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October 17, 2013

This is going to be easy, I thought.  I will drive to the base of a nearby mountain, climb 1.4 miles (2.2 km), 1000 (310 m) feet and come back down 1.4 miles.  I can do this in less than an hour, and I don’t need food or water.  It was afternoon; the Sun was in the southwest.

I arrived at the base, went up in 25 minutes to the summit, and came down another trail that had appeared on the Internet map to take a longer route, 2.4 (4 km) miles to where I had begun.  No problem.  I needed the exercise.  The trailhead where I started was west of me as I started down the trail.  All went well for 15 or 20 minutes, but then I noted by watching the Sun that I was heading south, and I needed to be heading north or at the very least northwest. I should have been walking with the Sun to my left, and it was to my right.

This concerned me a little, and right then I should have stopped and turned around.  The trail was wide and good, however, so I kept going.  When it bent towards the Sun and even a little beyond, I felt better, but I generally had the Sun on my right.  When I got towards the bottom, I saw a parking lot that was clearly different from the one I started at.  I saw a sign saying “west Trailhead 3.3 (5 km) miles.”  That was where I had started.  I was down the mountain but an hour’s walk from where I had started.

I saw a nearby road and thought that maybe the road would take me to the trailhead faster.  That was my second mistake.  I had no map of the road, and my Internet connection was not helpful, either.  But the road headed north.  That was where I wanted to go, until the road headed west and then southwest.  I thought more and more about turning around, and saw a woman walking.  I asked her if this road went near a certain landmark I had passed.

“I don’t know that place, but you’ve walked over the mountain and are on the back side.”

That is not what the Internet maps had shown.  I knew immediately what to do:  turn back. It’s a shame an hour earlier I didn’t do what I knew I needed to have done, for I would now be approaching where I wanted to be. When I reached the trailhead, I had two options:  completely retrace my steps, which was not a bad idea, but I would have to walk up to the summit again, 4.1 miles (6 km) in all, and why didn’t I bring water?  That way had a 100% probability of returning me to where I wanted to go.  Or, I could start on the signed trail that led north 3.3 miles.  The trail had a couple of forks that were not marked.  One led to the summit, which I considered, because that was familiar, but I stayed on the flat trail I had found–the Sun remained on my left, and within forty minutes was back at the car.

I was thirsty when I got back, and I thought what I had done is how people get into trouble.  Step 1, you have a sense of uncertainty., but you ignore it.  Step 2, you start fitting things into place so that you convince yourself you are going in the right direction.  Step 3, things aren’t right, and retracing your route seems too long.  Step 4, you try what turns out to be a shortcut, and it isn’t.  Step 5, you run out of daylight, you injure yourself, you panic, start burning energy and consuming water by running, get more lost, and you are stuck in the woods all night, with no food, water, or shelter.  I’m not young; my reserves are less, and while the young are often the ones who die of hypothermia, I am far from immune.

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Seven years ago, on Isle Royale, I hiked in the dark after a wolf had visited my camp.  My flashlight was good, so I could see the trail, until there was a big blowdown in front of me.  I walked around the blowdown, and it took some time, but soon I was back on the trail.  Something nagged at me, however.  For whatever reason, I wondered if I had turned around. It happened to me once in broad daylight on the Appalachian Trail in 1998.  I stopped.  That was smart.  I took out a compass, which I had never used in the woods before, but always brought with me.  I needed to be going generally northeast, and my direction was southwest.  I had been turned around on the blowdown.  I thought I would come to it again, if I were correct, and I did just that.  I saw what I had done wrong and continued, northeast.  I listened to myself.

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Twenty-one years ago, with nearly 90 days in the woods that summer behind me, I headed out on Burntside Lake for the Crab Lake portage several miles away.  I didn’t have a map for the particular part of Burntside I was on, but I had maps for the rest of the the lake.  My plan was to go due north and eventually reach the part of the lake that I had maps for.

About a mile from shore, I hadn’t arrived at the points listed on the map I had. I tried to “fit” some islands ahead of me into the map I had, and I kept going.  After a second and a third mile, the less certain I was whether I was on the map, or where the Crab Lake portage was.  I could still see the shore behind me, where I had launched.  I stopped paddling.

