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REMEMBERING PRINEVILLE AND 30 MILE

August 1, 2013

The Yarnell Hill fire that killed 19 Granite Mountain Hotshots from Arizona has already been blamed on “enviros”, like the 2011 Pagami Creek Fire in my favorite area of the Boundary Waters.  I don’t like the word “enviros,” and I am deeply disturbed how charged words end up in the vernacular, because the side who opposes my views keeps repeating them.  That’s how we got “Obama Care,” “death panels,” and “activist judges.”  For the record, it is the Affordable Health Care Act, and there is a lot of evidence to support the notion that the conservative side of the Supreme Court is activist, not the liberal.  Repetition does not always increase validity.  But back to Yarnell Hill.

Had the area been logged “appropriately,” some said, there would have been no fire.  Logging=jobs.  Jobs=money.  Money=things and kids.  Lots of kids.  Too many kids for the jobs available and for the carrying capacity of the world.  We think the world won’t change.  But it does. Email and online banking have hurt the post office.  Our big steel and copper industries are now small.  No longer are there well paying jobs for people coming out of high school.  Newspapers are in trouble.  The Grand Banks fisheries collapsed.  What happened to record and book stores?  I could extend the list; all these industries have had to change or disappear.

The world has changed, and the forests have, too; in part, because we put out natural fires, because of insects, and because of climate change, which affects the environment, including parasitic beetles.

Since I am an environmentalist, a so-called tree hugger (which I literally am), I am going to play the “blame game” here, since many of my detractors are not called out on their boorish behavior, counting on the rest of us to have been brought up well by our mothers to remain silent.

How dare you blame me and my beliefs for the deaths of the firefighters!!  We haven’t even had the investigation completed yet, but I will bet any amount of money there will be recommendations made that are going to anger a lot of people.  That is all I will say about my predictions.  I have a decent idea of why this occurred, but the investigation will tell me a lot more, some of which will be consistent with what I think, some of which will not.  But rather than wait for the investigation, some wish to blast the environmentalists, so we can mine, cut, hack, and destroy the Earth in the name of money….perhaps in the name of some sort of Deity, too.

Some of the fault was done in the name of what we once thought was good. The Smokey the Bear mindset convinced at least two generations of people that all fire in wild country is bad. Human caused fires are bad, but if they can be caused by humans, they can be caused by lightning, too.  The media will refer to “land destroyed by fire”.  In 1989, we built in the Sonoita grasslands, south of Tucson.  During the building, a 300 acre grass fire burned over all our property.  The house was scorched but hardly damaged.  When I saw the scorched land, I said to myself, “This will take a long time to come back.”  Six weeks later—SIX WEEKS–there was fresh grass, it was brilliant green, and it was home again to animals.

In 2005, on a solo canoe trip to Canada’s Quetico Provincial Park, I walked on a portage where the Bird Lake Fire burned 10 years previously.  I saw thousands of jack pine trees, all the same age, over this area.  Not all will survive.  Some will, others will die or be stunted.  Jack pine cones need fire to sprout.  This will be a big, shady jack pine forest in 40 years.  I won’t live to see it, but it will be there.  Natural fire clears and cleans the wilderness.  I haven’t been back to Yellowstone since the fires of 1988, but those who have know the positive changes it has had on wildlife and the ecosystem in general.  Remember what we all thought in 1988?

How dare you use the deaths of the firefighters as a reason to log the forests!  What could be logged, where they died?  Why do we allow houses to be built in these fire prone areas?  Why should young men and women put their lives at risk to save property?  If “Prineville” and “30 Mile” don’t ring a bell with you, will “Yarnell Hill” mean anything in 2025?  Prineville, Oregon, was the town where the hotshots came from, who died at South Canyon in 1994.  Thirty miles north of Winthrop, Washington, in 2001, the 30 Mile fire killed four young men and women.  The former had at least 20 rules violated; the latter was a tragedy that could have been prevented by not fighting it in the first place, and a concatenation of mistakes.  Easy in hindsight?  Sure.  Before?  Perhaps.  Listen to the video and draw your own conclusions.

Let the investigation proceed.  Afterwards, I would welcome a national debate on how we should manage our forests, except the boors will shout down everybody else and refuse to consider anything other than their ideas.  Can we debate the known science?  Can we honor the memory of these 37 young men and women and all the others who were killed or maimed by learning what to fight, what not to fight, when to fight it, how to fight it, and when to step back?

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THE LADY IN THE STYLISH BOOTS

July 29, 2013

“Oh, those damned government regulations.”

I looked towards the voice, that of a fortyish woman, with stylish boots, dyed blonde hair, and a southern accent, who was talking to a park ranger at Katmai, 400 km southwest from Anchorage, and a long way from any part of the lower 49.

I almost let her have it, because rangers have to be nice, I don’t. I’m an elder in my society, and I was a lot more in my environment than she was.  I was wearing boots that had walked the over peaks in the Brooks Range, in Kobuk Valley’s sand dunes, both above the Arctic Circle, in Alaskan rivers, and on tussocks and ice.  Hers had probably just spent their first time on a dirt trail.

At Katmai, there are two viewing platforms at Brooks Falls, the lower, where one can go as long as one wishes without waiting or time limits, and an upper, where 40 people are limited to one hour, then have to get into line again for another hour, should they wish to see more.

Brown bears at Brooks Falls, Katmai NP, Alaska

There is a question, and I think a good one, whether we should be having people view the bears in the Brooks River feeding on salmon.  We don’t know what effect we are having on the bears.  Perhaps none.  Perhaps a lot.  Katmai is pretty enough without having to see the bears close up, but most go to see the bears.

The upper platform, next to the falls, has more fish, and that is where the males, and the big ones, congregate, so people want to go there.  Forty are plenty.  Put 50 or 60 there, and the last 20 aren’t going to see much.  I waited for 20 minutes when I arrived, spent an hour at the upper falls, left, got back on the list again, went to the downstream viewing area a second time, skipped lunch, and waited my turn to go to the upper falls.

The downstream viewing was great.  I saw a bear sleeping in the mud on the other side of the river and pointed him out to others.  A bear ran right under the walkway with a salmon, off into the woods to eat it.  There weren’t many people talking, and within 45 minutes, I was back at the upper falls.  That wasn’t a long wait.

Bear napping in mud, Brooks River, Katmai NP

Bear taking salmon into woods

That second time was special.  I saw a boar chase a cub up a tree.  When the boar left, the mother came with two more cubs and soon all 3 cubs were in the tree.  Later, another sow with spring cubs, much smaller, appeared.  The whole time, several bears were fishing the river.  I had a good time and as I left the check-in station, I heard the woman complain.

Sow with her 3 cubs.

I almost let her have it. But being an elder means having wisdom, and I knew I would be more emotional than wise if I said anything to the woman wearing the stylish boots.

I would have started with the failure to properly regulate flights properly over another national park: the Grand Canyon.  On 18 June 1986, a helicopter and a fixed wing collided over Tuna Creek, killing 25, many of whom were Dutch tourists, who likely burned to death before they hit the ground.  The FAA stepped in.

