Politics is Applesauce

applesauce

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Politics is applesauce.
~Will Rogers
Our transparent apple trees are heavily burdened with fruit this year, to the point of breaking branches crashing to the ground with the weight. There have been plenty of windfalls, just perfect for making applesauce.

The transparent apple variety has a short window between fruit too green and sour before  becoming too soft and mealy.  With the hot weather, these thin-skinned apples will start to crack and turn to mush right on the tree without even letting go first.  So the time for applesauce is now, this week, ready or not.

Applesauce-making is one of my more satisfying domestic activities.  Peeling and coring apples is tedious, there are always a few bad spots to cut out, and there is the occasional wiggling worm to dispose of before cooking.  They make a tart sauce and need no sugar;  with all the careful preparation before the cooking, the result is smooth to the tongue and a lovely creamy light color, with all blemishes removed, extra unwanted wormy protein deposited in the compost bucket along with mountains of peel, cores and seeds.

Would that I could similarly pare out, peel off, dispose in the compost all the political opinions flooding my real and virtual mailboxes, the robo-calls coming into our unlisted phone number, the radio, TV and internet ads that burden us all until we crack and break under the weight.  Actually most of this year’s election fruit is already rotting on the tree, turning us all to mush in the process.  I’m weary just thinking about the millions, no billions, of dollars spent in advertising that could be used for far greater good and benefit for the citizenry.

The interminable process of selecting a president and members of Congress, as well as a governor and controversial initiatives can be so vile and mean-spirited that the whole kettle of sauce is spoiled.   I could cook it all day long and there still will be worms waving in the air, rotten cores festering, scabby peels floating on top, the bottom scalding with the heat of the cook stove.  How does a reasonable person decide what is best for the country when nothing is transparent at all in what politicians say versus what they do versus what the media says they do?

And how palatable will the political flavors be when all is said and done?   I guess we’ll need to wait until November to know how the messy mush of politics will taste.

Thankfully I will have stored up plenty of the real stuff in the freezer so we can drown our misery in the creaminess of summer apples prepared and cooked to perfection: no blemishes, no scabs, no rot, and no worms waving back.

What a world.

applesauce

Plenty Messy and Mushy

Politics is applesauce.
~Will Rogers
Our transparent apple trees are heavily burdened with fruit this time of year, to the point of breaking branches crashing to the ground with the weight. There have been few windfalls.

There is a short span for this variety between fruit too green and sour becoming too mealy and mushy.  With the hot weather, the thin-skinned apples will start to crack and turn to mush right on the tree without even letting go first.  So the window for applesauce is now, this week, ready or not.

Applesauce-making is one of my more satisfying domestic activities.  Peeling and coring apples can be tedious, there are always a few bad spots to cut out, and though rare with the organic transparents, there is the occasional wiggling worm to dispose of before cooking.  They make a tart sauce, need no sugar;  but with all the careful preparation before the cooking, the result is smooth to the tongue and a lovely creamy light color, with all blemishes removed, extra unwanted wormy protein deposited in the compost bucket along with mountains of peel, cores and seeds.

Would that I could similarly pare out, peel off, dispose in the compost all the political flyers flooding our mailbox, the automated telephone voter polls coming into our “unlisted” number, the radio, TV and internet ads that burden us all until we crack and break under the weight.  Actually most of the election fruit is already rotting on the tree, turning us to mush in the process.  I’m weary just thinking about the millions of dollars spent in advertising candidates that could be used for far greater good and benefit for the citizenry.

The process of selecting a president and members of Congress, a governor and voting on controversial initiatives can be so vile and mean-spirited that the whole kettle of sauce is spoiled.   I could cook it all day long and there still will be worms waving in the air, rotten cores festering, scabby peels floating on top, the bottom scalding with the heat of the cook stove.  How does a reasonable person decide what is best for the country when nothing is transparent at all in what politicians say versus what they do?

And how palatable will the political flavors be when all is said and done?   I guess we’ll need to wait until November to know how the messy mush of elections will taste.

