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?


Monday, February 16, 2015

Looking for that special Axman Surplus

Axman is one of the few stores I actually enjoy shopping at.  But this time I was there on a mission...

Perhaps this is the item needed?

Nope.  Close but I can't recall the last batch of home made rat cookies.

Some kind of theater props now being marketed as "General Purpose Weirdo Costume".  Likin' it, but given certain comments that have been offered up when I try to wear my tuxedo with tails along with my red fez.  Sigh.

It was not for sale but there was a swell AxMan special pinball machine on display.

The ghostly figure of Orson Welles, "Bat Boy" from the classic tabloid press and some vague threats to Oprah Winfrey.  But as I said, not for sale....

The intended recipient is a major fan of lip balm.  Probably ought to have bandoliers of the stuff draped off the shoulder in the style of Mexican banditos.  Still, pepperoni pizza flavor.  And at Axman it probably had been sitting around somewhere or another for years.

Eventually I did find a variety of appropriate gifts, and brought them up to the check out counter.  The clerk was the usual drowsy eyed, long haired hipster with enormous ear piercings.  I felt I needed to explain myself.

"Hey.  Valentine's shopping at Axman."


Saturday, February 14, 2015

Digging Dreams.....

Winter still holds Wisconsin in its icy grip, but hints of Spring sometimes pop up in the least expected ways.

One of my fellow excavators at the Vindolanda Roman site thoughtfully sent a few pictures of our digging last May.  These are different from the usual stuff I post because:

1. I am in them, and
2. He has the talent and equipment to take some darn good photos.



Small finds marker staff.  Moderate amounts of mud.

Down in the serious, early Roman mud

Gloomy skies, brilliant green.

Not so very many weeks to go now.  I have my travel bag out, a few items of kit already packed....

Friday, February 13, 2015

Desk Racers - Seven

Last building session.  Next week we have the race over the noon hour, then kids can take the machines to science classes in the afternoon if they wish.  Pizza and dismantling for our last class. I'm glad we had the extra session for this, usually these projects end up piled in my garage for my much later attention.

Racer B with some cool running lights:

The main power is 24 volts but these are 12 volt LEDs for automotive use.  The answer is using a voltage regulator.  The kids had fun with that.  It looks like the Hollywood idea of a nuclear bomb trigger!

Racer C.  Well, we learn from our successes.  We learn more from ambitious failure:

As I feared it did not have enough torque to run efficiently.  Also the long wheel base made turning problematic.  As in impossible.  I will spare myself the embarrassment of posting a picture of the place where I ran it into a wall and knocked off a bit of baseboard.

None of the makeshift fixes we tried worked.  Just too much weight and not enough power for the task at hand.  At least it looked cool.

Final touch of course was an Axman Surplus sticker for each machine.  Race day next week. Only two machines per heat but that should be fun enough.  I guess.

It should be fun.  I think maybe the desks will go back into the storage area they came from.  I could see reviving this project in a few years.  The nice thing about middle school robotics is that the kids are only there for three years, you can have a "rotation" of projects and not have kids repeating a build.

Wednesday, February 11, 2015

The Sir Lawrence Olivier of Drug Seekers

When I tell medical stories it is always with a couple of factors built in to protect what really has to be doctor patient confidentiality.

I always delay telling a story.  Sometimes for a decade or more.   And I always change some details. So today's story is true in the overall picture but has a bit of necessary camouflage.

Drug seekers are the bane of the Emergency Room.  They make the system work less efficiently for one thing.

If it were simply a matter of wanting narcotics to get high or to sell to like minded folks it would not be such a big deal.  People make bad choices. But in many ways the scamming of the medical system is a cancerous growth.

It increases costs for everyone.  It makes legitimately ill and injured people wait longer to be seen, potentially with harmful results.  It makes ER staff hardened and cynical, potentially less ready to offer pain meds to people in real need.  It increases liability risks....who is really at fault when a frequent flier turns up hypoxic, caked in vomit from a drug overdose.  Well, the person who abused the drugs of course.  But who gets blamed and potentially investigated...

Don't get me wrong.  I give people narcotics.  Plenty of them at times.   Somebody comes in with a dislocated shoulder and my standard line is "You know that stuff about just saying no to drugs? Well....forget that!"  I have even had a few occasions when notorious drug seekers have turned up with a serious injury.  Surprisingly they tend to make bad choices globally and injuries are common. Under those circumstances I bring out the major stuff, even dosing heavier than usual to allow for likely tolerance levels.

But seriously, coming to the ER expecting a shot of narcotics for your chronic back pain, or for the bad tooth that has prompted (true stat) 53 prior visits.....not appropriate.

Most of the time the process of sorting out the legitimate from the bogus is not rocket science. Some show up obviously intoxicated or stoned.  Their stories are knitted together from the faintest gauze and repeat themselves from one visit to another.  And another.  And another.