I would then have asked how much better off we might be today had we regulated the financial industry, so that people who almost took down the world’s economy, which is still struggling years later, got bonuses that themselves were in the top 0.5% of US income.

I might have asked her to imagine Katmai as a private park with a bus to the viewing platforms, so people wouldn’t have to walk 1.2 miles, selling tourists a salmon, then putting them on a tram over the falls, so people could look down and drop salmon to the bears, getting that “special” picture to post on their wall.

Ten years ago, during bear hunting season, many people went into Lake Two in the Boundary Waters without permits.  It’s an easy lake to get to, and surprise–people don’t always regulate themselves.  When my wife and I tried to camp there, with a permit, coming the other way, we were tired, disappointed, and angry that the lake was full.  We had to paddle a lot further before camping.  Afterwards, rangers were posted at the entry point to ensure people had permits.  Regulations make it possible for me to have my rights protected, too.  Even with rules, parks get trashed; without them, I shudder to think what would happen.

She probably would have screamed at me if I asked when a person’s right to own a firearm interfered with my right to be safe at my local Safeway, where Gabby Giffords was shot. Yes, I know, guns don’t kill people, people kill people, because if they are angry, it is easy to move a finger without thinking of the consequences.  Using a knife or a fist makes it a lot more personal, risky to the attacker, and requires enough time where maybe somebody can think “I shouldn’t do this,’ which is what I did before telling the woman in stylish boots what I thought of her.

All but forgotten now, the memorial to the 6 killed and 19 wounded in Tucson. Just a question: When was the last time you heard “Newtown”?

I’d like to know what the lady would think of regulating food quality and safety, something a good looking congressional candidate from my district wanted to do away with, since he had never had seen a case of typhoid fever or hepatitis, or a child die of shigella or salmonella.  That candidate scared the daylights out of me and missed winning the seat by 4,000 votes, because people were angry about the Affordable Care Act, many of whom were on Medicare or military retirees, ironically receiving government funded medical care.

No, lady, we regulate our public lands, because if we don’t, they will be lost for all time and be turned into money makers for a few.  The forests will be cut, the land mined, the water ruined, the silence gone, the animals gunned down.  I’d conclude with: “What about my rights and the rights of those who have yet to be born?”

I wonder whether she would kick me with those stylish boots.  Or think.

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KATMAI

July 26, 2013

Katmai National Park is for bear viewing and the valley of the 10,000 smokes.  I didn’t see the latter, but I did get to the former, and the bear viewing was spectacular.  Located about 220 nm SW of Anchorage, it is reached by float plane, with about an hour and a half ride over rather spectacular scenery.

Scenery on flight to Katmai

One arrives at Brooks Lake, and gets off the float plane on the floats.  There is a short walk to the visitor center, where the ranger talks, and there is a good 10 minute video on dealing with bears.  These are not the same behaved bears as in the Brooks Range, who have likely never encountered people.  These bears are near people, but so long as people stay on walkways, there shouldn’t be much of a problem.  The bridge over the Brooks River can be closed if there are bears in the vicinity, however, and bears are unpredictable.

The area for viewing has a lower and an upper platform.  The downriver or lower platform is open without waiting, and the smaller bears tend to congregate there.  The upper platform has room for 40, and one may stay no longer than an hour.  However, after one leaves, they may immediately put their name on the list to go back.  I did just that and spent an enjoyable 45 minutes at the lower platform seeing one bear sleeping in mud and another carrying his prize catch back into the woods.

Brown bear sleeping in mud.

Look what I caught!

The upper platform has a great view of the falls and bears will walk under the platform.

Some of the bears at the upper falls viewing area.

Fishing from the top.

The highlight was a cub chased up a tree by a big boar, who barely missed him.  Young bears until 3-4 years of age can climb, but older bears fuse joints necessary to climb and no longer can.  After awhile, the boar left and the sow returned with 2 siblings, sending them up the tree as well.

\ Literally climbing for his life

The reason.

Mom at bottom.

Two.

The third.

Mom with spring cubs.

The three cubs did come down from the tree, Mom got them a salmon from upriver, and they disappeared into the woods.  It is difficult to know how many will survive.  There is a lot of food, but there is also a lot of predation.  The spring cubs got a much later start, and it will be less easy for them.

We don’t know the effect of human visitation has on the bears.  Hopefully, it is not significant.  The day was spectacular, and this is a park I definitely want to see again.

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DREAMS

July 25, 2013

I was in the Anchorage airport, late one night on my way home from my tenth trip to “The Great Land.” I stopped in the men’s room, and before I saw the pair, I recognized the smell that to me characterizes one thing: “we’ve just come out of the woods.”

It’s a difficult odor to describe.  It is woodsmoke plus something more.  Many people would just say the person needs a bath, and they wouldn’t be wrong.  But in the woods, we neither notice the smell nor particularly want a bath.  I can attest to that with a great deal of experience.  It is when one comes out of the woods that one notices the odor and really wants a shower.

As I washed my hands and turned from the sink, I accidentally brushed the pack one was carrying.  He apologized.

“Been there a lot,” I replied.  While I’m shy, I knew these young men were kindred spirits.  “Where did you guys go?” I asked.  They knew I wasn’t talking about cities but wild country.  I wasn’t going to hear “Juneau” but the Chilkoot, not “Homer” but “The Kenai”.

We started to talk.  The pair was young, at least 35 years younger than I, and this was their first trip to Alaska, where they spent 2 weeks in Denali and the Kenai.  They had wanted to do this trip now, while they could, because their lives were going to be busy in the coming years.  They did it.

Been there, too.  I told them about my 5 trips to the Brooks Range, and their eyes showed a gaze I’ve seen many times, and which I have shown others. It’s a far away gaze of longing, of thinking about wild country, of rivers nobody down here has ever heard of, like Kongakut, Aichilik, Nigu, Itchilik, Kobuk or Noatak.  It’s mountains and remote valleys.  It’s slogging through tussocks, in rivers, in swamps, in bear country.  It’s aufeis hiking and bugs in June, blueberries in July, rain and autumn colors in August.  It’s the most difficult country to hike that anybody can imagine, and it is also the most beautiful.  It is a country that kicks one’s butt, until finally one accepts it with the simple words, “It’s Alaska.”  Everybody up here understands that.

Normally, I don’t talk much to strangers, but when I’ve been out the bush for awhile, I find myself pretty talkative.  These guys were me, 35 years ago.  Then, my dreams took me to the Boundary Waters Canoe Area Wilderness, every year, to get into the backcountry, away from people, civilization, only me and the wild lakes and rivers.  I explored that country until I knew it as well as my home town.  Maybe better.  I sure loved it more.  Always will.

