Around Docs

While it continues to talk about BMI as though it were a valid medical tool, and buys into a fair number of canards, this NYT article has some important info about surgery, anaesthesia, and chemo as well as some good reporting:

“Surgery involves anesthesia, of course, giving rise to another issue.

There are no requirements for drug makers to figure out appropriate doses for obese patients. Only a few medical experts, like Dr. Hendrikus Lemmens, a professor of anesthesiology at Stanford University, have tried to provide answers.

His group looked at several drugs: propofol, which puts people to sleep before they get general anesthesia; succinylcholine, used to relax muscles in the windpipe when a breathing tube must be inserted; and anesthetic gases.

Propofol doses, Dr. Lemmens found, should be based on lean body weight — the weight of the body minus its fat. Using total body weight, as is routine for normal-weight people, would result in an overdose for obese patients, he said. But succinylcholine doses should be based on total body weight, he determined, and the dosing of anesthetic gases is not significantly affected by obesity.

As for regional anesthetics, he said, “There are very few data, but they probably should be dosed according to lean body weight.”

“Bad outcomes because of inappropriate dosing do occur,” said Dr. Lemmens, who added that 20 to 30 percent of all obese patients in intensive care after surgery were there because of anesthetic complications. Given the uncertainties about anesthetic doses for the obese, Dr. Lemmens said, he suspects that a significant number of them had inappropriate dosing.”

https://mobile.nytimes.com/2016/09/26/health/obese-patients-health-care.html?_r=1&referer=https://m.facebook.com/

White Women, WTF

A friend challenged me to explain why white women voted for 45. Rightly so. She’s not white, and like a lot of women in the non-white world, has decided that it’s no longer her job to explain race to white folks. I suspect that many Black/Latinx/Asian/Native women have been tired of explaining things to us for ages, but have collectively (insofar as it’s possible for me to speak of collectivity in very diverse communities) hit some sort of wall and have given up on us in some senses.

It’s a pig-dog of a question—ultimately there is a sliver of mystery in human behaviors that no one can define, and in 2016 that manifested in large numbers of humans voting for a man who was certain to hurt them and theirs. I didn’t. I only know for certain that two women in my extended community did vote for him, and I’m not sure they constitute a sample. Both have degrees. Both are smart. I can’t really have extended conversations with either of them because they are my daughters’ mothers-in-law and I don’t have the right to make things worse than they already are in both situations.

Here’s what I do know: There is a new “Diversity Café” here at Pretty Good U run by the Women’s Studies program. The first speaker was a Latinx sociologist. Attendance was good—about 30 women and a couple of male grad students. Most of the 32 were white, and the whole group was a mix of grad students and various stripes of faculty (adjunct, not-yet-tenured, non-tenure track, tenured). Most were visibly and seriously concerned about What’s Going On outside of the Academy, and very happy to be there listening. An International Women’s Day teach-in came out of the meeting, so it was not without fruit. But the speaker said, almost casually, that white women need to step up and start talking about race. I got kind of excited and thought that would happen, but I don’t know that I have ever seen so many people nod in agreement and switch topics so quickly. It was stunning.

So there’s one reason—even highly educated, deeply politically aware and progressive white women really don’t want to confront their own whiteness or talk about what that whiteness means—at least if that one meeting is an indicator. I’ll keep bringing it up, and we’ll see if I can ever get that conversation started (as if I have any idea where to start it…though I am not too worried about that part, since much of my adult life has consisted of getting really good at flailing about until something happens). But I am construing on the basis of this one experience with elite white women that there are deep, deep wells of avoidance in which we are still choosing to drown ourselves. And if that is the case of a bunch of humans who probably all voted for Hillary, then you can begin to imagine the extent to which that kind of blindness drives all sorts of women who don’t have PhDs. Or therapists. Or self-awareness.

There is also that other thing women (this may be a white thing, but I don’t really know) don’t want to talk about: the misogyny of women. Some of the worst misogyny I have ever experienced was at the hands of women. I’ve written before here about my theory that there is only ever allowed to be one brainy fat woman in a room at a time, and the Alpha Fat Chick will go out of her way to see to it that the focus stays on her. And that’s just one of many facets of one of many issues. So, I’m going to assume that a chunk of the women who voted for 45 suffered from what I think of as Phyllis Schlafly Syndrome, which I think the APA really needs to list in its diagnostic bible.

