Science, Fiction, Life

Category: Uncategorized (Page 1 of 4)

The Gallbladder Saga: Epilogue

Just a quick follow-up to my post from last year. The good news is that my digestion has fully recovered from the gallbladder surgery! I can eat whatever fatty garbage foods I want with minimal issues.

The less good news is that one of the small incisions from my surgery never quite healed right. It took many visits to the surgeon’s office and then the dermatologist to finally get it to close. It continued to cause problems even after that: the scar itself would flare up and become intensely itchy, and I started getting itchy spots elsewhere on my body.

Last fall, I had an awful flare-up associated with getting sick, where my hands broke out in unbelievably itchy blisters like poison ivy, and I had many itchy spots elsewhere on my body. The dermatologist gave me some steroid shots and creams to keep things under control, but since then I have basically always had a handful of itchy spots somewhere on my body. Usually not too bad, but not ideal!

I don’t know why the scar didn’t heal properly, but it seems to have put my immune system on high alert, causing itchy spots to appear all over, especially if I get sick.

After exhausting all other options, today we final took the nuclear option: The dermatologist just excised the whole scar. I have a brand new, much larger wound, but the hope is that this time it will heal cleanly and let my immune system calm down!

The Gallbladder Saga: Part 1

On May 10, 2024, I am having surgery to remove my gallbladder.

It has been a long road of figuring out symptoms, trying to rule out other causes, learning, and indecision. Writing this all out is a way for me to process everything, to tell friends and family what’s going on, and hopefully provide useful information for others out there who may be in a similar situation. This is going to be long, but hopefully interesting and useful to someone.

I am NOT an expert, I’m just a scientist with gallbladder issues who has read way too much about this stuff to satisfy my own anxiety/curiosity. Please talk to a doctor if you are having similar problems.

Before we get any farther: heads up that this post will include frank discussion of digestive symptoms, medical conditions, and generally gross body stuff that some may consider to be Too Much Information. I’ll try to keep it relatively tame, but if you don’t want to read about this sort of thing, stop now!

History and Symptoms

I would start at the beginning, but it’s unclear when exactly that was. For many years I have occasionally suffered from very painful digestive symptoms. The first of these “attacks” that I remember occurred on November 6, 2012. I recall the exact date because it was election day. I was driving back to Arizona from California where I had been doing operations for the Curiosity Mars rover. It’s a long drive, so I spent the day sedentary in the car and eating fast food. That evening at home, as election results were coming, I was lying on the floor suffering from what I thought was a painful bout of gas.

Over the years this would happen occasionally with varying severity, and each time I just figured it was bad gas. I usually could (and did, and do!) eat whatever fatty food I wanted, but sometimes when I ate a large/heavy meal, especially if that meal also included a few alcoholic drinks, and especially if I was mostly inactive that day, I would end up triggering what I now know was a form of gallbladder attack.

Part of why it took so long to figure out what was happening is that my pain is usually not easy to localize. Often gallbladder attacks are described as a sharp stabbing pain in the upper right abdomen right where the gallbladder is. For me, it starts with “epigastric” cramping across the front of my abdomen, under the ribcage. As the intensity ramps up, the pain spreads to the upper middle of my back, like the muscles between my shoulder blades are extremely tense but no amount of stretching or rubbing can relax them. Often, it’s the inexplicable upper back tenseness that really clues me in that an attack is coming. There’s an irresistible urge to move, walk, stretch, anything to find a comfortable position, but there is no comfortable position. At the peak of an attack, I’m rolling on the floor, sweating, shaking, and generally miserable. During my worst attacks, my hands and arms went all tingly. The only things that slightly help are walking and a hot shower or bath. And to further confuse things, the attacks don’t just feel like gas, they are accompanied by gas and bloating. They tend to occur in the evening and last most of the night (one memorable attack had me awake and wandering the neighborhood moaning in pain like some deranged zombie all night on Christmas eve), subsiding in the morning. After an attack, it tends to take a day or so for my digestion to normalize. It’s almost like whatever happens completely shuts down my digestive tract and it needs time to reset and start working again.

A few years ago the symptoms were happening often enough that I changed my diet, cutting out all alcohol for several months, and switching from bagels and cream cheese to raisin bran for breakfast. This seemed to help, and even now that I do drink alcohol again, I usually only have problems once or twice a year.

In the last couple of years, I’ve also started to have symptoms of reflux. Often not traditional heartburn, but when my stomach is full and I do something like a plank or bend over or exert myself I can feel my stomach contents “overflow” and start moving up my esophagus. Rarely, after a really big meal, I’ll sometimes wake up at night on the verge of vomiting, but without nausea. Just… overflowing. (I know, it’s weird and gross) For a long time I’ve also often had to clear my throat a lot after eating (my dad does this too, so it’s likely some combination of our particular biology and learned behavior). Recently I’ve noticed that I need to do it more and that I’m increasingly prone to losing my voice if I talk a lot. Altogether, my reflux symptoms are most consistent with something called “silent reflux” or laryngopharyngeal reflux (LPR).

It’s unclear if this reflux stuff is related to my gallbladder issues or not but I’m quite curious to see if it changes after surgery.

Doctors and Tests

For a long time, I didn’t really go to the doctor, ever. I was young and healthy and didn’t see the need. But I’m almost 40 now, so last year I finally set up an appointment to establish care with a general practitioner. At the appointment, as I discussed my health history with my doctor, I mentioned these rare but severe bouts of pain. I said that I was pretty sure they were just gas, but figured it was worth mentioning. He ordered blood work and an abdominal ultrasound just to be safe.

At my follow up appointment with him after the ultrasound, he said (I didn’t actually get to see the images at this appointment) that it had come back showing “gallstones” and that he had referred me to a surgeon. This was shocking to me and seemed awfully drastic for something that only occasionally bothered me, so I told him I’d like to wait and see. (He also apparently had sent me a message that I missed about the gallstones and surgeon referral, so at the actual appointment I learned of all this from a casual remark along the lines of “So, you saw my message about the gallstones and the need for surgery…”) He agreed with holding off on surgery but recommended that I talk to a gastroenterologist about both the gallstones/abdominal pain and the reflux.

At the gastroenterologist, they listened to me describe my attacks, and said that it sounded consistent with gallbladder issues. (I have since learned that a whole host of GI symptoms can end up being gallbladder related.) They ordered two additional imaging tests to figure out what might be going on. The first is called a hepatobiliary iminodiacetic acid (HIDA) scan, and the second was an upper GI x-ray series with air contrast. I’ll describe the HIDA scan below, but first let’s review some basics.

What is a gallbladder? What is a gallstone?

The gallbladder is a small organ that sits just below the liver, in the upper right part of the abdomen. It’s a small sac (normally about 4 cm by 10 cm when full) that acts as a reservoir for bile, the chemical produced by the liver that helps break down fats in your food. When you eat a fatty meal, as that fat enters the upper portion of your intestines (the duodenum), it triggers the release of a hormone called cholecystokinin (CCK). CCK tells your gallbladder to contract, releasing bile through the bile duct into your duodenum to break down the fat.

BruceBlaus, CC BY-SA 4.0 https://creativecommons.org/licenses/by-sa/4.0, via Wikimedia Commons

Most gallstones form when the bile in your gallbladder contains too much cholesterol (which can occur for various reasons) and it essentially crystalizes and precipitates out as a solid. Some gallstones are “pigment stones” and are formed from bilirubin and salts that occur in bile. These are less common than cholesterol stones.

Gallstones cause problems because they block the bile duct, so when your body tells the gallbladder to contract, it does, but nothing happens. So it tries harder, and harder, essentially going into a self-destructive muscle spasm, and then you’re in excruciating pain. Small stones can actually get lodged in the bile duct, or even end up blocking the liver or pancreas which is a life-threatening emergency. Likewise, the gallbladder can become necrotic or burst, which is also life-threatening.

Larger stones are too big to fit through the bile duct (which is normally pretty tiny, just a few mm), so in some ways are safer than small stones, but can cause chronic inflammation of the gallbladder that can lead to significantly increased risk of gallbladder cancer, especially for stones larger than 3 cm.

Usually, gallstones are diagnosed via ultrasound. They can also show up in x-rays and MRIs. Many people have gallstones that don’t cause any problems at all, but once they start to cause problems, the problems generally don’t go away.

What is a HIDA Scan?

A HIDA scan is a test that lets doctors see how well your gallbladder is functioning. It uses a radioactive tracer (technetium-99) that is injected into your bloodstream. The tracer is incorporated into a chemical that is processed by the liver and passed into the gallbladder in bile. The tracer emits a small amount of gamma rays that easily pass through the body and can be detected and turned into an image of your gallbladder.

Before the scan I was told not to eat anything so that my gallbladder would be full of bile. The scan usually has two parts. First, they inject the tracer and you lie still on the scanner (basically a firm bed with a large boxy device above your abdomen) for about an hour. This lets the tracer get passed from your blood, through the liver, into the gallbladder.

Next, you are given something to trigger the gallbladder to contract. For me, they used an injection of CCK. I’ve also heard of some places that just have you drink a fatty drink like Ensure.

Triggering the gallbladder can cause an attack, especially if you have a stone blocking the bile duct. I was worried I would be in excruciating pain, but for me it wasn’t as bad as a real attack. I felt a sort of fluttering feeling as the gallbladder contracted, followed by nausea and tightness and discomfort similar to my attacks but maybe 10% as bad. This lasted for about 10 minutes and then subsided.

By measuring how much signal is coming from the gallbladder before and after triggering it to contract, the radiology technician calculates the Ejection Fraction (EF). Basically, how much of the bile in your gallbladder gets squirted out when it is told to do its job. Generally an EF of less than 35% is considered low, and can be reason to have surgery even in the absence of stones.

Recent research is also starting to suggest that an EF that is too high (“hyperkinetic”) can cause problems. Basically, your gallbladder overreacts and spasms when stimulated, dumping too much bile and causing pain and inflammation along with other digestive issues. The threshold for what is considered “too high” an EF is not well defined, but generally around 80%.

One thing I learned in reading about it is that there’s a pretty large uncertainty in the EF measurement. Many people get hung up on the precise number but often the more important thing is not what the EF number was, but whether the scan replicates your symptoms. If you have issues when your gallbladder is stimulated to contract during the test, it stands to reason that your gallbladder is likely the problem.

What nobody told me was that the gallbladder activity triggered by the HIDA scan can cause digestive issues for a day or two afterward, even if your gallbladder appears to be working properly. I felt odd the rest of the day after the scan, not exactly painful, not exactly nauseated, but “off” and restless and uncomfortable. That evening, I had a mild attack with my usual epigastric and upper back cramping feeling and restlessness. That was the first time I really thought maybe my symptoms were gallbladder and not just gas.

I reported my mild attack to my gastroenterologist, and a couple days later she called back with my results. My EF was 79%, which is considered normal (but is borderline hyperkinetic; many doctors are not current on the literature and/or don’t believe that biliary hyperkinesia is a real thing). But in particular because the scan and its after effects replicated my symptoms, she recommended surgery and referred me to a surgeon.

Is surgery the only option?

At this point I was getting super stressed out. It seemed like all signs were pointing to surgery for this thing that I had thought was a non-issue and almost didn’t bother mentioning to my doctor. It seemed very drastic to remove an organ from my body when it hardly ever caused problems, and the casual way that doctors seemed to just automatically jump to surgery really bothered me. I know it is a routine surgery (more than 1 million cholecystectomy surgeries are done in the US every year), but it’s not routine for the individual having the surgery!

I started compulsively reading papers about gallbladder issues, pros and cons of surgery, alternatives to surgery, etc. I joined online communities on Reddit and Facebook to learn more about whether surgery was really the only option, what to expect if I did go ahead of surgery, etc. There is a ton of interesting and useful information out there, but the social media communities also tend to self-select for people who have more complications: people who get better tend not to stick around. So although I learned a lot I also did not help my anxiety about surgery.

The general medical consensus seems to be that since you don’t really need your gallbladder to live, removal is the best treatment option if you have symptoms. Once your body starts producing stones, it’s likely to keep doing so until you have an emergency, so it’s better to do the surgery electively than risk a necrotic gallbladder or pancreatitis and emergency surgery. There are treatments that can help to dissolve stones if they are small and non-calcified, but the impression I got is that those treatments are still usually just delaying the inevitable.