It was much later that I discovered Alaska.  Oh, I did the Chilkoot Trail in ’84, the Nahanni the following year and the Chilkoot and the upper Yukon in ’87, but I didn’t camp above the Arctic Circle until 20 years later.  By then, I knew if I didn’t start to make my dreams come true, they never would.  I hiked to the Arrigetch Peaks in Gates of the Arctic National Park, and then decided I’d come back to see ANWR.  I thought once to ANWR would be enough, but when Christmas came I got a letter from the guide saying he planned a real special ANWR trip the following year.  I had to do that one, of course, because I had the longing in my eyes. I could see the Dall Sheep and Caribou, a river I knew would be special, so I accepted and did the trip.  Tough? Very.  Weather issues?  Plenty.  But we saw wildlife I couldn’t believe, and I came out of there saying I had seen the ANWR I wanted to.

Except I still haven’t.  Probably never will, either.  I did two more trips into the Gates, one combining backpacking with a paddling.  We saw a dozen bears, four of whom walked blithely through our campsite one night. Alaska.

I still want to see the Sheenjek Drainage in ANWR.  I would be 65 if I did it, but I think I can. A guide-friend is willing, and I know a pilot who would get us to the jumping off point.  No question that we could do this trip.  When I think about it, I know I have the look in my eyes those young men had.  Age  doesn’t destroy that look.

I didn’t tell the pair to follow their dreams, as I have tried to follow mine.  They didn’t need me to say anything; they were already dreaming.  I could see it in their eyes.  They didn’t know how they were going to get up here again, where they would go, or what they would do, but they were going to do it.

They will see the Brooks Range, ANWR and deal with all the issues Alaska throws at those who go into the bush.  They will come out of the country filthy again, smelling, but not of woodsmoke, because they will have been north of the treeline, where night doesn’t exist in summer.  They will again take the redeye to Seattle or the Bay Area, where they live, thrilled to have done the trip, and already planning the next one.  They would have had adventures I would be jealous of, but only a little.

No, the two needed no encouragement to come back. Had I shown them my pictures of the Arrigetch, the Aichilik, or the Noatak, they might have cancelled their flight and stayed.  Some people do that.

To the wife of one of them, should either some day be married, I apologize.  I just happened to run into a fellow dreamer, somebody who reminded me of myself, and planted a few more dreams in his head.

Let him go to the Far North.  He has to do it. He will come back better for it.

But he will want to go the following year.

And maybe some day he will be 64, in a men’s room in an airport, talking to a 30 year-old who has just finished his first backpacking trip in Alaska…..

2 year-old griz on the Noatak. Out of focus because my hands were shaking. Distance: 25 meters. Anything between us? Air

Bull caribou, Noatak.

The Maidens, part of the Arrigetch Peaks, Gates of the Arctic National Park.

Dall Sheep, ANWR, Upper Aichilik River drainage.

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LIKE LOCUSTS DESCENDING ON A FIELD OF WHEAT

July 23, 2013

Forty years ago, I was sold a $50,000 Whole Life insurance policy that cost me $750 a year in premiums.  When I cashed it out last year, it was worth about $84,000.  This is a rate of return well below 2%, and I paid the premium for several years.  It was a bad investment.  It was a good deal for the broker.

Back then, I didn’t know how to say no.  I was a first year medical student.  Life insurance salesmen descended on medical students like locusts on a wheat field, asking each one to give a couple other names of fellow students.  I refused to do that. Credit card companies in 1975 wouldn’t give me a card, when I became a physician (no way students ever got credit cards back then), because I was only an intern earning $10,000 a year.

I would have been much better off buying a 20-year $1 million term policy that I could afford. Every young married couple should have term insurance.  This is a time when people are usually healthy, their incomes are low, their debts are high, they may have children, and sudden death can devastate the survivors.   They can afford $500,000 term policies.  A whole life policy of that size is unaffordable.

Insurance salesman, however, make more money selling whole life policies, so that is why I got one.  It was an introduction to the world of people acting in their own self-interest. Having a fiduciary responsibility to a client means one does what is best for the client, not what is best for the provider’s income. As a physician, I had a fiduciary responsibility to do what was best for my patients, not me.  It meant that I got up at 2 or 3 a.m. to treat a drunk who had fallen, or a guy who had gone off his motorcycle and wasn’t wearing a helmet.  I was spat upon, had to hold a drunk still in a CT scanner, where the scans took a half hour to do, not a few seconds, yelled at, often not paid, but  able to be sued if I screwed up.  The next day, I was exhausted and functioned at a level of being legally drunk. Back then, in the “good old days,” doctors worked while exhausted.  I said at the time it was wrong, and I was slammed by my partners for saying so, because good doctors functioned well for 36 hours straight.  Research long ago showed that notion to be false.

Over the years, I have made many financial and medical mistakes:  I invested in a few REITs (Real Estate Investment Trusts), but not many.  I had suspicions that something was amiss in 2007, but I listened to my financial adviser explain them away.  He gave me an article by a Wharton professor, who ensured the reader that 2008 would be a great year. Financial advisors cannot be given carte blanche. I was executor of my father’s estate, and half of the legal advice I received was wrong.  Even the lawyers can’t understand our financial system, which is in my view deliberately made complex.

Credit card debt is a major problem and a classic example of how lack of regulation allowed banks to do well at the literal expense of their customers.  I pay the balance off every month.  Always. By doing so, I get an interest free loan from the bank.  Credit card debt has astronomical interest rates that only recently have been made public.  Many think that making the minimum payment on a credit card is all they need to do.  It is not.  The interest is charged on the full amount.

A brief comment on rate of return.  One will hear that a security has a 4% rate of return.  That rate does not include fees to buy and sell the security, nor does it include the taxes one pays on the gains.  It isn’t dishonest for the financial community to do so, but it isn’t realistic, either.  If I make $1000 on a stock but pay $400 in taxes and $50 in fees, I haven’t made $1000; I have made $550.  My wife and I had a house in rural Arizona.  We sold it for double of what it cost to build it, but after fees on both ends and capital gains taxes, over 20 years our rate of return was 1.8%.  That is a real rate of return:  money we had.  The doubling was simply a number, before costs of selling and taxes were factored in.   I take my net worth and multiply it by 70%, and that is my real net worth, because selling everything will be taxed.

I recently watched a story on Suze Orman about a 69 year-old woman, whose husband’s pension died with him.  She had a house underwater in Florida, and she was nearly destitute.  Indeed, she was living on social security, as do many Americans.  What happens to them if we “privatize it”?  Like the insurance agents descending on medical students, financial experts will descend upon the elderly.  Good looks and saying what people want to hear trump truth and fiduciary responsibility for the buyer’s best interests. A lot of elderly can’t understand finances and money, don’t think clearly, and are going to get burned.

I made many financial mistakes, and I teach math.  We don’t value math teaching and teachers;  the financial industry exists to do three things very well:  take your money in the form of high fees, move it around electronically, and generate paper.  Research has shown little value to society to moving money, compared to, say–a teacher.  I receive thousands of pages of financial paper annually (I sampled and made inferences), most of which are not understandable. I don’t have the time to read it.  Can you imagine how a poorly educated 80 year-old will handle it?  The few million words I get basically can be summarized with 12:  “you might lose all your money and we are not at fault.” Every other week, I receive a class action lawsuit notification about some company, often 4-5 copies, each 20 or so pages.   I have to decide whether to throw it away or try to research when I bought the stock and how long I held it.  I used to look up the information, but when the suit was settled in my favor, I got vouchers for something the company made.  I throw this stuff away now.  At least I can recycle it.

