In Defense of Clarence Thomas

(This piece was cross-posted at the HLPR blog, where I’ve been writing this semester, but I had long-ago intended it as part deux of the “In Defense of” series, which started with farm subsidies.)

I recently asked my Facebook network which Supreme Court justice, modern or historical, would they elect to partner with on a Constitutional Law final exam, assuming the justice had taken the class with them that semester. John Marshall, Oliver Wendell Holmes Jr., Robert Jackson, and William Brennan were predictable choices as powerful writers and influential molders of constitutional thought. Scalia, well-known for his bombastic style yet clear exposition of facts and law, was popular. Clarence Thomas received no votes. Perhaps it is to be expected that among the constellation of judicial stars, Thomas would pale in popularity–his legacy, after all, has yet to be defined. No doubt for others his judicial philosophy, hewing tightly to original intent and historical understanding, leaves progressive-minded comrades ill at ease. Yet if a motivating factor for unpopularity is Thomas’ silence at oral argument, I would ask my friends to reconsider.

Clarence Thomas joined the Supreme Court in October 1991. On February 22, 2006, Thomas posed a question during oral argument, and has stayed silent ever since. His silence has been the subject of much commentary and speculation, and perhaps inevitably, ridicule and accusations of un-intellectualism. This disparaging category of charges is unfair, and deserves some scrutiny.

In a piece on the fifth anniversary of Thomas’ silence, Adam Liptak of the New York Times quoted a law review article which opined: “If Justice Thomas holds a strong view of the law in a case, he should offer it . . . It is not enough that Justice Thomas merely attend oral argument if he does not participate in argument meaningfully.” One Huffington Post author, writing on important questions Thomas had asked, noted, “. . . Thomas’ silence has also left many casual observers — that is, ordinary American citizens — with the impression that the man either does not care about the cases or cannot intellectually compete with his colleagues.”

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Not So Easy

Remember that time I bragged about having a crazily speedy recovery from surgery. Um, yeah…. Last night reminded my why some people prefer not to have a fist-sized organ removed out a hole near their hip: a laparoscopic cut is a scar by any other name, and surgery is not quite the delightful pastime I may have made it seem in the previous post. Weird, right?

The difference a few hours made was extraordinary. At 3 PM, yesterday, I walked down from my hospital room to wait outside for my mom to bring her car around. Standing around for five minutes, the only discomfort I felt was a regular twinge of pain on my left side if I tried to stand straight. My mom dropped me off in front of my building; I took the elevator four floors up to my apartment, but if I had wanted to really push myself, I could have taken the stairs. I had taken one percocet an hour before; the last painkillers I’d taken previously had been at 6:30 AM (there were two hours at the hospital when I wasn’t even on painkillers. At 2, I’d just decided, why not?).
Fast forward to last night at 8:00 PM, when each trip to the bathroom had become an odyssey. Thirty minutes later, I gave up the effort of shuttling between the bathroom and the couch altogether and retired to bed. That was an adventure.

The difference between the surgery I had at 15 wiring up my jaw and the surgery I had at 26 removing my kidney from my abdomen is that you don’t use your jaw to move around. The jaw hurt, but it was a passive hurt. On the other hand, any sort of movement last nigh made me remember vividly that my stomach had just recently been cut open. Unfortunately, a fact I never knew as a healthy person was that traveling from the couch to the bed involves a plethora of fun little movements. First, there’s sitting up. To accomplish the transition from reclining to sitting , I relied as much as possible on levering my chest by the strength of my upper arms and spinning my torso limply around them. The squashed position into which this twists my left abdomen sends a nice overture of pain to my brain to introduce me to the concerto to follow. Despite my best limb-using effots, there’s some special moment where it becomes clear that sitting will require me to actually compress and bend the muscles of my abdomen of my own volition. This can resemble only the feelings of a fox caught in a trap when she realizes that if she wants to leave, she’s going to have to gnaw off her own leg. The muscles of my abdomen are cut up, inflamed, and generally angry with me for forcing them to undergo surgery for no reason; they loudly resist each effort of my body to lift itself.

