5 July 2020

[Above photo: Another amazing temple from 12th century Bagan.]

I’m not sure why it took me so long to notice the similarity. I suppose it’s because I haven’t watched South Park for decades but isn’t DT represented perfectly by Cartman? An ignorant, vengeful, foul-mouthed, impulsive bully, a school failure who enjoys torturing others? My god, he’s ruined another, if minor, pleasure—laughing at Cartman’s antics.

Our new clinic works amazingly well. We are in a large conference room with an open stage and a 30’x40’ open area in the back. The conference seating in between is on numerous immense matching overstuffed leather couches and chairs, obviously from an earlier era, as half of the metal upholstery button caps have fallen off.

It is a pop-up clinic. On Monday and Wednesday at 9AM we unlock the double doors and set up two portable child tables, two portable regular-sized tables and chairs, two cloth-on-metal -frame screens, two large blue foam pads in front of the child tables, a grouping of chairs on the stage for psychotherapy, and our box on wheels. In the latter are charts and charting materials, toys, art supplies, etc. Because the entire conference room has a green felt floor covering (no shoes allowed), the sound-proofing is pretty good.

Today, however, there is a conference in the conference room so we have moved to the cardiology clinic wing of the hospital. We were given only one small room with a table and three chairs so we have imported several other tables and are using the large waiting area to see our patients. Built with economy and ease of maintenance in mind, it is all hard, flat surfaces, maximally reflective of sound. We have our box on wheels and at the moment a psychotherapy session is happening with a 15yo teen in the one private room and two intakes are happening in the waiting area. I was prepared to do a Zoom therapy session with my one patient, sitting in a corner of the waiting area, but it is much too noisy, so I have rescheduled.

Since people’s lives are so precarious, interpersonal boundaries seem very porous, and most people live packed closely together, our clinic environment doesn’t seem to faze anyone. In addition, or perhaps primarily, people who come to us are so desperate for help that they overlook the material deficiencies. We learn and do good work.

We saw a fascinating 9yo boy with episodic vomiting that has put him in the hospital 11 times. He was brought to us from the Defense Academy hospital. He is intellectually disabled and cannot attend school. He was presumptively treated for tuberculosis on the basis of enlarged abdominal periaortic lymph nodes, so common is tb in his area. His mother beats him sometimes. He has become dangerously dehydrated at times, with a serum sodium of 150meq/L. Curiously, he has an apprehension before he begins to vomit, his body stiffens, his toes curl, and his feet dorsiflex tonically, and he has an outburst of aggression each time immediately after the vomiting ceases. While it may be that this is Cyclic Vomiting Syndrome, it also could be a Temporal Lobe Seizure disorder so we are working him up for both. And seeing if we can get the mother to stop beating him.

After clinic on Wednesday, my students drove me to Wake ‘n Bake, a durian shop. By that, I mean to say that is all they sell. Durian puffs, durian pillows, iced durian in coconut milk, and so forth. Year round. There is an adjacent storage room with racks full of durian. You either love it or are disgusted by it. We all love it and the groans of satisfaction from our packed booth would have suggested an orgy to a blind observer. Of course, we had to take off our masks to eat it.  One student called her husband, who was nearby, to join us. The sign—”No firearms. No durian.”—in hotels is pretty ubiquitous. More people globally are killed by falling durian in a year than by sharks, a fact.

I have seen more rats—both dead and alive—this week than ever before. Fresh roadkill, ancient flattened roadkill, and alive and scurrying across the road or the sidewalk immediately in front of me. One consistent fact, they are all huge. No timid little hickory-dickory-dock rodents; they are hefty, dark gray, solid beasts. I wonder if they are out more often in daylight now because they became accustomed to fewer cars and people, given our self-isolation for the past few months.  We need more cats.

We continue to have very few cases of Covid-19 here—about 300 confirmed for the country. Myanmar has been very conservative, strictly limiting international and local air traffic, as well as travel within the country.  Mingaladon International Airport is essentially closed and has been since late March. Many townships don’t allow people from adjacent townships to enter. People still wear masks in public, although more variably in Chinatown than in other areas. I cannot explain the lack of spread.  The hospitals have seen very few cases and there have only been a handful of deaths. With the crowding and poverty, I’d expect to see higher numbers; perhaps they will come soon. I have gradually relaxed my guard, although I still wear a mask in public and wash my hands frequently.  I don’t wear a mask when doing psychotherapy or at lunch with my students, however. Or with close friends at their homes. The latter have been very careful, mostly working from home.

I am enviously imagining my sister, her daughter, and the latter’s son all enjoying the beauty and tranquility of Beach Island for two months.  Next year for me, although who can tell? Maybe there will be a tsunami or a storm of durian. Perhaps the US borders will be closed to travelers from Myanmar. It is all such a strange time.

I have accepted another patient.  It is difficult not to, as it was in Malawi, since there is no one as qualified to see him. He is 15yo and was adopted by a single mother at 4 months of age after his mother and father abandoned him in the hospital. At first he was quite anxious about seeing me; by the end of the hour he was asking if he could come 2x/week! I think we’ll make progress with motivation like that. I’ll not take on any more, although I could clearly have a thriving practice here to support myself. At my age, I don’t think I should take on new, long-term cases.  The situation is somewhat different than in the US. There is an abundance, at least in the Bay Area, of good, younger people to see them.

The California Medical Board sends out a quarterly report. I often glance through to see if any of my acquaintances are in trouble. Usually it is “acts of negligence” and “failure to maintain accurate and adequate medical records”. There are few flagrant sexual violations, surprisingly, given how riven the analytic community has been with them at times. A fair number of “excessive prescribing of narcotics” and “prescribing without prior examination” or “prescribing with intent to divert”. Then there are the curious ones: “driving while intoxicated and performing an act forbidden by law”. Obscene stand-up comedy? Oral sex? Bestiality (which is, curiously, legal in Russia and Angola)? Or this doozy: “No admissions but convicted of three felony counts of obtaining and unlawfully using the personal identifying information of another; and charged with having a condition affecting his ability to practice medicine safely, dishonest acts, prescribing with intent to divert for self-use, and false representation.” How can you not admit to these things when caught red-handed? Or this: “No admissions but convicted of one misdemeanor count of inflicting a corporal injury resulting in a traumatic condition upon a person; one misdemeanor count of using force and violence upon the person of another; and two misdemeanor counts of violating a protective order.”  He sounds more like a Mafia enforcer than a physician. How did he get through medical school? Why did he want to? Why not just go directly to your local capo and enlist, saving the repayment of all those educational loans? I do, always, think of the cascade of problems that lands on their families.

As my friend, Jeff, once said to me, in the wake of 3 members of the Boston Psychoanalytic Institute having had sexual relationships with their patients: “We are so fragile.” Such strong feelings, ghosts from our past, are activated in therapy, it is amazing that it doesn’t happen more. I have certainly had my Id stirred many times in the course of a long career. Happily, I could always step back and be curious about it. In all humility, I’m lucky that the stars weren’t in alignment for such a transgression. We are fragile, men more than women, it seems.

Knowing how exercised, how filled with adrenaline I can quickly become in an argument about our Dear Leader, it was a good and sobering lesson to see an interview yesterday with Bob Woodward from 1 ½ years ago at the occasion of the publication of his book about DT, Fear.  I watch stuff when on my elliptical trainer; it allows me to run much further, distracting me from my fatigue. In the Q & A period at the end, an impassioned woman with a trembling voice implored him to say something about Trump; he quickly said, “I don’t want to respond to that kind of question.” He talked about the need to de-polarize our country and that calm, thoughtful discourse was more likely to succeed at that than strident confrontation.  We must calmly stick with the logical, the critical thinking part of dialogue to avoid polarization. We need to talk with each other and listen to each other based on facts, not scream at each other fueled by feelings. Women pulling pistols in parking lots and women calling police to report attacks by birdwatchers are based on hysteria, which only will go badly. The same with shouts, accompanied by fists, of “White Power” by old men in golf carts. Cars driving into protestors. Police killing black people has a more sinister, if similar, irrationally fearful basis.

