c1: (Star of Life)
Saturday, class all day. Saturday night, on duty until midnight. Sunday morning, up at the crack of dawn for class all day. Sunday evening, go kayaking on the Ipswich river in Topsfield, because sanity. Monday, drink five cups of coffee, fall asleep at my desk with my eyes wide open just the same. Monday evening, nearly bite the head off my CAD instructor because I've had it up to here with Creo and with him. And y'know, short fuse because I'm completely out of spoons on just about every level.

All that being said, there were a few cool things:
Saturday, test #1 of 4. I got within five points of turning in the answer key. Bummer that I missed out on acing the exam by a measly five points, but I'm happy with the 95 just the same.
Began discussing cardiology. I've always been fascinated with congestive heart failure, because it's an incredibly multi-faceted/multi-layered disease. This made it even more so. There is an almost certain elegance to how the cardiac aspect ties back to acid/base balance, sodium/potassium pump, fluid balance, and the pulmonary system.
Saturday night, ran a call soup-to-nuts, including giving the patch to the hospital. Apart from writing the report (I've been writing a "dummy" report for each call as it is) and driving the ambulance, this is about it. Hopefully I'll be out of field training in the coming weeks.
To that end, I had a chat with the field training coordinator, and my future Saturday night shifts will be full 12-hour shifts, which should get me more calls (he says about three per night ought to be a good average). Realistically speaking, when I was working professionally, three 911 calls in a shift was a busy day; most of what I did was inter-facility transports. More actual hands-on patient contact, but a practically identical amount of "real" emergency work.
Sunday's class was a combination of EKG interpretation (of which there will be much more coming up) and tying that into cardiology fundamentals, doing in-class practicum with the 12 lead EKG machine, and hearing stories from the instructor about what happens to your partner when you smear nitroglycerine paste on the toilet seat. (Hint: hilarity ensues, your boss won't get the joke, but your classroom full of students will be on the floor in tears laughing.) Don't ever think EMS folks don't know how to have a good time. Also, how not to get fired for setting fire to the planters hanging outside the office. Yep. And here I was, thinking we were living on the edge by driving the ambulance backwards through the Dunkin' Donuts drive-thru back in the day.
Sunday evening, kayaking. Got to see the shadow of a few river otters (past dusk) splashing in the water. Also got a picture of a heron earlier on and quite up-close.
c1: (Star of Life)
Class has gotten slightly easier; last week's A&P quiz, in a word, sucked. In more words, it was the only quiz to date that was graded leniently: everyone got 10 points for free. Not surprising, as the chapter was hands-down the longest in the book. It probably didn't help that the depth of knowledge goes further than anything in our collective experience.
Yesterday, we had a "guest lecturer" as our instructor is in CA attending a wedding. "Guest" in quotes, because he's a paramedic with the department. A decent part of his lecture was about how to read the exam questions appropriately, so we're not reading too much, nor too little into the question.
We did airway and respiration, which continued to tie down principles we learned about metabolism in the physiology lecture. Everything does indeed come back to metabolism, acid/base balance, and so on. (Seriously, the attendant problems brought on by choking can be described as a simple acid/base imbalance that triggers a cascade which, left unchecked, results in a stable state.)

My duty shift was also last night, and my preceptor has been insisting I take the lead, soup to nuts, on a call. Coincidentally, the calls since he started chiming up about this have all been paramedic level, which put the kibosh on his plans. Last night, we finally got a BLS call where I could run the call from beginning to end.
This was the first time in decades since I've done so.
Fortunately, the call was fairly simple, with little more than to examine the patient, and bring the patient and a family member to the hospital. I got to practice, on a stress-free call, putting on a 4 lead EKG, did arguably the most thorough interview ever, and then deliver the report to the ER nurse. Pretty straightforward.
As an aside, I've been using the "Rite in the Rain" EMS notepads for my notetaking, but I'm thinking that when I run out, I might look for a different solution. They're good, but I'd prefer a different arrangement of prompts than the ones they offer -- something that follows my patient interview/report style.
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The Currier Museum in Manchester, NH, will have a show of MC Escher's work from the 20th of September to the 5th of January, 2015.

