Monday, February 5, 2018

homeless census

The volunteers gathered at 8:45 at Boston City Hall, that local masterpiece/monstrosity of the architectural style that proudly declared itself as Brutalism. People standing in the area just past the metal detector pointed us to our team area.

The homeless census was framed as a local event, but in truth, every city that gets federal money to shelter homeless people is obligated to do this kind of "point-in-time" count. Whatever the flaws of this approach, don't blame your mayor. There are better ways to count homeless people if you're concerned about estimating the number of actual homeless people. But it's the perfect policy for counting homeless people if your concern about homeless people starts with those who are visible to others.

"Homelessness", as an idea for folks who aren't poor, mostly amounts to a category that translates to the visibly desperate, the obviously impoverished. I hear this when I explain what I do for a living in well-to-do social settings. There is sometimes this strange fumbling on the part of the person I'm talking to, where they end up blurting out some story like "I talked to a homeless person once" or "I bought a guy a sandwich" or "I see people with signs on my drive home from work." That's OK. I understand that when I say the word "homeless" that this pokes right into an until-then-healed-over confusion and anxiety that people feel when they actually see other people's desperation. What they feel in that moment when somehow the desperation connects to them, and they know that it's both simple and complicated at the same time.

Homelessness isn't just the man sleeping in a doorway in a wealthy neighborhood. The "homeless lady" who is seen in the park with her bags and her inner voices. This is mostly who people at parties I go to are thinking of. And those are important people too. But, I learned from my boss when I started doing this job, you can get all kinds of answers when you ask, what are the causes of homelessness?--and you can offer a very simple response in return. Homelessness is caused when the cost of having a home exceeds the ability of people to pay that cost. The rest--that's just details.

And this might remind you that there are some other homeless people you'll never count, people whose suffering is immense but not visible, not recalled as a "social problem" because it doesn't enter into the social urban space:

  • A woman who regularly must inhabit a treacherous ever-shifting zone between a man's simply selfish sex and his outright rapes in order to stay in an apartment.
  • A man who is sleeping in a storage unit, in a warehouse storage facility.
  • A woman and her child who won't leave her boyfriend's house because he really might kill them if they do.
  • A transgender woman who gets one kind of abuse in women's shelters and another in men's, and so stays outside to avoid both.
  • A man who has to stay out of his sister's house a few nights each week so she doesn't lose her housing for having people stay in her apartment.
  • A man, just out of prison, taken in by a woman who wants to fix him, to save him, and he's not sure that he's fixable or that he wants to be saved, but he knows he wants to be inside.

And there are so many more.

Even, almost, a small group of women in an ATM vestibule in a corner of the city I won't identify, women we didn't see at first, looking wary. We did count them, luckily. But we didn't count any of the others. And if it was easy to get an affordable place to live, all of them would have their lives changed. If we made housing a priority. If we thought it was what our fellow human beings deserved. If we could count them all, and they all counted.

Sunday, January 14, 2018

Not a superhero anonymized troll-boy / Pharoah Sanders healing powers

I was getting in a fight on some doctors' group on Facebook about Medicaid work requirements and some dude was being so irritating that he apparently provoked me into starting a sentence with, "Despite not being an Ayn Rand superhero anonymized troll-boy like yourself..." Which is a sure sign I need to not be on Facebook right now.

In this time of desperation--DACA still not fixed, CHIP still not fixed, Puerto Rico still devastated, no Puerto Rico Medicaid fix, no community health center funding renewal, and now they're going to ask impoverished people to work to keep their medical care because, I don't know why exactly, and it feels like in health policy and in many other places in policy, nothing nothing is working like it's supposed to... well, I am perhaps more easily provoked than usual.

Desperate times require desperate beauty: Pharoah Sanders' 1982 performance of the Coltrane song OlĂ© is not for everyone--it is 23 minutes of rough, raw, ecstatic, on-the-edge jazz--but since I heard this at some point in my early 20s, I am still not over its propulsive ferocious magic.

Tuesday, December 26, 2017

A song I still like for no good reason but then lots of things happen for no good reason

Yeah, still no CHIP fix, no community health center fiscal cliff fix, no Puerto Rico Medicaid fix, merry Christmas, y'all.

