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THE BUS TO ABILENE

November 18, 2016

(Taken from management guru Jerry Harvey, who said this about 25 years ago at a Physician Executive conference I attended):

On a hot afternoon visiting in Coleman, Texas, the family is comfortably playing dominoes on a porch, until the father-in-law suggests that they take a trip to Abilene [53 miles north] for dinner. The wife says, “Sounds like a great idea.” The husband, despite having reservations because the drive is long and hot, thinks that his preferences must be out-of-step with the group and says, “Sounds good to me. I just hope your mother wants to go.” The mother-in-law then says, “Of course I want to go. I haven’t been to Abilene in a long time.”

The drive is hot, dusty, and long. When they arrive at the cafeteria, the food is as bad as the drive. They arrive back home four hours later, exhausted.

One of them dishonestly says, “It was a great trip, wasn’t it?” The mother-in-law says that, actually, she would rather have stayed home, but went along since the other three were so enthusiastic. The husband says, “I wasn’t delighted to be doing what we were doing. I only went to satisfy the rest of you.” The wife says, “I just went along to keep you happy. I would have had to be crazy to want to go out in the heat like that.” The father-in-law then says that he only suggested it because he thought the others might be bored.

The group sits back, perplexed that they together decided to take a trip which none of them wanted. They each would have preferred to sit comfortably, but did not admit to it when they still had time to enjoy the afternoon.

Back when I was in management, we had a consultant come to help us at the hospital.  After she left, the executive team discussed how the meeting went.  Everybody was positive and effusive about what the woman had done. I didn’t board the bus and spoke up.  “I wasn’t impressed,” I said.  “Every time I brought up numbers and measurement, she pooh-poohed me. You’ve got to count certain things in life, if they are important, countable, and the counts matter.”

It was as if I had breached a dam.  Virtually everybody then started to say something negative about the meeting.  They had gone from Coleman to Abilene and back, saying all was great when in fact nobody thought it was.

My wife had a similar experience when radiology residents were discussed.  Everybody said one individual was fine, until my wife said that she had reservations about the person.  Suddenly, when the room was polled again, everybody had reservations.  How does a group, who has reservations about an individual, decide that the individual is just fine?  Nobody wants to rock the boat. Nobody wants to raise an unpleasant possibility that maybe the truth lies elsewhere.

Last week, nine of us were hiking that along the Middle Fork of the Willamette River, near 3000 feet elevation south of Oakridge, Oregon.  It was an easy hike, short and would get me back to town in time for me to lead the monthly hike up Mt. Pisgah I lead every full Moon.

Right away, I was concerned about the time.  I had called the leader to ask when we would get back and whether I should even be doing the hike.  She assured me there should be no problem, that we would be back at 2:30, plenty of time to get ready for a late afternoon hike.  Even with that reassurance, I should not have gone.  I need to be completely focused on the hike I am on, not thinking about other things.

The trip was to see three separate springs that formed the headwaters of the river. The first was easy, and we then returned to a road, walked south along it, then headed towards the river.  The trail went upstream for about a mile before forking.  Here, we waited about 20 minutes as two of the group were picking mushrooms.  The leader told me she was a little annoyed at this; I could sympathize, having led 76 hikes.  The leader expects people along to follow the hiking plan.  I once had a woman taking a video of the entire Scott Trail, which put her a half hour behind the group after only three miles. I almost had to abort the hike. It’s rude and unfair to others.

We regrouped at the junction and went further upstream.  This soon became a problem, for the trail ended in a mass of blowdowns.  Two of us looked for other routes, but there weren’t any.  In the meantime, the easy hike, where I could give my sore elbow a rest, suddenly wasn’t.  I was climbing  up on 24 inch diameter blowdowns, wet and slippery, trying to navigate well above the ground, where sharp branches were plentiful.  A slip would have made more than my elbow painful.

A few minutes later, others found a way—no trail, only a way— to the base of a steep muddy grade, leading to the other trail, well above us.

I muttered sotto voce that this was dangerous.  I didn’t want to do it, and I was one of the strongest hikers in the group.  Others just kept going.  So, I went along, too, but reluctantly.  I figured I could get up the muddy slope, although if anybody above me fell, I would be going down as well.  It was a nasty climb up about 75 meters, and more than once, I found myself in an area where I had to think for some time what I was going to do next.  Finally, I took a chance of sorts, where there was a decent probability I would make it, and I did.  Everybody else did, too, but just because we all made it safely didn’t make it a safe route.  It wasn’t.  If we had done this 10 times, somebody would have fallen, and a fall here would have been bad.

I was upset with myself.  I should have suggested we turn around and take the other route.  I wasn’t the leader, but the leader probably would have agreed.  I should have told her later, in private, that we should not have done what we did.  Additionally, I should have added that she scout trips before leading them, to know where the trail is and isn’t. That doesn’t rule out a blowdown that occurs before the hike, but the blowdowns we encountered had been there for years.  Every trip I lead I have hiked at one time or another, learning in advance about route finding difficulties, significant snow, or a change the map didn’t show.

We never did see the headwaters.  Afterwards, everybody in the group, sans me, thought it was a great hike. Nobody, and there were some people on the hike I respect, said anything about the danger.  Had we done what I suggested, we would have been safe, we would have had time to get to the spring, and we would not have been pushed to get back to town as quickly as we later did.  We made a bad decision, and nobody, including me, spoke up about it.  Had we had a hiker who signed up for this “Easy” hike, they would have been far over their ability.

I was annoyed with myself. While the Obsidians do have bus trips, Abilene has never been a planned destination.

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The top of the hill.  Note the angles of the trees, looking down through dense brush to the bottom.

 

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What passed for the spring that began the Middle Fork.

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The road referred to was behind us.

 

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One of the branches of the upper Middle Fork

SILVER LINING

November 16, 2016

It’s easy to be depressed, at least for people who share my values, by the election.  I’m back in the political wilderness, a time when people I don’t like are going to be running the country, and running it badly.  It’s easy to get angry at those who underestimated the opponent, voted for him, were too overconfident, did not see the handwriting on the wall, and other errors of commission or omission.  But I’m not going to primarily cast blame here. I am looking instead at the silver linings.

During the campaign, Ms. Clinton received a demand from Black Lives Matter to apologize for slavery and racism. Had she done that, the election would have been over in August. Instead of discussing what they would do about the economy–and they had good ideas– the Democrats were sidetracked by groups whom they help but who do not turn out to vote for them when it matters.  Working class whites—their traditional support— will turn out, but they don’t care a whit about bathroom regulation, and nor do I, quite frankly. Considering a significant number of LGBTQ folks voted for the Other, it might be wise to direct the Party’s outreach efforts elsewhere. That’s a silver lining, I hope.

The Democrats are going to learn a lot if they look at the numbers.  Secretary Clinton will win by more a million votes nationwide, but she needed about a tenth of those votes distributed into Pennsylvania, Michigan, and Wisconsin. Learning can start with Wisconsin, which had almost the same number of Republican votes in 2012, whereas the Democrats got two hundred thousand fewer.  Was this due to staying home or switching sides? Maybe the Republican vote would have been a lot less. The Democrats need to be walking through the state and finding answers.

