Sunday, February 16, 2014

Military Uniforms: The Virtues of Humility


Dig the stripes on the pants
 Whenever the Chief of Medicine walked on the ward, a junior medical resident ran ahead of him and told all the interns, residents and medical students to pull on their white jackets. Ordinarily, these jackets were left hanging about on the backs of chairs or thrown on counter tops. In those days only surgeons wore scrubs; at The New York Hospital, housestaff (interns and residents) in the Department of Medicine wore white tunics with a blue New York Hospital patch on the left shoulder and white pants with the same patch near the beltline. After twenty hours on call, most of the tunics and pants were stained with blood, urine, vomit, stool and presumably, the sight of troops on the line looking disheveled  and stained would be offensive to the delicate sensitivities of the Chairman of the Department of Medicine.  
We didn't much care what the Chairman thought. He didn't know any of our names. He was not a clinician. He had worked in laboratories most of his career, was British and he did not make rounds with the interns and residents the way the chairmen of Neurology, Gynecology or Surgery did. What would he have had to say about a patient who presented with a fever or pulmonary edema?  He appeared on the ward rarely, and usually because some distinguished, that is, wealthy person had been admitted. 
Looking at the get ups of the current chiefs of staff of the Army, Air Force and Navy, The Phantom wonders what all those gizmos are supposed to say about the guy wearing them. 
Consider Ulysses S. Grant, commander in chief of the greatest American army in our greatest war, a war in which more Americans were killed than all other wars in our history combined.  Pretty simple uniform. 
Grant had once, as a young lieutenant ridden into town in a fancy uniform and was ridiculed by a stable boy for putting on airs. Grant never dressed up much after that experience, preferring a private's blouse to wear around camp. He didn't need a lot of shiny hardware to command respect. 
One wonders what the current get ups say about the compensatory psychology of our current commanders. If they need all those merit badges, do they really command respect?
Look Ma! I'm an Eagle Scout.

wT

Tuesday, February 11, 2014

Obamacare: Slouching Toward Britannia





Yesterday, the Obama administration announced yet another fix to the nascent Obamacare healthcare program--this time delaying the requirement that businesses of a certain size, defined by the number of employees, could delay paying for health care coverage for their employees.

This can be seen as part of the normal process of government: A regulation is promulgated; affected parties complain, seek a redress of grievances and are accommodated. It works this way with farm legislation, with requirements for increased gas efficiency from auto makers--you name it.

But, in a larger sense, this is really a reflection of a basic flaw in thinking. Republicans, libertarians, conservatives of all stripes categorically rejected the idea that health care is an enterprise, a responsibility which belongs with the people or with its elected government. Healthcare, to Republicans/T party loonies/libertarians is a commercial venture, and is most efficient and best provided when the profit motive drives efficiency and innovation. 

President Obama and his party had no chance of getting even the first step of health care reform had they not conceded this point. What Obama was able to sign into law was a health insurance industry resuscitation act--a law which provided millions more customers for the health insurance industry.

Mad Dog, getting crustier and more ossified with each passing month, has long groused that America, when it comes to health care, is only now just catching up to where Great Britain was over 40 years ago.  When Mad Dog found himself in London as a fourth year medical student doing an elective, he was shocked and dismissive about what he saw as a second rate medical care system.  Patients were admitted to hospital and never seen by their primary care practitioners. Patients were cared for by hospital based physicians, who then returned the patients to their local general practitioners, with a report. 

When Mad Dog asked these patients when they expected their own doctors would be coming into the hospital to write their admission orders, the patients reacted in confusion. "What? You mean Dr. Jones? Why would he come here? He'll see me after I'm home."  

In America, the line was you wanted, nay, you needed to see the doctor who knows you best when you are in trouble, when you get sick enough to be admitted to the hospital. This was an article of faith among American physicians. Not seeing your own patient when he was admitted to the hospital smacked of "abandonment." It was part of that strong bond between doctor and patient. He is MY patient. I must arrive on my white charger and direct his care, protect him, defend him and be sure I steer him through the dangerous shoals of the American hospital.

It turned out, of course, this was a lovely story, but it was sentimental and not the best medical care. Having practiced in this system, once he graduated, Mad Dog quickly saw the dangers and problems with this system. Community hospitals often cleared out after 5 PM, with no doctors on the wards, patients left entirely in the care of nurses, who often spoke little English and were inadequate to their tasks.  Doctors, busy in their offices, could not come in to see their patients who had arrived earlier in the day, and so they called in "holding orders," for patients based on what the Emergency Room doctor who had seen the patients told the doctors who had not seen the patient.  Too many telephone calls from nurses ensued, too many doctors called in orders over the phone, blind.

