Guinness vs Bartlett

Once there was an employer that provided annual “Employee Appreciation” gifts. At first, these were items such as camp chairs, Thermos bottles, fanny packs, coolers. Then a new sheriff (CEO) came to town. Before she eliminated those gifts entirely, the last one was a tiny leatherette notebook with an equally tiny pen.

Unsure what to make of this, one employee used hers to record quotations (hence Bartlett) from patients. Alas, the book was lost to posterity in one of our numerous office moves. (In our latest office move, we are each allotted 32 inches of desk space – so much for social distancing – as we sit shoulder-to-shoulder and back-to-back along a series of long tables, facing a wall in a windowless room, that make us look like telemarketers in a call center.) Lest it sound like we are making fun of patients, we will provide herein a couple of quotations from doctors – eminently better to make fun of…but are we making fun of them, or celebrating their wisdom?

An attending physician, known to be tough on her residents, once told the assembled group, “There is no ‘I’ in team – but there are three ‘U’s in Shut the fuck up!”

A patient had been in the hospital for weeks with complex abdominal injuries. His nurses knew his needs and his day-to-day changes. An overnight resident became alarmed and ordered a barrage of unnecessary tests in a CYA move. The next day a senior resident, letting him know the importance of asking the experienced nurses for input first, said, “Just because you’re smart doesn’t mean you can’t be a fucking idiot!”

A surgeon friend was invited to join a sewing circle. She was told it was a fun group, they met in a bar, it would be low-key. She agreed to check it out. She went to a meeting and they asked her to introduce herself and say a few words about her sewing experience. She said, “I don’t have any experience sewing, except with flesh.”

Guinness is famous for his book of World Records. We keep informal records in our heads. The legal limit for blood alcohol level in most states is 0.08%. Evidence of impairment has been shown at 0.03%. We have had drivers come in at >0.50%, or more than six times the legal limit – a level that would be fatal for most of us, and a level that requires some serious training to reach without dying. These were no amateurs. [We normally measure alcohol intake in terms of “standard drinks”. This would mean 12 oz beer, 5 oz wine, or 1.5 oz hard liquor – these are estimates, as not all beer is 5% alcohol, not all wine is 12%, not all hard liquor is 80 proof. I have met drinkers who measure their intake by the “handle”. A “handle” is a 1.75 liter bottle – so named because of the handy handle to make pouring easier. I guess you could say “A handle a day keeps withdrawal at bay.”]

from binwise.com (images are not to scale)

The human bladder holds an average of 500 ml. A patient who was unable to urinate on his own had a catheter placed which immediately drained 2.5 liters (more than a giant Coke bottle).

A normal blood glucose level is around 100 mg/dL. I have seen from the teens to over 1000.

A human normally has 24 ribs – there are a few variations. Some will have cervical ribs @C7, some will have lumbar ribs @ L1, some will lack a rib at one end (T1) or the other (T12). Most of us have 24. Flagel, et al (Surgery, 2005) found that “half-a-dozen ribs” are “the breakpoint for mortality”. In other words, if you break 6 or more ribs you are at significant risk for serious complications. (Four in the elderly, per a subsequent paper.) I saw someone who broke 22 of them and survived.

And finally, we can’t talk about healthcare without talking about COVID-19 and profit. While we’d like to think that vaccine development was a humongous humanitarian venture, the truth is a bit murkier. When it was suggested that the vaccine “recipe” be shared widely to enable faster and cheaper production, Pfizer CEO Albert Bourla called that “dangerous nonsense”. (He will make $24 million this year – a 16% raise over 2021, which was a 17% raise over 2019. [Ed. note: That sounds like dangerous nonsense to me.]) BioNTech (co-producer with Pfizer of their vaccine) forecasts a 2021 profit margin of 77%, while Moderna’s profit margin was 70% for the first nine months of the year (figures from Oxfam). The lowest estimate for profit from the vaccine seems to be in the neighborhood of 30%. (Compare this with the average grocery store profit margin of 2%.) The British Medical Journal (Hawksbee, et al, 2022) found that drug company profits have consistently surpassed other market sectors for the past 70 years, and have jumped during this century. Vaccine sales have largely gone to developed countries, the ones that can afford the high price tag, while less-developed countries have lower vaccination rates.

And so, I enter my last week of work. Is healthcare a basic human right, or the most lucrative profit center? (1)

It’s a Major Award!

I have just received a Major Award! For meritorious service, I have just been awarded The Golden Bedpan! No gold watch for me – an honest-to-god Golden Bedpan! (miniature facsimile.) 24k over pewter. Had I known I would receive this, I’d have retired sooner!

How does it feel to want?

