How Important is a Hyphen?

How much of your own experiences that shaped your character will be passed on to your children? Will they be able to learn the same lessons you learned the hard way, i.e. by experience, or the easy way, i.e. by you teaching them?

I think this is a struggle that every family in America must contend with, and is especially true with immigrant families, as Seema Jilani describes. In America, there is at once a sense of the nation being a “cultural melting pot,” but within those groups, there is a rising tide of resistance that those original cultures should not be amalgamated in entirety such that their ideals are erased forever.

Jilani has a powerful testament to her own upbringing in America, using the metaphor of the hyphen:

At the dinner table, my father once coached us, “When people ask you where you’re from, what do you say?” I guessed, “Pakistani-American?”

“Wrong. You are American. Period. Lose the hyphen.”

That hyphen held our traditions, our dichotomies, our complexities, our spicy food and an even spicier culture, rich with tradition. That hyphen was the bridge to our past.

Seema Jilani

I think that there are two meanings to this. The hyphen is important; it contains the history of a family and the culture and values they bring with them. Those should not be forgotten. But ultimately, we are Americans first.

We all have a hyphen; it may not be another country, but that hyphen is by definition a part of America, and that should not be forgotten either.

Dossier

“My Daughter Passes for White,” by Seema Jilani, February 28, 2020. https://www.nytimes.com/2020/02/28/opinion/biracial-pakistani-child.html

The Value of Downtime

The appetite for written work has diminished. People don’t read nearly as much as they used to, choosing to watch or listen instead. Ironically, in an attempt to be more productive, people end up being less focused and therefore less engaged.

EDIT: I wrote this well before the COVID-19 pandemic came to full force. I think it is even more relevant now that we have been relegated to our homes, stuck to ponder. The downtime we have has sparked people to recognize that having purpose to life is critically important to sanity. While being “productive” in the common sense of the word is not necessary, it can imbue meaning. However, just relaxing during this time is perfectly fine. Just because you didn’t learn a new skill or read more books, does not mean that you wasted your time.

It also leaves little time for thought. So many fill their downtime—during a commute for example—with podcasts and audiobooks. With the advent of waterproof phones, even the once pristine shower has not been spared. We no longer have any sanctuaries of thought. Productivity seems to have taken over. This is why it can be important to throw productivity to the wayside, slow down, and be alone with your thoughts.

This is where music is useful. People listen to music all the time, but often only when doing something else mundane. And I think that robs music of its purpose. Music takes you on a journey of emotions. It allows you to feel emotion. Therefore it is valuable to listen to music and do nothing else. Allow your thoughts to wander and roam, guided along an open field by the music.

Dossier

“Is Reading a Chore?” by Sahil Nawab, April 24, 2020. http://www.sahilnawab.com/blog/is-reading-a-chore/

“Why Boredom is Good For You,” by Veritasium, September 29, 2018. https://www.youtube.com/watch?v=LKPwKFigF8U

Utopia to Dystopia

A few conflicting trends can be seen in society today. Over the past few decades, we have been a part of an unprecedented acceleration; one of technology, productivity and output, material consumption, pace of life, depression, and loneliness. Is all of that “forward” movement good? Or is it even movement at all?

Ross Douthat, in “The Age of Decadence,” argues that “the feeling of acceleration is an illusion, conjured by our expectations of perpetual progress and exaggerated by the distorting filter of the internet[.]” This American ideal that the future will be always be better is actually quite recent, and unique.

The peasantry in medieval Europe would not have such beliefs, but rather thought of a past in which Christ’s redeeming qualities were more than the abstractions described by the clergy. Even Renaissance writers described the exalted classics of Ancient Greece and Rome, believing that they would never be matched by their contemporary work. In this age, ironically when compared to today, only in the Islamic World did the future look bright, with scientific and literary advancements coming at a breathtaking pace.

When the transition from a hunter-gatherer society to an agrarian one occured, common wisdom says that this shift heralded a new age in which Humanity had finally began conquering the world. But it really wasn’t so for the average human alive. In fact, historians might argue that civilization conquered humanity.

This transition from a scavenger way of life instead resulted in a dramatic reduction in overall quality of life. While at times there was a surplus of food, farming became a monoculture; surviving on only one or two staples and their diets faltered on the front of diversity. People became stuck—attached to their land—and with that, imprisoned by the very crops they sought to domesticate. This lack of freedom became suffocating to culture and community.

