40th anniversary of Vietnam reunification.

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Stuff you never heard of and had little interest in 😉

saigon-tankThis date (April 30, 1975) marks the 40th anniversary of the day North Vietnamese tanks rumbled through the streets of Saigon and broke through the fence at the Presidential Palace to formally re-unify North and South Vietnam. Today, this action is called Reunification Day (Ngày Thống nhất) and is a public holiday in Vietnam.

https://www.dailyherald.com/article/20150429/news/150428483/

This action signaled the bitter end of the “Vietnam War” (technically more of a “conflict”), known in Vietnamese as Kháng chiến chống Mỹ (“Resistance War Against America”). It was the start of the transition period beginning July 2, 1976, when the Provisional Revolutionary Government of the Republic of South Vietnam and North Vietnam merged to form the modern-day Socialist Republic of Vietnam.

I bring this date up for two reasons. First, because I would like you to think just a little about Vietnam. It was one of the most important events in modern history, in many ways shaping the new millennium. But the Vietnam Conflict is quickly headed for obscurity if for no other reason than the exigency of our current nonsense conflict in Afghanistan. A war that can never be won by anyone, as the Russians previously proved in the 80s.

Secondly, I want to passionately recommend to everyone in earshot to find and view a new documentary by Rory Kennedy (Robert F’s daughter): “Last Days in Vietnam”. This documentary can be viewed on the PBS channel intermittently and also free on some of the PBS websites. It can be watched free on several sites:

http://www.pbs.org/wgbh/americanexperience/films/lastdays/player/

It can be easily downloaded off iTunes as well.

This is a very objective and important documentary because it vividly portrays the human aftermath of extremely bad political decisions. It is painful to watch but necessary to give a perspective to the human suffering that occurs following imperious political policy. The bad decisions of the French resulted in 1,726 killed in action and 1694 missing in action in about 6 months at Dien Bein Phu. The Russians were unceremoniously thrown out of Afghanistan after 13,310 soldiers had been killed, 35,478 wounded. Those lessons should have been heeded.

I went back to Vietnam in 2011 after 43 years and I have some profound reflections on things pertaining to it. Vietnam has changed so radically and yet has so stayed the same. In 1968, the entire country was a big American military base. Many troopers never saw any of the cities or the rest of the country. Ankhe City didn’t exist. Camp Radcliff dwarfed the entire region. Same for Camp Holloway In Pleiku, Camp Eagle in Phu Bai and endless others.

In 2011, I saw the real country for the first time without the Army green and camouflage that had obliterated every landscape. Therefore, that trip was much more of a simple tourist effort than a trip back in time. Many in my present reality were not alive in 1968. Coming back to that place was a much emptier experience than I had previously anticipated.

Most or all of the areas where I Iived my life are no longer recognizable. I felt no particular clarification or verification of any of my life as a result of going back to the past. Whatever I might have been seeking has eluded me. Thomas Wolff was right on more accounts than one; you can’t go home again and you can’t go back in time to re-live either. Trust me, I have tried.

Perhaps I yearn for a “Somewhere in time” where Chris Reeves desires to go back so intensely and approximates himself into a time warp so accurately it actually happens and he is given another chance at another path to take. But alas, in the end it might be possible to have it transiently, but the coin always lurks that brings it all tumbling down.

And so we come back to the clearing at the end of our road and make what we can of it.

“Goodbye to all my friends at home
Goodbye to people I’ve trusted
I’ve got to go out and make my way
I might get rich you know I might get busted
But my heart keeps calling me backwards
As I get on the 707
Ridin’ high I got tears in my eyes
You know you got to go through hell
Before you get to heaven”

Steve Miller Band (1977)

Some acerbic notes on the new generation of physicians

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“My impression is that the older ones found work-life integration while the younger ones are focused on work-life balance. There’s not a lot of balance when up at 3 am with a sick patient or 5. And the a common refrain is “I don’t want to work weekends “

Crippen: When I was a medical student on clinical rotations in the early 70s, I was expected to be the first to arrive and the last to leave. I “took” patients and was responsible to the resident for reporting on morning rounds everything going on. I did procedures under guidance and I got chewed out or my ass kicked when I didn’t perform up to expectations. I was expected to have no other obligations during that rotation and it NEVER crossed my mind to complain that I was overworked. Had I done so, that revelation would have been greeted with dropped jaw astonishment and an admonition to get with the program or take my mangy ass elsewhere.

When I was a resident at Bellevue, there were about 100 patients on the general surgery service and ten in the surgical ICU. There were two first year residents on the service and every-other-night call. Do the math. Similarly, there was no excuse for not getting the work load done. One learned to prioritize to get the important stuff done and suck up the hassles on the rest. Complaints of overwork were nonexistent. Not conceived of.

And yes, I did walk to work 20 miles one way on crutches in waist deep snow fighting off alligators and snakes along the entire course.

Then in the new millennium, Libby Zion came along and the path of least resistance led to the proposition that residents were overworked and too sleepy to function so they had to be given a break. That evolved to a situation where medical students and residents became entitled. No more of this “service” stuff, it has to be all book learning education. Complaints of “I’m overworked” are forwarded to the RRC (Residency something Committee) a body that immediately investigates all such complaints and the burden is on the teaching program that they’re not overburdening the poor babies with a work load that they can’t handle. As a result, that work load gets smaller every year.

