But technology can also be made to work for me.  Technology should allow me to connect to anyone I wish and maintain the level of privacy that I desire.  Since most of the people who would wish to access my information are people I actively wish not to communicate with, I think that my electronic privacy is also a right that should be protected by my government.

In my research, I have come across a few examples of people working as hard as they can to mine data from social networks in order to cure disease and save humanity.  This made me pause for a moment.  Here are noble people invading my privacy for a very good reason.  Often times the United States  government will attempt the same thing.  For instance my government may wish to mine my data and invade my privacy for the purpose of thwarting terrorism.  However, these measures have been largely unsuccessful and the mechanisms have often been abused for less noble purposes.  But tracking epidemics and eradicating disease…this is a whole new ball game.  In order to understand what’s at stake here, the reader needs to know who the big players are.  If you are willing to watch a few TED Talks you can be brought up to speed on just what exactly is emerging in this field.

First up is Nicholas Christakis.  He is a researcher at Harvard who maps social networks in order to detect epidemics and emerging threats.  He has given two TED Talks on this subject.  They are both worth your time.

The work that he does, and the information he obtains from network analysis could very well create a system that could prevent the deaths of hundreds of millions of people by catching an outbreak of the flu in its early stages before it becomes a pandemic.  Notice that he eludes to the fact that this technique can be used for other purposes.  In both videos he mentions advertising and product trends.  So it is obvious that Dr. Christakis is considering alternative income streams right out of the gate.

Larry Brilliant is another physician who is using these techniques to not only track disease outbreaks, but eradicate diseases.  He was actually the winner of the TED prize in 2006, and these funds were used to help realize his vision.

Not long after this he was named Executive Director of Google.org which is the philanthropic arm of Google.  So Dr. Brilliant sat atop the biggest cache of information the world has ever known and was in the perfect position to use it to detect and avert pandemics.  However, as this NY Times Article suggests, Google.org failed to live up to its expectations and Dr. Brilliant was let go in 2009.  Google.org still operates and there is a flu tracking tool, but it is apparently just a shadow of its previously hyped self.

The last TED Talk I have for you presents an interesting alternative to data mining.  Jamie Heywood started a website called Patients Like Me meant to track the trends of patients diagnosed with various conditions.

He got the idea after his brother died of ALS.  There wasn’t any way to connect with other people with ALS to find out if various treatments were prolonging life or improving the quality of life for these patients.  The premise is interesting: patients sign up for this service, input relevant data and allow themselves to be tracked  This information is made available with powerful statistical analysis tools that haven’t been used in the healthcare setting before.  The data sets are so rich and powerful that it is meant to provide a way for someone to make a study up on the fly.  If you want to sit down and find out was has happened to thousands of patients who are taking two specific drugs at once you can do this.  You can proceed to drill down into the data set to see outcomes, chart trends, see who died, and what the symptoms were like.  There is no need to spend the money to create a study.  The data is already there.

However, this service was made by patients for patients.  I have said time and time again that health care often suffers when the patient or the family (usually the least qualified people in the room) calls the shots.  One could make an argument against how samples and participants are chosen and how this information is acquired.  However, even if the source of this information (namely the patients themselves) is in question, it would be damned hard for a medical professional to deny that there is a lot of rich data about outcomes sitting there just waiting to be accessed.  And isn’t that what healthcare is all about, patient outcomes?  Ignoring this data set is like a doctor going into a room and ignoring all the complaints of the patient they have come to treat.  Why else would this doctor have showed up in the first place?

I like the concept of this service because no one is collecting the information of patients without their consent.  Indeed, patients input information in the hopes that other people will access it in order to learn more about their condition.  In this way, you have to actively opt in to have your data mined.  If you wish to opt out, simply don’t sign up for the service.

So, the examples given above bring up some sticky issues about privacy.  After examining a lot of evidence I truly believe that most invasions of electronic privacy by the government and the private sector are unwarranted.  Many would disagree.  This is the age old argument where privacy and the rights of individuals are weighed against the safety and the convenience of the society in which those individuals live.  But what if a health organization could track Facebook and Twitter comments to find out that a new strain of avian flu had broken out?  What if the data of those social media sites could be mined using techniques developed by researchers such as Nicholas Christakis to not only detect an outbreak, but detect it early?  What is the individual privacy/social benefit analysis of that?

If the data sets of services like Patients Like Me can be called into questions because of their source, will we ever be able to trust the comments of individual citizens using social media to pull the trigger on a multi-million dollar pandemic response?  It seems to me that a system like that is one false alarm away from ridicule.

Wikipedia is a great social experiment of what can happen when the average Joe decides to collaborate on something.  Yet I don’t know one teacher who would accept a Wikipedia article as a source for a paper.  Should physicians dismiss reams of patient data for the same reason?  Do these flaws make the invasion of privacy not worth the effort?  In a world where HIPAA guarantees the privacy of every patient of the United States by federal law, can we in good conscience mine data from social media sites to obtain information to treat those same patients?

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First of all, the term cookie is a bit odd. It comes from the term ‘magic cookie‘ which is an old school colloquialism that programmers used to refer to a small packet of data being passed between programs. In the early days of the public internet an employee of Netscape (Remember those guys?) was trying to write a secure shopping program for one of their clients. This was back in 1994 before the virtual shopping cart had been invented. They needed a way for a secure session to be held between the user and the store, and cookies were the answer.

So in the beginning cookies weren’t inherently evil, and they still aren’t. They simply provide a way for a website to track its current session with a specific user so that useful information can be passed back and forth. Without cookies there would be no web commerce, online banking, message boards, or any other of the useful web applications we have come to rely on. In its original implementation, the cookie was a very clever idea. However, it creates a situation where a website can place a file on your computer. And anytime that is allowed to happen, another programmer who is equally clever will find a way to exploit it.

Let’s start by finding a cookie and having a look at it. Every browser and every operating system stores cookies in a different place. So telling you which directory to look in would be useless. But searching for them is fairly easy. On most machines searching for a directory named ‘Cookies’ will get you were you are going, You could also do a web search for ‘cookie directory yourbrowser youroperatingsystem‘ to find the folder specific to your setup. In Windows 7 for instance they are stored in a directory that is conspicuously named ‘Cookies.’ At the time this writing, Internet Explorer cookies stored on a Windows 7 machine can be found in C:\Users\username\AppData\Roaming\Microsoft\Windows\Cookies. Windows users should realize that by default these directories are hidden from your view. Also make sure that you look under the directory with your user name spelled correctly. Different users on the same computer will have different cookies.

Now that you have found your cookie directory, have a look at the contents. If there are several hundred files in there be afraid. Be very, very afraid. Your browser settings are too permissive and you are being tracked by many people. But don’t worry. Read on and you will learn how to manage this. Your first step would be to stop using Internet Explorer, but that is the subject of another post.

How are cookies supposed to work?

Before I tell you the evils of cookies, let’s first cover how cookies should work. When you access a page on a website, that website will often instruct your browser to download a cookie. Your web browser will place that cookie in whatever directory it likes to keep them in. At the time of this writing, WordPress software is used for this blog, and it will place a few cookies on your computer. (So there you go. Even I am giving you cookies.) Different cookies do different things. If you have logged into a website, that website may constantly check for the presence of a cookie to verify your identity to ensure that no one is able to steal information you access from your session. Some websites allow you to customize the look and feel of a site for your tastes. Checking to see which cookie is on your machine will allow such a site to serve you a page stylized by a certain theme you have chosen. These are all benign uses. They actually improve your web experience.

The cookie will contain an individual identifier. Every time you request a page, the website will check the identifier against its database to see who you are. It will use this information to tailor your experience. Cookies also usually contain an expiration date, as well as some marker that will define what websites can access that cookie. Cookies that come from reputable websites will create cookies that can be accessed by only one site, or perhaps even one portion of a site. For instance if I installed some sort of image viewer on my site, it might leave a cookie that can only be accessed by a request from http://gomerville/images. In that particular case, other scripts from the same website couldn’t even access that cookie.

How do evil cookies work?

This could be the subject of a book, but I will try to keep it short. I wish it were as simple as dividing all of them into good cookies, and bad cookies. But there is a whole spectrum of cookiedom to be considered here. Let’s start with super bad cookies.

Some malicious websites just exist to put viruses and other malicious software on your machine. Cookies are part of that process. Viruses and other malware need to identify their victims just as much as legitimate programs do. One example of this would be a hacker that wanted to identify computers with a certain outdated copy of Windows in order to take advantage of a specific weakness in the software the user has neglected to update. The hacker may create a website that has a script that checks for this weakness and then installs a cookie that acts as a marker that can be recognized later. Further down the road, that hacker might want to use the same machine for another exploit.

Some cookies used for malicious purposes are tenacious and will not easily leave your system. Clever programmers have learned how to avoid the default folder, and store a cookie deep in the bowels of your hard drive where no one will ever find it. Java script or some other program on a website can later call it up even though it is not in the standard place.

