Quarantine day 7

April 7, 2020

I am not sleeping at night

I got out of bed just for spite

Then, what a fiesta!

An all-day siesta

Giving in to circatidan blight.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with further travel and adventures in temporary positions in Arctic Alaska, rural Iowa, suburban Pennsylvania, western Nebraska, Canada, and South Central Alaska.  I split the summer between hospitalist work in my home town and rural medicine in northern British Columbia, followed by vacations in Israel, San Francisco, Iowa, Miami, and Galveston.  Just back from Texas via airplane, we’re self-quarantining for 14 days. Any identifiable patient information, including that of my wife, has been used with permission.

 

Self-quarantine day 7.

After so much inaction I couldn’t sleep.  I went against my principles and got out of bed before 4:00 AM.  For the next three hours I worked on turning this blog into a manuscript.  Which meant reading through what I wrote in during February 2010.

The burnout that I didn’t see then glares at me from between the lines.

After 7:00 AM I went to pick up groceries, a new experience.  The red sign outside the door read   Grocery Pick Up Parking and gave a phone number, which I called but didn’t get an answer.

I accessed my email on my phone, which directed me to another door and another phone number, which worked.

Next time I’ll know to back into the parking spot.

On the one hand I didn’t get three items of produce I’d ordered.  On the other hand they didn’t charge me.

On return I successfully napped for 90 minutes.

I did more online tutorials to get me up to speed for telemedicine but at the end I still don’t have the confidence to navigate the new electronic medical record, and sent an email to the company saying so.  Nevertheless this outfit holds the speed record for onboarding even if it takes another couple of weeks.

I brought my bow out to the backyard. I dug out a stabilizer, a weight 3 inches long weighing a pound, that I’ve had for 25 years, and screwed it onto the front of the bow.  My next shot went 6 inches off center, but the next 14 shots kept finding the middle of the bull’s eye.

I brought out my best air rifle and cleaned the bore.  Then I went online and found out that cleaning air rifles has nothing to do with cleaning firearms.  I had removed the fouling and lead but I hope I haven’t damaged a fine rifle.

I discovered that WD40 contains nothing other than white spirit and lanolin.

We lunched on moose tenderloin.

We continued preparation for Passover.  I napped the afternoon away.  I doubt I’ll sleep much at night, I’ve thoroughly disrupted my circadian rhythm.  Which comes as no surprise without the structure of work.

Quarantine day 6

April 6, 2020

For exercise all day I have yearned,

My sacroiliac burned

You’re out on a limb

If you go to a gym

My back pain, I’m afraid, has returned.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with further travel and adventures in temporary positions in Arctic Alaska, rural Iowa, suburban Pennsylvania, western Nebraska, Canada, and South Central Alaska.  I split the summer between hospitalist work in my home town and rural medicine in northern British Columbia, followed by vacations in Israel, San Francisco, Iowa, Miami, and Galveston.  Just back from Texas via airplane, we’re self-quarantining for 14 days. Any identifiable patient information, including that of my wife, has been used with permission.

Self-quarantine day 6

I still can’t sleep past 6:30 AM.

Breakfast.  A couple of YouTube videos.  Email.

Even if I can’t sleep late, I can nap like a champ.

My back pain has returned after I halved my Enbrel frequency per my rheumatologist.  The pandemic closed the gyms, limiting exercise to outdoor activities.  And exercise is one of the main modalities I have to deal with the pain.

Bethany and I walked for a half hour this morning, and I went for an hour’s cycling this afternoon.  At the very far end of my ride, despite the National Weather Service’s prediction of 0% chance of rain, I got a few drops in my face.  I turned the bike around and pedaled like someone half my age for home.  I outran the rain.

it reminded me of the times in New Mexico and Arizona when I’d race the thunderstorms.  Usually, they won, but I can remember a time on the Hopi reservation, sitting at a trading post in the shelter of the vegas, watching the thunderstorms stalk across the landscape on legs of lightning.

I continued online instruction for telehealth.

