Archive for the ‘GENERAL STUFF’ Category

THANKS, “PRE,” YOU ARE STILL AN INSPIRATION

January 29, 2014

It was crazy, I knew it was, but I needed to do it.  I was depressed, it was raining hard outside, 39 F. (4 C.), but I decided to go for a 3 mile (5 km) run.  I live in Eugene; Track Town, USA, home of the Olympic Trials, NCAA championships, and a runner’s mecca.  I’ve camped in pouring rain many times; I can certainly run in this weather. I MUST run in it today.

Earlier, I got a video link from a friend showing how a former Attorney General in New Jersey used a data-driven approach to reduce crime.  I was depressed, mostly because I was jealous of her data-driven success, something for 3 decades I never could achieve.  Jealousy is one of the seven deadly sins.

I put on sweats, my rain jacket, a neck warmer, hat and hood, and went out.  I wondered if I would see others running, but it didn’t matter.  I was out there, running.  I needed to goAt the outset, I should have walked, but I immediately started running, not fast, but I wasn’t walking.

This video was on TED, and I usually look at links or books people recommend to me.  As a result, I learn a lot. I seldom, however, send links or recommend books to others, despite the fact I do a great deal of reading in both English and German.

I soon reached Alton Baker Park, feet wet, and just a bit cold, but my wool socks would soon warm me up.  This wasn’t bad so far, but it was raining harder.  Let’s see what happens.

The reason I seldom send anybody anything is I have sadly noted  that almost nobody, and I mean that word, nobody, has ever looked at any of my reading recommendations. Seldom has anybody asked for my recommendation, and I doubt those who did ever followed through.  It was discouraging, because as I learned from others, I got the feeling that others felt I have read nothing important. I taught myself to read when I was 3.

I haven’t been able to run at all for 3 months, because I had patellar tendonitis, which I had never had in 50 years of running.  I missed running.  This past week, I started again, first 100 steps at a time, 4 or 5 times.  It went well.  I walked 10 miles a day.  So far, so good, as I headed towards the Willamette River.

I recommended a New Yorker article about the new ecosystem discovered in the crown of California Redwoods, and it was unread. Same with Our Darkening Ocean, a must read in my opinion. The Khan Academy depresses me, because the man is brilliant, but basically does what I am capable of doing, but was unable to do.  I couldn’t even get local schools interested in my many skills, despite extensive efforts.

Within days, I was running 200, 300, 500, and 600 steps at a time.  It felt great.  Today, in the rain, I decided to go for 1000 when I hit the Pre-trail.  Steve Prefontaine died far too young, but I bet he would have been happy to see an old guy running in the rain.  And loving it.

When I was on the Medical Society Board of Directors, one of my detractors always gave me “reading assignments,” which I called them.  When people came to the monthly meeting, that individual was greeted warmly.  I wasn’t, but rather given articles to read, most of which I either knew about or was trying to implement.  I got the sense others felt I didn’t know much, and if I would only read these myriad books and articles, I would become more knowledgable.

I didn’t see another runner, but now my feet were warm, and I was cruising.  Five hundred steps, 600, 800, and 1000.  Wow, that wasn’t bad at all.  Nobody out here, and it is wide open and not dark, just raining. 

I was counting complications in carotid artery surgery (CEA) in my hospital in 1984, and I am interested whether hospitals track the following: CEA complication rate, non-elective readmission within 15 or 30 days, clean case wound infection rate; percentage of pre-operative antibiotics given within the proper time window, and the number of deaths where a significant medical error was causal. I tracked the first four 18 years ago and espoused the last in 2001, believing all are decent indicators of medical quality.  Yes, I know others, too.

The Pre-Trail is long, so I thought I’d do another 1000 steps.  No problem.  No runners, either.  Wow, am I crazy?  No, I am having fun in the rain, like a kid!

For those who are concerned about obesity, do you know the percentage of obese 6th graders in one district in your local school system?  I knew it in Tucson in 2010.  It was easy; the data were obtained, I analyzed them, and the results frightening.  I showed the results to the administrators.  They assured me there would be a meeting with other district superintendents. I never heard another word; the Medical Society’s Executive Director wrote, also hearing nothing.

I’ve always been a kid, curious.  Maybe that’s why I read what people send me,  until I either finish it or find it so poorly written or wrong that I stop.  I will read climate change articles until the first pejorative word.  Then I’m done.  It has never, and I mean never, taken long.  Sometimes, I don’t get past the title.

I am now out of date, but I wonder if medicine has a reporting system for medical errors akin to aviation.  We do not have a decent estimate of deaths with a known margin of error (a necessary requirement for every estimate), and with simple sampling techniques, we could know.  I promulgated this from 2001 until I quit in 2006.  Sadly, I was not an attorney general.

I left the Pre trail, went to MLK Blvd. and headed home.  Wow, this is great.  The people in the cars must think I’m nuts.  I saw no other runners, either.  I might be the craziest guy in Eugene! Or maybe one of the happiest.  What happened to the depression I had?

So, when I see an young, former attorney general of a populous state talk about data-driven crime statistics as if this were something new, I get a bit jealous and depressed.  I was pushing this stuff when she was in high school, and we still aren’t doing it the way we should.

Where did I go wrong?  You didn’t, guy.  Many try; few succeed.  Today, nobody, it appeared, tried to run the Pre-Trail.  You did, and you succeeded.  You are now happy, and many who own more would give a lot to feel the way you do.

FROM “NUMBER PLEASE” TO A 6000 MILE DISTANT QUERY ABOUT SCOURING PADS

January 28, 2014

In 1953, I first picked up a telephone receiver, hearing, “Number, please” (notice the please, now an endangered word).  Our telephone number (we called it a telephone) was Hillside 2765.  It didn’t matter on the dial, because we didn’t have dials. We neither made nor received calls during dinner, and answering a telephone call was a priority.

Twenty years later, James Garner had an answering machine on The Rockford Files, and his car phone was then high tech.  I called my wife from the Philippines, when the USS ST. LOUIS was in port; it was a big deal.  Fifteen years later, we didn’t believe that long distance phone calls some day would not incur additional charges. My first cell phone was in 1990, the “brick era”.  Today, we need an answering machine to screen 95% of our telephone calls, which ask for money, call during dinner, and even late into the evening.

When I see people talking to themselves, it is not psychosis, which it used to be, or discussing one’s problems with oneself, but talking on the phone. Hello is more difficult to say in public, when many are listening to music or using their phone. Formerly, when we called a store, we spoke to a human. Today, we get a menu beginning with “unusually high call volume,” and ending with “your call is important to us,“ which it is not. Things used to be stock, before “just in time” inventory was invented.  Now, items must be ordered.

Smart phones allow us to access the world from just about anywhere in the world, although there are places where it is impossible to do so. Such places are interestingly the most beautiful I have ever seen:  Alaska’s Brooks Range, Arctic Canada, the Quetico-Superior, Isle Royale, and Great Basin National Park.

