Challenged

Many years ago, I met someone who was born deaf.  “Deaf” was the term of choice back then.  The hearing loss was profound and probably due to complications from maternal rubella.  Nevertheless, this person had learned to speak fluently and confidently.  And, she had graduated valedictorian, at the top of her professional class.

I had the opportunity to talk to her mother and ask how she had taught her daughter to speak.  Her mother first told me about the older and unimpaired sibling.  “With our first child, we had to repeat a sound four or five times.  With each repetition he took in more information, until he could accurately repeat what he had heard.”

“With our younger daughter it was different.  First, we had to recognize that something was wrong.  Once the proper diagnosis was made, we had to get her fit with the best hearing aids available.  Even with that, she had only one or two percent of normal hearing.  Then came the hard work.”

“Instead of repeating sounds five or six times, we had to repeat sounds 50 or 60 times.  But, if we did this enough, if we persevered, she too got enough information in to be able to imitate and repeat our words.”

This story is filled with important lessons that I shared with many patients and parents.  First, a problem must be recognized and acknowledged, then followed by a thorough evaluation.  Proper treatment begins after an accurate diagnosis is made.

I compared the hearing aid to medication.  The hearing aid was not a cure.  Often, neither is medicine, especially when prescribed for conditions like ADHD.  The hearing aid created a window of opportunity, an increased receptivity to sound.  It made learning sounds possible.  Like the hearing aid, ADHD medication is prescribed in order to create an increased opportunity for learning. If medication allows more information to get in, more efficiently, then more learning is possible.

I reminded parents that the hearing aid did not make the hearing perfect, but it helped.  Medication does not make things perfect, but often it helps.

I pointed out that had the mother tried to teach speech without the use of a hearing aid, all the hard work would have been for nothing.  But if there had only been the hearing aid, and not all the hard work and diligent teaching, nothing would have been gained.   I cautioned parents that medication is not the end point, only a beginning.  The hard work of diligent parenting and teaching must follow.

I encouraged patients and parents to remember that this young girl’s deafness was a daunting challenge, but it was never allowed to become her excuse.

November 22nd, 1963

November 22^nd,1963, my tenth birthday, was marked by two great occurrences, one of great historical significance, one of great personal significance. 

It was lunch hour at school.  I’d finished eating and was outside for recess.  My friend Paul lived nearby.  He’d gone home for lunch.  When he got back to school, he immediately looked for me on the playground.  He told me that President Kennedy had been shot. My initial reaction was disbelief. I told Paul that I didn’t appreciate his humor, especially on my birthday.  However, I soon realized he was not joking. Something serious had happened.  We returned to class.  The teacher was in tears.  A black and white television was set up for us to watch.  We heard that President Kennedy was dead.  We continued to watch the news quietly, until it was time to go home. 

If I recall correctly, this took place on a Friday afternoon.  I am told that memory is quite unreliable, yet my recollections from that day feel very real to me. 

I got home.  Our television set was on.  A birthday celebration had been planned, but my parents were unsure what to do.  We ended up going out for a birthday dinner.  I remember the restaurant being very quiet, the employees and customers very somber. A television set was on for all to watch.  After dinner, there was a muted celebration. Relatives came to the house, presents were opened, and birthday cake was served. 

The day Kennedy was assassinated marked the end of “Camelot”, a period of national optimism and innocence.  What followed was the tumult that characterized the remainder of the ‘60’s. 

November 22^nd, 1963 was also the day my parents gave me a microscope.  It was not a plastic toy microscope.  It was a Swift student microscope, the kind used in the high schools.  It came in a heavy locked wooden cabinet.  It was anchored to the cabinet by a bolt, so it couldn’t slide around and get damaged in transport.  It had built in illumination and could magnify up to 600X. 

