Ólafur Ólafsson

Reprimanded by the Surgeon General

When running an inpatient surgical ward there is a constant struggle to get the patients home after operations. There is, of course, some reasonable length of stay needed for serious matters etc. However, from my point of view some of my patients could go home sooner than they themselves wanted. There were all kinds of ploys used to hasten their discharge, but the opposition had some tricks up its sleeve, too. For instance, when I would do the rounds on Monday, I expected that someone would be able to go home on Wednesday. So, I would suggest discharge on a Tuesday. Then when the patient began to balk I would suggest: „Well ok tomorrow then,” and everybody was happy. The hospital had a library and the patients used it in their convalescent period (Icelanders are a literate bunch). Then I had the following rule to lighten the atmosphere in the wards where there were a number of patients together. Of course, the patients preferred the romantic genre of books, for example, the Red Series (Fabian bare chested, etc.). The rule: Whenever a book like that was spotted on a patient’s nightstand, they would be unceremoniously discharged (or an attempt would be made on the basis of the evidence).  If you can read that stuff you are ready to go home,right. And It would happen that this did not go over too well.

Ólafur Ólafsson

Ólafur Ólafsson learn more here

read article At that time, we had a Surgeon General of Iceland Ólafur Ólafsson, who was and still is a crusty old guy. He sported bushy white hair, and his equally bushy eyebrows were in the Santa Claus class. He was at the tail end of his career at that time. His voice was deep and gravely, and had he been an American he would have been reading the voice overs in the Whiskey and Cigarette commercials. He probably would have put James Earl Jones out of the voice work. As Surgeon General he has a great sense of humor and the ability to see the absurd and funny in just about any setting. He was always a champion for the patients and their rights, and was never a tame tool for the politicians – he was a very unconventional civil servant. He gave me invaluable advice: “Jonas, just be yourself.”

http://dewoonvisie.nl/map Contrast him with the Suits and apparatchiki that we have met through our lives.

https://www.urbandictionary.com/define.php?term=suit

Author‘s addition to the definitions: A Suit – a civil servent totally devoid of any charm, humor or even a face check this out .

Ólafur could be a handful, especially when he called in the middle of the night (he is a night owl) to discuss some pressing issue. You are fast asleep in some happy dream and then “It is Ólafur” and you began thinking – it must be some damn volcanic eruption. When he was still working, his offices were next to the square where the homeless and unfortunate souls of Reykjavik congregated. To his credit, he always kept a protective eye on his neighbors and tended to their needs. When he retired he palmed them off to another humanist doctor. I just love this guy for lots of reasons.

http://dendrology.eu/map Now, one of my patients got offended by my Red Series comment and made a formal complaint to the surgeon general. Such a matter needed to be resolved and resolved it was.

I got a formal reprimand letter from the Surgeon General’s Office stating (loosely translated):

visit web page —————————————————————————————————————————————————–

Reprimand more info

http://awautotech.co.uk/map  

It has come to the Surgeons General’s notice that you have been joking around with your patients during the morning rounds.

It is decided by the Surgeon General that you are not to joke around with your patients.

 

Signed

Ólafur Ólafsson

 

P.S. Unless they have the same sense of humor that the Surgeon General has.

P.P.S. It is forbidden to divulge the content of this letter.

—————————————————————————————————————————————————–

I contacted Ólafur on my last visit to Iceland and he released me from the ban.

 

I am sure that gorvernments and especially the populations the world over are be better served by persons such as Ólafur as compared to their empty, talking Suits.

 

 

 

 

 

Berlin Airlift

The Booze Airlift

As a boy I vaguely remember reading about the Berlin airlift (Berliner Luftbrücke­­­ – i.e. airbridge).

https://en.wikipedia.org/wiki/Berlin_Blockade

That was when the russkies were naughty (they still are), and ­­when they wanted to mess with Europe they just squeezed its balls, i.e. Berlin. To get vital supplies to Berlin after the roads and railways were closed (by the russkies), the Allies resorted to a massive airlift to keep the city running.  I found this utterly fascinating and subsequently had a brief obsession with airplanes. One of my casting students (a retired pilot) actually flew on those missions via that corridor [via one of the three permitted air corridors]. But I am just rambling, so I will get on with it.

https://en.wikipedia.org/wiki/West_Berlin_Air_Corridor

During the tail end of my Med School days, I got the opportunity to do a locum (relieve some doctor who needed a break) in general practice out in the sticks. This was very welcomed since we med students got paid, and it was a learning opportunity for us. What the patients thought of it is not clear, but I guess they thought it better to have someone manning the shop, albeit an inexperienced medical student. It was deemed prudent by the authorities to send two med students to relieve one experienced doctor. So off we (I and my colleague) went and wound up in the farthest district from Reykjavik on the shores of the Arctic Ocean.

That month turned out to become very eventful, and we were very busy. At this stage in your journey as a doctor everything is just so damn interesting and stimulating. We for instance had a patient who developed a sudden onset of pain in one eye! What the heck can that be? So, dive into books (remember no internet), and if we needed more, a corded telephone was our best ally. We treated cardiac arrhythmia, overdose, urinary retention and even plucked shot gun pellets from the derriere of the local police officer. Plus, all the other more routine ailments. It turned out that the organ specialists in Akureyri (closest big town) and Reykjavik, whom we repeatedly had to consult, were very helpful. They probably remembered their own bygone locums, so the system worked – if you had the sense to ask for help. We both were keenly aware off our limitations, and relatively free of hubris (that came later) – but when I reflect on that period I realize that we were so ignorant of all the ways things can go caput [go to hell in a handbasket] in medicine, that we just happily forged on with our trusted ally, the telephone. When I gained more experience I never encountered a situation that I could not make substantially worse by untimely intervention or the wrong one. So, make sure your indications for doing anything in medicine are solid before proceeding.