“You are lost,” I said aloud, to the waves.  “You have no idea where you are.  You don’t want to admit defeat and turn around, but do so.  Nothing good is going to happen if you try to keep going.”  I turned around, quite embarrassed, and two hours later was back in Ely.  The first place I went to was an outfitting store to see where I had been.

I never would have made the portage that night.  The next morning, I launched from a different point and had a good trip into the Burntside Unit of the Boundary Waters.  I didn’t get lost once, and I was comfortable the whole time.

Failure to prepare properly sets the stage for getting lost in the woods.  Take proper gear, even if it is a short hike.  I didn’t on the mountain.  A sprained ankle, a minor issue,  becomes a big issue on a remote trail. Check directions.  I had a compass, but the Sun was more than adequate.  If you can’t tell yourself, “I know where I am, how far it is to a certain point, and how I am going to get to the end,” you should be concerned.  Listen to your concerns.  Sure, it is fine to walk a few more minutes, but start considering turning around and going to the last point where you knew exactly where you are.  Don’t ever look for shortcuts through the woods.  Unless you have a clear line of sight to a distant trail, stay exactly on the trail you are on.

Don’t be afraid to tell yourself you are on the wrong trail.   Don’t be afraid to turn back to familiar surroundings.  Don’t be afraid of saying you don’t know exactly where you are. Don’t be afraid of later having people laugh at your getting lost or having taken the wrong trail.  Later being laughed at means later you are alive.

Be very afraid of being lost, in trouble, alone, and saying, “I can’t believe this is happening to me.”

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CREAM PIES, BAD SERVICE, AND OCCASIONAL RECOVERY…WHAT’LL IT BE?

October 13, 2013

On the highway from Anchorage to Wrangell-St.Elias National Park, there is a small restaurant half way to the Richardson Highway, right near the view of the Matanuska Glacier.  If you are lucky enough to have the owner serve you lunch, you will have the choice of getting the dessert first.  I was at first taken aback, but the lady was an Alaskan, and I figured she knew what she was talking about.  Alaskans often do.

It was a fantastic lunch, with the best cream pie I ever had, followed by a grilled cheese sandwich.  On the way back from the Park to Anchorage, I had a late lunch, because I wasn’t going to eat anywhere else. I ordered the pie first and the grilled cheese second.  Granted, my lunch was not a big ticket item, but I was one customer who came back, because of how I was served.  I saw four national parks on that trip, and they were beautiful, as I expected they would be.  What I didn’t expect was to ever eat dessert first….and enjoy it.

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“I’m sorry I didn’t get back to you.  I just got back from vacation, and I had a meeting that was dumped on me this morning.”

I heard that after I answered my phone to hear, “Mr. Smith, how are you?”

My answer was terse:  “That depends upon what you have to say.”

Normally, I don’t partake in pleasantries, which I have been trying to change for years.  In this instance, however, “How are you?” was ludicrous.  It ranks with a customer service person not helping you, and then ending the conversation with “Have a nice day.”  Do people realize what they are saying? The previous day, the same individual, from the cable company, had failed to show for an appointment to look at the wiring at my house and tell me what I needed to do to get service.  This was electrical science, not rocket science.

One hundred five minutes after the agreed upon appointment, a voicemail was left on my phone.  At the time, I had long since given up and did not have my phone with me.  Apparently, this individual didn’t have his phone either, at the time of the appointment, or he could have used it to call me earlier in the afternoon to cancel or to change the time, something in my era that required a land line and knowledge of where all the pay phones in one’s city were located.  I thought it ironic that a man from the communication industry couldn’t make a simple call.

We agreed to meet the next day at 1.  At 2, still waiting, I called him, with the above exchange.  He eventually appeared, told me about his vacation (to watch a football game) and eventually set up the service, although he didn’t stay around long enough to make sure it worked.  It didn’t, although I was eventually able to fix the problem myself.