I turn my smart phone off at night, because I may get calls from those who aren’t aware of time zones or my sleep patterns.  Through Whatsapp, I have been asked–from Brazil– the difference between a scouring pad and a scouring towel, which may be found quickly on Google.  I listen to conversations in public about people and things I would just as soon not hear, and for the first time wonder whether my family history of deafness in late life might yet be a blessing.

On the bright side, headphones made boom boxes obsolete, so people can destroy their hearing silently, without bothering others.  Headphones do have a disadvantage, however.  While looking for a building on the University of Oregon campus; half the students didn’t know where it was, and the other half were wearing headphones.

Mail used to require pen, paper, an envelope, stamp, and going to the post office.  The stamp cost 3 cents. One corresponded with friends by mail; writing back was polite.  We wrote thank you and sympathy notes, saying specific things about the gift or the person who died.  More than one has commented my sympathy note was the best note they had received. I still have thank you notes from former patients; somehow, a CD containing them isn’t the same and may be unreadable in a decade.

Thank you notes for wedding presents were a necessity, not only for politeness, but to ensure the sender the gift arrived.  My wife and I wrote ours all before our wedding.  It was easy, and we personalized each one, for it was expected.  My parents used to have a large tray of Christmas cards, all personalized.  This year, I got four, two in mid-January. Back then, typed notes saying how stellar everybody in their family was were frowned upon.

We didn’t use calculators but slide rules, which got us to the Moon.  Calculators have  produced a generation of teachers who believe memorization of the multiplication tables is wrong, students who can’t subtract 8 from 10 without a calculator and can’t divide 3 into 12 by hand. I am not exaggerating.  Clerks counted change accurately.  Yesterday, a clerk at Dutch Brothers gave me an extra dollar in change. I gave it back, because I like the company.  Once, a clerk argued with me, so I kept the money.  Not knowing math is a tax on those who don’t.  Don’t expect Republicans to complain about that tax. They count on ignorance.

We taught writing: the act and the result. I can’t remember when I last saw a young person hold a pen properly.  Handwriting today is sloppy, and I say that as a physician.  Grammar is often not taught, because “people pick it up.”  No, they don’t.  “Whom,” one of my favorite words, is disappearing, and “gonna” and “wanna”  were considered by one language Website as correct, until I made a stink about it.  Nominative case is considered formal, rather than….nominative, and “these kind”  and “these ones” abound.  I find it ironic that many of the “English only” folks can’t write English properly.  If you don’t know English rules, please feel free to contact me.  I love teaching the most dynamic, beautiful language on Earth.

We can talk world-wide on Skype, making language instruction with a native speaker possible, once unheard of.  We may e-mail instantaneously and access information that used to be stored in large volumes of books called encyclopedias, which were once sold door to door.  On a German professor’s advice, I recently ordered a grammar book from Germany before I left his building.  Twenty minutes later, I sent my wife a picture of my standing on Autzen Bridge over the Willamette. This is great.

However, most of my e-mails go unanswered, ostensibly because “people are busy,” although “Dear Mr. Smith, We regret to inform you that we have no need for your skills to teach 6 subjects at our school.  Sincerely yours, xxxx” takes 24 seconds.  I timed it.  Much on the Internet is worthless, inaccurate, porn, and a forum for nasty people who formerly had no world-wide public voice.  I consider the routine daily emails from West Africa a price I pay for e-mail.

Tonight, an Asian woman, whom I had often helped, wanted to chat, proudly announcing she was currently chatting with a woman in Brazil.  I told her to continue; I felt it was time for dinner, I did not feel like being second in her priorities. Language websites are great for non-English speakers to learn English.  I have found them disappointing to learn German, French, or Spanish. These three languages are not nearly as tolerant of accents as we are; corrections are seldom explained. I explain mine. I am optimistic some day the Websites will improve. They are still new.

I have lived through changes in technology and the world that will continue in ways I can’t even dream of.  The winners will be those who adapt.  I hope that politeness, curiosity, willingness to change views in the face of new evidence, respect, friendship, and the ability to embrace diversity will thrive. The record suggests the opposite.  I hope I am wrong.

SOMETHING GOOD FROM THE TRAGEDY OF K-129

January 27, 2014

I often have online chats with people that delve into bad areas: politics and religion.  I avoid religion, because it is impolite to discuss it, other than to perhaps learn what somebody believes. Politics, however, I don’t so quickly avoid.  I ought to learn.

Today, a Russian friend on Skype began a discussion about how a US submarine collided with a Russian submarine, killing a Russian sailor.  Immediately, I was on “high alert,” because of the sentence, because I had no body language or voice behind it, and because my country was being criticized from abroad.  Oh, not just from abroad, but from Russia, and being 65, one can imagine how my life has been flooded with opinions about Russia.

A quick Google search led me to many places of interest, reminding me of when the Thresher sank, in 1963, still unknown as to why.  I vividly remember that.

This particular incident occurred five years later, well northwest of Hawaii.  K-129 sank without notable reason.  There are many such possibilities, but despite part being salvaged, the answers are still not clear.  Today, the cause of the disaster is believed by many in Russia to have been due to a collision with the USS Swordfish, although “officially” no US submarine was within 300 nm.  I suspect there may well have been an accident on board K-129, since these are most unforgiving vessels when mistakes are made or key systems fail.

My friend continued, saying the US got to the site the first.  We did, after the then Soviets had tried and failed to find it.  We had better sonar at the time, and we had the advantage of triangulation.  That led to the salvage operation, which was incomplete.

I did not like the tone of the conversation, which seemed critical.  I became excessively formal, which I do when I become annoyed or angry, and I admitted that.  I said it was a good time to end the conversation, which to me was going badly.  Regarding why the US found K-129, I again mentioned triangulation and better sonar that we had.

The other person typed back, “I see your point of view.”  Suddenly, the sky cleared.  She had said the magic words:  the notion “Maybe you are right” or “Maybe I was not correct.”  My first response was to comment that was one of the nicest sentences she had ever written.

Then, I went through all the possibilities for what could have happened to the submarine, including covert operations we had that nobody in my position will ever know.  I opened myself up to explain how these possibilities existed, which five minutes earlier, was completely contrary to what I had been thinking.

This is the idea that Stephen Covey promulgated, of “Seek first to understand, then to be understood.”  Neither of us started there, but my friend did first, and the effect on me was profound.  Such behavior should not be counterintuitive, but it is to many.  When we argue, we are often so busy thinking what to say next that we fail to listen to the other side.  Listening takes time; listening with a sense of trying to understand takes even more.  Many things that take time on the front end save far more on the back end.

