Archive for the ‘Culture’ Category


Photo Credit: AskmePC web design

“I was made for the library, not the classroom. The classroom was a jail of other people’s ideas. The library was open, unending free.” Ta-Nehisi Coates, Between the World and Me. I read these provocative words today while on a literary get-away to Barnes and Noble. I don’t know that I agree with Coates’ characterization of classroom as a “jail” as I actually find listening to other people’s ideas stimulating, but his challenge to chart one’s own path in seeking truth and knowledge, the “library path”, is important.

In Between the World and Me, Coates describes the vibrant yet turbulent tale of the African American experience in America. His whole book is written as  a letter to his teenage son with his best thoughts on how to live with dignity as a black man in an imperfect America. With my own son having just turned 13, I was interested to hear his thoughts. One question I wonder about is how to prepare my son for a environment in which race is still a controversial issue without making race color everything he sees.

It’s an unfamiliar challenge for many of us Generation X immigrants from Kenya, because we did not grow up with race being such a throbbing undercurrent to daily life. I am, in fact, biracial and grew up thinking it was quite natural to have a Scottish mother and a Kenyan father. It meant chapati and Scottish soup all in the same week and a common national fanaticism for football/soccer. What was not to love? I also grew up with a black (Kenyan) President, learning black (Kenyan) history.

I will pause here to say that in Kenya, we also had to learn the history of EVERYWHERE else as part of our highly ambitious 8-4-4 educational system at the time. When I say history of everywhere, I mean it. Basically if something had happened in the past, anywhere, whether that be in Northern Mongolia or Nebraska, we had to know it. But I’m not bitter . . .

What struck me about Coates’ words is how much change, of any kind, depends on our willingness to challenge the various scripts in our lives. I once tried to change the tired script and perception of Africa for my students as a vast “country” full of war, famine and poverty, but delightful animals . . . I decided to walk all around downtown Nairobi with my sister taking pictures of less familiar images, skyscrapers, fancy restaurants, malls. My mission was dramatically cut short when a few of our law enforcement officials detained me, quite concerned that I was taking pictures of multiple buildings, a suspicious act even at that time in a world of terror attacks. I was released once the confusion was cleared up, but it stuck with me that changing a narrative is not easy. It demands persistence, stubbornness, courage.


I started a new phase in my medical journey this week as I began my Masters in Clinical Research, a 2 year leave, before returning to complete and graduate from medical school in 2017. My research will mainly be in Neurosurgery, exploring the following topics:

1. The effectiveness of electrical stimulation in treating nerve injury.

2. A rare complication of brain aneurysm rupture treatment, known as PRES.

3. Patient costs of Pediatric Neurosurgical care in Kijabe, Kenya

I will also be working with Pediatric faculty on data visualization and bioethics projects. The bioethics project will involve analyzing the differing experiences of minority and majority pediatric patients in our University Hospital when facing difficult medical decisions.

Research, either personal or professional, is unique way to change the script; you can use hard earned data to challenge nonsense. I look forward to that challenge.

For today though, I am glad I could walk into a  room full of books, choose the knowledge I would seek, and create a script on the spot. Whether the original script is a skewed conception of Africa, a narrow view of each other by race, or medical treatments with flimsy support, some scripts were made to be changed . . .

Scottish Warrior

Photo Credit: CreativeFreedomrpg

It was the phone call you don’t want. My wonderful, routine-oriented mother was calling at an odd time for her. The news? Her brother, my Uncle Alan, had just passed away from diabetic complications this past week. It was a real blow to all of us as he seemed to have turned a corner in his clinical course. But diabetes had ravaged his vasculature and the organ shut-down overwhelmed his system. Adding to the shock was the realization that this was the one Uncle whose name I share (Alan is my middle name). That deepened my connection to this loss. I also realized that with Uncle Alan’s death, my son Cameron is the sole remaining male to carry on the Scottish Cameron name. I explained this to to him and he beamed with pride; he is also eager to learn more about Scotland by donning Braveheart-style warrior garb. We did some research together and discovered a proud Scottish song called “The March of the Cameron Men” He has been marching around the house ever since.

Just how much do our names matter?

