Author Archives: Mark Draughn

Fun and Games With the Sick and Elderly

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It’s been a little over a month since my friend Leo had heart failure and a stroke, and things have been very busy around here. As I mentioned, Leo had been planning to go into the hospital for heart surgery for a while, and since he was the sole caregiver for his 87-year old father, we had been planning that I would help take care of him by visiting him every other day.

At least that was the original plan, when Leo found out he needed heart surgery two years ago. For various reasons, some medical, some logistical, he kept having to put off the surgery, until last month his heart gave out and he had a stroke. And during that period, it turns out that things had changed. Things my wife and I were unaware of.

For about a week and a half, we tried to follow the original plan of making the 100-mile round trip to visit his father every day or so. Gradually, we realized that Leo’s father was not as independent as we thought. For one thing, his dementia is a little worse than we expected. He’s not totally out of it, and he’s able to live by himself surprisingly well — microwaving his own meals, taking his own medicine from pre-filled pill containers, and even doing his own laundry — and that fooled us for a while.

Eventually we realized that he was more forgetful than we realized, and that we would need to monitor him more closely. We decided the only thing that made sense was to bring him to live with us. It was already the weekend, and we knew we weren’t ready for him over yet, so we hired a home care service to help him out for three hours every day during the next week, with us still coming over most evenings as well. This would get us through until the following weekend, which would give us time to prepare the place.

Meanwhile, we were dealing with a medical mystery. Leo’s father was a diabetic, and his blood sugar levels had started rising since his son went into the hospital. We had a list of his medications, and there was no insulin, so it looked like he managed his diabetes with pills and diet, as evidenced by the supply of healthy low-calorie frozen dinners in his freezer. Our best guess was that he was eating too many of his favorite meals rather than a mix of healthy ones, so we began to shop for increasingly low-sugar/low-carb foods, and that seemed to help.

What neither of us knew is that Leo’s father was taking insulin. Or rather, he was supposed to be taking insulin. It turns out that the list of medications we had was only for filling Leo’s father’s pill boxes. Leo managed the insulin separately, since he didn’t want his father taking it by himself.

(I had asked Leo in the hospital if he managed his father’s diabetes with pills and diet, and he confirmed that he did. I knew not to entirely trust that answer, because Leo was often confused, but we had also asked Leo’s father if he took insulin injections, and he said no, so I felt pretty confident. In retrospect he must have misunderstood the question.)

We started to figure all of this out when I finally got Leo’s father’s primary care doctor’s office to send me a list of his medications, conditions, etc. I called his doctor immediately, and he told us that given the glucose levels we were seeing, the amount of time he had gone untreated, and the lack of any symptoms, we shouldn’t be too concerned. Just get him back on insulin again.

We went over that evening to get him started on the insulin. You’re supposed to take daily insulin in the morning, but we felt that giving it to him in the evening was better than nothing. Now that we knew what to look for, we immediately found a couple of boxes of insulin pens in the refrigerator. Then we had him test his glucose levels. They were perfectly normal.

There was no way we were going to dose him up with insulin and then just leave, because he could start to crash and we wouldn’t know it. So we just left things the way they were. The next day, a visiting nurse from the VA came to see him, and — thanks to a home care worker who gave him some high-sugar soft drinks she found in the refrigerator — his insulin was sky-high again. So the nurse dosed him up good and, with the help of someone at the VA, helped us figure out a proper insulin schedule.

The following Saturday, in an operation that went much smoother than it should have, we brought Leo’s father to live with us, along with his clothes, toiletries, meds (with insulin cold-packed for the trip), pillow, blankets, easy chair, iPad (for movies), bathroom scale, and binoculars (for bird watching).

Fortunately, this coincided with the beginning of our planned two-week stay-at-home vacation, so we had plenty of time to get Leo’s dad integrated into our household. It also gave me time to go back to his house for his microwave oven, so that he wouldn’t have to learn to use ours, which was also awkwardly located for him. I also prepped Leo’s house for vacancy by taking or discarding all perishable foods, emptying and shutting off the refrigerator, turning the air conditioning up to 87, setting some lights on timers, and installing an alarm system and security cameras. I also let the neighbor know we had moved him out and notified the Sheriff’s office so they could check the house periodically.

Meanwhile, while we were trying to take care of Leo’s father without putting him into a diabetic coma, Leo himself was working his way through the recovery process. He was transferred from the hospital where he was initially admitted to another hospital that had a good rehab program, and he immediately began receiving physical therapy, speech therapy, and occupational therapy. This was about 20 minutes closer to where I live, so I had little trouble continuing to visit him every other day or so, and he continued to get a little better every time.

After maybe a week, the discharge planning nurse called me to tell me they were ready to move him to a nursing home for rehab. They sent me a list of facilities that were covered by Leo’s insurance and asked me if I wanted to pick one. I wanted to find one that was close to me so I could visit more often, but after doing some research on the Medicare website and Yelp, I decided to go with one of two nursing homes that were near the hospital. I took a quick tour and was impressed by the cleanliness and preparedness of the staff of both, so I went with the one that was closest to the hospital, on the theory that they were used to working together.

Leo continued to improve at the rehab facility, and after a week or so they contacted me to let me know they were thinking of discharging him, if we could take him in. That had been our plan all along, but this call came the week after we took in his dad, just as we were getting settled down.