Meals have become a highlight in the day.  Tonight Bethany made biscuits and I made gravy

For the first time ever I used an app on my phone to order groceries for pick up in the morning.  I’ll see how they do picking out avocados and mangoes.  Because of my age, I will get priority between 7:00 and 8:00 AM.

I found out today our two neighboring states, South Dakota and Nebraska, closed schools but not much else to slow the pandemic.  Across the river, restaurants, bars, and casinos remain open.

South Dakota has a lot to lose; the Pine Ridge Reservation has the worst life expectancy in the western hemisphere outside of Haiti (48) and loosing a novel virus on a population riddled with diabetes, hypertension, and chronic renal disease could end in shameful disaster.

We played Scrabble in the evening.

I’ve been contemplating having a drink for a couple of days.

 

Quarantine day 4 and 5

April 5, 2020

Until the quarantine’s through

Your recreational options are few

When you run out of talk,

Play Scrabble or walk.

There’s really not much to do

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with further travel and adventures in temporary positions in Arctic Alaska, rural Iowa, suburban Pennsylvania, western Nebraska, Canada, and South Central Alaska.  I split the summer between hospitalist work in my home town and rural medicine in northern British Columbia, followed by vacations in Israel, San Francisco, Iowa, Miami, and Galveston.  Just back from Texas via airplane, we’re self-quarantining for 14 days. Any identifiable patient information, including that of my wife, has been used with permission.

 

Quarantine Day 4

Slept clear till 0630.

An elaborate omelet for breakfast.  I’m getting better at making those.

Temp below freezing with a glaze of ice under a dusting of snow: too cold and treacherous for a walk or a bike ride.

Struggled through setting up a new google account for my upcoming job.  I started pushing buttons, eventually I got to the right place.  Then I struggled through the authenticator process.

Email.

Nap.

An hour of online education regarding the electronic medical record (EMR) system for the new job, the 19th since 2014.

An hour of Continuing Medical Education.

Bag salad and fried fish for supper.  I’m getting better at frying fish, too.  Poured a glass of wine and finished it.

Quarantine Day 5

Slept late.  Read a novel with a fictionalized accounting of the Kennedy assassination.

About 11:00 AM opened the blinds.  For the next 45 minutes we watched the ice from last night’s freezing rain drop off the maple tree in the back yard.  I started to think about tapping the tree for syrup, despite the lateness of the season.

We saw 2 wild turkeys and 5 deer.

When the afternoon warmed up to 50 I went for a walk, passing a lot more pedestrians than I usually do.  I socially distanced to the middle of the road.  I passed the high school track, with 1 person running, 3 walking, and one person running the stairs.  He stopped 7 steps from the top.

Two serious cyclists on the road.

Two games of Scrabble.  Bethany played brilliantly the second one, landing 2 bingos, 3 hands with more than 50 points each, and 3 others with more than 30.

We ate leftovers for lunch and supper.

A friend called.  With turkey season just opened, he wanted to borrow a turkey decoy.  Actually he wanted me to come hunting, but I declined because quarantining means more than social distancing.

Quarantine day 3

April 3, 2020

Because of the fact that we’ve flown

We stay in the quarantine zone

Relying on tech

To check on the neck

The visit was done on the phone.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with further travel and adventures in temporary positions in Arctic Alaska, rural Iowa, suburban Pennsylvania, western Nebraska, Canada, and South Central Alaska.  I split the summer between hospitalist work in my home town and rural medicine in northern British Columbia, followed by vacations in Israel, San Francisco, Iowa, Miami, and Galveston.  Just back from Texas via airplane, we’re self-quarantining for 14 days. Any identifiable patient information, including that of my wife, has been used with permission.

Quarantine day 3

Too cold for a bicycle ride in the morning.

Cooked an elaborate, healthy breakfast.  Did an hour of Continuing Medical Education (CME).

Early email included a teaser for family practice in Alaska, doing Veterans’ disability physicals.  I replied that I’d be interested after the pandemic dust settles, especially if it’s in Fairbanks.  I haven’t heard back.

