The Rubix Cube

It was 110 in DC and humid on the day that I left.  As I stood in line outside to check my luggage, I felt as though I were on the border of life and death.  I would have passed out if the thickness of the air hadn’t been holding me up.  

Inside, the airport was packed.  The majority of terminals where I was waiting were also waiting for planes to Dallas.  It was so hot out that the planes were not able to take off with full passenger loads, leaving many, including some of my friends from training who had left for the airport over an hour before I had, struggling to get standby on flights.  My plane luckily boarded me but needed to make an emergency landing in Nashville for fuel.  Delayed taking off and delayed again in Tennessee when a leak in the hydraulics was discovered, I was starting to accept that I would probably be spending the night in the Dallas airport.  

In Dallas, I was booked on standby for a full flight.  I remained hopeful until I saw an entire high school boarding.  There was no way I would make it on this flight.

Somehow, I made it.  I was the last person allowed to board.  I breathed a sigh of relief as I sat down next to an attractive young man about my age deftly flipping the colors of a rubix cube into disarray then back to solids and again into checkered patterns.

You just have to know the algorithms.  he said.  I don’t even look at the cube anymore, you just know it in your fingers.

He was going to a naval academy in Annapolis, MD.  Both his parents were musicians and he grew up on the road.  His friends were shocked when he announced that he was joining the military after growing up in a family of musicians.  He did it for the travel, the education, and to serve his country.

I watched him play with the rubix cube some more.  Making order out of chaos then watching the colors spin out of control again with a few quick turns.

It’s hardest at the end.  You get so close to what you need it to be, then you have to mess it up almost completely to fix it.

I think that its the same in life.  Sometimes you just have to give into chaos, let it overtake you in order to restructure yourself and come out finding more meaning and order in your surroundings than ever before.  As I begin my career, part of me wonders what I am doing by completely uprooting myself and finding work in a place that may as well be a foreign country compared to Boston.  I just have to find the algorithm.

The Accident

Some of the people you meet on the road are really amazing.  I want to tell the story of one woman I met.

She is a White Mountain Apache woman living in Wisconsin/Minnesota.  She seems so motherly and gives off warmth and protection.  Her dark eyes under blond eyebrows show that her mind is whirling and part of her is off in some other world, she seems to be seeing something else, beyond what I am able to see around me.  She is difficult to follow because she seems to be lost in another realm and speaks almost painfully slowly and quietly. 

I sat with her at dinner and she was talking about her work and getting commissioned.

She mentions she was in a terrible motorcycle accident 2 summers ago.  She was biking with friends, some of whom had children serving overseas, and they were going to a memorial site to mourn those lost.  Her front tire lost 25 lbs of pressure rapidly, her cycle began veering side to side and she went down in a ditch, smashing her head against the pavement.  


She was not wearing a helmet.  


She smashed her cheekbone, split open the side of her face and cracked her skull, suffered a brain hemorrhage.

She lay in the hospital about to die.  Surrounded by the surgeon and her family.  One of the tribal counsel members came.  He laid eagle feathers across her body and called her back from the dead.  He told her that it was not her time to die, the Chippewa tribe needed her.  He called on her to live.  He called on her to open her eyes.   She opened her eyes.

Her face bore no scars as she calmly recounted the story.  The tribe needed her.  She is getting commissioned.  She has a duty and mission to serve for her tribe and country.  

So you wear a helmet now, right? I asked wide-eyed

Her dark eyes under blond eye-brows stared back at me and she laughed.

Disparity and the American Dream

The highest attainable standard of health is one of the fundamental rights of every human being.

-WHO

I have come full circle.  I left Boston, arrived in California, drove to Gallup, and have now flown back to Maryland for training.

After an 10+ hour drive from Los Angeles to Gallup, I rushed to the grocery store before closing for essentials like diet Coke and toilet paper.  I gushed to the clerk about my excitement in moving to Gallup from Boston and I am ready for new adventures!

You won't have any adventures here.

I'm sorry, I misunderstood you, could you repeat?

I said, you won't have any adventures here.

Oh....

I think that has been the meanest thing anyone has said to me.

The week and a half spent in Gallup flew by, but as I boarded my flight to Washington-Reagan, I felt as if I had already been there for months.  My coworkers welcomed me with arms outstretched and my transition to work and new living has been relatively smooth.

