Don't Duck This Rotary Puck

Marriages and mortgages. Gangs and gods, family and flag. And don’t forget sports teams.  We promise our love, fealty, credit rating and “good name” as though they were lottery scratchers, blind stabs at self-satisfaction and communalism.

Inevitably, our purposes, pursuits and passions take a detour. Commitments are tossed, consequences be damned.

My blue puck sits at this confetti crossroads. It’s a shredder paperweight. It’s also a life coach.

The puck isn’t slapshot material. It is a plastic memento of my Fresno Rotary service. Emblazoned within is the international community service group’s Four-Way Test, a set of expectations for how members should conduct themselves.

Millions of Rotarians worldwide have publicly promised to adhere to the following. That includes, presumably, one-time Rotarian Donald Trump:

“Of the things we think, say or do:

• “Is it the truth?

• “Is it fair to all concerned?

• “Will it build good will and better friendships?

• “Will it be beneficial to all concerned?”

Oddly, society now views honesty and honorable behavior as radical, risk-laden.

Maybe that’s why we assign them to heroic figures: Superman – truth, justice and the American way; and Robin Hood, brave, courageous and bold (truth, maybe, in his quiver).

The puck is an encourager, imposing neither penance nor a Pollyanna life view. Tipping off your true intentions – in politics, combat and business – can be deadly, illegal and, at the very least, imprudent. I recall the World War II mantra: loose lips sink ships.

But dousing moral benchmarks with a WD-40 of dishonesty and deception to limber facts and fairness more to our liking, that’s a swindler’s strategy.

The moral mud wrestling makes for memorable cinematic lines:

• “You can’t handle the truth.” -- A Few Good Men

• “The rules are there ain’t no rules.” – Grease

• “Pie crust promises. Easily made, easily broken.” -- Mary Poppins

It’s easy enough to relax good judgment.  Who doesn’t click “accept” to iPhone updates without reading the appended lawyer lingo? The same for “initial here” DocuSign electronic pledges on 30-year home loan documents.

Some take a deeper plunge to all-out weasel in word and deed, becoming smilingly vile and productively destructive.  There, we take our halves from the middle, skunk-spraying all else. We distort the truth until we’ve created plausible fantasy. Janus-faced, we become top hurlers on Rotten Tomatoes, downgrading benevolence, self-sacrifice and good Samaritan conduct as time-wasting flops.

As a newspaper reporter, I once asked Fresno church leaders if lying were ever acceptable. A United Methodist pastor affirmed it was, such as when Nazis demanded captive populations reveal whether they were concealing Jews. “A lie to the liars is not a lie,” he said. Not everyone in his flock agreed.

Silence in the face of dark stars suggests fear, indifference or complicity.

Options include activating the poet Robert Frost’s option: “Good fences make good neighbors.” Or we may adopt the dark autopsy given by J.K. Rowling’s character, Voldemort: “There is no good and evil, there is only power and those too weak to seek it.”

The Four-Way Test helps lift such selective blindness. The remedies always involve getting off your duff and staring into the mirror until one of you cracks. Next, assist others without serving your own self-interests.

Examples in the Rotary include worldwide programs to eliminate polio, reduce malaria, create human milk banks, provide job training for the needy, wheelchairs -- “the gift of mobility” -- for the disabled and solar-powered water purifiers to avert disease. Many nameless cogs empower these betterments.

There is no immaculate good. But the Rotary puck test is a useful Fitbit to strengthen moral character.

John G. Taylor, a former California journalist and retired hospital executive, is owner of JT Communications Company. He lives in St. George, Utah. Write to him at communicatejt@gmail.com

Living Without California

The sweaty gym sock of San Joaquin Valley air is in the rear-view.

When I mushed to California nearly 40 years ago, a mechanic said my Wisconsin car “had the disease” – from Rust Belt road salt. I leave now mottled from the disease of breathing -- allergies, asthma and bone-stripping prescription rescuers. My wife, a Valley native who twice sang in Europe with California choirs, has surrendered her choruses to coughing fits.

We can no longer live the aspiration that pollution is being slowly throttled. To us chokers, it’s a pipe dream.

Long-timers aren’t surprised by our leaving.  Many friends are weighing their own pull out.

Allergies, asthma and bronchitis steal into your life – no red flags, just dingy skies caked in microscopic particulates and baked in invisible ozone.  The scat we breathe is born of wildfires, agriculture, fireplaces for ambiance and for heat, cow methane, pesticides, diesel-spewing 18-wheelers and the geographic bad luck that wedges fetid Valley and Bay area air into a 50-mile-wide fissure of ag land, cities and national parks and forests.

We snore, thrashing riotously in phases of apnea. We breathe as though gargling through our noses. Our lungs rattle like a bag of marbles.

Oblivious, the Fresno area pulsates with new people and businesses. It’s affordable in a state riven and weakened by economic extremes. Affordability has primacy in California’s Maslow’s scale of livability.

My first 20 years in Fresno earned me the scar of asthma. Who knows how much ozone and PM 2.5 I’d blithely breathed. Some 20 years later I’ve joined the cast of “sensitive group,” a gelatinous term to diminish that all of us are living in a toxic risk environment.

Maybe if the daily air smelled and tasted like burned popcorn we’d pay attention. Maybe if we all wore beeping air monitors as though reconnoitering Chernobyl. Maybe if our electeds viewed us as more than a churning of mine canaries. That maybe is more real than the likelihood our health will stabilize or (ha!) get better by staying and praying.

Trust the regulators? The kind of pollution detector you employ, where it’s placed, how it’s read and how and when you share its data – that’s tinkering with my expiration date.

Medical remedies? We survive on crutches of antihistamines, decongestants, injections and, especially, daily maintenance and emergency inhalers. They can morph you into a chattering squirrel, saturate you in sweat and exhaust you like a spent marathoner.

For sensitive groups, “getting out” in Central California means getting the mail and taking out the trash. Hiking in Yosemite? Hollering for the Grizzlies Triple A team and the post-game fireworks? Too risky for pollution hermits.

Leaving packs a gut punch of guilt. We’re walking away from one of life’s treasures. The kids we raised here have stayed. We can – we could -- watch their kids converge on a soccer ball or wiggle holding an academic award. When hard luck hit, we offered welcoming shoulders.

Instead, we’ll schedule time-zone-friendly Skype calls. And being alive, however remote, will be our presence. There are no friends or family – yet – in our new Utah locale.

Guilt led me to another question: Have I been complicit in allowing our air to be salted with manure? Consider how we’ve passively, progressively allowed our airways to be crammed with every manner of fragrance or chemical taint.

An air-freshener electric pump has replaced the Glade manual sprayer. New cars and offices are dabbed with wallet-opening aromatic enticement. Sen-Sen has reappeared to spur a gag reflex. Try to find a toothpaste without mint. Is your mouthwash aroma different than your toilet-cleaner scent?

Real, faux and toxic scents – who wants a vanilla world? Soon, the hot item might be a scratch-and-sniff card for clean air. And suddenly the most important players on the football field are the bench-side oxygen tanks.

We’ve invested most of our lives in establishing family roots and growing with Central California, my wife as a teacher and I as a journalist. We will grieve it hard but lingering here might be the last bad move of our lives. We can’t chance it.

John G. Taylor, a former Fresno Bee reporter and editor, is owner of JT Communications Company. Write to him at jtcommunicates@comcast.net.

Below is a link to a podcast and story by Valley Public Radio reporter Kerry Klein detailing the personal impacts of Valley air pollution:

http://kvpr.org/post/some-move-work-or-family-these-fresno-residents-want-escape-air

The Inhaler as God

John G. Taylor

Running out of time. The grandkids are finishing Tee-ball, soon the inhaler will go from Mom’s purse to their gear bag.

Central California -- the state’s backwater, the nation’s breadbasket, a glance while ogling Yosemite at 30,000 feet -- is roiling in money and newcomers with nowhere else to go. It’s kicking up the Fresno-area economy as grape vines and fruit trees are disked and mulched to make way for 300k-starter homes, more warehouses for the Gap and Amazon, waystations for international truckers and sheds for deep-drillers of fast-vanishing wells.

