Industrial Snapshots

My niece, ever the promoter of all things Detroit-- and god bless-- recently posted a link to Instagram of photos the Detroit Free Press had collected. The common thread among the images is Packard and the long derelict Packard automobile plant in Detroit.

Looking through these photos is a sober reminder of the impermanence of it all. You look at the images of the ruins and one can't help but think of the thousands of jobs, the thousands of automobiles, the pride, the prestige, the magnitude of business that at one time all seemed so solidly affixed to the foundation of everything that was America, the very substance of a rising world power. It was all so very, well, American. Packard was a symbol of just exactly what it was we did so well. The plant, the product, the employment, all the jobs and resources required to feed that factory-- like everything else about American manufacturing, decline and demise seemed impossible. As with so many other tiles in the mosaic of our industrial heritage-- both here in Michigan and throughout the US-- we are continuing to discover just how temporal it all is.

Whether it is manufacturing, construction, humanities, or the arts-- there is not a human endeavor that is immune from the effects of time. Especially here in the US, where the economic landscape has so thoroughly transformed much of a culture we took for granted in the 1940's, '50's, and '60's. I don't say that to sound alarm, only to encourage us to never ever take this moment, this place, these things for granted. What we have will not last forever. It might be worth a snapshot now and then.

License to Drive

I got lucky Monday. Not a big deal, just a little ego bump. But I'd had my fingers crossed for sure.

Birthday month is license renewal month here in the great State of Michigan. The Secretary of State will give you about 5 years in which time you can simply go on line, pay your fee, and renew your license during each of those five years.  At the end of your prescribed 5 years, however, they need to check your hair color, wrinkle quota, and vision prior to handing over a new license.

The hair color is no problem. Mine's been a fairly uniform crop of silver-gray for several years now. I can't seriously be threatened by a photo update. Same thing wrinkles. I haven't studied the new photo yet but I'm fairly certain I won't look like a Shar Pei. It was the vision thing that was sticking in my craw. I've been wearing glasses for reading (and then some) since age 40 years and 1 hour. That landmark arrived a great many hours ago and in the interim my eyes have continued a slow stroll toward greater and greater dependency on these multifocal assistive devices resting on my nose. But, so far at least, I haven't needed them to drive. In fact, I really find wearing glasses to my disadvantage when driving.  Thus it was that, this past Monday, I proceeded to the nearby Secretary of State's office to renew my license, filled with dread that my new document would feature a photo of me with glasses and a notation indicating that's what I should be wearing whenever I'm behind the wheel.

Somehow I lucked out. "Read line two across." "A, F, S, O, P...." "Okay. All set!" Seriously?? Happy as I am I felt a little bit concerned. Now I have to wonder:  Just how bad do eyes have to get before they intervene on behalf of public safety? Likewise driving knowledge and driving skills.

Airplanes are supposedly safer than automobiles on a magnitude of several thousand times. Perhaps that's no wonder given that flying requires constant proof of both currency (you do fly) and competency (you can fly). With all due respect to that powerhouse of senior political clout the AARP, as the population hits age 65 at a rate of 10,000 people per day, isn't it about time we start requiring a bit more attention to who's out there behind the wheel?  I saw a couple of older citizens in that office who scared me just to watch them walk! It's not as pressing an issue as healthcare reform but I do feel we need to take a look at what it requires to remain a licensed driver for, say, 70 years. No offense.

In the meantime that's me behind the wheel of that big white truck. If I'm squinting it's just because the sun's a little bright.  Don't worry: I see you just fine.

Life's a Snap

Sometimes it's good to have a reminder. 4 year-olds are often good for that.

I got Ev dressed the other morning and he was somewhat distressed that I had selected a pair of jeans with a snap fastener at the top as opposed to a fastener that slides/clips shut. The reason for his concern was that he could manipulate the clip but the snap would not cooperate with his little fingers. With the snap jeans he feared he would need help fastening his pants.

