Monday, May 30, 2011

The New Tricks

(Note:  This is another bit of musings from 2007 when I was making the transition from conventional clinic work to free lancer.  One of my great anxieties was learning computerized medical record systems.  As it turns out I have subsequently learned six different systems, two of them well enough to trick them into efficiency.) 



Can you teach an old dog new tricks?  I don’t know that the question has ever really been resolved.  But at least it looked as if I had come to the right place to try.  There I was, at the Organizational Learning and Development (OLD) office.  And for the first time in my quarter century of practicing medicine I was going to learn an electronic health record system.

I confess, I liked the old ways.  Paper charts had a sense of authenticity to them.  Like the patients themselves they slowly increased in girth, and even acquired wrinkles and blemishes on their once smooth manila surfaces. 

The paper chart was a personal artifact, like a scrapbook.  As you paged further and further back you traveled in time.  Here is the pre-employment physical.  A little deeper in, there’s the broken wrist from the Little League game.  Go back to the earliest pages and you find the runny nose, the childhood immunizations, and the Apgar scores of a newborn.

But we must change with the times.  Electronic health records are the next big thing to contain costs, improve quality, and increase patient satisfaction.  So here I am, with a new practice, a new employer, and trying to learn the new tricks.

As it happens, there are an awful lot of passwords involved.  You need a different one for the network, the EHR and the radiology program.  They each have to have at least one capital letter, one number, and no less than seven total characters.  Its somewhat like playing Scrabble.  I generally base it on something easy to type, and that has sentimental value.  Anti-machine mottos like Luddite and Landru are my personal favorites.

Along with a handful of other neophytes I did my training in a classroom full of monitors, presided over by an energetic trainer who could make the cursor fly across the screen like an angry gnat.  Click and this happens.  Right click and link to another menu.  Hold the shift bar down and a towering column of orders waiting to be signed go down with a gentle tap of a key.  It’s all pretty impressive until the clinician part of your brain starts to ask nagging questions.

“Um, how can I confirm that the instructions to arrange a test have actually been received?  It just vanishes off the system once I send it.”

The trainer ponders this a while, and to give her credit it does seem as if her faith is not entirely dogmatic.  Who, I wonder, would be sued if something important fails to happen?  The nurse who never got the message?  Perhaps the software writers?  I doubt it.

Now I am starting to wonder about other things; generally a dangerous occupation.  The electronic prescription system is legitimately nice.  No more phone calls and faxes, just line ‘em up on the screen and click.  Of course it puts little roadblocks in your way in the form of warnings of potential drug interactions.  Sometimes these are worth considering.  But while safely in non-patient care training mode I typed in scripts for birth control pills for an 80-year-old man, and thalidomide for a 25-year-old woman.  The computer cheerfully put them both through.

Now my fellow novices are starting to get into the spirit of things, and we start feeding diagnoses into the problem list module.  Ehrlichiosis, pyelonephritis, quaternary malaria, otitis media.  I must give the machine its due, it handled the common ones at breakneck (odontoid fracture) speed, could sluggishly handle the oddballs with the help of an auxiliary index, and it taught me the correct spelling of ehrlichiosis.

After a while you get a sense for what the EHR does well and what it does poorly.  This is the key to getting along with it, because to effectively work an EHR what is necessary is this:  you have to stop thinking like a clinician.

Physicians who fail to understand this generally think that the computer is out to get them, to make their lives difficult.  Untrue.  The computer is not there to make your life easier or harder.  Frankly, it seems indifferent to us.  What is important to the computer is order.

Every time you open a patient chart you must take some action.  Every action, be it a test ordered, a procedure done or a medication prescribed must be documented.  Every action must be linked with a diagnosis code.  And everything must be associated with a charge.

Line up the patient’s open chart, an action, a diagnosis and a charge, and the computer, its quest for neatness and order appeased, will agree to anything.

Once you stop arguing with this implacable sense of tidiness the EHR will actually help you out in some ways.  I am for instance quite fond of a letter-writing feature.  Click on the patient’s name, call up a template and you instantly have a nice letter outlining all the lab work from the most recent visit, with normal values and a section for comments and instructions.  Hit a button and it prints off a copy to mail and simultaneously plugs it into the patient’s record. 

With the radiology program I have the patient’s x-rays on the screen before they make it back to the exam room.  The ability to zoom in and out on areas, and to call up old films for comparison is a striking improvement.

I also like the feature that allows you to “copy” a patient’s chart to their primary physician.  In a fragmented medical system this is a godsend. 

But I still dictate most of my charts, because the “templates” that allow you to document patient visits with a click of the mouse are still atrocious.

In theory you would do this while still in the room with the patient.  But at least in the exam rooms I work in this would require you to turn your back on a patient seated on the exam table, and that seems rude.  I also wonder to what extent patients will resent our taking their problems; their deep felt fears and reducing them to a few seconds of data entry. 

So I work with the computer, not through it.  A quick look at the patient’s history before entering the room, then the traditional face to face conversation with a few jotted notes for later reference.  If a question comes up, say on past lab results, a quick log on to the record and a quick, efficient answer.

My other objections to template based patient encounters are that they generate a large amount of data, but it is dry, dull, and of dubious specific content.

You could for instance click General Appearance: ill.  It might well be true.  But how much more of the truth is revealed by the description of the patient as “cachectic” or “gaunt”, or even “in extremis”.

Often the templates fail us by being too inclusive.  Given a required box to check for BUS Normal (Bartholin, Urethra, Skene’s glands) most everyone is going to click on it, never mind that the memory of just what Skene’s glands are supposed to look like is filed away with other distant memories of medical school lectures.  Did you really check the pupils for reaction to light AND accommodation?  On that routine physical did you really confirm that the nasal septum was midline?

