Boreal B[l]og

After finishing graduate school, I returned home to become a medical statistician.  At 51, I knew people in the community, I was a statistician, I knew medicine, medical administration, was trained in quality improvement, and a decent writer.  I had it all.

Except for the course on marketing.  I bombed, completely failed, one of the biggest failures of my life. I was bitter for at least 5 years, maybe longer, until time and dealing with the deaths of my parents both shoved me into another direction.  I often blamed my failure on the fact that I had pissed off the medical community.  War on Mike, I could have called it, sort of like the War on Christmas.

Except for a few vocal detractors, perhaps four, the medical community could have cared less about me.  They were too busy getting on with the stresses of their own practices, families, and other matters, not trying to think how they could screw me over.

Sometimes, I wonder if I will ever become an adult.

After being executor of my father’s estate, I moved on. I’ve been fortunate.  Nah, I won’t be famous, but I am content in my own skin.  I have discovered that there are some good things about growing old and there are things that just plain suck.  In short, I am alive, and a lot better off than most.

That brings me to Starbucks, which has a plain red cup for Christmas, and now accused by many so-called Christians as “hating Jesus,” being anti-Christian, and has Donald Trump calling for a national boycott.  I think the country has more important matters to address then the color, which I like, on a Starbucks cup.  To those who now hate Starbucks, I say, “get a life.”  Re-read the second, third, and fourth paragraphs above, especially the fourth.

My solar eclipse video in 2010 got 1000 views, yet the Starbucks customer who said that the company hated Jesus has a video with over three million views.  Sort of says something about Americans.  You know what?  I’d rather be a quiet guy who taught people about solar eclipses, volunteered teaching math, taught English online to people in 90 countries, donated to animal welfare in two countries and four cities, and on my own dime led hikes in the Cascades than a guy who had three million people listen to his stupid rant.  For the record, I decided not to add to his count.  If he looks at my video, I’ll look at his.

The holidays are a time I now look forward to.  Formerly, when in practice, they were a time I dreaded:  most of my partners took time off, patients who went to the hospital usually had a horrible reason, services at the hospital were often slow, because people were “away for the holidays,” and I usually came down sick with something.  Additionally, I had to do Christmas shopping, because my late mother made a big deal about Christmas. Oh yes, night call was really depressing when somebody with a Grade V subarachnoid hemorrhage or irreversible anoxic encephalopathy had to have the plug pulled on Christmas Eve.  I disliked the season.

These days, my wife and I go to the mall on at least one December Monday (more if we can) and watch people in line with their pet animals wait to get a picture with Santa.  What a hoot.  A woman last year had a Siamese cat perched on her shoulder for at least 45 minutes while she stood in line.  She had another half hour to go.The best we could do with any of our cats is about 4.5 seconds with the silver one, and maybe 4.5 milliseconds with the semi-feral 5 year-old.  I’m not exaggerating.

Yes, that is a Siamese on her shoulder. Valley River Mall, 2014

Christmas Eve Day, we go shopping for things we want, have lunch somewhere, and return home early.  After dinner, we walk the neighborhood looking at lights, then turn on the 24 hours of “A Christmas Story,” which we love.  Hell, two of our cats are named Red Ryder and Black Bart.  We use quotations from that movie often:  “The line ends here.  It begins back there.”  “Soooooaaap poisoning.”  Christmas Day is vegetarian; we do just fine with fake turkey and all the trimmings.  I put on some Christmas music, pick up the tree that the cats have knocked over and enjoy the day.

Who is declaring war on Christmas?  Well, the nightly progress reports about how well merchants are doing this year compared to last is a little counter to the message Jesus preached, if I understand the Bible.  I don’t think Jesus would like our constant war since 2003 and our troops overseas since 1945.  I think Jesus might have preached something about gun violence, but I’m not religious, so I may be wrong.