Over the next months and years, I built a small laboratory in the basement.  I did some primitive dissections, mostly on insects and worms.  From my specimens I prepared some primitive slides.  However, my favorite ‘experiment’ was examining drops of pond water under the microscope to see otherwise unseen creatures; daphnia, paramecium, and amoeba. 

Around then, I read Microbe Hunters by Paul De Kruif.  I learned about Louis Pasteur and Robert Koch, scientists who used the microscope to discover killer bacteria, heroic discoveries that subsequently led to cures and the saving of countless lives.  These famous scientists became my inspiration.  As it turned out, the day I got my microscope marked the beginning of a personal journey, culminating in my medical degree. 

November 22^nd, 1963, was my tenth birthday. It was a day of great historical significance.  And it was a day of great personal significance.  I remember that day well.

Discipline

“True freedom is impossible without a mind made free by discipline.”  Mortimer Adler (1902—2001)

When children and adolescents came to the office with out-of-control behavior, it was rarely for lack of punishment.  Many had accumulated years and years of punishments.  They’d been spanked, grounded, and yelled at.  They’d lost privileges and had possessions taken away.  Some had even been to court, in juvenile detention or on probation.  Most of these youngsters were over-punished and all were under-disciplined.

Mistakenly, impulse-ridden acting-out children are often labelled ‘willful’ whereas it would be more accurate to label them ‘will-less.’  They are not making ‘bad choices.’  There is no act of decision making.  Without self-discipline they don’t stop to think and choose.  They react.  Like tapping on a knee, their behavior is reflexive, not reflective.

It is important to know the difference between discipline and punishment.  Discipline comes from the Latin root ‘Discipulus’ meaning pupil.  Discipline is process of teaching that emphasizes hard work, the practice of good habits over time, setting long-term goals, and accepting delayed gratification.

Take for example a child learning to play a musical instrument.  Discipline is the 15 or 20 minutes spent practicing every day, even when they’d rather being doing something else, even when it feels boring or hard.  It may feel like punishment, but it’s not.  At first the music sounds clunky.  Scales are no fun.  But stick with it for a few months and they begin to play some melodies.  Stick with it for a few years and they begin to play and create beautiful music.

Punishment is getting yelled at or grounded for not practicing.  Punishment gets you no closer to the goal of mastery.  Practice does.  Inevitably a parent asks, “What do I do if my child refuses to practice.”  I reply, as in the movie Apollo 13, “Failure is not an option.”  “If your expectations are clear, your child will practice.”  (By the way, it is estimated that 1,200 hours of practice are needed to become 'good' on the violin.  6,000 to 8,000 hours of practice are needed to become a concert violinist.)

There are important keys to raising a disciplined child.  It takes a caring and committed parent, willing to instruct and to model.  The parent must teach the value of delayed gratification and help their child to set long-term goals.  The parent must motivate, conveying the belief in their child’s capacity for ultimate success. 

Disciplined, a child learns to postpone immediate gratification for more distant goals.  Disciplined, a child acquires the self-confidence that comes from hard work and achievement. Disciplined, a child grows prepared to assume adult responsibilities to family and to community.  Disciplined, a child is prepared to face life’s trials and challenges with courage and with character.

The Giving Tree

A popular children’s story begins, “Once there was a tree and she loved a little boy.”  When I first read The Giving Tree by Shel Silverstein, I didn’t understand its wide appeal.  I thought it was an awful story about a self-centered child and a tree who couldn’t say ‘no.’  I thought that the story might as well have been titled The Taking Boy.  The tree gave without restraint, and without any expectation that the boy give back in return.  She gave until there was no more to give.  The boy initially loved the tree as a child might love his mother.  But as he grew, the tree became his object to use and exploit.  She freely gave, and he selfishly took her fruit, her branches and even her trunk.  He wasn’t concerned for the tree’s well-being.  He visited her only to ask for more.  He never said thank you.  He didn’t call on weekends.  He never brought his family over to visit.  Had the tree ever said no to the boy’s request, I believe that the boy would have left and never come back.

