Pitching Relief

Two articles caught my eye recently, dealing with Red SOx pitcers and the physicians and psychologists keeping them on the field.

In today's Boston Globe, there's a discussion with noted sports psychologist Harvey Dorfman, on why he thinks Matt Clement will successfully return to the mound after being beaned in the head by a line drive:
"A lot of it has to do with where you've been hit, believe it or not," said Dorfman, who has worked with the Athletics and Marlins and is now on the staff of sports agent Scott Boras.

"I was watching on TV when Matt was hit and the first thing I said to myself was, 'I think he'll be all right, it was on the side of the head.'

"Look, you can't predict the future. How people respond is up to them individually. But what I mean when I say it was better that he was hit on the side of the head is that it allows a guy the idea that essentially, he got out off the way. Of course, that's almost absurd in a sense, but he was turning out of the way of the ball. When you're hit flush in the face, that's a different story."

Interesting, that a split-second response, barely effective, might save him from debilitating fear down the road. I would have thought the severity of the injury (in this case, luckily, minor) would play a larger role.

Also, from a few weeks ago, the LA Times had good report of Dr. Bill Morgan's dismissal from the Red Sox last fall (if you can stomach some of the sportswriter's overwrought style). The best part of the piece was the physician's perspective in watching Game 6:
While others were writing off the season, however, Morgan was having a brainstorm. Instead of fixing Schilling's ankle, he wondered, what if it were somehow possible to temporarily freeze its malfunction? What if the dislocated tendon could be held fast to the bone, just to keep the thing from flicking back and forth?

An intriguing idea. Just one small problem. It had never been done before. In the annals of medicine, in the annals of ankles, the procedure Morgan proposed was unprecedented, the surgical equivalent of coming back from 0-3. "I've never thought of doing it myself, nor have I ever read of someone else doing it," says Dr. Robert Leach, professor of orthopedics at Boston University Medical School and former team doctor for the Boston Celtics.

Morgan ran his idea by Schilling and found the pitcher willing. Nervous but willing. "I walked in the training room," Schilling recalls, "and Doc looked at me and said, 'Let me throw this at you.' It was a last gasp. We'd exhausted all our options. It was either this or I didn't pitch. I'd resigned myself to the fact that I was done."

Once Schilling—and Sox officials—agreed to the procedure, Morgan decided he'd better practice first. He needed to make sure the procedure was even feasible, that the tissue around a human ankle bone was soft enough to be penetrated by sutures. With time running out on the season, Morgan performed a dry run on a dead body.

The practice surgery worked. Sort of. There was no way to really test it because there was no way to send the dead guy out to face the Yankees. Then, turning from corpse to ace, in a remote training room far below Fenway Park, Morgan knitted Schilling's ankle with five or six deep O-shaped stitches.

Schilling's teammates, meanwhile, partly inspired by the specter of their comrade laid out on a makeshift operating table, managed two wins against the Yankees, staying alive until Schilling could take the ball again.

October 19, 2004. Game 6. Cameras zoomed in on Schilling's ankle and millions of Americans saw the sock slowly turn red, as Schilling's face turned white. "I was scared to death," Schilling says. Tentatively, perilously, he stood propped on his Morgan-repaired joint, peering at New York's batters over the webbing of his glove.

Fans everywhere held their breath. Morgan, watching on a TV in the clubhouse, held his breath, too. Some bleeding was normal, he knew, but what he looked for, what he dreaded, was blood on the sock that appeared "frank," or dark red, which would mean the sutures had torn.

Everyone in the Sox organization had a lot at stake that night, but Morgan and Schilling were risking the most. They both knew that if Schilling's tendon ruptured, if infection set in, if any number of things went wrong, Schilling could fall to the ground like a man shot with a deer rifle. More, he might never heal properly. He might date the end of his brilliant career from that night, that game, that unprecedented procedure.