That touched off a whole planning session for how to arrange the spare bedroom to hold a second bed. The bed that was in there was queen size, and we could fit another bed in next to it, but there wouldn’t be enough room between them for someone with a walker. Eventually, I got the idea of putting in a twin bed at a right angle, which would leave enough space for both of them to use walkers, but that idea was blown up when the home care service announced they were sending us a hospital bed for Leo. We considered not taking it, but they pointed out that he still had heart surgery coming up and would probably need it then. So we ordered another twin bed to go with the hospital bed and took out the queen size bed, which is now leaning against the fireplace into our family room/library.

Part of the discharge process from the nursing home was for me to receive caregiver instructions. So made a special trip over during the day, and the physical therapist explained to me the proper procedure for Leo to stand up from a chair and sit down safely, and which foot Leo should move first when climbing up and down the stairs. He also had me bring my car around so he could show us how Leo could get in and out of a car.

Leo and I agreed later that this training was mostly useless. I’ve taken care of someone more disabled than Leo before, and we’re both overweight, so we’re both used to moving carefully. For better or worse, pushing off the arms of a chair when standing up is not a novel idea for either of us.

On the other hand, you know what would have been nice to receive training on? The ZOLL LifeVest wearable defibrillator that Leo has to wear everywhere. Basically, it’s a cloth vest with EKG sensors and defibrillator shock paddles that snap into interior pockets, connected by a cord to a portable control box which is expected to sense dangerous fibrillation in Leo’s heart and if necessary, administer a shock.

I learned how it works by visiting the company website and watching their training video, which explains how to change the batteries and how swap the sensors between vests when it’s time to change to a new one. It also explains the alert sequence that occurs when it detects a problem with the patient’s heart: First the vest vibrates, then it emits a series of increasingly loud warbling tones, then it announces that bystanders should stand clear and not touch the wearer, and finally it extrudes conductive gel from the shock paddles and administers a defibrillation jolt. Rather annoyingly, all the LifeVest documentation refers to this as “treatment,” presumably to avoid alarming patients by admitting that it will electrocute the crap out of them.

In some sense, I guess I didn’t need training in how the vest works because Leo had been taught to take care of it himself, but it would have been nice to have been told what the LifeVest did and how it works. In particular, the control box has two buttons on it that the patient can press to stop the shock. In engineering terms, this step implements the condition that only a person who has lost consciousness is in need of defibrillation. For that reason it’s really important that only the patient operates the buttons.

So anyway, the rehab place sends Leo home to us on Saturday, and he and his dad have a reunion. Without the nursing home staff looking over his shoulder, Leo abandons his walker and quickly discovers that he can walk well enough without it. Everything is going fine.

And then later that evening the warbling alert tone starts on Leo’s life vest. Leo is standing up at the time, so he presses the buttons that prevent the vest from shocking him. He says he feels fine. And then the alarm goes off again. This happens several times in a row. He tells me it does this all the time and it’s nothing to worry about.

I’m not entirely convinced, but what really has me freaked out is that even if there’s nothing serious going on with his heart — and we’re pretty sure there isn’t because he’s still conscious — every single time that alarm goes off, it means that he’s within about 30 seconds of getting a painful electrical shock to the heart. Every single time. A few weeks of dealing with that and I’d be a nervous wreck.

Anyway, as I’d hoped, having Leo around makes our lives easier rather than harder. He’s still pretty messed up from the stroke, but he’s got it together enough that he can help take care of his father, which is a big load off our minds, because we knew we’d have a lot less free time once our vacation was over.

It’s a little weird, though. Leo has aphasia, which means he has trouble expressing himself, but that doesn’t necessarily mean his thinking is impaired. For example, one evening he told us that his father’s blood sugar was too low, “About 150.” That’s actually pretty normal, but when I checked the glucose meter myself, it was actually around 50, which is much too low. Leo had read the meter correctly and diagnosed the problem, but he was unable to say the number accurately. Similarly, he has trouble saying the numbers on his father’s insulin injection pen, but he can still do the math to figure out how much insulin to give his father and then set the pen correctly by counting clicks.

And of course, Leo has far more experience taking care of his father than we do, so he can spot subtle clues about his father’s health, such as the sluggishness that indicated low blood sugar. Leo also understands his father’s needs better than we do, and can point them out to us, even when his father is too polite to mention it.

For example… You remember when I mentioned that his father was only eating very healthy low-calorie meals? Leo had something to say about that. At first, all he could say is that his father needed “big food” not “small food.” After some back-and-forth, we eventually realized Leo was talking about low- and high-calories meals. He was telling us that the low-calorie meals were his meals, which he had been eating to lose weight. His father, on the other hand, had been eating normal nutritious foods. What must have happened is that by the time we showed up to do grocery shopping, his father had finished most of his food, so all we saw in the freezer was Leo’s low-calorie diet meals. We assumed that’s what his father normally ate, and so that’s what we bought for him. And he was far too polite to ask for better food.

In other words, over the past few weeks we managed to run a 78-year-old diabetic man’s blood sugar way up…and then starve him with a weight-loss diet.

No harm done, apparently, but…Yeah, it’s a good thing Leo’s here.

