Archive for April, 2019

END OF TWO ERAS

April 28, 2019

“Mike?” The woman, who had looked at me a little strangely when she had put her jacket down before ordering, sat on the couch across from me at The Front Porch, a small coffee shop in Ely. I had wondered if I knew her. The odds were against that, as Ely has a population of 3000, of whom I knew exactly three women and one man.  Two of the women I could immediately exclude. 

“Jett?” I replied, and the ensuing smile confirmed that I had the right third.  Wow, I come here once, occasionally twice a year, spend a night, then head out into the wilderness for days, and this is the second time I have run into someone I knew at The Front Porch.  Nineteen months prior, I saw Becca Manlove, widow of Mike Manlove,  with whom I had taken many canoe trips into the wilderness as a forest service volunteer.  Mike died hiking the Bass Lake Trail in 2007 and was was one of my best friends.

I knew Jett from two veterans scholarships I created, originally to student-veterans attending Vermilion Community College (VCC), now open to relatives of veterans.  Two of Jett’s nephews died in Iraq, and for several years, I funded scholarships given in their names. I have created four scholarships in all at VCC and am deeply satisfied to help even a little.  Money goes a long way in the North Country.  I have no direct ties to the college, but I have been coming to Ely since 1981, taken 68 overnight canoe trips into the woods to more than 300 lakes, spent 300+ nights, and want to give back to the community.

I have trod in the steps of the wilderness writer Sig Olson, once dean at then Ely Junior College.  I met Dorothy Molter, “The Loneliest Woman in America,” on Knife Lake in 1981.  I was interviewed for a newspaper article by the late Bob Cary, editor of the local Ely Echo, writer (including a book about Dorothy), fisherman and legend.  He and his wife endowed an annual scholarship, now presented by his daughter.  Both my parents met Bob, and my father died the same year as he, both having lived long, good lives.

My first scholarship was for a student, chosen by the faculty, currently taking course work leading to a career helping the wilderness.  When I can, I try to go to Ely in late April to present it at the annual banquet. This was the scholarship’s 14th year, and I’ve been there for half. It’s a long way to go, but it means a lot to the Foundation members and recipients that donors come.  Besides, I can canoe, hike, or snowshoe, depending upon the conditions.

In 2007, I created a second scholarship, believing that the Friends of the Boundary Waters should be an environmental organization saying a loud “Yes” to education in the neighborhood of the wilderness they wish to protect. The Friends and I split the cost; it has their name and they present it.  I had not gone to the banquet for six years, but I knew I would go this year when I learned that Patti Z., Executive Director of the Foundation, was retiring in June.  An era was ending. 

That day, after meeting Jett, after hiking 9 miles on a wet, beautiful spring day in the north woods,  visiting five still-frozen lakes, seeing a couple of eagles, and almost nobody else, I stopped by the Forest Service office on my return to town. Becca worked for the Forest Service and I hoped perhaps she might be free to meet with me.

She had retired.

Dry Creek Falls emptying into Bass Lake, Superior National Forest

I had two quick realizations: one, I wasn’t the only one growing old.  Others were, too.  Second,  another era had ended.  For nearly thirty years, I had known someone working for the Superior National Forest.  No more.

I then went to nearby VCC to talk to Patti, and for once we both had time to chat.  She was looking forward to retiring, but she was going to miss a lot of what she had been doing—in her three jobs.  She would stay busy, of course, because she is that kind of person. Already, she had possibilities lined up.  She decried the polarization in Ely with mining vs.no mining groups.  

I told her how several years ago at the banquet, a father of my scholarship recipient told me he worked in the mines on the Iron Range of northern Minnesota.  He was so happy that his daughter was getting an education, “so she won’t have to follow me into the mines.”  I continued that many were looking for short term profit and not dealing with the real, catastrophic risk that mining could unleash sulfide into one of the most pristine watersheds on the North American continent, poisoning it forever.  

I didn’t add that such would be called “An Act of God,” rather than an act of man, the company would of course be bankrupt and “just not be able to pay for the damages,” and likely My Side would end up being blamed for the disaster, due to “regulations, obstructionism, extremism,” because it is always My Side’s fault.  I could have mentioned that VCC calls itself “The Boundary Waters College,” not the School of Mines, which is in Golden, Colorado, not Ely, Minnesota.

