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Author Archives: Paul Bryan Roach

Chicago: Stop the Hemorrhage

10 Sunday Jul 2022

Posted by Paul Bryan Roach in Uncategorized

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Stop the Hemorrhage!

“What a gorgeous Spring day,” I said to my colleagues as we began our 30-hour shift at a downtown Level 1 Trauma Center.

“Ugh!” they groaned in unison. “We’ll be crazy-busy tonight.”

     Chicago and Suburbs have a security problem that’s determining the area’s fate: Murder, crime, violence, intimidation, lawlessness, unaccountability, and administrative paralysis are without question ascendant and widespread here.  These terrible forces characterize us both internally (within city/suburban areas) and externally (how the world sees us).  The security problem we have in Chicago dominates the collective landscape.  It holds the populace hostage.  It destroys our peace and prosperity.  It is taking the city down.

     The problem impacts every aspect of our society, and every social stratum.  Most acutely it degrades the life, liberty, and pursuit of happiness of our lower-income populations. The pain and misery of loved ones, friends, and neighbors lost to the violence and/or crippled by its whims; the daily accounting of neighborhood, work, and school shootings, robberies, and run-ins with outlaws; the consequent neighborhood blight and disinvestment; the functional loss of public spaces and parks; the surrender of public transportation; the stress, fear, emptiness, and bitterness creeping into each corner of one’s life; the generational effect upon children —pervasively traumatized— whose worlds and world-views are influenced and defined by the lawless environment around them, and who adapt to and accommodate the reality they’re presented with making it normal and oftentimes, permanent.

     Aside from ruining individuals’ lives and ruining children’s futures, it is also driving away small business (ref: looting and theft), and big industry, both of which find other cities more safe and hospitable to its employees.  Also lost is “opportunity cost:” things which could be built and which could evolve in the future, but don’t. These are harder to measure but in a fast-paced world they’re critical to maintain –otherwise we withdraw ourselves from the front tier, and we are left behind.

     Criminality, organized and unorganized, has been prominent in Chicago and Suburbs for over a century.  Al Capone, for example, did not invent this; he was part of a network already in place, and merely rose to its leadership. The city’s Security problem existed before him and has been a constant feature ever since.  So you may ask, “How is it a ‘crisis’ then, when it’s been going on for over a century? What makes things different, now?”

     I believe two things make it a crisis and make it different now:

            (1) The national political apparatus no longer functions. Like a pair of addicted parents, both national political parties have become self-obsessed, self-destructive, and more captivated by the resonance of their own bloviations, and by the piques of their private grudge-matches, than by fixing the real-world problems the rest of us face. The far-right is fascist, the far left is socialist, and the supreme court has gone rogue.  They cooperate on just one single thing:  creating a new, worse, USA.  And they’re succeeding.

We the people are subject to pure and ceaseless chaos. No help is going to reach us from above. In fact, only anti-help has been coming from above; and if we are going to survive, we as a city, as a region, perhaps as a state, are going to have to save ourselves.  It’s a hard reality and a damning one, but the sooner we understand and accept this, the sooner we can begin.

            (2) Civic and community support for police, policing, and the criminal justice system have eroded to a highly consequential degree, rendering the city functionally defenseless (or “immunocompromised” in Medical parlance).  The security structures (Police, Policing, and Criminal Justice) are critically degraded.  That’s where we need to put all our efforts, right now! Because that’s the immediate threat to life. If the security situation is allowed to persist or even worsen, well, we’ve all seen what happens next:  peace and prosperity leave the city for dead. It doesn’t take long.

     What do we do about it?

     After a gunshot to the chest or neck or abdomen, for example, Step 1 in the management process is to first, stop the hemorrhage.  Nothing else gets done ahead of that.  Nothing else matters ahead of that.  The patient is bleeding to death.  It sounds simple, but it’s powerful:  stop the bleeding. It gives you a little bit of time, enough to plan and execute your next moves. Similarly, for the city which is quite literally being attacked in an analogous way, I submit that the first step in the management is to reclaim order and control of our neighborhoods, schools, highways, parks, and trains.

     Ultimately the best solution for that will be to address and remedy the root causes of bad behaviors such as creating better neighborhoods, schools, cultures, climates, and opportunities for our children, so they never join a gang or become a criminal in the first place. But that is a slow-build.  It will take many years, many decades.  And regardless –and here is the crux of it– none of that can begin until the place is made safe, anyway.  It’s not the other way around.  Step 1 in this crisis –the first solution– is that we must reassert control.  We must create safety.  Peace is achieved.  We must stop the hemorrhage before it’s too late.

     How is it to be done?  Prelude:  if it were easy, it would have happened already.

  1. Culture of Violence.  We must accept that Chicago is our problem to fix.  Nobody is going to do it for us; in fact, we’ll need to tune out the rest of the national dialogue, as both sides have gone lost touch with reality. The overall remedy begins with fixing our culture of violence.  Like an evil spirit genie conjured up over a century ago and sustained ever since (a malicious “egregore”), this violent culture that belongs to nobody and to everybody at once, that has no shape or form but exerts a sustained, profound influence upon our present and our future, it must be confronted and it must be overcome.
  2. Land of the Free. We cannot adopt the complete and autocratic state-domination approach that China has taken: We have a culture of Freedom.  We have a Bill of Rights.  We respect the value of the individual.  Liberty is at the very center of our Democracy. Whatever we do, we cannot create the invisible cage that China has created. We must do better than that.
  3. Police, policing, and criminal justice. We must develop the best police force and criminal justice system in the country; perhaps in the world. Somebody already has that; we need it(!), and we need it now. That should be our “moon shot.”  Not the opposite.  Not the antagonistic approach to policing we hear from city hall.  Not the porous approach to dispensing justice we experience when those who commit crimes are released to keep doing so. We can no longer afford to elect people into positions of authority who are reluctant or unable to do their duty to protect us. We as a population need to set this as our collective goal, rank it above other goals, and we must work together to make it a reality.