This is an honest to God true anecdote told to me by the Chair of one of our clinical departments here. He was teaching a session for medical students on some subject he felt was important and after a while one of the students raised her hand. She told him maybe he had spent enough time on this subject and maybe he should move on. Astonished, he told her he wasn’t finished yet, whereupon she picked up her books and walked out.

Medical Emergency Teams (MET) appear in at least some, not all, data to be doing a good job in interdicting acute deterioration episodes for hospital inpatients. As they evolve, however, the propensity for nurses to call for the MET instead of the responsible resident evolves with it, for a number of complex reasons. Then the responsible resident stands at the back of a crowd of people watching as their patient is taken care of by someone else. The issue as far as the hospital is concerned is that patient safety trumps medical education, and that may be. But in the immortal words of Bill Gates:

“We always overestimate the change that will occur in the next two years and underestimate the change that will occur in the next ten”

And that’s exactly what’s happening with medical education. We’ve entered a realm where the “education” portion has exceeded the “experience” portion. We’re teaching them all the contents of the Textbook of Medicine and then sending them out into a world where the translation of education into experience is required to survive, and it isn’t there. They were standing in the back of the crowd that day, and every day they survive the mix is a day that their minuscule experience base fails them. To be exceeded only by the next wave of graduates.

Similarly, critical care fellows have complained about night and weekends now for the 28 years I have been involved with the UPMC system and they are following the lead of the rest of them. When I was a fellow in 1986, I was on call every third night and every other night when someone one went on vacation or got sick. Now the fellows are on call one night a week and the night calls are progressively being taken over by Certified Nurse Practitioners and Physicians Assistants. The fellows want to think of themselves as executives now, in a teaching and mentoring mode for the night and weekend crews. How they are getting that knowledge base now is with books and simulators.

I hasten to add that there is nothing intrinsically wrong with the CRNP and PA mode of direct patient call after hours. I have some in the NICU and they are REALLY great in every respect. They do EXCELLENT patient care and they know when to call for the executive modulators, which consist of the Resource Intensivists covering the house at night.

The problem with this model is that since every critical care fellow has the same training as most other residents in their specialty, they are at risk for the same dumbing-down (not always). As the syndrome as Med Student/resident Entitlement continues, will the fellows not bear fruit from the poisoned tree? Unclear at this point. We shall see.

There has been a lot of hand wringing about the poor overworked physician trainees that I am not particularly impressed with. I went through all that and not only did I survive, it made me a provider that is never surprised at ANY clinical situation because I’ve seen them all, and there aren’t many physicians that have had a fuller personal life than me (trust me on this).

Hand wringers lament that overwork and overstress creates drop outs, landing in psychiatrists office, going through ten divorces or killing themselves from what amounts to PTSD related disorders. Sorry, I can’t fix those that sink into PTSD. I wish there was a better way to sort those with a tendency for PTSD out before they get into medical school (unlikely as long as grades move all). I went through all that in Vietnam and I just worked it out and went on. I know Viet vets that thrived on it and wish they could go back and do more of it. PTSD is just luck of the draw.

I don’t know what the fix is for PTSD. I think arbitrarily decreasing work loads may solve some of it but invokes the Great Principle of Unintended Consequences (GPUC), we’re seeing it now and we will continue to see it in the future. Well rested physicians aren’t necessarily the ones you want to look up and see during a disaster in the middle of the night. But then at the rate things are going, no one may ever see one after 5 pm anyway.

I am the last of my kind.

Some comments on the Veterans Hospital situation in May, 2014

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I have a book somewhere in my library written in the late 70s that details how Vietnam vets got the same treatment as those complaining now at a New York Va. The problem was identical. That facility, however, had a huge number of injured and sick vets referred them from all over the area. They simply rationed so that no population of vets got more than others. They all got the same and there wasn’t enough for anyone.

I prefer not to think that these people are intentionally stiffing vets, although the woman head of the Phoenix VA is now showing signs that she did all this to “look efficient” to her bosses so she could climb the career ladder faster. I think they figured out ways to ration care and hide it from the media (for a while).

I “think” the problem is an overwhelming mass of returning vets with a ton of medical problems and a limited amount of resource to deal with them. There are more doctors than Carters has Liver Pills all over Iraq and certainly Afghanistan. None of these doctors can do much definitive care there but they can “patch up” and send them back to the USA alive but with disastrous issues they would have ordinarily died from. Then they require a ton of expensive care that isn’t available in the system.

This is especially true for neurosurgical injury. If a soldier got a serious neurosurgical injury in Vietnam they died. In fact, if s soldier got an injury that a paramedic couldn’t fix at the scene he still had a pretty good chance of dying. Now they get patched up by doctors at up-front field facilities and sent back to the USA for a lifetime of expensive care and many remain non-functional, requiring some form of welfare support. All this is incredibly expensive and the funds were never available.

Most of the Vietnam vets were sent back with relatively inexpensive health care issues and there was enough resources in the VA system to cover them. When I was a resident in both Indianapolis and New York City, I trained at the VA hospitals in both those cities and I was never impressed that their resources were stretched. I thought patients there got pretty good care and very good training of doctors. Now they’re coming back requiring a LOT of chronic care for injuries that should have killed them and the system is dramatically overloaded.  So what do you do when you have resources for 100 soldiers a week and you have 1000 pushing at the gate to get in?

