The Care of Humans

We have had a rough couple of weeks here, weeks that have provided ample opportunity to reflect on medical care. 

We talk about it in the abstract as if it's all a science, as if we can just give people a test, then just read the cut-and-dried results and then go to a book where we just cross-check those results on some chart that tells us that if the doctors do X then that will totally fix Y. 

But care of actual humans in the actual world doesn't look much like that. There are assorted tests to try and they give results which suggest a variety of possible issues that in turn suggest some possible responses. Add to those the moving target that is your own observation. Anyone who has had a loved one go through serious health issues knows the drill-- one minute you're thinking, "You know, this doesn't seem so bad. I bet we could go on down this road for a long time" and then ten minutes later it's "Oh, hell--I don't know if we can manage this for the rest of today." And on top of that, you add the fact that this is a loved one, a person you care about, and so all of what appears to be true bumps up against what you want to be true. 

Lord knows you want it to be easy, or at least clear, but you are dealing with the care of humans, and so you get occasional glimpses of clarity and certainty, just before the fog rolls in again.

Everyone is interested in reducing the care of humans to simple, scientific, evidence-based, rock-certain clarity. The humans there on the ground want it because God damn it this is hard to sort out when you're talking about the life and health and comfort of someone you love. The policy clowns in the clouds want it because they want to set their policies in stone, their procedures in concrete, because complexity and nuance is just tiresome and hard to sell. The bureaucrats in charge want it because it's just easier to run a business with fewer messy human variables in play. 

The best parts of the system are the places where you encounter someone who is bucking the system, ignoring the system, or has somehow negotiated a corner in the system where they can act like a human being who is dealing with human beings. Thank heaven we've encountered all of these in the past few weeks.

I get the desire for clarity and certainty when dealing with the care of humans. Lord, I get it. But that is not how the care of humans works. You find trained professionals, and you listen to their judgment, and then you fold that in with your own personal judgment, which includes your own knowledge of the specifics of the situation. You don't jettison any attempts to grab a picture of reality and fill in the blank with feelings and desires, but when you grab some reality, it is not facts alone that will tell you what exactly to do next. And then you move forward and just kind of keep your eyes and ears open.

Am I supposed to be writing about education? Okay, then.

You can't reduce education to settled cut and dried science, to some program where a teacher just looks at some numbers generated in order to have solid data, and then goes through the specific actions that will move the data needle in the required direction. You can't measure a human's educational progress in any way that reduces it to clear, simple, actionable data. You can't reduce the process of teaching to a clear, simple procedure that the teacher must simply follow "with fidelity" in order to get the required result out of every single student in the room. 

You cannot come up with policies, procedures and systems that eliminate all the human messiness and nuance from the educational process. But education in this country has suffered immeasurably at the hands of people who want to try, whose dream is schools that can be managed by screen and classrooms in which neither the humanity of the teacher nor of the students interferes with the smooth operation of the education machine. Let's stare at these high stakes tests scores, they say, as if staring at the toenail of an elephant will give you the complete picture of the animal itself. \

The care of humans, from the hospital to the classroom to the simple interaction with them in work and family, must be conducted in a human way by human beings. To treat humanity like a bug instead of a feature, to try to eliminate the human element is, by definition, dehumanizing, and dehumanized care of humans is Not A Good Thing. 

Yes, the human care of humans is messy and complicated and often results in debates and discussions that never reach a clear and perfectly settled conclusion. But a system that is perfectly clear, perfectly settled, perfectly flowing like a perfect machine is also perfectly inhuman, and that is no way to live.