Archive for the ‘MY WRITING’ Category

HENLINE

August 8, 2014

My wife thought I shouldn’t drive her to the airport; she would take the 5:30 a.m.shuttle instead.  I offered, because she could sleep longer and then sleep in the car.  She countered that she could sleep in the shuttle.  I took her anyway.

I was just rationalizing my desire to climb Mt. Henline in the Opal Creek Wilderness.

Coming back from the airport, I would go through Salem and detour to the southeast, eventually reaching the trailhead.  I had this trip planned as soon as I knew she was flying out of Portland.  I would enter the Opal Creek Wilderness, about 32 square miles, one of the nearly 700 wilderness areas that comprise about 5% of the US.  Call me selfish, but this was a place I wanted to hike, and coming back from Portland made it easier.

Only six states have no wilderness.  I’ve been in the largest, the Noatak-Gates of the Arctic contiguous wilderness, about 10,000 square miles, a tad smaller than Massachusetts. Imagine, Massachusetts with no cities, no roads, and no people, except for transient visitors.

Opal Creek is sacred ground.  The largest uncut forest in Oregon is here.  It was saved from the chain saws and the lumber mills, and it has only three trailheads from the road.  I took the one up the mountain, now my fourth of the 49 wilderness areas in Oregon I’ve visited in my four months here:  Cummins Creek, Three Sisters, and Mt. Jefferson are the others.  I have a lot of places to see.

Wilderness is not off limits to people, but mechanized travel and chain saws are not allowed.  I spent a summer volunteering in the Boundary Waters Canoe Area Wilderness, and every bit of sawing we did was with a two man.  If the national parks are the crown jewels of the nation, which I think they are, the wilderness areas are kept in a safety deposit box.  If one is lucky, a key is made available for one to enter these areas.  Such areas may be busy, as is the Boundary Waters in August.

Henline, however, had nobody.  I was alone.

I started up the trail in a true natural forest, quickly becoming wet from sweat and fog, from the prior two days’ rain.  I climbed 850 feet per mile for the first two miles.  Fortunately, the trail was good, except for some rock slides I crossed.  I could hear rocks fall occasionally, witness to the nature’s constant change, slow but continuous.  At the top of the main climb was where an old lookout once stood.  Through breaks in the fog, I could see forest:  uncut forest, forest the way it once was, and still ought to be in many places.  Yes, logging creates jobs, but now one person can do the work that many others used to have to do.  Trees create paper, which we waste on things like false financial statements that almost brought down the world.

 

Rockpile in fog

Rockpile in fog

But I wasn’t having those thoughts.  I was thinking how alone I was.  No, today I would not have a view of the Cascades.  I didn’t need one.  In fog, I felt part of the place, part of the forest, part of the world I inhabited for the day only. I felt like I belonged.  I heard no cars, saw nobody, and imagined what it must have been like for the pioneers trying to get through this forest, in valleys where rivers ran unchecked, from the Cascades to the tidewater flats at the ocean, rivers called Santiam, Alsea, Siuslaw, Umpqua, and Rogue.

The summit was about another mile from the lookout, and Sullivan’s book mentioned it had no views.  Well, no views, no matter.  I was going anyway.  The trail went up and down, and some of the areas along a knife-like ridge were a little hairy.  Fall here, and nobody is going to find you for a while.  I’ve thought of that a lot at Cummins Creek.  Go into the middle of that place, and you are going to be where nobody has been in a long, long time.  Everybody would do well to have that experience from time to time.  It changes one’s perspective.

Trail in fog.

Trail in fog.

The summit was where the trail stopped.  I walked around it a little while and then returned to the former lookout, where I had lunch.  I just sat there, thinking.  I didn’t think about much, just fiddled around and did the things one does in the wilderness.  Finally, I decided it was time to leave, so I went down the trail, carefully negotiating the rock slides, to the car.  Leaving no litter and no trace was turning the key back in to Mother Nature, so the safety deposit box was locked.  There would be other visitors tomorrow or the next day, for sure; the trail had been well used.  Go into places like Cummins Creek, however, and one finds places where the trail is not very evident.  That’s good. I’d like to camp there some time.  It’d be quiet.

I eventually drove back out to the freeway and home.  I felt a little special.  Nobody on the road likely had any idea what I had done today.  I had gone into a wilderness area.  Other than a few footprints, nobody knew I was there.

This doesn’t happen every day.  Shame it doesn’t.

 

View from ridge

View from ridge

One of many rockfalls

One of many rockfalls

Simple sign for a special place

Simple sign for a special place

WHEN AGE DOES AND DOESN’T MATTER

August 3, 2014

“Hardesty Hardcore,” intrigued me: an annual loop race through 3 trails in the Cascade foothills, open to anybody, with a 4 hour time cut off.  The route is 14 miles and begins with a 3000 foot climb in the first 4.5 miles.  I had hiked it once in the opposite direction, without hurrying,  in 5 hours, with a lunch stop. I thought I could do it in four, so I went out to try.  I am in good hiking shape, having hiked nearly 40 times in Oregon the past 4 months and frequently climbing well over a thousand feet, occasionally over two thousand.

I started by walking fast—too fast— becoming slightly short of breath and uncomfortable.  I slowed, and finished the initial climb in 1 hour 36 minutes.  That is pretty good for a guy my age, but at that pace I wasn’t going to finish in 4 hours, either.

I came down Eula Ridge, much steeper, so I had to watch my foot placement.  I finished that stretch two 2 hours and 45 minutes in, averaging 3.1 miles per hour, well below 3.5 mph I needed to average to make the cutoff.  The last 5.5 miles was on a trail between the two, but not at all flat; it climbed another 1000 feet, difficult on a humid day, when I had finished my water and food.  I got in just under 4 1/2 hours.

With cooler weather, an earlier start, a lighter pack, and running shoes for the last part, I might be able to make the cut.  But I don’t want to race.  I’m not sure I want to subject myself again to that stress, despite being in excellent hiking shape.  I am good but not great.  The fact that I can walk uphill on a 30% grade at 2.5 mph is nice, but I need to average 4 mph for this race, and I am not likely to do it:  I’m too old, but more importantly, it doesn’t matter.

When I was in my 30s, I got in a canoe, bound for lakes and portages I had never seen.  I camped in some of the most beautiful country imaginable, woke early, paddled hard the whole day, camped late.  I could carry pack and canoe together, and I never got sore.  Seeing the country mattered.

In my 40s, I did the same, the only difference being that I took anti-inflammatories before and after each day’s paddle.   For the first time, however, I had a neck problem, a pinched nerve, but that subsided, and I was able to continue.

