On hydroxychloroquine, expertise, and the power of persuasion.

On hydroxychloroquine, expertise, and the power of persuasion.

Recently, a friend who works in the ER wrote to ask me about hydroxychloroquine.

Yes, I know. I was shocked, too. But my friend was sincere. Although most reputable news outlets have publicized that hydroxychloroquine doesn’t work against Covid-19, my friend read an article from Harvey Risch in Newsweek that seemed really compelling.

Risch has impeccable credentials – he’s an M.D. Ph.D. and a professor of epidemiology at Yale’s School of Public Health. And a lot of what he wrote for his July 23rd article is quite sensible:

Why has hydroxychloroquine been disregarded?

First, as all know, the medication has become highly politicized. For many, it is viewed as a marker of political identity, on both sides of the political spectrum. Nobody needs me to remind them that this is not how medicine should proceed.

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Medical data isn’t perfect, and confirmation bias is very real. So there’s a chance that medical doctors really could hoodwink themselves into discounting a helpful medication, the same way that so many medical doctors get suckered into overprescribing drugs after pharmaceutical companies bribe them with gifts. Yup, medical doctors are human, too.

I know that I’m so dismayed by our current president that I’m inclined to distrust hydroxychloroquine just because he says the drug is great.

So it was a shock for me to read Risch’s article. He wrote that there was data showing that hydroxychloroquine, when used in a combination therapy early during a high-risk person’s Covid-19 infection, could dramatically reduce the risk of serious complications. If more people took hydroxychloroquine, he wrote, fewer would die.

Risch acknowledges that hydroxychloroquine is dangerous – it might kill 1 out of each 10,000 people who take it – but Covid-19 is obviously dangerous, too – it kills 3 out of each 1,000 people who contract it:

In the future, I believe this misbegotten episode regarding hydroxychloroquine will be studied by sociologists of medicine as a classic example of how extra-scientific factors overrode clear-cut medical evidence.

But for now, reality demands a clear, scientific eye of the evidence and where it points. For the sake of high-risk patients, for the same of our parents and grandparents, for the sake of the unemployed, for our economy and for our polity, especially those disproportionately affected, we must start treating immediately.

Those are strong words. And, really, the Newsweek article felt persuasive to me. And so I looked up Risch’s research in the American Journal of Epidemiology, hoping to see the actual data in support of his claims.

I’m lucky, that way. I’m a scientist, so I don’t have to trust the words of a supposed expert. I’m an expert. I get to look at the data.

The data are much less compelling than Risch’s words.

Risch discusses the results of an uncontrolled study by Vladimir Zelenko, a medical doctor in Monroe, New York: “For example, among Connecticut cases 60 years of age or older, at present the mortality is 20%. Thus it would be ballpark to estimate that some 20% of the 1466 treated high-risk patients in the Zelenko cohort would have died without outpatient hydroxychloroquine plus antibiotic.

This is an egregiously inaccurate statement. The high death rate cited – 20 – is for older patients who test positive for Covid-19 and have such severe symptoms that they need to be hospitalized.

As described in the short statement released by Zelenko, he treated 405 people who visited his office complaining of mild cough, fever, headache, sore throat, or diarrhea. His patients were not given a Covid-19 test. Presumably, many were never infected with Covid-19.

It is not a surprise to see that a 60-year-old patient who takes hydroxychloroquine after developing a sore throat from seasonal allergies is less likely to die than a 60-year-old patient who is diagnosed with Covid-19 in the hospital.

Of Zelenko’s 405 patients, at least two 2 died. This is lower than the expected 1% mortality rate of high-risk patients who contract Covid-19. But this set of 405 patients included low-risk patients experiencing shortness of breath and high-risk patients experiencing mild headache, many of whom never had Covid-19.

Zelenko’s report is two pages long and written in extremely lucid prose. Risch either totally misread it, which is galling, or intentionally mis-described it, which is worse.

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So, why was Zelenko giving people hydroxychloroquine in the first place?

Well, I’d heard that an in vitro study – which means “inside a test tube or petri dish, not a person” – showed that hydroxychloroquine reduced Covid-19 viral replication. But I hadn’t read the original paper. So I looked it up.

It should have taken me less than a minute to find this paper. Unfortunately, people have been pretty sloppy with their references. I get it. Covid-19 is scary, and it’s urgent, so people are publishing faster than usual.

I assumed that I could pull up almost any paper on hydroxychloroquine and Covid-19 and quickly find the citation for the original study. Indeed, most purport to be citing it. But in this, the citation that ought to have pointed to that study instead sent me to a paper on the differentiation of lung stem cells, and in this, the relevant citation incorrectly points to a paper on the drug lopinavir.

Ugh. I mean, these bungled citations aren’t that big a deal for me, personally – just means I had to give up on piggybacking and instead search Pubmed. But it undermines trust when you can’t get the little things right.

Anyway, the earliest reference that I found was from Liu et al., their study “Hydroxychloroquine, a less toxic derivative of chloroquine, is effective at inhibiting SARS-CoV-2 infection in vitro.” And, yes, I’ll admit – I thought about putting in the wrong link just to mess with you. But, if I did that, would you still trust me about the rest of this?

Liu et al. used Vero cells – a cell line derived from a kidney cancer in African green monkeys – and for Figure 1, they measured both how much hydroxychloroquine it takes to kill cells (about 200 micromolar is a cytotoxic dose) and how much hydroxychloroquine it takes to inhibit viral infection (about a 10 micromolar dose).

Okay. To me, that’s already sounding a little spooky. The bigger the difference between an effective dose and a lethal dose, the safer you are.

That’s why a bunch of hippies died after The Teachings of Don Juan was published. That book touted jimsomweed as a psychedelic. Indeed, the plant contains a high concentration of scopolamine, which can give people nightmarish visions of flying. It’s a powerful hallucinogen. But the effective dose is quite close to the lethal dose – when curious kids try to get high off it, they’re flirting with death.

Everyone’s body is a little different from everyone else’s. Maybe a dose that’s safe for you would kill me. The odds of disaster are worse when the effective dose and lethal dose are similar.

So, Liu et al. saw cytotoxicity kick in at around 100 micromolar hydroxychloroquine, getting pretty high by 200 micromolar. And for their visual assay of viral infection, they bathed their Vero cells in 50 micromolar hydroxychloroquine.

To block viral entry, they were coming pretty close to just killing these cells with the drug.

And the problem is even worse inside a human body. You take a drug and it gets into your bloodstream. It’ll reach some concentration there. This is the concentration that matters most for toxicity.

But the drug will only be effective against Covid-19 when it reaches your lungs. When Marzolini et al. used mass spectrometry to measure how much of hydroxychloroquine was actually getting from a patient’s blood to their lungs, they found that it wasn’t at a high enough concentration to reproduce any effects seen in vitro.

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Indeed, a randomized clinical study showed that hydroxychloroquine fails as a post-exposure prophylaxis. The drug was given to people who were worried about exposure because they’d spent time with someone who tested positive for Covid-19. The drug didn’t help – these people contracted the infection at the same rate as people who were given a placebo.

A randomized clinical study also showed that hydroxychloroquine fails as a cure. People who visited a hospital and tested positive for Covid-19 but had mild symptoms were given the drug. Their disease was just as likely to progress as people who received a placebo.

Hydroxychloroquine doesn’t work, and it’s toxic.

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I was left wondering: why would Risch write these things? Why would he write that article for Newsweek? He’s clearly intelligent, and, from the tone of his writing, I feel confident that he wants to help people.

He might even believe wholeheartedly in the conclusion he’s presenting.

That’s generally true among scientists. Confirmation bias is insidious.

That paper from the team at Harvard? They did some modeling and argued that, if Covid-19 is seasonal, we will save most lives by periodically shutting down. But their model left out the waning immunity that would cause Covid-19 to be seasonal! Whoops. That’s why they reached the wrong conclusion.

Or the recent New York Times editorial from Iwasaki and Medzhitov, both professors of immunobiology at Yale, reassuring readers that they won’t get Covid-19 twice. Well, that’s not correct.

Some antigens confer immunity that lasts about as long as our lives. Most don’t. Influenza immunity lasts months, not years. The paper that Iwasaki and Medzhitov cited in their article, a study in which people were intentionally infected with a less dangerous coronavirus, found that immunity to that virus lasted months, not years.

Covid-19 immunity will not last forever. The relevant question isn’t whether you can be infected again, it’s how soon you can be re-infected. With the data we have so far, it’s reasonable to expect that the answer will be measured in months, not years.

There’s some good news – the second time you contract Covid-19, it’ll probably be less severe than the first. In addition to antibodies, your immune system has “T cell memory” to help you fight off subsequent infections. But, as is also described in the paper cited by Iwasaki and Medzhitov, even people who felt fine were shedding virus again the second time they were infected.