The answer in a perfect world is you prioritize in some way so those requiring the more acute care get it first and the rest stand in line till their number comes up. But watch the “Wounded Warrior” commercials on TV. They’re all acute and they all need more expensive technical care, ICUs, neuro care, extensive rehab for blown off limbs.

In this country, allowing one group to cut in line on the basis of anything will get vociferous complaints of favoritism and discrimination. So I have little doubt that the VA simply found ways to thin out the demand for services by backing them all up into a barrel and turning the spigot open to allow a defined number of them into the system that could deal as effectively as possible. The rest just backed up waiting their turn. There are lots of ways to do that. What they did in Phoenix is one. Then the media got hold of it and the resulting feeding frenzy didn’t point out the fundamental problem of too many injured soldiers trying to get too few resources. It pointed out incompetence and stupidity which is much better copy.

So how to fix the fundamental problem.

As long as we’re resuscitating otherwise mortal injury in Afghanistan, we will continue to deal with them inadequately in the overheated VA system. Now that the toothpaste is out of the tube in the media, it won’t go away. We have several choices.

1.  Pour a ton of money into the VA system creating a “separate but equal” care system for acute injury and rehab.

2.  Close the VA system for acute injury and spread these patients out through the nearly overheated public health care system and pay for that care via a separate reimbursement provision that the military has in place anyway for veterans who for some reason cannot access a veterans facility.

I “think” that #2 is the logical way to deal with these patients most effectively. The VA system clearly cannot deal with them at all, much less effectively. It would cost a lot more to bring the VA system up to speed than to adjust the “private” system. At any rate, we better do something soon because there are a lot of soldiers out there who deserve better.

International MotoGP race at the Circuit of the Americas, Austin, Texas, April 11 – 13, 2014.

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38A new track constructed specifically to lure the Formula 1 for the World Championship of Drivers circus back to the USA. The track is immaculate, beautiful and specifically constructed for fans to see and absorb as much as possible from any vantage. Very fan-pleasing.

My medical credentials allowed me pretty much full access, but not necessarily into the “seats” where I could sit, have food and drink. That was “extra” but I managed to finesse my way in, at least on Friday where there weren’t too many people.

My buddy Billy Fanstone of Brazil and I wandered around the track all day and each site was as good as the next, although we nor anyone else can never get too close to the actual track. Double levels of fence.

The track is huge, biggest track I’ve ever seen. Something like 3.5 miles from one of the six parking lots to the main gate.  And of course, extremely expensive to get tickets US$1000.00 or so for the three-day race weekend including parking and a seat.

The Formula 1 circus directors liked this track and so the Formula 1 motorcycle series was a natural to add to its itinerary.  There are paramedics on the track but not doctors. The safety director is my old friend from CART Lon Bromley and we had a nice reunion. Long time CART medical director Dr. Steve Olvey is the Medical Director and there are several other doctors around under his direction.

This is the big leagues of two wheel racing, three separate series- Formula 3 (250 cc engines), Formula 2 (600 cc engines) and finally the big boys at 1000 cc, 220 mph on the straights.

It’s difficult to accurately describe the phenomenon of a flat-out motorcycle on the front straight. It’s so incredibly fast it’s difficult to understand how a human can retain control. The rider tucked in behind the diminutive windscreen…..then sitting upright to catch wind (slowing down), followed by clutching the side of the bike like a spider as it tilts to an impossible angle in a corner at speed.  And most of these riders are kids. It’s just ridiculous.

We wandered though the pits watching engineers and techs correlating virtually everything the engines do on a computer. On the actual track, each machine has a shack full of computer monitors that follow every stroke of the piston and turn of the wheel. Each rider has a tiny air conditioned apartment” for sleeping and resting during the day. They hang their tracksuits out to sun.

Then though the paddocks where T-Shirts and other memorabilia are hawked with a blood lust for money that would embarrass the Whore of Babylon. Of course I couldn’t resist picking up a couple of t-shirts, even at blatantly rip-off prices.

The state of motor racing in the new millennium continues to amaze me. When I was there in the 60s, we drove our MG-A’s, Triumph TR-3’s and Porsche 356’s to the track, taped the headlights, fitted a tubular roll bar behind the front seat, raced all day, uninstalled it all, then drove home. The few people that showed up had a good time and went home with full wallets.

Now it’s a big business indeed. Every square centimeter of space on a race bike is filled with an advertisement. Riders and drivers are forced into indentured servitude from their sponsors, the females, of course, encouraged to exhibit as much sexuality as they can pull off without looking “too” much like Playboy centerfolds. The money gleaned from everything and anything associated with racing is parceled out by intricate contracts.

Interestingly, the “fans” have little or no access to the really top riders.  I had a medical pass which allowed me to go anywhere I wanted and I never got anywhere near Dani Pedrosa, Casey Stoner, Nicky Hayden or Valentino Rossi. Their pits were carefully sequestered and closed to everyone and anyone not directly related to them. I got some shots of Rossi coming and going out of his pit.  If they do address “fans”, it’s briefly and very meticulously orchestrated with lots of sponsor visibility.

