This is kind of tagged to yesterday’s post. I’ve been reading a number of old Playboy interviews with the American icons of my youth. These longform in-depth articles can be fascinating.

From the 1992 interview with Robin Williams:

PLAYBOY: Before children start seeing you as Peter Pan, do a lot of them still recognize you as Mork: Do you still get a lot of “Nano nano” when you walk down the street?

WILLIAMS: Some of that still goes on, but that’s in their brains in the memory bank of a country because it comes from TV. Watch the way people watch TV, it’s hypnotic. Just sit back and you’ve got cable and ninety-five choices and you don’t really care much about anything else. Eventually, you don’t know about history, you can’t remember if there really was a Civil War, and eventually people get slaves again. You can have a President that basically reads cue cards and it seems OK, because he’s just the guy on the series with the family with the little black child and seems all right, because he’s kind, and when he’s angry, it’s TV angry, where you get kind of angry but you don’t go, “Fuck off!” You basically get where you eyes dim and world seems all right and you kind of tighten up so much that your sphincter doesn’t open. Then people at home can be TV pissed and they can go to a TV war and watch it. We basically fought a war, watched in on the TV set, and you buy the tapes, sucking on the glass teat.

Note: of course Playboy in 1992 did not hyperlink to the Wikipedia article about Ellison’s collection of essays. However, if time travel becomes a reality, they might.

There are number of reasons I like this quote. One, it brings to mind the Grebulons from “Mostly Harmless” (the fifth book of the Hitchhiker’s Guide to the Galaxy trilogy) who were studying Earth through the stray TV transmissions that echo across the vastness of space. As you might imagine, the Grebulon’s developed a somewhat less than ideal understanding of Earth’s people. Second, it reinforces the role played by popular art and media in our understanding of the world around us. And our language.

When one considers the hundreds of channels available, desperate for content, it does not take much effort to think about how often movies are broadcast on traditional networks and cable networks. With little effort, one can click over to IMDB.com and get a list of references in other media to a given film. For example, there are over 400 references to Silence of the Lambs. Does it take much effort to think that 20 years later the line, “It puts the lotion on its skin or it gets the hose again,” is not alive in the ether? The fact that I heard this quote used in completely unrelated casual conversation the other day just reinforces the fact it is alive.

In the mid- to late-80s, during the phase of my undergraduate career that followed my three-year sabbatical in the Army, one of my classmates in the art department confessed to an ongoing fascination with Stanley Kubrick’s “A Clockwork Orange.” He and some of his friends had memorized the dialog for the entire movie and would re-enact scenes. They were particularly fascinated with the milk bar concept. If, in an age when cable channels were relatively few and VHS rentals were still the big thing, such absorption was possible, is it any real stretch to understand how films or song can infiltrate the consciousness of a group?

It is an amazing time we live in today. Yesterday I sat in the waiting room of my wife’s rheumatologist and watched an episode of Last Week Tonight on my ever-present-personal-infotainment-device, also known as a Samsung Galaxy Note 4. I can Google the phrase “Paper Chase script” and get the movie script (I did this for another blog).

As a SiriusXM subscriber for the last decade I listen predominantly to a handful of channels, one of which is Outlaw Country. Talk about a wide-ranging format to fill commercial-free airtime! Decades of music from big names to names so little you wonder how their music ever got heard. And it is often good enough to make you wonder why it took so long to hear it. Genre and the preconceptions of others defining country music, outlaw or otherwise, are little more than a fiction for this channel. Bob Wills, Jimmie Rodgers, Johnnie Cash, Waylon Jennings, David Allen Coe, are all heard alongside Bruce Springsteen, the Rolling Stones, Tom Waits, and Old Crow Medicine Show.

Pandora, Spotify and other services, not to mention all the fileshare (media theft) sites make connections in music that cut across multiple subcultures and boundaries.

To think that people are not affected by these things is absurd. To not realize or be aware of the constant now-ness of the availability of media to young people (or old people) is just an insane level of cluelessness.

It is all available. Now. (Kind of like the end of Highlander, where there can be only one, but we’ll make it two if it justifies a sickening sequel.)

