Stranger in a Strange Land

The opening scene of "The Wire" has a policeman sitting on a stoop with a street kid, contemplating the body of a teenager called "Snotbogey" lying in a pool of blood, shot dead because he grabbed up the pile of money in a game of dice and tried to run off with it. He had done this dozens of times before and had been beaten for this transgression, but this time, for some reason, somebody shot him, which struck the street kid on the stoop as unwarranted. 

When the policeman asks the street kid why the others allowed Snotbogey to play in the first place, given his history of snatching up the cash, the street kid shrugs and looks at the policeman as if the question is impertinent: "Got to," the street kid says, "This America man."

And if that scene does not capture the essence of the bizarre nature of this nation, then the scene from a prayer service for the slain school children of Florida must win the prize, as people in religious costumes, garments, and head bands invoking the crown of thorns, but made of bullets, prayed holding automatic rifles.

NEWFOUNDLAND, Pa. (Reuters) - Hundreds of couples toting AR-15 rifles packed a Unification church in Pennsylvania on Wednesday to have their marriages blessed and their weapons celebrated as "rods of iron" that could have saved lives in a recent Florida school shooting.

Women dressed in white and men in dark suits gripped the guns, which they had been urged to bring unloaded to the church in the rural Pocono Mountains, about 100 miles (160 km) north of Philadelphia. Many celebrants wore crowns - some made of bullets - while church officials dressed in flowing bright pink and white garments to go with their armaments.

The Church, in Newfoundland, Pennsylvania thinks of AR 15's as religious rods of iron, accouterments and the description of the ceremony would have captivated Mark Twain.

These are the people who voted for Trump. Who swung the state of Pennsylvania to the red.

How do you run an election when the electorate looks like this?

These citizens each have a vote which counts as much as yours.

These are the folks who will give Donald Trump a second term.

God bless the United States of America.

What It Is Homemakers Do

Did you know that the president of the charitable organization, "Alzheimer's Association" makes $800,000 a year whereas the president of the "Alzheimer's Foundation" makes just a little over $200,000?

Homemaker at Work 21st century

Ask your wife. She might just know that.
How did I discover this? 
I recently demanded a session with my wife, who spends hours in front of her computer, doing things I had not even imagined.

New Age Homemaker. Not mine. 

I thought she was just emailing old boyfriends, setting up lunch dates with members of her chorus, looking for new Viking cruises to places I've never heard of.

But what I needed to do was to learn how to pay the bills, just in case she decides to stay in the Galapagos or South Africa.  In the old days, I'd just wait for the bills to arrive in the mail, get out my check book and write the checks.

But now the bills come into her gmail, or wherever, on her computer and then there is a whole process involving usernames, passwords, answers to security questions like, "What was your mother's father's firs name?" 

Do not know that answer. So now the VISA bill cannot be paid.

And then there is the income tax stuff--collecting the charitable deductions, the town tax bills, for what may be the last time. Not sure if local taxes will be deductible ever again. All this is on spreadsheets, in EXCEL on her computer, somewhere, guarded by passwords and questions about the first names of distant relatives. I do have a family tree stashed away, so I can crack the codes, eventually. 

But as we were working our way down the spreadsheet we came to charity and that meant reaching into a big bag with envelops soliciting contributions. Some are no brainers we give to every year: NPR, Planned Parenthood. But then there are our new would be friends and that's when the Alzheimer's Association came up. 
I would have said, yeah, well, I'm for curing Alzheimer's: write a check. But no, you have to go on line and look up through a web site called "Charity Navigator" and it shows you how much of your check goes to Alzheimer's research and how much lines the pocket of the CEO.  

Obadiah Youngblood, Exeter Bridge

If my wife walked out the door tomorrow, I'd have to put an ad on Monster.com and interview people to replace her and they'd have to have demonstrated computer skills including Excel spreadsheets, on line banking, charity vetting, Trip Advisor etc. 
My new homemaker might need an associates degree from Great Bay Community College in on line home management with a minor in computer technology. 

