The White Problem

I don't know if it's age, gender or genetics but I have no business wearing white.  It seems like all I have to do is put on a white t-shirt and wait.  I don't think I even need to move from a seated position: I can just sit there and it happens. Yesterday I went through three.

In all fairness to myself, the first one was in the line of duty.  Evan and I went out for a bike ride and he, slightly over-confident on a new bigger bike but still trailing training wheels, crashed three times which got my plain white T involved in picking up and righting the wreckage as well as using the soft fabric to mop up tears.  Line of duty.

The second one was less understandable but still, I can find the space to forgive myself. Go for a swim, hang up the wet suit, change into dry shorts and toss on a clean white T. Miniature golf, sporting goods store, pick up a new stool for the kitchen, stop in to check out a local daycare and reward ourselves with a MoJo Yogurt.  Chocolate.  I just sat there eating my frozen yogurt watching Volume II shorts from the Three Stooges Collection they had playing.  I was fully aware of the inherent danger of eating chocolate frozen yogurt while wearing a white shirt.  I was fully aware and careful in my cautious handling of that paper cup and green plastic spoon.  And yet, as we walked back to the car, my wife laughs and tells me I have chocolate all over that shirt. Laughingly.  And she was right!

As with any good story, it gets worse: Back to the pool for an evening swim then change into, what else?, a clean white T.  Bathe the boy, get him a snack and then off to bed. Before I do the same I decide to have just a couple of bites of the watermelon he'd been eating. Nice, safe, small cut-up pieces of watermelon.  I even took the precaution of standing over the sink and leaning with each bite.  Next thing I know I'm looking at a dumb-ass brushing his teeth with a single, well-placed spot of watermelon juice on his plain white t-shirt.

Has it always been this way with me?  Is it a guy thing?  I look at elderly men, shuffling along with their walkers and I study them for signs of spillage.  Am I witnessing the first signs of advancing age, the relentless march of time, the undoing of my macho self?  Is a walker with wheels and tennis balls just around the corner?

This could be genetic.  My well-performing University of Michigan daughter seems to have the same ability to soil herself.  I don't recall either of my parents having the problem.  It's times like this when I wish they were still around to ask them about such things as whether or not they had a problem when wearing white. There would be comfort in knowing.

I'd be out of white T's today if I hadn't spotted that watermelon juice at first sighting last night.  As it is, I did and have it on right now. Clean and pristine, I'm ready to make coffee. Wish me luck.

Deathcare Reform

This July our hospital begins a new phase in healthcare reimbursement.  In July we begin to get dinged, or rewarded, for "performance." Specifically, we will be financially incentivized by our ability to send home patients who are "completely satisfied." You may recognize that phrase if you've purchased a car or had one repaired at a dealership in the last few years.  It works the same for them.

The changes coming in healthcare are unbelievable.  Many of the changes which have evolved over the past 20-plus years of my career have been for the better, to be sure. And many of those proposed in the coming era of "accountable care" and "pay for performance" may also be for the better.  And I need to be clear here: the "better" I am referring to are the improvements which provide for fewer mistakes in care, healthier patients, and a better work environment for all involved.

The imposter in healthcare reform is that piece which is driven by those many corporate interests which look at healthcare as an industry with a significant capacity to generate, non-profit or otherwise, lots of money for someone. "Lean" ideologies which promote greater efficiency and cost savings in manpower and supplies are solely directed at the financial bottom line. These formulas have been demonstrated to work well in manufacturing as measured in profit. Greater efficiency, fewer "FTEs" ("employee" is too uncomfortable a term. It's easy, fun, and tres chic to "reduce FTEs" as opposed to firing people), purchasing groups, outsourcing, these moves cut costs and increase profits. In healthcare all of this is marched forward under banners which read "quality," "safety," "outcomes,"and "patient satisfaction." I guess the banner which reads "happy people" has been copyrighted by some other marketing interest.

