March 13, 2012

Years ago, loons were killed in Minnesota, because they had the gall to eat fish that fishermen wanted to catch.

Anybody who has traveled the boreal wilderness knows that without the sound of the loon, the scenery would still be there, but the experience would be lost.  I have awakened on hundreds of nights to hear the sound of loons calling.  They have four different calls, and I love each of them.  Those who have not heard a loon in the wild, and that would be most, have missed one of nature’s great sounds.  Gavia immer is a heavy bird, because its bones are solid, not porous, so it can dive and stay underwater for a significant time.  The bird needs a few hundred meters to get airborne, but flies at 60 knots.

The wonderful ability of the loon to do so much is not unique.  To me, animals are other nations, not something we should destroy.  Loons are superbly adapted to the boreal lakes.  What will happen to them as we continue to overpopulate the Earth and damage their habitat, may spell their doom.  It’s just a bird, some say.  Well, there are many Americans who dehumanize humans by calling them Kaffirs, ragheads, and words I will never dare say to myself, they are so ugly.  Femi-Nazis has been used by Rush Limbaugh, along with his other vile comments.  Dehumanizing your enemy is perhaps a great way to win arguments and wars; however, the cost is horrific, not just in war, but how it has polarized American society.  Another way, common in my experience, is to take their words out of context, and deliberately replace them with charged words.  A lawyer did that to me one time in court, and I called him out on it each time. He finally threw a book at me.  In court.  Literally.  But I have others who do the same, former colleagues, some of whom owe me a lot, for what I have done for them, and I call them out on their language, too.  Words are important.

Fortunately, in the case of the loon, a few wildlife biologists did some good science to show that fish eaten by loons really did not adversely affect overall fish population.  Nature regulates populations well, and nature will regulate us, too, should we fail to do so ourselves.  What did affect the fish population were those who caught and didn’t release large fish, the breeders, who kept the population alive.  I know some guides, if they have a client do this, quietly go to another area on a lake to ensure their client catches nothing more the rest of the day.

During the Great Leap Forward, the Chinese killed the sparrows, only to realize later that sparrows kept insects in check.  Before one disparages the Chinese, we kill coyotes, which keep rodents in check.  Most everything belongs, including wolves, since they are, after all part of the ecosystem.  What is remarkable is the number of people, who profess being religious and patriotic Americans, who believe removal of predators a good idea.  In Alaska, people killed the national bird, the Bald Eagle, which is remarkable for a group that prides itself on being “real Americans.”  How many of you have seen a Bald Eagle or a wolf in the wild?  Perhaps it doesn’t matter, any more than reading a great book or listening to great music.  But I am better for having seen eagles, reading books, and hearing music.  Seeing a wolf in the wild, both of us alone, 4 meters away, was one of the best experiences in my life.

We face tough choices.  We have too many invasive species, and we must decide how to handle them.  None of the answers is easy.  We can bring in species to kill species, but new species can become a problem.  We can poison lakes, kill the fish, and then restock, hoping to remove invasive species.  Tucson Arundo removal is trying to remove one invasive plant.  Alone, over 10 months I removed 20,000 buffelgrass plants, another invasive species, in 8 acres, battling snakes, and heaving heavy bags up a berm.  Buffelgrass was imported from the African savannah into Mexico for forage about 80 years ago.  It was a bad idea.

Three months after I finished my work, it was like I had never been there.  Nobody cared.

There are no easy answers.  Sadly, there are plenty of talk show radio hosts and others who act as if there were.  Most of their answers are less government, which frightens me, less taxes, and more freedom.  Having seen how people trash the wilderness, even when they know the rules, I am frightened when I think what would happen without regulation.  Without regulation, we would have lodges all over the Boundary Waters and have dammed Curtain Falls, ruining Crooked Lake.  How many of you have seen Curtain Falls?

