Nick's Blog

Growing Up With Fear

My childhood home was an hour south of Pittsburgh, one of the greatest steel producing centers in the industrialized world.  During those young years, my childhood was interrupted several times a year by adults who were attempting to help prepare us for the worst, the possibility of a nuclear holocaust. 

We used to practice hiding under our desks at school and would go into the hallway and cover our heads to protect ourselves from the flying glass.  (If you ever saw the films from the true tests, those desks were not impervious to the Hydrogen Bomb, and the hallway would probably have become a collection of toothpicks, but it was all that we had.) 

As a young paper boy, while walking home from my last customer, I can remember looking south toward Pittsburgh and wondering what the fireball and mushroom shaped cloud would look like when the Soviet Premier would finally become so frustrated with our democracy that he would launch the ultimate attack . . . on Pittsburgh. 

Imagine my lack of surprise when I moved to Johnstown, PA and discovered that at least one of the Superintendents of a steel mill here had their own personal bomb shelter, or that The Greenbriar had  a special underground shelter for our U.S. Congress.

Thankfully, the need to follow through with this planning never manifested itself as a reality in my life.  My dad, however, was born around the 1918 flu epidemic, and his parents couldn't get a doctor to come to the house because the doc was very busy.  That disaster did become a reality.

On the other hand, Y2K made plenty of my computer specialists friends a great deal of money.  Except for Cindy, a member of our Y2K team at the hospital, who accidentally leaned against a light switch at midnight, nothing of significance happened, anywhere in the world.

We can only pray that the current flu pandemic, the dirty bomb in New York Harbor and the premature death of our generation's overweight kids will also not become reality.  We can hope that, like my hydrogen bomb preparations, our time will be invested in worrying about a future that never arrives. 

Fortunately, I've been trained to worry.  It's been my history.  Most days, if i don't have some serious degree of anguish, it's probably either because I've slept in or was under some form of anesthesia for a medical examination.

Consequently, at Windber Medical Center, we are working to protect you from whatever disaster lurks out there.  It's our job to be prepared.  Steve, our internal co-coordinator for disasters, sent me this e-mail this morning: 

We utilize an all hazards approach for incidents whether white powder, radiological/nuclear, biological, chemical, natural, or man made.  The decontamination procedure for white powder or a dirty bomb would actually be the same. 

As far as pandemic and surge planning are concerned, we are working with multiple groups to coordinate a standardized plan, including Region 13/MMRS, Hospital Council of Western PA, Cambria/Somerset Disaster Management Task Force, and the Cambria Co. Community Health Preparedness Task Force.  Our local disaster management task force is currently coordinating a drill for October.  I will keep you updated.

And we will Keep YOU Updated, too.  Hopefully, just to have a good laugh someday that we worried about this stuff, too.  Y2K? . . . please.

Hospice Care

Having been employed at Windber Medical Center for the past nine years, several things have remained constant:  The incredibly high quality of medical care, the excellent commitment from our physicians, the low infection rates; the lower lengths of stay;  the lower death rates for adjusted acuity.  The thing that has remained the most constant, however, has been the endless number of people who approach me on nearly a daily basis to tell me how wonderful the care is in our palliative care and hospice program. 

If perfection could be measured by family and patient satisfaction, this program is truly a perfect program.  The nearly 100 volunteers, the dedicated staff, the loving, caring physician and even the therapy dogs are all part of the cast of angels who make this program such a wonderful part of our hospital.

Excerpts from the following article from "HealthDay News" on Thursday, Aug. 24, brought another aspect of hospice into focus:

U.S. nursing-home residents in hospice care are half as likely to spend their final 30 days of life in a hospital than residents who aren't in hospice care, researchers report.

Investigators at Brown Medical School in Providence, R.I., analyzed data from nearly 184,000 nursing home residents in five states.

 

"Our study provides strong evidence that access to hospice care in nursing homes significantly reduces hospitalization," study author Pedro Gozalo said in a prepared statement.

