Tuesday, December 20, 2011

In The Week Before Christmas

I questioned my patient's plan to move from northern Idaho to Colorado in the middle of winter, and near the ninth month of her first pregnancy.

"Joe found work down there, and we need to stay together," she explained. She seemed satisfied with her answer.

"What will happen if you go into labor in the middle of a Wyoming blizzard?" I asked gently. "Cars do break down sometimes, you know. If you must go, at least take the bus."

"Can't afford it until we get a paycheck. Anyway," she smiled at the rusty clunker parked outside my office window, "Joe just finished rebuilding the engine. And we'll carry a blanket. God'll get us there!"

The odds were strong against Jesus being born safely that night long ago, after a two-day journey from Nazareth. Mary must have had misgivings about the whole thing. Would a midwife be available? Or would the only one around be her husband? He was a good carpenter, but he didn't have much experience in assisting childbirth.

I think that perhaps we never have the right to demand miracles of God. But when there are no alternatives to taking risks, the knowledge that God is with us can sustain us in our endeavor. And God-directed endeavors can change the world.

(First written for "The Workplaces of Christmas"  1994, American Baptist National Ministries

Monday, October 24, 2011


I walked through the autumn leaves in the fall of 1950, toward my first day as a real medical student with a feeling of exultant expectation. Up till then, I had found that being a “pre-med” didn’t make as much impression as I would have liked. With girls, especially, the attitude seemed to be “Forget this one; he’ll be buried in the books for four more years.” But now my embryo medical career was finally on track. I had at least made it in through the door.
     Classes for first year medical students were all held in one building, across campus from my home. I joined seventy would-be doctors in the lecture auditorium that first day, all of us waiting with apprehension for the professor of anatomy to appear, who would rule our lives for the next five months. First semester in medical school covered only two subjects: Human Anatomy and Histology, which is anatomy viewed through a microscope.
     Dr. Phillip Armstrong was a deceptively bland man in his fifties, who made no effort to put us at ease. His aphorisms were memorable:
     “We will address you here as ‘Doctor’. For some of you, this will be the only time you will ever hear it applied to you.”
“Up until now, you have worked to achieve a well-rounded education. Here, we intend to flatten you out.”
     We spent that first day getting organized into working groups of four, and learning detailed instructions for the care and study of our cadavers. We took notes on everything; one nervous student even jotted down the professor’s “Good morning.” We entered the dissecting room that first afternoon, wondering what our reaction would be to studying the dead. We four, Onas Morgan, Tony Rivera, Tony Slivinski, and I, grouped ourselves around our dissecting table, and surveyed the motionless shape swathed in pungent, formaldehyde-soaked layers of sheeting beneath the yellow oil-cloth.
     Following the instructor’s directions, working one pair on each side, we laid bare the groin area and made a first incision along the inguinal ligament, surprised at the toughness of human skin, careful to go slowly and meticulously, exposing and identifying each nerve branch and blood vessel. We would spend most of the first week on the abdominal wall, laying open each muscle layer under the critical eyes of the instructors and Dr. Armstrong himself.
     Dissecting a dead person brought a feeling of awe, different from working with dead animals in my pre-med courses. All of us had a healthy fear of making a mistake in the work and earning Dr. Armstrong’s displeasure. Perhaps he kept us off-balance on purpose during these first uneasy encounters with death.
     “The name of the muscle is not pronounced ‘ili-op-soas’ as it is spelled,” he said. “Say ‘ilio-soas.’ The ‘p’ is silent. As in swimming.”
     Three students dropped out that first week. One fainted dead away. Another threw down his scalpel, cursing, and stalked out. We never saw him again. Rumor had it that the third decided to take his girl-friend’s advice to study pharmacy instead.
We compensated for our insecurity with a certain amount of dark humor. Medical students learn a large number of limericks and memory devices, ranging from the fate of nymphomaniacal Alice or the efficient young man from Bel-Air, to the names of the eight bones in the wrist or the sequence of the twelve cranial nerves.
     We four lab partners learned that our cadaver’s name had been Peter B_____, who had died in a state hospital of “old age.” Weeks later, deep in the abdomen, we found that undiagnosed urinary obstruction had destroyed his kidneys.
     A month after entering medical school, I had acute appendicitis. The operation went well, but spinal headaches from the anesthetic kept me on my back for a week. I still recall trying to study, holding the six-pound Gray’s Anatomy textbook on my sore abdomen. I also remember, when I was exhausted by the four-hour work sessions in the anatomy lab the following week, that even Dr. Armstrong had a compassionate streak. He stopped at my table to ask quietly how was I, and to tell me it was all right to take a rest break occasionally.
     We four, and most of the rest, survived that five months and the examination at the end. One of my tense friends panicked when the examiner thrust a skull at him, jabbed a finger at the large opening at the base and barked, “What goes through there!”
“Food!” the student blurted, then winced as he realized the answer should have been spinal cord. Our universal wish, we all agreed, was that we could repeat the whole course, now that we knew what we were supposed to be learning.
     We celebrated the end of anatomy the last weekend in January, a double milestone for me. That night I first met the girl I would marry.

