Archive for the ‘FUTURE COLUMNS STILL BEING WORKED’ Category

CONTINUING ON IN THE FACE OF SOME REALLY BAD S—

December 10, 2009

Well before the Cessna Grand Caravan cleared the mountains near Fairbanks, Nancy, a vivacious fortyish woman next to me, started talking.  We were traveling to Arctic Village, 235 miles northeast; from there I would fly over the Brooks Range in a smaller plane, landing along the Aichilik River on Alaska’s North Slope, near the Arctic Ocean.

Nancy told me that she and her husband, Jim (both names changed), who was dozing in the single seat on the other side of the aircraft, were going to a different river on the North Slope for their trip.  As she talked, I realized they were as familiar with this country as I was with the Boundary Waters, except “their country” was 20 times bigger and vastly more remote; the last road we would see for two weeks was behind us.

I noted that her husband looked not just older, but his hair was patchy and almost ravaged.  I didn’t say anything, and Nancy soon elicited from me that I had once practiced neurology.  Jim was an exceedingly smart geologist who several years earlier had been diagnosed with a left hemispheric astrocytoma and forced to retire.  These tumors are malignant, and at a young age grow slowly.  But they eventually get nastier and will kill in 5-10 years.  Jim was treated at Duke, which is about as far from Fairbanks as London is from New York.  She was remarkably upbeat for somebody who had gone through a hell I hope I never will, and they were doing the trip while they still could.  I was sitting next to a saint.

“He has some trouble word-finding,” she said, but with a smile that would light up an Arctic winter, added, “he just loves this country, and I do, too.  We’re going as long as we can.”

We talked about Alaska, the time passed quickly, and we soon landed on the dirt strip at Arctic Village.  The weather over the Brooks Range was poor, and many of us to be shuttled in.  Jim and Nancy would go in the mid-afternoon; I was in the last group and wouldn’t depart for 8 hours.  We put all our gear by a small building, new from the previous year, unstaffed and christened “Arctic Village Visitor Center.”  One hour took care of seeing the village; when I returned Jim and Nancy were inside, looking at a large map of the Refuge and nearby Yukon.  Jim was pointing out, with minimal but noticeable dysphasia, some of the areas where he had traveled.   I looked with awe and envy at his travels.  I was never going to see that incredible country and he had.  On the other hand, I’ve seen sixty, and he would likely not see fifty-five.

Later that afternoon, Nancy suggested Jim and I walk across the airport to a nearby lake.  Jim had a quick pace, was able to identify a lot of plants and birds, and soon, like his wife, asked me what I had done.  When he heard I was a neurologist, he said, “I have this s— growing in my brain.”

This was one of those difficult moments where one has to quickly decide whether to lie, tell the truth, change the subject, or just run away.  I knew what Jim had, but he didn’t know I knew.  I didn’t want to act curious; I just wanted to be somewhere else.  God, I thought.  What do I do?  Just then a couple of loons called in the distance, so I took option number 3:  I quickly changed the subject to loons.  I felt like a coward.  Whether Jim noticed, I’ll never know, but during the rest of the walk, we didn’t discuss his medical condition.  We birded, spending about a half hour sitting beside one of the many lakes that surround Arctic Village.  Jim pointed out the plants to me, and I just worked like mad keeping the subject off astrocytomas.  I’ll never know what he thought of me, but I sure learned much about the local flora.

We eventually returned to the airport, and later, Jim and Nancy left for their trip.  At 7 p.m., the guide, Aaron; I; and pilot Kirk Sweetsir, a Rhodes Scholar (in another life, as he puts it), finally departed.  When we saw the wall of black ahead over the Continental Divide, Kirk turned around and set us down in ANWR, along the Sheenjek River, half way to our destination. We had the stove, dinners, breakfasts, and a dry place to camp.  The other group that did get to the North Slope that day had none of those four things.