During the second infection, the research subjects were shedding viral particles for a shorter period of time. But, especially with Covid-19 – a virus that can be transmitted simply by talking – a person who sheds virus for a short time while feeling fine is probably more likely to transmit the disease than somebody who sheds virus for a whole week while feeling like garbage.

The person who feels like garbage will stay home. The person who feels fine won’t.

Still, though, I was left wondering – what underlying beliefs would sway Risch enough that he’d make these blunders?

Eventually, I decided to lump his motivation in with mine. Maybe that’s fair, maybe it’s not. Really, I have no idea what he was thinking, so this is just my best guess.

But I imagine that many of these people – Risch, Iwasaki, Medzhitov, John Ioannidis, David Katz, all of whom are very smart, and all of whom mean well – understand that the strategies we’re using against Covid-19 are both ineffectual and are causing harm.

No shutdown will eliminate Covid-19 – the best we can do is to delay it. And we can delay it only as long as we maintain the shutdown. Maybe that seems fine if you’re an older, wealthy person brimming with optimism about vaccine development, like Anthony Fauci who thinks we’ll have a working vaccine early next year, but it’s unconscionable if you think a working vaccine might be five or more years away.

I don’t think we should try to pause children’s development for five years.

Still, there’s no mathematical or logical way to prove what we should do. School closures definitely slow the spread of Covid-19. How do you balance the good of delaying an elderly person’s infection by three months (which is equivalent to a drug that extends a patient’s life by three months) with the harms we’re causing?

I know what I’d do, but other people have different priorities than me. And that’s okay!

I’d like to think, though, that I’m not trying to hoodwink anybody about the science in order to deceptively get them to do the thing I think is right.

Like, yes, I think schools should be open. I think we owe it to children. Right now, children are suffering, but this is our fault, the fault of grown-ups.

We have known for over a decade that we ought to make coronavirus vaccines – we didn’t devote enough resources to it, and now we don’t have one. We’ve known for decades that eating animals – both those sold in meat markets like in Wuhan and the ones raised in “concentrated animal feeding operations” throughout the U.S. – will create more zoogenic diseases, and we kept doing it. We know that a guaranteed basic income would’ve given people the resources they needed to self-isolate during an epidemic – we don’t have one. We know that guaranteed access to health care would keep our death rate down.

Climate change will make pandemics more frequent, in addition to making our world unliveable for future generations. And we haven’t taken action to stop it.

None of these failings are children’s fault. We, older people, have failed. We fucked up. And now we’re asking children to make sacrifices to dampen the impact of our mistake (although, again, it won’t work – it’ll just delay the eventual repercussions).

I think today’s children deserve a fair shot at a good life, and I think that school is an essential part of that.

But don’t let anybody try to convince you that it’s safe to re-open schools because hydroxychloroquine will stop Covid-19.

On fire and ash.

On fire and ash.

The phoenix falls into fire, burns, and dies. Then rises again, reborn.

The phoenix triumphs over adversity. Life gets hard, excruciatingly hard. Everything falls to shit. But the phoenix rises again.

Or so we hope.

Sometimes, the fire burns too hot. And then the phoenix dies and stays dead. Sometimes ash isn’t a phoenix egg.

Sometimes ash is only ash.

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Here’s a poem by my friend Satish:

COULD I BE

Satish Brown

a peacock, so vibrant

& bright, but vulnerable

for lack of flight, a

turkey that flutters

searching for height.

A dove that flies so

high, so pure & clean.

I’m none of these.

Just searching for a

balance – in between.

Maybe a phoenix, mystical,

reborn from fire &

ashes.

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Satish wrote this poem while he was living inside the dormitory on the ground floor of the Monroe County Jail. This is an awful little space. It’s about the size of my living room. Twelve men lived there. They slept on bunk beds. The fluorescent lights were turned off only from midnight until four a.m. The single window, a tiny rectangle of wire-reinforced glass inside the steel door, faced the subterranean booking desk – no glimpse of the outdoors. There were two steel tables bolted to the floor, and each table had six steel stools curving out from beneath it, like a pair of silver-skinned twice-amputated octopuses where the men could sit to eat their meals.

The jail dorm shared a wall with soft booking – “the drunk tank.” Much of the time, someone with mental health issues would be in there, hollering. If someone in the tank decides to stand there rhythmically kicking the steel door, the noise resounds through your skull like the repeated cocking of a shotgun inside your brain. All thoughts disappear but hate. At least, that was my experience, and I never spent more than two hours at a time inside that space.

Satish was there for months.

But he stayed chipper. It was always a pleasure to go in there with a stack of poems and have the chance to talk with him. On his good days, his enthusiasm was infectious, leaning in close to ask questions or banter about religion, his huge eyes gleaming like polished fishbowls.

The saddest poem he wrote was about cheating on his girlfriend with an old man – “old man” is slang for heroin.

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The other men in the dorm loved having him around. In such a small space, where people are going through the worst time of their lives and yet are expected to endure the constant presence of a roomful of other men who’re also going through the worst time of their lives, emotions fray easily. Twice when I came in there, my buddy Max had ugly blue bruises covering his face.

“We had a little disagreement,” Max would tell me. And he’d mention the name of somebody who’d been in the dorm the week before, but had since been moved to a different block.

But nobody had trouble with Satish.

Nobody except the judge.

Max told me, “Judge ______ gave him this deal, Satish was on this drug court thing, and she was going to pretend to care. She said, ‘write me a letter, write me a letter and convince me why I should go easy on you.’ But if she’s going to go easy, why would she need that letter? So Satish wrote this letter, he basically wrote to her, ‘Fuck you, just do what you’re going to do.’ “

The thing is, we all thought he would walk. The case, as far as I knew it, was pretty weak. He had come home, he’d lost his keys, and he was high. He thought he could sleep it off, go look for his keys in the morning, and so he tried to get in through the window.

Except he picked the wrong window. He was climbing in the neighbors’, and they freaked and called the police. The cops came. By then they figured out who he was, everybody was confused, but mistakes happen. Mistakes happen more when people are on drugs, but, regardless, mistakes happen.

The neighbors didn’t want to press charges. They weren’t going to cooperate with a case.

In the United States, prosecutors have a lot of leeway, though. Doesn’t matter what the police report says, doesn’t matter what the witnesses say, the prosecutor gets to decide what charges to file. They get to pile charges on as leverage for plea bargaining. They don’t have to justify which people get dog piled and which people walk free.

The prosecutor’s decisions are yet another place in our criminal justice system where racial injustice creeps in. Perhaps it’s worth mentioning that, in the eyes of the state, Satish was Black.

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So, a phoenix. Maybe they’d send him away. But he could overcome adversity.

Well.

We thought he would walk. We expected that he’d go to court, then get sent home for time served.

Instead, they gave him seven years.

He was shipped off to the “Reception & Diagnostics Center.” This is where they do psychological evaluations, figure out which prison you’ll be sent to. While at reception & diagnostics, nobody can get a hold of you.

He’d been there two days when his girlfriend – mother of his two children, pregnant with their third – overdosed and died. She’d been clean a while. But after something like that – you think he’s coming out, instead they give him seven years – it’s easy to relapse.

Heroin killed her. But the courts killed her too.

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He took it hard.

We volleyed letters for a while – he’d send me folded bundles, six or seven sheets that he’d written over the course of a week, and he stamped the envelopes low to dodge the postmark – but he always said that it was hard to find time to write. He was doing as many programs as he could, trying to get level-headed, trying to get out. Most programs will give you a time cut.

They’d given him seven years, but he was out after another two. Lots of guys have tried to explain the math of criminal justice time to me; I have never understood.

Max said, “He was in a pretty good place, at first. I mean, he had a handle on it, what’d happened with Chelsea, everything that happened. But when he started using …”

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He was trying to rise. Twenty-nine, and rebuilding his life.

But sometimes the fire burns too hot. Sometimes it burns and burns and the ash stops being an egg. Sometimes ash is only ash.

Rest in peace, Satish.

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.

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Header image from Badeeh Abla on flickr.

On empathy and the color red.

On empathy and the color red.

I can’t fly.

I try to feed my children every night, but I never vomit blood into their mouths.

When I try to hang upside down – like from monkey bars at a playground – I have to clench my muscles, and pretty soon I get dizzy. I couldn’t spend a whole day like that.

And, yes, sometimes I shout. Too often during the pandemic, I’ve shouted at my kids. But when I shout, I’m trying to make them stop hitting each other – I’m not trying to figure out where they are.

It’s pretty clear that I’m not a bat.

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Photograph by Anne Brooke, USFWS

Because I haven’t had these experiences, philosopher Thomas Nagel would argue that I can’t know how it feels to be a bat.