Saturday, October 22, 2011

Nottingham High

from "Bridge Ahead, A Medical Memoir" copyright 2008 Keith Dahlberg

High school is a time of many changes for any teenager. Still more so, if the teenager is a dissident. And I was a pacifist, in the middle of World War II.
I felt strongly about this. I took my cues from my Dad, whose sermons from the pulpit were pro-people, but against all war. To him, peace did not mean merely absence of war. He believed war went against the word of God and solved very few issues. It did not mean that a Christian should be a weakling or a doormat. On the contrary, Christians are expected to be strong in order to help the oppressed, enslaved, or lost to find a personal relationship with God, and so far as possible help them find a way out of suffering and injustice.
As a young man at the time of the first World War, Dad at first had refused even to register for the draft. He finally registered as a conscientious objector, although the draft board would have allowed him a clergy exemption. He continued to preach against war during World War II, even while he ministered to the needs of two hundred service men and women among his congregation in Syracuse. The FBI had him on their list for a while; they listened to him preach, and questioned the church members, but never found anything to even suggest that he was seditious or unpatriotic. (Years later, I read their conclusion in the FBI's dossier on Dad, released under the Freedom of Information Act.) His congregation, in fact, highly respected him, even though many members had questions about his message.
During World War II, a pacifist teenager was hard for most of my classmates and teachers to figure out. Following Pearl Harbor, the whole nation had mobilized to the war effort. Buy war bonds. If you can't afford a bond, buy war stamps each week until you have enough for a bond. Turn in your aluminum cooking pots to build airplanes. Plant victory gardens. Save gas. Knit sweaters. Write the boys overseas. The time I spent at Boy Scout farm camp, in 1942, weeding cabbage fields and picking beans, was to help the national effort to raise more food, and I had no problem with that.
But I had a decision to make on my own in wood-shop class in junior high school. The whole class was assigned the project of making scale-model wooden airplanes, about five inches long, used for training aircraft spotters and gunners in instant recognition. To me, that was supporting war and I told the shop teacher, Mr. Pepper, that I couldn't do it. "I understand,was his gruff reply, but I don't think he ever really did.
It got worse in high school, during home-room period each day. Students were expected to buy at least one war savings stamp (twenty-five cents) each Friday. If even one student in the whole school did not do so, the school could not display the 100% banner on the flag pole that week. Nottingham High never got to fly the banner when I was a student. Some of my classmates resented this, although most adopted a neutral attitude. Things improved after about a year when the school held a Red Cross fund drive one day. I figured up what I had not invested in war stamps over the past months, and gave it to the Red Cross, possibly more than the rest of my home room combined. A hostile classmate accosted me one morning, "How come you can give to the Red Cross but not to the war effort?"
I told him the Red Cross healed people. I added that I wouldn’t get any savings
investment returned after the war, like he would from his war bonds. He didn't like that at all; I thought he might hit me, but I stood my ground. The class president and his girlfriend were standing nearby; both took my side and told the guy to back off. After their endorsement, things got better.
During 1945, the Baptist Youth Fellowship at church became active in drama. I had a bit-part in Elmer and the Love-Bug, found that I liked acting, and when a drama club at school presented Why I Am a Bachelor, I got the lead role, playing a misanthropic lecturer. It was a corny play, but the student body liked it. In looking back, perhaps part of its popularity was their opinion that the role fit me exactly.
In my senior year, I happened to have Miss Frederica Smith as my English teacher. "Sister Smith was a middle-aged, self-possessed soul in horn-rimmed glasses who believed in getting the whole class involved. After we had studied poetry and verse-making for two weeks, Miss Smith announced that, tomorrow being Valentine’s Day, each student would choose some character from literature and write an appropriate valentine to him or her. After making sure that the Bible was considered literature, I submitted my valentine, from Samson to Delilah, with a straight face:
All the while I’ve been making your people feel blue,
Though I’m fighting with thousands, yet think I of you.
I’ve torn city gates from their place in the wall,
But your icy cold heart I cannot move at all.
In times of distress I’ve relied on my brawn,
But that’s no help at all when to you I am drawn.
Of all the Philistines I think you’re most fair
But Baby, I can’t keep you out of my hair.