This shotgun approach to documentation does ensure up coding and higher payment rates, for such is its purpose.  But it worries me.  If you ever had to take this stuff into a courtroom, would the admission that you might have just glossed over an area and clicked normal bring your entire defense toppling down?  To the extent that these templates encourage us to be more complete they are a good thing.  But this quest for better reimbursement by broader documentation has its hazards.  At a minimum it diverts you from areas where your attention may do the patient more good.

The computer also ruthlessly homogenizes our record.  Any “foreign” influences are expunged.  The Germanic K in EKG is converted to ECG.  Various Britishisms such as haemoglobin are tidied up.  And Latin is declared a Dead Language.

I resent that a little.  I was taught to write prescriptions by my father, and he learned it from Old School types who took their Latin seriously.  I know that Sig, Rx, QOD and all the other archaic forms are holdovers from a distant past, a legacy handed down from the Medieval Barber-Surgeons.  To them it was both the international language of the scholar and a way to preserve the mystique of the healing arts from the common man.  But it has been a long time since we have been able to hide behind that particular curtain, so perhaps the computer refusing to speak anything but plain English is just due recognition of the new era.

I guess I should make passing mention of a feature that makes me smile every time I use it.  When I order something that the EHR questions I have the ability to hit a button labeled “Override and Accept”.  In effect this is telling the computer to “Just do it!”  To which it replies, “Master, it shall be so.” while no doubt muttering in some deep subroutine “At least until version 6.6 comes out”.

To other senior physicians wondering if they can make the change to EHR I would offer reassurance.  Of course you can do it.  You are trained to recognize complex patterns, you are tough enough to persevere, and your work ethic is at least the equal of the younger, technophile physicians of the next generation.  The few exceptions in my experience are physicians either too close to retirement to muster the energy or too deeply mired in work habits that are woefully inefficient whether you do them on paper or electronically.

Will EHR systems deliver on the promises of their backers?  I’m uncertain.  With regards to costs there are some efficiencies in potentially averted duplication of work, and in reduced clerical help.  But the emphasis on better documentation as a means to “up coding”, or “right coding” if you prefer, is going to result in increased demands on the financing of health care.

I do see the potential for fewer errors and better patient satisfaction with electronic systems, particularly if coupled with effective patient education materials.  I really like having several quick and good medical search engines on my patient room terminals.  There is nothing like showing a picture of what the rash of Lyme disease really looks like to convince a panicking tourist that the microscopic red dot on their arm is not going to be fatal.

But as I said, you have to change your way of thinking.  The rigid, organizational “mind” of the EHR is not going to bend to accommodate the more intuitive thinking of a good clinician, who often “knows things” without being quite sure how he/she knows them, and then uses technology to confirm or rule out these impressions.

Computers and their software continue to grow more sophisticated.  We are in effect driving the Model T in the year 2007.  The systems are going to get better.  And in a few years the tension between clinical thinking and machine thinking should be less, if for no other reason than we will by then be training physicians who have tinkered with computers since they were in diapers.

Hopefully they will be kind to us old timers.  Figuratively we grew up in the horse drawn era.  Yes, we can learn to drive that Model T, and even to appreciate its virtues.  But we still occasionally get the urge to pull out a buggy whip and smack it across the hood a little.

The computer is more or less indifferent to that too, but it makes me feel better.


Friday, May 27, 2011

Life and Death in the ER

I am regularly asked if my work life resembles the long running TV show ER.  It does, although with two major differences.  First, the doctors are obviously not as photogenic.  And second, a single episode of ER condenses down perhaps 6 to 12 months of excitement into a one hour episode.

But sure, all the plot elements are there.  The tipsy, the belligerent, the heroic and the foolish. 

Most of what I do in our rural setting is routine work.  People really do use the ER as their primary care clinic, so it is a good thing that I spent many years looking in ears, removing splinters and wood ticks, pondering rashes of uncertain duration.

But eventually the bad stuff turns up.  Sometimes you can predict it.  A convergence of alcohol, motor vehicles and the tragic sense of youthful indestructibility seems to be largely a summer weekend affair.

And sometimes you have little to no warning.

I won't soon be forgetting a case from a few years back.  (Professional ethics requires me to blur some details in the telling).

The first warning is usually the police scanner.  A sudden increase in chatter, a bit of tension in the voices, maddeningly few early details.  We knew there had been an accident.  We knew it sounded bad.  We knew the ambulance was heading out.  And we had a location.

It's enough to work with, given the expected half hour it would take the ambulance to get there, load quickly and return, we would be ready.

The trauma bay was cleared.  Potentially needed equipment and personnel were called for.  Other patients in the ER were told they would have to wait.  A family with a young child was warned that things could get a bit scary shortly.

And in ten minutes, not thirty, the patient was there.  His friends had not waited for the ambulance, they had simply thrown him into their vehicle and driven as if pursued by Furies.

No pulse.  No pressure.  Blood everywhere.  Chaos as we threw ourselves, only half ready, into an attempted resuscitation.  It was a young man, his heart was strong.  You could see it marching out stalwart electrical activity on the monitor as it futilely tried to pump blood that was now congealed on the floor of his friend's SUV.  We tried to put direct pressure on his wounds, but it scarcely mattered, with each CPR compression of his sturdy chest nary a drop of blood oozed out.  He had bled out in the first couple of minutes after the accident.  His pupils were fixed and dilated.  Neurological death had already occurred, he was in effect just waiting for the bureaucratic ruling to catch up with him.

He was young, so we tried hard.  We did what we could, which was too little and far too late.  And at the end we did not even know his name.  I was still wearing my gloves-which give me slightly ridiculous Barney the Dinosaur hands-as I reached into his pocket for his wallet.

I flip it open and there, opposite his drivers license, was a picture of an adorable child, perhaps three years old.

Covered in blood.

