The Ku Klux Klan and My Grandmother's House in Vernonia

My grandmother’s house was located at the beginning of a plateau in the Coast Range, about 1500 feet above sea level along a gravel road.  To one side of the house was a fine strawberry field, perhaps 50 yards long and forty yards wide.  To the other side was a somewhat larger field, about half of which contained potatoes and the rest corn and a variety of other vegetables.  Behind and to the strawberry side of the house was a garage and small workshop, a heavily insulated shed where she kept canned foods, and a chicken coop where the chickens roosted after roaming the property during the day.  Further down was an electric, barbed wire fence which I now assume was a property boundary but then, just an obstacle to be carefully crossed.  Beyond the fence was a ravine with a mill pond at the bottom where a shingle mill once sat, its metal wood waste burner tilted a bit and badly rusted out, but its bed of ash still intact with a few charred pieces of cedar log scraps sticking out.  It was dark there and the monster dragonflies whose territory this was flew right up to your face, sometimes provoking a panicky dash up the hill, across the fence and to the safety of the garage or strawberries. 

It’s unclear why my grandmother, then in her late seventies, bought the little house in Vernonia, Oregon and moved there from Medford in 1950.  She probably would have said the reason was to be closer to her boys and grandchildren, though when she moved to Vernonia one of her sons lived 70 miles away and the other about 45. 

Vernonia then was at the tail end of the long and largely successful business of the Oregon American Lumber Company.  Following the depletion of the pine forests in the South and in the Midwest, O and A moved into town during the early twenties as the new owner of two billion board feet of timber from the

Quinault Forest Douglas Fir

remarkable Douglas Fir forests that colonized the coastal Northwest as the last ice age retreated.

The trees were mostly 300-600 years old with a few over a thousand years.  Southern and Midwest loggers preferred pine but would soon be seduced by these remarkable trees that made up 85% of the forest around Vernonia, located near the center of the tree’s natural range.  Often they would rise 100 feet before the crown of the tree would emerge.  Their stands were dense, 1000 trees/acre, and their wood was flexible but strong.  Normal yields of Douglas Fir in the region were 55,000 board feet to an acre.  Oregon American owned many stands near Vernonia producing twice that. 

Before Oregon American, most timber companies used rivers for transporting their logs downstream or they built great timber flumes that led to a mill on a river or bay where they could be cut into timber and

shipped, usually by boat, to customers.  Oregon American was unique in the logging business then because it wanted to ship its logs mostly by rail to a mill in the interior, closer to the trees.  Also, Oregon American wanted to dry the processed logs in a kiln on site and then ship them to customers by rail, the lighter, dried timber meaning lower freight costs.  Most of O and A's customers were in the Midwest.

Just after World War One, Vernonia was a primitive community in which a handful of pioneer families hung on as best they could, clearing trees to grow food and hunting and fishing for the rest.  In 1919, perhaps a hundred and fifty people were living around a cluster of crudely built structures in the Nehalem Valley.  Even the name was a mistake.  It was supposed to be Vernona, after the daughter of one founder, but somehow the letter “i” crept in when the city finally incorporated. 

Oregon American was an excellent operation.  Its mill was powered by electricity, its work buildings cement, its equipment the best.  It pounded out the timber -- 350,000 board feet for each of two eight hour shifts.  By 1924, there were 1500 souls in the town and then, by 1928, 2500.  A company town of sixty or so structures grew up on what people called O and A hill.  Management lived in a row of craftsman homes while smaller worker bungalows tumbled down the hill toward the town and along the east side of the mill pond. 

University of Washington Collections
Kinsey Logging Collection

Oregon American and its owner, Central Coal and Coke, brought several of their southern workers to Vernonia with them, and many were many racial and religious minorities.  The 1930 census had 96 Filipinos living in Vernonia, 55 African Americans, 51 Japanese, 5 Hindus and one Eskimo.  Those who worked at the mill and lived in Vernonia were well below the O and A Hill, segregated by race in shacks and in a hastily put up boarding house.  The census worker called the area “Down River Road” to distinguish it from O and A Hill “Up River Road.”  It was located across Rock Creek, close by the high school ball field.  

 

Those minorities that didn’t live on Down River Road were scattered in a few locations in the town, in logging camps outside of town or in a big boarding house for Japanese rail workers on St.  Helens Road.  Some worked for the railroad, some owned laundries, some cooked, one was a musician in the dance hall and another was the proprietor of a pool hall, but the biggest employer was the mill. 

University of Washington Collections

Not all lived on platted streets. Gessaro Kuge and his wife Takae ran a boarding house located by the census taker as ‘by the river across the tracks.’  Mr.  Kuge was a timber sorter at the mill as were most of the eight boarders.  They had five children, four boys and one girl, the eldest 16 and the youngest one month.  Takae described her vocation as ‘cook.’  Oregon American paid its minority workers the same as the whites.  About 500 people worked at the mill site at its peak and another 200 at its logging camps in the forest. 

In 1928, the town contained nine churches, two theaters, seven hotels, three schools, two auto repair shops, four pool rooms, five bars and taverns, four doctors, three dentists, two whorehouses and a dance hall. 

Oregon State Historical Society

At the same time that O and A was transforming this community, the revival of the Ku Klux Klan was transforming Oregon and some of it strongest outposts were communities at the edge of the great Douglas Fir forests, like Vernonia, Tillamook and St.  Helens.

From its founding in 1865 in Pulaski, Tennessee by confederate veterans, the Klan has had several incarnations, the first characterized by its resistance to reconstruction and the growing political power of Blacks in the South.  Increasingly, it became a terrorist organization and extremely violent.  By the time federal troops put down the rebellion, the terror had been successful and reconstruction overturned along with the rights of former slaves.  Another incarnation was the civil rights era in the 1960s when the Klan became even more secretive and violent, though its efforts were less successful.