In my 50s, I stopped carrying a canoe and a pack simultaneously.  I had nothing to prove and a lot I could hurt.  I started base camping, which I liked, but I still enjoyed seeing new territory.  I didn’t go as far as formerly, but I enjoyed practically every mile.

 

Agnes Lake, on my last trip into Kawnipi Lake, Quetico Provincial Park, 2005, age 56.

Agnes Lake, on my last trip into Kawnipi Lake, Quetico Provincial Park, 2005, age 56.  I have not been back.  I do not expect to see Kawnipi again.  It mattered that I saw it that year.  Agnes?  Seeing this picture makes me wonder….

 

Kawnipi Lake, 2005.  The most beautiful lake in the Quetico to many people. I have been there six times.  That matters.

Kawnipi Lake, 2005. The most beautiful lake in the Quetico to many people. I have been there six times. That matters.

 

 

Lake Insula sunset.  Having spent more than 30 nights on this beautiful lake matters.

Lake Insula sunset. Having spent more than 30 nights on this beautiful lake matters.

In my 60s, things have changed.  Many tell me that age is a number.  Those people who do are always younger than I, where one believes that the world will continue unchanged.  I still can solo trip, but I do it and base camp.

Sunset on my bay campsite, September 2013, solo.  Age 64.

Sunset on my bay campsite, September 2013, solo. Age 64.

 

I can make the miles if I have to, but I don’t feel the pressure to do so, either.  It doesn’t matter.  The year I turned 60, my wife and I aborted the first day’s paddle into Lake Insula, one we could normally do in 7 hours, where 40 year-olds we had spoken to said they needed three days.  We aborted the paddle in because of heavy rain.  We stopped, pitched the tent and stayed comfortable. Making Insula that day in 7 hours didn’t matter.  We made it easily the next day.  It was a great trip.

Twenty years earlier, I would have bulled on through.  Indeed, over our 25th wedding anniversary, we paddled 110 miles in 11 days with a day of rest.  One day, I portaged a canoe 15 times, a record for me.  Those trips mattered.

What will happen the next decade, if I make it that far?  I don’t know.  Perhaps the distance may stay the same, if my arms and legs are still working well, but I suspect it will decrease, and it won’t matter.  I still hope to be in the woods, away from people, enjoying the quiet, the Pileated Woodpecker’s crossing the lake by the campsite, loons, sunrise, sunset, and full Moon.

What about backpacking?  There, the clock ticks louder.  As I write this, I will soon leave for my sixth multi-day trip to the Brooks Range.  On my fifth, I carried 75 pounds with difficulty, but I did it.  I wasn’t sure I would do a sixth.  But then you see there was this trip offered to the Wulik Mountains in the far west Brooks, country I hadn’t seen, wonderful, wild country, and maybe I had one more trip in me after all.  Or two more, since I want to see ANWR’s Sheenjek’s River drainage.  Each year, backpacking requires more training.  Six weeks prior, I start carrying 25 pounds around the neighborhood, then 35, the 50, and finally 60.  This year, after hiking a lot more in spring, I started at 50 pounds, and I’ve carried that weight the past month.  I can comfortably walk 3 miles with it, essential if I want to complete the trip and enjoy it.  Ten years ago, I didn’t need to train.  Now I do.

Arrigetch Peaks on my way out of the area, August 2007, age 58

Arrigetch Peaks on my way out of the area, August 2007, age 58.  It mattered that I see these peaks, which had fascinated me for decades.

Dall Sheep, Aichilik River, ANWR, June, 2009.  Age 60. This afternoon mattered.

Dall Sheep, Aichilik River, ANWR, June, 2009. Age 60. This afternoon mattered.

Cubs, Noatak River campsite, August 2010, age 61. This day mattered

Cubs, Noatak River campsite, August 2010, age 61. This day mattered

 

Fording the Noatak, August 8, 2010. Age 61.  My guide said that day, "I hope I can do this when I am 61."  He was 51.

Fording the Noatak, August 8, 2010. Age 61. My guide said that day, “I hope I can do this when I am 61.” He was 51.

Gates of the Arctic, 2012, carrying 75 pounds.  This trip mattered. Age 63

Gates of the Arctic, 2012, carrying 75 pounds. This trip mattered. Age 63

My body isn’t betraying me, but changing, and my brain with its desires is fortunately changing, too.  I rely more upon experience than brute strength.  I read the weather well, pack dry in a pouring rain without leaving the tent, then striking the tent and quickly finish, putting the pack cover on a dry pack.  Alaska just is, with a lot of rain, mosquitoes and tussocks.  Fortunately, I know how to hike there.  That itself is probably worth 25 years of age.

My guess is that I will slow down in the next decade but will still enjoy what I do.  I look back fondly on the times when I was really good, especially the difficult trips, for that is what one remembers.  Age does matter.  I am grateful for what I can do, hope I will like it just as much during the coming changes, as I add more to my wonderful wilderness portfolio.

You see, I feel blessed.  Not a lot of guys my age can hike the Hardesty Loop.  I did it for time.  That’s pretty cool.  The fact I tried did matter.

It only hurt a little that night.

TIME TO TEACH ABOUT MONEY

July 28, 2014

I saw a Dave Ramsey quotation: “Identify your motivation and your passion.  Find what you’re good at and become world-class in that area.”

The term “world class” is overused, and I think harmful, making average people like me feel they are failures.  Indeed, most of us are average.  World class should apply to Olympians, bicycle riders in Le Tour de France, Nobel laureates, best seller writers, and those young people who competed at the IAAF Track Meet I saw today, a few young people who truly are at the top of what they do.

Mr. Ramsey would have done well to have removed the words and replaced them with something like “the best you can possibly be”.  That is achievable.  World class is not.  In standardized math tests when I was young, I was at the 99th percentile.  That is fine, except that if there were 10 million students, 100,000 of them were as good or better than I, making me hardly world class.

Where Mr. Ramsey does help is with people who hate their jobs and are poor.  Suze Orman does the same thing.  Both are good; both are rich; both are famous and charismatic.  It would be nice to be charismatic, but one has to have the wiring.  It isn’t in me.  What I am wired for, however, is math, and I am very opinionated about what we ought to be doing about it.

Key issues today are student loans, houses underwater, insufficient retirement savings, and too many having to live on Social Security, which it was never intended to do.  A frightening number of people go bankrupt each year, because we have a subpar health insurance and medical care system in this country.  Very few hospitals are “world class,” and saying “Centers of Excellence” does not bring it.  Having been on the medical quality front lines, I think I have a notion of what world class might mean, and we are a long, long way from there at the moment.  But we can address the financial issues that people face.

