Archive for the ‘MY WRITING’ Category

FRESNO

February 18, 2014

In my moves to Oregon, I  travelled through California, staying overnight, since I drove alone.  Going up, I stopped in Fresno; on the way back, at Bakersfield.  Hauling a trailer, it was a difficult two days, and I was tired, not always in the best mood when I arrived.  I had awakened early, driven well over 700 miles, and had the same ahead of me the following day.

At one hotel, the lobby was full of friends of the night clerk, who was wearing a Fresno State sweatshirt.  That was fine, I thought; maybe she is going to school there and working nights.  The room, however, was not so fine.  As a matter of fact, it hadn’t been made up, something I have encountered before.  It’s very disconcerting. Once, I was told that wasn’t possible. That’s not smart to say to a customer.

I returned to the lobby and asked for another room, explaining the problem.  There was a look of disbelief, but I bit my tongue and stated the facts.  I was given another room, actually more convenient, on the ground floor, but the key didn’t work in the door.  Problem 2.  Now, I was getting annoyed.  I had been on the road about 13 hours, and I just wanted a room.  Finally, I got a key to work, but the handle was stuck.  I returned yet again, and finally got in the room.

There were no apologies, no sense of embarrassment, and no sense of realizing I was a stranger in their town.  That happens too often, even when–or perhaps because–a person is old, like I am.

The next day, I checked out, and nobody asked me anything.  I didn’t say anything, either.  In a way, I understand the lack of interest.  Many who work the night shift, and I have, aren’t paid well, chronically poor, and are trying to get by.  They aren’t in any better mood than I am.  In a sense, their whole life is full of 750 mile daily drives with a trailer, except they are going nowhere.  I try to keep that in mind when I eat at Denny’s, leaving a larger than usual tip, even for poor service, because these people need the money, and I can afford the extra $2 that might just make their day.  Dear Prudence, a Slate columnist, taught me that, when some stockbroker wrote her and said people didn’t deserve great tips.  She ripped him a new one as only Dear Prudence can.

Fast forward a few months, and I am back in Fresno, now at a different motel, because I vote with my wallet. I had the sense to stop early at a Denny’s in Bakersfield for dinner.  The manager had a problem customer at the cash register, who couldn’t figure out his discount and answered “none” for tip. Yes, he was rude, but she should have asked somebody to seat me sooner.  I waited a long time, but the waitress was good and quick.  When I wanted to pay, I could have done without the customer ahead of me using a $100 bill, so the waitress had to find the manager to get change.  Still, I gave the waitress a good tip and arrived in Fresno more rested, but still tired.  I parked the car and trailer where I could, and as I walked to the reception, a woman ran up to me, asking me if I were checking in.  I said I was, and she opened the door for me.  She had checked on another room.  She might have even made it up.

The young woman asked me whether I wanted upstairs or downstairs. That I appreciated, as was the chance to move the car-trailer closer to the room.  I noted her pleasant accent, thought she was South Asian, and asked where she was from: India.  We started talking about India and her life.

Her father wanted her to marry some rich man who would care for her.  She didn’t like that idea and came here in 2007.  She has earned a BSN, now working on her MSN.  Because of regulations, she is not allowed to teach English, although hers is impeccable.  I can understand keeping jobs for locals, but we need many more good English teachers.  I had the same drive, the same stress, but I spent 15 unnecessary, but interesting minutes with the check in clerk. She felt her job was important, because it was a job, and jobs mattered.  She was going to be successful, and if she stayed here, America will do well by her.

The only problem with my stay was a stuck flapper valve in the toilet the next morning, which I adjusted.  Had the same woman been on duty, I would have told her when I checked out.  Alas, somebody took my key and only said good by.

Thoughts to the American hotel industry:  Talk to your customers. Show some interest in them using body language and tone of speech.  I taught myself to watch body language, and I can spot interest or disinterest in me in a moment.  I also can effectively use my body language to say things I wouldn’t dare say verbally. Tell your employees to learn to read and to use body language; it is far more important than “Have a nice day.”