The possible influences on culture and language are beyond myriad. Who knows what will resonate? Movies that were critical failures, or even box office failures, have found new life as cult classics or simply appealed more to another group at slightly different time. Mel Brooks one time defined comedy as taking reality and moving it two inches to the left or right. I suspect that sometimes two inches is not enough and new appreciation is found a year or so down the road when the two inches seems more like four or five.

To say that people don’t talk a certain way and use that as justification for a desired disbelief in an event is just nuts. I don’t have a clue how people talk until I sit and listen to all of them. Even then, I have to understand that my presence my influence how they speak. The language of youth has always been filtered around the old.

Deal with it.

“Despite Brown’s proven capacity for doing the impossible, as for example starting a magazine about mercenaries, he has a boundless talent for mismanagement.”

Life With Bob: A Sordid But Instructive Interval At Soldier of Fortune Magazine, March 1984.

This is such a good line. I read it and re-read it, thinking about all the college presidents, provosts, and vice presidents, I have known for which it is an apt description. If you doubt me, just look at the last two weeks of InsideHigherEd or the Chronicle, especially if you include mismanagement of self and the spoken word. It has not been pretty.

Another useful comparison is Senator Laffer on the  series “Alpha House” on Amazon Prime. It’s an over-the-top show, and Laffer is taken to tongue-tied extremes with an inability to speak coherently off the cuff. It’s fun though. (The second season episode “Retreat” with a Ronald Reagan impressionist presenting Reagan quotes to Senate GOP members who have lost touch with the real Reagan is terribly fun.)

Of course, if one goes by the comments at either site, it seems pretty clear that higher ed is a mess. None of us can be trusted to speak or write without extensive coaching.

“If, as someone said, the intelligent man adapts himself to the world, but the genius adapts the world to himself, Bob is a genius, living in a world he has built to his own specs. A fantasy world, yes, but Bob knows where reality begins and usually stops short of getting into trouble.”

Does this describe the modern university?

I think it probably does. Institutions are still pretty insular, isolated from the local communities in many ways, despite decades of talking about “town and gown relationships.” I mean the concept that somehow it is appropriate for institutions to determine how to handle sexual assault and rape still floors me. I understand the issues. I have had long discussions with presidents and board members about the topic, and I think I understand their positions. I just disagree. Even if I separate out the issues of governance and whether or not it is appropriate for college administrators or committees to adjudicate rape, the fact that a college has so much discretion, and even control, over determining whether an event occurred that they know they have to report to the federal government and thence to the public, is just wrong.

If an administration knows that each rape must be reported annually, and doing so “casts the institution in a negative light,” for that reason alone, an institution has a vested interesting in saying it wasn’t rape.

This is wrong. It violates the concepts of transparency and accountability, and for that reason alone it should not be allowed.

And that’s clearly the least of the reasons that it is wrong.

The mystery is how anyone as inept as Bob can survive while doing the things he does. In the Special Forces, he was known as Boo-Boo Brown because he couldn’t get a drink of water without breaking his leg, losing his wallet, or setting off NORAD alarms. It’s hard being a deaf commando with no memory. Bob once left an open bag full of cash in an airport in Bangkok—just forgot it, the way normal people forget a paperback book. Many who know him think he really needs a mother, or a keeper, and the incident suggested that he may have an invisible cosmic sponsor: The money was still there when a traveling companion went back, which is impossible in Bangkok.

Sometimes I wonder how these institutions have survived so long. Yes, there are many good, very intelligent, well-intended people at the helm and throughout each, but somehow dumb stuff keeps being done. A $219,000 conference table that is justified because of its embedded technology – technology that will be thoroughly outdated in just a few years. (Since one of the commenters at the linked article has already made the Holy Grail connection, I will forego my own reference, other than mentioning the Round Table portrayed in Excalibur was a segmented ring, leaving the center open. A much more practical design.) Justification and rationalization is second nature. After all, if funders, a state legislature, governing/coordinating body, or the federal government directs that something be done, compliance is cheaper if one can rationalize that an existing activity meets that need. The justification for doing so is generally “we’ve got limited resources and can only do so much.”

