My diminishing superpowers, mattering and the summoned life

In an earlier blog post, I wrote about my transformation into Tech Girl, a mature woman who would swoop in to rescue digitally challenged elders who were being attacked by electronic personal assistants and harassed by poorly designed log in routines.  And, while I am still looking forward to that superhero assignment once I retire and have the time I need to become a proper superhero–wardrobe, branding, licensing and insurance coverage—I am increasingly concerned that I am actually losing other superpowers.  Actually, what seems to be to be superpowers at age 66 were talents I took for granted a few decades ago. These seem to be simple enough tasks but it should be remembered that even a genius like Siri can’t do these things very easily so I should give myself a break as well and not be too concerned with these changes.

These superpowers once in hand no longer easily accessed include:

The Begats.  Keeping the names and the progeny of friends and family members straight and remembering without effort who gave birth to whom and in what order. Like the Old Testament in Genesis with all those begats. This contemporary version is harder because it seems back then everyone had his own name and you didn’t have to keep straight all the many Mallorys, Melanies, Melissas and Madison who are in your life.

Old dogs: no tricks. Adults are often surprised beyond reason when they hear a toddler speak perfect French. Well, maybe not like the French majors at the Sorbonne but French that is better than mine despite years of adult effort. While learning algebra or verb tenses seemed to be a normal part of growing up, learning some things grows harder as you age. It seems the memorizing part of your brain diminishes and the area of your brain some idiot designed for forgetting swells up. This is like saving something special in the refrigerator for lunch and having your partner pitch it in the trash (over and over again.)

Disappearing acts. In my earlier days, I could cavalierly reject the advice from Benjamin Franklin or Felix Unger—a place for everything and everything in its place. I could find things no matter I misplaced them. I had a great memory. My bathing suit? At the bottom of the swimming pool. My driver’s license? In that pair of pants I wore last summer. My keys? Somewhere in the house. None of these things were really missing. Just temporarily not in my possession. Now, I am seriously constrained. I spend way too much time putting things where they belong. The ease of the spontaneity has gone. Now, I have a Container Store mentality—I can’t not worry about storage and filing and I hate it. Now, when I lose things, I know right away that they are seriously lost. There is no mystery or hope or wonder.

Mindlessness. There is a lot written about the brain’s executive function. As I understand it, this is your brain’s control center. Like an air traffic manager, this function manages thoughts in and out; it lines up activities. It is a big to-do list maker, directing everything from brushing your teeth to ordering your bigger priorities. I used to leave this function to operate itself. I was confident in the management of my brain. In fact, I would be happy to give it a outsized salary and stock options; it was that high-performing. However, after a decade of disappointing results, I mounted a hostile takeover of operations. Never mind, I grumbled, I’ll do it myself. Now, I spend more time managing things—to do lists everywhere in every format. I write them over and over again. It is weird, no doubt. It is like ordering yourself to do work, like a memo from a manager who doesn’t want to deal with you face-to-face. I have moved from the pleasure of automatic pilot to to-do list automaton. I miss the mindless me.

A tale thrice (or more) told. There is no question but that I was blessed with a reliable memory. Not only could I remember a personal story, I could also recall when and with whom I had shared the tale. Now, when I am about to make a point with that story, I preface the presentation with, “I may have said this to you before” only to have the other party nod as quickly as they can so they don’t have to sit through another rendering. Not only is this embarrassing because it appears you have no recollection of this important conversation you had with your colleague, it is also makes it virtually impossible to lie effectively. To be a great liar, you have to keep track of your tracks and if you can’t do that, you need to be careful with your truth. Maybe, that is why the very young find their grandparents so lovely. Children sense that these elders are not as scheming as their parents because they can’t be. They don’t have good enough memories to cook up an airtight tale. They do, however, have enormous powers to make up things because the facticity of things seems to matter less.

In any case, all these powers came very easily to me in an earlier version of myself and now that they don’t, I am thinking I should make plans to cover my deficits and move onto to some important work legacy-like work. And, in fact, I think the powers that I will discuss below are sufficient compensation for any of the superpowers that I have lost.

I am thinking about the next stage of my life and what I need to leave behind. Erikson’s theories of development suggest that in the last two stages of development that adults are first directed to fashion accomplishments that will outlast them. These efforts are often directed to some work or activities that result in a positive impact for others. The final stage of life is a reflective one where a feeling of fulfillment and contentment may surface if one feels satisfaction from earlier stages.

To guide me in this important work, I draw upon two reservoirs of wisdom: first, the theory of mattering and second, the idea of the summoned life. Mattering is a social psychological concept developed and tested by Professor Gregg Elliott at Brown University. Of all the reading I have done in this field, the appeal of mattering stands out in its power and simplicity. Elliott’s work focuses on adolescent development and mattering explains much in a few empirically tested premises. Three elements are at play here. First, does this child feel that it matters to others that he shows up? Or does he feel invisible when he enters a room? Second, does she feel that other people are invested in her success? Do they indicate that they are on her team? Will they take an extra step for her? Will she feel that she is the object of their special attention? And finally, does the child understand that others can rely on her? That they depend on her to take care of them in some way? Does she appreciate those qualities that she has that others recognize but may be invisible to her?