Thoughts to American business:  Stop your “3-4 minute” surveys. I’m not interested, and I doubt most are. They are statistically invalid and poorly written. You want to make the customer happy?  Fix broken systems.  Every time a customer complains, you have a broken system. Fix the system, and listen to your employees, too, for they likely know a lot more about your customers and systems than you might think. You ought to ask every customer one question, only one absolutely essential question:

“How could we have helped you better?”  Trust me, people will speak.

THE RAINBOW BRIDGE

February 14, 2014

It was the eighth time I have done this, bringing a cat in a cage to the vet’s office, knowing that the cage would be empty on the return trip.

Harry had been with us for more than 12 years, ever since he was spotted around our house, looking eerily like another stray we had adopted a year earlier.  Unlike the other, however, Harry was aloof, not letting us near him.  I knew he was a male; I saw him mark the territory one night.

He was right about marking it, more right than either he or I expected.

We left food out, and it disappeared.  But he never came near us.  He wanted nothing to do with humans.

I was in the office, with my wife, both of us with red faces and barely trying to stop sobbing.  Lisa, the vet tech, knew us, and we sat down, as a woman paid her bill.

We put a trap out and kept it open, gradually starting moving food closer and closer to the trap.  Harry, who of course, wasn’t yet named, ate the food but avoided the trap. Finally, after 2 months, we put the food in the trap but left it open.  Harry could come and go into the trap, and he did.  Finally, we set the trap; my wife slept inside, on the other side of the door, a classic “bait and switch” maneuver.

BAM, CRASH; 1 a.m. the trap, plus one very upset large black cat, was on the ground.  My wife picked up the spitting and growling “prize,” putting it in the trunk of the car.

A little boy came up to the cage, and said, “Is that a kitty?”  Fortunately his mother said, “Honey, it is not a good idea to be around other animals here.  They aren’t feeling well.”  I silently thanked her.  

Harry was hauled to the vet, who gave him ketamine through the bars of the trap, since there was no other way to anesthetize him.  Jupiter would completely orbit the Sun before Harry would receive it again.  After neutering, I brought him home, putting him in the back room, where he tried to jump out a closed window, hitting glass.  We figured we wouldn’t keep him, but we waited to see what happened.

We were then taken in a room and sat down.  I had to tilt the cage to get Harry out, because he was at the far end of it.  

In three days, I had Harry purring.  In a week, he was out in the house.  At night, he was  kept in the room, door open, a gate with polyethylene bars blocking exit–we thought.  One night, he appeared in the hallway outside the room, as if the bars didn’t exist.  Two of bars apparently were loose, like station 9 3/4, where he could go right through a door, like Harry Potter, whom J.K. Rowling had recently introduced to the world.  All our cats–we’ve had 18–named themselves.  He would be Harry P., then just Harry.  He remained aloof and his coat was coarse, but  never again was he interested in the outdoors.

I lifted Harry into my arms, stroking his thin frame, every bone easily palpable, his coat so thin that skin was showing.  He buried his head in my elbow.

We had three black strays and wondered if they were related.  Jack arrived on a hot summer day in 1991, appearing on the front porch with one eye swollen and blind.  Nine years later, B.C., (Black Cat) appeared and accepted house life as well.  We didn’t think Jack would survive.  He lived 15 years.  We hoped B.C. would live 15 years; in 2006, he suddenly dropped dead in the hallway one night.

As we signed the permission slip, we asked about the sedative, which we hadn’t used before.  “We have started doing that, lately. Renal failure veins are often small to get into.” Sedation sounded fine, as I continued to stroke Harry, now calmer.

Over time, Harry became fat, 24 pounds, losing weight after one of his buddies died, when less food was available.  His coat became more silky, he stopped biting us, still remaining a little aloof.

“I’ll inject the sedative.”  Harry moved a little, but he quickly settled down.

As time passed, Harry became more sociable, but last year, we noted that he was thinner, 5 1/2 pounds lost in a year.  We thought it was age, but the vet found an abscessed tooth, needing difficult surgery. How that must have hurt, but cats hide pain. We learned then his creatinine was 7, a sign of serious renal failure.

Harry was fully relaxed in my arms now.  What a good boy you have been, Harry P.  Thank you for gracing our lives.

