Monday, March 2, 2015

Tourism in the Bandit Infested Hills

I both admire and envy my more adventuresome friends.  They travel, seemingly without fear, to Laos and Tunisia and Antarctica.  They trek across the Sinai on camels.  They join the Peace Corps and live in Central American hamlets.

I am speaking generally of people ten to twenty years younger than I, those who came of age in an era of cheap airline tickets and social tolerance of delayed adulthood.  The folks I am envying here did most of their globetrotting either before or in place of raising children.

I now have the available time and resources to travel where I will, but there are more risks than there used to be.  It once was that you were safe so long as you did not venture out on an ill advised jaunt into bandit infested hill country.  Now the bandits have come down from the hills and live among us.

I have walked through too many places where terrorists attacks have occurred.  The Olympic complex in Munich, the London Underground, the Valley of the Kings in Egypt.  I regularly pass through the Amsterdam airport where the infamous "underwear bomber" was helped onto a US bound plane on some sort of humanitarian ticket.  I have driven past the Pentagon and have walked under the dome of the US capitol that escaped its intended targeting on 9/11.

No center of culture and urbanity is safe.  Paris the City of Lights.  New York, the self styled "Greatest City on Earth", Moscow with its atrocious subway bombings and Tokyo its sarin gas attack. For all the negative publicity that rural America gets, it is still a very, very safe place to live.

In a matter of weeks we will be heading for Italy.  It seems like a safe enough place to go, certainly Italy has done little to offend anyone of consequence in recent times.

But just a few hundred miles away, on the shores of Libya we now see the barbarians of Islamic State lining up Coptic Christians for mass slaughter.  And at the end of their latest atrocity one of the jihadists points a bloody knife north across the sea and proclaims that they will march on Rome.

You don't hear about that part of the message much in American news media.  Oh, in part it is wise to give these monsters as little attention as possible.  But a bigger part of it is the sheer embarrassment of our Current Administration.  Having started an optional war against Mohamar Khadaffi they "led from behind", dropping equal numbers of bombs and press releases.  Now we have another festering, chaotic pool of terrorism, and one with convenient access to Italy via a well intended policy in which refugee boats are actually helped ashore by the Italian Navy.

I usually avoid politics in my writings.  But part of the reticence to discuss the catastrophic implosion of Libya is that to do so would be an embarrassment to our Current President - who was gifted a Nobel Peace Prize for his anticipated diplomatic brilliance - and to our hopeful "President in Waiting", who was Secretary of State when the Libyan incursion was somehow, implausibly, deemed to be a safe and prudent action.

But these are the conditions that exist.  This is the world we live in.  The bandits are probably now in the Seven Hills of Rome.

You do what you can.  I get in and out of airports as quickly as possible.  I like to think I have good situational awareness.  Several times in Egypt I got a vague sense of danger.  Usually a close look around would show up a few of the Mubareck era Secret Police on the periphery of things.

I think we will steer clear of obvious danger zones, St. Peter's square for instance.

I always try when traveling to avoid an easy identification of my nationality, although when dealing with a threat like Islamic State their hatreds are so eclectic that passing myself off as being from Luxembourg may not suffice.

I don't think it is morbid to have one's "affairs in order" before going on a journey.  It is one less worry in life and when I travel I prefer to live for the moment.  Another glass of "vino della casa", another bit of ancient building peeking out from under modern trappings, another day of having no obligations other than enjoying ourselves.

I am sure I will climb up on the Aurelian Walls that surround the ancient parts of Rome.  They were built at a time when the Empire was crumbling at the edges and savages were expected to reach to the very heart of Western Civilization.  The Walls held then, and in fact for another century and a half the external enemies were kept out.

Like all enduring things of a past age they are thought provoking.  And could give you justifiable reasons for either optimism or pessimism.

At one point in their history they were an inconsequential barrier when an army, flush with victory and carrying the banner of a radical new religion just marched on through.  Constantine the Great with his newly professed Christianity prevailed against greater numbers and carried the day.

