RWL #170 - still in the bunker
Greetings from the University of New Hampshire - Forward Operating Base Last Homely House (FOB LHH)! Hard to believe we’re still at this. My students are hanging on, showing up pretty regularly for class which I thought for sure would be a wreck. But I think it’s important to try to keep on with a routine, even when things get crazy. The Stoics taught that to be happy, you focused on what you can actually control and accept the things that are outside your control. We can control the little spheres around us, and sometimes those spheres get smaller, but it’s important to keep in mind where your influence ends to find some measure of peace. Probably the most important piece I am sharing this week is a short interview with Victor Frankl, which directly addresses this issue.
Also from the Coronavirus Kitchen here at FOB LHH, I made aebleskivers as a treat for breakfast. They’re basically pancake balls with filling. I made today’s with raspberry jam, but we’ve used all sorts of fillings - a favorite alternative is Nutella. Of course we have real maple syrup to dip them in - we are in New Hampshire after all. Here’s a video on how to make them. I use a cast iron aebleskiver pan and I don’t have any trouble with flipping them. There’s something satisfying and old about cooking with cast iron. Also, how can you not be happy eating a big pile of pancake balls? If you can’t control anything else, you can at least cook. :)
I’m continuing with more links. I feel like I need to share more in this crazy time. I hope you find them useful - as usual, feedback is welcome.
Wishing you all a happy Passover and happy Easter from FOB LHH. This will end and we will get back to life. Hang tight, cook some good food, read, watch, and listen, and take care of each other.
Read
What: US DHHS, Hospital Experiences Responding to the COVID-19 Pandemic: Results of a National Pulse Survey March 23–27, 2020
https://oig.hhs.gov/oei/reports/oei-06-20-00300.pdf
Why: A report from the HHS OIG on how hospital responses to the outbreak of the coronavirus. The office of OIG has been in the news a lot lately. If you haven’t spent time working in the federal government, you may not be familiar with the OIG function. The OIG provides a check on powerful agencies to ensure they are doing what they are supposed to do. But they also engage in fact finding missions, which is what this report is. For those of you working in the field, this represents a good review of the state of things two weeks ago. The first couple of pages are a summary of the findings. They are worth skimming over. We have to start thinking about after this pandemic - what we are going to do as a health system to be better prepared for the next time this happens. That is the value of this report in my opinion.
What: NEJM, Fair Allocation of Scarce Medical Resources in the Time of Covid-19
https://www.nejm.org/doi/full/10.1056/NEJMsb2005114
Why: I identify, among other things, as a free market economist. Based on what I have studied, I know markets generally produce the best allocations of resources. One of the challenges of markets is time. Markets can work fast under the right conditions (e.g., we don’t have Federal agencies blocking private actors from responding to the crisis), but those responses still take time. One of the questions is how efficient and effective is it to engage in command direction by government actors rather than let the market process work? My response is when time is too short to let the market work, then command direction is probably necessary. This article takes it for granted that allocation should be done by a central government agent. It then proposes a number of practices that could be used for a “fair” allocation of resources. These are interesting to review and consider for their various tradeoffs.
One thing to watch out for with this sort of approach is there is always an urge to centrally control the allocation of resources - medical or otherwise. Centrally planned economies don’t function well in any longer term time frame because central planning kills the incentives for additional capacity - markets ensure allocation and reward additional capacity, but take more time.
Watch
What: Viktor Frankl: Why Self-Actualization is Nonsense
Why: Given we are in the midst of both Passover and a very real plague, it seems appropriate to share an interview with the writer, philosopher, and Holocaust survivor Victor Frankl. In this interview Frankl discusses one of Nietzche’s aphorisms was “He who has a why to live for can bear almost any how.” This is an idea talks about in this video. He doesn’t actually think self-actualization is nonsense, but that the pursuit of self-actualization for its own sake is nonsense. He says self-actualization is a by-product (he says it “falls in your lap”) of the pursuit of meaning.
Also in this video the interviewer asks him to talk about a moment he discusses in his book Man’s Search for Meaning, specifically when he was being held by the Nazis in a death camp, and he remembered he and his fellow prisoners coming outside to appreciate the sunrise. He refers to the moment as “being rather than possessing”. Appreciating the moment. My interpretation of his words is that when the world takes away all your choices, you can still choose your attitude. You can choose how you meet life, however big or small your sphere of control becomes.