The Democratic Party can now be remade.  Clinton is gone.  It’s time for a younger generation to remake the Party into something relevant for the American people.  I suspect young Democrats will be more inclusive, tolerant of more diversity, hopefully more interested in science and climate change than the politicians today. In any case, they’ve got two years to figure out where the Party is going.  Secretary Clinton was going to be investigated during her entire term, had she been elected, and now that is moot. She probably would have had terrible midterms in 2018 and been voted out in 2020. It was unlikely that the Democrats would have 16 consecutive years of the presidency.  Twelve would have been a stretch.

Go where the votes are.  White voters are still the largest bloc. Listen to them and campaign where they live.  That means campaign in all 50 states, because even if the presidential nominee doesn’t win the state, the nominee can help with local elections. The number of Democrats in local and state offices has tanked in the last 8 years.  Increasing these numbers should be a major priority, especially before the 2020 redistricting. Every Democratic leader needs to know the numbers of Democrats in office throughout the country.  There is now time to fix this problem.

The Republicans now own the government, all three branches.  They own it, and if they start taking away safety nets, the Democrats need to remind people who is doing it. Frankly, the party  of people who actually understand the English language needs to quit losing the battle of words to those who can barely spell.

Addressing climate change won’t occur, but it was DOA under both candidates.  We reached a stage several years ago where people said the climate was changing, but it wasn’t due to man.  Now it is simply that it hasn’t changed at all—the snowball on the Senate floor, the record low that occurs, the warm year that is 0.1 degrees cooler than the prior year.  We are going backward on climate change.  While I deeply regret what is going to happen to the Earth in the next four years, I am optimistic.  I’m optimistic that nature, biology, chemistry, and physics will unleash energy that will perhaps be the Magnitude 10 environmental event that might wake us up.  In the next eight years, there is a high likelihood that fisheries will crash, stronger storms will occur, hotter days, floods, droughts, and to humans, environmental mayhem.  I’m a lot more certain it will be sooner than predicted, since predictions have been shown to be too conservative. To nature, it is just biology, physics, and chemistry following the rules when the ingredients are mixed with the proper temperature and pressure.

The Democrats won’t be responsible for any major terrorist attack, dealing with Russia, Iran, Syria, or North Korea; any one of which could blow any time.  Oh, the Democrats will be blamed, I’m sure, but the buck stops with the Republicans.  Should we go to war, the debt burden will be squarely upon the Republicans, assuming the Democrats don’t let them off the hook this time with off-budget “emergency authorizations.”

The Democrats won’t be responsible for any oil spill into the Missouri River, the Ogallala Aquifer or anywhere else where pipelines were resisted.  Much of the damage will be in red states.  We will help clean up the mess, but we will also be sure to remind people who did this to them.

While the Other says there will be a rebuilding of infrastructure, something we need to do, Mr. Ryan, should he still be Speaker, will be wanting to save money.  Such conflict should be interesting, and I am looking forward to see if it is infrastructure jobs, which I think an excellent idea, or protecting the national deficit, which while laudable, is second to infrastructure. Should Mr. Ryan prevail, many infrastructure jobs will not occur, and this will not be the salvation of the “jobs, jobs, jobs” group, who should instead be hearing “fewer children, fewer children, fewer children.”

We’ve had a Democrat womanizer in the White House.  He got impeached.  The Other may behave himself in the White House.  That remains to be seen. Suffice it to say that I think there will be far more scandals in his administration.  There will be more men in it, more white men, and that is a good recipe for scandals.  Newt Gingrich is Exhibit B.

I am worried about public land being transferred to the states.  On the other hand, I have been able to spend many happy hours in such land.  If there is a transfer, those who had been pushing for such will likely be denied access by those who have the money to buy it and to cut off access.  I’m selfish. I enjoyed it greatly.  I can read and teach math.

I expect the media to complain vigorously when they are denied access.  The media needs to stop treating the Other as a celebrity and hit him hard every time there is a scandal or a mistake.  In other words, they need to treat him like a Democrat.  There should be no more free passes for the winner.  This is not The Apprentice.  Or maybe it is, with the nation’s fate in the hands of a rookie, who is greener than the Chicago River on March 17.  We need better writers, not better looking celebrities who pass for them. Reporters now asking the Other what he really believes are a bit late.

I look forward to Trickle Down economics being given its full chance.  While I am not in the top 1%, I benefit from tax cuts, although I keep voting against my economic self-interest. When we are plunged into a recession, which we will,  Trickle Down will finally die its appropriate death, at least for this generation.  I doubt it will disappear forever.

I keep hearing “Fight them,” coupled with requests to donate money.  Someone else’s turn. Silver lining.

THE FIFTY STATE CAMPAIGN ROAD TRIP

November 10, 2016

Senator Jeff Merkley, junior senator from Oregon, has made over 300 town hall visits in each of the 36 counties in the state. He calls it his most important responsibility as a senator. Every year, he visits each county in the state. Oregon has some large counties: Harney, in the southeastern part of the state, has an area of 10,226 miles.  Were it a state, it would rank 42nd in size. It has only seven thousand people, so their votes don’t make a whit of difference when Merkley stands for election.  Or do they?

Merkley goes to each county, because he sees himself as a senator for the whole state, not just the population centers along the I-5 corridor. He learned from his predecessors, and town meetings give him a sense of the pulse of the state, what people are thinking.

It is interesting is where Merkley holds his town meetings.  In Lane County, home to Eugene and Springfield, he holds the meeting in the Odd Fellows Hall in nearby Coburg, a small town, not in Eugene.  He is making a statement, at least to me, that small town Oregon matters to him.  His town halls are in places most don’t know: Scappoose, Mt. Angel, Baker City, Gladstone.  Merkley won handily in 2014, and I suspect should he run in 2020, he will win handily again.  Yes, he’s a liberal and the only Senator who backed Bernie Sanders, but I would bet he has the respect, if not the votes, of many Oregonians east of the Cascades, where most of the state lies, but few of the people live.

I have often wondered why a presidential nominee has never visited Alaska.  Yes, Alaska votes Republican, but the message sent by a Democratic nominee for president would be huge.  Yes, she would get no electoral votes, but she would get a lot more by going: respect from Alaskans, shock at being visited, and probably an earful, too.  People everywhere like being respected, be they an inner city African-American or a farmer in Nebraska.  America is comprised of huge population centers and hundreds of thousands of square miles with few people, and the way people think in both is very, very different. I think Secretary Clinton made a mistake when she cast her campaign on the big cities in the swing states.  A lot of support was potentially available in places if had she gone and said, “I’m here to see where you live, what your local issues are, and to show you that I put on my pants one leg at a time, just as you do.”

Sure, many would have laughed.  Her handlers wanted her in the swing states, where the electoral votes were that mattered, in the cities, where Democrats live. But people read the newspaper and log online.  If they had seen that she were touring red states, for heaven’s sake, they might have been thrown off balance by such strange strategy.  They might have thought, “wow, she is seeing where the people live.”

