Wednesday, August 17, 2011

Moving Beyond Mammy: Why I Strongly Disagree With Some Criticisms of The Help


I read Kathryn Stockett's novel The Help two years ago, when it first became a literary sensation. I loved and was astounded by it; it quickly became one of my favorite books of all time, among novels like Harper Lee's To Kill a Mockingbird, Barbara Kingsolver's Prodigal Summer, Natalie Babbitt's Tuck Everlasting, Marilynne Robinson's Gilead, Mark Salzman's Lying Awake, and now also Sara Gruen's Water for Elephants. It was unexpectedly very personal for me. I grew up in a society where the privileged have help, the help wear uniforms and eat in the kitchen and call their employers their "masters," and in some families the kids are taught "not to get too friendly with the help." I was lucky, though, and had someone like Constantine (portrayed by Cicely Tyson in the photo above): a woman I bonded with who's like a second mom to me, who's now been in our family for forty years and whom I love with all my heart, and who I know loves me with all of hers. Because of her I learned that love transcends a lot of barriers people can try to erect in various situations.

My brief mention of The Help in a blog post from when I first read it in 2009 summarizes the major themes that made me like it so much: "story and story-telling, truth and lies, having a voice and keeping silence and secrets, writing and how it transforms both writer and reader, and the true meaning of dignity and of significance." It's also, one of my friends adds, about "the power you get over your own story when you break the secrets and silence." She and I read it as READERS, I might even venture to say students of literature - but not as scholars of history. For this reason, critics who have blasted both the book and the movie for (supposedly) failing to be true to the historical times in which the novel is set, and for not focusing on Black History and the sufferings endured by Blacks in the South in the 1960's, have irritated me profoundly. The book was not written to be a documentary about the Civil Rights Movement. It was written to be the story of the intertwining lives of three very different, complex, and compelling women. Novels are about CHARACTERS and novel writing is and should be entirely focused on who those characters are and how those identities drive what happens to them.

No one should presume to tell an author, "Your character should have done this" or "done that." Only the author knows her characters well enough to know why those characters do what they do; she then opens up their lives to us in moments, and we can get to know those characters, but not with the intimacy and authority to be able to dictate what their actions should have been. Any such criticisms are projections by readers, which may be out of keeping with the characters' identities and completely untrue to the world of the book. And that, right there, is the problem: people with an axe to grind couldn't accept a CREATED world, the world of the novel, but rather wanted it to be the world as THEY would have it or depict it.

I read the Open Statement to Fans of The Help by Ida E. Jones, National Director of the Association of Black Women Historians (ABWH) and a review by journalist and University of Georgia professor Valerie Boyd, who wrote Wrapped in Rainbows: the Life of Zora Neale Hurston. I sincerely respect the fact that they know much more than most of us about African American history, and I appreciated being educated on perspectives that might not have occurred or been familiar to me, but I couldn't agree with many of the statements they made. Some of them annoyed me because they missed the point, and because by being so ready to criticize the work - perhaps even before reading the book or seeing the film, like some of their commenters, and perhaps because it was not written by a Black woman? - these critics willfully obviated the possibility of appreciating its many gifts.

The ABWH statement asserts, "Portraying the most dangerous racists in the 1960's Mississippi as a group of attractive, well-dressed society women, while ignoring the reign of terror perpetuated by the Ku Klux Klan and the White Citizens Council, limits racial injustice to individual acts of meanness." What a short-sighted attitude. Stockett clearly did not set out to portray "the most dangerous" racists or write another Mississippi Burning. It's unfair to paint her as intentionally "ignoring" the more violent aspects of the 1960's simply because her novel is about the moments behind closed doors, about diaries and journaling, about words on pieces of paper. I thought that was the very beauty of her novel - that it's about these non-spotlighted things. Does EVERY author who chooses to write about Black women have to have a scene in her novel with a burning cross? Is that a requirement? I thought the special thing about this book WAS its focus on the tiniest moments - it's about the little things that aren't so little. The WHOLE POINT of it is that racism isn't just in KKK violence but ALSO, and perhaps even more insidiously, in the fake smiles of the well-dressed hypocrites and the not-so-hidden sneers of day-to-day interactions.