Once I make it up to a seated position, I pause for a slight moment to savor the “Oww, that really hurt” forced through my nervous system by my abdomen on behalf of my missing kidney. Then I stand up, which is really a crapshoot. Sometimes it’s suprisingly easy – press down with my hands, knees pull straight, my center following meekly along. Other times the abdomen feels the need to exert itself on the way up, stabbing at the left side of my brain with painful static for a moment as I recollect myself. After this, walking is relatively easy. I accomplish it sort of limping. Imagine if your bad knee started at your left shoulder and you’ll get the idea.

Then there’s getting into bed (I won’t describe the whole bathroom situation because that’s painful in just an anticlimactic way).  You never realize how many muscles and movement are awkwardly choreographed into the descent into bed until they are all hurting you. There are a few different elements of the bed-move with which the post-surgical ought to concern themselves: first, there’s getting onto the bed itself. You don’t step downwards onto a bed, you have to bring your leg up and onto it, throw yourself down on it like a hefty pillow and then wriggle your body up, or fall backwards like a vaulter over the high jump. All of these approaches have their selling points under the circumstances, and I tried variants on each. In any event once you do get yourself onto the bed, there usually involves some sort of turning process, which would have been less painful for me had I been rotating on a spit instead of of on my own accord. Once these two basic procedures (stepping and turning) have been executed, the real fun begins: the gymnastics competition of hunting for a resting position painless enough to make the attempt to fall asleep any more than agonizing farce.

At first, I tried laying neutrally on the middle of my back, using pillows to incline me to a thirty degree angle. This setup (and the morphine drip) had worked for me the night before. Unfortunately, last night my left side had decided that it wanted to be shorter than my right. Putting my weight flat on my back conflicted with that desire: my left side showed me that by trying to rip its way out of my body along the site of my incision (which was now starting to send to my brain a fiery incision-shaped line of pain whenever I moved or thought about the lower left half of my body). Eventually, I, or rather my amazing caretaker (and love interest), Erin, settled on a complicated ramp of pillows that angled my body in a mild-spiral staircase-like twist, laying my right side down with my head thrown back, thus placating my left torso’s whim to be shorter than my right while taking the weight off of the incision area.  That said, for all of my harsh description of last night (which really did suck), I was able to fall (and stay) asleep very well after that point (which came around midnight), entering a fairly deep sleep for a couple of hours, waking up for about ten minutes, and then falling asleep for another few hours, repeating until I finally got out of bed at 12:30 PM today. Today’s been tougher than yesterday, but a definite improvement over last night.

I have a lot of thoughts I wanted to share about what I think caused the pain to be worse last night (combination of bloating/constipation and having tried to do a bit much yesterday) and about how it fits in with the approach to recovery that I wrote about in yesterday’s post. This post is already incredibly long, so I will hopefully get to some of these thoughts in the days ahead.

The one moral of the story I wanted to draw out and felt couldn’t wait is this: Part of the reason I’m writing these series of posts are that I hope that someday, someone considering donating their kidney will stumble across this blog and find out a bit what someone else’s experience was like. I believe very strongly that more people should donate, so I’d expect to feel conflicted in telling the parts of my story that make donation out to be more curse than blessing. Strangely, I didn’t really feel that way at all as I wrote this post. I wanted to present my experience as accurately and vividly as I had the skill to do. This comes perhaps in part from simple honesty, but I think it more stems from the fact that the pain I underwent last night didn’t really make me think any less of the decision to donate, and if I could get that across truthfully it wouldn’t pose any conflict.