The MotoGP speeds are difficult to process. Any accident at these speeds would be reliably fatal. Each rider on swinging around the final turn before the main grandstand goes out of their way to lift he front tire for a while just to show their control at over 100mph. Their control of the machine if phenomenal.

All this forces the question of whether MotoGP is a “Sport” or an exhibition. In order for it to be truly a sport, the skill of the rider must exceed the inherent performance of the machine. Of course, the more money put into the machine, the faster it goes. A skillful rider can theoretically overcome limitations in the machine’s performance by simply taking more chances than the next guy.  This potential stoked by the sponsors’ demands to go faster presents a very dangerous situation indeed and transcends skill.

I think that nine time world champion Valentino Rossi is technically the fastest rider that ever lived, but is in the process of lugging a really uncompetitive machine. So, it’s unclear at this point how many chances he’s really willing to take before he cuts his losses and changes teams. .

Unclear also how any of this applies to open-wheel motorcar racing where driver’s ability is less than the car’s performance in a situation where passing is difficult or impossible. In Formula 1, the first cars on the grid usually finish first. Not so much in MotoGP as there is more room to pass.

This race was won by Spaniard Marc Marquez, who started from the poll, let the entire race and set the track record. The Honda team came in first and second, making them pretty much unbeatable so far. He looks like he’s ten years old and started shaving yesterday. Rossi finished 8th, complaining of tire issues.

The actual race is typically colorful and exciting. The fans can see much of the action from good vantage points. I think you have to see it live at least once to fully appreciate the unique ambiance. Then the best seat in the house is always in front of a nice, big high resolution TV screen. I was happy to have had the opportunity to experience this adventure.

 

 

A quick tour of the USS Midway in San Francisco

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While in San Diego for a CODES gig, I got a chance to tour the USS Midway, a simply enormous aircraft carrier sitting in the bay. This thing is a small city, laid down in the year of my birth,1943 and after many years of service, towed to San Diego as a historical exhibit.

After some refurbishing, a modernized Midway began service in the South China Sea during the Laotian Crisis of spring of 1961. In1965, she flew strikes against military and logistics installations in North and South Vietnam. On 17 June 1965, aviators of Midway’s Attack Carrier Wing 2, VF-21 downed the first two MiGs credited to U.S. forces in Southeast Asia.

On 12 January 1973 an aircraft from Midway made the last air-to-air kill of the Vietnam War. For her service in Vietnam from 30 April 1972, to 9 February 1973, the USS Midway and her crew received the Presidential Unit Citation from Richard Nixon.

Only twenty bucks to tour, this paltry fee offsets the half million dollars it cost to tow it to San Diego.  The Navy requires another half million in the bank from the promoters in case the exhibit goes bankrupt to finance the cost to tow it elsewhere.

One can walk all over the ship with recorded headphone remarks. It could easily take a full day to see it all. Most interesting part was the deck side lectures on taking off from- and landing on the Midway, given by retired fighter pilots mainly in the Vietnam era.  Both saw combat action.

Taking off from a catapult involved racing from standing still to 165 miles per hour (265 KPH) in two seconds over about 250 feet. Pilots pull 2.5 G’s. The steam driven catapult beneath deck weighs about three tons and while travelling 165 mph at the end of the flight deck it’s stopped cold in five feet by a water trap (shakes the entire ship).

The deck personnel wear color-coded jackets to delineate who is responsible for what and they communicate by a series of elaborate hand gestures. All are junior commissioned officers. Hands over head for pilots and hands under waist for other deck crew. When everything is set and the pilot is ready, he or she salutes, the lunch officer returns the salute and the switch is flipped. Just like in “Top Gun”.

The landing lecture was given by another retired pilot and was equally fascinating. The landing area is about 300 feet. The approaching aircraft drops a tail-hook (below the wheels) and on touchdown (at 150 mph) the hook has a grab at one of four wrist thick wires a few feet apart. This is usually successful, bringing the aircraft to a dead stop in 2 seconds with about the same G force as takeoff, except from the opposite direction.

Landing Signal Officers guide the plane in through radio communication as well as a collection of lights on the deck. The pilot will see different lights depending on the plane’s angle of approach. If the plane is right on target, the pilot will see an amber light, dubbed the “meatball,” in line with a row of green lights. If the amber light appears above the green lights, the plane is coming in too high; if the amber light appears below the green lights, the plane is coming in too low. This system is especially interesting at night where the pilot sees only the meatball bobbing up and down with the motion of the ship.

http://gizmodo.com/night-vs-day-aircraft-carrier-landings-in-one-harrowin-979263050

Accidents are infrequent but can be dramatic. Former Presidential candidate John McCain is said to have been sitting in the cockpit of his aircraft on the deck of the USS Forrestal stationed off the coast of North Vietnam, conducting combat operations. A rocket accidentally exploded on another plane, causing a chain reaction of dangerous fireworks. Hundreds of sailors were injured or killed in the melee. McCain is said to have ejected from his stationary aircraft. He was not significantly injured.

This is an incredible tour- highly recommended by me if you find yourself in sunny San Diego.

