https://www.youtube.com/watch?v=8CrOL-ydFMI
In the end it is a discussion of presence, patience, awareness, love, fellowship and the oneness of things. Said differently This is Water is about empathy and what has meaning in our culture. It is so full of truth that it makes one imagine that someone with so much wisdom just found it impossible to continue to bear the cacophony and tedium of our world and decided that he had had enough and was ready to move on.
Alternatively, you could read the speech as a PDF if you do not want to buy it as a book.
http://www.metastatic.org/text/This%20is%20Water.pdf
My first time through the book I read it as a message to me as an individual. Later, at some time along the way I began to read the book with the idea that it was a statement to healthcare. I will come back to that later.
After soaking up the wisdom in the little white book I purchased Infinite Jest and several of the other books that he had written in his volitionally abbreviated life. I have failed to make much headway reading Wallace but I still have good intentions. Perhaps I should try an audiobook version of Jest. You might imagine my delight when I heard that there was going to be movie about him. My delight was intensified last week when I heard Terry Gross replay a 1997 interview with Wallace in the context of the release of the movie with Jason Segel paying him.
Hearing that interview with Gross set me off gathering information about the movie. Here are a few of the connections (some with video from the movie) that you may want to peruse:
The New York Times:
So, now triggered by the replay of an eighteen year old interview with a man who has been gone from the world for seven years and is famous for writing a book that I have not been able to read, I offer you thoughts that have occurred at this time because of the release of a movie I have not yet seen! If you would like to hear the interview, be my guest:
I have lifted a few thoughts from the interview that begins with Gross asking Wallace about a recent book he had written which was a collection of essays about a Harper’s article he had been asked to write about taking a cruise. From there their conversation goes on to discuss the happiness of his generation in contrast to their parents and to the advantages that they enjoy. Gross probes him about his own life to try to discover the origins of his generalizations. They touch on irony and television as well as on his book.
What comes across to me is Wallace’s description of a whole generation suffering from some of the symptoms that we could call “burnout”. There are echoes of this point of view in the Kenyon speech given eight years later. As you read the highlights of the interview, try thinking about healthcare professionals collectively, instead of individuals. It is the same leap that I made after several readings of “This Is Water” . I think that looking at us collectively diminishes the individual discomfort of the message and suggests that collectively, working together to define goals and values, we might have a better outcome. I will come back to that after the abridged exchange between Gross and Wallace
Gross: ....We're going to hear an interview I recorded with David Foster Wallace in 1997. In 2008, at the age of 46, he hanged himself. Looking back on his work, New York Times book critic Michiko Kakutani described Wallace as having used his prodigious gifts as a writer, his manic, exuberant prose, his ferocious powers of observation, his ability to fuse avant-garde techniques with old-fashioned moral seriousness, to create a series of strobe-lit portraits of a millennial America, overdosing on the drugs of entertainment and self-gratification... When I spoke with David Foster Wallace, his book, "Infinite Jest," had just been published in paperback, and he had a new collection of essays called "A Supposedly Fun Thing I'll Never Do Again" about the luxury cruise he was asked to write about for Harper's Magazine. The cruise ads promised exciting adventures and entertainment to fill every moment of the day. He wrote, it's as if they were trying to convince you that you are guaranteed of having a good time because the cruise personnel will micromanage every pleasure option, and your troublesome capacities for choice, error, regret, dissatisfaction and despair will be removed from the equation...
GROSS: Do you think that when people are on vacation, they worry that they're not making the right choice in what they're doing and they're not having as much fun as other people on vacation are having? And that when you have the day managed for you, you can just relax because the professionals are handling it for you (laughter)?
DAVID FOSTER WALLACE: I think that's probably true, and I think that there's a weird kind of paradox that the more expensive the vacation is, the more potentially anxiety-producing it is. And that's why I think that, you know, the paradox is that a great deal of the expense of a luxury cruise, other than the facilities, is the - this entire battalion of professional fun managers going around, and a big part of their job is to assure you that you're having a good time. And their smiles were very high-watt, and they were constantly sort of inviting people up to the microphone to give sort of almost evangelical testimony to what a good time they were having.
GROSS: You write, there's something about a mass-market luxury cruise that's unbearably sad. What's sad about it?
