I am terrible at finding mentors. I accept this as it is primarily my failing. I am silently critical and judgmental of anyone I audition for the part. Not too intensely, but enough to tarnish the sheen which drew me to them in the first place.

I expect too much from a mentor. A mentor must have figured out all of life before I am willing to sit at his or her feet and await the flow of wisdom. I have never had harsh break ups with possible mentors, I simply never pursue the relationship past a certain point.

This is not to say I do not learn things from people. I study and examine decisions and approaches individuals have to life and career and pick and choose lessons from them all. I will learn anything from anyone who has something to offer

Yet, I can never quite slide into the role of mentee. I cannot quite let myself be vulnerable enough to to commit. That more complete learning relationship continues to elude me.

Invariably, I find something disappointing in any possible mentor. They may be highly successful in their field, but I always seem to find some flaw in their history or personality which leads me to slowly extricate myself from any burgeoning mentor-mentee relationship.

The reasons are numerous:

They have sacrificed more time with family than I am willing to.

Medicine fills them up enough, they don’t seem to have any other intellectual interests.

They aren’t philosophical or thoughtful enough.

They aren’t skeptical enough, too sincere and believing.

Despite all their success, they seem unfulfilled, not satisfied, sometimes even unhappy.

They are boring or uninteresting

There are many more.

Why Am I so Harsh?

Why do I do this? I don’t necessarily find myself yearning for a mentor, but I certainly think it would have been beneficial for me to find one at some point along the way. Yet, I cannot say I have ever had a long term and truly fulfilling mentor/mentee relationship.

I have come to an annoyingly Freudian conclusion: the mentor-mentee relationship is too close to a paternal relationship for me to ever be comfortable with it.

Unlike many young men with complicated paternal relationship, love and affection were never the issue.

My father is simply bad at functioning in the world on society’s terms. He has never been able to play the game. I have learned more about how to function in this world from his mistakes than I ever could from his example.

He struggles with his mental health and in typical boomer male fashion, avoided addressing it at all costs for most of my life. While loving, I also remember him being angry, impatient, and emotionally unreliable.

Additionally, I have inherited a certain amount of his difficulty with playing by the rules. Not the written rules, or the ethical rules, but the unwritten cultural rules which only exists to enforce group mediocrity.

And, I have found, it is the breaking of these rules which engender the harshest backlash because they are irrational, so the response to their transgression can only be similarly irrational.

Unfortunately, in practice, medicine is a life that punishes those who break from orthodoxy more fiercely than most.

I have come to terms with these things about my own father, but I cannot help but feel they are the root me being unable to be comfortable with a mentor. No mentor will ever be complete enough, reliable enough, wise enough for me to let my guard down.

I will always find some failing – moral, intellectual, spiritual, ethical which will sow doubt, and my walls will go up. Sadly, it has led to a rather lonely professional existence.

Mentors from the Page

As a poor substitute, I find myself turning to authors as mentors in situ. I can go to the arts and literature, the great stories to try and glean wisdom to apply. Occasionally, the inspirations have been specific to medicine, but more often they are general.

They are usually men, not surprisingly. Usually already dead, their story having reached its terminal moment, I can safely know the whole arc, analyze their decisions, inspect their psyches as best I can from the page.

They are Hemingways (who has been mentioned on this blog frequently), Edward Abbeys, Steinbecks, Anthony Bourdains. Their unconventional lives are a common thread. As noted above, I am drawn to the unconventional, unorthodox – not in my personal life, but in my intellectual life.

Deep down, I have always been a puzzle piece which doesn’t quite fit. Always a little uncomfortable in any given role or position. Always pushing moving, pushing, straining.

I may not have been well suited to a career in medicine because of this tendency. I am not saying poorly suited to being a doctor, but poorly suited to a medical career. All my sages tend to be tortured, horribly flawed, often kind of miserable shits, with some hole that can’t be filled. And, disproportionately men who have killed themselves.

Even in my imaginary world of mentors from the page, I seem to be able to learn only from their mistakes, from their character flaws, their weakness. Maybe this is because great art is inherently emotive, not intellectual. And only those who wrestle with great emotions can make art which makes you feel something meaningful.

Let me tell you something. Happiness is bullshit. It’s the great myth of the late 20th century. You think Picasso was happy? You think Hemingway was? Hendrix? They were miserable shits. No art worth a damn was ever created out of happiness. I can tell you that. Ambition, narcissism, sex, rage. Those are the engines that drive every great artist, every great man. A hole that can’t be filled. That’s why we’re all such miserable assholes.