We would have logged every bit of forest, and we would have cell towers everywhere in the wilderness.  As I write, PolyMet wants to put a molybdenum mine in the headwaters of much of the country I love.  The company lawyers and managers say it will be safe.  Everything is safe, until suddenly it isn’t.  There won’t be an accident with the pipeline from the Canada tar sands to Texas, either, until there is one, and the Ogallala Aquifer is destroyed.  The Alaska pipeline was safe, until 1989.  Three Mile Island was safe, until 1979.  Unregulated, we would trash the forests, pollute the wilderness lakes, cut down all the trees, mine, and get rid of every government regulation, because people will do the right thing.

Yeah.  Right.  Have somebody tell you what it is like on opening fishing day for salmon in Alaska.

Eventually, of course, like the forests world-wide, the salmon, and the cod, the biomass will disappear.  A few will become very rich, support those who lie their way into public office and keep the cycle going.

Glad I won’t be around when the bill comes due.  Also glad we don’t have children who would ask why I didn’t stop it.  “Because I couldn’t” seems pretty weak.


October 27, 2011

In 1900, Cuban meteorologists knew a big hurricane was going to strike the US.  We had our own US Weather Bureau (as it was called at the time), and since we were Americans, and Cubans were–well, Cubans–we did not believe them, even though Cubans had a great deal of real world experience with hurricanes.

The 1900 hurricane that destroyed Galveston is to date the single biggest weather disaster to strike the US.  The destruction of the city was not preventable; the massive loss of life was.  Unfortunately, arrogance trumped science and listening to people who might know what they were talking about.  It is a recurrent theme.  Congress passed a resolution stating that man-made climate change is not occurring.  I wonder when they can tell me when Tucson’s average temperature for a year will again be normal.  It has been above normal every year since 1984, and the normals have been raised 3 times.

While they are at it, perhaps these same people can tell me when Tucson will again have normal rainfall.  It isn’t just warming, it is ocean acidification, changes in rainfall patterns with floods and droughts longer lasting, and earlier springs, affecting animal life.  Two-thirds of the birds in the Christmas bird count have moved significantly northward.  Dust from Chinese pollution is falling on snow in the Rockies, leading to earlier snow melts and changes in water level.

A while back, a person challenged me to “prove” global climate change without using models.  As a scientist, and especially as a statistician, I use models as a way to depict the world.  A model is a map, and I would no sooner work without models than I would go into the wilderness without a map.

Perhaps this particular individual, who sold real estate in Phoenix, had no use for models.  After all, the mathematicians who created models for the housing market assumed that housing prices would never fall, which is a remarkably dumb assumption.  Worse, purportedly smart people believed these mathematicians.

I work with models in statistics; I use and am familiar with at least nine different weather models for predictions.  Would we do away with models for predicting a hurricane’s path?  Maybe we will, in the new America.  After all, models are an attempt to use science, and many presidential candidates are already anti-science, even as they use aircraft, electronic devices, and the media, all of which were developed by science.  Many are alive today, like me, because of science.  To deny science is to turn back the clock, and  that deeply disturbs me.

I hope everybody noted the science used with Hurricane Irene.  The models originally had Irene hitting Florida, then progressively changed as new data came in.  This is science at its best, changing predictions in the face of new data, not being afraid to admit that the Hurricane might miss the East Coast altogether, but that it would be unlikely to do so.  Should we just hope?  Is that the new America?

Why should I have my hands tied when I am asked to prove something?  We do guess what natural phenomena will occur.  But why should we do uneducated guessing?  Are the models right?  No, they aren’t.  If anything, they are under predicting the severity of climate change.  And they might be wrong, although they have confidence intervals, which is a measure of uncertainty.  If you don’t understand confidence intervals, that is fine.  You just shouldn’t be arguing against climate change.  True scientists admit where there is uncertainty, try to define it, and draw conclusions, just as clearly as physicians tell their patients what they can expect, knowing that there is a certain degree of uncertainty.  Unfortunately, many physicians, being human, are often shocked when they learn how their brain can play tricks upon them in dealing with uncertainty.  (How many people do you need in a room before it is more likely than not that 2 have the same birthday?  Answer:  23)

If I lived on the east coast, I certainly would not be using my spiritual beliefs to predict whether a given hurricane would strike near my house.  I would be tuned into the National Weather Service and looking at what the models show–the cone of uncertainty and the probability of a hurricane’s striking me.  To do anything else would be stupid.

