Bill Cosby’s Case

(http://www.torontosun.com/2017/06/12/defendants-say-the-darndest-things)

A Philadelphia native, I was weaned on Fat Albert cartoons and grew up watching The Cosby Show.  Bill Cosby’s face called out from billboards lining the Schuylkill Expressway and announced the greatness and accessibility of Temple University.  Bill Cosby’s long and varied career made him a local and national legend.  I’ve read with interest the reception his work has received, especially from different individuals and communities of African-Americans in the United States.  Professor Mark Anthony Neal’s opinion piece in The Washington Post (6-17-17) provides ample cultural context for what Bill Cosby did and did not achieve in terms of cultural representation of family life and, specifically of black family life, in the United States.  Neal declared that Cosby became largely irrelevant once The Cosby Show concluded in 1992 and the concurrent Rodney King decision made even more visible the criminalization and unjust adjudication of black men.  In 2015, journalist Roxanne Jones stated that Bill Cosby had “betrayed black community”.  Journalist Denise Clay takes Cosby to task in this June 18, 2017, piece in Philadelphia Magazine.  In a recent NPR piece, journalist Gene Demby writes: “That’s why it’s worth noting how much the very real political position Cosby himself occupied — the kindly cultural ambassador of Negritude — has become if not entirely outmoded, then at least viewed far more skeptically.”

It is not mine to speak for, against, or in neutral terms about Bill Cosby’s interactions with definitions and interpretations of being black in the United States.  No doubt, he already was a controversial figure in this regard in the 1990’s, and his recent increased visibility has heightened the controversy.  While it is impossible and not desirable to remove the question of race from Bill Cosby’s case, I am going to focus more on the elements of the Cosby case that emerge from power, especially television star power, and decades of obscene privilege gone unchecked.  These alleged actions (and some admitted to in the 2005 deposition; quotes from it at this link) are not unlike the alleged violence perpetrated by the likes of Roger Ailes, Bill O’Reilly, and other Fox News power players accused of rape, sexual assault, violence, and subsequent cover-up that occurred over decades. (*See this related Gender Shrapnel Blog post from 9-19-16).  In fact, The New York Times’ and other newspapers’ editorial decisions to place much of the Cosby trial coverage in their “television” sections speak to the focus on entertainment and the media circus, rather than to the real-life possibility that a person seemed to have developed a pattern of administering powerful drugs to unwitting women and then doing to them whatever he pleased.  Editors of respected national dailies have made similar decisions with rape cases surrounding athletic superstars—placing the coverage of the case in the sports section, rather than in sections that typically cover criminal and civil lawsuits.  (*See this related Gender Shrapnel blog post from 1-2-17.)  The fame and fortune of these alleged criminals help their stories to be reported as more pulp fodder, more Kardashian-esque gossip, more sensationalized rise and fall, and less of an actual criminal case that reveals cruel and predatory patterns of the dehumanization of women over multiple decades.

When there is a single he said-she said account of a single incident, we experience great difficulty in believing the person who makes the accusation and finding against the accused.  This somewhat dated (2002) Department of Justice report, titled “Prosecutors’ Charging Decisions in Sexual Assault Cases: A Multi-Site Study, Final Report,” reveals that decisions to charge sexual assault cases do still hinge on perceptions of the accused (more likely to be charged if the person is black) and of the accuser (more likely to succeed in going forward if the person fits the “ideal victim image”, i.e. “pure” or “innocent”), thus striking at the core of race and gender shrapnel.  This much more up-to-date 2016 report about prosecution of sexual assault cases in the District of Columbia demonstrates that police officers and prosecutors need better training on collection of evidence, language for interviewing people in sexual assault and rape cases, and shortened processing times and evaluation of so-called rape kits.  The system still favors letting sexual assault and rape cases go, appearing at least tacitly to reinforce that rape is just supposed to happen.  In this The New York Times piece from June 20, 2017, Susan Chira interviews Jeannie Suk Gersen, who says: “We chose to set up our system to be stacked in favor of the defendant in all cases,” she said. “So, in areas where most of the defendants are male, and most of the accusers are female, it’s a structural bias in favor of males. Even if we were to get rid of sexism, it would still be very hard to win these cases. I think this is what we have to live with on the criminal side, because we’ve made the calculation that this is the right balance of values.”

