Infections and Antibiotics

This blog entry is a follow-up to my last about allergy meds and antibiotics.  This one is focused on the use of antibiotics and the ineffectiveness of them because of overuse which has some serious consequences.

 

In 2003 the Joint Commission established National Patient Safety Goals (NPSG) that all accredited hospitals have to comply with.  Over 4,000 hospitals have Joint Commission accreditation, which is roughly 82% of all hospitals¹.  Failure to attain accreditation could jeopardize Medicare reimbursement, which generally accounts for 35% – 55%²  of all revenue a hospital earns.  So, as you can see, there is some incentive to follow the NPSGs. 

The NPSGs were in part a response to a 1999 U.S. Institute of Medicine report titled To Err is Human that suggested as many as 98,000 people die in U.S. hospitals each year from mistakes and errors that occurred within these hospitals.  Each year the NPSGs are updated to either add to the list based on sentinel events reported to the Joint Commission and medical care and practice concerns found during accreditation surveys, or removed from the list if the issue related to the goal has decreased significantly.  Sentinel events are any unanticipated event in a healthcare setting resulting in death or serious physical or psychological injury to a patient or patients, not related to the natural course of the patient's illness.    

NPSG #7 is "reduce the risk of healthcare associated infections (HAIs)."  One requirement under this goal is for hospitals to implement evidence-based practices to prevent HAIs due to multi-drug resistant organisms (MDROs) in acute care hospitals.   Evidence of Performance under this requirement includes providing education to the patients and their families as needed who are infected or colonized with a MDRO about HAI strategies.

One MDRO that was once attributed as an HAI is Methicillin-Resistant Staphylococcus Aureus (MRSA).   Unfortunately, this infection can now be acquired in the community as hospitals experience people coming to hospitals with this infection.  In 2007, the CDC reported that 14% of all MRSA infections were community acquired. 

MRSA is a bacterial staph infection.  It is spread by contact.  The garden-variety of staph are common bacteria that can reside in our body.  Many healthy people carry staph with them without getting infected and 25-30% of us have it in our noses.  Most staph infections can be treated with antibiotics. 

MRSA is a different animal.  MRSA -- have become resistant to antibiotics that once destroyed it. MRSA was first discovered in 1961. It's now resistant to methicillin, amoxicillin, penicillin, oxacillin, and many other antibiotics.  While some antibiotics still work, MRSA is constantly adapting. Researchers developing new antibiotics are having a tough time keeping up.  Though most MRSA infections aren't serious, some can be life-threatening. Many public health experts are alarmed by the spread of tough strains of MRSA. For this reason, MRSA is known as a “super bug.”

Another common MDRO is C. difficile (C. diff).  C. difficile bacteria can be found throughout the environment — in soil, air, water, and human and animal feces. A small number of healthy people naturally carry the bacteria in their large intestine. But C. difficile is most common in hospitals and other health care facilities, where a much higher percentage of people carry the bacteria.

C. difficile bacteria are passed in feces and spread to food, surfaces and objects when people who are infected don't wash their hands thoroughly. The bacteria produce hardy spores that can persist in a room for weeks or months. If you touch a surface contaminated with C. difficile, you may then unknowingly ingest the bacteria.

People in good health don't usually get sick from C. difficile. Your intestines contain millions of bacteria, many of which help protect your body from infection. But when you take an antibiotic to treat an infection, the drug can destroy some of the normal, helpful bacteria as well as the bacteria causing the illness. Without enough healthy bacteria, C. difficile can quickly grow out of control. The antibiotics that most often lead to C. difficile infections include fluoroquinolones, cephalosporins, clindamycin and penicillins.

Once established, C. difficile can produce toxins that attack the lining of the intestine. The toxins destroy cells and produce patches (plaques) of inflammatory cells and decaying cellular debris inside the colon.

An aggressive strain of C. difficile has emerged that produces far more toxins than other strains do. The new strain is more resistant to certain medications and has shown up in people who haven't been in the hospital or taken antibiotics.

Antibiotic resistance occurs when antibiotics no longer work against disease-causing bacteria. These infections are difficult to treat and can mean longer lasting illnesses, more doctor visits or extended hospital stays, and the need for more expensive and toxic medications. Some resistant infections can even cause death.

