Archive for the ‘2010’ Category


October 3, 2010

I recently took my 58th canoe trip into the Boundary Waters, having spent more than 1 month of my life camped on one lake and more than 1 year camped in the lovely country on both sides of the international border.  I’ve paddled on more than 300 different lakes, traveled 3000 miles, cleaned 500 campsites, and even dug 16 latrines in the 30 years I’ve been going there.  I’ve done half as much traveling in Ontario’s Algonquin Park back in the spring and early summer of my life.  I started 50 years ago and feel more comfortable in a canoe than in a car.  Safer, too.

I don’t travel hard any more.  I used to love to do so, glorying in 20 mile days with 15 portages, carrying a pack under a canoe for up to a mile at regular walking pace through the woods.  Oh, I was good in the summer of my life.  I could reach shore, unload and be portaging in under a minute.  When I reached the other side, I would be loaded and on the water in 30 seconds.  I could make camp at night in 30 minutes, break it the following morning in 45.  Now, however, I am happy to base camp with my wife and do short day trips around a lake we can truly say we know better than anybody else alive.  We have been on every one of the 47 campsites (the maps were in error and the Forest Service didn’t know that), and we now spend 5 nights a year on one campsite so remote that we don’t see any other human being during that time.

While I am not as strong as I once was, I am much more savvy in the wilderness.  I don’t waste effort on portages.  I am a superb weatherman in the wilderness, predicting storm onset and ending accurately with nothing more than a barometer on my wrist, reading the sky, and knowing the wind.  I thoroughly enjoy doing that.

Oh, I could do more if I HAD to.  Maybe.  But I don’t want to any more.  It’s been 9 years since I carried a pack and a canoe together.  I have nothing to prove and a lot I could hurt.  As I have gotten older, my desires have changed.  Do I miss the strength I once had, propelling me miles and miles to the next campsite?  A bit.  Do I need to do it again?  No.  For some reason, I revel in the fact that I once could do it but comfortable I don’t need to any more.  I know now that I probably took my last trip into Kawnipi Lake in 2005.  At the time I thought it would be.  Then I figured…maybe one more time.  Now, I’m not so sure I either need to, or more importantly, want to. I still want to see the northern sweep of Agnes Lake again, and a fellow teacher, who desperately wants to go, may be my partner on that trip.  The two of us could do it.  Gee, maybe Kawnipi, too, but nature may have other plans.

I have nothing to prove in the canoe country, although occasionally I still enjoy doing so.  My wife and I paddled 12 miles into our destination lake in 6 hours, with 7 carries, when several people we met, 20 years younger, were unable to get there in 3 days of work.  Neither of us is strong, but our experience, organization and leveraging of our skills, working together, enables us to still accomplish a good day’s work in a few hours.  Neither of us thought it was a difficult day.

Do I miss “roughing it”?  Not really.  I once liked sleeping under the canoe and paddling in a driving rain, but I don’t need to do it any more.  The way we camp is comfortable.  We eat well, stay clean and dry, and sleep better than we do at home.  The midnight bathroom breaks are a chance to look at one of the darkest skies in America and perhaps see an aurora, which we did a few years ago.

I find it interesting that as I have gotten older, my needs have changed, and I get pleasure doing different sorts of trips I once wouldn’t have enjoyed.  The trips I used to do no longer appeal to me.  I am at peace with that.  I expect more changes, and hope I still can paddle and portage for many years to come.  But I expect I will be doing so in a different fashion, and I believe that I will be enjoying it just as much.

We were in the canoe country in autumn, present when the colors peaked. In the autumn of my life, the colors are starting to peak.  I don’t have the strength and growth I had in the spring and summer of my life, but I have found my own inner beauty that mirrors the external beauty around me.  I still see new country, but I enjoy visiting familiar country the way some like meeting new people but enjoy old friends.

I tell myself I won’t be able to do this forever, but I am glad for the now.  I hope in ten years, in my seventies, I will be still be able to canoe and set up camp.  The gear is getting better, and my knees and shoulders are strong.  Whether my neck holds up is another matter, but I bet I could figure out a way to get a canoe on my head without stressing my neck, should that come to pass.  If not, I can paddle lakes where I don’t portage, because there are many of them, too.  In short, my body is like a well-used Old Town.  It won’t last forever, and it is showing use.  The paint is scraped, there are a few cracked ribs, but it is still sound and seaworthy.

I hope that as the winter of my life approaches, the white in my hair will mirror the brilliance of new fallen snow, untouched, in those areas of Alaska’s Brooks Range that I have been so fortunate to have explored four different times.  Could I canoe into my eighties or even nineties?  I can dream, for this year two very special people, different sex, different countries, different professions, and different beliefs had a profound influence upon me.  From each, and quite by accident, I learned that while I am a scientist and statistician, consider myself a practical person, not far below the surface lies a kid–a deeply emotional, spiritual dreamer.  I’m not planning to mentally ever grow up.  When I arrived in Fairbanks, many my age or younger went to the Princess Cruises sign.  I picked up my backpack.  In Minneapolis, I feel a bit unusual at 61, walking through the airport with my canoe pack on.  The white I want to see is not a golf ball but an eagle’s head.  With luck, I have just started autumn.  May it continue to be as brilliant inside as it was along the Fernberg east of Ely, Minnesota.  May the winter that follows it be as brilliant as the snow that made Mt. Igikpak so beautiful over the Noatak last August, up in Gates of the Arctic.

Eventually, of course, my eyes will finally close forever.  I hope at the end I feel the same as Sig Olson, the famous North Country writer, who still had written, in his typewriter, the day he died, snowshoeing, “I am ready for the next stage.  I know it will be a great adventure.”


