USA and Global news from ATLANTIC: July 2013

Tuesday 9 July 2013

Teaching Doctors How to Think

Jonathan_W (@whatie) / Flickr

"He who thinks he knows doesn't know. He who knows that he doesn't know, knows." -- Joseph Campbell

I have made clinical errors, also known as mistakes, at various points in my 40-year career. Fortunately, I don't think there have been many. One of them resulted in a long-settled malpractice suit where six different neurologists, including me, missed the diagnosis of rare disease. Presented with the same facts, I admit that I might make the same mistake again. I classify my mistakes in three broad categories:

Mistakes that didn't cause the patient any harm.
Mistakes that resulted in serious problems.
The mistakes I still don't know about because I either never recognized the error or the patie! nt went someplace else.

All doctors make mistakes, because it is impossible for an individual to be perfect - any endeavor that involves humans will involve errors. The man who has the wrong leg removed at surgery makes the headlines of the six o'clock news, but the larger problem resides in the 10 to 15 percent of times where the doctor fails to make the correct diagnosis.

I have always taken pride in the fact that I can trust my clinical judgment, almost always making the right decision at the right time. I sometimes get frustrated watching physicians paralyzed by their indecision. But an article in the New England Journal of Medicine last month has forced me to reconsider my decision-making process. Dr. Pat Croskerry from Dalhousie University in Canada explains that most of our everyday thinking is flawed, and that doct! ors are no different than the average person. It is not a lack! of knowledge (15 years of higher education followed by continuing education requirements take care of that end). The problem lies in the manner in which we approach "clinical thinking."

There are two major ways in which we process information, "intuitive (type I)" and "analytic (type II)" Our Intuitive approach is automatic, and happens at an unconscious level. Croskerry describes this as the "Augenblick diagnosis" or that which is made in the blink of an eye. You see it on television all of the time. The narcotic-popping curmudgeon Dr. House is a great example. No one can figure out what is wrong with the patient, but, through the blur of his own over-medicated psyche, Dr. House instantly makes the rare diagnosis and the day, if not the patient, is saved.

There is a real danger in thinking this way, to zero in on a specific diagnosis or problem and fail to consider other possibilities. The fact is that most physicians who trust their intuition a! re right most of the time. The vast majority of people coming to my office with a headache will have migraine headaches. My bias will be that you most likely suffer from migraine headaches. I will be right most of the time, but not always - and this automatic, unconscious mode leaves me vulnerable to make a mistake.

The other mode of clinical thinking is Type II, the Analytic process. This is a conscious, slower, and deliberate process that is usually more reliable than the Intuitive process. In this process, we take time to analyze all of the information, order confirmatory tests, consult with colleagues and consider all of the possibilities. Although reliable, it requires a great deal of resources like CT and MRI scans, coronary angiography and numerous vials of blood. In truth, it is just not practical for every patient. We must trust our clinical, intuitive judgment because we cannot order a nuclear cardiac scan or coronary angiogram on every patient with chest! pain. However, I know many physicians who order far too many tests. So! me claim it is to protect them from a malpractice suit, while others just don't want to miss a diagnosis.

But where is the correct balance between using one's "intuitive" clinical judgment and ordering too many tests under the banner of being an "analytic" diagnostician? It would be inappropriate for me to order an MRI scan of the brain on every patient with a headache. But, I also must get off the autopilot of intuitive thinking and reexamine how I evaluate patients. This is more difficult than it sounds because we are not born to be critical thinkers who can turn off our unconscious intuitive reactions and analyze a situation in a "timely" manner. Dr. Croskerry suggests that medical schools and post graduate medical education need to teach critical thinking as part of their formal curriculum. Doctors must recognize when their biases creep into their decision making and learn to move from their intuitive mode to their analytic mode. This is the elusive "sweet spot! " of critical thinking.

Even if I find the balance between intuitive and analytical thinking, I will still make an occasional error and miss a more serious problem, but it should happen less frequently. As hard as it is to accept, the laymen have to understand that bad outcome does not always equal malpractice and that clinical thinking is an imperfect cognitive process.

Dr. Croskerry believes that "all clinicians should develop the habit of conducting regular and frequent surveillance of their intuitive behavior. To paraphrase Socrates, the unexamined thought is not worth thinking."

&n! bsp;

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How Smart Investing Made the Pittsburgh Pirates Baseball's Best Team

AP / Keith Srakocic

What a difference three years makes.

