Rammy Cacked

Copyright © 2020 by David Tinling.

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Rev. date: 10/30/2020

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CONTENTS

1 Self Talk

2 Mentors

3 Men And Women

4 What If

5 Politics

6 Law Of Negative Behavior

7 Reading Eshleman

8 State Of The Union

9 Writing

10 The Long Haul

11 Prison Reform

12 The Candidates

13 Bipolarity

14 Skiing

15 A Drug To Cure Fear

16 Victoria’s Secret

17 Dumbing Down

18 Swim

19 Hiking Climbing

20 Tennis

21 Golf

22 Electability

23 Mountain Home

24 The Right Place

25 Valentines

26 Births And Deaths

27 Imprinting

28 Progressive Politics 101

29 The American Story

30 The Ghost Of Henry James

31 Psychiatry Today

32 Father

33 Reading Zadie Smith

34 Another Look At Peace

35 If

36 Living In A Frank Lloyd Wright House

37 Our Fathers

38 Varieties Of Madness

39 A Modern Medical Education

40 Let Them Eat Cake

41 Writers And Books

42 Problems With Psychiatric Care

43 First Love

44 Keep On Moving (Me And My Body At 82)

45 St Patricks Day

46 My Missing Brother

47 Hilton Head

48 Structural Change

49 Italy

50 Golf Season

51 Remembering 1964

52 Feeling Queasy

53 My Digital World

54 Aging

55 What Next

56 People In My Life

57 My Aching Gut

58 Unwritten Stories

59 American Fascism

60 Other Aspects Of Therapy

In the Tinling family to be rammy cacked was to be foiled or found out

in some poorly conceived miscalculation and brought to task for it.

SELF TALK

As I have aged I have more and more curiosity about my ancestors and regret missed opportunities to query them about their lives and their families. I wrote a book, UPSTATE REVISITED, which was in part to place myself somewhere in our family story in Upstate New York, while honoring Edmund Wilson who lived and worked in Upstate and whose family went back to the Revolution in Central New York, as did mine. I took a special trip to Newcastle in Northern England where the Tinlings came from and to the isle of Islay in the Hebrides where my maternal Grandfather’s parents came from in the 19th Century. I talked some with my Great Aunt Grace about her time working as a dietitian in a 19th Century Psychiatric Hospital in Maryland. I know very little about my Father’s Mothers family, who seem fascinating, with connections to Roger Williams, Lord Calvert of Baltimore and the Civil War. I never had a chance to talk with my maternal Grandmother about her role in the suffrage movement and how she seemed to style herself after Susan B. Anthony, who would have been active nearby when she was growing up in Upstate. My mother’s Father had three sisters who married three brothers on the Canadian prairies when single young people were a scarcity. I have never met any of them and am very curious about who they are. Enough said. Most likely each of us as we age becomes involved with the issues of aging that we had seen in our families, perhaps becoming more and more like them and curious about just who these family members were, what motivated them and their ancestors, how did they come to be the family that produced us? The enormous geography of America has dispersed so many family members that any reckoning of who they were and what they did becomes challenging and time consuming.

So it is I have come to writing something about myself, my life, my experiences, beliefs, work, friends and community, both for my sake, to screw the top off and take a look in, and to give something to my children so they can better know their Father and his background. I knew a lot of the superficial stuff about my parent’s courting in the roaring Twenties, enduring the Depression and prospering after the War, but I knew little about what that all meant to them and what had been central to each in developing their characters. One of the things that drew me to Edmund Wilson, besides his marvelous UPSTATE, was his close scrutiny of his life in his journals, decade by decade. He was the age of my Father’s oldest brother, Uncle Jack, both born in 1895, and as I read him I thought of my Father and his four brothers growing up through similar times and events. I think it deepened my understanding and respect for all the Tinling men.

I wish that I had spent more time with my late cousin, Marjorie Fisher. We had a fine reunion with her daughter’s family in Glens Falls several years ago, but not enough time to look more carefully at my Mother’s Canadian past. Her Father was my Grandfather’s oldest Brother. She could have told me so much about what the family had endured as immigrants in the 19th Century and shed more light on those who remained in the Prairies, and she was the last of her generation that I knew.

I have little interest in writing a memoir, most likely I and everyone else would find it boring with no significance to outsiders. What does feel relevant is to pick the topics that come to mind about my experiences that will better acquaint others with what has been important to me while allowing me to pull a lot of threads together in the fabric of my own life. Old age invites a summing up.

