Author: Jim Dowd

[ed note: Jim Dowd, as many of you know, was diagnosed with a Grade IV Gioblastoma last August. He recently entered hospice care at home and is as peaceful as one Jim Dowd can possibly be. He hates condolences. His amazing wife Bo transcribed this for him. – KT]

Carbon has a half life of approximately three and a half thousand years.

Right now, I’m basically a big bag of grass clippings.

That grass specifically having been corn processed into the “ITO” family of products.

Fritos

Doritos

Tostitos

In about 3000 years the protons and neutrons and electrons from these carbon atoms will probably get picked up by the solar winds.

They’ll fly around the solar system just as they did the first dozen billion years out from the big bang. I imagine it as a carefree time.

As I am mostly carbon I imagine there is lots of useful material I could be incorporated into. Maybe structures or even potentially living things of the microbial variety.

So, if you are looking for me, you’ll most likely find me at the bottom of a yogurt in the chunky stuff.

I’ll try to remember to smile as I pass through.

Clam Nation, Question 1 is the November 2018 ballot question which has caused the most consternation among your Clamrades, who are pretty much split down the middle or undecided regarding the vote.

Short answer: vote yes because it will keep more people alive.

Question 1, also known as the Patient Safety Act, would mandate specific patient staffing ratios at hospitals around Massachusetts. There’s a lot of uncertainty, speculation, and rumor surrounding Question 1.

Because we haven’t had enough of that yet, ffs

Here’s our analysis: Nurses are the front line of healthcare. For instance, if you wind up in a neuro ICU because an undiagnosed tumor in your brain just made you have full-on seizure including chewing on your tongue like a fruit roll-up, the people doing the actual work of keeping you alive (putting in lines and tubes, ordering tests, giving meds, all the actual action), will be done by nurses, not doctors.  

The pressure we currently put on nurses burns them out and they quit, especially floor nurses. Therefore: less burnout = more skilled nurses coming back to the bedside. And staffing more skilled nurses = less patient death overall because a skilled nurse is often the thing between a live patient and one stepping into a lighted tunnel going, “Granddad, you lost weight!”  

The outcome of the vote could change quite a few things around the highly-influential and science-y neighborhood that is the Massachusetts Health Care Industrial Complex, which regularly treats the sickest people in the world and gets penalized because of it (people come here literally from all over the world because they are really sick for treatment, some of them die, and we look like we’re not doing a good job).

So we would like to dissect the issue. Because that’s what nerds do. Also, we eat a lot of Fritos (unrelated). 

The Mass Nurses’ Association (MNA), our state’s most powerful nursing union, spearheaded this ballot initiative because of staffing concerns in hospitals throughout Massachusetts. There have been disagreements, even among nurses. Some are comfortable leaving things the way they are and say “This proposal undermines the flexibility and decision-making authority of nurses and puts rigid mandates above patient safety, clinical nurse input, nurse manager’s discretion, and every other consideration in a hospital.”

For hospital administrators and management staff who actually listen to floor nurses, this is great. However, would you believe some hospital administrations are more focused on the bottom line than they should be in our for-profit healthcare system? Shock, no? nursing unions exist for this reason, and we guarantee someone you love is alive because of them.

Looking at the hundred-year history of the MNA, it’s pretty interesting. And then, in 1994, it gets REALLY interesting.  With the introduction of managed care, health care systems in Massachusetts became more corporatized and, by design, pushed to get more for less. The nursing union pushed back because I mean, have you ever worked a 12-hour shift without going to the bathroom while being required to help everyone around you go to the bathroom, and then OMG there’s also a literal ream of paperwork you need to finish before you go home? That is some real Kafkaesque shit right there.

Not to mention being punched in the face, verbally abused, or possibly stabbed.

Meanwhile, in 1999, California passed AB 394, a benchmark safe staffing law similar to the one on the ballot here. In 2004, AB 394 was implemented. There isn’t anything else like AB 394 in the entire United States, so we don’t have much of a basis for comparison.

If you look at the “No on 1” website, they claim the effectiveness of mandated staffing ratios is “not scientifically proven” (right up there at the top of the page). ORLY?  Well, thank goodness after AB 394 was passed, a whole bunch of highly-credentialed folks including nurses, doctors, and policy wonks decided to study the outcomes of mandated ratios over several years.