A great look behind the events of that week. But some details are missing from the larger picture: though he touched upon Morgan's drinking, the the writer should have informed readers about Morgan's driving record. More importantly, the reporter neglected to mention the Red Sox management's principle of non-sentimentality. Hell, they traded the high-energy Cabrera and even Dave Roberts, who stole second base and began the greatest turnaround in sports history. Both these guys became fast fan favorites, performed above and beyond expectations, and certainly didn't cost much.

Breaking News

I like to browse the headlines on ScienceDaily, looking for stuff to read or blog about. I don't know if it's my mood or a particularly obvious set of headlines, but this Friday's edition gave my inner snark some material to work with:

Do Free Drug Samples Influence Residents' Prescribing Decisions?
I think it depends on how fastidiously the residents take the drugs.

Nuclear Weapons Continue to Pose a Serious Health Risk to Europe
I actually thought this was lazy headline-writing -- that it was really an article about storage leaks or background radiation. But no, the report is about nuclear weapon detonation being a health risk. Because, you know, they're weapons.

Delirium Associated with Premature Death
But what a way to go!

Knee Pain Often Linked To Pain Elsewhere In The Body
This was particularly true of patients who had been run over, or had fallen from great heights.

Top Ten Reasons Blogborygmi's Been Quiet

10. This new city I'm living in has more things to do
9. Furniture shopping can expand to fill all my free time if I let it
8. I've been writing on Medgadget (and using the royal "we" has left me without a sense of identity)
7. I have two posts about moving, two on orientation, and one post about my first shift that still need some polishing
6. Making new friends, keeping the old
5. The PGY-2's are 'teaching' me poker
4. It's really humid
3. I find myself reading more medical journals, instead of surfing medlogs
2. Interns don't seem to talk a lot

And the number one reason I haven't posted here in a while:

1. The networks stopped calling me, what's the point anymore?

Inside the Beltway

Last year I blogged about Nathan's Hot Dog eating contest. This year, I gave some thought to attending this spectacle of competitive eating (these plans were laid to rest the night before, when I enganged in the spectacle of competitive drinking).

Anyway, it doesn't look like I missed too much. The same guy, Takeru Kobayashi, won again (though last year, he was frequently called by his nickname, "the Tsunami." Not so much, this year).

Also unchanged: the dearth of scientific inquiry into this ... sport. I mean, it's been over twenty years since competitive race-walking was examined in detail -- is that any more of a sport than competitive eating? Which activity is of more relevance to the obese American taxpayer?

All I can really find on the matter is this press release from the International Federation of Competitive Eating:

The November 2003 Popular Science addresses the tendency for thinner, in-shape gurgitators to beat heavier eaters in competition. Many intuitively believe that a larger individual has more room to hold food, but this is not the case. The magazine states that the size of the stomach at rest is inconsequential and that the ability for the stomach to expand is all that matters.

This is the conclusion reached by former world champion hot dog eater Edward Krachie in his 1998 scholarly journal article, "CAN ABDOMINAL FAT ACT AS A RESTRICTIVE AGENT ON STOMACH EXPANSION? An Exploration of the Impact of Adipose Tissue on Competitive Eating." In his article, Krachie goes a step further and proves that the stomach of a heavier eater is prevented from expanding by a "belt of fat."

The IFOCE and Edward Krachie submitted his piece to numerous academic journals including the New England Journal of Medicine. Sadly, all journals rejected his piece.

Sadly, Popular Science doesn't really conclude the 'belt of fat' theory is correct. The reporter just asserts it, and goes on to talk about satiety signaling. The entire piece is not much longer than the IFOCE press release.

I think there's plenty of room for more ... data. Granted, I have an appetite for this stuff, but I think it's worthy of extra helping from the scientific community. Because the few morsels of information we have now are hard to digest (as are these puns. I'm sorry.)

Krachie and company are arguing, essentially, that a belly of fat is more compressive than skin and muscle are distensible. I'm not convinced. I wouldn't be surprised if the thin eating champs were born with weak pyloric sphincters, or exhibit higher capacity for smooth muscle relaxation. But until we start doing some barium swallows and endoscopies on these people, we're just guessing.