Reasonable enough. I suggested to him, however, that today might be the day he would be able to snap that stubborn snap and master that type pair of jeans. Hesitant, but ever willing, he pulled up those jeans, wrestled the snap into position and...."snap!" His eyes lit up and his face erupted into a smile that words can not describe. "I did it!"

His triumph made me wonder: When was the last time I faced an obstacle and succeeded with such a feeling of immense satisfaction? And too, when was the last time I did not take for granted one of the many small tasks I successfully accomplish each day? A hundred times a day we do small things like tie shoelaces, button shirts, wipe our butts, hold our own coffee cup, dial a phone number. We cannot possibly remember what it took to learn such things. And now such tasks are automatic-- unconscious and beyond even being taken for granted. Lucky us.

We might do well to pay better attention. Someone may be snapping our pants soon enough!

Bad Medicine

On behalf of crappy clinicians everywhere I offer this apology. I'm sorry we don't do a better job of educating patients.

I went to the market this evening to do a bare essentials re-stock. The rotund little checkout girl was sniffling and coughing. She apologized for her condition and then went on to tell me how she was on "tons" of medication and an antibiotic. I told her that wouldn't help me and that I hoped I would leave the store without her bug. Then she said, "It's okay. It's allergies. My doctor told me it's allergies."

Allergies! Allergies? To what, ice and snow? There's not so much as a grain of pollen within 1000 miles of here. We don't even have dust this time of year. But more to the point, why would a doc put someone on antibiotics for allergies?

I left the store irritated with the young woman's ignorance and then I realized: She only knows what her doctor, nurse, or whatever, tells her. That is truly one of the shortcomings of our system. Providers either don't have the time or they are not compensated in a manner that makes it worth taking the time to talk. So, patients are often sent on their way with mis-, incomplete, or no information at all. People get handed a prescription and pointed to the door. The pharmacy gives the patient a sheet or two of information that most patients either don't read or don't understand. Next thing you know the snot-nosed, misinformed, misdiagnosed, and fully medicated patient is scanning groceries and telling people she has allergies-- in Michigan, on March 4th, with a temperature of 29 degrees outside and snowing!

Every patient does not need to be provided with a medical education but they do deserve a reasonable explanation of their condition and treatment. Every doctor has the obligation to slow down, pay attention, and effectively communicate, aka, do a good job of being a "healthcare provider." Good grief!

Experienced Salesperson Wanted

Michigan can be an easy sale. When spring erupts the smells and sight of new growth is spectacular and as welcome as clean clear water. Summer brings welcoming lakes with sparkling fresh water for swims and skiing and streams for canoes and kayaks. Many of the states's residents will vigorously argue that fall is the most special season of all.  The colors of autumn extend across the state and provide the color palate for cool crisp mornings, cider mills, and the smell of the harvest permeates much of the countryside. Winter, too, can be an easy sell. Fireplaces ablaze. Snow skiing, snowmobiling, snowmen and sledding.

Then comes the frigid purgatory that extends from February to late March. The weather can be just about anything but useful. It ranges from cold to colder, from wet to frozen, from unfriendly to downright hostile. The calendar says 3 weeks until spring; dispositions say "I can't hear you. Send help."

No place is it worse than right here in my living room. In Phoenix. It started with the timid greetings when I showed up. Like a visit from the school nurse-- a really nice person with a Tootsie Roll treat but you know you're going to get a shot. As we get closer to Sunday morning departure time it seems to be getting worse. As the day dawned with clear skies and a glorious sunrise I started to think I may be headed for trouble. I'm starting to worry. I can just see Evan crying and fighting all the way down the jetway. The sheriff is called and we get detained. "Son, is this man your father?" "No! No! He's taking me and my mom against our will!"

Most months of the year I can counter and do a little salesmanship getting us all on board and headed happily on our way back to the Great Lakes State. This weekend I think I may be out of luck.

Fly Friendly

U.S. Airways has a feature in their monthly magazine where they showcase one of the members of their frequent flyer club in each new issue. This month the interview asked a businessman what insights or routines he uses to insure a good trip. In addition to saying he unplugs from all electronic accoutrements he always does one thing: He tries to always keep it in mind that the best way to insure a friendly satisfying experience is to be friendly. Genius.