If I, a mathematician, who can tell you right away what the doubling, and tripling time of money is for a given interest rate is (divide the interest rate into 72, and 110 respectively, and the quotient is the number of years), cannot understand much of American finance, what chance does an elderly woman who has just been widowed have?  Or a young person out of school?  Mortgages should require a 20% downpayment and consume no more than 1/3 your income.  You don’t throw away money on rent; you have somebody else taking care of things that break, and you can leave when you want to.

Many live only on Social Security, never its intention, but now their only choice.  Many in Congress would like to destroy it and privatize Medicare, because the “market” will do a better job.  In Ayn Rand’s mythical world, the market does well.  In the real world of greed and grab, birth defects, viruses, auto accidents–heck, appendicitis–the market needs regulation, which it isn’t getting.  The “market makers” almost took down the world’s economy in 2008.  Many of them got bonuses worth more than I made in my lifetime for doing it, and I practiced medicine. Five years later, we still are not back to where we should be, many will never recover, and we are talking about removing the safety nets from those who need it the most.

While the paper continues to flow into my mailbox.

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KOBUK VALLEY, NP, ALASKA

July 17, 2013

I really wanted to see this Park, the most remote one of the 57 Parks in the 50 states. It is about 100 air miles east of Kotzebue and about 150 west of Bettles. Many people haven’t heard of either of these places.  Had I thought about it after the Noatak River trip in 2010, I would have been able to have gotten a trip from Bettles.  I had a Gates of the Arctic backpack in 2012 that I decided to add a Kobuk Valley trip on.  The good news was that we had an early pick up at Summit Lake, on the Continental Divide, because the pick up pilot knew we were there and that the weather was going to deteriorate.  We got out before the storm hit.

Unfortunately, the fact that the storm was coming from the west meant that the next day’s trip was not likely to be easy.  A group of 5 of us, a family of “park collectors”, like me, and me got into a float plane (Beaver) and got over Ambler, a town near Kobuk Valley, on the Kobuk River.  Twenty miles from the Dunes, we turned around because of low visibility.  We were over the Park, and I thought that might be sufficient, but it wasn’t.  It never is sufficient not to see something the way you want to see it.

Let me digress on that last statement.  I wanted to see Kobuk Dunes.  I didn’t want to camp there for a week, hike the whole park, or canoe the river through the Park.  Those are all worthwhile activities for some people.  For me, seeing the Park was seeing the Dunes.  Pure and simple.

In 2013, I decided I was going to see all the rest of the Alaska National Parks (there are 8, and I had been in 4).  I decided to set up a week trip do see the southern 3: Katmai, Lake Clark,and Wrangell-St. Elias.  I started thinking, and I realized I could fly to Kotzebue and try Kobuk from there.  Kotzebue is on the Chukchi Sea, and that in itself would be worth seeing.  I booked the trip.  I flew from Phoenix to Anchorage, stayed a day in Anchorage, flying that evening to Kotzebue.  With no obvious taxi, I schlepped everything to the Nullavig Hotel and stayed the night.  I was told by Jim Kincaid of Northwestern Aviation that we would be flying the next day, probably in the afternoon.  The following morning, he confirmed that for me.

I took a walk right after an early breakfast, and I headed over to Northwestern Aviation’s office.  I don’t know why I did, but in Alaska, one does things like this.  Right after they opened, I walked in, and Jim met me, saying, “I’m really glad you’re here.  Can you go in 30 minutes?  I have some people I can’t pick up this morning, but I need to go this afternoon.”

I said that if he could take me back to the hotel, I could get my luggage and be back in 30 minutes.

It took 13.  I had everything pretty much packed before I had left the hotel the first time, so when I went in, I stopped at the desk and asked them to get my bill ready, while I went up to my room.  When I came down, the bill was ready, I paid and left.

We had to push the airplane into position, we got in, and we were on our way out over Kobuk Lake, brackish, and then to the north side of the river, passing Kiana.  We then crossed the river and went through a couple of small squalls until we reached the Dunes.  I didn’t even see the runway on the sand until we were 100 yards away.  We landed, got out, and I had a half hour.  Only a half hour?  Not less than a half hour!!  I sprinted up the ridge to a large dune, where I could look out over trees and a stream.  It was quiet, the sand was damp and firm, the size of the dunes huge, with a copse of trees and a stream nearby.  I immediately thought of it as a place to camp.

Time passed quickly, I got my pictures, we got into the plane, and we headed back to Kotzebue.  It was a wonderful trip, and I got into my 45th park on the second try.

We brought in the sign and put it in the sand. Kobuk has no trails, roads, NPS office (except in Kotzebue).

The copse of trees was by a small stream. To camp there would be lovely.

Plants can grow almost anywhere.

The size of the dunes is remarkable.

I suddenly realized that my footprints were a nice addition to nature.

More of the same.

Just such a lovely spot.

On the return trip. The Kobuk River has six channels, and this was only one of them.

Runway two seven at Kotzebue. It is too short for full size 737s, which have a special dispensation to land here. I thought when we came in, there was a bit more thrust reversal than usual.

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Posted in ALASKA TRIPS, KOBUK VALLEY NP, MY WRITING, National Park Odyssey, UNPUBLISHED OUTDOOR WRITING | 5 Comments »

WILDLAND FIRE IS INHERENTLY DANGEROUS; NO MORE PURPLE RIBBONS

July 6, 2013

Ten Standard Fire Orders 

  1. Fight fire aggressively, but provide for safety first.
  2. Initiate all actions based on current and expected fire behavior.
  3. Recognize current weather conditions and obtain forecasts.
  4. Ensure instructions are given and understood.
  5. Obtain current information on fire status.
  6. Remain in communication with crew members, your supervisor, and adjoining forces.
  7. Determine safety zones and escape routes.
  8. Establish lookouts in potentially hazardous situations.
  9. Retain control at all times.
  10. Stay alert, keep calm, think clearly, act decisively. 

Eighteen watch-out situations 

  1. Fire not scouted and sized up.
  2. In country not seen in daylight.
  3. Safety zones and escape routes not identified.
  4. Unfamiliar with weather and local factors influencing fire behavior.
  5. Uninformed on strategy, tactics, and hazards.
  6. Instructions and assignments not clear.
  7. No communications link with crewmembers/supervisors.
  8. Constructing line without safe anchor point.
  9. Building fireline downhill with fire below.
  10. Attempting frontal assault on fire.
  11. Unburned fuel between you and the fire.
  12. Cannot see main fire, not in contact with anyone who can.
  13. On a hillside where rolling material can ignite fuel below.
  14. Weather is getting hotter and drier.
  15. Wind increases or is changing direction.
  16. Getting frequent spot fires across the line.
  17. Terrain and fuels make escape to safety zone difficult.
  18. Taking a nap near the fireline.

