On The Fence

credit: Mutts by Patrick McDonnell 5/19/10

Oil Spill Management Screwed Up From Jump......

The management of the now awful oil well blow out and spill in the Gulf of Mexico was messed up almost from the beginning. How quick we were to want to start the blame game instead of actually working to fix the problem. We've taken something that was a Critical Incident and instead of working on fixing it up the best we could, evaluating possible solutions, and doing careful analysis to find out why it happpened we have loaded it up with politics, finger pointing and lawyers to the point that it is FUBAR (Fucked Up Beyond All Recognition). While I have no desire to find fault, other then the pressing technical issues with the incident itself, I can find plenty of places to assign some fault for the sorry response to the incident.

It's BP's fault, because more and more is coming out that this well was a difficult well, and needing the best management and it did not get it. Critical short cuts were taken. Thus, the set up was for the well to blow. It was only a matter of time. After the shit hit the fan, BP chronically underestimated both size and degree of difficulty. They may have done this due to outside pressures applied that had nothing to do with the science of drilling for oil. Which brings us to...

It's the Fed's fault in general due to their introduction of stupid political considerations and hesitation by our woefully inexperienced Chief Executive and our incredibly self centered legislature. Best hindsight proposal I've heard to date, put forth by the latest Rush sub: A Manhattan Project all scientific hands on deck effort to first, cap the well, and second, contain and sop up the oil, started within 10 days of the initial blow/fire. We almost ought to make this part of a super duper disaster plan: All Hands--Public and Private--On Deck to Solve the Problem--No Blame Game. Did we do this? No, we did not. We went golfing and called for hearings, new laws, fines, and corporate take overs instead. And finally...

It's all media's fault, including opinionators from both the left and the right for making this a political thing, comparing it to Katrina, to Haiti earthquake, to Jimmy Carter's hostage rescue operation failure, blah, blah, blah. In addition, it's anyone's fault who has hauled out their first finger and pointed it at anyone instead of going into critical thinking mode in the very beginning.

I proposed somewhere in someone's blog comment section that we start dunking the culpable in oil. Nah, let's just send them out to remove oil from beaches, water and wild life. If they end up all oil covered, so much the better.

Meantime, it just breaks my heart to look at the oiled critters and listen to the coastal residents watching their environment be ruined.

More Rain Overnight Leads to (More) Southland Flooding

This has been the story in the southland for the last few days. Rain in large amounts over a short period of time has left the ground saturated. Runoff is causing southland waterways to rise and streets to flood. Both the Blue River and Indian Creek left their banks overnight, and went much higher than they were Friday night/Saturday morning. Indian Creek went up over 103rd street at Wornall, putting three to four feet of water in businesses on the creek side of the street. Luckily because of the late hour, there were few motorists out, although a few did need assistance out of the fast rising water. As of 1300, Indian Creek had returned completely to its banks, still running fast, but no longer flooding.

Photos here are of the Blue River, which is still flooding, at Red Bridge Road between Holmes and Blue River Road. This stretch will be closed until the water is down.

Seeing a lot of these barricades these wet days. This one bars travel from Holmes east on Red Bridge Road.
Construction equipment at the new Red Bridge Road bridge site up to its fenders and more in water.
A view of the overflowing Blue River, taken from the Red Bridge. The bridge itself was never over come by water, but it was very close.

This pipe was in a tidy little pile yesterday with similar piping--now it has floated over to the other side of the road. Other piping was noted west of where it had been before. Note the water over the road, and pedestrians checking it out on the other side. This is on the east side of the bridge. The water appeared about mid calf high, with a fairly vigorous current flowing from right to left. I did not wade in.

The water filled the picnic area on the west side of the bridge--a mind boggling amount of water--and topped the road here. You might be able to make out some folks walking through the water. Your intrepid reporter made the same journey--water up to mid calve in spots with a mild current flowing from right to left. Definitely enough to bar travel by passenger cars.