DT’s Mt. Rushmore antics are true to form. Fear and division are all he knows, since he seems incapable of the character, discipline, or motivation to study and learn otherwise. He is, like Mike Mulligan and Mary Ann (his steam-shovel) in my favorite book from childhood, digging a nice deep pit with 4 square sides and 4 square corners for himself. Maybe, like Mike, he can set up house there. It may match his capabilities better than Trump Tower or Mar-a-Lago.  They could be re-purposed for low-income housing for the poor, including blacks and immigrants.

28 June 2020

[Above photo: One of my students, Dr. Su Myat Yadanar, on the beach at Dawei, taking a break from her clinic last weekend.]

There is so much good news here. The webinar we did for >500 physicians across Myanmar was such a success that I’ve volunteered myself and my students to do a series of 13 more. We’ll use the same format—a lecture-discussion followed by two detailed case presentations. Not surprisingly, one of the cases presented then, who had a near-miraculous turnaround of very aggressive and disturbing behaviors, reverted to his old ways the day after the presentation. But my intrepid student (see photo above) has continued to work with him and the family and he is doing well again. Success in this work is rarely a straight line, especially with intellectually disabled patients whose un-learning may be as impaired as their learning.

A follow-up on the 11yo boy who is cared for by his elderly grandfather and three elderly, spinster great-aunts. After his brief hospital stay and twice per week visits to clinic, he is sleeping at regular hours and only had a single, brief, daytime aggressive outburst when his great-aunt scolded him for something. The adults have been taking him outside to a park daily. He looks happier. He is mutable, I think; I fear the adults are much less so. The primary great aunt repeats that all she wants is a pill for his aggressive behavior and a pill to make him go to sleep at night. Whew!

Professor Tin Oo sent me an email from Nay Pyi Taw, the capitol, where he had just met with the Union Minister of Health and Sports. The latter agreed to build a child and adolescent psychiatry training center and clinic facility, presumably on the grounds of Yankin Children Hospital where we now hold our clinic. This is thrilling to me. If they will also fund a professorship in Child and Adolescent Psychiatry at University of Medicine 1, which the Rector mentioned to me, I’ll feel I have really gotten something going here.

Our Facebook page, Caring For Our Children, is off to a stumbling start. Never having done this sort of thing on Facebook before—I really don’t know how to navigate it well.—-I should have been much more clear about my idea and plan. One of my students suggested that we start again, with a different title. The student who has been administering it has used it like a regular Facebook page—-a self-advertisement with photos, etc. I want a simple informative newsletter, in Myanmar and English, with weekly entries and, eventually, a Q&A appendage. No photos, no advertisements for ourselves or our services. We’ll start again, after thinking it out together more carefully.

The pharma marketing CEO did follow-up with a lunch invitation. I asked that all my students could be included, which he seemed happy about. We had the best Thai meal yesterday, with lots of laughter. I was so full I came home and promptly fell asleep on the couch for 2+ hours. The soft-shell crab and the sautéed razor clams were outstanding, as was the chicken curry in coconut milk and the baked fish with ginger and lemon grass. Dish after dish. The CEO, whose name I don’t even know, was a friendly Indian from a small village outside of Lucknow. A handsome devil, he’s surrounded himself with a couple of lovely women assistants. The piece de resistance of the meal was frozen durian in coconut cream. Heaven!

My left shoulder was a bit painful in early April when I  lifted weights, small 5# dumbbells. My routine was 50 repeats of 9 different exercises, added to 45 minutes on the elliptical trainer. I stopped doing the exercises which caused pain and, finally, all exercise of my upper body but the pain has increased. For the past 3 weeks I cannot sleep well, every position hurts my shoulder. I often must nap in the afternoon, as a result. I cannot take non-steroidal anti-inflammatory medication, since I whacked my kidneys with chemotherapy 10 years ago and NSAIDs don’t agree with them. I’ll see a doc next week but it is definitely irritating, physically and emotionally. I had a frozen right shoulder some years ago as a result of doing competitive yoga (I, of course, was the only one in the class competing!). That was a terrifying experience. I couldn’t move my upper arm at all, could hardly sleep, etc. Two steroid injections later and I was fine and it hasn’t returned. It felt like a paralysis or an amputation, however; I couldn’t button my own shirts, let alone put them on or remove them. This shall pass, I am sure, but probably needs a little medical care.

It is awful to see the testing numbers rising in the US again, even as I feel a certain shadenfreude—“You deserve it, dummies.”—that it is hitting Texas and Florida especially hard, given their governors’ arrogant, dismissive stances. As if we can get the economy going without careful attention to the virus. But my niece lives in Austin and is at risk if she were to contract the disease, which helps me contain my splenic joy.

Why is scientific opinion so reviled by so many? Is it that, no matter how hard I wish for something to be otherwise, science always is right?  Is it that those guys who stayed in school and got advanced degrees actually do know more than me about some important things that affect me? Scientific opinion generally emanates from universities and government agencies with a mantle of authority, which infuriates people, like DT, who want their opinion to best all others. It’s a kind of group narcissism. “The world works the way I feel it does.”, critical thinking be damned. Many preachers, people with a direct phone line to God, feel it is their imperative to tell their flocks how the world is. Science, including evolution, can interfere with their power.  Often their power derives, in part at least, from opposing a rational viewpoint, which resonates with their flocks. I note that I am talking about his base.

It is chastening to reflect on how tidied-up my sense of history is. In 1862 The Great Emancipator, stated, “If I could save the union without freeing any slaves I would do it; and if I could save it by freeing all the slaves I would do it; and if I could save it by freeing some and leaving others alone I would also do that.” Sigh.  I had no idea. Just as was Freud, we are (mostly) all creatures of our time and place, imperfect.

21 June 2020

[Above photo:  After graduation last year, the Cats and I relax at a sculpture park. ]

I’ve had supper twice in the past few weeks at friends’ homes and shall do so again tonight. Yesterday Kelly called me to see if I wanted to go out for a bite. I haven’t eaten in a restaurant in over 3 ½ months so of course I said,“Yes!”  After visiting a child in the hospital, I took a Grab (the prevailing Uber/Lyft service here) to Kokkine Swimming Pool Road and walked to his house. We sat on his couch in a window alcove, looking out at the green forest of his back yard. I certainly miss the green, but his residential neighborhood is without much character. No wet markets, no one passing down the street early in the morning, calling out to sell coconuts or fresh fish. No real bustle. I’ll settle for my river view and busy Chinatown.

After an Anchor Steam beer, which he gets at the commissary of the American Club, we set off down Kokkine and turned right on Sayasan.  In a few blocks we came to Parami Pizza, which is the best in town and makes my sad efforts appear childlike.  At the entrance staff measured our temperatures, gave us hand goop, and made us scan a bar code. Why? It brought up a form to fill out which we then submitted, supposedly to alert the restaurant if we’d just arrived from a Covid-busy country. It didn’t work. Nor did scanning the bar code for the menu work.

