“The Procession of the Trojan Horse into Troy,” Giovanni Domenico Tiepolo (1727–1804), the National Gallery, London, used under Creative Commons licensing terms
In the world of politics and international intrigue, one of the oldest stratagems is that of the “Trojan horse.” This is the use of a deception or a trick to overcome the defenses and protection of an adversary.
This applies to everything: computer safety, viruses that attack their hosts, predatory behavior from evolutionary adaptation like spiders evolved to appear like ants, and mostly politics. The warning we have today is “beware of Greeks bearing gifts.”
The saying comes from one of the great tales from the Classical Age. It refers to subterfuge used by the ancient Greeks during the Trojan War, led by the trickster warrior Odysseus, as described in the epic Greek poem the Odyssey. The wily Odysseus and his fellow Greek warriors snuck out of the wooden horse at night that had been left as a fake tribute to the Trojans, whose city they could not conquer by force after years of war.
For those not familiar with the great story in epic Greek poems written by Homer, the Iliad and its successor the Odyssey, written in the 7th or 8th century BC, the summary by the British Museum is as good as any: “The Greeks finally win the war by an ingenious piece of deception dreamed up by the hero and king of Ithaca, Odysseus—famous for his cunning. They build a huge wooden horse and leave it outside the gates of Troy, as an offering to the gods, while they pretend to give up battle and sail away. Secretly, though, they have assembled their best warriors inside. The Trojans fall for the trick, bring the horse into the city and celebrate their victory. But when night falls, the hidden Greeks creep out and open the gates to the rest of the army, which has sailed silently back to Troy.”
The deception is the horse. It is dragged in willingly by the fooled Trojans. It is the Trojans who willingly opened the gates of impregnable Troy. In being fooled, they created the tragic events that ended in Troy’s violent and horrible fall.
The danger lies in the victim accepting the false promise and false gift.
I worked in the Washington State Legislature for the House Democratic Caucus for two sessions, and left in late 2000. One legislative issue that arose during my time there was the expansion of gambling. The proverbial Trojan horse used by the so-called “gambling industry” and its cronies were gaming rooms that were part of a wider spread of this “industry” to become the blight we see today widely in most states, eating away at our communities and wrecking countless lives.
Even though I was not a power player, I knew where the enabling legislation was going, and sadly, we are in that dark space now. This happened nationally too—36 states have legalized sports gambling alone as of now.
The lesson, really, is quite simple. Wherever there are piles of cash, with almost no ability to trace its origins, there is corruption. This eventually will eat its host from all sides.
There is no virtue with corruption either. Corruption knows no boundary by party, nationality, country, or by so-called “virtue” of the people who are sucked up in opportunities to gain personally. Corruption may be one of the great equalizers in the world.
Today, it’s always best to be aware of that proverbial Trojan horse. They come in all shapes and sizes. They are never what they appear to be. Sadly, the horse will usually be accepted with open arms and people fooled. People will cry alarms over the horse, and will be ignored and punished.
Photos of Auschwitz escapees and authors of the Auschwitz Report, Rudolf Vrba (left) and Alfred Wetzler.
I remember clearly the first time I learned about one of the 20th century’s greatest and yet least-known humanitarians and heroes, Rudolf Vrba.
Vrba is one of a small number of Jewish prisoners to have successfully escaped from the Auschwitz-Birkenau concentration and death camps, located in Oswiecim, Poland, in the spring of 1944, as the camps were speeding up the murder of Jewish civilians still living in areas of Nazi control and influence.
That so few know his story remains a tragedy to us all, because of this event’s sheer improbability and the obvious audacity of what he and his fellow Czechoslovakian prisoner, Alfred Wetzler, accomplished in April 1944. The two successfully undertook an escape and resistance mission, in order to save more than 800,000 Hungarian Jewish citizens from extermination at the Birkenau death camp gas chambers.
They provided a detailed report on Auschwitz-Birkenau to Slovakian Jewish leaders, who helped disseminate it to other Jewish leaders, the Papacy, and the Allies, making it the first reliable document to reach the world and the Allies and to be accepted as credible. The report broke the apathy and indifference to the genocide, already long underway by the Nazis. Yet the report and its news never reached the populace it was intended to save, and more than 400,000 Hungarian Jews would be killed between May and July 1944, when the transportations were halted.