(I’ve changed names, places, and other details to protect my friends’ privacy.)

 

 

Trump Wants Obamacare to Fail

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This tweet of President Trump’s yesterday illustrates what a clueless dick he is when it comes to healthcare policy:

Let me quote the key part:

…let ObamaCare fail and then come together and do a great healthcare plan.

People who talk like that — including some of the people who demand that Congress should “repeal Obamacare” —  have no idea what Obamacare is or how it works. Obamacare is not just bolt-on legislation (like a subsidy or a tax) that can easily be removed. The Affordable Care Act was a complex, multi-phase restructuring of the healthcare insurance market that ran to 2000 pages. It created standards, regulatory bodies, organizational structures, mandates, taxes, waivers, funding channels, and a schedule for implementing all of it.

Obamacare is not something added to healthcare, it’s a transformation of healthcare. If you want to undo it, you can’t just remove it — not without throwing the healthcare market into chaos. You have to specify the transformation process that will produce the market structure you want. Consequently, the people who talk about “repealing Obamacare” are talking about a transformation of the healthcare insurance market that is every bit as fraught with risk as Obamacare itself.

I’m pretty sure that Trump has no idea what market structure he wants for healthcare. I doubt he’s thought about it much beyond a few aspirational slogans about how great it will be. And in the tweet I quoted, he isn’t even talking about something as vague as repealing Obamacare. He wants to let Obamacare fail.

In an insurance market, failure means that the insurance companies and their customers are unable to reach an agreement on price. It usually happens when premium prices start going up and policy holders who are least in need of insurance — those who have few claims — refuse to pay the higher prices and don’t buy insurance. That leaves behind only policy holders who have a lot of claims, so insurance companies have to raise premium prices to avoid losing money. That encourages even more policy holders to quit their insurance plans, and the cycle continues until the insurance companies give up and leaves the market, leaving everybody uninsured. This industry term for this is a “death spiral.”

It’s an open question whether ACA healthcare plans are in a death spiral. The ACA has features which are intended to prevent a death spiral, most prominently the individual mandate penalizing people for not buying insurance, which is supposed to keep policy holders from leaving when prices go up. However, there have been signs that a death spiral is in progress, such as rising prices and health insurance companies abandoning some markets. On the other hand, the market could just be shaking out — weaker players quitting because they can’t figure out how to operate profitably — which happens in a lot of new markets. It’s clear the Obamacare markets aren’t healthy, but it’s not clear if they’re actually failing.

Under the Obama administration, insurance companies had good reason to believe that the government would try to prevent a death spiral: This was Obama’s namesake legacy achievement, after all, and he would try to protect it. Since they were unable to get the cooperation of congressional Republicans, the administration was limited to making changes that were within the authority of the executive branch (although some argue they exceeded that authority). Nevertheless, the Obama administration kept a close eye on what was happening in the healthcare insurance market, and they kept tweaking the implementation of the ACA to keep things going.

Things are different now. With control of Congress and the White House, Republicans are in charge of healthcare policy and can do pretty much whatever they want. Yet so far, the various Republican healthcare plans haven’t addressed the “death spiral” issue at all. In fact, some of their proposals weaken the individual mandate without strengthening other aspects of the healthcare exchanges, which seems likely to increase the risk of a death spiral.

And as this tweet makes clear, Trump has no personal interest at all in keeping the exchanges going. But rather than dismantling them in an orderly fashion, Trump sees no problem with letting them fail. This is deeply callous. It’s the healthcare equivalent of owning a run-down apartment building and deciding that rather than repairing it, or even demolishing and rebuilding it, you’ll just let it collapse on its own before you try to rebuild.

Trump doesn’t seem to care that the failure of the Obamacare markets will have real harmful effects on people. It was a running joke that what Republicans didn’t like about “Obamacare” was the “Obama.” That struck me as unfair, but I think it’s accurate for Trump. Not in a racist way, as was implied by the joke, but in a personal way. Trump doesn’t care what happens to people who lose coverage if Obamacare fails because he sees this as a personal fight: He sees himself as the greatest President, a winner, and for that to be the case, all challengers must lose. He wants to see Obamacare fail because that will show the world he’s better than Obama.

Free the Squawk!

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Oh my God! They’re going after Squawk!

It all started back in May, when Appellate Squawk (who somewhat disappointingly turns out not to be a bird with legal superpowers but a human female working for the New York Legal Aid Society) published a post poking mild fun at her office’s training about the importance of asking clients to clarify their gender. Here’s a taste:

Lawyer: [Reading from a card] I need to know whether your name expresses your internal deeply-held sense of your gender which may or may not be the same or different from your sex assigned at birth –

Defendant: Yeah, whatever. Then they handcuffed me to a chair and started throwing lighted matches on my lap, causing imminent danger to my manhood –

Lawyer: Tut, tut, gender isn’t a matter of stereotypical physical characteristics –

Defendant:   – so I confessed. But I can prove it’s false because there’s a surveillance tape showing I was on the other side of town at the time. My wife  –

Lawyer:  Your wife? What gender identity does they go by?

Defendant: Yo, are you calling me a FRUIT?

Lawyer: That’s a very discredited terminology. The term is non-binary gender fluid –

Defendant: Will you lower your voice? I’m in a holding cell with 20 other guys, you know what I’m saying?

