I'm Not Sure If Life Is Really Short

Life is short, they say, and I repeat it, although I don't think I really believe it. After all, I'm 73 and still going pretty strong, retired but still doing lots of stuff, so to me “retired” means “free,” not decrepit. I don't really see the end, it's still an abstraction.

Until I look at myself in the mirror, that is, and catch a glimpse as I turn around and wonder who that guy is with a gray beard and eyes that have some crackles around them, and wonder if I will ever look like I did when I was 25, which is the way I should look, I think, but which I guess I won't.

My son Allie is 44 and is in the next room sitting with his computer on his lap doing things that I can't exactly comprehend because he is, after all, an engineer, and I'm not. He used to be 10 when I was 39 and now he's not and I'm not, but it still doesn't feel like the end. I still think I could do lots of things if I wanted to, except that my lower back hurts a lot.

When I see myself in the mirror I wonder if Allie sees that I'm getting older. I guess he does. I didn't see my father continuously as he got older because he lived in Philadelphia and I lived in Berkeley, and I resisted thinking he was getting older. I didn't quite believe it. The power of denial is strong, especially in me. He was cashing out and I still wasn't believing he was actually that old, although he was 92 and I was sure to keep getting back to Philadelphia very often at the end, every other weekend the last two months, because then I believed the end was coming, although it took the actual end and my crying convulsively to really believe it was the end. It still didn't seem as though life was short, it's just that it ended. I still wish I could show him our Hawaii house, and Lola, and now little Tete Shenkin, wistfully.

I wonder what Allie thinks. We talked briefly yesterday here on vacation and I mentioned that I figured I had 10 years, anyway, although you never know. He's got a new baby, his first, he got his PhD last year, so he still feels like he's beginning. It must be hard to think that his dad, who he remembers so well, but not the time we played together in our first apartment in Stockholm and he climbed onto the desk with a smile, and not the time we sped away in my little $2,800 Alph Romeo to the YMCA in New Haven to swim – no seat belts then, that his dad is getting pretty much older and even wonders when he will cash in his chips. He probably doesn't think too much about it. He lives in Oxford now, we are in Berkeley, and even though we are psychically close, we don't see each other that much, and he has a career and I have enough money that he will inherit that he is not at all dependent on me now, so he probably doesn't think about it at all. He's done a lot so life probably doesn't seem so short to him now. Maybe it will as Tete, his daughter, grows up. That's probably what makes you think it's short, because kids grow fast, faster than we decline.

Actually, life doesn't seem that short. Just shorter than we would like, as long as we're healthy. If you fill it up with things, and make sure you don't wish for more than you can reasonably do. I guess.

Budd Shenkin

Two Patients

So, on Tuesday I had a busy day. Two cases – that is, two people, two patients – stand out.

Patient #1 was a prepubescent boy who complained about an instance of burning when he urinated. A urinalysis was normal, and my exam was normal – uncircumcised male (we wouldn't have such a complaint with a circumcised male, by the way) with partially adherent foreskin to the glans penis, which is not a problem. I could have said “it's nothing” and let him and his father go with reassurance and telling him to drink more water, but I thought I would take a minute and take advantage of the situation.

So I told him that I was glad that he had said something about the burning, because many kids are too shy about talking about their penis, and it's good that he spoke up. Then I said, “You know, you haven't started puberty yet, but you will pretty soon, and you'll notice first that you testicles (your balls) will start to get bigger, and your scrotum (the sack) will stop being so smooth and will develop ridges, which we call rugated.”

He was looking down at his shoes, occasionally glancing up at me.

“And get hair,” he said softly.

“Right,” I said. “And then your penis will get bigger.”

His eyes opened wide, then he looked down again.

“We've all been, through it,” I said. I nodded over to his father. “He's been through it, and I've been through it. It happens to all of us.”

“And not only that, you'll start thinking about girls differently, probably. And sometimes your penis will get hard, even when you don't want it to.”

With this he put his face in both hands and bent over as I talked, completely embarrassed, but I kept talking.