There’s also a lot of conflicting information out there about the long term effects of removal. Some sources will say that you can basically go back to normal and eat whatever you want immediately, others say that you likely will end up having to make long term changes to your diet (but because those changes tend to be toward healthier eating anyway apparently it’s all fine?). Some people suffer from long term effects such as pain, diarrhea, reflux, gas, etc. collectively called “post-cholecystectomy syndrome” but it is unclear how many of those cases are directly related to the surgery and how many are due to other issues.

A rant about medical imaging

I was wracked with indecision and decided I needed more information, so I set about trying to ask the radiologist’s office to provide me with the actual imaging and radiology reports from my ultrasound and HIDA scan so I could see for myself. (I had not yet done the upper GI x-ray because, frustratingly, the gastroenterology office referred me to a place that doesn’t do that particular imaging. We had to go back and forth several times, with them asking me why I hadn’t done the x-rays yet, and me telling them that they needed to refer me to a place that actually does the imaging they were ordering.)

Of course, the radiology office’s website was broken and they had no patient portal. I called them several times and followed their phone tree to try to request my medical records, but just got a voicemail box that never responded. Finally, I just pretended that I was trying to make an appointment until I got to a real live person, who took my request and passed it along to their medical records people.

Medical imaging is amazing. The quality of the images and the fancy tools used to analyze them are just fascinating to me as a scientist who analyzes data and writes analysis tools for a living.

Given how advanced medical imaging technology is, you can understand why I was shocked that the only way to get a digital copy of the images was on a CD. I have not had a computer with a CD drive for probably 10 years. When they handed me the CD, it had a post-it note with instructions for how to access the files using a built-in image reader on the disk. Sounds great, right? If only I had a way to read the disk…

My wife took the CD to the library, where she was able to use one of their old computers with an optical drive to copy the files over to a USB drive. With the USB in hand, I booted it up and opened the image reader. Here’s what it looked like:

Very user friendly for English speakers!

That’s right, the tool was in Japanese. Not to be deterred, I opened up Google translate on my phone to see if I could just struggle through the Japanese interface and see my darn images.

But not only was the tool in Japanese, it also could not find the images. Navigating through the disk directories on my computer, there were files there, but nothing recognizable as an image.

I almost gave up, but in my frustration I posted about this on Facebook and a friend of mine came to the rescue. She suggested that I try a free medical image reader called ONIS. Amazingly, it worked and I was able to export my images as JPGs!

It really boggles my mind that this is how medical images are shared with people. I am a scientist and I figure out how to read and work with weird data formats for a living, and I was barely able to access the images. They’re shared on obsolete physical media, with a viewer that is not in English and also does not actually work to view the images. It’s just unbelievable.

What the images showed

I was shocked when I looked at the ultrasound report and the associated images. When my GP said that I have “gallstones” I figured we were talking grains of sand. Maybe gravel-sized. I do not have “gallstones,” I have GALLSTONE. Specifically, to quote the radiology report that came with the ultrasound images, I have “a dominant 3.3 cm calcified stone within the fundus of the gallbladder”.

Recall that a normal gallbladder is only about 4 cm wide and 10 cm long. That means I have a stone that is taking up a significant portion of the volume of my gallbladder. Just take a look at this image:

There’s, uh, not a lot of room in there! Note the dark shadow behind the stone, indicating that it is reflecting all of the sound waves. I think this is how they know it is calcified. I added a picture of a US quarter for scale.

I was really struggling to wrap my head around how big a 3.3 cm stone really is, so I put together another picture, comparing a 3.3 cm circle to other familiar objects:

I still can’t believe there’s a stone this big inside me right now.
Sometimes things are easier to understand in meme form.

(As an aside, the ultrasound was a full abdominal ultrasound, so they also checked out my other organs. It’s kind of weird and neat to have pictures of my liver, kidneys, pancreas, spleen, and aorta.)

The HIDA scan results were also interesting. As I mentioned before, despite the apparently enormous gallstone, my EF was 79%. You can see in this first image how they calculated that number:

The picture on the lower left shows the area that they used to measure the signal from my gallbladder (red) and the area they used to measure the background signal (green). The graph on the right shows the gallbladder signal decreasing by 79% over a period of 15 minutes.

Here are the individual HIDA scan images. They form a time lapse showing the tracer moving from my gallbladder into the duodenum:

By comparing with the previous image, you can see that the gallbladder is the faint blob on the left hand part of the image that fades over time as the gallbladder empties. The darker blob is the tracer in the duodenum – apparently some had already left the gallbladder prior to the CCK.

The Upper GI X-Ray

I’ll just briefly talk about this because it didn’t show anything remarkable. This test’s full name is Upper GI X-ray series with air contrast and upper bowel follow-through. It has a few parts. First, you drink a barium slurry while standing up and they take x-rays, next, they lay you down and have you drink to see if your esophagus works ok without the help of gravity. (Barium is opaque to x-rays, so it lets them take pictures of soft parts of your body like your digestive system that normally wouldn’t show up in an x-ray.) Next, you swallow a mouthful of what the x-ray tech described as “super pop-rocks” (based on the taste, I think it was citric acid and baking soda). This makes bubbles in your stomach (they tell you to try not to burp) which, combined with some barium slurry in your stomach, makes it easier to see how your stomach walls are doing.

Next you have to drink a really large amount of the barium stuff. It’s thick and weird but not too bad. Then they take pictures every 15 minutes for an hour or two and watch the barium move from your stomach through your small intestine. Finally, when it has gone all the way through your small intestine, they do some final images. This last part was extra weird because the radiologist comes out with a big plastic paddle with an inflatable rubber ball on the end, and he firmly pokes and prods your abdomen while more x rays are taken. (They use the paddle so that his hands don’t have to be in the picture.)

I don’t have the images from this test yet (they’re mailing me another CD…) but they were very cool to see on the screen. Like the ultrasound, it’s just kind of neat to have pictures of my own guts and bones. The radiology report said that everything looked ok, except that my big fat gallstone showed up on the x-rays (more evidence that it is calcified). So as far as we can tell, there’s nothing else going on other than the gallbladder issues.

Another small rant

I also want to mention the astonishing lack of communication between medical offices, and with patients. I am 99% sure that my GP didn’t tell me I had an enormous gallstone because he didn’t know. My suspicion is that the radiology office just sent the written report, which was read by someone other than my GP at his office, and he was just told the diagnosis: cholelithiasis (gallstones), which he relayed to me.

When I went to the gastroenterologist, they did not have the ultrasound results. When I went to the surgeon for consultation, he did not have any of the imaging results. Each time I had to verbally describe the situation to bring them up to speed.

I also have not yet been able to be seen by my gastroenterologist’s office yet since my initial visit where they ordered the HIDA scan. First the follow up was delayed because they kept ordering the x-rays from a place that doesn’t do them. Then the follow up appointment was canceled and rescheduled twice because they kept making appointments for me to speak with someone who is not on my insurance. This last time they canceled, they tried to book me an appointment in June and I had to flat out tell them (remember, their office is the one that referred me to surgery) that I am having surgery on May 10, and that I want to talk to a gastroenterologist before I have an organ removed from my body. They are squeezing me in to see the actual doctor on May 6.

More Symptoms

Since the HIDA scan and discovering the magnitude of my gallstone, I’ve been hyper-aware of every little ache and pain and discomfort in my body. I am not sure how much is just psychosomatic and how much might be related to either the HIDA scan irritating my gallbladder, or just my condition getting worse, but I have started to notice a more persistent discomfort in the upper right quadrant.

Earlier this month we took a road trip from Arizona to Texas to see the eclipse (which was spectacular). I normally don’t have to watch my fat intake but I also don’t normally eat fast food for every meal. A couple days into the trip I had my first real attack in over a year (if you don’t count the HIDA scan). In a hotel room, trying not to wake the kids, unable to leave them alone in the room to pace around the hotel: not my preferred place to have a gallbladder attack.

I had another attack shortly after getting back from that trip, and have generally been having more symptoms since. There’s a persistent ache or feeling of pressure where my gallbladder is. Sometimes it feels more like a bruise, combined with a burning sensation like from an overworked muscle (ok, probably literally is an overused muscle). I’ve also started to feel faint discomfort in the gallbladder area if I take a really deep breath and hold it, or stretch my arms over my head.

Surgery is the right choice

All of this might sound unpleasant, and it is, but it’s also reassuring in its own way. It is a reminder that I am having surgery for a reason. Even though I usually can eat whatever I want, recent experience shows that is not always the case anymore.

I also was reminded over Christmas, as I shared the gallbladder saga so far with family, that my grandfather died of biliary cancer (I knew he had liver failure, but had not remembered that his cancer started in the biliary system.) Given that history and the fact that gallstones larger than 3 cm in particular are associated with chronic inflammation and an increased cancer risk, it makes sense to get the surgery even if I was not having other symptoms.

I still am very apprehensive about what life will be like after the surgery. I love eating fatty foods (who doesn’t) and I would hate to trade a normal life with occasional discomfort for constant bathroom issues and nothing but bland food. But I try to keep telling myself that it’s the right choice, and that very likely I’ll be back to normal, minus the cancer risk and occasional attacks.

Conclusion

So, apologies for the very long post. I hope if you’re someone who knows me that this was a useful update about what’s been going on. And if you are someone who doesn’t know me I hope this was a useful distillation of various information about gallbladder issues and treatment. I also hope this illustrates a few lessons that I have learned:

  • If you have a health issue, tell your doctor. Worst case it’s nothing, but you might find out that you have an enormous gallstone!
  • Ask for your images any time you have medical imaging (but be prepared for the CD and the weird image format)
  • Advocate for yourself and don’t assume any of your doctors will communicate with each other

I plan to write a follow up to this post some time after surgery, once I have the energy. I’m told recovery is usually 1-2 weeks, but many people feel fine within just a few days. So we will just have to see. Here’s hoping it all goes smoothly.

Renly

I remember the day we met you. We drove a couple of hours from Ithaca to a rescue in Pennsylvania because we wanted to have a good selection of puppies to choose from. You were in a large cage with your littermates, but you looked nothing like them. A black lab mix among a bunch of Australian shepherds. They told us you were born under a porch in Kentucky. I don’t know how you ended up in that shelter in Pennsylvania, but I am glad you did. They told us that you had never really been outside before. We let you out and watched you frolic around the yard on clumsy puppy legs with the bigger puppies. You had a distinctive, playful way of running, lifting both front legs straight out in front of you, a little higher than normal. The little floppy tips of your ears bounced with every step.

We brought you home and gave you a bath and settled in to becoming a family. We learned that you love to eat woodchips, and sunglasses, and remote controls. You learned to walk on a leash, starting out with a length of yarn trailing from your collar as you explored the path behind our condo for the first time. Our very own forest to explore.

Since we didn’t have a yard of our own, you got to go on walks often. You had so much energy that we would pick a 6 foot long dry reed from the marshy drainage next to the road, and use the tassel of seeds on the end of it to go “fishing” for you, luring you to leap higher and higher after it as we walked. We called you our graceful ballerino.

It became our morning routine to go to the grassy field near our condo and play fetch. The road was higher than the field, with a grassy slope that led down to the flat area, and from the top of that hill the frisbee would fly far, and you would run in a black streak down across the field to catch it, or pounce on it in a tumble of legs, and then run it back up the hill. On autumn mornings, the whole field was frosted and the morning sun glowed on the orange and yellow of the trees, and you left long tracks in the frost. You brought the frisbee back to me, soaking wet as the frost melted on your fur, clouds puffing with every panting breath. “Throw it again dad!”

One morning, you met a group of white tailed deer on our field. The two does took off into the bushes as you approached, but when you ran (ears forward, eyes bright, playful front legs forward) toward the buck, he didn’t budge. He charged briefly at you, and you got scared and ran back to me. We joked later that you told us an embellished tale of how you had had a great adventure and you confronted a scary “dragon” and “protected” me.

Another time, it was winter and people had built snowmen on the field. You didn’t notice them at first, but when I threw the frisbee down toward them you ran after it and then stopped short, caught off guard by these strange white towers that had appeared in your field. We had to walk down among them together to show you that they were safe. When the snow got deep, you loved to bound through it like a little deer, chasing snowballs and then leaping your way back to us for the next one. Exhausted but loving every minute.