September 1, 2010

On an early March afternoon this past year, I was on my hands and knees building a large sundial at Rowe Sanctuary in central Nebraska, where people stand on the date and their shadow tells the time.  From the second week in March through the second week in April, Rowe is busy as visitors arrive from all states and a few dozen countries to witness the Lesser Sandhill Crane migration, one of the three greatest natural sights I’ve seen  and one of Jane Goodall’s top ten.  I was working pre-season and decided a nature center like Rowe needed a sundial.

I was using markers, T-squares, a calculator and duct tape when a good looking young man stopped by.  He was friendly,  and I knew him as the Great Plains photographer Michael Forsberg.  Mike was interested in what I was doing with trigonometry and ellipses and then asked if I could find him information for the full Moon azimuth as it rose. He wanted to know exactly where in the eastern sky he would see it rise.

Fulfilling a request from Mike Forsberg suddenly became my top priority, so that evening I sent him the information.  He later e-mailed me pictures he had taken out in the viewing blinds, including an incredible shot of 4 different species of geese flying together.  Imagine, the premier wildlife photographer in the American midwest e-mailing me pictures he took!  Later that week, when I saw Mike again, I had him sign one of his books for me.  I just happened to be making a sundial when he walked by.  He just happened to stop.  And that changed my life. I just didn’t know it at the time.

When I left Nebraska in early March, I felt I had unfinished business.  I had not been there when the migration was in full swing, nor had I led tours to the viewing blinds, which had been a goal–a dream–of mine.  Four weeks later, I flew back to Nebraska, to volunteer at the height of the crane season, when 600,000 birds are on a short stretch of the Platte River, flying in at night to the safety of the braided channels and flying out to the fields in the morning to eat waste corn.  That week, I worked 17 hour days, sleeping on the floor in the visitor center, because local housing was full, listening to the cranes call on the nearby Platte.  The first night I shared a floor with– Mike Forsberg– who now knew me.  We didn’t talk much but I soon learned Mike is modest as he is good.  He deeply respects Rowe volunteers, because we help make some of his photography possible.  His nature photography is the best I’ve ever seen.

I finished my training and became a lead guide, meaning I could take visitors to the viewing blinds.  I got to talk about Lesser Sandhill Cranes; I watched people smile and heard them cry when they saw the cranes land, “dance,” and call before them.  Sandhills are large and loud, their voice primitive and deeply primal, echoing across 3 million years of time.  My enthusiasm outweighed my shyness, and I thoroughly enjoyed guiding.  We volunteers were a cohesive group, all of us working together to do whatever needed to be done, even if it wasn’t our “job.”  That week, I felt alive in a way I seldom have experienced.  So often, I told visitors, “I work 17 hour days, make coffee at 5 a.m., clean toilets, sweep the walk, give “Crane 101 talks,” do odd jobs, get dinner, sleep on the floor and see the cranes morning and night.  Am I lucky or what?”  When I called home, my wife commented my voice sounded different.

Mike stayed in the visitor center a second night:  two Mikes, two nights, too cool, two of his books I bought.  Mike signed the second one, too, adding a stunning phrase, calling me “a man of great spirit,” for he had quickly recognized something in me that I had not fully appreciated:  I have a deep spiritual connection to nature, the outdoors and wilderness. Mike is a man of faith and told me he felt closest to God when he was in the photography blinds, where people are taken in late afternoon and cannot leave for any reason until mid-morning the following day.  He said the experience was beyond comparison.  I’m going to do it next spring.  It has become one of my dreams, and while I, a scientist and a statistician, consider myself a practical person, not far below the surface lies a deeply spiritual, emotional dreamer.  Somehow, Mike knew that and how to help me understand myself better.

Last July, after the eclipse in El Calafate, Argentina, I sent Mike a picture.  I was a bit embarrassed to be sending a handheld shot to a famous photographer.  Mike, however, immediately replied “very, very cool,” saying I must be the only guy in the world who was going to Patagonia in July and to northern Alaska in August.  I wrote him after I returned from the Brooks Range, 118 degrees north of where I was in South America, telling him I would be ordering one of his pictures as a gift.  I am becoming friends with a special man, because we share a spiritual bond with the outdoors, especially Sandhill Cranes.  If he hadn’t stopped when I was making the sundial, this never would have happened, and my perception of myself and indeed my life wouldn’t have changed.

*                                *                                 *

July 9 is a holiday in Argentina, independence day.  I was in Buenos Aires, appropriately staying on Avenida 9 Julio, the largest street in the world.  That day reminded me of Christmas, for it was a winter holiday at a similar latitude south of the equator as I live north.

I went to a restaurant as part of a tour, going up a narrow set of stairs to a table with other people on the tour.  One of the guides asked me to sit in the middle of the table next to a young German woman.  And that changed my life and hers, especially hers. She and I will never be quite the same again.

The woman, Maria, was a young German scientist on her first trip out of Europe.  She, like me, was in Argentina for the solar eclipse.  Both of us had expected to take a plane to fly over the clouds to see the eclipse, but the flight had been cancelled.  My trip down to Buenos Aires involved barely making a connection; had I missed it, I might have gone home, since the probability of seeing an eclipse in Patagonia in winter is poor.  What kept me going was the idea if I didn’t go, and people saw the eclipse from the ground, I would never forgive myself. I didn’t know at the time the details of Maria’s trip, but it seemed clear we would be “clouded out.”  I later learned she had been at a conference in California, had a car accident on a freeway, and brought no winter clothes with her, since she was also planning to see the eclipse from the air.  To say we were both depressed and having an awful trip was an understatement.