Over the years, as I’ve reread The Giving Tree, I’ve come to believe that there is a great deal of subtlety to the story, subtlety that I did not originally recognize.  If the story is heard as a charming parable of loving and giving, then I believe that the meaning is missed.  If it was intended as a children’s story, it is a children’s story without a happy ending.  The illustrations in the book are telling.  The pictures are sparse, lines drawn in black and white.  The little boy becomes an unhappy, withered and worn out old man.  The tree is reduced to nothing more than a stump to sit upon; nothing left to give, nothing left to offer to a new generation.

The Giving Tree is a classic best-selling children’s book.  What is its appeal?  Perhaps, each of us has wished at some time or another for a giving tree, a source that gives without end and that asks nothing of us in return.  The brilliance of the story is that it does not romanticize this fantasy.  Instead, Silverstein shows us the ultimate emptiness of mindless indulgence.  Some wishes are best left not granted.  Sometimes it is important for parents to set limits, for children to hear, “Enough!”  The story is as much for parents as it is for children. Who among us as parents wants to raise a taking child?

American History

There are no facts, only interpretations.” (Friedrich Nietzsche, 1844--1900)

History is not objective.  There is no such thing as “what really happened.”  History is made of facts selected, facts ignored and omitted, facts interpreted and ultimately facts arranged into a narrative. Histories are written, rewritten, and perpetually revised often reflecting the tenor of the times in which they are written. Though built upon facts, History is a subjective story that mirrors the historian’s bias and agenda.

My high school American History textbooks were written in the 1950’s or early 60’s, pre-Viet Nam, in the congratulatory post-WW-II years. My textbooks were full of facts to be memorized. The narrative was patriotic.  The focus was largely on events involving presidents, politicians, generals, explorers, industrialists, inventors, and an occasional scoundrel.  With a few token exceptions, American History was largely about the achievements of our nation’s notable white males.

A few months ago, I read These Truths: a History of the United States by Jill Lepore (2018).  It is a history of America from colonial through modern times.  With the facts she selected, omitted, interpreted, and wove into a narrative, this female historian has authored a new, credible, yet very different American History.  Her narrative is filled with facts about the often over-looked; African-Americans, Native Americans and women. Her history is full of facts, but it is a very different history from what I was once taught.  It is a more nuanced and questioning narrative that includes both this country’s epic achievements and its epic short comings.

I can’t help but wonder how today’s news will one day be recorded in the history books.  In real time, based on the same daily ‘facts’, there is no agreed upon narrative. There is a FOX narrative and there is a CNN narrative.  There is a GOP narrative and a Democratic Party narrative.  There is a narrative from those who are rabidly pro-Trump and a narrative from those who are equally adamant that Trump must go.  Fifty years from now who will tell the story?  Who will be the interpreters of these times?  Who will decide what facts to include and what to omit in the high school textbooks?  What will be the agenda?

Fifty years from now, these turbulent and troubled times will be written about and remembered.  But not objectively, not “what really happened.” There is no such thing.

Memories

I visited an old friend today.  His kid sister and niece were there too.  I did a lot of talking, recounting many memories of our growing up.  We go way back together.  I met Marc through a common friend when I was in second grade and he was in third.  I remembered that we went to Ash Grove Elementary school.  I remembered that I lived on Monaco Street and he lived on Ginger Court.

I talked about memories of the many adventures we shared over the years.  I recounted tales of our prowess playing touch-football. I recalled our competitions on the tennis court, at the poker table and over the chess board.  I remembered, when we were a bit older, the many times we skied together at Loveland and Winter Park. 

I remembered the times we got together at my house to ‘jam’, Marc on the violin, me on the guitar, our friend Paul on the piano and another friend Steve on clarinet.  Marc’s sister reminded us of the times at his house where we brought our stamp collections together to barter and to trade.