The Klan’s appearance in 1920s America was different, rising from what would have been called ‘the new media’ of its day.  The release of D. W. Griffith’s film Birth of a Nation portrayed a Klan struggling against a hostile world order that favored immigrants, Catholics and Blacks over whites and Protestants, endangering their women and flooding the country with people who didn’t speak English.  The Klan in the early twenties was organized much like we would organize it today -- targeting specific groups, tailoring messages to time and place and offering substantial financial rewards for success.

Oregon State Historical Society
Klan Parade in Ashland

A public relations company, The Southern Publicity Association, hired regional sales managers, King Kleagles, who in turn hired Kleagles at the state and local level to recruit new membership.  They offered substantial rewards for successful recruitment.

According to Professor Thomas Pegram, who wrote recently of the rise and fall of the Klan in the 1920s, the $10 dollar Klan initiation fee was split this way:

 

$4 dollars went to the Kleagle who had actually recruited the member.  The regional rep, or the King Kleagle, received $1 dollar and the Grand Goblin, or state leader, got .50 cents.  $2.50 went to the Southern Publicity Association.  The remaining $2.00 went to the Imperial Wizard, the national leader, a man named William Joseph Simmons, headquartered in Atlanta. 

From Klan Catalogue

Other items of value contributed to the financial value of a new recruit.  The Klan costume cost $2.50 to make and was sold to new members for $6.50.  Other items that were part of the ritual Klan playbook were also sold to members.  As Klan membership soared nationally to somewhere around 2-3,000,000 members, about 35,000 in Oregon, the Klan’s founders did extraordinarily well. 

The focus on membership was on existing organizations like the Masons and Elks as well as Protestant churches and evangelicals.  Many ministers became deeply involved in the new Klan. The message behind the new face of the Klan also emphasized social activities and business agendas like referrals and mutual marketing.  As Pegram puts it:

“Within the restricted spheres of religious, racial and often gender exclusivity, the Klan provided meaningful community and sociability for its members.”

The New York Times, in its review of Professor Pegram’s book, One Hundred Percent American, described the twenties version of the Klan as “sort of Rotary, for white supremacists.”

Part of this sense of belonging in Oregon came from early political success.  The Klan messaging in Oregon was working.  Few African Americans then lived in Oregon and the state was more than 90% Protestant, leading to a focus on anti-Catholicism along with vigilantism against bootleggers and speakeasies, public drunkenness and marital infidelity.

The Klan helped put together and backed a ballot measure in 1922 that required all children within the state to attend public schools, shutting down the parochial schools of the Catholic Church.  Governor Benjamin J. Olcott, a Republican, was vigorously anti-Klan and against the Klan’s Compulsory Education Act.  

Some vigilante episodes in Medford led the governor to attack the Klan in the middle of a vicious primary fight against a Klan-backed candidate.  

Medford was the first town in Oregon to be visited by the recruiting Kleagles and the Klan had grown into a strong presence.  A white salesman there was known to be a philanderer and was abducted, taken into the woods and subjected to a “mock lynching” where a noose was placed around his neck and he was lifted momentarily off the ground.  He was returned to Medford and soon left town.  The Medford Klavern also took similar action against a Black man and an Hispanic man involved in the liquor business. 

Statistics about lynching have been kept by the NAACP, The Tuskegee Institute and others since about 1880 to the late 1950s.  Tuskegee’s statistics are considered the most accurate and say that about 5,000 people have been lynched over that time, 3500 of them black.  In that time, 20 whites and one black were lynched in Oregon.  Alonzo Tucker was shot and hung from a bridge in Marshfield in 1905.  A history of blacks in Oregon, “A Peculiar Paradise” attributes a black body found in 1924 to the Marshfield KKK though it is not included in the Tuskegee database.  There is no correlation of lynching in the US to the rise of the KKK in the twenties.   Tuskegee data shows that 258 people, nearly all black, were lynched during the twenties compared to 555 people during the previous decade.

Governor Benjamin Olcott

Governor Olcott could feel his government slipping away in the face of 58 Klaverns across the state.  Some, like Tillamook, LaGrande, St.  Helens, Medford were clearly in the thrall of the Klan, their public officials and law enforcement were Klan members or Klan supporters.  The Medford Mail Tribune fought the Klan, but in Tillamook the paper supported the Klan.  

Two weeks before the 1922 primary, Olcott tried to rally the anti-Klan community in the state:

“The time has come to determine whether our state government shall maintain its orderly way, controlled by the voice of all the people, or whether it shall be turned over to some secret clique or clan, to be made the tool of invisible forces, working in the dark toward aims unknown to others than themselves.  The true spirit of Americanism resents bigotry, abhors secret machinations and terrorism and demands that those who speak for or in her cause, speak openly, their faces to the sun.”

Governor Pierce

Olcott barely survived his primary election but went down in the general after the Klan threw its support to the democrat, Walter M.  Pierce, who hailed from another strong KKK community, La Grande.  The Compulsory Education Act was approved by the voters and Klansman Kaspar K. Kubli – not making this up -- was elected Speaker of the Oregon House of Representatives. The legislature soon passed the Alien Property Act, designed to deny property ownerships rights to Japanese.


This was the high water mark of the Klan in Oregon. As quickly as it rose, it fell. Infighting within the Oregon leadership, a sex scandal and fighting over the considerable money the Klan was bringing in – as much as $24,000,000 in 1922 -- helped lead to its demise. Disclosures by disaffected members showed the deep commercial nature of the Klan. By the end of the decade, the Klan had deteriorated significantly. The Klan push for what they called a 100% society was hard to maintain. The system of cross-referrals between Klan businesses hit a nerve. Signs advertising businesses as 100% American -- code for Klan -- started coming down. The compulsory Education Act was declared unconstitutional and a similar version failed badly in Washington State. Governor Pierce was badly beaten in his reelection. It was as if a big storm had blown through and there was considerable relief it was over. 

University of Washington Collections

It could not have been easy on Down River Road’s 200 or so residents.  The five black children of school age in 1924 were denied access to Vernonia Schools.  They went to school in Portland, boarding mostly with relatives, while Portland’s foremost Civil Rights leader at the time, Beatrice Morrow Cannady, negotiated on their behalf.  While certainly intimidated, the people in the shacks were not passive.  They formed their own NAACP Chapter and their kids were able to enter school in their home town in 1925. 