In our bedroom where the air purifier echoes Darth Vader, we awaken with plenty of sinus congestion and coughs. Any hope that the San Joaquin Valley will see resolution of its acidic pallor is receding faster than our reservoirs.

More than 100 languages are spoken here. For nearly 40 years I’ve added Brooklynese to this once-swell place where your kids walked with nary a fear to the school playground. I’m a “blow in” compared to my wife whose Mennonite kin have worked as farmers, judges and business owners for generations in Fresno’s neighbor, the once-tiny ag city of Reedley which posted her family name on a nice tree-lined street.

We chat in arcane code about the day’s threats … ozone, PM2.5, red flags and co-morbidities. Steroids help us edge through. Pills, inhalers, shots, sometimes multiples in a day, each leaching calcium from our bones, weakening our immune systems and slapping a depreciation sticker in our life-insurance actuarial tables.

Our aspirations accelerate our respirations spurring our expiration.

Our lungs are tenements of soot, soil and fuel toxins. The remedial promises of regulators, lawmakers and moneymakers are as squishy as cow manure pits. The pits’ residues soon marinate into breathable fragments along with acid rain and fog, and forest fires fueled by trees suffocated by pollution and vermin.

Wherever you live in the US, the cheap coin of blame and accommodation arrives by front-end loaders.

• Clogged sewers converted the relief of a New York City summer rain into pungent Okefenokee in Brooklyn streets.

• When summer smog engulfed Hartford, Conn., long-timers assured me it was a summer thing, just go fishing early.

• In Groton, Conn., the sea-breeze window opened only when Pfizer wasn’t brewing a noxious pharmaceutical.

• Milwaukeeans blamed the industrial fountains of Gary, Indiana, for the taupe swirl of skanky metals in the air near Lake Michigan, though I found it scant danger compared with the turgid nightly spew from south Milwaukee tanning plants and downtown beer brewers.

Maybe we can taper off, detox ourselves, with emission curbs, carbon tradeoffs, green-friendly transit and agriculture, quickening the speed of pimple-sized Fiats that tremble from the buffeting of 18-wheelers. But maybe is a weak drip feed. Maybe is our palliative care.

When we talk it’s like gargling, words spew with coughs. We cringe as our children now adults grapple with the drought of breathable, non-medically enabled air that imperils their kids, our grandkids.

We are all “on the clock,” morphing into statistics for the likes of the American Lung Association and the Alliance of Automobile Manufacturers. Clean air as optional extra. Chevy Nova to Prius to hearse.

I wrote this after being interviewed by Detroit Free Press (and former Fresno Bee) reporter Phoebe Wall Howard for a story detailing air pollution impacts vs. the fight over vehicle emission standards. Our comments comprise the story’s last five paragraphs.  Here’s a link: https://on.freep.com/2GSoeKO

John G. Taylor, a former Fresno Bee reporter and editor, is owner of JT Communications Company. Write to him at jtcommunicates@comcast.net

The many lives of newspaper dating ads

Before eHarmony and Ashley Madison, there were words-only newspaper dating ads, resembling agate listings of losing baseball teams.

The Fresno Bee rolled out its version in the early 1990s. Time heals, so I stand now to offer the Bee public forgiveness for a misdeed.

I had been cajoled then into placing an ad by two married friends, insisting I’d become too painful to watch in becoming suddenly single after twenty years. I guess Sugar Pops and Pepsi for breakfast further eroded my moribund mojo.

So, I nudged my DWM out there along with slivers of G-rated hankerings that, if so charmed, could progress to a pay-per-listen phone message.

I felt like both chum and chump. With several popes’ worth of monogamy under my belt, I weakly whispered a call for wise, witty and professional women with affinities for the Yankees and “off-beat” lectures. I intoned about the whereabouts of the Dead Sea Scrolls.

Though sounding as amorous as a shedding sloth, I experienced occasions for a catholicity of sin. There was the test of coffee, tea and woe-is-me; a taste of Friday Hot ‘n Now; golf as religious and spiritual obstacle course; and other Freudian tête-à-tête that fed my mind with endless replays of a favorite Allman Brothers’ tune, “Whipping Post.”

During this rapture, I also worked as the Bee’s religion reporter. This was the heyday of the Promise Keepers movement, Louis Farrakhan and scandalous televangelists. While I was meekly trying to set up something, I wondered about being set up.

Cancel the ad, I ordered. Immediately relieved, there followed a weekend of penitential repair for force-feeding spaghetti into a garbage disposal.

Then rang the phone. The Bee had screwed up. The dating ad was published again, past its cancellation.  

She’d seen me dripping wet, reporting from a soggy Martin Luther King Day parade. She was a marcher, who liked galleries, museums and the Yankees.

I activated my deflector shield of civility. Well, says I, to the sunny-voiced woman from Reedley, if you ever visit Fresno (lo, a biblically long 25 miles), do let me know and…

She called my bluff, concluding my dangling sentence by calendaring a Sunday lunch in a public place (my request).

She wore a green sweatshirt and a pulsing, peach-colored smile.  I could sense her warmth, as I deliberately walked past her sitting at the restaurant, pretending she wasn’t just about the mall’s only other sorry soul seeking a solution to solitary Sundays.

As I neared the down escalator -- I swear I was about to turn around – she left nothing to chance. No way, she said later, no way you were getting away that easy. I went through a lot expensive phone calls to catch up with you.

Thus, did the Bee’s mistake jump out from the page.

After she finished her pastrami, I suggested a short drive for a quick tour of the Bee news and press rooms. We could watch robots move tons of newsprint!

I told her to follow my white Toyota. I was driving a white Honda. Had her guessing.

I swear the redhead’s Ford pickup had a gun rack, along with a pox of dings, dents and a relentless fluid leak. 

She insisted she was a Mennonite pacifist and hinted I was dumber than an empty Pez dispenser when it came to knowing about sliding windows and pickups.

I recall little else beyond her inviting me to a second, equally unique date the next week at City Hall. There, as she snuggled a grandbaby, I watched the family celebrate her son-in-law’s police swearing in.

Some call the printed news a snapshot of history. Twenty years, roughly how long I was in the Bee’s trenches, and there were mistakes on both sides, So, boss types, no need to promise a “free” paid obituary to set things straight, although it would be a kick to have.

We’ll chalk it up to it just desserts as we celebrate our 20th wedding anniversary. When you’re married to the news profession sometimes it will marry you, even by mistake.

John G. Taylor, a former Fresno Bee reporter and editor, is owner of JT Communications Company. Write to him at jtcommunicates@comcast.net.

The Clout of One-Word Commercials

For TV ads, it tilted toward tedium, but I think #Volkswagen has given its scandal-ridden reputation a respectable nudge back into the marketplace with commercials hinging on a single word. Really. Check this out.

The impact reminded me of a #Geico insurance commercial, done in Civil War daguerreotype style, in which Mary Lincoln asks Honest Abe how attractive she looks in 1860s dress. From innocuous to memorable. Here’s a reminder.

But the all-time champ of to-the-point remarks remains Brigadier General Anthony McAuliffe’s reply to the German demand for surrender at the Battle of the Bulge. Here’s a recollection from the US Army website.

John G. Taylor is owner of JT Communications Company. Write to him at jtcommunicates@comcast.net.

The Navy's vital, aging "bus"

Our seats faced backward, adding disorientation atop dread.  We were buckled into what proved to be a reliable rattling relic. The C-2 Greyhound ferried us sweating rookies from Coronado Naval Air Station to the floating high-tech projection of power called the USS Abraham Lincoln.

It was like riding a reeking dinosaur to a tightly orchestrated yet lurching dance floor of jet landings and launches.

The memories of 2011 were revived last Thanksgiving after hearing a similar C-2 Greyhound had crashed near Japan while delivering 11 passengers to the USS Ronald Reagan. Eight survivors, three missing and presumed dead.

The C-2 Greyhound is a workhorse, designed 50 years ago and in the air ever since in some form, with phaseout not beginning until 2020. Hard to imagine the Navy doing business without this bus.

Without doubt, the most white-knuckle moments in my two-day Lincoln visit were my C-2 flights and watching nighttime shipboard landings.

