Returning from the East

After more than 700 miles in 15 hours, Big Red with Rudy in tow arrived back in our lush green middle America home site. We had left the South Shore of New Jersey, Ocean City to be exact, to blast Westward on the Interstate System. It is strange to view a map with the most Eastern endings of United States highways that were a stone's throw away from where I lived in the Cleveland area. US 322 is Mayfield Road. Go North on Ohio Route 91 a few miles and one gets to the East West Mayfield Road, plunging into Cleveland proper, down into "little Italy" near Case Western Reserve University and Severance Symphony Hall, ending in Euclid Avenue. Go South on Ohio 91 a few miles from Shaker Boulevard, and one comes to US 422, Chagrin Boulevard; beginning in Cleveland at Public Square and heading East to the Atlantic Ocean's water's edge in Atlantic City NJ. Interstates and limited access highways have displaced these routes as major pathways; yet, they still exist on Rand McNally Road Maps, nostalgic reminders of the growth of the US from its Eastern Seaboard Westward; horseback and wagons supplanted by SUV's with travel trailers like us.

South Shore NJ is developed sand beach requiring "beach tags" from 9:30 AM until 5:30 PM, no booz, no dogs, no frisby or ball playing, no picknicking, no bike riding or motorized vehicles. Surf fishing only with a license. The Ocean City Boardwalk is several miles long, constructed behind the reconstructed sand dunes, having a central cluster of tee shirt, saltwater taffy, amusement rides and arcades. North and South of this central congestion, are multistoried duplex and quad beach houses for rent. When the Boardwalk ends, the beach houses continue Southward to Cape May, and Northward, interupted by estuary outlets but eventually winding up at Atlantic City, and its Boardwalk. The visual difference between Ocean City and Atlantic City is mainly one of visible poverty juxtaposed with casinos in Atlantic City and second and tertiary tier beach houses in Ocean City. We had walked out of Caesar's Palace to our car with our meager winnings confronting boarded up store fronts, chain link fences, scissor gated and locked doorways, strip joints :GIRLS GIRLS GIRLS" signs puckered and in need of painting. Urban poverty reminded me of Woodward Ave. in Detroit.

The good news however is South of Ocean City. Cape May is a tourist town vintage Victorian times, middle of the 19th Century. We had arrived by a 1 1/2 hour ferry ride from Lewes Deleware, and Henlope State Park. The Park is a legacy of military coastal defense since our Revolutionary times as the Deleware Bay is the entre waterway to Philidelphia, our nation's first Capital, although briefly. The preservation of sand dunes, and walkabout trails through pine and scrub oak forests, we give thanks to the ARMY. Seabird nesting areas are blocked off, no pets are allowed. The walks from the Atlantic Ocean to the Deleware Bay across a spit of sandy land transports you back to a more isolated time in our history. Few parking spaces so there will be few people at any one time or place. Watery vistas are East and West. At times like these, reminded by placques telling of one part of our country's history, I can visualize a sailboat coming to Jametown in 1609, bumping along the coast looking for a suitable place to disgorge the 100 or so passengers who will begin a colony. The World War II concrete bunkers, are now being claimed by the sea; watch, triangulation gunnery obervation towers now give a view over the entire beach as far as the eye can see, and into the Bay, once commanded by 6 inch guns with a 17 mile reach. The days are warm in the protection of sand dunes or buildings, but the breeze off the Atlantic Ocean required me to wear layered sweat shirts and pullover windbreakers. I can feel our nation's history along with the wind blowing, striving in my mind to remember tidbits of events that ultimately shaped our Nation. As reported by the Park sign, the dunes are ever on the move, shaped in part by the wind and sea, and like our Nation, we have been shaped by the Wind's of War, and the Tides of Battle. The legacies of these occurances we can visit and remember, what we were taught or learned on our own, about where we stand.

