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Open Book Blog Hope – 19th February   Leave a comment

via Open Book Blog Hop – 19th February

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Posted February 20, 2018 by aurorawatcherak in #openbook, Uncategorized

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Spark That Lights the Fire   4 comments

Feb. 19, 2018 – Tell us a story about a time when a piece of inspiration hit you. We’ve all had them.

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1. Link your blog to this hop.
2. Notify your following that you are participating in this blog hop.
3. Promise to visit/leave a comment on all participants’ blogs.
4. Tweet/or share each person’s blog post. Use #OpenBook when tweeting.
5. Put a banner on your blog that you are participating.

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I get inspiration from a lot of different places. My apocalyptic series Transformation Project comes from news media interacting with my college studies of political science and all the lovely conspiracy theories available out there.

The Willow Branch (The Daermad Cycle Book 1) by [Markham, Lela]But I can’t point to just one point of inspiration. It’s more like a lot of bits of information that finally got together to propel me toward a story.

Now, Daermad Cycle started with an inspirational moment. It was close to 25 years ago. Our daughter was a baby. It was a hot summer day and a rainstorm rolled in. My husband and I were sitting in our one-room cabin, watching the kid try to catch her toes and listening to the raindrops pattering on the roof. Brad turned on one of Enya’s albums.

I remember the dog and the baby were snoring in unison and the music and the rain took my imagination to a new world. It was a rainy green meadow that stretched from high mountains to distant forests. A man was riding a sorrel mare along a trail between tilled fields and intermittent copses of trees. I could see water around the foots of bushes and trees and see young shoots pushing their way into the spring air. And, then, ahead, was a stone wall and a rough gate in it.

And that was my image of Celdrya and the character of Padraig who forms the central ensemble of Daermad Cycle. The scene appeared in The Willow Branch. I wanted to get to know that character and actually, the first several scenes for the book wrote extremely easily. Of course, things have changed as I worked on the early drafts, but that scene had to make it into the published book because … well, it is the spark that lit the fire.

What I Hate About Valentine’s Day?   4 comments

 

Valentine’s is this week. Chat about the most irritating thing about this event.

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Image result for image of valentine's day commercialisationHate might be a bit too strong of a word, but I do find a number of things very annoying about the day. Let me just concentrate on one.

Like almost every other holiday in the Western world that once meant something, Valentine’s Day (which really didn’t mean that much ever) has been reduced to commercial appeal. Buy, buy, buy! Grease up that Visa card. Take your love interest to dinner, buy flowers and candy and jewelry, maybe vacation in the Caribbean, and, last year, I caught a car dealership suggesting a new car was just the ticket to spice up your love life.

Americans are incredibly in debt. We were in deep debt when the financial collapse happened in 2008 and some of us learned to cut up our credit cards then, but recent news says we’re back wearing off those magnetic strips, so our debt is once more growing … and that’s a horrible idea. Yeah, yeah — flowers and expensive chocolates and bling-bling are all great … but what you’re really giving your loved one (if you’re married) is 30 years of paying it off.

STOP!

I know a couple of have spent the last few years paying off 10’s of thousands of debt and for Valentine’s Day, they’ve invited a bunch of us who supported their efforts over for a potluck at their place. They’re showing the love by not spending a lot of money. Brad is voicing an audio book for me. That costs nothing except time. I’m almost done with matching couch quilts that set me back $40 over the space of a year. Our son asked if he could make his girlfriend dinner since we won’t be home. She’s bringing desert and a video rental, so the whole evening with set him back $20.

And Valentine’s Day might actually mean something this way because it won’t be about buying the “best” and most expensive gift and then paying it off forever until it costs 10 times more than it would have originally. My audio book may actually make me money.

How romantic is that?

Discovering Great Characters   2 comments

Feb. 5, 2018 – Character Development; How do you achieve quality character development?

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lifeasweknewitTruthfully, I wasn’t sure about this topic at first because I don’t really work very hard at developing characters. They introduce themselves to me and reveal their histories, passions and quirks to me as I set about recording the story they tell me. I am more in agreement with Ray Bradbury that allowing interesting characters to run through your plot being authentic to who they are is the way to write better books than I am with writers who labor over the creation of a character. Yes, I do occasionally have to create a character to make something work in the plot, but they are never the characters I want to spend time with, so they never become main characters.

Despite that sort of laissez faire attitude toward character development, I do have a few steps I go through when I write to assure that my characters are living up to the standard of an entertaining character.

After I’ve finished the first draft of a novel and I come back to it for rewrite, I start by asking myself some questions. Did I put my characters in some challenging situations? If not, I fix that. How did my characters react to the challenge? Do they express strong opinions?  What are their connections? Do we see them and are they helpful to the plot and the characterizations? Have I left some ambiguity in those relationships? Are my characters being faulty enough? Do they hold grudges and are those grudges about to crawl out and bite them on the butt? Are there some everyday interactions mixed in with the plot-driven action?

 

I’m going to focus on Transformation Project because I have a lot of characters, but this series has two brothers who are sort of polar opposites and either one could be “the hero”.

objectsinviewWhen I first began writing the series, the only character that existed was Shane Delaney and he was perfect – a secret agent who would always rescue the damsel and save the town — well, there wasn’t really a town yet. He was a cartoon caricature suitable for a one-off tall tale told on a road trip.

