newyorker--2020-09-16--Biden’s Case to Latino Voters Comes Late. Will They Listen?

On August 29th , Kamala Harris addressed the Latino community for the first time as Joe Biden ’ s running mate .
The senator from California headlined the launch of Nuestros Negocios , Nuestro Futuro , a new campaign initiative designed for Latino business owners .
Held via Zoom , the event centered on Florida , a crucial battleground state where Biden needs to reverse an ominous sign for Democrats .
According to recent polls , Biden leads Donald Trump among Latinos by a smaller margin than that of Hillary Clinton , who won two-thirds of their votes in 2016 @ @ @ @ @ @ @ audience members had tuned in to the event searching for answers , or , at the very least , a measure of comfort .
When the coronavirus began spreading across the country , the unemployment rate among Latinos nearly quadrupled and their businesses shuttered .
Harris listened to the woes of business owners intently , and described an economic plan meant to provide much-needed relief .
She cast Biden ’ s Presidency as an imperative .
Her message felt overly scripted at times , but convincing enough to end with an ask of @ @ @ @ @ @ @ , our children , our grandchildren , will look in our eyes and they ’ re going to ask us , ‘ Where were you at that moment ?
And what did you do ?
’ ” Harris said , tilting slightly to the camera .
“ We will start by telling them , ‘ I voted.
’ ” In this year ’ s general election , Latinos will make up the largest minority group in the electorate and play a decisive role in four states that could give Trump an Electoral College @ @ @ @ @ @ @ Carolina , and Wisconsin .
During the primaries , Bernie Sanders beat Biden by wide margins among Latino voters in key states with large Hispanic populations , including Nevada , Texas , and California .
But , over the summer , the former Vice-President rolled out a more robust strategy to secure support from Latino voters , and Harris ’ s presence on the ticket has given him new momentum .
Leaders in the community nevertheless warn that the Biden-Harris effort may be overdue .
National polls show that Trump has the support @ @ @ @ @ @ @ is trailing behind Biden by about twenty points—a far narrower gap than the thirty-eight-point lead that Clinton had over him .
One cohort of voters , in particular , could boost Biden ’ s candidacy : young Latinos .
Approximately forty per cent of eligible Latino voters are between the ages of eighteen and thirty-five—nearly four million of them have become eligible to vote since 2016 .
Trump is highly unpopular with the group , yet polls also show that young Latinos , in particular men , are deeply cynical about politicians .
@ @ @ @ @ @ @ states , Biden and Harris must focus both on inspiring young and old generations and countering a plethora of false information meant to convince them to sit out in November .
“ They have failed to articulate a message that can convince our people that they matter and that their votes can be decisive , ” José La Luz , a Puerto Rican labor activist who served as a surrogate for Sanders in the primaries , told me .
Harris will , no doubt , be central to that effort .
Born to @ @ @ @ @ @ @ , the former attorney general of California can relate to the experiences of immigrant families through her own .
She has a track record—on housing , health care , and even criminal-justice reform—that could resonate with Latinos .
In California , Latino voters have already shown a remarkable degree of confidence in her leadership .
During the 2016 Senate primary , she defeated a Latina candidate , and , as attorney general , earned a majority of support from Latinos in two consecutive elections .
So when Biden announced his Vice-Presidential pick , @ @ @ @ @ @ @ described Biden ’ s decision as “ historic and wonderful , ” and the former Democratic Presidential candidate Julián Castro praised Harris as a “ groundbreaking leader.
” Within days , the Biden campaign released its first bilingual ad featuring Harris as a champion of Latino voters .
The video opens with a famous Spanish proverb , “ Dime con quién andas y te diré quién eres ” — “ Tell me who you walk with , and I ’ ll tell you who you are.
” During the Nuestros Negocios , Nuestro @ @ @ @ @ @ @ appeared drawn to Harris .
Pilar Guzman , the owner of a Miami empanadas business that had closed a third of its locations owing to the pandemic , asked Harris for advice .
“ You ’ ve been the first woman to secure many of the positions in your career , ” Guzman said .
“ What do you say to a woman like me ?
” Harris responded that her mother often told her , “ You may be the first to do many things .
Make sure you ’ re not @ @ @ @ @ @ @ , Harris added , drove her to “ lift up the people from our communities and let them know that they belong.
” Cecilia Tavera-Webman , one of the attendees , said that seeing Representative Debbie Mucarsel-Powell , the first South American to serve in Congress , moderate the event along with Harris created a unique sense of accomplishment .
“ It ’ s the American dream , ” Tavera-Webman , who was born in Peru , said .
For her , the event was as much a preview of what a future @ @ @ @ @ @ @ to the country ’ s diversity .
Asked about her takeaways , Tavera-Webman offered an unequivocal response : “ That there is hope.
” One would think that the notion of hope could serve the former Vice-President well with voters these days .
But Biden and Harris ’ s message to Latinos comes at a time when the pandemic has fundamentally upended political outreach .
María Elena López , a member of the group Cubanos con Biden and a vice-chair of the Democratic Party in Miami-Dade , said there was a “ disconnect @ @ @ @ @ @ @ the campaign ’ s limited bandwidth .
López , who was born in Havana and was a registered Republican until Barack Obama ’ s reëlection , explained that people were eager to engage with Biden in person .
“ One of the complaints that I hear , and I understand where it ’ s coming from , is ‘ Oh , we never see the Vice-President in person , ’ ” López said .
She feared people would lose interest in the election now that most , if not all , campaign activities @ @ @ @ @ @ @ Biden ’ s alacrity .
“ Biden is a gentleman , ” López observed .
“ On the one hand , that is a hundred per cent a great quality .
But , on the other hand , he does not have something that , let ’ s say , excites people.
” Next to Donald Trump , López argued , the Vice-President ’ s manner could be perceived as dull .
“ I ’ ve heard comments such as , ‘ Well , you know , he ’ s just , like @ @ @ @ @ @ @ , like , ‘ Boring is good !
’ ” Recent polls have only brought the limits of campaigning remotely to the fore .
In early August , a nationwide survey by the polling firm Latino Decisions found that most Latinos had not heard from a single campaign this year about voting in November .
An earlier poll by the same firm in six battleground states found that fewer than sixty per cent of respondents were definitely planning to vote in the general election .
Latino Decisions is now advising the Biden campaign @ @ @ @ @ @ @ , Matt Barreto , told me that as a result of the pandemic Latino voters were only now focussing on the race .
“ The high intensity of coronavirus in our community made it more difficult to have the election be a top-of-mind issue for us , ” he said .
Latinos have suffered disproportionately—they are twice as likely to die from the coronavirus as whites .
“ At the beginning it was just a matter of survival , frankly , ” Barreto said .
“ Now , the longer it goes on @ @ @ @ @ @ @ pandemic to our failed political leadership .
”