But all of us had functioning brains and bodies that would get us through eleven tough days in ANWR and hopefully for many, many years after.  But there are no guarantees.  Jim is one of the reasons why I go when I can.  Bad stuff – s—, if you will – happens, and it can happen to anybody, good or bad, young or old.  I’ve had some nasty medical problems, but compared to Jim, I’ve had nothing.  He’s still going while he can, able to carry gear, navigate and love his wife, who copes with a grace I wish to emulate.  Both of them have and will continue to see country that few will ever see.  They are special people, truly living fully while they can, as we all should.

A DAY IN A TEACHER’S SHOES

December 3, 2009

After 7 years as a volunteer math tutor at a local high school, I was allowed to be an on-call volunteer math teacher, meaning I teach with a certified substitute present.  I address the occasional problem when a teacher is absent and a fully qualified math substitute is unavailable.  On my first day, I was given a lesson plan for algebraic inequalities and prepared one for geometry.  While I don’t find these subjects difficult, understanding a subject is far different from teaching it. 

I arrived at 7 a.m. with water bottle, lunch and objects needed to explain the material, for good teachers don’t parrot the textbook.  The official substitute took attendance, introduced me and I began teaching.  Fortunately, I had no problems with student behavior, because the teacher for whom I substituted is an exceedingly good disciplinarian, knowing when and how to act with words, inflection and body language.  My experience could easily have been worse. 

What’s it like to teach for a day?  I was on my feet nearly continuously for 7 hours.  I needed a bathroom break at 10:30, but preparing for the class before lunch took priority, and I nearly sprinted to the men’s room an hour later.  Other than a few swallows of water, I ate nothing until I finished at 2:20.  I left at 3:45 and wasn’t the last teacher leaving.  That evening, I relaxed, not having to grade homework or prepare the next day’s lesson. 

My parents were both hard-working teachers, and I frequently heard, “You can’t eat dedication.”  I’ve taught exactly one day and didn’t deal with problem students, parental e-mails, after school tutoring, worth $40/hr, but freely offered by many teachers or faculty meetings.  I’m 61 and want to teach math.  I can afford to; many of our best and brightest teachers, with whom I’ve had the honor and pleasure to be associated, struggle to pay their student loans.  Summers off?  Many teach summer school out of necessity. 

A properly educated populace won’t solve all our problems.  But it is a necessary condition if we ever hope to address them sensibly.  Arizona ranks last in per capita spending for what is arguably the highest yield and lowest risk investment of all – education.  Nationally, we invest far more in low yield/high risk unwinnable wars and impossible nation building.  Those whose high risk complex financial instruments devastated our economy receive annual bonuses greater than a teacher’s lifetime earnings.  Important, difficult jobs requiring significant training and long hours deserve appropriate compensation, which is how we attract and keep good people.  As a former neurologist, I was paid well for my training, work and hours.  Teachers are not paid commensurate with their extensive training, hours and immense responsibility preparing the next generation.  Teaching math, or any other subject, to 35 teenagers who’d rather be elsewhere is difficult:  doubters should try it – assuming they have the skills to do so.  Increased funding for teachers and education is one of the best investments Arizona and America can make.  Our future depends upon it. 

Michael Smith, retired physician and statistician, has been a grader for the AP Statistics examination.

BODY BETRAYAL

November 26, 2009

I remember a time when I “owned” the ICU.  I had eight patients – eight – who were severely brain damaged, irreversibly brain damaged, or brain dead.  I don’t remember all the diagnoses, but they included aneurysms, intracerebral hemorrhages, ischemic strokes, hypoxic encephalopathies and a bad surgical outcome. 

During my ownership stage, the MICU staff were absolutely great in using my time, as they shepherded me from one family group to another.  It is easy to get jaded when one faces bad, irreversible or total brain damage in eight patients that one needs to see a few times a day.  I tried not to be, but I don’t know how successful I was.  Taking time to talk to families is often a real pain, but it is necessary, deeply appreciated and what physicians get paid for.  Do it.