So 20th Century! The Ideal Wife then.

If she needed to drive the car, shed need to master hands free cell phone, Blue Tooth and crash avoidance technology, not to mention lane drift stuff.

21st Century Wife

Being a "homemaker" is high tech now. 

What Happened to the American Medical Profession

From the comments section in the New York Times responding to an article "The Manly Jobs Problem" by Susan Chira, in which she described the problem women have doing work which had traditionally been the work of men. The article was pretty predictable in its "feminist studies" way, but the comments section got more interesting, as readers explored not just the effect of putting women in these jobs but the effect on the jobs themselves as women arrived.

Near Lincoln Center

Claudia

Oddly, there is little mention of the sea change in medicine and surgery. There was a riddle presented to medical students in the 1970's about a car crash in which a boy and his father were killed and the surgeon who received them at the Emergency Room says, "My, God! This is my son!"

So how could that be if the father was killed in the crash?

Most students guessed the answer turned on biological vs step father. But the answer was: the surgeon was a woman.

Few thought of that. Because there were almost no American women surgeons, or physicians in those days.
Now slightly more than half of medical students and doctors are female.
In formerly male dominated specialties like gynecology, men have been driven out or simply opted out.
There was plenty of misogyny in medical schools and housestaff training programs along the way, but all that is history now.
The sheer weight of numbers in the workplace changed behavior, ethics, sensitivities.
Not all the changes as women came to dominate medical practice redounded to the benefit of the patient, as many physicians and some surgeons said, "I'm a mother first, a doctor second." But overall, the sea change as been a positive force.
Whether that will ever happen on construction sites or coal mines is another question, but it will likely be settled, as it was in medicine, by demographics, the force of numbers, not by studies, commissions, academics or editorials.

Sza-Sza

Alexandria Va

Oh Claudia. If only it were really so. I got out of med school in the 1970s in a class of 6 women and 200 men. Truly there was great prejudice from doctors - and nurses - but medicine at that point was one of the highest paying professions around.
Now medicine is a salaried job, most practices taken over by hospitals or large national conglomerates. You get a salary, do shift work and - importantly - adhere to money producing guidelines or risk being fired.
So of course as it is devalued you see the void left filled by women as men go off to the real high paying fields like finance, where the payoff and prestige are greater. Only few women are found there.

Avarren

Oakland, CA

Not every female physician or surgeon is a mother, just as not every male physician or surgeon is a father. Prioritizing work-life balance is not at all to the detriment of the patient. Happier, more grounded doctors provide better care and result in healthier patients.

Iceland

Of course, Avarren spouts the au currant claptrap of the in-touch-with-her-feelings woman, who recites the line about "work-life" balance benefiting not just the worker but the work, and, of course there is the inevitable, "Happier, more grounded doctors provide better care and result in healthier patients." Where does she get that?

 And what is a "well grounded doctor?" Presumably somebody who makes herself or himself unavailable to his or her patients. 

And why would a happier doctor result in a healthier patient? Is that doctor dispensing herbs and minerals and positive vibes and good Karma? 

Sza-Sza's comment, however,  is in some sense a revelation. She is a doctor, and actually knows what she's talking about.  What she is saying is that a career in medicine is no longer an entry to upper class life, to high end of the scale income. 

Once the hang-out-your-shingle private practice, doctor as shop keeper, independent professional turned into a paid employee of a corporation, salaries steadily, inexorably, if gradually declined. 
Today, for most specialties in internal medicine, pediatrics and family medicine, the salary averages $85 thousand.

This is not a bad wage, but not a good deal, considering the doctor has medical school debt (in the USA) and does not start earning this until 10 years after high school at the earliest, typically full earning power does not begin until age 30-35.

By that time the kid who went to work as the power line man, or the plumber or electrician has been earning for 15 years and may be only 15-20 years away from retirement, depending on whether he has a union or company pension.