For nine months, we gave Harry fluids under the skin twice a day, with a phosphate binder injected into his mouth.  My wife did most of the work; I figured out how to get the binder into a syringe.  We didn’t think Harry would survive a week, but he made it through summer.  He became more sociable,too; indeed, he was a different cat, losing weight, but nicer.

“I think we’re ready now,” said the vet.  “He’s almost asleep.”  Thank you, Harry, for everything you gave us.  I’m so sorry I wasn’t nicer when you didn’t eat, because I didn’t know how to handle grief.  Boys are taught not to cry, when they should, but they have to direct their emotion elsewhere, and I directed mine towards anger.  I’m learning, Harry.  Thank you for teaching me. 

The vet put a rubber band around the right front leg, cutting a little of the beautiful black hair Harry had over the now visible vein. 

How many times we thought Harry wouldn’t survive a week, when the next day he ate a can of food!  He started chasing one of the other cats, which we loved to see.  His weight, however, relentlessly fell, below 12 pounds, then 11, then to 10.  It took 5 or 6 different cans of food some days for him to eat anything.  It was more difficult.

“I think we are ready.”  The lavender solution was pretty.  I couldn’t look at Harry’s eyes. I have seen life leave eyes before.  It’s incredibly sad, but it taught me compassion. 

Finally, nine months after Harry’s illness, one morning he ate nothing and went away.  My wife appeared, and I said, quietly, “Today or tomorrow.”  She hugged me, both of us in tears, and said, “Today.”  We had trouble finding him.  We blocked hiding places, but he still found a good one.  When cats start to hide, they are saying they are looking for a place to die.  We listened.

As the solution went into Harry’s vein, I felt no movement.  He had been relaxed for several minutes before the solution was injected.  It was over.  In tears, I picked him up, put him on the blanket, curling him up the way he always had slept.  I kissed him, thanked him again, saying, “I will see you at the Rainbow Bridge.”

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Harry with his buddy, Ace.

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He liked Gryffindor, too. This has been on my Phone for years.

FIFTIETH ANNIVERSARY

February 11, 2014

“A wilderness, in contrast with those areas where man and his own works dominate the landscape, is hereby recognized as an area where the earth and its community of life are untrammeled by man, where man himself is a visitor who does not remain.” –Wilderness Act of 1964

I am alone at 9453 feet, on a mountain top the way I imagine it, a quarter acre, maybe half, no trees, drop offs up to 1000 feet on all sides.  Above me, swifts are catching insects, their swept wings making identification easy.  I am dehydrated after hiking up on a hot June day, the 32 ounce drink I had at the start long gone before I even reached Josephine Saddle at 7200 feet. I am more than a vertical mile above Green Valley and 5 miles from the trailhead.  A million people live in the area I can see, but not one of them is within three hours of me by trail, and that is the only way up here.

My thirst doesn’t matter; I am higher than any other person in southern Arizona, seeing a wonderful sunset I will never forget, the reds and oranges stunning.  It was worth hiking up from my Baldy Saddle campsite to the top.  I must leave soon, as it is starting to get dark, and some of the trail will not be safe in darkness.  I will awaken tomorrow, away from the rush hour traffic of a large city, in one of the wilderness areas of Arizona, the trailhead little more than an hour’s drive from my house.  Few ever see this place, the Mt. Wrightson Wilderness, my favorite spot in southern Arizona, where I myself am a visitor and will not long remain.

I have camped here alone in a snowstorm, warm inside my sleeping bag, hearing the snow accumulate and then slide down the tent.  I have camped up here five times, a lot of work needed to haul a pack up the Old Baldy Trail, as it is known, but every bit of it worthwhile.  I have taken day hikes, once playing hooky from work for a few hours to come up in a snowstorm, returning to my job that afternoon, completely soaked, but absolutely happy and thrilled to be alive.  I have hiked up here and down the other side to Gardner Canyon, because I had never seen the Gardner Canyon trailhead.  I then turned around and came back up and over.  Wow, was I thirsty that day.  I came up the north side one day and stayed too long, hiking down in the dark with no flashlight, in old growth forest, never once cut, an owl’s sudden hoot making me almost jump off the trail.  That was a great hike.  They all are.  I know the trails like old friends.