Suppose she had left the DNC convention and with Tim Kaine, her VP Nominee, gotten aboard a  train and gone to York, Scranton, Harrisburg, and a stopover at the 9/11 memorial, finishing at Erie.  She would then have entered Ohio and done a tour south of Cleveland, maybe as far south as Mansfield, and then north up into Michigan, telling people in Detroit she’d be back, but she would continue to Ann Arbor, Flint and to the Upper Peninsula, where no nominee ever goes.  From Escanaba, she could have gone west into Rhinelander, Wisconsin and spent time touring the central part of the state, places that do have Democrats but also have Republicans who would have been surprised.  They would have seen a presidential nominee in their small town who spoke differently, saying hi, I’m here to see what your state looks like and what kind of people live here.  Can you tell me? Some would have laughed, some would have turned away or flipped her off, and I bet she would have gotten a ration, but come away with a good idea of the pulse of the country.  She could have entered Minnesota near Hinckley and gone through the small towns across the state, up to Red Lake, to the reservation, before traveling to Moorhead and Fargo, on the Red River of the North. She could have crossed North Dakota, perhaps making a statement at the standoff, before visiting the oil fields near Dickinson.  She also could have paid homage to Theodore Roosevelt by visiting the National Park named for him.

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Bison, Theodore Roosevelt NP, October, 2006

Continuing west, she would have seen Glendive, Montana, and ridden along the Yellowstone River to Billings, then west through the Big Sky Country, by Big Timber, Bozeman, Great Falls, Missoula.  In eastern Montana, she would have been near coal country, where much as I and others don’t like coal, one train of 100 cars is required daily for one of the eastern power plants for a single day’s use.  It gives one perspective to know that the power they take for granted comes from stuff that they think should be kept in the ground.  If she had visited a coal mine, trust me, a lot of folks would have taken notice. The miners might have made fun of her, but I think they would have given her grudging respect.

Entering Idaho, she would have seen Craters of the Moon, Snake River Country, places that burn in the summer, have frightful winters, and where Americans live.  Past Spokane, Washington, past Moses Lake, and she’d visit Yakima, maybe, Snoqualmie Pass and finally end in Seattle.  Because Washington is a blue state, few nominees go there.

But our nominee would then fly to Alaska, visiting Juneau, Anchorage, and Fairbanks, before flying to Hawaii for a day on either Oahu or the Big Island.

It’s a tough trip, but once flying back to San Francisco, she would go east, over Donner Pass, to Reno, Washoe County, and then along the northern tier of Nevada, past Winnemucca, Battle Mountain, and Elko, east to Salt Lake City.  She had no chance in Utah, but visiting the Mormon Tabernacle as a tourist, if allowed, would have shown respect.  She would then leave and go through Vernal and Grand Junction, by Rifle and Glenwood Springs, all the way to Denver. From there, she might miss Nebraska and the Platte for Kansas, then swinging south into Oklahoma and Texas, ending in Dallas.  She would have traveled through a dozen states she wouldn’t win, but the press corps would have loved it.  They would all see America as too many people in politics don’t see it, an America that belongs to the Republicans.  Not really, of course.  It belongs to all of us.

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West Texas, from Guadalupe Peak, from Guadalupe Mountains, NP, 2005.

At any point, the nominee could leave for a few days for a rally or for fundraising, but the goal would be to finish, meaning Nebraska and South Dakota, Oregon, Arizona and New Mexico, the Deep South and the “Red Crescent” of Kentucky and West Virginia.  Yes, even those states.  She would learn a lot from seeing them.  Americans are a diverse people, and much of the diversity in thought comes from the land in which they happen to live and work.

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Big Bend National Park. This is moist air striking 3000′ cliffs and being forced upward, condensing before me.  It is the best example of lifting air’s producing rain (orographic lift) I have ever seen. June, 2007.

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Foggy morning, Mammoth Cave, Kentucky, April, 2013

I think every nominee should visit every one of the fifty states.  I have. I’ve spent more than 100 nights in 13 of them. I’ve walked across two of them and part of two more. I have seen the diversity of America the land, camped in many states, seen nearly all of its national parks.  As a result, I understand the diversity of the people better than I otherwise would.  For me, it matters little in the grand scheme of things.  For a presidential nominee, it matters immensely.  The Democrats would do well to read these words before 2020.

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Salmon, Brooks Falls, Katmai, Alaska, 2016.

MY STEALTHY FREEDOM AND “THE TRUMP TALK”

October 23, 2016

“Because no little girl who gets groped on a bus or in a grocery store or on a subway or in a classroom should ever have to wonder if she did something wrong.”  Columnist Dan Savage, explaining “The Trump Talk,” the term coined by a woman who wrote in, defining the depressing conversation that every parent needs to give their daughters about predatory, entitled men.

Two years ago, I joined a half million people (then) who liked My Stealthy Freedom, a Facebook page that showed Iranian women taking off the scarf in public, as many of them called the mandatory head cover, an offense often leading to arrest.  As I saw more pictures of these women, heard stories of their abuse by husbands, brothers, fathers, and strangers, including acid thrown into their face, I also read support from husbands, brothers, fathers, and strangers.  It took me far longer than it should have to realize that not only were Iranian women being abused, so were Iranian men.  The page now has more than a million members.

The excuse given for covering women’s hair was that it excited men, who could not control themselves around women.  Yep, and that I guess was the reason that 7 year-olds are covered in school.  If a man can be excited by a 7 year-old girl, he’s a pedophile, a predator. The woman writing into Dan Savage had her 9 year-old daughter inappropriately touched by a man while in a grocery checkout line.

The vast majority of Iranian men are not pedophiles, I posted.  Publicly walking without a scarf in an 87 second video did not destroy the country, I wrote.  A few trolls tried to bait me with problems in the US, but I stayed quiet and let my fellow commenters handle them.  So long as women were being required to cover themselves, I realized men were insulted, too.  If the men didn’t see that, it was time they did, I wrote.  Real men control their “urges,” don’t assault women, resist as much as they dare the laws that require women to be covered, and treat their wives as equal partners.  There were many posts of Iranian men who did resist. Some even wore the scarf themselves.  There are many brave, smart and creative men and women in the country.  I’ve helped correct the English in several M.S. and  Ph.D. theses; I was even last author in a meteorological article about Tabriz.

I didn’t realize that my words about insulting men would come back during this presidential campaign, where I have been quiet, only writing about boorishness. Because I’m an old white guy, FB once targeted me with Republican ads.  I put a quick stop to that nonsense.

When Mr. Trump was caught on tape with his vulgarities, where the verb “to grope” was probably learned by many children for the first time, I was disgusted.  But frankly, I thought it would blow over, like every other epithet, crude remark, lie, and insult he has used during his campaign.  If he could get away with insulting John McCain, six bankruptcies, writing off a $900 million loss in one year, saying Muslims shouldn’t be allowed into the country, a Mexican-American judge born in the country was biased, what could he possibly do worse?  Mr. Trump was given a free pass on women.  He was allowed to call them ugly, “how would you like to wake up next to that?” and insulted Ted Cruz’s wife, a professional in her own right, not that it matters. Even using the toilet and menstruation were not off limits to Mr. Trump; no outrageous comment stuck.