Sooner or later, the reward money for these contests will prompt some competitors to fund their own clandestine research. And it would be a shame if these athletes were smeared with allegations of shady practices. Let's keep the research open and freely available -- let science have a seat at the table.

Escaped from the Madhouse

A conversation fragment from the incoming resident orientation (I used proper names in reality):

Me: "So, you did your medical internship at Hospital X? Maybe you know Madhouse Madman?"
2nd-Year Resident: "Oh, yeah. He's great. Actually, he told me to look out for you, that you'd be here. He said you two met online."
Me: "Uh, well, I wouldn't put it that way, really. I mean, I heard of him through his website..."
PGY-2: "You've never met him in person?"
Me: "No. I don't even know what he looks like. But I've seen pictures of his new daughter, though. And he just got back from this trip to Israel, it sounded nice."

PGY-2 pauses to wonder how I know these disparate pieces about a man I've never seen.

Me: "He leads a very public ... private life."

41

Tim Gee of Medical Connectivity is hosting Grand Rounds this week:
Grand Rounds always impresses me with the diversity, richness and good writing that comes from folks in the many areas in health care, and today is no different.

Well said. As a medical connectologist, Gee is an interesting and underreported player in the health care industry. Stop by his site, learn about what he does, and check out the latest from the medical blogosphere.

Next week's host is Shrinkette.

Lordy, Lordy: Grand Rounds 40

David Williams' Health Business Blog is hosting Grand Rounds XL (though it looks the appropriate size). Go check out the latest and greatest from medical bloggers around the world, and get your submissions to Medical Connectivity for next week.

Transition

Today, Lileks compares antique stores to funeral parlors -- the sadness that surrounds forgotten treasures of our past, abandoned when we go off to school. Coincidentally, I was just musing to a friend about my old Snoopy pencil-case today, which always signified the end of summer and start of another year of elementary school.

It's taken twenty-five years, but I'm not a student anymore. Tomorrow is my first day of work.

I wish I had more to say, more I could articulate about this transition. I'm going to try to heed Doc Shazam's advice, and record my early impressions of doctoring and internship. But for these past few weeks, it seems I've lost my voice. Blogging, for me at least, requires some modicum of stability, and these heady times have been anything but stable.

But I've found a new home, and a busy schedule is about to be thrust upon me. Order will reassert itself soon enough. And as Ben Folds reminds us on his new album, it's not wise to get nostalgic about the last ten years, before the last ten years have passed.

I think I get what he means. But of course, it's his song about airlines and new beginnings that really speaks to me:
If you wrote me off, I'd understand it
'Cause I've been on, some other planet
So come pick me up... I've landed.

The entry below is actually something I wrote a few weeks ago, around graduation, but couldn't quite bring myself to post. Now seems like a good time to clear out the drafts -- a new wave of experiences begins in a few hours.

Appearances

Graduation week alone should be more than enough to consume me, with its good-byes, fond remembrances, and the commencement of a grand and challenging career.

But add to the mix the ups and downs of apartment hunting, furniture shopping, trying to find a home for my cat and my car, a bachelor party in Cancun, and making sure I'm sufficiently overexposed, in print and on TV. I've got a full plate.

It's been over three months since I've seen a patient, and I'm missing it. This weekend our class heard some speeches about the privilege and noble duty of medicine, of treating the sick. Among the things that have stayed with me is a talk honoring a faculty member who passed recently. The speaker said:

"She was so enthusiastic about connecting with patients, really, deeply connecting. She sometimes called those encounters 'Level 5 Interactions' -- I have no idea what that means but it sounded really intense."

I think I know what she was talking about (and it's not hospital billing codes).

I think I need those kinds of encounters to stay grounded. I sometimes worry if that's pathological, but frankly, there's more pathology in the extremely fun but ultimately superficial interactions that have preoccupied me since I got back from Greece.