Shane Delaney developed during writing the first draft of Life As We Knew It. As I got to know him during the first draft, which actually started the day Shane returned home to Emmaus, I recognized that he needed flaws, even some Kryptonite to make him more human. I paused to ask him about his backstory. And, man, what a painful backstory, including the suicide attempt that opens the series. I didn’t see that coming. So I rolled the action back two months in story-time and I put him in the bottom of a pit and kept him there for half the book – and then had him switch to being a total mercenary halfway through. On the outside, he’s hard and single-minded. On the inside, he’s closed off and in denial. He’s got a lot of psychic bruises from the times he has violated his own conscience. These things keep him up at night and make him unable to trust anyone, not because they aren’t trustworthy but because he deems himself to be untrustworthy. And, sooner or later, that tension is going to be his Kryptonite. He’s going to come to a place where there’s no more hero left and then … well, I’m not telling. I don’t even promise that Shane will be one of the people to survive to the end of the series. He started the series with a gun barrel in his mouth, so what are the odds he’ll survive? But he’s so much fun to write, so … his dark night of the soul will come and it will be transformative. Will he remain a hero or become Che Guevara? You’ll have to buy the books to find out.

Cai is Shane’s older brother, and he’s always been the good son, the steady fellow. He’s done one truly immoral thing in his life and it turned out really badly, so he’s sworn that off forever … or plans to anyway. While that past stumbling block has colored his relationships, if  the Apocalypse had not come, he’d have been a good lawyer, a good father and husband, deacon at the local Baptist church and a comfort to his parents in their old age. And, he’d have been the one to go collect Shane’s body someday and wonder what happened to bring his brother to such despair.

A Threatening Fragility Front CoverAh, but the Apocalypse did come, and that presents me with an opportunity to challenge a plain-vanilla character with some difficult circumstances and see if he grows and changes. The thing about the world flipping and sliding down the road on its roof is that it will either make heroes of ordinary men or destroy them. I’m not rushing the transformation of either brother because it’s a series and it’s really only been about a week in story-time. Cai got tossed into a labor camp during the third (most recently published) book A Threatening Fragility and spent much of the book being victimized and feeling sorry for himself while making no real effort to escape … which makes sense because he’s not a mercenary. He’s a lawyer whose Kryptonite is that he’s a rule-follower. It sure looked like he would be rescued at the end of that book, but the danger isn’t over in Thanatosis … it’s an evolving situation. Cai hadn’t developed the skills to stand against oppression. He’s not got the great passions of his brother. His triggers are few. He’s mellow. What will he do when what he cares about is endangered and breaking the rules is the only way to save the people he loves? That’s a fascinating research experiment for me. What happens when good and boring people are pressed beyond endurance and must either act or come to an end?

One of the areas that I focus on when rewriting is assuring that my characters express their opinions. A lot of writers are afraid to give their characters strong opinions for fear of seeming overbearing, but I wrote a town full of people who have strong opinions. I don’t want them all to agree with one another. I didn’t start out writing Shane to be an atheist — well, really more like a deist because he acknowledges God might exist — and he currently hates the guy’s guts. Yeah, a born-again Christian wrote her lead character as a God-hater. This is what happens when you let your characters reveal themselves to you rather than construct them. On the other hand, I wrote Cai Delaney to have a strong faith. They’re adult brothers living in the same house and they are going to express their opinions.

I wasn’t planning on making a love triangle when I wrote Shane, Cai and Marnie, but Shane reacted to her like a cat reacts to a dog, so I had to explain that. Marnie has her own backstory and I was frankly surprised when it turned out she and Shane had dated. That creates a triangle. Most fictional relationships are fairly simple dyads – two people interacting with one another, but throwing in a few triangles is useful because those more complex relationships yield big rewards. Shane will be part of another triangle between Jazz, himself and someone else at a later point in the series. Because the character of Shane is part of a large family, he has many of these triangular relationships and I love the tension that creates. Our emotions are not rational, and our relationships aren’t, either. If I were a romance writer, I could use sexual attraction as the great motivator for millions of bad character decisions, but I can also work that tension into relationships within an apocalyptic or a fantasy, because the same rules for building strong characters apply, it’s just not the focus in non-romance fiction. Yeah, my people are dealing with the end of the world as they know it, but they can stop for a second and deal with that past history that has become front and center once more because they’re all living in the same house. What if, in the end, Shane’s protection of the town is compromised by his unrequited feelings for Jazz? Yeah, see what I mean about tension?

I think the secret to great character development (especially when your characters tend to develop themselves) is discovering what their passions, fears and failures are and determining what their Kryptonite will be. I introduce these stimuli to my characters and see how they react. A lot of times, I really don’t know how a character will react to a particular Kryptonite stimulus until I start writing it. No, I don’t interview them. That’s way too mechanical a process for my style of writing. I write my way through it. I discover it as the reader would discover it. Sometimes it works and sometimes it doesn’t. Often it requires a lot of editing to make work well. But the initial exploration of how a turn of a plot will effect my characters is done on the page. Occasionally, I have a character refuse to do something I want and suggest other possibilities. It’s always a surprise and a struggle when that happens, but ultimately it works because I get the authentic reaction of a fully fleshed-out character rather than just what I think they should do.

