Wise Words with Deb Harper

This is the complete transcript of the interview with Deb Harper, a Spokane pediatrician. She was the third interview in the “Wise Words in Troubled Times” series in The Spokesman-Review, Aug. 1, 2009.

The housing market was too crazy. My husband sells real estate and I have relatives in Southern California. My young nieces and nephews were completely unable to buy any kind of home in any neighborhood. There was nothing that people who worked as a vet tech, for instance, could afford. I would hear from physicians down there that they couldn’t make a living and I’m thinking “You’re a doctor. You make a very good living.” But not in Southern California.

I also read in newspapers and saw reality TV shows where people attempted to flip houses. And I remember my husband and I having this conversation many years ago here in Spokane about “you know people flip houses and all you need is one not to flip right and you’re bankrupt.” That was 20 years ago – in Spokane.

It felt to me like tulip mania – that great bubble in Holland in the (1600s.) Tulips came to Holland. They were beautiful. Everyone was thrilled. People started breeding them and coming up with fabulous new tulip petals. People were bidding on tulip futures. They wouldn’t even own the tulip bulb, but would sell a share of their bulb to someone else and someone else. There were tons of times when people never even held this tulip bulb in their hand. What kind of commodity is a tulip bulb? Someone finally said this doesn’t seem like the basis for an economy. And it popped the bubble and it was done. The housing market felt that way to me.

People who earned an extremely good living – a quarter of a million dollars a year, that’s considerably more than I make – were buying $2.5 million houses. You can’t afford a $2.5 million house with a $250,000 a year salary. Then they would lose their job and say, “I lost my house because I lost my job.” No, you lost your job because you could never afford that house! Just listening to people talking about homes they were going to buy and second homes and lake places, it was clear to me bad things were going to happen.

Another thing that got my attention was salaries of heads of companies just inflating hugely. Even the Wall Street Journal was saying on a regular basis, “Guys, think we’re going a little too far here. Stop the insanity.” And seeing our country beginning to look like Mexico, and not to be disrespectful to Mexico. There are people in Mexico whose children all go to boarding school in Switzerland and they are enormously rich and then very poor people and the middle class is just caught, rarely able to run their own grocery store without interference or having a connection with a powerful rich person who can protect them. That is how it’s been in the past. I think it’s changing, but there were times.

My husband and my three sons, who are all now in college, the last one just graduated from LC, we had moved from a fairly modest neighborhood to a somewhat more posh neighborhood higher up on the South Hill. I said to my husband, “Oh we’re moving from a front porch neighborhood to a back deck neighborhood.” And he said, “Honey, this is a lake place neighborhood.” And the neighborhood has been great. I’m very glad we moved there. But our children’s expectations changed for the kind of car we would drive after seeing the cars our neighbors had. We’d say “Boys, we will not buy those (kinds) of cars. Your friends parents are making very different decisions in regard to how they are spending their money.”

My parents grew up in the Depression. My father’s father was a newspaper reporter, a sports reporter, for the Winnipeg Free Press, and he didn’t lose his job during the crash, but was always bringing extra people home. He was Scottish. His wife was an Aberdonian. She was always saying “We can’t feed them all.” But she did feed them. He was a person of a very generous nature. He was an only child.

My mother grew up on a farm in the middle of Manitoba during the Depression. My grandfather has told me he had to sell a cow for a nickel once, because he couldn’t afford to feed it and didn’t want to shoot it. This was the days before refrigeration. My grandma got lots of extra jobs in addition to being a very busy farm wife. She was a cook in a little restaurant and she did lots of other things to bring in extra money. That’s how my parents were raised.

I’m going to flip forward to my sons who say, “How come grandma always saves the ribbons and the wrapping paper?” We have explained many times that they do not waste things. They are very intentional about what they spend money on. We have used my mom to help our boys, because a lot of times kids don’t want to listen to their parents, but they will listen to the generation away. My mom has been helpful getting them started with an IRA, talking to them about budgeting.

When I grew up, both of my parents worked. My mom was our budgeter. She graduated from high school and got a job during the war as a bookkeeper and kept beautiful books, with a fountain pen, none of this spread sheet stuff. She really understands money. She always wanted the opportunity to go to college. But there was a war and then the men all came back and there’s no room for (women) and then you marry and have children. So after we left home, she went back to college for an accounting degree. She tells the story that in the first week or two of college, the dean of her college came to her and said, “I want you to know Mrs. Harper that when you graduate, you will be 65.” She said, “Dean, I’m going to be 65 whether I graduate or not.”