I also COMPLETELY disagree with the description of any of the characters as "asexual, loyal, contented caretakers of whites." There are no Mammies in Stockett's book - just real-seeming, complex women with courage and heart. Each African-American woman in the book had an identity and a personality. There aren't well-developed male characters, but I think it's because another big POINT of this book is the power and impact of WOMEN's relationships with each other - the focus was, rightly, on Skeeter, Abilene, and Minny.

Many object to the fact that a Black male in the book is an abusive alcoholic. This, too, I find immature: the need for only positive portrayals when a given negative element is important to the story. Do people really think just because African Americans suffered for years, and continue to suffer in many ways still, that there were no wife-beaters among them, as there were among Caucasians, back in the 60's? Do all writers have to walk on egg shells and give terrible traits only to white people in their novels? This kind of reverse racism demonstrates some pretty stunted growth. The literature of my own culture suffers from similar post-colonial tensions. Poor us, it cries; look how the Spaniards raped and enslaved and colonized our people, and after them, the British and the Americans. We have to highlight how evil the white people were, and how long-suffering and noble we are. Give me a break. We have to tell the stories as the stories are - that's what writers DO.

At some point, the literature of a people has to move beyond the need to be perpetually and repeatedly social justice literature. Literature should ultimately be about story first and foremost - story and character. I don't think a story about any group is necessarily obligated to speak for "The Experience" of that group; a writer has to be true to the characters she creates, and those characters may NOT be at all representative in the way historical scholars would understand "representative," whatever that means. I thought the women in The Help were all worth "getting to know" for all their different strengths and faults - a sign of good writing and a story worth reading. In the end I always approach novels as being about the novel's characters, NOT about Black people in Mississippi or Native Americans in New Mexico or Haitians in Haiti. In this particular book, the message of having the courage to tell one's story, to use writing as a way of asserting voice, to paint oppressors of any kind as ultimately ridiculous, and to work together in friendship for justice despite danger, comprised such a valuable STORY that I find politicizing it really unnecessary and unhelpful. The characters are strong, courageous, humorous, imperfect, loyal to EACH OTHER, and different from one another. What's so Mammy about that?

There were many other points made in the aforementioned pieces and the comments they generated that inspired only incredulity and disagreement in me. Boyd's soap-boxy review The Help: a feel-good movie for white people can't even leave the anti-white venom out of its title. If a white person wrote something entitled "A Feel-Good Movie for Black People" there would be a public outcry. I am neither a white person nor a Black person and I certainly did NOT feel good about the pain I read about and saw on the screen, but like one African-American woman journalist who left a comment, I felt very good about the love I saw between women friends and the way the women "ultimately save themselves by telling their stories." Boyd's sweeping generalizations and judgments - that Black people would never confide in white people, that no white person would be remarkable enough to earn Black women's trust, that Skeeter was ONLY motivated by ambition as a writer and not by genuine compassion for the Black women working as domestics in her town, that this novel should have encapsulated the experiences of all maids working in Jackson in the 1960's AND been a portrayal of the larger Civil Rights Movement AND (unrealistically) shown a white woman breaking some kind of mold to confront her only circle of friends with their behavioral ugliness - reveal the bigoted stereotypes and narrow view of white people in her own mind. She's supposed to be this accomplished journalist and scholar - yet she can't rise above what one commenter aptly described as "petty grandstanding."

I honestly think a lot of people out there are just plain SORE that a white woman would DARE tell stories from Black women's point of view AND do such an amazing, vivid, compassionate job. Sour grapes, I say. They need to move beyond judging something for what they WANT it to depict and judge it instead by what the author actually set out to do - get into the small moments, the pouring of tea in kitchens and changing of diapers in the nursery, explore the daily moments and relationships in the lives of three characters: Skeeter, Abilene, and Minny. This is what novels do. They are not Civil Rights documentaries. Stockett didn't want to write a novel about the lynching of innocent, persecuted Black men; she wanted to write about courageous, funny, gifted, strong, inspiring women and their friendships, obstacles, trials and choices. I think her incredible writing and her portrayal of these characters has honored women of all races, and she should be praised and thanked for it.