I first saw their photographs hanging in the museum at the site of the Auschwitz camp complex in July 2000. At that time, I was completing a documentary photography project focused on the Nazi death and concentration camps.
Standing in the museum, housed in a former Nazi administrative building, I read with utter amazement a short history of an impossible feat. Two young Slovakian Jewish internees had escaped the greatest hidden facility in the Nazi’s universe of militarized camps across Europe and the nerve center of the Nazi death machinery still operating in 1944.
The entrance to the Birkenau Death Camp, from which Rudolf Vrba and Alfred Wetzler escaped in April 1944.
Vrba published his gripping account of this heroic and true story in his celebrated 1963 memoir, I Escaped from Auschwitz. The book remains in print in over a dozen languages around the world.
Vrba’s own words written on Sept. 7, 1963, in a letter to the British newspaper, the Observer, summarized what he details with scientific precision in his book. “With my friend Fred Wetzler from Slovakia, I managed to escape from Auschwitz on April 7, 1944, and we headed straight for the Zionist leaders. In April 1944, we handed to a high representative of the Zionist movement, Dr. Oskar Neumann, a sixty-page detailed report on the fact that extermination of 1,760,000 Jews had taken place in Auschwitz and that preparations were complete for the annihilation of one million Jewish Hungarians during the very next weeks. Did the Judenrat (or the Judenverrat) in Hungary tell their Jews what was awaiting them? No, they remained silent and for this silence some of their leaders—for instance Dr. [ Rezsö] Kasztner—bartered their own lives and the lives of 1,684 other ‘prominent’ Jews directly from [Adolf] Eichmann. They were not ‘helpless and benumbed hostages’ but clever diplomats who knew what their silence was worth. The 1,684 Jews whom they bought from Eichmann included not only various prominent Zionists, not only relatives of Kasztner, etc., but also such Jews who were able to pay with millions, like the family of Manfred Weiss. At the same time, they silently watched as more than 400,000 Hungarian Jews, unaware of their fate, were tricked into Auschwitz, where thousands of their children were not even gassed but merely thrown into the pyre alive.”
One of mine is to write my holiday cards on Thanksgiving day. I have kept this tradition for more years than I can recall. No matter where I have lived or what happened on that day, I always found time to think about those in my life, including family and friends.
The act of writing and remembering reminds me of the bonds of connection I have with people far-flung across this country. Some of these connections help sustain me, good times and bad. Some have little impact in my life.
I went with an Oregon-themed card this year. In past years I have made my own. On each of the cards I create a personal message, written by hand and signed. A regular theme, if I can find one, is to share a positive wish of good fortune for the coming year. It is always preferable to be positive, even when we know some persons may be experiencing hard times, like some of my relations and friendships.
In my case, my card writing involves my circle of friends who seem to remain a part of my life as I age. They can be called my “chosen circle.” They are not family, for me at least. They matter a great deal in my life.
My “family card list” includes my step-family, my adoptive family, and my biological family. Because I am adoptee, and because that status is fraught with complexities about the meaning of “family,” my holiday card tradition has challenged me.
Having had a step-family since I was 18 years old, I can vouch first-hand that these relations are not easy. Step-family bonds are not blood-based or kinship-based.
Everyone in those dynamics knows the minefields, and to deny these tensions is to deny the critical role of genetic kinship in how all species, including humans, care for and help their close genetic relations succeed. This is equally if not truer of adoptive-family relationships.
Author and adoptee Rudy Owens gets ready to mail his 2022 holiday cards to his biological, step-, and adoptive family and friends on Thanksgiving day 2022.
In my book, You Don’t Know How Lucky You Are, I write about the meaning of relationships with non-biologically related step-family and other distal adoptive kin: “There simply is no bond that joins us, much the way I feel about my adoptive cousins, uncles, and aunts. For me, there is no blood that ties us, nor DNA to bind us. We are not true kin, both as I perceive it and as I have experienced this relation for decades now.”
Yet each year, on Thanksgiving I will still write letters of fellowship for the coming Christmas, or winter holidays if you prefer to call it that.