The Klan was quite active in Vernonia and the local Klavern discussed constructing its own building.  The Klan marched in parades and held picnics there and the local paper, the Vernonia Eagle, reported extensively on its initiations. The powerful Tillamook and Astoria Klaverns held large rallies – Astoria claimed 2,000 Klansmen – which moved between Tillamook, Astoria and Vernonia one weekend in 1922.  The glow of many burning crosses fell on those shacks.  In 1924, the Klan decided that little Vernonia was just the place for its state convention.

Klan Rally in Eugene

It’s clear that Vernonia at the time was an explosion waiting to happen.  It’s thrown together population, not only contained fairly large communities of Blacks, Filipinos and Japanese, but also many immigrants.  A big crowd of Klansmen in town and the little Down River Road community never did clash, though doubtless there were humiliations and near misses.   Perhaps the O and A company was a steady hand in town, not wanting race or religion to complicate the business of making, transporting and selling the lumber from those mighty Douglas Firs. 

Fires damaged a great deal of O and A timber in the late twenties and the Depression closed the Mill in 1932.  The Tillamook Burn blew up in 1933 and destroyed many other timber holdings of O and A.  The company reopened in 1936.  It’s unclear what happened to those people in Down River Road when it was closed.  There was security and maintenance employment at the mill in slack times, but finding work was highly competitive, people showing up in the morning to be picked, or not picked.  In 1930, they paid between one dollar and five dollars a month for rent.

In the summer of 1954, we’d moved in with my grandmother during a tough time.  My brother and I slept on a big featherbed our parents had rigged up in the garage.  We’d slowly sink down until little but noses and toes peaked out of the mattress and those were quickly topped with a big comforter. 

We’d walk down the hill, past a very aggressive German Shepard, to the berry bus that would carry us out to Banks and its strawberry and blackcap fields, stopping at the Banks Dairy Queen on the way back to spend most of the two or three dollars we made.  Dropped off in the early afternoon, we'd then head down to play ball at the high school field, across the creek from the shacks.  A couple of kids from the shacks would play catch or join the pick-up games, but I don’t recall if those kids played on one of the several official teams in our little boys league that played in Vernonia, Mist, Goble, Scappoose, Clatskanie, St.  Helens. 

When we lived there, in 1954, the mill was in the process of being cannibalized in a series of mergers and purchases and finally closed in 1957.  It had created 2.5 billion board feet of lumber and cut nearly all the old growth fir in the area.  The last load of lumber sent out from the mill contained a message on butcher paper tacked to the logs:

“Last Load”

“Oregon American from 1922-1957.”

“Ain’t No More!!”

As a college student in 1964 I was driving from Eugene to Cannon Beach to meet friends.  Passing by the Banks cutoff, I made a snap decision to drive to Vernonia over the road where, years earlier, I would hold my breath and wonder if my Dad would pull over, stop the car and invite me to drive the rest of the way, my Mom not approving. 

“Russell!” She would bark.

Down River Road Today

After a disappointing stop at my grandma’s house – the strawberry field had a house on it – I drove down to the high school and walked down to the baseball field across from the shacks at what the census taker called "Down River Road."  It was known as Anderson Park Road after the RV Park the city developed once a successor company to O and A deeded the land to the city of Vernonia.  There was nothing there.  I hopped the creek and inspected the bushes and fill.  I could find no artifacts, none.  No pieces of plumbing or door knobs, a spoon or a clothes hanger. There was nothing to show that people once lived there, strangers in their own town. 

Somehow defeated, I drove on to the coast through the next generations of Douglas Fir.

Life in Portland, a Big Scandal and a Foot Through the Ceiling

A Farm in a Day and WPA Golf

Finding Charley Royer

KKK uniform selections

The Many Lives of Virginia Boren

Knee Replacement and the Baby Boomers

Personal note.  Three weeks ago I had my left knee replaced.  It is something I’ve thought of doing for many years but finally acted on and I wanted to share with my readers what I’ve learned and experienced about the procedure.  I also want to share some issues about knee replacement, a procedure that may soon become America's most popular surgery.  This peaceful Sunday morning I am cocooned on my couch as the KodiakPak pumps ice water around my knee while the dog warily cuddles, confused about how the Alpha in this pack was brought so low. 

In the past six months, both my wife and I have had a surgery, each for the first time.  For me, these events have cut into the time I use for writing.  After two years of producing these Cascadia Courier essays, publishing about three each month, they have become the center of my work rhythm to which I am now finally returning, my path beyond surgery becoming clear and more easily trod.  Barbara's health has returned fully.  While both of us think the past six months might have been more happily spent, we actually have come to treasure these experiences together. We have learned about the lives of medical professionals, meeting and trusting people we hardly know.  How cool it is to surrender to the love of family and friends, letting their support wash over us without questioning.  Who knew we had so many cooks and dog walkers among them?  How utterly sweet to have a daughter come home and nurse and cook for you.  How calming it is to know for sure that Barbara was paying attention when she said the words "in sickness and in health."

My Knee Hurts!!

Our ancestors had an elegant solution for painful, debilitating knee problems associated with aging.  They died before the onset of these problems.  However, the death solution, while elegant, has little favor today among older, active adults whose post-seventy agendas are defined by work, skiing, hiking, golf, swimming, fishing and travel.  

Ten years ago, my chronically painful left knee, pushed to its edge by an infatuation with running, had me trudging along with little hope while I thought about alternatives without the motivation to really consider them.  Then, on the way to a meeting up one of Seattle’s steep hills, I found I couldn't advance unless I walked up backwards.  That’s what my knee was giving that day so that’s what I took. 

Nodding to my fellow pedestrians staring at me, I offered a silent and sullen “opposite day, you sonofabitch!”  

