Say Goodnight Dick.

Before embarking on my soon-to-end career, I took a course called “Labor in Literature and the Arts”. For that course I wrote a series of poems about work (including delivering newspapers, selling concessions at football games, driving cab, plumbing). After several years working in healthcare, I realized I had not yet written about that endeavor. I decided to do something about it.

Fast forward a dozen years. I was looking for some old photos on a seldom-used hard drive. I came across some poems about health care that I’d forgotten about. I’ll reprint some here so that you can forget about them, too.

Surgery

Surgery is better than medicine.
That’s why surgeons get paid more than physicians.
If I give you a medication,
You have to keep taking it.
But if I cut something out of you,
It’s gone forever.
But then maybe you’ll have to take
Some medication.

I used to be a plumber.
I could be a vascular surgeon.
It’s the same work,
But it pays better.
It’s usually cleaner
And doesn’t smell as much,
But that’s not always true.

I can use a snake to clear a clog
But in your arteries we give it a different name.
I can replace your pipes
And if I were a surgeon I wouldn’t even have to
Know how to solder.

I used to be carpenter
But now I’m an orthopedic surgeon.
The tools are pretty much the same
But smaller and prettier.
I love stainless steel and titanium.
The work is still the same
But I get more respect.
I get paid ten times as much
And no one complains about the bill –
Not to me, anyway;
No one wonders if I’m worth that much.
No one complains about the materials cost
And asks me if I could use something cheaper.
No one tells me they can get a hip for less at Menard’s
And asks me if I can install that one and only charge for labor.

Alphabet Soup

There is a poem waiting to be written
But I don’t know how to write it.
I’ve been in this hospital for ten years.
There are stories to tell
But I still don’t know how to tell them.

You come in with a medical history written in code.
CAD, DM II, CHF, ESRD on HD.
The we ask you what’s wrong
And make a diagnosis.
Diagnosis means telling you what you just told me,
but saying it in Greek and Latin.
Just because I can recite your symptoms in another language
I get paid in 6 figures.
Well, not me
But someone like me.

We still don’t know how to fix it.
We can give you some drugs.
They’ll make some of the symptoms better
But only as long as you keep taking them.
The drugs will cause some other symptoms
But we have a drug for that.

We don’t use the word “drug”.
That’s how you know I’m not really a doctor.
If I were a doctor I would have said
“Medication”.
Drugs are what you take.
Medications are what we give you.

(3)

It’s not about getting old.

When I was in school I studied the related concepts of “Universal Design” and “Visitability”.

Universal Design is about designing spaces for accessibility from the beginning, so that what we consider “accommodations” are simply a part of reality.

Visitability is about making all living spaces “visitable” by people with mobility challenges.

Visitability was pioneered by Eleanor Smith of the organization Concrete Change in Atlanta. She posited that a few simple changes in how we design and build houses would make a world of difference. If all homes had a zero-step entrance (this could mean a ground-level entrance or a ramp), 32 inch clear openings in first floor doorways, and a wheelchair-accessible bathroom on the main level, wheelchair users could visit their friends and family. If all of these are incorporated into design, the costs are minimal. She began with a local ordinance requiring visitability in all housing built with government funds.

Visitability is not the same as accessibility. To make a home fully wheelchair-accessible includes (among other things) raising outlets and lowering light switches to make them reachable from a wheelchair.

Opponents argue about interference with private property rights, but all housing requires permits and all permits require compliance with building codes. Codes change. Incorporating visitability into building codes means we don’t single out government-funded housing. If we add these to the UBC (the model Uniform Building Code), we don’t have islands of compliance in a sea of non-compliance.

Universal Design means (from the Disability Act of 2005):

The design and composition of an environment so that it may be accessed, understood and used
1. To the greatest possible extent
2. In the most independent and natural manner possible
3. In the widest possible range of situations
4. Without the need for adaptation, modification, assistive devices or specialised solutions, by any persons of any age or size or having any particular physical, sensory, mental health or intellectual ability or disability, and
Means, in relation to electronic systems, any electronics-based process of creating products, services or systems so that they may be used by any person.

It is based on seven principles (from UniversalDesign.org):

In my work I see a lot of people who fall. Many of them are averse to making changes in their homes because they see them as for “old people” and getting old is something they don’t want to do or admit to. I often reply that it beats the hell out of the alternative. This leads to the third related principle, that of “Aging in place“.

Aging in place refers to staying in your own home as you age. If we incorporated universal design into all homes built, that would be a pretty straightforward task. If you live in a 100+ year old home, as I do, that takes a little more thought.

Installing grab bars during new construction is simple and cheap. Installing blocking in the walls to prepare for the future installation of grab bars is cheaper yet. It can usually be done with scrap lumber that would otherwise end up in a dumpster.

