Archive for June, 2020

STOP THANKING PEOPLE FOR THEIR SERVICE AND START SERVING

June 23, 2020

The day I arrived back in the US at Travis AFB, later SFO, I was carrying two arm loads of gear from my ship, which I had left about a day earlier in Subic Bay. As I half stumbled with the load along the sidewalk, people would not get out of the way.  I was still in uniform, and I would be until I could dig some civilian clothes out of my luggage, and that wouldn’t happen until after I arrived in San Diego.

That is how I left active duty in June 1977.  Nobody cared where I had been or what I had done, and there was no reason to care.  I filled a billet, I did what many young men did back then, and when my time was up, I rejoined the civilian world. The only things different would be that my hair would remain short—until the quarantine 43 years later—I lined up my shirt buttons with my zipper, and I called a lot of people “sir.”  I was 2 years older as a resident, and back then, that was considered significantly older.  November 11 came and went without my notice.  

For the next 25 years, that is about how things went regarding my past service. I had a few memorabilia on the wall in a bedroom, I drove lawyers crazy by using “sir,” because they expected a doctor to insult them, I guess. I learned a long time earlier that one could use sir in an infinite number of ways, just so the word got spoken. “Aye, aye, SIR!” I once yelled at the executive officer when I left his office having to do something I though was stupid and unnecessary.  I even let loose at an attending my first month, caught myself…and ended up with a “You are full of BULL–uhh-LONEY, SIR.”

It was 9/11 where things changed.  Suddenly, many wanted to get into the service and do something. I remember in 2003 at the AP Stat readers meeting, where a few hundred of us corrected the national AP exams, a couple of teachers were in the national guard and going to Iraq. At the meeting, they asked all veterans to stand. I was surprised.  Never heard that one before. As I stood, there were maybe 10 others in a group of about 200.  Interesting.  It is nationally about 7%.

The next time was Veterans Day that same year when I learned it was a holiday at a school where I was volunteering.  I was so surprised, I blurted out that hey, I was a veteran.  

Since then, there have been yellow ribbons on cars, flags everywhere, especially at football games, and on uniforms the players wore.  We started calling everybody who was serving a hero, which then was used for pretty much anybody who was doing what others didn’t want to do and who never before had been considered one or considered themselves one.  Heroes were also in charge of Abu Ghraib, too, or some of the more unsavory things that we did abroad. The flag got co-opted by one side, even as they did things in its name that the flag most assuredly did not stand for. 

At track meets here in Eugene, veterans and current military personnel are asked to stand before the national anthem. It is a weird and frankly kind of a neat feeling, although again, all I did was fill a billet on a ship.  If I hadn’t been there, some other guy would have had to do it. On Veterans Day, I now wear my ball cap and look for others wearing theirs, too, feeling a kinship over years, countries, and military actions.  One guy a hike with got blown up in Vietnam. He is a biologist and has had a full life. Once, one of the other vets told him that he felt guilty for staying stateside during Vietnam.  

“Don’t ever feel guilty,” the once injured man said.  He wore a hat that said “Peace.”

When Covid hit, I wanted to help.  I was willing to go to the USNS Comfort or Mercy as a medical officer—out of date to be sure, but able to help out in a military setting. It was a big pipe dream, of course, just like going elsewhere to help would have been.  I would have been  another person helping with some medical background, but I didn’t want to be one who got sick and made more work for others. I stayed home, was good, didn’t cause trouble, and did my part not to get infected. 

And so I find it strange, odd, and frankly reprehensible that when public health leaders in the country ask us to wear masks, to socially distance, to not crowd, and basically not to do stupid things, that there has been so much pushback. One of my military veteran former friends said that being worried was a result of watching too much TV.  Armed vigilantes descended on the Capitol here and demanded opening up the state. Wearing masks became a political statement, rather than a simple measure to try to limit the spread of the virus.  People complained that they weren’t being allowed “to live,” when in fact the whole idea of the restrictions was to ensure that more people did live. 

It was certainly a necessary, if unfortunate circumstance that people had to eschew normal human contact. But to don a mask—which can be decorated, like a hard hat or a helmet, or a car—to avoid infecting others and at the same time protecting oneself from infection, seems a tiny price to pay for the ability to again be outside, in public, able to do many things that for a couple of months we couldn’t do.  In Dallas, an increase of 12% absolutely for wearing a mask and social distancing—from 57 to 69%—would cause an outbreak to go from exponential growth to dying out.   A friend of mine went shopping where he counted 8 in 79 wearing a mask. I was surprised it was that high.

A couple of months of being limited in where we could go.  Anne Frank spent 25 months hidden where she was far more restricted than many of us were.  And she ended up dying.  

In Union County, Oregon, a few hundred had to attend church to sing and hold each other, ensuring that in a week 263 would get the virus in a county of about 15,000:  “Science is Real.”