Sexual assault is not a new problem on campus. It is time to seriously address it and stop making excuses. For those who find the event depicted in the Rolling Stone article fictitious because of the language used by the assailants (referring to the victim as “it”) as improbable, might wish to recall The Silence of the Lambs. Images and dialog often transcend generations and unless you hang out with a lot of young people in very informal circumstances, you may not have a freaking clue what is currently floating around.

In fact, you probably don’t have a clue anyway. There are always disconnects between generations.

This morning I read part one of Rick Hess’ blog post on experts. I reacted pretty much like, “okay, yeah, I get that.”

This afternoon I lived it.

My wife started physical therapy today. We are nine full months and three surgeries into this adventure. Today’s appointment was after weeks of pushing for it and demonstrating over and again that she needed more support than she was getting. The news was not particularly good in that the physical therapist recognized that the orthopedic therapy clinic was not fully equipped for a case like hers and so she was going to work to get her therapy at another facility. (At this point we are really trying to avoid moving my wife into a rehab facility. We recognize that might be necessary though.) It is a challenge for medical providers to work with such a complex case as my wife’s: fallen arches, severely arthritic knee, damaged hip, and a genetic connective tissue disease. And chronic pain. Severe chronic pain. There have been far too many tears and cries of pain in the last few weeks.

After physical therapy we dashed 20+ miles across town to meet with a surgeon on a non-orthopedic issue at a different hospital.

After negotiating the narrow maze of hallways, after the hard-to-open doors, and then squeezing into a small exam room, but only after the nurse pushed the exam table against the wall, I was struck again by just how ill-prepared most medical office buildings are for wheelchair access. We really are talking about the very bare minimum of accessibility standards being met.

Anyhow, we met with the surgeon, reminded him why we were there (at the recommendation of a colleague of his) to revisit and reverse a procedure from several years ago. The discussion was fairly brief. He agreed with the recommendation of his colleague. He then turned  to describing the surgery and risks. As he began to talk about scheduling, I interrupted.

“Excuse me. Wouldn’t it be better if we waited until she can walk again?”

“Why do you think so?”

“Well, I recognize that this is laparoscopic and outpatient, but she has rather significant problems now with mobility. They may yet have to repeat the foot reconstruction a third time, and she is already in far worse shape now than at this point after the first surgery. Also, if, as you say, your fallback is to do a fully open abdominal surgery in case something goes wrong, don’t we want her in better shape than she is now? Especially if this does not need to be done right away?”

“You’re right, absolutely. There’s no rush. It’s good he came with you. I’ll get you my scheduler’s card, and you can set up when you’re ready.”

Specialists. So focused on what they do, on what we hope they do best, that it seems sometime they forget the rest of the patient. In the last year, this is not the first time I have noticed this focus on specialty. Nor do I expect it to be the last. However, I do think it is evidence of a greater need for multidisciplinary care. While some would suggest that this is the proper role of primary care physician, but I disagree as it appears to that  primary care is just another limited specialty. Limited primarily because of the lack of quality time available to spend with each patient.

As George Hamilton said in Doc Hollywood, “Medicine is a volume business.”

We need doctors whose specialty is to support patients that are receiving care from multiple specialists at the same time. This is not to say there aren’t docs who do a good job with “whole patient care” now. There are. One of those was my brain surgeon. He was really good about understanding what I needed, what I might need, and why my own research about my very unusual case was necessary and helpful. Some cases are like mine. They are unique. They are atypical. And the patient and/or their advocate is likely the most capable about knowing what is going on. Good doctors recognize that.

My wife’s case is like that. We know that she is Case 0 if a specific genetic connective tissue disorder. Our son is Case 1. Similar to a well-known connective tissue disorder, but not exactly the same. Different. And some of the characteristics are radically different.

Which means that patient advocacy is important and that it is almost always good idea to have an advocate with you. Someone to ask the questions you forget, and to hear the things you don’t.