Lawyer: I’d feel so much better about our relationship if you’d only come out of the closet.

Defendant: But I’m a man. Like Muddy Waters says, “M-A-N, I’m the hootchie cootchie man -”

Lawyer: You sexist pig, how dare you! (Exit)

That should give you the general idea. It’s typical Squawk snark about the absurdities of criminal defense. But apparently it was enough to put some people over the edge, and the Legal Aid Society has started an investigation into the matter.

Scott Greenfield has more details about the original training,

As it turns out, soon after the announcement of the new discrimination and harassment policy, a CLE was held, where the lawyers were instructed that the first thing they must do when meeting their clients was not to ask about the case, not to ask about the defense, not to ask about anything having anything to do with that nasty old-school mission of criminal defense. How horrifying! How exhausting!

No, the first and foremost concern was that LAS lawyers were directed to ascertain their self-identified gender and sexual orientation. It didn’t matter that there was nothing to suggest a gender or sexual orientation issue. They must put it first. And never, but never, call a client “Mr. Smith,” as that would presume their gender, even if no one had ever shown them the respect of using an honorific before. As a last resort, they were trained to use the word “Mx.,” which always serves well in the holding cell to identify defendants who tend not to be particularly woke.

(Scott may be exaggerating a bit. He does that sometimes.) [Update: Scott clarifies in an email that no, he was not exaggerating at all about the substance of the training, which is apparently as self-parodying as it sounds…which is not nearly as self-parodying as the fact that Squawk’s post has triggered an investigation.]

Scott also has samples of the complaints, some of which are kind of amazing.

I am reporting the content of this blog as creating a contributing to a hostile work environment. Please read it. It is terrible.

Some of the complaint is a little more specific.

[Squawk’s] email has served as a huge distraction from doing my job today. I am upset and really troubled that someone who works at the Legal Aid Society-an organization whose motto is to make the case for humanity-is joking about the importance of honoring a person’s preferred pronoun and gender.

Actually, if I understand Squawk’s point correctly, she wasn’t joking about the importance of honoring a person’s preferred pronoun and gender. She was joking about CLE session’s over-emphasis on gender and pronouns.

Yes, I know people with non-traditional gender identities and sexual orientations are going to face special problems when arrested and jailed. I also know this is not news to most criminal defense lawyers. But criminal defense lawyers are supposed to represent the interests of their clients, and I’m pretty sure that for even the most gender atypical of criminal defendants, their main interest when meeting their lawyer is getting the hell out of jail.

It is disturbing that the message indicates that an attorney cannot zealously represent their client while inquiring about a client’s preferred pronoun and gender identity. If anything, by asking a client about their pronoun *furthers* an attorney’s ability to best represent their client.

Well, in the abstract, sure, the more a lawyer knows about their client, the better. But this conversation isn’t taking place in the abstract. It’s taking place in jail. There is no privacy in jail. It’s a terrible feeling, and Squawk doesn’t think their lawyers should be making it worse:

One of the many annoyances of being accused of a crime is having to put up with humiliating questions from your lawyer. Like, “Was your grandmother a drug addict?” “When was the last time you had sex?” or “Do you hear voices?”

So even if the client is a tough-talking street thug who sometimes feels he’d rather be a pretty girl, that may not be the sort of thing he feels comfortable sharing with a total stranger while locked in a cell block with a thousand other tough-talking street thugs.

Then there’s the possibility, also raised by Squawk, that the client may feel insulted that his lawyer is implying he’s less than 110% manly man. We can discuss whether he’s a bad person for thinking that being gay or transgender is an insult, but that doesn’t change the fact that zealous representation will be more difficult if he feels insulted by the very first thing his lawyer says.

But I’m drifting off the main point here. I’m not a lawyer, and I really have no business telling lawyers how to do their job. (Although, some lawyers, damn…) My point is that Squawk’s post wasn’t making fun of LGBTQ people. It was making fun of the people in her office who think LGBTQ issues are more important than proper representation of clients.

in Legal

The Perils of Restricting Hate Speech

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A while back, the Los Angeles Times published an op-ed by Laura Beth Nielson arguing that there’s a case for restricting hate speech.

As a sociologist and legal scholar, I struggle to explain the boundaries of free speech to undergraduates. Despite the 1st Amendment—I tell my students—local, state, and federal laws limit all kinds of speech. We regulate advertising, obscenity, slander, libel, and inciting lawless action to name just a few. My students nod along until we get to racist and sexist speech. Some can’t grasp why, if we restrict so many forms of speech, we don’t also restrict hate speech.

That’s where things get wobbly:

The typical answer is that judges must balance benefits and harms.

Okay…this feels awkward… Nielsen is a professor of sociology and the director of the legal studies program at Northwestern University, and she’s also a research professor at the American Bar Foundation, whereas I’m just a loudmouthed blogger. And yet…I’m pretty sure she’s wrong.