Our modern culture may have removed the shackles of agriculture, but in that process, it put on the yoke of technology and in recent years tightened the reins.

Technological progress has continued to accelerate, or has it? In recent years it seems that progress has slowed; we’ve reached the peak, arriving at an unbreakable glass ceiling. Moore’s Law has broken down, it seems like every new innovation is only the tiniest bit of change from the previous generation. No lone individual can innovate within a field; it instead takes an interdisciplinary team to do so, as we’ve exhausted the possibilities and reached the limits of individual human expertise.

But there is still hope. Marques Brownlee compares this to cars, asking the question, “Are we at peak car?” Answering this shines a glimmer of light on a future where, despite stagnation, society can continue to grow.

All of these, taken into the context of society at large, have thus far resulted in a breakdown of our future outlook. Society at large has moved from thinking of the future as utopia to dystopia. The enormity of this change in outlook is reflected in our popular literature.

[W]e are aging, comfortable and stuck, cut off from the past and no longer optimistic about the future, spurning both memory and ambition while we await some saving innovation or revelation, growing old unhappily together in the light of tiny screens.

Ross Douthat

It is that gloomy light that now illuminates our thoughts as we drift off to a spiteful sleep. In the elite ranks, even the notion of sleep is frowned upon. After all, it only detracts from productivity and constant output. Ironically the elite work longer hours than ever before, and it is now the middle class that works less and less. This isn’t laziness; rather they can’t. The elite have broken up middle class jobs into component pieces and taken away any semblance of skill, leaving little behind. What scraps are left are handed out to the cheapest labor, and the remaining high level management is reserved for the elite. The mundane jobs left have therefore no path forward; no future outlook where those employed can work their way up the corporate ladder.

It is because of this economic stagnation that Douthat argues that society today has entered into a period of decadence.

The word “decadence” is used promiscuously but rarely precisely. In political debates, it’s associated with a lack of resolution in the face of threats. . . . In the popular imagination, it’s associated with . . . gluttony, . . . and chocolate strawberries. Aesthetically and intellectually it hints at exhaustion, finality — “the feeling, at once oppressive and exalting, of being the last in a series,” in the words of the Russian poet Vyacheslav Ivanov.

But it’s possible to distill a useful definition from all these associations. Following in the footsteps of the great cultural critic Jacques Barzun, we can say that decadence refers to economic stagnation, institutional decay and cultural and intellectual exhaustion at a high level of material prosperity and technological development. Under decadence, Barzun wrote, “The forms of art as of life seem exhausted, the stages of development have been run through. Institutions function painfully. Repetition and frustration are the intolerable result.” He added, “When people accept futility and the absurd as normal, the culture is decadent.” And crucially, the stagnation is often a consequence of previous development: The decadent society is, by definition, a victim of its own success.

Ross Douthat

Key to Douthat’s argument is that “decadence is a comfortable disease.” Society is doing fine.

With this stagnation comes social torpor. America is a more peaceable country than it was in 1970 or 1990, with lower crime rates and safer streets and better-behaved kids. But it’s also a country where that supposedly most American of qualities, wanderlust, has markedly declined: Americans no longer “go west” (or east or north or south) in search of opportunity the way they did 50 years ago; the rate at which people move between states has fallen from 3.5 percent in the early 1970s to 1.4 percent in 2010. Nor do Americans change jobs as often as they once did. For all the boosterish talk about retraining and self-employment, all the fears of a precarious job market, Americans are less likely to switch employers than they were a generation ago.

Meanwhile, those well-behaved young people are more depressed than prior cohorts, less likely to drive drunk or get pregnant but more tempted toward self-harm. They are also the most medicated generation in history, from the drugs prescribed for A.D.H.D. to the antidepressants offered to anxious teens, and most of the medications are designed to be calming, offering a smoothed-out experience rather than a spiky high. For adults, the increasingly legal drug of choice is marijuana, whose prototypical user is a relaxed and harmless figure — comfortably numb, experiencing stagnation as a chill good time.

Ross Douthat

To me, it seems that the averages are deceiving. Younger people are increasingly mobile, and less likely to set down roots in one area and stay long term, even if that’s what they desire. The elite are constantly in search of better opportunities. While it is the middle class, where “forced leisure,” i.e. unemployment as a result of increasingly elite skills needed, keeps them stuck.