It’s like writing magic. I don’t know what will happen until it happens on the page, which is exactly the way the reader experiences it. There can be weaknesses in that method. It lends itself to blind spots, but I give good consideration whether that spontaneous fiction actually works when I am rewriting, thus drawing key influences from those who construct their characters.

A final word about writing characters. I have several races in my fantasy series, Daermad Cycle, and I separate them by different ways of speaking. It’s a series that has racial tension as a dynamic and so I state outright what the differences our. The round-ear humans don’t particularly like or trust the furl-eared, catslit-eyed elves and this causes problems that they need to overcome if they want to survive.

On the other hand, Transformation Project takes place in 21st century America the day-after-tomorrow. Based on the demographics of my real-life pattern town, it is a mostly white community, but I’ve included a few racial minorities to be true to reality. I don’t necessarily tell my readers that because I believe that in a survival situation, it wouldn’t mean much that Vin and Lila are black. So, I seriously contemplate how they would speak and what attitudes they might have that would show their slightly different culture. I provide hints in their physical description that they’re not white, but I’ve deliberately kept it subtle because, based on my own life experience, it doesn’t matter to most people.

My way is certainly not the only way and it may not even be the best way, but it works for me and I hope it works for my readers.

Do go see what my fellow authors have found works for them.

Posted February 5, 2018 by aurorawatcherak in Blog Hop, Uncategorized

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Trust by the Numbers   2 comments

Blog Hop Topic – Do a survey of your readers and publish the results.

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I didn’t participate in the blog hop last week because I really couldn’t think of a poll I wanted to do, but then I hit upon a question that I thought would work.

=How Much Do You Trust Mass Media to Report the News Fully, Honestly and Fairly?

I got different results depending on the forum I asked the question on.

Image result for image of public's trust of the mediaThe blog got likes on the question, but no responses — which was one reason I didn’t participate last week. That happens more often than not on blog polls – mine, anyway.

Facebook fans – many of whom are writers – don’t trust the mass media at all. Well, a few said they trusted some sources more than others and they disagreed about which sources are more trustworthy. There were the perennial arguments over whether Fox News can even be called news compared to, say, network news and if it would be better under the “Fairness” Doctrine. Such is the nature of a “poll” taken on a forum that encourages comments. I have liberal and conservative followers and even a few libertarians weighed in. I’d say fewer than 10% trust the media to any degree at all.

On Twitter, 8% mostly trust the mass media to give them full, fair and honest reporting, while 31% partially trust the mass media. That leaves 61% of the respondents who rarely trust the media to give them the straight scoop on anything.

What do I think about those results?

Twitter respondents are apparently optimists because 39% of them believe you can trust the media to some degree. One woman did comment that she trusts the sources she’s researched and approves of how they were funded. Okay, that makes sense — sort of. But who is to say that – for example, government-funded media is more trustworthy than privately funded media? I watch PBS and see a lot of propaganda being pushed there, then I flip over to CBS and that’s all propaganda. Fox and CNN … news with a decidedly ideological bent sometimes with propaganda mixed in. Some websites are also propaganda, while others report the news from an ideological bent.

I’m not surprised that only about 10% believe the media can be trusted most of the time and only about 40% believe it can be trusted at all, but I suspect we need to be honest with ourselves and say we really can’t trust any one source to report fully, honestly and fairly. You could maybe follow 2 or 3 and get a well-rounded idea of what’s really going on, but they all are slanted so you can’t just trust a single one.

I also asked a few coworkers about this question and got some interesting answers. A couple of them blame Donald Trump and his “fake news” diatribes for making people distrust the media … or they blame Sarah Palin for her “lame stream” media comments. But really, I think — unless you’ve been hiding in a bunker without an Internet connection for, well, decades … you’d have to be pretty naive to trust the mass media, because they’ve done such a poor job of being honest, fair and full in their reporting.  Remember when we were kids and our parents trusted Walter Cronkite to give them the truth? Well, it turned out he was lying and slanting the news for his own purposes. He wasn’t doing anything new, by the way. Edward R. Morrow lied about the World War 2. The New York Times lied us into World War 1 when it insisted the Lusitania wasn’t carrying arms. The Hearst Media empire created fake news to convince Americans that the Maine explosion was an act of war rather than an attempt at self-protection. Heck, newspapers in the Civil War days carried water for the Confederates and the Union. The media claims its goal is to provide full, fair and honest reporting of actual facts, but reporters are human beings who are influenced by their prejudices and who work for editors and producers who sometimes have agendas on one side or the other of an event. How could any human-made institution be wholly fair, honest and full given the biases that are so much a part of us as human beings?

And, there you have it.

Posted January 29, 2018 by aurorawatcherak in Blog Hop, Uncategorized

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Northern Adventures   11 comments

January 15, 2018 – Share a recent travel experience or anecdote.

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I heard recently that about 40% of Americans have never traveled outside of the United States and about 11% have never left the state they were born in. Wow! When you live in Alaska, which has no land connection to the contiguous 48-states, travel is sort of required to live.