But among the mostly unimaginative seekers of Percocet and Dilaudid you do on occasion run across a consummate professional.  A true Prince of Players.  I met one a while back....

It was a tranquil morning.  Usually these folks try to turn up when Chaos reigns, figuring that  most docs will just do what they ask to clear a room.  One also suspects that most substance abusers are not early risers.

The story was concerning.  Headache, tingling and weakness, unsteady gait, loss of part of a visual field.  It was close, so very close to making anatomic sense.  And since neurological diseases are notoriously treacherous it had to be taken seriously.

I had been told that he lived in a half way house.  This is a huge red flag, one which is often a deal breaker.  I asked him about that.  He actually teared up.  After a long minute he answered.

"I have post traumatic stress disorder" he said.  He went on to tell me a story of how he had found his teen aged son who had just committed suicide with a shotgun to the head.  It was a heart wrenching tale.  You did not want to look any closer, or to ask much more.  He said it was years ago and that he had begun drinking, but was now sober.

He was patient as I examined him and did not at first ask for anything for the pain.  He was appreciative and actually thanked me for being a good listener.

With this presenting problem you really don't have a lot of options, you have to do a CT or MRI of the head.  How do you know there is not a tumor there?

While waiting for the scan he said the pain was getting a little worse, and could he perhaps have something for it?

Interesting the first dose of pain medication did not have much effect, so he asked for a second.  And then a third.  Always politely of course.

The scan was negative.  It is always good news to not have a brain tumor.  At this point I figured he either had a migraine, or perhaps some sort of conversion reaction giving him neurological symptoms of psychological origins.  Or.....

I called the half way house up.  They were terse and would not say much.  But what they did say spoke volumes.

"There are no narcotics allowed in our facility."

So I had been scammed. A headache, a plausible story.  But the master touch, the thing that caused me to reduce my usual skepticism, was the story of his son's suicide.  What a horrific thing.

All parents live in dread of some things.  The thought that somehow we would miss some crucial hints of depression and that one of our children might commit suicide sits atop our list of ultimate horrors.  And to find the body...

Why even now I find myself sympathizing with the poor man, even though the story may well have been malarkey.

A truly inspired actor knows one thing above all: his audience.  He can sense what words and gestures and themes will resonate strongly.  Maybe the story was even true, it would make the performance more heartfelt.  But could anyone who went through such unspeakable horrors ever bring themselves to speak of them with a total stranger, just for the purpose of scoring some drugs?

Thirty years on into a career of working with people ever day and I still learn new things about them.

Tuesday, February 10, 2015

Mid Winter and Interesting Times

The days are getting a little longer now, and on occasion we get a balmy stretch that fuels my Delusions of Spring.

It's noon on a Monday and already I have heard from:

The Department of Natural Resources with a possible offer to explore a brewery cave on one of their Bat Hibernation Surveys!

Someone who is doing a book on medical care received by WWII POWs.

And most excitingly from a Vindolanda excavating crony who has - cue the triumphant fan fare - been accepted into a graduate level Archeology Program.

Yes, the world may look dead and frozen but there are lots of fun things waiting to awaken.

Also bats.  Opinions are varied on how fun they are.

Monday, February 9, 2015

A Bumper Sticker for our times.

Advance warning, this post will make little sense to my friends from the UK and places Continental. Consider it part of my cultural outreach mission.

It is quite common here in the States to see vehicles - mini vans being the classic - with bumper stickers like this:

It is a harmless bit of parental bragging, but I assume it must be a bit rankling to parents of special needs children and I know it is to parents of children who have been goofing around and not working to their abilities.

Our kids are now all "up and out" and I am considering getting a bumper sticker that looks like this:


Because in our modern society that has become the gold standard of success.  Kid has a job.  Kid is not working on an unpaid internship.  Job is not flipping burgers, they actually value him/her enough to offer health insurance.

As a goal in life getting a job with benefits is a much greater accomplishment than almost any academic achievement.  We have as a society allowed prolonged adolescence to become the norm. "Children" no longer have to be in school to stay on mom and dad's insurance plan, they just have to stay under 28 for as long as feasible.  (Oh, I admit this is usually approximately 28 years).

So I am happy to report that two of our three offspring have attained the treasured status of officially "grown up" people who have gainful employ with benefits.  The third is well on the way.

And the advantages financially to removing two of our three kids from the family's rather pricey health insurance policy?

Nothing.  A couple who have one child and a fecund reality TV family with eight pay the same amount.

Crazy, isn't it.  In a huge, massively complex health care system where there are probably 20 different charges for different ways to put bandages on an injury it has not proven possible to grasp the evidently simple concept that purchasing health care for three people costs less than doing so for five.

