I was entranced by an essay in Emergency Physicians Monthly. It’s an oral testimony by Dr. Kevin Menes, who was in charge of the emergency department of Sunrise Hospital in Las Vegas the night Stephen Paddock opened fire on a concert.
Menes’ description of what happened that night is dry, methodical and compelling, and it deserves the first of this second batch of the year’s Sidney Awards, which I named for the philosopher Sidney Hook and given for outstanding long-form journalism.
More than 200 patients arrived that night at Sunrise Hospital, sometimes piled five or six at a time in the back of cruisers, ambulances and pickup trucks. Menes had to decide who was “dying now, in a few minutes or in an hour.” He tagged each, from red to green.
“Some were shot in the neck or shot in the chest, but they were still awake and talking to me. These went into my orange area because I knew that I probably had 30 minutes before they crashed. … It was important to get the red tags into the operating room because the orange tags would start to crump and become the next red tags.”
It’s nearly impossible to write an essay capturing an entire region’s culture and feel, and it’s doubly hard if that region is as sprawling as the Midwest. So Phil Christman gets a Sidney plus for his essay “On Being Midwestern” in the consistently splendid Hedgehog Review.
Christman notes that the early settlers were fanatically devoted to education. The grid road pattern one sees across the Midwest was laid out so that children would grow up no more than 1.4 miles from a schoolhouse.
He also observes that the Midwest is always held up as the definition of normal America. “What does it do to people to see themselves as normal?” Christman asks. One thing it leads to is a certain self-repression. “Any emotion spiky or passionate enough to disrupt the smooth surface of normality must be shunted away.”
Caitlin Flanagan’s “Death at a Penn State Fraternity” from The Atlantic describes the death of a fraternity pledge during hazing: “After Tim Piazza fell, four fraternity brothers carried him, unconscious, to a couch. He was in obvious need of medical attention, yet the fraternity brothers treated him with a callousness bordering on the sadistic. They slapped him and punched him, threw his shoes at him, poured beer on him, sat two abreast on his twitching legs.”
But the essay is really about how the whole system closes up around the incident, refusing to see it and deal with it.
In “The New Class War” in American Affairs, Michael Lind points out that by the time of the Great Recession, 95 percent of microprocessors were manufactured by just four companies. Two-thirds of the glass bottles in the world were made by just two firms. In 2007, two firms controlled 86 percent of the global market in the financial information industry. Sixty percent of the tires in the world were made by just three companies.
These oligarchs spend a lot of their effort not in enhancing productivity but in playing nation-states off one another in search of tax breaks and subsidies. If any nation threatens to enforce a basic social contract, the companies threaten to move offshore.
This situation has sparked a populist uprising, but “when populist outsiders challenge oligarchic insiders, the oligarchs almost always win.” The result is rule by a banana republic elite. Many of us were raised to believe that political and market competition would produce mostly benign results. Lind describes a world of relentless economic warfare. He may not be right, but his sprawling essay is provocative and essential.
To finish on a hopeful note, let’s return to medicine and Atul Gawande’s “The Heroism of Incremental Care” in The New Yorker. He contrasts the heroic mode of medicine, in which the surgeon swoops in and performs some miracle procedure, with the humbler and more incremental medicine practiced by primary care physicians who see the same patient consistently over years, who prescribe a steady beat of small changes to gradually treat conditions like migraine headaches.
In the end, Gawande concludes that the incrementalist physicians probably have a greater impact on public health than his own, “heroic” surgeon type. It’s a lesson we could learn in politics, too.
— David Brooks is a columnist for The New York Times.