It is a goddam red coffee cup for Chrissakes!  It’s not Satan jumping over the counter.  Get over it!  Bring in your own decorative cup or mug and save the planet.  Starbucks lost $3.2 million last April when their computers crashed, so they gave customers free coffee.  It was April, not December, but isn’t there something  about keeping Christmas in your heart the whole year?  Saturday,  Safeway had $1, $5, and $10 coupons to donate food to the needy. On impulse, I threw in a five spot.  My heavens, the clerk started ringing the bell as if I were a breast cancer survivor in October at Starbucks in the MSP airport.  Yes.  That Starbucks.  Where the manager comes out and hugs a survivor.  I don’t cry easily, but that sort of stuff brings tears to my eyes.  Yes, that Starbucks.  The one that wants to increase hiring of veterans to 10,000 and provide free tuition to get a bachelor’s degree at Arizona State University.  And a red coffee cup is all the talk is about, rather than helping veterans to attend college?  I’m a veteran, and helping vets trumps any complaint about coffee cups, which I happen to like.

Anyway, the cashier asked if I wanted my name on the coupon.  Embarrassed, I declined.  She thanked me three times.  It was just $5.  But no, that’s not the point.  I was making this cashier and some unknown recipient happy.  That’s what Christmas is about, not politicizing the event to make it sound like we are trying to defeat the 70% of Americans who call themselves Christians.  Can’t we just have Christmas, Chanukah, Kwanzaa, and any other holiday this melting pot of people celebrate, without claiming there is some sort of war?  Can’t we do good things for others? Are these people Dementors or Ebenezers?

The very next day, I went right into Starbucks that’s part of Target, although I personally prefer Dutch Brothers, and by God, I got me one o’them red cups for my decaf.  Yeah, I have to drink decaf. It’s better for my heart, especially when I am dealing with damned idiots who think we’re having a War on Christmas. It’s repetition, and repetition doesn’t make it right.  It’s wrong, and I am by nature argumentative against wrongs.

Take it from me, you poor Christians who feel persecuted.  I thought the medical community was persecuting me, and I just didn’t do a good job marketing myself.  It took me a while, but I got over it.  Start marketing yourself.  Begin with following Jesus’s teachings.  Ya know?  Love, caring for the poor, he who is without sin….

Be big boys and girls.  This War on Christmas is bogus.  Get over it, you hear?  Go to Safeway, stick a tenner coupon in with your groceries, which I will do the next time I’m in, and you will be doing the Lord’s work.   The next time I might even put five of them in.  It will make the clerk’s day.  Then, this non-believer, who likes pagan holidays like Christmas, will say to her:  “Merry Christmas.”

And walk out of the store with a big smile on his face.  Won that war.

When I moved to Oregon, I volunteered for organizations I didn’t even know existed, and I didn’t volunteer, but thought I would, for others. Such is life, and I predicted this experience before the move. When I learned there was a state-wide reporting system for medical errors, I wrote them, eventually being invited to their offices to meet with the staff. I was optimistic.

But not surprisingly, nothing came of it. I knew that when I walked out the door after that meeting. I read body language well. I saw the expression, “I’m really busy and need to get back to work rather than talk to this guy.” What I brought, they didn’t need, and that is OK, just unfortunate for me. I later wrote an opinion piece about the need for pharmacies in the state to do more analysis of the errors they made, so that we could improve state-wide systems. Seven hundred pharmacies in the state generated only 20 reports last year. That’s disappointing, but again not surprising, either. Nothing came of my article, but I didn’t expect anything. I’ve gone down a lot of dead-end roads. I turn around and try others. Occasionally, I find a path that leads to interesting places. I don’t find one often, but if I don’t try, I won’t find it at all.

After a few problems obtaining my medication, which I recently wrote about, I sent a letter about my experiences to the head of the Patient Safety Commission. I didn’t know what would happen, but again, if I didn’t write, nothing would happen. I received a reply, saying my letter was forwarded to the staff as a reason why the Commission exists. I found that Interesting. A few days later, a staff member wrote me saying she knew a man who taught pharmacy students, and he might be interested in talking to me. This road was going a little further than I thought. After exchanging a few emails, the pharmacist called me and we spoke about medical errors, pharmaceuticals, and other issues.

It wasn’t a fit, and before I heard the words, I knew this wasn’t going to work out. I can read body language over the phone well, too. He wanted somebody “downstream,” a patient who could come to his class and explain how a medication error affected them. That’s asking for a lot, and I think is unrealistic. I sure couldn’t provide it. I saw the Dead End sign, but we had an interesting talk. I think his class would benefit from one who had seen a lot of errors in other fields, studied them, and could advise his students about system design and learning from errors. Somebody like me.