What: WMUR, Neighbors of Durham nurse show support for his work (about 1 minute)
https://www.wmur.com/article/neighbors-of-durham-nurse-show-support-for-his-work/32082828#
Why: And now for something lighter… This sweet little video was shot right here in Durham. Healthcare providers are being appreciated a little more than usual. Watch this, feel good for a minute before returning to our usual programming.
What: Moodivator Vintage Fitness (5 min)
Why: HT to my wife K. for sharing this with me. This is just a little fun. People can be so clever, and with technology, we can all share like we never have before. Right at the outset of the pandemic and the shut down our little community gym announced it was closing permanently. K. and I have since then been trying to maintain a reasonable workout routine in the living room with a few dumbbells and physical therapy bands. This video by motivational speaker Carole Bertuzzi Luciani has some fun with people like us who are trying to maintain their usual workout routines in spite of the shut down. This will make you smile. It’s still necessary to maintain some sort of fitness routine, especially if you are eating aebleskivers, but you don’t have to feel bad if it doesn’t look like it did.
What: Zoom Surprise: Some Good News with John Krasinski Ep. 2 (17 min)
Why: Here’s another feel-good video for you, and another example of someone taking control of their own sphere. Now granted we’re not all television, movie, and Broadway stars, so what we create isn’t going to get millions of views, but Krasinski is really bringing a little light to the darkness of this time with his funny and gentle show. There’s a real surprise in here if you are a Hamilton fan (and you haven’t already seen this video). In case it’s not obvious, I love how people are adapting to this new reality and really exploring the possibilities technology creates.
Listen
What: Counterpoint: MIT scientists translate coronavirus protein structure into music | Ars Technica
Why: So this is just weird. I don’t want to like anything about this virus, but what the MIT folks have done is rather interesting. They’ve mapped the protein structure of the virus into a spacey musical wandering. I start to kind of like it, then I remember what this horrible thing is and what it is doing. I do like this quote about how we process information:
"In one sweep, our ears pick up all of its hierarchical features: pitch, timbre, volume, melody, rhythm, and chords. We would need a high-powered microscope to see the equivalent detail in an image, and we could never see it all at once. Sound is such an elegant way to access the information stored in a protein."
The whole thing is almost two hours long - I suggest dipping in at a few different points to see the variation (it’s repetitive for long periods).
What: Ten Blocks Podcast, Covid-19: The Impact on State Budgets
https://www.city-journal.org/covid-19-economic-impact-on-state-budgets
Why: This is a rather depressing review of the financial impacts of the pandemic on state and local budgets. Most of the dialogue today is focused on the Federal response, but states in particular are being hamstrung by high deficits and debt, in particular due to poorly managed pension funds. Part of readiness is fiscal health. Many, if not most, states are in poor fiscal health.
What: NEJM Catalyst, Covid-19 Message from Milan: Be Ahead of the Curve. You Cannot Wait.
Why: An orthopedic surgeon from Italy’s hard-hit Lombardy region discusses how he and his community have been affected by the Covid-19 pandemic, and shares lessons learned. It’s a little dated (things are getting dated fast), but it’s powerful. Something to hang onto after this is over. As I’ve mentioned, I have family in Milan. Luckily they are all safe, but my aunts and uncles are all over 60 and at risk. I have watched the news there with personal interest.
Thanks for reading and see you next week! If you come across any interesting stories, won't you send them my way? I'd love to hear what you think of these suggestions, and I'd love to get suggestions from you. Feel free to drop me a line at mark.bonica@unh.edu , or you can tweet to me at @mbonica .
Also, if you find these links interesting, won’t you tell a friend? They can subscribe here: https://tinyletter.com/markbonica
See you next Friday!
Mark
Mark J. Bonica, Ph.D., MBA, MS
Assistant Professor
Department of Health Management and Policy
University of New Hampshire
(603) 862-0598
mark.bonica@unh.edu
Health Leader Forge Podcast: http://healthleaderforge.org
'It is the small things, everyday deeds of ordinary folk, that keep the darkness at bay. Simple acts of kindness and love.' - Gandalf (The Hobbit: An Unexpected Journey)