On August 29th, Kamala Harris addressed the Latino community for the first time as Joe Biden’s running mate. The senator from California headlined the launch of Nuestros Negocios, Nuestro Futuro, a new campaign initiative designed for Latino business owners. Held via Zoom, the event centered on Florida, a crucial battleground state where Biden needs to reverse an ominous sign for Democrats. According to recent polls, Biden leads Donald Trump among Latinos by a smaller margin than that of Hillary Clinton, who won two-thirds of their votes in 2016 and still lost the state. Many audience members had tuned in to the event searching for answers, or, at the very least, a measure of comfort. When the coronavirus began spreading across the country, the unemployment rate among Latinos nearly quadrupled and their businesses shuttered. Harris listened to the woes of business owners intently, and described an economic plan meant to provide much-needed relief. She cast Biden’s Presidency as an imperative. Her message felt overly scripted at times, but convincing enough to end with an ask of her listeners. “Years from now, our children, our grandchildren, will look in our eyes and they’re going to ask us, ‘Where were you at that moment? And what did you do?’ ” Harris said, tilting slightly to the camera. “We will start by telling them, ‘I voted.’ ”
In this year’s general election, Latinos will make up the largest minority group in the electorate and play a decisive role in four states that could give Trump an Electoral College victory: Florida, Arizona, North Carolina, and Wisconsin. During the primaries, Bernie Sanders beat Biden by wide margins among Latino voters in key states with large Hispanic populations, including Nevada, Texas, and California. But, over the summer, the former Vice-President rolled out a more robust strategy to secure support from Latino voters, and Harris’s presence on the ticket has given him new momentum. Leaders in the community nevertheless warn that the Biden-Harris effort may be overdue. National polls show that Trump has the support of roughly a third of Latinos and is trailing behind Biden by about twenty points—a far narrower gap than the thirty-eight-point lead that Clinton had over him. One cohort of voters, in particular, could boost Biden’s candidacy: young Latinos. Approximately forty per cent of eligible Latino voters are between the ages of eighteen and thirty-five—nearly four million of them have become eligible to vote since 2016. Trump is highly unpopular with the group, yet polls also show that young Latinos, in particular men, are deeply cynical about politicians.
To win in Florida and other battleground states, Biden and Harris must focus both on inspiring young and old generations and countering a plethora of false information meant to convince them to sit out in November. “They have failed to articulate a message that can convince our people that they matter and that their votes can be decisive,” José La Luz, a Puerto Rican labor activist who served as a surrogate for Sanders in the primaries, told me. Harris will, no doubt, be central to that effort. Born to a Jamaican father and an Indian mother, the former attorney general of California can relate to the experiences of immigrant families through her own. She has a track record—on housing, health care, and even criminal-justice reform—that could resonate with Latinos. In California, Latino voters have already shown a remarkable degree of confidence in her leadership. During the 2016 Senate primary, she defeated a Latina candidate, and, as attorney general, earned a majority of support from Latinos in two consecutive elections. So when Biden announced his Vice-Presidential pick, Dolores Huerta, the civil-rights icon, described Biden’s decision as “historic and wonderful,” and the former Democratic Presidential candidate Julián Castro praised Harris as a “groundbreaking leader.” Within days, the Biden campaign released its first bilingual ad featuring Harris as a champion of Latino voters. The video opens with a famous Spanish proverb, “Dime con quién andas y te diré quién eres”—“Tell me who you walk with, and I’ll tell you who you are.”
During the Nuestros Negocios, Nuestro Futuro virtual event, many business owners appeared drawn to Harris. Pilar Guzman, the owner of a Miami empanadas business that had closed a third of its locations owing to the pandemic, asked Harris for advice. “You’ve been the first woman to secure many of the positions in your career,” Guzman said. “What do you say to a woman like me?” Harris responded that her mother often told her, “You may be the first to do many things. Make sure you’re not the last.” That piece of advice, Harris added, drove her to “lift up the people from our communities and let them know that they belong.” Cecilia Tavera-Webman, one of the attendees, said that seeing Representative Debbie Mucarsel-Powell, the first South American to serve in Congress, moderate the event along with Harris created a unique sense of accomplishment. “It’s the American dream,” Tavera-Webman, who was born in Peru, said. For her, the event was as much a preview of what a future without Trump would bring as an ode to the country’s diversity. Asked about her takeaways, Tavera-Webman offered an unequivocal response: “That there is hope.”
One would think that the notion of hope could serve the former Vice-President well with voters these days. But Biden and Harris’s message to Latinos comes at a time when the pandemic has fundamentally upended political outreach. María Elena López, a member of the group Cubanos con Biden and a vice-chair of the Democratic Party in Miami-Dade, said there was a “disconnect” between the expectations of voters and the campaign’s limited bandwidth. López, who was born in Havana and was a registered Republican until Barack Obama’s reëlection, explained that people were eager to engage with Biden in person. “One of the complaints that I hear, and I understand where it’s coming from, is ‘Oh, we never see the Vice-President in person,’ ” López said. She feared people would lose interest in the election now that most, if not all, campaign activities are held virtually. She also questioned Biden’s alacrity. “Biden is a gentleman,” López observed. “On the one hand, that is a hundred per cent a great quality. But, on the other hand, he does not have something that, let’s say, excites people.” Next to Donald Trump, López argued, the Vice-President’s manner could be perceived as dull. “I’ve heard comments such as, ‘Well, you know, he’s just, like, boring.’ And I’m, like, ‘Boring is good!’ ”
Recent polls have only brought the limits of campaigning remotely to the fore. In early August, a nationwide survey by the polling firm Latino Decisions found that most Latinos had not heard from a single campaign this year about voting in November. An earlier poll by the same firm in six battleground states found that fewer than sixty per cent of respondents were definitely planning to vote in the general election. Latino Decisions is now advising the Biden campaign, and the firm’s co-founder, Matt Barreto, told me that as a result of the pandemic Latino voters were only now focussing on the race. “The high intensity of coronavirus in our community made it more difficult to have the election be a top-of-mind issue for us,” he said. Latinos have suffered disproportionately—they are twice as likely to die from the coronavirus as whites. “At the beginning it was just a matter of survival, frankly,” Barreto said. “Now, the longer it goes on, many people are connecting this ongoing pandemic to our failed political leadership.”
Biden’s success among Latinos will therefore depend on his ability to convince voters that he is more likely to revive the economy and stabilize the country than Trump—a message his campaign struggled to convey during the primaries. “One of the challenges he needed to overcome was that Joe Biden was well known, but he wasn’t sharply defined among Latino voters,” Stephanie Valencia, a co-founder of the research group Equis Labs, said. “Everybody knew that he was Barack Obama’s Vice-President, but they couldn’t really establish or say anything more than that.” At a policy level, Biden’s association with Obama put him at odds with a significant number of voters, particularly in the area of immigration. Many Latinos associate Obama with the deportation of more than three million undocumented people and the failure to secure comprehensive immigration reform. Early on in the campaign, Biden tried to justify Obama’s policies, quarrelled with protesters, and alienated immigration-rights activists with a number of gaffes. During the second Democratic debate, he suggested that undocumented immigrants should “get in line,” obviating the fact that there is no clear pathway to citizenship for them. Compared to Sanders and Elizabeth Warren, who promised to overhaul the country’s health and immigration systems, Biden appeared to be an advocate for the status quo.
But, ultimately, his underwhelming performance among Latino voters was a function of poor campaign strategy more so than policy. Vanessa Cárdenas, the Biden campaign’s former national-coalitions director, said the campaign’s limited budget caused it to prioritize some states, and by implication some demographics, over others. “The whole focus was on Iowa and New Hampshire,” she said. Cristóbal Alex, a senior adviser to Biden who has led his outreach efforts from the onset, said Democratic competitors had outspent the former Vice-President by more than twenty to one. “We were a small and very scrappy campaign in the primary,” Alex said. “A lot of folks counted out Joe Biden.” Two months before the Iowa caucuses, Cárdenas resigned her position, raising concerns over the departure of the campaign’s most senior Latina staffer. “I just didn’t think I was going to make the difference that I had hoped to make,” she told me. “A fundamental problem for our community is how do we translate those thirty-two million voters into actual votes. Because, I think, at the end of the day, the influence that we have is a mirror of the power that we exercise.”
For decades, Latino voters have been cast as a “sleeping giant.” Their turnout has lagged about twenty per cent behind that of white and African-American voters—less than half of eligible Latino voters went to the polls in 2016. Theories on why Latinos don’t vote abound, but if there’s a lesson from past elections it’s that much of the blame falls on the candidates. During this year’s primaries, Sanders showed that it was possible to rally Latinos, particularly younger ones, to vote for the first time. “When you think of Bernie Sanders, he is not some Latino savior. He’s a grouchy, old democratic socialist—he’s all the things that would make you go, ‘How the hell did he dominate this vote?’ ” Chuck Rocha, a political strategist and the architect of Sanders’s Latino outreach efforts, said. “It’s because I spent fifteen million to go talk to a whole bunch of Latinos. That’s the key here.” Rocha argued that Biden could still succeed by focussing on advertising, mailing, and outreach on social-media platforms, where Latinos have a strong presence. He thought of the Nevada primary as a telling example. Sanders earned the support of more than fifty per cent of Latino voters there, but his campaign managed to reach only two per cent of caucusgoers in person.
Over the summer, the Biden campaign ramped up its outreach to the community. The former Vice-President now has a Latino leadership committee, made up of elected officials, in more than eighteen states. Many Latinos have also taken on senior positions at the campaign headquarters and in several state offices. But the campaign faces yet another challenge: that Trump’s exaggerated claims about electoral fraud and mail-in voting will drive down Latino turnout. “I just wonder how many in our community, who may be first-time voters, because they were naturalized or because they just turned eighteen, and are already suspicious of the electoral process, will be swayed by the misinformation that their votes will not count,” Sindy Benavides, the C.E.O. of the League of United Latin American Citizens (LULAC), the oldest Latino civil-rights organization in the country, observed. To make matters worse, surveys have shown that a majority of Latinos are unfamiliar with how to vote by mail in their states. Julie Chávez, a former adviser to Obama who was recently named Biden’s deputy campaign manager, expressed concern about how Trump’s tactics could play out. “We are facing voter suppression in ways that we never imagined and that are 2016 on steroids,” Chávez, who is the granddaughter of the labor organizer César Chávez, said. “It is going to have an impact if we don’t create important strategies and avenues that insure that folks feel calm and confident in their ability to vote.”
As recent history has shown, Trump’s falsehoods are also a powerful tool for courting voters. María Elena López, the member of Cubanos for Biden, admitted that a strikingly high number of her Republican friends in Florida saw the former Vice-President as a radical socialist. “A very important part of our strategy is to counteract the messaging of socialism, which is still the most crucial Trump message that has taken hold in our community—that ‘Biden is a socialist’ and that ‘the world is going to come to an end,’ ” she said. The Trump campaign has repeatedly cast Biden as a “helpless puppet to the radical left” that will only bring “far-left policies” to the country. One of its radio ads released in July simulates a phone conversation between two Cuban women, Marita and Yesenia. “I think the Democrats have a loose screw, mamá. Now they want to raise our taxes and cut police funding,” Yesenia says. To which Marita responds, “And did you see them marching with the Che Guevara flag over by Biscayne?” Those messages, at once false and stereotypical to the point of absurdity, could well resonate among Cuban and Venezuelan émigrés in Florida, who have a deep loathing for the regimes of Raúl Castro and Nicolás Maduro.
Until last month, the Trump campaign had consistently outspent Biden on Spanish-language advertising, but that trend recently reversed. Since mid-June, the Biden campaign has put out a series of bilingual ads, meant to micro-target different nationalities within the Latino community. Some cast Trump as a caudillo akin to Hugo Chávez or Fidel Castro, while others denounce his lethal mishandling of the pandemic. Depending on whether the ad is being rolled out in Arizona or Florida, the narrator speaks with a Mexican or a Cuban accent. The subjects addressed, as well as the music chosen, are designed to convey a deep understanding of the voters Biden is trying to attract. Early last month, Biden also embraced the recommendations of a task force he convened with Sanders supporters, high-level government officials, and policy experts. Biden promised to create a path to citizenship for undocumented immigrants, reinstate the Deferred Action for Childhood Arrivals (DACA) program, and completely overhaul Trump’s executive orders on immigration. Marielena Hincapié, who co-chaired the task force’s immigration group and is the executive director of the National Immigration Law Center, said that she had found the Biden campaign’s openness to change encouraging. “The research shows that, if you provide a pro-immigrant message and share what are some of the policies that a Biden campaign would move behind, the support jumps tremendously,” Hincapié said.
That is precisely what the Biden campaign is trying to do in Arizona, where Latinos make up nearly a quarter of eligible voters. Congressman Ruben Gallego, a member of Biden’s Latino Leadership Committee, is leading the campaign’s outreach efforts in the state and is a critic of the Democratic Party’s strategy in 2016, when Hillary Clinton lost the state to Trump by three and a half percentage points. “We left too many young Latino votes on the table,” he said. In 2018, Democrats mounted a robust canvassing and registration effort, spent heavily on paid media, and doubled messaging via texts, social platforms, and phone calls. Boosted by higher turnout among young Latino voters, the community cast nineteen per cent of all Arizona ballots. Since the last Presidential election, more than a hundred thousand Latinos have registered to vote as Democrats. “Young voters are very politically savvy. They know that the election is happening. They know the sides. It’s a question of, ‘Can you just get them to take that one more step and vote?’ ” Gallego told me. “In 2018, we were able to do that by making the whole election about Donald Trump and they came out.”
On Tuesday, to mark the beginning of Hispanic Heritage Month, Biden flew to Florida for the first time since becoming the Democratic nominee. He visited a community college in Tampa, where he met with a diverse group of veterans. Of Trump, the former Vice-President said, “nowhere are his faults more glaring—more offensive—than when it comes to his denigration of our service members, veterans, wounded warriors, and the fallen.” Adding, almost scornfully, “It makes my blood boil.” After the roundtable, Biden headed to Kissimmee, where a lineup of Latino celebrities awaited him. Ricky Martin, Eva Longoria, and Luis Fonsi introduced the former Vice-President and made an urgent plea for their listeners to cast their ballots in November. “I would be lying if I didn’t recognize that this is one of the most difficult periods in this country’s history,” Fonsi said. “One song en español broke all the barriers across cultures, languages, and ages. ‘Despacito’ proved to me that, in this country, we will never be defined by our differences.” When Biden walked to the lectern, he pulled out his cell phone and played Fonsi’s hit song, smiling and swaying to its rhythm.
Hours later, Trump retweeted an edited version of the video that showed Biden playing the N.W.A. song “Fuck tha Police” instead of “Despacito.” Twitter labelled Trump’s tweet “manipulated media,” but the fake video had been viewed more than four million times the following day. During his address, Biden spoke of the “Hispanic roots” of the country and laid out his vision for a future where “there is no room for the idea of second-class citizens.” He trumpeted his policy agenda for the Latino community from health care to wages, housing to education. He reminded his audience that four million Latinos—who have the highest uninsured rates in the country—had gained coverage during the Obama Administration. In conclusion, Biden offered a personal plea. He recalled urging voters decades ago, when he knocked on doors in his first Senate race, “Look me over. If you like what you see and believe what I say, help me out” and added, “I’m here in Florida to say, ‘Look me over again.’ ” Biden then grew solemn. “Please, this election, make your vote heard,” he said. “More than any other time, the Latino community holds in the palm of their hand the destiny of this country.”
Read More About the 2020 Election