We ought to be starting early, in the schools.  That won’t cure the problem, but in a generation or two, it would help a lot.  Dealing with finances means dealing with ….uh oh…..numbers and math.  Yes.  If one cannot understand numbers and math, basic math, there is no way one can understand finance.  This means that students must be held back from moving to the next grade until they understand the math necessary for the current grade level.  If that means that we slow down education to a crawl, and people howl, then let it be so.  Let’s do it right, learning one basic lesson of math right away:  if you grade children and adults on certain measures, there will be attempts to game the system and make the person or school look good.  This happened in Atlanta.  If 80% of the students coming to a local community college, which happened in Tucson, have to take remedial math, what exactly were we—and they and their parents— doing for the prior 12 years?

It is time to be honest with math (and other subjects, too).  If students can’t pass basic arithmetic, let’s figure out how to get them to learn enough to pass, not game the system, from the teacher’s side and not play “how clever can I be?” from the tester’s side.  Certainly, we ought to have enough smart people in academics who know what should be mastered at each grade level.  Students are going to need algebra and geometry, too, but basic arithmetic is absolutely fundamental to understanding algebra, and math builds on itself.  Fail at the bottom, and there is no way anybody is going to suddenly jump to the top.  Other subjects build, too, but few as strongly as does math.

What good does it talk about an emergency fund of $1000, if the concept of a thousand is not understood?  Indeed, one of the big problems we face in this country is that few in Congress can comprehend what a billion or trillion is.  Comprehension of these numbers is not easy, but it is both essential to know and may be learned.

Students need to learn about interest, where the formulas come from, then simple rules for remembering them.  Trust me, one will use it.  They need to learn the difference between “the rate of increase” is slowing and “it is decreasing”.  These two are not understood by the majority of students I have taught.  They need to know the difference between an average and a median. They MUST be able to work with multiplication tables automatically.  This cannot be given over to a calculator or be googled.  One has to memorize it.  Learn something well, and it is no longer memorized.  It becomes innate.

I don’t have the answers to learning math.  I do know, however, one place where math would become interesting to students and worthwhile: dealing with finance.  Everybody wants money.  Everybody wants things.  Dealing with money requires dealing with numbers.  Frankly, if we could teach children enough math so that they could deal with basic finance, we’d be way ahead of the concepts we think we should be teaching them.  I could live without teaching many kids algebra if they knew enough division that they knew that 24% interest rates on credit cards led to doubling of debt in 3 years.   If they could multiply by 52, they could figure out how much money they spend annually by eating out once a week.  If they could multiply by $2000, they would know what dollars per hour wages equalled in a year.

This isn’t and should not be America’s goal for teaching math in the 21st century.  We have to go far beyond what I have stated.  But if the millions of kids who can’t make change, can’t comparison shop, don’t know what a mortgage is, or understand the basics of investment can learn to deal with these matters, even on a rudimentary level, we would be a lot better off than we are today.  I would rather see an improvement for millions than wait for perfection that will never come.  No, Mr. Ramsey, these millions aren’t anywhere near world class.  They just need to pass the class of basic material THAT EVERY CITIZEN SHOULD KNOW.

Want kids to understand math?  They need to work with, and understand, numbers.  To me, the best place to start is with finance.

SADLY, FACEBOOK IS NOT FACE-TO-FACE

July 21, 2014

I read a post in Facebook saying that doctors hid cures in order to make money.  I posted back:  “How dare you!!  I practiced for 20 years and wanted nothing more than to see a cure for the stream of patients with headaches, backaches, limb pain, dizziness, Workmen’s Compensation cases and depression (back when depression, a treatable disease, was not a mainstream diagnosis, and people equated the disorder with being crazy).  I actively de-marketed my practice.  Yes, I wanted to see fewer patients.”

Then, I deleted the post.

The two best things I’ve done on Facebook are:

1.  Been silent.

2.  Deleted a post shortly after I wrote it.

Over time, I have seen people disappear from Facebook for a month or so, a so-called “digital vacation”.  The idea is tempting, and with a trip to Alaska coming in the near future, I may just add a couple of weeks to my disappearance.

Facebook has been helpful in that it has allowed me to know about the few family members I have left.  I know about my nieces, whom I would otherwise not, and I connected with a camp where I guided canoe trips in 1967.  The late Steve Pawlowski, whom I unfortunately never met in person, was part of the Arizona Water Sentinels; his posts about the drought in the West and climate in general were excellent.

Unfortunately, there is a great deal of other stuff I have seen on Facebook which doesn’t sit well with me.  I’m sure some of my posts don’t sit well with others.  Research has shown that looking for certain posts can be beneficial, but “Facebook surfing” is correlated with depression. That is my impression.

Each of us approaches Facebook differently.  The attitudes of others aren’t necessarily wrong; however, they are not likely to be consonant with mine. I don’t, for example, agree with all the “fluff” sayings I see, like if one just tries hard enough, one can succeed at anything.  Indeed, I find that cruel, for it implies that if one fails, he just didn’t try hard enough.  It ignores the possibility that maybe one was not suited for the task, did not have the physical or mental ability, or could not devote his entire life to the task.  For me, wisdom is knowing when to quit, to give up, to stop.  Some disagree.  Having failed to change medicine after five years didn’t make me want to continue a sixth.  I found that a wise decision.

The lack of face-to-face interaction, ironic for the name “Facebook,” allows people to easily insult others, the young to insult the old, which I find rude, and to post comments I find reprehensible, racist, in bad taste, ignorant, and poorly written.  People don’t ask themselves, “Do I really want to say that in public?”   Face-to-face, many of these posts would not be said.  De facto anonymity is on Facebook; a third of my “friends” I have never and will never see; most of the others I will not see in the next year.

The worst posts, the most depressing, have been clips from right-wing news sources.  It took me too long to figure out that I could selectively block these sites and still see other posts from the rational side of the poster.  Facebook for many is an outlet for spiteful comments directed towards people who view the world the way I do:  I see posts on politics that may or may not be true, comments written by Americans who are either ignorant of the English language or don’t proofread what they write.  If something bad happens, it is my fault, or “the government’s fault” (the Democratic Party part, that is), showing lack of awareness that we are the government; any of us can run for office to fix things.  People I have never heard of and never will meet say astoundingly horrible things.  An American Mormon posted, “we ought to nuke all of Mexico.”  Wow, that is really godly behavior.  On a language web site, an Algerian saw my profile and told me it was a shame that as a non-Muslim, I would be going to hell.  Both would have done well to be silent.  I was.

Two young women, each a third my age, who insulted me got no rejoinder, only permanent silence.  Defriending is too strong and noticeable.  Silence is…..silence.

Many of these posts and comments deserve to be called out on their nastiness, spite, vitriol, and outright falsehood or looseness with the truth. But what’s the point?  Those who post these “news” items will not be influenced by anything I write.  They see their posts as truth, espousing simple solutions to complex problems, getting many “likes” from similar-minded people.

