June 2015

Portland to Puyallup Cycle Tour

Day 1 (13JUNE2015)

After a calm morning of knowing that I had packed everything, Betsy and I headed off to the Amtrak station to meet Russ and ride the Amtrak from Tacoma to Portland, where we would begin our grand adventure. We had done much recent roadbiking together, but our last tour was a few years ago. At the train station, I had discovered that I forgot my touring cycle shoes, which are bicycle shoes that had a mountain bike style clip that attaches the foot to the pedal. After a quick decision, I left my bicycle with Betsy and dashed back to Puyallup to get my shoes. I could have easily made it on time, except that this was the first day of the US Open golf tournament in Tacoma, and traffic was suddenly horrid. Finally arriving just five minutes late to the train station, Betsy and I decided we would outrun the train in our car, and catch Russ at the next station. Each station, we were just a few minutes late, and ended up going all the way to Portland to catch Russ. Finally, at 3:30 in the afternoon, we were on our bikes. We decided to skirt Portland by taking the bike route on Marine Drive, which follows the Columbia River. We got to Troutdale by 5:30pm, where we settled in at a cheap hotel, and went out for Chinese food at a very marginal diner.
Russ riding along the Marine Drive Trail, with the Columbia River and Mt. Hood in the distance

Day 2 (14JUNE2015)

This was our most beautiful day, and we were soon on the Old Historic Columbia River Highway. It was not a challenging ride, but we had not been touring with fully loaded bikes for a while, so it was getting the legs used to this sort of riding. This was a Sunday, and every beautiful spot was over touristed, so we rode on and stopped only briefly at the more popular places like Multnomah Falls. There were quite curious onlookers who had numerous questions about cycle touring. We crossed the Columbia River at the Bridge of the Gods, a hairy-scary experience riding on a grate high across a large river, with a car right on your tail. We finally decided to go as far as possible that day without having to camp, and to remain in civilization, which led us to the sleepy town of Carson. There was actually a great restaurant- brewery in town for dinner, but the accommodations were a slightly run-down set of cottages next to a golf couse about a half mile off the road. We were actually quite content, as the owner manager was a most friendly and informative fellow, and the accommodations were more than adequate. See http://sandhillcottages.com.
Russ and I posing at the
Women’s Forum Viewpoint.
Latourell Falls
Overlook of the Bridge of the Gods from the Washington side
Our cottage in Carson.

Day 3 (15JUNE2015)

We headed out early, and there were no restaurants open for breakfast at 7am in the town of Carson. Russ and I ended up eating breakfast at the local Carson market that had coffee and breakfast sandwiches. This was actually a great deal since it allowed us to chat with more locals. The ride demanded climbing over a 3000 foot high pass, appropriately titled Oldman Pass. It wasn’t too challenging and we arrived in Swift Creek Reservoir right when the temperature was starting to get too hot to ride. It was my first granny gear day. The granny gear is the smallest gear in the chainring, in which are the three gears in front on a triple chainring. It is called the granny gear since you can gear way down for long fatiguing climbs with a heavy loaded touring bike. There was no restaurant in the area, but a convenience store that had cold beer and frozen pizza. The cabins had no electricity and certainly no WiFi or internet. https://www.eaglecliffcamp.com Lighting was with propane gas lamps. We met a couple, George and Megan, who had been on touring bicycles the last three months, riding from Florida in a meandering path through the US, and enjoyed some pizza and brandy with them, accompanied with delightful conversation (sorry, but no photos of them). Note that the Garmin for today and tomorrow are not accurate, since they will understate our time, feet of climbing, and distance. This happened since we were in dense forest with tall mountains on both sides, preventing the Garmin from getting an accurate gps reading.
Old man Andersen at the pass.
Old man Feucht at the pass.
The cabin at Swift Creek Reservoir, called Eagle Cliff Store and Campground.

Day 4 (16JUNE2015)

Today was another early start day, with another significant pass to cross. Elk Pass was more of a grunt than Oldman Pass, but we felt great at the top and continued on. This was another granny gear day. At the summit of Elk Pass, we saw an RV with a guy that was obviously a bicyclist getting out of the RV. We stopped to talk, and he offered us a coke and a large piece of cold watermelon, asked if we would stay for lunch, and explained that today was his day to sag a group of seven cyclists doing the Sierra Cascades route from Canada to Palm Springs. Once we left these folk, the ideas with Russ and I discussed fast and furiously how we could also do such a thing. The ride was spectacular. Russ and I decided to do a variant of the Sierra Cascades route by riding Cline Rd. and avoiding much of route 12. Cline Road was quite spectacular, though a bit more hilly than route 12. Later on route 12 we met a young man, riding without a helmet, heading home to Eugene, Oregon. He had been on the bike for 5 months, going places like to Hanoi, Viet Nam. I was amazed at how long distance cycling has taken off in the US. Later, after we pulled into Packwood, got a hotel, went out to dinner, and then stopped by the grocery store, we again met George and Megan, and talked them into staying at our hotel. It was the same hotel that Russ and I stayed at several years ago when we did a touring loop around Mt. Rainier.
Overlook of Mt. St. Helens, and a valley that was completely wiped out by the volcano. It is now growing back quite nicely.
A very friendly cyclist pulling duty at manning the SAG wagon, but also being very hospitable to us.
Deep forest on the ride to Packwood
Russ at a river crossing on Cline Road