So, I could have been forgiven for thinking that “grope” and “pussy” would last a day or two and then disappear.  I mean, I had seen Mr. Trump getting softball coverage as a celebrity and not as a presidential candidate.  I had wondered when the media was going to be as hard on him as on Secretary Clinton.  When the shoe dropped, the final straw in the haybarn of insults turned out to be the verb and the noun alluded to above. I didn’t think what he said was much worse than what he had already said, but as a man, I missed something that women don’t miss.  It’s one thing to leer, to rate women on a 1 to 10 scale, to make fun of their bodies, even if the insulter is overweight, has dyed hair, and constantly glowers.  No, what really changed this campaign was the action, the groping, sexual assault.  That’s courage, by the way, to come forth as a woman who was sexually assaulted, and after which likely initially blamed herself for what she wore, said, or did.

And knew that probably 40% of the men in this country think today she was still in some way to blame.

The “locker room banter” comment significance was missed by me, too, mostly because I haven’t been in a locker room for years.  Athletes came forth en masse, insulted that Mr.Trump would suggest that every man in a locker room would say these things.

And so finally, it came full circle.  Whether it be in the United States or Iran, when women are insulted or physically violated, because a man thinks he can do that, he insults all men who don’t think this way.  When one says it is locker room banter, he insults the men who don’t partake in such banter, who, when given every chance to talk about a woman’s looks, body, whatever, DON’T.

So, I am angry.  I don’t talk to my male friends about women’s looks, bodies, whatever.  That doesn’t mean I give a free pass to all women, because they are women.  I quietly refused a request on a long car trip home last summer to give a ride to a woman who made me feel very uncomfortable. I won’t hike with another for the same reason.  That isn’t sexist.  I’m making a rational decision  based upon actions.

But, I’m with…..Michelle Obama.  She is a national treasure.  Her twenty minute speech, which will be known as the “Enough is Enough” speech, reminded me that attacks on women are attacks on men.  That belittling women belittles men.  That treating women as sex objects is saying that men can’t control their sex drive.  That allowing firearms in the hands of angry men in bad relationships is the major cause of the 3 women a day here who are killed by a man with whom they have or had a relationship.

I’m with Michelle Obama when she says, so truthfully, that we can’t deal with the plight of women in this world if we belittle them here in America.  Our women aren’t forced to wear the scarf, but they are too often treated as sex objects, take less money for equal work, are graded like beef or homework, kowtow to lecherous bosses, and have their looks matter more than their brain.

When Mr. Trump talks about groping, “getting away with anything,” “and finally, “in ten years I’ll be dating you,” to a ten year-old, when he was then 46, he was inculcating dating and pleasing a man as her worth.  By lowering the bar to 10, he is not far away from the Prophet, who in his fifties married young Aisha, consummating it when she reached puberty.  It is ironic that Mr. Trump, who proposed that Muslims not be allowed into this country, was once picking out 10 year-olds for his future.  He was damned close to mimicking The Prophet.

The only suggestion I would make to Dan Savage is that “The Trump Talk” be given to all children, not just girls.

PULLING A MALHEUR ON RACISTS

October 16, 2016

I go up to Ely, Minnesota every autumn to canoe in the Boundary Waters wilderness.  I spent the most content six months of my life there in 1992, when I was in the woods 100 days  working as a volunteer for the Forest Service during a leave of absence I took from my medical practice.  My ties with Ely are so strong that I sponsor several scholarships at Vermilion Community College (VCC).

The day before my last annual canoe trip, when in Ely packing to go into the woods, I visited Patti Zupancich, Executive Director of the VCC Foundation.  We spoke about the political situation, bemoaning the constant fact that the community colleges in Minnesota need a lot more funding than they are getting. Sadly, while the VCC scholarship pool has doubled in the last decade, scholarships are a very small drop in the bucket compared to what is needed.  Community Colleges are important.  I volunteer in the math lab at Lane CC here in Eugene, and from the students I see, the community college is the only way for those who didn’t learn math in school to learn it.  Yes, 50 year-olds need to learn how to deal with fractions. If you don’t think I see those people come in some time. I’m there a lot.

Back to Ely.  Patti also is the counselor, the sounding board, and the liaison between the few African-American students who come to Ely and the town.  VCC has no athletic scholarships, and Ely is a white town in very redneck northern Minnesota.  I judge how an election year is going by the number of Republican signs I see on the drive up.  I only saw two between Cloquet and Ely, and one house that always sported one didn’t this year.  That tends to bode well.

Several of the students were outright afraid of what might happen to them. Why not?  Mr. Trump has been spouting racial epithets for over a year.  He has galvanized a host of right wing groups: white supremacists, conspiracy theorists, anti-semites, alt-Right, and while his Twitter account doesn’t have them, his campaign staff does, with at least two dozen such groups with whom they are in contact. I know that through the Southern Poverty Law Center’s emails. Patti said that an African-American student told her a homeowner near campus put a noose up by his house.  I thought lynching was replaced by lunching in this country, but Mr. Trump has brought the word back into common use. Patti went by the house and didn’t see the noose, but she did see a ladder by the tree.  And while the noose is no longer there, the one in southern Oregon, hanging Ms.Clinton in effigy, is.  This is bullying, racism, sexism and fascism.  I was stunned and angry; my wife was incensed.  And so we decided to “pull a Malheur” on Trump.  An explanation is in order.

When Malheur Wildlife Refuge was occupied last January, Zach and Jake Klonoski set up a donation site for four organizations whose values were as contrary to the values of the occupiers as possible: Friends of Malheur, the Paiute Tribe, Americans for Social Responsibility (Gabby Giffords and Mark Kelly’s effort to change the makeup of Congress to make what most of think are commonsense laws regarding background checks), and the Southern Poverty Law Center. One made a pledge, which would be multiplied by the number of days the occupation lasted. In other words, the longer the occupation lasted, the more the occupiers were funding organizations they hated. A total of 1643 of us contributed nearly $136,000.

At Vermilion, funding from Access Opportunity Success (AOS), state funds, helps support groups, diversity education, and recreational opportunities for students of color as well as financial assistance awards to individual students (scholarships, textbook awards, assistance with housing deposits.)

AOS Scholarships are one-time awards for students returning for the following fall or students who will be taking summer classes through Vermilion to complete their two year degrees.

Currently, my scholarships at VCC are (1) One in our name that is given to a student, selected by the faculty, who is studying for a career that will involve the wilderness.  It has been awarded for 11 years.  (2) One in conjunction with the Friends of the Boundary Waters.  (3) Three for Veterans, which will this year needs a name.  My wife says I ought to name it after myself.  I said no, but not far below the surface, I need to know that something I did will live on after me.  I don’t know why it should matter since I won’t be around, but it does.

I hadn’t planned on giving any other scholarships, but after hearing about the noose, one way I can fight racism is to do things that are directly contrary to the values of the racists, like supporting a person of color in Ely.

I told Patti that I would cover whatever the College couldn’t cover this year, given that they are subject to funding constraints for the AOS Scholarships.  I will to go back up to Ely next April for the scholarship banquet, to which I haven’t been since 2013.  It’s a long trip, not cheap, but I can tie it into some time in the wilderness, before fishing season, when the lakes are quiet, and campsites haven’t been visited in 7 months.  I know exactly where I want to go.  Two or three days later, I’ll come out of the woods, shower at VCC, and wait around for the banquet that night at the Grand Ely Lodge.  I get considerable pleasure out of hearing my name being called to present my scholarship and the little buzz in the room when the audience is told I’m from Eugene, Oregon.  (There was a buzz with Tucson, Arizona, when I lived there.)

