Monday, July 20, 2009

The Value of Creating 'Community' In The Music Industry

I am writing on this topic tonight because I want to share with you an experience I have been part of here in Seattle involving my old alma mater of sorts...the Art Institute of Seattle. (I taught there for 18 wonderful years.)

Last Friday night,Tom Pfaeffle, a kind and amazing man, nationally recognized for his limitless talent as a live sound engineer as well as an Audio Producer and studio Engineer, and an outstanding teacher of audio production for the last 15 years at AIS, was senselessly murdered while on a weekend getaway with his wife. It has been on the national news, so I won't go into much detail other than to say that while staying at a rural vacation spot in Eastern Washington and staying at a small motel over there, he accidentally started to use his room key to get into his room, but it was the wrong room. The man in that room, without any words of warning or anything shot him through the door and the bullets went into Tom's kidneys and liver. The man was arrested, but Tom lay in his wife's arms for over two hours before help arrived and could get him to a hospital. He died a few minutes after arriving at the hospital.

Those are the raw facts. They traveled quickly over the internet and through Twitter and Facebook updates. Today the school canceled all audio class until Wednesday, and held a special school memorial meeting for any and all students and faculty and friends who wanted to gather to remember him in any way they chose.

This event was one of the most extraordinary gatherings I have ever experienced. Story after story came out about Tom as a teacher, a friend, a mentor, a professional, but mostly about the man he was!

I kept thinking about what I do now since I retired from formal music business teaching,(except for an online course I teach for a company called Music Industry Educators, and also the occasional workshop or classes I teach on my own through my company FourFront Media and Music.) The value of meeting in a formal setting and working with real live students compared to digital ones is huge. I write books, and record podcasts, and blog, and Twitter and all that stuff including some digital social networking, but it just ain't the same. I learned today how important it is to have a community. For that is what teaching or talking about music subjects, for me at least, is all

The music industry is very competitive as we know, but is also one of the most amazing industries when it comes to supporting each other when stressful, sad or happy events happen.

I am still mourning my friend and former colleague, and that will go on throughout the many planned memorial services the Seattle music community is already putting together to honor his memory and his many contributions.

But what I am getting at is this. There is REAL VALUE in creating a music community wherever you live. Yes, I know we can and do have the ability to have online video lectures and panels and classes, and that's all great. However it will never replace the sharing and the (excuse the politically incorrect word) bonding that happens when musicians gather to talk about how they are promoting their music, or what their struggles are.

I have contributed thousands of words over the years to help educate musicians and recording artists about the business of music, but while I was attending today's memorial gathering for Tom Pfaeffle, I realized that continuing to put on 'real world' events has to be in my future plans, not just be a part of my past contributions.

I know all of you who may read this won't be able to attend whatever events I come up with, but I am not the only guy out there who teaches or writes about music business issues for independent artists and bands.

Check out the remarkable work that Bob Baker does for example or David Hooper, Tim Sweeeny, and even Moses Avalon. They all put on some kind of live events all over the United States. In addition go to music business seminars and conferences like SXSW or join NARAS, the Grammy folks, and join a local chapter. They put on events in every city they have a chapter in. (Check out for a chapter near you).

Take my word for it. The internet is great and we can't even imagine what new developments it will offer all of us who love promoting music, but the value of a participating in a REAL WORLD meeting or school or whatever...cannot be replaced.
Shaking the hand of someone, pressing the flesh, as they use to say,IS STILL VERY IMPORTANT today, and will be important forever.

Perhaps someday you will hook up in-person with such a man such as Tom Pfaeffle was. I wish that for you. It will be an experience you will never forget.