In so far as I can imagine [flitting through the dark, catching moths in my mouth], it tells me only what it would be like for me to behave as a bat behaves.

But that is not the question. I want to know what it is like for a bat to be a bat.

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Perhaps I can’t know what it feels like for a bat to be a bat. And yet, I can empathize with a bat. I can imagine how it might feel to be trapped in a small room while a gamboling, wiry-limbed orc-thing tried to swat me with a broom.

It would be terrifying!

And that act of imagination – of empathy – is enough for me to want to protect bats’ habitats. To make space for them in our world. Sure, you could argue that bats are helpful for us – they’re pollinators, they eat pesky bugs – but empathy lets us care about the well-being of bats for their own sake.

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Literature exercises our minds: when we read, invent, and share stories, we build our capacity for empathy, becoming more generally aware of the world outside our own skulls.

Writing can be a radical act of love. Especially when we write from a perspective that differs from our own. The poet Ai said that “Whoever wants to speak in my poems is allowed to speak, regardless of sex, race, creed, or color.” Her poems often unfurl from the perspective of violent men, and yet she treats her protagonists with respect and kindness. Ai gives them more than they deserve: “I don’t know if I embrace them, but I love them.

Ai

That capacity for love, for empathy, will let us save the world. Although many of us haven’t personally experienced a lifetime of racist microaggressions or conflict with systemic oppression, we all need to understand how rotten it would feel. We need to understand that the pervasive stress seeps into a person’s bones, causing all manner of health problems. We need understand the urgency of building a world where all children feel safe.

And if we don’t understand – yet – maybe we need to read more.

Experiments suggest that reading any engaging literary fiction boosts our ability to empathize with others. Practice makes better: get outside your head for a while, it’ll be easier to do it again next time.

Of course, we’ll still need to make an effort to learn what others are going through. Thomas Nagel was able to ruminate so extensively about what it would feel like to live as a bat because we’ve learned about echolocation, about their feeding habits, about their family lives. If we want to be effective anti-racists, we need to learn about Black experiences in addition to developing our empathy more generally.

Luckily, there’s great literature with protagonists facing these struggles – maybe you could try How We Fight for Our Lives, Americanah, or The Sellout.

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As a bookish White person, it’s easy for me to empathize with the experiences of other bookish White people. In Search of Lost Time doesn’t tax my brain. Nor does White Noise. The characters in these books are a lot like me.

The cognitive distance between me and the protagonists of Americanah is bigger. Which is sad in and of itself – as high schoolers, these characters were playful, bookish, and trusting, no different from my friends or me. But then they were forced to endure hard times that I was sufficiently privileged to avoid. And so when I read about their lives, perched as I was atop my mountain of privilege, it was painful to watch Ifemelu and Obinze develop their self-protective emotional carapaces, armoring themselves against the injustice that ceaselessly buffets them.

Another reader might nod and think, I’ve been there. I had to exercise my imagination.

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In Being a Beast, Charles Foster describes his attempts to understand the lives of other animals. He spent time mimicking their behaviors – crawling naked across the dirt, eating worms, sleeping in an earthen burrow. He wanted a badger’s-eye view of the world.

Foster concluded that his project was a failure – other animals’ lives are just so different from ours.

And yet, as a direct consequence of his attempt at understanding, Foster changed his life. He began treating other animals with more kindness and respect. To me, this makes his project a success.

White people might never understand exactly how it feels to be Black in America. I’m sure I don’t. But we can all change the way we live. We can, for instance, resolve to spend more money on Black communities, and spend it on more services than just policing.

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Empathy is working when it forces us to act. After all, what we do matters more than what we purport to think.

It’s interesting to speculate what it would feel like to share another’s thoughts – in Robert Jackson Bennett’s Shorefall, the protagonists find a way to temporarily join minds. This overwhelming rush of empathy and love transforms them: “Every human being should feel obliged to try this once.

In the real world, we might never know exactly how the world feels to someone else. But Nagel wants to prove, with words, that he has understood another’s experience.

One might try, for example, to develop concepts that could be used to explain to a person blind from birth what it was like to see. One would reach a blank wall eventually, but it should be possible to devise a method of expressing in objective terms much more than we can at present, and with much greater precision.

The loose intermodal analogies – for example, “Red is like the sound of a trumpet” – which crop up in discussions of this subject are of little use. That should be clear to anyone who has both heard a trumpet and seen red.

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We associate red with many of our strongest emotions: anger, violence, love.

And we could tell many different “just so” stories to explain why we have these associations.

Like:

Red is an angry color because people’s faces flush red when they’re mad. Red blood flows when we’re hurt, or when we hurt another.

Or:

Red represents love because a red glow spreads over our partners’ necks and chests and earlobes as we kiss and caress and fumble together.

Or:

Red is mysterious because a red hue fills the sky at dawn and dusk, the liminal hours when we are closest to the spirit world.

These are all emergent associations – they’re unrelated to the original evolutionary incentive that let us see red. Each contributes to how we see red now, but none explains the underlying why.

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We humans are blue-green-red trichromatic – we can distinguish thousands of colors, but our brains do this by comparing the relative intensities of just three.

And we use the phrase “color blind” to describe the people and other animals who can’t distinguish red from green. But all humans are color blind – there are colors we can’t see. To us, a warm body looks identical to a cold wax replica. But their colors are different, as any bullfrog could tell you.

Photograph by Tim Mosenfelder, Getty Images

Our eyes lack the receptors – cone cells with a particular fold of opsin – that could distinguish infrared light from other wavelengths. We mistakenly assume these two singers have the same color skin.

When we look at flowers, we often fail to see the beautiful patterns that decorate their petals. These decorations are obvious to any bee, but we’re oblivious. Again, we’re missing the type of cone cells that would let us see. To fully appreciate flowers, we’d need receptors that distinguish ultraviolet light from blue.

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Most humans can see the color red because we’re descended from fruit eaters. To our bellies, a red berry is very different from a green berry. And so, over many generations, our ancestors who could see the difference were able to gather more nutritious berries than their neighbors. Because they had genes that let them see red, they were better able to survive, have children, and keep their children fed.

The genes for seeing red spread.

Now, several hundred thousand years later, this wavelength of light blares at us like a trumpet. Even though the our ancestors learned to cook food with fire, and switched from fruit gathering to hunting, and then built big grocery stores where the bright flashes of color are just advertisements for a new type of high-fructose-corn-syrup-flavored cereal, red still blares at us.

Once upon a time, we really needed to see ripe fruit. The color red became striking to us, wherever we saw it. And so we invented new associations – rage, or love – even though these are totally unrelated to the evolutionary pressures that gave us our red vision.

Similarly, empathy wasn’t “supposed” to let us build a better world. Evolution doesn’t care about fairness.

And yet. Even though I might never know exactly how it feels when you see the color red, I can still care how you’re treated. Maybe that’s enough.

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Header image: a greater short-nosed fruit bat, photograph by Anton 17.

On money, nursing home care, and Covid-19.

In April, I wrote several essays and articles about our collective response to Covid-19.

I was worried – and am still worried, honestly – that we weren’t making the best choices.

It’s hard not to feel cynical about the reasons why we’ve failed. For instance, our president seems more concerned about minimizing the visibility of disaster than addressing the disaster itself. We didn’t respond until this virus had spread for months, and even now our response has become politicized.

Also, the best plans now would include a stratified response based on risk factor. Much more than seasonal influenza, the risk of serious complications from Covid-19 increases with age. Because we didn’t act until the virus was widespread, eighty-year-olds should be receiving very different recommendations from forty- and fifty-year-olds.

Our national response is being led by an eighty-year-old physician, though, and he might be biased against imposing exceptional burdens on members of his own generation (even when their lives are at stake) and may be less sensitive to the harms that his recommendations have caused younger people.

I’m aware that this sounds prejudiced against older folks. That’s not my intent.

I care about saving lives.

Indeed, throughout April, I was arguing that our limited Covid-19 PCR testing capacity shouldn’t be used at hospitals. These tests were providing useful epidemiological data, but in most cases the results weren’t relevant for treatment. The best therapies for Covid-19 are supportive care – anti-inflammatories, inhalers, rest – delivered as early as possible, before a patient has begun to struggle for breath and further damage their lungs. Medical doctors provided this same care whether a Covid-19 test came back positive or negative.

(Or, they should have. Many patients were simply sent home and told to come back if they felt short of breath. Because they didn’t receive treatment early enough, some of these patients then died.)

Instead, our limited testing capacity should have been used at nursing homes. We should have been testing everyone before they went through the doors of a nursing home, because people in nursing homes are the most vulnerable to this virus.

