LGA--> ORD--> MSP--> ORD--> MDW--> LGA--> LAX--> BDL--> HPN--> DTW--> CID

Checked into the Heartland Inn, where there were guys drinking cases of bud light in the lobby. Then I wandered over to the strip mall, which had been renovated since the big flood two years ago, and found 15 guys playing "Magic". Ah, so this is Iowa.

A google search revealed that waiting for a medical examiner to arrive
after a train fatality is de facto. The medical examiner has arrived
and rumor has it they are bringing another train alongside this one
and we will be transferring to it. In another case, passengers were
permitted to exit the train to stretch their legs, but with weather
like this (cold, wet, and dreary) I don't mind being inside.

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Haven't moved yet

So three hours after boarding my train, I'm still in Hartford, CT. So
the Hartford police, coroner, and forensics team are thorough-- or
inefficient... Now they are waiting the medical examiner of CT. I'm
in an information vaccuum, which leads to wild speculation (not the
financial kind) and postulating. You don't typically need a forensics
expert in every death. We appear to be in the middle of nowhere, so
what was this guy doing on the tracks? Was he sleeping? Was he
inebriated? Was there foul play? Was he already dead before the train
hit him? Perhaps I've been watching too much Law and Order of late.

Yesterday: ROC --> LGA --> BDL

Tomorrow: Amtrak from Hartford to Penn Station

Up in the air

5am in MSN. 6am in ORD. 10am in LGA. Waiting for the 3rd leg to ROC.
Today is the start of my 2 month journey on the road. Let's call it
the grand Tour of America and Its Major Airports and Transportation
Infrastructure (TAIMATI).

Speaking of acronyms, yesterday we learned about SALT, a mnemonic for
disaster emergency response triaging in the field. S= sort. A= assess.
L= LSI. T= treat. The idea is that when there are limited resources,
triage is key to maximizing life saving measures for those who are
most likely to benefit from receiving care. Okay, "duh" you say. But a
catastrophic event is not the only time resources are limited. While
it doesn't feel as acute, the present state of health care is viewed
by many as a situation with limited resources. On the wards I see
physicians attempting to curb excessive test ordering in good faith,
but ordering only the hemaglobin instead of the H and H barely scrapes
the surface of grappling with limited resorces. I contend that, as
distasteful as it may be, it does not hurt to go through the mental
exercise of capping health care resources at different limits and at
least hypothetically prioritizing care, as we did in our disaster
preparedness course today. At the mere mention of rationing care,
people sling political career ending venom, like "death panels" and
"socialist medicine". But we accept that prioritizing and rationing
are reasonable in a disaster. Isn't this a disaster yet? I wonder what
the cost of Medicare would be if we decided to withold care that was
not expected to extend life beyond a few months. Twenty-five percent of Medicare recipients are spending 85% of Medicare costs, and much of this is during the last months of life.

We should be paying attention to what the profit driven entities are
doing. The pharm beomoth isn't jumping into cancer research just
because people buy pink or yellow wristbands, save yoghurt caps, and
walk 5k from time to time. They smell money. And we would be naive not
to pay attention. It doesn't have to be a battle ground, but it can
lead us to a better understanding of the perverse incentives
structures that are churning below.

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