The limits on our First Amendment rights are narrowly defined, and to the extent that those rights are balanced, it’s not by judges. First Amendment lawyer Ken White explains the distinction, in another LAT piece:

Censorship advocates often tell us we need to balance the freedom of speak with the harm that speech does. This is arguable philosophically, but it is wrong legally. American courts don’t decide whether to protect speech by balancing its harm against its benefit; they ask only if it falls into a specific 1st Amendment exception. As the Supreme Court recently put it, “[t]he First Amendment’s guarantee of free speech does not extend only to categories of speech that survive an ad hoc balancing of relative social costs and benefits. The First Amendment itself reflects a judgment by the American people that the benefits of its restrictions on the Government outweigh the costs.”

Back to Nielson:

At the same time, our regime of free speech protects the powerful and popular. Many city governments, for instance, have banned panhandling at the behest of their business communities. The legal justification is that the targets of begging (commuters, tourists, and consumers) have important and legitimate purposes for being in public: to get to work or to go shopping. The law therefore protects them from aggressive requests for money.

Yeah, I’m not a big fan of some of those anti-panhandling laws either.

Consider also the protections afforded to soldiers’ families in the case of Westboro Baptist anti-gay demonstrations. When the Supreme Court in 2011 upheld that church’s right to stage offensive protests at veterans’ funerals, Congress passed the Honoring America’s Veterans’ Act, which prohibits any protests 300 to 500 feet around such funerals.

Again, Nielson is some kind of expert and I’m not, but…I’m pretty sure that particular law is written in a way that is viewpoint neutral: It doesn’t prohibit protests based on the content of the protesters’ speech. In fact, it doesn’t prohibit protests at all. It prohibits disrupting veterans’ funerals.

Nielson does go on to make an important point in what I think is the best part of her piece:

So soldiers’ families, shoppers and workers are protected from troubling speech. People of color, women walking down public streets or just living in their dorm on a college campus are not. The only way to justify this disparity is to argue that commuters asked for money on the way to work experience a tangible harm, while women catcalled and worse on the way to work do not — as if being the target of a request for change is worse than being racially disparaged by a stranger.

In fact, empirical data suggest that frequent verbal harassment can lead to various negative consequences. Racist hate speech has been linked to cigarette smoking, high blood pressure, anxiety, depression and post-traumatic stress disorder, and requires complex coping strategies. Exposure to racial slurs also diminishes academic performance. Women subjected to sexualized speech may develop a phenomenon of “self-objectification,” which is associated with eating disorders.

These negative physical and mental health outcomes — which embody the historical roots of race and gender oppression — mean that hate speech is not “just speech.” Hate speech is doing something. It results in tangible harms that are serious in and of themselves and that collectively amount to the harm of subordination. The harm of perpetuating discrimination. The harm of creating inequality.

This part of Nielson’s argument is a solid explanation of why hate speech is unethical. In fact, I would go further: One of my recurring themes around here, usually in connection with economics, is that just because some benefit or cost isn’t tangible doesn’t mean it isn’t real. So even if people hurt by hate speech didn’t suffer tangible harms, they may still have suffered harm. For lack of a better word, their “hurt feelings” matter.

The hard part, however, is figuring out what to do about it. It is here that Nielson’s argument runs into the usual problems.

Instead of characterizing racist and sexist hate speech as “just speech,” courts and legislatures need to account for this research and, perhaps, allow the restriction of hate speech as do all of the other economically advanced democracies in the world.

Many readers will find this line of thinking repellent. They will insist that protecting hate speech is consistent with and even central to our founding principles. They will argue that regulating hate speech would amount to a serious break from our tradition. They will trivialize the harms that social science research undeniably associates with being the target of hate speech, and call people seeking recognition of these affronts “snowflakes.”

But these free-speech absolutists must at least acknowledge two facts. First, the right to speak already is far from absolute. Second, they are asking disadvantaged members of our society to shoulder a heavy burden with serious consequences. Because we are “free” to be hateful, members of traditionally marginalized groups suffer.

I acknowledge both of these facts, but I don’t think they get Nielson where she wants to go.

Actually, Nielson never says where she wants to go. Beyond a vague statement that “courts and legislatures need to…perhaps, allow the restriction of hate speech,” she never spells out what remedy she wants for the problem she identifies. So let’s get that out in the open: In order to protect members of traditionally marginalized groups from hateful speech, Nielson wants to make hate speech a crime.

How do you think that will turn out?

Pop quiz: If a middle-aged white guy walking down the street in a business suit calls a black woman a “cunt,” and at the same time in a different part of town a young black male walking down the street in baggy pants and a do-rag calls a white woman a “cunt,” which one of them is more likely to be arrested for hate speech? Which one is more likely to be stuck in jail because they can’t make bail? Which one is more likely to be pressured into pleading guilty because they are locked up? Which one is more likely to serve time in a cage? Which one is more likely to have trouble finding a job because they have a criminal record?

Oh, I’m sure there will be a few high-profile prosecutions of racist white guys — maybe some prosecutor will try to make his bones prosecuting Milo Yiannopoulos or Richard Spencer — but you’re kidding yourself if you think most of the arrests won’t be of people from the same groups that always get arrested for petty crimes: Blacks, Hispanics, poor people, immigrants, and the mentally ill.

History has shown that creating whole new reasons for incarceration rarely works out well for members of traditionally marginalized groups. Make hate speech a crime, and sooner or later we’ll be reading stories about a 45-year-old homeless black man killed by cops who were arresting him for a racist slur.

