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Health, Science, Environment

Commentary: Letting perfect stand in the way of the good

This article first appeared in the St. Louis Beacon: In correctional health care, life’s lessons are taught with a two by four.

More often than not, my patients are damaged people. And for many, their criminal accusations or convictions are the least of their problems. Many battle addiction to substances both legal and illegal. Many are mentally ill. Some are developmentally delayed. Almost all of the women, and many of the men, have experienced abuse — sexually, physically, and/or emotionally — at the hands of parents, children and other loved ones. Perfection is not an option for them; better is good enough.

Repeat offenders, or my frequent fliers, as I often tease them, come back on a regular basis for their annual exams. They often smile and tell me that yes, they’re back in because they dropped dirty on their urine drug screen, but they stayed away from meth this time out. Or a middle-age man may share that he finally got a job, and he arranged with his new employer to take a leave of absence to clear up charges that were still on his records. Mothers often come back worried about losing the progress they made on regaining custody of their children.

All these people will admit that their lives are not perfect, and usually they take responsibility for the actions that made them so. But they also cling to the hope of incremental change that can bring improvement to the quality of their lives.

Incremental change is central to every parent who raised a child. “Baby steps” is a metaphor widely embraced — often in the face of apparently insurmountable challenges. But the phrase comes from a clumsy process of crawling, pulling-up, cruising, stumbling and finally walking. There is nothing elegant about baby steps. There is no perfect launch from crawling to walking. But the drive to walk, and the baby fat on most toddlers, overcomes the set-backs along the way.

The perfect is the enemy of the good is a phrase attributed to Voltaire. As a leading thinker of the Enlightenment, he explored issues of separation of church and state, freedom of expression and freedom of religion. These are many of the same topics we grapple with as a nation today. And, as was Voltaire’s world, ours is one of rapid change in many ways. In the past 50 years, we have seen changes in how we view women, races, sexual minorities and other populations within our society. We have expanded our awareness through air travel, the internet and the 24-hour news cycle.

Except for the most sectarian communities, we bump up against new and different on a daily basis. And while a daily delivery of new and different can be exhausting, it can force us to reflect and consider how to move forward, often incrementally, toward what is good and what bring value to our lives.

But unfamiliarity can often also make us long for rules. Rules can bring us comfort in times of uncertainty. Rules can make actions easier and daily routine less complicated. But rules can also stifle change and growth, when, for example, the rules no longer fit.

In the time of the Gospels, Jesus upset the authorities of the day by calling for change in the way they considered those different from themselves. Among the memorable quotations recorded in a chapter devoted to social mores and justice (Mark 2:22) Jesus states, “And no one pours new wine into old wineskins. Otherwise, the wine will burst the skins, and both the wine and the wineskins will be ruined. No, they pour new wine into new wineskins."

Our legislators are pouring new wine into old wineskins. They are turning a deaf ear to their constituents. Society expects our representative government to acknowledge and represent our struggles of daily life — common sense, incremental change toward the good. Their labors should reflect the incremental changes that every individual and every household makes on a daily basis. Homes are not run and lives are not lived with inflexible rules. We don’t raise our children or educate our youth on sound bites. Life is messy and it requires engagement.

My patients live in worlds of imperfections. They educate me how to reduce risk while using intravenous drugs. They have told me how they can avoid relapse. How to stay away from prescription medication abuse. How to work soup kitchens in the city to keep their families fed. When to stay in the shelter or when to stay on the street.

They know how to make life a little better with the hope that someday they may get a real home, get off probation, or stay out of jail. They are resourceful and they are particularly resourceful in appreciating incremental change. While they have dreams of a very different life, they know they will not get there overnight. In the meantime they must continue to live in an imperfect world. Change will take time. And it will take miles of baby steps.

We need similar moral maturity and commitment among our legislators. Their work must reflect the messiness of everyday life. They must frankly discuss the needs of our nation as a whole with the needs and concerns of their constituents in order to provide incremental changes toward the good. We must challenge them to represent our valuing of life over philosophy, of compromise over absolutism, of incremental change over the illusion of perfection.

We must not let perfect stand in the way of the good.

Sometimes better is good enough.

Fred Rottnek is also an associate professor in the Department of Family and Community Medicine at Saint Louis University. He is also medical director for corrections medicine of St. Louis County Department of Health.

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