I am at a disadvantage in answering, because I process slowly, writing better when I have time to think about what I say, before I allow others to read it.  Many would do well to follow my example.  There is no sense becoming embroiled in a climate change debate with one who believes that everything is fine, that it is a plot by environmentalists, uses poor or no statistical evidence, and makes no predictions as to what will happen in the near future.  I won’t influence them.  I am capable of being influenced, but not by unscientific, hateful comments.

The best comments are short; long missives aren’t going to be read, any more than a bumper sticker on a car that tries to say too much will be.

Shortness works on Facebook.  Humor works.  Well written comments work.  Silence works really well.  I’ll make my posts here, because I have as much time as I need to try to say what I want.  Even then, I won’t always get it right.

 

NOT WHAT WE WANT TO HEAR

July 14, 2014

Years ago, soon after I began practicing, a colleague brought his wife to see me.  After a workup, I diagnosed her with probable MS.  About a month later, the colleague somewhat gleefully called, telling me he had his wife seen at University Hospital by an expert, who felt she did not have MS.  I don’t remember my reply.  I probably was quiet, concerned I had erred.

At a medical meeting dinner, years later, this same colleague was seated at the same table as I, and he told someone aloud about his wife’s treatment at UCLA for “MS.”  I stayed quiet; he didn’t show any sign of having made a faux pas. I was wise enough not to remind him. Being right doesn’t require one to say it.  My mistake that first day?  I told both of them what I thought was wrong, not what they wanted to hear.

Ted Cruz said the President was acting outside the law on immigration, when in fact Mr. Obama’s actions are in accordance with a 2008 law, signed by Mr. Bush, requiring deportations from countries other than Canada and Mexico to be processed here.  The Central American refugees came through not only a hole in the border but a hole in a law Mr. Cruz and his colleagues are in charge of making.  Mr. Boehner won’t move any law on immigration through this year.  He has the power to do something great, but he won’t.

DML News tells listeners what they want to hear: “we’re screwed,” bad immigration stories, things wrong in Washington, nuclear material missing, how Obama is destroying the country and wasn’t born here (which has become really tiresome), Benghazi an impeachable offense, and we should take action in Iraq.  The big problem in Iraq didn’t happen this year; it happened when we invaded it.  Remember Colin Powell’s “Pottery Barn” comment?  Remember the horrible year, 2006?  No, that is ancient history, and people don’t like to hear about inconvenient history.

Mr. Obama inherited two wars, an economy in shambles, a banking system almost shut down, an incipient depression, a horrible deficit (the war funding was kept off budget) and a divided Congress.  If one doesn’t want to hear that, I’m telling it anyway, because I tell people what I think, if it is truthful.  Surprise:  Obama hasn’t fixed everything yet.   Surprise:  He has had nearly zero Republican support.  If Ted Cruz or Rick Perry becomes President, by golly, we will have everything fixed and right with America in 100 days, max.

To those who believe that, please comment in detail exactly what needs to be done, and send to me, because I‘m curious.  Please address the following: how we will balance the budget, give every American health insurance, deal with immigration, the EU, Iraq, Iran, Palestine, North Korea, Russia, China, fix infrastructure, schools, and climate. I want details.  Please, tell me how we should deal with California’s water crisis using knowledge of what an acre foot is.  In this blog, I have addressed the budget, Iraq, schools, climate, and California’s water crisis.  It isn’t what a lot of people want to hear.  I may be wrong, but I used facts and offered detailed suggestions.  An acre foot is about 325 K gallons of water, by the way.

People don’t want to hear about climate change, because it bothers them.  People want politicians to tell the truth, until they do, and then vote for the opponent, because the truth is so unappealing.  The world is not simply a matter of US troops fixing what is wrong.  Superheroes don’t exist.  We cut FEMA to save money but then complained when government wasn’t immediately present after Katrina.  Remember Katrina?   Remember Sandy?  Who was president during each, how was the response and in what year did each occur?  If you are an American and can’t answer at least 7 of those 8 questions, shame.

Tell me how we fix unfairness that gives the Deep South more government money than they send, yet has taken a trillion dollars from New York State in the last 20 years.  Yes.  Look it up.  Incredibly, the South gets money from big government, hates same, and many of its states rank 45th or below in major health care indicators compared to the rest of the country.  What gives?

We live in a complex world, unable to be simplified in 30 seconds.  Immigration is no exception. I think overpopulation is the most significant issue we face, along with consequential environmental degradation and climate change.  In my lifetime, not likely to be more than a decade or two, I will survive. People, like Ted Cruz, in their 40s, are going to reap the wind they have helped sow.

I am a strong believer in public education, not only because people with education get good jobs, they have fewer children.  Complex problems are not addressed with simple answers: it is easy for Mssrs. Flake and Cruz, who don’t have to run the country, tell people what they want to hear.  Like my doctor colleague, they blast guys like me who conclude something else.  You are wrong, they say, and yes, I might be, words not one of them has used.  I have been right on evolution, climate change, the stock market bubble and Iraq, not because I am particularly brilliant, but because my education taught me to think about issues, open my mind, look at all sides, and draw conclusions, which subsequently I may change.  

We need good ideas about immigration; we need skilled workers who are legally here.  The 2008 law needs to be changed, and Mr. Cruz should be leading, not using his charisma and debating ability to tell people what they want to hear.  We must deal with illegal immigration, not win a debate, and there is no perfect solution.  Nobody wants to hear that.  Nobody is even saying it.

Nobody can balance the budget or pay for everything we want without raising taxes.  This is a mathematical truism.  Instead, politicians tell us what we want to hear:  “I will protect America’s elderly and borders, we will have a strong military, and I will do it without raising taxes.”  If we believe that, we are either downright stupid or believe in magical thinking.

I was sorry the woman had MS.  I was sorry for all the families to whom I told a loved one was either brain dead or irreversibly brain injured.  I am sorry for the people whom I told had metastatic cancer to the brain or carcinomatous meningitis.  I told the truth.  Many of my colleagues disliked me, for I said things that people didn’t want to hear.  Many referred patients elsewhere, not to me.

What interested me was that a dozen of these physicians—I counted— brought themselves or their family members to me, even though they sent neurological consults to the other guy.

 

OBSIDIAN LOOP 3 JULY 2014

July 8, 2014

I’m now out alone in a huge expanse of snow, cliffs to my south and east, South Sister towering 1500 meters, about a mile, above me, and only my tracks behind me to tell where I had been.  I had turned around about 50 yards ahead, stood there, wondering.  “Do I go back?  Or do I go on, and see what happens.”