Into this contemporary mix of modern healthcare and reform comes news of the recent death of Dr. Kevorkian, the infamous Michigan pathologist who promoted and practiced the belief that the terminally ill should have the right to die.  His passing gives me pause to wonder: In spite all of the controversy and moral outrage over the right to die movement, how long will it be before the "healthcare industry" recognizes the financial value and necessity of such an option and begins to advocate the very same philosophy? "Dignity in Death" or "Accelerated Terminal Care" or, perhaps, "Compassionate Closure." My God!  What a marketing bonanza.  But why, you ask, would healthcare reform take this direction? Because, like so much of everything else in U.S. healthcare, it's the money.  With 10,000 people a day turning age 65 it doesn't require a mathematical genius to calculate the financial burden we will be facing with care of the elderly in 20 years. People are living longer then ever before and many with greater disability requiring more care (read: "expense").  When it becomes financially unfavorable to provide decent care for the burgeoning population of elderly maybe it will give rise to a well marketed movement in healthcare to promote and offer euthanasia as a viable part of compassionate, patient centered, cost effective healthcare.  As a colleague of mine suggested, perhaps insurers will approach families of these expensive patients and offer them a deal:  Let Mom go and we'll not only provide her a comfortable end, we'll provide a cash settlement on her remaining actuarially adjusted years of care. Home run!  

So, I look forward to see how this all evolves.  As in so much of contemporary American life, I don't think it's the government we need to fear.  The death squads will be formed and staffed by those with a financial interest in your life, health, and longevity.

Historically it was the physician who looked after your health and physical well-being.  I have to believe that was Dr. Kevorkian's motive in his efforts to promote the right to death with dignity.  Next time around it will be the industry. And the industry will provide all the compassion and care financially feasible and allowed by law. And you will be completely satisfied.

Steel Wheels on Steel Rails

I had the coolest recollection today:  We all went off for a bike ride and, while riding on the path which passes our local steam railroad museum, discovered they were offering rides on the miniature railroad today.  My son Evan immediately insisted we stop for a ride, which we did….3 times.

The trains today were pulled by diesel locomotives in miniature, 1.5 inches scale to the foot.  The one operates with a battery-powered electric motor similar to a golf cart.  The other was powered by a pull-start lawnmower engine.  Both were operated by a teenage engineer with a teenage conductor riding on the rear.  I’ll admit: I was reluctant to climb aboard.  It wasn’t the age of the operators.  It was the flatcar with the wooden plank running its length which one straddles as the only seating option. I wasn’t worried so much about falling from this I-beam perched just inches above the rail.  No, I was concerned my hips or knees may not function sufficiently after our short excursion to allow me back on my bike for the ride home.

I love trains and my son knows it.  Even so, I’m not the miniature train kind of guy and, in addition to the risks mentioned above, the 7½ inch gauge railroad didn’t really seem too terribly appealing to the part of me that likes trains.  But Evan is 4.  And while he can distinguish a diesel train from a steam train, like most four year olds, he doesn’t care if it’s big or little, plastic, metal or wood.  Thomas the Tank or the real deal—if it’s a train he likes it.  And so we climbed aboard.

I’ve ridden a few trains in my life: I rode subways every day in New York for the two months I lived there with my brother Dan.  Between the ages of about 10 and 15 Dan and I got to ride the streamliner from LA to our brother Art’s house in Riverside a half-dozen times or so. I rode a train a few times up through California to my sister Nan’s house in Oregon.  I was amazed and struck with delight when, today, riding as the reluctant passenger on that miniature railroad I was immediately able to call to mind every great ride I’d ever taken on a train—especially those from Los Angeles to Riverside riding the Union Pacific’s streamliner, City of Los Angeles, up in the dome car with commanding views of the train and the railroad, rapt with the enthusiasm only a child can possess.

Thinking about it now I believe there are two things which account for my experience: First, I could feel that little train pull.  It doesn’t rock one back like an accelerating vehicle, boat or airplane.  It’s the feeling of being pulled, like you’re sitting in a desk chair and someone is tugging you along; a friendly, firm, slow, steady force. The second is the audible and very textural feel of those little steel wheels rolling on steel rails. Small as it was, the wheels of that car rumbled beneath my feet and buns as I straddled that beam. The effect of those two sensations was to utterly transport me in time.  And suddenly it was sad and glorious that it had taken me this long to remember, but I did remember; and this long to share this wonderful experience, but I was, at that very moment, sharing it with Evan.  And the really good news is this:  I think he gets it!

House of Wheels

My small Mid-Michigan town suffers the insults shared by so many small towns in the United States:  Failing independent businesses, Big Box buffet with Wal-Mart, Home Depot, Meijers and Staples; fast food food court with Taco Bell, MacDonalds, Burger King, and Wendy's to name a few.  We have representation from all the major big box pharmacy chains. We do still have a few independent restaurants, and that's another story.  The crown jewel in our town, however, is the bike shop, The House of Wheels.

