Mingling

Weekly planning usually occurs on Sunday mornings at my upstairs desk where I keep pens and highlighters of multiple colors.  Yontif postponed this session by until Monday, though I knew I had a special opportunity to assuage senior loneliness by immersing myself in different groups on consecutive days. 

1. Sunday: Simchat Torah Services at my synagogue
2. Monday: Platelet donation at Blood Bank
3. Tuesday:  OLLI Class
4. Wednesday: Philadelphia Endocrine Society
5. Thursday: Morning minyan at my synagogue
6. Friday: Two OLLI Classes
7. Saturday: Services at my synagogue

And toss in a flu shot at my pharmacy.

Mostly mixed result, colored perhaps by strains with people scripted differently than me about atrocities in Israel.  By I did my best to keep cordial and to interact, if not mingle.  Candid, not fully friendly comments are still forms of interaction, which is really the week's agenda.

Scorecard:

Simchat Torah experience somewhat above expectation.  Not a lot of me there, about 18 or so.  Hakafot shared with women, who were much less in number.  Songs selected by Cantor surpassed the Hebrew school ditties that I had come to expect.

Platelet donation proceeded smoothly.  Screening questions changed a bit.  My trip to France within the previous month did not disqualify me.  I watched Netflix home design show, actually four half-hour episodes.  No clogging of line, one minor reposition of needle.  Quick stop at canteen for my usual.  Afterward, stopped at Cabela's.  Saw nothing to buy.  Opted not to go out for lunch.

OLLI Class caused some friction.  I am not overly fond of the way the instructor presents the class.  Teaching us about "good people on both sides " amid asymmetric intentional atrocities while using the Muslim Brotherhood talking points did not reflect well on his intellect.  And his not well received analysis extended the class twenty minutes past closing time.  But I did make a YouTube Video of what I thought and he will not be happy with at least one of his student feedback reports.

Before driving to Philadelphia I had a very stimulating session at OLLI given by an expert.   I tried to extract more of his expertise at the end, creating some discord in the process.  But the Being with People initiative did not come until the end of the day.  I had not been to a Philadelphia Endocrine Society session live since Covid, and not at all in a couple of years.  I even did not pay my annual dues last year, but resumed this summer.  The live sessions had been reassigned to a less accessible location, but are now back to a place to which I am used to driving, as long as it is not very often.  My Waze App meant well, anticipating rush hour bottlenecks.  It tried to bypass one near my home by directing me north for two entrances to access the interstate.  Then manageable traffic.  Ordinarily it would take me to a main road that goes pretty much directly to my destination, though with a lot of traffic lights.  Instead, it exited me just past PHL Airport, directing me through some thoroughfares I do not remember ever driving on before.  I got to see the remotest of the PHL parking options and large swaths of the airport at its farthest reaches where private corporate and other non-airline jets take off and land.  Eventually return to the interstate, this time with a lot of other cars.  It took me to a highway divide where I had to change lanes on short notice, then through Philadelphia's Historical district, a place of very slim one-way streets, but at least in a recognizable grid. Got me to the parking garage where the gate failed.  After a few calls on the intercom, an employee let me in, providing me what would turn out to be a defective ticket trying to leave.

Not many people that I knew at the meeting.  A couple of old friends, friendly greetings to some new introductions.  Beverage server lives near me, taking the same roads and bottlenecks, so we had a short chat about that.  Outstanding lecture on hypoparathyroidism.

Route home by Waze also not what I expected.  Were I to commute by car to Center City, I'd probably get used to it, even in the dark for much of the year.  One time, I had to keep my attention focused on traffic, stopped delivery trucks, and some interstate access points that the civil engineers could have considered better, but once on the highway past a rather long and eerie on-ramp, getting home went smoothly.