I realize that it’s an imposition to make people get tested before going in, either for care or to work – even with real-time reverse-transcription PCR, you have to wait about two hours to see the results. But the inconvenience seems worthwhile, because it would save lives.

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From March 25 until May 10 – at the same time that I was arguing that our limited Covid-19 tests be used at nursing homes instead of hospitals – the state of New York had a policy stating that nursing homes were prohibited from testing people for Covid-19.

I really dislike the phrase “asymptomatic transmission” – it’s both confusing and inaccurate, because viral shedding is itself a symptom – but we knew early on that Covid-19 could be spread by people who felt fine. That’s why we should have been using PCR tests before letting people into nursing homes.

But in New York, nursing homes were “prohibited from requiring a hospitalized resident who is determined medically stable to be tested for COVID-19 prior to admission or readmission.

This policy caused huge numbers of deaths.

Not only do nursing homes have the highest concentration of vulnerable people, they also have far fewer resources than hospitals with which to keep people safe. Nursing home budgets are smaller. Hallways are narrower. Air circulation is worse. The workers lack protective gear and training in sterile procedure. Nursing home workers are horrendously underpaid.

The low wages of nursing home workers aren’t just unethical, they’re dangerous. A recent study found that higher pay for nursing home workers led to significantly better health outcomes for residents.

This study’s result as described in the New York Times – “if every county increased its minimum wage by 10 percent, there could be 15,000 fewer deaths in nursing homes each year” – is obviously false. But even though the math doesn’t work out, raising the minimum wage is the right thing to do.

If we raised the minimum wage, we probably would have a few years in which fewer people died in nursing homes. But then we’d see just as many deaths.

Humans can’t live forever. With our current quality of care, maybe nursing home residents die at an average age of 85. If we raise the minimum wage, we’ll get better care, and then nursing home residents might die at an average age of 87. After two years, we’d reach a new equilibrium and the death rate would be unchanged from before.

But the raw number here – how many people die each year – isn’t our biggest concern. We want people to be happy, and an increase in the minimum wage would improve lives: both nursing home residents and workers. Which I’m sure that study’s lead author, economist Kristina Ruffini, also believes. The only problem is that things like “happiness” or “quality of life” are hard to quantify.

Especially when you’re dealing with an opposition party that argues that collective action can never improve the world, you have to focus on quantifiable data. Happiness is squishy. A death is unassailable.

Indeed, that’s partly why we’ve gotten our response to Covid-19 wrong. Some things are harder to measure than others. It’s easy to track the number of deaths caused by Covid-19. (Or at least, it should be – our president is still understating the numbers.)

It’s much harder to track the lives lost to fear, to domestic violence, and to despair (no link for this one – suddenly Fox News cares about “deaths of despair,” only because they dislike the shutdown even more than they dislike poor people).  It’s hard to put a number on the value of 60 million young people’s education.

But we can’t discount the parts of our lives that are hard to measure – often, they’re the most important.

On money: Health care, police officers, and social services.

On money: Health care, police officers, and social services.

Last week, my kids and I visited my father in Indianapolis. We went to a playground near his apartment.

Playgrounds had re-opened the day before, so my kids were super excited. They’d gone almost three months without climbing much. And the playground near my father’s apartment is excellent, with a variety of nets and terraces suspended from platforms near the canal.

When we arrived – at about eleven a.m. on an eighty-five degree day – we noticed a child sprawled face down in the shade at the other end of the playground, apparently asleep.

My own eldest child promptly started climbing toward the highest slide, which was going to be quite difficult for her. I followed her up, ready to provide encouragement whenever she felt too nervous, and to catch her if she slipped.

My four-year-old hopped onto a swing.

My father, temporarily free of supervisory duties, crossed the playground. In addition to us and the sleeping child, one other family was playing – a woman my age with a baby strapped to her chest and a four-year-old careening in front of her.

My father asked if the sleeping child had come with them. The woman shook her head. So my father asked a few more people, calling down to folks who were sitting on benches near the water.

Nobody knew who this child was.

My father knelt down and gently woke him, to ask if he was okay. My father is a medical doctor. Helping people is what he likes to do.

When roused, the child had a seizure. His body shook. His eyes went stark white, having rolled all the way to the side.

My father called 911.

But then, after about thirty seconds, the child’s seizure ended. And, unlike the fallout from a typical epileptic seizure, the child sat up immediately, alert and unconfused.

My father told the dispatcher that maybe things were fine – no need to send an ambulance – then hung up to talk to the child.

“Are you okay?” my father asked.

“Oh, that’s my sugar high,” the child said. “Some people get a sugar high from eating sugar, but I get that when I sleep. It happens a lot, just when I sleep.”

“I think you had a seizure.”

“Well, I just call that my sugar high.”

“Do you take any medications?” my father asked.

“Only a little, sometimes, for my ADHD.” And then the child started to climb up toward the high slide of the playground, near me.

A few moments later, a drone began to hover near us. I’m not fond of drones, mechanically whirring through the air. And I’ve never even had reason to feel traumatized! They must be so terrifying for people who’ve survived contemporary war zones, or who’ve been subject to drone-enhanced policing.

“What’s that noise?” my six-year-old asked.

“It’s a robot,” I said. “A flying robot. See, over there. Sometimes they put cameras in them.”

“It’s called a drone,” the formerly sleeping child clarified. “I used to work with drones. I’m an inventor. But that person should be careful. That drone is over the water, and when drones crash into the water they can short circuit and catch fire.”

“You like drones?” I asked.

“I like to build stuff. Some drones you can control with your mind, like telekinesis, with a strap …”

“Oh, like an electroencephalogram?” I asked. “We played a game at a museum once, you wear a headband and try to think a ping-pong ball across the table.”

“You can make a drone fly that way, too. But those are tricky because if you laugh they crash.”

“You wouldn’t want to laugh while it was over the water!” my six-year-old exclaimed, giggling.

“You wouldn’t,” the child agreed, sagely. And then he turned to me to ask, “Say, do you know where the nearest McDonalds is? My dad wants me to get him something.”

I shook my head, apologizing. “We’re visiting my father, I don’t know where anything is around here. But you could try asking him.”

When asked, my father shook his head, too. His apartment is in a rather fancy part of of Indianapolis, it seems. “I don’t know of one … I don’t think I’ve seen a McDonalds around here.”

“Well, that’s okay, I’ll get something at a gas station instead. Thanks!”

And with that, the child jogged away. I never even learned his name.

My father walked over to me. “I’m worried about him,” he said. “That was a tonic-clonic seizure! I don’t know how he came out of that feeling lucid. I mean, he’s obviously a bright kid, but …”

“It didn’t look like he had a phone with him,” I said. “I don’t know, suddenly needing food … I’d guess schizophrenia, but that’d be really strange for an eight-year-old.”

“I know,” my father said. “But something’s wrong.”

On that, we definitely agreed. A lot of somethings might be wrong if a third grader is napping at a city playground on his own.

And I didn’t help him.

In retrospect, I’m still not sure what I should have done.

When my father thought the child was experiencing an acute medical emergency, he called 911. But then he canceled the request when the problem seemed chronic, not urgent. The arrival of an ambulance probably would’ve caused more harm than good, because a trip to the ER is often followed by egregious bills.

A few weeks ago, my spouse woke up with blurry vision. This might be nothing serious, or it might be the sign of a detached retina, so we drove her to the ER. After two hours of waiting, a doctor spent three minutes with her, visually examining my spouse’s eye while shining a light on it.

Thankfully, nothing was wrong.

We received a bill for $1,600. After requesting an itemized bill, they split the charges into a $200 ER fee and $1,400 for “ED LEVEL 3 REGIONAL.”

To diagnose a child who’d just emerged from an atypical seizure, they might levy poverty-inducing charges, which is why my father canceled with the dispatcher. He volunteers at the free clinic because he knows how many people are priced out of access to health care in our country.

But, if not a hospital, who could we call for help?

Currently, there’s a big push to defund the police. In many cities, the budget for policing is so large, and the budget for other public services so small, that police officers are de facto social workers. Which doesn’t make anybody happy.

In a recent New York Times conversation, Vanita Gupta said, “When I did investigations for the Justice Department, I would hear police officers say: ‘I didn’t sign up to the police force to be a social worker. I don’t have that training.’

Police officers are tasked with responding to mental health crises, despite receiving little training in psychology, counseling, or even de-escalation. Police officers use their budget to combat the downstream effects of poverty – which often includes theft, vandalism, and domestic violence – without a commensurate amount being spent on addressing the poverty itself. Police budgets dwarf the amounts spent on jobs programs and public work projects.