Yet recently, a countermovement has emerged; a resurgence of age old ideals of humanity. It seems to be something that only the elites embrace; the middle class once again left behind. One can argue that that embrace is only superficial. Ultimately, the race is ongoing; people aren’t willing to step out as much as they are to slow down and relax, in effect preparing for the final sprint. One that might not ever come.

A century from today, what will this age be remembered as? An age of decadence? The precursor to dystopia? Or the beginning of a long and comfortable decline; a society ultimately on its way to a gradual death?

[T]rue dystopias are distinguished, in part, by the fact that many people inside them don’t realize that they’re living in one, because human beings are adaptable enough to take even absurd and inhuman premises for granted.

Ross Douthat

I can’t help but think, how close are we to the Hunger Games? But Douthat counters: decadence doesn’t necessarily lead to dystopia.

[Decadence], to be clear, [is] hardly the worst fate imaginable. Complaining about decadence is a luxury good — a feature of societies where the mail is delivered, the crime rate is relatively low, and there is plenty of entertainment at your fingertips. Human beings can still live vigorously amid a general stagnation, be fruitful amid sterility, be creative amid repetition. And the decadent society, unlike the full dystopia, allows those signs of contradictions to exist, which means that it’s always possible to imagine and work toward renewal and renaissance.

Ross Douthat

Dossier

“The Age of Decadence,” by Ross Douthat, February 7, 2020. https://www.nytimes.com/2020/02/07/opinion/sunday/western-society-decadence.html

“Are we at Peak Smartphone,” by Marques Brownlee, January 31, 2020. https://www.youtube.com/watch?v=-DtSrdh5dHU

“The case that America’s in decline,” by Sean Illing, February 28, 2020. https://www.vox.com/policy-and-politics/2020/2/28/21137971/the-decadent-society-ross-douthat-book

“Sapiens,” by Yuval Noah Harari, 2015.

“The Meritocracy Trap,” by Daniel Markovits, September 2019.

Rural Medicine in Texas

I’m not sure that I can fathom what 11,000 square miles looks like, let alone being the only physician to serve that entire area. But Saslow does an amazing job conveying the sense emptiness that Garner and Cummings might feel when being the only physicians available in a vast and desolate region in Texas. On a side note, I still don’t understand how their economy works?

“In the medical desert that has become rural America, nothing is more basic or more essential than access to doctors, but they are increasingly difficult to find. The federal government now designates nearly 80 percent of rural America as “medically underserved.” It is home to 20 percent of the U.S. population but fewer than 10 percent of its doctors, and that ratio is worsening each year because of what health experts refer to as “the gray wave.” Rural doctors are three years older than urban doctors on average, with half over 50 and more than a quarter beyond 60. Health officials predict the number of rural doctors will decline by 23 percent over the next decade as the number of urban doctors remains flat.

In Texas alone, 159 of the state’s 254 counties have no general surgeons, 121 counties have no medical specialists, and 35 counties have no doctors at all [emphasis mine]. Thirty more counties are each forced to rely on just a single doctor, like Garner, a family physician by training who by necessity has become so much else…”

Eli Saslow

Dossier

“‘Out here, it’s just me’: In the medical desert of rural America, one doctor for 11,000 square miles,” by Eli Saslow, September 28, 2019. https://www.washingtonpost.com/national/out-here-its-just-me/2019/09/28/fa1df9b6-deef-11e9-be96-6adb81821e90_story.html

Medical Devices in the Age of COVID-19

In response to the shortage of ventilators, respiratory equipment, and personal protective equipment, people throughout the entire maker community are working on designing and manufacturing cheaper alternatives.

As a result, the medical device industry has come under more scrutiny. People have realized that most medical equipment is rather simple at its core. However, this is a double edged sword. They have also realized that medical equipment is expensive for a reason, and that a lot of thought goes into designing the equipment for a vast variety of patients and scenarios.

It’s a surprising dichotomy.

Brian McManus, from the YouTube channel Real Engineering, provides some excellent constructive criticism on the open source maker efforts. He explains exactly why ventilators are complex devices that need to take into account a large number of factors, such as the breathing rate and air flow of patients. The vast majority of simple low-cost “ventilator” designs simply don’t take these other critical factors into account and are instead automated BVMs. Of course, we don’t want to disparage the community effort, but it’s important to keep this in mind.