In discussing the scholarships, Patti said that some members of town asked her why the Foundation would accept money from the Friends.  Patti laughed, when she saw my jaw drop and the “O sign” appear on my face.  “I told them the money is for educating the students we have in the wilderness programs, and if they felt their organization should have a scholarship, they were welcome to create one themselves.”  She paused for effect.

“Funny how I never heard from them again.”

Stream at south end of Angleworm Lake, Boundary Waters Canoe Area

I went to the banquet the following night, my spirits remaining high.  That day I had hiked another bunch of miles into three different lakes, on trails having snow, ice, mud, streams and small lakes. I was happy to see young people at the banquet who will try to fix the mess my generation left them, the mess created in the name of jobs, quarterly earnings targets and balance sheets that never once looked at environmental impact liabilities.  I sat next to the executive director and the northern cities director of the Friends.  They were happy to be present, had looked forward to meeting me, and were so grateful I had created the scholarship. It is one of the better ideas I have had.

Angleworm Lake, south end, nearly ice-free, BWCA
Agassa Lake, Superior National Forest

Seated on my other side was a geology teacher at VCC with the last name Terwilliger, as in Terwilliger Hot Springs in Oregon, where I have done trail building as recently as two weeks ago.  He got to see pictures of the place he had long known about.  This year’s Friend’s scholarship recipient had paddled in a Louisiana bayou, fought fires in Montana, and done research on the Tasmania Devil in Tasmania. 

The following morning, I again ran into Jett at The Front Porch, and she told me that one of “my” scholarship recipients years ago went into law enforcement, began training as a first responder, until the instructors said he ought to go into medicine.  He’s now a physician, returning to Ely to practice.  

“We’ve come full circle,” she said.  

At the banquet, in the Grand Ely Lodge, I saw a flier for Hidden Valley, a winter sports facility near town with many trails which I had never visited in all my years coming there. Before I left, I stopped by and hiked up on now bare ground to one of those trails.  I do winter trail marking in the Cascades, and I have snowshoed a hundred miles this winter on them.  I went to specifically see and walk the loop trail named “Mike Manlove.”  

KNOWING IS BETTER THAN NOT KNOWING

April 13, 2019

I stood up as a very tall young man walked into the examining room, didn’t introduce himself, shook my hand, and as he sat down, his booming voice uttered one word:

“Questions?”

Interrogative.

It reminded me of the time in 2006 I was in Grand Marais, Minnesota, the night before I went to Isle Royale National Park.  I was at the casino eating dinner, since that was the only place open, and the waiter walked up and uttered one word.

“Walleye.”

Declarative.   

I remember repeating the fish’s name, interrogative, and he replied that it was the special. I’m not sure if I decided to have it, but I do remember his introduction.  

I went to the urologist’s lab a week prior to get my annual PSA test.  I am more concerned about my PSA than I should be, but I remember the adage that the probability in percent  of a man’s having at least microscopic prostate cancer is equal to his age.  In addition, my father had it, and he took an expensive medication to control it.  My only biological brother doesn’t write me often and may not have been checked in years, so I don’t know anything there. 

I arrived at the office for my appointment 20 minutes early to check-in, the check-in line out the door, and only one person working.  I joined a few old people there, and while waiting, I heard a daughter ask her mother-patient questions that the latter needed to have repeated and wasn’t sure of the answer.  The receptionist had a problem couple she was helping, and explaining the iPad check-in took time.  Life is sometimes difficult for those of us digital non-natives.

Eventually, it was my turn, and fortunately, I was checked in quickly and given two pieces of real paper on which to write down my medications.  Before I even got to the third line, I was called: “Michael?”  

While I usually introduce myself to younger people by my first name, I don’t like being called it in public by people who are a third to half my age and don’t know me.  It wasn’t worth saying anything, but whatever happened to basic formality? Perhaps if we were more formal in our speech and treatment of each other, we Americans might be less polarized.  Or not.  Just sayin.’

The nurse told me that “James” would be seeing me.  I didn’t know a James, and I started running through my head my doctor’s first name.  On my way to the inner sanctum, I had to get weighed, so I took my phone and wallet out of my pocket, stepped out of my shoes and got on the scale.  I lost 13 pounds two years ago, kept it off, and am proud of it.

I was put in a room to wait for “James,” saw my doctor’s first name (David) on a business card, and within a couple minutes, the tall man entered.