In my read, mattering works in two dimensions: Am I important to them and are they important to me? Elliott proposed that for children, the former can balance out an absence of the latter. In other words, a child can be neglected by his parents (or the opposite—subject to the object of too much of the wrong kind of attention) yet feel as if he matters if he feels his little brother is relying on him for protection, if his aunt can trust with him to complete his chores, or if a teacher understands that this child will protect more vulnerable children and the child acknowledges that her faith in his goodness.

Although designed to help us understand the treacherous waters of adolescence, mattering has significant practical appeal at each stage of our lives. As an older adult and faculty member, I use every opportunity to help my students understand that they matter. I offer investments and interest–Can I write you a letter of recommendation? I missed you in class on Monday; are you OK? I help them to recognize their strengths, as I understand them. You have such strong analytical abilities, I say. Have you thought about graduate school? Or, I saw how upset you seemed by that comment from that other student. You showed great restraint and did a wonderful job returning our class discussion to a more productive exchange. That takes real emotional maturity. We are lucky to have you in this class.

 I think about a younger generation of colleagues and the challenges they face in moving up and finding their place in the world. For someone with my career trajectory—finding my calling at age fifty—I am a good example of someone who has led a life of experimentation and ‘try and see’. But things seem much more serious for this generation I consider all the messages they receive about how to value their lives. E.E. Cummings once wrote, “To be nobody-but-yourself—in a world which is doing its best, night and day, to make you everybody else—means to fight the hardest battle which any human being can fight; and never stop fighting.”

That sense of constantly working towards who we are is a profound recognition of the second source of wisdom, lessons about the summoned life to use the term coined by David Brooks. On the surface of it, the summoned life appears to stand in direct opposition to living to execute one’s passion. Brooks suggests that there are two paths of living one’s life. The first is to drill down and find one’s passion and direct one’s energy toward fulfilling. This path seems to be the chief and only commandment adopted by career guidance services and admissions offices in colleges. We will help you put your passion into practice. You will never be happy until your passion aligns with your actions. But, the truth of is that we can move through many stages of development in our lives and that the individual who knows his passion early on may be the rare case.

The alternative path is the summoned life where contingencies and circumstances call you to action. We may be without a driving dream but we do have an integrity that is so strong that others seek to engage it. We may lack passion because we are divided among multiple interests but someone sees that we find connections they elude others. We are the sort of people who integrate ideas not dice them into tiny bits.

Like being inspired by mattering, I am likewise energized by this idea of the summoned life and the sort of work I want to engage people in. I would like to create flight plans for enrolling others in the summoned life and in embracing daily practices of mattering. I believe these are important tools for legacy making, not in grand gestures but in generously and lovingly passing along our belief and confidence in generations to come. Both help us understand and activate Erikson’s concept of generativity—the concern for making a mark, for co-creating a desirable future, and for making a sense of optimism about the future grounded in purpose. Maybe, these are super-powers that can only be granted if we are willing and able to forego others.

Bibliography

Brooks, David. “The Summoned Self.” New York Times, August 2, 2010.

Elliott, Gregory, Suzanne Kao, and Ann-Marie Grant. “Mattering: Empirical Validation of a Social Psychological Concept.” Self & Identity 3 (2004): 339-354.

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Coffee, class and culture: Airport consumption patterns as a measure of globalization and status hierarchy

Coffee, class and culture: Airport consumption patterns as a measure of globalization and status hierarchy.

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It takes a village to raise us all

Sometime you hear a phrase so often that you want to offer a reward to the person who doesn’t refer to that same quotation in a speech or commentary, even when it makes perfect sense. I believe that an individual who can reach into her collection of choice quotations and not fall on the easiest pick deserves recognition and praise. So, today I want to leave that praising for another occasion and simply suggest that we all take a rest from employing the African proverb: It takes a village to raise a child. We don’t need that break because this aphorism doesn’t reflect the truth but instead because it needs, as the academics would argue, to be unpacked.

In repeating this proverb so casually, we assume that those villages actually exist for all children. I can make an argument that for the most privileged of our children, that their parents can and do, in many cases, build that village by themselves around their children. They can buy tender and nurturing childcare; they can organize communities to support their children. T19926095-heart-shaped-many-houses-icons-realty-concept-vector-eps10hey can fashion every sort of safety net to make certain that their child doesn’t have to rely on services supported by taxes and donations. It may be too strong a statement but we can suggest that the richest families among us have privatized villages, taking care of their own, of course, and depriving our public spaces of their support and engagement. Take schools, example. It is true that in some areas where there are lots of private schools that public schools are not very good. What sort of relationship is that? Do the parents that can afford to do so get their kids out because the schools are bad? Or do the schools get worse because the talented students and their parents with resources have left them?

If children attend schools where there is a concentration of poverty, research suggests that academic achievement will be low. The segregation of Americans by income, culture and other dimensions, the great sorting out in Bishop’s terms, has been further investigated by Robert Putnam and Mark Dunkleman. They have examined the disappearance of middle-range ties, those connections that bridge income and opportunity classes. This, they suggest, hollows out community and leaves us concerned only about our own, because we don’t have encounters with others who are different from us, face different challenges in participating in the American dream and have worldviews that may challenge our own. It is here where I want to make the connection to those villages that are supposed to be raising children.