Chris Knab

Sunday, July 5, 2009

Who Says Our Health Care System Is Messed Up? or My Misadventures at Highline Medical Center

An explanation of this Blog: I was recently in the hospital for reasons that will become clear in this blog article. I wrote it for myself, for my family, and loved ones, and also I wrote it to share with any of you that are fed up with the medical care we get in this country. I want to thank all my friends, both those friends who support me in this real life, and the many friends old and new that I have made or rediscovered thanks to Facebook and Twitter. You asked for my story, so here it is:

Once upon a time, or to be more exact, on the evening of Friday, June 19th I was at home making some dinner for myself, and preparing to enjoy an evening of DVD watching when things started to get a bit weird. First, as I was preparing my meal, I noticed that my usual clumsy self was clumsier than usual....I kept dropping things, like my knife and fork, my plate-full of food, and I felt a bit dizzy as well. I tried to ignore all this and went to the living room and sat down in my favorite chair to eat what survived of my dinner. Then, a strange numbing sensation went slowly up and over my right lip and nostril, kind of like a slow lightning bolt that exploded into an even bigger headache at the top of my head.
Right away, I thought of my good friend Jon (who had some even more dramatic experiences of this kind in recent years) so I managed to call him. When he answered I could say "Hi", but not much else. My words were on the tip of my tongue, but I couldn't get them out! I couldn't talk!

Jon immediately knew what was happening to me and said "Chris, go to the emergency room of a hospital NOW". It's kind of hazy what I did next, but I said something like "OK" and hung up and pondered what I really should do. I probably should have called 911, but the symptoms I mentioned earlier suddenly stopped, except for a dull headache and some dizziness. I live in Burien, Wa. which is about 10 minutes south of downtown Seattle, and I knew from previous health issues, that a hospital called Highline Medical Center was only a few minutes away, and I felt OK to drive over to it. Which I did.

Things started out quite well in the emergency room. I barely finished explaining to the nurse on duty what I had experienced at home, when 3 other nurses or aids, put me in a wheelchair and pushed me directly into the emergency care ward, where I was transferred to a gurney and given oxygen while one nurse asked me to re-tell her what had happened. At this early stage things are going well, and I received close attention from the ER staff. After a half-hour or so, an orderly came up to me and said I was going with him to get a cat-scan of my brain. That went easy enough and then I just waited awhile.

Around this time I had reached by cell phone my partner Sue, and she arrived to be with me in the ER. Within a few minutes the orderly guy came back and said that they wanted to do another cat-scan, but this time injecting some dye in my veins so they could see more clearly whatever it was that they wanted to see. This also went quite smoothly. Then I came back to my temporary gurney room and waited. Some things get hazy again as to what came next, but I assure you that up to this point there is nothing for me to complain about. However, I will learn MUCH in the following week, that I had suffered what is called a TIA (Transient Ischemic Attack) or "mini-stroke", or really a "warning stroke".

I was NOT told that in the ER but when they got ready to release me, that is what was written on the release form for the diagnosis. I was told to take Meclizine, 3x a day as needed for dizziness, and 1 Aspirin tablet a day, and to see a neurologist on their campus the following Monday at 1pm. They gave me a handout with information on what a TIA was and how long they usually lasted, but NO ONE talked to me about what a TIA was and how dangerous it had been, NOR that behind all this was the fact that my blood pressure was VERY high. No blood pressure medicine was given to me at that time, by the way. They did administer a shot of something or other to help my headache, which it did temporarily.

So, Sue and I left and went home. I had a lousy weekend over the 20th and 21st of June, with mega headaches and continued dizziness. And yes, I took my 1 aspirin a day as well.

Monday comes around, and things start to get interesting.
I drove myself over again to Highline for my 1pm appointment with the Neurologist. As I am
walking up the stairs to his office, my headache and dizziness return and are quite pronounced as I sit in his waiting room. When he comes out to call me into his office I tell him right away about my pounding headache and dizziness. He takes my blood is 180/120!! Not good. He tells me immediately that he is sending me back to the ER. Then some drama occurs, as he calls for help to get me to the ER and eventually 3, (count 'em three) firemen arrive to give me oxygen, put me in a wheelchair and take me to the ER.

Little did I know that my stay in the ER this time would last for 25 HOURS!!!

After being admitted to the ER for a second time in 3 days I am told that my neurologist will be coming to see me, and when he arrived he said he wanted me to have an MRI to follow up on the cat-scan.