Another example of how Capitalism and the financing of Health Care are fundamentally incompatible in our current system.  This is the exact analog of going to the store and finding that the only size of pants they sell is XXL.  Wear 'em or go buck naked.

Friday, February 6, 2015

Desk Racers - Six

Short post this time.  My assistant was unable to be there tonight so the adults to monkeys ratio was not ideal.  We had a lot to get done.

Wheels mounted, motors mounted, bushings set into wooden blocks that actually fit.  Tested under power.  Impressive RPMs.

Racer C near completion.  Note the low ground clearance.  Hope nobody drops a Kleenex on the floor during the race, it might not make it over.  As is always the case with scavenged equipment, there were a couple of issues.  The main power switch was off of an old computer.  It did not work.  Maybe that had something to do with why it was thrown away.  And one of the PWM cables that connect the radio receiver to the speed controllers failed.  Heck some of them have been in a dozen projects over the years, not all of them qualifying for "gentle use".  Good troubleshooting lessons and swap out the bad parts.

If we had another 15 minutes we would have had our last machine running.  I always say that.  In this case I suppose I should say that it might run.  The balance of torque to RPM is not ideal. On race day (two weeks from today) it might just sit there.  Until we give it a little shove...

All three racers crowded into their closet / garage.  Great support from the tech ed teachers this year. To do robotics you really only need enthusiasm, durable electronics, and storage space.

Wednesday, February 4, 2015

Short cuts to learning Italian (and avoiding scary food).

I try when visiting parts distant to learn enough of the local language to at least be polite in my ignorance.  My German is passable and my fragmentary French and Arabic have been slightly useful. If all you can do is learn a few phrases then "Help", "Sorry" and variations on "Hello" are where you should start.

But in my ongoing efforts to learn Italian I have been surprised to find that I have some solid foundations under me; some unexpected advantages if you will.  For instance:

Via the wonders of the internet I was reading an article on the six "Must-Eat" dishes of classic cuisine in Rome.  The above tasty looking plate is Coda alla Vaccinara.  This is where having a background in medicine and an interest in history will come in really, really handy.

Vaccinara sounds like vaccine.  It means "from cows".  If you know your medical history this adds up, as the first real success in preventing serious disease by stimulating the immune system came when Dr. Jenner in the late 18th century figured out that the crusted lesions of cowpox (which milkmaids got in the course of their duties) could be used to keep people from getting the more serious disease smallpox!  So, Vaccinara.....cow, from the Latin vaccina.

Coda.  This is a musical term meaning the tail end of a composition.  It comes from the Latin cauda which means tail.  We still speak of cauda equina syndrome as the clinical picture that occurs when the nerves at the lower end of the spinal column (they look like a horse's tail) are damaged.

Coda alla Vaccinara.  Ox tail.  No thanks.  No grazie.

Monday, February 2, 2015

Travel Funding for 2015

When I go each spring to excavate at the Roman fort site of Vindolanda there are some constants.  I walk a lot.  I work fairly hard.  And my eyes are constantly scanning for artifacts.

Of course you can just show up and get right to it, but I feel a certain obligation to have my legs, my back and my eyes tuned up and ready to go.  And naturally it is an excellent idea to keep in shape generally when your 60th birthday is a lot closer than your 50th.

So we walk.  Almost every day if the weather is not unspeakable.  Days when it is we go to the Y and circle the indoor track like latter day charioteers on a "Circus Minimus".

One disadvantage to the indoor version is that you don't find much money.

Me culpa, when I am out for a walk I scan the ground for anything anomalous.  Coins for sure.  I have also over the years accumulated a partial set of socket wrenches and the occasional lost earring. The money comes home and gets tossed into the "Treasure Trove" tin.  Here is the haul from 2014, a year constrained somewhat by ill health, excessive work and a nasty winter that hung on longer than it needed to.

Not bad I suppose.  We live increasingly in an age of plastic and electronic money.  Lost pennies will someday become rare as they fall out of use or when repeated efforts to eliminate them from our currency entirely succeed.  A few close ups:

A very distressed penny.  I wonder how many ancient "holed coins" were in fact not jewelry but just very beat up small change.

Pennies really vary in condition.  Softer metal and more prone to corrosion.  Maybe they also stay on the ground longer, many people will not bend over to pick them up.

A couple of quarters.  The top one was so odd looking that I thought we had come across a stray Mexican peso or some such.  Nope, just a worn down quarter in which the superficial shiny stuff had vanished leaving the dull base metal underneath.  You saw this pretty often with Roman silver coins but of course they usually had some attempt at genuine silver on them, if only a thin deceptive wash of it.

As to financing the upcoming travels, I guess every little bit helps.  I appear to be able to purchase a nice pint of ale and a bag of crisps at the Twice Brewed Inn.  Or, with the exchange rate for the euro being the best in over a decade, maybe a bottle of modest vino in Rome?