“Thank you for your service” is now said to first responders, medical workers and essential workers. We need to stop saying it and realize all of us have a role in serving right now. We have a role not to get ill, not to enhance the spread of the virus, not to be jerks about it, not run too close to others in parks, or crowd in public.   We had a chance to stop the virus, and right now it looks like we will lose that chance. Wearing masks has somehow become against the constitution, against liberty, the right to infect man, the right to do what one wants, even if it infringes upon someone else’s rights—especially if that someone else is a Democrat.  

We have grown soft as a people. We are so concerned about our rights, we have forgotten about our responsibilities to collectively improve society. We want everything we want now.  But we aren’t willing to compromise a bit on anything that we think infringes upon our rights to do whatever we want without regard to consequences, costs to others, or anything else smacking of collaboration or helping one’s fellow person.

Wearing a mask is serving the country.  Use a face shield if one wants, but do something positive and useful. 

Thank you for…not being a jerk.

Face shields are easy to put on, allow one’s expression to be seen, and protect one’s eyes, which a mask can’t do.

The ball cap is wearing out, but the jacket still fits. 2016.
One can serve by volunteering outdoors, clearing trails. The author (right), Waldo Lake Wilderness, June 2019.
or…one can go on sites like zooniverse and help transcribe data from outer space, biology, physics, social sciences, or here, the names of prisoners at Mauthausen and other places, so that those who died are remembered. I visited Mauthausen, saw the “Gas Kammer” and the places where prisoners either had to jump into a quarry or be shot. It is a deep honor to be allowed to be part of the project.

THE ONLY TIME IN MY LIFE I WAS A RINGER

June 12, 2020

I had forgotten about this event for a half-century.  Or I had repressed it.  Anyway, while I was doing my morning 5-mile walk through the park today, just having seen my thirtieth different wild flower species (a Golden Iris), I thought of how this would be a lost summer for the young men who were on the canoe tripping staff at Camp Pathfinder, Canada, where I learned to canoe trip, nearly 60 years ago. One only has a few years when one is strong, has time, is willing to and can work hard, get muddy, sunburned, wet, cold, bitten by bugs, and travel by pack and paddle through of the most beautiful country anywhere.  I took 25 trips all over Algonquin Park in 6 summers, paddled to South River Village one year and spent two weeks up in Temagami in 1964.

I don’t know what brought the memory deep out of my hippocampus, but this morning I thought of a canoe race I was in 54 years ago–my only canoe race, a two man one, international competition (after all, we were in Canada).  

We staff members at Pathfinder had days off, where we either had to paddle two miles to the car dock from the island camp, or if we were lucky, caught a power boat.  Once there, it was 2-3 miles to the Park Road, and then we hitchhiked into Huntsville, about 40 miles away.  We did our laundry, had ice cream, great food (although it was great at Pathfinder, too, and lots of it), then had to retrace our route back to camp. One night, I went to the local night club at Hidden Valley, a nice hangout, which was still there in 2013 when I came through.  Back then, if one went to H.V., it would be a real late night getting back to camp. Somehow, we all did.

One weekend, and my memory is obviously very flawed, considering I hadn’t thought of this event since LBJ was president, Justin W. and I were approached by I believe the mother of two boys at the camp.  She was a rich socialite.  Her name would be immediately recognized in the clothing industry if I wrote it, but she wasn’t the story.  Justin and I were.  There was to be a canoe race on a lake nearby.  It may well have been Lake Muskoka, but all I remember was a big lake with powerboats.  Justin and I were handed paddles and a canoe, and I can’t remember if we wore PFDs.  We probably didn’t, because back then we thought we were immortal, rather than teenagers.

Justin and I weren’t great friends, and that summer, he was a loose cannon, one day holding on to a rock formation along the park road, head slumped over like he had hung himself. Cars stopped and people actually got out to check on him.  He was lucky he wasn’t cited by the OPP (Ontario Provincial Police).  He was a strong guy, so he took the bow for power, and I stayed in the stern for steering.  I can’t remember the number of canoes, but there were several but probably fewer than 10.  The water was calm, and when the gun went off, we exploded into a fury of foam, power, and testosterone.  Justin was amazing. Normally, I can overcome most bow paddlers from the stern, but he was giving me everything I could handle, and I didn’t want to waste anything on steering if I didn’t have to. My arms were aching like they never had ached before or since. I think the race was about a half mile, certainly not more than a mile.  

We won comfortably, but not a blowout.  Thrilled, we headed back to shore, arms quivering from the effort, but heads held high, very proud of ourselves.

Here is the part I don’t remember.  At first, I thought the camp leaders were present on shore and we had to leave, but a day later, my memory had changed a little. It turns out that thinking about something changes it neurologically, just like observing something in nano space changes it, too.

