Dear Dr. Berger,

What are the ethical arguments for and against providing an alcoholic with a liver transplant?

Robin Katcoff, Baltimore, MD

Find out the answer at the Talking To Your Doctor blog

I’m an internal medicine doctor, which means I see adult patients in Baltimore. Today I saw one of my favorite patients. She has chronic pain and a particular gastrointestinal syndrome which leads to frequent hospitalizations. Both make it very difficult, and really — in practicality — impossible for her to work. Her disability is taking a while to come through, because “chronic pain” and “back pain” are too often not considered as “real disease” by the powers that be. She can’t afford many of her prescriptions because she lacks an income. She might get evicted any day.

I realized today what medical intervention would help her the most.

You know what prescription she needs?

Money. She needs money.

This originally appeared in the Forward newspaper.

I stood, legs apart and face to the wall, in the Capitol Police Vehicle Maintenance Division. In other words, a garage. And I thought: I want to shake the hand of the person who invented plastic zip ties. They’re probably doing extremely well for themselves.

But let’s start from the beginning. How did I get here, hands cuffed behind my back, and why did I still feel, all in all, pretty good?

I’m a doctor who’s been in practice almost 10 years. During my training I wasn’t that involved in politics, and after 2009 even less involved. I was complacent after Obamacare passed.

In the following years it became evident that more and more patients were able to seek me out and start seeing me as their new doctor because of the insurance available through the Affordable Care Act. Sure the legislation wasn’t perfect.

Everything can always be improved. I even rolled my eyes and acted supercilious at those who wouldn’t shut up about single payer. Why rock the boat? Then Trump happened. During the run-up to the election I understood the abstract possibility that he could win. Though I’m certainly no prophet and I didn’t come near to predicting what eventually happened, I was really worried that a President Trump would wipe out the progress of the past few years: the millions more Americans with insurance; the decrease in the rise of healthcare costs, the improvements in population health.

I was shocked in November, and after the inauguration it was as if I had woken up from a long nap. With mounting fear and panic I understood that the priorities of Trump and his Congress collaborators are different from mine, and those of my doctor and nurse colleagues — and certainly different than what my patients think is important. Many Republicans believe that government should not help the sick, because being ill is a moral failing. The sick need freedom to cure themselves.

As a response, I founded a social media group called Doctors Against Trump which later, with the help of expert friends, I converted to a political action committee to support candidates who believe in progressive health policies. I started calling my Congressmen and Senators regularly,  and I made use of various on-line tools that connect blue-state voters with red-state constituents, urging them in their turn to call their elected officials.

This was something, but it didn’t feel like enough to me. I wanted to physically and concretely demonstrate support for my patients (sick, weak, old, marginalized), that I wasn’t sitting doing nothing while people were trying to take away their insurance. Once or twice I went and had a polite discussion with a senator’s health aide. That didn’t hit the spot either.

I saw that two separate groups were collaborating in a Senate protest action: those from various faith traditions (priests and ministers, rabbis, ordinary Jews and Christians; probably others too), on the one hand, joined also by health professionals: doctors, nurses, dentists; together with patients ready to tell moving stories for an audience and media. I joined them on a sunny morning in Washington, DC, at a Lutheran church not far from the Capitol and Union Station.

First we joined in prayer (as a Jew, I was happy that specific Christian expressions were deliberately avoided, and no one invoked Jesus’ name). I put on tefillin as a sign of serious piety in the public sphere defending the principle in the Biblical verse “you shall surely heal.” I was also thrilled to meet doctors and others who I had met before only on social media.

After a press conference at which we forcefully articulated our belief, as religious people and doctors, that health is a human right, we started off in a long, stately procession, slow and steady, to the Capitol building, two by two.
Good things come to those who wait, and protesting is no exception. They let the tourists up to the Senate galleries quite quickly, but apparently it was obvious to everyone that we were planning something different.

We finally got to the gallery, looking down at the Senate. It was like a Kabuki theater, Democratic and Republican statues frozen in their feigned gravity while true realities of life and death play out on the other side of the Capitol walls. When the number of the bill was called, we stood up and shouted, “Kill the Bill! Shame!”

Though we don’t yet know, while I write these words, if the terrible bill is truly dead, I am very happy with our work. We used our privilege as doctors and bearers of faith to march against the greed and cruelty of an unfeeling administration. As part of a group of activists I felt the collective frisson that many Jews have experienced in a minyan that davens with intention: the surety that all is not lost even when the hour is very dark. We are powerful precisely because we maintain, even under attack, our beliefs in healthcare and the needs of patients.

So maybe that’s why, when I stood feet apart in the police garage, the zip ties didn’t bite as much as I thought they would.

Read more:

With great respect, Mr. President, this is a banana. You have to remove the outer —

I don’t understand what the hell this yellow part on the outside of this is. Is it an umbrella? A condom? Where is it from?

Mr. President, you are correct that it is yellow. But it is actually part of the banana.

You’re worse than I am! You are removing it because you know that the fruit will explode if you do not. Is this a fruit? Are we real?

It’s a banana.

But where is it from? Could it be a terrorist?
The call with Putin was much pleasanter. I felt relaxed and in control. I am so. done.

Enjoy your lunch, Mr. President.

Stephen was a Jew
-ish boy.
He was a racist too.
Trump’s toy.
He thought, “I’m so white.
Like a goy.”
Maybe. They might
Be annoyed.

We’re all sick of the health care debate. But those who are sick, trying not to get sick, or taking care of others who are sick don’t have the luxury of absenting themselves from this debate.

They (we) are looking on in horrified fascination as the GOP makes its plan known: dismantling Obamacare and leaving millions without insurance — replacing it with stopgap subpar underfunded skimpycare.

The so-called “skinny plan” is chockfull of real harm. 15 million more uninsured. 20% premium increases. And that’s before the skinny bill is stuffed even more full with add-ons designed to pacify the elements in the GOP who take moral exception to Medicaid. (The poor should refrain from getting sick, you see. Government should not be involved in healthcare. We should go back to the good old days, whenever and wherever those were.)

It’s as if the check-engine light was blinking on your dashboard, and in response your mechanic doused the car with gasoline and set it on fire.

If you have a Republican senator, call them and tell them your healthcare story. Ask them if they came to Washington to harm the sick. If you have a Democratic senator (or if your senator is Collins or Murkowski!) call and thank them for standing up for what’s right. You can also go to the Indivisible website to be patched through to those in red states, whom you can connect directly with their senators. (I’ve done it. It’s addictive.)

Yes, life is full of complications. Things are hard. There’s plenty to do besides this sort of advocacy. You have work to go to, kids to raise, doorknobs and toilets to fix. If you are involved in whatever else you have to do, no one should criticize. But if you can just take a moment to speak up, you’ll feel good, and we’ll all thank you.

Each lawyer has a lawyer
And they’re all hunting witches
Megyn’s no Diane Sawyer
White House full of snitches

Each lawyer’s lawyer’s lawyer
Reads their Lawfare daily
Lawyers’ lawyers’ lawyers’ brawlers
Get ready for the melee

When a lawyer’s lawyer’s lawyer
Memoranding through the rye
Meets a lawyer’s lawyer’s lawyer,
May a lawyer testify?

How many lawyers’ lawyers
Can file a meta-brief?
And how many judges’ judges
Confer injunctive relief?

Jews call on one true Judge.
(Be they a Mother or Father.)
But even heaven needs a hedge.
God should get God a lawyer.

Plums-farmers-market-seemingleeI have taken
the insurance
that covered
your children

with which
you were probably

Forgive me
I think suffering
is so sweet
and so cold