     Investing in the police and making our criminal justice system the most effective in the country, these two improvements are fundamentally necessary to stop our city from cascading into chaos; they are preconditions to the emergence of a better culture.  They must be in place before we can drive a new narrative for Chicago; one that evolves out of the century-old legacy of crime and murder for which we are unfortunately known across the world.

     We must attract the highest talent to our police force and to our courts of law, and we must learn and adopt the most modern and effective techniques for both. We must make the Chicago Police Academy the envy of every other police department there is, and develop our officers professionally and continuously throughout their career. We must do the same for our attorneys and courts.  We must promote the ablest leaders and demote those who are not. We must define valid, reliable, practical standards for policing and adjudicating this complex, international, 21st-century city, and then meet them.  Then we must all support our force in what is the most difficult, hazardous, and essential job the city has, and be grateful for and take pride in the peace and prosperity they enable with their work and modern professionalism. And we must care for our police who are injured or traumatized in the line of duty because theirs is a tough and dangerous and never-ending task, and we honor it by caring for them.

     I am an ordinary citizen.  I very much believe we in Chicago are at an inflection point. Many others do as well.  The Chicago streets and trains and schools and shopping centers must get safer or we will soon lose this amazing city. It’s happened to other cities; it will happen to ours. The loss may not happen overnight but by the time we realize that things are beginning to crash we will be too late in the process to reverse it. I believe there is no “war on crime” for us or “war on drugs” or “war against terrorism” that makes any sense, here; there is only the necessary realization that our first priority must be the day-in, day-out safety and security of our citizens, businesses, and institutions and that in the 21st century / digital age / global village in which we all now live, how that is done will be a mix of classic wisdom and common sense (as a primary basis), with a variety of new technologies, ideas, values, and techniques added on top.

     Yes, there is much, very much to do on so many other fronts, but we must stop the hemorrhage, first, or there will be no patient left to save.

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2: “Do your Research!” John Turek History Teacher

24 Friday Jun 2022

Posted by Paul Bryan Roach in Fixing Chicago

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1 – Intro: Interview with History Teacher John Turek on the importance of teaching and learning History to children, the practical value of knowing your local history, the joys of teaching junior high students, and how we can understand and improve our city by knowing the history of other cities.

2– Guest bio: John Turek is a recently retired History teacher (30+ years) within Chicago and Oak Park areas.

3– Timestamps:

[00:30] Intro to John Turek, History Teacher, and his background

[03:30] What draw into Education

[07:30] Why study History?

[10:30] 4 key ideas on History

[14:30] Teaching Junior High Students

[17:15] What historical examples apply to Chicago today? For example, the Chicago Machine.

[24:00] Is this the first time this has ever happened?

[30:00] Sit, Think, Read, Analyze

[32:00] What does one city have to learn from the history of another city?

[36:35] You should have seen that coming. Do your research.

4– Key Takeaways:

—Need to study History to understand context of your life, generate meaning, and understand the others around you. Also, Biological perspective: H. sapiens the only species so minimally instinctual, and History learned from elders, others, imparts survival value.

—4 key ideas on History: customs (learned ideas), values (what a certain culture considers to be important), Institutions (families, schools, hospitals), and Beliefs (what a certain culture believes to be true). Most of what we now think we know comes from a “cultural” perspective. These help us understand “why I do the things I do.”

—The reward taken from student growth, and from your own growth and adaptation as a teacher

—Chicago’s 77 different cultural enclaves & have their own sense of place : if you know the history of your enclave you can see things that you didn’t understand about your present.

—Know your history, but be careful of the history you do read. Understand where your history is coming from. Do your Research.

5– Links: https://madiganrule.bettergov.org

https://www.nyjournalofbooks.com/book-review/al-capones-beer-wars

https://thehistoryofrome.typepad.com

6– Please “like” us and follow the show on your favorite podcast platform, visit paulbryanroach.com for more content, and follow on Twitter @PaulBryanRoach

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1: “So.. It’s Cancer?” Trailer

20 Monday Jun 2022

Posted by Paul Bryan Roach in So... It's Cancer

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  1. So doc, it’s Cancer? is a podcast dedicated to being a “how-to” manual for cancer patients and their friends and families.Each month we will work through different elements of the overall problem, “from soup to nuts” as they say, beginning at the beginning such as the the basics of what cancer is, who may be at risk, who is involved in the treatments, why treatments differ so much from one cancer to another, or even within the same type of cancer?The podcast will work through to the various possible outcomes, and quality of life.
  2. Why? Need for physician-led podcast series that is patient centric.It helps to have a chat with your physician, only, that chat is usually short, emotional, hard to remember, and often only a beginning.
  3. Hosts: Paul Roach – Surgical Oncology; Courtney Coke – Radiation Oncology; Pete Schlegel – Medical Oncology; Mike Riordan – Graphic Designer

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Lenin, Stalin & Memorial Day in the USA

30 Monday May 2022

Posted by Paul Bryan Roach in Writing

≈ 1 Comment

It’s Memorial Day in the USA and I just had the extreme pleasure of being on the sidewalk waving and clapping at our annual neighborhood Memorial Day Parade with close friends of ours and their neighbors and everyone’s pet dogs. Fire trucks from the surrounding six suburbs, Police cars as well, local politicians, marching bands, boy scouts, martial arts clubs, tumbling clubs, grade schools… you know the drill. It was fabulous.

Turns out, that’s one of life’s most generous and rarest pleasures.

It struck me, watching the happy parade in our suburb that borders Chicago as an urban war of its own rages just inside the city limits and in other neighborhoods around ours, how Peace and Prosperity are always achieved. They are not the baseline from which matters deviate. Rather, they are the heights to which we as individuals and we as communities and we as societies may aspire. And it struck me right between the eyes this mistaken assumption (that Peace on Earth is a baseline state) is a root cause for many of our societal troubles. The baseline state is actually chaos and misery; that’s what everything descends into, if we’re not careful.