Yup, we need a break from rain. How much do we need that break? According to the Weatherbug station at Ruskin High School, we had 5.27 inches of rain fall after midnight to this morning. I had four inches in a cup in my backyard. According to the Ruskin rain meter, we have had for June a total of 15.25 inches. That's a lot of rain and we are very very soggy around here!

Best Description of the Christian Church Ever

I didn't buy much at the book sale, but I bought a book called Grace by Mary Cartledgehayes. She writes about her spiritual life, her relationship to God as a Christian and her three years of pastoring a United Methodist Church. As her time with that congregation was drawing to a close she considered the state of the church:

Lurching on toward the kingdom, I decided. Staggering drunkenly toward the kingdom, the way every good church must because, while bringing in the kingdom of God is the business of the Church, we never get it right. We lurch, we stagger, we fall, we rise, we resist, we refuse, we fail, we fall, we rise, we fall, we rise. Bad planning on God's part, if you ask me, making human beings responsible, but there it is: the pattern abides.

I love this book. It made me laugh, it made me cry. It made me smile smiles of recognition at the silliness that can be the Christian church. It made me tingle when the sacred broke through. It reminded me of the struggles no one will talk about when it comes to women in the teaching and preaching ministry. It reminded me once again that it was no accident that when I finally came to faith in Jesus Christ, it was in the corner of Christendom called Wesleyan-Armenian. I'm so glad I picked up this book.

Morning Rain Raises Southland Waterways

South Kansas City has two waterways winding their way around the land, making their meandering way to the Missouri River. One is the Blue River. The other is Indian Creek. The additional two inches or so of rain that fell this morning onto saturated soil was enough to have both waterways running fast and at high levels again today.

The Blue River, looking from the bridge. It's much higher, and flowing much faster then normal. Usually, you can see very clearly the channel the water has carved out over the years, but the elevated water level has obscured that feature.

This is a view you would not have seen prior to the work being done in preparation for the new bridge. The river channel was lowered here and the water has taken advantage. In addition, water from the small artificial lake that is behind the photographer is moving into the river. The river is spread much wider then usual. Left in the photo, on the near bridge pillar, is a water gauge.

This is Indian Creek at Watt's Mill. This view, taken from 103rd street, looks east towards the remnants of the old mill. The water is really moving! Where the creek crosses Wornall Road, there is often flooding of the businesses along 103rd street and Wornall.

This view of Indian Creek shows how it is out of its banks, but you can see from the lines of debris, it had been higher earlier in the day.

Here's a view of Indian Creek looking west from the 103rd street bridge. I'd estimate this water was going 50 mph at this point.

We need a day or two to dry out around here! During the rain, there were numerous roadways that developed high water quickly--the classic urban flash flood. There is just no more room in the soil for water. More rain is forecast to fall over the next 36 hours; I would expect more urban creek flooding and flash flooding too. Local readers, please be careful out there!

No Profound Thoughts Tonight

Visited with friends from my Bible study group around lunch time, which extended into tea time. Then it was time to go cruisin' !

Hope everyone has a fabulous weekend!

Won't Get Fooled Again

Say what you will about The New York Times and newspapers in general getting smaller and less comprehensive and all that, they do provide a lot of food for thought. The latest? An article entitled "Fooling the Doctors, Some of the Time." It is a meditation on doctors and the dispensing of addictive medications, in this case benzodiazapines, but applicable, I think across the board to include interactions over pain medications. Here's a bit:

“It is better to suffer wrong than to do it,” Samuel Johnson wrote, “and happier to be sometimes cheated than not to trust.” Knowing that false positives are inevitable gives a statistical perspective to that wisdom — and frees the doctor from having to interrogate the patient like a criminal suspect. To put it another way, I’d rather be taken for a sucker once in a while than know that my suspicion had denied someone legitimate help. Furthermore, excessive suspicion compromises empathy and compassion. It is draining to approach patients as possible adversaries who must be bested.

In other words, according to the author of this piece, Dr.Michael W. Kahn, it is better to err on the side of prescribing for the patient then denying them. He ends the piece asking this question:

Since “first, do no harm” remains a guiding principle of care, let’s remember that the harm of missing a chance to help often greatly exceeds the harm of prescribing under a false pretext. Our system of justice is based on the idea that we should let the guilty go free rather than punish the innocent. Could our prescribing habits benefit from the same philosophy?