Mortal peril is a close companion to military service. Nothing can be taken lightly, one Lincoln sailor told me, any mistake or bad break and you’re done. I’d signed my permissions, waivers and a farewell note.

The Japan accident spurred me to track down a blog I wrote for Fresno’s Community Medical Centers, my employer during the Navy trip. Here’s what I wrote on the C-2 shuttle experience, and condolences to families in the recent crash.

“Layered like a mummy. Tucked into darkness. Awash in fumes of fuel and gusts of heated air.

“Welcome to the belly of a C-2 Greyhound -- you've been fed to the COD --"carrier on board delivery." You and 14 others are today's special meal, part of the Navy's Distinguished Visitors program, in this case social media writers, photographers, thought leaders who been invited to overnight aboard the nuclear aircraft carrier USS Abraham Lincoln.

“But as the twin-engine COD lifts off from Naval Air Station North Island, Coronado, you are only socializing with yourself, your anxiety heightened and your excitement tempered having just heard news of the deaths of Navy SEALs and other American personnel in Afghanistan.

“When F/18s and other aircraft descend onto a carrier, it's often called a "controlled crash," as they measure angles at high speeds and aim their tail-hooks for one of four wires strung across the ship.

“But when your COD is trapped, it's called an "arrested landing," going from about 105 mph to zero in two seconds. And, a day later when they "cat" – catapult -- you off, you’ll be shot from zero to about 128 mph in three seconds.

“And you think of the 4,500 sailors, aviators and others you're going to eat and chat with, and marvel and watch and worry with as well, however briefly. Where does their day take them, how do they deal with separation, if there's something they want to world to know -- the Navy has imposed no limits, other than no flash photography during nighttime landing. Sure, it's a time-controlled snapshot but you want to be illuminating.

“And so, you sit there in the dark, waiting, as you've been warned, for the flight officers in the COD's belly to yell and wave their hands to alert you that the trap is imminent.

“In your horse collar, cranial, ear plugs, ear muffs, goggles and spin-buckle, four-strap seatbelt, you're sweating and maybe hyperventilating just a tad, as you head for the gentle violence of a landing atop 4.5 acres of sovereign U.S. territory about 90 nautical miles west of San Diego.”

The latest in a sad string of accidents involving the Seventh Fleet drew me to old photos and a souvenir badge purchased from the “Providers” VRC 30, the crew of my twin-propeller Greyhound flights.

Again, I could smell nauseating fuel, feel the carrier deck quiver as engines thunder through my ear mufflers and my knees seesaw. Again, I am sealed in a dank, muggy metal purgatory, compelled to re-experience scattered memories while hurtling toward “Apocalypse Now.” Eternity was real as the sweat trickling down my spine.

John G. Taylor, a former Fresno Bee reporter and editor, is owner of JT Communications Company. Write to him at jtcommunicates@comcast.net.

The strangers we hire, then ignore

We invite scarcely vetted visitors into our house to revive air conditioners, exterminate critters. Expectation: Do the job right, right away and go away.

Some of us detest needs we can’t self-satisfy and revile waiting for the likes of a plumber’s snake. And thus, we shortchange ourselves from being a partner in our own material repairs and personal growth.

During a recent relocation, I decided to seize every chance to ask over-the-fence questions of haulers, installers, Lowe’s hardware staff, and customer service reps at Fresno and Clovis utilities.

No scripted secret shopper here, I’d chat sports, weather and then descend into silences long enough to watch corn grow. The hobnobbing positively refreshed my rationale as to why, although moving six times in nearly 40 years, I stay planted in the same Fresno bull’s-eye.

For one thing, I’m persuaded customer service is no longer a YouTube loop about what happens when stupid whacks a golf ball while standing on thin ice.

My wisdom came from vendors in their 20s to 60s, almost all men, of diverse ethnicity. Several started with a script, mostly from heavy-hitter outfits like Comcast and AT&T.  Smaller shops were more focused on tackling a task rather than replying to “but, what-if”?  And I discovered that the only people gifted enough to either instantly fix or irretrievably break something were handymen impaled on their cell phones. No asking them anything.

Virtually all were happy to call Fresno home, though some were surrendering hopes of snaring a decent home in the $150,000 to $200,000 range.

The visitors told of honor-winning children who were on track for college scholarships. They also shared frustrated shrugs for kids who behaved like junkyard dogs. At the doorstep, some would slip shoes into protective booties. Others stifled sneezes employing the bat-wing technique.

One claimed he’d fallen from a multi-story roof. Two blamed workplace injuries for lost jobs and pain relievers. Mideast veterans talked around and sometimes through their PTSD.

One man’s big dream: Opening a downtown Fresno coffee shop offering Christian speakers and computer repairs. A sales rep said daily job satisfaction was critical because she carried home all unresolved stresses. A utility worker anxiously awaited news of a corrections job.

I was stunned that a window repairman commuted weekly to a Fresno job from his Monterey home until he persuaded his wife to move to the Valley. He liked the community’s ethics and friendliness, something the Central Coast lost to the affordable housing shortage.

Fresno is already souring, other vendors remarked. The same San Francisco and Los Angeles investments that are fueling steady work are fattening the ranks of obnoxious customers.

Not all vendors were civilized. One Monday dawned with a visitor’s eyes shot full of red, ill will and bad intent. Two evaluators should consider the role of Fagin in any Oliver Twist remake.

More often, we crossed paths with ethical home inspectors and Realtors, making a new friend and imposing red circles around the toxins.

Other rewards included tapping handymen for techniques and tricks to avoid bonehead troubles. And, especially, the encounters with phone/online reps who were lubricated with courtesy and occasionally heroic in problem-solving, while sharing a rich stew of “still-checking,” time-killing exchanges about Chinese family relationships, how aliens are watching and why Hershey, PA has lost its mystique.

Fact is, nobody wants strangers eyeballing their home or pawing possessions. But investing your time may address that anxiety. So, inspect the ID and invoice, but also consider reaching out to the stranger who’s trying to straighten your cockeyed world.

Consider the immortal Ferris Bueller: Life moves pretty fast. If you don't stop and look around once in a while, you could miss it.

(Also published as an op-ed in the Oct. 28, 2017 edition of The Fresno Bee.)

John G. Taylor, a former Fresno Bee reporter and editor, is owner of JT Communications Company. Write to him at jtcommunicates@comcast.net.

Running for office? Audition on a cruise

If you’re thinking of running for public office, first book a week-long cruise. There is no better boot camp.

Politics and ocean cruising bring the promise of spectacle burdened by the weariness of process. It was never clearer than on our recent cruise through Alaska’s Inside Passage as to how voyaging has slipped into a scarcely muzzled dog fight mirroring American elections.

Cruises were once a petri dish for the refined. The slinkiness of Carole Lombard, the peregrinations of Agatha Christie, the skullduggery of Humphrey Bogart, the world reshaping of FDR and Churchill, all draped in waves of rhetorical or other inebriation.

The fancy people bathed in perfumes, Johnny Walker, winks, nods and Vaseline promises, and dirty deeds done (maybe not so) damn cheap.

On my first cruise, a 1972 honeymoon to Bermuda, the Holland America captain sat with us for dinner. Off the stern, you smacked golf balls into the Atlantic or shot-gunned clay pigeons. Earth Day had barely registered its arrival, and happy hour was a competitive sport.

Forty-five years, more voyages and uncounted elections later, cruises and politics are a fool’s gold of coarse ordinariness.

Cruise cities, as they are that, have become showcases of socioeconomic schmearing. Here, there is a forever high tide of pretension. Facts, like dollars, are shaken off like sudden salt spray. 

Here, you test regional humor -- “He stinks worse than a foggy outhouse.” Religion and sarcasm – “Bless her heart, she’d better save me than last slice of chocolate cake or there won’t be anything left to bless.”

Shipboard as in American politicking, what matters is Hot ‘n Now. You vie to become Buzz Lightyear -- first in line for infinity. Acquaintances are played like party balloons: extend, fill and release. Test every water, set it afire, walk on it, bottle same.