Dossier

“A Guide to Designing Low-Cost Ventilators for COVID-19,” by Real Engineering, April 4, 2020. https://www.youtube.com/watch?v=7vLPefHYWpY

“How to Help Your Hospital (Fight COVID-19 Locally) – Smarter Every Day 233,” by Smarter Every Day, April 7, 2020. https://www.youtube.com/watch?v=sbEj7M3aZIg

“Do Some Surgical Implants Do More Harm Than Good?” by Jerome Groopman, April 13, 2020. https://www.newyorker.com/magazine/2020/04/20/do-some-surgical-implants-do-more-harm-than-good

The Heroes During Disasters

Society has taken to calling those that continue to provide essential services through the pandemic heroes. This refrain continues to be used by society through every disaster, but this time it’s different. This time, essential workers are not there by choice.

Despite this, they are still forced to grapple with the prospect of their own mortality. And not just their own; when they go home, they are putting their families at risk as well. It is a difficult choice for many. Some feel pressured to continue to work by their civic duty and professional responsibilities, as is the case for many physicians and healthcare professionals. Far more, such as grocery workers and restaurant employees, feel pressured by their employers or their financial situation.

The impacts are therefore disproportionately felt by those at the bottom rungs of society whose work can often only be done in-person. In contrast, the wealthy can settle down in their home offices and use their laptops to continue doing the vast majority of their work remotely. In between are physicians and healthcare professionals. Traditionally seen as wealthy, they are nonetheless still at risk, particularly those caring for COVID-19 patients.

People have thus lauded healthcare workers, calling them the heroes of our age. That refrain has gone on to be used for all essential workers. But this hero talk obscures greater truth.

It can be difficult to focus on seemingly anything other than the coronavirus and COVID-19. But, as a consequence of this pandemic, a lot of the subtle issues that have always plagued our society have come to the front and center. These are trying times, and so, we should use them to reflect and ponder, think of solutions, and most importantly act on them today so that they are no longer problems tomorrow.

We have quickly realized that the world is more interconnected and interdependent than ever before. And while this comes with amazing benefits under normal circumstances, these are not normal circumstances. It seems that with every passing day, we have drifted away from normalcy; from those halcyon days we remember.

Sadly, even back then, the same problems existed. But they were swept under the rug. No one cared enough to address them because everything was moving forward, the world was becoming a better place. Society had a collective optimism about the future. And that was reflected in its values, its books, its movies. Slowly we moved into the idea of a cyber-dystopia. You can see it everywhere in the popular media of our time.

Finally, society has realized that the people we once overlooked, are in fact the ones we depend on the most. Take the grocery store employees, for example.

Working in a grocery store has earned me and my co-workers a temporary status. After years of being overlooked, we suddenly feel a sense of responsibility, solidarity, and pride. . . . A sign attached to the shirt read NOT ALL HEROES WEAR SCRUBS.

I’m grateful to be acknowledged for the risky work we’re doing. Being in an environment where morale is up despite global uncertainty is encouraging. But I have a problem with all this hero talk. It’s a pernicious label perpetuated by those who wish to gain something—money, goods, a clean conscience—from my jeopardization.

[. . .]

Unlike medical personnel and emergency responders, we didn’t sign up for potentially life-threatening work.

[. . .]

Cashiers and shelf-stockers and delivery-truck drivers aren’t heroes. They’re victims. To call them heroes is to justify their exploitation. By praising the blue-collar worker’s public service, the progressive consumer is assuaged of her cognitive dissonance. When the world isn’t falling apart, we know the view of us is usually as faceless, throwaway citizens. The wealthy CEO telling his thousands of employees that they are vital, brave, and noble is a manipulative strategy to keep them churning out profits.

Karleigh Frisbie Brogan

This sentiment is echoed by others in the industry: “We didn’t sign up to be heroes, and we certainly didn’t sign up to be martyrs,” says Maria Leon

I’m not sure that doctors and nurses did either.

I’ve been to disasters all over the world, and I have always seen health-care providers pour in to help. Usually, within an hour, there are more than are needed—nurses, lab workers, X-ray technicians, doctors. No one has to ask; they just show up. And then they work nonstop until someone makes them take a break or they fall exhausted. It’s what we do.