From Baldy Saddle, reached from the west by 33 switchbacks, I see Green Valley and the Catalinas north of Tucson.  To the east, about 30 steps, I see Sonoita, Sierra Vista, and south into Mexico.  From the top, I see all of these by just rotating, as is the Earth.

It took much effort to get up here, but that makes wilderness special.  I am getting my reward tonight. I earned this view, through the thirst and soreness I endured. I don’t yet know that later tonight, I will hear a cougar close by.  I need wilderness.  I can’t explain it or put a dollar sign on it, but I need it.  Periodically, I reach a stage in my life where I know I need to get outside and hike somewhere.  It doesn’t have to be long, but it has to be away from people.  I can’t prove it, but I suspect others might become happier if they went into the wilderness, even a short distance, where they too would not long remain. I think mankind still needs wilderness, but perhaps the need has been allowed to atrophy too much.  I needed Mt. Wrightson tonight. Right now, I need to return to my campsite.  The swifts call, still catching bugs, as I start down the rocky trail, the last bit of red still visible in the west.

QUITTING

February 5, 2014

February 1956:  Speculator Ski Area, Adirondack Mountains, New York State.

I was a 7 year-old boy who herringboned up to the rope tow, grabbed the rope, and didn’t let go, until my skis hit the edge of a rut, 50 yards later, and I fell.  Unlike the 100 prior times, however, I got back up, grabbed the rope, immediately falling  head first.  A third time, I went another 100 yards, the fourth, I fell again, but on the fifth. I finally made it to the top, letting go, jubilant.  For the first time, I had made it to the top of the hill. I later became an expert technical skier, but I never forgot that 7 year-old boy.

July 1960:  Massawepie Boy Scout Camp, also in the Adirondacks, on the swim dock, final test for my Lifesaving Merit Badge.  I failed to rescue the instructor, double my weight, on my first attempt.  The second time, I grabbed the skin of his armpit to hang on.  He yelled, “oh, you learned that trick!” throwing me off.  I should have kept trying, but I quit. I earned the merit badge back home.  I always regretted quitting that day.

I saw a “fluff” post on Facebook: “You can’t fail if you don’t give up.”  Not true. Moreover,   quitting is not invariably wrong. Sometimes, one is better off giving up and failing.  Sometimes, one is not better off by succeeding.  Our society believes that hard work is always rewarded and that continuous trying a virtue and quitting a vice.  Sometimes it is true, other times, it is not:

1. Margaret Mitchell tried 38 times to get Gone with the Wind published; J.D. Salinger and Agatha Christie’s works were also rejected before finally accepted.

2. The inventor of the intermittent windshield wiper switch, Robert Kearns, persevered and won $30 million for patent infringement.  His wife divorced him and he spent $10 million in the 14 year process.  He didn’t quit and was vindicated.  Having spent more time with lawyers than I would like, I’m not sure a 14 year battle with lawyers and divorce was worth the $2 million a year he made was worth it, but others may disagree.   I cannot put a dollar cost on a divorce and years spent in acrimonious debate.

For every successful athlete, singer, and entertainer there are hundreds who worked as much, maybe more, and never made it.  One may say, “Yes, but the next time, they might have succeeded.”  Perhaps.  To me, there are few things sadder than those who persevered when they should have quit:  Michael Jordan and Joe Paterno come to mind.  Age is real, and the infirmities that come with it.

Is quitting bad?  Is it worth throwing good money after bad, good time after bad?  At what point ought one give up?

I failed as a statistical consultant, because I knew nothing about marketing.  I then became interested in patient safety and medical error reporting, but after 5 years of trying to develop a confidential reporting system, writing legislation introduced in the Arizona House for two years, I quit. In retrospect, I had no chance, medicine wasn’t ready to learn from errors; perhaps we will some day.

What happened as a result of my failing?  When my parents’ health declined, I was there for them.  When I decided to see places in the world that meant a lot to me, like the Sandhill Crane migration, Isle Royale, the Arrigetch Peaks, total solar eclipses, and the National Parks, I did.  I worked on my writing, won two awards, and asked to write for the medical society, which I did for 9 years.  Those writings are here on the blog, my later articles better than my earlier ones. I became a better writer because failure gave me time to write, time to discover writing was my way to both relax and communicate.

