What isn't so

Irrationality at large

“It ain't ignorance causes so much trouble; it's folks knowing so much that ain't so.” —Josh Billings

The local affiliate of Salem Communications broadcasts a short news break just before the hour. Sometimes I tune it in just before punching the button for a more mainstream station's top-of-the-hour newscast. These occasional doses of right-wing media keep me informed on what the nut-case fringe is saying, and it can be enlightening. Recently, while driving to school in the early morning, I tuned in the Salem station and heard its newscaster's report, “The nonpartisan Congressional Budget Office reports that the Obama administration's healthcare act will cost the nation's economy two-point-three million jobs in the next dozen years.”

It was startling news. My first thought: That's a lie. I was considering the source. By the end of the day, I had discovered the truth. The full implementation of ObamaCare would pick the so-called “job-lock” and free people who had been forced to stay in jobs they hated simply to preserve their health benefits. The CBO estimated that over two million people would be able to give up their second (or third!) jobs, scaling back to something less burdensome without running the risk of losing health insurance. In many cases, it would presumably enable parents to spend more time at home with children, which is something Republicans also support as long as it's merely theoretical.

And, as we have already seen, the GOP will repeat the “job-killing” claim at the top of their lungs all during the 2014 election campaign. Will this be the year that it doesn't work because they've cried “wolf” much too often already? If so, I look forward to their being devoured.

Ignorance is not a mysterious thing. All of us have it in abundance, even as we whittle away at it during our lives. What we have been seeing, however, to a greater degree in recent years than I can recall in previous decades of politician-watching, is the deliberate nurturing of ignorance, the creation of fake knowledge (like an inoculation?) to keep people from absorbing genuine knowledge. The right-wing propagandists have raised this to a high art.

It was just a few years ago that I was in Texas during the summer to visit some friends who had moved from California. The matriarch of the clan was concerned about the state of the national economy and confided her worries to me. Knowing that I had been a legislative staffer in Sacramento and assuming I still had some insight into such matters, she wanted to know if there was any chance that the U.S. Congress would “fix” matters by repealing ObamaCare. “If only they could get rid of it, the national debt problem would be solved!” She really believed that (and had never heard about the CBO analysis that determined ObamaCare would reduce the nation's annual deficits).

She also had Fox News playing in the den during every waking hour. She wasn't uninformed. She was massively misinformed.

Quite recently one of my nieces became one of the president's hapless victims. She wasn't quiet about it. ObamaCare had forced her to change doctors (which, you know, never happened when insurance companies ran the world) and “Becky” was furious:

Becky feeling annoyed

So... I am so disgusted in Obama!!!! My insurance plan disappeared because it was not OBAMA approved. So instead of having basic insurance and paying cash for my dental and vision and paying $300 for my family. So now I am being forced to go to Covered California and pay $250 with the state paying $250 and putting my kids on medical. How does make any sense!!!!!!

After reading her plaintive post on Facebook, I pointed out a little bit of reality (cribbed from my blog post on same):

Your insurance company did not have to cancel your policy. It decided that it wanted to do it despite language in the healthcare act that permits individuals to maintain existing policies. It's in Section 1251 of the Affordable Healthcare Act:

SEC. 1251. PRESERVATION OF RIGHT TO MAINTAIN EXISTING COVERAGE. (a) NO CHANGES TO EXISTING COVERAGE.(1) IN GENERAL.—Nothing in this Act (or an amendment made by this Act) shall be construed to require that an individual terminate coverage under a group health plan or health insurance coverage in which such individual was enrolled on the date of enactment of this Act.

What the act did not do, however, was mandate that the insurance companies keep offering the plans people wanted to keep, and many companies have grabbed the chance to cancel lots of policies. They didn't have to. They wanted to. The administration should have anticipated this and blocked it, which would have given some teeth to the president's you-can-keep-it pledge.

I might as well been hollering into a dry well. Some of Becky's Tea Party buddies chimed in. Here’s a couple:

Sadie: I hated him before this - but we had all sorts of trouble getting coverage because of Joeys pre existing condition - even though that wasnt ment to be taken into consideration. Its a joke and a very bad one.

Sadie refused to recognize that the ACA is what made her husband’s pre-existing condition irrelevant. It was all the fault of the hated president, who was daring to occupy the White House while black.