This is a vetting of your political platform. On a recent Princess cruise, chance encounters offered these supporting-cast opportunities:

• A meat market manager from southeast Wisconsin was just back from trophy hunting in Africa. His seatmate was a Californian extolling the spread of state-legal marijuana. Jaws tensed in the cliché. A middle ground was brokered: both reveled in the joys of morel hunting. New office-seeker, these could be your regional campaign managers.

• A former teacher from Arizona wore a saggy, anti-Trump T-shirt. She also voiced disdain for teachers, students, administrators and her onetime union. She sampled and dismissed every purple gourmet cookie at a British Columbia tourist spot.  Her selective candor was refreshing and off-putting. Found, a potential high court nominee.

• A disembarking tour was delayed by bum directions from a ship bureaucrat. Another official, a young woman from South Africa, took to the theater loudspeaker, deflecting a peppering of nasty shouts. “Ladies and gentlemen, I don’t know how these mistakes were made but I know how to control a crowd. I will get you off the ship in a timely way but only if you listen to me.” Mmm, a potential chief of staff.

Your teething political chops might observe how tired hucksters and adventurers dive for the wallets of the bored. I tinker with the actual themes, but hear now sound of their lures: Art auctioneers, “Four hundred years in 40 minutes.”  Outdoorsmen, “Solo kayaking the Passage with breaks for beer and ice cream (but no sex).” And bartenders, “Mimosas and margaritas at dawn as glaciers die before your eyes!”

This is a PG-13 Las Vegas, leagues away from a Madison Square Garden balloon drop. Cruising is political training wheels, a gateway to yelling “Mouse!” in a Michelin-rated eatery. Nowhere will you likely eat worse Baked Alaska than offered on an Alaskan cruise – how better to serve a stump speech?

At journey’s end, I joined most bestowed with coffee-break fantasies explaining belt-buckle spillover.

But someone aboard this odyssey of the ordinary may have gleaned a recipe for earning a campaign check and a check mark on an absentee ballot. If I could only persuade two such newly minted visionaries to climb aboard, we’d create a killer reality show.

(Also published as an op-ed in the August 25, 2017 edition of The Fresno Bee.)

John G. Taylor, a former Fresno Bee reporter and editor, is owner of JT Communications Company LLC. Write to him at jtcommunicates@comcast.net.

The charade of patient education

The healthcare system has saved my life but my only trust is in its dedication to delivering incomprehensible bills.

Promises of patient-friendly invoices quickened with the Affordable Care Act in 2010. But closed-door jawboning has resulted in what many view as the usual self-perpetuating flimflam.

To wit: “The government created the mess that we’re forced to use (hint: blame them). … If we become too public, our competitors will put us out of business. … The formula for what we charge is proprietary information (suspicion: there is no reward for clarity).”

Invoices are a Pandora’s Box of hieroglyphics and hierarchies culminating in “patient share … pay this amount.” There’s neither  education nor empowerment in the drumbeat toward collection agencies. Ghosts still run the machine, which seemingly flaunts examples of excess.

Take the NYC Health + Hospitals corporation. The public health system cut nearly 500 management positions this year, saying it would save $60 million in fiscal year 2018.

"Today we've implemented a difficult but necessary action to help build a stronger, more agile and more stable public healthcare delivery system," said Stanley Brezenoff, interim president and CEO, in Becker’s Hospital Review. "By restructuring and reducing unnecessary layers of management, we can better direct resources where we need them most — at the front line of patient care."

So, until now, the resources were being squandered by layers of bureaucracy putting care was risk? We all pay for this doublespeak.

Executives know the price of everything but the value of nothing – save grandstanding. Why else would Daniel Snyder, CEO of Shreveport, La.-based University Health System, try to one-up a Louisiana state senate hearing inquiring why his company hadn’t paid a $12 million debt for Louisiana State University physician services.

There’s not be enough documentation to support the request, said he before whipping out a $6.2 million check from his coat for said services. So there, enjoy the half a loaf I’ve been carrying for lunch.

"If this is how you conduct business, the future doesn't seem to be too bright," replied a stunned Finance Chairman Sen. Eric LaFleur in Becker’s Hospital CEO newsletter.

Patients are jittery as they enter the sprawling boxes of concrete with jail-like windows. How do I get to the head of the line and out of here quickest -- in good health?

We are compelled to present government identification, proof of insurance (sound like a traffic stop?), to sign and pre-pay (credit card would be ideal, I’m told, but is that a good idea?) and authorize things that supposedly shouldn’t occur but which I’ll never recall approving anyway.

I’m compelled to trust whatever caregiver is assigned to me -- who changes every eight to 12 hours -- that they will adhere to the same care plan and advocate for me as my condition changes. That’s a fragile, frightfully important task remanded to strangers when my physical and psychological faculties are unsteady.

Troubling, too, is how little caregivers know about the cost of services.  More than 60% of emergency medicine clinicians can’t accurately estimate the costs of care, according to a study in the Journal of the American Osteopathic Association.

That’s odd given that administrators expect doctors to stick to a formulary of medications and a defined storehouse of gear and tests that have been proven to cost-effectively get the job done.

Fiscally empowered doctors can involve patients in cost containment.  When told that as part of cataract surgery I could have lenses installed that would end reliance on eyeglasses – if I forked over an additional thousand dollars – I opted to keep my eyeglasses.

Given the punitive nature of billing, it’s no surprise that:

• A survey from Bankrate, a financial planning site, found that a quarter of 1,000 adults went without treatment because of cost.

• Nearly 70% of patients with hospital bills of $500 or less didn’t pay off their balance in 2016, up from 49% in 2014 (Healthcare Financial Management Association).

• Those who can fork out thousands a year can bypass insurance by buying concierge care – “me first” access to doctors and medical facilities.

Explaining a hospital bill ranks right up there with educating patients about lifestyle choices. They’ve been triaged out of the picture by politicians and providers as too costly, time consuming and raising more questions they don’t really want to answer.

(Also published as an op-ed in the July 8, 2017 edition of The Fresno Bee.)

John G. Taylor, a former Fresno Bee reporter and editor, is owner/operator of The JT Communications Company LLC. Write to him at jtcommunicates@comcast.net.

Feasting on people: A diner’s guide

The sylph-like hostess sashayed through the restaurant like a baguette looking to shed a cold pat of butter as her shawl slipped, again and again, from the twist of her neck. By mid-evening, artifacts from the menu were destined to be dipped, dusted and otherwise magnetized from the floor into every fabric fold.

When it comes to take-your-time dining, the ballet and missteps of this Morro Bay kitchen were as much a Rubik’s Cube to patrons as was the industrywide marketing rationale that inevitably wrapped at least four but never more than six shrimp in a $30-ish glaze.

The back shop is predestined to dwell in the Twilight Zone, Gordon Ramsay be damned. But the clientele and the front staff can be sifted, sampled and given a Michelin review, welcomed like the perfume of sautéed garlic shrimp or scorned like burned popcorn.

Where the restaurant bends from its entryway bottleneck to full flagon there sat this evening’s Judge, earning the label for overall imperiousness commencing with crook of his neck. This patron’s gaze rendered all as miscreants or worse – perhaps potential juror panelists -- as his wife, shoulders dappled by the Morro Rock sunset, regaled him with a Democrat-flavored judgment of congressional hearings for then-Supreme Court Justice nominee Neil Gorsuch.

What, what? You know I can’t hear whispers, said his voice, a megaphone that invoiced what he would or wouldn’t have with his salmon, and how – bring cruets and shakers -- he would zest it himself when it debuted. Water was his beverage, wincing as his wife reordered a lemonade.

We early diners were a weak tide in this California offseason, choked by rain and mudslides. A woman with a yellow rain smock cinched around her waist. A grandmother holstered in a polished walker, shepherded by a benign young man who wended her to a perch that espied the ocean while reviewing a menu both knew by heart and agreeing that selecting an inexpensive red wine would escape anyone’s aspersions.

The servers regarded the regulars as though resuming an interrupted diary with updates of a wallet lost, the results of cancer screenings (the type specified as “women’s”), how a co-worker’s pregnancy leave had left them short-handed and, only when asked, a reminder about the chef’s specials.