Yes, that is it! The wild-eyed folks on the side of the guns bloviate that arming ourselves to the teeth (“harden the grade schools!”) is going to somehow make us safer and more prosperous (they’ve never been in Afghanistan, obviously, where John Q Public owns an AK and frequently a rocket propelled grenade launcher), and the wild-eyed folks on the side of the oppressed and disenfranchised bloviate that it’s wrong to arrest or prosecute crime when it happens because the person was obviously oppressed and disenfranchised (which fact only makes the other side angrier and more convinced about the need for personal weaponry), and they’re all feeding off this grand assumption that the peace and prosperity which we do have, that this Memorial Day Parade in front of us, happens and continues to happen no matter how much they alter and degrade the system that produced it. Wrong. This peace and prosperity can be broken quite easily. And they’re both breaking it, each in their own ways.

I’ve no idea how to counter such notions other than to encourage everyone to look not to me –who am I, I am nobody– but to History for lessons. Let us learn the right lessons from those who’ve experimented with all of this before us. But what are the right lessons? Here are my thoughts:

I recently took a fascinating and extraordinarily disturbing trip through modern history in the version of a couple of biographies (listed below), a history on the Soviets’ daily lives (The Whisperers) and then capped it off with a three hour podcast on the unspeakably evil horrors of the post WWII Soviet state (Martyrmade podcast: episode 19 the Anti-humans –if you dive into anything I’m suggesting to dive into in this article, dive into this podcast episode).

Why did I go down this path? I needed to better understand the history we Westerners collectively lived through one generation ago (how quickly we forget), and, I suppose I needed to better understand the design and construction of the US government –particularly were the framers of our Constitution expressly intent on creating a nation where dictators in whatever form could not emerge or if they did, could not remain for long? Was avoiding a dictatorship the sine qua non for the framers of our Constitution? (I believe the answer to that is “yes.”)

The reason for this focus on that period of Western history should be obvious right now: Vladimir Putin, Xi Jinping, and an assortment of lesser dictators all focused on disrupting the primacy of the Western-led world order. It’s relatively peaceful here in the USA, for now, but agents are afoot….

My learning excursion began with Vladimir Ilyich Ulyanov (22 April 1870 – 21 January 1924), who is better known by one of his pseudonyms, “Lenin,” founder of the Russian Communist Party (the Bolsheviks), inspirer and leader of the Bolshevik Revolution (1917), and the architect, builder, and first head (1917–24) of the Soviet State. It lead me from there to Ioseb Besarionis dze Jughashvili otherwise known as “Josef Stalin” one of the most notorious killers in the history of the world.

Why them? Because as I mentioned I was wondering about our politics these days: the left-right polarization, the lack of a middle ground, the hysterics, the fascination with the sound of one’s own voice and of staking out one’s theoretical stance combined with the complete lack of interest in listening to anybody else’s… and I wanted to learn about the history of such polarized arguments. What are those who have learned the hardest, bitterest, brutalest of lessons, what are they –from the tomb– trying to tell us now?

As JFK put it so well, “Too often we hold fast to the cliches of our forebears. We subject all facts to a prefabricated set of interpretations. We enjoy the comfort of opinion without the discomfort of thought [Commencement Address at Yale University, June 11 1962].” Or as my Mom used to tell me, “Two ears, one mouth;” in other words, listen first. We’re not listening.

Lenin: the Dictator by Victor Sebestyn

Lenin was the perfect example of someone with an extreme political opinion (his happened to be on the Left; the Nazi’s next door would form an equal and opposite position on the Right) who absolutized the worldview of his chosen sect of society (“The worker,” although some say he’d hardly ever met one) and he doggedly used that new ideology as a lever, exploiting all to catapult himself into power, establish his agenda, and when that agenda failed (it was an untenable concept all along), he altered his ideas to set in place a reign of terror to at least maintain the power; he forced the ideology into functioning in reality and who paid the price for that? You guessed it: the worker! The very individual he had professed to support.

He was Godless and Communism is Godless, and why that is important hearkens back to the original issue I brought up of Peace on Earth: unless you put love and human values in the center of your ideology (notice I didn’t say “religion,” as those suffering under the Iranian Republican Guard Corps can likely attest), you will get a society that doesn’t care about individuals. And that’s exactly what the Communists got, and it’s what they still have. The lack of concern showed then in the way they murdered and destroyed tens and hundreds of millions of their own not to mention others; and it shows now, in the way the Tibetans have been wiped off the map and in the way the Uyghurs are being wiped off the map, and in the way civil rights in Hong Kong are wiped away…

After Lenin came Stalin, who many historians say was worse. Stalin needed Lenin, of course, to get the thing started. But he took off from there. Read this biography! Read “The Whisperers!!” Books / histories like these are essential to understanding where we’ve been, to understanding why we celebrate Memorial Day in the USA today! We MUST learn and understand what has gone on in the past, if the present is to make any sense at all.

Stalin: A New Biography of a Dictator, by Oleg Khlevniuk, translated by Nora Seligman favorov
The Whisperers: Private Life in Stalin’s Russia by Orlando Figes

I wonder about our current turmoil within the USA. No one is overtly attacking us at present but we are certainly attacking ourselves. Where did these insane times originate? How did the USA become as ungovernable as Beirut? Was it the gerrymandering throughout every state’s electoral map? The 100+ Cable news stations that have to make up “news” even when there isn’t any? Internet search-engine bubbles? Social Media’s machinery amplifying the impact of fringe idiots? Economic disparities more drastic than pre-revolutionary France? The loss of focus on Humanities in American high school and collegiate education?

It’s moments like these I wish I had been a History major.