Gertrude: All the people that voted for him owe the rest of us working people an apology !!!

Don't hold your breath, Gertie!

And here’s my niece again, for the big finish!

Becky: To privately cover my family would now cost me $800-$1000 per month with a $4000 deductible. That is ridiculous.

So Becky points out that private health insurance is damned expensive. As much as a thousand per month, with a high deductible. Wow! Instead of like before, when her bare-bones insurance plan cost her $300 (as mentioned above). Now, of course, under Covered California, she’ll pay $250 for a $500 policy. Hurray? No! That's only because she's also getting a $250 subsidy, and that’s (apparently) awful and humiliating! Like welfare!

Sounds like ObamaCare worked to her advantage, although there is the aggravation of having to choose a new primary care physician, since her old doctor was tied to the old plan and (I guess) is not available under the new. But saving $50 each month is sort of good, no? No! It’s communism! (Or something.)

Perhaps I'll get some sympathy when I tell my niece that I had to change health plans in order to keep the doctor I've had for several years as my primary care physician. When she gloats that I, too, am a victim of the Affordable Care Act, I'll mention it occurred before the measure was enacted. I was, instead, a victim of my college district's health insurance providers—back in those days when the insurance companies ran everything and the president had yet to drive us from health-insurance paradise.

The medical merry-go-round

Caught in referral hell

It seemed a good idea at the time. Heck, it still seems like a good idea. People did try to help out and some leads were followed. So they turned into dead ends. Whose fault is that? Everyone who offered suggestions deserves thanks.

I prefer to blame the doctors.

Frankly, it's like they're playing a game of keep-away with a friend of mine. However, instead of swiping some short kid's cap and tossing it back and forth over his head, it's more like they're lobbing his medical file to and fro: “Here! You take it!” “Hell, I don't want it! You take it!”

I get it. They can't figure out what's wrong with him, so they ignore him as much as they can (this part is easy, because they are actually very busy people with easier cases to consider) and then try to make him someone else's problem when he gets to be a nuisance. My buddy wouldn't mind this latter part so much if at least someone in the long-running game of tag-you're-it could actually make sense of his situation.

As previously reported, one of my good friends (we go back all the way to the height of personal computer fun, West Coast Computer Faires, and user groups) is suffering from a combination of symptoms that include ferocious migraines, loss of voice, and a strangling sensation of throat constriction. Doesn't sound like fun, does it? Initially it seemed like his lymph nodes were going crazy, but now it appears the swelling and constriction must be from some other cause. His thyroid levels were messed up, but medication to bring his numbers under control had no impact on his other ills (even though the thyroid tests got back into the normal range). It's as puzzling as ever. Here's his most recent update:

I have seen three different otolaryngologists in three different clinics: One at UC Davis, one at UCSF, and one at the Sacramento ENT clinic. No one could find a cause in my throat. I followed up by seeing an endocrinologist at the UC Davis Elk Grove clinic. He ruled out my thyroid causing the problem and also ruled out Riedel’s thyroiditis as a potential diagnosis. On July 26 I saw an allergist at UC Davis and she ruled out allergies as a cause because allergies come and go. She suggested I go back to the UC Davis ENT clinic because the doctor I saw at that clinic said that I should see them again if the problem persists; the allergist said I should see them for voice and swallowing problems. I told her that would be useless because all the doctors I’ve seen are trying to address the symptoms, not the cause.

The swelling continues to grow in several places that have been swollen for a while, and a new area of swelling appeared on the back of my neck in the last week.  I’m starting to feel more pressure and pain on my throat when I lie down, which makes it even harder to get comfortable when I need to sleep. Twice this week I’ve slept for 8 hours at a time only to wake up exhausted. I still have no appetite and I’ve lost nearly 19 pounds since this started 4.5 months ago – I was at 163.8 pounds when I started and I’m now down to 145.2 pounds. I’ve asked my current primary care physician about next steps including a PET scan and a follow-up ultrasound scan. I’m currently looking for a new PCP.

He doesn't mention it, but his PCP's referral to the UCSF otolaryngologist provoked an irritated response from the latter, whose specialty is oncologic surgery; he was clearly irked at being sent a patient with no indications for cancer. The wasted trip to San Francisco was further evidence that his primary care physician is out of ideas and is randomly sending him around, hence the search for a new primary. And for a new referral that finally produces results.