newyorker--2020-09-16--A Life-Saving Race Against Time and Traffic, in “Blood Rider”

The okada motorcycle taxi has long been a feature of the urban landscape in many West African cities .
Some riders are even fashion icons .
They provide a fast way to get around gridlocked cities , and have spurred a wave of ride-hailing innovation in the past couple years .
Yet they also take part in a dangerous form of travel ; accidents and fatalities are common .
During the past year , in Lagos , there has been a battle between commuters who rely on this means of travel and politicians who want to tamp down on the @ @ @ @ @ @ @ meet in “ Blood Rider , ” a documentary by Jon Kasbe , is an angel of life .
Suited up in a black Fox Racing suit and red helmet , with the city lights of Lagos reflected on his face , Joseph speeds against traffic and time to deliver blood to a hospital .
Danger and fear is not an obstacle here .
“ I can remember the first time I rode a motorcycle .
I was scared at first , ” he confesses early on in the film .
“ I @ @ @ @ @ @ @ and I was , like , they had one head and I had one head also—if they can do it , then I can also do it.
” Weaving through the grain , and at times walking among stopped vehicles , Joseph expresses only this learned calm , and an earnest , determined manner .
Here , his aim , and the drama at the center of the film , is to deliver blood to Deborah , a pregnant woman who is rapidly losing blood .
The phrase “ postpartum hemorrhage ” is @ @ @ @ @ @ @ , many years ago , when Temie Giwa-Tubosun went looking for what was killing women in Nigeria .
Born and raised in Nigeria , she moved to America at the age of fifteen to join her parents , who had won the green-card lottery and studied there .
She would go on to work as a health professional with the United Nations Development Programme and the World Health Organization before resettling in Nigeria as an adult .
In 2014 , Giwa-Tubosun herself had a close encounter with death in the delivery room , @ @ @ @ @ @ @ birth to her son in a hospital , in Minneapolis .
She was perfectly healthy before becoming pregnant , but experienced a number of complications—preëclampsia , eclampsia , and then gestational diabetes .
Her son was born prematurely .
What was supposed to be a straightforward process—an ancient , joyous one to be celebrated and remembered—turned frightening .
“ It was one of those moments when you know your life has changed , ” she told me .
She made a promise to herself to focus on maternal health care .
More than @ @ @ @ @ @ @ giving birth .
Nigeria has one of the highest maternal-death rates in the world .
( The U.S. is among the highest for developed countries . )
Taking these numbers almost as a personal affront , Giwa-Tubosun began the One Percent Project , collecting blood donations and finding health facilities with excess supplies “ about to be discarded , ” then delivering them to patients in need .
Over time , the project became LifeBank , which began managing real-time data to connect blood to hospitals and patients and organizing its swift transport @ @ @ @ @ @ @ on streets clogged with traffic .
“ Blood is a living thing , ” Giwa-Tubosun explained to me .
“ And has to be kept in a certain way.
” Few hospitals are equipped with the infrastructure to keep it , and , for those that can , power outages and other system failures often put the stored blood at risk .
Since 2016 , LifeBank has expanded to seven states in Nigeria , and also to Kenya .
By its count , the organization has saved ten thousand and four hundred lives @ @ @ @ @ @ @ COVID-19 brought both challenges and opportunities to LifeBank .
Given concerns about exposure , all the riders and other staff members had to move into the LifeBank headquarters .
“ There are babies still being born , ” Giwa-Tubosun said .
With its large amount of data and know-how already in place , the organization has been able to oversee the movement of medical samples , medicine , and tests across Nigeria , including large trucks of oxygen to support intubated patients .
Giwa-Tubosun remains optimistic about this moment .
The pandemic , @ @ @ @ @ @ @ s eyes to what the needs are and where there are holes to be filled in the system .
“ We have a better sense for how to move testing kits around , gather inventory information about critical things , figure out how to get people oxygen , ” she told me .
She is now thinking about establishing a first-response infrastructure .
“ This is the generation and the people we have been waiting for , ” she said .
“ We can solve entrenched and uncommon problems .
”

The okada motorcycle taxi has long been a feature of the urban landscape in many West African cities. Some riders are even fashion icons. They provide a fast way to get around gridlocked cities, and have spurred a wave of ride-hailing innovation in the past couple years. Yet they also take part in a dangerous form of travel; accidents and fatalities are common. During the past year, in Lagos, there has been a battle between commuters who rely on this means of travel and politicians who want to tamp down on the riders.
Joseph, the motorcyclist we meet in “Blood Rider,” a documentary by Jon Kasbe, is an angel of life. Suited up in a black Fox Racing suit and red helmet, with the city lights of Lagos reflected on his face, Joseph speeds against traffic and time to deliver blood to a hospital. Danger and fear is not an obstacle here. “I can remember the first time I rode a motorcycle. I was scared at first,” he confesses early on in the film. “I saw my friends riding the bikes, and I was, like, they had one head and I had one head also—if they can do it, then I can also do it.” Weaving through the grain, and at times walking among stopped vehicles, Joseph expresses only this learned calm, and an earnest, determined manner. Here, his aim, and the drama at the center of the film, is to deliver blood to Deborah, a pregnant woman who is rapidly losing blood.
The phrase “postpartum hemorrhage” is what came up in a Google search, many years ago, when Temie Giwa-Tubosun went looking for what was killing women in Nigeria. Born and raised in Nigeria, she moved to America at the age of fifteen to join her parents, who had won the green-card lottery and studied there. She would go on to work as a health professional with the United Nations Development Programme and the World Health Organization before resettling in Nigeria as an adult. In 2014, Giwa-Tubosun herself had a close encounter with death in the delivery room, despite having access to resources and giving birth to her son in a hospital, in Minneapolis. She was perfectly healthy before becoming pregnant, but experienced a number of complications—preëclampsia, eclampsia, and then gestational diabetes. Her son was born prematurely. What was supposed to be a straightforward process—an ancient, joyous one to be celebrated and remembered—turned frightening. “It was one of those moments when you know your life has changed,” she told me. She made a promise to herself to focus on maternal health care.
More than six hundred women die every day while giving birth. Nigeria has one of the highest maternal-death rates in the world. (The U.S. is among the highest for developed countries.) Taking these numbers almost as a personal affront, Giwa-Tubosun began the One Percent Project, collecting blood donations and finding health facilities with excess supplies “about to be discarded,” then delivering them to patients in need. Over time, the project became LifeBank, which began managing real-time data to connect blood to hospitals and patients and organizing its swift transport, by motorcycle and other means, on streets clogged with traffic. “Blood is a living thing,” Giwa-Tubosun explained to me. “And has to be kept in a certain way.” Few hospitals are equipped with the infrastructure to keep it, and, for those that can, power outages and other system failures often put the stored blood at risk. Since 2016, LifeBank has expanded to seven states in Nigeria, and also to Kenya. By its count, the organization has saved ten thousand and four hundred lives.
The lockdown measures that came with COVID-19 brought both challenges and opportunities to LifeBank. Given concerns about exposure, all the riders and other staff members had to move into the LifeBank headquarters. “There are babies still being born,” Giwa-Tubosun said. With its large amount of data and know-how already in place, the organization has been able to oversee the movement of medical samples, medicine, and tests across Nigeria, including large trucks of oxygen to support intubated patients. Giwa-Tubosun remains optimistic about this moment. The pandemic, she said, had opened people’s eyes to what the needs are and where there are holes to be filled in the system. “We have a better sense for how to move testing kits around, gather inventory information about critical things, figure out how to get people oxygen,” she told me. She is now thinking about establishing a first-response infrastructure. “This is the generation and the people we have been waiting for,” she said. “We can solve entrenched and uncommon problems.”


