Micro Review: The Crossing

Just finished the latest from Michael Connelly, The Crossing, adding it to my bookshelf that contains every one of his novels in hardback. He is the most consistently high-quality hard-core detective-thriller novelist alive, and belongs in the all-time top 10.

He has a unique ability to combine a logically-rigorous plot with a consistency of purpose in his characters. Much like the experience of the best magicians, one never notices the sleight of hand that guides the action, even when one is looking for it. His lead character, Harry Bosch, combines a hardened righteousness for justice with a deep humanity for the most vulnerable that ultimately wins the day. One deft touch in this book is the vulnerability Harry displays as a single-parent, trying to reach out to his teen-aged daughter, while struggling with his own confusion about her inner life.

For those looking for a last minute gift, or for someone receiving the right gift card, I highly recommend this, or any other, of his novels.

 

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Chicago Sadness

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I’ve been trying to figure out how I’m “supposed” to feel over the past 24 hours.  I spent the day away from my office in Hyde Park in response to a credible threat of “gun violence” reported to the University of Chicago by the FBI.

As it turned out, the person posting the threat online was a student at the University of Illinois in Chicago.  The threat was a response to the recent horrific shooting of a young African American man by a Chicago police officer.  The officer shot the young man 16 times, and this was captured on video; the video was released to the public recently, in conjunction with a murder charge against the officer.

One of the specifics of the student’s threat was to kill “white male students and/or staff”.  Which meant, had I gone to work, I would have been a prime target, had the threat been real and gone unnoticed. There is a reasonable chance I would have been walking across campus at the 10am time given.

One emotion I don’t feel is anger.  I keep searching my mind for such feelings toward someone who, knowing nothing about me, would put me in a category based on nothing by my gender and skin color, then decide that it might be reasonable to kill me.  Sorry, it’s just not there.

What I primarily feel is sadness.  Sadness for Laquan McDonald’s family for his unnecessary death; sadness for the violence in my city that sometimes seems unending; sadness for the fear this all generates for decent people; and even sadness for the young man who felt compelled to post, just for a moment, his rage at the world that seems stacked against him.  Realizing, that for his anguished moment of misplaced judgement, he now faces the possibility of 5 years in jail – and the agony his mother must feel for him.  May fate spare me anything similar.

One of the joys of working at the University of Chicago as a physician is all the interesting people from every imaginable background that I am privileged to meet, work with, care for, and get to know.  Mostly, I’m thankful to be taking care of people, often with deadly diseases, too often near the end of their lives.  Last week, I spent much of my Thanksgiving holiday talking with people in pain and distress about the rapidly approach end of their lives.  All of which made me thankful for the opportunity to do so and still be healthy enough to help.

I spent the unexpected day away from work with my family, a rare weekday to enjoy them.  I helped the kids with their schoolwork (they are in a unique Chicago school program which has them working “virtually” many days), took them to their gymnastics practice, and took a walk through our south side neighborhood.  My 12-year old son asked me why I didn’t go to work, and I tried my best to explain honestly what was happening.  He asked some appropriate questions, which I answered, again as honestly as possible.  He accepted this, openly, and moved on with life.  It seemed surreal – to have an extra day enjoying time with my kids as a consequence of other, slightly older kids enduring life’s awfulness, mostly due a societal inability to deal with differences between people due to the color of their skin.  All of this turned my sadness into a sort of variegated melancholy – an amalgam of sadness about the world we live in, satisfaction in keeping the violent ugliness out of my kids’ lives a little longer, and the difficult realization that I don’t really know how to control either one.

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Existential Pain and History

mte5ndg0mdu0otg3mjq1mdcx“I am a dead man!” Alexander recognized immediately that his condition was mortal.

At first, the patient suffered such exquisite pain that Dr. Hosack did not strip off his bloody garments…When [the patient] complained of acute back discomfort, [the doctor] and other attendants took off his clothes, darkened the room, and began to administer [medicines] to dull the ache.

[The patient] was preoccupied with spiritual matters…No sooner was he brought to the Bayard house than he made it a matter of urgent concern to receive last rites from the…Church.

When [the pastor] entered the chamber, he took [the patient]’s hand, and the two men exchanged a ‘melancholy salutation’… He explained that…”It is a principle in our churches never to administer the Lord’s Supper privately to any person under any circumstances.” [The patient’s] friends thought it heartless to refuse a dying man’s last wish.

As befits a great orator, Alexander roused himself for one last burst of persuasion.

At that point, [the pastor] relented and gave holy communion to Alexander, who then lay back serenely and declared that he was happy.

——————-

One common felt pain for patients at the end of their lives is existential or spiritual pain. Though difficult to define, most of us practicing palliative medicine recognize it when we see it. The proper intervention for it is not additional opiates, but rather appropriate spiritual support.