For a couple of hours after the call, I had the usual down in the dumps feeling, which happens when I encounter a dead end sign. Maybe something will happen. He might talk to other people who are interested in what I have to say. But I strongly doubt it. It almost never happens. Networking to me has led only to my giving free advice, almost never receiving anything in return. Still, I keep trying, although I am running out of time.

I might have told the students about the error in a Bend hospital, where a lady after recent brain surgery came to the hospital and had fosphenytoin, an anti-convulsant, ordered. For some reason, she was given an IV bag containing rocuronium, a paralytic, but labelled as fosphenytoin. She might have survived had there not been a Code Red, for fire, and was left unattended for 20 minutes. She died a few days later from anoxic encephalopathy. It’s like a plane that has a landing gear problem that consumes the pilot’s attention so much that the plane runs out of fuel and crashes. That happened in Portland in 1978, killing 10. It spawned CRM, Crew Resource Management, which essentially considers everybody in the cockpit an equal resource in an emergency. The concept worked a decade later on a United jet and to perfection in 2010 when a Qantas A-380’s port engine exploded and the plane had to be nursed back to Singapore. The video is worth seeing, as an example of how teamwork in the cockpit saved the plane and all aboard. The investigation is worth reading, as well, as to how a seemingly minor quality assurance problem at Rolls-Royce had catastrophic results. Oh, it wasn’t a miracle that everybody survived. A miracle would be not to have had a problem ever occur with anything we make. Everybody survived because of redundancies built into the aircraft and skill of the crew. Medicine needs that kind of dedication to safety, where pharmacists are important resources who can find errors in drug choice, dosage, or interactions.

Instead, I read online that there now needs to be a safety zone where those mixing drugs will not be interrupted. I’ve been harping on that for 15 years. Sterile cockpit means that nobody talks about anything but the aircraft when the altitude is below 10,000 feet. In 2013, exactly four cases of incorrect medication being given were reported state-wide. Whatever the number, we aren’t learning from them. I later read that up to 440,000 deaths in the US occur from medical errors annually, and I don’t believe that number, either, because if we can’t even track something simple like the wrong medication’s being given, we can’t possibly know the number of medical errors. I offered a solution a decade ago, one that uses random sampling of hospitals, but I hit a Dead End sign.

I could have spoken to the students about our needing to count the number of prescriptions filled improperly, the number of prescribing errors made, and the number investigated, not to shame anybody, but to understand how many errors and what kinds of errors are made, so we could refine systems and know whether or not we had refined them successfully.

I think with examples compared to aviation, which I find compelling, we could start educating students the need to have a safe, effective, voluntary way to report safety issues. Maybe that generation would stand on my shoulders and see further than I.

No, I have spoken out on the topic enough, maybe too much. I’m out of date, but there are things still happening that shouldn’t be. A patient was recently awarded over $12 million from being given the wrong dosage of Amiodarone during a procedure. He is now brain-damaged for life. This was a preventable error. For him, normal life hit Dead End.

That’s far worse than the Dead Ends I’ve had.

Cummins Creek Trail, Oregon Coast, 2014

The 2015 Canoe Trip has been like the last twenty or so.  We fly to Minnesota, drive 4 hours north to Ely, get the gear we rented, drive to the entry point, our jumping off point, and the next morning, regardless of the weather, enter the wilderness, for entry permits are day and place sensitive.

We are both old now, although we do note with some pleasure a few more folks like us on the water than in years past.  I think it’s because the gear is better, lighter, and more convenient than it once was, and a lot of our generation grew up in the outdoors.  I don’t do the long travel trips that I once lived to do.  Instead, we go in a dozen miles, find a site we like, usually one we have stayed at before, pitch the tent, and settle in.

Fall Lake from the Fall-Newton portage, BWCA, 2015

I like base camping.  It’s nice to pitch the tent and not have to take it down the next day to do another dozen miles.  Yeah, we could do it, but we’d pay for it a lot more.  The site we have is really nice.  It’s not one people go to by choice, I suspect, because there are only two tent sites, neither of which is great.  The one we use has me slide slowly towards my feet during the night.  I can live with that.