I soldiered backwards up the hill and tried to find a positive in it, deciding on the fact that I could now enjoy the view of Elliott Bay, which if my knee was not a mess, would be at my back.  Of the many humiliations I experienced fumbling along for years with a bad knee, this one finally prompted action and I turned myself over to the orthopods who diagnosed osteoarthritis – arthritis of the bone, sometimes called the ‘wear and tear’ disease.  This called for serious measures, perhaps not at the time but certainly in the future.  The surgeons soon brightened, however.  The images also showed a tear in the meniscus, the padding between the joints, and they said that a little arthroscopic trimming would provide some relief. 

Bone on Bone

It did, but only for a couple of months.  When I went back to my surgeon he said he’d be happy to provide the same arthroscopy once more.  By now, I had read enough about the effects of osteoarthritis on the knee to know that when bone is grinding on bone, cortisone and a snip here and there is not going to do much.  My solution lay with a knee replacement; the only question would be when.  The timing would be driven by the presumed satisfactory life of the procedure – usually about 15-20 years -- my own age at the time of surgery and my assumption that I would continue an active life until I dropped.   The busy hum of everyday life creates a kind of analgesic effect on chronic pain and I waited some more.

Tons of ice and bottles of painkillers later, I was ready. Then I realized another factor was in play -- when could surgery be scheduled?  The growing use of joint replacement strategies and the great bow wave of wear and tear boomers hobbling through the health care system created some wait times.  

In addition, a fair amount of work-up was needed.  Knee replacement creates higher risks of blood clots and some patients may require surgical procedures or special medicine to mitigate clots.  Doctors also want sophisticated diagnostic imaging to choose among different hardware options and to make the precise measurements needed for a long term successful procedure.  The waiting continued.

A friend of mine has grown tired of the constant conversation about medical topics among the healthy looking adults we run with.  At a fine celebratory dinner, the conversation had quickly found its way to medicine, which explained his tight jaw.   I was thinking about health issues as well, wondering if you had walked into the fun restaurant we were eating at, laughing and drinking in and it was in your reach to switch your health profile to anyone else in the restaurant and take their profile as your own, when would someone of inferior health pick members of our group?  I had no illusions of any of us chosen in the top quartile, but I successfully argued to myself that we’d be definitely chosen in the second.  Okay, not tippy-top of the second, but not at the bottom either.  Looking across the bar to the mirror, we seemed to glow with good health, luminous compared to the neon green pallor of so many other customers.

 

As we have aged, however, our vocabulary reflected the backgrounds and terminologies of an astounding number of medical conditions.  Our little crowd, lubricated by a substantial upgrade from our everyday wine, was chattering on about lupus, chronic leukemia, a recent knee surgery, a couple of breast cancers, prostate cancer and several other pre-and proto-cancerous dribs and drabs.  As the conversation droned on, I could see our relative position among the quartiles began to sink, soon tumbling into the fourth where I decided not to propose my silly idea.  Besides, it was too late.   

“The medical discussion terminates precisely in five minutes,” my friend said, scanning the wine list he held in one hand while motioning for the waiter with the other.

My new knee

Total knee replacement is rapidly growing and is now among the most common surgeries performed today in America.  There have been 3.25 million of these procedures in the United States over the past twenty years and stands at 700,000 annually today.  When considered with hip replacement surgery, another fast growing, wear and tear procedure, nearly a million people a year turn to these two joint replacement strategies to shore up their deteriorating ambulatory frame.  The average age of a total knee replacement patient is 65.1 years while hip replacement patients have, in the past, averaged around 70 years, though the trends are driving the age average down substantially.  A high percentage of these patients – about 95% -- will use their new body part happily for at least 15 to 20 years with some lasting much longer.  The Washington Hospital Association hospital cost data base indicates that knee and hip replacement patients will participate, depending on insurance, location and many other factors, in a hospital cost of about $35-65,000 across the King County, Washington medical market. Negotiated discounts with insurance providers will reduce this cost variously.   A very high percentage of knee replacement patients return to work after their surgeries -- 98% of them -- while just under 90% actually go back to doing the same  work they had been doing before.   

These surgeries are amazingly beneficial for the patient.  A very high percentage of post-operative outcomes lead to lower weight, better self esteem, a return to a healthier life-style and more active sexual function.  Mortality among hip replacement patients seven years after surgery is half that of the general population.  What’s not to like?

Early attempts at dealing with the problems of chronic knee pain seem crude today, though many of them continue to be used.  A procedure that came to be known as interpositional arthoplasty began in the 1860s in which softer, cushioning materials were inserted between the lower leg bone, the Tibia and the thigh bone, the Femur, augmenting what remained of the natural cartilage, the amazing material that cushions and facilitates the mechanical movements of our skeletal frame.  Skin, fat and other soft materials from the patient’s own body or from donor animals -- chicken wattles are rich in collagen, for example, create a natural cushioning product.  We know collagen, when it is processed with water, as gelatin. 

Today, similar strategies continue in service, though usually as a short term bridge to more permanent replacement strategies.  Injections into the knee with collagen rich material are frequently called “chicken injections” in Europe.

Gluck's Knee

The 19^th century German surgeon Themistocles Gluck was an early advocate of augmenting cartilage with other soft tissues, however, he is best known for his early and remarkable excursions into joint replacement.  In his time, the 1880s, the lack of antibiotics meant that many more infections of the body would migrate to the joints, often leaving no alternative but amputation.  These problems propelled Gluck into the first true joint replacements.  He used ivory as the substitute for bone in his several different joint replacements, including the first knee joint replacement.  In a review of his work in 1891, two of Gluck’s knee transplants had been in place for five years.

Prosthetic knees in the 1950s and 60s were rigid, hinged affairs that loosened frequently.  However, engineers and physicians in the 70s were soon developing products that were far less rigid and more naturally supported by the ligaments and tendons supporting the natural knee.  The first modern knee replacement was done in Great Britain in 1968 and in the US in 1970.  While there have been many changes in materials and techniques, today’s knee replacement hardware is a bit like the Boeing 747, a design from the 1970s whose many component parts and functionalities are quite different  and advanced today but whose basic structure is the same. 

