During residency, we all hated Monday mornings.

Not for the usual reasons of the lost weekend, back-to-work blues, or residual fatigue from a busy Saturday night.  If it was just those things, Mondays would have been a pleasure.

No, we hated Monday mornings because of the "blame game."  Despite the comfortable chairs, hot coffee, warm donuts, and soft lighting, we all hated going to Monday morning conference because it was the time when our faults would be laid out naked for all to see.  The podium was our only refuge, and it seemed to get smaller as the hour wore on.

I was not a big fan of Krakauer's breakthrough book Into Thin Air. I had just finished reading The Perfect Storm (before it got Clooney-ized) and had a hard time feeling sorry for the mountaineers stuck on Everest. The fishermen of the Andrea Gail were trying to put food on the table in an established profession and met up with a one in a million freak storm that claimed their lives. It was a compelling and moving story. The mountaineers meanwhile were ill-equipped adventurers who thought that they could pay their way onto the ultimate E-ticket ride. As I read through Into Thin Air, I kept thinking "you didn't have to be there, you morons."

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Over and over again we have heard the phrase "Reagan won the cold war." The popular image of the Russkies simply folding and giving up in response to the brilliance and whiteness of Saint Ron's cowboy hat has been indelibly branded into our national consciousness. To back up their claims, conservatives will point out how Reagan both engaged the Russians and massively outspent them. Ignored, of course, is the inherent corruption that existed within the Soviet system. There was plenty of money for rockets, missiles, parades, and chemically enhanced athletes (sound familiar?) but very little for milk and butter.

Doesn't seem fair that the Gipper gets the credit for the inevitable tottering and collapse of an unwieldy and corrupt system, but if the conservatives want to give him the credit, they will not be denied.

Matt Drudge seems to have his panties in a knot over the recent Saturday Night Live skit depicting his old pal Rush "Lorcet" Limbaugh:

The "prime directive" of medicine is simple and to the point.

"First, do no harm."

In medicine, we are not tasked with the impossible job of deciding whether or not a person deserves to live or die. I have treated cops & prisoners. Priests & atheists. Rich & poor. It is what a doctor is supposed to do, and we are not supposed to do less for a patient based on our judgment (or even society's) of how they lived their life.

Some will say, with some justification, that we do practice some indirect judgment by accepting or not accepting Medicaid patients, the indigent, etc. That is true, and I am shamed by my colleagues who turn patients away based on ability to pay.

There has been an awful lot of finger-pointing going on in the press, the TV, and the blogs. The youth vote failed us. The minorities failed us. Kerry failed us. The DNC failed us. The media failed us.

On the other side, we also get the paranoia. Bush stole the election. The Diebold machines were rigged. No paper ballots. Voter intimidation. Karl Rove is a diabolical genius.

Blah, blah, blah.

We are all feeling it.

The end is approaching fast. Tomorrow is ELECTION DAY. Of course, voters have been going to the polls for a few weeks in some states, but after tomorrow, no more votes are cast, and the counting (and recounting?) begins. There have been ups & downs. There have been moments of elation & despair.

I just got back from a week of vacation in the Dominican Republic.  Aside from consuming my weight in Presidente beer (and that is a LOT of beer), lolling on the beach, and catching up on my reading; I also took the opportunity to feel out the locals on their take of our election.

The overwhelming sentiment was "what's the difference?"

It was pointed out to me over & over again that there was no difference between Kerry & Bush, and that it simply did not matter who wins on November 2nd.  I would retort with the usual arguments and even got most of them to recognize that Clinton was the one who provided them with much needed funds during the previous rounds of hurricanes -- something Bush has refused to do.  They agreed, smiled, and still said "no difference."

I drank some more.

I started to think about it.  When >90% of the population is below the poverty line and the odds of advancement are little to nil, I can see how this election might seem like so much in-fighting and not like the referendum on democracy and liberty that we see it as.  Bush gets elected - they remain poor.  Kerry gets elected - they remain poor.

I drank another Presidente.

And then it hit me.  These people had something in common with many of the lower and lower middle class folks here in the USA who proudly display their magnetic ribbons on the back of their cars and plan on voting for Bush.  For them there is "no difference" on issues such as income, advancement opportunity, education, etc.  So they are going to vote for the guy (in these uncertain times) who makes them feel a little safer and waves the flag a little higher.

Time for some extra viejo Brugal Rum.

How had we failed?  We know the Democrats have done some wonderful and substantive things for many of the people who plan to vote Bush - why??  Well, for starters, the Right has managed to push the "welfare state" frame and convinced people that the very programs that have helped them have hurt the country.  They have made "liberal" a dirty word.  They have marginalized us.  All the while they have waved the flag and played on the noble and wonderful patriotism of the people who serve them.

How can we turn this around?  November 2nd is NOT the prize.  It is not the end of the fight.  If we win and Kerry becomes President, we need to set our sights on the Senate, the House, the Governorships, and the local governments.  Just as importantly, we need to toot our own horn - A LOT.  Not just in election years.  We need to get talking heads on the TV and radio who spend less time discussing "pros and cons" and more time pointing out what we have done right.

John Kerry WILL win on Tuesday (and I believe it will be decisive) -- but then it will be time to sober up, straighten up, and get going.

As Bruce Springsteen says, "the country that is in our hearts is waiting."