10-29-11 0955 Dulles Intl Airport Gate B70. So, do I really prefer underground trains to those loveable dinosaurian mobile lounges that used to lumber out into the combat zone of the airfield itself, bravely dodging 747's and Cessna alike, and carrying a bunch of us nervous passengers, already subdued after being hydraulically lowered to bug level before being transported out to where I am now? Maybe not. The whole experience of Dulles is kind of emblematic of The Man’s foreign policy..Industrial grade concrete blocks and metal girders interspersed with seemingly random curves. Vast vertical spaces traversed by escalators. A whole airplane ('Daedalus’, the MiT human powered airplane), and of course us bugs, scurrying along in response to directives displayed by international style yellow black and white signage and voiced, if you wander off course, by chunky uniformed TSA employees. The trains that now take the place of the lounges are one step further away from a human touch. No operator in evidence and the tone of the gendered voice telling us assume battle stations make no pretense of Hal's gentle early communications. This is way beyond ‘Mind the Gap!!’ My favorite verbal was programmed into the last message warning of arrival at Gates B..'This train is now out of service'. A part of me hoped the power would be cut and our whole granfaloon would be left in the electronic twilight...halfway between heaven and hell..
But no, it all worked perfectly, with a hiss and a clunk, and the escalators escalated, the power consumption remained at...hmmm...about 10 Megawatts? Outside, DC is enjoying perhaps its first real winter tantrum...snow possible in some areas.
I stayed at the Hyatt Regency Reston for Thursday and Friday, here to meet people involved in simulations and medical practice management. Reston is a bedroom suburb (aka New City) dreamed up by a man of initials RES, whose still alive and also represented by a life size bronze statue sitting on a bench alongside is beloved Lake Anne. The rest of Reston was planned starting in 1961, and the Hyatt seems to date from then. So the elevators have a 15th floor, and my room card said 1510. I stood there pushing the button and needing to get to my room for a matter of urological urgency. Nothing happening. I got off and tried the stairs; locked at the top. Apparently, as a holdover from a now defunct ‘Regency Club’, you have to insert your card in an unmarked slot in the brass plate of the elevator to get to the 15th floor. That I found out by going back down and asking, fighting against a tide of teenagers who were talking and texting in the lobby and twittering on the carpeted stairs. . Turns out this is an annual event involving dramatic arts try outs on this particular weekend. So the 60's style dramatic lobbies and stairs were fully occupied by teens. The usual amazing mix of spindly thirteen year olds in t shirts and tennis shoes, and fully formed adults, also 13, in high fashion. Talking with them, however, is a great leveler; a 13 year old brain is a 13 year old brain. Not an un-interesting one in the bunch, however.
This was a working visit for me as well as for the teens, meeting people and things mostly. The people were of all sizes, shapes, ethnicities and mostly young. The things were of two sorts; a corporation created to offer medical practice management, based on several decades of successful practice in Maryland, and a corporation that develops simulations for training..both military and civilian.
The simulation center, in the Cointelpro building off Connecticut Ave was definitely an eye opener. I had seen earlier versions of all the components, and yet it was impressive to see them all assembled, and in a space more like a sound stage than the usual low ceilinged hospital space. I examined an avatar pregnant patient arriving in the emergency room. I used an X box to perform a virtual bronchoscopy, with coaching on how to find the important landmarks. I manipulated laparoscopic instruments to make a mess out of a gall bladder removal… the spreading red stuff in the simulation was, to me at least, alarming enough to get the adrenaline pumping as it would doing the real thing. Then there are the simulations of cardiac arrests, of massive head trauma, of operations under way when something unexpected happens...in a word, pretty much any simulation you could want. Except for group process…which I don’t expect them to have much of a problem doing.
"They still ask for pigs feet", said our young engineering graduate host. “We have lots of synthetics, and more on the way, but the older surgeons who teach suturing just say 'Give me pigs feet". And so, the simulation lab has all the electronics, and also has a freezer full of pig’s trotters and chicken breasts (to simulate abscesses).
Why simulation? Well, for me it’s an appropriate technology to help people train with less risk to humans or animals. We used to teach physiology by sacrificing dogs. We used to teach intubation by standing next to students when they attempted their first intubation. Now the dog labs are gone, and the students, by using simulators first, at least have the basic hand eye coordination running when they perform their first procedure on a human. Same for drawing blood, starting an IV, or performing a gall bladder surgery.
The weather stayed wonderful through Friday afternoon, although I saw most of it through a car window. Still, it was good to see the various iterations of Old Glory waving over the memorials to George and Thomas and Abraham. The Occupy movement in Wall Street and Frank Ogawa Plaza (aka Oscar Grant Plaza, to remember the black Oakland teen that was shot dead while restrained by police after being confronted for being black while riding rapid transit) seemed distant from the places I was visiting. As they really are, I guess.
We drove an hour down through Maryland and visited a very well designed two story health center in a rural farming and fishing community, a representative sample of what the organization I was there to meet with can do. If they can do this in Palm County Florida, it will make my job of figuring out how to teach clinical medicine without a hospital based academic staff a whole lot easier! I left in a good mood, but no time for local seafood.
And so now its winter in the East Coast, and the Occupy organizers have to rethink their campaigns, as Napoleon should have rethought his march on Moscow. The news says that Scott Olson, with a head injury as a result of police action in Oakland last two days ago, is awake after spending some time unconscious in an ICU. Hopefully, the police are rethinking their winter campaigns as well.
Aloha, Alan
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