Autumn War is so named because it takes place in the… um… well, summer, actually. Hey, it’s the SCA, we’re lucky it isn’t in the spring.
First off, the downsides: it was a frustrating drive both ways – in fact a google-predicted ~2.5 hour drive was almost exactly 4 hours each way. A four hour drive is not inherently bad for me, but an expected 2.5 hour drive (OK, I expected 3 hours) that becomes a 4 hour drive is highly annoying. Oh well. Also while helping setup for bardic the second night a spark from the fire burned a hole in my best shirt – fixable, but why did it have to be my best shirt?
Upsides, however, were more numerous, so let’s talk about them.
First off, Methelstede performed two showings of Arlecchino’s Surprise (in which Arlecchino has exactly one line and never appears on stage). In the second showing I provided the sound and visual effects for Ugolino (sp?) from offstage. We also did one showing of Arlecchino and the Cup of Love (the same show we did at June Faire) with me again being Lelio. I think the cast is a little burned out right now and we have no solid plans for future showings, though the general feeling seemed to be that we’d like to do a play again in the not-too-distant future. It is possibly worth noting that both the plays are written by a SCAdian using the characters and style of a set of plays from late-period Italy. The best short description I can come up with is that these plays were a proto-sitcom; the characters remain the same (and never change from episode to episode regardless of what happens) but the situations are different, and there are running gags despite the lack of any continuity of plot (so while Fiorenetta and Capitano are married in Surprise they are not married and never have been in Cup of Love). This presumably made things easier for both the audience, the writers, and the cast, as everyone would know, for example, that Pantalone was an old miser as soon as his name was mentioned.
Second, I created fire. Sure, using modern tools I do that all the time. At Autumn War, however, I created fire using nothing but a piece of flint, a steel striker, a few pieces of charred cloth, and some unraveled rope. This was a common way to start a fire in period (the bow method taught to boy scouts is more primitive and time consuming, and things like pre-made matches or flintlock strikers were too expensive for routine use where they existed at all). You can probably find a video online somewhere, but let me tell you it is harder than it looks. Getting sparks from striking steel on flint is easy. Making charred cloth is easy (though it is also easy to do it wrong). Finding a bird’s nest or a bit of old rope and making the nest is easy. Getting the spark from the steel to catch on the cloth and then blowing at just the right increasing level of force to ignite the nest is VERY HARD. The teacher demonstrated and had a solid flame well under a minute after he started striking (setup took a little longer). None of the three of us in the class came anywhere close to that. We did all manage flame in the end, but my flint had been chipped almost to the point of uselessness. At a guess I spent the better part of ten minutes not counting breaks and went through 20 or so pieces of charred cloth (maybe more). I will stick to modern firestarting methods wherever possible.
Third, I marshaled for some very fun rapier war scenarios. The first had a ‘ship’ (an oval slightly pointed on one end) laid out on the ground. On it were some red pieces of cloth representing fire. Yes, fire. See, these other guys came along and attacked the represented ship but forgot the key sequence of pillage THEN burn. Still, even smoky loot is loot, so they boarded anyway. Meanwhile one of the best fighters in the group was picked to act as The Kraken. The Kraken fought with case (a rapier in each hand), and would go around, tap someone near the edge of the ship, and require them to step off and fight him. If they won they got to go back to the burning ship (yay!). If they lost… well, they were eaten. Stepping on the fire was also counted as a kill. The second scenario was “The Water of Life” – a free-for-all where everyone gets a paper cup with water in it (any amount of water you want). Every time you are killed you must show one of the marshals that you still have enough water to cover the bottom of the cup and you get to go back in – an unlimited number of resurrections as long as you have water. Naturally this leads to people aiming for the cups. This is quite amusing for all involved, and leads to a large number of jokes.