There is also something called a ‘zombie cookie’. This is a cookie that comes back to life a short time after it has been erased. In order for this to happen, another piece of malware must be on your machine. It will check every so often to make sure that the cookie is still there. If not, it will be resurrected. This is just one of the many ways that junk on a computer can cause it to run slowly. Imagine an unwary user that has a lot of malware installed on his machine. Dozens of zombie cookies could be installed with dozens of pieces of malware checking in the background every few minutes just to see if their cookies still exist.  This is just one of many reasons why infected computers often run slowly.

The Gray Area

This is where things get tricky. There are many cookies that are created by webmasters and marketing companies that aim to provide ‘more relevant advertising’ to the user. Some people appreciate this. Has Amazon.com ever recommended a good book to you? Maybe you appreciated the recommendation and read the book cover to cover. Suggestions like this would not be possible without cookies. However, you may not be sure just how deep this rabbit hole goes.

Several data mining companies make cookies that track your movements all over the web. Large companies like Acxiom make deals with thousands of different websites. These websites agree to place a cookie on the computers of people who use that website. That cookie is not one of the site specific ones I was talking about before. This cookie can be recognized and modified by any of the thousands of partners working with the data mining company. In this way your movements are tracked all over the web. The data miner can then go back and request more information about you, knowing that you purchased services from a certain website. For instance, they know that you purchased a book about gardening from Amazon. So they know your credit card number, address, and your interest in gardening. The same cookie might have been spotted when you visited Netflix. Now they know your movie preferences.

This is a matter of degrees. What if I told you that Netflix used cookies to keep track of your movie preferences, and because of this they were able to recommend ‘Young Frankenstein’ to you when it became available on their streaming service? Would that seem invasive? Would that be okay? Now, what if I told you that a company you have never heard of used cookies to find out that you are a 34 year old white male who drives a Ford truck, hates sushi, loves Asian porn, voraciously reads self help books, and is a member of the NRA…and that information was available to any company who wanted it. And what if I told you that resulted in a canvasser knocking at your door and trying to win your vote because a marketing firm had determined you were a possible swing vote for the Republican party? Would that be invasive? Would that be okay? This isn’t paranoia. This isn’t science fiction. This is marketing in the 21st century.

How do you opt out?

The first thing you need to do is make your browser behave. Every browser is different, but somewhere in the settings of that browser you will find a section that allows you to control cookies. Most browsers will have an option to allow or deny third party cookies. Remember how I said that websites often send cookies from their site in order to give that website more functionality? Third party cookies provide no such functionality. Cookies that are ported to your browser from a domain other than the website being viewed are usually from an advertising partner. So turning off third party cookies in the settings for your browser strikes a mighty blow for your privacy. You will be surprised how much crap this cleans out of your system. Some web pages even load quicker when you change this setting.

Let me warn you though. Some websites are wise to the fact that some people are turning off third party cookies. Some websites may even look broken with them turned off. If this is a site you trust you can usually make an exception for a specific domain in the settings menu. But before you do that you should ask yourself if you want to continue visiting that site knowing that it lets others track your movements. Refusing to use a site because they mine your data is a perfectly valid complaint, and a fine way to roll in this day and age. If you stay tuned to future blog posts I will teach you how to go to such sites under a fake identity and use their services without divulging anything about yourself…but you are not a Jedi yet. For now just be careful and turn third party cookies off.

Another common browser setting will allow you to determine how long cookies are kept in your system. If you do nothing about this, many cookies will stay on your hard drive until their expiration date. Some cookies have no expiration date so they will stay there forever. But most browsers have a setting that allows you to erase cookies at the end of any browser session. This is the preferred choice. In this way data miners can only track you for this browser session. After that, they are back to square one as far as cookies are concerned.

None of the above techniques will get rid of the truly malicious stuff though. Zombie cookies and cookies that are stored in weird places on your hard drive may persist no matter what settings you have or what precautions you take. So every now and then you should sweep your system with a trusted anti spyware program. A good program for this purpose is SuperAntiSpyware. The folks at SuperAntiSpyware work really hard at catching all the new stuff that emerges from the bowels of internet douchebaggery. There are several programs that will perform the same function, but SuperAntiSpyware is absolutely free. If you just want to manually run it once a week or so (which is perfectly fine in most usage cases) they will never charge you a dime. However, if you would like to have more functionality out of the program, feel free to throw some money their way by purchasing a license. Just in case it sounds like I’m endorsing their product…I’ll freely admit that they have been protecting all of my computers for years and I have never given them any of my money.

If you change the settings on your browser, perform the occasional system scan, and use a little common sense, your cookies folder will become manageable. Now when you peek in that folder you will find a handful of cookies instead of hundreds. This is completely reasonable.

Fun with cookies

Now that you know a little about cookies, it’s time to tinker with them. Cookies are only text files. (If you ever find something in your cookies folder that is not a simple text file, you have a problem and need to fire up your anti-spyware program of choice.) Open a cookie in a text editor and have a look at it. Windows users can use notepad if you wish. Cookies don’t have the *.txt extension, but if you right-click one and choose notepad as the program to open the file it will work just fine. When you examine the contents you will find a lot of gobbledygook that at first glance may not make much sense.

Many cookies have an IP address or domain that designates which website can access them. There will be a long chunk of text and letters that acts as an identifier for you as an individual user. And there will be other text as well. Have a look at a few cookies and see if you can decipher any of the text or notice any similarities with other cookies.

Another useful thing to do is to start a browsing session, clear your cookies folder, and then go to a website you are curious about to see what turns up. If you started out with your cookies folder empty, the only cookies there now should be ones from the site you are curious about. How many cookies did the site give you? How many are third party? How many of them are domain specific? What kind of information do they contain?

Once you are familiar with cookies you can start to try fun things like taking the cookies from your significant other’s account, copying them into your own cookies folder, and then going to the websites they like to frequent. You may be surprised at the results. Did the website think you were someone else? Did the website show an error? There is much to be learned by tinkering…the kind of stuff you can’t find in books.

Conclusion

In the end, power users and ninjas alike must be masters of the cookie for the sake of security and anonymity. Since cookies are nothing more than text files there is no reason for aspiring hackers not to make this a jumping off point for learning more about how websites work. The average user would probably be shocked to find how much info is being collected from the average browser session. So dive in and start tinkering until your cookies folder starts to behave.

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And then one day, we got a phone call.

As I said, this was a small fire department.  The police department in this same town was also very small, and we were familiar with all the officers.  One of those officers had been hired by the FBI a few years previously, and it was this man who had called us.

He told us that his phone call was just a friendly warning.  His new job was in cybercrimes and apparently our little firehouse had been “red flagged” somehow as a connection to be investigated for “suspicious activity.”  He made a few comments about us obviously being “a nasty bunch of sick bastards who need a life” and offered other constructive criticism.  He called as a friendly warning to get us to tone it down before someone in the bureau decided to investigate further into our excesses.  Upon asking him how they knew what we were looking at he replied, “Oh…we know at a lot of stuff.  We know exactly what pages you are looking at.  Sick fuckers…”

This experience has always stuck with me.  I was being watched and judged without my knowledge.  No one presented themselves.  No one showed me a warrant.  No one even asked me any questions.  This was in the years shortly after 9/11, perhaps in 2002 or 2003.  This may lead the reader to conclude that FBI agents were utilizing the Patriot Act to find possible terrorists.  These agents were just doing their jobs, right?  But if this is true, why on earth would they have been monitoring the porn and message board habits of a Mayberry-sized fire department?  What kind of net had they cast to retrieve this information?

But that was ten years ago.  Fast forward to today.  Not only is the Patriot Act still in full force, but our online movements are being monitored by private interests as well.

I just got done reading a book by Eli Pariser called ‘The Filter Bubble‘.  This book outlines in shocking detail the lengths that certain companies and websites go to track your online movements.  This information is complied and sold in order to specifically target you as a consumer  for personalized advertising.  This personalization doesn’t stop with advertising.  It persists into web searches, social media, news streams, and your total online experience until you find yourself inside the bubble described by Pariser.

What do these companies know about you?  Everything apparently.  The biggest data mining company is Acxiom.  Acxiom and other companies like them build a dossier on you with your social security number, driving record, shopping habits, likes, dislikes, and interests.  If a company wishes to obtain a list of medical professionals between the ages of 35 and 40 who are heterosexual, vote Democrat, drive ford trucks, and like Brad Pitt movies the information is available.  This information (your information) is sold to companies in order to target you, sell you products, and sway your opinion.

And no, I am not being paranoid.  This is completely real.  And guess what, Acxiom was once compromised by a hacker for almost two years and much of that information was leaked.  They have been compromised a few times…that we know of.

So it boils down to this: companies you’ve never heard of are collecting vast amounts of information about you without your knowledge in order to sell it to the highest bidder so that you can further go in debt buying stuff you don’t need with money you don’t have so that you can be one of the lemmings that patriotically supports our mindless consumer culture.  And by the way, your government is fine with this and is an occasional client of this system.

Do you want to opt out?

Acxiom actually provides you with a way to opt out, assuming you trust them.  But I’m not talking about that.  I’m talking about really opting out.

