Tuesday, December 1, 2009

Regarding Obama's speech in Eisenhower Hall

It was interesting to see the expressions on the faces of the cadets listening to their commander-in-chief explaining our plans for Afghanistan. The quote of Eisenhower echoed in Eisenhower Hall: "Each proposal must be weighed in the light of a broader consideration: the need to maintain balance in and among national programs."

I wonder how hard cadets at West Point weigh broader considerations. Eisenhower maintained a low profile in Vietnam because he felt that was the practical scale of engagement in a war of attrition he realized was bound to last a great while. Perhaps that is the direction we are headed in Afghanistan. Limited engagement. Persistent, but at levels that are sustainable. But nothing black and white, and no commitments etched in stone.

There was an almost stony intellectualism in the President's speech. A very different commander-in-chief than we have seen is a while. The whole presentation boils down to this: We did not choose this war, so now we must fight to get into a position where we do choose the battles we will fight.

And John McCain vouched for much of the President's approach, with the exception of setting a target time for a draw down. A loyal opposition with a caveat. Senator McCain is very valuable ally to the President on Afghanistan, albeit an incomplete endorsement. An honorable extension of good faith at a time when our republic is replete with partisan bickering at each and every turn. Would Senator Obama have extended the same gesture if President McCain was speaking this evening? Tonight I feel grateful to have Senator McCain supporting with passion the cerebral approach of a President that is deliberate to a degree that might be seen as lacking temerity to those unfamiliar with the complexity of Afghanistan. McCain is very much a soldier who simply seeks to put the mission first without considering all the other factors that a President must to keep our country the preeminent leader of both force and freedom.

Friday, November 20, 2009

A mariner never drowns

A mariner never drowns
but only returns to the surf
from which he sprang.

The waves are calling me today
on a late October day
when the winds whip the sound
into a gauntlet of breakers
battering the indifferent shore.
Waters like this will take you down
and return you so bloated
only your sweater will prove
whose corpse has washed ashore.

The sea birds have gone inland
but I remain to listen
as the wind and waves
speak my name
and welcome me
like a yearning lover
who misses my touch
and lives to breath beside me.
How can I refuse her?
I wade up to my ankles and feel sand rush
from beneath my soles.
The undertow will take me
If I wade in above my knees.

Thursday, November 19, 2009

The Undecided

Without consensus
without confidence
a conflict continues to burn low but steady
while a hesitant will continues to tarry.

Will fate be left to chance?
What deserves swift action
when so much can and will go wrong?
I am no merchant of chance.
Should I roll the dice with my life bet on it?
Perhaps it is safer to sit pat, and not tempt fate.
Cowardice has its place in a dangerous world.
Who but a fool wanders into the breach
for no reason at all.

At the same time,
the ground beneath me is not terra firma.
Every storm washes away more ground
exposing roots that no longer hold back eroding soil.
The atmosphere is ripe with turbulence
undermining the shore at ever chance.
This is no place to build a home.
The waves threaten to swamp
the foundation dug too low for this terrain.

Time to move to higher ground?
I will have to consider it.

Monday, October 19, 2009

Wishing for peace

When the leaves fall
The scent of decay
somehow smells sweet.
Yesterday's leaves are today's litter.
Cast away is most of a year's new growth.
Thousands of leaves come and go
to let the tree grow a single ring.
A tree does not recall leaves that fall
after pre-winter breezes tear them away.

But I am not so stoic as a tree.
I recall everything that was a part of me
long after it is torn asunder.
Even those that last but a short season
live within me forever,
making me human.
Even if they torture me with their passing,
these memories make me whole.
If I remember less each day
Somewhere inside a ring is disappearing.
This year was a good growing season.
A thick ring added around my core.
I will not soon forget
those that made it grow
even though they have now long left.

Wednesday, September 9, 2009

A Common Farewell

When all is said and done, the greatest failure is the loss of a friend.
Someone you cared for, someone you liked.
Gone, just passed on like a ghost, never again materializing,
but there to haunt you with the question, "Why?"
There's no certainty, sometimes, just a sinking suspicion that
things are out of whack.
Someone reliable starts getting flaky.
Someone friendly grows distant.
That is as great to me as a loss of love.
Unwritten on a tombstone,
not mentioned in our eulogies,
but nevertheless they are the cores of our lives.
Some we know for years, others for months, others for less.
What will happen when our worlds cease to collide?
Sadder because nothing can replace you.
Gladder because someone else can try.

Monday, July 27, 2009

When flu flies over the coop

There is a risk, with a reemergence of a new strain of flu, that the weaknesses in how we provide health care in the United States will be exposed to the breaking point. While the CBO does not consider the short term value of preventing illness through providing universal preventive and primary care, the CBO and everyone familiar with an overburdened emergency department understands how costly it is to everyone, patients, hospitals, insurers, and the insured, when people without access to a primary care physician become ill and require emergency care. The price this year for not already having these measures in place could be tremendous.
The H1N1(2009-A) virus has characteristics that indicate a propensity for the lower respiratory tract, or the lungs. Accounts from Australia suggest that artificial ventilation is often required when the disease progresses beyond its early stages. Countering this concerning news is the rapid development of vaccines and the success had in treating this disease with anti-virals that are already in large scale production. Unfortunately for the U.S., versus most other industrially developed nations, tens of millions of our citizens will not have a provider to see to get a vaccination before being infected or treatment with anti-virals within the first forty-eight hours of initial symptoms. For those who do not get better with rest and fluids, intensive care will be common to an extent not seen in our lifetime. A shortage of ventilators could leave people dying in hospitals across the nation. Use of ventilators will cost hospitals dearly, and these costs will be passed along to the rest of us. With all due respect to the CBO, it is obvious to almost all close to the issue that preventive and primary care provided to all will save a great deal in terms of finances and lives.
I sometimes wonder how bad it has to get before the status quo in health care will be fundamentally reworked. This fall, the emergence of this new flu will give us another chance to compare our system to our peers in Canada, Europe, Japan and elsewhere. We will see, if we care to look, how well we stack up when our emergency departments fill up and there are no more vents available to keep people alive. What Churchill would call an “Era of Consequences” appears to be coming over the horizon. This time the costs may be too great to continue doing business as usual.