There are some very hard phone calls to make.  Sometimes people have no clue that their life is about to be radically, horrifically altered.  And sometimes they do.  Late night calls, calls when a loved one is far from home.  From much practice I have gotten better at giving the bad news in person, but over the phone....

It is impossible to read the person on the other end.  Impossible to convey any condolence that will register at all in the face of overwhelming, surreal, discordant tragedy.  You say what must be said as best you can.

There is one unexpected benefit to leaving clinic based medicine and moving to the ER.  I am never "on call" at home.  As a parent of three children I am happy that the phone does not ring, unexpectedly, in the small hours of the morning.

Wednesday, May 25, 2011

History of England Part Eight

Note:  This is the final installment of my highly unofficial brief history of England.  It was written for Babs and Sis, in hope that their upcoming journey be enlightened.  And watch out for that scrumpy stuff, it's mean! 
--------------------------------------------------------------------
So what else was going on in England while the later Royals were carrying on?  Lots, of course.  England went from a European power to a globe spanning empire.  How?

Well, it helped to be a maritime nation.  British ships fanned out across the globe setting up colonies and carrying raw materials and manufactured goods back and forth.  Sometimes the natives had a few issues with all this-the prices of things seemed very much to favor the British side.  In modern eyes the degree of bribery, gunboat diplomacy and private wars that it took to build the Empire would not look good.

Britain was also at the forefront of the Industrial Revolution, where things were made en masse at a factory versus by hand in a workshop.  England had plenty of coal, relatively effective transportation by sea or canal, and a certain knack for innovation.  Perhaps that whole rebellion from the Church provided a degree of  liberation of the imagination.

Of course there were problems.  Industrialization put a lot of folks out of work.  Some, the Luddites, even tried to do something about it.  And there were always a few international issues.  England has not gotten along with the French at all until recent times.  Why, in the closing days of the 1700s the French actually deposed and executed their king, replacing him with a dictatorship.  Wherever did they get such a notion.

The struggle with France, especially under Napoleon was a stirring era for England.  Read the Hornblower series of naval stories if you want a flavor for it.

But mostly England got rich and just a bit lazy.  New wealth built the great manors that now serve as backdrops for PBS shows. 

By the late 1800s England had the system down so well that the other rising nations of Europe decided to imitate them.  A rush to build navies and to acquire overseas colonies resulted.  Serene in their belief that war was unlikely, and if it occurred would be short and ceremonial, the diplomats of the Great Powers made a series of secret treaties that brought disaster.

In World War I the Royal Navy mostly waited in vain for the German navy to turn up.  The British army of that time has been described as “lions led by donkeys”.  In one of the stupidest conflicts in the long troubled human epic, an entire generation sat in trenches waiting for clueless upper class officers to order them forward to try and win a few more square feet of worthless mud.  In one battle roughly 20,000 British soldiers died in a single horrific day.  And to make it worse, the Army had as a recruiting gimmick allowed the young men of a given neighborhood or village to enlist as a group in “Pals Battalions”, so there were instances where the entire future of a small community was wiped out all at once.

The Great War created a profound sense of disillusionment in British society.  Religious belief took a nosedive and has not recovered.  Poetry and literature became cynical and bitter.  The very class structure of England was weakened.

You will see a lot of war memorials in English villages.  They reflect a profound sense of loss.  Not just of lives but of a way of life.

By the time the Second World War came around England was mostly running on empty.  Despite a spirited and crucial effort by the RAF, much of central London was destroyed in the third of the great calamities to strike that city. (Boudicca and the Great Fire being the other two).

By herself England would not have been able to survive, and more or less made it through on the basis of allies.  True, the French did not help all that much, but the overseas colonies pitched in manfully---in exchange for assurances of independence to follow.  And both America and Russia came into the war, winning it by sheer force of numbers.

The England you will find today has a curious feel to it.  London in particular is a city filled with monuments and great buildings.  It was at one time the capital of the world.  Now it is the capital of an island with severe financial issues.

It is akin to an elderly but yet spry former Guardsman, slightly stooped but still proud in his ornate but now too large uniform.

But it is for all that a place of greatness.  A place of tradition where gulfs of time that seem enormous to mere colonists are as yesterday. 

Enjoy!

Monday, May 23, 2011

Carpe Circadiem


Back when I was in Residency I once was awake for 36 hours.  Finally flopping on a very comfortable bed I looked over at the end table and saw a small green lizard.  He winked at me.  I took this as a cue to close my own eyes and to sleep for an indefinite stretch of time.

I should mention that this occurred during a high risk OB rotation in Houston Texas, so seeing a green lizard was not quite so unexpected as it would be here in Wisconsin, but for the rest of my month living there I never saw one of these critters indoors again.  To this day I am not sure whether the lizard was real.

Fast forward 28 years.

My main job these days is working ER.  12 hour shifts, 8 to 8.  Day shift is not bad, but 8pm to 8am on a regular basis is tough duty for a mid 50’s brain.

The term circadian, as it applies to the concept of an on board clock, derives from the Latin words circa (as in going around) and diem (or day).  And ER work is a big brutal boot stomp to the natural circadian cycle.  Gracious me, I am at an age where afternoon naps are rising rapidly in my esteem.

So here is how it can be done, or at least how I manage.

Rule 1.  Do not over commit.  10 to 12 shifts a month are plenty.  No more than three in a row.  At least 24 hours off before switching from day to night shift.

Rule 2.  Before night shifts always sleep between 2 and 5 pm.  If you do not fall asleep at least be lying in a comfy bed with your eyes closed.  Low grade rest is better than no rest.

Rule 3.  During the rare quiet stretch at work, lie down.  See rule 2.

Rule 4.  Keep track of sleep debt.  If you are up all night you need to find a way to sleep 8 hours in the 12 hours between shifts.  This is more important than meals.  We all carry extra calorie reserves but tired doctors are not good doctors.