WALLACE: Oh boy, I think - now, again, I'm not any kind of cruisologist, right, so I'm just a regular sort of civilian who was on this thing. I think that I noticed the same kind of sadness whenever, in my own life, I know that there's hard stuff that I'm not dealing with...
GROSS: You know, I really like the way you talk. You write about a pleasure and how difficult it can be (laughter) to really achieve. You write about pleasure in the "Infinite Jest," your latest novel. And I'm thinking, you know, one of the things relating to that, in "Infinite Jest," one of the characters finds that marijuana is - marijuana is no longer a pleasurable experience, it just makes him terribly self-conscious and therefore anxious. And I'm wondering what happens to you when you do something that's supposed to give you pleasure and it just makes you uncomfortable or anxious.
WALLACE: Boy, I'm not really even sure how to respond to that. Look, a lot of the impetus for writing "Infinite Jest" was just the fact that I was about 30 and I had a lot of friends who were about 30, and we'd all, you know, been grotesquely over-educated and privileged our whole lives and had better healthcare and more money than our parents did. And we were all extraordinarily sad. I think it has something to do with being raised in an era when really the ultimate value seems to be - I mean a successful life is - let's see, you make a lot of money and you have a really attractive spouse or you get infamous or famous in some way so that it's a life where you basically experience as much pleasure as possible, which ends up being sort of empty and low-calorie. But the reason I don't like talking about it discursively is it sounds very banal and cliche, you know, when you say it out loud that way. Believe it or not this was - this came as something of an epiphany to us at around age 30, sitting around, talking about why on earth we were so miserable when we'd been so lucky….But it just sort of seems as if - we sort of knew how happy our parents were, and we would compare our lives with our parents and see that, at least on the surface or according to the criteria that the culture lays down for a successful, happy life, we were actually doing better than a lot of them were. And so why on earth were we so miserable? I don't think - you know, I don't mean to suggest that it was, you know, a state of constant clinical depression or that we all felt that we were supposed to be blissfully happy all the time. There was just - I have a very weird and amateur sense that an enormous part of, like, my generation and the generation right after mine is just an extremely sad, sort of lost generation, which when you think about the material comforts and the political freedoms that we enjoy, is just strange...
I guess the idea is a lot of the book is about a kind of art film director who eventually comes up with a film that's so entertaining that anybody who watches it never wants to do anything else. Then the interesting thing becomes, if such a thing exists, do you avail yourself of it or not, and various people wring their hands about various elements of that question, but that's part of what the book's about...
Well, I guess the basic idea that - see, I feel lame saying it out loud, and it sounds like I'm Bill Bennett or something. I guess the basic idea that the purpose of life is to be happy or is to experience the most favorable ratio of pleasure to suffering or productivity to work or gratification to sacrifice or any of that stuff, which, you know, a couple generations ago, to say that kind of stuff would have made you, you know, a freak - a freak and an Epicurean - and now seems to be so much - simply an unquestioned assumption of the culture that we don't really even talk about it anymore.
My sense is that we need the very vigorous discussion about values and shared objectives and purpose that both John Toussaint and Patty Grabow have called for in their recent books as one of the first steps of transformation. Healthcare is a part of our entire culture. Our culture is the water that we swim in every day. Wallace evolved his own answer to how to live in that culture and offered it with humor in This is Water. Given that our industry is a part of the larger culture, we are prone to the universal confusion about priorities and purpose. Being a part of the entire community also allows our profession to “heal ourselves”, and then offer more to our patients in their own confusion and anxiety. I do not think that it is surprising that Toussaint’s books are about being “on the mend” or “potent medicine” and Gabow’s book is a “prescription”. Many now see Lean with its articulation of values as a medicine that can heal and mend. I am convinced of its efficacy including its ability to function as a “balm” for burnout. Now if we could just engage the “patient”.
Having coopted the message of the book and movie, I should really read the book and I can’t wait to see the movie, if it ever comes to New Hampshire. It’s not here yet.