When Mad Dog arrived in the hospital, he discovered Mad Dog's twenty-third law applied: Whatever you had been told over the phone, it was wrong.

The English hospitals were far safer, far better run in 1972 than the American hospitals were in 2000, until the American hospitals finally discovered and accepted the idea of "hospitalists," doctors who stayed anchored on the wards, able to go to the bedside, examine the patient, generate orders for tests and treatments based on what they could see first hand. True, they did not "know" the patients as well as the patients' family doctors, but they knew the acute illnesses very well and they knew what was happening in the immediate present. 

Hospitalists provided better care. 

There are a whole host of ways in which the National Health System of the United Kingdom, circa 1972  surpassed the care in the United States even 40 years later, from the use of midwives, the organization of superior home care following hospitalization, the rational restriction of extreme care for patients who would not benefit, to the use of blood products in the treatment of gastrointestinal bleeding. 

And all through those years, when the United States health care system was wasting money, providing inferior care and spending far more money than Britain doing all this, the Republican Party and the conservative voices all loudly proclaimed, "We have the best health care system in the world. People come here from everywhere around the world for the best care. Why would we want socialized, inferior medicine when we've already go the best?"

Of course, we might have had the best care for the top 10% of America's richest people (although Mad Dog doubts even that) but we clearly had inferior care for the rest of the 90% of American citizens.

And 2012, the Republican Party still blocked the path toward improving American healthcare, and the result was Obamacare, about which the Republicans still loudly complain and they plan to seize control of Congress in 2014, riding on the horse they have been whipping while facing its tail rather than its head. 


Saturday, February 8, 2014

Reasons to love the New Hampshire Seacoast




E. B. White wrote an ode to New York City and what made it great. Among the forces he noted was the "newcomers," that steady stream of people who gave the city its vitality, with all their enthusiasm for the place. 

The same is likely true of the New Hampshire seacoast. For Mad Dog, who grew up in the Washington, D.C. area, and then spent 8 years after college in New York City, the Seacoast has been a new love affair, and the bloom hasn't worn off after 6 years. 
In some ways, Mad Dog has got accustomed to the rhythm of life here and what seemed so charming at first--the fact that most Hampton stores closed down by 3 PM, Saturday and are not open Sundays, hearkened back to  the 1950's, when blue laws closed stores on Saturdays and forbade the sale of alcohol on weekends in suburban Washington. Moving to Hampton seemed like walking through a portal in a time warp; Mad Dog was back to a town like the one he had grown up in, frozen in time, 50 years ago.  Now, Mad Dog has got used to the laundry closing at 3 PM on Saturday and plans his morning to get things done early Saturday. 

It's really just fine, and it makes him feel good to know the shop keepers have Saturday afternoon off to go hike up Mount Major or to go surfing.

Some pleasures remain fresh: Reading the Police Log in the Portsmouth Herald.  Some of Mad Dog's favorites:  1. Responded to complaint from woman who said her neighbor called her "obese."  2. Took report from woman who said a young man with "nasty blue eyes" was harassing her while she was cross country skiing. 3. Took report from woman who said a man was following her in a car,  while he may have been delivering newspapers.
These reports, Mad Dog has it on good authority,  are not fictional. They are simply entered and logged in and the newspaper serves them up dry and without comment. 

Of course, Mad Dog would be world's happier if they closeddown the Seabrook nuclear plant. If ever Mad Dog packs up and moves to Maine, it will be because he is seeking a refuge from being at ground zero. When he moved up to Hampton from Washington, D.C., it was surprising the  number of his friends, who,  bidding him farewell, said, "Well, I don't know about New Hampshire, but at least you won't be living at ground zero any more."  And that cheered Mad Dog at some level. But then he discovered his house is about 2 miles, as the crow flies, from the Hampton Falls/Seabrook plant.

When Mad Dog was in middle school, a Congressman parent of one of his classmates gave a talk at a school assembly about the impossibility of hiding from the world and the problems which afflict it. This was 1960, before anyone every heard of "globalization."  He told the story of one of his friends who, tired of living at ground zero, moved to Idaho or Montana, one of those Western states with no people. And he built his home and felt, for the first time in years, safe. But then he drove by an isolated area fenced off with barb wire a few miles from his new home, only to discover it was home to a nuclear missile silo. So there he was, back at ground zero. 

