Saturday, June 28, 2014

Coping With Texas Heat

Published in the Sun June, 2014

Dwight Richter of Georgetown checks out an outdoor shower on the Cool Home Tour
Even though I was born here, I believe that Texas is barely fit for human habitation in the summertime.  Every winter when the sky is blue and the air is cool and dry, I fantasize that the coming summer will finally be the one in which a sturdy fan, a tall glass of iced tea, and a hefty dose of ecological self-righteousness will suffice in lieu of air conditioning.  In the spring, the balmy breeze through the open windows is soft as a caress, the rustling trees and the thrum of cicadas are a lullaby, and I feel kinship with a benevolent Mother Nature.  People thrived here for hundreds of years without air-conditioning; surely I am no less hardy than they.

But every year, usually in May, a deathly still day arrives when the humidity tops 80 percent and the temperature has climbed into the mid nineties.  Sweat runs down my back even if I could sit perfectly still, but I can’t sit still because of a cloud of blood-sucking mosquitoes.  Mother Nature is no longer benign, but rather an uncaring dominatrix awaiting my eventual return to compost.  I cannot save the planet in this infernal heat.

This year I made it until June before admitting that I am indeed less evolutionarily fit than my forebears.  My grandmother used to sleep under a wet sheet to stay cool, but I have more convenient options.  With a reluctant twist of the thermostat I both increased my carbon footprint and sealed myself into a habitable pod, like an astronaut on the Space Station.

It hasn’t always been the case that a house was meant to seal us off from the hostile environment.  For thousands of years people lived mostly outside and a shelter was considered adequate if it kept the rain off and the predators out at night.  But being human, and by nature chronically dissatisfied, we gradually demanded more.

First we began to cook inside, even though the smoke was deadly until chimneys were invented.  Then, however crazy it sounds, we decided to poop indoors, which clearly required other technological innovations.

Sometime in the latter half of the twentieth century we decided we needed more space; about a thousand square feet per person would be very comfortable.  To remind us of our European roots we put a steep roof on the house to shed snow (no matter that there wasn’t really any snow), decorated with a stylish Italian fa├žade, and surrounded the house with a lawn like an English manor, which looks appealing and would be perfect for grazing sheep or croquet, but you can’t play in the grass because of chiggers, so it is only useful for mowing practice.   Next we wanted a perfectly modulated indoor climate, even though heating and cooling a home accounts for almost 50% of residential electricity usage.  And to top off the absurdity of our housing desires we build this modern version of a house several hundred copies at a time on rocky pastures where there is not enough water to support one cow per five acres.

On June 8, almost the same day that I turned on my AC, I also visited some of the homes on the 18th annual Cool House Tour, sponsored by the Texas Solar Energy Society and Austin Energy Green Building.  The purpose of the tour is to showcase new homes and remodels that have been designed to be energy efficient and comfortable, with less negative impact on the environment.  These houses are technologically advanced, but because they are all one-off projects, they are creative far beyond anything you might find in a tract home.

HausBar Farm was one of the most popular homes on the tour.  Sitting on less than two acres in east Austin, this working urban farm has space enough for a large garden, dozens of hens, ducks, and rabbits, and even a donkey.  A 30,000 gallon rainwater tank provides irrigation for the vegetables and animals and a 22 kilowatt solar array covers a pole barn in the yard.  Although the house is efficiently insulated and air conditioned, the owners can stay cool outside on either a shady screened porch or a shady patio beside an inviting swimming pool.  Shade is absolutely the first, most important step in energy efficiency for Texas.  Keep the summer sun off the walls and windows and make the roof light-colored to reflect the heat, and you have gone a long way toward reducing energy costs.

A kitchen on the patio allows the farmers to do their cooking outside in warm weather, so the house stays cooler.  A shower is also located on the patio.  A regular feature at scout camps and Caribbean resorts, outdoor showers put the excitement back into bathing, while also keeping humidity out of the house and lessening the load on the AC unit.

Another home on the tour economized on space.  The young professional couple packed lots of luxury into 903 square feet.  The small size means they used less material to build, and will spend far less to heat and cool.  They will not have to waste a lot of time cleaning either, and will have time and money to do the fun things they want to do.  Less is more.

Texas can be a hostile environment, but with a little imagination you can find clever ways of dealing comfortably and efficiently with summer heat, without having to sleep between wet sheets.

Sunday, June 1, 2014

Notes From the Wrong End of a Stethoscope

Published in the Sun June 1, 2014

I have recently accompanied my father, who is 84, on some of his medical excursions, which has been an enlightening experience, and not in a particularly good way.  As a former practitioner of medicine, I am used to being on the other end of the stethoscope; the end with all the power and prestige.  Being the patient, or even the patient’s family member, is a different kettle of fish.

Here are some things I have noticed about the medical profession when viewed from the supine position, and I would be willing to bet that I am not the only person with these experiences.  First, old people can still speak regular, adult English.  A medical assistant interviewed my dad in a high-pitched, patronizing voice “Are we taking our medicines?“ and “How is our blood pressure today?”  When she got to “Are we having trouble walking?” my dad, who started several businesses and has multiple patents, turned to me and asked sarcastically, “Does she have trouble walking also?”  Save the baby talk for patients under four years old.

Another puzzling thing happens if a patient or family member questions a recommendation for yet another invasive test or increase in medication.  The doctor’s eyes narrow suspiciously and you can almost see a little text box over his (or her) head flashing the alarm “Noncompliant patient-Beware!”  You might think a little caution would be in order, since medical errors and complications are the third leading cause of death in the US, responsible for somewhere between 100,000 and 400,000 premature departures annually.  Doctors and hospitals are almost as deadly as cancer and heart disease.  Remember that old saying, “He was at death’s door and the doctor pulled him through.”  There is wisdom in those old sayings.  One of the first things I learned in medical school was the adage, “Primum non nocere.”  First, do no harm.  It was a solemn reminder that every medication has side effects and any procedure can go wrong.  Another saying I learned in medical school, and a personal favorite of my dad’s, is “All bleeding stops eventually.”

At one of my dad’s appointments with a cardiologist, the doctor suggested another coronary arteriogram with possible stents.  I asked, because I did not know the answer, if placing another stent in an artery that had previously been both bypassed and stented could reasonably be expected to provide benefit.  He said he couldn’t be sure unless he looked, but hastened to add that we could also just wait and see how Dad would do on his medications.  Not discussed in our conversation, because cost is almost never discussed, was that an angiogram would cost at least $20,000.  For $20,000 it seems like there should be some reasonable expectation of benefit, wouldn’t you think?

The subject of cost poses the most difficult ethical question in medicine today.  How much intervention is appropriate at the end of life?  Patients who are placed on hospice or palliative care as they approach death spend many thousands of dollars less than those who continue medical therapy.  Interestingly, the hospice patients also live longer.  Patients with heart failure, like my dad, live almost three months longer on hospice than they do if they continue aggressive treatment.  This fact is often used to extol the virtues of hospice care, but I think more likely it illustrates the hazard of futile interventions in the intensive care unit.  More hospital humor – The risk of dying in the ICU increases exponentially with the number of specialists required.  But here is the real good news:  proactive discussions (and written instructions) between you and your physician about how you want to spend the last few months of your life increase your chances for a pain-free, dignified death in the company of your family and friends.

My dad likes to say that he has already lived as long as most people can expect to live, so he is getting ready for his next assignment.  Whenever he hears the siren of an ambulance he grins and says, “There goes another meat wagon without me in it.”