This confessional, mindless of us nearby as we dropped eaves, on no occasion led the servers to provide the irregulars with their first names or position themselves as inviting, knowledgeable resources about preferences on a blissfully limited menu that hasn’t needed more than a fresh varnishing of plastic over the decades.

No hard sell, no memorable menu to share with tourists many of whose car undercarriages suffered keel-hauling on humpback streets in arriving at this 75-year-old perch above the fuss of the embarcadero. This restaurant, whose name I spare, rests abundantly well, thank you, on the elbows of its reputation, no need for ruffles about dining experiences or special ministrations beyond adjusting shades to accommodate the sun’s death glare.

As this evening’s first tables were turned, the woman in the rain smock was surprised to find it diving to her feet, transfixing her like an anchor dropped and compelling her husband to drag a leg like a poorly trained skier to avoid a cavalcade of tumbling well-fed, poorly toned bodies.

Somehow, the Judge missed this side-chapel sketch as he slurped his salmon and moved on to finish every crust of bread while his wife elsewhere was possibly reallocating her lemonade.

His arms opened to assess the table’s remnants, unfurling a scowl. Well-seasoned or otherwise, morsels did not belong ensnared in his teeth. He grabbed a dinner fork and prosecuted them with four fine tines before handing a raft of cash to his server and softly parading to the door behind his wife.

A breeze had kicked the outdoor air cold. There was no jovial buzz, the kind spawned by the warm alcohol of summer. Off-season tips were less rich, more dear.  Maybe the hostess caught the drift. She plastered menus against her chest, clawing her shawl to her throat like a suddenly sacred scapula as though there were no etiquette for such things and certain no one would ever pay her any mind anyway.

(Also published as an op-ed in the April 29, 2017 edition of The Fresno Bee.)

John G. Taylor, a former Fresno Bee reporter and editor, is owner/operator of The JT Communications Company LLC. Write to him at jtcommunicates@comcast.net.

Mysteries surrounding 'Play Ball!'

Three hours evaporate too quickly in baseball, says me. If time inexplicably drags for you, consider mysteries of the game.

Umpire Dirt Devil: In a daily ritual, umpires or designees use mud harvested from a secret New Jersey bog to slap down the polished look of new baseballs, presumably helping pitchers’ grip. This isn’t illegal scuffing designed to baffle hitters, which pitchers and catchers execute surreptitiously. How do muddy middlemen eat up time, spritzing dozens of balls? Do they rub to the Ipod churn of Metallica (maybe Muddy Waters)? Scope out the Home Run Derby on ESPN Classic? For kicks, do they sneak in a still-polished orb to see if anyone notices?

Ground Rules or Grub Guide: What’s up with the pre-game huddle at home between umpires and managers, presumably to discuss individual ballpark oddities? What’s really discussed – stir fry and brew joints? How many times during a four-game series can you jawbone over what happens if a ball gets hung up in Wrigley Field ivy or underneath a tarp? It sure couldn’t have prepared for Yankees outfielder Dave Winfield being arrested in Toronto in 1983 when he accidentally killed a wayfaring seagull with a warmup throw.

Tarp Dancers: How often do groundskeepers practice the Tchaikovsky ballet of rolling out the tarp? Hire a Sikorsky chopper to create a headwind in preseason to prep for a summer thunderstorm?

Janitors in a Drum: The Oakland Coliseum innards stink like “Indiana Jones” catacombs. Snakes? You bet maintenance guys don’t venture far without those base-clearing clubhouse potty excavators. What ghoulish tales handymen could tell, if only the Centers for Disease Control dare ask?

Jocks-of-All-Trades: Sometimes a line drive will snap a glove’s webbing. A slide will tear a pants leg. A jock strap will go missing. A Nutshellz (aka family jewels’ shield) will crack. A collision will knock out a tooth or contact lens. Microphone batteries will fail for a slurpy-voiced anthem singer. Who are the sometimes game savers, lurking in the stadium bowels? Their packs of tricks including scissors, tongue depressors, ear irrigators, cold packs, duct tape, saline solution, location of emergency shutoff valve for sprinklers and an Uber hotline for the gold-toothed reliever whose car battery expired.

Mr. Nice Guy: What are the rules (does slipping cash help?) on who is bequeathed a foul retrieved by the ball boy?  Would love to see the liability policy preventing pitching the keepsakes to cheaper seats.

Evictor-in-Chief: A friend got mouthy with Jose Canseco back when he was half of the steroid-challenged Bash Brothers. He wanted the critic tossed. The Oakland security shirts ultimately ejected the wrong jouster. How does security decide when you’ve crossed the line? And what are their “judicial” options?

Sultan of Sales: There are other winners and losers in games. Hauling cases of soda when it’s 31 degrees at Milwaukee, when you need pliers to crack open peanuts? Selling beer in a section dominated by elementary kids? Some kind of pit boss makes assignments for what vendor hawks the top sellers and who waves cotton candy in the rain. What’s the racket?  And, painful reality, who decides the geographic borders so that I’m always outside bellowing distance of the churro dealer?

Odor Eaters: Lastly, for the hourly staff who churn volcanoes of garlic fries – What’s the trick? High pressure hoses filled with Febreze? -- so they can shed their Eureka! aroma and sleep regularly with the family.

I’ll snap out of such puzzling with opening day in April. Rebirth arrives when the first, fast, mud-speckled sphere challenges a hand-sanded, finely grained chisel of ash whipped by Buyanesque wrists soon to be tailored for All-Star sleeves.  

(Also published as an op-ed in the March 4, 2017 edition of The Fresno Bee.)

John G. Taylor, a former Fresno Bee reporter and editor, is owner/operator of The JT Communications Company LLC. Write to him at jtcommunicates@comcast.net.

Telling a doctor 'no' -- A healthy option

By John G. Taylor

No, you can’t autopsy my father. When I was 19, saying no to a physician was like cursing at a priest.

I mustered the answer because it carried certainty – funeral then burial then true mourning. Years later, I grasped deeper consequences – Dad becoming body, then cancer specimen, then data blocks and, overriding all, an autopsy delaying everyone getting on with their lives.

In medicine, saying no has muscle. Patient told there are no beds, no chances of survival and no water after midnight. Physicians told no end to paperwork (verifying, testifying, glazing over), no end to pushy hospital administration (earn your privileges) and no relief from second-guessing.

It takes courage for a patient to say “no” or “not yet” to a physician’s recommendations. It arises from conflict –  frustration, mistrust, fear.

For some, it launches dialogue –  persuade me how your therapy will benefit me now and 10 years from now. For the newly insured, it’s a blunt challenge to the white-smocked expert that he explains my care in simple doughnut-shop speak.

Why is such transliteration not built in? The jagged-glass payment system doesn’t reward education and lifestyle management.

No requires homework. The doc says you need a total knee replacement. After a lengthy wait for a second opinion, you opt for a simpler, outpatient meniscus repair. In between, you’d scoured the Web, talked to physical therapists and patients. Maybe you’ll need a new knee, but you weren’t sold now.

No – to hand reconstruction. That was a hand surgeon’s high-cost, long-recovery remedy for a recurring cyst.  You chose less radical but highly cringe-worthy draining by a primary care doc. Author-surgeon Dr. Atul Gawande said incremental care, providing a grocery store of services, never gets the credit it deserves. Skilled specialty surgeons draw research grants and myriad resources, while primary care docs are lucky to afford a nurse.

Biopsies, mammograms, colonoscopies – gray areas to patients. Physician-as-mentor won’t pillory you for wariness. There is time in a bottle – watchful waiting -- for lots of ailments and diagnostic tools. Even so, the patient should feel compelled to remind a physician about worsening aches or discolorations.

Physicians are rarely praised for their relentlessness, selflessness and frenzy. Neither are abusive physicians pursued for their self-lubricating criminalities with the zeal we accord terrorists.

Some patients need to be told no. Some milk the system to feed addictions (so much so that California enacted CURES, an electronic data base that tracks prescriptions for painkillers and other controlled substances). Some saturate emergency departments as though they were taking free carnival rides (Fresno County has taken steps to deter such “frequent fliers”). And some patients – and doctors – need to experience a hard stop when it comes to pumping kids with cough medicine and useless antibiotics for the convenience of pawning them off as healthy enough for day care.