Ed Harris, as Ben in Kodachrome (2017)

I have learned much from some of these names. Their grand pursuits, their art, all seemed to stem from a deep unhappiness. And so I increasingly shy away from the addictive pursuit of art, accomplishment, money, career. They all seem to lead to a generally miserable life, punctuated by acclaim and accomplishment – but certainly not happiness.

Is it all a sham as Ed Harris’ character says? Is happiness a myth of the late 20th century which has visited upon us the curses of consumerism, the opiate epidemic, multiple other converging mental health crises?

Are greatness and happiness antithetical? Is is impossible to have a family, to be generally content with life, and work in the pursuit of something larger and more meaningful than oneself?

Who knows? I guess all I can do is keep reading, because I am pretty sure I am never going to let anyone show me the way.

Featured Painting: Alcibiades being taught by Socrates, François-André Vincent, 1776. Musee Fabre.

America’s COVID Response is Old News

Our current media environment is simply overwhelming. Talking heads dissect and opinionate on every minute occurrence and off-handed comment ad nauseam. Enough true news simply does not exist to support the advertising driven media ecosystem which now saddles us.

The pandemic has only made this worse.

I suppose whenever you live within an environment or industry, it is always rather amusing when the news and social media discover what has been known for years within your circles. This is how I feel about much of the news surrounding the boots on the ground handling of the pandemic.

None of this is New

“America’s health care system is neither healthy, caring, nor a system.”

-Walter Cronkite

Hospitals overwork nurses, doctors, EMTs, clinical staff everywhere leading burn out and unsafe conditions? Who knew? COVID just shines a light.

Hospitals have making money hand over fist on procedures which, when postponed have apparently had little effect on the over health of the population(which begs the question of why we are doing them in the first place), This has destroyed hospital hospitals bottom lines. COVID shines a light.

America incentivizes hospitals not to care for the sick and ill, but to provide procedures aimed at making the lives of people with good insurance more comfortable. Is it so shocking this has led to hospital systems prioritizing such care over general health? COVID shines a light.

Health systems were caught flat footed protecting front line workers because prioritizing staff safety didn’t generate RVUs and billable procedures? COVID shines a light.

Health inequalities are rampant and appalling – both at point of care but as part of the baseline health of large portions of the population? People of color are suffering more disability and dying at higher rates than the general population? COVID shines a light.

The American Healthcare System Prioritizes Private Wealth over Public Health

Walter Cronkite knew what the problem was decades ago, and we haven’t done a damn thing to fundamentally alter the situation. COVID isn’t anything new, it is just happening all at once when we are all paying attention.

We do not have a meaningful public health system. We have a private disease treatment facilities. Our healthcare system works great for young, healthy, and wealthy individuals. Guess what? They rarely need healthcare.

Why can’t we effectively respond to a widespread, nationwide public health crisis? Because we do not have a comprehensive, nationwide public health infrastructure.

As long as we treat health as an individual problem, we will be unable to respond to any true public health problem.

Just Look at our track record:

Obesity Epidemic – only getting worse

Opiate Epidemic – people dying by the thousands

COVID 19 – check the counters on your favorite news platform.

Well…you get the idea.

Hospitals are not substitutes for Public Health Infrastructure

Hospitals treat individuals, they do not coordinate responses to widespread public health disasters, even if those disasters produce individual illness.

Yet, we keep trying to force a square peg through a round whole. We call it population health now, as if it is somehow different from public health. Hospitals and clinics will always fail to address these problems because they are the wrong tool for the job.

Healthcare services determine only about 20% of a person’s health status. That means, 80% of the outcome of any individual’s health is already decided when they show up at the hospital.

We need to actually protect the public’s health

It is unfair to our fellow citizens (particularly to the poor, people of color, and the mentally ill) to expect doctors and nurses to make up for a lifetime of abuse and neglect society has visited upon many people in our society.

Yes, bias (based on race, class, disability, mental illness, etc) in the provision of healthcare negatively affects the health of many people. However, it is time that society accepts responsibility for our fellow citizens and recognizes the patterns of our lives drive our health far more than anything that happens within the doors of a hospital.

My work reminds me of this reality daily. I have the power to do many things, yet more often than not, I am effectively powerless in the shadow of a life lived without access to healthy food, a good education, a safe environment, the list goes on.

Poor people will always have poorer health outcomes than rich people, because resources matter. Yet, we as a country can and should do better. And we need to stop looking at the end of the pipe for solutions.

The disaster COVID is wreaking on the health of Americans is no surprise, if you were paying attention.

A system is designed to get the outcome it gets. We have designed our system to produce these unequal, inconsistent, and often deadly results.

The outcomes the pandemic has brought to light have been happening every day, in every corner of this country, for decades.

The light was apparently just not bright enough.