You have no items in your cart. Want to get some nice things?Go shopping
Last week, I called the main hospital in Marietta, Georgia, to ask how many ventilators they have. The call was rerouted at least seven times, and I ended up being transferred to a voicemail in the patient relations department. I did not leave a message. I called again and was rerouted five times until I was back to the same operator who initially took the call. In New Jersey, where I grew up, we call this “the runaround.”
My purpose in making this call was to conduct a small personal experiment. A few days earlier I had tried unsuccessfully to find this information on the hospital’s website. I asked myself, what if I call and ask the question as a citizen who lives less than a mile from the hospital – a citizen who will likely end up there if I develop a serious case of COVID-19? My hypothesis was that the hospital would not easily share this information. I was correct.
This story illustrates the power dynamics underlying my relationship to Big Medicine. The hospital is part of a regional chain in Georgia, and because my primary care physician is also a doctor in their network, I am already an e-chart in its “system.” This chart is full of notes and test results from my doctor, and in the unfortunate event that I contract a severe case of COVID-19, she will refer me to that imposing cluster of buildings about a mile away from my house. My file will follow me as I disappear into the hospital – all very efficient and digitally advanced. Of the hundreds of nurses, doctors, and staff working there, I will know no one. I will exist only to the extent that my file has been attached to my body with one of those paper wristbands with a barcode.
I may not walk out alive.
Because of COVID-19, the hospital has very recently taken on a grim existential countenance. On any given day, the possibility of death always radiates from this space – a weird low-intensity glow around the base of what is otherwise a tower of salvation and good health. You come here for the heart valve operation that will save your life, to take swimming lessons in the Olympic sized pool, to get stitched up after slicing your hand with the tomato knife. Death is a possibility but not the main expected outcome. The pandemic, however, has re-signified this space. If I am sick with COVID, I may find myself here, cared for by medical professionals suited up to handle me as if I am a leaking bag of biohazard material. This is the kind of place where thousands of people a day are dying all over the country, alone and surrounded by strangers wearing plastic shields over their faces.
I was fortunate as a child to grow up in a small town in New Jersey, and for the first twenty years of my life, I had a family physician, Dr. Robert Pierce – a WWII Navy veteran who practiced family medicine for fifty years. He knew everything about my medical conditions and physical health. If my parents called his office on the phone, they were very likely to speak to him directly. He was accessible. He was real, tangible. My family had a relationship with him, and as a consequence, our relationship to medicine was a personal one.
This relationship was also local. I could walk to his office from my house in about twenty minutes. His office was in his home, in one of the old Victorian houses on Center Street. If I close my eyes now, four decades past, I can still pace out the dimensions of his waiting room. I can list the magazines on the coffee table and describe in detail the illustration of animals streaming into Noah’s Ark from the Children’s Bible that was always there.
I could describe the scope of his capabilities. He stitched me up once after I wrecked my go-kart. He treated my recurring bouts of strep throat and once remarked that my tonsils looked like the surface of the moon from all the scarring. He helped my parents figure out my allergic reactions. They trusted him. He delivered my sister in the local hospital. I trusted him too.
If he were my doctor now, I would call him on the phone to ask questions about COVID-19. His assistant would hand the phone to him as she did when my parents called decades ago. I would ask him how many ventilators are in the local hospital, and he would tell me in his direct, candid, no-nonsense manner.
He would also very likely tell me to wash my hands often and practice social distancing. He would take the time to explain how vaccines are made and how long the process takes from initial research to actual vaccination shots.