Since I live in this world, I am using what scientific models I can find to determine what the world will be like in the next 30 years, hopefully my lifetime.  I know these models aren’t accurate, but I believe in facts such as ice core analysis, oceanic warming, oceanic acidification, and what appear to me to be major changes in rainfall patterns, with three 500 year floods in North Dakota in the last 15 years, a prolonged drought here, and in Africa.  Perhaps I am just over worried and not scientific, but again, maybe this is all normal.  If it is, perhaps somebody could tell me when we will return to the temperatures and the rainfall that we used to have.

I just want an answer with a number, the word “years,” and a confidence interval. I don’t need any reading material.  How long?



October 26, 2011

I had a a screening colonoscopy recently, which went very well.  The process for check in, the procedure, and the departure went smoothly.  It ought to.  This center does thousands a year.

The bill for everything was about $4000.  We know that screening colonoscopies catch early cancers and can be treated at the same time.  It is a great test.  It helped me 10 years ago.  Early colon cancer, as far as we know, is completely treatable, and this is one of the common cancers.  We cannot say that for sure about breast cancer, because it is entirely possible that many of the early cancers might stay that way.  But certainly screening mammography has some value.

Here we are, with an expensive test that clearly can save lives.  You can think of many others.  I had insurance.  If I didn’t, well…. I guess I take my chances and hope.  Many Americans do.

How do we as a country provide better medical care to our citizens?  It is clear that our care is suboptimal.  Nobody counts errors in care, which I tried to know more than a decade ago.  Nobody knows what percentage of people who need screening colonoscopies–those over 50 and those with a family history–get them.  And I am not even mentioning the other cancers and the other biochemical screening that we should do.

Of course, I don’t have time here to mention how we provide after illness care without bankrupting the country.  I just think we should do better than we do.  My detractors will probably say we have the best care in the world.  Perhaps, at some places, we do.  I would like to see good data.  But nobody can convince me we have the optimal care for people given costs and illness burden.  We do not.

And we will continue not to.  I saw what happened during the insurance reform debate.  It was called health care reform by the media, and it had nothing to do with care.  I bet my career on improving care and lost.  This was about insurance reform and little else.  We polarized the country, and those who have not treated as many dying patients as I have (including family members) had the gall and the audacity to call end of life planning, something only 30% of us have, “death panels”.  We polarized the country, in large part because those who had theirs cared not a whit for those who did not have care.  Many decried government’s role in health care, even as they were receiving Medicare or were in the military.  This is a fact.

What is the best answer?  I have my thoughts.  I want my detractors to come up with an answer, and I want it now.  I want it to be put to the House of Representatives and the Senate, and I want it enacted now.  If America can afford a trillion dollars for one war that was not necessary and another that is no longer necessary and cannot be won, then America can afford a trillion dollars for improving what we have now.  We can call it an “emergency authorization,” as Mr. Bush did, and keep it off the budget, so our finances don’t look so bad.  It worked for Mr. Bush, so it should work now.

I’ve offered my solutions to deal with waste and to improve the care we give.  I have been slammed for it.  So to my detractors, I ask, time to stop slamming me.  I have offered my solutions.  You offer yours.  No rhetorical questions, please.  Just tell me, how do we screen people for colon cancer in this country?  How do we screen for other issues?  How do we care for those who do not have 7 or 8 figure net worths and do not have the good fortune to have medical insurance?  How do we prevent things better, and how do we have efficient treatment for the most common medical conditions?  How do we allow people to die when it is time, and how do we deliver good care to those who bodies are failing but whose brains are fine?  How do we deliver good care to those whose brains have failed but whose bodies are fine?  How do we quit when we should, and how do we know we have done this appropriately?