Here are some lessons for people in the service industry:

  1. If you can’t keep an appointment, tell the customer immediately, apologize, don’t offer excuses, especially that you were on vacation (many people these days can’t afford them or are taking an unplanned, unpaid one), and had extra work.  Your family is interested in excuses; your customers are not.  We are interested in an apology and a new, early, convenient appointment.
  2. If you miss a second appointment, you are in trouble.  You begin the conversation with “I am so embarrassed, and if I can still convince you I will show up, I will give you a month’s of service free.”  That is an apology and use of a term called “recovery,” which was shown to me by the motel clerk in Anchorage, after I slept on the floor in the airport because they had given my reservation to another Michael Smith.  I got two nights in a large suite at half price.  Unfortunately, the night “sleeping” on the floor was not refundable.
  3. You are so in trouble, that you need to drop everything and serve that customer.  That means you don’t call ten minutes later and check where the customer lives, especially since you have a computer-phone which can give you that information as well as even substitute for a pay phone.
  4. You make it certain that you have your phone with you at all times, especially if you are in the–uhhh  communications industry, so if your boss calls you unexpectedly, you make sure that your customers are aware if there will be a delay.  If your boss objects to that, find a new line of work or a new boss.

I read body language well, and it was clear the cable guy either wanted to leave or needed to use my toilet. I’m not sure I ever did it right, but I have had doctors who were incredibly busy but made me feel they had all the time in the world for me.  Those people are worth a great deal.  Find them.

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In this city, to which my wife and I travel frequently, we eat almost exclusively at a certain restaurant.  After a while, not only did they give us “a little extra” or “try this and see what you think,” great business practice, the owner, a woman, remembered us, despite our sometimes having been absent for months.  That is impressive; if you have that skill, you need to tell any potential employer you have it.  People like to be remembered.  Why would we eat anywhere else?

I was recently at this restaurant, this time alone.  Unfortunately, the owner was away on vacation, and there was a fill in staff.  The food was great, but the place wasn’t the same. I still left a large tip, because these days tips matter a great deal to people.

The next night, however, was different, maybe even a disaster.  As I entered, I noted many cars parked outside.  There was a large group in one room.  I sat down and immediately ordered, not because I knew there would be a wait, but because I knew what I wanted.  Fifteen minutes later, the woman across from me asked if anybody was going to serve her.  This was a bad sign.  Ten minutes later, I was told by one waitress there was a group of 14, and the kitchen was getting “slammed.”  There was an apology, but the lady still not had her order taken.

Fifteen minutes later, and fifteen minutes before I was going to leave, my food came, slid to me by the server, without one of the side dishes I particularly like.  I had to go up front to request that side dish, and when it arrived, it was again slid about a meter across the table to me by a hurried waiter.  Simultaneously, a table of 5 was getting special treatment by one server.  It was an elderly lady’s birthday, but I wished that they could have just ordered the dessert a little faster.  The lady across from me was now saying people who had come in behind her were getting served.  I finished as fast as I could and left.  I did leave a tip, less than I normally do, and left.

This restaurant was too busy that night.  The lady across from me will never go there again, UNLESS  there is recovery and her meal is free.  That would likely bring her back at least for another try.   Is a free meal worth it?  I think so.

The next night I returned.  Within 30 seconds of sitting down, I had my order taken and the side dish was at the table.  I had a good meal and left a good tip.  On the way out, I did talk to one server I knew.  I told her that had the restaurant told people there would be a 15 minute wait, they likely would not have had so much difficulty.  People are willing to wait to be seated, so long as the wait time is reasonable.  What people don’t like is be put at a table and forgotten.  Once a customer is seated, the process has to begin.  The server thought I had a good idea.  This isn’t even electrical science.

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The following night, at a different restaurant, I got prompt service, but the menu was  stained with food, and I received an “is everything OK?” called to me from about 10 meters.  To be fair, I was the only one in the restaurant, so maybe that was fine.  It seemed a little tacky, however.  The bill came with a feature that costs the restaurant industry millions in lost revenue every year:  Nobody asked me, “Would you be interested in looking at our dessert menu?  We have some interesting choices.”  I’m thin for my age, and on this particular day, I was hungry.  I paid the bill, left a better tip than deserved, and left.

You can bet the lady running the restaurant in the Alaskan hinterland wouldn’t have forgotten the dessert.