The OP for this blog hop, however, says a recent travel experience. I flew down to Seattle a couple of months ago, but Seattle is just a gateway city for Alaska where my mother’s family happens to live. Kind of boring – Pike’s Market is only super exciting if you live in the vegetable-deprived northland, although I really do want to explore the Puget Sound area more thoroughly when I have time and a car and no relatives suggesting sights within Seattle’s urban environs. The west side of Puget Sound looks cool to me … a mystery that must be explored.

Alaska, however — most everybody thinks that’s sexy. So, digging back into our summer travels -we drove the Dalton Highway this summer.

I do say that living in Alaska is the adventure of a lifetime. Even our Sunday drives can be exciting. We realized that our son had never driven the Dalton, so we decided it was time. Brad has driven it many times as an electrician on the Trans-Alaska Pipeline, but I hadn’t been above Yukon River Bridge for several years. Not a lot has changed since the days when we called it “the haul road” (because the Legislature took decades to name it), but memories fade and I was excited to renew an old acquaintance.

We got up early on Friday morning of the four-day weekend we had planned. It’s 400 miles one direction and this is not a road to be driven quickly, so we were prepared for it to take all four days. At 6:30 in the morning, the June air was crisp and clean and the sun was already up over the roofs to the east, having barely dipped below the horizon from midnight to 2 am the night before. It was sunny and the Jeep was packed. Really, all we had to do was put our toiletries kit and cooler in the car, let the dog and 18-year-old into the back seat and stop for breakfast. I always make a thermos and pack at least one meal before we go because there are not a lot of services outside of Fairbanks, but by tradition, we stop for mochas and something to eat on the way out of town. It’s like a final hurrah to civilization, even if we’re just taking the paved Parks Highway to Anchorage. We had filled up with gas the night before and Brad had checked all the tires, including the spare, and the fluids. We rubbed each other down with sunscreen in anticipation of the day and we made sure we had plenty of water and food. In case you’re wondering, our dog eats dry kibbles off the ground on road trips. As a final step, even though it was June, I checked 511 for the road conditions. You just never know with Alaska roads. A previously planned trip the year before had been canceled when the Dalton washed out at spring breakup.

The first 84 miles of the trip is technically not on the Dalton, which doesn’t start until you get to the mining community of Livengood. It’s a lovely drive on paved highway through alpine regions and we stopped in Livengood for an early lunch/late breakfast from the cooler at which point Brad decided he wanted a nap, so I became the driver with Keirnan shot-gun and the yellow Lab sitting on the floor in the backseat with her chin on Brad’s stomach.

Image result for image of yukon river bridgeThe highway parallels the pipeline for the most part. It’s one of the most isolated roads in the United States. There are only three towns along the corridor and fuel stops are few. The road is mostly gravel. Still, despite its remoteness, the Dalton carries a fair amount of truck traffic, about 160 trucks a day in summer and twice that in winter. Trucks have the right of way and I’m not about to argue with them about it. I signaled every truck that pulled up behind me to let them pass and pulled over whenever I could to make their lives easier.

I have seen the TAPS plenty of times and so has Keirnan, so we didn’t stop until we reached Yukon River Bridge. We went into the visitors center so Keirnan, who is a budding engineer could view the pipeline’s attachment to the bridge and I could use the port-a-pots. Goldeneyes took a dip in the river and Brad woke up. It was too early in the season to pick blueberries, but they were in full pink flower, scenting the air with their candy-like fragrance. We walked down the trail to the viewing deck to take some photos. Then we lost our minds at that point and decided to splurge on lunch at the Hot Spot Cafe. Great burgers, fresh salads, and homemade desserts. By this time, it was midday and we decided to let Keirnan drive since he has a learners permit and needs the practice.

Image result for image of finger mountain wayside alaskaIt’s boreal forest on both sides of the highway, some of which was devastated by forest fires in 2005 and 2006. There’s a lot of new-growth brush with charcoal trees standing above, like wicks in a tub candle. We saw a lot of scraggly black spruce, several moose, a fox, a lot of snowshoe hares, and a family of black bears. After a truck scared the daylights out of Keirnan, we pulled over at Finger Mountain Wayside and hiked the trail to the summit. We dawdled taking photographs and then we stopped and hiked to a small lake to fish for our 5-fish limit of arctic grayling. We stopped for the night (though it was pretty early) at the Arctic Circle. This is an undeveloped campground with a nearby viewing deck and picnic area. There’s no water, but there was an outhouse and trash containers.  We cooked the foil-wrapped grayling over a campfire with pan-fried potatoes on the side. Because this is bear country, we pitched our tent a good distance from where we ate and locked up all food in the car.

Related imageWe didn’t rush to get up in the morning. The sun never really went down, which isn’t a problem if you’re used to it. So we lazed about in the tent until the sun began to warm the air. Then we had eggs scrambled with cheese and thick slices of homemade bread slathered with butter and reloaded the Jeep for our second day of travel. We ate grapes during our morning drive.

We stopped at Gobblers Knob because Brad confessed he never had. I’d swear we stopped there once a long time ago, but he is apparently a victim of memory wipe. He had also never stopped (or more accurately, never gotten out of the truck) at the Arctic Interagency Visitor Center. It is such a quintessential tourist stop I just had to do it and we did learn about a fishing stream he hadn’t known about before.