Our graduating seniors take the Oath of Maimonides, and the excerpt below seems particularly relevant:

The eternal providence has appointed me to watch over the life and health of Thy creatures. May the love for my art actuate me at all time; may neither avarice nor miserliness, nor thirst for glory or for a great reputation engage my mind; for the enemies of truth and philanthropy could easily decieve me and make me forgetful of my lofty aim of doing good to Thy children.

I'm very, very lucky to be in medicine, and to have such family and friends.

Mainstreamed

The phenomenon that is medical blogging receives coverage in today's LA Times. The reporter, Marianne Szegedy-Maszak, chose to focus on physician blogs, but that's ok, what with me now being a physician and all. My Medgadget colleagues, Dr. O and Dr. Bradley, are also featured.

And I like how she introduces the topic:

The family pictures on the desk. The diplomas on the wall. A few magazine subscriptions, perhaps, or some sailing, tennis or golf memorabilia scattered around the office. In the past, a curious patient could only turn to these bits of evidence to try to know more about the individual behind the medical degrees, the white coat and the carefully scripted bedside manner.

The temptation is understandable. After all, when someone holds your life in his or her hands, it would be nice to know a bit more about what makes them tick. But today, anyone with an Internet connection can have access to the fevered, funny, angry and very human thoughts of these men and women who help us navigate the perilous shoals between illness and health. The vehicle? The doctor's blog. A blog is the name used to describe a weblog, the constantly updated platform for the idiosyncratic and highly personal musings (or rantings) of anyone who wants to set one up in cyberspace.

"It's a direct line to see what doctors think that you won't pick up in the office or from television shows," says Michael Ostrovsky, a cardiac anesthesiologist in Daly City, Calif...

I'm consistently surprised about what makes it into the final version of a story. For instance, the reporter and I were discussing how bloggers discover each other, how we cross-reference posts. Sure, there's medlogs.com, and now Grand Rounds (which she graciously acknowledged). I also mentioned one post which really seemed to put me on the map last year -- "Hard to Swallow", a pun-laden critique of a Austrian nose-picking advocate.

Well, very little of the conversation about blog cross-linking and meme propagation made it into print. But, naturally, my views on nose-picking are prominently excerpted in the sidebar (in stark contrast to the really insightful quotes from Dr. Charles, the Cheerful Oncologist, and others -- I suppose it's appropriate that the print debut of "Dr. Nicholas Genes" is a little... juvenile).

At any rate, the article provides a good survey of doctor blogging, and the various motivations behind it. And the reporter leaves her readers (and interviewees) with some good questions: will blogging improve the doctor-patient relationship? Will it help disseminate medical data amongst peers? Will it "spawn the next Oliver Sacks?"

I've tried to be cognizant of the risks in believing our hype, of overestimating the potential of medical blogs. So it's exciting to hear an outside reporter asking these questions. And I look forward to learning the answers, in the coming years.

Lacrimation Day

I was standing in the buffet line of one of the many graduation fetes this weekend, next to a dear physician on my school's faculty. But she was suffering:

Distinguished faculty: My eyes are watering, my nose is running, I feel awful.
Me: Allergies?
Distinguished faculty (chuckling): Yeah, how could you tell?

I smiled back and said, for the first time, "Well... I am a doctor."

Not surprisingly, at the ceremony today, quite a few of us graduates, faculty, and family members got a little misty-eyed. Must be the pollen.

XXXV

Michael Chaplin is hosting this week's Grand Rounds, the best posts of the medical blogosphere. It's chock full of quotes, and a discerning description of yours truly. Go check it out! He's got doctoring in his blood (or at least, that's my translation of Iatremia.)

Next week's host is Dr. Sanity!

Our Place in the Sun

I took my med school's course on nutrition back in the 90's, when Vitamin E was all the rage. If I recall those heady days, the only question about E was whether we should slather it on our skin, eat it, or freebase it.

