Just Got Back From Chile.

I didn't really go to Chile; Sara Wheeler's travelogue of her adventures in Chile - Travels in a Thin Country -  made me feel like I was along for the ride.  Of all the things in my life I haven't spent much time thinking about, Chile (the country) is close to the top of the list.  Turns out, that's Richard Nixon's fault! Chileans substitute his name for Hitler's in conversations about maniacal tyrants and they aren't overfond of North Americans in general. Bet you didn't know that, or that Charles Darwin thought Chile was nearly unmatched for beauty, or that much of Chile is still living under a feudal system! Ms. Wheeler brings the earthy reality of this spine-shaped country to vivid life in a thin, highly-readable journal of wild beauty and wrenching politics.
Thought-provoking.

Things My Father Taught Me.

The number one song burning up the pop charts these days is Shut Up and Dance by Walk the Moon. I hate it.  Which is odd, considering it has the kind of catchy, driving rhythm I usually like.  It niggled why the song repulsed me until I realized it's because I was taught that telling someone to shut up is rude; I don't like Shut Up and Dance because it's rude.  Also vapid.
That got me started to think about other things my dad taught me that stuck.  There's too many to count, honestly, but here's a few that came to mind:

How to split wood.
How to find the North Star.
How to drive a stick-shift.
How to start a fire.
How to change a tire.
How to kill and skin and animal.
How to plan and plant a garden.
How to bale hay.
How to shoot a gun.
How to ride a horse.
How to change spark plugs.
How to clean battery terminals using water and baking soda.
How to identify edible plants.
How to mend fence.
How to make do with little.
How to keep my temper under control.
How to forgive foolish decisions.
How to be cheerful under duress.
How not to be afraid of the dark.
How history is important.
How to love road trips.
How the military is a valid option.
How to appreciate the Bible.
How to help others.
How to play football.
How to say 'please' and 'thank you'.

Thank you for all you taught me, Dad - Happy Father's Day!

A Man, A Plan... Nicaragua?

Manly men doing manly things in manly ways on manly adventures.

I finished Tim Cahill's delightful little travel book Jaguars Ripped My Flesh and was casting about for another well-written book about man vs. nature when I came across David McCullough's in-depth study, The Path Between the Seas: The Creation of the Panama Canal, 1870 - 1914. 

 I haven't finished it - in truth, where I am in the story they haven't even started digging yet - but the preliminaries are fascinating.  What's even more fascinating is that 100 years later China is building another canal through Nicaragua, following the route that was originally decided on - then discarded - in the 1870s.  You can read more about that here:

 http://www.bbc.com/news/world-asia-china-31936549.
 
Oh, China - is there nothing you can't do?  Tammy asked me why China thinks it can just build islands

( http://www.nytimes.com/2015/04/12/opinion/sunday/chinese-mischief-at-mischief-reef.html?_r=0)

and dig canals all over the place; I said it was like the old joke: "Where does an 800 lb gorilla sit?" Wherever it wants.  The last thing we need is to upset 1.3 billion indoctrinated people who know Wing Chun and can hack our defense system; it went badly in 1950's Korea.  I wonder how it will be under their rule when they take over the world?  Will they let us use their fancy canal?

Why?  Because it's there.  Closer to us.

The Fantastical, Fruity Pursuit of Zero.