Coldfoot was established as Slate Creek in 1898 by miners. In 1902 it was a toddling little town with two roadhouses, two stores, seven saloons, a gambling house and a post office. By 1912, it was a ghost town. The town revived for a short while during the 1970s during the TAPS construction and then faded. But in 1981, Iditarod musher, Dick Mackey set up a hamburger stand for truck drivers and now it’s an important stop along the highway, but since we’d blown our first day’s food budget at the Hot Spot, we just topped off with very expensive gas and ate sandwiches from the cooler instead. It’s on our return itinerary.

Image result for image of black jeep cherokee along dalton highwayWe stopped for photos and some short hikes along the way, finally pulling into Wiseman, which has about 20 people living in it these days. Most of Coldfoot’s buildings were sledged to Wiseman after the town died, so it’s still a lot of fun to poke around there. I do have some friends who live up in the mountains west of Wiseman, but the Jeep, which a great wilderness vehicle, is not a truly off-road one, so we decided not to attempt a visit. It would have taken us all the rest of the day to travel that far anyway.

We stopped at Sukakpak Mountain. Brad and I climbed it years ago and wanted to give Keirnan, an accomplished rock-climber a shot at it. I made dinner while they climbed and then Goldeneyes and I did a little bouldering while the fish simmered over a low fire. The mountain is an incredible limestone deposition of absolutely gorgeous marble.

Image result for galbraith lakeWe didn’t camp at Sukakpak because the mosquitos were a little heavy – marshy land surrounds the mountain — but also because it was still way too early to stop for the night. We continued northward to Atigun Pass, which is the Continental Divide of Northern Alaska, a narrow wind slot through the awe-inspiring Brooks Range.  Just south of there we passed the last tree on the Dalton Highway. That’s sort of a misnomer. North of there, the tundra doesn’t support tall trees, so trees you and I might know – birch and willow for example, only grow to knee height or so. The mountains to either side of the road are austere, beautiful in a lonely kind of way. Not far past Atigun, just at the start of the Arctic North Slope, is Galbraith Lake where another undeveloped campground with spectacular views of the Brooks Range awaited. We slept there. It was lovely ….

Sometimes during the night, the dog asked to come into the tent because she was afraid of dying of hypothermia. Keirnan had to towel ice off her fur before we could all go back to sleep. It was cold and rainy when we woke up the next morning. Not taking off our shorts and tank tops, we layered on our polar fleece and rain gear. We spent a good bit of the morning hiking around and didn’t leave until mid-morning.

The North Slope is a broad, mostly flat, treeless plain that tilts north from the Brooks to the Arctic Ocean. It’s a subtle place – a land of browns and tans and shifting shadows. Fog glittered around us when we woke up and then the sun peeked through the clouds, sending rainbows dancing.

Image result for galbraith lakeWe arrived at Franklin Bluffs by the Sagavanirktok River (we just call it the Sag). The east bank of the Sag is this rich yellow-tan-orange hue from heavy iron deposits. While I was utilizing nature for a natural activity, I spotted the young lady to my right. It’s not safe to interact with Arctic fox because rabies is endemic, but she was willing to pose for a photo.

Brad has been this way many times, so has more photos from more trips. Here are some of the sights he has seen along the Sag. Those are caribou, not reindeer and they were just a few feet off the highway when he snapped the photo.

Image result for sagavanirktok

But Keirnan got this picture while hiking away from our camp.

Related image

Yes, that’s a muskox. He was farther away than it seems. Keirnan has a telephoto. And we was also part of a herd of about five. No doubt there were more that Keirnan didn’t see.

By design we made Deadhorse in the early afternoon. You can go further north if you pay for a tour that will allow you to see the Arctic Ocean and we did – but I might want to use that tour of the oil fields some other time. The public road ends here. We had lunch at Brower’s Restaurant (the sweet tea was really good and we took soft serve ice cream with us).

And then we turned south and drove all the way to Coldfoot where we had two rooms rented for the night. The rooms are very pipeline man camp-ish and the only reason Brad wanted to stay there is that he can’t stand baby wipe baths for more than two nights. Keirnan and I have dry, curly hair, so it doesn’t bother us, but Brad likes to shower. The breakfast was GREAT and it was so lovely to wake up on the sunny side of the Brooks Range.

Related imageIt was now Monday morning and I needed to be back to work the next day, so we drove pretty steadily back south, taking turns behind the wheel, but stopping for photos from time to time and to get the dog wet. She is happiest when her fur is damp. We stopped at that fishing stream near the Interagency Visitors Center. It was a bust for fishing, but a pleasant place to picnic.

Technically, it’s not on the Dalton, but on the Elliott, but we stopped at Hilltop Restaurant and Truck Stop for dinner. Their pies are to die for – unfortunately, Brad and I are reaching the age where we do need to watch our calories. The sun was still above the trees to the west when we turned back onto the New Steese Highway for the last 10 miles to home.

“So what do you think, Keirnan?” I asked, as I was driving and he was my copilot (Brad having climbed into the back with the dog cuddled to his chest this time).

“The state just got bigger, Mom. I’m sort of use to the idea of it taking seven hours to drive to Anchorage and six hours to drive to Chitina (where we go salmon fishing), but now — wow.”