Here are the brief collections of photos by me. Remember these are high def. and you can increase the size of the screen by the appropriate YouTube icon.

Stress, physicians and age

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Physician “burnout” is defined as loss of enthusiasm for work, feelings of cynicism, low sense of personal accomplishment.

I think the factors involved are infinitely complex. I will also hazard a guess that the issue of burnout builds on two fronts:  Stress and Age, and the nomenclature for each is radically different.

Front 1– The peak “burnout” in the age group of 36-45 comes on two groups:

Group 1.  Doctors that emerge from the long training grind to find out they’ve bitten off more than they can chew and are having trouble digesting it. Too many responsibilities, too much work load combined with the era of mortgages, spouses, kids and mounting expenses acquiring the creature comforts lacking in the austere training days.

Group 2.  Doctors that emerge from the grind to find out that their reward was a false promise and they really don’t like living with the end product. The difference between training for a career and the nuts/bolts of the career don’t match and they’re miserable locked into the saddle with no escape.

The salvation of group 1 is usually that the personality type that thrives in this environment is selected out during the gauntlet. Those that can’t hack it fall by the wayside during training, like Navy Seals in boot camp that ring the bell when they’ve had enough. I think this is an unusual burnout group.

I think group 2 is much more common and not necessarily amenable to filtering by the gauntlet. By and large, there is a big qualitative difference between trainees and attendings, and the realities of that difference are not necessarily apparent before the fact. Some seemingly high quality trainees go bust quickly in the clinch and vice versa, and as far as I can tell, it’s very difficult to discern which is which before the saddle is cinched.

I’d hazard a guess that this group is at highest risk for becoming functionally incapacitated, call it what you will, and also I might add a risk for suicide if there is no escape valve.

All complain about the following factors, but most realistic physicians understand these factors are identical to working for any major corporation in any career position.

Bureaucratic tasks, Too many hours, Compassion fatigue, Difficult employer, Difficult colleagues, The Affordable Care Act of 20008

I don’t think I have ever met a doctor that burst into tears at the thought of onerous paperwork. I do know some however that started drinking heavily at the thought of the Affordable Health Care Act of 2008. The stark reality is that all these things are the price of admission to medicine highly unlikely to cause significant lack of professional fulfillment for no other reason than they are ubiquitous to nature.

Front 2-  aging physicians are a much more convoluted and textured phenomenon- physicians who have successfully run the gauntlets to arrive at a place of relative safety only to discover seniority is a new liability. Inevitable physical limitations and the duty and obligation to make way for others climbing up the same ladder behind them. A different and much more subtle order of “burnout” from the rest.

The limitations and hassles of old age are not linear. They escalate rapidly after a variable certain age”. At 65 I was doing four night calls a month and bounced back easily. I was racing motorcycles and doing high-speed track days at 66. I thought of myself as limitless.

Then I slowly discovered my concentration on the track at 120 mph was fading and I started crashing, once twice in the same corner. I quit at age 66+ before I hurt myself or someone else. Night call quickly became difficult to maintain concentration and the day-after became more difficult to bounce back. I still had the same knowledge base but not as much concentration ability to apply it under stress.

At age 70, I have the exact same drive and passion to be the best I can as when I was at the top of my game at 36.  The only limiting factor is my physical ability to bring it all to bear as effectively and efficiently in a world of emerging young people with the same fire in their bellies. Thereby burns the age related “burnout” flame- the fear of becoming irrelevant. An absolutely terrifying, life threatening burden.

That will be the burnout issue that I think will require some creative thought on how to rectify, if it’s even possible.

Epitaph on my headstone:

“This is my generation…..

Hope I die before I get old”

Pete Townshend, 1965. (BTW, Pete is 71 this year)

 

 

Crippen enters the rarified air of high-end audio

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mcintosh-mcaire-xlI’ve been thinking that I’m behind the curve when it comes to actually listening to music anymore: a victim of the “digital ease” age.  It’s easy to just keep a menagerie of music in my iMacs and play them out of relative cheap desktop speakers.  In my office, I have speakers that stand about 2 inches high and they’re hooked to my desktop computer.  I have a huge supply of music and I just let it run during my day, mostly in the background.

My ears have grown accustomed to music the fidelity of which is about the same as a car radio. But as it turns out, the “real” fidelity of digital music is incredibly bad once you have something to compare it too.

The advent of iTunes has killed “high fidelity” as I remember my dad exploring it in the 50s with tube amplifiers and incredibly big speakers fed through enormous turntables. Highly compressed (for portability) MP3 music files lose a LOT of fidelity in the process. Even the music on garden variety CDs is pretty crummy compared to what it could be. The vast majority of the speakers they’re played through are junk, including and especially ear buds.

Music purchased through iTunes or over Internet radio contains a fraction of the total sound information captured in the studio — as little as 3% of the original. Even CD formats contain as little as 10% of the original information so it can be contained on a 4 3/4-inch disc.

It dawned on me that there must be more to musical life than Pablum in a world otherwise filled with sirloin, so I started sniffing around the erudite world of “audiophiles”.

To begin with, digital music is capable of “high fidelity” in the form of uncompressed audio files such as FLAC, WAV, AIFF, and “Apple Lossless files” but there are two problems.  Space and bandwidth. It takes a LOT of space to contain these files and the equipment required to play them to their maximum extent is expensive.