(OK...time out for some essential background information). You see, when I was a kid from about the age of 10 to 18 I was a sick kid. For almost 8 years I suffered horrible headaches and bloody noses- not from fighting by the way-and my balance was way off. My parents did all they could to get medical help for me, but being the early 1960's the medical equipment to explore any head or brain issues was scarce to say the least. So, my symptoms would come and go throughout my childhood, and it got so bad that after exhausting all neurological avenues to find out what was causing all my pains, everyone involved with my health gave up, and actually told my parents that there was nothing wrong with me. I just was faking it because I didn't want to go to school. Hmmm. Anyway, in 1963 during a relatively good health period, I actually joined the Air Force. I didn't last long, barely 3 months, when all my symptoms described earlier returned with double intensity. So, what did the Air Force do with me....why they released me from being an Airman, and sent me home, whereupon another attempt was made to diagnose me.

Well, finally in August of 1963 I found an amazing brain surgeon who had the insight. if not the technology to take a chance on his hunch I had a brain tumor. On August 12th, 1963 he operated on me, and after 20-odd hours in surgury he found a benign brain tumor the size of a large chicken egg in my brain, and removed as much of it as he could. He saved my life is what he did.)

Now, over the years I have had many reasons to keep track of the remaining part of the tumor, to see if it was growing back or causing any other problems, and so as medical technology progressed, I have had around 8 or 9 MRI's. I am use to them, to say the least and all of them have shown all is well in my noggin.

We now return you to Monday, June 22nd at Highline Medical Center. The neurologist who was dealing with me requested a MRI, as I said earlier. However an unforeseen problem pops up. It seems the cat-scan technician who on the previous Friday night had taken the two cat-scans tell the neurologist doctor that he cannot do an MRI on me because the catscans showed that I had a metal clip in my brain! " I have a WHAT?," I say. I turn to the doctor and the technician and say that is impossible. With over 8 MRI's taken in the last 40 odd years, wouldn't you think someone would have noticed that before? An MRI machine is a giant magnet. If you have any metal in your head, that metal would be attracted to the magnet, and as has been explained to me, the metal object would tear away from the brain matter in my head, which would cause uncontrolled bleeding and simply put ... I would have died 8 times over if indeed I had any metal in my head. This technician refuses to do the MRI. The neurologist is frustrated with him, believes ME, and says quietly to me..." I will get some other technician to do the MRI"...Well, he never did. I never had the MRI at Highline. (By the way, Sue even went home to bring back the copies we have of my last 2 MRI's and the technician at Highline never even looked at them.)

I would like to state at this point, that the diagnosis I was given of having had a "minor stroke" the TIA, was later confirmed by my regular doctor who has been helping me with it since I got out of Highline. My doctor is at Swedish Hospital's Cherry Hill Campus in Seattle. She told me, after I had told her what I am telling you the reader, that there is a protocol....a set of tests that are mandatory for any patient that is diagnosed with having had a TIA. Highline did NONE of those tests! But, recently in the last week (June-3oth thru July 3rd 2009 I have now had all those tests and we are dealing with what they have shown. More to come on this...lets get back to my misadventures at Highline Medical Center, as things are about to get interesting; if they haven't already.

After the technician refuses to do an MRI on me, I go back to my gurney 'bed' in the ER. I am told several times that I have to stay in the ER because " there are NO BEDS anywhere in the hospital" for me. So, I become what is known in the ER as a "Border", a patient that needs hospitalization, but there is no room in the Inn for them.

I would like to say before going any further that my issues with Highline are primarily with the doctors and decision-makers on staff, NOT with the hard-working nurses, nurses aids, orderlies, or any of the over-worked and under-paid staff. With a few exceptions, the 'troops' working the ER and the rest of the hospital are just that...hard workers with far too much to handle, but doing the best they can. One thing about being in the ER for so long was I was able to see first-hand the many patients that fill that facility and how much work the ER staff does just trying to keep up with the new admittances.