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DR. NONEG

October 11, 2013

When I was medical director of a hospital, I dealt with a Dr. Noneg, a prominent member of the medical staff.  Noneg entered practice near the time as I was changing my role to hospital medical director from neurologist.  Because of personality clashes, he soon left the practice that hired him.  He wouldn’t budge on his demands, but he was new to the practice, so there were choices, but not very good ones.  He could lessen his demands, or he could leave.  He left and began his own practice.  He was against insurance companies, as many were, and for some time got a great deal of press because of his outspokenness.

Noneg occasionally practiced outside his field.  When we were both in practice, he handled carotid artery disease cases, something I believed then and now only a neurologist should do.  Since 1984, I had tracked outcomes and referred my patients to only one surgeon, whose outcomes were slightly better than untreated disease.  I made my data available, but the local surgical community slammed me for my data and approach.  I was the only one to deal with this issue using outcomes at my local hospital.  Dr. Noneg did not.  He handled MS cases, which an internist can, but really a neurologist should.  For me, it was a matter of doing what is best for the patient; I wasn’t protecting my turf. Indeed, I wanted less work, not more.

Noneg and I clashed when it came to coverage of the emergency department at night.  Many patients who come to the emergency department don’t have physicians.  If it were a particular specialty, that patient would be assigned to the physician on call for that speciality.  Each physician was on call in a rotation that lasted a month, and several of us had several months a year we had to take new patients.  When one was building a practice, this was a way to do it, unless, of course, the patient couldn’t pay for the services.  I wrote off $30,000 a year in unpaid bills for over a decade.  It was considered normal, but I made good money in spite of it.

Noneg didn’t like this coverage arrangement, and he convinced many of his colleagues that the hospital should pay for such, $500 a night per specialty.  Needless to say, this would have been a great expense for the hospital, since there were at least ten specialties a night that would need payment.  Noneg wouldn’t negotiate.  Not a bit.  In many ways, he reminded me of the Republican Party.  There was no give or take.  If you did what he wanted, he was a nice guy.  If you didn’t, he was an enemy.  Had the hospital capitulated, I certainly would have been laid off, which I could have dealt with, but then the physicians would have had to deal with their issues (yelling at nurses, turf wars) themselves, which physicians, for all their power, are loath to do.  By the way, physician behavioral issues were the single biggest problem I faced as medical director.  I counted.  “Administration is the problem,” was said, until there was a thorny issue, and then “administration needs to fix it.”  Substitute “government” for administration, and you have a common national refrain.   We hate government, until a Cat 5 or an EF4 devastates our town, and then we can’t have enough of it.

Back then, we had nurses from managed care companies review patient charts to see if continued care was necessary in the hospital.  On the one hand, it was a physician’s decision whether or not to discharge a patient, not an insurance company’s.  On the other hand, many physicians would write “Doing well” for days, without any indication of why if the patient were doing so well why they needed hospitalization.  Hospital resources were consumed, not the physician’s worry.  But if somebody is paying the bills, that somebody usually wants to have some control over the costs involved.

An additional issue with utilization occurred in winter, because the city had an influx of visitors, and hospital beds were in short supply.  Getting patients discharged was necessary to allow new admissions, otherwise having to go on “divert,” which was not good for the city.  It was not uncommon for patients to stay in the Emergency Department 24 hours, no bed being available.  This was not good care.  When we didn’t have a bed, because a physician hadn’t visited that day, the physician said the patient wasn’t ready to go, without any documentation in the chart, or because the person covering for a physician refused to make a decision, we had one less bed we could fill.  Dr. Noneg responded to the notes from managed care nurses, polite as they were, with a simple “Drop Dead.”

In a hospital, that is not particularly funny.  Nor was it helpful.

Dr. Noneg persuaded his colleagues that the care of emergency department patients was the hospital’s problem, and the physicians stopped accepting them.  Accordingly, the hospital hired people willing to practice in the hospital full-time, called hospitalists.  They took care of these patients, and during their stay, found a physician willing to care for them after discharge.  I would have liked that job: regular hours, taking care of sick patients, then not having to manage their problems in the office afterwards.

Soon, hospitalists started caring for more and more inpatients.  For some physicians, who were very busy in their office, this was a good idea.  For others, who found that they were no longer going to be able to take care of their patients in the hospital, this was resisted.  The state medical association tried to intervene, but when physicians give up control of taking care of emergency patients, sometimes there are consequences.