To give you a glimpse of the Zeitgeist  I can share the following story. We got a call from a farmer who had some pain in his chest. “A stick  fell on my back” was the story. “Can you come out here and have a look?” When we arrived at the farm, we met the family, and then we were invited to a meal. There was no examining until after. After that and conversations about our family trees (yup, that was the social norm) we got to have a look at the farmer. This was the typical attitude of those people in those days. Tradition dictates a certain decorum, and it is to be observed even if you had a “stick” fall on your back.

Driftwood

Driftwood a.k.

As it turned out, the “stick” was in fact a large driftwood log. This farm owned a stretch of beach where you could harvest these logs. Such logs drift from Siberia to Iceland’s shores and were through the ages extremely valuable as there were no big trees in Iceland for construction purposes.

Transpolar current bringing driftwood to Iceland

Transpolar current bringing driftwood to Iceland

Furthermore, they were salt impregnated after their journey in the ocean and thus rot resistant. The farmer had his ribs on one side broken with air under the skin (subcutaneous air). When you encounter such air, it feels like the crunch of newly fallen snow under your fingers. The lung was punctured, but the farmer was stable so we sent him off via airplane to the nearest hospital in Akureyri.

During the Cold War the Americans had built a radar station on the top of a nearby mountain and ran it from 1954 to 1968.

Driftwood and the mountain

Driftwood and the mountain

To service it there was a small airfield on the shore running from east to west. To be able to land there, a radio beacon had to be turned on.  The airfield manager (and only personnel) turned the beacon on after receiving a call from Keflavik. ”Can you turn the beacon on Mr. X?” to which the answer was “Whiskey?” “No damn it – no whiskey.” “No whiskey no beacon.” They could get by with few words.  If the negotiations were successful, the beacon got turned on, and the airfield manager was happy. The way alcohol is sold in Iceland is through state monopoly shops. Sweden has the same system, for instance, and it is rumored that the people living on the Faroe Islands only get to buy their liquor if their taxes are paid. The state shops in Iceland are called “Der Reich” (The state) and exist only in the bigger towns. The population with no “Der Reich” makes a phone call, and the merchandise is delivered with the next post delivered by flight. It was thus imperative to receive the post on a Friday. On Friday the airfield manager had radioed in the local weather conditions on which the pilot made his decision to fly or not. The “terminal” at our local airfield was the bridge cut off from a decommissioned trawler.  Yet it functioned well.  We were in the terminal once waiting for some medical supplies when we witnessed another interesting exchange on Friday afternoon:  “You reported the local weather – visibility unlimited – calm – no clouds” came the voice of the pilot from the radio. Then we could hear the drone of a plane from above, but it was totally overcast (clouds 600 feet), wind from the north 10 mph (crosswind). “Yes – it is amazing how the weather on the arctic ocean can change in a heartbeat,” answered the airfield manager tongue in cheek. Now the calm voice of the pilot was heard – “I am going to kill you Mr. X.” “Well, you have to land to do that” was the logical answer. The bush pilots are very good, so nothing untoward happened despite dicey weather. We got our supplies, and the village its vital necessities.

Neskirkja í Aðaldal

The farewell portrait and a death certificate

“Hi doctor X! You’ve got free air in your abdomen.” Doctor X is a pediatrician, rotund and florid. He is rather excitable and has a vivid imagination. You often expect him to have a cerebral hemorrhage during a conversation (blow a gasket). He is a great story teller with artistic tendencies, and has good rapport with children and their parents. A bit unorthodox perhaps, but never boring. “I can sell this darling on the internet for you,” he said once when some parents were complaining about their son’s stomach. Well, the doctor had been seen by the surgeon on call, because of an abdominal pain, who had promptly ordered a CT scan because of his abdominal pain. After the examination he&the patient somehow got through the cracks and just went home. The surgeon on call came across the CT later in the day and there it was — free air in the abdominal cavity (which means there is a hole in a bowel somewhere). The surgeon immediately contacted Doctor X and ordered him to come post haste to the hospital. Understandably Doctor X got really scared, and with his imagination racing, thought his days were numbered. He was expected to return within the hour, but time dragged on, and finally he shows up obviously freshly shaven and sporting a new haircut! “Where the hell have you been?” was the first question. “I am certain that I am not going to make it,” came the retort — “that´s why I went to have a haircut and a shave.” Now the surgeon is incredulous “we fix this all the time you idiot” (is that how you talk to a pediatrician?). “No, I am a goner,” he continues, “to be on the safe side I also had my portrait taken by a professional photographer – in black and white for effect. Something for my family to remember me by.”

His treatment was uneventful, and he recovered. Since that time, he has a new found respect for surgeons and thinks we are miracle workers, nothing less. Doctors are a very difficult group to deal with as patients. Especially those who are cynical and meddle in their treatment plans. The only group that is worse is probably the clergy. “It is all in His hand” type of reasoning can get you to a boiling point. “Perhaps He put us here to take care of you” reasoning does not seem to enter their minds.

Neskirkja í Aðaldal

Neskirkja í Aðaldal

At the end of my training I used my vacation to do locum work at my first surgical department. I was a newly minted surgeon (licensed and all), and it was common for new specialists to do locum work in Iceland instead of taking a vacation. The family got to go home to all the relatives, and we got some brownie points for relieving the staff doctors. It was a bit like a dress rehearsal, where we could show just how good we were and also get a feel for working there for the future.