There are any number of tired and annoying cliches about happiness: If life gives you lemons… Make your own happiness. The fact of the matter is, however, that in a great many cases the advice is good. It's like public speaking: If you find yourself, speech in hand, facing a fidgeting audience remember that no one in the audience wants to be in your spot. At the same time, they hope the speech they're about to hear will be engaging. So it is with public travel. Most people are wary of what to expect but everyone is hoping it will be pleasant. In either scenario, if you meet the expectation you become the hero, the person who made it a pleasant experience.

Succeeding at air travel is usually a bit less stressful than public speaking. But not always. Delayed flights, long check-in lines, bag fees, security screening hassles, botched seat assignments-- any of these elements can put a whole lot of people in a bad mood in a hurry. Likewise, keep in mind that there are quite a few people on the flight that have to put up with such challenges several times a week en route to presentations, sales meetings, and customer visits. Not fun. Choosing to be the person who remains positive, maintains a smile, and continues to greet with a friendly voice may be just the influence needed to change a few attitudes. And even if you can't get a smile out of that grumpy TSA guy you will still be preserving your own good karma, making it all the easier to finally settle into that middle seat between those two grumps and, maybe, still enjoy your flight. After all, you are about to cross a patch of the globe at two-thirds the speed of sound, completing in hours what used to require days, weeks, or months. Worse case scenario, however, you may just need that iPad.

Illiteracy v2.0

I took care of a 14 year old the past few days. He had to be admitted to the hospital to have a hand infection surgically cleaned out and then stay for a few days for antibiotics. He was a pretty quiet kid. Polite. Respectful. All the character traits one seems to have such difficulty finding in teenage boys these days.

The other morning when I went into his room on rounds I found him there with his laptop open. It looked like he had some school work out. His parents were there too. After finishing my business I stopped and asked the young man, "Are you a pretty good student?" "Ya. Pretty good." "Do you like school?" He laughed, "No. Not really." He couldn't tell me why not. He also couldn't tell me what he hoped to be doing some day when he's 39 years old. "You'll be 39 in the blink of an eye, you know." He seemed to have no conception of the future.  "What kinds of things do you like? What do you like to do?" "The computer. Games and stuff." I asked and, yes, he meant playing games on the computer, not developing them.

I left that room feeling discouraged. His caring parents did not appear to be college educated. They appeared to be from a blue-collar lower-middle class background. I think the dad, at least, is employed in manufacturing although, come to think of it, he seemed able to be at the hospital more often than not. I don't know if his mom works but both parents seemed very attentive to their son.  Their son who doesn't like school and has no vision of what he'll amount to in another 25 years.  Their son that really likes to just play games on his computer.

Boys like my patient bring to light what I think is a fairly large and growing population that is both without direction and has no interest in being given any. I think he illustrates a widening chasm in the US that is not just rich - poor but productive - nonproductive, engaged - not engaged, focused - distracted. And I'm not interested in blame. I'm not even terribly concerned with the social or financial burden a kid like this threatens (although each of us should be). I'm concerned with our loss. A sharp mind. A capable body. A Ferrari left to rust in a barn. I think there must be oceans of kids who are growing up without anyone to engage them, to show them that life at 30, at 40, at 50 can be really fulfilling and pleasurable because of work. They aren't just poor inner city youth, these kids are everywhere.

When I left that room I really had to wonder: Is there a program to mentor such kids? How many of us could meet with a group of 14 year olds and tell them about what we do in this world? How many of us could relate what excites us about work, about contributing in this world, about why we don't want to spend the day playing games on a computer. How many of us could invite one of them to come along one half or one whole day a week to see how it happens? In my neck of the woods too many kids are never afforded a vision and so remain in the dark. It is a tragic form of illiteracy and one that cannot be fixed in the classroom. It's definitely a homework assignment for all of us.