You can live in that state your whole life and never see all of it, which I guess is as good excuse as any for living here your whole life. I love to travel out and away, but there is something about the road untraveled in Alaska … I can just imagine what it must have been like for the early pioneers seeing it for the first time and smelling the blueberries in bloom and thinking “This is heaven.”

Heaven with the capacity to bite you on the bum anyway.

Posted January 15, 2018 by aurorawatcherak in Blog Hop, Uncategorized

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Interviewing with Expertise   4 comments

Interview someone you follow or admire.

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So, I’m interviewing my cousin Rick, a doctor, for this blog hop topic. I admire Rick a lot because he doesn’t just follow the herd in his thinking, but researches and considers before stating his opinion.

Tell us something about yourself.

Image result for image of doctors opposed to Medicaid expansionI go by “Rick” on your blog to protect my identity because some of what I have to say is controversial and can result in retaliation within some professional circles. I am married with adult children and grandchildren. I work for a major hospital and I am a researcher in a particular kind of immune system disorder that has a high disability and death rate, but the odds of surviving decades longer have vastly increased due to discoveries and treatments developed by the research team I am a member of. I have done two research exchanges to Europe and spent time in Africa and Mexico as a medical missionary. I am now looking at retirement and have not yet decided what I want to do when I grow up. Maybe like my friend Francis Collins, I’ll have a second career in retirement. I don’t know.

 

Tell me about your faith.

I was an agnostic most of my life, but a family dialogue sprang up at a gathering. You and our cousin Bill were arguing with Daniel, who is Bill’s brother, about evolution. Bill’s a biologist who believes in what Collins’ calls Biologos over evolutionary creation and Daniel was at that time a raging atheist who is also possessed of a great sense of truthfulness. I remember you zinged him with the lack of transitional forms and he ended up sputtering. He couldn’t argue something that wasn’t true, but I felt sorry for him because he’d had maybe a beer too many and journalists are trained in being argumentative.

 

I love you too, cous!

Image result for image of doctors opposed to Medicaid expansionSo, I stepped in sort of in the middle and kind of halfway argued both sides. Bill suggested we do a reading group over email (since we live in three different states — the group has expanded within the cousins and now we’re in six different states, (I think). So the genesis was more than 20 years ago. Every time it was your turn to pick a book, you’d pick something theological or philosophical and I felt obligated to read it because you were reading and making substantive comments on our geeky science tomes.

I was sort of lazy agnostic. As a doctor, I really could see the evidence for design in the human body, but I didn’t want to think about a designer. But, slowly, over five or six years of this ongoing conversation, I found myself considering it more and more. My wife renewed her faith and started going to an English-speaking evangelical church when we were in Europe. I went mainly because working in French all day was getting on my nerves. I was hungry to hear English. I didn’t expect for the sermons to mean anything, but before the end of that two years, I had prayed a salvation prayer with Bill over the telephone (largest long distance bill I’ve ever had). I was in my mid-40s then.

 

Do you struggle to reconcile your faith and medical science?

Not really. I discovered that a lot of doctors are deists if not theists. I think my relationship with Jesus Christ has made me a better doctor and my commitment to science has not been lessened in the least. Where I struggle is with other scientists who regard science in an almost-religious view and cannot accept that I might see evidence for God that they are either missing or ignoring. As a couple of the breakthroughs in my field of study involved someone seeing evidence others had been bypassing as “irrelevant”, I find the condescension frustrating.

 

What are your religious beliefs?

I like that you make that distinction. My religious beliefs are similar to yours. I do go to a church that baptizes (or christens) babies, which actually bothers me, but our kids were already near-adults before they accepted Christ, so it was never an ethical problem for us and our daughter married a Baptist, so it hasn’t a problem with our grandchildren.

 

So, what are your political standpoints?

Image result for image of doctors opposed to Medicaid expansionAccept for my first vote for McGovern at 18, I was always a moderate Democratic until President Obama spent us into $20 trillion in debt and never broke 2% GDP while also involving us in seven wars. That irritated me, so I couldn’t vote for him the second time. Now I’m registered independent and not sure who I’m going to vote for. Which I guess is how you have approached every election of your adult life.

 

Pretty much. Did you vote for Donald Trump?

No. You and I are two of the three people who voted for Gary Johnson. I think you voted for him because you believe he was the closest to the libertarian stance of any of the remaining candidates. I voted for him because I just couldn’t vote for crooked Hillary or buffoon Trump, but I could hear my parents in my head telling me I am not allowed to not vote.

 

Yeah, I got my parents in my head too. You and I have had several conversations about medical care in the United States. You were anti-ACA back in 2009.

Yes, I was. A lot of doctors are. They just don’t get the press that the advocates get. I didn’t really support HillaryCare back in the 90s. I’ve worked in European universal health care and was not impressed. Long waiting lines work as triage that results in treatable patients dying before they can get treatment. It’s inhumane. I’d rather have people need to raise money or take out loans and still be able to get treatment than not be able to get treatment at all. And, I saw that a lot in Europe. Unless you had the money to board a plane, you couldn’t get medical treatment. I had people on my waiting list when I got there who died before I left two years later, who still hadn’t reached the top of the waiting list, and they had diseases that would have been treated in the United States and perhaps added decades to their lives. That experience showed me that medical insurance and even universal health care is not the same thing as actual access to medical care. I believed in universal government-provided medical care until I saw it in action.