You would think, though, that if 50 or 60 people told their stories, each story with its own specific context and details, but each contributing to a composite indication of malicious intent to disable people and then to violate them, you might be able to believe the 50 or 60 people who were victims of a pattern of violence and privilege and to act on your belief that they are telling the truth.  The pattern was able to establish itself, in fact, because each of the victims over this long stretch believed it impossible to take on the legendary Bill Cosby.  A person rendered an object might believe herself less important and less able to tackle an enormously difficult task, that of confronting “America’s dad.”

Take a moment to review the accounts of the now 60 accusers (there were 50 back in 2015), outlined here by The Los Angeles Times (6-17-17).  The first woman on this long list must wonder if there would have been fewer (or no more) victims had she been able to go up against Cosby and his star power.  In Andrea Constand’s case against Bill Cosby, Cosby is reported (e.g. here) to have claimed to have given Constand an “herbal” pill and later to have told Constand and her mother that it was only Benadryl.  Lili Loofbourow in the same opinion piece from The Week, quotes Cosby’s version of the events: “’I don’t hear her say anything.  And I don’t feel her say anything,’ Cosby says of the sexual contact.  ‘So I continue, and I go into the area that is somewhere between permission and rejection.  I am not stopped.’”  What the hell?  You were never looking for either permission or rejection because you had drugged the person so that you could ensure her silence and temporary ignorance of her own situation.  Cosby here is trying to co-opt consent language to make the case seem more innocent, but instead confirms the worst—a decades-long pattern of administration of drugs, forceful incapacitation of women, and sexual assault and rape.

The power and privilege of Bill Cosby, television superstar and celebrated member of Temple University’s Board of Trustees, has protected him from the full freight of potential conviction and punishment.  Here I give two specific examples.  First, most individuals with multiple charges of sexual assault against them would quickly lose support from high-level institutions (although we have seen time and again that these individuals often do not lose the support of their wives and/or immediate family members).  Cosby’s 2005 statement about drugging women did not get him removed from Temple’s Board of Trustees.  It wasn’t until the multiple charges were issued ten years later that he “resigned” from the Board.  This 2015 Washington Post piece analyzes Temple’s troubled relationship with Cosby.  Cosby’s lawyer from 2015, Patrick J. O’Conner, is still the chair of Temple University’s board of trustees.  This must send a rather fraught message to the university community about Title IX protections, or lack thereof, for students, staff (of which Andrea Constand was a member back in 2004), and faculty in the university community.

The second example of Cosby’s astounding sense of privilege and protection is his plan to offer “a series of town hall meetings this summer to educate people, including young athletes and married men, on how to avoid accusations of sexual assault,” as reported here in a 6-22-17 piece from The New York Times.  (*See this related post in the Gender Shrapnel Blog.) This plan absurdly ignores that the best way to avoid accusations of sexual assault is not to sexually assault.  This fake rehabilitative proposal is insulting, as is the statement by another Cosby employee that “anything at this point can be considered sexual assault” (same piece from The NYT).  As I write this, another Cosby spokesperson has announced that the time isn’t right for Cosby to undertake these town hall meetings.

This is a Trump world in which reality t.v. glitz and glamour override logic, decency, and even the law.