Back to Lenin: the context of Lenin’s rise was the lingering reign of the Tzarist Russian monarchy (the Romanovs and Tzar Nicholas II), and the faltering of that entire system of governance. The wealth gap in Russia at the time was astounding, the secret police (the Okhrana) highly intrusive and dangerous, the middle class was more or less nonexistent and categorically blocked from progress, anyway. Further context is Lenin’s father being laid off of work, and his brother being hung for being a revolutionary against the Tzar. The Industrial Revolution was raging through Europe, and Russia was behind them already, and getting further behind every day.

Lenin was a brilliant mind but he was a kook, an exiled wing-nut, a whack-job. We’ve seen it a thousand times how you can have a smart mind that is clever and effective but its fundamental assumptions are wrong, and therefore everything that the mind produces is wrong. And I’ll allege here, as I did a few paragraphs up, that what was wrong was Lenin ascribed no unique value to the individual and absolutized the state’s priorities alone. The Menshaviks were far more reasonable than the Bolsheviks, but somehow [read: ruthlessness] the Bolsheviks won out. Once again, how did an entire country fall for his bizarre ideology? And more to the point… will we in the USA fall prey to a similar kind of idiot, some day?

I tried to begin by looking at the beginning. Peter the Great in the 1600’s and Catherine the Great in the 1700’s… they tried to modernize Russia to be more like Europe. During the second half of the 19th century, a faction of so-called “Slavophiles” emerged in intellectual circles. These “Slavophiles” were convinced that Peter the Great made a mistake in trying to modernize / Westernize the country, and that Russia’s “salvation” lay in the rejection of Western ideas. The Slavophiles apparently believed that while the West polluted itself with science, atheism, materialism, and wealth, they should return to a simple peasant-based society centered on the Orthodox faith.

I went through the entirety of Napoleon’s attack of Russia a century earlier, Tolstoy’s “War and Peace,” prior to that. Fascinating book, by the way; I highly, highly, highly recommend it.

I tried to see what happened in the century between Napoleon’s invasion and the Bolshevik revolution. Best as I can tell, while Europe had its Agricultural and Industrial Revolutions, and had the Enlightenment as a social development Russia reinforced the Middle ages in its Serfdom rule and became farther, and farther, and farther behind its neighbors to the West.

Ultimately the strain was too great and the Communist cataclysm was the result.

I wish for a solemn and meaningful Memorial Day for everyone, and please remember that the peace and prosperity we enjoy at the moment is no accident: it is the result of generations, centuries, even of countrymen and individuals working together –imperfectly, yes; very imperfectly working together– and sacrificing and holding a particular ideal above all others. And remember that whenever tempted to tinker too much with the formula and cultural norms that have gotten us this far, to think about it some more and try to put the great ideas we have at the moment into historical context and see if anyone has tried them before, and see where that got them, then. Maybe your great idea needs to be implemented in order for us to move forward? But maybe with respect to your great idea the experiment has already been run (in Soviet Russia, or Iran, or Afghanistan…) and it’s worth a second look before widespread implementation?

Lastly, although above I’m primarily focused upon our fight against post WW-II Totalitarianism and the meaning behind all those who gave their lives opposing Communism whether in Korea, Viet Nam, or elsewhere, let us not fail to honor all those who have given the last full measure in the war against Terrorism whether Iraq, Afghanistan, Somalia or elsewhere. None of these conflicts have been unalloyed or perfect or beyond criticism but that’s not my point: today is the day to honor those who have given their lives in the intent to make a better peace for the rest of us. Today’s Memorial Day Parade is their gift to us, and what joy we feel in and through it, is for them.

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1: School Superintendent Dr. Robert McBride

28 Saturday May 2022

Posted by Paul Bryan Roach in Fixing Chicago

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Join us for an hour with the fascinating and brilliant Dr. Robert McBride, superintendent of Lockport Schools, for a discussion on education, leadership, and how to teach kids despite a Covid pandemic.

2 – Guest bio

3 – Timestamps:

*[00:40] Intro

*[01:40] Interest in Education; Oak Park & River Forest High School, Northwestern undergraduate English/Writing, Harvard graduate Masters in Curriculum & Teaching.

*[05:14] Fulbright Scholar St. Andrews, Scotland, School of English; differences between U.S. & U.K. educational systems

*[11:17] What motivates students?

*[14:27] Life lessons on being a Departmental Chair, executing the role, it’s many hats, pro tips, leadership at the mid-levels.

*[23:00] Being a Principle: the joys, the sorrows, the travails. Empowerment of department chairs and other staff. Personal evolution within the role. The Blue Ribbon and the Bell Awards, and what they did to earn them. Specifically how doggedly focusing on four cardinal elements across multiple academic years was transformative and lifted ALL boats.

*[36:10] The Superintendent role, its best expression, and lessons learned.

*[39:30] COVID 19 and getting the community ready; how they did it [with great success]; lessons on preparedness, network building; their amazing data on the impact of mitigation strategies; what “right” looks like in disaster preparedness.

*[53:29] School Boards’ bizarre phase and the threat to Democracy.

*[58:10] Current & Future projects: Educational Research & Development Institute (concentrating on Equity & Diversity); Council of Superintendents (exploring what kinds of Superintendents & Principals will be necessary in the future?).

4 – Key Takeaways:

*Differences b/w US & UK: Scheduling is fluid in UK (every two week changes to fit student progress) and static in US; Team (5-6 teachers/single course) approach to teaching classes in UK versus solo in US; US obsessed with grading but in UK teachers more of a coaching role/feedback, with grades only end of semester or year [real focus on A- & O-levels]. UK has no extracurricular life whereas prominent in US.

*What motivates students: (1) Coaching relationships / positive relationship (not just a judge; (2) Must be more than a critic/must give tools to make progress.

*What makes a real leader at the Department level? 1,000 conversations! Be whatever you need to be for your staff at that time.

*Key drivers of progress / core focus for student improvement: Argument construction; Inference skill; drawing Conclusions; Academic Vocabulary.

