Archive for the ‘2012’ Category

MUST WE DEBATE EVERYTHING?

April 4, 2012

1983:  I am in court testifying that a woman post cardiac arrest is irreversibly brain damaged.  Her husband wants to discontinue support; her sisters sued to keep her on the ventilator.  Nothing I said in the hospital had changed the sisters’ mind.  I knew the science and the outcomes of persistent vegetative states after cardiac arrest, and I agreed with the husband.  Eventually, he prevailed.

February 1988:  I show a nurse the conjunction of Saturn and Uranus in the morning sky.  She said they were in Capricorn (the proper name is Capricornus), but the two planets were visibly in Sagittarius.  I argued with her for 5 minutes before realizing nothing I said would change her mind.  Their next conjunction is in 2032.

Later, a man got a great deal of publicity for supposedly having discovered a new planet near Neptune.  I got a call at home from the man, who told me the planet was moving rapidly.  I stated that at Neptune’s distance from the Sun, the planet would move about a finger breadth at arm’s length every year among the stars.  No matter.  The man was convinced.  Nothing I could say would change his mind.

A physical therapist took me to lunch and told me that manipulation of the bones in the skull got rid of headaches.  I told him that skull bones were fused in adults.  No matter.  “It works!” he said; nothing I could say would convince him otherwise.

1984-1994: I said that the science underlying asymptomatic carotid artery stenosis meant that operations should be done only if the surgeon had a complication rate of less than 0.5%.  No matter.  Many were done at the hospitals I practiced; the major complication rate was 14%.  I got screamed at and threatened a few times, for intimidation, repetition, and reputation often trump facts.  I did not prevail.

2005:  Terri Schiavo.  Senator Frist, a physician, said she had cognition, despite clear evidence she was vegetative (smiling is part of the vegetative state).  Congress intervened briefly, an example of government’s dictating medical care if ever there was one.  Fortunately, science (amicus curiae brief by the American Academy of Neurology) and the court prevailed; indeed, the 600 gm brain with large ex vacuo hydrocephalus at autopsy confirmed what we neurologists knew.

March 2012:  I am in Tower Blind at Nebraska’s Rowe Sanctuary, guiding people to a suitable place to see the Lesser Sandhill Crane migration, one of Jane Goodall’s top 10 sights in nature and one of my top three.  As we waited for the cranes to land, my co-guide, an elderly woman, told me how she saw an egg stand upright on the recent equinox.  I said that can happen any day of the year.  The equinox is an instantaneous point in time, like the tangent to a function, with no influence on egg behavior.  No matter.  She was convinced.  Nothing I could say would change her mind.

More people believe in astrology than know why we have seasons.  Many believe we didn’t land on the Moon, that strange lights in the sky are aliens, who may abduct us.  A woman doing the luge at the Olympics held her neck in a certain way to “increase vertebral artery blood flow to the brain”; holding her breath would have been better.  Each of us has heard some remarkably odd ideas from people, totally convinced, totally wrong, about how the body functions.  Laetrile and colonic cleansing come to mind.

Our Sun is at least a second generation star, for elements heavier than iron must form in supernovae.  I believe in evolution and that vaccines are several orders of magnitude more helpful than harmful. I wish in the above instances I asked a simple question:  “Is there anything that you could learn that would convince you that you are incorrect?”  If the answer is “nothing”, then I am wasting my time.

We should change our beliefs when sound science shows that our beliefs are wrong.  When I learned that anticoagulation did not help vertebrobasilar insufficiency, I stopped using it.  When physicians at the University of Western Ontario discovered EC-IC bypass didn’t improve outcomes, they discontinued the operation.  They discharged four patients that very day.  There are many issues in medicine that we should study, in order to do the best for our patients; after all, each of us will be a patient.   We should discuss, not debate, the way we need to change American medicine, because I believe few are happy with the current situation.  We need to listen to and understand other points of view.  We must be willing to try new approaches, in order to learn from and modify them.  We need leaders able to convince people they can do great things that they never thought possible.  We need to use the best science available, even if it shows that our beliefs are wrong.