I am reminded of the story—more a parable—that is often told to college students and congregants where the teaching objective is to get them to consider the root causes of social problems. The Babies in the River story tells the tale of an individual who quite unexpectedly sees a baby floating in the river, and, of course, rescues him. Another baby comes down the river; another rescue ensues and so on and so on until our hero has to enlist others to help her care for the children. More and more babies arrive and pretty soon, a sizable community is needed to care the needs of these infants. Not only are we pulling them out of the water, we are also comforting them. We are seeing if they are well; we are feeding them and fashioning ways to keep them warm and safe. And, we are continually organizing and re-organizing ourselves. Not only do we need caretakers; we need supplies and resources. We need some assurance that these children are ours to care for. We need someone to make certain that these obligations that we are taking on can be supported by our community. And, we need to rely on people who are just as motivated as we are by this mission to save and nurture these children. Imagine today, if your community—you personally had accepted the responsibility of helping to support an unknowable number of infants. Imagine what you would need to get this done.

But, in the telling, that is not the end of the story. The moral of the story is that someone should travel upstream to see how these babies are coming to travel down the river in the first place. Who or what is creating this humanitarian crisis and what can we do to address this? In whose interest are these babies landing in the river? Is someone benefitting from such an arrangement? The lesson here for students is that we shouldn’t get so focused on immediate needs of those we care for that we neglect understanding and addressing roots causes. This makes obvious sense. If we eliminate a disaster, avoid suffering, that is all to the good. But, I think there is another important point that is not often made.

What has made it possible for that community to organize itself on behalf of the babies in the river? What made it impossible for them to walk away from the river in the comfort that certainly this mission was someone else’s? Or that these children or their parents made this misfortune on their own and that released them from obligation? What made it possible for there to be a match between the needs of the children and those who gathered around them? Where did these resources—time, talent, and compassion—originate? This sort of community making doesn’t emerge out of thin air. And finally, what came before, what human connections, communities of caring, trust and concern had evolved in earlier settings and were activated in this one?

Villages require connections and what some call social capital. People bring resources, which are connected to other people; or they know people. Others know how to get things done; they k20498242-cityscape-sketch-seamless-pattern-for-your-designnow when to call City Hall and demand action. Others know when we need some new ideas. With other talents, some know how to tell a story so that our hearts are fired up and our cynicism melted. All this can be enlisted in the building of our village. To use Paul Light’s term, all are drivers for change and without these, no village is complete enough to care for its children.

Certainly, some of us can pay or move our way out of these sorts of obligations but that is not the sort of society that assembles when there is a need nor it is the sort of village that asks for truth when we seek the source of suffering.

And, as Rasmussen would suggest, we ought to look into our own souls, to see if the problem we aim to fix is one that we may have made.

thIn summary, not only does it take a village to raise a child. It takes a village to raise us all up to become members of a community where we contribute our best and which we can turn to when we ourselves are in need of its care and kind concern.

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Broken Windows: Slamming Doors

 It is hard to get your head around issues that don’t directly affect you or the people in your social circle. So, let’s try a thought experiment. Imagine you are a typical family with a few children, one a teenager and one several years younger. Then, imagine that your wages hardly allow you to get by even with a few jobs and careful management of your income. Then, consider how much you can pay for rent and where you are able to live. And, then let’s say that your choices are constrained by your need to live close to transportation and to members of your family. And, finally, let’s suggest that you are living in a high crime neighborhood, not out of choice but from lack of choice. This fact has some startling implications. One, that your life just getting around the streets could be dangerous. Your chances of being the victim of a serious crime are high, not because of your behavior but because of your location. Second, is that because you are in a high crime neighborhood, police may assume that you are a criminal so you will be the object of aggressive policing. These sort of life experiences can be deeply alienating. Your view of law enforcement—the first-hand picture of state authority—for many of our citizens is complicated. The police seem powerless to get the truly bad actors, evidenced by the declining homicide clearance rates in many of our communities, and they seem to wield too much power to intervene in and interrupt the lives of law-abiding citizens. Then, finally, imagine helping your children to understand how to navigate this world and consider how, as well, to have them embrace the idea of hope in their futures and faith in the system. (Elijah’s Anderson ethnography presents a masterful picture of these challenges.) If you can imagine all of that, then you can come to see the other side of mass incarceration and how it works on a smaller more human scale.

A few years ago, I published an article on the relationship between race, gender and mass incarceration (Enos 2012). I argued in that essay that the regime of mass incarceration had been especially harsh on poor women of color. Using incarceration as the only tool in our toolbox applied a hammer to problems that were more appropriately in the domain of mental health care, substance abuse treatment, social and economic supports and community care. Many researchers have provided careful analyses of the roots and branches of mass incarceration, perhaps the best-known Michelle Alexander’s The New Jim Crow: Mass Incarceration in the Age of Colorblindness (2012), a damning indictment of the movement to mass incarceration in the United States. The New Jim Crow has sparked an important discussion and more significantly, the beginnings of an important movement that not only incites the usual suspects—liberal politicians, civil rights attorneys–but also Republican and conservative stalwarts like Americans for Tax Reform and some elements of the Tea Party.