There is very little power I have to create relations where none are hardwired to exist by the determinant laws of biology and genetics. What I do control is my ability to offer a hopeful gesture. Whether that gesture is accepted or rejected, like so much in our lives, is not in our power to manage.
Because I was separated as a newborn baby from my biological family by laws and systems that erased my past and discriminated against me and millions of others by status of birth, I only began my biological family relations in my mid-20s. I explain all of this in my book for any reader seeking to understand what that means for me and other adoptees.
As someone who is now in my mid-50s and getting older, I remain clear-eyed how those relations will remain forever impacted by this system of separating families. And with my surviving biological family members who I do have contact with, again, I am not able to control how they respond. It has never been simple or easy to explain to anyone who is not adopted and separated from their biological family relations.
So with Thanksgiving now behind us, and my holiday cards on their way to my blended, adoptive, and biological family, I will celebrate what some may call our betters selves, to be the person I prefer to be.
Yes, adoption as a system forever made my holidays a mixed up time, but I have, for decades now, not let this define the meaning I give this time of year freely.
I love random meetings when I travel. Most of the time these moments prove far more memorable and meaningful than the trip one sets out upon, even when one is traveling for a purpose.
In my case, my trip to St. Louis, Missouri, from Sept. 28-30, 2022, involved seeing a very sick family member. It was a heavy trip, and I had a lot to do. At that moment, thoughts of life and death weighed on my mind, so I was in a reflective mood. Perhaps I was willing to share stories with a stranger.
This short cross-country jaunt was also my first out-of-state trip from Portland, Oregon, in more than 15 months. I had booked a cheap flight, which meant I would leave at an early hour.
Because I always prefer to arrive early, I parked my car at the airport extended car park parking lot around 1:30 a.m. and quickly got the shuttle bus without much waiting time. That meant I walked into the nearly empty Portland International Airport for my 5 a.m. flight far before I expected.
It was still the dead of night, when nearly no one was in the facility. Because of that hour, Transportation Security Administration (TSA) staff had not opened the check-through area for the gate I would use. That meant I had an hour to wait and perhaps read my books I had brought for the flights.
I sat in the nearly empty front lobby by the empty check-in area, until the full staff would arrive. Few other travelers were around, and a handful of security personnel walked the quiet space. A few weary travelers had crashed in the lobby area, sleeping on the floor, perhaps waiting for another early morning flight too.
An older woman, who I learned was 81, approached my seating area with four seats. We both were wearing masks. She asked, “Can I sit next to you.”
“Of course,” I replied.
That was the beginning of a conversation that meandered for an hour. I never got her name. I should have asked.
The retired nurse told me she was a widow. Her husband died more than a decade earlier, she said. She now lived alone in an apartment in downtown Portland, which she liked. She told me about her life, like her recent trip to the Alps this past summer to hike with a group. She told me she needed to go on that trip, before she could do trips like this in the future. She loved it, she said.
She then talked about her coming travels. She was estranged from her family, back in Kansas. But now she was traveling to Topeka, Kansas, for an indefinite time. She was going to care for a slightly younger sister dying of cancer. She did not know how long she would be there.
I learned that her oldest daughter, who lived in Portland, was also dying of stage four breast cancer. I did not probe with questions. I could sense it was not going well and would end badly. The pending deaths in her family made her increasingly aware that her days also were numbered, she mused.
Though she said she had left her family decades earlier, it was now time to connect with kin who would be passing. I concurred. I told her it was very caring for her to be so generous to her sister. She nodded, in agreement.
I told her I was seeing my ailing family member, who was not well and living in a nursing home. I told her briefly about my mom, who had died in early 2020 from Alzheimer’s after a seven-year battle. Mostly, though, I was the listener.
Near 3 a.m., we noticed the TSA team had arrived and the security checkpoint was open. We both walked over. That was the last time we spoke. I saw her get a seat ahead of me on the plane. She got off the connecting flight in Denver before me, and I never saw her again.
The encounter, with a stranger I will likely never see again, reminded me why it is good to listen to people and let them share their burdens. We all need to listen when we can and just be kind.
My mother’s misfortune of developing Alzheimer’s still shapes my way of navigating the world. She endured the horrible disease for more than seven years, before finally dying, with little left of her cognitive functions.