Before we called them man caves, we called them offices.  I haven’t spent much time in mine for the last 6 years because we’ve been on the road.  Today I descended the stairs, and I started throwing stuff away that should have been thrown away years ago.  I just can’t seem to part with my slide rules.

Bethany met with her ENT about the swelling near her thyroid incision.  The visit involved his computer and her phone.  I sat by the sidelines .  When asked I gave the results of the physical exam in medicalese.

We went for a stroll in the cold (40 Fahrenheit) and wind (25 MPH), glad that we layered well.

A first-class nap followed a late lunch.

This telemedicine job looks like it’s going to happen a lot faster than any job I’ve had yet.  Credentialing took one particular hospital more than 120 days, and this outfit will probably have it done in 120 hours.  They have impressed me with their efficiency. It probably has to do with the fact that young, computer-savvy docs run the company.

After a light supper and some more office cleaning, Bethany helped me set up a space in the basement for my telemedicine job.

It has to look professional, like a doctor’s office.  The company advises positioning the web cam so as to avoid doors and back lighting.

Quarantine day 2: not much to write about

April 2, 2020

The quarantine? Now day 2.

There isn’t much I can do.

Some reading, some writing

Some bicycle riding

Some arrows and a bow that I drew. 

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with further travel and adventures in temporary positions in Arctic Alaska, rural Iowa, suburban Pennsylvania, western Nebraska, Canada, and South Central Alaska.  I split the summer between hospitalist work in my home town and rural medicine in northern British Columbia, followed by vacations in Israel, San Francisco, Iowa, Miami, and Galveston.  Just back from Texas via airplane, we’re self-quarantining for 14 days. Any identifiable patient information, including that of my wife, has been used with permission.

Breakfast.

Bicycle ride, 7 ½ miles.  Cool, clear, windy.  Sunscreen stung my eyes.  3 other people on the bike path.

Credentialing materials input for an upcoming job.  I understand wanting to know work history and education, but I question the utility of the issue dates of my medical licenses.  Especially if someone else gets paid to verify everything that I said.  Still, I’ve dealt with worse processes.

Lunch.

Took a break and had a long phone conversation with an ex business partner.  We’re both worried about the pandemic, and both anxious about getting complications when we do come across the virus.

More credentialing.  I shanghaied Bethany into helping me.  Credentialing makes me cranky.

Target archery in the back yard.  I shot 14 arrows brilliantly though I haven’t pulled a bow for a month.

More credentialing.

A walk around the yard to look at the fruit trees.  At this point every year I tell them to hold off blossoming.

More credentialing.

A friend brought some groceries and left them in the garage.

A break to do some recreational reading and take a nap.

Finished credentialing.

Supper.

Online for the instructional videos for the next job.

It’s gonna be a long quarantine.

Self-quarantine day 1: telemedicine, bicycle maintenance, and naps

April 1, 2020

We’re doing the self- quarantine

The number of days is 14

I can go outside

My bike I can ride

But it’s a real slow start for the spring.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with further travel and adventures in temporary positions in Arctic Alaska, rural Iowa, suburban Pennsylvania, western Nebraska, Canada, and South Central Alaska.  I split the summer between hospitalist work in my home town and rural medicine in northern British Columbia, followed by vacations in Israel, San Francisco, Iowa, Miami, and Galveston.  Just back from Texas via airplane, we’re self-quarantining for 14 days. Any identifiable patient information, including that of my wife, has been used with permission.

We got in at a reasonable time last night and unpacked.  We dealt with the mail till midnight.

In the morning I called the Medical Practice Formerly Known As Mine, and gave the facts: I’d been exposed to the virus on March 8, there had been a question of symptoms not strong enough to justify testing, and I’d just been on a plane, wearing mask and gloves.

The airport had been eerily empty, security lines non-existent.  The plane for 180 occupied by 20 and downright spooky.

Should I quarantine?

At noon, the answer came back, “Yes.”

I sighed.