Down a bay is an isthmus site where I stayed in 2013.  It’s pretty, being ten yards from water to water at its narrowest spot.  There are a lot of tent pads, a decent kitchen area, and great sunsets.  I liked it and thought in 2014, when my wife was again well, we’d stay there.  She had seen the site once before with me when we were exploring and in 2014 we fully expected to stay there.

The isthmus campsite from our site on the point. They get the sunset, we get the “Ross Light,” a special light at sunset, coined by the great wilderness author Sig Olson.

However, the site was taken. Bummer.  We paddled back out the bay, deciding to look at a site on the point.  It rises up some ledge rock from the lake, only 20-30 feet, but elevation matters in the Canoe Country.  We immediately noted the view down the lake a couple of miles to Canada and back to the isthmus site where we had just been.  Yeah, it’s work bringing the packs up, but we only have to do it once.  We get here in 4 1/2 hours and we often just sit for hours, watching the water and an occasional traveler.

Evening view down the lake

We have learned that by sitting still, we see a lot more.  This is basic to observing nature, but in the past, I’ve been in a hurry to see what’s out there, not as conducive to seeing wildlife.  Last year, we were treated to a nightly show of beavers swimming into the small swampy inlet next to us.  This year, we had no beavers, although the beaver house was still nearby.

No matter, the weather was rainy for three straight days, so we got out for some short paddles and spent a lot of time in the tent, sleeping.  We sleep a lot out there.  The autumn colors were better last year; this year they are just beginning, although they were going to peak the week after we left. We get what we get.  The last full day out, we awoke to mist everywhere, threatening rain, figuring we’d take another day trip with the canoe.  The weather cleared, but then the wind came up, strong enough that we decided just to sit in camp the last day, reading, writing, looking down the long channel, or over to the isthmus.  We had a long paddle out the next day and wanted to save our arms.  At least that was our excuse.  Neither of us was looking at anything, just the trees that had changed color, the sky, the shadows, and the.….otters that suddenly appeared right off shore, three of them.  The day before, we watched one play with a stick on a rock face, before he ran down into the water.  We had missed the beaver show, but the otters played right below us, diving, allowing us to see them underwater, come up by a rock, by each other, and then disappear again.

Otter, Basswood Lake, BWCA, September 2015

By remaining silent, we saw a hermit thrush walk through camp, a Hairy Woodpecker and a Three-toed Woodpecker work on a dead birch tree near us.  Sometimes you see this stuff when you are traveling fast; the chances are greater you will if you sit still. I have long had the philosophy that wildlife viewings are a gift.  I never expect any, so if I see something, I feel blessed and grateful.  The otter viewing was the best I’ve seen, and I’ve seen a lot of otters.

We talked about what we would do when either of us or both of us can no longer do the work to get up here, or if the benefits don’t outweigh the effort, which can be considerable.  We can see those years in the future now.  It could be next year.  For my wife, 2013 was such a year.  On the other hand, we are able to do the work, and we hope maybe we’ve got a few more years out at this site until we need to move to a place that closer in, but still keeps us in the wilderness we’ve grown to love.  Eventually, we may have to stay in a cabin and canoe from there, not in the wilderness, but close to it.  That is how we hope our lives may play out.

There are many who say that age is just a number, but they are young and not wise in the ways of probability and genetics.  Things happen as we age.  The work necessary to get into this country requires strong enough arms to paddle long distances, often against headwinds, legs and body to carry packs and a canoe, decent balance to walk in camp, and ability to take care of oneself in the outdoors.  I’m relying heavily on experience these days.  On the trip in, the canoe went up on my head automatically, without my even thinking of it.   I can still move a canoe in any way I want it to go, I can read the sky and try to travel smart.  There are no guarantees, however.  I want to come out here as long and as I safely can.

I spend only a few nights every year up here.  They have now added up to more than three hundred in the border lakes country.  The special places I’ve seen are where I go in my mind when things are bad, life is difficult, and I need to mentally separate from the present.  Like the otter, I appear there, spend some time, then go, glad for what I experienced.

Eagle near the Canadian Border, BWCA