Opting out may just become the new subject of this blog.  My EMS days are thankfully behind me.  Don’t worry, I will post a story or two every now and then.  But I obviously don’t post with the frequency that I used to.  One of my other big interests has been computer hacking.  However, the kind of hacking I do is not the usual stuff you see portrayed on TV.  (Which is usually horribly inaccurate.)  No, the kind of hacking I do is the kind that allows the average Joe to stroll around the internet unnoticed.  I like to find ways to maintain privacy and anonymity so I can avoid the trappings of our consumer culture.

As an EMS instructor I learned a long time ago that someone who is knowledgeable in a subject may be an awful teacher.  This is usually doubly true for hackers who usually aren’t the most sociable people I have ever come across.  I have lurked around many hacker websites over the years, and it has always amazed me why someone would go to the trouble of running a message board if they are just going to tell everyone who comes to them with a question to piss off.  But I am not like that.  I am a nerd with people skills and I like to teach.

So what I would like to do is write a series of articles that take the average computer user, and educate them to the level where they are savvy in the ways of the force.  Companies like Acxiom and your representatives in Washington don’t really care much about your right to free speech and privacy.  But maybe you do.  And with knowledge comes power.  You don’t have to be a lemming.  You don’t have to be a patriotic little consumer who pays 19% interest and has all his movements tracked.  So I think this will be my new project, educating you on how to opt out.

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I want to borrow a piece of pop culture for my first point.

Here we have Princess Leia, telling Grand Moff Tarkin how it is, “The more you tighten your grip, the more star systems will slip through your fingers.”  This is true with just about any system which includes tyranny and injustice. And this is true of our own socioeconomic system. (BTW, there is actually a site called http://www.leiasmetalbikini.com. I found it while searching for the above Youtube clip, and it has changed my social and political views.  Every guy should have a girl who is willing to dress up in Leia’s metal bikini.  If I ever run for office, this will be the linchpin of my campaign.)

There is only so much debt a blue collar worker can incur before the average Joe wakes up and says, “Goddamn, I need to cut up all these cards and live within my means.”  As a country, we are there.  No amount of stimulus will replace the sinking feeling that comes with debt.  Yet all of our financial analysts who are smoking the crack of the ‘wealth without limits’ mindset still firmly believe in a model that includes an economy that expands forever without collapsing.

Here is where some of the common sense creeps in.  I am not an economist, but I am smart in other ways.  If you are an economist who believes in this ignorant pipe dream, can you please point me towards another system in the history of this planet that survived under the same parameters?  Please enlighten me and point to any ecosystem, any species, any economy, or any social system that was able to survive with constant growth and expansion.  So…you are unable to do this?  With all of science and academia at your fingertips, you are unable to show me one system that expanded constantly without collapsing or failing for hundreds of years on end?  Then why in the hell would you be so ridiculous as to consider that our economy could survive under a set of parameters where there are no other successful examples in the history of the world?  I’m sorry, but your own greed and egocentrism has gotten the better of you.  Not one scientist in America believes in the existence of a perpetual motion machine.  Why is it that every economist is convinced that our economy is one?

Jeff Jarvis is a very interesting pundit and analyst.  This blog post by him has been discussed all over the internet over the last few days.  This post makes the argument that the jobs that have been lost by this country have been lost forever.  Severe changes in the way we live, consume, and make a profit have marginalized a certain segment of our society, and these jobs will never return.  I couldn’t agree more, but the criticism does not end there.  He is just skimming the surface.  I would like to make a few points and illuminate a few truths that will never be discussed by politicians.  Why won’t these things be discussed?  Because it would be political suicide.  But I am not running for office, and I have nothing to lose.  So here it goes…

Truth #1: Not everyone in this country is bright enough to get a masters degree and pursue a promising career.  Some people have to mow the lawns and mop the floors.

I have been responding to 911 calls for sixteen years.  I have seen the not-so-well-to-do segment of our population.  You could get Ed McMahon,  (if he were alive) drive to the trailer park, knock on a door, and tell one of these families that they have won the education sweepstakes.  All the little kids in this trailer can go to school for free forever.  They can go to college, grad school, get PhD’s…the sky is the limit.  I don’t think anyone would take you up on it.  (I have often thought that the trick to fixing some of our nation’s woe’s is not to provide more services, but simply get the people living here to use the services that are already here. But that’s the source of another blog post.)  No politician will ever tell you this, but it is simply impossible for everyone in our country to be successful. Politicians have learned to soften the blow of this truth by painting Americaas a place where everyone has the possibility of being rich and successful.  And it is up to each and every one of us to maximize this possibility.  This is the same reason why the lottery is so popular with the poor.  Let’s all go to the convenience store to buy our beer, cigarettes, and lotto tickets.  Isn’t that productive?  But I have digressed a bit.

I hear entrepreneurs, politicians, and economists all talk as if there will soon be a day when everyone in America is well educated and working productively in the information sector. America will be a leader in technology and innovation, and we have no need to rely on production as long as everyone gets with the program.  I’m sorry, but I have run calls in the trailer parks and the projects.  Some of these people are simply not going to get with the program, no matter how free, advanced and wonderful it is.  The change you are suggesting would be nice, but it’s just not possible.

Truth #2: Infinite growth is not possible.

Every for-profit company I have ever worked for labors under the delusion that every year must be better than the year before.  The investors who own stock in these companies, and therefore a share of the profits, could care less whether or not the company is successful or not.  They just want to make sure the price of the stock goes up in a certain way that they can predict so that they can later sell the stock at a profit.  Therefore the long term success of the company is not a factor in any decisions that are made.  As a matter of fact, long term success may be undesirable when compared to a quick meteoric climb.  Whether or not the company can survive the meteoric climb does not matter.  If things start to go south, just sell the stock and move on to the next company that will make them a fortune.

Again, step back and look at this system for a moment.  The losers litter the base of this ivory tower.  The bodies are stacked deep and thick.  How many times do we have to see white collar crooks redline a company into the ground only to float away in their golden parachute just before impact?  How many times can we be fooled by this before attempting to regulate it?  But wait…everyone in America has a chance to be one of those successful executives.  If we regulated this, then the average Joe would no longer have the chance to make it big.  So let’s just look the other way so that we can continue to buy these lotto tickets.

Truth #3: The market will not successfully regulate itself.

Greed will always trump responsibility and accountability.  Have a look at Ralph Nader’s career before everyone labeled him as a crackpot for trying to create a third political party.  (The “I Actually Give a Shit About the American People Party.”)  If you ask the average guy on the street what he thinks about Nader, you will usually hear something like, “Oh, that guy is a crackpot.”  If you ask the same person what Nader did before he ran for president, that person will say, “I don’t know.”  If you don’t know either, I will tell you.  He was a tireless consumer advocate who shaped regulation and policy for decades.  Seatbelts?  That was Nader. Airbags?  That was Nader. Cigarette pack warnings?  Nader.  His work has literally saved thousands of lives.  And you know what?  American business fought him tooth and nail every step of the way.  Not just every step, but every millimeter.  Every nanometer.  Both Republicans and Democrats are responsible for the deregulation of mega corporations that sodomize you everyday.  People whose lives have been saved by Nader’s work call him a crackpot because he dares to try and regulate our precious church of Laissez-faire.

Mortgages weren’t regulated enough and look what happened there.  Derivatives?  Please.  So this is also something you will never hear a politician say: “We need more regulation.  No just a little, but a lot of regulation.”  Why won’t a politician say that?  Because his campaign is funded by business, and what business wants to be regulated more heavily?  Is there still anyone out there who doesn’t get this concept?

Truth #4: We have been living way beyond our means.  We are all going to have to dial it back and lower our expectations.

We are going to have to make do with less money, less services, less energy, and smaller houses.  No one wants to hear this.  Interestingly enough, Jimmy Carter once got on TV and told this to America during a national address.  So confident was he in his convictions that not long after that speech he fired his entire cabinet and replaced them with people who would help him convince the American people that they needed to conserve and live with less.  And you all know what happened to him, don’t you?  We got his ass out of office as fast as we could, and replaced him with the nearest Republican that would allow us to run up our credit cards again.  Hey, who is handy?  Some old actor?  Yeah, why not?  Let’s put him in office for the next eight years.  Whew…that’s better.  Man, that Carter guy…can you believe the nerve of that guy wanting me to live more responsibly and frugally?  Fuck a bunch of that!

Truth #5: At some point we are going to have to pay back every cent that we owe with interest.

In order to do this, we will have to sacrifice comfort and do without some things.  How many times have you heard someone bitch and complain about the deficit and in the very same conversation complain about taxes and budget cuts?  Have I missed something here?  Have the laws of physics and math somehow changed?  Can we actually expect to pay back trillions of dollars with nothing but procrastination and selfishness?  I can only shake my head at this one and say, “What the fuck?”  I have never had a bank loan me money and later tell me, “You know what, we were kidding.  Go ahead and keep that money.  We don’t need it.  You don’t owe us a cent.”  Yet most of the people who are reading this right now are somehow able to reconcile in their head the retarded notion that as a nation we can borrow trillions of dollars, and that will in no way impact any of us personally.  You would never vote for any politician who got up on TV and said, “You know what?  We’re boned.  We all need to raise our taxes a bit and do with less services and comforts until we pay off this debt and get the books balanced.”  Who the hell would vote for that guy?  Well…I would, but I’m weird.