Patients should weigh their words carefully. Unlike politics, good manners and civility count for something. A January 2016 study in Pediatrics found that nurses and doctors didn’t provide the same quality of care when they encountered rude behavior.

Navigating no is getting more complex. For one thing, the hands-on part of caregiving is diminishing. Your doctor visit doesn’t routinely include checking ears, throat and eyes unless they’re attached to your complaint.  Medical intermediaries abound – tasked with gauging your blood pressure and pulse, taking an X-ray. You’re supposed to know – instinctively? -- what not to ask them.

So, digging in your heels may get you the higher-up attention you want. Any doctor who doesn’t appreciate a patient’s commitment to his own well-being deserves a turnstile not a waiting room.

(Also published as an op-ed in the Jan. 28, 2017 edition of The Fresno Bee.)

John G. Taylor, a former Fresno Bee reporter and editor, is owner/operator of The JT Communications Company LLC. Write to him at jtcommunicates@comcast.net

Hunting for a new MD: Recurring nightmare

On a scale of dreadful things, searching for a new family physician ranks up there with hunting for a divorce attorney.  Unlike divorce, pursuit of a new doctor has become nearly an annual punishment.

What’s worse, the triggers for this torture are increasing.

• Elections: It was called the Patient Protection and Affordable Care Act when it became law in 2010. But political demonization quickly lopped off “patient protection.” It’s not hard to imagine that repealing/replacing Obamacare will hugely upset the patient-physician relationship.

• Networks: Insurers annually rejigger their accounting Rubik’s Cubes, and our favorite docs quietly disappear from “the network,” leaving us “physician du jour.” Patients lose in the caregiver numbers game. The California Health Care Foundation found 40% of California physicians provide 80% of Medi-Cal visits.

• Life cycle: Physicians die or open wineries in Paso Robles. The Physicians Foundation found that 46% of 17,000 doctors surveyed are accelerating their retirement, cutting back on patients or getting out of direct, hands-on care. For those who remain, morale is tanking.

• Bad habits: Injecting 20 million newly insured into a chaotic industry has encouraged the Dickensian viper pit behavior of the worst medical practices while leaving unmet the need to educate new patients.

Doctor shopping is the opposite of speed dating. Docs aren’t standing by the window with shades open. This is more a mandatory trial marriage or the luck of a mail-order spouse. It comes with a whole built-in family of doctor/insurer-preferred relationships – the preferred hospital, X-ray services and pharmaceuticals.

I’ve rarely seen it happen, but it would help if doctors and patients openly aligned their expectations from the start.

• Timeliness, courtesy, clarity and follow-up. Mistakes ought to be rare and acknowledged. Dishonesty and evasiveness, unacceptable.

• Bring a script or crib sheet reminding you why you’re seeking medical help. Also, bring a list of medications, surgeries. And take notes while the physician is assessing you. “Patients need to be more sophisticated and do more homework,” said Dr. Alan Kelton, a Fresno primary care physician and faculty member who specializes in internal medicine at the University of California, San Francisco Fresno medical education program.

• “There’s less touching than in the past, and fewer head-to-toe exams,” said Kelton. Patients need education on routinely self-monitoring chronic conditions such as high blood pressure and diabetes. More physicians are engaging in email follow-up with patients, although payment and liability concerns remain. A patient’s after-hours call needs a better mechanical engagement than “call 911.”

• The need and value of medical tests needs to be weighed, especially given disputes about mammograms, PSAs and others. What will insurance cover – and what may happen with the results? Still more tests, involving a specialist?

If there is truth to “patient-centered” care, then we must vaporize the dehumanizing institutional maze.

Patients are not “the 2:30 appointment.” Often under-dressed and sometimes dehydrated, they are cold-shouldered into an overly bright room encountering a man whom they see rarely and briefly but always in the most vulnerable times in their lives. The feel is like slipping into a crevasse.

Doctors are not typically coddled craftsmen who flash through patients like FBI mugshots while whining about burdensome paperwork that rewards them comparatively lavishly. In slivers of time, they must repeatedly sleuth a remedy based on what patients say, how they look and act and what new evidence can be uncovered. Success and satisfaction aren’t assured and rarely arrive in tandem.

For both parties, access remains the No. 1 issue. A backed-up waiting room may well signal a compassionate and involved physician – someone who has trouble turning away need. Physician and patient are wholly interdependent. Both need to get their acts together because every failed audition ultimately can turn tragic.

(Also published as an op-ed in the Dec. 10, 2016 edition of The Fresno Bee.)

John G. Taylor, a former Fresno Bee reporter and editor, is owner/operator of The JT Communications Company LLC. Write to him at jtcommunicates@comcast.net

Truth serum: Daily dose required

Just before bed, I reach for truth serum. It’s a gift of nothingness, no flashing images or pulsing sounds – save for a vibrating ceiling fan, an aching ankle and the outlines of a spider web at a joist.

I tune out so I can get attuned to how I responded to the day. Often, about the only control in our hands is how we react to choices, both incidental and impactful.

This daily meditation, if that’s what you call it, is not purgatory. It begins with sensory fasting. Heeding the Scriptural “still silent voice.” It’s clearing the decks, taking stock of experiences, setting the stage for the next act.

Surgical teams call a “time out” to ensure they and their tools are aligned before operating. Yes, music is frequently played during medical procedures – but it’s not competing with everyone knowing their role and clarity of purpose.

Most of us breeze past self-reckoning. As the gag line goes, we all speak at least three languages – English, sarcasm and profanity. Did we choose wisely? Do we wish we had a do-over? Do we ever question ourselves?

One pastor’s homily included this suggested daily critique: What have I done today for which God would have said, “thank you”?

Consider what we ask our children. What happened at school? How did you spend your time? What kept you busy? We attach neglect or blame to the usual response: “Nothing.”

As adults, our good-soldier answers might raise eyebrows. Especially replies like “Nothing special” and “I don’t know where the day went.”

If we invest in second guessing, we may arrive at: Where did I screw up? Why did I yell at the dog rather than pay attention? Where did I give honor when none was expected – a smile?

All experiences are not of equal value. Holding a door open only matters when your arms are crammed with groceries. Cutting someone off on a roadway matters more if you’re required to jam on your brakes – unless, at some part of the day, you own up to making that reckless turn.

Some people fear being alone with their thoughts. Some have the experience foisted upon them.

The late Fresno Bishop John Steinbock injured an eye during seminary, requiring prolonged periods of total darkness. He used the time to learn Spanish from recordings.

Retired Yankees superstar reliever Mariano Rivera has had 60,000 people hurrahing or jeering at him. He routinely tuned it out and delivered. And when a hitter won the day, he took it as a lesson learned rather than a beating absorbed. A casual mindset does not get you to that crossroads.

Focus. Fasting. Pain. Deprivation. Isolation. Attached are such names as Cesar Chavez, Mohandas Gandhi, Nelson Mandela, John McCain and Aung San Suu Kyi.

We covet busy-ness as a blessing, the heartbeat of being goal-driven. And “nothingness,” if not fertile grounds for deviltry, is allocated the disdain accorded sloth, a purposeful disabling of God-given talents.

Taken as a whole, we know the price of very many things, but not the value of nothing.

Sleep provides distillation, but is not an active recollection. Showers relax, but are more reminders of our desperate need for more out-of-the-ordinary time. Our day needs an exceptional bookmark.

So, before I surrender to night, I put aside my printed and digital stimuli. I dust off my memory and assess my soul. In my faulted scale of justice, have I left the world – my friends, the happenstance of those I’ve encountered – in a better or less kind condition than if I’d not drawn a single breath?

I’m often chagrined by my answers. Truth is a motivating mirror. But only when you pause to look.

(Also published as an op-ed in the Oct. 29, 2016 edition of The Fresno Bee.)

John G. Taylor, a former Fresno Bee reporter and editor, is owner/operator of The JT Communications Company LLC. Write to him at jtcommunicates@comcast.net

Hospital quality: Spinning the 'Wheel of Fortune"

What’s a good hospital? The one good enough in a life-or-death event – the nearest emergency department for a heart attack – may not best when you have time to plan for a heart bypass, knee replacement or hysterectomy.