I had a multitude of reactions to this essay. My first reaction was a gut one, and was basically, "You've got to be kidding, these drug seekers will run your ass over at the first sign of weakness." Then I thought some more, considered patients I have known and assessments I have struggled to make, and realized that yes, the author does have a point. The patient and provider should not be involved in a battle over the drugs. In fact, patient and provider are supposed to work together, not at loggerheads. This conclusion says that giving the benefit of the doubt is the right thing to do. There are times this is not the right battle to fight. There are times you are not sure if you are dealing with real pain or really good fakery. The thing is, if someone has real pain, the compassionate thing is to give medication to help that pain. If we are not sure we are looking at real pain, we have to err on the side of giving medication that is likely to give relief, even if there is a chance the whole thing is an act to get narcotic medication.

Sometimes, though, I think drug seekers need to be confronted. I don't think they should always get what they want. A person will never hit the hard bottom if there's always someone sticking a cushion there. To go to an ER and hear that you will not be given the narcotic because you don't need it may be just what a person needs to hear. Pain medication is for medicating physical pain, not for getting away from a bad life or treating psychological pain. Some folks need to be told this at some point. That could be what it takes to get them going towards recovery, and living a drug free life.

Finally, there is that natural dislike for being played. No one likes to be a sucker, to be deceived, to give someone something that they don't need or deserve. No one likes being taken. That's when you can lapse into a "competitive cynicism" --and start thinking that no one is to be trusted in their complaint. You cannot give good compassionate care that way. The moment you start thinking that everyone is out to game the system is the moment to consider taking a break.

One last thing: It's amazing to consider how much of an ER's energy and time is consumed with people with chronic pain complaints and drug seeking behaviors. Just take a look at my ER oriented blogs in the blog roll. These types of patients are a pretty common blog topic for the ER doc and nurse bloggers. I don't know what the stats are, but I won't be surprised that chronic pain and prescription drug abusing patients are a good 25% of ER clientele. It's too bad we can't find a better way to work with patients on these problems then in the Emergency Department.

In the end, assessment needs to be diligently done. If it's time for a patient to hear the truth, then tell it. If you are not sure, then I agree with the author, give the addictive prescription medication. If you are an ER doctor, and too many chronic pain/drug seeking patients like you, you may be too easy. If you are an ER doctor, and those patients hate you, you may be becoming too cynical. It's a tough balance, that takes up a lot of a provider's psychic energy.

Rainy Afternoon, Much Water

Well it's been raining in a torrent around here since about 1600, finally settling down maybe around 1830. I've been at the library, not doing exactly what I came to do, but getting around to a few items on the list. Well, my attention is drawn to my car out in the parking lot. It is sitting in a rather large pond of water that has developed due to overwhelmed storm drains. I took off my shoes and socks and waded through water over my ankles to rescue the car.

It looked like this after I reparked and then grabbed the camera. I'm glad it wasn't moving or anything--might have had a drowned car. The still dark clouds are reflected in this shot of the ponded water.

The rainfall created this little stream behind the library building. It's flowing into a storm sewer opening to the lower right. According to the radar calculated totals, we've had 2.5 inches of rain from 1600 to 1930 or so. It looks like we should be done after this last little batch comes through. In the five county Kansas City metro, south Kansas City got the most rain. Indian Creek started to rise, but appears to be stabilizing now. 6-8 inches of water collected on interstate 435 at the State Line due in part to a clogged storm drain on the Kansas side. Reports of water ponding on Red Bridge Road near Highway 71 also were received. Just south of the five county metro, most of Cass County got at least 2.5 inches of rain. Now, the southern edge of the storm complex is starting to generate tornado warnings as it moves to the south and east of Kansas City.

In other weather news, after having a tornado and severe thunderstorms Sunday, the northeastern counties of Vermont are under a frost warning.