newyorker--2020-09-16--The 2020 National Book Awards Longlist: Translated Literature

This week , The New Yorker will be announcing the longlists for the 2020 National Book Awards .
This morning , we presented the ten contenders in the category of Young People ’ s Literature .
Check back tomorrow morning for Poetry .
In 2015 , the Tamil author Perumal Murugan announced the end of his literary career .
A few years earlier , he had published a novel , “ One Part Woman , ” that sparked a series of protests over its depictions of a traditional village festival .
Murugan was forced to apologize for the book and @ @ @ @ @ @ @ was driven from his village by right-wing fundamentalists .
On Facebook , he wrote , “ The writer Perumal Murugan is dead.
” A year later , the Madras High Court pulled Murugan out of his silence , upholding his right to free expression in a landmark decision .
The first novel Murugan published after his exile , “ The Story of a Goat , ” is a contender for this year ’ s National Book Award for Translated Literature .
The book follows a black goat named Poonachi as she witnesses the @ @ @ @ @ @ @ a farm in southern India .
“ It is a slim book , but Murugan has given it an epic form , ” Amitava Kumar , who spoke with the author in 2019 , writes .
Of the ten authors on the longlist for this year ’ s award , Murugan is the only one who has been nominated previously .
Other nominees include Linda Boström Knausgård , whose novel “ The Helios Disaster ” adapts the myth of Athena in a modern Swedish setting ; Pilar Quintana , whose novel “ The @ @ @ @ @ @ @ lonely woman and her dog ; and Yu Miri , whose novel “ Tokyo Ueno Station ” is narrated by the ghost of a homeless man living outside the titular train stop .
The ten books being considered for the award are all works of fiction , originally published in eight different languages .
The full list is below .
Shokoofeh Azar , “ The Enlightenment of the Greengage Tree ” Translated , from the Persian , by Anonymous Europa Editions Linda Boström Knausgård , “ The Helios Disaster ” Translated , from @ @ @ @ @ @ @ Editions Anja Kampmann , “ High as the Waters Rise ” Translated , from the German , by Anne Posten Catapult Jonas Hassen Khemiri , “ The Family Clause ” Translated , from the Swedish , by Alice Menzies Farrar , Straus and Giroux / Macmillan Publishers Fernanda Melchor , “ Hurricane Season ” Translated , from the Spanish , by Sophie Hughes New Directions Yu Miri , “ Tokyo Ueno Station ” Translated , from the Japanese , by Morgan Giles Riverhead Books / Penguin Random House Perumal Murugan , “ The @ @ @ @ @ @ @ from the Tamil , by N. Kalyan Raman Black Cat / Grove Atlantic Cho Nam-joo , “ Kim Jiyoung , Born 1982 ” Translated , from the Korean , by Jamie Chang Liveright / W. W. Norton & Company Pilar Quintana , “ The Bitch ” Translated , from the Spanish , by Lisa Dillman World Editions Adania Shibli , “ Minor Detail ” Translated , from the Arabic , by Elisabeth Jaquette New Directions The judges for the category this year are Heather Cleary , whose translation of “ Comemadre , ” @ @ @ @ @ @ @ the 2018 National Book Award ; Anne Ishii , the executive director of Asian Arts Initiative ; John Darnielle , the leader of the Mountain Goats , whose novel “ Wolf in White Van ” was longlisted for the 2014 National Book Award ; Brad Johnson , the owner of East Bay Booksellers ; and the writer Dinaw Mengestu , who was a 2012 MacArthur Fellow .

This week, The New Yorker will be announcing the longlists for the 2020 National Book Awards. This morning, we presented the ten contenders in the category of Young People’s Literature. Check back tomorrow morning for Poetry.
In 2015, the Tamil author Perumal Murugan announced the end of his literary career. A few years earlier, he had published a novel, “One Part Woman,” that sparked a series of protests over its depictions of a traditional village festival. Murugan was forced to apologize for the book and withdraw unsold copies. Later, he was driven from his village by right-wing fundamentalists. On Facebook, he wrote, “The writer Perumal Murugan is dead.” A year later, the Madras High Court pulled Murugan out of his silence, upholding his right to free expression in a landmark decision.
The first novel Murugan published after his exile, “The Story of a Goat,” is a contender for this year’s National Book Award for Translated Literature. The book follows a black goat named Poonachi as she witnesses the indignities suffered by animals and humans on a farm in southern India. “It is a slim book, but Murugan has given it an epic form,” Amitava Kumar, who spoke with the author in 2019, writes.
Of the ten authors on the longlist for this year’s award, Murugan is the only one who has been nominated previously. Other nominees include Linda Boström Knausgård, whose novel “The Helios Disaster” adapts the myth of Athena in a modern Swedish setting; Pilar Quintana, whose novel “The Bitch” details the relationship between a lonely woman and her dog; and Yu Miri, whose novel “Tokyo Ueno Station” is narrated by the ghost of a homeless man living outside the titular train stop. The ten books being considered for the award are all works of fiction, originally published in eight different languages. The full list is below.
Shokoofeh Azar, “The Enlightenment of the Greengage Tree”
Translated, from the Persian, by Anonymous
Europa Editions
Linda Boström Knausgård, “The Helios Disaster”
Translated, from the Swedish, by Rachel Willson-Broyles
World Editions
Anja Kampmann, “High as the Waters Rise”
Translated, from the German, by Anne Posten
Catapult
Jonas Hassen Khemiri, “The Family Clause”
Translated, from the Swedish, by Alice Menzies
Farrar, Straus and Giroux / Macmillan Publishers
Fernanda Melchor, “Hurricane Season”
Translated, from the Spanish, by Sophie Hughes
New Directions
Yu Miri, “Tokyo Ueno Station”
Translated, from the Japanese, by Morgan Giles
Riverhead Books / Penguin Random House
Perumal Murugan, “The Story of a Goat”
Translated, from the Tamil, by N. Kalyan Raman
Black Cat / Grove Atlantic
Cho Nam-joo, “Kim Jiyoung, Born 1982”
Translated, from the Korean, by Jamie Chang
Liveright / W. W. Norton & Company
Pilar Quintana, “The Bitch”
Translated, from the Spanish, by Lisa Dillman
World Editions
Adania Shibli, “Minor Detail”
Translated, from the Arabic, by Elisabeth Jaquette
New Directions
The judges for the category this year are Heather Cleary, whose translation of “Comemadre,” by Roque Larraquy, was longlisted for the 2018 National Book Award; Anne Ishii, the executive director of Asian Arts Initiative; John Darnielle, the leader of the Mountain Goats, whose novel “Wolf in White Van” was longlisted for the 2014 National Book Award; Brad Johnson, the owner of East Bay Booksellers; and the writer Dinaw Mengestu, who was a 2012 MacArthur Fellow.


newyorker--2020-09-16--Scientists Believe Congressional Republicans Have Developed Herd Mentality

WASHINGTON ( The Borowitz Report ) —Researchers at the University of Minnesota believe that Republican members of Congress have obtained @ @ @ @ @ of herd mentality , a new study shows .
According to the study , the @ @ @ @ @ obtaining herd mentality , the G.O.P .
lawmakers have developed “ near-total immunity ” to @ @ @ @ @ , and audio tapes .
Herd mentality was observed in congressional Republicans from every region @ @ @ @ @ the exception of one senator from Utah , Mitt Romney , who was deemed an @ @ @ @ @ .
Davis Logsdon , the scientist who supervised the study , said that Republicans were @ @ @ @ @ degree never before observed in humans .
“ Herd mentality at these levels historically has @ @ @ @ @ species , like lemmings , ” the researcher said .

WASHINGTON (The Borowitz Report)—Researchers at the University of Minnesota believe that Republican members of Congress have obtained “extremely high” levels of herd mentality, a new study shows.
According to the study, the researchers found that, in obtaining herd mentality, the G.O.P. lawmakers have developed “near-total immunity” to damning books, news reports, and audio tapes.
Herd mentality was observed in congressional Republicans from every region of the country, with the exception of one senator from Utah, Mitt Romney, who was deemed an outlier and therefore statistically insignificant.
Davis Logsdon, the scientist who supervised the study, said that Republicans were exhibiting herd mentality to a degree never before observed in humans.
“Herd mentality at these levels historically has appeared only in other mammal species, like lemmings,” the researcher said.


newyorker--2020-09-16--The 2020 National Book Awards Longlist: Young People’s Literature

This week , The New Yorker will be announcing the longlists for the 2020 National Book Awards .
Check back this afternoon for the list for Translated Literature .
Kingston James , the protagonist of Kacen Callender ’ s novel “ King and the Dragonflies , ” is convinced that his deceased older brother Khalid has transformed into a dragonfly , and spends every afternoon searching for him by the bayou in his Louisiana home town .
What haunts King is not just the loss of his brother but a sense that Khalid died without knowing who King really was @ @ @ @ @ @ @ to share the truth with his grieving parents .
The book follows him as he tries to reconcile the memory of his brother with a new understanding of himself .
Callender ’ s book is one of several on the longlist for this year ’ s National Book Award for Young People ’ s Literature that depict children making sense of death and the afterlife .
Aiden Thomas ’ s début , “ Cemetery Boys , ” follows a transgender boy who summons a spirit in order to prove himself as a brujo @ @ @ @ @ @ @ by Gavriel Savit , is about two Jewish teens living in a shtetl who are visited by messengers of Death ; “ Trowbridge Road , ” by Marcella Pixley , narrates the summer of 1983 from the perspective of a girl whose father has just died of AIDS .
All of the authors on this year ’ s longlist are first-time nominees .
The full list is below .
Kacen Callender , “ King and the Dragonflies ” Scholastic Press / Scholastic Inc. Evette Dionne , “ Lifting as We Climb : Black @ @ @ @ @ @ @ Box ” Viking Books for Young Readers / Penguin Random House Victoria Jamieson and Omar Mohamed , “ When Stars Are Scattered ” Dial Books for Young Readers / Penguin Random House John Rocco , “ How We Got to the Moon : The People , Technology , and Daring Feats of Science Behind Humanity ’ s Greatest Adventure ” Crown Books for Young Readers / Penguin Random House The judges for the category this year are Randy Ribay , whose novel “ Patron Saints of Nothing ” was a finalist for the @ @ @ @ @ @ @ , the author of more than thirty novels , including “ Challenger Deep , ” which won the 2015 National Book Award ; Ebony Elizabeth Thomas , a professor at the University of Pennsylvania ’ s Graduate School of Education ; Colleen AF Venable , whose graphic novel “ Kiss Number 8 ” was longlisted for the 2019 National Book Award ; and the bookseller and writer Joan Trygg .