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Women in the Resistance

(Sojourner Truth, Library of Congress image)

A friend of mine has expressed frustration that most people who “like” the Gender Shrapnel Blog posts on Facebook are women.  Another friend has counted up numbers of women and men at the many resistance events she has both organized and attended and has found that participants are at least 75% women (both cis and trans).  Another friend and I organized a workshop on women’s rights and gender justice.  Of the 166 people eligible to join the workshop, all of the ones who joined were women.  In my experience, working with women (cis, trans, African-American, Latina, white, living in poverty, and middle-class) on issues of gender justice is effective and rewarding.  At the same time, the roll-taking and roster-building become a frustrating exercise of organizing groups whose members are already fatigued from the daily struggle of losing lives, being threatened, earning less, and having less expected of them.  Sometimes, when the white men do get involved, they’re busy telling everyone else all the things they should have already done, or the ways they should have organized the group, or the strategic plan that should already have been put in place.  They tell you all of this, but then don’t roll up their sleeves to get any of the shit done.  This is tiresome, meddlesome, and ineffective.  We need both the less and the more powerful white men to step up and give a shit.

As more people absorb the realities of the loss of black lives and the lack of justice in the adjudication of these losses, more people understand that it is impossible for an oppressed group to effect change alone.  Nevertheless, in the seven months of active resistance I have practiced (and decades of academic-style resistance), I still don’t see enough cis, hetero, white men involved in social justice struggles. Oftentimes, too, resistance movements forget the embedded oppression of women within the movement itself.  When the Communists did their power play on the Socialists in the Spanish Civil War, they relegated the active fighting women to the gendered roles of nurses and cooks.  The patriarchal Communists decided that there should be second-class citizens, and woman was that name.

This interview by Kaavya Asoka with scholar and activist Marcia Chatelain points to the need across all movements, and specifically in the Black Lives Matter movement, to consider the experience of women.  Chatelain says: “I think any conversation about police brutality must include black women. Even if women are not the majority of the victims of homicide, the way they are profiled and targeted by police is incredibly gendered. There are now renewed conversations about how sexual violence and sexual intimidation are part of how black women experience racist policing. You don’t have to dig deep to see how police brutality is a women’s issue—whether it’s the terrifying way that Oklahoma City police officer Daniel Holtzclaw preyed on black women in low-income sections of the city, or the murder of seven-year-old Aiyana Stanley-Jones inside her Detroit home. We know that girls and women of color are also dying. The question is: does anyone care?”

Ah, this poignant question—“Does anyone care?”—must be asked at every turn.  When we don’t ask, we don’t care, and women are forgotten.  I believe this has been the fundamental downfall of every justice movement, whether based on economy or social group or both.  I saw it in Bernie Sanders’ rhetoric, gestures, and actions.  The disastrous Democratic Party Unity Tour launched by Tom Perez and Bernie Sanders reinforced the ways in which women in the resistance are supposed to shut up about women’s rights.  I’ve seen it in local and state politicians who appeal to small groups of voters by assuming that women will sacrifice their own rights in the name of the Democratic party, or who assume that everyone in the room has experienced the life of the boy scout, just like they did.  They are perceptive on other social justice issues, just not the ones for and about women.

A coalition of amazing women, comprised of Linda Martín Alcoff, Cinzia Arruzza, Tithi Bhattacharya, Nancy Fraser, Barbara Ransby, Keeanga Yamahtta Taylor, Rasmea Yousef Odeh, and Angela Davis, composed an opinion piece about women’s resistance published in The Guardian in February (2-6-17).  In the piece, they state: “In embracing a feminism for the 99%, we take inspiration from the Argentinian coalition Ni Una Menos. Violence against women, as they define it, has many facets: it is domestic violence, but also the violence of the market, of debt, of capitalist property relations, and of the state; the violence of discriminatory policies against lesbian, trans and queer women; the violence of state criminalization of migratory movements; the violence of mass incarceration; and the institutional violence against women’s bodies through abortion bans and lack of access to free healthcare and free abortion.”  This platform sees women as part and parcel of the whole platform, not as an add-on to get votes and then not care. The Women’s March and the March 8th protests were worldwide and thus have signaled a generative force across the nations, a group of women and men who are willing to envision many types of equality that sometimes criss-cross and sometimes don’t.