The class, Miss Smith included, burst into laughter. To my surprise, I was later elected senior-class poet based on this offering, and was invited to join the staff of the school newspaper, but I never wrote any more poems worth remembering.
The year went by quickly after that, and on June 24, 1946 graduation night came for 256 of us. Our principal, Harold Coon, was graduating too, moving up to a post in the school district headquarters downtown. There was the usual procession to Pomp and Circumstance, speeches, awards etc. My mind was chiefly on summer vacation; I would go directly from school to the railroad station and catch the night train west for my second summer of work at Green Lake, Wisconsin, along with one of my classmates.
I was startled out of my reverie by hearing my name called at the tail end of the athletic and citizenship award presentations. Mr. Coon announced that the class had voted me the one they would most like to represent them in life. I hadn’t known there was such an award, but it’s the one I would most like to have.

Wednesday, October 12, 2011

Front Halves of Horses Sent to Washington DC for Assembly

That was one of the guesses about what was being manufactured at the super-secret city of Oak Ridge, Tennessee back in the 1940s. The closely guarded production turned out to be purified Uranium-235 for the first atomic bombs, but in a back-handed way the earlier guess has been quoted as a paradigm for thought processes in the nation's capital.
This was reinforced in my hometown of Kellogg, Idaho back around 1984, when the Cold War and atomic bomb threats were often in the news. Someone in the national bureaucracy, pondering how to save citizens' lives in case of atomic attack thought "Mine tunnels!" The Silver Valley in northern Idaho has more than 200 miles of tunnels underground, thought to be enough to accommodate most of the population of the city of Spokane (seventy miles away, it's true, but they had a super-highway.) Accordingly, 200 cots and a few initial supplies of food and medicine arrived for storage in our local hospital against the day of holocaust.
The bureaucrat's thinking was not entirely off the wall. An atomic bomb hitting Fairchild Air Force Base (ten miles the other side of Spokane) might conceivably give citizens an hour or two to take shelter from the radioactive dust that would be borne on our usual westerly winds. And after three weeks underground, people might (we were told) be able to survive in the diminishing radioactivity. When Mount St. Helens had blown up, four years earlier, the volcanic dust did indeed reach Kellogg and beyond. The local miners noticed that it only penetrated the mine tunnels about 300 feet before adhering to the moist tunnel walls, and it was reasonable to suppose that radioactive dust from a bomb might behave in the same way. Anyway, some of us had enough interest in the topic to spend some of our days off evaluating the suitability of mines as fall-out shelters.
After getting permission from the mine companies, four of us - a fireman, a public health worker, an instructor from the mine rescue training school, and myself (a doctor) - formed the core of a crew to map the mines, We pre-supposed that in any atomic attack electric power would be gone, and the mine hoists and ventilation fans would not be operating. So only entry level, horizontal tunnels would be accessible. (Try climbing twenty flights of stairs, the distance between one mine level and the next, and see how your legs feel.) There would be no light or food except for what could be brought in or stored ahead of time.
There is natural air circulation in many mines, and a warm enough temperature. Our public health man tested various underground water sources and found some of them drinkable. Some had drainage ditches that would provide sanitation. The tunnel floors are rocky and wet, and many of the mines had nothing but a vertical shaft access. We checked out ten or fifteen mines. It wasn't until we saw our mine rescue expert casting worried glances at some of the rotting mine timbers in a long-abandoned tunnel that we decided we had explored enough.
The mines of Shoshone County, Idaho, those with horizontal access, drinkable water and breathable air, had enough room to accommodate perhaps 1,200 people, if food, medicines, and electric batteries were stored ahead of time and people did not mind the dark, damp, sometimes dangerous surroundings.
But as is often the case, bureaucrats in the nation's far-away capital city had no clue about conditions in mines. Nor did they realize how much preplanning, and checking the facts of the local situation, was needed to provide genuine safety for the people on site. Our bureaucrats took no further action.
When I told some of my patients about our study, showing room in the mine tunnels for only about one-tenth the local population, let let alone 250,000 Spokanites, they were philosophic. One told me:
"Well, that's okay, Doc. If the bomb ever drops and we can't dynamite the river bridge in time to keep the city folks out, I'll just sit on my front steps with a six-pack of beer, and watch the fireworks."