Truth is, the wellspring of informed intelligence for patients on medical decision-making is murky and likely will take years to clarify.

Irrespective of the Affordable Care Act, reform was urgently needed for our episodically wonderful and nearly indecipherable health system.

But the critical conversion from volume-driven payment to pay-for-performance – quality outcomes borne of cost-effective, best practice medicine – hasn’t yet resulted in a universal, reliable value-driven scale. Sure, the jargon bandied about is sensible enough for Google News readers – centers of excellence, star ratings, the patients’ choice.

Consumers are being told what they want to hear and where they ought to seek care. But there’s no definition – among insurers, providers and regulators – on a single set of benchmarks to separate fair, good, excellent and execrable. No one has created a medical Federal Reserve Board to oversee and certify best practices and practitioners.

Yes, the Joint Commission, the premier hospital evaluating body, has certification programs. So do insurers and organizations like the National Cancer Institute. But it’s not clear if they share their criteria or evaluation methods.

Consumers are still tasked with substantial, Byzantine self-education. So, in a Yelp world, how about a star ratings system for hospitals? That major controversial step occurred last July.

The Centers for Medicare & Medicaid Services released its first star ratings for hospitals based on 64 quality measures ranging from patient satisfaction, to mortality, readmissions and safety and effectiveness of care.

Few hospitals earned five stars; some prestigious names earned one. The Central Valley had one five-star facility (Fresno Surgical Hospital) and one of the state’s and nation’s lowest (Tulare Regional Medical Center with one star). Even those who did well criticized the methodology.

Consider a few of the wild cards involved.

Take readmissions. Not every hospital operates an emergency department, and even fewer are teaching hospitals which educate future physicians.

Hospitals which have both, like Fresno’s Community Regional Medical Center, are likely to see more patients with multiple chronic illnesses that have sporadically, if ever, received medical attention. They arrive in bad shape, take longer to leave the hospital as an inpatient and are more difficult to place with follow-up continuing care. For socioeconomic reasons, their progress may be hard to track. As a result, many are readmitted within 30 days of discharge for their same problems.

The result: Such hospitals may be hit with federal financial penalties. And their star ratings suffer.

How about patient experience? One survey aspect involves querying how pain is being addressed. Pain management is a complex science that factors in a patient’s ailments, age, other medications – and whether substance abuse is an issue. Here again, safety-net hospitals get hit harder on ratings that those that don’t have emergency departments or take Medicaid patients.

“They liken or cheapen medicine to a 4-star hotel rating,” one longtime Valley physician told me.

Fact is, being held to a very public standard of accountability – however shaky it now is -- insults some, infuriates a few and encourages those who believe in a more holistic, transparent approach to well-being.

“Administrators know the lay person cannot ascertain truth concerning quality care nor can they define it,” my physician friend said.  “It is an experience!  And the image is part of the experience.”

Many folks don’t know anything about their caregivers – their training, what they do well and, more importantly, what they do rarely or poorly. Patients may not know an endoscope from an angiogram. They trust and do what they’re told.

They don’t research (asking Siri doesn’t count).

The myriad of ratings and possible excellence centers is, at best, a convoluted start for the clear, sustaining education that consumers – and caregivers – urgently need.

(Also published as an op-ed in the Sept. 24, 2016 edition of The Fresno Bee.)

Civility: What would George Carlin say?

When networks have to bleep a presidential candidate, we’ve surpassed the George Carlin benchmarks of what can’t be publicly said. That’s as opposed to what should be normal discourse and is increasingly being rendered archaic.

When I wrote a blog-- The Martial Arts of Common Courtesy -- detailing how the “please and thank you” standard of good manners has devolved into the spoken equivalent of shoulder shrugs, the Fresno Bee published it as an op-ed. And readers amplified.

“I am exasperated by people, mostly young, who say ‘no problem’ as if they were incapable of uttering ‘you're welcome.’

“I'm damn tired, too, of being told to ‘have a good one’ instead of being thanked.” – Don Slinkard

“I cracked up reading your article. My husband and I have been irritated with the ‘no problem’ response for years. So our comment back is ‘Was there going to be a problem?’ Employers should educate employees on manners.  Have a good day!” – Karen Miller

“I used to think I was perhaps the only who thought this was an issue for me.  Call me ‘old school,’ but I do believe the ‘art of civility.’  When I say ‘thank you’ to the clerk, cashier, waitress or the person who held a door for me, the response is always, ‘no problem.’  How I would love to hear a ‘you're welcome,’ once in a while.  Could this be generational? 

“Another generational phrase that has been shortened is, ‘I'm sorry.’  On campus, I constantly hear students respond, ‘sorry.’  That is just a word without identifying who is sorry!  I am teaching my grandchildren how important it is to have ownership, ‘I'm’ and for the issue, ‘I hurt your feelings; I hit you, etc.’

“As for your comments on customer service, I had an experience such as you described.  Can't a manager see there is an issue with a customer, and respond ‘I'm sorry for the misunderstanding, mix-up, etc.?’  Whatever happened to ‘customer service? ´

“Yes, all those wonderful responses I grew up with: ‘Please,’ ‘thank you,’ ‘you're welcome’ and ‘I'm sorry,’ do matter.  Perhaps with their return it might make our world kinder, gentler. -- Martha Magnia

“You are spot on: ‘No problem’ is definitely a problem. And so are some of the other absurdities that have sprung up recently, and which I staunchly condemn: ‘No problemo’ (a disgrace to Spanish and probably unique to California); ‘You guys’ (sad testimony to the lack of a second-person plural pronoun); ‘I’ve got your back’; and that terrible word ‘frigging.’

“The language is definitely under assault, and at extreme risk are the irregular preterits – to which scant attention is paid anymore. We are daily bombarded with such atrocities as “speeded, slayed, thrived, bidded, dived and pleaded” – all from sources who should know better. Where is Eric Partridge when we need him?

“Can we expect a future of, say, ‘eated, goed, flyed, thinked, sleeped’ and kindred horrors?

“Thank you for the response, Mr. Taylor. It’s a real pity that such a sorry fate has befallen so many verbs of long-standing and accepted irregularity. There is no end to which this theme could be enlarged.” -- Paul Watts

The martial arts of common courtesy

We continue to screw up two of our most powerful words: thank you.  Give a simple “thank you” to a cashier. If you get a response, it’s: “No problem … Sure ... Who’s next?”

The airing of “You’re welcome” makes you gasp. And “It’s been my pleasure” transports you to Downton Abbey.

We’re nearly as lousy with “I’m sorry.”

Apart from politics, we’ve fallen so far in the art of civility that it’s costing money and prompting action. Nearly every industry is attempting to hardwire customer service – aka, common courtesy -- into its employees.

Hospital attorneys are even coaxing some administrators and doctors into injecting “I’m sorry for our errors” into oral and written explanations to patients and their families irrespective of lawsuits that often attend medical mistakes.

Most of us are forgiving folks. Just don’t spit in our faces if you’ve accidentally jammed a door into us. “What can I do to make it right” goes a long way in affirming good will, especially if it can be made real – a complimentary meal, a write off of charges.

Doing the honorable thing has become such a surprise that I can easily recall three personal examples.

A jammed bathroom pocket door had trapped a granddaughter during a visit. She was in tears by the time we extricated her. We hired a carpenter and were satisfied with the outcome of his hours of work.  He shook his head. Don’t give me your money, he said. It doesn’t pass my muster.

Wow.

News reporters and editors often don’t see eye to eye. During my decades in the newspaper business, the office atmosphere was “condemn in public and praise in private.”

I once cautioned a Fresno Bee editor about a story I was covering on a Saturday night. Nation of Islam leader Louis Farrakhan was scheduled to speak.  He was regularly in the national spotlight, frequently criticized for anti-Semitic comments. He would talk for hours – loading his most contentious remarks in his final 90 minutes. I’d listened to numerous speeches and knew the arc of his oratory. This won’t work within regular deadlines, I said.

Deadlines are deadlines, the editor told me. We’ll publish what we can in the Sunday paper and trust that will be enough.