I think Justin and I got the trophy.  I think so, because I have a vague memory of our having come back to camp with it.  

Briefly.  

Because I also remember, and this memory is fairly clear, that we were not going to keep the trophy, and I have a vague recollection of giving back the hardware.  

How I wish I could remember this, and now as an old adult, wonder what in the world had been going on with the socialite and the canoe race.  I do remember our being told that we had no business being in that race.  That was before the term “ringer,” but today someone would say that she brought in a couple of ringers to win the race.

Today, we recognize a ringer as someone who shows up for a pick up sport who played for a Division I NCAA school. In basketball, he dribbles through your legs and you wonder what happened. If you shoot, he blocks and you have a leather sandwich. 

Justin and I talked about the race only briefly afterwards.  I remember his saying that we were racing against trappers and real woodsmen, and we beat ‘em all.  Thinking back, I wonder if the competition was a bunch of middle aged guys with beer bellies who couldn’t tell a J-stroke from jaywalking, or thought the bow was something you did after a good performance.  But I like to think we beat tough competition.  Of course, today, there would be video and posting on Instagram or Facebook, but back then it was a lot better, because we could make up a better story, sort of like I am doing here.

The following year, 1967, was my last at Pathfinder, and I was head man on four canoe trips.  I thought it was only two, but years ago, Pathfinder put them all on line, and I found my name as “Mike Smith in charge” four times. I decided to check on the trip I had with Justin. I went on Pathfinder’s Web site and found the trip about a minute later. Bless the guy who did this; what a great service to past canoe trippers.  There it was, a two day 12-man trip to McIntosh and Brûlé lakes, a loop I had forgotten about, and which I had mixed up with my last trip that year. On August 7, Justin was second man to me on that trip with four staff, four canoes, 12 men, the Blackbear-Ink portage, my first time over the miler, and the 1 mile Nature Trail portage which I would carry again four days later on my last trip as a staff man, and not again for 46 years, when I carried a canoe over it on a day trip.

Without putting it down.  I texted my wife, saying something like “That mattered.”  She texted back an eyeroll icon with “if you say so.”

The trip Justin and I took was for one purpose: to get every camper still in camp out of camp for one night so the staff could have a break.  That time of year, the long trips were underway, and the camp had fewer kids present. We took the last 8, along with four trip staff.  These guys weren’t into canoeing, but we got them out and back, and Justin was superb. He made sure there was no nonsense, and he helped the third and fourth men on the trip as well.  Nobody swamped, I checked the box “No” on the return where it asked, “Was there any profanity on the trip?” (not until the first portage, anyway) and  the staff had a great night alone in camp.

I gave Justin an AAA, the top rating, for the trip.  He told me he didn’t deserve it. I assured him that his presence was valuable.  He was great. I wonder if we spoke of the canoe race. We probably didn’t.  Too bad.

I’ve got to send in a donation to the Algonquin Campership Fund for Pathfinder. And I think I will send this to the current owner.  Maybe he can give me more information on the great race. Or be glad he wasn’t around when it took place.

I’d never add that trophy to go with winning the 5-10 hp power boat race on Honeoye Lake in 1960, and a bowling trophy at Clover Lanes in 1963, which was still there, too in 2013, but closed in 2016 to make way for Whole Foods.  I got a clock for winning my age group in the 2nd Annual AAN (American Academy of Neurology) 5 km run in 1992, but that and the other two were national events.

I’m still undefeated in international canoe race competition.  

The author back again in a red canoe.. Camp Pathfinder canoe dock; August 2013. Note the red neckerchief I am wearing

Day trip to Little Island Lake (and others). Author in blue shirt in back. I camped at this site nearly a half-century earlier.

JEALOUS

June 8, 2020

I was coring strawberries yesterday, after picking 20 pounds of them at a U-Pick spot out near Mt. Pisgah.  I was glad to get out there, and while the place was jammed, I was directed to a spot where I could be away from others. Picking is the fun part.  Washing is fine, but coring is boring, and going through several hundred berries makes for a long day.

My wife came in and had on a radio show from Doctor Radio from NYU Langone. Dr. Leora Horwitz of Health Care Innovation and Delivery Science discussed work in Covid survival in those who had been admitted to the hospital. It was a long session, so as I cored, put a red berry in a second colander, I listened to a study where people got key information from patients who later were admitted, tracking them until discharge. Wow, a hospital actually tracking something in real time, something important, with a lot of variables.  I would have loved to have spent some time doing that when I practiced.  I was jealous.