The weather was much better than anticipated over the weekend thanks to a heavy overcast Saturday and Sunday (Friday it was well over 90 and sunny, but I didn’t arrive until Friday evening). Only a few scattered drops of rain fell, and the night time temperatures were some of the warmest I’ve ever seen (it generally gets very cold in a tent at night around here). Methelstede camped with Key Point, who also had Black Company camping with them, and Key Pointe provided breakfast and dinner for a reasonable fee (good food too – omelets to order, duck soup, deep-fried bacon, pasta with ham and cheese…). The inevitable bardic circles suffered a little from the camp setup and the fact that we performed the plays in the evenings just beforehand but they were still fun (“Not the knight with the shiniest armor in all the land, the finest horse in all the world, who has defeated the seven greatest nights in the seven tourneys in the seven kingdoms and slain the dragon!” “Yes I am the knight with the shiniest armor in all the land, the finest horse…”).
Overall it was a good event, but I’m quite glad there isn’t one this weekend!
Friday, August 24, 2012
Wednesday, August 8, 2012
From the Recruiting Station: WA Ren Faire
Saturday I went to the local Ren Faire.
My perspective on Ren Faires has changed since I became a belly dancer and as I become more experienced in the SCA. I watched a trio of dancers (along with some other people from the troop who showed up) and found myself critiquing them for things like touching the ‘live’ edge of the dance sword, etc. I also considered their garb from a much more experienced eye – down to figuring out how they’d made their tops.
There were some entertaining acts (including a ‘Robin Hood’ show that used children recruited from the audience as actors/props), but most importantly I was recruited into a company of pike with sleeves of shot. It was admittedly a very short tour of duty, of course.
The demo group had a little over a dozen people including a sergeant, an ensign, two arquebusiers, and eight pike(wo)men. I include the feminine form because I think almost half of them were. They had some extra pikes (both adult and children’s sizes) which they loaned out, forming two ranks of novices behind the two ranks of veterans. They then taught us how to hold our pikes, march with our pikes, how to form a pike square (with only sixteen pikemen a very SMALL square), and the different angles to use for fighting infantry and cavalry. Finally they actually had us wheel about the center of the square (which is a LOT harder than it sounds for any formation, much less one holding ten foot pikes), and posed us to fight while the arquebusiers fired a volley (yeah, there were only two of them – they fired at the same time so it was a volley). As my SCA persona is an officer in a company of pike it was a doubly enjoyable experience. I’m seriously considering seeking them out for further persona development.
FYI, “sleeves of shot” is the period term for a company of infantry that had men with firearms, normally arquebuses, since very early on the gunmen were kept to the edges of the formation so as not to disturb the order of pikes. This was because the pikes were considered the real power of the formation. It was not until the end of the SCA period that the pike square was replaced by the more flexible rotating line formations that allowed the arquebus to become the dominant weapon.
My perspective on Ren Faires has changed since I became a belly dancer and as I become more experienced in the SCA. I watched a trio of dancers (along with some other people from the troop who showed up) and found myself critiquing them for things like touching the ‘live’ edge of the dance sword, etc. I also considered their garb from a much more experienced eye – down to figuring out how they’d made their tops.
There were some entertaining acts (including a ‘Robin Hood’ show that used children recruited from the audience as actors/props), but most importantly I was recruited into a company of pike with sleeves of shot. It was admittedly a very short tour of duty, of course.
The demo group had a little over a dozen people including a sergeant, an ensign, two arquebusiers, and eight pike(wo)men. I include the feminine form because I think almost half of them were. They had some extra pikes (both adult and children’s sizes) which they loaned out, forming two ranks of novices behind the two ranks of veterans. They then taught us how to hold our pikes, march with our pikes, how to form a pike square (with only sixteen pikemen a very SMALL square), and the different angles to use for fighting infantry and cavalry. Finally they actually had us wheel about the center of the square (which is a LOT harder than it sounds for any formation, much less one holding ten foot pikes), and posed us to fight while the arquebusiers fired a volley (yeah, there were only two of them – they fired at the same time so it was a volley). As my SCA persona is an officer in a company of pike it was a doubly enjoyable experience. I’m seriously considering seeking them out for further persona development.