I used the technique often with others when I was a hospital medical director, when people called, complaining about the care.  I would initially try to understand all facets of the complaint.  I would summarize the person’s view, not only in their words, but in their emotions, too. If I weren’t correct, I continued until I could summarize the complaint to their satisfaction, asking them as often as I needed, “Do you feel I understand the entire nature of your complaint?” I could feel, over the phone, the anger go out of the person’s voice.  They were expecting quite the opposite; I was neither agreeing with them nor defending my institution.  I was only trying to understand them, nothing more.  I then asked the caller what they wanted me to do.  Some problems I could fix, but a surprisingly large number of people were satisfied that they had been understood by another human being, something called “validation.”

The next time in an argument with someone, I will again try that technique.  It has been a while since I have used it, mostly because I do not spend a lot of time in the public eye.  It takes time, and validating somebody does not mean agreeing with them. Nor does it mean one is weak in allowing openness to new ideas, although many in this country believe that.  Validating does not allow the other side a “free pass” to avoid listening to my side:  “Seek first to understand, then to be understood.”  So far, I have stressed the first part.  I have my turn, too, once I have understood the other side, and a right to my opinion.  My opinion, however, will now be given knowing what the other person believes and why.  By understanding their thoughts, I understand their view, which, while different from mine, allows me to choose what I should and should not say. They are more likely to give me the same courtesy if I give it to them first.

What happened to K-129?  I honestly don’t know.  Does anybody?  I don’t know that, either.  What did happen is that two people today avoided a fight over its fate.

DAD’S RULES

January 19, 2014

I recently stayed out of an Facebook argument about climate change, unusual, because I usually go to the mat on this issue.

I don’t fight every battle.  Life is too short, and those who insist on fighting every issue to win often live alone. Don’t laugh; I know more than one individual, very strong, who must win at all costs and wonders why they are unmarried.  If there are three words that define a good marriage, I’d pick friendship, respect, and love.  If there are eight more I would be allowed to use in two phrases:, I would pick “yield right of way” and “I could be wrong.” (“You might be right” may be substituted.)

Before I get to the climate issue, here are some rules I learned from my father, which I call Dad’s Rules:

  1. Don’t get into a pissing contest with a skunk.
  2. Don’t argue with those who buy their ink by the barrel; to those of us who are old enough, don’t argue with the press.
  3. If it is a matter of faith, don’t argue.  It’s impolite, and you won’t change their mind.
  4. If it is a matter of fact, but nothing you say will change the other person’s mind, walk away, even if you are called a coward.

I have walked away from debating climate change with two people whom I simply cannot stand–Dad’s Rule #1–at a medical society meeting.  One of the two had immense power, despite promulgating intelligent design, vaccine harm, beneficial effects of low dose radiation, as well as denying climate change. I was an invited columnist; she got 2/3s my space with her letters.  The best way I handled her occurred when she once complained about the government’s decision to regulate physician laboratories:  I replied quietly, “Because my side won the Civil War.”  She literally sputtered and fell silent.  On another occasion, she had attributed a word to me I don’t use, and I quietly called her out on it:  “I don’t believe I used that particular word.  Did anybody else hear me say that?”  The room was quiet.  My detractor was not used to being called out on her words.

The reason I didn’t go to the mat on climate change is that the individual on Facebook once quoted a magazine that I checked and found both inaccurate and extremely biased.  He is unlikely to be influenced by anything I happen to say (Dad’s Rule #4 above).  He is not scientifically trained, quotes articles inaccurately, and his posts attack people.

There is a German organization devoted to helping abused Islamic women. I once supported it strongly, until it quoted this same magazine.  I posted a strong objection then quietly disappeared.  In my view, they had gone beyond the pale; they had pushed Christianity, rather than staying on message, and a woman who screened their Facebook posts frankly insulted me by sending me articles that I reviewed and felt to be biased, inaccurate and impolite.  She is a Christian; I am a “none.”  Go figure.  I couldn’t.

So, what is my view on climate change?

Based on the peer-reviewed data I have seen published and analyzed, I am highly confident that manmade climate change is altering the Earth. The changes not only have already occurred, but will likely affect life as we know it in ways that while we cannot yet know, are likely to be harmful.

Notice my choice of phrases: “peer-reviewed data,” “analyzed,” rather than “this scientist says.”  I use “highly confident,” not “certain”; “altering,” not “ruining”; “life as we know it,” not “everything on the planet,”; ”likely,” not “definitely”; “in ways that we don’t yet know”; not “it is completely clear”; “are likely to be harmful,” not “will definitely harm everybody.”

Notice what I didn’t do in the paragraph:  attack  individuals, political beliefs or companies.  I didn’t state my case with certainty, because that would require my being completely certain I can accurately predict the outcome of a dynamic system, whose complexity and interactions among the variables are not fully known.

Understanding climate is science, the same science that forced Steve Jobs to change the location of an antenna on the iPhone to a place where it would work properly.  Names don’t matter; laws of nature do.  Prayers don’t turn around hurricanes; getting accurate information on their path to people matters.  That is science.  I have nothing against religion; I have seen parents devastated by the death of their daughter be comforted by their belief she was in heaven.  Religion has the ability to provide a road map how to live what we consider a good life.  Religion offers an explanation for how we got here; however, I disagree, because the explanation is testable, and religion fails the test. Science, however, can’t measure faith, hope, love, or charity, which religion promulgates.  Science has, however, measured the consequences of greed, knows consequences to the developing brain if children are malnourished before age 5, shows that educated women past 5th grade have fewer children than uneducated women, measures annual ocean rise to the nearest millimeter, and has reduced the uncertainty of hurricane forecasts about 75%.

I live a scientific life with a lot of spirituality, which may be found in my posts on wilderness.  While to me this melds both well, I could be wrong, and both sides might well say I am a hypocrite.  I am willing to discuss that.

Here are my four requirements to debate climate change (and my possible hypocrisy):

  1. No personal attacks, and that is difficult.  It is why I didn’t mention the name of either the magazine or the German organization, but the latter’s behavior was fact.  I have the emails and articles sent me.
  2. Statement of conclusions using statistical terminology, such as confidence intervals, which cannot never be 100% for a complex system.  A confidence interval is a statistician’s way of saying, “I could be wrong,” something every person should say at least once.  See above on using it to help a relationship.
  3. Verifiable predictions of global climate conditions in the next 5, 10, and 50 years.
  4. Statement of consequences should one be wrong.

I have never gotten past Rule 1 with anybody, and realize now my Facebook post violated Dad’s Rules #1 and #4.  Unfortunately, Dad’s Rule #1 trumped my climate change debate Rule 1.  I’m not perfect.

I wish a few on the other side could say that, too.  The world would be a better place.

Dad, age 90, in Nebraska, viewing the Lesser Sandhill Crane migration.  He lived to see this wonderful spectacle.

Dad, age 90, in Nebraska, viewing the Lesser Sandhill Crane migration. He lived to see this wonderful spectacle.

WHAT GOES AROUND….