I do feel the constraints of place and would like to liberate myself in my writing from this cozy mountain home I own and live in here in Vermont. I want to be able to fly away in my imagination to the places where I have lived and with the people I have known. I want to feel the endless drizzle of the Pacific Northwest, then walk the Oregon beaches and swim and surf in Southern California. I want to return to my little German village of Nohfelden in the Saarland and stroll with my neighbors on their Sunday walks, and invite you in to the magic of my Frank Lloyd Wright Prairie house in Rochester, NY, and see if his grasp of human spaces doesn’t impact you. I will trust my memory and imagination to do the best they can to bring this all alive.

I enjoy the privacy and the isolation I have in Vermont. There are some seventy houses in my mountain development just west of Rochester, and most of them are vacation homes so that only about twenty of us live here year round. I have made no special efforts to get to know my neighbors, feeling no need for ongoing relationships with neighbors, and what connections I have had have happened because of chance and proximity. I spent a lot of time swimming in our pond when I first came here and was not yet working full time, so I got to know Hans, who was an interesting former CIA agent who had come here from Germany as a teen and then fought in the Italian campaign in the unit where Bob Dole was wounded. He and his wife Connie had me over for dinner, which was pleasant and we spoke whenever we encountered each other out walking or by the pond where he took care of feeding the trout. Hans could recall the horrific fire laid down by the German troops as the American charged up the hill and he had no idea why he wasn’t wounded like Dole in the fusillade. I have golfed once with Jeff who lives just down the hill from me. He is a pleasant, retired real estate man from New York City and I see him at concerts in Randolph. He once invited me to play bridge with some women friends of his, which I turned down, having no interest in returning to a game I gave up decades ago. His golf game was painful to watch so I have not wanted to play again with him, but if we met at the course I certainly would play a round with him. A young couple, Ted and Carol, lived across from me and he helped me out a few times and she brought over maple syrup they had made from their trees. We were friendly in passing but I am sure they had no interest in having me over nor did I in them. Later a Massachusetts professor moved in across the street and we got to know each other in our driveway encounters. She is smart and interesting to be with, so I have developed a friendship with her and she has had my girl friend Sarah and I over for dinner, while we still owe her one.

She called this morning from Eastern Massachusetts with urgency and anxiety about the cold snap up here in Vermont, and unable to reach Dennis, her caretaker, asked me, her proximate neighbor, to go over and check out her furnace. At first I thought she was another friend, a transplanted Southerner, doing her intellectual work in the Northeast. We joked a little about my misidentification and I went on over, finding her house warm after Dennis had responded, getting her auxiliary heater going. She was grateful and promised me a dinner when she would be up next week, along with a special bottle of French wine she had been saving.

This got me thinking about these two women, both lovely and very smart, and how they managed to escape their Southern families. It was probably a lot easier for me as a man to leave home. My Father studied engineering and economics at the University of Washington and Mother was a graduate in Fine Arts and both read widely and welcomed intelligent conversation. There were no cultural or regional roadblocks as we children moved ahead with our educations.

One had been inspired by her interests in the arts and exploited imaginative ways to cope with adversity and pursue education, first as a nurse, then as an artist and finally as a scientist, all the time finding that each of these areas added to her intellectual life and broadened her world of collegial work while fortifying her disciplined and hard working professional life. What was it that allowed her to say no to all the many distractions for a young attractive woman in the South. Did she have a teacher who won her over, who said there were other possibilities awaiting her, or maybe a book or certain authors who invited her to imagine alternative life narratives? It only takes one meaningful dissenter to show the way. Her first work as a nurse could have opened up all kinds of human narratives as she got to know patients who when sick and vulnerable might well reveal deep and meaningful stories, stories full of life transforming wisdom.

My neighbor, an early Renaissance scholar, has been a department chairwoman at her university, and found a way to escape the sexist torpor of her youthful Texas. I have had my own issues with Texas, spending a few weeks at Fort Sam Houston as a new Army doctor, where I found the heat and arid terrain more than uncomfortable. The shooting in Dallas left most of my friends and me never wanting to go there. Then the legacy of their governor/President was so grim that we couldn’t imagine any progressive minded person ever wanting to work there. We all but forgot about the progressive work of LBJ. I had made conceptual art and written a book about capital punishment where Texas was the unchallenged champion of executions. I now have to modify my reactions as my oldest son has been living in Austin for a few years, which seems like a modern enclave in that regressive, confederate state, although I still shudder when I see images of the University of Texas tower where that killer rained down death on several below. In addition, my good friend Sue, a gifted psychiatrist and writer, recently widowed, has returned to Texas to be near her family and her roots. She is spunky and smart, like the late Molly Ivins, our favorite Texan, and we have a rewarding correspondence.

