Consistency

consistency, n: 

1. Solidity, substance, firmness

2. Condition, degree, quality

3. Agreement, harmony, compatibility

Identity x vision is our compass, 

Paving the path we must walk 

To move from who we are 

To who we want to be. 

Must our professional 

And personal identity 

Be one and the same? 

Or might it be sufficient to 

Have two compasses, distinct 

But consistent, to point the way?

Knight of the Round Wing

I kneel before you
Gowned and gloved,

Yet you bless me still

With a gallant kiss

To the hand you hold

With more gentle care

Than it has to give.

Barrier precautions

Preclude contact,

Yet you touch me still,

Lips through latex,

Warmth into skin and veins

Flowing upwards to

Somber, smiling cheeks.

I knelt before you,

Humble and distraught,

No more cures to offer,

No way to raise the sun

On your tomorrow,

Yet you blessed me still,

And still you remain.

Health is not about Medicine

"Water-borne diseases are not caused by lack of antibiotics but by dirty water, 
and by the political, social, and economic forces that fail to make clean 
water available to all; heart disease is caused not by a lack of coronary care 
units but by the lives people lead, which are shaped by the environments 
in which they live; obesity is not caused by moral failure on the part of 
individuals but by the excess availability of high-fat and high-sugar foods."

- WHO’s Commission on Social Determinants of Health, 2008

Medicine may be about health and illness, but health is not about medicine. It is about the lives people lead, and the world in which that happens. Medicine can save lives, sometimes miraculously. It can improve quality of life, sometimes significantly. But we know now, or perhaps have re-learned, that health is determined by all sorts of factors far more than medicine or health care. (Not to mention how all those factors affect access to care.)

This 2012 infographic from the Bipartisan Policy Center's Lots to Lose illustrates the gap between what matters and what we spend on. What it does not show is the extent to which healthy behaviors and environment are themselves dependent on social, economic, and political factors. 

 It is hard to eat healthily when the closest supermarket is over a mile away and you have no car. It is hard to get an education when your family needs you at home to work or take care of younger children. It is hard to enjoy activity and sleep when you might be arrested for loitering and being homeless. It is hard to find a home when your prior incarceration prevents you from finding a job.

Is it any surprise, then, that the United States performs so poorly compared to other high-income countries? We are among the most unequal nations in the world, and our social institutions (including health care systems) are far from equitable. Our best hospitals can work magic to save patients from heart attacks and strokes, but our impact on chronic disease is tepid at best. Our impact on what causes chronic disease is not tepid, but instead profoundly detrimental. Public health matters, so public policy matters. As is often said in the quality improvement world, "every system is perfectly designed to get the results it gets."

Further reading:

1. "Tools for Putting Social Determinants of Health into Action." CDC, 2018.
2. "It's an Unequal World. It Doesn't Have to Be." New York Times, 2017.
3. "Poor Health: When Poverty Becomes Disease." UCSF News Center, 2016.
4. "Criminal Justice, Homelessness, and Health." NHCHC, 2012.

Fireflies, Part 4: Playing Around with Poetry

Whenever I'm asked or inspired to write poetry about a particular topic, there are a few short forms that I often play with to get my synapses firing. They each have their own constraints, and it is a fun puzzle to write within them. So, here are examples of all three from the last week of fireflies. :)

Haiku
A traditionally Japanese form, haiku has 3 lines with 5-7-5 syllables. They usually involve a juxtaposition of two subjects with focus on nature or seasons.

Dancing in darkness

A lightbulb flickers off

The firefly unseen

Limerick
A 5-line poem with an AABBA rhyme scheme, where the 3rd and 4th lines are usually shorter. The meter is mostly anapestic (duh-duh-DAH). Often humorous, sometimes bawdy, it arose in 18th century England.

Our love letters used to be mail 

Sent at speeds seeming slow as a snail. 

Now as fast as we think, 

Like a firefly’s blink, 

We can send light-speed text and email! 

Acrostic
A literary form where the first letter/word of each line spells out another word or message. This is one of my favorites because when not highlighted, it can be a kind of code.