I knew that pain would be a part of my surgery when I decided to donate my kidney. Part of what made me want to give my kidney was because I wanted to present a challenge for myself. Could I make into fact the idea I accepted as good in theory? Could I have the strength to go through the whole process of a rare and life-changing choice? I gave my kidney because I wanted to answer those questions myself, because I wanted to do something I found audacious and amazing. The pain hurt; it was more pain than I remember ever being in. It made me get some brief glimpse of how bad my dad’s failing knee (corrected, finally, by serious surgery) must have been for him, of how awful chronic pain must be. But there was something comforting to me about it as well, because though I wish I could have gotten off with having the miraculous recovery, I knew the pain I had last night was (a bad) part of the choice I made. When I made the choice, months ago, I was happy with it. Luckily, I still am.


Day (after the Day) of Days

Yesterday was my surgery, and while part of me was tempted to live-tweet it, even I am not that much of an exhibitionist. I am, however, enough of an exhibitionist, or at least enough of a braggart, to describe my recovery a bit today as it unfolds.* I say braggart because of my weird coping mechanism towards surgery, which is to treat it as a competition to get well the quickest. I know that makes little rational sense and sounds like an unhealthy approach, but it is of a piece with my obsessive goal-orientation in general: I’m most myself when sprinting my way towards a remote goal. As it involves getting well, I don’t think that fighting to “win” my recovery is sufficient to be healthy: trying hard is no cure for illness. I do think that, for me, having a goal in mind makes the hurts hurt less and allows time to heal more. if approaching surgery like a marathon is sort of  insane, at least it’s my kind of insane.

A few of my gambling-minded friends had the urge to drag me to Foxwoods this past weekend as a karmic good luck charm. Given that I’m writing this blog post twenty-eight hours after I went under general anesthesia, reclined on my couch, with Archer episodes playing in the background, I think they might have been on to something: my luck has been extraordinarily good. Last night at 6 PM was when I was first lucid enough to ask nurse in the post-op recover room what time it was. (My surgery, delayed again, till 2:30 PM, lasted a bit longer than expected but was otherwise unremarkable). I remember one of my first thoughts upon waking was that I hurt way less than I had expected it would. Lying back to rest didn’t hurt at all. Shifting my weight or leaning up in the bed, produced pain but not agony. It was isolated in my left abdomen, the morphine drip dampened it to a manageable “Ouch!” rather than an  “Oh My God, This is Horrible.” Perhaps even more surprising, I was completely lucid while on the morphine drip: when my friend Andrew called to see how I was doing, our conversation turned to the law school exam he had taken yesterday. We discussed how he organizing his exam answers differed from mine when I was in law school (his approach: analyze each issue and argument; mine: keep saying somewhat intelligent things that each plausibly connect to the thought in the previous sentence until I reach the word limit).

This morning at 6:30 AM (didn’t sleep well because turning onto my side hurt), they removed my catheter, unplugged me from the IV (no more morphine), and gave me two Percocet. By that point, I had started doing laps around the 9th floor of the hospital. On one of these, I spoke to one of my surgeons (who had been searching for me in my room). She said that I was doing well and that it was likely that I’d be able to go home today if  wanted to. A nap, another Percocet, a visit from my old work office-mate, some painful climbing in and out of bed later, and I was on my way back home, feeling far healthier than anyone who just had surgery has any right to feel. Maybe tomorrow I should head to Foxwoods.

*This post brought you by five miligrams of oxycodone

(Previous posts in this series can be found (in order) herehereherehere,here, and here)

A New Normal

Nobody likes to listen to someone brag about themselves. The best charity is done anonymously and performed in silence. Your gift,  about the person receiving it, not about yourself. Doing a good act to aggrandize oneself, to revel in one’s goodness, doesn’t make the act bad per se, but it just seems wrongheaded. When you are constantly trumpeting something good you may have done, you make it seem like you don’t care about the beneficiary, like you’re just acting out your own tumescent ego.

All of this is in the way of asking how should I discuss my kidney donation without sounding like simply a self-righteous jerk? I ask this as someone who’s probably more than a bit self-righteous (though hopefully not more than a bit of a jerk). Perhaps a better question is, should I talk about it at all? Better, perhaps, to give quietly and unassumingly, to make it about the gift rather than the giver.