I know much less about my neighbor. She is divorced and has two sons and a new grand daughter. She has had a battle with cancer and one of her two dogs died last year, which caused her considerable sorrow. She walks our mountain roads, up and down hills, with her surviving dog, the same hills she ran when she first moved here before the cancer. Maybe she was once a young runner and ran out of Dallas. Her parents could have been aware of her intelligence and perhaps encouraged her to go wherever she had to go to realize her intellectual goals. I think she did her undergraduate work at Rice and then came up this way to obtain her Ph. D. from Yale. I know that her father was from Minnesota, which may have been enough of a connection to the North to allow her to escape. Was it her marriage that brought her to Vermont? I think her ex is in the area. It has been the story for so many couples, me included, that the job destination of the husband determines their moves.

Both of them came of age in the Sixties. Was that it, the incredible atmosphere of change for college students back then. If you were young, curious, troubled, how could you not respond to the youthful surge of rebellion against the cultural stupidity and militarism of America? I loved my medical students in the Sixties who were committed to making the world a better place. How did both of them dress? Did they smoke weed, do mushrooms, drop acid? Imagine what some Psilocybin would have done to their magnolia blossom histories.

What about sex? Men must have pressured them. When did their active sexual lives begin and what did that mean for a young Southern woman in the Sixties? They sure as hell couldn’t talk with Mom and Dad about that and probably not even their friends.

In 1963 Betty Friedan came out with THE FEMININE MYSTIQUE. They must have read it. Did they identify as Feminists? My God, that seems so ancient now! Were they part of the effort to pass the Equal Rights Amendment? Will they both campaign for Hillary?

If they were my age, a dozen years older, I can imagine missing out on all of this. They probably would have married well, good looking and smart, and lived upper middle class lives laced with booze and Sunday services. Maybe I could invite them both over and ask them to explain themselves. I think of them as friends and intellectual colleagues. We would have some wine and light food and good conversation and see where my questions took us.

I have some questions for you. Do you realize how remarkable you are: Two lovely Southern women who escaped becoming cheerleaders and debutants? Was there an underground railroad for you, too? Did you realize along the way what you were doing? Who were your heroes? I want to know. Life was more or less easy for me: Smart, money, professional, Westerner, a man, no real hurdles. I am amazed by your journey. I’ll shut up and listen to you. Tell me how you did this. I have a daughter and grand daughter who should be listening, too.

Maybe one would say, Come off it Dave, you and your other Coastals have such a slanted notion of Southern life and such a bias against Texas, that you have constructed a myth about us, as if we escaped some manufactured tyranny. I might hang my head and confess to overlooking things I should not forget, like my good friend Terri who taught in Alabama and during the 2004 election told all of us up North to get off her back, to realize that progressive minded folks all over the South were working for a better United States. My heart wants to defer to her. Before I moved here this house was once owned by Tom Wicker, the late, former Washington Bureau Chief for the New York Times and a Southerner who came North, and could have instructed me about our internal immigrants.

MENTORS

You might think that all doctors have rigorous educations with lots of training about taking histories and listening to patients. What could be more basic to the healing arts? You would be disappointed when you discovered what a hit and miss thing it really is. How often, however, have you or a friend complained about the bed side manners of a physician, perhaps recalling a favorite family doctor who took splendid, personal care of you and your family, and who always took the time to listen to you. I can’t remember how many mentors have guided me in becoming competent at interviewing patients, able to be truly present and listening with all my brain and heart, but it has been my good fortune to have been blessed with a plethora of able teachers. By the time George Engel was supervising me I was getting pretty good. He co-authored one of the best books on the examination of the patient, with special attention paid to history taking. His group was very Rogerian in their approach, let the person tell the story and feed back bits of what was said to keep it going. Later when I taught medical students, who were usually very anxious in the beginning, often armed with a list of questions, I modeled myself as being empty headed, like a backboard, bouncing the patient’s story back at her. Of course, I wasn’t really empty headed, my noggin was full of medical knowledge and I knew what to bounce back and what to let go, but it was a good metaphor, acknowledging the patient and getting yourself on her side, facilitating a mutual experience as colleagues developing her story.

I would tape brief segments of a student interview, merely minutes, and then spend well over an hour going over it with three or four students. When you talk with young doctors from other schools you find that most of them were poorly supervised and some had no interview supervision at all. So, when you wonder about a doctor’s bedside manner, there it is.

As I got older and more doctors were inclined towards digital medicine and electronic records, I found more of them even less skilled when it came to listening and obtaining a meaningful history. Most are highly arbitrary and go after the information they want, not what the patient has to offer. I feel anxious when watching this happen, and not able to intervene when it is a colleague. I can only model it when I am interviewing at rounds with a group of doctors, nurses and others observing me. I sometimes let people know about my style, what I am up to and encourage them to look for that in the upcoming interview and then will go over any aspects they have questions about, hoping that knowing more about what I am attempting will enhance their interviewing skills.