I have offered my solutions to these problems for the past quarter century, without success.  I am now dealing with my own medical issues.  I want solutions, I want them clearly defined, I do not want personal attacks, which are cowardly, I just simply want the country to run better.  That to me is patriotism.  If the Republicans do it and take credit, good.  They should deserve it.  If the Democrats do, then also good.

We would do well to heed the comment by one who cut waste in government, and was called by one of the leading House Republicans as a patriot–Harry S Truman. Mr. Truman once said, “There is no limit to what a man can accomplish if he doesn’t care who gets the credit.”


December 18, 2009

I had a depressing holiday season.  Too much death.  Not in my family but in the families of two people that I know.  The three of us were once riding buddies, but after my bad accident in 2006, I gave up the sport, and while we stayed in touch, calls became less and less frequent.  I basically let the friendship go.

Shame on me.  I kept the friendship alive with Mike Manlove from my days in the Forest Service by stopping by every time I was in Minnesota.  Mike died at 52; I had visited him two weeks prior to his sudden death and he expressed his gratitude for my coming by.  It was important to him that night.  And to me.  But at the time I didn’t realize how very important it was.

The first death was Don’s son, in an accident.  I’ve known Darrell for 8 years.  When my mother was dying, in 2002, I had to bring her and my father back from Oregon.  I had to fly up to Portland, get their car and bring it back.  On his own, Don told me he would pay for his flight up and help me drive back.  I was astounded that anybody would do that.  But that’s the kind of friend Don is.  So, when I read about his son’s death in the paper and called Don, I didn’t know what to say, except that my wife and I never forgot what he did for us, and we were going to be there in any way we could for him.  I reminded him of our 1500 mile old guy road trip, and got him to laugh, even briefly.  Don has many friends, so there wasn’t much I could do to help except attend the funeral, where I saw several other people I knew.

One of them was Rick, the oldest of the three of us,  fifteen years my senior, and a nationally ranked cyclist in his age group who could outride me on flat road any day of the week.  Rick and Don are really tight.  They and their wives had dinner together every week.  But a month earlier, Don told me that Rick’s wife was dying from cancer.  I didn’t know Rick as well as I had Don, but I still should have called him.  I didn’t.  At the funeral, I had to not only express my sadness at his wife’s illness but apologize for my behavior.

Right in the pew, I gave Rick a hug and in tears told him how sorry I was about his wife and how much I appreciated his support for me back in late 2005, when my father was dying.  Back then, I was running ragged with visits to the hospital and then to his care facility.  One Sunday, Rick called me and said, “Hey Mike,” in his great booming voice, “you need a break.  We’ve got a bike ride with your name on it.  Come out with us.”  I don’t remember much of the ride, except that once again Rick whupped me.  But I never forgot the fact he had called me.  Such a little thing.  But in relationships, the little things are the big things.  I owed Rick big time.  But good friends never keep score, they just find a way to help each other when it matters.

Four days after the funeral for Don’s son, Rick’s wife died.  Don was the one to call me.  One can only imagine how he was feeling, given how close he and Rick were.  I asked when it would be appropriate to call Rick.  “He’s sleeping, now, Mike,” Don said, “but he really wants you to call him tomorrow.”  I suddenly felt like a friend again.  Somebody needed me, and I needed to step up.

I called Rick the next day expressing my condolences.  Yes, it was a blessing his wife died quickly, but she was still dead.  He then asked, “Do you have a few minutes?”  I had all day if he wanted it.  For a half hour he went through the last few weeks of his wife’s illness, the support he received from his children and his closest friends.  I just listened, because I knew enough that all he needed was somebody just to listen.  But he then blew me away:  “I never knew that day when I asked you to do that ride how much it meant to you.”