Few have accused me of being quiet and unassuming: Where’s the fun in that? I’d like to think, however, that my telling people about my donation isn’t driven by some desire for recognition (not typically my thing) or to hear the sound of my own voice (definitely my thing). In part, my desire to tell people reflects the drive to be honest about what’s going on in my life. I could horde  my privacy from those who ask me about why I’m taking my time off of work, but why not just tell them the truth?

Perhaps to be so detailed is immodest, but if so, it’s immodesty in pursuit of a good cause. As I’ve gone through with my donation,  several friends I’ve talked to about it have begun exploring whether that decision would be a good one for themselves. When I see the gleam of curiosity in the eyes of coworkers to whom I tell my story, I can’t help but thinking that if one of them were asked by a loved one in need, the fact that they knew someone who donated might lead to them being generous and feeling better about the choice.

I feel like the biggest obstacle to people giving a kidney, more even than whatever sacrifice donation involves, is that it doesn’t seem like a regular, everyday, choice: potential donors (that’s you, dear reader) don’t approach it as a feasible option, to be selected or rejected depending on one’s preferences. Spreading awareness that someone you may know, someone like you, has donated their kidney and (fingers crossed) been perfectly OK may bring donation a bit closer to being a significant but standard choice in your mind.

It may seem that the reason altruistic kidney donation feels like such an unusual gift is just that it imposes a greater harm than other choices that are more typical. This misunderstands the costs of kidney donation (it’s a laparoscopic surgery, has no impact on the donor’s long term health, and does not increase the donor’s chance of kidney disease), but more importantly, regarding giving a kidney as an extraordinary sacrifice undersells the difficulty of decisions that are considered normal and are made every day. Thousands of college graduates devote two years of their lives to working 80-hour weeks teaching underprivileged students at Teach for America; thousands more go to developing countries in the Peace Corps. Even more commonly, soldiers volunteer to leave the comforts and safety of the modern U.S. to serve their country in places where every day could ruin their lives with gunfire or an IED. All of these people take up far greater burdens than those assumed by donors, but people picture them as sane, reasonable options for how to do good in the world: noble, yes, but more importantly, normal. I want to tell my own story so that people can see that a donor can be a normal person with a normal story. Someone who’s non-heroic and flawed, someone who can be stubborn and slothful, someone who has a higher opinion of himself than he probably should, someone who isn’t above using his donation to impress women. By talking about my donation and showing readers that, yes, real people, normal people, actually do make this choice, I hope to make it seem like one that’s worth considering. Sure, I want readers to think donating a kidney is a good decision, but really, I’d settle for it just seeming like a sane one.

(Previous posts in this series can be found (in order) herehere, herehere, and here)


False Starts

On Thursday, I mentioned that there had been a couple delays and surprises in the run-up to my surgery. Let me explain:

When I first made my decision to donate, back in April, I thought I would need to use up vacation time at work to donate my kidney. Accordingly, I planned on doing the operation in mid-December, allowing me to use Christmas and New Years to minimize the amount of vacation days I’d have to spend (My Judaism renders Christmas insignificant to me except as a chance to tell people about Hanukkah Harry).  Once my work informed me that the surgery would be covered as paid medical leave, I modified my desired time slightly to be shortly after Thanksgiving, with a hoped-for donation date of either November 29 or 30 (Beth Israel does surgery on Tuesdays and Wednesdays). My parents, who moved  to Florida last September, would be up for Thanksgiving, and I couldn’t think of anything that would make my mom more thankful than surgery for her oldest son. She’s not the strongest advocate of donating a kidney to a stranger, but she wanted to be here to take care of me while  I was in the hospital and convalescing at home.