January 15, 2014

CRASH!  At 4 a.m., I am up to feed the cats and to listen to German videos.  As I opened the refrigerator, a beer bottle fell out and shattered on the kitchen floor.  The cats scattered; I cleaned up the mess.  Now the kitchen smelled like a fraternity house on Sunday morning.  And I wasn’t sure I had gotten all the glass.

I listened to a long video, understood more of an Austrian accent than I ever had before, but I still missed a lot.  I have seen close to 1000 German videos, and I’ve understood both the plot and German in 9.  Nine.  I received feedback about a post I made on a language site about the verb “umgehen,” which was completely demoralizing.  I did more work and realized that the verb, which I had been told had 3 meanings, really had two:  One was the separable form, which means to go around; the other, inseparable, where the um and gehen always stay together, and  pronounced differently, means to manage or to care for or to bypass, out of fear or concern.  The third meaning was prepositional, one of the most common expressions in German. This meaning, howevert was gehen um, which is very different from umgehen.  Trust me.

I replied politely to the comment in German, ending with that it was perhaps time to leave and study something else.

I have worked  3-6 hours a day for 3 1/2 years to learn the language.  I know many language Websites; I’ve read many grammar books, I have three dictionaries and a lot of books.  Lately, however, I have made little progress.  I am self-taught, because my trainer wasn’t, despite my living in a large city where a trainer was “guaranteed” by a company to whom I paid a good deal of money.  She had lived in the US 27 years and had never taught German. I didn’t know this fact immediately.

I am moving to a smaller town with a university, and my upcoming interview with the department head will likely decide whether I continue or just keep alive what I have done.  Something had become wrong; the language, once fun, had become work, and I wasn’t seeing results.  English students I have taught have not put in nearly the work I have, and yet they expect to become fully fluent. My expectations are far lower.

That afternoon, after correcting some English submissions, which I find relaxing, I received a note from a German reviewer.  He was honest, admitting that he and other reviewers often could not explain their grammar:  they just “knew” what was right and wrong.  While it didn’t help me learn, I appreciated his honesty. The writer continued, telling me to put the grammar book away.  I had done that a long time ago, but he said something else very important.  While I had put the grammar book away, I still was in prison: I was forcing myself daily to learn lists of words.  I suddenly realized that I didn’t have to do this.  Nobody was forcing me, and memorization was part of the day I did not look forward to.

It was a breakthrough.  Some people I talk to, in Iran, can’t change their lives, because others forbid it.  Some people here, like me, don’t change their lives, because of themselves.  Nobody was forcing me to learn these words.  I could stop and do what I wanted.

It was liberating.  A weight came off my shoulders.  Suddenly, I realized I was freer than I had felt for a long time.  It’s worth letting oneself out of prison periodically.  Life becomes a lot more fun.  Some never do; some never put themselves in prison.  I did, but I process slowly.  It took a verb called umgehen, frustration, thinking, and the right letter at the right time to open the lock.

I wrote the reviewer, thanking him for what really helped me.  What he advised I didn’t do; what he did advise, however, gave me the piece I needed to unlock the door.

I watched another video, then took a walk in a nearby playground.  I really want to run again, and my knee, which was bothering me, is cleared to do so.  I enjoy the walks, however, and the thinking I do on them.  Before leaving, I checked my email and logged on to Facebook.  I had a note from a young woman from whom I had not heard in 2 years.  Three years ago, she asked to befriend me on the advice of a mutual friend.  We had lost touch.

For whatever reason, on the last day of 2013, I wrote her and told her I had been in her neck of the woods last summer, while I was traveling.  I was too far away to visit, but I was at least in her general region.  I said nothing more of note, and forgot about it.  Yesterday came the response:

I cannot tell you how much it meant to receive your message. I was so grateful, it came at the perfect moment when I needed a light in the dark.”

I hadn’t thought I had done much. I was obviously wrong.

I don’t know this woman well.  We’ve never met, and we may never will.  That doesn’t matter.  What does and did matter, is that something I said deeply resonated with her at a critical time and place in her life.  Maybe I gave her a key to something she needed, in order to unlock something that was holding her back.  I don’t know.

What I do know was I did exactly for her what hours earlier a young man, whom I will also never meet, did for me.

What goes around can come around.  While the connotation is usually used in a retaliatory sense, it need not be. Often, simple words from others have helped me greatly.  I hope that I have done the same often. I know now I have done it at least once.

TIME TO STOP THE DUMBING DOWN OF AMERICA

January 12, 2014

“The dumbing down of America is most evident in the slow decay of substantive content in the enormously influential media, the 30 second sound bites (now down to 10 seconds or less), lowest common denominator programming, credulous presentations on psuedoscience and superstition, but especially a kind of celebration of ignorance.”

Carl Sagan (1932-1996)

Picture of Earth taken in December.  Notice how Antarctica and the Southern Hemisphere are accentuated and that the Sun is shining at a lower angle, therefore producing less heat, in the northern hemisphere.  This is why we have seasons.  The Earth circles the Sun, and in 6 months, the northern hemisphere faces the Sun.  That is why the Sun circles the sky in the Arctic in June. Seasons have nothing to do with distance from the Sun; they have to do with the tilt of the Earth’s axis.  The continent you are looking at is Africa, with the Arabian Penisula at the top.  Notice the comma shaped white areas over the blue ocean.  They are storm systems.   Notice the white over the middle of Africa.  This is the ITCZ, the Intertropical Convergence Zone.  The Sun is so hot at the equator that humid air rises, condenses when it cools in the upper atmosphere and produces thunderstorms.  Notice how there are no clouds over the Sahara, in North Africa.

Image

A financial consultant I know is deeply religious and went to Bible camps.  When his wife came ill with lymphoma, he took her to the hospital where she was put into remission for many years.  While he prayed for her, I found it interesting he took her to a hospital, where she was cured.  Dr. Sagan himself said much as he would have liked an afterlife, the chances as he knew it were zero.

When I was young, I had multiple strep throats.  Had it not been for penicillin, I would have likely developed acute glomerulonephritis or rheumatic heart disease, with subsequent kidney failure and mitral stenois.  I would either be dead or never have seen the world the way I have, by pack and paddle.  Uremia used to kill in the 20s: The sex symbol Jean Harlow died from it at age 26; Sean Elliott and Alonzo Mourning would not be alive today if science had failed to progress.

The dumbing down of America: where people don’t know why we have seasons (note picture above; rocket science got man to that distance) but can tell you what is happening in Hollywood; where rap stars are idolized, but Frances Oldham Kelsey is unknown.  Don’t know her, right?  Well, use science and Google her name.  She did more for this country than any rapper, actor, or artist.  Jonas Salk will probably be unknown in another 30 years.  He kept me from getting polio.  Now, we have to practically force otherwise intelligent people to vaccinate their children, the idea being that vaccines cause autism, rather than perhaps genetics, overstimulation, pollution, our obsession with cleanliness, and maybe even the water we drink and food we eat.