My new knee started with an incision beginning about five inches above the center of the knee cap and extending down a full ten inches.  Soon, two other deeper cuts expose the joint.  The thigh bone, called the Femur, is at the top of the frame and the Tibia, the shin bone, is at the bottom.  The two bones are connected in the front by the huge quadriceps tendon which also covers the kneecap, or Patella.  Other tendons connect along each side of the knee and in the rear.

University of Washington

At the end of the Femur are the condyles, the weight bearing interface of the thigh bone. Because of the wearing away of the cartilage and the bone-on-bone contact, this surface has grown tender and it is one of the places in the knee where the arthritis is most severe.  The surgeon removes a slice of the femoral bone condyles and readies a metal plate whose outward shape is like the natural surface.  It also has a groove along the front over which the kneecap can slide while use.  In the back are two metal posts that fit into holes bored into the bottom part of the femur.  It is all connected with a surgical glue.

The Tibial part of the knee reconstruction also starts with a new surface, shaved level by the surgeon as on the Femur, though the plate on top of the new surface is different with a small lip around its edge that faces upward toward the Femur. 

Fitting into this metal on top of the Tibial plate is a hard plastic surface that slides between the two metal surfaces above and below.  This plastic takes on the function of the natural cartilage, the Femur’s new cap sliding along the plastic surface when the knee is flexing while walking.  The surgeons slide all the tendons back into place so that the entire knee is supported to the left and right and by the big quadriceps on the front with the smaller posterior cruciate ligament supporting the back of the knee.  When the operation is complete, the joint is not fused, but stable, flexible and ready to bear all your weight, though on day one that would be very painful.  

The length of the operation is about two hours and it is conducted under a spinal block and a femoral nerve block which does not allow pain transmission from the knee outward.   I actually heard some noises during the operation, but I was unable to connect them to anything.  Having no general anesthesia speeds recovery.

Today’s efforts to push down cost and to free up revenue producing hospital space has reduced the hospitalization associated with this procedure from nine days twenty years ago to about three days today.  I’m not sure what the medical implications of this are, but I am certainly clear about the implications for sleep.  After the operation, devices monitored oxygen levels in my blood, while another device designed to avoid blood clots squeezed both my legs every ten seconds or so.  When they would fall off as I struggled to pee while lying on my back (tip:  next time, allow the catheter) or slipped off as I perspired, alarm bells would begin sounding and the mayhem was complete.  When the monitoring bells stop ringing, it’s time for meds, a blood pressure check or new blood work.  My best night’s sleep was four hours, coming in two, two hour blocks. 

Physical therapy begins the first day after surgery.  The immediate goal of physical therapy is to as quickly as possible regain flexibility in the knee joint.  One of the items I was given there was a thick plastic belt which, when looped at the end, could be used to swing your leg in or out of the bed.  I made a game of it.  I became good at it.  Unlike in the hospital, where you are cared for, in therapy, you have a job to do.  When I met my physical therapist, Franklin,  after returning home, I was showing off with the strap and he took it from me.  He said he would make my knee strong enough after the first hour so that I wouldn’t need the strap.  “This isn’t the hospital,” he said.

After the procedure, my left leg was minus 12 degrees from a perfectly straight 180 degrees.  The ability to straighten your knee is the first step toward eliminating a limp as a future outcome.  The operation should ultimately allow about 120 degrees of flexion in the knee.  The first measurement of my leg showed I could flex it to just 56 degrees which increased to 65 degrees two weeks from my surgery and into the seventies after three weeks. I've talked with people who were at 130 degrees of flexion after a couple weeks and others who never crested 100 degrees.  I’ve done two one hour exercise sessions a day including the physical therapy every other day from professional, in-home PT visits.  Though drug averse, particularly to the opiates, I came to the conclusion that taking enough pain medicine to do quality exercise sessions was important to my recovery.  I will tend to gain my flexibility more slowly due to increased and more persistent swelling in the joint because of blood thinners.  Blood clots are a risk of this surgery and the blood thinner Warfarin, a derivative of rat poison, is used the day surgery begins until three, four or six weeks after surgery. 

Doctors describe the basic progression of healing this way, predicated on regular physical therapy and exercise.  On the afternoon after surgery, or on the next morning, you will begin physical therapy which will occur each day you are in the hospital.  After three days, you will go home and have home physical therapy, usually one hour, three days a week for three weeks, plus whatever you do on your own.  After three weeks, you will be able to use a cane or nothing at all while at home, walking with stiffness, though no pain.  I intend to use the walker while walking on the streets for the time being. Sometime around week five, you will ditch the walker and the cane.  In fact, I never used the cane.

By three months you are walking without pain or other discomfort.  I know some people who played golf at three months.  Assuming you’ve done a good job of continuing your exercise and stretching, you will have forgotten the procedure after a year.  Walking, golf, swimming and other similar exercises are fully within reach, though running and jumping are not recommended.  Some people ski.

Things do go wrong.  Three percent of the new joints fail each year from mechanical loosening or component failure.  An additional 1-2% of these joints require revisions or replacement because of infection that moves to the new joint.  In hips, failure rates are somewhat less, in the past about 1%/year, though the recent problems with the recalled metal-to-metal hip recently sold by Johnson and Johnson will skew those averages for now.

Though I spent considerable time talking with doctors, other health care professionals and friends and acquaintances who had experienced the surgery, I had several surprises during the real thing.  First, perhaps because most of my previous conversations focused on recovery, I was not prepared for what is truly a major surgery.  The pain was major league.  The difficulty of getting out of bed, to the bathroom, the pain of standing for relatively short periods of time, the fatigue from lack of sleep or from the trauma of the operation, the pain of the early physical therapy, all conspired to create an uncomfortable anxiety that led to a serious questioning of the decision to do the surgery.  After the second week, however, the results of the exercise began kicking in – the legs growing stronger, the routine of stretching and strengthening paying off, the arrival and therapeutic placement of the blessed ice, created a rhythm that seemed to be heading somewhere, a place where I could see the redemption of the procedure’s considerable benefits. 