Maria was completely fluent in English.  I asked her what she did, learning of her work in preparing an X-Ray satellite for launch to the LaGrangian point furthest from the Sun.  Fortunately, I knew something about LaGrangian points, where the Earth and Sun’s gravitational pulls are equal, leading to stable orbits for bodies located there.  Because I had studied physics, I was able to ask intelligent questions, soon learning about the LaGrangian point 1.5 million km beyond the Earth where the satellite was going.  Because I knew about conics, the concept of parabolic and hyperbolic mirrors was understandable, and the major and minor axis of the elliptical orbit clear to me.  I listened to Maria for a good 30 minutes.  When she asked me what I did, there wasn’t much to say except I chased eclipses, taught math as a substitute, once practiced neurology, liked cats and was a vegetarian.  She taught math, liked cats and was also a vegetarian.  Naturally, she was most interested about my eclipse experiences.

On the afternoon tour of the city, we spent some time together, Maria convinced she wouldn’t see the eclipse.  This being my 20th eclipse trip, I told her many times:  “Maria, it isn’t over until it is over and we didn’t see it.”  Indeed, a year earlier, in China, a small window opened up through thick clouds right at totality.  We went absolutely nuts.  It was the only eclipse I ever saw while I held an umbrella.

I didn’t see Maria again until the next afternoon in Patagonia, when she was an invited speaker at an eclipse conference.  I asked a question, later going up and telling her she gave a good talk.  She looked like she needed to hear that.  That night, at the hotel, I invited myself to Maria’s table of 4, since I was otherwise going to eat alone.  I was the de facto trip weatherman; I was following several South American weather models, knew the barometer was rising, the streaming moisture into the “cone” of the continent was cutting off, and high pressure was building over the eastern South Pacific.  Maria wanted to know my forecast; I was cautiously more optimistic, telling her to ask me about the barometric pressure the next morning.

That night, the barometer rocketed upward, the sky cleared, and we awoke to a beautiful sight:  the southern hemisphere stars were visible.  Maria had never seen the southern sky before.  I didn’t sit on the bus with her but with Anita, a senior colleague.  When Anita pointed out the Southern Cross on the bus ride to Perito Moreno glacier, I did something quite uncharacteristic for me:  I went to the front of the bus and asked how many wanted to see the Magellanic Clouds under a dark sky.  A lot of sleepy faces raised hands.  Nobody objected.  We stopped for 5 minutes so everybody, including Maria, could view our companion galaxies.

That afternoon, I worried about clouds interfering with the eclipse, but Anita fortunately kept Maria far from me.  When totality was imminent, Maria and Anita joined me, and Maria cried as the Moon completely covered the Sun.  I shouted, as did others, and I stared in awe of the shadow cone of the Moon, which I had never seen so clearly.  But my greatest memory is hearing Maria cry.  It was one of the most moving experiences of my life, and I’ve seen totality 12 times.

The next morning, I said goodby to Maria, and I haven’t seen her since.

But unlike every other eclipse trip I’ve been on, we’ve corresponded.  First it was by Facebook then e-mail and frequent Skype chats.  That has never happened before.  Maria told me that she almost had a panic attack in the restaurant, and my listening to her calmed her down.  Just my listening.  She got so excited from the eclipse that she has cast off shackles that led her from living a full life.  My wife and I invited both Maria and Anita to the May 2012 annular eclipse in northern Arizona, so they can see the Grand Canyon and the eclipse.  Maria will cry at both. I know she will.   Recently, she went skydiving for the first time.  She is learning C++ programming so she can become indispensable on the Australia eclipse in 2012 and get a free trip there.  Maria has been the best correspondent I’ve encountered in my life and we’ve become good friends.  Because of her, I’m learning German, and I plan to visit her next year.  Maybe every year.  And that has changed my life.

Had we not had such bad starts to our trips…Had we not been seated next to each other in Buenos Aires…Had I not known something about LaGrangian points and infrared radiation…Had I not been an amateur meteorologist and in demand…Had I not stopped the bus so people could see the Magellanic Clouds…Had we not seen the eclipse, none of this would have happened. Maria would still be wanting to see her first eclipse, and I would  not be learning the four German cases.  In August, when I returned from northern Alaska, I had a four hour layover from 10 p.m. to 2 a.m. in Anchorage.  Had I not met Maria, I would have been bored, tired and cranky.  Instead, I chatted with her on Skype, passing the time quickly.

The older I get, the more unpredictable my life has become.  If I hadn’t been making a sundial, if Mike Forsberg hadn’t stopped by, if I hadn’t been seated where I was, and if I hadn’t known about LaGrangian points....


June 17, 2010

When I saw a familiar ship steam into Subic Bay and moor, I decided I ought to visit to check out their sick bay.  It would be the only time in our 8 month WESTPAC deployment my ship and theirs would simultaneously be in the same port.

It was a wise decision.

The other ship had a corpsman, and it had been one of my ancillary duties to ensure their medical readiness for deployment to the Western Pacific.  Before boarding, I had received a list of their deficiencies:  instruments still wrapped in cosmoline, poor record keeping and outdated supplies were the worst.  On my first visit, I additionally discovered their Executive Officer (XO) was a Type I diabetic, who apparently varied his insulin depending upon how he felt (this was before blood glucose monitoring). The ship was a floating medical mess, and I told my shore-based medical boss my concerns about the XO.  He ordered me to ignore the diabetic and do whatever else it took to get them ready.

My adoptee vessel would spend time training at sea when my own was in port, giving me opportunity to ride her and fix deficiencies.  So, the following week, I boarded for three days of steaming 50-100 miles off southern California.  After morning sick call, where the corpsman was thrilled to have me, we got to work cleaning instruments, removing outdated supplies, ordering new ones, re-organizing the department.  We had a lot to do; unfortunately, their ship rode a lot worse at sea than mine.