But please don't be like the intellectually lazy commenters under Boyd's review who don't feel like thinking for themselves and have decided instead, based simply on her tirade or other negative hype, to hate The Help already and not bother to read the book or see the movie. Have a little cultural integrity and responsibility and experience the work for yourself, then decide. It deserves that much, if only because it has us all thinking and talking.


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Addendum 8/18/11: for an articulate, balanced, scholarly critical essay on what The Help could have done better, with a concrete and appropriate LITERARY example, check out this wonderful NPR piece by W. Ralph Eubanks: "Eudora Welty's Jackson: The Help in Context." He gracefully avoids undermining his own credibility by not lapsing into shrill, knee-jerk invective and thus successfully invites readers to open their minds and think critically - presumably the desired effect of any good critic.

8/29/11: Another thoughtful critical piece that makes an excellent point.

Thursday, June 30, 2011

To Bare Or Not To Bare


Topless sunbathing is widely accepted in France, where we've spent a lovely vacation visiting my husband's family. Our recent day trip to a beach on the northern coast sparked interesting conversations between my daughter and me and between my husband and me.

On one hand, I think the relative absence of Puritanical sexual repression in Europe, as compared to the United States, has provided some advantages. People are accustomed to seeing bare breasts on billboards and other media from a young age. Breasts therefore need not be objects of shock value or secret, horny fascination. Women are allowed to be comfortable with their own bodies - as they should be - and men allowed to be comfortable with women's bodies in multiple ways without having to be so obsessively titillated by the one aspect of them, their sexuality.

On the other hand, I value modesty. I think there's something to be said for being feminine and even sexy without needing to bare all, for keeping private parts private (and thus in some way sacred, and meant for reverent care) and preserving the meaning of intimacy. My husband pointed out, though, that two-piece bathing suits are already immodest; what's the big deal with doing away with the top piece? (He is, of course, half European.) My young daughter, on the cusp of womanhood, sounds torn between two cultures; she was a little shocked at how easily modesty was abandoned here in France, but also admired young women for their confidence in their bodies regardless of body type.

Not long after our trip to the beach I read the current National Geographic article about child brides in India and Yemen. So much in that article dredged up a lot of anger in me - at how girls and women are still seen around the world as possessions or goods for use, whose worth is directly associated with the integrity of their hymens, whose appearance or even presence is often blamed for what is really the uncontrolled lasciviousness and misogyny of the males around them. Are men all over the world really so incapable of controlling their basest tendencies? Really? Can't the rape just STOP already? What is WRONG with people?

In my mind the jury's still out on topless sunbathing. Where it's commonplace and culturally comfortable, there doesn't appear to be a down side, and there may even be many positives. Women's efforts at extreme modesty elsewhere don't seem to quell the animal frenzy that leads to their victimization by stupid, irresponsible, and worthless men. Perhaps if the whole world would just relax about the human body we could all just step back, appreciate it, and take good care of it.

Saturday, June 11, 2011

Why I Hate Birth Plans


Recently on a physicians' forum I came across a tragic story about a home birth gone bad. The doctors on the forum were mercilessly critical of the individuals involved, but I couldn't disagree with them. Their tone may have crossed the line from anger over the tragedy into disrespect or even cruelty, but I can't say I blame them entirely - there's a part of every conscientious physician that does get enraged over what's perceived to be preventable catastrophe, and sometimes venting the outrage in private (which this forum was supposed to be), among others who understand, can release some of the tension raised by the story.

There seems to be a wide chasm between expectant women who distrust or perhaps even hate doctors and doctors who see themselves as the protectors of human safety and life and who thus sometimes see such mothers-to-be as close-minded, willfully uninformed, and even selfish. From the physician's point of view, a) "natural" isn't synonymous with "safer;" b) pregnancy causes physiologic changes that can sometimes pose real dangers to mother and infant - DANGERS, not just inconveniences or discomfort; and c) a rigid "plan" for birth is nonsensical in light of the possibility of unplanned concerns necessitating prompt and sometimes life-saving intervention.