*COVID mitigations actually work, extremely well & far better than one might think, and Lockport Schools has the data to prove it.

5 – Links:

The Terrel H. Bell Award for Outstanding Leadership

6 – Please “like” us and follow the show on your favorite podcast platform, visit paulbryanroach.com for more content, and follow on Twitter @PaulBryanRoach

7 – Completing the initial focus on youth Education, next episode will be with a much beloved local Junior High History Teacher, Mr. John Turek, with thoughts and reflections across his 30+ year career.

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A Memoir?

22 Sunday May 2022

Posted by Paul Bryan Roach in Writing

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It seems egotistical and obnoxious, writing your own memoir.  And a self-portrait on the cover?!?  C’mon, really?

Reasonable as those sentiments may be, and believe me I’ve experienced them over this, there are reasons behind the project which I hope will expiate me.  The project was borne out of necessity, and from there it evolved.

At first I simply kept a journal.  I was in country, in the war, and many nights before I could sleep I sat on my haunches in a chair in our tent and typed away for all I was worth. I had to record what this was, My Officewhat had happened there, what they’d done, what we’d done.  I didn’t know else what to do with it all.  I’d jog five or six miles in the desert almost every day, I’d talk with my company mates who became so dear to me it’s indescribable, but it wasn’t enough.  You absorb this energy and it’s got to go somewhere.  I had to place it somewhere.

And then when I got home I went back to writing.  More thoughts would pop into my head in the day and at night, like faeries, and before I forgot them all I had to capture them in print. I had to remember them.  Then once I remembered everything I had to work it through, arrange, rearrange, get it right or as best as I could.  And then I had to recognize all the people involved as best as I could before they all dissipated from memory too, like ghosts at dawn. Once I’d done all that it was probably two years down the road from returning.

Afghanistan 2009-2010 was stressful and intense and during that time I took every spare moment –and being “Medical” there were spare moments to be had– to write a story called “The End.”  My father had always intended to write a book but he died before he ever got the chance so during that deployment although I didn’t really expect I’d be killed I figured to be safe I’d better get something down for my kids to have just in case.  Was it melodramatic of me to feel that way?  yes, as only a few doctors have died in these conflicts, but not zero doctors.  Plus on a practical note when would I ever get that kind of time again?

AlphaSurgCoAfter I got back I went to a writer’s conference in San Francisco regarding “The End” and aside from that book I was urged to work more on collecting those other notes from the war into a book of it’s own. After finishing work on “The End” I asked my editor (Ralph Scott), who was not a p’s and q’s guy, (he is a person who could read the whole thing, digest it, ask what it was I needed to communicate, and figure out the best way to communicate it) about the idea of a memoir on Afghanistan. He liked the idea and I gave him my first draft.  He was a coach and a tough one at that.  And halfway through the first draft he wrote me that he couldn’t read any more of it. It was that bad.

I got that kind of time again during the second tour to Afghanistan which came a couple of years later. During the interim between I’d spent a thousand hours writing and re-writing notes on the first deployment, and sent them back to Ralph.  This time we had it right, and we moved forward from there.  Another six or ten complete re-writes and we were done.

Tom Craig, Amy Zaycek, Paul Roach, Stephen McCartney at the gala event

Earlier this month we had our 10-year (pushed back x2 years because of covid) 2nd MEB reunion, held in Quantico Virginia. The 2nd MEB received a Presidential Unit Citation hence the colors of the lanyards around our necks.  That’s where having written the memoir, for the first time, really felt like it was worth all the effort.  “Medical” is usually a black box:  you send your troop, your best friend, your son in there fresh from the battlefield, something happens you don’t know what, and then you live with the results for the rest of your life.  The memoir clarified for the Marines there, their families, and all the other concerned individuals what went on in “Medical.”  I really felt that at the time, and across the entire reunion.  “Citizen Surgeon” was about us; I had to be its protagonist as every book needs one, but it’s really about us as a group, doing our best to “negotiate the price for freedom.”

The most lasting memory of the reunion for me will be sitting amongst the Gold Star families at the Marine Corps parade at the 8th & I Barracks, and when the Star Spangled Banner was played by the Marine Corps Band, hearing hearing their voices as they sang along.  What an incredible, amazing, patriotic, and giving group of people.  I shall never forget them. 

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The Internet as the globe’s psyche

21 Saturday May 2022

Posted by Paul Bryan Roach in Writing

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The invention of the internet is something as profound for humanity as Prometheus’ discovery of fire, and over time will be just as transformative. It’s a worldwide neural network, a communal brain for the globe, and more importantly a psyche for the entire globe.

What is that? what exactly is a “psyche” and how could it be one for the entire globe?

In medical school we learn Neuroanatomy, and learn that the lumpy brain (see above) (https://www.neurosurgicalatlas.com/neuroanatomy/lateral-view-of-the-lateral-cerebral-surface-showing-the-sulci-and-gyri) has dedicated areas for every last neural function we creatures have got. There’s a dedicated area for every function except one: the psyche. There’s no anatomic place for it. That thing exists in a neural cloud spreading across the surface of the brain: it’s everywhere and nowhere at once.

One could argue that the psyche is sourced out of the amygdala (a limbic system structure deep in the central brain mediating emotion and memory), but others might argue it’s somewhere in the frontal lobes (that moderate and govern mood, behavior, and social judgment). But no one –unless I am much mistaken and please comment if I am– has ever identified or proven the psyche has an actual, discreet, single locus within the human brain. Yet, metaphysical as it is, the psyche undeniably exists and exerts tremendous influence –or, rather than merely influence, it may be the deep source of who we really are… (whatever that means, “who we are”) and perhaps all that we ever do is really an expression of that psyche.

