Matula Thoughts Feb 2, 2018

 

Gaps, stories, & authenticity

3707 words

 

(Above: MIA this February)

One.         

Minding the gap. February is a gap month, adjusting for the tiny discrepancy between solar years and calendar years by an awkward change that lengthens the month once every 4 years. The next 29-day adjustment will happen in 2020.

Missing this month is the full moon like that which happened two days ago and coincided with a super moon, a blue moon, a blood moon, and a total lunar eclipse (the picture above was taken last year). Full moons usually happen monthly, sometimes even twice a month, with the second of the full moons called a “blue moon,” although having no blueness whatsoever. The super moon refers to the optical effect of the moon being “super close” to the Earth. The blood coloring  relates to lighting effects from the lunar eclipse.

Given lunar periodicity of 29.53 days, February is the only month in which a full moon gap can happen. This last occurred in 1999 and will happen next in 2037.  A similar gap occurs in occasional Februarys with the new moon, as last in 2014 and next in 2033. [Macdonald. J. Brit. Astron. Assoc. Dec 1998. p. 324.]

February, in the Midwest, also provides a gap between the celebratory early days of winter and the promise of spring rejuvenation in March or April, before May contingent perhaps on today’s groundhog forecasts from Punxsutawney, Pennsylvania. If you are in Punxsutawney today and travel east along Interstate 80 near the interface between Pennsylvania and New Jersey you will encounter another type of gap, the Delaware Water Gap, where the Delaware River cuts through a ridge of the Appalachian Mountains.

Last summer I passed through a second geological gap after being stuck in traffic in the Rockies along with cars, trucks, and Greyhound buses backed west of an accident on Interstate 70 (below).

I had been returning from a continuing medical education course that Quentin Clemens, Brent Hollenbeck, and Jeff Montgomery had organized conveniently close to excellent fly fishing opportunities that would be warmly relished this cold month. This summer, by the way, will likely be a gap year for their course, but with encouragement they might reprise it in 2019, the year Michigan Urology begins its Centennial celebration.

The specific phrase, mind the gap, came into play exactly fifty years ago, in 1968, when London Underground leadership automated and standardized the warnings that drivers and local station attendants had been giving to passengers regarding the gaps between the station platforms and train doors. Because the gaps were sometimes dangerously large, an automated short announcement was planned with digital technology. The AEG Telefunken Company supplied the equipment and sound engineer Peter Lodge recorded test phrases intended to read later by an actor. After the actor demanded royalties, the thrifty London Underground deemed Lodge’s own test readings of “Mind the gap” and “Stand clear of the doors please” good enough and ultimately implemented them in stations in 1969.

Minding the gap is a useful metaphor for medical professionals and residency trainees. The gap between conjecture and truth is the workplace of the health sciences and the rapid advances of knowledge and technology create new inevitable gaps. Additionally, complex systems, health care economics, and divided loyalties create tensions that force ethical and moral challenges. An editorial in JAMA by Donald Berwick last year highlighted some of the moral choices confronting today’s doctors, explaining that the gaps between choices come in three tiers, personal, organizational, or societal. [Berwick. JAMA. 318: 2081, 2017.]

 

Two.

London Underground dates back to 1854 when the Metropolitan Railway gained permission to build a subterranean system and began to evaluate digging methods in test tunnels, but it wasn’t until January, 1863 that it opened the world’s first underground railway, which ran between Paddington and Farringdon Stations. Steam locomotives hauled wooden gas-lighted carriages. A second line, The District Line, between Kensington and Westminster, opened in December, 1868. The first underground lines were trenches that were “cut and covered,” in a manner like the setting of the Terra Cotta Army of Qin Shi Huang 2100 years earlier. Newer methodology of deeper bored circular tunnels, avoiding the need to involve surface property owners, began with electric locomotives on the City and South London Railway between King William Street and Stockwell in 1890. The deep tube system expanded and by the time of the “Mind the gap” recorded announcements, the London Underground map had become one of the iconic graphics of the 20^th century. Some versions of the map noted the distances involved, vertically and horizontally, for the more egregious gaps.

[Wikipedia. The left side shows the 1933 Beck map and the right side the Underground map as it appeared in 2012.]

The Darkest Hour, a new film about the gap between England’s meager armed forces in 1940 and Hitler’s military advance in Europe shows a fanciful scene where Churchill takes the Underground to Westminster one day seeking to understand the “will of the people.” His imagined conversation with the working people on the train bolsters his courage to resist rather than capitulate to the overwhelming and imminent threat. Churchill goes on to deliver his first galvanizing wartime speech. In the film two political opponents grouse: “What just happened?” one asks as parliament erupts in patriotic cheers. “He [Churchill] mobilized the English language,” comes the reply, “and sent it into battle.” Creative devices of the cinema notwithstanding, it’s hard to imagine what today’s world would be like without Winston Churchill’s leadership in that precarious year.