Anyone out there have any ideas? Are you a retired diagnostician with time on your hands and an itch to solve an intractable problem? Everybody needs a hobby!

The situation gets monotonically worse, with neither diagnosis nor remedy on the horizon. What can we do to get this guy out of purgatory?

And please don't suggest prayer.

It's a headache!

And that's not all

A friend of mine is (figuratively) banging his head against a brick wall. The results are similar to what they would be if his activity were literal.

Interestingly enough, his medical condition began quite misleadingly. Eventually his doctors figured out that his symptoms of disorientation, dizziness, and weakness were the results of “silent” migraines. While migraines are most commonly associated with acute, debilitating headaches, this is not the only case. The headaches might be absent, while the victim nevertheless experiences the distorted vision and weakness that migraines induce.

The diagnosis of silent migraines resulted in my friend's introduction to the extensive pharmacopeia of anti-migraine medications. Problem solved!

Sort of. Temporarily, anyway.

Things began to change. For one thing, my friend's prescriptions worked for only a limited time. As he became inured to the therapeutic effect of one drug and the symptoms ramped back up, the doctors would move him on to another. He was now working his way through the list of drugs, wondering how long this could go on. For another thing, the pain showed up. Classic, stabbing, excruciating headaches. “Silent” no more. Fortunately for my friend, the sharp, stabbing headaches are intermittent—triggered by loud noises (he suffers from hyperacusis). Only the dull pain in his head is constant, day in and day out (and denying him sleep, because there's no longer any such thing as a soft-enough pillow).

Now he was getting passed around in the medical community. The UC San Francisco headache clinic looked into his case and shot him up with drugs to “reset” his pain level. It failed. UCSF was on the verge of confining him to a hospital bed for a days-long infusion of a drug that required 24-hour monitoring when a bad reaction to a milder form of the medication provided a very serious contraindication.

The UC Davis Medical Center subjected him to a series of tests, none of which proved definitive. It was clearly something more than just a migraine condition. My friend was wobbling about with a cane and it took a regimen of physical therapy to help him relearn how to stay upright and walk like a sober person. The migraines had laid waste to his balance system.

The standard migraine drugs were used up and then recycled at higher and more dangerous levels. Relief was still merely temporary and palliative. His doctors began a series of off-label prescriptions (where “off-label” means using medications to treat conditions for which they are not formally approved). It was, in a word, a series of experiments. Each experiment lasted as long as a month or two. Much shorter, of course, in the case of hallucinations or other serious reactions. Recently the doctors started mumbling about using botox, but I'm not sure what that's all about.

But that was merely prelude. This year his condition escalated in a completely unexpected way. Let him tell it in his own words. It's a total mystery:

In early March I started to experience swelling in the front center of my neck. A couple of days later there was a small lump on the back of my neck. The lump in the front of my neck has continued to swell and the swelling has grown into my jaw. This past weekend a new, fairly large lump has appeared at the intersection of my jaw and neck just below my right ear. The swelling in my neck has put enough pressure on my neck to cause difficulty swallowing, occasional difficulty breathing, and the loss of my voice. (I can only talk in a whisper.) I have also had swelling in both underarms and in my groin, but the doctors can’t feel anything in those spots that would warrant more testing.

Blood tests suggested that I have hypothyroidism, and I’ve been taking levothyroxine (50 mcg/day) for over a month to combat that potential cause. The levothyroxine has lowered my thyroid stimulating hormone level to normal, and I’m still taking it per my doctor’s orders, but that drug hasn’t lowered the existing swelling, kept existing swollen areas from growing, or prevented new growths from forming.

I’ve had three ultrasound tests of my neck and though these tests have found a slightly enlarged lymph node that hasn’t grown or shrunk in the subsequent two tests, the node is too small for a biopsy. I’ve also been to the ENT and to a gastroenterologist without any success or insights. My primary doctor is now at a loss about what to do next.

While lymphoma has been suspected because of the swollen lymph nodes, nothing has ruled it definitively in or definitively out. The constellation of symptoms is totally confusing.

And Hugh Laurie is busy wrapping up his final season of House and isn't taking new patients.