Roman artwork Memento Mori, in the Naples National Archaeological Museum
To deal with the illness as a family member, I had to readjust my way of navigating the world. I had to deal with stress. I had to deal with family conflict. I had to deal with helping someone who could never be cured.
Most of all I had to practice what philosophers did more than 2,000 ago, meditate on one’s mortality, or memento mori.
Death, as the ultimate end of my mother’s condition, became relentless as a nagging thought. I had to think about it because it was the way her suffering would end. This is simply an honest reflection, because that is what Alzheimer’s was truly like. It was worse for my step-father, who was her dutiful and loving caregiver.
However, practicing memento mori was not a scary thing. It was and remains a pragmatic thing, as all human life ends, and avoiding thoughts about this is folly. All of us will die, regardless of our station in life or our deepest fears about the end.
Because of this knowledge, I continue to tidy up my plans. I have attended to my probate planning instead of putting off the boring but critical details.
I also realize that by living alone, I am at much greater risk of misfortune, mostly because no one will care for me. This is also a byproduct of being adopted, which is a related and complex story.
So I have started making plans for logical “what if” possibilities.
What if I am hit by a bus? What if I have a bike accident that goes tragically wrong if I am struck by a car? What if I get a serious illness that arrives suddenly?
Too many things have happened in my immediate world of family and friends lately to forestall such thinking and planning.
Tonight I took another small but practical step. In my apartment, I hung a very visible sheet of paper on a wall that could be seen and found in the event of an emergency. It is my cheat sheet who to contact if I am not there and there is a need to reach my emergency contacts. It is a small thing, but it was both easy to and logical. I will add this to my wallet too. And why not?
My mom and step-father had a similar list on their refrigerator door for years as she was sliding to her end. I know hundreds of thousands of others may have done the same thing. They are like the paintings Romans made of skulls and skeletons, reminding all of us our end will eventually come.
I cannot remember if it was 21 or 22 years ago, but the timing was right around this time of year, as classes were ending for public schools. What I do remember well is that my mom officially retired from her career as a public school teacher with the University City Public Schools system.
My mother poses with me shortly after her retirement from lifelong service as a public school teacher.
I joined her the day she turned in her paperwork at the district office. I happened to be traveling from my home in Seattle to the St. Louis area. I wanted to be there to congratulate her for her years of service to kids, many from families with many difficulties. She was mostly happy, and the staff were pleasant, but there was no big celebration for her many years with the University City Public Schools. I wish I had been more thoughtful and treated my mom that day. I let her down.
Today, as I think about the stresses facing kids and teachers over the last two years in particular, I recall the way my mom’s career of service ended. I now wish I had pictures of her in the classroom. Unfortunately, this was before the social media era. What I have is a photo is from that era, maybe two years after she left the classroom.
My mom’s post-retirement life went well for a while, until she succumbed to Alzheimer’s disease, and then her life was hell for seven years, until her death in February 2020, just before the world experienced the COVID-19 pandemic.
At her funeral, the minister who led the sermon, and who I helped with some stories about my mom’s life, said these words: “She was one who devoted her life to teaching and encouraging little children. She was also ahead of the disciples, and on the same page with Jesus, as much of her career was teaching and nurturing those of differing communities. As the little bio notes, much, if not most, of her career was engaged in teaching young African American children. Jesus’ own teaching and ministry was inclusive. In fact that was a major point of his teaching — to teach and demonstrate that the community of faith, the community of God did not discriminate. This is a justice issue, but it is also a deeply spiritual issue, and faithful to the one who calls us to follow … . What the children recognized was a relationship, someone who cared for them, wanted them to learn, as she would want her own children to learn, to be cared for.”
It still saddens me that the school district, which I contacted repeatedly, never acknowledged my mom’s passing in their official communications. It was COVID-19 time, but this willful shunning of a public teacher still left me upset how even school districts remembered their own.
With June around the corner, millions of kids and families are getting ready to head into summer. It is an uncertain time too, with school safety foremost on the minds of many, along with so many other economic issues facing the kinds of families my mom served. So, if you can, please remember to thank a teacher before the school year ends, in person, if you know one. They will always remember that kindness.
Masks are coming off soon, when previously many jurisdictions had required them in many indoor settings to prevent the spread of COVID-19. Many want this. Many who also know about the term “endemicity” would also like to believe we have “immunity” and can get back to “normal.”