Of course, all this applies in higher education and elsewhere. I have some expertise in higher ed data and data policy from years of experience. I try very hard to be aware of the blinders I wear. I can’t pretend they are not there as they are a result of expertise and an inherent need to feel competent and thus define problems in a way I can best address them. (This is something I learned in the public policy program at Saint Lous U, so I doubt that it is unique to me.) I try also to be well-read enough to be at least comfortably aware of the very many things of which I am ignorant. It is all too easy to get wrapped up in yourself and assume your expertise carries across other things.

Save me from the sin of expertise.

There is an essential helplessness to being a caregiver. There are times one just has to stand by and hear the groans and complaints and accept that nothing can be done at the moment to eliminate the pain or difficulty. At other times you stand by and watch your patient/spouse/child/parent struggle to do something, waiting until they ask for help, knowing that doing too much for them slows down their recovery.

When my wife brought me home from the hospital in 2010, it was a nightmarish ride through the streets of Richmond and Chesterfield. At least from my point of view. A mere two weeks after 32-hours of brain surgery followed by six days on a breathing tube and 12 days with an NG tube, my head was incredibly wonky and I had only been able and allowed to walk a few days, with a great deal of help, and so I was incredibly weak. When we got home, I had to figure out how to slide out of the truck and get in the house. My wife had “raced” ahead and “dashed” up the stairs of the front porch. She stood at the door and grinned wickedly as I struggled to decide first, if I could get up the steps, and then to make myself.

She knew to wait until I asked for help, one of the advantages of being a special ed teacher.

The situation is reversed now. The inability to walk since May has led to significant muscle loss. After another fall, she has spent this week in a wheelchair and we are looking at further minor modifications to the house to make things a bit easier. There are frequent times that I have to stand by and listen to her moans and struggle to do something, knowing I can’t really do much to relieve the pain or make things easier for her. I can talk to her, I can listen, and do what is needed, but I can’t solve all the problems. I can’t make the pain go away. Nor can I take away the frustration she feels at her inability to do basic things. I can only help her try to get stronger and to continue to self-manage as much as possible.

One of things I can do, must do, is recognize when she is unable to make a decision in her best interests. This can be as simple as suggesting that attempting to go out to dinner is not a good idea, or, as we learned the hard way, recognizing when a new medication is causing a problem and taking it away. It also comes down to insisting when it is time to go the ER, or not. At some point, it may come to the point of insisting on moving to rehab or other arrangements if we get to the point where the house is no longer adequate or she needs more time than I can give.

It is hard to do these things without a certain amount of helplessness and ruthlessness. Helplessness in knowing and understanding the limits of what you can, and should, do to help. Ruthlessness is also required to do things that cause pain or discomfort, out of necessity for the well-being of the patient. There is potential for degrading a patient’s agency that is too great if one does too much. There must be a balance.

And all of this is part of what struck me in reading the Rolling Stone article about the gang-rape at UVa. There seemed to a complete lack of any sense of caregiving in the story. Whether it was the victim’s friends or the institution. No one seemed interested in or capable of stepping into the role and doing what is needed for the good of woman at the center of the story…or any other woman at the center of similar stories.

The role of a caregiver is not easy. It is the human thing to do though, and the right thing to do.

It can be hell keeping a secret.

Especially if it is not really a secret. But it kind of is, for a few days at least. Sometimes stories emerge from data. Other times it is only the necessity of a story that emerges from the data. When that happens, you call, email, or text, and ask for the story. And wait.

Usually, such stories only matter because they are interesting on their own.

Sometimes the stories need to be told at a time that the telling intersects with other events, other stories. That is when things get to be a lot more entertaining. Those are the stories I like. I like it when Stephen King pulls in bits of other stories to reinforce the place and time of the “current” story. I also grew up listening to Paul Harvey and his signature line, “…and that’s the rest of the story.”

The thing is, and this what is really on my mind, there is never really enough information available when many decisions have to be made. Sometimes we have to just go with what we know, hoping all the while we have asked the right questions, and have been accurately and truthfully answered. As an observer of an unfolding story, I often wonder, “who knew what, and when?”

Sometimes though you simply just have to make a decision and trust the process.