The Point?

Okay, the title of this post is ‘Capitalism Without Consumers.’  I need to explain that.  Remember Princess Leia talking about star systems slipping through the Empire’s fingers?  Well, that is what has happened to America.  The banks, government, and big business have squeezed way too tight and millions of American consumers have slipped through their fingers.  You bled them dry, and they have no more money or credit, so they have stopped consuming.  And capitalism without consumers just doesn’t fucking work no matter how many pep talks you give or how much fuzzy math you apply to the numbers.

Banks make a profit by collecting interest on money they lend out.  So banks want to lend you money and charge you interest.  They want to do this as much as they possibly can.  So, they try to convince you that buying things you can’t afford and paying for them later is a good idea.  And they actually succeeded in doing that.  I’m so confused by this, that my confidence in humanity is gone.  If they can convince a nation of 300 million people that living beyond their means and paying 20% interest is a good idea, they can do anything.  What are they going to tell me to do next?  Periodically go out in the backyard, find a brick, and smash my junk with it?  Or maybe go find a stick and beat myself?  Cause that makes about as much sense as paying 20% interest for a bunch of shit I don’t need while my government borrows trillions of dollars without raising my taxes.  Sure, this will all work out.  We’re going to be fine.

There has been a lot of speculation as to why this bailout hasn’t worked.  Tax cuts and incentives haven’t worked either.  It’s all very simple.  Like so many people I know, I have stopped buying things I can’t afford.  I haven’t borrowed money or used a credit card in a couple of years now.  I stopped smoking the crack the banks were dealing and I have simply decided to go cold turkey and live within my means.  Every time I get a little extra money, I pay down debt.  I imagine a good percentage of us are doing exactly what I am doing.

And this is why the banks perceive this as not working: they make money by loaning money.  A bank’s idea of a stimulus is to get people to borrow money again.  But if any stimulus money trickles down to me, I take it and pay off debt.  By doing this I am actually reducing the amount of profit made by the banks by reducing the amount of revolving interest I pay to them.  And I am sure that I am not the only one doing this.  I have heard several reports that this is exactly where much of the stimulus went.

So isn’t that a good thing for the consumer at least?  Can we all finally say, “Yay stimulus!”  At least the part that trickles down to the consumer after executives skim their bonuses off the top is getting us out of debt, right?  Not exactly…you see that stimulus money gets transferred to the national deficit which is the equivalent of using one credit card to pay the bill for another credit card.  So, my own government has created a stimulus package that has reduced the amount of profit the banks are making and creates debt that I will some day be liable for in interest.  Make no mistake about it.  I will someday pay that debt either through higher taxes or a reduction in services.  Now I am no longer in charge of my own financial destiny.  The government has taken the credit card out of my wallet, ran up the bill, and handed it back to me.  Thanks.

The Solution

I have been losing weight recently.  Someone at work asked me what my secret is.  Here is what I told her, “I have been exercising a bunch.  I ride my bike to work.  I do crunches, leg lifts, and other strength exercises at least once, sometimes twice a day.  After I do those exercises I go walk for a mile to loosen up.  I have also reduced my calorie intake.  I eat very little meat.  I eat reasonable sized meals made up of mostly fruits and vegetables.”

“Fuck!  That’s not a secret.  That’s work.  Who wants to do that?”

“Well, I never actually said I had a secret.  You asked me how I was losing weight.  You expected and hoped that I had some secret that you could apply to your own situation that would make weight loss easy for you.  You didn’t want to hear that I lost weight through lots of self control, exercise, and diet.  You don’t want to hear it, but that’s what worked.”

Why should our accountability be any different with our failed economy?  As I said earlier, I have the answer.  No one wants to hear it, but I have it.  So here goes.

I am aiming lower.  I sold one car because it was too expensive to maintain.  I sold it and paid off more of my debt.  I have reorganized my life to where I work closer to home.  I ride a bike to work.  It saves me tons of money and makes me healthy.  We recycle and re-purpose just about everything we own.  We set the thermostat to 78 or 80 during the summer and 60 or 62 in the winter.  I think my government should raise my taxes and stop making bailouts for bankers.  We should stop invading other countries to turn them into puppet democracies so that we can insure a cheap supply of oil to our morbidly obese and unhealthy economy.  We should take all of the money we use to invade people and pay down our debt and try to refine alternate sources of energy such as solar power.  We should strive to pay a little bit more for locally produced goods so that we can support our own economy and communities.  There are plenty of people living all around us who are not capable of getting a masters degree and working for Google, but they can work 40 hours a week producing goods sold locally and make a living.  We should strive to provide healthcare and education for these people because generations down the road will benefit.  And if we don’t give them something to do they are going to start robbing us and setting up guillotines in the town square.

I’m not a socialist.  I’m a capitalist.  But you can’t have capitalism without consumers.  If the banks and the government would stop stealing the credit card out of my wallet to run up my bill, I might actually have more money in the future to spend on goods and services to support my economy.  The CEO’s of these corporations should think about making $250,000 per year for the next 20 years instead of making $3,000,000 this year and hiding it in tax shelters while they look of another job and another company to ruin.  Our economy will sustain a CEO that makes $250,000 per year if there are consumers who can actually afford to buy goods and services.  Our economy won’t support a $3,000,000 per year douchebag who turned all of his customers into unemployed debt defaulters.

You can’t lose weight on the “all cake and no exercise diet.”  You also can’t build a healthy economy by living beyond your means, borrowing money, lowering taxes, being wasteful and selfish, and basing everything on a fantasy perpetual motion machine.

But I know full well that none of you care.  So feel free to vote for the Democrat or Republican of your choice.  Keep going to Walmart so you can buy silly plastic shit you don’t need out of a sense of entitlement you don’t deserve.  Keep trading in all of your financial security for a one in a million chance at winning the lottery.  Keep swallowing that bullshit that the super rich are going to allow things to trickle down to poor little you.  By all means let’s keep invading other countries to secure expensive non renewable energy while free sunlight keeps baking the ground we walk on.  And let’s all keep going to the grocery store to buy shitty food that was shipped from thousands of miles away.  Let’s keep eating it until we become morbidly obese diabetics with vitamin deficiencies.  Oh yeah, and lets do all this on credit and run up the tab until the machine seizes and no one will buy anything.  Yep…capitalism without consumers…that’ll work.

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“I have been a paramedic for 16 years. I have lost count of how many shootings I have responded to. All of these calls were crimes or accidents. People blow their toes off while cleaning guns. People shoot family members by accident. People kill other people during crimes. Not once have I ever responded to a shooting where someone successfully defended their home from a ‘bad guy.’ Not once.

“To continue with this…I now work for an organ procurement agency. It is my job to sit in a little room where hospitals are required to inform me of deaths. I take dozens of these calls each night. And as you can imagine, I get plenty of shootings. Again…accidents, murders, suicides…but not once has the gun related death of a ‘bad guy’ been reported here while I was clocked in.

“But wait…I’m not done. I also spent years teaching paramedic classes. I always loved to pose this question to the class: ‘Have any of you at any time in your careers ever made a run on a ‘bad guy’ who had been shot by the good guy?’ For years, everyone had to admit that this had never happened. Finally, during the last class that I taught an EMT became very animated while telling me about a call he ran where an intruder was shot. Since this was the only time I had ever heard of this in my entire career I asked some questions. Apparently an intruder was trying to forcibly enter a man’s home. So the home owner opened the door and shot him. Let me repeat this…opened the door…and shot him. So I asked the student why he didn’t just leave the door locked and call the police. I have had to do that myself when I lived in a shady apartment complex in college. It worked for me. Why did he have to aggravate the situation by opening the door and blowing someone away?

I always end my argument like so:

“So during my career as a paramedic I have responded to dozens…maybe over 100 shootings and none of them were for the reasons that gun owners cling to. Over the past couple of years I have taken hundreds of death referrals from hospitals and the same holds true. Out of all the experienced EMTs I have asked about this, only one time has anyone reported shooting an intruder, and that just didn’t need to happen. So its either 100’s to 1 or 100’s to 0. Either way, the numbers are ridiculous. This also seems to support and reflect data from real studies that have been done. So why in the hell do we allow people to own these things?

I would like to ask you the same question. If you think it is cool to tote guns around, I would like to ask you the following:

1. How many shootings have you responded to in your career? (This one is obviously for EMS folks only.)
2. How many ‘bad guy shootings’ have you run in relation to ‘oops I’m a dumbass who blew my toe off shootings’?
3. If you are a gun owner, have you ever even come close to needing to use it to defend yourself? (Really needing it, not just threatening to shoot a guy because you’re having an argument about basketball.)
4. If you never have had to defend yourself, how much money have you spent stockpiling things you have never needed?
5. If you have spent hundreds or thousands of dollars preparing for an emergency that has not happened yet, how much money do you spend preparing for other unlikely emergencies? Do you have a $500 lightning rod on your house? Is your basement stocked with MREs just incase you are cut off from food? Do you keep a wreath of garlic on your door to ward off vampires?

