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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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“THIS CAN’T BE HAPPENING TO ME”

June 8, 2013

Last week, an elderly couple, experienced canoeists, capsized in Upper Basswood Falls, which straddle the Canadian border, and the 78 year-old man drowned.  His 75 year-old wife made it to the Canadian side.  She heard him say, “I can’t move,” but was unable to help.  I can imagine that.  Ice out was 3 weeks ago, and she probably was hypothermic.

I don’t like Upper Basswood Falls.  Never have.  A couple once left their young daughter at the end of a portage, while they returned to get the remainder of their gear.  She fell in the river, and that was the last time they saw her alive.  I was there on September 12, 2001, and that’s where I first heard the news that the world had changed forever.  In 1991, I did one of the most stupid things I have ever done in the woods.  Solo, I was coming upstream, on the Canadian side, and moved forward in the canoe to deal with the current.  I later learned that there are three things that a solo canoeist cannot manage:  wind, muck, and current.  I was  thrown out of the canoe, without its capsizing.  I found myself suddenly underwater thinking “This can’t be happening,”  usually the first thought people have in these circumstances.  It isn’t a good one. Quetico maps often don’t show portages, and when I went ashore, there was a short carry.  Fortunately, the water was warm, and all that was hurt was my pride.  I could have drowned, because back then I didn’t wear a PFD (Personal Flotation Device), either.  I know that, because I was underwater, which wouldn’t happen with a PFD.  I made two bad decisions and got away with them.  In 40 years of canoeing, it is the only time I dumped.  I’ve worn a zipped up PFD since, for it cannot come off.  The victim was found without one.

Upper Basswood Falls is not a waterfall but a series of falls, and there is a long portage around them.  The Horse Portage, as it is called, is 340 rods (1700 m).   It is longer, should one choose to set in downstream a little further, which I have also done.  The trail is not good, and the put in spot isn’t, either.  But in high water, it is safer.

The couple had reportedly discovered they could paddle Upper Basswood Falls and avoid the Horse Portage. The thought of bypassing the Horse Portage has never crossed my mind, and I’ve paddled 5 miles (8 km) of Class III rapids in the Far North on the Nahanni, a week’s travel from civilization and no way out other than on the river. This information shocked me.  A solid rule in the Boundary Waters-Quetico is never to paddle rapids if a portage exists.  In known high water, with 3 feet of snow on the lakes a month earlier, probable water temperatures of 45-55 F., Upper Basswood is a killer.  The widow isn’t sure whether he scouted the rapids; that means that both of them did not decide together whether to continue.  In any case, he took a different channel from usual, and that was that.

A few people die annually in the Boundary Waters-Quetico from falls or drowning; lightning is another cause.  Rapids must be avoided; further downstream I once tried to dissuade a pair not to run Wheelbarrow Falls.  They asked me to take pictures.  I have some good ones, which first show the pair with no helmets and bare feet.  Not wise.  Then the pictures show the canoe tipping, going broadside, and two guys in the water being taken downstream.  They survived, unscathed.  The canoe was perpendicular to the rapids, full of water.  They said they could handle it, although a canoe full of water weighs about 600 kg.  I later learned they did get the canoe out, before the keel bent and the Grumman became scrap metal.

I told my wife last night I would never stay on shore if I heard her say in the middle of the river, “I can’t move.”

“I’d get you out, or we’d both go together.”  I really meant that.  She reminded me that we have animals.  I reminded her that we have each other.  I wouldn’t live with myself if I did anything less.  But, I said, “I wouldn’t put us in that situation.”  I won’t, and I haven’t.  I hope to be 78 and still canoeing, although I would be exceptionally careful in rivers, high winds, rain, and thunderstorms.   I insist she speak up any time something doesn’t seem right.  That took a while to get her to do, and for me to listen, but we’re better off for it. The man’s widow didn’t know if he had a life jacket on.  If I forgot to put mine on, my wife would tell me.  These are little things, perhaps, but in the woods, as in so many other places, it is the concatenation of little things that produces the disaster.  Was the reason the victim couldn’t move was that he was pinned down?  Would a PFD had prevented it?  We will never know.

Bad things happen.  Some are simply not preventable.  Lightning strikes kill, although if one pitches a tent where there are no tree roots and uses a pad, there is a good chance of avoiding ground currents.  Trees fall;  high winds are frightening, because healthy trees can be suddenly splintered like matchsticks.  I’ve seen it.   I will sleep during a thunderstorm; during high winds, I stay awake listening for the first loud “CRACK,” for once I hear it, we are out of the tent, until the wind dies down.  The BW had a derecho in 1999, wiping out 30 million trees.  Incredibly, nobody was killed.