Over the weekend, resigned to the idea that I’d not be able to do regular patient care for months, I contacted a telemedicine company, and in the afternoon I had a telephone conference.  I have hesitance when it comes to telemedicine, because I think the physical exam is as important as the reasoning process but I also recognize that if the whole picture includes a pandemic, the best care might not include physical contact, waiting rooms, or catching the physician’s germs.  Thus even the Canadian system has embraced remote visits.  Alaska Natives have accessed medical care via radio at least since the ‘50s. New Zealand accepted telephone medicine outside office hours.  In complete honesty, I’ve given remote advice to a select few over the years.

I also resigned myself to not going to the gym for the next several months though I know I need exercise. Yes, I could get a used elliptical for not much money, but I already own a bicycle and I love to ride.  So I brought it down, did my spring time bicycle renewal ritual, and took a very brief shake down ride.

In between I did email, read a novel, took naps, and had substantial snacks.

In the evening, we played Scrabble.  Bethany started off strong and kept on strong but I caught up 4 words from the end and won.

Fast fishing in Galveston Bay

March 31, 2020

Timeless the time that it took

Bringing in fish that we’ll cook

We got speckled trout

And a sheepshead so stout

He ended up bending my hook.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with further travel and adventures in temporary positions in Arctic Alaska, rural Iowa, suburban Pennsylvania, western Nebraska, Canada, and South Central Alaska.  I split the summer between hospitalist work in my home town and rural medicine in northern British Columbia, followed by vacations in Israel, San Francisco, Iowa, and Miami.  I am now in Galveston, Texas, visiting two physicians (our oldest daughter and her husband) and our grandchildren. Any identifiable patient information, including that of my wife, has been used with permission.

We went fishing in Galveston Bay, our 4th trip with a fishing charter.

We don’t know much else about fishing except that we love it.  And we didn’t know we loved it till August 2010, the end of our first Alaska trip.

I have improved my cast in the last 2 months, but I still can’t cast as far as our guides, young men with decades of fishing experience.  We anchored near the causeway, pulling in speckled trout, one after another.  The biggest were 2 feet long, the smallest went free.

Bethany landed 2 for every one that I caught.  When we had our limit our guides moved the boat to a jetty, where small family craft anchored 50 yards apart for 4 miles.  Because we got there last, we took the end of the jetty.

Following the guides’ instructions, we cast inches shy of the riprap.  Our bobbers sank and we reeled but the nibbles didn’t turn into bites.  Actually Bethany caught a couple of just undersized sheepshead.

Our guides, very excited, interrupted our rhythm.  The fish are 12 feet below us, on the bottom.

They took off the bobbers.  Drop to the bottom, they said, reel up three times, wait for a bite and set the hook.

Those sheepshead took three of my shrimp, while Bethany got strike after strike, only to lose the fish before the net could swoop in.

With nothing to lose by trying,  I dropped the line, reeled in 6 inches, and without waiting, jerked to set the hook, and hauled in a 6 pound sheepshead.

Then it was drop, reel, jerk, and catch.  Half a dozen big sheepshead got away before we discovered that the hook had been bent by an extraordinarily big fish.

We also discovered that Bethany’s barbless hook accounted for many of those fish that escaped.  She got a replacement.

Sometimes an experience goes for so long in its wonderfulness that it becomes transcendent.

The time I bicycled 120 miles in 6 hours on a clear Arizona night with no wind, traffic, hills, or mechanical problem.  Finding morel mushrooms in such density that I picked for 45 minutes without stopping, filling both my bags, and taking off my jacket and filling it as well.  A really great improvisational jazz session in the summer of 1968 when I found my vibrato.  Our honeymoon.

Those are moments when you laugh not because of humor or punch line but because of the joy of the moment.

Now I’ve added a fishing trip to that list.

When we hit our limit we beckoned to the next family boat in line, and told them how we’d done so well.

Such undiluted deliciousness can’t last.  It felt like time stood still and I never wanted it to restart.

We moved for catch-and-release elsewhere till we ran out of bait.  We came back to the dock 4 hours after we left.