Some Friends Of Mine Are Having a Very Hard Time…

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Some friends of mine are having a very hard time, and I just need to write about it.

At about 4:30 on Wednesday, my cellphone goes off with an incoming call from my friend Leo. Leo never calls. We communicate by text message (encrypted, lately) and sometimes email, so I kind of figured something was wrong. He’s my age, and he’s taking care of his 87-year-old father, who has some health problems. So I’m not expecting this to be good news.

The conversation goes something like this:

Leo: “I think I’ve just had a stroke and I need to go to the hospital. The problem is my father is almost out of food and I was just about to go to the grocery story. Can you come over tomorrow and do some grocery shopping for him?”

Me: “… Did you call 911?”

Leo: “No. I guess I should do that.”

So we discuss the importance of him calling 911 for another minute and then hang up.

A few minutes later, I text him back “How’s it going?” I figure if I don’t get an answer, I’m going to have to figure out how to get an EMS response at his house, which is about 50 miles from where I live. He calls me back and tells me he called 911.

My wife gets home and we drive out to his house. Along the way, we call the hospital he’d most likely go to, and he isn’t there. We reach out to the Nortown Fire & Rescue department, and they tell us they have no information but they’ll look into it. Lacking any further information, we decide to go to his father’s house. It is, after all, what Leo asked me to do, and it’s the only place where we know we can help.

Thirty minutes later, Nortown Fire & Rescue calls back. It turns out the call was handled by county emergency resources, not the town, but they’ve found out my friend is in transport to the hospital. We decide to keep on going to his father’s place.

Leo has heart problems, and we’ve discussed the possibility of my taking care of his father if he is ever unable to, so a few years ago he gave me a key to his home. The thing is, Leo is a tech geek, and his front door is electronic, so the key is just a piece of information stored in an app on my phone. We’ve tested it, and it works just fine. So it was something of a surprise that it didn’t work this time.

My wife and I start ringing the bell and knocking on the door and yelling for a while, but nobody answers. A neighbor comes over. She saw the emergency vehicles and wants to know if we know what’s going on. I give her a brief answer and ask if Leo’s father is home. She doesn’t know.

I go walking around the house, trying to see inside, and through one of them I can see his father calmly working in the kitchen. He’s a bit deaf.

We ring and knock some more, but no luck. Eventually I think to check if I have his father’s cell phone number in my phone, and it turns out I do. Amazingly, he answers, and after a minute I get him to understand that we’re at his front door, and he lets us in.

It got easier after that. I went grocery shopping while my wife kept him company. She gave him both our numbers and added them into his phone. I visited the next door neighbor and gave her a mission: If she sees anything unusual, like the father wandering around outside or EMS showing up again, or he comes over and asks for help, please call me. She agreed to do so.

After that we go see Leo at the hospital He’s still in the emergency department, although they’re getting ready to transfer him to the ICU. He’s groggy, in and out, and a bit confused, but we tell him we took care of his father, and he looks very grateful to hear that, but I don’t know if he’ll remember. We didn’t get to talk to his physician — it was getting very late and we had a long drive home — but after talking to his nurse, it turns out he had heart problems. To me, this makes more sense than a strokes since he had already had one or two minor heart attacks.

He was trying to talk to us, but the effort just made him start coughing, so we decided it would be better if we left. I managed to snag his house keys so my next visit to his dad would go more smoothly.

That was Wednesday. Thursday was a normal day. The hospital told us that Leo’s vital signs were improving, and we got in touch with Leo’s father who said he was doing fine as well.

On Friday, I get a call from an MRI technician at the hospital. He wants to know if I know if Leo has any metal in his body. (Someday I must find out why such a sensitive and versatile magnetic imaging system can’t detect pieces of metal ahead of time.) I ask what’s going on, and he tells me they need more information after a CT scan showed a large infarction in his brain. That means he had a stroke after all.

That evening, we went to see Leo’s father again. We didn’t tell him what I’d found out, since I had very little information. We didn’t want to give him bad news on little more than a technician’s comment. And we need to think this through.

While we were there, my wife got him to agree to call us that night when he had taken his meds. He did, but he didn’t answer when I spoke to him, and then he hung up and called back about ten more times, each time saying nothing. We were just about to start the drive back to his house to see if he was alright, when he finally got through and explained that his fingers were a bit shaky at the moment and he was having trouble operating the touch screen on the phone. We stood down and went to bed.

On Saturday, we got the word that Leo had been transferred to a regular hospital room, and we went to see him. It turns out there was rather a lot of bad news.

One of the doctors gave me a description of what happened. It turns out he had congestive heart failure, which turns out to be the good news. It’s a relatively manageable condition, and he has essentially mostly recovered from the episode. His vital signs are healthy and his lungs are almost clear. The cardiology team hadn’t yet reported in, however, so they may very well want to do some procedures while they’ve got him.

The bad news is that he did indeed have a stroke. I’m assuming that one of the clots affecting his heart was dislodged during the event and traveled to his brain. It was described as a pretty large infarction, which appears to be a way of saying the stroke caused some brain damage. He’s not a vegetable, nor does he seem to have any major paralysis. His face isn’t sagging. When we visited him, he recognized us and held a conversation that was in many ways ordinary and normal. He also seems to be in relatively good spirits, although that could be an effect of the drugs.

