“Hey, Dr. Ryan!”

I had to laugh at a piece in today’s New York Times about the increasing informality of students’ emails and other communications with their professors: https://www.nytimes.com/2017/05/13/opinion/sunday/u-cant-talk-to-ur-professor-like-this.html?emc=edit_th_20170514&nl=todaysheadlines&nlid=44005038&_r=0

In recent years, I, too, have opened an email from a student and been stunned by the salutation: “Hey, Dr. Ryan!”

Just a few days ago, I received an email inquiring about the possibility of obtaining an internship from an English major I’ve never met. The message began, “Hi Cynthia!” Really?

Like the author of the NYT piece, I pride myself on creating a comfortable environment for my students. I do so because 1) I want students to feel at ease asking questions and confident in their ability to participate in the learning process, and 2) a laid-back style best matches my personality. That said, I’m sometimes thrown off by a student’s disregard for the role I play in the classroom and the work I put into getting there.




Packaging illness

The following story in The New York Times laments the delay in the U.S. of presenting images of diseased lungs, oral cancer, and other effects of smoking on cigarette packs: http://www.nytimes.com/2016/06/03/opinion/let-smokers-see-the-warning-they-need.html?emc=edit_th_20160603&nl=todaysheadlines&nlid=44005038&_r=0

According to the author, the FDA’s release of these images and mandate that the images be displayed on tobacco products to offer a frank warning to consumers was met with legislation on the part of the tobacco industry. As with many battles caught up in the legal system, the industry has bought itself a good amount of time. Five years, at least.

As I read Cohen’s op-ed, I thought back to the packaging I saw on cigarettes when I visited Nepal in 2011. Images like those described by Cohen were already displayed on tobacco products there, an observation I made while standing in line at one of many small shops on the streets of Kathmandu.

Inside a cancer hospital in the ancient city of Bhaktupar, I noticed a similar trend. Lining the walls of the facility, where families venture with loved ones addressing cancer to seek the level of care they are able to afford (see my post on “Opening a Window on Cancer,” an article that I wrote about cancer care in Nepal), were informative posters presenting details about cancer causes, symptoms, and treatments. I was surprised by the graphic images shown on these documents, especially given the hesitancy in Nepalese culture to speak about cancer.

Cohen claims that more graphic images on tobacco packages have been shown to deter smoking among consumers, including among children who might think twice about starting if they are faced with the ugliness of tobacco’s physical and aesthetic effects. I have to wonder, though, how big a difference the images will make in individual behaviors.

While I agree with Cohen that the tobacco industry is getting away with murder–my words, not hers–I’m often amazed by the lack of effect quite graphic images have on the choices we Americans make. In fact, in some instances, as in widespread coverage of gun violence, the more graphic the image, the more desensitized we seem to become.

Ignorance is bliss?

A story in today’s New York Times caught my eye: http://www.nytimes.com/2015/08/24/opinion/the-case-for-teaching-ignorance.html?emc=edit_th_20150824&nl=todaysheadlines&nlid=44005038&_r=0

The author claims that overstating the certainty of knowledge is a problem. When we convey the message that we know everything there is to know about just about anything–climate change, the common cold, characterization in Winnie the Pooh–we’re apt to 1) be wrong, and 2) ignore the questions yet to be asked and answers yet to be given. Curiosity, Jamie Homes claims, is fueled by uncertainty.

I run into the discussion of what scientific understandings are more and less certain every semester when I teach a writing class to college freshman enrolled in UAB’s Science and Technology Honors Program. While many students have learned to appreciate those ideas that are backed by stacks and stacks of evidence, fewer are eager to share the complexities that confound researchers.

It’s my task as a teacher to encourage students to view research gaps, questions, and puzzles as opportunities to keep on looking. As I tell my students, that’s where the fun lies.

Both Worlds

An excellent op-ed appeared in yesterday’s Washington Post: http://www.washingtonpost.com/posteverything/wp/2015/02/18/we-dont-need-more-stem-majors-we-need-more-stem-majors-with-liberal-arts-training/?hpid=z11

Author Loretta Jackson-Hayes argues against the traditional dichotomy opposing STEM fields and the liberal arts, as she claims that divorcing one worldview from the other could have disastrous effects. Jackson-Hayes insists that the best scientists–whether they become physicians, work in academic or commercial labs, or serve as hands-on engineers in large corporate settings–bring the sort of critical thinking and writing skills learned in the liberal arts to the bench. One particularly poignant paragraph draws on the example of leading thinkers Leonardo da Vinci and Steve Jobs:

“Our culture has drawn an artificial line between art and science, one that did not exist for innovators like Leonardo da Vinci and Steve Jobs. Leonardo’s curiosity and passion for painting, writing, engineering and biology helped him triumph in both art and science; his study of anatomy and dissections of corpses enabled his incredible drawings of the human figure. When introducing the iPad 2, Jobs, who dropped out of college but continued to audit calligraphy classes, declared: ‘It’s in Apple’s DNA that technology alone is not enough — it’s technology married with liberal arts, married with the humanities, that yields us the result that makes our heart sing.'”

I agree wholeheartedly with the argument Jackson-Hayes makes. When I teach students from the Science and Technology Honors Program each semester, I’m stuck by the spark of creativity and insight that comes from embracing both worlds.

