Our church recently held a graduation ceremony for our high-school seniors, who stood in front of the congregation and talked about their dreams and plans. The one who struck me most was the young man, already father of a child, who said, “I plan to get a two-year degree in welding and make a living to raise my daughter.”

He not only had a plan, he was pursuing an employment field where there is a need. Welders are in demand and are reasonably paid these days.

Since jobs are tight for college graduates (with a 53% unemployed or underemployed rate), I wonder how long it will take for young blue-collar workers to rise to the top of the economic food chain.

In a remarkable inversion of modern American culture, how long will it be until the kids with expensive four-year degrees or graduate degrees wish they had pursued heating and air, electronics, welding, pipe fitting, two-year registered-nurse degrees, or other low-prestige programs which nevertheless provide incomes?

Regardless, my friends and medical colleagues are still putting away money left and right, doing all they can to ensure that their kids can go to the nation’s finest colleges and earn their coveted four-year degrees, followed by graduate or professional degrees, which (depending on course of study) may result in little more than service-industry jobs.

Few of them follow the numbers these days. They remain convinced that yesterday’s educational pathways will continue into the future. I think it’s a shocking self-delusion considering that my own career has changed dramatically in the 22 years since I became a physician. (The “filthy rich” doctor is becoming a rare species.)

What will kids who have been highly educated—or even overeducated—do? What about parents who will be shocked that their honor graduates, their valedictorians, their SAT-mastering kids aren’t going to have good jobs?

Those with degrees act as if they are entitled to good jobs and benefits exactly like their parents had. We have seen this mentality in the battles with Wisconsin teachers’ unions and in the pathetic discontent that populated the Occupy movement, as advanced degrees offered no advantage to young people who refused to work jobs that were “beneath” them.

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I anticipate that one day, kids with marginally useful degrees and heavy loan burdens after attending expensive schools will be complaining as follows:

Well, I never had an opportunity to work with my hands! I mean, I wanted to weld and do contracting work! But my mom and dad kept sending me to polo camp and diversity training! I never got to hang drywall or clean up vomit or work on pipes because dang it, I was at Camp Climatechange learning about environmental sustainability! I didn’t understand that my degree from my lovely college with the shaded lawns wouldn’t give me a career! I wouldn’t have gone there if I knew! Is it too late to enroll in a Blue Collar Multidisciplinary Studies program? Come on, I studied Spanish in Spain! Can I at least cut somebody’s grass?

They will be petted and coddled while the president establishes programs to bring equity to the educational system so that the poor, downtrodden, and highly educated can move into career fields where jobs abound, as work in LGBT studies or sociology remains unavailable.

At that point, I suspect we’ll hear that everyone in America has a right to a vocational education, just as they currently seem to have a right to a college education.

I only hope that when it does, my young friend from church isn’t the CEO of a large welding interest. If he is, he’ll be demonized and taxed into oblivion for daring to work in a field with promise. Heaven forbid he should subvert the paradigm of the entitled by doing something of tangible value.

Image courtesy of Shutterstock

In our native Appalachia, my wife’s family and my own were fruitful and multiplied; in fact, my wife has roughly 60 first cousins. But to most moderns, our own family of three boys and one girl seems unusually enormous. Some hotels force us to have two rooms, and New York taxis won’t take more than five people, even in a minivan designed for more. And it may be part of why car manufacturers don’t make sufficiently safe vehicles for very large families. And I know it’s why a coworker once looked at me and said, “The problem is people like you who have all those kids!”

Still, we’re accustomed to it. We make adjustments and simply pay more for rooms, vehicles, gas, and especially food for the delight of having our family: Two parents and four future teachers, parents, doctors, engineers, or who knows what. (They’re also four future taxpayers, but who’s counting?)

As gasoline prices rise, some say this is beneficial, but to whom? The problem is, many of us (especially those with larger families) do not live in large cities where mass transit is widely available. We live in places where we have only a few options. We can:

1) Walk or bike to work, the store, and school starting around 5AM each morning;
2) Hitch up a horse and ride to work, store, and school starting around 5AM each morning (and in the process force poor, hapless animals to work for a living…oh, the pathos!);
3) Drive our vehicles.

Mass transit based on the European model would be rather nice. I enjoyed the Japanese system’s efficiency when I traveled there. But those are smaller, more compact nations. America’s geography, especially in mountainous places such as Appalachia, makes those systems less viable even if we had begun them decades ago.

The truth is, those of us who live in suburban or rural areas simply must have access to transportation, and as it stands, cars and trucks are the best options we will have for some time.

I don’t have any service to haul off my trash; I have to do it in my pickup. I have animals that sometimes need to be transported in a private vehicle to the veterinarian. I work in a semi-rural hospital that is a twenty-minute drive from my door. My partners and I work at all hours of the day and night. (A similar phenomenon exists in local industries such as our regional nuclear power plant.) Shift work is a thing for which even the best (real or theoretical) public transport is often unavailable.

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I have friends who work in construction jobs which change from month to month. I know elderly persons who live in the country and need to buy groceries or access medical care so they can continue to live independently. More to the point, I know folks with not only children, but limited incomes, for whom $5-a-gallon or higher gasoline would be a crushing economic blow.

If folks in rural areas don’t have vehicles, pesky little things such as energy production, manufacturing, and farming won’t happen. Fine dinners in city restaurants would lack a certain ambiance without food and lighting.