 It made Mad Dog think of that poor man whose farm in Mananas, Virginia became a killing ground at the first battle of the Civil War. So he moved his farm south, to Appomattox, and 5 years later, the war found him there--but of course, that is where the war ended, so he was there at the beginning and the end of the greatest upheaval in American history.

Mad Dog has no ambition to be at the center of American history, at his age. All the movers and shakers he knew in Washington and New York brought to mind Dylan's words:
Princess on the steeple, all the pretty people
They're drinkin', thinking they've got it made.

Nope. They didn't.
People here, in New Hampshire may feel constrained some days. May feel the world is out there, throbbing, growing, doing and here we are in small towns, going to jazzercise on Saturday mornings, and dropping our dogs off at the Barking Dog when we go into Boston for the night. But the fact is, we can go into Boston--C&J connects us to Boston and Manchester airport connects us to the world, as does the internet and so now we can live in the boondocks and live our doggy lives and not be isolated.

Wednesday, February 5, 2014

Chris Muns to the Media: Do Not Bear False Witness

Howard Altschiller
Rep. Chris Muns

Alfred Dreyfus 


Chris Muns, a Hampton Democrat recently introduced a bill in the New Hampshire House of Representatives which would require news media to remove from their websites stories about individuals arrested for crimes if these people were subsequently acquitted.  
Mad Dog has not spoken with Mr. Muns about his thinking on this legislation, but on first consideration, the motivation must be to right a wrong committed against the accused, who was later exonerated. At first blush, this sounds like an acknowledgement that being accused of a crime of which you are innocent is a terrible thing. And the harm continues as long as your picture and the accusation and the report of the trial remains on the internet. At least in past centuries, the records would fade with memories, newspapers would be used for kindling and a person could put the whole experience behind him. Now, not so much. The internet is eternal. In fact, the problem on the internet is frequently distinguishing a report which is a decade old from one which happened today.

Howard Altschiller, publisher of the Portsmouth Herald, predictably, objected. His paper can report on an arrest, a trial, splash it all over the front pages and then simply not report the acquittal, or bury that story in the back pages. And he likes it that way. It's his right, guaranteed by the First Amendment, to say whatever he likes about anyone and to keep it out there.

Full disclosure here: Mad Dog is a lifetime member of the American Civil Liberties Union. Mad Dog applauded when the ACLU supported the right of the Ku Klux Klan to march through a Jewish suburb in Michigan with anti Semitic placards. (Best thing for a bad product is good advertising.) But Mad Dog has always been aware the ACLU, which supports Mr. Altschiller and opposes this bill, is absolutist about the First Amendment.  It is easy to be consistent and pure, when you are an absolutist, but the wisest course often lies in the middle. For the pure ACLU zealot, the man who cries "Fire!" in a crowded theater when there is no fire, has the right to do that. Not for Mad Dog; certain circumstances demand some restriction of the right to free speech if that right tramples on other important rights.

So Mr. Altschiller says it is important to put on the public record the accusation (the arrest and trial) and to keep it there, even if the outcome of the trial  is exoneration. What he is really saying is that in some cases the only punishment meted out to guilty parties is the arrest, the "perp walk" the photos of the accused in handcuffs, humiliated, shuffling with chains binding his ankles, and the trial. And if the jury votes not guilty, well, that's just the jury getting it wrong, but we can make that accused pay every day thereafter, by keeping his image on our website and keeping the accusation fresh every day, because we know he's guilty; judicial process be damned.

"O.J. Simpson was acquitted of second degree murder charges; George Zimmerman was acquitted of second degree murder and manslaughter in the killing of Trayvon Martin," he notes. Which is to say: They got away with murder, but as a newsman, I can keep after them.

But what of the unjustly accused and legally exonerated?  

Alfred Dreyfus is the  name which has become symbolic of unjust accusation and the harm  that can do.  Unjustly accused of treason, he was railroaded toward conviction, before it was overturned and it eventually became clear who the real culprits were and how Dreyfus was chosen as the fall guy because he was Jewish in a France where anti-Semitism was a fact of life.  