(*See more coverage of International Women’s Day here and here. See also this interesting piece on Chinese-American women’s resistance from the 19th century and the ways in which women’s resistance is less visible than that of men.  This academic piece by Mary E. Triece provides a history of three centuries of resistance movements in the United States. It demonstrates the ways in which African-American men and women at times coincided with mostly middle- and upper-class white women’s movements and at times were marginalized from or necessarily separated themselves from such movements.  The piece is interesting and thorough and also addresses Latinx civil rights movements and environmental justice movements.  Sady Doyle’s April, 2017, piece in Talk Poverty provides statistics about women in the anti-Trump trenches in the United States.)

The activists who wrote the February piece for The Guardian have gracefully integrated the issues of the 99% with issues of women, who comprise a disproportionate number of the 99%, and even more disproportionate when you consider race or perception of race.  The less money you have, the less valuable your time appears to be, and the more people think your labor should be free.  Maybe that’s why black and brown women and men and white women do so much of the labor of resistance—a labor that is never-ending and is never remunerated.  We’re used to having to fight oppression and we’re used to doing it as part of the third or fourth segment of the work day.  Some Cuban women have called this “la tercera jornada” (third workday) because they hold a formal job in the labor sector, continue to do the work of the home, and complete the family’s required volunteer labor.

Here’s how to get involved when you’re not sure how:

  1. Just show up at a resistance event and look and listen. This is a solid start.
  2. Read up on the issues so that you can understand them from a variety of perspectives and speak about them in more fully representational ways. Ask questions of many people.
  3. Sign up to do a small task—invite a speaker, reserve a space, bring food, write a protest script, create a Facebook page.
  4. Support the people who are running events. Ask them how you can help.  Tell them you have 20 minutes a week (or an hour or five) to devote to this work.
  5. Have an opinion and express it well and often.
  6. Write to your representatives on a variety of issues. They don’t have to affect you personally.  They just have to matter to someone or to a group of someones.
  7. Understand different styles of leadership. Some leaders work from the trenches, and for free.
  8. Consider intersectional possibilities, realities, and challenges.

We’re in this for the long haul, so we may as well keep growing and moving.

Mi mamá me mima mucho

“Mi mamá me mima mucho”—a silly tongue twister that I use to have my students studying Spanish practice the five vowel sounds.  We practice it slowly, emphasizing the tight, precise pronunciation of the vowels; then we practice it with speed, attempting a fluidity we hope to capture over time.  We use this easy tongue twister at the beginning of class for the first week or so, and I tell the students that they can call me, stop by my office, or find me around campus to recite it perfectly for extra credit.  Like most tongue twisters, the emphasis is on the sound, not the meaning.  Nevertheless, the “my mother spoils/pampers me a lot” meaning of this tongue twister has kept entering my mind over the past few weeks.  While I am not entirely comfortable writing about my mother being sick or my feelings of gradual, and now imminent, loss, I also feel like I can’t write about anything else right now.  Not about terrible governance, unfettered violence, bad politics, or rife social injustice.  There will be no informative links today, no self-assured comments about everything I know I’m right about.  I mostly just need to keep raining, at least for a little while, even if this isn’t really the point of the Gender Shrapnel Blog.

Last week I dreamt of being chased by a large bear, whose cubs seemed underfoot the whole time I ran.  I ended up in a beautiful treehouse enclosed by glass, scrambling to an uppermost branch which appeared also to be a coffee table.  As I peered down from this perilously high perch, the cubs were playfully trying to join me, and the mother bear was nowhere in sight.  When I woke up the next morning, I couldn’t shake the dream.  I kept mulling it over, ignoring the obvious signs of what the dream was trying to work out.  When I googled “dreaming of being chased by animals” and “dreams about bears,” the quick results managed to take me by surprise and bring a fresh well of tears to my eyes.  I was dreaming about my mother, worried about her cubs, one of which I was (or am).  I was dreaming about slow decline and hospice and loved ones and fear and loss.  I was dreaming about this end stage of life that is such a challenge for us and those around us.  I was dreaming about our perilous perches that barely hold us against the devastation and desperation of the biggest loss of our lives.  I suspect I was dreaming, too, about my own fear of death.