The owner of the boat dock and bait shop came out and quietly but sternly talked to the guides: ok to clean fish but be quick about it and maintain social distance.

Because while we fished, the novel Corona virus had strengthened its grip on the country, and the town went to lock down at midnight.

Tough Decisions in a Pandemic

March 23, 2020

In the midst of the pandemic fright

As Corona stalks through the night

Patient care I will miss

But it comes down to this

For the patient I’ll do what is right

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with further travel and adventures in temporary positions in Arctic Alaska, rural Iowa, suburban Pennsylvania, western Nebraska, Canada, and South Central Alaska.  I split the summer between hospitalist work in my home town and rural medicine in northern British Columbia,, followed by vacations in Israel, San Francisco, Iowa, and Miami.  I am now in Galveston, Texas, visiting two physicians (our oldest daughter and her husband) and our children. Any identifiable patient information, including that of my wife, has been used with permission.

Do what’s right for the patient has been a first principle for more than 30 years. After much soul searching and with great ambivalence I decided to take myself out of acute family practice until either the pandemic ends or I recover from Corona, whichever comes first.

The decision made me physically nauseated.  It meant reneging on commitments to the teams in Canada and Nebraska.

But I had to look at things objectively.  I’m set to turn 70 in May, which gives me a risk factor for serious complications from the Corona virus, as does taking Enbrel.

I called my rheumatologist through the VA; she advised cutting my Enbrel frequency to every 14 days, enough to prevent a flare but less of an immunocompromise  risk.   But she also advised that I not take care of people with respiratory infections.

A week ago I felt that covid 19 was no worse than common influenza, but the mortality rates coming out of Italy are about 10 times higher than we expect from influenza, and their medical system is overwhelmed by those with serious complications.

In the absence of a vaccine the probability that I’ll get the disease comes close to 1.  Two risk factors and a near- inevitable infection means a Canada assignment would increase the risk I’d have complications in an under-resourced system.

Yet no system can accommodate peak demand, not even the US medical system.  After all, the Creator designed the Missouri River and it still floods.

I will miss taking care of patients during this pandemic.  Medicine is what I do, it’s who I am.  Writing, cycling, archery, reading, hunting, fishing, and learning other languages only take up so many hours.  And patient care is my passion.

But I do what’s right for the patient.  One ventilator for me is one less ventilator for one of my patients.

The protagonist of Stover at Yale, a 1912 young adult novel, finds himself with a high fever just when the track team really needs him.  He wins the race but collapses at the finish line, saying, “For God, for country, and for Yale.”  Heroic sentiments at the time, but now consideration of teammates’ safety trumps any single footrace victory.

So I sent my emails to the government agency and to my colleagues in BC.  They wrote back that they weren’t a bit surprised, they had anticipated my choice.  And the warmth I felt crossed the border and the thousands of miles all the way to Texas.

It helped.

So does repeating, “It’s all part of the adventure.”

Corona virus: my predictions

March 16, 2020

The Corona virus, that bummer

I predict will last through the summer

Wall Street will fall

Stay away from the mall

Let’s lose regulations, dumb and dumber. 

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with further travel and adventures in temporary positions in Arctic Alaska, rural Iowa, suburban Pennsylvania, western Nebraska, Canada, and South Central Alaska.  I split the summer between hospitalist work in my home town and rural medicine in northern British Columbia,, followed by vacations in Israel, San Francisco, Iowa, and Texas.  I just attended my undergraduate mini-reunion in Miami Beach.   Any identifiable patient information, including that of my wife, has been used with permission.

At my mini-reunion, a week ago, the conversation briefly mentioned the Corona virus.  I gave my opinion freely.

There’s a lot we don’t know: transmission, actual dangers, real origin, and long term sequelae.

We know that neither the media and their fear mongering nor the government with their minimization can be trusted.

The Israelis have a line on a vaccine that will be available in less than 6 months.  We do not know efficacy, nor side effects.