“Rick,” I said, “it meant the world to me.  I was so grateful to you.”  We had a good conversation and agreed to meet later in the holiday season.  Out of this hell will come a rekindling of a friendship that I let go.  I really bumbled, but one of the things I’m good at is not ignoring people after a death.  I also try to say something specific about the person who died.  I’ve long known how much those small details mean to the bereaved.  You see, small to you may not be small to somebody else.  What appears to be a few insignificant trite-sounding words to you may make somebody else’s day.  Sometimes, you never find out how important those words mean.  Other times, it may take four years to discover that what you said really mattered to somebody, as it did with Rick.  Don’t ever forget that.

I have every thank you note a patient ever wrote me.  When I left Ely, Minnesota, after my leave of absence from practice in 1992, I didn’t get to say goodby to my boss, because he was helping in Florida after Hurricane Andrew.  But I later got a post-it note from him, along with a framed picture of a two man handsaw, a hardhat,  Pulaski, pack, radio gloves and a broom leaning up against a tree.  They symbolized what I did as a trail crew volunteer in the Boundary Waters for six months, and I still view the picture fondly.  But what I never have thrown away after 17 years was that single yellow, small square post-it note:

All it said was, “Thanks a lot for your help, Mike!”

Such a little thing.  Such a big thing.


December 3, 2009

After 7 years as a volunteer math tutor at a local high school, I was allowed to be an on-call volunteer math teacher, meaning I teach with a certified substitute present.  I address the occasional problem when a teacher is absent and a fully qualified math substitute is unavailable.  On my first day, I was given a lesson plan for algebraic inequalities and prepared one for geometry.  While I don’t find these subjects difficult, understanding a subject is far different from teaching it. 

I arrived at 7 a.m. with water bottle, lunch and objects needed to explain the material, for good teachers don’t parrot the textbook.  The official substitute took attendance, introduced me and I began teaching.  Fortunately, I had no problems with student behavior, because the teacher for whom I substituted is an exceedingly good disciplinarian, knowing when and how to act with words, inflection and body language.  My experience could easily have been worse. 

What’s it like to teach for a day?  I was on my feet nearly continuously for 7 hours.  I needed a bathroom break at 10:30, but preparing for the class before lunch took priority, and I nearly sprinted to the men’s room an hour later.  Other than a few swallows of water, I ate nothing until I finished at 2:20.  I left at 3:45 and wasn’t the last teacher leaving.  That evening, I relaxed, not having to grade homework or prepare the next day’s lesson. 

My parents were both hard-working teachers, and I frequently heard, “You can’t eat dedication.”  I’ve taught exactly one day and didn’t deal with problem students, parental e-mails, after school tutoring, worth $40/hr, but freely offered by many teachers or faculty meetings.  I’m 61 and want to teach math.  I can afford to; many of our best and brightest teachers, with whom I’ve had the honor and pleasure to be associated, struggle to pay their student loans.  Summers off?  Many teach summer school out of necessity. 

A properly educated populace won’t solve all our problems.  But it is a necessary condition if we ever hope to address them sensibly.  Arizona ranks last in per capita spending for what is arguably the highest yield and lowest risk investment of all – education.  Nationally, we invest far more in low yield/high risk unwinnable wars and impossible nation building.  Those whose high risk complex financial instruments devastated our economy receive annual bonuses greater than a teacher’s lifetime earnings.  Important, difficult jobs requiring significant training and long hours deserve appropriate compensation, which is how we attract and keep good people.  As a former neurologist, I was paid well for my training, work and hours.  Teachers are not paid commensurate with their extensive training, hours and immense responsibility preparing the next generation.  Teaching math, or any other subject, to 35 teenagers who’d rather be elsewhere is difficult:  doubters should try it – assuming they have the skills to do so.  Increased funding for teachers and education is one of the best investments Arizona and America can make.  Our future depends upon it. 

Michael Smith, retired physician and statistician, has been a grader for the AP Statistics examination.