Antibiotics are effective against bacterial infections, certain fungal infections and some kinds of parasites. Antibiotics don't work against viruses. The chart shows common illnesses and whether they're caused by bacteria or viruses. Taking an antibiotic when you have a viral infection won't make you feel better — and can contribute to antibiotic resistance.

 

Bacterial infections	Viral infections
Bladder infections          Many wound and skin infections, such as staph infections          Severe sinus infections that last longer than 2 weeks          Some ear infections          Strep throat	Bronchitis         Colds         Flu (influenza)         Most coughs         Most ear infections         Most sore throats         Stomach flu (viral gastroenteritis)

 Repeated and improper use of antibiotics is the primary cause of the increase in the number of drug-resistant bacteria. Here's what you can do to promote proper use of antibiotics:

·         Understand when antibiotics should be used

      ·         Don’t pressure your doctor for antibiotics if you have a viral illness

      ·         Take antibiotics as prescribed

      ·         Never take antibiotics without a prescription (including a prior prescription where you      

             leftover pills)

      ·         Get recommended vaccinations

      ·         Practice good hand hygiene!!!!
 

I know this won’t satisfy the Element of Performance related to education for NPSG #7, but this is good stuff to know.  I am sensitive to infections and infection control.  My father acquired a HAI during the last time he was in a hospital.  That infection took its toll on him and accelerated his terminal condition.   I know I am not alone in having many antibiotic prescriptions in the course of my lifetime, but being armed with this information, you can be assured going forward, I will let the viral bug run its course without taking any antibiotics.    

¹  www.jointcommission.org

²  Hospitals and Health Networks magazine, September 2010

It's That Time of Year Again

It generally starts with a sneeze, a cough, a headache, nasal stuffiness, or a scratchy throat.   For many the seasonal changes bring forward allergic reactions and increased opportunities for germs to spread resulting in common colds and influenza. 

The most common course of action people take is to go to a store and purchase a “remedy” in the form of an over-the-counter (OTC) medication.  The Consumer Healthcare Products Association estimates that $4.2 billion were spent on OTC cold / cough drugs in the U.S. in 2011. 

The choices are plenty:

·         Analgesics for headaches, aches and pains

·         Antipyretics for fevers

·         Antitussive for nonproductive (dry) coughs

·         Expectorants for productive (mucus) coughs

·         Antihistamines for runny nose, itchy eyes

·         Decongestant for stuff nose / congestion

·         Anesthetic – Analgesics for sore throat

And then there are the concoctions that are designed to provide relief for people experiencing multiple symptoms of their self-diagnosed condition.  It should be noted that when people feel miserable that they tend to purchase these meds without concern about how they might interact with some prescribed medication they may be taking.  For example, individuals with high blood pressure, cardiac conditions, and diabetes are advised not take antihistamines without consulting their doctor first.  Yet, most people don’t because they prefer immediate peaceful tranquility to pain and suffering regardless of the potential side effects.

Knowing which cough medicine to take is kind of important.  Antitussive meds keep the cough at bay.  You want this for a dry cough.  Expectorants encourage coughing that breaks up mucus and works to keep it from collecting in your lower respiratory tract.  If mucus continues to collect significantly, then pneumonia could possibly set in. 

There are also differences in decongestants.  I have learned that nasal decongestants have an effective shelf life of 3 – 5 days, and after that comes a rebound effect which creates even more stuffiness.  The alternative oral decongestant does not have such an effect, however, it does not provide results as quickly as its nasal alternative.  One of the most common oral brands is Sudafed, which now has restrictions around its purchase because of the Pseudoephedrine ingredient that is also used in the illicit manufacturing of amphetamines. 

There are impatient Type A souls like me who want and need to feel well to get on with what needs to be done ASAP.  So, if I don’t start feeling better after 3 days, then I move on to a different brand of medication to see if it does better or I move on to a multi-symptom wonder drug.  For most of us, viral sinus infections move out of our system within 14 days.   If it goes beyond that, then there may be a secondary bacterial infection looming about.

If one seeks out antihistamines, one discovers many choices.  A couple options with their primary ingredient bases include:  Dimetapp (Brompheniramine), and NyQuil (Doxylamine).  Of course, there are the OTC “allergy” relief drugs (antihistamines) that are available.  The non-drowsy versions include Allegra (Fexofenadine), Claritin (Loratadine) and Zyrtec (Cetirizine).  The ones that make one drowsy are:  Benadryl (Diphenhydramine), Chlor-Trimetron (Chlorpheniramine), and Tavist (Clemastine).