This week, The New Yorker will be announcing the longlists for the 2020 National Book Awards. Check back this afternoon for the list for Translated Literature.
Kingston James, the protagonist of Kacen Callender’s novel “King and the Dragonflies,” is convinced that his deceased older brother Khalid has transformed into a dragonfly, and spends every afternoon searching for him by the bayou in his Louisiana home town. What haunts King is not just the loss of his brother but a sense that Khalid died without knowing who King really was. King is gay, and terrified to share the truth with his grieving parents. The book follows him as he tries to reconcile the memory of his brother with a new understanding of himself.
Callender’s book is one of several on the longlist for this year’s National Book Award for Young People’s Literature that depict children making sense of death and the afterlife. Aiden Thomas’s début, “Cemetery Boys,” follows a transgender boy who summons a spirit in order to prove himself as a brujo; “The Way Back,” by Gavriel Savit, is about two Jewish teens living in a shtetl who are visited by messengers of Death; “Trowbridge Road,” by Marcella Pixley, narrates the summer of 1983 from the perspective of a girl whose father has just died of AIDS. All of the authors on this year’s longlist are first-time nominees.
The full list is below.
Kacen Callender, “King and the Dragonflies”
Scholastic Press / Scholastic Inc.
Traci Chee, “We Are Not Free”
Houghton Mifflin Harcourt
Evette Dionne, “Lifting as We Climb: Black Women’s Battle for the Ballot Box”
Viking Books for Young Readers / Penguin Random House
Eric Gansworth, “Apple (Skin to the Core)”
Levine Querido
Candice Iloh, “Every Body Looking”
Dutton Books for Young Readers / Penguin Random House
Victoria Jamieson and Omar Mohamed, “When Stars Are Scattered”
Dial Books for Young Readers / Penguin Random House
Marcella Pixley, “Trowbridge Road”
Candlewick Press
John Rocco, “How We Got to the Moon: The People, Technology, and Daring Feats of Science Behind Humanity’s Greatest Adventure”
Crown Books for Young Readers / Penguin Random House
Gavriel Savit, “The Way Back”
Knopf Books for Young Readers / Penguin Random House
Aiden Thomas, “Cemetery Boys”
Swoon Reads / Macmillan Publishers
The judges for the category this year are Randy Ribay, whose novel “Patron Saints of Nothing” was a finalist for the 2019 National Book Award; Neal Shusterman, the author of more than thirty novels, including “Challenger Deep,” which won the 2015 National Book Award; Ebony Elizabeth Thomas, a professor at the University of Pennsylvania’s Graduate School of Education; Colleen AF Venable, whose graphic novel “Kiss Number 8” was longlisted for the 2019 National Book Award; and the bookseller and writer Joan Trygg.


newyorker--2020-09-16--The Recurring Trauma of California’s Wildfires

I grew up in Chico , a rural college town just down the hill from Paradise .
On Saturday , when the area ’ s air quality ranked third worst in the country , I traded texts with a friend whose family was pushed out of their house for nearly a month by the Camp Fire .
They live in a canyon west of Paradise , and have had to evacuate twice in the past two weeks , because of the smoke and a lack of power , which the local utility had cut off to prevent further fires .
@ @ @ @ @ @ @ no A.C. , no water , ” my friend wrote .
“ Can ’ t open a window because of the smoke .
Ash is everywhere covering everything .
I am in town right now trying to buy an air purifier .
Chico is sold out .
It ’ s the toilet paper all over again.
” Another friend , who lives in Chico , told me that “ exhaustion and disbelief ” were the dominant moods around town .
“ During COVID the outside was all we had left and now that @ @ @ @ @ @ @ said in a text message .
“ It ’ s just an unbelievable reckoning of all we ’ ve done wrong .
The list is long and the loss is deep.
” When the Camp Fire ignited , on November 8th , 2018 , shortly after 6 A.M. , Kalina and Olen Eagler and their two children were living in an apartment in Magalia , up the ridge from Paradise .
The Eaglers noticed smoke in the air while dropping their son at his school-bus stop that morning , and , when Olen @ @ @ @ @ @ @ saw thick billows rolling up the canyon walls .
He collected his son and went back to the apartment , where Kalina and their daughter , then twelve , had already started packing their Honda Prelude .
By 8 A.M. , they were driving south , into Paradise .
Along the way , Kalina looked down a stretch of road that headed toward Noble Orchards .
Through the trees , she could see flames taller than houses .
“ I realized this was incredibly serious , ” she said .
“ We started @ @ @ @ @ @ @ to leave.
” After spending a few months in Amador County , a few hours south , where Olen ’ s mother lived , the Eaglers moved to Reno , Nevada .
Kalina had briefly lived in Reno before .
It was , she said , “ a place I could relate to .
I felt like maybe we ’ d be comfortable there , and the job market was really excellent.
” Once they moved , Olen , who had been a d.j .
and stay-at-home dad in Magalia , took delivery @ @ @ @ @ @ @ arranged his schedule so that he could take care of the kids after school .
Kalina , who worked for a short time in behavioral therapy , found herself , for the first time in her life , sunk in a deep depression .
“ I kind of stared at a wall for a year , ” she said .
The children started having a hard time at school , something that had never happened before .
This March , during the children ’ s spring break , the Eaglers were visiting family @ @ @ @ @ @ @ s thirty-eighth birthday , when the coronavirus caused Butte County to impose a stay-at-home order .
They were still on lockdown in Magalia a few weeks later when they got a call from the owner of a farm in nearby Berry Creek , where they ’ d worked during the summer of 2018 .
The farm had been unoccupied for a year , and the owner asked if Kalina and Olen would care for the property in exchange for rent .
By then , the children ’ s school had shut down because @ @ @ @ @ @ @ Reno ’ s tourist economy in free fall , there was little reason to return to Nevada .
“ The opportunity to be back in Butte County , with the people we love , was too much to pass up , ” Kalina said .
On the farm in Berry Creek , a mountain town of about twelve hundred people , the Eaglers moved into a three-bedroom house with a wraparound porch and a stained-glass window that refracted the morning light .
Huge Ponderosa pines surrounded the farm ; the property itself featured @ @ @ @ @ @ @ , strawberry and blackberry bushes , and a small apple orchard supposedly planted by moonshiners a hundred years ago .
At least ten varieties of roses grew in planter boxes milled from trees that had fallen around the farm .
The house was off the electrical grid , which made it difficult to manage remote learning , so the Eaglers ’ kids shuttled back and forth to their grandmother ’ s , in Amador County , for most of the summer .
Still , it was exactly the sort of place where Kalina @ @ @ @ @ @ @ It was just big and beautiful , really an opportunity to be able to provide everything for your family , ” Kalina said .
Kalina and Olen both grew up in Paradise , where they learned at a young age to pay close attention to fires burning in the Sierra Nevada foothills .
During the last weeks of August , they kept a close watch on the North Complex Fire , checking the Internet regularly for news of its path .
Last week , on Tuesday morning , they woke to find the @ @ @ @ @ @ @ but when Kalina checked her phone she did not see any evacuation notices .
“ And then the sky started to clear , ” she said .
“ The sky was blue—there was no smoke anymore .
We saw that the wind had changed , and we were good.
” The kids were staying with their grandmother , so Kalina and Olen took advantage of the smokeless air to prune branches and collect fruit from their apple trees .
Around three-thirty that afternoon , Kalina got a call from her brother-in-law .
He @ @ @ @ @ @ @ Laurie Noble , had spotted the ash cloud .
“ He was very concerned , ” Kalina said .
“ ‘ Are you guys O.K.
?
The cloud that I ’ m seeing looks really bad.
’ I ’ m , like , ‘ No , I can ’ t see any clouds.
’ It was really blue and clear over here , you know ?
And then , within a half an hour , we received the emergency order that we needed to evacuate.
” The Eaglers wasted no time getting out @ @ @ @ @ @ @ not going to mess around , ” Kalina said .
“ We ’ ve been through this .
There was no way we were going to wait on anything.
” Earlier in the summer , during another fire , they had packed a few boxes with photographs and documents .
Now they grabbed their pets and stuffed some clothes in a duffel bag .
On her way out , Kalina took with her a handcrafted hood that Olen had given her as a gift .
“ For whatever reason , during the Camp @ @ @ @ @ @ @ it was the last thing I saw before I left .
And I thought , Well , that ’ s kind of a frivolous thing , but I love it , so I ’ m going to grab it .
I had that exact moment when we were leaving Berry Creek.
” By the time they got to the highway , three miles from the farm , the Eaglers could see the smoke rising up over the trees .
A few minutes later , they saw an orange glow on top of a @ @ @ @ @ @ @ they reached Bidwell Bar—a green suspension bridge that was captured , backlit by an infernal landscape , in a slow-exposure photograph that made front pages around the country last week—the atmosphere underwent a familiar , sickening change .
“ It got dark , almost black , ” Kalina told me .
“ Any light coming through looked flat .
The change in the air felt like being in a vacuum.
” Her body started to shake , and she heard herself whispering “ Don ’ t panic ” as she drove .
There @ @ @ @ @ @ @ mix of fear and panic and certainty that comes from doing it a second time .
It ’ s almost like hope is not an option , because we had already seen this scenario play out .
”