 

Three.

Fictional views of the world help us understand it more accurately and deal with it more effectively. When fiction artfully imagines facts and relationships and renders them in coherent stories with enough historical fidelity and realism the past, present, or even the future become clearer. The Darkest Hour did this effectively for those dark days of 1940, when England found itself unprepared for a re-armed and hostile Germany. Although the Underground scene was fiction, it gave substance to the reality that Churchill was able to tap into the will of the English people, understanding that their values, hopes, and dreams were quite distinct from the views of the rarified aristocracy that surrounded him and had ruefully shaped English policy until that moment. Churchill, like his peers and advisors, had limited contact with ordinary, working people, but he had enough sense of them to gain an imagined understanding of their aggregate intent on the choice between surrender or fight. Furthermore, his inspiring speeches at the right moments tilted the scale further against appeasement and surrender. While the Underground scene might make historians grumble, the fictional device artfully illuminated Churchill’s likely state of mind.

The 1993 film, Groundhog Day, offered more outlandish fiction, giving an imaginative spin to the Punxsutawney myth. A successful musical version premiered in London at the Old Vic in 2016. This story is a fiction about a fiction. Yet, who hasn’t wished for moments like Bill Murray’s Groundhog Day where time repeats itself, offering us another chance, or like “a glitch in The Matrix,” and as Yogi Berra is reputed to have said: “Déjà vu all over again.”

 

Four.

Our species, Homo sapiens, is not only defined by its stories, but stories shaped our emergence from the earlier members of our genus Homo, if you accept a Darwinian point of view. Allen Lichter, former UMMS Dean, sent me a book recently that elegantly consolidates our specific human story. Aptly named Sapiens and written by historian Yuval Harari, the account tells how our genus, Homo, evolved 2.5 million years ago from an earlier and now-extinct genus of great apes in East Africa and set out to see and change the rest of the world. Some kindred species, Homo neanderthalensis, evolved in western Eurasia of the Ice Age while others, Homo erectus appeared in Eastern Asia and survived for 2 million years. Homo soloensis evolved on the island of Java, Homo floresiensis on Flores, and Homo denisova in Siberia were also members of our category of biologic classification, the genus. Evolution also continued in East Africa with other competing species in our genus: Homo rudolfensis and Homo ergaster, along with us, Homo sapiens.

Harari gives reasonable evidence that storytelling was central to the emergence and dissemination of Homo sapiens, who eventually replaced all the other species of the Homo genus, although collecting bits of their DNA along the way. All hominoid species existed in communal groups that must have depended on some form of verbal communication, but Harari indicates the language skills of H. sapiens were superior and in time gave total competitive advantage to our species of humans: “The ability to create an imagined reality out of words enabled large numbers of strangers to cooperate effectively.” [Harari p. 32]

The earliest storytelling logically was a matter of gossiping and rumors related to clan folk, hunting, competing clans, predators, seasons, and climate. Storytelling expanded, perhaps around campfires, into durable tales of myth, history, and fantasy. Without the advantage of scientific thought and verifiable information early story tellers undoubtedly relegated competing some clans to barbarian enemies. Some of these may legitimately been other human species, although as opposed to traditional ideas that different species could not breed, evidence is clear that successful interspecies mingling occurred in the last 100,000 years before the other human species became extinct.

For the last 10,000 years Homo sapiens has been the sole human species. Historical ideas of polygenesis have been effectively debunked – there is only one human kind, although 7 billion of us have myriad ethnic origins, ideas, experiences, hopes, and dreams. Diversity is an uncontestable true fact, and equity and inclusion are mandatory to our survival as a species. John Kennedy once was reported to have said: “Our most basic common link is that we all inhabit this small planet. We all breathe the same air. We all cherish our children’s future. And we are all mortal.” [Commencement Address at American University, Washington, DC. June 10, 1963]

Today’s world is cosmopolitan in fact and by necessity.

 

Five.

Today, February 2, has interesting links to the past. Notably, in 1887 in Punxsutawney, Pennsylvania, Groundhog Day began on this day. February 2 in 1901 was the day of Queen Victoria’s funeral. My grandfather recalled that he watched part of it from a rooftop in London, guessing that he was around seven years of age at the time. On this day in 1922, the book Ulysses by James Joyce was published, resetting the line between pornography and “acceptable” literature. In 1925, on February 2, dog sled relays carrying life-saving diphtheria antitoxin reached Nome, Alaska when all other access was impossible. This superhuman feat, a half-century later, inspired the Iditarod Race. Balto, the most celebrated of the original relay dogs, is immortalized in a statue in New York’s Central Park and his remains, preserved by taxidermy, are at the Cleveland Museum of Natural History.