He’s missing a few things, however. His arm and leg on one side are weak or difficult to control — He described them as “not being there,” which sounds like there’s something wrong with his kinesthetic sense.

More troubling, he seems to have a hard time processing symbolic information. He recognized my wife and I instantly when we walked in, but later when the doctor asked him our names, he was unable to come up with my wife’s name, and he used his own name when referring to me. He also chooses the wrong word for some things. I had loaned him some camera gear, and was trying to tell me I could take it back, and he referred to it as a “telephone.” Lots of technical things seem to be “telephone” to him. It’s like he’s got a concept that he’s trying to come up with a word for, and he can’t find the word, so he uses one that is conceptually nearby.

This is all pretty devastating. Leo is a technical geek like me. He has two college degrees, and he used to teach at a nearby college. One of his hobbies is photography. And now his ability to understand symbolic information, technology…just isn’t there. Despite his fondness for the word “telephone,” he can’t figure out how to use the one at his bed.

On the other hand, he has no trouble understanding that he’s in the hospital, and he’s asked questions about how we’re taking care of his father. The other day he had the nurse call me to ask if we had turned on the air conditioning for his father, because it was a hot day, and he was pretty sure he had left it off on the day of the stroke. (He was right. I turned it on.)

This is obviously going to be a lot of work. I’ve already talked to Leo about a medical power of attorney, and some folks at the hospital are going to help us set it up. His doctor asked him if it was okay, and Leo gratefully said it was.

As for his father, I’m going to have to be able to talk to his doctor and get information about his medical condition and the medications he’s taking. I think I’ll probably have to figure out how to get a medical power of attorney for him as well.

There’s also the problem of money. The good news is that Leo doesn’t have a job. Instead of working, he’s been staying home and taking care of his dad. I know they have some investments, and I think his father has retirement income. The reason this is good news is that it means his illness isn’t going to reduce household income.

The real problem is going to be getting the bills paid. Everything is fine for the moment, but I don’t know how long this will go on. I keep having this mental image of Leo driving a stagecoach with his father in the passenger compartment. Now Leo has passed out, but the horses are still running. Sooner or later, if someone doesn’t take the reins, their lives are going over a cliff.

I’m going to have to figure out how to manage all this for them. With my parents, all I needed was a financial power of attorney, but this is a more complicated situation, not the least because I’m not a relative.

Meanwhile, I’m trying to spin up some social services for the father. I’ve reached out to the Illinois Department on Aging, and they’ve referred me to a local aid organization, but they tell me it could be a few weeks before they can begin helping us.

The most infuriating part is that Leo and I were making plans for all of this. We knew he had to have heart surgery, and we knew I’d have to take care of his dad, and we knew it could last a while, so we had already discussed setting up powers of attorney, providing me with lists of doctors and financial institutions, and a bunch of other things. His traitorous heart just beat us to the punch.

I’m trying to find reasons to be hopeful. For example, Leo’s dad is much better at taking care of himself than my father was at that age. And I already have all the house keys and computer passwords.

There’s also the incident with the clock. The last time we saw Leo, his therapist pointed to the big digital clock on the wall and asked him to read the time. He was unable to. He had no clue how to do what she asked. Maybe ten minutes later, when we I started to wind up our visit, my wife said something like “Well, we’d better get going. We’re going to see your father next.”

Leo glanced up and replied, “Yeah, it’s almost five. He’ll be eating dinner soon.”

(I’ve changed names, places, and other details to protect my friends’ privacy.)

The DOJ’s Dick Move on Legal Aid for Immigrants

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Ever since President Trump took office, we’ve been hearing a lot about the public interest legal organizations that have been helping immigrants with the legal fight to come to America and remain here. That these organizations are even necessary is because immigration law is (for the most part) civil law, not criminal law. In many ways that’s a good thing, because it means that people who violate immigration rules aren’t saddled with a criminal record for the rest of their lives.

But there’s a nasty twist: Because they are not charged with a crime, they do not have a Sixth Amendment right to a government-provided lawyer under Gideon. That’s the “If you cannot afford a lawyer, one will be provided for you” part of the Miranda warning. People with immigration problems don’t have that right, so indigent defendants can go through the entire deportation process without ever having a lawyer at their side. Even children. (That story is insane, but it’s not a lone example.)

Having a lawyer is really important. As immigration lawyer Mirriam Seddiq put it in an email to me,

The real problem is that people in immigration court don’t have the right to counsel. They can get one if they can get one, but they aren’t entitled to it in the same way they are in the criminal context (no 6a right) This is a thing that probably needs to change because what could be worse than being sent away from your entire world to another country?

Because of that, these public interest organizations have taken it on themselves to offer a variety of free services, from helping with paperwork to fully representing people through deportation proceedings.

I guess that pisses off someone like Donald Trump, and now it looks like his man at the Department of Justice, Jeff Sessions, is striking back with a cease-and-desist letter to one of these organizations, the Northwest Immigrant Rights Project, which describes it this way:

The DOJ letter purports to rely on agency regulations issued in 2008 that require attorneys to enter a formal notice of appearance if they provide any legal assistance to persons in deportation proceedings. However, the immigration courts do not allow limited appearances, so once an attorney files a notice of appearance they are obligated to take over full representation in the deportation proceedings.