How does the average consumer know which is the best for them?  Trial and error, I suppose. 

After a week or more taking OTC meds and enduring discomfort with no end in sight, people take on a more aggressive approach and go to a doctor.    Past experience with this problem suggests the need for a prescription of the Holy Grail of medications  – Antibiotics.  You go in, and in a minute or two of face-to-face time with the doctor or nurse practitioner, you typically receive an acute rhinosinusitis or upper respiratory infection diagnosis with “take one daily for 10 days, drink a lot of fluids, get some rest and come back if you are not well or things get worse.”  $Cha-ching$.  “Next, patient please.”  Scientific studies have consistently shown this scenario is played out with more than 80% of people diagnosed with this condition. 

Next you are off to the drug store.  You contribute to the $5.8 billion Americans spend to treat this diagnosis as you purchase your Antibiotics and maybe a nasal steroid spray.  You now believe you are on your way to wellness because you got a real diagnosis from a medical person.  A few days later you begin to feel better, so much in fact that you cease taking the Antibiotics since you think you are “cured” of your ailment, with the thought of maybe hanging on to what is left to be used during the next episode. 

 
The truth be told, over 90% of all sinus infections are viral based, which means antibiotics aren’t effective.  The reason they are tend to be prescribed is “just in case” the condition is bacterial based.  There is a price to be paid for our casual use of antibiotics.  I will speak to that in a follow-up blog.

A Sense of Community

My live college football game experiences have been largely at the Liberty Bowl stadium in Memphis watching my beloved University of Memphis Tigers give their best effort.  Tiger football has seldom been the University’s claim to fame in athletics.  Yet, occasionally Tiger fans get an enjoyable treat watching standouts, such as DeAngelo Williams (Carolina Panthers RB), whom we got to watch run at every home game and pile up enough yards to get national recognition. 

 Last weekend I had the opportunity to take in the whole aura of a SEC college football game at the University of South Carolina.  The SEC can arguably be cited as the best and most competitive conference in college football at this time.   Although, after watching the televised game between Alabama and Arkansas yesterday, Alabama clearly showed not all teams in the conference are equal…sorry Mary. Stephen and Jim L.

Columbia, the capital of South Carolina is the largest city in the state with a population of 130,000.  The state is void of any major professional sports team, so college athletics reign.  One does not have to be here very long to understand there are two primary loyalties among the populace in the state…the University of South Carolina and Clemson University. 

On game day, in Columbia, traffic is at a stand-still within 3 miles from the stadium at least three hours prior to the kick-off.  Traffic is re-routed where roads that are regularly bi-directional are now one way.  And from personal experience, you need to learn which roads to avoid, which roads will lead you to the Fairgrounds fields where thousands of people are tailgating and the road to avoid which takes you to a parking area where the affluent park, play and party.   Police cars and staff from different counties and municipalities are scattered throughout to control the traffic and crowd. 

Because of the traffic flow and the lane I was in I was forced into a parking lot that was across the street from the stadium which cost me $40.  The huge expanse of grass lots with painted lines to guide cars into slots was full of luxury and late model SUVs.  As I went down to the end of the grassy area to find a parking spot, my small late model pickup received ridicule from several rich kids (college students) who jumped out of their folding chairs and yelled “Ranger Alert.”  Ford quit making the Ranger pickup last year, and as pickups go, they tend to be the least expensive.  I parked my vehicle and walked down one long lane of portable sun shade structures bearing the University of South Carolina name and Gamecocks logo.   Underneath each of these tents were people dressed in Maroon, Black or White tops that left no one to wonder which team they were rooting for.  Scents of meat cooking on portable grills and voices filled with laughter came from this crowd. Beer and other alcoholic beverages were in abundance.  There was one tent with two TV’s set up airing other televised games.  I understand that some people come to the games without tickets just to socialize with others before, during and after the game.  This was tailgating unlike anything I had seen before, but this was just an appetizer.