Thursday, July 28, 2011

Watchdogs versus "Government Interference"

Think about this a minute. You maybe have a burglar alarm at your business site, or a watchdog at your home. Military installations routinely post sentries. And most of us are familiar with airport security inspections. None of these guardians are violating Constitutional rights. You may not like the inconvenience, but few would dispute the need. That's because there are occasional people out there, whether citizens or aliens is irrelevant, who do not respect your property or your life.

So why is a watchdog agency such as the Federal Aviation Authority, or the Federal Drug Administration, or the Securities and Exchange Commission, or any of dozens of other government groups considered "interfering" when they blow a whistle on the shenanigans of Wall Street, or lax safety inspection, or executive greed?

Someone does need to blow a whistle when a smelter lets clouds of unfiltered lead dust billow out of the smokestack. Or when a drunk takes the wheel of a car. Or when a bank or insurance company risks its customers' investments by loaning billions of dollars to high risk enterprises.

When an industry persuades Congress that deregulation of pharmaceuticals, or neglecting building codes, or cutting taxes are in the public interest, there is often a thin line between good business practice and corruption.

When a physician, called about a patient, doesn't see the patient but orders some medicine over the phone, and then charges the patient's insurance a fee for doing an exam, "because he is taking the responsibility," he's getting pretty close to fraud. That's a nasty word, but sometimes it has to be said, and it is another large factor in the rising cost of medical care.

There are trade-offs. If the government is to repair highways, it must find funds to pay for the workers, the material, and the equipment. If there is obvious waste in a program, it doesn't make sense to let the money continue to bleed away while the work stands idle. Nor does it make sense to continue to borrow endlessly and let hundreds of billions of dollars go to pay interest on the debt. And it doesn't make sense for a First World nation to leave 15% of its citizens medically uninsured. This makes the taxpayer or those with insurance pay the cost for the visits of the uninsured.

What Government Could Do Better: One of the tasks of Congress is to create laws for public benefit. To leave no doubt of what the law means, Congress adds regulatory clauses, often to the extent of a thousand pages or more. That length creates a lot of doubts of its own. For one thing, I doubt that many lawmakers or their aides have read the whole thousand pages carefully enough to grasp their full meaning.

How about a two or three-page summary stating concisely the purpose and actions required by the act, to which the other 997 pages must conform? And if any don't conform, they must be revised until they do.