If I returned to medical practice, which I won’t, I would be a far more compassionate physician than I was during the twenty years I did practice.  Mind you, I think I did a good job.  I allowed patients to die at the right time with dignity and less stress on the families.  When it came time for my parents to die, I did everything I promised them, and neither lived more than eight weeks from the time they started to die. Ensuring the quiet, painless dignified deaths of my parents was one of the best things I’ve ever done in my life. 

If you want to read about how I dealt with the change in my relationship with my father, after he was widowed, read A Wise Owl.    That is probably the best thing I will ever write. 

But having lived through their deaths and several personal infirmities, I look at life a good deal differently.  I could now tell families how it is normal to feel guilty when it is time to stop life support.  I could tell them how one will miss having that loved one to talk to, all the conversations that one would want to have in the coming years.  I could tell them how the relationship between children and surviving parent would change.  I would really be compassionate, because I have been there.

 I’ve had two major infirmities of my own in the past decade.  The first was getting buggered when a Buick turned in front of my bicycle up in Durango.  I went down and hit my fortunately helmeted head on the bumper.  Remarkably optimistic (some would say stupid), I got back on the bike, not realizing I had broken my right femoral head, the coronoid process of my left elbow, my fifth right metacarpal, and had a comminuted fracture of my right index finger.  I actually rode the bike six miles with these injuries, hobbling 100 yards into the school where the group was staying to take a shower.  While I was drying myself, the bench on which I was sitting collapsed.  It was a totally crappy day. 

Denial wore off when the adrenaline did, and I was operated on that night.  I had one functioning limb for about three weeks, and I was pretty damn miserable.  But I healed.  Still, I know what it is like to need a handicapped parking spot, have kids say “Mommy, what’s wrong with him?” have people hold doors and yet not wanting to be treated like a invalid.  I was a full-time graduate student then and teaching basic stats to college students. 

More recently, I had a nasty non-life threatening miserable infection for several months.  Without getting into details, I really didn’t want to live with it, which put me into counseling and from there into self-hypnosis.  Once, I might have been skeptical of self-hypnosis, but desperation changes one’s mind set, and it is amazing what hope and practice can do.  I can now get myself into a deep altered state and become pretty comfortable. 

During this infirmity, I went on the Internet and learned a good deal about the condition.  As much of a scientist as I want to be, there was simply no way I was going to try one thing at a time for a few weeks and see what happened.  I was too uncomfortable.  Rather, I tried a few things, had hope, lost hope, wondered what else I could do, figured out something new and kept going. 

My advice?  Do your research.  Hope your doctor is willing to work with you.  Write down questions, which is something I always hated patients doing.  Hope your doctor calls you back when you have an occasional question.  Try things.  Try other things. 

I took sleeping pills every night for a month, because getting sleep was one thing that really helped.  My condition didn’t affect my ability to exercise; indeed, exercise seemed to alleviate it.  So I tried to stay in shape.  I canceled a volunteer trip to Nebraska to help out with the Cranes.  It broke my heart, but it was the right decision.  Two other trips on the chopping block were at the moment salvaged by great people who knew me and gave me a bit more time on paying the final deposit. 

I’d be so much more understanding of patients with chronic conditions today.  I’d be a wonderful doctor.  Too bad it took me so long to figure it out.  Don’t you make the same mistake.

A CURIOUS CAT PERSON

November 21, 2009

It’s our third night out on Lake Insula, 40 miles from civilization, completely quiet, the weather mild for late September.  The barometer is falling and I notice a slight south wind, so change is coming, but for now, we savor Indian summer in Minnesota.  We camped on a point with views on three sides and up into Museum Bay, haven’t seen another soul for two days and won’t for three more.  On the north shore, a half mile away, is a fine beach that few ever see.  We walked it yesterday.  After dinner, I head out to ledge rock 20 feet above the water and start scanning with binoculars.  I do that when I’m in the woods.  I usually see conifers and rocks, but sometimes I strike gold. 