But that sort of bravery, that work ethic, is not boundless. No one is so fearless or stupid as to discount all risks.

[. . .]

This is the dark secret of planning for a pandemic that can also kill health-care providers and their families. When we prepare for disasters, we plan using the mnemonic “Staff, stuff, space, and systems.” We can always make more space by wedging an extra bed in, or by repurposing another building. We can buy more stuff, supplies, and equipment. We can find new supply lines, reboot our computer systems. But we cannot conjure up doctors and nurses and health-care technicians. Physicians take at least 11 years to train after high school. Nurses at least four. Techs take years or months.

The United States needs its health-care workers to see it through this crisis. But there are no replacements on the shelf. They can’t be built, trained, or repurposed from other jobs. Unless the country does dramatically more to provide them with the equipment they need to do their job safely, to assure them they will be cared for if they fall ill, and to provide their family with a measure of security, it risks losing them. What happens when they need to be quarantined? When they start to die? Or don’t come to work?

Thomas Kirsch

Despite the sacrifices that doctors, nurses, and other clinicians make, I’m not sure that many of them would have imagined that their own mortality, much less the mortality of their loved ones, would be at stake as a result of their work.

Society has now come to grips with a question that no one really wants to know the answer to: are physicians, healthcare professionals, grocery store workers, and other essential workers still responsible for coming in to work?

I hope we don’t come close to the answer that we all know.

Clap for me and other healthcare workers at seven o’clock if it makes this pandemic feel more bearable. I concede, your cheers help us trudge on. Just know that cheers and hollering don’t change the outcome. This is my fervent plea – that we change what we can after all this is over.

KP Mendoza

Mendoza’s poignant call reminds us of the stakes. No one can escape the pandemic, much less its drastic effects. This will live on for the rest of our lives, perhaps longer. It is now up to us if it will result in good, or no action at all.

Dossier

“No One Is Supporting the Doctors,” by Steven McDonald, April 18, 2020. https://www.theatlantic.com/ideas/archive/2020/04/doctors-already-manage-alone/610249/

“Calling Me a Hero Only Makes You Feel Better,” by Karleigh Frisbie Brogan, April 18, 2020. https://www.theatlantic.com/ideas/archive/2020/04/i-work-grocery-store-dont-call-me-hero/610147/

“I Did Not Sign Up for the Military. I Signed Up for Walmart,” by Anna North, April 23, 2020. https://www.vox.com/2020/4/23/21229942/coronavirus-grocery-store-workers-walmart-covid-pandemic

[Facebook Update], by KP Mendoza, April 14, 2020. https://www.facebook.com/kp.mendoza.23/posts/10216675050615188

“America’s Other Heroes,” by David Goldfein, March 31, 2020. https://www.theatlantic.com/ideas/archive/2020/03/americas-other-heroes/609145/

“The Reason Hospitals Won’t Let Doctors and Nurses Speak Out,” by Theresa Brown, April 21, 2020. https://www.nytimes.com/2020/04/21/opinion/coronavirus-doctors-nurses-hospitals.html

“What Happens If Health-Care Workers Stop Showing Up?” by Thomas Kirsch, March 24, 2020. https://www.theatlantic.com/ideas/archive/2020/03/were-failing-doctors/608662/

Electrification of Last Mile Delivery

The sight of a USPS postal van driving around, or stopped by the side of the road with its blinkers on, is a familiar site for most Americans. And rightly so; these vehicles have been on the roads for over 26 years, well past their intended duration of use.

David Roberts suggests that now might be the perfect time for the electrification of the USPS postal van fleet. His arguments are wide-ranging, including environmental, economic, and political. I want to focus on the environmental and practical reasons why electrification makes a lot of sense, particularly for the type of operations that the postal vans do on a daily basis.

There are two aspects to postal logistics, each with very different requirements and timeframes. The main logistics operations occur mostly behind the scenes, overnight, at large postal sorting facilities, warehouses, and airports, across the country. But what most people see and experience is the “last mile,” that is, the actual delivery of items to its final destination at homes and businesses.

The last mile delivery is a perfect example where an electric drivetrain particularly suits the demands. Roberts argues that electrification solves several problems at once.