That is the dumbing down of America.  We used to say “UCD” in medical histories, for “usual childhood diseases.”  These diseases were removed, except a bunch of otherwise intelligent (one would hope) parents seem to think that they don’t exist because we don’t see them. These diseases are still out there, lurking, waiting for us to let our guard down.  Pertussis has already made a resurgence.  Pertussis kills.

In schools, we teach math to the tests, rather than to show where it can be useful and fun.  In 2011, I was requested to do a Nature by the Numbers course for a non-for-profit organization.  I did the work, asked for feedback, and heard nothing.  Some time later, I learned that schools didn’t have time to teach this material.  Perhaps if kids could see how knowing the volume of a cylinder determines cubic inch displacement in engines, how land use led to land grant universities, what a section is, what DNA is, what carbohydrates and proteins are, how chemistry and physics work in real life, they might be more interested.  I always teach the use of math when I substitute.  I show where algebra works, I teach why interest on money matters, where exponential functions are used, how quadratic equations are equations of motion of baseballs, footballs, basketballs and projectiles.  I teach about probability, so they learn the chances of winning Powerball are equivalent to guessing one minute, randomly chosen beforehand, since the Declaration of Independence was signed.  I teach them what year it was signed, because most don’t know.  I don’t even bother with teaching them the 50 states, because I’m lucky if they know 10.  I once made a comment about Delaware having the second highest cutoff rate in the nation for National Merit scholarships.  I joked, “I’d be a finalist if I lived in Arizona.”  Well, I have.  I asked the students to name all the states that border Delaware.  That is easy.  There are only three.  One named one.  The other responses were frightening.

I tell them about the 49 countries I have been in, courtesy of science and systems that has made aviation safer.  I tell them about solar eclipses, about wilderness so remote that even their cell phones don’t work.  I tell them about the 49 national parks I have seen, what they contain. I don’t treat kids as dumb, but I am stunned at the mindless guessing and their dependence upon electronic products that are the result of good science, not prayer, not wishing, not falling from heaven.

I teach them about cyclonic circulations in our hemisphere, and how they are necessary to balance the heat of the Earth between the equator and the poles.  Sometimes, I have an opportunity in the woods to show people the right directions, or even predict the weather.  More than one time, the barometer I wear on my wrist, coupled with a new south or southwesterly wind, has told me rain was coming.  In the wilderness, my life depends upon this knowledge.  I can read the sky, day and night.  I know where the Moon will be, where Polaris is, where the Sun will rise, and they can learn this, too.  This is our heritage.

Kids aren’t dumb.  They are curious until we drum it out of them, because we hate to be asked Why? when we don’t know.  In my youth, we had encyclopedias.  Now, we have access to the correct information, but we don’t know how to determine what is correct and what isn’t.

Every kid occasionally ought to be bored.  Every kid ought to be read to and learn to read.  Every kid should sit on the ground somewhere, where there is no asphalt, only natural grass, rocks, sticks, muck, or sand.  Every kid should put his feet in water and learn how to float.  Every kid ought to see the stars from a dark site and understand the phases of the Moon,  which drives the calendars of Islam and Judaism.

At one school I worked at, chess was allowed but cards were not.  Kids couldn’t learn how to play bridge, a fascinating game where bidding is allowed with only with 15 specific words, 7 of which are numbers.  It teaches partnership, politeness, probability, tactics, and when to be aggressive on offense or defense.  I am not very good at it, but the game ought to be allowed in schools, before it dies out, because most bridge players are old.

We allow dumbing down, because science and math aren’t cool.  Next time you use your computer, cell phone, car, wear clothes, shower, take a pill, sleep in a bed, walk upright, and listen to music, remember what brought it to you.  It wasn’t God, and it wasn’t prayer.  It was science.

If you have arms and legs, thank Frances Kelsey.  If you ever think that it is impossible to stand up to big business, thank her again.  If you think that science is only for men, think about her.  But if you are a guy, get busy.  The girls are going to run the world.  That might not be bad, but if you want a decent job, think about science and math.  Chances are very high you won’t be a famous athlete, rock star, or the next Steve Jobs.  I understand probability; too many don’t.

The world will belong not only to those who guess right but to those who adapt to the changes that will come.  You don’t have to be a Steve Jobs.  I found that being myself, adaptable to a changing world, has been a good ride.  I’ve been all over the world, I’ve seen the great wilderness areas, I’ve traveled alone and known solitude, and I have taught myself much.  I’ve adapted, and science has led the way.

I don’t want to die tomorrow or soon, but if I do, I’ve lived a full, interesting life.  I haven’t been a sports or rock star; I’ve been much, much more.

Thank you Jonas Salk and Alexander Fleming.  If you don’t know who they are, then you ought to.  Look it up.  Use science that is in your computer.  Or you can pray for the answer.  I know what I’d do.

BEEN DOING THIS STUFF SINCE I WAS 8….AND YOU CAN LEARN HOW, TOO.

January 8, 2014

A letter came in the mail from Humana, my Part D Medicare Drug Plan,stating my medication, 2 mg pills, was “excessive;” while I would be given a 30 day supply, I would need a letter from my doctor to get more.  I take 2 pills twice daily.  That is 4 *30, or 120 pills per month.

Getting a hardship letter from a physician is difficult. When I practiced, this sort of stuff was the norm.  Some of us did it as part of the job, others charged for it, still others ignored it.  I realize we live in different times.  I wrote off $30,000 annually for bad debts and poor people. In 1984, when Arizona went on the “successful” non-Medicare AHCCCS program, it worked, because we didn’t get paid for “AHCCCS Noncert” patients, but we saw them anyway.  You’re welcome.

I was not going to fight the doctor’s office staff.  I had a better idea.  I went on Humana’s Web Site and found the problem: only 90 pills were allowed a month.  I thought that odd, but Medicare is interested in preventing falls in the elderly.  Being Medicare, they set rules in stone.  Had my colleagues fixed the problem, we wouldn’t need government regulation, but I’ve been saying that for decades and would have had better luck saying it to the wall.  At least, the wall wouldn’t have yelled back at me.  But I digress.

I discovered that the 5 mg pills were restricted to 90 as well, odd, but I could buy them, use a pill cutter and do just as well with 1 1/2 a day.  That would be easy.  So, I went to my doctor’s office and asked for a prescription for 1 pill twice a day, 70 a month, to have a few extra.  I would do the cutting, and I didn’t want the staff to deal with fractions, for people don’t understand fractions and don’t like them, mostly because they were not taught how to deal with them. I should quit digressing.

Two weeks later, I got another letter from Humana stating the same thing, this time about the 5 mg pill.  I was annoyed.  I called their number, and entered a loop that sent me back to where I started.  At least I didn’t hear “Your call is important to us.”