If you grew up in the 50's or 60's you surely remember independents like the local Rexall drug store, the camera shop, the hobby shop, the book store, and the bike shop. Most places, in cities of all sizes today, virtually none of these exist in any form that would recall that time in your youth when a trip to a place like the bike shop was filled with all the sights, sounds, and smells that gave comfort and the promise of fun and service. These retailers still exist in many cities all over the U.S. but most are reincarnations, and many, impostors.

Somehow, as improbable as it seems, this little town, fully pillaged by every conceivable form of retail assault, retains its bike shop.  And this, my friend, is that bike shop: Owner on the premises with his bike parked against the wall, rack upon rack of road bike, cruiser, mountain bike, kids bike, tricycle, 1-speed, 3-speed, 7-speed, or 21.  All these and trailers and carriers and helmets and shoes and skateboards.  All these and maps and brochures and stickers, sunglasses, and shorts and bright colored shirts  The whole lot crammed into 2 small show rooms either of which would be considered a big bedroom; neither of which would be considered a big living room, all of which are covered with well aged linoleum.  The walls are hung with more bikes, antique bikes, pedal cars and posters. The glass case at the register stuffed with old stuff and new: pedals and clips and gear shifters and stickers.  And more stuff on the shelves behind.

You can enter off the street through the front door, but why would you?  Why when you can enter off the alley, past the dumpster and the rack full of junkers.  Step in through the store room the size of a small milk house, full of repairs mostly ready for pick-up.  Then pass into the work shop with its two stands manned by the high-school type, the owner, and his experienced help guy-- that thirty-something who has dedicated his life to stunt-riding BMX bikes and realizes the good fortune he enjoys in this small town oasis. The uniform is a well-worn, thin with age bike tee-shirt. That's where you want to enter, the workshop, with the tubes and tires hanging from the ceiling, the shelves above lined with new and antique pedal cars some of which will remain preserved forever in their fine coat of rust; with the smell of rubber and the sight of work rags draped across the work stands.

Walk in any day and you will step out of this troubled failing economy, this troubled failing society, this troubled failing age, and you will land smack dab in the middle of somewhere you want to be, somewhere you used to be, somewhere you will long to be.  The sights, the sounds, and the smells are of another time and place, well preserved, and presented for your pleasure at the Owosso House of Wheels.

Dependents: Do the Math

In my line of work I take care of a lot of elderly people.  Almost all of the people I see in their 60’s are a healthy active bunch.  60 is the new 50 they say. A great many of the people I see in their seventies are also quite healthy and active. Some of the people I see in their 80’s are healthy and active as are a few of those I see in their 90’s. Their counterparts in those groups are not doing so well.

Last week I was asked to see a woman in her mid-80’s with hip pain.  She is one of those who suffers with early dementia, who doesn’t walk much, and who cannot live independently even though she remains in her own home. I walked in her room and discovered her son there visiting who turned out to be a man I know.  He is about ten years older than me, a professional who lives pretty well.  We visited and he told me of his mother’s failing health and her ever-increasing needs.  Forgive me, but I had to think, “thank God my parents are gone.” My dad was 48 when I was born, my mother 47.  They were both gone by the time I was 33.

This evening, shortly after dinner, as my 4 year old son was jumping up and down on my belly I was given cause to consider the wisdom of having a 4 year old at my age.  I try to stretch and work on my core strength at least 5 days a week but, even so, I am inclined to think my body at 34 was far better equipped to accommodate the vigor of a 4 year old climbing on my belly just moments after dinner.  Every time he asks me to race him, or crawl, or push, or jump, or to climb into a freezing cold pool with him it’s the same:  I hope I survive this journey.

Be that as it may, there is never a day that goes by when I don’t feel like a lucky man to have this little boy.  His energy and joy and humor and curiosity are boundless and bring the same to my life.  He makes me happy far more often than I feel sore; he makes me feel renewed far more often than fatigued; makes me laugh far more often than he causes frustration.  And better still, I can hope that by the time I’m 70 he’ll be out of the house, living an independent life (even if he is still on the Dad Scholarship Plan), will not need me to take him to doctors appointments, will not be in diapers,  and perhaps, will even be dating a hot young babe he can bring home to meet dear ol’ dad.  Yes, I’ll definitely take my 4 year old at 54.  Good luck to the rest of ya!