While only 1/50 states have anything this comprehensive on the books, California is basically a country of 40 million people with a massive health care system. A quick Google search will take you to several publications touting the effectiveness of the mandated staffing ratio they implemented, even if only a little more effective than being without one. Your Google experience may vary – and always check your sources. Some hospital systems have published findings skewed in their favor.

“Nurse staffing and patient outcomes: a longitudinal study on trend and seasonality” There are lots of equations and deltas and variables here, and right off the bat, the authors stipulate more research is needed. However, they found evidence that the incidences of things like falls and pressure ulcers (both of which kill people) lessen when there are more nurses on staff.

References to a study by Linda Aiken, Ph.D. RN, comparing staffing, staff satisfaction and patient outcomes in California to those in New Jersey and Pennsylvania:  
DPE Fact Sheet
UPenn’s LDI Issue Brief
Lower burnout rates = better employee longevity = more experienced nurses taking care of us over a longer period of time.

Newark, probably

Some emergency room nurses are actually afraid the hospitals will make them turn patients away if this mandate is passed, which is why they’re voting no. What is particularly shocking to us is that hospital administrations would continue to spread this rumor, putting the burden of responsibility on their staff. Thankfully, since 1986, it’s been illegal for hospitals to turn people away as long as those hospitals take Medicare. Though to be fair, that requirement combined with ratios does create a potential conflict. But the law does give wiggle room for a crisis. 

“Question 1 would remove real-time decision-making power from nurses and caregiving teams and put it in the hands of a rigid government mandate.”

No. Just No.  Nurses exhibit real-time decision-making power all the time. Nurses need to think about notifying doctors of one person’s critical labs as they wade through blood and shit and are berated and harassed. Having fewer patients to focus on will give them more time they need to make decisions and advocate. Again, put yourself or your loved one in that bed and ask, “How much time should the nurse be given to review the critical lab results before they have to go deal with changing the fluid bag in room 5?”

If you have misgivings about government oversight of staffing, think about day care centers. Sure, a daycare provider would get more bang for her buck by having a 12:1 ratio. But would you really want to leave your kid for 10 hours with someone who has 11 other children to watch? Nah. Neither did other people, which is why Massachusetts imposed staffing regulations on licensed day care centers.

To be real, nobody in Massachusetts really knows what the health care climate here will be like if people vote in favor of mandating nursing staffing ratios. But if you end up in the hospital, do you want the nurse who hasn’t eaten in 12 hours, or the one who isn’t going into hypoglycemia as she takes your blood pressure? From this writer’s perspective (and the experience of the entire fucking state of California), more nurses = less death.

The politics behind this one are weird. The MNA fought for years to try and get some measures taken to protect their members through the legislative process, only to be outmaneuvered the whole way. So finally, they took Every. Single. Thing. on their wishlist and got it into a ballot question. If this had managed to go through the Legislature (where good ideas go to die at the hands of Speaker DeLeo) we’d probably have a common-sense system now, and not an incredibly expensive, divisive ballot question. Thanks, spineless legislature!

For a mostly balanced perspective on this topic, head over to WGBH’s take on the matter.

Last note: The final claim is regional hospitals will have to close because of mandated ratios. We can’t believe this is even an argument. Charitably, it’s the “You have to let us keep coal mines unsafe, otherwise you won’t have any coal,” line always made by billionaire coal-mine owners. Uncharitably, it’s what the passenger representative says to the press from the wing with a Kalashnikov in her back. “Just give the guys holding the plane what they want and they won’t kill us…or at least all of us.” It’s a hostage-taker argument. It’s obscene that it’s being made. We’re the richest country in the world. We can have safe regional hospitals and nurses not so exhausted they’re guaranteed to make critical mistakes. The end.

Threatening us with death: not the foundation of a productive discussion

Greetings, Clamunists. Are you enjoying the heat? We, ourselves, walked our dog in the woods last week and it felt more like a fateful patrol in a Nam movie. We fully expected a member of the Sheen family to show up and start imparting wisdom in the form of low, growly and possibly cocaine-induced narration.

As our brain cooks inside the Instapot of our skull, something has been annoying the piss out of us. More than one person has reached out in a rage about the several housing developments going up, decrying it as a sure symbol of “Gentrification” – the dreaded “G” word which indicates Gloucester will very soon be Newport Rhode Island and we will all be forced to wear red shorts and boat shoes with dress shirts. Then we will all perish from punching ourselves to death, as is just.

They had breastplates like breastplates of iron, and the sound of their wings was like the thundering of many horses and chariots rushing into battle. They had tails with stingers, like scorpions, and in their tails they had power to torment people for five months.