And before you answer these questions or comment you should know one more thing about me. Personally, I am not a pacifist. And I am not squeamish. If someone was threatening my life or the lives of my family I would not hesitate to act. A chair, a baseball bat, my bare hands…I would be willing to take a life with just about anything lying around if the circumstances necessitated the event. But I’ve been living in the same world that you have for 40 years and have never needed to use a gun. When I think of how dangerous guns are to me, how many lives they take, how many people they injure, how much money they cost…I might as well keep a rod of plutonium around my house. I’ll never need it for anything, the kids can play with it while I’m not in the room, I can slowly get cancer from it, and I would have to take out a loan to get one.

Hey, that brings up a point…are you paying interest on a loan to finance a gun you don’t need? Thanks! You’re helping our economy grow big and strong!

Here are my real views on gun control:

See link to the left for hate mail. Add angry comments below.

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And now you are probably wondering how I broke my back, so I won’t leave you hanging.  When I was a child I was involved in a freak dodge ball accident.  This isn’t a joke.  I am being serious.

I was either in seventh or eight grade.  I can’t remember which.  We were playing a variant of the game called ‘Back Board Dodge’.  I won’t bore you with too many details, but there was a dead ball lying in our court.  There were only two or three boys left on our side of the court.  I really wanted that downed ball so that I could chuck it at someone and have a chance of throwing the winning ball.  Someone else on my team had the same idea.  We both ran for the ball and upon reaching it collided headlong into each other.  He was lower to the floor when we hit and stood up suddenly after reaching the ball.  This hit me at just the right moment and launched me into the air.  I fell from a height of about 6 feet in the air to the floor.  I fell flat on my back.

What came next was pain.  Real pain.  Pain like I have never felt before or since.  I am an atheist, but a shortcut to finding the words to describe this pain is to categorize it as “Old Testament Biblical Pain.”  As you might expect, I was unable to get up.  If you, dear reader, are a reasonable person you might think to yourself, “If I saw a young boy thrown into the air, land on his back, scream in pain, and then proceed to be unable to get off the floor, I would be concerned.  As a reasonable person, I would most definitely be concerned about this, and I would call for help and have the boy’s injuries assessed by a professional.”

Unfortunately, a reasonable person was not there.  The only adult present was our cro magnon redneck douchcanoe of a gym coach named Coach M.  There are many reasons to hate Coach M.  I have even started and stopped several blog posts about this man.  Why have I never published one?  Because every time I read my own work, I am unsatisfied with the results.  There is just no way for me to convey how stupid and worthless this man was.  There is also no way to convey how much I hate him.  So all attempts have failed me and I have never posted one.  Instead of letting words fail me yet again, I will just tell you what his actions were.  He rolled his eyes, slowly got up, walked across the gym floor, and stood over me.  He told me to get up and walk it off.  I told him I couldn’t.  He called me a pussy.  I told him I still couldn’t get up.  He had two other boys grab my arms and drag me off the court across the floor to the bleachers.  I laid there for the rest of the period unable to move.

I don’t think that one person in that gym considered for even a second that I was actually injured.  I am not sure why.  I never complained about anything.  In fact, I never really talked to anyone at all. Junior High was awkward for me, just like the rest of my childhood.  And to be honest I did not have one friend in that room.  And in the end, this is probably why it never occurred to anyone to attempt to help me.  No one there really gave a shit.

When the bell rang the coach slowly walked over to the bleachers, stood over me and said, “Are you going to continue being a pussy, or are you going to get up and go to your next class.”  A few of the other kids in the class laughed and called me a cry baby.

So I got up.  It was slow.  And it hurt.  But I got up went into the locker room, changed my clothes, and went to my next class.  I was late because I was walking so slowly, but I made it.

I went home and asked to see a doctor.  My parents didn’t honor my request for several days.  I had to pester them about it.  They told me, “I’m sure whatever you did hurt, but if you can walk on it there is no way you could have broken it.  So you are just going to have to take it easy for a few more days until it feels better.”

Over the next several days I complained enough until they arranged a doctor’s appointment for me.  I had to wait a couple of weeks until an appointment was available.  I told the doctor all about my accident.  He sat patiently listening to my story.  When I was finished he said, “Well…you’re walking around on it, so it can’t be broken.  We’ll try rotating some ice and heat to loosen the muscles up and you’ll feel better soon.”

That was about 28 years ago.  And my back still hurts.

But to be honest, after a few months it did feel better.  I learned to live with it.  At that time in my life I was very fit.  I lifted weights a lot and got tons of exercise.  After a while my muscles strengthened around the injury.  I also learned what aggravated my back and what to avoid.  But I was young and it didn’t stop me from doing stupid things.  I played soccer with that back.  I played football.  I wrecked a moped a couple of times.  I got in fights.  You name it, I did it.  And most of it hurt.

There is this weird bubble that exists around you if you say your back hurts.  So many people say their back hurts that people skim over it without caring.  I would often complain about it over the next few years to my parents.  This actually used to make my mother angry.  You see, she had suffered a real back injury.  She used to complain of back pain constantly.  When I was much younger she had surgery to repair a disc.  Recovery was slow for her.  I remember that my dad had a pool built in the back yard and claimed that it was tax deductible because of my mother’s back injury.  She also took a lot of pills for her back.  And knowing my mother, I sure most of them were pain pills of the ‘feel good’ variety.

But when I complained about my back I was told, “Now I don’t want to hear any more of that from you.  Your mother had a real back injury.  She needed surgery for it.  You’re young and strong.  There’s nothing wrong with you.  Now I don’t want to hear any more about this.  Just walk it off.  You’ll be fine.”

So for the next 28 years I learned to live with it.  As an adult I found that people cared even less when I mentioned it.  And there was a new problem.  My career.

Back injuries are the bane of everyEMSand fire service.  If you so much as mention back pain, many services look at you as a liability.  They see you as a potential money pit.  Who wants an employee on light duty drawing a check and not being productive?  And there has always been the problem that even though I have worked in healthcare for almost 20 years, I have never been well insured.  If you are an adult who works hard in a physical industry and relies on overtime, seeking treatment for an injured back is suicide.  High deductibles, apathetic doctors, and 40 hours of straight time each week is all that awaits you.  So for years I purposely hid the fact that I had back pain.  After I got married and had a child, it almost became imperative that no one found out about it because lost shifts and large bills would affect my family.

Thankfully, for the last few years my job has been less physical.  I found myself in the classroom more often than on the street.  And when I accepted a job in organ procurement I thankfully spent most of my time at a desk when I first started.

But recently the game has changed.  Two things have created a situation that finally made me seek treatment.  A few months ago I started recovering tissue.  This got me away from my desk and standing for many hours on a tile floor, bending over at the waste in a sterile field where movement has been limited to the point where I am not even allowed to scratch an itch.  To be honest its not very physical, but it is exactly the kind of thing that hurts my back.  I would rather dead lift over 400 pounds and climb ten flights of stairs then bend over at the waste for a few hours.  The second thing that has compounded my situation is that good old fashioned middle aged arthritis has set in.  I have always been careful about bending over with my back, but now I don’t want to bend my knees either.  If I drop a pencil on the floor, there are very few options for me to get to it.  Consequently I often just walk away from things I have dropped.  I give up.

A few days ago it got so bad that my wife demanded that I go see our doctor.  I put it off as long as possible.  I didn’t think it would do any good.  No doctor has ever cared before.  But I had an episode the other day where I tried to get on my knees to pull some weeds out of the garden and I wound up in bed for two days.  So I went to my current primary care physician and made my complaint.  She asked a few questions, and patiently listened to my answers.  To my shock and amazement she ordered a series of x-rays and an MRI.  I wasn’t sure what to think.  I had been complaining of the same damn thing for over 25 years, and finally a doctor did something besides explain the fine art of rotating ice and heat.

So I went and had my tests.  A couple of days later the doctor called me on the phone.  Not one of her nurses.  She called me herself.

“Do you know you’re back is broken?”

“Well…no…but it doesn’t surprise me.  I bet it’s an old fused injury.”

“You’re right.  It is.  Some time in your life you cracked one, maybe two vertebra, and you have a terrible disc that is trying to herniated into you spinal canal.  I’m sending you to a neurosurgeon.”

A few days ago I had my appointment with him, and was able to add some bad news to the mix.

“Yep, at some time in the past you cracked your vertebra.  It shows up as an old stress fracture now.  And yep, that disc looks like crap.  That has to hurt too.  But what I am really concerned about is the amount of slippage L5 has.  This old fracture and bad disc have caused a lot of instability.  And when you lean forward this bone slides back and presses on your nerves.  I’m sure it is hurting you.  I bet you hate to bend over forward.”