Ennis, Ireland

In a sense, this may simply be the regression to the mean. In the 1930's and 1940's doctors were upper middle class, for the most part. It was only when health insurance and third party payers emerged that doctors could charge more and make upper class incomes. But, after half a century of prosperity, financial forces drove doctors out of self employment and into salaried positions and their incomes declined.

Doctors have not been the only profession to decline in income and status. Ironically, airplane pilots who during that same halcyon period of the 1950's and 60's made top salaries, saw their incomes decline and they are no longer earning upper class salaries. Ironically, because just at the time air travel became safer and more dependable and more widely used, the remuneration for pilots crashed. 

Humble Country Doctor

For doctors, the fear was always that the government would take over American medical care and fix salaries and the income and prestige of doctors would tank. As it happened it was the private sector which brought down the proud medical profession--as commercial insurance companies gained control of the companies which employ doctors if not in name, at least in fact.

It's Come to This

Our American medical profession now looks a lot like the British rendition: There are highly paid specialists, few in number, competitive positions, and then there is the great mass of practitioners, humble, paid about what the manager of a McDonalds might make.  

The companies who employ doctors have realized they really don't need to employ doctors at all: Nurse practitioners and physicians assistants wearing white coats, write prescriptions, dangle stethoscopes around their necks and many, if not most, of their patients can't tell them from the folks who earned MD's.

Why Trump Doesn't Matter

It was 1968, and I was listening to several speakers talking about my choices: 
1. I could allow myself to get drafted and go to Vietnam.
2. I could go to jail.
3. I could cross the border into Canada and hope to be allowed to stay and become a Canadian citizen and renounce my American citizenship.

Fortunately, I found option #4: Get into medical school and hope the war ended in the next 4 years while I was deferred.

But, before I knew about option #4, as I talked about these options with my friends, we all realized, individually and collectively, no matter how disgusted we were with our country, which was incinerating babies in Vietnam with Napalm, no matter how we loathed Johnson, Nixon all those government leaders who kept us in that quagmire rather than risk their own political futures, we could not simply walk away from being Americans. 

I had never been outside the country at that point, but nearly four years later I went to England for two months, and there I discovered just how American I really was.

As alienated as I felt from my own country, it was part of me. 
It was threaded through the fabric of my personality and soul: the music, the shared memories of sporting events, the unconscious assumptions that I wanted life to be more prosperous, that I wanted to rise from the social standing my parents enjoyed to something just a little better, the desire to own things, a house, a car.  

General Cump--Obadiah Youngblood

As I talked about American movies, about the Super Bowl, about suburban life, about an American Graffiti sort of high school experience with my American friends in London, one a Black kid from the Bronx, another a kid from Texas who was attending medical school at Pittsburgh, we thought of ourselves as very different, but we shared something--being American.

None of us had thought much about what being American meant. But we knew, somehow, we were and we could never really shake that.

So it doesn't matter who is in the White House today. He'll be gone in eight years, and we'll still be, like it or not, American. 

The Peregrine, the Octopus and The Hidden Life of Trees

A gift of "The Peregrine" captivated me and, as is so often the case in my own combustible personality, once it got me going, there was no stopping the conflagration: So I am now reading "The Peregrine," and "The Soul of an Octopus" and "The Hidden Life of Trees."

"The Peregrine" is a work not just of intensely fascinating natural writing, but real high grade literature. J.A. Baker wandered the English flatlands, communing with peregrine falcons in a way which would dazzle Thoreau. These birds  have eyes which are far larger, proportionately, and heavier than human eyes. If human beings had eyes this size they would be 3 inches across and weigh four pounds. 

But the peregrine is only 2 1/2 pounds, and fast.  It can fly up 1,000 feet in the air, and come out of the sun, so even other birds cannot see or sense it coming. Falling 100 feet it can attain enough speed to snap the neck of large birds, gulls, ducks, pigeons. Then, snatching up its kill from the ground, it soars off with it.

"Evanescent as flame, peregrines sear across the cold sky and are gone, leaving no sign in the blue haze above. But in the lower air a wake of bird trails back, and rises upward through the white helix of the gulls."