Day 5 (17JUNE2015)

Home. It was a 72+ mile venture. The weather was phenomenal, and we had one pass to go over, 1500 feet of climbing over Skate Creek. The climb was over about double the distance of the other 1500+ foot passes, making it much easier to get over. It still was a long plod, now in entirely familiar territory where we had ridden many times before. We stopped for lunch at the back porch of an abandoned house on Ohop Lake, and rode on. The only disgusting part of our entire ride was that of the last 10 miles through South Hill and Puyallup, with nasty traffic, no bicycle shoulders, and mean drivers. We were glad to get home.
Our view of Ohop Lake
Russ preparing a sandwich on Ohop Lake at an abandoned house.
After a ride, I immediately unpack everything, and jotted down ideas and thoughts for the next trip. I had no idea how beautiful this trip would be, and the weather was absolutely perfect for our adventure. It’s not only a delight to ride, but also to meet so many other bicycle enthusiasts, as well as hotel managers, local personalities, and people on the road. Bicycling is NOT a lonely sport, though it mostly is just you against the road and hills that it gives you. Each day of the ride, we felt a little bit stronger, and could have kept going, should the journey had demanded it. Neither of us were terribly sore, and we were blessed with no major injuries. Both of us are eager and ready for more adventures. Hopefully, next time, it might be with my brother Gaylon, who is eager to do a cross-country tour. With all the people we met who have been on their bike on the road for over 5 months, it is no longer looking like a highly unusual plan.

County: Life, Death and Politics at Chicago’s Public Hospital

County: Life, Death and Politics at Chicago’s Public Hospital, by David Ansell ★★
David Ansell offers his personal reflections as a resident and then junior attending in internal medicine at Cook County Hospital in Chicago, Illinois. This book was to complement another recent read by Dr. Guinan et. al. titled The History of Surgery at Cook County Hospital. Having been a resident in surgery at CCH from 1982 to 1989, this book was of great interest to me. I do not recall ever having encountered Dr. Ansell, but there was minimal contact between the surgical and internal medicine residents at the County. Part of the reason for that was the highly inconsistent care that our patients received under the internists at CCH, necessitating that we as surgeons care for most diseases that would usually fall in the realm of needing an internist.
I have very mixed feelings about this book. I appreciated DR. Ansell’s candor and honesty, which was not always seen in the History of Surgery. Ansell was willing to speak at length about the wantonly corrupt Chicago politics and how CCH was considered by the politicians as a nuisance rather than a necessity for the county. He spoke at length about a system completely overwhelmed, and yet ignored by the powers in public office. He gives a nice feel about the frustrations of a doctor in that system trying to do the best to provide for the patients that come under his care.
Unfortunately, Ansell is over-burdened by his ideology, and this has controlled his behavior as a CCH physician to an extreme degree. Ansell is at least honest about how his was a public agitator, and often acted against his superiors to promote his vision of “the good”. Yet, he remains completely blind to how his personal politics and behaviors have perhaps made matters worse rather than better for the poor of Cook County. He labors hard to expose the corrupt Democratic machine that runs Chicago, yet offers no alternative to that Democratic machine, speaking very demeaningly of the other political party. His oft repeated delusion that “health care is a right” (i.e., and not a privilege) suggests that Ansell will not be happy until at health care in the US is reduced to the quality found at CCH, so that there is an equalization of care among the “rich” and the “poor”. I’m sure that even then Ansell would be a dis-satisfied character.
I was particularly annoyed when Ansell spoke so disparagingly of my mentor, Dr. G. Dr. G. happened to be Bangladeshi in origin, probably one of the finest surgeons I had ever met in my life, and a role model of acting in a thoughtful and non-discriminatory manner. The entire episode of his interaction with Dr. G. suggests to me that Ansell was more a blind ideologue than a brilliant innovator. This is not unusual for the Chicago system, and we are now having to suffer under a community activist but now national Führer from this same corrupt Chicago  system.
That Ansell now sits on the Cook Country Board for the hospital is testimony that Stroger Hospital will be the same failure that its predecessor was.  I wish that Ansell could spend a lengthy amount of time working in a truly destitute health care system, such as I have done in Extrem Nord Cameroon or in Bangladesh, to see that a bleeding heart doesn’t solve the problem of disparity in health care. Ingenuity does allow for solutions that Ansell (and for the most part, the entire American health care system) will not allow. This has nothing to do with financial reasons, but rather for legal, sociological, political and ideological obstructions to providing for the poor.
I’ll mention just one example. Ansell heavily criticizes the large open wards that once were at Cook County Hospital. I’ve never had a patient complain about that, and we as physicians would work hard to preserve the privacy of our patients. Yet, the large ward allowed a nurse to quickly assess in a few glances if everything was ok. I would frequently ask a patient to watch out for the patient in the bed next to them if they were doing poorly, and to report that immediately to the nurse. A little care was able to prevent the spread of infection from one patient to another. The total cost of care was vastly less for the same quality as the private rooms that we now have throughout the US.
I read this book a bit frustrated and with great disappointment–Ansell seemed to care for the indigent patient of CCH, but allowed his personal ideology and obnoxious behavior to dominate his stay at the County. For that reason, this book would  be most fittingly titled “Clueless at County”.