Any ideas, anyone? Know anyone who might? Perhaps you have a better clue than any of my friend's doctors. They keep passing him back and forth like a hot potato, cheerfully suggesting to him that his life isn't really at risk because they can always resort to intubation if his throat becomes too constricted to permit adequate breathing. It's a comfort, isn't it?

Please feel free to pass this post along, link to it, or otherwise bring it to the attention of medically savvy professionals who can solve this puzzle. It's a headache—and then some.

This is not about Steve Jobs

Death at a young age

[D]eath is very likely the single best invention of life. It is life’s change agent. It clears out the old to make way for the new. Right now the new is you, but someday not too long from now, you will gradually become the old and be cleared away.

The quote is from the commencement address that Steve Jobs gave at Stanford in 2005. Naturally lots of people have been considering those words since the report that Jobs died on Wednesday. Naturally people have been thinking it's unfortunate that Jobs was “cleared away” after having lived only 56 years.

I can remember when the fifties seemed like old age to me. That was a few years ago, of course. I no longer think that. Especially since I am no longer in my fifties. In fact, I used to doubt that I would ever make it that far.

Young people. How foolish they can be.

By a curious coincidence, I have a cousin who is 56. The same age as Jobs. My cousin is in hospice care. Perhaps you know what that means. It provides some relief to his wife, of course, because she has been bearing the burden of caring for a terminally ill man who can no longer get about under his own power. However, it is also a harbinger of imminent death, because hospice workers don't show up till the final days, which is where my cousin is now.

By a peculiar circumstance, my cousin is acquainted with the hospice workers. He knows them from the meticulous and considerate care they gave to his sister last month, in the days before she died at the age of 53. She was the first of our generation to go. Her brother will soon be the second. He attended her funeral in a wheelchair, knowing that the ceremony could be considered a dress rehearsal for his own imminent last rites.

How do people deal with tragedies like this? I don't know. I suppose that having no choice is a big part of it. You can't pick any alternatives. You have to endure the unendurable because it cannot be avoided. My uncle and aunt are still alive, having buried one child and expecting soon to bury another. I can't imagine how they feel.

I am insulated from the grief. These are cousins who live at a distance. Not cousins I used to see on a daily basis when we all lived on a big farm. They're the city cousins I used to see a couple of times a year when we traveled down to southern California to visit my maternal grandparents. Many years have passed since I last saw any of them in person. We've been out of touch and the bad news has been percolating north through the family grapevine—my mother, mainly. My dying cousin is her godson.

No, this post is not about Steve Jobs. It's about people dying young. People younger than me. I wanted to say something about it. Not that it does any good.

Back away from the penis!

San Francisco on the cutting edge

The voters of the City and County of San Francisco have placed a proposed circumcision ban on the November general election ballot. It would make it illegal to remove the foreskins of minors without a showing of medical necessity. It would not, however, have any impact on adult males who wish to have their penises clipped. The rationale is simple: Baby boys cannot give informed consent.

The reaction to the ballot initiative is unsurprisingly shrill. Here's the opening paragraph of an opinion piece by Rabbi Gil Leeds, which was published on May 20, 2011, in the San Francisco Chronicle:

Freedom of religion, enshrined over two centuries ago by the Constitution and the Bill of Rights, is now subject to a vote with the certification in San Francisco of the referendum on circumcision for the November ballot. The vote will empower a secular majority to impose its will, and ban one of the oldest religious traditions known to humanity. When religious belief and practice become subject to vote by the majority of a city council, government agency or referendum, it endangers all of our rights and freedoms.

The proposed legislation contains no religious exemptions, so the traditional Jewish bris ceremony could no longer be practiced in San Francisco if the circumcision ban were enacted. That is why Leeds frames it as an attack on religious freedom. This got me to thinking.

What does religious tradition protect? How far can it go? Leeds correctly points out that male circumcision is a very old religious practice, so it definitely fits under the mantle of tradition, at least for Jews. It's also long been considered normative for American males, quite apart from religious practice. As a culture, we're inured to it and most people take it in stride as expected and unexceptional. While a few circumcised men have complained about having been robbed of their foreskins, most clipped males appear to be content with their condition. It hasn't been a major controversy.