I found out quickly that being a "Border" in ER is a far cry from being admitted to the general hospital patient population, with a real bed of your own, access to 3 meals a day, and a regular routine for being monitored.

I had, in 25 hours 2 so-callled "meals" and I had to beg for something to eat. On the night of June 22nd I finally got around 7pm my first food since being admitted. It was meatloaf with gravy and overcooked carrots, and black coffee. ( I know, I know, what did I expect when it comes to hospital food!) Within an hour of eating my dinner, I had a run of diarrhea. Next up: finding a place to put me so the ER noise and constant activity and lights might allow me to get some sleep. They do push my gurney into a back area of the ER, which was thoughtful of them, but of no value. You don't get sleep in an ER unless they shoot you up with some heavy sleep inducing drug, which I did not get.

So, morning comes, but no breakfast until around 10 am I beg for something to eat....I get a plate with 2 pieces of wet toast, and a cold bland omelet, again with coffee which I don't drink due to the diarrhea from the night before. At around 2pm I ask for a sandwich, and I get what I asked for .... a sandwich (fake turkey).

Ahh, but good news arrives. I needed some, my time in ER included only a short visit from a doctor who did nothing to or for me and my condition, but smiled a lot. The news....they found a room for me!! Hooray!!


I am rolled up to a ward that is used for respiration ailment patients....not my problem, right?, but at least I have a real bed, access to better food, and nurses and orderlies, and nurses aides...actual hospital treatment.

Now, whenever you go into a hospital and are admitted, one of the routines that happens is a nurse comes by at some point and asks you what meds you are taking on a regular basis, so that you can stay on your regime. I have been on a med that I need to take 4 times a day on a low dose. I explain that to the nurse. In fact I explained it several the ER and in my new room as well. So, its time for my night time med, and the nurse comes in with the little pill cup containing my med and says to me: "Here is the 3.75 mil tablet of your medicine you always take. I stop, think, and say " But this is the WRONG DOSAGE, I take 0.5 mil of this medicine 4 times a day and this dosage is 7 times more powerful a dosage than I have been taking for the last 4 years!!!" "Well" she says " THIS is what YOUR doctor prescribed for you in this hospital, and I don't care what your doctor outside this hospital says, when you are in here you take what YOUR Highline Dr says you need to take."

I do not take it. and by the way after I am released I call the physician who gave me the med in question and tell him about this episode. He tells me "thank god you didn't take that higher dosage, you would have found yourself in another ward, and may not have survived."

At this point I could go into the subject of a male orderly making very brazen and obvious passes at me, or I could talk about the poor guy next to me in the other bed who, without warning, and without a bowel movement in over a week, decided to use a simple chair near his bed to take a very large dump. Apparently he didn't know what a kamode was. The stench in my room cannot be described in words....but's a fact, we cannot control who are neighboring bed room-mates will be. That is just part of being in the hospital.

Oh, I almost forgot. the nurse who told me I had no say in my meds, or what other doctors outside Highline had prescribed for me....turns out she wasn't even a nurse!!! She was a respiration therapist, just sticking her nose into my business, with no authority to even deal with meds!

The end is near, dear reader.

Things calm down for awhile. Since I haven't had a bath or shower since I arrived, and I was feeling kinda funky seeing as I was still in my street pants and shirt, with only a gown thrown over me to help keep me warm. (It was roughly 60 degrees in the ER by the way) I asked if I could go take a shower. There was one right next to my bed. Well, the happy orderly I mentioned earlier told me I couldn't do that till the next day, but he would be willing to give me a personal bed-bath if he had time later. I declined, as I also declined his offer to "tuck me in" that night.

At around 1am I am still not able to sleep, and the noise from the hallway is like a party on New Year's Eve, I go out to the nurses station and ask if I am allowed any meds for sleeping. No is the answer, but I am allowed to take one Vicadin....I take it.