Morning minyan takes place every Thursday at 9AM.  I was curious about who would go.  The usual suspects, those inner circle men and one other.  I was seven.  We got nine, but needed ten.  The new Rabbi really wanted to repeat the Amidah and read Torah that morning.  He summoned the lady in the kitchen, declaring it a fast day due to Israel atrocities and obviating her the task of making coffee or setting out donuts.  In its place she was placed in a sanctuary seat.  Then he repeated the Amidah, read Torah, did kaddish, all the parts that our tradition requires us to have ten men.  Nobody said anything.  At the end, the President asked me a few things about my trip to France, with another fellow joining in.  I had scheduled a flu vaccine that morning, so excused myself.

While I got to Walgreens in time for my appointment, the line at the pharmacy counter was long. The pharmacists and technicians seemed overwhelmed by volume, not only at the counter but also the drive-thru, and what was coming their way from online customers.  These folks were not trained by Disney MBAs who understand enough throughput to keep lines flowing.  My turn came, my deltoid got injected, and I roamed the aisles for the next fifteen minutes as the pharmacist had asked me to stay on site for safety.  Then home.  And a Zoom course on thermodynamics followed.

Friday morning I have two OLLI classes, the National Parks first, The Common Man to follow.  I made my own coffee, keeping it hot in a thermal mug given to me by a pharmaceutical company in the days when they gave doctors various reminders of which drug the companies wanted us to prescribe to the max. I got there just as the first presentation was to begin.  There is a half hour break between the two morning sessions.  I sat at a table for a while, sat on the patio for a while.  Did not mingle.

For shabbos morning the two casting directors assigned me two parts.  I would lead shacharit, which I do frequently.  And I would chant the Haftarah, an invitation that is rather infrequent.  I prepared the Prophetic portion to decent fluency.  The morning worship I do not prepare at all.  Instead, since I am already fluent, I select two tunes to insert that differ from what I had done the last time, usually the last two times.  And so I did.  Rabbi read Torah.  And when the Rabbi reads Torah, a congregant gives the sermon about the Torah portion.  Despite being a participant, I did not feel inspired.  A few handshakes along the way, mostly of a protocol variety.  Kiddush banter makes or breaks the morning experience.  I drove home broken.

When corporations and other employers try to boost morale and engagement of their staff, they take a number of approaches.  Look at the good our organization has done in its history would be one direction.  It seems to give a transient boost.  The strongest, though, comes from testimonials people receive as feedback for the benefits their personal efforts provided.  My congregation approaches zero.  There are influencers who matter and consumers who don't.  I'm a consumer.  I could say the same about the Endocrine Society.  As much as I enjoyed the session along with the minor adventure of driving each way, I wasn't a contributor.  But platelets, while often physically uncomfortable in the donation chair squeezing a rubber ball and watching Netflix, the people at the donor center are really appreciative of having donors who come on a regular basis.  I never see the platelet recipients, only sample pictures of kids on chemotherapy, but I know somebody somewhere is better off for the three hours between leaving my house and returning home.

While the intent was to be with people more than in most weeks, and I succeeded, those experiences mostly made me a taker.  The challenge is not only to be a person of genuine value, as platelet donors are, but to matter beyond the protocol handshakes.  I did in small ways.  Leading worship offered some thought and effort that made our synagogue a place where traditional services are executed by men of proficiency.  At the flu shot, I chatted with a lady behind me in line who may have been less lonely from the interaction.  I challenged the teachers at each of the OLLI sections. That might have advanced their perspectives on their subjects beyond what they would figure out for themselves.

So it is not so much inserting oneself into the herd as having that herd take a better form because they let me in it.  I think it did.

Take Me Out to the Ballgame

It had been years since I watched baseball from the stadium.  My town has minor league baseball, the A-division for starting players, some of whom have progressed to MLB. Not been there in a while, but always entertained when I went there.  Free parking, manageable crowds, and with just a few thousand seats, everyone gets to sit close to the field.  And they involve the community, picking out a few spectators, usually kids, to go onto the field for a small contest.  And batted balls can really come pretty close with a few homers reaching the parking lot.

Major league baseball was a springtime enjoyment when I was in my 20s.  I could walk to the stadium but after dark take the bus home for safety.  I would sit in the Grandstand for $1.50 with the other university students who rooted for their own hometown visiting teams while local people glared at us from their more costly places.