As we head into this year's mid-season All-Star Game break, the Pittsburgh Pirates, formerly the perennial worst team in baseball, have the best record in the game (well, they're tied with their division rivals, the St. Louis Cardinals). So after their 20th consecutive losing season last year—a record for the most consecutive losing seasons in any of the four pro sports—how did the Pirates manage to become the best team in baseball? By getting creative with the money they made through revenue-sharing.

The Pirates' transformation began in 2010; back then, they were terrible, even by their own standards. The team finished 57-105, 34 games behind the division-winning Cincinnati Reds. In 2011 and 2012,the Pirates extended their own record for futility—their 72-90 mark last year made for 20 straight seasons in the tank. If postseason play is the measure of a team's success or failure, the Pirates have been a disaster since 1992, the last time they were in the playoffs. And if you go by world championships, it's even worse: The last ring winner was Willie Stargell's 1979 "We Are Family" team.

2010 was also the year that documents were leaked revealing that three major-league franchises—the Pirates, the Florida Marlins, and the Tampa Bay Rays—actually made money and in fact made substantial profits from losing. Under the MLB revenue-sharing plan, small-market, lower-revenue teams get a kickback from the richer teams' local TV profits. In theory, this wealth-redistributing dose of socialism should give the poorer teams a chance at parity. But what the leaked documents seemed to indicate was that the Pirates, Marlins, and Rays weren't putting those funds toward competing for free agents but instead pocketing the revenue-sharing checks.

In reality, that's what the Marlins and Rays were doing. But though the press came down particularly hard on the Pirates ("MLB Should Dump the Pittsburgh Pirates From Revenue Sharing," a headline on Bleacher Report read), what the press didn't understand was that at the time, the Pirates were in the midst of a radical overhaul from the bottom up. Between 2008 and 2011, owner Robert Nutting and general manager Neal Huntington spent nearly $50 million—more than any other team in baseball—on scouting and signing young talent in the amateur draft. They poured millions more into stocking their farm system with the new prospects—unlike other owners and managers who prioritized their teams' main rosters.

The results of Nutting and Huntington's unorthodox approach have been dramatic. Now that the Pirates are tied for first place, a black baseball cap with a bright yellow script "P" is suddenly baseball chic for the first time in nearly two decades. The Pirates are selling out at home, moving merchandise hand-over-fist, and even becoming a road attraction.

Between 2008 and 2011, the Pirates spent more than any other team in baseball on scouting and signing young talent in the amateur draft. This season, they will face the rest of the schedule with the best array of young talent on any major-league roster.

One-half of a baseball season doesn't make a pennant winner, of course, but thanks to their shrewd tactics in scouting and signing promising amateur players, the Pirates will face the rest of the schedule with the best array of young talent on any major-league roster. After 87 games, Pittsburgh leads the majors in overall ERA, 3.14. Starters Jeff Locke (age 25), Francisco Liriano (29), Jeanmar Gomez (25), and Gerrit Cole (22) have won a remarkable 22 of 26 decisions. Their relief corps has kept pace with the starting pitching, too, holding hitters to the lowest batting average of any bullpen in the National League.What the Pirates aim for is to be ahead after six innings when they hand the ball to "hold" guy Justin Wilson (ERA 2.06),set-up man Mark Melancon (ERA 0.87), and, finally, sure-to-be-All-Star closer Jason Grilli (2.15 ERA, with 28 saves).

At bat, they're not nearly so potent, ranking just 12th out of 15 teams in runs scored. But in All-Star center fielder Andrew McCutchen, third baseman Pedro Alvarez, and left fielder Starling Marte, they have three young hitters who all rank in the top 25 among the league's batters in combined On-Base Average and Slugging.

While most of the Pirates' talent is homegrown, the front office has also made judicious use of the free-agent market.Catcher Russell Martin, a former free agent who signed a two-year contract with the Pirates in the off-season, has batted near a respectable .250 mark all season with excellent power (he's hit nine home runs as of today). He is also a superb defensive catcher, an excellent handler of pitchers who has thrown outa career-high 49 percent of would-be base stealers so far this season.