After I gathered myself and moved towards getting work done, images of the dream kept returning, and with them came some kind of odd release.  Suddenly I experienced memory after memory of my mother, who is still here with us, and I gloried in these memories.  My mother casing a thrift shop for great looks and bargains.  My mother as the matron of honor in her youngest sister’s wedding.  My mother with a knife in her hand, looking threatening as the dog took off with one of the 24 sandwiches made for that day’s lunches.  My mother pulling me into a hug after I had a tough day at school.  My mother dressing up for her first day back at work.  My mother in the laundry room on Fairhill Road, surrounded by racks of drying jock straps and baskets of freshly folded laundry.  My mother testing me on vocabulary words for school.  My mother’s ankles creaking as she walked up the steps to tell us all to get to bed, that she had had it.  My mother’s eyes narrowing dangerously as she heard someone mention “a dumb football player,” with her sharp words not far behind, wondering aloud why people don’t talk about dumb tuba players.  My mother going to Europe for the first time at the age of 70.  My mother at 72 climbing the Segovia tower and vowing to learn Spanish.  My mother serving another homemade birthday cake to another excited child.  My mother looking beautiful for a party.  My mother telling us we couldn’t watch t.v., and giving us a list of things we could do (“You may talk with your brothers and sisters.  You may do a puzzle.  You may bake a cake.  You may play a game.  You may knit a scarf.  You may read a book.  You may do an extra credit project for school.  But you may not watch t.v.”).  My mother giving my father a good morning kiss.  My mother saying that if you don’t have something nice to say, don’t say it at all (we have had several debates about that one since).  My mother holding my husband’s and my firstborn and our second-born and helping us to figure out how to bathe them (we managed to forget in the time between their arrivals, but somehow she didn’t).  My mother creating a special jelly bean box for each of the 15 grandchildren and hiding the boxes just before the youngsters’ arrivals.  My mother laughing a big laugh, cracking a big joke, living a big life. The image of my mother from the time I met her when she was thirty to now, at 82, always small and beautiful and strong, always smart and funny and over-the-top kind, often stubborn as hell.  Thank goodness for that flood of memories, which carries more along with it.  Thank goodness for today’s new memories, too, and, well, thank goodness for my mother.

Isn’t it amazing to think about how one life touches so many others, not just in that one lifetime, but way beyond it?  I guess this is the theme of at least one-third of the literary canon.  In the last few weeks, I have shared stories with my mother (“Remember the time, Mom, when we hit a deer?”  “Remember when we went to see flamenco at midnight?”  “Remember when you and dad roadtripped with Pat’s parents to meet our son?” “Remember when I worked at the hospital with you and we drove that old bomber of a car every day?”). I’ve also shared stories about my mother.  I’ve had the pleasure of sharing memories and tears with some of my mother’s dearest friends, who are wondering about her and loving her as they approach the mourning process.  My brothers and sister and I have sat with our dad and told more stories, always with that multiperspectivist view—the cubist painting that is a family.

Of course, a life is the sum of these moments and of the unnarrated spaces between the moments.  How to tell the rest of the story about this beloved and loving person?  Well, it’s impossible.  The rest of the story resides in our laughter, tears, quivering hearts, and little personal memory boxes.

A month after a former colleague lost his mother, I asked him how he was doing.  He said, in his gentle, lilting, extrasyllabic Alabama accent, “Well, you know, it’s your mother.”  That about sums it up, doesn’t it?