“Obsidian Trail Loop, July 4” was posted on the Obsidians Web Site.  That was what I had been looking for, but there was a waiting list, since I was the 16th to sign up, and only 12 could go.  Since the hike was scheduled for the fourth, I figured I could go the third.  A club member was going with me, but when she called the Ranger’s Office, were told there was “serious snow” 3 miles in and there were so many mosquitoes, they would chase a person back to the car.  I was on my own, updates were 1-2 weeks old, which in the high country, are ancient history.  Snow accumulates and disappears quickly at 6000 feet in the Cascades.

I decided to do the hike, realizing that if I couldn’t do the 4 mile loop (with an additional 4 miles in and out) gaining 1800 feet, there were other places I could go to hike.  As I left Eugene, bound for the high country, a dark wall of clouds and fog were ahead of me, about where I would be.  This did not bode well.  I kept going, turned on Highway 242, soon was past 2000 feet.  There was fog above me, and I figured by 3000 feet I would be in it.

Fog below in the McKenzie Valley.

Fog below in the McKenzie Valley.

 

The road narrowed and climbed, and suddenly I was in sunlight.  So much for the fog, which now lay below me in the valley.  I got to the road in to the trailhead, which two weeks earlier had a 3 foot high snowdrift blocking it.  The snow was not only gone but the road dry.  I parked the car, shouldered my pack, and turned on my GPS.

I am new to GPS.  I have had one 20 years for marking points, but I never used one with a trail marker before, and I had loaded mine with high definition topographical maps of Oregon and Washington.  Those came on a mini-SD disk, a few mm on a side.  I can’t believe how much memory we can put on small objects.

I had on gaiters to keep water and snow out of my boots, so long as I was in fewer than 18 inches.  I had a light shirt on, because I was climbing and knew I was going to be warm.  I had my day pack on with my nine essentials, a whistle still missing, and a few other things added.  On a warm day, most people don’t think a jacket is needed; should one get lost and have to spend a night out, having an extra waterproof layer is essential.  That has never happened to me, but it can.  It is insurance, and the premium is carrying it with me.  The first 2 miles were a gentle climb on a dry trail.  The third mile had a large series of snowdrifts, upon which I was able to walk on top.  No problem, and I reached the lava flow area.

 

Life grows in some of the most inhospitable places.

Life grows in some of the most inhospitable places.

 

 

First view of South Sister from lava field.

First view of South Sister from lava field.

 

After I got the above view, serious snow was on the trail, and I realized there was no more trail for me to see.  The Forest Service had placed orange ribbons on the trees, so from one tree, it was possible to see the next.  And this navigation got me uphill to about 6200 feet, 600 feet below where I would top out.

 

Orange ribbons to navigate by.

Orange ribbons to navigate by.

 

 

Open snow field

Open snow field

 

One man had come down the trail recently, and I followed his prints back up a steep hill,  switchbacking in snow, so that I could work less hard. This was not going to be easy.  It already hadn’t been, and if my Achilles Tendon still bothered me, I would have stopped.  But I felt fine.  I crossed a ridge and saw a gorgeous blue lake that was starting to melt.

Lake beginning to appear.

Lake beginning to appear.

I bypassed the lake and realized that my sense of direction was different from the GPS.  I was supposed to be on the “open” Pacific Crest Trail, but what looked like a trail was a creek with a lot of snow on it.  I started navigating on GPS, because now there were no footprints to follow, except those I had made leading back.  I was in a beautiful blinding white bowl of snow, somewhere in the middle of the Obsidian Loop.  I stopped by a tree which had no snow under it, heard a waterfall, and looked down at obsidian at my feet, beautiful black volcanic rock, that touched no water as it ascended to the Earth’s surface.  I picked up a piece and then dropped it,   leaving it where I found it, which is required in the wilderness.  The Trail here has a permit system, because there is so much use.  If each person takes one stone, in a few years, there will be fewer left.  Below me was Obsidian Falls, and I then realized my sense of direction had me on the wrong side.

Obsidian Falls

Obsidian Falls

 

 

Obsidian

Obsidian, lava that reaches the surface without touching water.

For the remainder of the loop, I seldom saw a trail, but the route tracker had me going by the trail, or at least near it.  Occasionally, I went into the woods, but the direction arrow had me clearly going the wrong way, and I had at one point to climb a rocky area to get back near the trail.  When I got near the end of the loop,I saw the trail about 50 feet below me, so I could slide down the now softer snow to reach it.  I knew from the stored track that I was close to where I had started the loop, and if necessary, I could walk over to my track.  But I continued, reaching the trail junction, not quite where the GPS said it would be, but close enough.  GPS accuracy is somewhere between 4 and 10 meters, depending upon satellite reception.  I then retraced my now familiar route back to the car.

Back in the lava field.

Back in the lava field.

 

A Sister.

A Sister.

I had wanted to see the loop, but I saw it without the summer wildflowers.  On the other hand, I saw the loop in a way few do—in snow, alone, and having to work much harder than expected.  I also learned how to trust my GPS, and I learned again other ways to navigate, should they be available.  What was perhaps the most important thing I learned was again not to “trust” my sense of direction.  It isn’t bad, but it can be very flawed, be it on the Appalachian Trail, the Canoe Country, or in the Oregon Cascades.  Using the Sun, when available, is helpful.  A compass is better.  A map is even better.  Knowing when to quit is important, and periodically asking oneself:  “Do I know exactly where I am?”  is essential.

 

PULLING UP THE FOOTBALL

July 4, 2014

In the famous Peanuts cartoon, Charlie Brown is running to kick the football, when Lucy pulls it up, and Charlie kicks at air, falling down.  Every time, he thinks the result will be different, and every time, he is wrong.  That is the famous definition of insanity.

So maybe I am insane.  I’m getting better, but it has taken me a long, long time to do so, because I still kick at air.

Last summer, I got a call from a younger alumnus from a canoe tripping camp that I attended in the ‘60s, both of us going to the camp’s reunion in August.  There was a special request to create a special endowment for this centennial year, and I planned to give.  I thought that was obvious, since I give financial support to young people who cannot afford the camp’s fees.

Yes, fifty years ago, I was in a select group of canoe trippers that canoed Temagami Provincial Park in northern Ontario.  It was a difficult trip; I still remember my knees hurting from kneeling in the bow in 2-3 foot waves.  We were never allowed to sit in the bow seat.  We knelt. In the stern, the staff man sat. To this day, if I am in the bow of a canoe, I kneel.  Every day on that trip it rained, but it was a good trip. We saw remote country, and while I never will see Temagami again, the memories of places called Lady Evelyn, Ostergut, Makobe, and Fat Man’s Misery Portage are part of me.  I have trod that country.