I used to manage a housing project. As part of that job I supervised a maintenance crew, since I couldn’t do everything myself. I would get there early, check the maintenance requests that had come in overnight, balance those with the ongoing maintenance that was due, and any projects we had working. When Tom came in to work, I’d say, “I want you to…” and name a job.

Tom would reply, “How does it feel to want?” On the surface, this was me giving him a job for the day and him giving me shit in return. But what was below the surface? When I asked, this truly was what I wanted. As a human being, he had autonomy and could say no. We could talk about all of the work that needed doing, or something he had noticed the day before. We could have had that conversation first, in which I laid out all the work for the day and we chose together. He also was used to a boss who gave orders, not one who stated wants. Ultimately, he could refuse (whether an order or a want). Ultimately, I could fire him. He wanted the job and I wanted a staff I could count on, so we worked it out each day.

But on another level, he was offering me a spiritual/ontological lesson. I could actually take him up on the offer and feel what it was to want. I wasn’t paying him for that. It was a bonus.

There was someone else I was paying for that. We’ll get into that soon. So what is it to want? One meaning of want is to lack. Another meaning is to desire. If we smash those meanings together, we get desiring what we don’t have.

The Buddha taught that all life is suffering and all suffering arises from desire. Chew on that a bit. A lot of us will chafe at the notion that all life is suffering and insist we are happy. Buddha didn’t demand that we believe him. He demanded that we experience for ourselves. To get that suffering arises from desire might be a little easier but even that might get you thinking about how much pleasure you get from wanting something, planning and saving for it.

We bring a lot of passion to the quest. Passion comes from a Latin word which means “to suffer”. [It’s now a small leap to recognize that compassion means “to suffer with”. That’s a topic for another day.] So you want something. Depending on your personality, maybe you rush out and buy it. Maybe you read Consumer Reports and product reviews. Maybe you go try it out or compare different options. Maybe you save money for a long time, or maybe you just go into debt.

Now you have the thing. Then what? You go onto the next thing to want. My teacher asked us to consider the possibility of wanting exactly what we have. I suggested this to someone recently and they said “You can’t really ‘desire’ what you have though you can desire to maintain it. You CAN be content with it.”

Notice that there isn’t a lot of “juice” in contentment – it’s nothing like wanting, desiring, pining for, coveting. What if my friend is wrong? What if you can want what you have? What if you can bring the same intensity of experience to what is, as you can to what isn’t? Wouldn’t you suffer a whole lot less? Try it some time. (I’ll wait. Let me know how it goes.) Want what you have, not what you lack. See if it’s possible. See how you feel.

We like to complain about what we “have to” do. How would the experience change if we thought of it as what we “want to” do? You might object and say that is lying. But is it? When we make a choice, there is always at least one alternative. Let’s say I told Tom to trim the hedge. He could say he “has to” trim the hedge. He could also say he “wants to” trim the hedge. What is the alternative to trimming the hedge? Obviously, not trimming it. What are the consequences of not trimming it? The hedge doesn’t get trimmed, people get upset because the property looks run down. Someone else trims the hedge and resents Tom for not doing it. I fire Tom and he is out of a job and has no income. There are certainly others. But Tom has chosen to trim the hedge rather than accept the consequences of not doing so. He wants to trim the hedge more than he wants the consequences. How would the experience be different if it started with wanting to trim the hedge?

Mr Natural tries wanting to do the dishes

Top of the World!

Sunday’s ride with the Bombay Bicycle Club included the “Alpe d’ Huez option”. While that is a considerable exaggeration, it did include 3 consecutive climbs over a ridge in the driftless area.

A horse camp for kids at the top of the first climb (PS I was a counselor here 50+ years ago)
My kinda road!

After picking someone up at the airport, I hit the road an hour after the group left, so I didn’t see anyone. The forecast said warm, windy, and cloudy. There was no mention of rain. Twenty miles in, the sky to the north looked ominous. The radar showed it moving southwest to northeast and that it would miss me entirely, just giving some dark sky to watch. The wind was strong out of the south, so that seemed like a safe bet. Thirty-some miles in, it started to rain. There was no cell service, so I had only the sky to go by, not radar or a revised forecast. It was cooling down. With no access to a map, I guessed on a shortcut. It turned out to be more of a detour than a shortcut, only cutting 1.5 miles from the total ride. The good news is that it cut some descents that would be hazardous in the rain. The bad news is that it cut a couple of favorite climbs, substituting straight and flat miles in the valley.

One of the climbs I missed out on Sunday

If you can remember this

you’re old.