And then my outings lapsed.  I had taken my son to a major league game one time at a stadium that no longer exists, being replaced by a more state-of-the-art facility, as was the one from my student days.

As a platelet donor inducement, they asked if I wanted tickets to a game where the team would promote the blood bank.  I would be out of town for the game closest to me but I accepted two tickets to Camden Yards about 75 miles south on I-95.  Players make a lot more money now, subsidized by big TV contracts.  Tickets no longer cost $1.50, though to my surprise Camden Yards still has bleachers beyond right field.  And now a few days after the game, the experience of being there has changed considerably.

Camden Yards sits just off downtown Baltimore, a rather grimy city that has seen better days.  Apparently a Convention Center attracts enough mid-sized conferences to justify a few luxury hotels adjacent to the stadium.  Its other neighbor is the U of Maryland Medical Center, anchored by a staid old building. And the Inner Harbor, Fort McHenry, Babe Ruth House attract tourists coming for a day or two, or perhaps conventioneers wanting some sightseeing.   While getting there guided by GPS went easily, the stadium attracted a massive number of cars, something difficult for a cramped downtown to handle.  While I could see open parking spaces on lots as I passed by, and fans an hour early teeming by to see the game clad in their Orioles regalia, getting to those lots was not obvious.  I followed everyone else, never finding the driveway or side street.  But the hotels and medical center had garages.  Experienced fans, perhaps season ticket holders, parked closer, but I eventually paid the $30 for an evening in the medical center garage, employees parked on the lower level, fans on the higher tiers.  The walk to the stadium. still the daylight of a summer afternoon, was neither elegant nor squalid.  There was no appreciable litter, no aggressive motorists despite the heavy density of cars, and a mostly downslope stroll to the stadium.  Orange shirts with Orioles patterns and O's hats prevailed.  Mine was neither.  

We made it easily to the entrance, past a scalper, to the security gate.  The Orioles have a lengthy list of what must be left outside. Whether or not Maryland is an open carry state, it probably isn't, no weapons can come inside.  I had left my pocket knife in the car.  Nothing that makes serious noise, no foghorns.  I suppose they'll look the other way for a Purim grogger.  My pockets set off the metal detector, emptied to reveal my coins, keys and phone to the satisfaction of the attendant.  Our tickets were paper, most were screenshots on phones.  

We had no idea how to find our seats.  Orioles in season is a big industry.  We walked along on the bleacher side of the sidewalk.  Stores selling Oriole logo stuff on our left, massive restrooms and concessions to buy stuff to eat on the right.  The signs indicated sections with numbers under 100.  Ours was 364.  My wife and I followed people past the gate into the enclosed area.  Food concessions everywhere with somewhat excessively price beer, mass market and craft, burgers, pizza, hot dogs, chicken.  And more places to get another O's T-shirt. We figured our seat must be on the opposite side of the stadium so we headed in that direction.  Finally, somebody there to serve people rather than sell them stuff, a first aid station.  We asked the attendant how to get to our section.  It would require an elevator ride to the uppermost level.  She gave us general directions to the elevators, of which there were only two.  An attendant across from them gave us more specific directions to finding our assigned seats.  The elevator cars themselves were massive.  They also had an elevator operator managing the switches, something I'd not seen anywhere since staying at a rather snooty hotel for a convention in DC in the 1990s.  We arrived, followed signs to our section, where we found an usher to point to our seats.  He did not have the stamina to escort everyone, as our seats were in the penultimate row, a steep ascent for seniors.  But they afforded a perfect view of the skyline and of the field.  We could see the many electronic displays that rim the stadium, though a little far to read everything easily with my bifocals.  We were far enough from the field to see the whole thing from about the midpoint of the third base foul line.  No distortion at all when trying to discern team strategy.