 

So what would you do here in the United States?

I would like to see a return to the system we had before the rise of the American Medical Association. A lot of hospitals were operated by churches, so patients who couldn’t afford hospitalization were treated as charitable cases. Maybe we’d use community foundations today rather than so many churches, but something along those lines so that hospitalization wouldn’t be so expensive. Insurance was available through fraternal organizations, mostly covering operations and serious medical treatment, but some fraternal organizations had worked out systems where they ran a clinic that doctors worked in at affordable rates. Private doctors offered basic medical care for what the patient could pay. They weren’t quite so greedy back then. Doctors were there to serve patients, not become millionaires. People who could afford it could get top line medical care if they needed it. And it was those doctors who saw those low-cost alternatives and felt they were being deprived of patients and formed the AMA and lobbied the government to regulate the medical industry into the mess it is in today. I think there’s great potential in this country to restore that balance if we can get government and insurance companies out of the way of patient needs.

 

So when we got together in Seattle a couple of months ago, it was before tax reform had essentially dismantled the Affordable Care Act by removing the individual mandate to purchase medical insurance. At that time they were discussing various replacements for Obamacare and you didn’t like any of them, though there seemed to be parts you didn’t wholly hate. So is the setting aside of the individual mandate a step in the direction you would want to head?

It’s a tiny step … a shift from heel to toe. At least they removed one restraint, but there’s a boatload of regulations strangling the US medical care system and plenty of third party entanglement. I am comforted to see the GOP House set their sights on Medicaid reform for the new year.  It’s clear to anyone who is paying attention that the country is spending itself into bankruptcy. We’re in trouble. We have an enormous debt that’s dragging on the economy. You don’t help the poor by not solving problems of debt and the resultant slowing of the economy which keeps them trapped in poverty.  Medicare, Social Security and Medicaid are the largest drivers of deficit spending at the federal level. You need to address all three, but starting with Medicaid is less fraught than the other two.

 

How so?

Old people vote and they have fewer options than the younger population of the Medicaid expansion.  They are not as adaptable. Reform there needs to be put out a decade or so to allow working people to adjust their future plans. Medicaid expansion is a cornerstone of the Affordable Care Act. It’s sacrosanct to the Left. I know you folks on the Right hate it. I had the privilege to begin my career as a resident physician in Missouri and to work in that environment both before and after Obamacare came in. I have a long-time colleague in Louisiana, where they did expand Medicaid, but I live in Missouri where they didn’t.  Moreover my daughter is in medical practice in Kansas, which has some of the innovative direct-care solutions that I advocate. So, I’ve had a chance to observe Medicaid expansion versus non-expansion and to render a learned opinion. Simply put, expanding Medicaid will not be society’s cure for indigent medical care. It’s the equivalent of putting a Barbie Band-Aid on a brain aneurysm.

 

You are not a free-market fan like I am, but you’ve said you think the free market is the answer to the woes of the US medicare system.

Yeah. I’m a research-driven kind of guy and you’ve introduced me to a lot of information that supports what my gut feeling has been for nearly 20 years. Medicaid reform would greatly improve the medical system in this country.

 

Explain what you mean.

Well, let’s be honest. Many of the characterizations of the GOP Senate’s previous medical care plans as inadequate were very reasonable and debatable in a real-world context. You and I debated them and came to the conclusion that they were inadequate. My bosses would have been proud. Simply put, the GOP Senators (with the possible exception of Dr. Rand Paul) were being stupid, as if to show the country that they really didn’t have a plan. But now, the real issue is that the Republicans truly have an opportunity for market-based reform that would actually drive the equity Democrats crave, mainly because continued Medicaid expansion will not be a sustainable long-term solution.

 

Whoa! So you think it’s doomed?

Yeah! First and foremost, Medicaid is simply bad insurance. The definitive study on the subject in the New England Journal of Medicine noted no substantial improvements in physical health outcomes for two years in patients randomly selected for either having Medicaid or no insurance in Oregon.

 

You were the one who introduced me to that one.

Well, of course. It’s my area of expertise. What this study did was excellent. It compared Medicaid patients to those who have no insurance at all and found the differences in outcomes are minimal and in some case worse than if they had no insurance.

Now, Medicaid hasn’t been expanded in Missouri, but I did some research on Lousiana’s Medicaid expansion. Medicaid spending will represent nearly one half of Louisiana’s $28.6 billion budget in the 2018. It seems mildly intuitive that the billions spent on Medicaid expansion could have been used in a more efficient manner, or more justly, returned to its owners, the taxpayers. See, I have been listening to you. Furthermore, Louisiana lawmakers had to add $368 million more in federal funding in May because of misjudged age and health statuses of those who joined. It’s a goat-rope and we all know what happens to the goat eventually.

 

So what does all that spending get them?

Well, you know … you used to work in a Medicaid-recipient agency.

 

It can be hard for those with Medicaid to find quality care.