Anatomic events, such as strokes, dementia, tumors, and trauma (bifrontal hematomas, for example, after a bike crash with no helmet) can change a person’s psyche. Life events, such as loneliness, bereavement, changes in wealth (for better or worse) do the same. The psyche can be built up, and the psyche can break. But it’s not something you can physically touch. Nor can you view or image the psyche directly, not with CT, MRI, or even SPECT scanners. You cannot operate on a psyche the way you can with a rupturing appendix or a meningioma. But it’s there and it matters, nevertheless.

And if all the world is one collective organism, and if the universities and theaters and city halls and financial institutions, for example, constitute its neural network, then the internet is its psyche.

(1) Individual psyche: If you’re religious you might refer to a “psyche” as a manifestation of your “soul;” if you’re secular, you might say it’s your “mind.” If you look up the definition it will refer you first to Sigmund Freud (Id, Ego, and Superego) and next to ancient Greece (Psyche marries Eros). In other words, for something as central to our existences as whatever it is that constitutes the essence of our very selves, there’s not a whole hell of a lot to either localize or define it, clinically speaking.

Personally, I don’t go with the religious or the secular definitions. As for the religious, I believe a soul is more than a psyche: it existed before “me” and will exist after my body is dead, and if I develop schizophrenia for example and my psyche becomes deranged, does that similarly impugn my soul? Of course not. And as for the secular, I think the psyche is more than a clearing-house for the collective impulses of the human mind and body; it’s not some higher-level algorithm who’s function it is to assimilate dis-cohesive data and produce survival benefit for the species. It’s not simply a computer.

I take a more mystical view. The psyche is some magical thing: it’s an entity, all right, but not one like the others. Maybe it’s the interface between soul and mind? It’s fluid, and its boundaries are not distinct (my wife’s psyche and my own, for example, intersect like two colors in a rainbow), but it’s got a center and it’s got a periphery, it exerts influence in everything I do, and it’s likewise affected by everything i do. I have some element of control regarding what goes into it, but not complete.

(2) Collective psyche: We as individuals are separate creatures than we are in groups; so separate, it seems, as to be completely different organisms (ref: Lives of a Cell, by Lewis Thomas). A single bacterium will operate and behave along a completely different set of rules and objectives than it will follow when in a group or colony; a domesticated dog will be equally different than the same dog in a pack; humans in one-on-one can be unrecognizable in comparison to their public manifestations or mob mentalities. The group “psyche” is a different psyche. The internet psyche is a different psyche.

So here’s my final point, and there main point of the whole post: just as a individual brain has a gyri, sulci and corpus callosum (the corpus callosum is a large bundle of more than 200 million myelinated nerve fibers that connect the two brain hemispheres, permitting communication between the right and left sides of the brain), and these impact and govern the human being, and just as the human brain has this metaphysical “psyche” existing above and beyond all that, which, you might say, comprises “the real me”… collectively we’ve got the same thing: a metaphysical psyche spanning across all the members of the human species; and now that nearly every human on the planet is connected more or less directly to every other human on the planet through the internet, we’ve got a collective psyche like it or not, and that point is critically important to understand if we’re to make sense of its influence upon us, and if we’re to influence it back.

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Failure in Afghanistan

21 Saturday May 2022

Posted by Paul Bryan Roach in Writing

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What just happened? How did it happen so fast? What did we do wrong? I’ll tell you what we did wrong, we didn’t think it through: You don’t get to leave; unless you lose. That should have been obvious from the start.

Post WW-II we’re still in Italy, Germany, Japan; post Korea we’re still in Korea; post Viet Nam we are out from there, but we’ll have to categorize that one as a “loss;” post Iraq we had to rush right back in, in 2016, to counter ISIS, and we’re still in Iraq today. And that, I suppose, is how it should be.

Afghanistan is and was important geopolitically, in terms of it existing in the center of Asia and as it happens in-between Iran and Pakistan; and culturally, in terms of bringing that group of 30+ million people into the modern family; not to mention the explicit reason for being there which was to prevent it being a privileged site for the harboring and nurturing of terrorist groups (now that we’re leaving, it will go right back to doing just that, I am quite sure).

But the instantaneous failure of our 20-year Afghan investment and the nightmare of its president skulking off before the war was even lost with truckloads of stolen cash in tow, this has given the whole world pause…

…so it should probably give every American pause, too… and we all together are asking the same question: “Is the USA the dominant influence across the globe any longer? If not, who is?”

Maybe we in the USA are too busy to think deeply about what just happened because we’re so mired in distracting, fatuous internal debates over whether vaccines actually work; or if the election, of which over the 245 years of our history we’ve done a bunch of times, was done right; or if the Earth is flat or not? This country of ours has become indulgent and foolish beyond description, we’ve lost our way, and it appears very likely that we are incapable of leadership maybe as the USA’s detractors allege… maybe we are too soft and weak and selfish to lead the world any longer?

We need to mature-up enough to stop our un-disciplined haggling in order to take-in what just happened. The catastrophe in Afghanistan isn’t just another news story in the 24/7/365 cycle of news stories. This is a national failure of epic proportion.

Afghanistan, my friends, was much more than a war. It wasn’t as if we just went there to blow up an enemy. This was a “Pygmalion” on a massive scale. We did take on enemies there and we did that part more or less brilliantly, but above and beyond that we also made a lot of promises to the 14 separate tribes comprising the Afghan people. Remember COIN (Counter-insurgency) Strategy? Clear, Hold, and Build? We built them a representative government. We built a lot of schools. We established a free press. We convinced them –some of them, at least– to believe in Western democracy and the institutions that make it viable. We built an Army and Air Force over there, one in our own image in fact, one that couldn’t function even for a single day without us or our contractors, in fact. What were we doing? We lost a lot of men and women over there and injured ten times more, and psychologically impacted even more than that. And that’s just on our side. We had many coalition partners. We had Afghan partners. We spent $2 trillion dollars. And then it lasted ten, eleven days after we pulled out? And we didn’t see that coming? How could that be? What did we do wrong?

Group think.