The atmosphere at the surgical department was jovial, and the morale good. The rhythm of the day was to present new patients at the morning meeting. The emergency patients were discussed, and any problems incurring during the last 24 hours were recounted. I had been on call, and we had admitted an old lady with a distended abdomen in the morning hours. She was emancipated and in dire straits, and the bowels were obstructed. What to do? Well, first off you discuss that with your patient. She understood that an operation was very risky, but by doing nothing she was going to die. She still enjoyed life she told me, and we decided on an operation as our only option. The staff surgeons were very negative about this endeavor. One of them of the “It is none of your damn business” fame (see my blog, http://everyjonahhasawhale.com/?p=1811) thought me mad. “Are you going to operate on that mummy?” He went on and on about it. Then there were the anesthetists! “The electrolytes are terrible, the kidney function impaired and my god that heart.”   Well, I honestly love anesthetists and I understand their plight. First, they have to anesthetize such a person, and then they have to deal with the surgeon – at the same time. So, the discussion with the anesthetists on the merits of such an operation, and the risks involved could be interesting. My central argument was always simple. The primary disease process causing all those abnormalities in the electrolytes, etc. was perhaps, and quite likely something that could be reversed. Our philosophy is, if the primary process can be fixed, the secondary problems have a chance of getting better. So, the patient will only survive the operation that fixes the primary problem. We must be very focused on that, and actually try to simplify things (some might call it tunnel vision). If you do not do that you will become mired in minutiae, and you can not do anything at all because it is all so terrible and rapidly getting worse. My arguments carried the day, and the anesthetists got the old lady ready for an operation. I was about to open her abdomen when the door of the operating room banged open, and the surgeon with his walrus mustache barged in.

Dánarvottorð

Dánarvottorð – Death certificate

He was in fine spirits and was holding a pen in one hand and a death certificate in the other  hand (those forms were the only ones we used on yellow paper.) Then he bellows – “When you start cutting – I will start writing!” He really was a lovable scoundrel.

There you go – what an auspicious start to an operation. By that time, I was getting to know him and I suspected that he was only “weighing my cojones,” so I did not get too rattled. All this black humor is a coping mechanism in a stressful environment. The operation was easy, and I found the suspected incarcerated femoral hernia, which was easy to fix. This lady recovered nicely and was duly discharged.

I sit here alone on the banks of the river

The lonesome wind blows and water runs high

I can hear a voice call from out there in the darkness

But I sit here alone too lonesome to cry

The Lonesome River – Bob Dylan

For doctors the river is constantly there. Our lives are lived on the banks of the river. Sometimes our toil is to prevent early departures and sometimes it is to help people to navigate across. We might as well fish it while we are at it!

 

“It is none of your damn business!” — And a reason for fly fishing

My first rounds

I graduated from med school 1977. My class was required to do internships in various departments to fulfill a certain standard (Europe adheres to this system). When the standard was met, we could embark on studies in our chosen fields. This system is not used here in the States. Here you graduate and go directly into a specialty without going through the main departments of medicine and surgery. Young doctors, in the European system, can sniff various branches of medicine, so it helps them to choose right. It is amazing how similar personalities aggregate in the same specialty. Think about the orthopedic surgeons you have met – and my case is proven. There are even some medical idiot savants who can tell the speciality of male doctors just by looking at their ties. I think the European system has the edge, as it exposes young doctors to more varied scenarios, but it takes a year, and time is expensive.

It is known that surgeons can be a handful. They can get a very bad case of the “God complex,” and the cardio-thoracic ones tend to be severely afflicted, with neurosurgeons, who are a close second. Society has some blame here, as witnessed by this rendering on a stamp of one of the pioneers of modern surgery, Professor Theodore Billroth.

Theodor Billroth

Theodor Billroth

This could easily be Jesus with his disciples, right? I, however, am the most humble surgeon that I know.

My first day as an intern was at the Department of Orthopedics, and I was eager to learn proper bedside manners and how to conduct the morning rounds. The Chief of Orthopedics was a big personality. He was a bit under average height, but compactly built, and a former gymnast. His hair was black, combed straight back – he wore black glasses. He was always very neatly attired, and brought his own white gowns to work, which were starched to perfection. I discovered quickly that the attending doctors at that time had two faces. First was the “inside face” for the medical and nursing staff, then there was the “outside face” for the ´patients. He was very charming and funny in his own way, and I grew to like him a lot. However, he could be brusque, and small talk was not his forte. Professionally, he had his opinions and he made them known. I never detected any meanness in him.

Hip replacement

Hip replacement – painless!

Well, I will get to the morning round now. We set off from the nursing station, in a big posse, The Chief, his attending ortopods, the head nurse, and finally I, trailing behind. We got through the first patients, and nothing special occurred, and I was picking up pointers, drinking it all in. Then we entered a room where yesterday´s patients were located. Lying there were four elderly ladies who had undergone hip replacement surgery the day before. The method used by the Chief was called the Charnley´s operation. Charnley pioneered the so-called plastic and steel concept. The part of the hip joint that is the pelvis was replaced with a steel cup that was lined by plastic. The other part of the hip joint, the femoral head, was summarily cut off by slicing through the femoral neck. This part was then replaced with a metallic prostheses with a ball part that fitted the plastic cup.  So, all in all it is a considerable operation with a long incision and severing of a bone. The Chief bursts into the room and asks the first patient about her status. “Doctor, I am in pain” said the first lady, and this turned out to be the answer du jour for the four ladies operated on. The Chief did not answer the first lady, just moved on to the next lady, asks his question, does not respond, and moves on, etc. Wow, I was impressed by the compassion and tenderness of the spectacle. Now the Chief heads for the exit and turns around and says, “You ladies cannot have any pain in steel and plastic,” and he was gone. It was an absolutely correct statement, and I begin to think – I need be to toughen up some for this specialty.