There's a delicious irony to how the Pirates got Martin that points to an oddity that keeps big-market teams from dominating the game. Last season,Martin was the regular catcher for the New York Yankees; it is widely rumored that the Steinbrenner family has been cutting the Yanks'payroll, the highest in baseball, to make the franchise more attractive to prospective buyers. Whatever the reason, the Yankees let Martin, whomade $7.5 million last season—not a particularly high sum for an experienced catcher who can hit with power—go to the Pirates, who signed him for a bargain $6.5 million. (Next year,he'll make $8.5 million.) Simply put, the Yankees, in an attempt to cut their payroll, practically handed the small-market Pirates one of their most valuable players.

The Yankees' 2013 payroll is estimated to be nearly three times the Pirates'. Yet Pittsburgh's win-loss percentage is more than 60 points higher than New York's. Whether the Steinbrenners decide to sell or not, they could benefit from a look at the Pirates' business model.

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Egypt's Army Has More People Than Miami and Answers to No One

An injured supporter of ousted President Mohammed Morsi sits at a field hospital in Nassr City in Cairo on July 8, 2013.(AP/Khalil Hamra)

In some of the worst violence since the fall of Mubarak, Egyptian soldiers opened fire on supporters of ousted president Mohammed Morsi while they were praying this morning, killing 43 people and wounding 300.

The New York Times described the gruesome scene:

There were pools of blood on the pavement. Some of the blood and bullet holes were hundreds of yards from the walls of the facility's guard house, suggesting that the soldiers continued firing as the demonstrators fled.

To the uninitiated, it may seem strange that a country's armed forces not only orchestrated the ouster of an elected leader, but also fired on the nation's own citizens with seeming impunity.

But unlike in most countries, where the military takes orders from the chief executive, Egypt's military is the strongest institution in the land, and in many ways, it has called the shots ever since it took power in a 1952 coup. None of the country's leaders have had an independent political base strong enough to counteract the mammoth army, which casts itself as the guardian of Egyptians' freedom. What happened today shows the extreme downside of the fact that the country is controlled, even if temporarily, by unchecked soldiers.

Here's how the military became so powerful:

In 1952, a group of military officers pushed out Egypt's King Farouk and established the Egyptian Republic. The military immediately took charge, and a few years later the revolution's linchpin, Colonel Gamal Abdel Nasser, became president. But even though he came from the army, tensions with the military became "an abiding theme of the entire Nasser period," said Robert Springborg, an expert on the Egyptian military at the Naval Postgraduate School in Monterey, Calif. "The entire time of his rule was caught up in trying to deal with the military."

During a coup d'etat, Egyptian army tanks and field guns are drawn up in front of the royal Abdin Palace in Cairo on July 26, 1952. (AP)

Perhaps the most dramatic example of this was Nasser's power struggle with Abdel Hakim Amer, the deputy supreme commander, which ended after Nasser arrested Amer following Egypt's defeat during the 1967 war with Israel. Amer either killed himself while under house arrest, or was killed on Nasser's orders.

The military's relationship with the next two leaders wasn't much smoother.

Anwar Sadat, the next president, purged the military of his opponents, and there is a theory that his assassination in 1981 was plotted by the military as revenge.

In the 1980s, U.S. military aid allowed the army to begin modernizing and expanding, but the troops got even richer when Hosni Mubarak, who took power after Sadat, again possibly at the hands of the military, essentially dealt with them "by buying them off," Springborg explained. Mubarak simply gave them total control over their own mini-economy, propped up by low-paid conscripts, while using his own private forces to monitor the troops.

Egyptian troops parade in Cairo on Oct. 6, 1974. (AP)

The U.S. and World Bank pushed for the privatization of the massive military enterprises, but Mubarak, to some degree, fended them off, fearing the political consequences of infringing too much on Egyptian Military Inc.

" ... The military views the GOE's [government of Egypt's] privatization efforts as a threat to its [the military's] economic position, and therefore generally opposes economic reforms," a Wikileaks cable from 2008 noted.

Camel corps members head out on patrol in El Arish, Egypt in 1980. (AP)

By 2011, the army's political and military might was unparalleled. The Times detailed how the army was operating a lavish hospital and a fleet of luxury Gulfstream jets. The interim armed forces government, which governed the nation between Mubarak and Morsi, put foreign NGO employees on trial, leading to the sentencing and expulsion of 43 such workers.

The military absorbs most of the aid the U.S. continues to send to Egypt. It's now the largest army in Africa and one of the largest in the world, and by developing an extensive network of businesses, it has also become a dominant economic force, controlling between 10 and 30 percent of the economy and employing hundreds of thousands of Egyptians.

