Friday, August 7, 2015

"Your care is important to us"

Remember my monolithic healthcare practice? As with all businesses the size of General Motors, they try to get their customers (“patients”) to do as much of the work for them, with the least amount of human involvement on their part, as possible. They worship anything “online”.

Then they enhance the experience by making it as tedious and opaque as they can.

Remember those days of yesteryear, when the day before your appointment one of the practice people would call to remind you? Palo Alto Medical Foundation (PAMF) sends you an email:


Please take note of the fact that they give you no actual, you know, information. They make you log into their site and click through at least two screens to get that.

(Actually, the orthopedics department robocalls you. Seriously, it’s a computer, inexorable and implacable, that calls within two minutes of 1800, when all their office staff has left for the day. So if you do need to speak with a human, you’re SOL until the next business day. Man, nothing says “we care” like robocalls.)

They do the same thing with any appointment follow-up—lab results, or diagnosis from X-rays: an email advising you that they have important information about your health; so go log in if you’re at all interested, because it’s sure as hell not in the email.

(Yes, I know, they’re concerned about privacy. I’m concerned about dealing with an organization with enough employees to fill their own ZIP code, supposedly focused on providing healthcare, who go to great lengths to exhibit all the warmth of an ATM. Also, they have no problem with leaving those robomessages on voicemail or answering machines; there goes your privacy argument.)

The other day I wanted to do some follow-up of my own, so I used the site’s “talk with your care team” function. (Yes, that’s what they call it.) Here’s what they show you when you initiate the application:


Not only do they have the disclaimer that you have to listen to with any medical-related IVR system, but you cannot get to the message screen until you swear that you’re not a danger to yourself or others.

Does losing the will to live while trying to navigate their kludgy systems count?




Thursday, August 6, 2015

A rain of ruin

Seventy years ago today a B-29 Superfortress took off from the island of Tinian in the Marianas and headed toward Japan with a single uranium-based bomb in its hold. The Enola Gay was escorted by two more planes, The Great Artiste (stuffed with instruments for measuring the blast) and an unnamed bomber (equipped for photography) that was later christened Necessary Evil.

Their primary target was Hiroshima, an industrial city with a major military presence. Nagasaki and Kokura were the alternate targets. All three were sizeable urban centers with either industry, communications or military infrastructure that had so far escaped the massive bombings that had destroyed large swathes of Tokyo and other cities.

These were the basic criteria determined by US leaders for deploying the world’s first atomic weapon, which was intended to have a psychological effect on Japan’s will to wage war, rather than cause extensive physical devastation. We’d already done that with air raids involving bombers in their hundreds obliterating Japanese cities. The first nuclear explosion was meant to focus the minds of Japan’s leadership on how far we’d moved the needle on the destruction-capability wheel and rethink their strategy of resisting to the last person.

On 6 August, while approaching southern Japan, Colonel Paul W. Tibbets, commanding Enola Gay, got the go-ahead for the primary target. A little after 0800 the bomb, named “Little Boy”, detonated about 1900 feet above the center of the city, causing destruction in a one-mile radius and starting fires that spread out further.

And, of course, there was the radiation, which was a game changer in the arsenal of war at that time. The next day, a team of Japanese nuclear physicists visited Hiroshima and verified that the damage had been caused by an atomic blast, which they reported to Tokyo. The Imperial cabinet conferred. They knew exactly what they were facing, but they concluded that the US could only have one or two more such weapons in their arsenal. So their best course of action would be to just take the hits and continue to fight with conventional means. 

The Japanese people could withstand a few nuclear bombs and go on fighting. They wouldn't win, but they'd make the Allied victory a Pyrrhic one, and that was something worthwhile.

It was kind of like corporations today that do risk-benefit analyses on things like product safety and decide that it’s more cost-effective to settle a few lawsuits than to clean up their manufacturing processes. Only, of course, more so.

Harry S Truman—who had known nothing about the atomic weapons program when he became President in April that year—announced the dropping of the bomb and promised the Japanese “a rain of ruin from the air” if they did not surrender unconditionally. They did not, so he authorized the deployment of a second bomb, “Fat Man”, which was dropped on Nagasaki (again, a secondary target for the day, but the primary was too clouded over to be feasible) on 9 August. A few days later, the Emperor announced to the nation his government’s intention to surrender, citing the “new and terrible weapon” that had been used against them.

Finally, a good call, because as it happened, the Americans had several more devices in the pipeline. They reckoned the next one would be ready for use on 19 August, with more to follow, and the only debate was about whether to drop each one as it became available or gather a few and take out multiple targets simultaneously to make the point.