With the benefit of a cell phone my co-worker and I were able to meet up at a landmark.  He guided me past the stadium to the Fairgrounds where his family had parked.  There were literally thousands of people milling about in the grassy area that was reserved for people who had pre-paid for a spot to park. I learned many of these people had the same reserved spot for years and it was a given that they would be there every home game.  Of all the people there, my friend seemed to know several and oddly, someone there knew me…another co-worker.  More tents, more food, more booze, and many more people than the parking lot I just left.  If I were 30 years younger and single, this would be a great play ground J.   I met my co-worker’s family and they took me in as if I had always been a part of their pre-game ritual.  A couple of beers, and a shot of mint liqueur and off to the stadium we went.   I was with my co-worker, his brother and his brother’s fraternity brothers and their girlfriends, all of whom were half my age. 

The stadium does not sell alcoholic beverages, so many students and alums sneak in the mini-bottles of spirits to spike their sodas that they buy at the concession stands.  After a stop at the concession stands and paying $5.50 for a souvenir cup full of Coke we moved through the crowd to find our gate.  As we walked up the ramp to our gate, my co-worker’s brother and his frat brothers were yelling out cheers where many others on the ramp and breezeway joined in.  Certainly, USC has passionate and loyal fans.  We found our seats at the 40 yard line located about half way between the field and top of the stadium.  The seats were in a great location, and it wasn’t long before you were talking to people on your row, behind you and in front of you, unassuming to any stranger that these people had not known each other before this day.  The old man fit in just fine with the “kids.”

As the team came on the field, the place became electric…over 80,000 people in the house with a safe estimate of 75,000 being Gamecock loyalists.  Every USC student in their designated section below the new scoreboard was aggressively waving small towels overhead in a circular motion in unison to music blasting from the sound system right before kickoff.  I can only image how amped I would be as player if I walked into that environment. 

South Carolina does have a good team this year.  They also have an accomplished college coach in Steve Spurrier.  He is not hard to miss on the sidelines...look for the infamous visor and you’ll likely see him viewing every play at the line scrimmage.  The starting quarterback was injured in the previous game and did not play.  Their second string quarterback led them to a 35-0 halftime lead…after halftime the student section was ½ empty and people started exiting in droves.  My co-worker told me when the Gamecocks have a large lead like this, the masses head back out to continue tailgating or try to beat the traffic. 

 

I left with 5 minutes left in the game.  My co-worker went back to tailgate with his family and I went the other way to my truck.  At the end of the grassy area where my truck was parked there were port a potties and a fence nearby.  I heard some music blaring beyond the fence, so I walked over to take a peek.  Down a hill from the fence there were makeshift tents set up in another grassy area with signs displaying Greek symbols for each fraternity represented.  There students, more students, and I expect alums all there having a good time.  This had to be where the real party was.

All in all, this was a wonderful experience.  In spite of all the differences and disagreements among people, there are circumstances, events, and occasions when we put all that aside and come together as one community.  This day was one of them.  USC won 48-10.  Go Cocks!

A Week of Novelties

There are many experiences we encounter on a daily basis.  When compounded, the numbers are astronomical.  At some point, you have enough to make generalizations of what to expect.  Every now and then, someone throws a curve ball that deviates from our often straight and narrow focal point. 

Last weekend I was on a plane from Atlanta going to Memphis.  I typically bury my head in a book and pop in the earphones to listen to my iPod.  Most often as the plane boards I smile, nod my head to the person next to me and keep the exchange to a cursory hi, how are you, and mention the weather.  The book generally comes out once the plane lifts off the runway and the music comes on at 10,000 feet.  Before I could get the book open a gentleman sat next to me and started a conversation.  This guy hooked me by asking me if Memphis was home…it kind of is, sort of is; probably so.  Memphis is not my roots, not where either of my two residences are, but a place where I spent over half my life.  The conversation moved forward and I discovered that we both knew some of the same people (small world!).  We talked about the politics and state of affairs in Memphis and surrounding areas.  We talked about business.  He showed me the book he was using to teach college manufacturing and production management, I told him about what I was doing at the hospital that had its roots in manufacturing.  He was retired military and I was also a veteran.  I found out his kids went to the same high school as I did – 10 years or so past my reign of terror there.  We talked about healthcare.   His daughter is in healthcare and is married to the Chief of Pediatric Medicine at the children’s hospital in Memphis.  We ended our hour trip, with neither of us cracking the books we intended to read, and talked about a chance meeting at IHOP the next morning where I had a birthday breakfast date with my granddaughter.  I was there, and he wasn’t, but for once this deviation from my normal behaviour on a plane was one I enjoyed.