If Alexander’s book tells the tale of an overreaching, aggressive ever expanding net of criminal justice intervention that captures many poor men and women of color, Jill Leovy’s Ghettoside: A True Story of Murder in America (2015) tells another side of this story. Her careful and compelling study of homicide set in Los Angeles reveals that the clearance rate for homicide in poor communities of color is less than one of out three. If you are unfamiliar with the technical term, the FBI deems a case is cleared when an arrest has been made for an offense or when it is otherwise solved. Meaning that fewer that one of three homicides of black victims in Los Angeles has been solved. There are similar data in other communities. In Providence, RI, of over 110 homicides committed in the period 2000 to 2013, 43% are unsolved. This reflects a national trend. In 1961, 91% of all homicides cases were cleared; forty years later, the clearance rate had plummeted to 62%. This is not because the murder rate is so much higher that the police are not able to get to this work because of an outsized rate of homicide. The number of homicides has fallen. So, as a character in a crime drama might ask, “So, Sargeant, what’s up with that?” What has broken in our system? Why is harder to solve crimes? And, it should be noted that the clearance rates for other index crimes—assaults, robberies–are typically even lower. And, as tragic as these rates are for the larger community, they are worse for black men and communities of color. Like so many of the statistics about race and criminal justice, these data are absolutely and amazingly stunning if we could imagine them in stable middle class communities. We would have overthrown the government, gotten an attorney, filed a civil action, or most likely, voted with our feet, and taken ourselves, our families and our futures somewhere far away. How can it be that law enforcement both over-police and under-police inner city neighborhoods? It is indeed a special dynamic.

As I have written elsewhere, it truly takes a village to incarcerate millions of our citizens. All hands needed to be on deck for this movement to have been as successful as it has been, not just those in the criminal justice system–law enforcement, courts and corrections–but well beyond that to politics, media, entertainment, employment, credit, education and more. And as Alexander notes, to make the whole thing work–to go from a prison population which was relatively stable for decades to doubling, tripling and those numbers, requires a great social ignorance, an inclination to look the other way. The graph compiled from Bureau of Justice statistics shows incarceration rate, which takes into account changes in the size of the population. As can be readily seen, the variation in incarceration rate from the decades beginning in 1925 and extending to 1975 is small compared to the acceleration in the growth curve beginning in 1975 and continuing a steep climb thereafter. These numbers don’t include inmates held in local jails; neither do they count young offenders help in juvenile detention facilities.

For mass incarceration to have succeeded, the usual systems of checks and balances on excessive power needed to be rolled back or rendered ineffective by the failure of the other branches of government to exercise corrective power So, the Supreme Court needed to support a strict crime control philosophy and reduce its concern about due protections which it did in a series of decisions. State legislatures, eager to find money to support the prison boom and the increasing costs of court processing and detention have passed these off to those who are targets of the system through fines, court fees and other assessments that can drive those charged with crimes into deeper holes–financial and spiritual. A recent suit filed in Ferguson MO highlights some of these abuses. Aggressive policing with stop and frisk policies has been credited with reducing street crimes but these are overwhelmingly put in place in poor minority communities casting too wide a net on law abiding citizens and turning residents into suspects by virtue of their addresses.

The role of these developments—court decisions, the imposition of fines and fees, targeted policing strategies—has all been well documented. There has been some coverage of miscarriages of justice where innocent defendants are finally released, some with state-funded compensation and others who have to file suits to get restitution. We could expect in a system as large as our criminal justice system that mistakes would be made. One in four Americans has an arrest record. We spend $70 billion on corrections alone. The criminal justice “system” is not really a system-each part has a different reporting path. The parts are in some instances adversarial and even worse for defendants, sometimes too friendly with each other. The system and its actors has little interest in what happens in other parts of the system so evaluating whether our policies work well rest on questionable measures–the number of arrests, the number of people in prison, caseloads. If our automotive industry worked in same fashion, we would be counting how many carburetors, drive trains and tires were manufactured, rather than examining the safety, fuel economy and features of our cars.

As we think about problems in this complicated system, it is important to distinguish individual errors from systemic failures. The former may be caused by human errors; the latter are errors that lend themselves to correcting through policies and legislation. What makes the U.S. situation even more interesting is the fact that most criminal justice is done close to home. What I mean by this is we have a fifty-state experiment in criminal justice. We see wide disparities in incarceration and sentencing to rates, in how defense counsel is provided, in rates of return to prison, in the discretion given to judges, in policies to fight street crime from city to city. So, we have lots of ways to make mistakes and great opportunities to do better, especially at this time in our history when increasing number of thinkers and law makers are facing the cold hard facts that we have been running down a bad path for way too long at great expense. If we were getting great results, that would be one argument for staying the mass incarceration path but the truth is that those results have been disastrous for many individuals, many families and many communities.

Whats to be done?

This is an auspicious time in criminal justice. Proposals for reform are being advanced from many sectors—law makers, the bar associations, advocates, community leaders, think tanks. It seems that no one is for mass incarceration any more.