Your other favorite place was the Ithaca dog park. Big grassy fields, toys, wading pools, and lots of other dogs to play with. You were young and sleek and fast, and would race around the park with other dogs. When you got hot, you would come to the wading pools and splash down into the muddy water and dig dig dig dig dig at the bottom of the pool, splattering water everywhere. The dog park became my refuge from the stresses of graduate school. It’s hard to stay stressed in the presence of so much pure joy.

We went on adventures. You came with us when we went to the Adirondacks with a group of friends, and you and I got covered in mud when we stepped into a deep puddle hidden by leaves. You ran miles ahead on the trail with our runner friend. In the evening, you snuggled up with us on the floor of the cabin.

We took you to Michigan, where you got to enjoy the freedom of the north woods. Running for miles on the trails as we drove around on golf carts and ATVs. We tried taking you out on the kayaks and canoes, but after you fell into the lake from one of the kayaks, you were always wary of water.

At home, you had your stuffed animals that you would carry around the condo and occasionally shake like a vicious hunter. You had a rope pull toy that became absolutely disgusting but you loved it. When it finally fell apart and we had to throw it away, we joked that you called it your “childhood” (since you had had it since you were a baby puppy) and kept asking us where it went. You loved to lounge on your blankets and cushions in our wide picture window and watch the forest and bark at rabbits and deer. In the summer, we would go down the gorge behind our condo to the waterfall. When Erin and I went in the water to swim, you stood on the banks, whining, worried that we were obviously in some distress if we were out in the water.

The evening that I asked Erin to marry me, I talked to you about it first. She and I had just come back from a date and I took you outside for a short walk. I talked to you in the woods as I worked up my nerve, and then we went back inside together and we started the next chapter of our life. (You were very handsome at our wedding rehearsal picnic in your white bow tie.)

You moved with us across the country to Arizona, where we traded gorges and waterfalls for rocky ponderosa forests and sunny days. You discovered the joy of a backyard, and spent many lazy afternoons basking in the sun after playing fetch.

You joined us on adventures here too. You went with Erin to Mexico, and went camping in Utah and Sedona even though you were always a little unclear on why someone would voluntarily choose to sleep somewhere cold and uncomfortable instead of in a nice warm house. You even joined us on our memorable visit to Loy Canyon in Sedona, where you led us down a game trail and we ended up at a dead end 40 feet upslope from the real trail. You trusted us completely as we slid, scrambled, and squeezed our way down the slope and through scrub and cacti to get back on the trail. We all ended up exhausted, hot, and with more than a few cactus related injuries, but you were a trooper.

When we had to leave you at home and go to work, you cried and cried, so we finally decided to get a second pup. You helped us choose from among the puppies at the shelter, playing the best with a little fuzzy guy named Chewbacca, who we renamed Pippin when we took him home. He grew into a big floppy doofus who yanked you around on walks and shoved you aside at the door to the backyard, but you stopped crying when we left you at home because you had a friend.

All of our lives changed when Shane came home. You were a sweet big brother to Shane, greeting him for the first time with gentle sniffs and wags, and tolerating him admirably as he got bigger and more “hands on”. When we put him in a bouncer seat in the backyard while doing yard work, you would lay down next to your baby to keep him company. Then Rowan came, and you were just as sweet with him, even though you were getting older.

The last few years disappeared in a blur, and somehow gradually and then all at once you were an old dog. I wish we had played fetch a few more times before it got too hard for you to run and jump. I wish we had taken you on a few more hikes and walks before even walking became too hard.

You got sick last year and the vet expected that you had only a few months left, but you stayed with us for a whole year. I thought that extra time would help me mentally prepare to say goodbye. It didn’t. Your health finally deteriorated rapidly, and I’m sorry for the pain that you had to endure at the end. I know that it was scary and confusing for you and I hope that you were also able to take some comfort in knowing how much we loved you.

We said goodbye to you yesterday. Deciding and scheduling and then waiting for the end was one of the hardest experiences of my life. I have lost loved ones before, but every loss is a fresh grief, and I was not prepared. It is a desperate, gasping grief that comes in sudden overwhelming waves. I know it will get better with time. I know that you loved us and that we will look back fondly on all of the good memories. That doesn’t make it any easier to say goodbye.

You were our first baby. You made us a family, and were our constant, trusting, loyal companion through some of the most important years of our life. I don’t think I realized how deep our bond was until it was gone.

We will always love you, our sweet Renly pie.

“Sunsets are loved because they vanish. Flowers are loved because they go. The dogs of the field and the cats of the kitchen are loved because soon they must depart. These are not the sole reasons, but at the heart of morning welcomes and afternoon laughters is the promise of farewell. In the gray muzzle of an old dog we see goodbye. In the tired face of an old friend we read long journeys beyond returns.”

Ray Bradbury

Tour of my huge Lord of the Rings-inspired 7 Days to Die base

In my review of 7 Days to Die, I showed a couple of screenshots of the absurdly huge Lord of the Rings-inspired base that I made in my latest single player game. Now I want to spend some more time showing off the base in more detail. Probably the easiest way to do that is with a video tour:

I know that personally I don’t always want to watch a video when I can read something instead, so I’ll use the rest of this post to walk through the base in writing with lots of screenshots.

This project started out as a regular play-through, with no cheats or changed settings. However, I quickly decided I wanted to build something more creative than just a place where I could survive horde nights. I’ve always loved the epic architecture of Lord of the Rings, and so I thought it would be cool to try to build a base that borrowed from some of the coolest LOTR locations. Once I got motorized vehicles, I started exploring the game world in search of a nice mountain or cliff to use as a starting point.

An early candidate location. I really prefer the forest biome’s looks, but in the end, the desert had the best cliffs.
Gyrocopter made scouting much easier. This cliff caused by the city intersecting with a mountain was decent, but still not perfect.

I was looking for a cliff in particular because I knew I wanted to create a switchback staircase like Dunharrow in LOTR:

Finally, I discovered that the way random world generation works in this game, the steepest cliffs are always in the desert biome. After some more scouting I found a great location and started building:

The earliest screenshot I have of the base location. I’ve just started placing temporary frame blocks for the staircase.
Pretty soon I had a full set of switchbacks framed out (note how the path tunnels through a protruding part of the cliff too), along with a platform at the top and stairs up to an entrance into the mountainside.

I knew that in addition to the switchback stairs, I wanted to dig into the mountainside and create my very own Mines of Moria. I started off by digging a tunnel into the mountain for a ways, with a nice arched entrance, leading to a chokepoint:

Standing at the main entrance.
Closer view of the chokepoint. The turret up above and the doorways on either side are late additions that I’ll come back to later. For those not familiar, the striped blocks are steel, the strongest blocks you can build. I don’t know why they are stripey, I wish they weren’t. But it’s useful to have a funnel location like this reinforced so that zombies don’t destroy it.

At the chokepoint itself, I set up a series of electric fences to stun zombies and dart traps in the ceiling with pressure plated beneath, so that zombies would trigger the trap while stunned and be shot from above. I also added a shotgun turret at the end of the chokepoint so that any zombie that somehow made it through the dart traps would be shot from above by the turret:

Standing on the other end of the chokepoint, looking back toward the entrance. Shotgun turret is visible at the top, and the red cubes are the downward-pointing dart traps. The wires across the hallway are the electric fences, and you can see the pressure plat tiggers on the floor.

From the chokepoint, I decided that I wanted to re-create the famous Bridge of Khazad-dûm from Lord of the Rings. If you are less geeky than me and are wondering what the heck I’m talking about, it is the place where Gandalf fights the Balrog and says “You shall not pass!”

I unfortunately didn’t take any screenshots while digging out the chamber where I built the bridge, so I can only show off the finished product. But it was as I was digging out this chamber that I decided to make this building project a bit less tedious by cranking up my block damage to 300%, meaning that I could drill through the rocks of the mountain at 3x the speed. In the end, I made myself a nice deep pit, with a narrow, arcing bridge spanning it. I couldn’t very well summon a balrog, but to get a similar firey ambiance, I put a lot of torches and burning barrels in the pit.

Side view of Khazad Dum in its nearly-finished state. I put robotic turrets on little protrusions on either side of the bridge, The red lines are their laser sights, indicating that they are active. You can also see the steel ladders I placed so that zombies that end up in the pit can climb up to the bridge (and then get shot). At the foot of the ladders are some spinning blade traps to slice and dice zombies.
Here is a “god mode” view of the pit. This mode allows you to fly and to travel through formerly solid objects. A neat thing happens when you are inside the terrain: it disappears! Basically, the terrain is only opaque when viewed from the “outside” but if you are inside it is transparent. This is super-handy for viewing complex tunnels inside a mountain! I made liberal use of god-mode in building this base.
Standing at the end of the bridge, across from the chokepoint. The steel hatch to the left of the chokepoint provides access to the generator that powers the traps.
Looking the other way.

I returned to this pit later for some finishing touches, but for now let’s continue. From the Khazad Dum room, I dug some stairs up, doubling back to end up above the room. Here is where the digging really got serious. I wanted to re-create the huge hall in Moria filled with rank upon rank of pillars stretching off into the distance.

Alan Lee concept art of Moria.

I had learned in the process of digging out the pit for the bridge of Khazad Dum that to dig out such a huge volume block by block would take forever, even with 300% block damage. So instead I got smart. I dug around the perimeter of a huge rectangle and then undermined it so that it collapsed. The way the game physics works, if you cause a collapse, most of the blocks that are no longer supported are destroyed, and a small percentage remain as rubble which is much weaker and easier to clear.

Here are some screenshots showing the stages of digging out this huge hall. It was around this stage of the project that I also started really using “god mode” much of the time.

God mode view as I dug around the perimeter of the huge rectangle that will eventually be the great hall of Moria. The tool I’m holding is my trusty auger – in this game the auger is the ultimate digging tool, rapidly breaking through solid rock (completely unlike an actual auger, as I can attest from real-world experience…).
More progress, you can see that all sides of the rectangle are dug out now. Just need to undermine the bottom to make the whole thing fall. (Also notice that you can see the Khazad Dum room below in its unfinished state.)

The full length of the rectangular hall was too much to collapse all at once, so I split it into several chunks. Here’s a little video I recorded of the last chunk collapsing. You can see how very unrealistic the collapse is, but it’s a fast way to clear out a large volume!

At 1:28, the block starts to collapse (onto me) before I expected. Luckily, collapsing blocks don’t do too much damage!

After clearing out the space of the hall, I filled it with huge pillars to mimic Moria. I’m pretty pleased with how it came out:

Climbing the stairs into the hall.
Looking down the length of the hall.

At this point, with the hall constructed, I wanted to build a functional “residential” section of the base. When I decided to build this base, I moved all of my stuff from the original base I had been using from the start of the game, but had just been keeping it stashed in crates out front. My work stations were also just sitting out front, and I wanted to get them placed in an actual “workshop” part of the base.

I created a hallway and staircase off the end of the Moria hall, leading up to a large living space that emerges from the cliff face above the main entrance.

God-mode view of the Moria hall, Khazad Dum pit, and the beginnings of the living area.

Where the living area emerged from the cliff, I built a huge concrete “prow” sticking out in a way that was sort of reminiscent of the way the Citadel of Gondor sticks out over the walled city of Minas Tirith in LOTR:

An overhead view of the Citadel of Gondor, from Return of the King.
Note the spotlights lighting up the “prow” at night!
This is the classy living-quarters part of the base, so why not make a pretty garden and stained glass window?
View inside the stained glass area, standing by the “kitchen” area.
Here is the finished “workshop” area. Storage crates on the left. Cement mixers in the corner, workbench centered on the back wall, forges in the other back corner, and chemistry station on the right. Garage door in case I want to close off the workshop, electric light overhead, and bulletproof glass window through the natural rock wall.
“Kitchen” area, complete with mini-fridge. (I think it’s kind of hilarious that you can craft a gyrocopter and automated turrets in this game, but all cooking is done on a campfire.)

Along with the workshop and kitchen, I also made a living area. Not inspired by LOTR (though it might be fun to try a “hobbit hole” sometime), just a nice place to live, complete with bed, couch by the fire, and reading nook.