 

He noted that people who choose hospice care tend to refuse aggressive end-of-life treatment. Even when this was factored in, the study still found that hospice has a major impact in keeping people out of a hospital in their dying days.

It's cheaper, it's better, but pay close attention to this last sentence:

That's important, because being in hospital may have a negative impact on a person's quality of life in their final days. In addition, this kind of hospital care can be expensive.

There it is.  "The hospital may have a negative impact on a person's quality of life in the final days.'  Tell your relatives.  Tell your friends.  Shout it from the roof tops. LET PEOPLE YOU LOVE KNOW.  Hospice is the only choice.  Choose quality at the end.  Choose Hospice, and know that Windber's Hospice was the first rural hospice in the United States.  The tradition is Strong, and the care is beautiful.

The Clouds Have Lifted a Little

Let's begin with a comment that we received on our recent blog post, Birth of the Chaordic Age:

Name: CW
Email: [email protected]
URL: http://www.speculationsblog.blogspot.com

Comment:

Dear Nick:

Another new wave utopian fantasy, but you're entitled. Funny how education always leaves you searchin'...

To which I reply:

During my second psychology class, (or was it philosophy?), the professor, a brilliant, Harvard PhD, drew two circles, a little circle and a big circle on the board.  "If you put everything you know into this circle, the outside of the circle represents what you don't know. As you learn something new, the area of the circle increases, but this means that as you increase the knowledge within the circle, you also increase what you don't know, and, usually, that aspect of knowledge or lack thereof grows faster than the first. This is why wise and knowlegable people usually say (and truly believe!) they don't know much at all." Perfectly clear?   

So, as CW said, "Education leaves you searchin'." Two Masters plus two certifications and a Fellowship have definitely left me searching for the TRUTH, and I'm a lightweight compared to many of the PhD's and MD's with whom I work.

If my circle was spread out as a line, it would be about seven miles long and five inches deep.  Sure, I understand how to read a 32 staff page of music and hit every cue for every entrance. I also know that I can rub my belly and pat my head, and I understand the nuances between proteomic and genomic science (well, almost).  I even know how to request my check in Italian, but don't ask me how to make money in the stock market, if there are more than 200,000,000 angels on a pin head or if you can hear a tree fall in the forest when no one is there.

It's when I talk to my quantum chemists that it becomes clear to me that their need for knowledge is insatiable.  They read, study, and seek information about everything, constantly.  Their need to know never ends.  They do sometimes watch "American Idol," and most love Starbucks. Periodically, my need to know does go into hiatus.  Sometimes, I just like to shut down and contemplate my navel. Well, as you may have read before, I can't exactly see my navel right now, but, hopefully, if I eat two bowls of cereal a day and skip one meal, it will come into view. 

So, CW, you nailed it.  It is utopian and a fantasy.  Sometimes I just dream about what could be in the perfect world. In fact, jealousy regarding another's assets or talents has not been part of my personal make-up for about thirty years, but when I meet people who are completely convinced that everything they know or believe is absolute, I sometimes do become very envious. 

This week, a person called me to criticize me, accuse me of misdeeds because we were supportive of Mr. Murtha, and then he said, "Let me guess, you're a liberal?"  The label was placed. (There's a lot of labeling going on in this country right now.)  It is my belief that everything is relative.  It is my belief that I am a liberal and a conservative, that I am as complex as the universe and as simple as a newborn child's cry. 

When I asked my critic why he was convinced that the truths that he espoused were accurate, he proudly boasted into the telephone, "I listen to Rush." Let me assure you that "I don't listen to Rush," EVER.  Mom always said, "Everything in moderation." Not too Republican. Not too Democrat. Not to fatalistic. Not too utopian.

During an exchange at a board meeting this week, I started a string of comments directed toward my board that went something like this,  "We have $750,000 coming from grants, right?" My Foundation Director said, "Yes, maybe," and my Chief Financial Officer said, "It's not here yet."  To which our board chairman replied, "Perfect, the Optimist, the Realist and the ACCOUNTANT."  The next day we received the first $350,00 of the $750,000. Hah.