On the other hand, female circumcision is widely condemned as genital mutilation and is against the law in the United States and the target of an international campaign to suppress it. In fact, “circumcision” is rather a misnomer for the procedure(s) applied to young girls in those cultures that practice it. The term comprises a broad range of actions, from reduction or amputation of the clitoris to wholesale excision of the labia. The most extreme form involves infibulation, stitching up the vaginal passage to make it smaller and to ensure the virginity of the victim; the procedure may be reversed when she is properly married off.

Female “circumcision” is an ancient practice that is done in secret in places like the United Kingdom and the United States, nations in which it is legally banned. Members of immigrant families may go to great lengths to ensure that their daughters are genitally cut so that future suitors may be assured of their respectability. The UK and US make no allowance for the ancient tradition, deeming it a violation of basic human rights and labeling it as “female genital mutilation.”

The sponsors of the anti-circumcision measure in San Francisco took a page from the international campaign to protect girls when they titled their proposal as the “San Francisco Male Genital Mutilation” initiative. The city attorney toned that down to the “Male Circumcision” measure, but Leeds the mohel is unmollified:

The proposal's backers are trying to deceive the voters by labeling it a “ban on genital mutilation.” Honesty would have demanded they called it a ban on circumcision. By using such a toxic term as mutilation, they hope to garner support from an unsuspecting public.

My question is this: How is cutting off part of a little boy's penis not a “genital mutilation”? Because our society is inured to it? Because some people practice it as a religious rite? Because it's not as grotesque as the female version? Because there are some supposed health benefits?

What if a religious sect insisted it was their right to practice infibulation on their infant daughters? Would we be violating their freedom of religion if we refused to allow it? (We have clearly already decided that question, haven't we?)

Circumcised males can take comfort in being in the majority and having undergone a procedure that has long been considered unremarkable and of which they haven't the slightest recollection. They understandably react negatively at being told that they were “mutilated” at birth. It's a charged term. At the same time, the uncircumcised minority cringe at the thought of having their foreskins lopped off and marvel that their clipped brethren can be so complacent about having lost theirs. It's what you're used to, I suppose.

The religious aspect doesn't faze people for whom religion is just a superstitious practice that gets more respect than it deserves. Rabbi Leeds hung his argument on the right of people to clip their sons' penises in honor of a supposed covenant with Yahweh. After his article appeared in the Chronicle, San Francisco's archbishop weighed in with an angry letter in support of the rabbi:

I would like to add my “Amen” to the op-ed piece by Rabbi Gil Leeds, “Circumcision ignores our basic religious freedom” (May 20).

The proposed ban on circumcision represents an unconscionable violation of the sanctuaries of faith and family by the government of San Francisco. Although the issue does not concern Christians directly, as a religious leader I can only view with alarm the prospect that this misguided initiative would make it illegal for Jews and Muslims who practice their religion to live in San Francisco—for that is what the passage of such a law would mean.

Apart from the religious aspect, the citizens of San Francisco should be outraged at the prospect of city government dictating to parents in such a sensitive matter regarding the health and hygiene of their children.

George Niederauer, Archbishop of San Francisco

I don't know that you're helping, George. Protecting the health and hygiene of one's children these days would seem to include keeping them away from Catholic churches. May I suggest that you—ahem!—keep your hands off their penises?

Now hear this!

Trust Dr. Rock Star

Farm life is not necessarily a bucolic idyll accompanied by the soulful lowing of cattle and the melodic twittering of songbirds. The roaring of tractors and other farm equipment may imprint you with less restful souvenirs—like a ringing in the ears.

During my childhood, no one on the farm wore ear protection during long hours in the field, driving tractors to and fro with equipment in tow. Some of the farm gear was unpowered and relatively quiet: discs, harrows, plows, and rakes. The diesel engines of the tractors provided most of the noise. Other devices raised a ruckus of their own, powered devices like balers, whirling choppers, reciprocating scythes, and stalk cutters. Then there were odd devices like the cultipacker, an unpowered farm tool that consisted of a big cylindrical axle festooned with toothed steel rings, which clashed against each other as they rolled across the field. It sounded like a continuous explosion in a cymbal factory.

One legacy of my life as a farm kid is tinnitus—a continual ringing in my ears. It's a mild case, usually easily ignored, but it varies from time to time and I wish it would go away. I unknowingly did my best to avoid it, always letting my brother volunteer for farm tasks that he would happily do while I would regard them as infringing on my reading time. Despite my shirking, the damage was done.