I also assume that some of the women were fundamentalists of one sort or another (Jewish & Christian, to be honest—I doubt very much that any significant numbers of Muslims, Hindus, or Buddhists voted for him) who voted the way their husbands told them to. Because.

I am also fairly sure that there are a number of women who voted for him—maybe on purpose, or maybe without realizing it—precisely because he is a woman-hating, abusive, moral-less mountain of lies. In my own defense, the “demon lover” types I was involved with when I was younger were smarter and better looking than he ever was, but many of us, if pushed, will admit that there is still a pull for us in dangerous men. And he is definitely dangerous. Not all of us have been lucky enough to (mostly) grow out of that attraction.

It’s unlikely that I have covered all the reasons my white sisters voted for a repulsive, destructive, inexcusable, unconnected-to-reality narcissist. We’re no more of a uniformity than any other group of women. Then again, I doubt that there are all that many other statistically significant factors. I am most emphatically NOT a sociologist, though.

There is, I think, a list of what seem to be “tipping point” issues that drove the election results other than the votes of white women (though that is certainly one of the most important ones): in historical terms, the chances of the American electorate going from one revolutionary president to another, back-to-back, might have been nearly non-existent; the white Patriarchy is not going to go down easy, no matter how much progress we like to think we’ve made, and it is a boiling sea of rage; the no-one-really-wants-to-talk-about-it misogyny of the Bernie voters; Bill Clinton. Then there’s the Electoral College.

But the bottom line here is that white women, as a block, have to deal with collective responsibility for what has happened. That is one reason I was unbothered by the mostly-whiteness of the crowd in DC on January 21st—it’s our blasted JOB to get out there and fix the mess. The other reason is that The March was not (at least in DC) quite as pale as folks have charged, though it was pretty white. I’m fairly sure that the whiteness was not the reason, as some writers have suggested, that the DC police were so nice to the marchers. I was at the Standing Rock March, and the cops were polite then, too. That crowd was definitely not predominantly white. The DC cops have no investment in supporting the current administration—the city is predominantly non-white, it is taxed without representation, and he is causing them to work a lot of overtime.

So, collective responsibility: In my lifetime, I’ve watched Germany go from being a deeply wounded (and often unpleasant to be in for long periods of time) nation determined to avoid its past, to being a healed/healing nation that is alive to its past and committed to not repeating its own horrific errors. Basically, they’ve spent a long, painful time staring at and telling their own truths—a kind of collective confession and penance. They also got the other half of their country back, which was a mess, but an important mess. We’ve never really put our country back together since 1865. White people might want to take note of Germany’s choices. Of course, Americans are justly notorious for refusing to learn from any other country’s successes. American Exceptionalism and The Partriarchy have been festering together for ages. In the best of all possible worlds, this administration will have burst the boil and we’ll be able to move on soonish. My Pollyanna half is allowed a few minutes to contemplate that each day. Then my non-Pollyana self goes back to screaming in a corner for the other 23 hours, 57 minutes of the day.

I don’t know what to do. I’m pretty sure there is no one answer, and pretty sure that answers are going to prove hard to come by. So I now have a “White silence is violence.” button I intend to wear to church and sometimes to teach. I’ve started talking about race in my classes whenever there’s the least excuse. And I’ve kind of made peace with the idea that I will screw it up sometimes, because thinking it’s my job to do it perfectly is permission to be silent. And in the tradition of English law, silence gives consent. I think many of those white women who voted for 45 did so silently.

If I figure out any other ways to add my infinitesimal efforts in any right direction, I’ll try to find my way to acting on them. It won’t be enough. It never could. And it certainly doesn’t make me particularly righteous. This isn’t nearly enough of an answer. I am profoundly sorry not to be able to do better.

Rounding Up

Re-posted from my friend’s blog (miriamswell.wordpress.com):

How To Activate Your Inner Activist

by Miriam Sagan

Since Trump’s election, many folks have felt depressed or paralyzed. But we don’t have to suffer that way. You’ll have to forgive me—but I once made a big chunk of my living as a freelancer writing How To articles. So I’m just going to continue…

How To Be Politically Active

First off, settle on this as you goal. Your goal is not to save America—or even yourself. Your goal is to engage in an activity that might be new to you, or that you might be out of touch with. The following steps aren’t that different than those you’d take towards a healthier diet or a good exercise regime.