I heard an NPR segment a couple years ago featuring a physician / author arguing that there was no reason a visit to the hospital couldn't be analagous to a dinner at the Cheesecake Factory.  I had to turn off the radio; I felt physically nauseous.  I wanted to grab that pseudo-doctor by the lapels of his ( I imagined) Brooks Brothers tweed and shout "What are you doing!  Actual, un-informed people are listening to your tripe and think it's true!"  You can't compare a fine-dining experience that people willingly and briefly partake of to an unwilling stay at a cinder-block instutution packed with suffering - it's apples and oranges!
Unfortunately, the incomprehensible and incomparable nature of today's health care cries out for a parable to render it relevant and last Friday I attended a healthcare simulation conference where they trotted out their Sermon on the Mount of analogies: the airline industry and its incredible safety record.  Capt. Chesney Sullenberger and his miracle bird-strike landing of US Airways Flight 1549 on the Hudson River always gets plenty of play (although he admitted he'd never practiced that scenario in the simulator).
Any high-risk organization likes to utilize simulated scenario training to increase safety: the military, nuclear industries, healthcare, and flight - indeed, airlines have set the standard for simulation and very nearly perfected it. Simulation is a powerful and adaptive winnowing tool, incredibly effective at producing near-realistic arousal states and responses in a safe environment. The fighting soldier, the suburbanites dwelling in the nuclear silo's shadow, air travelers - all are much safer today than the mid-20th century, in large part because of the rigorous simulator training, but also because of better protocols, procedures and communication. There are also personal investments to consider: 3 people sit in the cockpit flying the plane and each is enthusiastically motivated to have a precisely equal number of take-offs and landings - U.S. airline disasters have fallen to nearly zero. This number is held up as a shining target for the U.S. healthcare industry since, alas, hundreds of thousands of people are dying in our hospitals!
Because that's where people go to die, you tweedy, ivory-tower-hunched, statistics-blind cretins! 
I love healthcare simulation, obvously, since it's my profession.  I think it's invaluable and I can't wait to see it evolve into a more realistic, more refined, more flexible tool.  But you can't compare the training that makes a mechanical flying machine driven by three people safer, to the training of a few worker ants that scuttle around the anthill of a hospital - it's apples and oranges.  A better analogy might be; a hospital is like an enormous kennel run by veterinarians and their assistants and business partners that outnumber the animals 2:1, but that falls short too, because the 'patients' - while fed, sheltered, medicated, their diseases treated and heads petted - can also be caged, controlled and legally euthanized.  A street poll of most humans would reveal this to be unsatisfactory healthcare.
I don't know that there is a good parable to unpack the complexity of western medicine, so I'm uneasy with the slavering after an unattainable goal like zero airline fatalities should equal zero hospital fatalities, despite some truly outstanding presentations on the topic by people I highly respect.
People want to board an airplane and pay good money to do so with an expectation that, allowing for a few variables, they will fly through the air to their destination by harnessing the immutable laws of physics to overcome the immutable theory of gravity. Now that we know how to do it, it's an expectation that's almost always met.  It's largely done by a machine - as long as the cold, dumb parts don't fail, you'll get to Kalamazoo.
People do not want to enter a hospital but usually have to, accompanied by the unrealistic expectation of a rapid and glowing return to normal health. 60% of the time they have no money to pay for services but receive them anyway thanks to the onerous burden carried by the rest of us. 90% of the time (this is a real statistic for abdominal pain), despite the best technology available, some of the most highly-educated humans on earth can't reach a definitive conclusion as to why the person is suffering but don't want them to leave empty-handed so offer a palliative medicine for that suffering that is then trumpeted on the cover of TIME magazine as the gateway to the downfall of civilization. In our instant-gratification, media-saturated society, healthcare can't win - the immutable laws of physics and chemistry cannot overcome the immutable law of biological decay.  It's important and exciting to create simulated scenarios that prevent unnecessary deaths, but there's no simulation that can bring the death rate to zero. Perhaps patients themselves could reduce that rate a little if they spent less time peering through their tobacco smoke to excavate the last pork-rind in the bag and more time enjoying fresh apples and oranges,but I'm no doctor - just a realistic sim geek who, in the face of humankind's relentless fatalities, is trying to put the care back in healthcare.

Blessed.

This week's writing assignment: "I am blessed."

