Further reflections on a U2 concert, Pittsburgh, 6-7-17

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There’s something about the energy of a world-class rock band playing to a throbbing throng of 40,000 people in a stadium. It’s infectious and a rare opportunity to people watch.

So it was with the Irish band U2 Wednesday night at Heinz Field in Pittsburgh. Normally, I would watch them on TV to avoid the obligatory expense and congestion of getting to and from such a huge venue, but the first on-stage performance of The Joshua Tree piqued my interest. It is the 30th anniversary of the time I saw them perform it last in 1987.

It was in Indianapolis and I happened to be there visiting family. I had had just started my career as a junior attending at St. Francis at the time. The event was at the then Market Square Arena that I think might have held about 15,000 souls. U2 was not nearly as famous as they are now and the event was not sold out. I had a good seat.

As a personal aside, at the end of the concert when the lights came up, I happened to turn to face a kid sitting next to me and we caught each other’s eye for a moment. I was 44 years old starting my life and he couldn’t have been more than 18 starting his. We silently connected for a moment, smiled at each other and went on our way. I thought about that encounter all the way home in my car, ultimately to pull out a sheet of paper & pen and write a hasty poem about the encounter, I will provide at the end of this missive for anyone interested.

I loved that album and still do. I think The Joshua Tree is among the top collections of incredible music ever put on vinyl. It transformed a post-punk U2 to a world-class phenomenon where they reside today, but they never matched that album again. U2 is a very unique band if for no other reason that they continue to like and respect each other from the time they started playing together in high school in Dublin. That’s VERY unusual. The never lost the focus that made them great.

But at age 57, the heart and soul of U2, Bono (Paul Hewson) is getting a little long in the tooth for these kinds of gigs. These days, he’s more of a full time social and political activist. He’s always been that way but nowadays, he has a lot more money to plug into it. They’ve been doing this for a long time, not as long as the Rolling Uglies, but long enough to where it’s getting just a little strained. I think that the Foo Fighters, only a few years younger, have ascended to that rarified air maybe gently pushing at them. But, all that aside, so begins my many complaints with this gig.

Firstly, it was expensive. Very expensive to get seats where much can actually be seen live. That’s just the way it is for stadium performances of any stripe. The closer to the podium, the more expensive it got. I was willing to sport for this expense because I really wanted to “see” the band. So perusing the seating map of Heinz field, I selected two seats that would be to the side, closely visualizing the stage at about a 45 degree angle, halfway up. Perfect vantage according to the map.

Then came parking. Oh, you want to park? Maybe somewhere less than a mile from the stadium? Well, those spots are “available” at exponentially increasing prices. So more money outlay, all pretty smoothly from StubHub by the way. Legalized scalping but necessary to get any efficiency in a huge congested area.

Safety measures at the arena were in place of course. No purses over a few inches in length. No full sized cameras. Metal detectors for all. iPhones OK. Close observation of everyone entering. However, once inside, I didn’t see any police. The stadium is exceptionally well laid out, with plenty of bathrooms and food between every entrance to the seating area. A hot dog and small coke $11.25.

Once in the seating area, I found that the stage had been moved forward significantly from where it was supposed to be on the previous map. From my vantage, I was looking at the stage from a 90-degree angle, unable to see the huge screen behind them. The actual performing area was far enough away that no details could be made out. The promoters should NEVER have allowed these seats to be sold, and there were only a few there. No one to my right, even further out. These were terrible seats.

Then to add insult to injury, when the band emerged at about 9 pm, they played their first set from a “B Stage” on the opposite side of the field!! It might as well have been an ant colony from where I was. The people had had less expensive seats on the other side of the field had incredible views and the “standees” were right next to the stage. I was furious. The band should never have allowed this insult to those on the opposite side of the field.

They did eventually move to the center stage to play the Joshua Tree standards but they weren’t playing them the way they were on the album and I know every note on the album. It’s probably impossible to play a complex studio album live anyway but it wasn’t the same and it showed. I was disappointed. The iconic song “Streets with no name” was done much, much better in 2009. Please watch it all the way through. It’s spellbinding.

https://www.youtube.com/watch?v=GzZWSrr5wFI

The musicology of the band was pretty well preserved. Bono hit the high notes pretty well, better than Roger Daltrey I think. The Edge (Dave Evans) played masterfully from his guitar effects rig, as complex as a Boeing 747 dashboard. Bass player Adam Clayton was typically reserved. But the really interesting observation was the drummer Larry Mullen Jr. He was the hardest working man on the stage. He was amazing, in constant motion, working all of the skins to perfection. Neal Pert of Rush is considered a “greater” drummer but he has a stage full of drum kit completely surrounding him. Mullin has a “standard” kit and he uses all of it to perfection.

Here’s a passable previous performance of my favorite song off the album: “One Tree Hill”, not as good as the vinyl but showing off the entire band. This is a truly great song; one of the songs that made them stars, I think.

https://www.youtube.com/watch?v=VrlmhnBlH0Q

All things considered, I was very disappointed. I think the band is losing its musical edge as Bono spouts some of his political displeasure from the stage and increasing pyrotechnics slowly displaces intricacy. I paid a lot for really crummy seats that the promoters knew were crummy when they sold them. The band favored one side of the arena, stiffing the other side. They surely must have known this in advance.

I give this event a miserable one and a half of five bright lights. Be very careful before you buy tickets to this event. Find out more about seating before you lay a lot of money out.

REFLECTIONS AT A U-2 CONCERT

“Warily we fix each other,
this testament to my immortality and I.
All of fifteen, a shock of blond hair,
jacket collar insouciantly upturned.
I stand a paradox to him.

Similar in garb, but with an air of cynicism
born of war and pestilence,
The burden of human life balanced upon my fragile whims,
and having been to a county fair or two.

When I became a man, I did not put aside childish things.
He weighs this curiosity in silence,
portending a specter of myself in another lifetime,
for now an intruder in his world.