What I would suggest is that we understand the criminal justice as if it really were a system. We need to examine each step and stage and think about all the implications that flow from point of determination and discretion. We need to map out the implications for the people caught in the system—not just in criminal justice—but way beyond. We know that having an arrest record follows as individual like a dark cloud, shutting doors and closing out opportunity. We know that fines and fees disable our neediest citizens and fund public institutions on their backs. We know that long sentences don’t correct any more than do shorter terms in prison. We know all this and more. What I suggesting here is that “fixes” need to be systemic and courageous. We can tweak reforms but those adjustments may not be enough to reassure the family we left in the first paragraph that their streets will be safe even though they are poor.

In an essay that will follow this one, I will investigate sources of error in the criminal justice system. Some are related to police procedure; some to prosecution; others to forensic science or what passes as “science.” I will trace the work of the Innocence Project and assess recent court rulings on the assuring that those who are responsible for miscarriages of justice might be held accountable.It is important to consider how much error we tolerate in our criminal justice system as a society that embraces standards of justice in process and outcome.

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Doctoral dissertation

As wonderful as the digital world is with its gifts and surprise wonders, it is somewhat troubling to find that your stuff is online without you having any idea that this is the case.  Just today, I found my dissertation on line. http://digitalcommons.uconn.edu/dissertations/AAI9831873/

I imagine this is a good thing. No one buys a dissertation, I don’t imagine. So, at least putting it online in the digital commons means that it is available to a wider audience. It was published in 1998 so it is a bit dated but that doesn’t diminish my fondness for it–a 200-page ticket to the most fulfilling career I have ever had.

 

 

 

 

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The tests fail us

When you receive a medical diagnosis that is serious, your mind moves out like a posse chasing a dangerous suspect. At first, the deputies fan out in all directions at once without much coordination. One team is off in the hills investigating where all this began, the very moment when your blood vessel bulged. A special team investigates the question: was it climbing up the stairs on the second to the last day of class in the winter session when the pressure behind your eyes pounded so hard that your brain seemed to have been invaded by a timpani orchestra? A squad of detectives inquires: was it that night when in your half-wake consciousness that you felt a sharp pain and colors swarmed in paisley patterns behind your eyes shut and you swear, your eyes opened as well? Members of the posse quickly tire of this chase, especially after learning from the Merck bible that the doctors have no idea of why aneurysms occur. You and the doctors have called back the search parties back from their assignments. So, after the news settles, the investigation begins to narrow and to focus. We find words clinging to diagnoses: we learn new vocabulary. A new word—idiopathic—flows into your conversation with friends. Idiopathic, in medical terms, means “of unknown or spontaneous origin.” Something has gone wrong; they don’t have an idea why. You think what a wonderful word. I can use this to explain relationships gone sour, missing cookies from the cupboard, and maybe, as well, unearned blessings. More about that later.

And, finally after lots of preliminary wondering about the sources of the problem, you understand that it is well beyond the point of wondering who did the dirty deed, it’s time to move to a conviction and begin the treatment. But, this neglects the long periods, or so it seems, of waiting. Every patient with a potentially troublesome diagnosis must feel that his is a cold case. The doctors and the laboratory technicians seem matter-of-fact, too measured, and taciturn. They process your case in turn as if you were ordering at the deli. In a few short weeks, I had two imaging tests and one consult with the neurologist and each encounter would have been enhanced by some training on my part in what Goffman, a favorite people-reading sociologist, calls the signals that we “give off” in impression management. Two weeks earlier, I submitted myself to a cerebral angiogram, a test where contrast is injected into your veins in order to trace your blood flow through the major arteries. The artery under suspicion was the carotid artery, specifically the choroidal artery, as the blood bearer that enters the head making its way from the heart and through the neck.   The technician was matter of fact, as disinterested in my case, as a character you would find in a tale by Kafka . Her voice modulated; her conversation as scripted as any cabin attendant warning you to fasten your seat belt and to turn off electronic devices for the first part of the flight.

The first part of the test is without the contrast, sort of to mark the ground, I suspect. Then the needle goes into your elbow crease at the opposite side of the elbow. I asked, “Will this be cold?” “No, it is warm” she replied. “For some women, it feels like they need to urinate, but that feeling will pass quickly.” I nodded and she returned to her station. The test lasted maybe ten minutes, maybe shorter. In a CAT scan machine, you enter a different time zone. One cannot be trusted to tell the time. It is suspended, in your own particular time zone, as you are when you are in the place where the long trail of medical diagnoses process.. And, that is the funny thing, I suppose. At the time of your life, when you should be most engaged, your brain recedes back and you stall. You begin not to make plans. Things are tentative.

“OK, that’s it. You can relax, Sandra.” She called my name and she was smiling sweetly and patiently. Her manner had changed and I thought, “Hmmm. I have moved or more accurately, my case has moved from “Worries-too-much-middle-aged-woman” to “Cerebral aneurysm. Too bad, she seemed like a nice person.” She helped me from the table and said that the results would be on my doctor’s desk on Monday morning. Surprisingly, the doctor called me later that day asking me to come in as soon as I could. It reminded when of crime dramas when the detective asks the unsuspecting person to come to the station and answer a few questions. Unlike a younger person with fewer medical miles under their belt, I have had plenty of health scares and I can’t tell yet which side of the equation this little medical issue will fall on. As statistics show us about tests, there are only four options:

The test could find something that really is there.