In fact, the US Patent Office has issued patents on a number of corona viruses, genetic recombinants engineered to not cause disease.  Any one of them could be the basis for a vaccine.

Once the corona virus starts, it will be an ongoing problem at least till July. And probably longer.

But that was last weekend.  My classmates who know about such things predicted a stock market crash worse than that of 2008, but their prediction had nothing to do with the Corona virus.  No one predicted it in less than 6 months.

And the coming stock market problem has nothing to do with the virus, they said, though the virus might change the timing.

Since then, more than half my incoming email has been dedicated to the Corona virus, advising social distancing and good hand washing.

The stock market is in free fall.

We now have injunctions against large gatherings.  Conferences I’d planned to attend got canceled.

But the Centers for Medicare Services (CMS) announced a temporary waiver of certain unnecessary regulation.  Colorado’s Board of Medical Examiners announced a loosening of licensing regulations that comes close to bringing the process to something that could be called reasonable.

The Texas Board of Medicine sent an email saying it would temporarily accept telemedicine.  I read, between the lines, that some of the sillier license requirements would be waived for the time being.

The Corona virus will leave a stamp on society for a very long time.  Two weeks ago, most physicians rejected telemedicine outside of dermatology and psychiatry.  When the Corona virus dust settles, a lot more doctors will work from home.  And I predict that at least one entrepreneur will democratize the digital stethoscope and the otoscope.

The incipient growth of online learning and shopping will come to full flower and the restaurant trade will capitalize on the carry out and delivery sectors.

There will be more changes that we can’t foresee, some good and some bad.

Predicting economic downturns

March 15, 2020

I asked those experts on banks

And dollars and Euros and francs

Back on that date

In 2008

When we saw our economy tank.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with further travel and adventures in temporary positions in Arctic Alaska, rural Iowa, suburban Pennsylvania, western Nebraska, Canada, and South Central Alaska.  I split the summer between hospitalist work in my home town and rural medicine in northern British Columbia,, followed by vacations in Israel, San Francisco, Iowa, and Texas.  I just attended my undergraduate mini-reunion in Miami Beach.   Any identifiable patient information, including that of my wife, has been used with permission.

I went to college with a bunch of brilliant people.  A couple years early for the 40th reunion, we had a mini-reunion in Miami Beach.

A majority of the attendees came from the Eastern Seaboard.  Only 3 of us call the Midwest home.

While I talked to literary agents, writers, and professors of English, a disproportionate number of the others went to law school, and, of those, a majority went into banking or finance in one form or another.  Some work in Manhattan, but quite a few go international.  And some of the financiers didn’t go to law school.

One classmate actively practices law and travels a good deal, making sure that certain mineral concerns in the US and Canada comply with anti-trust laws.  He was surprised I knew the difference between potash and soda ash, and I was surprised at the location of those mineral deposits.

All of us around 70, our degree of preservation ran quite a spectrum.  The years have been kinder to some than to others.  One looked just like he did the last time I saw him in 1972, others showed terrible aging.

One wore a t-shirt with the image of a fish, and of course I immediately showed the picture of my wife and I with our monster halibut.  We talked about fishing and where to go; he’s planning an Alaska fishing trip for his 70th birthday.

I struck up conversations with 2 other physicians, both in one or another phase of Slowing Down, and doing varying amounts of pro bono (literally, for the good of it as opposed to for the money) work.

I asked one of the financiers what he thought of the movie, The Big Short, and whether or not he thought the same thing could happen again.  Accurate, he said; spot on and humorous, and the next crash will be worse than 2008.  He followed with some stats about China’s economy and debt load that I didn’t understand.  He predicted a major economic downturn in 6 to 24 months.

I polled my classmates who said they work in banking.  They agreed with those prognostications, including the time frame.

I found their world fascinating, even if I could never bring myself to live in New York, or even imagine myself in that lifestyle.  I was surprised at how many of them seemed interested in my experience with Native Americans and rural, farming America.

I suspect quite a few were horrified when I mentioned hunting, but they were too polite to say anything.