On Bat Patrol, May 2007

The bumps one hears thoughout the day and night reflects the wind bending shrubs and tree branches against the cottage. These noises sound loud against the otherwise silence of this world. I am keenly listening for the sounds of bats who may have returned from their wintering further north. Bats return to the exact same roost year after year after year. Tired of the bat droppings on our mantel and the diseases that come with that "guana" (Histoplasmosis from the organism Histoplasma capsulatum), I hired a "bat control company" who came last year and sealed every nook and cranny that the bats might concievabley wiggle through to get back to their roost. The bat control person, came with his sidekick, he wearing a blue baseball cap with a red boardered brown bat centerd logo in front. They diligently went about caulking every orfic they could find. I have returned to the cottage for the first time this year to listen for the squeeks of the bats and the telltale droppings on the mantle. I have been here two nights; so far, no squeeks. I am encouraged that we will not have a repeat of last year, when Leah and Chris were awakened by Shag's standing on the fold out couch, head raised high and barking. 24 bats chose to exit from their lair located above the great room paneling via the space between the paneling and fireplace. The outside metal chimney left by the bat control man for the bats' exist was not used, rather an internal escape; hence, the barking Shag, and the late evening swirl of winged rodents circling in a clockwise fashion, squeeking and fluttering as they encountered walls and windows, and other objects (us). Although we had opened the front door and screen, their sonar system could not locate the opening since their flight took them past the doorway. We got into their flight plane and managed to change their direction to a counter clockwise circle, and once they could "see" the exist, they were off and out. The next night, there were four bats who had emerged from the cracks between the paneling and fireplace, again we were alerted by Shag, again we opened the door and out they flew. The following night, there were two bats, and subsequently, there were none. I am here at the cottage, to be sure we do not have a repeat performance of the "bat ballet." I can not be absolutely sure however, since Shag is not here to alert me to the bat's presence. I do miss her in more ways than that though. Walking the shores and roads and trails, I miss her.

Clinical Depression and the Law

Recently, we have seen a spate of news reports on violence committed by people clinically depressed. In addition, there have been accusations of rape and abduction by a "stripper" against 3 Duke lacrosse team members only to find out that, none of the accusations were true, the accuser herself had multiple partners that fateful night, none of whom were Duke lacrosse team members, and that she had a previous diagnosis of "bipolar disorder" and depression and was not taking prescribed medications. In a Lansing State Journal report this morning, a women is suing a pastor and Mt Hope Baptist Church for failing to catch her when she came to the alter one Sunday and was smitten by the Lord, swooned and fell down, striking her head. She had no immediate troubles the day of nor the days after the fall. However, since her fall, her depression, which had been stable prior to the event, was now causing her back and head pains, inability to concentrate, walk, and carry out productive activities.

An article in PEDIATRICS this April reported a study assessing parental depression and pediatric health care use. The pattern of increase use of expensive health care resources (emergency room/in hospital care/ specialty clinic visits) and decreased use of preventive services by depressed parents reprsented one of the hidden costs of adult depression.

My own recent experiences involves three medical liability cases in which I have been a medical expert. In each case, the mother of the child has been clinically depressed prior to the event in which the infant died, they stopped taking prescribed antidepresant medications. Two cases have now been withdrawn by the plaintiffs with no settlement just days before going to trial; the third case is still in progress prior to trial. One case, the infant, who had a complex congenital problem with his esophagus resulting in difficulty in swallowing liquids and foods, who was fed and left unattended for more than a hour immediately following a feeding, he aspirated and died. The mother was clinically depressed and was not taking prescribed medications. Another case, the infant died and the story told by the mother, that the infant was fed and lay down to sleep alive and well one hour prior to being found stone cold with rigor mortis. The mother's story did not fit with the known facts of the processes and timing of those processes that go on after a person dies. Again, the mother had been clinically depressed prior to the infants death and was not taking her prescribed medications. The third case, the infant died of complications from being born prematurity. The law suit was brought two years after his death because the mother reported that she could not get over watching her child die in the Neonatal Intensive Care Unit and that her long standing depression was worse; she also had stopped taking her medications.

From the above, I am left with a question: since it appears that clincal depression has such major public consequences, let alone the private effects depression has upon the individual, and the diagnosis has been established yet the depressed individual, likely as part of their depression, does not take their therapies, how does society deal in a proactive way with the myriad of ways that clinical depression expresses itself, and has devastating long term consequences? To me the externalizing of one's depression is larger than the issues of whether guns are easily accessable, or what does one believe when told by an accuser of terrible things that have happened to her, or parents who engage in self focused behavior and neglect their child, or suffer unconsolable depression having witnessed terrible tragedies. There are enormous social consequences which I believe are impacting upon the costs to our health care delivery system.