The test could correctly determine that there is nothing there.

The test could find something where there is nothing.

The test could miss something that is a problem.

With a minimal understanding of probability theory, you understand that the latter two outcomes are Type I and Type II errors, respectively. The challenge for those of us facing medical tests is that we have no idea of how accurate the tests are, how often they miss the problem or how frequently they identify problems that are not there. We assume that the tests are accurate with a certainty that simply doesn’t exist.

If I had the powers of reliable prediction, this would save me some wasted concern or it would propel me to get my affairs in order.

When this story happened, I had just one year short of sixty years old. That decade of my fifties had been a good period in my life. In fact, it is miserly and ungrateful to write “good.” These years have been wonderful and blessed. I see my left-sided brain losing its grip and see my right-sided brain coming to the rescue, allowing me to relish the beauty of the visual world. I think this is why middle-aged people find the young so lovely. The visual world begins to kick in and perhaps, in some cases, quiets that noisy interfering left side. It is the lesson of dwelling in the moment that comes with some aging. It is also the age where your contemporaries have survived medical crises. Heart attacks, breast cancer, skin cancer and others. Some close friends have died; our parents have passed away or may be in a steady decline. These incidents all line up and one hardly pays close attention until one takes her own turn. This is not to say that we are not sympathetic to the medical challenges of others but we don’t listen as carefully as we might. I think with deep shame of how not there I was when my mother was admitted to the hospital for emergency surgery. She seemed so intact, so independent, and so not needy of me. I did my duty but I probably was not that loving daughter that I am certain women dream of when they are carrying their children, hoping for a girl with whom to share the pains and promises of womanhood. One can be completely blind to one’s sins if convinced that duty is being done, especially if it is done out of obligation, and not out of love and the opportunity to love more generously.

During that episode, I wrote a question in my journal for consideration, “If you wrote a book this year and it would be the last thing or the most important thing you would write, what would it be about? Who would you want to read it? I have a lifelong friend who has been urging me to write this book for years and I have delayed doing this, believing that I have all the time in the world. I wrote in my journal that if this medical scare passed, I didn’t believe that I would change my life very much. Here is a quotation from that journal entry,

There are people who swear they will live every day to the fullest, that they will greet every day as a gift from God. I am not that sort of person. I am too programmed, too average, too much in my head. I would go on my way, thinking about squeezing in time and space here and there.

A few days later after that first troubling test, I visited the neurovascular surgeon. The doctor was very likeable and easy to speak with. He ordered an angiogram to further study the aneurysm. They are trying to locate the exact place of the aneurysm to determine if it is as dangerous as it looked in the image they had taken earlier. Another procedure. This reminded me of the stories in children’s books where the hero faces a series of challenges, running the gauntlet to slay this dragon or the monster until he is redeemed and can go home again a braver and more courageous person. And, in the same way, the hero is very much alone in this quest, even as the doctor says, “We will try this new procedure to see how we do.” The specialist reveals that discovering the aneurysm was an auspicious event because the original tests to chase down the cause of pounding head pain is completely unrelated to the suspicious blood clot in head. In other words, we are pursuing a villain for an unrelated crime. While potentially life-ending, the blood clot is completely innocent of the crime of throbbing head pain.

A few weeks later, I checked into the hospital for the cerebral angiogram. I took a careful look at the other patients in the waiting room to see if I could draw any conclusions about how sick I might be. I could draw no conclusions. A little girl. A ninety-five year old man. A middle-aged man who had to be lifted from his wheelchair to the hospital bed. I listened to the conversations between the patients, their caregivers and the nurses—all assuredly similar. We had to recite our names, our dates of birth, and the names of the procedures scheduled for us and had to point to the surgical site. I signed some paperwork, including the one document that warned me that the procedure could result in serious damage to my brain or death. I wondered if, perhaps, this was a good time to ask for a second opinion when mercifully, one of nurses brought me a heated blanket. This simple act of care and concern anchored me in a place of dispassionate observation where Buddhists hope to dwell. I was partially sedated and felt calm throughout the procedure as the doctors inserted a tube in my thigh where the dye would travel up to my brain to light up my blood vessels where more images would be taken.

After all the examinations and MRI, the angiogram revealed nothing suspicious. The MRI mistook a congenital bulge in my blood vessels for an aneurysm, sort of the like making a serious error in identifying the wrong suspect in a lineup. I learned that these malformations are common and most of them undiscovered. So, the average patient begins to wonder about these tests and their veracity. The first test that led up to the angiogram was wrong in that it concluded I did have one. The most recent test argued the opposite case. Who knows and should not the doctors tell us, like the pollsters do, about the margin of error? Shouldn’t there be a disclosure on these procedures, some clear labeling? This might read something like, “This MRI misses 15% of the tumors it is looking for and mistakes innocent cysts and congenital abnormalities for cancers/aneurysms 20% of the time. See your physician or a statistician for more information.”