Charnley´s hip prostheses

Charnley´s hip prostheses

At that time, we did not have any ultrasound, computed tomograms (CT) or magnetic resonance imaging (MRI). Understandably, diagnostics were really difficult. The hospitals had their fair share of people who had all kinds of complaints, mostly rooted in some neurosis or other. How to sort it all out was a challenge. We were doing all kinds of investigations and taking all kinds of tests on these patients. Patients lingered in their beds as this waltz was being performed. Next I became an intern at the department of Surgery at the City Hospital. Our hero is now a crusty general surgeon with a walrus mustache, a small beer belly, and outsized personality. He is one of the most charming persons I have ever met, and a superb conversationalist. Full of humor and mischief. We were discussing a difficult case where we were coming up empty in test after test. It was becoming apparent that there was malingering behind this. Come the morning rounds next day and we found ourselves at this patient´s bedside. Our surgeon recounts the negative results of all our testing. The patient is whining and whining and whining (you know, honestly, they can do that) and our hero was becoming irritated and fed up of all the b.s. going on. Finally, our patient laments “Then what is wrong with me doctor?” — to which he immediately answers “It is none of you damn business.” That response was truly one for the ages!

It could be very hard to discharge this type of a patient. However, we had an ace up our sleeve! You know when all else fails – we suggested the Air Encephalogram. That was done by tapping a little bit of cerebrospinal fluid via lumbar puncture, and replacing the fluid with air. The air rose into the skull, and then x-rays were done. This usually was a quite a painful procedure and the clientele was aware of this. This suggestion usually worked to get them check out of the hospital.

Did this behavior influence us young men and women at the beginning of our careers? Sure, it did up to a point. Society was changing fast at that time, and iconoclasts were hard at redefining professional roles in society, and pretty much the whole of society.

After that I found myself in an ER setting, fresh from graduating and probably pretty full of myself probably. I was asked to see an old man whom I had not encountered before. However, I immediately recognized his name (which is magnificent – but cannot be divulged). I had read about him in a contemporary novel describing the diverse and often colorful characters on our national scene years prior. He had led a tragic hard life of addiction, and was well known in the ER setting, and now he was there old, burnt out, with withdrawal symptoms, and generally in a bad way. Despite all that, he had a presence of serenity, and was still in possession of his dignity. His speech was immaculate, the voice was clear, and he was very courteous. It started badly. He, in his calm courteous voice listed the drugs he needed to counter the withdrawal symptoms – then he said he needed to be admitted to his usual ward. He had quite the experience with this situation. I was young, inexperienced, cocky and stupid, took umbrage at the patient telling me what to do. I delivered a mini rant of sorts for a while. He just looks at me with a sad expression on his face and experienced eyes, and he obviously pitied me. Jonas, he asks me “Are YOU really going to become one of those?” It was like being hit with a sledgehammer. Was I in jeopardy of becoming a stereotype? Well, I cannot have that. Since that day, I have tried to be just me. So, I sobered up and pretty much followed his plan of action, and off he went to his ward. What are the chances that you can “cure” such a person?  Well, nonexistent really.

The Kanagawa wave

The Kanagawa wave

I am sure that all these patients and my interactions with them, and a host of colorful specialists shaped my personality.  Sometimes it felt being like drowned by a great Kanagawa wave.

After my surgical training, on return to Iceland, I realized that I would need a hobby to stay sane. The constant barrage of sick patients, and the pressure cooker of the hospital environment is stressful, and I needed something to get away from all that. Then there were the meetings! My Lord, those were the worst of all. Imagine being trained to make decisions on the spot, and then acting on those decisions. Then you have to suffer through meetings where no decisions are ever taken. And to boot, the people at those meetings really did not want a decision, as it would risk scrapping some future meetings (coffee and danish is good remember). Is it any wonder that I choose the solitary and quite sport of fly fishing?

One thing I have learned on the way. Old doctors are the worst cynics you will ever encounter.

Laxá í Mývatnssveit. Sigurbrandur Dagbjartsson, urriðaveiði.

Becoming a Master Angler – Marginal gains and Sibbi

Introduction

I fish with my friend Sibbi, whenever we can team up. He is about 20 years younger than I, and it is quite common that a fishing pair are of different ages. We have some things in common — we just love being outdoors and taking it all in. We suffer fools badly (remember, false modesty is no virtue), and are very old school, both of us. We first met at a lake in Iceland (Vífilsstaðavatn). This is a shallow lake that warms fast in the so called Icelandic spring. This is where the trout start to move the earliest in the Reykjavik area, and naturally that’s where you would find us. I was just starting out on this fishing journey of mine, and I really was a terrible caster and a worse catcher. At that time I was an attending surgeon at the City Hospital, and was working on my thesis. I guess my ego was at least extra-large and all that. We were fishing the Vífilstaðavatn one evening, and I was on call at the hospital. We were fishing with an old crusty trouter, Jón Petersen (the type who wades until water pours into his waders, then he is happy), my cellphone kept chiming, and I was barking orders. At that time Jón and I did not did not know each other, and he turns to me and says, “what is going on, either you are selling moonshine or delivering pizzas.” That cracked up this kid whom I had noticed there fishing. This led to our friendship. He laid out his line like a god (ok, let´s award a him demigod status at this juncture). He was catching char after char and the rest of us were – well, not. However, he was in a foul mood and cursing out his line. “This worthless piece of shit etc. etc.” “Well, Sibbi what is wrong with your line?” He replies “It is too effing short” (at 80 feet!). He was well into his backing at fourteen! The way I roll, I have no problem realizing that someone is way better at something than I am. However, I also know that if somebody can do something manually, chances are that I can copy it and master it. Just imagine the situation — the kid teaching the surgeon with an outsized ego. The kid, however, was willing to teach me in his own way. And to my credit I buckled down, swallowed my pride, observed and took his guidance. He did not teach by talking. I had to observe and figure out what was going on. Let´s assume it could be A or B. I then asked, “do you yada yada A?” He then looked at me with a touch of irritation, and then I knew it was B! He is not the kind that has found the Holy Grail and wants everyone to know about it. Little by little my fortunes improved, and I started catching, and my casting improved, too.