Aging 60s rocker Neil Young has led the charge to affordable players for uncompressed music files for the past several years. Young filed six trademarks with U.S. Patent and Trademark Office in 2012, all of which would offer a higher quality audio alternative to mp3 files, but none have reached the marketplace yet. He’s starting to release albums on Blu-Ray for better sound quality and his high-resolution player is said to be in the works for 2014.

http://www.rollingstone.com/music/news/neil-young-plans-pono-launch-for-2014-20130904

Then comes the re-emergence of “audiophile” 33-1/3 vinyl discs. Yes, vinyl is definitely coming back, and in extremely high-resolution format, said to be as close to studio quality as it’s possible to get.

They’re going all the way back to the 50s and finding the original master tapes, then putting them on vinyl in an amazingly lossless high tech process no one dreamed of back in the day. What you hear is as if you were standing in the control booth watching Linda Ronstadt in 1976. They now cost about US$30.00 each. The “sound” is said to be amazing and spectacular (I have not heard one yet).

http://www.mofi.com/product_p/mfsl1-319.htm

As the discussion proceeds, we’re now talking about the rarified air of hardware for the discriminating listener.  With a little research, three things become apparent. There is no limit to the ability of hardware to reproduce sound fidelity, there is no limit to the amount of money that can be spent to do so but there is a limit to what my aging ears are capable of discerning.  A perusal of the available hardware is fascinating (especially the cost).  You can easily pay US$10,000 for a set of speakers.  Many of the hard core literally build their houses around US$350,000 audiophile hardware.

There is simply no discernable point of diminishing returns. The more you pay, the more rarified audio acuity you can get. But at some point, the line on the graph heading up into infinity exceeds sanity, especially since I only listen to 60s and 70s classic rock. Not exactly the same fidelity required might be the entire New York Philharmonic playing Beethoven at 100 decibels.

Interestingly, all my research eventually led to the same place it did for my dad in 1956 when my mother was loudly predicting the end of the world at the hands of the Prince of Darkness, Elvis. McIntosh Audio. (Note different spelling- not to be confused with Macintosh Computers). In the end, when you’re seeking high end, all paths lead to McIntosh and once that obsession becomes manifest, an emptying of your wallet.

http://www.mcintoshlabs.com/us/systems/pages/systemdetails.aspx?SystemId=SoHoIIMusicSystem&Systemcatid=Music

Back in the day, the high-end amplifiers were all vacuum tube driven. They were big and heavy and required equally big pre-amplifiers to drive them into enormous stereo speaker cabinets.  My father ate peanut butter sandwiches for months to afford what was then a rudimentary McIntosh setup. Tell the truth I can’t remember what it sounded like but I remember him reposing for hours in a darkened room enjoying it.

So I decided to dip my toe in these waters with a relatively entry-level McIntosh combo unit that will play uncompressed digital files (for me, FLAC “Free Lossless Audio Codec” files) on my iPad and iPhone. Each of these files are not completely uncompressed but somewhere in the range of “better” to “much better” than straight up MP3. Not even close to vinyl but cheaper.

http://www.mcintoshlabs.com/us/Products/pages/categorylanding.aspx?CatId=NewProducts

The unit allows wireless loading with FLAC files from either an IPhone or iPad.

http://www.youtube.com/watch?v=_SMma_CQJ3I

It sounds absolutely amazing. So this will give me a taste of audiophile. Someday if I save my pennies and dimes (US$100 bills) I might look into building a full McIntosh system with a high-end phono player for the emerging mastery of vinyl.

It’ll be in my Scaife office around Christmas week. Drop by and I’ll give you a quick lesson in the difference between MP3 and FLAC.

 

 

 

 

 

 

Some personal observations on the events of Nov 22, 1963

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It was the year 1959 AD. My dad was the only general surgeon in a town of about 10,000 souls located in northwestern Wisconsin studiously picked for his hunting and fishing passions.

He was a very conservative Republican as most if not all doctors were at that era. The “up by your bootstraps” age selected for them. The best government was no government, and in the escalating post war, post-Eisenhower age of prosperity, that seemed attractive.

Credit cards were virtually unknown. Gas was 29.9 cents a gallon, a mortgage on a nice house was a hundred bucks a month, a nice car cost US$2000 and virtually all health care was affordable out of pocket. There was no Medicare or Medicaid.

But the Eisenhower era was closing and a new era of cold war paranoia was emerging with the Presidential election of 1960. The world was becoming a dangerous. I was a sophomore in high school and my only interest was girls and cars, pretty much in that order. My interest in politics was yet to emerge so I was pretty much a disinterested observer.

The two candidates that emerged for 1960 were polar opposites, Richard M. Nixon, a crusading anti-communist from California and Kennedy, a relatively new senator from Massachusetts.

In the first ever TV debates in living black and white, he looked sneaky, dark and foreboding as opposed to the other guy, Kennedy, who brightened up the screen with an articulate vernacular. Even to my naïve eye, Nixon looked positively sinister.

Seemed like a pretty easy choice to me, but there was a problem. Kennedy happened to be a Catholic, a big problem in 1959 American culture. Catholics were very much discriminated against in mainstream America, thought by many to be as much a cult as “Christian Scientists” or “Scientology”.