Times change. Now, E is out and D is in, in a big way. You may know that Vitamin D is the vitamin we make, by sitting in the sun's UV rays (technically, since we produce it, can't be a vitamin, but I digress).

Some oncologists and dermatologists currently believe D is so important in fighting cancer, it's actually worth running the risks associated with increased sun exposure (namely, cancer. And wrinkles. But mostly cancer). Needless to say, this is controversial:

...Dr. Edward Giovannucci, a Harvard University professor of medicine and nutrition ... laid out his case in a keynote lecture at a recent American Association for Cancer Research meeting in Anaheim, Calif.

His research suggests that vitamin D might help prevent 30 deaths for each one caused by skin cancer.

“I would challenge anyone to find an area or nutrient or any factor that has such consistent anti-cancer benefits as vitamin D,” Giovannucci told the cancer scientists. “The data are really quite remarkable.”

It gets juicier:
“I am advocating common sense,” not prolonged sunbathing or tanning salons, Holick said.

Skin cancer is rarely fatal, he notes. The most deadly form, melanoma, accounts for only 7,770 of the 570,280 cancer deaths expected to occur in the United States this year.

More than 1 million milder forms of skin cancer will occur, and these are the ones tied to chronic or prolonged suntanning.

Repeated sunburns — especially in childhood and among redheads and very fair-skinned people — have been linked to melanoma, but there is no credible scientific evidence that moderate sun exposure causes it, Holick contends.

“The problem has been that the American Academy of Dermatology has been unchallenged for 20 years,” he says. “They have brainwashed the public at every level.”

This guy, Dr. Michael Holick, helped discover how Vitamin D works. But when he published his book about the benefits of UV and the dermatology brainwashing, he was stripped of his professorship (which no doubt led to more ... exposure)

Via metafilter, who reminds us that Baz Luhrman's advice about sunscreen, and life, is suddenly suspect.

Red Scare

Here's some provocative, if underpowered, research findings (via the guy at Scared Monkeys, whose name is actually... Red):

"Across a range of sports, we find that wearing red is consistently associated with a higher probability of winning," report Russell A. Hill and Robert A. Barton of the University of Durham in England. Their findings are in Thursday's issue of the journal Nature.

Red coloration is associated with aggression in many animals. Often it is sexually selected so that scarlet markings signal male dominance.

Just think of the red stripes on the scowling face of the male Mandrill, Africa's largest monkey species. But red is not exclusively a male trait. It's the female black widow spider that is venomous and displays a menacing red dot on her abdomen.

Similarly, the color's effect also may subconsciously intimidate opponents in athletic contests, especially when the athletes are equal in skill and strength, the researchers suggest.

One's thoughts immediately turn to the Red Sox, who didn't wear much red until the past few years. In their previous world series appearances, they've lost to teams like the 1949 Cardinals and... 1975 Reds... But you can't overlook the fact that the most dominant team last century wore blue pinstripes. Also, in NFL football, the dynasties of the Patriots, Cowboys, Steelers, Packers, Bears... not a red shirt or helmet in the bunch (The Patriots in particular have done much better since moving away from red).

There ought to be a more innovative way to study this, a la Steven Leavitt's Freakonomics, where looked at the statistics behind Sumo matches and found it's likely some important status-determining matches are thrown. The current red study just doesn't seem to have a lot of data behind it, especially the team sport analysis. I'm not sure how they can do better, though, short of having the same teams play each other dozens of times, switching uniforms halfway through.

Besides, even if there is a visceral reaction to the color red, it's hard to say whether it would always be negative. If red arouses the fight-or-flight response, it seems just as likely that opponents would fight harder, rather than be intimidated. I think bulls would agree with me.

And if this turns out to be true, it may go a ways toward explaining the "Red Shirt phenomenon" of classic Star Trek, in which hostile aliens would always spare Kirk, Spock, and McCoy but kill the random crewman with the red shirt.