I’m going to be a Monday morning quarterback, but on the other hand, accidents and their investigation interest me, for we must learn from them. Commercial aviation has done so to a remarkable extent; medicine has not.

1949: Mann Gulch fire.  Thirteen died when the fire blew up due to strong winds.  From the time trouble was recognized until the men were dead was 11 minutes.  Those who died did so running uphill.  They died from asphyxiation or burns.  The fire was not affecting houses or civilian lives.  We had a culture from the 1910 fire, where 87 died, that all fires were to be put out before 10 a.m. the next day.  Ironically, this has created many problems we face today.

1994: South Canyon fire, near Glenwood Springs, Colorado.  In early July, a lightning strike started it.  Because some residents complained about smoke, a decision was made to fight the fire, which was not endangering any structures or lives, and was 5 acres when a decision was made to attack it, despite its being one of the lowest priority fires in Colorado at the time, where there were at least 35 fires burning, and resources were stretched.  When the fire was initially scouted, the difficulty and the risk were noted, and recommendations were made not to fight it in that particular area.  Catastrophes occur when there are major errors, but they also occur when there is a concatenation of smaller errors.  This fire was an example of the latter.  It was attacked because a person complained of the smoke–an inadequate reason.  Had the fire grown, it might well have been clearly inaccessible to attack in the place where the people who attacked it subsequently died.  It might have been fought differently.  I do wonder whether those who complained about the smoke ever wondered whether they were culpable.

Fourteen people died, including most of the Prineville, Oregon hotshot crew, when they descended a hill, in this worrisome area, in thick growth to build fire lines. Several members thought this maneuver was dangerous, because they had unburned fuel, extremely volatile fuel,  between them and a fire they couldn’t see (Watch out #9). Nobody spoke up, except some smokejumpers elsewhere on the fire, who did not think what they were asked to do was a good idea.  Eight of the ten major rules for fire fighters, 12 of 18 Watch Out guidelines were eventually compromised or violated.

A dry cold front came through that afternoon, predicted, but the information wasn’t relayed to the firefighters.  At 1520 hours, concerns were raised, and some left the area.  At 1600 hours, all left, but sawyers were still carrying their saws, and many were walking.  Twenty minutes later, they were dead, shelters not deployed.  Not only can fire move faster than we can run (this one moved 14 mph), superheated gases and radiant heat can kill people at a great distance, and winds can knock them over.  On Mann Gulch, winds lifted a survivor up and down three times.  The idea that fire suddenly erupts and people die with no warning is not true.  Fire does suddenly erupt, but usually there are hints.  There were such hints at South Canyon.  There were draws, and there was wind, an ideal situation for fire spread, and one that had been previously noted.  Many firefighters didn’t appreciate the severity of the situation until it was too late, for the safety zones were too far away and uphill.

The recommendations after South Canyon were hoped to make fire fighting safer.  They didn’t.

Thirty Mile Fire, Washington State, 2001.  Four fire fighters died after deploying their shelters in a rock field when a small fire earlier in the day suddenly exploded, overwhelming the crew. The problem was many small errors–virtually no sleep the night before (impairs judgment equivalent to being legally drunk), going suddenly to a fire that they hadn’t planned on, faulty equipment, slow start, and pulling in the lookout.  At the lunch spot, not a safety zone, two spot fires were noted up a dead end road (which had not been previously appreciated when the group arrived at the fire), and tankers were sent to the spots.  At this point, the hauntingly sad video given by survivors stops, and the listener is told to put himself in the position of the fireboss, rather than knowing what happened later.  The fireboss sent more help to the spot fires, had no lookout to look at what the main fire was doing, and ultimately, the whole group was cut off from escaping from the lunch site the other way.  Instead, they went up the dead end road (which also had civilians present) to what appeared to be a safe area, with a stream to the east, a rock slide with no growth (but fuel between the rocks), and the road.

Thirty minutes before the fire overwhelmed the crew, many were taking pictures of themselves, not looking for safe spots or beginning shelter deployment, not knowing this would be the last picture of them alive.

Shelter deployment means that people were in an area they should not have been in.  They were too far from the safety zone.  That happens.  Shelters are a last ditch effort to save oneself.  Had everybody deployed on the road, they would have all survived.  But some deployed on the rocks.  They died of asphyxiation.  Many at the time were not adequately trained to deal with shelters, which one must be able to get in either standing or lying.  Several wore fusees and backpacks into the shelter; fusees burn at 375 degrees and can ignite if in contact with the shelter itself.  Some lost gloves, which were in retrospect available and nearby, and others left backpacks too close to the shelter, where they burned, adding fire near the shelter.  I don’t know what I would do if I were in that situation.  I haven’t been trained; all of these people were.  Many deploying shelters do so when there is a great deal of wind from the fire, sometimes ripping the shelter from a person’s hand. When I saw this haunting video, I said to myself, “When the tanker on the downwind spot fire radioed that they needed additional help, that is when I would have pulled out.  Everything is going wrong on this day, and we need to regroup.”

We get back to the basic part of fire fighting.  It is dangerous, and everybody who fights fire knows that.  My experience is nearly nil, only having driven a water tanker on a controlled burn in 1995.  The culture had been not to question orders, and there is a degree of pride in being able to handle adversity.  Nobody likes to lose a fire, nobody wants to say that they couldn’t attack it.  Nobody wants to see houses destroyed.

What I don’t remember about 1994, although I could be wrong, was that we didn’t refer to the fallen firefighters as heroes.  They were professionals, and they were sadly victims. The fire should have been allowed to burn, nobody should have been deployed in any area that was unsafe, regardless of the risk to property and especially not because somebody complained about the smoke.  And that brings me to 19 years later, a lot closer to home.

2013:  Arizona.  Nineteen firefighters die fighting the Yarnell Hill fire.  We don’t know many details yet.  A lookout was posted, and he radioed that the winds had shifted and he was leaving.  We’ve heard he did all the right things, but I know nothing yet of whether his messages were received, or what else was said or not said.  Shelters were deployed, unlike Storm King, so there was more time for the firefighters to realize they were in trouble.  There wasn’t much time, but the early reports saying “nothing could have been done, the fire was on them in seconds” may not be accurate.  I don’t yet know.  More than one report is comparing the Yarnell Hill fire with the South Canyon fire.  Both were initially small, both were in difficult terrain with extreme drought, and both were handled by hotshots.  Both had a major, predictable wind event, both had unburned fuel between the firefighters and the main fire, and both led to disasters.