The caller was interested in my subsequent canoeing experience, and I gave him a brief rundown of my outdoor water resume:  the Nahanni, the upper Yukon Basin from Lake Bennett to Carmacks, the Alatna and Noatak Rivers in Alaska, and 32 years canoeing the Boundary Waters-Quetico.  I have been blessed.  The caller had canoed Labrador, which I thought cool, but he especially wanted to see my Nahanni pictures, a trip he had always wanted to do.

Yep, sooner or later, it came to money, and I told him I would contribute, as I had planned to.  The conversation ended soon afterwards, and I felt a little used, but hey, maybe he was busy, and we would learn at the reunion about each other’s trips.  Maybe. These things almost never pan out:  the call was about money, interspersed with feigned interest of what I had done.  People seldom call me curious about what I’ve done.  The calls are usually about money or medical advice.

I arrived a day early for the reunion in late August, back on a lake where I spent 6 summers, and I got to see the island, 46 years later, with relatively few people present.  The next day, the rest arrived; I was present at the dock where they came in.  I heard the name called of the individual who had phoned me, and I went over to introduce myself. He greeted me semi-warmly then saw somebody else he knew and disappeared.  For good.

The football had been pulled up.  I had the Nahanni slides with me, for we took slides in 1985.  I had lost the roll of film, wrote Parks Canada, saying it might be in the campground at Fort Simpson, where we had stayed on our last night.  Incredibly, six weeks later, the roll was sent to me.  Canadians do those sorts of things.  I had pictures of a remarkable area very few people will ever see.  After arriving at Fort Simpson, we flew to the Nahanni in a Twin Otter with 6 people and 3 canoes, landing on a sandbar.  The Nahanni was a difficult trip through Class III rapids, the worst mosquitoes I have ever seen—and I have seen more than most— but I saw the highest waterfall, Virginia Falls, in North America.  I paddled through four canyons almost as deep as the Grand Canyon itself, sat in some natural hot springs, came out on the Liard River and saw the great Mackenzie.  The Nahanni was pure wilderness.  It is the crown jewel of my outdoor water resume.

 

Virginia Falls, South Nahanni River, NWT, July, 1985.

Virginia Falls, South Nahanni River, NWT, July, 1985.

 

I should have known better than to bring the slides.  Getting money from me was the issue, not what I did or who I was.  I’ve felt that way a lot, these past 16 years, after I left medicine.  I give on my own terms to those I wish.  I do what I can, hope to make a difference, and wish some day one of my ideas will be accepted, improved, and have a significant impact.  I had many such ideas in medicine.  My wish to be a busier volunteer in the public schools has yet to be granted.  We ought to have paid universal mandatory national service, which would give young people a sense of purpose and direction, lessening the likelihood of student debt catastrophes.  We ought to be saving water every way possible.  We should ban companion animal breeding.  I have written about all of these in this blog.

We should have had incremental single payer medical care, starting with the very young.  This would have been easier, cheaper, and less likely to have been voted against.  We should have tracked a whole host of quality issues in medicine.  We need free, unbiased, end-of-life counseling to elderly people to help them understand what “all those tubes” mean, and what their options are.  By ignoring the elderly, we ignore elders, wasting resources I can’t begin to fathom.  In short, we need incremental changes, keeping both the enemies of change and the perfectionists at bay.

I wish I hadn’t brought the pictures of the Nahanni back up to the country where they were taken.  I knew he would not be interested, but I persevered, hoping, like Charlie Brown, it would matter. People are busy, too busy for guys like me.  I tried to travel light, and those pictures and his call were excess baggage.

But I was lucky.  I have seen the Nahanni, drunk the water, know what’s out there. There is no blank spot on my map.  While it’s on my resume, far more importantly, it is in my brain.  I can call it up any time I want:  the magnificent falls, Fourth through First Canyons, Pulpit Rock, and the Gate. Wow. I was there!  I got back up to the camp one last time, and I don’t ever need to go again.  I have taken my last look.  Yeah, the football was pulled up, but I had a soft landing.

It was his loss, not mine.  That line is in Peanuts, too.

OUTFOXED

June 30, 2014

A recent Fox News show claimed Minnesota was the first state to allow Sharia Law.  The reasoning included Somali cab drivers at MSP Airport, who refused to transport people who carried alcohol and a Muslim cashier at Walmart, who refused to handle bacon.  The latter was re-assigned.  The former?  Well, if a cab driver doesn’t want to take me, there are a lot of other cab drivers who would be more than happy to jump the queue.  We all must decide whether we are willing to take the financial consequences of our beliefs.

Assuming this is true, and given Fox, I would have liked to see this for myself, these are scare tactics, NOT news.  Sharia Law says that a nonbeliever must be put to death after first being allowed to convert to Islam and refusing.  I have been to Minnesota well over forty times, I have spent more than 300 nights in the state, and I haven’t even seen a mosque.  Fox plays on American fears of Muslims, the 25% who believe Mr. Obama is a Muslim (as if it mattered if he were), and Muslim beliefs.  Let’s look at a few of those beliefs: eschewing alcohol (like Mormons), not eating pork (like Jews), praying in hundreds (which every large Church does during its service).  Fox omits saying Islam requires charity outside of taxes, limits loan interest, which we would do well to adopt, believes in prayer as a time to reflect upon one’s life (doubt many do that), and fasting to remember how the poor feel. I respect these tenets, just as I respect many in Judaism and Christianity.  There is a lot of good in religion.  The Holy Books have beautiful passages.  The idea is good; the execution often is too good, using a different meaning of “execution”.

In other words, Fox News was cherry picking, and the cherries weren’t ripe to begin with.

Let me demolish the argument right now by going back to 1960, before most of the anchors were born.  John F. Kennedy was seeking to be the first Catholic President of the US.  Back then, people then said that if Kennedy were elected, the Pope would be making American policy.  Yes, I remember that.  We also know that the Pope did not make American policy.

Now, we have over 60 million Catholics in the US, our vice-president is one, and I didn’t hear anybody’s saying that an Argentinian (good heavens, a LATIN-AMERICAN) would order, from ITALY, of all places, Mr. Biden or 20% of our population what to do.  Fox missed the boat on that one.  Indeed, in the process of googling this, I saw a picture of women whose hair was covered, and thought they were Muslims.  They were NUNS. Why is it fine for a nun to cover her hair but not a Muslim woman who desires to do so?

This particular clip upset some.  One said the Somalis should “become Americans.”  What is that?  I think she meant waving the flag (even if you don’t look at it when the national anthem is played), have a yellow ribbon on your car (but never have served), go to a Christian Church every Sunday (but deny people who love each other the right to marry).  We have the right to believe what we wish in this country, no matter how detestable it may be.  They believe life begins at conception, have no idea how the fetus develops, but do not care about the baby’s welfare after birth, especially if a person of color.  The Declaration of Independence said all men are created equal, but didn’t say “physically equal”: some have bad genes and really rotten luck.  As a doctor, I saw many with horrific conditions, some preventable, most not.  How do we handle them?  By dismantling safety nets?