One Administrative Assistant I Know and the Unrecognized Value of the Home and Office Resume

How many of you out there are or have been administrative assistants? How many of you work with an administrative assistant?  And how many think about the broad and deep work that administrative assistants do to keep organizations running?  Let’s face it, if an office lacks a capable office manager and/or administrative assistant, the office is not running well.  In this post, I address the role of the administrative assistant (AA), the preponderance of women in these roles, and the generally poor remuneration for and recognition of the importance of this job.  I also want to think about how many of the invisible tasks and responsibilities of the AA translate to other realms in which these jobs are undervalued.

When I was 10, my mother returned to work after having eight children in eight years and getting us all launched into school.  She became a part-time administrative assistant and had responsibilities in two different departments.  She soon moved to full-time work and from there became an “executive assistant.” Although I doubt my mother articulated this, I suspect her years raising children prepared her quite well for the spoken and unspoken tasks of the AA role.  She was expert at managing the lives of nine people.  This meant searching for and shopping for the best bargains at a discount bread store, a meat store, the regular supermarket, and even imperfect dough at a reduced price used for Friday night pizza. (I don’t remember my family ever having a pizza delivered until well into my college years.)  In office terms, she expertly operated the budget and did it better than most of us realized.

My mother was on top of nine schedules for nine very busy people at a time when there were no cell phones and when changes on the fly were difficult to effect.  She knew the logic of scheduling and the need to remind everyone to get us in the right directions.  She alone did the laundry of nine people and knew which uniforms for which events had to be ready on short notice for the next day.  My mother and father also parceled out the chores for all the children, which meant understanding how to do so equitably and efficiently.  My mother was already managing people—her own children’s work and her interactions with the doctor, dentist, teachers, band directors, and coaches of us all.  My mother was also a short- and long-order cook.  Her constant and varied grocery shops reflected the need to plan menus for a big group (again, on a tight budget).  Nine people multiplied by 21 meals a week for each equal 189 meals a week to be planned for, purchased, and prepared.  Two-thirds of those meals were prepared at 5:00 am, before the “official” work day began.

Imagine how easy going to the office must have seemed, compared to all the moving pieces at home.  I believe the underappreciated and usually unpaid (unless it’s outsourced, of course) labor of the home needs its own polished resume, one that reveals the high level of function and decision-making necessary and the great potential to move these skills from the home to the office workplace.  The updated resume should also make clear that these varied skills are essential in the office workplace and not always easy to come by.  Therefore, individuals who can claim these types of experience should be in improved positions to be hired and then to negotiate for higher and more appropriate salaries.

Administrative assistants’ jobs typically include managing the office’s operational budget, event planning, scheduling, communication (on an ever-increasing number of platforms), interactions with multiple people in the office and across the organization, planning meetings, tracking supplies, keeping records and reports, managing business travel, and responding to short- and long-term requests.  The personnel management piece must present deep challenges that many administrative assistants seem to overcome time and again with little fuss or fanfare.

According to this CNN article, as of 2011, 96% of administrative assistants and office managers were women.  (*See this link for more information from the Bureau of Labor Statistics.)  This convincing statistic means that the underpaid and undervalued work of the administrative assistant is by its very nature gendered.  Just as we are often unaware of what it takes to manage a home, we are also unaware of the broad and deep skills required to run an office or an organization.  Bleak statistics (e.g. from this 2015 US News report) on administrative assistant salaries confirm the ways in which we consistently undervalue this work.

Many of the skills and responsibilities I’ve listed above form a part of people’s workdays, no matter the profession.  As a teacher, adviser, committee chair, writer, and collaborator on research projects, I need and apply many of these skills every day.  The labor differential in my profession often falls along these same gender lines, as women pick up the invisible and undervalued chores of the workplace.  One male colleague labeled undesirable committee chair work as “mostly clerical, anyway.”  I translated this offhanded comment as: “I didn’t do the work because it’s beneath me”; “no one pays us for this work anyway”; “these skills are minor, so it doesn’t matter that I don’t have them”; “if I did have these skills, then of course the job would be important”; and “someone else will clean up this mess.”  He was right that we neither value nor compensate well the people—mostly women—who apply these skills in the home or formal workplace.