Today I spotted a sweet little brick Ranch-style house for sale, not far from where we live. We have been thinking about moving because it may become necessary if my wife is going to be unable to climb stairs for a couple of years or longer. It is either move, spend a lot of money reconfiguring our house in a very nontraditional way, or building a substantial addition. However, I am not in a hurry to move. It is a lot of effort and time that could be spent doing other things at a point when the necessity is unclear. Actually, I am not actually in a hurry to do any of these things because of the cost.

But. A house that may be ideal is available now with a good price. It’s tempting. I simply don’t have enough information right now as to the necessity. Sure, there is no real loss, other than time, if we were to move now. But the driving need is not there, and, quite frankly, I may need to consider other issues when it is time to do move out of necessity. So the decision, which is the right one, is to stand pat. Time of this nature is a real luxury.

Pity the poor soul that did not have the luxury of time and had to make a decision when he did. Or at least, when he thought he had to do so.

So, I have thought about this today.

I think it is kind of hard to have a relationship with an admiral (or general, and I have known more generals than admirals). Boomers grew up with Captain Kangaroo and he may have been naturally replaced by Captain Kirk, depending on one’s age. In Northern Virginia, and I guess the DC metro, in the 1970s on UHF we had Captain 20.

We have Captain America.

And, of course, Picard, Sisco,Janeway, and Archer.

Captain Jack Sparrow.

Captain Jack Harkness.

Captain Underpants.

Captain Fantastic (and the Brown Dirt Cowboy).

Captain Morgan (of whom a number of my friends seem to have intimate knowledge).

Captain Dallas.

Captain Lone Star.

Captain Hook.

Captain Crunch.

Captain Jonas Grumby.

But even though Kirk made admiral, we never call him Admiral Kirk (save, I guess those of more rotund stature desiring a more flattering cosplay experience).  All these captains above are pretty cool. I can’t think of an Admiral that I would consider cool. Akbar was always too stiff to be considered cool.

I guess for me, growing up, and mostly still, my heroes were always cowboys and captains.

Captain Fantastic raised and regimented, hardly a hero
Just someone his mother might know
Very clearly a case for corn flakes and classics
“Two teas both with sugar please”
In the back of an alley

While little Dirt Cowboys turned brown in their saddles
Sweet chocolate biscuits and red rosy apples in summer
For it’s hay make and “Hey mom, do the papers say anything good.
Are there chances in life for little Dirt Cowboys
Should I make my way out of my home in the woods”

-“Captain Fantastic and the Brown Dirt Cowboy” Bernie Taupin

I remember every little thing , as if it happened only yesterday.

Of Mans First Disobedience, and the Fruit
Of that Forbidden Tree, whose mortal tast
Brought Death into the World, and all our woe

And I never had a girl, Looking any better than you did
And all the kids at school, They were wishing they were me that night

Things unattempted yet in Prose or Rhime.
And chiefly Thou O Spirit, that dost prefer
Before all Temples th’ upright heart and pure,

And now our bodies are oh so close and tight
It never felt so good, it never felt so right
And we’re glowing like the metal on the edge of a knife
Glowing like the metal on the edge of a knife

Who first seduc’d them to that foul revolt?
Th’ infernal Serpent; he it was, whose guile
Stird up with Envy and Revenge, deceiv’d

Though it’s cold and lonely in the deep dark night
I can see paradise by the dashboard light

The Mother of Mankind, what time his Pride
Had cast him out from Heav’n, with all his Host
Of Rebel Angels, by whose aid aspiring
To set himself in Glory above his Peers,
He trusted to have equal’d the most High,

Ain’t no doubt about it we were doubly blessed

‘Cause we were barely seventeen
And we were barely dressed

Ain’t no doubt about it
Baby got to go out and shout it
Ain’t no doubt about it
We were doubly blessed

No light, but rather darkness visible
Serv’d onely to discover sights of woe,
Regions of sorrow, doleful shades, where peace [ 65 ]
And rest can never dwell, hope never comes
That comes to all; but torture without end
Still urges, and a fiery Deluge, fed
With ever-burning Sulphur unconsum’d:

Baby don’cha hear my heart
You got it drowing out the radio
I’ve been waiting so long
For you to come along and have some fun
And I gotta let you know
No you’re never gonna regret it
So open up your eyes, I got a big surprise
It’ll feel all right
Well I wanna make you motor run

Cloth’d with transcendent brightness didst out-shine
Myriads though bright: If he Whom mutual league,
United thoughts and counsels, equal hope
And hazard in the Glorious Enterprize,
Joynd with me once, now misery hath joynd

Do you love me
Will you love me forever
Do you need me
Will you never leave me

To whom mild answer Adam thus return’d.
Sole Eve, Associate sole, to me beyond
Compare above all living Creatures deare,
Well hast thou motion’d, well thy thoughts imployd
How we might best fulfill the work which here [ 230 ]
God hath assign’d us, nor of me shalt pass
Unprais’d: for nothing lovelier can be found
In Woman, then to studie houshold good,

Do you love me
Will you love me forever
Do you need me
Will you never leave me

And good workes in her Husband to promote.
Yet not so strictly hath our Lord impos’d [ 235 ]
Labour, as to debarr us when we need
Refreshment, whether food, or talk between,
Food of the mind, or this sweet intercourse

I gotta know right now
Do you love me
Will you love me forever
Do you need me
Will you never leave me
Will you make me so happy
For the rest of my life
Will you take me away
And will you make me your wife
I gotta know right now
Before we go any further
Do you love me
And will you love me forever

O Woman, best are all things as the will
Of God ordain’d them, his creating hand
Nothing imperfet or deficient left [ 345 ]
Of all that he Created, much less Man,
Or aught that might his happie State secure,
Secure from outward force; within himself
The danger lies, yet lies within his power:
Against his will he can receave no harme.

I couldn’t take it any longer
Lord I was crazed
And when the feeling came upon me
Like a tidal wave
I started swearing to my god
And on my mother’s grave
That I would love you to the end of time
I swore I would love you to the end of time

With thy permission then, and thus forewarnd
Chiefly by what thy own last reasoning words
Touchd onely, that our trial, when least sought, 
May finde us both perhaps farr less prepar’d,
The willinger I goe, nor much expect
A Foe so proud will first the weaker seek,
So bent, the more shall shame him his repulse.

Wast present, and with mighty wings outspread
Dove-like satst brooding on the vast Abyss
And mad’st it pregnant: What in me is dark
Illumin, what is low raise and support;
That to the highth of this great Argument
I may assert Eternal Providence,
And justifie the wayes of God to men.

So now I’m praying for the end of time
To hurry up and arrive
‘Cause if I gotta spend another minute with you
I don’t think that I can really survive
I’ll never break my promise or forget my vow
But God only knows what I can do right now
I’m praying for the end of time
So I can end my time with you

Our lingring Parents, and to th’ Eastern Gate
Led them direct, and down the Cliff as fast
To the subjected Plaine; then disappeer’d. 
They looking back, all th’ Eastern side beheld
Of Paradise, so late thir happie seat,
Wav’d over by that flaming Brand, the Gate
With dreadful Faces throng’d and fierie Armes:
Som natural tears they drop’d, but wip’d them soon; 
The World was all before them, where to choose
Thir place of rest, and Providence thir guide:
They hand in hand with wandring steps and slow,
Through Eden took thir solitarie way.

Apologies to Milton, Meat Loaf, and Steinman

In May of 2014, my wife had reconstructive surgery on her right foot. The objective was to give her an arch and reduce her pain. Up to this point in life, she had a painful inverse arch that had worsened over time. Following surgery the plan was that she would be in a non-weight-bearing cast for six weeks, a walking cast for four weeks, and then a boot for another six weeks.

This requires change and adaptation. Especially in a two-story house. With the master bedroom upstairs and a houseful of people.

Prior to surgery, I built a temporary ramp on the side of the front porch. Why? Because non-weight-bearing means exactly that – she was not allowed to put any weight at all on that foot for six weeks. The most she was allowed to do was was use it for momentary balance. How did she get about? A knee walker, or kneelie as we call it, a rolling cart for her to rest her leg on.