Meanwhile, there was this time in my life where I was living in Washington, DC. Nothing policy-wonky; as a matter of fact I was a mouse-killer. I lived in a seventh floor studio apartment; it was mostly a pretty lonely year. I was buying music to pass the time, and somehow got into this one song on one French house music compilation (Respect is Burning, Part 2). "Casa Campo", by Clement, somehow grabbed me, and I've had a soft spot for that track ever since. And it wasn't like I was going to clubs or meeting people at that point. I was sitting in this seventh floor apartment, watching planes in the distance flying into National, listening to house music for no especially good reason. This is music for dancing and having sex and taking drugs, not sitting around your apartment being a stone-cold-sober mope-tastic pre-med. So, I can't explain why I was buying that kind of record, or why on that kind of record, it was this particular song at that time.

But even though now I can't find the CD in my stuff, every now and then I go find the song on the internet. I've never known anything about the person who made it--though you can look that up these days--and I can't even say why this la-de-da chill-out kinda song makes me happy. Especially with the little guitar bit at 0:27, it starts like something that should be playing at the pool bar in some kind of boutique hotel where probably nothing good ever happens and a lot of money changes hands to make those nothing-goods happen.

But, the pleasures of music can't always be explained, and the moment where a little synthesizer riff starts dancing around at about 3:33, with the bass kicking in a few seconds later, makes me inexplicably happy, moving my shoulders at my desk, as if somehow I was like, some Parisian getting ready to go to le discotheque.

Which is probably at least as inexplicable as, why there's still no CHIP fix, but there you have it.

Thursday, December 14, 2017

The Black Madonna, "He is the voice I hear"

"if she’s dance music’s mom, she’s a rad, weird and decidedly cool mom" -- MixMag

The New York Times described her in passing as "warm left-field disco"; but I gotta say, I just had to write down the first time I heard her song "He is the voice I hear" because I feel like it might later turn out to be an important moment. The first time The Black Madonna entered my headphones. And yeah, I realize I'm like a year or many years late to the party as usual, though I want to say in my defense I found this song from Spotify not from the Times. I mean, I have never and will never hear this in a club, but I'm not such a looo-zah that I'm getting dance music recommendations from Paul Krugman or whatever.

But anyway, during my twenties, if I had the cool and the common sense to be in the back of the club with the DJ instead of up at the front handing out condoms and public health information, "He is the voice I hear" is the kind of music I would have dreamed of producing as a result. Smart, propulsive, genre-mixing, obscure-sampling, and somehow, intellectual about being emotional. But no, due to my misspent youth in public health, I go to work and write prescriptions instead of dropping beats at a Barcelona music festival. Instead, I'm a doctor, telling you that

we still need the Children's Health Insurance Program fully funded,

and we still gotta fix the Puerto Rico Medicaid cliff,

and may our dance music be welcoming and warm, always.

Because, wow, Holy Record Store Nerd, Batman!--check it, from 2012:

Alright this morning

Sunday, November 26, 2017


I stayed up late re-watching Arrival. I decided that I love that movie. 

I was thinking about Arrival today while folding laundry, the morning after I'd stayed up late to re-watch it, wondering why this movie speaks to me so much. I often connect strongly to moody cerebral science fiction movies, so maybe it was inevitable. But more deeply, on watching the movie this second time, I connected strongly to the particular combination of fear and wonder, of feeling intellectually challenged and emotionally overwhelmed, that Amy Adams conveys for much of the movie. She is haunted but enlivened by what haunts her. She walks towards the fear, the dread. In doing so she embodies a quiet, kind power; a form of strength that incorporates curiosity and love as part of its structure.

This is the emotional quality I seek in my work and my life. The heroic version of this quality looks easier in the movies than it is in real life, and I'm not even using advanced linguistic theory to bridge the gap between alien civilizations across time and space. I'm just trying to help people stay alive. I don't compare this experience to trying to communicate with aliens; these are my people. It's less the experience of the aliens as it is another part of the story, about grief, that I think I connected to most strongly. The idea of going towards love even if grief lives in the same room.

And yet, these aren't my deaths to grieve. I haven't lost the people I'm closest to.