November 26, 2009

I remember a time when I “owned” the ICU.  I had eight patients – eight – who were severely brain damaged, irreversibly brain damaged, or brain dead.  I don’t remember all the diagnoses, but they included aneurysms, intracerebral hemorrhages, ischemic strokes, hypoxic encephalopathies and a bad surgical outcome. 

During my ownership stage, the MICU staff were absolutely great in using my time, as they shepherded me from one family group to another.  It is easy to get jaded when one faces bad, irreversible or total brain damage in eight patients that one needs to see a few times a day.  I tried not to be, but I don’t know how successful I was.  Taking time to talk to families is often a real pain, but it is necessary, deeply appreciated and what physicians get paid for.  Do it.

If I returned to medical practice, which I won’t, I would be a far more compassionate physician than I was during the twenty years I did practice.  Mind you, I think I did a good job.  I allowed patients to die at the right time with dignity and less stress on the families.  When it came time for my parents to die, I did everything I promised them, and neither lived more than eight weeks from the time they started to die. Ensuring the quiet, painless dignified deaths of my parents was one of the best things I’ve ever done in my life. 

If you want to read about how I dealt with the change in my relationship with my father, after he was widowed, read A Wise Owl.    That is probably the best thing I will ever write. 

But having lived through their deaths and several personal infirmities, I look at life a good deal differently.  I could now tell families how it is normal to feel guilty when it is time to stop life support.  I could tell them how one will miss having that loved one to talk to, all the conversations that one would want to have in the coming years.  I could tell them how the relationship between children and surviving parent would change.  I would really be compassionate, because I have been there.

 I’ve had two major infirmities of my own in the past decade.  The first was getting buggered when a Buick turned in front of my bicycle up in Durango.  I went down and hit my fortunately helmeted head on the bumper.  Remarkably optimistic (some would say stupid), I got back on the bike, not realizing I had broken my right femoral head, the coronoid process of my left elbow, my fifth right metacarpal, and had a comminuted fracture of my right index finger.  I actually rode the bike six miles with these injuries, hobbling 100 yards into the school where the group was staying to take a shower.  While I was drying myself, the bench on which I was sitting collapsed.  It was a totally crappy day. 

Denial wore off when the adrenaline did, and I was operated on that night.  I had one functioning limb for about three weeks, and I was pretty damn miserable.  But I healed.  Still, I know what it is like to need a handicapped parking spot, have kids say “Mommy, what’s wrong with him?” have people hold doors and yet not wanting to be treated like a invalid.  I was a full-time graduate student then and teaching basic stats to college students. 

More recently, I had a nasty non-life threatening miserable infection for several months.  Without getting into details, I really didn’t want to live with it, which put me into counseling and from there into self-hypnosis.  Once, I might have been skeptical of self-hypnosis, but desperation changes one’s mind set, and it is amazing what hope and practice can do.  I can now get myself into a deep altered state and become pretty comfortable. 

During this infirmity, I went on the Internet and learned a good deal about the condition.  As much of a scientist as I want to be, there was simply no way I was going to try one thing at a time for a few weeks and see what happened.  I was too uncomfortable.  Rather, I tried a few things, had hope, lost hope, wondered what else I could do, figured out something new and kept going. 

My advice?  Do your research.  Hope your doctor is willing to work with you.  Write down questions, which is something I always hated patients doing.  Hope your doctor calls you back when you have an occasional question.  Try things.  Try other things. 

I took sleeping pills every night for a month, because getting sleep was one thing that really helped.  My condition didn’t affect my ability to exercise; indeed, exercise seemed to alleviate it.  So I tried to stay in shape.  I canceled a volunteer trip to Nebraska to help out with the Cranes.  It broke my heart, but it was the right decision.  Two other trips on the chopping block were at the moment salvaged by great people who knew me and gave me a bit more time on paying the final deposit. 

I’d be so much more understanding of patients with chronic conditions today.  I’d be a wonderful doctor.  Too bad it took me so long to figure it out.  Don’t you make the same mistake.