On the return leg of this same trip I was flying from Atlanta to Charleston. As I boarded the plane, I scanned the faces of my fellow passengers and one man stood out among the rest.  He was 3 seats in front of me.  He was dark skinned with a white goatee and smartly dressed with a sport jacket and a Muslim cap.  I assumed from my observation that he was probably from Africa.  All the passengers except one had boarded the plane.  That last passenger came to her seat only to see it was occupied by the man I had noticed.  The flight attendant asked the man to move to his assigned seat which was next to mine.  The smile, and hello were extended and we were off.  This time, I did get a few pages of my book read.  The flight attendants came through the cabin offering complimentary drinks and a bag of peanuts.  It was obvious, that the person next to me spoke limited English, but he did say water and no ice.  As I opened my bag of peanuts, I could see through my peripheral vision the gentleman next to me was watching me intensely.  He copied what I did in trying to open the bag of peanuts, but it would not open.   He quizzically looked at me and opened his hands with his palms up and a shrug of the shoulders.  I reached out with my palm open and he placed the bag of peanuts in my hand.  Indeed this bag was a more difficult to open than mine, but I was able to open it for him.  He gave me a nod of thanks and ate every morsel of his snack.   It is hard to imagine someone never opening a bag of peanuts, but I do understand this may be a novelty for this person…another lesson in diversity for me. 

When a plane lands, most of the passengers follow the courteous protocol of an orderly exit, meaning each row is emptied before the next row proceeds forward.  You get the occasional people who have connecting flights with little layover time who break that routine and there is often a Type A jerk who just has to beat everyone else off the plane.  I was in a window seat.  My seat neighbor was in the middle seat.  He jumped out in front of the person in the aisle seat on our row and aggressively moved to where he stored his luggage in the overhead bin.  Once he got his bags, he continued to push forward to quickly get off the plane.  I wrote this behavior off as a cultural nuance.  As I left the plane and entered the boarding tunnel, I saw this same man in a wheel chair with his bags stowed and an attendant behind the chair waiting for the rest of us to clear the ramp.  Hurry up and wait is what we learned in the military…I don’t think he was ever a member of our militia.   

Yesterday, I went through the drive-thru at McDonald’s to purchase a meal.  The total came to $4.56.  I drove up to the first window and gave the cashier $5.56.  I was expecting $1 back.  I know my memory is not what it once was, but I still can do basic math without a calculator.  The cashier at the window took the money and put it in the cash register.  She pulled out a dollar bill and then put it back.  Then she asked me how much I gave her.  I told her.  She then gave me 30 cents in return.  I held at my hand and looked at her with the facial expression that said, “you gotta be kidding me, really?” She realized that there was a shortage in the amount of change she gave me.  She gave me a couple more quarters and told me she had set them on the cash register to give to me.  My wife would have created a stink about it, but I on the other hand felt bad for this young girl.  I recognized that she did not know how to count change.  How much money is that location losing or gaining (my 20 cents) because of the lack of competence?    Or maybe, she does know how to count change…maybe I just got hustled. 

This weekend my wife also went to an eatery that has a drive-thru window.  She got her food and paid for it, but it was less expensive than it usually was.  She went home and looked at the receipt.  Lo and behold, she received a senior discount J.  She was so offended that went online to see what age this company considered senior.  She was past the age by a few years, so she felt better.  I told her that in a few years it will be a treat to eat out, and we’ll be asking for the senior discount if they forget to mention it.  I told her to enjoy it while she can get it because she earned it. 

 
It’s the new experiences that make life more interesting and adds more filler to our individual tome of wisdom.

Just a little bit of patience

As I think about our society, especially where the masses congregate in a rat race with zero sum outcomes, we do not tolerate waiting very well.  A couple of great innovations that prove this point are the microwave oven and drive through windows at fast food restaurants.  Quick, efficient and it satisfies our need for immediacy.  ATMs have popped up everywhere to eliminate the middle person (bank teller) for simple transactions.  All you need is a bank card, a PIN number and money to either deposit or withdraw.  Simple, efficient, and quick. 