Then, decide on what you—and you alone—count as resistance to tyranny and fighting for justice. Make a list of everything and anything. Voter registration? Food equity? Land preservation? Fighting racism? This is your list.

The Jewish philosopher Maimonides said there were four levels of ethical action:

1. Ordinary kindness (holding the door for someone)
2. Following a formal commandment/good deed—known as mitvot (visiting the sick)
3. Social Justice
4. Charity

It’s fascinating that charity is the highest, but I’m guessing that is because it has the spiritual element of sacrifice, even a small one. We’re going to focus on levels 3 and 4, in large part because I’m guessing you’re already engage in 1 and 2.

Now, make a giant list of anything you might do from fundraising to letter writing to marching to joining a group to clicking on a donation link. You can prioritize the things you like best. And respect your own strengths and character—introverts will chose differently than extroverts, moms with little kids are different than childless folks, etc. I’m actually going to allow you self-education as part of your program. This is about reading a book on history or theory—not checking Facebook (or articles on line).

OK—now here is the important part. Decide exactly how often you are going to engage in these activities. I suggest starting off with twice a week. Write this down. Concretize it. Actually, quantify it. This technique is something I learned in twenty plus years of peer coaching with my friend Ana.

Frequency is more important than duration (you wouldn’t brush your teeth for 30 minutes once a week). Also, a minimum frequency can always be extended or added to.

If you do this, you will have activated yourself. You won’t have met a grandiose goal, but coaching is made up of attainable sized ones. In the book “Designing A Life” the authors say that something is not a problem if it doesn’t have a solution. Rather, these things are conditions of our existence—like suffering, death, and the human inclination to do evil as well as good.

But many things do have solutions, including our own passivity.

My last piece of advice: have some fun.

Let’s say you go to a rally or protest march. Will this make America the country you want to live in in fifteen minutes? No. Will it give you super powers to save the world? No.

It will, however, meet several goals:

1. You can check an activism item off your list for the week
2. You will get fresh air and exercise
3. You may enjoy some music or poetry or something edifying
4. You may see your friends—you might even do some networking
5. You will get out of the house and enjoy your city or town
6. You will most likely have your thoughts provoked and learn something
7. It will make the news
8. It will put pressure on your elected representatives
9. It will bring people together

Do remember. To take positive action, you do NOT have to
1. Provide a complex solution
2. Be perfect
3. Blame anyone

By analogy, if you were diagnosed with diabetes, you would not have to find the cure. You would not need to be a poster child of compliance. But you should do what you need to do to take care of yourself. You already have the skills to be an activist—because they are your usual problem solving skills.

Let me know how it goes!

Rounding the Corner

I was going to talk about this nice bit of (now months old, I gather) intelligence from Tim Gunn, who has undergone a probably-wasn’t-very-drastic conversion to pro-acceptance fashion politics:  bodyhttp://www.npr.org/2016/09/14/493965878/tim-gunn-the-fashion-industry-is-not-making-it-work-for-plus-size-women

But really, people, really, has there ever been an election that was more about the body than this one. Whether the body of a woman can withstand the savage stresses of the Presidency? (dumb and retrograde, but the question is nonetheless out there) About whether the bodies of women belong to them? (Have you paid attention at all to Mike Pence’s record? And who, precisely, do you think will end up running things if the Cheeto-from-hell is elected?) Is the body worth protection from bad cops, bad medicine, bad water, bad air, bad education, bad men?  Are the bodies of women valuable/worthy beyond their surface conformity to grossly artificial standards? Are the bodies of non-white people worthy/valuable of anything beyond poverty and degradation? Are the bodies of non-cis-hetero-non-binary humans even human? And, in the end, are the bodies and minds of white males to go on being crippled by dangerous constructs about the nature of masculinity?

Although I’ve spent years and years studying the history and literature of the Holocaust, and though I understand WWII as a complex extension of the grossly stupid, vicious (and overwhelmingly privileged-male-driven) desire of revenge on the part of the winners (I use the term loosely–no-one “won” that war) of WWI, and though I have lived in and visited Germany over the last 40 years during which it has undergone massive and remarkable change (mostly) in the direction of facing up to and growing beyond its own wounds and idiocies, I have never truly understood Germany  1919-1939 and how it came to be the genocidal/suicidal horror that it did. I can’t say that I understand it even now. Something in me cannot grasp the capacity of so many humans engaged in such profound denial of obvious facts, even though I believe heartily in the capacity of individuals to engage in radical denial. But I can say that I know what it it looks like.