So, this week is exactly one week before vacation.  It is a week of clean up work, balancing work, policy work, Department of Health inspection foreplay work.  It is a week where things will be addressed that can't wait another day, i.e., our GE grant and the fact that we dramatically missed our projected numbers, our Ornish Program and its make-over, our reorganization of the Red Cross board, and our continued restructuring of the Windber Research Institute.

A little bit of old stuff, a little bit of new, a little bit conservative a little bit of liberal, a little bit of agnostic stuff, a little bit of spiritual.  Hey, this could be a song lyric.  Now should it be Country or Rock?

How about "crossover?" 

Like a Bridge Over Troubled Water

Maybe my childhood was too perfect. Ward and June, Wally and the Beaver had dinner together every night. We went to church, had Sundays with my grandparents, took walks in the woods and experienced wonderful sharing of love. It was as perfect as it could be for a kid. There wasn't much money, but money didn't matter. I could walk home everyday from school at noon and have lunch with my mom.  My entire first grade class came to my house in their Halloween costumes to wave to me when I had the mumps.  It was just nice.  Lots of love and support.

Clearly, it didn't prepare me for this world very well.  If I had been raised as Jack Dawkins, the Artful Dodger in Fagin’s gang of boys from Charles Dickens' Oliver Twist, I could handle this all a little better.  As it stands now, I head off for another day of shark swimming with only my Speedos and a pack of Trident gum.

So, Wednesday, two weeks ago rated as one of the greatest business days ever. The Merck meetings were great.  It took exactly 24 hours, however, to blow that memory away. We got word that, although we had done everything according to Hoyle at multiple meetings over several months regarding our grant relationships, some newly-assigned bureaucrat with more power than St. Peter decided to send them down a nine month sink hole to determine if everything is the way he/she wants it. 

When I asked about making payroll or keeping our research going, it was not unlike the response that I got from a federal related officer who decided to freeze our grants two years ago who said, "I don't care about curing cancer. This is not about finding cures. This is about my interpretation of policy." Position power can be a miserable thing.

Well, we've been given a 97% chance of getting our grants back on track by Monday. Last May, I went into shock and nearly bought the farm after a procedure that is 99% safe. Consequently, my preference is for absolute resolution. 

Both this and last weekend have been tough. 

So, "Like a Bridge Over Troubled Water," I say, come to the Translational Medicine conference on Monday and Tuesday at the Pasquerilla Convention Center.  You will hear great scientists from The Netherlands, Italy, the UK and the USA . . . students from our local schools, and the WRI gang describing our passion and mission to get M.D.'s to work with PhD's to find answers and to bring them to you in the clinics. 

Maybe this week our grants will be cleared up, we'll have wonderful partnership announcements at our Translational Medicine conference, and there will be peace in the Middle East.

When Oliver is sent out with The Artful Dodger and another boy on a pickpocket expedition Oliver is so shocked when he realizes what is going on that he and not the two other boys are caught. 

Ward, June, where are you?

Wah Wah Wah

The world is falling apart at the seams. Wars in Lebanon, Israel, Iraq and trouble in North Korea, Iran, Syria... and Windber. Our grants have come under fire once again. and maybe not coincidentally. Mr. Murtha is being attacked by those individuals who haven't listened. Like it or not, he has dared to go where no politician had gone before... he has predicted, reported and spoken THE TRUTH about impending civil war, lack of troops, worn out weapons, and a more than difficult situation in what is becoming "the longest war since the War of the Roses." 

It's not my place, however, to spew political rhetoric in my blog. It is my place to tell you what's really really bothering me.

In nine and a half years I had gained only five pounds. Count 'em. 172 to 177.  Sure, I'd gain a little on vacation, but could always count on a bout of the stomach flu to get me back down.  I have exercised and watched my weight to the point of being spoiled.  It was a beautiful thing.  It was something that only smokers had achieved in the past. NO WEIGHT GAIN. 