Oregon will probably be pronounced wrong.  I’m not a native, so I won’t correct it.  Don’t laugh; one VCC alumnus, a guest speaker in 2012, was from Portland, and the first thing he said when he began to talk was how to pronounce the state’s name.  Oregonians are like that.

In any case, I will have a smile on my face as I do one concrete thing that sticks it to the racists.  No, it’s not huge, but you see, I’m doing something positive. That’s important.  Positive stuff matters.  Do a lot of it. It doesn’t have to be a scholarship.  It might just be a letter to the editor, or calling people out who state racist, sexist, derogatory comments that have no place in civilized society.  If we don’t do this, and don’t it soon, we risk be dragged through the mud of fascism and taking the whole world with us.

Not only will I feel better, one more young person will have money he or she didn’t plan on having, I will be in the woods in late April, and my subsequent September trip will equalize the number of canoe trips in the Boundary Waters-Quetico with my age. Don’t laugh.  I find that important, too.

SECOND CHOICE

September 26, 2016

“Is the site open?” I asked.

“I can’t tell from here,” said my wife in the bow of the canoe, as we entered a small bay with a low isthmus separating it from another part of Basswood Lake, forty-five square miles that  straddles the border between the US and Canada.  I looked with binoculars and couldn’t be sure whether I was seeing a rock or some part of a person’s camp.

We paddled a little further until we found to our dismay that the object was a tarp.  Site taken.  Damn.  We had walked on that site in 2012, and I had camped there solo a year later.  Not this year.  We turned back to another site that we had passed, second choice, at the mouth of the bay and still out of the motorized zone, for while we were in wilderness, concessions were made in 1964, one of them allowing parts of Basswood Lake, a national treasure, to allow small motors.

We landed on Second Choice, walking up from the narrow beach landing on ledge rock to the fire grate, part of every Boundary Waters (BW) campsite.  When we turned around, we had a splendid northeast view down a channel to Canada, two miles distant.  A little elevation makes a significant difference in what one can see in the BW.

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View from the top of the ledge rock.  Canada in the distance.

That first year on the site, we stayed five nights, with a nightly parade of three beavers, two adults and a young, swim by getting food, branches from trees they fell in the adjacent swampy area.  We heard and saw one tree fall. We saw the northern lights twice, heard wolves, and had a moose visit.  Second Choice?  This place was a gem, and with two small tent sites, it probably didn’t get much use.

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Beaver with stick, 2014

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Moose, 2014

We returned in 2015, but while the beavers were gone, we saw three otters playing. Every sunset, we marveled at the lovely way the light appeared on the isthmus site and the rock face across the bay.  We returned again this year, where we didn’t day trip much because of wind, so I sat and read, looking at Canada in the distance, realizing that Tru- as a leader really meant Trudeau, and seeing things I had never noticed before, because I had more time to look.

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Otters at play, 2015

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Sunset on the isthmus site

I saw a chipmunk, an occasional pest, climb up on a wild rose bush and eat rose hips.  I didn’t know they ate them.  A flock of eight common mergansers swam by, not uncommon for the BW, and we saw them again nearby on a day trip.  This was clearly their territory.  An otter walked on the shore one afternoon, swam across the swamp, and disappeared among the rocks.  Many times, a raven announced itself by the WHAP, WHAP of its wings over us.  I watched an altercation between a Broad-winged hawk and a raven.  Twice, looking high in the sky, we saw an eagle soar, easily 1000 meters up, a dark spot against a white cumulus cloud.  These things you don’t see on high mileage trips.  They matter to me now.

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Chipmunk eating rose hips

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Mergansers

There was more.  For the first time in my wonderful outdoor career, heavy dew and morning fog did NOT presage a wholly sunny day.  It rained that morning, only later becoming sunny.  I had never seen that before.  I had thought the channel led north, until one night, I saw the North Star 45 degrees to the west of the channel.  It led northeast. The North Star doesn’t lie.

I found myself studying little things: the waning gibbous Moon each day, a long curvilinear cloud one evening, and its stunning reflection, which appeared like disturbed water in a calm lake.  We twice found a rock where turtles hang out, and noted the one’s shedding part of its carapace.  We know all the campsites up the lake towards Canada.  They are nice, but they aren’t Second Choice.  We may be the last on the site this year, for all we know.

One morning, we heard Basswood Falls, a mile or two distant across forest in a straight line, considerably further by canoe.  We had never heard the falls before on our prior two visits, but on a quiet, calm morning, they were unmistakeable.  I saw orange hawkweed, one of my favorite flowers from my boyhood, right next to our tent. It has the most wonderful smell.

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Orange Hawkweed

Second Choice has become for us one of our most special places we can go.  My wife has reluctantly said good-by to the area.  If she doesn’t return, I may go by there, but I don’t know if I will go on the site.  Not alone.  It’s hard to say why.  Only that I don’t think it is a place for me alone.  Once, when severe illness visited us, I paddled into the bay alone and stayed on the isthmus site.  I can stay there again, if it is open.  If not, there are other sites.

Every year, it gets more difficult to canoe.  I threw my back out the day we left, and my dominant elbow was inflamed.  Somehow, I was able to paddle and carry, and we paddled to the site in just over 4 hours, due to a tail wind that we had not planned on.  We don’t assume good weather for our trips.  That’s a recipe for trouble.  Because of a falling barometer, we decided we would spend four nights there, not five, and come out most of the way to a busier lake near the entry, avoiding heavy rain, thunderstorms, and strength sapping headwinds.

On clear nights, the Milky Way is bright, brighter than nearly any American can see on a given night.  We told time by the moonrise, for this trip coincided with the latter part of the Harvest Moon.  As I type this, I just heard the crash of a tree fall across the bay. Yes, if a tree falls in a forest it makes a sound.

Second Choice taught us that sometimes less visited sites have value.  In such places, I can learn a little about the neighborhood, see things that I have seen before, learn something new, so long as I sit quietly for a few days, foregoing the high miles that once appealed to me, back when I once wanted to know what was out there in the Quetico-Superior.

Second choice sites do that.  I may not physically return, but I will often go there in my mind.

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Sunrise

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Sunrise

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Evening sky

FROM OUT OF THE BLUE

September 19, 2016

I got an email from a former colleague, a physician trained in geriactics who once practiced in the office next door to mine.  We were good friends, and I often went to his office for a few minutes each day in order to pet his Portuguese Water Dogs, which he often brought to work.  It was a good way to relax.  If he sent me a patient, I would talk to him person to person about what I found.  But this was a quarter century ago.

He is older than I and retired, not long after I went into administration, and took up farming in another state, where he was successful.  We were part of his Christmas card list and heard each year about the family and the dogs.  He had several health issues, but he was tough and got through each one.

About a decade ago, although I can’t be sure these days, because the years go by so fast, his Christmas cards developed a significant religious tone and he mentioned his involvement with several well known evangelists.  I just wished him well, although the change didn’t resonate with me.

