destroy. If the control is from without, it proves more poisonous than want of control. It can be profitable only when exercised from within.
                                                         -Gandhi (autobiography Beacon, 1993 p. 287)

Sunday, November 24, 2019

A Problem of Diagnosis

Efforts at cultural diagnosis are hampered if they are pursued from within the same framework of fundamental assumptions that brought into being the disorders they hope to cure.
                                                                                           -Ken Myers