These are general rules.  But since the ER is by definition an uncontrolled environment they may not be sufficient.  There are peculiar shifts of very high intensity where you have to stay on an hour or two and tidy up.  Sometimes you have to pick up an extra shift for colleagues.  And on occasions the non work world intrudes on the sleep-work-sleep patterns. 

The only thing you can really do is fluid management.

After a difficult day shift it is appropriate when safely in evening quarters, to enjoy a beer.  One.  I operate on the same principle as airline pilots, no alcohol unless you have a minimum of 12 hours and a night sleep before your next shift.  And while one beer has the salutary effect of inducing rapid somnolence, more that one has the effect of disrupting your sleep a time or two for trips to the loo.

The other important aspect of fluid management is obviously coffee.

There is no doubt that the metaphorical “kick from Juan Valdez’s mule” will give you several hours of enhanced logic ability.  But there is a point of diminishing returns, so the infusion of several cups of go-juice has to be timed properly.  Sometimes in the wee hours if you are simply waiting out test results on a minor illness it is better to operate the brain on “PowerSaver” mode and save the high voltage thinking for when it is perhaps literally a matter of life or death.

And speaking of life and death there is a state of existence somewhere betwixt the two.  After finishing a night shift it seems seductively good and proper to enjoy a mug of steaming java.  But if there is another shift looming in 12 hours you must resist.  It is better to exist in a slight state of drowsy, headachy caffeine withdrawal and get decent inter-shift sleep.  Your patience and low level suffering will be rewarded when 7pm rolls around and the pre-shift “cuppa” puts the hammer down with eye opening force!

Thursday, May 19, 2011

Job the Fan

I am going to run on a bit about being a baseball fan.  If this does not interest you, please come back another day.  I'm going to be a bit basic too, for some reason this humble blog seems to have become the internet's go-to source for pictures of small dogs in Darth Vader gear, and I feel a certain obligation to folks who drop in from Serbia.

I am a fan of the Minnesota Twins.  Your status as a fan is generally established early in life, in my case during lazy childhood summers at my grandparent's house.  In the evening the ballgame was always on the radio, the play by play punctuated by staccatos of static as thunderstorms mixed it up somewhere out over the Dakotas.

It is possible-barely-to be a fan of more than one team.  But only if your working life takes you to another part of the country, and even then, only if your two teams are in different leagues.  To be a fan of, say, two American League teams is an abberation, sort of like polygamy.

So through the years, good and bad, I have cheered on my team.

And despite pre-season predictions of glory this is one stinky season.

Baseball is a game of both poetry and statistics.  One stat that is rarely in error is that all teams will win one third of their games and will lose a third.  The difference between the top and bottom finishers is how they do in the remaining third.  As I put pinkies to the keyboard my team is currently 12-27.

Things went wrong from the very beginning.  And I mean that literally.  On the first play of the first game of the season an opposing batter beat out a scratch hit, pretty much getting a shoelace on first base ahead of the throw.  Moments later the Twins pitcher caught the runner leaning the wrong way and they had him picked off.  Or should have, but the newly acquired Japanese second baseman was in the wrong place, giving the runner second base and starting the early rally that lost Minnesota the game.

Perhaps hiring a player who did not understand English was a bad move.

And it just kept getting worse.  The best player on the team is a catcher who makes 23 million dollars a year.  He caught some sort of virus that gave him weakened legs and has missed almost the entire season to date.  Half the team seems to have caught the same bug in short order.  This virus must have been kind of like the ones that octagenerian premiers used to get during the latter days of the Soviet Union....a minor illness that lingers on and on.  We won't soon be burying Joe Mauer in the Kremlin (I don't think) but the hopes for the 2011 season are dead barring a performance worthy of Lazarus himself.

"...Martha the sister of him that was dead, saith unto him, Lord, by this time he stinketh: for he hath been dead four days."  John 11:39

As veteran players shuffled off the scene looking like extras in a George Romero zombie flick the team brought in untried youngsters to fill the gaps.  And like most child soldiers thrown into the heat of battle, they have fared poorly.

Well, as a long time fan I can find consolation in the reality that all teams, other than the despised New York Yankees, go through these stretches, and that better days will come.  Next month, next year, (gulp) next decade.  Somewhere in the wavering ranks of callow youths getting off the bus from the minor leagues there might be a pitching arm of supernatural power.  Perhaps in the expected trading away of gimpy veterans a larcenous deal may be struck bringing in an infusion of new life.

In the meantime the relentless march of sore arms, weak legs, and relief pitchers who resemble arsonists more than firemen brings to mind the Trials of Job.

Job proved true at the end, but sitting in the dust, all his worldly goods gone, covered in hideous boils his faith might have wavered slightly at times.

Hmmm....hideous boils.  Perhaps that is what the mysterious virus really was.



Addendum:  The unexpected passing of Harmon Killebrew caused me to bump this post forward a few days. In the interim the Twins have won three straight.  This is more than enough to kindle "the hope that springs eternal".  But you must realize that "Casey at the Bat" was merely quoting a fragment of the Alexander Pope poem "Essay on Man".  The full line actually runs:

"Hope Springs Eternal, in the Human Breast;
Man never Is, but always To be Blest."

By this he meant that while it is our nature to hope, perhaps even unrealistically, the reality is that our Blessings seem ever to lie in the indefinite future.

Al Pope.  Chicago Cubs fan.

Tuesday, May 17, 2011

A Hero Departs

Harmon Killebrew 1936-2011

Today one of my heroes died.  I came of age in the late 1960s and early 70s, a time of societal unrest when heroes were few and far between.  Mostly we had scruffy anti-heroes of the Eliot Gould "Easy Rider" type.