It always impresses me, when reading history, just how often our common humanity binds us across time. The patient above is Alexander Hamilton, lying on his death bed following his infamous “Interview at Weehawken” with Vice-President Aaron Burr . This slightly edited account, taken from Ron Chernow’s masterful biography, Alexander Hamilton, is a dramatic rendering of a man in existential crisis at life’s end. Hamilton recognized instinctively, as he so often did, his need for spiritual input to his pain. Unfortunately, in today’s medical world, we too often fail to recognize this need, delivering the wrong intervention, in the form of another dose of dilaudid, to patients needing spiritual uplifting.

This is not the first time I’ve noticed this in reading through historical biography. U.S. Grant eloquently describes a palliative approach to end-of-life care, as he completes his famous Memoirs while dying from head-and-neck cancer. John Adams describes a receding of the fear of dying, to be replaced by a fear of dementia. Human life, and death, resonates across the ages.

As I prepare for another stint on our Supportive Care Unit, a typically draining two weeks full of existential pain, I find reflecting on our common humanity, and the special role physicians are privileged to play in it, helps sustain me through the experience.

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Everest: A Movie Micro-Review

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To my wife’s chagrin, I love the book Into Thin Air by Jon Krakauer, the first-person account of the 1996 disaster on Mt. Everest. It’s gripping, terrifying, and heartbreaking, highlighting the difficulty of decision-making in lifeboats — even when those lifeboats of one’s own creation.

The movie is a faithful rendering of the tragedy, plucking away madly at the heartstrings as people freeze to death while talking to loved ones on the phone. It succeeds in telling the two most compelling stories, about Rob Hall and Beck Wethers. It modestly fails in showing the reasons for the tragedy — primarily people’s desire’s to achieve a goal overcoming their rational capacity to recognize when that goal is no longer achievable.

It is a near-great movie, better for those who have read the excellent book than for those seeing it without that benefit. Recommend for those who have read the book, wait for home rental or streaming on a nice screen for those who have not.

Side note: My 12-year old found it “boring”, except for the parts where people fell off the mountainside, which were not “dramatic enough” for him.

Side-side note: Krakauer, the author of Into Thin Air, didn’t like the movie, in which he’s a character. He has a small role in the movie, and some of the worse criticisms are reserved by the director his character.

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Filed under Decision Making, psychology, Risk

When Lincoln Kissed a Reporter: Tales from the Printer’s Row Lit Fest

I love the Printer’s Row Lit Fest — even though it will always be the “PR Book Fair” to me. A solid two-plus blocks of tents of book-sellers, including quite a few with a collection of “vintage” books, which I love.

This year, I found an original (1913) hard-backed copy, in very good condition, of a small book of 39 pages intriguingly entitled, “When Lincoln Kissed Me.” It’s an account from a young reporter, Henry E. Wing, a 25 year old reporter of the New York Tribune, the NYT of the day. Following the Battle of the Wilderness, the beginning no reports came from the front for 2 days — there was no account of the location of the 100,000 strong army US Grant was leading against Lee on the final push to Richmond. I had never heard the story before, and it is a gripping one, full of drama, intrigue, and insight. I read it on the train ride home.

After a harrowing journey through enemy territory over 70 miles over two days, much of it on foot, Wing makes it back to Washington. Not only does he have a report to deliver to his paper and to the President and his Cabinet, he has a personal message from General Grant for the President.

Lincoln dismisses the Cabinet members, locks the doors, and stares down at the reporter.  As Wing describes it:

“He took a short, quick step toward me, and, stooping to bring his eyes level with mine, whispered, in tones of intense, impatient interest, ‘What is it?’

“‘General Grant told me to tell you, from him, that, whatever happens, there is no turning back.’:

As the diminutive Wing tells it, while standing trembling in front of the towering President behind closed doors:

“Mr. Lincoln put his great, strong arms about me and, carried away in the exuberance of his gladness, imprinted a kiss upon my forehead.”

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Joshua Hemmerich, RIP

Joshua Hemmerich, PhD, was the first project manager I hired after I received my first grant as a new faculty member at the University of Chicago in 2004.  He was recommended to me by a member of the Society of Medical Decision Making, Julie Goldberg, PhD, with whom Josh had worked at the University of Illinois-Chicago.  As a cognitive psychologist with significant training in statistics, Josh was a perfect fit for my research agenda on the role of emotions in medical decision making for older cancer patients. Over the next decade, we became well-matched research colleagues as well as close friends.

Over that decade, as we co-authored 25 papers and successfully competed for several grants, we also shared innumerable conversations about life growing up in small towns in the Midwest, especially about playing sports under the demanding eye of tough-love fathers.  Over the years, we attended many SMDM conferences together, and we even managed to attract one of the Founding Fathers of the field, Arthur Elstein, PhD, to join us as a mentor and a collaborator.  We both marveled at our good-fortune to get to know such an important scholar who is also such a supportive mentor.  We each continued to build our respective careers, with Josh becoming the Research Manager for our Section of Geriatrics & Palliative Medicine, and then joining as our first PhD-only hire onto the faculty, an unusual ascension for a staff member.  When I became the Section Chief, we continued to expand our research, as Josh began building his own independent career, including as the Newsletter co-editor for SMDM.  Although we had increasing less time to share on non-work-related discussions, we were both looking forward to contributing more to the field of medical decision making.