FYI, “sleeves of shot” is the period term for a company of infantry that had men with firearms, normally arquebuses, since very early on the gunmen were kept to the edges of the formation so as not to disturb the order of pikes. This was because the pikes were considered the real power of the formation. It was not until the end of the SCA period that the pike square was replaced by the more flexible rotating line formations that allowed the arquebus to become the dominant weapon.
Saturday, August 4, 2012
Triage
In the world we live in there are usually two answers to any question: the simple one, and the real one.
Politicians only seem to have time for the simple one.
Partially, that is because the modern media has trained them to talk to the public in sound bites. So any concept too difficult to fit into a sound bite, such as the real answers to most questions that the government should be addressing, doesn’t get talked about. Now, if you’re a politician and mostly concerned with getting re-elected, why spend time on something you’re not going to talk to the public about?
So the simple answers tend to be the only ones that get into legislation.
“But Federal laws are enormous! Thousands of pages! Surely they can’t be simple?”
Wrong. The basic concept that the law is based on is often quite simple.
The basic concept of Obamacare, for example, is that everyone should have healthcare. Simple concept. Easy to say, easy to defend on an emotional level.
Problem is, not one bit of that enormous bill with its simple concept answered the question of ‘how do we make healthcare better?’
To see why, let’s talk about triage.
If you provide a paramedic (or a doctor, but let’s talk about paramedics since I am one) with one patient, they treat that patient. Healthcare or no healthcare, we treat that patient. We do our best to collect their healthcare information so they can be billed later (because that’s where we get the money that allows us to treat the next patient), but bottom line is whatever healthcare they have or don’t have, we treat the patient.
If you provide a paramedic with ten patients, they treat none of them.
Wait, what?
Yup, you read that right, NONE OF THEM get care. Because our lone paramedic is going to do something called ‘triage’. He’s going to assess each patient and put them in one of three or four (depending on exact protocol) categories. These are color coded, and the colors are often used as shorthand even outside of triage. Exact definitions vary by region, circumstances, and a few other factors, but more or less they break down as:
Red: requires immediate care, but with immediate care can probably be saved.
Yellow: requires care, but not immediately.
Green: does not require care. Note that this doesn’t mean uninjured: someone with a paper cut is injured, but they’re going to get better on their own (OK, if they’ve got a couple of rare blood disorders or if they swoon from the sight of blood and fall down the stairs they won’t get better, but those are extraordinarily rare and triage is all about playing the odds).
Black: probably cannot be saved even with immediate care. Again, note that this doesn’t mean they’re already dead, or that we wouldn’t treat them if they were the only patient. If we’ve got one patient with no pulse we treat them (we do that quite often in fact). If we’re passing out triage tags someone without a pulse gets a black tag.
Let’s talk about those green and black tag patients a little more. Again, a green tag doesn’t mean you’re just going to be sent home. Triage is done quickly, which means that it can miss things. Someone who feels, and looks, fine may have internal injuries for example which are actually very serious. So some of the available medical resources watch the green tags. They’re watching a much larger group, so they’re providing little to no actual care. Then the black tags. Most people don’t respond well to being told “sorry, you’re going to die, please go sit in the corner over there so your blood doesn’t create a slip hazard.” In civilian triage we seldom reach the stage where we black-tag people who are still conscious, of course, but it does happen. In the military a large dose of morphine is often applied to solve the consciousness problem. On the civil side someone is often assigned to cover the bodies. Again, they aren’t giving care, or at least not care that is going to save anyone.
The bottom line is that as you increase the number of patients the amount of care given starts to drop. If you flood a medical unit (hospital, ambulance company, whatever) with minor to moderate cases the amount of care given will drop sharply. If the unit is not well managed or if the crisis is prolonged, effective care can approach zero. This doesn’t happen in the US, where there are numerous methods in place for temporarily overwhelmed units to get temporary support and providers are generally well trained and equipped. It happens all the time in the third world. It happens in Europe on a fairly frequent basis.