The Merry Month of May 2015

May was a busy month. I had three main activities that consumed my time.
1. Adventure Cycle Association Leadership Course
This course is required by those who wish to lead ACA tours, but is also an excellent source of information for leading one’s own bicycling adventures. The classes were held at Champoeg State Park in Oregon, south of Portland and along the Willamette River. It was three packed days of most classwork, but also with short rides mixed in. Much discussion was held in discussing the ACA philosophy of leadership, being that of allowing tour participants much freedom of individual decisions and responsibility. The ACA regimen of daily cycling activity, and conflict resolution were also discussed. I had a great time, met some delightful people, and hope to be assisting in the leadership of tours soon.
The Willamette River at Champoeg State Park
Camping at Champoeg State Park; my tent is on the far left
Classroom discussion with Joyce
Wally and the staff make dinner
Chowing down
2. Dayton, WA bicycling
It has been several years since Russ A. and I have gone to Dayton, WA for bicycle riding. Another friend of Russ, Pete, also comes with, and is a great complement to the rides. This year, our first ride was loop down to Walla Walla, starting from Howie’s cabin, half way from Dayton up to the Bluewood Ski Resort. The second day was a mountain bike ride up into the Blue Mountains, and a most serious grunt. The third day took us to Starbuck, and north of Dayton. The weather was perfect, and rides were most delightful.
Second day mountain bike ride, just after a beastly climb
The Three Musketeers
Russ at home in the Blue Mountains
3. Hikes to Indian Henry’s — two variations
On two consecutive weekends, Jon and I hiked up to Indian Henry’s hunting grounds, a most beautiful spot on the timberline of Mount Rainier. The first hike took the Kautz Creek route, which goes straight up a ridge following Kautz Creek up to Indian Henry’s, wrapping around Mt. Ararat. The top photo is of Mt. Ararat engulfed in clouds. On this hike, the weather was overcast, and we could not see the mountain. Close to Indian Henry’s, we hit much snow, which eventually led us to turn back. The second weekend, we followed the Wonderland Trail going counter-clockwise around the mountain. The weather was spectacular, and most of the snow at Indian Henry’s had since melted. The views of the mountain were awesome.
More flowers
And More flowers
Jon on the Kautz Creek hike
Me on the Kautz Creek hike
Approaching Indian Henry’s. Lots of flowers and little snow.
Indian Henry’s Hunting Grounds via the Wonderland Trail
Leaving Indian Henry’s
We camped here before on the Wonderland Trail, and will be camping here again in August when we do the Wonderland Trail again.