Many police officers join the force because they want to help people. They’re motivated by the same altruism that inspired my father to practice medicine. But just as hospital billing, as a system, undermines the altruism of individual doctors (“In this seminar, we’re going to train you to optimize billing. If you perform diagnostics on a third organ system, we elevate patient care to the preferred reimbursement tier.”), American policing, as a system, exacerbates racial injustice and inequality.

Even a charming, well-spoken, eight-year-old Black child has good reason to fear the police. I don’t think any good would have come from us calling the cops.

And so I’m left wondering – what would it be like if we did have an agency to call? What if, instead of police officers with guns, we had social workers, counselors, and therapists patrolling our streets?

Maybe then it would have been easy to help this child.

As is, I did nothing.

. .

Feature image: photograph of sidewalk chalk by Ted Eytan, Washington D.C.

On hubris and climate change.

On hubris and climate change.

Recently, a local science teacher sent me an essay written by a climate change skeptic.

Well, okay. I figured that I could skim the essay, look over the data, and briefly explain what the author’s errors were. After all, it’s really important to help teachers understand this topic, because they’re training our next generation of citizens.

And I thought to myself, how hard can this be? After all, I’m a scientist. I felt unconcerned that I’ve never read research papers about climate science before, and that it’s been years since I’ve worked through the sort of differential equations you need for even basic fluid mechanics calculations, and that I’ve never run any simulations on oceanic heat transfer or glacier melting.

#

Since then, I’ve read a fair bit about climate science. I’ll be honest: I didn’t go through the math. All I did was read the papers and look over the processed data.

This is lazy, I know. I’m sorry. But my kids are at home. At the moment, this is the best I’ve got.

#

Prominent climate change skeptic Richard Lindzen, an emeritus professor of meteorology, recently delivered a lecture to the Global Warming Policy Foundation. I wholeheartedly agreed with Lindzen when he stressed that the science behind climate change is really, really complicated.

Former senator and Secretary of State John F. Kerry is typical when he stated, with reference to greenhouse warming, ‘I know sometimes I can remember from when I was in high school and college, some aspects of chemistry or physics can be tough. But this is not tough. This is simple. Kids at the earliest age can understand this.’

As you have seen, the greenhouse effect is not all that simple. Only remarkably brilliant kids would understand it. Given Kerry’s subsequent description of climate and its underlying physics, it was clear that he was not up to the task.

#

Climate science is tricky. In a moment, I’ll try to explain why it’s so tricky.

When people make predictions about what’s going to happen if the average global temperature rises by half a degree – or one degree, or two – their predictions are probably incorrect.

My assumption that I could skim through somebody’s essay and breezily explain away the errors was incredibly arrogant. I was a fool, I tell you! A fool!

But my arrogance pales in comparison to the hubris of climate change skeptics. Once I started learning about climate science, I realized how maddeningly difficult it is.

Lindzen, who should know better, has instead made brash claims:

So there you have it. An implausible conjecture backed by false evidence and repeated incessantly has become politically correct ‘knowledge,’ and is used to promote the overturn of industrial civilization. What we will be leaving our grandchildren is not a planet damaged by industrial progress, but a record of unfathomable silliness as well as a landscape degraded by rusting wind farms and decaying solar panel arrays.

There is at least one positive aspect to the present situation. None of the proposed policies will have much impact on greenhouse gases. Thus we will continue to benefit from the one thing that can be clearly attributed to elevated carbon dioxide: namely, its effective role as a plant fertilizer, and reducer of the drought vulnerability of plants.

Meanwhile, the IPCC is claiming that we need to prevent another 0.5ºC of warming, although the 1ºC that has occurred so far has been accompanied by the greatest increase in human welfare in history.

#

So. What aspects of climate science can we understand, and what’s too hard?

Let’s start with the easy stuff. Our planet gets energy from the sun. The sun is a giant ball of thermonuclear fire, spewing electromagnetic radiation. When these photons reach Earth, they’re relatively high energy – with wavelengths mostly in the visible spectrum – and they’re all traveling in the same direction.

What we do – “we” here referring to all the inhabitants of our planet, including the rocks and plants and other animals and us – is absorb a small number of well-organized, high-energy photons, and then release a larger number of ill-organized, low-energy photons. This is favorable according to the Second Law of Thermodynamics. We’re making chaos.

And here’s the greenhouse effect: if the high-energy photons from the sun can pass through our atmosphere, but then the low-energy photons that we release get absorbed, we (as a planet) will retain more of the sun’s energy. Our planet heats up.

Easy!

And, in defense of former senator John Kerry, this is something that a kid can understand. My children are four and six, and this summer we’re going to build a solar oven out of a pane of glass and a cardboard box. (After all, we need stuff to do while all the camps are closed.)

If we fill our air with more carbon dioxide, which lets the sun’s high-energy photons in but then won’t let our low-energy photons out, the planet should heat up, right? What’s the hard part?

Well, the problem – the reason why climate science is too difficult for humans to predict, even with the most powerful computers at our command – is that there are many feedback loops involved.

Some of these are “negative feedback loops” – although atmospheric carbon dioxide causes us to absorb more energy from the sun, various mechanisms can buffer us from a rise in temperature. For example, warm air can hold more water vapor, leading to more cloud formation, which will reflect more sunlight back into space. If the sun’s high-energy photons can’t reach us, the warming stops.

And some are “positive feedback loops” – as we absorb extra energy from the sun, which causes the planet to heat up a little, various mechanisms can cause us to absorb even more energy in the future, and then the planet will heat up a lot. This may be what happened on Venus. The planet Venus may have been habitable, a long long time ago, but then runaway climate change led to the formation of a thick layer of smog, and now it’s broiling, with sulfuric acid drizzling from the sky.

On Earth, an example of a positive feedback loop would be the melting of polar ice caps. As polar ice melts, it reflects less light, so our planet absorbs more of the sun’s energy. Heat made the ice melt in the first place, but then, once the ice has melted, we heat up even more.

And it turns out that there are a huge number of different positive and negative feedback loops. After all, our planet is really big!

For instance, the essay I was sent included graphs of ice core data suggesting that, in the ancient past, changes in average global temperatures may have preceded changes in the concentration of atmospheric carbon dioxide.

Frank Brown Cloud holding demo ice core.
Holding a demo ice core like my spouse uses in her classroom. The real ones drilled from glaciers are several miles long! I haven’t spent enough time at the gym to lift those.

But this is just another feedback loop. In the past, there was no mechanism for carbon dioxide to pour into our atmosphere before temperatures rose – dinosaurs didn’t invent internal combustion engines. This is the first time on Earth when carbon dioxide levels could rise before temperatures, and we don’t know yet what the effect will be.

Extra carbon dioxide will probably cause an increase in temperature, but a planet’s climate is really complicated. We have huge quantities of poorly mixed water (otherwise known as oceans). Our topography is jagged, interspersed with valleys and mountains. There are huge forests (only some of which are on fire). The air is turbulent.

We might find that temperatures are buffered more than we thought. The ocean might act like a giant heat sink.

Or then again, the ocean might warm up, accelerate polar ice loss by lapping at the undersides of glaciers, and magnify the changes.

The mathematics underlying fluid mechanics and heat transfer within an enormous, inhomogeneous system are so complex that it’s almost impossible to say. Nobody knows how much detail you’d need to put into a simulation to get accurate results – all we know for sure is that we can’t simulate the world with as much detail as actually exists. All our models are approximations. Some of them contradict each other.

With my admittedly limited understanding, I don’t think anybody knows enough to assert with confidence whether our climate will exhibit either buffered or switch-like behavior. Maybe we can muck about without hurting much. Or we might bring about our own doom with a tiny mistake.

#

Our planet’s climate is so complex that you could make a similar argument – we really don’t know whether we’re going to be buffered from future changes, or whether we’re at the precipice of doom – no matter what evidence we obtain.

Maybe sea levels start rising – well, perhaps that will somehow reduce the further heating of our planet. Maybe we get more horrible tropical storms – well, perhaps they’re linked to a greater density of sunlight-reflecting clouds.

Maybe things seem to be changing fast for a little while, but then we enter another stable state.

Or, insidiously, maybe it will seem like we’re in a well-buffered system – pumping large amounts of carbon dioxide and methane into the atmosphere without seeing much harm – until, suddenly, we tip over the edge. We often see that sort of behavior from positive feedback loops. Nothing seems to happen, for a while, then everything changes at once. That’s how cooperative binding of oxygen to hemoglobin works in your body.

Another problem is that climate change will probably happen on a very different rhythm from our lives. Weather happens on timescales that we can understand. A decade of droughts. Two years of tropical storms. A few hard winters, or hot summers. But climate happens over hundreds or thousands of years. Most of the time, it changes more slowly than we’d notice.

A two degree shift in average global temperatures, spread out over a few decades? That’s bad, but it’s boring. Which was the main focus of Jonathan Safran Foer’s We Are the Weather.