This is a thrilling book about a thrilling creature.
But it is a creature one can see and understand. It is a vertebrate and obeys vertebrate rules.

Not so with the octopus, a creature so alien we cannot even imagine what its consciousness might be like. It both tastes and feels through the suckers on its gelatinous legs. It has an eye with a slit pupil and its mouth is under an arm. Its beak  is hidden. It has "three hearts, a brain the wraps around its throat and a covering of slime instead of hair. Even their blood is a different color from ours; it's blue, because copper, not iron, carries its oxygen."
It can slither through the smallest hole because it has no bones or joints, and its brain is malleable as silly putty and octopuses often escape their containers because there was a crack nobody saw, or they simply unlock the locks with their arms and suckers. 

They turn colors with different "emotions" from white to red to brown and their skin changes texture and tone. 
They live only three years.

For trees, on the other hand, three years--even twenty years-- are the blink of an eye. There's a tree in Sweden thought to be 9,000 years old. There are redwoods and sequoias in California who were alive at the time of Jesus Christ. 

But the most amazing thing about trees is not their longevity; it's their connectivity. Trees put communists to shame. They are connected but underground fungal strands which allow them to shunt sugar from one tree which is doing well to another which needs help. Mother trees grow crowns which deny light to their children for decades, centuries, until they are ready to retire, but the children are not injured by this--the delay forces them to develop tightly packed innards which resist insects.

Tree leaves can "taste" insect saliva so they can emit just the right toxin for the particular insect and when giraffes graze on acacia trees, the trees not only produce toxins but aerosolize scents so other acacia threes down wind do the same to ward off the giraffes, who leave the scene or simply walk up wind. 

Some years ago, I criticized Dr. Nadine Unger,  a Yale professor of forestry because she suggested that  northeastern deciduous forests being dark green, may absorb heat and actually not ameliorate temperatures on the planet, but contribute to global warming. I did not want to hear that forests were anything other than "good guys" in protecting the planet from global warming and lambasted her. I was not alone:  dozens of  outraged readers posted insulting comments on that blog.


Professor Unger calculated that the clear cutting of northeastern forests in the 18th century reduced global climate temperature by 0.1 degree, or something like that. Forest emit volalitile compounds which may contribute in some way to global warming. That was incendiary stuff, because it suggested that global warming and climate change may not be entirely owing to works of man, and in fact man, before he started erecting smoke stacks, man may have benefited the climate by clearing fields and growing crops.
Liberals, who are not immune to bias, did not want to hear that.


Only Maud stepped forward as the voice of dispassionate reason.
I am now chagrined at my own spasm of irrational speak. 

Professor Nadine Unger

Forests have their own logic, trees their own ways.

Truth is truth, no matter how it may undermine your most cherished beliefs.

Certainty and Uncertainty in Science

I was one of those medical students who was more impressed by what was wrong with what we were being taught than with what the professors extolled as truth.

This did not apply to static things, like anatomy, but to understanding how disease processes proceeded; it was a relevant mode of learning.


One of the most basic things we were taught was that heart attacks occurred when cholesterol plaque accumulated like rust in the pipes, concentrically layering until the stream of blood which could surge through the cylindrical arteries was so narrowed it simply couldn't keep up with demand downstream from the heart muscle which depended on that vital irrigation.

New York Hospital-Cornell Medical Center

There were problems even then, with this theory. Occlusions seen in arteries occurred a few months after a coronary catherization had shown that same artery to be mostly open.


Clots were found in arteries with not much internal plaquing. It wasn't clear if those clots were simply the result of post mortem changes--pooled blood simply clotting after death.

And always there were those perplexing marathon runners who dropped dead of heart attacks despite their low body weights, low cholesterols and high level of exercise.