Now, get this. It is 3am and all of a sudden the head nurse on duty barges into my room, along with two nurse's aides, turns on the bright lights in my room and shouts out. " Mr. Knab, get out of your bed! We need it for an emergency patient who has just arrived." I'm a bit shaken up, but realize what is going on...I am being kicked out of the room I had only been in for barely 12 hours!. They start touching my personal belongings and packing up my bag and I shout. " STOP,what in the hell is going on here." I walk out to the hallway, and find a doctor, and I recognize him. Actually he was another one of the two doctors who came to visit me in the ER 20 odd hours ago, and actually suggested they start me on a low dose of a blood pressure medicine, and then walked away. But it WAS him. I asked him what was going on, and he explained to me that they needed my bed because it was a special bed made only for certain types of patients that had a particular respiration problem, and there was a patient desperately needing that bed now.

I humbly asked him: "Why did you put me in a special bed made only for certain patients who have a certain type of respiration ailment?" and the doctor says to me: "Well, maybe I shouldn't have put you in that bed". NO SHIT you shouldn't have!

"So what do you plan to do with me now doctor?" I ask. It's 3 o'clock in the morning. No one has really done anything for my problem with the TIA diagnosis, except give me an aspirin and start me on a low dose of a blood pressure med. AND you have a technician who won't do an ordered MRI on me because he wrongly is convinced I have a metal object in my head, which I don't. So, why am I even here. I would like you to release me from this hospital NOW" " Will you do that?"

He said he couldn't do that, and if I left on my own without a doctor's signing my release, I would risk having my insurance company NOT pay the hospital bill.

I asked what he suggested we do now. His answer, with a straight face was:" Well, we can put you in a wheelchair and you can sit in the hall for 3 hours, until 6 am, when a new doctor comes on duty, and ask him to release you."

Sit in a wheelchair in a hallway for 3 hours and wait for some other doctor to show up?! This is medical care from a hospital that puts patient care first, as their motto proclaims.

The next thing I know I am in a wheelchair, and two nurse's aides are wheeling me down a hallway, and all of a sudden one of them says..."lets take a look in this ward, maybe he can stay here". I am pushed into a ward called the Observation Ward. The two nurse's aides look into a couple of rooms, and find a bed open next to another sleeping patient. They turn on the bright room lights, waking up the stunned patient and plop me in the bed next to him and leave.

After about an hour of being as quiet as I can, so the poor guy next to me can get back to sleep, I notice he is coughing and moving around and awake. So, we talk. He tells me his misadventures at Highline and I tell him mine.

Then, I get an idea....I get up and walk down the long hallway of the ward, and funny thing, I look into about 12 rooms, and you know what? All the beds are empty!!! They fucking lied to me the whole time I was in the ER for 25 hours. They had plenty of beds but for some reason refused to put me in one, until I was kicked out of the bed in the respiration ward, which I never should have been in, in the first place.

I go up to the nurse’s station. There actually IS a nurse’s station with a nurse on duty.
I get bold. I say this: "Hi, I'm Chris Knab, the wandering patient and I am now in your ward. I tell you what I want. I hear that a new doctor is coming on duty at 6am. Good. Now I want you to do me a favor. When he arrives, you tell him that you have a new patient in your ward who wants to speak with him and demands to be released from this facility. Then I paused and said to her:" Do you know what I have done for a living most of my working life? Well, I have been involved with the Media. and I have friends in the media".

"The media love a good story, and my experience in this hospital is going to make a great story for the media. So, I want this doctor who comes on duty at 6am to come down to my room, and tell him I want to speak with him ASAP regarding getting out of this place."

I went back to my room. At 6:05 am on Wed June 24th that doctor came into my room, signed my release papers, and lamely apologized for my experience at Highline Medical Center.
"I can assure you Mr. Knab that the type of incidents you have been through are not typical of the care we give our patients. And, I will make it a point to inform the Board of Directors of your situation, and I apologize for everything that happened to you. You are free to go."

I was out of there faster than you can say "We need health-care reform."

And that, kind reader, is the story of my stay at Highline Medcial Center, in Burien Washington, just 10 minutes from downtown Seattle, Washington. I welcome your comments.

Chris Knab