I had hoped to sleep on the plane, my first flight was only an hour and I ended up in Dallas, walking around in a daze.  Just as I had settled into my seat, I had to get up again to let by a bulky man with dark slicked back hair, smooth skin, and a long braid.  His friend, who had leopard print dyed hair settled in to the window seat behind him.

"Excuse me, miss?" he asked the stewardess.

"Are animals allowed on the plane?" giving a nod to his friend and laughing as the stewardess tried to suppress a smile and shook her head.

We soon struck up a conversation on travel.  This man seemed to have been everywhere in Europe, the US, and central/south America.  I jotted down notes on places I needed to visit in the future as he announced that he had been receiving pilot lessons and had been giving talks to inner city kids about the high investment-returns on becoming a pilot.

You don't have to be a rocket scientist.  Some of the best people to be pilots are people who are creative, or people who are good a video-games.  You have to be able to multi-task, to get creative if something goes wrong.  But you don't need to be book smart.  


These kids, they don't want to work for something.  They want to make money quick.  The pimps and drug dealers, they become role models in the inner cities.  The kids see people like me or you with good jobs, but they don't see all the work and struggle we went through to get what we have.  They don't want to do the work.  They want the money quick.

I added that many inner city kids are less likely to be encouraged by their parents to do school work or go to school.  They end up so far behind that catching up becomes impossible.  Even community college may be out of reach for someone who never graduated from high school and barely made it through grade-school.

Inner city kids are also more likely to be raised by a single parent working multiple jobs.  As a result, the parent is unable to be at home enough to enforce school attendance.  Even if the parent recognizes the value of education, if they are always working and unable to be home, their ability to encourage school attendance is low.

An unexpected lesson on humility.

In the glare of the American dream lie inequality and disparity.  Poverty, lack of education, and poor health always seem to appear together.  

While theoretically a microbe should be just as able to infect one person as the next, Paul Farmer outlines in his book, "Infections and Inequalities" that while the first world designates funds for research into preventative medicine, the threat of bioterrorism, and getting patients the best and newest treatments, the global South struggles to provide treatment for curable or treatable diseases to its patients.  In 1990, only 8% of the world’s wealthiest fifth died of infectious disease, in comparison to 56% of the poorest fifth.  Poverty is directly related to increased susceptibility to infectious diseases in addition to worse outcomes.

In Tanzania, cancer, hypertension, hyperlipidemia, diabetes, and other chronic diseases are all present but are overshadowed by malaria, tuberculosis, HIV and other infectious diseases.  I saw the same infectious diseases, save malaria, present in the homeless population in Boston.  Although I do not have prevalence data, it is unreal to me that such high incidences of tuberculosis were present in a population living practically within my neighborhood while, to my knowledge, I know of no college friends who have been afflicted.

The poor are less likely to have access to proper sanitation facilities and more likely to live in cramped crowded spaces.  The poor are less likely to have a means to pay for health care, such as health insurance.  

In 2008, extra funding allowed Oregon to insure more of its residents.  90,000 Oregonians enrolled, far exceeding the amount of people that could be covered by the funding.  The result: a computer randomized Oregonians to receive or not receive a health plan.  Due to ethical reasons, this was the first experiment of its kind and showed that residents with insurance were more likely to access health care, have less medical debt (and more medical bills paid), and have better self-reported health.  There was no difference in emergency room visits.

Under looming threats of increasing cuts to Medicaid, the nation would likely be affected if less people are insured or as plan coverage worsens by decreased productivity and the possibility of increased strain on other assistance programs.  The Oregon study showed that medical debts are less likely to be paid by patients that do not have insurance, which would also place a strain on the budgets of hospitals and clinics.

Available treatment options are far from flawless.  While I highly admire scientists struggling to innovate panaceas and better methods for testing and treating patients, the real challenge in health care lies in distribution of resources ensuring that those in our communities, states and nation are not dying of preventable and curable diseases.

References:
Farmer P.  Infections and Inequalities: the modern plagues.  University of California Press 2001.


Allen H et al.  What the Oregon Health Study can tell us about expanding Medicaid.  Health Affairs 2010:29(8)1498-1506.


Finkelstein A et al.  The Oregon health insurance experiment: evidence from the first year.  National Bureau of Economic Research 2011.