I’ve been thinking about the intersection of this procedure with the 77 million baby boomers who, like me, are moving to a time in their lives when they will choose this surgery.  A 2006 study released at the American Academy of Orthopaedic Surgeons annual meeting created a bit of a sensation when it predicted the number of first time total knee replacement surgeries would increase nearly seven times by 2030, to 3.5 million/year.  The study also predicted hip replacements would nearly double in 2030 to nearly 600,000/year.  In addition to new replacement therapies, the study saw strong growth in second hip and knee surgeries, called revisions, in which old equipment installed in the 80s and 90s must be replaced.  The study's fundamental questions are:  

"Do we have enough orthopaedic surgeons to do the work?  Do we have enough money?  Is longer life, better sex and higher self-esteem a set of good trade-offs for the social and financial costs?"

What the study didn't consider is the escalating use of medical imaging and other pre-operative work that must be done prior to this astounding increase in knee replacements.

The cost of serving these additional patients is very significant, into the many billions of dollars.  Managing the growing cost of knees and hips among all the other rising medical costs depends on finding new and better treatment outcomes.  The development of implants that last longer is a priority.  Understanding the humble cartilage that, when healthy, saves us so much pain.  Unfortunately, cartilage is a highly unusual material.  It is avascular – it has no blood supply – and, when it is damaged, it is a poor healer.  After absorbing a certain amount of energy over time, cartilage begins to break down.  Adult stem cell research is a major focus now for the development of artificial replacement cartilage.  Controlling obesity is a big opportunity for joint health and longer lasting outcomes as is better and more consistent pain management that can more effectively delay surgery.

Medical tourism is another tool for demand management.  The cost of total knee replacements in many countries is far less than in the United States.  Hospitals in Columbia, Costa Rica, Jordan and India charge about 15% of a US joint replacement while Korea, Mexico, Singapore and Thailand charge about a quarter of US cost. 

A fair amount of political management is also necessary.  A very large portion of the 77 million boomers will seek the benefits of this procedure are medicare and medicaid patients.  As we cut these programs over time, are we implicitly making choices about who receives chronic pain relief and the other benefits of knee or hip replacement?  How do we deal with obese patients, whose weight reduces the efficiency of the replacement system?  Do we set upward limits on weight?  Do we also have an upward limit on the age of knee or hip replacement patients?  Do we establish implicit wait times for this procedure, as the Canadian health care system establishes explicitly?  Demand there rises at 7%/year for the past several years and the system is frequently not able to meet the six month wait time the Canadians have established.  

When combined with extremely beneficial patient outcomes, as in knee and hip replacement, medical technology becomes its own boss, dictating its own terms and moving at its own pace.  While we want to exert control over its cost implications, we are forced to the margins of control by the pressure of patient demand and by the zeal of the medical profession to meet it.

While my daughter was here, we talked a bit about the implications of this technology for the health care system.  Putting on my insurance company hat, I said:

"You could argue that this might be an example of too much of a good thing."

"Daddy," she said.  "Listen to me.  This is a good thing."

Thinking of Mitchell Baker

Isaac Baker, left, with President Obama

A friend sent along an email with a photo attached on election day, 2012. The photo is of a young man named Isaac Baker standing next to President Obama and it looks like it is taken backstage, prior to an event.  I’m assuming it is an event in Ohio, because Baker worked on the campaign and later the staff of former Governor Ted Strickland and he was also communications director for Senator Hilary Clinton during the 2008 Ohio Democratic Primary. 

After she left the race, the Obama campaign hired him.  He now works for David Axelrod’s political consulting firm and I’m assuming he was using his Ohio expertise that day before this election to make sure the state fell to his candidate one more time.

 

This is a young man near the top of the biggest political game.  Though his life and ours are so different and we don’t connect that often, we work hard at being so very proud of him, because his father, our friend, can’t.  Mitchell Baker died while Isaac was a student at Northwestern University’s Medill School of Journalism with Isaac's interesting life almost completely ahead of him.

Mitch died in 1999 before the Internet provided so much information about people and made it so convenient to find them.  All you find about Mitchell today is his listing as an author on Amazon, of something called “The New Neighborhood at Sand Point”, a 26 page plan to accomplish the city of Seattle’s vision of how a piece of US Navy surplus property would be developed.  The document shows how we would transfer the land from the feds to the city of Seattle and our ideas for the development options of the property.  It’s mistakenly listed as a book and, Amazon reports, the “binding is unknown.”  It’s the plan Mitchell and I worked on together and the reason we met, giving new purpose to a 20 acre radio transmitter site used by the US Navy to support Sand Point Naval Air Station during World War II.  At the same time, the early stages of the sensational Warren G.  Magnuson Park were coming together nearby.

 

I hate it when wonderful people with many different accomplishments are missing in action on the Internet.  One of the reasons I write this blog is that I want to bring people who are Internet dead to greater awareness in cyberspace.  And I also miss Mitchell Baker, something I share with many of his other friends who worked with him and who wish he could have been at the event we had earlier this month, celebrating a victory we feared we would not see.

When I met Mitch, he was working in the city of Seattle’s Department of Community Development as a neighborhood planner and he was bored there, thinking that his skills were underused.  He was also a new father of this boy, Isaac.  Mitch saw a job we had posted internally and said he was interested in applying.  The Mayor’s Office was looking for someone to work full-time on the Sand Point project, particularly after The Community Development department showed so little enthusiasm about our ideas for affordable housing, associated day care and energy efficiency.

  

I read Mitch’s note and we arranged to meet.  He was on the outs with the administration of his department, run by a cerebral, articulate guy we had hired, likely because he was cerebral and articulate.  Mitchell was interested in leaving the city, but hesitated because he loved public service.  He yearned for a bigger role.  He wanted to make things happen.  And nothing much was happening for him.