Not negotiating has consequences outside of medicine.  It has tied Congress in knots over a host of issues, all of which could be dealt with given some creative thinking and a little willingness to let the other side have something.  But if you are Dr. Noneg, or a member of the Tea Party, you simply don’t negotiate.  Maybe the other guy caves, maybe not.  I learned early in life that the world isn’t going to do what I demand it do.  I had a lot of temper tantrums.  Some apparently do not learn that.

Eventually, Dr. Noneg set up a boutique practice, where he would be available 24/7 for his patients, each of whom paid him $1500 a year.  It wasn’t for the money that Dr. No did this, of course, except whenever somebody says it isn’t for the money, it is always for the money.  Dr. Noneg tried to have his patients jump the queue in Emergency Departments, but one soon learns in medicine that ED physicians and nurses are extremely strong-willed individuals who work in a high stress environment and deal with it well.  They don’t negotiate, either.  Dr. Noneg lost, and his patients had to wait.  The $1500 didn’t cover hospital or consultant costs, although I suspect–but cannot prove–many patients thought it would.

A while back, I got a call at home from Noneg’s office, wanting “my staff” to pull a chart of a patient I had once treated.  I haven’t practiced in over 20 years, and my charts, if still intact, would have remained with my group.  I was surprised that Noneg didn’t know that.

I was also surprised he didn’t demand I produce the charts. That would have been an interesting negotiation.  I would have enjoyed it.  But the world doesn’t always work the way I want it to.

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PRIORITIES

October 8, 2013

Vermilion Community College in northeastern Minnesota had to cut its budget 8.5%, or $750,000.  Concomitantly, there is a tuition freeze.  The latter is good for students, but further budget cuts are required, and they can come only from curtailing services, like laying off faculty members. Gee, that’s a great way to help unemployment, cutting college budgets so that fewer students can get an education that helps them get a better job, or to create jobs, through innovation.

Big government has often been the enemy, until 2005, when most of the country asked “Where’s FEMA?” and heard “Heck of a job, Brownie.”  That was the answer to gutting FEMA.  Fast forward to 2012 or 2013, where FEMA was positioned before Sandy hit and Moore was devastated.  Watch Coast Guard Alaska sometime and see how many lives are saved by government people–military personnel–who fly choppers into harm’s way to save people.  Does anybody in their right mind think we could do this privately with less cost?  Many feel each of us should take care of ourself.  That’s fine, until a family member is T-boned at an intersection with major trauma, a spouse says “I have cancer,” or a child needs something common–an appendectomy–and you don’t have insurance.

Vermilion is uniquely located in a town of 3400 at the edge of the largest roadless area in the Lower 49.  North and east of Vermilion, one travels only by canoe.  Vermilion offers courses in wilderness studies, including management, biology, and law enforcement.  Ten per cent of their students are minorities, and the student body comes from 250 different high schools.  Ask your local community college how many high schools their student body comes from.  Or whether they offer studies in Park Service Law Enforcement.

There are scholarships awarded to VCC students.  I am involved in three.  In the past seven years, the monies have doubled, from $20,000 to $45,000.  That’s a long way from $750,000.  I am trying to get the Friends of the Boundary Waters to create more scholarships than the one I initiated and mostly fund.  I want 3, 4, or 5 scholarships.  The Friends couldn’t stop the cell phone tower that is visible for 20 miles in the wilderness, and they probably can’t stop the sulfide mine, either.  But the Friends could fund several scholarships, sending a strong message to the Conservationists with Common Sense and those who think mining is the answer to joblessness that no, it is education that matters in Ely, and education is what will save the town, not mines.  My letter to the membership will be sent soon.  But even 100 scholarships would barely make a dent in the deficit.

There is a vocal group in this nation that says we should all pay our own way.  They are against government funding for education, immunizations, family planning, health care, food safety, milk pasteurization, science in all forms, weather forecasting, and early reading programs, all of which pay huge dividends.  This vocal group does not consider long term issues, like what happens should you get disabled, demented, ill, hurt, or suffer from consequences of a hurricane, tornado, flooding or drought.  To these people, government is bad, the private sector is good.  Stated differently: Republicans in government are public servants; Democrats are bureaucrats.