My country has made me sad and angry. My country has made me grieve. My country has made me furious. Under every administration of my politically-aware life (so, since I was 14), I have had occasion to be disgusted, frustrated, or baffled. And I believed we’d hit bottom with W., I really did.

It is 1939 here in the United States. Voting for anyone other than Hillary (I don’t care how much you don’t like her. If you don’t like her, please do look deep into your soul to find the part of you that is simply willing to believe any stupid shit about her emails because she has the “wrong” body parts and recognize that the media is complicit in teaching you to ignore that ugly fact) is voting for 1939. Understand this: Flint is 1939. Refusing to let refugees in the country is 1939. White supremacy in any form is 1939. The Alt-Right is 1939. I am trying very hard not to descend to the “shouting match” level so much of this campaign has been decapitated by. I still don’t understand Germany in 1939, except that I know it was not made by monsters who were “not like us.” It was made by the consent and silence of people who were precisely like us, and who were sucked in gradually by their own sense of grievances unaddressed, their frustrations with a world they couldn’t face or comprehend, and their enthrallment to a history they imagined, but that had never actually existed.

Vote, please. Vote like it’s Munich and 1939 and you have some idea of what’s coming if you stay silent. Because you do. You do.

 

 

 

Round & Furry

There’s this:

http://www.weightymatters.ca/2016/09/mouse-diet-studies-arent-conclusive-for.html

Lots of interesting material in that very brief piece. There is also an interesting subtext about the actual value of using non-humans to test human medical issues. I understand that human testing, especially in the early stages of trials for important (as opposed to bogus or pseudo-important profit-driven crap like most weight-loss meds) drugs are a complicated issue, but it does rather stand to reason that it would be good to not use animals where it is possible not to do so. Of course, that would mean that the companies making quiet billions by supplying animals to labs would lose business, and the humans working there would lose jobs–another case of nothing happening without un-intended consequences.

Somehow it seems like the problems/systems involved in moving folks from middle-class jobs in inherently un-ethical (and usually planet- or human-destroying) industries ought to be more solvable than it currently seems. I insist on believing that someone could apply a consortium of big brains to the global shifts in industrial (and academic, come to thing of it) structures so that the majority of the planet could stop living in a constant state of panic and instability. You’d think the Masters wanted the Workers to be permanently insecure so they don’t have the energy or resources to pay attention to The Man Behind the Curtain. Or something.

 

‘Round About Time

Watch this, please:

http://shine.forharriet.com/2016/08/white-feminists-need-to-get-in.html#axzz4JJF5nmdo

For several reasons. The first is the obvious one. White feminists do need, have needed to pay more attention to what black women have to say about their experiences for a long time. A very long time. Reading This Bridge Called My Back and an essay or two by Audre Lorde won’t do it anymore, at least in terms of being able to claim that you have any real awareness of the complexities of being a woman with brown skin. It’s an interesting question for fat white women–on the one hand, there have been lots of white feminists who’ve been talking body-acceptance for a long time, and on the other hand, the simple fact is that Gloria Steinem got to be Gloria Steinem partially because she’s conventionally beautiful. Also largely because she’s ferocious and kicks ass, but there was always a certain weird fascination about how&why someone so beautiful could/would/should be a FEMINIST that you could tell got her certain kinds of attention from certain kinds of male-dominated media. But I confess that I sometimes think I have a tiny fraction of an idea what it’s like to be a woman who is judged immediately and negatively simply because of the surface of her skin–NOT as though I were black (I claim ZERO understanding of the complex anguishes, irritations, frustrations, furies, and difficulties of that)–but as someone whose intelligence, integrity, character, worth, and general right to exist is something many folks feel they have a right to judge based simply on my physical geography. So being, say Gabourey Sidibe, must be a whole other universe of soul-bruising pain in the ass, as witness the assinine kerfuffle over whether she has or has not lost weight (google it, it’s actually nuts) and how and why.