Gentrification is real. And a massive challenge. And happening. But it is not just “shit you don’t like.”

See, here is the thing. If a person wanted to actually do something effective against gentrification, they would do all of this (which have been done other places, look it up, there are case studies):

1. Create very strict rent control You would tell landlords, individual owners, many elderly, oftentimes somebody’s grandma, what they can charge for rent. As you can imagine, this would not be popular. But if you actually care about gentrification, you would do it. You’d have to.  
2. Buy up all the available developable land and put it in trust This would cost hundreds of millions of dollars. And the land wouldn’t be fun parks or whatever, it would just be undevelopable rando plots of land. That will be a fun city budget item to propose: “We’re buying millions of dollars in land to do nothing with. It’s going to cost money and provide no return.” Or raise the money privately. So, great. Where is this trust? Do you need a website? A Gofundme? Reach out, we’ll help, but we don’t have access to millions of dollars until the Magnitsky act gets overturned and we can access our Cyprus bank accounts.  
3. Build as much densely-packed affordable housing as possible Yes, you prevent gentrification by building new housing. Public/private partnerships, tens of millions of dollars invested at least. And you’d have to listen to closet-racists say shit like, “it will just bring in people from Lynn,” by which they mean brown people because racists.

You’d have to do all three of these things, and you’d need to start fifteen years ago. But if you are not fully on board with each and all of these, then you are not doing shit about gentrification and you’re just opposing a housing project you don’t like. That’s fine. Some housing project ideas are terrible. But don’t come running to us, the local firebrand lefties, with the “G” word unless you really plan to do something about it.

Additional note: Do not, under any circumstances, send us articles about gentrification that begin like this:

This once authentic neighborhood, which previously supported payday loan storefronts and off-track betting parlors, now is the domain of tattooed tech-industry workers riding fixed gear bicycles, flitting to brewpubs featuring single strands of lightbulbs and farm-to-table ingredients.

Hell on Earth, obvs. Hopefully with outdoor seating.

Don’t send us that, because it will enrage us. Something like ⅙ of downtown Gloucester is un or underoccupied. New cool places to hang out, new and interesting businesses, all that is very hard to make happen here because for some reason Gloucester landlords prefer to leave space empty. They ask for very high rents, and when they don’t get the rates they want, they just leave it vacant for months, years or decades.

This confuses the shit out of us. No Snark- can someone please explain this? In college we took economics and we seem to remember this “law” that when a commodity had high supply and low demand, the price would adjust downward. Markets, we were told, were perfect, almost ethereal entities and would always prevail. Then we were forced to don robes and worship a vision of Ayn Rand formed from cigarette smoke from an ashtray held by a statue of Alan Greenspan. Later we were told the shrooms Justin had found in the woods were not what he thought they were and the entire dorm spent the night puking, but that still markets were perfect and would always adjust. But for some reason, this economic law does not work here. For our part, we’d pretty much dig some variety of businesses shoved into those empty spaces.

We are also actual tech workers, entrepreneurs, even, and we ride a bike and have an electric car and all that dorky crap. Newsflash: we have a right to be here too. Because this is an actual town where people live. This is not some kind of Plimoth Plantation-esque historical museum dedicated to one particular epoch. It’s a city. Things change. And there are kids to educate and roads to fix and high schools to keep from sliding off the continental shelf into the ocean and septic plants to relocate (next to your house- I saw the drawings). It’s real life here. It’s not curated.  

They’re also putting in a pile of burning tires across the street from you

The last thing I’ll tell you is this. We do much of our work in Cambridge these days. When you get on an elevator in a building with a lot of tech workers, there are one or two people like us: nerds in biz casual (jeans, sneakers, button-downs) carrying laptops in messenger bags and holding expensive coffee drinks. Everyone else is drinking Dunks, in Carharts, carrying lunch boxes and with safety glasses on the backs of their necks. These folks (who also have tattoos, btw) are laughing their asses off at us because they don’t have student loans, absolutely will not get laid off they are in such high demand, and never ever have to sit through a 93 slide presentation titled, “Generating Optimal Outcomes by Leveraging Core Deliverables.” These folks make good money- many start at something like 40K right out of a one year, 10K training program and go up from there. A lot of these folks are leveraging training they received in the military. Industry is fighting tooth and nail for these workers, offering signing bonuses, ed reimbursement, all that. It’s 21st century blue collar middle class.