Don't get me wrong; I firmly believe in women's right to express PREFERENCES and to have those preferences respected as closely as possible when safety allows. Of COURSE I would never insist on placing an epidural in a woman who preferred to give birth without one. But I resent the kind of pseudo-feminist culture that creates guilt or a sense of "failure" in women who feel they would like an epidural to relieve childbirth pain. I've heard it so many times; a tearful woman saying "I'm a failure" because natural childbirth became medically assisted childbirth. No woman should ever feel BAD about bringing a new life into the world. That, and the social signals that engender it, I definitely resent.

And despite the title of this post, I don't actually hate birth plans. I had one myself. I scrapped it in the end and decided to just trust in the process, and take things a step at a time, and actually have face-to-face conversations with my caregivers, but I did draft one. A birth plan that is meant to clarify preferences is a good thing. A birth plan, written or spoken or just held in one's mind, that is meant to be a binding contract for a physician, come hell or high water, is stupid and ultimately, in my opinion, wrong. The priority should be the baby's and mother's SAFETY, not the parents' "birth experience." If the so-called birth "plan" interferes with safety, it has to go, and any parent who insists on adhering to it under such circumstances doesn't deserve to be a parent. What I hate about certain birth plans is the unspoken attitude or culture behind them that seems to declare that nothing is more important than the mother's "birth experience." This is irresponsible and wrong.

So when a screaming doula verbally abused an obstetrician colleague of mine recently for going to stimulate a baby who was cyanotic and was making no respiratory effort - and when I say screaming, I mean I was three doors down attending to someone else and I could hear her yelling at my colleague at the top of her lungs - I felt the same anger that the physicians on the forum were feeling over the home birth disaster. My colleague was doing her JOB, protecting the baby's life and ensuring the mother's safety, according to standards that have been carefully studied, and here was this medically untrained woman interfering with this physician's care and potentially threatening the life of the child by screaming at the doctor that clamping the cord and stimulating the baby were against the parents' wishes. The baby's safety didn't seem to matter; it was all about the parents' wishes. THAT kind of ignorant, selfish "care" is completely inexcusable, yet in certain circles is glorified and touted as advocacy of women's rights and empowerment of mothers. There's nothing empowering about medical ignorance, stubbornness, or selfish adherence to a dream of a birth experience contributing to a child's death.

Here's what I would want all expectant mothers to know about giving birth at our hospital. Pregnancy may be natural, but it can also be dangerous. If you show up at our door, we're going to bend over backward to protect you and your baby, but we're going to do so according to the high standards of safety to which we've been trained to adhere. Please tell us what you prefer, by all means - we do want to create as wonderful a birth experience for everyone as we can - but we also have to put safety above EVERYTHING. We would be bad doctors, and morally culpable people, if we did any less.

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ADDENDUM:
See also this well-articulated critique by an ob/gyn:
BIRTH PLANS: WORSE THAN USELESS.

Thursday, June 2, 2011

Anesthesia v. The Joint Commission, Part II


Yesterday's post mentioned that the leaders of this country's most important anesthesia organizations had sent a letter protesting several inane mandates that were being imposed or about to be imposed on anesthesia providers by the JCAHO.

This letter, requesting written confirmation that we anesthesiologists and anesthetists could keep our current, safe practices rather than switching to the suggested idiotic, less safe practices, was sent last December.

Now...let the back-pedaling begin!

JCAHO's response arrived at the American Society of Anesthesiologists' desk just about a month ago, and our anesthesia group has been abuzz about it this week.

The highlights:

"Dear Anesthesia Providers:

...Your letter points out that if specially designed processes are followed to accomplish [the task of pre-labeling syringes], labeling a syringe first and later filling that syringe can be accomplished in a consistently safe manner. [REALLY?! YOU DON'T SAY...?! Is that why we've managed to do this for the last several DECADES?! Imagine that!]