Then, about five years ago, not at Christmas, he sent out a e-mail to his address book complaining about the New World Order, how the UN would be stationing troops here, guns would be confiscated, and we would lose our freedoms.  I don’t know much about this stuff, but to be honest, I thought it might be better than the Project for the New American Century, which did exist and was behind the Iraq and Afghanistan wars.  I wondered if my friend, or really ex-friend now, might be becoming demented.  That’s tough to diagnose, so I said nothing and heard nothing more.  I now wish most people well, even my so-called detractors, so long as they don’t interfere with my attempts to quietly lead my life. I must be mellowing.

Today, out of the blue, after at least a 3 year hiatus, I heard from him.

He isn’t demented, which was the good news.  The first “How are you?” was, unfortunately, followed by a video clip of Hillary Clinton’s supposed Parkinsonian symptoms that he wanted me to view, along with several other attachments, all on YouTube.

I’ve heard these allegations before.  I didn’t notice anything obvious about her at the Convention, but I didn’t look carefully.  Bill looked like he lost a lot of weight, maybe too much.  I do know Mr. Trump is 70 and has been overweight for years.  That is a significant concern to me.  My board certification is from the American Board of Psychiatry and Neurology, so I can say with some confidence Mr. Trump meets the criteria for narcissistic personality disorder, and the press has often given him a free pass on that and virtually everything he has said, the free advertising likely to elect him president, in what is becoming the highest stakes reality TV ever, given the country’s infatuation with media celebrities.  Ms. Clinton has been a public servant for 35 years, long enough to make mistakes, long before the millenials, who are “cool to her,” were born.  Trump’s failed business ventures, failure to release his tax returns, his boorishness, racism, xenophobia, bullying, and litigation don’t appear to bother much of the electorate, including his ridiculing those with disabilities (a reporter), injuries (Harry Reid), nervousness (the woman in Flint), or his suggesting violence (that the Secret Service not guard Ms. Clinton).

I do not like it when my detractors want me to read a series of articles or look at videos with the idea that I must be changed to their way of thinking, because for years, I read their articles, the ad hominem attacks, the statistics that were clearly in error, the bias, the grammatical mistakes, the inflammatory language, and I was not convinced.

I will not reply. Silence is best.  He will not know whether I received it or what I think. I will not look at the video.  I have no way of knowing how it was edited, whether the purported “freezing” is like “Hitler’s jig” when France fell.  I have no way of knowing if her silent speech was in a focus group and dubbed in to another speech.  And if I say she doesn’t have clinical Parkinson’s, a view which her facial expression on a post today would support, somebody will come back and say I haven’t practiced in years, which is true.  Anything short of agreeing with him will likely lead to an argument I want no part of.

I’ve seen thousands with Parkinson’s, was involved in a clinical trial of bromocriptine; many patients functioned well mentally and physically.  One can outwork me at Rowe Sanctuary in Nebraska every spring and at age 70 taught me the definition of an acre (it’s 10 chains squared, and a chain is 22 yards.)

Bet Mr. Trump doesn’t know that.  Mr. Cruz said we had billions and billions and billions of acres owned by the federal government.  The country outside of Alaska has 1.9 billion acres total, and non-public land in Texas alone has about 161 million of it. A great majority of the land east of the Mississippi is not public.  Candidates for public office ought to be required to say what a billion or a trillion is operationally, before they can run for office. I bet many wouldn’t be able.

As for presidents with disabilities, FDR ran the country for 12 years, during the Depression and  WWII, in a wheelchair. John Kennedy had Addison’s Disease. Johnson had severe enough heart disease to require a defibrillator nearby.  Carter almost collapsed on a run in Catoctin.  Ford tripped coming down Air Force One and became the butt of many jokes. Reagan was shot and had Alzheimer’s for a significant part of his last term.  The first Bush vomited on the Japanese prime minister and fainted at a state function. His son was an alcoholic.

The sudden claim of Parkinson’s for Hillary Clinton is odd, since the supposed symptoms quoted are usually seen late, and she has been in the public eye for years.

I was disappointed, but not surprised, when after a venous thrombosis in her skull four years ago gave her diplopia (double vision), it was treated by the Congressional Republicans as a minor headache, a skimpy excuse keeping her from testifying before Congress on one of their many Benghazi investigations.  She is subject to a double standard.  When Ms. Clinton had a rather common illness—I’ve had pneumonia and hallucinated, but I returned to practice medicine three days later—it was blown out of proportion. When it comes to Parkinson’s, I’m sure there are some neurologists who without an exam, but with bias, repetition, and intimidation, will claim that she does. And so what? Parkinson’s has treatments.  Narcissism?

Both presidential candidates are at an age where bad things happen to people.  I am at that age, too. Being old means that the vice presidential choice matters.  One thing scares me more than Mr. Trump, and that is having him incapacitated.  Trump at least isn’t a social conservative. Governor Pence would send us back to the 19th century in our treatment of women.

I don’t need “re-education.”  I can teach math, statistics, neuroanatomy, guide people on hikes, show them the night sky, and teach them what happened when the most civilized society in the world became fascist.

MITCH

September 14, 2016

Six months ago, Mitch joined our Wednesday hikes up Spencer Butte here in Eugene.  We meet early, pay a dollar that goes to the Club, have one of us lead the hike, and take the 3.1 mile route 1500 vertical feet to the top.  It’s a “conditioning hike,” meaning people can go at their own speed, whatever suits them.  I like to go fast, as if I were hiking alone.  I’m told I’m fast, but I can think of at least 4 people in the group who are faster.  I do OK.  I’m not young, but the four who are faster aren’t young, either.

Mitch was in the back of the group the first day. He was overweight, and just making it to the top was an event for him.  He was pleased and so were we.  Several in the group use the hiking time to socialize on the way up, and nobody is racing.  I’ve done it in 53 minutes, alone, just to see what I could do.  The top part now has steps in places, which make it safer, but it’s an average 20% grade, and it is a real cardiac workout to do it.  My pulse tops out at 160, and I can take it just fine by listening to the pounding in my chest.

With time, Mitch began to hike better, both in appearance and on the trail.  He was 50, diabetic, and his doctor told him he needed to exercise.  Mitch took him up on it. He wanted to do some out of town hikes, which the Club offers every weekend and almost every day in the summer.  Somebody has to organize one and lead it.  We meet at a place arranged by the leader, everybody pays a dollar, five for non-members, we carpool to the trailhead and hike at whatever pace the leader has decided.

I’ve led about 70 hikes now, both in town and all over the west Cascades.  My longest hike led is 17 miles; I’ve been over 20 miles twice. I did a 22 miler in 7 hours.  I hike a trail before I will lead a hike on it.  That requires I “scout” hikes, sometimes even hikes I’ve done, because there may be snow on the trail, or blowdowns of trees, and I need to know if the hike is even feasible.  The Club gives credit for being on a hike, leading a hike, but not scouting one.  On early season hikes, I am also a volunteer, reporting and photographing blowdowns to the Forest Service and High Cascade Volunteers, the Scorpion Crew, so they can later prioritize resources to clear the trail.  I may join one of their work crews some day.