“Bless me, father, for I have sinned.  It’s been years since my last confession.”
“What sins have you committed, my son?”
“I am spiritually bankrupt, father.  I have nothing to offer our Savior.  I am starving for righteousness.”
“Our Lord tells us to seek, and we shall find.  We have but to knock, and the door to the Kingdom will open.  Have you sought?”
“With all my heart, father.  I have wandered the earth, devoured the wisest of writings, intercoursed with the most knowledgeable of teachers, given alms to the poorest until I, too, was one of the poorest, broken my health against wickedness, wept with anguish at death, and cruelty, and avarice, provided succor to the victims of those vices and felt hollow and unworthy of their gratitude.  All my efforts crumble to dust under the onslaught of shame at their shallowness.”
“What did you find, in your search?”
“That no matter the pureness of my heart, I am the most unworthy of sinners.  That I am as revolted of myself and the plight of the victims as I am by the machinations that produced them.  That the wisest teachers and soundest philosophers are crippled by vanity the instant they rise in esteem among men. That the world of men is a tortured place, filled with inverted logic and selfish ambition. That the hard, bright desire burns within me to murmur peace among them but my voice remains too meagre to sound.”
“What would you have to amplify your voice, my son?”
“In my travels it is universally acknowledged that health, wealth, wisdom, family, skill, knowledge, honor, luck, peace, comfort and dignity are the blessings bestowed by our Lord.  I would have these, father, as proof of His face smiling upon me, of His acceptance of my worth so that others might see and believe.”
“Alas, I fear the words of men have misled you.  While such things are admired and sought, they will not bring conviction nor are they proof of the blessings of God – for that we must turn to the words of our Savior.”
“What words, father?  Where are they found? I must know!”
“You already know, my son; you are already blessed! I will read you His words from the Gospel of Matthew and as I do, reflect on your life and see if this is not so:
Blessed are the poor in spirit, for theirs is the kingdom of Heaven.
Blessed are those who mourn, for they shall be comforted.
Blessed are the meek, for they shall inherit the earth.
Blessed are those who hunger and thirst after righteousness, for they shall be filled.
Blessed are the merciful, for they shall be shown mercy.
Blessed are the pure in heart, for they shall see God.
Blessed are the peacemakers, for they shall be called children of God.
Blessed are those who are persecuted for righteousness’ sake, for theirs is the kingdom of heaven.

Go, my son, continue on your search, continue doing those things for which the world reviles you – it is through their revulsion you may recognize the ineffable blessings of Jehovah.  Go, and remember me to Him - His humble servant – when the keys to the Kingdom are placed in your hand!”

I knew what awaited me....

Writing assignment: " I knew what awaited me..."  

I had a vague notion - enough for the color to drain from my face - what was in store for the rest of my life when she held the plus-sign up to my eyes - it shimmered red in the dim foyer light.  This notion was more accurate than the notion I’d had when she’d called 30 minutes earlier to say we needed to talk. 

It was early fall and I’d been wheeling my bike out the door to see my friend; we were working on plans for a Pacific Crest Trail-hike after graduation.  While hiking, we’d formalize our partnership and sketch out the foundation for a school in Ouray, Colorado modeled on the Oregon Extension.  We would open the school and spend the rest of our lives cracking the windows for young, suffocating Christians. I was literally bouncing with excitement when I answered her call.  She sounded subdued, but I had a notion she was simply tired, I figured I’d pop by to cheer her up then roll on.  But she, and a train, and a dump truck, and a judge’s gavel all met me five feet inside the door; 30 seconds later the bounce abandoned me as I looked away from that damning plus-sign and surveyed the wreckage of my dreams.  The vague notion, and the buzzing fear , blended together in roaring certainty:  “I guess we’d better get married, then”, I heard myself say faintly, launching the first of many impulsive, enormous, sideways jumps onto rocky and untried paths.  My crushed spirit knew what awaited: syrupy condolences, congratulations and prayers covering iron-clad ex-communication from “righteous” fellowship, my mother’s tears, morning sickness, hasty plans for a bitter-sweet ceremony, the frantic search for housing, the snickers and whispers from un-stained classmates, the relentless responsibility of parenthood, the grind of survival, and the endurance of a life-time of shame.