In Portland, Oregon’s Sellwood neighborhood, the masks are coming off already, indoors and outdoors, at most eating establishments.
Hey, as a person who yearns for social contact like millions of others, I would like to go back to that now-crowded, maskless wine bar in Sellwood near my home too. Personally, I won’t do that any time soon.
The reason is, the underlying SARS-CoV-2 virus and its mutations will remain prevalent and potentially a real public health concern, based on what current science tell us. But I’m not saying this. Professor Aris Katzourakis, of the Department of Zoology, at Oxford University in the United Kingdom, made this point in the Jan. 24, 2022 issue of Nature.
Rudy Owens, wearing two masks, on a flight in June 2021 from Seattle to St. Louis.
In his essay, “COVID-19: endemic doesn’t mean harmless,” published just before the Omicron surge began to fall in many countries, Katzourakis wrote: “There is a widespread, rosy misconception that viruses evolve over time to become more benign. This is not the case: there is no predestined evolutionary outcome for a virus to become more benign, especially ones, such as SARS-CoV-2, in which most transmission happens before the virus causes severe disease.”
Katzourakis, and other public health and scientific experts, are not rooting for one outcome or the other. They are just using science to provide an informed opinion, hopefully to keep people healthy. And if some people keep wearing masks, that is fine with me. I will likely be one of them. That is a decision we all will still be able to make, for reasons that make good scientific and health sense.
Dr. Paul Farmer speaks at the University of Washington School of Public Health in 2018. Photo is courtesy of the University of Washington; story here.
World-renown global health advocate, Dr. Paul Farmer, died in his sleep in Rwanda, leading to an outpouring of both sadness and praise from many health and public health practitioners in the United States and around the world. At the time of his sudden death, Farmer was working in the central African nation at the medical school he co-founded with the Rwanda’s former minister of health, Dr. Agnes Binagwaho.
Farmer, a medical doctor and anthropologist with advanced degrees from Harvard, co-founded of the Boston-based Partners in Health (PIH). The group confirmed his death on Twitter today, Feb. 21, 2022. ABC News reported PIH had confirmed Farmer died from an acute cardiac event that happened during his sleep.
Despite his prestigious graduate pedigree and also having attended Duke University as an undergraduate, he eschewed the path of traditional power and influence that his elite training afforded him. He had his eyes set on the world, where many lacked access to basic health care. According to Duke University, Farmer sought to “strengthen public health systems in order to provide quality health care in some of the world’s most vulnerable communities.” By the time of his untimely death, he had established a wide following after having spent decades of his life working on addressing global health inequities, in Haiti, Africa, Eastern Europe, and Latin America.
It is fair to say Farmer influenced nearly a generation of health and public health practitioners in the United States who have an interest in global health and health inequities. Those singing his praises today range from policy hawks like Samantha Power, to Hollywood celebrities, to former President Bill Clinton, as well as scores of public-health minded doctors who shared comments on Twitter, expressing sadness at the news of Farmer’s passing.
Farmer left a mark with his peers and colleagues globally who shared his passion to fix the same root issues driving and underlying global health inequities. The day after Farmer’s death is filled with diversity of persons who work in those fields sharing personal comments explaining why Farmer mattered in this collective effort. One former colleague, Dr. Sriram Shamasunder, met Farmer as a university student and was inspired to join in the work Farmer was doing. “He conveyed with his words, the irresistibility of social medicine, where health workers aim to address the root causes of disease in its social and economic context,” wrote Shamasunder in an essay published by National Public Radio just after Farmer’s demise. “This work is where necessity, urgency, and joy become bound together.”
Nearly every graduate student I met at the University of Washington School of Public Health (UW SPH) when I got my degree there (2010-‘12, as an older student) shared tales describing that their interest in working in international health was influenced by Farmer’s thinking and writing. He also visited my alma matter to speak about his work. That praise felt very close to hagiography, which can also hide any famous person’s flaws and blind spots. Those who know better of making saints from mere mortals can easily describe this type of myth-making as “white saviorism.” That is real too, regardless of Farmer’s accomplishments.