Laxá í Mývatnssveit. Sigurbrandur Dagbjartsson, urriðaveiði.

Laxá í Mývatnssveit. Sigurbrandur Dagbjartsson.

The Problem

Sibbi is a marvelous angler (out fishes everyone all the time), and therefore his contemporaries just can’t stomach it. I suspect there is a healthy dose of testosterone poisoning and self-image problems in this situation, but I digress. I have no problem fishing with him because I turn it into a learning experience. By observing and “copy & paste,” I have turned into a decent angler, I like to believe, but I am still learning. In his teens and twenties, Sibbi was a Ghillie (guide) in our top rivers. Sometimes the merriment of anglers at the lodges went on into the morning with resultant late or non-starts. Imagine being a teenager with a whole blue ribbon salmon river for yourself to experiment with.

Once we guided together in a brown trout heaven called Laxá í Mývatnssveit (see my books). The group we guided there for a week there was headed by Mel Krieger and his fishing buddies from California. It was great fun, and in the kitchen we had one of our well known chefs, who incidentally was fond of pot, and his specialty was fish. He was a big bruiser who liked to cooke in shorts. It was very nice to visit the kitchen, and take in the aroma. It turned out that Mel did not eat fish at all. It was all sorted out though. Some of these Californian anglers were very good casters, and it irked them that the kid cast farther than they could. They brought out the shooting heads and special lines to no avail. It was a custom of Americans, at that time, to leave the their gear as an extra gratuity for their Ghillies, instead of lugging it all back home. I was not tipped since I was a surgeon and in their view did not need the money (although I did). However, I was awarded a brand new two piece GLX 9´eight-weight rod. I still have that rod, and fish with it often, and it is still every bit as good as the new rods being touted today. It has lasted much longer than money would have!

Salmon and Red Frances

Salmon and Red Frances

Self-deception

We have fished lots of lakes and rivers together, and sometimes we do not catch anything. However, we never grumble or get into a foul mood because of that. I have been in the company of countless anglers that become very upset when the going is tough, and I can not stand that attitude. The unpleasant truth is that we sometimes do not have the skills needed for a certain situation. Assume we are in a river, and the first day we catch nothing, and nobody else does either. “There are no fish here” …….. and on and on they go. The day after the fish start hitting and god is in his heaven. Do they think that the fish went somewhere on vacation – to Tenerife maybe? To return 24 hours later? The fish are always there, because they live there – if you do not catch them it is because your skills are lacking in that situation.

I often hear anglers around us comment something like this about Sibbi “He just has some thunder-stick rod.” “He is just so diligent.” “He is just lucky.” “Lady fortune has just touched him” – and on and on. All of it is utter fish crap. I have reflected on this self-deception, which it essentially is, and I think anglers just can not admit that their skills are lacking. Thus, we are back to the testosterone and frail self-image speculation (we sorely need more female anglers). If you can not judge your abilities correctly, chances are that you will have trouble improving.

Sheepshead and Sibbi (they almost never take a fly)

Sheepshead and Sibbi (they almost never take a fly)

The marginal gains

This has been a lengthy rumination to get me to the marginal gains and the way Sibbi does it.

 The fly

A familiar sight

A familiar sight

Let´s start with the fly. Certain fisheries seem to favor certain types of flies. By talking to other anglers and based on one’s own experience, the “right” type of fly is tied on from the beginning. There are thousands of flies but only a limited number of types of flies. We do not carry a lot of flies, we just cover the types. Furthermore, Sibbi gets that fly to the depth where we think the fish are.

 The leader

At Ægissíðufossar - Hekla looms in background

At Ægissíðufossar – Hekla looms in background

The leader Sibbi uses is the thinnest he can get away with, for instance, 10-pound or even 5-pound for salmon. Leader to fly-line connection is the least bulky for a nail knot connection. Tapered leaders are expensive (especially in Iceland), so he goes with a straight level tippet. Dry fly opportunities seldom present themselves in Iceland so he uses stiff tippet material. This results in the leader landing straight (fly line too), and the fly is fishing from the moment it is in the water. He also uses longer leaders than customary. When your casting improves, you can turn over longer leaders.

 The line

In Hrútafjarðará

In Hrútafjarðará

Sibbi never over-lines his rods, rather he under-lines them. Good casters do this frequently – the head might be a tad light but by carrying more running line (more overhang) the rods load well. Floaters are his preferred lines but he sometimes uses floaters with a clear intermediate section if he wants the fly deeper. He uses fly lines with “normal” weight distribution (the head has the same diameter throughout), but opts for the longer heads. The backing is totally immaterial.

 The rod

Searching for an angle

Searching for an angle

Now for the rod. Typically he uses lighter rods than the average angler, but often favors ten feet rods. Thus, he can cast a bit farther, hence stand farther away from the pools, which is important. He is into the so called fast action rods, but prefers rods that will bend in the middle. Fast, but no broomsticks. Most of his rods are old Loomis rods. His casting is superb, both length and accuracy, because he has practiced, and taken the time to develop such a cast. There is no or absolutely minimal false casting. The fly is placed with laser loops at the spot he thinks is the right one, then it swings across. One back cast and the fly is where it is supposed to be again, and everything is straight and fishing from the start. Basically, his fly is in the water (that´s where the fish they are) as much as possible. He can do this with any decent fly rod but he just likes the “feel” of certain rods. All good casters can use any rod, but they choose their rods based on “feel,” which is purely subjective.