I suspect by the end of August, most of the investigation will be completed.  Lack of a meteorologist will be one issue, I suspect, or at least under appreciation of what the winds would be.  Working in dense fuels with fire nearby, not seen, will likely be another.  An adequate escape route will be another.  Beyond that, I would not speculate further except to unequivocally state, this was NOT an Act of God.  That statement to me is a copout, an excuse for not trying to understand circumstances that people should understand, and a way to sweep the matter under a rug.  Unfortunately, the mistakes made will be publicized, likely inflaming many communities as much as the fire did.  But mistakes were made.  Thunderstorm downdrafts, erratic winds, Venturi effects, plentiful dry fuel, and a burning fire are all understandable.  Whether we can predict what they will do is another matter, and evidence is beginning to mount that our modeling of fire behavior is inadequate due to increased size of fires because of suppression, climate change allowing bark beetles to survive winters, and more houses in the wildland-urban interface.  Ability to recognize danger and to speak up is part of firefighter training.  If we cannot adequately predict the worst case scenario, and plan for it, then we have no business sending people into harm’s way, except to save lives, not property.  Worst case scenario planning is why firefighters are required to have safety zones and exits to them, both hopefully plural.

Just as Challenger repeated 17 years later with Columbia, almost to the day, with many of the same cultural problems still persisting in NASA, so did South Canyon repeat 19 years later with Yarnell Hill, almost to the day.  I suspect, like NASA, there are still cultural problems in the firefighting community.  Hopefully, the investigation will uncover these issues, and the wildland firefighting community will address exactly how we will approach fires, what we will do, and what simply will not be tolerated.  Whether one wishes to call the men heroes dying doing what they loved is a matter of choice.  I call the men tragic victims who died, not one of whom expected to that day in Yavapai County.  I don’t call dying doing what I loved great.  If I love doing something, dying is not the outcome I want. But that is a my opinion.  We didn’t learn from Mann Gulch in 1949; 45 and 52  years later we had South Canyon and 30 Mile fires respectively.  We didn’t learn enough from them, and 12 years after 30 Mile we had Yarnell Hill.

To the Watch Out situations, I would add:

19. Size of fire does not matter.  Small fires can kill you.

20. Always be aware that you may have only 10 minutes to live, should things turn sour. Act accordingly.

My prediction:  another catastrophe will recur.  My hope:  It won’t.

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CONTEXT

June 29, 2013

“A fanatic won’t change his mind and won’t change the subject”  

Winston Churchill

Twenty-seven years ago, I went to trial for malpractice and was not convicted.  Many people say, “You can’t be convicted in a civil suit.”  My reply: “When you have been sued and have gone to trial, then come back and tell me what word you would choose.”

During the pre-trial deposition, quotations from a textbook of neurology came from the prosecutor, and I did not question them.  I learned something that day:  people quote out of context.  At the trial, the prosecutor grilled me on the stand: “Is it not true, doctor, that Adams’ Textbook of Neurology says, “a brain tumor is not likely to be missed.”?

I looked at the prosecutor and quietly said, “May I see the book, please?”  He handed me the book.  I read the paragraph before and after the quotation the prosecutor had used, which stated essentially that with classic symptoms and signs and good imaging techniques, yes, certain kinds of brain tumors were not likely  (italics mine) to be missed.  That is a lot different.

A little later, the prosecutor quoted the textbook again, and again I read the pertinent passages before and after the quotation, politely handing the book back to him.  A third time, this happened, and again I asked for the book.  The prosecutor literally threw the book at me from four feet away.  I never have forgotten that.  At least one juror gasped at the rudeness.  I stayed calm, again reading the passages before and after.  I wasn’t sure what the jury was going to do, but after I stepped off the stand, the bailiff came up to me and said, “You’re a hell of a witness, doc.”

Of course, not losing didn’t mean I won, and I was never the same again.  A few years later, I left medicine.  I still feel like I was a bad doctor, nearly three decades later.

Out of context quotations are dangerous, and one recently surfaced when an Austrian woman came and spoke in Boston about the lack of free speech given to those who speak out against Islam. She spoke at a synagogue, and a person I know in Germany sent me the article.  This individual and I have very different political beliefs, although we share a concern about young women–often girls–who are forced into marriages with older men, have limited rights in their society, and can be killed by family members for not agreeing to these marriages.  These are well documented facts.

The woman who sent me the article is to me quite typical of those who are politically far right of me.  They have several common approaches.  One is to write comments with questions, rather than making statements.  A second is to send me articles, the implication (to me) that if I only would read this article I would come around to their way of thinking.  Third, they have never–that is true, the number is zero– read anything I have sent, so I no longer send articles.  A fourth characteristic is they take things out of context and often use words I don’t.  That’s how I know they are talking out of context. At a medical meeting once, I quietly asked one of my detractors  and the rest of the group if I had used a word she just had.  The room remained quiet.  The point was made.

The first article I got from the woman in Germany, a non-scientist, was that climate change wasn’t occurring.  The article, written by a non-climate scientist, good looking woman, paid by ExxonMobil, quickly stated, “Don’t let them fool you.”  Those words are not scientific, and it violated the first rule I have in dealing with those who disagree with me on science–personalization of the issue.  To a high level of confidence, we are causing climate change.  The confidence is not 100% (meaning we could be wrong), because climate is complex; but to disagree, one must offer high confidence limits that include 0, no change.  I have not seen any such articles.  I won’t discuss my other rules here.

The article about the Boston speech mentioned several men who allegedly had their rights infringed upon for speaking out.  I researched  the first man and found disturbing parts of his past behavior.  I wondered why he was used as an example.  Then the woman mentioned what “Barack Hussein Obama” had said, and my hackles rose.  Obviously, she knew Hussein is a charged word in today’s society, and she used the President’s name in a way that I consider rude, especially from a foreigner in my country.  I realize others might not agree, but to me, she was playing “loose” with Mr. Obama’s name.  I doubt Mr. Obama would care, but I did.

The quotation was “The future must not belong to those who slander the prophet of Islam,” and this was meant to imply that Mr. Obama supported those who were offended by complaints against Mohammed.

Personally, there is no love lost between me and fundamentalists of any breed, including Christianity.  Others feel differently. But I thought that Mr. Obama had said more than what was quoted, and I found the rest of the paragraph quite easily.  First, one had to recognize that the President spoke at the UN about the infamous video insulting Mohammed was circulating on YouTube, inciting violence.  That context was crucial, because it meant that Mr. Obama was criticizing the video maker, not everybody who criticized Mohammed. He continued:

“Yet to be credible, those who condemn that slander must also condemn the hate we see when the image of Jesus Christ is desecrated, churches are destroyed, or the Holocaust is denied. Let us condemn incitement against Sufi Muslims, and Shiite pilgrims. It is time to heed the words of Gandhi: “Intolerance is itself a form of violence and an obstacle to the growth of a true democratic spirit.” Together, we must work towards a world where we are strengthened by our differences, and not defined by them. That is what America embodies, and that is the vision we will support.”

This is a very different view from the first line, and the quoting out of context meant that the speaker was deliberately choosing what she wanted to choose.  This is done by many, including the man who prosecuted me for malpractice, but it is wrong, and violators need to be called out on it.  To me, the speaker had lost credibility, and I wanted to call my German contact out on it.