The band dispenses promises of hope and fulfillment;
deafening undercurrents finding common ground within us,
plucking his imagination as it once did mine.
But that was another time, another world.

I thoughtfully study technical nuances.
He conjures revelations of peace and love from nonsense,
and eyes me with curiosity
and rejoins me with an unexpected smile.

Behold my apocalypse,
this child, father to the man, prophesy yet to be fulfilled,
destined to go forth into the darkness, as I have done,
and keep the candle burning”.

David Crippen, MD, FCCM
Professor Emeritus
University of Pittsburgh (Ret)

The Crippen visit Alaska (May, 2017)

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We had decided to visit the Alaska coast and glaciers before global warming melted it all. Much of it is only accessible by either aircraft or boat, so a formal “cruise” seemed to be the best way to see it all in comfort. There are many of them registered in several countries; we chose the “Princess” line for no particular reason, and for the most part it worked well for us. I’m told that most other lines are similar and they all plod the same route.

I’ve already mentioned the nightmare of having to get into Canada through the monstrously huge port of Vancouver, standing for hours, then standing for hours again getting back into the USA to get on the ship. Then came the comical x-raying of all luggage entering the ship looking for any form of alcohol (they discard it).

Yes, no one can bring any alcohol aboard. They sell it to you at a tidy profit, along with any other form of liquid other than water and coffee or tea. Every can of coke, mixed drink, glass of wine, cup of hot chocolate must be individually signed off against your tab and it piles up quickly. I must say an extremely irritating nickel & dimeing for their profit margin.

Otherwise, the stateroom was quite comfortable and accommodating. Each has a private deck overlooking the water. A TV set with a pretty lousy array of programming. Internet access was satellite and expensive, 69 cents a minute and each minute trying to connect to the system was counted. I spent ten minutes waiting (and paying) before I figured out the system was too slow to work.

The ship was a huge, Leviathan-like beast that cruised along about 16 knots or so but was big enough that seasickness wasn’t an issue. All the logistics of moving about the ship were flawless. No standing in line anywhere. There were multiple restaurants of all types, the food was excellent and there was a lot of it. All kinds of things, art shows, live entertainment, lectures by experts in various things, exhibits. There was plenty of room on various decks to lounge around. The staff were all very kind and accommodating.

First stop was Ketchikan, Alaska where we had arranged a seaplane flight up into the rain forest fiords. This was an interesting trip but the pilot was particularly interesting. The woman bush pilot that owned and flew the plane originally came from Nebraska to visit and she stayed. She started out with a light Cessna 172 carrying people around, then graduated to a more powerful 182 then finally she ended up with an old but venerable 1959 de Havilland Beaver, the classic work horse of Alaskan bush pilots.

This beast has a rotary piston engine, can take off and land in short distances and carry a lot of weight (see photo in my youtube presentation at the end). We had a great flight into the wild and I got some good photos. No way to see any of this except by air. No roads at all.

This gal exemplifies “fiercely independent” doing it all her way all the way. She’s in her 50s now, flying since she was 16 years old. But she’s worried about her future. This (and most of the other) aircraft use 100-octane low-lead aviation gasoline, which is expensive. The maker of that fuel isn’t making enough profit and so they’re threatening to quit making it, which will bring most of these kinds of aircraft to a halt.

Also, 9 pistons in a rotary fashion move the unique crankshaft of this engine and it needs to be re-built every so often as there are a lot of stresses on it. These planes are getting old and are disappearing as they age. The numbers of serviceable crankshafts are slowly disappearing and no new ones are being made. This aircraft could die on the vine in time. They’re already expensive to maintain, around US$100,000 a year for an aircraft that costs half a million dollars to buy To convert to a turbine engine probably a million $.

Speaking of aircraft in Alaska, only about 10% of the flying pilots have a “real” pilot’s license. There are a lot of pilots. 90% of the state is wilderness only approachable by air. There are no four-lane interstates in Alaska and few roads. Driving into any of the airports, there are hundreds of small aircraft, many on pontoons that can cost US$10,000 for a set. One of the favorites is the venerable Cessna “Super-cub” an extremely light plane that can take off and land in very small fields. When fitted with oversized super-fat tires, it can take off and land virtually anywhere in the bush. Cost US$4000 per tire. Slots for pontoon craft at one of the connecting lakes near Juneau are a 15 year wait to get one, sort of like Pittsburgh Steelers season seats.

In Juneau we boarded a helicopter to go out and view one of the big glaciers, then actually land on it and walk around with a lecture for about 30 minutes. It was a fascinating experience and none of this could have been seen by any other than air transportation. Photos later.

Ultimately the ship entered a large fiord where at the end of it several glaciers emptied into the water. It was deep water so the entire ship turned 360 degrees twice, affording spectacular views of the glaciers from any spot on the ship. The weather was perfect, cool, clear and blue sky.

The glaciers were stunning, but in the middle of the pack lay one particularly large glacier that didn’t look like one. It was pointed out as a glacier “in trouble” as it wasn’t moving. Normally they advance in the winter and recede in the summer. This one receded and then just stopped like a dying star. Just a flat line of rocks. Maybe the fate of all of them eventually as global warming takes its course.

So, if any of you are thinking of taking this trip, here are the pros and cons:

Pro: The trip is not terribly expensive as 6-day full service tourist trips go. The logistics of the trip are well thought out and very smooth. I think probably cheaper than Disney World with no standing in line, a deal breaker for Disney. The accommodations are very nice and roomy, the food is excellent, there’s a lot to do and see on the ship, seasickness is rare and the sights are spectacular. The logistics of coming and going in ports are flawless.

There are lots of side trips at each port, mostly air trips that we enjoyed. You can also go out with a musher on a dog sled trip and do some hiking, small boating and similar athletic things in the area. The cities ported are amenable to “walking around” and some of the local handcrafts are excellent quality and real art, not cheap tourist junk. Food is good on shore. Photographic opportunities are excellent.