As a Type A card carrying person, I hate to wait.  I am continuously competing with the clock.  I am rarely late and seldom too early.  My wife loves that about me – NOT.  I move swiftly with determination to my destination.  Chit chat beyond obligatory respectful greetings can wait for another time.  I work hard to arrive where I need to be just in time.  And so it goes, if I am on time at a defined event, so should everyone else be. 

Often that is not the case.  We wait for “key” people at work to arrive before we can start the meeting.  We sit in an overbooked doctor’s office for extended periods of time, hoping there is a gender oriented magazine there to flip through as we wait.  We are inconvenienced by people who arrive at the movie theater after the movie has begun and they just have to sit on the row you have comfortably sat yourself in.  We are endangered by people who are late out of the gate and are driving their vehicle at unsafe speeds and weaving from lane to lane in an attempt to get ahead of the next car in front of them during rush hour.  In the city, if we are not waiting, we are rushing.

There are times when I demonstrate considerable patience.  Those times include coaching, teaching, listening, learning and helping others.  There are other times, where impatience rules and tolerance wanes.  Those include:  red lights, conscious incompetence, slow drivers in the fast lane, automated phone directives or being put on hold, people who are habitually late, etc.

I typically take in a new flick every weekend.  Last weekend I went to the cinema to watch the new Batman movie.  For occasions like this I tend to arrive earlier than just in time.  At this location there are generally two lines of ticket buyers and then there is this “secret” self-service station that very few people know about because it is hidden so well.  I found it and use this wonderful time saver which allows me to readjust my time of arrival to enter the screening room just as the trailers for the upcoming movies begin. 

 
On this day, someone else found my haven of expediency and was there before me.  As luck would have it, this person was older than me, visually challenged, physically and cognitively slow and not so keen on using technology.  Twice this person had to select the “do you need more time” option.  I offered to help the person through the process, but my offer was spurned.  People were zipping through the ticket lines while this individual wondered how to get from screen to screen.  The word “CONTINUE” must have a different meaning for people other than me. 

For people who know me, you can imagine how frustrated I was as I observed this person struggling and stumbling through something that was designed to be user friendly and simply efficient.  My body language certainly exhibited this frustration.  After this person got their ticket I zipped through the process and passed this slow poke on my way to the show, stopping long enough to shoot a look of disgust at this person.  Even though I found a choice seat before the trailers started, I still inconveniently had to wait because of another person’s conscious incompetence…”all good things come to he who waits.”

Faith

Today marks the day that Christians throughout the world celebrate the resurrection of Jesus Christ.  His death and subsequent ascension to heaven provides salvation with everlasting life for all who believe.  I am one whom is not bashful in proclaiming that I subscribe to the Christian doctrine.  And I am not alone.  It is estimated that 33.1% of the world’s 7 billion people are Christians¹ and 76%² of the 313,325,399³ people in the United States, 76% claim to be Christian.

Yet, not all Christians are created equal.  There are some fundamental tenets that all Christian religions hold sacred.  One for example, is the events that mark this day as significant for all Christians.  Another is the commonality among all Christian denominations that The Holy Bible is the transcript of Christianity which was written by man, but inspired by God.  From that one book, there have been multiple meanings people have taken, hence, multiple religious denominations.

Each religious faction within the Christian world worships differently.  Some have communion, some don’t.  Many have some form of baptism, some require a declaration of “being saved, and the list goes on.  Some groups suggest condemnation for non-believers.  Some believe that the Bible is wholly literal, while others contend some of it is metaphorical.  Which group is more right or truer than the other?

The allure of temptation can be overwhelming for many.  There are people who claim to be Christian, but their behaviours do not reflect “What Would Jesus Do?”  Some find Christ after committing a heinous crime.  Can or should they be forgiven for their sin(s), especially if it was a crime that resulted in premeditated and intentional harm or death?   Would a self-proclaimed Christian be able to forgive this same criminal if his/her parent, spouse or child was the victim?  A debate I often hear about Christian behaviour is “what does a Christian act like?”  Many people attend a religious service regularly, while others don’t.  Does attending a service make a person any more a Christian than someone who doesn’t?