The belief that $5 or higher gasoline will make us drive less, become more efficient, and convert to better fuels is a bitterly new flavor of anti-rural prejudice. The progressive intolerance of, and antipathy toward, rural people and their cultures reaches a new high when it insists we would all be better off if only we drove less. Ultimately, it implies that we should all move closer to the urban beehive or simply deal with our country perversity and stay on the porch out here in the sticks.

I’m not suggesting that the government set or control prices. Government price-fixing in medicine is leaving many seniors without physicians. So if the market drives the prices beyond $5 per gallon, Americans (both rural and urban) will be forced to adapt by driving less or obtaining vehicles with better mileage—if such conveyances are affordable. Hopefully, decreased usage will allow fuel prices to drop as manufacturers sell less gasoline.

For progressives to hope for higher gas prices, especially because of their orthodox belief in the highly questionable topic of climate change, is a reflection of urbanite disdain for those who actually need to drive out in remote “hick” areas where the distances are greater.

If progressives were true to their doctrine of helping the poor and being attentive to diverse groups, they would favor increased domestic drilling and production. They would encourage the use of shale oil, natural gas, and other petroleum products that might actually help lower fuel costs through quantity and competition.

No amount of wishing will make all of our cars stop using gas. Wishing economic hardship on rural America—which would be the inevitable result of escalating fuel costs—smacks of a nasty elitism that is fundamentally un-American.

Lying on the backboard, a frail little old lady moaned with discomfort. She had fallen beside her bed in the nursing home and was then tightly bound by straps onto the backboard, a cervical collar pushing her chin up and holding her immobile. A person not familiar with modern medicine might think the ensemble looked like a torture device. Indeed, it can be. Not only uncomfortable, a backboard is made of hard plastic and can quickly cause pressure ulcers even in younger patients. It’s all too common a scene.

Looking at her, I thought about all of the confused, weak, elderly patients subjected to aggressive care and why it happens. They don’t come to us merely due to the vagaries of age, gravity, and balance. They are sent to us because of the confusing way we mix medicine with legality, anxiety, and unexamined expectations.

If the 95-year-old Alzheimer’s patient has a cervical spine fracture, will we subject him to surgery? When the 80-year-old woman with multi-infarct dementia has a thoracic spine fracture, will the surgeons intervene? And if a lucid 100-year-old man has a brain hemorrhage, will he be whisked off to the operating room so neurosurgeons can drill a hole in his skull?

We are actually being cruel, and we neglect common sense and kindness, when nursing homes send their patients to the emergency department for extensive (and expensive) evaluations of marginally treatable conditions.

In our fragmented treatment algorithms for the elderly, injuries aren’t the only problems. Will the end-stage emphysema patient, diagnosed with pneumonia, be placed on a ventilator for more sustained misery? Will the patient bedridden and confused from multiple strokes benefit from a coronary stent if her chest pain is due to a heart attack? These are reasonable questions, both ethical and economic—especially since most Medicare dollars are spent in the last months of life.

It seems there is an endless tug of war when physicians are dealing with many of our elderly citizens, particularly those who can’t contribute their own opinions to the decision-making process. Largely because the government refuses to address tort reform, elderly patients’ frail bodies and hazy minds are endlessly subjected to tests and therapies that add little enjoyment to their lives and probably less to meaningfully extending those lives.

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From the physician’s standpoint, caring for nursing-home patients is fraught with peril. Physicians face the possibility that they will violate some nebulous standard of care or endure litigation by the patient’s family. And they fear the misinterpretation of Medicare rules, which financially punish physicians and hospitals for “inappropriate” admissions, failure to follow their clinical guidelines, return visits for the same problem, and missed diagnoses. And there is the most appropriate fear of all: doing the wrong thing and causing suffering in another human being.

It is little wonder that nursing-home patients are so frequently sent to the hospital for even the slightest complaint. They are frail, osteoporotic, confused time bombs to their physicians and facility administrators, sadly juxtaposed to their position as vulnerable, weak, and often forgotten members of society.

Dementia aside, I have had the more competent patients from nursing homes say to me, “I didn’t want to come to the hospital, but they said I had to be seen!” And family members have complained, “We asked them not to put grandma in the ambulance. It only confuses her, but they said it was policy!”

Medicine is practiced in a labyrinth of uncertainty when it comes to treating these individuals. Partly born of corporate policies in nursing homes, partly born of a mentality by some that, “It doesn’t matter, Medicare will pay for it” (which is remarkably untrue), and partly from a deeply ingrained fear of litigation, we do too much that matters too little.

Lately I find myself doing less and reassuring families more. I often preface it all with: “If something is broken, do you want him to have surgery?” Or, “I know she had chest pain, but if it is a heart attack, how aggressive will we be?”

The answer is usually either, “No, I don’t want much done” or “I never really thought about it that way.” And if I can make the light come on in either the patient or the family, we all shake our heads at modern medicine, which is so often practiced by uncertain physicians genuflecting before ridiculous federal regulations and aggressive lawyers.

Pity we can’t simply learn to fix what we reasonably can, then allow some of our sick and injured elderly to sleep in comfortable beds rather than cry and languish on hard plastic backboards. When caring for the infirm aged, sometimes less is really more. Learning to do less, and being allowed to do less by all parties involved, is the real challenge.