But Harmon was clean cut, and strong and well spoken.  I do not believe I have ever heard anyone say a single bad thing about him.

He hit 573 home runs in a 22 year career.  And did this without any performance enhancing substances stronger than milk.  But it was how he hit the home runs that sticks in the mind of anyone who has seen him do it.  He had a gigantic, extravagant, wide open haymaker of a swing.
When our oldest son was born we gave him the middle name of Harmon.  It was my hope, largely realized, that he would grow up to be somewhat in the mold of his namesake.  I wrote Harmon a fan letter to this effect and got in return a nice autographed picture that is on the wall behind me. 

Last summer my wife noted that Harmon would be speaking at a banquet in a nearby town.  We had no particular connection with the event but also did not have much going on that night.  So we got tickets, sat with some nice strangers and heard Harmon speak about his playing days.  I thought then that he looked a bit frail, some six months before he announced he had esophageal cancer.

Afterwards I came up to where he was autographing things for fans.  I said "Mr. Killebrew, I don't need anything signed, I just wanted to let you know we named our son after you."

He smiled, shook my hand and said he had heard of a few dogs named after him, but not children.

He was probably, and so typically, being modest, as I have since heard of  other "Harmons" born to fans.

Oh, his life was not perfect.  He married young and got divorced.  One of his children did time in prison for robbing a bank.  He was too nice a guy not to be taken advantage of in business matters and had a few financial setbacks.  But through it all I repeat, nobody ever said a bad word about him.

Scroll back up to the picture.  This is the iconic Killebrew.  It is the moment just after contact, the solid crack of the bat still reverberating across the stadium.  The picture show us only one thing, a man who has just thrown his entire being into accomplishing the single most difficult feat in all of professional sports.

The other team is represented only by the outstretched hands of the catcher, futilely awaiting a ball that will never arrive. 

Because the ball is also out of the picture just as Harmon has now left us.  And like him it is out of our view but is without doubt ascending, heavenward, majestically rising.

Monday, May 16, 2011

Vindolanda, The Road Back

I always enjoy my sojourn on the Roman frontier.  I even like the muddy slogs with the wheelbarrow up the spoils mountain on a day when finds are few and the Goddess Fortuna is giving me the cold shoulder.

Generally I am planning my return while still in the air over the Atlantic.

I know the road back. 

And I mean that quite literally.

The Roman fort of Vindolanda sits on the Stanegate road built in the first century to run east west across the barbaric province of Brittania.  My walk to the site each day is literally in the footsteps of the Romans, the current country lane either being the original route or within a few feet of it.  Note the ruler straight layout, which suggests a Legionary engineer laid it out rather than some bare footed peasant driving baulky cattle:
All Roman roads featured milestones, stone markers that indicated one thousand paces of an experienced soldier.  In fact our term mile comes to us direct from the latin "mille pacem".  The above stretch of road actually has the remnants of two milestones still in their original location.  (Or pretty close, this is a subject of pub table discussion).  Here is the first one:

And tucked off in some roadside greenery, the second:

My routine each morning was to walk to the site.  It is about two miles, and a good opportunity to loosen up 54 year old muscles before a day of manual labor.  One day I decided to test the "mille pacem" premise, as part of the ongoing discussion of whether the milestones are actually in situ.

With my best impression of a hard marching Roman soldier I determined that it was 938 paces between the two stones.  Case closed. 

Or is it?

Much depends on whose pace was the standard.  Some studies suggest that the typical legionary soldier was five foot six inches tall.  In my walking boots I run about five foot nine.  Allowing for this difference the corrected distance was 980 paces.  Getting close now.

Perhaps some additional allowance needs to be made for it being a down hill stretch.

Or perhaps I was more eager to see my destination than a footsore soldier doing a twenty year hitch.

If we give a ten pace correction for each factor I think the pub table debate can be brought to a successful resolution. 

Vindolanda is where it has always been.

The road is where it has always been.

And the milestones along the way still read true.

Saturday, May 14, 2011

Vindolanda Week Two Final Report

Pictures sometimes do a better job than words.  Here is the focus of our week's work.....it appears to be a barracks room from the late 300s overlying a road from the 200s which of course overlies many other earlier features.  The Before Picture:
And, after five days work, many wheelbarrows of rock and soil removed, here is the site all cleaned up on the last day:

The angle of the photo is somewhat different, but you can clearly see the odd accumulation of rock right in the middle of the road.  Perhaps some kind of fill for a sunken area?  Or just where some rocks fell out when something got demolished.

I did not get to find out, as the weather turned soggy the last two days.  We ducked in and out of shelter, and our progress was much slowed.  In particular we were not able to excavate a feature such as the above, as all low spots turned into sticky goo that does not trowel well, and in which artifacts are difficult to see.

Another digger up the street a bit resorted to unusual measures to attempt to influence the weather--he built a small altar out of a rectangular wall stone, decorated it with various colored pebbles and placed small offerings of rusty nails and bits of brick in front of it!  To little apparent effect.
I can't report any brilliant finds in my two weeks over here, but as always it has been marvelous fun.  Great company with my fellow obsessed enthusiasts, excellent walks in the green countryside, and some very nice ale.

I look forward to returning next year, and as such have left a bit of my digging "kit" in the storage room of the Twice Brewed Inn.  Mostly stuff spouse would regard as too shabby for wearing anywhere but a dig site.

Homeward Bound

Friday, May 13, 2011

On the road

Blogger has been rather twitchy, only intermittently showing my day 9 post.  I am traveling homeward in the morning and will post end of dig stuff when time and wifi connections permit.

Next week back to M-W-Fri. posting and a mixed menu of topics.