Cons: Flying from Pittsburgh to Vancouver is a long trip. Getting into Vancouver, through Canadian customs, then back through USA customs just to board the ship is a terrible, exhausting trial. I guess technically that’s how it needs to be done. Once on the ship, the only nickel & dimeing is for drinks of any kind. Mainly for any kind of liquid other than water and coffee. Want a glass of wine at dinner or a glass of Coke? Sign here first. I found that extremely irritating. Otherwise passengers are quickly made comfortable.

The Anchorage International Airport is rudimentary by most standards, and for unclear reasons, most flights depart from 9 pm to 2 am daily. Since most ships dock at 8 am on the day of home departure, you’ll get to sit around somewhere all day and most of the evening before departing out on a red-eye. Quite irritating. This is an overbite trip but Delta doesn’t treat it like an intercontinental voyage so seats in first class go back about three inches. I can’t sleep that way so I completed a full book read all night long while my wife sawed logs next to me. I think women can sleep anywhere.

Everything considered, I definitely do recommend this trip as the benefits outweighed the detriments. The sightseeing possibilities are diverse and always interesting (not cheap but affordable). Very much OK for kids to enjoy. I can honestly give this trip 3 of 5 spinning ships. I’d give it 3.5 but the extra half-ship would sink. Probably a once in a lifetime for most. See it before it all melts, I think. I would take this trip before going to Disney World in a heartbeat.

Here are some of my photos I’ve made into youtube. It’s high resolution so you can watch full screen:

https://www.youtube.com/watch?v=HsrDEtSrowc

The CODES: Old and New

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The CODES: Old and New

picture-clippingThe CODES have been playing together for over 10 years. First gig was for a Neurocritical Care Society banquet, November 2006 in Baltimore. We had no equipment other than personal instruments, so we hired another local band “Rockgut” to set up their stuff and let us play as their opener. We created and gave away “Codes t shirts” to anyone wanting one at the gig. I still have mine. We weren’t very good but we had limited time to practice. We got better.

Since then we’ve put out a CD in 2009 and I wrote a coffee table picture book of the photographs taken of us through the years.

https://www.amazon.com/CODES-David-Crippen/dp/1364974150/ref=sr_1_21?ie=UTF8&qid=1488045444&sr=8-21&keywords=David+Crippen

Over the years we’ve played for various medical meeting banquets all over the country, several House of Blues venues, an SCCM symposium, a sleazy back street bar in New Orleans, a Texas Juke Joint and private invites. We opened for a great metal band in Germany and played for a meeting in Manchester, UK.

We were never a band that traded on four doctors playing novelty stuff. Our set list consisted of what used to be called “soft rock”, even “classic rock”. Very listenable covers of numerous famous hits from the 60s, 70s and 80s mostly, I think. We became fairly serious musicians and knew our way around technical arrangements.

https://www.youtube.com/watch?v=NYo6QbKKgBQ

But we started getting older through the years and the lives of each member inevitably changed. There were job changes, marital changes, sick kids and limited time to practice as we all lived in different cities. I’m 73 years of age. I haven’t looked at their drivers licenses lately but I’m pretty sure the rest of the group are at or near their 50s now. We’re changing with the times, but in a rather unusual way for our idiom.

We’ve embraced and absorbed a much younger member into the CODES. That would be Dr. Mohan Kottapally, currently assistant Professor of Neurology at the University of Miami heath center in Miami, Fla.

http://uhealthsportsmedicine.com/sports-medicine-team/mohan-kottapally-md

This addition has fomented a fairly radical change for us. It’s pushed toward a much harder edged musical direction.

Mohan is one of those charismatic guys with a stage presence that has changed the way audiences view us. I see his style as a bit of of Prince, I think. He interacts in that manner with the audience, very aggressively. He is in constant motion, flaunting and vaunting. He’s an excellent guitarist; I think a world-class rock lead singer and the woods ain’t full of ‘em. I think we’re lucky to find him and he has changed our world.

He has made my role in the band easier as my age advances and generalized arthritis and deteriorating physicality takes its toll. I can do lead guitar and I have done it in the past but it’s harder for me now, just like you can be sure it is for Eddie Van Halen. The most important base of a rock band pyramid is the drummer, followed by the bass line, then the rhythm. The fingers don’t fly like they used to, but I’m still an OK guitarist and I can definitely hold down a needed and necessary serviceable rhythm floor.

So we decided to re-invent ourselves as a much more modern band, discarding a lot of the material we’d played for years in favor of new material. That material became much more what I would call “hard edged rock”. Not metal or especially death metal, as most of that is simply a cacophony of high volume din that renders the listener eventually hearing impaired.

“Hard-edged rock” is loud but much more technical in its arrangement, a little unusual for guys of our generation to be playing. A lot of it is lead guitar driven which brings me to the subject of one of our songs now. That would be, of course, a hard-edged classic if there ever was one: Sweet Child O’ Mine” (Guns & Roses, 1987). An insane initial lead guitar solo that is said by many critics to have changed the face of Rock drives this song. Check out the lead intro in this amazing music:

https://www.youtube.com/watch?v=1w7OgIMMRc4

CODES lead guitarist Gary Bernardini must have played with effects pedals for weeks before he got the tone nailed down, and it definitely works. Mohan can definitely do Axl. This is an amazing song for us as a band. I was surprised to see how many in our crowd instantly recognized this song and responded vividly to it. Many were kicking the slats of their playpens in 1987. Of course, Guns & Roses, being the volatile mixture they were, imploded after a fairly short period of time.

We played as the headliners for the International Stroke Conference in Houston, Texas on February 22, for a very large group of I believe as many as 300 people. Standing room only in a very big auditorium. We had a huge stage with professional sound technicians doing the auditory honors. We played three full sets over four hours, starting at about 8:30 pm and ending at 12:30 am. Between sets there was a DJ playing songs off his computer, and an “ice sculpture artist” that really entertained the crowd by forming a detailed cowboy boot from two big chunks of ice.