Fire is another concern, and even small “distant” fires can blow up into monsters, which almost killed a pair in 2011, when the Pagami Creek fire ran 12 miles in a day, and the couple had to turn their canoe over in a river, stay underneath it, breathing the air that was there.  Getting caught in a fire that day was nothing anybody could have foreseen.  The couple survived a freak occurrence by doing the right thing.

I am not afraid to solo.  I did that in April in snow into Angleworm Lake.  Or almost.  The snow got too deep, the trail difficult to find, and the map showed more distance left than I had hoped for.  I didn’t spend time analyzing; I automatically turned around to return to a known dry spot on the trail that I had noted on the way in.  I was fine.  What I told my wife after the trip was simple:  “I think this was the smartest I’ve ever behaved in the woods.”  But being smart just makes the stupid things less likely to occur; freak occurrences and unexpected illnesses are wild cards.

I’m sure some might say that dying in the woods is not the worst way to go.  Maybe.  The problem with dying “doing what you loved,” is that people who love you are left behind, and others often have to put their lives at risk to recover your body.  It is clear if I am ever in the position where death is a real possibility, there is a good chance I did something wrong.  I’d like to think if I got on a river that was unusually high, a lake with huge waves, or a thunderstorm that looked really bad, I would tell my wife we were going to stop to think about our options.  Nature isn’t out to kill us.  Nature just is.  We decide whether we run rapids, deal with waves, lightning, bears, and falling trees.

It’s a real shame what happened.  I never dreamed an elderly couple would shoot the beginning of Upper Basswood in spring.  I’m just filled with sadness, hoping some learning will come from this.

If there is one, only one rule I would tell people in the woods, it is this:  if you aren’t certain what to do, stop immediately and think of your options, remembering the best one likely is to turn back or change what you are doing.  It may be inconvenient and annoying, but you will survive to have those emotions.

If you allowed me a second rule, it would be this:  “Nobody ever drowned on a portage.”

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DRESSING UP A PIG

June 1, 2013

In 1967, when we began heavily bombing North Vietnam, we called it a “protective reaction.”  Doonesbury asked “what are the casualties?”  The answer, in the same cartoon, was, “On language, very great.”  The following year, we heard, “We had to destroy the village in order to save it.”  We use derogatory terms I won’t write here to de-humanize an enemy, since it is easier to kill somebody one doesn’t think is human.

In many instances those somebodies are women and children.  Let’s start with circumcising women, which I will call by a proper name: “Genital mutilation.” This has no medical reason, unlike male circumcision, which completely prevents penile cancer and makes HIV less prone to be transmitted.  I don’t remember mine, and I don’t believe it caused lasting harm, but I am open to evidence on the latter, just not the former.

I read recently that Reuters refuses to use the term “Terrorists,” and the Associated Press now refuses to use “Islamic terrorists” or “illegal aliens.”  This is equally bad as dehumanizing an enemy.

I’m a liberal, but I am a strong believer in using the proper word to describe a situation or condition.  An improper word or phrase, used frequently, can become harmful if it becomes ingrained in the vocabulary.

Examples of the latter include “The Death Tax,” which is the estate tax.  There is a threshold over which the estate is be taxed at about 40%.  The threshold varies and is now $5.25 million. The proper term is “Estate Tax.”

“Death Panels” were used when during the debate on the Affordable Health Care Act (called Obama Care, another misuse of the language, since the Congress passed the law, and the Supreme Court upheld it).  One part of the bill was to have Medicare pay for counseling on End of Life planning.  As a neurologist who dealt with end of life issues, often when no other physician was willing to do so, I found that lack of advance directives was a significant impediment to decision making families had to make, when a member had irreversible brain injury.  I saw families torn apart over the issue.  Paying to have these discussions with competent people in advance seemed to me to be a good use of money, since the amount was 1-5% of the cost of one day in intensive care, and many of these people languished, and that is the proper word, in intensive care for days, weeks, or in some instances months. I saw this often.  Many elderly want their estate going to their offspring, not for futile, unwanted care. ICU beds are in short supply, so having them used to house patients who were going to die soon, when seriously ill people could benefit from those same beds, made no sense.  I made sure neither of my parents lingered.  They made me promise not to let it happen to them.