So back to Leslie Jones. Who is not fat, but who is not small. And who has been trolled relentlessly by all the usual cadre of tragically pathological losers who spend their time vomiting their wretchedness onto social media, and by questionable humans like Milo Yiannopoulos who make their livings spewing hate at people they don’t even know (what is his pathetic deal???? Feminism is cancer????? Really????? I don’t even begin to know how to address this sort of hyperbolic stupidity.) I didn’t see Ghostbusters because it was the sort of summer when I didn’t much get to the movies, and I gave up SNL before John Belushi died, so I don’t know much about Leslie Jones. But I do know that she’s tall enough, and not-conventionally-gorgeous enough that she had a terrible time finding a dress for the red carpet until Christian Siriano stepped in and up. And I know that any black woman who makes it into the cast of any big budget movie (especially as something other than the amusing sidekick, though even that has to be no small feat) has managed to put up with rafts of crap along her road that I couldn’t begin to calculate. And being merely smart-as-hell, and having killer cheekbones to go with your 6 feet of grandeur and goofiness is clearly not enough for the world to leave your un-cringing womanhood alone. So, for what it’s worth, this is me standing up for Leslie Jones. And acknowledging/claiming that there is a hierarchy of crap-to-deal-with in the universe of feminism, and conventionally attractive white women have X amount of unacceptable, human-rights-violating garbage and violence and barrier to deal with, but women outside that demographic have a additional layers of often paradoxical (fat women are both too female and not female enough…) shit to cope with, and women of color have pretty much infinite numbers of other stupid, violent, terrifying, frustrating shit to cope with, fight with, deal with, overcome on a moment-to-moment basis. Part of me doesn’t understand why all my black woman friends don’t just start every conversation we have by punching me first and then asking how I’ve been, just to even things up a bit. Not that I’m making a suggestion.

We’re at a weird point. As much as I believe in the First Amendment, I wonder whether the guys who wrote it could begin to envision a universe in which there would be so much violent speech with so little consequence. It’s not just the asshole trolls like Yiannopoulos and the basement-dwelling, id-spewing losers for whom he is a weirdly glam proxy, it’s members of Congress and presidential candidates whose words and actions seem to me to cross the border from protected repugnance to active treason. And there are no consequences for them. There are too many white men (and women, but I fear it’s the white guys who are carrying the ugly flags on this) out there who feel free to say in public things that do violence to us all. All. I don’t know where or when this consequence-less will run into the law. I don’t even know if it will. I don’t delude myself that the hatefulness currently making so much noise in the public discourse wasn’t there all along. I might argue that Trump & Co. have done us the weird favor of turning over a bunch of rocks that really needed to be turned over so that the pathetic darkness-dwellers would be exposed to the light. But it’s getting to be like climate change–it used to be a matter of projection and theory; it’s now unavoidable (unless you’re really working on it) reality, and it’s eating the planet. The shitchat on social media is eating our culture. The planet is dying. The planet’s conversation is also toxic. There need to be consequences for the folks who are poisoning the atmospheres. But it’s a lot easier to (relatively) to name and fine and impose consequences on Exxon (be nice if we’d get around to that…) than it is to name and fine and impose consequences on shitheads like Roger Ailes and Mitch McConnell.

How does all this fit together, you ask? Well, the thing about feminism was, when I was growing up into it, that it would free men to stop being jerks just because they had penises; free women to make choices no matter who they loved, how they looked, or what color their skin was; free children from having to be one thing or another from birth, and free bodies (including the planetary body) from casual (or intentional and entrenched) violence. I’m not as naively, blithely hope-filled as I used to be. And I seem to have missed a lot of forms of oppression going on around me. But I have figured out one thing: Pretty much everything starts with the sanctity of the body. Gabourey Sidibe’s body is her business. Leslie Jones’s body is hers. The bodies of black, brown, and red humans are as sacred as those of white people, the bodies of queer humans as sacred as those of cis-hetero humans (funny, I bet self-described “faggot” Yiannopoulos would agree at least far as it comes to his queer body . Those of fat, short, disabled, un-pretty, tall, gifted, scarred, violated, famous, solitary, pea-brained, small-hearted, gorgeous, rich, poor, Trumpish–all sacred. It really is all about the body–whether you see it from a Christian perspective or any other. When we get around to seeing the individual body as the beginning of care for both humans and the planetary body they inhabit, we’ll start giving a shit instead of talking shit and being shits.

Meanwhile, I have a word for you to learn and use: Misgynoir. And I propose a rule: Remember that every time anyone disrespects a woman of color (including those in some form of hijab), they have disrespected you, oh feminists, no matter where you started from. And you should be angry.