The problem is that NWIRP is not staffed to fully represent a lot of people through the entire process. They’ve found they most effectively use their limited resource by giving a smaller amount of help to a larger number of people.

While NWIRP is able to provide full representation in some of those cases, the majority of people are left without an attorney. In response, NWIRP has historically provided limited assistance to help those individuals fill out applications for asylum, cancellation of removal, family visas; file motions to reopen removal proceedings, change venue, and to terminate proceedings; and advise them on defenses, forms of relief, and the procedural requirements for moving forward on cases. But now the cease and desist order has caused a dramatic and immediate impact in the way NWIRP is able to serve hundreds of unrepresented persons.

The DOJ order is based on regulations from the Executive Office for Immigration Review intended to protect immigrants from unscrupulous lawyers who take advantage of them by taking a fee and then disappearing without helping them. Obviously, lawyers who work for free aren’t trying to take advantage of anyone, and organizations like NWIRP have long been allowed to operate without having to follow this rule.

Now, however, somebody at Sessions’ Justice Department wants to enforce this rule against NWIRP, and presumably other such organizations, probably because they think this would be a good way to fulfill Trump’s goal of getting more illegal immigrants out of the country.

Any way you look at it, it’s kind of a dick move. Fortunately, at least for now, it’s a dick move that’s blocked by a federal judge. But it’s not a good sign.

(Hat tip to my occasional co-blogger Ken, who directed me to a Nation story by Rachel B. Tiven. Read the whole thing.)

Windypundit In the Age Of Trump

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I seem to be having trouble blogging. My last post was on March 28th, an even 50 days ago. I think that’s one of the longest periods I’ve gone without posting since the very early days of the blog. I blogged more frequently than this throughout the months when my parents died.

Part of the reason for the reduced blogging is that I’ve been doing small projects around the house. We never really finished moving in, so I have a lot of catching up to do — unpacking boxes, moving furniture, putting things together. It uses up my spare time.

It also doesn’t help that my day job is changing. I’m taking on additional responsibilities, and I’m spending more time having to learn about some new technologies, which uses up more of my spare time. More importantly, it uses up my mental energy. Writing Windypundit is hard work. I have trouble finding the time to start new posts, and I have trouble keeping up the momentum it takes to finish a post.

(I have a bunch of partial posts from the last few weeks — taking The Federalist to task for attacking Elizabeth Nolan Brown, the dangers of weakening Section 230 protections, explaining why I’m skeptical of that study suggesting auto insurance pricing is racist, ranting about Jack Marshall’s ugly values, analysis of the Trump “tax plan,” a point that climate activists missed in Bret Stephens’s NYT piece, and a multi-part series on how insurance works. Some of those might still see daylight, but most are already too stale.)

There’s one other cause for my lack of blogging: The presidency of Donald Trump. Or rather, the difficulty I have in dealing coherently with the presidency of Donald Trump. I tend to blog about what might be called policy issues, and those aren’t much in the news these days.

That’s no surprise. My position has consistently been that Trump is a narcissistic sociopath. It’s not easy to talk about Trump’s policy preferences because he doesn’t have any beyond doing whatever is good for him. Heck, his “tax plan” consisted of a one page summary of provisions and some details given by his staff, and the provisions with the most details were the ones that would give Trump himself a big tax break.

I don’t know how to talk about policy ideas so vague and incomplete. Other pundits filled in the holes, but some of their assumptions were contradictory. Anything I wrote would be dependent on way too many assumptions to be useful.

The Republican healthcare plan was a lot more detailed — an actual bill before Congress — but even then it didn’t offer a solution to any of the major problems with Obamacare, nor did it deliver on Trump’s promises of much better healthcare plans. It just didn’t seem like serious policy, and that didn’t seem worth writing about, especially since non-serious policy could change when the wind blows.

In any case, both the tax plan and the healthcare plan were met with scathing responses from throughout the punditocracy. Much of the response was partisan, a little too much of it was crazy, and some of it I strongly disagreed with it. But all too often, by the time I caught up to the news cycle, everyone else had already said what I wanted to say, or close enough that I didn’t feel motivated to write.

That’s not to say there aren’t some real policy issues. Jeff Sessions all by himself is ramping up the war on drugs and shutting down criminal justice reform. I could certainly say things about that. But I’ve been saying things about that for a decade and a half, and everything I want to say right now boils down to “it’s very, very, very, very wrong to hurt people for committing consensual crimes.” That’s what I always say, and it doesn’t seem to be helping.

So right now it feels like everything I could write about anything going on is basically pointless.

I’m sure I’ll get over it. In part, I need to find better sources of news and information. I now realize that much of my daily skim was geared toward covering the liberal/leftist/Democratic establishment. I need to reorient my reading to find more interesting approaches to the sins of the conservative/right/Republican establishment. I’m not talking only about sites that attack the issues of the right. Sites that smugly defend them are just as useful for my purposes.

I also need to get away from the news cycle’s breathless coverage of every single Trump controversy. Potential scandals involving Russians, Comey, and Flynn may very well have an important, even devastating, effect on the Trump presidency, but they’re not what I want to blog about. I’m sure there are important policy changes going on — immigration is an obvious example — and I need to find out more about them.

Any suggestions?

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