  • sprocket boards at the bike shop, so you could build a custom freewheel
  • “corn cob” or “straight block” freewheels (14-15-16-17-18)
  • “alpine” gearing (14-28)
  • “Half-step” gearing (in which each shift between chainrings is ½ of each shift between cogs) or the “half-step plus granny” touring variant
  • downtube shifters
  • pre-Hyperglide cogs, which you could flip over when worn and they’d be like new again.
  • Zeus (the Campagnolo clone company)
  • Jack Taylor, Ron Cooper, 3Rensho, Cinelli, Ciocc, and other framebuilders
  • Framesets hanging from ceiling hooks in the bikeshop – you ordered parts to have them built up custom.
  • Suntour, Stronglight, Atom, Regina, Normandy, Simplex, Weinmann, Dia-Compe, and other component manufacturers
  • center-pull brakes
  • No braze-ons – all accessories clamped onto frame tubes
  • Braze-on pump pegs
  • When Cannondale made bags (panniers, handlebar bags), not bikes
  • Tire savers
  • Tubular (“sew up”) tires

How old is old?

  • “40 is the new 30.” (Douglas Coupland, author of “Generation X”)
  • “50 is the new 30…and delusion is the new self-esteem.” (Steve Kelley snd Jeff Parker – from the comic strip “Dustin”)
  • “Don’t trust anybody over 30.” (Jack Weinberg of the UC-Berkeley Free Speech Movement)
  • “14 or Fight.” (Christopher Jones, fictional character from the movie “Wild in the Streets”)
  • “Your old road is rapidly agin’/Please get out of the new one/If you can’t lend your hand/For the times they are a-changin’.” (Bob Dylan)
  • I saw a sign advertising Senior Apartments the other day. This is old to them:

I discovered the lifespan of a Campagnolo Super Record cassette is 3 chains. I placed my fourth chain on the Wilier last week and took it out for a test ride. Fine around the block, so we headed into the countryside. Soon, one cog began skipping under load. Fine, I thought, I can get by without that gear for today. I’ll change before the next ride. Then another and another began skipping. I realized I could not get up the infamous Mounds Park Road missing 3 of my lower gears, so I cut the ride short. I still got to see (and climb) this:

Actually, Campagnolo 11 speeds come with two groups of 3 and 5 loose sprockets, so individual parts could be replaced, if one could buy them that way – or if one chose to take some of the parts out of the box and leave others behind.

Note that we are moving on from the trees blooming to the trees leafing out. This is a few miles down the road from our adopted highway, and a few seconds before I came upon a rider with a broken derailleur hanger – which kind of ends one’s ride. I didn’t feel so bad about cutting ten mostly uphill miles from my ride.

With a new cassette in place I headed out again on Sunday, riding into a strong headwind for 25 miles. It was 45 degrees (7 C), so I tucked a bag between my jersey and my jacket for the first several miles to add insulation and wind-proofing. My luck held and the wind was still blowing for the tailwind part of the day when the temperature soared to 55 (13 C).

I was thinking that the bike is almost ready to go (more so than I), but that it needs new shoes (tires and tubes) before the trip, which brought this to mind:

The wind had me singing wind songs – the mind brings up what it brings up.

(2)

Busman’s Holiday

Not really, but that sounds better than a “working vacation.” The British coined the term in 1893, referring to a bus driver taking a road trip for a holiday, so it was much like work.

My job includes paid vacation (not a big deal outside of the US). We used to be allotted our vacation at the beginning of the year, to use at any time. If we left the job before the end of the year, any pay that we had used before earning it would be withheld from our last check.

That system worked pretty well, which is why they had to fix it. Now we can’t use vacation until we earn it, so the year starts at zero. If we want to take a winter vacation, we have to save time from the prior year. And, we have a “use it or lose it” system now. If we accrue too much vacation, we stop gaining any new hours until we use up enough hours to get below the ceiling again – a definite incentive to go on vacation.

The pandemic has not been conducive to taking vacations, so last fall I realized I was going to have to use some hours this spring or lose them. I took a week in March for no specific reason. I often take a week in May to work on a home repair/maintenance project. This year the project is my own body.

It was a cold, dark, and wet April – not just by gut sense, but by the numbers. I spent much less time on a bike than planned. My dry erase board calendar for this week says “Ride” and “Ride more”. With six weeks until the coast-to-coast ride begins, there is work to be done. The “working vacation” means riding every day. As I haven’t ridden long distances yet this year, I clearly haven’t ridden long distances on back-to-back days.

At the age of 69, I’d be a fool to think I can “ride into shape” on the transcontinental tour. The 105 mile third day would ride me into the ground, not into shape. This week’s focus is on riding, not numbers. As such, I will start the week with no Garmin, no Strava, no bike computer. (Then again, since I don’t own a Garmin and I’m not on Strava, 2 out of 3 are no change from any ride.)

Sunday 55 degrees (13 C) and cloudy. It being Mother’s Day, I stayed home with family.