These curious bits of information are facts that can be authenticated, for the most part. The late Don Coffey used to tell his students to learn to distinguish facts and true facts. What he intended with that admonishment was the recognition of authenticity in the pursuit of truth, authenticity being a state of worthiness of acceptance or belief by conforming to true fact.

Facts (and data) have some degree of relativity as Coffey knew well, they may change as new information is gained. Truth is something greater than fact, a higher degree perhaps of accuracy or authenticity. Something authentic is genuine, factual, truthful, or honest. As fanciful as the idea that a groundhog could predict the remaining length of winter or the notion that someone could be trapped in a repetitive time cycle, there is something authentic in the human aspiration to find easy ways to forecast the future (much like ancient uroscopists) or to have a chance to repeat a day in one’s life to achieve a better outcome.

 

Six.

Human nature seeks truth and its embodiment in personal conduct, integrity, is the basis of successful social interaction. The line between authenticity and inauthenticity can be difficult to discern and it can change. As we become informed that facts we had previously taken for “true” are found to be inaccurate, we are playing the intellectual game of science. More generally, this is the game of life as Homo sapiens. New information – observations in life – reasonably cause us to reset beliefs and values. It is no moral lapse or inauthenticity to discard facts when better facts are discovered based on new information, rather this is the natural human arbitration of the world.

Inauthenticity is another matter, being usually deliberate deception with antonyms that include counterfeit, inaccuracy, infidelity, deception, exaggeration, erroneousness, falseness, miscalculation. For a physician, nurse, PA, MA, researcher, other health care worker, or patient, the presumption of absolute authenticity is the basis of daily transactions. This is no less true for a historian, English professor, geologist, or physicist. Yet facts and stories are likely to have different interpretations or aspects to them. We arbitrate “truth” through collaboration with knowledgeable peers, or other sources of information. Such calibration is the nature of the scientific process, but it is more generally at the heart of all the social and intellectual interactions of human civilization.

A storyteller’s success is a matter of telling an authentic story. The story may be fact or fiction, but in either instance, the ability to make it ring true to a discerning ear is the hallmark of success. A successful factual writer, such as a journalist, will collect facts and study relationships in order to weave them coherently and artfully. The writer must strip away non-essential information or information perceived as inaccurate or misleading to create a story that is clear, accurate, and authentic to the reader.

The distinction between authenticity and inauthenticity is more complex for the writer of fiction, the value of which is to entertain and inform. Good fiction is authentic when it creates a story that rings true to readers in terms of realistic dialogue, details both relevant and accurate, and narrative that is clear. In the best instances, good fiction not only illuminates reality, but it distills it to capture and enhance its essence.

 

Seven.

Churchill’s language. Years ago, when the Society for Pediatric Urology was held in New York City and Bernie Churchill was president of the group, a well-known Winston Churchill authority and impersonator, James Humes, appeared as the surprise dinner speaker. When Humes described Churchill’s approach to speechwriting, the ideas resonated enough to write them down. Curiously, I’ve been unable to verify these in anything I’ve read of Churchill since then, so I can’t promise them as “true facts.”  Nonetheless, they ring true to me:

• Start strong
• Simple language
• One theme
• Paint a picture
• End with emotion

In his own writings, Humes himself is the source of some good quotes.

• The art of communication is the language of leadership.
• Every time you have to speak you are auditioning for leadership.
• Most speakers speak ten minutes too long.

If you want to explore Churchill and Humes further, a book Humes wrote in 2001, Eisenhower and Churchill: The Partnership That Saved the World, is well worthwhile.

 

Eight.

The Tet Offensive began fifty years ago and should be recalled for many reasons, but none less than it offers important lessons in leadership. Last year on these pages we told some of the story of Larry Hawkins, a young man from Detroit, who was one of the thousands injured during the Tet Offensive and how he came to the Ann Arbor Veterans Hospital paraplegic and deteriorating from urosepsis due to a neuropathic bladder. Jack Lapides saved his life by performing a vesicostomy, that also gave Larry personal independence. Larry went on to become a lawyer and influential public servant in Florida. After a distinguished career that included advocacy for the rights of the handicapped, Larry passed away a year ago and was buried at Arlington National Cemetery last summer. We had come to know of Larry through the efforts of his sister in contacting us for stomal supplies, that were becoming harder and harder to obtain for the Lapides vesicostomy, an operation that was life-saving in its day, but has been largely replaced by other management techniques.

Fifty years ago, in January 1968, when the combined forces of the Viet Cong and the North Vietnamese People’s Army of Vietnam launched surprise attacks on dozens of cities, towns, and hamlets throughout South Vietnam, the tide of the war began to shift. My professional education had begun amidst the Vietnam War, when we still had a national military draft, but my service was deferred via the Berry Plan until I completed my training. By then the draft and war had ended, but my service was still mandated and I was assigned to Walter Reed Army Hospital.