Was the plan to stay there forever? It might have been. It only makes sense that way. Hey, what WAS the plan, by the way. Oh yes, the Neo-cons: Wolfowitz, Rumsfeld, and the lot. A quick victory in Afghanistan, to be followed by a quick victory in Iraq, and at that point we’ve got both sides of Iran covered, and we can control the Middle East. Or it was something other than that?

What is the plan now?

The fact is, somebody has to be the leading culture and force on this planet; for a little while it was us. World War II was very much about that –who would it be? The Axis or the Allied powers?– as were the wars in Korea and Viet Nam: Communism versus Capitalism. The duel is playing out still, but in a more civilized way, with respect to China’s ascendent-power “Belt and Road” initiative. And like it or hate it, our “War on Terrorism” was an attempt to bring the stickiest places on the globe a step forward.

Marx had famously predicted with the rise of Industrialization that economic development would follow that logic and move from undeveloped country to undeveloped country until all of the cheap labor sites on the planet had been exhausted, and only then would the workers of the world have more of a say in their conditions and circumstances. You gotta hand it to the guy, he had that part correct.

The terrorist phenomenon introduced the same kind of logic, which was that troubled places, like the unindustrialized ones before them, needed to be brought up to date in order for the rest of the world to be able to live in a truly modern era. Failure or not in Afghanistan (and although we’ve pulled out, the final chapter on that place is definitely not written, just yet) the job continues on. And who is going to lead it, if not US?

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When Lilacs Bloom

25 Tuesday May 2021

Posted by Paul Bryan Roach in Writing

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When Lilacs Bloom


If Death does come it will be too soon.

“Wait! Until the lilacs bloom!

And those flowers in the vase beside the door

For whom I had not time enough, before.”


If Death does come it will be too fast

Opportunities all gone past

Like toddlers grown, or children gone,

Or laughter’s echo across the lawn


Catch it all.  Make it whole.

Search, run, from pole to pole.

Sand will sift through every grip.

Sing your song. Take your trip.

–PBR, 2021

 

 

 

 

Dedicated to the memory of CAPT Zsolt Stockinger, MC, USN

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Citizen Surgeon

25 Thursday Jun 2020

Posted by Paul Bryan Roach in BOOKS

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Citizen-Surgeon takes readers into the otherwise inaccessible, remote, and intense world of life and surgery within a combat zone. In the backdrop of the U.S. led war in Afghanistan, amidst a defining U.S. Marine Corps’ offensive to conquer the Marjah region of Helmand Province, [then] U.S. Navy Commander Paul Roach and his company-mates assemble and congeal as a medical unit in Southern California, transport from the United States to their tents in Dasht-e-Margo (the “Desert of Death”) in Helmand Province, Afghanistan, and professionally execute their role as one of the few medical and surgical companies supporting this major military offensive. In the course of the book’s events the author undergoes a transformation from being a physician in a military uniform into a military officer that happens to be a physician. The crucible effecting this change is the military offensive and his role within it. Shocking and intense, an array of critical injuries and their treatments are described in rich language that anyone, medical or non-medical alike, can absorb. Death also pervades the atmosphere; intrusive, unyielding and painful, its battlefield familiarity and personal impact is resisted, suffered, and ultimately, accepted.

Citizen-Surgeon is an intimate portrayal, a chronicle, a celebration of friendship, love, success, failure, contemporary war and military medicine.  It is a highly-readable account of a slice of reality that few people are privileged to know. It reflects deeply upon the nature of personal choice and how that choice puts us where we are in life, even if we did not fully see in advance how the choice would change us. Citizen-Surgeon also explores a variant of post-traumatic stress particular to medical assets, and it reveal’s one man’s chess-match against it. It is a must-read for those with a specific interest in contemporary military medicine, and for those with broader, essentially human interests in individual growth, adventure, and self-actualization.

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Endorsements from Commanding General and MEB Surgeon

As the former Commander of all US Marines in Afghanistan’s brutal Helmand Province during 2009-1010, I stand in awe of the medical professionals who were forward deployed in harm’s way at our most remote, vulnerable, and dangerous locations providing life-saving resuscitative care to our freshly and often grievously wounded Marines and Sailors. There are Marines, allies and Afghans alive today precisely due to the risk these Doctors, Nurses and Navy Corpsmen took every day to save lives. I saw innovation, agility and heroic actions taken by these medical teams to guarantee each wounded warrior the best chance of survival. Marines and Sailors knew that if they were wounded, that within minutes, not hours, they would be in a forward deployed medical facility attended to by world class and caring teammates. Captain Roach takes you on a journey into the triage and operating rooms through his vivid and brilliant descriptions that transport a reader into a place where they can smell, sweat and for a few moments feel the raw emotions of saving lives on a distant battlefield. This book pays tribute to the selfless and heroic actions of our too often unheralded but always immensely appreciated and respected combat medical teams. Semper Fidelis,

Lieutenant General USMC (ret) Lawrence D. Nicholson, Commanding General 2nd MEB-A Helmand Province

“Citizen Surgeon is expertly written by Dr. Paul Roach who was right in the middle of history-making and ‘highly kinetic’’ USMC engagement in Helmand Province, Afghanistan. I commend his ability to give a superbly accurate close and descriptive view of what a combat surgeon performs in today’s lethally weaponized combat theaters. He takes off the shelf, and selflessly shares with the reader, the many emotional and spiritual battles we face as we rapidly scrub our hands and take the scalpel to a rapidly bleeding young warrior. As battle-tested surgeons in austere places we all, at one time or another, have to ‘visit our own personal and private cemetery’ where we perform tortured self-analysis on our decisions and ourselves. In Citizen Surgeon a brave, professional and gifted Captain Paul Roach allows the reader to travel with him to that very place with great humility and literary skill.”– Captain Stephen F. McCartney, USN (Ret.), former command surgeon, US Navy Medical Corps, Second Marine Expeditionary Brigade, Task Force Leatherneck (2009-2010)