My wife’s knee walker.

At first, this went fairly well. The ramp I built was steeper than ADA specifications, but we believed it would be fine for six weeks of the kneelie, and then another six to eight weeks of a walking cast and a boot.

Did I mention her other problems?

Her knees were almost, and now just about completely, without cartilage. Bad arthritis. Her left knee must support all efforts to sit or stand. Her right knee supports part of her weight on the kneelie. she has bad bunions, and a host of other problems. Most of which originate from a connective tissue disease, which we understand, based on DNA analysis, she is Case 0 and our son is Case 1. Yep, a new genetic disorder similar to Marfan Syndrome.

So, like I said, things started off well enough.

On June 24th, during my last presentation at the VLDS conference, she fell off the wheelchair ramp at the office of her neurologist. She wound up in the ER with a concussion. Save that the concussion wasn’t really diagnosed until weeks later after a second (or it might have been third) fall. The cause of the fall was a poorly maintained ramp with a crack in it. A crack which caught the wheel of the kneelie, twisted the steering, and cost her balance.

Wheelchair ramps, unsurprisingly, are constructed (and maintained) with foot traffic and wheelchairs in mind. Not so much for these new mobility devices. More on this later.

The concussion lead to balance problems and then more falls. At one point I decided our former daughter-in-law (who was living with us at the time with the two grandelves) would no longer drive and escort my wife to appointments. The falls never occurred in my presence. There were some near falls, but I

Our new wheelchair ramp

was paying attention and caught her. Fortunately, I am big enough and strong enough to do so. This is why I have spent so much time taking her to appointments since July. In part, at least.

In part because about three weeks after she got her walking cast she started experiencing a lot of foot pain. It got worse when they put her in the boot. It was then we all noticed that things did not look right. Her arch had fallen back out. X-rays showed the surgery had failed. Other parts of the surgery had healed properly, but not the arch. The bones had not fused. We scheduled a second surgery in September to make a second attempt. In this case, the plan was that she would be non-weight-bearing for 12 weeks and we would use three hours daily of magnetic therapy (to encourage healing).

The downside to this is that she has gotten steadily weaker since May. She was not fit to begin with (and I should note May’s surgery was following arthroscopic surgery on her left knee in February, and she had not regained strength from that) and the lack of walking and other activities had a really negative effect on her. By mid-September the pain in her left knee was becoming unbearable. Her knee specialist suggested that she might have to resort to a wheelchair full-time for she was out of a cast again.

It was then we started thinking about access to the house again.

My wife is a big girl. That temporary ramp was going to give me a workout pushing her in a wheelchair. More importantly, and we learned this the hard way, the design of the porch is such that  is almost impossible, almost but not quite, to get her wheelchair in front of the door from the side. Further, there is very little margin of error to avoid rolling her down the front steps. So, we had a wheelchair ramp constructed the first week I was away for the executive institute. I designed its layout to minimize the incline and impact on curb appeal. It would have been possible to build it in such a way that there was no incline whatsoever, but that would have looked odd.

The new ramp makes a huge difference in accessibility to the house. So far we have used the wheelchair only one day. That was the day after we were rear-ended and she had gotten pretty stiff and sore. (By the way, we have moved the bedroom downstairs into what used to be the office. This may be the case for a couple of years as she faces having both knees and a hip replaced. And bunion surgery.)

Escorting her to all these appointments, some 15 or 20 hours each week, has taught me a lot about what accessibility really means. And it is not just clinics and hospitals, but also restaurants and hotels.

Like I said earlier, most accessibility adaptations are focused on wheelchairs. Wheelchairs have great big drive wheels and much smaller wheels for maneuvering and balance. They tend to much less effected by relatively small deformations and surface imperfections. This is especially true for powered wheelchairs.

However, with a greater range of technologies for mobility and surgical options that didn’t really exist before, combined with an aging population that wants to be out in the world, accessibility takes on new meaning. The 3/4 inch-wide, 8 inch diameter wheels found on these devices are more subject to getting caught or redirected than what is required in the minimal ADA-compliance standards.