When Laurie Noble was growing up, in Fort Bragg, California, in the nineteen-fifties and sixties, her family’s home doubled as a government weather station. The house was equipped with rain and wind-speed gauges, thermometers, a barometer, and a recording barograph, and the family belonged to a network of part-time observers paid by the federal Weather Bureau, the forerunner of the National Weather Service, to fill in gaps between its professionally staffed stations. By the time Noble was a teen-ager, she was earning a dollar and thirty-five cents to read the instruments every six hours, write down measurements in their handwritten logs, and call the information in, using the appropriate codes, to the San Francisco airport. Noble credits her early apprenticeship in meteorology with helping her spot, around two o’clock on Tuesday of last week, a terrifying column of smoke that appeared several canyons away from the apple orchard she owns with her husband, Jim, in Paradise, California. “I’ve always had my eyes to the sky,” she told me last week.
The smoke emerged from an offshoot of the so-called North Complex Fire, a conglomeration of several smaller fires that had started in mid-August, in Plumas County, more than sixty miles to the northeast. Around noon, the complex made what officials described as a “historic run” through the crowns of the area’s Ponderosa pines, and launched itself down into Butte County, where Paradise is situated. “When I saw that smoke, I knew it could be over here within hours,” Noble said. “It was very evident that that was a roiling fire that was just ripping.”
Noble appreciated the threat better than most. In November, 2018, the Nobles’ orchard was overrun, along with most of Paradise, by the Camp Fire, a conflagration that caused $8.4 billion in damage and killed eighty-five people. The fire largely spared the Nobles’ apple trees, but it destroyed eleven buildings on their farm, including their ninety-year-old home. For the past year, the Nobles have been living in an R.V. trailer on their property. A new house that they’ve been building is just weeks from completion, but Noble told me that her biggest fear, when she contemplated another evacuation, was what would happen to the stacks of legal and insurance paperwork that she has been working through since the Camp Fire. “It is kind of a monumental task to figure out what was in eleven buildings and try to write it all down,” she said.
Of the eleven thousand houses in Paradise that were destroyed in the Camp Fire, only around four hundred residential structures have been rebuilt. Even before the coronavirus pandemic, the town’s recovery was slowed by the time it took to remove nearly four million tons of contaminated soil, ash, and debris, and by the lingering threat of damaged trees, which sway lethally over the recovery effort. The same day that Noble saw the smoke cloud, she heard a huge Ponderosa crash while she was working outside. “I found out that it was one that had fallen on somebody’s motor home, maybe ten parcels up from here,” she said. “It was dead and hadn’t been removed.”
In November, 2018, most of Paradise, California, was overrun by the Camp Fire, a conflagration that caused $8.4 billion in damage and killed eighty-five people. Photograph by David Paul Morris / Bloomberg / Getty
Noble suggested that it would be “a generous estimate” to say that around three thousand people are living in Paradise now, down from a pre-fire population of twenty-seven thousand. She knows plenty of people who will never come back. “There are lots of terrible stories of people having felt trapped, or being alone and scared to death. You don’t forget those things,” she said. The Nobles’ decision to return was motivated largely by history. Noble Orchards was originally planted ninety-nine years ago, by Jim’s grandfather; when they saw that the trees had survived the fire, she told me, “that kind of made the decision.” Still, the smoke she spotted last week took her right back to November, 2018. “It was very frightening to watch all that, because I knew what it meant,” she said. “Just talking about it now, I can feel my head and body tensing up. It was a horrific feeling.”
The Camp Fire remains, for now, the deadliest and most destructive California wildfire on record. But, even in 2018, it was clear that there was nothing special about the circumstances that caused it to pummel Paradise and the surrounding areas with such explosive force. The same conditions—the effects of climate change, the development of communities in forested areas, and particularly an abundance of fuel, the result of a century-long forest-management regime that took fire suppression as its watchword—were present in much of the state. Everyone knew that it was only a matter of time before another fire tried to outdo the Camp Fire’s awful accomplishments. As Noble told me, “Fire is part of our lives now.”
Six of California’s twenty largest recorded fires have occurred this year, and the Butte County fire—which has been renamed, somewhat clumsily, the North Complex West Zone Fire—has already killed fifteen people. If the Camp Fire opened this new phase in California’s age-old relationship with fire, the events in Butte County over the past week suggest a new mode of living with catastrophe more generally, one in which Americans are forced to contend with multiple acute community-scale disasters all at once. In the seven days leading up to last week’s fire, the county saw its highest weekly COVID-19 caseload, and the coincidence of the two disasters has made each more difficult to manage. The pandemic, for instance, prevented the county from setting up traditional evacuation centers. Instead, people fleeing the fire were directed to drive to “Temporary Evacuation Points” and asked to remain in their cars there until relief workers could help them. The fire, in turn, has hindered efforts to cope with the pandemic. For one day last week, officials rescinded some of the county’s restrictions on indoor dining, because the smoke outside was deemed a greater health risk than the virus that was potentially lurking indoors. (The restrictions were reimposed on Friday.)
The compounding tragedies levied a heavy emotional toll even on those who were out of the fires’ path. For many on the West Coast, the blood-orange skies that blanketed California, Oregon, and Washington last week looked like a warning about a coming climatological apocalypse. In Butte County, the hue appeared no less ominous, but there it also pointed to the past, a reminder of the trauma from which the area was still working to recover.
I grew up in Chico, a rural college town just down the hill from Paradise. On Saturday, when the area’s air quality ranked third worst in the country, I traded texts with a friend whose family was pushed out of their house for nearly a month by the Camp Fire. They live in a canyon west of Paradise, and have had to evacuate twice in the past two weeks, because of the smoke and a lack of power, which the local utility had cut off to prevent further fires. “With no power, that means no A.C., no water,” my friend wrote. “Can’t open a window because of the smoke. Ash is everywhere covering everything. I am in town right now trying to buy an air purifier. Chico is sold out. It’s the toilet paper all over again.” Another friend, who lives in Chico, told me that “exhaustion and disbelief” were the dominant moods around town. “During COVID the outside was all we had left and now that’s gone too,” he said in a text message. “It’s just an unbelievable reckoning of all we’ve done wrong. The list is long and the loss is deep.”
When the Camp Fire ignited, on November 8th, 2018, shortly after 6 A.M., Kalina and Olen Eagler and their two children were living in an apartment in Magalia, up the ridge from Paradise. The Eaglers noticed smoke in the air while dropping their son at his school-bus stop that morning, and, when Olen drove to a nearby outlook, he saw thick billows rolling up the canyon walls. He collected his son and went back to the apartment, where Kalina and their daughter, then twelve, had already started packing their Honda Prelude. By 8 A.M., they were driving south, into Paradise. Along the way, Kalina looked down a stretch of road that headed toward Noble Orchards. Through the trees, she could see flames taller than houses. “I realized this was incredibly serious,” she said. “We started calling everybody we knew and encouraging them to leave.”
After spending a few months in Amador County, a few hours south, where Olen’s mother lived, the Eaglers moved to Reno, Nevada. Kalina had briefly lived in Reno before. It was, she said, “a place I could relate to. I felt like maybe we’d be comfortable there, and the job market was really excellent.” Once they moved, Olen, who had been a d.j. and stay-at-home dad in Magalia, took delivery jobs with DoorDash and Grubhub, and arranged his schedule so that he could take care of the kids after school. Kalina, who worked for a short time in behavioral therapy, found herself, for the first time in her life, sunk in a deep depression. “I kind of stared at a wall for a year,” she said. The children started having a hard time at school, something that had never happened before.
This March, during the children’s spring break, the Eaglers were visiting family in Magalia, to celebrate Kalina’s thirty-eighth birthday, when the coronavirus caused Butte County to impose a stay-at-home order. They were still on lockdown in Magalia a few weeks later when they got a call from the owner of a farm in nearby Berry Creek, where they’d worked during the summer of 2018. The farm had been unoccupied for a year, and the owner asked if Kalina and Olen would care for the property in exchange for rent. By then, the children’s school had shut down because of the pandemic, and, with Reno’s tourist economy in free fall, there was little reason to return to Nevada. “The opportunity to be back in Butte County, with the people we love, was too much to pass up,” Kalina said.
On the farm in Berry Creek, a mountain town of about twelve hundred people, the Eaglers moved into a three-bedroom house with a wraparound porch and a stained-glass window that refracted the morning light. Huge Ponderosa pines surrounded the farm; the property itself featured Japanese maples, peach and plum trees, strawberry and blackberry bushes, and a small apple orchard supposedly planted by moonshiners a hundred years ago. At least ten varieties of roses grew in planter boxes milled from trees that had fallen around the farm. The house was off the electrical grid, which made it difficult to manage remote learning, so the Eaglers’ kids shuttled back and forth to their grandmother’s, in Amador County, for most of the summer. Still, it was exactly the sort of place where Kalina and Olen wanted to be. “It was just big and beautiful, really an opportunity to be able to provide everything for your family,” Kalina said.
Kalina and Olen both grew up in Paradise, where they learned at a young age to pay close attention to fires burning in the Sierra Nevada foothills. During the last weeks of August, they kept a close watch on the North Complex Fire, checking the Internet regularly for news of its path. Last week, on Tuesday morning, they woke to find the farm swaddled in thick white smoke, but when Kalina checked her phone she did not see any evacuation notices. “And then the sky started to clear,” she said. “The sky was blue—there was no smoke anymore. We saw that the wind had changed, and we were good.” The kids were staying with their grandmother, so Kalina and Olen took advantage of the smokeless air to prune branches and collect fruit from their apple trees.
Around three-thirty that afternoon, Kalina got a call from her brother-in-law. He was in Paradise, and, like Laurie Noble, had spotted the ash cloud. “He was very concerned,” Kalina said. “ ‘Are you guys O.K.? The cloud that I’m seeing looks really bad.’ I’m, like, ‘No, I can’t see any clouds.’ It was really blue and clear over here, you know? And then, within a half an hour, we received the emergency order that we needed to evacuate.”