Eventually, we had them bring us menus and remove the plexiglass partition dividing our table. We had wondered, on which side will they set the pizza, his or mine? Whoever got it had a definite advantage. It recalled the ‘70’s SNL sketch with Father Guido Sarducci (Don Novello); he held a pizza up to the TV camera and encouraged viewers to “Find-a the Pope in-a the pizza.”, like those miracles of the Virgin Mary appearing in the foliage of a tree or on the wall of a brewery. He was hilarious; apparently he was once arrested in Rome for impersonating a priest.

We had a good meal and a good talk. Kelly turned 64 two days ago. He’s had such an interesting life. He was in Peace Corps in Benin after college, then had a series of different jobs in West Africa, Malawi, Bangladesh, and Myanmar. He worked for CARE and was country director here of Save the Children and now for PLAN International. Early on he was doing some humanitarian work in Malawi, living in a house near Liwonde on the Shire River. He brought a small outboard on the plane with him from the US and, with a friend, built a houseboat on pontoons on which they would cruise around. Since it was a bit slow, he built a skiff and they’d fly up the river. Unfortunately, the Shire is filled with crocs and hippos and their speed was such that the hippos couldn’t get out of their way. Once one rose as they were passing over, throwing them both out of the boat into the croc-infested river. Somehow they managed to get back into the boat before being attacked. He later went to the famous pottery at Dedza and commissioned a ceramic sculpture of the incident, hippo, boat and the two of them on their way into the water.

Kelly is a wonderful man, funny and smart and kind. He met his wife in Malawi; she was working in the same area. They raised their 3 boys mostly in Myanmar.  We’re planning a trip to Putao in the far north of Myanmar, to trek in the Himalayan foothills—Myanmar is the only SE Asian country with snow— and another to Kauthong, at the southern tip of Lower Burma, to snorkel in the Meik Archipelago. We’ll travel well together, I imagine. He’s in a quandary; he loves the exotic and the freedom of his work but is approaching retirement age. (The Tina Turner song comes to me, “What’s love got to do with it?”—“What’s age got to do with it?”) His wife has been teaching in Santa Barbara for the year and his kids are in California, as well; he misses them all and calls regularly. But what can he do there that will have ½ the meaning or attraction of what he is doing here? We both love just going out to buy groceries here; there is always something new.

Our Yankin Children (Not, I was corrected, “Children’s”) Hospital clinic is a going concern with a busy complement of patients. We saw an 11yo boy in clinic Wednesday. Both parents are separately incarcerated for 5-6 years for dealing drugs. He has lived with his elderly grandfather (65) and three maiden aunties (70, 75, & 84) since he was two; at that time his parents were having daily physical fights and doing drugs. Since Covid isolation and the closure of school, he has become increasingly violent and demanding. They all seem like their batteries have run down and, despite being only 65yo, his grandfather moves like a feeble 90yo. I think it is from simple disuse. All in the house are fearful of the boy, as he is strong, impulsive, and gets very violent.

At the end of the interview the boy left to sit on a couch nearby. I joined him and had him show me his phone and the Tic Tok memes that intrigue him. Pretty soon, he was smiling which my student pointed out to the grandfather, who seemed to get the importance of someone being interested in the child’s interests. Playing with friends is not possible, apparently, because all are sheltering from Covid. School doesn’t resume until August at the earliest. There are no other, younger, relatives with whom he can live.

Friday my student got a call that the boy had beaten, bitten, and terrorized the household for hours in the middle of the night, seriously rearranging the furniture. We made a house-call, a first for my student. They live in a 3 bedroom old British colonial-era apartment, with lovely wood floors and recessed ceilings with crown molding. It was filled with toys, everywhere, clearly in an attempt to placate the boy and perhaps salve their guilt about feeling so burdened by him. After coffee and much deliberation, we put him in the hospital for two days and then will see him, and them, twice per week to see if he can be contained in their home. I visited him yesterday (Saturday) and will see him again today. We drew, played Winnicott’s Squiggle Game, and made rather pathetic paper airplanes. I am trying to both engage with  him and model for his caregivers how they might. I have grave concerns because there is literally no place for him to go; no group home, no proper child psychiatric facility, no foster home, no agency in charge of helping to place a child like him. But it seems impossible to raise a child who is violent if the caregivers are so frightened of him that they cannot set limits and contain him.  We have only his affectional ties to work with, I think. He is depressed and very angry with his parents, who he knows enough about to say, “They don’t love me.” I’m worried about our limited options.

As for Tulsa, 3 minutes of hearing his languid, lying, inciting speech filled me with enough feeling I had to stop watching. What insanity has gripped our country?!!  What he feels threatened by, the protesters, feel like a breath of fresh air to me, like the crisis of pneumonia just before the fever breaks. Come on, Supremes! Come on Southern District of New York!  We must help others snap out of the trance into which they’ve been lulled. Meanwhile, scummy John Bolton whistles as he happily walks to the bank, having chosen to miss the moment when his testimony might have altered history. In truth, he doesn’t appear to be either happy or like someone who whistles for pleasure.

14 June 2020

[Above photo: At our University of Medicine 1 library classroom. The woman on the TV screen is out of the picture to the left. She is doing Zoom psychotherapy with a 15yo girl in Dawei.]

This was the first week in our new clinic space. The students and I bought a couple of child-size tables and interlocking rubber foam pads for seeing children from a huge discount warehouse. On our second day a 15yo girl was brought in by her employer. The girl is a housemaid from a very poor village family and has been having nightmares. She imagines that a man is naked in bed with her and squeezing her very hard. She’s also been hearing voices telling her that she is a bad girl, but she is far from psychotic. She is bright and quick and very engaging. I wonder if she is trying to tell us that a naked man, the husband of her employer, for example, is getting into bed with her and squeezing her very hard. I fear for her if the man of the house is abusing her; she’ll have to leave and her employer, the woman, seems very attached to her and helpful. There is no child protection service, no SCAN team (Suspected Child Abuse and Neglect) to summon. We’ll see how it plays out at the next visit.

I’ve done some more cooking. I baked another loaf of onion bread but this time I ran out of wheat flour. I had a sack of glutinous rice flour to make an incredible cardamom cake Ariane told me about so I used that. It wasn’t so great as it browns quickly, doesn’t rise very well, and the bread is pretty underdone inside. Still, it’s good for grilled cheese sandwiches and for toast with lovely New Zealand butter on it. I bought asparagus and made a lazy man’s aioli—juice of 2 limes, 5 cloves of garlic minced, salt, some yoghurt, and an equal amount of mayonnaise. It is good on anything; I used it on French fries, as well. It likely can be used to soften skin and as an alternative to Brylcreem.

“Brylcreem, a little dab ‘ll do ya, Brylcreem, you look so debonair. Brylcreem, the gals ‘ll all pursue ya. They love to run their fingers through your hair.”, hearkening back to the 40’s and 50’s. Little did I know that Brylcreem was de rigeur for British pilots during WW2 in order to keep their long hair in place during air battles. Since they wore leather helmets, I wonder is that simply myth?  Maybe it was for the romantic films of British WW2 aces in air battles and they didn’t wear helmets so the swooning females in the audience could see their long hair in place..

Another culinary treat is to finish rolling your pizza dough in oats. My Scottish take on an old Italian favorite. It makes for a really crisp, yet chewy, crust. I mentioned both the aioli and the pizza crust to my friend Clementina, who is Italian; she just looked down at the floor and said nothing.

The monsoon is with us. It rains most days, some nights, and sometimes 4x/day. Since I don’t like to sleep with aircon, I leave several windows open as the wind direction changes during the night. I’ve gotten up and had to mop the floor at 3 AM a couple of times. I haven’t personally gotten drenched yet. The rain has brought the temperatures down to a reasonable 90/80F with 70-90% humidity. I love the storms. A downpour is always preceded by a strong, gusty wind, so you hustle to your destination. The air is clear and the Yangon River is muddy. I hate to think of the poor boatmen, plying the river and caught in weather. I can often see them, chugging across the river as the rain pours down. They run all night; if I am up at 2AM, I can hear a boat or two crossing.