<em>M.C. Escher created intricate geometric drawings and prints of spaces that can only exist on paper and in the viewer’s mind. His images continue to boggle the eye and the brain, captivating viewers more than 40 years after his death. In Escher’s world, stairways are built upside-down, water runs uphill and every object is reproduced with mathematical precision. This Escher retrospective is one of the largest and most comprehensive ever offered in the United States. Its exclusive New England showing at the Currier Museum of Art will contain his best-known works of art, early family portraits, original preparatory sketches and mezzotints he created, and one of the of lithographic stones he used to print a later work.</em>

My, my, my, my drawings hit me
So hard
Make me say
"Oh my lord
Thank you
For blessing me
With a hand that draws
And a mind that sees."

It feels good
When you know you're down
A super dope homeboy
From a Dutch town
And I'm known as such
And this is art, uh,
You can't touch.

(Parachute pants optional.) 


Sep. 1st, 2014 10:18 am
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So Thursday night had a lot of fail.

I was chopping an onion, and of course, my thumb decided to go out on an adventure to see what was really under the edge of the knife. As thumbs don't typically have eyes, it had to examine said edge of knife by braille. The expected happened: I did a lot of dancing around the kitchen. Some words were uttered that one typically doesn't utter in the presence of one's mother.

Happily, most of my thumb is still attached: I am pleased to report that I can still count to ten without taking off my shoes.

That wasn't the worst of the fail.

No, the worst was finding a band-aid. It is indeed ironic, but I don't actually have that many. Gigantic multi-trauma dressings suitable for packing around all kinds of gruesome mess that Michael Bay won't even touch, yes. Piddling little band-aids? Strangely not so much.

I did have a couple 2x2 gauze pads and some tape, which right then was exactly what I wanted. Friday, I managed to find a couple band-aids in my hiking first-aid kit, and that carried me until Saturday. But Saturday afternoon, on my way home from A-EMT class, I had to stop at the drugstore, because I was running out. (No, I didn't just grab a handful from one of the ambulances. Not my style to leave a truck depleted without a real patient. Having been jammed on calls like that myself, I'm twitchy about that kind of thing.) 

But now I'm ready for the next time my thumb decides to be foolish.
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ATD has signed an agreement, where for the paltry sum of $1.5B, he gets control over the company.

Which is just in time, because I'm running low on their white rye, and nothing else but theirs is even nearly as tasty.


Aug. 24th, 2014 12:04 pm
c1: (Star of Life)
Yesterday's lecture was on physiology. In 8 hours, a UNH professor covered what she normally teaches over a 90-hour/semester long course. It was a lot of material, to put it mildly -- I got home and just sat drooling in a cup for an hour.

That being said, it was intensely interesting. There was a brief summation of gross anatomy for around an hour, and then into the meat of physiology. Everything from metabolism to how all that affects acute diseases we see in the field: the visiting professor was an A-EMT herself, so she could talk to us about things that mattered to us from her own personal experience, not some abstract idea of "well, you should probably know this..." 
It's the kind of thing I'd like to take a more in-depth course on (perhaps that 90-hour version) because for as many questions she answered, there were at least a dozen that popped up. I ended up taking around 15 pages of notes, which at times was as fast as I could keep up.

Something that was curious (and I asked her about during breaks) is that my normal assumptions about chemistry don't always hold true in physiology -- being potassium deficient can make your body's acid-base balance more basic, but it makes sense when you realize that the hydrogen is seen as "similar" by the body, so it's being eliminated, skewing the balance.

Useful was the discussion of how metabolism affects not just the obvious things like diabetes, but also the non-obvious things like cardiology, mainly because we're all walking chemistry labs, and sometimes physics does things you'd rather it didn't.


Aug. 21st, 2014 08:50 pm
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So last night, we were sitting down to spaghetti dinner. Discussion of the evening was tension pneumothorax. This is when the patient gets air in between the lung and the pleural sac that surrounds the lung, essentially diminishing the lung capacity and consequently impacting gas exchange/oxygenation. No, it wasn't a coincidence; we talk shop over dinner regularly. Doesn't everyone? 

Needless to say, that's when the tones dropped. It's annoying when that happens. C'est la vie.