A History of Surgery at Cook County Hospital

A History of Surgery at Cook County Hospital, edited by Patrick Guinan, Kenneth Printen, James Stone, and James Yao ★★★
This book was of great interest to me, since I did my residency at Cook County Hospital during the years 1982 -1989. At that time, we were never given much of a history of the place. There was the operating amphitheater which was being used as a large storage area. There was Karl Meyer Hall, which was rarely used except as a place to grab some food at the 1st floor cafeteria, as we usually slept in unused beds at the hospital when on call. There was Karl Meyer’s residence, which was then being used as the trauma office. We were never really told much about Karl Meyer, or how Cook County Hospital created so many legends. Thus, I found the book of great interest, and since I prefer to read books on my iPad, that is how I purchased the book. I have mixed feelings about the book.
First, the book was exceptionally poorly edited. Spelling errors and other errors were everywhere. The organization of the book created multiple repetitions, and a clear linear timeline of history of CCH was never well developed. The most early history, being that before the 1915-2002 building was erected, are sketchy at best, and not well laid out. I don’t get a good feeling as to how surgery developed in Chicago, and since Cook County Hospital was so dependent on the rise and development of Northwestern, Rush, University of Illinois, and Loyola University, the history of those residency programs should have been better described. The book is written in a manner that if one never set foot in CCH, they would have no clue as to what was being talked about–the book’s value is primarily for former surgery residents of CCH.  I get the feeling that the book was haphazardly slopped together without much thought for the potential audience.
Secondly, I was left with the feeling that surgery training at CCH was rather haphazard and chaotic, that instruction came mostly from the chief resident, and that attendings were not often present, owing to the voluntary nature of the surgical leadership. To some extent, that actually was my experience at CCH, with a mixture of absolutely superb attendings (such as Dr. Abcarian and Dr. Jonasson) and absolutely horrid, possibly even incompetent attendings, whose names will go unmentioned, though some were mentioned with praise in the book. The attitude of the residents at the time of my residency was of pompous arrogance that the CCH residency in surgery was the greatest in the world, and  that it was one of the few that truly produced consistently great surgeons. I didn’t see that at all. Perhaps the punishment of the system led some residents into a minor form of Stockholm Syndrome, where the abused become attached and fall in love with the tormentor. This book hints at such a possibility. Unintentionally, the book does more to disparage the training one received at CCH rather than compliment it.
Thirdly, there were many historical inaccuracies (or, perhaps, incomplete truths) in the book, at least related to the years that I was a resident. The real reason for Dr. Baker’s departure goes (and should go) unmentioned. The cause for Dr. Jonasson’s departure was greatly misrepresented, since she was fired by the Cook County Board, as we were told at the time. I’m left wondering about the real cause for Freeark’s departure, since he never again set foot in CCH. The editors chose political correctness, rather than indicting the most politically corrupt city & county government in the United States for poor management of their hospital. The “dirty laundry” of Cook County Hospital was swept under the rug, leaving us only half a history of the place. Other details were minor errors. For instance,  I remember some of the windows of the operating room still being able to be opened, and battling flies in the operating room. (Even in the 1980’s, we still occasionally used the windows at X-Ray view boxes and as air-conditioning units!) There is a mention of contending with the AIDs problem in the 1970’s, yet it wasn’t until 1987 that we knew enough about the HIV epidemic to take any actions, such as actually wearing gloves in the trauma unit when doing procedures.
Fourth, there was much history that was glossed over. What about the county jail on the 8th floor of the A building? How did the A building come to be? How did the Fantus Clinic emerge to the place and character that it was throughout the 1970’s – 1990’s? Could one have elaborated more on Karl Meyer and his living arrangement in the hospital? Surely there were anecdotes about the highly quirky elevator operators and other employees of the hospital that formed a special characteristic of the place. Many people with great histories were glossed over, such as Dr. Lowe in trauma, and way-too-short  histories of certain individuals such as Dr. Abcarian, Dr. Walter Barker in thoracic surgery and Dr. Jonasson, all true giants in the world of surgery.
There was much good in the book that made it enjoyable to read. I appreciated the elaboration of the development of various departments of the hospital. Most relevant were the development of the trauma unit and blood bank, both being nation’s first. Having worked in many of the departments mentioned, such as the orthopedic, colon rectal, thoracic, pediatric, and burn services, I would have appreciated having a better understanding of the history of the department when I was still a resident. Thirty years later, it is still fascinating to read about how these departments came to be.
The personal stories at the end of the book were a total delight. These stories and vignettes of the old County hospital make for the best memories. When I started surgical residency, one of my first encounters was with Dr. Robert S., who had just graduated from the County residency, and was then doing a fellowship in Cardiothoracic surgery at the University of Illinois. He would spend countless hours with me, relating stories of the Greeks, of cases that he had done, and how things worked at CCH. I am sure that virtually every resident that graduated from CCH has a book full of stories, myself included, of unusual and interesting events that transpired while serving at CCH. For me, there were stories in the ER dealing with drug addicts and prostitutes, the trauma unit with famous (infamous) criminals, with survival tactics while working the floor or taking call, with various quirks of attendings (both good and bad), and with living an experience that nobody could ever repeat at this time, since there is no more CCH.
It was with great sadness that I learned that the old hospital was removed and a new, much smaller facility was built in its place. Many of the buildings needed to be removed or were completely obsolete, such as the nursing building and Karl Meyer hall, as well as the Children’s hospital and the “A” building. The Children’s hospital also held the burn unit, and was so run down during my time as a resident, that it was downright spooky to go into. The only thing good about that building were the elevators, which were fun to ride. But, it is only fitting that the new hospital be named Stroger Hospital, as it is no longer Cook County Hospital. Cook County Hospital has died, and a new beast has arisen in its place. It is unlikely that Stroger Hospital will generate any surgical giants, save for total happenstance. Thus, I am delighted that a history of the old Cook County Hospital, written by those that had a long experience with the place, has been produced. For all its faults, this is still a history worth reading by those who have spent a few years of their life within those halls.