Personal Responses from readers:

I have finished your book (for me it was pretty much a page turner) and I feel that it is an essential read for a) those considering becoming a military physician, and b) perhaps more significantly, for the spouses of those individuals.  You speak eloquently of the light and the dark in that line of work, both at home and deployed.  You make it very clear that PTSD is not limited to those who have endured physical trauma, but is a condition affecting all those exposed to war and the injuries inherent in that – both to friends and enemies. I really loved your final Paradox paragraph.  It was especially moving.  Finally, I especially loved the chapter on Moshtarak.  It basically says it all concerning medical care during combat.  As a last word, I feel that your book should be read by all and should be nominated for a Pulitzer prize (some spelling things to fix). Very Respectfully,  Norris Childs , MD, FACS,  CAPT, MC, USN (ret)    PS, I hope I will be able to get a hard copy of this book – so my wife can read it, and know she was not the only one.

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From: Jeffrey Bailey

I finished your book this evening. I was up late reading it on more than one night. On more than one night it evoked my recurring dream of deployment: being separated from my wife and being frustrated in my every attempt to get back to her. Of course we know many of the same people and share many of the same experiences as surgeons in combat theaters of operation. Thank you for the candor and reverence in your accounting. Thank you for sharing this work with me.

Best Regards.

Jeff


From Amazon Reviews:

MikeyB 5.0 out of 5 stars An outstanding book! Reviewed in the United States on October 10, 2016Verified PurchaseA superb and heartfelt book! The author tells his story in a very understandable and sympathetic way. Don’t believe the saying that “surgeons are cold and unfeeling”, the author clearly feels for his patients and adores his wife and children. He returned to Afghanistan for a second tour subsequent to writing this book – I hope that he writes about that tour too! Highly recommended.

Reviewed in the United States on October 16, 2020 A must read. This book will take you on a very heartfelt journey of a young man attempting to find himself and his purpose for being placed on this earth, to a middle aged experienced military surgeon and officer, who now must deal with the emotional baggage that he’s accumulated over the course of this incredible life experience. Citizen Surgeon is an intensely descriptive story of the strength and sacrifices our military personnel, and their families, experience and endure. It also portrays the horrific challenges and split second decisions our medical military face daily on the combat field. The writing is so descriptive, the reader will feel as though they are taking the journey right along side the author. A highly informative, descriptive, emotional, horrific story that will leave the reader with an even higher respect for our men and women in the military and especially those in military medicine who fight their own war daily with devastating trauma on the battle field. God bless America.


Don S and TeamGolfwell 5.0 out of 5 stars A Memorable Read Written by a Very Intelligent and Caring Man. Reviewed in the United States on February 16, 2018 I enjoyed reading Dr. Paul Roach’s, “Citizen Surgeon: A Memoir.” A dramatic, intense, and intriguing book, from a surgeon who boldly bares his sincere feelings and thoughts about the emotions, and the horrific experiences of war, his concern for patients and his love for his family. Going to war makes most concerned about their own survival, but the author seemed to show (in my opinion) even more concern for his own family and his patients.

In the Forward of his book, he writes, “For every injured or killed service member there is also a circle of family and friends directly affected by those wounds and a larger additional circle of individuals who are in some way concerned or involved. If you have gotten this far in this book you are already part of that larger circle and the more concerned and involved you get, the closer you will come to its center.” When I read this author’s clear factual accounts, I felt I became closer to the center.

I liked the way he described his journey after it was over, “…the citizen-turned combat surgeon had to find a way back to becoming a citizen. He didn’t return to being the same citizen he had been before he left…The one he became was bit grayer and wiser than the one that departed.”

I became wiser and more aware after reading this book. Thank you for writing it.


Morgan Gilmour5.0 out of 5 stars This book could change your lifeReviewed in the United States on May 16, 2019 A thorough, heartfelt, thoughtful glimpse into the the life of a surgeon forward deployed in Afghanistan. This phenomenal book left a lasting impact on me, as a budding military surgeon. The author’s ability to capture a scene brought me as close to his environment as I could be, reading in the safety and comfort of the United States. I truly appreciated the author’s historical insights, honest introspection, and reflections on the current conflict. His introspection was perhaps the most significant aspect of the book for me. As the author described the transcendence one achieves by serving these brave men and women of the US military and the civilians in the area, I was profoundly captivated. This book cemented my decision to pursue this profession as my life’s work and calling. It is my impression that this book has the potential to serve as a powerful recruiting tool for anyone remotely interested in combat medicine. At the very least, any who read it will come away with a deeper and perhaps even life-changing respect for those who do this work and their families, and brotherly love for the men, women, and children of Afghanistan.


Shari C.5.0 out of 5 stars Hardships of combat medicine Reviewed in the United States on August 1, 2021 I did 3 tours in a combat medical unit, his words are what wish I could have conveyed to those who followed me. As military medical professionals, we go forward and do our job with no real thought as to how it will affect us when we return home. So real, so true.


Craig5.0 out of 5 stars Insight from someone who was there Reviewed in the United States on August 2, 2021A great primary source for anyone interested in hearing the words of those who served. Paul Roach gives an excellent personal account of his deployment.


Zoomazoom5.0 out of 5 stars Great Read Great Man Reviewed in the United States on August 3, 2021This book took me down a path I hadn’t explored. The author tells a heartfelt story that is enlightening. A must-read!


Amazon Customer5.0 out of 5 stars A great read and fascinating look at military life and the …Reviewed in the United States on January 1, 2017A great read and fascinating look at military life and the US war in Afghanistan. Roach takes the reader through his decision process from a young man losing his father, to a US Navy surgeon operating in an alien and war torn country, in one of the driest regions on the planet. Told beautifully with precise detail, this is a must read for all interested in understanding the sacrifices extraordinary members of our military and their families make for our country

 

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