Monday 80 (27 C) degrees, bright sun, 25 mph wind gusting to 40. I was glad to have the weight of a steel bike under me so I didn’t blow away. My first day of the year over 50 miles, which grew to the first day over 5 hours of riding. Soles of my feet burning by the end, just like old times. Tailwind for the last 10 miles, which saved me.


Tuesday I met a friend for coffee to tell her about my retirement party and ran a few errands, so by the time I was on my bike it was 90 degrees (32 C). The wind was down to 15 mph. Late enough in the day to settle for an old classic – the Paoli Ride. The ride to Paoli was a classic when I first rode it 48 years ago. The A&W Two-Tyred Wheelmen rode there regularly. They were sponsored by A&W and met at a local root beer stand for their rides, enjoying a frosty mug at the end. While I never rode with them, I adopted the tradition and often rode to root beer stands – once I rode 60 miles for a root beer. When I told them they were the first root beer stand in 60 miles, they were unimpressed. Sometimes while riding to Paoli we would stop at the old Same place for pizza, served by Tim and Kathy Same in their gazebo after the ride.

Driveway to the old Same place

In the hardware store I saw a guy with a t-shirt that said “I like my puns intended”, so I told him about the standup comic I saw with a monologue of puns. He was desperate for one of his jokes to get a laugh, but no pun in ten did.

I rode through the arboretum, where we usually go on Mother’s Day to see the lilacs. Mother’s Day was early this year and the blooms are late. The magnolias are dropping but the crabapples (which bloom before the lilacs) are just beginning to bud. These sandhill cranes seemed to find plenty to eat. I also saw a few turkeys – the birds, I mean.

Wednesday The air conditioning is on. How many days ago were we needing heat? The “windows open” season was really short this year. I hope it returns. Over 90 degrees. Wind down to 15-20 mph. Rode the Wednesday Night ride with friends. Heat stroke for one, but he made it to the end.

Thursday It dropped below 90. Too cold for a ride 😉 Began gathering tools and parts for the trip, making a list and checking it twice. Actually, I was wrong. My indoor/outdoor thermometer stopped responding. It was hotter yet.

Friday Today was supposed to be an early ride. Replace the chain, adjust the front derailleur cable, and head out on the bike that is going on the trip with me. I’ve been riding the other bike for weeks. I was derailed by unforeseen problems. It wasn’t a cable problem, it was a shifter problem. I disassembled the shifter (which required removing the bar tape I thought I had saved earlier this spring, so I could remove the lever). Putting everything back together, the cables (both front derailleur and brake) magically became too short. This was not the quick job it started out to be. It is now over 90 degrees again, I feel like an idiot, and my whole house is shaking due to the huge machine out front tamping the sand back into place after replacing the sewer main and laterals. This is the third time the street (I use the term loosely, as there has been no pavement for weeks) has been dug up. We are getting new gas, water, and sewer lines, then new pavement, curb, gutter, and sidewalk. They are not burying the power lines because that is somehow too expensive. Since power lines are smaller and more flexible than the other three, and the ground is already dug up, there is a logic here which escapes me.

Surprise! The bar tape that I like so much (but whose brand name I don’t know, having gotten it somewhere on sale) is so good that, after removing it to take the shift/brake lever off, I was able to rewrap it. Being late enough to decide not to go for a ride, I started packing.

Saturday A beautiful day. Still under 90 degrees when I got home from a long ride. After 4 days of record highs and record high lows ( a datum that I didn’t even know they kept), today was a day to wander in the countryside and sing along with James Brown:

Sunday A week of firsts for the season: first ride over 50 miles, first ride over 5 hours, first consecutive days of long rides, first week over 200 miles. First time I feel like I can make it across the country. When I no longer go to work 5 days/week, will I still have a Sunday Feeling?

A humbling experience. Forty miles into the ride I was feeling worn out. I briefly considered a shortcut home, then realized that, any other time, a shortcut would be reasonable. But with five weeks until I’m supposed to be strong enough to ride across the country, I opted to stop for lunch instead. I made it back but “fun” would not be the word for the last 20+ miles. That paragraph above about feeling I can make it across the country? That was written early this morning. At least I have five more weeks to be ready.

Wisconsin (as I’ve said here before) used to have the best system of secondary (county) and tertiary (township) roads in the country. With thousands of small dairy farms needing milk picked up every day, roads had to be maintained for the tankers. With the consolidation of the dairy industry and general decay of our infrastructure, the roads are no longer impressive…but today I must have encountered a township flush with cash. Instead of potholes filled with gravel (as I encountered later in the day) , or slapdash chipsealing, or ribbons of squishy tar-filled cracks, I rode on several miles of new asphalt. I was in bicycle nirvana this morning.