Shakespeare famously said, in Romeo and Juliet, “A rose by any other name would smell as sweet.” In context, the sentiment was right. Romeo and Juliet should not have been prevented from loving each other just because one was a Capulet and the other was a Montague. But yet, names do matter. When I named my second son Cameron, my Aunt Lynne in Scotland was very moved. She would have loved him just the same, but his name mattered.

Speaking of sons, my other son Christian once had a friend named “Confidence.” I arranged a play-date with his parents after school one day and Christian was so excited that he boldly shouted to all his teachers while leaving school “I’m going to play with Confidence!!!” and all the teachers broke into supportive smiles, and one said, “Good for you Christian! That’s how you should play.” Names can be funny things . . .

And then there is the whole question of whether your name guides your destiny. Apparently, there is a whole school of thought about this called “normative determinism”, discussed with interesting examples in a recent article by Graham Nelson. Solid scientific support for being influenced by your name is elusive as causality is difficult to demonstrate. But I couldn’t help but imagine that my son’s friend Confidence was influenced by this quality being called out to identify him dozens of times a day.

Is it pure coincidence that mother’s name is Anne, my wife’s name is Anne and my sister-in-law’s name is Anne?

Many of my friends and classmates from high school chose to switch to their African names when they left Kenya. Why? Presumably, this was to maintain a strong connection to their Kenyan identity. Your name matters more when there are less of you around to carry it.

And what about patients? Do we use their last names in addressing them out of professionalism and respect? Or their first names to convey familiarity and warmth?

And why do I hate being called “John” instead of “Jonathan”, but my friend Jonathan has no problem with that?

Names matter. As a friend once remarked, you could never have a “Toyota Sputum.” Names also offer definition, although this may be an illusion. My friend’s daughter develops fevers every month without falling sick and was recently diagnosed with “Periodic Fever.” It is a legitimate diagnosis, but what has the name really illuminated for us? Not much. But it gives the patient comfort that the problem has somehow been defined. Is this an honest comfort? Similar concerns were raised in the area of mental health when certain psychiatric diagnoses were introduced to the Japanese medical lexicon and suddenly the rate of diagnosis of multiple mental illnesses shot up. Was this a case of unidentified problems now being appropriately identified by the imported names or medical diagnoses being appropriated without real basis?

Names are powerful, but they are not benign. Who can tell the true toll on the African-American psyche after slaves were stripped of their traditional African names? And yet, names can also edify. How much has Usain Bolt’s mental game been bolstered by the constant connections made between his name and his speed?

“What’s in a name?” A great deal it appears . . . what is your name?

Labels Graphic

“The moment they diagnosed me, I disappeared.” This was the striking statement of a man who went extremely public with his experience of carrying brain cancer. By “disappear” he meant that he was now labeled by his disease “brain cancer.” His name, his history, his persona all evaporated. Isn’t a terrifying diagnosis enough? Should patients have to lose themselves as well? It is ironic that a label, which should by definition offer identity, instead often strips it away.

Let’s dispense with the obvious: labeling others is dehumanizing and fails to recognize the complexity and full humanity of each person. We shouldn’t label others, but we do. An interesting social experiment was carried out recently in which 6 strangers met each other for the first time in the dark and had a conversation. When the lights were flipped on, their jaws dropped. The participants were shocked at how different each person looked from the perception each had created in their minds. The participants included a heavy metal rocker dressed in a suit and a tattooed professor.

But is moving beyond labeling even a winnable battle? Our brains are designed to categorize. It is how we make sense of the world. It is helpful to be able to assess quickly who is a friend or foe, for example. Even the most intense politically correct “training” will never stop our brain from forming an instant impression, that may in fact be false or superficial. But maybe this is not the point where intervention is needed. We all label and will continue to do so, but can we become “fluid labelers”, ready to release a false impression in a second and embrace the dissonance that comes with the unexpected image? I once had a Chemistry professor (what do you picture?) who looked and sounded like a football coach. To hear this bald headed, stocky, brash teacher talk about electrons with the intensity of a Super Bowl final pep talk was wonderfully bizarre. It shattered every label I would have placed on him. And I just chose to run with it. Chemistry class was never the same.

But to be fluid with labels is to leave your brain naked for a moment. Bereft of convenient categories how will your brain feel at ease? I would submit that this discomfort is healthy and in fact important. I once saw a patient with liver problems instantly ascribed to alcoholic cirrhosis simply, because he presented with alcohol on his breath. He was not in fact an alcoholic; his liver disease had another cause entirely but he was quickly labeled. Jerome Groopman tells similar stories in his excellent book How Doctors Think about how medical mistakes are made by labeling patients in two-dimensional ways.