What of the man accused of a rape or murder he did not commit? Should he continued to be dogged by this suspicion because a newsman or a cop has decided he was guilty, no matter what the jury thought?

In a less dramatic way, Mad Dog has felt the sting of an accusation which has become indelible in the record. In 1975, Mad Dog responded to a Code Blue, ran up 8 flights of stairs to the operating room, where a man had gone into "complete heart block" when the anesthesiologist put him under general anesthesia.  Mad Dog placed a temporary pacemaker, trundled the patient off to the ICU, wrote a note and left the patient in the care of the ICU staff. Two years later, a sheriff showed up at Mad Dog's with lawsuit papers. The patient had died and the lawyers were suing anyone who had written a note in the chart.  For having saved the patient (temporarily) Mad Dog endured several years of depositions, trips to New York City, and small outrages connected with frivolous charges of ineptitude. From that day onward, every time Mad Dog applied for a license to practice medicine in a new state, every time he applied for hospital privileges, he had to write another essay about that lawsuit. 

So charges, false charges which cannot be put to rest, which continue to haunt you are a violation; they are an offense against the falsely accused. 

Mr. Altschiler cites the First Amendment, but there is also a Fifth Amendment, which says the accused shall not be "deprived of life, liberty, or property without the due process of law."  Can it not be argued the man unjustly accused has been deprived of liberty? We ordinarily think only the government can deprive a man of his liberty--by jailing him, but there are other ways to deprive a man of liberty without the government depriving him: The man who cannot apply for a job, who cannot walk into a bar or join a club because he is listed on the internet as an accused felon, or a sexual pervert, is he not deprived of liberty by unbridled freedom of accusation, unrestrained freedom of speech?

And then there is the Ninth Amendment: "The enumeration in the Constitution of certain rights shall not be construed to deny or disparage others retained by the people."  Which is to say, just because we haven't said so specifically, that doesn't mean the right to enjoy a reputation unsullied by judicially refuted accusations is not contravened simply because we haven't mentioned that specifically. 

You may say, there is another remedy, short of muzzling a free press: The man who was found not guilty can sue the Portsmouth Herald for slander.  But the bar for "slander" is rightly set high: You must prove the defendant 1. Published accusations he knew were false  and published these with 2. Intent to harm (malice of forethought)   and 3. Harm was actually done, specifically and how and how much.  Not likely that remedy is going to help many unjustly accused and found innocent. 

Mr. Muns is running for New Hampshire State Senate. He has taken on the media. He has not done this because he is a conservative who hates the media. He is not a conservative, nor even a card carrying liberal. He is simply thoughtful, and this bill is where his thoughts have led him.  It is not a politically smart move. 

As someone said in "The Wire":  "It's not a good idea to piss off people who buy printer's ink by the barrel."

Thursday, January 30, 2014

Flaring in North Dakota: The Perfect Story of Profit Motive Purloining Envirnoment




North Dakota's oil boom isn't just about oil; a lot of natural gas comes out of the ground at the same time. But there's a problem with that: The state doesn't have the pipelines needed to transport all of that gas to market. There's also no place to store it.
In many cases, drillers are simply burning it.
"People are estimating it's about $1 million a day just being thrown into the air," says Marcus Stewart, an energy analyst with Bentek Energy. Stewart tracks the amount of gas burned off — or flared — in the state, and his latest figures show that drillers are burning about 27 percent of the gas they produce.

--Morning Edition, NPR, January 30, 2014

The story of the burning of natural gas as "flaring" in North Dakota is an elegant story illustrating how the profit motive may undermine the planet.  For Republicans of all stripes, one bedrock proposition is that a free market, driven by the desire for profit is ultimately the most efficient and beneficent way. Get government involved with a bunch of do good regulations and you kill efficiency.
Now consider the oil boom in North Dakota: When unearthing oil,  the petrol companies drilling with abandon up there are releasing gargantuan quantities of natural gas, which they burn as a "flare."  Why would they waste all this potentially valuable fuel, you ask. I know I asked. The reason is profit. Natural gas sells for about $4 a cubic foot, whereas oil sells for $40-$90 a barrel, depending on the month. So the oil is more profitable. 
But why waste the gas? Why not cash in on that? Why burn more gas and send more CO2 into the atmosphere?  Because, to capture that gas, you'd need to build infrastructure: Storage tanks, pipelines to transport it. Doing all that would delay getting the oil to market, and it's the oil where the big profits are.
So, it makes sense to just burn the gas, financially, if you are an oil company executive who cares more about profit than about the environment. You might say, well, you can get your profit later, but why despoil the air burning, wasting, natural gas. Just wait a few months, build your infrastructure and reap your profit later. 