I put together a bit of a slide show to tell some things about The CODES, old and new.

https://www.youtube.com/watch?v=fxAIbVyPBBc

Make sure you tick off the High Def option and it’s best watchable on full screen.

 

 

 

On Suicide…..assisted or otherwise

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originalRecall that in England, back in the day, it was technically illegal to commit suicide. Actually the English cared nothing about whether they offed themselves, it just gave them a chance to confiscate their property. This from the guys that shipped the Irish to America because it was cheaper than feeding them during the potato famine and shipped social undesirables to Australia simply to get rid of them.

Taking one’s life in America is not technically illegal, but very, very unfashionable. Any unsuccessful attempt landed the individual in a position of “substituted judgement” where they can land in an emergency department or a psychiatric facility with no civil rights until they “get their mind right”.

https://www.youtube.com/watch?v=8CBqjZX6FjE

Suicidal ideation has been a marker for “incompetence” to understand that “life”is always better than death” (italics mine), and choosing death for whatever reasons is a marker for “involuntary treatment” to get the afflicted person to understand that reality. After treatment, the afflicted person has their mind right and voluntarily chooses life because they have come to understand it’s always preferable.

However, as I mentioned in my previous missives about aging musicians and others choosing death, those rationales are different than endogenous depression. They feel they lived what they wanted to and after the blaze of their streak across the sky extinguishes, they no longer have any desire to live in the new world. That’s a different thing, and we’ll see much more of it as there are a LOT of persons out there (much of it because of the baby boom) that are out of the loop and life in the new loop doesn’t work. That said, many are prosperous in their 70s (Paul McCartney, Neil Young et al). But there are a LOT of their ilk out there that no one hears from till their obit appears.

29906170001_3726240352001_video-still-for-video-3726115417001Now, in the new millennium, a whole different agenda for suicide is appearing, that of terminally ill persons that aren’t quite bad off enough for traditional hospice but definitely suffering with no respite. The classic example that has been brought up is that of Robin Williams, deciding to cope “his way” with progressive Lewy Body Dementia, a particularly cruel, progressive disease that doesn’t spare the victim any misery

https://en.wikipedia.org/wiki/Dementia_with_Lewy_bodies

Again, traditionally, the best course for many is hospice where suffering can be alleviated by a titrated treatment plan. But Hospice is usually thought of as an end stage remedy, when it’s “time to die”. Because of our ability to “prolong life” by a high intensity clinical care program, we’re lengthening the distance between ambulatory, functional suffering and the “death spiral”. As this distance increases, suffering persons want the legal and moral ability to decide when they’ve had enough, and that time may come before the “death spiral”.

More people are now deciding it should be their call as to when to end their suffering, but the nuts & bolts on how to accomplish that goal remain murky. The way out for some of these afflicted is sometimes painful and uncomfortable. Death by hanging or shooting. Robin should not have had to hang himself when he decided his time was up. He should have received “humane” treatment by someone that cared enough about him to respect his wishes and that he was competent to express those wishes.

This will inevitably become a legal issue, the reciprocal of the issue of a woman controlling what goes on within her own body, a firestorm that’s on the way. There are a few States that allow physicians to assist in a suicide and as far as I can see, those plans work well and are not misused. I think it’s time for us as physicians to start looking at this issue through the lens of the new millennium. It’s isn’t our father’s world anymore.

A great many of us are aging reasonably well but the specter of “not so well” is always shadowing us. At age 73 I’m still doing pretty much everything I want to do, albeit a bit more clumsily but I still feel the same passions I felt in my 20s. I’m working pretty hard to maintain my physical strength to match my expectations for as long as I can. But the day will come when I will not function as I desire due to progressive age and God knows what other disease that could grasp me.

When that day comes and I’ve hopefully reached the bottom of my bucket list, I could deal with lying around in a personal care home for a while, photos of glory days on the wall, with a cable TV and a laptop to keep up with what’s happening in the world. If the day came where I was a burden to anyone, was uncomfortable and unable to get around, I have a hidden stash of sixty tabs of 10 mg Propranolol and ninety 10 mg Ambien tabs. I might very well decide when it’s right to exit stage left, and you know me, I’m neurotically maintaining notebooks of virtually everything I’ve ever done in my life so those that come after me will get a chance to know me.

Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.

Though wise men at their end know dark is right,
Because their words had forked no lightning they
Do not go gentle into that good night.

Good men, the last wave by, crying how bright
Their frail deeds might have danced in a green bay,
Rage, rage against the dying of the light.

Wild men who caught and sang the sun in flight,
And learn, too late, they grieved it on its way,
Do not go gentle into that good night.

Grave men, near death, who see with blinding sight
Blind eyes could blaze like meteors and be gay,
Rage, rage against the dying of the light.

                  Dylan Thomas (1952)

David Crippen, MD, FCCM
Professor Emeritus
University of Pittsburgh (Ret)

A passing: Butch Trucks (Allman Bros Band) Jan 24, 2017

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170125-butch-trucks-2005_f1bdfd6a8199b71fad90385f71f2d1e6-nbcnews-ux-2880-1000Sadly, another rock musician now taking his own life: Allman Brothers Band Percussionist Butch Trucks, age 69.

http://www.syracuse.com/entertainment/index.ssf/2017/02/police_death_of_allman_brothers_drummer_butch_trucks_was_suicide.html

The Allman Bros were legends in their own time and continue to be important for the history of rock. One of the most influential bands in rock history. Butch was there from the beginning in 1969.

They lived fast, peaked early and died young. They headlined one of the biggest outdoor rock concerts in history (Atlanta International Pop Festival, 1970). Crowd estimates range as high as 600,000. Their album “Live at the Fillmore” continues to be one of the classics of all time, Rolling stone lists it as #49 in the top rock albums.

24-year-old Duane Allman died in a motorcycle crash in Macon, Georgia in 1971, bassist Berry Oakley, age 24 followed in another bike crash a year later four blocks from where Duane lost his life. Brother Gregg Allman carried on with various iterations of the band until finally calling it quits in 2014. But the band was never the same, essentially playing the same material with increasingly younger musician replacements until it became seriously dated.