I practiced in a Catholic Hospital, and the Church had no problem with discontinuation of futile care.  Nor should anybody else.  I used terms like “die,” and “death”, hard words, but final in meaning.  “Expire” is too soft, and “pass on” implies something I don’t believe in.

Some of the terms we use would be funny if they weren’t so pernicious in their ability to dress up a pig in such a fashion that people forget it is still a pig.  “Pre-owned” means “Used”, half the letters and twice as easy to understand.  “Fastest growing” is another term for “smaller,” since large firms need proportionately more money to grow a given per cent. If my firm grosses $1 million a year, and next year it grosses $1.1 million, it has grown 10%.  If my competitor grosses $100 million a year and next year grosses $105 million, his has grown 5%, but his share of the market has increased nearly 4%, from 100/101  to 105/106.1.  The amount of new business in the market has increased $5.1 million, and nearly 98% of that increase went to my competitor.

We can say “undocumented immigrants,” and the term is correct.  But people who cross borders without going through customs and immigration are violating the law.  That is why we have the word “illegal.”  There may be all sorts of reasons for the person to do so, and there may be appropriate words for those reasons–fleeing a repressive regime, starvation, an epidemic of disease.  But the person is still performing an illegal act.  Whether the act is immoral is another matter altogether.  We saw during the last financial crisis that people did immoral acts that were not necessary illegal.  We should not confuse immoral and illegal.

Beheading a British soldier in broad daylight and saying that his country is responsible for killing millions of Muslims daily is a gross act of religious terror and exaggeration.  [Mathematical note:  “millions of people daily” would require about 5 years to have no Muslims on the planet, using a minimum number of “2” for the plural and 2 billion for the number of Muslims.  This error was not brought out in any article.]  Terror scares people, and that act scared the hell out of me.  Since this was a brutal act carried out in the name of religion, both the act and the modifier belong. I fail to see why Reuters won’t use the term.  Indeed, a mullah interviewed on British television refused to call the beheading an “abhorrence,” using only the word “shocking,” which is far milder and has many different meanings.  Abhor is very clear, and the man refused to use the word.

My liberalism has limits.  When I saw Corregidor, the American Cemetery in Manila, the prison where men drowned during high tide, I felt strongly that we had a place in the world that we had earned through the blood of men who fought and died in places not many people know of today, like Guadalcanal, Tarawa, Leyte and Lingayen Gulfs, Bataan, Kwajalein, Enewetak, and Saipan.

The issue we face as a country is how we deal with a very nasty world without compromising our values.  For if we become what our enemy is, then we have lost.  But if we allow the enemy to proceed without resistance, then we have lost as well.  The world is not black and white but a large shade of gray.  Any time the gray hides something evil, we need to shine a spotlight on that evil and address it.

With a carefully chosen word or phrase, because it is proper, regardless of who may be offended.

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THE TERM IS NEITHER “PASS ON” NOR “EXPIRE”. THE VERB IS “TO DIE” AND THE NOUN IS “DEATH”

May 11, 2013

A 90 year-old man presents in an emergency department with abdominal pain and is found to have an abdominal mass.  It is likely he has colonic cancer with impending perforation.  He refuses colonoscopy, and he refuses surgery. “I am ready to die,” the man says, who is competent.  The surgeons think they can help him.  The man refuses again.  The surgeons say that without surgery, this will be a painful way to die.

This scenario is being played out as I write in a nearby city.  I was asked, as a former member of a hospital ethics committee, what I would do.

It’s difficult to say, without really talking to the patient and whatever family members are available.  I don’t know whether the man has a living will or a health care power of attorney.  If you don’t have either, I would do so at the earliest possible opportunity.  Don’t think because you are in your 20s, this isn’t an issue.  Accidents can leave people in permanent coma; Terri Schiavo, Nancy Cruzan, and Karen Ann Quinlan were all young, when a catastrophic event left each of them vegetative.

If the man is truly competent, he has the right to his decision.  Patients have the right to refuse things that we physicians think they ought to have.  This doesn’t hold for children, and more than one physician has given blood to a Jehovah’s Witness.  But one is on shaky ground to treat a competent patient who has refused such treatment.

That doesn’t mean we have to take care of that patient for that particular illness.  I had people refuse to take anti-convulsants for epilepsy.  I said that I would provide a list of physicians to whom they could go, and they had 30 days to do so.  I could not, in good conscience, have a patient whom I thought was a danger to himself and others be under my care, yet refuse my recommendations.  But, I also would not, as some did, fire the patient and dump the case on the hospital medical director, which more than one time happened to me.

