Here I Go.

I just surfaced from reading all 380-odd pages of my Uncle Stewart's memoirs; I'm not sure I could have stopped if the house had caught fire, they were that good. One of the most captivating stories is the last illness and death of my amazing 98 year-old Aunt Alta:


Shortly into the New Year, 1997, my dear old aunt collapsed in her lovely Royal Oaks apartment and was whisked away to the Emergency station of Boswell’s Hospital.  She was still conscious when we arrived.  She who always seemed to have a smile, gave Liz a small, whimsical smile as she whispered, “Here I go.”  (p. 304)


As we were driving to the gun range I tried explaining to Denver - my 14 year-old - why they enthralled me the way they did; I came up short.  "It's not merely 85 years of world or U.S. or even just my uncle's history, it's all that plus my history - and your history - an intimate look at our genetic timeline, past and future.  It shines light on my father and grandfather, and their fathers and grandfathers, that reveal facets I had no idea existed. That knowledge affects me and you directly because they are part of us."  He watched the passing scenery for a moment then said, "Huh."  I could tell my explanation fell short of the passion I felt for the subject, which held no fascination for him at all.  For one thing, Denver doesn't know my Uncle Stew, shares no immediate context with me for what a smiling, teasing, truly joy-filled man he represents in my memories - he's as mythical to Denver as my Aunt Janet is to me.  For another, Denver's sphere of interests do not include genetic traits such as he and his brother's tallness or slender build (which, after reading Stew's memoirs, I suspect comes from their great-great grandfather Hugh Stewart).  Perhaps one day he'll care, in which case the Memoirs will be there, thanks to Uncle Stew's efforts.

We were headed to the gun range in part to try out a beautiful old .22 target rifle inherited from Denver's maternal great-grandfather and also because I was inspired by the Memoirs to take a half-day from work to spend more time with my boys. Work, for multiple reasons, has usually held the highest priority for me; today, at least, I wanted that priority to change. I also looked forward to shooting the Kalashnikov I'd bought as a favor from an out-of-work neighbor two years ago; it had been collecting dust in my closet since then.  It's hard to find a rifle range near a big city but I'd recently taken a concealed / carry handgun class and the range we qualified on was only 45 minutes away, just across the border in South Carolina (perhaps the most gun-friendly state this side of the Mississippi).  I bought a family membership to the range and this was our first opportunity to use it.

The owner (Stony) and a sleepy-eyed pit bull met us and showed us around.  The range was arranged on 50 acres of woods and featured places to practice pistol, rifle, shotgun, and archery shooting.  We were the only ones there on a workday afternoon.  Stony and the dog left us on the rifle range and headed back to the office shack.  We walked downrange to place our targets at 50 and 100 yards then mounted the steps to the upper level of the two-story firing line shed.  We screwed in our ear protection and after a quick safety briefing Denver and his .22 immediately started blasting the 50-yard target with uncanny accuracy.  I had nearly 300 rounds of old 7.62x39 ammo I wanted to use up with the AK-47 so I started blasting too - for three rounds, before it jammed.  The humidity was making the bullets 'sweat' and they weren't sliding into the chamber all the way. I had to pull back the operating handle between each shot to manually load the round.  I fired 14 more rounds before the pin securing the firing hammer worked its way loose and the whole hammer twisted sideways under the bolt cover from the tension of the wire wrap around its base . Denver, meanwhile, was merrily blazing away with his ancient - and apparently indistructible - .22.  "I thought these things were built by the Russians to be tough!", I thought with frustration. I flipped it over.  "Manufactured in Monroe, NC.".  Nuts. I spent 25 minutes disassembling the gun and investigating the malfuction while Denver happily shot through his box of 50 rounds.  Later, I asked Stony why my Kalashnikov broke when it had such a reputation for ruggedness. "It's not as famous for durability as it is for being easy to fix when it breaks,which it does all the time.  That's the design you go to when you need to make 50 million guns in a hurry and hand them to teenagers to fight your war for you - it has to be idiot-proof".  Well, I felt like an idiot for not being able to fix it but with Stony's (and Google's) help we figured it out. Even though I didn't get to shoot as much as I'd hoped I still felt like I learned a lot and it was a productive trip.  Denver loved it.