I took a head shot for a webinar I did last night.  The sponsors wanted to identify me on the announcement. Good lord! I look old. I mean, wrinkles and creases and thinning hair. A white soul-patch. It woke me up. I am woke now—at least to my own age bracket! It really was a shock, although I’m sure I look like the same old guy to everyone else. I mean, the barber 4 days ago guessed I was 55! He’s a young kid from Yunnan, China; anyone over 50yo must seem ancient to him. I’ve been in a state of denial, definitely. Better to face it, unpleasant as I find it. Time appears to have marched on.

The webinar went, I think, well. After I spoke, two of my students presented a case each. Professor Tin Oo distributed audience questions, of which there were 45 before we started talking. There were >500 participants from all over the country: GP’s, Pediatricians, and General Psychiatrists. The presentation was sponsored and arranged by an Indian pharmaceutical company. I said there was not much call for psychopharmacology in Child Psychiatry, excepting in a few disorders, and certainly not much for Behavior Disorders, about which I spoke. I was clear that medications were never the first thing to think about in managing these issues. I’m not sure but I probably won’t get asked back by the drug company. The local head suggested before the program started that we have lunch together this week but hasn’t followed up and I suspect won’t. Why would he, or I, want to? Not for a free lunch. I was, however, impressed by the number of interested physicians and will talk with Professor Tin Oo about using University of Medicine 1 resources to spread the word. People are very hungry here to learn other than medication approaches. We may get a flood of patients from the webinar.

I have been thinking about tribalism. And epigenesis. As they relate to racism. We are wired, I am convinced, to be tribal.  Be wary of strangers, those different from you. Gather your friends and press the others down so they aren’t a threat to you.  When we were roaming bands of hunter-gatherers, there must have been some survival utility, some evolutionary advantage, in tribalism. Although the value of it has long since vanished, it is tough to throw off several thousand years of bad habits. We started this country on the premise, not usually mentioned during 4^th of July celebrations, that whites of European origin were the lords and rightful owners of all they saw. Thus, slavery (Africans), genocide (Native Americans), and land theft (from Native Americans) were our initial accomplishments as we began this, also, quite amazing experiment in democracy. We haven’t relieved ourselves of the legacy and since tribalism is likely in our genes (or epigenes), its removal  is like purging ourselves of ourselves.

If you pair a neutral odor with a painful stimulus, classical conditioning, after awhile the odor alone causes fear and trembling in experimental rats. But most amazing is that the odor alone will cause fear and trembling in subsequent litters of rat pups.  Epigenesis, or acquired heritable traits. Is our tribalism like that, encoded in our RNA? Is that partly why racism, prejudice and fear with consequential actions towards those not like us, is so hard to eradicate. Not to mention the worry that if I let you on this ladder, you may displace me to a lower rung. It is totally worth the struggle and effort to shed, of course, but it is interesting to consider this as one reason it is so stubborn to remove and how it leaves many among us so vulnerable to the divisive predations of a coward like Donald Duck—I mean Trump.

“You’re just lucky we want equality, not revenge.” True and powerful words by a black female protester. For years I have been amazed that, given all the oppression and suffering of blacks, they haven’t arisen in armed struggle. The Black Panthers were a self-defense and community social movement, feeding children and operating medical clinics before J. Edgar Hoover harassed, infiltrated, and assassinated  them. The rest is a very sad tale of black leaders being jailed, exiled, and executed as the Party, with thousands of members and offices in 68 cities in the US, shrank and died.

7 June 2020

[Above photo: My first baking trial—-oatmeal-onion bread—with a rotisserie chicken in the background.]

NB: When my blog post appears in your email, double click the green sticker to the left of the title to see the latest edited version, including the accompanying photo.

DT’s shenanigans are more Damon Runyan, Quentin Tarantino, or Steven Segal than Shakespeare. He isn’t a tragic figure; he doesn’t have the stature. Also, tragic figures must fall from a great height; he has been in the basement bunker all along, down with his creepy crawly “friends” and associates.  The quotes are to underline his incapacity to truly relate to another human being as a friend. But his reign is certainly a tragedy for our country and planet and their people.

However, despite paying a steep price with the coronavirus and ongoing police malevolence, we may emerge stronger and more purposed on equality than before.  It will be a struggle, however, as there will always be wealthy people who cannot accumulate enough and need to ensure the existence of a distinct underclass with inexpensive and disenfranchised laborers.  As well as fearful ordinary people.

I am previewing my friend, John Sprinson’s, new book about the contexts and consequences of poverty and racism in the US. It isn’t quite to the publisher yet so I get an early glimpse. It is timely and beautifully illustrates and analyzes the personal and institutional field tilt and devaluation of the poor and those of color in our country. It is no wonder, with all the little microaggressions (as well as macroaggressions) in their lives, that black people in the US have shorter life spans and suffer from epidemics of stress-related hypertension, diabetes, and chronic disabling diseases. May the protesters, and subsequent leaders, help to remedy this by setting new standards and regulations and modelling a new tone and consciousness.

I am increasingly aware of how the bureaucratic constipation in Nay Pyi Taw stifles incentive and innovation here, as well as consuming inordinate amounts of effort by those diligent few who persist trying to get Ministry approval for something. Like a visa. Like a position and a tiny ($200/month) salary for a (essentially volunteer) visiting faculty member committed to introducing child mental health to the country. I want the position for a sense of legitimacy, rather than simply being a “volunteer”, since my Fulbright affiliation is done. I plan to spend 8 months here and 4 months, July-October, in the US, which seems like a nice balance to me. I must expand my circle of friends here, however, and once the isolation truly lifts, I’ll put some effort into it.

“For Sama” is a beautiful, painful, and overall remarkable documentary about the siege of Aleppo, Syria in 2016, filmed by a young woman. Her husband is a physician who started and ran a hospital, amidst the bombing and gassing by the Russians and long-time dictator, Bashir al-Asaad. It is quite unbelievable. Cinema verité.

https://video.search.yahoo.com/search/video?fr=mcafee&p=for+sama#id=1&vid=3bfb9ca9beb0a3e80bce1795a72b65da&action=view

PBS Frontline has many investigative videos, both free and of high quality.  “Policing the Police”, from 2016, is excellent. A New Yorker journalist imbedded himself in the Newark Police Department to try to understand its issues with racism.

On Tuesday Professor Tin Oo picked me up in his notorious rocket-mobile and we zipped north to Yankin Children’s Hospital. He overshot the turnoff from Kabah Aye Pagoda Road and, again, overshot the next turn to the hospital. When we finally arrived, three of my current students joined us and we had a warm reception by the Medical Superintendent and the head of the ICU. They offered us a small room to use for our clinic.   When we noted it was too tiny, they proceeded to show us the main conference room for the 550 bed (Here they say, even on signs, “bedded”.) hospital. They are hardly using it at all at present because of corona virus and even before March it was only used 2-3 times per month. It is a large, quiet room with green felt all over the floor so the sound is absorbed and it is a bit softer for children’s play. There is plenty of area to set up several assessment stations and there is a projector, etc. for teaching.  Overall, it is a significant improvement on last year’s Child Development Center. In addition to the noise and lack of confidentiality, we always felt we were intruding there. Clearly someone else must have felt it, as well, since we weren’t offered a spot for this year. We’ll continue to do 2 days of virtual clinic so the students can continue learning psychotherapy and we can continue to reach into remote villages.