My goal for the Thanksgiving donation, was to create a chain of “paired donations.”  Paired donation is a fairly new but very valuable trend in the transplantation. Here’s how it works: say that I would like to donate to my brother, Bob, and you’d like to donate yours to your sister, Sue. If I don’t match Bob, and you don’t match Sue, but I do match Sue  and you do match Bob, we’d pair off and swap kidneys, you to Bob and me to Sue so that each of our intended beneficiaries ends up with a transplant that we couldn’t give ourselves. If an unpaired donor puts in a kidney, it creates a chance to make longer chains of donation, and allows multiple exchanges.

I had hoped to be that unpaired donor, and my name was submitted in a drawing to match up pairs on October 18th. The next day I discovered that I’d be starting a a  chain of, I believe, five people and that we’d likely be able to do the surgery on my desired date. I was obviously excited, both to get the day I wanted and to be able to contribute to multiple transplants. I quickly gave a blood sample with which to run a cross-match that would ensure that  the intended recipient had not built up  immunity against markers on my kidney. This test came back positive, and that’s bad: it means that their body would reject my kidney. Because their personal information is understandably confidential, I have no idea what happened to whoever I had been paired with, nor to the other recipients with whom the chain had been made, though of course I still speculate.

Rather than wait another month  for another drawing of paired matches, I instead decided  to try my luck with an individual recipient on Beth Israel’s internal waiting list, still hoping to make the post-Thanksgiving date. I submitted samples  to be matched against five potential recipients: each test came back negative (that’s good), and I was set to give my kidney. By then, however, the operating dates I had wanted had been booked up, so my surgery was pushed to December 6th. A fairly small inconvenience. The main effects were: (1) to extend the dead period at work where I’d be sitting on my hands because I couldn’t take on new deals and (2)   to  require my mom to stay at our family friend’s house for another week rather than head back to Florida with my dad . This made the delay last week (which I wrote about on Thursday) more than a bit irksome to her.

Minor issues all, but they point to medical care’s unpredictability that I as, luckily, a novice, have only recently and mildly discovered. I’m undergoing an elective surgery, have as much support in as idyllic a set of circumstacnes as a patient is likely ever to have, and have experienced only minor deviations to my plan for how my surgery would work out. For me, it’s been less emotional roller coaster and more emotional Ferris Wheel. The potential recipients of my kidney, however, have a bit of a different story. To them, the best case scenario for such delays, reversals, and surprises is brutal,vertiginous, worry; the worst consequences are deadly. My mom’s heart jumps to her throat at even the mild bumps in the road I’ve experienced; how much worse are  the feelings for the families of those for whom this surgery is not a choice?

In order to end on a slightly more happy note (I hope), my transplant looks like a go for tomorrow. Wish me luck.

(Previous posts in this series can be found (in order) herehere, here, and here)

Hurry Up and Wait

As yesterday’s post indicated, my surgery, scheduled for Tuesday, December 6, had to be pushed back a week to December 13, due to the recipient’s becoming sick with (I believe) a cold or a flu over the weekend. Due to the immunosuppressive back-end of receiving a kidney, the hospital prefers not to put one into a patient if he (my recipient’s a he) or the kidney are suffering from infectious disease. I suspected the bad news as soon as the email from my donor coordinator showed up Monday morning. It asked me to call her back “at my earliest convenience,” a phrase unusually formal for her normally emoticon-suffused correspondence. This time, there were no smileys. Continue reading

Vegetarianism and Kidney Donation

After my divorce, the first girl I dated at all seriously was a vegetarian (lapsed vegan really; she was a great cook and liked dairy products too much to give them up). Interestingly, even though her father had become a rabbi at a relatively late age, she herself was an atheist. Her father, when he became more religious, decided that he would observe Hebrew dietary laws (avoiding shellfish, no milk with meat, etc.), and they bonded over their self-imposed dietary restrictions. In fact, it was her vegetarianism that had inspired him to keep Kosher. He told her that he admired her taking something (eating) she had to do by necessity and transforming it into a daily manifestation of her beliefs and her values. Her choice encouraged him as well to enact his religion every time he set fork to plate. Though they acted out different rules, father and daughter were each able to live out the best part of themselves a little bit each day by imposing what would seem to be burdens on themselves.