Later that morning, I took a break to the bridge wing, watching California recede, when the Captain came up beside me.  I saluted, he returned it, promptly ripping me a new one:  “I don’t appreciate your trying to torpedo the career of my XO.”

Stunned, I replied,  “Captain, what are you talking about?”

“Your concerns about his diabetes went to the Commodore, and I had to answer to him.  My XO sees a full Captain at Balboa (the Naval Regional Medical Center), who knows far more about diabetes than you do.  So stay out of this, doctor.”

He walked away, not returning my salute.

The Captain at Balboa did know more about diabetes; I was 3 months out of internship.  But I was a shipboard doctor, and he almost certainly never was.  We had shore based physicians who sent sailors back to the ship with instructions not to climb, when we dealt with ladders dozens of times a day.  Another said a sailor couldn’t return to a ship because of exposure to salt spray, as if we were a catamaran, not a 14,000 ton vessel where I stayed drier on a Pacific crossing than a 5 year-old at the beach.

I felt relaxed that December day in the Philippines when I went to the other ship.  I had made their medical department ready for deployment.  I taught the corpsman everything I knew about diabetes and on a routine physical of a crewman discovered an abdominal mass that was lymphoma.

I asked permission to come aboard, saluting the colors and Officer of the Deck (OOD), saying I could find my way to sick bay.  As I walked down the passageway on the 1 deck, the corpsman practically ran me down.  “Quick,” he said, “The XO.”

Surprise, surprise.

We rocketed up 3 ladders topside to the XO’s stateroom, where I found him sweaty, uncoordinated with slurred speech, a vial of insulin and a glass of orange juice on his desk.  Fortunately, I had ensured the emergency kit had an amp of D50, 50% sugar.  I told the XO to lie down, found a vein, and injected.  Within seconds, he was normal.

We had the OOD call the local Naval Hospital and the Chief Staff Officer, (CSO), the squadron’s troubleshooter.  The CSO was superb; he and I took the XO to the hospital for admission, his sea career finished after 14 years.  He would never command a ship.  Worse, the ship needed a new XO immediately, difficult in mid-deployment.

I had been proven right but felt like hell.  I wish I had been wrong, the XO having no further problems, eventually wearing the 5 pointed star in a circle signifying command at sea.  But I knew he never should have been aboard.  I occasionally wonder why I went over to their ship that day.  Like the lady and the tiger, I wondered had I not been there whether he would have taken/given insulin or orange juice. Not surprisingly, I never heard from the Captain; the CSO, however, thanked me profusely.

We all like being right, dreaming about revenge upon our detractors.  I was right, not because of brilliance, but because common sense, my medical training and probability dictated a brittle diabetic had no business being second in command of a deployed warship.  I’ve been right on many other issues for decades:  climate change, too many carotid endarterctomies, diagnosing depression in patients who thought I was saying they were crazy, chronic pain being highly correlated with not at fault injury, the need for a medical error reporting system.  I wasn’t brilliant; all I did was to observe nature and people, be realistic, use science, probability and tried to avoid magical, irrational, ideological behavior I and all of us are prone to. I often wish my conclusions were different or I was wrong, but I try to follow the facts.

Whenever I want to say “I told you so!” I remember that time in Subic Bay.  Being right often brings no joy; it only means that one’s observations and conclusions are correct.


June 10, 2010

How many people do you need in a room before any two are more likely than not to have the same birthday?


I’m sure there are those who disbelieve, saying “I know that can’t be right.”  What is disturbing is that even when a simple proof is delivered, many continue not to believe it.  Our minds can play tricks on us.  That’s normal.  But in the face of a compelling proof, failure to accept the premise borders on stupid.  The proof, by the way, looks at the probability that two people don’t have the same birthday.  Sometimes, looking at what you don’t want makes it easier to find what you do want.  Here’s the proof:

Number of People              Probability 2 have same birthday           Probability 2 don’t

1                                                   0.000                                                          1.000

2                                                   0.003                                                          0.997

3                                                   0.008                                                          0.992

5                                                   0.027                                                          0.973

10                                                 0.117                                                           0.883

15                                                 0.253                                                           0.747

20                                                0.411                                                             0.589

21                                                 0.444                                                           0.556

22                                                 0.476                                                           0.524

23                                                 0.507                                                           0.493

25                                                 0.569                                                            0.431

30                                                 0.706                                                           0.294

35                                                 0.814                                                            0.186

A disease has a prevalence of 1 in 200 (0.5%), a sensitivity and specificity each of 99%, meaning if you have the disease you test positive 98% of the time and if you don’t you test negative 99% of the time.  Not knowing if you have the disease, you test positive.  What is the probability you will have the disease?   The issue here is that having the disease and testing positive is very different from testing positive and wondering if one has the disease.  If the disease is rare, the likelihood of a positive test’s being a false positive is significant.  Here’s why, using 10,000 people and the above percentates:

Test + Test – Total
Disease Positive 49 1 50
Disease Negative 99 9851 9950
Total 148 9852 10000

If you test positive (148), a third of the time (49) you will have the disease.  The others are false positives.  That’s why we don’t do routine HIV blood tests for marriage.  In a randomly selected individual, and that is important, a positive test for something rare has a significant likelihood of being a false positive.

Many mountaineers defend the safety of their sport by saying one can get killed in a car accident.  That’s true.  But nearly all of us drive and a lot.  We all know someone who died in a motor vehicle accident, but relative to the denominator, it is small, 1 in about 5000 to 6000 Americans this year.  Mountaineering is a small community, and number of climbs is an incredibly small fraction of number of auto trips.  Every serious mountaineer has lost several friends to the mountains.  Mountaineering is much more dangerous.  I love reading about it, and I admire those who do it, but it is high risk.