For the next few decades the collective American consciousness wanted to forget Vietnam and its many lessons, something that was easy to do for most people whose bodies, minds, and families had escaped the war’s sequelae. Nevertheless, occasional great memoirs gained public attention, including the Things They Carried by Tim O’Brien and Robert McNamara’s book In Retrospect. That latent period passed with the recent Ken Burns encapsulation, The Vietnam War. These books should be required reading for every American citizen. Continuing with the de facto “movie review theme” this month, we call attention to The Post, a current film that combines fact and fiction to tell an important and authentic story about The Washington Post and The Pentagon Papers.

 

Nine.

Leadership. A much older book recently came to public attention as a favorite of General F. John Kelly, Chief of Staff for the President. The General, by C.S. Forester is described as the classic example of leadership during WWI, but its lessons transcend any era. Written as fiction in 1936, its authenticity made it a best-seller and it tells the timeless tale of leaders who fail by fighting this year’s war with the tools and tactics of the last decade’s war. This book impressed Churchill, as well as Hitler according to Forester. Kelly singles The General out as an example of the importance of what he calls “Professional Reading,” a necessity for anyone aspiring to competence in their work. An article in Foreign Policy quotes Kelly:

“When I came back in the Marine Corps as an officer — close to my first days as a second lieutenant — I ran into a fellow named Capt. Ed Wells, a Harvard-educated, upper-crust guy. That first day I knew him he started talking to me about professional reading and how the real professionals read and study their professions. A doctor who doesn’t read peer articles and stay attuned to the developments in his field is not the kind of doctor you would want to go to, and the same is true for officers in the Marine Corps. He got me going on reading, specifically focused on military things, and I just never stopped. When I read a new book I wrote a notation in the front of the book what billet I was in, the date I finished reading it, and where in the world I was…

I’ve read this book [The General] every time I got promoted just to remind myself of the effect. I’ve noted where I was when I finished reading it the last time, then when I read it again I will try to remember what it meant to me as a major and, depending on as you get older and higher in rank, it’s a different book every time you read it. When a lieutenant reads that book it’s different from when a lieutenant general reads it. And I think the same is true for every book. So it’s just kind of a fun thing I’ve done over the years and with this book in particular just to remind me of the critical importance of thinking.” [Ricks. Foreign Policy. April, 2017. Reprinted, by permission, from Adm. James Stavridis, USN (Ret.) and R. Manning Ancell, The Leader’s Bookshelf (Annapolis, Md: Naval Institute Press, © 2017).]

 

Ten.

The Greyhound bus line company. Travelling through the Delaware Water Gap this winter on Interstate 80 or stalled in traffic last summer on Interstate 70 along a cut through the Dakota Hogback west of Denver I saw a number of the ubiquitous Greyhound buses. Greyhound is as synonymous for intercity travel in North America as the Underground is for intracity transportation in the United Kingdom. Greyhound’s first route traces back to 1914 in Hibbing, Minnesota when Carl Eric Wickman, a failing Hupmobile car salesman, used his last remaining 7-passenger vehicle to transport iron ore workers from Hibbing to the town of Alice, known for its saloons, at 15 cents per passenger. The next year Wickman teamed up with Ralph Bogan who had a transport service between Hibbing and Duluth. The newly named Mesaba Transportation Company had a positive margin of $8000 that first year. Through mergers and acquisitions of networks, Mesaba grew.

The Greyhound name appeared informally on the inaugural run of a segment from Superior, Wisconsin to Wausau, Wisconsin when the local operator of the affiliated Blue Goose Line run, Ed Stone, saw a reflection of his bus as it passed by a shop window and the moving image reminded him of a greyhound dog. Stone later applied the name to his entire network. By 1927 the entire Wickman system was transcontinental and by 1930 it had consolidated 100 bus lines into the Motor Transit Company, that was soon rebranded the Greyhound Corporation. In 2007 Greyhound became a subsidiary of the British FirstGroup transportation company, although Greyhound itself remains based in Dallas. While most large metropolitan subway systems have consolidated into public utilities the interurban bus lines have remained private.

The Bus depot in Ann Arbor serviced interurban bus lines including Blue Goose, Greyhound, and Shortway from a little building (above) until September, 1940 when it was replaced by a state-of the-art facility with 62 seats, a telegraph booth, a ticket office, a baggage room, and a 12-seat lunch counter.

Over the years, as Greyhound became the dominant carrier, the art deco building lost its luster through a number of renovations until 2014 when it was taken down to build the Marriott Residence Inn. The historically attuned developer, First Martin Corporation, retained the façade (below) and encapsulated the story of the bus station on the lovely visual displays, seen above.

……………………………………..

It’s been a challenging winter, but spring is not far away.

David A. Bloom

University of Michigan, Department of Urology, Ann Arbor