Naturally my ears pricked up when I heard a radio advertisement for a new remedy. Although my doctor had told me there was no useful treatment for tinnitus, hope springs eternal. Had there been a recent breakthrough? The pitchman on the radio cheerfully reported that Quietus would safely provide relief from the ringing, humming, or squealing in the ears that characterizes various forms of tinnitus. Sounded good to me.

Now you can alleviate the ringing with all-natural Quietus, a proprietary formula that helps support healthier cochlear auditory nerve function in the inner ear, to relieve that annoying internal noise.

Oops! I hear buzzwords. Do you hear buzzwords? “All natural”? “Helps support”?

I also smell something. Like a rat.

The male voice of the pitchman gave way to the female voice of a supposed satisfied customer of Quietus:

I like it that it's homeopathic and doesn't require a prescription.

Okay. Got it. Quietus is a bogus nostrum with no medical value (unless you count the placebo effect). Out of curiosity, I visited the Quietus website. That where I discovered that Quietus was “discovered by a drummer.”

Sounds like someone was inspired by Airborne, the supremely successful fraud perpetrated “by a school teacher.” Who wouldn't trust a remedy invented by a rock star? (They're way more credible than mere doctors and researchers.)

The only good part of the Quietus website was the fine, fine (really fine) print at the bottom of the page (complete with the product name misspelled!):

Queitus™ Advanced Homeopathic Medicine. **These results not typical. Individual results will vary. These real testimonials do not represent the typical or ordinary experience of users. They are for demonstration purposes only and do not accurately capture the actual results you will experience. Your results may vary and you may need to use the product for a longer or shorter period of time. Each person’s experience with Quietus is different, which cannot be determined from these testimonials.

It's a lovely bit of cover-your-ass prose, which approximately 99% of visitors to the website will not read (or perhaps even see).

We tinnitus sufferers will have to continue to wait for a genuine remedy from real scientists—perhaps something along the lines of current research, which has succeeded in regrowing cochlear hair cells in mice. In the meantime, one can find a consumer-alert message about Quietus on YouTube (although I must warn you that it has an irritatingly noisy soundtrack!). I'd rather direct you to this trenchant commentary by Dara Ó Briain, who thinks we should “bag” homeopathy. But please don't clap too loudly. My ears are delicate.

The placebo solution

Take two nothings and don't call me in the morning

The Associated Press covered House minority leader John Boehner as the Republican congressman made his party's case for its position on health care reform. First of all, the GOP doesn't really think there's a health crisis. The socialized medicine programs we have now (Medicare, Veterans Administration) are fine the way they are and don't need to be expanded. Furthermore, the Democratic plan is just too darned big. The Republicans don't see any reason that a national program should require as many pages as found in the current consensus plan being advanced by House Democrats. In a telling AP photo, Boehner mockingly poses with the stack of paper representing the Democratic plan. You can see the multi-ream pile on Boehner's right. Meanwhile, that's the GOP plan that Boehner is brandishing in his left hand. The entire plan.

Let's not shake hands

A completely clean fable

Friends who were present will recognize the liberties taken with the following story and the embellishments that punch up the narrative and highlight the unsubtle message it contains. When you get to recount the incident yourself, you can repair the lapses that produce l'esprit de l'escalier. I take my cue from a statement attributed by Mark Twain to the learned historian Herodotus: “Very few things happen at the right time, and the rest do not happen at all. The conscientious historian will correct these defects.”

❑

There we were, having a friendly chat over burgers at a local restaurant, when a hostess bustled over and seated a party of four at the booth adjacent to ours. It looked like a gaggle of college students—late teens or early tweens. I didn't recognize any of them and took no particular note. Except for one thing.

The red hair.

My paternal grandmother used to wax eloquent about the redheads in our family, especially (as best as I can recall) her twin sisters. The gene for red hair, however, appears to have been lost. There are no redheads in any generation I'm familiar with, and I know four: Dad's, mine, my nieces' and nephews', and that of their children. Not one ginger child in the bunch.

But my grandmother loved red hair and admired it immensely. To this day, although she's been gone for a quarter-century, I cannot see a redhead without having a nanosecond's recollection of my grandmother. Funny how persistent these odd connections can be.