newyorker--2020-09-16--Compliments I’ve Received in My Thirties, Translated

“ That ’ s not one of the three black Target V-necks that you usually wear.
” “ You don ’ t look like you ’ re in your thirties !
” “ You have the hormonal acne of a much younger woman.
” “ You always have snacks in your purse.
” “ You ’ ve been lying on the ground petting that beagle for two hours .
You ’ re making everyone at this back-yard baby shower uncomfortable.
” “ I ’ m glad you found such a nice guy to settle down with !
” “ Your @ @ @ @ @ @ @ were a person.
” “ It ’ s so brave of you to turn your back on current trends and embrace orthopedic sandals.
” “ I think it ’ s great the way you ’ ve followed your dreams !
” “ Aw , your apartment is so cute !
” “ I can ’ t believe you share such a small space with so many mice.
” “ Wow , you have a really good memory !
” “ How did you even know it ’ s my dog ’ s birthday @ @ @ @ @ @ @ information with you.
” “ I seriously thought you were in your early twenties !
” “ I have the same job title as you and I ’ m in my early twenties.
” “ You look like if a sherpa throw blanket from Bed Bath & Beyond were a person.
” “ You ’ re never funny like this in person.
” “ My dog knows you keep snacks in your purse.
” “ Did you lose weight ?
You look amazing !
” “ I equate beauty with being as thin @ @ @ @ @ @ @ ’ t know about your irritable-bowel syndrome.
” “ You still have some time to squeeze out a baby .
But not a lot !
”

“You’re all dressed up today!”
“That’s not one of the three black Target V-necks that you usually wear.”
“You don’t look like you’re in your thirties!”
“You have the hormonal acne of a much younger woman.”
“You’d make such a great mom!”
“You always have snacks in your purse.”
“Wow, you really love dogs!”
“You’ve been lying on the ground petting that beagle for two hours. You’re making everyone at this back-yard baby shower uncomfortable.”
“I’m glad you found such a nice guy to settle down with!”
“Your previous boyfriend was basically like if SantaCon were a person.”
“Your shoes look really comfortable!”
“It’s so brave of you to turn your back on current trends and embrace orthopedic sandals.”
“I think it’s great the way you’ve followed your dreams!”
“Having money isn’t for everyone.”
“Aw, your apartment is so cute!”
“I can’t believe you share such a small space with so many mice.”
“Wow, you have a really good memory!”
“How did you even know it’s my dog’s birthday? I’ve never shared this information with you.”
“I seriously thought you were in your early twenties!”
“I have the same job title as you and I’m in my early twenties.”
“Your outfit looks so cozy!”
“You look like if a sherpa throw blanket from Bed Bath & Beyond were a person.”
“I can’t believe you wrote this!”
“You’re never funny like this in person.”
“Wow, my dog really likes you!”
“My dog knows you keep snacks in your purse.”
“Did you lose weight? You look amazing!”
“I equate beauty with being as thin as possible, and also I didn’t know about your irritable-bowel syndrome.”
“You’re still young!”
“You still have some time to squeeze out a baby. But not a lot!”


newyorker--2020-09-16--Joy Harjo Reads Sandra Cisneros

Joy Harjo Reads Sandra Cisneros

Joy Harjo joins Kevin Young to read “ Still-Life with Potatoes , Pearls , Raw Meat , Rhinestones , Lard @ @ @ @ @ ” by Sandra Cisneros , and her own poem “ Running.
” Harjo is the @ @ @ @ @ United States , as well as a chancellor of the Academy of American Poets .
@ @ @ @ @ Ruth Lilly Poetry Prize and the Wallace Stevens Award .

Download a transcript.
Photograph by J. Vespa / Getty
Joy Harjo joins Kevin Young to read “Still-Life with Potatoes, Pearls, Raw Meat, Rhinestones, Lard, and Horse Hooves,” by Sandra Cisneros, and her own poem “Running.” Harjo is the current Poet Laureate of the United States, as well as a chancellor of the Academy of American Poets. Her many honors include the Ruth Lilly Poetry Prize and the Wallace Stevens Award.


newyorker--2020-09-16--Why a Negative Test Doesn’t Guarantee You Don’t Have the Coronavirus

During my medical residency , I spent a month on the obstetrics ward , learning how to deliver babies .
On one occasion , I was paged to a delivery room down the hall .
Inside , I saw the mother-to-be propped up in bed , her husband sitting next to her .
Then I noticed the crowd .
In addition to the obstetricians and delivery nurses , a special team of nurses and pediatricians from the neonatal I.C.U .
had gathered .
“ Is this a high-risk delivery ?
” I asked one of the obstetrics residents .
“ @ @ @ @ @ @ @ “ The baby had a positive screen for cri du chat.
” Cri du chat , which means “ cat ’ s cry ” in French , is a rare genetic syndrome affecting one in fifteen thousand to fifty thousand infants .
It was discovered by Jérôme Lejeune , a French geneticist , in 1963 .
Early in fetal development , genes situated on the short arm of chromosome 5 are accidentally left out , like parcels falling off the back of a delivery truck ; affected children can have poor muscle tone @ @ @ @ @ @ @ palate , unusually small heads , speech delays , learning disabilities , and heart problems .
As many as one in ten children with cri du chat don ’ t survive the first year of life .
The anatomy of the vocal cords is often affected , as well , resulting in a highly abnormal cry that sounds startlingly like the mewing of a cat .
Because the syndrome can cause such significant handicaps , pregnant women with risk factors are often offered a screening test .
By sampling fragments of fetal DNA @ @ @ @ @ @ @ the mother ’ s blood , doctors can sometimes detect the fingerprints of a genetic disorder .
But , because the test doesn ’ t inspect the infant ’ s DNA directly , it can ’ t provide a perfect picture of fetal genes and chromosomes ; it ’ s more like a slightly blurry snapshot .
It ’ s possible for a result to be incorrect—falsely positive or falsely negative .
If the screening test does come back positive , another test is needed to confirm the diagnosis .
This second test @ @ @ @ @ @ @ samples of fetal or placental tissue .
And yet , although it ’ s more accurate than the screening test , it ’ s not perfect , either .
Even the confirmatory tests can sometimes be misleading .
As we stood near the back of the room , the obstetrics resident told me that the laboring woman had undergone some of these more advanced tests .
The results had been reassuring , and the team had told the parents that the fetus was most likely normal .
But the tests couldn ’ t @ @ @ @ @ @ @ we .
The neonatal-I.C.U .
team was there on standby because , despite our most sophisticated tests , the nature of the child would remain a mystery until the moment of its birth .
In the room , that moment unfolded in stages .
First , we glimpsed the child ’ s head ; then the shoulders , then limbs , then a body .
The room was strung on a wire as the crowd of nurses and doctors watched the delivery in silence .
The obstetrician lifted the newborn free of the @ @ @ @ @ @ @ and cut , and the newborn opened its mouth , filled its lungs , and cried .
The exhausted mother beamed as she held her child in her arms .
She didn ’ t hear what everyone else heard .
The cry was not a normal cry .
Shrill and plaintive , it sounded like the mewing of a cat .
Some medical problems are obvious .
When the sidewalks in Boston are icy , I see a lot of patients who ’ ve lost their footing and fallen onto their outstretched hands @ @ @ @ @ @ @ glance if they ’ ve broken a wrist .
But most medical problems aren ’ t obvious .
They arise from hidden processes that occur within the body , in tissues , cells , enzymes , or genes .
They manifest only indirectly , through symptoms or signs .
As the American Medical Association noted , in 1912 , internal medicine is concerned primarily with “ abstract problems ” and the “ intangible struggle against unseen infections.
” Choosing an appropriate treatment depends on discerning the cause of an illness—and yet there are @ @ @ @ @ @ @ symptoms .
How do doctors connect a symptom to a cause ?
The answer , of course , is that we test .
To test is to examine something critically , to put it to the proof .
The word is often thought to derive from the Latin testari , meaning to testify .
But the Reverend Abram Smythe Palmer , a respected nineteenth-century lexicographer , placed its origins with the Old French test , which referred to a vessel used for cupellation , the extraction of precious metals with heat .
“ @ @ @ @ @ @ @ ” Palmer wrote , in 1882 , “ is properly to submit it to the crucible or melting pot , to assay the quality of its metal.
” The emergency department often feels like a crucible , where we approach our patients , undifferentiated , as a minter approaches ore. We apply our tests to find out what lies within .
Today , amid the coronavirus pandemic , we are thinking about medical tests more than usual .
Often , we have a fairly simple vision of how tests work .
We picture @ @ @ @ @ @ @ see them cutting through the ambiguities of an often asymptomatic virus .
We hope that , by speedily distinguishing between the sick and the well , tests might help us establish defensive cordons around schools , workplaces , and public events .
Colleges and universities have used coronavirus tests to sort students into different dormitories as they return to campus .
Sports teams , too , have created testing-based “ bubbles ” within which they hope something like normal life can go on .
We envision simple steps—a nasal swab , a sample @ @ @ @ @ @ @ news or an all-clear .
But physicians tend to approach testing more cautiously , and in an incremental fashion .
In fact , we are always testing , often in ways that don ’ t involve technology .
One of our most important tests is one of our simplest : the visual assessment , what we call “ eyeballing ” a patient .
There ’ s a double meaning to the statement “ the doctor will see you now ” ; just laying eyes on someone can yield a huge amount of information @ @ @ @ @ @ @ patient is critically ill or stable ; we can often recognize critical illness from the way someone looks in a doorway .
We may not know the cause , but we can sense the severity .
A lot of testing happens through language .
Around 100 A.D. , Rufus of Ephesus , a Greek physician , published the first treatise on taking a medical history ; he described aspects of the patient interview that medical students still learn today , such as asking about the location , duration , and character of pain @ @ @ @ @ @ @ in medical school but didn ’ t realize until my residency that interviewing patients is actually a way of testing them .
“ Think about it this way , ” one of my supervisors said .
“ When you question a patient about their symptoms , do their answers influence your suspicion of potential causes ?
” They do , just as the results of a blood test would .
In the centuries after Rufus , doctors pioneered new ways of testing the body .
“ Water casting , ” or inspecting urine @ @ @ @ @ @ @ in medieval Europe .
The Jerusalem Code of 1090 made doctors liable to public beatings if they failed to examine it .
A blood-pressure measurement was taken for the first time in 1733 , when an English clergyman inserted a brass pipe into the artery of a horse .
( He found that the animal ’ s blood pressure rose by a factor of four when it began struggling . )
In the seventeen-fifties , Leopold Auenbrugger , an Austrian physician , developed a groundbreaking technique called percussion , which is still in @ @ @ @ @ @ @ tapping wine casks to determine how full they were , he realized that a similar method could be employed to localize diseases , such as pneumonia , within the body of a living patient .
He discovered that a healthy lung , when rapped with a couple fingers , sounded like “ a drum covered with a thick woolen cloth , ” whereas a diseased region was “ entirely destitute of the natural sounds .
”