We got back, sat down, and picked things up from where we left off, but it would be nice if people could have the decency to not schedule their emergencies during dinner hours. Really, people.
c1: (Star of Life)
Class started last Saturday. It's a reflection of how busy things are already getting that it's taken me two days to sit down and write about it.
Not really a lot to say, except that there was a fair amount of review of what I've learned in my initial EMT course and from con-ed classes over the past 20-odd years. The adage is that for every skill you learn beyond your basic certification, you forget a skill you learned for your basic certification, so it's worth reviewing those basic skills. The course will continue to review what I already know, but more in depth, and will add to everything I already know. So everything on trauma, geriatric and pediatric medicine, and so on. But to that will be added pharmacology and cardiology. It's going to be an intense 22 weeks.
In a few weeks, we've been told that we'll be learning to start IVs, and the 12 of us will be rolling up our sleeves for each other to practice. Not sure what I think about that. But it's necessary if I'm going to be able to do my clinical rotations, which include infusing medications into at least 25 patients.

Other than that...
Got some work done in the basement on some projects. Furniture being made, storage for stuff in the basement itself has been made and populated. Basement is becoming more useful as stuff finds more structured homes. There will still be some reorganization of things, but at least the weight of that millstone is being steadily lifted.
c1: (Star of Life)
Wednesday night, we had two medical calls. One in particular stood out.

Person was having SVT (supraventricular tachychardia) that wouldn't abate. For about 45 minutes, we tried just about everything we could; any one of the interventions should have stopped it in its tracks. Finally, literally at the ER door, the patient converted to a normal rhythm.

For me, it was mildly stressful, as this was my first time working on an ALS call in two decades. While I've worked with this medic before, I hadn't gotten the chance to learn his preferences.
At the same time, it was exciting, because there was a lot going on. The patient was very unquestionably sick. Not really the sickest of the sick, but still, very much in the woods. I always try to take something from every call, and this one was no slouch in that regard.

I got to do a 12 lead EKG in the field, which was a first. Got to see the patient get externally cardioverted (or at least attempted) which I hadn't seen done in ages. Tried to get a blood pressure, which is nigh impossible with SVTs (the heart is beating too damn fast to acquire it.) 

Nicely, both my patients that night were quite charming; both commented favourably on the hair, which brings a smile. The crew I worked with are ones I've worked with in the past, and we get along well together. Again, a nice thing. Surprisingly, the town EMS director was working at the hospital that night; it was nice seeing him there.

I got a decent amount of good comments on my participation in the call, which was good. I'm still unsettled for the fact that I'm still finding my groove, but people keep telling me I did fine.

Two calls took up 4 hours of a 6 hour shift. I barely had time to get through checking the truck's stores. Oy!

Tomorrow, A-EMT classes start. The book is 1500 pages, 8x11 inches. It's going to be about three chapters of reading per week. Yeouch! 
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So Tamidon offered a K-Cup use-your-own-coffee filter gizmo a few days ago. Sunday, went over for a visit, and today I got to try it out.
The quantity of coffee needs to be tweaked (counter-intuitively, it seems less is more), but it works nicely. It gave me pause to think about making others happy in ways that are effectively cost-free, which is the best thing.
Tamidon, this made me happy. Thank-you. I hope the fact that it makes me happy makes you happy in turn.


Aug. 9th, 2014 10:34 pm
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In NH, all calls are recorded in a statewide database. This means that for every call I go on, within 24 hours, I have to log into the DB and log in patient care information. For now, because I'm not out of field training, I'm "logging calls" in the sandbox version.
The website is thoughtfully dumbed down to keep things in categories that can easily be quantified: drop down menus abound for patient condition, etc. which I would imagine makes it simple to use that data to draw statistical trends. (If providers were filling in some of this stuff, you'd have seventeen different ways people would label a diabetic emergency, for example; a nightmare when you're some bureaucrat trying to figure out if the state needs to apportion more money to interdiction efforts.) The cool thing is that logging in automagically sets up your database interface with particulars specific to your service area -- the neighbourhoods in your town, drop down menus for all the providers in your service (required when specifying who was on the call, and in what capacity) and so on.
When I was a kid, I was glued to the TV every afternoon when Emergency! was on. No kidding, my heroes back then were Roy DeSoto and Johnny Gage. "We gotta get 'im to Rampart!" was my mantra. My Radio Flyer wagon was my Squad 51 truck.
So imagine my glee when I saw my two childhood EMS heroes as the top two choices in the personnel dropdown menu. Better yet, I responded in Squad 51.
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Particle Clicker: 
You've been warned. (At the same time, once you're up and running, it can take care of itself.) 
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T-storm last night that included some fairly blustery winds. All very well and fine. Finale was the excitement: a crack of lightning Right Over Head that was immediately followed by a crash of thunder loud enough to rip the paint off the walls. Wow!
All of it over within about 10-15 minutes.
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After having enough of hearing/reading references to Deliverance (including a funny t-shirt of Stewie and Brian in a canoe, with "paddle faster -- I hear banjos!") I got it on Netflix. File this one with Fight Club and A Clockwork Orange. I think it was easier to watch Kurosawa's Ikiru, or Kieslowski's Blue, than it was to watch Deliverance.
It was emotionally exhausting, to say the least. If you've seen it, you know what I mean. If you haven't, I suggest it if you made it through the above mentioned films.

