Rest In Power, King

https://www.facebook.com/chadwickboseman/photos/a.10154144681649864/10157949281529864

My heart is so heavy this weekend, friends.  Maybe yours is, too.  Humanity lost such a bright star last night.  I post today to collect, for myself in one place, words and videos of and about Chadwick Boseman, so I may return here for inspiration and grace hereafter.  This is my tribute.

Read about his most visible and important body of work, in the space of only seven years.  I wish I had known him sooner.  But I’m sure many would agree, once we knew him, we were mesmerized.  Just seeing him, watching and hearing him speak, we felt an immediate kinship.  Superhero?  Yes, absolutely.  And also someone we could sit down with over a drink and really relate—easily.  At least that’s my fantasy. Through his work, he calls us to be better, to fulfill our potential.

Read about his family and early life experiences, his journey to and through acting, and how he approached his characters and life in general:

In a pop taxonomy of black male nobility, he is cut squarely from the mold of Barack Obama — generally cool-blooded, affable, devoted to unglamorous fundamentals — a figure whom he is doubtlessly on a shortlist to portray in an inevitable epic.

Boseman told me his method of humanizing superhumans begins with searching their pasts. He’s looking for gestational wounds, personal failures, private fears — fissures where the molten ore of experience might harden into steel.

Watch Black moviegoers, young and old, express what he means to them in his portrayal of Wakanda’s King T’Challa in Marvel’s Black Panther. This video made me cry. To see the deep and profound emotions of people who finally see themselves represented on the big screen—why have they had to wait so long? It reminds me of how I cried during Crazy Rich Asians, when I heard Yeh Lai Xiang, a song I grew up listening to, when I heard such familiar words spoken by the characters, when I watched and understood viscerally the meaning of the ma jiang scene. Watch also how Boseman emerges from behind the curtain to meet and embrace each of these fans—see his presence, his empathy, his respect, humility, grace, humor, and magnanimity.

Watch him speak on behalf of his colleagues on their challenges in their industry, and the meaning of their success for themselves and those who will come after them. Watch how he effortlessly inhabits confidence, strength, humility, authenticity, hope, and challenge. See how he graciously accepts accolades while simultaneously conveying a message that we have work yet to do (that’s how I hear it). To be “young, gifted, and Black,” indeed.

Finally, watch—don’t just listen or read, really watch—his 2018 commencement address at his alma mater, Howard University.  See his easy and relaxed, generous and relatable demeanor.  Hear his words—stories of challenge, integrity, perseverance, and generosity—both his and the students’.  Feel his hopes for and blessings on the graduates, and his admonishment to us all, to be better, to lead, to take the harder path, for the sake of those who come after us.  Some brief exerpts: 

But beyond the physical campus, the Hilltop represents the culmination of the intellectual and spiritual journey you have undergone while you were here. You have been climbing this academic slope for at least three or four years. For some of you, maybe even a little bit more. Throughout ancient times, institutions of learning have been built on top of hills to convey that great struggle is required to achieve degrees of enlightenment. Each of you had your own unique difficulties with the hill.

Most of you graduating here today struggled against one or more of the impediments or obstacles I’ve mentioned in order to reach this hill top. When completing a long climb, one first experiences dizziness, disorientation and shortness of breath due to the high altitude, but once you become accustomed to the climb, your mind opens up to the tranquility of the triumph.

As is often the case, those that follow most often enjoy the results of the progress you gained. You love the university enough to struggle with it. Now, I have to ask you that you have to continue to do that even now that you received your demands. Even if you are walking today, you have to continue to do that. Everything that you fought for was not for yourself. It was for those that come after. You could have been disgruntled and transferred, but you fought to be participants in making this institution the best that it can be.

Your freedom of speech was exercised in a way where you can contribute to this place. It also shows that you can contribute to the democracy. The administration and the campus police at the time when I was protesting were not nearly as open-minded as this current one. I know this was a difficult time, but because of both of you, I believe Howard is a few steps closer to the actualization of its potential, the potential that many of us have dreamed for it. Students, your protests are also promising because many of you will leave Howard and enter systems and institutions that have a history of discrimination and marginalization. The fact that you have struggled with this university that you love is a sign that you can use your education to improve the world that you are entering.

…execs of the show called me into their offices and told me how happy they were with my performance. They wanted me to be around for a long time. They said if there was anything that I needed, just let them know. That was my opening. I decided to ask them some simple questions about the background of my character, questions that I felt were pertinent to the plot. Question number one: Where is my father? The exec answered, “Well, he left when you were younger.” Of course. Okay. Okay. Question number two: In this script, it alluded to my mother not being equipped to operate as a good parent, so why exactly did my little brother and I have to go into foster care? Matter-of-factly, he said, “Well, of course she is on heroin”.

That could be real, I guess, but I didn’t want to assume that’s what it was. If we are around here assuming that the black characters in the show are criminals, on drugs and deadbeat parents, then that would probably be stereotypical, wouldn’t it? That word stereotypical lingered. …I was let go from that job on the next day.

…But am I actually black balled. We are hesitant about sending you out to some people right now because there is a stigma that you are difficult. As conflicted as I was before I lost the job, as adamant as I was about the need to speak truth to power, I found myself even more conflicted afterwards. I stand here today knowing that my Howard University education prepared me to play Jackie Robinson, James Brown, Thurgood Marshall and T’Challa.