“It might get hard at embarrassing times, and you'll turn away so no one will see, if you can. Once, when I was in high school, one kid was in the Senior Play, and he had to come on the stage in tights. So he came on, and he had to stay there, and his penis got hard, and everyone in the whole audience could see. We were real quiet, except for one of my friends, who said 'Look at Roger!!'”

Laughter, all three of us in the exam room. Commiserating.

“So, these things happen. It's good for you to talk to your Dad about whatever you want to, about your penis. I'm glad you said something to him today about how you felt the burning. It's important to talk and not feel embarrassed.”

“Actually,” he said, “I told my Mom.”

“Well,” I said, “that's good, too.”

I figured I had done some good; I hoped so. I was back in the office I share with Mary, our office manager, and she came back and said, “That patient you just saw? His father just asked if they could come back and see you regularly.”

Mary is so proud of me. I like that. Of course, with my schedule, one half-day a week, it'll be hard for them to see me, but I think I did them some good. Hopefully. Nice family. Nice kid.

Then later in the day I saw a 15 year old boy who used to be with Kaiser and now came in for his first physical with our office, this patient also with his father. Again, I was able to take some time and the later patients understood when I was a little late with them. With these patients I know I can't check everything, especially the first time, so I try to zero in on what's meaningful to them and what I maybe can help a little. I want them to leave the office somehow better off, in some way. Getting to a significant issue is helped by having them fill out questionnaires, but truthfully, I've been doing this a long time, and it's that experience that really helps find the soft spot. So with this patient just going into his junior year of high school, I soon discovered that it was school performance that was the problem. He had a sensitive and nice father with him who suggested that he excuse himself while I talked to the boy, which is what I normally do anyway, but it's nice when the parent suggests it, which they do with some frequency, it turns out.

It's kind of complicated with this kid. He's obviously a smart kid, just from talking to him, or smart enough, anyway. He's tall if not heavy, and he plays cornerback for his team, but he's not a macho kid. I asked him what his GPA was last semester, and surprisingly to me, it was below 2. How it got there I'm not sure, but it used to be higher. No drugs, no alcohol, no big problems I could find. In fact, it turns out he loves history, of all things. But he says, basically, he thinks there's no future in history. I think that's because we all hear about needing math and science and engineering, but this kid loves history. He also likes science, and as luck would have it, I'm a history and science guy, too. So I was able to connect with him on that, strongly, and tell him that he was lucky to have such a great focus, and that history is the mother of all study, in my book. Don't think it's useless! It will lead somewhere good. He even told me with pride of things he knew in class that no one else knew. How, I wondered, is this kid not doing well?

Turns out that he lives one week with his father and one week with his mother. It's not so great to go between two houses. I almost told him that that was what I made my first two kids do, but resisted this time, for the sake of time. Both parents try to help him, but his mother is angry with him a lot – I didn't have time to figure this out, but lots of times parents get very afraid for their kids when they aren't doing well, and they get angry at them as a result, fearing for their failure in life. Didn't have time to go into that; I had patients waiting.

He said that what he needs is someone just to set him on task, to say, basically, OK, time to study now, and then leave him alone. I also asked about help at school, and he said his counselor is good, but it seemed that she couldn't help him with his problem. His problem seemed to be, and he was amazingly self-analytical about this, that when he gets stymied about something, he just stops and gives up, and he should persist. He started out well in the year but got behind and couldn't catch up. I thought that I wished he could get some tutoring about this, but I doubt that his family had the resources.

We talked about college and the need to get ahead. He hoped that his football would get him in somewhere, and somehow he had heard from a coach that football was the important thing, and that when he gets to college the studies will be helped by the coach, or something like that. Sounded bad to me and I tried to set him straight.

I kind of got caught here. What more could I do? I probably should have urged him to come back, and talk more with his father about this issue. Maybe I should call him back, or talk to his father and see how he's doing and what more I could do in directing them for help. I did give him a talk about studying being a marathon, and you just have to keeping training yourself and go farther each time. But I don't think that's enough help to give him. I'll need to do more.