The “painful death” part disturbed me.  Yes, peritonitis is painful.  So is colonic surgery, with a colostomy likely, and the possibility of further surgery, poor healing, infection, or pulmonary complications, for major surgery on a 90 year-old will be complicated by definition.

We can control pain.  We have palliative medicine physicians, and we have hospice.  There is no reason for somebody to die in horrible pain.  There are those who worry about addiction to morphine, which would be laughable in a dying patient, if the problem weren’t laughable and people really didn’t say that.  But they do.  We have a conflicting dichotomy in this country:  hospitalized patients are asked constantly about how much pain they are having.  Once you are an outpatient, then narcotics are bad things.  Oh, it isn’t quite that simple; however, the truth is not all that distant, either.  This dichotomy is grist for another mill.

There are others who worry that we will kill somebody by giving them so much morphine that they will stop breathing.  Morphine depresses respiration, but if a patient dies by receiving too much morphine, isn’t that in fact what was going to happen anyway?  What in the world are we so afraid of?

Death.

Not passing away, not going on to a “better place,” not “expiring”.  Death.  Dying.  Ceasing to exist as a human being.  I always used the term “death” in talking to families.  I wasn’t always popular, but I was far more often respected by people I cared about than I was despised by those whom I did not respect.

Yes, I do worry about contracting certain conditions.  I know medicine, and I know what can befall the human body.  But I am also worried about being kept alive when I would not want to be.  If I am vegetative, I wouldn’t be aware of it by definition, but it would be hell on my wife, and I would not want her to go through that.

I worry a great deal that I might end up in an ICU with a bunch of “keep him alive at all costs” folks working on me, long after it is obvious that the result will be poor and counter to my living will.  I worry that somebody will point out a “miraculous cure after 20 years in coma,” when in fact the person was vegetative and happened to smile, which vegetative people do.  I do not want my name associated with a court case, like the three women I mentioned above.  Nor do I want to hear “you never really know what will happen,” when we do know with extremely high probability what will happen. The best thing I did in medicine was not curing people, for I did little of that.  The best thing I did was allow people to die when it was time.  I knew when it was time, not to “give up,” but to accept reality.

The next day, both hospice and palliative care people talked to the man and his family.  He died soon afterwards.  For me, he no longer exists.  For others, he has gone to a better place, and they have memories of a long, happy life.  For all of us, he is no longer suffering.

 

 

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MAMMOTH CAVE, 2013, MIDWEST ROAD TRIP TO GET MY HEAD BACK ON STRAIGHT

May 7, 2013

It was time; indeed, it was past time, to get back into the woods again, even for a day or two.  A good hike in the mountains around Tucson would help, but I really wanted to get deeper into the woods.  The Vermilion Community College Scholarship Banquet is held the last Thursday of April, and twice I have canoe tripped into the Boundary Waters before the banquet.  I decided I would do the same this year.

I also decided I could probably see Mammoth Cave National Park on the way, if I went to Minneapolis by way of St. Louis, and drove from St. Louis to Mammoth Cave.  The distance is about 330 miles, but it is good road the whole way, and on a Friday I did just that.  Illinois, in exceptional drought the year before, was now in flood.  I could have canoed in the forests along the road, or in the open fields that would not be ready for planting for some time to come.  I was just behind the latest storm, and as I reached Mammoth Cave in late twilight, the temperature was in the low 50s, down 30 degrees from the day before.

The next morning, I awoke to fog over the Green River Valley, which cuts through the center of the park.

Morning Fog, over Green River Valley

One of many springs

Mammoth Cave is truly mammoth.  It is the largest cave in the world, nearly three times the length, in passages, of the next largest.  With more than 400 miles (650 km) of passages, the Cave offers several tours.  With my time limited, I took two tours, one in the original entrance, the other in the new entrance, that was blown up to make way for an entry point, back before the cave became a national park and entrepreneurs took people down into the cave, people wearing top hats, long skirts and high heeled shoes.

Saltpeter for gunpowder used in the War of 1812 was made here;

Saltpeter for gunpowder used in the War of 1812 was made here;

Bat on wall

In between the tours, I walked the 12 miles (20 km) of trails near the visitor’s center, then took a wildlife flower hike to relearn what I once knew about wildflowers, such as jack-in-the-pulpit and trillium.  The trees were just beginning to leaf out, and the temperature was mild.

