Archive for November, 2009

FRUMPY

November 27, 2009

It’s 7 a.m. on a Saturday, and I’m hauling 60 pound jugs of water through thick sand about 100 yards to a picnic area along Sabino Creek.  The water spills on me, and in 50 degree temperatures, the warming I get from carrying quickly dissipates.  In an hour, 80 girl scouts are showing up, and I sure hope there will be a lot of adults with them.  I volunteered to be a birding leader, and I’m wondering what I got myself into. 

The scouts will spend an hour hacking out giant reeds that are a desert invader, sucking up 20 times the water of a cottonwood, an hour learning GPS so that the plants removed can have their root systems identified, an hour at the riparian habitat, since there is a small pool of water still present, and an hour birding with one of us four leaders. 

Everybody shows up, and there is a great deal of singing, energy and all the things young girls do.  I’m now really wondering what I got myself in to.  We start, and the birding is not what it might be, even for early morning.  I’m hearing several species, but hearing birds and seeing them is very different for these girls.  The cool morning and the trails are certainly nice to be out in, the girls are having fun playing with the binoculars, but it would have been nice to be seeing something more than a few nests.  But that’s birding.  Sometimes you see birds, sometimes you don’t.  On the other hand, there is a dead fox near a log, and I am amazed to see how many young girls went up to take a close look at it.  I really expected a very different response.  But, as I was beginning to learn that morning, I was quite prejudiced towards my experience with these girls. 

I had earlier noted a young scout, obviously paraparetic, needing significant assistance to walk.  She came on my third trip, and we didn’t walk too far because of her difficulty moving.  The girl was dysarthric, and looking at her gums, I figured probably took phenytoin as an anti-epileptic.  I diagnosed her in five seconds, and I thought this would be a tough hour, but I was wrong about both the hour and the girl. 

She soon was picking up seeds from the reed, and saying, “Mr. Mike,” look at this.  I didn’t realize where the seeds were in the giant reed.  She had.  Ten minutes later, “Mr. Mike, look at my rocks.”  She showed me a collection of 5 pretty rocks.  “I have one thousand two hundred eighty at home.” 

“One thousand two hundred and eighty-five, now,” replied her mother, as the girl came up and gave me a hug. 

I can count on the past unbroken fingers of my right hand (that would be three), the number of people besides myself who count things just because they can be counted.  I counted the license plate tabs on New York state cars in early 1957.  I know that, because I still have my diary for that year and read it.  I know fairly closely the number of miles I have driven a car.  The night on Isle Royale, when the wolf made it wise for me to leave my campsite and hike 10 miles in the dark, I counted 1000 steps, then every other step 1000 times, every third step 1000 times up to every 9th step 1000 times.  People think this weird.  I do it naturally, just like whenever I hear a four digit number, like a hospital page, I multiply the first two and second two numbers.  I can outdo any calculator multiplying a pair of two digit numbers.  So to know a girl is counting the number of rocks she has was a real treat.  Bet she wouldn’t have thought counting steps weird.  Or seeing a wolf, for that matter.  She taught, too.  One of the other girls wondered if mica came from trees.  My disabled friend, and I use the word disabled cautiously here, told her no, pointing out more of the rock in the wash. 

She made my morning.  At the end of the four sessions, I was putting all the binoculars back in their cases.  I then heard “Mr. Mike!” again.  I looked across the table, and the girl gestured for me to come over.  In a water bottle, with a fern, she had a caterpillar.  I hadn’t seen any ferns or any caterpillars, but obviously she had.  I think I’m a decent observer; after all, I had diagnosed this girl.  Only I had let my prejudice get in the way of seeing what else was inside this girl – a curiosity about the natural world, an ability to see things in the world that many did not, and to collect and categorize them.  I finally admitted to myself that I wasn’t sure what her medical situation was, but that this was an incredibly interesting girl who I hope will have a chance to be fully educated.  My advice to teenage guys is to marry a woman smarter than they are.  Fortunately, I continue, that won’t be difficult.  I hope some guy looks beyond the physical impairments of this girl, because he will find an incredibly fascinating smart brain in her head. 

The caterpillar’s name, by the way, was Frumpy.

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.

NONFLUENT DATAPHASIA

November 24, 2009

IS ANYONE LISTENING?

November 24, 2009

NOBODY ASKED ME

November 24, 2009

OLDER. WISER?

November 24, 2009

I HAVE NO PROBLEMS

November 24, 2009

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.

PRHI-ty IMPRESSIVE

November 18, 2009