Even though we occupied the top deck, there were still vendor stalls right outside the seating area.  What we did not have were vendors hawking soda, peanuts, more beer, and hot dogs.  My own college yearbook was dedicated to that lovely man who would sell hot dogs as he wandered the bleachers at our college football games.  In some ways the face of my Alma Mater.  Camden Yards opted for decorum.  People brought cheeseburgers and soft-serve ice cream to their seats.  They threw nothing on the floor to be swept by college kids needing a few bucks after the game.

The Blood Bank representation got the high seats.  A few messages of donor and organizational appreciation appeared.  The National Anthem was sung by a mezzo, African-American lady with a stellar voice who returned at the seventh inning stretch for a patriotic encore.  Everyone stood, caps off, no protests.  Did not see any MAGA hats or other visible political statements the entire evening.  

I found the many screens that circled the field, from scoreboards to replays to dazzling orange pleas for those in attendance to Make Noise a bit distracting.  I could see the entire field.  If balls came toward my direction on the third base side, I could see the ball.  Pitching speeds are now about 95 mph very consistently with all pitchers.  I could not see the ball moving from the mound to the plate, not sure the batters could see it to their satisfaction either, and I wonder about the accuracy of umpire judgment as a sphere moves across the plate that fast.  But for the whole game, only one disputed call, resolved in the O's favor by instant replay.

The O's got their come from behind, one run win in the end.  A lot of people exited at the same time but it remained orderly.  Sidewalks, elevators, stadium exits, and parking garage exits were all packed with people.  Despite this, the drivers all seemed courteous, pedestrians waited their turn at the lights and at elevators.  A couple of homeless people, or maybe just professional panhandlers with a place to sleep when the crowds dissipated, tried to get their needed income, though none aggressive.  Very little police presence.

In our current America, one in which the majorities people elect to represent them generate hostility as their motivator, for about four hours the people who took the evening to root for the O's got a break from that. We all cheered with the orange lights on the scoreboard said to cheer.  We left the contraband in our cars.  We didn't shove each other to get a hot dog more quickly or get the last spot on the elevator.  We had a good time.  We were nice to each other.  We had a common purpose.  If only for a short time in a confined location, but at least still possible.

Hematoma

 

Platelet donations have had some recent misadventures.  For a while my hemoglobin did not measure up to their standards.  Lab testing showed iron deficiency, for which I added a multivitamin with 18 mg iron and set up a GI investigation.  A few weeks later, the Blood Bank of Delmarva's desktop hemocytometer displayed my Hb at 14.7 g/dl, which is wrong, as were some of the previous borderline low ones.  It all comes out in the wash.  They prepped me for a donation.  The left antecubital vein has become less of a standout than the right, but still easily accessible for an experienced phlebotomist.  They accessed it, assigning it the afferent arm.  Shortly into the donation it clogged and could not be successfully repositioned.  I was sent home.

Back in less than three weeks for another go.  Due to some elbow pain on squeezing with my left hand, I opted to have the left are as the efferent side to receive the RBC's after the machine extracted the platelets and plasma.  No problem.  Set Netflix to Queer Eye visits Japan.  All systems go.  Felt good squeezing with my right hand.  It seemed to take longer than usual.  With seven minutes to go on the second episode of Queer Eye the TV streaming failed, leaving me alone with my mind and a digital clock that I could see on the far wall.

Like many places, the Blood Bank seemed short-staffed, especially in the cavernous bleeding room divided by the type of donation and the machines required for them.  After checking up on me with less frequency, my last encounter was receiving one of their white blankets as prolonged donations usually leave donors a bit chilled.  My nurse disappeared.  Ordinarily, the collecting machine would signal some type of violation, for which an attendant would check the screen, push a button, and the sound would go off.  No signals, so nobody came by to check me.  I glanced at the bag of collected plasma to my left. It appeared pretty full.  My right hand became sore from squeezing the inflatable ball for so long.  And then my left anterior elbow began to get sore, and then more sore.  The machine finally signalled, bringing the attendant over.  He checked the time, estimated another two minutes, then came back to close off the afferent line.  I mentioned the pain at my left IV site.  He lifted the bandage to find a pretty impressive infiltration hematoma.  I did not really need any more of the few RBC's not already returned, and they weren't going into the antecubital vein anyway, so he shut down the line, removed the needle, called over a more experienced colleague, and applied a compress.  The afferent line was then removed and compressed in the more conventional way, while a freeze gel pack was placed over the injured antecubital fossa.  Pain resolved as soon as the needle was removed.  Swelling took a little longer.  By the time they put the final sterile compress on, the swelling had greatly diminished, discoloration started, and I went on my way to their canteen for coffee and two oatmeal raisin cookies, then home.  And-they gave me a new t-shirt and a discount coupon for a beer at our nearby Two Stones Pub.