Some of the things I have noticed:

• Maintenance of ramps and transition points are critical. Much of this is not being done.
• The pebbled/bubbled surfaces on outdoor ramp transition pads are not helpful for mobility devices.
• Many doors, surprisingly in clinics and doctor offices are not really accessible. They are too heavy.
• Examining rooms too often do not have chairs with arms. These are a necessity for people like my wife as she has to push up with her arms to get onto her one good foot, orthopedic centers tend to understand this, but even they don’t always carry the ideas through into the exam rooms.
• Office staff apparently don’t always know what to do if a patient falls.
• Deep pile carpeting can be make things much more difficult.
• Hotels should be careful about advertising accessible rooms with a roll-in showers when they, in fact, have tubs.

Some offices are well-run business operations. Others are just lousy. This is true for both public/nonprofit clinics and for-profit clinics.  There seem to some themes about the problem areas, but I don’t really have enough observations to confident with being more specific. It is clear though that some places we simply have to plan on an 8am or 9am appointment going until almost noon.  Other offices are very well-run, never appear to be over-booked, and we know how long we expect each appointment to be. Certainly there is great diversity in patients and their issues, and if I understand that, I expect healthcare providers to be able to understand that and schedule accordingly. Don’t assume every patient is a five-minute visit if you can calculate an actual average of 18 minutes. I understand the need to maximize revenue and reduce costs, but I have heard enough patients at one facility complain about a 2.5 hour visit and process to get five minutes with the doctor to believe there is something untoward going on.

And here’s a pro-tip for a now former provider: It doesn’t make any sense whatsoever to deny that you called your patient and left a message when we have the recording and caller ID and a digital record. Either you are insane or stealing narcotics.

The most difficult part of getting my wife the care she needs is that we are dealing with a dozen specialists. All of whom suggest someone should be reviewing her meds and coordinating care. Unfortunately, they don’t who that person should be. It is beyond the skillset of her primary and they have no other recommendations and don’t volunteer. She is in process of being referred to Mayo Clinic for review and study of her connective tissue disorder. We hope they are able to offer a solution.

She makes my big-ass brain tumor look like a walk in the park. Almost.

We are six weeks through this recovery. With luck. She will be walking in a boot at Christmas.

My brew-to and and brewing assistant

Today kicks off the first-ever homebrew competition restricted to ingredients grown in Virginia. The allowed ingredients are available from the Weekend Brewer in Chester, VA. This will be my first entry in a brewing competition.

Inside the mash tun

Brewing apparatus: hot water tank, mash tun, brewing keggle. Pvc pipe delivering water to the hot water tank and to the wort chiller.

My recipe is this.

10lbs Virginia 2-row
1lb red wheat
1lb medium crystal/55L
60 min 2oz Va Cascade hops
30 min 1oz Va Cascade hops
15 min 1oz Va Willamette hops
5 min 1 oz Va Willamette hops

yeast 805 RVA Piedmont

I plan to ferment at 64F for two weeks

My brewing assistant was showing signs of being cold, so I laid her sleeping bag on top.

It is one of my favorite type of fall days for being outside. Cool, occasional light rain from the deep gray skies, and trees still in fall transition. Its chilly, and I am not sure how long my furry companion will last out here. She is really an indoor dog. A 10 year-old rescue representing a kept promise to my son. She was four months old, give or take, when he brought her home from the shelter. Her arthritis bothers her and she is a bit lame in her back right leg. She is an absolute sweetheart though.

I love the renewed brew-to. Previously, the shelves and platforms were very minimal. These are more like counters. The height is right for a standard school if I wish to sit and type and just about high enough to stand and type. You may notice the mini-platforms that give about 4.5″ of additional height difference. These allow me shift things around and still use gravity to feed liquid from one place to another.

Ooops. I have screwed up. The instructions limit the IBUs (bitterness) to no more than 60, and I have hit 71. So, this batch will not going to the competition. Perhaps I will try again next weekend. Truth to tell, I didn’t really plan this recipe out, and a couple of things went wrong. It’s all good. I have four taps.

Inside the fermentation chamber