The longer I live, the more I learn.  The more I learn, the more I think.  The more I think, the more I question.  My beliefs are the function of what has been handed down and taught to me (culture) coupled with life experiences.  I am comfortable in what I believe.  I am proud to say I am a Christian.  I am the first in line to say that what I believe will be largely or slightly different than what you believe.  I will also be the first to say that what you believe may be no more right or wrong than what I believe and I respect your beliefs.  Be clear though, that in my world respect does not mean agreement.  Yet, however different we land on what our beliefs and hopes are, we have them and it is what we call Faith.

¹ World Christian Database of Gordon-Cromwell Theological Seminary

² The American Religious Identification Survey (ARIS) was conducted in 2008

³ http://www.census.gov/population/www/popclockus.html

Sign of the Times

Last Friday I went to Memphis to watch my son-in-law battle in a MMA event.  I “touched down in the land of the delta blues”¹ around 10:30 p.m. and waited outside for over an hour in the chilled air for the rental car bus that never came.  I ended up hopping on the last bus of the rental car companies, which turned out to be the most expensive choice.  As the last customer of the night, they gave me a new car.  I guess that justified the price :-/. 

I walk to the new car and open the door ready to turn the key and drive off.  But this was no ordinary car.  There was no ignition switch or key.  There was a remote for locking/unlocking the doors and trunk, but no key.  Of course being the man I am, there was no way I was going to go back into office where I rented the car and ask how to start the car without a key.  Even if I felt the desperate need to go back, it was too late.  I saw the lady in the office lock up and trek to another building. 

On this car, like my sports car, there is a start button.  I pushed it and some icons appeared along with the word Brake.  Now I start searching for the emergency brake.  Found it…not engaged.  Hmmm.  I kept on trying different things and accidently stepped on the brake pedal and pushed the button.  Zoom, zoom, zoom.   

On Saturday, I spent the day with my 7 year old granddaughter.  We took in a movie (Puss in Boots) and then went shopping.  She knows she gets what she wants when Papa’s in town J.  She saw this tea party set with metal cups and a metal teapot that she wanted “really bad”…or at least that is what she told me.  Suffice to say it wasn’t cheap and she got it.  When I took her to my mom’s I saw she already had a plastic tea party set.  I asked her why she needed this new one if she already had one.  The new one is real, the other one is “fake.”  I have a feeling she’ll be emptying a future beau’s wallet fairly quickly J.

After the fight, a group of ten, including my son-in-law and daughter went to a local establishment that my daughter recalled me taking her to after my indoor soccer games many years ago.  The indoor soccer facility was a couple blocks away.  This group consisted of either millennials or Gen Xers, save me.  I was the only card carrying Baby Boomer.  As I looked around, I was also the only one without a cell phone.  People were posting or checking in on their Facebook pages, or texting, or tweeting as we waited for our drinks and food, and inhaled the thick smoke of burning cigarettes.  I watched in amazement of how well these young people used their thumbs and their ability to type faster than I can on a standard keyboard.  My phone was safely stowed in the rental car.  I haven’t yet made it a mandatory accessory to my being. 

My flight back to South Carolina had a layover in Atlanta.  I was at my gate and watched the folks come off the plane that I was about to board.  I noticed a need for at least 3 wheel chairs.  Additionally, there was an older nicely dressed gentleman who had to be 80+ and another couple around the same age.  I was intrigued with the older man in how he navigated to the flight schedule board and slowly walked to his next connection.  The older couple was just as interesting and as a team they figured out where to go next, and off they went. 

A thought occurred to me around those three people.  Ten years ago, if I were behind them, I would have seen them as an inconvenience and a hurdle because they were slow.  I tend to be on a mission in airports because I most often cut it pretty close in regard to having time to spare before I have to board the plane or if the truth be told, for most things where I have to be somewhere.   The wife can validate this behaviour.  

Statistically speaking, my life expectancy is around 75 +/- 5.  If life is divided into 3 sections, then I have quickly moved into the final phase.  As I saw those 3 on this day, I said to myself, “good for them.”  Let me hope that people like me will come to that realization that we all will not be so limber or so keen as we once were and that if we should happen to be lucky enough to remain healthy and live beyond expectations then I hope we too will be able to enjoy the same independence to go wherever the next flight takes us.

¹ From the song, “Walking in Memphis” by Marc Cohn.