Blood Bank Brew

Platelet donors at one time left with a form of home clutter at one time.  My collection of T-Shirts, caps, fleece covers, a beach bag, flip flops, and thermal mugs could start a Blood Bank Museum in my house.  Platelet donors are their most dedicated group. We largely set our schedules and maintain it, not really needing an incentive or even thanks.  They got the message and did away with the parting gifts some time ago but still offer incentives to donate periodically, though to all donors.  Whole blood sources may be less consistent with their giving, creating the need for rallies at mobile sites or other means of making it as easy as possible for people to participate.

In lieu of clutter, the Blood Bank substituted an experience.  Donate anything, or even just register and get screened out as ineligible, and they will offer a coupon good for a $2 off a pint of craft beer at any of the sponsoring brewpubs.  Only one being convenient to me, I redeemed it as a reward to myself for accomplishing a difficult writing submission before deadline.

While Two Stones Pub's northern location around the corner makes for a quick and mostly good supper, I had not been there in a while, maybe never in their late afternoon Happy Hour time.  Easing Covid restrictions, which became official the day before in our state, pretty much opened the bar where I helped myself to the last seat that could offer me empty seats on either side.  I never quite understood Cheers or even the Public Houses of the British Isles where people went more to create community than to buzz the susceptible parts of their CNS.  At one time beer had a safety advantage over water so people consumed it as their primary beverage, though eventually hot tea and hot coffee could also sterilize the water.  Now beverages of any type have become so available as to be overconsumed.  It is also more economical to purchase and consume for home use, making the beverage, whether beer or coffee, a forum for communal presence rather than serve a physiological need.

Two Stones must have had its small cohort of regulars who gather along the bar in late afternoon.  Since my last visit, the restaurants have expanded their own unique brews in a central location to distribute to the small eating sites.  Good variety of house offerings and not unusually expensive even if not discounted by my Blood Bank donation or Happy Hour.

I selected a pint of one of their signature blends, a very crisp dark amber liquid with fine bubbles and just the right blend of bitterness and sweetness.  One that would sell in a much expanded market, I think.  While I took a paper to work on, and did for a bit, the two folks behind the bar served a little as cruise directors, opening conversations with their patrons, including me.  We spoke about the Blood Bank promotion primarily.

Pint glass emptied, amply rewarded by the Blood Bank for my consideration and by myself for submitting my article, I drove the half-mile home.  I'd pay full price for this experience.

Returned as a Donor

It's been a tough couple of months in Blood Bank of Delmarva exile.  My Hb dropped below their 13 g/dl threshold two months ago, far enough under to not be borderline and confirmed by the lab.  Search for blood loss via stool testing and colonoscopy was unrevealing.  My eGFR had dropped gradually to 55 which assigns me CKD 3a but, which the gastroenterologist attributes the minor anemia, though I think the creatinine has been stable a while and the reduction seemed a little precipitous since the Hb measured 13.5 when I had my appendix out a year and a half earlier and had been rather stable at just about 13 on blood bank screening as recently as a couple of months earlier.  Sit tight two months.  Repeat Hb 12.9 which restores me to recent baseline.  Back to the Blood Bank to give more platelets.  I passed, with the desktop Hb at 14.0, which is probably just as wrong as the low ones, but an uneventful extraction of blood with return of the RBCs.  Thought they were having a cap promotion for donors, but nobody offered me a Kewpie doll of any type.  What I wanted I got, some reassurance that health decline was not inexorable and the ability to be useful to somebody I didn't know without any expectation  of anything in return.  