Non-plussed, I called the line for those wanting to contest a denial. While on hold, I called another pharmacy to find I could get what I wanted off Medicare if I paid for it.  Good.  I had Plan B. I wasn’t really contesting the denial, but I soon learn to find the right number to talk to a real person.  I got a guy from Tampa on the line and told my story.  He explained the 90 pills was a precaution against falling.  I knew that. He then said that the pharmacy had given me an 18 day supply of the 5 mg pill, because it was the prescription was written for 4 a day.  I didn’t thank him for the extra pills: 18*4=72, and there is really an easy way to do that in one’s head. I was polite.  I know that, because after the call, my wife agreed.

In other words, I concluded, either the pharmacy or the doctor’s office made an error.  I wasn’t done.  I asked him to look up how many pills I could get of the 10 mg size.  I knew, because when I deal with irrational thinking I ask questions I already know the answer to.  Jeesh, I’m sounding like a lawyer.  That’s worse than digressing.

There was a pause, and then I heard, “120”.  I asked him what he thought about the number.

“I think I better get the clinical pharmacist on the line.”  Good answer. Now I’m having fun.

A few minutes later, I was speaking to the clinical pharmacist and the operator.  Wow, this is great.  I outlined the problem in simple math, since I am after all both a mathematician and a substitute math teacher.  In my last post, I said I was better than average with dealing numbers.  No, I am far better than average in dealing with numbers.  I always counted things; I still have a 1957 diary wherein I counted license plate tabs I saw.  Yeah, I did that stuff when I was 8.

I outlined my issue in simple math I thought an 8 year-old would understand:

“I can get 90  2 mg pills a month, right?”  Both agreed. “So,” I added, “I can take 180 mg a month.”  The pharmacist started saying something about Medicare, but I interrupted her.  Yes, I shouldn’t interrupt; the German verb for it translating literally to “under break”.  Gotta love the Germans for that.

“I know what Medicare says,” I continued.  “I can get 120 of the 10 mg pills a month, right?

The pharmacist and the operator agreed.  I then lay down my royal flush:  “That is 1200 mg a month, right?”

There was dead silence on the line.

I started arranging the Ace, King, Queen, Jack, and Ten spot and said, “So Medicare says I can only take 180 mg a month of the 2 mg size but 1200 mg a month if I take the 10 mg size.  Does that make sense to you?”

The silence continued a little longer.  Almost in unison, I heard, “I think we need to talk to our supervisors.”

I thought that was reasonable.  I doubt anything will happen.  It seldom does.  But once in a while there is real thinking about numbers at high levels of business, numbers that don’t have parentheses around them and lie at the bottom of the page.  Somebody might actually say, “Hey, some old codger from Arizona called and said he could get 1200 mg of this medication if he took one size pill, but only 180 mg if he took the smaller size.  We need to change that.”

“That can’t be true,” will be the reply.  “The codger doesn’t know what he is talking about.”

“But he said that was 6 2/3 x the lower dose.  He did that without pausing.”  Man, I’d pay a C note to be present at that conversation.

That was easy.  Been doing that since I was 8.

The harder part was multiplying the two, just for fun.  The product is 216,000.  It is meaningless, but I did it in my head.  It is not difficult to teach…..should you want to learn the technique.  It’s not like directing Swan Lake, for heaven’s sake.  It’s just working with numbers.  I gave the link.  We read left to right.  Learn to multiply left to right.  You may not have born with mathematical ability, but you can learn this.  I wasn’t born with musical ability, but I sure love to listen to Swan Lake.

Math really matters.

ON THE ROAD TO SOCHI

January 4, 2014

That was what the sign on the trailer said, as we drove by the US Olympic Trials ski jumping venue.  After seeing a line of parked cars a mile long, we instead went to Park City for lunch.  I was visiting a German friend whom I had met on line, and because she and her family were in the US, I decided to visit. 

Salt Lake City (SLC) got the Olympics by cheating, not that such is unique to any Olympic city, although I expected more from a place that is heavily Mormon. Being religious requires maintaining higher values that those of us non-believers in order to avoid being called hypocrites.  The SLC Olympics had a US federal subsidy of $1.3 billion; $40 million went permanently to SLC to maintain the areas and use locally.  If the current president, who got very few votes in Utah, tried to spend that kind of money, I would need sound canceling headphones to drown out the screaming from Provo to Brigham City.

That subsidy, however, was only 5 times that of Alex Rodriguez’s contract, for hitting a baseball and maybe fielding one.  It equals the combined revenue from sports of the top 10 universities in the US. The NCAA itself receives $1 billion in sponsorship in March alone; about the same is paid for the NFL post-season.

Exceptional athletes are born.  We used to think it was just a matter of training, although if that were the case, then any of us could become an exceptionally good mathematician, musician, or runner, and that isn’t the case. Summiting an 8000 meter peaks without oxygen is an accomplishment, but people who do that have something innate that the rest of us don’t.

One may therefore say that sports are a matter of watching somebody exceptionally programmed (read: born right), who has worked hard, do things the rest of us can never do.  Hard work is only part of the equation.  We aren’t watching a freak show, but the rest of us aren’t going to be the Three Tenors, either.  Money and sports engender greed.  The fact we have to test for illegal drug use is proof of that.  If I improve my running time 1%, it doesn’t matter.  If I am an elite  runner, it matters a lot.  Lance cheated, and many he beat cheated, too.  Doping is part of high level sports, because sports are big money.  Too big.  Money corrupts.  We have our priorities wrong, and it is not popular to comment about it.  As a child, I was in awe of exceptional athletes, back when both “awe” and “exceptional athlete” meant something.

Now, when I see an exceptional athlete, I think “born talent, a lot of work, and what drugs did they take?”  I’m 1.8 m tall and 75 kg.  It’s difficult to believe those men on the front line of virtually every top college program are twice as heavy by eating what I eat and lifting weights.  In 1985, “The Refrigerator” was a freak at 140 kg.  Now, he would be the lightest person on many offensive lines.  If this is evolution, than we have an even worse problem with the species than I suspected.

Yeah, a lot of the money paid goes to the school.  Then why not cut ticket prices?  Why not cut student debt, stop the “student athlete” charade, where they “forego their senior year” (which I call dropping out of college) to go pro,  the required “study halls,” as if college were a place where one studied occasionally, rather than the 12 hour days I put in?  Sport worshipping filters down to high school, where now we have high school national rankings.  On ESPN, I have seen on a pair of high school teams playing a sport that has been shown to harm the brain of those young people playing it, who are the most susceptible to long term complications. This is outrageous.

The Olympics have become an expensive 17 day display of talent, work, cheating, and money, to bid for the site, to build the site by moving homeless people to construct venues (Rio), to have bad contracting (Greece, Russia) that may or may not be used much in the future.  Apparently, this expenditure of time and effort is worth it, despite the fact only a quarter of graduating seniors from Harvard know why we have seasons, at least 40% of Americans believe in astrology, 3 in 8 can find Iraq on a map, only half New York; we have world-wide poverty beyond comprehension, limited family planning, don’t believe in population control, and could protect the environment if we had the same will.