Phlox

Jack-in-the-Pulpit

IMG_3046 IMG_3047

The Second Tour took us in a different entrance, one that was blown open when some cold air was exiting the cave and a small hole discovered.  This one descended about 270 steps and went through a wider variety of terrain.  There are longer tours that will show more of the passages, and there are caving tours, for those who want to see what exploring is like.

Gate to keep people from touching stalactites and stalagmites, since one touch will destroy any future growth. Past generations of visitors did this.

IMG_3064 IMG_3083 IMG_3084 150 meters below ground.

On Sunday, I drove back to St. Louis, first looking at the Green River Ferry:

Green River Ferry

….and doing one more trip around an area over one sinkhole and looking down on an underground river, above ground further south in the park, and here emptying in to the Green River.  This part of Kentucky is full of sinkholes.

Underground river emptying into the Green River.

Underground river emptying into the Green River.

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UNCOUNTABLE COSTS: HOW MUCH IS THE BOUNDARY WATERS WORTH?

April 30, 2013

There is serious possibility of opening a sulfide mine in the Boundary Waters watershed, with politicians on both sides supporting it, because it will create jobs.  I haven’t heard much about the costs of such an mine.  Costs are different from money.  For example, we have spent more than a trillion dollars in Iraq and Afghanistan.  That’s money.  The cost, in dead, maimed, displaced, and ruined families is uncountable, but I would submit it is enormous. Because we can’t place a value on a human life, we don’t, so the money we were told we would spend–a laughable $1.7 billion–was at least four if not five orders of magnitude too low.  Before going to war, costs should be understood, but few in Congress understand costs.

Without doubt, the mine near Ely would provide jobs, although mining is more than pick and shovel work these days.  Mining requires engineering skills, knowledge of geology, and more important, knowledge how to do it safely, which means disposing of the waste in such a way that the environment is not polluted.

There are a few of us who think this mine is a bad idea.  A really bad idea.  One company that may be involved is not American; while that doesn’t make it necessarily bad, they don’t have the deep connection to the Boundary Waters that some of us have.  Worse, these types of mines have in every instance been shown to have left toxic metals on the surface that leach into the water and pollute it.

The name of the most beautiful wilderness in the Lower 49 is the Boundary Waters.   Connect the dots.  This region has some of the cleanest water on the continent.  I have drunk from the lakes on every one of my 62 trips up there. How many places can we still drink water out of a lake?

Fish live in water, too.  The second Saturday in May is a special day in Minnesota, for it is fishing opener.  I wonder how people will feel about the possibility of far fewer fish, should the mine pollute the watershed.

But the mine won’t be a problem, I have been told.  I will hear the good-looking young men and women, who sound so sincere, say that there is nothing to worry about.  The executives, who have so much money to gain from the mine, will say technology will make this mine safe, and there won’t be a problem.  The jobs that will be created will be so important to the Iron Range communities, where many are short on money and long on clean water and forests.  Everything will be just fine.  Listen to the reassuring voices.  Look at the handsome young people.  Watch the pictures of cute deer drinking out of a lake near the mine site.  Everything will be fine.

Until it isn’t.  Let me repeat that in a different way.  Everything is safe until it isn’t.  That goes for Challenger, Columbia, Tenerife, the Comet, Electra, and DC-10, shipping oil out Prince William Sound, pipelines through Arkansas, Deep Water Horizon, Chernobyl, Fukushima, and I suspect Keystone XL.

When the you know what hits the fan, suddenly people will be sorry.  “It’s an Act of God,” “we couldn’t have possibly foreseen this,” “we will do everything we can to make you whole.”  And the company will file for bankruptcy.  I wasn’t born yesterday. I could name dozens of other catastrophes.

But then it will be too late.  It will NOT be an Act of God, any more than rheumatic fever or tuberculosis was, death from infected hangnails, or acute lymphoblastic leukemia. Complex systems will fail.  It is a matter of statistics and probability, and there are not many who understand these concepts.

The questions I ask are quite simple:

1.  How much is the Boundary Waters Canoe Area Wilderness worth?

2.  What is the probability that the mine will pollute, and how are you computing that probability?

The first  question has no answer, and the second is difficult to compute.  We could do an Expected Value analysis on  the Boundary Waters.  We could add up the tourism dollars, the cost of the timber, the fresh water, the campsites, and multiply it by 1, since it already exists with probability 1.  We could have the money the mine puts into the hands of the people of northern Minnesota (not how much ore is there, but how much money goes to the locals, which is a much smaller number) and multiply it by the probability it will cause no problem, which from past experience, is fairly close to zero, and get another expected value.  We then compare the two.  But the first expected value is too low, because no price can be placed on the Boundary Waters. We can’t place a cost on certain things, like people’s lives, unless we want to use human trafficking as a means.  Is this what we’ve come to?