I mused the whole way home about little moments like these that make up a person's Memoirs. Almost every moment of my life I feel like a failure but today Denver and I made a lifetime memory.

I want to make more of those.

When he was my age Uncle Stew made the firm decision to create memories with family trips.  His Memoirs have inspired me to pursue more memory-making outings with my family.  I want to live so that when I feel that inexorable slide toward death I won't fight and wail "Not yet!"; I want to smile serenely and say with anticipation: "Here I go!"  

"Oh, wait..."

"One more thing..."

"...You can have my Kalashnikov - it sucks."

On It Like Oxford.

I just started school for my BSN - with the focus on the BS - so I read a lot to clear my head of nonsense.  Just finished Craig Mullaney's outstanding book on becoming an Army officer and fighting in Afghanistan, The Unforgiving Minute. 

Mullaney attended Oxford on a Rhodes scholarship and explains that it's completely different from school in the U.S. - you don't study for your degree, you read for it. Essentially they hand you a library card and tell you to go crazy.  When I look at the stack of books I finished over the last three weeks I think I might be on track for my Oxford degree in Random Historical Trivia. Here's the list:

Theodore Rex, by Edmund Morris (Reagan, The Rise of Theodore Roosevelt) showcases Teddy's presidency.  I read it simultaneously with Truman by David McCullogh and their leadership styles were fascinating in juxtaposition.

While I drive I listen to audio books - the miles vanish in visions of glory and wonder!  A friend loaned me Ken Follett's 40-hour Pillars of the Earth, a story of cathedral building in Medieval England - it was so engrossing I hated to arrive at my destination.

I had to listen to its sequal, World Without End, which takes place 200 years after the end of Pillars and featuring the descendants of the main characters who now want to build a steeple on the cathedral to make it the tallest, most glorious building in all of England - absolutely absorbing!

Dovetailing with the time period was a book my brother loaned me Dissolution, by C.J. Sansom, historical fiction about a little-known (I didn't know about it) period in England under Cromwell when the monasteries were dissolved and razed - 400 years of tradition leveled in 4.

To take a trip back even further into English history I read The Pagan Lord by Bernard Cornwell, a rousing account of the uneasy occupation of Northern England by the Danes just after the death of Alfred the Great.  It's such a popular book series that BBC is premiering a TV show this fall based on the books.

I listened to a mildly amusing book by Jon Stewart (The Daily Show) called Earth: The Audiobook. It's a tounge-in-cheek description of mankind's life on earth as described to aliens who've arrived after we've all gone extinct. It's a primer on pop-culture and sarcasm.

On a more serious note, I've always wanted to read a first-hand account of the conditions healthcare providers endured in New Orleans hospitals during hurricane Katrina; Code Blue, by Richard Deichmann, M.D. was a study in ingenuity, endurance, and bureaucracy.  Fascinating read.

I also enjoyed Kurt Vonnegut's short story 2BR02B, a dystopian future reminiscent of Brave New World.

No one writes better short stories that Poppa Hemingway; he's a study in evocative style and dramatic action.  I've been dipping into his stuff for 30 years - it never gets old.

Finally, I started a new series that's popular not only as a book but more recently as a TV show: The Outlander, by Diana Gabaldon.  It takes place both after WWII and in Medieval England - it's a time-travelling adventure.  It's no Game of Thrones, but it's OK so far.

I don't think my eclectic taste in books would find approval for a degree at Oxford but as much as I'm reading about the turbulent history of the island it inhabits, it almost feels like I'm on it.  Does that count for anything?

Killer Lag.