Children are born curious; alas, too many have it drummed out of them.  Perhaps if more were curious, we would look for answers, discover what we thought was true wasn’t.  That to me is moving forward.  Could I be wrong on climate change?  Yes. I don’t think I am, but yes, sound science could change my mind.  But I would rather discuss how we are going to fix medicine, locally and nationally.  My error reporting system has languished, unused, for 11 years.

I hope I am wrong about human-caused climate change; if I am, I will admit it.  Promise.

Tags:
Posted in 2012, MY WRITING | Leave a Comment »

GIVING BACK TO THE COUNTRY

January 7, 2012

In the visitor’s center in Waldport, Oregon, mid-way down the Oregon Coast, is a sign that reads:  Federal Emergency Administration of Public Works, 1936, Project #982.

This project was a bridge over Alsea; the river flows into the Pacific about 0.5 nm after the bridge crossing.  The original bridge no longer stands, having been replaced by a new span in 1993.  Outside the visitor’s center is a wall covered with plaques of names of people, who wrote their names, all volunteers in helping with traffic, explanations of the need for a new bridge, and other jobs.  At the top, on the right side, are the names of my parents.  My father showed that to me in 2003, his last summer up there, and the only one of the 30 summers he spent there alone.  I will not visit Waldport without looking at their plaque.  This is sacred ground for me. This time, I viewed it with sadness, happiness, but no tears.

I don’t believe in turning back the clock to the “golden days,” which weren’t so golden (cars broke down a lot, more people died in transportation accidents, Jim Crow, the Poll Tax, and the KKK were all alive and well), but I do believe in learning from history.  I had hoped we would have learned from Vietnam, before our “misadventures” in the Middle East.  We didn’t, other than to support the troops, so long as most of us didn’t have to change our lives one iota.

I also believe that maybe we can learn from the ideas engendered by the Great Depression, where we put people to work–honest, hard work–rebuilding this country’s infrastructure.  It used to take several weeks and ferry crossings to traverse Oregon from north to south.  Now it can be done in a few hours, although the coast itself should require a few days.

A few kilometers south of Waldport is Cape Perpetua, about 300 meters above the Pacific with a trail, a tunnel through rock, and a park that was built by the CCC, whose abbreviation everybody should know.  We need a new version of the CCC, a need for volunteerism, a need for giving back to this country.  I had hoped in 2009 we would see this, but I was wrong.  We need it, and I know I am right.  I am often right, and I wish I weren’t.  I wrote a column on that a while back.  I make mistakes, but I admit mine, and in the need for mandatory national service and volunteerism, I am about as right as I can be.

We need those who have to give freely to those who do not. Interestingly, this is one of the five tenets of Islam.  That statement, I’m sure doesn’t go over well, but fundamentalists of all sorts are dangerous.  American fundamentalists blamed Katrina on homosexuality, rather than on a rather normal way for the Earth to remain in heat balance.  That is, of course, why we have tropical and extra-tropical cyclones.

We need those who have to give freely to their country, by giving of time to a variety of secular organizations in this country.  I have no problems with people who give to religious organizations, but to me giving to the country as a whole, in some other way than to a specific religion, is required.  I can name several possible places, besides rebuilding our infrastructure, so that Interstate bridges in Oklahoma and Minnesota don’t fall into rivers, trains don’t derail near Kingman, because water washed out part of the rail bed.

I think we need volunteers in the public schools.  We need people to tutor, before, during, after school and on weekends.  We need people to help kids of all sorts get outside and exercise more, as well as to teach good eating habits.  That might help with obesity.  We need people to actually measure some of these outcomes appropriately, the way I did for free, so we know what works and what doesn’t.  Things that don’t work are still good, if we learn from the mistakes.

I think we need volunteers in animal shelters and to teach the next generation about care of animals, which correlates highly with care of people.  Animal cruelty in the young is a red flag for real trouble as an adult.  Did I mention that leg hold traps and cock fighting used to be legal?  How about two other words:  Michael Vick.