Because these mines have ALWAYS had problems, it is incumbent upon those supporters to show why THIS mine will be different.  But let’s get back to what we can’t measure–the  value of wilderness that is nowhere else this accessible, this pristine, and this transformative of people.  No, we can’t say what that is worth, but it sure is worth something.  It falls into the category of “It ain’t for sale at any price,” and that is what some of us are saying.

There are a few other things that ought to be pointed out as well.

First, Ely, one of the towns that would be impacted by this mine, was once populated by miners, whose kids went to work in the mines.  There is a community college in Ely–Vermilion Community College–where the last Thursday in April is a scholarship banquet, where $42,000 is donated to students.  I am responsible for 3 of those scholarships. 

In 2007, I gave a scholarship to a young woman, whose parents came to the banquet.  Her father worked in the mines on the Iron Range west of Ely, where the mine tailings are, for lack of a better word–ugly.  He was so proud of his daughter, whose education would have her not go into the mines, the way he did.

Now we are offering jobs back in the mines.  We seem to be going backward.

Second, many call the Boundary Waters “God’s country,” a term used for unspoiled wilderness, Up North, in Boreal Country.  I wonder how many believers up there think that mining in a sensitive watershed is in keeping with Creation.  Just a thought.  BOUNDARY WATERS_2007114

The third issue I have is one that we don’t discuss in this country, because the major religions don’t believe in it, and many people don’t either.  We need to have fewer children.  If we had fewer children, we wouldn’t need to find so many jobs for them.  The notion that somebody can finish high school, go into the mines for good money (so long as the mine keeps working), buy a truck, a snowmobile, a boat, have 5 or 6 kids, lots of debt, and expects the kids will be able to do the same thing–and their kids, too–just doesn’t apply any more in this country.

I’ve got skin in this game, although I have no kids.  I think we leave some areas off limits to mining, just as we limited the dams in the Boundary Waters, even though it was a matter of cheap power.  Really?  Cheap?  What would the cost have been had we destroyed Curtain Falls and flooded Crooked Lake and Lower Basswood Falls?  It almost happened.

Crooked Lake at top; Iron Lake at bottom.

Curtain Falls today:  Crooked Lake at top; Iron Lake at bottom.

DSCF0026

The Friends of the Boundary Waters, of which I am a member, is going to fight this mine tooth and nail.  So is Steve Piragis in Ely, for whom preservation of the water resource is his livelihood.  I will support them.  The Friends wants to expand its scholarships too, so that more young men and women are trained to do jobs that wilderness management requires.  That is where the money ought to go.

It’s a harder slog to fight this mine as it was recently for me to get into Angleworm Lake in 3 feet of snow. IMG_3096 I’m not young, handsome, or have a reassuring voice.  I am in the minority who dares say we have too many people and that polluted wilderness will not return.  I’m looking at 10-100 years, not next week’s pay check.  I’m thinking of those like me, who need wild country to find themselves and to think thoughts that can only be answered in God’s country. I may not win.

But I am going to the mat on this one.

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NOT HAVING TO HAVE THE LAST WORD

April 27, 2013

Over the years, I have written many letters and many words, most of which were never read by others.  I got the anger and sarcasm off my chest by writing those words, but I decided against causing a lot of pain by sending those words out into the world.

A cardiologist I know, the  medical director of a cardiology program in the hospital where I was medical director, often sent letters that he obviously dictated, never read afterwards, and never let sit for a few days.  It fell to me, who was paid far less than he was, to reread the letters and tell the cardiologist what to write and what not to write.  Most of the letters would have been better off had he not written them.  The facts were not checked, the grammar was poor, and the point often could have been made with a lot fewer words or a telephone call.

With the onset of social media, it becomes very easy to comment on posts.  Many times, I have done so, only to delete the comment after it was written.  This morning, I started to reply to a comment on my comment, and finally just decided to let it go.