Image from Paradigm Interiors – blocking for grab bars, allowing lots of choices

Retrofitting with grab bars takes a bit more thought but is still pretty simple. Wall studs are generally built on 16 inch centers. Grab bars generally come in increments of 6 inches. Do you see a problem here? 6 and 16 only line up at 48 inches (and multiples thereof). Do you need a 48 inch bar? Probably not. But this brings an opportunity. (All of these numbers may change in countries that use the metric system.)

Studs on 16 inch centers with 36 inch (or 18 inch, stopping halfway) grab bar in blue.

We are not all the same height. Standards that you read may show the “correct” height for a grab bar. Actually, the correct height is the one that works for the user. The same height won’t work for one person who is 6’2″ and another who is 4’11”. Our wrist works best when our hand is in line with our forearm, like (e), not (f) below.

If a horizontal bar is too high, your wrist will look like (f). If the bar is too low, you will either bend awkwardly to reach it or not use it at all. If you mount the bar at an angle as shown, you have a range of available heights to reach with the appropriate wrist position. The other alternative, of course, is to mount the bar vertically, along a stud. Generally, to get into a shower or built-in bathtub, I recommend one bar mounted vertically to hold as you step in, then a second bar mounted at an angle along the side wall to hold once you’re in. Due to the standard dimension of bathtubs, there should be a stud in an appropriate spot. Shower stalls have more variation, but you should still be able to find a stud in an acceptable spot, either inside or outside of the door.

Before you screw it in place, try it! Either have someone hold the bar while you try it (grasping it but not bearing weight on the hand as you step), or mark the proposed location with blue painter’s tape and fake it, checking the height and angle. If more than one person is in the home, have them all try it.

If you don’t know how to install it, find someone who does. Your life may depend on proper installation. If you’re drilling through tile, tape the spot where you will drill, and drill through the tape. This will help prevent the tile from chipping. Use a sharp masonry drill. If you are drilling through a plastic tub surround, tape it and apply pressure with your free hand to prevent the plastic from chattering in and out from the wall with the drill action. Don’t trust screw anchors to hold the bar. Drill into studs or blocking. Some bars have multiple choices for mounting holes so you can maximize the number of screws into studs.

Think before you place screws. In the pictures above, the solid blue are studs, the large blue circles are the grab bar mounting plates, and the small blue circles are the screw holes. This is a common design. (The ones I mounted today have five holes in each plate, with three screws, so you can pick the best combination.) On the left you note that two screws are solidly in the stud and the third misses. On the right, no screw is solidly in the stud. If your choice is two screws (on each end) solidly into framing and one anchor (or unused hole) or three screws, none of which are actually going to hold, I’d opt for two solid screws over zero. With a three hole plate and nominal 2 x 4 framing (which is actually 1½ x 3½), this is what you get.

When mounting in a wet area, caulk the side of the mounting plate that will be against the wall to keep water from getting behind it and running into the screw holes, ruining your wall over time. Leave an opening at the bottom so that, if any water gets in, it can drain out.

The caulk will not be visible from the outside but, if I drew it that way, you couldn’t see it.

There are lots of choices for bars. Feel the bar in your hand. Is it slippery? Probably not a good choice. How is the diameter? Can you get a good grip? You can get them in stainless steel, chrome, or enameled finishes. You can get finishes that match your other hardware. You can get brushed or knurled finishes to make it grippier when wet.

If you use a suction-mounted bar, don’t have the suction cups cross a tile grout line. The suction will not hold. Don’t place it on a plastic tub surround that is not firmly adherent to the wall. Remount it every time you use it, to be sure it is firmly adherent. They work best on solid surface (e.g. Corian) tub surrounds.

A towel rack is not a grab bar, nor is a curtain rod nor the handle on a shower door!

The hand-held shower shown above is a nice addition, simple to install, and inexpensive – or you can spend a ton of money for the aesthetic you want.

If you tire or tend to lose balance in the shower, a shower chair comes in handy. If you can’t step over the tub edge, a tub transfer bench fills the bill for a lot less money than removing the tub to install a shower or modifying the tub to a step-in model. Note that you can buy them a lot cheaper from a hardware store or drug store than from a medical supply store or a home health agency. I do not recommend falling in the bathroom, as there are no soft places to land.

Why should you listen to anything I just said? As a plumber (and before that, as maintenance director of a housing cooperative), I installed grab bars for a living. As an occupational therapist, I work with people who have been injured from falls and I work with them to make their homes safer. As an old person, this is not merely academic to me. As a bicyclist, I plan to stay healthy and keep riding for a long time.