There are some emerging issues in the arena of maintaining a passion for over 50 years, then finding out it’s irrevocably done. We’re an older population now and we’re living long enough to become irrelevant with unforeseen consequences. In the year 1965, 50% of the population was under 25 years of age, 41% under age 20. In contrast, in 2012, only 23.5 % of Americans were below the age of 20 *. I was 22 in 1965. I’d hazard a guess that in 2017, close to 50% of the population is over 60. That’s a different world.

People flash across the sky and then there is an end to that trajectory. They get old and find out they’re irrelevant as new generations crowd them out. It’s hard to let go of that and some poor souls are unable to do so. They observe from the outside what they can no longer do for various reasons, not the least of which is they can no longer relate to the new generation.

I’ve mentioned in the past that infamous 60s writer Hunter Thomson took his life when he discovered he was simply out of date and couldn’t relate anymore to the 21st century. When the world changed from the 60s he couldn’t adapt to the process of adapting. It wasn’t fun anymore. Keith Emerson (Emerson, Lake & Palmer) took his own life when he discovered he could no longer play the keyboards as in his glory days. Ronnie Montrose of “Montrose” (spawned Van Halen’s Sammy Hagar) took is life in 2012; he just didn’t find it fulfilling anymore. Bob Welsh, formerly in the formative stages of “Fleetwood Mac” took his life in 2012 in failing health and enduring the frustrations of the group’s success without him. Robin Williams at age 63- career waning and health issues.

These lives and deaths are radically different than young people with fertile lives killing themselves. David Foster Wallace, one of the most influential and innovative writers of the last 20 years, unexpectedly killed himself at age 46. Kurt Cobain kilted himself at age 27 at the peak of his musical career. These guys succumbed from endogenous depression, not an inability to cope with aging and an emerging generation that made them irrelevant.

Like it or not, time passes, things change and new generations emerge. The ability to survive is the ability to adapt and with a rapidly aging population, that ability isn’t guaranteed. Butch Trucks, a world-class musician in his glory days is collateral damage to this phenomenon. I fear he won’t be the last.

* Braunstein, Carpenter, Edmonds: “The Sixties Chronicle”, pp 263

Film review: “Jackie” (2016)

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02-jackie-portman-w529-h529“Jackie” (2016), interestingly not yet released in wide distribution is playing at the Manor in Shadyside, one of my favorite theaters. The Manor gets everything first.

Unclear what the incentive is to re-explore this history, arguably the worst saga that the emerging modern United States ever endured. Some things should maybe be relegated to dry history books rather than Natalie Portman’s wrenching performance of a woman in the public eye’s unimaginable shock and grief. Maybe not many of you in this group were there on November 22, 1963. Like Zelig, I was and I remember the fine details to this day. The news break-in from a soap opera:

Followed by a profound shock that covered the country like a big wet blanket. Everything, EVERYTHING stopped dead in its tracks. No one went to work, businesses closed, no traffic. Every American that had one was glued to (then) ancient black & White televisions or radios. Schools closed. Crowds gathered to storefront picture windows to watch. There was an eerie silence everywhere. The radio stations played funeral dirge music continuously. Children were terrified as were their parents. No one really knew what was possible next.

Natalie Portman is an excellent, multi-decorated actress and she poured herself into the persona of a woman in the public eye who very intimately experienced the destruction of her life and the life of her country in a virtual heartbeat. Losing a husband on the world’s largest stage. In all seriousness, I can’t think of another contemporary actress that could have brought this to a screen. Her physical similarity to Jackie is striking as is her voice and manner.

But there was a lot more to this woman than her ability to stand and persist following this unqualified disaster. Jackie knew two things intuitively. That the American public, millions of them, were watching her during this aftermath and counting on her to show strength and resilience. No one in post-modern America had ever experienced anything like this and they clearly needed pillars of strength to point toward a better future. Mrs. Dead president was clearly that person.

Jackie also knew that the remembrance of history is the written word, written after facts, suggesting the initial scenes where a world-class writer is engaged to write the intimate history of the aftermath insuring her husband’s rightful place as Jackie saw it, not as a politician might. (That actor, Billy Crudup is based on presidential biographer Theodore H. White, who wrote “For President Kennedy: An Epilogue,” a Life Magazine article that ran one week after Kennedy’s assassination).

This Is the Real <i>Jackie</i> Interview With LIFE Magazine

Toward both of those ends, Jackie demanded a spectacle for the funeral and burial of JFK, and she very nearly didn’t get it, as there were concerns that there may be more shooters out there. In the end, the entire pageant played out to her specifications. Mother and children front & center at the Rotunda, followed by all marching to St. Mathews, a distance of 8 city blocks behind a rider-less horse with boots reversed in stirrups. Watched by millions along the route and on television. It was a spectacle no one believed could have ever happened.

Parenthetically, following the assassination of Jack Kennedy’s brother Bobby, a train carrying the body to it’s final resting place was met by literally standing room only people along the route for it’s entire length. I think would have been a radically different world had Robert F. Kennedy lived.

This is a “historical figure contemplates self” film that relies completely on Natalie Portman’s ability to morph into her subject. She becomes Jackie Kennedy is a very real and convincing way, warts and all.

Interestingly, watch for something I noticed. During the film, the director portrays some of Jackie’s 1962 tour of the White House, using ancient 16 mm cameras and film digitally doctored to appear as early ‘60s black & white viewing screens. These scenes are scattered throughout the film. Keep your eye out for one of these scenes near the end of the film. You’ll notice that in this one clip, the audio of Jackie (Natalie) speaking for the camera doesn’t match. Look closely at the woman in this clip. I’m VERY convinced they slipped a clip of the real Jackie in there and most of the audience didn’t notice. The resemblance is nearly perfect except the real Jackie as a bit larger mouth. The director, Pablo Larraín, later hinted that they played around a bit with some of these clips. Jackie had to stand for herself as an ordinary woman but also for Jackie the historical figure, the myth, especially for the myth of Camelot she embraced and promoted.