Tested Negative

A letter arrived from the Blood Bank.  They tested my blood for SARS-CoV-2 antibodies , detecting none.  I'm disappointed.  They had sent a notice that they would be testing all donor blood for this through the end of this month, so I had planned to squeeze in my next platelet donation a few days early to have this, but now it can wait until the following week when the new month arrives.

In the four decades that I have been a reliable donor, with a 50 donation lapel pin to show for it, this is only the second time the blood bank has passively notified me of my results.  The first came many years ago when they found me to be CMV-negative.  I have no idea why they tested for this, but with the notification, I became eligible for platelet donations, which I have maintained a few times each year.  Platelets with incidental plasma provides more value to a blood bank than whole blood fractionated to its components, as it is less readily available and the need by the recipients is usually more critical.  Donors in my category are usually honored to help out.

SARS-CoV-2 antibodies have less established utility, as the disease they treat is a newcomer to the world of health scourges.  There is evidence that large amounts of antibody can keep Covid-19 patients with ARDS on an otherwise unlikely survival path, so it can be a very useful thing to offer, though far less established in efficacy than platelets, RBC, or various plasma components.  I'm disappointed at not being able to help out more than I currently do, but the platelets and plasma still have people who will benefit from them.

Alas, my RBC have other antigens that limit recipients.  B-antigen, Rh+ so even my red cells have a restricted number of people who can safely use them.  Can't save everyone but can aid some people.  Not that I want to acquire Covid-19 even with recovery that generates natural antibodies.  I'll let the vaccine boost those when it's my turn.

Post-Platelet Crash

My state had its Presidential primary yesterday.  I thought it was just the primary and there is a state senatorial candidate I wanted to vote for so I schlepped a few miles just after polls opened, already a line to stand on with Covid-19 mandated spacing that made that line look longer than it really was, and waited my turn.  To my disappointment, only the Presidential candidates were on the ballot.  No uncertainty over who will prevail in each party, so I could have just stayed home and not have to rush to keep my Blood Bank of Delmarva appointment.

I arrived with more than ample time, hung out at the Home Depot lot, surfing the web on my cell phone a while, then headed over to the Blood Bank.  They changed their eligibility a bit.  Potentially infectious behavior exclusions have been reduced from 12 to 3 months, a very recent amendment that will make more people eligible, particularly those with body piercings.  Basically an uneventful session, one that needed a repeat finger Hemoglobin to assure adequacy.  I set the TV for Dirty Jobs, including a session on making scrapple at a factory in my home state.  No unusual soreness as the transfer of blood from my left arm to the pheresis separator to my right arm took place over 90 or so minutes, or about 1.5 shows.  On removal of the needles, though, I found both elbows frozen, unable to flex either for a couple of minutes with less effect at the right wrist.  Onward to the snack station where I just got coffee and their complimentary promotion of flip-flops.  Gray, entirely plastic, probably too flimsy for beach but ok for pool.  Very unobtrusive Blood Bank of Delmarva printed at each heel.

Typically, if I complete the session before noon, I drive someplace other than home, but with Covid-19 restrictions there's really no place to go.  I could have had my glasses adjusted, maybe even purchase the new prescription at the nearby Costco's.  No interest in the regional mall.  Had just been to Cabela's.  Don't want to go all the way to Lancaster, a common post-donation detour, to find nothing open.  Home being the best option, I returned non-stop.

I did not expect the physical crash that followed.  Normally I omit the treadmill on platelet days, but I could not have done it even if I wanted to.  Too sore for housework, even finishing the dishes I had started before heading off.  Mind not in gear for anything mentally taxing.  Already had my quota of coffee.  Just an off-afternoon with no serious redemption.  I did not feel sore enough for naproxen.  I was not sleep deprived.  Just a day to stare into space, read the Forward, grapple with tying a fluorocarbon leader to a fishing line which still did not succeed.  I did not feel depressed, just achy and unmotivated, and unfocused.  

I still have things I want to do, so a second go round today, off to a better start.