The congressman from Colorado, whose district was devastated by the recent flood, voted against Hurricane Sandy aid.  Many in Congress whose districts have been  beneficiaries of FEMA voted against aid to Sandy victims.  That’s real Christian.  Perhaps the churches can fix the roads in Lefthand Canyon, where I once lived, with a few collection plates.  Without federal aid, these people are SOL, because they lived in the wrong place, like Moore, Oklahoma, or Joplin, Missouri.  Should we pray more, like Governor Perry suggested?  Or do we fund the National Weather Service? I sometimes wonder what century I live in, whether I need to reset my watch back 75 years.

This vocal group is dangerous.  They will destroy the country as we know it.  They want to remove SSI and Medicare, devastating the elderly, destroy public education, and send us into default that will destroy our leadership and the world’s economy.. They want troops to go everywhere, so long as troops aren’t them or their children.  Only 7% of us are veterans.  I don’t think this group will ultimately win, but  Mr. Obama inherited a huge mess in 2009: 2 wars, the credit markets nearly frozen, and bad unemployment.  The wars had been kept off budget, so it wouldn’t look so bad. He couldn’t fix the mess in 2 years, and those with insurance were so vociferous about the Affordable Health Care Act that the American public voted in a bunch of crazies, who will do whatever it takes to bring down the government to get their own way.  They are also impolite, shouting “lie” at the State of the Union Speech, and shouting down a CIB Congressman (Combat Infantry Badge) who was against the Iraq War.

We could, of course, fund education and basic research better.  We could restore public education to the extent that the US educated its citizens to read books, write a coherent sentence, understand enough math to deal with debt and calculate interest (the Rule of 72 for doubling time of money–P/Po=exp(rt); P/Po=2, and take ln–the natural log– of both sides, so that the doubling time is 72 divided by the interest rate in per cent).  They  ought to know where, say, Azerbaijan is and why it is important (Caspian Sea, oil, proximity to Dagestan and Iran) and speak 2 or maybe 3 languages.  We could do this.  Then perhaps we wouldn’t complain about outsourcing of jobs to countries who believe education is important.

I find it annoying and hypocritical that Rand Paul’s state of Kentucky gets more in federal aid than it pays the government.  I think Kentucky should get funding for one thing:  Mammoth Cave National Park. New York State in the past two decades has paid more than a trillion dollars (that is 1E12, Rand, in case you didn’t know) than it has received.

Back to Vermilion, which could, of course, raise tuition and force students to get loans.  That would balance their budget but create students leaving with large debt.  Well, then, let’s open a sulfide mine.  Except mining jobs don’t last.  Only the tailings do.  Unemployment on the Iron Range, is the highest in the state, triple that of other parts.  Ask the people in Morenci, Arizona, how well things are going now.  Ask people who work in the mines what they want their kids to do.  Hint: it is not work in the mines.  The world has changed; the days of high school to the mines to having lots of money with ever increasing benefits are gone.  That was a past world.  The present is much leaner.  The future will be even more so.

With both age and illness stalking my life, I’m more interested in next year and the next decade, too, hoping that good science will be there when I need it, not prayers and collection plates, because I don’t believe in the first, and the second denies the reality of medical costs.  We could start with a tax rate of 39.5% for AGI over $250,000 and 50% for AGI over $2 million, because nobody in my view is worth $2 million a year.  In addition, deny them SSI, and tax 80% for bonuses of any sort.  Oh yeah, charge a buck for every $1000 trade in the stock market.  Stop policing the world, and fix the infrastructure that our “strange weather” (that really is no longer so strange) destroys every year.

Yes, raise taxes.  It’s an investment.  Fixing infrastructure will create jobs and long lasting value.  Fixing education will allow young and older people get out of the rut to go places their families never have gone before.  Health insurance will improve lives.  This has been proven in Oregon.  Hire more teachers at Vermilion and have a scholarship fund that allows deserving kids to have impacts in many areas. We need mines: we need them to be more productive of materials, safer, using less energy, with  far less impact on the environment.  Those new mines exist; we need only the right people to create them.  They will appear, if we educate them.

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