Marc and I once drove together to California to visit a friend.  I remember on that trip camping at Yosemite among the bears and camping at Lake Tahoe among the casinos.  Coming home, we camped at the Maroon Bells among the aspens.

When I was in medical school and Marc was in law school, we shared a house.  If I remember correctly, our total monthly rent was $121.72.  I remember that Marc disliked my cooking, especially my turkey soup made from a leftover carcass.

I remember being there for each other as we weathered the ups and downs of girlfriends and dating.  Eventually, I introduced Marc to my cousin, and they got married.  The same cousin introduced me to my wife-to-be.

Today, I shared with Marc my memories of last night, when I attended his daughter’s wedding.  I shared with him how in love his daughter and son-in-law appeared to be.  I told him that his other children seemed well and that his grandson looks just like him.  I told him that he could be very proud of his family.  I assured him that even though he wasn’t at the wedding, he was not forgotten.

Today, I was flooded by memories.  I needed to tell the old stories.  Marc had no stories and no memories to share.  About eight years ago his family noticed some subtle changes in his personality.  Now, he is in a nursing home due to his advanced dementia.  Marc has tremors. He speaks but a few words and can barely stay awake.  Marc was a good man and a dear friend.  Why this?

Marc no longer recognizes me.  For a few moments he seemed to recognize his sister and she was able to get him to smile, a smile from the past that I remember very well. 

Ecclesiastes

One week ago, on the holy day of Yom Kippur, Jews prayed that they be inscribed and sealed in the Book of Life.  How odd that one week later, on the harvest festival of Sukkot, the biblical book of Ecclesiastes is read in which a disheartened author questions life’s significance.  “I thought the dead more fortunate than the living.  Better off than either is he who has not yet been.”  Last week we prayed for life.  This week we ask, “Why?”

Koheleth, the author of Ecclesiastes, raises fundamental existential questions. What is the point of our lives?  What is purpose of human events?  Like many of the modern existentialists, Koheleth finds no obvious answer.  To him the world appears stale and unalterable.  “There is nothing new under the sun.”  He comes to doubt the divine attributes of justice and mercy in a world where those who are evil prosper and those who are righteous suffer.  He finds nothing of substance in the pursuit of knowledge, power, wealth or pleasure.  All is for naught.  The wise and the foolish, man and animal, share the common fate of death.  Better never to have been born.

“Vanity of vanities, all is vanity.”  This familiar refrain, from the poetic English of the King James Bible, echoes throughout Ecclesiastes.  However, a more accurate translation of the Hebrew word hevel is not vanity, but breath or vapor.  “A breath of breaths.  All is but a breath.”  Ecclesiastes is not about vanity.  It’s about the elusive and illusory nature of our lives.  All is transient, like a breath exhaled, visible momentarily and then gone.

Despite doubt and disillusionment, Koheleth teaches a pragmatic philosophy of happiness.  Know that the cycle of life and death is inescapable, “a time to be born and a time to die.”  Therefore, understand and accept that which is inevitable.  Don’t pursue what is futile, because that leads to despair.  Instead, savor if you can the good fortune that comes during the brief span of life.  Live life in moderation.  “Do not be over-scrupulous.  Do not be wicked either.”  There is solace in the words of Koheleth, reassuring us that we don’t have to be perfect.  “There is no man so righteous that he always does what is best and never makes a mistake.”  Enjoy youth, appreciate good health, and rejoice in life’s bounty.  Seek companionship and “enjoy life with the woman you love all the fleeting days of your life.”

Why is Ecclesiastes read during the joyous harvest holiday of Sukkoth?  Rosh Hashana and Yom Kippur, the Days of Awe, have just passed.  Perhaps Ecclesiastes marks the beginning of a new spiritual cycle.  Yom Kippur and Sukkoth. . . “To everything there is a season and a time to every purpose under heaven.”  A time to repent and a time to question.  A time for faith and a time for doubt.