The Dr. Pierce approach – hands on, knitted into the community, a known quantity – is an anachronism now. His brand of medicine has gone the way of the blacksmith and the typewriter. Instead, most of us share the experience of being ushered into an examination room only to wait twenty minutes for the doctor to arrive – the doctor you have seen dozens of times who will nevertheless stand at the door for a minute examining notes on a clipboard before he or she enters the room. When I was younger, I thought the pause at the door allowed the doctor to quickly review the notes from the nurses pre-exam – and maybe that is true – but when I was older, I realized that my doctors were also reviewing my basic information – name, date of birth, hometown, etc. I once had a doctor who would always ask me questions about American literature because I had once brought a copy of Moby Dick with me to his office while I was studying for my doctoral comprehensive exams. I was impressed that he remembered this detail about me from one visit to the next. But then I saw him in Costco once and waved to him from the other end of the aisle. He squinted at me briefly and then walked away. He did not even know who I was, and then it struck me: he probably had the words “Moby Dick” written somewhere in his patient notes to remind him of who I was.
It isn’t just medicine that looks like this. We are all at the mercy of big systems now – the supply chains that stretch halfway across the globe that were designed by industrial engineers you will never meet using opaque algorithms that you will never understand; the fortress-like meat-packing plant in Nebraska whose employees have just been declared “essential” under the Defense Protection Act by a President you have only ever seen on TV; the company whose name you have just learned that pays people to deliver groceries from Costco to your front porch in the trunks of their cars. For all the heartwarming stories on Twitter this month about DIY mask-making and mutual aid, the pandemic has reinforced my suspicion that most Americans have become more vulnerable to harm then we were decades ago – less in control of our lives and more dependent on systems that render us powerless.
The classic example of this vulnerability in the face of big systems is our access to food. The supply chains and food production capacity of the US are so complex and far flung that the average American has been reduced to a mere consumer within the system. We whip out our credit cards at the end of the process and pay. That is our role.
Sometimes when I raise this concern, well-educated, thoughtful friends will respond with eye rolls. The system works, they will argue. Food is cheap and plentiful. Everyone eats. You’re looking for problems where none exist.
But preventing starvation is not the only yardstick for measuring the success of our access to food, as anyone in the local food movement will tell you, Americans do not flock to farmers markets because they are hungry. The farmers market is popular because it engenders relationships with food that are absent in the produce aisle of a chain grocery store. You can meet the people who grow your tomatoes. You can ask them questions. You can buy tomatoes that were picked that day or the day before, and shake hands with the people who picked them. You will likely see your neighbors, say hello, grab a cup of coffee to catch up.
As a writer, I have searched for the right language to describe my current sense of unease. The words “estrangement” and “alienation” come close. “Alienation” is an anachronism among intellectuals now, having fallen out of favor since the 1970s, but I should like to drag it back up into the light and reinvest it with the power and signification it enjoyed in the ’60s, when – at its apex – it described for many the basic condition of life in America. Historian Martin Jay has written of the rise and fall of “alienation” as a term of social critique, “After the Second World War,” he argues, “alienation came to betoken a near-universal spiritual and psychological malaise.” Postwar intellectuals like Sartre and Camus popularized the concept, and in the 60s, it found mass appeal as a sweeping critique of the modern condition.
Who was to blame for all of this alienation? There were many targets. For fans of William H. Whyte’s The Organization Man, it was the bland conformity of corporate America which valued a servile collectivism over strong individuals. For anarchist Paul Goodman writing in the countercultural classic Growing Up Absurd, it was the failure to provide the youth with a healthy society: “Modern times have been characterized by fundamental changes occurring with unusual rapidity,” he wrote. “These have shattered tradition but often have not succeeded in creating a new whole community. We have no recourse to going back, there is nothing to go back to.”
My favorite articulation of alienation from this period comes from Mario Savio, the student organizer who electrified crowds during the Berkeley Free Speech protests of 1964:
There is a time when the operation of the machine becomes so odious, makes you so sick at heart, that you can’t take part; you can’t even passively take part, and you’ve got to put your bodies upon the gears and upon the wheels, upon the levers, upon all the apparatus, and you’ve got to make it stop. And you’ve got to indicate to the people who run it, to the people who own it, that unless you’re free, the machine will be prevented from working at all!