Mitchell was the strongest candidate because he clearly understood that this development wasn’t a carpenter’s job, but a politician’s kind of work.  This would be the first low income housing in the largely white North end of Seattle and the neighborhood was thick with activists who were, at that time, not liking growth very much and sharpening their considerable community expertise by killing freeway projects and making sure they got what they wanted in the brand new Warren Magnuson Park. We didn’t need a grant writer, we needed a person who could survey the field and make both subtle and not so subtle judgments about what we could do and should do.

I knew intuitively that Mitch was the right one, but I was concerned that his negative views about his work in the city meant that he was likely to leave shortly, even if he had such a cool job as this exciting project.

So, I scheduled another time to talk, this time at the Lockspot Tavern, a regular guy kind of tavern in the Ballard neighborhood of Seattle, a place once known as the Scandinavian neighborhood, but now known more for its Scandinavian history and the fertility of the young people who have taken it over.  A few days ago, at Ballard's Firehouse Tavern, a fine place for an after movie dinner, the place was packed with kids eating its Sunday night fried chicken special, $15 bucks for several pieces of chicken, a biscuit that could pass for a Volkswagen, a pile of carrots and pan gravy. 

Ballard was once the only place in Seattle you could buy Lutafisk, the gelatinous goo soaked in lye to preserve fish, usually a cod, though it worked with other fish.  I knew all about Lutafisk.  I represented the Mayor, my brother, at all five of the Lutafisk eating contests held in Ballard while I worked for him.  They were staged outside in a small park in Ballard’s downtown with a Ballard elder doing play-by-play.  The Seafair princess always gagged and shrieked and the council member stared straight ahead while the stuff was dumped on his paper plate.  I smiled, ate the stuff and pretended to be a good soldier. 

I love neighborhoods during Seafair, when each unique Seattle neighborhood celebrated its heritage with a locally organized celebration, nearly all with a parade, this one burdened only by the forced ingestion of Lutefisk.

Sometimes Ballard High School cheerleaders would be at the park and chant the school's famous cheer:

“Lutafisk, Lutafisk, Lefsa, Lefsa.”

“Do we like Ballard?”

“Ya, Sure! You Betcha!”

At the Lockspot, over more than one beer, Mitchell told me about his family, his journey from eastern Pennsylvania to Seattle and his Jewish faith, described aptly by the Rabbi who officiated at his funeral:

“Let’s face it, Mitchell was not a familiar presence at Temple.”

By the end of the evening conversation at the Lockspot, Mitchell had a new job and a new friend to go along with it.

We cemented the friendship during the complicated process of transferring property under the ownership of the Department of Defense to the city.  Despite the considerable help of United States Senator Warren Magnuson, the federal to locality land transfer is a treacherous process.  We had nearly buttoned up the transfer when hoards of soccer field interests descended on us and then on the City Council. Fortunately, the only thing that the neighbors disliked more than new housing were soccer fields and their lights, traffic and noise. 

Burke Gilman Place
Google Earth

Burke Gilman Place, we called it, referring to the old rail line that was converted to one of the country's first rails-to-trails projects.  It ran right next to the property we started calling ours.  

Once the land was in our hands, however, we had to find money to put homes on it.  That required two different sources of money because we had promised the neighbors that Sand Point would be a mixed income development.  The Seattle Housing Authority was a very willing participant for the low income part, but getting the market rate housing was tougher.  Then Mitch came in one day and described the problems an office building developer was having because he wanted to tear down an old apartment complex to make room for his building.  This required him to build replacement, affordable housing and the boom in Seattle’s center city was then so big he could not find property downtown.

Mitchell had written up a little proposal he thought we should take to the developer, assuring him of support for his project if he put the replacement housing units he was obligated to build into Burke Gilman Place.   “That’s a stroke of good luck,” I gushed to Mitch.  “Let’s do it.”  

Taking back the letter, he left scowling and I later understood why.  The luck was Mitchell.  He had greased it with the council, the neighborhood activists who had passed the replacement housing ordinance and the Law Department.  He had made it possible to make good on the mixed-income pledge.

Two things conspired to dramatically affect Mitch’s future while he was working on Burke Gilman Place.  One was the sudden death of Senator Henry M.  Jackson and the second was the near collapse of Washington State’s oldest and biggest bank, Seattle First National Bank, then known as Seafirst.

 

Henry M.  Jackson
HistoryLink.org

When Senator Henry Jackson died of a ruptured artery in his heart on September 1, 1983, just two weeks before the primary election, I was no longer working for the Mayor.  But there’s an old saying, “once staff, always staff” and I got a call soon enough from my brother.  He wanted to talk about offering his name in the special election that would replace the Senator and, by the way, he had offered my name as someone who would drop everything and help him.  He knew he was right.

 

A special primary was scheduled for October 11, 1983 with a general election to take place on the regular general election day in November.  It was a dash of a few weeks played out in an open primary where voters could choose between a collection of Republicans and Democrats -- former Republican Governor and interim Senator Dan Evans, Democratic Congressman Mike Lowry, conservative television commentator Lloyd Cooney and Mayor Royer, whose office is non-partisan though everyone knew he was a Democrat.

   

The mayor finished fourth in that scramble, taking just over 15%, and it stung.  Particularly galling was finishing behind Cooney, a right wing blowhard with a Harley Davidson and an ego that would just barely fit inside Mount Rainier. It turned out that Evans went on to defeat Lowry in the general election and replace Senator Jackson.  

In the ruins of the Mayor’s defeat, he recognized a serious threat to his ability to continue being mayor, a job he loved.  In the middle of his second term, it was clear that a big piece of the constituency that gave him 65% two years before was thinking that he wanted to be somewhere else.  To top it off, he had been elected President of the National League of Cities, a role that involved a lot of travel.  He was the subject of many political cartoons with air travel themes.  In one he’s buckling into his Mayor’s Office chair.  In another, he’s entering the council chambers, his boarding pass in hand. 