How I did that was difficult, but I know exactly how I must do it.   I am incapable of writing what I feel and sending it immediately.  I am an emotional person, and if I am not careful, my emotions will hijack me into using sarcasm and hurtful, non-factual comments.  In short, I become the person they often are.  I thought about the comments for three days, then I sat down and suddenly, opened the computer and wrote 1200 words–in English.  I then let the writing sit for a day, removed the anger, the sarcasm, the nastiness, stayed factual where there were facts, and translated it to German.

Eventually, she wrote me back, and I sent the article.  I was disappointed in the response, not because she disagreed, but because she did not even acknowledge my comments about context, which are as basic to arguing what people believe as statistics is to arguing whether a trend exists. My last paragraph discusses the words I use–probably, possibly, I think, I once thought, I am 95% confident, and “I could be wrong.”  These are words of science, of probability and uncertainty, of openness, of being human.

My letter to her in German is not good German, but I am self taught, and it was important to write her in her language.

Es ist nicht einfach, diesen Brief zu schreiben.  Ich bin absichtlich verschwunden, um Deinen Artikel zu denken und endlich darüber zu schreiben.  Ich war enttäuscht und ein bisschen wütend.  Wahrscheinlich würde es besser verschwinden, weil diese kürzlichen Tage sehr schwierig für mich gewesen sind.  Ich will schreiben, ohne Sarkasmus, ohne wütend, und mit allen Tatsachen.  Ich werde in meinem Brief nur zwei Fragen stellen, weil viele Radikalemenschen mir die Frage stellen mögen, wenn sie mir schreiben, und das gefällt mir nicht.  Ich schreibe, ich stelle oft keine Fragen, die ich die Antwort schon wissen.

Vor mehrere Tagen hast Du mir eine Frage gestellt (vide infra).  [Übringens habe ich gesagt: Seit 20 Jahren gab es keinen Krieg in den Balkan, nicht die Welt.  Achttausend Muslimen sind in Srebrinica gestorben.  Ich erinnere mich daran.  Dieser Krieg hat in Dayton, Ohio, mein Land beendet.  Unser Präsident war Clinton, ein Demokrat.  Es war das erste Mal, dass einen Krieg beendet wurde, mit nur den Luftverbomben.  Die Republikaner hatten gesagt, dass es unmöglich sein würde.]

 1. “Syrien?”  Es ist eine Tragödie des Menschens.  Mein Land können nicht mehr die Welt retten. Ich frage mich, ob diese Frau und Europa wollen, dass Amerika in Syrien mit unseren Soldaten, mit unserem Geld kämpfen sollen.  Wenn es viele Probleme stattfinden werden, und vertraut mir, es wird viele Probleme geben, wird man sagen, “Verdammten Amerikaner.”  Plötzlich wird niemand sagen: “Vielen Dank.”  Es hat immer stattgefunden.  Immer.  Ich bin alt, und ich habe es oft erlebt.

 2. Deine zwei Artikel haben mich beleidigt.  Ja, beleidigt. Das letzte Mal, dass ich so beleidigt war, eine muslimiche Frau, die Dagestan auskam, hat mir geschrieben, dass meine Regierung 9/11 verursacht hat.  Wieder bin ich sehr enttäuscht, und ein bisschen wütend. 

Die Wahrheit macht uns Frei.  Aber sie ist die ganze Wahrheit, nicht ein bisschen Wahrheit. Es ist sehr wichtig, der Unterschied zu erkennen. 

Sie hat “Barack Hussein Obama” gesagt.  Das ist unglaublich unanständig für eine Ausländeringaste in meinem Land zu sagen. Ja, wir haben unsere First Amendment.  Sie können sagen, was sie willst.  Wir bedürfen nicht, höflich zu sein.  Er ist President oder Mr. Obama.  Sie hat absichtlich “Hussein” gesagt, um ihre Zielgruppe zu beeinflussen.  Ich bin voll überzeugt.  Ich werde alle Opfer nicht hier diskutieren.  Ich habe ein paar schon erforscht, und ich war nicht beeindruckt, besonders der erste Mann. 

Sie hat seine Ansprache nicht im Zusammenhang zitiert.  Das war völlig falsch, und sie soll sich schämen.  Mit diesem großen Fehler kann ich ihre ganze Ansprache nicht glauben. 

Hier ist der volle Absatz.  Meine letzte Frage: hast Du dieser Absatz gelesen? Wenn ein Zitat merkwürdig erscheint, lese ich immer den Zuhammenhang.  “Ich liebe die Muslimen, die nicht zu Europa kommt” kann “Ich liebe die Muslimen” werden, und nicht mehr. Leider habe ich mehrmals gesehen.  Hier: 

“The future must not belong to those who slander the prophet of Islam (Es war sehr wichtig zu verstehen, was passiert ist, wenn Mr. Obama darüber gesprochen habe.  Es gab ein schlechtes Video auf YouTube, das von den USA auskam.  Es gab nichts mit Sabatina oder mit anderen muslimischen Kritiker(in) zu tun.  Es geht ein Video.  Du mußt  in diesem Rahmen erkennen, darüber Mr. Obama gesprochen hat). Yet to be credible, those who condemn that slander must also condemn the hate we see when the image of Jesus Christ is desecrated, churches are destroyed, or the Holocaust is denied. Let us condemn incitement against Sufi Muslims, and Shiite pilgrims. It is time to heed the words of Gandhi: “Intolerance is itself a form of violence and an obstacle to the growth of a true democratic spirit.” Together, we must work towards a world where we are strengthened by our differences, and not defined by them. That is what America embodies, and that is the vision we will support.” 

Das war der ganze Absatz.  Das ist die ganze Wahrheit.  Sie hat absichtlich das Zitat nicht im Rahmen, um die Menschen zu beeinflussen.  Ich kann ihre Ansprache nicht vertrauen.  Es gibt keinen Grund zu tun.  Meine Frau konnte es auch nicht glauben.  Man muss immer im Rahmen zitieren.  Es ist traurig, weil die Tatsachen sich sprechen können.  Sie hatte genug Tatsachen, ohne diesen Fehler zu machen. 

Ich kann verschwinden.  Wenn Du etwas diskutieren wollst, kann ich bleiben.  Du kannst entscheiden, ob ich ein wertvoller, aufgeschlossener Mann bin, mit wem Du schreiben willst.  Ich kann Dir sagen, dass ein Fundi hier gesagt hat:  Weil ein LGBT Umzug in New Orleans geplant war, ist warum Hurricane Katrina kam.  Der Gott hat New Orleans bestraft.  Ja, hat gesagt.  Oder eine Frau, die ist vergewaltigt, wird nicht Schwanger werden, weil ihr Körper eine Verwaltigung erkennen, und kann eine Schwangerschaft verhüten.  Jedoch muss die Frau das Baby haben. (32K Babys gebären nach den Vergewaltigen hier jedes Jahr).  Vielleicht wird Sabatina diese Tatsachen wissen wollen.  Oder nicht.  Ich weiß nicht, aber ich denke, dass es hier ein “Republikanerkrieg gegen Frauen” gibt, ein Missbrauch der Frauen.   