Is this medicine? Well, it's his most important problem. At the end he said his father wanted to talk more about nutrition because he doesn't eat red meat or fish, but he does eat chicken, so I told him that's fine and make sure he gets fruits and vegetables. So I did some minor medicine. But I can't help thinking that I should be doing more with him, at least get him and his parents talking more about it. I think I'll try giving them a call next week. I keep thinking that someone else would have done it better.

Now, one small reflection for a recurrent concern of this blog. Look at what I did with these two patients. How could one ever detect the quality of these visits? Quality assessment is an area of immense concern in medicine, and the scientific approach they have taken is to survey what questions have been asked, what shots have been given, what fields have been “covered.” That's fine as far as it goes, shots are important, talking about nutrition is important, talking about sex and drugs is important, God knows; it should all be done. But if you think about these two visits, doesn't the quality of the care rest with making real, personal, concerned contact with the patient, finding out what the issues are, and seeing what can be done to help? It's just so personal.

The problem with assessing quality of care as we are now doing it is that, if you were going to assess these visits for quality, the most important things I did would be entirely overlooked. Moreover, if they were to assess my quality continually, they would be giving me all kinds of incentives not to take the visits in the directions I did, but in the first case just to say “you don't have an infection, drink more water,” and in the second case, to give detailed instructions about nutrition and to refer the patient for counseling at school for school failure, and onto the next patient.

On our fabled American Academy of Pediatrics Section on Administration and Practice Management (SOAPM) listserve, we call that LUC – the Law of Unintended Consequences. The problem with quality assessment is just that – you think you are doing good by measuring the hell out of things, but in fact, LUC takes over, and you take the humanity out of what needs to be a humanitarian science.

I think I'll call that kid and his father next week, see what I can do. I hope they don't have a high deductible health plan, which would make any further visits unaffordable for them. Maybe they have Medicaid....

Budd Shenkin

Kind of a haiku

We live in memory,

And after a while

Not even that.

Budd Shenkin

Miracle at Camp David

Synchronicity!

In today's NYT, Nick Kristof praises Jimmy Carter.
http://www.nytimes.com/2015/07/09/opinion/nicholas-kristof-jimmy-carter-his-legacy-and-a-rabbit.html?action=click&pgtype=Homepage&module=opinion-c-col-right-region&region=opinion-c-col-right-region&WT.nav=opinion-c-col-right-region&_r=0

Just yesterday I wrote up a potential post on Seven Days in September by Lawrence Wright, an account of the Camp David accords brokered by Carter between Anwar Sadat and Menachim Begin: 

http://www.amazon.com/s/ref=nb_sb_ss_c_0_12?url=search-alias%3Dstripbooks&field-keywords=wright+thirteen+days+in+september&sprefix=wright+thirt%2Caps%2C284.

This book is the 11th of the 12 great books I got for my best Christmas haul ever, every one carefully chosen by my family who obviously know my tastes, all thoughtful, every single one.  I lived through the 1978 Camp David peace conference, but it has faded into memory, and I sure didn't know the details. Jimmy Carter is much maligned, as Kristof says, and the Norwegian Nobel Peace Prize committee gets away with … well, probably incompetence. As the Swedes would say, what do you expect of the Norwegians? They gave the prize to Obama on the come, didn't they? Giving it to Sadat and Begin? Well, in Jimmy Carter's words, Sadat deserved it.

It is a riveting read.  It is the best thing Carter did.  It gives a vivid picture of the best of them, Sadat, who caused Kissinger to say, “Great men are so rare that they take some getting used to,” (this referred to Sadat's kicking out the Russians without checking with anyone first and not asking for anything from the US in return – brilliant move that Kissinger said even he didn't understand at first).  Menachem Begin was first, last, and always a destructive pain in the ass with no sense of honor in carrying out agreed-to obligations, which to this day condemn Israel to lack of closure and lack of peace. And then Sadat and Begin got the prize, and Carter finally got it for his post-presidential work and the Norwegians admitted they had made a mistake.