I was so stunned by the start, I couldn’t think of anything to reply to  “Questions?”  

I should have asked, “Who are you?” But, I read the “PA” on his badge.  I could have then asked, “Where’s David?” But obviously I was going to be seeing a PA.  I stammered, much like Ralphie does in the movie “A Christmas Story,” near the end, on Santa, he clams up and finally says, “A football?”  with my version of the pigskin:  “What was my PSA?”  

Tappety tap, mouse clicks.  Then, “When was it done?” Answer—with plenty of time for it to have been sent here and written on a piece of paper that you could have taken in your large hands in here and given me the result immediately instead of tappety, tap.  I stared at the wall and finally learned it was a good 1.8.  

I liked my physician, David. He’s a major player in the local and state medical community plus being a principal investigator for the practice.  I was once a player in my local and state medical community but never a principal investigator, although I tried to get my colleagues to investigate errors, but that didn’t work out.  

I have called the office and been on hold, where I heard about the great cutting edge, literally and figuratively, care is given.  It’s truly impressive, as is the information given to patients, hearing, “Knowing is better than not knowing.”  But, I didn’t know why I wasn’t seeing David but a PA.  I realized that being a retired physician counts for little these days, either in a medical office or outside of one, where first responders, nurses, and therapists carry the day and docs are good for ….well, let’s face it—being donors, bashed as a group, or occasionally being asked to give a curbside or trailside diagnosis. I had several questions, and while some were answered, it wasn’t the same.  I got my exam and some recommendations.  David told me a lot more.

The next thing I knew, I was walking out of the office, aided by a sign pointing to the exit, which was needed, because I needed to be in the left lane or else walk into somebody’s office. I remember thinking that the sign needed to be permanent, because it was necessary and the temporary one looked tacky in this 21st century office.

I had been looking forward to telling my urologist that I was off diazepam, that I had both discovered and used it successfully for a nasty condition. I tapered it myself, after one internist suggested as I got older I had more of a fall risk taking it, which was true. I tapered it faster when my next internist ignored my refill order. Don’t get severe pain today, because physicians are scared of the feds coming down on them for opioids and other controlled substances scripts, even when diazepam is not an opioid.  We went from pain as a 5th vital sign to don’t ever give opioids. I’ve been on this pendulum before.

I never got to talk to my urologist about the fact that some of my issues arise from other medications I am now taking.  This stuff happens at 70. I wanted to talk to him, because “Knowing is better than not knowing,” unless one is an old man with a stable condition and can be put off on a mid-level practitioner, rather than the physician.  I never did that when I was in practice.  I saw people, I returned their calls myself, I gave mountains of free advice and care, and I was a chump in another era.  But I was available, for better or for worse; for worse, if I were sleep-deprived, which was often. My office didn’t require people to make more than two 90 degree turns or walk more than 10 meters from the waiting room.  We didn’t need signs showing how to leave the sanctum sanctorum.  

It’s a different world.  

I wrote David and said I had missed him and had looked forward to seeing him.  I never got a reply.  That hurt.  It takes 24 seconds to send a polite blow off email.  I timed it once.  I sent an email to James deciding to take the medication we discussed, and several days later screwed up logging in to my patient portal, getting my account locked.  I waited and sent a couple of emails, and nothing happened.  A call finally settled everything, and I was told an email for me was on the portal, except it wasn’t.  Three days later, I got a three emails giving me a password to my account. Not being a digital native, I just thought it was a bad system, but digital is always better.

I thought that the bill would be less because I saw the midlevel and didn’t have a urinalysis, which I wanted to have.  It is, after all, a urology office.  One colleague told me that my bill would be the same. We were both wrong. It was $150 more than the prior year, when I saw the physician AND had not only a urinalysis but an ultrasound. My followup care charges in 1992 were $35. By medical inflation, they should now be $90. It was $350 for what I described above. We’ve lost something in 21st century medical care.  We are arguing as a nation as to who should and should not have care and how it is paid for.  Fair enough.  We need to do more, in my opinion.

But how the care is delivered is not unimportant. Knowing is better than not knowing.  And there is still important magic given by physicians who actually take time to see patients. That time matters.  Knowing matters. Laying on the hands matters.  I didn’t fully understand that when I was in practice.  I do fully understand it now.

And we have yet to fully address quality of care.  That’s for the 22nd century.