Tracy Kidder’s famous book about him, Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World, is the one book that came up in many conversations among UW SPH grad students. Here are some works by Farmer that provide some insights to his influential thinking, which are not uniquely his and also are shared by many doing similar work. I have not read it, but clearly the book has what can best be called a “dedicated following.” One cannot deny that Farmer was tireless in communicating the change he worked on, in the mud and in the field.
A good profile of him can be found in a New Yorker piece from 2000 that is circulating among those in global health who are lamenting this loss. The myth-making portrait by Kidder in her book about Farmer is based on a Haitian proverb: the Haitian proverb “Beyond mountains there are mountains”—as you solve one problem, another problem presents itself, and you go on and try to solve that too. That is a good metaphor to living life, ready to engage and never losing your purpose why you do what you do.
Nearly every year I catch a live or filmed version of A Christmas Carol by Charles Dickens.
With COVID-19 still a threat globally and the Omicron variant still the dominant strain in Oregon and the country, I will forego my normal Christmastime pilgrimage to the theater for a live show. I will miss it, because at these live shows of this timeless story, I am in the company of theatergoers who share in the many profoundly humanistic themes of this masterwork of literature.
There are too many scenes and themes to call out that speak to our common humanity, particularly this time of year, when we are asked to think of others less fortunate.
Patrick Stewart plays Ebenezer Scrooge in my favorite adaptation of A Christmas Carol, from 1999.
One of my favorites scenes is when the ghost of Jacob Marley visits the still hard-nosed and taciturn Ebenezer Scrooge to give him a chance to save his soul, while he is among the living. The ghostly apparition of his former friend and business partner warns of the three spirits who will visit him on Christmas Eve.
Marley’s ghost also reminds Scrooge of our purpose in life, to be of service to others.
“But you were always a good man of business, Jacob,” faltered Scrooge, who now began to apply this to himself. “Business!” cried the Ghost, wringing its hands again. “Mankind was my business. The common welfare was my business; charity, mercy, forbearance, and benevolence, were, all, my business. The dealings of my trade were but a drop of water in the comprehensive ocean of my business!”
The chills that one feels at a sprit giving us a chance for redemption never grow old for me. For me, this scene is among the best ever written telling us that we do in life, day in and day out, matters. The encouragement, spoken with the grim knowledge of death and the afterworld, reminds us all why our work matters in the here and now.
So with that holiday message, remember the importance of our “real business” in life, particularly this time of year.
This week, I found myself locking horns with two intractable systems that are among the least accountable and most unbending in the United States. One is a nursing home in St. Louis, Missouri, that cares for a family member of mine, which in its operation is not that different than the more than 15,000 licensed facilities nationally. The other is a medical clinic in metro Portland, Oregon, where I visited a doctor for a visit in September this year. Each represents a part of the much larger systems of for-profit healthcare and nursing home care, and their structure and management are likely representative of their thousands of counterparts throughout the country.
Sociologist Max Weber was the first to describe how modern bureaucracies function, often immorally, and to explain the historical emergence of bureaucratic institutions.
Both of these institutions that provide medical and health services are, theoretically, there to serve others and provide services that are essential and also something most persons see as “morally good.” These two facilities are not related in any way. Yet both are much alike in how they function as bureaucracies that are mostly intractable in their actions and inflexible when asked to be accountable.
In my long decades now of dealing with bureaucratic systems, I have learned important lessons. The most important of those lessons is to never accept “no,” which is the reflex response of organizations that do not take ownership for their actions that can cause harm and can be morally wrong.
I spent decades of my life fighting a large bureaucracy in Michigan, the Michigan Department of Health and Human Services, which denied me my original birth records for nearly three decades, even after I had met my birth mother who signed a consent form in 1989 that should have forced the agency to give me my original birth certificate. It took a court battle to secure my birth certificate’s release in 2016. The long dance I had with that ossified bureaucracy provided wisdom I continue to use in how I do my work professionally today in a large government agency and how I deal with other bureaucracies that intentionally choose to do wrong as opposed to good. In nearly every sense, being an adoptee denied basic legal rights was my advanced training how I respond to immoral, inflexible systems and institutions to this day.