This was one of those nights.  Within 15 seconds, my hands stop.  I see a large bull moose – his antlers catch the last bit of light – in water by the beach, and as I watch, he starts walking the shoreline toward us with alternating clops and splashes.  I’ve seen more than sixty moose in the wild, been within 12 feet of several, far too close.  One even followed me.  But to see one sauntering through the water, unaware of our presence, was one of my more memorable sightings.  We watched him 15 minutes in the growing dusk before he disappeared into the woods with the crashing of branches only a moose can produce. 

Curiosity is one of the greatest gifts I’ve been given.  A while back, I worked with a church group removing buffelgrass in Oro Valley.  I’m not willing to cede our part of the Sonoran Desert to an invader.  Nor is “Dave,” who manipulates his wheelchair into deep sand of washes to bag it.  He is amazing. 

Usually, I listen to music or podcasts while hacking, but this group was friendly, not trying to convert me and were living their faith, good stewards of a portion of the Earth.  That impressed me.  When we finished, a boy started asking questions about invasive species — why it was a problem, how it got there and burned so hot.  That impressed me, too.  I answered the first two questions, couldn’t answer the third, telling his mother that her son asked great questions.  She said he attended a science charter school.  Science and religion need not be mutually exclusive, but the anti-science drift and rise of American fundamentalism is disturbing.  Fortunately, I’m probably not going to be around when the bill comes due.  Perhaps this boy will help keep America competitive in science. 

Later, his brother asked why clouds were white and how they formed.  They were also great questions, along with why the sky is blue and sunsets red or yellow.  More than half of Americans don’t know the astronomical definition of a year.  Bet these boys did. 

I wish I had told the mother how good she was not quieting her boys.  Too many adults think it impolite for children to ask searching questions and drum curiosity out of children.  That’s wrong.  Perhaps it is a misguided sense of politeness.  Or perhaps the adult is embarrassed they don’t know the answer.  We need better questions asked, and we need more “I don’t knows.”  Maybe then we would be smarter.  I have a few questions:

  • When you awaken at night, why aren’t you fully dark adapted, but within a minute are?
  • What causes us to have annoying, persistent songs in our head?
  • What is the neuroscience behind dreaming?
  • Why do people with right hemispheric infarcts keep their eyes closed during the acute phase?
  • What causes shadow bands just prior to a total solar eclipse? 

Instead, we are fed a fare of stupid tweets and non-balloon boys.  Another question:  What is happening to Tucson’s climate?  Colton hunts and sees first hand the desert’s dying.  He knows it is changing.  The Sonoran desert suffers from 26 consecutive years with above normal temperatures (and “normal” has been raised twice in the interval), 14 of the last 16 years with below normal rainfall, 2 ½ years’ deficit in the last 10; 7 of the 10 warmest years this decade and 1 in 5 days “unseasonable,” more than 10 degrees above normal.  Except 20% is no longer unseasonable.  It occurs two-thirds as frequently as below normal temperatures. 

A snowfall in Baghdad is anecdotal.  Tucson’s changes are over decades and worsening.  For 20 years I’ve called it climate change, to be more precise, for world-wide rainfall patterns are changing, too.  This year, Tucson will be a “minor” 3 degrees above normal.  “Minor” is 7 of the first 11 months in the top 10 for warmest, even during the strongest solar minimum in a century, which ought to enhance cooling. 

Half the bird species in the annual Christmas bird count have significantly moved north.  They don’t think climate change is a hoax.  Kutek Lake in Gates of the Arctic NP is disappearing as the permafrost melts.  My wife and I will eventually follow the birds, for we see the meteorological and political climate in Arizona both worsening.  I still have not heard a counterargument containing a margin of error, no pejorative attacks and no charged language.  We may be in an Anasazi drought.  I never dreamed I would become a climate refugee.

We can still deal with buffelgrass.  Go to www.buffelgrass.org and help out.

FOR THIS I SERVED AMERICA?