But no, companies are not in business to wait for profit.
So what force could possibly force these paragons of private enterprise to do the right thing by the environment and by the nation (if we are worried about energy independence)? Why, the government, of course. The government cares about the common good, not just one company's bottom line or stock price. 
Oh, that nasty beast, the government. Always getting in the way, always thwarting the efficient operation of American industry. Democrats doing that bad thing. Republicans say, drill baby, drill. Burn, baby burn.

Sunday, January 26, 2014

David Remnick: Obama Going The Distance




Rocky Balboa's goal, in the first "Rocky" movie was not to defeat Apollo Creed, but to simply survive, to remain standing after going 15 rounds with the champion, to Go The Distance.

In his 20 page report in the New Yorker, Remnick portrays Barack Obama as having the same mindset, the same limited ambition.  It is his strength to be unfazed by immediate set backs, by people who are writing history in 10 minute increments, but the portrayal is in some ways depressing, not because Mr. Obama looks less admirable, but because as he talks about Obama, Remnick portrays the world in which he lives, the polluted water in which he must swim every day. Obama is discovering, as Thomas Carcetti does in "The Wire," how limited his options are, how little power he actually wields and how the intransigence of his opposition, the structure of our government, the effect of gerrymandering, a Congress which is largely absent, which is not representative of the American people in important ways, can combine to  thwart his best intentions.

One remark which has gained great attention is Mr. Obama's simple observation that marijuana is less worrisome than many other legal drugs, to wit, alcohol and tobacco. Mad Dog speaks with doctors every day, in specialties from pulmonary to gastroenterology to neurology to cardiology and not one would disagree with Mr. Obama's assessment.

But local police chiefs in New Hampshire are shocked, outraged and dismayed the President should say such a thing when the police are working hard to discourage the use of marijuana among the innocent youth of New Hampshire, who risk beginning their slide down the slippery slope from marijuana to crack cocaine because the President has told them that's okay.

It was, surprisingly, a Republican delegate the New Hampshire House of Representatives who said the opposition of the police chiefs was in a sense, a move for job security. As long has they have kids to arrest for smoking pot, we will always need more police, more jails and the so the police justify their own jobs. Pot arrests are something like speeding stops--the police can always count on that business. It's low hanging fruit, shooting fish in a barrel, easy pickings. 

Mr. Obama is said to be "a reluctant politician: aloof, insular, diffident, arrogant, inert, unwilling to jolly his allies along the fairway and take a 9-iron to his enemies. He doesn't know anyone in Congress. No one in the House or in the Senate, no one in foreign capitals fears him. He gives a great speech, but he doesn't understand power...This is the knowing talk on Wall Street, on K Street on Capitol Hil, in green rooms--the 'Morning Joe,' consensus."

Of course, what Remnick demonstrates is the problem is not in Mr. Obama's personality but in the world he finds himself. Lyndon Johnson would not get a single bill through committee in the current Congress.  "They could invite every Republican in Congress to play golf until the end of time...and never cut the Gordian knot of contemporary Washington." That trope, the wisdom of the chattering classes is just the story the Morning Joe people like telling themselves. It fits their own needs, makes them feel superior. 

The description of Mr. Obama's trip to the West Coast  "rattling the cup in one preposterous mansion after another,"  is as depressing a scene as the Mad Dog can remember. It is worse than "The Candidate"  and worse than "Shampoo." It is the view of what it really means that 1% of the population controls 50% of all the wealth in the nation.  People with so much money they junk up their lawns with sculptures, load their walls with priceless art, people who know the price of everything and the value of nothing.

Mad Dog deeply hopes Mr. Obama will survive his Presidency, riding about in his "beast"  Cadillac, with 5 inch thick glass windows, secured against bomb blasts, poisonous gas and sniper attacks. He hopes Mr. Obama can go back to Chicago and walk down the street, with his Secret Service guards a discreet distance behind, and go into a Starbucks and buy coffee and a paper. That's what Mr. Obama misses most, the real world. 

Where he lives is something between "VEEP" and "House of Lies."