 The reel

Did a salmon just jump?

Did a salmon just jump?

Its importance has been vastly overblown. For most trout and grilse fishing you do not need an expensive reel. Any trout reel will do, and most trouters never see their backing. I have seen him catch countless salmon with a five-weight rod and a simple trout fly reel. However, if you connect with a 20 pound plus salmon in a foul mood (you very rarely do), you need something better. Last trip he connected with a salmon in that class, and the reel was a simple trout reel. It is no more, because it spun so fast that the lubricant overheated and it seized up – goodbye salmon.

Réttarstrengur in Hrútafjarðará

Réttarstrengur in Hrútafjarðará

 Reading the water

I have dealt with that subject for lakes fishing

http://everyjonahhasawhale.com/?page_id=1567

and here is the link to stream fishing

http://everyjonahhasawhale.com/?page_id=1570

 Addition

When all of this is added together it becomes crystal clear why he is so successful at angling. He gains an advantage at every link in the system and when all is added up, it translates into a huge advantage in the end. Most anglers are too lazy or complacent to analyze themselves and do not hone their casting. And thus they are doomed to mediocrity.

What is the single most important item? – The cast

If I were to pick just one component of all these, I would absolutely pick the casting. The other ones are really rather simple, but good casting only comes from practice. It kills me when I see anglers in costly salmon rivers, and they have no cast or just terrible casts. This is also the case here where I live, most fly slingers can not handle the wind when fishing the salt.

Laxá í Mývatnssveit. Sigurbrandur Dagbjartsson, urriðaveiði.

Laxá í Mývatnssveit. Sigurbrandur Dagbjartsson

 The truth

“You can observe a lot just by watching” – Yogi Berra

 

Ruby Throated Female

Return of Hummingbirds and schadenfreude

“Whoa – what was that”? It is late February early March in Texas. Something just whistled past me as I was gardening. This UFO was small, the size of a big bumblebee or a big moth. No way I could identify it, such was the speed. I rewound the memory spool, and yes there was some sound too. Could it be? I had never in my life seen hummingbirds, but knew they existed in the Americas. My interest was piqued and I did some googling. Yes – it very well could be a hummingbird. I discovered that they will drink a sugar solution if available to them. Now next step was to procure a feeder which I did. The mix is one part sugar dissolved in three parts water. Then you just hang the feeder in a place where the birds can easily access it and feel secure (think like a bird eh?). Now the wait and after a little while I was rewarded when this exquisite creature came to the feeder.

Ruby Throated Female

Ruby Throated Female

 

I was so overjoyed by seeing this bird for the first time that I felt like a little kid. (Those of us who are not grownups by fifty do not have to.)  I must put a disclaimer here. These birds move so fast that it is very hard to get sharp pictures and some of mine could be better. However I use them since they are mine, and if you are interested, go to the net and enjoy their colossal beauty in professional photos.

https://www.google.com/search?q=hummingbird+facts&client=safari&rls=en&biw=1313&bih=1131&source=lnms&tbm=isch&sa=X&ved=0ahUKEwiv1PD8xa7SAhWDRiYKHblbD_cQ_AUICigD

Ruby Throated male on his property

Ruby Throated male on his property

Why do I find them so special? First off they are the smallest birds there are, from 3-5 grams. They can hover in the air, go up and down, sideways and even back. They can cross the Gulf Of Mexico in a 20 hour flight, losing half their body weight enroute. It is very tedious to list all their factoids, so I put a facts website here. What really sets them apart is their rapid metabolism. Heart rate per minute is 500 bpm at rest and 1200 on the wing! I guess it could be called delirium cordis?

http://www.worldofhummingbirds.com/facts.php

They eat insects for protein, and then they hunt for flowers to drink their nectar, which supplies their energy. The plants need pollinators and will provide just enough nectar to keep them flying, doing their job. I already have mentioned my Bottlebrush in a previous post and how the Monarchs love that plant. The butterflies like their nectar a bit fermented explaining their erratic flight! The Hummers just love the Bottlebrush too, and the nectar it provides. Late summer there are probably up to a hundred of these birds in my trees.

Monarch

Monarch sampling the Bottle Brush

They are solitary birds and the males are surprisingly aggressive and territorial. When a male has located the feeder, it is his property, and magnificent aerial battles are fought over the right to have a sip. Of course a male will allow a female to drink from his feeder. I suspect the motivations  are somewhat less than pure, but what the heck, I understand. If the number of males gets to be too much to defend against, they change strategy and all are friends and drink the sugar solution together.

Ruby Throated males in aerial battle

Ruby Throated males in aerial battle

 

In Iceland the migratory birds are the harbingers of spring. Here I have chosen the hummingbird for that task.