Graduating class, hear me well on this day. This day, when you have reached the hill top and you are deciding on next jobs, next steps, careers, further education, you would rather find purpose than a job or career. Purpose crosses disciplines. Purpose is an essential element of you. It is the reason you are on the planet at this particular time in history. Your very existence is wrapped up in the things you are here to fulfill. Whatever you choose for a career path, remember, the struggles along the way are only meant to shape you for your purpose. When I dared to challenge the system that would relegate us to victims and stereotypes with no clear historical backgrounds, no hopes or talents, when I questioned that method of portrayal, a different path opened up for me, the path to my destiny.

Our time on this earth is truly short, my friends.  What are we doing with it? 

God bless you, Mr. Boseman, for your shining example.  You are a king of our hearts in so many ways.  Now you rest.  We carry on in your honor.

On the Full Body CT Scan: Don’t Do It.

caduceus

NaBloPoMo 2016, Letters to Patients, Day 27

To Patients Considering Full Body CT Scans:

Please reconsider.

Forgive me for putting on my preachy doctor hat for this post.  I will also break my NaBloPoMo 500 word limit for this one.

As we approach the end of the calendar year, many of you may have met your health insurance deductibles.  Maybe now would be a good time to get in some tests to ‘check under the hood,’ as some of you have said.  I share below some of my screening  recommendations, along with rationale.

Keep in mind that for this article, I define ‘screening’ as looking for a disease in a person with a) average risk for developing the disease and b) no symptoms.

Please also know that the opinions I express here are my own only and do not necessarily represent those of my colleagues, employer, or professional societies.

 

  1. Full body CT scan: This is not recommended by any clinical guideline or medical professional society as a screening test for anything.  As I will describe below, specific screening tests are recommended for specific diseases, and the best ones obtain actual cells or tissue, rather than imaging alone.  In addition, a full body CT exposes you to significant radiation, the long term consequences of which are still not fully understood.  Lastly, CT scans inevitably detect incidental abnormalities that have no clinical consequences, but that often lead to invasive tests that can cause real harm, such as bleeding, pain, infection, and anxiety.  This article from the FDA and this one by a radiologist at Harvard explain pretty clearly how the risks of this test far outweigh the benefits.
  2. Colonoscopy (colon cancer): This is the one test that nobody argues.  It is both diagnostic (can see signs of early disease) and therapeutic (can take it out).  Start at age 50, and repeat every 10 years if normal, barring new symptoms.  Read the full guideline from the US Preventive Services Task Force (USPSTF) here.  I know the prep is a pain, and I know you have to take a day off of work to have it.  But on the whole, the returns here are well worth the investment.
  3. PSA and digital rectal exam (prostate cancer): This is perhaps the most personal decision of all cancer screening. Population-wise, we have yet to show mortality benefit from screening of any kind, such that the USPSTF now recommends against screening until better tests become available.  But it’s not really that simple, because prostate cancer affects so many men, and is the second leading cause of cancer deaths in men in the US.  The most important thing here is to decide which risks you are more comfortable with: potential serious harm from screening and unnecessary treatment, or finding cancer at a later, potentially more high-risk stage.  This article from the New York Times may help, and this one from the National Cancer Institute.cancer-cases-and-death-2016
  4. Mammogram (breast cancer): It’s hard to walk back from more screening to less; people fear loss of security. When I started my training over 20 years ago, the recommendation was to screen every woman every year, starting at age 40.  Since then epidemiologists have kept track, and similar to prostate cancer screening, the mortality rate from breast cancer has not decreased proportionally to the amount of screening done.  Diagnosis has increased dramatically, due to early detection.  Again, screening increases the risk of certain harms:  anxiety (so much, for so many), pain, deformity, infection (from invasive biopsies), and then commitment to repeated testing (a vicious potential cycle of imaging, needling, more imaging, and more needling), while likely not saving your life.  Here is the USPSTF guideline, and a helpful infographic .  Like prostate cancer screening, this is one you have to decide for yourself, with the help of your doctor.mammo-infographic
  5. Pap smear (cervical cancer): Again, former guidelines called for annual screening. Today, if your test is repeatedly normal and your sex habits are low risk, the interval can be lengthened to 3 to 5 years, and can start later in life (over 21).  Cervical cancer is highly correlated to exposure to human papilloma virus, or HPV, which is sexually transmitted.  Positive pap results, which range from mild to severe, occur far more often in younger women, and of those, many will revert to normal without progression to cancer in a woman’s lifetime.  The main risk of over-screening, again, is unnecessary procedures when true disease not present.

In summary, these are the most common conversations I have with patients about screening.  You may rightly infer that my personal bias is minimalist:  Primum non nocere.  Unfortunately, we have no good screening tests for some diseases, such as pancreatic cancer, ovarian cancer, and liver cancer, and the screening guidelines in other countries (eg Taiwan screens adults regularly for liver cancer) do not apply here because prevalence rates differ so widely.

This is why I think it’s important to establish care with a primary care physician and get regular check-ups.  That fatigue you feel is likely just life and chronic sleep deprivation.  You’re probably constipated because you eat too few stems/stalks/leaves and don’t move enough.  You and your doctor can review your general health together, and if there is suspicion for some underlying health risk, it can be addressed personally and specifically.

To look up USPSTF guidelines yourself, I recommend searching Google for “USPSTF (disease) guidelines” and look for the hit that starts with “Final Recommendation Statement…”  I have no financial or professional interests in Google or the USPSTF.  Other respected sources for screening recommendations include the National Cancer Institute, the American Cancer Society, and the American Medical Association.  As an internist, I recommend the American College of Physicians.

I hope this piece has helped illuminate the complex decision-making behind screening and diagnostic testing.  I have only scratched the surface; the links contain the data and full rationale.  Please take the time to read through them and discuss them with your doctor.