It’s Raining

 

 

 

 

 

The skies have been sobbing for several months.  Gray clouds, torrents of tears, occasional peaks of sun, more torrents of tears.  The rivers are overflowing, thick brown mud churning as the waters make their serpentine path through this beautiful area.  This is southwestern Virginia in a climate-change spring and summertime.  While skies are gray and rivers are brown, everything else is green, green, green.  It’s beautiful, if you’re in the mood, you don’t think too much about the doom of ignoring climate accords, and you don’t have arthritis.

I’m a bit of a “torrents of tears” person.  I’ve always cried easily—at sad stories, sentimental moments, and hilarious events.  The tears just flow.  I used to apologize for them but eventually learned not to.  Now I just keep tissues nearby.  At this point, too, after having plugs literally placed in my eyes’ tear ducts to slow corneal erosion, tears are always welled in my eyes, just physically sitting there to maintain the health of the windows to the soul. I also use dozens of small vials of artificial tears each week, just in case my own natural sentimentality and plugged tear ducts aren’t enough.  So, yes, it’s raining, and so am I.

Over the last several days, I have sat with my father and brothers in my mother’s hospital room in the ICU.  While the notion and reality of tears and sobbing play a part in this context, my focus here is not on my own or my family’s worry and sorrow.  I’m writing today to sort through, in a preliminary way, what there is to cry about as we consider our health systems.  I’m concerned about three main factors: decentralization of care, poor communication, and high costs.  The comments I make here are quite apart from my support for the Affordable Care Act, which still makes the most sense for most people in the United States.  (*See this post to learn more about my support for the ACA and opposition to the AHCA.)

Deep knowledge about and experience in treating specific conditions are important.  We need nurses, nurse practitioners, physician assistants, and doctors to specialize in treating specific systems and parts of the body and specific illnesses and ailments.  I don’t argue at all with specialization, but I am concerned that an extreme focus on specialization has made us forget about the whole person who becomes the medical (and “medicalized”) subject.  There are excellent medical personnel who are working long hours to take outstanding care of patients.  The complexity of the job they do must be much greater than I can imagine, as they combine intellectual smarts, physical skill and stamina, and emotional intelligence.  They interact with many patients (more and more, as pushed by a healthcare system overly hungry for greater profit), their co-workers, the insurance companies, their internal and external IT systems, and the pharmaceutical companies.  A gigantic population of the aging introduces even more needs and ethical considerations in the healthcare realm.  All the while, medical personnel are trying to take care of real, live human beings who are complicated bundles of the physical, emotional, and intellectual.  They’re also dealing with the families of their patients.  It sounds close to impossible to manage it all, doesn’t it?  But they do it, and they keep up the pace, and I respect this.

One significant problem, nevertheless, is the decentralization of patient care.  From the patient and her family’s perspective, a medical emergency brings a foreign environment (the hospital, with its weird beds, beeping machines, loud entrances and exits, and frequent interruptions of rest and recovery), a host of visits from dozens of medical practitioners (the ones I listed above, plus the people who take meal orders, clean the rooms, and check on insurance policies), and a bewildering stream of disconnected explanations of the patient’s state (platelets here, crackly lungs there, the unexplained threat of “interventions,” whatever they are).  Oftentimes, the general practitioner, or primary care physician, is nowhere on the scene (busy as he or she may be with the hectic day-to-day of office and clinic visits).  This leaves the interpretation of the multiple explanations and medical pokes, prods, and procedures to the surrounding family members, who are often taking turns being in the room to nurture their loved one and understand the medical messages.  It ends up feeling like the patient who has a neurologist, cardiologist, ophthalmologist, oncologist, and hematologist becomes just a line item for each of these specialists, who is doing her or his darnedest to take good care of the patient, but who often seems unaware of the other doctors’ movements. In fact, my mother just spent three days in the hospital before being able to communicate to a medical staff member that she really wanted and needed her teeth brushed.  The little things for a patient’s care and daily well-being also matter and can be easily overlooked.