There are all kinds of arguments for and against the morality of using nuclear weapons on Japan. I believe Truman made the right call, difficult as it was; I believe that “Little Boy” and “Fat Man” served the purpose in an immediate way of convincing the Japanese that meeting the Allies’ terms (unconditional surrender) was the only alternative to unimaginable annihilation of their nation, their people and their lands.

Yes—we were well on the way to accomplishing those goals with conventional weapons. But the atomic bombs made it clear that we could now obliterate them without sustaining the kinds of losses that massive air raids and amphibious landings would cost us. That old risk-benefit analysis was clearly seen to be in our favor.

I admit to being uncomfortable with that old rationale that’s hauled out every fucking time someone wants a government to buy and deploy an expensive, untried device, substance or application that has the potential to cause mass destruction. You know—“It’s actually more humane to use [horses; Gatling guns; poison gas; unrestricted submarine warfare; air raids on civilian targets; atomic bombs; SDI], because it will force the enemy to surrender faster and thus it’ll save lives. Right? Sign here. And here.”

Cavalry, poison gas, machine guns didn’t shorten any wars. (In fact, machine guns dragged out the fighting on the Western Front in World War I year after year because no one seemed to be able to win with them and everyone refused to lose to them.) Submarine warfare came close to strangling Britain in World War II, but in the end failed. Star Wars?—meh. And don’t get me started on “strategic” bombing; I can’t even believe we’re still having that conversation 70 years later.

But I do believe that “Little Boy” and “Fat Man” hastened the end of one war. Probably not an option these days, unless you’re down with mutually assured destruction being the full stop to that expedient. And some people are, so that makes it a little tricky for the rest of us.

In the meantime, I take heart in the story that there’s a 390-year-old white pine bonsai tree in the Washington, D.C., Arboretum that survived the atomic bomb in Hiroshima. It was two miles away from ground zero, in the grounds of bonsai master Masaru Yamaki’s home, and protected from the blast by a fence on 6 August 1945. Yamaki donated it to the Arboretum in 1976. It’s survived natural and manmade disasters through daily attention by its keepers over the centuries.


It would be nice if we could apply that kind of care to one another, both individually and nationally.  



Wednesday, August 5, 2015

Special delivery. Ish

As I’ve reported before, I’ve received several phishing expeditions that use the USPS and FedEx as clickbait. So the other day when I found this in my queue I just thought, gee, another one:


It did occur to me that the spammers had improved their corporate plagiarism techniques, as well as their verisimilitude-oriented detail (like the tracking number). And then I realized that, hey—this actually was a general UPS email for a genuine UPS shipment.

(In fact, it was my new DVR box from Comcast.)

It is indeed a sad state of affairs, however, when your first response to getting pretty much any kind of “parcel-delivery” notification is to hit the delete button.



Tuesday, August 4, 2015

Check it out again

It seems that I’m not the only patron of the Santa Clara County Library District to have noticed that their new web interface sucks eggs. I went there over the weekend to renew a couple of items coming due and in the process discovered this notice:


I’m just wondering how long it’ll take them to flip the Back switch on it?

Monday, August 3, 2015

Gratitude Monday: A tragic high-tide accident

During my morning walk on Saturday I listened to Scott Simon interview architect Renzo Piano. Not about his stunning public and private buildings, but about an entirely different design form.

Sandcastles.

Piano, 77, has been building sandcastles man and boy, and has taught his children (ranging in age from 50 to 16) the craft for quite a long time as well. He says you can build them whatever your age, but it helps to think like a child. This is an approach to art that completely resonates with me.

You must first resign yourself to the knowledge that creating a sandcastle is a completely in-the-moment exercise. (“Totally useless,” he says.) Water—an integral component of construction—also carries the inevitability of its destruction. Whatever you build is going to get washed away before you pack up the beach towels. Deal with it.

(This is one of the reasons I totally love baristas who create latte art: it’s never going to last longer than the first sip. But it’s gorgeous while it’s there, and “the usefulness is in the act of the doing.”)

There are, of course, lots of elaborate sandcastle competitions, where people use all manner of tools to fabricate elaborate confections; I like that Piano is a hands-on kind of guy. I can attest to the sense of satisfaction that comes from both the feeling and the sound of small hands packing mud-like clomps of sand into place. You can use a pail and plastic shovel, but—as in making pastry—the magic is in the fingers.

I also like the way the architect connects the lessons learned while racing the waves to principles necessary for architects designing skyscrapers: physical laws, intuition, forces of nature.

So today I’m grateful for overhearing the conversation about the joy of creating something beautiful, of approaching it with the clarity of a child and of carrying the benefits with you long after the waves have washed away your creation.