Now and Then


Nancy Baker2017.JPG

Nancy J. Baker, MD

We travel
in two dimensions,
living in time and place
experiencing life and death.

Now and here
or then and there.
What about now and there
and then and here?

Pancreatic cancer
means then is now,
there is here

Old age
implies then, not now,
remote from here
and unimaginable.

What if we live
as if today is our last?
Is now forever
and there everywhere?

The paradox of
now there and then here.
Impermanence means
take nothing for granted.

Heaven on earth
now and then,
here and there.

Seeing Through

Christopher Lee, Medical Student

Christopher Lee, Medical Student

When his older brother got ALS,
he promised they’d find a cure.
When his older sister got ALS,
he promised her his untiring care.
When he himself got ALS,
with self-love and a sense of certitude
he found belief in a lie, which he knew
was white as the doctor’s coat:
each ability he’d come to lose
would be transferred to a child
a girl in Africa, a boy in Vietnam, so he imagined.
As it was for his siblings,
the gift-giving began focally,
then gradually, reliably spread.
First, the ability to walk:
one day his feet grew heavy
and soon like lead gave up;
thus, a baby hearing “Come to Momma”
took a few first suspenseful steps.
Next, was teeth brushing:
his hands argued with each other
as mint paste squeezed to the floor;
and in his mind, with parents hovering,
a child made a few foamy, delicate swirls.
Eventually, the ability to swallow:
his and his family’s hoarded frustrations
and the worry in his wife’s eyes
made it progressively difficult, then impossible;
he almost forgot that somewhere –
to a babbling choo-choo train
or cooing propeller plane –
first bites of solid food were being gobbled.
By the time it was too much to leave the house
(such were his cramps, fatigue, and incontinence),
he longed more for being honest than happy.
Perhaps this was why there came a day,
when he muttered a favor to his neurologist.
Understanding, having been asked before,
the doctor led the man and his wife
through the hospital corridors, to a set of doors.
The wife pressed the button; they wheeled in.
The maternity ward was large, but they found
the double-paned window.
He sat just tall enough to see through –
babies receiving life.

STFM’s Top 10 Ways to Win (Policy) Friends and Influence (Government) People

by Joseph W. Gravel, Jr, MD and Hope Wittenberg, MA

Wikipedia defines advocacy as “an activity by an individual or group which aims to influence decisions within political, economic, and social systems and institutions.” This blog will focus on federal legislative advocacy, but you can use the very same skills in state or local legislatures, your home institution, or advocating for patients in the course of your work.

# 1: Begin With the End in Mind

Identify what change you want, how to make it happen, and who can make it happen. For example, is the issue a federal law that needs changing? Which committees have jurisdiction over that issue? Who sits on that committee? If it’s not legislation, who holds the decision-making power? Refining the problem and the solution you want, along with knowing who can make it happen, is the first step to moving forward with an advocacy goal. When you meet with who can make it happen, come ready with viable solutions, not just problems. There’s power in providing viable solutions, as you could be essentially writing a bill’s “first draft”, even if/when your ask gets amended in the legislative process.

#2: “Friends” Wasn’t Just a 90’s Show

Are you alone in trying to create change? Who can you identify that might strengthen your position? With whom might you ally? There is strength in numbers and power in broad movements. A corollary question is who would oppose the change you want? What are their arguments and how can you address them? Can you change their minds?

#3: Tell Me a Story. I Like Stories

How do you reach people to gain their support? Data and facts are important, but not enough. With advocacy, forget what you learned in professional school about the scientific method and the problem with anecdotal evidence. You’re not writing a paper here. Anecdotes are often more powerful than data in the advocacy realm. You need to develop a good story that both portrays the problem you are trying to solve and captures one’s attention at an emotional level. What are the key reasons to support your cause that would reach someone? Use examples that come from your patients, practice, or neighborhood. Remember that your community is your legislator’s community as well, and their job is to represent you and the community. (Read the blog posts Moving Away From Data Points and Back to the Patient Story and From Journalism to Medicine: Not Such a Huge Leap After All to be prepared.)

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