History not only makes a good story in retrospect; good stories become history. With regard to the fate of our planet – which is also the fate of our species – that is a profound problem. As the marine biologist and filmmaker Randy Olson put it, “Climate is quite possibly the most boring subject the science world has ever had to present to the public.”

Climate science doesn’t fit our culture. Especially not now, when the pressures of surveillance capitalism have forced even the New York Times to run like an advertising company. They earn more from news that gets clicks. Stories need to be sensational. Yes, they run stories about climate change. For these, the polar bears need to be dying, now, and there needs to be an evil villain like Exon lurking in the shadows.

Nobody wants to click on a story explaining that we, collectively, have made and are making a whole lot of small shabby decisions that will cause grizzly bears and polar bears to re-mix and de-speciate.

I got bored even typing that sentence.

#

Life is incredibly robust.

Our planet has swung through many extremes of temperature. At times, it’s been much hotter than it is now. At times, it was much colder. And life has marched on.

The human species is much less robust than life itself, though. Our kind has flourished for only a brief twinkling of time, during which our climate has been quite stable and mild. A small change could drive us to extinction. An even smaller change could cause our nations to collapse.

Disrupt our food supply – which could happen with just a few years of bad weather, let alone climate change – and there will be war.

#

So. I tried to learn about climate change, focusing on the work of skeptics. And in the end, I partly agreed with the skeptics:

I agree that climate science is too complicated for anyone to understand.

I appreciate that people are trying. I had fun learning about ice cores, atmospheric modeling, energy absorption, and the like. Well, sometimes I was having fun. I also gave myself several headaches along the way. But also, my kids were being wild. They’ve been home from school for three months now! I was probably on the precipice of headaches before I even began.

Here’s where I disagree with the skeptics, though: given that climate science is too complicated for us to understand – and given that we know that small changes in average temperature can make the world a much worse place to live – why would be blithely continue to perturb our climate in an unprecedented way?

Maybe things will be fine. Yay buffers! Or maybe we’ll reduce the carrying capacity of the planet Earth from a few billion humans to a few million, dooming most of our kind.

I know, I know – eventually our universe will dwindle into heat death, so our species is terminal anyway. We will go extinct. It’s guaranteed.

I still think it would be neat if our great-great-grandchilden were out there among the stars. At least for a little while.

Or even, if they stay here on Earth, it’s nice to imagine them living on a comfortable planet with lots of beautiful trees, and interesting animals to see.

#

Also, I’m biased.

After all, what are the things that you’re supposed to do if you want to reduce your carbon emissions?

Eat fewer animal products. Live in a smaller home. Drive less. Fly less. Buy less stuff.

Those are all things that I’d recommend to most Americans, for ethical and philosophical reasons, even if we weren’t concerned about climate change. So for me, personally, I don’t need to see much proof that we’ll ruin our climate unless we do these things. I think we should be doing them anyway.

Instead, I think the burden of proof should fall to the people hawking Big Macs. I’d want them to show that a world full of CAFO-raised cows won’t cause climate change, won’t propagate antibiotic resistant bacteria, won’t condemn billions of conscious beings to a torturous existence.

The world is complex. We’re going to err.

I’d rather err on the side of kindness.

On hostage situations and jail.

On hostage situations and jail.

My family recently visited a state park for some hiking. I know that we are quite privileged to be able to do it, but visiting nature is really restorative right now.

At the end of the day, we sat near a firepit and roasted vegan marshmallows.

After a few minutes, a woman and her partner asked if they could join us. They sat on the other side of the fire, and we got to talking.

The woman used to work in special education, but now she teaches geography and world religions. She loves her work, because she helps students in her small Midwestern town realize how much possibility there is in our world.

Her partner works for the Department of Corrections as a hostage negotiator.

“In training, you feel like you’re doing the same things over and over. Like, hasn’t there been enough of this already? But then, when you have to use it, you hardly have to think about it, you know just what to do. All that repetition really pays off.”

#

A few months earlier, several of the guys in our jail poetry class were talking about the drills they’ve been in.

“It was the scariest thing of my entire life. I knew it was just a drill, too. It was fucking terrifying. All these SWAT guys running in, screaming, they’ve got paintball guns, Get on the ground!, yelling, If you fucking move your ass is grass!”

“You’re lying there, face on the ground, can’t move, they might ziptie your hands behind your back, you can’t move for hours. I mean, I was lying there, just watching this puddle of piss spreading from the guy next to me. I fucking hated that guy right then. But he tried to hold it, I know he did. They had us lying there so long.”

“You tell a guard, I have to piss, he’s going to say, too fucking bad.

“You’re lying there smelling shit, because you know some guy shit himself.”

“You’re smelling shit like right away. They come in yelling like that, some guys shit themselves from fear.”

“I know! I’m that guy. I was so fucking scared.”

“Your on the ground, lying on your stomach on the ground, I mean, the ground is gross, right? You’re lying there with your face on the floor and your neck hurts and you want to like turn your neck, but you got this guy yelling, You so much as fucking move, your ass is grass. Like, it’s pathetic, but it hurts.

“Walked through this indoor rec later, paintball splatters all over the place. Like, fuck, what happened in here? Some guy in there, they must’ve lit him up.”

“I been through some rough shit in prison, but this one time, it was a piss-ant county jail, I was in the drill there. That was the worst. Like, there were only fifty guys in that place, what’s the big deal? But they came in there, boom, they fucking pepper sprayed us. For a drill.”

“I’ve watched guys die. But that shit, that’s the most scared I’ve ever been.”

I asked one of the guys, Jason, if he’d write about it.

“That’s something people should read,” I told him.

He shook his head.

“I’m trying to write, like, uplifting stuff. Help guys get on a better track, do better than what I done. This stuff … I don’t know. I don’t even really like talking about it. I don’t want to think about it enough to write it down.”

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Header image: cropped photograph of a Val Verde county (Texas) drill from the Laughlin Airforce Base. Most of the time, cameras aren’t allowed inside jails or prisons.

On gambling.

On gambling.

At about eleven a.m. on my birthday, I buckled the kids into the car to drive to our local print shop. Taking the kids with me for a fifteen minute errand seemed like a good gift for my spouse: she’d have some time in our house alone, which is rare to come by right now.

The print shop is just across the street from the (currently closed) services center for people experiencing homelessness, just down the street from the services center for people recently released from incarceration, a few blocks from the hospital. There’s a popular bus stop on the sidewalk out front. Across the street, a truck rental company has a large, mostly empty parking lot.

Large crowds of people have been hanging out near the print shop. Day and night.

I pulled into a shaded parking spot. We had the windows down. “I’ll just be a minute, can you sit in the car?” I asked.

The kids nodded, not looking up. A friend recently gave us a stack of Ranger Rick magazines, and we’ve been doling them out gradually for car rides.

I had my wallet in my pocket with a twenty and a ten, and we’d already been sent the bill for our print order. $20.49 for a stack of postcards to send to my spouse’s future AP biology students, explaining their summer assignment.

Normally she’d give kids a slip of paper with their assignment sometime during finals week, but this year had no finals. For many kids, no school.

But don’t worry. The assignment isn’t too bad. Students choose from a set of things like “fill an old sock with trash, bury it, then dig it up six weeks later” or “take a walk and look for things that match each of these different colors.”

I looked in the center console of the car for a pair of quarter. We keep them in a little pouch, ready to pay for parking. Haven’t been using them recently – the meters are still on, but there’d be nowhere to go after parking the car.

I thought it would be a nice gesture to pay in cash with exact change. The credit card company wouldn’t be taking a cut of the profits, and exact change would minimize the length of our transaction.

As I was zipping the pouch closed, a man ambled over. I’d guess he was a little over six feet tall, a little over two hundred pounds, with light brown skin, a buzzed head, and a bristly beard. He leaned down to the open passenger-side window and said something to me, but I couldn’t parse it – his words sounded mushy, thick with saliva.

“Hang on,” I said, “I’m hopping out of the car, let me come around.”

I walked around the back of the car, stopping a few feet away from him. He said the same thing again. I shrugged and shook my head. My brain takes a while to process spoken words, even under the best of circumstances. I can’t listen to audiobooks – whole chapters wash over me without any understanding. I can’t listen to podcasts – when people recommend them, I’ll search for a transcript, then read it and pretend that I too listened while riding an exercise bike or something.

By the fourth time he repeated himself, I understood him better. I think part of the problem was that he was speaking too quickly – almost everybody gets nervous when approaching a stranger.

I can relate. I doubt I’d ever be able to flirt with strangers in a bar.