The public wants action to produce a medical care act that reduces waste, increases efficiency, and addresses the problems of 45 million uninsured citizens. Instead, both houses of Congress, and many agencies besides, jockey for a political agenda rather than addressing the merits and flaws of the act they are trying to put together. Such delays cost money. Endless catch phrases and frank misstatements of meaning, on TV ads and talk shows, don't get the job done.

Congress can't expect to mandate new standards of care without funding them. It is hypocrisy to say "no new taxes," while cutting federal funding, leaving the states to finance new federal laws through state taxes. And cutting funding for watchdog agencies would be reckless negligence.

This blog post is adapted from my book, "Access to Medical Care, Common Sense for Doctors, Patients, and the Public," © 2009 by Keith Dahlberg, MD; iUniverse, publisher.

Tuesday, July 26, 2011

Road Block Deadlock

All right, it's time to stop fixating on each party blocking the other party and work together to move the nation off the railroad tracks before the train comes along.

Okay, there have to be budget cuts, and yes, they must include parts of the major entitlement programs; I say that as a Democrat and beneficiary of Social Security and Medicare myself. Those who have no other income should not bear the burden, but those of us who do have other resources should not expect full benefits to go on increasing forever. Incremental reductions over several years need not be a disaster.

Republican spokespeople are fond of saying that new taxes destroy jobs. What do they think budget cuts do? I am told (today's Spokane Spokesman-Review editorial) that failure to renew the operating authority of the Federal Aviation Administration last week laid off 4,000 clerical workers, and that in turn halted construction work on the nation's airports and runways, suspending the jobs of the construction workers.

Hospital emergency rooms have been the last resort of the uninsured ill and injured. Now there is a movement afoot, already enacted into law in some states, to limit Medicaid patients to only three paid ER visits per year, with shared computer data bases to detect hospital-hopping. With unpaid ER visits increasing each year, hospitals have no other choice when their funding is cut, but what is the child with chronic severe asthma or any number of other maladies to do?

Yes, small businesses need reassurance that they can plan ahead on tax rates, etc., but the mega-corporations' profits are doing quite well, thank you, and they may have to struggle along, even without the tax loopholes and exclusions and subsidies to which they have been accustomed.

One big difference between President Obama's four trillion dollar debt reduction and the one trillion proposed by Mr. Boehner is the saving in annual interest costs. At six per cent, that extra three trillion cut saves l80 billion dollars per year. So, enough with the smokescreens already. Even the Congressional rookies will have to learn to sacrifice. It comes with the job.

Sunday, July 10, 2011

Solving the Nation's Fourteen Trillion Dollar Debt

I'm glad to see that the President and Congressional leaders appear to be getting closer to reality about lowering the national debt. At least, all sides now acknowledge that defaulting on the debt or endless raises in the debt limit are dead ends. I hope they will also see that cuts in spending and increases in revenue must both begin now, not two years or ten years down the line, if we are to retain our creditors' trust. Some suggestions where to start:

Social Security is one of America's biggest expense programs; I and tens of millions of other senior citizens depend on it for a major part of our old age income. My wife and I contributed to the fund for decades, and now our combined SS benefits are a little over 2,000 a month. We have about an equal amount of other, non-government income, and with our house and our children's college paid for, a modest reduction would not be a hardship for us, as it would be for some who depend on a 500 dollar benefit as their only income. Leave theirs intact, but many of us who are better off could make both Democrats and Republicans happy by accepting a few per cent reduction in our benefit, and a less generous tax break at income tax time. (Because of my low tax bracket, I am only taxed on about 30% of SS income.) You could call that last one either a spending cut or a tax increase, depending on your political view, but there is no doubt that applying it to upper-middle and upper class families translates into billions of dollars off the deficit annually.

Medicare is another big budget expense. My open-heart surgery at age 77 has given me five more years of active life so far, and I am grateful to both the program and to my surgeon, who may have accepted a reduced fee at Medicare rates. But I have a neighbor who also could have benefited from such expensive surgery; he had a heart attack, had to quit his physically active mining engineer job, lost his employer-funded insurance, and ran out of unemployment benefits. There are few new jobs for a fifty-five year old. Emergency rooms have to accept him even if he can't pay, but the ER has to charge over $1,000 per visit to the rest of us to make up for the 45,000,000 Americans like my neighbor whom no insurance company will accept.