That’s really the secret:  knowing when to let something go.  If one insists on winning every battle and every argument, one may.  It is not a good way to live, and it almost guarantees failure of relationships with the opposite sex.  It took me far too long to realize that I needed to pick and choose those battles for which I would go to the mat on.  But even some of those, I would let the other person have the last word.  I’ve done that many times on Facebook, so I would not clutter up another person’s wall with my comments.

I often go to the mat on climate change, but I usually state my points and let the other person have the last word.  I make my five points very quickly:

  1. Is there anything I can say that will influence your thinking?  If the answer is no, then there is no use arguing.  We are now into the realm of ideology, faith, or religion.  I can be influenced about climate change; it is just that I require the following four statements to be present, and to date, they have not been.
  2. Can one state the argument without personalization?
  3. Will you use appropriate statistical terminology?
  4. Can you offer verifiable predictions to the Earth’s climate over the next 10-50 years?
  5. Can you state the consequences of your being wrong?

Once I have stated those issues and made my predictions, I have nothing further to add.  I will undoubtedly get something to read, which I will, until I see the first personalization of the argument, at which point I stop reading.

On gun control, which I also have strong feelings about, I am becoming more and more silent.  Like the conflict between Israel and the Palestinians, it flares up from time to time, and nothing will change in my lifetime.  I knew nothing would change after Newtown.  There are people who honestly believe that the government–the same government they say can’t do anything right–is going to confiscate their guns; something that is not being said by anybody in government.  They will not be influenced by me, and I am never going to change the feelings I had when I saw the handgun my late father had, when I cleaned out his apartment.  I looked at the gun, and I saw evil and death.  From a gun.  No, it isn’t likely I will be influenced, either.  So what is the point in arguing, other than to say as a teacher I will NOT carry a gun?

Most letters I write are about a quarter longer than they need to be.  They say all the feelings I have in my mind at the time.  I don’t omit anything.  They are powerful….and they are wrong and hurtful.

Letters with these strong emotions I require to sit for three or four days, unless they are a letter to the editor, more time sensitive, in which case I still let them sit for a day.  In that time, I discover some of the things I want to say really aren’t going to help my cause, may hurt it, are repetitive, and need to be deleted.

Posts that are on this blog are never written without letting them sit at least a week.  Sometimes, even that isn’t long enough.  Sometimes, a week is long enough to let them never see the light of day.  I got the issue off my chest, and that is what I really needed to do.

I didn’t need to put it on somebody else’s chest.

The disadvantage of allowing people the last word is that some make the mistake that my silence is tacit approval.  That is not true.  I might have decided the battle wasn’t worth fighting.  When I do decide the battle is worth fighting, one best be ready with statistics, probability, facts, and no tolerance for personalization of the issue.  That is the price I pay for waiting, being silent, and not having to win every argument.

That price is worth paying.

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LOOKER-UPPERS

April 1, 2013

Several years ago, out in the Sonoita Grasslands, southeast of Tucson, I saw a thunderstorm develop over in Rain Valley.  Several of the thunderheads were producing a lot of rain, but the southernmost one wasn’t.  Instead, it kept discharging cloud-cloud lightning, as if it had a choice to either rain or light up periodically, and chose the latter.  In any case, it looked like a giant lightbulb.  I thought that interesting, so I stayed out to watch it.  I often just sit somewhere and look up.  It isn’t wasted time.

I am a looker-upper.

As I continued to gaze, I noted Jupiter high to the right of “Lightbulb,” shining with a steady light, as planets do.  I knew the object was Jupiter, because of its brightness and location.  Now I had a gas giant in view, with its own clouds and storms, as I observed from a rocky planet with its own storms, all right before my eyes.

And “Lightbulb” kept discharging.

I was fascinated with the show, but I knew that storms don’t last too long in the high desert, and I began to think of going inside, grateful, as I always am, for any show that nature provides.  For some reason, however, I stayed out a little longer.  I’ve long known that a an extra minute spent just looking may occasionally be worthwhile.  Besides, I was absolutely fascinated with “Lightbulb”.

Suddenly, a meteor shot through the sky between Jupiter and “Lightbulb.”  There aren’t many times my jaw drops suddenly, but it sure did here.  I had a simultaneous show in three levels of the sky:  the troposphere, high above the stratosphere, and in outer space.  I said another thank you to the heavens, watched for a while longer, and then finally went inside.