All clear? Good, stick a pin in that key point and let’s move on.
ERs and ambulances spend most of their time treating people who would be ‘yellow’ or ‘green’ in a triage situation. We complain about it on a regular basis. Sometimes these people know they aren’t really seriously ill but want the attention. Still, most people who aren’t actually that badly off don’t seek emergency medical care. They, in effect, self-triage themselves as green or yellow and don’t clog up emergency services with their problems. Another key point: people without insurance self-triage better than those with. Someone who knows they’ll have to pay for their care is much more likely to take some over-the-counter medication and hope they get better. Another key point: most people DO get better on their own given some time and a little self-treatment. Sometimes, of course, they diagnose themselves incorrectly and wind up being red. And yet another key point: just about everyone who winds up being red gets treated whether they have insurance or not.
See where I’m going? The higher the portion of the population that has insurance, and thus a great reduction in their immediate cost for getting emergency care, the more low-priority cases the emergency medical system has to deal with… and eventually the less efficient it gets at providing care.
Now to me the obvious solution is that if you think you’re close to a capacity problem (which the rapidly rising cost of health care and the generally crowded state of emergency rooms leads me to believe we are) the logical thing to do is increase the capacity of the medical system. How do you do that? Train more doctors. Train more nurses. Medical technicians of all types. Pharmacists. Lab techs. Build or expand medical facilities while you’re at it, and maybe buy a few more ambulances.
On the surface, this solution ought to be very appealing to politicians – after all, that’s a lot of JOBS, the majority of which pay at least a living wage. Two problems: one, that takes a lot of time. It takes the better part of a decade to turn someone into a doctor who is a net provider of care (interns actually reduce the care provided since they have to be so closely supervised, and in some branches junior residents aren’t much better). That’s bound to be an election away whatever office you hold, so no politician really has an interest in pushing for it. Second, how do you train more doctors? Uh… teach them? Yes, but how do you increase the pool of people who are willing AND capable of becoming doctors? That’s a VERY complicated problem – and one that we’re not only not solving, that is becoming worse. The only thing that is keeping the US medical profession growing are the addition of non-clinical positions (usually as the result of government legislation) and the importation of providers from overseas. That’s right folks, a LOT of doctors are trained in India or the UK (to give two examples) and then work in the US. While this is just fine from a temporary prospective (most of those doctors are just as good as the ones we train in the US), it hardly seems sustainable. The domestically-trained pool of nurses is graying fast, and nursing schools are shrinking. Paramedic training is healthy last I heard, but the drop-out rate in EMS is appalling.
So at the same time our glorious leader has ensured medical care for all, the pool of providers is shrinking. Further, as discussed above, as the ratio of patients to providers rises, the amount of care drops. Can anyone say “negative feedback” and “descending spiral”?
I’ll be fully frank and honest: I don’t know how to solve the healthcare problem in the US, and yes we most certainly DO have a problem. The long term trend is especially bad. On the other hand, I do know what we need, and what we don’t need. We need more providers. We need fewer lawsuits over claimed malpractice. We need less well-meaning but ignorant government legislation (HIPPA was the crowning example when I was active, but was neither the first nor the last – what do you call someone who goes to the hospital every three days with the same problem? A Medicare patient). We need, as we need so desperately in so many fields in the US, to think about the long term.
But most importantly I don’t know any way to make actually solving our healthcare problem appeal to politicians, because I don’t know any way to compress this post into a sound bite that will help them get votes.
Politicians only seem to have time for the simple one.
Partially, that is because the modern media has trained them to talk to the public in sound bites. So any concept too difficult to fit into a sound bite, such as the real answers to most questions that the government should be addressing, doesn’t get talked about. Now, if you’re a politician and mostly concerned with getting re-elected, why spend time on something you’re not going to talk to the public about?
So the simple answers tend to be the only ones that get into legislation.
“But Federal laws are enormous! Thousands of pages! Surely they can’t be simple?”