With his untimely passing, coming as a shock to us all, I will deeply miss having Josh around, both personally and professionally.  In many ways, I am still struggling to figure out how to move our shared agenda ahead without him.  He was a uniquely gifted person, combining the insights of a psychologist with the acumen of an excellent statistician.  And for such a talented person, he we very down-to-earth and friendly, quick to tell a joke or to shoot the breeze about the latest in Cleveland versus Chicago sports.

One thing many may not know about Josh was his love of books.  I always admired, when I stopped by his office to chat, his eclectic collection of books on a wide range of topics from statistics, to cancer, to history, psychology, and (of course) decision making.  In honor of this collection, we have gathered the books he left behind and created the Joshua Hemmerich Memorial Library, which now lives in our Section Conference Room, for all to enjoy and to honor his memory.

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“I hope to have God on my side, but I must have Kentucky.”

Becoming a lay expert on a specific historical period, the American Civil War, two related methods for learning history have become crucial to me. First, having broad-based knowledge about this period deepens my understanding of specific local history. Second, travelling to a place to imbibe the local atmosphere where important history happened, brings the sights, smells, sounds and imagination to bear on that history. Both improve the richness of my full understanding of that time – and the human experience overall.

When travelling, I’ve taken to purchasing a book about local history, preferably about Civil War history, to bring these two learning tools together. My most recent experience in central Kentucky was especially delightful. The area we visited was Bowling Green, a place that switched hands several times throughout the war, as both sides tried to bring this crucial “neutral” boarder state into their fold. As newly-elected President Lincoln said about his birth state, “I hope to have God on my side, but I must have Kentucky.”

The book I found is Josie Underwood’s Civil War Diary, edited by Nancy Disher Baird. A passionate 20-year old woman from a prominent Kentucky family, whose father was a leader of the pro-Union elements in the state, writes movingly about the shattering impact of the war on the families in Kentucky. As the country descends from arguments about preserving the Union, the principles of the Constitution, and the status of slavery to outright war, the dissolution of families, friends, and communities into outright hostilities is heartrending. The articulate and beautiful young woman finds her life pulled apart as the miasma of a country in upheaval at a fulcrum point in history throws her life into disarray.
A favorite part of the book was her one-time meeting with Abraham Lincoln when in Washington with her father, who was being appointed by the President as Ambassador to Glasgow. Like many contemporary accounts of Lincoln, its cinematic quality is captivating:

“As we returned to the city, about sun down, there were no other people in sight on the road [from the Soldiers House] except a lone horseman we were meeting. He was on a long-tailed black pony (the horse looked so small) galloping along – a high silk hat on his head – black cloth suit on, the long coat tails flying – behind him. Pa called our attention to him—saying ‘some farmer – who has been in the hot city all day and is now eager to get home to supper and his family.’ So Miss Bell and I thought the man and he looked it. As we met, Pa had the carriage stop. The man did the same and Pa introduced us to Mr. Lincoln. He leaned over, shook hands with us, then slouched down on one side of the saddle—as any old farmer would do, as he talked for ten or 15 minutes with us.”

Can you imagine it? She captures so many historical facts in this one little story. Lincoln’s notorious lack of concern for personal safety, chillingly foreboding—His “everyman” demeanor of an uncouth Westerner—His benevolence toward humanity. It’s all there in this brief, personal account. She goes on…

“Pa and Mr. Etheridge thought is very imprudent and unwise risk for him in such a time of warfare and especial hatred of Mr. Lincoln himself for him to be riding unattended, unguarded out a lonely country road – and called his attention to the dangers—Mr. Lincoln’s smile—expressed kindliness to all men and fear of none—as he said—he ‘did not think anybody would hurt him that way’—shaking hands again with us—he galloped on, neither did we meet anybody else for quite a little way so it was very evident there were no guards—following him.”
Finally, she summarizes her impressions of the man she, and her contemporaries from the South, even those “Unionists” who supported the war effort.
“Lincoln in appearance certainly falls far short (though he is so long) of my idea of how a President should look. In fact a very common-looking man he is—but I must confess there was a kindliness in his face—that does not fit the tyrant—unfair man I have been thinking him…Thinking of his kind, troubled face I can’t believe it is.”

Absolutely spellbinding.

Much of this moving account, especially for a Civil War buff, is infused with details and examples of the local consequences of the war in the border states. I urge anyone with an interest in the times or who is visiting the area to read this mesmerizing account, especially during this 150-year anniversary of Lee’s surrender to Grant at Appomattox Court House. And to remember the 150-year anniversary of Lincoln’s untimely death at the hands of one of the people he so confidently believed wouldn’t “hurt him in that way.”

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Filed under Civil War, History, Lincoln, vacation