In a Pew Research Center poll conducted in March, 73 percent of Egyptians said the military had a good influence on the country, making it more popular that most of the country's other political parties.

Meanwhile, the military has stayed out of the political spotlight, preferring to avoid the appearance of direct rule while bolstering its stature with parades, youth sports leagues, and museums. Egyptians cheer on the Border Guards' soccer team and wait in military-organized breadlines during shortages.

***

Last year, Morsi installed new army commanders that he hoped would be more loyal to him. But his biggest error was playing too dominant a role in national security policy, which the military has always felt was its domain, Springborg said.

In June, Morsi seemed to give tacit approval to politicians who wanted to subvert an Ethiopian plan to build a dam on the Nile. Later that month, he expressed support for the Syrian rebels at a rally that was also attended by hardline Islamists.

The military, seeking to avoid both Islamist alliances and unnecessary overseas conflicts, soured on Morsi, and last week's protests only served to cement the alliance of Egypt's opposition and the military against Morsi and the Muslim Brotherhood, the group that backs him.

Springborg said that despite how large the military looms in Egypt, today's shooting is likely to put a dent in their popularity, if not their power. But they might still recover their image if they cast Muslim Brotherhood supporters as the bad guys. According to one military spokesman, the troops only fired on the civilians when armed Morsi supporters attacked them.

"The struggle over the narrative now is going on between the Brotherhood and the military -- what really happened here and who's responsible," he said. "The outcome of that will determine the future of Egypt. If the military looks like it's killing good Muslims, they're in big trouble. But if people get behind them and say the army is defending people against the Brothers, they'll maintain their political position."

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Why Nobody Trusts China's Courts

Wang Shujin addresses the Higher Court of Handan City on June 25. (Weibo)

At 9:00 am on the morning of June 25, Wang Shujin was escorted into the Higher Court of Handan City, Hebei province. More than 200 seats in the courtroom's public gallery were occupied. In 2005, the 46-year-old man was arrested on charges of raping and killing three women in 1994 and 1995. In 2007, he was sentenced to death.

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What makes Wang's case unique, however, is that he insists his guilt in a fourth murder, but prosecutors have sought to invalidate his confession and affirm his innocence. Scholars say Wang's trial will test the impartiality and integrity of China's judicial system, as well as the public confidence in the judiciary. The verdict, nearly 8 years in coming, has been deferred once again.

The crime to which Wang Shujin has now confessed was thought solved long ago. Another man, Nie Shubin, was executed for raping and murdering the woman in a corn field in Shijiazhuang City, Hebei Province. Wang Shujin has claimed he was the real murderer and is appealing his death sentence, asking for leniency owing to his confession to a fourth murder case. The greatest controversy of the trial is whether Wang Shujin in fact killed the woman -- meaning Nie Shubin was grievously wronged -- or was just trying to reduce his sentence. According to Article 68 of China's Criminal Law, any criminal who not only voluntarily surrenders after committing the crime but also performs major meritorious services shall be given a mitigated punishment or be exempted from punishment.

The courts have repeatedly dismissed Wang's confession and invalidated his appeals upon a finding that Wang's descriptions of what he said he did deviated significantly from crucial evidence found at the crime scene. The official Sina microblog of the Hebei Provincial High Court listed the contradictions: "1. The neck of the victim was tangled with a floral shirt and Wang Shujin did not mention that in his confession. 2. The victim was smothered while Wang Shujin said he strangled and trampled her to death. 3. The times of murder do not match. 4. The heights of the victim do not match either."

Prosecutors argued that Wang Shujin was able to provide some accurate details about the murder only because he worked in a factory near the corn field, and so was familiar with the surroundings.

Since 2005, when Wang was first arrested and confessed to the murder, the trail has been highly anticipated. He has been seeking a reduced sentence since the first trial on March 12, 2007.

To overturn Nie Shubin's wrongful conviction is not only to give an explanation to Nie's family but also to fulfill a promise to all Chinese mothers that the judiciary will not wrongly kill their children.

On February 22, shortly after the Chinese New Year, law professor Xu Xin wrote on Weibo: "In the new year, we will stick to Nie Shubin's case and never surrender." The tweet was forwarded more than 290,000 times. Denunciation of the courts was prevalent among the over 30,000 comments. The absurdity of the trial has generated disappointment, complaints and exasperation among the public, scholars, lawyers and public intellectuals.