Without a doubt, the Matt Knight Arena in Eugene is a wonderful place to watch college sports and to seat thousands for other events.  On the other hand, I think the $227 million spent by Phil Knight, to honor the memory of his son, Matt, who died accidentally, could also have been used to eradicate hunger once and for all in Lane County and do something about the Whoville homeless tent cities, one of which was 800 meters from the Arena last holiday season. It wasn’t my money, but I know what I would want for my legacy.

Sports and education testing are big businesses.  I’m not certain education is benefiting from either.  We have students whose writing is atrocious; many young people do not know how to handle a pen, can’t write a sentence, and can’t count change.  This is outrageous.  Many make wild guesses, because they were taught to “participate,” regardless of what they say. I have helped 10th graders in an affluent district divide 3 into 12.  We don’t require multiplication table memorization, which is fundamental to math. Memorization is important in life. Many can’t deal with percentages, like credit card interest, which might be useful; 1 of 100 high school students I have asked could tell me how many feet there were in a mile; none yet can tell me how many acres in a square mile (real estate relevancy).  Their grammar is atrocious, so at least two of the three “R”s are not being learned.  I don’t know how much they read, but I suspect it isn’t much.  The concept of a written thank you letter, let alone basic politeness, is often unknown.  I called a Medicare hotline, and the choices the operator gave me for asking how to address me were “Mike and Michael.”  By definition, people who call this line are over 65, unless their children are calling. This approach is impolite to MY generation, and I AM the customer.  Teaching students basic material, and the above is basic, should be mandatory in this country, and it is far more important than the $1 million median salary in MLB or the $37 million Hank Paulson made at Goldman Sachs in 2005, when he left to join the Bush administration. He was outraged at the bonuses paid after TARP.  He made millions helping to set up the collapse that required TARP. This is outrageous.

We have 50 states, 50 laboratories to try new approaches to see what works and what doesn’t.  A lot won’t work, and we will learn why not.  A lot, however, will work, and the benefits will be enormous, not the least being America’s being true to itself for a change.

Where will the money come from?  We should tax stock trades at $1/$10000 or 0.o1%.  That would raise $6 billion a year, enough to pay each teacher in the public schools (I deliberately ignore all others) $2000 more, right there.  Raise it to $1/$1000, and we get $60 billion a year, some serious money to pay teachers an income that would encourage good students to enter the field.  A 39.4% marginal tax rate in high income gave us a surplus.  I’d make it 45%, tax Wall Street bonuses at 75%, and not let students graduate until they mastered basic skills that any reasonable person thinks a kid should know before leaving school.  You want more examples, let me know.  I don’t care if the parents complain.  Education matters more than sports, actors, or rock stars.

America should get gold medals for feeding all its citizens appropriately, educating our population adequately, and reducing homelessness.  In 2024, how we do these will matter and be remembered; nobody will remember Sochi.

Right now, I’m lucky if I encounter a high school student who can find Russia on a map.  Extra credit if they now know the body of water Sochi is near.  Double if they can name the country, the region, and nearby body of water in that region the Boston Marathon bomber came from. I think this sort of stuff is important.  Triple, if they know the doubling time of money at 8% interest.  Sorry to make the last question so easy, since one only needs the basic multiplication tables to answer it.  Hint: it’s the Rule of 72.

WHOVILLE #9

January 2, 2014

I had read about Whoville, but I hadn’t seen it until the Friday before Christmas, when I walked about 4 miles from the house to a bar to meet a friend.  I can walk a lot of places in Eugene in 4 miles, even in the rain, which it was doing.

Once across the river, I walked by a lot, devoid of buildings, and saw many tents pitched.  This didn’t look like the right type of tents or the right time of year to be displaying them, and there was a sign: Whoville #9.  There was a Mission Statement and Rules.  Only in Eugene would the homeless have a Mission Statement and Rules in plain view.  One might say it made the city uglier, but to me it made the city more real.  Every city has homeless; any city that doesn’t is either lying or hasn’t looked.  I walked to the bar a little bit more muted, thinking about what I had seen.

These places are not pleasant to see.  The poor aren’t.  Many are down on their luck.  Some are mentally ill.  Others are alcohol or drug dependent.  Many are people that once were like the rest of us, until they got ill and couldn’t pay the medical bills.  This is the single biggest cause of bankruptcy.  We see the jars and the places for the dollar coins to fight leukemia, cerebral palsy, or help a family whose daughter just had a bad car accident, or whose son is in a coma.  These coins and singles may make us feel better, but realistically, they do nothing.  The cost of treating each of these diseases overwhelms the ability of the average person to pay for it, or even the average church.  I practiced medicine years ago, when the bills for a brief stay in the ICU could not be paid by more than maybe 1% of the people.  Even having insurance, which many decry, isn’t a panacea.

Why are people homeless?

Medical bills

Foreclosure

Domestic violence

Decline in public assistance

Lack of good jobs

Mental Illness

Addiction disorders

Look it up, if you don’t believe me.  Are all of these easily solved?  Nope.  But we could do something about medical bills with better insurance.  We could have and still could do something about foreclosures.  We are absolutely shoddy in our dealings with domestic violence.  Decline in public assistance can be reversed.   The last three are difficult, but so was getting to the Moon, and this country once did that, before a minority in Congress decided that we were going to stop any meaningful legislation, because big government was bad.

So was Lehman Brothers.  So was George Bush, when he took days to come to New Orleans after Katrina.  Big government includes Congress, so by deduction, those Congressmen have just stated they are bad.  Why don’t they resign, and let somebody who actually has a testable solution fill the seat?  I’d even move out of Eugene to a place where I could do that.  Even Texas, if I could have Ted Cruz’s seat. Here’s mine.  It doesn’t say “shut down the government”.

We can improve the situation to the homeless and end hunger.  I’m not talking food stamps here.  I’m talking about feeding the hungry who have virtually no place to take their groceries.  This thought doesn’t sit well with many, because we might be feeding a slacker for free, somebody who ought to get off his duff and find a job.  Sure.  Good luck in finding a job without connections.  I read the papers about how to interview, and somebody who doesn’t shower, has no experience, no recommendations, and had to drop out of school and out of sight, is not likely to land a great job.  Most of these people don’t have people skills.  I don’t either, which is one of the reasons I failed as a consultant, even when I paid a coach, who was no help at all. I was fortunate enough to have worked hard and had a career as a physician, otherwise I’d be in Whoville.

But a few might have people and other skills.  I would bet money on that, if one had a sign detailing a Mission Statement and Rules.  Given enough food, some of these people might start looking for work, looking for a way out of Whoville, a way to a better life.  If saving one child with leukemia is important, is not saving one homeless person from continued homelessness important?  Leukemia was once untreatable; much of it now is not only treatable but curable.  Some of the homeless are there because of medical costs.  Now, we are talking money, something we can print.  Sure, that is inflationary, but this is a lot easier than finding something better than vinblastine for Acute Lymphoblastic Leukemia.