One of my students, who is a long-time personal friend of the family of my 17yo patient, told me that the girl had been taken to a “doctor” by her mother.  The “doctor” had used a “Quantum Resonance Magnetic Analyzer” to diagnose “very high cholesterol” and “many calcifications around her brain and heart”. In two minutes. 10 minutes of “research” on the internet revealed that these machines, costing $70-125 on Amazon, are a big scam from China, used to prey on poor, uneducated people in developing countries. The latest snake oil. The girl is very fearful in any case and this “information” has worsened her anxiety.  I want to accompany her to the office and confront the man, though I know that isn’t appropriate, would be stupid, and could cause me all sorts of trouble. I’ll strategize with my students about the best course forward.

Being stimulated by the protests in the US, I proposed to my students that I would distribute a couple of good papers on racism and we could have an open discussion about it. It is rampant here, especially against the Muslims. The one Muslim in the class said it was too sensitive and she didn’t want to discuss it. She and I were chatting about something else on WhatsApp and I began to talk about it, thinking it was a private discussion. Dummy, I didn’t realize we were on our class’ site. I made a remark about the government wanting to keep the populace frightened by the Rohingya, so as to preserve the necessity of a hefty military. Of course, one of my students is in the military.

I have been scrupulously careful in two areas since I have been here:  discussing politics and how I conduct myself with women. This is a very conservative country. So I feel like I was very careless and didn’t sleep well last night. This morning I realized I could delete the most potentially offensive or provocative remarks from WhatsApp and I did but I fear the damage is done. [Now I find I can only delete it from my WhatsApp.] I must keep my mind on my primary objective, always, and realize I will likely not change anyone’s mind about racial or religious prejudice here. I just think of all the children in the world and what a terrible burden, if not outright danger, that fear and hatred of The Other will present to them.  As adults, we must stretch ourselves to grow beyond our parochial limitations. I look back on examples of my naiveté in the past in these areas and cringe. Facing them will make me better, I know. Maybe that’s it—personal work, not group work. Stretch myself, not others.

The image of DT holding up “a Bible”, after gassing peaceful protesters, is both chilling and ludicrous, this man who is about as far from Jesus as anyone could be.  He’s not “imperfect”; he’s fatally flawed. It also looks like he’s holding it upside down, which figures.

31 May 2020

[Above photo: Boat traffic on the Yangon River is insanely busy these days.]

For some reason I receive an inordinate number of advertisements for massive, Chinese-made rock crushers. I’d think with all the advertising algorithms available they would know my preferences for vacant oceanfront land for sale in Maine and small sailboats capable of circumnavigating the globe. That’s what I tend to browse, when I’m not reading the NY Times, the WaPo, Science, or the New Yorker. Rock crushers. I’m not into highway construction, in particular.

I’ve been reading Barry Lopez’ Arctic Dreams.  He writes beautifully and it has memorable passages and insights into the adaptation of plant and animal life to a land of two seasons, one of which is very, very brief. Oh, the desperation plants and animals must feel to reproduce successfully in the tiny window available to them. I’m also finishing Spike Lee’s “When the Levees Broke”, a 4 part documentary about Hurricane Katrina and the inundation of New Orleans. The amazing thing about the documentary is that it shows so well the massive scale of devastation and the criminal stupidity and neglect of the Bush administration for the citizens, largely black, of that city. “You’re doin’ a heck of a job, Brownie.”, GW says to Michael Brown, the unqualified and inept head of FEMA; a hell of a (disastrous) job, it seems. Seeing Part I is probably adequate but it was good to be reminded of Barbara Bush’s—the apple doesn’t fall far from the tree—stingingly unfeeling analysis of those in the Superdome in Houston, her take on Marie Antoinette’s “Let them eat cake.”

When Susan Collins says, “I am very concerned.” with no subsequent action to demonstrate the same concern, as she does frequently in a curtsy to moderate never-Trump Republicans and Independents, we can conclude she isn’t very concerned.  I do hope that Sara Gideon steamrolls her, even though SC’s Super-Pac money keeps pouring in.

In class on Monday one of the students presented a paper she was given by Dr. Khin Maung Zaw, who teaches on Tuesdays. She had internet problems and couldn’t present it the previous week in his class. It was entitled “Current research in child and adolescent bipolar disorder”. The senior author was Robert Findling, MD, a well-known pharmaceutical shill and enthusiast for the concept of bipolar disorder in pre-pubertal children. I once went to my only drug-sponsored supper at Charles Phan’s Slanted Door in San Francisco, urged by some friends, at which Findling was speaking about the use of 2^nd generation antipsychotics. Someone in the audience questioned why he only showed studies of Risperdal, not the other 4 then in use. Someone else asked, “Who sponsored the supper?”  Janssen Pharmaceuticals, the maker of Risperdal, of course. Anyway, Findling has been paid by many different drug companies, despite having a good salary as an academic (currently Chief of Child Psychiatry and an endowed professorship at Johns Hopkins and previously at Case Western Reserve).

The paper was pure crap, trying to drum up business for Pediatric Bipolar Disorder. Take this convincing and informative sentence: “For instance, regions on chromosomes 2, 4, 6, 8, 11, 13, 16, 18, 21, 22, and X have been possibly linked to bipolar disorder.”  And, “Examination of neuroanatomical structure differences of children with bipolar disorder compared with children without psychiatric disorders have reported conflicting results.”

Basically, the diagnosis of Pediatric Bipolar Disorder is one of phenomenology since the DSM doesn’t consider causality or context.  A man is running past me down the street. Did he rob a bank? Is he delusional, imagining state security is after him? Is he late for his wedding? Has he won the lottery and he’s hightailing it to collect the winnings? Is he training for a half-marathon? Was he about to have a panic attack in a crowded market and he’s escaping from the scene? You get the point.

Happily, one of my students called the other one at 10PM one night last week, well before my rant of today, and said, “Look out for that Findling. I’ve looked him up and he’s getting money from so many drug companies.” It warmed my heart. I worry that my students will be naïve prey to drug manufacturers and their minions. They are not patsies, it seems.

We’ve “seen” on Zoom a 9yo boy in a village outside of Magway. His parents are concerned because he has become aggressive and oppositional. There is a complicated history.  His father’s farmland was on the east bank of the Ayeyarwaddy River and the bank collapsed, taking away the house and much of the farmland. He, his wife and son had to move in with his mother, brother, and sister. Complicating this further was the fact that his wife, the boy’s mother, had been a domestic worker for the father’s family, coming from another village. As such, she was always treated poorly, even after marrying the father. The boy developed lumps in his neck after the family moved in with his grandmother, was taken to Yangon Children’s hospital for 1 month and determined to have multidrug-resistant tuberculosis. The parents decided to try to stay in Yangon, since the home situation was so hostile. The father opened a mohinga stand and supported the family for several years. City life was too hard, however, and they moved back to his mother’s house. It has been difficult for the boy in the village because all the other parents won’t let their children play with him, fearing he is contagious. Plus, he struggles in math so doesn’t like school.

This was all described via Zoom at the first visit, using an uncle’s phone. The data charge was about $2 for an hour of Zooming; the therapist was able to send the money electronically to the uncle after each session. By the third session of merely telling their stories, the boy looked happy and had a couple of playmates, the father seemed relieved, and the mother was able to say she became aware she was displacing her anger toward her demeaning relatives onto her son. Reciting a dream in which her husband died and she didn’t know what she would do, she burst into tears. The uncle is leaving the village for work soon and his phone will accompany him, so we have one more appointment with the family unless they can find another phone to borrow or rent.