Fascinating was the Dueling Banjos leitmotif, and how it didn't change in terms of musical tonality throughout the film, but at various points, its emotional tone took on different forms.
Also fascinating was how three of the principal actors -- Burt Reynolds, Jon Voight, and Ned Beatty -- are stars in their own right, but the movie was really about the evolution of Jon Voight's character.

A brutal film, but a very good one.

Who Knew?

Aug. 3rd, 2014 11:23 am
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Weird Al just did a rousing version of Elvis Costello's "Radio Radio."
Find it on Studio 360's blog, if they end up posting it -- they did an interview with Weird Al himself. Apparently, if you hear it in concert, it's because something seriously went wrong with their computers, etc. backstage.

Went kayaking yesterday on Thorndike Pond, in the shadow of Mt. Monadnock. It's a lovely pond, good for a couple hours of lazy paddling without a lengthy drive to get there. Clear, clean water, a heron, a family of loons (including a kiddo). Slight minus is the Boy Scout camp on one end, with a couple speed boats racing around dragging tubes and water skiers.
Weather was lovely: forecast for weird, but things cleared up quite nicely. Not a lot of scorching sun, but some clouds to modulate same, and overall temperate weather.
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I am convinced that if Obama took the time he's dedicating to Syria, and instead turned it toward unemployment in the US, he'd make a far more positive impact on more people in the world. Why on earth does the US need to get involved in yet another Middle East quagmire? Did no-one learn from Iraq and Afghanistan that those problems won't be solved by even a decade of direct military involvement? 

Send refugee aid? Absolutely. Send over bullets, bombs, or boots? Forget it.
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Saw the fireworks again from the Charles. Much the same as in years past, though this time, law enforcement was a lot more heavy handed. Boston is still, unfortunately, scared of its own shadow, and so under the guise of "if we save just one life, it's worth it", they had at least twice the number of police boats out on the river, and created a bunch of rules out of thin air that were supposed to make things "safer". Unfortunately, I don't think any of them did. Affecting me personally was a mystery rule that *all* boats had to be at anchor after 7PM. This included kayaks and canoes. What they forgot is that most of the kayaks on the river are rented by inexperienced paddlers, who's only understanding of basic seamanship came after hastily skimming a list of boating rules before signing a release waiver.
Managing a boat at anchor isn't as easy as it seems. To wit, while we were at anchor waiting for the fireworks to begin, a guy and his GF showed up in their rental kayak and dropped anchor near us. Before long, they drifted across the path of our anchor line, tried to fix things, and that's when our anchor was fouled by them. After about 10 minutes of watching them try to sort things out and trying to keep a sense of humour, it became clear that the solution was for them to cut their anchor line. Of course, they didn't have a knife, so they borrowed mine... and he promptly demonstrated that he didn't have the know-how to cut a rope with a knife. (How does this happen?!) No kidding, this guy was dangerous, and from all outward appearances, seemed an otherwise educated guy.
Something else that was bothersome was the habit of the police to go whizzing past in their boats, oblivious to the fact that they were kicking up huge wakes. I'm fine in the ocean with its large waves, but in confined waters, with a lot of other large boats around, this wasn't a smart idea in the slightest. I have no idea what they were thinking, but perhaps they really weren't thinking.
Anyway, it's got me questioning whether I want to go next year, or go do something else entirely. For me, the event lost a lot of its gloss.
On the bright side, we had glorious weather. Temps in the low 80s to start, that went down to the mid 70s. Wind was about 5 kts, which kicked up the surface of the river quite a bit -- at anchor we were constantly getting splashed by waves breaking against our boats which was a little sub-optimal. Otherwise, we were quite comfortable, weather-wise.
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I won't be having anything to do with Ender's Game. I know a lot of people think it's a great work, but I can't separate the work from its author, and more specifically, his views. This is despite any plea for "forgiveness" that he's made -- cynically, I can only think he's trying to protect his potential profits in light of a potential boycott of the film.