But his idea of fixing it wasn’t pretty.  Here’s what he had to say about that:

“I could fix it with surgery, but I am not going to lie to you.  It’s invasive and you don’t want me to do it.  To fix this I would have to open you up, break this process off, remove this disc, fill the void with a bone graft, then try and stabilize the moving bone with screws and rods, then fuse the whole assembly together.  It would hurt.  It would be expensive.  You would be off work for a long time, and recovery would be hard.  This isn’t fun.  And I won’t lie to you, in the end this may be something you seek.  But we want to avoid it if at all possible.”

“Alright, so how do we avoid it?”

“Exercise.”

“That’s all you got?”

“Like I said, we want to avoid this kind of surgery.  You’re walking around, and it’s obvious that this doesn’t bother you all the time.  It would be irresponsible of me if we didn’t exhaust all other possibilities before I did all that to you.”

“What kind of exercises?”

“Swimming…yoga?”

“Really?”

“Yep.  And you need to hit it hard.  You basically have to strengthen the muscles around this injury so that you can hold that bone in place yourself.  If you can lose some weight and strengthen those muscles, you might feel a lot of relief.”

“And if I don’t?”

“Well, we’ll talk other options if this doesn’t work.  But you are going to try this first.”

So here I am.  I have a broken back, a slipped disc, and a bone that keeps slipping out of position, and the best avenue for treating it is to go exercise with it.  That sounds…really fucking fun.

My physical therapist gave me even more great news.  He was doing his first examination and started tapping various parts of my legs with a mallet.  He lingered at my left ankle, banging away at it like he was dissatisfied or had missed something.

“The doctor did that too.  I forgot to ask him why?  What’s going on down there?”

“You have permanent damage to these nerves.  There are no reflexes down here.  I didn’t see you limping.  Do you have trouble moving that foot?”

“Nope,”  I said and started rotating my ankle to prove it worked.  “I ride my bike to work everyday.”

“That’s really weird,” he said, “Most people with this problem drag their foot around or have drop-foot or something similar.  You don’t seem to be affected.”

He went on in more detail than my doctor to show how my back was broken.  He told me that one of the processes had most likely broken off and is free floating.  Since that anchor was taken away from my vertebra, it just floats around banging on nerves.  He said something about how weird it was that I was just walking around.  Then I told him that I played football, and was a fireman with this injury.  He looked at me like I was from Mars.

So he prescribed all of these exercises which I diligently do twice each day.  I spend about 45 minutes doing all these leg lifts and crunches in various directions and positions.  It’s kind of gross, but some of these exercises pop my bone out of place in a way that is audible to my wife and daughter.  I get the occasional, “Gross…was that your spine?!”

So here I am with very sore tummy and back muscles.  This was way beyond the workout that once gave me a six pack when I was younger.  So…what happens when you get a six pack under a layer of fat?  I may very well be able to tell you that soon.  I promise not to post pictures of that.

I will be writing more on my blog though.  I have had a lot of inspiration recently.  A few people have noticed that I have kind of disappeared from social media lately.  Nothing could be farther from the truth.  I post mostly on Google Plus now.  I have to admit that Facebook is so mundane that I just can’t bring myself to log in there anymore.  And Twitter is just too limiting and vast at the same time.  G+ is more my speed.  You should give it a try if you are bored with other venues.

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Why did I wait a year to do this?  Copy Code Three wound up being a much more time intensive project than I ever could have imagined.  Since I stopped producing episodes there has not been a week that has gone by without someone asking if the project would be revived.  This has really made an impression on me since most things on the internet are usually forgotten within five minutes.

Here is your official notice that the project has been revived.  There are a few ground rules though.  Copy Code Three will not be produced on a regular schedule.  It’s just too hard.  I will do it when I have the time.  I wish I could promise more than that, but sometimes life gets in the way.  And I have always promised myself that if any of my internet projects seemed too much like work that I would walk away.  This is why you sometimes only see a post once every few months.  I make money in other places on the internet, but not here.  Some people have suggested that I start producing regular content for Gomerville and Copy Code Three and then try to sell ad space and get endorsements.  I can’t really imagine anything that would be more distasteful to me than the thought of doing that.  If I invited some people over to my house for a cookout, would I charge them cover at the door?  Of course not.  I would offer you a beer and a brat, and have you enjoy my company.  And this is the way Gomerville and Copy Code Three will remain.

However, I might ask you to bring your own dish.  And in that spirit, if any of you have an amazing story, please let me know so that I can help you share it.  Consider it the podcasting equivalent of bringing some potato salad to the party at my house.

Special thanks to all of the wonderful musicians who have granted us permission to use their music for this project.

Ben Sollee is a local musician here in Louisville, KY that plays the cello in a blues and folk setting.  He very well may be the only person attempting anything like this and the result is astounding.

Ani DiFranco has been a music maverick for 20 plus years.  She started producing, distributing, and selling her own music long before artists had so many tools to do so.  She is one of the pioneers of self publishing, and everyone who benefits from this today owes her a debt of thanks.  She wouldn’t have been able to make a living like this for so long if she wasn’t so talented, so we are honored to have her.

David Wax Museum is currently my favorite new band.  They are at ground zero of what I have been referring to as the Nouveau Folk Movement.  David is a young man with a lot of energy who has blended Mexican folk influences into his own style.  And Suz is the lovely violinist and donkee jawbonist.  Is that a word?  I can’t describe it, so you are just going to have to listen to it.

Thank you for listening.

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He was of Mexican decent. He was exceedingly proud of this and often referred to himself as the Emergency Mexican Technician. Raul was one of those Latino men who somehow got away with making jokes that were rife with racial stereotypes because he himself was a minority. He often liked to point out that he had married a white woman. He liked to tell people that he defiled her in ways that a white man just couldn’t do, and that she had married him because she was ‘nasty like that.’ He claimed that she cooked him rice and beans for every meal, even if they were having lasagna. And according to Raul, Emergency Mexican Technicians had to steal a car radio at least once every two years in order to recertify in the state of Texas.

He was one of the senior members of our flight team which was born from a contract with a large hospital chain in Dallas that demanded their own dedicated helicopter transport. There was a story that was often retold about a meeting that was attended by several hospital administrators and our management staff in which the radio call name of the aircraft was to be decided. Raul suddenly raised his hand and started bouncing in his seat. When he was called upon he stood up and spoke at length of his ideas for the naming and the paint scheme of their new aircraft. Raul argued that it should be named Selina One. Old English lettering would be the official font that would adorn the side of the aircraft and our letterhead. He further explained how one of his cousins owned a shop that did custom work. His cousin apparently had offered to airbrush Our Lady of Guadalupe on hood of the aircraft at cost. The final touch was that a CD should hang from the rearview mirror. Raul was quickly escorted from the meeting while several hospital administrators gawked at him, speechless.

One of Raul’s great pastimes was to scare trainees with strange behavior. This could be subtle or overt. For instance he liked to have fake phone conversations near the new employee, talking in hushed whispers about how he would pay the money that he owed as soon as he could. He pleaded that it would be unfair for them to come to collect while he was at work because innocent people might get hurt. He would hang up the phone and start pacing nervously up and down in hall. Then he would come out and quietly explain to his trainee that while she was riding in the back she should be mindful of any vehicles that looked like they were following the ambulance. As he ushered his frightened protégé out the door he would look back and give us a conspiratorial wink.

When he was promoted to critical care, he didn’t often get to train people anymore. This made him sad because according to him he couldn’t ‘fuck with anyone’s head.’ But his big chance came when a new medic in our organization named James was promoted to the Critical Care Team. James had been hired after Raul had moved to the team and so he never got to experience his antics. James was assigned to Raul for a month so that he could become acclimated to the new protocols and equipment before being released on his own. Raul immediately swung into action.

It was slow at first, almost imperceptible. We saw Raul and James making runs together. And James often looked uncomfortable. But whatever Raul was doing to him, James seemed to be suffering through it quietly. One day James came up to me and said, “Hey can I talk to you for a minute?”

James was an ex military man, short in stature and sometimes awkward around strangers. His mannerisms and nervous habits sometimes made people underestimate him. His southern drawl and lack of formal education often prevented people from realizing just how fiercely intelligent he was. And sadly, James himself often underestimated himself.

“Hey Buckman, do you know Raul?”

“Yeah, I’ve worked with him for a few years.” I was playing it cool. Like many senior medics, I appreciated Raul’s antics and tried to play along whenever I could. In my mind I was trying to figure out whether I was going to have to confirm that Raul was being chased by the mob, or whether he was working at night as an exotic dancer, or perhaps even that he was a schizophrenic who normally was able to function as a professional but had recently stopped taking his meds. I had rehearsed speeches for all of these personas.

“I think that Raul might be trying to…” James was obviously finding it hard to find the right words for this, “…trying to make a pass at me.”

Aha! So Raul was playing the homosexual gag. It had been a while, but I was ready for that one too.

“What makes you say that?” I asked.