Couch and fireplace on the left, reading nook on the right.
View of the bed from the reading nook. (Stupidly, you still have to have a sleeping bag as your respawn point if you die, even if you have crafted a big bed. So you can see my bedroll by the wall.)
From the living quarters, I have a door leading to a scenic catwalk.
I put a little garden with a tree at the end of the catwalk.

I also added a spiral staircase from the residential area to the top of the mesa, where I placed a generator and solar panels. I also built a landing pad for my gyrocopter and wired it up with lights to turn on at night.

God-mode view of the residential part of the base from inside the mountain (this was before I added the tree at the end of the catwalk.
Landing pad and generator building on top of the mesa.

Once I had the residential area finished, I went back outside. I decided that I wanted to build a tower at the top of the switchback stairs that was (a) reminiscent of Orthanc, Saruman’s tower at Isengard in LOTR, and (b) also an effective horde base. As a reminder, here is what Orthanc looks like:

And here’s what I came up with. A little stubbier than Orthanc, but it gets the right “feel”:

The base of the tower is fortified to steel, and has electric fences across the 4 entrances.
I put a bunch of burning barrels at the top along with the Orthanc-like spires to make it look cool.
Looking down the ladder inside the tower. You can see the blade trap that is centered on the tower, and one of the several turrets aimed at the ladder. They do a good job of taking care of most zombies before they reach the top.
Better view of the turrets.
The tower connects to the entrance of the underground base via drawbridge, so if you are in trouble (or getting bored) during horde night, you can ditch the tower and run to the Khazad Dum room.

At this point, the base had all of the LOTR “landmarks” I wanted. I had originally thought about doing a Helm’s deep fortress, but ended up not trying to do that too. This was large enough! So my work on the base shifted to trying to improve it on horde nights. I found that the tower worked quite well, but if I camped out in the Khazad Dum room, the zombies didn’t follow the existing paths and instead tunneled through the rock to try to get to me. Their favorite paths were to tunnel just above the main entrance tunnel for some reason, or to try to break into the Moria hall. I also had screamer zombies (zombies that appear when you have been doing too much stuff in an area, such as crafting or digging, and which summon mini-hordes of other zombies) spawning around my workshop or finding their ways in to the Moria hall. So I started trying to work with the zombies, digging formalized tunnels where they had been trying to get in and feeding them toward turrets, or toward the chokepoint.

I made entrances like this at either end of the big Moria hall. Three tunnels converge in an “entryway” to the hall, with a turret looking down from above.
To handle the zombies that insisted on digging a tunnel just above my main entrance tunnel, I built a little balcony to catch them as the came down the face of the cliff. This funnels them down one of three hallways, which ended in stairs that lead to the chokepoint (both spiral stairs and stairs that converge in the middle). The two side hallways also connect to the Moria hall, so that zombies that find themselves in the Moria hall can find their way down to the chokepoint. At the bottom of the two staircases to the Moria hall, I have dart traps connected to motion sensors, so any zombie coming down the hall gets shot with darts. I also noticed that some zombies tended to just mill around the main entrance and attack the walls, so I added a machine gun turret above the chokepoint to shoot any loitering zombies and make them come in.

I found that one downside of the many entrances to the base was that if I was sitting on the bridge of Khazad Dum, a lot of the zombies got killed by the turrets at the different entrances before they could reach me. So, to at least get some idea of what was going on, I rigged motion sensors at each entrance to a set of lights in the Khazad Dum room, so that the lights would tell me where the zombies were coming in. Turns out a lot of the zombies were trying to enter through the south end of the Moria hall, and through the tunnels over the main entrance.

Finally, for no good reason other than that in LOTR the big hall with pillars is supposed to be part of a road, i.e. it is supposed to actually lead somewhere, I extended the tunnel off one end of the big Moria hall so that it came out the distant side of the mesa, and built a big arched bridge spanning the canyon there.

So there you have it! A super-detailed walkthrough of this super-huge base that I built. I’ll finish with a few parting shots showing all the crazy tunnels involved in the base, and then a video I recorded during a horde night so you can see the base in action.

Here’s what horde night looks like, starting in the tower and ending in the underground base. As a bonus, you get to see what happens when I accidentally leave the chokepoint traps active and try to run through them. Ouch…

Update: I have managed to export the base as a “prefab” that can be loaded into other people’s games so that it appears in randomly generated worlds. It doesn’t work perfectly – wiring doesn’t transfer, and I had to chop off the mesa unnaturally – but the main parts of the base are there. Check it out: https://www.nexusmods.com/7daystodie/mods/2306

Talking to Myself About Writing

Me: “It sure has been a long time since you wrote anything. What happened?”

Also me: “Well, you know. It’s hard to find time.”

“Oh really? Seems like you’ve found a lot of time to play video games in the last… What has it been, 9 months since your last blog post? And another 4 before that?”

“You know it’s different with writing. You need a decent block of time to really get into it.”

“Yeah, I seem to recall saying that before about gaming too though. You claim to want to be a writer but when push comes to shove, you make time for video games but not something that is supposedly very important to you. What gives?

“Well, video games are easier right? You play a video game to mentally relax. And they’re all about guaranteed competence. You know that if you keep playing, you’ll get better and more powerful and eventually you’ll win.”

“You do realize that if you wrote regularly you’d get better at that also, right?”

“Yes, but it’s hard.”

“What’s hard about it? Just put the words on the page.”

“It’s easy to put words on the page, but it’s hard to do it well.”

“Who cares if you do it well?”

“I do. I have these ideas in my head, and when they’re there they seem so great, but the moment I try to put them on the page, I realize that they’re not as good as they seemed.”

“But once they’re one the page, then you can make them better. If they’re just rattling around in your head you can’t see where they need to be improved.”

“Yeah, I know, but it’s also scary.”

“What is scary about writing? It’s not like someone is making you do it and they’re going to punish you if you don’t do it well. You’re not being graded. You don’t even have to show it to anyone until you’re ready. Or at all! You can write stuff down and not show it to anyone!”

“I know. But I build these ideas up in my head so much that it’s hard to finally see their flaws when I write them down. One of the main reasons I want to write is to get some part of myself out of my head and into the world. So when I build these ideas up in my head, they get tangled up in my sense of self and self-worth. It’s a lot more pressure when the words that I’m dumping on the page are in some way a part of me.”

“So you’re scared to work on writing that you find important or meaningful, because if it ends up not as good as you hoped, then in some way, you’ve immortalized that you yourself are not as good as you hoped.”

“Yeah. That’s why for a long time I was just doing blog posts here. Blog posts are lower-stress. I especially liked writing reviews of things because I could just jot down my opinions and move on. Not a lot of self-worth caught up in my opinion of the latest video game or TV show or whatever.”

“But you basically stopped writing here on the blog too…”

“Well, toward the end of 2020 I started writing a follow-up to my previous two very personal and philosophical “Finding Balance” posts, trying to figure out the extent to which I actually believe in all the nice things in those posts, and how much of it was trying to justify not working as hard. But that grew into a whole series of posts trying to pin down my own personal understanding of the meaning of life, and whether I am living the values that I claim to believe in. And it got to the point where working on those posts would often ruin my mood and send me into an existential crisis.”

“Sounds like they stopped being low-stakes blog posts and became something very personal, and therefore scary to work on.”

“Yeah. I still want to finish them, but it’s daunting. And it’s not like I have new insights. People are probably better off just reading Sartre.”

“Well, but the point is to get your personal take on these big philosophical questions. But if it’s hard to make progress on this project, take a break and write something else. You have other ideas.”

“Yeah, there’s a novel idea and a nonfiction book idea that have been rattling around in my head for years, but working on a “real” book project seems even more daunting than the philosophical blog posts. It’s much longer, much more work and then when all the work is done I know that I might face rejection trying to get it published anywhere. I have made small starts on both ideas, but never got very far. The self-doubt just kills all motivation.”

“Yeah, I get that. But let’s look at this rationally. What is the worst case scenario if you write?”

“I guess the worst case would be I spend a bunch of time on something that turns out not to be any good, and it doesn’t get published. It’ll feel like I wasted my time and I’ll be embarrassed by how it turned out.”

“And what’s the worst case scenario if you don’t write?”

“I’ll be disappointed in myself for not achieving one of my life goals. I’ll never know if I could’ve gotten something published. My thoughts and ideas will be stuck in my head.”

“The con for writing is interesting: You’ll feel like you wasted your time if what you write isn’t any good, but you’ll at least have something to show for it. Which is more of a waste of time, writing something that ends up not getting published or is not as good as you hoped, or spending that time passively consuming media with no end result to show for it?”

“I mean obviously writing is better. But it doesn’t change that it’s hard and scary and hard to get started and stick with it.”

“So how do we get over it and write anyway?”

“Momentum helps. I should try to write as often as I can. And probably need to get away from the idea that writing can only be done in big chunks. Little bits here and there can add up.”

“And lower the stakes. Everything you write doesn’t have to be the last or most important thing that you write. Especially on a first draft, you know it’s more about getting the words written so that you have something to edit. Writing the first draft is creating the lump of clay, not the finished statue. Nobody just sits down and writes a finished novel in one go.”

“Yeah, I know.”

“And the best way to do good creative work is to do a lot of it. Instead of agonizing over one thing, write ten things instead. Maybe nine are crap but one might be great, and you can’t really know until you do it.”

“Yeah, I recall a quote along those lines. Something about how it’s not the writer’s job to judge what they write, it is their job to write it. But I can’t find it.”

“Oh well. There’s always this one. Seems like a good place to end this post. Let’s write.”

Nobody tells this to people who are beginners, I wish someone told me. All of us who do creative work, we get into it because we have good taste. But there is this gap. For the first couple years you make stuff, it’s just not that good. It’s trying to be good, it has potential, but it’s not. But your taste, the thing that got you into the game, is still killer. And your taste is why your work disappoints you. A lot of people never get past this phase, they quit. Most people I know who do interesting, creative work went through years of this. We know our work doesn’t have this special thing that we want it to have. We all go through this. And if you are just starting out or you are still in this phase, you gotta know its normal and the most important thing you can do is do a lot of work. Put yourself on a deadline so that every week you will finish one story. It is only by going through a volume of work that you will close that gap, and your work will be as good as your ambitions. And I took longer to figure out how to do this than anyone I’ve ever met. It’s gonna take awhile. It’s normal to take awhile. You’ve just gotta fight your way through.

Ira Glass

AGU 2021: Initial Major Element Quantification Using SuperCam Laser Induced Breakdown Spectroscopy

The virtual poster interface for the AGU fall meeting leaves something to be desired, so I thought it might be worth posting the contents of my poster here, where it is easy to access and share.

Audio recording walking through the poster.
Figure 1: Distribution of compositions in the laboratory spectral library. Orange bars represent the Training set, Green bars represent the test set.
Figure 2: (Left) All library points (grey dots) projected onto the first two PCs with selected sample types denoted by a range of colors and symbols (see legend). The dashed line represents the convex hull of all the library points. (Right) Same data without the SCCTs highlighted. Approximate groupings of samples are shown by shaded regions.
Figure 3: Test set predictions for the selected multivariate models. Perfect results would fall on the line.
ElementRMSEP wt.%Model
SiO26.1Average (GBR, PLS)
TiO20.3RF
Al2O31.8Average
FeOT3.1GBR
MgO1.1GBR
CaO1.3Blend RF+PLS
Na2O0.5Blend GBR+LASSO
K2O0.6LASSO
Summary of 3 m test set RMSEPs and selected models.
Figure 4: Histograms of Mars predictions through Sol 239 for each major element.
Figure 5: PCA plot of Mars spectra with convex hull of laboratory data superimposed (dashed line). Most Mars data plot within the space spanned by the lab data. Points that plot outside are indicated in red.
Figure 6: Local RMSEP indicates how accuracy is estimated to vary with predicted composition. Black points are the unsmoothed values calculated using the nearest 60 test set predictions. Blue curves show the result of smoothing and extrapolating.

It’s the end of the world as we know it and I feel…

We’re in the middle of a pandemic, tens of thousands in the US alone are dying mostly preventable deaths, our federal government is doing a worse job managing the crisis than I could have ever imagined, the world economy has been shut down, millions have lost their jobs, and I have barely left the house in over a month. So why do I feel generally… okay?