Ender’s Game is set more than a century in the future and has nothing to do with political issues that did not exist when the book was written in 1984.

With the recent Supreme Court ruling, the gay marriage issue becomes moot.  The Full Faith and Credit clause of the Constitution will, sooner or later, give legal force in every state to any marriage contract recognized by any other state.

Now it will be interesting to see whether the victorious proponents of gay marriage will show tolerance toward those who disagreed with them when the issue was still in dispute.

Orson Scott Card

While I do believe that people's views can change over time, the plea made by OSC is that of a defeated man, not a redeemed one, and certainly not one seeking real forgiveness. Given the last line of his plea, and the fact that this is written by a man of letters who really should know the power of words, both written and unwritten, I find his comments disingenuous at best. Never in his statement did he say "I was wrong", but instead, he lays the blame for the change in acceptance of his views plainly at the feet of the Supreme Court and the Constitution.

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First, to the NSA who are probably reading this post: get lost.

Really interesting blog post from the WSJ -- normally I dismiss them as a right wing mouthpiece, but I think this hit it on the head.

On the Tsarnaevs, I'm in agreement especially. I think the way both Boston and the state handled the issue begs a lot of hard questioning. Rolling up the streets while sending out dozens of SWAT teams and soldiers was the incorrect response. Not the least was that those resources were taken from the communities that might have needed them (great that there wasn't a garden variety hostage incident on the Cape, because their SWAT team was stuck up in Watertown for the day). Forget the massive cost, both in paying for the cops for their time, and the hit to the local economy because everything was forced to grind to a halt.
The entire exercise was fruitless. Tsarnaev was caught *after* the governor announced that despite the fact that he seemingly got away, the streets were safe and everyone could come out of their homes.
...and then a homeowner found the kid. In a backyard that had been searched by the cops. Go team.
For this, we're left with cameras everywhere and other intrusions in our lives that aren't paying dividends that match the incursions on our liberties and convenience. (Remember when you could board a plane without spending 90 minutes taking off your shoes and getting x-rayed?) 
Seriously, the latest additions to the military industrial complex needs to be brought down.

Text from the article follows...

Five blunt thoughts on the growing surveillance state:

1. The thing political figures fear most is a terror event that will ruin their careers. The biggest thing they fear is that a bomb goes off and it can be traced to something they did or didn’t do, an action they did or didn’t support. They all fear being accused of not doing enough to keep the citizenry safe.

This is true of Republicans and Democrats. Their anxiety has no ideology. They all fear being the incumbent in the election in which the challenger says, in a debate: “That’s all well and fine, Senator, we’re sure you’re upset at what happened. But at the moment it counted, when you could have supported all efforts to keep the people safe and bust the terror network, you weren’t there. You were off giving lectures on what you call civil liberties, and explaining why you were voting ‘no.’ Well, life is a civil liberty—and now a thousand people are dead.” Nobody wants to be that incumbent.

Because of that primal political fear, there is a built-in bias within the U.S. government toward doing too much and not too little. There is a built-in bias toward using too much muscle, too much snooping, too much gathering of data. The bias is toward overreach. The era of metadata encourages all this: There’s always more information to be got.

Presidents are very much part of this, as are congressmen, and judges too. Nobody wants to be the judge who didn’t sign off on the request that could arguably have impeded the network that put the dirty bomb on 42nd and Eighth. No one wants to be the judge whose name the U.S. intelligence agencies leak to the press as the real culprit, the real reason they couldn’t stop the bad guys. “Judge Murphy was generally seen as a loner on the bench, a man more drawn to horticultural pursuits and abstruse comment-thread debate on the history of the Fourth Amendment than evenings out with colleagues on the court and in the local bar association. ‘He’s about to discover why people have friends,’ said a court worker who spoke anonymously in order not to appear to be taking sides in the growing controversy. ‘I hope he survives this, even in a diminished capacity, because in a way the law benefits from his kind of detachment and ethereal approach.’” Nobody wants to be Judge Murphy.