Catholic. That’s all my bible thumping conservative Baptist mother needed to hear. So I could hear from my bedroom the fervent pleas that Richard Nixon would save us from being ruled by the Pope. But it wasn’t to be. Kennedy was elected by the thinnest of margins and my dad had to pull my mothers head out of the oven.

But in the end, Kennedy went on to become possibly the more revered President in American history, maybe rivaled by Bill Clinton. Interesting that they shared the same vices, but with different media access saturation.

But no matter. Kennedy was perhaps the most intelligent, articulate, funny President our country ever had. If he had shortcomings, all downplayed them. He and his family formed a veritable dynasty that was almost immediately equated with the Camelot legends of King Arthur. It is impossible to overestimate the love this man accumulated by the American public, (never my mother).

It was an idyllic scene unsullied by the eventual cultural revolution of the late 60s and the war in Vietnam. A relatively brief period of quietude and prosperity that was destined to collapse under it’s own weight, but it was extraordinary while it lasted. My only worries were girls and cars.

Cut to November, 1963. I had flunked out of the University of Wisconsin the first time (long story) and had eased into a job as an “orderly” at the local hospital where my dad practiced general surgery as I plotted my next move. The then Director of Nursing was the venerable and formidable Miss Myrtle Worth who watched me closely. After she died the hospital was re-named after “Myrtle Worth Memorial Hospital”. But that’s another story.

Sometime in the early afternoon of 22 November I was perambulating down the hall of one of the hospital floors on my way to some chore, probably carrying a bedpan, when one of the TV sets in the rooms I was passing by suddenly proclaimed a “We interrupt this program”.

This was a little unusual as these kinds of interruptions rarely justified breaking into regular programming. So I stopped and backed up in time to see Chet Huntley (NBC News) solemnly announce that President Kennedy had been shot in Dallas and no details were available.

Everything in the entire hospital instantly stopped cold. Every nurse, every administrator, every doctor all stopped what they were doing and congregated around the nearest available TV. Shortly thereafter came the famous spectacle of American’s most trusted TV commentator, Walter Cronkite, sadly proclaim with tears in his eyes that the President was dead.

There are no words even in my formidable vocabulary to express to you the emotional and cultural disaster that followed. This was absolutely unprecedented on every level. Camelot by its nature was impenetrable. No one ever thought in their wildest dreams that Camelot was vulnerable. To have it come crashing down was a cultural train wreck of immeasurable consequences. Like an out of control LSD trip, there was n way to process it.

What was to follow was unbroken ground, chronicled minute to minute by the unblinking eye of network TV in living black and white. Everything in the country stopped dead in its tracks, and I mean EVERYTHING. Every radio station carried only continuous funeral dirge music. There was no traffic anywhere. All businesses were closed including gas stations.

Everyone in the country sat ensconced before a TV set watching the funereal progression, the caisson, the riderless horse with boots reversed in the stirrups, the lying-in-state under the Rotunda, the unimaginable grief and horror of his wife preserved on.

It was like a nuclear winter until after the funeral when things slowly came back to at least baseline, but never actually back to normal. Even my mother was in tears. We then went on to the further culture shock of Bobby Kennedy and Martin Luther King, further illustrating the danger society never dreamed of on November 21, 1963.

 

 

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EddieWhen I was a resident in about 1980 or so, someone from a production company landed in the ED at Methodist Hospital in Indy and I ended up involved somehow. A bunch of their wonks showed up and I ended up getting involved with them explaining the case. Turns out they were part of Detroit rocker Bob Seger’s road show “Bob Seger and the Silver Bullet Band”. So one of them gave me 2 tickets to the show and a backstage pass. Also gave me a T-Shirt from the British metal group “Iron Maiden” as they were involved with that road show as well.

That was back in the days when I wore a medium T-Shirt and that particular shirt has been long since lost. I should have kept it as EBAY is selling authentic vintage 70s “Iron Maiden” T-Shirts (featuring “Eddie”) for US$1500 (but that includes free shipping).

http://www.ebay.com/itm/VINTAGE-IRON-MAIDEN-T-SHIRT-1980-L-ORIGINAL-RARE-/350893574413?pt=Vintage_Unisex_T_Shirts&hash=item51b2e3090d

Iron Maiden been around 33 years now, still playing, over 80 million album sales, more than 2000 live performances and 15 studio albums. Original bass player Steve Harris is still with the band.

http://www.ironmaiden.com

Iron Maiden has also played the T-Shirt niche like a Stradivarius.  THere are a thousand variations of Iron Maiden T-Shirts and they still sell briskly. Serious collectors snap them up like hotcakes.

http://tshirtslayer.com/patch/iron-maiden-backpatch-collection

Recently one turned up in a box of my junk. It’s a little small but it still pretty much fits. I think I purchased it in London sometime in the 80s. It doesn’t have the outrageous value of the 70’s versions but it’s pretty much the same ilk. I wore it for a CODES gig a while back.

Take Home message:  Save those Allman Bros T-Shirts. Who knows in 20 years?

 

Forward to the past: Come walk with me

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I send this remembrance out every year at this time. This and Timothy Leary and “Alice’s Restaurant”, the theme song of a generation that my Fellows know nothing about threaten to be forgotten, like Vietnam.