...After discussions with the Joint Commission staff, it was decided that it is beyond the scope of this NPSG [National Patient Safety Goals] to detail all of the various safe and unsafe processes in which a syringe could be filled and labeled. The Joint Commission decided to leave the current NPSG as is, which requires all filled syringes to be labeled, and to remove from the FAQ the prohibition against prelabeling...

As a follow-up to the previous discussion, one exception does exist to the requirement that all syringes be labeled...As long as there is no break in the process, labeling is not required during the administration of spinal and epidural anesthetics and analgesics. [Why THANK you! But we already KNEW that, because to require something so USELESS and intrusive would be completely STUPID.]

...The issue of anesthesia professionals (or anyone for that matter) carrying a medication is left to the individual health care organization."

Thank you, JCAHO, for taking our concerns seriously and realizing the idiocy and lack of groundedness-in-reality of so many of your requirements. Keep up the good work. Maybe if you keep paying attention to what you described in your response as "a number of concerns" voiced by many medical practitioners from many different fields, you can make up for your deficiencies in clinical knowledge and practical imagination with responsiveness to those who actually live and work in the real world every single day.

[Photo source here.]

Wednesday, June 1, 2011

Anesthesia v. The Joint Commission





The following was written by a colleague who wishes to remain anonymous but whose permission I have to reprint it here. I think it expresses what a lot of people are thinking but can only admit in private.




Dear JCAHO (Joint Commission on Accreditation of Healthcare Organizations, a.k.a. "Jay-Co" to clinicians talking about you or, most commonly, complaining about you):


Over the years I have dealt with your incessant nitpicking by reminding myself that the regulation of institutions responsible for human lives is, in principle, a GOOD THING. I believe in safeguards. I believe in holding organizations to high safety standards. I believe accountability is important.


But over the years I have also wondered how it is that the bureaucrats that come to survey our hospitals can be so unimaginably clueless about the practicalities of patient care. Yes, perhaps they have had clinical experience in the past, are highly qualified (according to you), and have an alphabet soup of degrees after their names that purportedly validate their authority. Yet why do they seem unable to belie the stereotype of the out-of-touch, small-minded bean counter who has absolutely no idea how the real world of caring for patients really works?


You've already received a missive about this from representatives of all the major anesthesia organizations in the U.S., but I feel that their diplomacy diminished the forcefulness their words could have had.


I've gritted my teeth and had to accept the locked anesthesia cart you mandated in the obstetric O.R. despite the fact that if a pregnant woman were hemorrhaging TO DEATH and needed a true STAT C-section, the delay caused by having to retrieve the key to open the cart might actually KILL her AND her baby.


I've rolled my eyes at the various little rules you add each year, with the determination and scrupulousness of people whose mission in life is to add at least ONE new rule each year come hell or high water, even if on occasion one of your commands might, for example, be to get rid of the very form you made us adopt the LAST time you came.


But I cannot, cannot, CANNOT wrap my mind around the completely ASININE prohibition against pre-labeling my medication syringes and against the transport of medicines on my person for the sake of patient safety / emergencies, and the criticism of anesthesia practitioners for not labeling the STERILE syringes of a spinal kit when there is absolutely no discontinuity in the opening of the kit, drawing up of the medication, and injection of the medication into a SHARP OBJECT STABBED INTO SOMEONE's BACK which needs to be done as swiftly as possible once the patient's cerebrospinal fluid is observed leaking out of his or her spinal canal.


You would rather, as I understand it, INTERRUPT a procedure for the sake of a literally USELESS step, CONTAMINATE a sterile kit with a nonsterile label, and risk the injurious complication of arachnoiditis from the ink on a labeling pen, than have a spinal anesthetic performed cleanly, efficiently, and above all, SAFELY.


You would rather I draw medication up into an UNLABELED syringe, leaving it unrecognizable for a few seconds or its contents potentially forgotten, than allow me the opportunity to SAFEGUARD the drawing-up process by making sure my label and my medication vial MATCH. Pre-labeling, by the way, is an EVIDENCE-BASED safety practice, unlike your nonsensical and over-intrusive prohibition.