I failed to write a book in 1983, 720 pages, typewritten, about a my experiences serving aboard a Naval ship.  The Naval Institute Press was tentatively interested, asking me to revise it.  Sadly, after my revision, they turned me down; concurrently, a young man named Tom Clancy was submitting material to them.  I quit writing and concentrated on my medical practice, where I succeeded so long as I subjected myself to unreasonable hours, malpractice suits, hurry, arguments about compensation, and constant interruptions.  At 43, I decided to quit, one of the best decisions I ever made.

I worked for the Forest Service in Minnesota for six months, more content than I ever dreamed possible, returning to become medical director of a hospital, a new world, until I quit again, five years later, to become a graduate student in statistics.  When I left medicine, I lost money, power, and influence.  I obtained my Master’s, although had I known I would fail as a statistician, perhaps I might have quit.  From failure, I entered a new world, not only writing, but volunteering, becoming a substitute math teacher, teaching English on line to people in 90 countries, and learning German.

Stopping aggressive treatment of dying patients was my greatest contribution to medicine.  I knew how and when to end life support for patients with irreversible brain injury, long before hospice and The Hemlock Society.  Some doctors save lives, but others know when it is time for a patient to die. Germans call it “ein schöner Tod;” we call it a good death.  I used the word “die,” not “pass on” or “expire,” because DIE is the strongest verb, the only one that belongs with “death.”  I knew when it was time to let go, but I also respected the wishes of those who opted to continue.  Recovery from coma depends upon age, length of time, and cause. There are specific indicators that highly predict irreversible brain injury.

It is not euthanasia to quit treating; indeed, it is dying naturally, rather than with feeding tubes inserted into the abdomen, treating pneumonia, urinary catheters, bed sores, with no possible chance of returning to a normal life.  Many spouses didn’t know they had a choice and were relieved when I gave them one.  How did I know?  I had studied the neurological literature extensively about coma when I trained.  I knew the probabilities, I talked to patients and their families, heard often “he never wanted to be like this,” and discontinued life support, without discontinuing dignity or caring.  There was a sense in medicine that once a tube was placed, it had to stay.  I had no trouble removing tubes when I was certain of the prognosis and the family agreed.  The act was neither easy for the families, nor for me, but I knew how important this final decision was for families.  When my parents reached this stage, when “the door out” opened, I allowed them to go through; I kept my promise to them.  I knew when to quit.

Hanging on to a rope tow or a drowning person is worth persevering; knowing when and when not to persevere is a definition of wisdom.  Perhaps that should have been posted on Facebook.

SURVEYING THE DOMAIN…AND THE RANGE

February 2, 2014

“You have been selected at random….”  I do not enjoy hearing these six words.  A survey.  Two more often used here that push my buttons are “team” and “professional.”

Customer satisfaction has taught at B-schools for a long time, although businesses have done a lot to hurt it, such as the average experience one has calling a business, or just in time inventory, which isn’t (“that will be here in 3 business days.”)  Surveys are now frequent.  I don’t like the questions or the choices; while I buy the product, I don’t buy the inferences they might make from a survey.

Recently, I got three.  Two were from Comcast, following as many calls during an e-mail outage.  If I agree to complete a survey, I get through faster to a human being.  Try it some time. I contacted Comcast twice, later receiving two surveys, answering the second.  By not responding to the first I hurt the assumption of randomness, required for a decent survey.

Comcast told me the survey would take 2 minutes.  There were questions about my satisfaction, having my the question answered, professionalism (undefined, desperately in need of definition today), offering the Website as a source of information (incredibly dumb, if there is an Internet outage), and others.  I hung up at 2 minutes.  They said two minutes, and I gave them two. The other was from Peace Health, which I almost tossed, but decided to fill it out.  There were about 35 questions, too many, so a 3 or a 4 on a Likert Scale didn’t matter a whit to me.  I don’t like averaging Likert scales, either.  Two “5”s and two “1” s average to an “average,” but it suggests there are huge differences in customer satisfaction.