The Oriental Morning Post, a newspaper based in Shanghai, summarized the trial in just three lines: "Wang Shujin: I killed the person. Defenders: Yes he did. Prosecutors: No, he did not." The sarcastic post was forwarded more than 4,000 times and imitated the Weibo account of The People's Daily, the online presence of the Party mouthpiece paper.

Zhu Zhiyong, a columnist, tweeted: "The Hebei prosecutors reject Wang Jinshu's confession outright. It is the flagrant blaspheming of the law and the darkest moment in the history of the judiciary. Jurisdiction should be handed over to another court." He called on the National People's Congress to set up a judicial investigation team.

Even the criminal Wang Shujin, convicted of killing and raping three other women, seemed to be more popular among people than the Hebei court that was determined to affirm his innocence. A popular Weibo user named Writer Tianyou hailed Wang Shujin as a warrior fighting for the reputation of an executed man he never met, while describing the prosecutors as devils.

Beyond simple indignation, the trial has generated discussion of the deeper aspects of the case among some prominent figures.

Xu Xin, a professor of law at the Beijing Institute of Technology, published an article a day before the trial entitled Expect Judicial Justice in the Name of Mothers, expressing great admiration and compassion for Nie Shubin's mother, Zhang Huanzhi. He wrote, "Zhang Huanzhi is struggling for the redemption of the judiciary in the name of mothers. To overturn Nie Shubin's wrongful conviction is not only to give an explanation to Nie's family but also to fulfill a promise to all Chinese mothers that the judiciary will not wrongly kill their children."

Why was it so difficult to launch the retrial? Who was blocking the proceedings? Xu Xin gave an answer:

Firstly, the High Court, which was responsible for Nie Shubin's final sentencing, could not possibly rectify its own wrongdoings. Additionally, this case involved police, prosecutors, a Political Committee, a Party Committee and the administration. If it was overturned, all of the parties would have to be held accountable. Many people in power had to collude to block the proceedings of the retrial. The deepest reason is that China's court system is not an independent entity, and it is subordinate to the administrative department. The court and procuratorate act as branches or extensions of the Party and government.

Some scholars contesting the proceedings in other ways. He Weifang, a highly respected constitutional scholar at Peking University, commented on the verdicts: "I think Wang Shujin has performed major meritorious services because he insists on taking responsibility for a forth crime, and he has thwarted the movers and shakers from covering up the wrongful conviction."

He also asked, "Why has the procuratorate deferred the presenting of the evidence? Why couldn't this have happened at some point during the past eight years? What evidence was presented in this trial? Did any witnesses attend to be questioned by the lawyers? Most importantly, was the court neutral? How opaque!"

Some declined to judge whether Wang Shujin or Nie Shubin was the guilty party, arguing that suspects must be presumed innocent until proven guilty. Mao Lixin, an expert in criminal procedure law, elaborated on this point:

There is not adequate evidence to sustain Wang's guilt or Nie's conviction. Under these circumstances, the principle of 'innocent until proven guilty' should apply to the trial of Wang and Nie. The court did not convict Wang of the Shijiazhuang's murder now, nor should it have convicted Nie then. The sentencings in Nie's first and second trial were too simplistic and rough to tolerate. Regardless of historical reasons, it reflected the nation's perfunctory and arbitrary attitude toward its citizens' lives. Only by implementing the principle of 'innocent until proven guilty' can the criminal judiciary make substantial improvements and establish rule of law.

It is not hard to understand the landslide of rebuke of the court and support for Nie Shubin's innocence, given what happened to the Nie family and the extraction of Nie Shubin's confession by torture.

According to a lengthy report from Southern Weekly, Nie Shubin was 20 in 1994. By all accounts, he was introverted and honest. On September 14, several policemen arrived at his home, where Zhang Huanzhi was working and Nie Shubin had not been at home since the night before. The police told Zhang that Nie Shubin was suspected of committing a crime and was apprehended the previous night.

The police did not fully explain the charges during repeated visits, and the family remained unaware of the charges against Nie Shubin; they even held a joyful wedding for Nie's sister as they had earlier planned.

One day, Nie Shubin's father, Nie Shusheng, received the arrest warrant at the factory for which he worked. The words claiming Nie Shubin was convicted of murdering and raping shocked him immensely. Asked by the police to sign his name on it, Nie Shusheng snarled: "No! My son is not the kind of person who would do such a thing!" "Sign it," the police said, "Your son has confessed."