Talk about taking gambles. It seems Sadat understood his gambles and just accepted them; he had taken them all his life. I hadn't known that his father was black, probably a Nubian I figure. Talk about working your way up. I knew that the Irgun was a terrorist organization, but I didn't know how racist Begin was – as long as it wasn't Jews getting killed, he didn't care. I'm not sure how much of a gamble Carter knew Camp David was – he thought that the rationale path was clear, that getting Sadat and Begin together and having them make nice at Camp David would take three days, and that his role would just be to get them together.  He was an engineer, after all, and feelings and irrationality didn't calculate easily.  That's actually what made him a poor President, not just his taking charge of the White House tennis schedule.

But then you just have to hand it to him. When he realized that he, Carter, would have to come up with the proposals, and he would have to whittle down the obstacles one by one, by God, he did it and he didn't stop. He forged a true friendship with Sadat, and Sadat said, I'll sign what Carter puts in front of me without reading it. Sadat drove his staff crazy with stuff like that; he was brilliant and trusted his ability to maneuver in the future. Everything didn't have to be all worked out. When on day 11 or 12 Sadat had packed his bags to leave without an agreement, Carter confronted him and said not to leave without peace, and not to leave their friendship in tatters. That's what Sadat listened to at the end.

Begin drove his own staff crazy, too, because he didn't really want peace, what he wanted was land and he didn't want to have to trust anyone else, and he didn't want to give anything up. While Sadat was the ultimate intuitive, Begin was the ultimate in sensation-based and detail-oriented. The Israeli staff had the opposite task with Begin of what the Egyptian staff had with Sadat – they had to push him to reasonable positions and trust, the latter of which never really came. Begin prevaricated and never sent the letter that he promised he would about settlements, which was a subsidiary part of the agreement, and this is the basis of Israel's continued expansion and the increasing isolation of Israel from the Western world. The current Israeli government stems from him, it seems. I just read yesterday that the government has blocked a move to make conversions to Judaism easier. God forbid they should be inclusive. It's really racism, I think.

So, as followers of the three great monotheistic religions met at Camp David, and we think of the Charleston Massacre, I can't help but think about these religion's world views. Begin seems to have cleaved to the Book of Joshua, where God grants the land of Canaan to the Israelites, and tells them to wipe out all the tribes who live there, which they do. That sounds like the Islamic State as well – wipe them out! Carter's religion is more like the the Charleston Mother Emanuel church surviving families, those remarkable people. Sadat's religion was not central to his life, it seems, but given a choice, he would choose peace and reason. You can slice viewpoints many ways, but this might be as good as any. Probably three thousand years ago “wipe them out” was a viable strategy, but I don't think it works any more, maybe, hopefully, in major parts of the world, hopefully.

So the Norwegians give the prize to Sadat and Begin and they omit the peacemaker, who risked his presidency on this effort. Sadat gets assassinated by a true believer Islamist, Carter goes down in ignominy, and Begin, the wipe-them-out man? He is reincarnated in the present Israeli government. I can see the gods fighting – the Greek gods fighting and contending with their surrogate humans as pawns seem to capture what's going on better than monotheism, to me. Don't you think?

Budd Shenkin

WSJ oped on HDHPs - Ideology Rules

Department of more than you ever wanted to hear.

High Deductible Health Plans, HDHPs, is an issue that won't go away anytime soon. It became my baby when I was assigned to write the policy paper for the American Academy of Pediatrics and did a pretty comprehensive job on it. Published last May, the result is here: http://pediatrics.aappublications.org/content/133/5/e1461.full.pdf+html.

The pro-HDHP argument is often supported by Right wing ideologues on the oped pages of Wall Street Journal. Now, I myself am pro-market when there can be a market. Markets are easier and better than regulation when they operate correctly. That's why a carbon tax is a good idea, to let the market figure out the best way to minimize carbon in the atmosphere, or failing that, a cap and trade system. Markets rule, when possible.