Anyway, Mitch asked me in June if he thought he could be able to do my Obsidian Loop hike on July first, a classic, requiring a permit, that goes through the Obsidian Limited Entry Area up near McKenzie Pass.  It’s a great hike with closeup views to North and Middle Sister, has a beautiful waterfall, and a couple of miles on the Pacific Crest Trail.  By then, I thought he could.  The hike is difficult, with 12 miles and 2000 feet vertical climb, but half the climb is spread out over the first 3 miles.  I had scouted the hike 5 days prior, concerned about snow, finding a lot of it, off trail a lot depending entirely upon GPS and trail memory, making it difficult to complete the loop, so I was fairly certain we would have to do an out and back hike, not completing the loop.

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Obsidian Falls on the scouting hike.  The trail is under about 5 feet of snow to the right.

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Middle Sister from Obsidian Loop Trail.

Mitch thanked me profusely the day of the trip for scouting the Obsidian Loop Hike.  That was a pleasant surprise.  Usually nobody does that, nor do I expect it. I appreciated that somebody acknowledged that on my own, I had driven a total of 4 hours and hiked another 4 in snow, alone, rather difficult conditions, to see if a trail was passable.

On the day we all went, there was less snow on the path through the woods to the loop.  That was a good sign.  Other areas had less snow as well. I made the decision to go around Obsidian Falls, because of significantly less snow than had been present just five days earlier.  On the way down, however, I had to again use the GPS to try to find the track I had taken earlier, and we ended up glissading on hills where there was no clear way to get to the trail, which was buried under snow anyway.  One of the guys told me at the end, “Now, that was a HIKE.”  Another said it was one of the most beautiful hikes he had ever taken.  Mitch thanked me yet again for the work I did.  He had no problems with the difficulty.

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Hill we glissaded down, not far from the trail.

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High Country Lake.

 

Mitch started adding more on the Spencer Butte hike. There is a back way up to the top, longer, steeper, that he wanted to do.  He did it.  I led a 17 miler that involved climbing two cones, Collier, which is a long climb, and Four in One, shorter, where four vents came out of one cone. In addition to the 17 miles, the hike involved net 2700 feet of vertical climbing.  It’s the most difficult hike I’ve led.  Mitch did just fine.  I knew he would.

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View from atop Collier Cone, with Belknap, Washington, Three-fingered Jack and Mt. Jefferson (the largest) in the distance.

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View of Collier Cone from Four in One Cone

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Four in One Cone from the base

I had led three hikes in five days when I led a fourth two days later, up Spencer Butte.  The prior three hikes had all been difficult, but I felt I was rested.  In other words, I had no excuses.  Mitch and another man were with me on the first mile up to Fox Hollow.  There, we cross the road and continue on the trail upward.  I led to Fox Hollow; Mitch passed me on the road, and I said, “Go ahead and I’ll see you at the top.”

Mitch replied that I’d probably catch up to him.  When I hear that, I know I won’t.  And I didn’t.  He got up to the top, mostly still in sight, but at least a minute ahead of me.  He’s faster and stronger, no doubt about it.  Yes, I’ve got 17 more years of age on him, but he’s lost 40 pounds and is only going to get stronger.

Three days later, I led a hike that did the whole Ridgeline Trail in Eugene, out and back.  Mitch hiked it and asked if he could detour and climb Spencer Butte as well.  That added 3 miles and another 1000 feet to an already difficult hike.  I told him to go ahead. I didn’t find myself jealous at all.  The last time I did the hike, he started off fast, and I couldn’t have caught him if I had wanted to.  Mitch earned it.  He’s strong, and he’s good.  I am glad I had a part in it, encouraging him to do difficult hikes that I led in the Cascades.  I had faith in him, but more importantly he had faith in himself.

It’s great to see.  Even from well in the back.

PLANETARY CONJUNCTION

September 7, 2016

I went out recently to see the close conjunction of Venus and Jupiter.  I could have done without the hype: that it was the closest they would be for many years.  Indeed, the hype ignored the fact that for a few days prior and afterwards, the two would be almost as close in the sky as they were that night.  It would have been better to have said that Venus and Jupiter would be close together all week, changing a little each night relative to one another, and that Saturday would be the night they were closest.  That gets people looking up and noticing that planets move from night to night.  The very name comes from the Greek “asters planetai,” wandering stars.

One lady in particular was almost adamant about seeing the conjunction, as if she might never get another chance.  I didn’t tell her that the next night it would be almost as good.  I like to teach, so I explained that conjunctions often occur in 10 and 14 month intervals, although there is a better 3.3 year interval. I didn’t have the ephemeris at my fingertips, but this was the 28th conjunction between the two since the beginning of 1991.  They aren’t exactly rare; they are beautiful.  Her expression didn’t change.

She then told me how Mars was as “big as a basketball” when it rose, last year, closer than it had ever been for “thousands and thousands of years.”  That simply wasn’t true, but I quietly replied no, Mars was bright, but it was still far away and about as bright as Jupiter was that night.  I didn’t have at my fingertips the fact that in 1924 Mars was only about 12,000 miles further away than it was in 2003, which was when it was closest.  Perhaps, I thought, she was thinking of the reddish eclipsed Moon a year ago.

She wasn’t having it.  Somewhere, she heard it was Mars, and she wasn’t wrong.  Shortly thereafter, she left.

This “knowing” of something that is blatantly false has come to the fore this year.  American immigration peaked in 2007, not continually rising.  All nine categories of major crime have fallen dramatically in the past 20 years. We aren’t having a massive crime wave.  The Earth’s temperature is rising slowly but definitively, the oceans are slowly rising, and California is in its fifth year of drought.  I don’t like any of the last three.  I wish they weren’t occurring, but they are, and I need to face reality.  As a country, we aren’t.

I was disappointed on several fronts astronomically.  How in the world does somebody think that Mars can suddenly appear in our sky looking the size of the full Moon?  Then I remembered for years after the August 27, 2003 closest approach, I would get emails from people—smart people— saying that on August 27 that particular year, Mars would be closer to the Earth than it had been for thousands of years.  That was wrong.  So was the picture of the huge Moon blotting out the Sun, posted by somebody who said that is what an eclipse at the North Pole looks like. Nope, that’s wrong, too.  As was the photoshopped large Moon rising over Houston, where somebody commented, “I didn’t realize it was so big.”  The Moon appears smaller on the horizon that it does overhead, when it is 4,000 miles closer, because we aren’t looking across the Earth’s radius.  We can’t perceive a change in the lunar size of 1.7%, but it isn’t larger on the horizon.

While I’m at it, the idea of Supermoons, full Moons at perigee, or close to Earth, can’t be perceived with the eye.  Indeed, Project ASTRO personnel once laid out on a desk twelve phases of the Moon and asked us trainees to order them.  When I got done ordering them, I pointed out the change in the Moon’s size during the cycle.  The teachers had never noticed this simple and important finding before, and they were teaching astronomy for schools.  If they weren’t aware of the change in the Moon’s apparent size photographically during every cycle, it is unlikely that anybody will be aware with the eye.