I want to underline the fragility of their existence and their resilience in the face of that. They have no steady income, no retirement savings, no shares of stock, virtually nothing of monetary value and yet their love for their son is strong enough to allow them to overcome the stigma of seeing a psychiatrist, to allow their personal vulnerability in the face of that, and to use their ingenuity to scrappily, but honestly, piece together their lives.

I had my first outing in 10 weeks two evenings ago. Clementina, a terrific Italian woman in our small poker group, is leaving in a week with her family. Olivier, her husband, will train prison observers in all of West Africa for the International Red Cross, based in Dakar, Senegal. He’s been doing the same here for the 46 prisons and 42 labor camps in Myanmar. They’ll visit her family in Milan first. They live at 8 Mile, which is just about that distance from my apartment. They are in a gated park, in a huge and lovely house. There are 4 other homes in the park, as well as a swimming pool and a tennis court. How the other half live. They have 3 children and each parent has led a full and interesting life. We consumed Parami Pizza—the truffle pizza is pretty darn good, although my crust is better—and Army beer at 8% alcohol. Wonder of wonders, I left the poker table with more than twice my buy-in. That has never happened to me before and in celebration I paid for all the cab fares home!

Our poor country is convulsing and DT is certainly withholding the diazepam. Rather, he’s injecting metrazole (A drug that induces seizures and was a predecessor to ECT). Racism is alive and well, kicking, one might say, despite John Roberts and the Supremes relieving southern states of some provisions of the Voting Rights Act. Of course, they all immediately began to institute measures of voter suppression.  People always get tribal when frightened; DT and others pouring gasoline on the fire certainly doesn’t help. If I were a young black man, I’d say “Up yours!” to all the laws of the land and loot and wreak havoc, I am sure. It isn’t helpful and will provoke a backlash, which is certainly what Trump seeks—those “Law and Order” votes— but the rage is understandable when the police, and other white men, continue to murder black men without cause.  Hateful whites certainly activate my hatred for them.  An endless, desperate, chaotic spiral downwards and, again, the “leadership” in DC at best mumbles platitudes, at worst incites the rage. He makes the current crop of generals in Myanmar look like choirboys.

24 May 2020

[Above random photo: I have no idea how the birds get in and out. On the way to Mvuu Camp in Liwonde National Park, Malawi, 2017.]

The idea of a woman VP, running for President in 2024, is thrilling for me. And that Elizabeth Warren is a possible choice is fantastic. She is brilliant, accomplished, principled, honest, a workhorse, and gets things done. It is good that she is to the left of Joe; he’ll reassure people, she’ll move stuff ahead in a humane, sensible, and progressive way. It also is very exciting to me that Joe is forming task forces to develop a campaign platform, task forces filled with smart, honest, principled people.

It has been a hideous 3+ years, living among the swamp dwellers, under their power. It reminds me of the time my distant cousin, Sim, was visiting. He was a couple of years older than me at 11yo. We were playing on the lawn after a swim and he grabbed me by the testicles through my bathing suit, squeezing them just hard enough that I knew I couldn’t escape or fight back. I was paralyzed and surprised and frightened and enraged. No one had ever done that to me before (or since).

We’ve never been in this position as a country before. Donald Trump and His Assault on Truth by Washington Post journalist Glenn Kessler—https://www.washingtonpost.com/opinions/trump-is-lying-to-sway-his-reelection-and-democrats-arent-paying-attention/2020/05/22/60c79e4a-9b80-11ea-ac72-3841fcc9b35f_story.html —documents and examines the patterns of the 16,241 lies DT has told since Inauguration Day. That averages out to be 15 per day. And the dismantling of government oversight, the dismissal of all whose primary loyalty isn’t to him, appointing unqualified people to cover his schemes and blunders. It has felt like he had us all by the balls, squeezing just hard enough, and we could do little about it. Reckoning time approaches, thankfully.

A switch to local issues. My war with the black ants continues, although I am beginning to feel a bit for them. They are incredibly athletic, whizzing around at amazing speeds to avoid my thumb. Maybe I’ll just live and let live. That is not so with the weevils, or whatever the creepy-crawlies are in my rice. Happily, they are easily washed out when I rinse it, since they float. If it is dried corn—say, popcorn—they are more difficult to exterminate. They eat their way into the kernel so when you think you have finally removed the last one, 6 more appear. You then realize that 50% of the kernels house these critters. It must be some experience for them when the kernels pop. I suppose they’ve expired from the heat but it would be exciting to be nibbling away in your home when it suddenly explodes, like a meth house, perhaps. The last local issue is the drain in my bathroom sink. It has gotten slower and slower. I don’t see Drano in the grocery store. I know when I have cleaned out sink drains in the past they are filled with hair as a basic matrix; then goopy stuff adheres, fills up the spaces, and the sink is plugged. I’d dissemble the trap but it is a pedestal sink with the trap concealed and I don’t want to try to do it blind. So, I heated an electric kettle of tap water and poured it down. Voila! The goopy stuff relaxed its grip and the drain works again. For awhile. I can always call the landlord but I think one task at a time is enough for him. I’m working on the TV antenna now; it has taken a month so far.

I’m planning to start, with my students for sustainability, a For Children and Families column in local newspapers. Facebook may reach more; I’ll check with my students. It would include both basic information on child/family development (including developmental needs) and serve a Q & A function. I want to address bullying, corporal punishment, intellectual disability, behavior disorders, psychotherapy, sexual abuse, sex education, and myriad other topics. It could be a fun and useful advocacy arm for child mental health. A friend is working on the newspaper angle for me now. My students can translate and keep me culturally-attuned and I can provide some experience, good writing,  and a progressive nudge to it. It can help to insure our momentum.

Now every student in the Child Psychiatry course has a therapy patient, either a child/adolescent or a parent. Naturally, the parents are the most difficult to engage. Privacy is an issue with Zoom, since so many families live in a single room. Happily, some of the kids are fluent in English and their parents are not.

So much for final decisions. After deciding “definitely” go to Maine in July, I’ve reversed course. 35 hours flying from Yangon to Boston, 6 hours driving from Boston to Brooksville, 14 days quarantine on the mainland, the same travel times in reverse, and between 14 and 28 days quarantine in a hotel upon arriving back in Myanmar. Uh, not a lot of sense to it. The pre-Island quarantine is because there will be at least 3 elders on the Island and the pump, boats, etc. all are possible vectors of disease. It just isn’t worth it.  I’ll miss another summer away from the Island, as well as visits with friends and family.

I did, however, receive notice that my proposed presentation on “The Dawn of Child and Adolescent Psychiatry in Myanmar” was accepted for the American Academy of Child and Adolescent Psychiatry annual meeting in San Francisco.  My kneejerk was, “Oboy, I’ll get to see my friends, fly to Maine and see family, and return to Myanmar by circling the globe”. It is most likely that the meeting will be virtual and I’ll present from my living room in Yangon.  I can then easily assemble a panel of my former students who can participate. I want everyone in ethnic costume, like Dr. Hnin Aye at graduation in her brilliant Karen traditional outfit with the cute little hat. I was planning on wearing formal Myanmar garb in SF, anyway, for a little local color. I love that virtually everyone here wears traditional clothing—-one-sets for the women and longyis for the men—rather than succumbing to Western dress. Keep that culture. Plus, longyis are so much better for this climate: cooler in the heat, quickly dry after a monsoon downpour. They are colorful and inexpensive, as well.