Predating the Kennedy assassination by three years, the “real” Camelot on Broadway starring Richard Burton and Julie Andrews played for 873 performances in 1960 and earned four Tony’s. It got mixed reviews at the time but spawned an eponymous movie in 1967 (Richard Harris, Vanessa Redgrave). The sound track album topped the charts for 60 weeks. The plot of Camelot involved a mythical kingdom of equal peers that functioned to political and social perfection, much like Sangri la. Then, inevitably, jealously, greed, covetousness and dishonor color the perfection, bringing it to ground, never to resurrect. Richard Burton’s speech reminding Arthur of the idealism and hope that he had as a young king haunts to this day. “For one brief shining moment…….there was Camelot”.

Jackie knew that the three years of her husband’s presidency resembled the myth of Camelot in many respects and she nurtured that image which persists to this day.

This is a very, very intense film interpreted to perfection by Natalie Porter and director Pablo Larraín, who gives her free reign. There are some issues. The extreme close ups become a bit irritating after a while. Jackie ignores or dismisses some of the more controversial facets of the Camelot myth, infidelity and having to fix disasters of his own making.

If you’re up for some serious melodrama, I recommend it. I give it 4 of 5 gloomy flag draped caskets.

David Crippen, MD, FCCM
Professor Emeritus
University of Pittsburgh (Ret)

A political/medical care observation for the New Year

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donald-trumpIt is after all Sunday and this is a bit more of a time for a “Village Green” observation by your FL, for what it might be worth. What I’m about to say involves an obligatory observation on National politics because it impacts what’s happening in medicine today and in the near future. My observations are NOT so much for public debate here as they are simply pointing out facts, as they are readily apparent. Please just reflect on this, not start arguments. Med-Events does that very nicely. If you want to argue about politics, join Events.

A paper came across my desk (enclosed) suggesting that the potential for health care providers’ autonomy is under assault and eventually will all but disappear. I think there are clear reasons for this. The demand for medical care continues to increase but the supply remains relatively static. All kinds of schemes have been developed though the years do decrease the demand (cutting the price). Denying service for pre-existing conditions, “managed care”, “rationing by inconvenience” and yet the cost of health care continues to increase yearly.

The “Affordable Care Act of 2008” (Obamacare) hoped to put a dent in that by spreading the cost out over a very large population, some sick, some well, and of course, “opt-outs” wouldn’t be allowed, as they would eventually turn up in emergency rooms demanding care even though they hadn’t paid the premium. Part of this plan would have been the “public option” to take care of outliers.

There isn’t really much argument that this plan would have worked pretty well, allowing for adjustments, had it been implemented as formulated. Not perfect but a very good start to get people covered for their health care affordably. What happened was a bit unexpected. We didn’t realize at the time that opponents of the President became the “party of no” vociferously obstructing, delaying and destroying everything and anything that came out of that White House. The ACA then became a political issue and was widely advertised by the Party of No as something it wasn’t. Then the Public Option was killed, removing much of the efficiency of the entire program, followed by allowing healthy people to opt out of the program leaving a large population of sick ones.

Of course, as a natural consequence of supply and demand, the price per individual rose, as it would have (and did) for any kind of health care indemnification. Blamed on the program, of course. I had lunch with a very intelligent, perceptive friend (not the only one I have that supports repeal of the ACA) who solemnly advised me that she couldn’t wait to see the ACA repealed because middle class people couldn’t afford it and it was literally bringing the economy down. Never mind that any- and every health care indemnification program in the country was similarly raising their rates, including mine.

Enter the stimulus for all this, the current President-Elect of the USA, Mr. Trump, and his new best friends, ultra-conservative Republicans now in control of congress and soon to be also in control of the Judiciary. Mr. Trump, a very talented and experienced huckster knows nothing about any of it, but his new friends do and they’re now after many years of trying, in place to do damage to health care and a great many other things in our lives.

As is widely observed, the election of Mr. Trump caught virtually every observer by surprise, but not me. They that Pennsylvania is a state with two cities on either end (Pittsburgh & Philadelphia) with Alabama between, and that turned out to be true last Nov 8). I saw it coming as I rode bikes around the rural center of Pennsylvania, spotting Trump signs on virtually every home or business in small towns and country areas. I knew all these people would vote and they intended to “shake up” the establishment that no longer worked for them (not suspecting they had the potential to destroy it).

So now, before the new President-Elect actually takes power, we’re already getting a view of how it’s going to be.

  1. The institution of a Presidential Cabinet full of officers dedicated to untried and unlikely theoretical political ideals, not necessarily the benefit of the population.
  1. The dissolution of a health care system that currently serves about (said to be) twenty million should to one degree of another with the promise of something to replace it someday.
  1. A President-Elect that has publically disputed the opinion of every single individual in every single intelligence and law enforcement office regarding the illegal and intrusive activities of Russia in our political-social system. “The difference between skepticism and disparagement”
  1. As of Friday, the funding of a wall separating the USA from Mexico asked to be funded by congress with a bill to be sent to the other side with no mechanism to collect it. Estimated cost ~ 25 billion $ and estimated by most experts to be worthless.
  1. Active plans to decrease any and all funding for the poor and disadvantaged, active plans to decrease taxes for the well-off, active plans to get more guns on the street and eliminate “Planned Parenthood”, a service that benefits many women.

All this even before January 20.

Now, again, I ask not for argument. The above remarks are above argument, they simply exist and can be substantiated anywhere. It’s just my humble personal observation and it all matters in our health care future, which is why I bring them up.

Our current health care situation is quickly falling apart for at least two reasons (I’ll omit my scathing remarks on what’s going on in medical education).