What I didn’t know was the clutch of tiny fingers, the giggle of a little throat, the generosity of my parents arranging for us living those first numb months in their home, the later joy of throwing rocks in the ocean with a bright, happy boy who thought I hung the moon, the smiling gurgles of his baby brother and a second set of clutching fingers, the pride of watching the older one graduate high school magna cum laude, get his first car to drive to his first job while the younger one is renowned for his generosity, joie de vivre, and affability.  I couldn’t have known that the struggle for survival would lead me to Coast Guard Medic training and teaching life-support courses, which would lead me to nursing, which would lead me to an award for best nurse in the nation, which would lead me to directing the simulation lab program for a multi-national organization. 

I knew what that damp, red plus-sign meant – my destruction.  What I knew turned out to be true, and it was all horrible, but I didn’t know it would only jolt me sideways, bringing my life scattered, brilliant diamonds of joy - destroying my juvenile dreams, not me.   In the end, I knew nothing of what awaited me - a surprise gift from a wise, patient, loving Creator.

Diapaga.

Writing assignment: a short story a la Hemingway. Like Nick Adams, this is fiction, based on fact.

“We need water”, Whiteman said with a low curse. John looked at Jeff, who looked at his shoes in the gravel at the side of the road.  The native woman with the withered baby sat placidly in the bed of the scalding truck.  She hummed quietly and rocked.  The open hood blocked John’s view of the vitriolic Swiss girl in the cab but he bet she was sweating, and cursing too, in French.  “There’s a lake over there, through the scrub”, John said.  Whiteman looked glum, but handed him a cracked pail and slumped against the shady side of the truck where the engine ticked behind his head like a patient bomb.  “I’ll be right back”, John said, hesitating a little when he squinted through the scrub toward the lake.  “Don’t dawdle”; we’ll melt!” Whiteman guffawed. Soft, vehement French dribbled out the open truck window.  The black lady rocked and hummed under the sun, her head drooped over the baby like a prayer.  Jeff put his hands in his pockets and drew circles in the gravel with his toe, glancing blankly at the yawning compartment where the engine ticked metallically.

                John wove through thorny scrub that scratched against the pail like fingernails. He thought about the guavas they’d eaten for breakfast at the mission, plucked warm and giving from the tree like a kiss, but he was only 18 and didn’t know about things yet, only that guavas were warm from the sun, and soft, and sweet.  The Australian ladies at the mission had laughed too much over the meager dinner in the lamplight the night before, the sahba rolled into balls and dipped into spicy peanut tikpindi.  They had laughed about the puppies that chased over their feet, calling them silly burkes but their eyes said they were glad about the puppies.  He remembered when they’d left for Diapaga, the native lady with her bundle climbed aboard silently and no one said anything so he sat with her and glanced shyly at her while she nursed. No one saw one of the puppies sleeping just in front of the back wheel as they rolled away from the mission. John saw it writhing behind them after a slight bump that could have been just a root to the others but John knew was not a root.  He said nothing about the puppy but his stomach felt ill, and the woman’s baby with its dull eyes looked listlessly at him. 

Diapaga has waterfalls, and cliffs with baboons, and miles of waving millet fields that would be a nice break from work, Whiteman had told them, his mouth full of tikpindi - it was worth the drive. The French girl distractedly said she knew some people in the village and they would be glad to kill a chicken and perform the drum circle.  John thought Diapaga would be good. He liked exploring. He liked to ride in the truck bed and stand facing the wind. Once a bug hit his eye at speed and he just rubbed it hard, blinked the tears away and smiled as they slowed for the boys herding goats across the road, their slingshots hung around their necks, their cries of “Ca va!  Ca va!  fanned by short, happy waves.  The single paved road that ran from Liberia through Burkina Faso to Niger stretched ahead of his grin in a straight, diminishing line like a bullet’s track.  Once, as they chugged along, a black Mercedes hissed past, rubber tires singing, hurrying to where there was a great need - or because the passenger had a great need.  John hoped the driver knew about the boys, and the goats. That was when the fan belt broke and the radiator erupted hot in his face.