My boys spend years online playing team warfare games with their friends.  Occasionally I’ll hear a screech emanate from the back room, “Lag. Lag! LAAAAAGGGG… oh no - Noooooooo!!!!!!  … (softly, bitterly) I’m dead.”  I look at my wife and we chuckle.  Ah, the innocence of youth, believing that screaming at the computer can improve its refresh rate.  “Lag” means that the normally fluid motion of your on-screen character has become suddenly halting and jerky, while the rest of the virtual world continues to stream by in real time, creating a strobe-light effect; the distant enemy you were lined up to snipe has, while you were frozen in place, suddenly jumped to three feet away. You might catch a glimpse of his K-Bar plunging toward your neck before lag strikes again and by the time your aging computer or dribbling internet catches up to real time your character is a lifeless, bleeding bundle of loser.  It’s a feeling of powerlessness during a high arousal state that makes you want to kick the wall, pull out your hair, and weep. It’s so infuriating there’s a meme circulating the internet claiming “Guns don’t kill people.  Lag kills people.”

                I was struck by this while editing a clinical skills checklist the other day.  The skill was oral suctioning, a routine, 15-second task wherein you grab a plastic wand called a Yankauer, turn on the suction machine, insert the wand in someone’s mouth to suck up excess saliva & whatnot, rinse out the wand & turn off the machine.  It’s as simple as vacuuming your windowsill.  This checklist broke it down into 39 steps, each step deeply researched and verified as “best practice” which means if you skip a step you obviously have no business caring for patients.  Seriously, skipped steps are what regulators drill down for when auditing charts and the punishments usually far outweigh the “crime”.  I imagined how this checklist would flow as an instructional video, maybe a 5-second clip for each step, and I chuckled when I realized what the finished video would look like: Lag.

                I sobered quickly when I made the mental leap to patient care in general and I sucked in my breath when I realized this is why healthcare is so slow and providers want to kick the wall and pull out their hair – checklist-driven healthcare regulation and the fear of litigation is causing patient care lag!   Your 4-hour visit to the Emergency Department consists of 30 minutes of actual hands-on care and 3 ½ hours of doctors, nurses and imaging specialists slumped in front of a computer protecting themselves from censure and litigation by checking every box, dotting every i, crossing every t. With government-mandated EHR (electronic health records) - which consist entirely of checklists – for civilian medicine, this lag and its accompanying frustration is only going to get worse.  Time magazine this week includes an article on doctor burnout and suggests a solution might be talking out their frustrations with a trained counselor or spiritual mentor.  Would that work for my boys after an infuriating lag session, I wonder?  I can’t imagine it would, if they went right back into the virtual battlefield with the same slow processor.  What they require is not a sympathetic ear; it’s no lag.

  In my experience military medicine (I don’t know about the VA – I’ve never worked with them)  is much more fluid than civilian because they globally standardize their training, globally standardize their checklists, keep checklists to a minimum, trust their providers with broader scopes of practice, and - perhaps most crucially - give care without concern for lawsuits.  Without the crippling regulatory burden and the cross of “patient satisfaction” carried by civilian healthcare they’re remarkably more limber and dynamic when they engage with damaged humans.  Even they, however, could benefit from a technology upgrade.

We’ve already moved to voice-recognition software for doctor’s dictation, what if that was combined with motion-recognition (think Wii or XBOX Kinect) and instantaneous actionable feedback (think Laerdal’s HeartCode instructorless CPR class) for real-time virtual charting and skill verification?  Add “best practice” skill sets culled from millions of real life videos coalesced by informatics gurus to create one global motion-capture database and voila – no more need for human healthcare workers – everything can be done perfectly by robots, just like making cars or bottling beer!  Sigh.  Maybe one day.  I wonder, would patient satisfaction scores would improve?

Of course, we’d all be out of a job, but we wouldn’t be slaving under the sword of Damocles, so we’d have that going for us, which is nice.  Maybe I’d just hang out in my underwear and play video games all day on my virtual reality headset.  I’d be poor, so it would have to be an older model though, bought second-hand.  Nah.  Couldn’t do it. The lag would absolutely kill me.