Miscellany. My pizza crust was pretty good. The topping was less than I’d hoped: a marinara sauce with added capers and sautéed onions and garlic. I was out of cheese. I just read that in 30 years the mass of plastic in the ocean will outweigh the mass of fish and mammal life. And cows are the single largest producers of methane in the world. Plus they use a lot of water and oil (for tractors to grow and haul the feed), so decreasing our meat intake is probably the most effective thing most of us can do to decrease global warming. That and flying less. Which, I’ll note, I’m doing.  Oh, we’re in for it.

The Covid-19 tales out of Latin America are horrifying. Lots of young people are dying. Lots of cheek by jowl living in poor areas of Rio and Sao Paulo and Lima and Quito and Santiago, causing multiple exposures in a not-so-healthy population with poor health care.  I suppose this is what it looks like when the ship sinks.

17 May 2020

[Above photo: Looking down the meadow from my cottage in early morning.]

I just received word that the University of Medicine 1 requested that the Ministry of Health and Sport request of the Ministry of Foreign Affairs that I will have assured re-entry if I leave the country for a holiday. I’ll have to quarantine for 14 days when I get back but perhaps that can be in my apartment. So, I’ve begun looking into plane reservations. The best so far seems a 35 hour flight—here to Hong Kong, 16 hour layover, Hong Kong to Boston. I can drive a rental car from Boston to Bangor where I can drop it and steer my old Subaru to S. Brooksville. Then I can jump on Stella for the 45 minute ride to Beach Island. Where better to quarantine for 14 days than on a sparsely populated island 6 ½ miles offshore. Aeneas didn’t have to quarantine. Nor did Odysseus. Since it is unavoidable if I want to go, I’ll not whine, as long as I get to that rock-bound, spruce-covered Maine island. It does sound like an arduous journey for a 4 week vacation, though.

Friday and Tuesday are the two days I don’t teach. Last Friday I was bored and decided to make an onion bread. Why not put some oats in it? Awhile later, after much kneading, baking, and much, much cleaning up I had a wonderful loaf of oatmeal-onion bread. Using instant oats, which I generally despise but of which I was given generous quantities by two people, cuts the preparation time by an hour. It is excellent bread, chewy, but airy, as well.

Trying to bake using a small area would seem to suggest less clean-up. However, there is more, as flour and dough seem to fly all over, landing on my shirt, my shorts, the floor tiles, the floor mat, and every horizontal surface in the vicinity, including the top faces of all the drawers leading down to the floor. Perhaps I can be more meticulous next time, though I am doubtful. Wasn’t Meticulous the name of the intrepid shepherd in “Oedipus at Colonus”?

I’m puzzled by the evangelical Trumpers. You’d think they’d read this plague as a sign of the End of Days, of which these folks are always warning with a certain smugness. Like they have already reserved all the good heavenly chariots for themselves. Yet they are treating it as if it is nothing and doesn’t exist, damn the body count. “Liberate!”. Whip the market up! None of those people have skin in the stock market so I’d think his drumbeat about “the economy” would fall on deaf ears. They’ll seem to take any opportunity to carry guns and shout grievances. I realize many people are desperately suffering. I know I am stereotyping and lumping together and making massively false assumptions and I am (only) a little ashamed of myself. Fortunately, this missive is for the Chosen Few, not the Unwashed Masses, so I’ll let it stand. This week’s rant.

Yesterday as I was teaching my weekend group the Termination Phase of Interpersonal Therapy for Adolescents, I received a WhatsApp from two students in my other class, on their way to my apartment with food. I asked them to delay until class was over. They arrived with all manner of fruit and vegetables, some snacks, my “opium”—two fabulous hot relishes they concocted and gave me 3 weeks ago, to be eaten with rice—, and a huge container of chicken soup with glass noodles, mushrooms, quail eggs, etc. One of them told me a joke about a monk. They are so kind and sweet—I think the unmarried one is perhaps a little sweet on me. It is so nice to see people in the flesh. This time they came without a husband in tow, confident I’ll not act inappropriately. Or maybe that they won’t!

I’ve solved a conundrum using Critical Thinking, about which we talk a lot in class. This is as opposed to Reductionistic Thinking, which serves most of Psychiatry poorly. When first showing me the apartment, the landlord told me, and even proudly demonstrated at the kitchen tap, that I had hot water. He referred to “the boiler”.  But I’ve noticed that there is only hot water in the evening, not for my morning shower. I assumed that “the boiler” was on a timer to save energy. I was crawling around the roof yesterday, attempting to see if I could adjust the satellite dish to get CNN on the TV when I saw my two water storage tanks. Against a wall so they get lots of hot sun in the afternoon. Aha, “the boiler”! Mystery solved.

I finally finished John Walsh’s memoir about growing up Irish in London and am onto another immigrant experience book, On Earth We’re Briefly Gorgeous by Ocean Vuong.  Quite a different book but the cruel tribalism that is expressed in each links them. How newcomers so want to fit in without losing themselves and how the established can be such bullies, either overtly or snidely. Fear of The Other appears to be so primal, residing so deeply (redundant) in our DNA and our bones. And, of course, along come people who want to exploit, fan, and manipulate the fear of difference for their own benefit. Can we not just simply get along together? I may not fancy blood pudding or menudo or monkey brains or whatever, but whatever happened to tolerance, let alone appreciation, of difference, and kindness, respect?

I am definitely going to make the trip to Maine, however arduous and potentially dangerous. Being cooped up here is grinding me down, as you can see from the above. My writing here has the flat, dull taste of mud; kind of like shouting “Shit” when you are angry but not providing any richness of detail. Sort of like those “Liberate” guys. We are much more similar than different, curiously.  We just shout different words.

[Above photo: By popular demand: Long of tooth, rich of wrinkle, sleight of hair, soul-patch rising.]

10 May 2020

It is a challenge to think critically these days. Sewerage plant effluent may look like spring water, so many streams of “facts” gush out of my computer. My daughter just alerted me to Dr. Judy Mikovits and a supposed plot coursing through the Internet which depicts Tony Fauci and Bill Gates attempting to corner the vaccination market—“Maybe they actually caused the pandemic for profit and power.”  If it is confusing for me, imagine what it must be for someone with a 10^th grade education. Or less.

As I pointed out to the INGO Forum group last Monday, if anxious and uncertain, turn to your core values: love, kindness, curiosity, honesty, etc. They don’t eliminate the uncertainty but they can be a little LED flashlight showing me rocks and logs I might otherwise stumble over.

It does seem as if the world will never be the same, never revert to the same level of safety as pre-virus. Such care is required when going out—or staying home. Three big guys came into my apartment to fix my TV.  Afterwards I wondered, What had they touched?  Were they asymptomatic carriers? Yesterday I went for a walk in People’s Park with my former student, her husband, and her 5yo son. Aung (the child) sweetly took my hand as we walked along.  Is there anything as wonderful as a child’s trust in you to protect him/her? Was he a carrier? The trees, grass, flowers, and shrubs all looked so vital and green and health-giving. The Shwedagon Pagoda was visible across the park at times, regally golden in the late afternoon sun. Some men were handing out free water bottles toward the end of our walk. Unthinkingly thirsty, I took one and swigged it down, then wondered if I’d just done myself in.

It is rumored that the government is starting to do more serious testing now. The peak in Myanmar is predicted for August.  Sweden, noting how many more deaths they have than Norway next door, is regretting their “open-style” response.  Which is nothing like the embrace we are encouraged—in some cases ordered—to endure in our country to get the economy, and stock market, roaring again. Clearly DT doesn’t want to ramp up testing because, if you can’t test, you don’t get the full numbers.  He’s sunk, anyway, after this performance.