What is an American? Somebody who believes what Fox News says, or somebody who thinks about what they say and disagrees?  Somebody who believes food stamps should be outlawed because of an abuse story, yet thinks guns should be available despite very deadly countable daily abuse?  Food stamps have less fraud than Medicare. Illegal gun sales are common, not just anecdotes.

What is an American?  Somebody who thinks America right or wrong, but tosses litter out the window, or puts a box of kittens out in the desert?  Somebody who obeys laws they don’t like, or grazes cattle on public land without paying?  What is an American?  Is it prayer at public events, Christian prayer, that is, insulting non-Christians and non-believers, like me?  Who is “big government” we love to hate?  Do we hate ourselves?  WE ARE THE GOVERNMENT.  Would we demand government tell a Somali cab driver whom he should carry?  He has the right to refuse to serve a person.  Or do rights belong only to “native born” Americans?

Does being an American mean we need to start speaking and writing English better?  I’d welcome that.  Is it knowing American history?  Then why didn’t we learn from Vietnam and not attack another country in a part of the world that we have little understanding of?

Jews eat Kosher; their diets forbid pork, so I don’t see a problem with a Muslim who doesn’t want to touch pork.  I am vegetarian and don’t want to touch meat. The Native American Church is allowed to use peyote, otherwise illegal.  The Catholic Church uses wine, alcohol, in its services, forbidden by Islam.  Ironically, “blue laws,” which restrict the sale of alcohol on Sundays, affect me, although I neither abuse alcohol nor am a believer.  I have to obey religious doctrine in buying alcohol on Sunday.

How is a Somali’s refusal to transport alcohol Sharia Law?  Do we have Jewish, Catholic or Mormon Law in this country?  No, we have religious beliefs of many types, and we try to accommodate those beliefs.  The NCAA doesn’t make BYU play tournament games on Sunday.  Jews don’t work on their holy days, and we allow that.  Catholics celebrate Holy Week, most of of us Christmas.  Sharia Law?  No.  Are there women who wear the Hijab here?  Yes. Sikhs wear head coverings.  So do nuns.  What’s wrong with that?  At the last funeral I attended, the number of people wearing jeans appalled me.  And we worry about covering hair?  I’m ex-Navy, and I soon learned when one did and did not cover.  One salutes only when covered, not otherwise.  Sounds like covering the head is special.

People have strong beliefs.  I have mine, too, that one may read in the nearly three hundred posts here on the blog.  Some are perhaps irrational; others may appear to be but are not.  Decide for yourself this belief of mine:  Fox News promotes hatred and fear, is biased, too often appears in public places, and violates the interpretation of the First Amendment. There are limits to “free speech,” and Fox has crossed them.  If I am wrong on that, correct me.  Then try to convince me Fox is “fair and balanced.”

If my wife wears a cover in Minnesota, it is to protect against mosquitoes, not Sharia Law.

 

STUDENT-ATHLETES

June 17, 2014

At the recent Track and Field championship in Eugene, I heard numerous announcements and saw commercials on the big screen about “student athletes”. I don’t like big screen ads during competition, since it is distracting, and I doubt the money generated goes to help students in financial difficulty or to pay grad students better,

It appears the NCAA is pushing the term “Student athlete” vigorously, as former UCLA basketball star Ed O’Bannon is suing them about not receiving compensation for the NCAA’s use of pictures of former “student athletes”.  He was joined by Oscar Robertson, who puts Mr. O’Bannon in lofty company.  O’Bannon was one of the few who succeeded professionally in his sport.  He led UCLA to the NCAA basketball championship in 1995.  He was drafted 9th but played only 2 years in the NBA and 8 years in Europe.  He now sells cars in Las Vegas.  He disappeared, but his reappearance now may be the most important thing he does in his life: change the sham that college football and basketball are played by “student athletes.”

Universities generate $4.5 billion from football and basketball alone, enough to cancel 190,000  student loans of $24K, the average for Oregon.  Or pay grad students better.  Or pay the players who actually do the work, not those who benefit from such work.  Alabama’s football coach makes $5.5 million; Arizona’s basketball coach $2 million, and he is far from the best paid.  The median salary of an associate (tenured) professor of physics is $70,000.   In Eugene, Matthew Knight Arena cost $227 million, a 2002 “facelift” at Autzen Stadium was $20 million.  The NCAA generates nearly $1 billion, mostly from the “March Madness” basketball tournament.  I heard numerous times 89 championships and 450,000 “student athletes,” with 90% of the revenue returning to the schools.  Why would the NCAA be saying what per cent goes back to the schools, unless they felt they were under fire?

So, $100,000,000 remains, and I write the number, because seeing it is often useful. The $4,500,000,000 ($4.5 billion) is one-seventh of what America spends on the NIH, which I think does a lot more good for people, but I might be wrong.  Sports are perhaps more important than finding cures for diseases like Alzheimer’s.

The issue the NCAA doesn’t appear to understand, or at least doesn’t want to admit, is that football and basketball are different:  athletes and coaches involved in these sports are not the same as athletes and coaches in other sports.  John Calipari at Kentucky has well over a $35 million package for the rest of the decade.  An assistant football coach makes 6 figures, one has made a million; an assistant track and field coach makes about $20-40K.  Look it up.  I did.

The question for the NCAA is this: how much should men’s basketball and football players be paid?  It isn’t “whether” but “how much?”  These players are abusing their young bodies, not mentally mature, and vulnerable to being used.  They often do not finish college, taking a slim chance they will have a pro career, that in the case of even O’Bannon was short. The probability a college football player’s playing professionally is 2%; basketball is 1%.  OK, 1.2%.  The probability of graduating without a degree and without playing a professional sport is a minimum 15-30 times higher, approaching 70% in some places. These players are not going to find good jobs, their joints worse than mine, and I am 3 times older.  Football brain damage isn’t even being factored in here.

The concept of “student athlete” works if it is a Dartmouth runner who loves to run but must meet high standards of an Ivy League school.  The runner may perform well enough to be in the 5000 meter finals in Eugene, but he was lapped well before the end. This is a student athlete.  He loves track, but his life work will be something else.  Dartmouth, like all Ivy League schools, does not offer athletic scholarships.  If a university does, it is subsidizing an athlete, not a student.  This to me, a Dartmouth alumnus, is an important distinction.  Only a third of the 450,000 get athletic scholarships; four sports: football, men and women’s basketball, and women’s volleyball, give full rides.  Is that payment?  If it is, then they aren’t primarily students.