From the Twice Brewed Inn, Northumbria

Wednesday, May 11, 2011

Vindolanda digging report day eight. Various diversions

When you are on an archeological dig you spend most of your time, naturally, digging.  But there are a few other tasks.  We are also expected to do a bit of pot washing.  You would be surprised how often interesting small details turn up in this process--one bit of pot I found last week actually had a potter's mark on it indicating its origins.  Sometimes we even see scratched on graffiti that identifies the owner of the vessel.

Here are some contented pot washers:
And the final results
We also have to do a bit of training in site recording.  We get to use equipment similar to that used by surveyors, that allows exact location in three dimensions.  Here is one of my digging cohorts trying his hand.

All this is instructional, of course, but coupled with periodic rains it was a short digging session.  We are currently, painstakingly, exposing the patio outside a barracks floor.  For some reason there is a big pile of boulders in the middle of it all.  I hate these boulders.  I look forward to taking a pick axe to them in the very near future.

And underneath?  Well, I shall let you know.  It could be a pit (with or without other artifacts) filled in with rubble.  It could be rocks thrown there for no apparent reason.  But it should be mentioned that in the building just past that stone wall an unexpected find occured last season...a murder victim buried in the barracks floor!

Maybe we will find the murder weapon.

Tuesday, May 10, 2011

Vindolanda digging report day seven--and the Quiz again.

I myself am working through a patch of fairly barren slag and rock.  The best thing I came up with was another bit of the marked tile.  I call it Brand XXX

Elsewhere on the site various lost items of the Roman era have turned up, a spindlewhorl, a few small coins, a copper belt buckle.  And some nice pottery bits.  Here is a decorated pot with a warrior and a bunny!



One of my photogenic fellow diggers, Al, with a nice vase top....
And the quiz.  Ah, yes. There were actually four teams with at least some Vindolanda diggers on board.  I was able to assemble a fair pool of talent, which mostly means a misspent youth listening to bubblegum pop music.  We set our sights on third prize.  First prize was an antiquated LP of Scottish ballads.  Second prize a bottle of Rose of dubious vintage.  And third prize, well, wait and see.

For a while we were in peril of total victory.  Then a question came up that, if I recall correctly, was:  "By tradition in Liverpool, if a virgin walks under an eave which contains a bird's nest, what happens?".

By strategically pointing out that this was a highly theoretical proposition, unlikely to have ever been tested, we incurred a five point penalty and secured a second place finish.

We were then able to trade the bottle of wine for the dime store fake bird.  (advertised as a budgie, but this like so much of the quiz, is questionable at best).

Roman legions had an eagle attached to their legionary standards, something like this:

We decided we needed a legionary budgie to go on the marker pole used to photograph the location of finds.

Here is a long range view

And the close up:

Your humble correspondent on the Roman frontier.


Monday, May 9, 2011

Digging Roman Vindolanda--Day six.

A new week and some new recruits with a large Canadian contingent.  The phrase "eh?" has been uttered a few times on site.

Also for me a new area.  And with enthusiastic first timers at either elbow we have made the dirt move today.

I found a bit of bronze armor, heavily corroded.

This bit of tile came up as well, perhaps part of a heating duct it has an eye pleasing pattern to it.
Another eye catching bit....we rather imagined it to be a fossilized snickers bar but it in fact is a naturally occuring rock.  We have a geologist on site and I asked him what it was.  A ten minute treatise followed.  I prefer the snickers bar theory.



Finally, a picture that may look upside down.  It is.  But the brand name on this roll of stuff used to protect archeology sites between seasons deserved a pic of its own.
Hoping all is Invisibly Good with you.

From the wilds of Northumbria....

History of England, Part seven

(note to later arrivers, this is an unauthorized brief history of England compiled for a couple of North American sisters visiting in July)

I don't know about you, but I am getting pretty tired of the British Royals.  Lets dispatch them (literally in one case) as quickly as possible. 

Queen Elizabeth was a great monarch.  Her successors of course suffer in comparison.  Some seem absolutely cartoonish, a feature that may sneak into my narrative.  Maybe its the wigs.

We have already met King James I.  He was ok, but not very charismatic.  His son Charles I had a little more personality, but was always in trouble with Parliament.  Its not all his fault, Parliament was always wanting to do stupid things like go to war over mistreatment of Protestants in Europe.  They would egg King Chuck on until he reluctantly tried to take action, then badger him about money to do so.

Eventually it got so bad that civil war broke out between Parliament and the Royalists.

You don't really need to know that much about the English Civil War.  But it lasted from 1642 to 1651.  It slowed the British settlement of America, although Jamestown and several Charlestowns got started beforehand.  And the two factions were distinguished by their fashion sense.

Supporters of the Royal party were the Cavaliers:
 And for Parliament, the Roundheads, so called for their propensity for crewcuts:


  

It ended poorly for Charles I, he was captured and beheaded.  England got along ok for a while, being run by Parliament then by a semi dictator named Cromwell.  But after a bit the nation got a nostalgia bug and invited Charlie's son, Charles II to come back and be king.  I guess Chucky II did what he could, he gets points for helping fight the Great Fire of London in 1666, but by now the kings were becoming figureheads.

In fact, after a few lesser editions of the Charles series, England just started outsourcing their Royals, inviting outsiders to marry in.  The first was William, a dutch fellow who became one half of the William and Mary duo.  Later some German princes supplied the George series.

As near as I can tell the job description for monarchs in this era was to be solidly Protestant, look good in a wig, and to stay out of the way.  They spent most of their energies producing illegitimate children.  The apparent record holder in this regard was King William IV, known as Silly Billy, who had at least ten irregular offspring.

It is an interesting question as to how much the female side of the royal family strayed.  There were affairs for certain.  And we have in our historical journey encountered a few kings who would not object to the outsourcing of heir production.  My guess is that the occasional appearance of a competent monarch suggests that there are a few offspring of groundskeepers buried in Westminster Abbey.