It is with perverse joy I write this since today in Iceland there is 2-3´of snow and here there is this glorious spring. It only proves the article of Swedish faith that the only real lasting joy in this world is schadenfreude.

https://en.wikipedia.org/wiki/Hummingbird

https://en.wikipedia.org/wiki/Schadenfreude

Cartagena Colombia

Cartagena – Colombia

Cartagena is a walled city in Colombia on the Caribbean coast. It is renowned for its well preserved architecture. This post is going to be just pictures all taken by Drifa Freysdottir. There is nothing to add, the pictures say it all.

https://en.wikipedia.org/wiki/Cartagena,_Colombia

 

The choice, the sun and Icelandic crepes

After graduating Med School I worked for six months as a general practitioner during the coming winter. At that time it was a requirement for obtaining a license as a doctor before you could embark on your chosen speciality. I took a post in a small village in the countryside where I was the sole doctor. It was remote from Reykjavik. The villages around Iceland are mostly coastal with fishing interests and service to what is left of the farming community around. The movement of people from the country to the towns and villages had already depleted areas that once were thriving communities. Where I was posted the fjords are deep and the mountains are layered up to a flat tabletop. The mountain sides are steep and they will block the sun if the village is so located. These fjords are ringed by mountains where the foothills run into the sea with limited lowland. Some places the mountains cascade into the sea with vertical cliffs and the surf pounding the walls. The ocean is a part of the allure sometimes flat and other times raging and cold it is. These fjords are barren devoid of trees, mostly stones and tundra but exceptionally beautiful even majestic.

The preceding summer I worked as an intern in one of the hospitals where I got to know a young patient in her twenties. She was battling a cancer. She was from the rural area where I became posted and her only wish was to live in there. South of the mountains in the next fjord she lived with her husband on a farm in a valley where there were no other inhabitants. Mountains both sides and then a bay with yes you guessed it more mountains. There were no lights from any other settlements to be seen from where she lived.  When the snow started in the fall it became impossible to to get there driving. There was a an airstrip at villages north and south of her but if you can not get there it is useless. The lady had a relapsing condition and after each treatment and actually from the first treatment she absolutely refused to be in Reykjavik extended periods for follow up and such. She could not stand the city and would go back to her farm immediately after the chemo. She had had a number of relapses and then recovered. This lady was very intelligent and understood well her predicament. However living on her farm was the only thing she would accept despite the consequences.

In these fjords the mountains are so high they will block off the winter sun that only manages to get up over the horizon some few degrees in the wintertime. It takes for ever for the sun to rise and it sets slowly. Some villages do not get any direct sun at all for a while. You can see the mountain tops across the fjord illuminated and you track when the rays are creeping lower as the sun rises after the winter solstice.  So winter at these latitudes is prolonged periods of dusk little bit of sun but mostly pitch dark. To not feel the sun on your skin for an extended period of time is depressing and you long for the caress of the sun again. The feeling of the sun on your skin after this period of deprivation is indescribable even wonderful. The day will come that the sun manages to get over the mountains blocking it and shine on our village and that day is understandably a very special day. This day we have the sólarkaffi (sun coffee). We bake what is locally called pönnukökur (pancakes) but the rest of the world calls crepes (we think everyone else has it wrong). We do not care so pönnukökur (or pönnsur a nickname) it is. We bake them on flat round crepe pans that must not ever be washed and are not used for anything else. These pans become heirlooms. My sisters wondered what became of momma’s pan but I know. There are many recipes and I for instance put a little bit of coffee in the batter to get a better color, I actually prefer instant coffee if it is to be had. We like them thin and roll them up warm with sugar brown or white or we we put whipped cream and fruit jam on top and fold them twice so they look like a padded quarter circle. This is a great tradition as we indulge in crepes and the revitalizing rays of the sun. This is the best celebration I have experienced in my life.

The winter I was working there I took some blood samples which were sent to follow up on her condition. The winter was uneventful and I returned to the City and soldiered on. Next year in the fall I learned that the lady was getting weaker again. She understood the situation and as she was snowed in the Coast Guard was summoned to help out. Before that she in her weakened state hiked up the mountain and sat down on a stone and awaited the return of the sun. When the sun reached her she sat there and soaked it up and then hiked back to the farm. Pönnukökur  were baked and she enjoyed her sólarkaffi (sun coffee). Now she was ready and the Coast Guard got her out of the isolation and she had to return to the hospital. She did not make it back alive. I am certain that her spirit, if there is such a thing, is there in these barren isolated majestic valleys. The memory of her certainly is.

That damn fireplace is smoking again irritating my eyes so I have to fix that.

Pictures Drifa Freysdottir

 

 

Hofn i Hornafirdi

My friend, the river and a slab of stone

Now that I am retired from surgery memories come floating into my head. Incidents that I had forgotten big and small and good and bad. I have been ruminating on one of my patients who was quite an inspiration to me (we will call him E). If the rebirth theory and Nirvana holds true he was close to attaining that state, old soul and all that. It so happened that when I dealt with patients that some of them became my friends. It was understandably those with serious diagnoses. They and their families need so much more from you than simple cases solved quickly. The simple cases mainly need technical excellence and that is that. In some ways I was rationing my “love” because I think my “love” is finite. I know that some teach that the more you give the more you can give but I don´t think so. I have seen so many health professional who have become callous and burnt out with no “love” left to give.

Back to my friend and our journey together. In some ways you might say that I have lived through many lives with my patients especially their last years. We sat together drinking coffee and telling each other stories. When my friend was a boy on a farm in South East Iceland one of our national bards Thorbergur was visiting as he was born in that area. Thorbergur was notorious for his angst of ghosts and everybody knew that even little boys.

“So little E are there any ghosts here on this farm” Thorbergur asks? “There are some in the barn and stables but that is nothing compared to the farmhouse. It is very bad here” E answers.  “Now that is some news. Where are they most aggressive” Thorbergur asks? “Well if you insist it will be in guest room where you will be sleeping.” And so it went little E worked himself up telling ghost stories real and imagined. He was so focused that he started to believe them himself. Thorbergur believed any and all ghost stories. When it became time to go to bed E told me that Thorbergur had said to him. “Little E it is best that you sleep with me tonight.”