Julian Bond: A Unique Voice for Human Rights
Julian Bond’s voice seemed different compared with the other voices coming from the civil rights movement of the sixties. He seemed younger. He was very articulate and he wanted to be in a broader conversation. Like Dr. King he spoke not only to the injustices visited upon African Americans, he spoke to injustice in all its forms to all people. Like Dr. King he was early to link the conversation between civil rights, poverty, education, inadequate housing, lack of economic opportunity and healthcare. He was an outspoken critic of the war in Viet Nam. He was so outspoken that when he was elected to the Georgia House of Representatives at age 25 in 1965, the House refused to seat him because they thought he was a traitor. It took an appeal to the Supreme Court to reverse the circumstances and preserve his right to protest and to serve in public office.
While thinking about how to demonstrate his intellect and wit which was consistent across fifty five years of presence as a participant and a spokesman in the journey toward equality in this country, I thought, “Why not let him speak for himself?”. With that in mind I found an article on the Internet that I offer to you:
President Obama put his life in context:
Julian Bond was a hero and, I’m privileged to say, a friend. Justice and equality was the mission that spanned his life – from his leadership of the Student Nonviolent Coordinating Committee, to his founding role with the Southern Poverty Law Center, to his pioneering service in the Georgia legislature and his steady hand at the helm of the NAACP. Michelle and I have benefited from his example, his counsel, and his friendship – and we offer our prayers and sympathies to his wife, Pamela, and his children. Julian Bond helped change this country for the better. And what better way to be remembered than that.
And now in his own words:
- America is race. From its symbolism to its substance, from its founding by slave holders to its rending of the Civil War...From Emmett Till to Trayvon Martin and to Michael Brown.
- Violence is black children going to school for 12 years and receiving 6 years worth of education.
- Good things don’t come to those who wait. They come to those who agitate!
- If your Bible tells you that gay people ought not to be married in your church, don’t tell them that they can’t be married at city hall. Marriage is a civil rite as well as a civil right, and we can’t let religious bigotry close the door to justice to anyone.
- ...Leadership can come from anywhere. You don’t have to be a certain type of person or have a certain type of education to be a leader. You just have to be willing to throw yourself into the fight. That’s all it takes.
- Many are attracted to social service-the rewards are immediate, the gratification quick. But if we have social justice, we won’t need social service.
- The civil rights movement didn’t begin in Montgomery and it didn’t end in the 1960s. It continues to this very minute.
- The humanity of all Americans is diminished when any group is denied rights granted to others.
- There is no coloration to rights. Everybody has rights. I don’t care who you are, where you come from. You got rights. I got rights. All God’s children got rights.
In case you want to read more about Julian Bond let me offer you the following links. The WBUR link is especially good because it contains an interview with Shirley Franklin, the first black woman to serve as Mayor of Atlanta. She was a close friend and colleague of Bond's. The report also contains 1968 footage from the turbulent Democratic Convention in Chicago where there were riots outside and old school politics winning inside. Robert Kennedy had been recently assassinated and Eugene McCarthy’s inspiring candidacy was losing ground to the establishment choice, Hubert Humphrey. Bond, age 28, led an alternative Georgia delegation which created a controversy at the convention. He was nominated for the Vice Presidency by the Wisconsin delegation, despite the fact that one must be 35 to serve. A young Dan Rather then interviews him on the floor of the convention and Bond reveals that he knows that he is too young to be nominated but he hopes that the nomination will be his ticket to address the convention. He knows that the civil rights of black Americans is important but so is ending the War in Viet Nam and our attention to the issue of poverty for all Americans. It is history worth watching as Bond expands his concerns beyond the issues that relate only to African Americans.
The New York Times obituary is a complete review of his accomplishments.
Bond wrote books, taught at several colleges and became a regular on the lecture circuit. As the rights issues of the day changed, Bond kept up. When black civil rights leadership was slow to push for gay rights in America, Bond called those leaders out, like in this 2012 CNN interview.
BOND: They've adopted our songs; we ought to be happy. They've adopted our slogans; we ought to be happy. And when others imitate what we did to gain their rights, we ought to be first in line to say can I help you. You helped me. Can I help you?
SANDERS: Bond never really stopped. Just two years ago he was arrested at the White House during a demonstration over the Keystone Pipeline. Some of the protesters used plastic ties to chain themselves to the White House gates. Bond and organizer Bill McKibben ended up in the same police vehicle.