We need people who are fluent in other languages to help out in public places, be it airports, hospitals, or national parks.  One of my dreams, that probably won’t become reality, is that I will be able to do that adequately in German some day.  We need volunteers to teach people how to read, since a frighteningly high percentage of Americans cannot.

I see volunteers who wear large V pins, red, white and blue if they are a veteran, blue (for justice, since that is what the blue in our flag stands for).  They can have stars for 1000 hours, and they would pay for the pin, a nominal cost, whose funds would be used for something special in this country.

I think citizen science should count as volunteerism:  the annual Christmas Bird Count is one example, where we have learned a great deal about birds, including the fact that nearly two-thirds have moved significantly further north in the past 112 years.

We need volunteerism.  Oh, there would be mistakes, but it would help. I went to Senator Jon Kyl’s office to push the idea.  I received a letter from him saying it was a bad idea.  Senator Kyl has never worn the uniform of his country.  The fact he doesn’t support it doesn’t mean I can’t.  There is nothing stopping me from getting a red, white and blue V pin with four stars on it, wearing it in the schools, where I teach children math, physics, chemistry, or English.  I’d love to wear one in the canoe country of Minnesota, where I’ve logged over 1000 hours.  I’d wear it at Rowe Sanctuary in Nebraska, where I have logged about 500 hours.  Maybe a few people might be curious and ask me what it is all about.

Posted in 2012, MY WRITING | Leave a Comment »

TOUCHING OTHERS

November 13, 2011

I never knew Jamalee Fenimore or Stephne Staples.  Nobody who reads this knew them, either.  Both of them loved the Sandhill Cranes, as do I.  Both have a viewing blind named for them at Rowe Sanctuary in Gibbon, Nebraska, at the southern bend of the Platte River.

Every spring, the Sandhill and the Whooping Cranes, the most and least common of the 15 worldwide crane species, begin their 5000-7000 mile migration to the subarctic in North America and Siberia.  Their final staging area is on the Platte River.  They go to the Platte because there is food nearby–formerly small animals, but now mostly corn–and because of the safety that one of the largest braided rivers in North America affords.  They feed in the adjacent fields by day and roost in the river at night, where the shallow water allows them to hear predators approach.  Before the Platte was dammed and water used for irrigation, recreation and drinking, it was a mile wide and an inch deep, “too thick to drink, too thin to plow.”

Now, the Platte in many areas contains less water, has invasive species and many trees nearby, limiting the suitable habitat to 50 miles from the former 200.  Rowe Sanctuary manages 4 miles of river and owns 1900 adjacent acres, preserved as habitat.  Every night, for 6 weeks in March and April, up to 600,000 Sandhill cranes, 90% of the world’s population, roost in the river.  Every morning, they leave.  It is a spectacle that Jane Goodall has called one of the world’s best.  I’ve been fortunate to have seen many great sights in nature.  This one is in my top three; seeing a solar eclipse and a wolf in the wild are the other two.  I love the cranes so much that I volunteer at the Sanctuary, along with dozens of others, helping the full time staff of four–that’s right, four–show visitors the cranes from viewing blinds, for cranes are shy birds and will not let people near them.

Many talk about the cranes that migrate to Arizona.  I simply reply, “You don’t understand.”  And you can’t, until you witness the a flock of fifty thousand cranes, darkening the sky.

Stevie Staples mentored one of the Rowe Staff and lived 74 years, dying in 2006 from cancer.  She was a former canoe racer and a real character.  I once raced canoes, and I would have loved to have discussed racing with her.  She touched the staff at Rowe.  She knew it, for she did live to see a beautiful picture of a Sandhill Crane in flight with her volunteer tag with “9 years of service” on it.  The picture hangs on the wall in the hallway of Rowe.  A picture of Stevie’s receiving the picture from the Rowe staff hangs in Keanna Leonard’s office.  Keanna is the dynamic educational director at Rowe.

Jamalee Fenimore grew up in Nebraska and practiced veterinary surgery in Washington State.  She died of cancer far too young at 49, donating her estate to Rowe.  Nobody at Rowe knew or remembered her being there.  But obviously, she was touched by the river, the cranes and the sanctuary.  We volunteers learn that we may touch visitors in ways we never know at the time.