He told his stories quietly with a soft smile and immense presence. He was a tall man powerfully built and with the largest pair of hands I ever have seen. He radiated kindness but he was firm all the same. Previously the nightlife in Reykjavik had become rowdier and wilder. In one incident the bad boys had spilt into the ER and were partying. Knocking over medicinal cabinets and what not. Young Dr. H (one of my closest friends) was dusted a bit and the attending orthopedic surgeon Dr. H* who is built like a classical orthopedic surgeon (a tank) and behaves like one. Not the kind kumbaya type you meet today. He sustained rib fractures so good times were had all around.  The countermeasures were to have an officer there during the weekends. Officer E was one of the first to take that shift and when he was there all was calm. The bad boys came and he just met them and genially said “How are you boys” smiled and placed his hand on someone´s shoulder and that was enough. You can radiate power in different ways.

I had to do a rather big abdominal operation on him one early spring and he recovered from that eventually. I meet him the next fall. “What have you been up to my friend?” “Well I was not sure if I was alive after all I have been through” he said. “You look alive to me.” “I know and I feel alive now after my experiment.” “Now what did you do” I asked him? “Well as I was in doubt on my vitality I returned to my birthplace. You know there is this glacial river there Jokulsa i Loni?”  “I know” I answered “I have seen that river and passed it on the bridge several times.” He says “I know a ford in that river from my youth.” “And” I ask? He goes on and “I picked up a big slab of stone to weigh me down.” Now I became worried “You idiot you could rupture the wound or some such doctor worries.” His answer was “But I needed to know if I was alive.” A verbal touchdown?

“Then I proceeded to the ford on the river and made it over to the other bank. The current was fast and cold but the stone kept me down but I became pretty tired though.” And goes on “Now I realized the car was on the opposite site so I had to wade it again.” I am now flabbergasted. He continuous “Then I knew I was alive.” Just like that calmly half smiling and with this gentle and loving presence that I cannot fully describe.

Now as fate would have it his disease returned and it slowly led him to his demise. “How are you E what is going on now?” On one of his last visits to the outpatient clinic. “Well I am so happy now.” “What is going on” I ask. “My disease and the way things are going have brought my family together.” There had been some discord and strife that I knew about in his life (discord and strife, isn´t that just generally life eh?) “Now that I am dying we have solved some of our problems and we are united again. I am very grateful for that.”

I loved this man and will always be grateful that I got to know him.

As I write this I think that the smoke from the fireplace has gotten to my eyes and I need to go fix that.

*Dr. H is without question my favorite orthopedic surgeon. Both Drs. H are fly fishermen and there is a river there somewhere as this is a fishing blog.

Pictures Drifa Freysdottir

Laxa in Adaldal

The billionaire´s compliment

“Are you a fly fisherman”? “It is a disease” I retorted. “I will pick you up tomorrow,” he said. “Sure” I answered – “what river are we fishing”? “It is the river Mine” he answers and we were practically engaged.

I had in my lapel a small brown trout pin made of tin. Nothing fancy but a statement all the same. “Who is this guy?” I asked after he had disappeared. I was visiting with a leading surgical instruments maker in the New England area and being chaperoned around by a sales rep. I noticed that everyone around us had gotten quiet and very respectful. The rep looked at me and said, “this is Mr. X and he owns this place”.

So next morning a car is in front of my hotel to pick me up. I have gone fishing in all kinds of vehicles but never before or since have I gone in a stretch limo. SUVs small and large even Skodas but never a limo. I say that is just a great way to travel. We drive out into the countryside for a bit and come to a great estate that is walled in. When inside it was just a beautiful land with some bass ponds here and there and a hill. The river Mine was so constructed that water was pumped to the top of the hill and then it came flowing down through pools and meandering curves when it was being fished otherwise it was just a trickle. Trees and brushes were on the banks and the pools were so constructed that you could cast in the correct direction and the back cast was unobstructed. It was a like a Japanese garden – serene and peaceful. Of course the fishing was fabulous – rainbows and browns galore.

Later he came to Iceland on his private jet and I served as his ghillie salmon fishing. Now salmon fishing can both be crushingly boring and fabulously exciting. The way it works in Iceland is that you buy a fishing permit for one rod for 3 days for instance. Each river has only a certain number of rods each day that are allowed to fish it depending on the annual catch. Some rivers have just 2 rods per day other have more also depending also on the length of the river.  The salmon are a migratory fish and if they are “late” or you are “early” it is boring I tell you. If the salmon are running up the river and you are there it is magical but then there is the weather.

Iceland is in the subarctic zone. The Arctic Circle is just north of Iceland and traverses Grimsey (small island off the coast of Iceland). Any day of the year at those latitudes can bring a blizzard or a howling northerly or both.  We do have a month called July in Iceland but it is a far cry from an USA July. So of course we have 3 days of howling north wind at our river when we were supposed to be fishing, with temperature around 40F. Mr. X was not expecting this weather and was a bit underdressed for it. All the same we were flogging the river and shivering. Now in Iceland we have a curious custom when we get cold. We slap our palms on our torsos for a bit and presto we get warmer. This custom was totally alien to the billionaire so I gave him a good hiding with my palms. He suddenly got furious but then suddenly he smiled and said “You are the only one who has beaten me in a long while – and I liked it”! – When fishing a considerable time is spent on the banks just shooting the breeze and having a little dram of whiskey every now and then. I was on a roll telling stories (I can b.s. with the best of them) and explaining the geology and what not when he wrapped up the pause by saying “Jonas – you are full of useless information”.

I would say that this is the best backhanded compliment I have ever gotten.

Pictures Drifa Freysdottir