I don’t feel good about any of this, mind you. But I see a lot of friends on social media who are really struggling, while I am mostly stressed out about normal things like deadlines and responsibilities at work and kids who won’t go to sleep. I’ve been trying to stay aware of how I’m feeling as we watch the world change in unprecedented ways, and I’m actually kind of disturbed by how not-disturbed I am generally feeling about all of this. In many ways the pandemic reminds me of a government shutdown, but worse: It’s a stupid, avoidable situation that is hurting a lot of people, but for myself it’s not too bad and actually has some perks. Of course some days are better than others depending on the absurdity of the day’s news and my own mental state. Of course I find much of what’s happening outrageous and infuriating (more on that later). But generally, I’m doing okay. Or at least, not significantly worse than what has become my new normal in the last few insane years.

I want to be clear before I get any farther with this post that my goal is not to say “look at me, I’m doing fine, why aren’t you?” If you are feeling Not Okay during this pandemic, you are having the correct, rational response. What I’m trying to do here is figure out and articulate some of the reasons that I am not having the correct, rational response.

Perspective and Gratitude

I am finding that this pandemic is having an effect on me similar to other momentous life events like births and deaths. These sorts of events offer a rare clarity: the distractions fall away and we are given a brief moment where we see what really matters. The clarity of this pandemic is showing me something that I already knew, but that despite my best efforts at being a socially responsible person, I am not normally reminded of so frequently or so vividly. It is showing me how astoundingly lucky I am. It is forcing me to practice gratitude, which is an effective way to improve your mental health.

I thought about listing all of the things that I am grateful for here, all the unearned privileges that allow me to observe this pandemic from a place of comfort and safety and ease, but it ended up seeming gratuitous and boastful, which was not my intention. My point is this: I know. I know how lucky I am to be able to react to this disaster the way that I am. And in some ways, being reminded of this fact so often is probably helping me emotionally deal with this situation.

I can’t resist calling out one advantage in particular, however, because in basically all other circumstances so far in my life it has been disadvantage. I’m talking of course about being an introvert. Being unable to socialize with people in person and instead doing any (limited) socializing over the internet? Mostly hanging out at home, or at most occasionally going outside for a walk? Needing to fill any spare time with hobbies rather than by going out and doing stuff with friends? Little did I know it, but I have been training for this my whole life.

Denial and Compartmentalization

One of the strangest things about this pandemic is how little it actually changes my day to day life. The nature of my job is such that most of the people I work with on a daily basis are not at my home institution, so communicating by email or by phone or video conferencing is perfectly normal to me. It’s just that I get to stay home and have lunch with my family, and I also have to do video calls with people I’d normally go down the hall to talk to. 

The pandemic did cancel my trip to the annual Lunar and Planetary Science conference, which I have attended every year since 2006, and it forced Erin and the kids to cancel their trip to visit her parents in Florida the same week (her dad is on immunosuppressants for rheumatoid arthritis and is therefore high risk). But those cancellations came early enough that in a way they just added to the surreal feeling rather than driving home the reality.

The fact that my life is for the most part minimally disrupted is nice but it also has the side effect of making it very difficult to internalize how messed up things are in the world right now. As far as I am aware, nobody I know has gotten sick, for which I am very grateful. Like many people, I have been reading a truly unhealthy amount of news so I’m well aware of what is happening in the world, but on some deep level it doesn’t quite seem real. Intellectually I get it, but emotionally there’s still some disconnect.

There are of course moments where I imagine what would happen if I or someone I loved got sick or died. I read news articles, or hear the medical helicopters flying overhead on their way to the hospital, and I imagine disaster striking my family. When that happens, there is a gnawing dread that sits in my gut like a cold stone and crawls up the back of my skull. But, maybe this says something about me, but that’s nothing new for me. It’s the same feeling I get when I read about gun violence, or a car crash, or kids getting sick, or any of the many horrible events in the world that for some reason the news seems to think that everyone needs to know about. I think most adults, and especially most parents, become very skilled at compartmentalizing these sorts of thoughts. I know that if I didn’t I just wouldn’t be able to function. 

So, don’t get the wrong impression. It’s not that I don’t worry about what would happen if I or a loved one got sick. It’s that it’s just one more thing in a world full of unpredictable dangers. My family and friends are for the most part lucky enough to be able to do everything possible to avoid this one. So I worry, but it isn’t consuming me.

Outrage and Vindication

To me, the worst part about this pandemic is the extent to which it was preventable. You’ve read the news: The Trump administration dismantled the safeguards that the Obama administration had put in place and ignored the pandemic training that was part of their transition into the White House. They fired key experts. They were warned when this new virus first appeared and did worse than nothing. They downplayed the problem and treated it like every other aspect of reality: they ignored it and hoped it would go away. Of course it didn’t go away, and since that became clear, the response has been so deeply incompetent and corrupt and confused that it leaves me speechless and furious. I mean, look no further than this week. We’re months into this crisis, more than 50,000 Americans have died, and the president openly wondered on national television this week if maybe ingesting cleaning products might be a good way to stop the disease. He suggested that scientists look into the idea. The he has been receiving briefings on this virus for months, and that’s what he comes up with now. The ignorance is genuinely terrifying.

I read an article the other day that suggested that 90% of the deaths we’re seeing now from the virus could have been prevented if the country had enforced physical distancing just two weeks earlier. Trump and his people downplayed and dragged their feet on this for many weeks. They have tens of thousands of deaths on their hands, and now they are agitating to open back up prematurely, which will set off a second wave of pandemic that is even worse and prolong both the economic and medical suffering for months.

So yeah. I am not at all okay with what is happening. How can I say that I’m doing okay through this? Because I’ve been not-at-all-okay with what is happening with our government since 2016. The Trump administration has been an endless cascade of incompetence and corruption. I reached saturation long ago. So while this situation is worse than anything that came before it, what came before was already so far beyond what is acceptable that I genuinely don’t have the emotional capacity to react to these new horrors all that differently.

There is also another facet to this that I think may be helping me cope, though I’m not particularly proud of it, and that is a feeling of vindication. I am a scientist. The bedrock of my worldview is that reality matters. Facts matter. Expertise matters. Good governance must be based on reality. This brief and imperfect life is all we get, so we must treat each other with empathy and the acknowledgement that bad things can happen to good people, and that society and government exist so that we can help each other. 

The Republican party has been systematically undermining these ideas for decades, and the Trump administration is the culmination of all their efforts. The last 4 years have been a nightmare of lies and ignorance and selfishness, and for the most part Republicans have been able to get away with it. But this time is different.

This pandemic epitomizes why the Republican worldview is wrong and dangerous. You know what matters in a pandemic? Facts. Expertise. Good governance based on reality. Compassion for others. Personal sacrifice for the greater good.

The pandemic shines a harsh light onto all of the injustices in our society. The racial disparities, the wealth inequality, the lack of living wages for the people who form the foundation of our society, the absurdity of a for-profit system that links health care coverage to employment, the appalling treatment of native communities, and on and on. 

I hate that it had to come to this. I hate that even as it has come to this, many people are denying the evidence right in front of them. I do not like that I feel this way, but I can’t deny that as I watch the world around us failing in precisely the ways that people with a left-leaning and fact-based worldview warned about, there is a grim and bitter solace in knowing that we were right.

Fascination and Hope

One of the strongest reactions I’ve had to this pandemic, and another one that seems inappropriate even to myself, is fascination. This pandemic has been a crash course in epidemiology, obviously. But also economics and history and civics and psychology and more. I’m reminded of a quote from The Once and Future King, which now that I look it up is even more apt than I expected:

“The best thing for being sad,” replied Merlyn, beginning to puff and blow, “is to learn something. That is the only thing that never fails. You may grow old and trembling in your anatomies, you may lie awake at night listening to the disorder of your veins, you may miss your only love, you may see the world about you devastated by evil lunatics, or know your honour trampled in the sewers of baser minds. There is only one thing for it then–to learn. Learn why the world wags and what wags it. That is the only thing which the mind can never exhaust, never alienate, never be tortured by, never fear or distrust, and never dream of regretting. Learning is the thing for you.”

The Once and Future King, T.H. White

Learning stuff is already my default state, and in times of stress and crisis my instinct is to double down and learn more. I’m also reminded of another relevant quote:

My pandemic coping strategy.

I find it fascinating to see on full display how interconnected the world is. How our current situation so closely mirrors that in 1918 when a similar pandemic swept the world (and not just in the particulars of the disease, but the broader circumstances in the country and the world). How years of bad policy decisions which were mostly survivable during a period of economic growth are now revealing so much of our society to be a house of cards. How fighting a virus can so rapidly lead to unexpected consequences like inability to purify water due to a lack of CO2 gas due to the shutdown of certain chemical processing plants due to a drop in demand for oil. How the immediate economic catastrophe caused by “flattening the curve” to save lives is going to give way to so many ripple effects for months and years to come.

I know that to a lot of people the uncertainty and chaos we are witnessing right now is extremely stressful. It feels an awful lot like the end of the world. In a sense, maybe that’s true. But if it is the end of the world, it is an end whose time had already come, and it opens up the opportunity for something new and better. To me this feels less like an end than like a turning point. A culmination of forces that have been building up for many years, long before this virus arose. It is the chance to recognize what matters. To clearly see what aspects of our society, our government, our lives, actually serve us well and what needs to be changed.

I am not naive. I don’t expect to see our government suddenly and miraculously institute universal basic income and universal health care and nationwide vote by mail and everything else. I don’t expect it to proactively address the next, even greater global challenge – climate change – before it is too late. I suspect when this pandemic is over, we’ll see things mostly go back to the way they were before. But I think the illusion that “the way things were before” was acceptable will have been dispelled. Not for everyone, of course, but for enough people to make a difference. This experience is going to have a lasting effect on everyone. Kids in high school and college right now are learning lessons a lot more profound than what they’re learning in their online classes. We’re all learning from this experience. I think the memory of this pandemic is going to become a part of who we are, as individuals, as families, as countries, and as a world. Whether we are aware of it or not, it is going to guide us in the coming years, and despite the pain and chaos of the present, I choose to hope that it will allow us to create a better world.


As the lyric goes, “It’s the end of the world as we know it, and I feel fine.” That’s not exactly true for me, but through a combination of good fortune and some healthy (and some maybe not-so healthy) emotional responses to everything that is happening, I am doing okay. With things as bad as they are, doing “okay” is better than I have any right to expect. I hope you’re doing okay too. If you’re not, and you want to talk about it, don’t hesitate to reach out. If there’s one thing we are all learning right now, it is how interconnected we are. We will get through this together.

Finding Balance – Part 1: Mental Health

I recently finished taking a month off of work for paternity leave, and in that haze of diapers and and missed sleep and blissful new parent moments, I read two books – a self-help book and a collection of essays – that unexpectedly resonated with each other. Taken together, they provided me with a change in perspective that has been eye-opening and challenging. I’m still working through it, and anyone who reads this blog knows that one of the ways I process things is to write them down here. So here we go.

The first book is Feeling Good: The New Mood Therapy. I haven’t talked about it much, but I have been struggling with insomnia, anxiety, and “low mood” (I wouldn’t go so far as to call it true depression) for a while, and it has gotten worse in the last few years. Some might argue that between having a kid and the state of the world right now, an increase in anxiety is the appropriate response, but the problem goes back farther than that. Those things have just accelerated what was already happening.

Since at least early grad school, I have suffered from occasional “downward spirals” where I get in a bad mood and it spirals out of control and I end up questioning my path in life and generally having an existential crisis. Of course, everyone has bad days and maybe this is normal, but these spirals feel like a growing avalanche of negativity. I can usually tell when one is coming on but am nearly powerless to stop it. The only things that work are doing some intensive writing (hard to do when you’re feeling negative about literally everything), exercise, or just going to sleep and resetting my brain.

What has changed in recent years is that those episodes have become more frequent and I don’t bounce back as well as I used to. My baseline happiness has dropped, my interest in work has waned, and those questions about my path that used to be restricted to when I was spiraling have become more chronic, nagging doubts. I have started feeling vaguely anxious all the time for no clear reason, and the anxiety has started to keep me up at night.