Falling fairies shower their dust 

In tall grass under taller trees 

Radiant in their summer green 

Ecstasy for the warmest season 

For a longer day and shorter night 

Loving the twilight in between. 

You ever see a firefly in sunlight? 

More Firefly Posts:
Fireflies, Part 1
Fireflies, Part 2
Fireflies, Part 3

Fireflies, Part 3: On Communication and Arguments

Do Fireflies Fight?

Lovers’ spats sparking from missed messages - 

sorry it was a black hole behind that tree 

…can you see me now? 

Fire and fury on one side 

Flashing out in public for anyone to see, 

Yet unnoticed by the other, in their own world. 

Head turned away, distracted by other lights, 

Or just looking for peace and darkness 

To recover for a bit? 

where are you going? 

Sending thought after lonely thought - 

will you look at me when i’m talking to you!? 

And when communication fully fails, you find not

 Silence that makes you feel invisible,

But darkness - 

where are you? 

So complete that you feel utterly alone 

As if no one else exists for you, or ever will again.

More Firefly Posts:

Fireflies, Part 1

Fireflies, Part 2
Fireflies, Part 4

A Firefly Bonus!

Fireflies, Part 2: An Existential Lament

Letting My Light Shine

They tell me to let my light shine, that it’s who I am. 

What do they know of my life?

Of the years I’ve spent in the dirt, 

Working and growing, maturing and waiting 

Until I finally have a light worth shining 

And others worth showing it to? 

Would they truly have me believe 

My past is no part of my present, 

When my past is all that I am?

And what about my daytime life,

And my unlit midnight moments too?

 The hours I spend eating, positioning myself
Just so beneath this tree, in the tall grass,

Are these to be consigned forever to darkness?

I am more than my light in these seconds of splendor,
More than most people will ever get to see.
So make not the foolish mistake that you know me
When all you see is my light shining under this tree.

A few reflections here...

• For most people, most of the time, we are not just the part we play in a given moment. We are the sum of our past - experiences, memories, genetics, relationships - and our present (and perhaps our future?). Indeed, what we bring uniquely to a present situation, as opposed to anyone else, is exactly what our pasts have made us.
• How much of our identity is based on our public persona, versus how we act in private or with close loved ones? Should it be different? Is it even correct to talk about only these two, when we may have many public and private facets? Are we a weighted average of these? A summation? A product?
• Fundamental attribution error: explaining others' behavior with undue emphasis on internal traits rather than external factors, in contrast to judging our own behavior. When we know someone only in a single context, e.g. a professor at school or a manager at work, it is far to easy to assume that how they act is how they are in all situations.
• If you would like to learn more about the full lives of fireflies, here are a few places to start!
• Facts about Fireflies | firefly.org
• The Firefly Life Cycle | ThoughtCo
• Fireflies | National Geographic 

More Firefly Posts:

Fireflies, Part 1
Fireflies, Part 3
Fireflies, Part 4 

Fireflies, Part 1: An Introduction

It's firefly season!! Magical in their transient bioluminescence, as full of symbolism as light itself, fireflies are fantastic in every sense of the word. In the Great Smoky Mountains, members of a certain firefly species (Photinus carolinus) synchronize their flashing lights for their few weeks of summer dancing. They are the only species in the US to do this, and so the spectacle is a rare natural wonder in both space and time.

One member of the poetry group I meet with won the lottery to go this year, and so I was given inspiration to write some firefly poetry! As this is the first Part of perhaps four, here is the first poem, written about my first firefly encounter this year...

Falling Away

Computer left forgotten in the reading room 

So I’m walking back in the dusk and gloom 

When a sudden spark brightens the night 

Veering through the dark, vanishing... 

Reappearing, as if I were stirring 

A pot of hot embers in the air 

Loosing fire, and lighting 

My way until they 

All fade away 

Fall away

Other Firefly Posts:
Fireflies, Part 2
Fireflies, Part 3
Fireflies, Part 4

And as a bonus, here is a beautiful firefly video made by a talented firefly photographer:

Radim Schreiber, http://www.fireflyexperience.org/