Plumbum

Plumbers are called that because the Latin word for lead is “plumbum” (thus the atomic symbol Pb). Before my time, water lines were lead, because it is flexible. During my time, the joints in cast iron drain and waste pipes (the “DW” of “DWV” – vents are another story) were made of oakum (oil-impregnated hemp) and lead tamped into a hub. One pipe fit inside of the hub of the other and sat on the bottom of the hub. Once the joint was ½ filled with oakum (tamped in with a yarning iron), one melted lead in a crucible (or a ladle if using a small amount) and poured the molten lead into the joint over the oakum. After a few minutes to cool, one pounded the lead into the joint with a set of caulking irons (one beveled to match the inner edge of the hub, one beveled for the outer edge, and one flat for the middle). This was much of the craft of plumbing. If one had sense, one wore a respirator while melting lead. We also soldered copper tubing for vents and smaller drains, as well as all water lines.

Lead was removed from some solder years ago. When I was working it was still legal to use lead solder – 50% lead/50% tin) for drains but not for water. People used it because it melts at a lower temperature and is therefore easier to use in larger joints. Rather than take the chance of grabbing the wrong spool, I never used lead solder. (Also because lead in the environment is not a good thing, even if not being added to drinking water lines. In theory, lead in a soldered joint should not get into the water once in use. In a caulked waste line, it is even farther from the water.) Lead-free solder contains silver (and several other metals) and is more expensive. Don’t tell my boss I always used the high-priced spread.

It is a craft rapidly disappearing. My toilet was leaking. The toilet seals to the waste pipe with a wax ring. Usually, a slow drip that only occurs when (or just after) you flush the toilet is caused by a leaky wax ring. Replacing it is simple.

I pulled my toilet and found that the joint between the closet flange (the thing the toilet is bolted to) and the closet bend (the pipe that it attached to and which hauls away the waste) was, itself, loose and leaking. I pulled it off (which should not be possible) and found no lead or oakum in the joint. Some dried crud (which may have been old plumber’s putty – made for sealing the drain to the bottom of your sink, not for sealing a toilet drain) fell out. I was amazed that the toilet hadn’t leaked long before.

I no longer have access to a yarning iron, caulking irons, a ladle for lead. I don’t have lead and oakum lying around. This called for a plumber. But wait! Aren’t I a plumber? Not any more. One of the plumbers I called (a big service company) had no idea what I was talking about. Apparently the craft has died out in their firm. I found a guy who trained under an old friend of mine (a retired plumber my age) and he came to the rescue. (Truth be told, I called him first and he was busy for a couple weeks and advised calling the Big Guys.) The trade as I knew it is not dead yet.

Gluing together plastic drain tubing and snapping together plastic water lines are totally different skills than in my day when we soldered copper and poured lead joints in cast iron. (Okay – in new work I didn’t use lead. We used “No-hub” pipe which fastened with neoprene seals inside of a stainless steel collar applied with a torque wrench. We did still pour lead for repairs and setting toilets.) Damn! I must be old.

Probably more than you want to know about plumbing. If your eyes didn’t glaze over, thanks! We turn on the tap and assume water will come out. We flush the toilet and assume shit will disappear. We seldom think about the before and after. Just doin’ my part…I got stories would make your hair curl, but discretion is the better part of valor;)

“An excellent plumber is infinitely more admirable than an incompetent philosopher. The society which scorns excellence in plumbing because plumbing is a humble activity, and tolerates shoddiness in philosophy because it is an exalted activity, will have neither good plumbing nor good philosophy. Neither its pipes nor its theories will hold water.” John W. Gardner, in Excellence: Can we be equal and excellent too?

RIP Robert Marchand

I’m a little late hearing the news, but Robert Marchand has died at the age of 109. Marchand died, according to the Washington Post, on May 22, 2021.

From CapoVelo.com – Marchand sets the hour record.

I first heard of him when he set the Hour Record (distance riding a bike for one hour) for the >105 age group in 2017. After setting the record he said, “Now I’m waiting for a rival.” The Post says a coach told him to give up cycling in his youth because he was too small. He kept busy, as a truck driver in Venezuela, a logger in Canada, and a firefighter. He took up cycling again at age 68 and rode from Paris to Moscow at age 81 and set the 100km record in the over 100 age group. (Multiple sources include the same information word-for-word. The Post is credited because we saw it there first.)

Marchand, a longtime supporter of the French Communist Party, lived alone until last September when he moved into a senior facility. The director of the facility said he continued riding his exercise bike 20 minutes/day until the week before his death. His coach, Gerard Mistler, said he owed his longevity to a healthy lifestyle, eating a lot of fruits and vegetables, and enjoying wine and chocolate. (From GrandFondoGuide.com)

Bare Necessities

Growing up, I was taught that the necessities of life were food, clothing, and shelter. Going to work, I found those definitions changing. This is another story alluded to in an old post – “a story for another time”. Here we are, in another time.