I sent around a sad and hilarious video of Jason Klapper interviewing people at a Trump rally. It was conducted to make the Trumpers look like idiots, which they obligingly did.   On review, it is very snarky and exactly what DT would have us do, further alienate ourselves from our neighbors and I feel a little ashamed taking such pleasure in it.  I realized that in mau-mauing my brother Chas, repeatedly, I really have been expressing my own fear and trying to gain some control by changing his convictions. I’m worried about the virus but much more about the state of the nation: which dishonest, greedy, and lawless path our leaders will walk us down, their hands in our pockets. It makes me frantic to see the drivel and lies pour out of His mouth and be totally unable to influence it. Well, I can vote. I am giving $ to Democrats. But even the Dems are awash in money and too beholden to banks and Wall Street and big corporations. So it is time to stay in touch with my fear and uncertainty, my desire to control things, and the knowledge that only by trying to connect in an empathic way with other’s fears (and hopes) will I help, rather than add to the corrosive wave sweeping over us all.  I’m grateful for my enlightenment, resulting from a 1 ½ hour conversation with my daughter, Ariane.

Ari said a contractor she knows had just gotten 4 calls from New Yorkers looking to buy and build in Maine. It may be that city dwellers will begin to arrive and land prices will start to move up soon. I’ve located a piece of waterfront property that looks lovely and Ari will visit next week. If it looks good up close—and the location on Eggemoggin Reach appears perfect — I’ll buy it to develop later. It would be largely my winter place, since I will spend summers on the Island. I realized that, given good internet, I can teach from there as well as from here. I won’t decamp just yet but if I am going to be confined for years, better there in nature than here in a penthouse. I do love looking at the amazing amount of traffic on the river in front of me, however.  Yesterday I counted 30 small open boats at one time ferrying people to the far shore. Plus, limitless numbers of barges, small dredges, large freighters, and other watercraft.

I’m settling into the idea that I’ll be single for the duration. I don’t want to marry again but I’d thought maybe a mate was possible. I’m pretty sure I don’t want to live permanently with anyone, however. I have been reluctant to call any life possibilities off the table until now. Stephen Arkin, a friend from New York days, recently died in San Francisco, which snapped me to attention.  Age is foreclosing on my fantasies. Although fit, I have brown spots all over my body and hair sprouts more vigorously from my ears than my scalp. Removing my beard makes me look younger in one sense but also reveals wrinkles that were less obvious before. A metamorphosis.  I’m turning into something softer, spottier, and more wrinkled. Not a cockroach, happily.  It is more strange than sad to me.

It is time to bake some bread and go to Marketplace for supplies. I am sorely missing marinara sauce. I buy it in a jar and then add more basil, garlic and onions.

[Above photo: Geting a trim at the Beauty Parlor next door.]

3 May 2020

Can you believe it? (My rant for the week.)

After my Zoom class from 9-12 today, a former student with her husband and 5yo son came to visit and bring me lunch. Anawar Yee Nyo is a total sweetie and smart; I went to her PhD graduation ceremony a few months ago. Her boy, Aung, is autistic with no functional language. She was determined to bring me lunch, she messaged me yesterday. They sat and watched me as I ate it and Aung dis-assembled the living room. He didn’t break anything, just moved stuff around trying, it seemed to me, to get objects to do something. Autistic children don’t develop representational play, so a bit of plastic with 8 wheels in the form of a truck is just a bit of plastic and, accordingly, boring, not a fantasied play-object. I wonder how he’d do with a pet, something more animated.

After lunch I found myself sitting in a chair with Anawar on one side of me, operating scissors and a comb and her hubby on the other, running my electric hair trimmer. A pile of hair on the floor later, I  had a hair-cut. Inspired, after they left I cut off my beard and mustache and shaved all clean. I’ve only had those two off x2 since 1968 when I grew a full beard during my residency in Medicine. Both times my wife and kids demanded I re-grow, since I looked too unfamiliar (I like to think. Not that I shattered mirrors.) I’m not sure how I feel but it is kind of nice not to have white-grey chin whiskers advertising my age. Why? I don’t want to be this old—-I have many more things I want to do and some of them require I am fit and stronger than you’d expect a near-80yo to be.

Reading an interview with Laurie Garrett (The Coming Plague and others), she suggests that we are in a 36 month period  with this virus. In Myanmar Covid-19 is supposed to peak in August. I may not get home to Beach Island this summer. Cripes!

One of the crueler coordinated moves is DT’s order to open the meat-packing plants. They closed because the workers are in very close proximity and the Covid-19 rates were skyrocketing. Citing our food supply, he is doing it without any safety directions for the owners. It is similar to when George W. Bush made chemical discharge control a choice of the factory owners, optional. Since the meat packing plants will be open, any workers who stay away to protect their health and that of their families are no longer entitled to unemployment benefits. Meanwhile, back at the ranch, Evil Mitch is holding up the next funding relief package until the Dems agree to a no-liability clause for the meat-packing factory owners: Hormel, Tyson, Smithfield—-huge, rich corporations and generous Republican donors. The laborers who would get ill would, thus, have no recourse to address the owners’ neglect of safety standards. It’s like Wisconsin voting—forcing people into dangerous situations— but worse. Of course, the vulnerable are largely poor and non-white. We could eat vegetables, fruit, nuts, and grains and skip meat for awhile. Numerous super-elite athletes are strict vegetarians. It would likely be better for our health, as well. Perhaps the owners don’t want us to get out of the meat habit and realize we don’t really need it.

Lila, meanwhile, is so beautiful and smart and impetuous, bringing ruin upon herself. The drama of her life is over the top. As Lenu says to Lila’s son in the first episode, “Your mother always went too far.” It is especially dangerous among the poor in Naples, where the strong (and brutal) survive. I had a patient once who, when stationed with the US military outside Naples, would ride on a motorbike with a buddy and snatch purses from women pedestrians. Not such a good thing. Later, he was furloughed from his work at a large corporation for a work-related back injury, collecting benefits until someone filmed him in his front yard heaving logs about and mowing the lawn. It gives the disabled a bad name.

We’ll play Texas Hold-em tonight on Pokerface, an internet poker site. Our group has a well-defined complexity, some looking to Dante and TS Eliot for inspiration, others sinking into Lust and Sloth. We’ll see if virtue triumphs. In any case, I thank Clementina. I was looking through some poetry and found a stanza in Italian preceding The Love Story of J. Alfred Prufrock. The poem is a marvel but I’ve never understood the Italian. Clem is Italian and happened to mention it to her mother, who is re-reading Dante and gave her an exact translation. Much [envious] jeering from the Lusts and Sloths, but those of a higher nature appreciate the beauty of anything written by Dante Alighieri. [I realize this paragraph will be unintelligible except to the small circle of our poker group. I seem to have run out of intelligible things to say.]

I’d forgotten that DT managed to get one of the alleged victims of Bill’s lust in the front row at a DT-Hillary debate. I’m glad Joe has encouraged a careful investigation of Tara Reade’s allegations. A bit different than DT’s response—“Never happened.” or “She’s not my type”. For the latter read, “If she were, I would have raped her, sure.”

DT is demanding a release of Joe’s private Senatorial papers, in storage at the University of Delaware. Of course, there would be nothing there about Tara Reade’s accusations (She just backed out of her Fox News interview, BTW.) but the ‘Pubs figure they can cherry-pick and get some good campaign ad material. I’d say, Sure, when you release the tax returns you promised and all the information related to the many sexual harassment accusations against you, even from those women who you paid off. DT is a serial molester; Joe has had poor boundaries, rubbing shoulders and necks, a very different kettle of fish.

I don’t know if this is so random because I am gradually, unwittingly, going stir-crazy or because I don’t have my customary external stimuli which keep me writing. Otherwise, I turn inward, miss having a mate with me, and simply think about how messed up the world seems right now.