Medicare is an even bigger problem than Social Security, because SS beneficiaries eventually die (and that's okay—I sure don't want to be kept alive on machines for months). Patients eventually die too, of course, but medical science keeps on growing, and growing more costly every year. New tests, new machines, new and vastly more expensive medicines come on market, and more training and knowledge is expected of doctors, nurses, technicians and therapists. No matter how rich the nation, there will come a point where there won't be enough funds to pay for all the medical inovations each year.

Some nations' medical systems deal with this problem by having waiting lines. Others have hospitals whose pharmacy shelves are empty before the end of the fiscal year. Still others simply let their people starve or die untreated. Call these methods rationing if you like, but eventually every nation must prioritize. America is to be congratulated on having a good public health system in general, with emphasis on prevention, immunization, and maternal and child health care as priorities

Doctors could share in the burden, too. During my fifty years of medical practice, many doctors would accept some patients that couldn't pay much, or could pay nothing at all. The doctors kept track of how much medicines cost, and prescribed generics when possible. And they listened to the patient first, before firing off orders for routine tests. Today many doctors prescribe with no idea of the cost.

Government could help. Everybody talks about simplifying tax forms, but it hasn't happened yet. I have always been a big fan of charitable gift deductions, but I bet most of us who support charities would continue our support even if only 50% of each gift were deductible instead of the more generous deduction of 50% of adjusted gross income. Hey, are you giving to help the needy or to help yourself?

As to complicated tax forms, consider Singapore, arguably the nation with the largest budget surplus (and one of the smallest populations) in the world. My son has lived there for years, making a well-paid living. He says it takes him only a half hour to fill out his Singapore income tax return, but takes days to do his US form. 'Nuf said.

Military costs are a big budget item too. Sometimes it's necessary to defend our nation, or to stop genocide as part of an international effort. I would like to think failed nations like Somalia and a few others have taught us we cannot police the whole world alone.

National debt interest payments of half a Trillion dollars are one of the biggest expenses we should learn to do without. Every trillion we reduce the debt this year means 60 billion dollars less interest we must pay next year (@ 6%.)

Millionaires and corporations, are you part of this nation or not? You need to contribute to debt reduction too.