I’m not a vegetarian; I like meat too much and animals too little. I could go ahead and accept responsibility for my own callousness towards the wonderful creatures of God’s beautiful creation, or I could shirk accountability for my carnivory onto my upbringing. Since I prefer the latter, I blame my childhood  pets:  my first dog, a vicious poodle named Brandy, tried to bite my eye out when I was two*. My second, Coty, was fun as a puppy when she’d  playfully teethe onto me and my little brother. Nevertheless, she soon became man’s boringest friend. Coty’s only moments of activity involved chasing geese, and as soon as  a mother goose stood her ground and bit her, she gave up on that hobby.  Her sole pleasure became laying on the AC vents around the house (or really just two of them, since she was too lazy to seek out a third). Neither Coty and Brandy taught  me to love animals, so now I eat them.**

Wherever I lay the blame, like many meat-eaters, I’m somewhat conflicted about my dietary choices, since I recognize that some meat is raised amidst horrible conditions. Most of the time,  I don’t worry myself as I chew happily away, but sometimes, perhaps when I’m eating meat that is bland and boring, I question my choices. I think it might be these very pangs of guilt that drive many omnivores to find vegetarians off-putting and to perceive them as being pushy and judgmental. I’m sure many are, but I think part of this common characterization is driven by a sensation of implicit moral rebuke that so many omnivores feel — the sense that vegetarians have faced the same choices as those of us who eat meat, have made better ones, and are now looking down on us for our failings.

People come in all sorts, and surely many vegetarians use each bite of broccoli to feel one morsel more superior to we who munch on bacon. But Cassandra*** wasn’t like that; she was just a nice person who didn’t want to eat animals. I never met her dad, but I’m sure  he wasn’t trying to be a rabbi to get off on being better than people either. In fact, eating ethically meant different rules to each of them: If each felt like following these rules was a linear contest between better and worse, they wouldn’t be able to help looking down on the other, and it’d be a source of division. Instead, each of their varying paths brought them closer together rather than further apart. The rules they ate by weren’t a source of judgment they used against others, but just a fount of strength they kept for themselves, a way to each express their best selves which allowed them to become more close and not less.

I write this (very) long meditation on vegetarianism as  an analogy to my own decision to donate a kidney. Sometimes I think that decision comes across to people as explainable only as some sort of vain way of asserting moral superiority over the rest of the world. It’s not that at all. Instead, I like to think of it as being like Cassandra’s vegetarianism or her father’s keeping Kosher. It’s something I’m done for myself, a choice that fits with my values and from which I can draw strength. It’s the right choice for me, but one that I hope draws me closer to the people I care about in my life instead of pushing them further away.

* My family kept him (yes, Brandy was a boy) till I was six.

** There was another pet in the midst of this, a goldfish my parents bought me after a moving episode of Under the Umbrella Tree. In it, one of the main characters (the gecko, Iggy, I believe) acquired a goldfish and loved her dearly. The happiness was not to last, however, as the fish passed on (as goldfish are wont to do), which allowed the characters the privilege of hosting a stirring funeral as Iggy’s fish swirled bravely down the toilet. This made me ask for a goldfish of my own. My parents acceded, but to their horror, soon discovered that what I wanted (uncaring to animals even at the age of five) was not a beautiful goldfish but instead a beautiful goldfish funeral. The fish (who I don’t know if we ever even named) soon obliged by dying due to what I can only assume was  either lack of love by me or gentle poisoning by my parents.

*** Name changed for privacy

(For those not following me on Twitter and surprised that I’m posting this post-surgery, sadly my surgery got bumped a week to next Tuesday because the recipient came down with a (I think minor) illness. Surgery delayed is not surgery denied, however, and this is just a temporary hiccup before donating.)

(Previous posts in this series can be found (in order) here and here)