During my medical residency, I spent a month on the obstetrics ward, learning how to deliver babies. On one occasion, I was paged to a delivery room down the hall. Inside, I saw the mother-to-be propped up in bed, her husband sitting next to her. Then I noticed the crowd. In addition to the obstetricians and delivery nurses, a special team of nurses and pediatricians from the neonatal I.C.U. had gathered.
“Is this a high-risk delivery?” I asked one of the obstetrics residents.
“Maybe,” he whispered back. “The baby had a positive screen for cri du chat.”
Cri du chat, which means “cat’s cry” in French, is a rare genetic syndrome affecting one in fifteen thousand to fifty thousand infants. It was discovered by Jérôme Lejeune, a French geneticist, in 1963. Early in fetal development, genes situated on the short arm of chromosome 5 are accidentally left out, like parcels falling off the back of a delivery truck; affected children can have poor muscle tone, low birth weight, a cleft palate, unusually small heads, speech delays, learning disabilities, and heart problems. As many as one in ten children with cri du chat don’t survive the first year of life. The anatomy of the vocal cords is often affected, as well, resulting in a highly abnormal cry that sounds startlingly like the mewing of a cat.
Because the syndrome can cause such significant handicaps, pregnant women with risk factors are often offered a screening test. By sampling fragments of fetal DNA that have migrated from the placenta into the mother’s blood, doctors can sometimes detect the fingerprints of a genetic disorder. But, because the test doesn’t inspect the infant’s DNA directly, it can’t provide a perfect picture of fetal genes and chromosomes; it’s more like a slightly blurry snapshot. It’s possible for a result to be incorrect—falsely positive or falsely negative. If the screening test does come back positive, another test is needed to confirm the diagnosis. This second test is more invasive, and involves taking samples of fetal or placental tissue. And yet, although it’s more accurate than the screening test, it’s not perfect, either. Even the confirmatory tests can sometimes be misleading.
As we stood near the back of the room, the obstetrics resident told me that the laboring woman had undergone some of these more advanced tests. The results had been reassuring, and the team had told the parents that the fetus was most likely normal. But the tests couldn’t say for sure, and neither could we. The neonatal-I.C.U. team was there on standby because, despite our most sophisticated tests, the nature of the child would remain a mystery until the moment of its birth.
In the room, that moment unfolded in stages. First, we glimpsed the child’s head; then the shoulders, then limbs, then a body. The room was strung on a wire as the crowd of nurses and doctors watched the delivery in silence. The obstetrician lifted the newborn free of the birth canal. The cord was clamped and cut, and the newborn opened its mouth, filled its lungs, and cried. The exhausted mother beamed as she held her child in her arms. She didn’t hear what everyone else heard. The cry was not a normal cry. Shrill and plaintive, it sounded like the mewing of a cat.
Some medical problems are obvious. When the sidewalks in Boston are icy, I see a lot of patients who’ve lost their footing and fallen onto their outstretched hands; I can usually tell at a glance if they’ve broken a wrist. But most medical problems aren’t obvious. They arise from hidden processes that occur within the body, in tissues, cells, enzymes, or genes. They manifest only indirectly, through symptoms or signs. As the American Medical Association noted, in 1912, internal medicine is concerned primarily with “abstract problems” and the “intangible struggle against unseen infections.” Choosing an appropriate treatment depends on discerning the cause of an illness—and yet there are a number of possible causes for most symptoms. How do doctors connect a symptom to a cause?
The answer, of course, is that we test. To test is to examine something critically, to put it to the proof. The word is often thought to derive from the Latin testari, meaning to testify. But the Reverend Abram Smythe Palmer, a respected nineteenth-century lexicographer, placed its origins with the Old French test, which referred to a vessel used for cupellation, the extraction of precious metals with heat. “ ‘To test’ a thing,” Palmer wrote, in 1882, “is properly to submit it to the crucible or melting pot, to assay the quality of its metal.” The emergency department often feels like a crucible, where we approach our patients, undifferentiated, as a minter approaches ore. We apply our tests to find out what lies within.
Today, amid the coronavirus pandemic, we are thinking about medical tests more than usual. Often, we have a fairly simple vision of how tests work. We picture them as high-tech and definitive; we see them cutting through the ambiguities of an often asymptomatic virus. We hope that, by speedily distinguishing between the sick and the well, tests might help us establish defensive cordons around schools, workplaces, and public events. Colleges and universities have used coronavirus tests to sort students into different dormitories as they return to campus. Sports teams, too, have created testing-based “bubbles” within which they hope something like normal life can go on. We envision simple steps—a nasal swab, a sample tube, an expensive machine—followed by bad news or an all-clear.
But physicians tend to approach testing more cautiously, and in an incremental fashion. In fact, we are always testing, often in ways that don’t involve technology. One of our most important tests is one of our simplest: the visual assessment, what we call “eyeballing” a patient. There’s a double meaning to the statement “the doctor will see you now”; just laying eyes on someone can yield a huge amount of information. We can quickly tell whether a patient is critically ill or stable; we can often recognize critical illness from the way someone looks in a doorway. We may not know the cause, but we can sense the severity.
A lot of testing happens through language. Around 100 A.D., Rufus of Ephesus, a Greek physician, published the first treatise on taking a medical history; he described aspects of the patient interview that medical students still learn today, such as asking about the location, duration, and character of pain. I learned many of these principles in medical school but didn’t realize until my residency that interviewing patients is actually a way of testing them. “Think about it this way,” one of my supervisors said. “When you question a patient about their symptoms, do their answers influence your suspicion of potential causes?” They do, just as the results of a blood test would.
In the centuries after Rufus, doctors pioneered new ways of testing the body. “Water casting,” or inspecting urine, became the diagnostic test of choice in medieval Europe. The Jerusalem Code of 1090 made doctors liable to public beatings if they failed to examine it. A blood-pressure measurement was taken for the first time in 1733, when an English clergyman inserted a brass pipe into the artery of a horse. (He found that the animal’s blood pressure rose by a factor of four when it began struggling.) In the seventeen-fifties, Leopold Auenbrugger, an Austrian physician, developed a groundbreaking technique called percussion, which is still in use today. After observing his father tapping wine casks to determine how full they were, he realized that a similar method could be employed to localize diseases, such as pneumonia, within the body of a living patient. He discovered that a healthy lung, when rapped with a couple fingers, sounded like “a drum covered with a thick woolen cloth,” whereas a diseased region was “entirely destitute of the natural sounds.”
Within a hundred and fifty years, the stethoscope, the thermometer, the blood-pressure cuff, and the electrocardiogram became standard medical tools. Techniques to measure blood-clotting time and the concentration of white blood cells became available; diagnostic tests for tuberculosis, diphtheria, cholera, and typhoid were introduced. But the most astonishing addition to the arsenal of medical tests during this period was the X-ray, developed in 1895. A medical reference book that I keep on my desk, published in 1910, is ecstatic in its description. “Verily the X-ray opens the field for the grandest of electrical possibilities,” the authors write, allowing physicians to make “far-reaching diagnoses, and to ascertain with certainty the whole internal structure of the human body.” It must have seemed that this flood of new technology would bring doctors closer to certainty than ever before. But it was the X-ray which first demonstrated that testing was much more complicated than anyone realized and that medical tests might deceive as well as diagnose.
In an essay for the Harvard Law Review, in 1897, Oliver Wendell Holmes, Jr., wrote about an eminent judge who refused to issue verdicts until he was absolutely certain that they were correct. It was an understandable impulse, Holmes argued, given the “longing for certainty and for repose which is in every human mind.” But he thought it misguided. “Certainty generally is illusion,” Holmes concluded, “and repose is not the destiny of man.”
Holmes was right that a longing for certainty is fundamental to human psychology. Studies have suggested that we tolerate physical pain better than uncertainty; the psychologist Jerome Kagan has argued that the impulse to resolve uncertainty is a chief driver of human behavior. Uncertainty about the world around us is difficult enough. But when it comes to our own bodies it can be especially unsettling, and the impulse to peer inside and resolve it is powerful. From 2001 to 2002, researchers asked five hundred Americans whether they would prefer a thousand dollars in cash or a free full-body CT scan; seventy-three per cent chose the scan, even though they had no symptoms of disease at the time. In the E.R., it’s common for my patients to press for an X-ray or scan, even if my assessment suggests that they don’t need one. I imagine it’s because they find the idea of a test to be more definitive, more objective, than my words of reassurance.