I’ve also fallen deeper into an unhealthy pattern of thought that I have struggled with for a long time. It goes like this: I fixate on a grand goal (usually it is to become a published author) but then I don’t actually do much to work toward that goal and then I beat myself up about how I’m not achieving my goals, and that rapidly escalates to how I am wasting my life and am going to have regrets on my deathbed about all the things I didn’t accomplish. Or if I do work toward the goal, I get paralyzed by all the pressure I’ve put on myself, I am disappointed in what I accomplish, I stop working on it, and quickly end up in the same place. Not a very healthy pattern of thought, but it is one that has haunted me for most of my adult life.

So, yeah. Given all of that, I decided to try therapy last year. I went to see a counselor, but it soon became clear that we weren’t a good fit so I stopped going. (She didn’t seem to know how to handle my lack of belief in anything supernatural, and the existential angst that goes with that.) Then earlier this year the insomnia got bad enough that I went to a doctor and got a prescription. The drug they prescribed (Trazodone) helps with sleep and anxiety and depression and is quite safe and cheap so it was a good fit for me. It worked for a while, but taking a sleep aid is not a great idea when you have a newborn baby to take care of. It’s hard enough to wake up multiple times in the night when not drugged. So I stopped taking it when the new baby arrived.

Of course, then the anxiety came back. In particular, I was feeling disproportionately stressed out about taking paternity leave earlier than expected and how that messed up the bookkeeping for my projects at the end of the fiscal year. As I was dealing with that stress, I figured that if I couldn’t take medication maybe it was time to revisit therapy. I’m cheap, and there are hardly any therapists in Flagstaff, so I looked into the next best thing: self-help books. In particular, I recalled that the counselor I saw was frequently referring to this book “Feeling Good” and some Googling showed that it is basically the bible for Cognitive Behavioral Therapy (CBT). It’s also a step above most self help books: it’s based on peer-reviewed research, and it has been shown to work as well or better than medication alone. So I went ahead and read it.

The idea behind CBT is deceptively simple. Essentially, it boils down to the idea that it is not a given situation that directly determines how you feel, but the thoughts triggered by that situation. If you have gotten into the habit of having negative thoughts in certain situations, that will lead to feeling miserable in those situations. By learning to identify the automatic negative thoughts that you are having and respond to them with more reasonable, rational, and positive thoughts, you can end up with significant improvements in mental health.

In particular, there are a list of cognitive distortions that allow you to name and fight back what your brain is doing to itself. For example, some of the distortions that I’m most susceptible to are “should statements” (“I should be writing”, “I shouldn’t play video games”), “magnification” (“If I’m not productive today, I’m wasting my life”), “overgeneralization” (“I never get to do what I want to do”), and “all or nothing” (“What’s the point of doing my writing; I’ll never follow through and get it published and even if it gets published nobody will read it”).

The book emphasized writing down your automatic thoughts and the rational responses, but I mostly just did it in my head as I was reading. Even just doing it that way, it was remarkably effective. As I read the book, I felt similar to the first few days after I started taking medication. Like an invisible weight had been lifted and I could breathe easier. (Caveat: I was in an almost ideal situation, where I knew the main thing that was stressing me out, and I was taking time off work so I had less other stress to deal with. Since returning to work, I have slipped back into my old patterns and am struggling again.)

The book also included a short survey tool designed to help identify some of the root causes of the distorted thoughts that lead to depression and anxiety. Normally these sorts of quizzes run the risk of being like horoscopes, where no matter what they say you can find a way to make it apply to you. I don’t know, maybe that’s happening with this one too, but it is backed up by rigorous research and whatever my reservations might be, I found the results of this survey to be eye-opening.

The survey indicated that a lot of my distorted thinking is centered around two main themes: seeking approval from others, and seeking achievement. Basically, I tend to base my self esteem and happiness on these things, which opens me up to anxiety and depression if I perceive that someone might not approve of me or if I am unable to achieve milestones.

If you wear glasses, you know what it’s like for your eyesight to gradually, imperceptibly, get worse until it finally reaches the point where it bothers you enough to get a new prescription and the sudden clarity is shocking. That’s sort of what it was like for me to see the results of this quiz. The results in retrospect are obvious, just as once you’ve put on new glasses it’s obvious how poor your eyesight was getting. I shouldn’t be surprised by the results, but they have offered a lens that lets me see myself clearly for the first time in quite a while.

Seen through this new lens, knowing that I crave achievements and the approval of others to boost my self esteem, a lot of things start to make sense. For example, I was stressed about paternity leave because (a) taking a lot of leave is still somewhat unusual in my workaholic field, and (b) the end-of-fiscal-year stuff led me to send an annoyed email which was uncharacteristic behavior for me. Both of which led to the possible disapproval of people I respect and therefore stress for me.

Likewise, I’ve been stressed and unhappy about work because on a lot of fronts I’m struggling to make accomplishments and get recognition, and in some cases the amount of interest or recognition that I get for my work is not proportional to the amount of effort I put in. I also have a tendency to speculate that people who I respect are not happy with what I am doing, which stresses me out.

With this new lens I can also see that my dwindling interest in my work may be related to the fact that I have run out of major career accomplishments to aim for. I’ve been incredibly fortunate and hit career milestones one after another (finish undergrad, accepted to grad school, grad school fellowship, PhD, post doc, mission involvement, permanent position). But now I’m in a situation where there are no “built-in” milestones left (at least, none that I want to pursue: I’ve seen what leading an instrument or mission is like and it’s not for me!). I’m facing the rest of my career at basically the same level doing the same thing, and that stresses out my achievement-hunting brain. Put another way: I have reached the point where unless I make some big changes, I have basically locked into “what I’m going to be when I grow up”. After 3 decades of always looking ahead to the next thing, that’s a strange feeling.

I want to be clear that I recognize that it’s ridiculous to be stressed out by being successful. I know that to many people I have what would be considered a “dream job”. I get to be involved in very cool work with very cool people, I’m paid well, I have flexibility, I live in a beautiful place. In a way that just makes it worse: I get another layer of stress about how people might perceive me complaining about this, and guilt for feeling bad about a job I worked so long to achieve and that is so cool.

To make matters worse, especially since the 2016 election I have been stressed about not making enough of a positive difference in the world. Who cares what a rock on Mars is made of when there are children dying in cages and the highest levels of our government are indistinguishable from an international organized crime syndicate and the Amazon is burning? It makes me look at space exploration in a different, less favorable light. Some of the justifications for space exploration that for years were compelling to me, now sound hollow. Like stories we tell ourselves to feel good about dedicating our lives to what is ultimately an esoteric luxury. I find it harder to get invested in the scientific questions that are at the heart of my work. All of this is demoralizing, so the cycle feeds on itself.

It’s gotten to the point where I contemplate drastic changes in my career path. What if I quit and dedicated my time to writing full time? What if I quit and try to find a job in another country that isn’t rapidly becoming an authoritarian dystopia? (New Zealand seems nice.) What if I quit and try to become a full-time science communicator? What if I quit and devote my time to politics and trying to change the country’s disastrous course? What if I just quit, period? What if I tried to compromise and go part-time in my current job while pursuing something else? But then contemplating such a drastic change stresses me out for different reasons: What would people think? What if I failed? What if it’s just a case of the grass being greener on the other side and I want to go back? I worked all my life to reach where I am now, do I really want to throw that away? etc.

So what is my point here other than to ramble about my own mental health adventures? Partly I’m just working thought this stuff, but I am also posting here for two other reasons. First, because especially in the era of social media, it’s easy to just share a highlight reel of life and hide the hard parts. I want to push back against the idea that we’re not supposed to talk about these sorts of things, that we have to always present a perfect face to the world. And second, because I hope this helps others who might be struggling with anxiety or depression of a similar flavor.

The tendency to seek the approval of others and to judge yourself based on achievements is not particularly unique (and our society in general and social media in particular are engineered to encourage these patterns of thought), but I have a hunch that those of us who dutifully follow the achievement ladder of academia may be more susceptible than usual to this pattern of thinking. Just consider graduate school. You spend 5-6 years working with an adviser whose approval becomes the most important measure of your success, and you pin your hopes of happiness on achieving that highest academic achievement, a PhD. And then when you finish, you still are stuck in these mental ruts even though now you don’t have an advisor watching over you and there is no next degree to strive for. (Though, I guess if you stay in academia, the tenure process fills both roles for a while.)

It’s not clear which is the cause and which is the effect: Did I go to grad school because I crave approval and achievement, or was I taught to crave approval and achievement by my time in grad school? Likely some of both, but the end result is the same. A lot of people who make it through grad school end up with these tendencies that research shows lead to anxiety and depression.

The thing is, these tendencies are not all bad. When kept in check as part of a balanced life, they can lead to great productivity and satisfaction. The problem comes when they become the sole focus. Yeah, you want people to think well of you, but you need to maintain some perspective and (a) be able to function if someone doesn’t, and (b) not get overly worked up and anxious about your speculations about how someone feels (this is what I do most). Yeah, you want to achieve things (who doesn’t?) but it’s not healthy to be defined only by your job and achievements to the exclusion of the rest of your life.

For me, it has gotten to the point where I am almost incapable of framing things in terms other than achievements. This is part of why I struggle to get writing done on anything other than blogs: I build the project up in my head until it is THE book that is going to make or break my (nonexistent) writing career, and then when the first draft sucks (which is what first drafts always do), I give up because of all the pressure. Ironically, if I would just relax and focus on enjoying the writing process and not worry about the end result, I’d probably get to the end result a lot faster, having done a lot better writing along the way.

Bottom line, reading Feeling Good gave me some tools to help fight anxiety and depression and a new perspective to help understand why I struggle with the things that I do. It isn’t a miracle cure: it made me feel better while I was reading it, but now a couple of weeks later, I’m back to work and struggling again. I may actually go back and read sections of the book that are most relevant to me.

Meanwhile, I am trying to be more conscious about my tendencies to seek approval and achievements in place of actual self esteem. (And yes, I recognize the irony that I am posting this publicly in part to seek approval from people on social media!) I am trying to steer my life and my patterns of thought toward more balance. I’m trying to appreciate the present and be confident in myself without relying on approval from others. I’m trying to enjoy the process and not just the end product. And it is in that context that the second book had an impact on me. Primed with all of these thoughts from reading Feeling Good, Ursula K. LeGuin’s “Dancing at the Edge of the World: Thoughts on Words, Women, Places” gave me yet another lens through which to view the world and myself and these mental health struggles. I have rambled on long enough here, so I’ll talk more about that in a follow-up post.

Democrats on the Issues: Education

This post is part 3 of a series taking a look at the leading Democratic presidential candidate positions on key issues that are important to me. Post 1 was on Democracy and Political reform and also includes some details on my methods. Post 2 was on health care.

Introduction

Education is an incredibly important issue to me. Education is everything. It is the foundation of a functioning society, it is essential to solving the many complex issues we face, to allow us to learn from the past instead of repeating it, to allow us to express ourselves and make connections with our fellow humans. It gives people the ability to follow their passions and make the most of their lives.

Education is under attack in our country. Facts like evolution and the age of the universe and human impacts on our planet are not being taught. The histories of things like slavery, fascism, workers’ rights, and colonization are taught in a highly sanitized way, if at all. For many years, Republicans have been cutting education funding and promoting charter schools and private schools as alternatives to public schools, and as a result public schools have suffered. This path leads to a society where a privileged few get a great education, and most people do not. Just fund public schools adequately, and you don’t need to turn to private and charter schools to get the education you want.

Biden

Biden has a pretty detailed page on education. It is divided into three main themes: helping educators, improving schools, and improving access to education. Under the first theme, Biden proposes boosting wages and benefits for teachers by tripling Title I funding and requiring that that funding go toward teacher wages first. It’s unclear to me how this would impact teachers in districts that don’t serve as many low-income families but who still are grossly underpaid. His plan also talks about funding to pay teachers to do professional development and mentoring with other teachers. Basically, pay teachers to teach the teachers. This would also pay for additional certifications like special ed of bilingual ed. This part of the plan sounds to me like asking teachers to do more than they are already doing. I guess it’s good to pay them for it, but still, I’m a little iffy on this. A third point under this first theme would adjust the Public Service Loan Forgiveness Program to help teachers pay off their student loans, which sounds good.