Thankfully I will have stored up plenty of the real stuff in the freezer so we can drown our misery in the creaminess of summer apples prepared and cooked to perfection: no blemishes, no scabs, no rot, and no worms waving back.

What a world.

Learning the Hard Way

photo by Nate Gibson

“There are three kinds of men. The ones that learn by reading. The few who learn by observation.  The rest of them have to pee on the electric fence for themselves.”
— Will Rogers

photo by Nate Gibson

Learning is a universal human experience from the moment we take our first breath.  It is never finished until the last breath is given up.  With a lifetime of learning, eventually we should get it right.

But we don’t.  We tend to learn the hard way when it comes to our health.

As physicians we “see one, do one, teach one.”   That kind of approach doesn’t always go so well for the patient.   As patients, we like to eat, drink, and live how we wish,  which also doesn’t go so well for the patient.  You’d think we’d know better, but as fallible human beings, we sometimes impulsively make decisions about our health without using our heads (is it evidence-based?) or even listening to our hearts (is this what I really must have right at this moment?).

The cows and horses on our farm need to touch an electric fence only once when reaching for greener grass on the other side.  That moment provides a sufficient learning curve for them to make an important decision.  They won’t try testing it again no matter how alluring the world appears on the other side.   Human beings should learn as quickly as animals but don’t always.  I know all too well what a shock feels like and I want to avoid repeating that experience.  Even so, in unguarded careless moments of feeling invulnerable (it can’t happen to me!), and yearning to have what I don’t necessarily need,   I may find myself touching a hot fence even though I know better.   I suspect I’m not alone in my surprise when I’m jolted back to reality.

Many great minds have worked out various theories of effective learning, but, great mind or not,  Will Rogers confirms a common sense suspicion: a painful or scary experience can be a powerful teacher and,  as health care providers, we need to know when to use the momentum of this kind of bolt out of the blue.  As clinicians, we call it “a teachable moment.”  It could be a DUI, an abused spouse finally walking out, an unexpected unwanted positive pregnancy test,  or a diagnosis of a sexually transmitted infection in a “monogamous” relationship.  Such moments make up any primary care physician’s clinic day, creating many opportunities for us to teach while the patient is open to absorb what we say.

Patient health education is about how decisions made today affect health and well being now and into the future.  Physicians know how futile many of our prevention education efforts are.  We hand out reams of health ed pamphlets, show endless loops of video messages in our waiting rooms, have attractive web sites and interactivity on social media, send out innumerable invitations to on-site wellness classes.  Yet until that patient is hit over the head and impacted directly– the elevated lab value, the abnormality on an imaging study, the rising blood pressure, the BMI topping 30, a family member facing a life threatening illness– that patient’s “head”  knowledge may not translate to actual motivation to change and do things differently.

Tobacco use is an example of how little impact well documented and unquestioned scientific facts have on behavioral change.   The change is more likely to happen when the patient finds it too uncomfortable to continue to do what they are doing–cigarettes get priced out of reach, no smoking is allowed at work or public places, becoming socially isolated because of being avoided by others due to ashtray breath and smelling like a chimney (i.e. “Grandma stinks so I don’t want her to kiss me any more”).  That’s when the motivation to change potentially overcomes the rewards of continuing the behavior.

Health care providers and the systems they work within need to find ways to create incentives to make it “easy” to choose healthier behaviors–increasing insurance premium rebates for maintaining healthy weight or non-smoking status, encouraging free preventive screening that significantly impacts quality and length of life, emphasizing positive change with a flood of encouraging words.

When there is discomfort inflicted by unhealthy lifestyle choices, that misery should not be glossed over by the physician– not avoided, dismissed or forgotten.  It needs emphasis that is gently emphatic yet compassionate– using words that say “I know you can do better and now you know too.  How can I help you turn this around?”

Sometimes both physicians and patients learn the hard way.  We need to come along aside one another to help absorb the shock.