1. I honestly believe that there is about a 50-50% chance that Mr. Trump’s coalition will collapse completely within 30 days of Jan 20. He has no clue about the delicate realities of global politics and his Cabinet members have no real experience in any other than “business” and that isn’t the way any of it works. Any number of other countries in the world could hurt us more than we could hurt them if they took a mind. Mr. Trump’s coalition fully intends to create a society built on unlikely or untried theoretical political conditions as a practical matter. It is absolutely not out of the question that the fabric of our society could be ripped apart into chaos and very quickly.

It’s already started. An increasing number of Republicans, his own party, have figured out he has no firm foundation for any of his Tweeted opinions, all capricious ramblings of what he happens to think at the moment. They’re making it known they’re re-thinking their support for him. This brings up another potential reality, that Mr. Trump et al will become very quickly bogged down in a system of government meant for- and created for bipartisan cooperation to get things done. If Mr. Trump’s coalition descends into the same kind of stubborn non-participation that has marked the past eight years, then nothing (again) will go forward and our system of government will descend into vicious and bitter fighting, wasting time and money in a very dangerous world. So much for “fixing” broken government. I do NOT see Mr. Trump actually achieving many if any of the advertised platform (such as it was) that elected him.

2. If any of that hat happens, our currently fragile health care provision system will collapse, if for no other reason than our current strategy to cope with administrative rationing will fail with it. Insurance and government strategy is to make reimbursement increasingly complicated so that those unwilling or unable to comply don’t get paid. What we’re doing now is allowing “middle management” and “financial specialists” to deal with the increasing complexities of reimbursement.  There are now an entire hall full of administrators and financial people where a lot of doctors used to be (including me). These guys peck at computers all day long all getting excellent salaries and benefits.

Now, at this point, everyone on this List should download and read every word of the following Time Magazine site (let me know if it doesn’t open for some reason).

http://content.time.com/time/subscriber/article/0,33009,2136864-1,00.html

Pay particular attention to the justifications given for incredibly outrageous charges by an automated service “Chargemaster” for patient caught in the middle- too young for Medicare and too many resources for Medicaid. Both Medicare and Medicaid pay providers only a small fraction of “Chargemaster” bills and they’re accepted. Also pay attention to the salaries for middle managers, CEOs, COOs and the like. You’ll note somewhere in the middle that the CEO of the University of Pittsburgh Medical Center’s salary (before bonuses) was close to 6 million $ per year. The same guy that mandates draconian budget cuts for the clinical departments, including mine every year.

W
e as providers are losing the battle of self-determination. We are losing that battle because we’re handing middle managers and financial officers the authority to order health care in an administrative system that considers us irrelevant. It considers us providers that create demand and they want to limit demand. They formulate policy and let us know how we fit into it, which is why the majority of us are not “hospital employees”. We can be controlled.

This is the state-of-the-art now for providing medical care for our population and I can assure you that if the administration, such as it is, of Mr. Trump collapses, this will all collapse with it. If Mr. Trump’s administration becomes embroiled in an endless fight with everyone creating chaos and stasis, this system will follow suit. If Mr. Trump is successful in killing the ACA, there will be a lot of people left wondering what and when their promises will be kept, even if it could be financed which is unlikely if he spends 25 billion on a useless wall. It took Obama two years to formulate the ACA and it wasn’t perfect. We’ll see what Republicans dedicated to “conservative principles” can come up with and when they can come up with it.

To end this diatribe as I sit here “retired” with a cup of coffee and my trusty iMac, I am very, very fearful for the future of the country, the health care system or the world for that matter and I’m not by nature a terribly pessimistic person. I am now an observer. We’ll all observe in time.

 

 

Retrospective: John Kay and Steppenwolf

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For no particular reason, I occasionally come upon a very interesting person not many know much about. Sitting at my computer working on something else and playing from my collection of 60’s songs, one popped up I had never heard before and the lyrics caught my attention.

Rock music is not usually noted for insightful lyrics. It’s unusual for rock lyrics to do much else but rhyme with the pentatonic scale. If you want discerning lyrics, you switch to Bobby Dylan. Rock is not a medium of libretto. It is a medium of rebellion and insurgence. It’s loud, raucous and in your face. The music is written to pull at the right heartstrings, the lyrics are added later. This was true for McCartney and Lennon. They hummed a tune to each other, then wrote the words to fit. Elton John played the chords and Bernie Taupin fit the lyrics. The list goes on.

john-kayThe band was named after the novel Der Steppenwolf by German author Hermann Hesse. Lead singer John Kay is an interesting outlier in some, not all of his writing. Real name Joachim Fritz Krauledat, age now 72, was born in East Prussia, Germany, in 1944 (now part of  Russia).  Another interesting facet- John was born with a rare ocular anomaly, achromatopsia – complete color blindness – a defect of the cone cells in the eyes which causes him to see only with his rod cells and thus only in black and white and grey shades.  He has no concept of color, and this disorder also causes increased sensitivity to light so he usually wears sunglasses, not as a fashion statement. Technically, he’s legally blind.

The band Steppenwolf’s glory days were 1968 – 72. They sold 25 million records and had eight gold albums. Like many bands of the time, they couldn’t get along with each other and after 1972 they never ascended to former glory. Many critics think they broke up at the top of their game.

But John Kay was a very interesting songwriter. He was unique in the field of most of them in that he was able to fit meaningful, intelligent lyrics into the more-or-less usual rock melodies. He had a penchant for describing the drug habits of his era in very vivid language. He didn’t hold back much. Some of his lyrics are brutal and uncompromising. Give a look briefly.

“Stoned on some new potion he found upon the wall

Of some unholy bathroom in some ungodly hall

He only had a dollar to live on ’til next Monday

But he spent it on some comfort for his mind

He said he wanted Heaven but prayin’ was too slow

So he bought a one-way ticket on an airline made of snow”

https://www.youtube.com/watch?v=OMxCi3ljWEg

I think he’s most famous for the “The Pusher”, actually written by Hoyt Axton in 1968 and featured in the classic film “Easy Rider” in 1969. The lyrics of the song distinguish between a “dealer” in drugs such as marijuana—who “will sell you lots of sweet dreams”—and a “pusher” of heroin- a “monster” who doesn’t care if you live or if you die”. The song is fitted to a rather funereal chord progression of E7 – Dm7 – A7 – F#7 that drones on as Kay “sings” (closer to melodic talking) the verbiage. It’s pretty raw, quite so for 1968. It’s a very interesting song, give it a listen.