All this does not mean we should ignore impressions. We should look out for subtle clues in people and certain categories make sense. The real question is not whether we label but how tightly we hold onto that label. There is a word for refusing to let go of a label no matter how much we know . . . prejudice.

And this is the exact place I was going to end this blog post, but I had to get all over-achieving and look up a few quotes on labeling! Most of what I found was predictable, in the vein of not letting others define you, resisting society’s labels and so on, an important point of view, of course. But somewhere in the middle of all those quotes was this:

“I have always been taught to be proud of being Latina, proud of being Mexican, and I was. I was probably more proud of being a “label” than of being a human being, that’s the way most of us were taught.”

Erin Gruwell, The Freedom Writers Diary

Erin’s words stood out because she is not talking about other people’s labels, she is talking about her own. Can our own labels be just as problematic, maybe even more so because they seem benign? I’m extremely proud of my Kenyan and Scottish heritage. What’s wrong with these labels? Nothing except, as Erin reminds us, when these labels become more important to me than the humanity I share with people who don’t happen to Kenyan, or Scottish, or American or in medicine, or in Theatre, or . . . what’s your list?

What makes you say “Yes”? I have begun my journey into the book Hidden in Plain Sight by Jan Chipchase. So far, Chipchase is interested in how we respond to new things and what leads us to adopt or reject them. He argues that adoption is not a one step process but rather a 5 step sequence: Awareness-getting to know about the existence of new things  Interest-wanting to find out more Evaluation-imagining one’s life with this new thing Testing- giving it a trial run and finally Adoption- a commitment to use. He further argues that we can be early adopters who are typically, but not always, innovators or the young and highly educated; medium stage adopters who are slightly older, perhaps less educated and late adopters or laggards and flat out rejectors.
Why do you adopt some things and reject others? The biggest factor seems to be what everyone else is doing. And why does this matter? For me, it matters because I want be part of the effort to effect widespread change in healthcare delivery and knowing what makes people behave a particular way seems central to that vision. Take a simple example: I was skeptical about joining Twitter for a long time. I wondered what was really worth saying in 140 characters. It seemed superficial and an excuse to spout fluff about bacon for breakfast (although, it should be noted that bacon is indeed delicious). Then, I found out people and organizations I respect were on it, and some of the dynamic ways it was being used and I began to reconsider my opinion. I have since joined Twitter and now integrate it in both personal and professional areas of interest. But did I simply have a limited understanding of Twitter or was my perception altered by those around me, even though the platform stayed the same? What was the “reality” of the usefulness of Twitter?
On the subject of reality, can we take a quick detour for a moment? I heard something thought provoking this week from a cognitive scientist who argued that we often do not perceive reality as it really is (optical illusions, misread social cues etc) but that this may not actually be a bad thing in every instance. This scientist ran some evolutionary experiments on his computer and found out that accurate perception of reality did not necessarily translate to increased survival. Is there an evolutionary benefit to believing certain illusions? Are we witnessing the triumph of tact?
Truth matters of course and I don’t think anyone would argue for living in a fantasy world defined by illusion, except perhaps actors, but that’s the job;) Is it in our benefit (or others’ benefit) to know everything accurately and share everything accurately at all times? For the die-hard “tell it like it is” types, this question may seem obvious, but consider the Alzheimer’s patient who keeps forgetting her husband has died. Every time we confirm that he has, she feels fresh grief. The next time she asks “Is my husband still at the store?” Is “Yes” more compassionate than breaking the news of his death once again? What happens when reality and compassion clash?
Or consider this headline from BBC Health this week:
Virtual reality could help stroke patients recover by “tricking” them into thinking their affected limb is more accurate than it really is, researchers find.” In this case, an illusion is central to the therapeutic process . . .
Stroke Arm

The virtual reality arm appears to move faster and more accurately than the real arm. Courtesy of BBC Health

Perhaps the guiding principle is that we should be more interested in meeting people where they are, than where they should be. This does not mean abandoning timeless ideals of truth and justice, but it does ask for a certain nuance and compassion in how we apply these lasting principles.

Christian, in flight at the District Finals . . .