Anyway, one of the kids at the next booth had red hair, which he had cropped close and looked rather like red felt. It gave me a tiny smile as I thought how my grandmother would have taken special note of it (as indeed I was now doing) and then I consigned it to the memory hole as I returned to the conversation at my table. It was entirely possible that my brain's next attempt at garbage collection would wipe out the memory forever. But later something else happened to make it stick.

Thanks to my primary-care physician, who decided that I should be on a diuretic, I heartily appreciate Churchill's dictum that one should never miss an opportunity to empty one's bladder. It was almost time to leave the restaurant and I excused myself to make a quick pit stop. Having taken care of business, I was at the sink scrubbing my hands when in the mirror I saw the bathroom stall behind me open up. Out popped the redheaded kid, who made a beeline for the exit without sparing even a glance at the unoccupied sink next to me.

I returned to my table. The redheaded boy was back at his own table, chatting cheerfully with his companions.

“We ready to go?” asked one of my friends.

I pondered for a long moment.

“Um. Just give me a minute, okay?”

I often lug my briefcase around with me, just in case I have some downtime and there's an opportunity to correct some papers. I often have a steno pad in my briefcase, a practice that goes back many years. A pad in hand gives one a reporterish aspect (in, I admit, a retro sort of way). I dived into my briefcase and pulled out the pad. I flipped it open to a blank page, got up, and sauntered over to the neighboring table.

“Excuse me,” I said. “If you don't mind, this will interrupt you only a minute or two. I'm a faculty member at a local college and I have a couple of questions I'm collecting answers to.”

The young people paused in their conversation and blinked curiously at me, puzzled. But I was an older guy who was wearing a tie. A nicely conventional authority figure. I turned to the redhead and pulled a pen from my pocket.

“The first question is, do you know what E. coli is?”

The boy made a vague sound and shrugged his shoulders. His friends tittered.

“That's okay,” I said, jotting a note on my pad. “Lots of people don't know that one. E. coli is a bacterium that often causes food poisoning, among other things. So now you know what E. coli is. My second question is, do you know how E. coli is spread?”

The redhead narrowed his eyes just a bit, perhaps getting suspicious. They were hazel, I think, but I'm the wrong person to ask about that. Practically everyone in my family has dark-brown eyes and dark-brown hair (if it hasn't gone gray or fallen out). I have no expertise in the nuances of eye color.

“I don't know,” said the boy. His friends were exchanging glances. One of them volunteered: “Contamination?”

I nodded my head and scrawled another note on my pad.

“Yes, food contamination is one way. E. coli is commonly found in the lower digestive tracts of warm-blooded animals. That includes humans.”

“You mean in shit,” exclaimed one of the young people, to general laughter.

“Yes,” I agreed. “I do believe that is the correct technical term for it. One last question.”

I looked the redheaded boy in the eye (hazel- or whatever-colored). He was looking just a little bit pale, which is a good trick for someone already so white, but he was clearly anticipating trouble from the inquisitive professor.

“Please tell me if you don't bother washing your hands in the restroom because (a) you didn't know that dirty hands spread germs, (b) you don't believe that dirty hands spread germs, or (c) you just don't care.”

I poised my pen above my notepad. The boy went crimson (but not quite enough to match his hair). His friends had been looking at me as I asked the final question. Their heads snapped back toward their friend and their hands pulled back sharply from the finger-food appetizers in the middle of their table.

“No! I always wash my hands!” he blurted.

I did a little more random scribbling.

“Fascinating,” I observed. “I ask these questions only of guys I have personally seen leave a restroom stall without washing their hands.” (A true statement, even if I had never asked those questions before.) “A majority always seem to lie about it, so I guess that means they actually know better, but couldn't be bothered to take the time to wash their hands. Fascinating.”

I wrapped it up.

“Okay, we're done here. Thanks for letting me interrupt your meal. You'll forgive me, I trust, if I don't shake hands. Now go wash your hands before you eat lunch with your friends or touch anything they might touch. So long!”

I flipped the notepad shut and shoved it back into my briefcase. I gave the agitated young people a cheerful nod and headed toward the door. As we got outside, one of my friends said, “Talk about a dirty trick! You humiliated that poor kid.”

“It was a teachable moment,” I replied. “Other than that, I wash my hands of the whole thing.”