When I volunteer at Rowe, I work 17 hour days, sleeping on the floor in the sanctuary so I can hear the cranes on the river in the middle of the night.  I guide people to the viewing blinds, and I teach them everything I know about cranes.  Mostly, however, I let people look at the sight, staying silent, so they can hear the birds.  I clean toilets, paint, greet people, make a noonmark, build a sundial, do whatever needs to be done.

On one tour, I took a disabled person to Stevie’s blind in an electric golf cart.  Had he been able to walk, all of the group would have gone to Strawbale blind, which had better views at that time.  But we still saw many cranes, American white pelicans, and unusual crane behavior.  My rider loved the view and tried to tip me, which I of course refused, asking him to put the money in the container at the sanctuary.  I planned to talk to other clients, because as the lead guide, I hadn’t spent time with them.  But I spent time with this man.  He was originally from Singapore; when I told him I had been there twice, his first comment was “Thank you for saving my country.”  I’ve never heard that before, and it did me good.  I hope I and Rowe did him good.

We touch each other in ways we may never know.  Good people spread kindness throughout their world.  The lucky ones receive that kindness or are those who live long enough to discover that their kindness was deeply appreciated and honored.  But all who spread kindness are fortunate that they have the ability to do so.  Stevie knew in her final days that her kindness was appreciated.  I hope Jamalee Fenimore did, too.  But if not, I know she knew she was doing the right thing.  I deeply appreciate what she did.  And every time I guide people to either of the two blinds, I tell them the story. Both women deserve to be remembered.  To have a viewing blind named for you on a river where a half million cranes visit every March is a wonderful honor.  I really can’t imagine a better one, frankly.

Tags:,
Posted in 2012, COLUMNS IN "REALITY CHECK", ECLIPSE CHASING, HOT SPRINGS NP, MY WRITING | Leave a Comment »

SWIMMING WITH THE ORCAS

July 17, 2011

“In nature, there is no right or wrong, only consequences.”

An Alaskan cruise ship happened upon several deer swimming across an inlet.  Suddenly, several Orcas appeared, attacking the deer, killing the whole group.  The passengers screamed, begging the captain to “do something.”  There was, of course, nothing the captain could do.  Or should have done.  This is how nature works, predator and prey, survival of the fittest.  It is terrible to see it, but deer feed other animals as well as to breed and make more deer.  It is the way of the world.

Unfortunately, I didn’t like the way of the world when lightning caused Minnesota’s Pagami Creek Fire,  It was monitored, because wilderness fires are beneficial phenomena to the ecosystem. Jack pine seeds can only open after a fire, and I’ve seen large forests of young jack pines 10 years after a major burn. Unfortunately, one day the fire exploded, running 12 miles, ultimately burning 92,000 acres.  Regrowth has already begun, but I will never again travel my favorite route to Lake Insula.  It is the way of the world.

Large fires have burned huge swaths of Minnesota, the last big one in 1918.  That fact has not stopped many on the Iron Range from blaming the fire on the Forest Service or “radical environmentalists” like me. Scientists know fire belongs; if there is anything “radical”, it is the idea that forests, like life itself, are immutable.

Often, those who decry big government are first to ask where government is when there is a disaster.  FEMA was decimated in the name of smaller government, until Katrina, proving the adage to some that government can’t do anything right. I might counter with “Lehman Brothers.”  Wildland firefighters, who save so much property and risk their lives, are part of “big government”.  A PCMS member once made a pejorative remark to me about “government doctors.”  I think those of us who were medical officers, including the VA physicians who trained all of us, might feel differently. The previous Vice-President, who never wore a uniform, referred to those 16% of us against the Iraq invasion as traitors.  I want every president to succeed, because if they fail, we are in big trouble. If being against a war is treason, wishing a president to fail is the same, unless there is a double standard.