The problem with ideologues is that their ideologies are the proverbial hammer that finds every target to be a nail. Ideology trumps facts for the ideologue. So last week we read on the WSJ oped page that Obamacare had inadvertently produced a pro-market force called HDHPs. Of course, it wasn't really inadvertent – it was part of the regrettable but perhaps necessary strategy of continuing the trend that existed. Oh, let the magic of markets work, the authors said! Find ways to make prices more transparent!

Here's the link: http://www.wsj.com/articles/SB11486026120286184909004581077971604057968

My cogent response is this, sent to the WSJ as an (unpublished) letter to the editor:

Competition in a marketplace is a wonderful thing when it is possible. HDHPs, however, act at precisely the wrong place in the system, with precisely the wrong population, and demand more medical savvy from patients than is reasonable.

Deductibles impact the first dollars spent for care, but the bulk of health care dollars are spent by the 10-20% of patients who are sickest, who blow by the deductibles early on. Likewise, the highest costs and prices exist in hospitals and specialty procedures – little of which is affected by deductibles. Deductibles have most impact on primary care, which has the lowest prices in the medical arena, and which is generally not over-utilized. Deductibles have the biggest impact in the working population, those just making it, those to whom we should be giving the most support, while poorer Medicaid patients get care for free, and well off patients can often well afford the deductibles and thus are much less deterred. Studies show that many patients of modest means forego important care just when it is needed most.

Markets require consumer knowledge of the value of care and the price of care. Yet because most people are not medical professionals themselves, they find it impossible to make wise choices, a phenomenon that we in practice see every day. In addition, not even clinicians can easily discover prices. HDHPs cannot create a market where a market cannot easily exist.

HDHPs and a market mechanism could possibly work at the higher levels of care, where the real money is. Primary care practitioners could choose well for their patients if they were paid to do so and prices were readily available. Hospitals could compete if they were not merging instead, and thus protecting their prices. Alas, political power lies with those whom HDHPs don't affect, the big money regions of healthcare, but it is the politically weakest actors, primary care practitioners and patients of modest means, who are subjected to these insidious plans.

My pediatric colleague Mark Simonian of Fresno replied:

“There were more issues than high deductibles and Health Saving’s Plan discussed by the authors like finding mechanisms to make the cost of care more available and comparable.”

So here is how I answered Mark:

Price transparency is a good idea.  We should have more of it.  I wish we had had it available a few years ago before our local hospital charged us $12,000 for an abdominal MRI.

But with HDHPs, the only services that will be affected will be the lower cost ones, and by assigning patients be the ones to explore the field for bargains, some will but many won't, it will be very hard for them to do it knowledgeably, and it is really putting the harness on the wrong horse.  The primary care physician should be the one best placed to make decisions for the patient, since we know more and can do so more easily.  But if we are to do this work of helping the patient to choose wisely, as we should, we need to be paid for it.  Rushing along every 15 minutes and doing the EMR charting, etc. --- if you are going to do some shopping, then you need to be paid for it somehow.  And let's remember, the point of HDHPs is to get the primary physician less used by patients, not more used, thereby undercutting the whole concept of a PCMH.

Price transparency and good competition by hospitals would be great.  Except, they increasingly own each other, and make their bills so incomprehensible that transparency means virtually nothing.  Also, our local children's hospitals are usually the best place for us to send our patients, and they are natural monopolies, so competition won't work with them, and so price transparency won't help all that much.  Hoping for a market here is the triumph of ideology over reality.  Ain't no market, ain't gonna be no market.

Some say that HDHPs ask patients to do what the profession and the industry has been unable to do itself, which is to make utilization and prices reasonable.  Good luck with that.

At least, that's my opinion, unhedged.  In fact, pissed at these ideologues who further their own careers by spewing this drivel, aided and abetted by those who profit by the status quo, and those who just don't care about others as long as they get theirs.

So, the beat goes on. Who knows when it will end? But I am actually optimistic that sooner rather than later, the HDHP policies will be amended, more visits allowed without the deductibles, and even, eventually, competition applied to higher priced items. The key word being, alas, “eventually.”