On October 26, the Shijiazhuang Daily published an article detailing Nie Shubin's crime. The author claimed Nie Shubin was riding bicycle when he was apprehended at the scene of the crime: "He admitted to nothing but molesting the woman at first. But with the police's ingenious use of psychological methods and evidence, the barbaric perpetrator confessed to his crime after a week of interrogation."

From Nie Shubin's capture to his execution in April, 1995, Zhang Huanzhi only saw her son once.

After the execution, Zhang Huanzhi began the long journey of petition and appeal. Nie Shusheng could not accept his son's conviction and death, and attempted suicide twice. He has been bedridden and paralyzed since 1996.

In 2005, Wang Shujin was arrested and confessed to four cases of murder and rape, including that of Nie Shubin's case, stunning the entire country and the Nie family.

However, this twist of fate has not, as of yet, affected Nie Shubin's case. In an interview with the Oriental Morning Post on June 25, Zhang Huanzhi said she has gone to the High Court of Hebei Province every month for the past eight years to appeal to overturn her son's sentence and she has always been told to "wait for notice at home."

The public and legal scholars suspect that Nie Shubin was wronged because the courts have been delaying their response. Nie Shubin was convicted based solely on his confession -- which many believe was forced. Aside from his oral confession, prosecutors did not prove his guilt with witnesses or physical evidence such as fingerprints, blood, or semen.

In recent years, many staggering injustices similar to Nie's case have come to light. In part due to assuming suspects are guilty and requiring that their innocence be proven, instead of the other way around, Chinese courts have maintained a very high conviction rate -- 99.9 percent in 2009, according to official statistics -- so it is no surprise that some of those who stand trial are wrongly convicted.

Wrote Xu Xin, 'Nie Shubin's case might be the last straw that causes the judiciary to collapse.'

In March 2013, Zhang Hui and Zhang Gaoping were released from jail after serving 10 years for being convicted of raping and killing a girl whom they gave a free ride. In 2011, a famous lawyer named Zhu Mingyong and a respected prosecutor named Zhang Biao succeeded in soliciting the High Court in Hangzhou City in Zhejiang Province to reinvestigate and retry the case. It was found that the DNA left in the victim's nails matched the DNA of a criminal who was convicted of rape and murder and executed in 2005. The Zhangs said they were tortured for multiple consecutive days and nights to confess.

In May 2010, Zhao Zuohai was released from jail after serving 11 years because the victim named Zhao Zhenshang whom he was convicted of murdering in 1999 returned. It was found that the victim's body had been misidentified by the family as Zhao Zhenshang.

In May 2005, after serving 11 years, She Xianglin was acquitted because his wife, whom he was charged with murdering in 1995, went back home for a visit. She had moved to another province and remarried. In April 1994, the police found a body and determined it was She Xianglin's wife and that he had killed her. She Xianglin said he was tortured for ten days and ten nights.

Other well-known injustices include Du Peiwu's case,Wu Daquan's, Hutengjile's,Zhang Zhenfeng's, and Teng Xingshan's. These and other cases continue to erode the Chinese people's belief in their judiciary and government. Wrote Xu Xin, "Nie Shubin's case might be the last straw that causes the judiciary to collapse."

Zhang Huanzhi has said that she looks forward to the trial, scheduled to take place, but worries that justice will be deferred again and again, and that her son's name will not be cleared before she dies. Though the verdicts have continued to disappoint, she has stated: "I will take good care of myself and conserve my strength to keep on appealing."

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The Atlantic_ In Paris: Dispatch #3

The 15th New York aka "The Harlem Hellfighters." Regiment of black and Puerto-Rican soldiers. Winners of the Croix de Guerre in World War I. (The National Archives)

We are doing a house-swap in order to spend these eight weeks in Paris. House-swapping is the trusted method of travel for those of us with European dreams and a Baltimore budget. I didn't even know house-swapping existed until last summer when I first began plotting my way out. This might be pedestrian for the folks here, but for those who were like me, house-swapping is what it sounds like--you live in someone else's home and they live in yours. I know a family that does this, every summer, sight unseen. Keys are left in appointed places, supers are informed, and whole families from other continents make moves. For others it's like dating--personal ads, vague guarded e-mails, g-chat, then video-skype to see if you like the look of your paramours.