There is one other place I have seen three parts of the sky come into splendid conjunction.  If one travels to the Platte River in March, near the Great Southern Bend of the river, one may see the Sandhill Crane migration.  I really should use three different verbs here: to see, to experience, and to transform.  Many people see the migration, some experience it, and a few–like me–are transformed by it.  Transformation of a person by a sight means that the person is never again quite the same.  Not many sights transform me: a total solar eclipse did, and so did a sighting of a wolf in the wild 12 feet away, with nobody within 10 trail miles.  That’s heady stuff, being transformed.

To see these spectacular birds, with their haunting call, darken the sky during a splendid Nebraska sunset and a full Moon rising in the eastern sky may transform a person.  I volunteer in Nebraska every spring, paying my way up there and working at Rowe Sanctuary, so I can go to the viewing blinds morning and evening.  It’s really selfish, but I do some work, too.  I work with other volunteers and Rowe Staff, all of whom are looker-uppers.

SUNSET CRANES

SUNSET CRANES

Sure, this conjunction may be explained by biology, astronomy and physics, but I doubt  many observers in Stevie’s Blind at Rowe Sanctuary on a March evening feel that way when twenty-five thousand cranes in the sky land right in front of them.  I doubt Stevie Staples, for whom the blind was named, looked at the cranes that way, either, and she was a teacher.

PART OF A FLOCK OF 20,000

Once one becomes a looker-upper, the person may become a bit of an astronomer, meteorologist, and birder, too.  Oh, I don’t mean the person can spot Andromeda Galaxy without optical aid, knows the difference between a Pied-billed and a Western Grebe, or can tell whether the sky is convectively active, but the person is learning.  I find myself looking up at the day sky, noticing where the deepest blue occurs.  There is a mathematical point in the sky where the sky is bluest, depending upon where the Sun is, but I don’t bother with the math.  I’m more interested in finding the deepest blue, and my 1x eyes are perfect for the task.

From blue sky, I started noticing clouds and weather, too.  Soon, I became as interested in the weather as I was in the night sky.  It’s easy to do, and as a guy who goes into the woods a lot, it helps to know how to predict the weather.  Oh, of course, I wasn’t a professional meteorologist, but I knew enough to keep myself more comfortable than I otherwise would have been.

I continued to look up and became a birder.  I won’t say I am a great birder, but I’ve seen many species, many of which I actually figured out on my own.  It’s often good to bird alone.  It makes a person a better observer, requiring spotting the subtleties that allow identification.  Other times, it is good to go with an experienced birder who can spot a particular bird and explain why and what it is. Birding is fun, but it is not a passion.

Looker-uppers aren’t necessarily experts; they just know where beauty lies.  And a lot of beauty lies above us, free for those who look.

SLEEPING PAIR OF CRANES

CRANE MOON

As I became a birder looker-upper after first being a star looker-upper, some birders come to my star parties after first being a bird looker-upper. They wonder how I know the night sky so well.  I wonder how they know the birds so well.  We all laugh.  We are all learning from each other, fellow looker-uppers, trying to get answers to questions we have about what is out there, what it is, why it is, who and why we are.

What I have learned about my fellow looker-uppers is that each of us finds our own faith in the sky.  Each of us has called the sky “the heavens” at some time.  None of us really knows what lies beyond, but we are all curious.  I don’t think there is a one of us who looks at the Sandhill Crane migration, Orion, Saturn, the rising of the full Moon, a Vermilion Flycatcher or a yellow-headed Blackbird

YELLOW-HEADED BLACKBIRD

YELLOW-HEADED BLACKBIRD

, a towering cumulonimbus, or a 2000 year-old Sequoia

STANDING BY A SEQUOIA, MARIPOSA GROVE, YOSEMITE NP.

STANDING BY A SEQUOIA, MARIPOSA GROVE, YOSEMITE NP.

without being filled with a sense of wonder.  I’m a deeply spiritual person, and a fellow looker-upper helped me discover that fact.

That same person, a wise man, a good friend, a fellow looker-upper, and a devout Christian, recently told me, “There are no atheists in foxholes and no atheists who watch cranes.”

CRANES LANDING AT SUNSET, 2012

CRANES LANDING AT SUNSET, 2012

Judging by how often I hear “Oh my God, they are beautiful,” when I take people to the viewing blinds, I think he is right.


CRANES LANDING AT SUNSET, FROM STEVIE’S BLIND

CRANES OVER FULL MOON, ROWE, 2013

CRANES OVER FULL MOON, ROWE, 2013IMG_2918

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Posted in GENERAL STUFF, MY WRITING, UNPUBLISHED OUTDOOR WRITING | 1 Comment »

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