You often see in third world physicians a very authoritarian approach: They are the doctors so the patients must follow their lead. As you watch this happen, feeling in your gut how arbitrary it is, you see the patient shutting down, waiting for the next question. We forget how patients imbue us with power and quickly figure out how to respond to us, maybe as inquisitor, hopefully as engaged helper.

I recall a second year student emptying his doctor’s bag on the patient’s bed so that she had almost no room left except in a small corner of her own space. I helped him pick up his equipment while making light of it with him and the patient. Humor goes a long way in these situations to ease tension and get back on track. So many of us providers are rigidly professional that we miss these opportunities to lighten up, which wouldn’t happen if we were with our friends or families.

Some of us have been advocating for a long time to make medicine more democratic. I learned a lot from my radical Sixties students who were infuriated by the old school, rigid, medical hierarchy. You can see that learning to follow the patient’s lead when history taking opens the door to democracy, to becoming colleagues in addressing their health, and most doctors will tell you that it really helps to have doctor and patient on the same side.

While electronic medicine may be distancing providers and patients, it is also arming patients. They can with their hand held devices walk around with their medical records, use apps to guide and monitor their health, obtain the latest information about a problem, and be an excellent and informed consumer of healthcare. In this century a lot of visits will become remote, from home or work, where people can share information about health issues without having to schedule appointments, whenever they might be available. It will become more and more a dialogue between colleagues, physicians and nurses hand in hand with their patients. With the quarantines during the Corona virus pandemic Telemedicine has been very helpful.

I can imagine that as democracy wins out that providers will want to, indeed, need to, come for training, which helps them be more open minded and democratic. It will be back to Carl Rogers, a great advocate for listening, who died in his late eighties helping black and white South Africans learn how to listen to each other. Sound fundamental principles never become meaningless, they only go out of fashion or style, to be rediscovered when circumstances open doors.

The powers of insurance companies, drug manufacturers and medical authorities have mostly operated against the democratization of health care. The Old Boys (And Girls) don’t change easily and usually come to enjoy their power. I recall the story about one renowned professor who was listening to a student presenting a case and wrote a note that he had passed on to the presenting student who opened it and read (silently) Your fly is open. The old school has a lot to learn about becoming helpful.

Meanwhile, wherever I go I am open to stories. I know my own, so I don’t always have to recite them, unless you want to know and ask. An old philosopher friend of mine, with an international reputation, never spoke about himself or his ideas. He was the most curious friend I ever had, always asking others what they thought or how they viewed something. When I truly realized that he deeply felt no need to hear his own story over and over again, then I understood the profoundly human possibilities of his stance, which seemed idealistically Socratic. Think about it. We all know what we think and we don’t know much about what others think unless we inquire.

So what do you think? Who listens to you? How do you go about asking? What if that opens up doors to feelings, emotions, or tears? I recall watching our President cry as he discussed children killed by gun violence. He was the leader of the Western World. When you deeply, seriously open yourself up and listen, you better be prepared for your heart to lead the way.

MEN AND WOMEN

I saw a Lisette Model show in Ottawa several years ago and recall a photograph of an elderly couple standing under a banner celebrating their fifty years together, but their weary, joyless expressions made it appear that their golden anniversary was likely to be their last, so caved in upon themselves were they, that they seemed ready to topple over from a little push. Margaret Mead when questioned about her three marriages, with the interviewer saying something sympathetic about failing marriages, was quick to point out that she had three wonderful marriages and when they were over they were over. This seems more like many of our lives as we enjoy longer life spans and find ourselves in several relationships over the years. I have heard many people say they would find it very difficult to be with the same person for a lifetime, a view I am completely in agreement with, imagining several long chapters with new and different characters.

I have been with the same woman for over ten years. We have done some fascinating brain work together, enjoyed our time in galleries, raised a fine dog, swum and skied. She was the best friend of my lover, Char, forty years ago, so she and her daughters became friends of mine. She came to a graduation party for my daughter long after Char and I had separated, with her new husband and was quite pregnant with her last daughter. She has a good friendship, as did Char, with my daughter.

That doesn’t mean I don’t see other women, but it is a rare lunch or gallery or concert event with a friend, nothing more, a good time with no hint of sex, just as my companion spends time with her old friends. At our age it seems the reasonable thing to do, especially when we value our decades old friendships. In fact, I am at a point where most of my decades old male friends have died off and it seems that the fact that longevity is given to women envelops me with older women friends, almost exclusively.

My first experiences with losing a relationship may have set me on my way to be careful, to placate, to do what I could to avoid loss. My high school sweetheart in Portland, my first love, was going to college in the Bay area and I was heading north to Seattle. She made it clear that she wanted to date Stanford men and gave