My connection was as old fashion as you can imagine in these times. A sharp, learned journalist on this side was a fan of my blog and a native New Yorker. We exchanged a few e-mails, then dined together in Paris and instantly liked each other. He wanted to get home with his son for the summer. I wanted to get out with mine and my wife. Et voilà. C'est ça.

Before he left, my new found homeboy plugged me into to a number of Parisians--most of them people of color with some kind of immigrant connection. Their job, I suspect, is to get me out of the Sixth and into the underbelly of things. I saw some of it yesterday riding the RER. The further out you go on the train, the more African and Asiatic the world becomes. The kids look like our kids with their headphones and haircuts. They talk loud and boastfully, as I once did, so that you might know that they are alive.

"Here is the thing," my buddy said to me, just before leaving. "I am not trying to get you to hate France. I want you to love France. But I want you to love it for the right reasons."

"Yeah, yeah, yeah," I thought. "Pass me a pain au chocolat and let's get this swap-joint popping."

And popping it was. Yesterday, when I went out to get milk, I saw a man outside the store preparing le poulet et pommes de terre. I want to pause here and point out that "Pomme de terre"--"apple of the earth"--is beautiful name for a potato. The man was preparing this in a rotisserie oven. At the bottom the potatoes were roasting in the juices. I came back, told my wife, and I had found dinner.

After we dropped off our son we picked up dinner along with a salad and some chocolate for desert. We drank a bottle of wine together--it's becoming a tradition--and ate an awesome dinner. I got up this morning and hit La Seine for my morning run. I came back, showered, and was immediately felled by food poisoning. So this is loving France, wholly, right reasons and all.

Illness aside, there is always the danger in falling in for a distant lover who seems magically free of all the complications back home. I was raised by a generation that--to varying degrees--found this out. My friend Brendan Koerner just published a book which is getting raves everywhere--The Skies Belong To Us. The most bracing portion, to me, is Brendan's hard look at the New Left. I got my first lessons in skepticism and counter-intuitiveness from a lot of these guys. But it's worth remembering that there was when they sung the praises of Kim il Sung.

I don't want to take this too far. If America has the right to be wrong, then so do its reformers. It mirrors our discussion here where we find people attacking other countries for not being "democratic" without understanding our own long, ugly and sometimes dishonorable path. More, I would say that because of my particular background, my canon was a little different than most, and whatever differences you might find in my voice are attributable to that.

It's also attributable to discovering the Western canon, and the significance of the West, almost as something exotic since my roots seemed elsewhere. That allows me to be fascinated, to be blown away. Nothing is more fascinating than finding your allegedly foreign roots are common. I thought of this recently digging through Rousseau:

This passage from the state of nature to the civil state produces a most remarkable change in man, by substituting justice for instinct in his behaviour and endowing his actions with the morality they previously lacked before. Only then when the voice of duty succeeds physical impulsion and law succeeds appetite, does man, who until now had thought only of himself, find himself forced to act according to other principles, and to consult his reason before heeding his inclinations.
Although in this state he denies himself a number of advantages granted him by nature, he gains others so great in return – his faculties are exercised and developed, his ideas expanded, his feelings ennobled, his entire soul soars so high – that if the abuses of this new condition did not often degrade him below that from which he emerged, he ought continually to bless the happy moment that wrested him thence for ever, and out of a stupid, limited animal made him an intelligent being and human.

Right down to the language around civilization, this is remarkably similar to Malcolm X's parable of transition wherein black people go from being savages "deaf, dumb and blind" and "lost in the wilderness of North America" to civilized black men committed to some higher ideal. In Malcolm's vision it was Islam. Among his nationalist descendants it was black people.

For one such as myself, schooled on the savagery of Cortez and Pizarro, once inculcated with the theories of a natural impulse toward warfare among white people, raised up to seethe after the partition of Africa, it is still odd--a decade and a half after I left that world--to see myself in the image of people I once solely took as conquerors and barbarians.

I like to think I've come some ways since then, bearing the skepticism of those days, but free of the prejudice and the utopian romance. I like to think that I know that every home is imperfect, that I don't come to France looking for something better than America, that I know that America is my own imperfect home. I like to think that you need worry about me going too zealous and hard. This is a great great trip. But it's the food poisoning that makes it real.

URL: http://feedproxy.google.com/~r/TheAtlantic/~3/LQ8nXGsQuWQ/story01.htm