Fighting in the trenches with the nursing home system
For nearly two years I have had to engage in long-distance advocacy for my family member who is permanently bedbound in a Medicaid-funded nursing home in St. Louis. These efforts mostly focus on getting the staff there to provide legally mandated, competent care, which is lacking. The facility is privately run, but receives federal reimbursement in the life-saving help for my family member. However, it continues to fall short in many ways, such as how it informed family members of COVID-19 outbreaks, the offering of required services such as oral health care, and most recently in not offering seasonal influenza vaccine and COVID-19 vaccine boosters. Both are recommended for these settings and for patients like my family member. My family member has not received either of these shots, but should have already by early November.
I continue to work with the Missouri Ombudsman Program, which has no regulatory power over these places. It mostly has moral authority to embarrass the nursing homes and nudge them to providing what is mandated already by law. I did that again this week, when I found the facility caring for my family member had failed to offer either of these potentially life-saving shots to my family member.
When I called the nursing home facility, I could not get a straight answer if and when the shots would be provided. I was transferred four times. No person gave their full name. A woman said I should call back the director, who now refuses to respond to my communications. The last person I spoke to told me, in true bureaucratic fashion:
The nursing home where my family member lives is no different than thousands of others licensed in the United States.
They were “just in zoom meeting” that morning to plan for vaccinations—a remarkable coincidence of timing.
They claimed the pharmacy has not been provided materials. This was not explained further, and often there are partnerships that come into nursing homes.
They could not provide any timeline about when either boosters or the flu vaccine could be provided.
They refused to answer my questions if they had planned for routine seasonal influenza vaccinations, which for decades has been is a standard healthcare activity in for all nursing homes and long-term care facilities in this country.
I do not think my efforts solved this problem. I doubt the root issue of poor care is solvable. But I was determined to do my best and just ask them to do their job and care for their residents that they have legal, professional, and moral responsibilities to fulfill as a licensed care facility in the state of Missouri. I also relayed my concerns in writing to the Ombudsman representative, who said they would send a representative to that facility to see how my family was doing and if these vaccines would be administered.
The black box of medical billing, the hallmark of the for-profit U.S. healthcare system
This week, I continued in my efforts to get answers to questions I posed to a medical clinic in Portland to explain why it charged me a high cost for a procedure that could have been charged less than half the final amount. My call marked the third time I asked this medical clinic to explain why a visit involving a conversation with a doctor and the analysis of a test result was charged more than $500, when it could have been as low as just over $230 or up to $600 or more. The black box hiding this information is hidden to all patients, as it is for many charges for medical care in the United State. My efforts with all providers is to get them to tell me the cost in advance, and when they fail to do that—which is nearly always—I ask for breakdown how a consumer can learn how a charge is made.
My call a month ago was never returned, and once again I talked to a billing representative lasting nearly 15 minutes. I was not rude, but I was firm and unflinching asking for the company to explain how it determined a cost of service. The replies were:
Sir, I don’t understand your question (said three times after I kept repeating my request).
The insurance has paid for this. Your balance is zero. That really means, what is your problem, leave it alone, and the system is broke and let’s not try to fix it with this issue.
You’ll have to speak with our manager. I am not able to answer your questions. It could be because it was a new office visit.
I was then transferred to a manager’s voicemail. I left my third message and await a call that may or may not ever happen.
When I have made such calls in the past, I have been “accidentally” canceled as a patient for future visits. Mostly I have been told that the team reviewed the notes and that the medical charges are correct and not being changed.
Why fight battles that may never win the conflict?
The choice we face against intractable systems is never easy, and that choice is informed by lived experience. I prefer to be the lion, not the lamb.
As I contemplate my skirmishes with bureaucracy this week, in that enormous world of health care and nursing home care, I again had to confront myself and my goals. So why do what I do? When I look in the mirror, I see the person I was when I was younger, as an adoptee denied my legal rights, and told by every institution and person around me I was never going to get what I was legally mandated to own and have as a human. I see someone who had to learn, through trial and painful error, a path forward.
So again, why? The answer is simple: Because even small efforts matter and because when harm happens, to millions of patients or nursing home residents, it is clearly immoral and wrong. These engagements also help focus my mindset and my practice that is needed for dealing with unaccountable bureaucratic systems.
In those engagements, the lambs are usually skewered and the lion will always stand strong, even if the victory means losing that battle. I choose to be the lion.
The Path to Wisdom 