“Well, now if I were president of this land

You know, I’d declare total war on the pusher man

I’d cut if he stands,

And I’d shoot him if he’d run

Yes, I’d kill him with my Bible

And my razor and my gun.

God damn, the pusher

I said God damn, God damn the pusher man”.

https://www.youtube.com/watch?v=3XqyGoE2Q4Y

Several members of the original band still play occasionally on the nostalgia circuit.

 

 

Bob Dylan- Nobel laureate

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“It’s been a long, long time coming

But I know a change gonna come

Oh, yes it will”

Sam Cooke (1964)

BD_Claxton_1.jpg HAND OUT PRESS PHOTOGRAPH. PROVIDED BY parris.oloughlin-hoste@sonymusic.com

It has been a long time coming, indeed. The Nobel Prize has expanded its previous boundaries to accept lyrics put to music, lyrics composed of the same elegance as the masters. This is absolutely the right thing to do; should have been done long ago.

Dylan’s lyrics transcend almost all of what constituted text for music, especially rock. Most song lyrics don’t really hold up without the music. Most if not all of the lyrics are either nonsense or superfluous, created to match the “feel” of the melody and largely ignored. Dylan changed all that radically.

Dylan’s eponymous first album full of standards in1962 didn’t create much stir. It was his second album, “The Freewheelin’ Bob Dylan”, containing 11 of 13 original songs (1963) that pretty much single handedly created the “folk” era and put Greenwich Village on the map. The litany of his continued work has never been equaled, now finally to be recognized in traditional literary circles.

Not everyone is thrilled with the prospect. An editorial yesterday in the New York Times decried the choice, opining that the Grammies are the right place for songwriters, not the same company as Steinbeck, Sartre and Beckett. But this is the nonsense of supercilious purists. The lyrics are what they are and they are the product of the same species of genius.

There is precedent for alternative views of classical literature. It isn’t the first time that a Nobel has been awarded to a non-writer. Winston Churchill won in 1953 for his oratory. In 2015, when the prize went to the Belarussian journalist Svetlana Alexievich for her historical narratives.

Mr. Dylan is the first American to win the prize since Toni Morrison in 1993. Thick books have been written exploring his lyrics. Classes at universities are taught about him. For the first time, Mr. Dylan’s lyrics are considered to stand alone as poetry. He has been compared to Homer and Sappho, whose works were delivered orally.

Through the years, Dylan has changed his visions according to the tempers of the times. His many honors include Grammys and Academy and Golden Globe awards. He was inducted into the Rock and Roll Hall of Fame in 1988, won a special Pulitzer Prize in 2008 and was awarded the Presidential Medal of Freedom in 2012.

He is a stellar American literary icon and most deserving of this Nobel honor. Hearty congratulations to him.

 

 

Syd Barrett remembered (1946-2006)

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Last summer marked the 10th anniversary of the death of Roger (Syd) Barrett the original heart and soul of the mega-band “Pink Floyd”. Syd was the lead singer and principle songwriter, credited with naming the band in the mid-60s.

I mention Syd for a reason, yet to come.

First, a brief background history: Syd’s brilliance flashed across the sky for only about 3 years, beginning at the band’s inception around 1965 and pretty much ending around 1968. The band’s seminal album: “Piper at the gates of dawn” was recorded in 1967 and put them on the map in the UK. His instrumental “Interstellar Overdrive” (10 minutes long) marked the Brit interpretation of psychedelia. Of the eleven songs on “Piper”, Syd wrote eight and co-wrote two.

During the latter part of 1967 into ’68, Syd’s behavior became increasingly erratic, blamed on his use of LSD, which at the time was pervasive in the youth culture. His ability to perform on stage progressively deteriorated and in late 1968, his school friend David Gilmour gently replaced him in the band.

After leaving Floyd, Syd tried his luck at several solo projects but none went anywhere. By 1972, Syd’s functionality had degenerated to the point where he ensconced himself in a small flat in Cambridge and rarely emerged except to get the mail. Royalties continued to come his way and he remained essentially in custodial care until his death on July 7, 2006 at the age of 60 years. Cause of death said to be pancreatic cancer.

There has been much speculation about Syd’s state of mind over his few productive years. Much has been made of his fondness for LSD as a precursor and catalyst for psychosis. His sister Rosemary Breen said that his mental abilities and inconsistencies were consistent with Asperger’s Syndrome. In fact, many who have studied him feel that he had classic delayed adolescent schizophrenia and his deterioration was an incurable self-fulfilling prophesy.

I have seen several schizophrenics through the years. They are usually highly intelligent and creative in their young years and they flash brightly but quickly across the sky. Their deterioration is progressive, sometimes lasting into their late 20s. One I knew deteriorated in her last year of medical school. It’s right out of that film a while back “A Beautiful Mind” (2001). The signs and symptoms actually started much earlier but were as ascribed to the eccentricity of genius.
photo-oneAt any rate, my point, and I do have one is for you to now peruse this photo. Syd in his glory days, early 20s.

Now, much is made of Architectural feminine beauty, in the range of Victoria’s Secret models. A face that launched a thousand ships (a mini-Helen, of course, would launch one ship). The media is plastered with it selling everything from bug spray to diapers. But, alternatively, Syd was a drop-dead beautiful young man. Look at that face. A face that would generate madness in an alternate universe.
photo-three
Then, sadly, peruse this photo to see Syd in his late 50s shortly before his death. Rode hard and put away wet for too long. What a strange and terrible transformation that quietly awaits most of us. Unfair that we must eventually suffer the ravages of time and age. Almost an incentive to get in as much as possible for as long as possible before we go gently into that good night.