Portland Clogs

It’s sometimes amazing, and surprising, and disappointing, and gratifying, how one’s attitudes change with time.  We have had rain here over the past 4 days.  The kind of rain that brings the ordinarily hyperactive squirrel industry to a crawl, the soggy little bastards keeping to their trees and nests.  The birds, too, seem to have taken the day off in spite of the streets and sidewalks being littered with displaced worms struggling for breath.  Across the street the river continues to rise, fast flowing, and the mighty Shiawassee River has become, indeed, the mighty Shiawassee.

Thirty some years ago I moved from sunny Southern California to a very small town in the Willamette Valley of Oregon.  (And that’s a whole other story.)  One of the memories I have of that time, however, is that of the rain.  I hated the rain.  I was the high school kid without a car and, most days, walked about a mile to school.  When it would rain, as seemed so often the case, I would curse my existence and the sorry circumstances which had put me in that miserable little town.  Walking along the rudimentary sidewalk, pant bottoms wicking the water up my legs, shoes getting soaked and my feet squishing within: I hated the rain.  Every step was misery. The rain was the meteorological manifestation of everything that was wrong with my life at that time.

The first time I softened my miserable perspective on rain was just a few years later, early on in college. I had a girlfriend with a '73 Mustang and we drove to the beach in the rain.  And, right then and there, she convinced me of the beauty to be found taking a walk on a stormy ocean beach with the waves exploding and a steady mist enveloping all, soaking us through and through.  No sex, no drugs, no booze; just a happy afternoon getting soaked in an Oregon rain.  What a first.

That was the day, and maybe there were others, but slowly, surely, and unbelievably I have come to love a rainy day.  And so it is as I walk up to work, river rising, wrapped in my trench coat, umbrella in hand, clopping along in my Portland Clogs, I feel energized and look forward to the day ahead.  The shoes are a throwback to my days at the University of Oregon and they look like something borrowed from the prop box backstage at a KISS concert.  But they do make for happy feet and happy memories as I walk up the hill and only wish I had all the day to enjoy the rain.

Crazy

I'm not sure how long it will take for all the excitement over the death of Osama Bin Laden to dissipate.  I'm not sure how long it will take for his compatriots to act out in revenge.  I'm am certain both will happen.

For years I have been a pacifist and against the death penalty.  I have changed my mind to some degree, however, in that I don't think you can rehab some people.  More importantly, some people are probably just not worth the effort.  When I think about truly heinous crimes in which children are grossly molested, tortured, or killed, I realize such acts are perpetrated by individuals who are severely damaged.  Nonetheless I have come to believe that in such cases it is simply better to say, "game over."  What is the point in housing them in prison for the rest of their lives?  Rehabilitation? I believe there is no point whatsoever and society is best served by simply removing such individuals from the planet.

Bin Laden may have been such a person.  I'm fairly sure many people in this world believe the same of the U.S. and its aggressor policies and actions which leave the dead and injured in their wake.  I can't really say I know enough to vote yea or nay on that one. Given the horrors of September 11, 2001, I definitely lean towards a yea vote.  Adios, Osama.

The sad part in all of this is that we continue performing the same actions and expect a different outcome. We kill and hope to achieve peace.  We wage war and hope to end war.  After hundreds of years of human history we continue to adhere to policies of aggression in order to resolve political and religious disputes.  We kill one man as the literal and figurative head of a hated organization and hope that action will lead to their larger demise.  All sides invoke the power of God and righteousness.  Through all of time, through thousands upon thousands of people killed, lives destroyed, humanity decimated, we have made no peace.  The harvest has been nothing but strained intervals of quiet among factions, a quiet which now appears to be dissolving.

As a friend of mine's Grandmother used to say: If you always do what you've always done, you'll always get what you've always got.  To believe otherwise is the very definition of crazy. The only question I really have is not whether or not we should have killed Bin Laden. Rather, I wonder whether or not our biology will ever allow us to successfully subvert the animal and elevate the intellectual.  Will humans ever learn that war does not bring peace?  There are evil people in the world who do unspeakable evil to others and I have come to believe they need to disappear.  The same is not true of entire nations and societies.  We have to figure out a better way, one which involves caring rather than killing or, I fear, we are doomed. Crazy, huh?