The lottery is a tax on those who don’t understand probability.  The chances of winning the Powerball jackpot are approximately those of randomly picking a minute chosen since the Declaration of Independence was signed, 1 to 110 million.  Yet people continue to tax themselves because “if you don’t play, you can’t win.”  You have far more likelihood of being struck by lightning or dying in a motor vehicle accident than you do winning the lottery.

Too many Americans play another lottery, the I’m sick do I see a doctor? lottery:  I have abdominal pain, and I don’t have insurance.  I can’t afford to see a doctor, so I will bet it goes away.  But it doesn’t; instead, the pain worsens, and I now can’t walk.  I have to call an ambulance, go to an emergency department and am admitted with a ruptured appendix.  The costs have increased and are well in five figures.  I’m bankrupted by the illness, few who are involved in the care get paid, and my productivity is zero for a long time.  I’ll probably never get out of debt.  If I get sick again, I’ll bet again it goes away.  I will have no other choice.

Well, you say, that is just a bad example.  Here’s another:  I have abdominal pain and go to urgent care, because I don’t have a family doctor or it takes weeks to get in.  The workup costs $2000.  I can’t pay it except in $20 increments.  That was my Literacy Volunteer student’s experience.   How many Americans say some morning “I  have a toothache, I can’t afford to take off work.”  They are miserable, and their productivity isn’t very good.  Maybe it will go away, or maybe they will need a root canal, which hurts like hell, because there is already a problem.  That’s about $1200, so they are more in debt.  Sure, they say. if I had the money for dental care, I might have been able to avoid this.  Instead,  I’m betting that my body’s natural healing ability will bail me out.  Maybe it will.  Or maybe it won’t.

We were once the richest country in the world.  Our annual medical costs are far more than a trillion dollars.  A trillion, by the way, is roughly the number of days since the Earth formed.  How many these costs could have been avoided by timely prevention?  How many could have been avoided by universal coverage?  I don’t know.  But I do know that our poor system makes it impossible for at least a sixth of Americans to get decent, timely care and not get bankrupted by it.  This is America, not Zimbabwe, India or Tajikistan.  If you don’t like my solution, you fix it.  And not by going back to the 20th or 19th century, since going backwards never works.  Here are my metrics:  your fix has to show an increase in productivity, a decrease in emergency department overcrowding, a decrease in bankruptcies that are primarily due to medical reasons and a decrease in late diagnosis of disorders like appendicitis, that should all be picked up early–in America, again, not Tajikistan.

If that requires I pay more taxes, I’ll pay them.  I’d rather pay taxes for education and health care than for fighting, and not building schools in Iraq and Afghanistan, which is the fundamental solution to terrorism, not nuking Muslims and letting Allah sort it out.  We stop foreign aid to countries who despise us and bailouts to car makers who built monstrous SUVs, when it was obvious decades ago we needed to retool.

Do I like government as a single payer?  No.  But again, if you disagree, you fix it.  I don’t want reading assignments.  I’m a patient, and I’m tired of waiting weeks to see a physician (I thought only Canadians waited), worrying about medical errors that have affected me and three family members and really tired of the bickering that has stalled any kind of reform.  It is disgusting – and is un-American.

The America I served used to have innovative solutions to tough problems.  Where is that country?


March 11, 2010

“In another life, I would have been a good math teacher,” I once told a teacher friend.  I don’t believe in another life, but I still have this one and realized I can become a good math teacher.  I now substitute; based on my training and experience I ought be allowed to teach full-time.

I’ve often felt I never belonged in medicine.  Indeed, looking back on what has given my life meaning, medicine ranks a distant fifth–yes, fifth–behind my wife, allowing my parents to die the way they wanted, the companion animals I’ve taken in and my experiencing the beauty of nature all over the world.

I did belong in medicine, just not here.  I belonged in medicine where physician training was geared towards dealing with patients typically seen in practice. Surgeons are trained in and do surgery; radiologists interpret images; ED physicians field emergencies; dermatologists treat skin disorders.

I mistakenly thought that neurologists were consultants who treated neurological disease.  Nearly half of my new patients had limb pain, spine pain, dizziness and headache.  I counted.  In my training, I learned little about headache and spine pain and nothing about dizziness and limb pain.  Yes, we need to learn rare diseases, but we also need to learn how to treat the common ones.  I had learn it myself.  Too many patients with carotid artery disease were sent directly to surgeons, bypassing me.  Yet, in 1984, I had city-wide data showing a 15% major complication rate for carotid endarterectomy (CEA), much worse than medical management.  I sent my referrals to the only surgeon whose outcomes beat medical treatment.  Locally, the complication percentage didn’t change during the next decade.  I counted.  I used outcomes data years before it was a buzzword and got blasted by my colleagues for using it to help my patients. I diagnosed and successfully treated depression a decade before it was mainstream, when still equated with being “crazy.”  Got blasted for that, too, by patients, expecting a deadly neurological disease (which it is).

Much of my practice consisted of patients with normal tests, post-surgical disasters and chronic pain; the last I was unable to help.  I was not taught how to diagnose irreversible brain injury, discontinue support and deal with families.  While I was trained to treat epilepsy, most of the seizures I saw were psychogenic.  I counted.  In 1982, I proved statistically that perceived I’m-not-at-fault injuries dramatically increase the likelihood of chronic pain.