Tuesday, June 28, 2011

Prospecting for Gold

Back in the 1930s, when gold was $36 an ounce, many people found it worthwhile to head for mountain streams with a shovel and a pan. It was harder physical work than some of the amateurs expected, and the icy water from melting snow was hard on those with arthritis, but if you were lucky, you could eke out a living. Nowadays, silver is worth $36, and as I write this, gold is getting $1,548 per ounce. What makes gold so valuable?
Well, inflation accounts for some of the price rise of course, but basically, people want it, and are willing to pay that high price. Can you eat it? No. Will it keep you warm? Nope; won't burn; and a blanket of it would be way too hard and heavy. But it has several other features that are unequalled by almost any other substance.
First, it is beautiful, not only as a symbol of wealth, but in itself. About half of new gold production is used in jewelry, especially in Asia. Second, gold is dependable. Even when inflation lowers the value of paper money, gold is usually accepted in exchange for goods. About one sixth of gold production is stored in government vaults like Fort Knox ,or the Federal Reserve in Manhattan, which also holds funds in trust for other nations. Another sixth of the annual gold production is held by private investors. Thirdly, gold has industrial uses. Silver and copper are better electric conductors than gold, but they tarnish..Gold never tarnishes or corrodes. Plating switch contacts in computers and other electronic devices with a very thin layer of gold prolongs the life of the device.
For all these reasons, gold continues to be in demand. Most gold nowadays is produced, not by lonely prospectors with gold pan and pick, but by international corporations employing thousands of men and women. As recently as five years ago South Africa was the world leader in gold production, but its gold mostly lies two to four kilometers below the surface, and is therefore expensive to mine. Recently China took first place with 320,000 kilograms mined in 2009. Australia, South Africa, United States, and Russia were all nearly tied for second place with a little over 200,000 kg apiece. Most of USA's gold nowadays comes not from California or Colorado, but from Nevada, with Alaska next.
Papua New Guinea is rising through the ranks of gold producers, being number12 in 2009, but may soon be number 6 if some of its new projects are successful. A Canadian company working in PNG is pioneering the first deep water gold mine, Solwara 1. There, a mile below the ocean surface, the top of an undersea mountain is covered by a hundred-feet-thick layer of copper and gold-bearing silt deposited from a natural hot water vent spewing a black plume of mineral matter. (think of it as a baby volcano.) Nautilus Minerals Corporation believes it can pump this sediment up through a pipe, dry it aboard ship and haul it by the barge-load to the town of Rabaul, 70 kilometers away for further refining. And a former Nautilus executive is now leading a similar project deep in the Red Sea off Saudi Arabia.
Pumping sediment or gravel off the ocean floor appears to be much less polluting than on-shore mining. Any initial residue can be laid down on the ocean floor again No blasting is involved, no sludging of rivers and flooding of rice fields. Presumably little or no toxic waste deposited at the site (though it will ultimately have to go somewhere.)
But there must be precautions taken. There are hundreds of such sea vents in the dark deeps, home to strange life forms which don't depend on sunlight or chlorophyll, but live on the sulfides and other minerals from the vent. No one has thoroughly studied these plants and creatures yet; no one knows what medicines or other products they might produce. We must not carelessly damage their environment, even if it can be shown that they can migrate on deep ocean currents to other hot, nourishing sea vents hundreds of miles away.
Nor should we endanger fish and other dwellers nearer the surface by polluting rivers with sludge, cyanide, mercury, acids and other toxic products used to refine gold and other minerals we extract. A great many people's jobs and income depend on wildlife, forests, and tourist industries. Jobs and income from mines and and oil wells are also important, but must be balanced against those from co-existing industries.
As an example, a huge deposit of copper and gold in Alaska lies at the root of the Aleutian Peninsula, near the shores of Iliamna Lake and the rivers that drain into the Pacific Ocean's Bristol Bay, the center of Alaska's salmon fishing industry. Two mining corporations, Rio Tinto and Anglo-American, are proposing a 2 mile-wide, 2000 feet deep open pit mine, with 80-foot high dams to contain waste products. They have not reassured anyone about plans to use cyanide or other toxins in the refining process; they reportedly only say they are "considering" the matter.
When genuine and legitimate conflict arises among two industries like mining and fishing, the average wage earner can't compete with the resources behind the big company executives and lawyers. The only ones with clout enough to assure that proper precautions are taken are government watchdogs. I will have to amit I don't really like the arrogance (and sometimes incompetence) of some bureaucrats, but neither do I like the arrogance and greed of some big businesses.
I practiced medicine for thirty-five years in Idaho's "Silver Valley" mining towns. Some mine accidents are inevitable, but others are preventable. In 1972, ninety-one miners died of monoxide poisoning in an underground mine fire for which management was unprepared. No one thought it could happen. A few years later, the filter system in the lead smelter was accidentally destroyed. It could have been repaired by shutting down the smelter for a few days, but management decided (deliberately, the jury found) to ignore the danger to the surrounding towns and run operations without filtering the lead from the smokestack. The lawsuits over the next few decades have cost management over one billion dollars. Corporate CEOs sometimes make huge errors, that cannot later be corrected. That is why public authorities must sometimes step in and say. "Thoroughly study the effect on the environment and local economy first." There are other values besides gold.