“Well, I don’t want you to think that I have any problems with gay folks. It’s nothing like that. You know if Raul just came out and told me he was gay, I would be fine with working with him. But, there is something more to it. It’s the way he acts. It’s the stuff he says. It’s just inappropriate sometimes.”

“Be careful now. Raul is a good medic. If you want to go through the proper channels and make a complaint that he is creating a hostile work environment for you, you have that right. However, that kind of accusation is quite serious. I think if you do something like that, you should probably write it up and turn it into me so that I can give it the once over before you give it to management.” That’s how I usually played this one. One employee actually wrote it up once. Raul was laughing so hard that tears were streaming down his face as he read the heart felt complaint.

“Well, I’m not sure I want to go that far with it. I just wanted to know if my fears were warranted.”

I was just about to set the hook and reel James in the boat when Raul’s wife came walking in the door with all their children in tow. She couldn’t have timed it any worse. She had come to pick up Raul’s check. She noticed me as a familiar face and said, “Hi, we’ve met before haven’t we? I’m Raul’s wife. Is he around here, or is he out on a run?”

It took a moment to sink in, but I could see the wheels turning in James’s head. I told Raul’s wife that he was in a meeting but that she could pick up his check in support services if she wanted to. When I finally turned back to James, he was still trying to piece it together.

“So, let me get this straight. Raul is married?”

“Yep,” I replied.

“And he has how many kids?”

“Six,” I answered, “he’s prolific like that.”

“So…he’s not gay?”

“Not in the slightest bit. He’s been fucking with you as hard as humanly possible for about two weeks now.”

“Son of a bitch!”

I was expecting a pretty hard fallout from this, but James got an impish smile on his face. Raul’s wife was coming back down the hall with an envelope in her hand. James walked up and introduced himself.

“Hi, I don’t think we’ve met, but your husband is training me.”

“Oh, it’s great to meet you! We’ll have to have you over to dinner some night,” her face lit up and she seemed genuinely pleased to meet someone working closely with her husband.

“Well, I kind of had something different in mind. It seems that Raul has been playing a trick on me. Seeing you and your children just busted him.”

“Oh, is he doing that gay thing again? I’m so sorry. I’ve told him to stop screwing with people so much, its going to get him in trouble someday.”

“Well there’s no hard feelings, but can you keep a secret?”

James then explained what Raul had been doing and let her in on his plan for revenge. She seemed to relish this, and immediately agreed to tell Raul nothing.

* * *

Later on that night James and Raul were posting back at the tiny room the hospital provided. It was nothing more than a closet. They managed to fit a set of bunk beds in there and a small TV that set on top of a dorm fridge. If you were spending the night there with a partner, there was no privacy whatsoever. Raul was laying it on thick before turning it in for the night. James kept up the ruse and suffered the crass innuendo until it was time for lights out.

James laid in silence for a few minutes until he heard the rhythmic breathing that told him that Raul was finally asleep. Then James did something a bit unorthodox. He closed his eyes and thought happy thoughts until he was erect. He then got up and crawled into bed with Raul. As Raul started to wake up he was still disoriented. James whispered into his ear, “You know, I’ve been thinking about some of the things you have been saying to me, and well…I think it’s time to experiment.” That’s when James poked his fully erect penis into the small of Raul’s back.

“Oh, fuck, shit, no, goddamn, Jesus, fuck, shit, no!” Raul finally figured out what was going on and launched himself out of the top bunk crashing down onto the floor. “I’m not gay! I’m not gay! I’m not gay!”

“I know mother fucker! I had a talk with your wife earlier, you sick bastard! You’re busted!”

And so it came to pass that Raul had finally been beaten at his own game. He who lives by the sword, dies by the sword. Quite figuratively.

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EMSEducast Episode 94

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In 2005 the American Heart Association dropped a bomb on the whole resuscitation community: hyperventilation doesn’t work.  The very thing that had been drilled into every healthcare provider’s head since the first day of school just wasn’t true.  In 2005 the AHA published the ECC’s findings in Circulation.  Part 7.5 of the guidelines entitled ‘Postresuscitation Support’ had the following quote:

“There is no evidence that hyperventilation protects the brain or other vital organs from further ischemic damage after cardiac arrest. In fact, Safar et al³⁴ provided evidence that hyperventilation may worsen neurologic outcome. Hyperventilation may also generate increased airway pressures and augment intrinsic positive end-expiratory pressure (so-called “auto PEEP”), leading to an increase in cerebral venous and intracranial pressures.^35,36 Increases in cerebral venous pressure can decrease cerebral blood flow and increase brain ischemia.”

These new findings were sprinkled all throughout the new guidelines, student texts, instructor materials, and the videos used for ACLS and PALS.  The studies were irrefutable and the evidence was overwhelming.  We needed to stop bagging people so fast during the code and after.  Period.

So, back to this run that occurred in 2008 or 2009 well after these new guidelines were established and put into practice.  We rolled our cot into the ER, and we witnessed the usual amount of flurry and hubbub that accompanies a situation like this.  Our patient was unconscious, intubated, had multiple drips, and was on a vent setting that was way too high.  They were giving him 100% O2 at 20 breaths per minute with a tidal volume of 800ml.  A transport ventilator was unavailable, so it was determined that we were going to be bagging our patient on the way to the cath lab.  I immediately took this opportunity to disconnect the patient from the ventilator and bag him at a much more reasonable 10-12 breaths per minute.  His pulse ox stayed pegged at 100%, and there was no visible change in his condition after the decrease in ventilations.  There was no reason to think that the patient needed any more ventilation than this, and so I was going to go with the reduced rate to try and save some brain tissue.

A nurse that I had known for years appeared next to me and said, “They want me to go with, hon.  You mind stopping by the liquor store on our way out there?”  She was a wiry redhead who had been amusing me for years with her abrupt behavior and shall we say ‘colorful’ patient observations.  In fact, we had a running gag were each time she triaged a patient I thought was going to be trouble I would take the patient’s temperature with the red probe on the thermometer.  “Oh, it’s like that is it?” she would ask.

“Yes,” I would reply ominously, “it’s like that.”

Our patient was about as well off as you might expect for someone who was dead a few minutes ago.  I usually dislike nurses accompanying me on runs. (What exactly are they going to do?  They aren’t familiar with any of our equipment or protocols.  They are unable to bring any of their equipment or use their protocols.  They wind up being just another set of hands.  I might as well take an employee from housekeeping along for the ride.)  But I was familiar with Helen, and this was most likely going to be fun.

When we finally got all the various tubes untangled and got the patient loaded into the back of the ambulance, Helen took the head so she could continue bagging the patient.  My partner started us out of the ER dock code three.  I was fiddling with the monitor a bit, and when I looked up I noticed that she was bagging the patient even faster than the previous rate of 20 on the ventilator.

“Whoa girl, slow that thing down.  You’re not trying to inflate a balloon you know.”

“He needs oxygen.  As much as he can get.”  She mindlessly repeated the mantra I had heard so many times.  So many small minded providers had resisted the 2005 changes.  I was disappointed to find out that she was also an ‘oxygen zombie.’

“Now don’t tell me you haven’t had ACLS in the past couple of years.  You know as well as I do that hyperventilation doesn’t work.”  I was appealing to reason.

“I’ve heard all that crap, and I don’t care.  I was taught in school that resuscitation patients need oxygen, and he’s going to get as much as I can shove into him.”  She continued to bag him with a renewed vigor.

“Helen, you may not know this, but I am a paramedic instructor, and ACLS instructor, and a PALS instructor.  I am also a nerd whose has read all of the ECC Guidelines and there is a dog-eared copy of it in my bag.  What you are doing right now reduces venous return to the heart, it reduces cerebral perfusion pressures, and no one argues with this.  You are using out dated medicine, and you are hurting this patient.”

“I’ve heard all of that, and I could care less.  I was taught in school to bag ‘em fast, and by God that’s what I’m going to continue to do.”

It was at that moment that I lost all respect for that nurse.  I truly wish I had taken someone from housekeeping with me.  The chick who mops the floor could have followed directions better.  We bickered all the way to the hospital, and I was never able to get her away from the head of the patient.  Thankfully it was a short ride, and I didn’t have to watch her hyperventilate the patient too long.

And now it is 2011.  The AHA has published yet another set of guidelines that reaffirms those previous findings, and takes the philosophy further.  And even though it is 2011, we find our healthcare system full of providers that refuse to change their treatments.

Why are people so stubborn?  Why are people so attached to what they were first taught?  I have some thoughts on this, but I would like to provide you with another shocking example of this phenomena.

My wife is completing a degree in anthropology from the University of Louisville.  One of her instructors relayed to her an anecdote about a fellow anthropologist who was new to the field.  Apparently this individual used to be a paleontologist.  However, he had decided to go back to school and become an urban archaeologist.  Why?  Because he was having trouble reconciling his personal beliefs with paleontology.  To translate this for people unfamiliar with these fields, what basically happened was this: this guy was a 6000 year Christian who found himself in a field where he was constantly studying things that were older than the earth from his viewpoint.  So rather than change his viewpoint, he switched to a similar career that would not place him in contact with many things that were more than 6000 years old.  In other words, he stuck his head in the sand.