Reader, I know I am pounding this nail so hard and so repeatedly that it is boring, boring. I promise to let up on it and review more books instead.

Budd Shenkin

The Brothers Wright

Tried and true authors are treasures. Always have been. The Hardy Boys never disappointed! Even though Franklin W. Dixon was a myth. No need for character growth or change! Always 16 and 18, always Frank steady and Joe excitable and more prone to mistakes, the same girl friends who never got pregnant. That would certainly have been something. The books were formulaic, so why not in chapter 8 Carrie generally says, “Frank, I hate to tell you this, but I'm late on my period again.”

“Jesus, Callie, again? What is it with you?”

“With me? Frank, you were the one who said you'd pull out.”

“I thought I did.”

“Well, you didn't, not in time.”

And then they go to old Doc McCubbins on the other side of the lake for another fix, but on the way, as Frank is driving his detective father Fenton Hardy's car he notices an old Dodge that seems strangely like the one the old lady described as driving away from the crime scene....

“Carrie, that abortion's going to have to wait! Hold on, here we go after the culprit!”

“Oh, Frank, be careful! This time, anyway.”

Well, this isn't much of an introduction for the latest David McCullough book, The Wright Brothers, although it isn't that far off, either, even though the Hardy Boys just came to me as I thought, I need an introduction to this short essay, and there they were, although I also toyed with Cat in the Hat and Dr. Suess, and now I'm thinking of Christopher Robin. There's a difference between a formula and consistent voice. McCullough, along with Suess and A. A. Milne, has a consistent voice, not a formula. I like his reliability; I always know I'm going to like the book, and it's always worth reading.

I really had known very little about the Wright brothers. I kind of thought of them like the Smith Brothers on the front of cough drop packages. But it turns out they didn't have beards. Wilbur was clean shaven and Orville, three years younger, sported a mustache. And it turns out there was a third Wright who didn't help with the project directly, but who was a wonderful support and the third member of a family triumvirate (bad word to use, since vir means man, but there it is), their extroverted and to me wonderful little sister Katherine, three years younger than Orville, the only college graduate – Oberlin – and so much an emotional center. When they had solved the puzzle of flying and went to Europe and Washington and New York to show what they could do, she went along, too. And when Orville hurt himself badly in an accident at Fort Myer in Washington – I used to go to the PX there when I was in the US Public Health Service – she immediately went there and nursed him constantly in the hospital, then took him back to Dayton where he got better, especially since he was home. That's the way it was then, medicine wasn't much. As a matter of fact, later on, Wilbur died from typhoid fever and Katharine died of pneumonia, neither of which is fatal now. That was then, when man had just learned to fly but couldn't yet cure.

It's a great story and McCullough is just as he always is, clear, insightful, succinct, intelligent, subtle, yet not hesitant in bringing the message home. Memorable, always memorable; you never have to think, now, what was that about? And here's the thing – they could have been the Hardy Boys! My unconscious strikes again. They have such upright characters! Not stuffy, but so, so steady, so much informed by their religious father who was a bishop of his church. They had two older brothers who had gotten married and moved away, and their mother died in 1889 (f tuberculosis, now curable, of course) before they had gotten started on their aeroplane project. So the three younger children were a troika – can't get away from them foreign words – with their father coming and going on his church missions, all living in the same house, 7 Hawthorn Street in Dayton. Although now perhaps best known as the home of the Dayton Flyers (in my density I didn't realize where the name came from until now), then it was an up and coming town with their pride and joy, before the brothers Wright, being National Cash Register. The high school they built, Steele High, looked like an elaborate college building with spires, such were their aspirations. I don't get the sense of any Babbitry. Dayton was an up and coming city in an up and coming country in an up and coming time, when growth was constant and insistent but, as Thomas Piketty reminds us, incomes and wealth were distributed very unequally.