Race and Health Disparities

U.S. News and World Report addresses the vast differences in health outcomes between white and black Americans: http://www.msn.com/en-us/news/other/black-americans-have-fewer-years-to-live-%e2%80%93-heres-why/ar-BBhuWCH?ocid=DELLDHP

The report is far from surprising. People from varying socioeconomic groups, which oftentimes parallel color lines, experience life differently. Family traditions, cultural assumptions and expectations, and hereditary predispositions affect how people live and the diseases from which they suffer.

I see many of the patterns mentioned in the article during my visits to Edwina’s apartment and in contrast to my own family’s lifestyle choices.

Edwina struggles with obesity and smoking, trying but never quite achieving the kinds of dietary changes that would enable her to lose weight and get the exercise she needs to make smoking an inconvenient pastime. Bruce and the girls and I wake up and have our running shoes on before we finish eating breakfast, making sure to leave enough time to hit the trail near our house before the work of the day begins.

The difference between Edwina’s world and mine, I believe, has little to do with personal motivations.

As noted in the article, many layers contribute to health disparities: education, lifestyle, environment, genes. The complexity is yet one more reason to quit pointing fingers and assigning blame when people get sick. It makes far more sense to begin peeling back the layers to understand what lies beneath.

Doctor’s orders

Edwina called me late yesterday afternoon to tell me that she’s in the hospital at Princeton, a facility just a couple of blocks from her apartment. On Saturday, she said, she got “to coughing real bad” and “couldn’t catch [her] breath.” The ER folks clocked her oxygen level at 80%. The docs also discovered blood clots in her legs, so Edwina’s been receiving blood thinners along with oxygen and steroids for her COPD.

I made my way to Room 5117 this morning, bearing gifts of red grapes (Edwina’s favorite!) and a word search book focusing on the scriptures. Edwina’s face lit up when I handed them over.

We talked for more than an hour. Edwina told me that she was ready to go home, since she has an oxygen machine and her CPAP machine there to use.

“The doctor says I got to use both of my machines all the time,” Edwina told me, looking weary at the very thought.

Plus, she said, “I kicked Tyrone out. He make my blood pressure go up. And Joe-Joe [Edwina’s brother] says he ain’t gonna smoke in my apartment anymore or let in anybody who do.”

Edwina told me she was worried about how to get all the prescriptions she was probably going to need when she was released from the hospital.

“I already get four medicines,” she said, listing them off on her fingers. “And Medicaid only lets you get five prescriptions every month.”

I requested a visit from one of Princeton’s social workers, who arrived within ten minutes to talk over the problem with Edwina. Mandy told Edwina that she’d send the pharmacist from the hospital up, telling Edwina that this woman is particularly effective at finding the cheapest routes possible to filling prescriptions. Through coupons and special delivery plans, Mandy thinks Edwina might be able to manage.

The doctor’s visit interrupted our conversation, as a tall man in a white coat strode in with a team of doctors in training.

After a brief check on Edwina’s breathing, the doctor told her that she’d be going home either later today or tomorrow.

“You’ve got the oxygen machine and the CPAP at home and I want you to use them,” he said sternly.

“And,” he continued, “either you quit smoking or you’ll die. It’s that simple.”

I chimed in with a question about how to make the nicotine patches more afforable for Edwina. Her last attempt to use them cost her $85 at Wal-Mart, and she wasn’t able to buy more than one box.

“How much do cigarettes cost?” he replied.

“‘Bout $4 a pack,” Edwina said.

“So what’s a better deal, cigarettes that are gonna kill you or patches that are going to help you stop and save your life?”

“Yes, sir, I know I got to quit,” Edwina responded, lowering her head–a sign that I’ve come to recognize as Edwina’s response when she’s embarrassed about being scolded.

All I could think as I walked down the hospital hallway at the end of my visit was how hard the doctor’s reasoning would be to implement. I’m certainly not in favor of Edwina resuming her smoking habit, but the fact is that she can afford $4 many days to pick up a pack of cigarettes. But her lack of money management skills makes reserving $85 for a box of nicotine patches close to impossible.

In situations like this, I’m reminded of the need for medical professionals to educate themselves about the circumstances of many patients’ lives that make following doctor’s orders a lot more complicated than it might seem on the surface.


One of the survivors featured in the expanded exhibit of The Alabama Project recently passed away from complications of breast cancer. Debbie Tabb welcomed David, Lauren and me into her home last July 4 to celebrate with her family. The joy and love in the room was infectious, despite the realization among many that her health was rapidly declining.

Debbie was unstoppable. A breast cancer diagnosis, and metastasis to her ovaries, her bones, and her left eye did little to slow her down. Every morning, she continued to rise early to be in place at the Hale County Board of Education when the busses pulled out at 6:00 a.m. to make their rounds. For a while, she even drove a school bus. She refused to let cancer change how she went about her days.

Her journey encouraged her to educate other women, to empower them to care for themselves and to face their fears and talk about their experiences.

“I saw somebody I knew in the grocery store and she looked like she didn’t care what she looked like, no makeup on, her hair stuck up under a hat,” Debbie told me as we sat waiting for members of her family to arrive for the Fourth of July feast she was hosting. “I told her, ‘you need to take care of yourself and make yourself look like you’re still living.'”

“Cancer is nothing to be ashamed of or embarrassed about,” Debbie continued. “Some people in the community think they’ve got to hide. That needs to stop if we’re going to change the mindset in Black communities.”

Debbie recognized that how she walked the walk, how she lived her life with cancer, was important. For her own need to feel alive. For her family to see that she was living the life she wanted to live, all the way to the end. For her neighbors, to witness the vitality and passion that can characterize a life affected by cancer.