Big government cleaned the air (under Nixon) and the rivers, because corporations would not do it voluntarily. Accountants do not factor environmental costs in the bottom line.  When free markets fail because of greed or poor planning, big government must step in. If government is bad, then it must not interfere in the bedroom, marriage, and how I should decide to die. Drowning government in a bathtub would appear, in my world, to drown national defense. I don’t want that.

We did canoe in Minnesota, just not where we had hoped. While the fire was beneficial, we are likely to see more of these as boreal rainfall patterns are changing to a savannah-like ones with floods and droughts, rather than even, a phenomenon ascribed to climate change.  The oceans are more acid, the Ksp (solubility product) of calcium and phosphate will now, with 30% more hydrogen ions, cause deterioration in shell formation.  This is a major concern, since the oceans are acidifying at a rate 100 times faster than ever recorded during the past 20 million years.  Carbon dioxide + water=carbonic acid.  Nearly every glacier is retreating, and the volume of cubic kilometers of fresh water entering the ocean will further change the climate.  This isn’t bad, it just is, unless you are human, live on a coast, eat seafood, or get your water from a glacier, as do Peruvians and Indians, in which case it is a huge concern.

Every prediction of the future must quantify uncertainty; to do otherwise is unscientific. Not one argument I have heard against climate change has stated a p-value, confidence interval or margin of error. The late Sen. Moynihan said “you can choose your opinions but not your facts.” The IPCC is 95% confident, which we statisticians consider high. Using a cold week or a record low as a counterexample shows an inability to distinguish between local weather and global climate, which is basic to understanding climate change. For the record, in Tucson there have been 6.5 times as many record highs than lows since 2001 (142/22). This is a fact.

Not one argument I have heard against climate change has been free of personal attacks.  These attacks, having nothing to do with science, obscure the issue, ironically diluting and degrading the writer’s thesis. The subject is climate change, not what hikers wear.  I have discussed the science using statistics, which may be confirmed.  To clarify, I have been to ANWR twice, hiked 120 miles in three of its major river valleys, including 1002, and I find it and Antarctica among the most beautiful places on Earth.  I strongly disagree with those who disparage ANWR or climate change without having ever seen or understanding each respectively, and I have considerable knowledge of both topics.

Of course, some scientists, ever fewer, do not agree, but the vast majority of reputable scientists believe manmade climate change has occurred. Per cent occupancy of the globe is statistical misuse: 70% of the planet is water, and vast stretches are desert.  Fukushima is 0.0003% of Japan’s area, but radioactive Cesium contaminated 10% of the country. It is the way of the world that as a statistician, I frequently see statistics misused (99.999996% of aircraft flights in the US were not hijacked in 2001).  Mankind has never encountered CO2 levels this high.  We are running an uncontrolled experiment; worse, models are under-predicting the consequences. The average temperature has risen, overall weather patterns have changed and the higher sea level has already caused problems. These are facts.  It is the current way of this world.

When I was a neurologist, I often delivered bad news.  I do so again as a scientist and writer.  As a physician, I changed my patient management in the face of convincing evidence.  I believe I have convincing evidence about the world’s climate. I believe if nobody speaks out against those who disagree, and I continue to be polite with my word choice, misinformation will continue. I am calling them out; I will not be silent.  It is the way of my world.

The voters who elected this Congress believe that they will benefit from smaller government.  Ironically, many of these voters will need SSI and Medicare, which may be cut.  They are deer, and they actually want to swim with the Orcas.  It is, sadly, the way of their world.

Tags:
Posted in 2012, MY WRITING | Leave a Comment »

TOUCHING OTHERS

April 8, 2010

I never knew Jamalee Fenimore or Stephne Staples.  Nobody who reads this knew them, either.  Both of them loved the Sandhill Cranes, as do I.  Both have a viewing blind named for them at Rowe Sanctuary in Gibbon, Nebraska, at the southern bend of the Platte River.