But at a later date and against even more lopsided odds the Byzantine general Belisarius strode these battlements.  He had prevailed against armies of Goths that should have matched him ten times over. But he had sturdy walls and strong resolve and the barbarians raged against them and broke.

Friday, February 27, 2015

Memories of Minerva

On my travels here and there I always carry a camera and keep an eye open for additions to my collection of "Tree Shaped Tombstones".  I ran across this interesting specimen in the little town of Turtle Lake, Wisconsin.

It is a nice bit of craftsmanship, of the style I refer to as a "stack of logs".  They seem to be more common in areas where the timber industry was once prominent.  Something about this caught my eye.  Sometimes it is the little details that are just a bit off that stop you.  Did you notice it?

OK, maybe not.  But I spend a lot of time with these and was struck by how rare it was to have a woman listed alone on one.  Like, pretty much never.  There were some other Stewarts buried nearby so my initial whimsical thoughts of a spinster schoolmarm or of a frontier "soiled dove" gone legit did not seem to be likely.  So I did a little research.

The full text can be found HERE.  But the story is this.

Minerva (nee Owrey) Stewart was living in Crawford County, Pennsylvania when she gave birth to her son George in 1865.  Four years later her husband died.  Apparently she was an indomitable woman, as she packed up her little family and moved to the still wild and rustic environs of eastern Iowa in 1869. Later, in 1878 they moved to Wisconsin, settling eventually in Turtle Lake township.  George was by then all of 14 years old and started working in the local lumber mills.

George prospered by the standards of the day, in 1885 he had enough money to buy 40 acres of land to clear for a modest farm.  I assume that Minerva spent her final days there, and when she passed away her son - perhaps recalling both her strength and his time in the sawmills - sprung for this swell monument.

Minerva Steward, Pioneer and Good Mother.

Wednesday, February 25, 2015

Absolutely Confabulous

The process by which medical knowledge is passed on to the next generation of doctors has always had a certain "hands on" element to it.  Some things can't really be taught from a text book, to reliably establish the "pattern" that must be recognized one has to see it close up.

It is probably a good thing that I am not regularly involved in teaching these days.  Late in your career there is a tendency, even with the best of intentions, to operate in a kind of "shorthand mode".  I generally will take any clinical challenge that hits my ER and very quickly create a mental checklist of three or four things it could be.  Even allowing, as I always do, for the possible diagnosis of "some other weird stuff", it is perhaps a bit too much data compression for kids just starting out as clinicians.

But every now and again one of the clinic docs who has a med student or resident working with them will drop them off for an ER shift with your grizzled correspondent.  I wonder what kind of instructions they get first....

We always have fun.  My standard line is: "Every patient has a reason why they are in the ER at this time and with this problem.  Figure it out."

Maybe their shoulder is dislocated.  Maybe the twinge of discomfort in their chest worries them because their dad just had a heart attack.  Maybe they did not feel like going to work today.  Maybe they have a 105 degree fever.  Maybe somebody thinks they have a bizarre, rare diagnosis.  Once in a while they might even be right.  (Working with a student one day we had a Latvian college student with an EKG diagnostic of acute myocardial infarction.  As it turns out he really had a viral myocarditis but either way I said "study this case closely, it will be a very long time before you see another like it".)

One of the hardest things to sort out is confusion.  It takes a fair amount of effort to figure out, mostly because the patient can't help you much.  One day when working with a medical student we had a classic.

Mid 50's but looked older.  Reported history of alcohol abuse but at the time we saw him neither intoxicated nor in obvious withdrawal.  He was a pleasant, talkative fellow, but much of what he said made no sense.  It lacked context.  I told my young Jedi Padawan to pay attention:

Me: "Hey, have we met before?"
Patient: "Sure, sure we have!"
Me: "Oh yeah, it was that time we went to Las Vegas!"
Patient: "Yeah! Vegas! That was fun."
Me: "And those two waitresses we met, was one of them named Ruby?"
Patient: "Yep, Ruby and Emerald, swell gals!"