Wrong. The basic concept that the law is based on is often quite simple.
The basic concept of Obamacare, for example, is that everyone should have healthcare. Simple concept. Easy to say, easy to defend on an emotional level.
Problem is, not one bit of that enormous bill with its simple concept answered the question of ‘how do we make healthcare better?’
To see why, let’s talk about triage.
If you provide a paramedic (or a doctor, but let’s talk about paramedics since I am one) with one patient, they treat that patient. Healthcare or no healthcare, we treat that patient. We do our best to collect their healthcare information so they can be billed later (because that’s where we get the money that allows us to treat the next patient), but bottom line is whatever healthcare they have or don’t have, we treat the patient.
If you provide a paramedic with ten patients, they treat none of them.
Wait, what?
Yup, you read that right, NONE OF THEM get care. Because our lone paramedic is going to do something called ‘triage’. He’s going to assess each patient and put them in one of three or four (depending on exact protocol) categories. These are color coded, and the colors are often used as shorthand even outside of triage. Exact definitions vary by region, circumstances, and a few other factors, but more or less they break down as:
Red: requires immediate care, but with immediate care can probably be saved.
Yellow: requires care, but not immediately.
Green: does not require care. Note that this doesn’t mean uninjured: someone with a paper cut is injured, but they’re going to get better on their own (OK, if they’ve got a couple of rare blood disorders or if they swoon from the sight of blood and fall down the stairs they won’t get better, but those are extraordinarily rare and triage is all about playing the odds).
Black: probably cannot be saved even with immediate care. Again, note that this doesn’t mean they’re already dead, or that we wouldn’t treat them if they were the only patient. If we’ve got one patient with no pulse we treat them (we do that quite often in fact). If we’re passing out triage tags someone without a pulse gets a black tag.
Let’s talk about those green and black tag patients a little more. Again, a green tag doesn’t mean you’re just going to be sent home. Triage is done quickly, which means that it can miss things. Someone who feels, and looks, fine may have internal injuries for example which are actually very serious. So some of the available medical resources watch the green tags. They’re watching a much larger group, so they’re providing little to no actual care. Then the black tags. Most people don’t respond well to being told “sorry, you’re going to die, please go sit in the corner over there so your blood doesn’t create a slip hazard.” In civilian triage we seldom reach the stage where we black-tag people who are still conscious, of course, but it does happen. In the military a large dose of morphine is often applied to solve the consciousness problem. On the civil side someone is often assigned to cover the bodies. Again, they aren’t giving care, or at least not care that is going to save anyone.
The bottom line is that as you increase the number of patients the amount of care given starts to drop. If you flood a medical unit (hospital, ambulance company, whatever) with minor to moderate cases the amount of care given will drop sharply. If the unit is not well managed or if the crisis is prolonged, effective care can approach zero. This doesn’t happen in the US, where there are numerous methods in place for temporarily overwhelmed units to get temporary support and providers are generally well trained and equipped. It happens all the time in the third world. It happens in Europe on a fairly frequent basis.
All clear? Good, stick a pin in that key point and let’s move on.
ERs and ambulances spend most of their time treating people who would be ‘yellow’ or ‘green’ in a triage situation. We complain about it on a regular basis. Sometimes these people know they aren’t really seriously ill but want the attention. Still, most people who aren’t actually that badly off don’t seek emergency medical care. They, in effect, self-triage themselves as green or yellow and don’t clog up emergency services with their problems. Another key point: people without insurance self-triage better than those with. Someone who knows they’ll have to pay for their care is much more likely to take some over-the-counter medication and hope they get better. Another key point: most people DO get better on their own given some time and a little self-treatment. Sometimes, of course, they diagnose themselves incorrectly and wind up being red. And yet another key point: just about everyone who winds up being red gets treated whether they have insurance or not.
See where I’m going? The higher the portion of the population that has insurance, and thus a great reduction in their immediate cost for getting emergency care, the more low-priority cases the emergency medical system has to deal with… and eventually the less efficient it gets at providing care.