Every spring, the Sandhill cranes and the Whooping cranes, the most and least common of the 15 worldwide crane species, begin their 5000-7000 mile migration to the subarctic in North America and Siberia.  Their final staging area is on the Platte River.  They go to the Platte because there is food nearby–formerly small animals but now mostly corn–and because of the safety that one of the largest braided rivers in North America offers.  They feed in the adjacent fields by day and roost in the river by night, where the shallow water allows them to hear predators approach.  Before the Platte was dammed and water used for irrigation, recreation and drinking, it was a mile wide and an inch deep, too thick to drink, too thin to plow.

Now, the Platte in many areas contains less water and has invasive species and many trees growing nearby, limiting the habitat to 50 usable miles from the formerly 200.  Rowe Sanctuary owns 4 miles of river and 1900 adjacent acres, which has been preserved as habitat.  Every night in March, up to 600,000 Sandhill cranes, 90% of the world’s population, roost in the river.  And every morning, they leave.  It is a spectacle that Jane Goodall has called one of the world’s best.  I’ve been fortunate to have seen many great sights in nature.  This one is in my top three, seeing a solar eclipse and a wolf in the wild being the other two.  I love seeing it so much that I volunteer at the Sanctuary, along with dozens of others, helping the full time staff of four–that’s right, four–show visitors the cranes from viewing blinds, for cranes are hunted in every one of the 17 states they pass through except Nebraska.

Many talk about the cranes that migrate to Arizona.  I just say, “You don’t understand.”  And you can’t, until you witness the occasional flocks of fifty thousand cranes, darkening the sky.

Stevie Staples mentored one of the Rowe Staff and lived 74 years, dying in 2006 from cancer.  She was a former canoe racer and a real character.  I once raced canoes, and I would have loved to have discussed racing with her.  She touched the people at Rowe.  She knew that, for she did live to see a beautiful picture of a Sandhill Crane in flight with her volunteer tag with “9 years of service” on it, because a picture of her receiving the picture is on a desk of the person she mentored.

Jamalee Fenimore grew up in Nebraska and practiced veterinary surgery in Washington state.  She died of cancer far too young at 49, donating her estate to Rowe.  Nobody at Rowe knew or remembered her being there.  But obviously, she was touched by the river, the cranes and the sanctuary.  We volunteers learn that we may touch visitors in ways we never know.

When I volunteer at Rowe, I work 17 hour days, sleeping on the floor in the sanctuary so I can hear the cranes on the river in the middle of the night.  I guide people to the viewing blinds, I clean toilets, paint, greet people, and now am setting up “Nature by the Numbers,” where we hope to show teachers and students how math and science are used in the real world, so we don’t lose our connection to nature.  The escaped, illiterate slaves used the North Star on the Underground Railroad.  How many of you readers can find the North Star?  How many of you have slept under the stars, how many bird species or constellations can you identify?  What is the Moon’s phase tonight?  How many large mammals, excluding deer, have you seen?

On my last tour, I took a disabled person to Stevie’s blind in an electric golf cart.  Had he been able to walk, all of the group would have gone to Strawbale blind, which was the plan.   But we still saw many cranes, American white pelicans, and unusual behavior.  My rider loved the view and tried to tip me, which I of course refused, asking him to put the money in the container at the sanctuary.  I planned to talk to other clients, because as the lead guide, I hadn’t spent time with them.  But I spent time with this man.  He was originally from Singapore; when I told him I had been there twice, his first comment was “Thank you for saving my country.”  I’ve never heard that before, and it did me good.  I hope I and Rowe did him good.

We touch each other in ways we may never know.  Good people spread kindness throughout their world.  The lucky ones receive that kindness or are those who live long enough to discover that their kindness was deeply appreciated and honored.  But all who spread kindness are fortunate that they have the ability to do so.  Stevie knew in her final days that her kindness was appreciated.  I hope Jamalee Fenimore did, too.  But if not, I know she knew she was doing the right thing.  I deeply appreciate what she did.  And every time I guide people to either of the two blinds, I tell them the story. Both women deserve to be remembered.  And to have a viewing blind named for you on a river where a half million cranes visit every March is a wonderful honor.  It also reminds me of my duty.

Tags:
Posted in 2012, COLUMNS IN "REALITY CHECK", MY WRITING | Leave a Comment »