November 21, 2009

I visited two elementary schools in the Sunnyside District to speak to the nurses about obtaining obesity data on their children.  Sunnyside is the only district in Arizona to mandate a nurse in every school.  Because of the nurses, fewer children are sent home with medical problems, and the nurses are able to immunize some of the children who haven’t completed their immunizations.  I know these days many Americans on both sides of the political spectrum think vaccines are dangerous; the diseases they prevent, like rabies, are still out there in the wild just waiting for us to let our guard down.  I find myself wishing they would get a case of measles.  Not complicated measles, which is not rare.  Just measles.  Maybe that would change their perspective. 

All districts must check hearing in the 6th grade.  But Sunnyside additionally weighs, measures and checks vision of their students pre-K, 2nd, 6th and 9th grade.  Nobody else in the Tucson valley is doing this.  They don’t have extra money; they just decided it was important. 

Because of their work, we have the first step to obtaining obesity data on middle school kids in Tucson.  From there, we hope to get the other districts involved and have county-wide data on public school 6th graders, which likely would be some of the best data in the state, if not nationally.  I’m pretty excited about the prospect. 

It was eye-opening to watch the kids leaving the school going home.  There weren’t a line of large SUVs and vans picking the kids up.  Many actually walked home.  Imagine that.  The houses down there aren’t six to seven figure ones up in the Foothills.  Their parents aren’t movers and shakers.  They can’t home school their kids.  They are too busy trying to scrape by.  If they don’t have public education, how will these kids get educated?  Or is it just too bad and they should just stay in entry level jobs and be house or yard cleaners because they can’t do anything else? 

America has given three things to the world — liberty, the national park system, and public education to support a vibrant middle class.  None of these has occurred as quickly or as effectively anywhere else.  In 1966, I learned what LIONS Club stands for “Liberty, Intelligence.  Our Nation’s Safety.”  Exactly how are we going to educate millions of children without public education?  Who is going to pay for it?  Or will volunteers step forward?  Why not have volunteers step forward to save public education?

Will this be an America where people don’t vaccinate, and visitors will need vaccinations the way I needed a yellow fever shot to go to Africa?  Already, immunocompromised children can’t go to day care centers, because there are too many unvaccinated children.  Will this be an America where we end public education, because it is a government program, and all government programs (except defense, of course) are bad?  Should people should be free to do whatever they want, including logging the rest of the redwoods and old growth forest, mining the national parks, taking oil out of ANWR, because somebody rich has bought the land and can do whatever they want?  Is this why I, among only 7% of Americans, served America in uniform? 

If we end education, health care, food stamps, social security and Medicare, we will have people on the streets the way we have stray animals, lots of people, because the fundamentalists would have banned birth control, too.  We’d have people dying horrible deaths from treatable conditions, the way stray animals do.  Isn’t that a death panel?  And I don’t consider a stray animal an “only,” having taken in many.  Indeed, I rank companion animals above the Norquists and the Newts of the world.  Reread that. 

Those who espouse smaller government have not been in these schools, learned nothing from Katrina and have not been down to the county public health department. 

I don’t know how big our government should be.  But I do know that leaving people unregulated is akin to a fraternity house on a Sunday morning, the economy a year ago, the 60 to 37,000% fold difference in frequency of medical procedures depending upon where you live and worse driving than we already see.  How much do we regulate?  As much as we need without doing too much.  And what would that be?  I don’t know, but we better start figuring it out as a country and soon.

In these pages, I have stated that I am not religious.  But I think we have a duty as human beings to help make our society better.  Sometimes by saying no, we make things better and by saying yes, we make them worse.  Sometimes we should leave people alone; other times, we should step in.  Those who argue solely from one side are as wrong as they are loud and nasty, and I have never heard an ideologue naturally laugh, not once, nor make fun of themselves, which healthy people do. 

Those who read my columns are in general well off in life, probably wealthy.  One of my mottos is “Those to whom much is given, much is expected.”  Give of your time, your knowledge and your resources to make this country better.


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