Twenty years ago, medical director of a hospital, I learned we spent $100,000 annually on quarterly surveys, arriving on glossy paper, with nice colors, like a dressed up pig:  pretty, but still a pig.  Only I read them.  I know that, because I went to the Executive Meetings at the hospital and asked a good question:  “How many have read this?”  And a second:  “Has anything changed as a result?”  Answers: No, and nothing, respectively.  The survey asked patients whether their food was hot.  If a patient had 10 meals and 7 were hot, what should they answer?  The survey asked whether the physician or nurse was professional, whatever that means, especially if the patient had several of each.  The return rate was about 5%, and even before I got my stats Master’s, I knew the figure was meaningless.

I proposed a different approach:  we hire one person, far less than $100K including benefits, ditch the company, and call 100 discharged patients every month, picked at random, with all replying, or the non-reply would be considered the worst possible.  This is worthwhile and it conservatively estimates how well one is doing.  We asked three questions:

  1. Did you like the care?  Yes/No.
  2. Would you recommend us to a friend?  Yes/No
  3. What suggestions do you have?

We didn’t learn about hot food, but care results could now be inferred to all patients, and we received good suggestions, too. People will toss most 6 page surveys; three questions from a human might be answered.

I tried this at a hospital in Las Cruces, told that time made a difference when you surveyed, whether the day of discharge or 6 weeks later.  I countered: if people didn’t respond to a random sample, or responded to a call 6 weeks later, the results were worthless.  I lost.

I tried it with the medical society, where we had success. We randomly surveyed primary care physicians about colonic cancer screening with two dichotomous questions, only two.  We used 90% confidence intervals and margins of error of 10%.  This wasn’t Bush v. Gore; this had to do with recommending screening for colon cancer.  The large margin of error and the small confidence interval decreased the needed sample size to about 70, manageable, and we had the finite population correction factor, which helped further.  The latter means that if the sample is a large enough percentage of the population, the sample itself is a significant part of the population: less error.

Confidence intervals are given in percent.  A 90% confidence interval means one is 90% confident the true value is contained in the interval.  The true value (parameter) is unknown and unknowable; the interval either does or does not contain it, so probability is irrelevant.  A 100 similar samples generate 100 confidence intervals, 90 contain the parameter.  Which 90?  We don’t know.

We sent the questionnaires by mail and called those offices or physicians who didn’t reply.  It worked.  We got all but 1 response, worthwhile.  We made inferences to all primary care physicians in the Medical Society with high confidence and reasonable error. Cost?  Small.

A decade later, I was asked to help in a survey about insurance companies.  Unfortunately, too many questions were asked, because “all were important.”  They weren’t. The response rate to the survey was poor, and physicians who were supposed to call their colleagues didn’t. I was asked to call; I replied as the statistician, I was not carrying the flag for what I considered a suboptimal survey, which should have taken a quarter year to complete but instead a quarter of a decade.  Really.  When I performed two sample proportion tests, a physician asked me whether it were the right test.  I resisted asking him if he performed the right tests on his patients.

If you want a good survey, randomize, ask 1 or 2 questions, use 90% confidence intervals and high margins of error.  Randomize a thousand or a a hundred thousand people, sample 100, obtain all responses, and you will have 90% confidence that the true result for the million is within 8-9% of your point estimate, your sample result. I can prove it mathematically. Do you need 80% +/- 2%?  Or can you live with 60% +/- 9%?  I submit the latter is useful.  Want more information? Ask two more questions and survey another 100 at random. The expected value is 1 in 10,000 will be called twice.

Sampling is an incredibly powerful technique, but it has to be used carefully.  Read a newspaper article sometime and note how percentage of respondents gradually becomes percentage of people.  That is incorrect.

Please act on the results.  If the survey sits in an office unread, it wastes time and money.  Asking for suggestions is useful to generate good ideas. If you want to call everybody afterwards, don’t ask how professional their people are.  Ask only how you can do better.  Trust me, you will hear a lot.  People like to answer that question.  Then it is your turn.

Act on the suggestions.

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 go.  At 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.