Why do people do this?  What makes a person capable of such a deep and elaborately constructed denial?  Why do so many people place so much importance on knowledge previously gained when new bits of knowledge are being dangled in their face?  What is so disturbing about change?  How can educated people reconcile such wildly different beliefs in their everyday lives?

There is a time in every young person’s life when their job is to be a student.  They learn full time.  Most people seem to really value what they learned during this period in their lives.  They refer to it.  They feel nostalgic about it.  They cling to it tenaciously.  Despite these positive thoughts and feelings about a person’s formative years, there are also some negative thoughts.  How many times have you heard someone say, “Whew, I’m glad school is over.  I could never do that again.”  Or “I can’t wait till I graduate.  I’ll never have to pick up a math book for the rest of my life if I don’t want to.”

So it would seem that although the average student values what they learned in school, they are also glad that it is over.  In the average person’s mind there is a threshold or a dividing line.  I truly think that most people believe that after a certain point, they have learned enough.  They are satisfied with this base level of knowledge, and from here on out most of their mental energy will be spent maintaining that hard fought knowledge and defending it from attack.  Where is this attack coming from?  The attack comes from new knowledge that conflicts with deeply held beliefs.

In years past, this was not so much of a problem.  Science was progressing at a slow pace.  What you learned when you were a child served you well for most of your life.  But the technological advances of the last century or so have really upset the apple cart.  My father grew up in a small farm in Texas where his primary modes of transportation were a horse and his father’s old Model T.  We now regularly get Twitter updates from astronauts orbiting the earth in a multinational space station.  When viewed from this perspective, it is not hard to see how technological advances can be disorienting for many individuals.

When I was younger, I used to keep hamsters as pets.  And just like everything else, I took this small hobby to its nerdiest extreme.  It wasn’t good enough to just keep a hamster or two in a ten-gallon aquarium.  I had to build something.  I would go to the garage and build these elaborate habitats, the largest of which was a six foot bookshelf converted into a multilevel hamster amusement park.  But I was always disappointed with this hobby.  Why?  Because no matter how big a space I built for a hamster, no matter how elaborate a habitat I designed, all they ever did was sleep in one corner and occasionally run in one wheel.  They found a comfortable nook in their cage and stayed there.

Most people are the same way.

In the end, this is what disappointed me about education.  (That and that little part about almost going bankrupt.  But that’s another post.)  I would spend so much time building this elaborate student amusement park, and all the adult student ever wanted to do was sleep in one corner and run in the wheel a bit.  Teaching something new to the adult learner is an exercise in futility that I couldn’t really fathom until I was at ground zero, looking at the detonation point of my career.

One of the things that has caused friction between me and other people is my inability to think this way.  Everyone has some capacity for denial, but I truly believe that if you charted the human race on a denial bell curve, I would fall on the farthest left point.  This point is where all us atheists, makers, and hackers put on our freak show.  The hard part is interacting with the rest of the people out there who are perfectly fine with reconciling conflicting viewpoints from day to day.

The really confusing thing for people like me is that a certain amount of this is expected in social interaction.  You’re considered a bit weird if you’re fine with change.  Continuing to learn new things makes you a bit odd and sometimes annoying.  It leads to beliefs that often offend other people, so you wind up keeping your opinions to yourself.  (Blogging not withstanding.)  You get labeled as a know-it-all or a nerd.  It is perfectly okay to work in the oil and gas industry and be a 6000 year creationist.  People will say, “Look, he’s so successful and yet he has always maintained his faith.  Isn’t that inspiring?”  Our hypothetical oil baron has gotten rich from a substance that by definition must be over 6000 years old.  He employs vast teams of scientists and technicians who use scientific principals he doesn’t believe in.  They toil away filling his bank account with dollars while he is in church discussing ideas that would make the very existence of his company’s product impossible.  Yet, his story is inspiring.  Am I the only one who has a problem with this?  Sometimes I feel like I am.

And looking back on it I think there are two things that happened during my formative years that made me the way that I am.  The first was my parents.  They are freaking nuts.  There is no other way to put it.  If I am on the far left of the denial bell curve, they are on the extreme right.  I have worked in a psychiatric hospital, on an ambulance, in hospitals, and in organ donation.  I have seen people at their worst.  I have seen people at their most desperate moment.  I have seen people dangling by a mental thread.  But to this day, I have encountered no one during the course of my professional career that has the capacity for denial that my parents do.  It is truly shocking.  The disorientation they feel from the changes that have occurred during their lifetimes is so profound that they have ceased to be functional.  Now if you are raised by people like this, one of two things will happen.  You’ll either be just like them, or you will rebel.  The fact that no one in the family talks to me anymore should let you know what happened there.

The second thing that happened to me during my formative years was the personal computer revolution.  Our first computer arrived in our home when I was 7 or 8 years old, and I was fascinated from day one.  And what are computers all about?  Change.  “Version 1.0 just came out, but version 1.1 will be out in a few months.  I hear an advance team is already working on version 2.0!”  Or how about, “This 9600 baud modem is really fast, but think of how deathmatches in Doom will be with a 14.4 modem!”  For over 30 years I have not just tolerated change.  I have welcomed it.  I demanded it.  It’s not disorienting.  It’s intoxicating.  It’s exciting.

So what are we going to do about this?  Do we give up and say that fifty million Frenchmen can’t be wrong?  Of course not, you should know me better than that.  Besides, have you seen my dad?  Denial leads to you being a senile old man who tries to tell anyone who will listen that “this DVD thing is never going to catch on.”  He’s a diabetic because he is obese, and according to him massive amounts of candy and desserts are great for that condition.  This has caused his teeth to rot out of his head, but he won’t go see a dentist.  He also smokes to relax and lower his heart rate, and takes aspirin to settle his stomach.  Yeah…that’s not working so much.

We need to do something to stop this.  Nip it in the bud.  Healthcare is a dynamic industry on the bleeding edge of science that is full of people who resist change.  This is probably why healthcare in this country is in the state that it is in now.  Well, that and blind greed and thievery.  But that’s another post.

The problem is faith.  Blind faith.  (Not the 1969 album by the band of the same name.  That’s actually quite good.)  The definition of faith I am referring to is “a belief that is not based in proof.”  For some reason, no matter how successful science appears to be, humans have this irrational faith in well…faith.  It’s what makes a Republican promote a policy of abstinence.  It’s what makes this idiot Democrat use taxpayer money to build a replica of Noah’s Ark.

I can honestly say that I have faith in nothing.  If I tell that to someone, they look at me all sad and suggest that I go to therapy.  But there is nothing wrong with me.  This allows me to have other qualities that people report to admire such as rationality and accountability.  I say ‘report to admire’ because this is only on the surface.  Most people want nothing to do with being rational or accountable.

So, for the few of us who want to fix this, what do we do?  We need to start early.  Kids need to be taught from day one that learning is something they will be expected to do until they are on their death bed.  Change is exciting, and they should look forward to it.  Advancement is a goal to constantly strive for because only through advancement can we heal more people and improve the quality of peoples’ lives.

What can an EMS educator do?  I’ve been wrestling with this recently.  I am working on a project to update a body of course work to the current 2010 ECC Guidelines.  Hence my mention of the AHA way back at the beginning of this rant.  It has been interesting to delve into education again, and it’s always fun to look at what clever people have come up with.  It was shockingly easy to get started with this project since the AHA makes all this information available for free in several formats including searchable PDFs.  So why not make a student go through the same experience?

Here’s the idea: if I was ever going to teach my own paramedic class again (which would never happen, I don’t want to have anything repossessed and I want to stay married) I would make every effort to incorporate new material such as these 2010 guidelines with the regular curriculum.

For example: your students are studying cardiology.  You have covered all the drugs and algorithms in the paramedic text.  Give the students some copies of the new guidelines and assign them a project such as updating a set of ACLS protocols.  Tell them, “Here are the protocols as they are now.  But the AHA has incorporated a lot of changes in their recommendations for 2010.  Your assignment is to update these protocols for your medical director.  Every change you make must be well documented with a rationale from these guidelines and any other sources you care to site.  If the AHA recommends a change and you do not adopt it, you had better be able to defend that decision as well.”

This can be done for just about anything.  Pharmacology is rife with changes.  Dopamine is still in all the protocols in my area despite the fact that many ICUs are discontinuing its use.  Assign some of these studies for reading and have your students decide to either defend or discontinue dopamine use in the field.

If the learning process of the student incorporates change and makes it obvious that medicine is a dynamic industry, the same student will be less disoriented by changes that occur in their field after graduation.  At least, that is my hypothesis.  This needs to be tested against a control group to see if it would really be effective because I will never have faith in this idea.  It must be proven.

And as for faith itself?  It has no therapeutic use and may even be harmful.  It should be discontinued due to its untoward effects on society.  Providers are to update their protocols accordingly.

So in an attempt to really confuse my readers, I will leave you with an old Blind Faith tune called ‘In the Presence of the Lord.’  Enjoy.

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