Mayor Charles Royer, 1982
City of Seattle Archives

Charley told HistoryLink, the on-line encyclopedia of Washington State, that the loss woke him up. "I hadn’t been paying attention to my political base. Nothing like a hanging to focus a guy, and I got hanged.”

In short order, he hired Mike Lowry’s campaign manager to be his Director of Community Development and brought Mitch Baker into the Mayor’s Office to fix his political base. There was a lot to fix and some real urgency. Norm Rice, a popular councilmember who would later become Mayor, was getting ready to run for the office in 1985, originally assuming that Mayor Royer would not seek a third term and then deciding to run anyway when the Mayor said he would run for a third term.

By the time the election came around, Mitchell had worked his magic again. Two intense years of community work and a locally focused Mayor paid off with a 2-1 victory for Mayor Royer over Councilmember Rice.

Shell Oil Company

The Alaska Pipeline was very good to Seattle, the great supply barges staging in Elliott Bay and dashing up the Inside Passage to the North Slope oilfields when the weather stabilized. All during the 1970s there was this feeling that Seattle was once again a frontier town for some activity in Alaska that was very valuable and needed supporting.

Bill Jenkins, the Chairman of Seafirst, the state’s premier bank, would watch this tableau everyday for years -- the barges filling up with houses, trucks, cranes, 48’ steel tubes, the tugs standing off smartly, ready for another run. Seafirst did what came naturally, providing loans in Alaska for exploration. As the cost of oil ran up during the seventies, Seafirst got into oil exploration loans deeper and deeper. In the Alaska oil rush, two volatile personalities with too little maturity and too much money met and the combustion nearly brought down Seafirst and a few other banks around the country.

Bill Patterson, right, with his Lawyer

Bill Patterson was a wild and crazy guy from Penn Square Bank in Oklahoma City who sometimes came to work in a Mickey Mouse hat and sometimes in an SS Uniform. He ran the energy department at Penn Square, was a graduate of Texas Tech and was fond of shaking up his north of Mason Dixon Line clients by drinking beer from his boot.

John Boyd was the one man energy department at Seafirst and soon was having a hell of a good time with Patterson and also doing a lot of business, running up $1.2 billion in energy loans, $400 million of them from Penn Square. Many of those loans, according to subsequent lawsuits, were a mess. In the end, $800 million of the Seafirst energy loans went sour.

At the beginning of the 80s, oil had dropped from $40/barrel to $10 and Seafirst losses started piling up. By 1982, Penn Square Bank had been closed by the government but the losses continued to mount at Seafirst, $300 million over the three years between 1981 and 1983. The leadership of Seafirst was sacked, including Jenkins, who was allowed to retire early. A lawsuit was settled with the five former leaders of the bank agreeing to a judgment of $110 million with the condition that the only money to be collected from the judgment would be what the insurance companies would ultimately pay. It was a little bit of accountability, but from today's vantage, not very much.  Reading the settlement today causes me to get up and walk around the kitchen, where I am writing this.  Although, among my thoughts is the fact that Jenkins was an explosives guy in the US Army, one of the first to crawl out of the sea at Omaha Beach.  This accountability stuff is not as easy as it seems.

Richard Cooley
Bank of America

Dick Cooley, a banker from California, was hired as Chairman at Seafirst to figure out what it would take to keep the bank alive. Ultimately, he agreed to its hat-in-hand sale to Bank of America that brought in enough cash to keep the bank standing and the regulators from locking up the front door of Seattle’s biggest bank.


Cooley stabilized the bank after a couple of years and the bank began to focus less on survival and more on profits, performance and solving a host of old problems that the regal Jenkins felt beneath him. Cooley’s second-in-command, bank president Luke Helms, found himself doing some community work with Mitch Baker on an issue about the Seattle Center, Seattle's World's Fair site. Helms was impressed and saw an excellent negotiator in Mitch.  Turns out Helms was looking for a negotiator.

Long before Cooley and Helms were working at Seafirst, many administrative and technical employees at the bank voted to join the United Food and Commercial Workers and Jenkins, true to form, handed the problem to the lawyers. Now, twelve years later, it appeared that the Seafirst lawyers might lose what was likely the last appeal.

So, Helms hired Mitchell as Vice-President of Labor Relations and, of course, Mitch found a path that got to yes.

Mitchell steadily rose at Seafirst. He handled the charitable giving, intergovernmental relations and many other things. Mitch was a homer. He loved local art.  Seafirst began collecting it.  Even when the bank’s name was changed to Bank of America, he got something out of it. Bank of America became the naming sponsor of the newly remodeled basketball stadium at the University of Washington.

One day in 1999 Mitchell called me up and said he wanted to have coffee. Mitchell was a fine base toucher and list maker and was up to something. He told me and his friends that after many tests, doctors had found the problem that was disturbing his sleep and making him tired. A tumor had wound itself around one of his kidneys and the cure was removal of the kidney. It was a serious, though not an earth shattering procedure. He was going into the hospital in a couple of weeks and his wife, Sandy, would give everyone a call when he came out of the operating room.

She called. Mitchell was laughing and joking in post-op and would be delighted to see his friends in a couple of days when he got detached from all the medical bells and whistles.

She called. After the move from post-op, Mitch’s heart had stopped. He had been moved to a regular hospital room and the fact that no oxygen was going to his brain was not detected for at least a half hour. She had to make the call whether he would be detached from the ventilator.

After the service, many who had worked for Mayor Royer with Mitch went to a bar on Lake Washington, but there wasn’t enough air in that room. Mitch was just 50 years old.  We just stood there, trying to say something that had meaning or gave context to what had happened.  But there was no context.  It was just a bummer deal.  There was so much fun in Mitch -- plenty of dark as well -- but he was a talented guy whom we loved and thought there was so much more accomplishment to come, for him and with us.  Hoping to toast Mitchell, we just went home, defeated.

Mitchell would have been delighted about the election and nearly all the other political events of November, 2012 and be especially proud that his son, who grew up in the Seattle Mayor’s Office, was there to claim Ohio when Karl Rove could not.