We are lucky as hell, here in Eastern MA, to have this, while the traditional middle class disappears everywhere else.

These folks run the labs, shops, benches, QA, shipping, chryo, and other essential infrastructure for what we coined as “Loading Dock Technology.” Back in the 90s when everything was all about programming, all you needed were computers and some bean bag chairs and maybe a foosball table. Today, in the exploding medical device, biotechnology, robotics, specialty manufacturing, nanotech, alternative energy and IOT (Internet Of Things) industries you need actual humans to build and run stuff because you are making actual, physical objects. You need the labs and benches built and that takes plumbers, electricians, HVAC, cryogenics and technicians.

These hands-on folks, often called, “science athletes” are what the Gloucester Biotech Academy  is producing for just one of these industries. It is truly amazing we have this resource right here, giant props to everyone who made this happen. Let’s get more of this.

Because these companies are coming to Gloucester. Near the MIT dome, lab and office space is $90 a square foot. Once a company gets their product developed down there, they move out to commercialize it at lower cost and wind up in places like Burlington, Watertown, the office parks in Lexington and now, Beverly (ever wonder why there is all that traffic on 128 now?). Soon, here.

This is just the way of things. We can stare out at the sea all we want and talk about marine industry, which is great, but let’s be honest. We haven’t had many takers on putting thriving industrial businesses next to the water here. But up in the office parks, we’re going to see more and more of loading dock tech companies, and people from here are going to work at them and that is good. As we said, we’re absurdly lucky to be in a place with economic options in modern-day America.  

Still safer than Bitcoin

Yes, it’s change, but it’s only gentrification if we price out people. And for all the rage-posting at whatever ugly collections of townhouses someone will slap together, that really is up to private landlords and homesellers and the extent to which we commit to building and maintaining affordable housing. Affordability is a huge factor everywhere two hours or less from a tech industry hub. You can be as pissed off as you want, but it’s not going away.

Our task as a community will be to figure out how to make all this work for actual, real-live people as tech creeps north. Our job will be to create new opportunities for as many folks as possible, and to protect the vulnerable and the young in particular, whom we want to stay here, raise families and continue to make fun of our inability to use Snapchat correctly. Because we’re a city, not a “market” and the engines of our economy don’t pause to think about the real consequences on people lives, so that’s up to all of us.  

Unless Amazon winds up in Eastie, then we’ll all get priced out and wind up living a collection of abandoned shipping containers in a vacant strip mall parking lot in New Hampshire, which will be fun. If someone has a generator, I can bring the Instapot.

Great, they didn’t even text. Now we’re going to need more chili.

NOTE: Any responses to this post implying we can have a thriving, multi-level economy based on the vague concept of “Arts” will be deleted. We love the arts, please keep doing art, we’re fans and patrons. But this ain’t Tanglewood and “art” communities (see: Provincetown) actually have worse Gentrification problems than tech towns. Look it up.

In 1992 science fiction author Neal Stephenson released a book called “Snowcrash” which was about, among other things, an information virus with the ability to infect the human brain the way a computer virus gets embedded in operating software.

After the past week, I’ve seen it. It’s now painfully obvious that, as a country, we’re guncrashed.

The book also features an Innuit biker with a nuclear bomb sidecar, a skatepunk girl who attaches herself to cars, Sumerian religion, the mob, Russian attack helicopters and atomic cyborg dogs. The whole thing is pretty badass, is what I’m saying.

I have now come to believe the very idea of guns in our culture, literally just the thought of them, is restricting the ability of our brains to conduct logical operations. Last week someone online posted the popular meme that we blame bombers, not bombs and therefore we should blame shooters, not guns. When I replied that we do, in fact, restrict access to bombs, he pointed out one can still buy fertilizer like the kind the Oklahoma City bombers used.

Except you can’t.

I told him you can’t buy more than 25 lbs of Ammonium Nitrate without a background check now and that industry has actually formulated it to be less explosive. It’s a perfect example of a mass killing leading to reasonable regulation. People still farm, but it’s much harder to build a bomb that way now.

His response? He didn’t believe me, then changed the subject, then got mad and said, “Why do you always assume everything I say is wrong?” This is after what he said was demonstrably wrong, a counterpoint to the point he was trying to make. But he couldn’t handle it. Guncrashed. He’s totally guncrashed. 17 people were dead and his primary thought was, “I’d better get out there and defend guns.” No one who isn’t guncrashed would think that way.