AMA, Premium

While I was away, my colleagues at Medgadget.com went beyond our usual pithy medical device commentary and actually took on the AMA:
We have reported earlier about the proliferation of free, open-source, online medical journals. When it comes to the spread of information, the American Medical Association (AMA), however, is moving in the opposite direction.

It has come to our attention that the AMA, has quietly announced that it will make the contents of its AMNews online edition (website) available for AMA members only. Bylined as the "The Newspaper for America's Physicians", the AMNews was the last AMA publication with current content available online for free (for your information, JAMA, which publishes research that is mostly funded by the U.S. taxpayer, has never been available to the general public.)

It reminds me of the this year's Homestar Runner April Fool's Day subscription plan, called Pay Plus!, which was pitched as "Same content! New annual fees! Just Pennies per Pixel!"

The Medgadget call to action got the attention of the AMNews editor, who responded by saying, essentially, that membership has its privileges. However, as GruntDoc suggests, it's actions like this that guarantee AMA membership will become more irrelevant as time goes on.

In case you're worried, Blogborygmi will continue to remain free, as the administration costs are almost entirely supported by revenue from Storeborygmi, the online shopping experience.

Diversion

After two weeks of seeing extended family in Greece, I was returning home in a mood to start writing again. I had some layover time in the Milan airport before the second leg of my trip, and had prepped a few posts. But nothing was quite as blogworthy as what happened on the flight home.

Even so, the first seven hours of yesterday's Alitalia flight 618 were uneventful. I was too sleepy to appreciate the movie, too hungry to mind the airline food, and not pleased with the International Herald-Tribune crossword. I settled into a light sleep about halfway through, with occasional wakeups for snacks and drinks.

I woke up with a start, for instance, when the captain announced we’d begun our descent into Boston. He said the weather was partly cloudy. The elderly Greek woman seated next to me noted the temperature – 12 C – would be a big change from what we’d enjoyed in Athens.

As we past through the cloud layer, I peered through my window seat to look for landmarks. I didn’t see any, but was pleased that things looked I lot greener than when I left in April. We got closer to the ground and I fretted that I couldn’t spot the Boston skyline –- or even the ocean. What approach was this? As we touched down, the passengers applauded, but I was growing alarmed: this didn't look like Logan. I saw a fleet of gray military cargo planes outside a hangar. There were no passenger planes from my view, just wet tarmac and an overcast sky. Where were we?

The Greek lady remarked she’d made this flight twenty times, and had never seen this part of Logan. The woman behind me suggested, “It might be that new runway they’re talking about.” The cockpit told us nothing. Some passengers had unfastened their belts and began to retrieve carry-on bags. I thought about turning on my GPS receiver. The Greek lady checked her watch and announced that, wherever we were, we landed a half-hour early.

After about a minute of growing unease, the captain announced (in Italian first, then English) that we were in Bangor, Maine, and under what he termed “police control.” As I was translating this to the Greek woman next to me, the plane was boarded. Four men in black uniforms, along with a plainclothed man with a large ID badge, walked past us to an aisle seat about eight rows behind me. They surrounded a man who calmly stood up, and then they all quietly walked out. The whole thing took less than a minute. I got a good look at the deposed passenger (but was afraid to reach for my camera): he was tall, maybe 6’, with light brown skin, a curly beard, no mustache, and short black hair.

The captain told us we were still under police control, and the passenger who was removed was wanted by US authorities. We would stay in Bangor until they identified and removed the man's luggage, a process they estimated would take 30-45 minutes.

We were allowed to circulate during the luggage search, so I got up and interviewed the man nearest to the deposed passenger (note: I am not a journalist). Here's how the interview transpired:

Me: Hey, wow, was he, like, sitting right there?
Nearby passenger: Yeah! They just came right in and took him! They didn’t even ask his name.
Me: Is that his jacket?
Him: He just got up and left. Didn’t take any carry-on with him, either.
Me: Was he doing anything weird during the flight?
Him: No, nothing I could see.
Me: Um... So, what did you think of the movie?