I remember a moment when I was doing AIDS work and I saw this movie Fearless in 1993, at a time when everything seemed like it was just going to keep getting worse. And I remember losing it at this movie. Crying my eyes out for reasons I didn't totally understand, for deaths that hadn't yet occurred, for grief that wasn't really mine to grieve. And yet, was. I think I'd been getting numb for the weeks preceding seeing the movie, and then cried much more than I normally would have. Some guy's story came back to me, some horrible story that I don't remember now, and it was like I'd shut myself down after hearing his story, and then after the movie, for some reason opened myself back up to the world, to pain, to other people's stories.

Arrival wasn't that for me last night. It was just a very evocative sinking into the deep spare melancholy of the world; of the universe. And how this connects to who I am right now, I feel like I'm still working out. But I do know there is something about Amy Adams' character that I identified with, that I found in common with how I am feeling. When I figure that out, maybe I will be able to read some alien alphabet of time and physics. Or maybe I'll just know my own language better.

* * *


Maybe something in this territory:

From Chris Plante in The Verge:

"Arrival tells the story of one woman who chooses a life of grief to save the world. I find her so painfully relatable. As I get older, the emotional struggle of life — the one I couldn’t see when I was a child — has revealed itself. Friends and family die. Unexpected tragedies interrupt banal work weeks. To live and to love is to court inevitable grief, and we make the choice to move on. I’ve attended many funerals over the past few years, and I thought about each of them on the drive home from my screening. I don’t have the advantage of knowing my future, but I do have the memory of my past. I know the pain that comes with emotional investment, and it does not hobble me, or at least I try my best not to let it. I found Arrival’s bigger themes of communication and trust compelling. But what will stick with me is its defense of choosing life in the face of profound grief."

* * *

Don't worry: I haven't forgotten the musical note:

It seems like a good ecologic/musicologic question to ask whether the Arrival soundtrack would've sounded even a little bit the way that it did if no one had ever recorded humpback whales. I mean that as a compliment. I like listening to humpback whales. 
An accidental discovery leads me to recommend playing these two links by clicking them in rapid sequence to play in different browser tabs. If you make that happen, the soundtrack becomes a backing track to the whales (or vice versa?):



Admittedly it's a little late on Saturday night and I'm listening on headphones so as not to wake anyone up. And I'm in a mood, and might have descended a little more deeply into the humpback song / Icelandic film score mash-up zone than others might choose. Still, you might consider playing them both, from the beginning, starting at the same time.

There is also a very non-whale-ish piece of music, "On the Nature of Daylight", that is not a part of the movie's score, but serves as the underpinning of a key portion of the movie. (Written by Max Richter, who wrote the score for The Leftovers, speaking of haunting science fiction.) I recommend this also via YouTube link:

Wednesday, June 7, 2017

Vox Care / Healing

Look, whatever I thought I might do in giving updates on Medicaid issues, is pointless. I think I thought only a few desperate people crying in the dark would defend Medicaid, and... it hasn't been quite so bad. Not good, mind you. From the point of view of this blog, though, the bigger point is that the job of keeping you posted on a daily level is being done really well right here:

Vox Care

and also here:

Andy Slavitt

...among others.

                           *   *   *

Check this while you read: "Healing." Ignore the visual. Deep house music by a band that doesn't usually swing that way. Kinda glorious.


"I don't care who you are, what you done, or who you done it to. If you're here, so am I."

"Ain't no shame in holding on to grief. As long as you make room for other things too."

It's been one of my professional ambitions to be Bubbles' doctor. I mean, not Bubbles himself. He's a fictional character from The Wire. (Sort of.) But people like Bubbles.

And I'd sort of forgotten about that until I was talking today about 12-step. For a lot of my patients on buprenorphine, the 12-step movement is a mixed blessing. There's wisdom there, but also judgment. But some folks find a way to put the two together. They find the help of a medication, and they find the wisdom of a community.

I can't tell you how many times I say, "One day at a time" as part of a sentence, and I really really mean it. Every day. Sometimes multiple times a day.

And there are none of my patients where I see them and I go, dude, that guy's just like Bubbles. They are each their own person. But I do see Bubbles now, and say, that guy's a lot like my patients.