Monday, June 22, 2009

Underneath it all

Living in a small town makes me appreciate riding a subway in a big city.
A walk down Main Street in my hometown usually results in a random encounter with an acquaintance. Normally that is a welcome occasion; generally speaking, I enjoy meeting someone I know. Kind of like a surprise party, but without all the wrapping between you and the present.

This almost never happens on the subway. In the big city you trade in familiar faces for complete anonymity. And it is liberating. There is no one else there to remind you of who you were, so who you are is up to you. And sometimes that is just what you need. A break from the past just long enough to let you live in the moment. Sitting on a platform in Queens, after a full night of drinking and a half night of sleep; that is when an early morning flock of pigeons can be heard between trains. And your soul takes flight with them. You have no one to answer to, and no one to listen to. A rare chance to listen to the sound of your own wings flapping in the stillness and unencumbered backdrop of a city of millions completely unconcerned with where you are going or where you have been, but still willing to offer good directions if you decide to move from where you are.

Wednesday, May 6, 2009

Murder on Broad Street, Middletown

A Wesleyan junior was murdered on the street where my daughter goes to school.
How often have we seen a single impulsive act born of anger bring lifetimes of suffering? There is a sickness in our culture that turns heart-sick men into monsters.My daughter's school walked by this place on the way to the Y minutes before this happened. My wife was called to pick her up at the Y when the return route was blocked by a police perimeter. She was told a bad crime had taken place, and she asked "Was something stolen?" When she was told no,she asked "Was someone killed?" How will this eight-year-old feel next week when she walks past this place? And when she is eighteen, I will worry for her safety at the hands of some young man too blind with passion to know what it is to truly love a woman.
Somehow we must teach our young men the horror and destruction that will follow should they lose faith in the goodness of life in the face of emotional pain from life's many disappointments. We need to build circuit breakers into their thought process so that they never choose to destroy what they can not possess. That is the difference between seeing a woman as an object of desire and truly caring for her.

Wednesday, February 4, 2009

Mid Winter's Dream

There is something incredibly soothing about snow falling on a busy day. Cars slow, and the world pauses to watch a new coat of white paint dry. Familiar landmarks are subdued as a dreamscape descends and buries not just the surface, but thoughts of the day, as well.
I do not think the the same way when I am watching the snow fill the air and cover the ground. It is as though the old world has come to an end, blanketed by a fine linen sheet drawn gently across the face of a recently expired patient. For a while time is frozen by the relentless piling of powder.
Old songs on the radio play like new. Worries and memories disappear in the face of the ancient threat of wind and cold tamed by a car heater set on hi. Driving through the cloud of flakes, the traffic proceeds slowly, carefully, red lights blazing a trail to the horizon until they disappear into a point. Brake lights call out in warning of ice on the road ahead.. The danger claims me from the cloud and I grip the wheel tight, ready to turn away from whatever might hurl itself in my way. Once past the frozen bridge the tail lights line up two y two and march into infinity bliss. My ride has cut a ribbon through heaven, but it closes behind me as soon as I pass. My ride is almost over, and with it a dream of oblivion to end a busy day.

Monday, January 19, 2009

Healthcare Nation - To be or not to be.

In these times when even our most dependable institutions are challenged to their breaking point, it is important to appreciate that it is the commitment of a community to provide for its members that is the bedrock of a society. Institutions come and go and are replaced with new ones as humanity tries and tries again to create systems and structures to achieve a defining mission.

All of these collective efforts include an identifiable membership with roles essential to the success of the mission. The roles played by various members change as an institution is forced to adapt to changing circumstances. An organization where roles are rigidly defined often neglects important feedback and fail to change with the times. Sometimes when a system is under stress it fails to fulfill the mission and contracts, decreasing the membership it benefits. Other times it is a change in the membership that forces a change in the system. More mouths to feed challenge nations and families, alike, to extend themselves to meet basic commitments. Priorities change. Values assert themselves at the expense of other values. A rising tide lifts all boats, except when it is a sea of red ink.

Returning to the theme that a society is defined the commitments it fulfills for its members; our nation’s identity is not just a matter of who we are, although that is a question that is the subject of great debate. Our nation is also defined by what it is we do for one another.

Other nations provide affordable healthcare to its members. In the United States today there co-exist two nations: one whose members have access to healthcare, and one whose members do not. The border between these two separate nations is not well guarded. With every pink-slip families slip across the porous border between Healthcare Nation and Healthcare-Not Nation. This is a border I wish our leaders would strive to secure. So long as we accept a sub-nation of people lacking access to healthcare there is going to be a risk that their numbers will swell, as their domain encompasses more and more Americans.

Lincoln spoke of how a house divided against itself will not stand. We must let our leaders know that we will not stand for our nation to endure the fate of a divided people.

John Kilian, RN