He felt dizzy from the heat. The lake was further than he remembered, lost beyond the scrub, and he hurried because of the baby under the sun, watered by tears, and humming.

Oh, Brother.

 A Band of Brothers at the BB&T Ballpark.

My brainiac brother came by for a blistering baseball bonanza - brilliant!  The Charlotte Knights moved last year to a stellar stadium uptown where a hot dog comes with mac & cheese on it and costs more than a ticket to the game - and both are worth every penny.  The Knights lost 2 of 3, it rained, the seats were hard, it was hot, crowded and redolent of beer.  It was a great weekend.

 Sunny Charlotte.

Rainy Charlotte.

Charlotte Knights, swimming against the Norfolk Tides.

Merry, Merry Month of May.

April 30: Big deep breath.  Another. One more and hold it. Now, move.  Move. MOVE!

May felt like a video game - one long burst of motion between explosions.

May 1: Work in the Charlotte lab then zip down to Rock Hill, SC to teach CPR.
May 2: Breathe. Try not to be anxious about crowded calendar. Fail.
May 3: Work with home-health client.
May 4: In the lab then pack up the whole lab, stuff the truck and bolt to Asheville.
May 5: Unpack the truck, set up the lab, cram two nurses through 8 hours of training in 5 hours, pack up the lab, stuff the truck, fly to Shelby, NC, unpack the truck, set up the mannequin for 3 hour education station, pack up the lab, stuff the truck, cruise home.
May 6 & 7: Full lab days in Charlotte. In-laws here.
May 8: Charlotte lab, River's birthday dinner with in-laws.
May 9: Celebrate Mother's day with in-laws, prep for D.C. trip.
May 10 - 14: To Washington D.C. as primary nurse for home-health client.  Work 56 hours.  Sleep 17. Spend at least 6 working hours looking for !@#$% parking.  Good trip, though.
May 15: Charlotte lab followed by foggy phone conference.
May 16: Breathe. Feel bad for being too busy to call Mom on Mother's day. Breathe harder.
May 17: Work with home-health client.
May 18: Charlotte lab then hustle to VA clinic in Rock Hill, SC for CPR class.
May 19: Teach I.V classes in Charlotte lab then evening CPR class in Charlotte.
May 20: Early morning drive to Raleigh for day spent advocating and educating legislature on value of home healthcare.  Had to wear a suit. Sigh. 3 hour drive back to Charlotte that night.
May 21: Full day in lab.  Had to dismiss the student early for being terrible.  I HATED to do that. I NEVER do that. But she really was dangerous.
May 22: Full day in lab, rush home, pack, drive to Banner Elk, NC for Tammy's art show.
May 23 & 24: Beautiful, beautiful Banner Elk.  Crystalline air, skies of Carolina blue, sun-drenched mountains, Mookie's Kettle Corn, Chicago-style hot dogs, capricious zephyrs, shattered stained-glass art, wealthy waddlers from NY & FL, the hidden, jaw-dropping Los Arcoiris Mexican restaurant, the quaintly moldering Pixie Inn (Cash only! Bikers welcome!), Mountain Ground Coffee & Tea Co., two days of reading in a camping chair under a benevolent sun, good jewelry sales.  It was OK, I guess.
May 25: Memorial Day.  Breathe.  Remember.  Too frazzled to remember anything.
May 26: Teach First Aid class in Monroe, NC for Japanese chemical company.
May 27: Teach another First Aid class for same company. Very fun group.
May 28: Full day in Charlotte lab, zoom to CPR class for smart pharmacists. Bomb home to pack.
May 29 - 31: Fly to Philadelphia for BAYADA Awards Weekend; a non-stop celebration of excellence, compassion and reliability.
Fly home.
Stop moving.
Breathe.