At some point you need to stop, because the poor guy was obviously inventing stuff on the fly.  He had a condition called Korsakoff syndrome.  It is caused by chronic alcoholism and nutritional deficiencies.  They live in the moment mostly, they have memories, albeit with many missing elements,  but no way to sort them, no way to tell the difference between real and imaginary.

In the later stages of the condition they tend to be dull, torpid, "burned out".  But in the earlier stages they retain the gregarious personality that likely made them the favorite patron of their local tavern, and add to it the "gift of gab", that uninhibited freedom of thought that all the very best story tellers have in spades.

The process of filling in the gaps in what they know is called confabulation.  Translated from the Latin in means "to tell tales together".  The shared conversation we had was a "fable" that we created together.  I wanted to demonstrate "confabulation" so that my student would spot it next time it came along. The patient was just having a nice chat, assembling his reality as he went along with what ever brightly colored bits he could collect from my verbal cues or out of thin air.
Post script.  After dashing off this post I googled the title I had used.  As it turns out the phrase Absolutely Confabulous pops up in an article about conversation forums held in Washington DC by some very serious minded and frankly sour faced looking young folks.  You would probably have more fun at the local tavern.

Monday, February 23, 2015

A Haiku of Destruction

Crumbled stack of prescriptions, unfilled.

Can't stay in the hospital, no smoking allowed.

No family, no friends.

Striding off into the night, the artifical leg keeping pace with the doomed one.

Saturday, February 21, 2015

Robots and Drones

My middle school robotics class ran their "Desk Racer" Grand Prix through the hall ways of the school recently.  It was some spirited fun, although one of the lunchroom monitors seemed a little put out by the disorder.  And the water squirter.

On the starting line.

We got some decent video footage of the races....there was some remarkably bad driving on display at times.  I guess the kids are just a little excitable at that age.


Oh, but that driving was NASCAR quality compared to this next one.  The kid filling his tray was remarkably calm about it all!


One of the tech ed teachers turned up with a camera drone.  It was creepy seeing this thing following behind the racers like a menacing black bat.


In our after school session we broke the machines down into components for future projects.  But not before I let the kids up volt the machines and try to drive the "hot" versions in the empty hallways. The wisdom of limiting the power for the competition became very quickly apparent!

Friday, February 20, 2015

Nerd Week

The last week for my two after school classes at the middle school.  I have not said much about the Dungeons and Dragons group because, frankly it is a silly undertaking and bereft of any plausible educational content.  It is also a lot of fun.

Perfect timing as the final session concluded with all the right elements.  Faced with a 25 foot tall, slime covered horror the lads (and one intrepid lady gamer!) rose to the occasion and prevailed albeit in a slightly digested state.  Pathos points to Jabbo the puppy who avenged his master's death by howling mournfully, then launching a fangs bared frontal assault.  As he was clobbered by multiple tentacles he  expressed his utter contempt by lifting a leg on the monster in his final seconds of life!

I am already being asked to reprise my role as game master next year.  We shall see....

Thursday was Race Day for our robot "desk racers".  More than the usual ration of last minute glitches but we had a race in each of the three lunch sessions. Some, er, interesting driving made none of them photo finishes.  I think the third and deciding heat would have been close but there was a power failure in the final turn.  To their credit the lads pounced and had it diagnosed and fixed in 30 seconds, but the lead and the best of three title slipped away in that time.

I will have some very interesting video clips up this weekend, but just a couple of shots.

Ready for the starting flag.  Yes, that black hovering object is a camera drone.  It followed the racers on their lap around the school hallways.

My traditional "privacy compliant" class photo.

Fun times.  The robotic hi-jinks now go on hold until fall.

Wednesday, February 18, 2015

Harvest Time

A recent post's pictures from a digging buddy overseas reminded me not only of happy times among the Roman stuff but also that he collects clay pipes from the 16th to 19th centuries.  It made me pull down a specimen that has been sitting on a shelf for a while.

I recall it turning up at a construction site.  I leave the dating and provenance to the more learned.


Here is the image, on close scrutiny I can see it was hand painted.

Can you guess the translation?