What’s worse is person is actually a computer programmer- someone who inherently understands logical operations. Yet he refused to accept the logical outcome of reasonable restrictions leading to effective outcome, even though there is ample evidence of same. As before, people still farm. Ammonium nitrate is still available, we’re just more careful with it now. But applying this same reasoning to firearms is simply not possible when you’re guncrashed. Just the idea alone of guns somehow prevents these calculations from being made accurately. Every subroutine somehow ends with “All guns are OK all the time,” and then tries to work backwards from there, often leading to sadlarious results, as the above “blame the bomber” example demonstrates.  

We outlawed some specific kinds of availability to fertilizer and yet non-outlaw farmers still grow crops. Weird.

Think of how guncrashed we’ve been. 20 years of mass killings with guns and the simple idea that some firears are just too powerful to be owned by the general public is still anathema. And the absurd arguments, especially the idea that adding more guns into the mix will somehow help, is maddening to watch for the non-guncrashed. It’s gone from annoying to terrifying.

Did you know there are ants who literally get taken over by a tiny flatworm, Dicrocoelium dendriticum? This fluke releases chemicals into the ant’s brain making it think the idea of hanging out chomped on to the top of a blade of grass where it can get eaten by a bird is the best idea, like, ever. I imagine the other ants yelling up to it, “Ted! Ted, you stupid asshole, that’s incredibly dangerous, you’re going to get eaten by a bird, Ted!” and Ted yells back, “BUT I’M SO FUCKING BEAUTIFUL!” That ant is “wormcrashed.” It’s pretty much the same thing. He’s getting positive signals from his brain for thinking something obviously wrong and very likely harmful to himself.

just sayin’

The exalted place guns are given in our society, how they feature in movies, TV, games- and not just the stuff the kids play, but shows like “24” and “Homeland,” the power they give to the characters, is completely outsized to their actual utility (guns, like all tools, do have utility). But we’ve come to treat them as totems of power and respect in a society where weakness is seen as anathema. I would argue our history as Americans coupled with a lack of any kind of social safety net and an increasingly “winner take all loser gets none” society has left a power vacuum in many people’s psyches that the idea of guns has come to fill. True or not, the idea of guns in our minds is nothing like the reality.

There are actually very few problems that can be solved satisfactorily from the perspective of either party with a gun. And even when it’s possible, it’s unlikely- for instance NYPD officers only hit their targets less than 20% of the time. Yet we imagine guns, and we especially picture our own selves armed with guns, saving the day, making impossible shots, being the hero. Yet Chris Kyle, a SEAL sniper, was shot in the back by someone he trusted on a firing range in Texas. The trained, armed deputies in Parkland Florida did not go into the school and try and confront the shooter, even though protocol calls for them to form a “contact team” and attempt to do so. It turns out the gap between what we imagine guns can do, and what they can actually do in the hands of failable humans is massive. A chasm the guncrashed have fallen into, and it honestly remains to be seen if they can or care to return.

The late Richard Earle, an early pioneer in cause marketing, had an incredible observation about powerful ideas once they have rooted themselves in the brain. His teams found that when making anti-drug ads, if you showed a needle with copy or voiceover saying, “When you use drugs you go broke, lose your family and will probably die,” addicts didn’t listen to the message at all. They just saw the needle and wanted to use. The idea of the drug had “infected” the brain of the user through the memory of the powerful pleasure chemicals they had released, and was now communicating on a deeper level than language. You might call them “drugcrashed.” All addiction could be framed this way: a powerful idea or compulsion that makes an end run around our logic filters and causes us or others undue harm. 

Only $3.98? Gotta get me some.

Guns in America, it is all too obvious, have bypassed the language and logic centers. They are chomped up there on the blade of grass where everyone can see. The one hope is for the first time in a long time we seem to have a clear view of the situation. In no small part this is thanks to the Parkand High School Students slapping us out of our guncrash coma, and for this alone we owe them a huge debt of thanks. We’re starting to realize we have to actually do something, and that the truly guncrashed can’t be reasoned with, as somehow they are blocked from this capability.

It’s going to be up to the rest of us.

Author’s note: Please don’t read this article and attempt to argue that once high-capacity firearms have been restricted perpetrators will then conduct mass killings by other means and try and fall into the massive logical fallacy that more people are killed with hammers than guns. Even if that’s true, we’re talking about mass shootings here, not mass hammerings, which to our knowledge are exceedingly rare. You’re guncrashed. Get help.