I belonged in medicine where counting was valued, not mocked, and we tracked important matters, like CEA morbidity and clean case surgical wound infections.  I developed a non-discoverable reporting system for errors, so we could learn from and not hide mistakes.  More legislators backed my bills than doctors; had the bills passed, we would have advanced the cause for liability reform, because they were primarily about helping patients, not decreasing premiums.  Ironically, four immediate family members have suffered consequences of medical errors.

I was frequently asked “Are you busy?” but never “Are you happy?”  Yes, I was busy–and no, I was not happy, because I was rushed, interrupted, and chronically tired, three classic setups to make errors, in order to pack in another “emergency,” an overused term increasing stress, cost, shortcuts and mistakes.  Some ED clerks were instructed to call every neurological consult “stat.”  I accepted that many neurological conditions couldn’t be helped; I grew weary of the many conditions neither diagnosable nor treatable. It took me too long to realize I could quit.  I never regretted doing so.

In a better medical world, we would fix the numerous faulty processes that decrease quality, increase costs and suck the fun out of life. We would review every hospital death to see if a medical error occurred.  With appropriate sampling, we would have a decent estimate, not the old, inaccurate infamous “100,000 deaths.”  I once thought my experience in practice, administration, quality, statistics and writing would make me a valuable local resource.  I was as mistaken, as those at GM who pushed for Japanese style quality outside of NUMMI.

My local and state medical societies should demand real-time data on breast and other cancer incidence, not difficult, rather than 4 year-old results (look it up).  We should have city/state-wide standardized checklist approaches to central line insertion/care, ventilators and pre-op antibiotics, to name just three.  Public health committees should discuss important issues they could influence: obesity in the young and annual motor vehicle deaths, the latter unnecessarily killing more local teens than Mad Cow, West Nile, mercury, terrorism, autism or kissing bugs combined.  My challenge to the committee to change its approach received one letter of support; I resigned.  Surveys, which I randomized for free, should take a quarter of a year, not a quarter of a decade, to complete.  Yes, 2.5 years.

My solutions aren’t perfect, but every one is better than what we have.  Waiting for perfection is like waiting for Godot.  I’m not a shaker but a mover, moving so far ahead I’m no longer visible.  In my lifetime, I will teach math, but in my lifetime I will neither develop nor see the medical changes that would have been so easy, effective and necessary.


February 7, 2010

Foregoing the elevator, I went to the stairwell at the Nairobi Intercontinental, ascending to my third floor room.  When I reached the spacious second floor, there were a dozen hotel workers taking a break.  When I appeared, an old white western guy, the scene got–shall we say–awkward.  Their conversation stopped.

I smiled and said, “Jambo,”  an all purpose Kenyan greeting, one from the heart, my guide, Danson, told me several days later.  I heard several “Jambo’s” in return, and tension left the stairwell like air from a popped balloon.  I continued up the stairs, and they continued their conversation.  Trying to speak the language in another country is a sign of respect.  “Jambo,” told the men that I was cool with the situation, I knew a little KiSwahili and was a guy who respected Kenyans as people, not former colony inhabitants.

One of my big regrets in life is never having learned any foreign language well.  Still, within 12 hours of arriving in Nairobi, I could count, say please and thank you, and “Jambo,” which I used a great deal, along with “Hakuna Matata,” the Kenyan version of “Don’t sweat it.”  My French in France was not appreciated.  But my Spanish worked in Spain (and not badly in Italy, either), and the Filipinos absolutely loved it when I spoke Tagalog, 35 years ago.   I blew one vendor away with my “Hindi ako kumakain nang barbeque dito,” essentially stating I wasn’t interested.

At Lake Nakuru, I showed several lodge staff the annular solar eclipse through solar filtered binoculars, the eclipse being the reason I traveled to Kenya.  I love eclipses, and I love showing them to people and explaining the phenomenon.  Many were flat out amazed a guest would take an interest in making sure they could see something that almost certainly they will never see again (the November 2013 eclipse will be partial in Kenya).  In the short time I was there, many called me “Mr. Mike,” an appellation I particularly like, since it simultaneously shows respect and liking.  I told one waiter my age was sitini na moja, (look it up!)  It took him a few seconds, but he got it, and later (in English) talked to me at length about the lodge.  Danson later told me that I had made a big impression on the staff, one of the nicest compliments I received.

People are people.  Just like me.  The Kenyans have a life, a far more difficult one than I can imagine, but they are still people.  Unlike us, they have a beautiful memorial site for their disaster of 7 August 1998. Also unlike us their cellphones work everywhere.  I texted the eclipse phenomenon in real time back home. My text immediately went through from Jomo Kenyatta airport; it didn’t from Houston’s Intercontinental.  Not infrequently, I get “No Service” from Campbell and Skyline.  So who is Third World?

When I left practice in 1992 to take a leave of absence, I received many notes, cards and letters.  The one I remember the most was from a dietitian, who was also leaving to go to pharmacy school.  She said, “You respected the little people.”  I tried to.  I was taught at a very young age not to beat up on those who can’t defend themselves (nurses, custodians, aides), which I have done and for which I have been ashamed.  I’ve seen too many physicians and others in power who beat up on people, and I remember taking the brunt of it when I was an intern scrubbing on a bypass case.  It was difficult to hold the retractor properly when my eyes were filled with tears.  I was thanked only 5 of the 12 times I scrubbed with those two surgeons.  I was the little people, and I never forgot that treatment.  It was so bad, I got blisters on my hand from learning how to take a hemostat off a piece of wet kleenex with one hand without tearing the kleenex, so I wouldn’t get yelled at in the OR.  And I mean yelled.