Sunday, January 19, 2014

Hiroo Onoda: Get Over It




Mrs. Haversham, of Great Expectations is the example of the woman who cannot move beyond disappointment about whom most American school children learn. But there are other, mostly fictional, examples of people, mostly women, who cling to a vow or a hope beyond reason. Joan Baez's first album had a haunting song about a woman who waited 16 years for her lover to return, but when he did, it turned out he had forsaken her while she had waited. Madam Butterfly waited for her naval officer. 
In most cases, we suspect the personwho clings to a promise or a vow beyond reasonable expectation, who clings when the steadfastness seems self sacrificial, has something wrong with her, or with him. 
In this world, the individual who cleaves tight to a proposition despite sea changes in the world around him (or her), is a rarity.
In a sense, the idea of marriage is based on this fidelity to a vow, til death do us part, even after it is apparent clinging to the vow, has been "for worse."
If we have come to suspect psychopathology in some forms of fidelity then we have to come to doubt the proposition that any form of fidelity to a promise made early in life may be a form of neurosis: but that would include the marriage vows.

So, when Hiroo Onoda died, his story still fascinated across time and across cultures.
Onoda was the Japanese lieutenant who remained in the jungles of the Phillipines for 29  years after the end of World War II, claiming he did not believe the war was over and he was remaining faithful to his orders not to surrender until and unless his commanding officer specifically returned to order him to stop fighting.

When you think about it, you know he must have known, or strongly suspected.  the war had ended--when no more soldiers appeared to fight him, when no more ships bombarded his island, when the only people left to fight were villagers and policemen. 
You know he could have slipped into a village and ascertained there really was no more war going on. He must have known the fighting had stopped.

But he continued the fight, knowing hostilities had stopped and he was the only one who still fought on.

Jesse James and  other bands of Confederate soldiers continued to act as marauders after the American Civil War, but the local population came to think of them as simple criminals.  Citizens sent police, not the Army after these die hards. 

When Onoda finally emerged from the jungle and his former commander arrived to deliver the order to cease and desist, he was returned to Japan, to a Tokyo which had glass skyscrapers and he was greeted as a hero. Here was a man who had not embraced the culture of avarice, creature comforts and money, a man who had lived in the jungle, in discomfort, because of fidelity to a sense of honor.

It must be telling, however, that he lasted only a year in the Japan he found on his return, then moved to Brazil and married a Japanese woman there, returning to Japan 10 years later to open a survivalist school, and the story became one which sounds like a man finally cashing in. 

It all reminds Mad Dog of the Japanese student who  studied in the stacks of his college library. He would arrive as soon as the library opened in the morning and stay until it closed at night, coming and going only for classes and meals. Mad Dog knew the Japanese student did this, because Mad Dog was doing the same thing. 
But what Mad Dog did not at first appreciate was that the Japanese student was doing this in a tacit competition. 
 Mad Dog caught this student looking in Mad Dog's direction, as 10 PM approached, often enough that he began to suspect.  One Saturday night, at 9:30,  Mad Dog gathered his books up, put on his coat, took the stairwell down one flight of stairs. The library closed at 10 PM on Saturday. Mad Dog never left before 10 PM, but just to test his own hypothesis, that night Mad Dog cleared out his stuff from his study carrel 30 minutes early. He waited in the stairwell for 10 minutes and returned to his carrel, looked down the row of carrels to the carrel occupied by the Japanese student, and saw the student had cleared out.

In retrospect, Mad Dog realized his own devotion to study and isolation was more than a test of will; it occurred against a background of no other really tempting options, and in a state of neurosis.

And Mad Dog wonders whether or not most or all fidelity is like that. As Oscar Wilde said:   "I can resist anything but temptation."

We project a set of heroic features on a man and his story, but, in the end, extreme behavior often looks more like simply eccentricity, sometimes simple social inadequacy dressed up as strength of will. 

And if that applies to the man who chooses to remain in the jungle, does it apply less to the woman who stays loyal to a husband who has moved on psychologically, or to a marriage which has become little more than a habit?

When young soldiers pledge themselves to each other, when they fight for survival together,  that loyalty is functional, self preserving. But they do not expect to carry sacrifice forward for thirty years. They anticipate a battle "for the duration," but the duration is expected to be relatively brief.

But what do we do with people who remain loyal to one idea for an unreasonably long time? And what do we say about institutions which depend on this sort of vow taking?
Obadiah Youngblood,  "Feeder Canal"