The only real standout in the post Elizabeth royal line was Queen Victoria.  She had a whopping great reign from 1837 to her death in 1901.  She was ruler during the salad days of the British Empire, and had good advisers starting with Prince Albert, then several standout Prime Ministers.

Later in life she did form an overly fond attachment to a Scottish groundskeeper named Brown, a relationship portrayed in the film Her Majesty Mrs. Brown.
Brown by the way looks and sounds pretty much like the Simpsons character Willie the Groundskeeper, whose opinions accurately reflect the views of Scotsmen past and present.

http://www.youtube.com/watch?v=VsL3QkA97nE&feature=related

After Victoria, well the best you can say is that the Royal Family means well, and that the incidence of Royal hanky panky seems to be down by about 12% since the advent of the tabloid press.  With the recent Royal Wedding bringing in some fresh genetics the current Queen may have reason to hope that at some point in the intermediate future her descendants will have more intelligence and less inbreeding than her Corgis...



January 25, 2012-
The ongoing popularity of this post remains a puzzlement to me.  My apologies to anybody whose search engine sent them here for real information on cavaliers and roundheads.  In atonement I plan on doing a serious post on this topic in the year ahead.

But if you just like pictures of royal corgis, you're welcome. 
T

Sunday, May 8, 2011

Haute Dogs (and Anti-Prom)

It is the season of Prom.  For the benefit of blog visitors from elsewhere -I am thinking of my small but loyal Croatian following- I should explain that this is an annual rite of passage for kids in their last couple of high school years.  It involves formal clothing, flowers, a fancy dinner out followed by a dance that nobody seems to enjoy very much.  A particularly attractive couple get to be Prom King and Queen.  It runs a bit of money for even sensible people to attend, and for the spendthrifts it can stimulate the local economy considerably.

But who is talking about sensible people here.  Or even people.

Dogs in formal wear are an interesting inversion of humans in same.  I stand ever ready to have my opinions scoffed at and derided, but as I see it young men generally look silly in formal wear, young women not so much.

I figure it is because tuxedos are generally associated with a degree of social stature, a certain gravitas.  They are designed to camoflage the middle and minimize the expanding waist line that  often goes along with success.  17 year old kids tend to have the tux hang loose on them, their skinny necks with prominent adam’s apples doing little to enhance the effect.   Some dogs have a similar issue.
Too scrawny to make this work
Of course there are a few tuxedos that really should not see the light of day or the dark of prom night.  Unless you have the supreme confidence to wear some over the top burgundy wide lapel 70’s get up you should just stick with classic black and white.  I think dogs are color blind so this poor pooch did not suffer too much.

Looks like a Hugh Hefner bathrobe to me
The classic tux in a guy wearing it with panache?  Here it is.


Regards young ladies in formal wear let me make clear that my opinions are simply aesthetic.  There is an age at which a more intense interest in these matters is appropriate but I am about 3.1 multiples of that age.

Dogs just have a difficult time managing a good looking formal dress.  As in all things they try so hard.  Maybe it is that unfortunate chest hair thing.   Maybe, well, if you have a tail just about any outfit actually will make your butt look big. 

Here is a well accessorized young pup ready to “put on the dog”.
hmm, that pic of her boyfriend looks photoshopped...



And a couple of pretty good outfits.

rather squinty eyed..was this post prom, next morning look?
I note a slight resemblence to Carrie, from Sex in the City
Sadly, our household is at present dogless.  But we still have a Prom age kid nominally under our supervision.  But this year no Prom for him.  Along with some cohorts he is organizing an Anti-Prom.  Details are sketchy so far but a riverside venue is anticipated, the music will be live banjo, and the main activity of the night is to be cat fishing.

It sounds like at least as much fun as the official Prom, and much cheaper.  And less bother for us parental types.  Just make sure there is a rain plan, issue the usual prohibitions on alcohol and untimely progeny and I guess our work is done.

Outfits for a cat fishing Anti-Prom?  Maybe..

Posting from Hadrians Wall, six time zones away and on the edge of the Civilized World; best wishes to "Huck" and "Becky" the King and Queen of Anti-Prom

Friday, May 6, 2011

Vindolanda digging report day five. Mystery solved a different way.

This has been a week in pursuit of archeological features.  Nifty finds have been of secondary importance but Nigel and I have still turned up an assortment of broken pottery, some shards of roof and drain tile and another coin.  Myself, it has been pursuit of the missing wall, presumably part of the centurion's quarters.

As it turns out, it actually was there all along, just a little deeper.  Here is a picture of the final clean up, with the elusive wall extending from the earlier segment (dry and on the right) to the new discoveries.

It is frankly not that great a wall, poorly constructed around AD 214, but in some small measure my painstaking work here will advance archeological knowlege of this era.  Of course in a few weeks some other digger will be assigned to demolish it to get at what lies below.

Elsewhere on the site other "bits and bobs" have turned up.  Another brooch, the metal fittings for a spear handle, a couple of knife blades.

But overall the end of the week paired with more fine weather induces a sort of euphoria.  The diggers get a little silly.

One team discovered a huge, ill shaped boulder plopped down in their area of road/roadside ditch.  For some unfathomable reason this massive thing was quarried elsewhere, hauled with some effort into the fort---and dropped in a location guaranteed to be a persisting pain in the posterior.  This hideous rock has been dubbed "the monster", and the picture below shows a digger vamping a bit like a Siren luring sailors to their doom....

But for real nonsense I did not have to look farther than the other side of my roman roadway.  "Pete" unearthed a bit of rock that he first decided was a depiction of the continent of Africa (never you mind that the romans had no idea what the southern two thirds of Africa looked like).

But after a minute of reflection he concluded that in fact this was a different sort of artifact. 