The Machine. The Establishment. The Organization. Cold, depersonalized metaphors for a structure of human society that, despite its rhetoric to the contrary, values neither free individuals nor healthy small communities. Arrayed against this chilly monolith was the individual human in a state of disillusionment – freaks, queers, hippies, hipsters, beats, back-to-the-landers, blacks, chicanos, denizens of a thousand communes and alternative communities … people with bodies that could be broken as they are thrown up against the gears and upon the wheels.
It is a strange form of myopia, I think, that has made intellectuals shrink from this word even as Reaganomics and the New World Order Neoliberalism were baking alienation into the very DNA of American life. Jay observes that the word “alienation” enjoyed a fifteen-year ascendency in the culture, beginning in the late 1950s and fading out in the 1970s. The timing does not surprise me. This was roughly the period in which the first generation of children to grow up in the atomized, circuit board-grid American suburbs was coming of age. Plainly speaking, these kids revolted against the system.
Sebastien Junger wrote this in the introduction to his excellent book Tribe:
It [the book] is about what we can learn from tribal societies about loyalty and belonging and the eternal human quest for meaning. It’s about why – for many people – war feels better than peace and hardship can turn out to be a great blessing and disasters are sometimes remembered more fondly than weddings or tropical vacations. Humans don’t mind hardship, in fact they thrive on it; what they mind is not feeling necessary. Modern society has perfected the art of making people not feel necessary.
Junger touches the taproot of the human psyche, the fact that we evolved to live in small interdependent groups and consequently, the modern systems we have created to make our lives safer, more efficient, and more comfortable also alienate us from the primal need to belong, to matter, to be important to others. In moments of extreme crisis, humans long for this primal state again. Sometimes we find flashes of it through volunteering and mutual aid – the thousands of people who streamed into Manhattan after 9/11, for instance, or the people today bringing hot food to first responders in their community. Disasters crack open the system, suspending its norms of trained vulnerability briefly to allow spontaneous eruptions of from-the-ground-up humanity to flourish.
But sometimes the crisis also exposes the baseline vulnerabilities of the system in crushingly painful ways. One obvious example from modern history is Hurricane Katrina, which left thousands of poor, mostly minority people stranded on rooftops in New Orleans and crammed into the fetid, smashed up Superdome awaiting rescue. Sadness descends in these moments, and shame perhaps for what we have tolerated, abandoned, and lost in the collective quest to create this society.
The saddest COVID-19 stories by far are the ones told from outside nursing homes. The woman who cannot get inside to comfort her husband of fifty-eight years. The folk duo performing a concert on the lawn outside. The woman standing outside of her grandfather’s nursing home touching the window to show him her engagement ring. It is here, at the literal physical boundary between old and young, that we see the true depth of American alienation. Among its most dubious accomplishments since the end of World War II, the U.S. became the world leader of the nursing home and the assisted living facility. In doing so, we have smashed norms that stretch back into prehistory – the multigenerational household, the extended family, the respect for elders that is a feature of most tribal societies, the previously unassailable value of passing knowledge and wisdom from the oldest to the youngest.
Defenders of our social system will argue that abandoning these small-scale human tendencies was the price we paid for modernity. They will say, A tribal society could never have invented the Internet, or The kind of knowledge required to land a vehicle on the moon (or a missile on the house of an enemy) could not have been passed from grandfather to granddaughter. But these arguments are made retrospectively, after the tribal societies that lived in North America for thousands of years were conquered, colonized, culled, and subjugated. After we structured a society based on immigration that encourages immigrants to quickly forget the most counter-consumerist values of the “old country,” where extended families, interdependence, and frugality were the norm. There was never a serious conversation about how we could incorporate the best aspects of tribal and “strong-group” societies into the new one we were building in North America.
I am not entirely certain why I called about the ventilators. I know full well that most hospitals are black boxes with PR departments and lawyers and layers of bureaucratic regulations walling off information from within. What was I hoping to learn? Maybe it wasn’t information I was seeking, but the reassurance of a human voice on the other end of the line. In the era of Big Medicine and Big Everything, many of us keep reaching for Dr. Pierce but we can’t quite find him.