Monday, February 14, 2011

Book Signing


I was down in Richland, WA, house sitting and cat sitting for my daughter while she was away,and using the time to sell a few books to the local libraries and bookstores. I hadn't made major plans in advance, but usually carry a dozen-or-so assorted copies of my books in the car when traveling.
Talking with the book department supervisor in a local franchise of a regional chain, I showed her my latest novel, The Samana Incident, and its companion novel, Flame Tree, and asked if she'd like to carry a few of each in stock.
"Glad to," she replied; "we can arrange a book signing too, if you like." This took me by surprise. Store managers aren't usually that receptive to authors wandering in off the street, even if they can reasonably be featured as a local or regional author. Maybe her budget is better at the beginning of a new year.
"When's your busiest customer load?" I asked.
"Probably Friday, four to seven. People are getting off work then, and it's payday for a lot of them."
"I'll be here. I have a few copies of my other books with me, too. Can I sell them?"
"Sure. But I'll have to make a separate inventory contract for each one. Fill out these forms, and then leave the books here. You get 60%, we get 40."
My publisher takes 50%, but even the remaining 10% of the 60 nets me about a dollar-fifty per copy, and there is always the possibility of more business later on in other branches of the bookstore chain.

Friday, at ten to four, my wife and I checked in. The manager had set up a table facing the entry doors, with all my books arranged. But wait a minute; where were the copies of Flame Tree?
"I'm sorry. Our major wholesaler already has that one available in their list. We would have to order through them." She handed my six copies of Flame Tree back to me..
"Can I give these six to my wife and have her sell them out of my car in the parking lot?" I asked.
"You can do whatever you like as long as it's not inside the store" I didn't know what her boss might think of that idea, but I took her at her word, and stationed my wife in the car and myself at the book table.
Bookstores provide authors with a chair, but I've found it better to spend most of the time standing and making eye contact with approaching people. (Guys, if a man and woman enter together, eye the man. His wife/girlfriend will likely express interest too, if he stops., and you avoid the risk of irritating the man by eying his girl. My greeting is not "Would you like to buy one my books," but "Do you like a good story?"
The potential customer may pick up a book and/or say "About what?" Some, of course, will just pass by, perhaps with a smile of brief greeting, or with eyes averted. That's okay; Some do stop. I try to answer with no more than a sentence or two for each one they seem interested in. I think it helps to have all five displayed - if an author has that many titles to offer, most people assume he can write.
The first to approach me that night was a boy who couldn't have been more than eleven or twelve. After looking over my table, he asked "Did you write these?"
"Yes I did."
"I've written a book too," he said.
"Have you? What's its name?"
"Pulling Weeds to Picking Stocks." he said. Seeing me take out a notepad, he offered "Here, I'll write down my website." Talking about this experience to the store manager later, she told me, "Oh yes, I know him; he did a book signing for us not long ago."
I have learned that I can't tell much about book readers from their appearance. Three grungily dressed teenagers eyed my table from a distance for a short while and then came up and looked at the books. "You a doctor? That's cool." They muttered among themselves for a while, and it turned out that hadn't enough money among them to buy a book. But they reappeared after a few minutes and chose the least expensive Access to Medical Care, for $8.95.
I thanked them, and offered to autograph it. "How shall I sign it"
"We're a musical group. You can sign it to Pigeon Fist."
They spelled it out. So I signed the book "To Pigeon Fist" and my name. Who knows? maybe one or more of them are headed for medical school.
One thirty-something man with a dirty T-shirt over a large abdomen, was apparently just off work. I asked him what kind of story interested him. "Oh, music." What kind? Rock. I didn't have anything to fit that, but he bought a book anyway.
A young couple took a copy of Samana, and after I told them it was a sequel to Flame Tree, wanted that too. I think they were more intrigued by buying a copy out of a car in the parking lot, but my wife said later that yes, they came out and bought one.
Others bought out of interest in the stories or because they worked at the nearby hospital, or just seemed to be looking for something, I - and maybe they - didn't know what.
With a final purchase of two books by a lady at one minute to seven, table was bare, every copy of every book sold (except Flame Tree out in the car.)
The manager wanted five more copies of each, but shipping them would shave away my narrow 10% profit. Never mind, she said, I could send them with my daughter next time she comes home.