For nine and a half years I had lived on the Dr. Dean Ornish Coronary Artery Disease Reversal Diet.  Do you want to talk about FUN?  I know what fun is and that was NOT FUN, but it kept me svelte.

It was a vegetarian diet. No problem.  I got real used to that. Vegetables, whole grains, fruit, some soy and an occasional fake hamburger made from "stuff."  The diet was about 75% carbs, but I ate PLENTY of food and didn't gain a pound. Actually, that part was fun.  Give me a bag or two of sourdough pretzels and some water. In fact, my eating habits were a lot like Seabiscuit's. 

The tough part about this diet was NO ADDED FATS.  No olive oil.  No almonds.  No butter.  No LARD.  No M&M's with peanuts.  No fish.  NO . . . well, you get the picture.  Alcohol was permitted once a day, and there were plenty of weeks where I wanted to save it all up and drink a case of beer on a Saturday night to celebrate my Euell Gibbons diet. 

Then came Crestor.  Don't get me wrong, up to this point, Lipitor, Zocor, Mevacor, anything with an or on the end of it had been part of my life. 

It was early February when my physician sent me an article written by a cardiologist at the Cleveland Clinic. I contacted this gentlemen, who politely responded to me by e-mail, and we began our relationship. He suggested, "Go Mediterranean."  Crestor, fish oil, Zetia, lots and lots of Niaspan... and then a miracle occurred. After nearly six decades, my numbers fell and/or rose to near prenatal proportions. HDL over 31?  Unheard of anywhere in my family.

Fish re-entered my diet once or twice a week. Almonds hit my pallet after nearly nine years, and canola oil, God bless oil. I had it twice a week on salads. Compound that with some chocolate.  I once stared at an M&M for two and a half hours on the floor by my shoe on a trip to San Diego before I kicked it away.

What happened? 

According to my numbers, I might not only live, but I might actually reverse some of the two or three hundred pounds of plaque in my system, but what really happened. I went to bed on a Sunday night and woke up on Monday morning seven pounds heavier, 177 to 184. The heck with the wars.  My pants don't fit. Seven ugly, miserable, couldn't-be-worse pounds of fat. I'm going to need Husky blue jeans with reinforced knee pads.  (Did they think that fat kids fell down a lot?)

I'm going to go back to grass and hot sauce.  Dean, where are ya, man?

A Great Day in WINDBER, PA

The Merck jet landed early at the John P. Murtha Airport, and Mr. Clark and his wife Angela arrived at the Windber Research Institute nearly 20 minutes earlier than predicted by the agenda.  The primary narration for the tour of the Institute was provided by Dr. Michael Liebman, and clearly, captured everyone's imagination. Congressman Murtha joined us in the lab and spent quality time with our individual technicians and PhD's. 

As quoted from Randy Griffith's article in the Johnstown Tribune Democrat, "The leader of a major vaccine maker commended Windber Research Institute’s preventive approach while discussing collaboration opportunities Wednesday." And that was just the beginning of a spectacular day that involved serious negotiations with Congressman Murtha, The Conemaugh Health System, Governor Ed Rendell, and leadership from CHS and WRI.

The most enjoyable part of the day, however, was yet to come when Mr. and Mrs. Clark had a reunion with three of their best friends from high school. The Creagers, Feskos and Hornicks from Johnstown, North Carolina and Connellsville, respectively, brought their spouses and had dinner and fun with the Clarks.

As the corporate jet took off from Johnstown, through the front window, you could see the pilot eating a Coney Island hotdog. The Merck jet, Johnstown, and Windber will never be the same, ever.  As Mr. Clark left town, he shook my hand and informed us that we would be working together in the near future.

What are our dreams? Minimally, we hope that we will be successful in setting up several research partnerships between WRI. the DoD and Merck. With the Conemaugh Health System we are hoping to include Merck in a Data Fusion project, and would love to see independent labs built out in the new tech park.  Finally, a grand slam home run would be the construction of a full blown vaccine plant in Western Pennsylvania for the production of either AIDS or Avian flu vaccines.  So, say a little prayer for progress, and we'll keep you informed.