The next section is focused on schools. It starts off with a plan to double the number of psychologists, counselors, nurses, and social workers at schools. It also talks about expanding on the “community schools” model, where schools work with families and community organizations to provide things like after school care, adult education, preventative health care, eye exams, etc. Things that low-income parents might have trouble accessing without help. This is another idea that sounds good in theory, but I worry that it is adding a burden to already overworked schools. The site claims this is a model that has seen some success though, so I’d be open to the idea if done right. Another item in the plan is to invest in school infrastructure, prioritizing health risks first, but also going toward things like technology and labs.

The next section of Biden’s plan is about access to education. He talks again about tripling Title I funding and how that will help close the funding gap between rich and poor districts. This section also talks about improving teacher diversity in a few different ways such as working with Historically Black Colleges and Universities (HBCUs) and helping parapros get their teaching certificates. There’s also a somewhat vague bullet about building the “best, most innovative” schools that teach “problem solving, collaboration, and technical skills” as well as academics in low income communities. I think this ties in to what is stated later on about increasing availability of vocational training and ability to take classes at community colleges while still in high school. This section also talks about reinstating some strategies from the Obama administration for diversifying schools and fully funding the Individuals with Disabilities Education Act.

Biden’s education page finishes by talking about early childhood education. He proposes universal pre-K as well as providing childhood development support through pediatrician offices. The plan also talks about expanding home visiting programs during early stages of parenthood to make sure everything is on track.

Sanders

Sanders has a detailed plan for education too! It is divided into ten numbered sections, so let’s just work through them.

  1. This section focuses on fighting racial discrimination and school segregation. His plan would increase funding for desegregating schools, triple Title I funding, and enforce the Civil Rights Act for school desegregation. He also mentions addressing biased disciplinary tactics in schools, which sounds nice but seems like a very local thing for a president to try to tackle directly. Sanders’ plan also includes funding more teacher training programs at HBCUs and tribal colleges, fully funding the Dept. of Education’s office of civil rights, and funding school transportation, magnet schools, and expanding ESL instruction.
  2. Next up are charter schools. Sanders rightly points out that Charters are being used to erode public school systems and move the country toward privatizing schools. He plans to ban for-profit charter schools and investigate the role charter schools are playing in intensifying school segregation. He also proposes making existing charter schools more accountable by, among other things, mandating that they comply with the same oversight requirements as public schools, disclosing attrition rates, non-public funding, and financial interests, and matching employment practices with district schools.
  3. Next up he addresses public school funding, starting off with something that has always bothered me: the fact that public schools are funded by property taxes, which leads to huge disparities in funding. Unfortunately he doesn’t really present a solution for this other than to “rethink” this practice. In this section he also mentions setting a per-pupil funding floor, covering fees for ACT and SAT exams and funding “career and technical” education.
  4. This section is about strengthening the Individuals with Disabilities Education Act (IDEA). He proposes having the federal government provide 50% of special ed funding, enforcing the ADA, and working to train more special ed teachers and making sure they are paid fairly.
  5. Sanders next talks about teacher pay in general. He proposes a nationwide minimum teacher salary of $60,000, ending racial and gender disparities in pay, providing professional development, expanding collective bargaining and teacher tenure, and addressing the costs of classroom materials with grants and tax credits.
  6. This section is short and sweet: provide more funding for summer and after school education.
  7. Here Sanders proposes year-round universal school meals, providing breakfast, lunch and snacks for kids. “It is not a radical idea that no child in this country should go hungry.” I agree and this seems like a reasonable way to tackle that.
  8. This section talks about “community schools” and is very similar to what Biden proposed: making schools hubs for other services like health care, adult education, etc.
  9. Another short section: provide funding for school infrastructure needs.
  10. And finally, there’s a brief section about school safety, mentioning enforcing Title IX, protecting LGBTQ students, and addressing gun violence and ensuring that immigrant students (and their parents) are safe at school.

Overall, a lot of good ideas, though I would have liked to see more about how all of these great things would be accomplished and funded.

Warren

For a candidate whose catchphrase is that she has a plan for everything, I’m shocked and disappointed that I am unable to find a K-12 education plan on Warren’s site.

What she does have are plans for pre-K and higher education. On the younger side, she proposes universal child care and early education. I think this is a really good idea: it not only addresses one of the most significant costs associated with raising kids, it also would enable more people to stay in the workforce thereby boosting the economy, while also providing kids across the board with quality childcare and early childhood education, something that leading economists say has a massive return on investment (as if the intrinsic value of caring for our children was not enough). Warren’s plan would not replace existing childcare providers, but it would hold them all to uniform standards. The plan would also pay childcare workers wages comparable to public school teachers: not amazing, but better than their current situation in most cases.

On the higher education side, Warren proposes cancelling student debt up to $50,000 and provide free higher education. Again, these sound to me like excellent ideas. The debt cancellation would eliminate all student loan debt for the vast majority of people who are carrying that debt right now, which would provide an enormous stimulus to the economy. And the benefit would be scaled based on income so it would provide the most help for the people who need it the most, helping to reduce wealth disparities.

I’ve seen some people react to this plan by saying that it’s not fair: they had to pay off their debt, so why do people with student loan debt now get out of paying for it? This attitude baffles me. It’s basically saying “I suffered, and therefore so should you” when really what we should be saying is “I suffered and I hope nobody else has to do so”. That’s where the second part of Warren’s plan comes in: free public college as well as additional funding for non-tuition education expenses. The plan also includes some provisions specifically geared toward increasing enrollment of students of color.

I like that Warren also has a plan for how to pay for these ideas. She estimates that debt forgiveness and free public college will cost $1.25 trillion over ten years. She points out that the effective cost is likely to be less due to the economic stimulus these plans would produce (allowing an entire generation of young people to spend their money on things other than paying off student debt makes that money work much more effectively in the economy), but even without that, the cost would be easily covered by her “ultra-millionaire” tax, which would tax the wealth of people with more than $50 million (another plan that I think is an excellent idea, but which I won’t go into here).

So for Warren, I’m disappointed in the lack of a K-12 education plan, but I really like her other education related ideas.

Harris

Harris has two main sections on her site related to education. One focused on raising teacher pay, the other on student debt.

For teacher pay, she proposes a significant boost, with the average teacher receiving a $13,500 raise. To do this, her plan would establish a base salary for teachers in each state, with the exact number accounting for things like years of teaching experience and salary earned by other professionals with similar amounts of education. The federal government would provide the first 10% of the funding needed to close the pay gap and then would match every dollar put forward by states with $3 from the federal level, and states would be required to keep up their end of the bargain to keep getting the funding. Harris’ plan would also allocate more funding to high-needs schools, which would help serve students and teachers of color. And, like most candidates, she talks about the need to invest in teacher training and professional development, especially at HBCUs. And finally, she mentions fighting for teachers’ right to unionize. To pay for all this, which is estimated to cost $315 billion over ten years, Harris says that she will strengthen the estate tax.

Regarding college and student debt, Harris’ plan is not quite as dramatic as Warren’s. She proposes allowing people with student debt to refinance at lower rates, expanding Income Based Repayment, and cracking down on for-profit colleges and lenders. As for the cost of college, Harris has a brief couple of sentences promising to make community college free, make four-year college debt free, and points to her “LIFT act” which is apparently a tax cut for “working Americans”. I would have liked to see some more details on this topic. Right now it comes across as a sort of “Warren has a plan for this stuff so we should say something too”.

Overall, I though Harris had some good stuff on teacher pay but her college and student debt section needs work.

Buttigieg

Buttigieg has two sections on education within his larger “Freedom” piece of his site. The first (relatively brief) section is higher education, where the key policy he lists is debt-free college. He proposes a state-federal partnership to reduce public tuition and make college free for those with lower incomes. He also suggests a large increase in Pell Grants. The net result is that he says middle-income families will pay zero tuition for public colleges. He also proposes canceling debt for people in low-quality for-profit programs, and investing more in HBCUs and Minority Serving Institutions. Beyond that, he has some pretty vague bullet points about student loan debt, transparency, and standards for for-profit institutions.

The second section on Buttigieg’s site is about making public education more equitable. It basically just points to his whole separate page laying out his plan for helping Black Americans, specifically the section on “schools of the future”. The first part of this is familiar from other candidates’ plans: increasing federal funding for Title I schools. He also proposes new rules for transparency in hiring practices at schools and new guidelines for using Title II funds, all aimed at getting more diversity among teachers (another goal shared by most candidates, I’m starting to notice some themes). He also proposes federal investments and incentives for improving readiness in STEM fields and fields with a lot of employment opportunities (health care, software, finance, alternative energy are listed).

Overall, Buttigieg’s education plan seems less ambitious and less detailed than some others but with familiar goals and strategies for achieving them.

O’Rourke

O’Rourke has a good amount of info on education. His plan is broken down into 5 key components.

The first component is a permanent fund for “equity and excellence” which would do a variety of good things. This fund’s main purpose would be to close gaps based on race and income, and would require schools receiving the funding boost to undergo equity “audits” to evaluate outcomes and ensure funding is being used appropriately. This component also includes having a committee determine an appropriate level of funding taking into account cost of living and proportion of students with higher needs. States that are not meeting that level would have to provide a 50% match to receive money from the Equity and Excellence fund. Likewise states would have to show that they are providing equitable funding across schools and districts, again accounting for higher needs in some areas.

However, despite those requirements, O’Rourke’s plan has a whole section emphasizing that the details of how the funds would be used in a given school are somewhat flexible, allowing people at a local level decide what makes the most sense for their situation. If done well, this seems like it could be a smart way to do things.

He also talks about how to pay for this “equity and excellence” fund, by taxing stock speculation with a 0.1% tax on transactions that would have a bonus effect of decreasing high-frequency trading and its destabilizing influence on the stock market.

O’Rourke also includes fully funding the Individuals with Disabilities Act and investing on school infrastructure under part one of his plan.

Part two is focused on diversity. The first piece is to address racial disparities in discipline by banning corporal punishment, funding restorative justice programs, and funding teacher education to “address racial bias and cultural competency in their curriculum”. The second piece is to boost funding for programs to increase integration such as housing and busing. The third piece of part two is to increase funding for English language learning and dual language programs by boosting Title III funding and supporting teacher credentialing.

Part three is focused on student debt relief for educators. This plan would suspend student loan payments for teachers who are teaching in a public school, and forgive 20% of the principal per year, for total loan forgiveness after 5 years of teaching. This is a tweaked version of O’Rourke’s broader loan forgiveness plan, which would forgive 10% of a borrower’s outstanding debt per year of working a “public interest job” and would also forgive monthly payments in excess of 10% of a person’s disposable income.

Part four is about teacher diversity: it proposes a program support partnerships between postsecondary institutions and high needs school districts to create residency programs, which could also support people already working in those schools to become certified teachers. O’Rourke’s plan also would fund teacher education at HBCUs and MSIs, similar to what other candidates have suggested.

The final part of O’Rourke’s education plan is focused on continuing education for teachers. This would include free tuition for educators to acquire graduate degrees and funding to pay for National Board Certification. The plan also calls for the creation of a “Master Teacher Corps” which would provide extra funding to allow qualifying teachers to take on more leadership roles, get involved in mentorship, allow for more collaboration between teachers, and the like. This one is kind of vague but I get the impression that it’s supposed to be similar to the “equity and excellence” fund in that the exact way the funding would be used is somewhat flexible. This point is also a little vague on whether it is expecting these master teachers to take on these extra duties in return for extra pay, or whether the idea is that the extra funding allows schools to hire more people so that the course load for these master teachers is lower, allowing them to take on these extra duties. The final piece of this last part of the plan is to allow teacher “micro-credentialing”: basically, teachers can submit evidence of mastering specific skills to meet continuing education requirements. In other words, you don’t necessarily have to take a professional development course, you just have to prove you have a certain skill and how you learned it is de-emphasized.

Overall, I think O’Rourke has a solid set of education plans. Some are similar to other candidates’ plans, others are unique. Some areas are a little bit vague, but in general it seems well thought-out, at least to this non-educator.