BILL MCKIBBEN: Sitting there in the paddy wagon - talked beautifully about the connection of struggles. The civil rights struggle and the fight for a livable environment and the fight of economic equality and things were all part of the same broad struggle in a very deep way.
SANDERS: A 73-year-old Julian Bond in handcuffs with a stranger speaking to the theme of his entire life with clarity that many struggles for rights across the globe are and always have been connected.
I feel that connection to our journey in healthcare. It was Bond’s mentor, Dr. King, who put the two together when he said:
Of all the forms of inequality, injustice in health care is the most shocking and inhumane.
Julian Bond was true to a mission for 55 years. He saw a little progress, but when he departed I am sure he would have said that there is still so much that needs to change. The confusion that our candidates for president demonstrate when confronted by the issues of “black lives matter" is a manifestation of that reality. Last week I tried to give a sense of our history and the one hundred plus years of effort that have brought us this far in the quest for affordable high quality care for everyone. I am sure that there are many years left to go before there will be equality in healthcare. We will never reach the Triple Aim until there is more progress in all forms of civil rights and we have equal educational and economic opportunities. We must also become better stewards of our scarce resources. Many may believe the dream is impossible. I doubt that Bond was in that group. He is one who never gave up and he should be a continuing inspiration for anyone who dreams a dream of a better world.
Big Happenings at Fenway and at the Beach in North Carolina
Monday evening Russ Morgan, who is the technical magician behind the publication of these musings and strategyhealthcare.com, drove down with me from New Hampshire to watch his first game at Fenway. We saw the Sox lose 9 to 1 but Russ was able to capture the picture that is in the header. We consoled ourselves enjoying a deep conversation about fan loyalty. As the week evolved it looks like we saw the only disappointing game of the week. It is my hope that when Deb Smith (the drawing was supervised by my wife) enjoys these same seats on September 9, as the Sox take on Toronto, the game will be more like the terrific win last night against the first place KC Royals, who have the best record in the American League, than like the game that Russ and I saw!
I feel that I need to share another big event, that has made all the Lindseys very happy, from the life of my father who will have his 95th birthday in December. Things are really looking up for him. You might remember that he had a tough road with two horrendous falls resulting first in a hip fracture five months after Mom’s passing and then a year later a second fall left him with a pelvic fracture. He was really struggling after the death of my mother in January 2013. They had been married almost 69 years.
Over the last year he has received terrific care from his PCP from Carolinas Health. He has had counseling, a vigorous program of balance exercises and was walking daily for strength development. Now he is much better. His doctor (son of his former doctor and neighbor) has continued to reduce his meds and he has lowered the sodium in his diet. He walks a mile or more every day, rain or shine, and he now has a social life. He has had several outpatient eye surgeries to prevent recurrent infections without missing a beat in his exercise program.
About four months ago my sibs and I discovered to our surprise that he had a “significant other”. He began spending more time at her house than at the home he shares with my brother. He was always careful to drive home before dusk when his vision gets tricky, but it became increasingly obvious to all of us that he wanted to spend more time with her than just a long afternoon.
Mary Lou and Dad have known each other for many years. Like Dad, she lost her spouse about two years ago. She was a friend of my mother’s although she is almost twenty years younger. When my parents moved to Atlanta they emailed regularly. After a lot of planning, Mary Lou and Dad tied the knot on Wednesday while at a Seniors’ Retreat with their friends at the beach in North Carolina. My brother was there to represent the family and take pictures, and we will all gather in the fall to make sure that Mary Lou understands how wonderful and brave we all think that she is and how happy we are that she is now in a part of the family.
I’ll present my Dad as an example of “the possible”. He made it back to a sense of purpose and refound his joy for life with the help of a lot of talented providers and dedicated people. I am sure that he would agree with the idea that everyone deserves the care and support that was available to him. I am sure that Julian Bond would agree and I think that those dedicated to making the Triple Aim a reality are immune from the anxieties and pain that David Foster Wallace wrote about. It was Wallace’s thesis in This Is Water that by exercising empathy and awareness we can have a better life in a world with less anxiety and confusion. I bet I can find the same idea buried in Infinite Jest if I just keep trying to read it. It is a universal truth.
Follow my Dad’s example and find a good reason and a good friend to take a walk with you this weekend.