For last mile delivery, an electric drivetrain is particularly well-suited. For example, electric drivetrains have (1) more torque and acceleration, and negligible energy loss during idle, (2) fewer moving parts for less need of maintenance, (3) reduced emissions where they are difficult to control, i.e. at the vehicle rather than a power plant, and (4) significantly cheaper for the USPS in the long run. I discuss this topic in more detail, specifically in the context of aviation and its requirements, in my earlier post on the Dilemma of Electric Aviation.

The post office primarily delivers during the daytime. Therefore, the vehicles can easily be charged overnight when electricity costs are significantly reduced. Electricity infrastructure is already widespread and so retrofitting post offices with charging stations does not seem to be too challenging.

While I am certainly not an expert on electric grid optimization, I suppose that charging postal vehicles during the night would create a baseline demand to help absorb the excess output of traditional power sources, such as natural gas or nuclear. These types of power plants must remain functional at all times, (1) as a backup source and (2) as they cannot easily be switched on and off rapidly.

Additionally, Amazon has made some advances in partnership with Rivian, developing a vehicle platform that could also be adapted for the postal service.

Interestingly, Roberts pointed out that these vehicles, which collectively drive to almost every address in the United States every day, would be a powerful platform for mounting weather sensors. This is a fascinating application that I would not have thought of. While this certainly does not require electrification, I think it is interesting.

Earlier this year, when I wrote about the dilemma of electric aviation, where I mentioned that ground-based transport would likely be the biggest driver of electric innovation. I think that the electrification of the USPS postal van fleet would be a powerful statement and would likely contribute positively to the public perception of electric vehicles.

Roberts argues that now is a great time to act. I’m inclined to agree and I think that such action would be an incredibly large step in the right direction.

Dossier

“A No-Brainer Stimulus Idea: Electrify USPS Mail Trucks,” by David Roberts, April 22, 2020. https://www.vox.com/energy-and-environment/2020/4/22/21229132/usps-coronavirus-electrify-postal-trucks

“The Dilemma of Electric Aviation,” by Sahil Nawab, January 10, 2020. http://www.sahilnawab.com/blog/the-dilemma-of-electric-aviation/

Empathy in Medicine

Years ago, in religion class, we learned about virtue. This is a lesson that has stuck with me ever since. Here, I use virtue in a strictly philosophical sense. Aristotle defined virtue as the balance between two extremes of a trait. Specifically, he noted that balance does not necessarily mean the exact middle point. Rather, Aristotle used the concept of the golden mean to emphasize that virtue relies on moderation.

When Aristotle wrote about this, he used the example of courage. He defined courage as the golden mean between bravery and cowardice. Someone who is brave is rash, and has no fear. Someone who is cowardly is so overwhelmed by fear that he fails to act.

However, with courage, there is no absence of fear. Rather, someone who is courageous acts despite that fear. It is in facing that fear that makes courage a virtue. And so, to exhibit the virtue of courage requires moderation between the two extremes.

Likewise, empathy in medicine is a virtue.

In order to effectively treat patients, physicians need to emotionally distance themselves from the patient. They must not let emotion cloud their judgement. In most hospitals, there are rules against treating family and friends for this very reason.

Yet, as the ones responsible for presiding over some of the darkest times in patients’ lives, physicians must have empathy. Patients rely on them for support and guidance, and without empathy, physicians are no more than mere technicians.

Dr. Stuart quotes Brené Brown, “Rarely, if ever, does an empathetic statement start with ‘At least.’ . . . Rarely can a response make something better. What makes something better is connection.”

That last part stood out to me. We often have the idea that we can solve any problem, and this is especially true in medicine. We can be overcome by hubris; we think that we have the power to stop death in its tracks.

This serves as a stark reminder that all we really have is the human connection.

It can be hard as a doctor to keep my “empathy tank” full. I’ve had bad days when I diagnose a 25-year-old with a terminal illness, and later find I have trouble caring when a friend calls to complain about a snack-stealing roommate. I worry that the coronavirus era will strain our collective ability for empathy, but I also have hope that we will rise to the challenge.

Jessie Stuart

Dossier

“The Least Empathetic Thing to Say, by Jessie Stuart, April 9, 2020. https://www.wsj.com/articles/the-least-empathetic-thing-to-say-11586458213