Our parents were very open about what the monies were. We weren’t rich people, but my parents both always had a job. We always had food, always clothes. Did we always get what we wanted? No. Was that always because they couldn’t afford it? No. It was because they thought we should spend our money on other things. They always talked to us about how money should be spent and what they were aiming for.

Starting in third grade, each of us had to start our own college fund. I think I put 25 cents in. It was just the idea that everyone in the family was going to go to college. It was the water we swam in. Education was going to be our highest priority.

One message from my parents that I would share with young parents? It’s important to be very clear on what you need, what you want and what you yearn for. Want and yearn are very different things. Be intentional. Just think about it before you buy it. You may yearn for it for reasons that you don’t fully understand.

It’s important for people to understand that there are thoughts in your head that might not really match what’s truly important to what you need.

What can at-risk kids teach us? They can teach us a great deal. People accuse me often of being a Pollyanna, and it’s true. I can be a paranoid Pollyanna, but I do my best to look on the bright side.

In medicine, one of the things we do to keep us organized with patients who have a variety of illnesses, we keep a problem list, so it might be hypertension, domestic violence, depression, kidney stones. So we have a problem list. I trained at Cook County Hospital in Chicago, and it was the poorest of the poor, but you know, they weren’t dead yet. So I started keeping a strengths list for my patients.

Sometimes I had to reach really far to get to a strength. I have found that very helpful in working with people who are in a really rotten situation. Work from strength doesn’t mean denying what is wrong. Work-from-strength has been one of the modus operandi in my life.

There’s research on children who have been abused or gone through something awful. On the island of Kauai in Hawaii, has been a very long sociological study that was started in the (1950s.) Emmy Werner has been publishing most recently. But when they started this study, Kauai was a very different place. It was very poor. It had a variety of ethnic groups – Filipino, Japanese, Native Hawaiians – who were often dislocated from extended family. It had a huge poverty rate. It had a single industry. The job you got on the weekends in high school was the job you had when you retired. No chance for advancement. No surprise – lots of drugs and alcohol.

They got lots of data. About a third of the people growing up in this poverty who did enormously well, who were way more successful than anyone would have predicted. And then Hurricane Iniki came and just flattened the island in 1992. Now they have an acute stress and how are people going to deal with this? And (researchers) know all these people now, since the (1950s.) They know whose mother was an alcoholic, whose parents were divorced, who had domestic violence.

What they discovered was that girls tend to be more resilient than boys. We don’t know why. Children who liked to read did better than children who didn’t like to read. I don’t know if that has to do with the power of story or the power of coming up with your own narrative of how your life is going to progress. Children whose parents weren’t divorced did better. And children who had an important job. So, the kid who wove palm leaves together into place mats and could sell them and bring some money into the home. The child who had to carry water and bread up to the auntie who lived in the area where the power had been cut off. The child who had an important job. Those are the kids who did best. What they discovered was that girls tend to be more resilient than boys. We don’t know why. Children who liked to read did better than children who didn’t like to read. I don’t know if that has to do with the power of story or the power of coming up with your own narrative of how your life is going to progress. Children whose parents weren’t divorced did better. And children who had an important job. So, the kid who wove palm leaves together into place mats and could sell them and bring some money into the home. The child who had to carry water and bread up to the auntie who lived in the area where the power had been cut off. The child who had an important job. Those are the kids who did best.

I made sure our kids had chores and jobs that if they weren’t done, the harm was done to the family.

There was a story some years ago from Minnesota where a little boy attended school, so he wasn’t completely cut off from school, and they had police officers who came to the school in an Officer Friendly or Dare type program. He was a shy little guy and never spoke to the officer at all. Unbeknownst to anyone, he and his sister were kept duct-taped in the basement of their home. And one day, he broke out and he ran in bare feet through Minnesota cold to the police station and it was the same police officer and he said, “Thank God, it’s you.”

Everybody thinks this is a sad story, but to me it’s a wonderful story. This is another piece of resilience. I have to give credit for this to Lynn Williams, a (Spokane) child psychiatrist. So resilient kids realize that all families are kind of nutty but my family is truly awful and the world is not like this. There are good people in the world and I need to seek them out. Those are the kids who do well.

You run into them all the time. When I hear about the kid who volunteers at the library and is the manager for the football team and does this and this and this, I think, “This is a kid who is trying not to be home.” That’s not always the case, but trying not to be home is trying to hook up with good role models.

What can children teach despairing adults? The most important thing is to have an important job, understand what gives your life worth. I may have lost my vocation, but I have an avocation that gives my life worth. Find what you do well. It may mean you are volunteering. It may not mean you are bringing money in and that’s very scary.

The current health care situation is a mess. If you lose your job, you lose your health insurance. If you lose your health insurance and something bad happens to you, you will go bankrupt.