Let me bring back the vibrant remembrance because it’s important.

August 28, 1963 is the date of one of the most important and profound communications ever uttered by a human.

I have been a student of the 60s for most of my life, having lived and participated in much of 60s culture. I’ll spare you the details this time of my own experiences standing twenty feet from Dr. King during a speech in Atlanta in 1965, but if you have an interest, you can check out my first book on the subject:

http://store.blurb.com/ebooks/404827-the-60s-70s-confessions-of-an-attentive-observer

The eBook version is free.

I lived in Georgia for a huge chunk of the civil rights years and I experienced and participated in much of it. Someday I’ll write the full book on it, but for the moment, just walk along with me.  I’ll paint you the color commentary as we maneuver through the throngs toward he stage. I’ll interpret what’s going on from the vantage of a participant.

This day, August 28, 1963, produced the “I have a dream” speech by Dr. Martin Luther King, a communication rivaled only by Lincoln’s Gettysburg Address at Gettysburg, PA, November, 19,1863, 100 years earlier. There are similarities and differences between the two speeches.

Like King, Lincoln explored the principles of human equality, but proclaimed the Civil War as a struggle for the preservation of the Union necessary to frame principles thereof.  But unlike the King speech, Lincoln’s mood is described by Ken Burns as a quiet, almost whispering matter-of-fact tone directed at no one in particular within the relatively small group present.  At the time, it was virtually ignored. There is only one photograph from the Matthew Brady collection of Lincoln delivering the speech and it was from a distance.

The enormity of Lincoln’s speech is contained in the words, not the enunciation. Conversely, Dr. King’s speech occurred at the largest and most important civil rights demonstration in history and it was loud, covered by all three major TV networks. At the time of the demonstration, two thirds of the nations persons of color were not allowed to vote, attend integrated schools or use public facilities. 250,000 participants jamming the National Mall demanding civil rights legislation that was only to come two years later.

King took the stage just before noon with a prepared speech and began reading from it word for word. The text decried the fact that “fivescore years ago” Lincoln’s Emancipation Proclamation on July 1, 1863 freed the slaves in the ten states that were still members of the Confederate States of America, applying to a relatively small number, around 4 million slaves at the time.

But King goes on to lament: “100 years later the negro is still not free!”  “Lincoln’s promises were a bad check and “we’re here to cash it!” Then about halfway through the text something important changes. King looks up at the crowd sensing an opportunity to pontificate extemporaneously, as he did frequently in other speeches. The text did not match the emotion required at the moment and King simply went with the flow as he felt it, acting more like a Baptist preacher on a roll than an interpreter of a prepared text.

King was the undisputed master of grabbing audiences and holding them spellbound. On this day, he found his theme and worked it mercilessly, alternately chastising the crowd then raring back smugly, basking in himself. His words did not exist in any text. They were created in his soul for the occasion and they flowed freely, some of the most important words ever uttered by a human, relegating King to every history book.

 “I have a dream that one day on the red hills of Georgia the sons of former slaves and the sons of former slave owners will be able to sit down together at the table of brotherhood”

“I have a dream that my four little children will one day live in a nation where they will not be judged by the color of their skin but by the content of their character”.

“I have a dream that one day every valley shall be exalted, every hill and mountain shall be made low, the rough places will be made plain, and the crooked places will be made straight, and the glory of the Lord shall be revealed, and all flesh shall see it together”.

At this point, King is totally consumed by unrelenting passion and running completely on maniac fervor.  A shoddy analogy might be watching Neil Young play “The needle and the damage done” on The Johnny Cash variety show in 1971. Young doesn’t know where he is or who’s in the room. He doesn’t know where the chords come from. He’s completely consumed with the story he wants to tell and everything accompanying it flows like a wild river.

“I hit the city and

I lost my band.

I watched the needle

Take another man….

Gone, gone, the damage done……”

But I digress.

Dr. King continues:

 “From every mountainside, let freedom ring. And when this happens, when we allow freedom to ring, when we let it ring from every village and every hamlet, from every state and every city, we will be able to speed up that day when all of God’s children, black men and white men, Jews and Gentiles, Protestants and Catholics, will be able to join hands and sing in the words of the old Negro spiritual………”

At this point King is close to emotional collapse. Those around him stare with slack jaws.

(Rising tonal cadence)  “Free at last! Free at last! Thank God Almighty, we’re free at last!”

King collapses into a chair, staring blankly at Ralph Abernathy. For a moment, the audience was shocked silent. John Kennedy allegedly turned to an aide and muttered: “Damn, this guy’s good”.

The “I have a dream” speech was he high point of his career, changing his public persona dramatically from a commonly perceived rabble-rousing jailbird to a fisher of men.  King biographer David J. Garrow wrote that King had created a masterpiece on the fly like some kind of jazz musician.

King was assassinated on April 4, 1968.  I was finishing Jungle School in preparation for Vietnam on that day and I witnessed the pain and frustration.

Here is a youtube rendition of the speech. It MUST be watched and absorbed by anyone claiming to be an educated person. Take the time to watch the entire eleven minutes of this one of the most important speeches ever made by a human. Watch for the transition to extemporaneous passion.