Now to me the obvious solution is that if you think you’re close to a capacity problem (which the rapidly rising cost of health care and the generally crowded state of emergency rooms leads me to believe we are) the logical thing to do is increase the capacity of the medical system. How do you do that? Train more doctors. Train more nurses. Medical technicians of all types. Pharmacists. Lab techs. Build or expand medical facilities while you’re at it, and maybe buy a few more ambulances.
On the surface, this solution ought to be very appealing to politicians – after all, that’s a lot of JOBS, the majority of which pay at least a living wage. Two problems: one, that takes a lot of time. It takes the better part of a decade to turn someone into a doctor who is a net provider of care (interns actually reduce the care provided since they have to be so closely supervised, and in some branches junior residents aren’t much better). That’s bound to be an election away whatever office you hold, so no politician really has an interest in pushing for it. Second, how do you train more doctors? Uh… teach them? Yes, but how do you increase the pool of people who are willing AND capable of becoming doctors? That’s a VERY complicated problem – and one that we’re not only not solving, that is becoming worse. The only thing that is keeping the US medical profession growing are the addition of non-clinical positions (usually as the result of government legislation) and the importation of providers from overseas. That’s right folks, a LOT of doctors are trained in India or the UK (to give two examples) and then work in the US. While this is just fine from a temporary prospective (most of those doctors are just as good as the ones we train in the US), it hardly seems sustainable. The domestically-trained pool of nurses is graying fast, and nursing schools are shrinking. Paramedic training is healthy last I heard, but the drop-out rate in EMS is appalling.
So at the same time our glorious leader has ensured medical care for all, the pool of providers is shrinking. Further, as discussed above, as the ratio of patients to providers rises, the amount of care drops. Can anyone say “negative feedback” and “descending spiral”?
I’ll be fully frank and honest: I don’t know how to solve the healthcare problem in the US, and yes we most certainly DO have a problem. The long term trend is especially bad. On the other hand, I do know what we need, and what we don’t need. We need more providers. We need fewer lawsuits over claimed malpractice. We need less well-meaning but ignorant government legislation (HIPPA was the crowning example when I was active, but was neither the first nor the last – what do you call someone who goes to the hospital every three days with the same problem? A Medicare patient). We need, as we need so desperately in so many fields in the US, to think about the long term.
But most importantly I don’t know any way to make actually solving our healthcare problem appeal to politicians, because I don’t know any way to compress this post into a sound bite that will help them get votes.
Thursday, August 2, 2012
On the Move
Yup, I did Boeing’s On The Move challenge again this year.
This year the company offered a $100 gift card as an incentive for doing an average of 10,000 steps per day over the course of the 42 day program.
While I did not manage to reach 10,000 steps every day, I did make the average. My total steps were 427,433.
Getting 10,000 steps a day when you work a desk job is HARD. One day a week I’m currently a traveling circus going around the Everett site to touch base with various groups that aren’t located at Harbor Pointe, so 1/7 of the time I made my daily goal with ease. 10,000 steps is about five miles. From wearing the pedometer the rest of the year I found I averaged about 3,500 steps a day, so I needed to walk over three extra miles per day.
Each On The Move my goal has risen, but unless my job changes I think I've hit the limit of what I can really do.
This year the company offered a $100 gift card as an incentive for doing an average of 10,000 steps per day over the course of the 42 day program.
While I did not manage to reach 10,000 steps every day, I did make the average. My total steps were 427,433.
Getting 10,000 steps a day when you work a desk job is HARD. One day a week I’m currently a traveling circus going around the Everett site to touch base with various groups that aren’t located at Harbor Pointe, so 1/7 of the time I made my daily goal with ease. 10,000 steps is about five miles. From wearing the pedometer the rest of the year I found I averaged about 3,500 steps a day, so I needed to walk over three extra miles per day.
Each On The Move my goal has risen, but unless my job changes I think I've hit the limit of what I can really do.
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