I don’t like hearing  “rare, once in a lifetime sightings,” that next year will be followed by another similar rare, once in a lifetime sighting.  Venus-Jupiter conjunctions shouldn’t be hyped; viewing the night sky, as well as the day sky, should be.  People need to get out and look up, safely of course.  It beats looking down at the cellphone. Venus-Jupiter conjunctions are not rare, but you don’t see them often.  Look for them.  Mars becomes bright every other year, and that’s worth noting.  Venus and the crescent Moon pair often, and particularly close pairings are spectacular.  Indeed, the idea of educating people about astronomical events is important, given that many Americans do not know what a year means, how to find the North Star, three ways to distinguish a planet from a star (motion over several nights, shines with a steady light, usually brighter than surrounding stars), or how to see the Milky Way.  Hint: go outside in summer or winter, far from city lights, and look overhead.

I have been disappointed in my occasional attempts to get people interested in what is up in the night—or even day—sky.  Last May, I had my telescope out near Autzen Stadium to show people the uncommon transit of Mercury, where it crosses the Sun’s disk, viewed from Earth.  There was moderate foot traffic, but only 7 people came by and looked during the 4 hours I was there.  One woman spent time talking about her special breed of dogs but made no move to see something that happens 13 times a century.  The transit of Venus was even more rare, occurring twice 8 years apart, about every 120 years.  One of the people to whom I showed the latter commented that it wasn’t very spectacular.  No, it is not, but he got to see something nobody else alive today will see again. And he liked the buttons I was handing out, commemorating it.

Recently, I wrote, on short notice, an opinion piece for the local paper about the need to prepare for the large influx of people coming to Oregon for the total solar eclipse in 2017.  Perhaps there isn’t much interest in Oregon, but there is worldwide.  The article gave me a chance to talk about planning ahead, how to protect one’s eyes from blindness and one’s brain from falsehoods that will be spewed when the eclipse comes.  I hope the article will be helpful.  There were four comments about it in the newspaper; four people told me they read it.

I do what I can and hope that somewhere, sometime, it will make a difference.

THEY WAY WE WERE

September 4, 2016

“You will wear this monitor for 30 days, and if you feel anything strange, push this button.”

Thirty days? I thought. After my first episode of palpitations, a 48 hour Holter had been non-diagnostic. A second episode a few months later lasted long enough to obtain an EKG during it and show I was in atrial fibrillation.  A mid-level provider reassured me this was not serious.  As a neurologist, however, I knew full well (and I knew it before the mid-level was born) that atrial fibrillation is a strong risk factor for stroke.  It wasn’t his heart; it was mine. I didn’t see the cardiologist that day, but I did get an appointment for a week later, with one who had seen me before.  I’m an established patient—a week is a bit long to wait but acceptable.

My first appointment had been well after my first episode.  A then-66 year-old with palpitations ought to be seen quickly, I thought, but It took two weeks to get a Holter monitor and another month to be seen, in part because the referral got lost, and I had to call to find out what was going on.  I do wonder what happens to the elderly who aren’t physicians and might not be thinking clearly.  Would they ever call?  Would anybody notice there was no appointment? We don’t discuss bad system problems when we discuss health care reform.  We assume access and dealing with cost is the problem; quality is supposedly a given.

It isn’t.

After my diagnosis was confirmed, the cardiologist told me all the probabilities, gave me a medication if I needed it, and said he didn’t need to see me for a year.  OK, I had better than 95% chance (but not better than 97% chance) of doing well.

Twenty days later, I had another episode after a hike, and while I was fine while walking, I was light-headed in the car, so somebody drove me home.  I wrote the cardiologist, because we now have e-mail communication.  I was called two days later, not from him but from the appointment scheduler, telling me to come in for a monitor. That sounded odd, because I knew what I had.  Shortly after, I was discussing a month-long monitor, which had never been mentioned at either of my first two appointments.  Worse, it was the wrong kind of monitor for my condition, and that bothered me.  The tech was savvy enough to say I could decline the monitor, and she was right.  Patients can refuse tests.  I could not understand that if my appointment were a year away, why did I suddenly need another test?

The problem was that the cardiologist neither called me nor spoke to me.  It appears today that doctors are so busy that patient inquiries are handled by middlemen and middlewomen.  That’s a recipe for miscommunication.  I think, but don’t know for sure, the cardiologist received a message that I was desperate to know what was going on, which I wasn’t.  I was just informing him.

My wife gets after me every time I complain that “medicine isn’t the way it was when I practiced it.”  Well, it isn’t.  I spent an hour or two a day in practice on the telephone with patients, and these calls were never billed.  They were part of giving care. The patients didn’t want to talk to a nurse; they wanted to talk to me. They called about test results, and if I had my staff tell them their test was normal, they still wanted to speak to me.  I answered every call the day it was received.  I didn’t blow them off.

This is lost, now.  Thirty weeks later, I had my fourth episode, followed by my fifth 4 weeks later, both after hikes, both spontaneously converting in 2-3 hours.  I e-mailed the cardiologist asking whether I should take the pill or just ride the episode out.  I said the problem wasn’t urgent, but the longer the e-mail sits (3 business days is the reply time they say, but it has now been 9), the more likely it is to be forgotten.  Why can’t somebody pick up a phone and call me?  Or, since we have technology, answer a simple e-mail?  We’re talking 30 seconds.

My wife has the same issue.  She needed a GI evaluation, and the referral wasn’t successfully  transmitted across a street.  It was finally hand carried, which I would have done the first time. I used to walk 150 yards to an imaging center to look at my patients’ head scans with a radiologist.  It took fewer than 10 minutes, during which I got a great reading, the radiologist loved having clinical information, and I could tell the patient what was occurring, not having them go home to wait 1-2 weeks (or longer) for a report.  This is what medicine should be doing. Today, I could pull the scan up in the office and view it myself.  I probably could talk to the radiologist at the same time.

My wife had a later reason to call GI and was told she couldn’t see the doctor for five months. She’s an established patient, and five months is unacceptable. She got to talk to a PA who had a 2 month appointment wait.  I can’t count how many “Headache, emergency, see today” patients I had to work in to my daily schedule, and they were nearly all tension headaches. Same day service by a specialist.  Even a walk-in one day who was a Canadian winter visitor. I discounted the charge on the Canadian, because the problem was simple.  Who does that?

My wife got three pages of information what to try.  This involved the PA’s talking to the physician and deciding what she had on the basis of second hand communication.  Doctor Radio on Sirius XM has better.  I am convinced that a good GI physician could deal with her problem in 10-15 minutes.  Talking to a physician appears to be closely regulated. If this improves medical care and flow of patients, fine.  I’d like to see the data, however.

Fortunately, we still know a physician in Tucson, where my wife frequently goes, who does answer calls.  Semi-retired, he is as wise as they come.  He’s the kind of doctor I wish I could have been.  He’s old style when it comes to seeing people but adept at using technology, so that I could have pictures of my colonic polyps that he removed. When I needed to see him for something else, he sat down in the office and gave me the sense he was there as long as I wanted. He’s great.

If we’re too busy to do it right, then we are too busy.  I was too busy, and my only solution was to leave.  I think medicine lost something, although some might disagree.  Technology is essential in medicine, but the human voice, the human touch, the human approach is also essential.  I can’t put a price tag on it.

Robots are great in the OR.  I hope they never end up in the office.