My youngest son just had a major blowout of his knee. I’m so grateful we live in Spokane and have these very skilled surgeons and physical therapists. The bill for the surgery was a little under $25,000. We paid $10 for our co-pay. But $25,000 would have been a very big hit for a physician to take in; $25,000 for someone earning the median income in Spokane of $37,000 a year is an impossibility. Knowing how precarious people’s financial situation is now, we have to find a way for there to be access to health care for at least major medical, the huge-car-accident kind of health care. There has to be access for everybody and it can’t be attached to your job.

Do I think health care reform solve some of the financial insanity? I do. In Spokane – and I get this information from title companies who track who is going bankrupt, back and in the early 90s – over 80 percent of Spokane bankruptcies were related to health care expenses. The rest of the nation was lower than that, but they are catching up with us. We’re a leader. This has to be fixed.

I look at my own sons and my friends’ children and we can keep them covered until 25 as long as they are in college. But then they have to get a job that will cover them. Some of them may have acquired a health problem between now and then that will make it difficult to get that job. It’s very worrisome for me. I’m very prejudiced because this is the lens through which I look at the world – health care and children and their parents. People have to feel safe and people have to feel their health can be kept safe.

It’s very interesting to look at what we doctors charge, what pharma decides to charge for their medicines and what equipment manufacturers want to charge. We used to joke that if you have a fridge it’s $300, but if you put a sign on it that says “medical fridge,” it’s $3,000. There has been a certain amount of insanity there.

There’s a Harvard health economist whose name is David Cutler and he has a short, easy read book that’s been out more than five years called “Your Money or Your Life.” He asks a very interesting question which is not as much about cost but about what you value. He asks, “What are you willing to pay to not have to go back to 1963 medicine?”

My husband, for instance, before the age of 60 had two hip replacements, two cataract replacements and then he ruptured his Achilles tendon and had that fixed. At one point, he was asking the surgeon, “Back in the day before you did it this cool way, what did they do for an Achilles tendon? I said, “You don’t get an answer to that question, because back in that day, you would be a blind, crippled man in a wheelchair by the time you were 55. You would not have been pushing your car and rupturing your Achilles tendon. You are lucky to have had this opportunity.”

I think we as Americans have to look at what we value for our health. I found the process the people in Oregon did really interesting in the ‘90s. They had grassroots meetings throughout the state and asked “What should we pay for? Given that the bucket will be empty, what is the first thing we pay for and what is at the bottom of that bucket?” I think that was an important process to go through and one that most of our country hasn’t been willing to do yet.

Will it happen in five years? Yes. I’m a little bit of a health care policy wonk. I read these books and these articles and sometimes I just shake my head and say, “You Harvard health economist, you’re a crazy person. I want to call them up and say “Get on a plane. I want to show you some stuff.”

The catch word I keep hearing is “accountable care organization.” I’m not sure what it will look like but that’s what they are going to call it. I don’t know what it will be. I think we have hints.

I like to think of this (economic crisis) as an insanity, because I’m thinking of what I noticed during my psychiatry rotations as a medical student and then later in life is that frequently when a family member is hospitalized in a mental ward, when you get the whole family together you realize, “This is the least crazy person in the family.” The real crazy people in the family are comfortable with the chaos and randomness of their life and the person who sometimes feels most sane is the person who is cracking. More often than not, the family can be healed and reorganize themselves. Sometimes, you can’t heal the family, so you say “I’m going to find a new family.”

I don’t want to see that happen to our nation, because the principles on which we were built, our core values, are a bright and shining light for the whole world. I would like us to be able to heal some of this nuttiness around money. More importantly than money in the next 10 years will be our craziness around energy use.

Peak oil is going to be reached really soon, and we use oil for more than just making our cars and airplanes go. We use it for making polyester, like the skirt I’m wearing. We use it to make insecticides, which you can argue whether that’s a good thing or bad thing, and fertilizer. (Oil) is going to be running out and it will run out in my children’s time. I realize we’re finding new (sources) of oil, but we have to stop being so crazy about using energy. We’ll know we’re healed when we become more sane about wastefulness about energy.

What can society learn about healing an economy from how healing works in medicine? Our patients think the antibiotic we gave them, or the surgery we did for them, healed them. And sometimes it did save their life, but what it really did was give their body time enough to heal itself. What we try to learn as physicians is don’t mess ‘em up now, don’t hurt them, and give them time to heal. So how does this relate to the larger microorganism that we’re calling America? I think the individuals and communities of this country, if we give them the time, will find the ways to heal themselves. And they will be ways that are completely surprising.

