Cylinders of Death

One of the great advantages of being figuratively on the beach is that you have more time to occasionally really be on the beach. Put another way, I just got back from spending eight days on a beach on the island of Kauai. If you bear with me I will by the end of this brief piece find a way to tie my Kauai beach experience with a few healthcare comments.

We have been to Kauai several times and compared to the rest of the islands in Hawaii it is by far the most laid back island. Life is slow and languid. The island is very rural. Even the one city of any size is not particularly large. Nothing much happens on Kauai. That’s the whole point of Kauai.

There are the chickens thoughout Kauai. They are everywhere. It seems that Hurricane Iniki which devastated Kauai in 1992 destroyed every chicken coop on the island. The birds took flight to the extent chickens can fly and left the roost. Kauai, being a verdant place, made it possible for the chickens to flourish. The roosters and hens did what roosters and hens do and they quickly multiplied.

Today chickens are everywhere in Kauai. I encountered them on my daily morning beach walks.

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We found chickens running around thousands of feet above sea level at the top of Waimea Canyon. Then there were the chickens running around the many open air restaurants hoping for a crumb or two despite the signs (ignored by tourists) not to feed the chickens.

I became convinced that the Kentucky Fried Chicken stores on the island simply opened their doors early every morning after sprinkling bread crumbs and in walked their daily supply of nuggets. Kauai chickens are most definitely free range birds.

When not counting the chickens and avoiding the occasional aggressive rooster, I indulged my love of hot dogs. Kauai is the home of Puka Dog, a hot dog stand made famous by the late gourmand Anthony Bourdain. Most of the time this place has so much business that the line is organized like the lines at Disneyland. You wait your turn while confined by cordons of rope and silver posts.

We avoided the lines by eating lunch there twice at 10 a.m. It gave the bored employees something to do while they awaited the hordes. You choose your dog (besides a real hot dog you can opt for a polish dog or if you are from California a vegan dog), the relish you would like (choosing from such exotics as mango, banana and other ridiculous relishes) and whether you would like their special mustard and/or plain ketchup.

The hot dog is long and plump and is dropped into a bun which looks like a small loaf of bread with a long deep hole that traverses its length. The condiments are dropped down the same hole. It’s a big meal. The Puka Dog staff seemed insulted when I asked for just ketchup on my dog. One person I know refers to the Puka Dog as the “Cylinder of Death”. I rounded out my meal with a lemonade and a bag of Maui Chips. Why they don’t serve Kauai chips remains a mystery.

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I did have time on Kauai to think about healthcare, especially after I consumed my second cylinder of death. I like to visit urgent care centers when I travel to get a feel for them. As I have indicated previously, I have reservations about their utility. I did scope one out twice during my Kauai stay. It was located in a small but upscale shopping center. Upscale shopping centers in the Hawaiian islands are defined as having a Tommy Bahama store.

The Kauai urgent care center seemed devoid of patients both times I took a look. There was not even a chicken in the waiting room. Perhaps they get busy later in the day after tourists have had their Puka Dog.

I did try to keep up to date on healthcare matters on the mainland by reading several recent issues of Modern Healthcare I took with me. I noted with interest that CommonSpirit Health would be having only one CEO with the retirement of one of its Co-CEOs after just one year of this dual arrangement. I had predicted this outcome in an entry on this site. These arrangements come about because the boards of merged organizations don’t like to make hard decisions.

I also noted that Modern Healthcare said that CommonSpirit Health had a $227 million operating loss in its first year. Outside financial analysts are beginning to get concerned. As I have also noted previously, big is not always better. In fact, it often makes performance improvements of all kinds more difficult. There is no virtue in being ponderous.

A final comment—-another recent issue of Modern Healthcare I read on the chicken island had this headline: “As competition heats up, hospital outpatient visits see first dip in 35 years”. The headline was a little misleading as the “dip” was in emergency visits. Otherwise, hospitals saw an increase in outpatient net revenue of 4.5% which was more than twice the 2.1% increase in inpatient net revenue. The hospital haters don’t get it——hospitals are more than holding their own against so called disrupters in healthcare.

It is nice to be back on the mainland where chickens know their place.

Aloha.