Recently, the New York Times ran a piece about CHIP, clonal hematopoiesis of indeterminate potential, which is about stem cells in the bone marrow which carry mutations in the DNA of one or more of three genes (DNMT3A, TET, ASXL1--such memorable names) and what exactly these mutations do to the cells which harbor them is not exactly clear, but these mutated cells accumulate in the bone marrow, living in parts of the marrow "less hospitable" sort of like sickle cells live in a blood stream afflicted with malaria parasites. They survive, although the may cause trouble.


People with these mutations die of heart attacks and strokes at high rates, even if they have normal LDL cholesterol, blood pressure, body weight and even if they exercise.

Van Gogh

These mutations accumulate through life, but they don't seem to happen much before the age of 40, as if these stem cells just fray or pill like an old wool sweater.  Lots of 70 year old people carry these CHIP cells in their marrow; few 40 year olds do.


So now we have a new idea of how heart attacks happen, at least in some people.
Which means all those answers I marked on my medical school exams which were counted as correct and moved me toward my MD degree were wrong. The total cholesterol in the blood was not put there by eating too many eggs; the trouble in the coronary arteries was not caused by high levels of total cholesterol--it was the LDL portion of the total that wound up in the plaques; the plaques were not gradually strangling off blood flow but were gelatinous and would occasionally rupture, attracting clot which occluded blood flow and the plaques themselves may have formed and been vulnerable because of the accumulation of cells with CHIP mutations inside them.

Add caption

You may say, what I was taught was not really wrong, just incomplete. I beg to differ. Those professors were very certain of their knowledge.
I was the doubter. There were too many cases which didn't fit their theory.

That's the way science is: constantly changing, a work in progress.
So it is with climate science, climate change. I would not be so sure human activity is warming the planet, but living with uncertainty is the human condition. In the case of climate change you have to ask: If we are wrong and burning fossil fuels  has not harmed the planet, what have we lost by shifting to sun and wind?

Blog Clicks for Jesus

One of the cool and humbling things about the internet and the blogosphere is you can see how many times something you've written got clicked and not just that, but where, if not who, that click came from.

Clicks on the Phantom for the past week

This is not the same as how many different people actually read what you wrote--many clicks may not have resulted in somebody interested enough to read beyond the headline. Some clicks may be the same person coming back later.

But you do get some idea. 
The Phantom, for example, knows he has fewer than 10 steady readers, mostly members of his immediate family who use the stuff to open phone conversations. But it's the 21st century version of the Sunday evening family meal.

There are occasional clickers, and those numbers have sometimes drifted into the hundreds but mostly stay below.
What is really astonishing and inexplicable is the where.  You can see where your clicks are coming from.

For almost a year the greatest number of clicks came from Ukraine and Russia.
For the past six months Ukraine has disappeared and Italy is big. More clicks from Italy than even from the USA. 

Icelandic drama

For a week or two France will emerge as a leader-but that's almost understandable if he's  written something with a French personality or France in the headline.

The Phantom had a good run with Portugal for a while.

Island belonging to Norway

Almost never anyone from Africa. The Phantom guesses he is just not addressing topics of interest to Africans.

The Middle East does very few clicks--apart from the occasional few from Israel. 

Danish journalist

South America may as well not even be on the map, which is actually an accurate reflection of the Phantom's state of mind.
Asia and the subcontinent run hot and cold, but none from China, ever. Japan, occasionally, and Hong Kong.

My friend in Reykjavik 

A regret is the absence of Scandinavian clicks. The Phantom is a devotee of Nordic noir. He has watched every episode of every series on Netflix, Amazon etc set in Norway, Finland, Denmark, Sweden and Iceland. But the love and interest are not reciprocated. The Phantom is a non entity in Scandinavia. sad to say.
On the other hand, the Phantom has to this day never been able to keep those Scandinavian flags straight. They are all variations on the same cross. I think Denmark has a white cross on red, and Sweden a yellow cross on blue, but Norway has red and blue and white and so does Iceland and Finland. It's all very confusing. 

Swedish chess

Perhaps what the Phantom needs is a marketing consultant. Surely, there is someone out there who will try to sell the Phantom on the idea she actually knows why he has no appeal in those northern latitudes.