I finally got some revenge.  On a later case, with the pair, I had my thumb too far through a hemostat.  “Don’t hold your instruments like that, Smitty,” one yelled (a term I detest), “you don’t hold your silverware like that, do you?”

“I don’t use silverware,” I retorted.  “I use my fingers.”  That was the end of that conversation.  When they quizzed me on anatomy, which I happened to know cold, I spat the correct answer back at them.  After three correct answers in a row, they left me alone.  One later had a nervous breakdown; both must have been incredibly unhappy people.

I always thanked nurses for helping, I tried to clean up after myself, and if you read Code Team on my blog, you will discover what other things I cleaned up in the hospital.  But occasionally I lost my cool.  We all do.  I just tried to remember to apologize when I did.  And if one is polite most of the time, he or she can easily be forgiven for a lapse.  There just can’t be too many of them, and an apology,must be coupled with a change in behavior.

When you’ve been at the bottom as many times as I have–undergraduate, medical school, internship, residency, graduate school and now teaching, you understand a lot better what it’s like being the little people.  That gives you two choices:  to haze those below you or to break the cycle.  I’ve tried to choose the latter.


January 7, 2010

“For them is sweat and toil, hunger and thirst, and the fierce satisfaction that comes only with hardship.” Sigurd F. Olson (1938)

Forty-five years ago, after three summers at Camp Pathfinder, a canoe tripping camp in Ontario’s Algonquin Park, I became staff, “third man”  on canoe trips.  Being staff was different.  I no longer knelt in the bow, looking for rocks and setting the pace; I was in the stern, responsible for steering, orders and keeping up with the other canoes.  When we reached the portage,  I flipped the 90 pound canoe over my head, carrying it anywhere from a few yards to four miles.

I no longer had to wash dishes, only chop wood and help cook.  But I had difficulty with my new role.  I abused my new power by excessively bossing campers.  So, on my second trip I was third man under a second man who had never been a camper with my experience.  That hurt.  On my third trip, 14 difficult days, I struggled so much that I didn’t ask what my rating was.  Instead, I snuck in the cabin one night where the ratings were kept, and saw mine:  “He needs a LOT more tripping experience.”  I never forgot the pain of seeing those words by flashlight.  They were true.

The next year, I was 17, stronger, and vowed to do better.  I was sent out as second man, paddling and carrying well, kinder to campers.  I realized that my job was to ensure they had a good time on the trip, even as they worked hard, for hard work is what makes a canoe trip so satisfying.  On the first day of one trip, the head man and third man were hung over from a previous day off, and I had to keep telling my two canoe mates to slow down so we wouldn’t lead the trip.  When we reached the dreaded 1 1/2 mile Iris-Alder portage (named for the lakes it connected), I was allowed to go first.  I blasted over the wooded, rocky, swampy, hilly trail in 20 minutes, canoe on my head, well ahead of everybody.  I was second man for 3 more trips that summer.

There was a hierarchy of neckerchiefs worn by the staff.  It was an unwritten rule that nobody but a head man wore red, second men blue.  Pathfinder was and is known for its challenging trips and its red canoes, which today are part of their e-mail address.  That summer in 1966, I wore blue.  To entertain the campers, I thought up games like tree golf (I won’t describe it) and told scary ghost stories around the campfire.  When a camper’s asthma flared up on one trip, the head man and third man took him to help, several hours away.  I was left in charge, nervous, but thrilled to have the responsibility.

My ratings were good, and my last summer, I was promoted to head man on short trips.  I bought my red neckerchief, proudly put it on, and at 18, took 8 other lives under my care into South Tea Lake.  I navigated, carried canoe and a pack together, chose the campsite and cooked the meals.  The trip was only three days, and I was familiar with the area so that navigation wasn’t a problem, but I was in charge of two other staff and six pre-teen boys—no adults anywhere.   Even today, I am amazed that I was given such responsibility at my age.

Command changes one’s perspective.  When the campers swam, I counted heads, over and over again.  If I didn’t see one, I got everybody to stop playing until I was certain.  As head tripper, I had to decide the menu, time the meal right, and make special goodies, like fudge, which was how everybody rated a head man.  And every night in the tent, I listened to every sound, anybody crying out, responsibility weighing heavily on me.

Back in camp, I wore the red proudly, the way an airliner captain wears four stripes, or the commander of a naval vessel wears the five pointed star in a circle on their right chest pocket signifying current command at sea (left pocket for former command).  I took a second trip as head man, the responsibility still weighing heavily on me.  Two days after that trip, I went out as second man on a better trip, just like a pilot of a 737 becoming a co-pilot on a 747.  I put my blue neckerchief back on, helped outfit, did my job well, and made sure the campers had a good time.  I never wore blue again.  In late summer, my fourth trip as guide, I took six men six days on a super trip to Pine River farm and Big Trout Lake.  I didn’t remember all of these trips, but Pathfinder’s Web site lists them going back to my era.  My fondest memory of my final trip was a day a camper couldn’t carry his pack, so I carried it and my canoe—at least 140 pounds—a half mile with no trouble along the slippery shoreline of the Tim River.  To this day, I have worn the red neckerchief on nearly all the 60 additional canoe trips I’ve taken. Occasionally, I put on the blue as a reminder of the days I wasn’t in charge and what I had to do to earn red.  I have no other colors in my collection of neckerchiefs.