Hey, admit it, you and I have both seen less attactive fashions paraded down the runways of Paris and Milan!

A two day break from archeology, various other nonsense will turn up in the interval.

Cheers from the Twice Brewed Inn.

Thursday, May 5, 2011

Digging Vindolanda Day Four--Mystery solved

Various things coming up around the site today.  My digging mate Nigel came up with a broken coin that had enough inscription remaining to be helpful dating our confusing welter of walls, present and absent.

Here's a nice bit of jewelry from the other side of my road:
I think I mentioned yesterday that another team had encountered a large batch of broken storage jars (amphorae if you are curious).  Here's what happens when you are careless with several large pottery containers:

Somebody did not clean up after themselves!

As for me, not much to report.  I am still in pursuit of the missing wall.  I continue to advance my trench through largely barren clay, just a few pottery bits here and there.

But I have figured out where the missing wall stones are:


A snug little cottage just up the road from the excavations.  Hey, nice stones mister, don't suppose you want to tell us where your great grandfather got em......

Wednesday, May 4, 2011

Vindolanda digging report day three. Dude, where's my wall?

Ridiculous, intoxicatingly nice weather today.  My apologies in particular to those of you back home in Wisconsin where anything that is growing is probably some form of cold tolerant fungus, but here in Northumbria it is green and glorious.  In fact, the only way that digging conditions could have been improved upon today would have been the unexpected arrival of winged dryads in diaphenous togas offering us cool pints of ale on silver trays. 

That in part makes up for a day of very limited discoveries.  Elsewhere on the site a few beads turned up, and quite a cargo of broken storage jars that may have been used for fill.  But other than that...not much. 

My digging partner and I were assigned to follow a wall.  The only problem was, it was gone.   Here is what we were supposed to follow:
The sunglasses, trowel and kneeling pad are at the end of the previously excavated wall segment, which is supposed to be roughly three tiers of stone thick.  Beyond the marked point it is simply----gone.

The problem of course was stone robbers.  Back in the 1700s and 1800s farmers who needed some nifty building stone would just drive their carts up to the old roman fort site and start digging out whatever sized stones they needed.  Heck, it was free and much easier than cutting your own building stones.

To make matters worse I think they left the trench open long enough to fill in with clean silt, so my only finds of the day were a few pottery shards.  Oh, and some nails.  When you get mildly excited by this kind of find it has been an unproductive day.  But as I mentioned, still a very pleasant one.

Tuesday, May 3, 2011

Vindolanda Digging Report Day two. And the Worst Pub Quiz in Great Britain


Bright sunny day again, fine weather for picking through more rocks.  One of the first ones I lifted up and turned over had this on the bottom side!


Yes, it is just what it appears to be, a Roman spear head.  Or rather, the iron shadow of one.  The actual spearhead was rather corroded and could not be salvaged.  This often happens in the upper layers.

Not long after I came up with a round stone disc.  It had obviously been worked into a nice shape, and may have had some faint graffiti on it.  (No rubbing the artifacts, sometimes you obliterate fine details).

Opinions vary as to whether this sort of object was a stone lid to some sort of container, or a rather large gaming counter.  This was a substantial specimen, so if this was an ancient poker chip I imagine was redeemable for two sheep and an evening with the slave girl of your choice.

Late in the day I came up with a small coin.  These are less exciting than you would think.  Fourth century coins were smaller than a penny, artistically mediocre, and of such low value that you needed a handful to buy a loaf of bread.

Since the dig report is a bit light I offer up the following as a travelogue add on.

It’s official you know.  In some sort of nationwide contest the Twice Brewed Inn was given the dubious honor of having the worst Pub Quiz in Great Britain.  It’s hard to say how they would rank on a world wide census but I am certain that they would be competitive.

I should mention that while I have some categorical deficiencies I am overall a dab hand at trivia.  On the flight over there was an opportunity to play against other passengers.  I logged on, played one round in which I outscored the next closest opponent by a 2:1 ratio.  After that the entire competitive field retired.

So I know a few things about a few things.

Brian, the genial publican of the Twice Brewed, freely admits that the Quiz is “not for purists”.  He claims it is primarily for the amusement of the Inn staff.  A secondary function seems to be systematically humbling the “mavens” from the Vindolanda team.

Penalty points are handed out with abandon, especially when any ruling of the quizmaster is questioned or even simply howled at.  On the other hand the official ban on cheating via smart phone devices is very loosely enforced.

It is very heavily oriented to music, not my strong suite at all.  And the songs, to which you are supposed to supply title and artist, are run together in an eclectic mash up without any indication of what number song it is on the answer sheet. 

Of course, sometimes clues are provided. There were five bonus points if you could identify what “recent movie” a certain song had appeared in.  “Recent” in this case was 11 years ago!

Another song was described as being “a very big hit last year”.  Nobody had ever heard of it so I risked a potential penalty point by asking: “where?”.  The answer---“Manchester”.  Presumably nowhere else.

After a while you become a bit paranoid, suspecting trickery at every turn.  One one song I was able to dredge up the title from some fossilized grey matter dealing with the early 1970s.  Certainly it was “Annie’s Song”, but darn it all, that did not sound like John Denver.  It sounded like someone with measurable testosterone levels.  (Turns out it was indeed Mr. Denver, presumably recording on a day when he had a moderate sinus infection).

But the overall tone of the quiz was actually set by the very first question. 

“What is the name of a young goat?”

The answer, and nothing else got the point, was arbitrarily ruled to be “Billy the Kidd”.

Despite all obstacles the Vindolanda team did prevail this night, after a fashion.  For no particular reason the second prize is a bottle of wine, an item that one might actually find useful under the appropriate circumstances.

First prize was a DVD of the royal wedding.   No, not the recent one, the previous Charles and Dianna event. 

I guess that also is regarded as a “recent movie”.