I looked over to my wife, saying, “I was trying to do this stuff 20 years ago.”  I was jealous.  I was also exaggerating on the low side.  I was doing it 35 years ago in the case of carotid endarterctomy.  I kept statistics for about ten years, until I finally got tired of beating my head against a wall and started doing quality improvement in a nursing home, since I couldn’t get anywhere in a hospital on the other side of the 110th meridian, which ran down Anklam Road between the two. I’ve often wondered how the nursing home did during these past few months. I proved then that one could decrease reporting of weight changes to the state about 80% if patients were weighed on the same scale. That’s an example of saving money and improving quality. I couldn’t get that information to fly over the meridian.

They did good work at Langone.  They found fully 75% of the patients there admitted survived to discharge.  That is useful information and impressive care, which also made me jealous.  I didn’t see too much impressive care in practice, although I sure tried to steer the place towards it.  Langone looked at risk factors and found that some lung conditions surprisingly did not seem to be problematic  They studied 5300 patients.  Of course, they had a lot of throughput and nice computers, rather than the pen and paper and the work I did by myself in medical records, back in the mid-80s and later.

I listened to the whole show and shook my head, now green with enby, which went well with the red on my fingers, my jealousy giving me a Christmas appearance in June.  I never got the chance to work for a group that really was in to dealing with learning like this one.  That’s exciting, when people are engaged in something bigger than themselves and proud of their work.  I had a little of that in the Navy, but only a little.  

I finished cleaning the strawberries and put the last two trays in the freezer. It was a good start for the season.

I have followed the Covid numbers from the beginning, when US deaths were still grouped by county and state, and we were well behind China.  I’ve watched as Mississippi briefly rescinded open up orders when they had a flurry of cases. Turned out, it was a data dump from the prior weekend.  I’ve listened to people who were concerned about our death rate here in Oregon, when on the same graph as New York, there was no daylight between the line in Oregon and the x-axis.  Here, we flattened the flounder.

I’ve watched, as Britain and the US had peaks and valleys in the daily death count, which seemed to be 5 days of the former and 2 of the latter.  Yep, the weekend.  This sort of data dumping wreaks havocs on the models that we are using to deal with the epidemic.  We had a $35,000,000,000 (worth writing it out) information system a decade ago in health care, and it was shut down during the pandemic, because it was taking valuable time away from patients.  

What in the world is wrong with us?  Or with the generation behind mine, where we counted things, pen and paper, made lists on paper, tracked stuff on paper, and knew where we were very quickly?  If an information system is only used for billing, and it slows down patient care, we really have lost our way.  Now I moved to anger.

Well, we need data inputters to do this.  Fine, put out a call. I will volunteer my time. This is bunk.  The Vice President and the Coronavirus Task Force—remember them?— asked hospitals to “please” send numbers of Covid-19 cases in their intensive care units daily. You don’t say please. You say, “Do it.” Finally, we did it, and our numbers are currently at about 17,000, compared to under 1000 in many European countries, about 300 in Italy now. Italy. Brazil is stuck on 8315, where they’ve been for a month, so they aren’t updating it. We aren’t alone. We do share the same type of leadership, however, as do two other countries in the top five, Britain and Russia.

Please?  From this group?  OK, they put out a flow chart how to get Covid tests in California that had precisely three lines. Remember Dr. Birx holding that up?  Amazing.

How difficult is it for any hospital in this country to count, as of midnight every night, the number of Covid-19 cases and the number in ICU?  You don’t need a computer for this stuff. You need someone who can count, write it down, and call it to a central hot line.  Oh yes, we could use email, too, but apparently our tech savvy populace doesn’t like that.  

It’s disgusting, and if it screws up the models we have, it is going to kill people through lack of timely information.  

Because we cannot do things in real time, we need people go back and “clean” the data, and that takes more time.  Fine, clean the data, but get the preliminary out immediately. We need it for planning.  It is easy to do, cheap, certainly not $35 billion, and it is data that everybody interested in Covid-19 wants on a daily basis.  NYU figured it out, but they are good.

I know Americans really don’t like numbers and counting, preferring nice looking software, glossy paper, and lots of colorful worthless pie charts to make the data “look good” (the human brain does not distinguish angles well, so that pie charts are a sub-optimal way to present data.) I’ve had this tirade before when I learned that mortality data, like for breast cancer, was three years old.  We ought to be able to track diagnoses in nearly real time. They have to be made by a pathologist, and there are a limited numbers of pathologists.  Every week, send the appropriate numbers to a central registry.  That way, we have immediate data, and can later use the 3 year old clean data, to compare and see exactly how much error there is and why. 

This is not the first time I offered to count things. I wanted to do it with medical errors with chart reviews with a three part ordinal score of No Error, Possible Error, Significant Error.  This could have been done in every hospital in Arizona, where I once lived, and we could have had a state wide tally of possible errors.  Oh sure, someone would sue, so those who have never been sued, unlike me, wanted to shut the whole thing down or asked me what kind of software I was using.

My brain, That’s the software.

It is soft.  Gelatinous even. That good enough?