As usual, reality snickered at benchmarks.

Local television and radio had captured the midnight hour rhetoric, commanding the Sunday airwaves. Community leaders were outraged that their newspaper of record contained nary a word. And my byline was attached to a story that chronicled only the eloquent calm before the vitriolic storm.

The next day my editor sought me out. I blew it, he said. You were right and I should have figured something out. I’m sorry. Will you please write a follow-up story and make it right with the readers?

Wow. Never heard such self-effacing comments from an editor before or since.

Lastly, some expressions of honesty crack the mold. I was 30, living in Wisconsin when my mother died suddenly in the New York City area. During her wake, her physician – who’d taken care of me as a child back in the days when doctors made house calls – pulled me aside.

I’m shocked and sorry, he said. I should have better monitored the potassium levels for her heart. As I struggled to react, he shook his head and then my hand, and walked away. It was the last time I would ever see him.

As I near the age at which my mother died, I’m still astonished and refreshed by his “out of nowhere” candor and caring.

I’m a tad late. Thank you, doctor.

(Also published as an op-ed in the Aug. 27, 2016 edition of The Fresno Bee)

Elie Wiesel: No safety on the sidelines

Elie Wiesel lived in a world, the one here still, where gray ruled over black and white. And it was the gray that he fought relentlessly.

His spoken and written words were shorn of adjectives. Evil and good were nouns and verbs, his weapons. They needed no embellishment. He stood as exclamation point. Read “Night,” his riveting recollection of his existence in Nazi death camps. Listen to his presentations, interact with him as I did as a Fresno Bee reporter during his May 1990 visit to Fresno.

What he experienced in surviving the Holocaust suspended his belief in God and the value of memorializing his existence. Fortunately, he reawakened and never ceased shining a spotlight on the authenticity and invasiveness of evil until his death July 2 at age 87.

It is in the gray areas of our lives – the formative, the evolving, the dissolute – that good and evil forever vie. We take a turn. We shrug a shoulder. We respond to a message. A primal urge takes the lead. Instinct squares off with intellect – and the devil takes the hindmost.

The gray that leans toward evil is too easily excused by hormonal powers, bowing to rather than questioning illicit authority and the contrivance of waiting for evanescent better times to stand one’s moral ground.

The gray that bends toward good paradoxically has some of the same mettle as evil. Goodness requires the churning and fertilization that Wiesel wielded. He knew that it is in the gray that the good fight must be fought and won, and won again as though for an eternity of first times.

“We must always take sides,” he told the world in his 1986 Nobel Prize acceptance speech. “Neutrality helps the oppressor, never the victim. Silence encourages the tormentor, never the tormented. Sometimes we must interfere.”

He spoke before a crowd of 2,000 at a Fresno State lecture – “Building a Moral Society.” The world of 1990 is alien to many in the black, white and gray bubbles of today.

Iraq invaded Kuwait, setting the stage for the first US Persian Gulf War. Nelson Mandela was released from prison in South Africa. East and West Germany had reunified. The World Wide Web had been born, and the Hubble Space Telescope launched. The Exxon Valdez tainted Alaska with its oil. The Baltic states declared independence from the Soviet Union amidst the era of “perestroika” or “openness” of Mikhail Gorbachev’s rule. And tens of thousands of Soviet Jews were allowed to emigrate to Israel, while some who remained were targeted by an anti-Semitic pogrom. The Soviet Union was a year away from collapse.

Wiesel saw the contradiction between the sudden freedom of Soviet Jews and the unvarnished remaining hatred.

“Does it mean that liberty, in a paradoxical way, could bequeath hatred? If so, what is the meaning of liberty?”

He had little stomach for religious fundamentalism of any stripe. “It is dangerous because fanatics believe that they possess the holy truth, that they possess God. They keep God prisoner. And I believe it is our duty and our privilege to free God from their prison.”

He joined scores of Nobel laureates in calling for an end to the political sidestepping and affirming that a genocide had indeed occurred to millions of Armenians at the turn of the 20th Century. Referring to Serbian leader Radovan Karadzic who oversaw the slaughter of Bosnian Muslims, Wiesel said, “How can you ever adequately punish a man who is guilty of ordering the assassination of 8,000 human beings [in Srebrenica]?” Only last March was the longtime fugitive Karadzic sentenced to 40 years for the genocide that occurred in the early 1990s.

Freeing prisoners of conscience. Challenging “it’s not my fight” placidity.  Examining the word “tolerance” –  and finding in it a dangerous permissiveness, something that can be bestowed or revoked.

What would be his greatest fear on his deathbed, I asked. Society’s forgetfulness, he said. That all his efforts to bear witness had changed nothing.

That’s no less our fear now, lacking as we do the presence of this moral lightning rod.

Killing off, adding hospital beds --- Why?

Hospitals nationwide appear to be seesawing over the fate of hundreds of inpatient beds and, with them, the future of thousands of jobs, entire communities and how patients will get care. The add-them, subtract-them decision isn’t so much a show of uneasiness as it is the result of hard realities, often unique to a hospital’s geography, as well as redesign born of healthcare reform.

In California, billions are being spent on retrofitting or new construction to ensure that hospitals meet earthquake standards that take effect in 2030. The deadly 1994 Northridge quake resulted in a legislative mandate that has caused some hospitals to close, downsize or sell to others who envision something other than intensive care beds on hospitals’ pricey, seismically rocky coastal real estate.

Whether the end result will provide sufficient beds to handle California’s growth and aging Baby Boomers depends on where in the state you live. In a 2015 report, the California Health Care Foundation said the San Joaquin Valley and the Inland Empire may be hard pressed to meet demand by 2040.

Different factors play out in rural areas, especially in southern states. Changing reimbursements have inhibited the ability of smaller hospitals to weather financial challenges, to satisfy requirements for installing electronic records and to lure and retain physicians, especially specialists. Some may call them “mom and pop” hospitals, but many smaller hospitals are critical “way stations” for healthcare emergencies, tending to patients until they’re transported to higher-acuity locales.

With fewer than 100 beds – many of them unoccupied – these hospitals are closing or becoming freestanding emergency departments where state laws permit.

Sometimes a single decision can push a once-successful small hospital to the edge. That’s occurring in Coalinga, Calif., where the district hospital took a huge fiscal hit when California shifted care of nearby state inmates to distant, newly created prison hospitals.

In New York City, the problem has been a chronic oversupply of beds coupled with costly, politically charged labor agreements.  Sometimes that has meant paying sizable staff and operational costs when there were few or no patients to oversee.

Nearly 20 city hospitals have closed since 2000, and Mount Sinai Beth Israel has been facing a fiscal crisis threatening its existence. It’s opted to try something radically different. Over the next four years, it will replace its existing 856-bed hospital with a 70-bed hospital with an ED as part of a massive expansion of outpatient care services.

The scale of transformation at Mount Sinai is astounding. Some of the 4,000 unionized workers will need to be retrained or laid off.  Perhaps $700 million in hospital real estate will be sold. The institution’s goal is focused on outreach and public education, to avoid or remediate medical issues before they necessitate costly inpatient care.

The seesaw effect of the Affordable Care Act of 2010 is nowhere close to flattening. The U.S. Centers for Disease Control said the nation’s uninsured rate in 2015 fell to 9.1%, the lowest on record. It was 16% when the law was signed, 14.4% in 2013 before its major provisions kicked in, and 11.5% in 2014.

The newly insured continue to seek treatment for ailments they habitually ignored, some of which have become chronic and irreversible. Many will need highly specialized care, complex surgeries and other sustained interventions and costly hospitalizations. Hospitals in regions of historically high unemployment and shortages of medical access can expect high rates of inpatient utilization to endure for years.

The reward for doing what matters – cradle-to-grave education and prevention, and doing it very well – will be empty hospital beds. That still sounds like a “pay me later” experiment, where later means future generations while today we’re addicted to “Hot ‘n Now” results. Ultimately, for hospitals, it forms the only solid ground when choosing to add or subtract inpatient beds, or just flat out go out of business.

(Also published as an op-ed in the July 30, 2016 edition of The Fresno Bee)