Another passenger remarked, “He didn’t seem surprised at all. It’s like he knew they’d be coming for him.” I wouldn’t ascribe so much to that brief encounter, but then again, we didn’t have a lot to work with.

That’s when Mom called. She and Dad were supposed to pick me up at Logan. She was really worried about how the Arrivals board switched from “On Time” to “Delayed” so late in the flight. The group of reporters massing at Logan alarmed her, too, until Channel 5’s Kelly Tuthill explained to her that we had a suspected terrorist aboard, and had landed safely in Maine.

“How did all these reporters know so fast?” Mom wondered. Tuthill revealed: The network told them.

When I explained that the luggage search, refueling, and flying home would take at least another hour, Mom asked what we were still doing on this plane. It’s a good question: if this man is wanted by the US, and dangerous enough to prompt a landing at the first available international airport on US soil, why not evacuate the plane during the luggage search? Wasn’t it possible we were sitting on a ticking bomb?

As if on cue, the cockpit requested we take our seats but keep our belts unfastened (“the better to evacuate us,” I suspected.) Flight attendants positioned themselves by the exits, and for the first time since we were boarded, I got nervous. But soon after, the luggage was found and we were told we’d be underway again soon.

As we maneuvered onto the runway, I saw some TV trucks and photographers gathered by a fence, to film us. Of course, by now, our cameras were snapping away at them (a fellow passenger joked, “Reporters observed strange flashes of light from within the cabin...”).

Back in the air, I publicly speculated Alitalia had spare snacks on hand, for just such an occasion. But if they do, we didn't see them -- we were served only water. I took the opportunity to ask our flight attendant when they learned of the diversion. “Was it just a ruse when the cockpit said we were descending into Boston?”

“No,” he replied. We learned we were landing in Bangor right after that announcement.”

When we finally landed at Logan, I worried that we’d be subject to lengthy inspections or questioning at customs. At this point I really just wanted to go home. Other passengers were trying to catch connections. But the lines moved pretty quickly, and the only questions I was asked came from the Boston news stations.

The reporters were angling for the frustration angle – why not check the passenger lists before the flight leaves? While that sounds well and good (though is apparently technically difficult) I’m more confused about other aspects of the way this emergency was handled: The location to which we were diverted, and the apparent lack of concern after the suspect was removed.

The no-fly list is reserved for those with known or suspected links to terrorism, or other “threats to aviation.” This man was considered enough of a risk to scramble escort jets from Canada and the US, and enough of a risk to divert us to the nearest US airport available to a 767. On other occasions, however, the US has refused international planes carrying no-flyers, forcing diversions to Canada. And we were over Canada for a good long while.

I’ll try to guess what Homeland Security was thinking: since Flight 618 had made it across the Atlantic without incident, the risk of the suspect trying something between Canada and Bangor was apparently not worth bringing the plane that early, and maybe the US wanted custody of the suspect. But the risk of him flying into Boston was too great. OK, I can buy that. So the plane was diverted to Bangor, and the suspect removed. But, his carry-on and jacket are left behind for at least fifteen minutes (I didn’t see if when or if they were taken off the plane). The luggage compartment was checked for over thirty minutes to find and remove his items, while 200 or so passengers are kept on board.

Why is this man considered such a risk to Boston, but his suitcases and personal items are considered no risk to the passengers?

I don’t know. Maybe the authorities have their secret reasons, but I’m not so sure. This is the second such diversion in a week, and there’s been no announcement about improving the existing system, despite complaints from a Massachusetts congressman and hundreds of inconvenienced passengers.

What I did learn from this experience:
  • Window seats aren’t just for fun anymore, they're educational.
  • Mom is more media-savvy than I give her credit for.
  • If the in-flight movie is dull, maybe something else will enliven the trip.
  • The Smooth Retsina

    Posting will be light the next few weeks. I'm, well, globe-trotting again.