Wenn Du über Deinem Garten, über der Erde, über deine Familie, uber dem Leben, schreibst, würde es gut sein.  Alles Artikel gefällt mir nicht.  Ich habe Dir keinen Artikel geschickt.  Es ist für mich höflich nicht zu tun.  Du wirst ihn wahrschinlich weder wollen noch lesen.   Ich werde ein Artikel lesen, aber wenn ich etwas voll Unrecht finde, würde ich den ganzen Artikel wegwerfen.  Jetzt bist Du null für zwei.  Mein Brief über Syrien wird diese Woche  in The New Yorker Zeitschrift erscheinen.   TNY ist sehr wohlbekannt hier, und einen Brief ist sehr schwierig in diesem Zeitschrift zu haben.  Ich bin ein guter Wissenschaftler, Arzt und Stastiker.  Ich bin sehr neugierig.  Ich kann gut schreiben, und ich lese sehr vorsichtig.   

Endlich schlage ich die Leute vor,  diese Wörter zu lernen, dass ich oft benutzte:  “Vielleicht,”  “Wahrscheinlich,” “Ich denke,” “Ich dachte einmal, aber jetzt denke ich nicht”, Ich habe 95% Zuversicht” und am wichtigsten:  ICH KONNTE UNRECHT HABEN. Man würde gut tun, diese zu lernen. 

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THE NEW YORKER LETTER

June 23, 2013

One has to be a writer to appreciate fully how we want to get our work accepted by the top publications in the world.  The New Yorker has a circulation of over a million.  The articles are extremely well written; I have long been jealous at the medical writers, who put me to shame.  But I read every word they write.  A very good friend, writer, and neurologist helped me write A Wise Owl, which won me the Creative Expression Award for Human Values in Neurology 10 years ago.  His goal was to get a letter published in the magazine.  Sadly, he died before that could happen.

I don’t set out to write letters to get published.  I read something, and if it connects with me in some fashion, I write.  It is difficult for me to do so, because I am under a time pressure, which adversely affects my writing.  I am under a word pressure, too, but I have learned to cut words.  Some will say, “You should have said such and such.”  Maybe, but if the letter is too long, it will never appear, so all the wisdom is lost.

The current letter had to do with an article about Syria.  I thought Senator McCain, who represents me in the Senate, was allowed too much space and did not see the same picture I did.  I thought maybe I had something to impart on the debate, so I wrote.  I never expected anything to come of my letter, but last week, I was told it was a “finalist,” which gives one some idea of how difficult it is to get writing into the magazine.  I said to my wife that I got lucky, but both of us realized it wasn’t just luck.  I get a high percentage of my letters to the local newspaper published, because I pick my battles carefully and keep the letters short.

 

Filkins reports that Senator John McCain has pushed for military intervention in Syria. But I doubt Republicans in 2013 will tolerate “emergency authorizations,” even if they raised no objections to these off-budget costs a decade ago. Indeed, overruling a national security team might show more wisdom than McCain might think. President Obama overruled his Secretary of Defense in 2011, when he authorized the raid that killed Osama bin Laden. Obama is weighing morality, costs, and unintended consequences of another conflict after learning the hard lessons of exiting the military morass in Iraq and Afghanistan. Perhaps he is heeding the proverb, “The more we sweat during peace, the less we bleed in war.” 

Michael S. Smith

Tucson, AZ

 

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BELIEVING IS SEEING

June 14, 2013

My wife read a CT Scan of the heart recently, done to check coronary artery calcification, and told the referring physician the patient had breast cancer.

Whoa!  What does that have to do with heart disease?  The answer: nothing, and that is the point: we need radiologists to read films formally and not clinicians, and I say that as a former clinician who read CT head scans really well.  It’s fine for a medical group to have its own X-Ray facility and for clinicians to read the images.  But every image must have a formal reading by a radiologist, for that individual is both unbiased and trained to look at everything on the image, every corner, every part.  There is no law in nature that says a person will have one thing wrong.  It is entirely possible for a neurologist to look at an MRI of the spine and miss a large abdominal aortic aneurysm.  We see what we expect to see.  Seeing isn’t believing.  Believing is seeing.  We believe something, and we tend to look for it.

On a CT scan, there is a side view, which shows the skin.  This isn’t a mammogram, but it certainly is capable of showing a breast cancer.  In addition to the breast cancer, there was a “ground glass” area in the lung suggesting there might be an early lung cancer, too.  Wow. A CT scan of the heart is done for coronary disease, and two other systems have primary cancers.  Maybe the cardiologist would have found those, but I doubt it.  I doubt when I read CT scans of the head that I would have found a throat cancer, even though the throat was scanned and on the film.

In my defense, I was once sent a patient with leg pain, with a concern that this was due to pinched nerve in the back.  The lady had pain near the knee, but it was point tender, and I obtained a bone scan, looking for a fracture.  I found a hairline fracture of the proximal  tibia.  I got a lot of pleasure diagnosing something correctly out of my field.  Most specialists do.  There is a cardiologist in town, whom I met 31 years ago when he was new here.  I had seen a man in the emergency department who had driven 2500 km to Arizona and presented with sudden, brief unconsciousness.  I saw him and noted he seemed to be breathing a little faster than normal.  I obtained an arterial blood gas and found pronounced hypoxia.  Thinking that a cardiac arrhythmia would cause unconsciousness (strokes seldom do), and thinking of pulmonary emboli as a cause of both that and hypoxia, I did a lung scan, since that is what we did back then, and there were pulmonary emboli, because of leg clots that occurred during prolonged sitting on his drive to Arizona from Minnesota.  The cardiologist happened to be present, and I referred the patient to him.

Several years later, one of that cardiologist’s partners referred a patient to me on whom he had diagnosed an occipital lobe infarct.  For a neurologist, that is not difficult, but I was impressed the cardiologist had picked it up.  Most non-neurologists miss it.

So when the MRI of my neck was unchanged from 9 years ago, that was good news, I was a bit chagrined, however, when the radiologist told me that I had a significant thyroid nodule.  It never occurred to me look for thyroid disease on my MRI.  It is sort of like people’s being surprised when I tell them the Moon is visible in broad daylight.  “It is?” they say.

“It’s there, isn’t it?”  I reply.  The thyroid nodule was quite present.  Once I looked, there it was, plain as can be, like the first quarter Moon in the southeastern sky in the afternoon.  Try finding the Moon in daylight, sometime, if you haven’t seen it.  You will discover a whole new world–literally., and wonder why you never noticed it before.  That’s the problem.  We notice only what we are willing to notice.  Once we are willing to notice many things, a brand new world opens up to us.  Like the Moon, or even Venus, which you can often see in broad daylight, if you know where to look.

Look around you.  See, smell, touch, hear, and taste the world.  Notice things.  Life becomes very interesting when you do.

Even when you have an “interesting” thyroid nodule.  By the way, it was benign.

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