Lane County wants to eradicate hunger, and we can do this as a country.  Nobody in America should want from food.  Affordable housing is tough, because these people don’t have great skills in keeping homes clean, although I’ve seen plenty of neighborhoods that aren’t exactly stellar, either.

I hope the Whoville stays.  It changed how I thought about the homeless, and it puts a face on a lot of people that are faceless in America today.

Want to do something really radical?  Let’s take these people off the street and put them on the street, the highways and byways of America.  Let’s house them and teach them how to fix bridges, build roads, fix the deteriorating infrastructure of the country.  Let’s put them in the national parks, helping build trails and repair others.  Let’s put them with animals, in the humane societies of this country, because love of animals is a good thing for both the animal and the people.

Come to think of it, let’s require mandatory national service, so that everybody ought to serve the country that has given them so much.  I assume every flag waver does know what red, white, and blue stands for, but in case I am again wrong, which they love to say I am, the flag colors stand for courage, honor and justice.

Are some beyond saving?  Probably.  Are all beyond saving?  No, not at all.  It is a question of what America will become, and what we Americans decide.  At Market of Choice in Eugene there is a way to donate each time to eradicate hunger in one of the more than 3000 counties in the US.  It’s a small county in the 9th largest state.  To the City Council:  let’s keep the Whovilles, until we don’t need them, because we have found a solution.  Let’s show the nation that we are trying, because anything less is wrong.

To Rand, Ted, Rush, and the others.  That’s my testable solution.  I am waiting for yours, which would prove to me you have some courage, honor, and a sense of justice, rather than cowardly saying no, turning your back on millions of Americans, and as a lawyer, Mr. Cruz, a disturbing sense of what justice means.  Be sure to go to church next Sunday.

PART D MEDICARE. FIRST TEST: GRADE D.

December 4, 2013

I apologize to those waiting at Wal-Mart on Wetmore for their prescriptions, while I was on the phone tying up one of the pharmacists.  I know I was inconveniencing you, because she eventually said she had a long line of people waiting, so I got off the phone, in order to give her time.

What happened?  Bad system.

Why?  Good question, and easy to answer, because in large part, nobody in Tucson listened to me when as medical director of a hospital, I said we had to fix bad systems, not punish bad people.  Since then, bad systems helped speed the demise of both my parents and affect every other member of my small family’s medical care. I’ve been through all of that in prior posts: I will stick only to the current problem.

I am on Medicare and needed to sign up for Part D drug benefits. I went online and decided to do it through Humana, which meant Wal-Mart and not CVS.  OK, no problem.  I can drive, rather than walk, to get my medications.

On the Web site where I went, it asked for what year.  I checked 2014, since I wasn’t interested in 2013.  I MADE A MISTAKE.  Or did I?  I was born in December, so I went on Medicare on 1 December.  I needed to sign up for a 2013 plan (December), then sign up for a 2014 plan.  I am quite certain this was not made clear.  The broker whom I used for my supplemental did not make this clear at all.  I am certain of that.  I was told it would be “easy to do”.  What I was not told was, “You have to take care of 2013 before you do 2014.”

Watch what happened.

I signed up for 2014, and I got a lot of paper with an ID card for my 2014 plan.  In the paper, which I try to read,  I learned my drug plan began 1/1/2014, so I said, “Uh oh.  I need coverage for December.”  I could have just paid for it on my own, since I take very few prescription medicines, but that assumes I stay healthy in December and not need a lot of high powered drugs for a ruptured bowel, a traffic accident when I drive to Oregon, or a host of other possibilities.

I called Humana.  I was transferred four times, the fourth back to the original person.  I finally had to explain to them clearly that I was a first time user and not changing my plan.  This is a problem I find far too often in this country.  There is an implicit assumption made, whether it is your car getting fixed or having major surgery, that each person innately understands the key vocabulary.  I did not say the right words, which were, “I am NEW to Medicare.”  That cost me about 20 of the 66 minutes I would spend on the phone.  I explained diagnoses to people.  I explained treatments.  Whether people listened was another matter.  Back then, there were a lot of complaints about how long doctors let patients talk (18 seconds) before interrupting.  I never heard how long patients let ME talk, before interrupting (5-10 seconds).

The next 25 minutes were spent giving out all my personal information, which at least was easy to do.  That led to the last 21 minutes, which was a “phone signature,” which I had never done before.  I have seen 14 total solar eclipses, traveled to 48 countries, published 60 articles, and am well on my way to being bilingual, but I do not know what a phone signature is.  Eventually, that was explained, and I hoped that the telephone system would not crash the whole time I heard a lot of words and had to remember to say “yes” after the prompt.  Starting over was not an option.  I then was accepted, and got the 2013 paperwork, which I added to the 2014 paperwork.

Later, I got another call, this time from Cincinnati, Humana’s headquarters.  Because I had signed up for 2013, now my 2014 plan was invalid, so I had to reapply for 2014.  That was easy, since I had done it before.  The one good thing was that I had a telephone number to call if I had trouble.  I had no trouble.  Why I kept the phone number, I don’t know, but I often save things, although I have trouble finding them later.  Again, I will be sent the same volume of 2014 paper coming, because I originally signed up for it.  This country runs on paper.

On the first of December, I took to the pharmacy the letter that later arrived from Humana, which explicitly stated I had coverage.  The pharmacist at Wal-Mart was efficient, and I inconvenienced virtually nobody.  I was set to get my first Medicare prescription on the sixth.

On the third, I got a call from Wal-Mart, saying my prescription was not ready, for I was not in the system.

I didn’t get incensed.  I was mostly disappointed in that I couldn’t find all the necessary pieces of paper. I thought computerization was going to do away with paper; it has increased it vastly, until recently, when with great fanfare companies send electronic prospectuses and tout how many trees they are saving. I think a prospectus ought to be limited to the following: “we can take all your money, and there is nothing you can do about it.”  But back to Wal-Mart, where I’m keeping people waiting.

I gave all the numbers I needed to, but there was still a problem.  As I saw it, once I cancelled 2014, somewhere in the system 2013 was cancelled, too.  At that point, the pharmacist begged off to serve other people.  I didn’t blame her.  Had I been waiting, I would have been annoyed, too.  Sorry, folks.

Somewhere, in the pile of paper, I got lucky and \found the number in Cincinnati.  I called the woman, told her my problem, and she said I was in the system.  So, I can only think that Wal-Mart hadn’t called.  I can’t think of another reason.  I called Wal-Mart back and gave them the number in Cincinnati.  This at least will save the pharmacist time, since the person (1) will know about me and (2) will assure her that I am in the system.

I have to hope the two of them don’t comment on what a bastard I was to deal with over the phone, a retired physician, whom nobody listened to when he discussed broken systems, a bitter old man, but one who WAS ultimately right, who ONCE again had to find the short term fix.

Welcome to American medicine.  Part D, by the way, is not Mr. Obama’s fault.