That’s because Medicaid, on average, only pays about 71% of what Medicare, which is the government program for those over 65, will pay a physician for a given procedure. Private insurance, on average, will pay roughly 150% the Medicare rate. It doesn’t take too much insight to understand why nearly one third of doctors simply won’t see Medicaid patients. A lot won’t see Medicare patients, which should give us pause, but it’s the topic of discussion at the moment.

 

Is it fair that nearly one-third of doctors won’t see Medicaid patients?

We could debate that. I think it’s a sign of greed, but there’s also the satisfaction factor. I want to treat a patient and make them well or at least extend their life and quality of that life, but Medicaid rules on treatments and medications often tie my hands, so would I see Medicaid patients for a reduced rate if I didn’t work for a major research hospital that requires me to see them and live with the frustrations of knowing I could make their lives better? That’s a hard one. What would I do if I were in private practice? But, hey, let’s not chase that ethical rabbit.

Suffice it to say that you have people who believe they have insurance, but in reality they might as well not have insurance. Medicaid plans are largely managed care structures. Medicaid pays a private entity to manage a fixed set of dollars per patient. This creates incentives to gain patients or to “cover lives” without providing any incentive to pay for services or provide actual care. This has real-world consequences.

 

Runaway diabetes in the chronic mental health population?

Among other issues, yeah. I’ve got a friend in New Orleans … a colleague, who tells me his neurosurgical service runs a free-care clinic. It takes care of all patients regardless of their ability to pay. This has taken place pre- and post-Louisiana’s expansion within the Affordable Care Act. Simply, the physicians in the clinic evaluate patients for surgery on the nervous system. This tends mostly to be spinal surgery. And, they’re under intense pressure to not provide those services free of charge, but to cover those clients under Medicaid. The state and local AMA is pushy about it. My friend and his colleagues don’t want to do that because it is far easier to schedule and perform surgery on patients without Medicaid than it is on patients with Medicaid. The amount of administrative red tape is stifling. Patients with significant pain are turned away because their specific disease diagnosis code does not meet the standardized peer-reviewed requirement for surgery approval. This can be sickening, frustrating, and disheartening.

And it’s a treadmill experience. Patients are told they need surgery. Several days later they are told their insurance won’t pay for it unless certain qualifying steps happen first. They have insurance that prevents them from getting care, so what is the purpose of having insurance?

We should not be throwing one of our worst insurance options at our most vulnerable populations. And the doctors who advocate for Medicaid expansion don’t have to explain to these patients that they have a facsimile of insurance, but it isn’t ordinary insurance, it’s Medicaid. They leave that to the gals in the billing office and the social workers. It’s not equity. It’s morally wrong. I sincerely doubt that any Democratic lawmaker in Louisiana, Missouri, Kansas or Alaska would ever deliberately seek out Medicaid insurance for themselves or their family. However, it’s worth asking, how many Republicans would want a family member to have no insurance rather than Medicaid coverage? Some of them tout Medicare, which has its own problems, but none of them advocate for Medicaid for their own families.

The tragedy is that sincere options exist for a market-based  “universal” medical care apparatus. There are a variety of truly thoughtful policy constructs that could challenge our assumptions on medical care. We should be asking ourselves some questions. Why should we continue to link medical care insurance to our employer? Employers generally are not required to provide food, clothing, and shelter, but we feel they should provide medical care? Why?

 

It’s a substantial tax loophole, and vestigial counterbalance from the wage restrictions of the Great Depression.

Now you’re just showing off having read The Forgotten Man. The Great Depression has been over for 60-70 years and I would say, those who refuse to learn from history are destined to repeat it. Maybe instead of this bewildering system that is Obamacare, we could actually make moves for price transparency in medical care, embrace a savings account platform, and look to reduce moral hazards in medical care? Right there, you would achieve a gradual reduction in medical care costs. Then there’s direct primary care, where you pay a set monthly fee for access to a clinic for all treatment less than hospitalization — and it’s cheap. In Kansas you can cover a family of four for $300 a month, which is about one-quarter of what my daughter pays for ACA-required insurance she almost never uses. You augment that with a high-deductible plan (sometimes called a catastrophic plan) and a medical savings account. People now have wrap around medical coverage at half the price they’re paying today and because they pay the bills directly, they care about the costs, so they ask the big questions — Do I need this treatment? What are the alternatives? Now do I prevent a major medical event that is going to wipe out my medical savings account? That drags the cost of medical care down and, as they see their compensation shrinking, doctors hopefully remember why they went to medical school in the first place. I know I didn’t spend 15 years of post-graduate exhaustion to be a millionaire. I wanted to work in healing.

My heart breaks when I look at Congress right now. They have a once-in-a-generation opportunity for real transformative reform that could help all people and they’re blowing it because they are judging policies and programs by their intentions rather than their results. Instead of talking about wanting to “throw people off medical insurance” (which is the AMA and Democratic Party talking points) they ought to be looking at whether the system that replaces it would treat more people, more effectively and for less money. Now just less government money, but less money in real dollars. Until they do that, both parties are failing Americans when it comes to medical care.

 

Wow, big topic! Important topic. I could chase a thousand rabbits here, but let’s just let what you’ve said rest for now. Thank you for stopping by the blog. 

Posted January 8, 2018 by aurorawatcherak in Blog Hop, Uncategorized

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