Conclusion

I’m having a harder time deciding on a favorite candidate for this topic than the others. There are a lot of similarities, but also a lot of different strengths. Sanders checks a lot of boxes and highlights some issues such as property taxes that have always bothered me, but doesn’t always have a lot of detail. I love Warren’s universal childcare and debt forgiveness plans, but am very disappointed in the lack of a core K-12 education plan and without that I can’t rank her very high. Biden and Harris both have solid plans with decent amounts of detail. O’Rourke also has a lot of good stuff and some unique and interesting ideas. Buttigieg was pretty light on details. So, I guess if I had to rank the candidates from best to worst it would go: Sanders, Harris, Biden, O’Rourke, Warren, Buttigieg.


BidenSandersWarrenHarrisButtigiegO’Rourke
Increase Title I Funding
(or similar)
XX
XX
Increase professional
development/mentoring
XX
X
X
Increase teacher payX
(Title I
schools)
X
X

Help teachers/others
pay off student loans
X
XX
X
Student loan forgiveness

X
X
(limited)
X
Free/reduced cost college

XXX
More counselors,
social workers, etc.
X




“Community schools”
idea
XX



School infrastructureXX


X
Improve teacher
diversity
XX
XXX
Support teacher unions
X
X

Universal pre-KX
X


Universal childcare

X


Address racially biased
disciplinary tactics

X


X
More vocational trainingXX



Charter school reform
X



Address property tax
funding disparities

X



Cover college exam fees
X



Increase support for
IDEA

X


X
Universal school meals
X



“Equity fund” with
federal oversight





X
Talks about how to
pay for plans


XX
X
Increase Title III
funding for ESL





X
Increase school
integration
XX


X

Democrats on the Issues: Health Care

This is part 2 of a series of posts I’m doing to compare the policies of the frontrunners for the Democratic presidential nomination. You can read Part 1 here, which discussed my general rationale and methods for these posts and looked at issues related to democracy and political reform. Since that post took care of all the introductory stuff, let’s jump right in.

According to this article from https://www.wphealthcarenews.com/, the Affordable Care Act was a major achievement that brought health insurance to millions, and improved it for those who already had it, but anyone who has had any experience with health care in this country should know that it is a deeply broken system.

My first son was born at the end of 2016 and had to spend 20 days in NICU. He was about as healthy as it is possible to be while requiring a NICU stay, and yet when all was said and done the bill for his care was over $100,000. Thankfully, I was able to choose decent insurance to help cover most of those costs, but we had to argue with the insurance company over the course of months to get them to cover everything they were supposed to. It was a whole ordeal just to get an itemized list of costs from the hospital for the services they were providing. I am haunted by the fact that many people don’t have insurance in the first place, or don’t have the time or ability to argue over the details of their coverage. Having a child in the hospital is stressful enough without having to worry that it is going to bankrupt you.

A free market approach just does not work for services like health care. It’s not a “free market” when I have no choice but to pay for a service, and even if I did there’s no way to see what it is going to cost me. It’s not like we could shop around for a different NICU to take our newborn son to for emergency treatment. And it is deeply immoral for people with more money to be able to get better care simply because they can pay for it.

Health care is a really complicated topic, so it was a real challenge to distill some of the candidate positions down and to compare them on an even footing, but I tried!

Biden

There’s a lot more detail here than there was for the previous topic, which is great. Of course since Biden is running as the Democratic successor to Obama, his plan calls for building on the ACA rather than switching to something completely different. However, one of the first things in his plan is the availability of a public option similar to Medicare that would be able to negotiate lower prices with providers. To me that sounds like a great step in the right direction. He also talks about a tax credit to help middle class families pay for coverage. I generally don’t love tax credits as a way of providing services, but ok I guess that’s good. His plan also would fix “surprise billing” from specialists who are out of network but work at an in-network hospital, and would use antitrust laws to help fix the lack of competition in some parts of the health care system.

There is also an extensive section on lowering prescription drug prices, with ideas including: repealing a law that prevents Medicare from negotiating with drug companies, independent review board to set prices for new drugs with no competition, allowing people to buy prescription drugs from other countries where prices are lower, getting rid of the tax break for pharmaceutical company advertising, and improving availability of generic drugs. 

A final section is focused on access to health care. It places access to contraception and abortions front and center, along with repealing the Hyde amendment, and restoring funding to Planned Parenthood. This section also talks about rescinding the “global gag rule” preventing the US from aiding international organizations that dare to mention abortion. There is also mention of adopting a policy pioneered in California to reduce maternal mortality rates. Other topics include ensuring access regardless of gender, gender identity, or sexual orientation; investing in community health centers; and expanding mental health care.

At the very end of Biden’s health care page, he promises more details in the future on health care in rural communities, and in relation to gun violence and opioids. There is also a little bit at the end about how he proposes to pay for all of this by eliminating capital gains tax loopholes for the super rich.

All in all, I found Biden’s health care page to be very good. Yeah, maybe it’s a lot of smaller and less sexy changes than just making sweeping statements about “Medicare for All” but it also strikes me as well thought-out and realistic.

Sanders
Compared to Biden’s extremely detailed Health Care section, Sanders’ page is kinda laughable. Sanders famously is in favor of a “Medicare for all” single-payer option, and that’s pretty much all his page says. There are a few bullet points about lowering drug prices with ideas that are mostly similar to what Biden’s plan listed: allow Medicare to negotiate drug prices, allow people to buy drugs from other countries, and pegging drug prices to the median of five other major countries. I guess the lack of detail on Sanders’ page could be chalked up to the fact that a lot of what Biden is trying to fix with specific tweaks should get sorted out by the drastic shift to a single payer plan for everyone, but still, I expected better than this. Medicare for all is great, but you need a plan on how to get there from here.

Warren
I can’t find anything resembling a Health Care section on Warren’s website. She mentions Medicare for All in the context of how her proposed tax on the ultra rich would pay for a variety of things, but that’s about it. There’s speculation that this lack of detail is strategic, allowing her to lump herself in with Sanders on this issue, but since Sanders also has essentially no details, that doesn’t really help. Gotta say, I’m disappointed in both of them. I hope they flesh out their plans soon.

Harris

Harris has a detailed health care section! As before, her site is quite a bit more verbose than others, but in this case there are plenty of good specifics. She is in favor of Medicare for All, and after some introductory text, she gets right to the heart of the matter: how do we get to medicare for all from our current system? This is my big question about Medicare for All, so I’m excited to see a candidate who actually addresses this.

Her plan would start with allowing Americans to buy into Medicare immediately, and specifically says this would be similar to Sanders’ bill. Then there would be 10-year phase in period where newborns and the uninsured are automatically enrolled in Medicare, doctors can get added to the system, and others on Medicaid and ACA plans can transition. And the third part of the plan is to allow private insurance to offer Medicare plans as long as they follow strict guidelines. People will still have the option to buy supplemental insurance for stuff Medicare doesn’t cover.

Harris’ plan also mentions that the Medicare for All system would have to meet certain benchmarks along the way to ensure it is working the way it is supposed to. “Data matters and should inform our transition.” Music to my data-loving ears.

She then talks about costs and says that the 10-year phase in period will make the transition less expensive than Sanders’ plan. She also contrasts with Sanders’s plan to levy a 4% tax on households making more than $29,000, saying this hits the middle class too hard. (I find it ironic that I’m getting more details about Sanders’ plan from his opponent than from his website.) Instead, Harris would raise that threshold to $100,000 with adjustments to that threshold for high cost of living areas. To make up the difference, she would add a small tax on stock trades (2%), bond trades (1%), and derivatives (0.002%), and tax offshore corporate income.

Harris also has separate pages on drug prices and women’s health. For drug prices she proposes having HHS set the fair prices for drugs based on prices in other first-world countries. She also mentions ending the advertising tax loophole and directing the proceeds toward the NIH. Her plan also addresses the likely scenario where congress does not take action on drug prices in the first 100 days. In that case, Harris says she would take executive action to investigate price gouging and and if a company is found to be overcharging, work to import lower cost drugs from other countries or refer the company to DOJ investigation. If that doesn’t do the trick, then for drugs developed through publicly funded R&D, there is apparently a law that allows the government to license production of that drug to a lower cost company.

Her plan for women’s health would take a page from the Voting Rights Act, and require states with a history of discriminatory practices regarding abortion access to pre-clear new laws with the DOJ. Similarly, it would prevent any abortion law from taking effect until DOJ determines it complies with Roe v. Wade. The plan also includes provisions for future dates after a Harris administration when DOJ might be hostile to abortion rights again, codifying that the DOJ must do the reviews mentioned above and that the people have the right to challenge the DOJ’s approval in court. She also mentions protecting Planned Parenthood, repealing the Hyde amendment, appointing judges who respect Roe v Wade, and rolling back the Trump administration’s rules that limit access to contraceptives and abortions.

All in all, I’m very impressed with Harris’ health care plans. They’re ambitious but well thought out and realistic.

Buttigieg

Buttigieg has a pretty slim section on health care. He proposes a “Medicare for All Who Want It” plan where people can buy into a public option. The idea being that this would force private insurers to lower costs and do better or else would lead to a smooth transition to Medicare for All. Beyond that he just has a bulleted list: improved health equity, invest in maternal and infant health, lower drug prices, more affordable long term care, invest in mental health, and combat the opioid and meth epidemics. I guess I’ll count the items on this list for the summary table at the end of this post, but barely. Pretty disappointing.

O’Rourke

O’Rourke has a brief health care section with some more detail on certain issues. His plan is basically in the “Medicare for all who want it” camp. Anyone who doesn’t have health care would be enrolled in Medicare, and everyone would have the option to enroll, but could opt to stick with their employer’s private insurance plan. No discrimination for pre-existing conditions. His plan would also cover long-term care.

On drug prices again a lot of familiar ideas. Importing drugs from Europe and Canada, allow Medicare to negotiate drug prices, and have the government step in and license production to other manufacturers if drug companies refuse to set reasonable prices.

On reproductive health care he has a more extensive page, divided up into executive, judicial, and legislative sections. In the executive section, he talks about appointing an attorney general who would honor Roe v. Wade, as well as reversing the “gag rule” and increasing Title X funding with no restrictions on use for abortions, effectively overturning the Hyde amendment. He also mentions removing FDA labeling regulations related to medication-induced abortions. The judicial section is short and sweet: appoint judges who respect Roe v Wade and women’s right to choose. In the legislative section, he points to existing legislation that would address many of the issues: the Women’s Health Protection Act and the Equal Access to Abortion Coverage in Health Insurance act. Specifically, he supports legislation that would affirm a woman’s right to choose, ban regulations that are meant to close clinics, prevent mandates for unnecessary ultrasounds and waiting periods, repeal the Hyde amendment, and prohibit abortion restrictions on private insurance. And then he points back to a universal health care system that includes contraception and abortion coverage.

He also has a brief section on racial disparities in maternal and infant mortality. O’Rourke would address this by using Title X and the National Health Service Corps to reduce “maternal health deserts”, ensure access to all maternal health screenings as well as midwives/doulas, and ensuring mental health services for new mothers and expanding home visiting programs.

Summary

Overall, on health care Biden and Harris lead the pack in terms of detailed plans, with Harris being more ambitious. I really liked the fact that she spent time explaining not just that our current system is broken and needs to be replaced with something better, but talked about how to make that transition happen. O’Rourke also had a decent amount of detail, especially on reproductive health care. Sanders, Warren, and Buttigieg were pretty disappointing on such an important topic. If I was a single-issue voter on health care, Harris would get my vote.


BidenSanders Warren HarrisButtigieg O’Rourke
Medicare for allXX(phase-
in)


Medicare/public option
for all who want it
X

XXX
Medicare/HHS negotiate
drug prices
XX
XX
Review board to set
prices for new drugs
X




Import drugs / peg prices
to other countries
XX
X
X
Re-license drug production
if prices are too high



X
X
Get rid of drug ad tax loopholeX

X

Repeal Hyde amendmentX

X
X
Protect Planned Parenthood/
allow federal funding
X

X
X
Rescind “gag rule”X

X
X
Address maternal mortalityX

XXX
Ensure access for
minority groups
X

XXX
Talks about how to
pay for plans
X
XX

DOJ oversight on
abortion-related laws



X

Long term care
more affordable




X
Invest in mental healthX

XX
Address opioid epidemic(coming
soon)



X
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