“I like your hair,” he said. “I grew up in Gary, came down fifteen years ago for Indiana University, but I caught that bipolar. Just got out of the hospital, today’s my birthday, five twenty-six, and I just got out.

He still had a white plastic bracelet on his arm, which seemed to be printed with his name and age. He didn’t gesture to it or anything, which felt nice. As though the two of us would need no evidence to trust each other.

“Your birthday? How old are you?”

“Thirty-seven,” he said, without hesitation.

Indeed, the bracelet was printed with the number 37 in a fairly large font. But it seemed like this was a nice thing to ask.

“No shit,” I said, “thirty-seven. Same as me. Today’s my birthday, I just turned thirty-seven.”

“Naw, man, you’re shitting me.”

“It’s true.” I turned to the car, shouted to the kids, “Whose birthday is it today?”

The kids said something, but neither the man nor I could hear them. The crowd across the street was loud.

The man reached into his pocket, pulled out a jumble of stuff. Dice, some black beaded necklaces, a keychain, a tiny flashlight, nail clippers, a tube of toothpaste. He put the toothpaste back into his pocket.

“Don’t need this yet,” he mumbled.

“You got a toothbrush?” I asked. We actually have some spare ones in the car to give to people.

“Yeah,” he said, pulling out the green plastic handle of a toothbrush, “but I used that already. See these, my teeth so fucking white.”

He smiled for me and I nodded approvingly, murmuring that his teeth were indeed very white. A full smile. Several teeth were stained dark near the edges, but I’ve met lots of men with worse teeth than that.

“Hey, you paint your nails, too,” he said, noticing. “See this, look at this.” He reached out, his hands still full of stuff, to show me his fingers. They had tiny remnants of polish, pink on several but a pointer finger with a mix of red and black, just like I use on mine. My nails were barely even chipped, because I’d painted them the week before. I usually do them about once a month these days. Hard to find time for the little things since having kids.

“I got … here, how about this,” he said, handing me the nail clippers. “They good, they good ones, I haven’t even used them yet, they’re clean.”

As he spoke, spittle flew from his mouth. Luckily, I’m not much of a germophobe. Luckier still, I think I already had the disease that’s going around right now. Between a pair of kids in preschool, a spouse at the high school, and me teaching in jail, I catch most of the viruses that come through town.

I turned the clippers over in my hand. A large pair, space-age iridescent top glimmering in loops of purple and blue, big letters “Made in China” etched into the metal.

“They’re beautiful,” I said. “I like the look of that metal. But we’ve got so much stuff already. Meeting you, that’s present enough today.”

I handed the clippers back. As he took them, one of his dice tumbled from his hand. I bent down to pick it up, gave that back to him, too.

“You play craps?” he asked.

“Never have.”

“Hey, I’ll teach you. Come on, here, you gotta get a seven, eleven, don’t want snake eyes.” He bent down, blew on the dice, and rolled. A five and a six.

“Eleven, hey, that’s good,” he said. Then picked up the dice, blew on them again, and rolled. A two and a six.

“Eight. Now I got to roll an eight before I get a seven, see, that’s crap out.” And he rolled about four more times before he hit his seven.

“Now it’s your turn,” he said, and handed them to me.

I rolled, got a two and a four.

“That’s a six, that’s a hard one, got to roll a six again before you crap out.”

I rolled again, same two and a four. Maybe I didn’t shake the dice enough – they didn’t really tumble on the ground, they just sort of plopped down on the asphalt in front of me.

And I found myself thinking how strange it is that dice are a big thing for both the toughest and the wimpiest groups of people in town. Street people and folks in jail gamble with dice, and then there’s Dungeons & Dragons, fantasy buffs rolling 2d6 as they tell stories.

I’ve heard that Dungeons & Dragons is pretty big in some prisons, too. A few prisons have banned D&D or roleplaying books from being sent in – reputedly, people got killed over developments in their games. Somebody’s elf cleric was betrayed and a few days later guards found a body in the showers.

I don’t know how much truth there is to that. But, when people at those prisons ask for D&D books, I have to write an apology and send some fantasy novels instead.

I tried to give the dice back after rolling my second six, but he said I had to keep playing. “I got two, hey, you got to see where you go on this next roll.”

“Okay,” I said, “but then I got to pick up, my spouse is a high school teacher, she has this print order, some post cards to send to her students.” I gestured with my head toward the shop. And then I rolled.

An eight. Followed by a seven. I was done.

“Thanks for teaching me,” I said.

“And, hey, hey, I was thinking, for my birthday, you help me get something at Rally’s. I’m trying to get a pair of ice cones, for me and my girl.”

I gave a wan smile. Normally I don’t give money to people. It’s a tricky situation – people have things they need to buy, and even the chemical escape can seem necessary. My life is really good, and even I struggle with the sense of being trapped inside my head sometimes. And yet, I don’t really like the thought of my money being part of the whole cycle, keeping drugs in town. I’m even pro-drug, mostly, but meth and heroin typically do bad things to people’s lives.

A few days earlier, when I crossed paths with a friend from jail while my dog and I were out running, I’d asked if my friend was eating enough. He laughed at me and said, “Fuck, no!”

It’s true, I’m pretty bad at looking at people’s faces when I talk to them. When my friend started laughing, I finally met his eyes and realized how gaunt he looked.

“Is it a money problem, or …?”

“Oh, dude, don’t give me any money. I could eat, I think I can eat, I just don’t. You give me anything, I’d just spend it on meth.”

Instead of handing money to people on the street, we buy paper and pencils for folks in jail; we support our local food bank; we give time. Building human connection takes time, and there’s no shortcut.

Still, on my birthday, I was standing there in the print shop parking lot next to a man who’d just given me a present – nice nail clippers, even if I didn’t keep them. And we’d played craps. Maybe he’d won – I’m not sure what the rules are about draws. And I had a pair of quarters in my hand.

I’d hoped to have exact change. But I shrugged and gave him the quarters.

“Thanks, man,” he said, and I told him “Thanks for the game,” and walked over to ring the doorbell at the print shop, ready to pick up my order. The kids had been doing a great job of waiting patiently in the car.

On bias.

On bias.

At the beginning of our poetry class, back when the county jail was still admitting volunteers, two men read some poems they’d written together. 

The first was a love poem – the gist was that any relationship that could survive a partner’s incarceration could probably survive anything. 

The second was a poem about living in a trailer park:

If you’re looking for drugs – not just grass –

Depends where you look, you’ll pro’lly find glass

Pitbulls in the back

Nine times outta ten you’re already in a trap

As it happens, I already knew that one of the authors had a pack of five chihuahuas that road around town in his backpack.  After they finished reading, I mentioned the dogs.

The other guy answered: “Well, yeah, he has those chihuahuas, but I’ve got two pitpulls.”

After we finished talking about their poems, they had a question for me:

“Hey, so you’re a scientist, right?  Cause I heard there’s like this planet where diamonds rain from the sky.  Do you know anything about that?”

I said it sounded ridiculous.  I was imagining walking through a field and suddenly getting hit on the head by a diamond.  Like a really hard hailstone.

Whenever hail falls, my children dart outside to eat ice.  But a fallen diamond would break your teeth.  Doesn’t melt in your mouth or your hand!

During class, we spent a while talking about how diamonds form.  Under extremely high pressure, the hydrogen atoms in an organic molecule can be displaced by carbon-carbon bonds.  There are a few different shapes that work for a molecule made entirely of carbon.  You can have all the atoms in a flat sheet, which we call graphite.  The atoms can form spheres, which we can buckeyballs.  A length of graphite can wrap between the two round caps of a buckeyball.  Or you can have the atoms in a tetrahedral lattice – a diamond.

If you squeeze carbon atoms under really high pressure, you can turn any of the other shapes into diamonds.  Diamonds are the most stable form.  You can make diamonds just by compressing natural gas.

“This pencil, the part it writes with is graphite,” I said.  “If you were strong enough, you could squeeze it until it was a diamond.  But I don’t think they’d fall like rain.”

#

I was wrong.  I was biased about what planets should look like – I live on a small, rocky ball with a thin atmosphere, very different from the gas giants that broil like miniature stars – and biased, unfortunately, against the people who wind up in jail.  I study chemistry, I big expert!

Obviously, there are many occasions when the other people in class know things that I do not.  About poetry, chemistry, and physics.

#

Since 1981, computer models have shown that the extreme heat and pressure deep inside Neptune was likely to create diamonds.  If I’d ever taken an astronomy course – or had borrowed library books about our solar system when I was growing up, instead of reading the same book about Godzilla movies over and over – I could have known this, too.

The sky on Neptune is very different from the sky on Earth.  Our air hugs us with a pressure of about fifteen pounds per square inch.  Deep inside the clouds of Neptune, though, the air would squeeze you six million times tighter.  Needless to say, you’d be crushed.  Parts of you might compress into diamond. 