It took me a while, but I eventually noticed a pattern: It was the last of Christian’s track meets and I had just finished watching the closing races of the season. Long distance races have always intrigued me because they are lengthy enough for a narrative to develop, for a back and forth, for a test of stamina, for the dramatic come back win. But it wasn’t the dynamics of victory that caught my attention on Thursday. It was the reaction of the crowd to the various participants in the race. Predictably, the first few runners got the cheers of victory. But so did the very last runners, especially if they were way behind and struggling. We feel for the underdog, the determined “loser.” But what about those in between runners? What did they get? Wild cheers from their parents, perhaps (or sometimes suppressed disappointment). But from the crowd at large? Mild interest, half-hearted applause, if that. But mostly, they were invisible, extras to frame the exploits of the first runners and the determination of the last.

Invisibility has been on my mind since Michelle Obama mentioned the idea in her speech earlier this week at Tuskegee University. She spoke of the challenges of the African American experience this way:

“So there will be times, just like for those Airmen, when you feel like folks look right past you, or they see just a fraction of who you really are . . . the realization that no matter how far you rise in life, how hard you work to be a good person, a good parent, a good citizen — for some folks, it will never be enough.  And all of that is going to be a heavy burden to carry.  It can feel isolating.  It can make you feel like your life somehow doesn’t matter — that you’re like the invisible man that Tuskegee grad Ralph Ellison wrote about all those years ago.”


Some of the kids at the middle school track meet worked really hard, gave it everything and still did not end up receiving honor for their work. They were invisible.

That made me consider my own experience with invisibility.

The truth is I don’t have a harrowing story to tell. I cannot say I have felt invisible on account of my race for example . . . well, that’s not quite true. Quick context: I grew up in Kenya, biracial with a Scottish mother and a Kenyan father. In Kenya, there is a defined racial category for mixed people. We are called “point-fives”; you cannot deny the mathematical accuracy of that term! Connotation? Not derogatory at all. If anything, the term is used positively. At least, that was how I experienced the word growing up. So, like many biracial African immigrants, I came to America, and became “black” for the first time (One of my favorite comedians, Trevor Noah, has a great bit on the same experience!). The transition to “black” took some adjustment, but was ultimately fine, except in one area, casting.

I came to America to pursue a graduate degree in Theatre (Acting) and began to notice a trend. Directors would come up to me and say “I think you’d be great for this role” and I slowly began to notice that all the roles I’d be “great for” were black roles, that is explicitly written as black characters. Many of these roles were in fact good, but in those same plays I saw many other attractive roles that were not necessarily written as black characters. I was used to being selected for roles based on the depth and layers of the character, but now part of me was invisible. To some, I was black first, an actor second (quite the adjustment after being in an all Kenyan cast of Fiddler on the Roof many years ago. Yes, you read that right; 40 Kenyans playing Russian Jews without batting an eyelid!). That said, there have been many notable exceptions: I was cast as Jack in The Importance of Being Earnest and Pooh Bah in The Mikado by directors who recognized, but did not define, my acting by my color. I respected that.

But how did the limited view that some other directors took feel? It felt restrictive of course, but perhaps also put me in touch with certain parts of the minority experience in America in a more tangible way.

I must emphasize, though, that these challenges in no way compare to the very real, difficult and often daily experience of many in this country who are just not seen, either on account of their race, class, financial status, or position in all the races we run. But, I at least caught a glimpse of Ralph Ellison’s predicament in The Invisible Man:

“When they approach me they see only my surroundings, themselves or figments of their imagination, indeed, everything and anything except me.”

In medicine, there is an irony that it is possible to look at patients very closely, yet somehow manage not to see them. We pore over chest x-rays, dissect MRIs, scrutinize pathology slides, diligently save the finest image slices of their brains in a navigation program, yet somehow miss who they are.

So how then do we see the invisible?

There is a difference between the invisibility of an object and that of a person. A truly invisible object has some intrinsic quality that makes its presence unapparent. But an invisible person is not intrinsically invisible. That invisibility is conferred. That is what is so disheartening, that we as humans would ever choose to not see someone else. But perhaps, therein lies also the possibility for change. If we can confer invisibility, we can confer visibility. Each day can be an exercise in noticing the “middle runners.” Who is invisible to you? Who can you choose to see?