In my own case, I have a primary care physician who is wonderful.  Nevertheless, when I went to her to try to understand the big picture of my health (which doctors to trust; when to get a second opinion; how a drug for one chronic condition affects a different chronic condition; how certain forms of exercise are of harm or benefit; etc.), she asked quite bluntly (which I appreciated), “What do you want me to do?”  I heard myself answer, “Well, it would be great if you were to centralize my care.”  And that’s when I realized that the only people really centralizing care at this point are the patients themselves.  I realized, too, that this enormous burden, which I believe is a significant outcrop of the medical industry’s attempt to protect itself from risk, has dire implications for patients’ mental well-being.

The decentralization of care connects profoundly to the communication problems in the medical industry.  People who feel well could easily find it hard to track which doctor does what and why, and so imagine the increased difficulties for people who don’t feel well.  Most medical personnel do introduce themselves and identify their roles, but they frequently do not give an explanation for why they are poking, prodding, pouring, or popping.  It is even rarer for an explanation to be linked to the previous ministrations done to a patient.  While there are still many, many nurses and doctors who look at and really see the whole person/patient, many others are distracted by entering data into computers whose screens become the focus of attention.  They mumble to a screen, ask rapid-fire questions whose responses they don’t seem to register, and sometimes even ask why the patient is undertaking a course of treatment prescribed by that very doctor!  Sometimes they don’t even touch a patient, which certainly contradicts best practices from non-western medical traditions.

Some doctors charge patients for a missed or changed appointment, but the patient receives no recompense or reassurance when the doctor’s office changes or cancels an appointment.  Patients also often have to describe their symptoms on one single visit to numerous medical personnel, leading patients to believe that no one is actually listening.  One of my own sources of frustration is the perennial update of the medications list.  I bring an updated list to any doctor I ever go to, but the list is never updated by the next time I visit.  If this small example is extrapolated to the realm of urgent care, then we should have profound concerns about who is aware of a patient’s whole self and well-being.  Who is taking care of this communication?  Do they understand the uneasiness that poor communication sows?  Again, I believe the stresses on medical personnel are enormous, and so I am blaming the system, not its employees.

Not unlike the argument I made about the airlines in the “Who’s Sorry” post, I believe that many of the people on the frontlines of patients’ frustration with the big system are women—nurses, nurse practitioners, nurse aides, and insurance billing personnel.  While 2016 statistics show that CEOs of the biggest healthcare businesses (with pharmaceutical and insurance companies appearing to earn more than hospitals) are mostly men (the people on this list named Jody, Kelby, and Kerry are also men), we know the large majority of nurses and nurse aides to be women (here are old 2003 Bureau of Labor statistics that provide statistics on men and women nurses, African-American nurses, and Asian nurses in the United States; these 2015 statistics from Becker’s Hospital Review sort only by women-men).  Again, the people managing the healthcare industry and earning astronomical yearly salaries (in the tens of millions) are not the people dealing with the day-to-day frustrations of the problematic industry from which the ones in charge profit so greatly.

An additional obvious element of healthcare costs is the impact they have on patients.  (Here’s a useful link from the Kaiser Family Foundation about costs in the healthcare industry.) High premiums and deductibles, reduced employer contributions, decreased job mobility due to limits on pre-existing conditions, and high hospital and drug costs all contribute to a health system that is suffering from extreme ill health.  We need leaders who are willing to have broad and open conversations about the gray clouds and storms of our nation’s healthcare industry.