So what are the bare necessities in my book, and how did I find them? My first full time job was in a restaurant – preparing food for people. My first “career” was in a grocery co-operative – providing basic food via the Willy Street Co-op. I was pretty sure food counted as a basic need.

After 10 years I left the co-op and moved to Northern California, where I was Maintenance Director (then Financial Manager and General Manager) of the Twin Pines Co-operative Community, a community of 79 families that jointly owned an 80-unit low-income housing co-operative (the 80th unit was a rental reserved for an employee and I was the sole renter for part of my time there). I learned that the Silicon Valley was not filled with Yuppies. Before it became the Silicon Valley, the Santa Clara Valley was The Valley of Heart’s Delight, a vast area of fruit orchards. Now I knew why the supply of apricots had dried up back when I was in the grocery biz – the orchards were being ripped out for factories, office buildings, and housing. (The apricot supply has since recovered somewhat.) There were people who worked in those factories and were the secretaries in those offices and who fixed the fancy cars of those over-priced engineers. They were the people I worked for, and they needed a place to live. Yup, housing made my list.

I’d always had a side job or two. While at Willy Street I was a volunteer programmer at WORT-FM, a listener-sponsored community radio station. I was a patient advocate at the Near East Side Community Health Center, and I was the local representative of FLOC (the Farm Labor Organizing Committee, a farmworkers union started in the tomato fields of Ohio – they later merged with the UFW). In California my side job involved co-operative housing in Nicaragua.

In Nicaragua I found that the Matagalpa River (where we cleaned up after a work day) was also where everyone did their laundry and drew their drinking water, as well as where towns discharged their raw sewage. We found a mountain spring, had the water tested, built a dam and a pipeline, and supplied pure water to the houses we were building. (Fred Colgan deserves the lion’s share of the credit for that.) While we weren’t big enough to set up a sewage treatment program, we dug outhouses so sewage from our little community would not go straight to the river.

When my second visa expired I moved to San Francisco and became a plumber (after a side trip for the Mole Poblano tour, o quiere decir La Vuelta de Mole Poblano). It was pretty clear that clean water and sewage treatment made the list of bare necessities, so I made my living doing that. I mostly did residential service work, but also some remodeling and work in bars and restaurants. I used to tell people that my job involved hanging out in gay bars at 9 o’clock in the morning.

Life being what it is (and a story that I probably won’t bother telling here unless shelter in place lasts a really long time), my plumbing career came to an end. I became a college student and then an occupational therapist. Before I became a patient, I had never heard of occupational therapy. My sister (a Speech and Language Pathologist) defined occupational therapists as the people who come up with a simple commonsense solution to a problem; a solution that seems obvious in retrospect. Then she’d realize that she hadn’t though of it. When people ask me what the difference between a physical and an occupational therapist is, I sometimes say the PT’s job is to make sure you can move around, and my job is to make sure you can do all the things you want to move around for. It is a job that varies widely depending on the setting you are working in; and the lines between what I do and what my PT partner does are sometimes pretty blurry. (If you really want to know the gritty details, I have a 13 hour online course for you. Someday I may be able to do it live again.)

I saw firsthand how much access to healthcare depends on money, and how the US, unlike most industrialized countries, lacks a healthcare system. (I work in a hospital that provides care to all regardless of ability to pay – but that doesn’t mean they don’t get billed later, and it clearly affects the care they get after discharge.) Other countries have a healthcare system. We have an insurance system. Healthcare was now clearly on my list of bare necessities.

A common thread running through these, and made clear by our shelter at home situation, is community. I realized I had found my personal definition of the bare necessities: food, housing, water and sewer, healthcare, and community. I hope my list is complete because I’m closer to 70 than to 60 and I probably don’t want to start another career now. I’d like to pretend I had the forethought 50 years ago to build a life based on the necessities and pretend that my life and career trajectory was planned. Never mind, I don’t even want to pretend that. This was a case of going where life led me, then looking back and seeing what the path looks like. Or, as Robert Hunter said:

There is a road, no simple highway, between the dawn and the dark of night…

Le Tour de France/La Vuelta a España/Il Giro d’Italia

The French tour has been postponed and is now scheduled from 29 August to 20 September. The Spanish tour is still scheduled from 14 August to 6 September, but there is talk of moving it to the fall. The Italian tour is being run in a virtual format and the real version may be moved to late fall. The World Championship is also scheduled in the same timeframe as the rescheduled tours.

I think the only answer to scheduling anything right now is “Who knows?” I know of one cycling event scheduled for June that is still scheduled and another in July that has already been canceled.

Stay safe out there…ride alone and enjoy the scenery.