To them, however, wealth didn't matter; to get rich was not their inspiration. When they had succeeded and came to mix with the rich and the famous, it didn't intimidate them at all, and as a matter of fact, they got on rather well with the European aristocracy. Being self-confident and having a secure feeling of self-worth led them not to change a thing about who they were or how they acted and where they ended up eventually, which was right back in Dayton, which was good enough for them. What they wanted was to solve the problem of human flight.

I read in Walter Isaacson's Einstein biography that what stayed with Einstein was a childhood book about riding on a light wave – what would that be like, the childhood book asked and Einstein wondered? Not so many years later, the theory of relativity gave an answer. What stayed with the Wrights was a French childhood toy their father brought them, a little toy helicopter that actually flew. When I read that, I thought, My God, I had no idea there had been such a toy before actual manned flight! Yes, what they did is still totally amazing, for sure, but then again, there was this toy that flew. How encouraging did that have to be? I mean, you had to know that flying was possible, somehow, it was just a question of figuring it out, hard as it may have been.

And it was very hard; it took genius. You would think that one of the things that was hard about it would be raising the money for it. But in those days, if you were the Wrights, you just did it without much money. They put in tremendous amounts of time, and had some help from Charlie Taylor, a mechanic they recruited to work with their bicycles and then with the flyers, and others who rallied to the idea. But for materials, McCullough estimates that they spent maybe $1,000 until they flew, including train fare from Dayton to Kitty Hawk and back several times. It didn't cost much to live if you built you own sheds and camps and you didn't eat anything expensive, or maybe much at all. They were all very thin. When they finally took passengers with them flying, it was chancy with one of them because he was very heavy, weighing … 175 pounds. Nowadays, I guess we're pretty fat, most of us.

So, to get back to the beginning, Wilbur and Orville and little sister Katharine and their father all lived in the same house, and apparently none of them had girlfriends or boyfriends. McCullough doesn't comment on this. But you have to think about it, don't you? I mean, it's good to be a close family … but then, actually, as you read the story, they wouldn't have been able to do what they did if they had others in the picture. McCullough even says that they saw the jobs the two older brothers, Reuchlin and Lorin, needed to get to support their families and how they struggled, and Wilbur and Orville just seemed to think it wasn't worth it. So what were their alternatives, then, since they were solid, Midwestern, god fearing folk? I imagine their hard work – many comment that “they were the workingest boys I ever saw” – and furtive masturbation were the only answers. Sublimation works. I wonder what they did when they didn't have their own rooms, and lived in the tents at Kitty Hawk? Franklin W. Dixon doesn't tell us about that with Frank and Joe, either. I didn't wonder about that when I read the Hardy Boys, but now I do wonder about Wilbur and Orville, and I guess about Katharine, too. Years later, after Wilbur died at 47 of typhoid fever, at 55 Katharine announced she was getting married and Orville was primevally angry and didn't speak to her again until she was on her death bed. What was going on? But it's not a speculative book, and not a psychological exploratory book, so who knows. Maybe he had been deserted by Wilbur when he died, and now he was being deserted by the other troika member – but truthfully, I have to think it was more than that. It was more than Orville just “having one of his spells,” as they put it, when Orville got morose. Something was going on.

Anyway, it's clear that Wilbur was a genius of the first order. He could do everything, and I guess Orville wasn't far behind. They figured out the physics of it by watching birds and reading theory, and they could just make anything; they made their own tools when they needed to. Then they worked and they worked and they thought and they worked and they got it done. And then, just as when Roger Bannister broke the dam with the four minute mile, everyone and his brother in France started flying. Most of it was probably that they saw how it was done, and they copied more or less. The Wrights themselves trained three in France to fly. But some of it had also to be that they saw that it could be done, so they became bolder and more optimistic. It's amazing how our brains work. I think the four minute mile was more psychological, but flying had some of it, too.

There was something about Wilbur Wright that led people to know he was the real item just by talking to him. He knew what he was talking about, he had figured it out, and even when it wasn't quite done, people knew that he was the Real McCoy. He was the one.

I hadn't known that. I hadn't known anything like that at all. I just thought he was one of those guys with beards who sold cough drops. Silly me.

Budd Shenkin