One of the great lessons I’ve learned over time is that when I work with a few other people somehow we come up with a much better work product in the end than if they had left me to my own devices. Left to my own devices, I will come up with something and it will be just fine, but it won’t be as great as when I work with a community of people willing to pull together. I have faith in our American organism.

Might we go through some awful, awful times? I mean look at some of the countries who have had to go through fascist regimes and horrible tyranny. I hope we will be spared that. We’ve done 200 years without it. We went through the Depression. Now we have the Depression plus an energy problem coming up.

I continue to have great faith. I love talking to young people – teenagers and young adults. They have all sorts of predictions of how their world is going to look. They may be right. They may be wrong. They are all working in different ways. I’m curious to see the life my children will have.

Will this crisis be a great leveler? Today’s Wall Street Journal had a little map showing where all these former CEOs were in prison. I thought, “Good Lord, these are your people! You are freaking them out!” That was very interesting. Will it level that insanity? Will it give the middle class the chance to re-establish themselves as the great strength of our country? I really hope so. But I think the middle class is going to be really hurt when the energy thing hits.

What will our country look like 10 years from now? “She who look in crystal ball eat a lot of glass.” My husband says that all the time. I am known for making really wrong predictions. Some of my predictions have been spot on and fabulous, but I just constantly make the wrong prediction. So I feel vulnerable that people will be showing this to me in 10 years and say, “Deb, this isn’t how it looks.”

Certainly our use of petrochemicals will be down, because they will have become too expensive to use. We will have health-care access for all in our nation. I think there will be fewer McMansions. I don’t know what will happen to the McMansions we have now. I have looked at some of the housing developments, and I just think that’s not going to be really sustainable on the secondary market when it’s time to sell your home and move somewhere else. I think there will be more real estate difficulties. I think people will move more into towns of the Spokane size and out of cities of the sprawl-of-the-I-5 corridor size. The future is with communities of our size, because we’re livable. You can get to where you need to get more easily. Spokane will have a light rail system and an efficient bus system and workable bike paths that are actually connected. We have to do that.

People will be living in a more energy efficient way. I have someone who I respected greatly who worked in a high power position in Avista for many years and he said all this infrastructure of wires going back and forth is going to go away and we’ll have individual home or individual apartment building generators.

We lost our power in the wind and bless our power company employees who are just out there and our power was on very quickly. I said to my husband, “This happens a lot and we have this infrastructure where we have these nice men and women who come out and give us our power back. But eventually we won’t be able to pay that many people to do this, and we have to be prepared not to have power for weeks and weeks, as happens in countries like Bolivia and Iraq.” So we will be prepared for that.

We’ll go back to the moon. I needed to throw that in.

The baby boomers? I think we have grown up. I think a lot of the housing bubble was generated by boomers, but frankly a lot of it was generated by young people behind us. Maybe we as parents failed to properly educate them on financing and risk-taking.

One of the books I made my book club read this year was “A Canticle for Leibowitz.” It is a hugely apocalyptic story. They just predict, yes, it’ll all end up bad.

I’m now reading “A Distant Mirror” Barbara Tuchman’s book about the 14th century. For the people of the 14th century, they’d been making all this progress and then all of a sudden, there were brigands everywhere, literally barbarians at the gate. The Black Death comes through. It was horrendous. After it comes through, there’s no labor to till the fields. There’s no one left who knows how to weave the wool into cloth. Just huge tracts of community were destroyed. They were having climate issues, due to sunspots. They had earthquakes. So it certainly looked like the apocalypse to them. But we know it got better.

The 1300s were just awful. Give me a choice when not to live. Other than land of the dinosaurs – just because I don’t do humidity – the 1300s were bad. But by the 1500s, it was better. That wasn’t that long. We’re lucky we can look back for several thousand years and see how humans have had horrible declines in their ability to make a living and death everywhere and yet how resilient they were. We are all descended from those survivors. We’re not descended from people who died in childhood. We are descended from people who made it.

It may be we’ll go through some extremely difficult times and I’m sorry to say it won’t be my husband and I so much as our children.

I was an adored child. It was a wonderful thing to grow up in a family where your family adore and support you, who told me I could be a doctor. I knew two women doctors growing up. I was in 10 schools by eighth grade. My dad is a “cereal chemist” – a flour miller for Gold Medal Flour. Wherever flour was ground, we lived there. I would hope that all children have the blessing to have parents like I have parents.

Families are great. I get to see at least 20 people a day who are doing their best to nurture their children. I get to see babies in the first minute of love. There is a depth of caring and love that parents and their children have that give me great faith. I work with child abuse and some really unfortunate situations, but when our community works to strengthen our parents and their ability to nurture children, that makes a huge difference. They are the next generation. We need them to be descended from strong people, too.