I practiced medicine for 20 years, a hierarchy if ever there was one, but I never once thought about the red neckerchief.  I wish I had.  For the past eight years, I have been a volunteer math tutor at two high schools, never being as busy or as in demand as I had hoped.  So this year, I set up a program to be an on-call volunteer substitute math teacher, teaching when the substitute was unable to do so.  I have taught twice, and that is a huge step up from tutoring, like being staff.  But I still felt I was wearing blue, not red.  I wanted to be in charge, to take full responsibility for running a class, even if only for an occasional day.  I got my substitute certificate and waited.  One day my call came from a statistical colleague, wanting me to teach AP statistics, sports statistics and his algebra 1 class.  I looked at his lesson plans, made modifications that I felt might help, and went to school to teach–by myself, no certified substitute in the room.  I put my red neckerchief on the desk beside me.  No student noticed it, but I looked at it frequently.  As expected, I made some mistakes that first day, but one of the students left the class saying, “You’re the best sub we’ve had all year.” I won’t take the neckerchief every time I’m called, but I will take it often, to remind me of what being in charge means—the responsibility, the worry, the challenge, the chance to do well.  Most importantly, I will remember where I have worn red:  on the lakes and rivers of the Canadian Shield, from Algonquin to ANWR, and many places in between.  I will remember the rain and sun, bugs, moose, fish and loons.  I will remember those days at Pathfinder, the eyes of my fellow travelers reflecting the light of campfires from Little Island Lake to Big Trout, my being in charge of the whole trip.  I earned the red once, and I have earned it again, doing different work, once again in charge.


January 3, 2010

A 52 year-old woman lies in extremis in ICU following a gastric perforation discovered after contrast is put through an NG tube. So what?  These things happen.  Yep, they sure do.  Here’s how this particular one happened.

The woman had an Upper GI four months earlier showing a paraesophageal hernia, where the esophagus went through.  The report mentioned the hernia, it didn’t mention its prediposition to gastric volvulus.  While one can’t mention every possibility in a report, it might have been useful to mention this particular fact.

Four months later, the woman presented with abdominal pain.  Her initial CT of the abdomen and pelvis mentioned the hernia and an ovarian cyst, but no comment was made about gastric distention or the type of hiatal hernia.  Unfortunately, the prior study wasn’t re-evaluated during the reading.  That was unfortunate, but many studies today contain a thousand images; indeed, a radiologist may encounter 100,000 images a day.  An NG tube was passed, and a second scan, with contrast, showed the perforation – really well.  Fatigue, the volume of images, hospital and referring physician demand for quick reads, compensation for number of studies (not images) viewed, make errors more possible.  Reviewing past studies is not compensated, so there is less of a  tendency to do so.  What do clinicians do if they receive a huge chart when a new patient arrives, inconveniently booked into a follow up slot?  Compensation is based on a numbers game; what game is played dictates what gets done well, what gets done, and what doesn’t.  Having been on both sides of the medical fence, I can easily spot a distracted, harried and hurried physician.  All three of these are a setup for cognitive errors, the single biggest type of mistake a physician can make.

The patient developed peritonitis.  Perhaps if fewer CT scans were ordered, it would be easier to routinely evaluate prior studies as part of the reading process.  Once having practiced neurology, I believe, and the literature supports, a person with intact cortical function, no neck pain, no tenderness to palpation and no neurological deficit doesn’t need a cervical spine CT after an injury.  Whole body scans are often done when clinical judgment would suffice.  Besides being a radiation issue, it is a time issue affecting emergency department throughput (we patients call it waiting), a money issue, because these studies are expensive, and a quality of care issue.  After my bicycle accident, I had several studies, but nobody took off my shirt to look at the road rash on my back.  Nobody palpated my entire body, since severe pain in one place may mask a significant injury elsewhere.  Those additions take perhaps thirty seconds.

Worse, if little clinical history is provided, it affects the type of study and the radiologist’s approach.  Differentiating PE from dissection makes a big difference in timing of the scan after contrast.  “Chest Pain” is not helpful to the radiologist.  Yes, you are in a hurry.  I was too.  But I always put clinical information on my neuroimaging requests.  The radiologists appreciated it.  I got better reports.  It helped my patients.

This woman survived.  The medical community ought to learn from this, rather than copping out and saying “these things happen,” “nobody’s perfect,” or “who made you the quality expert?”  “Nobody’s perfect” doesn’t cut it if a person dies from something preventable, either in or out of medicine.  You don’t hear the civilian or military aviation community say that.  They learn from the mistakes, and they publicize them.  Read a few sometime, and you would be surprised how much we could take away from their field, rather than the mantra, “We’re doctors.  We’re different.”

Rheumatic fever, polio and gas gangrene used to happen; 30 years ago auto accidents killed twice as many people per capita, anesthesia deaths were once far more common.  Sean Elliott and Alonzo Mourning would have died from uremia the way actress Jean Harlow did.

Excessive workload increases the likelihood of a radiologist’s not reviewing past studies and not dictating, “Paraesophageal hernias can lead to gastric volvulus.”  What does workload do to you in your field?  There ought to be a way that physicians can do a decent job, make decent money, learn from their mistakes and those of others, have a life and not fear lawsuits.  Here are a few thoughts:

It’s time we had community standards for common, high risk procedures that lend themselves to standardization: hyperalimentation, ventilator management, pre-op antibiotic delivery and central lines.  We can standardize and still respect individual differences.  It’s time disciplines who function together, like emergency medicine and radiology, work together.  It’s time to have legislation mandating a free from discovery error reporting system which I proposed in 2001 and which failed the legislature in 2004 and 2005; the hospital association worked to  kill it.  It’s time to have liability reform so physicians aren’t treated like criminals when they err.  Maybe if we did the first two and supported the third, we could get the fourth.  Along the way, we might additionally work towards complete medical coverage for childhood up to at least age 18 – with real-time data on outcomes and costs.  We might start having a better system.  Maybe we could expand age 18 to all.

And perhaps see fewer cases of preventable peritonitis.


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.


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.