Because of the built-in bias in the system—the bias to do too much, to go too far—the creation of an invasive American surveillance state is probably inevitable. Politicians are people who can do math. The number of people who want to be safe, they are certain, is far greater than the number worried about abstract issues of privacy. Moreover, they figure voters are more or less like this: They’ll have their little blog debates about privacy right up until a bomb goes off, and then they’ll all go into a swivet and join a new chorus: “Why didn’t you protect me? Throw the bums out!”

2. There is no way a government in the age of metadata, with the growing capacity to listen, trace, tap, track and read, will not eventually, and even in time systematically, use that power wrongly, maliciously, illegally and in areas for which the intelligence gathering was never intended. People are right to fear that the government’s surveillance power will be abused. It will be. There are many reasons for this, but the primary one is that humans are and will be in charge of it, and humans have shown throughout history a bit of a tendency to play every trick and bend and break laws. “If men were angels,” as James Madison wrote, limits, checks, balances and specifically protected rights would not be necessary. But they aren’t angels. Add to all this simple human mistakes, innocent and not, and misjudgments. And add to that sheer human craziness, partisan lust, political mischief of all sorts. In the Clinton White House there was a guy named Craig Livingstone who amused himself reading aloud the confidential FBI files of prominent Republicans. The files—hundreds of them—were improperly secured and disseminated. Imagine Craig Livingstone at the National Security Agency. Imagine Lois Lerner.

So if we have and develop a massive surveillance state, it will be abused. And that abuse will, down the road, do damage not only to individuals but, quite probably, to the nation’s morale, to its very vision of itself.

But it will make us – or allow us to feel — physically safer. And it may help break real terror networks bent on real mayhem.

Discuss. Really: Discuss.

3. The president said Friday, in his remarks on the NSA surveillance story: “I think it’s important to recognize that you can’t have 100% security and also then have 100% privacy and zero inconvenience.”

But is that really the trade-off? Will a surveillance state make us 100% safer? It let the Tsarnaevs through. We had the surveillance state when they set off their bombs at the Boston Marathon. We’d even been tipped by the Russians to watch them. The surveillance state didn’t thwart the Fort Hood massacre. Maybe in the end we’ll find the surveillance state is massive, cumbersome, costly, potentially helpful, certainly powerful, menacing and yet not always so effective.

4. The president said the recently revealed programs are subject to congressional oversight, which will help keep them from getting out of hand. But that sounded more like a Washington inside joke than a comfort. Congressional oversight of executive agencies has been chronically lacking and lackluster for years. If you are a congressman oversight is, generally, an unrewarded time-suck. It’s housekeeping that demands deep bureaucratic, accounting and now technological expertise. (“Thank you for providing the email records, but is there any chance you have secret email accounts that aren’t included here?”) And usually nobody knows about your good work—it yields little in the way of credit.

Oversight is time taken away from fundraising calls, from the four-minute hit on “Hardball” or Fox, from the urgent call with the important constituent, from time in the gym where you hide from your staff. And Congress isn’t even in Washington often enough to establish ready and present oversight—members work from Monday through Thursday, and then go home to meet with people and show they’re normal. That’s part of the reason the Internal Revenue Service thought it could function as a political entity—they didn’t fear oversight. The General Services Administration on its champagne-soaked boondoggles—they didn’t fear oversight. Do the technicians, data miners, lawyers and technology officers in the NSA warehouses fear oversight?

Props here to Darrell Issa: He does oversight. But his work is exceptional because it is the exception. And congressional oversight still leads us back to where we began: the built-in bias toward doing too much.

5. The security age began on Sept. 12, 2001. The enormity of the surveillance state since has grown. Americans, in the shock after 9/11, didn’t mind enhanced security, and in fact were mostly grateful for it and supportive of it. But built into that support, and the acceptance of the surveillance mentality’s intrusions, was I suspect a broadly held assumption that we’ll just do it now, and down the road we can stop it. It’s just an emergency thing. We can make it go away when we no longer want it. But can we? Do government programs tend to remain static, or wither? Or do they tend to grow?


May. 4th, 2013 10:49 am
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May the Fourth be with y'all.
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