Football and basketball players are too often athletes who happen to attend classes.  Their graduation rates approach 70%, better than it was, but a significant number of programs graduate fewer than half. What was their major? I doubt it was physics, chemistry, mathematics, English, or literature.  Many athletes on full athletic scholarships are a farm team for the pros, leaving college when they believe they can turn professional.  To put their faces or names on a shirt, while they are in college, so that the NCAA or the school can make money, is using them as pawns.  This happened to Michigan’s “Fab Five” 20 years ago.

There are student athletes, and there are student athletes.  The NCAA compares both equally, and they are not.  The volleyball coach at the University of Arizona knew full well that successful recruiting and funding of his program depended upon a successful football and basketball program. Eleven of Arizona’s 13 programs listed lost money, including volleyball.  The profits from men’s football and basketball were about $26 million, more than enough to compensate.  Graduation percentages are tricky, and I don’t like the 6 year definition; I got through Dartmouth in 4, and the Dartmouth man who ran the 5000 at the NCAAs will likely do it in 4, too.

I am concerned about big corporations buying advertising, using handsome young men and pretty young women with nice voices to push a toxic agenda, be it chemical, like ExxonMobil, or sport, like the NCAA.  Money talks, it talks too much, and it is time to shut it up. Money could be used to pay for good professors, not coaches, lessen the burden of student debt, develop first rate researchers, writers, educators, and try to lift more poor out of poverty.  Ads? Request retired people like me to help tutor or use our experiences and wisdom.  Bet they wouldn’t cost much on a Jumbotron.   This is the 21st century.  We need educated people to understand the growing complexity of this world. Fox News has a simple answer for everything.  There are few simple answers, and that makes life difficult. Instead of embracing complexity, we pay tens of millions to a coach to help young men put a ball through a metal rim.  If your team wins, you feel better about life. Is escape the point?

When I cared about basketball, O’Bannon was a name to be feared in Arizona.  Now, I wish him every bit of success off the court.  Stay with this cause, sir, for this is where you may make your mark in life.  I bet you never expected that.

 

 

 

BROKEN SYSTEM: C2 FIXING IT

June 11, 2014

An elderly man is seen in a major hospital in a large city with neck pain following an automobile accident.  He is evaluated with neck X-Rays, read as normal, and discharged in a cervical collar.  A day later, he goes to another hospital in another large city with the same complaint and is found to have a fracture of C2, the second cervical vertebra, the so-called “hangman’s fracture”, because this bone is broken in hanging, compressing the spinal cord above where the phrenic nerve, which runs the diaphragm and breathing, exits.

The man will survive, and he will survive without deficits, although he will require a surgical procedure to stabilize the fracture.  Elderly people tend not to complain about head and neck pain the way younger people do.  When I practiced, new onset headache and neck pain in the elderly was something I took seriously.  You won’t read about this in books; a lot of neurology I learned in practice.  I noticed things, and I counted.

Had the man been rear-ended or even had a minor fall, he could have died suddenly.  At his age, with no autopsy, he might have been diagnosed as “heart attack,” with the outpouring of grief and comments about his life cut short.

And nobody would have noted the error.

The system will continue unchanged, with the first hospital’s staff thinking they provided high quality care, not knowing that they made a major error; they missed an odontoid (the name of that part of C2, the axis) fracture.  Somewhere in their clinical evaluation, they failed.  They don’t need to be sued, nor do they need to be publicly humiliated or embarrassed.  They need to learn from this error.   I learned medicine through gamesmanship and humiliation when I made a mistake; making people feel fearful, stupid or embarrassed (or sued) isn’t how they learn.

Ironically, 12 years ago, I went to this hospital and explained to the CEO why we needed a reporting system for medical errors.  He told me that they had one of the best systems in the country.  If that were truly the case, for this problem to occur a dozen years later says the quality of our programs to prevent errors needs immediate attention.

Doctors make mistakes.  They are human.  They make errors for all sorts of reasons: There may be insufficient knowledge, hurry, distractions, interruptions, lack of sleep, shift changes, miscommunications, and other reasons.  To assume a doctor is perfect is to deny reality.

What is needed is recognition of this reality and building of systems robust enough to find problems before they become critical.  How the system works is a matter of involving those who are involved.  It doesn’t come from the government, although if the medical profession doesn’t change, it will some day, and will have all the problems that come from government regulation.  Changes don’t come from the CEO or the head of the emergency department either.  They come from involving the doctors who work in this department, the nurses, the technicians, the people who first see these patients, the first responders who bring them there, and the radiology department.

The question to be answered is this:  How do we ensure we never miss this problem again?  The goal should be 0 misses, which means that part of the solution has to be followup with the patient, the way my veterinarian calls me at home the day after she does dental surgery on my cat.  If a cat can get better followup medical care than a human, then I have a major complaint with the medical system in America.

Hubris.  “World class.”  “We will take care of it.”  “We don’t need you.”  “Centers of excellence.” “99.99% of our patients do fine.”  The last I particularly worry about, because it means that 1 in 10,000 does not do fine, and if it is wrong-sided surgery, that is 2 cases a year in a busy hospital.  There are some things where percentages are appropriate, and there are others where counts are better.  There should be 0, null, zero, cases of missed odontoid fractures after an automobile accident.  Does everybody need a CT scan of the neck?  No.  Who should get one?  Look at the literature.  We put people in cervical collars routinely, when they have no neck pain, no neurological findings, no drug or alcohol abuse, and no tenderness to palpation of the neck.  Having all of these negatives was shown two decades ago not to require a collar.  Yet, we do it anyway, “just in case”.  In case of what?

I am telling the medical community to fix their broken systems, for they are broken when an important bone is broken and not recognized.  We have the ability to easily diagnose these problems when they occur, and we know enough about algorithms to know when we should work these patients up further, and when we do not need to.

I get follow-up surveys from nearly every company I deal with.  Amazon now surveys the packaging process.  I don’t know if anybody actually does anything based on these surveys, but if there is a mistake, they sure hear from me.  I would bet a great deal of money the hospital never called the patient to find out how he did.

If Comcast, for heaven’s sake, surveys, and if my veterinarian calls me to ask about my cat, it would appear maybe medicine ought to start doing the same thing.  Aviation has been investigating errors and disseminating the results for 40 years.  In 2001, I suggested medicine do the same.  I contacted 64 different groups.  Nothing happened.  Fine, don’t use my system, but put something in place to address this problem, because it happened once and it shouldn’t happen once; you guys aren’t learning from your mistakes, and you aren’t even counting.  

I wonder in the past 13 years how many hangman’s fractures were missed, causing death.

I wonder if in the next 13 years we will address the issue.  The smart money bets no.