A recent article in the NYTimes makes these points convincingly. Patients are typically not informed about the risks in treatment and tests and they typically over-estimate the benefits of procedures. We believe that each new procedure provides us with an invisible shield of protection when in fact the added benefits may be small. Without this information, we go blindly into the world of medical care. Some may argue that patients cannot understand this sort of information or that they are better off believing in good outcomes, even if these are not the most likely ones. There is a fruitful debate to engage here. But, that shouldn’t deter us from expecting more.

Someday I will write an article one day about my history with false positives tests and their effect on the psyche and the body and the spirit. Every time I receive one of these diagnoses (torn rotor cuff, pancreatic cancer, blocked carotid artery, heart attack, intestinal blockage, and leukemia) I could readily think the worst but these episodes have worn down my anxiety response. I used to think about my will. I fantasized about some lovely and noble ways for the managers of my family foundation to spend my fortune once I am gone, but no longer. With every test that releases me from my near-death sentence, I am reborn as the fool I am. Maybe, my brush with death is not close enough. Maybe, I am too suspicious of the field of medicine. I am growing cynical and suspect that when I die it will be of no cause at all. They will take an autopsy and find no grounds that led to my death–an idiopathic end. And, then I am certain the doctors will suggest to each other that they should have tried one more test or two more medications. I am going to take noncompliant patient to new levels of perfection.

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Coffee, class and culture: Airport consumption patterns as a measure of globalization and status hierarchy

I am sitting on a tiny plane in seat 2A, a prime piece of real estate. I have just transferred from a red eye five hour fully sold out flight from Oakland where I also enjoyed an aisle seat. “Enjoyed” as it is used here is employed in the way one would say that she had a good pelvic exam. I don’t think I slept at all. I ached to sleep but a desire is never as satisfying as the real event, no matter what St. Augustine wrote about this issue, although lust is a nice run up to the real thing.

Dulles Airport, where we landed, has its own culture. I almost ran off the long flight, banging my feet on the jetport to wake up my legs to the task of carrying me into the concourse. It is just before 6 a.m.

In concourse D, few concessions are open. These include the Great American Bagel, Burger King, and for some unaccountable reason, Borders Books. Every individual staffing the fast food counters was a person of color. All the check out people were people of color.  All the baggage haulers were persons of color. I was being overly race conscious here, I guess, but it was startling. A bunch of weary travelers had lined up at Burger King begging the lady servers for breakfast. At the bagel place, they were struggling with a power outage and because of that couldn’t sell anything because their cash registers were off-line. A few of us offered cash way in excess of the cost of a plain, unsliced, untoasted, un-crème-cheesed bagel but the staff refused saying they’d get fired if they processed a transaction like that. So, we all moved on.

A clique of weary travelers made our way to the Burger King, the only show in town. The Burger King staff, maybe they are known as nourishment interfacing agents or convenience food expediters, spoke several languages, which I think is a beautiful thing in our diverse welcoming society. We monolingual Americans were being served by a variety of individuals with command of a multiplicity of tongues and dialects. This is the way we liberals think about migration. We believe it is all to the good or will be some day, if not this morning or later today. However, one problem here was that the food preparers were all Hispanic, I think. I was not certain of the country of origin. The check out lady was from Southern Asia, maybe Pakistan or Bangladesh. The lady taking the order was from Eastern Europe, I think, maybe Poland. I thought how lovely this was that those striving for freedom and life in a democratic state could find themselves joined together in common cause behind a counter at Burger King. I don’t remember many details from my history about the war between Hispaniola and the Indian sub-continent, but if the interaction between the food staff and the check out lady was any measure, there is a reservoir of very bad feelings from this conflict. The Hispanic women making the breakfast sandwiches could not get the Pakistani lady to understand what they were saying to her, no matter how loud they shouted, no matter how many of them spoke together, and no matter how many swear words they borrowed from English to try to make their point. The point in question can be boiled down to a simple one, “Does a breakfast sandwich contain meat just because the wrapper says it does?” And this moves us directly to the subsidiary issue, a simple episode that reveals class conflict, globalization, the hegemony of the West, the failure of our educational system and the need for universal training in sociology.

I joined the ordering queue at Burger King at approximately 6:15 a.m. I was fourth in line. In a matter of minutes, the line had grown to twenty and it appeared that without a miracle, the staff at Burger King would fail to serve any customer at all this morning and certainly, not the requisite share of billions. Almost every one of us in line was white. There was a black woman in line just ahead of me and she fared no better in getting her food from the staff. The customers in line were displaying typical consumer behavior in twenty-first century America. Although we know that behind the counter stands a gigantic corporate entity whose only interest is to make money in this transaction, to convince you to pay everal dollars for food that costs a lot less to prepare, we present ourselves to these corporate monoliths like children before a doting mother. Actually, this is only true of some of these transactions in the commercial feeding industry.