Temperature is a measure of how fast molecules are moving.  Hot air bumps into you more often than cold air, and each collision is a little harder.

Deep in the clouds of Neptune, the gravity is so strong that air molecules accelerate dangerously fast between every collision.  This means the air is really, really hot – thousands of degrees.  Any parts of you that weren’t being compressed into diamond would melt, or wisp away into the broiling clouds.

The high temperature means there’s plenty of energy available for chemical reactions, so molecules can adopt their most stable configurations even if there is a high “activation barrier.” 

An activation barrier is like a wall that separates a thing from what it wants.  Maybe you’d like to eat breakfast but dread the thought of leaving your warm bed – that’s an activation barrier, too.  We could make the activation barrier lower by yanking your blankets off, which makes your current circumstance worse.  Or we could increase your odds of overcoming the activation barrier by pumping you full of caffeine.  With more jittery energy, maybe you’d get up on your own. 

The second strategy – caffeine! – is roughly what happens when you raise the temperature of a chemical reaction.  Carbon is very stable once it becomes a diamond, but it’s difficult for methane to slough off the warm security of all those bonds to hydrogen atoms.

After methane on Neptune is compressed to form a diamond, the diamond will fall.  A diamond is more dense than the air around it.  But the diamond won’t hit the ground like hail, because there’s no ground beneath the hot dense sky of Neptune.  Instead the rocky core seems to be covered by a superheated ocean – well above its boiling point, but still not evaporating because the liquid is kept in place by dense clouds.  Roughly the same way an Instant Pot uses high pressure to cook food in superheated water.

When the diamonds splash into this ocean, they melt.

#

In class that day, I hadn’t yet researched Neptune’s atmosphere. I was mostly scribbling crude schematics of crystal structures. I explained how to read a phase diagram.  We talked about diamond mining and the technology used to create synthetics.

I claimed, incorrectly, that diamonds weren’t likely to fall from the sky.

One of the guys shook his head.

“I mean, yeah, that sounds all smart and all, but I swear I heard this thing about diamond rain.  Can you look it up before next week?”

The guys in jail can pay to use iPads – at a rate of five or ten cents per minute – but they have very limited access to the Internet.  There’s one un-blocked application with some scientific lectures, but that’s very different from being allowed to learn what you want.

So I agreed.  It sounded ridiculous to me, but I jotted “SKY DIAMONDS?” and promised to do some research.

#

The next week, I was ready to deliver my big mea culpa.  But when I got there, we were missing one of the guys who’d been invested in our discussion.  I asked about him.

“Yeah, he’s not coming back,” said the guy sitting next to me.  “Somebody said he was a cho-mo.”

“Oh,” I said, grimacing.  “He went to seg?”

“Yeah,” said the guy, nodding. We left unsaid that this man probably got the shit kicked out of him first.  If somebody convincingly claims that you’re locked up on a child molestation case, bad things happen.  In prison, you might get murdered by a gang looking to bolster their reputation – because child molesters have such a toxic reputation, there are less likely to be reprisals.  And even a county jail can be a violent place.

After the first fight, the guy who got beaten up will usually choose to go to seg.  Segregation, or solitary confinement, is known to cause permanent brain damage – people suffer from depression, anxiety, and hallucinations.  But staying in a cell block with thirty people who want to kick the shit out of you is likely to lead to brain damage, too.

Solitary confinement might be the less bad of two terrible options.

Despite his bias, the guy I was talking to offered a little sympathy.

“It’s rough,” he said.  “But them’s the politics of the place.”

On grammar in Latin and English.

On grammar in Latin and English.

I spent most of my time during high school doodling in notebooks – during an entire year of biology, the only thing I learned was that the word for several fish of a single type is “fish,” but the word for several fish of different species is “fishes.” 

For dissections – earthworms, giant crickets, pig hearts, and frogs – we were partnered with whomever sat at the table with us.  My partner always brought the newspaper and ostentatiously checked stock prices during class.  The kid in front of me spent a few weeks reading A Confederacy of Dunces. 

My eyesight wasn’t good enough to read over her shoulder.

At least the distinction between fish and fishes turned out to be correct.  My statistics teacher was a baseball coach – he didn’t know calculus, so the only explanation he gave for the workings of a Gaussian distribution was that the numbers were printed on a chart. 

The baseball team had a winning record, though. 

Even in English class, my brain was filled with junk.  We were taught not to split infinitives or end sentences with prepositions.  These are sensible rules in Latin.  An infinitive – like “to read” – is a single word in Latin, so it would be quite strange to put another word in the middle.  Latin also has strict rules about word order — a sentence would be garbled if the preposition was in the wrong place.

But we weren’t learning Latin!  We were learning English, and – lo and behold! – the grammar rules of English are different.  In English, word order is flexible.  A lot of nuance comes from the arrangement of our sentences.  English doesn’t have as many tenses as other languages – there’s no subjunctive – so we English speakers need to scrape out nuance where we can.

In my high school English class, we were also taught not to use “their” as a singular possessive.  Even now, I rarely do – I don’t write “Each student brought their book,” I instead sacrifice the meaning of my sentences and write things like “Students brought their books.”

I was hoodwinked!  Instead of using the word “their” as a singular pronoun – which it is, in English – I trusted my teachers when they claimed that this word was exclusively plural.

Hogwash!  The equivalent claim would be to say that it’s incorrect to write:

You are reading this essay.

After all, “you” is a plural pronoun.  And “are” is the plural conjugation of the verb “to be,” which I used only to match the expected conjugation of the pronoun “you.”  The correct thing to write is:

Thou is reading this essay.

See?  There’s only one person reading, so I need a singular pronoun, “thou,” and a singular conjugation, “is.”

From What’s Your Pronoun? by Dennis Baron, I learned that the pronoun “they” has been used as a singular since the 1300s.

In a sense, singular you is even more of a newcomer on the pronoun scene.  The plural you was applied as a singular pronoun to address royalty as early as the thirteenth century and was used in other situations demanding deference and formality – call the monarch thy majesty instead of your majesty and it could mean off with your head.

But you doesn’t appear as a singular in all contexts until the 1600s, when it slowly, slowly starts pushing out thou, thee, thy, and thine, second-person singulars that English speakers had been using since the days of Beowulf.  The th- singulars persist even now in some English dialects, and nineteenth-century grammar books regularly demanded singular thou and thee, along with thy and thine, even though these pronouns were no longer considered standard English.

It consoled me somewhat to read that students have long been taught outdated, inaccurate information.  It’s not just my brain that was filled with rubbish.

When a cabal of misogynistic grammarians worked to replace singular they with he in English textbooks, people tried to protest. 

In 1885, in an article titled “The New Pronoun,” the Atlanta Constitution printed:

There is nothing awkward or ungrammatical in [singular they] so far as the construction of English is concerned.  It is ungrammatical when measured by the Latin method – but what has Latin grammar to do with the English tongue?

If you wanted, you could even make a scientific argument for the validity of singular they – in quantum mechanics, the state of each single particle is described by a superposition of states.  Immediately after a measurement, wavefunctions can “collapse” to be composed primarily of a unique form – after a photon passes through a polarizer, it’s fluctuation will be parallel to the polarizer’s axis.  But even this “up and down” state can be expressed as an equal superposition of two perpendicular polarizations tilted forty-five degrees.  Indeed, the latter expression is the only useful way to describe this photon if it’s about to pass through a second polarizer tilted forty-five degrees from the first.

We are not monolithic.  Each and all of us can be described as an amalgam of many different traits.

But we don’t need any scientific justification for the use of singular they in English.  This grammatical usage is deeply enshrined in our language, and the singular pronoun “they” can best convey the plenitude of many individual humans’ identity & experience.

It’s still difficult for me to use the word “they” as a singular pronoun in formal sentences – my crummy education was pernicious.  The proscriptions are deeply ingrained in my brain.  But I’d like to think that I’m not totally calcified in my ways.  And I’m quite grateful that Denis Baron prepared such an erudite history of English pronoun usage.  What’s Your Pronoun​? is a lovely little book.

I hope that my kids’ brains will be less muddled than my own.  When we read stories aloud, we typically correct unnecessarily gendered language.  Girls and boys become kids.  An actress is an actor, too.  Our Curious George lives in a world of fire fighters and police officers.

I was reading Rob Harrell’s gorgeous Monster on the Hill to our kids when our three-year-old interrupted me.  At first, I couldn’t understand what she was saying.  I asked her to repeat herself.

“You should say spouse.”

from Rob Harrell’s Monster on the Hill

She was right, of course.  I’d unthinkingly read the text as written.  So I felt embarrassed … for a moment.  Then I remembered to feel proud.