Most egregiously, you would rather a patient CODE AND DIE during transport than have me carrying with me the very interventions that might save that patient's life. And for what? For the sake of making sure pharmaceuticals are locked away, locked away, locked away? Who is protected by this kind of imbecilic medical tyranny?


The above satirical cartoon sums up in a few seconds why you appear to be almost universally despised by the medical community. Arguably no one is more obsessed with patient safety than an anesthesiologist, and we certainly know intimately the day-to-day practices that safeguard it. Perhaps, then, YOU should take a few mandates from US. You might subsequently find your recommendations and regulations actually having some lasting positive impact and earning something with which you might be unfamiliar: respect.


Sincerely,


An anesthesiologist somewhere in the U.S. who cares deeply about patients and their safety.

Saturday, May 21, 2011

How I Spent "Judgment Day" 2011


If you knew, or thought you knew, when the world was going to end, would you change the way you live your life?

Would you spend your life savings and forego career plans? Would you take one last trip to see some places you'd always wanted to see?

I never believed in preacher Harold Camping's prediction that the Rapture would occur today. Even if Jesus himself hadn't said plainly that no one can know the day or the hour, Camping's calculations would still have held no merit, based as they were on a) a literal interpretation of the Bible and b) a calendar that failed to take Dionysus Exiguus into account. But I did follow some of the media coverage around this phenomenon with interest. It generated questions like, "What makes people willing to take such risky actions for the sake of one fallible man's ideas?" and "What would you change about your life if you knew it was ending - SOON?"

I was pleased to realize that the answer to the latter was "not much." I'd still go to work and do my job - but keep it part-time, or make it even MORE part-time. I'd still spend as much time enjoying my family's company as I could. And if today had really been our last day, I would have been truly happy to have spent it as we did today.

My husband and I had a long, relaxing lunch outdoors. The weather was perfect - sunny, breezy, dry, in the 70's. The food was delicious. Later in the day we went to a fair two towns over. I love small town fairs; they evoke simpler times, happy families, and friendly communities with something to celebrate. The best thing about this particular fair was the presence of a book tent, where my husband and I spent contented hours browsing through tables laden with used books while the kids enjoyed the games and rides outside. Back home I concocted some Thai-spiced burgers for a late dinner, and they were yummy. It was a day full of all the things I enjoy and the people I love most. If the world had actually ended, I would have counted myself blessed to have known such lovely moments.

Monday, May 16, 2011

Blog Anniversary - It Kinda Snuck Up On Me!


I can't believe this blog has been around for four years!

I know it's been much quieter lately, but that's been working for me. Not that there's anything too extraordinary going on in the rest of my life right now - other than the usual extraordinariness of my ordinary life. One day I am running to the emergency room to help with a potential difficult airway, anesthetizing a patient for abdominal surgery, or putting epidurals in expectant moms; the next day I have a cake decorating class, or a post office errand, or a movie night with spouse and kids. Life's got stresses, life's got joys, and I'm finding that this kind of balanced, un-remarkable existence is just what the doctor ordered (so to speak!).

It seems fitting, then, that I should celebrate with...

Berry-Basil Guacamole. An ordinary treat with an extraordinary twist.

This is my latest obsession. I had some at my in-laws' and fell head-over-heels for it. I really enjoy this kind of food adventure: take something rather ordinary (mashed avocado), and make it a little special with the unexpected ingredient, a not-your-usual combination of flavors. The strawberry-basil combo is, I must admit, kinda old news; it's been done a lot, as a salad, an ice cream, and even a cupcake. But I still consider it somewhat special.

Let me know if you develop (or have) a good version. Mine is just what you see above: avocados, strawberries, fresh basil, a little diced cherry tomato and onion, and whatever sprinkling of seasoning and citrus juice happens to be on hand and palatable at the moment. Best with my other latest obsession: Tostitos brand Artisan Recipe roasted-garlic-and-black-bean whole grain tortilla chips.

Happy Berry-Basil Blogiversary!