The upper and middle upper classes constitute a special category. Starbucks has created the model here transforming what had been a simple cup of coffee to a drinking experience that conveys and celebrate class distinctions. The upper class aesthete delivers his order with instructions detailed enough to execute D-Day. What I saw this early morning was what happens when the Starbucks crowd finds itself at Burger King, or in other words, what occurs when the upper class takes its consumer behavior and preferences to a typically lower income setting. The first man in line had evidently never been to Burger King or any equivalent fast food joint. He looked at the menu and considered it not like the Ten Commandments, which it is—written in stone, the word made food–but instead like an opening for further discussion. He wanted scrambled eggs and whole-wheat toast. He wanted a latte. He wanted to know if everything was fresh. He wanted soy milk. The ladies behind the counter gave him that sort of big arching eyebrow look that black women deliver most effectively. “What, are you kiddin’ me?” Translated: “You must be insane to ask me that because if I had the time, I would give you a piece of my mind or the end of my fist.” The first man exhausting his welcome asked if they had anything wrapped, like a Devil Dog or something. The second man tried something simpler. He was asking the staff to put together a croissant breakfast sandwich without meat. The woman who took his order nodded and titled her head indicating that like the rest of the cattle, he should move along to pick up his sandwich. I ordered the same thing. We traveled down the line and found instead two English Muffins with sausage. I took mine and moved to the checkout. The second guy decided to rectify the situation. He cut in front of someone and reordered. The same lady nodded and he picked up the new sandwich, which now had ham and was on an English muffin. Partially victorious, he moved to the checkout where another backup was in the making. I had also ordered coffee but that wasn’t ready yet so a bunch of us were waiting around like drug addicts looking for a new dealer. One man actually had the shakes and we had to calm him down. The line continued to grow. The man behind me ordered five sandwiches, all different and specialized.   The lady nodded and pointed him down the line. These customers eventually reached the check out lady who was either praying or swearing to herself. The sandwiches were piling up in the chute. The check out lady would ring the purchases up coming up with widely different prices. I thought this was all supposed to be automated but there were big breakdowns this morning.

It was clear that things were not going to work out this morning at Burger King. The servers should have adopted the stance of my working class mother which is,

Listen, you little brats. This is what I have made you for breakfast. Either eat it now or go to your room. I don’t have all day to cook this and that for you and fussy brother, missy. This is not some fancy restaurant and I am not your slave!

That would have set us straight.

If I had had more time, I would have suggested to the line of customers that we take whatever the cooks made us and paid whatever the Pakistani lady charged us and then gathered our food at the nearest gate. We would disassemble all the food and then remake the sandwiches to our liking. This would have led to a happier outcome and also would have tapped into another bit of my mother’s sage advice, which is, “God’s sake, make your own damn sandwich!”

As I watched the customers, they were slow to learn the drill. They insisted on tailoring their orders. “What kind of tea do you have?” one nice lady asked.

The eyebrow look again, glancing up at the menu,

“Lady, we have hot tea. Hot tea in a cup.”

The lady smiled apologetically, understanding that she had asked the wrong question.

“Oh, no, I’m sorry,” smiling her liberal educated smile, “I meant do you have any green tea? Or maybe something herbal?”

The counter lady didn’t have time for this.

Listen, lady, I don’t know what color the tea is. It looks rusty to me. I don’t nothin’ about herbal.

Well, OK, then. Could I have a cup of hot tea with a two ice cubes in it?

Thinking that today is the day that she has heard everything from these crazy customers, she makes a show of putting ice in hot water, making certain the other ladies see this!

 Now, you want ice in here in this hot tea, right?

She glances at all the customers to demonstrate clearly to them that they are in the company of a bunch of fools and idiots.

So, in a brief few minutes, at this Burger King, we have a glimpse into the class dynamics in fast food. Unsophisticated people may see the scene as bad service but that is a wrong interpretation. What this is is class conflict. A sociologist can see the big things simmering here–the significant differences in the privileges and customs of class, even in something as prevalent as fast food. My mother won’t go to Starbucks. “They ask you too many damned questions there,” she complains. “They makes you feel stupid.” The ladies behind the BUGER KING counter must feel the same way, confronted on these occasions by the upper classes who are demanding accommodations they are unknown in the world of the fast food shoveler. It takes certain denseness on the part of the privileged to expect this. Sort of an ugly American thing going on.

A minute before class warfare broke out, the feeling of the crowd changed.   Word was spreading that Starbucks was open for business in the adjacent concourse. A businessman stopped his order in mid-sentence to abandon his place at the top of the Burger King queue. Others followed in hungry pursuit. The scene was reminiscent of footage of the American exit from Cambodia. That loyal Starbucks clientele was rescued. They could go home to a place where they spoke the language, where their every desire for foam, and cream and shots, for sprinkles, and would be respected and fulfilled.

It is good to go home, even if that is Starbucks. My sociological understanding also suggests that Burger King and Starbucks are stand-ins for different parenting styles in our culture. Starbucks, the indulgent parent who seeks to give his child as much variety as possible and allows him to make his own choices. The psychologists say that this style of parenting leads to great success since the children learn decision making skills early on in their careers. The other style of parenting, the Burger King approach  more the subject of criticism by the scientists is where the parents make the choices and preach obedience, a bending of the child’s will to a larger authority.

I am not certain the Freud would agree with this analysis but I am quite certain the marketing geniuses know that this is the way fast food culture plays out and that they are betting market share on it.

 

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